adnic bronze policy drug list greenrain code ddc code...

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size 1101-6987-001 1504-480601-0051 21ST CENTURY CALCIUM PLUS Boron, Calcium, Manganese, 250mcg, 600mg, 1.8mg, 40mg, Tablets (Caplets) 120's Bottle 1472-1003-001 0005-379303-1022 3 V Vitamin - B1, B6, B12 100mg, 100mg, 1mg/3ml Solution for Injection 3ml Ampoule x 3 1472-1003-004 0005-379302-1171 3 V Vitamin - B1, B6, B12 100mg, 200mg, 200mcg Film Coated Tablets 20's (10's Blister x 2) 1447-1011-001 0015-101502-0271 ACC LONG 600 Acetylcysteine 600mg Effervescent Tablets 10's Tube 1475-1015-001 0017-101802-1172 ACETAB 25MG Captopril 25mg Tablets 20's (10's Blister x 2) 1475-1015-002 0017-101801-1171 ACETAB 50MG Captopril 50mg Tablets 20's (10's Blister x 2) 1513-4682-002 0024-101503-0511 ACETYLCYSTEINE Acetylcysteine 20% Injection 10ml Ampoule 1556-4573-001 0027-102501-1021 ACLASTA 5MG/100ML Zoledronic Acid 1mg/20ml Solution for Injection 100ml Plastic Vial 1417-1033-006 0006-103902-1172 ACTIFED Pseudoephedrine HCl, Triprolidine HCl 60mg, 2.5mg Tablets 24's Blister 1417-1033-003 0006-103901-1162 ACTIFED Pseudoephedrine HCl, Triprolidine HCl 30mg, 1.25mg/5ml Syrup 200ml Bottle 1544-7242-001 0067-108102-1161 ACTILOR 2.5MG/5ML Desloratadine 0.5mg/ml Syrup 150ml Glass bottle 1699-1042-001 0046-104802-1171 ACTOS 15MG Pioglitazone 15mg Tablets 30's Plastic Bottle 1699-1042-002 0046-104801-1171 ACTOS 30MG Pioglitazone 30mg Tablets 30's Plastic Bottle 1559-1044-002 0043-105001-0511 ACTRAPID HM 100 UNITS/ML Insulin - Soluble (human) 100 Units/ml Injection 10ml Vial 1559-1045-002 0043-105001-0512 ACTRAPID HM PENFILL 100 Insulin - Soluble (human) 100 Units/ml Injection 3ml Cartridge x 5 1559-1045-001 0043-105001-0515 ACTRAPID HM PENFILL 100 Insulin - Soluble (human) 100 Units/ml Injection 1.5ml Cartridge x 5 1576-1048-002 0016-105201-1171 ACUITEL 20MG Quinapril (as HCl) 20mg Tablets 30's (10's Blister x 3) 1576-1048-004 0016-105202-1171 ACUITEL 5MG Quinapril (as HCl) 5mg Tablets 30's (10's Blister x 3) 1272-4916-003 0052-102404-0061 ACYCLOVIR Acyclovir 200mg Capsules 100's 1300-1052-001 0054-105401-1451 ADALAT 10MG Nifedipine 10mg Capsules (Hard Gelatin) 30's Bottle 1300-1053-001 0054-105403-2001 ADALAT LA 30 Nifedipine 30mg Modified Release Tablets 30's (10's Blister x 3) 1300-1053-002 0054-105402-2001 ADALAT LA 60 Nifedipine 60mg Modified Release Tablets 30's (10's Blister x 3) 1472-1058-001 0005-106603-1631 ADOL 100MG/ML Paracetamol 100mg/ml Drops (Oral) 15ml Glass Bottle + Dropper 1472-1058-004 0005-106604-1161 ADOL 120MG/5ML Paracetamol 120mg/5ml Syrup 100ml Bottle 1472-1058-007 0005-106605-2232 ADOL 125MG Paracetamol 125mg Rectal Suppositories 10's (5's Blister x 2) 1472-1058-010 0005-106602-2232 ADOL 250MG Paracetamol 250mg Rectal Suppositories 10's (5's Blister x 2) 1472-1058-011 0005-106606-1111 ADOL 250MG/5ML Paracetamol 250mg/5ml Suspension 100ml Glass Bottle 1472-1058-018 0005-106601-2231 ADOL 500MG Paracetamol 500mg Rectal Suppositories 10's (5's Blister x 2) 1472-1058-016 0005-106601-0051 ADOL 500MG Paracetamol 500mg Tablets (Caplets) 96's (12's Blister x 8) 1472-1058-014 0005-106601-0052 ADOL 500MG Paracetamol 500mg Tablets (Caplets) 24's (12's Blister x 2) 1472-1064-001 0005-107001-0051 ADOL EXTRA Paracetamol, Caffeine anhydrous 500mg, 65mg Tablets (Caplets) 24's (12's Blister x 2) 1916-5226-001 0062-107301-0511 ADRENALINE Adrenaline 1mg/ml Injection 1ml Ampoule x 10 1567-6759-001 0207-391002-0391 ADVAQUIN 500MG Levofloxacin (as hemihydrate) 500mg Film Coated Tablets 5's Blister 1228-1075-004 1233-107901-0112 ADVIL 200MG Ibuprofen 200mg Coated Tablets 24's Plastic Bottle 1228-1077-005 1233-107901-1481 ADVIL LIQUI-GELS 200MG Ibuprofen 200mg Capsules (Soft Gelatin) 32's Bottle 1650-1078-001 0070-108102-1161 AERIUS 0.5MG/ML Desloratadine 0.5mg/ml Syrup 150ml Glass Bottle 1650-1078-005 1069-108101-0392 AERIUS 5MG Desloratadine 5mg Film Coated Tablets 30's (15's Blister x 2) ADNIC bronze policy drug list

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Page 1: ADNIC bronze policy drug list Greenrain code DDC Code ...pbmuat.dimensions-healthcare.net/PBMLink/Website/pdf/ADNIC_Bronze_Drug... · 1699-1118-003 0046-111803-1171 ALLERFIN 4MG Chlorphenamine

Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

1101-6987-001 1504-480601-0051 21ST CENTURY CALCIUM PLUS Boron, Calcium, Manganese,

Magnesium, Zinc, Copper, Vitamin D

250mcg, 600mg, 1.8mg, 40mg,

7.5mg, 1mg, 200IU

Tablets (Caplets) 120's Bottle

1472-1003-001 0005-379303-1022 3 V Vitamin - B1, B6, B12 100mg, 100mg, 1mg/3ml Solution for Injection 3ml Ampoule x 3

1472-1003-004 0005-379302-1171 3 V Vitamin - B1, B6, B12 100mg, 200mg, 200mcg Film Coated Tablets 20's (10's Blister x 2)

1447-1011-001 0015-101502-0271 ACC LONG 600 Acetylcysteine 600mg Effervescent Tablets 10's Tube

1475-1015-001 0017-101802-1172 ACETAB 25MG Captopril 25mg Tablets 20's (10's Blister x 2)

1475-1015-002 0017-101801-1171 ACETAB 50MG Captopril 50mg Tablets 20's (10's Blister x 2)

1513-4682-002 0024-101503-0511 ACETYLCYSTEINE Acetylcysteine 20% Injection 10ml Ampoule

1556-4573-001 0027-102501-1021 ACLASTA 5MG/100ML Zoledronic Acid 1mg/20ml Solution for Injection 100ml Plastic Vial

1417-1033-006 0006-103902-1172 ACTIFED Pseudoephedrine HCl, Triprolidine HCl 60mg, 2.5mg Tablets 24's Blister

1417-1033-003 0006-103901-1162 ACTIFED Pseudoephedrine HCl, Triprolidine HCl 30mg, 1.25mg/5ml Syrup 200ml Bottle

1544-7242-001 0067-108102-1161 ACTILOR 2.5MG/5ML Desloratadine 0.5mg/ml Syrup 150ml Glass bottle

1699-1042-001 0046-104802-1171 ACTOS 15MG Pioglitazone 15mg Tablets 30's Plastic Bottle

1699-1042-002 0046-104801-1171 ACTOS 30MG Pioglitazone 30mg Tablets 30's Plastic Bottle

1559-1044-002 0043-105001-0511 ACTRAPID HM 100 UNITS/ML Insulin - Soluble (human) 100 Units/ml Injection 10ml Vial

1559-1045-002 0043-105001-0512 ACTRAPID HM PENFILL 100

UNITS/ML

Insulin - Soluble (human) 100 Units/ml Injection 3ml Cartridge x 5

1559-1045-001 0043-105001-0515 ACTRAPID HM PENFILL 100

UNITS/ML

Insulin - Soluble (human) 100 Units/ml Injection 1.5ml Cartridge x 5

1576-1048-002 0016-105201-1171 ACUITEL 20MG Quinapril (as HCl) 20mg Tablets 30's (10's Blister x 3)

1576-1048-004 0016-105202-1171 ACUITEL 5MG Quinapril (as HCl) 5mg Tablets 30's (10's Blister x 3)

1272-4916-003 0052-102404-0061 ACYCLOVIR Acyclovir 200mg Capsules 100's

1300-1052-001 0054-105401-1451 ADALAT 10MG Nifedipine 10mg Capsules (Hard Gelatin) 30's Bottle

1300-1053-001 0054-105403-2001 ADALAT LA 30 Nifedipine 30mg Modified Release Tablets 30's (10's Blister x 3)

1300-1053-002 0054-105402-2001 ADALAT LA 60 Nifedipine 60mg Modified Release Tablets 30's (10's Blister x 3)

1472-1058-001 0005-106603-1631 ADOL 100MG/ML Paracetamol 100mg/ml Drops (Oral) 15ml Glass Bottle + Dropper

1472-1058-004 0005-106604-1161 ADOL 120MG/5ML Paracetamol 120mg/5ml Syrup 100ml Bottle

1472-1058-007 0005-106605-2232 ADOL 125MG Paracetamol 125mg Rectal Suppositories 10's (5's Blister x 2)

1472-1058-010 0005-106602-2232 ADOL 250MG Paracetamol 250mg Rectal Suppositories 10's (5's Blister x 2)

1472-1058-011 0005-106606-1111 ADOL 250MG/5ML Paracetamol 250mg/5ml Suspension 100ml Glass Bottle

1472-1058-018 0005-106601-2231 ADOL 500MG Paracetamol 500mg Rectal Suppositories 10's (5's Blister x 2)

1472-1058-016 0005-106601-0051 ADOL 500MG Paracetamol 500mg Tablets (Caplets) 96's (12's Blister x 8)

1472-1058-014 0005-106601-0052 ADOL 500MG Paracetamol 500mg Tablets (Caplets) 24's (12's Blister x 2)

1472-1064-001 0005-107001-0051 ADOL EXTRA Paracetamol, Caffeine anhydrous 500mg, 65mg Tablets (Caplets) 24's (12's Blister x 2)

1916-5226-001 0062-107301-0511 ADRENALINE Adrenaline 1mg/ml Injection 1ml Ampoule x 10

1567-6759-001 0207-391002-0391 ADVAQUIN 500MG Levofloxacin (as hemihydrate) 500mg Film Coated Tablets 5's Blister

1228-1075-004 1233-107901-0112 ADVIL 200MG Ibuprofen 200mg Coated Tablets 24's Plastic Bottle

1228-1077-005 1233-107901-1481 ADVIL LIQUI-GELS 200MG Ibuprofen 200mg Capsules (Soft Gelatin) 32's Bottle

1650-1078-001 0070-108102-1161 AERIUS 0.5MG/ML Desloratadine 0.5mg/ml Syrup 150ml Glass Bottle

1650-1078-005 1069-108101-0392 AERIUS 5MG Desloratadine 5mg Film Coated Tablets 30's (15's Blister x 2)

ADNIC bronze policy drug list

Page 2: ADNIC bronze policy drug list Greenrain code DDC Code ...pbmuat.dimensions-healthcare.net/PBMLink/Website/pdf/ADNIC_Bronze_Drug... · 1699-1118-003 0046-111803-1171 ALLERFIN 4MG Chlorphenamine

Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1648-4919-001 0070-108101-1171 AERIUS S 5MG DESLORATIDINE 5mg Tablets Blister Pack x 100 tablets

1472-1096-001 0005-109801-1171 ALBENDA 200MG Albendazole 200mg Tablets 2's Blister

1472-1096-002 0005-109802-1111 ALBENDA 400MG/20ML Albendazole 20mg/ml Suspension 20ml Bottle

2095-1105-005 0088-110503-0511 ALDACTONE SPIRONOLACTONE 20mg/ml Injection 10ml Ampoule

1656-1105-001 0087-110502-1171 ALDACTONE 100 Spironolactone 100mg Tablets 10's

1656-1105-003 0087-110501-1171 ALDACTONE 25 Spironolactone 25mg Tablets 20's

1256-1107-001 0003-110702-1171 ALDOMET 250MG Methyldopa 250mg Tablets 30's (10's Blister x 3)

1472-1109-001 0005-111001-0151 ALFACORT Hydrocortisone 10mg/g Cream 15g Tube

1472-1109-002 0005-111001-0651 ALFACORT Hydrocortisone 10mg/g Ointment 15g Tube

1542-1116-001 0097-111701-0251 ALKA-UR Sodium bicarbonate, Tartaric acid, Citric

acid, Sodium citrate Anhydrous

Combination Effervescent Granules 4g Sachet x 10

1544-6966-001 0067-290301-0393 ALLERCET 5MG Levocetirizine 2HCl 5mg Film Coated Tablets 100's (10's Blister x 10)

1699-1118-001 0046-111801-0511 ALLERFIN 10MG Chlorphenamine Maleate 10mg/ml Injection 1ml Ampoule x 5

1699-1118-003 0046-111803-1171 ALLERFIN 4MG Chlorphenamine Maleate 4mg Tablets 30's (10's Blister x 3)

2189-1122-002 1148-112202-2011 ALLERGODIL 0.1% Azelastine (as HCl) 1mg/ml Nasal Spray 10ml

2325-1140-004 1513-114002-1391 ALVESCO 160MCG Ciclesonide 160mcg Aerosol Inhaler 120 Puffs Metered Dose Inhaler

1283-1143-001 0114-114204-1171 AMARYL 1.0MG Glimepiride 1mg Tablets 30's (15's Blister x 2)

1283-1143-002 0114-114201-1171 AMARYL 2.0MG Glimepiride 2mg Tablets 30's (15's Blister x 2)

1283-1143-003 0114-114203-1171 AMARYL 3.0MG Glimepiride 3mg Tablets 30's (15's Blister x 2)

1128-5573-001 0115-114302-0391 AMARYL M 2/500 Glimepiride, Metformin HCl 2mg, 500mg Film Coated Tablets 30's (10's Blister x 3)

1289-1148-002 0130-115305-0511 AMINOPHYLLINE Aminophylline 25mg/ml Injection 1 Injection x 10ml

1472-1152-001 0005-115601-1171 AMIRONE 200MG Amiodarone HCl 200mg Tablets 30's (10's Blister x 3)

1360-6097-001 0118-115901-1451 AMLODAR 10 Amlodipine (as besilate) 10mg Capsules (Hard Gelatin) 28's (14's Blister x 2)

1360-6097-002 0118-115902-1451 AMLODAR 5 Amlodipine (as besilate) 5mg Capsules (Hard Gelatin) 28's (14's Blister x 2)

1472-1154-001 0005-115902-1451 AMLOPHAR 5MG Amlodipine (as besilate) 5mg Capsules (Hard Gelatin) 30's (15's Blister x 2)

1250-1155-001 0135-116203-0851 AMOCLAN 156MG/5ML Co-amoxiclav 156.25mg (125mg +

31.25mg)/5ml

Powder for Suspension 100ml Bottle

1250-1155-002 0135-116201-1171 AMOCLAN 375MG Co-amoxiclav 375mg (250mg + 125mg) Tablets 20's (5's Blister x 4)

1250-1156-001 0135-116206-1171 AMOCLAN BID 1G Co-amoxiclav 1g (875mg + 125mg) Tablets 14's Bottle

1250-1156-003 0135-116204-0851 AMOCLAN BID 400MG/5ML Co-amoxiclav 457mg (400mg + 57mg)/5ml Powder for Suspension 70ml Plastic Bottle

1250-1157-002 0135-116207-1171 AMOCLAN FORTE 625MG Co-amoxiclav 625mg (500mg + 125mg) Tablets 15's (5's Blister x 3)

1641-5460-001 0137-115902-1451 AMOPRESS 5MG Amlodipine (as besilate) 5mg Capsules (Hard Gelatin) 28's (7's Blister x 4)

1671-1161-004 0139-116404-1451 AMOXIL 250MG Amoxycillin (as trihydrate) 250mg Capsules (Hard Gelatin) 20's (10's Blister x 2)

1955-4928-001 0144-101103-0511 AMPHOTEC Amphotericin B (Liposomal) 50mg Injection 1 Vial

Page 3: ADNIC bronze policy drug list Greenrain code DDC Code ...pbmuat.dimensions-healthcare.net/PBMLink/Website/pdf/ADNIC_Bronze_Drug... · 1699-1118-003 0046-111803-1171 ALLERFIN 4MG Chlorphenamine

Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1916-1168-005 0056-116501-0512 AMPICILLIN Ampicillin 250mg Injection 1 Vial

1276-1168-001 0147-116502-0801 AMPICILLIN 1G Ampicillin (as sodium) 1g Powder for Injection 1 Vial (Dry)

1276-1168-002 0147-116504-0801 AMPICILLIN 2G Ampicillin (as sodium) 2g Powder for Injection 1 Vial (Dry)

1276-1168-003 0147-116503-0801 AMPICILLIN 500MG Ampicillin (as sodium) 500mg Powder for Injection 1 Vial (Dry)

1464-1173-001 0031-115901-1451 AMVASC 10MG Amlodipine (as besilate) 10mg Capsules (Hard Gelatin) 30's (10's Blister x 3)

1464-1173-002 0031-115903-1451 AMVASC 2.5MG Amlodipine (as besilate) 2.5mg Capsules (Hard Gelatin) 30's (10's Blister x 3)

1464-1173-003 0031-115902-1451 AMVASC 5MG Amlodipine (as besilate) 5mg Capsules (Hard Gelatin) 30's (10's Blister x 3)

2344-1187-004 2104-118203-0391 ANGIOTEC 10 Enalapril maleate 10mg Tablets 30's Blister

2344-1187-005 2104-118201-0391 ANGIOTEC 20 Enalapril maleate 20mg Tablets 20's Blister

2344-1187-006 2104-118202-0391 ANGIOTEC 5 Enalapril maleate 5mg Tablets 30's Blister

1429-1188-001 0006-118301-1171 ANGISED 0.5MG Glyceryl trinitrate 0.5mg Tablets 100's Bottle

1436-7359-003 2066-290301-0391 ANTALLOS 5MG Levocetirizine 2HCl 5mg Film Coated Tablets 10's Blister

1360-7184-001 0118-532201-0391 ANTIPLEX 75 Clopidogrel (as bisulfate) 75mg Film Coated Tablets 30's (10's Blister x 3)

1969-1207-001 0170-119901-1022 APIDRA 100 U/ML Insulin - Glulisine 100 Units/ml Solution for Injection 3ml Cartridge x 5

1969-1207-002 0170-119901-1021 APIDRA 100 U/ML Insulin - Glulisine 100 Units/ml Solution for Injection 10ml Glass Vial

1283-5181-001 0044-119901-1021 APIDRA SOLOSTAR 100IU/ML Insulin - Glulisine 100 Units/ml Solution for Injection 3ml Pre-filled Pen x 5

1268-1210-001 0169-120201-1681 APIGEN 0.3% Gentamicin (as sulphate) 3mg/ml Eye / Ear Drops (Solution) 10ml Dropper Bottle

1272-1219-004 0171-120802-1171 APO-ATENOL 50MG Atenolol 50mg Tablets 30's (10's Blister x 3)

1892-4664-004 0173-121202-0511 APRESOLINE Hydralazine 20mg Injection Pack of 5 Ampoules x 1ml

1635-1223-001 0030-121401-0391 APROVEL 150MG Irbesartan 150mg Film Coated Tablets 28's (14's Blister x 2)

1635-1223-002 0030-121402-0391 APROVEL 300MG Irbesartan 300mg Film Coated Tablets 28's (14's Blister x 2)

1787-4645-001 0178-121501-0152 AQUALAN L 60% Aqua 60%, Petrolatum 60% Cream 100g

1544-6715-001 0067-155402-0391 ARBITENSE 100MG Losartan potassium 100mg Film Coated Tablets 30's (10's Blister x 3)

1544-6715-002 0067-155401-0391 ARBITENSE 50MG Losartan potassium 50mg Film Coated Tablets 30's (10's Blister x 3)

1531-1235-001 0090-122302-0391 ARCOXIA 120MG Etoricoxib 120mg Film Coated Tablets 7's Blister

1531-1235-003 0090-122301-0391 ARCOXIA 60MG Etoricoxib 60mg Film Coated Tablets 28's (7's Blister x 4)

1531-1235-006 0090-122303-0392 ARCOXIA 90MG Etoricoxib 90mg Film Coated Tablets 28's (7's Blister x 4)

1280-1241-001 0188-122801-0111 ARIMIDEX 1MG Anastrozole 1mg Coated Tablets 28's Calendar Pack (14's Blister x 2)

1464-7322-002 0031-125902-0391 AROX 400MG Moxifloxacin (as HCl) 400mg Film Coated Tablets 5's Strip

1464-7322-001 0031-125902-0392 AROX 400MG Moxifloxacin (as HCl) 400mg Film Coated Tablets 7's Strip

1754-4575-003 0194-123315-1021 ARTHRUM H 40MG/2ML Sodium hyaluronate 20mg/ml Intraarticular Injection 2ml Pre-filled Syringe x 3

1707-1250-001 0197-123903-0331 ASACOL 4% Mesalazine 40mg/ml Solution for Enema 100ml Bottle

1707-1250-002 0197-123903-0332 ASACOL 4% Mesalazine 40mg/ml Solution for Enema 50ml Bottle

1707-1250-003 0197-123902-0341 ASACOL 400 Mesalazine 400mg Tablets 100's

1707-1250-004 0197-123904-2231 ASACOL 500MG Mesalazine 500mg Rectal Suppositories 20's

1707-1250-005 0197-123901-1751 ASACOL 800 Mesalazine 800mg Gastro-Resistant Tablets 60's (10's Blister x 6)

Page 4: ADNIC bronze policy drug list Greenrain code DDC Code ...pbmuat.dimensions-healthcare.net/PBMLink/Website/pdf/ADNIC_Bronze_Drug... · 1699-1118-003 0046-111803-1171 ALLERFIN 4MG Chlorphenamine

Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1276-1254-001 0147-124001-2401 ASIA BRAX Chlordiazepoxide, Clidinium bromide 5mg, 2.5mg Sugar Coated Tablets 30's (10's Blister x 3)

1276-1255-001 0147-118502-0081 ASIA LOX Aluminium OH dried gel, Magnesium

hydroxide

132mg, 275mg Chewable Tablets 60's (10's Blister x 6)

1276-1256-001 0147-124101-0391 ASIAMODIN 20MG Famotidine 20mg Film Coated Tablets 20's (10's Blister x 2)

1276-1258-001 0147-124201-0341 ASIAPIRINE 81MG Aspirin 81mg Enteric Coated Tablets 20's (10's Blister x 2)

1276-1259-001 0147-106201-1161 ASIAVIT - M Vitamin & Mineral - A, B1, B2, B6, B12,

Nicotinamde, C, D, E, Iron (as Ferrous

sulfate),

2500 IU, 1.05mg, 1.2mg,

1.05mg, 4.5mcg, 13.5mg, 60mg,

400 IU, 15 IU, 10mg/5ml

Syrup 200ml Glass Bottle

1276-1257-001 0147-116604-1171 ASIAZOL 500MG Metronidazole 500mg Tablets 20's (10's Blister x 2)

2344-1262-004 ASMANORE 4MG Salbutamol (as sulfate) 4mg Tablets 30's (10's Blister x 3)

1704-1265-001 0201-124202-0341 ASPIMED 75 Aspirin 75mg Enteric Coated Tablets 56's (14's Blister x 4)

2250-1271-003 1150-124204-0341 ASPIRIN PROTECT 100MG Aspirin 100mg Enteric Coated Tablets 90's (10's Blister x 9)

1120-1271-005 1007-124204-0342 ASPIRIN PROTECT 100MG Aspirin 100mg Enteric Coated Tablets 30's (10's Blister x 3)

1747-1271-001 0096-124204-0341 ASPIRIN PROTECT 100MG Aspirin 100mg Enteric Coated Tablets 20's (10's Blister x 2)

1348-1276-001 0203-124505-1391 ASTHAVENT HFA

100UG/DOSE

Salbutamol (as sulfate) 100mcg Aerosol Inhaler 200 Doses Inhaler

1279-1277-002 0188-124904-1171 ATACAND 16MG Candesartan cilexetil 16mg Tablets 28's (14's Blister x 2)

1279-1277-006 0188-124901-1171 ATACAND 8MG Candesartan cilexetil 8mg Tablets 28's (14's Blister x 2)

1279-1278-001 0188-125001-1171 ATACAND PLUS Candesartan cilexetil,

Hydrochlorothiazide

16mg, 12.5mg Tablets 28's (14's Blister x 2)

1714-1279-004 0205-125104-0391 ATARAX 25MG Hydroxyzine diHCl 25mg Film Coated Tablets 25's Blister

2234-6200-001 0320-120801-0051 ATEN 100MG Atenolol 100mg Tablets (Caplets) 30's Plastic Bottle

2234-6200-003 0320-120802-0051 ATEN 50MG Atenolol 50mg Tablets (Caplets) 30's Plastic Bottle

1593-1280-001 0206-120801-0391 ATENO 100 Atenolol 100mg Film Coated Tablets 30's (10's Blister x 3)

1593-1280-002 0206-120802-0391 ATENO 50 Atenolol 50mg Film Coated Tablets 20's Blister

1431-6324-001 0503-211702-0391 ATORLIP 10MG Atorvastatin (as calcium amorphous) 10mg Film Coated Tablets 30's (10's Blister x 3)

1431-6324-002 0503-211703-0391 ATORLIP 20MG Atorvastatin (as calcium amorphous) 20mg Film Coated Tablets 30's (10's Blister x 3)

1431-6324-003 0503-211701-0391 ATORLIP 40MG Atorvastatin (as calcium amorphous) 40mg Film Coated Tablets 30's (10's Blister x 3)

1567-1283-003 0207-120802-1171 ATORMIN 50MG Atenolol 50mg Tablets 28's (14 Blister x 2)

1289-1286-003 0130-120703-0511 ATROPINE Atropine 0.6mg/ml Injection 1 Injection x 1ml

1967-6420-001 0042-367401-1391 ATROVENT COMP HFA

20MCG/50MCG

Ipratropium Bromide (as monohydrate),

Fenoterol HBr

20mcg, 50mcg Aerosol Inhaler 200 Metered Doses (10ml) Inhaler

1967-1290-001 0042-125406-1391 ATROVENT N 20MCG/PUFF

(CFC FREE)

Ipratropium bromide 20mcg Aerosol Inhaler 200 Metered Doses (10ml) Inhaler

1276-1292-001 0147-116208-0851 AUGMATIC 312.5 Co-amoxiclav 312.5mg (250mg + 62.5mg)/5ml Powder for Suspension 100ml Glass Bottle

1276-1292-002 0147-116207-0391 AUGMATIC 625 Co-amoxiclav 625mg (500mg + 125mg) Film Coated Tablets 10's (5's Blister x 2)

1671-1293-001 0139-116211-0781 AUGMENTIN 1200MG Co-amoxiclav 1200mg (1000mg + 200mg) Powder for Infusion 10 Vials (Lyophilisate)

1671-1293-002 0139-116203-2151 AUGMENTIN 156MG/5ML Co-amoxiclav 156.25mg (125mg +

31.25mg)/5ml

Powder for Syrup 100ml Bottle

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1671-1293-003 0139-116206-1171 AUGMENTIN 1G Co-amoxiclav 1g (875mg + 125mg) Tablets 14's (7's Blister x 2)

1671-1293-004 0139-116205-2151 AUGMENTIN 228MG/5ML Co-amoxiclav 228.5mg (200mg + 28.5mg)/5ml Powder for Syrup 70ml Bottle

1671-1293-007 0139-116201-0391 AUGMENTIN 375MG Co-amoxiclav 375mg (250mg + 125mg) Film Coated Tablets 20's (10's Blister x 2)

1671-1293-008 0139-116204-2151 AUGMENTIN 457MG/5ML Co-amoxiclav 457mg (400mg + 57mg)/5ml Powder for Syrup 70ml Glass Bottle

1671-1293-009 0139-116210-0781 AUGMENTIN 600MG Co-amoxiclav 600mg (500mg + 100mg) Powder for Infusion 10 Vials (Lyophilisate)

1671-1293-010 0139-116208-2091 AUGMENTIN 62.5MG/ML

(INFANT)

Co-amoxiclav 62.5mg (50mg + 12.5mg)/ml Powder for Drops (Oral) 20ml Bottle + Dropper

1671-1293-011 0139-116207-1171 AUGMENTIN 625MG Co-amoxiclav 625mg (500mg + 125mg) Tablets 20's (10's Blister x 2)

1797-4658-001 0213-118702-1171 AVACLOR 250MG Chloroquine Phosphate 250mg Tablets 6's

1300-1299-001 0054-125902-0391 AVALOX 400MG Moxifloxacin (as HCl) 400mg Film Coated Tablets 5's Blister

1300-1299-003 0054-125902-0392 AVALOX 400MG Moxifloxacin (as HCl) 400mg Film Coated Tablets 7's Blister

1750-5182-001 0189-126001-1971 AVAMYS 27.5MCG/DOSE Fluticasone furoate (micronised) 27.5mcg Nasal Spray 120 Actuations Spray Bottle

1774-4697-002 AVLOCLOR Chloroquine Phosphate 250MG Tablets 20's (10's Blister x 2)

1487-1307-001 0006-126701-1481 AVODART 0.5MG Dutasteride 0.5mg Capsules (Soft Gelatin) 30's (10's Blister x 3)

2429-6605-001 0997-380001-0671 AZARGA 10MG/ML +

5MG/ML

Brinzolamide, Timolol (as maleate) 10mg, 5mg/ml Eye Drops (Suspension) 5ml LDPE Dropper Bottle

1094-5578-001 0222-127301-0391 AZATHIOPRINE 50MG Azathioprine 50mg Film Coated Tablets 100's (25's Blister x 4)

1464-1316-003 0031-127401-0852 AZI-ONCE 200MG/5ML Azithromycin dihydrate 200mg/5ml Powder for Suspension 30ml Glass Bottle (Powder) + 1 Plastic

Ampoule (15ml Water) + 1 Plastic

Syringe (10ml)

1464-1316-002 0031-127401-0853 AZI-ONCE 200MG/5ML Azithromycin dihydrate 200mg/5ml Powder for Suspension 22.5ml Glass Bottle (Powder) + 1

Plastic Ampoule (12ml Water) + 1 1464-1316-001 0031-127401-0851 AZI-ONCE 200MG/5ML Azithromycin dihydrate 200mg/5ml Powder for Suspension 15ml Glass Bottle (Powder) + 1 Plastic

Ampoule (9ml Water) + 1 Plastic

Syringe (10ml)1464-1316-004 0031-127402-1451 AZI-ONCE 250MG Azithromycin dihydrate 250mg Capsules (Hard Gelatin) 6's Blister

1641-1318-001 0137-127402-1451 AZOMAX 250MG Azithromycin (as dihydrate) 250mg Capsules (Hard Gelatin) 6's Blister

1472-1319-001 0005-127401-0851 AZOMYCIN 200MG/5ML Azithromycin (as dihydrate) 200mg/5ml Powder for Suspension 15ml Bottle

1472-1319-003 0005-127402-1451 AZOMYCIN 250MG Azithromycin (as dihydrate) 250mg Capsules (Hard Gelatin) 6's Blister

2026-5678-001 0012-127601-0511 AZTREONAM AZTREONAM 1g Injection 1 Vial

1524-1328-004 0095-103201-0391 BACTIFLOX 500MG LACTABS Ciprofloxacin (as HCl) 500mg Film Coated Tablets 10's Blister

1524-1328-005 0095-103203-0391 BACTIFLOX 750 LACTAB Ciprofloxacin (as HCl) 750mg Film Coated Tablets 10's Blister

1392-1329-004 0035-128202-1161 BACTRIM Cotrimoxazole 240mg/5ml Syrup 100ml Bottle

1392-1330-002 0035-128203-1173 BACTRIM FORTE Cotrimoxazole 960mg Tablets 10's Blister

1973-1331-003 0139-128302-0651 BACTROBAN 2% Mupirocin 20mg/g Ointment 15g Tube

1622-1332-001 0202-128401-0151 BALAD 2% Fusidic Acid 20mg/g Cream 15g Tube

1368-1337-001 0228-128801-2021 BALKIS 0.05% Xylometazoline HCl 0.5mg/ml Nasal Drops 10ml Bottle

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1368-1337-002 0228-128802-2021 BALKIS 0.1% Xylometazoline HCl 1mg/ml Nasal Drops 10ml Bottle

1309-1342-001 0233-129301-0651 BANEOCIN Bacitracin zinc, Neomycin sulfate 250 IU, 5000 IU/g Ointment 20g Tube

1309-1342-002 0233-129301-1641 BANEOCIN Bacitracin zinc, Neomycin sulfate 4.583mg, 8.209mg/g Dusting Topical Powder 10g Plastic Bottle

