what is the centene employee formulary? - envolve health · what is the centene employee formulary?...

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What is the Centene Employee Formulary? The Centene Employee Formulary is a list of covered drugs used to treat common diseases or health problems. The formulary is selected by a committee of doctors and pharmacists who meet regularly to decide which drugs should be included. The committee reviews new drugs and new information about existing drugs and chooses drugs based on: • Safety; • Effectiveness; • Side effects; and • Value (If two drugs are equally effective, the less costly drug will be preferred) How much will I pay for my drugs? To figure out how much you will pay for a drug, the abbreviations in the table below appear in the Drug Tier column on the formulary. The copayment or coinsurance levels are defined in the table below. If you do not know your copayment or coinsurance for each tier, please refer to your plan documents.

Abbreviation Description

1 Value generic drugs

2 Preferred generic drugs

3 Value brand drugs

4 Preferred brand drugs

5 Non-preferred brand drugs

6 Prevention Drug $0 (ACA regulated)

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Are there any limits on my drug coverage? Some drugs have limits on coverage. The table below provides a description of abbreviations that may appear in the Limits column on the formulary:

Abbreviation Definition Description

AL Age Limit These drugs may require prior authorization if your age does not fall within manufacturer, FDA, or clinical recommendations.

PA Prior Authorization These drugs require prior authorization for coverage, effectiveness, or safety reasons. This means that your doctor must request approval from the plan before the drug will be covered.

PV Preventive Drugs Preventive benefit drugs covered at no cost to members under the Affordable Care Act. A deductible does not apply. To get a brand drug that has a generic available, your doctor must request prior authorization to show medical necessity. You will be responsible for the difference in cost between the brand and the generic drug.

QL Quantity Limit These drugs have a limit on the amount that will be covered. Your doctor must request approval for a higher quantity of the drug.

RX/OTC Prescription & Over-the-Counter (OTC)

Certain drugs are available both in a prescription form and in an OTC form. Only prescription drugs are covered by your plan with the exception of some insulins, insulin supplies and some covered preventive drugs.

ST Step Therapy You must first try and fail another specific drug(s) before these drugs will be covered.

Can I go to any pharmacy? You must use pharmacies that are in the network. These pharmacies have a contract with Envolve Pharmacy Solutions. Most chain pharmacies and many independent pharmacies are in the network. To find a pharmacy near you, visit our website at https://pharmacy.envolvehealth.com or call us at the telephone number on your member ID card. If you fill your prescription at an out-of-network pharmacy, the pharmacy will not be able to bill us online so you will have to pay the full cost of your drug. Some injectable and high cost drugs may be considered “specialty drugs”. Specialty drugs are limited to a 30 day supply and in most cases must be must be obtained from one of the plan’s Specialty Pharmacies.

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Can I use a mail order pharmacy? You can use the HomescriptsTM Mail Order Pharmacy for the home delivery of most maintenance drugs. Maintenance drugs are those that you take daily and are needed for a long term condition. To use the mail order pharmacy, your doctor must provide new prescriptions that allow up to a 90-day supply of each drug. For more information about Homescripts Mail Order Pharmacy go to www.homescripts.envolvehealth.com. How can I save money on my prescription drugs? You can save time and money with these simple steps: • Ask your doctor about generic drugs that may work for you. • Fill prescriptions at network pharmacies. • Be sure your doctor prescribes drugs on the formulary. • Fill your maintenance drugs through our mail order pharmacy.

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Nondiscrimination Notice

Envolve Pharmacy Solutions, Inc. on behalf of itself and its affiliates does not treat members differently because of sex, age, race, color, disability or national origin.

If you think you were treated unfairly because of your sex, age, race, color, disability or national origin, you can send a complaint to the Civil Rights Coordinator. Email: [email protected]

Mail: Civil Rights Coordinator Envolve Pharmacy Solutions 1850 W. Rio Salado Parkway, Suite 211

Tempe, AZ 85281 Phone: 800-460-8988 or (800) 413-7721 Fax: 888-246-1422 TTY: 866-492-9674

You must send the complaint within 60 days of when you found out about it. A decision will be sent to you within 30 days. If you disagree with the decision, you have 15 days to ask us to look at it again. If you need help with your complaint, please call the toll-free phone number listed on your ID card, or TTY 711.

You can also file a complaint with the U.S. Dept. of Health and Human Services.

Online: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. Phone: Toll-free 1-800-368-1019, (TDD 1-800-537-7697 Mail: U.S. Dept. of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201

mailto:[email protected]

https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

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

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Language Assistance Notices

We provide free services to help you communicate with us. Such as, letters in other languages or large print. Or, you can ask for an interpreter. To ask for help, please call 1-844-262-6337, or TTY 711.

ENGLISH We have free services to help you communicate with us. Such as, letters in other languages or large print. Or, you can ask for an interpreter. To ask for help, please call the toll-free phone number on your ID card or TTY 711.

SPANISH Brindamos servicios gratuitos para ayudarle a comunicarse con nosotros. Ofrecemos cartas en otros idiomas o en letra grande. Puede pedir un intérprete. Para obtener ayuda, llame al número telefónico gratuito de su tarjeta de identificación o TTY 711.

FRENCH

Nous avons des services gratuits pour nous aider à communiquer avec vous, comme des lettres écrites dans d’autres langues ou imprimées en gros caractères. Vous pouvez également solliciter un interprète. Pour toute demande d’assistance, veuillez appeler le numéro gratuit figurant sur votre carte d’identification ou bien TTY 711

GERMAN

Wir bieten kostenlose Services an, um Ihnen dabei zu helfen, mit uns Verbindung aufzunehmen, beispielsweise durch Briefe in anderen Sprachen oder Großdruck. Sie können auch einen Dolmetscher anfordern. Wenn Sie Hilfe benötigen, rufen Sie bitte die gebührenfreie Nummer auf Ihrem Ausweis oder TTY 711 an.

ITALIAN Offriamo servizi gratuiti per aiutarla a comunicare con noi, come lettere in altre lingue o a caratteri più grandi, oppure il servizio di interpretariato. Per chiedere aiuto, chiami il numero verde sulla sua tessera ID o TTY 711.

PORTUGUESE Temos serviços gratuitos para ajudar a se comunicar conosco – tais como, cartas em outros idiomas ou impressão em letras grandes. Ou você pode obter a ajuda de um intérprete. Para pedir ajuda, por favor ligue para o número de telefone gratuito em seu cartão de identidade ou TTY 711.

FR CREOLE Nou gen sèvis ki gratis pou sa ede w kominike avè n. Tankou lèt nan lòt lang oubyen eki ak lèt laj. Oubyen, ou kapab mande pou yon entèprèt. Pou w mande pou n sa ede w, sonnen nimewo telefòn gratis la ki sou kat idantifikasyon ou an oubyen TTY ka sonnen 711.

CHINESE 我们有有费有务有有帮有您与有们有有，例如提供其他语有有有有有有号有有有有有有有。或者您有有

有有有有有有译员。有有帮有，请有电您 ID 卡上的免费电话号码有有 TTY 711。

JAPANESE 言語サービスは無料でご提供いたします。通訳を依頼できます。

また文書の代読および、ご希望の言語による文書の郵送が可能です。

支援が必要な場合は、IDカードの裏側に記載されている[電話番号を記入]までお電話ください。

KOREAN 귀하께서 저희와 소통하시는 데 도움이 되는 무료 서비스를 제공해드립니다. 다른 언어로 또는 대형 활자본으로 서신을 제공하는 것이 그러한 예입니다. 통역사를 요청하실 수도 있습니다. 도움이 필요하시면 귀하의 ID 카드에 안내된 수신자 부담 전화 번호로 또는 TTY의 경우 711번으로 연락해 주십시오.

POLISH Oferujemy bezpłatne usługi ułatwiające komunikowanie się z nami, na przykład pisma w innym języku lub duża czcionka. Można również poprosić o pomoc tłumacza. Aby poprosić o pomoc, proszę zadzwonić pod bezpłatny numer znajdujący się na karcie identyfikacyjnej lub numer TTY 711.

RUSSIAN

Мы предоставляем бесплатные услуги, которые помогут вам поддерживать с нами связь. Такие как, например, отправка писем на различных языках или писем, выполненных крупным шрифтом. Вы также можете обратиться за помощью переводчика. Чтобы получить соответствующую помощь, позвоните нам, пожалуйста, по бесплатному номеру телефона, указанному в вашем членском удостоверении, или наберите номер 771 на телекоммуникационном аппарате (телетайпе) для слабослышащих.

TAGALOG

Mayroon kaming mga libreng serbisyo upang tulungan kang makipagkomunika sa amin. Halimbawa, mga letra sa mga ibang wika o large print. O kaya’y maaari kang humingi ng interpreter. Upang humingi ng tulong, mangyaring tawagan ang toll-free na numero na nakasulat sa iyong ID card o tawagan ang TTY 711.

VIETNAMESE Chúng tôi có các dịch vụ miễn phí để giúp quý vị liên lạc với chúng tôi. Như, thư từ bằng các ngôn ngữ khác hoặc chữ in khổ lớn. Hoặc, quý vị có thể yêu cầu một thông dịch viên. Để yêu cầu giúp đỡ, xin gọi số điện thoại miễn phí có ghi trên thẻ ID của quý vị hoặc TTY 711.

ARABIC لدینا خدمات مجانیة لمساعدتك في التواصل معنا. على سبیل المثال، رسائل بلغات أخرى أو بأحرف كبیرة. أو، یمكنك أن تطلب مترجم .TTY 711شفوي. لطلب المساعدة، رجاًء أن تتصل بالرقم المجاني الموجود على بطاقة تعریفك أو بواسطة خط

PERSIAN نامھ با مانند نامھ بھ زبان ھای دیگر و یا با ما، ارتباط براي برقراري برای کمک بھ شما ي راما خدمات رایگان . برای درخواست کمک، لطفا باکنید شما می توانید تقاضای مترجماینکھ یا در دسترس داریم و چاپ بزرگ است

تماس بگیرید.TTY 711 د و یا کارت شناسایی خوبر روي شماره تلفن رایگان

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Disclaimer: FOR YOUR INFORMATION: Generics should be considered the first line of prescribing. This drug list represents a summary of prescription coverage. It is not all-inclusive and does not guarantee coverage. New-to-market products and new variations of products already in the marketplace may not be added to the formulary until the product has been evaluated, determined to be clinically appropriate and cost-effective, and approved by an independent Pharmacy and Therapeutics Committee (or other appropriate reviewing body). In most instances, a brand-name drug for which a generic product becomes available will be designated as a non-preferred option upon release of the generic product to the market. Specific prescription benefit plan design may not cover certain products or categories, regardless of their appearance in this document. The member's prescription benefit plan may have a different copay for specific products on the list. Unless specifically indicated, drug list products will include all dosage forms. This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. Generics listed in therapeutic categories are for representational purposes only. Listed products may be available generically in certain strengths or dosage forms. Dosage forms on this list will be consistent with the category and use where listed. Please contact Envolve Pharmacy Solutions Customer Service at 1-844-262-6337 to check coverage and copay information for a specific medicine. The preferred options in this list are a broad representation within therapeutic categories of available treatment options and do not necessarily represent clinical equivalency. Member privacy is important to us. Our employees are trained regarding the appropriate way to handle members' private health information. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers. Listed products are for informational purposes only and are not intended to replace the clinical judgment of the prescriber. The document is subject to state-specific regulations and rules, including, but not limited to, those regarding generic substitution, controlled substance schedules, preference for brands and mandatory generics whenever applicable. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. ©2017. All rights reserved. www.envolvehealth.com Your specific prescription benefit plan design may not cover certain products or categories, regardless of their appearance in this document. For specific information, please contact an Envolve Pharmacy Solutions Customer Service representative at 1-844-262-6337.

Drug Name DrugTier

Requirements/Limits

ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS - Drugs to TreatADHD, Sleep and Eating DisordersAmphetaminesADDERALL TABS (UseAmphetamine-Dextroamphetamine)

5

ADDERALL XR CP24 (UseAmphetamine-Dextroamphetamine)

5

amphetamine-dextroamphetamine cp24 2

amphetamine-dextroamphetamine tabs 2

DESOXYN TABS (UseMethamphetamine HCl) 5

DEXEDRINE CP24 (UseDextroamphetamineSulfate)

5

dextroamphetamine sulfatecp24 2

dextroamphetamine sulfatesoln 2

dextroamphetamine sulfatetabs 2

methamphetamine hcl tabs 2

PROCENTRA SOLN (UseDextroamphetamineSulfate)

5

VYVANSE CAPS 4

ZENZEDI TABS 4

AnalepticsCAFCIT SOLN (UseCaffeine Citrate) 5

caffeine citrate soln 2

CAFFEINE/SODIUMBENZOATE SOLN 4

DOPRAM SOLN 4

Attention-Deficit/Hyperactivity Disorder (ADHD)clonidine hcl (adhd) tb12 2 PA

Drug Name DrugTier

Requirements/Limits

guanfacine hcl (adhd) tb24 2 PA

INTUNIV TB24 (UseGuanfacine HCl (ADHD)) 5 PA

KAPVAY TB12 (UseClonidine HCl (ADHD)) 5 PA

STRATTERA CAPS 4 PA

Stimulants - Misc.armodafinil tabs 150 mg,50 mg, 250 mg 2 QL(1 ea daily)

armodafinil tabs 200 mg 2

CONCERTA TBCR (UseMethylphenidate HCl) 5

dexmethylphenidate hclcp24 2

dexmethylphenidate hcltabs 2

FOCALIN TABS (UseDexmethylphenidate HCl) 5

FOCALIN XR CP24 (UseDexmethylphenidate HCl) 5

METADATE CD CPCR(Use Methylphenidate HCl) 5

METHYLIN CHEW (UseMethylphenidate HCl) 5

METHYLIN SOLN (UseMethylphenidate HCl) 5

methylphenidate hcl chew 2

methylphenidate hcl cp24 2

methylphenidate hcl cpcr 2

METHYLPHENIDATE HCLER TB24 4

methylphenidate hcl soln 2

methylphenidate hcl tabs 2

methylphenidate hcl tbcr 2

modafinil tabs 100 mg 2 QL(1 ea daily)

modafinil tabs 200 mg 2 QL(2 ea daily)

Centene Employee Formulary

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Drug Name DrugTier

Requirements/Limits

NUVIGIL TABS 150 MG,50 MG, 250 MG (UseArmodafinil)

5QL(1 ea daily)

NUVIGIL TABS 200 MG(Use Armodafinil) 5

PROVIGIL TABS 100 MG(Use Modafinil) 5 QL(1 ea daily)

PROVIGIL TABS 200 MG(Use Modafinil) 5 QL(2 ea daily)

QUILLIVANT XR SUSR 4

RITALIN LA CP24 (UseMethylphenidate HCl) 5

RITALIN TABS (UseMethylphenidate HCl) 5

AMINOGLYCOSIDES - Drugs to Treat BacterialInfectionsAminoglycosidesamikacin sulfate soln 2

BETHKIS NEBU 5 PA

gentamicin in saline soln 2

gentamicin sulfate soln ij10 mg/ml, 40 mg/ml 2

gentamicin sulfate soln iv10 mg/ml 2

GENTAMICINSULFATE/0.9% SODIUMCHLORIDE SOLN

4

KITABIS PAK NEBU 5 PA

neomycin sulfate tabs 2

paromomycin sulfate caps 2

STREPTOMYCINSULFATE SOLR 4

TOBI NEBU (UseTobramycin) 5 PA

TOBI PODHALER CAPS 5 PA

tobramycin nebu 2 PA

TOBRAMYCIN NEBU 5 PA

Drug Name DrugTier

Requirements/Limits

tobramycin sulfate soln 1.2gm/30ml, 80 mg/2ml, 40mg/ml, 10 mg/ml

2

TOBRAMYCIN SULFATESOLN 10 MG/ML, 40MG/ML

4

tobramycin sulfate solr 1.2gm 2

ANALGESICS - ANTI-INFLAMMATORY - Drugsto Treat Pain, Swelling, Muscle and JointConditionsAnti-TNF-alpha - Monoclonal AntibodiesHUMIRA PEDIATRICCROHNS DISEASESTARTER PACK PSKT

4PA

HUMIRA PEN PNKT 4 PA

HUMIRA PEN-CROHNSDISEASESTARTER PNKT 4 PA

HUMIRA PEN-PSORIASISSTARTER PNKT 4 PA

HUMIRA PSKT 4 PA

SIMPONI ARIA SOLN 5 PA

SIMPONI SOAJ 5 PA

SIMPONI SOSY 5 PA

Antirheumatic - Enzyme InhibitorsXELJANZ TABS 5 PA

XELJANZ XR TB24 5 PA

Antirheumatic AntimetabolitesOTREXUP SOAJ 10MG/0.4ML, 7.5 MG/0.4ML,25 MG/0.4ML, 22.5MG/0.4ML, 17.5MG/0.4ML, 15 MG/0.4ML,12.5 MG/0.4ML

5

PA

OTREXUP SOAJ 20MG/0.4ML 4 PA

RASUVO SOAJ 4 PA

RHEUMATREX TABS 5


2

Drug Name DrugTier

Requirements/Limits

Interleukin-1 BlockersARCALYST SOLR 5 PA

Interleukin-1 Receptor Antagonist (IL-1Ra)KINERET SOSY 5 PA

Interleukin-1beta BlockersILARIS SOLR 5 PA

Interleukin-6 Receptor InhibitorsACTEMRA SOLN 5 PA

ACTEMRA SOSY 5 PA

Nonsteroidal Anti-inflammatory Agents (NSAIDs)ANAPROX DS TABS (UseNaproxen Sodium) 5

ARTHROTEC 50 TBEC(Use Diclofenac w/Misoprostol)

5

ARTHROTEC 75 TBEC(Use Diclofenac w/Misoprostol)

5

CELEBREX CAPS (UseCelecoxib) 5 QL(2 ea daily)

celecoxib caps 2 QL(2 ea daily)

CHILDRENS ADVIL SUSP(Use Ibuprofen) 5 RX/OTC

CHILDRENS MOTRINSUSP (Use Ibuprofen) 5 RX/OTC

DAYPRO TABS (UseOxaprozin) 5

DERMA SILKRXDICLOPAK THPK (UseDiclofenac Sodium-Capsaicin)

5

diclofenac potassium tabs 2

diclofenac sodium tb24 2

diclofenac sodium tbec 2

diclofenac sodium-capsaicin thpk 2

Drug Name DrugTier

Requirements/Limits

diclofenac w/ misoprostoltbec 2

EC-NAPROSYN TBEC(Use Naproxen) 5 QL(2 ea daily)

etodolac caps 2

etodolac tabs 2

etodolac tb24 2

FELDENE CAPS (UsePiroxicam) 5

FENOPROFEN CALCIUMCAPS 4

FENOPROFEN CALCIUMTABS 4

FENORTHO CAPS 4

flurbiprofen tabs 2

ibuprofen lysine soln 2

ibuprofen susp 100 mg/5ml 2 RX/OTC

ibuprofen tabs 400 mg, 800mg, 600 mg 2

indomethacin caps 2

indomethacin cpcr 2

indomethacin sodium solr 2

ketoprofen caps 2

KETOPROFEN ER CP24 4

ketorolac tromethaminesoln ij 15 mg/ml, 30 mg/ml 2

KETOROLACTROMETHAMINE SOLN IJ30 MG/ML

4

ketorolac tromethaminesoln im 30 mg/ml, 60mg/2ml

2

ketorolac tromethaminetabs or 10 mg 2

QL(20 ea per30 days retail);AL


3

Drug Name DrugTier

Requirements/Limits

LODINE TABS (UseEtodolac) 5

MECLOFENAMATESODIUM CAPS 4

mefenamic acid caps 2

MELOXICAM SUSP 7.5MG/5ML 4

meloxicam tabs 15 mg, 7.5mg 2 QL(1 ea daily)

MOBIC SUSP 7.5 MG/5ML 4

MOBIC TABS 15 MG, 7.5MG (Use Meloxicam) 5 QL(1 ea daily)

nabumetone tabs 2

NALFON CAPS 4

NAPRELAN TB24 (UseNaproxen Sodium) 5

NAPROSYN SUSP (UseNaproxen) 5

NAPROSYN TABS (UseNaproxen) 5

naproxen sodium tabs 2

naproxen sodium tb24 2

naproxen susp 125 mg/5ml 2

NAPROXEN SUSP 125MG/5ML 4

naproxen tabs 250 mg, 500mg, 375 mg 2

naproxen tbec 375 mg, 500mg 2 QL(2 ea daily)

NEOPROFEN SOLN (UseIbuprofen Lysine) 5

oxaprozin tabs 2

piroxicam caps 2

PONSTEL CAPS (UseMefenamic Acid) 5

READYSHARPKETOROLAC KIT 5

Drug Name DrugTier

Requirements/Limits

SPRIX SOLN 5

sulindac tabs 2

TOLMETIN SODIUMCAPS 400 MG 4

tolmetin sodium caps 400mg 2

TOLMETIN SODIUM TABS200 MG, 600 MG 4

VOLTAREN-XR TB24 (UseDiclofenac Sodium) 5

Phosphodiesterase 4 (PDE4) InhibitorsOTEZLA TABS 5 PA

OTEZLA TBPK 5 PA

Pyrimidine Synthesis InhibitorsARAVA TABS (UseLeflunomide) 5 QL(1 ea daily)

leflunomide tabs 2 QL(1 ea daily)

Selective Costimulation ModulatorsORENCIA CLICKJECTSOAJ 5 PA

ORENCIA SOLR 5 PA

ORENCIA SOSY 5 PA

Soluble Tumor Necrosis Factor Receptor AgentsENBREL SOLR 4 PA

ENBREL SOSY 4 PA

ENBREL SURECLICKSOAJ 4 PA

ANALGESICS - NonNarcotic - Drugs to TreatPain, Muscle and Joint ConditionsAnalgesic Combinationsacetaminophen-salicylamide-phenyltoloxamine caps

2

butalbital-acetaminophentabs 2


4

Drug Name DrugTier

Requirements/Limits

butalbital-acetaminophen-caffeine caps 300mg-50mg-40mg

2

butalbital-acetaminophen-caffeine caps 325mg-50mg-40mg

2QL(6 ea daily)

butalbital-acetaminophen-caffeine soln 325mg/15ml-50mg/15ml-40mg/15ml

2

butalbital-acetaminophen-caffeine tabs 325mg-50mg-40mg

2QL(6 ea daily)

butalbital-aspirin-caffeinecaps 2 QL(6 ea daily)

ESGIC TABS (UseButalbital-Acetaminophen-Caffeine)

5QL(6 ea daily)

FIORICET CAPS (UseButalbital-Acetaminophen-Caffeine)

5

FIORINAL CAPS (UseButalbital-Aspirin-Caffeine) 5 QL(6 ea daily)

TENCON TABS 4

VANATOL LQ SOLN 4

Analgesics Otherclonidine hcl (analgesia)soln 2

DURACLON SOLN (UseClonidine HCl (Analgesia)) 5

Analgesics-Peptide Channel BlockersPRIALT SOLN 5 PA

SalicylatesASCRIPTIN TABS 6 AL

aspirin chew 6 AL

ASPIRIN LOW DOSETABS 6 AL

aspirin tabs 6 AL

aspirin tbec 6 AL

choline & mag salicylateliqd 2

Drug Name DrugTier

Requirements/Limits

CHOLINE MAGNESIUMTRISALICYLATE TABS 4

diflunisal tabs 2

DISALCID TABS (UseSalsalate) 5

ECOTRIN REGULARSTRENGTH TBEC (UseAspirin)

5AL

salsalate tabs 2

ANALGESICS - OPIOID - Drugs to Treat Pain,Muscle and Joint ConditionsOpioid AgonistsABSTRAL SUBL 4 QL(4 ea daily)

ACTIQ LPOP (UseFentanyl Citrate) 5 PA; QL(4 ea

daily)ALFENTANIL HCL INJ(Use Alfentanil) 5

alfentanil inj 2

AVINZA CP24 (UseMorphine Sulfate Beads) 5 QL(1 ea daily)

codeine sulfate tabs 15 mg 2 QL(2 ea daily)

CODEINE SULFATE TABS15 MG (Use CodeineSulfate)

5QL(2 ea daily)

codeine sulfate tabs 30 mg,60 mg 2 QL(6 ea daily)

CODEINE SULFATE TABS30 MG, 60 MG (UseCodeine Sulfate)

5QL(6 ea daily)

CONZIP CP24 4 QL(1 ea daily)

DEMEROL SOLN IJ 100MG/ML, 50 MG/ML, 25MG/ML (Use MeperidineHCl)

5

DEMEROL TABS OR 100MG, 50 MG (UseMeperidine HCl)

5QL(6 ea daily)

DILAUDID LIQD 1 MG/ML(Use Hydromorphone HCl) 5 QL(15.767 ml

daily)


5

Drug Name DrugTier

Requirements/Limits

DILAUDID TABS 2 MG, 8MG, 4 MG (UseHydromorphone HCl)

5QL(8 ea daily)

DILAUDID-HP SOLN (UseHydromorphone HCl) 5

DOLOPHINE TABS 10 MG(Use Methadone HCl) 5 QL(10 ea daily)

DOLOPHINE TABS 5 MG(Use Methadone HCl) 5 QL(4 ea daily)

DURAGESIC PT72 (UseFentanyl) 5 QL(0.334 ea

daily)EXALGO T24A 12 MG, 32MG (Use HydromorphoneHCl)

5QL(2 ea daily)

EXALGO T24A 16 MG, 8MG (Use HydromorphoneHCl)

5QL(1 ea daily)

fentanyl citrate lpop bu1200 mcg, 800 mcg, 600mcg, 400 mcg, 200 mcg,1600 mcg

2

PA; QL(4 eadaily)

FENTANYL CITRATESOCT IJ 100 MCG/2ML 4

FENTANYL CITRATESOLN IJ 100 MCG/2ML,250 MCG/5ML (UseFentanyl Citrate)

5

fentanyl citrate soln ij 100mcg/2ml, 2500 mcg/50ml,250 mcg/5ml, 1000mcg/20ml

2

FENTANYL CITRATESOLN IJ 500 MCG/10ML 4

fentanyl pt72 2 QL(0.334 eadaily)

FENTORA TABS 4 QL(4 ea daily)

hydromorphone hcl liqd or1 mg/ml 2 QL(15.767 ml

daily)hydromorphone hcl soln ij 1mg/ml, 500 mg/50ml, 50mg/5ml, 4 mg/ml, 2 mg/ml,10 mg/ml

2

hydromorphone hcl t24a or12 mg, 32 mg 2 QL(2 ea daily)

hydromorphone hcl t24a or16 mg, 8mg, 8 mg 2 QL(1 ea daily)

Drug Name DrugTier

Requirements/Limits

hydromorphone hcl tabs or2 mg, 8 mg, 4 mg 2 QL(8 ea daily)

HYDROMORPHONEHYDROCHLORIDE/SODIUM CHLORIDE SOLN

5

HYSINGLA ER T24A 4

KADIAN CP24 (UseMorphine Sulfate) 5 QL(2 ea daily)

LEVORPHANOLTARTRATE TABS 4

MEPERIDINE HCL SOLNIJ 10 MG/ML 4

meperidine hcl soln ij 100mg/ml, 50 mg/ml, 25 mg/ml 2

MEPERIDINE HCL SOLNOR 50 MG/5ML 4 QL(500 ml per

fill retail)meperidine hcl tabs or 100mg, 50 mg 2 QL(6 ea daily)

methadone hcl conc 10mg/ml 2 QL(10 ml daily)

methadone hcl soln 10mg/5ml 2 QL(50 ml daily)

METHADONE HCL SOLN10 MG/5ML (UseMethadone HCl)

5QL(50 ml daily)

METHADONE HCL SOLN5 MG/5ML (UseMethadone HCl)

5QL(100 mldaily)

methadone hcl soln 5mg/5ml 2 QL(100 ml

daily)

methadone hcl tabs 10 mg 2 QL(10 ea daily)

methadone hcl tabs 5 mg 2 QL(4 ea daily)

methadone hcl tbso 40 mg 2 QL(2 ea daily)

METHADOSE CONC (UseMethadone HCl) 5 QL(10 ml daily)

METHADOSE SUGAR-FREE CONC (UseMethadone HCl)

5QL(10 ml daily)

MORPHINE SULFATEADD-VANTAGE SOLN 4

morphine sulfate cp24 or10 mg, 80 mg, 60 mg, 50mg, 30 mg, 20 mg, 100 mg

2QL(2 ea daily)


6

Drug Name DrugTier

Requirements/Limits

MORPHINE SULFATE ERCP24 4 QL(1 ea daily)

morphine sulfate soln ij 0.5mg/ml, 8 mg/ml, 15 mg/ml,10 mg/ml, 1 mg/ml

2

MORPHINE SULFATESOLN IJ 10 MG/ML, 15MG/ML

4

morphine sulfate soln iv 1mg/ml, 8 mg/ml, 4 mg/ml,10 mg/ml

2

MORPHINE SULFATESOLN IV 10 MG/ML, 8MG/ML, 4 MG/ML (UseMorphine Sulfate)

5

MORPHINE SULFATESOLN IV 15 MG/ML, 50MG/ML, 25 MG/ML

4

morphine sulfate soln or 10mg/5ml 2 QL(100 ml

daily)morphine sulfate soln or100 mg/5ml, 20 mg/ml 2 QL(10 ml daily)

morphine sulfate soln or 20mg/5ml 2 QL(50 ml daily)

MORPHINE SULFATESUPP RE 10 MG, 5 MG,20 MG

4QL(24 ea perfill retail)

MORPHINE SULFATETABS OR 15 MG, 30 MG 4 QL(6 ea daily)

morphine sulfate tbcr or100 mg, 60 mg, 30 mg, 200mg, 15 mg

2

MS CONTIN TBCR (UseMorphine Sulfate) 5

NUCYNTA ER TB12 4 QL(2 ea daily)

NUCYNTA TABS 4 QL(6 ea daily)

OPANA ER (CRUSHRESISTANT) T12A 10 MG,7.5 MG, 5 MG, 30 MG, 20MG, 15 MG

4

QL(2 ea daily)

OPANA ER (CRUSHRESISTANT) T12A 40 MG 4 QL(4 ea daily)

OPANA TABS 10 MG (UseOxymorphone HCl) 5 QL(12 ea daily)

Drug Name DrugTier

Requirements/Limits

OPANA TABS 5 MG (UseOxymorphone HCl) 5 QL(6 ea daily)

oxycodone hcl caps 5 mg 2 QL(6 ea daily)

oxycodone hcl conc 100mg/5ml 2 QL(6 ml daily)

OXYCODONE HCL ERT12A 4 QL(2 ea daily)

oxycodone hcl soln 5mg/5ml 2 QL(30 ml daily)

oxycodone hcl tabs 10 mg,5 mg, 30 mg, 20 mg, 15 mg 2 QL(6 ea daily)

OXYCONTIN T12A 4 QL(2 ea daily)

oxymorphone hcl tabs 10mg 2 QL(12 ea daily)

oxymorphone hcl tabs 5 mg 2 QL(6 ea daily)

oxymorphone hcl tb12 10mg, 7.5 mg, 5 mg, 30 mg,20 mg, 15 mg

2QL(2 ea daily)

oxymorphone hcl tb12 40mg 2 QL(4 ea daily)

OXYMORPHONEHYDROCHLORIDE ERTB12 10 MG, 7.5 MG, 5MG, 30 MG, 20 MG, 15 MG

4

QL(2 ea daily)

OXYMORPHONEHYDROCHLORIDE ERTB12 40 MG

4QL(4 ea daily)

ROXICODONE TABS (UseOxycodone HCl) 5 QL(6 ea daily)

SUBLIMAZE SOLN (UseFentanyl Citrate) 5

SUBSYS LIQD 100 MCG 4 QL(4 ea daily)

SUBSYS LIQD 1200 MCG,800 MCG, 600 MCG, 400MCG, 200 MCG, 1600MCG

4

QL(8 ea daily)

sufentanil citrate soln 100mcg/2ml, 50 mcg/ml, 250mcg/5ml

2

SUFENTANIL CITRATESOLN 50 MCG/ML (UseSufentanil Citrate)

5


7

Drug Name DrugTier

Requirements/Limits

TRAMADOL HCL ERCP24 4 QL(1 ea daily)

tramadol hcl tabs 50 mg 2 QL(8 ea daily)

tramadol hcl tb24 100 mg,300 mg, 200 mg 2 QL(1 ea daily)

ULTRAM ER TB24 (UseTramadol HCl) 5 QL(1 ea daily)

ULTRAM TABS (UseTramadol HCl) 5 QL(8 ea daily)

Opioid Combinationsacetaminophen w/ codeinesoln 120mg/5ml-12mg/5ml 2 QL(75 ml daily)

acetaminophen w/ codeinetabs 300mg-15mg 2 QL(13 ea daily)



acetaminophen-caff-dihydrocod caps 2

ASPIRIN-CAFFEINE-DIHYDROCODEINE CAPS 4

butalbital-acetaminophen-caffeine w/ codeine caps300mg-50mg-40mg-30mg

2

butalbital-acetaminophen-caffeine w/ codeine caps325mg-50mg-40mg-30mg

2QL(6 ea daily)

butalbital-aspirin-caffeinew/cod caps 2 QL(6 ea daily)

FENTANYLCITRATE/ROPIVACAINEHYDROCHLORIDE/SODIUM CHLORIDE SOLN

5

FIORICET/CODEINECAPS (Use Butalbital-Acetaminophen-Caffeinew/ Codeine)

5

FIORINAL/CODEINE #3CAPS (Use Butalbital-Aspirin-Caffeine w/Cod)

5QL(6 ea daily)

HYCET SOLN (UseHydrocodone-Acetaminophen)

5QL(180 mldaily)

Drug Name DrugTier

Requirements/Limits

hydrocodone-acetaminophen soln10mg/15ml-325mg/15ml,7.5mg/15ml-325mg/15ml,5mg/10ml-217mg/10ml,2.5mg/5ml-108mg/5ml

2

QL(180 mldaily)

hydrocodone-acetaminophen tabs 10mg-300mg, 7.5mg-300mg,5mg-300mg

2

QL(13 ea daily)

hydrocodone-acetaminophen tabs 10mg-325mg, 7.5mg-325mg,5mg-325mg

2

QL(12 ea daily)

hydrocodone-acetaminophen tabs2.5mg-325mg

2

hydrocodone-ibuprofentabs 2 QL(5 ea daily)

HYDROMORPHONEHYDROCHLORIDE/BUPIVACAINEHYDROCHLORIDE/SODIUM SOLN

5

IBUDONE TABS (UseHydrocodone-Ibuprofen) 5 QL(5 ea daily)

NORCO TABS (UseHydrocodone-Acetaminophen)

5QL(12 ea daily)

oxycodone w/acetaminophen tabs 2 QL(12 ea daily)

oxycodone-aspirin tabs 2 QL(12 ea daily)

OXYCODONE/ACETAMINOPHEN SOLN 5 QL(60 ml daily)

OXYCODONE/IBUPROFEN TABS 4 QL(4 ea daily)

PERCOCET TABS (UseOxycodone w/Acetaminophen)

5QL(12 ea daily)

PERCODAN TABS (UseOxycodone-Aspirin) 5 QL(12 ea daily)

REPREXAIN TABS (UseHydrocodone-Ibuprofen) 5 QL(5 ea daily)

ROXICET SOLN (UseOxycodone w/Acetaminophen)

5QL(60 ml daily)


8

Drug Name DrugTier

Requirements/Limits

SYNALGOS-DC CAPS 4

tramadol-acetaminophentabs 2 QL(8 ea daily)

TREZIX CAPS (UseAcetaminophen-Caff-Dihydrocod)

5

TYLENOL/CODEINE #3TABS (Use Acetaminophenw/ Codeine)

5QL(12 ea daily)

TYLENOL/CODEINE #4TABS (Use Acetaminophenw/ Codeine)

5QL(6 ea daily)

ULTRACET TABS (UseTramadol-Acetaminophen) 5 QL(8 ea daily)

VICOPROFEN TABS (UseHydrocodone-Ibuprofen) 5 QL(5 ea daily)

XODOL TABS (UseHydrocodone-Acetaminophen)

5QL(13 ea daily)

ZAMICET SOLN (UseHydrocodone-Acetaminophen)

5QL(180 mldaily)

Opioid Partial AgonistsBUNAVAIL FILM 2.1MG-0.3MG, 4.2MG-0.7MG 5 PA

BUNAVAIL FILM 6.3MG-1MG 5

BUPRENEX SOLN (UseBuprenorphine HCl) 5

buprenorphine hcl soln ij0.3 mg/ml 2

buprenorphine hcl subl sl 2mg, 8 mg 2 PA; QL(3 ea

daily)buprenorphine hcl-naloxone hcl dihydrate subl 2 PA; QL(3 ea

daily)butorphanol tartrate soln ij1 mg/ml, 2 mg/ml 2

butorphanol tartrate soln na10 mg/ml 2 QL(0.4167 ml

daily)BUTRANS PTWK 10MCG/HR, 5 MCG/HR, 20MCG/HR

4PA; QL(0.143ea daily)

BUTRANS PTWK 15MCG/HR, 7.5 MCG/HR 4 PA

Drug Name DrugTier

Requirements/Limits

nalbuphine hcl soln 2 QL(8 ml daily)

pentazocine w/ naloxonetabs 2 QL(12 ea daily)

SUBOXONE FILM 12MG-3MG, 4MG-1MG 4 PA

SUBOXONE FILM 2MG-0.5MG, 8MG-2MG 4 PA; QL(3 ea

daily)ZUBSOLV SUBL 1.4MG-0.36MG 5 PA

ZUBSOLV SUBL 5.7MG-1.4MG 5

ANDROGENS-ANABOLIC - Drugs to RegulateHormonesAndrogensANDRODERM PT24 4 QL(1 ea daily)

ANDROGEL GEL 25MG/2.5GM (UseTestosterone)

5QL(5 gm daily)

ANDROGEL GEL 50MG/5GM (UseTestosterone)

5PA; QL(10 gmdaily)

ANDROGEL PUMP GEL(Use Testosterone) 5 PA; QL(5 gm

daily)ANDROID CAPS (UseMethyltestosterone) 5

AXIRON SOLN 4 PA; QL(6 mldaily)

danazol caps 2

DEPO-TESTOSTERONESOLN (Use TestosteroneCypionate)

5PA; QL(0.334ml daily)

FORTESTA GEL 4 PA; QL(4 gmdaily)

methyltestosterone caps 2

TESTIM GEL 4 PA; QL(10 gmdaily)

testosterone cypionate soln 2 PA; QL(0.334ml daily)

testosterone enanthatesoln 2 PA

testosterone gel 1 % 2 PA; QL(5 gmdaily)


9

Drug Name DrugTier

Requirements/Limits

TESTOSTERONE GEL 1%, 50 MG/5GM 4 PA; QL(10 gm

daily)TESTOSTERONE GEL 10MG/ACT 4 PA; QL(4 gm

daily)testosterone gel 25mg/2.5gm 2 QL(5 gm daily)

TESTOSTERONE GEL 25MG/2.5GM 4 QL(5 gm daily)

testosterone gel 50mg/5gm 2 PA; QL(10 gm

daily)TESTOSTERONE PUMPGEL 4 PA; QL(5 gm

daily)TESTRED CAPS (UseMethyltestosterone) 5

VOGELXO GEL 4 PA; QL(10 gmdaily)

VOGELXO PUMP GEL 4 PA; QL(5 gmdaily)

ANORECTAL AGENTS - Rectal Drugs to TreatPain, Swelling and ItchingIntrarectal SteroidsCORTENEMA ENEM (UseHydrocortisone(Intrarectal))

5QL(420 ml perfill retail)

CORTIFOAM FOAM 4

hydrocortisone (intrarectal)enem 2 QL(420 ml per

fill retail)Rectal Combinationslidocaine-hydrocortisoneacetate (rectal) crea 2

lidocaine-hydrocortisoneacetate (rectal) kit 2

PROCTOFOAM HC FOAM 4

Rectal SteroidsANUSOL-HC CREA (UseHydrocortisone (Rectal)) 5

hydrocortisone (rectal) crea 2

PROCTOCORT CREA 1 %(Use Hydrocortisone(Rectal))

5

ANTHELMINTICS - Drugs to Treat WormInfections

Drug Name DrugTier

Requirements/Limits

AnthelminticsALBENZA TABS 4

ivermectin tabs 2

STROMECTOL TABS (UseIvermectin) 5

ANTI-INFECTIVE AGENTS - MISC. - Drugs toTreat Bacterial InfectionsAnti-infective Agents - Misc.AZACTAM SOLR (UseAztreonam) 5

aztreonam solr 2

bacitracin solr im 50000unit 2

colistimethate sodium solr 2

COLY-MYCIN M SOLR(Use ColistimethateSodium)

5

FLAGYL CAPS (UseMetronidazole) 5

FLAGYL TABS (UseMetronidazole) 5

metronidazole caps 2

metronidazole in nacl soln 2

metronidazole tabs 2

TINDAMAX TABS (UseTinidazole) 5

tinidazole tabs 2

trimethoprim tabs 2

VANCOCIN HCL CAPS(Use Vancomycin HCl) 5

vancomycin hcl caps or125 mg, 250 mg 2

vancomycin hcl solr iv 10gm, 5000 mg 2

vancomycin hcl solr iv 1000mg 2 QL(14 ea per

fill retail)


10

Drug Name DrugTier

Requirements/Limits

vancomycin hcl solr iv 500mg 2 QL(0.4667 ea

daily)VANCOMYCINHYDROCHLORIDE/SODIUM CHLORIDE SOLN

5

XIFAXAN TABS 4 PA; QL(2 eadaily)

Anti-infective Misc. - CombinationsBACTRIM DS TABS (UseSulfamethoxazole-Trimethoprim)

5

BACTRIM TABS (UseSulfamethoxazole-Trimethoprim)

5

sulfamethoxazole-trimethoprim susp40mg/5ml-200mg/5ml

2AL

sulfamethoxazole-trimethoprim tabs 160mg-800mg, 80mg-400mg

2

SULFAMETHOXAZOLE/TRIMETHOPRIM SOLN 4

Antiprotozoal AgentsALINIA SUSR 100MG/5ML 5 AL

ALINIA TABS 500 MG 5

atovaquone susp 2 AL

MEPRON SUSP (UseAtovaquone) 5 AL

Carbapenemsimipenem-cilastatin solr 2

meropenem solr 2

MERREM SOLR (UseMeropenem) 5

PRIMAXIN IV ADD-VANTAGE SOLR (UseImipenem-Cilastatin)

5

PRIMAXIN IV SOLR (UseImipenem-Cilastatin) 5

Chloramphenicols

Drug Name DrugTier

Requirements/Limits

CHLORAMPHENICOLSODIUM SUCCINATESOLR

4

Cyclic LipopeptidesCUBICIN RF SOLR (UseDaptomycin) 5

CUBICIN SOLR (UseDaptomycin) 5

daptomycin solr 2

Leprostaticsdapsone tabs 2

LincosamidesCLEOCIN CAPS OR 150MG, 75 MG, 300 MG (UseClindamycin HCl)

5

CLEOCIN IN D5W SOLN(Use ClindamycinPhosphate in D5W)

5

CLEOCIN PEDIATRICGRANULES SOLR (UseClindamycin PalmitateHydrochloride)

5

AL

CLEOCIN PHOSPHATESOLN IJ 300 MG/2ML, 900MG/6ML, 9 GM/60ML, 600MG/4ML (Use ClindamycinPhosphate)

5

CLEOCIN PHOSPHATESOLN IV 300 MG/2ML, 900MG/6ML (Use ClindamycinPhosphate)

5

CLEOCIN PHOSPHATESOLN IV 300MG/50ML-5%, 900MG/50ML-5%,600MG/50ML-5% (UseClindamycin Phosphate inD5W)

5

CLEOCIN PHOSPHATESOLN IV 600 MG/4ML 4

clindamycin hcl caps 2

clindamycin palmitatehydrochloride solr 2 AL

clindamycin phosphate ind5w soln 2


11

Drug Name DrugTier

Requirements/Limits

clindamycin phosphatesoln ij 150 mg/ml, 9000mg/60ml, 900 mg/6ml, 600mg/4ml, 300 mg/2ml

2

CLINDAMYCINPHOSPHATE SOLN IV150 MG/ML

4

clindamycin phosphatesoln iv 150 mg/ml, 900mg/6ml

2

LINCOCIN SOLN (UseLincomycin HCl) 5

lincomycin hcl soln 2

Oxazolidinoneslinezolid soln iv 600mg/300ml 2

LINEZOLID SOLN IV600MG/300ML-0.9% 4

linezolid susr or 100mg/5ml 2 AL

linezolid tabs or 600 mg 2

SIVEXTRO TABS 4

ZYVOX SOLN IV 600MG/300ML (Use Linezolid) 5

ZYVOX SUSR OR 100MG/5ML (Use Linezolid) 5 AL

ZYVOX TABS OR 600 MG(Use Linezolid) 5

Polymyxinspolymyxin b sulfate solr 2

ANTIANGINAL AGENTS - Drugs to Treat ChestPainAntianginals-OtherRANEXA TB12 1000 MG 4 QL(2 ea daily)

RANEXA TB12 500 MG 4 QL(3 ea daily)

NitratesDILATRATE SR CPCR 5

ISORDIL TITRADOSETABS 5

Drug Name DrugTier

Requirements/Limits

ISORDIL TITRADOSETABS (Use IsosorbideDinitrate)

5

ISOSORBIDE DINITRATEER TBCR 4

isosorbide dinitrate tabs 2

isosorbide mononitrate tabs10 mg, 20 mg 2 QL(2 ea daily)

isosorbide mononitratetb24 120 mg, 60 mg, 30 mg 2 QL(1 ea daily)

NITRO-BID OINT 5

NITRO-DUR PT24 (UseNitroglycerin) 5

NITRO-DUR PT24 5

nitroglycerin in d5w soln 2

NITROGLYCERIN INDEXTROSE 5% SOLN(Use Nitroglycerin in D5W)

5

NITROGLYCERINLINGUAL AERS 4

nitroglycerin pt24 td 0.1mg/hr, 0.6 mg/hr, 0.4mg/hr, 0.2 mg/hr

2

nitroglycerin soln tl 0.4mg/spray 2

nitroglycerin subl sl 0.3 mg,0.6 mg, 0.4 mg 2

NITROLINGUALPUMPSPRAY SOLN (UseNitroglycerin)

5

NITROMIST AERS 4

NITROSTAT SUBL (UseNitroglycerin) 5

ANTIANXIETY AGENTS - Drugs to Treat Anxiety

Antianxiety Agents - Misc.buspirone hcl tabs 2 QL(3 ea daily)

droperidol soln 2

HYDROXYZINE HCLSOLN IM 25 MG/ML 4


12

Drug Name DrugTier

Requirements/Limits

hydroxyzine hcl soln im 50mg/ml 2

hydroxyzine hcl soln or 10mg/5ml 2

hydroxyzine hcl syrp or 10mg/5ml 2

hydroxyzine hcl tabs or 10mg, 50 mg, 25 mg 2

HYDROXYZINEPAMOATE CAPS 100 MG 4

hydroxyzine pamoate caps25 mg, 50 mg 2

meprobamate tabs 2

VISTARIL CAPS (UseHydroxyzine Pamoate) 5

Benzodiazepinesalprazolam tabs 0.25 mg, 2mg, 1 mg, 0.5 mg 2 QL(4 ea daily)

alprazolam tb24 0.5 mg, 3mg, 2 mg, 1 mg 2

alprazolam tbdp 0.25 mg, 2mg, 1 mg, 0.5 mg 2

ATIVAN SOLN IJ 2MG/ML, 4 MG/ML (UseLorazepam)

5

ATIVAN TABS OR 0.5 MG,2 MG, 1 MG (UseLorazepam)

5QL(4 ea daily)

chlordiazepoxide hcl caps 2 QL(4 ea daily)

clorazepate dipotassiumtabs 2 QL(4 ea daily)

diazepam conc or 5 mg/ml 2

DIAZEPAM SOLN IJ 5MG/ML 4

DIAZEPAM SOLN OR 1MG/ML 4

diazepam tabs or 10 mg, 5mg, 2 mg 2 QL(4 ea daily)

lorazepam conc or 2 mg/ml 2 QL(5 ml daily)

lorazepam soln ij 2 mg/ml,4 mg/ml, 20 mg/10ml 2

Drug Name DrugTier

Requirements/Limits

lorazepam tabs or 0.5 mg,2 mg, 1 mg 2 QL(4 ea daily)

oxazepam caps 2 QL(4 ea daily)

TRANXENE T TABS (UseClorazepate Dipotassium) 5 QL(4 ea daily)

VALIUM TABS (UseDiazepam) 5 QL(4 ea daily)

XANAX TABS (UseAlprazolam) 5 QL(4 ea daily)

XANAX XR TB24 (UseAlprazolam) 5

ANTIARRHYTHMICS - Drugs to treat abnormalheart rhythmsAntiarrhythmics - Misc.ADENOCARD SOLN (UseAdenosine) 5

adenosine soln 12 mg/4ml,6 mg/2ml 2

ADENOSINE SOSY 60MG/20ML 5

Antiarrhythmics Type I-Adisopyramide phosphatecaps 2

NORPACE CAPS (UseDisopyramide Phosphate) 4

NORPACE CR CP12 5

PROCAINAMIDE HCLSOLN 4

quinidine gluconate tbcr 2

QUINIDINE SULFATE ERTBCR 4

QUINIDINE SULFATETABS 200 MG, 300 MG 4

quinidine sulfate tabs 300mg 2

Antiarrhythmics Type I-Blidocaine hcl (cardiac) soln 2

LIDOCAINE HCL SOLN IV10 MG/ML 4

lidocaine in d5w soln 2


13

Drug Name DrugTier

Requirements/Limits

mexiletine hcl caps 2

XYLOCAINE SOLN (UseLidocaine HCl (Cardiac)) 5

Antiarrhythmics Type I-Cflecainide acetate tabs 2

propafenone hcl cp12 2

propafenone hcl tabs 2

RYTHMOL SR CP12 (UsePropafenone HCl) 5

RYTHMOL TABS (UsePropafenone HCl) 5

Antiarrhythmics Type IIIamiodarone hcl soln iv 150mg/3ml, 50 mg/ml 2

AMIODARONE HCL SOLNIV 900 MG/18ML 4

amiodarone hcl tabs or 100mg, 400 mg, 200 mg 2

CORDARONE TABS (UseAmiodarone HCl) 5

CORVERT SOLN (UseIbutilide Fumarate) 5

dofetilide caps 2

ibutilide fumarate soln 2

TIKOSYN CAPS (UseDofetilide) 5

ANTIASTHMATIC AND BRONCHODILATORAGENTS - Drugs to Treat Lung ConditionsAnti-Inflammatory AgentsCROMOLYN SODIUMNEBU 4 QL(8 ml daily)

Antiasthmatic - Monoclonal AntibodiesNUCALA SOLR 5 PA

XOLAIR SOLR 5 PA

Asthma and Bronchodilator Agent Combinationsdyphylline-guaifenesin liqd 2

Drug Name DrugTier

Requirements/Limits

Bronchodilators - AnticholinergicsATROVENT HFA AERS 3

ipratropium bromide soln 1 QL(12.5 mldaily)

SPIRIVA HANDIHALERCAPS 3 QL(1 ea daily)

SPIRIVA RESPIMATAERS 4

TUDORZA PRESSAIRAEPB 3

Leukotriene ModulatorsACCOLATE TABS (UseZafirlukast) 5 QL(2 ea daily)

montelukast sodium chew4 mg, 5 mg 1 QL(1 ea daily);

ALmontelukast sodium pack 4mg 1 QL(1 ea daily)

montelukast sodium tabs10 mg 1 QL(1 ea daily)

SINGULAIR CHEW 4 MG,5 MG (Use MontelukastSodium)

5QL(1 ea daily);AL

SINGULAIR PACK 4 MG(Use Montelukast Sodium) 5 QL(1 ea daily)

SINGULAIR TABS 10 MG(Use Montelukast Sodium) 5 QL(1 ea daily)

zafirlukast tabs 2 QL(2 ea daily)

ZYFLO CR TB12 5

ZYFLO TABS 5

Selective Phosphodiesterase 4 (PDE4) InhibitorsDALIRESP TABS 3 QL(1 ea daily)

Steroid InhalantsAEROSPAN AERS 5

ALVESCO AERS 3

ASMANEX HFA AERO 4

ASMANEX TWISTHALER120 METERED DOSESAEPB

3


14

Drug Name DrugTier

Requirements/Limits


3


3


3


3

budesonide (inhalation)susp 1 QL(4 ml daily);

AL

FLOVENT DISKUS AEPB 3 QL(2 ea daily)

FLOVENT HFA AERO 3

PULMICORT FLEXHALERAEPB 3

PULMICORT SUSP (UseBudesonide (Inhalation)) 5 QL(4 ml daily);

AL

QVAR AERS 3

SympathomimeticsADVAIR DISKUS AEPB 3

ADVAIR HFA AERO 3

albuterol sulfate nebu in0.083 %, 1.25 mg/3ml, 0.63mg/3ml

1QL(12.5 mldaily)

albuterol sulfate nebu in0.5 % 1 QL(2 ml daily)

albuterol sulfate syrp or 2mg/5ml 1 AL

albuterol sulfate tabs or 2mg, 4 mg 1

albuterol sulfate tb12 or 4mg, 8 mg 1

ANORO ELLIPTA AEPB 4

ARCAPTA NEOHALERCAPS 4 QL(1 ea daily)

BREO ELLIPTA AEPB 3

Drug Name DrugTier

Requirements/Limits

BROVANA NEBU 3

COMBIVENT RESPIMATAERS 3

DULERA AERO 3

epinephrine hcl soln 2

epinephrine hcl sosy 2

FORADIL AEROLIZERCAPS 5

ipratropium-albuterol soln 1 QL(18 ml daily)

levalbuterol hcl nebu 0.31mg/3ml, 1.25 mg/3ml, 0.63mg/3ml

1QL(9.6 mldaily)

levalbuterol hcl nebu 1.25mg/0.5ml 2 QL(2 ea daily)

LEVALBUTEROLTARTRATE HFA AERO 3

METAPROTERENOLSULFATE SYRP 10MG/5ML

4QL(30 mldaily); AL

METAPROTERENOLSULFATE TABS 10 MG,20 MG

4

PERFOROMIST NEBU 4 QL(4 ml daily);AL

PROAIR HFA AERS 3

PROVENTIL HFA AERS 3

SEREVENT DISKUSAEPB 3 QL(2 ea daily)

STRIVERDI RESPIMATAERS 5

SYMBICORT AERO 3

terbutaline sulfate soln 1

terbutaline sulfate tabs 1

VENTOLIN HFA AERS 3

VOSPIRE ER TB12 (UseAlbuterol Sulfate) 5


15

Drug Name DrugTier

Requirements/Limits

XOPENEXCONCENTRATE NEBU(Use Levalbuterol HCl)

5QL(2 ea daily)

XOPENEX HFA AERO 3

XOPENEX NEBU (UseLevalbuterol HCl) 5 QL(9.6 ml

daily)Xanthinesaminophylline soln 2

ELIXOPHYLLIN ELIX 5

LUFYLLIN TABS 5

THEO-24 CP24 5

theophylline soln 2

theophylline tb12 2

theophylline tb24 2

ANTICOAGULANTS - Blood Thinners

Coumarin AnticoagulantsCOUMADIN TABS (UseWarfarin Sodium) 4

warfarin sodium tabs 2

Direct Factor Xa InhibitorsELIQUIS TABS 4

XARELTO STARTERPACK TBPK 4

XARELTO TABS 10 MG 4 QL(1 ea daily)

XARELTO TABS 15 MG,20 MG 4

Heparins And Heparinoid-Like AgentsARIXTRA SOLN (UseFondaparinux Sodium) 5 PA

enoxaparin sodium soln 2 PA

fondaparinux sodium soln 2 PA

FRAGMIN SOLN 5 PA

Drug Name DrugTier

Requirements/Limits

heparin (porcine) in sodiumchloride soln 2

HEPARIN LOCK FLUSHSOLN 4

heparin sod (porcine) ind5w soln 2

heparin sodium (porcine)lock flush & nacl lock flushkit

2

heparin sodium (porcine)lock flush soln 2

heparin sodium (porcine)soln 2

HEPARIN SODIUM/D5WSOLN 100UNIT/ML-5%,50UNIT/ML-5%

4

HEPARIN SODIUM/D5WSOLN 50UNIT/ML-5% (UseHeparin Sod (Porcine) inD5W)

5

HEPARINSODIUM/SODIUMCHLORIDE 0.9% SOLN(Use Heparin (Porcine) inSodium Chloride)

5

LOVENOX SOLN (UseEnoxaparin Sodium) 5 PA

Thrombin InhibitorsANGIOMAX SOLR (UseBivalirudin) 5

argatroban soln 2

bivalirudin solr 2

PRADAXA CAPS 110 MG 4

PRADAXA CAPS 150 MG 4 QL(2 ea daily)

PRADAXA CAPS 75 MG 4 QL(1 ea daily)

ANTICONVULSANTS - Drugs to Treat Seizures

AMPA Glutamate Receptor AntagonistsFYCOMPA SUSP 4

FYCOMPA TABS 4


16

Drug Name DrugTier

Requirements/Limits

Anticonvulsants - Benzodiazepinesclonazepam tabs 2 QL(4 ea daily)

clonazepam tbdp 2 QL(4 ea daily)

DIASTAT ACUDIAL GEL 4 QL(1 ea per fillretail)

DIASTAT PEDIATRIC GEL 4 QL(1 ea per fillretail)

DIAZEPAM GEL RE 10MG, 20 MG, 2.5 MG 4 QL(1 ea per fill

retail)KLONOPIN TABS (UseClonazepam) 5 QL(4 ea daily)

Anticonvulsants - Misc.APTIOM TABS 5

BANZEL SUSP 5

BANZEL TABS 5

carbamazepine chew 100mg 2

carbamazepine cp12 100mg 2

carbamazepine cp12 200mg 2 QL(6 ea daily)

carbamazepine cp12 300mg 2 QL(4 ea daily)

carbamazepine susp 100mg/5ml 2

carbamazepine tabs 200mg 2

carbamazepine tb12 100mg 2

carbamazepine tb12 200mg 2 QL(6 ea daily)

carbamazepine tb12 400mg 2 QL(4 ea daily)

CARBATROL CP12 100MG (Use Carbamazepine) 4

CARBATROL CP12 200MG (Use Carbamazepine) 4 QL(6 ea daily)

CARBATROL CP12 300MG (Use Carbamazepine) 4 QL(4 ea daily)

gabapentin caps 100 mg,400 mg, 300 mg 2 QL(4 ea daily)

Drug Name DrugTier

Requirements/Limits

gabapentin soln 250mg/5ml, 300 mg/6ml 2 QL(60 ml daily)

gabapentin tabs 600 mg,800 mg 2 QL(4 ea daily)

KEPPRA SOLN IV 500MG/5ML (UseLevetiracetam)

5

KEPPRA SOLN OR 100MG/ML (UseLevetiracetam)

5QL(30 ml daily)

KEPPRA TABS OR 1000MG (Use Levetiracetam) 5 QL(3 ea daily)

KEPPRA TABS OR 250MG, 750 MG, 500 MG (UseLevetiracetam)

5QL(4 ea daily)

KEPPRA XR TB24 (UseLevetiracetam) 5 QL(4 ea daily)

LAMICTAL CHEWABLEDISPERSIBLE CHEW (UseLamotrigine)

5

LAMICTAL ODT KIT (UseLamotrigine) 5

LAMICTAL ODT TBDP(Use Lamotrigine) 5

LAMICTAL STARTER/NOTTAKINGCARBAMAZEPINE KIT

5

LAMICTALSTARTER/TAKINGCARBAMAZEPINE/NOTTAKING VALPROATE KIT

5

LAMICTALSTARTER/TAKINGVALPROATE KIT

5

LAMICTAL TABS (UseLamotrigine) 5

LAMICTAL XR KIT 5

LAMICTAL XR TB24 100MG, 50 MG, 25 MG (UseLamotrigine)

5

LAMICTAL XR TB24 200MG, 300 MG, 250 MG (UseLamotrigine)

5QL(2 ea daily)

lamotrigine chew 25 mg, 5mg 2


17

Drug Name DrugTier

Requirements/Limits

lamotrigine kit 2

lamotrigine tabs 100 mg,25 mg, 200 mg, 150 mg 2

lamotrigine tb24 100 mg,50 mg, 25 mg 2

lamotrigine tb24 200 mg,300 mg, 250 mg 2 QL(2 ea daily)

lamotrigine tbdp 100 mg,50 mg, 25 mg, 200 mg 2

levetiracetam soln iv 500mg/5ml 2

levetiracetam soln or 100mg/ml, 500 mg/5ml 2 QL(30 ml daily)

levetiracetam tabs or 1000mg 2 QL(3 ea daily)

levetiracetam tabs or 250mg, 750 mg, 500 mg 2 QL(4 ea daily)

levetiracetam tb24 or 500mg, 750 mg 2 QL(4 ea daily)

LYRICA CAPS 100 MG, 75MG, 50 MG, 25 MG, 200MG, 150 MG

4PA; QL(3 eadaily)

LYRICA CAPS 225 MG,300 MG 4 PA; QL(2 ea

daily)

LYRICA SOLN 20 MG/ML 4 PA

MYSOLINE TABS (UsePrimidone) 5

NEURONTIN CAPS 100MG, 400 MG, 300 MG (UseGabapentin)

5QL(4 ea daily)

NEURONTIN SOLN 250MG/5ML (Use Gabapentin) 5 QL(60 ml daily)

NEURONTIN TABS 600MG, 800 MG (UseGabapentin)

5QL(4 ea daily)

oxcarbazepine susp 300mg/5ml, 60 mg/ml 2 QL(40 ml daily)

oxcarbazepine tabs 150mg, 600 mg, 300 mg 2 QL(4 ea daily)

OXTELLAR XR TB24 150MG, 300 MG 4 QL(3 ea daily)

OXTELLAR XR TB24 600MG 4 QL(4 ea daily)

POTIGA TABS 5

Drug Name DrugTier

Requirements/Limits

primidone tabs 2

QUDEXY XR CS24 4

TEGRETOL SUSP (UseCarbamazepine) 4

TEGRETOL TABS (UseCarbamazepine) 4

TEGRETOL-XR TB12 100MG (Use Carbamazepine) 4

TEGRETOL-XR TB12 200MG (Use Carbamazepine) 4 QL(6 ea daily)

TEGRETOL-XR TB12 400MG (Use Carbamazepine) 4 QL(4 ea daily)

TOPAMAX SPRINKLECPSP 15 MG (UseTopiramate)

5QL(6 ea daily)

TOPAMAX SPRINKLECPSP 25 MG (UseTopiramate)

5QL(8 ea daily)

TOPAMAX TABS 100 MG(Use Topiramate) 5 QL(3 ea daily)

TOPAMAX TABS 200 MG(Use Topiramate) 5 QL(8 ea daily)

TOPAMAX TABS 25 MG,50 MG (Use Topiramate) 5 QL(4 ea daily)

topiramate cpsp 15 mg 2 QL(6 ea daily)

topiramate cpsp 25 mg 2 QL(8 ea daily)

TOPIRAMATE ER CS24 4

topiramate tabs 100 mg 2 QL(3 ea daily)

topiramate tabs 200 mg 2 QL(8 ea daily)

topiramate tabs 25 mg, 50mg 2 QL(4 ea daily)

TRILEPTAL SUSP 300MG/5ML (UseOxcarbazepine)

5QL(40 ml daily)

TRILEPTAL TABS 150MG, 600 MG, 300 MG (UseOxcarbazepine)

5QL(4 ea daily)

TROKENDI XR CP24 4

VIMPAT SOLN IV 200MG/20ML 5


18

Drug Name DrugTier

Requirements/Limits

VIMPAT SOLN OR 10MG/ML 4 QL(40 ml daily)

VIMPAT TABS OR 100MG, 50 MG, 200 MG, 150MG

4QL(2 ea daily)

ZONEGRAN CAPS (UseZonisamide) 5 QL(6 ea daily)

zonisamide caps 2 QL(6 ea daily)

Carbamatesfelbamate susp 600mg/5ml 2 QL(120 ml

daily)

felbamate tabs 400 mg 2 QL(9 ea daily)

felbamate tabs 600 mg 2 QL(6 ea daily)

FELBATOL SUSP 600MG/5ML (Use Felbamate) 5 QL(120 ml

daily)FELBATOL TABS 400 MG(Use Felbamate) 5 QL(9 ea daily)

FELBATOL TABS 600 MG(Use Felbamate) 5 QL(6 ea daily)

GABA ModulatorsGABITRIL TABS (UseTiagabine HCl) 5

GABITRIL TABS 5

SABRIL PACK 5 PA

SABRIL TABS 5 PA

tiagabine hcl tabs 2

HydantoinsCEREBYX SOLN (UseFosphenytoin Sodium) 5

DILANTIN CAPS (UsePhenytoin SodiumExtended)

4

DILANTIN INFATABSCHEW (Use Phenytoin) 4

DILANTIN-125 SUSP (UsePhenytoin) 4

fosphenytoin sodium soln 2

Drug Name DrugTier

Requirements/Limits

PHENYTEK CAPS (UsePhenytoin SodiumExtended)

4

phenytoin chew 2

phenytoin sodium extendedcaps 2

phenytoin sodium soln 2

phenytoin susp 2

Succinimidesethosuximide caps 250 mg 2 QL(6 ea daily)

ethosuximide soln 250mg/5ml 2 QL(30 ml daily)

ZARONTIN CAPS 250 MG(Use Ethosuximide) 4 QL(6 ea daily)

ZARONTIN SOLN 250MG/5ML (UseEthosuximide)

4QL(30 ml daily)

Valproic AcidDEPACON SOLN (UseValproate Sodium) 4

DEPAKENE CAPS (UseValproic Acid) 4

DEPAKENE SYRP (UseValproate Sodium) 4

DEPAKOTE ER TB24 (UseDivalproex Sodium) 5

DEPAKOTE SPRINKLESCSDR (Use DivalproexSodium)

5

DEPAKOTE TBEC (UseDivalproex Sodium) 5

divalproex sodium csdr 2

divalproex sodium tb24 2

divalproex sodium tbec 2

valproate sodium soln 2

valproate sodium syrp 2

valproic acid caps 2


19

Drug Name DrugTier

Requirements/Limits

ANTIDEPRESSANTS - Drugs to Treat Depression

Alpha-2 Receptor Antagonists (Tetracyclics)mirtazapine tabs 2

mirtazapine tbdp 2

REMERON SOLTAB TBDP(Use Mirtazapine) 5

REMERON TABS (UseMirtazapine) 5

Antidepressants - Misc.bupropion hcl tabs 2

bupropion hcl tb12 2

bupropion hcl tb24 2

MAPROTILINE HCL TABS 4

WELLBUTRIN SR TB12(Use Bupropion HCl) 5

WELLBUTRIN TABS (UseBupropion HCl) 5

WELLBUTRIN XL TB24(Use Bupropion HCl) 5

Monoamine Oxidase Inhibitors (MAOIs)NARDIL TABS (UsePhenelzine Sulfate) 5

PARNATE TABS (UseTranylcypromine Sulfate) 5

phenelzine sulfate tabs 2

tranylcypromine sulfatetabs 2

Selective Serotonin Reuptake Inhibitors (SSRIs)CELEXA TABS (UseCitalopram Hydrobromide) 5 ST

citalopram hydrobromidesoln 10 mg/5ml 2

citalopram hydrobromidetabs 10 mg, 40 mg, 20 mg 2 ST

escitalopram oxalate soln 5mg/5ml 2

escitalopram oxalate tabs10 mg, 5 mg, 20 mg 2 ST

Drug Name DrugTier

Requirements/Limits

fluoxetine hcl caps 10 mg,40 mg, 20 mg 2 ST

fluoxetine hcl cpdr 90 mg 2 ST

fluoxetine hcl soln 20mg/5ml 2

fluoxetine hcl tabs 10 mg,20 mg 2 ST

FLUOXETINE HCL TABS60 MG 4 ST

fluvoxamine maleate cp24 2 ST

fluvoxamine maleate tabs 2 ST

LEXAPRO SOLN 5MG/5ML (Use EscitalopramOxalate)

5

LEXAPRO TABS 10 MG, 5MG, 20 MG (UseEscitalopram Oxalate)

5ST

paroxetine hcl tabs 2 ST

paroxetine hcl tb24 2 ST

PAXIL CR TB24 (UseParoxetine HCl) 5 ST

PAXIL TABS (UseParoxetine HCl) 5 ST

PROZAC CAPS (UseFluoxetine HCl) 5 ST

PROZAC WEEKLY CPDR(Use Fluoxetine HCl) 5 ST

sertraline hcl conc 20mg/ml 2

sertraline hcl tabs 100 mg,50 mg, 25 mg 2 ST

ZOLOFT CONC 20 MG/ML(Use Sertraline HCl) 5

ZOLOFT TABS 100 MG,50 MG, 25 MG (UseSertraline HCl)

5ST

Serotonin ModulatorsBRINTELLIX TABS 4

NEFAZODONE HCL TABS100 MG, 200 MG, 150 MG 4


20

Drug Name DrugTier

Requirements/Limits

nefazodone hcl tabs 250mg, 50 mg 2

trazodone hcl tabs 2

TRINTELLIX TABS 4

VIIBRYD KIT 4

VIIBRYD STARTER PACKKIT 4

VIIBRYD TABS 4

Serotonin-Norepinephrine Reuptake InhibitorsCYMBALTA CPEP (UseDuloxetine HCl) 5 ST

DESVENLAFAXINE ERTB24 4 ST

duloxetine hcl cpep 20 mg,60 mg, 30 mg 2 ST

DULOXETINE HCL CPEP40 MG 4

EFFEXOR XR CP24 (UseVenlafaxine HCl) 5 ST

IRENKA CPEP 4

KHEDEZLA TB24 4 ST

PRISTIQ TB24 4 ST

venlafaxine hcl cp24 2 ST

VENLAFAXINE HCL ERTB24 150 MG, 75 MG,37.5 MG (Use VenlafaxineHCl)

5

ST

VENLAFAXINE HCL ERTB24 225 MG 4 ST

venlafaxine hcl tabs 2 ST

venlafaxine hcl tb24 2 ST

Tricyclic Agentsamitriptyline hcl tabs 2

AMOXAPINE TABS 4

Drug Name DrugTier

Requirements/Limits

ANAFRANIL CAPS (UseClomipramine HCl) 5

clomipramine hcl caps 2

desipramine hcl tabs 2

doxepin hcl caps 10 mg, 50mg, 25 mg, 150 mg, 100mg

2

DOXEPIN HCL CAPS 75MG 4

doxepin hcl conc 10 mg/ml 2

ELAVIL TABS (UseAmitriptyline HCl) 5

imipramine hcl tabs 2

imipramine pamoate caps 2

NORPRAMIN TABS (UseDesipramine HCl) 5

nortriptyline hcl caps 10mg, 75 mg, 50 mg, 25 mg 2

NORTRIPTYLINE HCLSOLN 10 MG/5ML 4

PAMELOR CAPS (UseNortriptyline HCl) 5

protriptyline hcl tabs 2

SURMONTIL CAPS (UseTrimipramine Maleate) 5

TOFRANIL TABS (UseImipramine HCl) 5

TOFRANIL-PM CAPS (UseImipramine Pamoate) 5

trimipramine maleate caps 2

ANTIDIABETICS - Drugs to Regulate Blood Sugar

Alpha-Glucosidase Inhibitorsacarbose tabs 2 QL(3 ea daily)

GLYSET TABS (UseMiglitol) 5 QL(3 ea daily)

miglitol tabs 2 QL(3 ea daily)


21

Drug Name DrugTier

Requirements/Limits

PRECOSE TABS (UseAcarbose) 5 QL(3 ea daily)

Antidiabetic - Amylin Analogs

SYMLINPEN 120 SOPN 4 QL(0.36 mldaily)

SYMLINPEN 60 SOPN 3 QL(0.2 mldaily)

Antidiabetic CombinationsACTOPLUS MET TABS(Use Pioglitazone HCl-Metformin HCl)

5QL(2 ea daily)

ALOGLIPTIN/METFORMINHCL TABS 3

ALOGLIPTIN/PIOGLITAZONE TABS 4

DUETACT TABS (UsePioglitazone HCl-Glimepiride)

5QL(1 ea daily)

glipizide-metformin hcl tabs2.5mg-250mg, 2.5mg-500mg

2QL(2 ea daily)

glipizide-metformin hcl tabs5mg-500mg 2 QL(4 ea daily)

GLUCOVANCE TABS2.5MG-500MG (UseGlyburide-Metformin)

5QL(2 ea daily)

GLUCOVANCE TABS5MG-500MG (UseGlyburide-Metformin)

5QL(4 ea daily)

glyburide-metformin tabs1.25mg-250mg, 2.5mg-500mg

1QL(2 ea daily)

glyburide-metformin tabs5mg-500mg 1 QL(4 ea daily)

JANUMET TABS 3 QL(2 ea daily)

JANUMET XR TB24100MG-1000MG, 50MG-500MG

3QL(1 ea daily)

JANUMET XR TB2450MG-1000MG 3 QL(2 ea daily)

JENTADUETO TABS 3 QL(2 ea daily)

JENTADUETO XR TB24 4

KAZANO TABS 3

Drug Name DrugTier

Requirements/Limits

KOMBIGLYZE XR TB24 3

OSENI TABS 4

pioglitazone hcl-glimepiridetabs 2 QL(1 ea daily)

pioglitazone hcl-metforminhcl tabs 1 QL(2 ea daily)

PRANDIMET TABS (UseRepaglinide-MetforminHCl)

5QL(2 ea daily)

REPAGLINIDE/METFORMIN HYDROCHLORIDETABS

4QL(2 ea daily)

XIGDUO XR TB24 4

BiguanidesFORTAMET TB24 1000MG (Use Metformin HCl) 5 QL(2 ea daily)

FORTAMET TB24 500 MG(Use Metformin HCl) 5 QL(4 ea daily)

GLUCOPHAGE TABS1000 MG (Use MetforminHCl)

5QL(2 ea daily)

GLUCOPHAGE TABS 500MG (Use Metformin HCl) 5 QL(5 ea daily)

GLUCOPHAGE TABS 850MG (Use Metformin HCl) 5 QL(3 ea daily)

GLUCOPHAGE XR TB24500 MG (Use MetforminHCl)

5QL(4 ea daily)

GLUCOPHAGE XR TB24750 MG (Use MetforminHCl)

5QL(3 ea daily)

GLUMETZA TB24 1000MG (Use Metformin HCl) 5 QL(2 ea daily)

GLUMETZA TB24 500 MG(Use Metformin HCl) 5 QL(4 ea daily)

metformin hcl tabs 1000mg 1 QL(2 ea daily)

metformin hcl tabs 500 mg 1 QL(5 ea daily)

metformin hcl tabs 850 mg 1 QL(3 ea daily)

metformin hcl tb24 1000mg 1 QL(2 ea daily)


22

Drug Name DrugTier

Requirements/Limits

metformin hcl tb24 500 mg 1 QL(4 ea daily)

metformin hcl tb24 750 mg 1 QL(3 ea daily)

Diabetic OtherGLUCAGEN HYPOKITSOLR 4 QL(1 ea per fill

retail)GLUCAGONEMERGENCY KIT KIT 4 QL(1 ea per fill

retail)Dipeptidyl Peptidase-4 (DPP-4) InhibitorsALOGLIPTIN TABS 5

JANUVIA TABS 3 QL(1 ea daily);AL

NESINA TABS 5

ONGLYZA TABS 3

TRADJENTA TABS 3 QL(1 ea daily);AL

Dopamine Receptor Agonists - AntidiabeticCYCLOSET TABS 3

Incretin Mimetic Agents (GLP-1 ReceptorBYDUREON PEN PEN 3

TRULICITY SOPN 4

VICTOZA SOPN 3 QL(0.3 mldaily)

Insulin Sensitizing AgentsACTOS TABS (UsePioglitazone HCl) 5 QL(1 ea daily)

pioglitazone hcl tabs 1 QL(1 ea daily)

InsulinAPIDRA SOLN 3

APIDRA SOLOSTARSOPN 3

BASAGLAR KWIKPENSOPN 5 QL(1 ml daily)

HUMALOG MIX 50/50KWIKPEN SUPN 3

Drug Name DrugTier

Requirements/Limits

HUMALOG MIX 50/50SUSP 3

HUMALOG MIX 75/25KWIKPEN SUPN 3

HUMALOG MIX 75/25SUSP 3

HUMALOG SOLN 3

HUMULIN 70/30 KWIKPENSUPN 3

HUMULIN N KWIKPENSUPN 3

HUMULIN N SUSP 3 QL(1.67 mldaily)

HUMULIN R SOLN 3 QL(1.67 mldaily)

HUMULIN R U-500(CONCENTRATED) SOLN 3 QL(13.34 ml

daily)HUMULIN R U-500KWIKPEN SOPN 5

LANTUS SOLN 3 QL(1 ml daily)

LANTUS SOLOSTARSOPN 3 QL(1 ml daily)

LEVEMIR FLEXTOUCHSOPN 3 QL(1 ml daily)

LEVEMIR SOLN 3 QL(1 ml daily)

NOVOLIN N RELIONSUSP 3 QL(1.67 ml

daily)

NOVOLIN N SUSP 3 QL(1.67 mldaily)

NOVOLIN R RELIONSOLN 3 QL(1.67 ml

daily)

NOVOLIN R SOLN 3 QL(1.67 mldaily)

NOVOLOG FLEXPENSOPN 3 QL(1 ml daily)

NOVOLOG MIX 70/30PREFILLED FLEXPENSUPN

3QL(1 ml daily)

NOVOLOG MIX 70/30SUSP 3 QL(1.67 ml

daily)NOVOLOG PENFILLSOCT 4 QL(1 ml daily)


23

Drug Name DrugTier

Requirements/Limits

NOVOLOG SOLN 3 QL(1.67 mldaily)

TOUJEO SOLOSTARSOPN 4

TRESIBA FLEXTOUCHSOPN 4

Meglitinide Analoguesnateglinide tabs 1 QL(3 ea daily)

PRANDIN TABS 0.5 MG, 1MG (Use Repaglinide) 5 QL(4 ea daily)

PRANDIN TABS 2 MG(Use Repaglinide) 5 QL(8 ea daily)

repaglinide tabs 0.5 mg, 1mg 2 QL(4 ea daily)

repaglinide tabs 2 mg 2 QL(8 ea daily)

STARLIX TABS (UseNateglinide) 5 QL(3 ea daily)

Sodium-Glucose Co-Transporter 2 (SGLT2)FARXIGA TABS 3

INVOKANA TABS 3

JARDIANCE TABS 4

SulfonylureasAMARYL TABS (UseGlimepiride) 5 QL(2 ea daily)

CHLORPROPAMIDETABS 4

DIABETA TABS 3

glimepiride tabs 1 QL(2 ea daily)

glipizide tabs 1

glipizide tb24 1

GLUCOTROL TABS (UseGlipizide) 5

GLUCOTROL XL TB24(Use Glipizide) 5

glyburide micronized tabs 2

Drug Name DrugTier

Requirements/Limits

glyburide tabs 1.25 mg, 5mg, 2.5 mg 1

GLYBURIDE TABS 5 MG 3

GLYNASE TABS (UseGlyburide Micronized) 5

tolazamide tabs 250 mg 2

TOLAZAMIDE TABS 250MG, 500 MG 4

TOLBUTAMIDE TABS 4

ANTIDIARRHEALS - Drugs to Treat Diarrhea

Antiperistaltic Agentsdiphenoxylate w/ atropinetabs 2

DIPHENOXYLATE/ATROPINE LIQD 4

IMODIUM A-D CAPS (UseLoperamide HCl) 5 RX/OTC

LOMOTIL TABS (UseDiphenoxylate w/ Atropine) 5

loperamide hcl caps 2 RX/OTC

opium tincture tinc 2

PAREGORIC TINC 4

ANTIDOTES AND SPECIFIC ANTAGONISTS

Antidotes - Chelating AgentsEXJADE TBSO 5 PA

JADENU TABS 5 PA

Antidotes and Specific AntagonistsACETADOTE SOLN (UseAcetylcysteine (Antidote)) 5

acetylcysteine (antidote)soln 2

ANTIZOL SOLN (UseFomepizole) 5

deferoxamine mesylate solr 2 PA

DESFERAL SOLR (UseDeferoxamine Mesylate) 5 PA


24

Drug Name DrugTier

Requirements/Limits

fomepizole soln 2

methylene blue (antidote)soln 2

METHYLENE BLUE SOLN 4

SODIUM THIOSULFATESOLN 10 %, 25 % 4

sodium thiosulfate soln 25% 2

VISTOGARD PACK 4

Benzodiazepine Antagonistsflumazenil soln 2

Opioid AntagonistsEVZIO SOAJ 4

NALOXONE HCL SOCT0.4 MG/ML 4

naloxone hcl soln 0.4mg/ml, 4 mg/10ml 2

NALOXONE HCL SOSY 2MG/2ML 4

naltrexone hcl tabs 2

NARCAN LIQD 4

REVIA TABS (UseNaltrexone HCl) 5

VIVITROL SUSR 5 PA

ANTIEMETICS - Drugs to Treat Nausea andVomiting5-HT3 Receptor Antagonistsgranisetron hcl soln iv 0.1mg/ml, 4 mg/4ml, 1 mg/ml 2

granisetron hcl tabs or 1mg 2 QL(0.334 ea

daily)ondansetron hcl soln ij 4mg/2ml, 40 mg/20ml 2

ondansetron hcl soln or 4mg/5ml 2 QL(50 ml per

fill retail)ondansetron hcl tabs or 24mg 2 QL(0.143 ea

daily)

Drug Name DrugTier

Requirements/Limits

ondansetron hcl tabs or 4mg, 8 mg 2 QL(2 ea daily)

ondansetron tbdp 2 QL(2 ea daily)

SANCUSO PTCH 4 QL(0.0667 eadaily)

ZOFRAN ODT TBDP (UseOndansetron) 5 QL(2 ea daily)

ZOFRAN SOLN 4 MG/5ML(Use Ondansetron HCl) 5 QL(50 ml per

fill retail)ZOFRAN TABS 4 MG, 8MG (Use OndansetronHCl)

5QL(2 ea daily)

Antiemetics - Anticholinergicmeclizine hcl tabs 2 RX/OTC

TIGAN CAPS (UseTrimethobenzamide HCl) 5

trimethobenzamide hclcaps 2

Antiemetics - MiscellaneousDICLEGIS TBEC 4

dronabinol caps 2

MARINOL CAPS (UseDronabinol) 5

Substance P/Neurokinin 1 (NK1) ReceptorVARUBI TABS 4

ANTIFUNGALS - Drugs to Treat Fungal Infections

AntifungalsAMPHOTERICIN B SOLR 4

ANCOBON CAPS (UseFlucytosine) 5

flucytosine caps 2

GRIFULVIN V TABS (UseGriseofulvin Microsize) 5

GRIS-PEG TABS (UseGriseofulvin Ultramicrosize) 5

griseofulvin microsize susp 2


25

Drug Name DrugTier

Requirements/Limits

griseofulvin microsize tabs 2

griseofulvin ultramicrosizetabs 2

LAMISIL TABS (UseTerbinafine HCl) 5 QL(1 ea daily)

nystatin powd 2

nystatin tabs 2 QL(6 ea daily)

terbinafine hcl tabs 2 QL(1 ea daily)

Imidazole-Related AntifungalsDIFLUCAN SUSR 10MG/ML (Use Fluconazole) 5 QL(70 ml per

fill retail)DIFLUCAN SUSR 40MG/ML (Use Fluconazole) 5 QL(70 ml per

fill retail); ALDIFLUCAN TABS 100 MG(Use Fluconazole) 5 QL(1 ea daily)

DIFLUCAN TABS 150 MG(Use Fluconazole) 5 QL(2 ea per fill

retail)DIFLUCAN TABS 200 MG(Use Fluconazole) 5 QL(2 ea daily)

DIFLUCAN TABS 50 MG(Use Fluconazole) 5 QL(7 ea per fill

retail)fluconazole in dextrosesoln 2

fluconazole in nacl soln 2

fluconazole susr 10 mg/ml 2 QL(70 ml perfill retail)

fluconazole susr 40 mg/ml 2 QL(70 ml perfill retail); AL

fluconazole tabs 100 mg 2 QL(1 ea daily)

fluconazole tabs 150 mg 2 QL(2 ea per fillretail)

fluconazole tabs 200 mg 2 QL(2 ea daily)

fluconazole tabs 50 mg 2 QL(7 ea per fillretail)

itraconazole caps 2 PA; QL(1 eadaily)

ketoconazole tabs 2 QL(2 ea daily)

SPORANOX CAPS (UseItraconazole) 5 PA; QL(1 ea

daily)

Drug Name DrugTier

Requirements/Limits

SPORANOX PULSEPAKCAPS (Use Itraconazole) 5 PA; QL(1 ea

daily)VFEND IV SOLR (UseVoriconazole) 5

VFEND SUSR 40 MG/ML(Use Voriconazole) 5 AL

VFEND TABS 200 MG, 50MG (Use Voriconazole) 5

voriconazole solr iv 200 mg 2

voriconazole susr or 40mg/ml 2 AL

voriconazole tabs or 200mg, 50 mg 2

ANTIHISTAMINES - Drugs to Treat Allergies

Antihistamines - AlkylaminesBROMPHENIRAMINETANNATE CHEW 4

DEXCHLORPHENIRAMINE MALEATE SYRP 4

Antihistamines - Ethanolaminescarbinoxamine maleatesoln 2

carbinoxamine maleatetabs 2

CLEMASTINE FUMARATESYRP 0.67 MG/5ML 4

CLEMASTINE FUMARATETABS 2.68 MG 4

clemastine fumarate tabs2.68 mg 2

diphenhydramine hcl capsor 50 mg 2 QL(4 ea daily);

RX/OTC

diphenhydramine hcl elix or12.5 mg/5ml 2

QL(240 ml perfill retail);RX/OTC

diphenhydramine hcl soln ij50 mg/ml 2

Antihistamines - Non-Sedatingcetirizine hcl chew 10 mg, 5mg 2 QL(1 ea daily)

cetirizine hcl soln 1 mg/ml,5 mg/5ml 2

QL(240 ml perfill retail); AL;RX/OTC


26

Drug Name DrugTier

Requirements/Limits

cetirizine hcl syrp 1 mg/ml,5 mg/5ml 2

QL(240 ml perfill retail); AL;RX/OTC

cetirizine hcl tabs 10 mg 2 QL(1 ea daily)

CLARINEX TABS (UseDesloratadine) 5 QL(1 ea daily)

DESLORATADINE ODTTBDP 4 QL(1 ea daily);

AL

desloratadine tabs 2 QL(1 ea daily)

levocetirizinedihydrochloride soln 2.5mg/5ml

2QL(10 mldaily); AL

levocetirizinedihydrochloride tabs 5 mg 2 QL(1 ea daily)

XYZAL SOLN 2.5 MG/5ML(Use LevocetirizineDihydrochloride)

5QL(10 mldaily); AL

XYZAL TABS 5 MG (UseLevocetirizineDihydrochloride)

5QL(1 ea daily)

ZYRTEC ALLERGY TABS(Use Cetirizine HCl) 5 QL(1 ea daily)

ZYRTEC CHILDRENSALLERGY SYRP (UseCetirizine HCl)

5QL(240 ml perfill retail); AL;RX/OTC

Antihistamines - PhenothiazinesPHENERGAN SOLN (UsePromethazine HCl) 5 AL

promethazine hcl soln ij 25mg/ml, 50 mg/ml 2 AL

promethazine hcl soln or6.25 mg/5ml 2 QL(240 ml per

fill retail); ALpromethazine hcl supp re12.5 mg, 50 mg, 25 mg 2 QL(12 ea per

fill retail); ALpromethazine hcl syrp or6.25 mg/5ml 2 QL(240 ml per

fill retail); ALpromethazine hcl tabs or12.5 mg, 50 mg, 25 mg 2 AL

Antihistamines - Piperidinescyproheptadine hcl syrp 2

cyproheptadine hcl tabs 2

Drug Name DrugTier

Requirements/Limits

ANTIHYPERLIPIDEMICS - Drugs to Treat HighCholesterolAntihyperlipidemics - Combinations

VYTORIN TABS 4 ST; QL(1 eadaily)

Antihyperlipidemics - Misc.KYNAMRO SOSY 5 PA

LOVAZA CAPS (UseOmega-3-acid Ethyl Esters) 5 QL(4 ea daily)

omega-3-acid ethyl esterscaps 2 QL(4 ea daily)

VASCEPA CAPS 5

Bile Acid Sequestrantscholestyramine light pack 4gm 2 QL(6 ea daily)

cholestyramine light powd4 gm/dose 2 QL(6 gm daily)

cholestyramine pack 4 gm 2 QL(6 ea daily)

cholestyramine powd 4gm/dose 2 QL(6 gm daily)

COLESTID FLAVOREDGRAN 5 GM (UseColestipol HCl)

5QL(6 gm daily)

COLESTID FLAVOREDPACK 5 GM/7.5GM (UseColestipol HCl)

5QL(6 ea daily)