1472-1352-001 0005-129703-1391 BECLOHALE 250MCG Beclomethasone dipropionate 250mcg Aerosol Inhaler 200 Metered Doses Inhaler

1472-1352-002 0005-129702-1391 BECLOHALE 50MCG Beclomethasone dipropionate 50mcg Aerosol Inhaler 200 Metered Doses Inhaler

1570-1353-001 0239-129701-1971 BECLOMET 100MCG/DOSE

NASAL AQUA

Beclomethasone dipropionate 100mcg Nasal Spray 200 Dose (23ml) Unit

2246-1373-006 0244-109606-0431 BENZAC AC 5% Benzoyl peroxide 50mg/g Gel 60g Tube

1805-1375-007 0096-130804-0151 BEPANTHEN 5% Dexpanthanol 50mg/g Cream 30g Tube

1805-1375-006 0096-130804-0651 BEPANTHEN 5% Dexpanthanol 50mg/g Ointment 30g Tube

1379-1382-001 0248-131401-0151 BETADERM 0.1% Betamethasone (as valerate) 1mg/g Cream 20g Tube

1379-1382-002 0248-131401-0651 BETADERM 0.1% Betamethasone (as valerate) 1mg/g Ointment 20g Tube

1847-4702-005 0249-125803-0651 BETADINE POVIDONE IODINE 0.1 Ointment 40gm tube x 1

1937-4702-006 0250-125803-2721 BETADINE Povidine Iodine 10% Vaginal Pessaries Pack x 14 Vaginal Pessaries

1847-4702-007 0250-125805-1401 BETADINE ANTISEPTIC PAINT Povidone Iodine 10gm/100ml Cold Sore  Antiseptic Paint 8ml Glass Bottle

1280-4939-001 0213-131701-0511 BETALOC Metoprolol 1mg/ml Injection Pack of 5 Ampoules x 5ml

1523-1385-002 0009-131402-0651 BETAMED Betamethasone (as valerate) 1mg/g Ointment 15g Collapsible Tube

1523-1385-001 0009-131402-0151 BETAMED Betamethasone (as valerate) 1mg/g Cream 15g Collapsible Tube

2341-1388-006 1291-380702-1171 BETASERC 8MG Betahistine dihydrochloride 8mg Tablets 100's (25's Blister x 4)

2341-1388-005 1291-380701-1171 BETASERC 16MG Betahistine dihydrochloride 16mg Tablets 60's (20's Blister x 3)

1464-1393-001 0031-131901-0151 BETAZOL Betamethasone dipropionate,

Miconazole nitrate

0.5mg, 20mg/g Cream 30g Tube

1464-1394-001 0031-132001-0151 BETAZOL G Betamethasone dipropionate,

Miconazole nitrate, Gentamicin

0.5mg, 20mg, 0.1mg/g Cream 30g Tube

1269-1398-001 0184-111202-1021 BETO-12 1MG/ML Cyanocobalamin 1mg/ml Solution for Injection 1ml Ampoule

1262-1399-001 0253-111202-1021 BETOLVEX 1MG/ML Vitamin - B12 (as Cyanocobalamin-

tannin Complex)

1mg/ml Solution For Injection 1ml Ampoule + 1 Disposable Syringe +

1 Needle

2344-1403-002 2104-381101-0391 BEVACOL 135MG Mebeverine HCl 135mg Film Coated Tablets 48's (16's Blister x 3)

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1567-1404-002 0207-131401-0651 BEVASON 0.1% Betamethasone (as valerate) 1mg/g Ointment 20g Collapsible Tube

1982-5462-002 0071-132605-0391 BI PRETERAX ARGININE

10MG/2.5MG

Perindopril arginine, Indapamide 10mg, 2.5mg Film Coated Tablets 30's LDPE Bottle

1982-5462-001 0071-132602-0391 BI PRETERAX ARGININE

5MG/1.25MG

Perindopril arginine, Indapamide 5mg, 1.25mg Film Coated Tablets 30's Bottle

1637-1411-001 0030-132701-0511 BICLINOCILLINE Penicillin benethamine, Penicillin

Sodium

Injection Vial + 3ml Solvent Ampoule

1631-7133-001 0397-378902-0391 BIODROXIL 1000MG Cefadroxil (as monohydrate) 1000mg Film Coated Tablets 12's (6's Blister x 2)

1631-7133-008 0397-378905-0462 BIODROXIL 500MG/5ML Cefadroxil (as monohydrate) 500mg/5ml Granules for Suspension 60ml Glass Bottle

1125-7313-002 BISOLOL 5 Bisoprolol (as fumarate) 5mg Film Coated Tablets 30's (10's Blister x 3)

1259-1425-001 0268-120801-1172 BLOKIUM 100MG Atenolol 100mg Tablets 15's Blister

1259-1425-003 0268-120802-1171 BLOKIUM 50MG Atenolol 50mg Tablets 30's (15's Blister x 2)

1699-1426-003 0046-125001-1171 BLOPRESS 16 PLUS Candesartan cilexetil,

Hydrochlorothiazide

16mg, 12.5mg Tablets 28's (14's Blister x 2)

1699-1426-001 0046-124904-1171 BLOPRESS 16MG Candesartan cilexetil 16mg Tablets 28's (14's Blister x 2)

1699-1426-004 0046-125002-1171 BLOPRESS 8 PLUS Candesartan cilexetil,

Hydrochlorothiazide

8mg, 12.5mg Tablets 28's (14's Blister x 2)

1699-1426-002 0046-124901-1171 BLOPRESS 8MG Candesartan cilexetil 8mg Tablets 28's (14's Blister x 2)

1392-1432-001 0035-134304-0391 BONVIVA 150MG Ibandronic Acid 150mg Film Coated Tablets 1's Blister

1121-6116-001 0274-135201-1171 BREXIN 20MG Piroxicam (as b-cyclodextrin) 20mg Tablets 20's (10's Blister x 2)

1279-6422-001 0188-366601-1171 BRILINTA 90 Ticagrelor 90mg Tablets 56's (14's Blister x 4)

2679-1457-015 BRUFEN 100MG/5ML Ibuprofen 100mg/5ml Syrup 100ml Plastic Bottle

2413-1457-011 0278-107904-1162 BRUFEN 100MG/5ML Ibuprofen 100mg/5ml Syrup 100ml Plastic Bottle

1241-1457-014 0278-107902-0391 BRUFEN 400MG Ibuprofen 400mg Film Coated Tablets 30's (10's Blister x 3)

1241-1457-013 0278-107903-0391 BRUFEN 600MG Ibuprofen 600mg Film Coated Tablets 30's (10's Blister x 3)

1241-1458-002 0278-107905-1141 BRUFEN RETARD 800MG Ibuprofen 800mg Sustained Release Tablets 20's (10's Blister x 2)

1348-6765-002 1393-135919-3301 BUDECORT 100 HFA Budesonide 100mcg Aerosol Inhaler 200 Metered Doses Inhaler

1348-6765-003 1393-135920-3301 BUDECORT 200 HFA Budesonide 200mcg Aerosol Inhaler 200 Metered Doses Inhaler

1317-1465-001 0042-136501-1173 BUSCOPAN 10MG Hyocine butylbromide 10mg Tablets 20's (10's Blister x 2)

2015-5252-003 0284-136701-1171 BUSPIRONE Buspirone 10mg Tablets 100's

2015-5252-002 0284-136702-1171 BUSPIRONE Buspirone 5mg Tablets 100's

1472-1467-008 0005-124501-1172 BUTALIN 4MG Salbutamol (as sulfate) 4mg Tablets 20's Blister

1583-1469-001 0186-136903-0391 CADUET 10MG/10MG Amlodipine (as besilate), Atorvastatin

(as calcium)

10mg, 10mg Film Coated Tablets 30's Bottle

1583-1469-004 0186-136906-0391 CADUET 5MG/10MG Amlodipine (as besilate), Atorvastatin

(as calcium)

5mg, 10mg Film Coated Tablets 30's Bottle

1632-1471-002 0285-137101-1172 CAFERGOT Ergotamine tartrate, Caffeine

anhydrous

1mg, 100mg Tablets 20's

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1288-1472-001 0220-137301-2571 CALAMINE Calamine Topical Lotion 100ml

1782-4641-001 0288-137301-0572 CALAMINE GREEN WOOD Calamine lotion Lotion 150ml

1697-5254-001 0291-138201-1971 CALCITEC 200 IU Calcitonin (salmon, synthetic) 200 IU Nasal Spray 1.5ml (14 Sprays) Spray Bottle

1632-1482-001 0285-139201-0271 CALCIUM SANDOZ FORTE

500MG

Minerals - Calcium carbonate, Calcium

lactate-gluconate

0.3g, 2.94g Effervescent Tablets 10's

1475-1489-001 0017-138905-2471 CALSYR Calcium glubionate, Calcium

lactobionate

1.437g, 0.295g/5ml Syrup (Alcohol Free) 100ml Glass Bottle

1735-1490-001 0069-138502-1171 CALTRATE 600MG Calcium (as Calcium Carbonate) 600mg Tablets 60's Bottle

1794-4649-001 0243-139502-1171 CALTRATE WITH VITAMIN D

600MG + 200 IU

Calcium Carbonate, Vitamin D3 600mg + 200 IU Tablets 60's Bottle

1125-6677-001 0013-124904-1171 CANDESART 16 Candesartan cilexetil 16mg Tablets 30's (10's Blister x 3)

1125-6677-002 0013-124901-1171 CANDESART 8 Candesartan cilexetil 8mg Tablets 30's (10's Blister x 3)

1697-5913-001 0195-140201-1451 CANDEUR 150MG Fluconazole 150mg Capsules (Hard Gelatin) 1's Blister

1249-1496-001 0307-140201-1451 CANDIVAST 150MG Fluconazole 150mg Capsules (Hard Gelatin) 1's Blister

1523-1497-002 0009-140401-1211 CANDIZOLE 2% Miconazole nitrate 20mg/g Vaginal Cream 45g Collapsible Tube + Applicator

1523-1497-001 0009-140401-0151 CANDIZOLE 2% Miconazole nitrate 20mg/g Cream 30g Collapsible Tube

1120-1499-007 1007-140501-0151 CANESTEN 1% Clotrimazole 10mg/g Cream 20g Tube

1747-1499-006 0096-140503-1241 CANESTEN 500MG Clotrimazole 500mg Vaginal Tablets 1's Strip + Applicator

1334-1502-001 0011-101802-1171 CAPOTEN 25MG Captopril 25mg Tablets 30's Blister

1334-1502-002 0011-101801-1171 CAPOTEN 50MG Captopril 50mg Tablets 30's Blister

1442-1515-001 0313-141503-1171 CARDURA 1MG Doxazosin (as mesilate) 1mg Tablets 20's (2 x 10's Blister)

1442-1515-003 0313-141502-1171 CARDURA 4MG Doxazosin (as mesilate) 4mg Tablets 20's (2 x 10's Blister)

1344-1520-002 0183-142201-2401 CATAFLAM 50MG Diclofenac potassium 50mg Sugar Coated Tablets 20's (10's Blister x 2)

1318-1521-003 0042-142302-0511 CATAPRESS Clonidine Hydrochloride 150 mcg/ml Injection Pack of 5 Ampoules x 1ml

1342-1526-001 0320-107701-0801 CEBACT 1000 Ceftriaxone sodium 1g Powder for Injection 1 Vial (Dry)

2414-1531-005 0252-133012-0851 CECLOR 125MG/5ML Cefaclor (as monohydrate) 125mg/5ml Powder for Suspension 75ml Bottle

2414-1531-006 0252-133001-0851 CECLOR 250 MG/5ML Cefaclor (as monohydrate) 250mg/5ml Powder for Suspension 75ml HDPE Bottle

2414-1532-004 0252-133006-1171 CECLOR MR 375MG Cefaclor (as monohydrate) 375mg Tablets 10's Blister

2414-1532-005 0252-133002-1171 CECLOR MR 500MG Cefaclor (as monohydrate) 500mg Tablets 10's Blister

1250-1537-001 0135-142702-0801 CEFAMEZIN 1000MG Cefazolin Sodium 1g Powder for Injection 1 Vial (Dry) + 1 Diluent Ampoule (3ml)

1250-1537-002 0135-142701-0511 CEFAMEZIN 500MG Cefazolin Sodium 500mg Injection 1 Vial

1523-1539-003 0009-142802-1451 CEFAXINE 250 Cefalexin (as monohydrate) 250mg Capsules (Hard Gelatin) 20's (10's Blister x 2)

1523-1539-006 0009-142801-1451 CEFAXINE 500 Cefalexin (as monohydrate) 500mg Capsules (Hard Gelatin) 20's (10's Blister x 2)

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1567-5466-001 0207-142901-1452 CEFIM 200 Cefixime 200mg Capsules (Hard Gelatin) 12's (3's Blister x 4)

1567-5466-002 0207-142902-1451 CEFIM 400 Cefixime 400mg Capsules (Hard Gelatin) 6's (3's Blister x 2)

1592-1540-001 0219-142903-0851 CEFIX 100MG/5ML Cefixime (as trihydrate) 100mg/5ml Powder for Suspension 30ml Glass Bottle + Graduated Spoon

1592-1540-002 0219-142903-0852 CEFIX 100MG/5ML Cefixime (as trihydrate) 100mg/5ml Powder for Suspension 60ml Glass Bottle + Graduated Spoon

1592-1540-004 0219-142902-1451 CEFIX 400 Cefixime (as trihydrate) 400mg Capsules (Hard Gelatin) 5's Blister

1592-1543-001 0219-143105-0391 CEFODOX 100MG Cefpodoxime (as proxetil) 100mg Film Coated Tablets 10's Blister

1592-1543-002 0219-143104-0851 CEFODOX 100MG/5ML Cefpodoxime (as proxetil) 100mg/5ml Powder for Suspension 50ml Glass Bottle

1592-1543-003 0219-143102-0392 CEFODOX 200MG Cefpodoxime (as proxetil) 200mg Film Coated Tablets 10's Blister

1592-1543-004 0219-143103-0851 CEFODOX 50MG/5ML Cefpodoxime (as proxetil) 50mg/5ml Powder for Suspension 50ml Glass Bottle

2342-6678-002 1313-386402-0801 CEFOKEM 500MG IM/IV Cefotaxime (as sodium) 500mg Powder for Injection 1 Glass Vial (Powder)

1523-4583-001 0009-143408-0851 CEFPROZ 125 Cefprozil Anhydrous 125mg/5ml Powder for Suspension 50ml Glass Bottle

1523-4583-002 0009-143402-0851 CEFPROZ 250 Cefprozil anhydrous (as Cefprozil) 250mg/5ml Powder for Suspension 50ml Glass Bottle

1523-1545-003 0009-143502-1451 CEFRAMED 500 Cephradine (as monohydrate) 500mg Capsules (Hard Gelatin) 20's (10's Blister x 2)

1472-1546-001 0005-142812-0851 CEFRIN 125MG/5ML Cefalexin (as monohydrate) 125mg/5ml Powder for Suspension 100ml Bottle

1472-1546-006 0005-142804-0851 CEFRIN 250MG/5ML Cefalexin (as monohydrate) 250mg/5ml Powder for Suspension 100ml Bottle

1472-1546-009 0005-142801-1452 CEFRIN 500MG Cefalexin (as monohydrate) 500mg Capsules (Hard Gelatin) 20's (10's Blister x 2)

1697-1548-001 0195-107705-1371 CEFTRIAXONE-TABUK 0.5G IV Ceftriaxone (as sodium) 500mg Powder for Injection 1 Vial (Dry) + 1 Solvent Ampoule (5ml)

1697-1548-003 0195-107704-0801 CEFTRIAXONE-TABUK 1G IV Ceftriaxone (as sodium) 1g Powder for Injection 1 Vial (Dry) + 1 Solvent Ampoule

(10ml)1592-1549-002 0219-143601-0391 CEFUTIL 250MG Cefuroxime (as axetil) 250mg Film Coated Tablets 10's Blister

1592-1549-003 0219-143602-1171 CEFUTIL 500MG Cefuroxime (as axetil) 500mg Tablets 10's Bottle

1472-1550-001 0005-143604-0391 CEFUZIME 125MG Cefuroxime (as axetil) 125mg Film Coated Tablets 10's (5's Blister x 2)

1472-1550-003 0005-143601-0391 CEFUZIME 250MG Cefuroxime (as axetil) 250mg Film Coated Tablets 10's (5's Blister x 2)

1472-1550-004 0005-143602-0391 CEFUZIME 500MG Cefuroxime (as axetil) 500mg Film Coated Tablets 10's (5's Blister x 2)

1541-1551-001 0326-142702-0801 CEFZALIN 1000MG Cefazolin Sodium 1000mg Powder for Injection 1 Vial (Dry)

1541-1551-002 0326-142701-0801 CEFZALIN 500MG Cefazolin Sodium 500mg Powder for Injection 1 Vial (Dry)

1340-1552-002 0011-143408-0852 CEFZIL 125MG/5ML Cefprozil 125mg/5ml Powder for Suspension 50ml

1340-1552-003 0011-143405-0391 CEFZIL 250MG Cefprozil 250mg Film Coated Tablets 10's (5's Blister x 2)

1340-1552-005 0011-143402-0851 CEFZIL 250MG/5ML Cefprozil 250mg/5ml Powder for Suspension 50ml

1340-1552-006 0011-143404-0391 CEFZIL 500MG Cefprozil 500mg Film Coated Tablets 10's (5's Blister x 2)

1583-1553-002 0186-143701-0061 CELEBREX 200MG Celecoxib 200mg Capsules 10's Blister

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1360-1567-001 0118-142801-1452 CEPHADAR FORTE 500MG Cefalexin (as monohydrate) 500mg Capsules (Hard Gelatin) 20's (10's Blister x 2)

1616-6773-001 0333-368802-1171 CEPODEM 200 Cefpodoxime (as proxetil) 200mg Tablets 10's Blister

1787-4643-001 0178-145001-0152 CERALAN 55% Aqua 55%, Ceramide 55% Cream 100g

1507-1580-002 0325-143602-1171 CETIL 500 Cefuroxime axetil 500mg Tablets 10's Blister

1472-1581-001 0005-123701-0391 CETRALON 10MG Cetirizine HCl 10mg Film Coated Tablets 10's Blister

1472-1581-002 0005-123703-1161 CETRALON 5MG/5ML Cetirizine HCl 5mg/5ml Syrup 75ml Bottle

1228-1586-002 1233-107904-2421 CHILDREN'S ADVIL

100MG/5ML

Ibuprofen 100mg/5ml Suspension (Alcohol Free) 100ml Plastic Bottle

1151-5702-001 0223-119702-0511 CHLORAMPHENICOL CHLORAMPHENICOL 1.2g Injection 1 Vial x 10's

1472-1591-003 0005-111806-1161 CHLOROHISTOL 2MG/5ML Chlorphenamine Maleate 2mg/5ml Syrup 100ml Glass Bottle

1472-1591-005 0005-111803-1171 CHLOROHISTOL 4MG Chlorphenamine Maleate 4mg Tablets 20's Blister

2047-5265-001 0342-118703-0511 CHLOROQUINE SULPHATE Chloroquine Sulphate 40mg/ml Injection 5ml Vial

1988-4625-004 0345-146502-1171 CHLORPROMAZINE Chlorpromazine 25mg Tablets 100's

1369-4625-005 0344-146501-1171 CHLORPROMAZINE Chlorpromazine 50mg Tablets 100's

1768-4625-006 0347-146504-1171 CHLORPROMAZINE Chlorpromazine 100mg Tablets 100's

2060-5266-001 0351-146701-0452 CHOLESTYRAMINE RESIN Cholestyramine resin Granules 30's (4g)

1475-1603-004 0102-103201-0391 CIFLOX 500MG Ciprofloxacin (as HCl) 500mg Film Coated Tablets 10's Blister

1253-1608-001 0085-103204-0371 CILOXAN 0.3% Ciprofloxacin (as HCl) 3mg/ml Eye Drops (Solution) 5ml Dropper Bottle

2469-7065-003 1394-395404-0391 CINFALAIR 10MG Montelukast (as sodium) 10mg Film Coated Tablets 28's (7's Blister x 4)

2469-7065-001 1394-395401-0081 CINFALAIR 4MG Montelukast (as sodium) 4mg Chewable Tablets 28's (7's Blister x 4)

2469-7065-002 1394-395402-0081 CINFALAIR 5MG Montelukast (as sodium) 5mg Chewable Tablets 28's (7's Blister x 4)

2469-7065-004 1394-395401-2082 CINFALAIR PAEDIATRIC 4MG Montelukast (as sodium) 4mg Granules for Liquid (Oral) 4mg Sachet x 28

2469-6766-001 1394-166103-0391 CINFAVAL 160MG Valsartan 160mg Film Coated Tablets 28's (7's Blister x 4)

2469-6766-004 1394-166101-0391 CINFAVAL 80MG Valsartan 80mg Film Coated Tablets 28's (7's Blister x 4)

1438-1613-001 0354-144302-1171 CIPRAM 20MG Citalopram (as HBr) 20mg Tablets 28's (14's Blister x 2)

1300-1614-003 0054-103202-0391 CIPROBAY 250MG Ciprofloxacin (as HCl ) 250mg Film Coated Tablets 10's Blister

1300-1614-004 0054-103201-0391 CIPROBAY 500MG Ciprofloxacin (as HCl ) 500mg Film Coated Tablets 10's Blister

1622-1616-001 0355-103204-1681 CIPROCIN 0.3% Ciprofloxacin (as HCl) 3mg/ml Eye / Ear Drops (Solution) 5ml Plastic Dropper Bottle

1360-1617-002 0118-103201-0391 CIPRODAR 500MG Ciprofloxacin (as HCl monohydrate) 500mg Film Coated Tablets 10's Blister

1622-1620-002 0355-103201-0391 CIPROGEN 500MG Ciprofloxacin (as HCl) 500mg Film Coated Tablets 10's Blister

1369-1621-001 0356-103202-0391 CIPROLET 250MG Ciprofloxacin (as HCl) 250mg Film Coated Tablets 10's Blister

1369-1621-002 0356-103201-0391 CIPROLET 500MG Ciprofloxacin (as HCl) 500mg Film Coated Tablets 100's Plastic Bottle

1369-1621-003 0356-103201-0392 CIPROLET 500MG Ciprofloxacin (as HCl) 500mg Film Coated Tablets 10's Blister

1680-1623-001 0252-103202-0391 CIPROMAX 250MG Ciprofloxacin (as HCl.H2O) 250mg Film Coated Tablets 10's Blister

1680-1623-002 0252-103201-0391 CIPROMAX 500MG Ciprofloxacin (as HCl.H2O) 500mg Film Coated Tablets 10's Blister

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1680-1623-003 0252-103203-0391 CIPROMAX 750 Ciprofloxacin (as HCl.H2O) 750mg Film Coated Tablets 10's Blister

1592-1624-002 0219-103201-0391 CIPROPHARM 500MG Ciprofloxacin (as HCl) 500mg Film Coated Tablets 10's Blister

1125-6158-001 0013-116206-0391 CLAMOX 1G Co-amoxiclav 1g (875mg + 125mg) Film Coated Tablets 14's (7's Blister x 2)

1125-6158-002 0013-116207-0391 CLAMOX 625MG Co-amoxiclav 625mg (500mg + 125mg) Film Coated Tablets 20's (10's Blister x 2)

1472-1638-001 0005-148601-0391 CLAMYCIN 250MG Clarithromycin 250mg Film Coated Tablets 14's (7's Blister x 2)

1472-1638-002 0005-148602-0391 CLAMYCIN 500MG Clarithromycin 500mg Film Coated Tablets 14's (7's Blister x 2)

1464-1639-001 0031-148701-1171 CLARA 10MG Loratadine 10mg Tablets 10's Blister

1360-1642-003 0118-148608-0851 CLARIDAR 125 Clarithromycin 125mg/5ml Powder for Suspension 60ml Glass Bottle

1360-1642-002 0118-148602-0391 CLARIDAR 500MG Clarithromycin 500mg Film Coated Tablets 14's Plastic Bottle

1622-4586-001 0202-148601-0391 CLARIMAC 250MG Clarithromycin 250mg Film Coated Tablets 14's Blister

1622-4586-002 0202-148602-0391 CLARIMAC 500MG Clarithromycin 500mg Film Coated Tablets 14's (7's Blister x 2)

1650-1643-001 0070-148901-1171 CLARINASE REPETABS Loratadine, Pseudoephedrine (as base

and sulphate)

5mg, 120mg Tablets 14's

1650-1644-002 0070-148701-1172 CLARITINE 10MG Loratadine 10mg Tablets 30's (15's Blister x 2)

1697-1645-003 0195-148608-0851 CLARITT 125 Clarithromycin 125mg/5ml Powder for Suspension 60ml Plastic Bottle

1697-1645-001 0195-148601-0391 CLARITT 250 Clarithromycin 250mg Film Coated Tablets 14's Blister

1697-1645-004 0195-148605-0851 CLARITT 250 Clarithromycin 250mg/5ml Powder for Suspension 70ml Plastic Bottle

1697-1645-002 0195-148602-0391 CLARITT 500 Clarithromycin 500mg Film Coated Tablets 14's Blister

1697-6098-001 0195-148602-0361 CLARITT XL 500 Clarithromycin 500mg Extended Release Tablets 7's Blister

1592-1646-002 0219-148602-0391 CLARIXIN 500MG Clarithromycin 500mg Film Coated Tablets 14's (7's Blister x 2)

1360-6425-002 0118-116206-0391 CLAVODAR 1G Co-amoxiclav 1g (875mg + 125mg) Film Coated Tablets 14's (7's Blister x 2)

1121-5582-001 0274-129703-1391 CLENIL 250MCG Beclomethasone dipropionate 250mcg Aerosol Inhaler 200 Metered Doses Inhaler

1285-1648-001 0044-387604-1021 CLEXANE 10000 ANTI-XA

IU/1ML

Enoxaparin Sodium 100mg/ml Solution for Injection 1ml Syringe x 2

1285-1648-003 0044-387605-1021 CLEXANE 4000 ANTI-XA

IU/0.4ML

Enoxaparin Sodium 100mg/ml Solution for Injection 0.4ml Syringe x 2

1285-1648-004 0044-387602-1021 CLEXANE 6000 ANTI-XA

IU/0.6ML

Enoxaparin Sodium 100mg/ml Solution for Injection 0.6ml Syringe x 2

1285-1648-005 0044-387601-1021 CLEXANE 8000 ANTI-XA

IU/0.8ML

Enoxaparin Sodium 100mg/ml Solution for Injection 0.8ml Syringe x 2

1703-1651-001 0366-149102-2611 CLINDACIN T 1% Clindamycin ( as phosphate) 10mg/ml Topical Solution 50ml Squeeze Bottle

1703-1658-001 0366-149801-0151 CLODERM 0.05% Clobetasol propionate 0.5mg/g Cream 25g Tube

1472-1660-010 0005-149904-2231 CLOFEN 50MG Diclofenac Sodium 50mg Rectal Suppositories 10's Strip

2235-6161-002 0988-244101-0391 CLOPACIN 75MG Clopidogrel (as besylate) 75mg Film Coated Tablets 28's (14's Blister x 2)

1360-1667-001 0118-133012-0461 CLORACEF 125MG/5ML Cefaclor 125mg/5ml Granules for Suspension 75ml Bottle

1360-1667-004 0118-133011-0461 CLORACEF 375MG/5ML Cefaclor (as monohydrate) 375mg/5ml Granules for Suspension 75ml Glass Bottle

1360-1669-001 0118-133002-2001 CLORACEF MR 500MG Cefaclor 500mg Modified Release Tablets 10's Blister

1360-1669-002 0118-133005-2001 CLORACEF MR 750MG Cefaclor 750mg Modified Release Tablets 10's Blister

1635-1673-001 0030-150602-1171 COAPROVEL 150/12.5MG Irbesartan, Hydrochlorothiazide 150mg, 12.5mg Tablets 28's (14's Blister x 2)

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1635-1673-002 0030-150601-1171 COAPROVEL 300/12.5MG Irbesartan, Hydrochlorothiazide 300mg, 12.5mg Tablets 28's (14's Blister x 2)

2344-1674-003 2104-378501-0393 COBAL 500MCG Mecobalamin 500mcg Film Coated Tablets 30's (15's Blister x 2)

2469-6767-001 1394-151101-0391 CO-CINFAVAL

160MG/12.5MG

Valsartan, Hydrochlorthiazide 160mg, 12.5mg Film Coated Tablets 28's (7's Blister x 4)

2469-6767-003 1394-151103-0391 CO-CINFAVAL 80MG/12.5MG Valsartan, Hydrochlorthiazide 80mg, 12.5mg Film Coated Tablets 28's (7's Blister x 4)

2083-4964-002 0370-150701-1171 CO-CODAMOL Paracetamol, codeine 500mg+ 30mg Tablets 100's

1556-1679-001 0027-151101-0391 CO-DIOVAN 160/12.5 Valsartan, Hydrochlorthiazide 160mg, 12.5mg Film Coated Tablets 28's Calendar Pack (14's Blister x 2)

1556-1679-003 0027-151103-0391 CO-DIOVAN 80/12.5 Valsartan, Hydrochlorthiazide 80mg, 12.5mg Film Coated Tablets 28's Calendar Pack (14's Blister x 2)

1825-4717-005 1558-151502-1171 COLCHICINE Colchicine 0.5mg Tablets 100's Bottle

1593-1683-001 0206-103901-1161 COLDIFED Pseudoephedrine HCl, Triprolidine HCl 30mg, 1.25mg/5ml Syrup 120ml Glass Bottle

2085-5275-001 0377-151701-1631 COLICAID Simethicone 40mg Drops (Oral) 30ml

1252-1696-001 0023-151901-1681 COLIRCUSI GENTADEXA Dexamethasone sodium phosphate,

Gentamicin (as Sulphate), Tetryzoline

Combination Eye / Ear Drops (Solution) 10ml Plastic Dropper Bottle

1252-1697-001 0023-120201-1681 COLIRCUSI GENTAMICIN 0.3% Gentamicin (as sulphate) 3mg/ml Eye / Ear Drops (Solution) 10ml Plastic Dropper Bottle

1405-4965-002 0380-152001-0511 COLOMYCIN COLISTIN 1 Million (1000000) IU Injection 1 Vial

1379-1705-001 0248-132301-1171 COLOSPASMIN FORTE 135MG Mebeverine HCl 135mg Tablets 20's (10's Blister x 2)

1527-1721-001 0321-133803-0391 CONCOR COR 2.5MG Bisoprolol fumarate 2.5mg Film Coated Tablets 30's (10's Blister x 3)

1527-1722-001 0321-133802-0392 CONCOR 10 Bisoprolol fumarate 10mg Film Coated Tablets 30's

1527-1723-001 0321-133801-0392 CONCOR 5 Bisoprolol fumarate 5mg Film Coated Tablets 30's

1527-1720-001 0321-153301-1171 CONCOR 5 PLUS Bisoprolol fumarate,

Hydrochlorothiazide

5mg, 12.5mg Tablets 30's (10's Blister x 3)

1776-5276-001 0386-153501-1171 CONJUGATED ESTROGENS /

MEDROXYPROGESTERONE

Conjugated Estrogens,

Medroxyprogesterone

0.625mg / 2.5mg Tablets 100's

1392-1731-001 0035-153801-1171 COPEGUS 200MG Ribavirin 200mg Tablets 168's Bottle

1635-1733-001 0030-115602-0511 CORDARONE 150MG/3ML Amiodarone HCl 50mg/ml Injection 3ml Ampoule x 6

1635-1733-002 0030-115601-1171 CORDARONE 200MG Amiodarone HCl 200mg Tablets 30's (10's Blister x 3)

1529-1746-001 0090-154701-0371 COSOPT 2% / 0.5% Dorzolamide (as HCl), Timolol (as

maleate)

20mg, 5mg/ml Eye Drops (Solution) 5ml Dropper Bottle

1779-1747-003 0012-155004-1171 COUMADIN 1MG Warfarin 1mg Tablets 100's

1338-1747-001 0393-155002-1171 COUMADIN 2.5MG Warfarin Sodium 2.5mg Tablets 100's (10's Blister x 10)

1779-1747-004 0012-155003-1171 COUMADIN 2MG Warfarin 2mg Tablets 100's

1338-1747-002 0393-155001-1171 COUMADIN 5MG Warfarin Sodium 5mg Tablets 100's (10's Blister x 10)

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1125-6884-001 0013-151101-0391 COVALIS 160/12.5 Valsartan, Hydrochlorthiazide 160mg, 12.5mg Film Coated Tablets 30's (10's Blister x 3)

1125-6884-003 0013-151103-0391 COVALIS 80/12.5 Valsartan, Hydrochlorthiazide 80mg, 12.5mg Film Coated Tablets 30's (10's Blister x 3)

1982-5914-001 0071-155101-1171 COVERAM 10MG/10MG Perindopril arginine, Amlodipine (as

besilate)

10mg, 10mg Tablets 30's Polypropylene Tube

1982-5914-002 0071-155104-1171 COVERAM 10MG/5MG Perindopril arginine, Amlodipine (as

besilate)

10mg, 5mg Tablets 30's Polypropylene Tube

1982-5914-003 0071-155102-1171 COVERAM 5MG/10MG Perindopril arginine, Amlodipine (as

besilate)

5mg, 10mg Tablets 30's Polypropylene Tube

1982-5914-004 0071-155103-1171 COVERAM 5MG/5MG Perindopril arginine, Amlodipine (as

besilate)

5mg, 5mg Tablets 30's Polypropylene Tube

1499-1748-001 0071-155201-1171 COVERSYL 10MG Perindopril arginine 10mg Tablets 30's Bottle

1499-1748-003 0071-155202-1171 COVERSYL 5MG Perindopril arginine 5mg Tablets 30's Bottle

2690-7538-002 2118-143701-1451 COXIB 200 Celecoxib 200mg Capsules (Hard Gelatin) 10's Blister

1622-1749-001 0202-155302-1171 COXICAM 15MG Meloxicam 15mg Tablets 10's Blister

1529-1750-001 0090-155402-0391 COZAAR 100MG Losartan potassium 100mg Film Coated Tablets 30's (10's Blister x 3)

1529-1750-002 0090-155401-1171 COZAAR 50MG Losartan potassium 50mg Tablets 28's (14's Blister x 2)

1280-1752-001 0188-155602-0391 CRESTOR 10MG Rosuvastatin (as calcium) 10mg Film Coated Tablets 28's Calendar Pack (14's Blister x 2)

1280-1752-002 0188-155601-0391 CRESTOR 20MG Rosuvastatin (as calcium) 20mg Film Coated Tablets 28's Calendar Pack (14's Blister x 2)

1280-1752-004 0188-155604-0391 CRESTOR 5MG Rosuvastatin (as calcium) 5mg Film Coated Tablets 28's (14's Blister x 2)

1822-4718-002 0395-156001-0511 CRYSTAPEN BENZYLPENICILLIN 1,000,000MU Injection 1 Vial x 25

1631-1758-005 0397-116211-0801 CURAM 1.2G Co-amoxiclav 1200mg Powder for Injection 10 Vials (Powder)

1309-1758-001 0233-116203-0851 CURAM 156.25MG/5ML Co-amoxiclav 156.25mg (125mg +

31.25mg)/5ml

Powder for Suspension 100ml Glass Bottle

1631-1758-002 0397-116206-1171 CURAM 1G Co-amoxiclav 1g (875mg + 125mg) Tablets 14's (2's Stip x 7)

1631-1758-004 0397-116204-0851 CURAM 457MG/5ML Co-amoxiclav 457mg (400mg + 57mg)/5ml Powder for Suspension 70ml Glass Bottle

1631-1758-006 0397-116213-0801 CURAM 600MG Co-amoxiclav 600mg Powder for Injection 10 Vials (Powder)

1631-1758-003 0397-116207-0391 CURAM 625MG Co-amoxiclav 625mg (500mg + 125mg) Film Coated Tablets 20's (4's Foil Strip x 5)

1252-1760-004 0023-112103-0371 CUSICROM 4% Sodium cromoglycate 40mg/ml Eye Drops (Solution) 10ml Dropper Bottle

1252-1762-002 0023-120501-0371 CUSIMOLOL 0.5% Timolol (as maleate) 5mg/ml Eye Drops (Solution) 5ml Dropper Bottle

1252-1763-001 0023-102407-0381 CUSIVIRAL 3% Aciclovir 30mg/g Eye Ointment 4.5g Tube

1750-1765-002 0006-126003-0651 CUTIVATE 0.005% Fluticasone propionate 0.05mg/g Ointment 15g Tube

1750-1765-004 0006-126002-0151 CUTIVATE 0.05% Fluticasone propionate 0.5mg/g Cream 15g Tube

1097-1766-002 1050-367701-1451 CYCLO 3 FORTE Hesperidin (as methylchalcone), Ruscus

aculeatus (as extract at 22% of sterolic

150mg, 150mg, 100mg Capsules (Hard Gelatin) 30's Glass Bottle

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1657-1770-001 0078-102404-1171 CYCLOVIRAL 200MG Aciclovir 200mg Tablets 20's (10's Blister x 2)

1503-1772-001 0094-157001-1451 CYMBALTA 30MG Duloxetin HCl 30mg Capsules (Hard Gelatin) 28's (14's Blister x 2)

1503-1772-002 0094-157002-1451 CYMBALTA 60MG Duloxetin HCl 60mg Capsules (Hard Gelatin) 28's (14's Blister x 2)

1700-1776-001 0271-293901-0391 CYSTONE Achyranthes aspera (Prickly chaff flower

extract), Cyperus scariosus (Umberila's

edge extract), Didymocarpus pedicellata

(Shilapushpa extract), Mineral pitch

(purified shilajeet powder), Onosma

32mg, 32mg, 130mg, 26mg,

32mg, 32mg, 98mg, 32mg

Film Coated Tablets 60's HDPE Bottle

1499-1789-001 0071-158501-0391 DAFLON 500MG Diosmin (Flavonoidic fraction),

Hesperidine (as Flavonoids)

450mg, 50mg Film Coated Tablets 30's (15's Blister x 2)

1498-1798-003 0281-367801-0432 DAIVOBET Calcipotriol (as hydrate),

Betamethasone (as dipropionate)

50mcg, 0.5mg/g Gel 30g HDPE Bottle

1498-1798-005 0281-367801-0652 DAIVOBET Calcipotriol (as hydrate),

Betamethasone (as dipropionate)

50mcg, 0.5mg/g Ointment 30g Collapsible Tube

1497-1799-004 0281-159001-2262 DAIVONEX 50MCG/ML Calcipotriol 50mcg/ml Scalp Solution 30ml Squeeze Bottle

1465-1800-001 0415-159101-0151 DAKTACORT Hydrocortisone, Miconazole Nitrate 10mg, 20mg/g Cream 15g Tube

1465-1801-003 0415-140401-0151 DAKTARIN 2% Miconazole nitrate 20mg/g Cream 30g Tube

1465-1801-006 0415-140401-1641 DAKTARIN 2% Miconazole nitrate 20mg/g Dusting Topical Powder 20g Plastic Jar

1465-1801-005 0415-140401-1781 DAKTARIN 2% Miconazole (as nitrate) 20mg/g Gel (Oral) 40g Tube

1595-1803-001 0318-149102-2571 DALACIN T 1% Clindamycin (as phosphate) 10mg/ml Topical Lotion 30ml

1597-1804-001 0416-149105-2711 DALACIN VAGINAL OVULE

100MG

Clindamycin (as phosphate) 100mg Vaginal Ovules 3's Strip + Applicator

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1589-1805-008 0336-149103-1451 DALACIN-C 150MG Clindamycin (as HCl) 150mg Capsules (Hard Gelatin) 16's (8's Blister x 2)

1589-1805-009 0336-149106-1451 DALACIN-C 300MG Clindamycin (as HCl) 300mg Capsules (Hard Gelatin) 16's (8's Blister x 2)

1595-1805-004 0318-149107-0511 DALACIN-C 300MG/2ML

I.M/I.V

Clindamycin (as phosphate) 150mg/ml Injection 2ml Ampoule

2702-7529-001 2149-368008-2011 DALMAN AQ 50MCG Fluticasone propionate 50mcg Nasal Spray 120 Metered Sprays Bottle

1804-4669-001 0418-159201-0151 DAMOR-LINE Fitostimoline, Phenoxyethanole 15% + 1% Cream 32g Tube

2524-1809-006 DAONIL 5MG Glibenclamide 5mg Tablets 20's Blister

1522-1810-001 0421-159703-1171 DAPRIL 10MG Lisinopril (as dihydrate) 10mg Tablets 30's (10's Blister x 3)

1522-1810-002 0421-159701-1171 DAPRIL 20MG Lisinopril (as dihydrate) 20mg Tablets 20's (10's Blister x 2)

1522-1810-003 0421-159702-1171 DAPRIL 5MG Lisinopril (as dihydrate) 5mg Tablets 30's (10's Blister x 3)

2043-4633-002 0423-159801-1171 DAPSONE Dapsone 100mg Tablets 100's

1360-1813-001 0118-143601-0391 DAROXIME 250 Cefuroxime (as Aextil) 250mg Film Coated Tablets 10's Glass Bottle

1360-1813-002 0118-143602-0391 DAROXIME 500 Cefuroxime (as Aextil) 500mg Film Coated Tablets 10's Glass Bottle

1256-1817-001 0003-122102-1161 DECADRON Dexamethasone 0.1mg/ml Syrup (Elixir) 100ml Glass Bottle

1270-1820-001 0148-387801-1161 DECAL B12 Cholecalciferol, Calcium laevulinate,

Cyanocobalamine

1000 IU, 50mg, 10mcg/5ml Syrup 120ml Glass Bottle

1268-1825-001 0169-128801-2021 DECOZAL 0.05% Xylometazoline HCl 0.5mg/ml Nasal Drops (Solution) 10ml Bottle

1635-1839-002 0030-161303-1171 DEPAKINE 200MG Sodium valproate 200mg Tablets 40's Plastic Bottle

1635-1839-001 0030-161301-1381 DEPAKINE 200MG/ML Sodium valproate 200mg/ml Solution (Oral) 40ml Glass Bottle + Graduated Dosing

Syringe

1635-1839-004 0030-161305-1171 DEPAKINE 500MG Sodium valproate 500mg Tablets 40's Plastic Bottle

1635-1840-001 0030-387901-0391 DEPAKINE CHRONO 500MG Sodium valproate, Valproic acid 333mg, 145mg Film Coated Tablets 30's Plastic Jar

1766-6592-001 0669-244101-0391 DEPLATT 75MG Clopidogrel 75mg Film Coated Tablets 100's (10's Blister x 10)

2548-1841-004 0336-447501-1131 DEPO MEDROL 40MG/ML Methylprednisolone Acetate 40mg/ml Injection 1ml Vial

1523-1847-001 0009-149801-0651 DERMAMED 0.05% Clobetasol propionate 0.5mg/g Ointment 30g Collapsible Tube

1598-1858-001 0416-162802-1171 DETRUSITOL 1MG Tolterodine l-tartrate 1mg Tablets 28's (14's Blister x 2)

1598-1858-003 0416-162801-1171 DETRUSITOL 2MG Tolterodine l-tartrate 2mg Tablets 28's (14's Blister x 2)

1268-1860-001 0169-163001-0241 DEWAX 0.5% Docusate Sodium 5mg/ml Ear Drops (Solution) 10ml Dropper Bottle

1727-1864-001 0437-122107-1021 DEXAMETHASONE

PHOSPHATE 4MG/ML

Dexamethasone (as phosphate

disodium salt)

4mg/ml Solution for Injection 1ml Ampoule x 10

2423-5283-002 0444-137802-1481 D-FORTE 50,000 IU Vitamin D (as Ergocalciferol) 50000 IU Capsules (Soft Gelatin) 100's HDPE Bottle

1472-1889-001 0005-164102-0391 DIALON 1000MG Metformin HCl 1000mg Film Coated Tablets 30's (10's Blister x 3)

1472-1889-003 0005-164103-0392 DIALON 500MG Metformin HCl 500mg Film Coated Tablets 48's (12's Blister x 4)

1472-1889-004 0005-164101-0391 DIALON 850MG Metformin HCl 850mg Film Coated Tablets 30's (10's Blister x 3)

1499-1891-001 0071-164201-2001 DIAMICRON MR 30MG Gliclazide 30mg Modified Release Tablets 30's Blister

1499-1891-002 0071-164203-2001 DIAMICRON MR 60MG Gliclazide 60mg Modified Release Tablets 30's (15's Blister x 2)

1703-1896-001 0366-164103-0391 DIAPHAGE 500MG Metformin HCl 500mg Film Coated Tablets 50's (10's Blister x 5)

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1360-6428-003 0118-114204-1171 DIAPRIDE 1 Glimepiride 1mg Tablets 30's (15's Blister x 2)

1360-6428-001 0118-114201-1171 DIAPRIDE 2 Glimepiride 2mg Tablets 30's (15's Blister x 2)

1360-6428-002 0118-114203-1171 DIAPRIDE 3 Glimepiride 3mg Tablets 30's (15's Blister x 2)

1360-6428-004 0118-114202-1171 DIAPRIDE 4 Glimepiride 4mg Tablets 30's (15's Blister x 2)

1472-1900-006 0005-164501-1173 DIAZEPAM 5MG Diazepam 5mg Tablets 20's (10's Blister x 2)

1675-1901-001 0155-164801-0391 DICETEL 100 Pinaverium bromide 100mg Film Coated Tablets 20's (10's Blister x 2)

1447-1902-002 0015-149908-2001 DICLO 150 ID Diclofenac Sodium 150mg Modified Release Tablets 10's Blister

1447-1902-004 0015-149907-2001 DICLO 75 ID Diclofenac Sodium 75mg Modified Release Tablets 20's (10's Blister x 2)

1447-1903-001 0015-149904-0171 DICLO DISPERS 50MG Diclofenac Sodium 50mg Dispersible Tablets 20's (10's Blister x 2)

1523-5584-001 0009-142201-1171 DICLOFLAM-K 50MG Diclofenac potassium 50mg Tablets 20's (10's Blister x 2)

1360-1907-001 0118-149909-0371 DICLOGESIC 0.1% Diclofenac (as sodium) 1mg/ml Eye Drops 5ml Dropper Bottle

1360-1907-002 0118-149901-0431 DICLOGESIC 1% Diclofenac Sodium 10mg/g Gel 30g Tube

1360-1907-006 0118-149904-2231 DICLOGESIC 50MG Diclofenac Sodium 50mg Rectal Suppositories 10's (5's Blister x 2)

1360-1907-007 0118-149904-1171 DICLOGESIC 50MG Diclofenac Sodium 50mg Tablets 20's (10's Blister x 2)

1360-1907-009 0118-149902-0511 DICLOGESIC 75MG/3ML Diclofenac Sodium 25mg/ml Injection 3ml Ampoule x 5

1360-1908-002 0118-149903-1171 DICLOGESIC RETARD 100MG Diclofenac Sodium 100mg Tablets 10's Blister

1468-1909-001 0152-149901-0291 DICLOMAX 1% Diclofenac Sodium (as diethylamine) 10mg/g Gel (Emulgel) 50g Collapsible Tube

1468-1909-007 0152-149904-1171 DICLOMAX 50MG Diclofenac Sodium 50mg Tablets 20's (10's Blister x 2)

1523-1910-001 0009-149901-0291 DICLON 1% Diclofenac Sodium (as diethylamine) 10mg/g Gel (Emulgel) 45g Collapsible Tube

1566-1911-006 0277-165001-1171 DICYNONE 500MG Etamsylate 500mg Tablets 20's (10's Blister x 2)

1589-1914-001 0186-140201-1451 DIFLUCAN 150MG Fluconazole 150mg Capsules (Hard Gelatin) 1's Blister

1587-1914-003 0186-140203-0491 DIFLUCAN 2MG/ML Fluconazole 2mg/ml Infusion 50ml Vial

1748-4975-003 0072-165703-0511 DIGOXIN Digoxin 0.25mg/ml Injection 1 Vial x 2ml

1392-1922-001 0035-141702-1171 DILATREND 25MG Carvedilol 25mg Tablets 30's (10's Blister x 3)

1392-1922-002 0035-141701-1171 DILATREND 6.25MG Carvedilol 6.25mg Tablets 30's (10's Blister x 3)

1896-5285-001 0107-134105-0511 DILTIAZEM HCL Diltiazem 50mg/10ml Injection 10ml Single Dose Vial

1574-1925-001 0016-134104-1171 DILZEM 60MG Diltiazem HCl 60mg Tablets 50's (10's Blister x 5)

1574-1926-002 0016-134102-1171 DILZEM RETARD 90MG Diltiazem HCl 90mg Tablets 30's (10's Blister x 3)

1621-1932-001 0458-166001-1161 DIMETAPP Brompheniramine Maleate,

Pseudoephedrine HCl

1mg, 15mg/5ml Syrup (Elixir) 4 Fl Oz (118ml) Plastic Bottle

1556-1933-002 0027-166103-0391 DIOVAN 160 Valsartan 160mg Film Coated Tablets 28's Calendar Pack (14's Blister x 2)

1556-1933-005 0027-166101-0391 DIOVAN 80 Valsartan 80mg Film Coated Tablets 28's Calendar Pack (14's Blister x 2)

1523-1935-001 0009-116903-1161 DIPHELIN Diphenhydramine HCl, Sodium Citrate,

Menthol

14mg, 57mg, 1.1mg/5ml Syrup 100ml Glass Bottle

1748-4977-001 0072-116703-0511 DIPHENHYDRAMINE Diphenhydramine 50mg/ml Injection 1 Injection x 1ml

1650-1942-004 0070-131405-0651 DIPROLENE 0.05% Betamethasone (as dipropionate) 0.5mg/g Ointment 30g Tube

1650-1942-002 0070-131405-0151 DIPROLENE 0.05% Betamethasone (as dipropionate) 0.5mg/g Cream 30g Tube

2421-1945-007 1325-151702-1631 DISFLATYL Simethicone 40mg/ml Drops (Oral) 30ml Dropper Bottle

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

2421-1945-008 1325-151701-0082 DISFLATYL 40MG Simethicone 40mg Chewable Tablets 30's (10's Blister x 3)

1774-4630-001 0460-167201-1171 DISTAMINE 250MG Penicillamine 250mg Tablets 100's

1697-1953-002 0195-149907-0612 DIVIDO 75 Diclofenac sodium 75mg Modified Release Capsules

(Hard Gelatin)

20's (10's Blister x 2)

1368-1961-004 0228-107902-1172 DOLGIT 400MG Ibuprofen 400mg Tablets 20's (10's Blister x 2)

1368-1961-009 0228-107906-0151 DOLGIT 5% Ibuprofen 50mg/g Cream 50g Tube

1368-1961-008 0228-107906-0152 DOLGIT 5% Ibuprofen 50mg/g Cream 20g Tube

1368-1961-010 0228-107903-1171 DOLGIT 600MG Ibuprofen 600mg Tablets 20's (10's Blister x 2)

2344-1966-002 DOLORAZ 400MG Ibuprofen 400mg Capsules (Soft Gelatin) 20's (10's Blister x 2)

1464-1968-001 0031-168201-0391 DOMPY 10MG Domperidone 10mg Film Coated Tablets 30's (10's Blister x 3)

1464-1968-002 0031-168202-1111 DOMPY 1MG/ML Domperidone 1mg/ml Suspension 200ml Glass Bottle

1986-5230-001 0471-168501-0511 DOPRAM DOXAPRAM 20mg/ml Injection 20ml Vial

1601-1973-001 0473-168801-1171 DOSTINEX 0.5MG Cabergoline 0.5mg Tablets 2's Bottle

1566-1976-001 0277-169301-2221 DOXIPROCT PLUS Calcium dobesilate, Lidocaine,

Dexamethasone

40mg, 20mg, 0.25mg/g Rectal Ointment 20g Tube

1566-1977-004 0277-169401-1451 DOXIUM 500MG Calcium dobesilate 500mg Capsules (Hard Gelatin) 30's (10's Blister x 3)

1360-1982-002 0118-169101-1452 DOXYDAR 100MG Doxycycline (as hyclate) 100mg Capsules (Hard Gelatin) 8's Blister

1703-1992-001 0366-133301-1452 DROXIL 500MG Cefadroxil (as monohydrate) 500mg Capsules (Hard Gelatin) 12's (6's Blister x 2)

2054-5291-002 0479-367201-0151 DU'IT FOOT & HEEL BALM

PLUS

Urea, Vitamin E 25% Cream 75g Tube

2054-5292-001 0479-139601-0151 DU'IT HAND & BODY CREAM Urea 10% Cream 50g Tube

1317-1995-001 0042-133702-1171 DULCOLAX 5MG Bisacodyl 5mg Tablets 30's (10's Blister x 3)

1262-1999-001 0253-116606-0151 DUMOZOL 1% Metronidazole 10mg/g Cream 25g Tube

1262-1999-003 0253-116607-1111 DUMOZOL 25MG/ML Metronidazole 125mg/5ml Suspension 100ml Bottle

2610-2001-004 1291-170801-1161 DUPHALAC 66.7% Lactulose 667mg/g Syrup 300ml Plastic Bottle

1276-2009-001 0483-132301-1171 DUSPAMED 135MG Mebeverine HCl 135mg Tablets 20's (10's Blister x 2)

2341-2011-004 1291-381101-2401 DUSPATALIN 135MG Mebeverine HCl 135mg Sugar Coated Tablets 50's (10's Blister x 5)

1129-2012-002 0155-132303-1451 DUSPATALIN RETARD 200MG Mebeverine HCl 200mg Capsules (Hard Gelatin) 30's (15's Blister x 2)

1544-2016-003 0067-142902-1171 DYNACEPH 400MG Cefixime 400mg Tablets 6's Blister

1259-2022-002 0268-171902-0391 EBASTEL 10MG Ebastine 10mg Film Coated Tablets 20's (10's Blister x 2)

1122-7165-001 1080-174616-1021 EBETREXAT 20MG/ML (20MG) Methotrexate (anhydrous) 20mg/ml Solution for Injection 1ml Pre-filled Syringe

1122-7165-002 1080-174616-1022 EBETREXAT 20MG/ML (25MG) Methotrexate (anhydrous) 20mg/ml Solution for Injection 1.25ml Pre-filled Syringe

1253-2029-001 0085-119804-0371 ECONOPRED PLUS 1% Prednisolone acetate 10mg/ml Eye Drops (Suspension) 5ml Plastic Dropper Bottle

2181-7066-001 1614-497101-1171 EDARBI 40MG Azilsartan medoxomil (as potassium) 40mg Tablets 28's (7's Blister x 4)

2181-7066-002 1614-497102-1171 EDARBI 80MG Azilsartan medoxomil (as potassium) 80mg Tablets 28's (7's Blister x 4)

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1747-2050-001 0096-106201-0391 ELEVIT PRONATAL Vitamin & Mineral - A, B1, B2, B6, B12,

Biotin, Calcium pantothanate, Folic acid,

4000 IU, 1.6mg, 1.8mg, 2.6mg,

4mcg, 0.2mg, 10mg, 0.8mg,

Film Coated Tablets 30's (10's Blister x 3)

1464-2051-001 0031-124403-0151 ELICA 0.1% Mometasone furoate 1mg/g Cream 30g Collapsible Tube

1464-2051-002 0031-124403-0651 ELICA 0.1% Mometasone furoate 1mg/g Ointment 30g Collapsible Tube

2461-6727-001 0011-394101-0391 ELIQUIS 2.5MG Apixaban 2.5mg Film Coated Tablets 60's (10's Blister x 6)

2461-6727-002 0011-394102-0391 ELIQUIS 5MG Apixaban 5mg Film Coated Tablets 60's (10's Blister x 6)

1648-2055-002 0070-124403-0151 ELOCOM 0.1% Mometasone furoate 1mg/g Cream 30g Tube

1648-2055-003 0070-124403-2571 ELOCOM 0.1% Mometasone furoate 1mg/g Topical Lotion 30ml Squeeze Bottle

1648-2055-004 0070-124403-0651 ELOCOM 0.1% Mometasone furoate 1mg/g Ointment 15g Tube

1417-2057-002 0006-172805-1171 ELTROXIN 100MCG Levothyroxine Sodium 100mcg Tablets 100's Bottle

1417-2057-004 0006-172804-1171 ELTROXIN 50MCG Levothyroxine Sodium 50mcg Tablets 100's Bottle

1431-2061-001 0503-103202-1171 EMICIPRO 250MG Ciprofloxacin 250mg Tablets 10's Blister

1431-2061-002 0503-103201-1171 EMICIPRO 500MG Ciprofloxacin 500mg Tablets 10's Blister

1431-2062-002 0503-164202-0391 EMICRON 80 Gliclazide 80mg Film Coated Tablets 60's (10's Blister x 6)

1431-2063-001 0503-106604-1111 EMIDOL 120MG/5ML Paracetamol 120mg/5ml Suspension 100ml Bottle

1431-2063-003 0503-106606-2421 EMIDOL 250MG/5ML Paracetamol 250mg/5ml Suspension (Alcohol Free) 100ml Glass Bottle

1431-2063-005 0503-106601-1173 EMIDOL 500 Paracetamol 500mg Tablets 24's (12's Blister x 2)

1431-2065-001 0503-107904-1111 EMIFEN 100MG/5ML Ibuprofen 100mg/5ml Suspension 100ml Glass Bottle

1431-2065-003 0503-107903-0391 EMIFEN 600MG Ibuprofen 600mg Film Coated Tablets 20's (10's Blister x 2)

1431-2066-001 0503-149904-0171 EMIFENAC 50 DT Diclofenac Sodium 50mg Dispersible Tablets 20's (10's Blister x 2)

1431-2068-001 0503-174201-1451 EMILOK 20MG Omeprazole 20mg Capsules (Hard Gelatin) 14's Plastic Bottle

1431-2069-002 0503-148701-1171 EMILORA 10MG Loratadine 10mg Tablets 20's (10's Blister x 2)

1431-2069-003 0503-148702-1161 EMILORA 5MG/5ML Loratadine 5mg/5ml Syrup 100ml Glass Bottle

1431-2070-001 0503-148601-0391 EMIMYCIN 250 Clarithromycin 250mg Film Coated Tablets 14's (7's Blister x 2)

1431-2070-002 0503-148602-0391 EMIMYCIN 500 Clarithromycin 500mg Film Coated Tablets 20's (10's Blister x 2)

1431-6612-002 0503-191203-0391 EMIVANZ 500MG/2.5MG Metformin HCl, Glibenclamide 500mg, 2.5mg Film Coated Tablets 30's (10's Blister x 3)

1431-6612-001 0503-191202-0391 EMIVANZ 500MG/5MG Metformin HCl, Glibenclamide 500mg, 5mg Film Coated Tablets 30's (10's Blister x 3)

1379-2075-002 0248-116402-0851 E-MOX 250MG/5ML Amoxycillin (as trihydrate) 250mg/5ml Powder for Suspension 100ml Bottle

1379-2075-003 0248-116403-1451 E-MOX 500MG Amoxycillin (as trihydrate) 500mg Capsules (Hard Gelatin) 16's

1276-2076-001 0147-118203-1171 ENAPRESS 10MG Enalapril maleate 10mg Tablets 20's (10's Blister x 2)

1276-2076-002 0147-118201-1171 ENAPRESS 20MG Enalapril maleate 20mg Tablets 20's (10's Blister x 2)

1276-2076-003 0147-118202-1171 ENAPRESS 5MG Enalapril maleate 5mg Tablets 20's (10's Blister x 2)

1277-2081-002 0099-175101-2401 ENDOXAN ASTA 50MG Cyclophosphamide 50mg Sugar Coated Tablets 50's (10's Blister x 5)

1368-2083-001 0228-106611-1161 ENELFA 100MG/5ML Paracetamol 100mg/5ml Syrup 100ml Bottle

1368-2083-002 0228-106605-2231 ENELFA 125MG Paracetamol 125mg Rectal Suppositories 10's (5's Blister x 2)

1368-2083-004 0228-106602-2231 ENELFA 250 Paracetamol 250mg Rectal Suppositories 10's (5's Blister x 2)

1368-2083-006 0228-106601-2231 ENELFA 500MG Paracetamol 500mg Rectal Suppositories 10's (5's Blister x 2)

1368-2083-009 0228-106601-1171 ENELFA 500MG Paracetamol 500mg Tablets 20's (10's Blister x 2)

1616-2086-007 0333-116206-0391 ENHANCIN 1G Co-amoxiclav 1g Film Coated Tablets 14's (7's Blister x 2)

1342-2089-001 0320-118203-1171 ENVAS 10MG Enalapril maleate 10mg Tablets 30's (10's Blister x 3)

1342-2089-002 0320-118202-1171 ENVAS 5MG Enalapril maleate 5mg Tablets 30's (10's Blister x 3)

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1576-2091-001 0016-175403-1451 EPANUTIN 100MG Phenytoin Sodium 100mg Capsules (Hard Gelatin) 100's Bottle

2041-5298-001 0441-175502-0511 EPHEDRINE SULFATE Ephedrine Sulfate 50mg/ml Injection 1ml Ampoule

1544-7314-001 EPICITAM 100MG/ML Levetiracetam 100mg/ml Solution (Oral) 300ml Glass Bottle

1379-2095-001 0248-104702-1111 EPICOGEL Aluminium hydroxide gel, Magnesium

hydroxide, Dimethicone

405mg, 100mg, 125mg/5ml Suspension 125ml

1379-2097-001 0248-175603-0251 EPIMAG Magnesium citrate 2.125g/5g Effervescent Granules 5g Sachet x 10

1840-4739-007 0063-175702-0511 EPINEPHRINE Epinephrine 1mg/ml (1:1,000) Injection 1ml Single Dose Vial

2041-4739-005 0441-175703-0511 EPINEPHRINE Epinephrine 0.1mg/ml (1:10,000) Injection 10ml PFS

2007-5232-001 0512-175704-0511 EPIPEN EPINEPHRINE 0.3mg/0.3ml Injection 0.3ml Syringe x 1

2078-5299-002 0084-175704-0511 EPI-PEN Epinephrine 0.3mg/0.3ml% Injection 1 Pre-filled Syring

1814-4740-001 0296-107303-0511 EPIPEN ADULT Adrenaline 0.3mg/0.3ml Injection 1 syringe x 1

1826-4741-001 0084-107304-0511 EPIPEN JUNIOR Adrenaline 0.15mg/0.3ml Injection 1 syringe x 1

2007-4741-002 0512-175705-0511 EPIPEN JUNIOR EPINEPHRINE 0.15mg/0.3ml Injection 0.3ml Syringe x 1

2344-2103-004 2104-148602-0391 ERACID 500 Clarithromycin 500mg Tablets 14's Blister

1695-2104-001 0516-176401-1451 ERCEFURYL 200MG Nifuroxazide 200mg Capsules (Hard Gelatin) 28's

1472-2106-007 0005-109502-1172 EROMYCIN 500MG Erythromycin 500mg Film Coated Tablets 10's Blister

2690-7577-001 2118-171902-2901 EROSTIN 10MG Ebastine 10mg Orodispersible Tablets 20's (10's Blister x 2)

1835-2112-003 0129-109502-0511 ERYTHROCIN ERYTHROMYCIN 500mg Injection 1 Vial x 1

1243-2112-001 0053-109504-0461 ERYTHROCIN 200MG/5ML Erythromycin ethylsuccinate 200mg/5ml Granules for Suspension 100ml Bottle

1843-4743-002 0298-109508-0511 ERYTHROMYCIN ERYTHROMYCIN 1000mg Injection 1 Vial

1556-2117-001 0027-176801-1171 ESIDREX 25MG Hydrochlorothiazide 25mg Tablets 20's (10's Blister x 2)

1896-4992-001 0107-135103-0511 ESMOLOL HYDROCHLORIDE

100MG/ML

Esmolol 10mg/ml Injection Pack of 10 Vials x 10ml

2412-6596-002 1308-232402-1452 ESOM 20MG Esomeprazole (as magnesium

dihydrate)

20mg Capsules (Hard Gelatin) 14's (7 Blister x 2)

2412-6596-004 1308-232401-1452 ESOM 40MG Esomeprazole (as magnesium

dihydrate)

40mg Capsules (Hard Gelatin) 14's (7 Blister x 2)

1125-6954-001 0013-232402-1451 ESVIN 20 Esomeprazole (as magnesium

dihydrate)

20mg Capsules (Hard Gelatin) 14's (7's Blister x 2)

1125-6954-002 0013-232401-1451 ESVIN 40 Esomeprazole (as magnesium

dihydrate)

40mg Capsules (Hard Gelatin) 14's (7's Blister x 2)

2423-6613-001 0444-348905-0971 EURO D 10000 Vitamin - D (as cholecalciferol) 10000 IU (250mcg) Capsules (Soft Gelatin) 30's HDPE Bottle

1527-2142-001 0321-172805-1171 EUTHYROX 100MCG Levothyroxine Sodium 100mcg Tablets 100's (25's Blister x 4)

1527-2142-002 0321-172807-1171 EUTHYROX 150MCG Levothyroxine Sodium 150mcg Tablets 100's (25's Blister x 4)

1527-2142-003 0321-172806-1171 EUTHYROX 25MCG Levothyroxine Sodium 25mcg Tablets 100's (25's Blister x 4)

1527-2142-004 0321-172804-1171 EUTHYROX 50MCG Levothyroxine Sodium 50mcg Tablets 100's (25's Blister x 4)

1503-2144-004 1076-178701-0391 EVISTA 60MG Raloxifene HCl 60mg Film Coated Tablets 28's (14's Blister x 2)

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1556-4590-001 0027-179202-0391 EXFORGE 10MG/160MG Amlodipine (as besylate), Valsartan 10mg, 160mg Film Coated Tablets 28's (14's Blister x 2)

1556-4590-002 0027-179203-0391 EXFORGE 5MG/160MG Amlodipine (as besylate), Valsartan 5mg, 160mg Film Coated Tablets 28's (14's Blister x 2)

1556-6164-005 0027-344905-0391 EXFORGE HCT

10MG/160MG/12.5MG

Amlodipine (as besylate), Valsartan,

Hydrochlorothiazide

10mg, 160mg, 12.5mg Film Coated Tablets 28's (7's Blister x 4)

1556-6164-006 0027-344906-0391 EXFORGE HCT

10MG/160MG/25MG

Amlodipine (as besylate), Valsartan,

Hydrochlorothiazide

10mg, 160mg, 25mg Film Coated Tablets 28's (7's Blister x 4)

1556-6164-007 0027-344907-0391 EXFORGE HCT

5MG/160MG/12.5MG

Amlodipine (as besylate), Valsartan,

Hydrochlorothiazide

5mg, 160mg, 12.5mg Film Coated Tablets 28's (7's Blister x 4)

1556-6164-008 0027-344908-0391 EXFORGE HCT

5MG/160MG/25MG

Amlodipine (as besylate), Valsartan,

Hydrochlorothiazide

5mg, 160mg, 25mg Film Coated Tablets 28's (7's Blister x 4)

1631-2153-003 0397-381301-0151 EXODERIL 1% Naftifine HCl 10mg/g Cream 30g Aluminium Tube