COLESTID GRAN 5 GM(Use Colestipol HCl) 5 QL(6 gm daily)

COLESTID PACK 5 GM(Use Colestipol HCl) 5 QL(6 ea daily)

COLESTID TABS 1 GM(Use Colestipol HCl) 5 QL(16 ea daily)

colestipol hcl gran 5 gm 2 QL(6 gm daily)

colestipol hcl pack 5 gm 2 QL(6 ea daily)

colestipol hcl tabs 1 gm 2 QL(16 ea daily)

QUESTRAN LIGHT POWD(Use Cholestyramine Light) 5 QL(6 gm daily)

QUESTRAN PACK 4 GM(Use Cholestyramine) 5 QL(6 ea daily)


27

Drug Name DrugTier

Requirements/Limits

QUESTRAN POWD 4GM/DOSE (UseCholestyramine)

5QL(6 gm daily)

WELCHOL PACK 3.75 GM 4 QL(1 ea daily)

WELCHOL TABS 625 MG 4 QL(7 ea daily)

Fibric Acid DerivativesANTARA CAPS 5

choline fenofibrate cpdr 2 QL(1 ea daily)

FENOFIBRATE CAPS 150MG, 50 MG 4 QL(1 ea daily)

fenofibrate micronized caps 2 QL(1 ea daily)

fenofibrate tabs 120 mg 2

fenofibrate tabs 145 mg, 54mg, 48 mg, 40 mg, 160 mg 2 QL(1 ea daily)

FENOFIBRIC ACID TABS 4 QL(1 ea daily)

FENOGLIDE TABS 120MG (Use Fenofibrate) 5

FENOGLIDE TABS 40 MG(Use Fenofibrate) 5 QL(1 ea daily)

FIBRICOR TABS 4 QL(1 ea daily)

gemfibrozil tabs 2 QL(2 ea daily)

LIPOFEN CAPS 4 QL(1 ea daily)

LOFIBRA CAPS (UseFenofibrate Micronized) 5 QL(1 ea daily)

LOFIBRA TABS (UseFenofibrate) 5 QL(1 ea daily)

LOPID TABS (UseGemfibrozil) 5 QL(2 ea daily)

TRICOR TABS (UseFenofibrate) 5 QL(1 ea daily)

TRIGLIDE TABS 4 QL(1 ea daily)

TRILIPIX CPDR (UseCholine Fenofibrate) 5 QL(1 ea daily)

HMG CoA Reductase InhibitorsADVICOR TB24 5

Drug Name DrugTier

Requirements/Limits

ALTOPREV TB24 5 ST

atorvastatin calcium tabs 2 ST; QL(1 eadaily)

CRESTOR TABS (UseRosuvastatin Calcium) 5 QL(1 ea daily)

fluvastatin sodium caps 2 ST; QL(1 eadaily)

fluvastatin sodium tb24 2 ST; QL(1 eadaily)

LESCOL CAPS (UseFluvastatin Sodium) 5 ST; QL(1 ea

daily)LESCOL XL TB24 (UseFluvastatin Sodium) 5 ST; QL(1 ea

daily)LIPITOR TABS (UseAtorvastatin Calcium) 5 ST; QL(1 ea

daily)

LIVALO TABS 5 ST

lovastatin tabs 10 mg, 20mg 2 ST; QL(1 ea

daily)

lovastatin tabs 40 mg 2 ST; QL(2 eadaily)

MEVACOR TABS (UseLovastatin) 5 ST; QL(2 ea

daily)PRAVACHOL TABS (UsePravastatin Sodium) 5 ST; QL(1 ea

daily)

pravastatin sodium tabs 2 ST; QL(1 eadaily)

rosuvastatin calcium tabs 2 QL(1 ea daily)

SIMCOR TB24 5 ST

simvastatin tabs 2 ST; QL(1 eadaily)

ZOCOR TABS (UseSimvastatin) 5 ST; QL(1 ea

daily)Intestinal Cholesterol Absorption Inhibitorsezetimibe tabs 2 QL(1 ea daily)

ZETIA TABS (UseEzetimibe) 5 QL(1 ea daily)

Microsomal Triglyceride Transfer Protein (MTP)JUXTAPID CAPS 5

Nicotinic Acid Derivatives


28

Drug Name DrugTier

Requirements/Limits

niacin (antihyperlipidemic)tbcr 1000 mg, 750 mg 2 QL(2 ea daily)

niacin (antihyperlipidemic)tbcr 500 mg 2 QL(1 ea daily)

NIACOR TABS 4

NIASPAN TBCR 1000 MG,750 MG (Use Niacin(Antihyperlipidemic))

5QL(2 ea daily)

NIASPAN TBCR 500 MG(Use Niacin(Antihyperlipidemic))

5QL(1 ea daily)

Proprotein Convertase Subtilisin/Kexin Type 9PRALUENT SOPN 5 PA

PRALUENT SOSY 5 PA

REPATHA PUSHTRONEXSYSTEM SOCT 4

REPATHA SOSY 4 PA

REPATHA SURECLICKSOAJ 4 PA

ANTIHYPERTENSIVES - Drugs to Treat HighBlood PressureACE InhibitorsACCUPRIL TABS (UseQuinapril HCl) 5 QL(2 ea daily)

ACEON TABS (UsePerindopril Erbumine) 5 QL(2 ea daily)

ALTACE CAPS (UseRamipril) 5 QL(2 ea daily)

benazepril hcl tabs 10 mg,40 mg, 20 mg 2 QL(2 ea daily)

benazepril hcl tabs 5 mg 2 QL(1 ea daily)

captopril tabs 2 QL(3 ea daily)

enalapril maleate tabs 2 QL(2 ea daily)

enalaprilat inj 2

EPANED SOLN 5

EPANED SOLR 5

Drug Name DrugTier

Requirements/Limits

fosinopril sodium tabs 10mg, 20 mg 2 QL(1 ea daily)

fosinopril sodium tabs 40mg 2 QL(2 ea daily)

lisinopril tabs 10 mg, 5 mg,40 mg, 30 mg, 20 mg 2 QL(2 ea daily)

lisinopril tabs 2.5 mg 2 QL(1 ea daily)

LOTENSIN TABS (UseBenazepril HCl) 5 QL(2 ea daily)

MAVIK TABS 1 MG, 2 MG(Use Trandolapril) 5 QL(1 ea daily)

MAVIK TABS 4 MG (UseTrandolapril) 5 QL(2 ea daily)

moexipril hcl tabs 2 QL(2 ea daily)

perindopril erbumine tabs 2 QL(2 ea daily)

PRINIVIL TABS (UseLisinopril) 5 QL(2 ea daily)

quinapril hcl tabs 2 QL(2 ea daily)

ramipril caps 2 QL(2 ea daily)

trandolapril tabs 1 mg, 2mg 2 QL(1 ea daily)

trandolapril tabs 4 mg 2 QL(2 ea daily)

VASOTEC TABS (UseEnalapril Maleate) 5 QL(2 ea daily)

ZESTRIL TABS 10 MG, 5MG, 40 MG, 30 MG, 20 MG(Use Lisinopril)

5QL(2 ea daily)

ZESTRIL TABS 2.5 MG(Use Lisinopril) 5 QL(1 ea daily)

Agents for PheochromocytomaDIBENZYLINE CAPS (UsePhenoxybenzamine HCl) 5

phenoxybenzamine hclcaps 2

PHENTOLAMINEMESYLATE SOLR 4

Angiotensin II Receptor AntagonistsATACAND TABS 16 MG, 8MG, 4 MG (UseCandesartan Cilexetil)

5QL(2 ea daily)


29

Drug Name DrugTier

Requirements/Limits

ATACAND TABS 32 MG(Use Candesartan Cilexetil) 5 QL(1 ea daily)

AVAPRO TABS (UseIrbesartan) 5 QL(1 ea daily)

BENICAR TABS 20 MG, 40MG (Use OlmesartanMedoxomil)

5QL(1 ea daily)

BENICAR TABS 5 MG(Use OlmesartanMedoxomil)

5QL(2 ea daily)

candesartan cilexetil tabs16 mg, 8 mg, 4 mg 2 QL(2 ea daily)

candesartan cilexetil tabs32 mg 2 QL(1 ea daily)

COZAAR TABS 100 MG(Use Losartan Potassium) 5 QL(1 ea daily)

COZAAR TABS 25 MG, 50MG (Use LosartanPotassium)

5QL(2 ea daily)

DIOVAN TABS 160 MG, 80MG (Use Valsartan) 5 QL(2 ea daily)

DIOVAN TABS 320 MG, 40MG (Use Valsartan) 5 QL(1 ea daily)

EDARBI TABS 5

EPROSARTANMESYLATE TABS 4 QL(1 ea daily)

irbesartan tabs 2 QL(1 ea daily)

losartan potassium tabs100 mg 2 QL(1 ea daily)

losartan potassium tabs 25mg, 50 mg 2 QL(2 ea daily)

MICARDIS TABS (UseTelmisartan) 5 QL(1 ea daily)

olmesartan medoxomil tabs20 mg, 40 mg 2 QL(1 ea daily)

olmesartan medoxomil tabs5 mg 2 QL(2 ea daily)

telmisartan tabs 2 QL(1 ea daily)

valsartan tabs 160 mg, 80mg 2 QL(2 ea daily)

valsartan tabs 320 mg, 40mg 2 QL(1 ea daily)

Antiadrenergic Antihypertensives

Drug Name DrugTier

Requirements/Limits

CARDURA TABS (UseDoxazosin Mesylate) 5

CATAPRES TABS (UseClonidine HCl) 5

CATAPRES-TTS-1 PTWK(Use Clonidine HCl) 5 QL(0.143 ea

daily)CATAPRES-TTS-2 PTWK(Use Clonidine HCl) 5 QL(0.143 ea

daily)CATAPRES-TTS-3 PTWK(Use Clonidine HCl) 5 QL(0.143 ea

daily)clonidine hcl ptwk td 0.1mg/24hr, 0.3 mg/24hr, 0.2mg/24hr

2QL(0.143 eadaily)

clonidine hcl tabs or 0.1mg, 0.3 mg, 0.2 mg 2

doxazosin mesylate tabs 2

guanfacine hcl tabs 2

methyldopa tabs 2

METHYLDOPATE HCLSOLN 4

MINIPRESS CAPS (UsePrazosin HCl) 5

prazosin hcl caps 2

RESERPINE TABS 4

TENEX TABS (UseGuanfacine HCl) 5

terazosin hcl caps 2

Antihypertensive CombinationsACCURETIC TABS 10MG-12.5MG, 20MG-25MG (UseQuinapril-Hydrochlorothiazide)

5

QL(1 ea daily)

ACCURETIC TABS 20MG-12.5MG (Use Quinapril-Hydrochlorothiazide)

5QL(2 ea daily)

amlodipine besylate-benazepril hcl caps 2 QL(1 ea daily)

amlodipine besylate-olmesartan medoxomil tabs 2 QL(1 ea daily)

amlodipine besylate-valsartan tabs 2 QL(1 ea daily)


30

Drug Name DrugTier

Requirements/Limits

amlodipine-valsartan-hydrochlorothiazide tabs 2 QL(1 ea daily)

AMTURNIDE TABS 5

ATACAND HCT TABS(Use Candesartan Cilexetil-Hydrochlorothiazide)

5QL(1 ea daily)

atenolol & chlorthalidonetabs 2 QL(1 ea daily)

AVALIDE TABS (UseIrbesartan-Hydrochlorothiazide)

5QL(1 ea daily)

AZOR TABS (UseAmlodipine Besylate-Olmesartan Medoxomil)

5QL(1 ea daily)

benazepril &hydrochlorothiazide tabs 2 QL(1 ea daily)

BENICAR HCT TABS (UseOlmesartan Medoxomil-Hydrochlorothiazide)

5QL(1 ea daily)

bisoprolol &hydrochlorothiazide tabs10mg-6.25mg

2QL(2 ea daily)

bisoprolol &hydrochlorothiazide tabs2.5mg-6.25mg, 5mg-6.25mg

2

QL(1 ea daily)

candesartan cilexetil-hydrochlorothiazide tabs 2 QL(1 ea daily)

CAPTOPRIL/HYDROCHLOROTHIAZIDE TABS25MG-15MG, 50MG-15MG

4QL(3 ea daily)

CAPTOPRIL/HYDROCHLOROTHIAZIDE TABS25MG-25MG, 50MG-25MG

4QL(2 ea daily)

CLORPRES TABS 4 QL(2 ea daily)

CORZIDE TABS (UseNadolol &Bendroflumethiazide)

5QL(1 ea daily)

DIOVAN HCT TABS (UseValsartan-Hydrochlorothiazide)

5QL(1 ea daily)

DUTOPROL TB24 100MG-12.5MG, 50MG-12.5MG 5

DUTOPROL TB24 25MG-12.5MG 4

Drug Name DrugTier

Requirements/Limits

EDARBYCLOR TABS 5

enalapril maleate &hydrochlorothiazide tabs 2 QL(2 ea daily)

EXFORGE HCT TABS(Use Amlodipine-Valsartan-Hydrochlorothiazide)

5QL(1 ea daily)

EXFORGE TABS (UseAmlodipine Besylate-Valsartan)

5QL(1 ea daily)

fosinopril sodium &hydrochlorothiazide tabs10mg-12.5mg

2QL(1 ea daily)

fosinopril sodium &hydrochlorothiazide tabs20mg-12.5mg

2QL(4 ea daily)

HYZAAR TABS (UseLosartan Potassium &Hydrochlorothiazide)

5QL(1 ea daily)

irbesartan-hydrochlorothiazide tabs 2 QL(1 ea daily)

lisinopril &hydrochlorothiazide tabs10mg-12.5mg

2QL(1 ea daily)

lisinopril &hydrochlorothiazide tabs20mg-12.5mg

2QL(4 ea daily)

lisinopril &hydrochlorothiazide tabs20mg-25mg

2QL(2 ea daily)

LOPRESSOR HCT TABS(Use Metoprolol &Hydrochlorothiazide)

5QL(2 ea daily)

losartan potassium &hydrochlorothiazide tabs 2 QL(1 ea daily)

LOTENSIN HCT TABS(Use Benazepril &Hydrochlorothiazide)

5QL(1 ea daily)

LOTREL CAPS (UseAmlodipine Besylate-Benazepril HCl)

5QL(1 ea daily)

METHYLDOPA/HYDROCHLOROTHIAZIDE TABS250MG-15MG

4QL(3 ea daily)

METHYLDOPA/HYDROCHLOROTHIAZIDE TABS250MG-25MG

4QL(2 ea daily)


31

Drug Name DrugTier

Requirements/Limits

metoprolol &hydrochlorothiazide tabs 2 QL(2 ea daily)

METOPROLOLSUCCINATEER/HYDROCHLOROTHIAZIDE TB24 100MG-12.5MG, 50MG-12.5MG

5

METOPROLOLSUCCINATEER/HYDROCHLOROTHIAZIDE TB24 25MG-12.5MG

4

MICARDIS HCT TABS40MG-12.5MG, 80MG-25MG (Use Telmisartan-Hydrochlorothiazide)

5

QL(1 ea daily)

MICARDIS HCT TABS80MG-12.5MG (UseTelmisartan-Hydrochlorothiazide)

5

QL(2 ea daily)

moexipril-hydrochlorothiazide tabs15mg-12.5mg, 7.5mg-12.5mg

2

QL(1 ea daily)

moexipril-hydrochlorothiazide tabs15mg-25mg

2QL(2 ea daily)

nadolol &bendroflumethiazide tabs 2 QL(1 ea daily)

olmesartan medoxomil-amlodipine-hydrochlorothiazide tabs

2QL(1 ea daily)

olmesartan medoxomil-hydrochlorothiazide tabs 2 QL(1 ea daily)

PROPRANOLOL/HYDROCHLOROTHIAZIDE TABS 4 QL(2 ea daily)

quinapril-hydrochlorothiazide tabs10mg-12.5mg, 20mg-25mg

2QL(1 ea daily)

quinapril-hydrochlorothiazide tabs20mg-12.5mg

2QL(2 ea daily)

TARKA TBCR (UseTrandolapril-VerapamilHCl)

5QL(1 ea daily)

TEKAMLO TABS 5

Drug Name DrugTier

Requirements/Limits

TEKTURNA HCT TABS150MG-12.5MG, 150MG-25MG

4QL(2 ea daily)

TEKTURNA HCT TABS300MG-12.5MG, 300MG-25MG

4QL(1 ea daily)

telmisartan-amlodipine tabs 2 QL(1 ea daily)

telmisartan-hydrochlorothiazide tabs40mg-12.5mg, 80mg-25mg

2QL(1 ea daily)

telmisartan-hydrochlorothiazide tabs80mg-12.5mg

2QL(2 ea daily)

TENORETIC 100 TABS(Use Atenolol &Chlorthalidone)

5QL(1 ea daily)

TENORETIC 50 TABS(Use Atenolol &Chlorthalidone)

5QL(1 ea daily)

TEVETEN HCT TABS 5

trandolapril-verapamil hcltbcr 2 QL(1 ea daily)

TRIBENZOR TABS (UseOlmesartan Medoxomil-Amlodipine-Hydrochlorothiazide)

5

QL(1 ea daily)

TWYNSTA TABS (UseTelmisartan-Amlodipine) 5 QL(1 ea daily)

valsartan-hydrochlorothiazide tabs 2 QL(1 ea daily)

VASERETIC TABS (UseEnalapril Maleate &Hydrochlorothiazide)

5QL(2 ea daily)

ZESTORETIC TABS10MG-12.5MG (UseLisinopril &Hydrochlorothiazide)

5

QL(1 ea daily)

ZESTORETIC TABS20MG-12.5MG (UseLisinopril &Hydrochlorothiazide)

5

QL(4 ea daily)

ZESTORETIC TABS20MG-25MG (UseLisinopril &Hydrochlorothiazide)

5

QL(2 ea daily)


32

Drug Name DrugTier

Requirements/Limits

ZIAC TABS 10MG-6.25MG(Use Bisoprolol &Hydrochlorothiazide)

5QL(2 ea daily)

ZIAC TABS 2.5MG-6.25MG, 5MG-6.25MG(Use Bisoprolol &Hydrochlorothiazide)

5

QL(1 ea daily)

Antihypertensives - Misc.VECAMYL TABS 5 PA

Direct Renin InhibitorsTEKTURNA TABS 150 MG 4 QL(2 ea daily)

TEKTURNA TABS 300 MG 4 QL(1 ea daily)

Selective Aldosterone Receptor Antagonistseplerenone tabs 2 QL(2 ea daily)

INSPRA TABS (UseEplerenone) 5 QL(2 ea daily)

VasodilatorsCORLOPAM SOLN 4

hydralazine hcl soln 2

hydralazine hcl tabs 2

minoxidil tabs 2

ANTIMALARIALS - Drugs to Treat Malaria(Parasitic Infections)Antimalarial Combinationsatovaquone-proguanil hcltabs 2

COARTEM TABS 5 QL(24 ea perfill retail)

MALARONE TABS (UseAtovaquone-Proguanil HCl) 5

AntimalarialsCHLOROQUINEPHOSPHATE TABS 250MG

4QL(2 ea daily)

chloroquine phosphatetabs 250 mg 2 QL(2 ea daily)

Drug Name DrugTier

Requirements/Limits

chloroquine phosphate tabs500 mg 2 QL(0.1429 ea

daily)

DARAPRIM TABS 5

hydroxychloroquine sulfatetabs 2

mefloquine hcl tabs 2

PLAQUENIL TABS (UseHydroxychloroquineSulfate)

5

PRIMAQUINEPHOSPHATE TABS 5

QUALAQUIN CAPS (UseQuinine Sulfate) 5 QL(84 ea per

fill retail)

quinine sulfate caps 2 QL(84 ea perfill retail)

ANTIMYASTHENIC/CHOLINERGIC AGENTS

Antimyasthenic/Cholinergic AgentsBLOXIVERZ SOLN (UseNeostigmine Methylsulfate) 5

MESTINON SYRP 5

MESTINON TABS (UsePyridostigmine Bromide) 5

MESTINON TIMESPANTBCR (Use PyridostigmineBromide)

5

neostigmine methylsulfatesoln ij 0.5 mg/ml, 1 mg/ml 2

NEOSTIGMINEMETHYLSULFATE SOLNIJ 0.5 MG/ML, 1 MG/ML

4

neostigmine methylsulfatesoln iv 10 mg/10ml, 5mg/10ml

2

NEOSTIGMINEMETHYLSULFATE SOLNIV 10 MG/10ML, 5MG/10ML

4

pyridostigmine bromidetabs 2

pyridostigmine bromide tbcr 2

ANTIMYCOBACTERIAL AGENTS - Drugs toTreat Tuberculosis (Bacterial Infections)


33

Drug Name DrugTier

Requirements/Limits

Antimycobacterial AgentsCYCLOSERINE CAPS 4

ethambutol hcl tabs 2

ISONIAZID SOLN IJ 100MG/ML 4

ISONIAZID SYRP OR 50MG/5ML 4

isoniazid tabs or 100 mg,300 mg 2

MYAMBUTOL TABS (UseEthambutol HCl) 5

MYCOBUTIN CAPS (UseRifabutin) 5

pyrazinamide tabs 2

rifabutin caps 2

RIFADIN CAPS (UseRifampin) 5

RIFADIN SOLR (UseRifampin) 5

rifampin caps 2

rifampin solr 2

ANTINEOPLASTICS AND ADJUNCTIVETHERAPIES - Drugs to Treat CancerAlkylating AgentsALKERAN SOLR IV (UseMelphalan HCl) 5

ALKERAN TABS OR 5

BENDEKA SOLN 5

carboplatin soln 2

cisplatin soln 100mg/100ml, 50 mg/50ml 2

CISPLATIN SOLN 200MG/200ML 4

CYCLOPHOSPHAMIDECAPS OR 25 MG, 50 MG 5

cyclophosphamide solr ij 1gm, 500 mg, 2 gm 2

Drug Name DrugTier

Requirements/Limits

ELOXATIN SOLN (UseOxaliplatin) 5

GLEOSTINE CAPS 4

HEXALEN CAPS 5

IFEX SOLR (UseIfosfamide) 5

ifosfamide soln 2

ifosfamide solr 2

LEUKERAN TABS 5

LOMUSTINE CAPS 4

melphalan hcl solr 2

MYLERAN TABS 5

oxaliplatin soln 2

oxaliplatin solr 2

TEMODAR CAPS OR 100MG, 5 MG, 250 MG, 20MG, 180 MG, 140 MG (UseTemozolomide)

5

PA

TEMODAR SOLR IV 100MG 5

temozolomide caps 2 PA

TREANDA SOLN 5

TREANDA SOLR 5

Antimetabolitesazacitidine susr 2

capecitabine tabs 2 PA

cladribine soln 2

cytarabine soln 2

CYTARABINEAQUEOUSSOLN 4


34

Drug Name DrugTier

Requirements/Limits

DACOGEN SOLR (UseDecitabine) 5

decitabine solr 2

FLOXURIDINE SOLR 4

fludarabine phosphate soln 2

fludarabine phosphate solr 2

fluorouracil soln iv 1gm/20ml, 500 mg/10ml, 5gm/100ml, 2.5 gm/50ml

2

gemcitabine hcl soln 2

gemcitabine hcl solr 2

GEMZAR SOLR (UseGemcitabine HCl) 5

mercaptopurine tabs 2

methotrexate sodium soln ij1 gm/40ml, 50 mg/2ml, 250mg/10ml, 200 mg/8ml, 100mg/4ml

2

METHOTREXATESODIUM SOLN IJ 250MG/10ML

4

methotrexate sodium solr ij1 gm 2

methotrexate sodium tabsor 2.5 mg 2

PURINETHOL TABS (UseMercaptopurine) 5

TABLOID TABS 5

TREXALL TABS 5

VIDAZA SUSR (UseAzacitidine) 5

XELODA TABS (UseCapecitabine) 5 PA

Antineoplastic - Angiogenesis InhibitorsAVASTIN SOLN 5

ZALTRAP SOLN 5

Drug Name DrugTier

Requirements/Limits

Antineoplastic - AntibodiesADCETRIS SOLR 5

ARZERRA CONC 5

ERBITUX SOLN 5

HERCEPTIN SOLR 5

KADCYLA SOLR 5

KEYTRUDA SOLR 5

LARTRUVO SOLN 5

PERJETA SOLN 5

RITUXAN SOLN 5

VECTIBIX SOLN 5

YERVOY SOLN 5

Antineoplastic - Hedgehog Pathway InhibitorsERIVEDGE CAPS 5 PA

ODOMZO CAPS 5 PA

Antineoplastic - Hormonal and Related Agentsanastrozole tabs 2

ARIMIDEX TABS (UseAnastrozole) 5

AROMASIN TABS (UseExemestane) 5

bicalutamide tabs 2

CASODEX TABS (UseBicalutamide) 5

ELIGARD KIT 5

EMCYT CAPS 5

exemestane tabs 2

FARESTON TABS 5


35

Drug Name DrugTier

Requirements/Limits

FEMARA TABS (UseLetrozole) 5

FIRMAGON SOLR 5

flutamide caps 2

HYDROXYPROGESTERONE CAPROATE SOLN 4

letrozole tabs 2

leuprolide acetate kit 2

LUPRON DEPOT KIT 5

LYSODREN TABS 5

MEGACE ORAL SUSP(Use Megestrol Acetate) 5

megestrol acetate susp 2

megestrol acetate tabs 2

NILANDRON TABS (UseNilutamide) 5

nilutamide tabs 2

SOLTAMOX SOLN 5 PV

tamoxifen citrate tabs 6 AL

TRELSTAR MIXJECTSUSR 5

TRELSTAR SUSR 5

VANTAS KIT 5

XTANDI CAPS 5 PA

ZOLADEX IMPL 5

ZYTIGA TABS 5 PA

Antineoplastic - ImmunomodulatorsPOMALYST CAPS 5 PA

Antineoplastic Antibioticsbleomycin sulfate solr 2

Drug Name DrugTier

Requirements/Limits

daunorubicin hcl inj 2

DOXIL INJ (UseDoxorubicin HClLiposomal)

5

doxorubicin hcl liposomalinj 2

doxorubicin hcl soln 2mg/ml 2

DOXORUBICIN HCLSOLR 10 MG, 50 MG 4

ELLENCE SOLN (UseEpirubicin HCl) 5

epirubicin hcl soln 2

IDAMYCIN PFS SOLN(Use Idarubicin HCl) 5

idarubicin hcl soln 2

mitomycin solr 20 mg, 40mg 2

MITOMYCIN SOLR 5 MG 4

mitoxantrone hcl conc 2

VALSTAR SOLN 5

Antineoplastic Enzyme InhibitorsAFINITOR DISPERZ TBSO 5 PA

AFINITOR TABS 5 PA

BOSULIF TABS 4 PA

CAPRELSA TABS 5

FARYDAK CAPS 5 PA

GILOTRIF TABS 5 PA

GLEEVEC TABS 100 MG,400 MG (Use ImatinibMesylate)

5PA

GLEEVEC TABS 400 MG 4 PA

IBRANCE CAPS 5 PA


36

Drug Name DrugTier

Requirements/Limits

ICLUSIG TABS 5 PA

imatinib mesylate tabs 2 PA

INLYTA TABS 5 PA

ISTODAX (OVERFILL)SOLR 5

ISTODAX SOLR 5

JAKAFI TABS 5 PA

MEKINIST TABS 5 PA

NEXAVAR TABS 5 PA

SPRYCEL TABS 4 PA

STIVARGA TABS 5 PA

SUTENT CAPS 5 PA

TAFINLAR CAPS 5 PA

TARCEVA TABS 5 PA

TASIGNA CAPS 5 PA

TORISEL SOLN 5

TYKERB TABS 5 PA

VELCADE SOLR 5

VOTRIENT TABS 5 PA

XALKORI CAPS 5 PA

ZELBORAF TABS 5 PA

ZOLINZA CAPS 5 PA

ZYKADIA CAPS 5 PA

Antineoplastic EnzymesONCASPAR SOLN 5

Antineoplastics Misc.

Drug Name DrugTier

Requirements/Limits

ACTIMMUNE SOLN 5

ALFERON N SOLN 5

bexarotene caps 2 PA

DACARBAZINE SOLR 100MG 4

dacarbazine solr 200 mg 2

HYDREA CAPS (UseHydroxyurea) 5

hydroxyurea caps 2

INTRON A SOLN 5

INTRON A SOLR 5

INTRON A W/DILUENTSOLR 5

MATULANE CAPS 5

PROLEUKIN SOLR 5

SYLATRON KIT 5

SYNRIBO SOLR 5

TARGRETIN CAPS OR(Use Bexarotene) 5 PA

tretinoin (chemotherapy)caps 2

Chemotherapy Rescue/Antidote Agentsamifostine crystalline solr 2

dexrazoxane solr 2

ETHYOL SOLR (UseAmifostine Crystalline) 5

FUSILEV SOLR (UseLevoleucovorin Calcium) 5

leucovorin calcium solr ij100 mg, 50 mg, 350 mg,200 mg

2

LEUCOVORIN CALCIUMSOLR IJ 500 MG 4

LEUCOVORIN CALCIUMTABS OR 10 MG, 15 MG 4


37

Drug Name DrugTier

Requirements/Limits

leucovorin calcium tabs or25 mg, 5 mg 2

levoleucovorin calcium soln 2

levoleucovorin calcium solr 2

LEVOLEUCOVORIN SOLN 5

mesna soln 2

MESNEX SOLN IV 100MG/ML (Use Mesna) 5

MESNEX TABS OR 400MG 5 PA

ZINECARD SOLR (UseDexrazoxane) 5

Mitotic InhibitorsDOCETAXEL CONC 20MG/ML, 80 MG/4ML 4

docetaxel conc 20 mg/ml,80 mg/4ml 2

ETOPOSIDE CAPS OR 50MG 4 PA

etoposide soln iv 1gm/50ml, 500 mg/25ml,100 mg/5ml

2

HALAVEN SOLN 5

IXEMPRA KIT SOLR 5

JEVTANA SOLN 5

NAVELBINE SOLN (UseVinorelbine Tartrate) 5

paclitaxel conc 100mg/16.7ml, 300 mg/50ml,30 mg/5ml

2

PACLITAXEL CONC 150MG/25ML 4

TAXOL CONC (UsePaclitaxel) 5

TAXOTERE CONC (UseDocetaxel) 5

VINBLASTINE SULFATESOLN 4

vincristine sulfate soln 2

Drug Name DrugTier

Requirements/Limits

vinorelbine tartrate soln 2

Topoisomerase I InhibitorsCAMPTOSAR SOLN (UseIrinotecan HCl) 5

HYCAMTIN CAPS OR 0.25MG, 1 MG 5 PA

HYCAMTIN SOLR IV 4 MG(Use Topotecan HCl) 5

irinotecan hcl soln 2

IRINOTECAN SOLN 4

TOPOTECAN HCL SOLN4 MG/4ML 5

topotecan hcl solr 4 mg 2

ANTIPARKINSON AGENTS - Drugs to TreatParkinson's DiseaseAntiparkinson Adjuvantscarbidopa tabs 2

LODOSYN TABS (UseCarbidopa) 5

Antiparkinson Anticholinergicsbenztropine mesylate soln 2

benztropine mesylate tabs 2

COGENTIN SOLN (UseBenztropine Mesylate) 5

trihexyphenidyl hcl elix 0.4mg/ml 2 QL(16.67 ml

daily)trihexyphenidyl hcl tabs 2mg, 5 mg 2

Antiparkinson COMT InhibitorsCOMTAN TABS (UseEntacapone) 5

entacapone tabs 2

TASMAR TABS (UseTolcapone) 5

tolcapone tabs 2

Antiparkinson Dopaminergics


38

Drug Name DrugTier

Requirements/Limits

amantadine hcl caps 2

amantadine hcl syrp 2

amantadine hcl tabs 2

APOKYN SOLN 5 PA

bromocriptine mesylatecaps 2

bromocriptine mesylatetabs 2

carbidopa-levodopa tabs 2

carbidopa-levodopa tbcr 2

carbidopa-levodopa tbdp 2

CARBIDOPA/LEVODOPA/ENTACAPONE TABS 4

MIRAPEX ER TB24 (UsePramipexoleDihydrochloride)

5

MIRAPEX TABS (UsePramipexoleDihydrochloride)

5

NEUPRO PT24 4 QL(1 ea daily)

PARLODEL CAPS (UseBromocriptine Mesylate) 5

PARLODEL TABS (UseBromocriptine Mesylate) 5

pramipexoledihydrochloride tabs 2

pramipexoledihydrochloride tb24 2

REQUIP TABS 0.25 MG, 4MG, 3 MG (Use RopiniroleHydrochloride)

5QL(6 ea daily)

REQUIP TABS 0.5 MG, 5MG, 2 MG, 1 MG (UseRopinirole Hydrochloride)

5QL(3 ea daily)

REQUIP XL TB24 12 MG,8 MG (Use RopiniroleHydrochloride)

5QL(2 ea daily)

REQUIP XL TB24 2 MG, 6MG, 4 MG (Use RopiniroleHydrochloride)

5QL(1 ea daily)

Drug Name DrugTier

Requirements/Limits

ropinirole hydrochloridetabs 0.25 mg, 4 mg, 3 mg 2 QL(6 ea daily)

ropinirole hydrochloridetabs 0.5 mg, 5 mg, 2 mg, 1mg

2QL(3 ea daily)

ropinirole hydrochloridetb24 12 mg, 8 mg 2 QL(2 ea daily)

ropinirole hydrochloridetb24 2 mg, 6 mg, 4 mg 2 QL(1 ea daily)

SINEMET CR TBCR (UseCarbidopa-Levodopa) 5

SINEMET TABS (UseCarbidopa-Levodopa) 5

STALEVO 100 TABS 4

STALEVO 125 TABS 4

STALEVO 150 TABS 4

STALEVO 200 TABS 4

STALEVO 50 TABS 4

STALEVO 75 TABS 4

Antiparkinson Monoamine Oxidase InhibitorsAZILECT TABS (UseRasagiline Mesylate) 5 QL(1 ea daily)

ELDEPRYL CAPS (UseSelegiline HCl) 5

rasagiline mesylate tabs 2 QL(1 ea daily)

selegiline hcl caps 2

selegiline hcl tabs 2

ZELAPAR TBDP 5

ANTIPSYCHOTICS/ANTIMANIC AGENTS -Drugs to Treat Mood DisordersAntimanic AgentsLITHIUM CARBONATECAPS 150 MG, 600 MG(Use Lithium Carbonate)

4

lithium carbonate caps 150mg, 600 mg, 300 mg 2


39

Drug Name DrugTier

Requirements/Limits

lithium carbonate tabs 300mg 2

lithium carbonate tbcr 300mg, 450 mg 2

LITHIUM SOLN 5

LITHOBID TBCR (UseLithium Carbonate) 4

Antipsychotics - Misc.EQUETRO CP12 5

GEODON CAPS (UseZiprasidone HCl) 5

LATUDA TABS 4

ziprasidone hcl caps 2

BenzisoxazolesFANAPT TABS 5

FANAPT TITRATIONPACK TABS 5

INVEGA SUSTENNASUSP 117 MG/0.75ML, 78MG/0.5ML, 39 MG/0.25ML,156 MG/ML

5

PA; QL(0.034ml daily)

INVEGA SUSTENNASUSP 234 MG/1.5ML 5 PA

INVEGA TB24 (UsePaliperidone) 5

INVEGA TRINZA SUSP 5 PA

paliperidone tb24 2

RISPERDAL CONSTASUSR 5 PA

RISPERDAL M-TAB TBDP(Use Risperidone) 5

RISPERDAL SOLN (UseRisperidone) 5

RISPERDAL TABS (UseRisperidone) 5

risperidone soln 2

risperidone tabs 2

Drug Name DrugTier

Requirements/Limits

risperidone tbdp 2

ButyrophenonesHALDOL DECANOATE100 SOLN (UseHaloperidol Decanoate)

5

HALDOL DECANOATE 50SOLN (Use HaloperidolDecanoate)

5

HALDOL SOLN (UseHaloperidol Lactate) 5

haloperidol decanoate soln 2

haloperidol lactate conc 2

haloperidol lactate soln 2

haloperidol tabs 2

DibenzapinesCLOZAPINE ODT TBDP 4

clozapine tabs 2

clozapine tbdp 2

CLOZARIL TABS (UseClozapine) 5

FAZACLO TBDP 100 MG,25 MG (Use Clozapine) 5

FAZACLO TBDP 12.5 MG,200 MG, 150 MG 4

loxapine succinate caps 2

olanzapine solr 2

olanzapine tabs 2

olanzapine tbdp 2

QUETIAPINE FUMARATEER TB24 4 PA

quetiapine fumarate tabs100 mg, 50 mg, 400 mg,300 mg, 25 mg, 200 mg

2

quetiapine fumarate tb24400 mg 2 PA


40

Drug Name DrugTier

Requirements/Limits

SAPHRIS SUBL 5

SEROQUEL TABS (UseQuetiapine Fumarate) 5

SEROQUEL XR TB24 150MG, 50 MG, 300 MG, 200MG

4PA

SEROQUEL XR TB24 400MG (Use QuetiapineFumarate)

5PA

VERSACLOZ SUSP 5

ZYPREXA RELPREVVSUSR 5 PA

ZYPREXA SOLR (UseOlanzapine) 5

ZYPREXA TABS (UseOlanzapine) 5

ZYPREXA ZYDIS TBDP(Use Olanzapine) 5

DihydroindolonesMOLINDONEHYDROCHLORIDE TABS 4

Phenothiazineschlorpromazine hcl tabs 2

fluphenazine decanoatesoln 2

FLUPHENAZINE HCLCONC OR 5 MG/ML 4

FLUPHENAZINE HCLELIX OR 2.5 MG/5ML 4

FLUPHENAZINE HCLSOLN IJ 2.5 MG/ML 4

fluphenazine hcl tabs or 1mg, 5 mg, 2.5 mg, 10 mg 2

perphenazine tabs 2

prochlorperazine edisylatesoln 2

prochlorperazine maleatetabs 2

prochlorperazine supp 2

thioridazine hcl tabs 2

Drug Name DrugTier

Requirements/Limits

trifluoperazine hcl tabs 2

Quinolinone DerivativesABILIFY DISCMELT TBDP10 MG 4 PA

ABILIFY DISCMELT TBDP15 MG 4

ABILIFY MAINTENA SUSR 5 PA

ABILIFY SOLN IM 9.75MG/1.3ML 5 PA

ABILIFY SOLN OR 1MG/ML 4 PA

ABILIFY TABS OR 10 MG,5 MG, 30 MG, 20 MG, 2MG, 15 MG (UseAripiprazole)

5

PA

aripiprazole soln 1 mg/ml 2 PA

aripiprazole tabs 10 mg, 5mg, 30 mg, 20 mg, 2 mg,15 mg

2PA

aripiprazole tbdp 10 mg 2 PA

aripiprazole tbdp 15 mg 2

ARISTADA PRSY 5 PA

Thioxanthenesthiothixene caps 2

ANTISEPTICS & DISINFECTANTS - Drugs toPrevent Bacterial Skin InfectionsAntiseptics & DisinfectantsFORMA-RAY SOLN 4

formaldehyde soln 2 QL(90 ml perfill retail)

HYDROGEN PEROXIDESOLN 4

TRIPLE DYE LIQD 4

ANTIVIRALS - Drugs to Treat Viral Infections

Antiretrovirals


41

Drug Name DrugTier

Requirements/Limits

abacavir sulfate tabs 2 QL(2 ea daily)

abacavir sulfate-lamivudinetabs 2 QL(1 ea daily)

abacavir sulfate-lamivudine-zidovudine tabs 2 QL(2 ea daily)

APTIVUS CAPS 5

APTIVUS SOLN 5

ATRIPLA TABS 4 QL(1 ea daily)

COMBIVIR TABS (UseLamivudine-Zidovudine) 5 QL(2 ea daily)

COMPLERA TABS 4 QL(1 ea daily)

CRIXIVAN CAPS 5

didanosine cpdr 125 mg,200 mg 2 QL(2 ea daily)

didanosine cpdr 250 mg,400 mg 2 QL(1 ea daily)

EDURANT TABS 5 QL(1 ea daily)

EMTRIVA CAPS 200 MG 5 QL(1 ea daily)

EMTRIVA SOLN 10MG/ML 5 QL(24 ml

daily); ALEPIVIR SOLN 10 MG/ML(Use Lamivudine) 5 QL(30 ml

daily); ALEPIVIR TABS 150 MG(Use Lamivudine) 5 QL(2 ea daily)

EPIVIR TABS 300 MG(Use Lamivudine) 5 QL(1 ea daily)

EPZICOM TABS (UseAbacavir Sulfate-Lamivudine)

5QL(1 ea daily)

EVOTAZ TABS 4

FUZEON SOLR 5

INTELENCE TABS 100MG 5 QL(4 ea daily)

INTELENCE TABS 200MG 5 QL(2 ea daily)

INTELENCE TABS 25 MG 5 QL(8 ea daily)

Drug Name DrugTier

Requirements/Limits

INVIRASE CAPS 5

INVIRASE TABS 5

ISENTRESS CHEW 100MG, 25 MG 4

ISENTRESS PACK 100MG 4

ISENTRESS TABS 400MG 4 QL(2 ea daily)

KALETRA SOLN400MG/5ML-100MG/5ML(Use Lopinavir-Ritonavir)

5QL(12.5 mldaily); AL

KALETRA TABS 100MG-25MG, 200MG-50MG 5 QL(4 ea daily)

lamivudine soln 10 mg/ml 2 QL(30 mldaily); AL

lamivudine tabs 150 mg 2 QL(2 ea daily)

lamivudine tabs 300 mg 2 QL(1 ea daily)

lamivudine-zidovudine tabs 2 QL(2 ea daily)

LEXIVA SUSP 5

LEXIVA TABS 5

lopinavir-ritonavir soln 2 QL(12.5 mldaily); AL

NEVIRAPINE SUSP 50MG/5ML 4 QL(40 ml

daily); AL

nevirapine tabs 200 mg 2 QL(2 ea daily)

nevirapine tb24 100 mg 2

nevirapine tb24 400 mg 2 QL(1 ea daily)

NORVIR CAPS 100 MG 4 QL(12 ea daily)

NORVIR SOLN 80 MG/ML 4 QL(15 mldaily); AL

NORVIR TABS 100 MG 4 QL(12 ea daily)

PREZCOBIX TABS 4

PREZISTA SUSP 100MG/ML 4


42

Drug Name DrugTier

Requirements/Limits

PREZISTA TABS 150 MG,75 MG, 600 MG 4 QL(2 ea daily)

PREZISTA TABS 800 MG 4

RESCRIPTOR TABS 5

RETROVIR CAPS 100 MG(Use Zidovudine) 5 QL(6 ea daily)

RETROVIR IV INFUSIONSOLN 5

RETROVIR SYRP 50MG/5ML (Use Zidovudine) 5 QL(60 ml

daily); ALREYATAZ CAPS 150 MG,200 MG 4 QL(2 ea daily)

REYATAZ CAPS 300 MG 4 QL(1 ea daily)

REYATAZ PACK 50 MG 4

SELZENTRY TABS 5

stavudine caps 15 mg, 40mg, 30 mg, 20 mg 2 QL(2 ea daily)

stavudine solr 1 mg/ml 2 QL(80 mldaily); AL

STRIBILD TABS 4

SUSTIVA CAPS 200 MG 5 QL(2 ea daily)

SUSTIVA CAPS 50 MG 5 QL(3 ea daily)

SUSTIVA TABS 600 MG 5 QL(1 ea daily)

TIVICAY TABS 4

TRIUMEQ TABS 4

TRIZIVIR TABS (UseAbacavir Sulfate-Lamivudine-Zidovudine)

5QL(2 ea daily)

TRUVADA TABS 150MG-100MG, 250MG-167MG,200MG-133MG

4

TRUVADA TABS 300MG-200MG 4 QL(1 ea daily)

VIDEX EC CPDR 125 MG,200 MG (Use Didanosine) 5 QL(2 ea daily)

VIDEX EC CPDR 250 MG,400 MG (Use Didanosine) 5 QL(1 ea daily)

Drug Name DrugTier

Requirements/Limits

VIDEXPEDIATRIC SOLR 5

VIRACEPT TABS 5

VIRAMUNE SUSP 50MG/5ML 4 QL(40 ml

daily); ALVIRAMUNE TABS 200 MG(Use Nevirapine) 5 QL(2 ea daily)

VIRAMUNE XR TB24 100MG (Use Nevirapine) 5

VIRAMUNE XR TB24 400MG (Use Nevirapine) 5 QL(1 ea daily)

VIREAD POWD 40 MG/GM 5

VIREAD TABS 150 MG,250 MG, 200 MG 5

VIREAD TABS 300 MG 5 QL(1 ea daily)

ZERIT CAPS 15 MG, 40MG, 30 MG, 20 MG (UseStavudine)

5QL(2 ea daily)

ZERIT SOLR 1 MG/ML(Use Stavudine) 5 QL(80 ml

daily); AL

ZIAGEN SOLN 20 MG/ML 5

ZIAGEN TABS 300 MG(Use Abacavir Sulfate) 5 QL(2 ea daily)

zidovudine caps 100 mg 2 QL(6 ea daily)

zidovudine syrp 50 mg/5ml 2 QL(60 mldaily); AL

zidovudine tabs 300 mg 2 QL(2 ea daily)

CMV Agentscidofovir soln 2

CYTOVENE SOLR (UseGanciclovir Sodium) 5

ganciclovir sodium solr 2

VALCYTE SOLR 50MG/ML (Use ValganciclovirHCl)

5

VALCYTE TABS 450 MG(Use Valganciclovir HCl) 5 QL(4 ea daily)

valganciclovir hcl solr 50mg/ml 2


43

Drug Name DrugTier

Requirements/Limits

valganciclovir hcl tabs 450mg 2 QL(4 ea daily)

VISTIDE SOLN (UseCidofovir) 5

Hepatitis Agents

adefovir dipivoxil tabs 2 PA; QL(1 eadaily)

BARACLUDE SOLN 0.05MG/ML 5 QL(20 ml

daily); ALBARACLUDE TABS 0.5MG, 1 MG (Use Entecavir) 5 PA; QL(1 ea

daily)COPEGUS TABS (UseRibavirin (Hepatitis C)) 5 PA; QL(7 ea

daily)

DAKLINZA TABS 5 PA

entecavir tabs 2 PA; QL(1 eadaily)

EPCLUSA TABS 5 PA

EPIVIR HBV SOLN 5MG/ML 5 QL(60 ml

daily); ALEPIVIR HBV TABS 100MG (Use Lamivudine(HBV))

5QL(3 ea daily)

HARVONI TABS 4 PA

HEPSERA TABS (UseAdefovir Dipivoxil) 5 PA; QL(1 ea

daily)

INCIVEK TABS 5 PA

lamivudine (hbv) tabs 2 QL(3 ea daily)

MODERIBA 1200 DOSEPACK TABS 4 PA; QL(2 ea

daily)MODERIBA 800 DOSEPACK TABS 4 PA; QL(2 ea

daily)

MODERIBA MISC 5 PA

OLYSIO CAPS 5 PA

PEG-INTRON KIT 5 PA; QL(0.143ea daily)

PEG-INTRON REDIPENKIT 5 PA; QL(0.143

ea daily)PEG-INTRON REDIPENPAK 4 KIT 5 PA; QL(0.143

ea daily)

Drug Name DrugTier

Requirements/Limits

PEGASYS PROCLICKSOLN 5 PA; QL(0.0714

ml daily)PEGASYS SOLN 180MCG/0.5ML 5 PA; QL(0.0714

ml daily)PEGASYS SOLN 180MCG/ML 5 PA; QL(0.143

ml daily)

PEGINTRON KIT 5 PA; QL(0.143ea daily)

REBETOL CAPS 200 MG(Use Ribavirin (HepatitisC))

5PA; QL(7 eadaily)

REBETOL SOLN 40MG/ML 5 QL(35 ml

daily); ALRIBASPHERE RIBAPAKTABS 5 PA

RIBASPHERE RIBAPAKTABS 400 MG, 600 MG 4 PA; QL(2 ea

daily)

RIBASPHERE TABS 4 PA; QL(2 eadaily)

RIBATAB MISC 5 PA

RIBATAB TABS 400 MG,600 MG 4 PA; QL(2 ea

daily)

ribavirin (hepatitis c) caps 2 PA; QL(7 eadaily)

ribavirin (hepatitis c) tabs 2 PA; QL(7 eadaily)

SOVALDI TABS 4 PA

TECHNIVIE TABS 5 PA

VEMLIDY TABS 5

VICTRELIS CAPS 5 PA

VIEKIRA PAK TBPK 5 PA

VIEKIRA XR TB24 5 PA

ZEPATIER TABS 5 PA

Herpes Agentsacyclovir caps 200 mg 2

acyclovir sodium soln 50mg/ml 2


44

Drug Name DrugTier

Requirements/Limits

ACYCLOVIR SODIUMSOLR 1000 MG, 500 MG 4

acyclovir susp 200 mg/5ml 2 QL(13.34 mldaily); AL

acyclovir tabs 400 mg 2 QL(5 ea daily)

acyclovir tabs 800 mg 2 QL(1.67 eadaily)

famciclovir tabs 2

FAMVIR TABS (UseFamciclovir) 5

valacyclovir hcl tabs 1 gm,1000 mg 2 QL(4 ea daily)

valacyclovir hcl tabs 500mg 2 QL(2 ea daily)

VALTREX TABS 1 GM(Use Valacyclovir HCl) 5 QL(4 ea daily)

VALTREX TABS 500 MG(Use Valacyclovir HCl) 5 QL(2 ea daily)

ZOVIRAX CAPS OR 200MG (Use Acyclovir) 5

ZOVIRAX SUSP OR 200MG/5ML (Use Acyclovir) 5 QL(13.34 ml

daily); ALZOVIRAX TABS OR 400MG (Use Acyclovir) 5 QL(5 ea daily)

ZOVIRAX TABS OR 800MG (Use Acyclovir) 5 QL(1.67 ea

daily)Influenza AgentsFLUMADINE TABS (UseRimantadineHydrochloride)

5QL(2 ea daily)

oseltamivir phosphate caps30 mg 2 QL(20 ea per

30 days retail)oseltamivir phosphate caps45 mg, 75 mg 2 QL(10 ea per

30 days retail)RELENZA DISKHALERAEPB 4 QL(0.6667 ea

daily); ALrimantadine hydrochloridetabs 2 QL(2 ea daily)

TAMIFLU CAPS 30 MG(Use OseltamivirPhosphate)

5QL(20 ea per30 days retail)

TAMIFLU CAPS 45 MG, 75MG (Use OseltamivirPhosphate)

5QL(10 ea per30 days retail)

Drug Name DrugTier

Requirements/Limits

TAMIFLU SUSR 6 MG/ML 4QL(120 ml per30 days retail);AL

ASSORTED CLASSES - Miscellaneous Drugs

Chelating AgentsSYPRINE CAPS 5 PA

EnzymesXIAFLEX SOLR 5 PA

ImmunomodulatorsREVLIMID CAPS 5 PA

THALOMID CAPS 5 PA

Immunosuppressive AgentsASTAGRAF XL CP24 5

AZASAN TABS 5 QL(3 ea daily)

azathioprine tabs 2

CELLCEPT CAPS 250 MG(Use MycophenolateMofetil)

5QL(2 ea daily)

CELLCEPTINTRAVENOUS SOLR(Use MycophenolateMofetil HCl)

5

PA

CELLCEPT SUSR 200MG/ML (UseMycophenolate Mofetil)

5QL(15 ml daily)

CELLCEPT TABS 500 MG(Use MycophenolateMofetil)

5QL(4 ea daily)

cyclosporine caps or 100mg, 25 mg 2 QL(4 ea daily)

cyclosporine modified (formicroemulsion) caps 100mg, 50 mg, 25 mg

2QL(4 ea daily)

cyclosporine modified (formicroemulsion) soln 100mg/ml

2QL(8 ml daily)


45

Drug Name DrugTier

Requirements/Limits

CYCLOSPORINEMODIFIED CAPS (UseCyclosporine Modified (ForMicroemulsion))

5

QL(4 ea daily)

cyclosporine soln iv 50mg/ml 2

ENVARSUS XR TB24 5 PA

IMURAN TABS (UseAzathioprine) 5

mycophenolate mofetilcaps 250 mg 2 QL(2 ea daily)

mycophenolate mofetil hclsolr 2 PA

mycophenolate mofetil susr200 mg/ml 2 QL(15 ml daily)

mycophenolate mofetil tabs500 mg 2 QL(4 ea daily)

mycophenolate sodiumtbec 180 mg 2 PA; QL(2 ea

daily)mycophenolate sodiumtbec 360 mg 2 PA; QL(4 ea

daily)MYFORTIC TBEC 180 MG(Use MycophenolateSodium)

5PA; QL(2 eadaily)

MYFORTIC TBEC 360 MG(Use MycophenolateSodium)

5PA; QL(4 eadaily)

NEORAL CAPS 100 MG,25 MG (Use CyclosporineModified (ForMicroemulsion))

5

QL(4 ea daily)

NEORAL SOLN 100MG/ML (Use CyclosporineModified (ForMicroemulsion))

5

QL(8 ml daily)

NULOJIX SOLR 5 PA

PROGRAF CAPS OR 0.5MG, 5 MG, 1 MG (UseTacrolimus)

5QL(6 ea daily)

PROGRAF SOLN IV 5MG/ML 5 PA

RAPAMUNE SOLN 1MG/ML 5 QL(4 ml daily)

RAPAMUNE TABS 0.5 MG(Use Sirolimus) 5

Drug Name DrugTier

Requirements/Limits

RAPAMUNE TABS 1 MG(Use Sirolimus) 5 QL(6 ea daily)

RAPAMUNE TABS 2 MG(Use Sirolimus) 5 QL(2 ea daily)

SANDIMMUNE CAPS OR100 MG, 25 MG (UseCyclosporine)

4QL(4 ea daily)

SANDIMMUNE SOLN IV50 MG/ML (UseCyclosporine)

4

SANDIMMUNE SOLN OR100 MG/ML 5 QL(8 ml daily)

sirolimus tabs 0.5 mg 2

sirolimus tabs 1 mg 2 QL(6 ea daily)

sirolimus tabs 2 mg 2 QL(2 ea daily)

tacrolimus caps 2 QL(6 ea daily)

ZORTRESS TABS 5 PA

Irrigation Solutionsirrigation solutions,physiological soln 2

lactated ringer's (irrigation)soln 2

ringer's irrigation soln 2

water for irrigation, sterilesoln 2

Misc Natural ProductsAURUM LIQD 4 RX/OTC

BLACK CHERRYCONCENTRATE LIQD 4 RX/OTC

BODY CHOICE HOODIAWEIGHTLOSS/HIGHFIBER LIQD

4RX/OTC

CHELIDONIUMCOMPOUND LIQD 4 RX/OTC

CRAMP RELEAF LIQD 4 RX/OTC

CRANBLADDER RELEAFLIQD 4 RX/OTC

CYSTEX LIQD 4 RX/OTC


46

Drug Name DrugTier

Requirements/Limits

DEEP HEALTH LIQD 4 RX/OTC

DEEP SLEEP LIQD 4 RX/OTC

EARLY ALERT LIQD 4 RX/OTC

ECHINACEA COMPOUNDLIQD 4 RX/OTC

ECZEMA & PSORIASISSPRAY LIQD 4 RX/OTC

ESSIAC TONIC LIQD 4 RX/OTC

HERBAPROFEN LIQD 4 RX/OTC

HIMALAYAN GOJI LIQD 4 RX/OTC

JOINT LUBE LIQD 4 RX/OTC

LOVIRAL LIQD 4 RX/OTC

LUNG TONIC LIQD 4 RX/OTC

LYDIA PINKHAM LIQD 4 RX/OTC

LYMPHATONIC LIQD 4 RX/OTC

MENOPAUTONIC LIQD 4 RX/OTC

MOUTH TONIC LIQD 4 RX/OTC

NF FORMULAS CALCIUMMAGNESIUM/BOTANICALS LIQD

4RX/OTC

PHYTOCILLIN LIQD 4 RX/OTC

RESPIRATONIC LIQD 4 RX/OTC

SINGERS SAVINGGRACE SOOTHINGTHROAT SPRAY EXTRASTRENGTH LIQD

4

RX/OTC

SINGERS SAVINGGRACE SOOTHINGTHROAT SPRAY LIQD

4RX/OTC

SINGERS SAVINGGRACE SOOTHINGTHROAT SPRAYPROFESSIONAL LIQD

4

RX/OTC

Drug Name DrugTier

Requirements/Limits

SPATONE IRON PLUSLIQD 4 RX/OTC

STRESS RELEAF LIQD 4 RX/OTC

SWAMP ROOT LIQD 4 RX/OTC

Peritoneal Dialysis SolutionsDELFLEX-LC/1.5%DEXTROSE SOLN 4

DIANEAL PD-2/1.5%DEXTROSE SOLN 4

peritoneal dialysis solutionssoln 2

ULTRABAG/DIANEAL PD-2/1.5% DEXTROSE SOLN 4

Potassium Removing AgentsKAYEXALATE POWD (UseSodium PolystyreneSulfonate)

5QL(454 gm perfill retail)

sodium polystyrenesulfonate powd or 2 QL(454 gm per

fill retail)sodium polystyrenesulfonate susp or 15gm/60ml

2

sodium polystyrenesulfonate susp re 30gm/120ml, 50 gm/200ml

2

Prostaglandinsalprostadil soln 2

PROSTIN VR PEDIATRICSOLN (Use Alprostadil) 5

Sclerosing Agentsmorrhuate sodium soln 2

Systemic Lupus Erythematosus AgentsBENLYSTA SOLR 5 PA

BETA BLOCKERS - Drugs to Treat High BloodPressureAlpha-Beta Blockerscarvedilol tabs 12.5 mg,6.25 mg, 3.125 mg 2 QL(3 ea daily)

carvedilol tabs 25 mg 2 QL(4 ea daily)


47

Drug Name DrugTier

Requirements/Limits

COREG CR CP24 4 QL(1 ea daily)

COREG TABS 12.5 MG,6.25 MG, 3.125 MG (UseCarvedilol)

5QL(3 ea daily)

COREG TABS 25 MG (UseCarvedilol) 5 QL(4 ea daily)

labetalol hcl soln iv 5 mg/ml 2

labetalol hcl tabs or 100 mg 2 QL(3 ea daily)



Beta Blockers Cardio-Selectiveacebutolol hcl caps 2

atenolol tabs 2 QL(2 ea daily)

betaxolol hcl tabs 2

bisoprolol fumarate tabs 2 QL(1 ea daily)

BREVIBLOC SOLN (UseEsmolol HCl) 5

BYSTOLIC TABS 4

esmolol hcl soln 2

KERLONE TABS (UseBetaxolol HCl) 5

LOPRESSOR SOLN IV 1MG/ML (Use MetoprololTartrate)

5

LOPRESSOR TABS OR100 MG (Use MetoprololTartrate)

5QL(2 ea daily)

LOPRESSOR TABS OR 50MG (Use MetoprololTartrate)

5QL(3 ea daily)

metoprolol succinate tb24100 mg, 50 mg, 25 mg 2 QL(1 ea daily)

metoprolol succinate tb24200 mg 2 QL(2 ea daily)

metoprolol tartrate soln iv 1mg/ml, 5 mg/5ml 2

Drug Name DrugTier

Requirements/Limits

metoprolol tartrate tabs or100 mg, 25 mg 2 QL(2 ea daily)

METOPROLOLTARTRATE TABS OR 37.5MG, 75 MG

5

metoprolol tartrate tabs or50 mg 2 QL(3 ea daily)

SECTRAL CAPS (UseAcebutolol HCl) 5

TENORMIN TABS (UseAtenolol) 5 QL(2 ea daily)

TOPROL XL TB24 100MG, 50 MG, 25 MG (UseMetoprolol Succinate)

5QL(1 ea daily)

TOPROL XL TB24 200 MG(Use Metoprolol Succinate) 5 QL(2 ea daily)

ZEBETA TABS (UseBisoprolol Fumarate) 5 QL(1 ea daily)

Beta Blockers Non-SelectiveBETAPACE AF TABS (UseSotalol HCl (AFIB/AFL)) 5 QL(2 ea daily)

BETAPACE TABS (UseSotalol HCl) 5 QL(2 ea daily)

CORGARD TABS (UseNadolol) 5 QL(2 ea daily)

HEMANGEOL SOLN 5 QL(1 ml per fillretail)

INDERAL LA CP24 (UsePropranolol HCl) 5 QL(2 ea daily)

INDERAL XL CP24 5

INNOPRAN XL CP24 5

nadolol tabs 2 QL(2 ea daily)

pindolol tabs 2

propranolol hcl cp24 or 120mg, 80 mg, 60 mg, 160 mg 2 QL(2 ea daily)

propranolol hcl soln iv 1mg/ml 2

PROPRANOLOL HCLSOLN OR 20 MG/5ML, 40MG/5ML

4

propranolol hcl tabs or 10mg, 80 mg, 60 mg, 40 mg,20 mg

2


48

Drug Name DrugTier

Requirements/Limits

sotalol hcl (afib/afl) tabs 2 QL(2 ea daily)

sotalol hcl tabs 120 mg, 80mg, 160 mg 2 QL(2 ea daily)

sotalol hcl tabs 240 mg 2

TIMOLOL MALEATE TABS 4

CALCIUM CHANNEL BLOCKERS - Drugs toTreat High Blood PressureCalcium Channel BlockersADALAT CC TB24 30 MG,90 MG (Use Nifedipine) 5 QL(1 ea daily)

ADALAT CC TB24 60 MG(Use Nifedipine) 5 QL(2 ea daily)

amlodipine besylate tabs 2 QL(1 ea daily)

CALAN SR TBCR (UseVerapamil HCl) 5 QL(2 ea daily)

CALAN TABS (UseVerapamil HCl) 5 QL(3 ea daily)

CARDIZEM CD CP24 120MG, 300 MG, 180 MG (UseDiltiazem HCl CoatedBeads)

5

QL(1 ea daily)

CARDIZEM CD CP24 240MG (Use Diltiazem HClCoated Beads)

5QL(2 ea daily)

CARDIZEM CD CP24 360MG (Use Diltiazem HClCoated Beads)

5

CARDIZEM LA TB24 (UseDiltiazem HCl CoatedBeads)

5

CARDIZEM LA TB24 5

CARDIZEM TABS (UseDiltiazem HCl) 5 QL(3 ea daily)

diltiazem hcl coated beadscp24 120 mg, 300 mg, 180mg

2QL(1 ea daily)

diltiazem hcl coated beadscp24 240 mg 2 QL(2 ea daily)

diltiazem hcl coated beadscp24 360 mg 2

Drug Name DrugTier

Requirements/Limits

diltiazem hcl coated beadstb24 180 mg, 420 mg, 360mg, 300 mg, 240 mg

2

diltiazem hcl cp12 or 120mg, 90 mg, 60 mg 2 QL(2 ea daily)

diltiazem hcl cp24 or 120mg, 180 mg 2 QL(1 ea daily)

diltiazem hcl cp24 or 240mg 2 QL(2 ea daily)

diltiazem hcl extendedrelease beads cp24 2 QL(1 ea daily)

diltiazem hcl soln iv 125mg/25ml, 50 mg/10ml, 25mg/5ml

2

diltiazem hcl tabs or 120mg, 90 mg, 60 mg, 30 mg 2 QL(3 ea daily)

felodipine tb24 2 QL(1 ea daily)

isradipine caps 2

nicardipine hcl caps 2

nicardipine hcl soln 2

nifedipine caps 10 mg, 20mg 2 QL(4 ea daily)

nifedipine tb24 30 mg, 90mg 2 QL(1 ea daily)

nifedipine tb24 60 mg 2 QL(2 ea daily)

nimodipine caps 2

NISOLDIPINE ER TB24 4

nisoldipine tb24 17 mg, 8.5mg, 34 mg 2

NISOLDIPINE TB24 20MG, 40 MG, 30 MG 4

NORVASC TABS (UseAmlodipine Besylate) 5 QL(1 ea daily)

NYMALIZE SOLN 5

PROCARDIA CAPS (UseNifedipine) 5 QL(4 ea daily)

PROCARDIA XL TB24 30MG, 90 MG (UseNifedipine)

5QL(1 ea daily)


49

Drug Name DrugTier

Requirements/Limits

PROCARDIA XL TB24 60MG (Use Nifedipine) 5 QL(2 ea daily)

SULAR TB24 (UseNisoldipine) 5

TIAZAC CP24 (UseDiltiazem HCl ExtendedRelease Beads)

5QL(1 ea daily)

verapamil hcl cp24 or 100mg, 300 mg, 200 mg 2

verapamil hcl cp24 or 120mg, 240 mg, 180 mg 2 QL(2 ea daily)

verapamil hcl cp24 or 360mg 2 QL(1 ea daily)

verapamil hcl soln iv 2.5mg/ml 2

verapamil hcl tabs or 120mg, 80 mg, 40 mg 2 QL(3 ea daily)

verapamil hcl tbcr or 120mg, 240 mg, 180 mg 2 QL(2 ea daily)

VERELAN CP24 120 MG,240 MG, 180 MG (UseVerapamil HCl)

5QL(2 ea daily)

VERELAN CP24 360 MG(Use Verapamil HCl) 5 QL(1 ea daily)

VERELAN PM CP24 (UseVerapamil HCl) 5

CARDIOTONICS - Drugs to Treat Heart Failureand Abnormal Heart RhythmCardiac Glycosidesdigoxin soln ij 0.25 mg/ml 2

DIGOXIN SOLN OR 0.05MG/ML 4

digoxin tabs or 0.125 mg,250 mcg, 125 mcg, 0.25mg

2

LANOXIN SOLN IJ 0.25MG/ML (Use Digoxin) 4

LANOXIN TABS OR 125MCG, 250 MCG (UseDigoxin)

4

LANOXIN TABS OR 187.5MCG, 62.5 MCG 5

Phosphodiesterase Inhibitorsmilrinone in dextrose soln 2

Drug Name DrugTier

Requirements/Limits

milrinone lactate soln 2

CARDIOVASCULAR AGENTS - MISC. - Drugs toTreat Heart and Circulation ConditionsCardioplegic Solutionscardioplegic soln soln 2

PLEGISOL SOLN (UseCardioplegic Soln) 5

Cardiovascular Agents Misc. - Combinationsamlodipine besylate-atorvastatin calcium tabs 2 QL(1 ea daily)

BIDIL TABS 4

CADUET TABS (UseAmlodipine Besylate-Atorvastatin Calcium)

5QL(1 ea daily)

ENTRESTO TABS 4

Peripheral Vasodilatorspapaverine hcl soln 2

Prostaglandin Vasodilatorsepoprostenol sodium solr 2 PA

FLOLAN SOLR (UseEpoprostenol Sodium) 5 PA

ORENITRAM TBCR 5 PA

REMODULIN SOLN 5 PA

TYVASO REFILL SOLN 5 PA

TYVASO SOLN 5 PA

TYVASO STARTER SOLN 5 PA

VELETRI SOLR 5 PA

VENTAVIS SOLN 5 PA

Pulmonary Hypertension - Endothelin ReceptorLETAIRIS TABS 4 PA

OPSUMIT TABS 4


50

Drug Name DrugTier

Requirements/Limits

TRACLEER TABS 4 PA

Pulmonary Hypertension - PhosphodiesteraseADCIRCA TABS 5 PA

REVATIO SOLN IV (UseSildenafil Citrate(Pulmonary Hypertension))

5PA

REVATIO SUSR OR 5 PA

REVATIO TABS OR (UseSildenafil Citrate(Pulmonary Hypertension))

5PA

sildenafil citrate (pulmonaryhypertension) soln 2 PA

sildenafil citrate (pulmonaryhypertension) tabs 2 PA

Pulmonary Hypertension - Sol Guanylate CyclaseADEMPAS TABS 4

CEPHALOSPORINS - Drugs to Treat BacterialInfectionsCephalosporins - 1st Generationcefadroxil caps 2

cefadroxil susr 2

cefadroxil tabs 2

cefazolin sodium solr ij 1gm, 500 mg, 20 gm, 10 gm 2

CEFAZOLIN SODIUMSOLR IJ 20 GM 4

CEFAZOLIN SODIUMSOLR IV 1 GM 4

CEFAZOLINSODIUM/DEXTROSESOLN

5

cephalexin caps 250 mg,750 mg, 500 mg 2

cephalexin susr 125mg/5ml, 250 mg/5ml 2

CEPHALEXIN TABS 250MG, 500 MG 4

KEFLEX CAPS (UseCephalexin) 5

Drug Name DrugTier

Requirements/Limits

Cephalosporins - 2nd Generationcefaclor caps 250 mg, 500mg 2

CEFACLOR SUSR 125MG/5ML, 375 MG/5ML,250 MG/5ML

4

CEFOTAN SOLR (UseCefotetan Disodium) 5

cefotetan disodium solr 2

CEFOTETAN SOLR 4

cefoxitin sodium solr 2

cefprozil susr 125 mg/5ml,250 mg/5ml 2 AL

cefprozil tabs 250 mg, 500mg 2 QL(20 ea per

fill retail)CEFTIN TABS (UseCefuroxime Axetil) 5 QL(20 ea per

fill retail)

cefuroxime axetil tabs 2 QL(20 ea perfill retail)

cefuroxime sodium solr 2

ZINACEF SOLR (UseCefuroxime Sodium) 5

Cephalosporins - 3rd GenerationCEDAX CAPS 4

CEDAX SUSR 4

cefdinir caps 300 mg 2 QL(20 ea perfill retail)

cefdinir susr 125 mg/5ml,250 mg/5ml 2

CEFDITOREN PIVOXILTABS 4

cefixime susr 2 AL

CEFOTAXIME SODIUMSOLR 1 GM 4

cefotaxime sodium solr 10gm, 500 mg, 2 gm 2

cefpodoxime proxetil susr100 mg/5ml, 50 mg/5ml 2 AL


51

Drug Name DrugTier

Requirements/Limits

cefpodoxime proxetil tabs100 mg, 200 mg 2

ceftazidime solr 2

CEFTIBUTEN CAPS 4

CEFTIBUTEN SUSR 4

CEFTRIAXONE IN ISO-OSMOTIC DEXTROSESOLN

4

ceftriaxone sodium solr ij 1gm, 500 mg, 250 mg 2 QL(0.1 ea

daily)ceftriaxone sodium solr ij 2gm 2

ceftriaxone sodium solr iv 1gm, 2 gm, 10 gm 2

CLAFORAN SOLR (UseCefotaxime Sodium) 5

FORTAZ SOLR (UseCeftazidime) 5

ROCEPHIN SOLR (UseCeftriaxone Sodium) 5 QL(0.1 ea

daily)

SPECTRACEF TABS 4

SUPRAX CAPS 400 MG 4

SUPRAX CHEW 100 MG,200 MG 4

SUPRAX SUSR 100MG/5ML, 200 MG/5ML(Use Cefixime)

5AL

SUPRAX SUSR 500MG/5ML 4

Cephalosporins - 4th Generationcefepime hcl solr 2

MAXIPIME SOLR (UseCefepime HCl) 5

CHEMICALS

Bulk Chemicals - A'sARNICA LG LIQD 5

Bulk Chemicals - B's

Drug Name DrugTier

Requirements/Limits

BELLADONNA TINC 4

Bulk Chemicals - I'sIODINE STRONG SOLNXX 4 RX/OTC

LUGOLS SOLN 4 RX/OTC

CONTRACEPTIVES - Drugs to PreventPregnancyCombination Contraceptives - OralBEYAZ TABS (UseDrospirenone-EthinylEstradiol-LevomefolateCalcium)

5

BREVICON-28 TABS (UseNorethindrone & EthEstradiol)

5QL(1 ea daily)

CYCLESSA TABS (UseDesogestrel-EthinylEstradiol (Triphasic))

5QL(1 ea daily)

DESOGEN TABS (UseDesogestrel & EthinylEstradiol)

5QL(1 ea daily)

desogestrel & ethinylestradiol tabs 6 QL(1 ea daily)

desogestrel-ethinylestradiol (biphasic) tabs 6 QL(1 ea daily)

desogestrel-ethinylestradiol (triphasic) tabs 6 QL(1 ea daily)

drospirenone-ethinylestradiol tabs 3mg-0.02mg 6

drospirenone-ethinylestradiol tabs 3mg-0.03mg 6 QL(1 ea daily)

drospirenone-ethinylestradiol-levomefolatecalcium tabs

6

ESTROSTEP FE TABS(Use NorethindroneAcetate-Ethinyl Estradiol-Fe)

5

ethynodiol diacet & ethestrad tabs 1mg-35mcg 6 QL(1 ea daily)

ethynodiol diacet & ethestrad tabs 1mg-50mcg 6


52

Drug Name DrugTier

Requirements/Limits

FEMCON FE CHEW (UseNorethindrone & EthinylEstradiol-Fe)

5

GENERESS FE CHEW(Use Norethindrone &Ethinyl Estradiol-Fe)

5

levonorgestrel & ethestradiol tabs 6 QL(1 ea daily)

levonorgestrel-eth estradiol(triphasic) tabs 6 QL(1 ea daily)

levonorgestrel-ethinylestradiol (91-day) tabs 6

QL(1 eadaily,91 day(s)limit)

levonorgestrel-ethinylestradiol (continuous) tabs 6

LO LOESTRIN FE TABS 6

LOESTRIN 1.5/30-21TABS (Use NorethindroneAcet & Eth Estra)

5QL(1 ea daily)

LOESTRIN 1/20-21 TABS(Use Norethindrone Acet &Eth Estra)

5QL(1 ea daily)

LOESTRIN FE 1.5/30TABS (Use Norethin Acet &Estrad-Fe)

5QL(1 ea daily)

LOESTRIN FE 1/20 TABS(Use Norethin Acet &Estrad-Fe)

5QL(1 ea daily)

LOSEASONIQUE TABS(Use Levonorgestrel-Ethinyl Estradiol (91-Day))

5QL(1 eadaily,91 day(s)limit)

MINASTRIN 24 FE CHEW 6

MIRCETTE TABS (UseDesogestrel-EthinylEstradiol (Biphasic))

5QL(1 ea daily)

MODICON TABS (UseNorethindrone & EthEstradiol)

5QL(1 ea daily)

NATAZIA TABS 6

NECON 1/50-28 TABS 6 QL(1 ea daily)

NECON 10/11-28 TABS 6

norethin acet & estrad-fetabs 75mg-20mcg-1mg 6

Drug Name DrugTier

Requirements/Limits

norethin acet & estrad-fetabs 75mg-20mcg-1mg,75mg-30mcg-1.5mg

6QL(1 ea daily)

norethindrone & ethestradiol tabs 6 QL(1 ea daily)

norethindrone & ethinylestradiol-fe chew 6

norethindrone acet & ethestra tabs 6 QL(1 ea daily)

norethindrone acetate-ethinyl estradiol-fe tabs 6

norethindrone-eth estradiol(triphasic) tabs 6 QL(1 ea daily)

norgestimate-ethinylestradiol (triphasic) tabs 6

norgestimate-ethinylestradiol (triphasic) tabs 6 QL(1 ea daily)

norgestimate-ethinylestradiol tabs 6 QL(1 ea daily)

norgestrel & ethinylestradiol tabs 6 QL(2 ea daily)

NORINYL 1+35 TABS (UseNorethindrone & EthEstradiol)

5QL(1 ea daily)

NORINYL 1+50 TABS 6 QL(1 ea daily)

OGESTREL TABS 6 QL(1 ea daily)

ORTHO TRI-CYCLEN LOTABS (Use Norgestimate-Ethinyl Estradiol(Triphasic))

5

ORTHO TRI-CYCLENTABS (Use Norgestimate-Ethinyl Estradiol(Triphasic))

5

QL(1 ea daily)

ORTHO-CEPT TABS (UseDesogestrel & EthinylEstradiol)

5QL(1 ea daily)

ORTHO-CYCLEN TABS(Use Norgestimate-EthinylEstradiol)

5QL(1 ea daily)

ORTHO-NOVUM 1/35TABS (Use Norethindrone& Eth Estradiol)

5QL(1 ea daily)


53

Drug Name DrugTier

Requirements/Limits

ORTHO-NOVUM 7/7/7TABS (Use Norethindrone-Eth Estradiol (Triphasic))

5QL(1 ea daily)

OVCON-35 TABS (UseNorethindrone & EthEstradiol)

5QL(1 ea daily)

QUARTETTE TABS 6 PV

SAFYRAL TABS 6

SEASONIQUE TABS (UseLevonorgestrel-EthinylEstradiol (91-Day))

5QL(1 eadaily,91 day(s)limit)

TAYTULLA CAPS 6

TRI-NORINYL 28 TABS(Use Norethindrone-EthEstradiol (Triphasic))

5QL(1 ea daily)

YASMIN 28 TABS (UseDrospirenone-EthinylEstradiol)

5QL(1 ea daily)

YAZ TABS (UseDrospirenone-EthinylEstradiol)

5

Combination Contraceptives - TransdermalORTHO EVRA PTWK (UseNorelgestromin-EthinylEstradiol)

5QL(0.1071 eadaily)

XULANE PTWK 6 QL(0.1071 eadaily)

Combination Contraceptives - Vaginal

NUVARING RING 6 QL(0.0357 eadaily)

Emergency ContraceptivesELLA TABS 6

levonorgestrel (emergencyoc) tabs 6

LEVONORGESTRELTABS 6

PLAN B ONE-STEP TABS(Use Levonorgestrel(Emergency OC))

5

Progestin Contraceptives - IUDKYLEENA IUD 6

Drug Name DrugTier

Requirements/Limits

LILETTA IUD 6

MIRENA IUD 6

SKYLA IUD 6

Progestin Contraceptives - ImplantsIMPLANON IMPL 6 PA

NEXPLANON IMPL 6 PA

Progestin Contraceptives - InjectableDEPO-PROVERACONTRACEPTIVE SUSP(Use MedroxyprogesteroneAcetate (Contraceptive))

5

DEPO-PROVERACONTRACEPTIVE SUSY(Use MedroxyprogesteroneAcetate (Contraceptive))

5

DEPO-SUBQ PROVERA104 SUSY 6

medroxyprogesteroneacetate (contraceptive)susp

6

medroxyprogesteroneacetate (contraceptive)susy

6

Progestin Contraceptives - OralNOR-QD TABS (UseNorethindrone(Contraceptive))

5QL(1 ea daily)

norethindrone(contraceptive) tabs 6 QL(1 ea daily)

ORTHO MICRONORTABS (Use Norethindrone(Contraceptive))

5QL(1 ea daily)

CORTICOSTEROIDS - Steroid Hormone Drugs toTreat Systemic Swelling ConditionsGlucocorticosteroidsbetamethasone sodphosphate & acetate susp 2

budesonide cpep 1


54

Drug Name DrugTier

Requirements/Limits

CELESTONE-SOLUSPANSUSP (UseBetamethasone SodPhosphate & Acetate)

5

CORTEF TABS (UseHydrocortisone) 5

CORTISONE ACETATETABS 4

DEPO-MEDROL SUSP(Use MethylprednisoloneAcetate)

5

dexamethasone elix 0.5mg/5ml 2

DEXAMETHASONESODIUM PHOSPHATESOLN IJ 10 MG/ML

4

dexamethasone sodiumphosphate soln ij 100mg/10ml, 4 mg/ml, 20mg/5ml, 120 mg/30ml

2

DEXAMETHASONE SOLN0.5 MG/5ML 4

dexamethasone tabs 0.5mg, 6 mg, 4 mg, 1.5 mg,0.75 mg

2

DEXAMETHASONE TABS1 MG, 2 MG 4

DEXPAK 10 DAY TBPK 5

DEXPAK 13 DAY TBPK 5

DEXPAK 6 DAY TBPK 5

ENTOCORT EC CPEP(Use Budesonide) 5

hydrocortisone tabs 2

MEDROL DOSEPAK TBPK(Use Methylprednisolone) 5

MEDROL TABS (UseMethylprednisolone) 5

methylprednisolone acetatesusp 2

methylprednisolone sodsucc solr 2

methylprednisolone tabs 2

Drug Name DrugTier

Requirements/Limits

methylprednisolone tbpk 2

ORAPRED ODT TBDP(Use Prednisolone SodiumPhosphate)

5

PEDIAPRED SOLN (UsePrednisolone SodiumPhosphate)

5

prednisolone sodiumphosphate soln 15 mg/5ml 2 QL(240 ml per

fill retail)PREDNISOLONE SODIUMPHOSPHATE SOLN 25MG/5ML

4

prednisolone sodiumphosphate soln 5 mg/5ml,6.7 mg/5ml

2

prednisolone sodiumphosphate tbdp 10 mg, 30mg, 15 mg

2

prednisolone soln 2

prednisolone syrp 2

PREDNISONE SOLN 5MG/5ML 4

prednisone tabs 1 mg, 5mg, 20 mg, 2.5 mg, 10 mg 2

PREDNISONE TABS 50MG 4

PREDNISONE TBPK 10MG, 5 MG 4

READYSHARPDEXAMETHASONE KIT 5

READYSHARPMETHYLPREDNISOLONE80 KIT

5

READYSHARPTRIAMCINOLONE KIT 5

SOLU-MEDROL SOLR(Use MethylprednisoloneSod Succ)

5

UCERIS TB24 4

Mineralocorticoidsfludrocortisone acetate tabs 2


55

Drug Name DrugTier

Requirements/Limits

COUGH/COLD/ALLERGY - Drugs to TreatCough, Cold and Allergy SymptomsAntitussivesbenzonatate caps 100 mg,200 mg 2

BENZONATATE CAPS150 MG 4

hydrocodone w/homatropine syrp 2

hydrocodone w/homatropine tabs 2

TESSALON PERLESCAPS (Use Benzonatate) 5

ZONATUSS CAPS (UseBenzonatate) 5

Cough/Cold/Allergy CombinationsALLEGRA-D 12 HOURALLERGY &CONGESTION TB12 (UseFexofenadine-Pseudoephedrine)

5

QL(2 ea daily)

fexofenadine-pseudoephedrine tb12 2 QL(2 ea daily)

hydrocodone polistirex-chlorpheniramine polistirexsuer

2

phenyleph-promethazinew/ cod syrp 2

phenylephrine w/ dm-ggliqd 2 RX/OTC

PHENYLEPHRINE/GUAIFENESIN LIQD 4

promethazine &phenylephrine syrp 2 QL(240 ml per

fill retail); ALpromethazine w/codeinesyrp 2

promethazine-dm syrp 2

PROMETHAZINE/PHENYLEPHRINE SYRP 4 QL(240 ml per

fill retail); ALpseudoephed-bromphen-dm syrp 2

pseudoephed-cpm w/hydrocod soln 2

Drug Name DrugTier

Requirements/Limits

TGQ 50PSE/3BRM/30DMSYRP 4

TUSSIONEXPENNKINETICEXTENDED RELEASESUER (Use HydrocodonePolistirex-ChlorpheniraminePolistirex)

5

ZUTRIPRO SOLN (UsePseudoephed-CPM w/Hydrocod)

5

Misc. Respiratory InhalantsHYPER-SAL NEBU (UseSodium Chloride (Inhalant)) 5

HYPERSAL NEBU (UseSodium Chloride (Inhalant)) 5

sodium chloride (inhalant)nebu 2

Mucolyticsacetylcysteine soln 2

DERMATOLOGICALS - Drugs to Treat SkinConditionsAcne Products

ABSORICA CAPS 4 QL(2 ea daily);AL

ACANYA GEL 4

adapalene crea 0.1 % 2

adapalene gel 0.1 %, 0.3 % 2

ADAPALENE LOTN 0.1 % 4

ATRALIN GEL (UseTretinoin) 5 AL

AVAR LS CLEANSERLIQD (Use SulfacetamideSodium w/ Sulfur)

5

AVAR-E LS CREA (UseSulfacetamide Sodium w/Sulfur)

5

BENZACLIN GEL (UseClindamycin Phosphate-Benzoyl Peroxide)

5


56

Drug Name DrugTier

Requirements/Limits

BENZACLIN WITH PUMPGEL (Use ClindamycinPhosphate-BenzoylPeroxide)

5

BENZAMYCIN GEL (UseBenzoyl Peroxide-Erythromycin)

5

BENZEFOAM FOAM (UseBenzoyl Peroxide) 5 RX/OTC

BENZEFOAM ULTRAFOAM (Use BenzoylPeroxide)

5

BENZEFOAMULTRAFOAM (Use BenzoylPeroxide)

5

BENZIQ WASH LIQD 4

benzoyl peroxide foam 5.3% 2 RX/OTC

benzoyl peroxide foam 9.8% 2

benzoyl peroxide gel 10 % 2 RX/OTC

benzoyl peroxide liqd 10 %,2.5 % 2 RX/OTC

benzoyl peroxide liqd 7 % 2

benzoyl peroxide lotn 6 % 2 RX/OTC

benzoyl peroxide misc 6 % 2

benzoyl peroxide-erythromycin gel 2

BP CLEANSING WASHEMUL 4

CLARIFOAM EF FOAM(Use SulfacetamideSodium w/ Sulfur)

5

CLEOCIN-T GEL (UseClindamycin Phosphate(Topical))

5

CLEOCIN-T LOTN (UseClindamycin Phosphate(Topical))

5

CLEOCIN-T SOLN (UseClindamycin Phosphate(Topical))

5

Drug Name DrugTier

Requirements/Limits

CLEOCIN-T SWAB (UseClindamycin Phosphate(Topical))

5

CLINDAGEL GEL 4

clindamycin phosphate(topical) foam 2

clindamycin phosphate(topical) gel 2

clindamycin phosphate(topical) lotn 2

clindamycin phosphate(topical) soln 2

clindamycin phosphate(topical) swab 2

clindamycin phosphate-benzoyl peroxide(refrigerate) gel

2

clindamycin phosphate-benzoyl peroxide gel 2

clindamycin phosphate-tretinoin gel 2

DESQUAM-X WASH LIQD(Use Benzoyl Peroxide) 5 RX/OTC

DIFFERIN CREA 0.1 %(Use Adapalene) 5

DIFFERIN GEL 0.1 %, 0.3% (Use Adapalene) 5

DIFFERIN LOTN 0.1 % 4

DUAC GEL (UseClindamycin Phosphate-Benzoyl Peroxide(Refrigerate))

5

EPIDUO FORTE GEL 4

EPIDUO GEL 4

ERYGEL GEL (UseErythromycin (Acne Aid)) 5

erythromycin (acne aid) gel 2

erythromycin (acne aid)pads 2

erythromycin (acne aid)soln 2


57

Drug Name DrugTier

Requirements/Limits

EVOCLIN FOAM (UseClindamycin Phosphate(Topical))

5

isotretinoin caps 2 QL(2 ea daily);AL

KLARON LOTN (UseSulfacetamide Sodium(Acne))


PANOXYL LIQD (UseBenzoyl Peroxide) 5 RX/OTC

PLEXION CLEANSERLIQD (Use SulfacetamideSodium w/ Sulfur)

5

PLEXION CREA (UseSulfacetamide Sodium w/Sulfur)

5

PLEXION LOTN (UseSulfacetamide Sodium w/Sulfur)

5

RETIN-A CREA (UseTretinoin) 5 AL

RETIN-A GEL (UseTretinoin) 5 AL

RETIN-A MICRO GEL (UseTretinoin Microsphere) 5 AL

RETIN-A MICRO PUMPGEL 0.04 %, 0.1 % (UseTretinoin Microsphere)

5AL

RETIN-A MICRO PUMPGEL 0.08 % 4 AL

ROSULA PADS 4

SODIUMSULFACETAMIDE/SULFUR CLEANSER IN UREAEMUL

5

SODIUMSULFACETAMIDE/SULFUR IN UREA GEL

4

SODIUMSULFACETAMIDE/SULFUR LOTN

4

SODIUMSULFACETAMIDE/SULFUR SUSP

5

SSS 10-5 FOAM 4

Drug Name DrugTier

Requirements/Limits

sulfacetamide sodium(acne) lotn 2 QL(120 ml per

fill retail)sulfacetamide sodium(acne) susp 2 QL(120 ml per

fill retail)sulfacetamide sodium w/sulfur crea 2

sulfacetamide sodium w/sulfur emul 2

sulfacetamide sodium w/sulfur liqd 2

sulfacetamide sodium w/sulfur lotn 2

sulfacetamide sodium w/sulfur pads 2

sulfacetamide sodium w/sulfur soln 2

sulfacetamide sodium w/sulfur susp 2

sulfacetamide sodium-sulfur in urea vehicle emul 2

sulfacetamide sodium-sulfur w/ skin cleanser kit 2

sulfacetamide sodium-sulfur-sunscreen kit 2

SUMADAN KIT KIT (UseSulfacetamide Sodium-Sulfur w/ Skin Cleanser)

5

SUMADAN WASH LIQD(Use SulfacetamideSodium w/ Sulfur)

5

SUMADAN XLT KIT (UseSulfacetamide Sodium-Sulfur-Sunscreen)

5

SUMAXIN PADS (UseSulfacetamide Sodium w/Sulfur)

5

SUMAXIN TS SUSP (UseSulfacetamide Sodium w/Sulfur)

5

SUMAXIN WASH LIQD(Use SulfacetamideSodium w/ Sulfur)