1516-2156-002 0536-106601-0051 EXTRA STRENGTH TYLENOL

500MG

Paracetamol 500mg Tablets (Caplets) 24's Plastic Bottle

1431-7119-001 0503-395404-0391 EZEAIR 10MG Montelukast (as sodium) 10mg Film Coated Tablets 30's (10's Blister x 3)

1431-7119-002 0503-395401-0081 EZEAIR 4MG Montelukast (as sodium) 4mg Chewable Tablets 30's (10's Blister x 3)

1431-7119-003 0503-395402-0081 EZEAIR 5MG Montelukast (as sodium) 5mg Chewable Tablets 30's (10's Blister x 3)

1531-2160-001 0090-312201-1171 EZETROL 10MG Ezetimibe 10mg Tablets 28's (7's Blister x 4)

1697-5191-001 0291-179801-0391 FACTIVE 320MG Gemifloxacin (as mesylate) 320mg Film Coated Tablets 5's Blister

1360-2164-002 0118-124103-1171 FAMODAR 40MG Famotidine 40mg Tablets 10's Blister

1589-2175-002 0186-180202-1171 FASIGYN 500MG Tinidazole 500mg Tablets 4's

1235-2176-003 0541-180401-0431 FASTUM 2.5% Ketoprofen 25mg/g Gel 50g Plastic Dispenser

2341-2180-006 1291-381402-0391 FAVERIN 50MG Fluvoxamine Maleate 50mg Film Coated Tablets 60's (20's Blister x 3)

2341-2180-005 1291-381401-0391 FAVERIN 100MG Fluvoxamine Maleate 100mg Film Coated Tablets 30's (15's Blister x 2)

2460-2185-002 1381-186002-3291 FEFOL SPANSULES Ferrous sulfate dried, Folic acid 150mg, 500mcg Capsules (Hard Gelatin) 30's (15's Blister x 2)

1587-2187-004 0186-135201-0171 FELDENE 20MG Piroxicam 20mg Dispersible Tablets 10's Bottle

1587-2187-006 0186-135202-0511 FELDENE 20MG/ML IM Piroxicam 20mg/ml Injection 1ml Ampoule x 3

1556-2188-001 0027-180901-0391 FEMARA 2.5MG Letrozole 2.5mg Film Coated Tablets 30's (10 Blister x 3)

1250-2197-001 0135-181302-1171 FENDOL DS Mefenamic acid 500mg Tablets 20's (10's Blister x 2)

1552-2198-002 0027-181401-0431 FENISTIL 0.1% Dimethindene Maleate 1mg/g Gel 30g Tube

1552-2198-004 0027-181403-1171 FENISTIL 1MG Dimethindene Maleate 1mg Tablets 20's

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1552-2198-005 0027-181402-1631 FENISTIL 1MG/ML Dimethindene Maleate 1mg/ml Drops (Oral) 20ml Glass Dropper Bottle

1746-2198-006 0542-181402-0511 FENISTIL 4MG/4ML Dimethindene Maleate 1mg/ml Injection 4ml Ampoule x 2

1732-2204-001 0311-106201-1161 FEROGLOBIN B12 Vitamin & Mineral - B1, B2, B6, B12,

Folic acid, Nicotinamide, Pantothenic

acid, C, Lysine, Copper, Iron,

Combination Syrup 200ml Glass Bottle

1732-2204-002 0311-181801-0061 FEROGLOBIN B12 Elemental Iron, Folic Acid Combination Capsules 30's

1622-2205-001 0202-182001-1631 FEROMIN 25MG/ML Minerals - Iron (as Ferrous sulfate) 25mg/ml Drops (Oral) 30ml Bottle + Dropper

1680-2207-001 0252-182103-0081 FEROSE Minerals - Iron (as Iron III hydroxide

polymaltose complex)

100mg Chewable Tablets 30's (10's Blister x 3)

1680-2208-001 0252-182201-0081 FEROSE - F Minerals - Iron (as Iron III hydroxide

polymaltose complex), Folic acid

100mg, 0.35mg Chewable Tablets 30's (10's Blister x 3)

1680-2207-003 0252-182101-1161 FEROSE 50MG/5ML Minerals - Iron (as Iron III hydroxide

polymaltose complex)

10mg/ml Syrup 100ml

1655-4591-003 0498-182501-1451 FERRO SANOL DUODENAL Iron (as Ferrous II - glycine Sulphate

complex)

100mg Capsules (Hard Gelatin) 20's (10's Blister x 2)

1655-4591-005 0498-347601-1451 FERRO SANOL GYN Iron (as Ferrous II - glycine Sulphate

complex), Folic Acid

80mg, 1mg Capsules (Hard Gelatin) 20's (10's Blister x 2)

1241-2211-001 0053-182601-1171 FERROGRAD FOLIC Vitamin & Mineral - Folic acid, Iron (as

Ferrous sulfate)

0.35mg, 105mg Tablets 30's Bottle

1732-2221-001 0311-294401-0061 FERUS B12 Vitamin & Mineral - B6, B12, Folic acid,

Copper, Iron (as fumarate & gluconate),

Combination Capsules 30's

1680-2223-003 0252-106614-2481 FEVADOL 160MG/5ML Paracetamol 160mg/5ml Syrup (Sugar Free) 145ml Glass Bottle

1680-2223-007 0252-106601-1172 FEVADOL 500 Paracetamol 500mg Tablets 20's (10's Blister x 2)

1680-2224-001 0252-107001-1171 FEVADOL EXTRA Paracetamol, Caffeine 500mg, 65mg Tablets 20's (10's Blister x 2)

1697-5593-002 0195-183201-0391 FEXODINE 120MG Fexofenadine HCl 120mg Film Coated Tablets 14's Blister

1697-5593-001 0195-183202-0391 FEXODINE 180MG Fexofenadine HCl 180mg Film Coated Tablets 14's Blister

2412-6600-002 1308-252702-0391 FINAGEN 5MG Finasteride 5mg Film Coated Tablets 30's (15's Blister x 2)

1592-2225-002 0219-123701-0391 FINALLERG 10MG Cetirizine HCl 10mg Film Coated Tablets 20's (10's Blister x 2)

1592-2225-004 0219-123702-1381 FINALLERG 1MG/ML Cetirizine HCl 1mg/ml Solution (Oral) 100ml Glass Bottle

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1464-2227-001 0031-127002-1451 FIXIT 150 Nizatidine 150mg Capsules (Hard Gelatin) 14's (7's Blister x 2)

2214-2228-006 0170-116610-1171 FLAGYL 200MG Metronidazole 200mg Tablets 21's Plastic Bottle

2214-2228-007 0170-116609-1171 FLAGYL 400MG Metronidazole 400mg Tablets 14's Blister

1635-2229-002 0170-116603-1111 FLAGYL-S Metronidazole (as benzoate) 200mg/5ml Suspension 100ml Glass Bottle

1622-2230-003 0554-183502-0151 FLAMAZINE 1% Silver sulphdiazine 10mg/g Cream 50g Tube

1256-2231-001 0003-183601-0241 FLAVACO OTIC Aminacrine HCl, Benzocaine,

Hydrocortisone, Neomycin Sulphate,

Combination Ear Drops 10ml

1490-4592-001 0138-155302-1172 FLEXICAM 15MG Meloxicam 15mg Tablets 10's Blister

1490-4592-005 0138-155301-1173 FLEXICAM 7.5MG Meloxicam 7.5mg Tablets 10's Blister

1420-2242-001 0006-126004-1972 FLIXONASE AQUEOUS

50MCG/ACTUATION

Fluticasone propionate 50mcg Nasal Spray 120 Dose Unit

1422-2243-008 0006-126007-1391 FLIXOTIDE 250 Fluticasone propionate 250mcg Aerosol Inhaler 60 Metered Dose Inhaler

1422-2243-007 0006-126004-1391 FLIXOTIDE 50 Fluticasone propionate 50mcg Aerosol Inhaler 60 Metered Dose Inhaler

1348-5594-001 0203-126007-3111 FLOHALE - 250 DP CAPS Fluticasone propionate 250mcg Powder for Inhalation

(Capsule)

100's (10's Blister x 10)

1641-2248-001 0137-103202-0391 FLOXACIN 250 Ciprofloxacin (as HCl) 250mg Film Coated Tablets 10's Blister

1641-2248-002 0137-103201-0391 FLOXACIN 500 Ciprofloxacin (as HCl) 500mg Film Coated Tablets 10's Blister

1304-2249-001 0140-184806-2151 FLOXAPEN 125MG/5ML Flucloxacillin (as sodium) 125mg/5ml Powder for Syrup 100ml Bottle

1304-2249-003 0140-184802-1451 FLOXAPEN 250MG Flucloxacillin (as sodium) 250mg Capsules (Hard Gelatin) 20's (10's Blister x 2)

1960-4751-002 0050-184803-0511 FLUCLOXACILLIN Flucloxacillin 500mg Injection Pack of 10 Vials

1960-4751-003 0050-184802-0511 FLUCLOXACILLIN Flucloxacillin 250mg Injection Pack of 10 Vials

1472-2260-003 0005-185301-1172 FLUKIT Paracetamol, Phenylephrine HCl,

Promethazine HCl, Salicylamide

200mg, 5mg, 5mg, 250mg Tablets 20's (10's Blister x 2)

1680-2271-001 0252-185801-0391 FLUTAB Paracetamol, Diphenhydramine HCl,

Pseudoephedrine HCl

500mg, 25mg, 30mg Film Coated Tablets 20's (10's Blister x 2)

1680-6957-001 0252-389802-1171 FLUTAB SINUS Paracetamol, Pseudoephedrine HCl 500mg, 30mg Tablets 20's (10's Blister x 2)

1472-2278-001 0005-186001-2451 FOLICRON Iron (as Ferrous Sulfate), Folic Acid 47mg, 500mcg Sustained Release Capsules

(Hard Gelatin)

30's (10's Blister x 3)

1472-2279-001 0005-185901-1171 FOLICUM 1MG Folic Acid 1mg Tablets 20's Blister

2532-6944-002 1516-185902-1171 FOLILIFE 5MG Folic acid 5mg Tablets 40's (20's Blister x 2)

1475-2280-001 0102-185901-1172 FOLITAB 1MG Folic Acid 1mg Tablets 20's (10's Blister x 2)

1475-2280-002 0102-185902-1172 FOLITAB 5MG Folic Acid 5mg Tablets 20's (10's Blister x 2)

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1529-2291-001 0090-110801-1171 FOSAMAX ONCE WEEKLY

70MG

Alendronic acid (as sodium

alendronate)

70mg Tablets 4's Blister

1531-2292-001 0090-186802-1171 FOSAVANCE 2800 IU Alendronic acid (as sodium

alendronate), Colecalceferol

70mg, 2800 IU (70mcg) Tablets 4's Blister

1529-2292-002 0090-186801-1171 FOSAVANCE 5600 IU Alendronic acid (as sodium

alendronate), Colecalceferol

70mg, 5600 IU Tablets 4's Blister

1280-5757-001 0188-186901-0511 FOSCAVIR FOSCARNET 24mg/ml Injection 500ml Bottle

1121-6168-001 0274-344701-1391 FOSTER 100MCG/6MCG Beclomethasone dipropionate,

Formoterol fumarate dihydrate/Dose

100mcg, 6mcg Aerosol Inhaler 120 Metered Doses Inhaler

1497-2305-001 0281-389001-0151 FUCICORT Betamethason (as valerate), Fusidic acid 1mg, 20mg/g Cream 15g Collapsible Tube

1497-2306-006 0281-128401-0651 FUCIDIN 2% Fusidic Acid (as Sodium Salt) 20mg/g Ointment 15g Collapsible Tube

1497-2306-001 0281-128401-0151 FUCIDIN 2% Fusidic Acid 20mg/g Cream 15g Collapsible Tube

1497-2307-001 0281-187603-0151 FUCIDIN H Hydrocortisone Acetate, Fusidic Acid 10mg, 20mg/g Cream 15g Collapsible Tube

1523-2308-001 0009-128401-0151 FUCIMED 2% Fusidic Acid 20mg/g Cream 15g Collapsible Tube

1498-2309-002 0281-128406-0671 FUCITHALMIC 1% Fusidic Acid 10mg/g Eye Drops 5g Collapsible Tube

2344-2315-003 2104-140201-1452 FUNZOL 150MG Fluconazole 150mg Capsules (Hard Gelatin) 1's Blister

1379-2317-001 0248-187801-1171 FURAZOL Diloxanide furoate, Metronidazole 250mg, 200mg Tablets 20's (10's Blister x 2)

1464-2320-002 0031-128401-0651 FUSIBACT 2% Fusidic Acid (as Sodium Salt) 20mg/g Ointment 15g Tube

1464-2320-001 0031-128401-0151 FUSIBACT 2% Fusidic Acid 20mg/g Cream 15g Tube

1464-2321-001 0031-187502-0151 FUSIBACT B Betamethason (as valerate), Fusidic acid 1mg, 20mg/g Cream 15g Collapsible Tube

1680-2322-002 0252-128401-0651 FUSIDERM 2% Fusidic Acid 20mg/g Ointment 15g Tube

1680-2322-001 0252-128401-0151 FUSIDERM 2% Fusidic Acid 20mg/g Cream 15g Tube

1475-2323-001 0017-167501-1172 FUSIX 40MG Furosemide 40mg Tablets 20's (10's Blister x 2)

1623-5759-001 0317-188001-0511 FUZEON ENFUVIRITIDE 108mg (90mg/ml) Injection 1.2ml Vial

2235-6100-003 0988-188101-2501 FUZOCIM 10 Alfuzosin HCl 10mg Retard Tablets 30's (10's Blister x 3)

1556-5195-001 0027-188501-1171 GALVUS 50MG Vildagliptin 50mg Tablets 28's (14's Blister x 2)

1556-5596-001 0027-188601-0391 GALVUS MET 50/1000 Vildagliptin, Metformin 50mg, 1000mg Film Coated Tablets 60's (10's Blister x 6)

1556-5596-002 0027-188602-0391 GALVUS MET 50/850 Vildagliptin, Metformin 50mg, 850mg Film Coated Tablets 60's (10's Blister x 6)

1650-2333-003 0070-120201-1681 GARAMYCIN 0.3% Gentamicin sulphate 3mg/ml Eye / Ear Drops (Solution) 5ml Dropper Bottle

1648-2333-006 0070-120205-0511 GARAMYCIN 80MG/2ML Gentamicin (as sulphate) 40mg/ml Injection 2ml Vial

1673-2338-001 0227-174201-1453 GASEC 20MG GASTROCAPS Omeprazole 20mg Capsules (Hard Gelatin) 14's Bottle

1270-2340-001 0148-174201-1451 GASTRAZOLE 20MG Omeprazole 20mg Capsules (Hard Gelatin) 14's Plastic Bottle

1593-2341-001 0206-151703-0081 GASTREX Simethicone 42mg Chewable Tablets 30's (10's Blister x 3)

1379-2343-001 0248-189001-1171 GASTROFAIT 1G Sucralfate 1g Tablets 20's

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1397-2344-003 0581-189101-1112 GASTROGEL Aluminium OH, Magnesium OH,

Magnesium trisilicate

50mg, 24mg, 24mg/ml Suspension 500ml Plastic Bottle

1368-2345-005 0228-150406-1631 GASTRONERTON Metoclopramide HCl 4.14mg/ml Drops (Oral) 20ml

1368-2345-006 0228-150405-1171 GASTRONERTON 8.92MG Metoclopramide HCl 8.92mg Tablets 20's

1697-6432-001 0195-242802-0341 GASTROPAN 40MG Pantoprazole (as sodium sesquihydrate) 40mg Enteric Coated Tablets 30's HDPE Bottle

1618-2348-002 0435-189502-1112 GAVISCON ADVANCE Anseed Potassium Bicarbonate, Sodium alginate 100mg, 500mg/5ml Suspension 300ml Glass Bottle

1618-2347-006 0435-189501-2822 GAVISCON ADVANCE

PEPPERMINT

Potassium Bicarbonate, Sodium alginate 100mg, 500mg/5ml Suspension 300ml Glass Bottle

1618-2347-004 0435-189401-1113 GAVISCON Original Anseed Calcium Carbonate, Sodium alginate,

Sodium Bicarbonate

80mg, 250mg, 133.5mg/5ml Suspension 200ml Glass Bottle

1544-2353-003 0067-123701-0392 GENCET 10MG Cetirizine HCl 10mg Film Coated Tablets 20's (10's Blister x 2)

1544-2353-001 0067-123703-1161 GENCET 5MG/5ML Cetirizine HCl 5mg/5ml Syrup 100ml Glass Bottle

2412-7174-002 1401-125902-0392 GENLOX 400 Moxifloxacin (as HCl) 400mg Film Coated Tablets 10's Blister

1622-2360-001 0355-120201-1681 GENTACIN 0.3% Gentamicin (as sulfate) 3mg/ml Eye / Ear Drops (Solution) 8ml Dropper Bottle

1622-2360-002 0355-120201-0381 GENTACIN 0.3% Gentamicin (as sulfate) 3mg/g Eye Ointment 5g Metal Tube

1680-2363-001 0252-120204-0511 GENTAM 20MG/2ML Gentamicin sulphate 10mg/ml Injection 2ml Ampoule x 5

1773-2364-004 0378-120201-0382 GENTAMICIN 0.3% Gentamicin 0.3% Eye Ointment 5g

1556-5762-002 0586-190401-0371 GENTEAL LUBRICANT EYE

DROPS 10ML

Hypromellose 3mg/10ml Eye Drops 10ml

1585-2368-001 0186-190702-0511 GEOPEN 1G Carindacillin 1g Injection 1 Vial

1585-2368-002 0186-190701-0511 GEOPEN 5G Carindacillin 5g Injection 1 Vial

1430-7356-001 1541-395401-0081 GLEMONT CT 4 Montelukast (as sodium) 4mg Chewable Tablets 30's (10's Blister x 3)

1430-7356-002 1541-395402-0081 GLEMONT CT 5 Montelukast (as sodium) 5mg Chewable Tablets 30's (10's Blister x 3)

1430-7020-001 1541-290303-0391 GLENCET 5MG Levocetirizine (as diHCl) 5mg Film Coated Tablets 30's (10's Blister x 3)

2316-6251-002 GLENISIL 1% Terbinafine HCl 10mg/g Cream 30g Collapsible Tube

2316-6252-004 GLENMATE 0.1% Mometasone furoate 1mg/ml Lotion 30ml Plastic Bottle

1235-2385-002 0541-191201-0391 GLIBOMET 400MG/2.5MG Metformin HCl, Glibenclamide 400mg, 2.5mg Film Coated Tablets 40's (20's Blister x 2)

1680-6171-001 0252-114204-1171 GLIM 1MG Glimepiride 1mg Tablets 30's (10's Blister x 3)

1680-6171-002 0252-114201-1171 GLIM 2MG Glimepiride 2mg Tablets 30's (10's Blister x 3)

1680-6171-003 0252-114203-1171 GLIM 3MG Glimepiride 3mg Tablets 30's (10's Blister x 3)

1680-6171-004 0252-114202-1171 GLIM 4MG Glimepiride 4mg Tablets 30's (10's Blister x 3)

1276-2386-001 0147-114201-1171 GLIMARYL - 2 Glimepiride 2mg Tablets 30's (15's Blister x 2)

2316-6433-002 1142-114204-1171 GLIMULIN 1MG Glimepiride 1mg Tablets 30's (10's Blister x 3)

2316-6433-001 1142-114201-1171 GLIMULIN 2MG Glimepiride 2mg Tablets 30's (10's Blister x 3)

2316-6433-003 1142-114203-1171 GLIMULIN 3MG Glimepiride 3mg Tablets 30's (10's Blister x 3)

2229-6662-001 1000-385601-1171 GLIT 15MG Pioglitazone (as HCl) 15mg Tablets 28's (14's Blister x 2)

2229-6662-002 1000-385602-1171 GLIT 30MG Pioglitazone (as HCl) 30mg Tablets 28's (14's Blister x 2)

1431-2390-007 0503-116206-0391 GLOCLAV 1G Co-amoxiclav 1g (875mg + 125mg) Film Coated Tablets 14's (7's Blister x 2)

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1431-2390-004 0503-116201-0391 GLOCLAV 375 Co-amoxiclav 375mg (250mg + 125mg) Film Coated Tablets 20's (10's Blister x 2)

1431-2390-006 0503-116207-0391 GLOCLAV 625 Co-amoxiclav 625mg (500mg + 125mg) Film Coated Tablets 20's (10's Blister x 2)

1431-5197-001 0503-115902-1451 GLODIP 5MG Amlodipine (as besilate) 5mg Capsules (Hard Gelatin) 30's (10's Blister x 3)

1431-2392-007 0503-116402-0851 GLOMOX 250MG/5ML Amoxicillin (as trihydrate ) 250mg/5ml Powder for Suspension 100ml Bottle

1431-2392-009 0503-116403-1451 GLOMOX 500 Amoxicillin (as trihydrate ) 500mg Capsules (Hard Gelatin) 20's (10's Blister x 2)

1431-2394-001 0503-120801-1171 GLORMIN 100 Atenolol 100mg Tablets 28's (14's Blister x 2)

1431-2394-002 0503-120803-1171 GLORMIN 25 Atenolol 25mg Tablets 28's (14's Blister x 2)

1431-2394-003 0503-120802-1171 GLORMIN 50 Atenolol 50mg Tablets 28's (14's Blister x 2)

1431-2395-002 0503-121101-0391 GLOTAC 150 Ranitidine (as HCl) 150mg Film Coated Tablets 20's (10's Blister x 2)

1431-2396-002 0503-123701-0391 GLOTRIZINE 10 Cetirizine HCl 10mg Film Coated Tablets 20's (10's Blister x 2)

1431-2396-003 0503-123703-1161 GLOTRIZINE 5MG/5ML Cetirizine HCl 5mg/5ml Syrup 100ml Glass bottle

1300-2400-001 0054-191602-1171 GLUCOBAY 100 Acarbose 100mg Tablets 30's (10's Blister x 3)

1300-2400-002 0054-191601-1171 GLUCOBAY 50 Acarbose 50mg Tablets 30's (10's Blister x 3)

1528-2401-001 0321-164102-0391 GLUCOPHAGE 1000MG Metformin HCl 1000mg Film Coated Tablets 30's (10's Blister x 3)

1528-2401-009 GLUCOPHAGE 1000MG Metformin HCl 1000mg Film Coated Tablets 30's (10's Blister x 3)

1528-2401-010 GLUCOPHAGE 500MG Metformin HCl 500mg Film Coated Tablets 50's (10's Strip x 5)

1528-2401-003 0321-164103-0391 GLUCOPHAGE 500MG Metformin HCl 500mg Film Coated Tablets 50's (10's Strip x 5)

1528-2401-005 0321-164101-0391 GLUCOPHAGE 850MG Metformin HCl 850mg Film Coated Tablets 30's (15's Blister x 2)

1528-2401-011 GLUCOPHAGE 850MG Metformin HCl 850mg Film Coated Tablets 30's (15's Blister x 2)

1528-5598-003 0321-164102-2191 GLUCOPHAGE XR 1000MG Metformin HCl 1000mg Prolonged Release Tablets 30's (10 's Blister x 3)

1528-5598-002 0321-164103-2191 GLUCOPHAGE XR 500MG Metformin HCl 500mg Prolonged Release Tablets 30's (15's Blister x 2)

1528-5598-001 0321-164104-2191 GLUCOPHAGE XR 750MG Metformin HCl 750mg Prolonged Release Tablets 30's (15's Blister x 2)

1528-2405-001 0321-191203-0391 GLUCOVANCE 500MG/2.5MG Metformin HCl, Glibenclamide 500mg, 2.5mg Film Coated Tablets 30's (15's Blister x 2)

1528-2405-002 0321-191202-0391 GLUCOVANCE 500MG/5MG Metformin HCl, Glibenclamide 500mg, 5mg Film Coated Tablets 30's (15's Blister x 2)

1382-2406-001 0094-104802-1171 GLUSTIN 15MG Pioglitazone (as HCl) 15mg Tablets 30's Plastic Bottle

1382-2406-002 0094-104801-1171 GLUSTIN 30MG Pioglitazone (as HCl) 30mg Tablets 30's Plastic Bottle

1387-2410-004 0593-191704-2231 GLYCILAX FOR CHILDREN

0.75G

Glycerol (85%) 750mg Rectal Suppositories 12's (6's Blister x 2)

1748-4755-003 0072-192201-0512 GLYCOPYRROLATE Glycopyrrolate 0.2mg/ml Injection 1 Injection x 2ml

1544-6253-001 0067-164201-2001 GLYKA MR 30MG Gliclazide 30mg Modified Release Tablets 30's (10's Blister x 3)

1472-2414-002 0005-114204-1171 GLYPRIDE 1MG Glimepiride 1mg Tablets 30's (10's Blister x 3)

1472-2414-003 0005-114201-1171 GLYPRIDE 2MG Glimepiride 2mg Tablets 30's (10's Blister x 3)

1472-2414-004 0005-114203-1171 GLYPRIDE 3MG Glimepiride 3mg Tablets 30's (10's Blister x 3)

1472-2414-001 0005-114202-1171 GLYPRIDE 4MG Glimepiride 4mg Tablets 30's (10's Blister x 3)

1288-2415-001 0595-118305-2351 GLYTRIN 400MCG/DOSE Glyceryl Trinitrate 0.4mg Spray (Sublingual) 200 Metered Dose Pressurised Can

1472-2417-001 0005-164202-1171 GLYZIDE 80MG Gliclazide 80mg Tablets 60's (20's Blister x 3)

1472-2430-002 0005-119803-1171 GUPISONE 20MG Prednisolone 20mg Tablets 20's (10's Blister x 2)

1465-2435-002 0415-140402-2711 GYNO-DAKTARIN 200MG Miconazole (as nitrate) 200mg Vaginal Ovules 7's Blister

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1472-2437-002 0005-140402-2711 GYNO-MIKOZAL 200MG Miconazole nitrate 200mg Vaginal Ovules 7's Strip

1126-2440-005 0414-140201-1451 GYNOSANT 150 Fluconazole 150mg Capsules (Hard Gelatin) 1's Blister

1785-4637-001 0601-194001-0061 HAEM PLUS Ferrous Salt, Folic Acid Combination Capsules 30's

1342-4595-001 0320-106201-0551 HAEM UP Vitamin & Mineral - B12, Folic Acid,

Iron, Mg, Cu

Combination Liquid (Oral) 200ml Glass Bottle

2532-7427-003 1516-127405-0391 HENACYL 500MG Azithromycin (as dihydrate) 500mg Film Coated Tablets 3's Blister

1629-2486-001 0609-195901-0431 HERPESAN 2% Carbenoxolone 20mg/g Gel 5g Tube

1125-6132-001 0013-159703-1171 HIACE 10 Lisinopril (as dihydrate) 10mg Tablets 28's (7's Blister x 4)

1125-6132-002 0013-159701-1171 HIACE 20 Lisinopril (as dihydrate) 20mg Tablets 28's (7's Blister x 4)

1125-6132-003 0013-159702-1171 HIACE 5 Lisinopril (as dihydrate) 5mg Tablets 28's (7's Blister x 4)

2690-7479-001 HICET 5MG Levocetirizine dihydrochloride 5mg Film Coated Tablets 30's (10's Blister x 3)

1802-5316-001 0302-138502-1171 HIGH POTENCY CALCIUM 600

USP

Calcium Carbonate 600mg Tablets 60's

2199-2513-004 0729-447301-0431 HIRUDOID Mucopolysaccharide polysulfate

(Organo-Heparinoid)

3mg (corr. to 25000 U)/g Gel 40g Tube

2199-2513-003 0729-447301-0151 HIRUDOID Mucopolysaccharide polysulfate

(Organo-Heparinoid)

3mg (corr. to 25000 U)/g Cream 40g Tube

1523-6946-002 0009-108102-1162 HISDINE 0.5MG/ML Desloratadine 0.5mg/ml Syrup 200ml Glass Bottle

1472-2516-002 0005-196701-0391 HISTALOC 25MG Promethazine HCl 25mg Film Coated Tablets 20's (10's Blister x 2)

1382-2530-002 0094-197301-1021 HUMALOG 100 UNITS/ML Insulin - Lispro 100 U/ml Solution for Injection 10ml Vial

1501-2530-003 0094-197304-1022 HUMALOG 100 UNITS/ML Insulin - Lispro 100 IU/ml Solution for Injection 3ml Cartridges x 5

1501-2530-001 0094-197304-1021 HUMALOG KWIKPEN 100

UNITS/ML

Insulin - Lispro 100 IU/ml Solution for Injection 3ml Pre-filled Pen x 5

1382-2532-001 0094-524303-1131 HUMALOG MIX 25 (100

UNITS/ML)

Insulin - Lispro biphasic (25% Insulin

Lispro and 75% Insulin Lispro Protamine

suspension)

100 U/ml Suspension for Injection 10ml Glass Vial

1501-2530-004 0094-524302-1131 HUMALOG MIX 25 (100

UNITS/ML)

Insulin - Lispro biphasic (25% Insulin

Lispro and 75% Insulin Lispro Protamine

suspension)

100 IU/ml Suspension for Injection 3ml Cartridges x 5

1501-2531-001 0094-524302-1132 HUMALOG MIX 25 KWIKPEN

100 UNITS/ML

Insulin - Lispro biphasic (25% Insulin

Lispro and 75% Insulin Lispro Protamine

suspension)

100 IU/ml Suspension for Injection 3ml Pre-filled Pen x 5

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1501-2530-005 0094-524301-1131 HUMALOG MIX 50 (100

UNITS/ML)

Insulin - Lispro biphasic (50% Insulin

Lispro and 50% Insulin Lispro Protamine

suspension)

100 IU/ml Suspension for Injection 3ml Cartridges x 5

1787-4644-001 0178-197401-0152 HUMEKTAN 60% Aqua 80%, Butylene Glycol 60% Cream 100g

1382-2536-001 0094-389101-0511 HUMULIN (30/70) 100

UNITS/ML

Insulin - Isophane biphasic (human)

(Soluble/Regular 30%, Isophane 70%)

100 Units/ml Injection 10ml Vial

1382-2542-001 0094-197702-0512 HUMULIN-N (ISOPHANE) 100

UNITS/ML

Insulin - Isophane (human) 100 U/ml Injection 10ml Vial

1382-2543-001 0094-197803-0511 HUMULIN-R (REGULAR) 100

UNITS/ML

Insulin - Soluble (human) 100 U/ml Injection 10ml Vial

1403-2546-002 0619-123302-1021 HYALGAN 20MG/2ML Sodium hyaluronate 10mg/ml Intraarticular Injection 2ml Pre-filled Syringe

1403-6774-001 0619-123305-1021 HYALONE 60MG Hyaluronic acid sodium salt 15mg/ml Intraarticular Injection 4ml Pre-filled Syringe

1787-4646-001 0178-198301-0152 HYDRAN 80% Aqua 40%, Paraffinum 80% Cream 100g

1778-4652-001 0012-198401-0061 HYDREA 500MG Hydroxyurea 500mg Capsules 100's

2008-5318-001 0623-154102-1172 HYDROCORTONE Hydrocortisone 10mg Tablets 30's

1464-6474-001 0031-123312-0662 HYFRESH 0.2% Sodium hyaluronate 2mg/ml Eye Drops (Solution) 10ml Plastic Dropper Bottle

1615-2559-001 0549-174201-1451 HYPOSEC 20 Omeprazole 20mg Capsules (Hard Gelatin) 14's Plastic Bottle

1529-2562-002 0090-186702-0391 HYZAAR 50/12.5 Losartan potassium, HCTZ 50mg, 12.5mg Film Coated Tablets 28's (14's Blister x 2)

2532-6947-001 1516-107904-1111 IBULIFE 100MG/5ML Ibuprofen 100mg/5ml Suspension 110ml Bottle

2532-6947-002 1516-107902-1171 IBULIFE 400MG Ibuprofen 400mg Tablets 24's (12's Blister x 2)

2532-6947-003 1516-107903-1171 IBULIFE 600MG Ibuprofen 600mg Tablets 20's (10's Blister x 2)

1368-2572-002 0228-107906-0431 IBUTOP 5% Ibuprofen 50mg/g Gel 20g Tube

1279-2582-002 0188-173304-1141 IMDUR 60MG Isosorbide mononitrate 60mg Tablets 30's Bottle

2215-2583-007 0006-199803-1172 IMIGRAN 100MG Sumatriptan (as succinate) 100mg Film Coated Tablets 2's Blister

1465-2586-004 0415-200001-1452 IMODIUM 2MG Loperamide HCl 2mg Capsules (Hard Gelatin) 6's Blister

2419-2590-006 1319-127301-0391 IMURAN 50MG Azathioprine 50mg Film Coated Tablets 100's

1280-2594-002 0188-130103-0392 INDERAL 10MG Propranolol HCl 10mg Film Coated Tablets 50's Plastic Bottle

1280-2594-005 0188-130101-0391 INDERAL 40MG Propranolol HCl 40mg Film Coated Tablets 50's Plastic Bottle

1405-2606-001 0639-151702-1111 INFACOL 40MG/ML Simethicone 40mg/ml Suspension 50ml Plastic Bottle with Dropper

1699-2614-003 0046-149903-1141 INFLA-BAN 100 S.R. Diclofenac Sodium 100mg Sustained Release Tablets 10's Blister

1497-2618-006 0281-201306-1021 INNOHEP 3500 IU/0.35ML Tinzaparin Sodium 10,000 IU/ml Solution for Injection 0.35ml Syringe x 10 (5's x 2)

1497-2618-007 0281-201307-1021 INNOHEP 4500 IU/0.45ML Tinzaparin Sodium 10,000 IU/ml Solution for Injection 0.45ml Syringe x 10 (5's x 2)

1559-2623-001 0043-197703-0511 INSULATARD HM 100 IU/ML Insulin - Isophane (human) 100 IU/ml Injection 10ml Vial

1559-2624-002 0043-197703-0513 INSULATARD HM PENFILL 100

IU/ML

Insulin - Isophane (human) 100 IU/ml Injection 3ml Cartridge x 5

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1657-2626-001 0078-201501-1131 INSULIN H BIO NPH 100 IU/ML Insulin - Isophane (Recombinant

Human/Protamine sulfate)

100 IU/ml Suspension for Injection 10ml Vial

1657-2627-001 0078-197803-1021 INSULIN H BIO R 100 IU/ML Insulin - Soluble (Recombinant Human) 100 IU/ml Solution for Injection 10ml Vial

1657-2628-001 0078-389501-1131 INSULIN H MIX 100 IU/ML Insulin - Soluble-Protamin Insulin

(Recombinant Human)

100 IU/ml Suspension for Injection 10ml Vial

1410-2642-001 0244-202301-0921 IONIL - T Coal tar (solution), Salicylic acid 42.5mg, 20mg/ml Shampoo 200ml Bottle

1431-6863-001 0503-104802-1171 IPOZ 15MG Pioglitazone (as HCl) 15mg Tablets 30's HDPE Bottle

1431-6863-002 0503-104801-1171 IPOZ 30MG Pioglitazone (as HCl) 30mg Tablets 30's HDPE Bottle

1562-2645-005 0047-202703-0511 IPRADOL 5MCG/2ML Hexoprenaline 5mcg/2ml Injection 2ml Ampoule x 5

2412-6781-002 1308-121401-0392 IRBIGEN 150MG Irbesartan 150mg Film Coated Tablets 30's (10's Blister x 3)

2412-6781-004 1308-121402-0392 IRBIGEN 300MG Irbesartan 300mg Film Coated Tablets 30's (10's Blister x 3)

2412-7160-002 1401-150602-0391 IRBIGEN-H 150/12.5 Irbesartan, Hydrochlorothiazide 150mg, 12.5mg Film Coated Tablets 30's (10's Blister x 3)

2412-7160-004 1401-150601-0392 IRBIGEN-H 300/12.5 Irbesartan, Hydrochlorothiazide 300mg, 12.5mg Film Coated Tablets 30's (10's Blister x 3)

1525-2648-002 0095-107902-1171 IRFEN 400MG LACTABS Ibuprofen 400mg Tablets 20's (10's Blister x 2)

1523-2649-001 0009-182101-1161 IROKID 50MG/5ML Iron (as Ferric hydroxide polymaltose

complex)

50mg/5ml Syrup 100ml Glass Bottle

2086-5329-001 0076-181802-1161 IRON COMPLETE Elemental iron (ferrous fumarate), Folic

Acid

40mg/150mg Syrup 200ml

1431-7325-001 IRVEL 150MG Irbesartan 150mg Film Coated Tablets 28's (14's Blister x 2)

1431-7325-002 IRVEL 300MG Irbesartan 300mg Film Coated Tablets 28's (14's Blister x 2)

1431-7326-001 IRVEL-H 150MG/12.5MG Irbesartan, Hydrochlorothiazide 150mg, 12.5mg Film Coated Tablets 28's (14's Blister x 2)

1431-7326-002 IRVEL-H 300MG/12.5MG Irbesartan, Hydrochlorothiazide 300mg, 12.5mg Film Coated Tablets 28's (14's Blister x 2)

1650-2652-001 0070-203202-0511 ISEPACINE 100MG/ML

I.M./I.V.

Isepamicin (as sulfate ) 100mg/ml Injection 1ml Ampoule

1655-2657-003 0498-203505-1171 ISOKET RETARD 20 Isosorbide dinitrate 20mg Tablets 50's (10's Blister x 5)

2079-5330-001 0648-203701-1071 ISOMER BABY isotonic solution Spray (No gas) 30ml

2018-4634-005 0492-203801-0511 ISONIAZID ISONIAZID 50mg/2ml Injection 2ml Vial

2060-4634-004 0112-203803-1172 ISONIAZID 100MG Isoniazid 100mg Tablets 100's

1240-2661-001 0652-204102-0391 ISOPTIN 80MG Verapamil HCl 80mg Film Coated Tablets 20's (10's Blister x 2)

1240-2662-001 0652-204103-1141 ISOPTIN SR 240MG Verapamil HCl 240mg Film Coated Tablets 20's (10's Blister x 2)

2697-7503-001 ISOSORBIDE MONONITRATE Isosorbide Mononitrate 20mg Tablets Bottle x 100's

1443-5331-001 0654-115901-1171 ISTIN Amlodipine 10mg Tablets 28's

1641-6204-002 0137-268402-1451 ITRAZOL 100MG Itraconazole (as pellets) 100mg Capsules (Hard Gelatin) 15's (5's Blister x 3)

1641-6204-001 0137-268402-1452 ITRAZOL 100MG Itraconazole (as pellets) 100mg Capsules (Hard Gelatin) 4's Blister

1244-2674-001 0053-204402-1171 ITRIN 2MG Terazosin 2mg Tablets 30's

1244-2674-002 0053-204401-1171 ITRIN 5MG Terazosin 5mg Tablets 14's

1606-2675-001 0401-204601-1451 IXEL 25MG Milnacipran 25mg Capsules (Hard Gelatin) 56's (14's Blister x 4)

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1606-2675-002 0401-204602-1451 IXEL 50MG Milnacipran 25mg Capsules (Hard Gelatin) 56's (14's Blister x 4)

1507-2676-001 0325-142903-0852 IXIME 100MG/5ML Cefixime anhydrous 100mg/5ml Powder for Suspension 50ml Plastic Bottle

1529-4675-003 1400-204901-0391 JANUMET 50MG/1000MG Sitagliptin (as monohydrate phosphate),

Metformin HCl

50mg, 1000mg Film Coated Tablets 56's (7's Blister x 8)

1529-4675-004 1400-204902-0391 JANUMET 50MG/500MG Sitagliptin (as monohydrate phosphate),

Metformin HCl

50mg, 500mg Film Coated Tablets 56's (7's Blister x 8)

1531-2679-001 0090-205003-0391 JANUVIA 100 Sitagliptin (as monohydrate phosphate) 100mg Film Coated Tablets 28's (14's Blister x 2)

1531-2679-002 0090-205001-0391 JANUVIA 25 Sitagliptin (as monohydrate phosphate) 25mg Film Coated Tablets 28's (14's Blister x 2)

1531-2679-003 0090-205002-0391 JANUVIA 50 Sitagliptin (as monohydrate phosphate) 50mg Film Coated Tablets 28's (14's Blister x 2)

2090-5457-002 0656-151704-0582 JASICONE Simethicone 105.8mg / 1 Lozenge Lozenges 20's

1967-7205-001 0042-538301-0391 JENTADUETO 2.5MG/1000MG Linagliptin, Metformin HCl 2.5mg, 1000mg Film Coated Tablets 60's (10's Blister x 6)

1967-7205-002 0042-538302-0391 JENTADUETO 2.5MG/850MG Linagliptin, Metformin HCl 2.5mg, 850mg Film Coated Tablets 60's (10's Blister x 6)

1470-2682-001 0574-142201-0391 JOFLAM 50MG Diclofenac potassium 50mg Film Coated Tablets 20's (10's Blister x 2)

1472-2685-003 0005-116211-0802 JULMENTIN 1.2G I.V. Co-amoxiclav 1200mg Powder for Injection 1 Glass Vial (Dry Powder)

1472-2685-006 0005-116206-0391 JULMENTIN 2X 1000MG Co-amoxiclav 1g Film Coated Tablets 15's (5's Blister x 3)

1472-2685-007 0005-116204-0851 JULMENTIN 2X 457MG/5ML Co-amoxiclav 457mg/5ml Powder for Suspension 70ml Bottle + Oral Syringe

1472-2685-010 0005-116226-0851 JULMENTIN ES 642.9MG/5ML Co-amoxiclav 642.9mg/5ml Powder for Suspension 100ml Glass Bottle

1472-2686-001 0005-116208-0851 JULMENTIN FORTE

312MG/5ML

Co-amoxiclav 312.5mg/5ml Powder for Suspension 100ml Glass Bottle

1472-2686-002 0005-116207-1171 JULMENTIN FORTE 625MG Co-amoxiclav 625mg Film Coated Tablets 20's (5's Blister x 4)

1472-2688-007 0005-116404-1451 JULPHAMOX 250MG Amoxicillin (as trihydrate) 250mg Capsules (Hard Gelatin) 20's (10's Blister x 2)

1472-2688-008 0005-116402-0852 JULPHAMOX 250MG/5ML Amoxicillin (as trihydrate) 250mg/5ml Powder for Suspension 100ml Glass Bottle

1472-2689-008 0005-116503-1453 JULPHAPEN 500MG Ampicillin 500mg Capsules (Hard Gelatin) 20's (10's Blister x 2)

1472-2690-001 0005-389501-0511 JUSLINE 30/70 100 U/ML Insulin - Isophane biphasic (human)

(Soluble/Regular 30%, Isophane 70%)

100IU/ml Injection 10ml Vial

1472-2691-001 0005-197702-0511 JUSLINE N 100 U/ML Insulin - Isophane (human) 100 IU/ml Injection 10ml Vial

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1472-2692-001 0005-105001-0511 JUSLINE R 100 U/ML Insulin - Soluble (human) 100 IU/ml Injection 10ml Vial

1472-2693-005 0005-124201-0341 JUSPRIN 81MG Aspirin 81mg Enteric Coated Tablets 40's (20's Blister x 2)

1650-6601-001 1069-377801-0391 JUVICOR 100MG/10MG Sitagliptin (as phosphate monohydrate),

Simvastatin

100mg, 10mg Film Coated Tablets 28's (7's Blister x 4)

1650-6601-002 1069-377802-0391 JUVICOR 100MG/20MG Sitagliptin (as phosphate monohydrate),

Simvastatin

100mg, 20mg Film Coated Tablets 28's (7's Blister x 4)

1650-6601-003 1069-377803-0391 JUVICOR 100MG/40MG Sitagliptin (as phosphate monohydrate),

Simvastatin

100mg, 40mg Film Coated Tablets 28's (7's Blister x 4)

1472-2700-001 0005-205902-1111 KAPTIN Kaolin (light), Pectin 2.7g, 0.06g/15ml Suspension 200ml

1592-2715-002 0219-148801-0151 KENAZOLE 2% Ketoconazole 20mg/g Cream 15g Collapsible Tube

1714-2716-006 0205-206504-0392 KEPPRA 1000MG Levetiracetam 1000mg Film Coated Tablets 100's (10's Blister x 10)

1713-2716-004 0205-206502-1381 KEPPRA 100MG/ML Levetiracetam 100mg/ml Solution (Oral) 300ml Glass Bottle

1714-2716-007 0205-206503-0392 KEPPRA 250MG Levetiracetam 250mg Film Coated Tablets 100's (10's Blister x 10)

1714-2716-008 0205-206501-0392 KEPPRA 500MG Levetiracetam 500mg Film Coated Tablets 100's (10's Blister x 10)

1544-6173-002 0067-142201-0392 K-FLAM 50MG Diclofenac potassium 50mg Film Coated Tablets 20's (10's Blister x 2)

1544-6173-003 0067-142201-0831 K-FLAM 50MG Diclofenac potassium 50mg Powder for Solution (Oral) 1g Sachet x 30

1241-2728-005 0053-148602-0391 KLACID 500MG Clarithromycin 500mg Film Coated Tablets 20's (10's Blister x 2)

1241-2728-004 0053-148605-0461 KLACID 250MG/5ML Clarithromycin 250mg/5ml Granules for Suspension 100ml Bottle

1244-2728-001 0053-148608-0461 KLACID 125MG/5ML Clarithromycin 125mg/5ml Granules for Suspension 100ml Bottle

1244-2728-003 0053-148601-0391 KLACID 250MG Clarithromycin 250mg Film Coated Tablets 14's (7's Blister x 2)

1241-2729-001 0053-148602-2002 KLACID XL 500MG Clarithromycin 500mg Modified Release Tablets 7's Blister

1342-2730-001 0320-148701-1171 KLARFAST 10MG Loratadine 10mg Tablets 10's Blister

1699-2731-001 0046-148601-0391 KLARIBAC 250MG Clarithromycin 250mg Film Coated Tablets 14's Blister

1699-2731-002 0046-148602-0391 KLARIBAC 500MG Clarithromycin 500mg Film Coated Tablets 14's Plastic Bottle

1680-2733-006 0252-116206-0391 KLAVOX 1G Co-amoxiclav 1g (875mg + 125mg) Film Coated Tablets 14's (7's Blister x 2)

1680-2733-007 0252-116205-0851 KLAVOX 228MG/5ML Co-amoxiclav 228.5mg (200mg + 28.5mg)/5ml Powder for Suspension 70ml Glass Bottle

1680-2733-003 0252-116201-1171 KLAVOX 375 MG Co-amoxiclav 375mg (250mg + 125mg) Tablets 20's (10's Blister x 2)

1680-2733-005 0252-116204-2151 KLAVOX 457MG/5ML Co-amoxiclav 457mg (400mg + 57mg)/5ml Powder for Suspension 70ml Glass Bottle

1680-2733-004 0252-116207-1171 KLAVOX 625 MG Co-amoxiclav 625mg (500mg + 125mg) Tablets 20's (10's Blister x 2)

1338-6529-001 0011-375301-0361 KOMBIGLYZE XR 2.5/1000 Saxagliptin, Metformin HCl 2.5mg, 1000mg Extended Release Tablets 60's HDPE Bottle

2532-2742-002 1516-446701-1161 KUFDRIN Diphenhydramine HCl, Ammonium

chloride, Menthol, Sodium citrate

13.5mg, 131.5mg, 1.1mg,

57mg/5ml

Syrup 120ml Bottle

1490-2753-002 0138-148701-1171 LAGADINE 10MG Loratadine 10mg Tablets 10's Blister

1490-2754-002 0138-208101-1171 LAGAFLEX Paracetamol, Carisoprodol 250mg, 300mg Tablets 20's (10's Blister x 2)

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1490-2756-001 0138-128203-1172 LAGATRIM FORTE Cotrimoxazole 960mg Tablets 10's Blister

2215-2760-006 0006-208202-0181 LAMICTAL LIQUI-TABS 100MG Lamotrigine 100mg Chewable Dispersible Tablets 30's (10's Blister x 3)

2215-2760-008 0006-208203-0181 LAMICTAL LIQUI-TABS 25MG Lamotrigine 25mg Chewable Dispersible Tablets 30's (10's Blister x 3)

2215-2760-009 0006-208201-0181 LAMICTAL LIQUI-TABS 50MG Lamotrigine 50mg Chewable Dispersible Tablets 30's (10's Blister x 3)

1464-2761-003 0031-109203-0151 LAMIFEN 1% Terbinafine HCl 10mg/g Cream 15g Collapsible Tube

1464-2761-001 0031-109204-1172 LAMIFEN 250MG Terbinafine (as HCl) 250mg Tablets 14's (7's Blister x 2)

1552-2762-003 0027-109206-2621 LAMISIL 1% Terbinafine HCl 10mg/ml Topical Spray 30ml Spray Bottle

1552-2762-001 0027-109206-0151 LAMISIL 1% Terbinafine HCl 10mg/g Cream 15g Tube

1556-2763-001 0027-109206-1772 LAMISIL DERMGEL 1% Terbinafine 10mg/g Gel (Emulsion) 15g Tube

1766-6103-003 0669-208202-1171 LAMITOR 100 Lamotrigine 100mg Tablets 30's (10's Blister x 3)

1766-6103-001 0669-208203-1171 LAMITOR 25 Lamotrigine 25mg Tablets 30's (10's Blister x 3)

1766-6103-002 0669-208201-1171 LAMITOR 50 Lamotrigine 50mg Tablets 30's (10's Blister x 3)

2522-2765-011 1319-165705-0281 LANOXIN 0.05MG/ML

(PAEDIATRIC)

Digoxin 0.05mg/ml Syrup (Elixir) 60ml Glass Bottle with Dropper

2522-2765-012 1319-165707-1171 LANOXIN 0.125MG Digoxin 0.125mg Tablets 500's Glass Bottle

1705-2765-005 0041-165706-1172 LANOXIN 0.25MG Digoxin 0.25mg Tablets 25's Glass Bottle

1415-2766-001 0006-165708-1171 LANOXIN PG 0.0625MG Digoxin 62.5mcg Tablets 100's Glass Bottle

1969-2767-001 0170-208601-1021 LANTUS 100 IU/ML Insulin - Glargine 100 IU/ml Solution for Injection 10ml Vial

1969-2768-001 0170-208601-1022 LANTUS FOR OPTIPEN 100

IU/ML

Insulin - Glargine 100 IU/ml Solution for Injection 3ml Cartridge x 5

1969-2769-001 0170-208601-1023 LANTUS OPTISET 100 IU/ML Insulin - Glargine 100 IU/ml Solution for Injection 3ml Optiset x 5

1969-5203-001 0170-208602-1021 LANTUS SOLOSTAR 100IU/ML Insulin - Glargine 100 IU/ml Solution for Injection 3ml Pre-filled Pen x 5

2524-2771-002 LANZOR 30MG Lansoprazole 30mg Capsules (Hard Gelatin) 14's Bottle

1283-2773-001 0114-167505-1021 LASIX 20MG/2ML Furosemide 10mg/ml Solution for Injection 2ml Ampoule x 5

1635-2773-011 1161-167501-1171 LASIX 40MG Furosemide 40mg Tablets 20's (10's Blister x 2)

1472-6625-001 0005-244101-0391 LAVIGARD 75MG Clopidogrel 75mg Film Coated Tablets 28's (7's Blister x 4)

1472-2779-004 0005-133702-2231 LAXOCODYL 5MG Bisacodyl 5mg Rectal Suppositories 10's Strip

1379-2782-001 0248-209101-1111 LAXOMAG 7.5% Magnesium OH 75mg/ml Suspension 125ml

2412-6602-002 1308-290301-0392 LAZINE 5MG Levocetirizine (as diHCl) 5mg Film Coated Tablets 30's (10's Blister x 3)

1567-6735-001 0207-290301-0391 L-CET 5MG Levocetirizine (as diHCl) 5mg Film Coated Tablets 20's (10's Blister x 2)

1256-2791-001 0003-209702-0391 LERCADIP 10MG Lercanidipine HCl 10mg Film Coated Tablets 30's (10's Blister x 3)

2412-6626-001 1308-206504-0391 LETRAM 1000MG Levetiracetam 1000mg Film Coated Tablets 100's (10's Blister x 10)

2412-6626-003 1308-206503-0391 LETRAM 250MG Levetiracetam 250mg Film Coated Tablets 100's (10's Blister x 10)

2412-6626-002 1308-206501-0391 LETRAM 500MG Levetiracetam 500mg Film Coated Tablets 100's (10's Blister x 10)

2370-2797-004 1261-210102-0391 LEUKERAN 2MG Chlorambucil 2mg Film Coated Tablets 25's Glass Bottle

1544-6593-002 0067-274301-0391 LEVANIX 500MG Levofloxacin (as hemihydrate) 500mg Film Coated Tablets 5's Blister

1544-6593-001 0067-274301-0392 LEVANIX 500MG Levofloxacin (as hemihydrate) 500mg Film Coated Tablets 7's Blister

1559-2798-001 0043-210301-1021 LEVEMIR FLEXPEN 100 U/ML insulin - Detemir 100 U/ml Solution for Injection 3ml FlexPen x 5

1559-2799-001 0043-210301-1022 LEVEMIR PENFILL 100 U/ML insulin - Detemir 100 U/ml Solution for Injection 3ml Cartridge x 5

2015-5340-001 0678-210502-1171 LEVODOPA / CARBIDOPA Levodopa, Carbidopa 100mg/25mg Tablets 100's

1542-6353-001 0097-274301-0391 LEVOFLOX 500 Levofloxacin 500mg Film Coated Tablets 5's Blister

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1542-6353-002 0097-391002-0391 LEVOFLOX 500 Levofloxacin 500mg Film Coated Tablets 7's Blister

1631-6652-002 0993-274301-0391 LEVOFLOXACIN SANDOZ

500MG

Levofloxacin (hemihydrate) 500mg Film Coated Tablets 5's Blister

1631-6652-001 0993-274301-0392 LEVOFLOXACIN SANDOZ

500MG

Levofloxacin (hemihydrate) 500mg Film Coated Tablets 7's Blister

1431-6860-001 0503-274301-0391 LEVOTAB 500 Levofloxacin (as hemihydrate) 500mg Film Coated Tablets 7's Blister

1250-2803-006 0135-142804-0851 LEXIN 250MG/5ML Cefalexin monohydrate 250mg/5ml Powder for Suspension 100ml Bottle

1722-2805-002 0563-124001-2401 LIBRAX Chlordiazepoxide, Clidinium bromide 5mg, 2.5mg Sugar Coated Tablets 30's Glass Bottle

1489-2806-001 0138-124001-1171 LIBROCOL Chlordiazepoxide, Clidinium bromide 5mg, 2.5mg Tablets 30's

1595-2816-004 0318-211302-0511 LINCOCIN 600MG/2ML Lincomycin HCl 300mg/ml Injection 2ml Vial

1752-2821-002 0688-211501-1451 LIPANTHYL 300MG Fenofibrate 300mg Capsules (Hard Gelatin) 30's

1472-6354-001 0005-211702-0391 LIPIGARD 10MG Atorvastatin (as calcium) 10mg Film Coated Tablets 30's (10's Blister x 3)

1472-6354-002 0005-211703-0391 LIPIGARD 20MG Atorvastatin (as calcium) 20mg Film Coated Tablets 30's (10's Blister x 3)

1472-6354-003 0005-211701-0391 LIPIGARD 40MG Atorvastatin (as calcium) 40mg Film Coated Tablets 30's (10's Blister x 3)

2319-2822-008 0506-211702-0392 LIPITOR 10MG Atorvastatin (as calcium trihydrate) 10mg Film Coated Tablets 30's (10's Blister x 3)

2319-2822-009 0506-211703-0391 LIPITOR 20MG Atorvastatin (as calcium trihydrate) 20mg Film Coated Tablets 30's (10's Blister x 3)

1576-2822-003 0016-211701-0391 LIPITOR 40MG Atorvastatin (as calcium trihydrate) 40mg Film Coated Tablets 30's (10's Blister x 3)

1641-6205-001 0137-211702-0391 LIPOMAX 10MG Atorvastatin (as calcium trihydrate) 10mg Film Coated Tablets 30's (10's Blister x 3)

1641-6205-002 0137-211703-0391 LIPOMAX 20MG Atorvastatin (as calcium trihydrate) 20mg Film Coated Tablets 30's (10's Blister x 3)

1641-6205-003 0137-211701-0391 LIPOMAX 40MG Atorvastatin (as calcium trihydrate) 40mg Film Coated Tablets 30's (10's Blister x 3)

2339-2828-005 0011-212101-1172 LIPOSTAT 40MG Pravastatin Sodium 40mg Tablets 30's HDPE Bottle

1464-6105-001 0031-159703-0391 LISINO 10MG Lisinopril (as dihydrate) 10mg Film Coated Tablets 30's (10's Blister x 3)

1464-6105-002 0031-159701-0391 LISINO 20MG Lisinopril (as dihydrate) 20mg Film Coated Tablets 30's (10's Blister x 3)

1464-6105-003 0031-159702-0391 LISINO 5MG Lisinopril (as dihydrate) 5mg Film Coated Tablets 30's (10's Blister x 3)

1256-7007-002 0003-481902-0391 LIVAZO 2MG Pitavastatin (as calcium) 2mg Film Coated Tablets 28's (14's Blister x 2)

1256-7007-001 0003-481901-0391 LIVAZO 4MG Pitavastatin (as calcium) 4mg Film Coated Tablets 28's (14's Blister x 2)

1344-2841-003 0183-213302-0241 LOCACORTEN-VIOFORM Flumethasone, Clioquinol 0.2mg, 10mg/g Ear Drops 7.5ml

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

2246-2844-004 0244-459001-2561 LOCERYL 5% NAIL LACQUER Amorolfin 50mg/ml Topical Liquid 5ml Glass Bottle + Nail files + Spatulas

+ Swabs

1523-6138-001 0009-101701-1171 LOFLAM 100MG Aceclofenac 100mg Tablets 20's Plastic Bottle

1524-5345-005 1156-115901-1171 LOFRAL 10MG Amlodipine (as besilate) 10mg Tablets 30's (10's Blister x 3)

1524-5345-006 0095-115904-1171 LOFRAL 5MG Amlodipine (as besilate) 5mg Tablets 30's (10's Blister x 3)

1542-2850-001 0696-148701-1172 LOHIST 10MG Loratadine 10mg Tablets 10's Blister

1256-2855-005 0003-213903-2711 LOMEXIN 200MG Fenticonazole Nitrate 200mg Vaginal Ovules 3's Blister

1544-6175-001 0067-200001-1452 LOMIDEX 2MG Loperamide HCl 2mg Capsules (Hard Gelatin) 10's Blister

1574-2862-002 0016-214101-0392 LOPID 600MG Gemfibrozil 600mg Film Coated Tablets 30's (10's Blister x 3)

1567-4598-001 0207-144302-0391 LOPRAM 20 Citalopram (as HBr) 20mg Film Coated Tablets 28's (14's Blister x 2)

1556-2864-001 0027-131702-0391 LOPRESOR 100MG Metoprolol 100mg Film Coated Tablets 40's (10's Blister x 4)

1556-2864-002 0027-131703-0391 LOPRESOR 50MG Metoprolol 50mg Film Coated Tablets 40's (10's Blister x 4)

1360-2868-001 0118-148701-1172 LORADAD 10 Loratadine 10mg Tablets 10's Blister

1622-2870-002 0202-148701-1171 LORAHIST 10MG Loratadine 10mg Tablets 10's Blister

1622-2870-001 0202-148702-1161 LORAHIST 5MG/5ML Loratadine 5mg/5ml Syrup 100ml Glass Bottle

2532-6923-001 1516-148701-1171 LORALIFE 10MG Loratadine 10mg Tablets 10's Blister

2532-6923-003 1516-148702-2471 LORALIFE 5MG/5ML Loratadine 5mg/5ml Syrup (Alcohol Free) 100ml Glass Bottle

1472-2873-001 0005-148701-1171 LORATIN 10MG Loratadine 10mg Tablets 10's Blister

1567-4599-001 0207-112401-1171 LORIC 100 Allopurinol 100mg Tablets 100's (25's Blister x 4)

1567-4599-002 0207-112402-1171 LORIC 300 Allopurinol 300mg Tablets 28's (14's Blister x 2)

1680-2876-001 0252-389901-1161 LORINASE Loratadine, Pseudoephedrine Sulfate 5mg, 60mg/5ml Syrup 100ml Glass Bottle

1680-2876-003 0252-389902-1171 LORINASE Loratadine, Pseudoephedrine sulfate 5mg, 120mg Tablets 14's (7's Blister x 2)

1680-2877-002 0252-148701-1173 LORINE 10MG Loratadine 10mg Tablets 20's (10's Blister x 2)

1680-2877-004 0252-148701-1171 LORINE 10MG Loratadine 10mg Tablets 30's (10's Blister x 3)

1680-2877-003 0252-148702-2471 LORINE 5MG/5ML Loratadine 5mg/5ml Syrup (Alcohol Free) 100ml Glass Bottle

1697-2880-001 0195-115902-1451 LOTENSE 5MG Amlodipine (as besilate) 5mg Capsules (Hard Gelatin) 30's (10's Blister x 3)

1616-2883-003 0333-102401-1171 LOVIR 800MG Aciclovir 800mg Tablets 50's (5's Blister x 10)

1472-2884-006 0005-102404-0391 LOVRAK 200MG Aciclovir 200mg Film Coated Tablets 20's (10's Blister x 2)

1472-2884-001 0005-102409-1111 LOVRAK 200MG/5ML Aciclovir 200mg/5ml Suspension 120ml Bottle

1472-2884-003 0005-102403-0151 LOVRAK 5% Aciclovir 50mg/g Cream 10g Tube

1472-2884-005 0005-102401-0391 LOVRAK 800MG Aciclovir 800mg Film Coated Tablets 20's (10's Blister x 2)

2463-6782-001 1286-155402-0391 LOZAP ZENTIVA 100MG Losartan potassium 100mg Film Coated Tablets 30's (10's Blister x 3)

2463-6782-002 1286-155401-0391 LOZAP ZENTIVA 50MG Losartan potassium 50mg Film Coated Tablets 30's (10's Blister x 3)

1544-6356-001 0067-140201-1451 LUCONA 150MG Fluconazole 150mg Capsules (Hard Gelatin) 1's Blister

2332-6441-001 1157-348401-0151 LYDERM CREAM Permethrin 5% Cream 30gm

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1581-2891-005 0186-215005-1451 LYRICA 75MG Pregabalin 75mg Capsules (Hard Gelatin) 14's Blister

2546-2895-004 1267-118502-1111 MAALOX Aluminium hydroxide (as gel),

Magnesium hydroxide (as paste)

225mg, 200mg/5ml Suspension 355ml Plastic Bottle

2546-2897-007 1267-141614-1111 MAALOX PLUS Aluminium hydroxide (as gel),

Magnesium hydroxide (as paste),

225mg, 200mg, 25mg/5ml Suspension 355ml Plastic Bottle

1680-2903-001 0252-181302-0391 MAFEPAIN 500MG Mefenamic Acid 500mg Film Coated Tablets 20's (10's Blister x 2)

1615-2904-001 0549-142903-0852 MAGNACEF 100MG/5ML Cefixime (as trihydrate) 100mg/5ml Powder for Suspension 30ml Bottle

1615-2904-002 0549-142903-0851 MAGNACEF 100MG/5ML Cefixime (as trihydrate) 100mg/5ml Powder for Suspension 60ml Bottle

1615-2904-003 0549-142901-1451 MAGNACEF 200MG Cefixime (as trihydrate) 200mg Capsules (Hard Gelatin) 8's Blister

1615-2904-004 0549-142902-1451 MAGNACEF 400MG Cefixime (as trihydrate) 400mg Capsules (Hard Gelatin) 6's Blister

1926-6485-001 1159-322301-1171 MALARONE Atovaquone, Proguanil Hydrochloride 100mg/250mg Tablets 12's (6's blister x 2)

1926-6485-002 1159-322302-1171 MALARONE PAEDIATRIC Atovaquone, Proguanil Hydrochloride 25mg/62.5mg Tablets 12's (6's blister x 2)

1416-2913-001 0006-155004-1171 MAREVAN 1MG Warfarin Sodium 1mg Tablets 100's Plastic Bottle

1416-2913-002 0006-155005-1171 MAREVAN 3MG Warfarin Sodium 3mg Tablets 100's Plastic Bottle

1416-2913-003 0006-155001-1171 MAREVAN 5MG Warfarin Sodium 5mg Tablets 100's Plastic Bottle

2288-6690-002 1104-364602-1971 MARIMER Isotonic Sea Water 28ml/100ml Pressurised Bottle 100ml

1735-2917-001 0069-106201-1171 MATERNA Vitamin & Mineral - A, B1, B2, B6, B12,

Beta carotene, Biotin, Pantothenic acid,

Combination Tablets 100's Plastic Bottle

1254-2921-001 0085-122109-0371 MAXIDEX Dexamethasone 1mg/ml Eye Drops 5ml

1250-2922-002 0135-143603-0511 MAXIL 750MG Cefuroxime (as sodium) 750mg Injection 1 Vial

1254-2924-001 0085-217402-0371 MAXITROL Dexamethasone, Neomycin Sulphate,

Polymixin B Sulphate

Combination Eye Drops 5ml Dropper bottle

1254-2924-002 0085-217401-0381 MAXITROL Dexamethasone, Neomycin Sulphate,

Polymixin B Sulphate

Combination Eye Ointment 3.5g Tube

1544-2925-001 0067-127402-1451 MAZIT 250MG Azithromycin 250mg Capsules (Hard Gelatin) 6's Blister

1593-2926-001 0206-130501-0081 MEBENDA 100MG Mebendazole 100mg Chewable Tablets 6's Blister

1472-2927-003 0005-217501-0653 MEBO 0.25% Beta sitosterol 2.5mg/g Ointment 75g Tube

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1472-2927-002 0005-217501-0652 MEBO 0.25% Beta sitosterol 2.5mg/g Ointment 30g Tube

1523-2932-005 0009-133002-1451 MEDACEF 500MG Cefaclor (as monohydrate) 500mg Capsules (Hard Gelatin) 20's (10's Blister x 2)

1523-2934-003 0009-141603-1111 MEDACID PLUS Aluminium hydroxide (as 15% gel),

Magnesium hydroxide (as 30.7% paste),

225mg, 200mg, 25mg/5ml Suspension 200ml Bottle

1523-2936-003 0009-116206-0391 MEDACLAV 1G Co-amoxiclav 1g (875mg + 125mg) Film Coated Tablets 14's (7's Blister x 2)

1523-2936-001 0009-116201-0391 MEDACLAV 375 Co-amoxiclav 375mg (250mg + 125mg) Film Coated Tablets 20's (10's Blister x 2)

1523-2936-002 0009-116207-0391 MEDACLAV 625 Co-amoxiclav 625mg (500mg + 125mg) Film Coated Tablets 20's (10's Blister x 2)