5

tretinoin crea 2 AL

tretinoin gel 2 AL


58

Drug Name DrugTier

Requirements/Limits

tretinoin microsphere gel 2 AL

VELTIN GEL 4

ZIANA GEL (UseClindamycin Phosphate-Tretinoin)

5

Anti-inflammatory Agents - TopicalDERMACINRX LEXITRALPHARMAPAK THPK (UseDiclofenac Sodium-Capsaicin (Topical))

5

DICLO GEL/XRYLIXSHEETS THPK 5

diclofenac sodium (topical)gel 2

diclofenac sodium (topical)soln 2

diclofenac sodium-capsaicin (topical) thpk 2

ENOVARX-DICLOFENACSODIUM CREA 5

PENNSAID SOLN (UseDiclofenac Sodium(Topical))

5

VOLTAREN GEL (UseDiclofenac Sodium(Topical))

5

Antibiotics - TopicalBACTROBAN CREA (UseMupirocin Calcium(Topical))

5

BACTROBAN OINT (UseMupirocin) 5

CENTANY OINT 5

gentamicin sulfate (topical)crea 2

GENTAMICIN SULFATEOINT EX 0.1 % 4

mupirocin calcium (topical)crea 2

mupirocin oint 2

Antifungals - Topical

Drug Name DrugTier

Requirements/Limits

CICLODAN SOLUTIONKIT KIT (Use Ciclopirox) 5

ciclopirox gel 2

ciclopirox kit 2

ciclopirox olamine crea 2

ciclopirox olamine susp 2

ciclopirox sham 2

ciclopirox soln 2

clotrimazole (topical) crea 2 RX/OTC

clotrimazole (topical) soln 2 RX/OTC

clotrimazole w/betamethasone crea 2

clotrimazole w/betamethasone lotn 2

econazole nitrate crea 2

EXTINA FOAM (UseKetoconazole (Topical)) 5

JUBLIA SOLN 4

ketoconazole (topical) crea 2

ketoconazole (topical) foam 2

ketoconazole (topical)sham 2 QL(120 ml per

fill retail)LOPROX CREA (UseCiclopirox Olamine) 5

LOPROX SHAMPOOSHAM (Use Ciclopirox) 5

LOPROX SUSP (UseCiclopirox Olamine) 5

LOTRIMIN AF CREA (UseClotrimazole (Topical)) 5 RX/OTC

LOTRIMIN AF FOR HERCREA (Use Clotrimazole(Topical))

5RX/OTC

LOTRIMIN AF JOCK ITCHCREA (Use Clotrimazole(Topical))

5RX/OTC


59

Drug Name DrugTier

Requirements/Limits

LOTRISONE CREA (UseClotrimazole w/Betamethasone)

5

LUZU CREA 4

MICATIN CREA (UseMiconazole Nitrate(Topical))

5

miconazole nitrate (topical)crea 2

naftifine hcl crea 2

NAFTIN CREA 1 %, 2 %(Use Naftifine HCl) 5

NAFTIN GEL 1 %, 2 % 4

NIZORAL SHAM (UseKetoconazole (Topical)) 5 QL(120 ml per

fill retail)

nystatin (topical) crea 2

nystatin (topical) oint 2

nystatin (topical) powd 2

nystatin-triamcinolone crea 2

nystatin-triamcinolone oint 2

oxiconazole nitrate crea 2

OXISTAT CREA (UseOxiconazole Nitrate) 5

PENLAC NAIL LACQUERSOLN (Use Ciclopirox) 5

Antineoplastic or Premalignant Lesion Agents -CARAC CREA 5

diclofenac sodium (actinickeratoses) gel 2

EFUDEX CREA (UseFluorouracil (Topical)) 5 QL(40 gm per

fill retail)fluorouracil (topical) crea 5% 2 QL(40 gm per

fill retail)fluorouracil (topical) soln 2%, 5 % 2 QL(10 ml per

fill retail)FLUOROURACIL CREAEX 0.5 % 5

Drug Name DrugTier

Requirements/Limits

PICATO GEL 4

SOLARAZE GEL (UseDiclofenac Sodium (ActinicKeratoses))

5

TARGRETIN GEL EX 5 PA

Antipruritics - TopicalDOXEPINHYDROCHLORIDE CREA 4

PRUDOXIN CREA 4

ZONALON CREA 4

Antipsoriaticsacitretin caps 10 mg, 17.5mg 2 QL(1 ea daily)

acitretin caps 25 mg 2 QL(2 ea daily)

calcipotriene crea 2 QL(60 gm perfill retail)

calcipotriene oint 2

calcipotriene soln 2 QL(60 ml perfill retail)

CALCITRIOL OINT EX 3MCG/GM 4

COSENTYXSENSOREADY PEN SOAJ 5 PA

COSENTYX SOSY 5 PA

DOVONEX CREA (UseCalcipotriene) 5 QL(60 gm per

fill retail)

methoxsalen rapid caps 2 QL(4 ea daily)

OXSORALEN ULTRACAPS (Use MethoxsalenRapid)

5QL(4 ea daily)

SORIATANE CAPS 10MG, 17.5 MG (UseAcitretin)

5QL(1 ea daily)

SORIATANE CAPS 25 MG(Use Acitretin) 5 QL(2 ea daily)

SORILUX FOAM 4

STELARA SOSY 5 PA


60

Drug Name DrugTier

Requirements/Limits

TAZORAC CREA 4

TAZORAC GEL 4

VECTICAL OINT 4

Antiseborrheic ProductsOVACE PLUS SHAM (UseSulfacetamide Sodium) 5

OVACE PLUS WASH GEL(Use SulfacetamideSodium)

5

OVACE PLUS WASH LIQD(Use SulfacetamideSodium)

5

OVACE WASH LIQD (UseSulfacetamide Sodium) 5

selenium sulfide lotn 2 QL(120 ml perfill retail)

selenium sulfide-pyrithionezinc in urea vehicle sham 2

sulfacetamide sodium gel 2

sulfacetamide sodium liqd 2

sulfacetamide sodiumsham 2

Antivirals - Topicalacyclovir topical oint 2 QL(1 gm daily)

DENAVIR CREA 4

ZOVIRAX OINT EX 5 %(Use Acyclovir Topical) 5 QL(1 gm daily)

Burn Productsmafenide acetate pack 2

SILVADENE CREA (UseSilver Sulfadiazine) 5

silver sulfadiazine crea 2

SULFAMYLON PACK (UseMafenide Acetate) 5

Cauterizing AgentsARZOL SILVER NITRATEAPPLICATORS MISC 4

Drug Name DrugTier

Requirements/Limits

Corticosteroids - TopicalACLOVATE CREA (UseAlclometasoneDipropionate)

5

ALA SCALP LOTN (UseHydrocortisone (Topical)) 5

alclometasone dipropionatecrea 2

alclometasone dipropionateoint 2

AMCINONIDE CREA 4

AMCINONIDE LOTN 4

betamethasonedipropionate (topical) crea 2

betamethasonedipropionate (topical) lotn 2 QL(60 ml per

fill retail)betamethasonedipropionate (topical) oint 2

betamethasonedipropionate augmentedcrea

2

betamethasonedipropionate augmentedgel

2

betamethasonedipropionate augmentedlotn

2

betamethasonedipropionate augmentedoint

2

betamethasone valeratecrea 0.1 % 2

betamethasone valeratefoam 0.12 % 2

betamethasone valeratelotn 0.1 % 2 QL(60 ml per

fill retail)betamethasone valerateoint 0.1 % 2

calcipotriene-betamethasonedipropionate oint

2

CAPEX SHAM 5

clobetasol propionate crea 2


61

Drug Name DrugTier

Requirements/Limits

clobetasol propionateemollient base crea 2

clobetasol propionateemulsion foam 2

clobetasol propionate foam 2

clobetasol propionate gel 2

clobetasol propionate liqd 2

clobetasol propionate lotn 2

clobetasol propionate oint 2

clobetasol propionate sham 2

clobetasol propionate soln 2

CLOBEX LIQD (UseClobetasol Propionate) 5

CLOBEX LOTN (UseClobetasol Propionate) 5

CLOBEX SHAM (UseClobetasol Propionate) 5

CLOCORTOLONEPIVALATE CREA 4

CLOCORTOLONEPIVALATE PUMP CREA 4

CLODERM CREA 4

CLODERM PUMP CREA 4

CORDRAN CREA (UseFlurandrenolide) 5

CORDRAN LOTN (UseFlurandrenolide) 5

CUTIVATE CREA (UseFluticasone Propionate) 5

CUTIVATE LOTN (UseFluticasone Propionate) 5

DERMA-SMOOTHE/FSBODY OIL (UseFluocinolone Acetonide)

5

DERMA-SMOOTHE/FSSCALP OIL (UseFluocinolone Acetonide)

5

Drug Name DrugTier

Requirements/Limits

DERMACINRX SILAPAKKIT (Use TriamcinoloneAcetonide-Dimethicone-Silicone)

5

DERMATOP CREA (UsePrednicarbate) 5

DERMATOP OINT (UsePrednicarbate) 5

desonide crea 2

desonide lotn 2

desonide oint 2

DESOWEN CREA (UseDesonide) 5

DESOWEN LOTN (UseDesonide) 5

DESOXIMETASONECREA 0.05 % 4

desoximetasone crea 0.25% 2

desoximetasone gel 0.05 % 2

DESOXIMETASONE OINT0.05 % 4

desoximetasone oint 0.25% 2

DIFLORASONEDIACETATE CREA 4

DIFLORASONEDIACETATE OINT 4

DIPROLENE AF CREA(Use BetamethasoneDipropionate Augmented)

5

DIPROLENE LOTN (UseBetamethasoneDipropionate Augmented)

5

DIPROLENE OINT (UseBetamethasoneDipropionate Augmented)

5

ELOCON CREA (UseMometasone Furoate) 5

ELOCON LOTN (UseMometasone Furoate) 5

ELOCON OINT (UseMometasone Furoate) 5


62

Drug Name DrugTier

Requirements/Limits

fluocinolone acetonide crea0.01 %, 0.025 % 2

fluocinolone acetonide oil0.01 % 2

fluocinolone acetonide oint0.025 % 2

fluocinolone acetonide soln0.01 % 2 QL(60 ml per

fill retail)

fluocinonide crea 2

fluocinonide emulsifiedbase crea 2

fluocinonide gel 2

fluocinonide oint 2

fluocinonide soln 2

flurandrenolide crea 2

flurandrenolide lotn 2

fluticasone propionate crea 2

fluticasone propionate lotn 2

fluticasone propionate oint 2

halobetasol propionatecrea 2

halobetasol propionate oint 2

hydrocortisone (topical)crea 1 %, 1% 2 RX/OTC

hydrocortisone (topical)crea 2.5 % 2

hydrocortisone (topical)lotn 2 %, 2.5 % 2

hydrocortisone (topical)oint 1 % 2 QL(2 gm daily);

RX/OTChydrocortisone (topical)oint 2.5 % 2

hydrocortisone butyratecrea 2

hydrocortisone butyratehydrophilic lipo base crea 2

Drug Name DrugTier

Requirements/Limits

hydrocortisone butyrateoint 2

hydrocortisone butyratesoln 2

hydrocortisone valeratecrea 2

hydrocortisone valerate oint 2

KENALOG AERS (UseTriamcinolone Acetonide(Topical))

5

LOCOID CREA (UseHydrocortisone Butyrate) 5

LOCOID LIPOCREAMCREA (Use HydrocortisoneButyrate Hydrophilic LipoBase)

5

LOCOID LOTN 4

LOCOID OINT (UseHydrocortisone Butyrate) 5

LOCOID SOLN (UseHydrocortisone Butyrate) 5

LUXIQ FOAM (UseBetamethasone Valerate) 5

mometasone furoate crea 2

mometasone furoate oint 2

mometasone furoate soln 2

MONISTAT SOOTHINGCARE ITCH RELIEF CREA(Use Hydrocortisone(Topical))

5

RX/OTC

OLUX FOAM (UseClobetasol Propionate) 5

OLUX-E FOAM (UseClobetasol PropionateEmulsion)

5

prednicarbate crea 2

prednicarbate oint 2

PSORCON CREA 4


63

Drug Name DrugTier

Requirements/Limits

SYNALAR CREA 0.025 %(Use FluocinoloneAcetonide)

5

SYNALAR OINT 0.025 %(Use FluocinoloneAcetonide)

5

SYNALAR SOLN 0.01 %(Use FluocinoloneAcetonide)


TACLONEX OINT (UseCalcipotriene-BetamethasoneDipropionate)

5

TEMOVATE CREA (UseClobetasol Propionate) 5

TEMOVATE E CREA (UseClobetasol PropionateEmollient Base)

5

TEMOVATE GEL (UseClobetasol Propionate) 5

TEMOVATE OINT (UseClobetasol Propionate) 5

TEMOVATE SOLN (UseClobetasol Propionate) 5

TEXACORT SOLN 5

TOPICORT CREA 0.05 % 4

TOPICORT CREA 0.25 %(Use Desoximetasone) 5

TOPICORT GEL 0.05 %(Use Desoximetasone) 5

TOPICORT OINT 0.05 % 4

TOPICORT OINT 0.25 %(Use Desoximetasone) 5

triamcinolone acetonide(topical) aers 0.147 mg/gm 2

triamcinolone acetonide(topical) crea 0.025 %, 0.1%

2

triamcinolone acetonide(topical) crea 0.5 % 2 QL(15 gm per

fill retail)triamcinolone acetonide(topical) lotn 0.025 %, 0.1%


Drug Name DrugTier

Requirements/Limits

triamcinolone acetonide(topical) oint 0.025 %, 0.1%

2

triamcinolone acetonide(topical) oint 0.5 % 2 QL(15 gm per

fill retail)triamcinolone acetonide-dimethicone-silicone kit 2

TRIDESILON CREA (UseDesonide) 5

ULTRAVATE CREA (UseHalobetasol Propionate) 5

ULTRAVATE OINT (UseHalobetasol Propionate) 5

VANOS CREA (UseFluocinonide) 5

WESTCORT OINT (UseHydrocortisone Valerate) 5

Emollient/Keratolytic AgentsALUVEA CREA (Use Urea) 5

HYDRO 35 FOAM (UseUrea in Lactic Acid Vehicle) 5

HYDRO 40 FOAM FOAM(Use Urea) 5

KERALAC CREA (UseUrea) 5

UMECTA NAIL FILM SUSP(Use Urea) 5

URAMAXIN CREA (UseUrea) 5

URAMAXIN GEL (UseUrea) 5

URAMAXIN GT GEL (UseUrea) 5

URAMAXIN LOTN 4

urea crea 2

urea foam 2

urea gel 2

urea in lactic acid vehiclefoam 2

urea in lactic acid-salicylicacid vehicle susp 2


64

Drug Name DrugTier

Requirements/Limits

urea in zinc undecylenate-lactic acid vehicle emul 2

urea lotn 2

urea susp 2

Emollientshyaluronate sodium(emollient) gel 2

HYLIRA GEL (UseHyaluronate Sodium(Emollient))

5

LAC-HYDRIN CREA (UseLactic Acid (AmmoniumLactate))

5RX/OTC

LAC-HYDRIN LOTN (UseLactic Acid (AmmoniumLactate))

5RX/OTC

LAC-HYDRIN TWELVELOTN (Use Lactic Acid(Ammonium Lactate))

5RX/OTC

lactic acid (ammoniumlactate) crea 12 % 2 RX/OTC

lactic acid (ammoniumlactate) lotn 10 % 2

lactic acid (ammoniumlactate) lotn 12 % 2 RX/OTC

lactic acid w/ vitamin e crea 2

Immunomodulating Agents - TopicalALDARA CREA (UseImiquimod) 5 QL(0.2667 ea

daily)

imiquimod crea 2 QL(0.2667 eadaily)

ZYCLARA CREA 4 QL(0.934 gmdaily)

ZYCLARA PUMP CREA2.5 % 4

ZYCLARA PUMP CREA3.75 % 4 QL(0.934 gm

daily)Immunosuppressive Agents - TopicalELIDEL CREA 4 QL(1 gm daily)

PROTOPIC OINT (UseTacrolimus (Topical)) 5 QL(1 gm daily)

Drug Name DrugTier

Requirements/Limits

tacrolimus (topical) oint 2 QL(1 gm daily)

Keratolytic/Antimitotic AgentsCONDYLOX GEL 5

CONDYLOX SOLN (UsePodofilox) 5 QL(4 ml per fill

retail)KERALYT GEL (UseSalicylic Acid) 5

podofilox soln 2 QL(4 ml per fillretail)

SALEX CREAM KIT (UseSalicylic Acid w/ Cleanser) 5

SALEX LOTION KIT (UseSalicylic Acid w/ Cleanser) 5

SALEX SHAM (UseSalicylic Acid) 5

salicylic acid crea 2

salicylic acid foam 2

salicylic acid gel 2

salicylic acid liqd 2

salicylic acid lotn 2

salicylic acid sham 2

salicylic acid soln 2

salicylic acid w/ cleanser kit 2

SALVAX FOAM (UseSalicylic Acid) 5

ULTRASAL-ER SOLN (UseSalicylic Acid) 5

VIRASAL LIQD (UseSalicylic Acid) 5

Local Anesthetics - Topicalcapsaicin-menthol disk 2 RX/OTC

capsaicin-menthol ptch 2 RX/OTC

COCAINE HCL SOLN 4


65

Drug Name DrugTier

Requirements/Limits

EMLA CREA (UseLidocaine-Prilocaine) 5

ETHYL CHLORIDE AERO 4

ETHYL CHLORIDE/FINEPINPOINT AERO 4

ETHYL CHLORIDE/FINESTREAM AERO 4

ETHYLCHLORIDE/MEDIUM JETSTREAM AERO

4

ETHYLCHLORIDE/MEDIUMSTREAM AERO

4

ETHYL CHLORIDE/MISTAERO 4

LENZAPATCH PTCH (UseLidocaine-Menthol) 5 RX/OTC

LIDO-K LOTN 4

LIDOCAINE ANDTETRACAINECREAMCREA

4

lidocaine hcl crea ex 3 % 2

lidocaine hcl gel ex 2 % 2 RX/OTC

LIDOCAINE HCL LOTN EX3 % 4

lidocaine hcl soln ex 4 % 2

lidocaine oint 2

lidocaine ptch 2 PA

lidocaine-menthol ptch 1%-4% 2 RX/OTC

lidocaine-menthol ptch 4%-4% 2

lidocaine-prilocaine crea 2

lidocaine-prilocaine kit 2

LIDODERM PTCH (UseLidocaine) 5 PA

LIDOTRANS 5 PAK KIT 5

Drug Name DrugTier

Requirements/Limits

MEGRIX DISK (UseCapsaicin-Menthol) 5 RX/OTC

MEGRIX DISK 5 RX/OTC

PALLERIX DISK (UseCapsaicin-Menthol) 5 RX/OTC

PLIAGLIS CREA 4

pramoxine hcl gel 2 RX/OTC

SOLAICE PTCH 4 RX/OTC

TEROCIN PTCH (UseLidocaine-Menthol) 5

VEINPUNCTURE PX1PHLEBOTOMY SYSTEMKIT

5

XRYLIDERM KIT 5

XYLOCAINE SOLN (UseLidocaine HCl) 5

Misc. Dermatological ProductsATOPICLAIR CREA 5 RX/OTC

CALICYLIC CREA 5 RX/OTC

CURE-ALL CREA 5 RX/OTC

DERMAREST ROSACEACREA 5 RX/OTC

DEXERYL CREA 5 RX/OTC

ELETONE CREA 5 RX/OTC

ELETONE TWINPACKCREA 5 RX/OTC

HEAL AID PLUS CREA 5 RX/OTC

HPR PLUS CREA 5 RX/OTC

HYLATOPIC PLUS CREA 5 RX/OTC

MOISTURE CREAM CREA 5 RX/OTC

NEOSALUS CP CREA 5 RX/OTC

NEOSALUS CREA 5 RX/OTC


66

Drug Name DrugTier

Requirements/Limits

NIVATOPIC PLUS CREA 5 RX/OTC

PRUCLAIR CREA 5 RX/OTC

PRUMYX CREA 5 RX/OTC

TETRIX CREA 5 RX/OTC

XERALUX CREA 5 RX/OTC

YODORA DEODORANTCREA 5 RX/OTC

Misc. Topicalaluminum chloride soln 2

BASIS FACIALMOISTURIZER CREA 4 RX/OTC

BASIS OVERNIGHT CREA 4 RX/OTC

CARRINGTON MOISTUREBARRIER CREA 4 RX/OTC

CARRINGTON MOISTUREBARRIER/ZINC CREA 4 RX/OTC

DRYSOL SOLN 4

EUCERIN CREA (Use SkinProtectants, Misc.) 5 RX/OTC

HYDROCERIN CREA 4 RX/OTC

PROSHIELDPROTECTIVEHANDCREAM CREA

4RX/OTC

SENSI-CAREMOISTURIZING CREA 4 RX/OTC

skin protectants, misc. crea 2 RX/OTC

SORBIDON HYDRATECREA 4 RX/OTC

Rosacea AgentsDOXYCYCLINE CPDR 4

FINACEA FOAM 4

FINACEA GEL 4

Drug Name DrugTier

Requirements/Limits

METROCREAM CREA(Use Metronidazole(Topical))


METROGEL GEL (UseMetronidazole (Topical)) 5

METROLOTION LOTN(Use Metronidazole(Topical))

5

metronidazole (topical)crea 0.75 % 2 QL(45 gm per

fill retail)metronidazole (topical) gel0.75 % 2 QL(45 gm per

fill retail)metronidazole (topical) gel1 % 2

metronidazole (topical) lotn0.75 % 2

ORACEA CPDR 4

SOOLANTRA CREA 4

Scabicides & PediculicidesELIMITE CREA (UsePermethrin) 5

LINDANE LOTN 4

lindane lotn 2

LINDANE SHAM 4

lindane sham 2

malathion lotn 2 QL(59 ml perfill retail)

NATROBA SUSP 4

OVIDE LOTN (UseMalathion) 5 QL(59 ml per

fill retail)

permethrin crea 2

SPINOSAD SUSP 4

Scar Treatment ProductsBEAU RX GEL 4 RX/OTC

MEDERMA FOR KIDSGEL (Use Scar TreatmentProducts)

5RX/OTC


67

Drug Name DrugTier

Requirements/Limits

MEDERMA GEL (Use ScarTreatment Products) 5 RX/OTC

RECEDO GEL 4 RX/OTC

scar treatment products gel 2 RX/OTC

SP SCAR MANAGEMENTGEL 4 RX/OTC

Tar ProductsCOAL TAR SOLN 4

Wound Care ProductsDIAB CREA 4 RX/OTC

LUXAMEND CREA 4 RX/OTC

MIRODERMFENESTRATEDBIOLOGIC WOUNDMATRIX 2X2CM SHEE

5


5


5


5


5


5


5

Drug Name DrugTier

Requirements/Limits

MIRODERMFENESTRATEDPLUSBIOLOGIC WOUNDMATRIX 3X3CM/MESHEDSHEE

5


5


5

MIRODERMFENESTRATEDPLUSBIOLOGIC WOUNDMATRIX8X15CM/MESHED SHEE

5


5

MIRODERM MESHEDBIOLOGICWOUNDMATRIX 3X3CM SHEE

5


5


5


5


5


5

RADIACARE POSTHEALING CREA 4 RX/OTC

DIAGNOSTIC PRODUCTS

Diagnostic Tests


68

Drug Name DrugTier

Requirements/Limits

BLOOD GLUCOSE TESTSTRIPS 3 QL(5 ea daily)

CHEK-STIX COMBO PAKURINALYSIS CONTROLSTRP


CHEK-STIX CONTROLSTRP 3 QL(100 ea per

fill retail)

CHEMSTRIP-K STRP 3 QL(100 ea perfill retail)

KETOCARE STRP 3 QL(100 ea perfill retail)

KETONE TEST STRIPSSTRP 3 QL(100 ea per

fill retail)

KETOSTIX STRP 3 QL(100 ea perfill retail)

RELION KETONE STRP 3 QL(100 ea perfill retail)

RELION KETONE TESTSTRIPS STRP 3 QL(100 ea per

fill retail)DIGESTIVE AIDS - Drugs to Treat Low DigestiveEnzymesDigestive EnzymesCREON CPEP 4

PANCREAZE CPEP 5

PANCRELIPASE CPEP 4

PERTZYE CPEP 5

SUCRAID SOLN 5 PA

ULTRESA CPEP 4

VIOKACE TABS 4

ZENPEP CPEP 4

DIURETICS - Drugs to Treat Heart, CirculationConditions and Blood PressureCarbonic Anhydrase Inhibitorsacetazolamide cp12 500mg 2

acetazolamide sodium solr 2

Drug Name DrugTier

Requirements/Limits

ACETAZOLAMIDE TABS125 MG 4

acetazolamide tabs 250 mg 2

DIAMOX CP12 (UseAcetazolamide) 5

methazolamide tabs 2

NEPTAZANE TABS (UseMethazolamide) 5

Diuretic CombinationsALDACTAZIDE TABS 5

ALDACTAZIDE TABS (UseSpironolactone &Hydrochlorothiazide)

5

amiloride &hydrochlorothiazide tabs 2

DYAZIDE CAPS (UseTriamterene &Hydrochlorothiazide)

5QL(1 ea daily)

MAXZIDE TABS (UseTriamterene &Hydrochlorothiazide)

5QL(1 ea daily)

MAXZIDE-25 TABS (UseTriamterene &Hydrochlorothiazide)

5QL(1 ea daily)

spironolactone &hydrochlorothiazide tabs 2

triamterene &hydrochlorothiazide caps 2 QL(1 ea daily)

triamterene &hydrochlorothiazide tabs 2 QL(1 ea daily)

TRIAMTERENE/HYDROCHLOROTHIAZIDE CAPS 4 QL(1 ea daily)

Loop Diureticsbumetanide soln 2

bumetanide tabs 2

BUMEX TABS (UseBumetanide) 5

DEMADEX TABS 10 MG, 5MG, 100 MG (UseTorsemide)

5QL(1 ea daily)


69

Drug Name DrugTier

Requirements/Limits

DEMADEX TABS 20 MG(Use Torsemide) 5 QL(4 ea daily)

EDECRIN TABS (UseEthacrynic Acid) 5

ethacrynate sodium solr 2

ethacrynic acid tabs 2

furosemide soln ij 10 mg/ml 2

furosemide soln or 10mg/ml 2

FUROSEMIDE SOLN OR 8MG/ML 4

furosemide tabs or 20 mg,80 mg, 40 mg 2

LASIX TABS (UseFurosemide) 5

SODIUM EDECRIN SOLR(Use Ethacrynate Sodium) 5

torsemide tabs 10 mg, 5mg, 100 mg 2 QL(1 ea daily)

torsemide tabs 20 mg 2 QL(4 ea daily)

Osmotic Diureticsmannitol soln 2

OSMITROL VIAFLEXSOLN 4

Potassium Sparing DiureticsALDACTONE TABS (UseSpironolactone) 5

amiloride hcl tabs 2 QL(4 ea daily)

DYRENIUM CAPS 5

spironolactone tabs 2

Thiazides and Thiazide-Like Diureticschlorothiazide sodium solr 2

CHLOROTHIAZIDE TABS250 MG 4 QL(2 ea daily)

chlorothiazide tabs 500 mg 2 QL(4 ea daily)

Drug Name DrugTier

Requirements/Limits

chlorthalidone tabs 25 mg,50 mg 2

DIURIL SUSP 5

hydrochlorothiazide caps 2

hydrochlorothiazide tabs 2

indapamide tabs 2

METHYCLOTHIAZIDETABS 4

metolazone tabs 2

MICROZIDE CAPS (UseHydrochlorothiazide) 5

SODIUM DIURIL SOLR(Use ChlorothiazideSodium)

5

ENDOCRINE AND METABOLIC AGENTS -MISC. - Drugs to Treat Bone Disease andRegulate HormonesBone Density RegulatorsACTONEL TABS 150 MG,35 MG (Use RisedronateSodium)

5QL(0.143 eadaily)

ACTONEL TABS 30 MG, 5MG (Use RisedronateSodium)

5QL(1 ea daily)

ALENDRONATE SODIUMSOLN 70 MG/75ML 4 QL(10.8 ml

daily)alendronate sodium tabs10 mg, 5 mg 2 QL(1 ea daily)

alendronate sodium tabs35 mg, 70 mg 2 QL(0.15 ea

daily)ALENDRONATE SODIUMTABS 40 MG 4 QL(1 ea daily)

ATELVIA TBEC (UseRisedronate Sodium) 5

BINOSTO TBEF 5

BONIVA SOLN IV 3MG/3ML (Use IbandronateSodium)

5

BONIVA TABS OR 150 MG(Use Ibandronate Sodium) 5 QL(0.0357 ea

daily)


70

Drug Name DrugTier

Requirements/Limits

calcitonin (salmon) soln 2 QL(0.1233 mldaily)

ETIDRONATE DISODIUMTABS 4

FORTEO SOLN 4 PA

FORTICAL SOLN 4 QL(0.1233 mldaily)

FOSAMAX PLUS D TABS 5

FOSAMAX TABS (UseAlendronate Sodium) 5 QL(0.15 ea

daily)ibandronate sodium soln iv3 mg/3ml 2

ibandronate sodium tabs or150 mg 2 QL(0.0357 ea

daily)MIACALCIN SOLN IJ 200UNIT/ML 5 QL(0.0667 ml

daily)MIACALCIN SOLN NA 200UNIT/ACT (Use Calcitonin(Salmon))

5QL(0.1233 mldaily)

NATPARA CART 5 PA

pamidronate disodium soln30 mg/10ml, 90 mg/10ml 2

PAMIDRONATEDISODIUM SOLN 6MG/ML

5PA

pamidronate disodium solr30 mg, 90 mg 2

PROLIA SOLN 5 PA

RECLAST SOLN (UseZoledronic Acid) 5 PA

risedronate sodium tabs150 mg, 35 mg 2 QL(0.143 ea

daily)risedronate sodium tabs 30mg, 5 mg 2 QL(1 ea daily)

risedronate sodium tbec 35mg 2

XGEVA SOLN 5 PA

zoledronic acid conc 4mg/5ml 2 PA

ZOLEDRONIC ACID SOLN4 MG/100ML 5 PA

Drug Name DrugTier

Requirements/Limits

zoledronic acid soln 5mg/100ml 2 PA

ZOLEDRONIC ACID SOLR4 MG 5 PA

ZOMETA CONC (UseZoledronic Acid) 5 PA

ZOMETA SOLN 5 PA

CorticotropinH.P. ACTHAR GEL 5 PA

Fertility RegulatorsBRAVELLE SOLR 5 PA

chorionic gonadotropin solr 2

clomiphene citrate tabs 2

FOLLISTIM AQ SOLN 4

GONAL-F RFF REDIJECTSOLN 5 PA

GONAL-F RFF SOLR 5 PA

GONAL-F SOLR 5 PA

MENOPUR SOLR 5 PA

OVIDREL INJ 4

GnRH/LHRH AntagonistsCETROTIDE KIT 4

GANIRELIX ACETATESOLN 5

Growth Hormone Receptor AntagonistsSOMAVERT SOLR 5 PA

Growth Hormone Releasing Hormones (GHRH)EGRIFTA SOLR 5 PA

Growth HormonesGENOTROPIN MINIQUICKSOLR 5 PA

GENOTROPIN SOLR 5 PA


71

Drug Name DrugTier

Requirements/Limits

HUMATROPE COMBOPACK SOLR 4 PA

HUMATROPE SOLR 4 PA

NORDITROPIN FLEXPROSOLN 4 PA

NORDITROPINNORDIFLEX PEN SOLN 4 PA

NUTROPIN AQ NUSPIN10 SOLN 5 PA

NUTROPIN AQ NUSPIN20 SOLN 5 PA

NUTROPIN AQ NUSPIN 5SOLN 5 PA

NUTROPIN AQ PEN SOLN 5 PA

OMNITROPE SOLN 10MG/1.5ML, 5 MG/1.5ML 4 PA

OMNITROPE SOLR 5.8MG 5 PA

SAIZEN CLICK.EASYSOLR 5 PA

SAIZEN SOLR 5 PA

SEROSTIM SOLR 5 PA

TEV-TROPIN SOLR 5 PA

ZOMACTON SOLR 5 PA

ZORBTIVE SOLR 5 PA

Hormone Receptor ModulatorsEVISTA TABS (UseRaloxifene HCl) 5 QL(1 ea daily);

AL

OSPHENA TABS 4

raloxifene hcl tabs 6 QL(1 ea daily);AL

Insulin-Like Growth Factors (Somatomedins)INCRELEX SOLN 5 PA

LHRH/GnRH Agonist Analog PituitaryLUPANETA PACK KIT 5 PA

LUPRON DEPOT-PED KIT 5 PA

Drug Name DrugTier

Requirements/Limits

SUPPRELIN LA KIT 5 PA

SYNAREL SOLN 5 PA

Metabolic ModifiersALDURAZYME SOLN 5 PA

AMMONUL SOLN (UseSod Benzoate & SodPhenylacetate)

5

AMMONUL SOLN 4

BUPHENYL POWD 3GM/TSP (Use SodiumPhenylbutyrate)

5PA

BUPHENYL TABS 500 MG 5

calcitriol caps or 0.25 mcg,0.5 mcg 2

calcitriol soln iv 1 mcg/ml 2

calcitriol soln or 1 mcg/ml 2

CARBAGLU TABS 5

CARNITOR SF SOLN (UseLevocarnitine (MetabolicModifiers))

5QL(30 ml daily)

CARNITOR SOLN IV 200MG/ML (Use Levocarnitine(Metabolic Modifiers))

5

CARNITOR SOLN OR 1GM/10ML (UseLevocarnitine (MetabolicModifiers))

5

QL(30 ml daily)

CARNITOR TABS OR 330MG (Use Levocarnitine(Metabolic Modifiers))

5QL(3 ea daily);RX/OTC

CYSTADANE POWD 5 PA

doxercalciferol caps 2

doxercalciferol soln 2

ELAPRASE SOLN 5 PA

FABRAZYME SOLR 5 PA


72

Drug Name DrugTier

Requirements/Limits

HECTOROL CAPS (UseDoxercalciferol) 5

HECTOROL SOLN (UseDoxercalciferol) 5

KUVAN PACK 5 PA

KUVAN TBSO 5 PA

levocarnitine (metabolicmodifiers) soln iv 200mg/ml

2

levocarnitine (metabolicmodifiers) soln or 1gm/10ml

2QL(30 ml daily)

levocarnitine (metabolicmodifiers) tabs or 330 mg 2 QL(3 ea daily);

RX/OTC

LUMIZYME SOLR 5 PA

MYALEPT SOLR 5 PA

NAGLAZYME SOLN 5 PA

paricalcitol caps 2

paricalcitol soln 2

RAVICTI LIQD 5 PA

ROCALTROL CAPS (UseCalcitriol) 5

ROCALTROL SOLN (UseCalcitriol) 5

SENSIPAR TABS 5 PA

sod benzoate & sodphenylacetate soln 2

sodium phenylbutyratepowd 2 PA

VIMIZIM SOLN 5 PA

ZEMPLAR CAPS (UseParicalcitol) 5

ZEMPLAR SOLN (UseParicalcitol) 5

Posterior Pituitary Hormones

Drug Name DrugTier

Requirements/Limits

DDAVP SOLN IJ 4MCG/ML (UseDesmopressin Acetate)

5

DDAVP SOLN NA 0.01 %(Use DesmopressinAcetate Spray)

5QL(5 ml per fillretail)

DDAVP SOLN NA 0.01 %(Use DesmopressinAcetate Refrigerated)


DDAVP TABS OR 0.1 MG(Use DesmopressinAcetate)

5QL(6 ea daily)

DDAVP TABS OR 0.2 MG(Use DesmopressinAcetate)

5QL(8 ea daily)

desmopressin acetaterefrigerated soln 2 QL(5 ml per fill

retail)desmopressin acetate solnij 4 mcg/ml 2

desmopressin acetatespray refrigerated soln 2 QL(5 ml per fill

retail)desmopressin acetatespray soln 2 QL(5 ml per fill

retail)desmopressin acetate tabsor 0.1 mg 2 QL(6 ea daily)

desmopressin acetate tabsor 0.2 mg 2 QL(8 ea daily)

STIMATE SOLN 5 PA

vasopressin soln 2

VASOPRESSIN/SODIUMCHLORIDE SOLN 5

Prolactin Inhibitorscabergoline tabs 2

Somatostatic Agentsoctreotide acetate soln 2 PA

SANDOSTATIN LARDEPOT KIT 5 PA

SANDOSTATIN SOLN(Use Octreotide Acetate) 5 PA

SIGNIFOR LAR SUSR 5 PA


73

Drug Name DrugTier

Requirements/Limits

SIGNIFOR SOLN 0.3MG/ML 5

SIGNIFOR SOLN 0.6MG/ML, 0.9 MG/ML 5 PA

SOMATULINE DEPOTSOLN 5 PA

Vasopressin Receptor AntagonistsSAMSCA TABS 5 PA

ESTROGENS - Hormone Replacement/ModifyingDrugsEstrogen CombinationsACTIVELLA TABS 0.1MG-0.5MG (Use Estradiol &Norethindrone Acetate)

5

ACTIVELLA TABS 0.5MG-1MG (Use Estradiol &Norethindrone Acetate)

5QL(1 ea daily)

ANGELIQ TABS 5

CLIMARA PRO PTWK 5

COMBIPATCH PTTW 4

Limit 8 patchespermonth;QL(0.29ea daily)

DUAVEE TABS 4

estradiol & norethindroneacetate tabs 0.1mg-0.5mg 2

estradiol & norethindroneacetate tabs 0.5mg-1mg 2 QL(1 ea daily)

FEMHRT LOW DOSETABS (Use NorethindroneAcetate-Ethinyl Estradiol)

5

norethindrone acetate-ethinyl estradiol tabs 2

PREFEST TABS 5

PREMPHASE TABS 4 QL(1 ea daily)

PREMPRO TABS 4 QL(1 ea daily)

Estrogens

ALORA PTTW 4 QL(0.29 eadaily)

Drug Name DrugTier

Requirements/Limits

CLIMARA PTWK (UseEstradiol) 5 QL(0.143 ea

daily)

DELESTROGEN OIL 5

DELESTROGEN OIL (UseEstradiol Valerate) 5

DIVIGEL GEL 4

ELESTRIN GEL 5

ENJUVIA TABS 5

ESTRACE TABS OR 0.5MG, 2 MG, 1 MG (UseEstradiol)

5

ESTRADIOL MICRONIZEDPOWD 5

ESTRADIOL POWD XX 5

estradiol pttw td 0.025mg/24hr, 0.1 mg/24hr,0.075 mg/24hr, 0.05mg/24hr, 0.0375 mg/24hr

2

QL(0.29 eadaily)

estradiol ptwk td 0.025mg/24hr, 37.5 mcg/24hr,0.1 mg/24hr, 0.075mg/24hr, 0.06 mg/24hr,0.05 mg/24hr

2

QL(0.143 eadaily)

estradiol tabs or 0.5 mg, 2mg, 1 mg 2

estradiol valerate oil 2

ESTROGEL GEL 5

estropipate tabs 0.75 mg,1.5 mg, 1.5 mg, 0.75 mg 2 QL(1 ea daily)

estropipate tabs 3 mg 2 QL(2 ea daily)

EVAMIST SOLN 4 QL(0.27 mldaily)

MENEST TABS 5

MENOSTAR PTWK 5

MINIVELLE PTTW 4 QL(0.29 eadaily)


74

Drug Name DrugTier

Requirements/Limits

PREMARIN TABS OR 0.3MG, 1.25 MG, 0.9 MG,0.625 MG, 0.45 MG

4QL(1 ea daily)

VIVELLE-DOT PTTW (UseEstradiol) 5 QL(0.29 ea

daily)FLUOROQUINOLONES - Drugs to Treat BacterialInfectionsFluoroquinolonesAVELOX ABC PACK TABS(Use Moxifloxacin HCl) 5

AVELOX TABS (UseMoxifloxacin HCl) 5

CIPRO I.V.-IN D5W SOLN(Use Ciprofloxacin in D5W) 5

CIPRO SUSR 5GM/100ML, 500 MG/5ML(Use Ciprofloxacin)

5AL

CIPRO TABS 250 MG, 500MG (Use CiprofloxacinHCl)

5

CIPRO XR TB24 (UseCiprofloxacin-CiprofloxacinHCl)

5

CIPROFLOXACIN HCLTABS 100 MG 4 QL(6 ea per fill

retail)ciprofloxacin hcl tabs 250mg, 750 mg, 500 mg 2

ciprofloxacin in d5w soln 2

CIPROFLOXACIN SOLNIV 200 MG/20ML, 400MG/40ML

4

ciprofloxacin soln iv 200mg/20ml, 400 mg/40ml 2

ciprofloxacin susr or 250mg/5ml, 500 mg/5ml 2 AL

ciprofloxacin-ciprofloxacinhcl tb24 2

LEVAQUIN SOLN IV500MG/100ML-5%,750MG/150ML-5% (UseLevofloxacin in D5W)

5

LEVAQUIN SOLN OR 25MG/ML (Use Levofloxacin) 5 AL

Drug Name DrugTier

Requirements/Limits

LEVAQUIN TABS OR 250MG, 750 MG, 500 MG (UseLevofloxacin)

5QL(1 eadaily,14 ea perfill retail)

levofloxacin in d5w soln 2

levofloxacin soln iv 25mg/ml 2

levofloxacin soln or 25mg/ml 2 AL

levofloxacin tabs or 250mg, 750 mg, 500 mg 2

QL(1 eadaily,14 ea perfill retail)

moxifloxacin hcl tabs 2

OFLOXACIN TABS 300MG 4

ofloxacin tabs 400 mg 2 QL(56 ea perfill retail)

GASTROINTESTINAL AGENTS - MISC. -Miscellaneous Gastrointestinal DrugsFarnesoid X Receptor (FXR) AgonistsOCALIVA TABS 5 PA

Gallstone Solubilizing AgentsACTIGALL CAPS (UseUrsodiol) 5 QL(3 ea daily)

URSO 250 TABS (UseUrsodiol) 5 QL(7 ea daily)

URSO FORTE TABS (UseUrsodiol) 5

ursodiol caps 300 mg 2 QL(3 ea daily)

ursodiol tabs 250 mg 2 QL(7 ea daily)

ursodiol tabs 500 mg 2

Gastrointestinal Antiallergy Agentscromolyn sodium(mastocytosis) conc 2

GASTROCROM CONC(Use Cromolyn Sodium(Mastocytosis))

5

Gastrointestinal Stimulantsmetoclopramide hcl soln 2


75

Drug Name DrugTier

Requirements/Limits

metoclopramide hcl tabs 2

METOCLOPRAMIDE ODTTBDP 4

METOZOLV ODT TBDP(Use Metoclopramide HCl) 5

REGLAN TABS (UseMetoclopramide HCl) 5

Inflammatory Bowel AgentsAPRISO CP24 4

ASACOL HD TBEC 5

AZULFIDINE EN-TABSTBEC (Use Sulfasalazine) 5

AZULFIDINE TABS (UseSulfasalazine) 5

balsalazide disodium caps 2 QL(9 ea daily)

CANASA SUPP 4

CIMZIA KIT 5 PA

CIMZIA STARTER KIT KIT 5 PA

COLAZAL CAPS (UseBalsalazide Disodium) 5 QL(9 ea daily)

ENTYVIO SOLR 5 PA

GIAZO TABS 5

INFLECTRA SOLR 5

LIALDA TBEC 4

MESALAMINE DR TBEC 5

mesalamine enem 2 QL(60 ml daily)

mesalamine w/ cleanser kit 2

PENTASA CPCR 4 QL(8 ea daily)

REMICADE SOLR 5 PA

ROWASA KIT (UseMesalamine w/ Cleanser) 5

Drug Name DrugTier

Requirements/Limits

sulfasalazine tabs 2

sulfasalazine tbec 2

Intestinal Acidifierslactulose (encephalopathy)soln 2

Irritable Bowel Syndrome (IBS) Agents

alosetron hcl tabs 2 QL(2 ea daily);AL

LINZESS CAPS 4

LOTRONEX TABS (UseAlosetron HCl) 5 QL(2 ea daily);

AL

VIBERZI TABS 4

Peripheral Opioid Receptor AntagonistsMOVANTIK TABS 4

Phosphate Binder Agentscalcium acetate (phosphatebinder) caps 2

calcium acetate (phosphatebinder) tabs 2 RX/OTC

ELIPHOS TABS (UseCalcium Acetate(Phosphate Binder))

5RX/OTC

PHOSLO CAPS (UseCalcium Acetate(Phosphate Binder))

5

PHOSLYRA SOLN 4

RENVELA PACK 4

RENVELA TABS 4

VELPHORO CHEW 4

Short Bowel Syndrome (SBS) AgentsGATTEX KIT 5

GENERAL ANESTHETICS - Drugs Used inSurgery to Numb and to Cause Loss ofConsciousnessAnesthetics - Misc.


76

Drug Name DrugTier

Requirements/Limits

AMIDATE SOLN (UseEtomidate) 5

DIPRIVAN EMUL (UsePropofol) 5

etomidate soln 2

KETALAR SOLN (UseKetamine HCl) 5

ketamine hcl soln 2

propofol emul 2

Volatile AnestheticsFORANE SOLN (UseIsoflurane) 5

isoflurane soln 2

sevoflurane soln 2

ULTANE SOLN (UseSevoflurane) 5

GENITOURINARY AGENTS - MISCELLANEOUS- Miscellaneous Drugs to Treat ReproductiveOrgans and Urinary SystemAlkalinizerspot & sod citrates w/citricac soln 2

potassium citrate(alkalinizer) tbcr 2

potassium citrate-citric acidpack 2

potassium citrate-citric acidsoln 2

SHOHLS SOLUTIONMODIFIED SOLN (UseSodium Citrate & CitricAcid)

5

QL(16.67 mldaily)

sodium citrate & citric acidsoln 2 QL(16.67 ml

daily)UROCIT-K 10 TBCR (UsePotassium Citrate(Alkalinizer))

5

UROCIT-K 15 TBCR (UsePotassium Citrate(Alkalinizer))

5

Drug Name DrugTier

Requirements/Limits

UROCIT-K 5 TBCR (UsePotassium Citrate(Alkalinizer))

5

Cystinosis AgentsCYSTAGON CAPS 5 PA

PROCYSBI CPDR 25 MG 5 PA

PROCYSBI CPDR 75 MG 5 PA; QL(0.034ea daily)

Genitourinary Irrigantsacetic acid soln 2

glycine (gu irrigant) soln 2

neomycin/polymyxin b gusoln 2

NEOSPORIN GUIRRIGANT SOLN (UseNeomycin/Polymyxin BGU)

5

sodium chloride (guirrigant) soln 2

Prostatic Hypertrophy Agentsalfuzosin hcl tb24 2 QL(1 ea daily)

AVODART CAPS (UseDutasteride) 5 QL(1 ea daily)

dutasteride caps 2 QL(1 ea daily)

dutasteride-tamsulosin hclcaps 2 QL(1 ea daily)

finasteride tabs 2 QL(1 ea daily)

FLOMAX CAPS (UseTamsulosin HCl) 5 QL(2 ea daily)

JALYN CAPS (UseDutasteride-TamsulosinHCl)

5QL(1 ea daily)

PROSCAR TABS (UseFinasteride) 5 QL(1 ea daily)

RAPAFLO CAPS 4

tamsulosin hcl caps 2 QL(2 ea daily)

UROXATRAL TB24 (UseAlfuzosin HCl) 5 QL(1 ea daily)


77

Drug Name DrugTier

Requirements/Limits

Urinary Analgesicsphenazopyridine hcl tabs 2

PYRIDIUM TABS (UsePhenazopyridine HCl) 5

GOUT AGENTS - Drugs to Treat Gout

Gout Agent Combinationscolchicine w/ probenecidtabs 2

Gout Agentsallopurinol tabs 2

COLCHICINE CAPS 4

COLCHICINE TABS 4 QL(0.2 eadaily)

COLCRYS TABS 4 QL(0.2 eadaily)

KRYSTEXXA SOLN 5 PA

MITIGARE CAPS 4

ULORIC TABS 4 QL(1 ea daily)

ZYLOPRIM TABS (UseAllopurinol) 5

Uricosuricsprobenecid tabs 2

HEMATOLOGICAL AGENTS - MISC. - Drugs toTreat Blood DisordersAntihemophilic ProductsADYNOVATE SOLR 1500UNIT, 750 UNIT 5

Bradykinin B2 Receptor AntagonistsFIRAZYR SOLN 5 PA

Complement InhibitorsBERINERT KIT 5 PA

CINRYZE SOLR 5 PA

RUCONEST SOLR 5 PA

Drug Name DrugTier

Requirements/Limits

SOLIRIS SOLN 5 PA

Hematorheologic Agentspentoxifylline tbcr 2

Plasma Kallikrein InhibitorsKALBITOR SOLN 5 PA

Platelet Aggregation InhibitorsAGGRASTAT CONC 5

AGGRENOX CP12 (UseAspirin-Dipyridamole) 5 QL(2 ea daily)

AGRYLIN CAPS (UseAnagrelide HCl) 5

anagrelide hcl caps 2

aspirin-dipyridamole cp12 2 QL(2 ea daily)

BRILINTA TABS 4

cilostazol tabs 2 QL(2 ea daily)

clopidogrel bisulfate tabs300 mg 2

clopidogrel bisulfate tabs75 mg 2 QL(1 ea daily)

dipyridamole tabs 2

EFFIENT TABS 4 QL(1 ea daily)

eptifibatide soln 2

INTEGRILIN SOLN (UseEptifibatide) 5

PERSANTINE TABS (UseDipyridamole) 5

PLAVIX TABS 300 MG(Use Clopidogrel Bisulfate) 5

PLAVIX TABS 75 MG (UseClopidogrel Bisulfate) 5 QL(1 ea daily)

PLETAL TABS (UseCilostazol) 5 QL(2 ea daily)

ticlopidine hcl tabs 2

ZONTIVITY TABS 5


78

Drug Name DrugTier

Requirements/Limits

ProtaminePROTAMINE SULFATESOLN 4

HEMATOPOIETIC AGENTS - Drugs to TreatBlood DisordersAgents for Gaucher DiseaseCERDELGA CAPS 5 PA

CEREZYME SOLR 5 PA

VPRIV SOLR 5 PA

ZAVESCA CAPS 5 PA

Cobalaminscyanocobalamin soln 2

HYDROXOCOBALAMINSOLN 4

Folic Acid/FolatesFOLIC ACID SOLN IJ 5MG/ML 4

folic acid tabs or 1 mg 6 AL; RX/OTC

folic acid tabs or 400 mcg 6 AL; PV

folic acid tabs or 800 mcg 6 AL

Hematopoietic Growth FactorsARANESP ALBUMINFREE SOLN 10MCG/0.4ML

4PA

ARANESP ALBUMINFREE SOLN 100 MCG/ML,60 MCG/ML, 40 MCG/ML,300 MCG/ML, 25 MCG/ML,200 MCG/ML

4

ARANESP ALBUMINFREE SOSY 100MCG/0.5ML, 60MCG/0.3ML, 500 MCG/ML,40 MCG/0.4ML, 300MCG/0.6ML, 25MCG/0.42ML, 200MCG/0.4ML, 150MCG/0.3ML

4

PA

Drug Name DrugTier

Requirements/Limits

EPOGEN SOLN 4 PA

GRANIX SOSY 5 PA

LEUKINE SOLR 5 PA

MIRCERA SOSY 5 PA

NEULASTA ONPRO KITPSKT 5 PA

NEULASTA SOSY 5 PA

NEUMEGA SOLR 5 PA

NEUPOGEN SOLN 5 PA

NEUPOGEN SOSY 5 PA

NPLATE SOLR 5 PA

PROCRIT SOLN 4 PA

PROMACTA TABS 5 PA

ZARXIO SOSY 5 PA

Hematopoietic MixturesCORVITE 150 TABS (UseIron-Folic Acid-Vitamin C-Vitamin B6-Vitamin B12-Zinc)

5

CYFOLEX CAPS 5

fe fum-iron polysacchcomplex-fa-b complex-c-zn-mn-cu caps

2

fe fumarate-vitamin c-vitamin b12-folic acid caps 2

ferrous fumarate w/ b12-vitc-fa-ifc caps 2

ferrous fumarate-fa-bcomplex-c-zn-mg-mn-cutabs

2

ferrous fumarate-folic acidtabs 2

FOLGARD RX TABS (UseFolic Acid-Vitamin B6-Vitamin B12)

5


79

Drug Name DrugTier

Requirements/Limits

folic acid-vitamin b6-vitamin b12 tabs 2

HEMATRON-AF TABS(Use Iron-Docusate-B12-Folic Acid-Vit C-Vit E-Copper-Biotin)

5

RX/OTC

ICAR-C PLUS TABS (UseIron-Vitamin C-VitaminB12-Folic Acid)

5RX/OTC

iron combinations caps 2 RX/OTC

iron polysaccharidecomplex-vit b12-folic acidcaps

2

iron-docusate-b12-folicacid-vit c-vit e-copper-biotintabs

2RX/OTC

iron-folic acid-vitamin c-vitamin b6-vitamin b12-zinctabs

2

iron-vitamin c-vitamin b12-folic acid tabs 2 RX/OTC

TANDEM PLUS CAPS(Use Fe Fum-IronPolysacch Complex-FA-BComplex-C-Zn-Mn-Cu)

5

Ironcarbonyl iron susp 6

FER-IN-SOL SOLN (UseFerrous Sulfate) 5

FERRLECIT SOLN (UseSodium Ferric GluconateComplex in Sucrose)

5

ferrous sulfate elix 6

ferrous sulfate soln 6

FERROUS SULFATESYRP 6

ICAR PEDIATRIC SUSP(Use Carbonyl Iron) 5

INFED SOLN 4

iron dextran soln 2

MYKIDZ IRON 10 SUSP 6

Drug Name DrugTier

Requirements/Limits

sodium ferric gluconatecomplex in sucrose soln 2

Stem Cell MobilizersMOZOBIL SOLN 5 PA

HEMOSTATICS - Drugs to Stop Bleeding/TreatBlood DisordersHemostatics - SystemicAMICAR TABS 1000 MG 4

AMICAR TABS 500 MG 4 QL(24 ea perfill retail)

AMINOCAPROIC ACIDSOLN IV 250 MG/ML 4

aminocaproic acid soln iv250 mg/ml 2

aminocaproic acid syrp or25 % 2 QL(60 ml per

fill retail)AMINOCAPROIC ACIDTABS OR 1000 MG 4

aminocaproic acid tabs or500 mg 2 QL(24 ea per

fill retail)CYKLOKAPRON SOLN(Use Tranexamic Acid) 5 AL

LYSTEDA TABS (UseTranexamic Acid) 5 QL(6 ea daily);

ALtranexamic acid soln iv1000 mg/10ml 2 AL

tranexamic acid tabs or 650mg 2 QL(6 ea daily);

ALHemostatics - TopicalRAPLIXA POWD 5

HYPNOTICS/SEDATIVES/SLEEP DISORDERAGENTSBarbiturate Hypnoticsphenobarbital elix 20mg/5ml 2

PHENOBARBITALSODIUM SOLN 4

phenobarbital soln 20mg/5ml 2

PHENOBARBITAL TABS100 MG, 60 MG, 30 MG,15 MG

4


80

Drug Name DrugTier

Requirements/Limits

phenobarbital tabs 16.2mg, 97.2 mg, 64.8 mg, 32.4mg

2

Hypnotics - Tricyclic AgentsSILENOR TABS 4

Non-Barbiturate HypnoticsAMBIEN CR TBCR (UseZolpidem Tartrate) 5 QL(1 ea daily)

AMBIEN TABS (UseZolpidem Tartrate) 5 QL(1 ea daily)

dexmedetomidine hcl soln 2

DORAL TABS 4

estazolam tabs 2

eszopiclone tabs 2 QL(1 ea daily)

FLURAZEPAM HCL CAPS 4 QL(1 ea daily)

HALCION TABS (UseTriazolam) 5 QL(1 ea daily)

INTERMEZZO SUBL (UseZolpidem Tartrate) 5 QL(1 ea daily)

LUNESTA TABS (UseEszopiclone) 5 QL(1 ea daily)

midazolam hcl soln 2

midazolam hcl syrp 2

PRECEDEX SOLN (UseDexmedetomidine HCl) 5

QUAZEPAM TABS 4

RESTORIL CAPS (UseTemazepam) 5 QL(1 ea daily)

SONATA CAPS 10 MG(Use Zaleplon) 5 QL(2 ea daily);

ALSONATA CAPS 5 MG (UseZaleplon) 5 QL(1 ea daily);

AL

temazepam caps 2 QL(1 ea daily)

TRIAZOLAM TABS 0.125MG 4 QL(1 ea daily)

triazolam tabs 0.25 mg 2 QL(1 ea daily)

Drug Name DrugTier

Requirements/Limits

zaleplon caps 10 mg 2 QL(2 ea daily);AL

zaleplon caps 5 mg 2 QL(1 ea daily);AL

zolpidem tartrate subl 2 QL(1 ea daily)

zolpidem tartrate tabs 2 QL(1 ea daily)

zolpidem tartrate tbcr 2 QL(1 ea daily)

Selective Melatonin Receptor AgonistsHETLIOZ CAPS 5 PA

LAXATIVES - Bowel Treatment Drugs

Laxative Combinationsbisacodyl-peg 3350-potchloride-sod bicarb-sodchloride kit

2

COLYTE-FLAVOR PACKSSOLR 227.1GM-21.5GM-5.53GM-2.82GM-6.36GM

6AL

COLYTE-FLAVOR PACKSSOLR 240GM-22.72GM-5.84GM-2.98GM-6.72GM(Use PEG 3350-KCl-SodBicarb-Sod Chloride-SodSulfate)

5

GOLYTELY SOLR227.1GM-21.5GM-5.53GM-2.82GM-6.36GM

6AL

GOLYTELY SOLR 236GM-22.74GM-5.86GM-2.97GM-6.74GM (Use PEG 3350-KCl-Sod Bicarb-SodChloride-Sod Sulfate)

5

AL

MOVIPREP SOLR 4

NULYTELY/FLAVORPACKS SOLR (Use PEG3350-Potassium Chloride-Sod Bicarbonate-SodChloride)

5

peg 3350-kcl-sod bicarb-sod chloride-sod sulfatesolr 236gm-22.74gm-5.86gm-2.97gm-6.74gm

6

AL


81

Drug Name DrugTier

Requirements/Limits

peg 3350-kcl-sod bicarb-sod chloride-sod sulfatesolr 240gm-22.72gm-5.84gm-2.98gm-6.72gm

2

peg 3350-potassiumchloride-sod bicarbonate-sod chloride solr

2

PREPOPIK PACK 6 AL

SUCLEAR KIT 6 AL

SUPREP BOWEL PREPSOLN 6 AL

Laxatives - Miscellaneouslactulose soln 2

MIRALAX PACK (UsePolyethylene Glycol 3350) 5 RX/OTC

MIRALAX POWD (UsePolyethylene Glycol 3350) 5 QL(35.134 gm

daily); RX/OTCpolyethylene glycol 3350pack 2 RX/OTC

polyethylene glycol 3350powd 2 QL(35.134 gm

daily); RX/OTCLubricant Laxativesmineral oil oil 100 %, 99.9% 2 RX/OTC

MINERAL OIL OIL 55 % 4 RX/OTC

TH MINERAL OIL OIL 4 RX/OTC

LOCAL ANESTHETICS-Parenteral - Drugs forNumbingLocal Anesthetic Combinationsbupivacaine w/ epinephrinesoln 2

lidocaine w/ epinephrinesoln 2

MARCAINE/EPINEPHRINE SOLN (Use Bupivacainew/ Epinephrine)

5

XYLOCAINE-MPF/EPINEPHRINE SOLN(Use Lidocaine w/Epinephrine)

5

Drug Name DrugTier

Requirements/Limits

XYLOCAINE/EPINEPHRINE SOLN (Use Lidocaine w/Epinephrine)

5

Local Anesthetics - Amidesbupivacaine hcl soln 2

bupivacaine in dextrosesoln 2

CARBOCAINE SOLN (UseMepivacaine HCl) 5

lidocaine hcl (local anesth.)soln 2

MARCAINE SOLN (UseBupivacaine HCl) 5

MARCAINE SPINAL SOLN(Use Bupivacaine inDextrose)

5

mepivacaine hcl soln 2

NAROPIN SOLN (UseRopivacaine HCl) 5

READYSHARPBUPIVACAINE KIT 5

ropivacaine hcl soln 2

ROPIVACAINEHYDROCHLORIDE/SODIUM CHLORIDE SOLN

5

XYLOCAINE SOLN (UseLidocaine HCl (LocalAnesth.))

5

XYLOCAINE-MPF SOLN(Use Lidocaine HCl (LocalAnesth.))

5

Local Anesthetics - EstersNESACAINE-MPF SOLN 5

TETRACAINE HCL SOLN 4

MACROLIDES - Drugs to Treat BacterialInfectionsAzithromycinAZITHROMYCIN PACKOR 1 GM 4 QL(2 ea per fill

retail)

azithromycin solr iv 500 mg 2


82

Drug Name DrugTier

Requirements/Limits

azithromycin susr or 100mg/5ml, 200 mg/5ml 2

azithromycin tabs or 250mg 2 QL(6 ea per fill

retail)azithromycin tabs or 500mg 2 QL(2 ea daily)

azithromycin tabs or 600mg 2 QL(1 ea daily)

ZITHROMAX PACK OR 1GM 4 QL(2 ea per fill

retail)ZITHROMAX SOLR IV 500MG (Use Azithromycin) 5

ZITHROMAX SUSR OR100 MG/5ML, 200 MG/5ML(Use Azithromycin)

5

ZITHROMAX TABS OR250 MG (UseAzithromycin)

5QL(6 ea per fillretail)


5QL(2 ea daily)


5QL(1 ea daily)

ZITHROMAX TRI-PAKTABS (Use Azithromycin) 5 QL(2 ea daily)

ZITHROMAX Z-PAK TABS(Use Azithromycin) 5 QL(6 ea per fill

retail)ClarithromycinBIAXIN SUSR 250MG/5ML (UseClarithromycin)

5

BIAXIN TABS 250 MG, 500MG (Use Clarithromycin) 5 QL(28 ea per

fill retail)clarithromycin susr 125mg/5ml, 250 mg/5ml 2

clarithromycin tabs 250 mg,500 mg 2 QL(28 ea per

fill retail)

clarithromycin tb24 500 mg 2 QL(14 ea perfill retail)

ErythromycinsE.E.S. 400 TABS 4

E.E.S. GRANULES SUSR(Use ErythromycinEthylsuccinate)

5

Drug Name DrugTier

Requirements/Limits

ERY-TAB TBEC 4

ERYPED 200 SUSR (UseErythromycinEthylsuccinate)

5

ERYTHROCIN STEARATETABS 4

erythromycin base cpep250 mg 2

ERYTHROMYCIN BASETABS 250 MG, 500 MG 4

erythromycinethylsuccinate susr 200mg/5ml

2

ERYTHROMYCINETHYLSUCCINATE TABS400 MG

4

FidaxomicinDIFICID TABS 4

MEDICAL DEVICES AND SUPPLIES

Bandages-Dressings-TapeALLEVYN PLUS CAVITYPADS 3 RX/OTC; MO

ALLEVYN THIN PADS 3 RX/OTC; MO

AMD FOAM DRESSING4"X4" PADS 3 RX/OTC; MO

AMD FOAMDRESSING/TOPSHEET4"X4" PADS

3RX/OTC; MO

BAND-AID GAUZE PADSLARGE4" X 4" PADS 3 RX/OTC; MO

BAND-AID GAUZE PADSMEDIUM 3" X 3" PADS 3 MO

BAND-AID GAUZE PADSSMALL2" X 2" PADS 3 RX/OTC; MO

BAND-AID MIRASORBGAUZE SPONGESLARGE 4" X 4" PADS

3RX/OTC; MO

BIATAIN ADHESIVEFOAM DRESSING 4"X4"PADS

3RX/OTC; MO

BIATAIN FOAMDRESSING 4"X4" PADS 3 RX/OTC; MO


83

Drug Name DrugTier

Requirements/Limits

BIOGUARD GAUZESPONGE 2"X2" 8 PLYPADS

3RX/OTC; MO

BIOGUARD GAUZESPONGES 4"X4" 12 PLYPADS

3RX/OTC; MO

BORDERED GAUZEPADS 3 RX/OTC; MO

CARRASMART FOAMPADS 3 RX/OTC; MO

CARRASMART PADS 3 RX/OTC; MO

COPA ISLANDBORDERED FOAMDRESSING 4"X4" PADS

3RX/OTC; MO

COPA PLUSHYDROPHILIC FOAMDRESSING 4"X4" PADS

3RX/OTC; MO

COVRSITE COVERDRESSING PADS 3 RX/OTC; MO

COVRSITE PLUSCOMPOSITE DRESSINGPADS

3RX/OTC; MO

CUREX ALL-PURPOSESPONGES 4"X4" 4 PLYPADS

3RX/OTC; MO

CURITY ALL PURPOSESPONGES 2"X2" 4PLYPADS

3RX/OTC; MO

CURITY ALL PURPOSESPONGES 2"X2" PADS 3 RX/OTC; MO


3MO

CURITY ALL PURPOSESPONGES 4 PLY PADS 3 RX/OTC; MO


3RX/OTC; MO

CURITY ALL PURPOSESPONGES 4"X4"4PLY/SOFT POUCH PADS

3RX/OTC; MO

CURITY ALL PURPOSESPONGES 4"X4" PADS 3 RX/OTC; MO

Drug Name DrugTier

Requirements/Limits

CURITY AMDANTIMICROBIALGAUZESPONGES 2"X2" 8 PLYPADS

3

RX/OTC; MO

CURITY AMDANTIMICROBIALGAUZESPONGES 4"X4" 12 PLYPADS

3

RX/OTC; MO

CURITY COVER SPONGE4"X4" PADS 3 RX/OTC; MO

CURITY COVERSPONGES 3"X3" PADS 3 MO

CURITY COVERSPONGES 4"X4" PADS 3 RX/OTC; MO

CURITY DRESSINGSPONGES 4"X4" 6 PLYPADS

3RX/OTC; MO

CURITY GAUZE PADS2"X2" 12 PLY PADS 3 RX/OTC; MO

CURITY GAUZE PADS2"X2" PADS 3 RX/OTC; MO

CURITY GAUZE PADS3"X3" PADS 3 MO

CURITY GAUZE PADS4"X4" 12 PLY PADS 3 RX/OTC; MO

CURITY GAUZE SPONGE2"X2" 8 PLY PADS 3 RX/OTC; MO

CURITY GAUZE SPONGE2"X2"12 PLY PADS 3 RX/OTC; MO

CURITY GAUZE SPONGE3"X3" 12 PLY PADS 3 MO




CURITY GAUZE SPONGE4"X4"16 PLY PADS 3 RX/OTC; MO

CURITY GAUZESPONGES 4"X4" 12 PLYPADS

3RX/OTC; MO

CURITY GAUZESPONGES 4"X4" 8 PLYPADS

3RX/OTC; MO

CURITY NON-ADHERENTSTRIPS 3"X3" PADS 3 MO


84

Drug Name DrugTier

Requirements/Limits

CURITYSPONGES/CELLULOSEFILLED/2"X2" PADS

3RX/OTC; MO

CURITYSPONGES/CELLULOSEFILLED/4"X4" PADS

3RX/OTC; MO

CVS GAUZE PADS 2"X2"12-PLY PADS 3 RX/OTC; MO

CVS GAUZE PADS 4"X4"12-PLY PADS 3 RX/OTC; MO

DERMACEA DRAINSPONGES 4"X4" PADS 3 RX/OTC; MO

DERMACEA GAUZESPONGE 2"X2" 12 PLYPADS

3RX/OTC; MO


3RX/OTC; MO


3MO


3MO


3RX/OTC; MO


3RX/OTC; MO


3RX/OTC; MO

DERMACEA I.V. DRAINSPONGES 2"X2" PADS 3 RX/OTC; MO

DERMACEA I.V. DRAINSPONGES 4"X4" PADS 3 RX/OTC; MO

DERMACEA I.V.SPONGES 2"X2" PADS 3 RX/OTC; MO

DERMACEA NON-WOVENSPONGES 2"X2" 4 PLYPADS

3RX/OTC; MO


3MO

Drug Name DrugTier

Requirements/Limits


3RX/OTC; MO


3RX/OTC; MO

DERMACEA TYPE VIIGAUZE 2"X2" 12 PLYPADS

3RX/OTC; MO

DERMACEA TYPE VIIGAUZE 2"X2" 8 PLY PADS 3 RX/OTC; MO


3MO

DERMACEA TYPE VIIGAUZE 3"X3" 12PLYPADS

3MO


3RX/OTC; MO


3RX/OTC; MO

DERMACEA TYPE VIIGAUZE 4"X4" 8 PLY PADS 3 RX/OTC; MO

DERMACEA X-RAYSPONGES 4"X4" 16 PLYPADS

3RX/OTC; MO

DERMALEVIN ADHESIVEFOAMDRESSING 4"X4"PADS

3RX/OTC; MO

DRESSING SPONGES4"X4" PADS 3 RX/OTC; MO

DRYMAX EXTRA PADS 3 RX/OTC; MO

EQL GAUZE PADS2"X2"/SMALL PADS 3 RX/OTC; MO

EQL GAUZE PADS4"X4"/LARGE PADS 3 RX/OTC; MO

EQL GAUZE PADSSTERILE 3"X3"/MEDIUMPADS

3MO

EQL GAUZE STERILEPADS 3"X3" PADS 3 MO


85

Drug Name DrugTier

Requirements/Limits

EXCILON AMDANTIMICROBIALDRAINSPONGES 4"X4" 6 PLYPADS

3

RX/OTC; MO

EXCILON AMDANTIMICROBIALNON-WOVEN SPONGES 4"X4"6 PLY PADS

3

RX/OTC; MO

EXCILON DRAINSPONGE 4"X4" PADS 3 RX/OTC; MO

EXCILON DRAINSPONGES 4"X4" 6 PLYPADS

3RX/OTC; MO

EXCILON I.V. SPONGES2"X2" 6 PLY PADS 3 RX/OTC; MO

FLEXZAN 4 X 4 PADS 3 RX/OTC; MO

GAUZE DRESSING 4"X4"PADS 3 RX/OTC; MO

GAUZE PADS 2"X2" PADS 3 RX/OTC; MO

GAUZE PADS 3"X3" PADS 3 MO

GAUZE PADS 4"X4" 12PLY PADS 3 RX/OTC; MO

GAUZE PADS 4"X4" PADS 3 RX/OTC; MO

GAUZE SPONGE TYPEVII MEDI-PAK 2"X2" 8PLYPADS

3RX/OTC; MO

GAUZE SPONGES 4"X4"12 PLY PADS 3 RX/OTC; MO

GAUZE SPONGES 4"X4"PADS 3 RX/OTC; MO

GNP STERILE PADS3"X3" PADS 3 MO

HM STERILE PADS PADS 3 RX/OTC; MO

HYDROCELL ADHESIVEDRESSING 4"X4" PADS 3 RX/OTC; MO

HYDROCELL DRESSING4"X4" PADS 3 RX/OTC; MO

ISLAND GARD-GRX PADS 3 RX/OTC; MO

J & J GAUZE 2"X2" 8 PLYPADS 3 RX/OTC; MO

Drug Name DrugTier

Requirements/Limits



J & J GAUZE SPONGES12-PLY 4" X 4" MISC 3 RX/OTC; MO

J & J GAUZE SPONGES16-PLY 4" X 4" MISC 3 RX/OTC; MO

J & J GAUZE SPONGES8-PLY4" X 4" MISC 3 RX/OTC; MO

KENDALL HYDROPHILICFOAMDRESSING 2"X2"PADS

3RX/OTC; MO


3MO


3RX/OTC; MO

KENDALL HYDROPHILICFOAMPLUS DRESSING2"X2" PADS

3RX/OTC; MO

KENDALL HYDROPHILICFOAMPLUS DRESSING3"X3" PADS

3MO

KERLIX SPONGES 4" X 4"12 PLY PADS 3 RX/OTC; MO

KERLIX SPONGES 4" X 4"16 PLY PADS 3 RX/OTC; MO

MIRASORB SPONGES 2"X 2" MISC 3 RX/OTC; MO

MIRASORB SPONGES 4"X 4" MISC 3 RX/OTC; MO

NU GAUZE 4PLY 4"X4"PADS 3 RX/OTC; MO

NU GAUZE GENERAL-USE SPONGES 4"X4" 4PLY MISC

3RX/OTC; MO

OPTIFOAM PADS 3 RX/OTC; MO

POLYMEM DRESSING/3"X 3" PADS 3 MO

POLYMEM DRESSING/4"X 4" PADS 3 RX/OTC; MO

QC ALL PURPOSEDRESSINGS4"X4" PADS 3 RX/OTC; MO


86

Drug Name DrugTier

Requirements/Limits

QC BORDER ISLANDGAUZE PAD 2"X2" PADS 3 RX/OTC; MO

QC STERILE PADS PADS 3 MO

QC STERILE PADS PADS 3 RX/OTC; MO

RA ALL PURPOSEDRESSINGS4"X4" PADS 3 RX/OTC; MO

RA DRESSING SPONGES4"X4" PADS 3 RX/OTC; MO

RA GAUZE SPONGES4"X4" PADS 3 RX/OTC; MO

RA STERILE PADS 2"X2"PADS 3 RX/OTC; MO

RA STERILE PADS 3"X3"PADS 3 MO

RA STERILE PADS 4"X4"PADS 3 RX/OTC; MO

RAY-TEC X-RAYDETECTABLESPONGES4" X 4" 16 PLY MISC

3RX/OTC; MO

RESTORE CONTACTLAYER/NON-ADHERENT2"X2" PADS

3RX/OTC; MO

RESTORE FOAMDRESSING BORDERED4"X4" PADS

3RX/OTC; MO

RESTORE FOAMDRESSING NON-BORDERED 4"X4" PADS

3RX/OTC; MO

RESTORE ODORABSORBING DRESSING4"X4" PADS

3RX/OTC; MO

RESTORE TRIOABSORBENT DRESSING3"X3" PADS

3MO

SM GAUZE PADS 2"X2"PADS 3 RX/OTC; MO

SM GAUZE PADS 3"X3"PADS 3 MO

SM GAUZE PADS 4"X4"PADS 3 RX/OTC; MO

SM STERILE PADS 2"X2"PADS 3 RX/OTC; MO

SM STERILE PADS PADS 3 RX/OTC; MO

Drug Name DrugTier

Requirements/Limits

SOF-WICK 4"X4" PADS 3 RX/OTC; MO

STERILE GAUZE PADS2"X2" PADS 3 RX/OTC; MO

STERILE GAUZE PADS3"X3" PADS 3 MO

STERILE PADS 2"X2"PADS 3 RX/OTC; MO

STERILE PADS 3"X3"PADS 3 MO

STERILE PADS 4"X4"PADS 3 RX/OTC; MO

TEGADERM FOAMDRESSING 2"X2" PADS 3 RX/OTC; MO

TEGADERM FOAMDRESSING 4"X4" PADS 3 RX/OTC; MO

THERAGAUZE PADS 3 RX/OTC; MO

TOPPER DRESSINGSPONGES 4"X4" MISC 3 RX/OTC; MO

VERSIVA XC 3" X 3"FOAMDRESSING/HYDROFIBERTECHNOLOGY PADS

3

MO

VERSIVA XC 4" X 4"FOAMDRESSING/HYDROFIBERTECHNOLOGY PADS

3

RX/OTC; MO

VISTEC X-RAYDETECTABLE SPONGES4"X4" 16 PLY PADS

3RX/OTC; MO

ContraceptivesFC FEMALE CONDOMMISC 6

FC2 FEMALE CONDOMMISC 6

Diabetic SuppliesACCU-CHEK ACTIVEGLUCOSECONTROLSOLUTION LIQD

3MO

ACCU-CHEK AVIVACONNECT KIT 3 RX/OTC

ACCU-CHEK AVIVA PLUSKIT 3 RX/OTC

ACCU-CHEK AVIVA SOLN 3 MO


87

Drug Name DrugTier

Requirements/Limits

ACCU-CHEK COMFORTCURVE CONTROLSOLUTION (2 LEVELS)SOLN

3

MO

ACCU-CHEK COMFORTCURVE LINEARITYSOLUTION SOLN

3MO

ACCU-CHEK COMPACTPLUS CLEAR CONTROLSOLUTION (2 LEVELS)SOLN

3

MO

ACCU-CHEK NANOSMARTVIEW KIT 3 RX/OTC

ACCU-CHEK SMARTVIEWCONTROL LIQD 3 MO

ACCUTREND GLUCOSECONTROL SOLN 3 MO

ACURA BLOODGLUCOSE MONITORINGSYSTEM METER KIT KIT

3RX/OTC

ACURA BLOODGLUCOSE MONITORINGSYSTEM STARTER KITKIT

3

RX/OTC

ACURA CONTROLSOLUTION HIGH SOLN 3 MO

ACURA CONTROLSOLUTION LOW SOLN 3 MO

ACURA CONTROLSOLUTION NORMALSOLN

3MO

ACURA PLUS BLOODGLUCOSEMONITORINGSYSTEM METER KIT KIT

3RX/OTC

ACURA PLUS BLOODGLUCOSEMONITORINGSYSTEM STARTER KITKIT

3

RX/OTC

ADVANCE INTUITIONBLOOD GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

ADVANCE INTUITIONCONTROL SOLUTIONLIQD

3MO

ADVANCE MICRO-DRAWCONTROL LEVEL 1-2LIQD

3MO

Drug Name DrugTier

Requirements/Limits

ADVANCE MICRO-DRAWNORMAL CONTROL LIQD 3 MO

ADVOCATE BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

ADVOCATE BLOODGLUCOSE MONITORINGSYSTEM/TALKING KIT

3RX/OTC

ADVOCATE CONTROLSOLUTIONHIGH LIQD 3 MO

ADVOCATE CONTROLSOLUTIONLOW LIQD 3 MO

ADVOCATE REDI-CODE+CONTROL SOLUTIONHIGH SOLN

3MO

ADVOCATE REDI-CODE+CONTROL SOLUTIONLOW SOLN

3MO

ADVOCATE REDI-CODE+/TALKING KIT 3 RX/OTC

ADVOCATE REDI-CODE/TALKING KIT 3 RX/OTC

AGAMATRIX CONTROLHIGH SOLN 3 MO

AGAMATRIX CONTROLNORMAL SOLN 3 MO

AGAMATRIX CONTROLNORMAL& HIGH SOLN 3 MO

AGAMATRIX JAZZWIRELESS 2 KIT 3 RX/OTC

AGAMATRIX PRESTO KIT 3 RX/OTC

ASCENSIA AUTODISCLOW ANDHIGHCONTROLS LIQD

3MO

ASCENSIA AUTODISCNORMALCONTROL LIQD 3 MO

ASSURE 3 CONTROLLEVEL 1/2 LIQD 3 MO

ASSURE 4 CONTROLLEVEL 1/2 LIQD 3 MO

ASSURE DOSE NORMALCONTROL SOLN 3 MO

ASSURE DOSENORMAL/HIGH CONTROLSOLN

3MO


88

Drug Name DrugTier

Requirements/Limits

ASSURE II CONTROLLEVEL 1 LIQD 3 MO

ASSURE II CONTROLLEVEL 1/2 LIQD 3 MO

ASSURE PRISMCONTROL LEVEL 1/2SOLN

3MO

ASSURE PRO CONTROLLEVEL1/2 LIQD 3 MO

AT LAST CONTROLSOLUTION SOLN 3 MO

BAYER BREEZE 2 BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

BAYER BREEZE 2 HIGHCONTROL LIQD 3 MO

BAYER BREEZE 2 LOWCONTROL LIQD 3 MO

BAYER BREEZE 2NORMAL CONTROL LIQD 3 MO

BAYER CONTOURBLOOD GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

BAYER CONTOUR HIGHCONTROL LIQD 3 MO

BAYER CONTOUR LINKBLOODGLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

BAYER CONTOUR LOWCONTROL LIQD 3 MO

BAYER CONTOUR NEXTBLOODGLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

BAYER CONTOUR NEXTCONTROL LEVEL 1 SOLN 3 MO

BAYER CONTOUR NEXTCONTROL LEVEL 2 SOLN 3 MO

BAYER CONTOUR NEXTEZ BLOOD GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

Drug Name DrugTier

Requirements/Limits

BAYER CONTOUR NEXTLINK BLOOD GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

BAYER CONTOUR NEXTLINK WIRELESS BLOODGLUCOSE MONITORINGSY KIT

3

RX/OTC

BAYER CONTOUR NEXTUSB BLOOD GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

BAYER CONTOURNORMAL CONTROL LIQD 3 MO

BD LATITUDE DIABETESMANAGEMENT SYSTEMKIT

3RX/OTC

BD LOGIC BLOODGLUCOSE MONITOR KIT 3 RX/OTC

BLOOD GLUCOSEMETERS 3

BLOOD GLUCOSEMONITORINGSYSTEMKIT

3RX/OTC

BLOOD GLUCOSEMONITORINGSYSTEMPREMIUM KIT

3RX/OTC

BLOOD GLUCOSESYSTEM PAK KIT 3 RX/OTC

CAREONE BLOODGLUCOSE MONITORINGSYSTEM/PREMIUM KIT

3RX/OTC

CAREONE BLOODGLUCOSE MONITORINGSYSTEM/VALUE KIT

3RX/OTC

CARESENS CONTROL ASOLUTION SOLN 3 MO

CLEVER CHEK BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

CLEVER CHOICEGLUCOSE CONTROLHIGH LIQD

3MO

CLEVER CHOICEGLUCOSE CONTROLLOW LIQD

3MO


89

Drug Name DrugTier

Requirements/Limits

CLEVER CHOICE MICROBLOODGLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

CONTROL BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

CONTROL SOLUTIONNORMAL SOLN 3 MO

COOL BLOOD GLUCOSEMONITORING KIT KIT 3 RX/OTC

COOL CONTROLSOLUTION A SOLN 3 MO

COOL CONTROLSOLUTION B SOLN 3 MO

CVS ADVANCEDGLUCOSE METER KIT 3 RX/OTC

DIATRUE GLUCOSECONTROL SOLUTIONLEVEL 1 SOLN

3MO


3MO


3MO

DIDGET KIT 3 RX/OTC

DUO-CARE CONTROLSOLUTION LIQD 3 MO

EASY PLUS BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

EASY PLUS II CONTROLSOLUTION HIGH SOLN 3 MO

EASY PLUS II CONTROLSOLUTION LOW SOLN 3 MO

EASY STEP BLOODGLUCOSE MONITORSTARTER KIT KIT

3RX/OTC

EASY STEP CONTROLSOLUTION HIGH SOLN 3 MO

EASY STEP CONTROLSOLUTION LOW SOLN 3 MO

EASY STEP CONTROLSOLUTION NORMALSOLN

3MO

Drug Name DrugTier

Requirements/Limits

EASY TALK BLOODGLUCOSE MONITORINGSYSTEM/TALKING KIT

3RX/OTC

EASY TALK CONTROLSOLUTION HIGH SOLN 3 MO

EASY TALK CONTROLSOLUTION LOW SOLN 3 MO

EASY TALK CONTROLSOLUTION NORMALSOLN

3MO

EASY TOUCH CONTROLSOLUTION/HIGH & LOWSOLN

3MO

EASY TOUCH GLUCOSEMONITORING SYSTEMKIT

3RX/OTC

EASY TOUCHHEALTHPRO CONTROLSOLUTION/HIGH & LOWSOLN

3

MO

EASY TOUCHHEALTHPRO GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

EASY TRAK BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

EASY TRAK GLUCOSECONTROLSOLUTIONHIGH SOLN

3MO

EASY TRAK GLUCOSECONTROLSOLUTIONLOW SOLN

3MO

EASY TRAK GLUCOSECONTROLSOLUTIONNORMAL SOLN

3MO

EASYGLUCO CONTROLSOLUTION HIGH SOLN 3 MO

EASYGLUCO CONTROLSOLUTION LOW SOLN 3 MO

EASYGLUCO CONTROLSOLUTION NORMALSOLN

3MO

EASYGLUCO PLUSBLOOD GLUCOSEMONITORING SYSTEMMETER KIT KIT

3

RX/OTC


90

Drug Name DrugTier

Requirements/Limits

EASYGLUCO PLUSBLOOD GLUCSEMONITORING SYSTEMSTARTER KIT KIT

3

RX/OTC

EASYGLUCO PLUSCONTROL SOLUTIONLEVEL 1 SOLN

3MO

EASYMAX 15 GLUCOSECONTROL SOLUTIONLEVEL 1/LEVEL 2 SOLN

3MO

EASYMAX 15 LEVEL 1GLUCOSE CONTROLSOLUTION SOLN

3MO

EASYMAX 15 LEVEL 2GLUCOSE CONTROLSOLUTION SOLN

3MO

EASYMAX CONTROLSOLUTIONHIGH SOLN 3 MO

EASYMAX CONTROLSOLUTIONLOW SOLN 3 MO

EASYMAX CONTROLSOLUTIONNORMALSOLN

3MO

EASYMAX GLUCOSECONTROL SOLUTIONNORMAL/LOW SOLN

3MO

EASYMAX L BLOODGLUCOSE SYSTEM KIT 3 RX/OTC

EASYMAX N BLOODGLUCOSE SYSTEM KIT 3 RX/OTC

EASYMAX NG SELF-MONITORING BLOODGLUCOSE SYSTEM KIT

3RX/OTC

EASYMAX V BLOODGLUCOSESYSTEM/TALKING KIT

3RX/OTC

EASYMAX V2 SELF-MONITORING BLOODGLUCOSESYSTEM/SPEAKING KIT

3

RX/OTC

EASYPLUS R13N SELF-MONITORING BLOODGLUCOSE SYSTEM KIT

3RX/OTC

EASYPLUS V SELF-MONITORING BLOODGLUCOSESYSTEM/SPEAKING KIT

3

RX/OTC

Drug Name DrugTier

Requirements/Limits

EASYPRO BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

EASYPRO PLUS KIT 3 RX/OTC

ELEMENT AUTOCODESYSTEM KIT 3 RX/OTC

ELEMENT COMPACTCONTROL SOLUTIONLEVEL 2 SOLN

3MO

ELEMENT COMPACTCONTROL SOLUTIONLEVEL 3 SOLN

3MO

ELEMENT HIGHCONTROL LIQD 3 MO

ELEMENT LOWCONTROL LIQD 3 MO

ELEMENT NORMALCONTROL LIQD 3 MO

EMBRACE CONTROLSOLUTIONLOW SOLN 3 MO

EMBRACE EVO BLOODGLUCOSE MONITORINGKIT KIT

3RX/OTC

EMBRACE EVOGLUCOSE CONTROLSOLUTION LEVEL 1 LIQD

3MO

EMBRACE EVOGLUCOSE CONTROLSOLUTION LEVEL 2 LIQD

3MO

EMBRACE GLUCOSECONTROL SOLUTIONHIGH LIQD

3MO

EMBRACE PROGLUCOSE CONTROLSOLUTION LIQD

3MO

EQL TRUE2GO BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

EVENCARE CONTROLSOLUTION LIQD 3 MO

EVENCARE G2 GLUCOSECONTROLSOLUTION/LOW-HIGHSOLN

3

MO


91

Drug Name DrugTier

Requirements/Limits

EVENCARE G3 GLUCOSECONTROLSOLUTION/LOW-HIGHSOLN

3

MO

EVENCARE MINIGLUCOSE CONTROLSOLUTION NORMALSOLN

3

MO

EVOLUTION CONTROLSOLUTION NORMALSOLN

3MO

FIFTY50 CONTROLSOLUTION2.0 SOLN 3 MO

FIFTY50 GLUCOSEMETER 2.0 KIT 3 RX/OTC

FORA CONTROLSOLUTION HIGH SOLN 3 MO

FORA CONTROLSOLUTION LOW SOLN 3 MO

FORA CONTROLSOLUTION NORMALSOLN

3MO

FORA G20 BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

FORA TN'G VOICEBLOOD GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

FORA V30A BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

FORACARE GDHCONTROL SOLUTIONHIGH SOLN

3MO

FORACARE GDHCONTROL SOLUTIONLOW SOLN

3MO

FORACARE GDHCONTROL SOLUTIONNORMAL SOLN

3MO

FORTISCARE CONTROLSOLUTIONS HIGH SOLN 3 MO

FORTISCARE CONTROLSOLUTIONS LOW SOLN 3 MO

Drug Name DrugTier

Requirements/Limits

FORTISCARE CONTROLSOLUTIONS NORMALSOLN

3MO

FORTISCARE SELF-MONITORING BLOODGLUCOSE SYSTEM KIT

3RX/OTC

FREESTYLE CONTROLSOLUTION HIGH/LOWLIQD

3MO

FREESTYLE CONTROLSOLUTION LIQD 3 MO

FREESTYLE FREEDOMKIT 3 RX/OTC

FREESTYLE FREEDOMLITE KIT 3 RX/OTC

FREESTYLE INSULINXBLOODGLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

FREESTYLE PRECISIONNEO BOOD GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

FREESTYLE SIDEKICK IIVALUEPACK KIT 3 RX/OTC

GE100 BLOOD GLUCOSEMONITORING SYSTEMKIT

3RX/OTC

GE100 CONTROLSOLUTION NORMALSOLN

3MO

GHT BLOOD GLUCOSEMONITORING SYSTEMKIT

3RX/OTC

GLUCOCARD 01 BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

GLUCOCARD 01CONTROL SOLUTIONNORMAL/HIGH LIQD

3MO

GLUCOCARD 01CONTROLSOLUTION/NORMALSOLN

3

MO

GLUCOCARD 01-MINIBLOOD GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC


92

Drug Name DrugTier

Requirements/Limits

GLUCOCARDEXPRESSION AUDIO-ENABLED BLOODGLUCOSE MONITORINGKIT

3

RX/OTC

GLUCOCARDEXPRESSION CONTROLSOLUTION LEVEL 1SOLN

3

MO

GLUCOCARD SHINECONTROL SOLUTIONLEVEL 1 SOLN

3MO

GLUCOCARD SHINE KIT 3 RX/OTC

GLUCOCARD VITALBLOOD GLUCOSEMONITORING SYSTEMBLACK KIT

3

RX/OTC

GLUCOCARD VITALBLOOD GLUCOSEMONITORING SYSTEMBLUE KIT

3

RX/OTC

GLUCOCARD VITALBLOOD GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

GLUCOCARD VITALBLOOD GLUCOSEMONITORING SYSTEMPINK KIT

3

RX/OTC

GLUCOCARD X-METERCONTROLSOLUTION/NORMAL SOLN

3MO

GLUCOCARD X-METERKIT 3 RX/OTC

GLUCOCOM BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

GLUCOCOM BLOODGLUCOSE MONITORINGSYSTEM VALUE KIT KIT

3RX/OTC

GLUCOCOM HIGHCONTROL LIQD 3 MO

GLUCOCOM NORMALCONTROL LIQD 3 MO

GLUCONAVII BLOODGLUCOSEMONITORINGSYSTEM KIT

3RX/OTC

Drug Name DrugTier

Requirements/Limits

GLUCOSE CONTROLNORMAL SOLN 3 MO

GLUCOSE CONTROLSOLUTION SOLN 3 MO

GMATE CONTROLSOLUTION LEVEL 2SOLN

3MO

GMATE SMART STARTERKIT KIT 3 RX/OTC

GNP EASY TOUCHCONTROL SOLUTIONHIGH/LOW SOLN

3MO

IBG STAR BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

IN TOUCH GLUCOSECONTROLSOLUTIONSOLN

3MO

INFINITY BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

INFINITY BLOODGLUCOSE MONITORINGSYSTEM/STARTER KITKIT

3

RX/OTC

INFINITY CONTROLSOLUTION HIGH SOLN 3 MO

INFINITY CONTROLSOLUTION LOW SOLN 3 MO

INFINITY CONTROLSOLUTION NORMALSOLN

3MO

KROGER BLOODGLUCOSE MONITORINGKIT KIT

3RX/OTC

KROGER PREMIUMBLOOD GLUCOSEMONITORING KIT KIT

3RX/OTC

LANCET DEVICES 3 QL(1 ea per180 days)

LANCETS 3 QL(6.67 eadaily)

LDR BLOOD GLUCOSETRUETEST KIT KIT 3 RX/OTC

LIBERTY CONTROLSOLUTION HIGH SOLN 3 MO


93

Drug Name DrugTier

Requirements/Limits

LIBERTY CONTROLSOLUTIONNORMALSOLN

3MO

LIBERTY GLUCOSECONTROL LEVEL 1 SOLN 3 MO

LIBERTY GLUCOSECONTROL LEVEL 2 SOLN 3 MO

LIBERTY GLUCOSECONTROL MID SOLN 3 MO

LIBERTY GLUCOSECONTROL NORMAL LIQD 3 MO

MAXIMA BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

MAXIMA CONTROLSOLUTION SOLN 3 MO

MAXIMA CONTROLSOLUTION/NORMALSOLN

3MO

MAXIMA METER KIT KIT 3 RX/OTC

MAXIMA STARTER KITKIT 3 RX/OTC

MEDISENSE GLUCOSEKETONECONTROLSOLUTION 1-LOW,1-MED,1 HIGH LIQD

3

MO

MEDISENSE GLUCOSEKETONECONTROLSOLUTION 1-NORMALLIQD

3

MO

MEDISENSE HIGH/LOWCONTROL SOLUTIONLIQD

3MO

MEDISENSEHIGH/MID/LOWCONTROL SOLUTIONLIQD

3

MO

MEDISENSE MIDCONTROL SOLUTIONLIQD

3MO

MEIJER BLOODGLUCOSE MONITORINGKIT KIT

3RX/OTC

MEIJER ESSENTIALBLOOD GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

Drug Name DrugTier

Requirements/Limits

MEIJER PREMIUMBLOOD GLUCOSEMONITORING KIT KIT

3RX/OTC

MEIJER TRUE2GOBLOOD GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

MEIJER TRUERESULTBLOOD GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

MEIJER TRUETRACKBLOOD GLUCOSEMONITORING KIT KIT

3RX/OTC

MICRODOT BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

MICRODOT CONTROLSOLUTIONHIGH/LOWSOLN

3MO

MYGLUCOHEALTHBLOOD GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

MYGLUCOHEALTHCONTROLLOW/NORMAL/HIGHSOLN

3

MO

NEUTEK 2TEK CONTROLSOLUTIONS SOLN 3 MO

NEXGEN NORMALCONTROL LIQD 3 MO

NOVA MAX BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

NOVA MAX PLUSGLU/KET CONTROLSOLUTION-MID LIQD

3MO

ON CALL EXPRESSBLOOD GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

ON CALL EXPRESSGLUCOSE CONTROLSOLUTION SOLN

3MO

ON CALL PLUS BLOODGLUCOSE METER KIT 3 RX/OTC


94

Drug Name DrugTier

Requirements/Limits

ON CALL PLUS BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

ON CALL PLUSGLUCOSE CONTROLLEVEL 1/2 SOLN

3MO

ON CALL VIVID BLOODGLUCOSE METER KIT 3 RX/OTC

ON CALL VIVID BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

ON CALL VIVIDGLUCOSE CONTROLLEVEL 1/2 SOLN

3MO

ON CALL VIVID PALBLOOD GLUCOSEMETER KIT

3RX/OTC

ONETOUCH ULTRA 2 KIT 3 RX/OTC

ONETOUCH ULTRACONTROL SOLN 3 MO

ONETOUCH ULTRA MINIKIT 3 RX/OTC

ONETOUCH ULTRALINKSYSTEM (DEC) KIT 3 RX/OTC

ONETOUCH ULTRALINKSYSTEM (HEX) KIT 3 RX/OTC

ONETOUCH VERIOCONTROL SOLUTIONHIGH SOLN

3MO

ONETOUCH VERIO FLEXBLOODGLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

ONETOUCH VERIO IQBLOOD GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

ONETOUCH VERIO KIT 3 RX/OTC

ONETOUCH VERIO MIDCONTROL SOLUTIONSOLN

3MO

ONETOUCH VERIO SYNCBLOODGLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

Drug Name DrugTier

Requirements/Limits

OPTIUM BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

OPTUMRX BLOODGLUCOSE METER KIT 3 RX/OTC

OPTUMRX BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

OPTUMRX GLUCOSECONTROL LEVEL 1/2SOLN

3MO

PARADIGM LINK BLOODGLUCOSE MONITOR KIT 3 RX/OTC

PHARMACIST CHOICEAUTOCODE BLOODGLUCOSE MONITORINGSYSTEM KIT

3

RX/OTC

POCKETCHEM EZBLOOD GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

POCKETCHEM EZCONTROL LEVEL 1 SOLN 3 MO

PRECISION GLUCOSECONTROL LIQD 3 MO

PRECISION GLUCOSECONTROLSOLUTION(TRI-LEVEL/HI/LO/NORMAL)SOLN

3

MO

PRECISION GLUCOSEKETONECONTROLSOLUTION 1-LOW, 1-HIGH LIQD

3

MO

PRECISIONGLUCOSE/KETONECONTROL SOLUTIONS 1-HI 1-LO LIQD

3

MO

PRECISION LINK KIT 3 RX/OTC

PRODIGY AUTOCODEBLOOD GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

PRODIGY AUTOCODEBLOOD GLUCOSEMONITORING/TALKINGKIT

3

RX/OTC


95

Drug Name DrugTier

Requirements/Limits

PRODIGY CONTROLSOLUTIONHIGH SOLN 3 MO

PRODIGY CONTROLSOLUTIONLOW SOLN 3 MO

PRODIGY POCKETBLOOD GLUCOSEMETER KIT KIT

3RX/OTC

PRODIGY VOICE BLOODGLUCOSE METER KITKIT

3RX/OTC

QUICKTEK CONTROLSOLUTION LIQD 3 MO

QUICKTEK KIT 3 RX/OTC

QUINTET GLUCOSECONTROL/HIGH/NORMALSOLN

3MO

RA TRUE2GO BLOODGLUCOSEMONITORINGSYSTEM KIT

3RX/OTC

RA TRUERESULT BLOODGLUCOSE MONITOR KIT 3 RX/OTC

REFUAH PLUS BLOODGLUCOSEMONITORINGSYSTEM KIT

3RX/OTC

REFUAH PLUS GLUCOSECONTROL SOLUTIONSOLN

3MO

RELION CONFIRMBLOOD GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

RELION MICRO BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

RELION ULTIMA BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

REVEAL BLOODGLUCOSE MONITOR KIT 3 RX/OTC

REXALL BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

RIGHTEST GC300 HIGHCONTROL LIQD 3 MO

RIGHTEST GC300NORMAL CONTROL LIQD 3 MO

Drug Name DrugTier

Requirements/Limits

RIGHTEST GM100BLOOD GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC


3

RX/OTC


3

RX/OTC

SMART DIABETESXPRES BLOODGLUCOSE MONITORINGSYSTEM KIT

3

RX/OTC

SMART SENSE PREMIUMBLOODGLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

SMART SENSE VALUEBLOODGLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

SMARTEST CONTROLSOLUTIONMEDIUM SOLN 3 MO

SMARTEST EJECTSTARTER KIT KIT 3 RX/OTC

SMARTEST PERSONASTARTERKIT KIT 3 RX/OTC

SMARTEST PRONTOSTARTERKIT KIT 3 RX/OTC

SMARTEST PROTEGESTARTERKIT KIT 3 RX/OTC

SOLARTEK GLUCOSECONTROLSOLUTIONSLIQD

3MO

SOLUS V2 AUDIBLEBLOOD GLUCOSEMANAGEMENT SYSTEMKIT

3

RX/OTC

SOLUS V2 CONTROLHIGH SOLN 3 MO

SOLUS V2 CONTROLLOW SOLN 3 MO

SUPREME II HIGH/LOWCONTROL SOLUTIONLIQD

3MO


96

Drug Name DrugTier

Requirements/Limits

SURECHEK BLOODGLUCOSE MONITORINGSYSTEM STARTER KITKIT

3

RX/OTC

SURESTEP GLUCOSECONTROL SOLN 3 MO

SURESTEP GLUCOSECONTROLSOLUTIONSOLN

3MO

SURESTEP PRO HIGHGLUCOSECONTROLLIQD

3MO

SURESTEP PRO LOWGLUCOSECONTROLLIQD

3MO

SURESTEP PRONORMAL GLUCOSECONTROL LIQD

3MO

TAI DOC CONTROL SOLN 3 MO

TELCARE BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

TELCARE GLUCOSECONTROL SOLUTIONLEVEL 1/2 SOLN

3MO

TGT BLOOD GLUCOSEMETER MONITORINGSYSTEM KIT

3RX/OTC

TGT BLOOD GLUCOSEMONITORING SYSTEMKIT

3RX/OTC

TGT BLOOD GLUCOSEMONITORING SYSTEMPREMIUM KIT

3RX/OTC

TRUE METRIX AIRBLOOD GLUCOSEMETER/BLUETOOTHSMART KIT

3

RX/OTC

TRUE METRIX AIRW/BLUETOOTH SMARTKIT

3RX/OTC

TRUE METRIX BLOODGLUCOSEMETER KIT 3 RX/OTC

TRUE METRIX CONTROLSOLUTION LEVEL 1SOLN

3MO

Drug Name DrugTier

Requirements/Limits


3MO


3MO

TRUE METRIX GOBLOOD GLUCOSEMETER KIT

3RX/OTC

TRUE2GO BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

TRUECONTROLGLUCOSE CONTROLLEVEL 0 LIQD

3MO

TRUECONTROLGLUCOSE CONTROLLEVEL 1 LIQD

3MO

TRUERESULT BLOODGLUCOSEMONITORINGSYSTEM KIT

3RX/OTC

TRUERESULT BLOODGLUCOSEMONITORINGSYSTEM/NO CODING KIT

3RX/OTC

TRUETEST GLUCOSECONTROLLEVEL 1 LIQD 3 MO



TRUETRACK BLOODGLUCOSE MONITORINGSYSTEM KIT

3RX/OTC

TRUETRACK SMARTSYSTEM KIT 3 RX/OTC

ULTRA TRAK PROBLOOD GLUCOSEMONITORING SYSTEMKIT

3

RX/OTC

ULTRATRAK PROCONTROL SOLUTION 2LEVELS SOLN

3MO

ULTRATRAK PRONORMAL CONTROLSOLN

3MO


97

Drug Name DrugTier

Requirements/Limits

ULTRATRAK ULTIMATECONTROL SOLUTION 2LEVELS SOLN

3MO

UNISTRIP CONTROLSOLUTIONHIGH SOLN 3 MO

UNISTRIP CONTROLSOLUTIONLOW SOLN 3 MO

VICTORY CONTROLLEVEL 1/2 SOLN 3 MO

WAVESENSE AMP KIT 3 RX/OTC

WAVESENSE KEYNOTEKIT 3 RX/OTC

XPRES CONTROLSOLUTION NORMALSOLN

3MO

Misc. DevicesALCOH-GLOVECONTOURED WIPE PADS 3 RX/OTC

ALCOH-WIPE 12" X 12"PADS 3 RX/OTC

ALCOHOL PADS PADS 3 RX/OTC

ALCOHOL PREP PADSPADS 3 RX/OTC

ALCOHOL PREPS PADS 3 RX/OTC

ALCOHOL SWABS PADS 3 RX/OTC

ALCOHOL SWABSTICKPADS 3 RX/OTC

ALCOHOL WIPES PADS 3 RX/OTC

BD SWABS SINGLE USEBUTTERFLY PADS 3 RX/OTC

BD SWABS SINGLE USEPADS 3 RX/OTC

CARETOUCH ALCOHOLPREP PADS PADS 3 RX/OTC

CURITY ALCOHOLPREPS/MEDIUM 2 PLYPADS

3RX/OTC

CURITY ALCOHOLSWABS PADS 3 RX/OTC

CVS ALCOHOL PREPSWABS PADS 3 RX/OTC

Drug Name DrugTier

Requirements/Limits

CVS ALCOHOL SWABSPADS 3 RX/OTC

CVS PREP PADS PADS 3 RX/OTC

EASY TOUCH ALCOHOLPREP PADS/MEDIUMPADS

3RX/OTC

EQL ALCOHOL SWABSPADS 3 RX/OTC

FIFTY50 ALCOHOL PREPPADS PADS 3 RX/OTC

GLOBAL ALCOHOL PREPEASEPADS PADS 3 RX/OTC

GNP ALCOHOL SWABSPADS 3 RX/OTC

H-E-B INCONTROLALCOHOL PADS PADS 3 RX/OTC

HEALTHWISE ALCOHOLPREP PADS PADS 3 RX/OTC

MEIJER ALCOHOLSWABS EXTRA-THICKPADS

3RX/OTC

PHARMACIST CHOICEALCOHOLPREP PADSPADS

3RX/OTC

PRO COMFORTALCOHOL PADS PADS 3 RX/OTC

QC ALCOHOL SWABSPADS 3 RX/OTC

RA ALCOHOL SWABSPADS 3 RX/OTC

REALITY SWABS PADS 3 RX/OTC

RELION ALCOHOLSWABS PADS 3 RX/OTC

SAPS CARE ALCOHOLPREP PADS PADS 3 RX/OTC

SB ALCOHOL PREPPADS PADS 3 RX/OTC

SHOPKO ALCOHOLSWABS PADS 3 RX/OTC

SM ALCOHOL PREPPADS PADS 3 RX/OTC

SURE COMFORTALCOHOL PREP PADSPADS

3RX/OTC


98

Drug Name DrugTier

Requirements/Limits

SURE-PREP ALCOHOLPREP PADS PADS 3 RX/OTC

TGT ALCOHOL SWABSPADS 3 RX/OTC

ULTICARE ALCOHOLSWABS PADS 3 RX/OTC

WEBCOL ALCOHOLPREP LARGE 1 PLYPADS

3RX/OTC

WEBCOL ALCOHOLPREP LARGE 2 PLYPADS

3RX/OTC

WEBCOL ALCOHOLPREP MEDIUM 2 PLYPADS

3RX/OTC

Parenteral Therapy SuppliesAUTOJECT 2 MISC 4 PA; RX/OTC

BD AUTOSHIELD DUO30G X 3/16" MISC 3 QL(5 ea daily)

CORNWALL METALPIPETTINGHOLDER (FOR1240S) MISC

4PA; RX/OTC


4PA; RX/OTC


4PA; RX/OTC


4PA; RX/OTC

HUMATROPEN FOR12MG DEVI 4 PA; RX/OTC

HUMATROPEN FOR24MG DEVI 4 PA; RX/OTC

HUMATROPEN FOR 6MGDEVI 4 PA; RX/OTC

INJECT-EASEAUTOMATIC INJECTORMISC

4PA; RX/OTC

INJECT-EASE MISC 4 PA; RX/OTC

INSULIN SYRINGES ANDPEN NEEDLES 3 QL(5 ea daily);

RX/OTCJ-TIP KIT W/VIALADAPTERS KIT 5 PA

Drug Name DrugTier

Requirements/Limits

NORDIPEN 5 INJECTIONDEVICE MISC 4 PA; RX/OTC

NORDIPEN DELIVERYSYSTEM MISC 4 PA; RX/OTC

OMNITROPE PEN 10INJECTION DEVICE MISC 4 PA; RX/OTC

OMNITROPE PEN 5INJECTION DEVICE MISC 4 PA; RX/OTC

PCA INJECTOR MISC 4 PA; RX/OTC

PLASTIC ADAPTER FORBUSHINJECTOR B-DPLASTIPAK MISC

4PA; RX/OTC

PLASTIC ADAPTER FORBUSHINJECTOR MISC 5 PA

MIGRAINE PRODUCTS - Drugs to Treat MigraineHeadachesMigraine CombinationsMIGERGOT SUPP 4 AL

TREXIMET TABS 4 QL(0.3 eadaily)

Migraine ProductsD.H.E. 45 SOLN (UseDihydroergotamineMesylate)

5AL

dihydroergotaminemesylate soln ij 1 mg/ml 2 AL

DIHYDROERGOTAMINEMESYLATE SOLN NA 4MG/ML

5QL(0.2667 mldaily); AL

MIGRANAL SOLN 5 QL(0.2667 mldaily); AL

Serotonin Agonistsalmotriptan malate tabs12.5 mg 2 QL(0.4 ea

daily); ALalmotriptan malate tabs6.25 mg 2 QL(0.2 ea

daily); ALAMERGE TABS (UseNaratriptan HCl) 5 QL(0.3 ea

daily); ALAXERT TABS 12.5 MG(Use Almotriptan Malate) 5 QL(0.4 ea

daily); ALAXERT TABS 6.25 MG(Use Almotriptan Malate) 5 QL(0.2 ea

daily); AL


99

Drug Name DrugTier

Requirements/Limits

FROVA TABS (UseFrovatriptan Succinate) 5 QL(0.4 ea

daily); AL

frovatriptan succinate tabs 2 QL(0.4 eadaily); AL

IMITREX SOLN NA 20MG/ACT, 5 MG/ACT (UseSumatriptan)

5QL(0.2 eadaily); AL

IMITREX SOLN SC 6MG/0.5ML (UseSumatriptan Succinate)

5QL(0.134 mldaily)

IMITREX STATDOSEREFILL SOCT (UseSumatriptan Succinate)

5QL(0.134 mldaily)

IMITREX STATDOSESYSTEM SOAJ (UseSumatriptan Succinate)

5QL(0.134 mldaily)

IMITREX TABS OR 100MG, 50 MG, 25 MG (UseSumatriptan Succinate)

5QL(0.3 eadaily)

MAXALT TABS 10 MG(Use Rizatriptan Benzoate) 5 QL(0.6 ea

daily); ALMAXALT TABS 5 MG (UseRizatriptan Benzoate) 5 QL(0.4 ea

daily); ALMAXALT-MLT TBDP 10MG (Use RizatriptanBenzoate)

5QL(0.6 eadaily); AL

MAXALT-MLT TBDP 5 MG(Use Rizatriptan Benzoate) 5 QL(0.4 ea

daily); AL

naratriptan hcl tabs 2 QL(0.3 eadaily); AL

RELPAX TABS 20 MG 4 QL(0.2 eadaily); AL

RELPAX TABS 40 MG 4 QL(0.4 eadaily); AL

rizatriptan benzoate tabs10 mg 2 QL(0.6 ea

daily); ALrizatriptan benzoate tabs 5mg 2 QL(0.4 ea

daily); ALrizatriptan benzoate tbdp10 mg 2 QL(0.6 ea

daily); ALrizatriptan benzoate tbdp 5mg 2 QL(0.4 ea

daily); AL

sumatriptan soln 2 QL(0.2 eadaily); AL

sumatriptan succinate soajsc 4 mg/0.5ml, 6 mg/0.5ml 2 QL(0.134 ml

daily)

Drug Name DrugTier

Requirements/Limits

sumatriptan succinate soctsc 4 mg/0.5ml, 6 mg/0.5ml 2 QL(0.134 ml

daily)sumatriptan succinate solnsc 6 mg/0.5ml 2 QL(0.134 ml

daily)SUMATRIPTANSUCCINATE SOSY SC 6MG/0.5ML

4

sumatriptan succinate tabsor 100 mg, 50 mg, 25 mg 2 QL(0.3 ea

daily)

zolmitriptan tabs 2 QL(0.2 eadaily); AL

zolmitriptan tbdp 2 QL(0.2 eadaily); AL

ZOMIG NASAL SPRAYSOLN 4 QL(0.2 ea

daily); AL

ZOMIG SOLN NA 2.5 MG 4 QL(0.2 eadaily); AL

ZOMIG TABS OR 2.5 MG,5 MG (Use Zolmitriptan) 5 QL(0.2 ea

daily); ALZOMIG ZMT TBDP (UseZolmitriptan) 5 QL(0.2 ea

daily); AL

MINERALS & ELECTROLYTES

Bicarbonatessodium acetate soln 2

sodium bicarbonate soln 2

Calciumcalcium chloride (dihydrate)soln 2

calcium gluconate soln 2

CALCIUMGLUCONATE/DEXTROSESOLN

5

Electrolyte MixturesDEXTROSE 10%/NACL0.45% SOLN 4

DEXTROSE 5%/NACL0.225% SOLN 4

dextrose in lactated ringerssoln 2

dextrose w/ sodiumchloride soln 2


100

Drug Name DrugTier

Requirements/Limits

HYPERLYTE-CR SOLN 4

lactated ringer's soln 2

NORMOSOL-M IN D5WSOLN 5

parenteral electrolytes conc 2

parenteral electrolytes soln 2

POTASSIUM CHLORIDE/SODIUM CHLORIDESOLN

5

potassium chloride indextrose & sodium chloridesoln

2

potassium chloride indextrose soln 2

potassium chloride in naclsoln 2

POTASSIUMCHLORIDE/DEXTROSESOLN

4

ringer's soln 2

FluorideFLORIVA LIQD 5

FLUOR-A-DAY CHEW 5

FLUORABON SOLN 5 QL(6 ml per fillretail); PV

FLURA-DROPS SOLN 4

LOZI-FLUR LOZG 5

LURIDE SOLN (UseSodium Fluoride) 5

sodium fluoride chew 0.25mg, 2.2 mg, 1.1 mg, 1 mg,0.5 mg

2

sodium fluoride soln 0.125mg/drop, 0.5 mg/ml 2

SODIUM FLUORIDE TABS0.5 MG, 1 MG 4

Iodine Products

Drug Name DrugTier

Requirements/Limits

IODINE STRONG SOLNOR 4

Magnesiummagnesium chloride soln 2

MAGNESIUM SULFATE IND5W SOLN (UseMagnesium Sulfate inD5W)

5

magnesium sulfate in d5wsoln 2

magnesium sulfate soln ij50 % 2

magnesium sulfate soln iv2 gm/50ml, 40 gm/1000ml,4 gm/50ml, 4 gm/100ml, 20gm/500ml

2

MAGNESIUM SULFATESOLN IV 2 GM/50ML, 40GM/1000ML, 4 GM/50ML,4 GM/100ML, 20GM/500ML (UseMagnesium Sulfate)

5

MAGNESIUMSULFATE/LACTATEDRINGERS SOLN

5

ManganeseMANGANESE SULFATESOLN 4

MANGANESE TRACEMETAL SOLN 4

PhosphateK-PHOS NEUTRAL TABS(Use Pot PhosphateMonobasic w/ SodPhosphate Dibasic &Monobasic)

5

QL(8 ea daily)

pot phosphate monobasicw/ sod phosphate dibasic &monobasic tabs

2QL(8 ea daily)

potassium phosphates soln 2

POTASSIUMPHOSPHATES SOLN 4

sodium phosphate soln 2


101

Drug Name DrugTier

Requirements/Limits

PotassiumK-TAB TBCR 10 MEQ (UsePotassium Chloride) 5

K-TAB TBCR 20 MEQ, 8MEQ 4

MICRO-K CPCR (UsePotassium Chloride) 5

POTASSIUM ACETATESOLN 2 MEQ/ML (UsePotassium Acetate)

5

potassium acetate soln 2meq/ml, 4 meq/ml 2

POTASSIUM ACETATESOLN 4 MEQ/ML 4

potassium bicarb &chloride tbef 2

potassium bicarbonate tbef 2

potassium chloride cpcr or10 meq, 8 meq 2

POTASSIUM CHLORIDEER TBCR 4

potassium chloridemicroencapsulated crystalscr tbcr

2

potassium chloride pack or20 meq 2

potassium chloride soln iv0.4 meq/ml, 40 meq/100ml,20 meq/50ml, 20meq/100ml, 2 meq/ml, 10meq/100ml

2

POTASSIUM CHLORIDESOLN IV 10 MEQ/50ML 4

potassium chloride soln or10 %, 20 % 2

potassium chloride tbcr or10 meq, 8 meq 2

Sodiumsodium chloride flush soln 2

sodium chloride soln 2

Trace MineralsAMMONIUM MOLYBDATESOLN 4

Drug Name DrugTier

Requirements/Limits

CHROMIUM CHLORIDESOLN (Use ChromicChloride)

5

CHROMIUM CHLORIDESOLN 4

COPPER TRACE METALSOLN 4

SELENIUM SOLN 4

trace minerals (cr-cu-mn-se-zn) soln 2

trace minerals (cr-cu-mn-zn) soln 2

ZincZINC SULFATE SOLN 4

ZINC TRACE METALSOLN 4

MOUTH/THROAT/DENTAL AGENTS

Anesthetics Topical Oralbenzocaine (dental) soln 2 RX/OTC

HURRICAINE ONE SOLN(Use Benzocaine (Dental)) 5 RX/OTC

HURRICAINE SOLN (UseBenzocaine (Dental)) 5 RX/OTC

lidocaine hcl (mouth-throat)soln 2 QL(100 ml per

fill retail)LIDOCAINE HCL SOLNMT 4 % 4

Anti-infectives - Throatclotrimazole lozg 2

clotrimazole troc 2

nystatin (mouth-throat)susp 2 QL(120 ml per

fill retail)Antiseptics - Mouth/Throatchlorhexidine gluconate(mouth-throat) soln 2

PERIDEX SOLN (UseChlorhexidine Gluconate(Mouth-Throat))

5

Steroids - Mouth/Throat


102

Drug Name DrugTier

Requirements/Limits

triamcinolone acetonide(mouth) pste 2 QL(5 gm per fill

retail)Throat Products - Misc.cevimeline hcl caps 2

EPISIL LIQD 4

EVOXAC CAPS (UseCevimeline HCl) 5

MUGARD LIQD 4

pilocarpine hcl (oral) tabs 5mg 2 QL(6 ea daily)

pilocarpine hcl (oral) tabs7.5 mg 2

SALAGEN TABS 5 MG(Use Pilocarpine HCl(Oral))

5QL(6 ea daily)

SALAGEN TABS 7.5 MG(Use Pilocarpine HCl(Oral))

5

MULTIVITAMINS

B-Complex Vitaminsb-complex vitamins inj 2

b-complex vitamins soln 2

B-Complex w/ Folic Acidb-complex w/ c & folic acidcaps 1.5mg-5mg-20mg-1.7mg-6mcg-1mg-150mcg-10mg-100mg, 1.7mg-5mg-6mcg-1.5mg-20mg-1mg-150mcg-10mg-100mg

2

QL(1 ea daily)

b-complex w/ c & folic acidtabs 1.5mg-1.7mg-10mg-0.01mcg-20mg-1mg-300mcg-10mg-60mg,20mg-1.7mg-10mg-0.006mg-1.5mg-1mg-0.3mg-10mg-100mg,1.5mg-10mg-20mg-1.7mg-6mcg-1mg-300mcg-10mg-60mg

2

QL(1 ea daily)

Drug Name DrugTier

Requirements/Limits

b-complex w/ c & folic acidtabs 100mg-100mg-5.5mg-25mg-20mg-30mcg-400mcg-45mcg-5mg-180mg, 5mg-25mg-50mg-5mg-37.5mcg-200mcg-15mcg-5mg-150mg, 5mg-25mg-20mg-15mcg-100mg-400mcg-30mcg-2mg-150mg, 50mg-50mg-50mg-50mg-50mcg-50mg-400mcg-50mcg-500mg,50mg-50mg-50mg-50mg-50mcg-400mcg-50mcg-50mg-500mg, 30unit-10mg-20mg-100mg-10mg-12mcg-400mcg-45mcg-5mg-500mg, 30unit-10mg-100mg-10mg-20mg-12mcg-400mcg-45mcg-5mg-500mg, 30unit-100mg-10mg-1mg-20mg-1mg-1mg-10mg-12mcg-400mcg-45mcg-5mg-500mg, 25mg-5.5mg-25mg-20mg-100mcg-400mcg-1000mcg-5mg-60mg, 18mg-5mg-45mg-10mg-10mcg-400mcg-5mg-250mg, 15mg-50mg-10.2mg-10mg-6mcg-400mcg-5mg-300mg,15mg-50mg-10.2mg-10mg-400mcg-300mcg-5mg-300mg, 15mg-100mg-15mg-18mg-5mcg-0.5mg-4mg-500mg, 100mg-5.5mg-25mg-20mg-15mcg-400mcg-30mcg-2mg-150mg

2

RX/OTC

b-complex w/ c & folic acidtabs 10mg-20mg-1.5mg-1mg-1.5mg-5mg-300mcg-50mg-60mg, 20mg-1.5mg-10mg-1mg-1.5mg-5mg-300mcg-50mg-60mg

2

FOLBEE PLUS CZ TABS 4

MILCO-B-FORTE TABS(Use B-Complex w/ C &Folic Acid)

5RX/OTC


103

Drug Name DrugTier

Requirements/Limits

NEPHRO-VITE RX TABS(Use B-Complex w/ C &Folic Acid)

5QL(1 ea daily)

NEPHROCAPS CAPS(Use B-Complex w/ C &Folic Acid)

5QL(1 ea daily)

SM B-COMPLEX/VITAMINC TABS 4 RX/OTC

Multiple Vitamins w/ MineralsCORVITE TABS (UseMultiple Vitamins w/Minerals & Folic Acid)

5

multiple vitamins w/minerals & folic acid tabs 2

STROVITE FORTE SYRP55MCG/15ML-5MG/15ML-3MG/15ML-50MCG/15ML-15MG/15ML-50MG/15ML-10MG/15ML-17MG/15ML-100MG/15ML-25MG/15ML-4000UNIT/15ML-20MCG/15ML-400UNIT/15ML-15MG/15ML-1MG/15ML-30UNIT/15ML-150MCG/15ML-20MG/15ML-300MG/15ML

5

SUPERVITE EC TBEC 5

SYNAGEX CAPS 5

SYNATEK CAPS 5

MultivitaminsINFUVITE ADULT INJ 5

INFUVITE INJ 5

M.V.I. ADULT INJ 5

M.V.I.-12 WITHOUTVITAMIN K INJ 5

Ped MV w/ FluorideMULTIVITAMIN/FLUORIDE CHEW 4 QL(1 ea daily);

AL

Drug Name DrugTier

Requirements/Limits

pediatric multivitamins w/flchew 0.25mg-15unit-1.2mg-2500unit-4.5mcg-400unit-1.05mg-13.5mg-1.05mg-0.3mg-60mg, 1mg-15unit-400unit-2500unit-1.2mg-4.5mcg-13.5mg-1.05mg-0.3mg-1.05mg-60mg, 1mg-15unit-1.2mg-2500unit-4.5mcg-400unit-1.05mg-13.5mg-1.05mg-0.3mg-60mg, 15unit-1mg-2500unit-13.5mg-1.2mg-4.5mcg-400unit-1.05mg-0.3mg-1.05mg-60mg,15unit-1mg-1.05mg-13.5mg-1.2mg-2500unit-4.5mcg-400unit-0.3mg-1.05mg-60mg, 15unit-0.5mg-2500unit-13.5mg-1.2mg-4.5mcg-400unit-1.05mg-0.3mg-1.05mg-60mg, 15unit-0.5mg-1.05mg-13.5mg-1.2mg-2500unit-4.5mcg-400unit-0.3mg-1.05mg-60mg,15unit-0.25mg-2500unit-13.5mg-1.2mg-4.5mcg-400unit-1.05mg-0.3mg-1.05mg-60mg, 15unit-0.25mg-1.05mg-13.5mg-1.2mg-2500unit-4.5mcg-400unit-0.3mg-1.05mg-60mg, 0.5mg-2500unit-13.5mg-1.2mg-4.5mcg-400unit-1.05mg-0.3mg-15unit-1.05mg-60mg,0.5mg-15unit-400unit-2500unit-1.2mg-4.5mcg-13.5mg-1.05mg-0.3mg-1.05mg-60mg, 0.5mg-15unit-1.2mg-2500unit-4.5mcg-400unit-1.05mg-13.5mg-1.05mg-0.3mg-60mg, 0.25mg-15unit-400unit-2500unit-1.2mg-4.5mcg-13.5mg-1.05mg-0.3mg-1.05mg-60mg

2

QL(1 ea daily);AL


104

Drug Name DrugTier

Requirements/Limits

pediatric multivitamins w/flsoln 0.25mg/ml-5unit/ml-0.6mg/ml-1mg/ml-1150unit/ml-2mg/ml-2mcg/ml-400unit/ml-0.5mg/ml-29.7mcg/ml-3mcg/ml-0.4mg/ml-32mg/ml, 65mcg/ml-1mg/ml-0.25mg/ml-10mg/ml-1000unit/ml-0.8mg/ml-0.6mg/ml-2mcg/ml-400unit/ml-0.5mg/ml-35mcg/ml-5unit/ml-0.4mg/ml-35mg/ml, 5unit/ml-0.5mg/ml-8mg/ml-0.6mg/ml-1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-35mg/ml, 5unit/ml-0.5mg/ml-0.6mg/ml-8mg/ml-1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-35mg/ml, 5unit/ml-0.25mg/ml-0.6mg/ml-8mg/ml-1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-35mg/ml, 150mcg/ml-1mg/ml-0.5mg/ml-12mg/ml-1100unit/ml-2mg/ml-1mg/ml-3mcg/ml-400unit/ml-1mg/ml-81mcg/ml-12unit/ml-1mg/ml-45mg/ml,0.5mg/ml-5unit/ml-8mg/ml-0.6mg/ml-1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-35mg/ml, 0.5mg/ml-5unit/ml-0.6mg/ml-8mg/ml-1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-35mg/ml,0.25mg/ml-5unit/ml-8mg/ml-0.6mg/ml-1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-35mg/ml,0.25mg/ml-5unit/ml-0.6mg/ml-8mg/ml-

2

QL(50 ml perfill retail); AL

Drug Name DrugTier

Requirements/Limits

1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-35mg/mlpediatric vitamins acd w/fluoride soln 2 QL(50 ml per

fill retail); ALPOLY-VI-FLOR CHEW200MCG-0.25MG-15UNIT-400UNIT, 200MCG-1MG-15UNIT-400UNIT,200MCG-0.5MG-15UNIT-400UNIT

5

QL(6 ea per fillretail)

POLY-VI-FLOR SUSP200MCG/ML-0.25MG/ML 5

QUFLORA PEDIATRICCHEW 4 QL(1 ea daily);

AL

TRI-VI-FLOR SUSP 5

TRI-VI-FLORO SUSP 5

Ped Multi Vitamins w/Fl & FEESCAVITE D CHEW 5

ESCAVITE LQ LIQD 4 AL

MYKIDZ IRON FL SUSP 5

ped multivitamins w/fl &iron soln 2 QL(50 ml per

fill retail); ALPOLY-VI-FLOR/IRONCHEW 200MCG-0.5MG-10MG-15UNIT-400UNIT

5QL(6 ea per fillretail)

POLY-VI-FLOR/IRONSUSP 200MCG/ML-7MG/ML-0.25MG/ML

5

TRI-VIT/FLUORIDE/IRONSOLN 4 QL(50 ml per

fill retail); ALPed Multiple Vitamins w/ Mineralspediatric multiple vitamin w/minerals & c liqd 2 AL; RX/OTC

pediatric multiple vitamin w/minerals & c soln 2 AL; RX/OTC

Pediatric Multiple Vitamins & Minerals w/ FluorideFLORIVA CHEW 5

Pediatric Multiple Vitamins


105

Drug Name DrugTier

Requirements/Limits

INFUVITE PEDIATRICSOLN 5

Prenatal VitaminsACTIVE OB CAPS 5

ATABEX EC TBEC 5

BAL-CARE DHA MISC 5

BP FOLINATAL PLUS BTABS 4 AL

BP MULTINATAL PLUSCHEW 4 AL

BP MULTINATAL PLUSTABS 4 AL

C-NATE DHA CAPS 5

CALCIUM PNV CAPS 5

CITRANATAL 90 DHAMISC 4 AL

CITRANATAL ASSUREMISC 4 AL

CITRANATAL B-CALMMISC 4 AL

CITRANATAL DHA MISC 4 AL

CITRANATAL HARMONYCAPS 4 AL

CITRANATAL RX TABS 4 AL

CO-NATAL FA TABS 4 QL(1 ea daily);AL

COMPLETENATE CHEW 4 QL(1 ea daily);AL

CONCEPT DHA CAPS 5

CONCEPT OB CAPS 5

CVS WOMENSPRENATAL+DHA MISC 5

DOTHELLE DHA CAPS 5

DUET DHA 400 MISC 5

DUET DHA BALANCEDMISC 5

Drug Name DrugTier

Requirements/Limits

ELITE-OB TABS 4 AL

EXTRA-VIRT PLUS DHACAPS 5

FOCALGIN 90 DHA MISC 4 AL

FOCALGIN CA MISC 4 AL

FOLCAL DHA CAPS 5

FOLCAPS OMEGA 3CAPS 5

FOLET DHA THPK 5

FOLET ONE CAPS 5

FOLIVANE-OB CAPS 5

GESTICARE DHA MISC 5

HEMENATAL OB + DHAMISC 5

HEMENATAL OB TABS 5

INATAL ADVANCE TABS 4 QL(1 ea daily);AL

INATAL GT TABS 4 QL(1 ea daily);AL

INATAL ULTRA TABS 4 QL(1 ea daily);AL

INFANATE BALANCECAPS 5

INFANATE PLUS CAPS 4 AL

M-VIT TABS 4 QL(1 ea daily);AL; RX/OTC

MACNATAL CN DHACAPS 5

MARNATAL-F CAPS 5

MYNATAL ADVANCETABS 4 QL(1 ea daily);

ALMYNATAL ULTRACAPLETTABS 4 QL(1 ea daily);

AL

MYNATE 90 PLUS TBCR 5

NATACHEW CHEW 5


106

Drug Name DrugTier

Requirements/Limits

NATELLE ONE CAPS 5

NEEVO DHA CAPS 5

NESTABS ABC MISC 5

NESTABS DHA MISC 5

NESTABS TABS 5

NEWGEN TABS 5

NEXA PLUS CAPS 5

NIVA-PLUS TABS 4 QL(1 ea daily);AL; RX/OTC

O-CAL FA TABS 4 QL(1 ea daily);AL; RX/OTC

OB COMPLETE ONECAPS 5

OB COMPLETE PETITECAPS 5

OB COMPLETE PREMIERTABS 5

OB COMPLETE TABS 4 AL

OB COMPLETE/DHACAPS 5

OBSTETRIX DHA MISC 5 RX/OTC

OBSTETRIX ONE CAPS 5

OBTREX DHA MISC 5 RX/OTC

PAIRE OB MISC 5

PNV FERROUSFUMARATE/DOCUSATE/FOLIC ACID TABS

4QL(1 ea daily);AL

PNV FOLIC ACID + IRONMULTIVITAMIN TABS 4 QL(1 ea daily);

AL; RX/OTC

PNV OB+DHA MISC 4 AL

PNV PRENATAL PLUSMULTIVITAMIN TABS 4 QL(1 ea daily);

AL; RX/OTC

PNV TABS 29-1 TABS 4 QL(1 ea daily);AL

Drug Name DrugTier

Requirements/Limits

PNV-DHA CAPS 4 AL

PNV-DHA+DOCUSATECAPS 5

PNV-OMEGA CAPS 5

PNV-SELECT TABS 4 AL

PNV-TOTAL CAPS 5

PNV-VP-U CAPS 5

PR NATAL 400 EC MISC 5

PR NATAL 430 EC MISC 5

PR NATAL 430 MISC 5

PREFERA OB + DHAMISC 5

PREFERA OB TABS 5

PRENA1 CHEW CHEW 5

PRENA1 PEARL CPCR 5

PRENAISSANCE 90 DHAMISC 4 AL

PRENAISSANCEBALANCE CAPS 5

PRENAISSANCE CAPS 5

PRENAISSANCE DHAMISC 4 AL

PRENAISSANCEHARMONY DHA MISC 5

PRENAISSANCE NEXTTABS 5

PRENAISSANCE NEXT-BTABS 5

PRENAISSANCE PLUSCAPS 5

PRENAISSANCEPROMISE MISC 4 AL

PRENAPLUS TABS 4 QL(1 ea daily);AL; RX/OTC

PRENATA CHEW 5


107

Drug Name DrugTier

Requirements/Limits

PRENATABS FA TABS 4 QL(1 ea daily);AL

PRENATABS RX TABS 4 QL(1 ea daily);AL

PRENATAL 19 CHEW 4 QL(1 ea daily);AL

PRENATAL 19 TABS 4 QL(1 ea daily);AL

PRENATAL PLUS IRONTABS 4 QL(1 ea daily);

AL

PRENATAL PLUS TABS 4 QL(1 ea daily);AL; RX/OTC

PRENATAL TABS 4 QL(1 ea daily);AL; RX/OTC

PRENATAL VITAMINSPLUS LOW IRON TABS 4 QL(1 ea daily);

AL; RX/OTC

PRENATAL+DHA MISC 5

PRENATAL-U CAPS 5

PRENATE AM TABS 5

PRENATE CHEW 5

PRENATE DHA CAPS 5

PRENATE ELITE TABS 5

PRENATE ENHANCECAPS 5

PRENATE ESSENTIALCAPS 5

PRENATE MINI CAPS 5

PRENATE PIXIE CAPS 5

PRENATE RESTORECAPS 5

PRENATE STAR TABS 5

PREPLUS TABS 4 QL(1 ea daily);AL; RX/OTC

PREQUE 10 TABS 5

PRETAB TABS 4 QL(1 ea daily);AL

PROVIDA OB CAPS 5

Drug Name DrugTier

Requirements/Limits

R-NATAL OB CAPS 5

RELNATE DHA CAPS 5

RULAVITE DHA CAPS 4 AL

SE-NATAL 19 CHEW 4 QL(1 ea daily);AL

SE-NATAL 19 TABS 4 QL(1 ea daily);AL

SELECT-OB CHEW 5

SELECT-OB+DHA MISC 5

TARON-BC MISC 5

TARON-C DHA CAPS 5

TARON-PREX CAPS 5

THERANATAL CORENUTRITION TABS 4 QL(1 ea daily);

AL; RX/OTC

THRIVITE 19 TABS 4 QL(1 ea daily);AL

THRIVITE RX TABS 4 QL(1 ea daily);AL

TL-CARE DHA CAPS 5

TL-SELECT CAPS 5

TRI-TABS DHA MISC 5

TRIADVANCE TABS 4 QL(1 ea daily);AL

TRICARE PRENATALCOMPLEAT MISC 5

TRICARE PRENATALDHA ONE CAPS 5

TRICARE TABS 4 QL(1 ea daily);AL; RX/OTC

TRINATAL GT TABS 4 QL(1 ea daily);AL

TRINATAL RX 1 TABS 5

TRINATE TABS 4 AL

TRIVEEN-PRX RNF CAPS 5


108

Drug Name DrugTier

Requirements/Limits

ULTIMATECARE ONECAPS 5

ULTIMATECARE ONE NFCAPS 5

VEMAVITE-PRX 2 CAPS 5

VENA-BAL DHA MISC 5

VENATAL-FA TABS 4 QL(1 ea daily);AL

VINACAL B MISC 4 AL

VINATE C TABS 4 AL

VINATE CALCIUM TABS 5

VINATE DHA RF CAPS 5

VINATE ONE TABS 5

VIRT NATE TABS 4 AL

VIRT-ADVANCE TABS 4 QL(1 ea daily);AL

VIRT-C DHA CAPS 5

VIRT-CARE ONE CAPS 5

VIRT-NATE DHA CAPS 5

VIRT-PN DHA CAPS 4 AL

VIRT-PN PLUS CAPS 5

VIRT-PN TABS 4 AL

VIRT-SELECT CAPS 5

VIRT-VITE GT TABS 4 QL(1 ea daily);AL

VIRTPREX CAPS 5

VITAFOL-NANO TABS 5

VITAFOL-ONE CAPS 5

VITAMEDMD ONERX/QUATREFOLIC CAPS 5

Drug Name DrugTier

Requirements/Limits

VITAMEDMD PLUSRX/QUATREFOLIC MISC 5

VITAMEDMD REDICHEWRX CHEW 5

VITAPEARL CPCR 5

VIVA DHA CAPS 5

VOL-NATE TABS 4 AL

VOL-PLUS TABS 4 QL(1 ea daily);AL; RX/OTC

VOL-TAB RX TABS 4 QL(1 ea daily);AL

VP CH ULTRA CAPS 4 AL

VP-CH PLUS CAPS 5

VP-CH-PNV CAPS 5

VP-GGR-B6 PRENATALTABS 5

VP-HEME OB + DHA MISC 5

VP-HEME OB TABS 5

VP-PNV-DHA CAPS 5

WEGMANS COMPLETEPRENATAL+DHA MISC 5

ZATEAN-CH CAPS 5

ZATEAN-PN DHA CAPS 4 AL

ZATEAN-PN PLUS CAPS 5

ZATEAN-PN TABS 4 AL

Specialty Vitamins ProductsADRENAL STRESS CALMTABS 4 RX/OTC

ADVANCED COLLAGENTABS 4 RX/OTC

ALLERWELL ALLERGYFORMULA TABS 4 RX/OTC

BRAIN MIGHT/DHA & COQ10 TABS 4 RX/OTC


109

Drug Name DrugTier

Requirements/Limits

BRAIN TABS 4 RX/OTC

CA-PLUS TABS 4 RX/OTC

CARDIO TONE TABS 4 RX/OTC

CENTRUMPERFORMANCE TABS 4 RX/OTC

CENTRUM SPECIALISTENERGY TABS 4 RX/OTC

CU-PLUS TABS 4 RX/OTC

CVS HAIR/SKIN/NAILSTABS 4 RX/OTC

ELON MATRIX 5000TABS 4 RX/OTC

ELON MATRIX PLUSTABS 4 RX/OTC

ELON MATRIX 5000COMPLETE TABS 4 RX/OTC

ELON MATRIXCOMPLETE TABS 4 RX/OTC

ELON R3 TABS 4 RX/OTC

GREEN SOURCE TABS 4 RX/OTC

HAIR FARE TABS 4 RX/OTC

HEALTHY HEARTCOMPLEX TABS 4 RX/OTC

HEART TABS 4 RX/OTC

HM ESTROPLUS TABS 4 RX/OTC

KIDNEY TABS 4 RX/OTC

LIPIDSHIELD PLUS TABS 4 RX/OTC

LUNG TABS 4 RX/OTC

LYMPH TABS 4 RX/OTC

M2 CALCIUM TABS 4 RX/OTC

M2 CHROMIUM TABS 4 RX/OTC

MAMMARY TABS 4 RX/OTC

Drug Name DrugTier

Requirements/Limits

MENOPAUSE RELIEFTABS 4 RX/OTC

MG-PLUS PROTEIN TABS 4 RX/OTC

MIL ADREGEN TABS 4 RX/OTC

MILADRENE FORTETABS 4 RX/OTC

MILPAN TABS 4 RX/OTC

MULTI-GLAN TABS 4 RX/OTC

NEW LIFE HAIR TABS 4 RX/OTC

ORCHIC TABS 4 RX/OTC

OVARY TABS 4 RX/OTC

PARATHYROID TABS 4 RX/OTC

PITUITARY TABS 4 RX/OTC

PROSTATE TABS 4 RX/OTC

RA EAR CARE TABS 4 RX/OTC

specialty vitamins productstabs 2 RX/OTC

SPLEEN TABS 4 RX/OTC

STOMACH TABS 4 RX/OTC

TAB-A-VITE WOMENSTABS 4 RX/OTC

THERABETIC EYEHEALTH TABS 4 RX/OTC

THYMUS TABS 4 RX/OTC

UTERUS TABS 4 RX/OTC

VITAMINS FOR THE HAIRTABS 4 RX/OTC

ZN-PLUS TABS 4 RX/OTC

MUSCULOSKELETAL THERAPY AGENTS -Drugs to Treat SpasmsArticular Cartilage Repair Therapy


110

Drug Name DrugTier

Requirements/Limits

MACI SHEE 5

Central Muscle Relaxantsbaclofen tabs 2

carisoprodol tabs 250 mg 2 QL(3 ea daily)

carisoprodol tabs 350 mg 2 QL(4 ea daily)

chlorzoxazone tabs 2

cyclobenzaprine hcl tabs 2 QL(3 ea daily)

FEXMID TABS (UseCyclobenzaprine HCl) 5 QL(3 ea daily)

METAXALONE TABS 400MG 4 QL(4 ea daily)

metaxalone tabs 800 mg 2 QL(4 ea daily)

methocarbamol soln 2

methocarbamol tabs 2

orphenadrine citrate soln ij30 mg/ml 2

orphenadrine citrate tb12or 100 mg 2 QL(2 ea daily)

PARAFON FORTE DSCTABS (UseChlorzoxazone)

5

ROBAXIN SOLN (UseMethocarbamol) 5

ROBAXIN TABS (UseMethocarbamol) 5

ROBAXIN-750 TABS (UseMethocarbamol) 5

SKELAXIN TABS (UseMetaxalone) 5 QL(4 ea daily)

SOMA TABS 250 MG (UseCarisoprodol) 5 QL(3 ea daily)

SOMA TABS 350 MG (UseCarisoprodol) 5 QL(4 ea daily)

tizanidine hcl caps 2 mg 2

tizanidine hcl caps 4 mg 2 QL(9 ea daily)

Drug Name DrugTier

Requirements/Limits

tizanidine hcl caps 6 mg 2 QL(6 ea daily)

tizanidine hcl tabs 2 mg, 4mg 2

ZANAFLEX CAPS 2 MG(Use Tizanidine HCl) 5

ZANAFLEX CAPS 4 MG(Use Tizanidine HCl) 5 QL(9 ea daily)

ZANAFLEX CAPS 6 MG(Use Tizanidine HCl) 5 QL(6 ea daily)

ZANAFLEX TABS 4 MG(Use Tizanidine HCl) 5

Direct Muscle RelaxantsDANTRIUM CAPS (UseDantrolene Sodium) 5 QL(4 ea daily)

DANTRIUM IV SOLR (UseDantrolene Sodium) 5

dantrolene sodium caps or100 mg, 50 mg, 25 mg 2 QL(4 ea daily)

dantrolene sodium solr iv20 mg 2

Muscle Relaxant Combinationscarisoprodol w/ aspirin &codeine tabs 2 QL(8 ea daily)

carisoprodol w/ aspirin tabs 2 QL(8 ea daily)

ViscosupplementsEUFLEXXA SOSY 4 PA

GEL-ONE PRSY 4 PA

GELSYN-3 SOSY 5 PA

GENVISC 850 SOSY 4 PA

HYALGAN SOLN 4 PA

HYALGAN SOSY 4 PA

HYMOVIS SOSY 5 PA

MONOVISC SOSY 5 PA

ORTHOVISC SOSY 5 PA

SUPARTZ FX SOSY 4 PA


111

Drug Name DrugTier

Requirements/Limits

SUPARTZ SOSY 4 PA

SYNVISC ONE SOSY 5 PA

SYNVISC SOSY 5 PA

NASAL AGENTS - SYSTEMIC AND TOPICAL -Drugs to treat the Nose or SinusNasal AntiallergyASTEPRO SOLN (UseAzelastine HCl) 5

azelastine hcl soln 2

olopatadine hcl (nasal) soln 2

PATANASE SOLN (UseOlopatadine HCl (Nasal)) 5

Nasal AnticholinergicsATROVENT SOLN (UseIpratropium Bromide(Nasal))

5

ipratropium bromide (nasal)soln 1

Nasal SteroidsBECONASE AQ SUSP 5

budesonide (nasal) susp 1 RX/OTC

FLONASE ALLERGYRELIEF CHILDRENSSUSP (Use FluticasonePropionate (Nasal))

5

RX/OTC

FLONASE ALLERGYRELIEF SUSP (UseFluticasone Propionate(Nasal))

5

RX/OTC

FLONASE SUSP (UseFluticasone Propionate(Nasal))

5RX/OTC

flunisolide (nasal) soln 2

fluticasone propionate(nasal) susp 2 RX/OTC

mometasone furoate(nasal) susp 2 AL

NASACORT ALLERGY24HR AERO 4 AL; RX/OTC

Drug Name DrugTier

Requirements/Limits

NASACORT ALLERGY24HR AERO (UseTriamcinolone Acetonide(Nasal))

5

AL; RX/OTC

NASACORT ALLERGY24HR CHILDRENS AERO(Use TriamcinoloneAcetonide (Nasal))

5

AL; RX/OTC

NASONEX SUSP (UseMometasone Furoate(Nasal))

5AL

OMNARIS SUSP 5

QNASL AERS 5

RHINOCORT AQUA SUSP(Use Budesonide (Nasal)) 5 RX/OTC

triamcinolone acetonide(nasal) aero 2 AL; RX/OTC

VERAMYST SUSP 5

ZETONNA AERS 5

NEUROMUSCULAR AGENTS - Drugs toRelax/Paralyze MusclesALS AgentsRILUTEK TABS (UseRiluzole) 5

riluzole tabs 2

Neuromuscular Blocking Agent - NeurotoxinsBOTOX SOLR 5 PA

DYSPORT SOLR 5 PA

MYOBLOC SOLN 5 PA

XEOMIN SOLR 5 PA

Nondepolarizing Muscle Relaxantsatracurium besylate soln 2

cisatracurium besylate soln 2

NIMBEX SOLN (UseCisatracurium Besylate) 5


112

Drug Name DrugTier

Requirements/Limits

pancuronium bromide soln 2

rocuronium bromide soln 2

vecuronium bromide solr 2

ZEMURON SOLN (UseRocuronium Bromide) 5

NUTRIENTS

Carbohydratesalcohol soln 2

DEXTROSE 25% SOLN 4

DEXTROSE 30% SOLN 4

dextrose soln 2

Lipidsfat emulsion emul 2

INTRALIPID EMUL 4

Proteinsacetylcysteine (nutrient)caps 2 RX/OTC

amino acid electrolyteinfusion soln 2

amino acid infusion soln 2

amino acids caps 2 RX/OTC

AMINOSYN II SOLN (UseAmino Acid Infusion) 5

cysteine hcl soln 2

HEPATAMINE SOLN 4

L-CYSTEINE HCL SOLN 4

PHLEXY-10 CAPS 4 RX/OTC

TROPHAMINE SOLN (UseAmino Acid Infusion) 5

OPHTHALMIC AGENTS - Drugs to Treat the Eye

Drug Name DrugTier

Requirements/Limits

Beta-blockers - OphthalmicBETAGAN SOLN (UseLevobunolol HCl) 5

betaxolol hcl (ophth) soln 2

BETIMOL SOLN 4

BETOPTIC-S SUSP 4

carteolol hcl (ophth) soln 2

COMBIGAN SOLN 4

COSOPT PF SOLN 4

COSOPT SOLN (UseDorzolamide HCl-TimololMaleate)


dorzolamide hcl-timololmaleate soln 2 QL(10 ml per

fill retail)

ISTALOL SOLN 5

levobunolol hcl soln 2

METIPRANOLOL SOLN 4

timolol maleate (ophth) solg 2

timolol maleate (ophth) soln 2

TIMOPTIC OCUDOSESOLN 5

TIMOPTIC SOLN (UseTimolol Maleate (Ophth)) 5

TIMOPTIC-XE SOLG (UseTimolol Maleate (Ophth)) 5

Cycloplegic Mydriaticsatropine sulfate(ophthalmic) soln 2

ATROPINE SULFATESOLN OP 1 % 4

CYCLOGYL SOLN 0.5 %(Use Cyclopentolate HCl) 5 QL(15 ml per

fill retail)CYCLOGYL SOLN 1 %, 2% (Use CyclopentolateHCl)

5


113

Drug Name DrugTier

Requirements/Limits

cyclopentolate hcl soln 0.5% 2 QL(15 ml per

fill retail)cyclopentolate hcl soln 1%, 2 % 2

homatropine hbr soln 2

ISOPTO ATROPINE SOLN(Use Atropine Sulfate(Ophthalmic))

5

MioticsISOPTO CARPINE SOLN(Use Pilocarpine HCl) 5

pilocarpine hcl soln 2

Ophthalmic - Angiogenesis InhibitorsEYLEA SOLN 5 PA

LUCENTIS SOLN IO 0.3MG/0.05ML, 0.5MG/0.05ML

5PA

LUCENTIS SOSY IZ 0.5MG/0.05ML 5

MACUGEN SOLN 5 PA

Ophthalmic Adrenergic AgentsALPHAGAN P SOLN 0.1 % 4

ALPHAGAN P SOLN 0.15% (Use BrimonidineTartrate)

5

apraclonidine hcl soln 2

brimonidine tartrate soln 2

IOPIDINE SOLN (UseApraclonidine HCl) 5

SIMBRINZA SUSP 4

Ophthalmic Anti-infectivesBACITRACIN OINT OP500 UNIT/GM 4

bacitracin-polymyxin b(ophth) oint 2 QL(4 gm per fill

retail)

BESIVANCE SUSP 4

Drug Name DrugTier

Requirements/Limits

BLEPH-10 SOLN (UseSulfacetamide Sodium(Ophth))


CEFUROXIMESODIUM/SODIUMCHLORIDE SOLN

5

CILOXAN SOLN (UseCiprofloxacin HCl (Ophth)) 5

ciprofloxacin hcl (ophth)soln 2

erythromycin (ophth) oint 2 QL(4 gm per fillretail)

GARAMYCIN SOLN (UseGentamicin Sulfate(Ophth))

5

gatifloxacin (ophth) soln 2

gentamicin sulfate (ophth)oint 2 QL(4 gm per fill

retail)gentamicin sulfate (ophth)soln 2

levofloxacin (ophth) soln 2

MOXEZA SOLN 4

neomycin-bacitracin zn-polymyxin oint 2 QL(4 gm per fill

retail)neomycin-polymyxin-gramicidin soln 2 QL(10 ml per

fill retail)NEOSPORIN SOLN (UseNeomycin-Polymyxin-Gramicidin)


OCUFLOX SOLN (UseOfloxacin (Ophth)) 5

ofloxacin (ophth) soln 2

polymyxin b-trimethoprimsoln 2 QL(10 ml per

fill retail)POLYTRIM SOLN (UsePolymyxin B-Trimethoprim) 5 QL(10 ml per

fill retail)sulfacetamide sodium(ophth) soln 2 QL(15 ml per

fill retail)

tobramycin (ophth) soln 2 QL(5 ml per fillretail)

TOBREX SOLN (UseTobramycin (Ophth)) 5 QL(5 ml per fill

retail)


114

Drug Name DrugTier

Requirements/Limits

trifluridine soln 2 QL(8 ml per fillretail)

VIGAMOX SOLN 4 QL(3 ml per fillretail)

VIROPTIC SOLN (UseTrifluridine) 5 QL(8 ml per fill

retail)ZYMAXID SOLN (UseGatifloxacin (Ophth)) 5

Ophthalmic DecongestantsNAPHAZOLINE HCLSOLN 4 QL(15 ml per

fill retail)phenylephrine hcl (ophth)soln 2

Ophthalmic ImmunomodulatorsRESTASIS EMUL 4

RESTASIS MULTIDOSEEMUL 4

Ophthalmic Integrin AntagonistsXIIDRA SOLN 4

Ophthalmic Local AnestheticsALCAINE SOLN (UseProparacaine HCl) 5

proparacaine hcl soln 2

tetracaine hcl (ophth) soln 2

Ophthalmic Photodynamic Therapy AgentsVISUDYNE SOLR 5 PA

Ophthalmic SteroidsALREX SUSP 4

bacitracin-poly-neomycin-hc oint 2

dexamethasone sodiumphosphate (ophth) soln 2 QL(5 ml per fill

retail)DEXAMETHASONESODIUM PHOSPHATESOLN OP 0.1 %


DUREZOL EMUL 4

fluorometholone (ophth)susp 2

Drug Name DrugTier

Requirements/Limits

FML LIQUIFILM SUSP(Use Fluorometholone(Ophth))

5

LOTEMAX GEL 4

LOTEMAX OINT 4

LOTEMAX SUSP 4

MAXITROL OINT10000UNIT/GM-3.5MG/GM-0.1% (UseNeomycin-Polymy-Dexameth)

5

QL(5 gm per fillretail)

MAXITROL SUSP10000UNIT/ML-3.5MG/ML-0.1% (Use Neomycin-Polymy-Dexameth)

5

QL(5 ml per fillretail)

neomycin-polymy-dexameth oint10000unit/gm-3.5mg/gm-0.1%

2

QL(5 gm per fillretail)

neomycin-polymy-dexameth susp10000unit/ml-3.5mg/ml-0.1%

2

QL(5 ml per fillretail)

NEOMYCIN/POLYMYXIN/HYDROCORTISONESUSP


OMNIPRED SUSP (UsePrednisolone Acetate(Ophth))

5

PRED FORTE SUSP (UsePrednisolone Acetate(Ophth))

5

prednisolone acetate(ophth) susp 2

sulfacetamide sod-prednisolone soln 2

TOBRADEX OINT 4 QL(4 gm per fillretail)

TOBRADEX ST SUSP 4

TOBRADEX SUSP (UseTobramycin-Dexamethasone)

5

tobramycin-dexamethasone susp 2


115

Drug Name DrugTier

Requirements/Limits

ZYLET SUSP 4

Ophthalmic Surgical AidsCELLUGEL SOLN (UseHypromellose (Intraocular)) 5

hypromellose (intraocular)soln 2

Ophthalmics - Misc.ACULAR LS SOLN (UseKetorolac Tromethamine(Ophth))

5

ACULAR SOLN (UseKetorolac Tromethamine(Ophth))

5

azelastine hcl (ophth) soln 2 QL(6 ml per fillretail)

AZOPT SUSP 4

bromfenac sodium (ophth)soln 2

BROMFENAC SOLN 4

BSS PLUS SOLN (UseOphthalmic IrrigationSolution - Intraocular)

5

cromolyn sodium (ophth)soln 2 QL(10 ml per

fill retail)diclofenac sodium (ophth)soln 2

dorzolamide hcl soln 2 QL(10 ml perfill retail)

ELESTAT SOLN (UseEpinastine HCl (Ophth)) 5

epinastine hcl (ophth) soln 2

flurbiprofen sodium soln 2 QL(3 ml per fillretail)

ketorolac tromethamine(ophth) soln 2

ketotifen fumarate (ophth)soln 2

OCUFEN SOLN (UseFlurbiprofen Sodium) 5 QL(3 ml per fill

retail)

olopatadine hcl soln 2

Drug Name DrugTier

Requirements/Limits

ophthalmic irrigationsolution - intraocular soln 2

OPTIVAR SOLN (UseAzelastine HCl (Ophth)) 5 QL(6 ml per fill

retail)

PATADAY SOLN 4

PATANOL SOLN (UseOlopatadine HCl) 5

PAZEO SOLN 4

PROLENSA SOLN 4

TRUSOPT SOLN (UseDorzolamide HCl) 5 QL(10 ml per

fill retail)ZADITOR SOLN (UseKetotifen Fumarate(Ophth))

5

Prostaglandins - OphthalmicBIMATOPROST SOLN 4

latanoprost soln 2 QL(3 ml per fillretail)

LUMIGAN SOLN 5

RESCULA SOLN 5

TRAVATAN Z SOLN 4

TRAVOPROST SOLN 4

XALATAN SOLN (UseLatanoprost) 5 QL(3 ml per fill

retail)

ZIOPTAN SOLN 4

OTIC AGENTS - Drugs to Treat the Ear

Otic Agents - Miscellaneous

acetic acid (otic) soln 2 QL(15 ml perfill retail)

ACETIC ACID/ALUMINUMACETATE SOLN 4

Otic Anti-infectivesCETRAXAL SOLN 4

CIPROFLOXACIN SOLNOT 0.2 % 4


116

Drug Name DrugTier

Requirements/Limits

FLOXIN OTIC SOLN (UseOfloxacin (Otic)) 5

ofloxacin (otic) soln 2

Otic Combinationsantipyrine-benzocaine soln 2

antipyrine-benzocaine-polycosanol soln 2

ANTIPYRINE/BENZOCAINE SOLN 4

CIPRODEX SUSP 4 QL(8 ml per fillretail)

neomycin-polymyxin-hc(otic) soln 2 QL(10 ml per

fill retail)neomycin-polymyxin-hc(otic) susp 2

PRAMOTIC LIQD 4

pramoxine-chloroxylenolliqd 2

Otic SteroidsDERMOTIC OIL (UseFluocinolone Acetonide(Otic))

5

fluocinolone acetonide(otic) oil 2

hydrocortisone w/aceticacid soln 2 QL(10 ml per

fill retail)OXYTOCICS - Drugs to Prevent/Control UterineBleedingOxytocicsMETHERGINE TABS 4

methylergonovine maleatesoln 2

methylergonovine maleatetabs 2

oxytocin soln 2

PITOCIN SOLN (UseOxytocin) 5

PASSIVE IMMUNIZING AGENTS - AntibodyDrugs to Treat Low Immune SystemImmune Serums

Drug Name DrugTier

Requirements/Limits

BIVIGAM SOLN 5 PA

CARIMUNENANOFILTERED SOLR 5 PA

CUVITRU SOLN 5 PA

CYTOGAM INJ 5 PA

FLEBOGAMMA DIF SOLN 5 PA

GAMASTAN S/D INJ 5 PA

GAMMAGARD LIQUIDSOLN 5 PA

GAMMAGARD S/D IGALESS THAN 1MCG/MLSOLR

5PA

GAMMAKED SOLN 5 PA

GAMMAPLEX SOLN 5 PA

GAMUNEX-C SOLN 5 PA

HEPAGAM B SOLN 5 PA

HIZENTRA SOLN 5 PA

HYPERHEP B S/D SOLN 5 PA

HYPERRHO S/D MINI-DOSE SOSY 5 PA

HYPERRHO S/D SOSY 5 PA

MICRHOGAM ULTRA-FILTEREDPLUS SOSY 5 PA

NABI-HB SOLN 5 PA

OCTAGAM SOLN 5 PA

PRIVIGEN SOLN 5 PA

RHOGAM ULTRA-FILTERED PLUS SOSY 5 PA

RHOPHYLAC SOSY 5 PA

WINRHO SDF SOLN 5 PA

Monoclonal Antibodies


117

Drug Name DrugTier

Requirements/Limits

SYNAGIS SOLN 5 PA

Passive Immunizing Agents - CombinationsHYQVIA KIT 5 PA

PENICILLINS - Drugs to Treat Bacterial Infections

Aminopenicillinsamoxicillin caps 2

amoxicillin chew 2

AMOXICILLIN ER TB24 4

amoxicillin susr 2

amoxicillin tabs 2

ampicillin caps 250 mg,500 mg 2

ampicillin sodium solr ij 1gm, 500 mg, 250 mg, 2 gm,10 gm

2

AMPICILLIN SODIUMSOLR IJ 125 MG 4

AMPICILLIN SODIUMSOLR IV 1 GM 4

ampicillin sodium solr iv 10gm, 2 gm 2

AMPICILLIN SUSR 125MG/5ML, 250 MG/5ML 4

MOXATAG TB24 4

Natural Penicillinspenicillin g potassium solr 2

PENICILLIN G SODIUMSOLR 4

penicillin v potassium solr 2

penicillin v potassium tabs 2

PFIZERPEN-G SOLR (UsePenicillin G Potassium) 5

Penicillin Combinations

Drug Name DrugTier

Requirements/Limits

amoxicillin & potclavulanate chew 200mg-28.5mg, 400mg-57mg


amoxicillin & potclavulanate susr200mg/5ml-28.5mg/5ml,600mg/5ml-42.9mg/5ml,400mg/5ml-57mg/5ml,250mg/5ml-62.5mg/5ml

2

amoxicillin & potclavulanate tabs 250mg-125mg


amoxicillin & potclavulanate tabs 500mg-125mg, 875mg-125mg


amoxicillin & potclavulanate tb12 1000mg-62.5mg

2QL(13.34 eadaily)

AMOXICILLIN/CLAVULANATE POTASSIUM CHEW 4 QL(20 ea per

fill retail)ampicillin & sulbactamsodium solr 2

AUGMENTIN ES-600SUSR (Use Amoxicillin &Pot Clavulanate)

5

AUGMENTIN SUSR250MG/5ML-62.5MG/5ML(Use Amoxicillin & PotClavulanate)

5

AUGMENTIN TABS500MG-125MG, 875MG-125MG (Use Amoxicillin &Pot Clavulanate)

5

QL(20 ea perfill retail)

AUGMENTIN XR TB12(Use Amoxicillin & PotClavulanate)

5QL(13.34 eadaily)

piperacillin sodium-tazobactam sodium solr 2

UNASYN BULK PACKSOLR (Use Ampicillin &Sulbactam Sodium)

5

UNASYN SOLR (UseAmpicillin & SulbactamSodium)

5

ZOSYN SOLR (UsePiperacillin Sodium-Tazobactam Sodium)

5


118

Drug Name DrugTier

Requirements/Limits

Penicillinase-Resistant Penicillinsdicloxacillin sodium caps 2

nafcillin sodium solr ij 1 gm,2 gm, 10 gm 2

NAFCILLIN SODIUMSOLR IV 1 GM, 2 GM 4

oxacillin sodium solr 2

PHARMACEUTICAL ADJUVANTS

Liquid VehiclesBACTERIOSTATICWATERFORINJECTION/BENZYLALCOHOL SOLN

4

glycine diluent soln 2 PA

PH 12 STERILE DILUENTFORFLOLAN SOLN (UseGlycine Diluent)

5PA

saline, bacteriostatic soln 2

water for injection, sterilesoln 2

Semi Solid Vehicleslanolin oint 2 RX/OTC

white petrolatum gel 2 RX/OTC

PROGESTINS - Hormone Replacement/ModifyingDrugsProgestinsAYGESTIN TABS (UseNorethindrone Acetate) 5

MAKENA OIL 5 PA

medroxyprogesteroneacetate tabs 2

MEGACE ES SUSP (UseMegestrol Acetate(Appetite))

5

megestrol acetate(appetite) susp 2

norethindrone acetate tabs 2

Drug Name DrugTier

Requirements/Limits

progesterone micronizedcaps 100 mg 2 QL(1 ea daily)

progesterone micronizedcaps 200 mg 2 QL(0.6667 ea

daily)

progesterone oil 2

PROMETRIUM CAPS 100MG (Use ProgesteroneMicronized)

5QL(1 ea daily)

PROMETRIUM CAPS 200MG (Use ProgesteroneMicronized)

5QL(0.6667 eadaily)

PROVERA TABS (UseMedroxyprogesteroneAcetate)

5

PSYCHOTHERAPEUTIC AND NEUROLOGICALAGENTS - MISC. - Drugs to Treat Mental andEmotional ConditionsAgents for Chemical Dependencyacamprosate calcium tbec 2

ANTABUSE TABS (UseDisulfiram) 5

disulfiram tabs 2

Anti-Cataplectic AgentsXYREM SOLN 5

Antidementia AgentsARICEPT ODT TBDP (UseDonepezil Hydrochloride) 5

ARICEPT TABS 10 MG, 5MG (Use DonepezilHydrochloride)

5QL(1 ea daily)

ARICEPT TABS 23 MG(Use DonepezilHydrochloride)

5

donepezil hydrochloridetabs 10 mg, 5 mg 2 QL(1 ea daily)

donepezil hydrochloridetabs 23 mg 2

donepezil hydrochloridetbdp 10 mg, 5 mg 2

EXELON CAPS OR 1.5MG, 6 MG, 4.5 MG, 3 MG(Use Rivastigmine Tartrate)

5QL(2 ea daily)


119

Drug Name DrugTier

Requirements/Limits

EXELON PT24 TD 13.3MG/24HR (UseRivastigmine)

5

EXELON PT24 TD 4.6MG/24HR, 9.5 MG/24HR(Use Rivastigmine)

5QL(1 ea daily)

galantamine hydrobromidecp24 16 mg, 8 mg, 24 mg 2 QL(1 ea daily)

GALANTAMINEHYDROBROMIDE SOLN 4MG/ML

4QL(6 ml daily)

galantamine hydrobromidetabs 12 mg, 8 mg, 4 mg 2 QL(2 ea daily)

memantine hcl soln 2mg/ml 2 QL(10 ml daily)

memantine hcl tabs 2

memantine hcl tabs 10 mg,5 mg 2 QL(2 ea daily)

NAMENDA SOLN 10MG/5ML (Use MemantineHCl)

5QL(10 ml daily)

NAMENDA TABS 10 MG, 5MG (Use Memantine HCl) 5 QL(2 ea daily)

NAMENDA TITRATIONPAK TABS (UseMemantine HCl)

5

NAMENDA XR CP24 4

NAMENDA XR TITRATIONPACK CP24 4

NAMZARIC C4PK 5

RAZADYNE ER CP24 (UseGalantamineHydrobromide)

5QL(1 ea daily)

RAZADYNE TABS (UseGalantamineHydrobromide)

5QL(2 ea daily)

rivastigmine pt24 13.3mg/24hr 2

rivastigmine pt24 4.6mg/24hr, 9.5 mg/24hr 2 QL(1 ea daily)

rivastigmine tartrate caps 2 QL(2 ea daily)

Combination Psychotherapeutics

Drug Name DrugTier

Requirements/Limits

CHLORDIAZEPOXIDE/AMITRIPTYLINE TABS 4

olanzapine-fluoxetine hclcaps 2

PERPHENAZINE/AMITRIPTYLINE TABS 4 QL(4 ea daily)

SYMBYAX CAPS (UseOlanzapine-Fluoxetine HCl) 5

Fibromyalgia Agents

SAVELLA TABS 4 PA; QL(2 eadaily)

SAVELLA TITRATIONPACK MISC 4 PA; QL(0.1507

ea daily)Movement Disorder Drug Therapytetrabenazine tabs 2 PA

XENAZINE TABS (UseTetrabenazine) 5 PA

Multiple Sclerosis AgentsAMPYRA TB12 5 PA

AUBAGIO TABS 4 PA

AVONEX KIT 5 PA

AVONEX PEN AJKT 5 PA

AVONEX PSKT 5 PA

BETASERON KIT 4 PA

COPAXONE SOSY 20MG/ML (Use GlatiramerAcetate)

5PA

COPAXONE SOSY 40MG/ML 4 PA

EXTAVIA KIT 4 PA

GILENYA CAPS 4 PA

glatiramer acetate sosy 2 PA

LEMTRADA SOLN 5 PA

PLEGRIDY SOPN 5 PA


120

Drug Name DrugTier

Requirements/Limits

PLEGRIDY SOSY 5 PA

PLEGRIDY STARTERPACK SOPN 5 PA

PLEGRIDY STARTERPACK SOSY 5 PA

REBIF REBIDOSE SOAJ 4 PA

REBIF REBIDOSETITRATIONPACK SOAJ 4 PA

REBIF SOSY 4 PA

REBIF TITRATION PACKSOSY 4 PA

TECFIDERA CPDR 4 PA

TECFIDERA STARTERPACK MISC 4 PA

TYSABRI CONC 5 PA

ZINBRYTA SOSY 5 PA

Postherpetic Neuralgia (PHN) AgentsGRALISE STARTER MISC 4 PA

GRALISE TABS 4 PA

Premenstrual Dysphoric Disorder (PMDD) AgentsFLUOXETINE CAPS 4 ST

fluoxetine hcl (pmdd) tabs 2 MO

SARAFEM TABS (UseFluoxetine HCl (PMDD)) 5 MO

Psychotherapeutic and Neurological Agents -ERGOLOID MESYLATESTABS 4

ergoloid mesylates tabs 2

ORAP TABS (UsePimozide) 5

pimozide tabs 2

Smoking Deterrentsbupropion hcl (smokingdeterrent) tb12 6 QL(2 ea daily);

AL

Drug Name DrugTier

Requirements/Limits

CHANTIX CONTINUINGMONTHPAK TABS 6 QL(2 ea daily)

CHANTIX STARTINGMONTH PAK TABS 6

QL(53 ea per365 daysretail); AL

CHANTIX TABS 6 QL(2 ea daily)

NICODERM CQ PT24 (UseNicotine) 5 QL(1 ea daily);

ALNICORETTE GUM (UseNicotine Polacrilex) 5 PV

NICORETTE LOZG (UseNicotine Polacrilex) 5 PV

NICORETTE MINI LOZG(Use Nicotine Polacrilex) 5 PV

NICORETTE STARTERKIT GUM (Use NicotinePolacrilex)

5PV

nicotine polacrilex gum 6 PV

nicotine polacrilex lozg 6 PV

nicotine pt24 6 QL(1 ea daily);AL

NICOTINETRANSDERMAL SYSTEMKIT

6PV

NICOTROL INHALERINHA 6 PV

NICOTROL NS SOLN 6 PV

ZYBAN TB12 (UseBupropion HCl (SmokingDeterrent))

5QL(2 ea daily);AL

Vasomotor Symptom AgentsBRISDELLE CAPS 4

RESPIRATORY AGENTS - MISC. - Drugs toTreat Lung ConditionsAlpha-Proteinase Inhibitor (Human)ARALAST NP SOLR 5 PA

GLASSIA SOLN 5 PA

PROLASTIN-C SOLR 5 PA


121

Drug Name DrugTier

Requirements/Limits

ZEMAIRA SOLR 5 PA

Cystic Fibrosis AgentsKALYDECO PACK 5 PA

KALYDECO TABS 5 PA

ORKAMBI TABS 5 PA

PULMOZYME SOLN 5 PA

Pulmonary Fibrosis AgentsESBRIET CAPS 5

OFEV CAPS 5

TETRACYCLINES - Drugs to Treat BacterialInfectionsTetracyclinesADOXA CAPS (UseDoxycycline(Monohydrate))

5

ADOXA PAK 1/100 TABS(Use Doxycycline(Monohydrate))

5


5


5

ADOXA TABS (UseDoxycycline(Monohydrate))

5

demeclocycline hcl tabs 2

DORYX TBEC (UseDoxycycline Hyclate) 5

doxycycline (monohydrate)caps 2

doxycycline (monohydrate)susr 2

doxycycline (monohydrate)tabs 2

doxycycline hyclate caps 2

Drug Name DrugTier

Requirements/Limits

doxycycline hyclate solr 2

doxycycline hyclate tabs 2

doxycycline hyclate tbec 2

MINOCIN CAPS (UseMinocycline HCl) 5

minocycline hcl caps 100mg, 75 mg, 50 mg 2

minocycline hcl tabs 100mg, 75 mg, 50 mg 2

minocycline hcl tb24 135mg, 90 mg, 45 mg 2 PA

MONODOX CAPS (UseDoxycycline(Monohydrate))

5

SOLODYN TB24 5

tetracycline hcl caps 250mg, 500 mg, 250 mg 2

TETRACYCLINE HCLCAPS 500 MG (UseTetracycline HCl)

5

VIBRAMYCIN CAPS 100MG (Use DoxycyclineHyclate)

5

VIBRAMYCIN SUSR 25MG/5ML (Use Doxycycline(Monohydrate))

5

VIBRAMYCIN SYRP 50MG/5ML 5 AL

THYROID AGENTS - Drugs to Regulate ThyroidHormonesAntithyroid Agentsmethimazole tabs 2

propylthiouracil tabs 2

TAPAZOLE TABS (UseMethimazole) 5

Thyroid HormonesARMOUR THYROID TABS(Use Thyroid) 4

CYTOMEL TABS (UseLiothyronine Sodium) 5


122

Drug Name DrugTier

Requirements/Limits

LEVOTHYROXINESODIUM SOLR IV 100MCG, 500 MCG

4

levothyroxine sodium tabsor 100 mcg, 88 mcg, 75mcg, 50 mcg, 300 mcg, 25mcg, 200 mcg, 175 mcg,150 mcg, 137 mcg, 125mcg, 112 mcg

2

liothyronine sodium soln 2

liothyronine sodium tabs 2

SYNTHROID TABS (UseLevothyroxine Sodium) 4

thyroid tabs 2

TRIOSTAT SOLN (UseLiothyronine Sodium) 5

TOXOIDS

Toxoid CombinationsADACEL SUSP 6 PV

BOOSTRIX SUSP 6 PV

DAPTACEL SUSP 6 PV

DIPHTHERIA/TETANUSTOXOIDS ADSORBEDPEDIATRIC SUSP

6PV

INFANRIX SUSP 6 PV

KINRIX SUSP 6 PV

PEDIARIX SUSP 6 PV

PENTACEL SUSR 6 PV

QUADRACEL SUSP 6 PV

TENIVAC INJ 6 PV

TETANUS/DIPHTHERIATOXOIDS-ADSORBEDADULT SUSP

6PV

Drug Name DrugTier

Requirements/Limits

TETANUS/DIPHTHERIATOXOIDS-ADSORBEDSUSP

6PV

ULCER DRUGS - Drugs to Treat Bowel, Intestineand Stomach ConditionsAntispasmodicsANASPAZ TBDP (UseHyoscyamine Sulfate) 5

ATROPINE SULFATESOLN IJ 0.05 MG/ML, 0.8MG/ML

4

atropine sulfate soln ij 0.1mg/ml, 1 mg/ml, 0.4 mg/ml 2

BENTYL CAPS (UseDicyclomine HCl) 5

BENTYL SOLN (UseDicyclomine HCl) 5

BENTYL TABS (UseDicyclomine HCl) 5

dicyclomine hcl caps 2

dicyclomine hcl soln 2

dicyclomine hcl tabs 2

glycopyrrolate soln 2

glycopyrrolate tabs 2

hyoscyamine sulfate elix or0.125 mg/5ml 2

hyoscyamine sulfate solnor 0.125 mg/ml 2

hyoscyamine sulfate subl sl0.125 mg 2

hyoscyamine sulfate tabsor 0.125 mg 2

hyoscyamine sulfate tb12or 0.375 mg 2 QL(4 ea daily)

hyoscyamine sulfate tbdpor 0.125 mg 2

LEVBID TB12 (UseHyoscyamine Sulfate) 5 QL(4 ea daily)

LEVSIN TABS (UseHyoscyamine Sulfate) 5


123

Drug Name DrugTier

Requirements/Limits

LEVSIN/SL SUBL (UseHyoscyamine Sulfate) 5

methscopolamine bromidetabs 2

PAMINE FORTE TABS(Use MethscopolamineBromide)

5

PAMINE TABS (UseMethscopolamine Bromide) 5

PROPANTHELINEBROMIDE TABS 4

ROBINUL FORTE TABS(Use Glycopyrrolate) 5

ROBINUL SOLN (UseGlycopyrrolate) 5

ROBINUL TABS (UseGlycopyrrolate) 5

H-2 Antagonists

cimetidine hcl soln 2 QL(20 mldaily); AL

cimetidine tabs 200 mg 2 QL(4 ea daily);RX/OTC

cimetidine tabs 300 mg 2 QL(4 ea daily)



FAMOTIDINE PREMIXEDSOLN 4

famotidine soln iv 20mg/2ml, 40 mg/4ml, 200mg/20ml

2

famotidine susr or 40mg/5ml 2 QL(10 ml

daily); AL

famotidine tabs or 20 mg 2 QL(2 ea daily);RX/OTC

famotidine tabs or 40 mg 2 QL(2 ea daily)

nizatidine caps 150 mg 2 QL(2 ea daily)

nizatidine caps 300 mg 2 QL(1 ea daily)

NIZATIDINE SOLN 15MG/ML 4 QL(20 ml

daily); AL

Drug Name DrugTier

Requirements/Limits

PEPCID AC MAXIMUMSTRENGTH TABS (UseFamotidine)


PEPCID SUSR 40 MG/5ML(Use Famotidine) 5 QL(10 ml

daily); ALPEPCID TABS 20 MG (UseFamotidine) 5 QL(2 ea daily);

RX/OTCPEPCID TABS 40 MG (UseFamotidine) 5 QL(2 ea daily)

ranitidine hcl caps or 150mg 2 QL(2 ea daily)

ranitidine hcl caps or 300mg 2 QL(1 ea daily)

ranitidine hcl soln ij 150mg/6ml 2

ranitidine hcl soln ij 50mg/2ml 2 QL(2 ml daily)

ranitidine hcl syrp or 15mg/ml, 75 mg/5ml, 150mg/10ml

2QL(20 mldaily); AL

ranitidine hcl tabs or 150mg 2 QL(2 ea daily);

RX/OTCranitidine hcl tabs or 300mg 2 QL(2 ea daily)

TAGAMET HB TABS (UseCimetidine) 5 QL(4 ea daily);

RX/OTCZANTAC 150 MAXIMUMSTRENGTH TABS (UseRanitidine HCl)


ZANTAC SOLN IJ 25MG/ML (Use RanitidineHCl)

5

ZANTAC SOLN IJ 25MG/ML 5

ZANTAC SOLN IJ 50MG/2ML (Use RanitidineHCl)

5QL(2 ml daily)

ZANTAC TABS OR 150MG (Use Ranitidine HCl) 5 QL(2 ea daily);

RX/OTCZANTAC TABS OR 300MG (Use Ranitidine HCl) 5 QL(2 ea daily)

Misc. Anti-UlcerCARAFATE SUSP 1GM/10ML 5 QL(40 ml

daily); ALCARAFATE TABS 1 GM(Use Sucralfate) 5 QL(4 ea daily)


124

Drug Name DrugTier

Requirements/Limits

sucralfate tabs 2 QL(4 ea daily)

Proton Pump InhibitorsACIPHEX TBEC (UseRabeprazole Sodium) 5 ST; QL(1 ea

daily)

DEXILANT CPDR 4 ST; QL(1 eadaily)

esomeprazole magnesiumcpdr 20 mg 2 ST; QL(1 ea

daily); RX/OTCesomeprazole magnesiumcpdr 40 mg 2 ST; QL(1 ea

daily)ESOMEPRAZOLESODIUM SOLR 20 MG 4

esomeprazole sodium solr40 mg 2

ESOMEPRAZOLESTRONTIUM CPDR 4

lansoprazole cpdr 15 mg 2 ST; QL(1 eadaily); RX/OTC

lansoprazole cpdr 30 mg 2 ST; QL(1 eadaily)

NEXIUM 24HR CPDR 4 ST; QL(1 eadaily); RX/OTC

NEXIUM CPDR 20 MG(Use EsomeprazoleMagnesium)

5ST; QL(1 eadaily); RX/OTC

NEXIUM CPDR 40 MG(Use EsomeprazoleMagnesium)

5ST; QL(1 eadaily)

NEXIUM I.V. SOLR (UseEsomeprazole Sodium) 5

omeprazole cpdr 2 ST; QL(1 eadaily)

pantoprazole sodium solr iv40 mg 2

pantoprazole sodium tbecor 20 mg, 40 mg 2 ST; QL(1 ea

daily)PREVACID 24HR CPDR(Use Lansoprazole) 5 ST; QL(1 ea

daily); RX/OTCPREVACID CPDR 15 MG(Use Lansoprazole) 5 ST; QL(1 ea

daily); RX/OTCPREVACID CPDR 30 MG(Use Lansoprazole) 5 ST; QL(1 ea

daily)PRILOSEC CPDR (UseOmeprazole) 5 ST; QL(1 ea

daily)