1523-5475-001 0009-206402-0151 MEDACOMB Gramicidin, Neomycin (as sulphate),

Nystatin, Triamcinolone acetonide

0.25mg, 2.9mg, 22.72mg,

1mg/g

Cream 30g Collapsible Tube

1523-2938-003 0009-106601-0051 MEDAMOL 500MG Paracetamol 500mg Tablets (Caplets) 30's (10's Blister x 3)

1522-2940-002 0421-143603-0801 MEDO-AXETINE 750MG Cefuroxime sodium 750mg Powder for Injection 10 Vials

1601-2942-002 0318-217701-1171 MEDROL 4MG Methylprednisolone 4mg Tablets 30's Glass Bottle

1523-2944-001 0009-140504-0151 MEDSTEN 1% Clotrimazole 10mg/g Cream 30g Collapsible Tube

1245-6762-001 1395-397601-0391 MEDYGRAINE 100MG Sumatriptan (as succinate) 100mg Film Coated Tablets 2's Blister

1245-6762-002 1395-397602-0391 MEDYGRAINE 50MG Sumatriptan (as succinate) 50mg Film Coated Tablets 2's Blister

1544-4603-001 0067-181302-0392 MEFEX 500MG Mefenamic Acid 500mg Film Coated Tablets 20's (10's Blister x 2)

1272-2947-003 0604-143301-0511 MEFOXIN Cefoxitin 1gm Injection 25ml Vial

1468-2949-002 0152-116206-1171 MEGAMOX 1G Co-amoxiclav 1g (875mg + 125mg) Tablets 14's (7's Blister x 2)

1468-2949-003 0152-116214-0851 MEGAMOX 228MG/5ML Co-amoxiclav 228.5mg (200mg + 28.5mg)/5ml Powder for Suspension 70ml Glass Bottle

1468-2949-005 0152-116201-1171 MEGAMOX 375MG Co-amoxiclav 375mg (250mg + 125mg) Tablets 20's (10's Blister x 2)

1468-2949-006 0152-116204-0851 MEGAMOX 457MG/5ML Co-amoxiclav 457mg (400mg + 57mg)/5ml Powder for Suspension 70ml Glass Bottle

1468-2949-008 0152-116207-1171 MEGAMOX 625MG Co-amoxiclav 625mg (500mg + 125mg) Tablets 20's (10's Blister x 2)

1788-4653-001 0709-217801-1171 MEGAPLEX 160MG Megestrol 160mg Tablets 30's

1631-2950-002 0397-107705-0801 MEGION 0.5G Ceftriaxone (as sodium) 500mg Powder for Injection 1 Glass Vial (Powder) + 1 Plastic

Ampoule (5ml Solvent)1631-2950-003 0397-107704-0801 MEGION 1G Ceftriaxone (as sodium) 1g Powder for Injection 1 Glass Vial (Powder) + 1 Plastic

Ampoule (10ml Solvent)1697-2951-001 0195-217901-0391 MEIACT 200MG Cefditoren Pivoxil 200mg Film Coated Tablets 20's (5's Blister x 4)

1489-2953-003 0138-159601-1173 MELIX 5MG Glibenclamide 5mg Tablets 30's (10's Blister x 3)

1269-2954-002 0184-155302-1171 MELOCAM 15MG Meloxicam 15mg Tablets 10's Blister

2234-6206-001 0320-155302-1171 MEL-OD 15 Meloxicam 15mg Tablets 10's Blister

2234-6206-002 0320-155301-1171 MEL-OD 7.5 Meloxicam 7.5mg Tablets 10's Blister

1360-6442-001 0118-155302-1171 MELOXYDAR 15 Meloxicam 15mg Tablets 10's Plastic Bottle

1525-2966-001 0095-218201-1171 MEPHAQUIN 250MG LACTABS Mefloquine 250mg Tablets 6's Blister

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1524-2975-002 0095-107701-0801 MESPORIN 1000MG I.M. Ceftriaxon (as sodium) 1g Powder for Injection 1 Vial (Dry) + 1 Solvent Ampoule

(3.5ml)

1524-2975-001 0095-107701-0802 MESPORIN 1000MG I.V. Ceftriaxon (as sodium) 1g Powder for Injection 1 Vial (Dry) + 1 Solvent Ampoule

(10ml)1524-2975-006 0095-107702-0802 MESPORIN 500MG I.M. Ceftriaxon (as sodium) 500mg Powder for Injection 1 Vial (Dry) + 1 Solvent Ampoule (2ml)

1680-2981-002 0252-124403-0651 METAZ 0.1% Mometasone furoate 1mg/g Ointment 30g Collapsible Tube

1680-2981-001 0252-124403-0151 METAZ 0.1% Mometasone furoate 1mg/g Cream 30g Collapsible Tube

1556-2984-001 0027-219901-2401 METHERGIN 0.125MG Methylergometrine H Maleate 0.125mg Sugar Coated Tablets 30's (10's Blister x 3)

1376-5052-003 0007-174601-1172 METHOTREXAT "EBEWE"

2.5MG

Methotrexate 2.5mg Tablets Blister Pack x 50 tablets

1515-2985-010 0298-174609-1171 METHOTREXATE Methotrexate 10mg Tablets 100's

1788-2985-011 0709-174601-1171 METHOTREXATE 2.5MG Methotrexate 2.5mg Tablets 100's

1515-2985-013 0715-174605-0511 METHOTREXATE 50MG/2ML Methotrexate 50mg/2ml Injection 2ml Vial x 5

1380-5476-001 0717-378503-1021 METHYCOBAL 500MCG Vitamin - B12 (Mecobalamine) 500mcg/ml Solution for Injection 1ml Ampoule x 10

1380-5476-003 0717-378501-2402 METHYCOBAL 500MCG Vitamin - B12 (Mecobalamine) 500mcg Sugar Coated Tablets 30's (10's Blister x 3)

1748-5053-002 0072-150408-0511 METOCLOPRAMIDE Metoclopramide 5mg/ml Injection 1 Injection x 2ml

1839-5053-003 0126-150409-0511 METOCLOPRAMIDE METOCLOPRAMIDE 10mg/ml Injection 1ml Ampoule x 100

2051-5803-005 1181-174615-0512 METOJECT Methotrexate Disodium 50mg/1ml (0.5ML) Injection 0.5ml Pre-filled Syringe x 1

2051-5803-003 1181-174615-0513 METOJECT Methotrexate Disodium 50mg/1ml (0.4ML) Injection 0.4ml Pre-filled Syringe x 1

2051-5803-004 1181-174615-0511 METOJECT Methotrexate Disodium 50mg/1ml (0.3ML) Injection 0.3ml Pre-filled Syringe x 1

1489-2990-005 0138-116602-1171 METROLAG 250MG Metronidazole 250mg Tablets 20's

1489-2990-006 0138-116604-1171 METROLAG 500MG Metronidazole 500mg Tablets 24's (8's Blister x 3)

2200-2991-005 0056-116601-0511 METRONIDAZOLE Metronidazole 500mg/100ml Injection 100ml Vial

2344-2992-002 METROZOLE 250 Metronidazole 250mg Tablets 20's (10's Blister x 2)

1464-2993-001 0031-132301-0391 MEVA 135MG Mebeverine HCl 135mg Film Coated Tablets 30's (10's Blister x 3)

1250-2999-001 0135-115003-0511 MIACIN 100 I.V/I.M Amikacin sulfate 100mg Injection 2ml Ampoule x 6

1967-3000-001 0042-220701-1171 MICARDIS 40MG Telmisartan 40mg Tablets 28's (7's Blister x 4)

1967-3000-002 0042-220702-1171 MICARDIS 80MG Telmisartan 80mg Tablets 28's (7's Blister x 4)

1317-3001-001 0042-220803-1171 MICARDIS PLUS 40/12.5MG Telmisartan, Hydrochlorothiazide 40mg, 12.5mg Tablets 28's (7's Blister x 4)

1317-3001-002 0042-220802-1171 MICARDIS PLUS 80/12.5MG Telmisartan, Hydrochlorothiazide 80mg, 12.5mg Tablets 28's (7's Blister x 4)

1967-3001-003 0042-220801-1171 MICARDIS PLUS 80MG/25MG Telmisartan, Hydrochlorothiazide 80mg, 25mg Tablets 28's (7's Blister x 4)

2316-6444-001 1142-140409-0152 MICOGLEN 2% Miconazole nitrate 20mg/g Cream 30g Collapsible Aluminium Tube

2316-6444-002 1142-140409-1211 MICOGLEN 2% Miconazole nitrate 20mg/g Vaginal Cream 45g Collapsible Aluminium Tube +

Applicator

1271-3007-001 0723-221401-1171 MICTONORM 15MG Propiverine HCl 15mg Tablets 28's

1368-3014-001 0228-221901-1451 MIGRANERTON Paracetamol, Metoclopramide 500mg, 5mg Capsules (Hard Gelatin) 20's

1472-3016-002 0005-115005-0511 MIKACIN 500MG/2ML I.M/I.V Amikacin (as sulfate) 500mg/2ml Solution for Injection 2ml Ampoule x 5

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1472-3017-003 0005-222102-1111 MIKOSTAT 100,000 IU/ML Nystatin 100,000 IU/ml Suspension 30ml Glass Bottle + Dropper

1472-3019-002 0005-140401-0152 MIKOZAL 2% Miconazole nitrate 20mg/g Cream 30g Collapsible Tube

1267-5173-004 0181-222403-0391 MIMPARA 30MG Cinacalcet (as HCl) 30mg Film Coated Tablets 28's (14's Blister x 2)

1267-5173-005 0181-222401-0391 MIMPARA 60MG Cinacalcet (as HCl) 60mg Film Coated Tablets 28's (14's Blister x 2)

1598-3022-001 0065-222501-1171 MINIDIAB 5MG Glipizide 5mg Tablets 30's

1400-3036-001 0594-223203-1171 MINIRIN 0.1MG Desmopressin 0.1mg Tablets 30's Bottle

1400-3036-003 0594-223204-1171 MINIRIN 0.2MG Desmopressin 0.2mg Tablets 30's Bottle

1400-6630-004 0594-382101-1082 MINIRIN MELT 120MCG Desmopressin (as acetate) 120mcg Sublingual Tablets

(Lyophilized)

30's (10's Blister x 3)

1400-6630-005 0594-382102-1082 MINIRIN MELT 60MCG Desmopressin (as acetate) 60mcg Sublingual Tablets

(Lyophilized)

30's (10's Blister x 3)

1475-3037-001 0102-174201-1451 MINISEC-20 Omeprazole 20mg Capsules (Hard Gelatin) 14's Plastic Bottle

2071-4635-004 0726-223302-0061 MINOCYCLINE Minocycline 100mg Capsules 28's

2087-4635-005 0580-223301-0061 MINOCYCLINE 50MG Minocycline 50mg Capsules 100's

1697-3045-002 0195-116604-0391 MIRAZOL 500 Metronidazole 500mg Film Coated Tablets 20's (10's Blister x 2)

1559-3057-001 0043-389501-0511 MIXTARD 30 HM 100 IU/ML Insulin - Isophane biphasic (human)

(30% soluble, 70% isophane)

100 U/ml Injection 10ml Vial

1559-3058-002 0043-389501-0513 MIXTARD 30 HM PENFILL 100

IU/ML

Insulin - Isophane biphasic (human)

(30% soluble, 70% isophane)

100 U/ml Injection 3ml Cartridge x 5

1559-3058-001 0043-389501-0512 MIXTARD 30 HM PENFILL 100

IU/ML

Insulin - Isophane biphasic (human)

(30% soluble, 70% isophane)

100 U/ml Injection 1.5ml Cartridge x 5

1559-3059-001 0043-389501-0514 MIXTARD 30 NOVOLET 100

IU/ML

Insulin - Isophane biphasic (human)

(30% soluble, 70% isophane)

100 U/ml Injection 3ml Novolet x 5

1967-3064-001 0042-155302-1171 MOBIC 15MG Meloxicam 15mg Tablets 10's Bottle

1256-3069-001 0003-115701-1171 MODURETIC 5/50 Amiloride HCl, Hydrochlorothiazide 5mg, 50mg Tablets 30's (10's Blister x 3)

2702-7618-001 2149-124409-2011 MOMETIX AQ 50MCG Mometasone furoate anhydrous (as

monohydrate)

50mcg Nasal Spray 140 Metered Sprays Bottle

1559-3073-001 0043-224701-0511 MONOTARD HM 100 IU/ML Insulin - Zinc suspension (human)

(amorphous 30%, crystalline 70%)

100 U/ml Injection 10ml Vial

2344-3077-003 MONOZIDE 12.5MG Hydrochlorothiazide 12.5mg Tablets 30's (15's Blister x 2)

2344-3077-004 MONOZIDE 25MG Hydrochlorothiazide 25mg Tablets 30's (10's Blister x 3)

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1567-7059-003 0207-395404-0391 MONTAS 10MG Montelukast (as sodium) 10mg Film Coated Tablets 28's (7's Blister x 4)

1567-7059-001 0207-395401-0081 MONTAS 4MG Montelukast (as sodium) 4mg Chewable Tablets 28's (7's Blister x 4)

1567-7059-002 0207-395402-0081 MONTAS 5MG Montelukast (as sodium) 5mg Chewable Tablets 28's (7's Blister x 4)

2412-6786-006 1401-395404-0392 MONTEGEN 10 Montelukast (as sodium) 10mg Film Coated Tablets 30's (10's Blister x 3)

1125-6728-003 0013-395404-0391 MONTIKAR 10 Montelukast (as sodium) 10mg Film Coated Tablets 30's (10's Blister x 3)

1125-6728-001 0013-395401-0081 MONTIKAR 4 Montelukast (as sodium) 4mg Chewable Tablets 28's (7 Blister x 4)

1125-6728-002 0013-395402-0081 MONTIKAR 5 Montelukast (as sodium) 5mg Chewable Tablets 30's (10's Blister x 3)

1465-3082-008 0415-168205-2231 MOTILIUM - Adult 60mg Domperidone 60mg Rectal Suppositories 6's Blister

1465-3082-003 0415-168201-2231 MOTILIUM - Babies 10mg Domperidone 10mg Rectal Suppositories 6's Blister

1465-3082-006 0415-168204-2231 MOTILIUM - Children 30mg Domperidone 30mg Rectal Suppositories 6's Blister

1465-3082-001 0415-168201-0391 MOTILIUM 10MG Domperidone 10mg Film Coated Tablets 30's Blister

1465-3082-005 0415-168202-1111 MOTILIUM 1MG/ML Domperidone 1mg/ml Suspension 200ml Glass Bottle

1249-3083-001 0307-155302-1451 MOVEN 15MG Meloxicam 15mg Capsules (Hard Gelatin) 10's Blister

1472-3087-001 0005-141604-0081 MOXAL PLUS Aluminium Hydroxide, Magnesium

Hydroxide, Simethicone

200mg, 200mg, 25mg Chewable Tablets 30's (10's Blister x 3)

1472-3087-002 0005-141604-0082 MOXAL PLUS Aluminium Hydroxide, Magnesium

Hydroxide, Simethicone

200mg, 200mg, 25mg Chewable Tablets 50's (10's Blister x 5)

2405-6584-001 1302-193305-0361 MUCINEX 600MG Guaifenesin 600mg Extended Release Tablets 20's (10's Blister x 2)

1472-3095-001 0005-134003-1161 MUCOLYTE 4MG/5ML Bromhexine HCl 4mg/5ml Syrup 100ml Bottle

1316-3098-003 0042-114503-0511 MUCOSOLVAN 15MG/2ML Ambroxol HCl 7.5mg/ml Injection 2ml Ampoule x 10

2251-3098-008 0042-114502-1171 MUCOSOLVAN 30MG Ambroxol HCl 30mg Tablets 20's (10's Blister x 2)

1320-3098-005 0042-114504-2481 MUCOSOLVAN 30MG/5ML Ambroxol HCl 30mg/5ml Syrup (Sugar Free) 100ml Glass Bottle

1472-3100-001 0005-114501-2481 MUCUM 15MG/5ML Ambroxol (as HCl) 15mg/5ml Syrup (Sugar Free) 100ml Glass Bottle

1593-3101-001 0206-134003-1161 MUKINATE 4MG/5ML Bromhexine HCl 4mg/5ml Syrup 100ml Glass Bottle

1472-3112-002 0005-225601-1172 MUSCADOL Paracetamol, Orphenadrine citrate 450mg, 30mg Tablets 20's (10's Blister x 2)

2045-3116-004 0740-177402-1171 MYAMBUTOL 400MG Ethambutol 400mg Tablets 100's

1360-3121-003 0118-140401-0151 MYCOHEAL 2% Miconazole nitrate 20mg/g Cream 30g Tube

1360-3121-005 0118-140401-1211 MYCOHEAL 2% Miconazole nitrate 20mg/g Vaginal Cream 50g Tube + Applicator

1360-3121-004 0118-140401-1781 MYCOHEAL 2% Miconazole (as nitrate) 20mg/g Gel (Oral) 40g Metal Collapsible Tube + Spoon

1360-3122-001 0118-159102-0151 MYCOHEAL HC Hydrocortisone, Miconazole Nitrate 10mg, 20mg/g Cream 15g Metal Collapsible Tube

1268-3123-001 0169-222102-1111 MYCOSAT 100000 IU/ML Nystatin 100000 IU/ml Suspension 30ml Bottle + Dropper

1380-5477-001 0717-226501-2401 MYONAL 50MG Eperisone (as HCl) 50mg Sugar Coated Tablets 30's (10's Blister x 3)

1592-3139-001 0219-121101-1171 NADINE 150MG Ranitidine (as HCl) 150mg Tablets 20's (10's Blister x 2)

1592-3139-002 0219-121102-1171 NADINE 300MG Ranitidine (as HCl) 300mg Tablets 10's Blister

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1592-3139-003 0219-121103-1171 NADINE 75MG Ranitidine (as HCl) 75mg Tablets 10's Blister

1472-3146-003 0005-118202-1171 NARAPRIL 5MG Enalapril maleate 5mg Tablets 28's (7's Blister x 4)

1650-3153-001 0070-124404-2061 NASONEX 50MCG/DOSE Mometasone furoate anhydrous (as

monohydrate)

50mcg Nasal Spray Pump 120 Metered Dose Spray Unit

1499-3156-001 0071-200402-1171 NATRILIX SR 1.5MG Indapamide 1.5mg Tablets 30's (3 x 10's Blister)

1544-7318-001 0067-168201-1171 NAUSIDOM 10MG Domperidone 10mg Film Coated Tablets 30's (10's Blister x 3)

1124-5617-001 0750-229701-1171 NEBILET 5MG Nebivolol (as HCl) 5mg Tablets 28's (14's Blister x 2)

1472-6255-002 0005-109203-0151 NEGAFEN 1% Terbinafine HCl 10mg/g Cream 15g Collapsible Tube

1472-6255-001 0005-109204-0391 NEGAFEN 250MG Terbinafine (as HCl) 250mg Film Coated Tablets 14's Blister

1472-3166-002 0005-116603-1111 NEGAZOLE 200MG/5ML Metronidazole (as benzoate) 200mg/5ml Suspension 100ml Bottle

1472-3166-005 0005-116604-1171 NEGAZOLE 500MG Metronidazole 500mg Tablets 20's (10's Blister x 2)

1544-3172-002 0067-103202-0392 NEOCIPRO 250MG Ciprofloxacin 250mg Film Coated Tablets 10's Blister

1544-3172-004 0067-103201-0391 NEOCIPRO 500MG Ciprofloxacin 500mg Film Coated Tablets 10's Blister

1544-3173-001 0067-116203-0851 NEOCLAV 156.25MG /5ML Co-amoxiclav 156.25mg (125mg +

31.25mg)/5ml

Powder for Suspension 100ml Bottle

1544-3173-008 0067-116206-0391 NEOCLAV 1G Co-amoxiclav 1g (875mg + 125mg) Film Coated Tablets 14's (7's Blister x 2)

1544-3173-002 0067-116205-0851 NEOCLAV 228.5MG/5ML Co-amoxiclav 228.5mg (200mg + 28.5mg)/5ml Powder for Suspension 70ml Glass Bottle

1544-3173-003 0067-116208-0851 NEOCLAV 312.5MG/5ML Co-amoxiclav 312.5mg (250mg + 62.5mg)/5ml Powder for Suspension 100ml Glass Bottle

1544-3173-004 0067-116201-0391 NEOCLAV 375MG Co-amoxiclav 375mg (250mg + 125mg) Film Coated Tablets 20's (10's Blister x 2)

1544-3173-005 0067-116204-0851 NEOCLAV 457MG/5ML Co-amoxiclav 457mg (400mg + 57mg)/5ml Powder for Suspension 70ml Glass Bottle

1544-3173-007 0067-116207-0391 NEOCLAV 625MG Co-amoxiclav 625mg (500mg + 125mg) Film Coated Tablets 20's (10's Blister x 2)

1544-3174-001 0067-116705-1161 NEOCOFF 14MG/5ML Diphenhydramine HCl 14mg/5ml Syrup 125ml Glass Bottle

1544-3177-001 0067-103901-1162 NEOCOLD Pseudoephedrine HCl, Triprolidine HCl 30mg/1.25mg per 5ml Syrup 100ml Glass Bottle

1544-3177-003 0067-103902-1171 NEOCOLD Pseudoephedrine HCl, Triprolidine HCl 60mg, 2.5mg Tablets 20's (10's Blister x 2)

1544-3179-001 0067-169101-1451 NEOCYCLINE 100MG Doxycycline 100mg Capsules (Hard Gelatin) 1000's (10's Blister x 100)

1544-3180-002 0067-148701-1171 NEODAY 10MG Loratadine 10mg Tablets 10's Blister

1268-3181-001 0169-230101-1681 NEODEX Neomycin sulphate, Dexamethasone

sodium phosphate

5mg, 1mg/ml Eye / Ear Drops (Solution) 10ml Dropper Bottle

1544-3182-002 0067-230201-1452 NEOFERON Iron (Carbonyl Iron), Folic Acid Combination Capsules (Hard Gelatin) 30's (10's Blister x 3)

1544-3183-003 0067-149904-0343 NEOFLAM 50MG Diclofenac Sodium 50mg Enteric Coated Tablets 20's (10' Blister x 2)

1544-3184-003 0067-149903-2001 NEOFLAM RETARD 100MG Diclofenac Sodium 100mg Modified Release Tablets 10's Blister

1544-3185-001 0067-118503-0081 NEOGASTRO Aluminium Hydroxied/Magnesium

Hydroxide

200mg/200mg Chewable Tablets 50's (10's Blister x 5)

1544-3186-001 0067-141604-0081 NEOGASTRO PLUS Aluminium Hydroxide, Magnesium

Hydroxide, Simethicone

200mg, 200mg, 26.25mg Chewable Tablets 50's (10's Blister x 5)

1544-3187-002 0067-116604-0391 NEOGYL 500MG Metronidazole 500mg Film Coated Tablets 20's (10's Blister x 2)

1544-4647-001 0751-230602-0901 NEOLYTE 15G Oral Rehydration Salts 15g Sachets 5's

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1801-3194-003 0172-230801-1171 NEOMERCAZOLE NEOMERCAZOLE 5mg Tablets Box x 100's

1624-3194-001 0539-141001-1171 NEO-MERCAZOLE 5MG Carbimazole 5mg Tablets 100's Bottle

1544-3195-002 0067-164102-1171 NEOMET 1000MG Metformin HCl 1000mg Tablets 30's (10's Blister x 3)

1544-3195-001 0067-164103-1171 NEOMET 500MG Metformin HCl 500mg Tablets 30's (10's Blister x 3)

1544-3195-003 0067-164101-1171 NEOMET 850MG Metformin HCl 850mg Tablets 30's (10's Blister x 3)

1544-3196-002 0067-164103-0361 NEOMET-XR 500MG Metformin HCl 500mg Extended Release Tablets 30's (10's Blister x 3)

1544-3197-001 0067-106604-1112 NEOMOL 120MG/5ML Paracetamol 120mg/5ml Suspension 100ml Glass Bottle

1544-3197-003 0067-106601-0052 NEOMOL 500MG Paracetamol 500mg Tablets (Caplets) 20's (10's Blister x 2)

1544-3199-001 0067-106606-1112 NEOMOL PLUS 250MG/5ML Paracetamol 250mg/5ml Suspension 100ml Glass Bottle

1544-3200-001 0067-116421-0851 NEOMOX 125MG/5ML Amoxicillin (as trihydrate) 125mg/5ml Powder for Suspension 100ml Glass Bottle

1544-3200-005 0067-116402-0851 NEOMOX 250MG/5ML Amoxicillin (as trihydrate) 250mg/5ml Powder for Suspension 100ml Glass Bottle

1544-3200-010 0067-116403-1451 NEOMOX 500MG Amoxicillin (as trihydrate) 500mg Capsules (Hard Gelatin) 20's (10's Blister x 2)

1544-3201-001 0067-174203-1451 NEOPRAZOLE 10MG Omeprazole 10mg Capsules (Hard Gelatin) 14's (7's Blister x 2)

1544-3201-004 0067-174201-1451 NEOPRAZOLE 20MG Omeprazole 20mg Capsules (Hard Gelatin) 14's (7's Blister x 2)

1544-3201-007 0067-174202-1453 NEOPRAZOLE 40MG Omeprazole 40mg Capsules (Hard Gelatin) 14's (7's Blister x 2)

1268-3202-001 0169-231001-0371 NEOPRED-P Neomycin Sulphate, Polymixin B

sulphate, Prednisolone acetate

5mg, 10000 IU, 5mg/ml Eye Drops (Suspension) 10ml Dropper Bottle

1544-3203-001 0067-159703-1171 NEOPRIL 10MG Lisinopril (as dihydrate) 10mg Tablets 28's (7's Blister x 4)

1544-3203-002 0067-159701-1171 NEOPRIL 20MG Lisinopril (as dihydrate) 20mg Tablets 28's (7's Blister x 4)

1544-3203-003 0067-159702-1171 NEOPRIL 5MG Lisinopril (as dihydrate) 5mg Tablets 28's (7's Blister x 4)

1544-3204-010 0067-107904-1111 NEOPROFEN 100MG/5ML Ibuprofen 100mg/5ml Suspension 100ml Glass Bottle

1544-3204-003 0067-107901-1171 NEOPROFEN 200MG Ibuprofen 200mg Tablets 20's (10's Blister x 2)

1544-3204-006 0067-107902-1171 NEOPROFEN 400MG Ibuprofen 400mg Tablets 20's (10's Blister x 2)

1544-3205-003 0067-134003-1161 NEOSOLVON 4MG/5ML Bromhexine HCl 4mg/5ml Syrup 100ml Glass Bottle

1544-3206-001 0067-173301-1171 NEOSORBIDE 20MG Isosorbide mononitrate 20mg Tablets 30's (10's Blister x 3)

1544-3206-002 0067-173302-1171 NEOSORBIDE 40MG Isosorbide mononitrate 40mg Tablets 30's (10's Blister x 3)

1544-3212-001 0067-124502-1161 NEOVENTIL 2MG/5ML Salbutamol (as sulfate) 2mg/5ml Syrup 120ml Glass Bottle

1544-3213-003 0067-155302-1172 NEOXICAM 15MG Meloxicam 15mg Tablets 30's (10's Blister x 3)

1544-3213-005 0067-155301-1172 NEOXICAM 7.5MG Meloxicam 7.5mg Tablets 10's Blister

1544-3215-001 0067-143601-1172 NEOXIME 250MG Cefuroxime axetil 250mg Film Coated Tablets 10's Blister

1544-3215-003 0067-143602-1171 NEOXIME 500MG Cefuroxime axetil 500mg Film Coated Tablets 10's Blister

1125-6181-003 0013-188402-1452 NERVZ 300 Gabapentin 300mg Capsules (Hard Gelatin) 48's (16's Blister x 3)

1125-6181-004 0013-188405-1452 NERVZ 400 Gabapentin 400mg Capsules (Hard Gelatin) 48's (12's Blister x 4)

1650-3222-002 0070-231602-0511 NETROMYCINE 150MG/1.5ML Netilmicin (as sulphate) 100mg/ml Injection 1.5ml Vial

1650-3222-003 0070-231601-0511 NETROMYCINE 50MG/2ML

(PAEDIATRIC)

Netilmicin (as sulphate) 25mg/ml Injection 2ml Vial

1526-3225-001 0321-379305-0511 NEUROBION Vitamin - B1, B6, B12 100mg, 100mg, 1mg Injection 3ml Ampoule x 3

1526-3225-002 0321-100604-1171 NEUROBION Vitamin - B1, B6, B12 100mg, 200mg, 200mcg Tablets 20's (10's Blister x 2)

2319-3227-006 0506-188402-1451 NEURONTIN 300MG Gabapentin 300mg Capsules (Hard Gelatin) 50's (10's Blister x 5)

2319-3227-007 0506-188405-1451 NEURONTIN 400MG Gabapentin 400mg Capsules (Hard Gelatin) 50's (10's Blister x 5)

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1525-3228-002 0095-379306-1171 NEURORUBINE FORTE

LACTABS

Vitamin - B1, B6, B12 200mg, 50mg, 1mg Tablets 20's

1250-3229-001 0135-232001-1171 NEUROVITAN Vitamin - Vit. B1, B2, B6, B12 Combination Tablets 30's (10's Blister x 3)

1253-3233-001 0085-232201-0371 NEVANAC 0.1% Nepafenac 1mg/ml Eye Drops 5ml Plastic Dropper Bottle

1279-3234-001 0188-232402-0391 NEXIUM 20MG Esomeprazole 20mg Film Coated Tablets 14's (7's Blister x 2)

1279-3234-003 0188-232401-0391 NEXIUM 40MG Esomeprazole 40mg Film Coated Tablets 14's (7's Blister x 2)

1279-3234-005 0188-232401-0801 NEXIUM 40MG Esomeprazole sodium 40mg Powder for Injection 10 Vials (Dry)

1766-7176-001 0669-533801-0391 NEXPRO 20 Esomeprazole (as magnesium) 20mg Film Coated Tablets 30's (15's Blister x 2)

1766-7176-002 0669-533802-0391 NEXPRO 40 Esomeprazole (as magnesium) 40mg Film Coated Tablets 30's (15's Blister x 2)

1250-3241-002 0135-116617-1111 NIDAZOLE 125MG/5ML Metronidazole 125mg/5ml Suspension 100ml Bottle

1344-3250-002 0183-118309-2671 NITRODERM TTS 5 Glyceryl trinitrate (on lactose) 25mg Transdermal Patches 10 Sachets

1833-5363-001 0582-118302-2351 NITROLINGUAL 400MCG Glyceryl Trinitrate 0.4mg Spray (Sublingual) 12.2ml Metered Dose Spray Bottle

1946-3253-002 0059-118701-1161 NIVAQUINE CHLOROQUINE (BASE) 50mg/5ml Oral Syrup 100ml Bottle

1465-3254-001 0415-148801-0151 NIZORAL 2% Ketoconazole 20mg/g Cream 30g Tube

1465-3254-003 0415-148802-1171 NIZORAL 200MG Ketoconazole 200mg Tablets 10's Blister

1280-3261-001 0188-233502-0111 NOLVADEX - D 20MG Tamoxifen (as citrate) 20mg Coated Tablets 30's (10's Blister x 3)

1280-3260-001 0188-233501-0111 NOLVADEX 10MG Tamoxifen (as citrate) 10mg Coated Tablets 30's (10's Blister x 3)

1250-3275-001 0135-223401-1171 NOPAIN DS 500 Naproxen (as Sodium) 500mg Tablets 10's Blister

1587-3302-001 0186-115902-1451 NORVASC 5MG Amlodipine (as besilate) 5mg Capsules (Hard Gelatin) 30's (10's Blister x 3)

1379-3304-001 0248-112401-1171 NO-URIC 100MG Allopurinol 100mg Tablets 50's

1379-3304-002 0248-112402-1171 NO-URIC 300MG Allopurinol 300mg Tablets 20's

1470-3308-001 0574-102403-0151 NOVIRAL 5% Aciclovir 50mg/g Cream 15g Tube

1559-3312-001 0043-524501-1131 NOVOMIX 30 FLEXPEN 100

IU/ML

Insulin - Aspart biphasic (human

recombinant) (30% aspart, 70% aspart

protamin)

100 IU/ml Suspension for Injection 3ml FlexPen x 5

1559-3312-006 NOVOMIX 30 PENFILL 100

U/ML

Insulin - Aspart biphasic (human

recombinant) (30% aspart, 70% aspart

protamin)

100 IU/ml Suspension for Injection 3ml Cartridge x 5

1559-3318-001 0043-235201-1021 NOVORAPID FLEXPEN 100

IU/ML

Insulin - Aspart (human recombinant) 100 IU/ml Solution for Injection 3ml FlexPen x 5

1559-3319-001 0043-235202-1021 NOVORAPID PENFILL 100

U/ML

Insulin - Aspart (human recombinant) 100 IU/ml Solution for Injection 3ml Cartridge x 5

1234-3325-003 0089-236102-1172 NUELIN SA 250MG Theophylline 250mg Tablets 20's

1355-3327-001 0771-107904-1111 NUROFEN FOR CHILDREN

100MG/5ML

Ibuprofen 100mg/5mL Suspension 100ml Bottle

1410-5075-001 0244-212301-0151 NUTRADERM Liquid Paraffin 13% W/W in O/W

emulsion

Emollient Cream 60g Tube

1410-5075-002 0244-212301-0571 NUTRADERM LOTION Liquid Paraffin 13% W/W in O/W

emulsion

Lotion 200ml Bottle

1410-3329-001 0244-139601-0151 NUTRAPLUS 10% Urea 100mg/g Cream 100g Tube

1276-3333-001 0147-222104-0851 NYSTATIN 500,000 IU/5ML Nystatin 100,000 IU/ml Powder for Suspension 60ml Glass Bottle