Drug Name DrugTier

Requirements/Limits

PROTONIX SOLR IV 40MG (Use PantoprazoleSodium)

5

PROTONIX TBEC OR 20MG, 40 MG (UsePantoprazole Sodium)

5ST; QL(1 eadaily)

rabeprazole sodium tbec 2 ST; QL(1 eadaily)

Ulcer Drugs - ProstaglandinsCYTOTEC TABS (UseMisoprostol) 5 QL(4 ea daily)

misoprostol tabs 2 QL(4 ea daily)

Ulcer Therapy Combinationsamoxicillin-clarithromycinw/ lansoprazole misc 2

omeprazole-sodiumbicarbonate caps 20mg-1100mg


omeprazole-sodiumbicarbonate caps 40mg-1100mg

2ST; QL(1 eadaily)

omeprazole-sodiumbicarbonate pack 20mg-1680mg, 40mg-1680mg

2

PREVPAC MISC (UseAmoxicillin-Clarithromycinw/ Lansoprazole)

5

PYLERA CAPS 4

ZEGERID CAPS 20MG-1100MG (Use Omeprazole-Sodium Bicarbonate)


ZEGERID CAPS 40MG-1100MG (Use Omeprazole-Sodium Bicarbonate)

5ST; QL(1 eadaily)

ZEGERID OTC CAPS (UseOmeprazole-SodiumBicarbonate)


ZEGERID PACK 20MG-1680MG, 40MG-1680MG(Use Omeprazole-SodiumBicarbonate)

5

URINARY ANTI-INFECTIVES - Drugs to TreatBladder/Kidney InfectionsUrinary Anti-infective Combinations


125

Drug Name DrugTier

Requirements/Limits

methenamine-hyosc-methylene blue-benzoicacid-phenyl sal tabs

2

methenamine-hyosc-methylene blue-sod phos-phenyl sal caps

2

methenamine-hyosc-methylene blue-sod phos-phenyl sal tabs

2

methenamine-hyoscamine-methylene blue-sodiumphosphate caps

2

methenamine-hyoscamine-methylene blue-sodiumphosphate tabs

2

URIMAR-T TABS 4

UROGESIC-BLUE TABS(Use Methenamine-Hyoscamine-MethyleneBlue-Sodium Phosphate)

5

Urinary Anti-infectivesFURADANTIN SUSP (UseNitrofurantoin) 5 QL(40 ml

daily); ALHIPREX TABS (UseMethenamine Hippurate) 5

MACROBID CAPS (UseNitrofurantoin MonohydMacro)

5

MACRODANTIN CAPS(Use NitrofurantoinMacrocrystal)

5

methenamine hippuratetabs 2

METHENAMINEMANDELATE TABS 0.5GM

4

methenamine mandelatetabs 1 gm 2

nitrofurantoin macrocrystalcaps 2

nitrofurantoin monohydmacro caps 2

nitrofurantoin susp 2 QL(40 mldaily); AL

URINARY ANTISPASMODICS - Drugs to TreatMiscellaneous Bladder Spasms

Drug Name DrugTier

Requirements/Limits

Urinary Antispasmodic - Antimuscarinicsdarifenacin hydrobromidetb24 2 QL(1 ea daily)

DETROL LA CP24 (UseTolterodine Tartrate) 5 QL(1 ea daily)

DETROL TABS (UseTolterodine Tartrate) 5 QL(2 ea daily)

DITROPAN XL TB24 (UseOxybutynin Chloride) 5 QL(2 ea daily)

ENABLEX TB24 (UseDarifenacin Hydrobromide) 5 QL(1 ea daily)

GELNIQUE GEL 4

oxybutynin chloride syrp 5mg/5ml 2 QL(16 ml daily)

oxybutynin chloride tabs 5mg 2 QL(3 ea daily)

oxybutynin chloride tb24 10mg, 5 mg, 15 mg 2 QL(2 ea daily)

tolterodine tartrate cp24 2mg, 4 mg 2 QL(1 ea daily)

tolterodine tartrate tabs 1mg, 2 mg 2 QL(2 ea daily)

trospium chloride cp24 60mg 2 QL(1 ea daily)

trospium chloride tabs 20mg 2

VESICARE TABS 4 QL(1 ea daily)

Urinary Antispasmodics - Beta-3 AdrenergicMYRBETRIQ TB24 4

Urinary Antispasmodics - Cholinergic Agonistsbethanechol chloride tabs 2

URECHOLINE TABS (UseBethanechol Chloride) 5

Urinary Antispasmodics - Direct Muscle Relaxantsflavoxate hcl tabs 2

VACCINES

Bacterial VaccinesACTHIB SOLR 6 PV


126

Drug Name DrugTier

Requirements/Limits

BEXSERO SUSY 6 PV

BIOTHRAX SUSP 6 PV

MENACTRA INJ 6 PV

MENHIBRIX SOLR 6 PV

MENOMUNE-A/C/Y/W-135INJ 6 PV

MENVEO SOLR 6 PV

PNEUMOVAX 23 INJ 6 PV

PNEUMOVAX 23/1 DOSEINJ 6 PV

PNEUMOVAX 23/5 DOSEINJ 6 PV

PREVNAR 13 SUSP 6 PV

TRUMENBA SUSY 6 PV

TYPHIM VI SOLN 6 PV

Mixed Vaccine CombinationsCOMVAX SUSP 6 PV

Viral VaccinesAFLURIA 2014-2015SUSP 6 PV

AFLURIA 2015-2016SUSP 6 PV

AFLURIA 2016-2017SUSP 6 PV

AFLURIA PF 2014-2015SUSY 6 PV



AFLURIA QUADRIVALENT2016-2017 SUSY 6 PV

CERVARIX SUSP 6 PV

ENGERIX-B INJ 6 PV

Drug Name DrugTier

Requirements/Limits

ENGERIX-B SUSP 6 PV

FLUAD 2016-2017 SUSY 6 PV

FLUARIX 2014-2015 SUSY 6 PV

FLUARIX QUADRIVALENT2014-2015 SUSY 6 PV



FLUBLOK 2014-2015SOLN 6 PV



FLUCELVAX 2014-2015SUSY 6 PV

FLUCELVAX 2015-2016SUSY 6 PV

FLUCELVAXQUADRIVALENT 2016-2017 SUSY

6PV

FLULAVAL 2014-2015SUSP 6 PV

FLULAVALQUADRIVALENT 2014-2015 SUSP

6PV

FLULAVALQUADRIVALENT 2014-2015 SUSY

6PV


6PV


6PV

FLULAVALQUADRIVALENT 2016-2017 SUSY

6PV

FLUVIRIN 2014-2015SUSP 6 PV



127

Drug Name DrugTier

Requirements/Limits

FLUVIRIN 2015-2016SUSY 6 PV


FLUVIRIN 2016-2017SUSY 6 PV

FLUVIRIN PF 2014-2015SUSY 6 PV

FLUZONE HIGH-DOSE PF2014-2015 SUSY 6 PV



FLUZONE INTRADERMALQUADRIVALENT 2015-2016 SUPN

6PV

FLUZONE INTRADERMALQUADRIVALENT 2016-2017 SUPN

6PV

FLUZONE PF 2014-2015SUSY 6 PV

FLUZONEQUADRIVALENT 2014-2015 SUSP

6PV

FLUZONEQUADRIVALENT 2014-2015 SUSY

6PV


6PV


6PV


6PV


6PV

FLUZONE SPLIT 2014-2015 SUSP 6 PV

FLUZONE SPLIT 2015-2016 SUSP 6 PV

GARDASIL 9 SUSP 6 PV

Drug Name DrugTier

Requirements/Limits

GARDASIL 9 SUSY 6 PV

GARDASIL SUSP 6 PV

HAVRIX SUSP 6 PV

IMOVAX RABIES(H.D.C.V.) INJ 6 PV

IPOL INACTIVATED IPVINJ 6 PV

IXIARO SUSP 6 PV

M-M-R II INJ 6 PV

MEDICAL PROVIDER EZFLU SHOT 2014-2015PSKT

6PV

MEDICAL PROVIDER EZFLU SHOT 2015-2016PSKT

6PV

MEDICAL PROVIDERSINGLE USE EZ FLUSHOT PSKT

6PV

PROQUAD INJ 6 PV

RABAVERT SUSR 6 PV

RECOMBIVAX HB SUSP 6 PV

ROTARIX SUSR 6 PV

ROTATEQ SOLN 6 PV

TWINRIX SUSP 6 PV

VAQTA SUSP 6 PV

VARIVAX INJ 6 PV

YF-VAX INJ 6 PV

ZOSTAVAX SOLR 6 PV

VAGINAL PRODUCTS - Drugs to Treat VaginalInfections and Low HormonesMiscellaneous Vaginal ProductsFEM PH GEL 4


128

Drug Name DrugTier

Requirements/Limits

RELAGARD GEL 4

SpermicidesENCARE SUPP 6

nonoxynol-9 gel 6

OPTIONS CONCEPTROLVAGINALCONTRACEPTIVE GEL(Use Nonoxynol-9)

5

OPTIONS GYNOL IIVAGINALCONTRACEPTIVE GEL

6

SHUR-SEAL GEL 6

TODAY SPONGE MISC 6

VCF VAGINALCONTRACEPTIVE FILMFILM

6

VCF VAGINALCONTRACEPTIVE FOAMFOAM

6

Vaginal Anti-infectivesCLEOCIN CREA VA 2 %(Use ClindamycinPhosphate Vaginal)


clindamycin phosphatevaginal crea 2 QL(40 gm per

fill retail)METROGEL-VAGINALGEL (Use MetronidazoleVaginal)


metronidazole vaginal gel 2 QL(70 gm perfill retail)

MICONAZOLE 3 SUPP 4 QL(3 ea per fillretail)

TERAZOL 3 CREA (UseTerconazole Vaginal) 5 QL(20 gm per

fill retail)TERAZOL 7 CREA (UseTerconazole Vaginal) 5 QL(45 gm per

fill retail)terconazole vaginal crea0.4 % 2 QL(45 gm per

fill retail)terconazole vaginal crea0.8 % 2 QL(20 gm per

fill retail)terconazole vaginal supp80 mg 2 QL(3 ea per fill

retail)

Drug Name DrugTier

Requirements/Limits

Vaginal EstrogensESTRACE CREA VA 0.1MG/GM 4 QL(1.434 gm

daily)

estradiol vaginal tabs 2

PREMARIN CREA VA0.625 MG/GM 4 QL(1.434 gm

daily)VAGIFEM TABS (UseEstradiol Vaginal) 5

Vaginal ProgestinsCRINONE GEL 4

ENDOMETRIN INST 4

VASOPRESSORS - Drugs to Treat Heart andCirculation ConditionsAnaphylaxis Therapy Agents

ADRENACLICK SOAJ 4 QL(0.0667 eadaily)

AUVI-Q SOAJ 4 QL(0.0667 eadaily)

EPINEPHRINE SOAJ 4 QL(0.0667 eadaily)

EPIPEN 2-PAK SOAJ 4 QL(0.0667 eadaily)

EPIPEN-JR 2-PAK SOAJ 4 QL(0.0667 eadaily)

Vasopressorsdobutamine hcl soln 2

dobutamine in d5w soln 2

DOPAMINE HCL SOLN160 MG/ML, 80 MG/ML 4

dopamine hcl soln 40mg/ml 2

dopamine in d5w soln 2

ephedrine sulfate(pressors) soln 2

LEVOPHED SOLN (UseNorepinephrine Bitartrate) 5

midodrine hcl tabs 2


129

Drug Name DrugTier

Requirements/Limits

norepinephrine bitartratesoln 2

NOREPINEPHRINE/SODIUM CHLORIDE SOSY 5

phenylephrine hcl(pressors) soln 2

PHENYLEPHRINE HCLSOLN 4

VITAMINS

Oil Soluble VitaminsBABY DDROPS LIQD (UseCholecalciferol) 5

cholecalciferol caps 400unit 6 AL

cholecalciferol chew 400unit 6 AL

cholecalciferol liqd 400unit/ml, 400 unt/0.03ml 6

cholecalciferol tabs 400unit 6 AL

D-VI-SOL LIQD (UseCholecalciferol) 5

DRISDOL CAPS (UseErgocalciferol) 5 AL

ergocalciferol caps 6 AL

phytonadione soln 2

RAYALDEE CPCR 5

VITAMIN D2 TABS 6

VITAMIN D3 LIQD 6

VITAMIN K1 SOLN 4

WELLESSE VITAMIN D3LIQD 6

Water Soluble Vitaminsascorbic acid soln 2

NIACIN POWD 4

pyridoxine hcl soln 2

Drug Name DrugTier

Requirements/Limits

sodium ascorbate soln 2

thiamine hcl soln 2


130

Indexabacavir sulfate-lamivudine-zidovudineabacavir sulfate-lamivudine-zidovudine 42abacavir sulfate-lamivudineabacavir sulfate-lamivudine 42abacavir sulfateabacavirsulfate 42ABILIFY 1 MG/MLABILIFY 1MG/ML 41ABILIFY 10 MG, 5 MG, 30 MG,20 MG, 2 MG, 15 MGABILIFY 10MG, 5 MG, 30 MG, 20 MG, 2 MG,15 MG 41ABILIFY 9.75 MG/1.3MLABILIFY9.75 MG/1.3ML 41ABILIFY DISCMELT 10MGABILIFY DISCMELT 10MG 41ABILIFY DISCMELT 15MGABILIFY DISCMELT 15MG 41ABILIFY MAINTENAABILIFYMAINTENA 41ABSORICAABSORICA 56ABSTRALABSTRAL 5acamprosatecalciumacamprosatecalcium 119ACANYAACANYA 56acarboseacarbose 21ACCOLATEACCOLATE 14ACCU-CHEK ACTIVEGLUCOSECONTROLSOLUTIONACCU-CHEK ACTIVEGLUCOSECONTROLSOLUTION 87ACCU-CHEK AVIVACONNECTACCU-CHEK AVIVACONNECT 87ACCU-CHEK AVIVAPLUSACCU-CHEK AVIVAPLUS 87ACCU-CHEK AVIVAACCU-CHEK AVIVA 87ACCU-CHEK COMFORTCURVE CONTROL SOLUTION(2 LEVELS)ACCU-CHEKCOMFORT CURVE CONTROLSOLUTION (2 LEVELS) 88ACCU-CHEK COMFORTCURVE LINEARITYSOLUTIONACCU-CHEKCOMFORT CURVE LINEARITYSOLUTION 88

ACCU-CHEK COMPACT PLUSCLEAR CONTROL SOLUTION(2 LEVELS)ACCU-CHEKCOMPACT PLUS CLEARCONTROL SOLUTION (2LEVELS) 88ACCU-CHEK NANOSMARTVIEWACCU-CHEKNANO SMARTVIEW 88ACCU-CHEK SMARTVIEWCONTROLACCU-CHEKSMARTVIEW CONTROL 88ACCUPRILACCUPRIL 29ACCURETIC 10MG-12.5MG,20MG-25MGACCURETIC10MG-12.5MG, 20MG-25MG 30ACCURETIC 20MG-12.5MGACCURETIC 20MG-12.5MG 30ACCUTREND GLUCOSECONTROLACCUTRENDGLUCOSE CONTROL 88acebutolol hclacebutololhcl 48ACEONACEON 29ACETADOTEACETADOTE 24acetaminophen w/ codeine120mg/5ml-12mg/5mlacetaminophen w/codeine 120mg/5ml-12mg/5ml 8acetaminophen w/ codeine300mg-15mgacetaminophen w/codeine 300mg-15mg 8acetaminophen w/ codeine300mg-30mgacetaminophen w/codeine 300mg-30mg 8acetaminophen w/ codeine300mg-60mgacetaminophen w/codeine 300mg-60mg 8acetaminophen-caff-dihydrocodacetaminophen-caff-dihydrocod 8acetaminophen-salicylamide-phenyltoloxamineacetaminophen-salicylamide-phenyltoloxamine 4ACETAZOLAMIDE 125MGACETAZOLAMIDE 125MG 69acetazolamide 250mgacetazolamide 250 mg 69acetazolamide 500mgacetazolamide 500 mg 69

acetazolamidesodiumacetazolamidesodium 69acetic acid (otic)acetic acid(otic) 116ACETIC ACID/ALUMINUMACETATEACETICACID/ALUMINUMACETATE 116acetic acidacetic acid 77acetylcysteine(antidote)acetylcysteine(antidote) 24acetylcysteine(nutrient)acetylcysteine(nutrient) 113acetylcysteineacetylcysteine 56ACIPHEXACIPHEX 125acitretin 10 mg, 17.5 mgacitretin10 mg, 17.5 mg 60acitretin 25 mgacitretin 25mg 60ACLOVATEACLOVATE 61ACTEMRAACTEMRA 3ACTHIBACTHIB 126ACTIGALLACTIGALL 75ACTIMMUNEACTIMMUNE 37ACTIQACTIQ 5ACTIVE OBACTIVE OB 106ACTIVELLA 0.1MG-0.5MGACTIVELLA 0.1MG-0.5MG 74ACTIVELLA 0.5MG-1MGACTIVELLA 0.5MG-1MG 74ACTONEL 150 MG, 35MGACTONEL 150 MG, 35MG 70ACTONEL 30 MG, 5MGACTONEL 30 MG, 5 MG 70ACTOPLUS METACTOPLUSMET 22ACTOSACTOS 23ACULAR LSACULAR LS 116ACULARACULAR 116ACURA BLOOD GLUCOSEMONITORING SYSTEM METERKITACURA BLOOD GLUCOSEMONITORING SYSTEM METERKIT 88ACURA BLOOD GLUCOSEMONITORING SYSTEMSTARTER KITACURA BLOODGLUCOSE MONITORINGSYSTEM STARTER KIT 88

Index 1

ACURA CONTROL SOLUTIONHIGHACURA CONTROLSOLUTION HIGH 88ACURA CONTROL SOLUTIONLOWACURA CONTROLSOLUTION LOW 88ACURA CONTROL SOLUTIONNORMALACURA CONTROLSOLUTION NORMAL 88ACURA PLUS BLOODGLUCOSEMONITORINGSYSTEM METER KITACURAPLUS BLOODGLUCOSEMONITORINGSYSTEM METER KIT 88ACURA PLUS BLOODGLUCOSEMONITORINGSYSTEM STARTER KITACURAPLUS BLOODGLUCOSEMONITORINGSYSTEM STARTER KIT 88acyclovir 200 mg/5mlacyclovir200 mg/5ml 45acyclovir 200 mgacyclovir 200mg 44acyclovir 400 mgacyclovir 400mg 45acyclovir 800 mgacyclovir 800mg 45ACYCLOVIR SODIUM 1000 MG,500 MGACYCLOVIR SODIUM1000 MG, 500 MG 45acyclovir sodium 50mg/mlacyclovir sodium 50mg/ml 44acyclovir topicalacyclovirtopical 61ADACELADACEL 123ADALAT CC 30 MG, 90MGADALAT CC 30 MG, 90MG 49ADALAT CC 60 MGADALAT CC60 MG 49adapalene 0.1 %, 0.3%adapalene 0.1 %, 0.3 % 56adapalene 0.1 %adapalene 0.1% 56ADAPALENE 0.1 %ADAPALENE0.1 % 56ADCETRISADCETRIS 35ADCIRCAADCIRCA 51ADDERALL XRADDERALLXR 1ADDERALLADDERALL 1adefovir dipivoxiladefovirdipivoxil 44ADEMPASADEMPAS 51

ADENOCARDADENOCARD13adenosine 12 mg/4ml, 6mg/2mladenosine 12 mg/4ml, 6mg/2ml 13ADENOSINE 60MG/20MLADENOSINE 60MG/20ML 13ADOXA PAK 1/100ADOXAPAK 1/100 122ADOXA PAK 1/150ADOXAPAK 1/150 122ADOXA PAK 2/100ADOXAPAK 2/100 122ADOXAADOXA 122ADRENACLICKADRENACLICK 129ADRENAL STRESSCALMADRENAL STRESSCALM 109ADVAIR DISKUSADVAIRDISKUS 15ADVAIR HFAADVAIR HFA15ADVANCE INTUITION BLOODGLUCOSE MONITORINGSYSTEMADVANCEINTUITION BLOOD GLUCOSEMONITORING SYSTEM 88ADVANCE INTUITIONCONTROLSOLUTIONADVANCEINTUITION CONTROLSOLUTION 88ADVANCE MICRO-DRAWCONTROL LEVEL 1-2ADVANCE MICRO-DRAWCONTROL LEVEL 1-2 88ADVANCE MICRO-DRAWNORMALCONTROLADVANCE MICRO-DRAW NORMALCONTROL 88ADVANCEDCOLLAGENADVANCEDCOLLAGEN 109ADVICORADVICOR 28ADVOCATE BLOODGLUCOSE MONITORINGSYSTEM/TALKINGADVOCATEBLOOD GLUCOSEMONITORINGSYSTEM/TALKING 88ADVOCATE BLOODGLUCOSE MONITORINGSYSTEMADVOCATE BLOODGLUCOSE MONITORINGSYSTEM 88

ADVOCATE CONTROLSOLUTIONHIGHADVOCATECONTROL SOLUTIONHIGH88ADVOCATE CONTROLSOLUTIONLOWADVOCATECONTROL SOLUTIONLOW 88ADVOCATE REDI-CODE+CONTROL SOLUTIONHIGHADVOCATE REDI-CODE+CONTROL SOLUTIONHIGH 88ADVOCATE REDI-CODE+CONTROL SOLUTIONLOWADVOCATE REDI-CODE+CONTROL SOLUTION LOW88ADVOCATE REDI-CODE+/TALKINGADVOCATE REDI-CODE+/ TALKING 88ADVOCATE REDI-CODE/TALKINGADVOCATEREDI-CODE/TALKING 88ADYNOVATE 1500 UNIT, 750UNITADYNOVATE 1500 UNIT,750 UNIT 78AEROSPANAEROSPAN 14AFINITOR DISPERZAFINITORDISPERZ 36AFINITORAFINITOR 36AFLURIA 2014-2015AFLURIA2014-2015 127AFLURIA 2015-2016AFLURIA2015-2016 127AFLURIA 2016-2017AFLURIA2016-2017 127AFLURIA PF 2014-2015AFLURIA PF 2014-2015 127AFLURIA PF 2015-2016AFLURIA PF 2015-2016 127AFLURIA PF 2016-2017AFLURIA PF 2016-2017 127AFLURIA QUADRIVALENT2016-2017AFLURIAQUADRIVALENT 2016-2017 127AGAMATRIX CONTROLHIGHAGAMATRIX CONTROLHIGH 88AGAMATRIX CONTROLNORMAL& HIGHAGAMATRIXCONTROL NORMAL& HIGH88AGAMATRIX CONTROLNORMALAGAMATRIXCONTROL NORMAL 88

Index 2

AGAMATRIX JAZZ WIRELESS2AGAMATRIX JAZZ WIRELESS2 88AGAMATRIXPRESTOAGAMATRIXPRESTO 88AGGRASTATAGGRASTAT 78AGGRENOXAGGRENOX 78AGRYLINAGRYLIN 78ALA SCALPALA SCALP 61ALBENZAALBENZA 10albuterol sulfate 0.083 %, 1.25mg/3ml, 0.63 mg/3mlalbuterolsulfate 0.083 %, 1.25 mg/3ml,0.63 mg/3ml 15albuterol sulfate 0.5 %albuterolsulfate 0.5 % 15albuterol sulfate 2 mg, 4mgalbuterol sulfate 2 mg, 4mg 15albuterol sulfate 2mg/5mlalbuterol sulfate 2mg/5ml 15albuterol sulfate 4 mg, 8mgalbuterol sulfate 4 mg, 8mg 15ALCAINEALCAINE 115alclometasonedipropionatealclometasonedipropionate 61ALCOH-GLOVE CONTOUREDWIPEALCOH-GLOVECONTOURED WIPE 98ALCOH-WIPE 12" X 12"ALCOH-WIPE 12" X 12" 98ALCOHOL PADSALCOHOLPADS 98ALCOHOL PREPPADSALCOHOL PREPPADS 98ALCOHOL PREPSALCOHOLPREPS 98ALCOHOL SWABSALCOHOLSWABS 98ALCOHOLSWABSTICKALCOHOLSWABSTICK 98ALCOHOL WIPESALCOHOLWIPES 98alcoholalcohol 113ALDACTAZIDE 25MG-25MGALDACTAZIDE 25MG-25MG 69ALDACTAZIDE 50MG-50MGALDACTAZIDE 50MG-50MG 69ALDACTONEALDACTONE 70

ALDARAALDARA 65ALDURAZYMEALDURAZYME

72alendronate sodium 10 mg, 5mgalendronate sodium 10 mg,5 mg 70alendronate sodium 35 mg, 70mgalendronate sodium 35 mg,70 mg 70ALENDRONATE SODIUM 40MGALENDRONATE SODIUM40 MG 70ALENDRONATE SODIUM 70MG/75MLALENDRONATESODIUM 70 MG/75ML 70ALFENTANILHCLALFENTANIL HCL 5alfentanilalfentanil 5ALFERON NALFERON N 37alfuzosin hclalfuzosin hcl 77ALINIA 100 MG/5MLALINIA100 MG/5ML 11ALINIA 500 MGALINIA 500MG 11ALKERAN 2 MGALKERAN 2MG 34ALKERAN 50 MGALKERAN 50MG 34ALLEGRA-D 12 HOURALLERGY &CONGESTIONALLEGRA-D 12HOUR ALLERGY &CONGESTION 56ALLERWELL ALLERGYFORMULAALLERWELLALLERGY FORMULA 109ALLEVYN PLUSCAVITYALLEVYN PLUSCAVITY 83ALLEVYN THINALLEVYNTHIN 83allopurinolallopurinol 78almotriptan malate 12.5mgalmotriptan malate 12.5mg 99almotriptan malate 6.25mgalmotriptan malate 6.25mg 99ALOGLIPTIN/METFORMINHCLALOGLIPTIN/METFORMIN HCL 22ALOGLIPTIN/PIOGLITAZONEALOGLIPTIN/PIOGLITAZONE

22ALOGLIPTINALOGLIPTIN 23ALORAALORA 74alosetron hclalosetron hcl 76

ALPHAGAN P 0.1 %ALPHAGANP 0.1 % 114ALPHAGAN P 0.15%ALPHAGAN P 0.15 % 114alprazolam 0.25 mg, 2 mg, 1 mg,0.5 mgalprazolam 0.25 mg, 2 mg,1 mg, 0.5 mg 13alprazolam 0.5 mg, 3 mg, 2 mg, 1mgalprazolam 0.5 mg, 3 mg, 2mg, 1 mg 13alprostadilalprostadil 47ALREXALREX 115ALTACEALTACE 29ALTOPREVALTOPREV 28aluminum chloridealuminumchloride 67ALUVEAALUVEA 64ALVESCOALVESCO 14amantadine hclamantadinehcl 39AMARYLAMARYL 24AMBIEN CRAMBIEN CR 81AMBIENAMBIEN 81AMCINONIDEAMCINONIDE

61AMD FOAM DRESSING4"X4"AMD FOAM DRESSING4"X4" 83AMD FOAMDRESSING/TOPSHEET4"X4"AMD FOAMDRESSING/TOPSHEET4"X4" 83AMERGEAMERGE 99AMICAR 1000 MGAMICAR 1000MG 80AMICAR 500 MGAMICAR 500MG 80AMIDATEAMIDATE 77amifostine crystallineamifostinecrystalline 37amikacin sulfateamikacinsulfate 2amiloride &hydrochlorothiazideamiloride &hydrochlorothiazide 69amiloride hclamiloride hcl 70amino acid electrolyteinfusionamino acid electrolyteinfusion 113amino acid infusionamino acidinfusion 113amino acidsamino acids 113

Index 3

AMINOCAPROIC ACID 1000MGAMINOCAPROIC ACID 1000MG 80aminocaproic acid 25%aminocaproic acid 25 % 80AMINOCAPROIC ACID 250MG/MLAMINOCAPROIC ACID250 MG/ML 80aminocaproic acid 250mg/mlaminocaproic acid 250mg/ml 80aminocaproic acid 500mgaminocaproic acid 500mg 80aminophyllineaminophylline 16AMINOSYN IIAMINOSYN II113amiodarone hcl 100 mg, 400 mg,200 mgamiodarone hcl 100 mg,400 mg, 200 mg 14amiodarone hcl 150 mg/3ml, 50mg/mlamiodarone hcl 150mg/3ml, 50 mg/ml 14AMIODARONE HCL 900MG/18MLAMIODARONE HCL900 MG/18ML 14amitriptyline hclamitriptylinehcl 21amlodipine besylate-atorvastatincalciumamlodipine besylate-atorvastatin calcium 50amlodipine besylate-benazeprilhclamlodipine besylate-benazepril hcl 30amlodipine besylate-olmesartanmedoxomilamlodipine besylate-olmesartan medoxomil 30amlodipine besylate-valsartanamlodipine besylate-valsartan 30amlodipine besylateamlodipinebesylate 49amlodipine-valsartan-hydrochlorothiazideamlodipine-valsartan-hydrochlorothiazide

31AMMONIUMMOLYBDATEAMMONIUMMOLYBDATE 102AMMONULAMMONUL 72AMOXAPINEAMOXAPINE 21amoxicillin & pot clavulanate1000mg-62.5mgamoxicillin & potclavulanate 1000mg-62.5mg 118

amoxicillin & pot clavulanate200mg-28.5mg, 400mg-57mgamoxicillin & potclavulanate 200mg-28.5mg,400mg-57mg 118amoxicillin & pot clavulanate200mg/5ml-28.5mg/5ml,600mg/5ml-42.9mg/5ml,400mg/5ml-57mg/5ml,250mg/5ml-62.5mg/5mlamoxicillin & potclavulanate 200mg/5ml-28.5mg/5ml, 600mg/5ml-42.9mg/5ml, 400mg/5ml-57mg/5ml, 250mg/5ml-62.5mg/5ml 118amoxicillin & pot clavulanate250mg-125mgamoxicillin & potclavulanate 250mg-125mg 118amoxicillin & pot clavulanate500mg-125mg, 875mg-125mgamoxicillin & potclavulanate 500mg-125mg,875mg-125mg 118AMOXICILLINERAMOXICILLIN ER 118amoxicillin-clarithromycin w/lansoprazoleamoxicillin-clarithromycin w/lansoprazole 125AMOXICILLIN/CLAVULANATEPOTASSIUMAMOXICILLIN/CLAVULANATEPOTASSIUM 118amoxicillinamoxicillin 118amphetamine-dextroamphetamineamphetamine-dextroamphetamine 1AMPHOTERICINBAMPHOTERICIN B 25ampicillin & sulbactamsodiumampicillin & sulbactamsodium 118AMPICILLIN 125 MG/5ML, 250MG/5MLAMPICILLIN 125MG/5ML, 250 MG/5ML 118ampicillin 250 mg, 500mgampicillin 250 mg, 500mg 118ampicillin sodium 1 gm, 500mg, 250 mg, 2 gm, 10gmampicillin sodium 1 gm, 500mg, 250 mg, 2 gm, 10 gm118AMPICILLIN SODIUM 1GMAMPICILLIN SODIUM 1GM 118

ampicillin sodium 10 gm, 2gmampicillin sodium 10 gm, 2gm 118AMPICILLIN SODIUM 125MGAMPICILLIN SODIUM 125MG 118AMPYRAAMPYRA 120AMTURNIDEAMTURNIDE 31ANAFRANILANAFRANIL 21anagrelide hclanagrelide hcl 78ANAPROX DSANAPROX DS 3ANASPAZANASPAZ 123anastrozoleanastrozole 35ANCOBONANCOBON 25ANDRODERMANDRODERM 9ANDROGEL 25MG/2.5GMANDROGEL 25MG/2.5GM 9ANDROGEL 50MG/5GMANDROGEL 50MG/5GM 9ANDROGEL PUMPANDROGELPUMP 9ANDROIDANDROID 9ANGELIQANGELIQ 74ANGIOMAXANGIOMAX 16ANORO ELLIPTAANOROELLIPTA 15ANTABUSEANTABUSE 119ANTARAANTARA 28antipyrine-benzocaine-polycosanolantipyrine-benzocaine-polycosanol 117antipyrine-benzocaineantipyrine-benzocaine 117ANTIPYRINE/BENZOCAINEANTIPYRINE/BENZOCAINE 117ANTIZOLANTIZOL 24ANUSOL-HCANUSOL-HC 10APIDRA SOLOSTARAPIDRASOLOSTAR 23APIDRAAPIDRA 23APOKYNAPOKYN 39apraclonidine hclapraclonidinehcl 114APRISOAPRISO 76APTIOMAPTIOM 17APTIVUSAPTIVUS 42ARALAST NPARALASTNP 121ARANESP ALBUMIN FREE 10MCG/0.4MLARANESP ALBUMINFREE 10 MCG/0.4ML 79

Index 4

ARANESP ALBUMIN FREE 100MCG/0.5ML, 60 MCG/0.3ML, 500MCG/ML, 40 MCG/0.4ML, 300MCG/0.6ML, 25 MCG/0.42ML,200 MCG/0.4ML, 150MCG/0.3MLARANESP ALBUMINFREE 100 MCG/0.5ML, 60MCG/0.3ML, 500 MCG/ML, 40MCG/0.4ML, 300 MCG/0.6ML, 25MCG/0.42ML, 200 MCG/0.4ML,150 MCG/0.3ML 79ARANESP ALBUMIN FREE 100MCG/ML, 60 MCG/ML, 40MCG/ML, 300 MCG/ML, 25MCG/ML, 200MCG/MLARANESP ALBUMINFREE 100 MCG/ML, 60MCG/ML, 40 MCG/ML, 300MCG/ML, 25 MCG/ML, 200MCG/ML 79ARAVAARAVA 4ARCALYSTARCALYST 3ARCAPTANEOHALERARCAPTANEOHALER 15argatrobanargatroban 16ARICEPT 10 MG, 5 MGARICEPT10 MG, 5 MG 119ARICEPT 23 MGARICEPT 23MG 119ARICEPT ODTARICEPTODT 119ARIMIDEXARIMIDEX 35aripiprazole 1 mg/mlaripiprazole1 mg/ml 41aripiprazole 10 mg, 5 mg, 30 mg,20 mg, 2 mg, 15 mgaripiprazole10 mg, 5 mg, 30 mg, 20 mg, 2mg, 15 mg 41aripiprazole 10 mgaripiprazole 10mg 41aripiprazole 15 mgaripiprazole 15mg 41ARISTADAARISTADA 41ARIXTRAARIXTRA 16armodafinil 150 mg, 50 mg, 250mgarmodafinil 150 mg, 50 mg,250 mg 1armodafinil 200 mgarmodafinil200 mg 1ARMOUR THYROIDARMOURTHYROID 122ARNICA LGARNICA LG 52AROMASINAROMASIN 35ARTHROTEC 50ARTHROTEC50 3

ARTHROTEC 75ARTHROTEC75 3ARZERRAARZERRA 35ARZOL SILVER NITRATEAPPLICATORSARZOL SILVERNITRATE APPLICATORS 61ASACOL HDASACOL HD 76ASCENSIA AUTODISC LOWANDHIGHCONTROLSASCENSIAAUTODISC LOW ANDHIGHCONTROLS 88ASCENSIA AUTODISCNORMALCONTROLASCENSIA AUTODISCNORMALCONTROL 88ascorbic acidascorbicacid 130ASCRIPTINASCRIPTIN 5ASMANEX HFAASMANEXHFA 14ASMANEX TWISTHALER 120METERED DOSESASMANEXTWISTHALER 120 METEREDDOSES 14ASMANEX TWISTHALER 14METERED DOSESASMANEXTWISTHALER 14 METEREDDOSES 15ASMANEX TWISTHALER 30METERED DOSESASMANEXTWISTHALER 30 METEREDDOSES 15ASMANEX TWISTHALER 60METERED DOSESASMANEXTWISTHALER 60 METEREDDOSES 15ASMANEX TWISTHALER 7METERED DOSESASMANEXTWISTHALER 7 METEREDDOSES 15ASPIRIN LOW DOSEASPIRINLOW DOSE 5ASPIRIN-CAFFEINE-DIHYDROCODEINEASPIRIN-CAFFEINE-DIHYDROCODEINE 8aspirin-dipyridamoleaspirin-dipyridamole 78aspirinaspirin 5ASSURE 3 CONTROL LEVEL1/2ASSURE 3 CONTROLLEVEL 1/2 88ASSURE 4 CONTROL LEVEL1/2ASSURE 4 CONTROLLEVEL 1/2 88

ASSURE DOSE NORMALCONTROLASSURE DOSENORMAL CONTROL 88ASSURE DOSE NORMAL/HIGHCONTROLASSURE DOSENORMAL/HIGH CONTROL 88ASSURE II CONTROL LEVEL1/2ASSURE II CONTROL LEVEL1/2 89ASSURE II CONTROL LEVEL1ASSURE II CONTROL LEVEL1 89ASSURE PRISM CONTROLLEVEL 1/2ASSURE PRISMCONTROL LEVEL 1/2 89ASSURE PRO CONTROLLEVEL1/2ASSURE PROCONTROL LEVEL1/2 89ASTAGRAF XLASTAGRAFXL 45ASTEPROASTEPRO 112AT LAST CONTROLSOLUTIONAT LAST CONTROLSOLUTION 89ATABEX ECATABEX EC 106ATACAND 16 MG, 8 MG, 4MGATACAND 16 MG, 8 MG, 4MG 29ATACAND 32 MGATACAND 32MG 30ATACAND HCTATACANDHCT 31ATELVIAATELVIA 70atenolol & chlorthalidoneatenolol& chlorthalidone 31atenololatenolol 48ATIVAN 0.5 MG, 2 MG, 1MGATIVAN 0.5 MG, 2 MG, 1MG 13ATIVAN 2 MG/ML, 4MG/MLATIVAN 2 MG/ML, 4MG/ML 13ATOPICLAIRATOPICLAIR 66atorvastatin calciumatorvastatincalcium 28atovaquone-proguanilhclatovaquone-proguanil hcl 33atovaquoneatovaquone 11atracurium besylateatracuriumbesylate 112ATRALINATRALIN 56ATRIPLAATRIPLA 42atropine sulfate(ophthalmic)atropine sulfate(ophthalmic) 113

Index 5

ATROPINE SULFATE 0.05MG/ML, 0.8 MG/MLATROPINESULFATE 0.05 MG/ML, 0.8MG/ML 123atropine sulfate 0.1 mg/ml, 1mg/ml, 0.4 mg/mlatropine sulfate0.1 mg/ml, 1 mg/ml, 0.4mg/ml 123ATROPINE SULFATE 1%ATROPINE SULFATE 1% 113ATROVENT HFAATROVENTHFA 14ATROVENTATROVENT 112AUBAGIOAUBAGIO 120AUGMENTIN 250MG/5ML-62.5MG/5MLAUGMENTIN250MG/5ML-62.5MG/5ML 118AUGMENTIN 500MG-125MG,875MG-125MGAUGMENTIN500MG-125MG, 875MG-125MG 118AUGMENTIN ES-600AUGMENTIN ES-600 118AUGMENTIN XRAUGMENTINXR 118AURUMAURUM 46AUTOJECT 2AUTOJECT 2 99AUVI-QAUVI-Q 129AVALIDEAVALIDE 31AVAPROAVAPRO 30AVAR LS CLEANSERAVAR LSCLEANSER 56AVAR-E LSAVAR-E LS 56AVASTINAVASTIN 35AVELOX ABC PACKAVELOXABC PACK 75AVELOXAVELOX 75AVINZAAVINZA 5AVODARTAVODART 77AVONEX PENAVONEXPEN 120AVONEXAVONEX 120AXERT 12.5 MGAXERT 12.5MG 99AXERT 6.25 MGAXERT 6.25MG 99AXIRONAXIRON 9AYGESTINAYGESTIN 119azacitidineazacitidine 34AZACTAMAZACTAM 10AZASANAZASAN 45azathioprineazathioprine 45

azelastine hcl (ophth)azelastinehcl (ophth) 116azelastine hclazelastinehcl 112AZILECTAZILECT 39AZITHROMYCIN 1GMAZITHROMYCIN 1 GM82azithromycin 100 mg/5ml, 200mg/5mlazithromycin 100mg/5ml, 200 mg/5ml 83azithromycin 250mgazithromycin 250 mg 83azithromycin 500mgazithromycin 500 mg 82azithromycin 600mgazithromycin 600 mg 83AZOPTAZOPT 116AZORAZOR 31aztreonamaztreonam 10AZULFIDINE EN-TABSAZULFIDINE EN-TABS 76AZULFIDINEAZULFIDINE 76b-complex vitaminsb-complexvitamins 103b-complex w/ c & folic acid1.5mg-1.7mg-10mg-0.01mcg-20mg-1mg-300mcg-10mg-60mg, 20mg-1.7mg-10mg-0.006mg-1.5mg-1mg-0.3mg-10mg-100mg, 1.5mg-10mg-20mg-1.7mg-6mcg-1mg-300mcg-10mg-60mgb-complexw/ c & folic acid 1.5mg-1.7mg-10mg-0.01mcg-20mg-1mg-300mcg-10mg-60mg, 20mg-1.7mg-10mg-0.006mg-1.5mg-1mg-0.3mg-10mg-100mg,1.5mg-10mg-20mg-1.7mg-6mcg-1mg-300mcg-10mg-60mg 103b-complex w/ c & folic acid1.5mg-5mg-20mg-1.7mg-6mcg-1mg-150mcg-10mg-100mg,1.7mg-5mg-6mcg-1.5mg-20mg-1mg-150mcg-10mg-100mgb-complex w/ c & folic acid1.5mg-5mg-20mg-1.7mg-6mcg-1mg-150mcg-10mg-100mg,1.7mg-5mg-6mcg-1.5mg-20mg-1mg-150mcg-10mg-100mg

103

b-complex w/ c & folic acid100mg-100mg-5.5mg-25mg-20mg-30mcg-400mcg-45mcg-5mg-180mg, 5mg-25mg-50mg-5mg-37.5mcg-200mcg-15mcg-5mg-150mg, 5mg-25mg-20mg-15mcg-100mg-400mcg-30mcg-2mg-150mg, 50mg-50mg-50mg-50mg-50mcg-50mg-400mcg-50mcg-500mg, 50mg-50mg-50mg-50mg-50mcg-400mcg-50mcg-50mg-500mg, 30unit-10mg-20mg-100mg-10mg-12mcg-400mcg-45mcg-5mg-500mg, 30unit-10mg-100mg-10mg-20mg-12mcg-400mcg-45mcg-5mg-500mg, 30unit-100mg-10mg-1mg-20mg-1mg-1mg-10mg-12mcg-400mcg-45mcg-5mg-500mg, 25mg-5.5mg-25mg-20mg-100mcg-400mcg-1000mcg-5mg-60mg,18mg-5mg-45mg-10mg-10mcg-400mcg-5mg-250mg, 15mg-50mg-10.2mg-10mg-6mcg-400mcg-5mg-300mg, 15mg-50mg-10.2mg-10mg-400mcg-300mcg-5mg-300mg, 15mg-100mg-15mg-18mg-5mcg-0.5mg-4mg-500mg, 100mg-5.5mg-25mg-20mg-15mcg-400mcg-30mcg-2mg-150mgb-complex w/c & folic acid 100mg-100mg-5.5mg-25mg-20mg-30mcg-400mcg-45mcg-5mg-180mg,5mg-25mg-50mg-5mg-37.5mcg-200mcg-15mcg-5mg-150mg,5mg-25mg-20mg-15mcg-100mg-400mcg-30mcg-2mg-150mg,50mg-50mg-50mg-50mg-50mcg-50mg-400mcg-50mcg-500mg,50mg-50mg-50mg-50mg-50mcg-400mcg-50mcg-50mg-500mg,30unit-10mg-20mg-100mg-10mg-12mcg-400mcg-45mcg-5mg-500mg, 30unit-10mg-100mg-10mg-20mg-12mcg-400mcg-45mcg-5mg-500mg, 30unit-100mg-10mg-1mg-20mg-1mg-1mg-10mg-12mcg-400mcg-45mcg-5mg-500mg, 25mg-5.5mg-25mg-20mg-100mcg-400mcg-1000mcg-5mg-60mg,18mg-5mg-45mg-10mg-10mcg-400mcg-5mg-250mg, 15mg-50mg-10.2mg-10mg-6mcg-400mcg-5mg-300mg, 15mg-50mg-10.2mg-10mg-400mcg-

Index 6

300mcg-5mg-300mg, 15mg-100mg-15mg-18mg-5mcg-0.5mg-4mg-500mg, 100mg-5.5mg-25mg-20mg-15mcg-400mcg-30mcg-2mg-150mg 103b-complex w/ c & folic acid 10mg-20mg-1.5mg-1mg-1.5mg-5mg-300mcg-50mg-60mg, 20mg-1.5mg-10mg-1mg-1.5mg-5mg-300mcg-50mg-60mgb-complexw/ c & folic acid 10mg-20mg-1.5mg-1mg-1.5mg-5mg-300mcg-50mg-60mg, 20mg-1.5mg-10mg-1mg-1.5mg-5mg-300mcg-50mg-60mg 103BABY DDROPSBABYDDROPS 130BACITRACIN 500UNIT/GMBACITRACIN 500UNIT/GM 114bacitracin 50000 unitbacitracin50000 unit 10bacitracin-poly-neomycin-hcbacitracin-poly-neomycin-hc

115bacitracin-polymyxin b(ophth)bacitracin-polymyxin b(ophth) 114baclofenbaclofen 111BACTERIOSTATIC WATERFORINJECTION/BENZYLALCOHOLBACTERIOSTATICWATERFORINJECTION/BENZYLALCOHOL 119BACTRIM DSBACTRIM DS 11BACTRIMBACTRIM 11BACTROBANBACTROBAN 59BAL-CARE DHABAL-CAREDHA 106balsalazide disodiumbalsalazidedisodium 76BAND-AID GAUZE PADSLARGE4" X 4"BAND-AID GAUZEPADS LARGE4" X 4" 83BAND-AID GAUZE PADSMEDIUM 3" X 3"BAND-AIDGAUZE PADS MEDIUM 3" X3" 83BAND-AID GAUZE PADSSMALL2" X 2"BAND-AID GAUZEPADS SMALL2" X 2" 83BAND-AID MIRASORB GAUZESPONGES LARGE 4" X4"BAND-AID MIRASORBGAUZE SPONGES LARGE 4" X4" 83

BANZELBANZEL 17BARACLUDE 0.05MG/MLBARACLUDE 0.05MG/ML 44BARACLUDE 0.5 MG, 1MGBARACLUDE 0.5 MG, 1MG 44BASAGLARKWIKPENBASAGLARKWIKPEN 23BASIS FACIALMOISTURIZERBASIS FACIALMOISTURIZER 67BASIS OVERNIGHTBASISOVERNIGHT 67BAYER BREEZE 2 BLOODGLUCOSE MONITORINGSYSTEMBAYER BREEZE 2BLOOD GLUCOSEMONITORING SYSTEM 89BAYER BREEZE 2 HIGHCONTROLBAYER BREEZE 2HIGH CONTROL 89BAYER BREEZE 2 LOWCONTROLBAYER BREEZE 2LOW CONTROL 89BAYER BREEZE 2 NORMALCONTROLBAYER BREEZE 2NORMAL CONTROL 89BAYER CONTOUR BLOODGLUCOSE MONITORINGSYSTEMBAYER CONTOURBLOOD GLUCOSEMONITORING SYSTEM 89BAYER CONTOUR HIGHCONTROLBAYER CONTOURHIGH CONTROL 89BAYER CONTOUR LINKBLOODGLUCOSEMONITORINGSYSTEMBAYER CONTOURLINK BLOODGLUCOSEMONITORING SYSTEM 89BAYER CONTOUR LOWCONTROLBAYER CONTOURLOW CONTROL 89BAYER CONTOUR NEXTBLOODGLUCOSEMONITORINGSYSTEMBAYER CONTOURNEXT BLOODGLUCOSEMONITORING SYSTEM 89BAYER CONTOUR NEXTCONTROL LEVEL 1BAYERCONTOUR NEXT CONTROLLEVEL 1 89

BAYER CONTOUR NEXTCONTROL LEVEL 2BAYERCONTOUR NEXT CONTROLLEVEL 2 89BAYER CONTOUR NEXT EZBLOOD GLUCOSEMONITORING SYSTEMBAYERCONTOUR NEXT EZ BLOODGLUCOSE MONITORINGSYSTEM 89BAYER CONTOUR NEXT LINKBLOOD GLUCOSEMONITORING SYSTEMBAYERCONTOUR NEXT LINK BLOODGLUCOSE MONITORINGSYSTEM 89BAYER CONTOUR NEXT LINKWIRELESS BLOOD GLUCOSEMONITORING SYBAYERCONTOUR NEXT LINKWIRELESS BLOOD GLUCOSEMONITORING SY 89BAYER CONTOUR NEXT USBBLOOD GLUCOSEMONITORING SYSTEMBAYERCONTOUR NEXT USB BLOODGLUCOSE MONITORINGSYSTEM 89BAYER CONTOUR NORMALCONTROLBAYER CONTOURNORMAL CONTROL 89BD AUTOSHIELD DUO 30G X3/16"BD AUTOSHIELD DUO30G X 3/16" 99BD LATITUDE DIABETESMANAGEMENT SYSTEMBDLATITUDE DIABETESMANAGEMENT SYSTEM 89BD LOGIC BLOOD GLUCOSEMONITORBD LOGIC BLOODGLUCOSE MONITOR 89BD SWABS SINGLE USEBUTTERFLYBD SWABSSINGLE USE BUTTERFLY 98BD SWABS SINGLE USEBDSWABS SINGLE USE 98BEAU RXBEAU RX 67BECONASE AQBECONASEAQ 112BELLADONNABELLADONNA

52benazepril &hydrochlorothiazidebenazepril &hydrochlorothiazide 31benazepril hcl 10 mg, 40 mg, 20mgbenazepril hcl 10 mg, 40 mg,20 mg 29

Index 7

benazepril hcl 5 mgbenazepril hcl5 mg 29BENDEKABENDEKA 34BENICAR 20 MG, 40MGBENICAR 20 MG, 40 MG30BENICAR 5 MGBENICAR 5MG 30BENICAR HCTBENICARHCT 31BENLYSTABENLYSTA 47BENTYLBENTYL 123BENZACLIN WITHPUMPBENZACLIN WITHPUMP 57BENZACLINBENZACLIN 56BENZAMYCINBENZAMYCIN

57BENZEFOAMULTRABENZEFOAMULTRA 57BENZEFOAMBENZEFOAM 57BENZEFOAMULTRABENZEFOAMULTRA 57BENZIQ WASHBENZIQWASH 57benzocaine (dental)benzocaine(dental) 102benzonatate 100 mg, 200mgbenzonatate 100 mg, 200mg 56BENZONATATE 150MGBENZONATATE 150 MG56benzoyl peroxide 10 %, 2.5%benzoyl peroxide 10 %, 2.5% 57benzoyl peroxide 10 %benzoylperoxide 10 % 57benzoyl peroxide 5.3 %benzoylperoxide 5.3 % 57benzoyl peroxide 6 %benzoylperoxide 6 % 57benzoyl peroxide 7 %benzoylperoxide 7 % 57benzoyl peroxide 9.8 %benzoylperoxide 9.8 % 57benzoyl peroxide-erythromycinbenzoyl peroxide-erythromycin 57benztropine mesylatebenztropinemesylate 38BERINERTBERINERT 78BESIVANCEBESIVANCE 114BETAGANBETAGAN 113betamethasone dipropionate(topical)betamethasonedipropionate (topical) 61

betamethasone dipropionateaugmentedbetamethasonedipropionate augmented 61betamethasone sod phosphate& acetatebetamethasone sodphosphate & acetate 54betamethasone valerate 0.1%betamethasone valerate 0.1% 61betamethasone valerate 0.12%betamethasone valerate 0.12% 61BETAPACE AFBETAPACEAF 48BETAPACEBETAPACE 48BETASERONBETASERON 120betaxolol hcl (ophth)betaxololhcl (ophth) 113betaxolol hclbetaxolol hcl 48bethanecholchloridebethanecholchloride 126BETHKISBETHKIS 2BETIMOLBETIMOL 113BETOPTIC-SBETOPTIC-S

113bexarotenebexarotene 37BEXSEROBEXSERO 127BEYAZBEYAZ 52BIATAIN ADHESIVE FOAMDRESSING 4"X4"BIATAINADHESIVE FOAM DRESSING4"X4" 83BIATAIN FOAM DRESSING4"X4"BIATAIN FOAMDRESSING 4"X4" 83BIAXIN 250 MG, 500MGBIAXIN 250 MG, 500MG 83BIAXIN 250 MG/5MLBIAXIN250 MG/5ML 83bicalutamidebicalutamide 35BIDILBIDIL 50BIMATOPROSTBIMATOPROST 116BINOSTOBINOSTO 70BIOGUARD GAUZE SPONGE2"X2" 8 PLYBIOGUARDGAUZE SPONGE 2"X2" 8PLY 84BIOGUARD GAUZESPONGES 4"X4" 12PLYBIOGUARD GAUZESPONGES 4"X4" 12 PLY 84BIOTHRAXBIOTHRAX 127

bisacodyl-peg 3350-pot chloride-sod bicarb-sod chloridebisacodyl-peg 3350-pot chloride-sod bicarb-sod chloride 81bisoprolol & hydrochlorothiazide10mg-6.25mgbisoprolol &hydrochlorothiazide 10mg-6.25mg 31bisoprolol & hydrochlorothiazide2.5mg-6.25mg, 5mg-6.25mgbisoprolol &hydrochlorothiazide 2.5mg-6.25mg, 5mg-6.25mg 31bisoprolol fumaratebisoprololfumarate 48bivalirudinbivalirudin 16BIVIGAMBIVIGAM 117BLACK CHERRYCONCENTRATEBLACKCHERRY CONCENTRATE 46bleomycin sulfatebleomycinsulfate 36BLEPH-10BLEPH-10 114BLOOD GLUCOSEMETERSBLOOD GLUCOSEMETERS 89BLOOD GLUCOSEMONITORINGSYSTEMPREMIUMBLOOD GLUCOSEMONITORINGSYSTEMPREMIUM 89BLOOD GLUCOSEMONITORINGSYSTEMBLOODGLUCOSEMONITORINGSYSTEM 89BLOOD GLUCOSE SYSTEMPAKBLOOD GLUCOSESYSTEM PAK 89BLOOD GLUCOSE TESTSTRIPSBLOOD GLUCOSETEST STRIPS 69BLOXIVERZBLOXIVERZ 33BODY CHOICE HOODIAWEIGHTLOSS/HIGHFIBERBODY CHOICE HOODIAWEIGHTLOSS/HIGH FIBER 46BONIVA 150 MGBONIVA 150MG 70BONIVA 3 MG/3MLBONIVA 3MG/3ML 70BOOSTRIXBOOSTRIX 123BORDEREDGAUZEBORDERED GAUZE84BOSULIFBOSULIF 36BOTOXBOTOX 112BP CLEANSING WASHBPCLEANSING WASH 57

Index 8

BP FOLINATAL PLUS BBPFOLINATAL PLUS B 106BP MULTINATAL PLUSBPMULTINATAL PLUS 106BRAIN MIGHT/DHA & COQ10BRAIN MIGHT/DHA & COQ10 109BRAINBRAIN 110BRAVELLEBRAVELLE 71BREO ELLIPTABREOELLIPTA 15BREVIBLOCBREVIBLOC 48BREVICON-28BREVICON-28

52BRILINTABRILINTA 78brimonidine tartratebrimonidinetartrate 114BRINTELLIXBRINTELLIX 20BRISDELLEBRISDELLE 121bromfenac sodium(ophth)bromfenac sodium(ophth) 116BROMFENACBROMFENAC116bromocriptinemesylatebromocriptinemesylate 39BROMPHENIRAMINETANNATEBROMPHENIRAMINETANNATE 26BROVANABROVANA 15BSS PLUSBSS PLUS 116budesonide(inhalation)budesonide(inhalation) 15budesonide (nasal)budesonide(nasal) 112budesonidebudesonide 54bumetanidebumetanide 69BUMEXBUMEX 69BUNAVAIL 2.1MG-0.3MG,4.2MG-0.7MGBUNAVAIL 2.1MG-0.3MG, 4.2MG-0.7MG 9BUNAVAIL 6.3MG-1MGBUNAVAIL 6.3MG-1MG 9BUPHENYL 3GM/TSPBUPHENYL 3GM/TSP 72BUPHENYL 500 MGBUPHENYL500 MG 72bupivacaine hclbupivacainehcl 82bupivacaine indextrosebupivacaine indextrose 82

bupivacaine w/epinephrinebupivacaine w/epinephrine 82BUPRENEXBUPRENEX 9buprenorphine hcl 0.3mg/mlbuprenorphine hcl 0.3mg/ml 9buprenorphine hcl 2 mg, 8mgbuprenorphine hcl 2 mg, 8mg 9buprenorphine hcl-naloxone hcldihydratebuprenorphine hcl-naloxone hcl dihydrate 9bupropion hcl (smokingdeterrent)bupropion hcl(smoking deterrent) 121bupropion hclbupropion hcl20buspirone hclbuspirone hcl 12butalbital-acetaminophen-caffeine 300mg-50mg-40mgbutalbital-acetaminophen-caffeine 300mg-50mg-40mg5butalbital-acetaminophen-caffeine 325mg-50mg-40mgbutalbital-acetaminophen-caffeine 325mg-50mg-40mg5butalbital-acetaminophen-caffeine 325mg/15ml-50mg/15ml-40mg/15mlbutalbital-acetaminophen-caffeine325mg/15ml-50mg/15ml-40mg/15ml 5butalbital-acetaminophen-caffeine w/ codeine 300mg-50mg-40mg-30mgbutalbital-acetaminophen-caffeine w/codeine 300mg-50mg-40mg-30mg 8butalbital-acetaminophen-caffeine w/ codeine 325mg-50mg-40mg-30mgbutalbital-acetaminophen-caffeine w/codeine 325mg-50mg-40mg-30mg 8butalbital-acetaminophenbutalbital-acetaminophen 4butalbital-aspirin-caffeinew/codbutalbital-aspirin-caffeinew/cod 8butalbital-aspirin-caffeinebutalbital-aspirin-caffeine 5butorphanol tartrate 1 mg/ml, 2mg/mlbutorphanol tartrate 1mg/ml, 2 mg/ml 9

butorphanol tartrate 10mg/mlbutorphanol tartrate 10mg/ml 9BUTRANS 10 MCG/HR, 5MCG/HR, 20 MCG/HRBUTRANS10 MCG/HR, 5 MCG/HR, 20MCG/HR 9BUTRANS 15 MCG/HR, 7.5MCG/HRBUTRANS 15 MCG/HR,7.5 MCG/HR 9BYDUREON PENBYDUREONPEN 23BYSTOLICBYSTOLIC 48C-NATE DHAC-NATE DHA106CA-PLUSCA-PLUS 110cabergolinecabergoline 73CADUETCADUET 50CAFCITCAFCIT 1caffeine citratecaffeine citrate 1CAFFEINE/SODIUMBENZOATECAFFEINE/SODIUMBENZOATE 1CALAN SRCALAN SR 49CALANCALAN 49calcipotriene-betamethasonedipropionatecalcipotriene-betamethasone dipropionate 61calcipotrienecalcipotriene 60calcitonin (salmon)calcitonin(salmon) 71calcitriol 0.25 mcg, 0.5mcgcalcitriol 0.25 mcg, 0.5mcg 72calcitriol 1 mcg/mlcalcitriol 1mcg/ml 72CALCITRIOL 3MCG/GMCALCITRIOL 3MCG/GM 60calcium acetate (phosphatebinder)calcium acetate(phosphate binder) 76calcium chloride(dihydrate)calcium chloride(dihydrate) 100CALCIUMGLUCONATE/DEXTROSECALCIUMGLUCONATE/DEXTROSE 100calcium gluconatecalciumgluconate 100CALCIUM PNVCALCIUMPNV 106CALICYLICCALICYLIC 66CAMPTOSARCAMPTOSAR 38CANASACANASA 76

Index 9

candesartan cilexetil 16 mg, 8mg, 4 mgcandesartan cilexetil 16mg, 8 mg, 4 mg 30candesartan cilexetil 32mgcandesartan cilexetil 32mg 30candesartan cilexetil-hydrochlorothiazidecandesartancilexetil-hydrochlorothiazide 31capecitabinecapecitabine 34CAPEXCAPEX 61CAPRELSACAPRELSA 36capsaicin-mentholcapsaicin-menthol 65CAPTOPRIL/HYDROCHLOROTHIAZIDE 25MG-15MG, 50MG-15MGCAPTOPRIL/HYDROCHLOROTHIAZIDE 25MG-15MG,50MG-15MG 31CAPTOPRIL/HYDROCHLOROTHIAZIDE 25MG-25MG, 50MG-25MGCAPTOPRIL/HYDROCHLOROTHIAZIDE 25MG-25MG,50MG-25MG 31captoprilcaptopril 29CARACCARAC 60CARAFATE 1GM/10MLCARAFATE 1GM/10ML 124CARAFATE 1 GMCARAFATE 1GM 124CARBAGLUCARBAGLU 72carbamazepine 100mg/5mlcarbamazepine 100mg/5ml 17carbamazepine 100mgcarbamazepine 100 mg 17carbamazepine 200mgcarbamazepine 200 mg 17carbamazepine 300mgcarbamazepine 300 mg 17carbamazepine 400mgcarbamazepine 400 mg 17CARBATROL 100MGCARBATROL 100 MG 17CARBATROL 200MGCARBATROL 200 MG 17CARBATROL 300MGCARBATROL 300 MG 17carbidopa-levodopacarbidopa-levodopa 39CARBIDOPA/LEVODOPA/ENTACAPONECARBIDOPA/LEVODOPA/ENTACAPONE 39carbidopacarbidopa 38

carbinoxaminemaleatecarbinoxaminemaleate 26CARBOCAINECARBOCAINE

82carbonyl ironcarbonyl iron 80carboplatincarboplatin 34CARDIO TONECARDIOTONE 110cardioplegic solncardioplegicsoln 50CARDIZEM CD 120 MG, 300MG, 180 MGCARDIZEM CD120 MG, 300 MG, 180 MG 49CARDIZEM CD 240MGCARDIZEM CD 240MG 49CARDIZEM CD 360MGCARDIZEM CD 360MG 49CARDIZEM LA 120MGCARDIZEM LA 120MG 49CARDIZEM LA 180 MG, 420MG, 360 MG, 300 MG, 240MGCARDIZEM LA 180 MG,420 MG, 360 MG, 300 MG, 240MG 49CARDIZEMCARDIZEM 49CARDURACARDURA 30CAREONE BLOOD GLUCOSEMONITORINGSYSTEM/PREMIUMCAREONEBLOOD GLUCOSEMONITORINGSYSTEM/PREMIUM 89CAREONE BLOOD GLUCOSEMONITORINGSYSTEM/VALUECAREONEBLOOD GLUCOSEMONITORINGSYSTEM/VALUE 89CARESENS CONTROL ASOLUTIONCARESENSCONTROL A SOLUTION 89CARETOUCH ALCOHOLPREP PADSCARETOUCHALCOHOL PREP PADS 98CARIMUNENANOFILTEREDCARIMUNENANOFILTERED 117carisoprodol 250mgcarisoprodol 250 mg 111carisoprodol 350mgcarisoprodol 350 mg 111carisoprodol w/ aspirin &codeinecarisoprodol w/ aspirin& codeine 111

carisoprodol w/aspirincarisoprodol w/aspirin 111CARNITOR 1GM/10MLCARNITOR 1GM/10ML 72CARNITOR 200MG/MLCARNITOR 200MG/ML 72CARNITOR 330 MGCARNITOR330 MG 72CARNITOR SFCARNITORSF 72CARRASMARTFOAMCARRASMARTFOAM 84CARRASMARTCARRASMART

84CARRINGTON MOISTUREBARRIER/ZINCCARRINGTONMOISTURE BARRIER/ZINC 67CARRINGTON MOISTUREBARRIERCARRINGTONMOISTURE BARRIER 67carteolol hcl (ophth)carteolol hcl(ophth) 113carvedilol 12.5 mg, 6.25 mg,3.125 mgcarvedilol 12.5 mg, 6.25mg, 3.125 mg 47carvedilol 25 mgcarvedilol 25mg 47CASODEXCASODEX 35CATAPRES-TTS-1CATAPRES-TTS-1 30CATAPRES-TTS-2CATAPRES-TTS-2 30CATAPRES-TTS-3CATAPRES-TTS-3 30CATAPRESCATAPRES 30CEDAXCEDAX 51CEFACLOR 125 MG/5ML, 375MG/5ML, 250MG/5MLCEFACLOR 125MG/5ML, 375 MG/5ML, 250MG/5ML 51cefaclor 250 mg, 500 mgcefaclor250 mg, 500 mg 51cefadroxilcefadroxil 51cefazolin sodium 1 gm, 500 mg,20 gm, 10 gmcefazolin sodium 1gm, 500 mg, 20 gm, 10 gm 51CEFAZOLIN SODIUM 1GMCEFAZOLIN SODIUM 1GM 51CEFAZOLIN SODIUM 20GMCEFAZOLIN SODIUM 20GM 51

Index 10

CEFAZOLINSODIUM/DEXTROSECEFAZOLIN SODIUM/DEXTROSE 51cefdinir 125 mg/5ml, 250mg/5mlcefdinir 125 mg/5ml, 250mg/5ml 51cefdinir 300 mgcefdinir 300mg 51CEFDITOREN PIVOXIL 200 MG,400 MGCEFDITOREN PIVOXIL200 MG, 400 MG 51cefepime hclcefepime hcl 52cefiximecefixime 51CEFOTANCEFOTAN 51CEFOTAXIME SODIUM 1GMCEFOTAXIME SODIUM 1GM 51cefotaxime sodium 10 gm, 500mg, 2 gmcefotaxime sodium 10gm, 500 mg, 2 gm 51cefotetan disodiumcefotetandisodium 51CEFOTETANCEFOTETAN 51cefoxitin sodiumcefoxitinsodium 51cefpodoxime proxetil 100 mg, 200mgcefpodoxime proxetil 100 mg,200 mg 52cefpodoxime proxetil 100 mg/5ml,50 mg/5mlcefpodoxime proxetil100 mg/5ml, 50 mg/5ml 51cefprozil 125 mg/5ml, 250mg/5mlcefprozil 125 mg/5ml, 250mg/5ml 51cefprozil 250 mg, 500 mgcefprozil250 mg, 500 mg 51ceftazidimeceftazidime 52CEFTIBUTENCEFTIBUTEN 52CEFTINCEFTIN 51CEFTRIAXONE IN ISO-OSMOTICDEXTROSECEFTRIAXONE INISO-OSMOTIC DEXTROSE 52ceftriaxone sodium 1 gm, 2 gm,10 gmceftriaxone sodium 1 gm, 2gm, 10 gm 52ceftriaxone sodium 1 gm, 500mg, 250 mgceftriaxone sodium 1gm, 500 mg, 250 mg 52ceftriaxone sodium 2gmceftriaxone sodium 2 gm 52cefuroxime axetilcefuroximeaxetil 51

CEFUROXIMESODIUM/SODIUMCHLORIDECEFUROXIMESODIUM/SODIUMCHLORIDE

114cefuroxime sodiumcefuroximesodium 51CELEBREXCELEBREX 3celecoxibcelecoxib 3CELESTONE-SOLUSPANCELESTONE-SOLUSPAN 55CELEXACELEXA 20CELLCEPT 200MG/MLCELLCEPT 200MG/ML 45CELLCEPT 250 MGCELLCEPT250 MG 45CELLCEPT 500 MGCELLCEPT500 MG 45CELLCEPTINTRAVENOUSCELLCEPTINTRAVENOUS 45CELLUGELCELLUGEL 116CENTANYCENTANY 59CENTRUMPERFORMANCECENTRUMPERFORMANCE 110CENTRUM SPECIALISTENERGYCENTRUMSPECIALIST ENERGY 110cephalexin 125 mg/5ml, 250mg/5mlcephalexin 125 mg/5ml,250 mg/5ml 51CEPHALEXIN 250 MG, 500MGCEPHALEXIN 250 MG, 500MG 51cephalexin 250 mg, 750 mg,500 mgcephalexin 250 mg, 750mg, 500 mg 51CERDELGACERDELGA 79CEREBYXCEREBYX 19CEREZYMECEREZYME 79CERVARIXCERVARIX 127cetirizine hcl 1 mg/ml, 5mg/5mlcetirizine hcl 1 mg/ml, 5mg/5ml 26cetirizine hcl 10 mg, 5mgcetirizine hcl 10 mg, 5mg 26cetirizine hcl 10 mgcetirizine hcl10 mg 27CETRAXALCETRAXAL 116CETROTIDECETROTIDE 71cevimeline hclcevimelinehcl 103

CHANTIX CONTINUINGMONTHPAKCHANTIXCONTINUING MONTHPAK121CHANTIX STARTING MONTHPAKCHANTIX STARTINGMONTH PAK 121CHANTIXCHANTIX 121CHEK-STIX COMBO PAKURINALYSIS CONTROLCHEK-STIX COMBO PAK URINALYSISCONTROL 69CHEK-STIX CONTROLCHEK-STIX CONTROL 69CHELIDONIUMCOMPOUNDCHELIDONIUMCOMPOUND 46CHEMSTRIP-KCHEMSTRIP-K

69CHILDRENS ADVILCHILDRENSADVIL 3CHILDRENSMOTRINCHILDRENSMOTRIN 3CHLORAMPHENICOL SODIUMSUCCINATECHLORAMPHENICOL SODIUM SUCCINATE 11chlordiazepoxidehclchlordiazepoxide hcl 13CHLORDIAZEPOXIDE/AMITRIPTYLINECHLORDIAZEPOXIDE/AMITRIPTYLINE 120chlorhexidine gluconate (mouth-throat)chlorhexidine gluconate(mouth-throat) 102CHLOROQUINE PHOSPHATE250 MGCHLOROQUINEPHOSPHATE 250 MG 33chloroquine phosphate 250mgchloroquine phosphate 250mg 33chloroquine phosphate 500mgchloroquine phosphate 500mg 33CHLOROTHIAZIDE 250MGCHLOROTHIAZIDE 250MG 70chlorothiazide 500mgchlorothiazide 500 mg 70chlorothiazidesodiumchlorothiazidesodium 70chlorpromazinehclchlorpromazine hcl 41CHLORPROPAMIDECHLORPROPAMIDE 24chlorthalidone 25 mg, 50mgchlorthalidone 25 mg, 50mg 70

Index 11

chlorzoxazonechlorzoxazone111

cholecalciferol 400 unit/ml, 400unt/0.03mlcholecalciferol 400unit/ml, 400 unt/0.03ml 130cholecalciferol 400unitcholecalciferol 400 unit 130cholestyramine 4gm/dosecholestyramine 4gm/dose 27cholestyramine 4gmcholestyramine 4 gm 27cholestyramine light 4gm/dosecholestyramine light 4gm/dose 27cholestyramine light 4gmcholestyramine light 4 gm 27choline & mag salicylatecholine &mag salicylate 5choline fenofibratecholinefenofibrate 28CHOLINE MAGNESIUMTRISALICYLATECHOLINEMAGNESIUMTRISALICYLATE 5chorionic gonadotropinchorionicgonadotropin 71CHROMIUMCHLORIDECHROMIUMCHLORIDE 102CICLODAN SOLUTIONKITCICLODAN SOLUTIONKIT 59ciclopirox olamineciclopiroxolamine 59ciclopiroxciclopirox 59cidofovircidofovir 43cilostazolcilostazol 78CILOXANCILOXAN 114cimetidine 200 mgcimetidine 200mg 124cimetidine 300 mgcimetidine 300mg 124cimetidine 400 mgcimetidine 400mg 124cimetidine 800 mgcimetidine 800mg 124cimetidine hclcimetidine hcl 124CIMZIA STARTER KITCIMZIASTARTER KIT 76CIMZIACIMZIA 76CINRYZECINRYZE 78CIPRO 250 MG, 500 MGCIPRO250 MG, 500 MG 75CIPRO 5 GM/100ML, 500MG/5MLCIPRO 5 GM/100ML,500 MG/5ML 75

CIPRO I.V.-IN D5WCIPRO I.V.-IN D5W 75CIPRO XRCIPRO XR 75CIPRODEXCIPRODEX 117CIPROFLOXACIN 0.2%CIPROFLOXACIN 0.2% 116CIPROFLOXACIN 200MG/20ML, 400MG/40MLCIPROFLOXACIN200 MG/20ML, 400MG/40ML 75ciprofloxacin 200 mg/20ml, 400mg/40mlciprofloxacin 200mg/20ml, 400 mg/40ml 75ciprofloxacin 250 mg/5ml, 500mg/5mlciprofloxacin 250mg/5ml, 500 mg/5ml 75ciprofloxacin hcl(ophth)ciprofloxacin hcl(ophth) 114CIPROFLOXACIN HCL 100MGCIPROFLOXACIN HCL 100MG 75ciprofloxacin hcl 250 mg, 750mg, 500 mgciprofloxacin hcl250 mg, 750 mg, 500 mg 75ciprofloxacin ind5wciprofloxacin in d5w 75ciprofloxacin-ciprofloxacinhclciprofloxacin-ciprofloxacinhcl 75cisatracuriumbesylatecisatracuriumbesylate 112cisplatin 100 mg/100ml, 50mg/50mlcisplatin 100mg/100ml, 50 mg/50ml 34CISPLATIN 200MG/200MLCISPLATIN 200MG/200ML 34citalopram hydrobromide 10mg, 40 mg, 20 mgcitalopramhydrobromide 10 mg, 40 mg, 20mg 20citalopram hydrobromide 10mg/5mlcitalopramhydrobromide 10 mg/5ml 20CITRANATAL 90DHACITRANATAL 90DHA 106CITRANATALASSURECITRANATALASSURE 106CITRANATAL B-CALMCITRANATAL B-CALM 106

CITRANATAL DHACITRANATALDHA 106CITRANATALHARMONYCITRANATALHARMONY 106CITRANATAL RXCITRANATALRX 106cladribinecladribine 34CLAFORANCLAFORAN 52CLARIFOAM EFCLARIFOAMEF 57CLARINEXCLARINEX 27clarithromycin 125 mg/5ml, 250mg/5mlclarithromycin 125mg/5ml, 250 mg/5ml 83clarithromycin 250 mg, 500mgclarithromycin 250 mg, 500mg 83clarithromycin 500mgclarithromycin 500 mg 83CLEMASTINE FUMARATE 0.67MG/5MLCLEMASTINEFUMARATE 0.67 MG/5ML 26CLEMASTINE FUMARATE 2.68MGCLEMASTINE FUMARATE2.68 MG 26clemastine fumarate 2.68mgclemastine fumarate 2.68mg 26CLEOCIN 150 MG, 75 MG, 300MGCLEOCIN 150 MG, 75 MG,300 MG 11CLEOCIN 2 %CLEOCIN 2% 129CLEOCIN IN D5WCLEOCIN IND5W 11CLEOCIN PEDIATRICGRANULESCLEOCINPEDIATRIC GRANULES 11CLEOCIN PHOSPHATE 300MG/2ML, 900 MG/6ML, 9GM/60ML, 600MG/4MLCLEOCIN PHOSPHATE300 MG/2ML, 900 MG/6ML, 9GM/60ML, 600 MG/4ML 11CLEOCIN PHOSPHATE 300MG/2ML, 900 MG/6MLCLEOCINPHOSPHATE 300 MG/2ML, 900MG/6ML 11CLEOCIN PHOSPHATE300MG/50ML-5%, 900MG/50ML-5%, 600MG/50ML-5%CLEOCINPHOSPHATE 300MG/50ML-5%,900MG/50ML-5%, 600MG/50ML-5% 11CLEOCIN PHOSPHATE 600MG/4MLCLEOCIN PHOSPHATE600 MG/4ML 11

Index 12

CLEOCIN-TCLEOCIN-T 57CLEVER CHEK BLOODGLUCOSE MONITORINGSYSTEMCLEVER CHEK BLOODGLUCOSE MONITORINGSYSTEM 89CLEVER CHOICE GLUCOSECONTROL HIGHCLEVERCHOICE GLUCOSE CONTROLHIGH 89CLEVER CHOICE GLUCOSECONTROL LOWCLEVERCHOICE GLUCOSE CONTROLLOW 89CLEVER CHOICE MICROBLOODGLUCOSEMONITORING SYSTEMCLEVERCHOICE MICROBLOODGLUCOSEMONITORING SYSTEM 90CLIMARA PROCLIMARAPRO 74CLIMARACLIMARA 74CLINDAGELCLINDAGEL 57clindamycin hclclindamycinhcl 11clindamycin palmitatehydrochlorideclindamycinpalmitate hydrochloride 11clindamycin phosphate(topical)clindamycin phosphate(topical) 57clindamycin phosphate 150mg/ml, 900 mg/6mlclindamycinphosphate 150 mg/ml, 900mg/6ml 12clindamycin phosphate 150mg/ml, 9000 mg/60ml, 900mg/6ml, 600 mg/4ml, 300mg/2mlclindamycin phosphate150 mg/ml, 9000 mg/60ml, 900mg/6ml, 600 mg/4ml, 300mg/2ml 12CLINDAMYCIN PHOSPHATE150 MG/MLCLINDAMYCINPHOSPHATE 150 MG/ML 12clindamycin phosphate ind5wclindamycin phosphate ind5w 11clindamycin phosphatevaginalclindamycin phosphatevaginal 129clindamycin phosphate-benzoylperoxide (refrigerate)clindamycinphosphate-benzoyl peroxide(refrigerate) 57

clindamycin phosphate-benzoylperoxideclindamycinphosphate-benzoylperoxide 57clindamycin phosphate-tretinoinclindamycin phosphate-tretinoin 57clobetasol propionate emollientbaseclobetasol propionateemollient base 62clobetasol propionateemulsionclobetasol propionateemulsion 62clobetasol propionateclobetasolpropionate 61CLOBEXCLOBEX 62CLOCORTOLONE PIVALATEPUMPCLOCORTOLONEPIVALATE PUMP 62CLOCORTOLONEPIVALATECLOCORTOLONEPIVALATE 62CLODERM PUMPCLODERMPUMP 62CLODERMCLODERM 62clomiphene citrateclomiphenecitrate 71clomipramine hclclomipraminehcl 21clonazepamclonazepam 17clonidine hcl (adhd)clonidinehcl (adhd) 1clonidine hcl(analgesia)clonidine hcl(analgesia) 5clonidine hcl 0.1 mg, 0.3 mg,0.2 mgclonidine hcl 0.1 mg, 0.3mg, 0.2 mg 30clonidine hcl 0.1 mg/24hr, 0.3mg/24hr, 0.2 mg/24hrclonidinehcl 0.1 mg/24hr, 0.3 mg/24hr,0.2 mg/24hr 30clopidogrel bisulfate 300mgclopidogrel bisulfate 300mg 78clopidogrel bisulfate 75mgclopidogrel bisulfate 75mg 78clorazepatedipotassiumclorazepatedipotassium 13CLORPRESCLORPRES 31clotrimazole(topical)clotrimazole(topical) 59clotrimazole w/betamethasoneclotrimazole w/betamethasone 59

clotrimazoleclotrimazole 102CLOZAPINE ODTCLOZAPINEODT 40clozapineclozapine 40CLOZARILCLOZARIL 40CO-NATAL FACO-NATALFA 106COAL TARCOAL TAR 68COARTEMCOARTEM 33COCAINE HCLCOCAINEHCL 65codeine sulfate 15 mgcodeinesulfate 15 mg 5CODEINE SULFATE 15MGCODEINE SULFATE 15MG 5codeine sulfate 30 mg, 60mgcodeine sulfate 30 mg, 60mg 5CODEINE SULFATE 30 MG, 60MGCODEINE SULFATE 30 MG,60 MG 5COGENTINCOGENTIN 38COLAZALCOLAZAL 76colchicine w/probenecidcolchicine w/probenecid 78COLCHICINECOLCHICINE 78COLCRYSCOLCRYS 78COLESTID 1 GMCOLESTID 1GM 27COLESTID 5 GMCOLESTID 5GM 27COLESTID FLAVORED 5GM/7.5GMCOLESTIDFLAVORED 5 GM/7.5GM 27COLESTID FLAVORED 5GMCOLESTID FLAVORED 5GM 27colestipol hcl 1 gmcolestipol hcl 1gm 27colestipol hcl 5 gmcolestipol hcl 5gm 27colistimethatesodiumcolistimethate sodium10COLY-MYCIN MCOLY-MYCINM 10COLYTE-FLAVOR PACKS227.1GM-21.5GM-5.53GM-2.82GM-6.36GMCOLYTE-FLAVOR PACKS 227.1GM-21.5GM-5.53GM-2.82GM-6.36GM 81

Index 13

COLYTE-FLAVOR PACKS240GM-22.72GM-5.84GM-2.98GM-6.72GMCOLYTE-FLAVOR PACKS 240GM-22.72GM-5.84GM-2.98GM-6.72GM 81COMBIGANCOMBIGAN 113COMBIPATCHCOMBIPATCH

74COMBIVENTRESPIMATCOMBIVENTRESPIMAT 15COMBIVIRCOMBIVIR 42COMPLERACOMPLERA 42COMPLETENATECOMPLETENATE 106COMTANCOMTAN 38COMVAXCOMVAX 127CONCEPT DHACONCEPTDHA 106CONCEPT OBCONCEPTOB 106CONCERTACONCERTA 1CONDYLOXCONDYLOX 65CONTROL BLOOD GLUCOSEMONITORINGSYSTEMCONTROL BLOODGLUCOSE MONITORINGSYSTEM 90CONTROL SOLUTIONNORMALCONTROL SOLUTIONNORMAL 90CONZIPCONZIP 5COOL BLOOD GLUCOSEMONITORING KITCOOL BLOODGLUCOSE MONITORINGKIT 90COOL CONTROL SOLUTIONACOOL CONTROL SOLUTIONA 90COOL CONTROL SOLUTIONBCOOL CONTROL SOLUTIONB 90COPA ISLAND BORDEREDFOAM DRESSING 4"X4"COPAISLAND BORDERED FOAMDRESSING 4"X4" 84COPA PLUS HYDROPHILICFOAM DRESSING 4"X4"COPAPLUS HYDROPHILIC FOAMDRESSING 4"X4" 84COPAXONE 20MG/MLCOPAXONE 20MG/ML 120COPAXONE 40MG/MLCOPAXONE 40MG/ML 120

COPEGUSCOPEGUS 44COPPER TRACEMETALCOPPER TRACEMETAL 102CORDARONECORDARONE14CORDRANCORDRAN 62COREG 12.5 MG, 6.25 MG,3.125 MGCOREG 12.5 MG,6.25 MG, 3.125 MG 48COREG 25 MGCOREG 25MG 48COREG CRCOREG CR 48CORGARDCORGARD 48CORLOPAMCORLOPAM 33CORNWALL METALPIPETTINGHOLDER (FOR1240S)CORNWALL METALPIPETTINGHOLDER (FOR1240S) 99CORNWALL METALPIPETTINGHOLDER (FOR1250S)CORNWALL METALPIPETTINGHOLDER (FOR1250S) 99CORNWALL METALPIPETTINGHOLDER (FOR1260S)CORNWALL METALPIPETTINGHOLDER (FOR1260S) 99CORNWALL METALPIPETTINGHOLDER (FOR1270S)CORNWALL METALPIPETTINGHOLDER (FOR1270S) 99CORTEFCORTEF 55CORTENEMACORTENEMA10CORTIFOAMCORTIFOAM10CORTISONEACETATECORTISONEACETATE 55CORVERTCORVERT 14CORVITE 150CORVITE150 79CORVITECORVITE 104CORZIDECORZIDE 31COSENTYX SENSOREADYPENCOSENTYXSENSOREADY PEN 60COSENTYXCOSENTYX 60COSOPT PFCOSOPTPF 113COSOPTCOSOPT 113COUMADINCOUMADIN 16

COVRSITE COVERDRESSINGCOVRSITE COVERDRESSING 84COVRSITE PLUS COMPOSITEDRESSINGCOVRSITE PLUSCOMPOSITE DRESSING 84COZAAR 100 MGCOZAAR 100MG 30COZAAR 25 MG, 50MGCOZAAR 25 MG, 50 MG 30CRAMP RELEAFCRAMPRELEAF 46CRANBLADDERRELEAFCRANBLADDERRELEAF 46CREONCREON 69CRESTORCRESTOR 28CRINONECRINONE 129CRIXIVANCRIXIVAN 42cromolyn sodium(mastocytosis)cromolyn sodium(mastocytosis) 75cromolyn sodium(ophth)cromolyn sodium(ophth) 116CROMOLYNSODIUMCROMOLYNSODIUM 14CU-PLUSCU-PLUS 110CUBICIN RFCUBICIN RF 11CUBICINCUBICIN 11CURE-ALLCURE-ALL 66CUREX ALL-PURPOSESPONGES 4"X4" 4 PLYCUREXALL-PURPOSE SPONGES 4"X4"4 PLY 84CURITY ALCOHOLPREPS/MEDIUM 2 PLYCURITYALCOHOL PREPS/MEDIUM 2PLY 98CURITY ALCOHOLSWABSCURITY ALCOHOLSWABS 98CURITY ALL PURPOSESPONGES 2"X2" 4PLYCURITYALL PURPOSE SPONGES 2"X2"4PLY 84CURITY ALL PURPOSESPONGES 2"X2"CURITY ALLPURPOSE SPONGES 2"X2"84CURITY ALL PURPOSESPONGES 3"X3" 4PLYCURITYALL PURPOSE SPONGES 3"X3"4PLY 84

Index 14

CURITY ALL PURPOSESPONGES 4 PLYCURITY ALLPURPOSE SPONGES 4PLY 84CURITY ALL PURPOSESPONGES 4"X4" 4PLY/SOFTPOUCHCURITY ALL PURPOSESPONGES 4"X4" 4PLY/SOFTPOUCH 84CURITY ALL PURPOSESPONGES 4"X4" 4PLYCURITYALL PURPOSE SPONGES 4"X4"4PLY 84CURITY ALL PURPOSESPONGES 4"X4"CURITY ALLPURPOSE SPONGES 4"X4"84CURITY AMDANTIMICROBIALGAUZESPONGES 2"X2" 8 PLYCURITYAMD ANTIMICROBIALGAUZESPONGES 2"X2" 8 PLY 84CURITY AMDANTIMICROBIALGAUZESPONGES 4"X4" 12 PLYCURITYAMD ANTIMICROBIALGAUZESPONGES 4"X4" 12 PLY 84CURITY COVER SPONGE4"X4"CURITY COVER SPONGE4"X4" 84CURITY COVER SPONGES3"X3"CURITY COVERSPONGES 3"X3" 84CURITY COVER SPONGES4"X4"CURITY COVERSPONGES 4"X4" 84CURITY DRESSING SPONGES4"X4" 6 PLYCURITY DRESSINGSPONGES 4"X4" 6 PLY 84CURITY GAUZE PADS 2"X2" 12PLYCURITY GAUZE PADS2"X2" 12 PLY 84CURITY GAUZE PADS2"X2"CURITY GAUZE PADS2"X2" 84CURITY GAUZE PADS3"X3"CURITY GAUZE PADS3"X3" 84CURITY GAUZE PADS 4"X4" 12PLYCURITY GAUZE PADS4"X4" 12 PLY 84CURITY GAUZE SPONGE 2"X2"8 PLYCURITY GAUZE SPONGE2"X2" 8 PLY 84CURITY GAUZE SPONGE2"X2"12 PLYCURITY GAUZESPONGE 2"X2"12 PLY 84CURITY GAUZE SPONGE 3"X3"12 PLYCURITY GAUZESPONGE 3"X3" 12 PLY 84

CURITY GAUZE SPONGE4"X4" 12 PLYCURITY GAUZESPONGE 4"X4" 12 PLY 84CURITY GAUZE SPONGE4"X4" 16 PLYCURITY GAUZESPONGE 4"X4" 16 PLY 84CURITY GAUZE SPONGE4"X4" 8 PLYCURITY GAUZESPONGE 4"X4" 8 PLY 84CURITY GAUZE SPONGE4"X4"16 PLYCURITY GAUZESPONGE 4"X4"16 PLY 84CURITY GAUZE SPONGES4"X4" 12 PLYCURITY GAUZESPONGES 4"X4" 12 PLY 84CURITY GAUZE SPONGES4"X4" 8 PLYCURITY GAUZESPONGES 4"X4" 8 PLY 84CURITY NON-ADHERENTSTRIPS 3"X3"CURITY NON-ADHERENT STRIPS3"X3" 84CURITYSPONGES/CELLULOSEFILLED/2"X2"CURITYSPONGES/CELLULOSEFILLED/2"X2" 85CURITYSPONGES/CELLULOSEFILLED/4"X4"CURITYSPONGES/CELLULOSEFILLED/4"X4" 85CUTIVATECUTIVATE 62CUVITRUCUVITRU 117CVS ADVANCED GLUCOSEMETERCVS ADVANCEDGLUCOSE METER 90CVS ALCOHOL PREPSWABSCVS ALCOHOL PREPSWABS 98CVS ALCOHOL SWABSCVSALCOHOL SWABS 98CVS GAUZE PADS 2"X2" 12-PLYCVS GAUZE PADS 2"X2"12-PLY 85CVS GAUZE PADS 4"X4" 12-PLYCVS GAUZE PADS 4"X4"12-PLY 85CVS HAIR/SKIN/NAILSCVSHAIR/SKIN/NAILS 110CVS PREP PADSCVS PREPPADS 98CVS WOMENSPRENATAL+DHACVSWOMENSPRENATAL+DHA 106cyanocobalamincyanocobalamin 79

CYCLESSACYCLESSA 52cyclobenzaprinehclcyclobenzaprine hcl 111CYCLOGYL 0.5 %CYCLOGYL0.5 % 113CYCLOGYL 1 %, 2%CYCLOGYL 1 %, 2 % 113cyclopentolate hcl 0.5%cyclopentolate hcl 0.5 % 114cyclopentolate hcl 1 %, 2%cyclopentolate hcl 1 %, 2% 114cyclophosphamide 1 gm, 500 mg,2 gmcyclophosphamide 1 gm,500 mg, 2 gm 34CYCLOPHOSPHAMIDE 25 MG,50 MGCYCLOPHOSPHAMIDE25 MG, 50 MG 34CYCLOSERINECYCLOSERINE

34CYCLOSETCYCLOSET 23cyclosporine 100 mg, 25mgcyclosporine 100 mg, 25mg 45cyclosporine 50mg/mlcyclosporine 50 mg/ml 46cyclosporine modified (formicroemulsion) 100 mg, 50 mg,25 mgcyclosporine modified (formicroemulsion) 100 mg, 50 mg,25 mg 45cyclosporine modified (formicroemulsion) 100mg/mlcyclosporine modified (formicroemulsion) 100 mg/ml 45CYCLOSPORINEMODIFIEDCYCLOSPORINEMODIFIED 46CYFOLEXCYFOLEX 79CYKLOKAPRONCYKLOKAPRON 80CYMBALTACYMBALTA 21cyproheptadinehclcyproheptadine hcl 27CYSTADANECYSTADANE 72CYSTAGONCYSTAGON 77cysteine hclcysteine hcl 113CYSTEXCYSTEX 46CYTARABINEAQUEOUSCYTARABINEAQUEOUS 34cytarabinecytarabine 34CYTOGAMCYTOGAM 117CYTOMELCYTOMEL 122CYTOTECCYTOTEC 125CYTOVENECYTOVENE 43

Index 15

D-VI-SOLD-VI-SOL 130D.H.E. 45D.H.E. 45 99DACARBAZINE 100MGDACARBAZINE 100 MG 37dacarbazine 200 mgdacarbazine200 mg 37DACOGENDACOGEN 35DAKLINZADAKLINZA 44DALIRESPDALIRESP 14danazoldanazol 9DANTRIUM IVDANTRIUMIV 111DANTRIUMDANTRIUM 111dantrolene sodium 100 mg, 50mg, 25 mgdantrolene sodium 100mg, 50 mg, 25 mg 111dantrolene sodium 20mgdantrolene sodium 20mg 111dapsonedapsone 11DAPTACELDAPTACEL 123daptomycindaptomycin 11DARAPRIMDARAPRIM 33darifenacinhydrobromidedarifenacinhydrobromide 126daunorubicin hcldaunorubicinhcl 36DAYPRODAYPRO 3DDAVP 0.01 %DDAVP 0.01% 73DDAVP 0.1 MGDDAVP 0.1MG 73DDAVP 0.2 MGDDAVP 0.2MG 73DDAVP 4 MCG/MLDDAVP 4MCG/ML 73decitabinedecitabine 35DEEP HEALTHDEEPHEALTH 47DEEP SLEEPDEEP SLEEP 47deferoxaminemesylatedeferoxaminemesylate 24DELESTROGEN 10MG/MLDELESTROGEN 10MG/ML 74DELESTROGEN 20 MG/ML, 40MG/MLDELESTROGEN 20MG/ML, 40 MG/ML 74DELFLEX-LC/1.5%DEXTROSEDELFLEX-LC/1.5%DEXTROSE 47

DEMADEX 10 MG, 5 MG, 100MGDEMADEX 10 MG, 5 MG,100 MG 69DEMADEX 20 MGDEMADEX20 MG 70demeclocyclinehcldemeclocycline hcl 122DEMEROL 100 MG, 50MGDEMEROL 100 MG, 50MG 5DEMEROL 100 MG/ML, 50MG/ML, 25 MG/MLDEMEROL100 MG/ML, 50 MG/ML, 25MG/ML 5DENAVIRDENAVIR 61DEPACONDEPACON 19DEPAKENEDEPAKENE 19DEPAKOTE ERDEPAKOTEER 19DEPAKOTESPRINKLESDEPAKOTESPRINKLES 19DEPAKOTEDEPAKOTE 19DEPO-MEDROLDEPO-MEDROL 55DEPO-PROVERACONTRACEPTIVEDEPO-PROVERACONTRACEPTIVE 54DEPO-SUBQ PROVERA104DEPO-SUBQ PROVERA104 54DEPO-TESTOSTERONEDEPO-TESTOSTERONE 9DERMA SILKRXDICLOPAKDERMA SILKRXDICLOPAK 3DERMA-SMOOTHE/FSBODYDERMA-SMOOTHE/FSBODY 62DERMA-SMOOTHE/FSSCALPDERMA-SMOOTHE/FSSCALP 62DERMACEA DRAINSPONGES 4"X4"DERMACEADRAIN SPONGES 4"X4" 85DERMACEA GAUZE SPONGE2"X2" 12 PLYDERMACEAGAUZE SPONGE 2"X2" 12PLY 85DERMACEA GAUZE SPONGE2"X2" 8 PLYDERMACEAGAUZE SPONGE 2"X2" 8PLY 85

DERMACEA GAUZE SPONGE3"X3" 12 PLYDERMACEAGAUZE SPONGE 3"X3" 12PLY 85DERMACEA GAUZE SPONGE3"X3" 8 PLYDERMACEA GAUZESPONGE 3"X3" 8 PLY 85DERMACEA GAUZE SPONGE4"X4" 12 PLYDERMACEAGAUZE SPONGE 4"X4" 12PLY 85DERMACEA GAUZE SPONGE4"X4" 16 PLYDERMACEAGAUZE SPONGE 4"X4" 16PLY 85DERMACEA GAUZE SPONGE4"X4" 8 PLYDERMACEA GAUZESPONGE 4"X4" 8 PLY 85DERMACEA I.V. DRAINSPONGES 2"X2"DERMACEAI.V. DRAIN SPONGES 2"X2"85DERMACEA I.V. DRAINSPONGES 4"X4"DERMACEAI.V. DRAIN SPONGES 4"X4"85DERMACEA I.V. SPONGES2"X2"DERMACEA I.V.SPONGES 2"X2" 85DERMACEA NON-WOVENSPONGES 2"X2" 4PLYDERMACEA NON-WOVENSPONGES 2"X2" 4 PLY 85DERMACEA NON-WOVENSPONGES 3"X3" 4PLYDERMACEA NON-WOVENSPONGES 3"X3" 4 PLY 85DERMACEA NON-WOVENSPONGES 4"X4" 4PLYDERMACEA NON-WOVENSPONGES 4"X4" 4 PLY 85DERMACEA NON-WOVENSPONGES 4"X4" 6PLYDERMACEA NON-WOVENSPONGES 4"X4" 6 PLY 85DERMACEA TYPE VII GAUZE2"X2" 12 PLYDERMACEA TYPEVII GAUZE 2"X2" 12 PLY 85DERMACEA TYPE VII GAUZE2"X2" 8 PLYDERMACEA TYPEVII GAUZE 2"X2" 8 PLY 85DERMACEA TYPE VII GAUZE3"X3" 12 PLYDERMACEA TYPEVII GAUZE 3"X3" 12 PLY 85DERMACEA TYPE VII GAUZE3"X3" 12PLYDERMACEA TYPEVII GAUZE 3"X3" 12PLY 85DERMACEA TYPE VII GAUZE4"X4" 12 PLYDERMACEA TYPEVII GAUZE 4"X4" 12 PLY 85

Index 16

DERMACEA TYPE VII GAUZE4"X4" 16 PLYDERMACEA TYPEVII GAUZE 4"X4" 16 PLY 85DERMACEA TYPE VII GAUZE4"X4" 8 PLYDERMACEA TYPEVII GAUZE 4"X4" 8 PLY 85DERMACEA X-RAY SPONGES4"X4" 16 PLYDERMACEA X-RAY SPONGES 4"X4" 16PLY 85DERMACINRX LEXITRALPHARMAPAKDERMACINRXLEXITRAL PHARMAPAK 59DERMACINRXSILAPAKDERMACINRXSILAPAK 62DERMALEVIN ADHESIVEFOAMDRESSING4"X4"DERMALEVIN ADHESIVEFOAMDRESSING 4"X4" 85DERMARESTROSACEADERMARESTROSACEA 66DERMATOPDERMATOP 62DERMOTICDERMOTIC 117DESFERALDESFERAL 24desipramine hcldesipraminehcl 21DESLORATADINEODTDESLORATADINEODT 27desloratadinedesloratadine 27desmopressin acetate 0.1mgdesmopressin acetate 0.1mg 73desmopressin acetate 0.2mgdesmopressin acetate 0.2mg 73desmopressin acetate 4mcg/mldesmopressin acetate 4mcg/ml 73desmopressin acetaterefrigerateddesmopressin acetaterefrigerated 73desmopressin acetate sprayrefrigerateddesmopressin acetatespray refrigerated 73desmopressin acetatespraydesmopressin acetatespray 73DESOGENDESOGEN 52desogestrel & ethinylestradioldesogestrel & ethinylestradiol 52desogestrel-ethinyl estradiol(biphasic)desogestrel-ethinylestradiol (biphasic) 52

desogestrel-ethinyl estradiol(triphasic)desogestrel-ethinylestradiol (triphasic) 52desonidedesonide 62DESOWENDESOWEN 62DESOXIMETASONE 0.05%DESOXIMETASONE 0.05% 62desoximetasone 0.05%desoximetasone 0.05 % 62desoximetasone 0.25%desoximetasone 0.25 % 62DESOXYNDESOXYN 1DESQUAM-XWASHDESQUAM-XWASH 57DESVENLAFAXINE ER 100MG, 50 MGDESVENLAFAXINEER 100 MG, 50 MG 21DETROL LADETROL LA 126DETROLDETROL 126dexamethasone 0.5 mg, 6 mg,4 mg, 1.5 mg, 0.75mgdexamethasone 0.5 mg, 6mg, 4 mg, 1.5 mg, 0.75 mg55dexamethasone 0.5mg/5mldexamethasone 0.5mg/5ml 55DEXAMETHASONE 0.5MG/5MLDEXAMETHASONE0.5 MG/5ML 55DEXAMETHASONE 1 MG, 2MGDEXAMETHASONE 1 MG,2 MG 55dexamethasone sodiumphosphate(ophth)dexamethasone sodiumphosphate (ophth) 115DEXAMETHASONE SODIUMPHOSPHATE 0.1%DEXAMETHASONESODIUM PHOSPHATE 0.1% 115DEXAMETHASONE SODIUMPHOSPHATE 10MG/MLDEXAMETHASONESODIUM PHOSPHATE 10MG/ML 55dexamethasone sodiumphosphate 100 mg/10ml, 4mg/ml, 20 mg/5ml, 120mg/30mldexamethasonesodium phosphate 100mg/10ml, 4 mg/ml, 20 mg/5ml,120 mg/30ml 55

DEXCHLORPHENIRAMINEMALEATEDEXCHLORPHENIRAMINE MALEATE 26DEXEDRINEDEXEDRINE 1DEXERYLDEXERYL 66DEXILANTDEXILANT 125dexmedetomidinehcldexmedetomidine hcl 81dexmethylphenidatehcldexmethylphenidate hcl 1DEXPAK 10 DAYDEXPAK 10DAY 55DEXPAK 13 DAYDEXPAK 13DAY 55DEXPAK 6 DAYDEXPAK 6DAY 55dexrazoxanedexrazoxane 37dextroamphetaminesulfatedextroamphetaminesulfate 1DEXTROSE 10%/NACL0.45%DEXTROSE 10%/NACL0.45% 100DEXTROSE 25%DEXTROSE25% 113DEXTROSE 30%DEXTROSE30% 113DEXTROSE 5%/NACL0.225%DEXTROSE 5%/NACL0.225% 100dextrose in lactatedringersdextrose in lactatedringers 100dextrose w/ sodiumchloridedextrose w/ sodiumchloride 100dextrosedextrose 113DIABDIAB 68DIABETADIABETA 24DIAMOXDIAMOX 69DIANEAL PD-2/1.5%DEXTROSEDIANEAL PD-2/1.5%DEXTROSE 47DIASTAT ACUDIALDIASTATACUDIAL 17DIASTAT PEDIATRICDIASTATPEDIATRIC 17DIATRUE GLUCOSE CONTROLSOLUTION LEVEL 1DIATRUEGLUCOSE CONTROLSOLUTION LEVEL 1 90DIATRUE GLUCOSE CONTROLSOLUTION LEVEL 2DIATRUEGLUCOSE CONTROLSOLUTION LEVEL 2 90

Index 17

DIATRUE GLUCOSE CONTROLSOLUTION LEVEL 3DIATRUEGLUCOSE CONTROLSOLUTION LEVEL 3 90DIAZEPAM 1 MG/MLDIAZEPAM1 MG/ML 13DIAZEPAM 10 MG, 20 MG, 2.5MGDIAZEPAM 10 MG, 20 MG,2.5 MG 17diazepam 10 mg, 5 mg, 2mgdiazepam 10 mg, 5 mg, 2mg 13diazepam 5 mg/mldiazepam 5mg/ml 13DIAZEPAM 5 MG/MLDIAZEPAM5 MG/ML 13DIBENZYLINEDIBENZYLINE

29DICLEGISDICLEGIS 25DICLO GEL/XRYLIXSHEETSDICLO GEL/XRYLIXSHEETS 59diclofenac potassiumdiclofenacpotassium 3diclofenac sodium (actinickeratoses)diclofenac sodium(actinic keratoses) 60diclofenac sodium(ophth)diclofenac sodium(ophth) 116diclofenac sodium(topical)diclofenac sodium(topical) 59diclofenac sodium-capsaicin(topical)diclofenac sodium-capsaicin (topical) 59diclofenac sodium-capsaicindiclofenac sodium-capsaicin 3diclofenac sodiumdiclofenacsodium 3diclofenac w/misoprostoldiclofenac w/misoprostol 3dicloxacillin sodiumdicloxacillinsodium 119dicyclomine hcldicyclominehcl 123didanosine 125 mg, 200mgdidanosine 125 mg, 200mg 42didanosine 250 mg, 400mgdidanosine 250 mg, 400mg 42DIDGETDIDGET 90DIFFERIN 0.1 %, 0.3%DIFFERIN 0.1 %, 0.3 % 57

DIFFERIN 0.1 %DIFFERIN 0.1% 57DIFICIDDIFICID 83DIFLORASONEDIACETATEDIFLORASONEDIACETATE 62DIFLUCAN 10MG/MLDIFLUCAN 10MG/ML 26DIFLUCAN 100 MGDIFLUCAN100 MG 26DIFLUCAN 150 MGDIFLUCAN150 MG 26DIFLUCAN 200 MGDIFLUCAN200 MG 26DIFLUCAN 40MG/MLDIFLUCAN 40MG/ML 26DIFLUCAN 50 MGDIFLUCAN50 MG 26diflunisaldiflunisal 5DIGOXIN 0.05MG/MLDIGOXIN 0.05MG/ML 50digoxin 0.125 mg, 250 mcg,125 mcg, 0.25 mgdigoxin 0.125mg, 250 mcg, 125 mcg, 0.25mg 50digoxin 0.25 mg/mldigoxin 0.25mg/ml 50dihydroergotamine mesylate 1mg/mldihydroergotaminemesylate 1 mg/ml 99DIHYDROERGOTAMINEMESYLATE 4MG/MLDIHYDROERGOTAMINE MESYLATE 4 MG/ML 99DILANTININFATABSDILANTININFATABS 19DILANTIN-125DILANTIN-125

19DILANTINDILANTIN 19DILATRATE SRDILATRATESR 12DILAUDID 1 MG/MLDILAUDID1 MG/ML 5DILAUDID 2 MG, 8 MG, 4MGDILAUDID 2 MG, 8 MG, 4MG 6DILAUDID-HPDILAUDID-HP 6diltiazem hcl 120 mg, 180mgdiltiazem hcl 120 mg, 180mg 49diltiazem hcl 120 mg, 90 mg, 60mg, 30 mgdiltiazem hcl 120 mg,90 mg, 60 mg, 30 mg 49

diltiazem hcl 120 mg, 90 mg, 60mgdiltiazem hcl 120 mg, 90 mg,60 mg 49diltiazem hcl 125 mg/25ml, 50mg/10ml, 25 mg/5mldiltiazem hcl125 mg/25ml, 50 mg/10ml, 25mg/5ml 49diltiazem hcl 240 mgdiltiazem hcl240 mg 49diltiazem hcl coated beads 120mg, 300 mg, 180 mgdiltiazem hclcoated beads 120 mg, 300 mg,180 mg 49diltiazem hcl coated beads 180mg, 420 mg, 360 mg, 300 mg,240 mgdiltiazem hcl coatedbeads 180 mg, 420 mg, 360 mg,300 mg, 240 mg 49diltiazem hcl coated beads 240mgdiltiazem hcl coated beads240 mg 49diltiazem hcl coated beads 360mgdiltiazem hcl coated beads360 mg 49diltiazem hcl extended releasebeadsdiltiazem hcl extendedrelease beads 49DIOVAN 160 MG, 80MGDIOVAN 160 MG, 80 MG30DIOVAN 320 MG, 40MGDIOVAN 320 MG, 40 MG30DIOVAN HCTDIOVAN HCT 31diphenhydramine hcl 12.5mg/5mldiphenhydramine hcl 12.5mg/5ml 26diphenhydramine hcl 50mg/mldiphenhydramine hcl 50mg/ml 26diphenhydramine hcl 50mgdiphenhydramine hcl 50mg 26diphenoxylate w/atropinediphenoxylate w/atropine 24DIPHENOXYLATE/ATROPINEDIPHENOXYLATE/ATROPINE

24DIPHTHERIA/TETANUSTOXOIDS ADSORBEDPEDIATRICDIPHTHERIA/TETANUS TOXOIDS ADSORBEDPEDIATRIC 123DIPRIVANDIPRIVAN 77DIPROLENE AFDIPROLENEAF 62DIPROLENEDIPROLENE 62dipyridamoledipyridamole 78

Index 18

DISALCIDDISALCID 5disopyramidephosphatedisopyramidephosphate 13disulfiramdisulfiram 119DITROPAN XLDITROPANXL 126DIURILDIURIL 70divalproex sodiumdivalproexsodium 19DIVIGELDIVIGEL 74dobutamine hcldobutaminehcl 129dobutamine in d5wdobutamine ind5w 129DOCETAXEL 20 MG/ML, 80MG/4MLDOCETAXEL 20MG/ML, 80 MG/4ML 38docetaxel 20 mg/ml, 80mg/4mldocetaxel 20 mg/ml, 80mg/4ml 38dofetilidedofetilide 14DOLOPHINE 10MGDOLOPHINE 10 MG 6DOLOPHINE 5 MGDOLOPHINE5 MG 6donepezil hydrochloride 10 mg, 5mgdonepezil hydrochloride 10mg, 5 mg 119donepezil hydrochloride 23mgdonepezil hydrochloride 23mg 119DOPAMINE HCL 160 MG/ML, 80MG/MLDOPAMINE HCL 160MG/ML, 80 MG/ML 129dopamine hcl 40 mg/mldopaminehcl 40 mg/ml 129dopamine in d5wdopamine ind5w 129DOPRAMDOPRAM 1DORALDORAL 81DORYXDORYX 122dorzolamide hcl-timololmaleatedorzolamide hcl-timololmaleate 113dorzolamide hcldorzolamidehcl 116DOTHELLE DHADOTHELLEDHA 106DOVONEXDOVONEX 60doxazosin mesylatedoxazosinmesylate 30doxepin hcl 10 mg, 50 mg, 25mg, 150 mg, 100 mgdoxepin hcl10 mg, 50 mg, 25 mg, 150 mg,100 mg 21

doxepin hcl 10 mg/mldoxepinhcl 10 mg/ml 21DOXEPIN HCL 75MGDOXEPIN HCL 75 MG 21DOXEPINHYDROCHLORIDEDOXEPINHYDROCHLORIDE 60doxercalciferoldoxercalciferol

72DOXILDOXIL 36DOXORUBICIN HCL 10 MG,50 MGDOXORUBICIN HCL 10MG, 50 MG 36doxorubicin hcl 2mg/mldoxorubicin hcl 2mg/ml 36doxorubicin hclliposomaldoxorubicin hclliposomal 36doxycycline(monohydrate)doxycycline(monohydrate) 122doxycycline hyclatedoxycyclinehyclate 122DOXYCYCLINEDOXYCYCLINE 67DRESSING SPONGES4"X4"DRESSING SPONGES4"X4" 85DRISDOLDRISDOL 130dronabinoldronabinol 25droperidoldroperidol 12drospirenone-ethinyl estradiol3mg-0.02mgdrospirenone-ethinyl estradiol 3mg-0.02mg 52drospirenone-ethinyl estradiol3mg-0.03mgdrospirenone-ethinyl estradiol 3mg-0.03mg 52drospirenone-ethinyl estradiol-levomefolatecalciumdrospirenone-ethinylestradiol-levomefolatecalcium 52DRYMAX EXTRADRYMAXEXTRA 85DRYSOLDRYSOL 67DUACDUAC 57DUAVEEDUAVEE 74DUET DHA 400DUET DHA400 106DUET DHA BALANCEDDUETDHA BALANCED 106DUETACTDUETACT 22DULERADULERA 15

duloxetine hcl 20 mg, 60 mg, 30mgduloxetine hcl 20 mg, 60 mg,30 mg 21DULOXETINE HCL 40MGDULOXETINE HCL 40MG 21DUO-CARE CONTROLSOLUTIONDUO-CARECONTROL SOLUTION 90DURACLONDURACLON 5DURAGESICDURAGESIC 6DUREZOLDUREZOL 115dutasteride-tamsulosinhcldutasteride-tamsulosinhcl 77dutasteridedutasteride 77DUTOPROL 100MG-12.5MG,50MG-12.5MGDUTOPROL100MG-12.5MG, 50MG-12.5MG 31DUTOPROL 25MG-12.5MGDUTOPROL 25MG-12.5MG 31DYAZIDEDYAZIDE 69dyphylline-guaifenesindyphylline-guaifenesin 14DYRENIUMDYRENIUM 70DYSPORTDYSPORT 112E.E.S. 400E.E.S. 400 83E.E.S. GRANULESE.E.S.GRANULES 83EARLY ALERTEARLYALERT 47EASY PLUS BLOOD GLUCOSEMONITORING SYSTEMEASYPLUS BLOOD GLUCOSEMONITORING SYSTEM 90EASY PLUS II CONTROLSOLUTION HIGHEASY PLUS IICONTROL SOLUTIONHIGH 90EASY PLUS II CONTROLSOLUTION LOWEASY PLUS IICONTROL SOLUTION LOW90EASY STEP BLOOD GLUCOSEMONITOR STARTER KITEASYSTEP BLOOD GLUCOSEMONITOR STARTER KIT 90EASY STEP CONTROLSOLUTION HIGHEASY STEPCONTROL SOLUTIONHIGH 90EASY STEP CONTROLSOLUTION LOWEASY STEPCONTROL SOLUTION LOW90

Index 19

EASY STEP CONTROLSOLUTION NORMALEASYSTEP CONTROL SOLUTIONNORMAL 90EASY TALK BLOOD GLUCOSEMONITORINGSYSTEM/TALKINGEASY TALKBLOOD GLUCOSEMONITORINGSYSTEM/TALKING 90EASY TALK CONTROLSOLUTION HIGHEASY TALKCONTROL SOLUTIONHIGH 90EASY TALK CONTROLSOLUTION LOWEASY TALKCONTROL SOLUTION LOW90EASY TALK CONTROLSOLUTION NORMALEASYTALK CONTROL SOLUTIONNORMAL 90EASY TOUCH ALCOHOL PREPPADS/MEDIUMEASY TOUCHALCOHOL PREPPADS/MEDIUM 98EASY TOUCH CONTROLSOLUTION/HIGH & LOWEASYTOUCH CONTROLSOLUTION/HIGH & LOW 90EASY TOUCH GLUCOSEMONITORING SYSTEMEASYTOUCH GLUCOSEMONITORING SYSTEM 90EASY TOUCH HEALTHPROCONTROL SOLUTION/HIGH &LOWEASY TOUCHHEALTHPRO CONTROLSOLUTION/HIGH & LOW 90EASY TOUCH HEALTHPROGLUCOSE MONITORINGSYSTEMEASY TOUCHHEALTHPRO GLUCOSEMONITORING SYSTEM 90EASY TRAK BLOOD GLUCOSEMONITORING SYSTEMEASYTRAK BLOOD GLUCOSEMONITORING SYSTEM 90EASY TRAK GLUCOSECONTROLSOLUTIONHIGHEASY TRAK GLUCOSECONTROLSOLUTION HIGH90EASY TRAK GLUCOSECONTROLSOLUTIONLOWEASY TRAK GLUCOSECONTROLSOLUTION LOW 90

EASY TRAK GLUCOSECONTROLSOLUTIONNORMALEASY TRAKGLUCOSECONTROLSOLUTIONNORMAL 90EASYGLUCO CONTROLSOLUTION HIGHEASYGLUCOCONTROL SOLUTIONHIGH 90EASYGLUCO CONTROLSOLUTION LOWEASYGLUCOCONTROL SOLUTIONLOW 90EASYGLUCO CONTROLSOLUTIONNORMALEASYGLUCOCONTROL SOLUTIONNORMAL 90EASYGLUCO PLUS BLOODGLUCOSE MONITORINGSYSTEM METERKITEASYGLUCO PLUSBLOOD GLUCOSEMONITORING SYSTEMMETER KIT 90EASYGLUCO PLUS BLOODGLUCSE MONITORINGSYSTEM STARTERKITEASYGLUCO PLUSBLOOD GLUCSEMONITORING SYSTEMSTARTER KIT 91EASYGLUCO PLUSCONTROL SOLUTION LEVEL1EASYGLUCO PLUSCONTROL SOLUTION LEVEL1 91EASYMAX 15 GLUCOSECONTROL SOLUTION LEVEL1/LEVEL 2EASYMAX 15GLUCOSE CONTROLSOLUTION LEVEL 1/LEVEL2 91EASYMAX 15 LEVEL 1GLUCOSE CONTROLSOLUTIONEASYMAX 15LEVEL 1 GLUCOSECONTROL SOLUTION 91EASYMAX 15 LEVEL 2GLUCOSE CONTROLSOLUTIONEASYMAX 15LEVEL 2 GLUCOSECONTROL SOLUTION 91EASYMAX CONTROLSOLUTIONHIGHEASYMAXCONTROLSOLUTIONHIGH 91

EASYMAX CONTROLSOLUTIONLOWEASYMAXCONTROL SOLUTIONLOW 91EASYMAX CONTROLSOLUTIONNORMALEASYMAXCONTROLSOLUTIONNORMAL 91EASYMAX GLUCOSECONTROL SOLUTIONNORMAL/LOWEASYMAXGLUCOSE CONTROLSOLUTION NORMAL/LOW 91EASYMAX L BLOOD GLUCOSESYSTEMEASYMAX L BLOODGLUCOSE SYSTEM 91EASYMAX N BLOOD GLUCOSESYSTEMEASYMAX N BLOODGLUCOSE SYSTEM 91EASYMAX NG SELF-MONITORING BLOODGLUCOSE SYSTEMEASYMAXNG SELF-MONITORING BLOODGLUCOSE SYSTEM 91EASYMAX V BLOOD GLUCOSESYSTEM/TALKINGEASYMAX VBLOOD GLUCOSESYSTEM/TALKING 91EASYMAX V2 SELF-MONITORING BLOODGLUCOSESYSTEM/SPEAKINGEASYMAXV2 SELF-MONITORING BLOODGLUCOSESYSTEM/SPEAKING 91EASYPLUS R13N SELF-MONITORING BLOODGLUCOSE SYSTEMEASYPLUSR13N SELF-MONITORINGBLOOD GLUCOSESYSTEM 91EASYPLUS V SELF-MONITORING BLOODGLUCOSESYSTEM/SPEAKINGEASYPLUSV SELF-MONITORING BLOODGLUCOSESYSTEM/SPEAKING 91EASYPRO BLOOD GLUCOSEMONITORINGSYSTEMEASYPRO BLOODGLUCOSE MONITORINGSYSTEM 91EASYPRO PLUSEASYPROPLUS 91EC-NAPROSYNEC-NAPROSYN 3

Index 20

ECHINACEACOMPOUNDECHINACEACOMPOUND 47econazole nitrateeconazolenitrate 59ECOTRIN REGULARSTRENGTHECOTRINREGULAR STRENGTH 5ECZEMA & PSORIASISSPRAYECZEMA & PSORIASISSPRAY 47EDARBIEDARBI 30EDARBYCLOREDARBYCLOR

31EDECRINEDECRIN 70EDURANTEDURANT 42EFFEXOR XREFFEXOR XR21EFFIENTEFFIENT 78EFUDEXEFUDEX 60EGRIFTAEGRIFTA 71ELAPRASEELAPRASE 72ELAVILELAVIL 21ELDEPRYLELDEPRYL 39ELEMENT AUTOCODESYSTEMELEMENT AUTOCODESYSTEM 91ELEMENT COMPACTCONTROL SOLUTION LEVEL2ELEMENT COMPACTCONTROL SOLUTION LEVEL2 91ELEMENT COMPACTCONTROL SOLUTION LEVEL3ELEMENT COMPACTCONTROL SOLUTION LEVEL3 91ELEMENT HIGHCONTROLELEMENT HIGHCONTROL 91ELEMENT LOWCONTROLELEMENT LOWCONTROL 91ELEMENT NORMALCONTROLELEMENT NORMALCONTROL 91ELESTATELESTAT 116ELESTRINELESTRIN 74ELETONE TWINPACKELETONETWINPACK 66ELETONEELETONE 66ELIDELELIDEL 65ELIGARDELIGARD 35ELIMITEELIMITE 67ELIPHOSELIPHOS 76

ELIQUISELIQUIS 16ELITE-OBELITE-OB 106ELIXOPHYLLINELIXOPHYLLIN 16ELLAELLA 54ELLENCEELLENCE 36ELOCONELOCON 62ELON MATRIX 5000ELONMATRIX 5000 110ELON MATRIX PLUSELONMATRIX PLUS 110ELON MATRIX 5000COMPLETEELON MATRIX5000 COMPLETE 110ELON MATRIXCOMPLETEELON MATRIXCOMPLETE 110ELON R3ELON R3 110ELOXATINELOXATIN 34EMBRACE CONTROLSOLUTIONLOWEMBRACECONTROLSOLUTIONLOW 91EMBRACE EVO BLOODGLUCOSE MONITORINGKITEMBRACE EVO BLOODGLUCOSE MONITORINGKIT 91EMBRACE EVO GLUCOSECONTROL SOLUTION LEVEL1EMBRACE EVO GLUCOSECONTROL SOLUTION LEVEL1 91EMBRACE EVO GLUCOSECONTROL SOLUTION LEVEL2EMBRACE EVO GLUCOSECONTROL SOLUTION LEVEL2 91EMBRACE GLUCOSECONTROL SOLUTIONHIGHEMBRACE GLUCOSECONTROL SOLUTIONHIGH 91EMBRACE PRO GLUCOSECONTROLSOLUTIONEMBRACE PROGLUCOSE CONTROLSOLUTION 91EMCYTEMCYT 35EMLAEMLA 66EMTRIVA 10 MG/MLEMTRIVA10 MG/ML 42EMTRIVA 200 MGEMTRIVA200 MG 42ENABLEXENABLEX 126

enalapril maleate &hydrochlorothiazideenalaprilmaleate &hydrochlorothiazide 31enalapril maleateenalaprilmaleate 29enalaprilatenalaprilat 29ENBREL SURECLICKENBRELSURECLICK 4ENBRELENBREL 4ENCAREENCARE 129ENDOMETRINENDOMETRIN

129ENGERIX-BENGERIX-B 127ENJUVIAENJUVIA 74ENOVARX-DICLOFENACSODIUMENOVARX-DICLOFENAC SODIUM 59enoxaparin sodiumenoxaparinsodium 16entacaponeentacapone 38entecavirentecavir 44ENTOCORT ECENTOCORTEC 55ENTRESTOENTRESTO 50ENTYVIOENTYVIO 76ENVARSUS XRENVARSUSXR 46EPANEDEPANED 29EPCLUSAEPCLUSA 44ephedrine sulfate(pressors)ephedrine sulfate(pressors) 129EPIDUO FORTEEPIDUOFORTE 57EPIDUOEPIDUO 57epinastine hcl (ophth)epinastinehcl (ophth) 116EPINEPHRINE 0.15 MG/0.15ML,0.3 MG/0.3ML, 0.15MG/0.3MLEPINEPHRINE 0.15MG/0.15ML, 0.3 MG/0.3ML, 0.15MG/0.3ML 129epinephrine hclepinephrinehcl 15EPIPEN 2-PAKEPIPEN 2-PAK 129EPIPEN-JR 2-PAKEPIPEN-JR 2-PAK 129epirubicin hclepirubicin hcl 36EPISILEPISIL 103EPIVIR 10 MG/MLEPIVIR 10MG/ML 42EPIVIR 150 MGEPIVIR 150MG 42

Index 21

EPIVIR 300 MGEPIVIR 300MG 42EPIVIR HBV 100 MGEPIVIRHBV 100 MG 44EPIVIR HBV 5 MG/MLEPIVIRHBV 5 MG/ML 44eplerenoneeplerenone 33EPOGENEPOGEN 79epoprostenolsodiumepoprostenol sodium 50EPROSARTANMESYLATEEPROSARTANMESYLATE 30eptifibatideeptifibatide 78EPZICOMEPZICOM 42EQL ALCOHOL SWABSEQLALCOHOL SWABS 98EQL GAUZE PADS2"X2"/SMALLEQL GAUZE PADS2"X2"/SMALL 85EQL GAUZE PADS4"X4"/LARGEEQL GAUZE PADS4"X4"/LARGE 85EQL GAUZE PADS STERILE3"X3"/MEDIUMEQL GAUZEPADS STERILE3"X3"/MEDIUM 85EQL GAUZE STERILE PADS3"X3"EQL GAUZE STERILEPADS 3"X3" 85EQL TRUE2GO BLOODGLUCOSE MONITORINGSYSTEMEQL TRUE2GO BLOODGLUCOSE MONITORINGSYSTEM 91EQUETROEQUETRO 40ERBITUXERBITUX 35ergocalciferolergocalciferol 130ERGOLOIDMESYLATESERGOLOIDMESYLATES 121ergoloid mesylatesergoloidmesylates 121ERIVEDGEERIVEDGE 35ERY-TABERY-TAB 83ERYGELERYGEL 57ERYPED 200ERYPED 200 83ERYTHROCINSTEARATEERYTHROCINSTEARATE 83erythromycin (acneaid)erythromycin (acne aid) 57erythromycin (ophth)erythromycin(ophth) 114

ERYTHROMYCIN BASE 250MG, 500 MGERYTHROMYCINBASE 250 MG, 500 MG 83erythromycin base 250mgerythromycin base 250mg 83erythromycin ethylsuccinate200 mg/5mlerythromycinethylsuccinate 200 mg/5ml 83ERYTHROMYCINETHYLSUCCINATE 400MGERYTHROMYCINETHYLSUCCINATE 400MG 83ESBRIETESBRIET 122ESCAVITE DESCAVITED 105ESCAVITE LQESCAVITELQ 105escitalopram oxalate 10 mg, 5mg, 20 mgescitalopram oxalate10 mg, 5 mg, 20 mg 20escitalopram oxalate 5mg/5mlescitalopram oxalate 5mg/5ml 20ESGICESGIC 5esmolol hclesmolol hcl 48esomeprazole magnesium 20mgesomeprazole magnesium20 mg 125esomeprazole magnesium 40mgesomeprazole magnesium40 mg 125ESOMEPRAZOLE SODIUM 20MGESOMEPRAZOLE SODIUM20 MG 125esomeprazole sodium 40mgesomeprazole sodium 40mg 125ESOMEPRAZOLESTRONTIUMESOMEPRAZOLE STRONTIUM 125ESSIAC TONICESSIACTONIC 47estazolamestazolam 81ESTRACE 0.1MG/GMESTRACE 0.1MG/GM 129ESTRACE 0.5 MG, 2 MG, 1MGESTRACE 0.5 MG, 2 MG, 1MG 74estradiol & norethindroneacetate 0.1mg-0.5mgestradiol &norethindrone acetate 0.1mg-0.5mg 74

estradiol & norethindrone acetate0.5mg-1mgestradiol &norethindrone acetate 0.5mg-1mg 74estradiol 0.025 mg/24hr, 0.1mg/24hr, 0.075 mg/24hr, 0.05mg/24hr, 0.0375mg/24hrestradiol 0.025 mg/24hr,0.1 mg/24hr, 0.075 mg/24hr, 0.05mg/24hr, 0.0375 mg/24hr 74estradiol 0.025 mg/24hr, 37.5mcg/24hr, 0.1 mg/24hr, 0.075mg/24hr, 0.06 mg/24hr, 0.05mg/24hrestradiol 0.025 mg/24hr,37.5 mcg/24hr, 0.1 mg/24hr,0.075 mg/24hr, 0.06 mg/24hr,0.05 mg/24hr 74estradiol 0.5 mg, 2 mg, 1mgestradiol 0.5 mg, 2 mg, 1mg 74ESTRADIOLMICRONIZEDESTRADIOLMICRONIZED 74estradiol vaginalestradiolvaginal 129estradiol valerateestradiolvalerate 74ESTRADIOLESTRADIOL 74ESTROGELESTROGEL 74estropipate 0.75 mg, 1.5 mg, 1.5mg, 0.75 mgestropipate 0.75 mg,1.5 mg, 1.5 mg, 0.75 mg 74estropipate 3 mgestropipate 3mg 74ESTROSTEP FEESTROSTEPFE 52eszopicloneeszopiclone 81ethacrynate sodiumethacrynatesodium 70ethacrynic acidethacrynicacid 70ethambutol hclethambutolhcl 34ethosuximide 250mg/5mlethosuximide 250mg/5ml 19ethosuximide 250mgethosuximide 250 mg 19ETHYL CHLORIDE/FINEPINPOINTETHYLCHLORIDE/FINE PINPOINT 66ETHYL CHLORIDE/FINESTREAMETHYLCHLORIDE/FINE STREAM 66ETHYL CHLORIDE/MEDIUMJET STREAMETHYLCHLORIDE/MEDIUM JETSTREAM 66

Index 22

ETHYL CHLORIDE/MEDIUMSTREAMETHYLCHLORIDE/MEDIUMSTREAM 66ETHYL CHLORIDE/MISTETHYLCHLORIDE/MIST 66ETHYL CHLORIDEETHYLCHLORIDE 66ethynodiol diacet & eth estrad1mg-35mcgethynodiol diacet &eth estrad 1mg-35mcg 52ethynodiol diacet & eth estrad1mg-50mcgethynodiol diacet &eth estrad 1mg-50mcg 52ETHYOLETHYOL 37ETIDRONATEDISODIUMETIDRONATEDISODIUM 71etodolacetodolac 3etomidateetomidate 77etoposide 1 gm/50ml, 500mg/25ml, 100 mg/5mletoposide 1gm/50ml, 500 mg/25ml, 100mg/5ml 38ETOPOSIDE 50 MGETOPOSIDE50 MG 38EUCERINEUCERIN 67EUFLEXXAEUFLEXXA 111EVAMISTEVAMIST 74EVENCARE CONTROLSOLUTIONEVENCARECONTROL SOLUTION 91EVENCARE G2 GLUCOSECONTROL SOLUTION/LOW-HIGHEVENCARE G2 GLUCOSECONTROL SOLUTION/LOW-HIGH 91EVENCARE G3 GLUCOSECONTROL SOLUTION/LOW-HIGHEVENCARE G3 GLUCOSECONTROL SOLUTION/LOW-HIGH 92EVENCARE MINI GLUCOSECONTROL SOLUTIONNORMALEVENCARE MINIGLUCOSE CONTROLSOLUTION NORMAL 92EVISTAEVISTA 72EVOCLINEVOCLIN 58EVOLUTION CONTROLSOLUTIONNORMALEVOLUTIONCONTROL SOLUTIONNORMAL 92EVOTAZEVOTAZ 42EVOXACEVOXAC 103

EVZIOEVZIO 25EXALGO 12 MG, 32MGEXALGO 12 MG, 32 MG6EXALGO 16 MG, 8MGEXALGO 16 MG, 8 MG 6EXCILON AMDANTIMICROBIALDRAINSPONGES 4"X4" 6PLYEXCILON AMDANTIMICROBIALDRAINSPONGES 4"X4" 6 PLY 86EXCILON AMDANTIMICROBIALNON-WOVENSPONGES 4"X4" 6PLYEXCILON AMDANTIMICROBIALNON-WOVENSPONGES 4"X4" 6 PLY 86EXCILON DRAIN SPONGE4"X4"EXCILON DRAINSPONGE 4"X4" 86EXCILON DRAIN SPONGES4"X4" 6 PLYEXCILON DRAINSPONGES 4"X4" 6 PLY 86EXCILON I.V. SPONGES 2"X2"6 PLYEXCILON I.V. SPONGES2"X2" 6 PLY 86EXELON 1.5 MG, 6 MG, 4.5MG, 3 MGEXELON 1.5 MG, 6MG, 4.5 MG, 3 MG 119EXELON 13.3MG/24HREXELON 13.3MG/24HR 120EXELON 4.6 MG/24HR, 9.5MG/24HREXELON 4.6MG/24HR, 9.5 MG/24HR 120exemestaneexemestane 35EXFORGE HCTEXFORGEHCT 31EXFORGEEXFORGE 31EXJADEEXJADE 24EXTAVIAEXTAVIA 120EXTINAEXTINA 59EXTRA-VIRT PLUSDHAEXTRA-VIRT PLUSDHA 106EYLEAEYLEA 114ezetimibeezetimibe 28FABRAZYMEFABRAZYME 72famciclovirfamciclovir 45famotidine 20 mg/2ml, 40mg/4ml, 200mg/20mlfamotidine 20 mg/2ml,40 mg/4ml, 200 mg/20ml 124famotidine 20 mgfamotidine 20mg 124

famotidine 40 mg/5mlfamotidine40 mg/5ml 124famotidine 40 mgfamotidine 40mg 124FAMOTIDINEPREMIXEDFAMOTIDINEPREMIXED 124FAMVIRFAMVIR 45FANAPT TITRATIONPACKFANAPT TITRATIONPACK 40FANAPTFANAPT 40FARESTONFARESTON 35FARXIGAFARXIGA 24FARYDAKFARYDAK 36fat emulsionfat emulsion 113FAZACLO 100 MG, 25MGFAZACLO 100 MG, 25MG 40FAZACLO 12.5 MG, 200 MG,150 MGFAZACLO 12.5 MG, 200MG, 150 MG 40FC FEMALE CONDOMFCFEMALE CONDOM 87FC2 FEMALE CONDOMFC2FEMALE CONDOM 87fe fum-iron polysacch complex-fa-b complex-c-zn-mn-cufe fum-ironpolysacch complex-fa-b complex-c-zn-mn-cu 79fe fumarate-vitamin c-vitaminb12-folic acidfe fumarate-vitaminc-vitamin b12-folic acid 79felbamate 400 mgfelbamate 400mg 19felbamate 600 mg/5mlfelbamate600 mg/5ml 19felbamate 600 mgfelbamate 600mg 19FELBATOL 400 MGFELBATOL400 MG 19FELBATOL 600MG/5MLFELBATOL 600MG/5ML 19FELBATOL 600 MGFELBATOL600 MG 19FELDENEFELDENE 3felodipinefelodipine 49FEM PHFEM PH 128FEMARAFEMARA 36FEMCON FEFEMCON FE 53FEMHRT LOW DOSEFEMHRTLOW DOSE 74fenofibrate 120 mgfenofibrate120 mg 28

Index 23

fenofibrate 145 mg, 54 mg, 48mg, 40 mg, 160 mgfenofibrate145 mg, 54 mg, 48 mg, 40 mg,160 mg 28FENOFIBRATE 150 MG, 50MGFENOFIBRATE 150 MG, 50MG 28fenofibrate micronizedfenofibratemicronized 28FENOFIBRIC ACIDFENOFIBRICACID 28FENOGLIDE 120MGFENOGLIDE 120 MG 28FENOGLIDE 40 MGFENOGLIDE40 MG 28FENOPROFEN CALCIUM 400MGFENOPROFEN CALCIUM400 MG 3FENOPROFEN CALCIUM 600MGFENOPROFEN CALCIUM600 MG 3FENORTHOFENORTHO 3FENTANYL CITRATE 100MCG/2ML, 250MCG/5MLFENTANYL CITRATE100 MCG/2ML, 250MCG/5ML 6fentanyl citrate 100 mcg/2ml,2500 mcg/50ml, 250 mcg/5ml,1000 mcg/20mlfentanyl citrate100 mcg/2ml, 2500 mcg/50ml,250 mcg/5ml, 1000 mcg/20ml 6FENTANYL CITRATE 100MCG/2MLFENTANYL CITRATE100 MCG/2ML 6fentanyl citrate 1200 mcg, 800mcg, 600 mcg, 400 mcg, 200mcg, 1600 mcgfentanyl citrate1200 mcg, 800 mcg, 600 mcg,400 mcg, 200 mcg, 1600 mcg 6FENTANYL CITRATE 500MCG/10MLFENTANYL CITRATE500 MCG/10ML 6FENTANYLCITRATE/ROPIVACAINEHYDROCHLORIDE/SODIUMCHLORIDEFENTANYLCITRATE/ROPIVACAINEHYDROCHLORIDE/SODIUMCHLORIDE 8fentanylfentanyl 6FENTORAFENTORA 6FER-IN-SOLFER-IN-SOL 80FERRLECITFERRLECIT 80ferrous fumarate w/ b12-vit c-fa-ifcferrous fumarate w/ b12-vit c-fa-ifc 79

ferrous fumarate-fa-b complex-c-zn-mg-mn-cuferrousfumarate-fa-b complex-c-zn-mg-mn-cu 79ferrous fumarate-folicacidferrous fumarate-folicacid 79ferrous sulfate 15 mg/mlferroussulfate 15 mg/ml 80ferrous sulfate 220mg/5mlferrous sulfate 220mg/5ml 80FERROUS SULFATE 300MG/5MLFERROUS SULFATE300 MG/5ML 80FEXMIDFEXMID 111fexofenadine-pseudoephedrinefexofenadine-pseudoephedrine 56FIBRICORFIBRICOR 28FIFTY50 ALCOHOL PREPPADSFIFTY50 ALCOHOLPREP PADS 98FIFTY50 CONTROLSOLUTION2.0FIFTY50CONTROL SOLUTION2.0 92FIFTY50 GLUCOSE METER2.0FIFTY50 GLUCOSEMETER 2.0 92FINACEAFINACEA 67finasteridefinasteride 77FIORICET/CODEINEFIORICET/CODEINE 8FIORICETFIORICET 5FIORINAL/CODEINE#3FIORINAL/CODEINE #3 8FIORINALFIORINAL 5FIRAZYRFIRAZYR 78FIRMAGONFIRMAGON 36FLAGYLFLAGYL 10flavoxate hclflavoxate hcl 126FLEBOGAMMADIFFLEBOGAMMA DIF 117flecainide acetateflecainideacetate 14FLEXZAN 4 X 4FLEXZAN 4 X4 86FLOLANFLOLAN 50FLOMAXFLOMAX 77FLONASE ALLERGY RELIEFCHILDRENSFLONASEALLERGY RELIEFCHILDRENS 112FLONASE ALLERGYRELIEFFLONASE ALLERGYRELIEF 112

FLONASEFLONASE 112FLORIVAFLORIVA 101FLOVENT DISKUSFLOVENTDISKUS 15FLOVENT HFAFLOVENTHFA 15FLOXIN OTICFLOXINOTIC 117FLOXURIDINEFLOXURIDINE

35FLUAD 2016-2017FLUAD 2016-2017 127FLUARIX 2014-2015FLUARIX2014-2015 127FLUARIX QUADRIVALENT2014-2015FLUARIXQUADRIVALENT 2014-2015 127FLUARIX QUADRIVALENT2015-2016FLUARIXQUADRIVALENT 2015-2016 127FLUARIX QUADRIVALENT2016-2017FLUARIXQUADRIVALENT 2016-2017 127FLUBLOK 2014-2015FLUBLOK2014-2015 127FLUBLOK 2015-2016FLUBLOK2015-2016 127FLUBLOK 2016-2017FLUBLOK2016-2017 127FLUCELVAX 2014-2015FLUCELVAX 2014-2015 127FLUCELVAX 2015-2016FLUCELVAX 2015-2016 127FLUCELVAX QUADRIVALENT2016-2017FLUCELVAXQUADRIVALENT 2016-2017 127fluconazole 10 mg/mlfluconazole10 mg/ml 26fluconazole 100 mgfluconazole100 mg 26fluconazole 150 mgfluconazole150 mg 26fluconazole 200 mgfluconazole200 mg 26fluconazole 40 mg/mlfluconazole40 mg/ml 26fluconazole 50 mgfluconazole 50mg 26fluconazole indextrosefluconazole indextrose 26

Index 24

fluconazole in naclfluconazole innacl 26flucytosineflucytosine 25fludarabine phosphatefludarabinephosphate 35fludrocortisoneacetatefludrocortisoneacetate 55FLULAVAL 2014-2015FLULAVAL 2014-2015127FLULAVAL QUADRIVALENT2014-2015FLULAVALQUADRIVALENT 2014-2015 127FLULAVAL QUADRIVALENT2015-2016FLULAVALQUADRIVALENT 2015-2016 127FLULAVAL QUADRIVALENT2016-2017FLULAVALQUADRIVALENT 2016-2017 127FLUMADINEFLUMADINE 45flumazenilflumazenil 25flunisolide (nasal)flunisolide(nasal) 112fluocinolone acetonide(otic)fluocinolone acetonide(otic) 117fluocinolone acetonide 0.01 %,0.025 %fluocinolone acetonide0.01 %, 0.025 % 63fluocinolone acetonide 0.01%fluocinolone acetonide 0.01% 63fluocinolone acetonide 0.025%fluocinolone acetonide 0.025% 63fluocinonide emulsifiedbasefluocinonide emulsifiedbase 63fluocinonidefluocinonide 63FLUOR-A-DAYFLUOR-A-DAY

101FLUORABONFLUORABON 101fluorometholone(ophth)fluorometholone(ophth) 115fluorouracil (topical) 2 %, 5%fluorouracil (topical) 2 %, 5% 60fluorouracil (topical) 5%fluorouracil (topical) 5 % 60FLUOROURACIL 0.5%FLUOROURACIL 0.5 % 60

fluorouracil 1 gm/20ml, 500mg/10ml, 5 gm/100ml, 2.5gm/50mlfluorouracil 1 gm/20ml,500 mg/10ml, 5 gm/100ml, 2.5gm/50ml 35fluoxetine hcl (pmdd)fluoxetinehcl (pmdd) 121fluoxetine hcl 10 mg, 20mgfluoxetine hcl 10 mg, 20mg 20fluoxetine hcl 10 mg, 40 mg, 20mgfluoxetine hcl 10 mg, 40 mg,20 mg 20fluoxetine hcl 20mg/5mlfluoxetine hcl 20mg/5ml 20FLUOXETINE HCL 60MGFLUOXETINE HCL 60MG 20fluoxetine hcl 90 mgfluoxetinehcl 90 mg 20FLUOXETINEFLUOXETINE

121fluphenazinedecanoatefluphenazinedecanoate 41fluphenazine hcl 1 mg, 5 mg,2.5 mg, 10 mgfluphenazine hcl1 mg, 5 mg, 2.5 mg, 10 mg41FLUPHENAZINE HCL 2.5MG/5MLFLUPHENAZINE HCL2.5 MG/5ML 41FLUPHENAZINE HCL 2.5MG/MLFLUPHENAZINE HCL2.5 MG/ML 41FLUPHENAZINE HCL 5MG/MLFLUPHENAZINE HCL 5MG/ML 41FLURA-DROPSFLURA-DROPS 101flurandrenolideflurandrenolide

63FLURAZEPAMHCLFLURAZEPAM HCL 81flurbiprofen sodiumflurbiprofensodium 116flurbiprofenflurbiprofen 3flutamideflutamide 36fluticasone propionate(nasal)fluticasone propionate(nasal) 112fluticasonepropionatefluticasonepropionate 63fluvastatin sodiumfluvastatinsodium 28FLUVIRIN 2014-2015FLUVIRIN2014-2015 127

FLUVIRIN 2015-2016FLUVIRIN2015-2016 127FLUVIRIN 2016-2017FLUVIRIN2016-2017 128FLUVIRIN PF 2014-2015FLUVIRIN PF 2014-2015 128fluvoxamine maleatefluvoxaminemaleate 20FLUZONE HIGH-DOSE PF 2014-2015FLUZONE HIGH-DOSE PF2014-2015 128FLUZONE HIGH-DOSE PF 2015-2016FLUZONE HIGH-DOSE PF2015-2016 128FLUZONE HIGH-DOSE PF 2016-2017FLUZONE HIGH-DOSE PF2016-2017 128FLUZONE INTRADERMALQUADRIVALENT 2015-2016FLUZONE INTRADERMALQUADRIVALENT 2015-2016 128FLUZONE INTRADERMALQUADRIVALENT 2016-2017FLUZONE INTRADERMALQUADRIVALENT 2016-2017 128FLUZONE PF 2014-2015FLUZONE PF 2014-2015 128FLUZONE QUADRIVALENT2014-2015FLUZONEQUADRIVALENT 2014-2015 128FLUZONE QUADRIVALENT2015-2016FLUZONEQUADRIVALENT 2015-2016 128FLUZONE QUADRIVALENT2016-2017FLUZONEQUADRIVALENT 2016-2017 128FLUZONE SPLIT 2014-2015FLUZONE SPLIT 2014-2015 128FLUZONE SPLIT 2015-2016FLUZONE SPLIT 2015-2016 128FML LIQUIFILMFMLLIQUIFILM 115FOCALGIN 90 DHAFOCALGIN90 DHA 106FOCALGIN CAFOCALGINCA 106FOCALIN XRFOCALIN XR 1FOCALINFOCALIN 1

Index 25

FOLBEE PLUS CZFOLBEEPLUS CZ 103FOLCAL DHAFOLCALDHA 106FOLCAPS OMEGA 3FOLCAPSOMEGA 3 106FOLET DHAFOLET DHA 106FOLET ONEFOLET ONE 106FOLGARD RXFOLGARDRX 79folic acid 1 mgfolic acid 1 mg79folic acid 400 mcgfolic acid 400mcg 79FOLIC ACID 5 MG/MLFOLICACID 5 MG/ML 79folic acid 800 mcgfolic acid 800mcg 79folic acid-vitamin b6-vitaminb12folic acid-vitamin b6-vitaminb12 80FOLIVANE-OBFOLIVANE-OB

106FOLLISTIM AQFOLLISTIMAQ 71fomepizolefomepizole 25fondaparinuxsodiumfondaparinux sodium 16FORA CONTROL SOLUTIONHIGHFORA CONTROLSOLUTION HIGH 92FORA CONTROL SOLUTIONLOWFORA CONTROLSOLUTION LOW 92FORA CONTROL SOLUTIONNORMALFORA CONTROLSOLUTION NORMAL 92FORA G20 BLOOD GLUCOSEMONITORING SYSTEMFORAG20 BLOOD GLUCOSEMONITORING SYSTEM 92FORA TN'G VOICE BLOODGLUCOSE MONITORINGSYSTEMFORA TN'G VOICEBLOOD GLUCOSEMONITORING SYSTEM 92FORA V30A BLOOD GLUCOSEMONITORING SYSTEMFORAV30A BLOOD GLUCOSEMONITORING SYSTEM 92FORACARE GDH CONTROLSOLUTION HIGHFORACAREGDH CONTROL SOLUTIONHIGH 92FORACARE GDH CONTROLSOLUTION LOWFORACAREGDH CONTROL SOLUTIONLOW 92

FORACARE GDH CONTROLSOLUTIONNORMALFORACARE GDHCONTROL SOLUTIONNORMAL 92FORADILAEROLIZERFORADILAEROLIZER 15FORANEFORANE 77FORMA-RAYFORMA-RAY41formaldehydeformaldehyde 41FORTAMET 1000MGFORTAMET 1000 MG 22FORTAMET 500MGFORTAMET 500 MG 22FORTAZFORTAZ 52FORTEOFORTEO 71FORTESTAFORTESTA 9FORTICALFORTICAL 71FORTISCARE CONTROLSOLUTIONSHIGHFORTISCARE CONTROLSOLUTIONS HIGH 92FORTISCARE CONTROLSOLUTIONSLOWFORTISCARE CONTROLSOLUTIONS LOW 92FORTISCARE CONTROLSOLUTIONSNORMALFORTISCARECONTROL SOLUTIONSNORMAL 92FORTISCARE SELF-MONITORING BLOODGLUCOSESYSTEMFORTISCARE SELF-MONITORING BLOODGLUCOSE SYSTEM 92FOSAMAX PLUS DFOSAMAXPLUS D 71FOSAMAXFOSAMAX 71fosinopril sodium &hydrochlorothiazide 10mg-12.5mgfosinopril sodium &hydrochlorothiazide 10mg-12.5mg 31fosinopril sodium &hydrochlorothiazide 20mg-12.5mgfosinopril sodium &hydrochlorothiazide 20mg-12.5mg 31fosinopril sodium 10 mg, 20mgfosinopril sodium 10 mg, 20mg 29fosinopril sodium 40mgfosinopril sodium 40 mg29

fosphenytoin sodiumfosphenytoinsodium 19FRAGMIN 10000 UNIT/ML,95000 UNIT/3.8ML, 7500UNIT/0.3ML, 5000 UNIT/0.2ML,2500 UNIT/0.2ML, 18000UNT/0.72ML, 15000 UNIT/0.6ML,12500 UNIT/0.5MLFRAGMIN10000 UNIT/ML, 95000UNIT/3.8ML, 7500 UNIT/0.3ML,5000 UNIT/0.2ML, 2500UNIT/0.2ML, 18000 UNT/0.72ML,15000 UNIT/0.6ML, 12500UNIT/0.5ML 16FREESTYLE CONTROLSOLUTIONHIGH/LOWFREESTYLECONTROL SOLUTIONHIGH/LOW 92FREESTYLE CONTROLSOLUTIONFREESTYLECONTROL SOLUTION 92FREESTYLE FREEDOMLITEFREESTYLE FREEDOMLITE 92FREESTYLEFREEDOMFREESTYLEFREEDOM 92FREESTYLE INSULINXBLOODGLUCOSEMONITORINGSYSTEMFREESTYLE INSULINXBLOODGLUCOSEMONITORING SYSTEM 92FREESTYLE PRECISION NEOBOOD GLUCOSE MONITORINGSYSTEMFREESTYLEPRECISION NEO BOODGLUCOSE MONITORINGSYSTEM 92FREESTYLE SIDEKICK IIVALUEPACKFREESTYLESIDEKICK II VALUEPACK 92FROVAFROVA 100frovatriptan succinatefrovatriptansuccinate 100FURADANTINFURADANTIN

126furosemide 10 mg/mlfurosemide10 mg/ml 70furosemide 20 mg, 80 mg, 40mgfurosemide 20 mg, 80 mg, 40mg 70FUROSEMIDE 8MG/MLFUROSEMIDE 8MG/ML 70FUSILEVFUSILEV 37FUZEONFUZEON 42

Index 26

FYCOMPAFYCOMPA 16gabapentin 100 mg, 400 mg, 300mggabapentin 100 mg, 400 mg,300 mg 17gabapentin 250 mg/5ml, 300mg/6mlgabapentin 250 mg/5ml,300 mg/6ml 17gabapentin 600 mg, 800mggabapentin 600 mg, 800mg 17GABITRIL 12 MG, 16MGGABITRIL 12 MG, 16MG 19GABITRIL 2 MG, 4 MGGABITRIL2 MG, 4 MG 19galantamine hydrobromide 12mg, 8 mg, 4 mggalantaminehydrobromide 12 mg, 8 mg, 4mg 120galantamine hydrobromide 16mg, 8 mg, 24 mggalantaminehydrobromide 16 mg, 8 mg, 24mg 120GALANTAMINEHYDROBROMIDE 4MG/MLGALANTAMINEHYDROBROMIDE 4MG/ML 120GAMASTAN S/DGAMASTANS/D 117GAMMAGARDLIQUIDGAMMAGARDLIQUID 117GAMMAGARD S/D IGA LESSTHAN 1MCG/MLGAMMAGARDS/D IGA LESS THAN1MCG/ML 117GAMMAKEDGAMMAKED 117GAMMAPLEXGAMMAPLEX 117GAMUNEX-CGAMUNEX-C117ganciclovir sodiumganciclovirsodium 43GANIRELIXACETATEGANIRELIXACETATE 71GARAMYCINGARAMYCIN 114GARDASIL 9GARDASIL 9 128GARDASILGARDASIL 128GASTROCROMGASTROCROM

75gatifloxacin (ophth)gatifloxacin(ophth) 114GATTEXGATTEX 76GAUZE DRESSING4"X4"GAUZE DRESSING4"X4" 86

GAUZE PADS 2"X2"GAUZEPADS 2"X2" 86GAUZE PADS 3"X3"GAUZEPADS 3"X3" 86GAUZE PADS 4"X4" 12PLYGAUZE PADS 4"X4" 12PLY 86GAUZE PADS 4"X4"GAUZEPADS 4"X4" 86GAUZE SPONGE TYPE VIIMEDI-PAK 2"X2" 8PLYGAUZESPONGE TYPE VII MEDI-PAK2"X2" 8PLY 86GAUZE SPONGES 4"X4" 12PLYGAUZE SPONGES 4"X4"12 PLY 86GAUZE SPONGES4"X4"GAUZE SPONGES4"X4" 86GE100 BLOOD GLUCOSEMONITORING SYSTEMGE100BLOOD GLUCOSEMONITORING SYSTEM 92GE100 CONTROL SOLUTIONNORMALGE100 CONTROLSOLUTION NORMAL 92GEL-ONEGEL-ONE 111GELNIQUEGELNIQUE 126GELSYN-3GELSYN-3 111gemcitabine hclgemcitabinehcl 35gemfibrozilgemfibrozil 28GEMZARGEMZAR 35GENERESS FEGENERESSFE 53GENOTROPINMINIQUICKGENOTROPINMINIQUICK 71GENOTROPINGENOTROPIN

71gentamicin in salinegentamicinin saline 2gentamicin sulfate(ophth)gentamicin sulfate(ophth) 114gentamicin sulfate(topical)gentamicin sulfate(topical) 59GENTAMICIN SULFATE 0.1%GENTAMICIN SULFATE 0.1% 59gentamicin sulfate 10 mg/ml, 40mg/mlgentamicin sulfate 10mg/ml, 40 mg/ml 2gentamicin sulfate 10mg/mlgentamicin sulfate 10mg/ml 2

GENTAMICIN SULFATE/0.9%SODIUMCHLORIDEGENTAMICINSULFATE/0.9% SODIUMCHLORIDE 2GENVISC 850GENVISC850 111GEODONGEODON 40GESTICARE DHAGESTICAREDHA 106GHT BLOOD GLUCOSEMONITORING SYSTEMGHTBLOOD GLUCOSEMONITORING SYSTEM 92GIAZOGIAZO 76GILENYAGILENYA 120GILOTRIFGILOTRIF 36GLASSIAGLASSIA 121glatiramer acetateglatirameracetate 120GLEEVEC 100 MG, 400MGGLEEVEC 100 MG, 400MG 36GLEEVEC 400 MGGLEEVEC400 MG 36GLEOSTINEGLEOSTINE 34glimepirideglimepiride 24glipizide-metformin hcl 2.5mg-250mg, 2.5mg-500mgglipizide-metformin hcl 2.5mg-250mg,2.5mg-500mg 22glipizide-metformin hcl 5mg-500mgglipizide-metformin hcl5mg-500mg 22glipizideglipizide 24GLOBAL ALCOHOL PREPEASEPADSGLOBAL ALCOHOLPREP EASEPADS 98GLUCAGENHYPOKITGLUCAGENHYPOKIT 23GLUCAGON EMERGENCYKITGLUCAGON EMERGENCYKIT 23GLUCOCARD 01 BLOODGLUCOSE MONITORINGSYSTEMGLUCOCARD 01BLOOD GLUCOSEMONITORING SYSTEM 92GLUCOCARD 01 CONTROLSOLUTIONNORMAL/HIGHGLUCOCARD 01CONTROL SOLUTIONNORMAL/HIGH 92

Index 27

GLUCOCARD 01 CONTROLSOLUTION/NORMALGLUCOCARD 01 CONTROLSOLUTION/NORMAL 92GLUCOCARD 01-MINI BLOODGLUCOSE MONITORINGSYSTEMGLUCOCARD 01-MINIBLOOD GLUCOSEMONITORING SYSTEM 92GLUCOCARD EXPRESSIONAUDIO-ENABLED BLOODGLUCOSEMONITORINGGLUCOCARDEXPRESSION AUDIO-ENABLEDBLOOD GLUCOSEMONITORING 93GLUCOCARD EXPRESSIONCONTROL SOLUTION LEVEL1GLUCOCARD EXPRESSIONCONTROL SOLUTION LEVEL1 93GLUCOCARD SHINE CONTROLSOLUTION LEVEL1GLUCOCARD SHINECONTROL SOLUTION LEVEL1 93GLUCOCARDSHINEGLUCOCARD SHINE93GLUCOCARD VITAL BLOODGLUCOSE MONITORINGSYSTEM BLACKGLUCOCARDVITAL BLOOD GLUCOSEMONITORING SYSTEMBLACK 93GLUCOCARD VITAL BLOODGLUCOSE MONITORINGSYSTEM BLUEGLUCOCARDVITAL BLOOD GLUCOSEMONITORING SYSTEMBLUE 93GLUCOCARD VITAL BLOODGLUCOSE MONITORINGSYSTEM PINKGLUCOCARDVITAL BLOOD GLUCOSEMONITORING SYSTEMPINK 93GLUCOCARD VITAL BLOODGLUCOSE MONITORINGSYSTEMGLUCOCARD VITALBLOOD GLUCOSEMONITORING SYSTEM 93GLUCOCARD X-METERCONTROLSOLUTION/NORMALGLUCOCARD X-METERCONTROLSOLUTION/NORMAL

93

GLUCOCARD X-METERGLUCOCARD X-METER 93GLUCOCOM BLOODGLUCOSE MONITORINGSYSTEM VALUEKITGLUCOCOM BLOODGLUCOSE MONITORINGSYSTEM VALUE KIT 93GLUCOCOM BLOODGLUCOSE MONITORINGSYSTEMGLUCOCOM BLOODGLUCOSE MONITORINGSYSTEM 93GLUCOCOM HIGHCONTROLGLUCOCOM HIGHCONTROL 93GLUCOCOM NORMALCONTROLGLUCOCOMNORMAL CONTROL 93GLUCONAVII BLOODGLUCOSEMONITORINGSYSTEMGLUCONAVII BLOODGLUCOSEMONITORINGSYSTEM 93GLUCOPHAGE 1000MGGLUCOPHAGE 1000MG 22GLUCOPHAGE 500MGGLUCOPHAGE 500MG 22GLUCOPHAGE 850MGGLUCOPHAGE 850MG 22GLUCOPHAGE XR 500MGGLUCOPHAGE XR 500MG 22GLUCOPHAGE XR 750MGGLUCOPHAGE XR 750MG 22GLUCOSE CONTROLNORMALGLUCOSECONTROL NORMAL 93GLUCOSE CONTROLSOLUTIONGLUCOSECONTROL SOLUTION 93GLUCOTROL XLGLUCOTROLXL 24GLUCOTROLGLUCOTROL 24GLUCOVANCE 2.5MG-500MGGLUCOVANCE 2.5MG-500MG 22GLUCOVANCE 5MG-500MGGLUCOVANCE 5MG-500MG 22GLUMETZA 1000MGGLUMETZA 1000 MG 22

GLUMETZA 500 MGGLUMETZA500 MG 22glyburide 1.25 mg, 5 mg, 2.5mgglyburide 1.25 mg, 5 mg, 2.5mg 24GLYBURIDE 5 MGGLYBURIDE5 MG 24glyburide micronizedglyburidemicronized 24glyburide-metformin 1.25mg-250mg, 2.5mg-500mgglyburide-metformin 1.25mg-250mg,2.5mg-500mg 22glyburide-metformin 5mg-500mgglyburide-metformin 5mg-500mg 22glycine (gu irrigant)glycine (guirrigant) 77glycine diluentglycinediluent 119glycopyrrolateglycopyrrolate

123GLYNASEGLYNASE 24GLYSETGLYSET 21GMATE CONTROL SOLUTIONLEVEL 2GMATE CONTROLSOLUTION LEVEL 2 93GMATE SMART STARTERKITGMATE SMART STARTERKIT 93GNP ALCOHOL SWABSGNPALCOHOL SWABS 98GNP EASY TOUCH CONTROLSOLUTION HIGH/LOWGNPEASY TOUCH CONTROLSOLUTION HIGH/LOW 93GNP STERILE PADS 3"X3"GNPSTERILE PADS 3"X3" 86GOLYTELY 227.1GM-21.5GM-5.53GM-2.82GM-6.36GMGOLYTELY 227.1GM-21.5GM-5.53GM-2.82GM-6.36GM 81GOLYTELY 236GM-22.74GM-5.86GM-2.97GM-6.74GMGOLYTELY 236GM-22.74GM-5.86GM-2.97GM-6.74GM 81GONAL-F RFFREDIJECTGONAL-F RFFREDIJECT 71GONAL-F RFFGONAL-FRFF 71GONAL-FGONAL-F 71GRALISE STARTERGRALISESTARTER 121GRALISEGRALISE 121

Index 28

granisetron hcl 0.1 mg/ml, 4mg/4ml, 1 mg/mlgranisetron hcl0.1 mg/ml, 4 mg/4ml, 1mg/ml 25granisetron hcl 1 mggranisetronhcl 1 mg 25GRANIXGRANIX 79GREEN SOURCEGREENSOURCE 110GRIFULVIN VGRIFULVIN V 25GRIS-PEGGRIS-PEG 25griseofulvin microsizegriseofulvinmicrosize 25griseofulvinultramicrosizegriseofulvinultramicrosize 26guanfacine hcl (adhd)guanfacinehcl (adhd) 1guanfacine hclguanfacinehcl 30H-E-B INCONTROL ALCOHOLPADSH-E-B INCONTROLALCOHOL PADS 98H.P. ACTHARH.P. ACTHAR 71HAIR FAREHAIR FARE 110HALAVENHALAVEN 38HALCIONHALCION 81HALDOL DECANOATE100HALDOL DECANOATE100 40HALDOL DECANOATE50HALDOL DECANOATE50 40HALDOLHALDOL 40halobetasolpropionatehalobetasolpropionate 63haloperidol decanoatehaloperidoldecanoate 40haloperidol lactatehaloperidollactate 40haloperidolhaloperidol 40HARVONIHARVONI 44HAVRIXHAVRIX 128HEAL AID PLUSHEAL AIDPLUS 66HEALTHWISE ALCOHOL PREPPADSHEALTHWISE ALCOHOLPREP PADS 98HEALTHY HEARTCOMPLEXHEALTHY HEARTCOMPLEX 110HEARTHEART 110HECTOROLHECTOROL 73HEMANGEOLHEMANGEOL48

HEMATRON-AFHEMATRON-AF 80HEMENATAL OB +DHAHEMENATAL OB +DHA 106HEMENATAL OBHEMENATALOB 106HEPAGAM BHEPAGAMB 117heparin (porcine) in sodiumchlorideheparin (porcine) insodium chloride 16HEPARIN LOCKFLUSHHEPARIN LOCKFLUSH 16heparin sod (porcine) ind5wheparin sod (porcine) ind5w 16heparin sodium (porcine) lockflush & nacl lock flushheparinsodium (porcine) lock flush &nacl lock flush 16heparin sodium (porcine) lockflushheparin sodium (porcine)lock flush 16heparin sodium(porcine)heparin sodium(porcine) 16HEPARIN SODIUM/D5W100UNIT/ML-5%, 50UNIT/ML-5%HEPARIN SODIUM/D5W100UNIT/ML-5%, 50UNIT/ML-5% 16HEPARIN SODIUM/D5W50UNIT/ML-5%HEPARINSODIUM/D5W 50UNIT/ML-5% 16HEPARIN SODIUM/SODIUMCHLORIDE 0.9%HEPARINSODIUM/SODIUM CHLORIDE0.9% 16HEPATAMINEHEPATAMINE

113HEPSERAHEPSERA 44HERBAPROFENHERBAPROFEN 47HERCEPTINHERCEPTIN 35HETLIOZHETLIOZ 81HEXALENHEXALEN 34HIMALAYAN GOJIHIMALAYANGOJI 47HIPREXHIPREX 126HIZENTRAHIZENTRA 117HM ESTROPLUSHMESTROPLUS 110HM STERILE PADSHMSTERILE PADS 86

homatropine hbrhomatropinehbr 114HPR PLUSHPR PLUS 66HUMALOG MIX 50/50KWIKPENHUMALOG MIX 50/50KWIKPEN 23HUMALOG MIX 50/50HUMALOGMIX 50/50 23HUMALOG MIX 75/25KWIKPENHUMALOG MIX 75/25KWIKPEN 23HUMALOG MIX 75/25HUMALOGMIX 75/25 23HUMALOGHUMALOG 23HUMATROPE COMBOPACKHUMATROPE COMBOPACK 72HUMATROPEHUMATROPE72HUMATROPEN FOR12MGHUMATROPEN FOR12MG 99HUMATROPEN FOR24MGHUMATROPEN FOR24MG 99HUMATROPEN FOR6MGHUMATROPEN FOR6MG 99HUMIRA PEDIATRIC CROHNSDISEASE STARTERPACKHUMIRA PEDIATRICCROHNS DISEASE STARTERPACK 2HUMIRA PEN-CROHNSDISEASESTARTERHUMIRAPEN-CROHNSDISEASESTARTER 2HUMIRA PEN-PSORIASISSTARTERHUMIRA PEN-PSORIASIS STARTER 2HUMIRA PENHUMIRA PEN 2HUMIRAHUMIRA 2HUMULIN 70/30KWIKPENHUMULIN 70/30KWIKPEN 23HUMULIN N KWIKPENHUMULINN KWIKPEN 23HUMULIN NHUMULIN N 23HUMULIN R U-500(CONCENTRATED)HUMULIN RU-500 (CONCENTRATED) 23HUMULIN R U-500KWIKPENHUMULIN R U-500KWIKPEN 23HUMULIN RHUMULIN R 23HURRICAINE ONEHURRICAINEONE 102

Index 29

HURRICAINEHURRICAINE102

HYALGANHYALGAN 111hyaluronate sodium(emollient)hyaluronate sodium(emollient) 65HYCAMTIN 0.25 MG, 1MGHYCAMTIN 0.25 MG, 1MG 38HYCAMTIN 4 MGHYCAMTIN 4MG 38HYCETHYCET 8hydralazine hclhydralazinehcl 33HYDREAHYDREA 37HYDRO 35HYDRO 35 64HYDRO 40 FOAMHYDRO 40FOAM 64HYDROCELL ADHESIVEDRESSING 4"X4"HYDROCELLADHESIVE DRESSING4"X4" 86HYDROCELL DRESSING4"X4"HYDROCELL DRESSING4"X4" 86HYDROCERINHYDROCERIN

67hydrochlorothiazidehydrochlorothiazide 70hydrocodone polistirex-chlorpheniraminepolistirexhydrocodone polistirex-chlorpheniramine polistirex 56hydrocodone w/homatropinehydrocodone w/homatropine 56hydrocodone-acetaminophen10mg-300mg, 7.5mg-300mg,5mg-300mghydrocodone-acetaminophen 10mg-300mg,7.5mg-300mg, 5mg-300mg 8hydrocodone-acetaminophen10mg-325mg, 7.5mg-325mg,5mg-325mghydrocodone-acetaminophen 10mg-325mg,7.5mg-325mg, 5mg-325mg 8hydrocodone-acetaminophen10mg/15ml-325mg/15ml,7.5mg/15ml-325mg/15ml,5mg/10ml-217mg/10ml,2.5mg/5ml-108mg/5mlhydrocodone-acetaminophen 10mg/15ml-325mg/15ml, 7.5mg/15ml-325mg/15ml, 5mg/10ml-217mg/10ml, 2.5mg/5ml-108mg/5ml 8

hydrocodone-acetaminophen2.5mg-325mghydrocodone-acetaminophen 2.5mg-325mg 8hydrocodone-ibuprofenhydrocodone-ibuprofen 8hydrocortisone(intrarectal)hydrocortisone(intrarectal) 10hydrocortisone(rectal)hydrocortisone(rectal) 10hydrocortisone (topical) 1 %,1%hydrocortisone (topical) 1 %,1% 63hydrocortisone (topical) 1%hydrocortisone (topical) 1% 63hydrocortisone (topical) 2 %,2.5 %hydrocortisone (topical) 2%, 2.5 % 63hydrocortisone (topical) 2.5%hydrocortisone (topical) 2.5% 63hydrocortisone butyratehydrophilic lipobasehydrocortisone butyratehydrophilic lipo base 63hydrocortisonebutyratehydrocortisonebutyrate 63hydrocortisonevaleratehydrocortisonevalerate 63hydrocortisone w/aceticacidhydrocortisone w/aceticacid 117hydrocortisonehydrocortisone

55HYDROGENPEROXIDEHYDROGENPEROXIDE 41hydromorphone hcl 1 mg/ml,500 mg/50ml, 50 mg/5ml, 4mg/ml, 2 mg/ml, 10mg/mlhydromorphone hcl 1mg/ml, 500 mg/50ml, 50mg/5ml, 4 mg/ml, 2 mg/ml, 10mg/ml 6hydromorphone hcl 1mg/mlhydromorphone hcl 1mg/ml 6hydromorphone hcl 12 mg, 32mghydromorphone hcl 12 mg,32 mg 6hydromorphone hcl 16 mg,8mg, 8 mghydromorphone hcl16 mg, 8mg, 8 mg 6

hydromorphone hcl 2 mg, 8 mg, 4mghydromorphone hcl 2 mg, 8mg, 4 mg 6HYDROMORPHONEHYDROCHLORIDE/BUPIVACAINEHYDROCHLORIDE/SODIUMHYDROMORPHONEHYDROCHLORIDE/BUPIVACAINEHYDROCHLORIDE/SODIUM 8HYDROMORPHONEHYDROCHLORIDE/SODIUMCHLORIDEHYDROMORPHONEHYDROCHLORIDE/SODIUMCHLORIDE 6HYDROXOCOBALAMINHYDROXOCOBALAMIN 79hydroxychloroquinesulfatehydroxychloroquinesulfate 33HYDROXYPROGESTERONECAPROATEHYDROXYPROGESTERONE CAPROATE 36hydroxyureahydroxyurea 37hydroxyzine hcl 10 mg, 50 mg, 25mghydroxyzine hcl 10 mg, 50 mg,25 mg 13hydroxyzine hcl 10mg/5mlhydroxyzine hcl 10mg/5ml 13HYDROXYZINE HCL 25MG/MLHYDROXYZINE HCL 25MG/ML 12hydroxyzine hcl 50mg/mlhydroxyzine hcl 50mg/ml 13HYDROXYZINE PAMOATE 100MGHYDROXYZINE PAMOATE100 MG 13hydroxyzine pamoate 25 mg, 50mghydroxyzine pamoate 25 mg,50 mg 13HYLATOPIC PLUSHYLATOPICPLUS 66HYLIRAHYLIRA 65HYMOVISHYMOVIS 111hyoscyamine sulfate 0.125mg/5mlhyoscyamine sulfate0.125 mg/5ml 123hyoscyamine sulfate 0.125mg/mlhyoscyamine sulfate 0.125mg/ml 123hyoscyamine sulfate 0.125mghyoscyamine sulfate 0.125mg 123

Index 30

hyoscyamine sulfate 0.375mghyoscyamine sulfate 0.375mg 123HYPER-SALHYPER-SAL 56HYPERHEP B S/DHYPERHEP BS/D 117HYPERLYTE-CRHYPERLYTE-CR 101HYPERRHO S/D MINI-DOSEHYPERRHO S/D MINI-DOSE 117HYPERRHO S/DHYPERRHOS/D 117HYPERSALHYPERSAL 56hypromellose(intraocular)hypromellose(intraocular) 116HYQVIAHYQVIA 118HYSINGLA ERHYSINGLA ER6HYZAARHYZAAR 31ibandronate sodium 150mgibandronate sodium 150mg 71ibandronate sodium 3mg/3mlibandronate sodium 3mg/3ml 71IBG STAR BLOOD GLUCOSEMONITORING SYSTEMIBGSTAR BLOOD GLUCOSEMONITORING SYSTEM 93IBRANCEIBRANCE 36IBUDONEIBUDONE 8ibuprofen 100 mg/5mlibuprofen100 mg/5ml 3ibuprofen 400 mg, 800 mg, 600mgibuprofen 400 mg, 800 mg,600 mg 3ibuprofen lysineibuprofenlysine 3ibutilide fumarateibutilidefumarate 14ICAR PEDIATRICICARPEDIATRIC 80ICAR-C PLUSICAR-C PLUS 80ICLUSIGICLUSIG 37IDAMYCIN PFSIDAMYCINPFS 36idarubicin hclidarubicin hcl 36IFEXIFEX 34ifosfamideifosfamide 34ILARISILARIS 3imatinib mesylateimatinibmesylate 37imipenem-cilastatinimipenem-cilastatin 11

imipramine hclimipraminehcl 21imipramine pamoateimipraminepamoate 21imiquimodimiquimod 65IMITREX 100 MG, 50 MG, 25MGIMITREX 100 MG, 50 MG,25 MG 100IMITREX 20 MG/ACT, 5MG/ACTIMITREX 20 MG/ACT,5 MG/ACT 100IMITREX 6 MG/0.5MLIMITREX6 MG/0.5ML 100IMITREX STATDOSEREFILLIMITREX STATDOSEREFILL 100IMITREX STATDOSESYSTEMIMITREX STATDOSESYSTEM 100IMODIUM A-DIMODIUM A-D 24IMOVAX RABIES(H.D.C.V.)IMOVAX RABIES(H.D.C.V.) 128IMPLANONIMPLANON 54IMURANIMURAN 46IN TOUCH GLUCOSECONTROLSOLUTIONINTOUCH GLUCOSECONTROLSOLUTION 93INATAL ADVANCEINATALADVANCE 106INATAL GTINATAL GT 106INATAL ULTRAINATALULTRA 106INCIVEKINCIVEK 44INCRELEXINCRELEX 72indapamideindapamide 70INDERAL LAINDERAL LA 48INDERAL XLINDERAL XL 48indomethacinsodiumindomethacinsodium 3indomethacinindomethacin 3INFANATEBALANCEINFANATEBALANCE 106INFANATE PLUSINFANATEPLUS 106INFANRIXINFANRIX 123INFEDINFED 80

INFINITY BLOOD GLUCOSEMONITORINGSYSTEM/STARTERKITINFINITY BLOOD GLUCOSEMONITORINGSYSTEM/STARTER KIT 93INFINITY BLOOD GLUCOSEMONITORINGSYSTEMINFINITY BLOODGLUCOSE MONITORINGSYSTEM 93INFINITY CONTROL SOLUTIONHIGHINFINITY CONTROLSOLUTION HIGH 93INFINITY CONTROL SOLUTIONLOWINFINITY CONTROLSOLUTION LOW 93INFINITY CONTROL SOLUTIONNORMALINFINITY CONTROLSOLUTION NORMAL 93INFLECTRAINFLECTRA 76INFUVITE ADULTINFUVITEADULT 104INFUVITE PEDIATRICINFUVITEPEDIATRIC 106INFUVITEINFUVITE 104INJECT-EASE AUTOMATICINJECTORINJECT-EASEAUTOMATIC INJECTOR 99INJECT-EASEINJECT-EASE

99INLYTAINLYTA 37INNOPRAN XLINNOPRANXL 48INSPRAINSPRA 33INSULIN SYRINGES AND PENNEEDLESINSULIN SYRINGESAND PEN NEEDLES 99INTEGRILININTEGRILIN 78INTELENCE 100MGINTELENCE 100 MG 42INTELENCE 200MGINTELENCE 200 MG 42INTELENCE 25 MGINTELENCE25 MG 42INTERMEZZOINTERMEZZO

81INTRALIPIDINTRALIPID 113INTRON A W/DILUENTINTRONA W/DILUENT 37INTRON AINTRON A 37INTUNIVINTUNIV 1

Index 31

INVEGA SUSTENNA 117MG/0.75ML, 78 MG/0.5ML, 39MG/0.25ML, 156 MG/MLINVEGASUSTENNA 117 MG/0.75ML, 78MG/0.5ML, 39 MG/0.25ML, 156MG/ML 40INVEGA SUSTENNA 234MG/1.5MLINVEGA SUSTENNA234 MG/1.5ML 40INVEGA TRINZAINVEGATRINZA 40INVEGAINVEGA 40INVIRASEINVIRASE 42INVOKANAINVOKANA 24IODINE STRONGIODINESTRONG 52IOPIDINEIOPIDINE 114IPOL INACTIVATED IPVIPOLINACTIVATED IPV 128ipratropium bromide(nasal)ipratropium bromide(nasal) 112ipratropium bromideipratropiumbromide 14ipratropium-albuterolipratropium-albuterol 15irbesartan-hydrochlorothiazideirbesartan-hydrochlorothiazide 31irbesartanirbesartan 30IRENKAIRENKA 21irinotecan hclirinotecan hcl 38IRINOTECANIRINOTECAN 38iron combinationsironcombinations 80iron dextraniron dextran 80iron polysaccharide complex-vitb12-folic acidiron polysaccharidecomplex-vit b12-folic acid 80iron-docusate-b12-folic acid-vit c-vit e-copper-biotiniron-docusate-b12-folic acid-vit c-vit e-copper-biotin 80iron-folic acid-vitamin c-vitaminb6-vitamin b12-zinciron-folic acid-vitamin c-vitamin b6-vitamin b12-zinc 80iron-vitamin c-vitamin b12-folicacidiron-vitamin c-vitamin b12-folic acid 80irrigation solutions,physiologicalirrigation solutions,physiological 46ISENTRESS 100 MG, 25MGISENTRESS 100 MG, 25MG 42

ISENTRESS 100MGISENTRESS 100 MG 42ISENTRESS 400MGISENTRESS 400 MG 42ISLAND GARD-GRXISLANDGARD-GRX 86isofluraneisoflurane 77isoniazid 100 mg, 300mgisoniazid 100 mg, 300mg 34ISONIAZID 100MG/MLISONIAZID 100MG/ML 34ISONIAZID 50MG/5MLISONIAZID 50MG/5ML 34ISOPTO ATROPINEISOPTOATROPINE 114ISOPTO CARPINEISOPTOCARPINE 114ISORDIL TITRADOSE 40MGISORDIL TITRADOSE 40MG 12ISORDIL TITRADOSE 5MGISORDIL TITRADOSE 5MG 12ISOSORBIDE DINITRATEERISOSORBIDE DINITRATEER 12isosorbide dinitrateisosorbidedinitrate 12isosorbide mononitrate 10 mg,20 mgisosorbide mononitrate10 mg, 20 mg 12isosorbide mononitrate 120 mg,60 mg, 30 mgisosorbidemononitrate 120 mg, 60 mg, 30mg 12isotretinoinisotretinoin 58isradipineisradipine 49ISTALOLISTALOL 113ISTODAX(OVERFILL)ISTODAX(OVERFILL) 37ISTODAXISTODAX 37itraconazoleitraconazole 26ivermectinivermectin 10IXEMPRA KITIXEMPRAKIT 38IXIAROIXIARO 128J & J GAUZE 2"X2" 8 PLYJ & JGAUZE 2"X2" 8 PLY 86J & J GAUZE 4"X4" 12 PLYJ &J GAUZE 4"X4" 12 PLY 86J & J GAUZE 4"X4" 8 PLYJ & JGAUZE 4"X4" 8 PLY 86