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1276-3333-002 0147-222103-1171 NYSTATIN 500000 IU Nystatin 500000 IU Tablets 20's (10's Blister x 2)

1829-4834-001 0774-236601-1971 OCEAN SPRAY SALT SOLUTION 0.9% Nasal Spray 15ml spray/btl x 1

1622-3348-001 0355-119103-0371 OCURED Antazoline Sulfate, Naphazoline Nitrate 5mg, 0.25mg/ml Eye Drops (Solution) 10ml Dropper Bottle

1240-6031-002 0652-237302-1451 ODRIK 2MG Trandolapril 2mg Capsules (Hard Gelatin) 28's (14's Blister x 2)

1615-3350-001 0549-237401-1171 OFLACIN 200MG Ofloxacin 200mg Tablets 10's Blister

1257-3351-001 0049-237402-0371 OFLOX 0.3% Ofloxacin 3mg/ml Eye Drops (Solution) 5ml Dropper Bottle

1468-7112-001 0152-142201-0461 OLFAST 50MG Diclofenac potassium 50mg Granules for Solution (Oral) 10 Sachets

1525-3368-002 0095-149901-0431 OLFEN 1% Diclofenac Sodium 10mg/g Gel 50g Tube

1525-3368-004 0095-149904-1171 OLFEN 50MG LACTABS Diclofenac Sodium 50mg Tablets 20's (10's Blister x 2)

1525-3370-001 0095-149907-1141 OLFEN-75 SR DEPOTABS Diclofenac Sodium 75mg Sustained Release Tablets 10's Blister

2409-3370-003 0095-149907-1143 OLFEN-75 SR DEPOTABS Diclofenac Sodium 75mg Sustained Release Tablets 10's Blister

1641-4606-001 0137-238102-0391 OLMETEC 20MG Olmesartan medoxomil 20mg Film Coated Tablets 28's (14's Blister x 2)

1641-4606-002 0137-238101-0391 OLMETEC 40MG Olmesartan medoxomil 40mg Film Coated Tablets 28's (14's Blister x 2)

1641-4606-003 0137-238101-0392 OLMETEC 40MG Olmesartan medoxomil 40mg Film Coated Tablets 28's (7's Blister x 4)

1641-6585-001 0137-326801-0391 OLMETEC PLUS 20/12.5MG Olmesartan medoxomil,

Hydrochlorothiazide

20mg, 12.5mg Film Coated Tablets 28's (14's Blister x 2)

1641-6585-002 0137-326802-0391 OLMETEC PLUS 40/12.5MG Olmesartan medoxomil,

Hydrochlorothiazide

40mg, 12.5mg Film Coated Tablets 28's (7's Blister x 4)

1641-6585-003 0137-326803-0391 OLMETEC PLUS 40/25MG Olmesartan medoxomil,

Hydrochlorothiazide

40mg, 25mg Film Coated Tablets 28's (7's Blister x 4)

1542-3372-003 0696-142801-1451 OMACEPH 500 Cefalexin (Anhydrous) 500mg Capsules (Hard Gelatin) 20's (10's Blister x 2)

1542-3375-001 0097-103202-0391 OMACIP 250 Ciprofloxacin 250mg Film Coated Tablets 10's Blister

1542-3375-003 0097-103201-0391 OMACIP 500 Ciprofloxacin 500mg Film Coated Tablets 10's Blister

1677-3376-001 0155-238201-1481 OMACOR 1000MG Omega-3 ethyl ester 90 EPA 46%, DHA 38% Capsules (Soft Gelatin) 28's Bottle

1542-3378-002 0696-109504-0851 OMATHROCIN 200MG/5ML Erythromycin (as Ethyl Succinate) 200mg/5ml Powder for Suspension 100ml Glass Bottle

1542-3379-002 0097-123701-0392 OMCET 10 Cetirizine 10mg Film Coated Tablets 28's (14's Blister x 2)

1542-3379-004 0097-123704-1631 OMCET 10MG/ML Cetirizine 10mg/ml Drops (Oral) 15ml Glass Dropper Bottle

1360-3380-001 0118-174201-0341 OMEDAR 20MG Omeprazole 20mg Enteric Coated Tablets 14's Glass Bottle

1360-3380-002 0118-174201-0342 OMEDAR 20MG Omeprazole 20mg Enteric Coated Tablets 14's Blister

1641-3382-001 0137-174201-1452 OMEPREX 20MG Omeprazole 20mg Capsules (Hard Gelatin) 14's Bottle

1641-3382-002 0137-174201-1451 OMEPREX 20MG Omeprazole 20mg Capsules (Hard Gelatin) 28's Bottle

1567-3384-001 0207-174201-1451 OMEZYN 20 Omeprazole 20mg Capsules (Hard Gelatin) 15's Plastic Bottle

1697-3386-002 0195-174201-1451 OMIZ 20 Omeprazole 20mg Capsules (Hard Gelatin) 14's (2's Strip x 7)

2324-6448-001 1137-114003-2011 OMNARIS 50MCG Ciclesonide 50mcg Nasal Spray Pump 120 Puffs Nasal Spray

1641-3387-001 0137-238401-1451 OMNIC 0.4MG Tamsulosin HCl 0.4mg Capsules (Hard Gelatin) 30's (10's Blister x 3)

1641-6263-001 0137-238401-0391 OMNIC OCAS 0.4MG Tamsulosin HCl 0.4mg Film Coated Tablets 30's (10's Blister x 3)

1250-3388-001 0135-238504-0851 OMNICEF 125MG/5ML Cefdinir 125mg/5ml Powder for Suspension 40ml Glass Bottle

1250-3388-003 0135-238502-1451 OMNICEF 300 Cefdinir 300mg Capsules (Hard Gelatin) 10's Plastic Bottle

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1542-3391-001 0696-106603-1631 OMOL 100MG/ML Paracetamol 100mg/ml Drops (Oral) 15ml Glass Bottle

1542-3393-003 0097-111803-1171 OMVIL 4MG Chlorphenamine Maleate 4mg Tablets 20's (10's Blister x 2)

1556-6256-001 1038-348303-1461 ONBREZ BREEZHALER

150MCG

Indacaterol (as maleate) 150mcg Capsules (Hard Gelatin) for

Inhalation (Dry Powder)

30's (10's blister x 3) + Onbrez

Breezhaler1497-3395-002 0281-238902-1481 ONE-ALPHA 0.25MCG Alfacalcidol 0.25mcg Capsules (Soft Gelatin) 30's (10's Blister x 3)

1497-3395-004 0281-238901-1482 ONE-ALPHA 0.5MCG Alfacalcidol 0.5mcg Capsules (Soft Gelatin) 30's (10's Blister x 3)

1497-3395-005 0281-238904-1481 ONE-ALPHA 1MCG Alfacalcidol 1mcg Capsules (Soft Gelatin) 100's

1498-3395-006 0281-238903-1631 ONE-ALPHA 2MCG/ML Alfacalcidol 2mcg/ml Drops (Oral) 20ml

1338-6209-001 0011-346301-1171 ONGLYZA 2.5MG Saxagliptin 2.5mg Tablets 30's Bottle

1338-6209-002 0011-346302-1171 ONGLYZA 5MG Saxagliptin 5mg Tablets 30's Bottle

1567-3398-001 0207-140504-0151 OPIZOLE 1% Clotrimazole 10mg/g Cream 20g Collapsible Tube

1567-3399-001 0207-214402-0151 OPIZOLE B Betamethasone (as dipropionate),

Clotrimazole

0.5mg, 10mg/g Cream 20g Collapsible Tube

1250-3401-002 0135-174201-0341 OPRAZOLE 20MG Omeprazole 20mg Enteric Coated Tablets 14's Plastic Bottle

1464-3403-001 0031-119704-0371 OPTICHLOR 0.5% Chloramphenicol 5mg/ml Eye Drops (Solution) 10ml Dropper Bottle

1464-3404-001 0031-103204-0371 OPTICIN 0.3% Ciprofloxacin (as HCl) 3mg/ml Eye Drops (Solution) 5ml Dropper Bottle

1464-3407-001 0031-239201-0371 OPTIDEX - T Tobramycin, Dexamethasone 3mg, 1mg/ml Eye Drops (Suspension) 5ml Plastic Dropper Bottle

1464-3408-001 0031-237402-0371 OPTIFLOX 0.3% Ofloxacin 3mg/ml Eye Drops (Solution) 5ml Plastic Dropper Bottle

1464-3411-001 0031-185001-0371 OPTILONE 0.1% Fluorometholone 1mg/ml Eye Drops (Suspension) 5ml Dropper Bottle

1464-3414-001 0031-119804-0371 OPTIPRED 1% Prednisolone acetate 10mg/ml Eye Drops (Suspension) 5ml Dropper Bottle

1464-3415-001 0031-120401-0371 OPTIZOLIN Antazoline HCl, Tetrazoline HCl 0.5mg, 0.4mg/ml Eye Drops (Solution) 10ml Plastic Dropper Bottle

1475-3421-001 0102-230603-0831 ORALITE Dextrose, Potassium chloride, Sodium

chloride, Sodium citrate

Combination Powder for Solution (Oral) 28.5g Sachets x 10

1472-3422-001 0005-140201-1451 ORAMAX 150MG Fluconazole 150mg Capsules (Hard Gelatin) 1's Blister

1490-3430-004 0138-103201-0391 ORLIN 500MG Ciprofloxacin 500mg Film Coated Tablets 10's Blister

1542-3432-001 0097-230603-2091 ORS ORS - Dextrose (anhydrous), Potassium

chloride, Sodium chloride, Trisodium

20g, 1.5g, 3.5g, 2.9g Powder (Oral) 30g Sachet x 25

2214-3437-006 0170-180403-1531 ORUVAIL 100MG Ketoprofen 100mg Controlled Release Capsules

(Hard Gelatin)

28's (14's Blister x 2)

2214-3437-007 0170-180402-1531 ORUVAIL 200MG Ketoprofen 200mg Controlled Release Capsules

(Hard Gelatin)

28's (14's Blister x 2)

1631-3438-010 0397-116407-0391 OSPAMOX 1000MG Amoxycillin (as trihydrate) 1000mg Film Coated Tablets 16's (8's Blister x 2)

1309-3438-002 0233-116421-0461 OSPAMOX 125MG/5ML Amoxycillin (as trihydrate) 125mg/5ml Granules for Suspension 100ml Glass Bottle

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1309-3438-004 0233-116402-0461 OSPAMOX 250MG/5ML Amoxycillin (as trihydrate) 250mg/5ml Granules for Suspension 100ml Glass Bottle

1631-3439-008 0397-241302-0461 OSPEN 400 Penicillin V potassium (Phenoxymethyl

penicillin potassium)

0.3188g/5ml Granules for Suspension 60ml Glass Bottle

1631-3439-006 0397-241303-1171 OSPEN 500 Penicillin V potassium

(Phenoxymethylpenicillin potassium)

500000 IU Tablets 30's (10's Blister x 3)

1309-3440-001 0233-142812-0461 OSPEXIN 125MG/5ML Cefalexin 125mg/5ml Granules for Suspension 100ml Glas Bottle

1309-3440-004 0233-142804-0461 OSPEXIN 250MG/5ML Cefalexin 250mg/5ml Granules for Suspension 100ml Glass Bottle

1309-3440-006 0233-142801-0392 OSPEXIN 500MG Cefalexin 500mg Film Coated Tablets 1000's (10's Blister x 100)

2406-7177-001 1764-123302-0991 OSTENIL 1% Sodium hyaluronate 10mg/ml Intraarticular Injection 2ml Pre-filled Syringe

1732-3442-001 0311-106201-0551 OSTEOCARE Vitamin D, Calcium, Magnesium, Zinc 1.9mg (75 iu), 150mg, 75mg,

3mg/5ml

Liquid (Oral) 200ml Bottle

1732-3442-002 0311-106201-1171 OSTEOCARE Vitamin & Mineral - D, Calcium,

Magnesium, Zinc

100iu, 400mg, 150mg, 5mg Tablets 30's (15's Blister x 2)

1426-3445-002 0006-241601-0241 OTOSPORIN Neomycin sulphate, Polymixin B

sulphate, Hydrocortisone

3400 units, 10000 units,

10mg/ml

Ear Drops 5ml Dropper Bottle

1268-3446-001 0169-140504-0241 OTOZOL 1% Clotrimazole 10mg/ml Ear Drops (Solution) 10ml Dropper Bottle

1552-3448-003 0027-128801-2021 OTRIVIN 0.05% (PAEDIATRIC) Xylometazoline HCl 0.5mg/ml Nasal Drops (Solution) 10ml Bottle

1552-3448-004 0027-128802-1971 OTRIVIN 0.1% (ADULT) Xylometazoline HCl 1mg/ml Nasal Spray 10ml Metered Dose Spray Bottle

1552-3448-007 0027-296201-1971 OTRIVIN MENTHOL 0.1% Xylometazoline HCl 1mg/ml Nasal Spray 10ml Metered Dose Spray Bottle

1622-3450-001 0355-237402-0371 OXACIN 0.3% Ofloxacin 3mg/ml Eye Drops 5ml Dropper Bottle

1470-3452-001 0574-108602-2021 OXAZOLINE 0.05% Oxymetazoline HCl 0.5mg/ml Nasal Drops (Solution) 10ml Dropper Bottle

1665-3464-017 0788-107001-1172 PANADOL EXTRA Paracetamol, Caffeine 500mg, 65mg Tablets 24's (12's Blister x 2)

1475-3475-005 0102-106618-1001 PANADREX IV 10MG/ML Paracetamol 10mg/ml Solution for Infusion 100ml PVC Bag x 12

2532-6909-001 1516-106604-1161 PANALIFE 120MG/5ML Paracetamol 120mg/5ml Syrup 100ml Glass Bottle

2532-6909-005 1516-106601-1172 PANALIFE 500MG Paracetamol 500mg Tablets 24's (12's Blister x 2)

1472-3480-001 0005-206401-0151 PANDERM Gramicidin, Neomycin (as sulphate),

Nystatin, Triamcinolone acetonide

0.25mg, 2.5mg, 100000 IU,

1mg/g

Cream 15g Collapsible Tube

1472-6635-001 0005-242802-0781 PANTONIX 40MG I.V. Pantoprazole (as sodium sesquihydrate) 40mg Powder for Infusion 1 Glass Vial (Powder)

2681-7430-001 2161-242802-0802 PANTOPRAZOLE AZEVEDOS

40MG

Pantoprazole (as sodium sesquihydrate) 40mg Powder for Injection 10 Vials (Powder)

2325-3485-007 1513-242801-1751 PANTOZOL 20MG Pantoprazole (as Sodium sesquihydrate) 20mg Gastro-Resistant Tablets 15's Blister

2325-3485-011 1513-242802-1751 PANTOZOL 40MG Pantoprazole (as Sodium sesquihydrate) 40mg Gastro-Resistant Tablets 15's Blister

2325-3485-012 1513-242802-0801 PANTOZOL I.V. 40MG Pantoprazole (as sodium sesquihydrate) 40mg Powder for Injection 1 Vial (Dry)

1465-3492-003 0415-243002-1171 PARIET 20MG Rabeprazole Sodium 20mg Tablets 14's Blister

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1253-5622-001 0085-243301-0371 PATADAY 0.2% Olopatadine HCl 2mg/ml Eye Drops (Solution) 2.5ml Drop-tainer Bottle

1957-4845-004 1128-363501-0991 PEDIATRIC ELECTROLYTE

FRUIT FLAVOR

Sodium Chloride, Sodium Citrate,

Potassium Citrate

(2.046g + 0.937g + 2.33g)/1

Liter

Solution 237ml

1957-4845-005 1128-363501-0992 PEDIATRIC ELECTROLYTE

FRUIT FLAVOR

Sodium Chloride, Sodium Citrate,

Potassium Citrate

(2.046g + 0.937g + 2.33g)/1

Liter

Solution 948ml (4 Bottles x 237ml)

1957-4845-006 1128-363501-1382 PEDIATRIC ELECTROLYTE

GRAPE FLAVOR

Sodium Chloride, Sodium Citrate,

Potassium Citrate

(2.046g + 0.937g + 2.33g)/1

Liter

Solution 237ml

1957-4845-007 1128-363501-1381 PEDIATRIC ELECTROLYTE

GRAPE FLAVOR

Sodium Chloride, Sodium Citrate,

Potassium Citrate

(2.046g + 0.937g + 2.33g)/1

Liter

Solution 948ml (4 Bottles x 237ml)

1697-6111-001 0195-244101-0391 PEDOVEX 75MG Clopidogrel (as bisulfate) 75mg Film Coated Tablets 30's (10's Blister x 3)

1250-3509-005 0135-116404-1451 PENAMOX 250MG Amoxycillin trihydrate 250mg Capsules (Hard Gelatin) 500's (10's Blister x 50)

1250-3509-006 0135-116402-0851 PENAMOX 250MG/5ML Amoxycillin trihydrate 250mg/5ml Powder for Suspension 100ml Bottle

1400-3515-001 0272-123908-0331 PENTASA 1% ENEMA Mesalazine 10mg/ml Solution for Rectal Enema 100ml Squeeze Bottle x 7 + Polythene

Disposal Bags1400-3515-005 0272-123907-2231 PENTASA 1G Mesalazine 1g Rectal Suppositories 28's (7's Blister x 4)

1400-3515-004 0272-123904-0941 PENTASA 500MG Mesalazine 500mg Slow Release Tablets 100's (10's Blister x 10)

1400-3515-007 0272-123908-3511 PENTASA ENEMA 1G/100ML Mesalazine 10mg/ml Solution for Rectal Enema 100ml Squeeze Bottle x 7 + Polythene

Disposal Bags

1400-3515-002 0272-123907-2181 PENTASA SACHET 1G Mesalazine 1g Prolonged Release Granules 50 Sachets

1631-6664-001 0993-242801-0341 PEPSOLAN 20MG Pantoprazole (as sodium sesquihydrate) 20mg Enteric Coated Tablets 15's Blister

1631-6664-002 0993-242802-0341 PEPSOLAN 40MG Pantoprazole (as sodium sesquihydrate) 40mg Enteric Coated Tablets 30's (15's Blister x 2)

1631-6664-003 2115-242802-0802 PEPSOLAN 40MG I.V. Pantoprazole (as sodium sesquihydrate) 40mg Powder for Injection 10 Glass Vials (Powder)

1680-7056-001 0252-208402-1451 PEPTAZOL 30MG Lansoprazole (as enteric-coated pellets) 30mg Capsules (Hard Gelatin) 14's (7's Blister x 2)

2219-3520-003 0011-106618-1001 PERFALGAN 10MG/ML Paracetamol 10mg/ml Solution for Infusion 100ml Vial x 12

1256-3521-001 0003-157202-1171 PERIACTIN 4MG Cyproheptadine HCl 4mg Tablets 20's (10's Blister x 2)

1097-3529-002 1050-245402-1451 PERMIXON 160MG Serenoa repens Lipidosterolic Ext. 160mg Capsules (Hard Gelatin) 30's (15's Blister x 2)

1263-4626-008 0809-246203-1171 PHENOBARBITAL Phenobarbital 60mg Tablets 28's

2016-4626-005 0448-246201-1171 PHENOBARBITAL Phenobarbital 15mg Tablets 28's

1263-4626-004 0809-246202-1171 PHENOBARBITAL Phenobarbital 30mg Tablets 28's

2081-5384-001 0814-246601-0271 PHOSPHORUS Phosphorus 500mg Effervescent Tablets 100's

2288-6693-002 1104-111936-0991 PHYSIODOSE PHYSIOLOGICAL

SALINE SOLUTION

Sodium Chloride 0.9g/100g Unit Dose Vial 5ml

2417-3547-007 1291-246802-0391 PHYSIOTENS 0.2MG Moxonidine 0.2mg Film Coated Tablets 28's (14's Blister x 2)

1677-3547-001 0155-246802-0391 PHYSIOTENS 0.2MG Moxonidine 0.2mg Film Coated Tablets 28's (14's Blister x 2)

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

2417-3547-008 1291-246801-0391 PHYSIOTENS 0.4MG Moxonidine 0.4mg Film Coated Tablets 28's (14's Blister x 2)

2202-4651-002 0059-248001-1171 PLAQUENIL 200MG Hydroxychloroquine 200mg Tablets 60's

1635-3564-001 0030-244101-0391 PLAVIX 75MG Clopidogrel (as hydrogen sulphate) 75mg Film Coated Tablets 28's (14's Blister x 2)

1279-3565-002 0188-248102-1171 PLENDIL 10MG Felodipine 10mg Tablets 30's Bottle

1279-3565-006 0188-248101-1172 PLENDIL 5MG Felodipine 5mg Tablets 30's Bottle

1378-4609-001 0001-147401-1171 PLETAAL 100MG Cilostazol 100mg Tablets 20's (10's Blister x 2)

2060-7038-002 PMS-Terazosin Terazosin 2mg Tablets Bottle x 100's

1650-3569-001 0070-390501-1161 POLARAMINE 2MG/5ML Dexchlorpheniramine Maleate 0.4mg/ml Syrup 120ml Bottle

1574-3581-001 0016-181302-1172 PONSTAN FORTE 500MG Mefenamic Acid 500mg Tablets 20's (10's Blister x 2)

1250-3586-001 0135-124001-1171 POXIDIUM Chlordiazepoxide, Clidinium bromide 5mg, 2.5mg Tablets 30's (10's Blister x 3)

1967-5627-002 0042-341502-1501 PRADAXA 110MG Dabigatran etexilate (as mesilate) 110mg Capsules (Vegetable) 30's (10's Blister x 3)

1967-5627-006 0042-341503-1501 PRADAXA 150MG Dabigatran etexilate (as mesilate) 150mg Capsules (Vegetable) 60's (10's Blister x 6)

1967-5627-004 0042-341501-1501 PRADAXA 75MG Dabigatran etexilate (as mesilate) 75mg Capsules (Vegetable) 30's (10's Blister x 3)

1257-3592-001 0049-119804-0371 PRED FORTE 1% Prednisolone acetate 10mg/ml Eye Drops (Suspension) 5ml Dropper Bottle

1603-3595-001 0229-119806-2201 PREDFOAM 20MG/DOSE Prednisolone 20mg Rectal Foam Aerosol 14 Dose (25g) Patient Pack

1562-3597-001 0047-119805-1171 PREDNISOLON NYCOMED

5MG

Prednisolone 5mg Tablets 100's (10's Blister x 10)

1468-6721-001 0152-119813-1161 PREDO 15MG/5ML Prednisolone (sodium phosphate) 3mg/ml Syrup 120ml Glass Bottle

1732-4855-002 0311-106201-1172 PREGNACARE Pregnancy Multivitamins Combination Tablets 30 tabs/pack x 1 unit

1735-3601-002 0494-158802-1171 PREMARINE 0.625MG Oestrogens (conjugated) 0.625mg Tablets 100's Plastic Bottle

1472-3605-005 0005-150403-1021 PREMOSAN 10MG/2ML Metoclopramide HCl 10mg/2ml Solution for Injection 2ml Ampoule x 5

1472-3605-009 0005-150401-1111 PREMOSAN 5MG/5ML Metoclopramide HCl 5mg/5ml Suspension 120ml Bottle

1472-3605-010 0005-378101-1161 PREMOSAN 5MG/5ML Metoclopramide HCl 5mg/5ml Syrup 120ml Bottle

1606-5479-001 0401-250501-1161 PRIMALAN 1.25MG/2.5ML Mequitazine 0.5mg/ml Syrup 60ml Glass Bottle

1175-4857-002 0831-250602-1171 PRIMAQUINE PRIMAQUINE (AS BASE) 7.5mg Tablets 56's

1864-4857-001 0830-250601-1171 PRIMAQUINE PRIMAQUINE 15mg Tablets 1 tablet/loose x 100

1947-5100-001 0059-250601-1172 PRIMAQUINE PHOSPHATE

15MG

Primaquine 15mg Tablets Bottle x 100 tablets

1644-3616-001 0068-233901-1171 PRIMOLUT - N 5MG Norethisterone 5mg Tablets 30's Bottle

1644-3617-001 0068-390701-0511 PRIMOLUT DEPOT 250MG Hydroxyprogesterone caproate 250mg Injection 1ml Ampoule

1635-3619-007 0265-150407-1171 PRIMPERAN 10MG Metoclopramide HCl 10mg Tablets 20's Blister

1363-3619-002 0832-150407-2231 PRIMPERAN 10MG

(CHILDREN)

Metoclopramide HCl 10mg Rectal Suppositories 6's Strip

1363-3619-005 0832-150410-2231 PRIMPERAN 20MG (ADULT) Metoclopramide HCl 20mg Rectal Suppositories 6's Strip

1790-4655-001 0834-251501-1171 PROCARBAZINE 50MG Procarbazine 50mg Tablets 50's

1783-5102-004 0727-135804-1171 PROCHLORPERAZINE Prochlorperazine 5mg Tablets 100's

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1499-3627-001 0071-251701-0391 PROCORALAN 5MG Ivabradine 5mg Film Coated Tablets 56's (14's Blister x 4)

1499-3627-002 0071-251702-0391 PROCORALAN 7.5MG Ivabradine 7.5mg Film Coated Tablets 56's (14's Blister x 4)

1552-3628-001 0027-194101-0151 PROCTO GLYVENOL Tribenoside, Lidocaine (as HCl) 50mg, 20mg/g Cream 30g Tube

1552-3628-002 0027-194103-2231 PROCTO GLYVENOL Tribenoside, Lidocaine 400mg, 40mg Rectal Suppositories 10's

1434-3629-002 0240-251802-2231 PROCTO SYNALAR Fluocinolone acetonide, Lidocaine HCl Combination Rectal Suppositories 10's (5's Blister x 2)

1434-3629-001 0240-251801-2221 PROCTO SYNALAR Fluocinolone acetonide, Lidocaine HCl Combination Rectal Ointment 15g Tube

1360-3631-001 0118-251902-2221 PROCTOHEAL Bismuth subgallate, Fluocinolone

acetonide, Lidocaine HCl, Menthol

Combination Rectal Ointment 15g Tube + Applicator

1360-3631-002 0118-251901-2231 PROCTOHEAL Bismuth subgallate, Fluocinolone

acetonide, Lidocaine HCl, Menthol

Combination Rectal Suppositories 10's (5's Blister x 2)

1697-3636-001 0195-107904-1111 PROF 100MG/5ML Ibuprofen 100mg/5ml Suspension 100ml Glass Bottle

1697-3636-002 0195-107902-0391 PROF 400MG Ibuprofen 400mg Film Coated Tablets 30's (15's Blister x 2)

1636-3638-004 0837-180403-0391 PROFENID 100MG Ketoprofen 100mg Film Coated Tablets 30's (15's Blister x 2)

1678-3638-001 0838-180403-0511 PROFENID 100MG I.M Ketoprofen 100mg Injection 6 Vials + 6 Solvent Ampoules

1636-3638-005 1267-180405-0431 PROFENID 2.5% Ketoprofen 25mg/g Gel 60g Tube

1472-3640-001 0005-107904-1112 PROFINAL (PAEDIATRIC)

100MG/5ML

Ibuprofen 100mg/5ml Suspension 110ml Glass Bottle

1472-3640-005 0005-107901-1173 PROFINAL 200MG Ibuprofen 200mg Tablets 20's (10's Blister x 2)

1472-3642-001 0005-252201-0391 PROFINAL XP Ibuprofen, Caffeine 400mg, 65mg Film Coated Tablets 20's (10's Blister x 2)

1250-3644-003 0135-252303-0061 PROGRAF 0.5MG Tacrolimus 0.5mg Capsules HDPE Bottle x 100 Capsules

1250-3644-001 0135-252301-1451 PROGRAF 1MG Tacrolimus 1mg Capsules (Hard Gelatin) 100's Plastic Bottle

1250-3644-002 0135-252302-1451 PROGRAF 5MG Tacrolimus 5mg Capsules (Hard Gelatin) 100's Plastic Bottle

1644-3645-001 0068-252402-1171 PROGYLUTON Estradiol valerate, Norgestrel 2mg (E) &/or 0.5mg (N) Tablets 21's Blister (11 White Tablets + 10

Light Brown Tablets)2034-5391-001 0842-106101-1171 PROMISE NUNAL TABLETS Multivitamines Combination Tablets 100's

1960-4648-003 0050-252901-1171 PROPYLTHIOURACIL 50MG Propylthiouracil 50mg Tablets Bottle x 100 tablets

1531-3656-001 0090-252702-1171 PROSCAR 5MG Finasteride 5mg Tablets 28's

1499-3669-001 0071-253401-0451 PROTELOS 2G Strontium ranelate 2g Granules 28 Sachets

1680-6211-001 0252-242801-0341 PROTON 20 Pantoprazole (as sodium) 20mg Enteric Coated Tablets 28's (14's Blister x 2)

1680-6211-003 0252-242802-0342 PROTON 40 Pantoprazole (as sodium) 40mg Enteric Coated Tablets 28's (14's Blister x 2)

1595-3675-004 0318-149301-1171 PROVERA 5MG Medroxyprogesterone Acetate 5mg Tablets 24's Glass Bottle

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

2127-6638-002 0289-382601-1632 PROVITA D DROPS Ergocalciferol (Vitamin D2) 8000 IU/ml Drops (Oral) 60ml Bottle

2307-6369-001 1124-176506-1171 PROVITA D3 Cholecalciferol (Vitamin D3) 1,000 IU Tablets 90's

1433-3679-001 0240-223402-1171 PROXEN 250MG Naproxen 250mg Tablets 20's (10's Blister x 2)

1433-3679-002 0240-223401-1171 PROXEN 500MG Naproxen 500mg Tablets 20's (10's Blister x 2)

1279-3684-002 0188-135907-2441 PULMICORT 0.25MG/ML Budesonide 0.25mg/ml Suspension for Nebulization 2ml Units x 20 (5's x 4)

1279-3684-003 0188-135906-2441 PULMICORT 0.5MG/ML Budesonide 0.5mg/ml Suspension for Nebulization 2ml Units x 20 (5's x 4)

1279-3684-005 0188-135903-0791 PULMICORT 200MCG/DOSE

TURBUHALER

Budesonide 200mcg Dry Powder Inhaler 100 Dose Turbuhaler

1592-7226-001 0219-533802-0342 PUMPINOX 40MG Esomeprazole (as magnesium

trihydrate)

40mg Enteric Coated Tablets 14's (7's Blister x 2)

1781-4654-001 0121-254601-1171 PURINETHOL 50MG Mercaptopurine 50mg Tablets 25's

1859-5562-001 0487-106101-1171 PURITANS PRIDE PRENATAL

VITAMINS

Pregnancy Multivitamins Combination Tablets 100's (10's Blister x 10)

2060-4662-003 0112-255001-1171 PYRAZINAMIDE Pyrazinamide 500mg Tablets 100's

1472-3694-004 0005-196003-1171 PYRIDOXIN 40MG Vitamin - B6 40mg Tablets 20's Blister

1342-3695-001 0320-103202-0391 QCIP 250MG Ciprofloxacin 250mg Film Coated Tablets 10's Blister

1342-3695-002 0320-103201-0391 QCIP 500MG Ciprofloxacin 500mg Film Coated Tablets 10's Blister

1513-5108-002 0014-256001-0511 QUININE DIHYDROCHLORIDE QUININE DIHYDROCHLORIDE 300mg/ml Injection 1ml Ampoule x 10

1916-5108-001 0056-256001-0511 QUININE DIHYDROCHLORIDE -

FRESENIUS 300MG/1ML

Quinine 300mg/ml Injection Pack of 10 Ampoules x 1ml

1631-7609-002 0993-243002-1751 RAMEP 20MG Rabeprazole sodium 20mg Gastro-Resistant Tablets 14's (7's Blister x 2)

1471-3713-001 0141-121101-0391 RANIDINE 150 Ranitidine (as HCl) 150mg Film Coated Tablets 20's (10's Blister x 2)

2344-3713-003 2104-121101-0392 RANIDINE 150 Ranitidine (as HCl) 150mg Film Coated Tablets 20's (10's Blister x 2)

2344-3713-004 2104-121102-0392 RANIDINE 300 Ranitidine (as HCl) 300mg Film Coated Tablets 10's Blister

1471-3713-002 0141-121102-0391 RANIDINE 300 Ranitidine (as HCl) 300mg Film Coated Tablets 10's Blister

1276-3716-001 0147-121101-1171 RANIMED 150MG Ranitidine (as HCl) 150mg Tablets 20's (10's Blister x 2)

2532-6910-001 1516-415301-1171 RANITLIFE 150 Ranitidine (as HCl) 150mg Tablets 20's (10's Blister x 2)

2532-6910-002 1516-415302-1171 RANITLIFE 300 Ranitidine (as HCl) 300mg Tablets 10's Blister

1542-5632-003 0097-142903-0851 RANPIME 100MG/5ML Cefixime (as trihydrate) 100mg/5ml Powder for Suspension 30ml Glass Bottle

1542-5632-001 0097-142901-1451 RANPIME 200 Cefixime (as trihydrate) 200mg Capsules (Hard Gelatin) 10's Blister

1542-5632-002 0097-142902-1451 RANPIME 400 Cefixime (as trihydrate) 400mg Capsules (Hard Gelatin) 5's Blister

1348-3723-002 0203-103201-0391 RAPIDFLOX 500MG Ciprofloxacin 500mg Film Coated Tablets 10's Blister

1697-3724-002 0195-142201-0111 RAPIDUS 50MG Diclofenac potassium 50mg Coated Tablets 20's (10's Blister x 2)