J & J GAUZE SPONGES 12-PLY4" X 4"J & J GAUZE SPONGES12-PLY 4" X 4" 86J & J GAUZE SPONGES 16-PLY4" X 4"J & J GAUZE SPONGES16-PLY 4" X 4" 86J & J GAUZE SPONGES 8-PLY4" X 4"J & J GAUZESPONGES 8-PLY4" X 4" 86J-TIP KIT W/VIAL ADAPTERSJ-TIP KIT W/VIAL ADAPTERS 99JADENUJADENU 24JAKAFIJAKAFI 37JALYNJALYN 77JANUMET XR 100MG-1000MG,50MG-500MGJANUMET XR100MG-1000MG, 50MG-500MG 22JANUMET XR 50MG-1000MGJANUMET XR 50MG-1000MG 22JANUMETJANUMET 22JANUVIAJANUVIA 23JARDIANCEJARDIANCE 24JENTADUETO XRJENTADUETOXR 22JENTADUETOJENTADUETO

22JEVTANAJEVTANA 38JOINT LUBEJOINT LUBE 47JUBLIAJUBLIA 59JUXTAPIDJUXTAPID 28K-PHOS NEUTRALK-PHOSNEUTRAL 101K-TAB 10 MEQK-TAB 10MEQ 102K-TAB 20 MEQ, 8 MEQK-TAB 20MEQ, 8 MEQ 102KADCYLAKADCYLA 35KADIANKADIAN 6KALBITORKALBITOR 78KALETRA 100MG-25MG,200MG-50MGKALETRA 100MG-25MG, 200MG-50MG 42KALETRA 400MG/5ML-100MG/5MLKALETRA400MG/5ML-100MG/5ML 42KALYDECOKALYDECO 122KAPVAYKAPVAY 1KAYEXALATEKAYEXALATE

47KAZANOKAZANO 22KEFLEXKEFLEX 51KENALOGKENALOG 63

Index 32

KENDALL HYDROPHILICFOAMDRESSING2"X2"KENDALL HYDROPHILICFOAMDRESSING 2"X2" 86KENDALL HYDROPHILICFOAMDRESSING3"X3"KENDALL HYDROPHILICFOAMDRESSING 3"X3" 86KENDALL HYDROPHILICFOAMDRESSING4"X4"KENDALL HYDROPHILICFOAMDRESSING 4"X4" 86KENDALL HYDROPHILICFOAMPLUS DRESSING2"X2"KENDALL HYDROPHILICFOAMPLUS DRESSING2"X2" 86KENDALL HYDROPHILICFOAMPLUS DRESSING3"X3"KENDALL HYDROPHILICFOAMPLUS DRESSING3"X3" 86KEPPRA 100 MG/MLKEPPRA100 MG/ML 17KEPPRA 1000 MGKEPPRA 1000MG 17KEPPRA 250 MG, 750 MG, 500MGKEPPRA 250 MG, 750 MG,500 MG 17KEPPRA 500 MG/5MLKEPPRA500 MG/5ML 17KEPPRA XRKEPPRA XR 17KERALACKERALAC 64KERALYTKERALYT 65KERLIX SPONGES 4" X 4" 12PLYKERLIX SPONGES 4" X 4"12 PLY 86KERLIX SPONGES 4" X 4" 16PLYKERLIX SPONGES 4" X 4"16 PLY 86KERLONEKERLONE 48KETALARKETALAR 77ketamine hclketamine hcl 77KETOCAREKETOCARE 69ketoconazole(topical)ketoconazole(topical) 59ketoconazoleketoconazole 26KETONE TEST STRIPSKETONETEST STRIPS 69KETOPROFENERKETOPROFEN ER 3ketoprofenketoprofen 3ketorolac tromethamine(ophth)ketorolac tromethamine(ophth) 116

ketorolac tromethamine 10mgketorolac tromethamine 10mg 3ketorolac tromethamine 15mg/ml, 30 mg/mlketorolactromethamine 15 mg/ml, 30mg/ml 3ketorolac tromethamine 30mg/ml, 60 mg/2mlketorolactromethamine 30 mg/ml, 60mg/2ml 3KETOROLACTROMETHAMINE 30MG/MLKETOROLACTROMETHAMINE 30MG/ML 3KETOSTIXKETOSTIX 69ketotifen fumarate(ophth)ketotifen fumarate(ophth) 116KEYTRUDAKEYTRUDA 35KHEDEZLAKHEDEZLA 21KIDNEYKIDNEY 110KINERETKINERET 3KINRIXKINRIX 123KITABIS PAKKITABIS PAK 2KLARONKLARON 58KLONOPINKLONOPIN 17KOMBIGLYZEXRKOMBIGLYZE XR 22KROGER BLOOD GLUCOSEMONITORING KITKROGERBLOOD GLUCOSEMONITORING KIT 93KROGER PREMIUM BLOODGLUCOSE MONITORINGKITKROGER PREMIUMBLOOD GLUCOSEMONITORING KIT 93KRYSTEXXAKRYSTEXXA78KUVANKUVAN 73KYLEENAKYLEENA 54KYNAMROKYNAMRO 27L-CYSTEINE HCLL-CYSTEINEHCL 113labetalol hcl 100 mglabetalolhcl 100 mg 48labetalol hcl 200 mglabetalolhcl 200 mg 48labetalol hcl 300 mglabetalolhcl 300 mg 48labetalol hcl 5 mg/mllabetalolhcl 5 mg/ml 48LAC-HYDRIN TWELVELAC-HYDRIN TWELVE 65

LAC-HYDRINLAC-HYDRIN 65lactated ringer's(irrigation)lactated ringer's(irrigation) 46lactated ringer'slactatedringer's 101lactic acid (ammonium lactate) 10%lactic acid (ammonium lactate)10 % 65lactic acid (ammonium lactate) 12%lactic acid (ammonium lactate)12 % 65lactic acid w/ vitamin elactic acidw/ vitamin e 65lactulose(encephalopathy)lactulose(encephalopathy) 76lactuloselactulose 82LAMICTAL CHEWABLEDISPERSIBLELAMICTALCHEWABLE DISPERSIBLE 17LAMICTAL ODTLAMICTALODT 17LAMICTAL STARTER/NOTTAKINGCARBAMAZEPINELAMICTALSTARTER/NOT TAKINGCARBAMAZEPINE 17LAMICTAL STARTER/TAKINGCARBAMAZEPINE/NOT TAKINGVALPROATELAMICTALSTARTER/TAKINGCARBAMAZEPINE/NOT TAKINGVALPROATE 17LAMICTAL STARTER/TAKINGVALPROATELAMICTALSTARTER/TAKINGVALPROATE 17LAMICTAL XR 100 MG, 50 MG,25 MGLAMICTAL XR 100 MG,50 MG, 25 MG 17LAMICTAL XR 200 MG, 300 MG,250 MGLAMICTAL XR 200 MG,300 MG, 250 MG 17LAMICTAL XRLAMICTALXR 17LAMICTALLAMICTAL 17LAMISILLAMISIL 26lamivudine (hbv)lamivudine(hbv) 44lamivudine 10 mg/mllamivudine10 mg/ml 42lamivudine 150 mglamivudine150 mg 42lamivudine 300 mglamivudine300 mg 42

Index 33

lamivudine-zidovudinelamivudine-zidovudine

42lamotrigine 100 mg, 25 mg, 200mg, 150 mglamotrigine 100 mg,25 mg, 200 mg, 150 mg 18lamotrigine 100 mg, 50 mg, 25mg, 200 mglamotrigine 100 mg,50 mg, 25 mg, 200 mg 18lamotrigine 100 mg, 50 mg, 25mglamotrigine 100 mg, 50 mg, 25mg 18lamotrigine 200 mg, 300 mg, 250mglamotrigine 200 mg, 300 mg,250 mg 18lamotrigine 25 mg, 5mglamotrigine 25 mg, 5 mg 17lamotriginelamotrigine 18LANCET DEVICESLANCETDEVICES 93LANCETSLANCETS 93lanolinlanolin 119LANOXIN 0.25 MG/MLLANOXIN0.25 MG/ML 50LANOXIN 125 MCG, 250MCGLANOXIN 125 MCG, 250MCG 50LANOXIN 187.5 MCG, 62.5MCGLANOXIN 187.5 MCG, 62.5MCG 50lansoprazole 15 mglansoprazole15 mg 125lansoprazole 30 mglansoprazole30 mg 125LANTUS SOLOSTARLANTUSSOLOSTAR 23LANTUSLANTUS 23LARTRUVOLARTRUVO 35LASIXLASIX 70latanoprostlatanoprost 116LATUDALATUDA 40LDR BLOOD GLUCOSETRUETEST KITLDR BLOODGLUCOSE TRUETEST KIT 93leflunomideleflunomide 4LEMTRADALEMTRADA 120LENZAPATCHLENZAPATCH

66LESCOL XLLESCOL XL 28LESCOLLESCOL 28LETAIRISLETAIRIS 50letrozoleletrozole 36LEUCOVORIN CALCIUM 10 MG,15 MGLEUCOVORIN CALCIUM10 MG, 15 MG 37

leucovorin calcium 100 mg, 50mg, 350 mg, 200 mgleucovorincalcium 100 mg, 50 mg, 350mg, 200 mg 37leucovorin calcium 25 mg, 5mgleucovorin calcium 25 mg, 5mg 38LEUCOVORIN CALCIUM 500MGLEUCOVORIN CALCIUM500 MG 37LEUKERANLEUKERAN 34LEUKINELEUKINE 79leuprolide acetateleuprolideacetate 36levalbuterol hcl 0.31 mg/3ml,1.25 mg/3ml, 0.63mg/3mllevalbuterol hcl 0.31mg/3ml, 1.25 mg/3ml, 0.63mg/3ml 15levalbuterol hcl 1.25mg/0.5mllevalbuterol hcl 1.25mg/0.5ml 15LEVALBUTEROL TARTRATEHFALEVALBUTEROLTARTRATE HFA 15LEVAQUIN 25MG/MLLEVAQUIN 25MG/ML 75LEVAQUIN 250 MG, 750 MG,500 MGLEVAQUIN 250 MG,750 MG, 500 MG 75LEVAQUIN 500MG/100ML-5%,750MG/150ML-5%LEVAQUIN500MG/100ML-5%,750MG/150ML-5% 75LEVBIDLEVBID 123LEVEMIRFLEXTOUCHLEVEMIRFLEXTOUCH 23LEVEMIRLEVEMIR 23levetiracetam 100 mg/ml, 500mg/5mllevetiracetam 100mg/ml, 500 mg/5ml 18levetiracetam 1000mglevetiracetam 1000 mg 18levetiracetam 250 mg, 750 mg,500 mglevetiracetam 250 mg,750 mg, 500 mg 18levetiracetam 500 mg, 750mglevetiracetam 500 mg, 750mg 18levetiracetam 500mg/5mllevetiracetam 500mg/5ml 18levobunolol hcllevobunololhcl 113

levocarnitine (metabolicmodifiers) 1 gm/10mllevocarnitine(metabolic modifiers) 1gm/10ml 73levocarnitine (metabolicmodifiers) 200 mg/mllevocarnitine(metabolic modifiers) 200mg/ml 73levocarnitine (metabolicmodifiers) 330 mglevocarnitine(metabolic modifiers) 330 mg73levocetirizine dihydrochloride 2.5mg/5mllevocetirizinedihydrochloride 2.5 mg/5ml 27levocetirizine dihydrochloride 5mglevocetirizine dihydrochloride5 mg 27levofloxacin (ophth)levofloxacin(ophth) 114levofloxacin 25 mg/mllevofloxacin25 mg/ml 75levofloxacin 250 mg, 750 mg, 500mglevofloxacin 250 mg, 750 mg,500 mg 75levofloxacin in d5wlevofloxacin ind5w 75levoleucovorincalciumlevoleucovorincalcium 38LEVOLEUCOVORINLEVOLEUCOVORIN 38levonorgestrel & ethestradiollevonorgestrel & ethestradiol 53levonorgestrel (emergencyoc)levonorgestrel (emergencyoc) 54levonorgestrel-eth estradiol(triphasic)levonorgestrel-ethestradiol (triphasic) 53levonorgestrel-ethinyl estradiol(91-day)levonorgestrel-ethinylestradiol (91-day) 53levonorgestrel-ethinyl estradiol(continuous)levonorgestrel-ethinyl estradiol (continuous) 53LEVONORGESTRELLEVONORGESTREL 54LEVOPHEDLEVOPHED 129LEVORPHANOLTARTRATELEVORPHANOLTARTRATE 6LEVOTHYROXINE SODIUM 100MCG, 500MCGLEVOTHYROXINESODIUM 100 MCG, 500MCG 123

Index 34

levothyroxine sodium 100 mcg,88 mcg, 75 mcg, 50 mcg, 300mcg, 25 mcg, 200 mcg, 175 mcg,150 mcg, 137 mcg, 125 mcg, 112mcglevothyroxine sodium 100mcg, 88 mcg, 75 mcg, 50 mcg,300 mcg, 25 mcg, 200 mcg, 175mcg, 150 mcg, 137 mcg, 125mcg, 112 mcg 123LEVSIN/SLLEVSIN/SL 124LEVSINLEVSIN 123LEXAPRO 10 MG, 5 MG, 20MGLEXAPRO 10 MG, 5 MG, 20MG 20LEXAPRO 5 MG/5MLLEXAPRO5 MG/5ML 20LEXIVALEXIVA 42LIALDALIALDA 76LIBERTY CONTROL SOLUTIONHIGHLIBERTY CONTROLSOLUTION HIGH 93LIBERTY CONTROLSOLUTIONNORMALLIBERTYCONTROLSOLUTIONNORMAL 94LIBERTY GLUCOSE CONTROLLEVEL 1LIBERTY GLUCOSECONTROL LEVEL 1 94LIBERTY GLUCOSE CONTROLLEVEL 2LIBERTY GLUCOSECONTROL LEVEL 2 94LIBERTY GLUCOSE CONTROLMIDLIBERTY GLUCOSECONTROL MID 94LIBERTY GLUCOSE CONTROLNORMALLIBERTY GLUCOSECONTROL NORMAL 94LIDO-KLIDO-K 66LIDOCAINE ANDTETRACAINECREAMLIDOCAINE ANDTETRACAINECREAM 66lidocaine hcl (cardiac)lidocainehcl (cardiac) 13lidocaine hcl (localanesth.)lidocaine hcl (localanesth.) 82lidocaine hcl (mouth-throat)lidocaine hcl (mouth-throat) 102LIDOCAINE HCL 10MG/MLLIDOCAINE HCL 10MG/ML 13lidocaine hcl 2 %lidocaine hcl 2% 66lidocaine hcl 3 %lidocaine hcl 3% 66

LIDOCAINE HCL 3%LIDOCAINE HCL 3 % 66lidocaine hcl 4 %lidocaine hcl 4% 66LIDOCAINE HCL 4%LIDOCAINE HCL 4 % 102lidocaine in d5wlidocaine ind5w 13lidocaine w/epinephrinelidocaine w/epinephrine 82lidocaine-hydrocortisoneacetate (rectal)lidocaine-hydrocortisone acetate(rectal) 10lidocaine-menthol 1%-4%lidocaine-menthol 1%-4% 66lidocaine-menthol 4%-4%lidocaine-menthol 4%-4% 66lidocaine-prilocainelidocaine-prilocaine 66lidocainelidocaine 66LIDODERMLIDODERM 66LIDOTRANS 5PAKLIDOTRANS 5 PAK 66LILETTALILETTA 54LINCOCINLINCOCIN 12lincomycin hcllincomycinhcl 12LINDANELINDANE 67lindanelindane 67linezolid 100 mg/5mllinezolid100 mg/5ml 12linezolid 600 mg/300mllinezolid600 mg/300ml 12linezolid 600 mglinezolid 600mg 12LINEZOLID 600MG/300ML-0.9%LINEZOLID600MG/300ML-0.9% 12LINZESSLINZESS 76liothyronine sodiumliothyroninesodium 123LIPIDSHIELDPLUSLIPIDSHIELDPLUS 110LIPITORLIPITOR 28LIPOFENLIPOFEN 28lisinopril & hydrochlorothiazide10mg-12.5mglisinopril &hydrochlorothiazide 10mg-12.5mg 31

lisinopril & hydrochlorothiazide20mg-12.5mglisinopril &hydrochlorothiazide 20mg-12.5mg 31lisinopril & hydrochlorothiazide20mg-25mglisinopril &hydrochlorothiazide 20mg-25mg 31lisinopril 10 mg, 5 mg, 40 mg, 30mg, 20 mglisinopril 10 mg, 5 mg,40 mg, 30 mg, 20 mg 29lisinopril 2.5 mglisinopril 2.5mg 29lithium carbonate 150 mg, 600mg, 300 mglithium carbonate 150mg, 600 mg, 300 mg 39LITHIUM CARBONATE 150 MG,600 MGLITHIUM CARBONATE150 MG, 600 MG 39lithium carbonate 300 mg, 450mglithium carbonate 300 mg, 450mg 40lithium carbonate 300 mglithiumcarbonate 300 mg 40LITHIUMLITHIUM 40LITHOBIDLITHOBID 40LIVALOLIVALO 28LO LOESTRIN FELO LOESTRINFE 53LOCOID LIPOCREAMLOCOIDLIPOCREAM 63LOCOIDLOCOID 63LODINELODINE 4LODOSYNLODOSYN 38LOESTRIN 1.5/30-21LOESTRIN1.5/30-21 53LOESTRIN 1/20-21LOESTRIN1/20-21 53LOESTRIN FE 1.5/30LOESTRINFE 1.5/30 53LOESTRIN FE 1/20LOESTRINFE 1/20 53LOFIBRALOFIBRA 28LOMOTILLOMOTIL 24LOMUSTINELOMUSTINE 34loperamide hclloperamidehcl 24LOPIDLOPID 28lopinavir-ritonavirlopinavir-ritonavir 42LOPRESSOR 1MG/MLLOPRESSOR 1MG/ML 48LOPRESSOR 100MGLOPRESSOR 100 MG 48

Index 35

LOPRESSOR 50MGLOPRESSOR 50 MG 48LOPRESSOR HCTLOPRESSORHCT 31LOPROX SHAMPOOLOPROXSHAMPOO 59LOPROXLOPROX 59lorazepam 0.5 mg, 2 mg, 1mglorazepam 0.5 mg, 2 mg, 1mg 13lorazepam 2 mg/ml, 4 mg/ml, 20mg/10mllorazepam 2 mg/ml, 4mg/ml, 20 mg/10ml 13lorazepam 2 mg/mllorazepam 2mg/ml 13losartan potassium &hydrochlorothiazidelosartanpotassium &hydrochlorothiazide 31losartan potassium 100mglosartan potassium 100mg 30losartan potassium 25 mg, 50mglosartan potassium 25 mg, 50mg 30LOSEASONIQUELOSEASONIQUE 53LOTEMAXLOTEMAX 115LOTENSIN HCTLOTENSINHCT 31LOTENSINLOTENSIN 29LOTRELLOTREL 31LOTRIMIN AF FORHERLOTRIMIN AF FORHER 59LOTRIMIN AF JOCKITCHLOTRIMIN AF JOCKITCH 59LOTRIMIN AFLOTRIMIN AF 59LOTRISONELOTRISONE 60LOTRONEXLOTRONEX 76lovastatin 10 mg, 20 mglovastatin10 mg, 20 mg 28lovastatin 40 mglovastatin 40mg 28LOVAZALOVAZA 27LOVENOXLOVENOX 16LOVIRALLOVIRAL 47loxapine succinateloxapinesuccinate 40LOZI-FLURLOZI-FLUR 101LUCENTIS 0.3 MG/0.05ML, 0.5MG/0.05MLLUCENTIS 0.3MG/0.05ML, 0.5MG/0.05ML 114

LUCENTIS 0.5MG/0.05MLLUCENTIS 0.5MG/0.05ML 114LUFYLLINLUFYLLIN 16LUGOLSLUGOLS 52LUMIGANLUMIGAN 116LUMIZYMELUMIZYME 73LUNESTALUNESTA 81LUNG TONICLUNGTONIC 47LUNGLUNG 110LUPANETA PACKLUPANETAPACK 72LUPRON DEPOT-PEDLUPRON DEPOT-PED 72LUPRON DEPOTLUPRONDEPOT 36LURIDELURIDE 101LUXAMENDLUXAMEND 68LUXIQLUXIQ 63LUZULUZU 60LYDIA PINKHAMLYDIAPINKHAM 47LYMPHATONICLYMPHATONIC 47LYMPHLYMPH 110LYRICA 100 MG, 75 MG, 50MG, 25 MG, 200 MG, 150MGLYRICA 100 MG, 75 MG,50 MG, 25 MG, 200 MG, 150MG 18LYRICA 20 MG/MLLYRICA 20MG/ML 18LYRICA 225 MG, 300MGLYRICA 225 MG, 300MG 18LYSODRENLYSODREN 36LYSTEDALYSTEDA 80M-M-R IIM-M-R II 128M-VITM-VIT 106M.V.I. ADULTM.V.I.ADULT 104M.V.I.-12 WITHOUT VITAMINKM.V.I.-12 WITHOUT VITAMINK 104M2 CALCIUMM2CALCIUM 110M2 CHROMIUMM2CHROMIUM 110MACIMACI 111MACNATAL CNDHAMACNATAL CNDHA 106

MACROBIDMACROBID 126MACRODANTINMACRODANTIN

126MACUGENMACUGEN 114mafenide acetatemafenideacetate 61magnesium chloridemagnesiumchloride 101magnesium sulfate 2 gm/50ml, 40gm/1000ml, 4 gm/50ml, 4gm/100ml, 20gm/500mlmagnesium sulfate 2gm/50ml, 40 gm/1000ml, 4gm/50ml, 4 gm/100ml, 20gm/500ml 101MAGNESIUM SULFATE 2GM/50ML, 40 GM/1000ML, 4GM/50ML, 4 GM/100ML, 20GM/500MLMAGNESIUMSULFATE 2 GM/50ML, 40GM/1000ML, 4 GM/50ML, 4GM/100ML, 20 GM/500ML 101magnesium sulfate 50%magnesium sulfate 50 % 101MAGNESIUM SULFATE IND5WMAGNESIUM SULFATE IND5W 101magnesium sulfate ind5wmagnesium sulfate ind5w 101MAGNESIUMSULFATE/LACTATEDRINGERSMAGNESIUMSULFATE/LACTATEDRINGERS 101MAKENAMAKENA 119MALARONEMALARONE 33malathionmalathion 67MAMMARYMAMMARY 110MANGANESESULFATEMANGANESESULFATE 101MANGANESE TRACEMETALMANGANESE TRACEMETAL 101mannitolmannitol 70MAPROTILINEHCLMAPROTILINE HCL 20MARCAINE SPINALMARCAINESPINAL 82MARCAINE/EPINEPHRINEMARCAINE/EPINEPHRINE 82MARCAINEMARCAINE 82MARINOLMARINOL 25MARNATAL-FMARNATAL-F

106

Index 36

MATULANEMATULANE 37MAVIK 1 MG, 2 MGMAVIK 1 MG,2 MG 29MAVIK 4 MGMAVIK 4 MG 29MAXALT 10 MGMAXALT 10MG 100MAXALT 5 MGMAXALT 5MG 100MAXALT-MLT 10 MGMAXALT-MLT 10 MG 100MAXALT-MLT 5 MGMAXALT-MLT 5 MG 100MAXIMA BLOOD GLUCOSEMONITORING SYSTEMMAXIMABLOOD GLUCOSEMONITORING SYSTEM 94MAXIMA CONTROLSOLUTION/NORMALMAXIMACONTROLSOLUTION/NORMAL 94MAXIMA CONTROLSOLUTIONMAXIMA CONTROLSOLUTION 94MAXIMA METER KITMAXIMAMETER KIT 94MAXIMA STARTER KITMAXIMASTARTER KIT 94MAXIPIMEMAXIPIME 52MAXITROL 10000UNIT/GM-3.5MG/GM-0.1%MAXITROL10000UNIT/GM-3.5MG/GM-0.1%

115MAXITROL 10000UNIT/ML-3.5MG/ML-0.1%MAXITROL10000UNIT/ML-3.5MG/ML-0.1%

115MAXZIDE-25MAXZIDE-25 69MAXZIDEMAXZIDE 69meclizine hclmeclizine hcl 25MECLOFENAMATESODIUMMECLOFENAMATESODIUM 4MEDERMA FORKIDSMEDERMA FOR KIDS 67MEDERMAMEDERMA 68MEDICAL PROVIDER EZ FLUSHOT 2014-2015MEDICALPROVIDER EZ FLU SHOT 2014-2015 128MEDICAL PROVIDER EZ FLUSHOT 2015-2016MEDICALPROVIDER EZ FLU SHOT 2015-2016 128MEDICAL PROVIDER SINGLEUSE EZ FLU SHOTMEDICALPROVIDER SINGLE USE EZFLU SHOT 128

MEDISENSE GLUCOSEKETONECONTROLSOLUTION 1-LOW,1-MED,1HIGHMEDISENSE GLUCOSEKETONECONTROLSOLUTION 1-LOW,1-MED,1HIGH 94MEDISENSE GLUCOSEKETONECONTROLSOLUTION 1-NORMALMEDISENSEGLUCOSE KETONECONTROLSOLUTION 1-NORMAL 94MEDISENSE HIGH/LOWCONTROLSOLUTIONMEDISENSEHIGH/LOW CONTROLSOLUTION 94MEDISENSE HIGH/MID/LOWCONTROLSOLUTIONMEDISENSEHIGH/MID/LOW CONTROLSOLUTION 94MEDISENSE MID CONTROLSOLUTIONMEDISENSE MIDCONTROL SOLUTION 94MEDROL DOSEPAKMEDROLDOSEPAK 55MEDROLMEDROL 55medroxyprogesterone acetate(contraceptive)medroxyprogesterone acetate(contraceptive) 54medroxyprogesteroneacetatemedroxyprogesteroneacetate 119mefenamic acidmefenamicacid 4mefloquine hclmefloquinehcl 33MEGACE ESMEGACEES 119MEGACE ORALMEGACEORAL 36megestrol acetate(appetite)megestrol acetate(appetite) 119megestrol acetatemegestrolacetate 36MEGRIXMEGRIX 66MEIJER ALCOHOL SWABSEXTRA-THICKMEIJERALCOHOL SWABS EXTRA-THICK 98MEIJER BLOOD GLUCOSEMONITORING KITMEIJERBLOOD GLUCOSEMONITORING KIT 94

MEIJER ESSENTIAL BLOODGLUCOSE MONITORINGSYSTEMMEIJER ESSENTIALBLOOD GLUCOSEMONITORING SYSTEM 94MEIJER PREMIUM BLOODGLUCOSE MONITORINGKITMEIJER PREMIUM BLOODGLUCOSE MONITORINGKIT 94MEIJER TRUE2GO BLOODGLUCOSE MONITORINGSYSTEMMEIJER TRUE2GOBLOOD GLUCOSEMONITORING SYSTEM 94MEIJER TRUERESULT BLOODGLUCOSE MONITORINGSYSTEMMEIJER TRUERESULTBLOOD GLUCOSEMONITORING SYSTEM 94MEIJER TRUETRACK BLOODGLUCOSE MONITORINGKITMEIJER TRUETRACKBLOOD GLUCOSEMONITORING KIT 94MEKINISTMEKINIST 37meloxicam 15 mg, 7.5mgmeloxicam 15 mg, 7.5 mg 4MELOXICAM 7.5MG/5MLMELOXICAM 7.5MG/5ML 4melphalan hclmelphalan hcl 34memantine hcl 10 mg, 5mgmemantine hcl 10 mg, 5mg 120memantine hcl 2mg/mlmemantine hcl 2mg/ml 120memantine hclmemantinehcl 120MENACTRAMENACTRA 127MENESTMENEST 74MENHIBRIXMENHIBRIX 127MENOMUNE-A/C/Y/W-135MENOMUNE-A/C/Y/W-135

127MENOPAUSERELIEFMENOPAUSERELIEF 110MENOPAUTONICMENOPAUTONIC 47MENOPURMENOPUR 71MENOSTARMENOSTAR 74MENVEOMENVEO 127

Index 37

MEPERIDINE HCL 10MG/MLMEPERIDINE HCL 10MG/ML 6meperidine hcl 100 mg, 50mgmeperidine hcl 100 mg, 50mg 6meperidine hcl 100 mg/ml, 50mg/ml, 25 mg/mlmeperidine hcl100 mg/ml, 50 mg/ml, 25mg/ml 6MEPERIDINE HCL 50MG/5MLMEPERIDINE HCL 50MG/5ML 6mepivacaine hclmepivacainehcl 82meprobamatemeprobamate 13MEPRONMEPRON 11mercaptopurinemercaptopurine

35meropenemmeropenem 11MERREMMERREM 11MESALAMINE DRMESALAMINEDR 76mesalamine w/cleansermesalamine w/cleanser 76mesalaminemesalamine 76mesnamesna 38MESNEX 100 MG/MLMESNEX100 MG/ML 38MESNEX 400 MGMESNEX 400MG 38MESTINON 60MG/5MLMESTINON 60MG/5ML 33MESTINON 60 MGMESTINON60 MG 33MESTINONTIMESPANMESTINONTIMESPAN 33METADATE CDMETADATECD 1METAPROTERENOL SULFATE10 MG, 20MGMETAPROTERENOLSULFATE 10 MG, 20 MG 15METAPROTERENOL SULFATE10 MG/5MLMETAPROTERENOLSULFATE 10 MG/5ML 15METAXALONE 400MGMETAXALONE 400 MG111metaxalone 800 mgmetaxalone800 mg 111metformin hcl 1000 mgmetforminhcl 1000 mg 22metformin hcl 500 mgmetforminhcl 500 mg 22

metformin hcl 750 mgmetforminhcl 750 mg 23metformin hcl 850 mgmetforminhcl 850 mg 22methadone hcl 10mg/5mlmethadone hcl 10mg/5ml 6METHADONE HCL 10MG/5MLMETHADONE HCL 10MG/5ML 6methadone hcl 10mg/mlmethadone hcl 10mg/ml 6methadone hcl 10mgmethadone hcl 10 mg 6methadone hcl 40mgmethadone hcl 40 mg 6METHADONE HCL 5MG/5MLMETHADONE HCL 5MG/5ML 6methadone hcl 5mg/5mlmethadone hcl 5mg/5ml 6methadone hcl 5 mgmethadonehcl 5 mg 6METHADOSE SUGAR-FREEMETHADOSE SUGAR-FREE 6METHADOSEMETHADOSE6methamphetaminehclmethamphetamine hcl 1methazolamidemethazolamide

69methenaminehippuratemethenaminehippurate 126METHENAMINE MANDELATE0.5 GMMETHENAMINEMANDELATE 0.5 GM 126methenamine mandelate 1gmmethenamine mandelate 1gm 126methenamine-hyosc-methyleneblue-benzoic acid-phenylsalmethenamine-hyosc-methylene blue-benzoic acid-phenyl sal 126methenamine-hyosc-methyleneblue-sod phos-phenylsalmethenamine-hyosc-methylene blue-sod phos-phenyl sal 126methenamine-hyoscamine-methylene blue-sodiumphosphatemethenamine-hyoscamine-methylene blue-sodium phosphate 126

METHERGINEMETHERGINE117

methimazolemethimazole 122methocarbamolmethocarbamol

111methotrexate sodium 1 gm/40ml,50 mg/2ml, 250 mg/10ml, 200mg/8ml, 100 mg/4mlmethotrexatesodium 1 gm/40ml, 50 mg/2ml,250 mg/10ml, 200 mg/8ml, 100mg/4ml 35methotrexate sodium 1gmmethotrexate sodium 1gm 35methotrexate sodium 2.5mgmethotrexate sodium 2.5mg 35METHOTREXATE SODIUM 250MG/10MLMETHOTREXATESODIUM 250 MG/10ML 35methoxsalen rapidmethoxsalenrapid 60methscopolaminebromidemethscopolaminebromide 124METHYCLOTHIAZIDEMETHYCLOTHIAZIDE 70METHYLDOPA/HYDROCHLOROTHIAZIDE 250MG-15MGMETHYLDOPA/HYDROCHLOROTHIAZIDE 250MG-15MG 31METHYLDOPA/HYDROCHLOROTHIAZIDE 250MG-25MGMETHYLDOPA/HYDROCHLOROTHIAZIDE 250MG-25MG 31methyldopamethyldopa 30METHYLDOPATEHCLMETHYLDOPATE HCL 30methylene blue(antidote)methylene blue(antidote) 25METHYLENEBLUEMETHYLENE BLUE 25methylergonovinemaleatemethylergonovinemaleate 117METHYLINMETHYLIN 1METHYLPHENIDATE HCLERMETHYLPHENIDATE HCLER 1methylphenidatehclmethylphenidate hcl 1methylprednisoloneacetatemethylprednisoloneacetate 55

Index 38

methylprednisolone sodsuccmethylprednisolone sodsucc 55methylprednisolonemethylprednisolone 55methyltestosteronemethyltestosterone 9METIPRANOLOLMETIPRANOLOL 113metoclopramidehclmetoclopramide hcl 75METOCLOPRAMIDEODTMETOCLOPRAMIDEODT 76metolazonemetolazone 70metoprolol &hydrochlorothiazidemetoprolol &hydrochlorothiazide 32metoprolol succinate 100 mg, 50mg, 25 mgmetoprolol succinate100 mg, 50 mg, 25 mg 48metoprolol succinate 200mgmetoprolol succinate 200mg 48METOPROLOL SUCCINATEER/HYDROCHLOROTHIAZIDE100MG-12.5MG, 50MG-12.5MGMETOPROLOLSUCCINATEER/HYDROCHLOROTHIAZIDE100MG-12.5MG, 50MG-12.5MG 32METOPROLOL SUCCINATEER/HYDROCHLOROTHIAZIDE25MG-12.5MGMETOPROLOLSUCCINATEER/HYDROCHLOROTHIAZIDE25MG-12.5MG 32metoprolol tartrate 1 mg/ml, 5mg/5mlmetoprolol tartrate 1mg/ml, 5 mg/5ml 48metoprolol tartrate 100 mg, 25mgmetoprolol tartrate 100 mg, 25mg 48METOPROLOL TARTRATE 37.5MG, 75 MGMETOPROLOLTARTRATE 37.5 MG, 75MG 48metoprolol tartrate 50mgmetoprolol tartrate 50 mg 48METOZOLV ODTMETOZOLVODT 76METROCREAMMETROCREAM

67METROGEL-VAGINALMETROGEL-VAGINAL

129METROGELMETROGEL 67

METROLOTIONMETROLOTION 67metronidazole (topical) 0.75%metronidazole (topical) 0.75% 67metronidazole (topical) 1%metronidazole (topical) 1% 67metronidazole innaclmetronidazole in nacl 10metronidazolevaginalmetronidazolevaginal 129metronidazolemetronidazole

10MEVACORMEVACOR 28mexiletine hclmexiletinehcl 14MG-PLUS PROTEINMG-PLUSPROTEIN 110MIACALCIN 200UNIT/ACTMIACALCIN 200UNIT/ACT 71MIACALCIN 200UNIT/MLMIACALCIN 200UNIT/ML 71MICARDIS HCT 40MG-12.5MG, 80MG-25MGMICARDIS HCT 40MG-12.5MG, 80MG-25MG 32MICARDIS HCT 80MG-12.5MGMICARDIS HCT 80MG-12.5MG 32MICARDISMICARDIS 30MICATINMICATIN 60MICONAZOLE 3MICONAZOLE3 129miconazole nitrate(topical)miconazole nitrate(topical) 60MICRHOGAM ULTRA-FILTEREDPLUSMICRHOGAMULTRA-FILTEREDPLUS 117MICRO-KMICRO-K 102MICRODOT BLOODGLUCOSE MONITORINGSYSTEMMICRODOT BLOODGLUCOSE MONITORINGSYSTEM 94MICRODOT CONTROLSOLUTIONHIGH/LOWMICRODOT CONTROLSOLUTIONHIGH/LOW 94MICROZIDEMICROZIDE 70midazolam hclmidazolamhcl 81midodrine hclmidodrinehcl 129

MIGERGOTMIGERGOT 99miglitolmiglitol 21MIGRANALMIGRANAL 99MIL ADREGENMILADREGEN 110MILADRENEFORTEMILADRENEFORTE 110MILCO-B-FORTEMILCO-B-FORTE 103MILPANMILPAN 110milrinone in dextrosemilrinone indextrose 50milrinone lactatemilrinonelactate 50MINASTRIN 24 FEMINASTRIN24 FE 53mineral oil 100 %, 99.9 %mineraloil 100 %, 99.9 % 82MINERAL OIL 55 %MINERALOIL 55 % 82MINIPRESSMINIPRESS 30MINIVELLEMINIVELLE 74MINOCINMINOCIN 122minocycline hcl 100 mg, 75 mg,50 mgminocycline hcl 100 mg, 75mg, 50 mg 122minocycline hcl 135 mg, 90 mg,45 mgminocycline hcl 135 mg, 90mg, 45 mg 122minoxidilminoxidil 33MIRALAXMIRALAX 82MIRAPEX ERMIRAPEX ER 39MIRAPEXMIRAPEX 39MIRASORB SPONGES 2" X2"MIRASORB SPONGES 2" X2" 86MIRASORB SPONGES 4" X4"MIRASORB SPONGES 4" X4" 86MIRCERAMIRCERA 79MIRCETTEMIRCETTE 53MIRENAMIRENA 54MIRODERM FENESTRATEDBIOLOGIC WOUND MATRIX2X2CMMIRODERMFENESTRATED BIOLOGICWOUND MATRIX 2X2CM 68MIRODERM FENESTRATEDBIOLOGIC WOUND MATRIX2X3CMMIRODERMFENESTRATED BIOLOGICWOUND MATRIX 2X3CM 68

Index 39

MIRODERM FENESTRATEDBIOLOGIC WOUND MATRIX3X3CMMIRODERMFENESTRATED BIOLOGICWOUND MATRIX 3X3CM 68MIRODERM FENESTRATEDBIOLOGIC WOUND MATRIX4X4CMMIRODERMFENESTRATED BIOLOGICWOUND MATRIX 4X4CM 68MIRODERM FENESTRATEDBIOLOGIC WOUND MATRIX5X5CMMIRODERMFENESTRATED BIOLOGICWOUND MATRIX 5X5CM 68MIRODERM FENESTRATEDBIOLOGIC WOUND MATRIX8X15CMMIRODERMFENESTRATED BIOLOGICWOUND MATRIX 8X15CM 68MIRODERM FENESTRATEDBIOLOGIC WOUND MATRIX8X8CMMIRODERMFENESTRATED BIOLOGICWOUND MATRIX 8X8CM 68MIRODERM FENESTRATEDPLUSBIOLOGIC WOUNDMATRIX3X3CM/MESHEDMIRODERMFENESTRATEDPLUSBIOLOGIC WOUNDMATRIX 3X3CM/MESHED 68MIRODERM FENESTRATEDPLUSBIOLOGIC WOUNDMATRIX4X4CM/MESHEDMIRODERMFENESTRATEDPLUSBIOLOGIC WOUNDMATRIX 4X4CM/MESHED 68MIRODERM FENESTRATEDPLUSBIOLOGIC WOUNDMATRIX5X5CM/MESHEDMIRODERMFENESTRATEDPLUSBIOLOGIC WOUNDMATRIX 5X5CM/MESHED 68MIRODERM FENESTRATEDPLUSBIOLOGIC WOUNDMATRIX8X15CM/MESHEDMIRODERMFENESTRATEDPLUSBIOLOGIC WOUNDMATRIX 8X15CM/MESHED 68

MIRODERM FENESTRATEDPLUSBIOLOGIC WOUNDMATRIX8X8CM/MESHEDMIRODERMFENESTRATEDPLUSBIOLOGIC WOUNDMATRIX 8X8CM/MESHED68MIRODERM MESHEDBIOLOGICWOUND MATRIX3X3CMMIRODERM MESHEDBIOLOGICWOUND MATRIX3X3CM 68MIRODERM MESHEDBIOLOGICWOUND MATRIX3X7CMMIRODERM MESHEDBIOLOGICWOUND MATRIX3X7CM 68MIRODERM MESHEDBIOLOGICWOUND MATRIX4X4CMMIRODERM MESHEDBIOLOGICWOUND MATRIX4X4CM 68MIRODERM MESHEDBIOLOGICWOUND MATRIX5X5CMMIRODERM MESHEDBIOLOGICWOUND MATRIX5X5CM 68MIRODERM MESHEDBIOLOGICWOUND MATRIX8X15CMMIRODERM MESHEDBIOLOGICWOUND MATRIX8X15CM 68MIRODERM MESHEDBIOLOGICWOUND MATRIX8X8CMMIRODERM MESHEDBIOLOGICWOUND MATRIX8X8CM 68mirtazapinemirtazapine 20misoprostolmisoprostol 125MITIGAREMITIGARE 78mitomycin 20 mg, 40mgmitomycin 20 mg, 40mg 36MITOMYCIN 5 MGMITOMYCIN5 MG 36mitoxantrone hclmitoxantronehcl 36MOBIC 15 MG, 7.5 MGMOBIC15 MG, 7.5 MG 4MOBIC 7.5 MG/5MLMOBIC 7.5MG/5ML 4modafinil 100 mgmodafinil 100mg 1modafinil 200 mgmodafinil 200mg 1MODERIBA 1200 DOSEPACKMODERIBA 1200 DOSEPACK 44

MODERIBA 800 DOSEPACKMODERIBA 800 DOSEPACK 44MODERIBAMODERIBA 44MODICONMODICON 53moexipril hclmoexipril hcl 29moexipril-hydrochlorothiazide15mg-12.5mg, 7.5mg-12.5mgmoexipril-hydrochlorothiazide 15mg-12.5mg, 7.5mg-12.5mg 32moexipril-hydrochlorothiazide15mg-25mgmoexipril-hydrochlorothiazide 15mg-25mg 32MOISTURE CREAMMOISTURECREAM 66MOLINDONEHYDROCHLORIDEMOLINDONEHYDROCHLORIDE 41mometasone furoate(nasal)mometasone furoate(nasal) 112mometasone furoatemometasonefuroate 63MONISTAT SOOTHING CAREITCH RELIEFMONISTATSOOTHING CARE ITCHRELIEF 63MONODOXMONODOX 122MONOVISCMONOVISC 111montelukast sodium 10mgmontelukast sodium 10mg 14montelukast sodium 4 mg, 5mgmontelukast sodium 4 mg, 5mg 14montelukast sodium 4mgmontelukast sodium 4 mg14morphine sulfate 0.5 mg/ml, 8mg/ml, 15 mg/ml, 10 mg/ml, 1mg/mlmorphine sulfate 0.5mg/ml, 8 mg/ml, 15 mg/ml, 10mg/ml, 1 mg/ml 7morphine sulfate 1 mg/ml, 8mg/ml, 4 mg/ml, 10mg/mlmorphine sulfate 1 mg/ml,8 mg/ml, 4 mg/ml, 10 mg/ml 7MORPHINE SULFATE 10 MG, 5MG, 20 MGMORPHINESULFATE 10 MG, 5 MG, 20MG 7morphine sulfate 10 mg, 80 mg,60 mg, 50 mg, 30 mg, 20 mg, 100mgmorphine sulfate 10 mg, 80mg, 60 mg, 50 mg, 30 mg, 20 mg,100 mg 6

Index 40

morphine sulfate 10mg/5mlmorphine sulfate 10mg/5ml 7MORPHINE SULFATE 10MG/ML, 15 MG/MLMORPHINESULFATE 10 MG/ML, 15MG/ML 7MORPHINE SULFATE 10MG/ML, 8 MG/ML, 4MG/MLMORPHINE SULFATE 10MG/ML, 8 MG/ML, 4 MG/ML 7morphine sulfate 100 mg, 60 mg,30 mg, 200 mg, 15 mgmorphinesulfate 100 mg, 60 mg, 30 mg,200 mg, 15 mg 7morphine sulfate 100 mg/5ml, 20mg/mlmorphine sulfate 100mg/5ml, 20 mg/ml 7MORPHINE SULFATE 15 MG,30 MGMORPHINE SULFATE 15MG, 30 MG 7MORPHINE SULFATE 15MG/ML, 50 MG/ML, 25MG/MLMORPHINE SULFATE 15MG/ML, 50 MG/ML, 25MG/ML 7morphine sulfate 20mg/5mlmorphine sulfate 20mg/5ml 7MORPHINE SULFATE ADD-VANTAGEMORPHINE SULFATEADD-VANTAGE 6MORPHINE SULFATEERMORPHINE SULFATE ER 7morrhuate sodiummorrhuatesodium 47MOUTH TONICMOUTHTONIC 47MOVANTIKMOVANTIK 76MOVIPREPMOVIPREP 81MOXATAGMOXATAG 118MOXEZAMOXEZA 114moxifloxacin hclmoxifloxacinhcl 75MOZOBILMOZOBIL 80MS CONTINMS CONTIN 7MUGARDMUGARD 103MULTI-GLANMULTI-GLAN

110multiple vitamins w/ minerals &folic acidmultiple vitamins w/minerals & folic acid 104MULTIVITAMIN/FLUORIDEMULTIVITAMIN/FLUORIDE 104mupirocin calcium(topical)mupirocin calcium(topical) 59

mupirocinmupirocin 59MYALEPTMYALEPT 73MYAMBUTOLMYAMBUTOL34MYCOBUTINMYCOBUTIN34mycophenolate mofetil 200mg/mlmycophenolate mofetil200 mg/ml 46mycophenolate mofetil 250mgmycophenolate mofetil 250mg 46mycophenolate mofetil 500mgmycophenolate mofetil 500mg 46mycophenolate mofetilhclmycophenolate mofetilhcl 46mycophenolate sodium 180mgmycophenolate sodium 180mg 46mycophenolate sodium 360mgmycophenolate sodium 360mg 46MYFORTIC 180MGMYFORTIC 180 MG 46MYFORTIC 360MGMYFORTIC 360 MG 46MYGLUCOHEALTH BLOODGLUCOSE MONITORINGSYSTEMMYGLUCOHEALTHBLOOD GLUCOSEMONITORING SYSTEM 94MYGLUCOHEALTH CONTROLLOW/NORMAL/HIGHMYGLUCOHEALTH CONTROLLOW/NORMAL/HIGH 94MYKIDZ IRON 10MYKIDZIRON 10 80MYKIDZ IRON FLMYKIDZIRON FL 105MYLERANMYLERAN 34MYNATALADVANCEMYNATALADVANCE 106MYNATALULTRACAPLETMYNATALULTRACAPLET 106MYNATE 90 PLUSMYNATE 90PLUS 106MYOBLOCMYOBLOC 112MYRBETRIQMYRBETRIQ 126MYSOLINEMYSOLINE 18NABI-HBNABI-HB 117nabumetonenabumetone 4

nadolol &bendroflumethiazidenadolol &bendroflumethiazide 32nadololnadolol 48nafcillin sodium 1 gm, 2 gm, 10gmnafcillin sodium 1 gm, 2 gm,10 gm 119NAFCILLIN SODIUM 1 GM, 2GMNAFCILLIN SODIUM 1 GM, 2GM 119naftifine hclnaftifine hcl 60NAFTIN 1 %, 2 %NAFTIN 1 %, 2% 60NAGLAZYMENAGLAZYME 73nalbuphine hclnalbuphine hcl 9NALFONNALFON 4naloxone hcl 0.4 mg/ml, 4mg/10mlnaloxone hcl 0.4 mg/ml,4 mg/10ml 25NALOXONE HCL 0.4MG/MLNALOXONE HCL 0.4MG/ML 25NALOXONE HCL 2MG/2MLNALOXONE HCL 2MG/2ML 25naltrexone hclnaltrexone hcl 25NAMENDA 10 MG, 5MGNAMENDA 10 MG, 5MG 120NAMENDA 10MG/5MLNAMENDA 10MG/5ML 120NAMENDA TITRATIONPAKNAMENDA TITRATIONPAK 120NAMENDA XR TITRATIONPACKNAMENDA XR TITRATIONPACK 120NAMENDA XRNAMENDAXR 120NAMZARICNAMZARIC 120NAPHAZOLINEHCLNAPHAZOLINE HCL 115NAPRELANNAPRELAN 4NAPROSYNNAPROSYN 4naproxen 125 mg/5mlnaproxen125 mg/5ml 4NAPROXEN 125MG/5MLNAPROXEN 125MG/5ML 4naproxen 250 mg, 500 mg, 375mgnaproxen 250 mg, 500 mg,375 mg 4naproxen 375 mg, 500mgnaproxen 375 mg, 500 mg 4

Index 41

naproxen sodiumnaproxensodium 4naratriptan hclnaratriptanhcl 100NARCANNARCAN 25NARDILNARDIL 20NAROPINNAROPIN 82NASACORT ALLERGY 24HRCHILDRENSNASACORTALLERGY 24HRCHILDRENS 112NASACORT ALLERGY24HRNASACORT ALLERGY24HR 112NASONEXNASONEX 112NATACHEWNATACHEW 106NATAZIANATAZIA 53nateglinidenateglinide 24NATELLE ONENATELLEONE 107NATPARANATPARA 71NATROBANATROBA 67NAVELBINENAVELBINE 38NECON 1/50-28NECON 1/50-28 53NECON 10/11-28NECON 10/11-28 53NEEVO DHANEEVO DHA 107NEFAZODONE HCL 100 MG,200 MG, 150 MGNEFAZODONEHCL 100 MG, 200 MG, 150MG 20nefazodone hcl 250 mg, 50mgnefazodone hcl 250 mg, 50mg 21neomycin sulfateneomycinsulfate 2neomycin-bacitracin zn-polymyxinneomycin-bacitracinzn-polymyxin 114neomycin-polymy-dexameth10000unit/gm-3.5mg/gm-0.1%neomycin-polymy-dexameth10000unit/gm-3.5mg/gm-0.1%

115neomycin-polymy-dexameth10000unit/ml-3.5mg/ml-0.1%neomycin-polymy-dexameth10000unit/ml-3.5mg/ml-0.1%

115neomycin-polymyxin-gramicidinneomycin-polymyxin-gramicidin 114neomycin-polymyxin-hc(otic)neomycin-polymyxin-hc(otic) 117

neomycin/polymyxin bguneomycin/polymyxin bgu 77NEOMYCIN/POLYMYXIN/HYDROCORTISONENEOMYCIN/POLYMYXIN/HYDROCORTISONE 115NEOPROFENNEOPROFEN4NEORAL 100 MG, 25MGNEORAL 100 MG, 25MG 46NEORAL 100 MG/MLNEORAL100 MG/ML 46NEOSALUS CPNEOSALUSCP 66NEOSALUSNEOSALUS 66NEOSPORIN GUIRRIGANTNEOSPORIN GUIRRIGANT 77NEOSPORINNEOSPORIN114neostigmine methylsulfate 0.5mg/ml, 1 mg/mlneostigminemethylsulfate 0.5 mg/ml, 1mg/ml 33NEOSTIGMINEMETHYLSULFATE 0.5 MG/ML,1 MG/MLNEOSTIGMINEMETHYLSULFATE 0.5 MG/ML,1 MG/ML 33neostigmine methylsulfate 10mg/10ml, 5mg/10mlneostigminemethylsulfate 10 mg/10ml, 5mg/10ml 33NEOSTIGMINEMETHYLSULFATE 10MG/10ML, 5MG/10MLNEOSTIGMINEMETHYLSULFATE 10MG/10ML, 5 MG/10ML 33NEPHRO-VITE RXNEPHRO-VITE RX 104NEPHROCAPSNEPHROCAPS

104NEPTAZANENEPTAZANE69NESACAINE-MPFNESACAINE-MPF 82NESINANESINA 23NESTABS ABCNESTABSABC 107NESTABS DHANESTABSDHA 107NESTABSNESTABS 107NEULASTA ONPROKITNEULASTA ONPROKIT 79

NEULASTANEULASTA 79NEUMEGANEUMEGA 79NEUPOGENNEUPOGEN 79NEUPRONEUPRO 39NEURONTIN 100 MG, 400 MG,300 MGNEURONTIN 100 MG,400 MG, 300 MG 18NEURONTIN 250MG/5MLNEURONTIN 250MG/5ML 18NEURONTIN 600 MG, 800MGNEURONTIN 600 MG, 800MG 18NEUTEK 2TEK CONTROLSOLUTIONSNEUTEK 2TEKCONTROL SOLUTIONS 94nevirapine 100 mgnevirapine 100mg 42nevirapine 200 mgnevirapine 200mg 42nevirapine 400 mgnevirapine 400mg 42NEVIRAPINE 50MG/5MLNEVIRAPINE 50MG/5ML 42NEW LIFE HAIRNEW LIFEHAIR 110NEWGENNEWGEN 107NEXA PLUSNEXA PLUS 107NEXAVARNEXAVAR 37NEXGEN NORMALCONTROLNEXGEN NORMALCONTROL 94NEXIUM 20 MGNEXIUM 20MG 125NEXIUM 24HRNEXIUM24HR 125NEXIUM 40 MGNEXIUM 40MG 125NEXIUM I.V.NEXIUM I.V. 125NEXPLANONNEXPLANON 54NF FORMULAS CALCIUMMAGNESIUM/BOTANICALSNFFORMULAS CALCIUMMAGNESIUM/BOTANICALS

47niacin (antihyperlipidemic) 1000mg, 750 mgniacin(antihyperlipidemic) 1000 mg,750 mg 29niacin (antihyperlipidemic) 500mgniacin (antihyperlipidemic) 500mg 29NIACINNIACIN 130NIACORNIACOR 29

Index 42

NIASPAN 1000 MG, 750MGNIASPAN 1000 MG, 750MG 29NIASPAN 500 MGNIASPAN 500MG 29nicardipine hclnicardipine hcl49NICODERM CQNICODERMCQ 121NICORETTE MININICORETTEMINI 121NICORETTE STARTERKITNICORETTE STARTERKIT 121NICORETTENICORETTE 121nicotine polacrilexnicotinepolacrilex 121NICOTINE TRANSDERMALSYSTEMNICOTINETRANSDERMAL SYSTEM 121nicotinenicotine 121NICOTROL INHALERNICOTROLINHALER 121NICOTROL NSNICOTROLNS 121nifedipine 10 mg, 20 mgnifedipine10 mg, 20 mg 49nifedipine 30 mg, 90 mgnifedipine30 mg, 90 mg 49nifedipine 60 mgnifedipine 60mg 49NILANDRONNILANDRON 36nilutamidenilutamide 36NIMBEXNIMBEX 112nimodipinenimodipine 49nisoldipine 17 mg, 8.5 mg, 34mgnisoldipine 17 mg, 8.5 mg, 34mg 49NISOLDIPINE 20 MG, 40 MG, 30MGNISOLDIPINE 20 MG, 40MG, 30 MG 49NISOLDIPINE ERNISOLDIPINEER 49NITRO-BIDNITRO-BID 12NITRO-DUR 0.1 MG/HR, 0.6MG/HR, 0.4 MG/HR, 0.2MG/HRNITRO-DUR 0.1 MG/HR,0.6 MG/HR, 0.4 MG/HR, 0.2MG/HR 12NITRO-DUR 0.3 MG/HR, 0.8MG/HRNITRO-DUR 0.3 MG/HR,0.8 MG/HR 12nitrofurantoinmacrocrystalnitrofurantoinmacrocrystal 126nitrofurantoin monohydmacronitrofurantoin monohydmacro 126

nitrofurantoinnitrofurantoin126

nitroglycerin 0.1 mg/hr, 0.6mg/hr, 0.4 mg/hr, 0.2mg/hrnitroglycerin 0.1 mg/hr,0.6 mg/hr, 0.4 mg/hr, 0.2mg/hr 12nitroglycerin 0.3 mg, 0.6 mg,0.4 mgnitroglycerin 0.3 mg, 0.6mg, 0.4 mg 12nitroglycerin 0.4mg/spraynitroglycerin 0.4mg/spray 12nitroglycerin in d5wnitroglycerinin d5w 12NITROGLYCERIN INDEXTROSE5%NITROGLYCERIN INDEXTROSE 5% 12NITROGLYCERINLINGUALNITROGLYCERINLINGUAL 12NITROLINGUALPUMPSPRAYNITROLINGUALPUMPSPRAY 12NITROMISTNITROMIST 12NITROSTATNITROSTAT 12NIVA-PLUSNIVA-PLUS 107NIVATOPIC PLUSNIVATOPICPLUS 67NIZATIDINE 15MG/MLNIZATIDINE 15MG/ML 124nizatidine 150 mgnizatidine 150mg 124nizatidine 300 mgnizatidine 300mg 124NIZORALNIZORAL 60nonoxynol-9nonoxynol-9 129NOR-QDNOR-QD 54NORCONORCO 8NORDIPEN 5 INJECTIONDEVICENORDIPEN 5INJECTION DEVICE 99NORDIPEN DELIVERYSYSTEMNORDIPENDELIVERY SYSTEM 99NORDITROPINFLEXPRONORDITROPINFLEXPRO 72NORDITROPIN NORDIFLEXPENNORDITROPINNORDIFLEX PEN 72norepinephrinebitartratenorepinephrinebitartrate 130

NOREPINEPHRINE/SODIUMCHLORIDENOREPINEPHRINE/SODIUM CHLORIDE 130norethin acet & estrad-fe 75mg-20mcg-1mg, 75mg-30mcg-1.5mgnorethin acet & estrad-fe75mg-20mcg-1mg, 75mg-30mcg-1.5mg 53norethin acet & estrad-fe 75mg-20mcg-1mgnorethin acet &estrad-fe 75mg-20mcg-1mg 53norethindrone & ethestradiolnorethindrone & ethestradiol 53norethindrone & ethinyl estradiol-fenorethindrone & ethinylestradiol-fe 53norethindrone(contraceptive)norethindrone(contraceptive) 54norethindrone acet & ethestranorethindrone acet & ethestra 53norethindrone acetate-ethinylestradiol-fenorethindroneacetate-ethinyl estradiol-fe 53norethindrone acetate-ethinylestradiolnorethindrone acetate-ethinyl estradiol 74norethindroneacetatenorethindroneacetate 119norethindrone-eth estradiol(triphasic)norethindrone-ethestradiol (triphasic) 53norgestimate-ethinyl estradiol(triphasic)norgestimate-ethinylestradiol (triphasic) 53norgestimate-ethinylestradiolnorgestimate-ethinylestradiol 53norgestrel & ethinylestradiolnorgestrel & ethinylestradiol 53NORINYL 1+35NORINYL1+35 53NORINYL 1+50NORINYL1+50 53NORMOSOL-M IND5WNORMOSOL-M IND5W 101NORPACE CRNORPACECR 13NORPACENORPACE 13NORPRAMINNORPRAMIN 21nortriptyline hcl 10 mg, 75 mg, 50mg, 25 mgnortriptyline hcl 10 mg,75 mg, 50 mg, 25 mg 21

Index 43

NORTRIPTYLINE HCL 10MG/5MLNORTRIPTYLINE HCL10 MG/5ML 21NORVASCNORVASC 49NORVIR 100 MGNORVIR 100MG 42NORVIR 80 MG/MLNORVIR 80MG/ML 42NOVA MAX BLOOD GLUCOSEMONITORING SYSTEMNOVAMAX BLOOD GLUCOSEMONITORING SYSTEM 94NOVA MAX PLUS GLU/KETCONTROL SOLUTION-MIDNOVA MAX PLUS GLU/KETCONTROL SOLUTION-MID 94NOVOLIN N RELIONNOVOLIN NRELION 23NOVOLIN NNOVOLIN N 23NOVOLIN R RELIONNOVOLIN RRELION 23NOVOLIN RNOVOLIN R 23NOVOLOG FLEXPENNOVOLOGFLEXPEN 23NOVOLOG MIX 70/30PREFILLEDFLEXPENNOVOLOG MIX 70/30PREFILLED FLEXPEN 23NOVOLOG MIX 70/30NOVOLOGMIX 70/30 23NOVOLOG PENFILLNOVOLOGPENFILL 23NOVOLOGNOVOLOG 24NPLATENPLATE 79NU GAUZE 4PLY 4"X4"NUGAUZE 4PLY 4"X4" 86NU GAUZE GENERAL-USESPONGES 4"X4" 4 PLYNUGAUZE GENERAL-USESPONGES 4"X4" 4 PLY 86NUCALANUCALA 14NUCYNTA ERNUCYNTA ER 7NUCYNTANUCYNTA 7NULOJIXNULOJIX 46NULYTELY/FLAVORPACKSNULYTELY/FLAVORPACKS 81NUTROPIN AQ NUSPIN10NUTROPIN AQ NUSPIN10 72NUTROPIN AQ NUSPIN20NUTROPIN AQ NUSPIN20 72NUTROPIN AQ NUSPIN5NUTROPIN AQ NUSPIN 5 72

NUTROPIN AQPENNUTROPIN AQ PEN 72NUVARINGNUVARING 54NUVIGIL 150 MG, 50 MG, 250MGNUVIGIL 150 MG, 50 MG,250 MG 2NUVIGIL 200 MGNUVIGIL 200MG 2NYMALIZENYMALIZE 49nystatin (mouth-throat)nystatin(mouth-throat) 102nystatin (topical)nystatin(topical) 60nystatin-triamcinolonenystatin-triamcinolone 60nystatinnystatin 26O-CAL FAO-CAL FA 107OB COMPLETE ONEOBCOMPLETE ONE 107OB COMPLETE PETITEOBCOMPLETE PETITE 107OB COMPLETE PREMIEROBCOMPLETE PREMIER 107OB COMPLETE/DHAOBCOMPLETE/DHA 107OB COMPLETEOBCOMPLETE 107OBSTETRIX DHAOBSTETRIXDHA 107OBSTETRIX ONEOBSTETRIXONE 107OBTREX DHAOBTREXDHA 107OCALIVAOCALIVA 75OCTAGAMOCTAGAM 117octreotide acetateoctreotideacetate 73OCUFENOCUFEN 116OCUFLOXOCUFLOX 114ODOMZOODOMZO 35OFEVOFEV 122ofloxacin (ophth)ofloxacin(ophth) 114ofloxacin (otic)ofloxacin(otic) 117OFLOXACIN 300MGOFLOXACIN 300 MG 75ofloxacin 400 mgofloxacin 400mg 75OGESTRELOGESTREL 53olanzapine-fluoxetinehclolanzapine-fluoxetinehcl 120olanzapineolanzapine 40

olmesartan medoxomil 20 mg, 40mgolmesartan medoxomil 20 mg,40 mg 30olmesartan medoxomil 5mgolmesartan medoxomil 5mg 30olmesartan medoxomil-amlodipine-hydrochlorothiazideolmesartanmedoxomil-amlodipine-hydrochlorothiazide 32olmesartan medoxomil-hydrochlorothiazideolmesartanmedoxomil-hydrochlorothiazide

32olopatadine hcl(nasal)olopatadine hcl(nasal) 112olopatadine hclolopatadinehcl 116OLUX-EOLUX-E 63OLUXOLUX 63OLYSIOOLYSIO 44omega-3-acid ethyl estersomega-3-acid ethyl esters 27omeprazole-sodium bicarbonate20mg-1100mgomeprazole-sodium bicarbonate 20mg-1100mg 125omeprazole-sodium bicarbonate20mg-1680mg, 40mg-1680mgomeprazole-sodiumbicarbonate 20mg-1680mg,40mg-1680mg 125omeprazole-sodium bicarbonate40mg-1100mgomeprazole-sodium bicarbonate 40mg-1100mg 125omeprazoleomeprazole 125OMNARISOMNARIS 112OMNIPREDOMNIPRED 115OMNITROPE 10 MG/1.5ML, 5MG/1.5MLOMNITROPE 10MG/1.5ML, 5 MG/1.5ML 72OMNITROPE 5.8MGOMNITROPE 5.8 MG 72OMNITROPE PEN 10INJECTIONDEVICEOMNITROPE PEN 10INJECTION DEVICE 99OMNITROPE PEN 5 INJECTIONDEVICEOMNITROPE PEN 5INJECTION DEVICE 99

Index 44

ON CALL EXPRESS BLOODGLUCOSE MONITORINGSYSTEMON CALL EXPRESSBLOOD GLUCOSEMONITORING SYSTEM 94ON CALL EXPRESS GLUCOSECONTROL SOLUTIONON CALLEXPRESS GLUCOSECONTROL SOLUTION 94ON CALL PLUS BLOODGLUCOSE METERON CALLPLUS BLOOD GLUCOSEMETER 94ON CALL PLUS BLOODGLUCOSE MONITORINGSYSTEMON CALL PLUSBLOOD GLUCOSEMONITORING SYSTEM 95ON CALL PLUS GLUCOSECONTROL LEVEL 1/2ON CALLPLUS GLUCOSE CONTROLLEVEL 1/2 95ON CALL VIVID BLOODGLUCOSE METERON CALLVIVID BLOOD GLUCOSEMETER 95ON CALL VIVID BLOODGLUCOSE MONITORINGSYSTEMON CALL VIVIDBLOOD GLUCOSEMONITORING SYSTEM 95ON CALL VIVID GLUCOSECONTROL LEVEL 1/2ON CALLVIVID GLUCOSE CONTROLLEVEL 1/2 95ON CALL VIVID PAL BLOODGLUCOSE METERON CALLVIVID PAL BLOOD GLUCOSEMETER 95ONCASPARONCASPAR 37ondansetron hcl 24mgondansetron hcl 24 mg 25ondansetron hcl 4 mg, 8mgondansetron hcl 4 mg, 8mg 25ondansetron hcl 4 mg/2ml, 40mg/20mlondansetron hcl 4mg/2ml, 40 mg/20ml 25ondansetron hcl 4mg/5mlondansetron hcl 4mg/5ml 25ondansetronondansetron 25ONETOUCH ULTRA2ONETOUCH ULTRA 2 95ONETOUCH ULTRACONTROLONETOUCH ULTRACONTROL 95

ONETOUCH ULTRAMINIONETOUCH ULTRAMINI 95ONETOUCH ULTRALINKSYSTEM (DEC)ONETOUCHULTRALINK SYSTEM(DEC) 95ONETOUCH ULTRALINKSYSTEM (HEX)ONETOUCHULTRALINK SYSTEM(HEX) 95ONETOUCH VERIOCONTROL SOLUTIONHIGHONETOUCH VERIOCONTROL SOLUTIONHIGH 95ONETOUCH VERIO FLEXBLOODGLUCOSEMONITORINGSYSTEMONETOUCH VERIOFLEX BLOODGLUCOSEMONITORING SYSTEM 95ONETOUCH VERIO IQBLOOD GLUCOSEMONITORINGSYSTEMONETOUCH VERIOIQ BLOOD GLUCOSEMONITORING SYSTEM 95ONETOUCH VERIO MIDCONTROLSOLUTIONONETOUCHVERIO MID CONTROLSOLUTION 95ONETOUCH VERIO SYNCBLOODGLUCOSEMONITORINGSYSTEMONETOUCH VERIOSYNC BLOODGLUCOSEMONITORING SYSTEM 95ONETOUCHVERIOONETOUCHVERIO 95ONGLYZAONGLYZA 23OPANA 10 MGOPANA 10MG 7OPANA 5 MGOPANA 5 MG 7OPANA ER (CRUSHRESISTANT) 10 MG, 7.5 MG, 5MG, 30 MG, 20 MG, 15MGOPANA ER (CRUSHRESISTANT) 10 MG, 7.5 MG, 5MG, 30 MG, 20 MG, 15 MG 7OPANA ER (CRUSHRESISTANT) 40 MGOPANAER (CRUSH RESISTANT) 40MG 7

ophthalmic irrigation solution -intraocularophthalmic irrigationsolution - intraocular 116opium tinctureopium tincture 24OPSUMITOPSUMIT 50OPTIFOAMOPTIFOAM 86OPTIONS CONCEPTROLVAGINALCONTRACEPTIVEOPTIONSCONCEPTROL VAGINALCONTRACEPTIVE 129OPTIONS GYNOL IIVAGINALCONTRACEPTIVEOPTIONS GYNOL IIVAGINALCONTRACEPTIVE

129OPTIUM BLOOD GLUCOSEMONITORING SYSTEMOPTIUMBLOOD GLUCOSEMONITORING SYSTEM 95OPTIVAROPTIVAR 116OPTUMRX BLOOD GLUCOSEMETEROPTUMRX BLOODGLUCOSE METER 95OPTUMRX BLOOD GLUCOSEMONITORINGSYSTEMOPTUMRX BLOODGLUCOSE MONITORINGSYSTEM 95OPTUMRX GLUCOSECONTROL LEVEL 1/2OPTUMRXGLUCOSE CONTROL LEVEL1/2 95ORACEAORACEA 67ORAPORAP 121ORAPRED ODTORAPREDODT 55ORCHICORCHIC 110ORENCIA CLICKJECTORENCIACLICKJECT 4ORENCIAORENCIA 4ORENITRAMORENITRAM 50ORKAMBIORKAMBI 122orphenadrine citrate 100mgorphenadrine citrate 100mg 111orphenadrine citrate 30mg/mlorphenadrine citrate 30mg/ml 111ORTHO EVRAORTHOEVRA 54ORTHO MICRONORORTHOMICRONOR 54ORTHO TRI-CYCLENLOORTHO TRI-CYCLEN LO53

Index 45

ORTHO TRI-CYCLENORTHOTRI-CYCLEN 53ORTHO-CEPTORTHO-CEPT

53ORTHO-CYCLENORTHO-CYCLEN 53ORTHO-NOVUM 1/35ORTHO-NOVUM 1/35 53ORTHO-NOVUM 7/7/7ORTHO-NOVUM 7/7/7 54ORTHOVISCORTHOVISC 111oseltamivir phosphate 30mgoseltamivir phosphate 30mg 45oseltamivir phosphate 45 mg, 75mgoseltamivir phosphate 45 mg,75 mg 45OSENIOSENI 22OSMITROL VIAFLEXOSMITROLVIAFLEX 70OSPHENAOSPHENA 72OTEZLAOTEZLA 4OTREXUP 10 MG/0.4ML, 7.5MG/0.4ML, 25 MG/0.4ML, 22.5MG/0.4ML, 17.5 MG/0.4ML, 15MG/0.4ML, 12.5MG/0.4MLOTREXUP 10MG/0.4ML, 7.5 MG/0.4ML, 25MG/0.4ML, 22.5 MG/0.4ML, 17.5MG/0.4ML, 15 MG/0.4ML, 12.5MG/0.4ML 2OTREXUP 20MG/0.4MLOTREXUP 20MG/0.4ML 2OVACE PLUS WASHOVACEPLUS WASH 61OVACE PLUSOVACE PLUS61OVACE WASHOVACEWASH 61OVARYOVARY 110OVCON-35OVCON-35 54OVIDEOVIDE 67OVIDRELOVIDREL 71oxacillin sodiumoxacillinsodium 119oxaliplatinoxaliplatin 34oxaprozinoxaprozin 4oxazepamoxazepam 13oxcarbazepine 150 mg, 600 mg,300 mgoxcarbazepine 150 mg,600 mg, 300 mg 18oxcarbazepine 300 mg/5ml, 60mg/mloxcarbazepine 300 mg/5ml,60 mg/ml 18oxiconazole nitrateoxiconazolenitrate 60

OXISTATOXISTAT 60OXSORALENULTRAOXSORALENULTRA 60OXTELLAR XR 150 MG, 300MGOXTELLAR XR 150 MG,300 MG 18OXTELLAR XR 600MGOXTELLAR XR 600MG 18oxybutynin chloride 10 mg, 5mg, 15 mgoxybutynin chloride10 mg, 5 mg, 15 mg 126oxybutynin chloride 5mg/5mloxybutynin chloride 5mg/5ml 126oxybutynin chloride 5mgoxybutynin chloride 5mg 126oxycodone hcl 10 mg, 5 mg, 30mg, 20 mg, 15 mgoxycodonehcl 10 mg, 5 mg, 30 mg, 20 mg,15 mg 7oxycodone hcl 100mg/5mloxycodone hcl 100mg/5ml 7oxycodone hcl 5mg/5mloxycodone hcl 5mg/5ml 7oxycodone hcl 5 mgoxycodonehcl 5 mg 7OXYCODONE HCLEROXYCODONE HCL ER 7oxycodone w/acetaminophenoxycodone w/acetaminophen 8oxycodone-aspirinoxycodone-aspirin 8OXYCODONE/ACETAMINOPHENOXYCODONE/ACETAMINOPHEN 8OXYCODONE/IBUPROFENOXYCODONE/IBUPROFEN 8OXYCONTINOXYCONTIN 7oxymorphone hcl 10 mg, 7.5mg, 5 mg, 30 mg, 20 mg, 15mgoxymorphone hcl 10 mg, 7.5mg, 5 mg, 30 mg, 20 mg, 15mg 7oxymorphone hcl 10mgoxymorphone hcl 10 mg 7oxymorphone hcl 40mgoxymorphone hcl 40 mg 7oxymorphone hcl 5mgoxymorphone hcl 5 mg 7

OXYMORPHONEHYDROCHLORIDE ER 10 MG,7.5 MG, 5 MG, 30 MG, 20 MG,15 MGOXYMORPHONEHYDROCHLORIDE ER 10 MG,7.5 MG, 5 MG, 30 MG, 20 MG,15 MG 7OXYMORPHONEHYDROCHLORIDE ER 40MGOXYMORPHONEHYDROCHLORIDE ER 40MG 7oxytocinoxytocin 117paclitaxel 100 mg/16.7ml, 300mg/50ml, 30 mg/5mlpaclitaxel100 mg/16.7ml, 300 mg/50ml, 30mg/5ml 38PACLITAXEL 150MG/25MLPACLITAXEL 150MG/25ML 38PAIRE OBPAIRE OB 107paliperidonepaliperidone 40PALLERIXPALLERIX 66PAMELORPAMELOR 21pamidronate disodium 30 mg, 90mgpamidronate disodium 30 mg,90 mg 71pamidronate disodium 30mg/10ml, 90mg/10mlpamidronate disodium30 mg/10ml, 90 mg/10ml 71PAMIDRONATE DISODIUM 6MG/MLPAMIDRONATEDISODIUM 6 MG/ML 71PAMINE FORTEPAMINEFORTE 124PAMINEPAMINE 124PANCREAZEPANCREAZE 69PANCRELIPASEPANCRELIPASE 69pancuroniumbromidepancuroniumbromide 113PANOXYLPANOXYL 58pantoprazole sodium 20 mg, 40mgpantoprazole sodium 20 mg,40 mg 125pantoprazole sodium 40mgpantoprazole sodium 40mg 125papaverine hclpapaverinehcl 50

Index 46

PARADIGM LINK BLOODGLUCOSEMONITORPARADIGM LINKBLOOD GLUCOSEMONITOR 95PARAFON FORTEDSCPARAFON FORTEDSC 111PARATHYROIDPARATHYROID

110PAREGORICPAREGORIC 24parenteral electrolytesparenteralelectrolytes 101paricalcitolparicalcitol 73PARLODELPARLODEL 39PARNATEPARNATE 20paromomycinsulfateparomomycin sulfate 2paroxetine hclparoxetine hcl 20PATADAYPATADAY 116PATANASEPATANASE 112PATANOLPATANOL 116PAXIL CRPAXIL CR 20PAXILPAXIL 20PAZEOPAZEO 116PCA INJECTORPCAINJECTOR 99ped multivitamins w/fl & ironpedmultivitamins w/fl & iron 105PEDIAPREDPEDIAPRED 55PEDIARIXPEDIARIX 123pediatric multiple vitamin w/minerals & cpediatric multiplevitamin w/ minerals & c 105

pediatric multivitamins w/fl0.25mg-15unit-1.2mg-2500unit-4.5mcg-400unit-1.05mg-13.5mg-1.05mg-0.3mg-60mg,1mg-15unit-400unit-2500unit-1.2mg-4.5mcg-13.5mg-1.05mg-0.3mg-1.05mg-60mg, 1mg-15unit-1.2mg-2500unit-4.5mcg-400unit-1.05mg-13.5mg-1.05mg-0.3mg-60mg, 15unit-1mg-2500unit-13.5mg-1.2mg-4.5mcg-400unit-1.05mg-0.3mg-1.05mg-60mg, 15unit-1mg-1.05mg-13.5mg-1.2mg-2500unit-4.5mcg-400unit-0.3mg-1.05mg-60mg, 15unit-0.5mg-2500unit-13.5mg-1.2mg-4.5mcg-400unit-1.05mg-0.3mg-1.05mg-60mg, 15unit-0.5mg-1.05mg-13.5mg-1.2mg-2500unit-4.5mcg-400unit-0.3mg-1.05mg-60mg, 15unit-0.25mg-2500unit-13.5mg-1.2mg-4.5mcg-400unit-1.05mg-0.3mg-1.05mg-60mg, 15unit-0.25mg-1.05mg-13.5mg-1.2mg-2500unit-4.5mcg-400unit-0.3mg-1.05mg-60mg, 0.5mg-2500unit-13.5mg-1.2mg-4.5mcg-400unit-1.05mg-0.3mg-15unit-1.05mg-60mg, 0.5mg-15unit-400unit-2500unit-1.2mg-4.5mcg-13.5mg-1.05mg-0.3mg-1.05mg-60mg, 0.5mg-15unit-1.2mg-2500unit-4.5mcg-400unit-1.05mg-13.5mg-1.05mg-0.3mg-60mg, 0.25mg-15unit-400unit-2500unit-1.2mg-4.5mcg-13.5mg-1.05mg-0.3mg-1.05mg-60mgpediatricmultivitamins w/fl 0.25mg-15unit-1.2mg-2500unit-4.5mcg-400unit-1.05mg-13.5mg-1.05mg-0.3mg-60mg, 1mg-15unit-400unit-2500unit-1.2mg-4.5mcg-13.5mg-1.05mg-0.3mg-1.05mg-60mg, 1mg-15unit-1.2mg-2500unit-4.5mcg-400unit-1.05mg-13.5mg-1.05mg-0.3mg-60mg, 15unit-1mg-2500unit-13.5mg-1.2mg-4.5mcg-400unit-1.05mg-0.3mg-1.05mg-60mg, 15unit-1mg-1.05mg-13.5mg-1.2mg-2500unit-4.5mcg-400unit-0.3mg-1.05mg-60mg, 15unit-0.5mg-2500unit-13.5mg-1.2mg-4.5mcg-400unit-1.05mg-0.3mg-

1.05mg-60mg, 15unit-0.5mg-1.05mg-13.5mg-1.2mg-2500unit-4.5mcg-400unit-0.3mg-1.05mg-60mg, 15unit-0.25mg-2500unit-13.5mg-1.2mg-4.5mcg-400unit-1.05mg-0.3mg-1.05mg-60mg,15unit-0.25mg-1.05mg-13.5mg-1.2mg-2500unit-4.5mcg-400unit-0.3mg-1.05mg-60mg, 0.5mg-2500unit-13.5mg-1.2mg-4.5mcg-400unit-1.05mg-0.3mg-15unit-1.05mg-60mg, 0.5mg-15unit-400unit-2500unit-1.2mg-4.5mcg-13.5mg-1.05mg-0.3mg-1.05mg-60mg, 0.5mg-15unit-1.2mg-2500unit-4.5mcg-400unit-1.05mg-13.5mg-1.05mg-0.3mg-60mg, 0.25mg-15unit-400unit-2500unit-1.2mg-4.5mcg-13.5mg-1.05mg-0.3mg-1.05mg-60mg

104

Index 47

pediatric multivitamins w/fl0.25mg/ml-5unit/ml-0.6mg/ml-1mg/ml-1150unit/ml-2mg/ml-2mcg/ml-400unit/ml-0.5mg/ml-29.7mcg/ml-3mcg/ml-0.4mg/ml-32mg/ml, 65mcg/ml-1mg/ml-0.25mg/ml-10mg/ml-1000unit/ml-0.8mg/ml-0.6mg/ml-2mcg/ml-400unit/ml-0.5mg/ml-35mcg/ml-5unit/ml-0.4mg/ml-35mg/ml,5unit/ml-0.5mg/ml-8mg/ml-0.6mg/ml-1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-35mg/ml, 5unit/ml-0.5mg/ml-0.6mg/ml-8mg/ml-1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-35mg/ml, 5unit/ml-0.25mg/ml-0.6mg/ml-8mg/ml-1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-35mg/ml,150mcg/ml-1mg/ml-0.5mg/ml-12mg/ml-1100unit/ml-2mg/ml-1mg/ml-3mcg/ml-400unit/ml-1mg/ml-81mcg/ml-12unit/ml-1mg/ml-45mg/ml, 0.5mg/ml-5unit/ml-8mg/ml-0.6mg/ml-1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-35mg/ml,0.5mg/ml-5unit/ml-0.6mg/ml-8mg/ml-1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-35mg/ml, 0.25mg/ml-5unit/ml-8mg/ml-0.6mg/ml-1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-35mg/ml, 0.25mg/ml-5unit/ml-0.6mg/ml-8mg/ml-1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-35mg/mlpediatric multivitaminsw/fl 0.25mg/ml-5unit/ml-0.6mg/ml-1mg/ml-1150unit/ml-2mg/ml-2mcg/ml-400unit/ml-0.5mg/ml-29.7mcg/ml-3mcg/ml-0.4mg/ml-32mg/ml, 65mcg/ml-1mg/ml-0.25mg/ml-10mg/ml-1000unit/ml-0.8mg/ml-0.6mg/ml-2mcg/ml-400unit/ml-0.5mg/ml-35mcg/ml-5unit/ml-0.4mg/ml-35mg/ml, 5unit/ml-0.5mg/ml-8mg/ml-0.6mg/ml-1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-35mg/ml, 5unit/ml-0.5mg/ml-0.6mg/ml-8mg/ml-1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-35mg/ml,5unit/ml-0.25mg/ml-0.6mg/ml-8mg/ml-1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-

35mg/ml, 150mcg/ml-1mg/ml-0.5mg/ml-12mg/ml-1100unit/ml-2mg/ml-1mg/ml-3mcg/ml-400unit/ml-1mg/ml-81mcg/ml-12unit/ml-1mg/ml-45mg/ml,0.5mg/ml-5unit/ml-8mg/ml-0.6mg/ml-1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-35mg/ml, 0.5mg/ml-5unit/ml-0.6mg/ml-8mg/ml-1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-35mg/ml, 0.25mg/ml-5unit/ml-8mg/ml-0.6mg/ml-1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-35mg/ml, 0.25mg/ml-5unit/ml-0.6mg/ml-8mg/ml-1500unit/ml-2mcg/ml-400unit/ml-0.5mg/ml-0.4mg/ml-35mg/ml 105pediatric vitamins acd w/fluoridepediatric vitamins acd w/fluoride 105peg 3350-kcl-sod bicarb-sodchloride-sod sulfate 236gm-22.74gm-5.86gm-2.97gm-6.74gmpeg 3350-kcl-sodbicarb-sod chloride-sod sulfate236gm-22.74gm-5.86gm-2.97gm-6.74gm 81peg 3350-kcl-sod bicarb-sodchloride-sod sulfate 240gm-22.72gm-5.84gm-2.98gm-6.72gmpeg 3350-kcl-sodbicarb-sod chloride-sod sulfate240gm-22.72gm-5.84gm-2.98gm-6.72gm 82peg 3350-potassium chloride-sod bicarbonate-sodchloridepeg 3350-potassiumchloride-sod bicarbonate-sodchloride 82PEG-INTRON REDIPEN PAK4PEG-INTRON REDIPEN PAK4 44PEG-INTRON REDIPENPEG-INTRON REDIPEN 44PEG-INTRONPEG-INTRON

44PEGASYS 180MCG/0.5MLPEGASYS 180MCG/0.5ML 44PEGASYS 180MCG/MLPEGASYS 180MCG/ML 44PEGASYSPROCLICKPEGASYSPROCLICK 44PEGINTRONPEGINTRON 44

penicillin g potassiumpenicillin gpotassium 118PENICILLIN GSODIUMPENICILLIN GSODIUM 118penicillin v potassiumpenicillin vpotassium 118PENLAC NAILLACQUERPENLAC NAILLACQUER 60PENNSAIDPENNSAID 59PENTACELPENTACEL 123PENTASAPENTASA 76pentazocine w/naloxonepentazocine w/naloxone 9pentoxifyllinepentoxifylline 78PEPCID 20 MGPEPCID 20MG 124PEPCID 40 MG/5MLPEPCID 40MG/5ML 124PEPCID 40 MGPEPCID 40MG 124PEPCID AC MAXIMUMSTRENGTHPEPCID ACMAXIMUM STRENGTH 124PERCOCETPERCOCET 8PERCODANPERCODAN 8PERFOROMISTPERFOROMIST

15PERIDEXPERIDEX 102perindopril erbumineperindoprilerbumine 29peritoneal dialysissolutionsperitoneal dialysissolutions 47PERJETAPERJETA 35permethrinpermethrin 67PERPHENAZINE/AMITRIPTYLINEPERPHENAZINE/AMITRIPTYLINE 120perphenazineperphenazine 41PERSANTINEPERSANTINE

78PERTZYEPERTZYE 69PFIZERPEN-GPFIZERPEN-G

118PH 12 STERILE DILUENTFORFLOLANPH 12 STERILEDILUENT FORFLOLAN 119PHARMACIST CHOICEALCOHOLPREPPADSPHARMACIST CHOICEALCOHOLPREP PADS 98

Index 48

PHARMACIST CHOICEAUTOCODE BLOOD GLUCOSEMONITORINGSYSTEMPHARMACIST CHOICEAUTOCODE BLOOD GLUCOSEMONITORING SYSTEM 95phenazopyridinehclphenazopyridine hcl 78phenelzine sulfatephenelzinesulfate 20PHENERGANPHENERGAN 27PHENOBARBITAL 100 MG, 60MG, 30 MG, 15MGPHENOBARBITAL 100 MG,60 MG, 30 MG, 15 MG 80phenobarbital 16.2 mg, 97.2 mg,64.8 mg, 32.4 mgphenobarbital16.2 mg, 97.2 mg, 64.8 mg, 32.4mg 81phenobarbital 20mg/5mlphenobarbital 20mg/5ml 80PHENOBARBITALSODIUMPHENOBARBITALSODIUM 80phenoxybenzaminehclphenoxybenzamine hcl 29PHENTOLAMINEMESYLATEPHENTOLAMINEMESYLATE 29phenyleph-promethazine w/codphenyleph-promethazine w/cod 56phenylephrine hcl(ophth)phenylephrine hcl(ophth) 115phenylephrine hcl(pressors)phenylephrine hcl(pressors) 130PHENYLEPHRINEHCLPHENYLEPHRINEHCL 130phenylephrine w/ dm-ggphenylephrine w/ dm-gg 56PHENYLEPHRINE/GUAIFENESINPHENYLEPHRINE/GUAIFENESIN 56PHENYTEKPHENYTEK 19phenytoin sodiumextendedphenytoin sodiumextended 19phenytoin sodiumphenytoinsodium 19phenytoinphenytoin 19PHLEXY-10PHLEXY-10 113PHOSLOPHOSLO 76PHOSLYRAPHOSLYRA 76

PHYTOCILLINPHYTOCILLIN47

phytonadionephytonadione130PICATOPICATO 60pilocarpine hcl (oral) 5mgpilocarpine hcl (oral) 5mg 103pilocarpine hcl (oral) 7.5mgpilocarpine hcl (oral) 7.5mg 103pilocarpine hclpilocarpinehcl 114pimozidepimozide 121pindololpindolol 48pioglitazone hcl-glimepiridepioglitazone hcl-glimepiride 22pioglitazone hcl-metforminhclpioglitazone hcl-metforminhcl 22pioglitazone hclpioglitazonehcl 23piperacillin sodium-tazobactamsodiumpiperacillin sodium-tazobactam sodium 118piroxicampiroxicam 4PITOCINPITOCIN 117PITUITARYPITUITARY 110PLAN B ONE-STEPPLAN BONE-STEP 54PLAQUENILPLAQUENIL 33PLASTIC ADAPTER FORBUSHINJECTOR B-DPLASTIPAKPLASTICADAPTER FORBUSHINJECTOR B-DPLASTIPAK 99PLASTIC ADAPTER FORBUSHINJECTORPLASTICADAPTER FORBUSHINJECTOR 99PLAVIX 300 MGPLAVIX 300MG 78PLAVIX 75 MGPLAVIX 75MG 78PLEGISOLPLEGISOL 50PLEGRIDY STARTERPACKPLEGRIDY STARTERPACK 121PLEGRIDYPLEGRIDY 120PLETALPLETAL 78PLEXIONCLEANSERPLEXIONCLEANSER 58PLEXIONPLEXION 58

PLIAGLISPLIAGLIS 66PNEUMOVAX 23/1DOSEPNEUMOVAX 23/1DOSE 127PNEUMOVAX 23/5DOSEPNEUMOVAX 23/5DOSE 127PNEUMOVAX 23PNEUMOVAX23 127PNV FERROUSFUMARATE/DOCUSATE/FOLICACIDPNV FERROUSFUMARATE/DOCUSATE/FOLICACID 107PNV FOLIC ACID + IRONMULTIVITAMINPNV FOLIC ACID+ IRON MULTIVITAMIN 107PNV OB+DHAPNVOB+DHA 107PNV PRENATAL PLUSMULTIVITAMINPNV PRENATALPLUS MULTIVITAMIN 107PNV TABS 29-1PNV TABS 29-1 107PNV-DHA+DOCUSATEPNV-DHA+DOCUSATE 107PNV-DHAPNV-DHA 107PNV-OMEGAPNV-OMEGA107PNV-SELECTPNV-SELECT

107PNV-TOTALPNV-TOTAL 107PNV-VP-UPNV-VP-U 107POCKETCHEM EZ BLOODGLUCOSE MONITORINGSYSTEMPOCKETCHEM EZBLOOD GLUCOSEMONITORING SYSTEM 95POCKETCHEM EZ CONTROLLEVEL 1POCKETCHEM EZCONTROL LEVEL 1 95podofiloxpodofilox 65POLY-VI-FLOR 200MCG-0.25MG-15UNIT-400UNIT,200MCG-1MG-15UNIT-400UNIT,200MCG-0.5MG-15UNIT-400UNITPOLY-VI-FLOR200MCG-0.25MG-15UNIT-400UNIT, 200MCG-1MG-15UNIT-400UNIT, 200MCG-0.5MG-15UNIT-400UNIT 105POLY-VI-FLOR 200MCG/ML-0.25MG/MLPOLY-VI-FLOR200MCG/ML-0.25MG/ML 105

Index 49

POLY-VI-FLOR/IRON 200MCG-0.5MG-10MG-15UNIT-400UNITPOLY-VI-FLOR/IRON200MCG-0.5MG-10MG-15UNIT-400UNIT 105POLY-VI-FLOR/IRON200MCG/ML-7MG/ML-0.25MG/MLPOLY-VI-FLOR/IRON200MCG/ML-7MG/ML-0.25MG/ML 105polyethylene glycol3350polyethylene glycol3350 82POLYMEM DRESSING/3" X3"POLYMEM DRESSING/3" X3" 86POLYMEM DRESSING/4" X4"POLYMEM DRESSING/4" X4" 86polymyxin b sulfatepolymyxin bsulfate 12polymyxin b-trimethoprimpolymyxin b-trimethoprim 114POLYTRIMPOLYTRIM 114POMALYSTPOMALYST 36PONSTELPONSTEL 4pot & sod citrates w/citric acpot &sod citrates w/citric ac 77pot phosphate monobasic w/ sodphosphate dibasic &monobasicpot phosphatemonobasic w/ sod phosphatedibasic & monobasic 101potassium acetate 2 meq/ml, 4meq/mlpotassium acetate 2meq/ml, 4 meq/ml 102POTASSIUM ACETATE 2MEQ/MLPOTASSIUM ACETATE2 MEQ/ML 102POTASSIUM ACETATE 4MEQ/MLPOTASSIUM ACETATE4 MEQ/ML 102potassium bicarb &chloridepotassium bicarb &chloride 102potassium bicarbonatepotassiumbicarbonate 102POTASSIUM CHLORIDE/SODIUMCHLORIDEPOTASSIUMCHLORIDE /SODIUMCHLORIDE 101

potassium chloride 0.4 meq/ml,40 meq/100ml, 20 meq/50ml,20 meq/100ml, 2 meq/ml, 10meq/100mlpotassium chloride0.4 meq/ml, 40 meq/100ml, 20meq/50ml, 20 meq/100ml, 2meq/ml, 10 meq/100ml 102potassium chloride 10 %, 20%potassium chloride 10 %, 20% 102potassium chloride 10 meq, 8meqpotassium chloride 10meq, 8 meq 102POTASSIUM CHLORIDE 10MEQ/50MLPOTASSIUMCHLORIDE 10MEQ/50ML 102potassium chloride 20meqpotassium chloride 20meq 102POTASSIUM CHLORIDEERPOTASSIUM CHLORIDEER 102potassium chloride in dextrose& sodium chloridepotassiumchloride in dextrose & sodiumchloride 101potassium chloride indextrosepotassium chloride indextrose 101potassium chloride innaclpotassium chloride innacl 101potassium chloridemicroencapsulated crystalscrpotassium chloridemicroencapsulated crystalscr 102POTASSIUMCHLORIDE/DEXTROSEPOTASSIUMCHLORIDE/DEXTROSE 101potassium citrate(alkalinizer)potassium citrate(alkalinizer) 77potassium citrate-citricacidpotassium citrate-citricacid 77potassiumphosphatespotassiumphosphates 101POTASSIUMPHOSPHATESPOTASSIUMPHOSPHATES 101POTIGAPOTIGA 18PR NATAL 400 ECPR NATAL400 EC 107

PR NATAL 430 ECPR NATAL430 EC 107PR NATAL 430PR NATAL430 107PRADAXA 110 MGPRADAXA110 MG 16PRADAXA 150 MGPRADAXA150 MG 16PRADAXA 75 MGPRADAXA 75MG 16PRALUENTPRALUENT 29pramipexoledihydrochloridepramipexoledihydrochloride 39PRAMOTICPRAMOTIC 117pramoxine hclpramoxine hcl 66pramoxine-chloroxylenolpramoxine-chloroxylenol 117PRANDIMETPRANDIMET 22PRANDIN 0.5 MG, 1MGPRANDIN 0.5 MG, 1 MG 24PRANDIN 2 MGPRANDIN 2MG 24PRAVACHOLPRAVACHOL 28pravastatin sodiumpravastatinsodium 28prazosin hclprazosin hcl 30PRECEDEXPRECEDEX 81PRECISION GLUCOSECONTROLPRECISIONGLUCOSE CONTROL 95PRECISION GLUCOSECONTROLSOLUTION (TRI-LEVEL/HI/LO/NORMAL)PRECISION GLUCOSECONTROLSOLUTION (TRI-LEVEL/HI/LO/NORMAL) 95PRECISION GLUCOSEKETONECONTROL SOLUTION1-LOW, 1-HIGHPRECISIONGLUCOSE KETONECONTROLSOLUTION 1-LOW, 1-HIGH 95PRECISIONGLUCOSE/KETONECONTROLSOLUTIONS 1-HI 1-LOPRECISIONGLUCOSE/KETONECONTROLSOLUTIONS 1-HI 1-LO 95PRECISION LINKPRECISIONLINK 95PRECOSEPRECOSE 22PRED FORTEPREDFORTE 115prednicarbateprednicarbate 63

Index 50

prednisolone acetate(ophth)prednisolone acetate(ophth) 115prednisolone sodium phosphate10 mg, 30 mg, 15mgprednisolone sodiumphosphate 10 mg, 30 mg, 15mg 55prednisolone sodium phosphate15 mg/5mlprednisolone sodiumphosphate 15 mg/5ml 55PREDNISOLONE SODIUMPHOSPHATE 25MG/5MLPREDNISOLONESODIUM PHOSPHATE 25MG/5ML 55prednisolone sodium phosphate5 mg/5ml, 6.7mg/5mlprednisolone sodiumphosphate 5 mg/5ml, 6.7mg/5ml 55prednisoloneprednisolone 55prednisone 1 mg, 5 mg, 20 mg,2.5 mg, 10 mgprednisone 1 mg, 5mg, 20 mg, 2.5 mg, 10 mg 55PREDNISONE 10 MG, 5MGPREDNISONE 10 MG, 5MG 55PREDNISONE 5MG/5MLPREDNISONE 5MG/5ML 55PREDNISONE 50MGPREDNISONE 50 MG 55PREFERA OB + DHAPREFERAOB + DHA 107PREFERA OBPREFERAOB 107PREFESTPREFEST 74PREMARIN 0.3 MG, 1.25 MG,0.9 MG, 0.625 MG, 0.45MGPREMARIN 0.3 MG, 1.25MG, 0.9 MG, 0.625 MG, 0.45MG 75PREMARIN 0.625MG/GMPREMARIN 0.625MG/GM 129PREMPHASEPREMPHASE 74PREMPROPREMPRO 74PRENA1 CHEWPRENA1CHEW 107PRENA1 PEARLPRENA1PEARL 107PRENAISSANCE 90DHAPRENAISSANCE 90DHA 107PRENAISSANCEBALANCEPRENAISSANCEBALANCE 107

PRENAISSANCEDHAPRENAISSANCEDHA 107PRENAISSANCE HARMONYDHAPRENAISSANCEHARMONY DHA 107PRENAISSANCE NEXT-BPRENAISSANCE NEXT-B 107PRENAISSANCENEXTPRENAISSANCENEXT 107PRENAISSANCEPLUSPRENAISSANCEPLUS 107PRENAISSANCEPROMISEPRENAISSANCEPROMISE 107PRENAISSANCEPRENAISSANCE 107PRENAPLUSPRENAPLUS 107PRENATABS FAPRENATABSFA 108PRENATABS RXPRENATABSRX 108PRENATAL 19PRENATAL19 108PRENATAL PLUSIRONPRENATAL PLUSIRON 108PRENATAL PLUSPRENATALPLUS 108PRENATAL VITAMINS PLUSLOW IRONPRENATALVITAMINS PLUS LOWIRON 108PRENATAL+DHAPRENATAL+DHA 108PRENATAL-UPRENATAL-U

108PRENATALPRENATAL 108PRENATAPRENATA 107PRENATE AMPRENATEAM 108PRENATE DHAPRENATEDHA 108PRENATE ELITEPRENATEELITE 108PRENATEENHANCEPRENATEENHANCE 108PRENATEESSENTIALPRENATEESSENTIAL 108PRENATE MINIPRENATEMINI 108PRENATE PIXIEPRENATEPIXIE 108

PRENATE RESTOREPRENATERESTORE 108PRENATE STARPRENATESTAR 108PRENATEPRENATE 108PREPLUSPREPLUS 108PREPOPIKPREPOPIK 82PREQUE 10PREQUE 10 108PRETABPRETAB 108PREVACID 15 MGPREVACID 15MG 125PREVACID 24HRPREVACID24HR 125PREVACID 30 MGPREVACID 30MG 125PREVNAR 13PREVNAR13 127PREVPACPREVPAC 125PREZCOBIXPREZCOBIX 42PREZISTA 100MG/MLPREZISTA 100MG/ML 42PREZISTA 150 MG, 75 MG, 600MGPREZISTA 150 MG, 75 MG,600 MG 43PREZISTA 800 MGPREZISTA800 MG 43PRIALTPRIALT 5PRILOSECPRILOSEC 125PRIMAQUINEPHOSPHATEPRIMAQUINEPHOSPHATE 33PRIMAXIN IV ADD-VANTAGEPRIMAXIN IV ADD-VANTAGE 11PRIMAXIN IVPRIMAXIN IV 11primidoneprimidone 18PRINIVILPRINIVIL 29PRISTIQPRISTIQ 21PRIVIGENPRIVIGEN 117PRO COMFORT ALCOHOLPADSPRO COMFORTALCOHOL PADS 98PROAIR HFAPROAIR HFA 15probenecidprobenecid 78PROCAINAMIDEHCLPROCAINAMIDE HCL 13PROCARDIA XL 30 MG, 90MGPROCARDIA XL 30 MG, 90MG 49PROCARDIA XL 60MGPROCARDIA XL 60 MG 50PROCARDIAPROCARDIA 49PROCENTRAPROCENTRA 1

Index 51

prochlorperazineedisylateprochlorperazineedisylate 41prochlorperazinemaleateprochlorperazinemaleate 41prochlorperazineprochlorperazine

41PROCRIT 10000 UNIT/ML,40000 UNIT/ML, 4000 UNIT/ML,3000 UNIT/ML, 20000 UNIT/ML,2000 UNIT/MLPROCRIT 10000UNIT/ML, 40000 UNIT/ML, 4000UNIT/ML, 3000 UNIT/ML, 20000UNIT/ML, 2000 UNIT/ML 79PROCTOCORT 1%PROCTOCORT 1 % 10PROCTOFOAMHCPROCTOFOAM HC 10PROCYSBI 25 MGPROCYSBI 25MG 77PROCYSBI 75 MGPROCYSBI 75MG 77PRODIGY AUTOCODE BLOODGLUCOSE MONITORINGSYSTEMPRODIGY AUTOCODEBLOOD GLUCOSEMONITORING SYSTEM 95PRODIGY AUTOCODE BLOODGLUCOSEMONITORING/TALKINGPRODIGY AUTOCODE BLOODGLUCOSEMONITORING/TALKING 95PRODIGY CONTROLSOLUTIONHIGHPRODIGYCONTROL SOLUTIONHIGH96PRODIGY CONTROLSOLUTIONLOWPRODIGYCONTROL SOLUTIONLOW 96PRODIGY POCKET BLOODGLUCOSE METERKITPRODIGY POCKET BLOODGLUCOSE METER KIT 96PRODIGY VOICE BLOODGLUCOSE METERKITPRODIGY VOICE BLOODGLUCOSE METER KIT 96progesterone micronized 100mgprogesterone micronized 100mg 119progesterone micronized 200mgprogesterone micronized 200mg 119progesteroneprogesterone 119PROGRAF 0.5 MG, 5 MG, 1MGPROGRAF 0.5 MG, 5 MG, 1MG 46

PROGRAF 5MG/MLPROGRAF 5MG/ML 46PROLASTIN-CPROLASTIN-C

121PROLENSAPROLENSA 116PROLEUKINPROLEUKIN 37PROLIAPROLIA 71PROMACTAPROMACTA 79promethazine &phenylephrinepromethazine &phenylephrine 56promethazine hcl 12.5 mg, 50mg, 25 mgpromethazine hcl12.5 mg, 50 mg, 25 mg 27promethazine hcl 25 mg/ml, 50mg/mlpromethazine hcl 25mg/ml, 50 mg/ml 27promethazine hcl 6.25mg/5mlpromethazine hcl 6.25mg/5ml 27promethazinew/codeinepromethazinew/codeine 56promethazine-dmpromethazine-dm 56PROMETHAZINE/PHENYLEPHRINEPROMETHAZINE/PHENYLEPHRINE 56PROMETRIUM 100MGPROMETRIUM 100MG 119PROMETRIUM 200MGPROMETRIUM 200MG 119propafenone hclpropafenonehcl 14PROPANTHELINEBROMIDEPROPANTHELINEBROMIDE 124proparacaine hclproparacainehcl 115propofolpropofol 77propranolol hcl 1mg/mlpropranolol hcl 1mg/ml 48propranolol hcl 10 mg, 80 mg,60 mg, 40 mg, 20mgpropranolol hcl 10 mg, 80mg, 60 mg, 40 mg, 20 mg 48propranolol hcl 120 mg, 80 mg,60 mg, 160 mgpropranolol hcl120 mg, 80 mg, 60 mg, 160mg 48

PROPRANOLOL HCL 20MG/5ML, 40MG/5MLPROPRANOLOL HCL20 MG/5ML, 40 MG/5ML 48PROPRANOLOL/HYDROCHLOROTHIAZIDEPROPRANOLOL/HYDROCHLOROTHIAZIDE 32propylthiouracilpropylthiouracil

122PROQUADPROQUAD 128PROSCARPROSCAR 77PROSHIELD PROTECTIVEHANDCREAMPROSHIELDPROTECTIVEHANDCREAM 67PROSTATEPROSTATE 110PROSTIN VRPEDIATRICPROSTIN VRPEDIATRIC 47PROTAMINESULFATEPROTAMINESULFATE 79PROTONIX 20 MG, 40MGPROTONIX 20 MG, 40MG 125PROTONIX 40 MGPROTONIX40 MG 125PROTOPICPROTOPIC 65protriptyline hclprotriptylinehcl 21PROVENTIL HFAPROVENTILHFA 15PROVERAPROVERA 119PROVIDA OBPROVIDAOB 108PROVIGIL 100 MGPROVIGIL100 MG 2PROVIGIL 200 MGPROVIGIL200 MG 2PROZAC WEEKLYPROZACWEEKLY 20PROZACPROZAC 20PRUCLAIRPRUCLAIR 67PRUDOXINPRUDOXIN 60PRUMYXPRUMYX 67pseudoephed-bromphen-dmpseudoephed-bromphen-dm

56pseudoephed-cpm w/hydrocodpseudoephed-cpm w/hydrocod 56PSORCONPSORCON 63PULMICORTFLEXHALERPULMICORTFLEXHALER 15PULMICORTPULMICORT 15

Index 52

PULMOZYMEPULMOZYME 122PURINETHOLPURINETHOL

35PYLERAPYLERA 125pyrazinamidepyrazinamide 34PYRIDIUMPYRIDIUM 78pyridostigminebromidepyridostigminebromide 33pyridoxine hclpyridoxine hcl130QC ALCOHOL SWABSQCALCOHOL SWABS 98QC ALL PURPOSEDRESSINGS4"X4"QC ALLPURPOSEDRESSINGS4"X4" 86QC BORDER ISLAND GAUZEPAD 2"X2"QC BORDER ISLANDGAUZE PAD 2"X2" 87QC STERILE PADSQC STERILEPADS 87QNASLQNASL 112QUADRACELQUADRACEL 123QUALAQUINQUALAQUIN 33QUARTETTEQUARTETTE 54QUAZEPAMQUAZEPAM 81QUDEXY XRQUDEXY XR 18QUESTRAN 4GM/DOSEQUESTRAN 4GM/DOSE 28QUESTRAN 4 GMQUESTRAN 4GM 27QUESTRAN LIGHTQUESTRANLIGHT 27quetiapine fumarate 100 mg, 50mg, 400 mg, 300 mg, 25 mg, 200mgquetiapine fumarate 100 mg,50 mg, 400 mg, 300 mg, 25 mg,200 mg 40quetiapine fumarate 400mgquetiapine fumarate 400mg 40QUETIAPINE FUMARATEERQUETIAPINE FUMARATEER 40QUFLORAPEDIATRICQUFLORAPEDIATRIC 105QUICKTEK CONTROLSOLUTIONQUICKTEKCONTROL SOLUTION 96QUICKTEKQUICKTEK 96QUILLIVANT XRQUILLIVANTXR 2

quinapril hclquinapril hcl 29quinapril-hydrochlorothiazide10mg-12.5mg, 20mg-25mgquinapril-hydrochlorothiazide 10mg-12.5mg, 20mg-25mg 32quinapril-hydrochlorothiazide20mg-12.5mgquinapril-hydrochlorothiazide 20mg-12.5mg 32quinidine gluconatequinidinegluconate 13QUINIDINE SULFATE 200 MG,300 MGQUINIDINE SULFATE200 MG, 300 MG 13quinidine sulfate 300mgquinidine sulfate 300mg 13QUINIDINE SULFATEERQUINIDINE SULFATEER 13quinine sulfatequininesulfate 33QUINTET GLUCOSECONTROL/HIGH/NORMALQUINTET GLUCOSECONTROL/HIGH/NORMAL

96QVARQVAR 15R-NATAL OBR-NATALOB 108RA ALCOHOL SWABSRAALCOHOL SWABS 98RA ALL PURPOSEDRESSINGS4"X4"RA ALLPURPOSEDRESSINGS4"X4" 87RA DRESSING SPONGES4"X4"RA DRESSINGSPONGES 4"X4" 87RA EAR CARERA EARCARE 110RA GAUZE SPONGES4"X4"RA GAUZE SPONGES4"X4" 87RA STERILE PADS 2"X2"RASTERILE PADS 2"X2" 87RA STERILE PADS 3"X3"RASTERILE PADS 3"X3" 87RA STERILE PADS 4"X4"RASTERILE PADS 4"X4" 87RA TRUE2GO BLOODGLUCOSEMONITORINGSYSTEMRA TRUE2GOBLOODGLUCOSEMONITORINGSYSTEM 96

RA TRUERESULT BLOODGLUCOSE MONITORRATRUERESULT BLOODGLUCOSE MONITOR 96RABAVERTRABAVERT 128rabeprazole sodiumrabeprazolesodium 125RADIACARE POSTHEALINGRADIACARE POSTHEALING 68raloxifene hclraloxifene hcl 72ramiprilramipril 29RANEXA 1000 MGRANEXA1000 MG 12RANEXA 500 MGRANEXA 500MG 12ranitidine hcl 15 mg/ml, 75mg/5ml, 150 mg/10mlranitidinehcl 15 mg/ml, 75 mg/5ml, 150mg/10ml 124ranitidine hcl 150mg/6mlranitidine hcl 150mg/6ml 124ranitidine hcl 150 mgranitidine hcl150 mg 124ranitidine hcl 300 mgranitidine hcl300 mg 124ranitidine hcl 50 mg/2mlranitidinehcl 50 mg/2ml 124RAPAFLORAPAFLO 77RAPAMUNE 0.5 MGRAPAMUNE0.5 MG 46RAPAMUNE 1MG/MLRAPAMUNE 1MG/ML 46RAPAMUNE 1 MGRAPAMUNE 1MG 46RAPAMUNE 2 MGRAPAMUNE 2MG 46RAPLIXARAPLIXA 80rasagiline mesylaterasagilinemesylate 39RASUVORASUVO 2RAVICTIRAVICTI 73RAY-TEC X-RAYDETECTABLESPONGES 4" X 4"16 PLYRAY-TEC X-RAYDETECTABLESPONGES 4" X 4"16 PLY 87RAYALDEERAYALDEE 130RAZADYNE ERRAZADYNEER 120RAZADYNERAZADYNE 120READYSHARPBUPIVACAINEREADYSHARPBUPIVACAINE 82

Index 53

READYSHARPDEXAMETHASONEREADYSHARP DEXAMETHASONE 55READYSHARPKETOROLACREADYSHARPKETOROLAC 4READYSHARPMETHYLPREDNISOLONE80READYSHARPMETHYLPREDNISOLONE80 55READYSHARPTRIAMCINOLONEREADYSHARP TRIAMCINOLONE 55REALITY SWABSREALITYSWABS 98REBETOL 200 MGREBETOL200 MG 44REBETOL 40 MG/MLREBETOL40 MG/ML 44REBIF REBIDOSETITRATIONPACKREBIFREBIDOSETITRATIONPACK 121REBIF REBIDOSEREBIFREBIDOSE 121REBIF TITRATION PACKREBIFTITRATION PACK 121REBIFREBIF 121RECEDORECEDO 68RECLASTRECLAST 71RECOMBIVAX HBRECOMBIVAXHB 128REFUAH PLUS BLOODGLUCOSEMONITORINGSYSTEMREFUAH PLUS BLOODGLUCOSEMONITORINGSYSTEM 96REFUAH PLUS GLUCOSECONTROL SOLUTIONREFUAHPLUS GLUCOSE CONTROLSOLUTION 96REGLANREGLAN 76RELAGARDRELAGARD 129RELENZADISKHALERRELENZADISKHALER 45RELION ALCOHOLSWABSRELION ALCOHOLSWABS 98RELION CONFIRM BLOODGLUCOSE MONITORINGSYSTEMRELION CONFIRMBLOOD GLUCOSEMONITORING SYSTEM 96

RELION KETONE TESTSTRIPSRELION KETONETEST STRIPS 69RELION KETONERELIONKETONE 69RELION MICRO BLOODGLUCOSE MONITORINGSYSTEMRELION MICROBLOOD GLUCOSEMONITORING SYSTEM 96RELION ULTIMA BLOODGLUCOSE MONITORINGSYSTEMRELION ULTIMABLOOD GLUCOSEMONITORING SYSTEM 96RELNATE DHARELNATEDHA 108RELPAX 20 MGRELPAX 20MG 100RELPAX 40 MGRELPAX 40MG 100REMERONSOLTABREMERONSOLTAB 20REMERONREMERON 20REMICADEREMICADE 76REMODULINREMODULIN50RENVELARENVELA 76repaglinide 0.5 mg, 1mgrepaglinide 0.5 mg, 1mg 24repaglinide 2 mgrepaglinide 2mg 24REPAGLINIDE/METFORMINHYDROCHLORIDEREPAGLINIDE/METFORMINHYDROCHLORIDE 22REPATHA PUSHTRONEXSYSTEMREPATHAPUSHTRONEX SYSTEM 29REPATHASURECLICKREPATHASURECLICK 29REPATHAREPATHA 29REPREXAINREPREXAIN 8REQUIP 0.25 MG, 4 MG, 3MGREQUIP 0.25 MG, 4 MG, 3MG 39REQUIP 0.5 MG, 5 MG, 2 MG,1 MGREQUIP 0.5 MG, 5 MG, 2MG, 1 MG 39REQUIP XL 12 MG, 8MGREQUIP XL 12 MG, 8MG 39REQUIP XL 2 MG, 6 MG, 4MGREQUIP XL 2 MG, 6 MG, 4MG 39

RESCRIPTORRESCRIPTOR43

RESCULARESCULA 116RESERPINERESERPINE 30RESPIRATONICRESPIRATONIC

47RESTASISMULTIDOSERESTASISMULTIDOSE 115RESTASISRESTASIS 115RESTORE CONTACTLAYER/NON-ADHERENT2"X2"RESTORE CONTACTLAYER/NON-ADHERENT2"X2" 87RESTORE FOAM DRESSINGBORDERED 4"X4"RESTOREFOAM DRESSING BORDERED4"X4" 87RESTORE FOAM DRESSINGNON-BORDERED4"X4"RESTORE FOAMDRESSING NON-BORDERED4"X4" 87RESTORE ODOR ABSORBINGDRESSING 4"X4"RESTOREODOR ABSORBING DRESSING4"X4" 87RESTORE TRIO ABSORBENTDRESSING 3"X3"RESTORETRIO ABSORBENT DRESSING3"X3" 87RESTORILRESTORIL 81RETIN-A MICRO PUMP 0.04 %,0.1 %RETIN-A MICRO PUMP0.04 %, 0.1 % 58RETIN-A MICRO PUMP 0.08%RETIN-A MICRO PUMP 0.08% 58RETIN-A MICRORETIN-AMICRO 58RETIN-ARETIN-A 58RETROVIR 100 MGRETROVIR100 MG 43RETROVIR 50MG/5MLRETROVIR 50MG/5ML 43RETROVIR IVINFUSIONRETROVIR IVINFUSION 43REVATIO 10MG/12.5MLREVATIO 10MG/12.5ML 51REVATIO 10 MG/MLREVATIO10 MG/ML 51REVATIO 20 MGREVATIO 20MG 51

Index 54

REVEAL BLOOD GLUCOSEMONITORREVEAL BLOODGLUCOSE MONITOR 96REVIAREVIA 25REVLIMIDREVLIMID 45REXALL BLOOD GLUCOSEMONITORING SYSTEMREXALLBLOOD GLUCOSEMONITORING SYSTEM 96REYATAZ 150 MG, 200MGREYATAZ 150 MG, 200MG 43REYATAZ 300 MGREYATAZ 300MG 43REYATAZ 50 MGREYATAZ 50MG 43RHEUMATREXRHEUMATREX2RHINOCORTAQUARHINOCORT AQUA 112RHOGAM ULTRA-FILTEREDPLUSRHOGAM ULTRA-FILTERED PLUS 117RHOPHYLACRHOPHYLAC 117RIBASPHERE RIBAPAK 400MG, 600 MGRIBASPHERERIBAPAK 400 MG, 600 MG 44RIBASPHERERIBAPAKRIBASPHERERIBAPAK 44RIBASPHERERIBASPHERE

44RIBATAB 400 MG, 600MGRIBATAB 400 MG, 600MG 44RIBATABRIBATAB 44ribavirin (hepatitis c)ribavirin(hepatitis c) 44rifabutinrifabutin 34RIFADINRIFADIN 34rifampinrifampin 34RIGHTEST GC300 HIGHCONTROLRIGHTEST GC300HIGH CONTROL 96RIGHTEST GC300 NORMALCONTROLRIGHTEST GC300NORMAL CONTROL 96RIGHTEST GM100 BLOODGLUCOSE MONITORINGSYSTEMRIGHTEST GM100BLOOD GLUCOSEMONITORING SYSTEM 96

RIGHTEST GM300 BLOODGLUCOSE MONITORINGSYSTEMRIGHTEST GM300BLOOD GLUCOSEMONITORING SYSTEM 96RIGHTEST GM550 BLOODGLUCOSE MONITORINGSYSTEMRIGHTEST GM550BLOOD GLUCOSEMONITORING SYSTEM 96RILUTEKRILUTEK 112riluzoleriluzole 112rimantadinehydrochloriderimantadinehydrochloride 45ringer's irrigationringer'sirrigation 46ringer'sringer's 101risedronate sodium 150 mg, 35mgrisedronate sodium 150 mg,35 mg 71risedronate sodium 30 mg, 5mgrisedronate sodium 30 mg, 5mg 71risedronate sodium 35mgrisedronate sodium 35mg 71RISPERDALCONSTARISPERDALCONSTA 40RISPERDAL M-TABRISPERDAL M-TAB 40RISPERDALRISPERDAL 40risperidonerisperidone 40RITALIN LARITALIN LA 2RITALINRITALIN 2RITUXANRITUXAN 35rivastigmine 13.3mg/24hrrivastigmine 13.3mg/24hr 120rivastigmine 4.6 mg/24hr, 9.5mg/24hrrivastigmine 4.6mg/24hr, 9.5 mg/24hr 120rivastigmine tartraterivastigminetartrate 120rizatriptan benzoate 10mgrizatriptan benzoate 10mg 100rizatriptan benzoate 5mgrizatriptan benzoate 5mg 100ROBAXIN-750ROBAXIN-750

111ROBAXINROBAXIN 111ROBINUL FORTEROBINULFORTE 124

ROBINULROBINUL 124ROCALTROLROCALTROL 73ROCEPHINROCEPHIN 52rocuronium bromiderocuroniumbromide 113ropinirole hydrochloride 0.25 mg,4 mg, 3 mgropinirolehydrochloride 0.25 mg, 4 mg, 3mg 39ropinirole hydrochloride 0.5 mg, 5mg, 2 mg, 1 mgropinirolehydrochloride 0.5 mg, 5 mg, 2mg, 1 mg 39ropinirole hydrochloride 12 mg, 8mgropinirole hydrochloride 12mg, 8 mg 39ropinirole hydrochloride 2 mg, 6mg, 4 mgropinirole hydrochloride2 mg, 6 mg, 4 mg 39ropivacaine hclropivacainehcl 82ROPIVACAINEHYDROCHLORIDE/SODIUMCHLORIDEROPIVACAINEHYDROCHLORIDE/SODIUMCHLORIDE 82ROSULAROSULA 58rosuvastatin calciumrosuvastatincalcium 28ROTARIXROTARIX 128ROTATEQROTATEQ 128ROWASAROWASA 76ROXICETROXICET 8ROXICODONEROXICODONE7RUCONESTRUCONEST 78RULAVITE DHARULAVITEDHA 108RYTHMOL SRRYTHMOLSR 14RYTHMOLRYTHMOL 14SABRILSABRIL 19SAFYRALSAFYRAL 54SAIZEN CLICK.EASYSAIZENCLICK.EASY 72SAIZENSAIZEN 72SALAGEN 5 MGSALAGEN 5MG 103SALAGEN 7.5 MGSALAGEN 7.5MG 103SALEX CREAMSALEXCREAM 65SALEX LOTIONSALEXLOTION 65SALEXSALEX 65

Index 55

salicylic acid w/ cleansersalicylicacid w/ cleanser 65salicylic acidsalicylic acid 65saline, bacteriostaticsaline,bacteriostatic 119salsalatesalsalate 5SALVAXSALVAX 65SAMSCASAMSCA 74SANCUSOSANCUSO 25SANDIMMUNE 100 MG, 25MGSANDIMMUNE 100 MG, 25MG 46SANDIMMUNE 100MG/MLSANDIMMUNE 100MG/ML 46SANDIMMUNE 50MG/MLSANDIMMUNE 50MG/ML 46SANDOSTATIN LARDEPOTSANDOSTATIN LARDEPOT 73SANDOSTATINSANDOSTATIN

73SAPHRISSAPHRIS 41SAPS CARE ALCOHOL PREPPADSSAPS CARE ALCOHOLPREP PADS 98SARAFEMSARAFEM 121SAVELLA TITRATIONPACKSAVELLA TITRATIONPACK 120SAVELLASAVELLA 120SB ALCOHOL PREP PADSSBALCOHOL PREP PADS 98scar treatment productsscartreatment products 68SE-NATAL 19SE-NATAL19 108SEASONIQUESEASONIQUE

54SECTRALSECTRAL 48SELECT-OB+DHASELECT-OB+DHA 108SELECT-OBSELECT-OB 108selegiline hclselegiline hcl 39selenium sulfide-pyrithione zinc inurea vehicleselenium sulfide-pyrithione zinc in ureavehicle 61selenium sulfideseleniumsulfide 61SELENIUMSELENIUM 102SELZENTRYSELZENTRY 43

SENSI-CAREMOISTURIZINGSENSI-CAREMOISTURIZING 67SENSIPARSENSIPAR 73SEREVENTDISKUSSEREVENTDISKUS 15SEROQUEL XR 150 MG, 50MG, 300 MG, 200MGSEROQUEL XR 150 MG,50 MG, 300 MG, 200 MG 41SEROQUEL XR 400MGSEROQUEL XR 400MG 41SEROQUELSEROQUEL 41SEROSTIMSEROSTIM 72sertraline hcl 100 mg, 50 mg,25 mgsertraline hcl 100 mg, 50mg, 25 mg 20sertraline hcl 20 mg/mlsertralinehcl 20 mg/ml 20sevofluranesevoflurane 77SHOHLS SOLUTIONMODIFIEDSHOHLSSOLUTION MODIFIED 77SHOPKO ALCOHOLSWABSSHOPKO ALCOHOLSWABS 98SHUR-SEALSHUR-SEAL129SIGNIFOR 0.3MG/MLSIGNIFOR 0.3MG/ML 74SIGNIFOR 0.6 MG/ML, 0.9MG/MLSIGNIFOR 0.6 MG/ML,0.9 MG/ML 74SIGNIFOR LARSIGNIFORLAR 73sildenafil citrate (pulmonaryhypertension)sildenafil citrate(pulmonary hypertension) 51SILENORSILENOR 81SILVADENESILVADENE 61silver sulfadiazinesilversulfadiazine 61SIMBRINZASIMBRINZA 114SIMCORSIMCOR 28SIMPONI ARIASIMPONIARIA 2SIMPONISIMPONI 2simvastatinsimvastatin 28SINEMET CRSINEMETCR 39SINEMETSINEMET 39

SINGERS SAVING GRACESOOTHING THROAT SPRAYEXTRA STRENGTHSINGERSSAVING GRACE SOOTHINGTHROAT SPRAY EXTRASTRENGTH 47SINGERS SAVING GRACESOOTHING THROAT SPRAYPROFESSIONALSINGERSSAVING GRACE SOOTHINGTHROAT SPRAYPROFESSIONAL 47SINGERS SAVING GRACESOOTHING THROATSPRAYSINGERS SAVINGGRACE SOOTHING THROATSPRAY 47SINGULAIR 10 MGSINGULAIR10 MG 14SINGULAIR 4 MG, 5MGSINGULAIR 4 MG, 5 MG 14SINGULAIR 4 MGSINGULAIR 4MG 14sirolimus 0.5 mgsirolimus 0.5mg 46sirolimus 1 mgsirolimus 1 mg46sirolimus 2 mgsirolimus 2 mg46SIVEXTROSIVEXTRO 12SKELAXINSKELAXIN 111skin protectants, misc.skinprotectants, misc. 67SKYLASKYLA 54SM ALCOHOL PREP PADSSMALCOHOL PREP PADS 98SM B-COMPLEX/VITAMIN CSMB-COMPLEX/VITAMIN C 104SM GAUZE PADS 2"X2"SMGAUZE PADS 2"X2" 87SM GAUZE PADS 3"X3"SMGAUZE PADS 3"X3" 87SM GAUZE PADS 4"X4"SMGAUZE PADS 4"X4" 87SM STERILE PADS 2"X2"SMSTERILE PADS 2"X2" 87SM STERILE PADSSM STERILEPADS 87SMART DIABETES XPRESBLOOD GLUCOSEMONITORING SYSTEMSMARTDIABETES XPRES BLOODGLUCOSE MONITORINGSYSTEM 96

Index 56

SMART SENSE PREMIUMBLOODGLUCOSEMONITORING SYSTEMSMARTSENSE PREMIUMBLOODGLUCOSEMONITORING SYSTEM 96SMART SENSE VALUEBLOODGLUCOSEMONITORING SYSTEMSMARTSENSE VALUEBLOODGLUCOSEMONITORING SYSTEM 96SMARTEST CONTROLSOLUTIONMEDIUMSMARTESTCONTROLSOLUTIONMEDIUM 96SMARTEST EJECT STARTERKITSMARTEST EJECTSTARTER KIT 96SMARTEST PERSONASTARTERKITSMARTESTPERSONA STARTERKIT 96SMARTEST PRONTOSTARTERKITSMARTESTPRONTO STARTERKIT 96SMARTEST PROTEGESTARTERKITSMARTESTPROTEGE STARTERKIT 96sod benzoate & sodphenylacetatesod benzoate &sod phenylacetate 73sodium acetatesodiumacetate 100sodium ascorbatesodiumascorbate 130sodium bicarbonatesodiumbicarbonate 100sodium chloride (guirrigant)sodium chloride (guirrigant) 77sodium chloride (inhalant)sodiumchloride (inhalant) 56sodium chloride flushsodiumchloride flush 102sodium chloridesodiumchloride 102sodium citrate & citric acidsodiumcitrate & citric acid 77SODIUM DIURILSODIUMDIURIL 70SODIUM EDECRINSODIUMEDECRIN 70sodium ferric gluconate complexin sucrosesodium ferric gluconatecomplex in sucrose 80sodium fluoride 0.125 mg/drop,0.5 mg/mlsodium fluoride 0.125mg/drop, 0.5 mg/ml 101

sodium fluoride 0.25 mg, 2.2mg, 1.1 mg, 1 mg, 0.5mgsodium fluoride 0.25 mg, 2.2mg, 1.1 mg, 1 mg, 0.5 mg101SODIUM FLUORIDE 0.5 MG, 1MGSODIUM FLUORIDE 0.5MG, 1 MG 101sodium phenylbutyratesodiumphenylbutyrate 73sodium phosphatesodiumphosphate 101sodium polystyrene sulfonate15 gm/60mlsodium polystyrenesulfonate 15 gm/60ml 47sodium polystyrene sulfonate30 gm/120ml, 50gm/200mlsodium polystyrenesulfonate 30 gm/120ml, 50gm/200ml 47sodium polystyrenesulfonatesodium polystyrenesulfonate 47SODIUMSULFACETAMIDE/SULFURCLEANSER IN UREASODIUMSULFACETAMIDE/SULFURCLEANSER IN UREA 58SODIUMSULFACETAMIDE/SULFUR INUREASODIUMSULFACETAMIDE/SULFUR INUREA 58SODIUMSULFACETAMIDE/SULFURSODIUMSULFACETAMIDE/SULFUR

58SODIUM THIOSULFATE 10 %,25 %SODIUM THIOSULFATE10 %, 25 % 25sodium thiosulfate 25 %sodiumthiosulfate 25 % 25SOF-WICK 4"X4"SOF-WICK4"X4" 87SOLAICESOLAICE 66SOLARAZESOLARAZE 60SOLARTEK GLUCOSECONTROLSOLUTIONSSOLARTEK GLUCOSECONTROLSOLUTIONS 96SOLIRISSOLIRIS 78SOLODYNSOLODYN 122SOLTAMOXSOLTAMOX 36SOLU-MEDROLSOLU-MEDROL 55

SOLUS V2 AUDIBLE BLOODGLUCOSE MANAGEMENTSYSTEMSOLUS V2 AUDIBLEBLOOD GLUCOSEMANAGEMENT SYSTEM 96SOLUS V2 CONTROLHIGHSOLUS V2 CONTROLHIGH 96SOLUS V2 CONTROLLOWSOLUS V2 CONTROLLOW 96SOMA 250 MGSOMA 250MG 111SOMA 350 MGSOMA 350MG 111SOMATULINEDEPOTSOMATULINEDEPOT 74SOMAVERTSOMAVERT 71SONATA 10 MGSONATA 10MG 81SONATA 5 MGSONATA 5MG 81SOOLANTRASOOLANTRA 67SORBIDONHYDRATESORBIDONHYDRATE 67SORIATANE 10 MG, 17.5MGSORIATANE 10 MG, 17.5MG 60SORIATANE 25 MGSORIATANE25 MG 60SORILUXSORILUX 60sotalol hcl (afib/afl)sotalol hcl(afib/afl) 49sotalol hcl 120 mg, 80 mg, 160mgsotalol hcl 120 mg, 80 mg, 160mg 49sotalol hcl 240 mgsotalol hcl 240mg 49SOVALDISOVALDI 44SP SCAR MANAGEMENTSPSCAR MANAGEMENT 68SPATONE IRONPLUSSPATONE IRONPLUS 47specialty vitaminsproductsspecialty vitaminsproducts 110SPECTRACEFSPECTRACEF

52SPINOSADSPINOSAD 67SPIRIVA HANDIHALERSPIRIVAHANDIHALER 14SPIRIVA RESPIMATSPIRIVARESPIMAT 14

Index 57

spironolactone &hydrochlorothiazidespironolactone & hydrochlorothiazide 69spironolactonespironolactone

70SPLEENSPLEEN 110SPORANOXPULSEPAKSPORANOXPULSEPAK 26SPORANOXSPORANOX 26SPRIXSPRIX 4SPRYCELSPRYCEL 37SSS 10-5SSS 10-5 58STALEVO 100STALEVO100 39STALEVO 125STALEVO125 39STALEVO 150STALEVO150 39STALEVO 200STALEVO200 39STALEVO 50STALEVO 50 39STALEVO 75STALEVO 75 39STARLIXSTARLIX 24stavudine 1 mg/mlstavudine 1mg/ml 43stavudine 15 mg, 40 mg, 30 mg,20 mgstavudine 15 mg, 40 mg,30 mg, 20 mg 43STELARASTELARA 60STERILE GAUZE PADS2"X2"STERILE GAUZE PADS2"X2" 87STERILE GAUZE PADS3"X3"STERILE GAUZE PADS3"X3" 87STERILE PADS 2"X2"STERILEPADS 2"X2" 87STERILE PADS 3"X3"STERILEPADS 3"X3" 87STERILE PADS 4"X4"STERILEPADS 4"X4" 87STIMATESTIMATE 73STIVARGASTIVARGA 37STOMACHSTOMACH 110STRATTERASTRATTERA 1STREPTOMYCINSULFATESTREPTOMYCINSULFATE 2STRESS RELEAFSTRESSRELEAF 47STRIBILDSTRIBILD 43STRIVERDIRESPIMATSTRIVERDIRESPIMAT 15

STROMECTOLSTROMECTOL10

STROVITE FORTE55MCG/15ML-5MG/15ML-3MG/15ML-50MCG/15ML-15MG/15ML-50MG/15ML-10MG/15ML-17MG/15ML-100MG/15ML-25MG/15ML-4000UNIT/15ML-20MCG/15ML-400UNIT/15ML-15MG/15ML-1MG/15ML-30UNIT/15ML-150MCG/15ML-20MG/15ML-300MG/15MLSTROVITEFORTE 55MCG/15ML-5MG/15ML-3MG/15ML-50MCG/15ML-15MG/15ML-50MG/15ML-10MG/15ML-17MG/15ML-100MG/15ML-25MG/15ML-4000UNIT/15ML-20MCG/15ML-400UNIT/15ML-15MG/15ML-1MG/15ML-30UNIT/15ML-150MCG/15ML-20MG/15ML-300MG/15ML

104SUBLIMAZESUBLIMAZE 7SUBOXONE 12MG-3MG,4MG-1MGSUBOXONE 12MG-3MG, 4MG-1MG 9SUBOXONE 2MG-0.5MG,8MG-2MGSUBOXONE 2MG-0.5MG, 8MG-2MG 9SUBSYS 100 MCGSUBSYS100 MCG 7SUBSYS 1200 MCG, 800MCG, 600 MCG, 400 MCG,200 MCG, 1600 MCGSUBSYS1200 MCG, 800 MCG, 600MCG, 400 MCG, 200 MCG,1600 MCG 7SUCLEARSUCLEAR 82SUCRAIDSUCRAID 69sucralfatesucralfate 125sufentanil citrate 100 mcg/2ml,50 mcg/ml, 250mcg/5mlsufentanil citrate 100mcg/2ml, 50 mcg/ml, 250mcg/5ml 7SUFENTANIL CITRATE 50MCG/MLSUFENTANILCITRATE 50 MCG/ML 7SULARSULAR 50sulfacetamide sod-prednisolonesulfacetamide sod-prednisolone 115

sulfacetamide sodium(acne)sulfacetamide sodium(acne) 58sulfacetamide sodium(ophth)sulfacetamide sodium(ophth) 114sulfacetamide sodium w/sulfursulfacetamide sodium w/sulfur 58sulfacetamide sodium-sulfur inurea vehiclesulfacetamidesodium-sulfur in urea vehicle 58sulfacetamide sodium-sulfur w/skin cleansersulfacetamidesodium-sulfur w/ skincleanser 58sulfacetamide sodium-sulfur-sunscreensulfacetamide sodium-sulfur-sunscreen 58sulfacetamidesodiumsulfacetamidesodium 61sulfamethoxazole-trimethoprim160mg-800mg, 80mg-400mgsulfamethoxazole-trimethoprim 160mg-800mg,80mg-400mg 11sulfamethoxazole-trimethoprim40mg/5ml-200mg/5mlsulfamethoxazole-trimethoprim 40mg/5ml-200mg/5ml 11SULFAMETHOXAZOLE/TRIMETHOPRIMSULFAMETHOXAZOLE/TRIMETHOPRIM 11SULFAMYLONSULFAMYLON

61sulfasalazinesulfasalazine 76sulindacsulindac 4SUMADAN KITSUMADANKIT 58SUMADAN WASHSUMADANWASH 58SUMADAN XLTSUMADANXLT 58sumatriptan succinate 100 mg, 50mg, 25 mgsumatriptan succinate100 mg, 50 mg, 25 mg 100sumatriptan succinate 4mg/0.5ml, 6 mg/0.5mlsumatriptansuccinate 4 mg/0.5ml, 6mg/0.5ml 100sumatriptan succinate 6mg/0.5mlsumatriptan succinate 6mg/0.5ml 100SUMATRIPTAN SUCCINATE 6MG/0.5MLSUMATRIPTANSUCCINATE 6 MG/0.5ML 100

Index 58

sumatriptansumatriptan 100SUMAXIN TSSUMAXIN TS 58SUMAXIN WASHSUMAXINWASH 58SUMAXINSUMAXIN 58SUPARTZ FXSUPARTZFX 111SUPARTZSUPARTZ 112SUPERVITE ECSUPERVITEEC 104SUPPRELIN LASUPPRELINLA 72SUPRAX 100 MG, 200MGSUPRAX 100 MG, 200MG 52SUPRAX 100 MG/5ML, 200MG/5MLSUPRAX 100 MG/5ML,200 MG/5ML 52SUPRAX 400 MGSUPRAX 400MG 52SUPRAX 500 MG/5MLSUPRAX500 MG/5ML 52SUPREME II HIGH/LOWCONTROLSOLUTIONSUPREME IIHIGH/LOW CONTROLSOLUTION 96SUPREP BOWELPREPSUPREP BOWELPREP 82SURE COMFORT ALCOHOLPREP PADSSURE COMFORTALCOHOL PREP PADS 98SURE-PREP ALCOHOL PREPPADSSURE-PREP ALCOHOLPREP PADS 99SURECHEK BLOOD GLUCOSEMONITORING SYSTEMSTARTER KITSURECHEKBLOOD GLUCOSEMONITORING SYSTEMSTARTER KIT 97SURESTEP GLUCOSECONTROLSOLUTIONSURESTEP GLUCOSECONTROLSOLUTION 97SURESTEP GLUCOSECONTROLSURESTEPGLUCOSE CONTROL 97SURESTEP PRO HIGHGLUCOSECONTROLSURESTEP PRO HIGHGLUCOSECONTROL 97SURESTEP PRO LOWGLUCOSECONTROLSURESTEP PRO LOWGLUCOSECONTROL 97

SURESTEP PRO NORMALGLUCOSECONTROLSURESTEP PRONORMAL GLUCOSECONTROL 97SURMONTILSURMONTIL 21SUSTIVA 200 MGSUSTIVA200 MG 43SUSTIVA 50 MGSUSTIVA 50MG 43SUSTIVA 600 MGSUSTIVA600 MG 43SUTENTSUTENT 37SWAMP ROOTSWAMPROOT 47SYLATRONSYLATRON 37SYMBICORTSYMBICORT 15SYMBYAXSYMBYAX 120SYMLINPEN 120SYMLINPEN120 22SYMLINPEN 60SYMLINPEN60 22SYNAGEXSYNAGEX 104SYNAGISSYNAGIS 118SYNALAR 0.01 %SYNALAR0.01 % 64SYNALAR 0.025 %SYNALAR0.025 % 64SYNALGOS-DCSYNALGOS-DC 9SYNARELSYNAREL 72SYNATEKSYNATEK 104SYNRIBOSYNRIBO 37SYNTHROIDSYNTHROID 123SYNVISC ONESYNVISCONE 112SYNVISCSYNVISC 112SYPRINESYPRINE 45TAB-A-VITE WOMENSTAB-A-VITE WOMENS 110TABLOIDTABLOID 35TACLONEXTACLONEX 64tacrolimus (topical)tacrolimus(topical) 65tacrolimustacrolimus 46TAFINLARTAFINLAR 37TAGAMET HBTAGAMETHB 124TAI DOC CONTROLTAI DOCCONTROL 97TAMIFLU 30 MGTAMIFLU 30MG 45

TAMIFLU 45 MG, 75MGTAMIFLU 45 MG, 75 MG 45TAMIFLU 6 MG/MLTAMIFLU 6MG/ML 45tamoxifen citratetamoxifencitrate 36tamsulosin hcltamsulosin hcl 77TANDEM PLUSTANDEMPLUS 80TAPAZOLETAPAZOLE 122TARCEVATARCEVA 37TARGRETIN 1 %TARGRETIN 1% 60TARGRETIN 75 MGTARGRETIN75 MG 37TARKATARKA 32TARON-BCTARON-BC 108TARON-C DHATARON-CDHA 108TARON-PREXTARON-PREX

108TASIGNATASIGNA 37TASMARTASMAR 38TAXOLTAXOL 38TAXOTERETAXOTERE 38TAYTULLATAYTULLA 54TAZORACTAZORAC 61TECFIDERA STARTERPACKTECFIDERA STARTERPACK 121TECFIDERATECFIDERA 121TECHNIVIETECHNIVIE 44TEGADERM FOAM DRESSING2"X2"TEGADERM FOAMDRESSING 2"X2" 87TEGADERM FOAM DRESSING4"X4"TEGADERM FOAMDRESSING 4"X4" 87TEGRETOL-XR 100MGTEGRETOL-XR 100 MG 18TEGRETOL-XR 200MGTEGRETOL-XR 200 MG 18TEGRETOL-XR 400MGTEGRETOL-XR 400 MG 18TEGRETOLTEGRETOL 18TEKAMLOTEKAMLO 32TEKTURNA 150 MGTEKTURNA150 MG 33TEKTURNA 300 MGTEKTURNA300 MG 33TEKTURNA HCT 150MG-12.5MG, 150MG-25MGTEKTURNA HCT 150MG-12.5MG, 150MG-25MG 32

Index 59

TEKTURNA HCT 300MG-12.5MG, 300MG-25MGTEKTURNA HCT 300MG-12.5MG, 300MG-25MG 32TELCARE BLOOD GLUCOSEMONITORINGSYSTEMTELCARE BLOODGLUCOSE MONITORINGSYSTEM 97TELCARE GLUCOSE CONTROLSOLUTION LEVEL 1/2TELCAREGLUCOSE CONTROLSOLUTION LEVEL 1/2 97telmisartan-amlodipinetelmisartan-amlodipine

32telmisartan-hydrochlorothiazide40mg-12.5mg, 80mg-25mgtelmisartan-hydrochlorothiazide 40mg-12.5mg, 80mg-25mg 32telmisartan-hydrochlorothiazide80mg-12.5mgtelmisartan-hydrochlorothiazide 80mg-12.5mg 32telmisartantelmisartan 30temazepamtemazepam 81TEMODAR 100 MG, 5 MG, 250MG, 20 MG, 180 MG, 140MGTEMODAR 100 MG, 5 MG,250 MG, 20 MG, 180 MG, 140MG 34TEMODAR 100 MGTEMODAR100 MG 34TEMOVATE ETEMOVATE E64TEMOVATETEMOVATE 64temozolomidetemozolomide 34TENCONTENCON 5TENEXTENEX 30TENIVACTENIVAC 123TENORETIC 100TENORETIC100 32TENORETIC 50TENORETIC50 32TENORMINTENORMIN 48TERAZOL 3TERAZOL 3 129TERAZOL 7TERAZOL 7 129terazosin hclterazosin hcl 30terbinafine hclterbinafine hcl 26terbutaline sulfateterbutalinesulfate 15terconazole vaginal 0.4%terconazole vaginal 0.4% 129

terconazole vaginal 0.8%terconazole vaginal 0.8% 129terconazole vaginal 80mgterconazole vaginal 80mg 129TEROCINTEROCIN 66TESSALONPERLESTESSALONPERLES 56TESTIMTESTIM 9TESTOSTERONE 1 %, 50MG/5GMTESTOSTERONE 1%, 50 MG/5GM 10testosterone 1 %testosterone 1% 9TESTOSTERONE 10MG/ACTTESTOSTERONE 10MG/ACT 10testosterone 25mg/2.5gmtestosterone 25mg/2.5gm 10TESTOSTERONE 25MG/2.5GMTESTOSTERONE25 MG/2.5GM 10testosterone 50mg/5gmtestosterone 50mg/5gm 10testosteronecypionatetestosteronecypionate 9testosteroneenanthatetestosteroneenanthate 9TESTOSTERONEPUMPTESTOSTERONEPUMP 10TESTREDTESTRED 10TETANUS/DIPHTHERIATOXOIDS-ADSORBEDADULTTETANUS/DIPHTHERIA TOXOIDS-ADSORBEDADULT 123TETANUS/DIPHTHERIATOXOIDS-ADSORBEDTETANUS/DIPHTHERIA TOXOIDS-ADSORBED 123tetrabenazinetetrabenazine

120tetracaine hcl (ophth)tetracainehcl (ophth) 115TETRACAINEHCLTETRACAINE HCL 82tetracycline hcl 250 mg, 500mg, 250 mgtetracycline hcl 250mg, 500 mg, 250 mg 122

TETRACYCLINE HCL 500MGTETRACYCLINE HCL 500MG 122TETRIXTETRIX 67TEV-TROPINTEV-TROPIN 72TEVETEN HCTTEVETENHCT 32TEXACORTTEXACORT 64TGQ 50PSE/3BRM/30DMTGQ50PSE/3BRM/30DM 56TGT ALCOHOL SWABSTGTALCOHOL SWABS 99TGT BLOOD GLUCOSE METERMONITORING SYSTEMTGTBLOOD GLUCOSE METERMONITORING SYSTEM 97TGT BLOOD GLUCOSEMONITORING SYSTEMPREMIUMTGT BLOODGLUCOSE MONITORINGSYSTEM PREMIUM 97TGT BLOOD GLUCOSEMONITORING SYSTEMTGTBLOOD GLUCOSEMONITORING SYSTEM 97TH MINERAL OILTH MINERALOIL 82THALOMIDTHALOMID 45THEO-24THEO-24 16theophyllinetheophylline 16THERABETIC EYEHEALTHTHERABETIC EYEHEALTH 110THERAGAUZETHERAGAUZE

87THERANATAL CORENUTRITIONTHERANATALCORE NUTRITION 108thiamine hclthiamine hcl 130thioridazine hclthioridazinehcl 41thiothixenethiothixene 41THRIVITE 19THRIVITE 19 108THRIVITE RXTHRIVITERX 108THYMUSTHYMUS 110thyroidthyroid 123tiagabine hcltiagabine hcl 19TIAZACTIAZAC 50ticlopidine hclticlopidine hcl 78TIGANTIGAN 25TIKOSYNTIKOSYN 14timolol maleate (ophth)timololmaleate (ophth) 113

Index 60

TIMOLOL MALEATETIMOLOLMALEATE 49TIMOPTIC OCUDOSETIMOPTICOCUDOSE 113TIMOPTIC-XETIMOPTIC-XE

113TIMOPTICTIMOPTIC 113TINDAMAXTINDAMAX 10tinidazoletinidazole 10TIVICAYTIVICAY 43tizanidine hcl 2 mg, 4mgtizanidine hcl 2 mg, 4mg 111tizanidine hcl 2 mgtizanidine hcl 2mg 111tizanidine hcl 4 mgtizanidine hcl 4mg 111tizanidine hcl 6 mgtizanidine hcl 6mg 111TL-CARE DHATL-CAREDHA 108TL-SELECTTL-SELECT 108TOBI PODHALERTOBIPODHALER 2TOBITOBI 2TOBRADEX STTOBRADEXST 115TOBRADEXTOBRADEX 115tobramycin (ophth)tobramycin(ophth) 114tobramycin sulfate 1.2 gm/30ml,80 mg/2ml, 40 mg/ml, 10mg/mltobramycin sulfate 1.2gm/30ml, 80 mg/2ml, 40 mg/ml,10 mg/ml 2tobramycin sulfate 1.2gmtobramycin sulfate 1.2 gm 2TOBRAMYCIN SULFATE 10MG/ML, 40MG/MLTOBRAMYCIN SULFATE10 MG/ML, 40 MG/ML 2tobramycin-dexamethasonetobramycin-dexamethasone 115tobramycintobramycin 2TOBRAMYCINTOBRAMYCIN2TOBREXTOBREX 114TODAY SPONGETODAYSPONGE 129TOFRANIL-PMTOFRANIL-PM

21TOFRANILTOFRANIL 21TOLAZAMIDE 250 MG, 500MGTOLAZAMIDE 250 MG, 500MG 24

tolazamide 250 mgtolazamide250 mg 24TOLBUTAMIDETOLBUTAMIDE 24tolcaponetolcapone 38TOLMETIN SODIUM 200 MG,600 MGTOLMETIN SODIUM200 MG, 600 MG 4TOLMETIN SODIUM 400MGTOLMETIN SODIUM 400MG 4tolmetin sodium 400 mgtolmetinsodium 400 mg 4tolterodine tartrate 1 mg, 2mgtolterodine tartrate 1 mg, 2mg 126tolterodine tartrate 2 mg, 4mgtolterodine tartrate 2 mg, 4mg 126TOPAMAX 100 MGTOPAMAX100 MG 18TOPAMAX 200 MGTOPAMAX200 MG 18TOPAMAX 25 MG, 50MGTOPAMAX 25 MG, 50MG 18TOPAMAX SPRINKLE 15MGTOPAMAX SPRINKLE 15MG 18TOPAMAX SPRINKLE 25MGTOPAMAX SPRINKLE 25MG 18TOPICORT 0.05 %TOPICORT0.05 % 64TOPICORT 0.25 %TOPICORT0.25 % 64topiramate 100 mgtopiramate100 mg 18topiramate 15 mgtopiramate 15mg 18topiramate 200 mgtopiramate200 mg 18topiramate 25 mg, 50mgtopiramate 25 mg, 50mg 18topiramate 25 mgtopiramate 25mg 18TOPIRAMATEERTOPIRAMATE ER 18TOPOTECAN HCL 4MG/4MLTOPOTECAN HCL 4MG/4ML 38topotecan hcl 4 mgtopotecanhcl 4 mg 38TOPPER DRESSINGSPONGES 4"X4"TOPPERDRESSING SPONGES4"X4" 87

TOPROL XL 100 MG, 50 MG, 25MGTOPROL XL 100 MG, 50 MG,25 MG 48TOPROL XL 200 MGTOPROLXL 200 MG 48TORISELTORISEL 37torsemide 10 mg, 5 mg, 100mgtorsemide 10 mg, 5 mg, 100mg 70torsemide 20 mgtorsemide 20mg 70TOUJEO SOLOSTARTOUJEOSOLOSTAR 24trace minerals (cr-cu-mn-se-zn)trace minerals (cr-cu-mn-se-zn) 102trace minerals (cr-cu-mn-zn)traceminerals (cr-cu-mn-zn) 102TRACLEERTRACLEER 51TRADJENTATRADJENTA 23tramadol hcl 100 mg, 300 mg,200 mgtramadol hcl 100 mg, 300mg, 200 mg 8tramadol hcl 50 mgtramadol hcl50 mg 8TRAMADOL HCLERTRAMADOL HCL ER 8tramadol-acetaminophentramadol-acetaminophen 9trandolapril 1 mg, 2mgtrandolapril 1 mg, 2 mg 29trandolapril 4 mgtrandolapril 4mg 29trandolapril-verapamilhcltrandolapril-verapamil hcl 32tranexamic acid 1000mg/10mltranexamic acid 1000mg/10ml 80tranexamic acid 650mgtranexamic acid 650 mg 80TRANXENE TTRANXENE T 13tranylcyprominesulfatetranylcyprominesulfate 20TRAVATAN ZTRAVATANZ 116TRAVOPROSTTRAVOPROST

116trazodone hcltrazodone hcl 21TREANDATREANDA 34TRELSTAR MIXJECTTRELSTARMIXJECT 36TRELSTARTRELSTAR 36TRESIBA FLEXTOUCHTRESIBAFLEXTOUCH 24

Index 61

tretinoin (chemotherapy)tretinoin(chemotherapy) 37tretinoin microspheretretinoinmicrosphere 59tretinointretinoin 58TREXALLTREXALL 35TREXIMETTREXIMET 99TREZIXTREZIX 9TRI-NORINYL 28TRI-NORINYL28 54TRI-TABS DHATRI-TABSDHA 108TRI-VI-FLOROTRI-VI-FLORO

105TRI-VI-FLORTRI-VI-FLOR 105TRI-VIT/FLUORIDE/IRONTRI-VIT/FLUORIDE/IRON 105TRIADVANCETRIADVANCE

108triamcinolone acetonide(mouth)triamcinolone acetonide(mouth) 103triamcinolone acetonide(nasal)triamcinolone acetonide(nasal) 112triamcinolone acetonide (topical)0.025 %, 0.1 %triamcinoloneacetonide (topical) 0.025 %, 0.1% 64triamcinolone acetonide (topical)0.147 mg/gmtriamcinoloneacetonide (topical) 0.147mg/gm 64triamcinolone acetonide (topical)0.5 %triamcinolone acetonide(topical) 0.5 % 64triamcinolone acetonide-dimethicone-siliconetriamcinolone acetonide-dimethicone-silicone 64triamterene &hydrochlorothiazidetriamterene &hydrochlorothiazide 69TRIAMTERENE/HYDROCHLOROTHIAZIDETRIAMTERENE/HYDROCHLOROTHIAZIDE 69TRIAZOLAM 0.125MGTRIAZOLAM 0.125 MG 81triazolam 0.25 mgtriazolam 0.25mg 81TRIBENZORTRIBENZOR 32TRICARE PRENATALCOMPLEATTRICAREPRENATAL COMPLEAT 108TRICARE PRENATAL DHAONETRICARE PRENATAL DHAONE 108

TRICARETRICARE 108TRICORTRICOR 28TRIDESILONTRIDESILON

64trifluoperazine hcltrifluoperazinehcl 41trifluridinetrifluridine 115TRIGLIDETRIGLIDE 28trihexyphenidyl hcl 0.4mg/mltrihexyphenidyl hcl 0.4mg/ml 38trihexyphenidyl hcl 2 mg, 5mgtrihexyphenidyl hcl 2 mg, 5mg 38TRILEPTAL 150 MG, 600 MG,300 MGTRILEPTAL 150 MG,600 MG, 300 MG 18TRILEPTAL 300MG/5MLTRILEPTAL 300MG/5ML 18TRILIPIXTRILIPIX 28trimethobenzamidehcltrimethobenzamide hcl 25trimethoprimtrimethoprim 10trimipraminemaleatetrimipraminemaleate 21TRINATAL GTTRINATALGT 108TRINATAL RX 1TRINATAL RX1 108TRINATETRINATE 108TRINTELLIXTRINTELLIX 21TRIOSTATTRIOSTAT 123TRIPLE DYETRIPLE DYE 41TRIUMEQTRIUMEQ 43TRIVEEN-PRX RNFTRIVEEN-PRX RNF 108TRIZIVIRTRIZIVIR 43TROKENDI XRTROKENDIXR 18TROPHAMINETROPHAMINE

113trospium chloride 20mgtrospium chloride 20mg 126trospium chloride 60mgtrospium chloride 60mg 126TRUE METRIX AIR BLOODGLUCOSEMETER/BLUETOOTHSMARTTRUE METRIX AIRBLOOD GLUCOSEMETER/BLUETOOTHSMART 97

TRUE METRIX AIRW/BLUETOOTH SMARTTRUEMETRIX AIR W/BLUETOOTHSMART 97TRUE METRIX BLOODGLUCOSEMETERTRUEMETRIX BLOODGLUCOSEMETER 97TRUE METRIX CONTROLSOLUTION LEVEL 1TRUEMETRIX CONTROL SOLUTIONLEVEL 1 97TRUE METRIX CONTROLSOLUTION LEVEL 2TRUEMETRIX CONTROL SOLUTIONLEVEL 2 97TRUE METRIX CONTROLSOLUTION LEVEL 3TRUEMETRIX CONTROL SOLUTIONLEVEL 3 97TRUE METRIX GO BLOODGLUCOSE METERTRUEMETRIX GO BLOOD GLUCOSEMETER 97TRUE2GO BLOOD GLUCOSEMONITORINGSYSTEMTRUE2GO BLOODGLUCOSE MONITORINGSYSTEM 97TRUECONTROL GLUCOSECONTROL LEVEL0TRUECONTROL GLUCOSECONTROL LEVEL 0 97TRUECONTROL GLUCOSECONTROL LEVEL1TRUECONTROL GLUCOSECONTROL LEVEL 1 97TRUERESULT BLOODGLUCOSEMONITORINGSYSTEM/NOCODINGTRUERESULT BLOODGLUCOSEMONITORINGSYSTEM/NO CODING 97TRUERESULT BLOODGLUCOSEMONITORINGSYSTEMTRUERESULT BLOODGLUCOSEMONITORINGSYSTEM 97TRUETEST GLUCOSECONTROLLEVEL 1TRUETESTGLUCOSE CONTROLLEVEL1 97TRUETEST GLUCOSECONTROLLEVEL 2TRUETESTGLUCOSE CONTROLLEVEL2 97

Index 62

TRUETEST GLUCOSECONTROLLEVEL 3TRUETESTGLUCOSE CONTROLLEVEL3 97TRUETRACK BLOODGLUCOSE MONITORINGSYSTEMTRUETRACK BLOODGLUCOSE MONITORINGSYSTEM 97TRUETRACK SMARTSYSTEMTRUETRACK SMARTSYSTEM 97TRULICITYTRULICITY 23TRUMENBATRUMENBA 127TRUSOPTTRUSOPT 116TRUVADA 150MG-100MG,250MG-167MG, 200MG-133MGTRUVADA 150MG-100MG, 250MG-167MG, 200MG-133MG 43TRUVADA 300MG-200MGTRUVADA 300MG-200MG 43TUDORZA PRESSAIRTUDORZAPRESSAIR 14TUSSIONEX PENNKINETICEXTENDEDRELEASETUSSIONEXPENNKINETIC EXTENDEDRELEASE 56TWINRIXTWINRIX 128TWYNSTATWYNSTA 32TYKERBTYKERB 37TYLENOL/CODEINE#3TYLENOL/CODEINE #3 9TYLENOL/CODEINE#4TYLENOL/CODEINE #4 9TYPHIM VITYPHIM VI 127TYSABRITYSABRI 121TYVASO REFILLTYVASOREFILL 50TYVASO STARTERTYVASOSTARTER 50TYVASOTYVASO 50UCERISUCERIS 55ULORICULORIC 78ULTANEULTANE 77ULTICARE ALCOHOLSWABSULTICARE ALCOHOLSWABS 99ULTIMATECARE ONENFULTIMATECARE ONENF 109ULTIMATECAREONEULTIMATECARE ONE109

ULTRA TRAK PRO BLOODGLUCOSE MONITORINGSYSTEMULTRA TRAK PROBLOOD GLUCOSEMONITORING SYSTEM 97ULTRABAG/DIANEAL PD-2/1.5%DEXTROSEULTRABAG/DIANEAL PD-2/1.5%DEXTROSE 47ULTRACETULTRACET 9ULTRAM ERULTRAM ER 8ULTRAMULTRAM 8ULTRASAL-ERULTRASAL-ER

65ULTRATRAK PRO CONTROLSOLUTION 2LEVELSULTRATRAK PROCONTROL SOLUTION 2LEVELS 97ULTRATRAK PRO NORMALCONTROLULTRATRAK PRONORMAL CONTROL 97ULTRATRAK ULTIMATECONTROL SOLUTION 2LEVELSULTRATRAKULTIMATE CONTROLSOLUTION 2 LEVELS 98ULTRAVATEULTRAVATE 64ULTRESAULTRESA 69UMECTA NAIL FILMUMECTANAIL FILM 64UNASYN BULKPACKUNASYN BULKPACK 118UNASYNUNASYN 118UNISTRIP CONTROLSOLUTIONHIGHUNISTRIPCONTROLSOLUTIONHIGH 98UNISTRIP CONTROLSOLUTIONLOWUNISTRIPCONTROLSOLUTIONLOW 98URAMAXIN GTURAMAXINGT 64URAMAXINURAMAXIN 64urea in lactic acid vehicleurea inlactic acid vehicle 64urea in lactic acid-salicylic acidvehicleurea in lactic acid-salicylic acid vehicle 64urea in zinc undecylenate-lacticacid vehicleurea in zincundecylenate-lactic acidvehicle 65

ureaurea 64URECHOLINEURECHOLINE

126URIMAR-TURIMAR-T 126UROCIT-K 10UROCIT-K 10 77UROCIT-K 15UROCIT-K 15 77UROCIT-K 5UROCIT-K 5 77UROGESIC-BLUEUROGESIC-BLUE 126UROXATRALUROXATRAL 77URSO 250URSO 250 75URSO FORTEURSOFORTE 75ursodiol 250 mgursodiol 250mg 75ursodiol 300 mgursodiol 300mg 75ursodiol 500 mgursodiol 500mg 75UTERUSUTERUS 110VAGIFEMVAGIFEM 129valacyclovir hcl 1 gm, 1000mgvalacyclovir hcl 1 gm, 1000mg 45valacyclovir hcl 500mgvalacyclovir hcl 500 mg 45VALCYTE 450 MGVALCYTE 450MG 43VALCYTE 50 MG/MLVALCYTE50 MG/ML 43valganciclovir hcl 450mgvalganciclovir hcl 450 mg 44valganciclovir hcl 50mg/mlvalganciclovir hcl 50mg/ml 43VALIUMVALIUM 13valproate sodiumvalproatesodium 19valproic acidvalproic acid 19valsartan 160 mg, 80mgvalsartan 160 mg, 80 mg 30valsartan 320 mg, 40mgvalsartan 320 mg, 40 mg 30valsartan-hydrochlorothiazidevalsartan-hydrochlorothiazide 32VALSTARVALSTAR 36VALTREX 1 GMVALTREX 1GM 45VALTREX 500 MGVALTREX 500MG 45VANATOL LQVANATOL LQ 5VANCOCIN HCLVANCOCINHCL 10

Index 63

vancomycin hcl 10 gm, 5000mgvancomycin hcl 10 gm, 5000mg 10vancomycin hcl 1000mgvancomycin hcl 1000 mg 10vancomycin hcl 125 mg, 250mgvancomycin hcl 125 mg, 250mg 10vancomycin hcl 500mgvancomycin hcl 500 mg 11VANCOMYCINHYDROCHLORIDE/SODIUMCHLORIDEVANCOMYCINHYDROCHLORIDE/SODIUMCHLORIDE 11VANOSVANOS 64VANTASVANTAS 36VAQTAVAQTA 128VARIVAXVARIVAX 128VARUBIVARUBI 25VASCEPAVASCEPA 27VASERETICVASERETIC 32VASOPRESSIN/SODIUMCHLORIDEVASOPRESSIN/SODIUM CHLORIDE 73vasopressinvasopressin 73VASOTECVASOTEC 29VCF VAGINALCONTRACEPTIVE FILMVCFVAGINAL CONTRACEPTIVEFILM 129VCF VAGINALCONTRACEPTIVE FOAMVCFVAGINAL CONTRACEPTIVEFOAM 129VECAMYLVECAMYL 33VECTIBIXVECTIBIX 35VECTICALVECTICAL 61vecuronium bromidevecuroniumbromide 113VEINPUNCTURE PX1PHLEBOTOMYSYSTEMVEINPUNCTURE PX1PHLEBOTOMY SYSTEM 66VELCADEVELCADE 37VELETRIVELETRI 50VELPHOROVELPHORO 76VELTINVELTIN 59VEMAVITE-PRX 2VEMAVITE-PRX 2 109VEMLIDYVEMLIDY 44VENA-BAL DHAVENA-BALDHA 109

VENATAL-FAVENATAL-FA109

VENLAFAXINE HCL ER 150MG, 75 MG, 37.5MGVENLAFAXINE HCL ER150 MG, 75 MG, 37.5 MG 21VENLAFAXINE HCL ER 225MGVENLAFAXINE HCL ER225 MG 21venlafaxine hclvenlafaxinehcl 21VENTAVISVENTAVIS 50VENTOLIN HFAVENTOLINHFA 15VERAMYSTVERAMYST 112verapamil hcl 100 mg, 300 mg,200 mgverapamil hcl 100 mg,300 mg, 200 mg 50verapamil hcl 120 mg, 240 mg,180 mgverapamil hcl 120 mg,240 mg, 180 mg 50verapamil hcl 120 mg, 80 mg,40 mgverapamil hcl 120 mg, 80mg, 40 mg 50verapamil hcl 2.5mg/mlverapamil hcl 2.5mg/ml 50verapamil hcl 360 mgverapamilhcl 360 mg 50VERELAN 120 MG, 240 MG,180 MGVERELAN 120 MG,240 MG, 180 MG 50VERELAN 360 MGVERELAN360 MG 50VERELAN PMVERELANPM 50VERSACLOZVERSACLOZ 41VERSIVA XC 3" X 3" FOAMDRESSING/HYDROFIBERTECHNOLOGYVERSIVA XC3" X 3" FOAMDRESSING/HYDROFIBERTECHNOLOGY 87VERSIVA XC 4" X 4" FOAMDRESSING/HYDROFIBERTECHNOLOGYVERSIVA XC4" X 4" FOAMDRESSING/HYDROFIBERTECHNOLOGY 87VESICAREVESICARE 126VFEND 200 MG, 50 MGVFEND200 MG, 50 MG 26VFEND 40 MG/MLVFEND 40MG/ML 26VFEND IVVFEND IV 26VIBERZIVIBERZI 76

VIBRAMYCIN 100MGVIBRAMYCIN 100 MG 122VIBRAMYCIN 25MG/5MLVIBRAMYCIN 25MG/5ML 122VIBRAMYCIN 50MG/5MLVIBRAMYCIN 50MG/5ML 122VICOPROFENVICOPROFEN 9VICTORY CONTROL LEVEL1/2VICTORY CONTROL LEVEL1/2 98VICTOZAVICTOZA 23VICTRELISVICTRELIS 44VIDAZAVIDAZA 35VIDEX EC 125 MG, 200MGVIDEX EC 125 MG, 200MG 43VIDEX EC 250 MG, 400MGVIDEX EC 250 MG, 400MG 43VIDEXPEDIATRICVIDEXPEDIATRIC 43VIEKIRA PAKVIEKIRA PAK 44VIEKIRA XRVIEKIRA XR 44VIGAMOXVIGAMOX 115VIIBRYD STARTERPACKVIIBRYD STARTERPACK 21VIIBRYDVIIBRYD 21VIMIZIMVIMIZIM 73VIMPAT 10 MG/MLVIMPAT 10MG/ML 19VIMPAT 100 MG, 50 MG, 200MG, 150 MGVIMPAT 100 MG, 50MG, 200 MG, 150 MG 19VIMPAT 200 MG/20MLVIMPAT200 MG/20ML 18VINACAL BVINACAL B 109VINATE CALCIUMVINATECALCIUM 109VINATE CVINATE C 109VINATE DHA RFVINATE DHARF 109VINATE ONEVINATE ONE 109VINBLASTINESULFATEVINBLASTINESULFATE 38vincristine sulfatevincristinesulfate 38vinorelbine tartratevinorelbinetartrate 38VIOKACEVIOKACE 69VIRACEPTVIRACEPT 43

Index 64

VIRAMUNE 200 MGVIRAMUNE200 MG 43VIRAMUNE 50MG/5MLVIRAMUNE 50MG/5ML 43VIRAMUNE XR 100MGVIRAMUNE XR 100 MG 43VIRAMUNE XR 400MGVIRAMUNE XR 400 MG 43VIRASALVIRASAL 65VIREAD 150 MG, 250 MG, 200MGVIREAD 150 MG, 250 MG,200 MG 43VIREAD 300 MGVIREAD 300MG 43VIREAD 40 MG/GMVIREAD 40MG/GM 43VIROPTICVIROPTIC 115VIRT NATEVIRT NATE 109VIRT-ADVANCEVIRT-ADVANCE

109VIRT-C DHAVIRT-C DHA 109VIRT-CARE ONEVIRT-CAREONE 109VIRT-NATE DHAVIRT-NATEDHA 109VIRT-PN DHAVIRT-PNDHA 109VIRT-PN PLUSVIRT-PNPLUS 109VIRT-PNVIRT-PN 109VIRT-SELECTVIRT-SELECT

109VIRT-VITE GTVIRT-VITEGT 109VIRTPREXVIRTPREX 109VISTARILVISTARIL 13VISTEC X-RAY DETECTABLESPONGES 4"X4" 16 PLYVISTECX-RAY DETECTABLESPONGES 4"X4" 16 PLY 87VISTIDEVISTIDE 44VISTOGARDVISTOGARD 25VISUDYNEVISUDYNE 115VITAFOL-NANOVITAFOL-NANO

109VITAFOL-ONEVITAFOL-ONE

109VITAMEDMD ONERX/QUATREFOLICVITAMEDMDONE RX/QUATREFOLIC 109VITAMEDMD PLUSRX/QUATREFOLICVITAMEDMDPLUS RX/QUATREFOLIC 109

VITAMEDMD REDICHEWRXVITAMEDMD REDICHEWRX 109VITAMIN D2VITAMIN D2 130VITAMIN D3VITAMIN D3 130VITAMIN K1VITAMIN K1 130VITAMINS FOR THEHAIRVITAMINS FOR THEHAIR 110VITAPEARLVITAPEARL 109VIVA DHAVIVA DHA 109VIVELLE-DOTVIVELLE-DOT

75VIVITROLVIVITROL 25VOGELXO PUMPVOGELXOPUMP 10VOGELXOVOGELXO 10VOL-NATEVOL-NATE 109VOL-PLUSVOL-PLUS 109VOL-TAB RXVOL-TABRX 109VOLTAREN-XRVOLTAREN-XR 4VOLTARENVOLTAREN 59voriconazole 200 mg, 50mgvoriconazole 200 mg, 50mg 26voriconazole 200mgvoriconazole 200 mg 26voriconazole 40mg/mlvoriconazole 40mg/ml 26VOSPIRE ERVOSPIREER 15VOTRIENTVOTRIENT 37VP CH ULTRAVP CHULTRA 109VP-CH PLUSVP-CHPLUS 109VP-CH-PNVVP-CH-PNV 109VP-GGR-B6 PRENATALVP-GGR-B6 PRENATAL 109VP-HEME OB + DHAVP-HEMEOB + DHA 109VP-HEME OBVP-HEMEOB 109VP-PNV-DHAVP-PNV-DHA

109VPRIVVPRIV 79VYTORINVYTORIN 27VYVANSEVYVANSE 1warfarin sodiumwarfarinsodium 16water for injection, sterilewaterfor injection, sterile 119

water for irrigation, sterilewaterfor irrigation, sterile 46WAVESENSEAMPWAVESENSE AMP 98WAVESENSEKEYNOTEWAVESENSEKEYNOTE 98WEBCOL ALCOHOL PREPLARGE 1 PLYWEBCOLALCOHOL PREP LARGE 1PLY 99WEBCOL ALCOHOL PREPLARGE 2 PLYWEBCOLALCOHOL PREP LARGE 2PLY 99WEBCOL ALCOHOL PREPMEDIUM 2 PLYWEBCOLALCOHOL PREP MEDIUM 2PLY 99WEGMANS COMPLETEPRENATAL+DHAWEGMANSCOMPLETEPRENATAL+DHA 109WELCHOL 3.75 GMWELCHOL3.75 GM 28WELCHOL 625 MGWELCHOL625 MG 28WELLBUTRIN SRWELLBUTRINSR 20WELLBUTRIN XLWELLBUTRINXL 20WELLBUTRINWELLBUTRIN

20WELLESSE VITAMIND3WELLESSE VITAMIND3 130WESTCORTWESTCORT 64white petrolatumwhitepetrolatum 119WINRHO SDFWINRHOSDF 117XALATANXALATAN 116XALKORIXALKORI 37XANAX XRXANAX XR 13XANAXXANAX 13XARELTO 10 MGXARELTO 10MG 16XARELTO 15 MG, 20MGXARELTO 15 MG, 20MG 16XARELTO STARTERPACKXARELTO STARTERPACK 16XELJANZ XRXELJANZ XR 2XELJANZXELJANZ 2XELODAXELODA 35

Index 65

XENAZINEXENAZINE 120XEOMINXEOMIN 112XERALUXXERALUX 67XGEVAXGEVA 71XIAFLEXXIAFLEX 45XIFAXANXIFAXAN 11XIGDUO XRXIGDUO XR 22XIIDRAXIIDRA 115XODOLXODOL 9XOLAIRXOLAIR 14XOPENEXCONCENTRATEXOPENEXCONCENTRATE 16XOPENEX HFAXOPENEXHFA 16XOPENEXXOPENEX 16XPRES CONTROL SOLUTIONNORMALXPRES CONTROLSOLUTION NORMAL 98XRYLIDERMXRYLIDERM 66XTANDIXTANDI 36XULANEXULANE 54XYLOCAINE-MPF/EPINEPHRINEXYLOCAINE-MPF/EPINEPHRINE 82XYLOCAINE-MPFXYLOCAINE-MPF 82XYLOCAINE/EPINEPHRINEXYLOCAINE/EPINEPHRINE 82XYLOCAINEXYLOCAINE 14XYREMXYREM 119XYZAL 2.5 MG/5MLXYZAL 2.5MG/5ML 27XYZAL 5 MGXYZAL 5 MG 27YASMIN 28YASMIN 28 54YAZYAZ 54YERVOYYERVOY 35YF-VAXYF-VAX 128YODORADEODORANTYODORADEODORANT 67ZADITORZADITOR 116zafirlukastzafirlukast 14zaleplon 10 mgzaleplon 10mg 81zaleplon 5 mgzaleplon 5 mg 81ZALTRAPZALTRAP 35ZAMICETZAMICET 9ZANAFLEX 2 MGZANAFLEX 2MG 111ZANAFLEX 4 MGZANAFLEX 4MG 111

ZANAFLEX 6 MGZANAFLEX 6MG 111ZANTAC 150 MAXIMUMSTRENGTHZANTAC 150MAXIMUM STRENGTH 124ZANTAC 150 MGZANTAC 150MG 124ZANTAC 25 MG/MLZANTAC25 MG/ML 124ZANTAC 300 MGZANTAC 300MG 124ZANTAC 50 MG/2MLZANTAC50 MG/2ML 124ZARONTIN 250MG/5MLZARONTIN 250MG/5ML 19ZARONTIN 250 MGZARONTIN250 MG 19ZARXIOZARXIO 79ZATEAN-CHZATEAN-CH109ZATEAN-PN DHAZATEAN-PNDHA 109ZATEAN-PN PLUSZATEAN-PN PLUS 109ZATEAN-PNZATEAN-PN 109ZAVESCAZAVESCA 79ZEBETAZEBETA 48ZEGERID 20MG-1100MGZEGERID 20MG-1100MG 125ZEGERID 20MG-1680MG,40MG-1680MGZEGERID20MG-1680MG, 40MG-1680MG 125ZEGERID 40MG-1100MGZEGERID 40MG-1100MG 125ZEGERID OTCZEGERIDOTC 125ZELAPARZELAPAR 39ZELBORAFZELBORAF 37ZEMAIRAZEMAIRA 122ZEMPLARZEMPLAR 73ZEMURONZEMURON 113ZENPEPZENPEP 69ZENZEDIZENZEDI 1ZEPATIERZEPATIER 44ZERIT 1 MG/MLZERIT 1MG/ML 43ZERIT 15 MG, 40 MG, 30 MG,20 MGZERIT 15 MG, 40 MG,30 MG, 20 MG 43ZESTORETIC 10MG-12.5MGZESTORETIC 10MG-12.5MG 32

ZESTORETIC 20MG-12.5MGZESTORETIC 20MG-12.5MG 32ZESTORETIC 20MG-25MGZESTORETIC 20MG-25MG 32ZESTRIL 10 MG, 5 MG, 40 MG,30 MG, 20 MGZESTRIL 10 MG,5 MG, 40 MG, 30 MG, 20MG 29ZESTRIL 2.5 MGZESTRIL 2.5MG 29ZETIAZETIA 28ZETONNAZETONNA 112ZIAC 10MG-6.25MGZIAC 10MG-6.25MG 33ZIAC 2.5MG-6.25MG, 5MG-6.25MGZIAC 2.5MG-6.25MG,5MG-6.25MG 33ZIAGEN 20 MG/MLZIAGEN 20MG/ML 43ZIAGEN 300 MGZIAGEN 300MG 43ZIANAZIANA 59zidovudine 100 mgzidovudine100 mg 43zidovudine 300 mgzidovudine300 mg 43zidovudine 50 mg/5mlzidovudine50 mg/5ml 43ZINACEFZINACEF 51ZINBRYTAZINBRYTA 121ZINC SULFATEZINCSULFATE 102ZINC TRACE METALZINCTRACE METAL 102ZINECARDZINECARD 38ZIOPTANZIOPTAN 116ziprasidone hclziprasidonehcl 40ZITHROMAX 1 GMZITHROMAX1 GM 83ZITHROMAX 100 MG/5ML, 200MG/5MLZITHROMAX 100MG/5ML, 200 MG/5ML 83ZITHROMAX 250MGZITHROMAX 250 MG 83ZITHROMAX 500MGZITHROMAX 500 MG 83ZITHROMAX 600MGZITHROMAX 600 MG 83ZITHROMAX TRI-PAKZITHROMAX TRI-PAK 83ZITHROMAX Z-PAKZITHROMAXZ-PAK 83ZN-PLUSZN-PLUS 110ZOCORZOCOR 28

Index 66

ZOFRAN 4 MG, 8 MGZOFRAN 4MG, 8 MG 25ZOFRAN 4 MG/5MLZOFRAN 4MG/5ML 25ZOFRAN ODTZOFRANODT 25ZOLADEXZOLADEX 36ZOLEDRONIC ACID 4MG/100MLZOLEDRONIC ACID 4MG/100ML 71zoledronic acid 4mg/5mlzoledronic acid 4mg/5ml 71ZOLEDRONIC ACID 4MGZOLEDRONIC ACID 4MG 71zoledronic acid 5mg/100mlzoledronic acid 5mg/100ml 71ZOLINZAZOLINZA 37zolmitriptanzolmitriptan 100ZOLOFT 100 MG, 50 MG, 25MGZOLOFT 100 MG, 50 MG, 25MG 20ZOLOFT 20 MG/MLZOLOFT 20MG/ML 20zolpidem tartratezolpidemtartrate 81ZOMACTONZOMACTON 72ZOMETA 4 MG/100MLZOMETA4 MG/100ML 71ZOMETA 4 MG/5MLZOMETA 4MG/5ML 71ZOMIG 2.5 MG, 5 MGZOMIG 2.5MG, 5 MG 100ZOMIG 2.5 MGZOMIG 2.5MG 100ZOMIG NASAL SPRAYZOMIGNASAL SPRAY 100ZOMIG ZMTZOMIG ZMT 100ZONALONZONALON 60ZONATUSSZONATUSS 56ZONEGRANZONEGRAN 19zonisamidezonisamide 19ZONTIVITYZONTIVITY 78ZORBTIVEZORBTIVE 72ZORTRESSZORTRESS 46ZOSTAVAXZOSTAVAX 128ZOSYNZOSYN 118ZOVIRAX 200 MG/5MLZOVIRAX200 MG/5ML 45ZOVIRAX 200 MGZOVIRAX 200MG 45ZOVIRAX 400 MGZOVIRAX 400MG 45

ZOVIRAX 5 %ZOVIRAX 5% 61ZOVIRAX 800 MGZOVIRAX800 MG 45ZUBSOLV 1.4MG-0.36MGZUBSOLV 1.4MG-0.36MG 9ZUBSOLV 5.7MG-1.4MGZUBSOLV 5.7MG-1.4MG 9ZUTRIPROZUTRIPRO 56ZYBANZYBAN 121ZYCLARA PUMP 2.5%ZYCLARA PUMP 2.5 % 65ZYCLARA PUMP 3.75%ZYCLARA PUMP 3.75 %65ZYCLARAZYCLARA 65ZYFLO CRZYFLO CR 14ZYFLOZYFLO 14ZYKADIAZYKADIA 37ZYLETZYLET 116ZYLOPRIMZYLOPRIM 78ZYMAXIDZYMAXID 115ZYPREXARELPREVVZYPREXARELPREVV 41ZYPREXA ZYDISZYPREXAZYDIS 41ZYPREXAZYPREXA 41ZYRTEC ALLERGYZYRTECALLERGY 27ZYRTEC CHILDRENSALLERGYZYRTECCHILDRENS ALLERGY 27ZYTIGAZYTIGA 36ZYVOX 100 MG/5MLZYVOX100 MG/5ML 12ZYVOX 600 MG/300MLZYVOX600 MG/300ML 12ZYVOX 600 MGZYVOX 600MG 12

Index 67

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