2344-6184-002 2104-242802-0341 RAZON 40MG Pantoprazole (as sodium) 40mg Enteric Coated Tablets 14's Blister

1471-6184-001 0141-242802-0341 RAZON 40MG Pantoprazole (as sodium) 40mg Enteric Coated Tablets 14's Blister

1447-6902-003 0015-395404-0391 RELUKAST 10MG Montelukast (as sodium) 10mg Film Coated Tablets 28's (14's Blister x 2)

1447-6902-001 0015-395401-0081 RELUKAST 4MG Montelukast (as sodium) 4mg Chewable Tablets 28's (14's Blister x 2)

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1447-6902-002 0015-395402-0081 RELUKAST 5MG Montelukast (as sodium) 5mg Chewable Tablets 28's (14's Blister x 2)

1250-3757-003 0135-107902-1171 REMOFEN 400MG Ibuprofen 400mg Tablets 30's

1544-6367-001 0067-111705-0251 RENALKA Citric acid anhydrous, Sodium

bicarbonate anhydrous, Sodium citrate,

Tartaric acid

720mg, 1.76g, 630mg, 890mg Effervescent Granules 4g Sachet x 28

1747-3761-001 0096-258401-1171 RENNIE Calcium Carbonate, Magnesium

Carbonate

Combination Tablets 96's (12's Blister x 8)

2250-6265-001 0096-258402-0081 RENNIE PEPPERMINT Calcium carbonate, Magnesium

carbonate

680mg, 80mg Chewable Tablets 96's (12's Blister x 8)

1508-3763-001 0077-258502-1171 REPARIL 20MG Sodium aescinate 20mg Tablets 40's

1508-3764-002 0077-258601-0431 REPARIL GEL N Aescin, Aescin Sodium Polysulphate,

Diethylamine Salicylate

10mg, 10mg, 50mg/g Gel 40g Tube

1544-3766-006 0067-148608-0851 RESCLAR 125MG/5ML Clarithromycin 125mg/5ml Powder for Suspension 100ml Plastic Bottle

1544-3766-001 0067-148601-0391 RESCLAR 250MG Clarithromycin 250mg Film Coated Tablets 14's (7's Blister x 2)

1544-3766-008 0067-148605-0853 RESCLAR 250MG/5ML Clarithromycin 250mg/5ml Powder for Suspension 100ml Plastic Bottle

1544-3766-002 0067-148602-0391 RESCLAR 500MG Clarithromycin 500mg Film Coated Tablets 14's (7's Blister x 2)

1544-5216-001 0067-148602-0393 RESCLAR MR 500MG Clarithromycin 500mg Film Coated Tablets 7's Blister

1788-4650-001 0709-138802-1171 RESCUVOLIN 15MG Folinic Acid (Leucovorin Calcium) 15mg Tablets 10's

1777-4632-001 0134-118702-1171 RESOCHIN 250MG Chloroquine 250mg Tablets 100's

1250-3768-001 0135-148701-1171 RESTAMINE 10MG Loratadine 10mg Tablets 10's Blister

1309-3772-002 0233-244501-0511 RETARPEN L.A. 1.2 MIU Penicillin G benzathine (Benzathine

benzylpenicillin)

1.2 MIU Injection 1 Vial + Solvent Ampoule

1781-3774-005 0121-259005-0511 RETROVIR Zidovudine 10mg/ml Injection 20ml Single Use Vial

1279-3784-001 0188-135909-1971 RHINOCORT AQUA

32MCG/DOSE

Budesonide 32mcg (0.64mg/ml) Nasal Spray 120 Dose Spray

1279-3784-002 0188-135910-1971 RHINOCORT AQUA

64MCG/DOSE

Budesonide 64mcg (1.28mg/ml) Nasal Spray 120 Dose Spray

1552-5113-003 0027-111903-1971 RHINOMER FORCE 1 0.9% Sodium Chloride 0.9% Nasal Spray 115ml Bottle

1552-5113-002 0027-296801-1971 RHINOMER FORCE 3 0.9% Sodium Chloride 0.9% Nasal Spray 135ml Bottle

1622-3792-001 0355-119704-0371 RIACHOL 0.5% Chloramphenicol 5mg/ml Eye Drops (Solution) 10ml Plastic Dropper Bottle

1622-3792-002 0355-119701-0381 RIACHOL 1% Chloramphenicol 10mg/g Eye Ointment 5g Metal Tube

1622-3794-002 0202-170812-2561 RIALAC 66% Lactulose 660mg/ml Liquid (Oral) 300ml Glass Bottle

1622-3795-001 0355-172301-0431 RIALOCAINE 2% Lidocaine HCl 20mg/g Gel 20g Metal Collapsible Tube +

Applicator1622-3797-002 0202-118511-1111 RIALOX Aluminium Hydroxide, Magnesium

Hydroxide

225mg, 200mg/5ml Suspension 180ml Glass Bottle

1622-3804-001 0202-134003-1161 RIAXINE 4MG/5ML Bromhexine HCl 4mg/5ml Syrup 100ml Glass Bottle

1435-3810-001 0871-259801-1451 RIFADIN 150MG Rifampicin 150mg Capsules (Hard Gelatin) 100's

1435-3810-002 0871-259802-1451 RIFADIN 300MG Rifampicin 300mg Capsules (Hard Gelatin) 100's

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

2065-5396-001 0687-259804-0511 RIFOLDIN Rifampicin 600mg Injection 1 Single-Dose Vial

1472-7522-001 0005-124409-2061 RINELON 50MCG/DOSE Mometasone furoate anhydrous (as

monohydrate)

50mcg Nasal Spray Pump 120 Metered Dose Spray

1121-5635-001 0274-129701-1971 RINOCLENIL 100MCG Beclomethasone dipropionate 100mcg Nasal Spray 200 Actuations Spray Bottle

1472-3824-001 0005-174203-1451 RISEK 10MG Omeprazole 10mg Capsules (Hard Gelatin) 14's Bottle

1472-3824-002 0005-174201-1453 RISEK 20MG Omeprazole 20mg Capsules (Hard Gelatin) 14's Bottle

1472-3824-006 0005-174202-0781 RISEK 40MG Omeprazole 40mg Powder for Infusion 1 Vial (Lyophilisate)

1472-3824-005 0005-174202-1451 RISEK 40MG Omeprazole 40mg Capsules (Hard Gelatin) 14's Bottle

1392-3830-001 0035-260404-1631 RIVOTRIL 0.25% Clonazepam 2.5mg/ml Drops (Oral) 10ml

1392-3830-005 0035-260403-1171 RIVOTRIL 0.5MG Clonazepam 0.5mg Tablets 50's

1392-3830-009 0035-260401-1174 RIVOTRIL 2MG Clonazepam 2mg Tablets 30's

1392-3838-001 0035-107704-1372 ROCEPHIN 1G IM Ceftriaxone (as sodium) 1g Powder for Injection 1 Vial (Dry) + 1 Solvent Ampoule

1392-3838-003 0035-107704-1362 ROCEPHIN 1G IV Ceftriaxone (as sodium) 1g Powder for Injection 1 Vial (Dry) + 1 Solvent Ampoule

1392-3838-011 0035-107702-1362 ROCEPHIN 500MG IM Ceftriaxone (as sodium) 500mg Powder for Injection 1 Vial (Dry) + 1 Solvent Ampoule

1392-3838-013 0035-107702-1371 ROCEPHIN 500MG IV Ceftriaxone (as sodium) 500mg Powder for Injection 1 Vial (Dry) + 1 Solvent Ampoule

1680-3840-001 0252-149904-0171 ROFENAC - D 50MG Diclofenac Sodium 50mg Dispersible Tablets 20's (10's Blister x 2)

1680-3839-002 0252-149901-0432 ROFENAC 1% Diclofenac Sodium 10mg/g Gel 50g Tube

1680-3839-001 0252-149901-0431 ROFENAC 1% Diclofenac Sodium 10mg/g Gel 30g Tube

1680-3839-007 0252-149904-1171 ROFENAC 50MG Diclofenac Sodium 50mg Tablets 20's Blister

1250-3844-001 0135-121105-1021 ROLAN 50MG/2ML Ranitidine (as HCl) 50mg/2ml Solution for Injection 2ml Ampoule x 5

1369-3846-001 0356-174201-1451 R-OMEZ 20MG Omeprazole 20mg Capsules (Hard Gelatin) 20's (10's Strip x 2)

1636-3859-002 1267-261001-0391 ROVAMYCINE 3MIU Spiramycine 3 MIU Film Coated Tablets 10's (5's Blister x 2)

1477-3859-001 ROVAMYCINE 3MIU Spiramycine 3MIU Tablets 10's

1629-3858-002 0609-260901-1481 ROWACHOL Borneol, Camphene, Cineol,

Levomenthol, Menthone, Pinene (α + β)

5mg, 5mg, 2mg, 32mg, 6mg,

17mg

Capsules (Soft Gelatin) 50's

1629-3861-002 0609-261101-1481 ROWATINEX Anethol, Borneol, Camphene, Cineol,

Fenchone, Pinene (α + β)

4mg, 10mg, 15mg, 3mg, 4mg,

31mg

Capsules (Soft Gelatin) 50's

1641-3866-001 0137-261301-1171 ROXONIN 60MG Loxoprofen (as sodium) 60mg Tablets 20's (10's Blister x 2)

1541-5636-001 0326-107704-0801 ROZAXON 1G Ceftriaxone (as sodium) 1g Powder for Injection 1 Glass Vial (Dry Powder)

1541-5636-002 0326-107702-0801 ROZAXON 500MG Ceftriaxone (as sodium) 500mg Powder for Injection 1 Glass Vial (Dry Powder)

1410-5116-001 0244-116613-0151 ROZEX CREAM 0.75% Metronidazole 0.75% Cream 30g Tube

1276-3869-001 0147-107701-0801 ROZIFAX 1000MG Ceftriaxone sodium 1g Powder for Injection 1 Vial (Dry)

1276-3869-002 0147-107703-0801 ROZIFAX 250MG Ceftriaxone sodium 250mg Powder for Injection 1 Vial (Dry)

1276-3869-003 0147-107702-0801 ROZIFAX 500MG Ceftriaxone sodium 500mg Powder for Injection 1 Vial (Dry)

1628-3873-001 0877-260602-1171 RULID 150MG Roxithromycin 150mg Tablets 10's Blister

1622-3874-002 0202-149901-0432 RUMAFEN 1% Diclofenac Sodium (as diethylamine) 10mg/g Gel 50g Collapsible Tube

1622-3874-004 0202-149904-0341 RUMAFEN 50MG Diclofenac Sodium 50mg Enteric Coated Tablets 20's (10's Blister x 2)

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1703-3875-002 0366-260603-1171 RUXID 300MG Roxithromycin 300mg Tablets 7's Blister

1596-3886-001 0406-261801-1171 SALAZOPYRIN EN -TABS

500MG

Sulfasalazine (as combination with

polyvidone)

500mg Tablets 100's Bottle

1523-3887-001 0009-124502-2481 SALBUTAMED 2MG/5ML Salbutamol (as sulfate) 2mg/5ml Syrup (Sugar Free) 100ml Glass Bottle

1496-3889-001 0132-124510-0511 SALBUVENT 0.5MG/ML Salbutamol 0.5mg/ml Injection 1ml Ampoule x 10's

1472-3892-001 0005-151703-0081 SALINAL Simethicone (as 30% dry suspension) 42mg Chewable Tablets 30's

1472-3892-002 0005-151705-1631 SALINAL Simethicone 41.2mg/ml Drops (Oral) 15ml Bottle + Graduated Dropper

2084-5398-001 0878-111903-1071 SALINOSE ADULT Sodium Chloride 0.90% Spray 30ml

2084-5399-001 0878-111903-0221 SALINOSE BABY FORMULA Sodium Chloride 0.90% Drops 20ml

1173-6952-002 0943-123904-0341 SALOFALK 500MG Mesalazine 500mg Enteric Coated Tablets 50's (10's Blister x 5)

1472-3894-002 0005-167501-1171 SALURIN 40MG Furosemide 40mg Tablets 20's (10's Blister x 2)

1250-3895-004 0135-107701-0801 SAMIXON 1000 I.M Ceftriaxone (as Sodium) 1g Powder for Injection 1 Vial (Dry) + 1 Diluent Ampoule

(3.5ml)1250-3895-002 0135-107701-0802 SAMIXON 1000 I.V Ceftriaxone (as Sodium) 1g Powder for Injection 1 Vial (Dry)

1556-3900-001 0027-147203-1481 SANDIMMUN NEORAL 100MG Ciclosporin 100mg Capsules (Soft Gelatin) 50's (5's Blister x 10)

1556-3900-004 0027-147202-1481 SANDIMMUN NEORAL 25MG Ciclosporin 25mg Capsules (Soft Gelatin) 50's (5's Blister x 10)

1552-5506-002 0027-262101-0271 SANDOZ OSTEOMIX Cholecalciferol 1mg, Calcium Carbonate

1000mg, Zinc Sulphate 13.4 mg,

Combination Effervescent Tablets 10's x 2 Tubes

1680-3904-002 0252-107902-1172 SAPOFEN 400MG Ibuprofen 400mg Tablets 20's (10's Blister x 2)

1680-3904-005 0252-107903-1171 SAPOFEN 600MG Ibuprofen 600mg Tablets 30's (10's Blister x 3)

1472-3907-002 0005-103201-0391 SARF 500MG Ciprofloxacin (as HCl) 500mg Film Coated Tablets 10's Blister

1431-6150-002 0503-155402-0391 SARTAN 100 Losartan potassium 100mg Film Coated Tablets 30's (10's Blister x 3)

1431-6150-001 0503-155401-0391 SARTAN 50 Losartan potassium 50mg Film Coated Tablets 30's (10's Blister x 3)

1472-3919-003 0005-136501-0393 SCOPINAL 10MG Hyocine butylbromide 10mg Film Coated Tablets 20's Blister

1472-3919-004 0005-136504-1021 SCOPINAL 20MG/ML Hyocine butylbromide 20mg/ml Solution for Injection 1ml Ampoule x 5

1472-3919-006 0005-136502-1161 SCOPINAL 5MG/5ML Hyocine butylbromide 1mg/ml Syrup 100ml Bottle

1657-3926-002 0078-170806-1162 SEDALAC 67% W/V Lactulose 3.35g/5ml Syrup 120ml Glass Bottle

1592-7480-003 0219-238504-0852 SEFARIN 125MG/5ML Cefdinir anhydrous (as Cefdinir) 125mg/5ml Powder for Suspension 50ml Glass Bottle

1592-7480-001 0219-238502-1452 SEFARIN 300MG Cefdinir anhydrous (as Cefdinir) 300mg Capsules (Hard Gelatin) 10's HDPE Bottle

2522-3943-010 1319-128201-1171 SEPTRIN Co-trimoxazole 400mg, 80mg Tablets 20's (10's Blister x 2)

1426-3943-007 1162-128211-1001 SEPTRIN Cotrimoxazole (Sulfamethoxazole,

Trimethoprim)

80mg + 16mg Injection Pack of 5 Ampoules x 5ml

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

2522-3943-012 1319-128202-1112 SEPTRIN (PAEDIATRIC) Co-trimoxazole 200mg, 40mg/5ml Suspension 100ml Bottle

2522-3944-008 1319-128203-1172 SEPTRIN DS Co-trimoxazole 800mg, 160mg Tablets 10's Blister

1750-3946-001 0006-264102-0791 SERETIDE DISKUS 50/100MCG Salmeterol (as Xinafoate), Fluticasone

propionate

50mcg, 100mcg Dry Powder Inhaler 60 Dose Diskus

1750-3946-002 0006-264101-0791 SERETIDE DISKUS 50/250MCG Salmeterol (as Xinafoate), Fluticasone

propionate

50mcg, 250mcg Dry Powder Inhaler 60 Dose Diskus

1348-6898-001 1393-412001-1391 SEROFLO 125 Fluticasone propionate, Salmeterol (as

xinafoate)

125mcg, 25mcg Aerosol Inhaler 120 Metered Dose Inhaler

1348-6898-002 1393-412002-1391 SEROFLO 250 Fluticasone propionate, Salmeterol (as

xinafoate)

250mcg, 25mcg Aerosol Inhaler 120 Metered Dose Inhaler

1348-6898-003 1393-412003-1391 SEROFLO 50 Fluticasone propionate, Salmeterol (as

xinafoate)

50mcg, 25mcg Aerosol Inhaler 120 Metered Dose Inhaler

2547-3953-002 1549-469401-0111 SEROXAT 20MG Paroxetine 20mg Coated Tablets 30's (10's Blister x 3)

1472-3963-003 0005-183502-0151 SILVADIAZIN 1% Silver sulphdiazine 10mg/g Cream 50g Tube

1622-3967-001 0202-111402-0391 SIMVAGEN 10MG Simvastatin 10mg Film Coated Tablets 30's (10's Blister x 3)

1622-3967-002 0202-111401-0391 SIMVAGEN 20MG Simvastatin 20mg Film Coated Tablets 30's (10's Blister x 3)

1472-3968-001 0005-111402-0391 SIMVAST 10MG Simvastatin 10mg Film Coated Tablets 28's (14's Blister x 2)

1472-3968-002 0005-111401-0391 SIMVAST 20MG Simvastatin 20mg Film Coated Tablets 28's (14's Blister x 2)

1472-3968-003 0005-111403-0391 SIMVAST 40MG Simvastatin 40mg Film Coated Tablets 30's (10's Blister x 3)

1641-3969-001 0137-111402-0391 SIMVATEN 10MG Simvastatin 10mg Film Coated Tablets 30's (10's Blister x 3)

1641-3969-002 0137-111401-0391 SIMVATEN 20MG Simvastatin 20mg Film Coated Tablets 30's (10's Blister x 3)

1641-3969-003 0137-111403-0391 SIMVATEN 40MG Simvastatin 40mg Film Coated Tablets 30's (10's Blister x 3)

2344-6700-003 1200-265903-0081 SINCAST 4MG Montelukast (as sodium) 4mg Chewable Tablets 28's (7's Blister x 4)

2344-6700-004 1200-265902-0081 SINCAST 5MG Montelukast (as sodium) 5mg Chewable Tablets 30's (10's Blister x 3)

1552-3971-001 0027-265802-1161 SINECOD 0.15% W/V Butamirate dihydrogen Citrate 1.5mg/ml Syrup 200ml Bottle

1529-3972-001 0090-210502-1171 SINEMET 100/25 Co-Careldopa (Levodopa, Carbidopa) 100mg, 25mg Tablets 100's Bottle

1256-3972-002 0003-210504-1171 SINEMET 250/25 Co-Careldopa (Levodopa, Carbidopa) 250mg, 25mg Tablets 20's (10's Blister x 2)

1529-3973-001 0090-210502-1172 SINEMET CR 100/25 Co-Careldopa (Levodopa, Carbidopa) 100mg, 25mg Tablets 100's

1529-3973-002 0090-210501-1171 SINEMET CR 200/50 Co-Careldopa (Levodopa, Carbidopa) 200mg, 50mg Tablets 100's

1531-3975-001 0090-265901-1171 SINGULAIR 10MG Montelukast 10mg Tablets 28's (7's Blister x 4)

1531-3975-002 0090-265902-0081 SINGULAIR 5MG (PAEDIATRIC) Montelukast 5mg Chewable Tablets 28's (7's Blister x 4)

1531-3976-001 0090-265903-0461 SINGULAIR PAEDIATRIC 4 MG Montelukast 4mg Granules for Liquid (Oral) 28 Sachets

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1531-3976-002 0090-265903-0081 SINGULAIR PAEDIATRIC 4MG Montelukast 4mg Chewable Tablets 28's (7's Blister x 4)

1571-5485-002 0414-203702-1971 SINOMARIN MINI Sea Water Hypertonic 2.30% Nasal Spray 30ml Bottle

1276-3980-001 0147-103203-0391 SIPRO 750 Ciprofloxacin 750mg Film Coated Tablets 10's Blister

1259-3984-001 0268-209001-1631 SKILAX 7.5MG/ML Sodium picosulphate 7.5mg/ml Drops (Oral) 15ml Plastic Dropper Bottle

1795-4656-001 0175-206103-1171 SLOW K 600MG Potassium Chloride 600mg Tablets 500's

1823-4015-003 0798-163005-1171 SOFLAX STOOL SOFTNER Docusate Sodium 100mg Tablets 30's

2310-4023-004 0336-469501-0801 SOLU CORTEF 100MG/2ML Hydrocortisone (as sodium succinate) 100mg/2ml Powder for Injection 1 Act-o-Vial (Powder + 2ml Solvent)

1595-4024-001 0318-220306-0801 SOLU MEDROL 125MG/2ML Methylprednisolone sodium succinate 125mg/2ml Powder for Injection 1 Act-o-Vial (Powder + 2ml Solvent)

2310-4024-005 0336-220304-0801 SOLU MEDROL 40MG/ML Methylprednisolone sodium succinate 40mg/ml Powder for Injection 1 Act-o-Vial (Powder + 1ml Solvent)

1595-4024-004 0318-220303-0801 SOLU MEDROL 500MG/8ML Methylprednisolone sodium succinate 40mg/ml Powder for Injection 1 Vial (Powder) + 1 Diluent Vial

(7.8ml)1657-4025-001 0078-225203-1161 SOLVEX 250MG/5ML Carbomethyl cysteine (Carbocisteine) 250mg/5ml Syrup 120ml Glass Bottle

1472-4029-002 0005-135903-1391 SONIDAR 200MCG/DOSE Budesonide 200mcg Aerosol Inhaler 200 Metered Dose Canister

1472-4029-001 0005-135903-1392 SONIDAR 200MCG/DOSE Budesonide 200mcg Aerosol Inhaler 100 Metered Dose Canister

1680-6188-001 0252-155401-0391 SORTIVA 50MG Losartan potassium 50mg Film Coated Tablets 30's (10's Blister x 3)

1680-6189-001 0252-155402-0391 SORTIVA FORTE 100MG Losartan potassium 100mg Film Coated Tablets 30's (10's Blister x 3)

1680-6190-001 0252-186701-0391 SORTIVA H 100/25 Losartan potassium,

Hydrochlorothiazide

100mg, 25mg Film Coated Tablets 30's (10's Blister x 3)

1680-6190-002 0252-186702-0391 SORTIVA H 50/12.5 Losartan potassium,

Hydrochlorothiazide

50mg, 12.5mg Film Coated Tablets 30's (10's Blister x 3)

1400-6258-001 0272-280902-0391 SPASMEX 30MG Trospium chloride 30mg Film Coated Tablets 50's (10's Blister x 5)

2532-7153-001 1516-403203-1161 SPASMOLIFE 5MG/5ML Hyocine butylbromide 5mg/5ml Syrup 100ml Glass Bottle

1967-4052-001 0042-268301-1461 SPIRIVA 18MCG Tiotropium (as bromide monohydarate) 18mcg Capsules (Hard Gelatin) for

Inhalation (Dry Powder)

30's (10's Blister x 3) + Handihaler

Device1967-5641-001 0042-268302-1011 SPIRIVA RESPIMAT 2.5MCG Tiotropium (bromide HCl) 2.5mcg Solution for Inhalation 60 Puffs Inhaler (Respimat + 4ml

Cartridge in situ)

1465-4053-002 0415-268402-1452 SPORANOX 100MG Itraconazole 100mg Capsules (Hard Gelatin) 4's Blister

1369-5217-001 0904-115901-1171 STAMLOM 10MG Amlodipine (as maleate) 10mg Tablets 28's (14's Blister x 2)

1369-5217-002 0904-115902-1171 STAMLOM 5MG Amlodipine (as maleate) 5mg Tablets 28's (14's Blister x 2)

1325-4062-001 0011-269101-1171 STARIL 10MG Fosinopril Sodium 10mg Tablets 28's (14's Blister x 2)

1325-4062-002 0011-269102-1171 STARIL 20MG Fosinopril Sodium 20mg Tablets 14's Blister

1125-6212-001 0013-211702-0391 STATIX 10 Atorvastatin (as calcium) 10mg Film Coated Tablets 30's (10's Blister x 3)

1125-6212-002 0013-211703-0391 STATIX 20 Atorvastatin (as calcium) 20mg Film Coated Tablets 30's (10's Blister x 3)

1125-6212-003 0013-211701-0391 STATIX 40 Atorvastatin (as calcium) 40mg Film Coated Tablets 30's (10's Blister x 3)

1689-4073-001 0028-109501-2611 STIEMYCIN 2% Erythromycin (as base) 20mg/ml Topical Solution 25ml

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1465-4080-001 0415-270701-1171 STUGERON 25MG Cinnarizine 25mg Tablets 50's (25's Blister x 2)

1544-4616-001 0067-114204-1171 SUCRATEC 1MG Glimepiride 1mg Tablets 30's (10's Blister x 3)

1544-4616-006 0067-114201-1172 SUCRATEC 2MG Glimepiride 2mg Tablets 30's (10's Blister x 3)

1544-4616-008 0067-114203-1172 SUCRATEC 3MG Glimepiride 3mg Tablets 30's (10's Blister x 3)

1430-6675-001 1142-128302-0651 SUPIROCIN 2% Mupirocin 20mg/g Ointment 15g Tube

1312-4091-003 0910-123313-1021 SUPLASYN 1-SHOT Sodium hyaluronate 60mg/6ml Intraarticular Injection 6ml Pre-filled Syringe

1312-4091-004 0910-123302-1021 SUPLASYN 20MG/2ML Sodium hyaluronate 10mg/ml Intraarticular Injection 2ml Pre-filled Syringe

1309-4092-002 0233-116604-0391 SUPPLIN 500MG Metronidazole 250mg Film Coated Tablets 20's (10's Blister x 2)

1433-4097-004 0240-102403-0151 SUPRAVIRAN 5% Aciclovir 50mg/g Cream 2g Tube

1250-4098-001 0135-142903-1111 SUPRAX 100MG/5ML Cefixime 100mg/5ml Suspension 30ml Bottle

1250-4098-002 0135-142903-1112 SUPRAX 100MG/5ML Cefixime 100mg/5ml Suspension 60ml Bottle

1250-4098-004 0135-142902-1452 SUPRAX 400MG Cefixime 400mg Capsules (Hard Gelatin) 6's Blister

1475-4679-001 0017-116610-1173 SUPRAZOLE 200MG Metronidazole 200mg Tablets 20's (10's Blister x 2)

2229-6665-001 1000-148602-0361 SWIFT OD 500MG Clarithromycin (as citrate) 500mg Extended Release Tablets 7's Blister

1279-4108-002 0188-272102-0791 SYMBICORT TURBUHALER

80/4.5MCG/DOSE

Budesonide, Formoterol fumarate

dihydrate

80mcg, 4.5mcg Dry Powder Inhaler 120 Dose Inhaler

1279-4109-001 0188-272103-0791 SYMBICORT TURBUHLER

160/4.5MCG/DOSE

Budesonide, Formoterol fumarate

dihydrate

160mcg, 4.5mcg Dry Powder Inhaler 120 Dose Inhaler

1244-4112-003 0053-272302-0801 SYNAGIS 100 Palivizumab 100mg Powder for Injection 1 Vial (Dry)

1244-4112-004 0053-272301-0801 SYNAGIS 50 Palivizumab 50mg Powder for Injection 1 Vial (Dry)

1434-4113-001 0240-162401-0151 SYNALAR 0.025% Fluocinolone acetonide 0.025% Cream 15g Tube

1434-4114-001 0240-272401-0151 SYNALAR-N Fluocinolone acetonide, Neomycin

Sulphate

Combination Cream 15g Tube

1434-4114-002 0240-272401-0651 SYNALAR-N Fluocinolone acetonide, Neomycin

Sulphate

Combination Ointment 15g Tube

2305-6569-001 1290-375901-1171 SYNERGYS VITA D 1000 IU Vitamin D 1000 IU Tablets 60's

1252-5122-003 1312-377901-0371 SYSTANE Polyethylene Glycol (400), Propylene

Glycol

4mg, 3mg/ml Eye Drops 10ml Dropper Bottle

1697-4124-001 0195-149901-1771 TABIFLEX COOL 1% Diclofenac Sodium (as diethylamine) 10mg/g Gel (Emulsion) 50g Tube

1697-4125-001 0195-169101-1451 TABOCINE 100MG Doxycycline (as hyclate) 100mg Capsules (Hard Gelatin) 10's Blister

1697-7377-001 2138-166103-0391 TABUVAN 160MG Valsartan 160mg Film Coated Tablets 30's (10's Blister x 3)

1697-7377-004 2138-166101-0391 TABUVAN 80MG Valsartan 80mg Film Coated Tablets 30's (10's Blister x 3)

1699-4128-002 0046-208402-1451 TAKEPRON 30MG Lansoprazole 30mg Capsules (Hard Gelatin) 14's Bottle

1496-4132-002 0132-233502-1171 TAMOFEN 20MG Tamoxifen 20mg Tablets 30's (10's Blister x 3)

1097-5486-001 0401-182006-0393 TARDYFERON 80MG Iron (Ferrous sulfate) 80mg Film Coated Tablets 30's (10's Blister x 3)

1119-4141-002 0114-237401-1171 TARIVID 200MG Ofloxacin 200mg Tablets 10's Blister

1240-4142-001 0652-274001-2001 TARKA 180MG/2MG Verapamil, Trandolapril 180mg, 2mg Modified Release Tablets 28's (14's Blister x 2)

1635-4143-008 1161-274301-0391 TAVANIC 500MG Levofloxacin 500mg Film Coated Tablets 5's Blister

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1119-4143-006 0114-274301-0391 TAVANIC 500MG Levofloxacin 500mg Film Coated Tablets 5's Blister

1119-4143-005 0114-274301-0392 TAVANIC 500MG Levofloxacin 500mg Film Coated Tablets 7's Blister

1635-4143-007 1161-274301-0392 TAVANIC 500MG Levofloxacin 500mg Film Coated Tablets 7's Blister

1632-4144-003 0285-274402-0513 TAVEGYL 1MG/ML Clemastine 1mg/ml Injection 2ml Ampoule x 5

1254-4150-001 0085-391101-0371 TEARS NATURALE Dextran 70, Hydroxypropylmethyl

cellulose

Combination Eye Drops 15ml Dropper Bottle

1253-4152-001 0085-391101-0372 TEARS NATURALE II Dextran 70, Hydroxypropylmethyl

cellulose

Combination Eye Drops 15ml Dropper Bottle

1556-4154-003 0027-140905-1161 TEGRETOL 2% Carbamazepine 20mg/ml Syrup 100ml Bottle

1556-4154-004 0027-140901-1172 TEGRETOL 200MG Carbamazepine 200mg Tablets 50's (10's Blister x 5)

1556-4155-001 0027-140901-1541 TEGRETOL CR 200MG Carbamazepine 200mg Tablets 50's (10's Blister x 5)

1635-4157-003 0030-183201-0391 TELFAST 120MG Fexofenadine HCl 120mg Film Coated Tablets 15's Blister

1635-4157-005 1111-183201-0391 TELFAST 120MG Fexofenadine HCl 120mg Film Coated Tablets 30's (15's Blister x 2)

1635-4157-004 0030-183202-0391 TELFAST 180MG Fexofenadine HCl 180mg Film Coated Tablets 15's (5's Blister x 3)

1635-4157-006 1111-183202-0391 TELFAST 180MG Fexofenadine HCl 180mg Film Coated Tablets 30's (15's Blister x 2)

1475-4164-001 0017-120801-1171 TENOL 100MG Atenolol 100mg Film Coated Tablets 20's (10's Blister x 2)

1475-4164-002 0017-120802-1171 TENOL 50MG Atenolol 50mg Film Coated Tablets 20's (10's Blister x 2)

1280-4165-001 0188-275201-1171 TENORETIC 100/25 Atenolol, Chlorthalidone 100mg, 25mg Tablets 28's (14's Blister x 2)

1280-4166-002 0188-120801-1171 TENORMIN 100MG Atenolol 100mg Tablets 28's (14's Blister x 2)

1280-4166-005 0188-120802-1171 TENORMIN 50MG Atenolol 50mg Tablets 28's (14's Blister x 2)

1585-4174-005 0186-241905-0513 TERRAMYCIN 250MG/3ML I.V Oxytetracycline 250mg Injection 3ml Ampoule

2246-6193-003 0244-346001-1451 TETRALYSAL 300 Lymecycline 408mg (equiv. to 300mg

Tetracycline base)

Capsules (Hard Gelatin) 16's (4's Blister x 4)

1676-4191-001 0155-275701-0392 TEVETEN 600 Eprosartan 600mg Film Coated Tablets 28's Calendar Pack (14's Blister x 2)

1802-5414-002 0302-106201-1172 THERAVIM M Multivitamins, Minerals Combination Tablets 30's

1125-7167-001 0013-532201-0391 THINRIN 75MG Clopidogrel (bisulfate) 75mg Film Coated Tablets 30's (10's Blister x 3)

1592-4208-003 0219-148702-1161 TIDILOR 5MG/5ML Loratadine 5mg/5ml Syrup 100ml Bottle

1392-4211-005 0035-275301-1172 TILCOTIL 20MG Tenoxicam 20mg Tablets 10's

1529-4215-001 0090-120502-0373 TIMOPTOL 0.25% Timolol (as maleate) 2.5mg/ml Eye Drops (Solution) 5ml Dropper Bottle

1529-4215-002 0090-120501-0371 TIMOPTOL 0.5% Timolol (as maleate) 5mg/ml Eye Drops 5ml Dropper Bottle

1631-4218-001 0397-143202-0801 TIROTAX 0.5G Cefotaxime 500mg Powder for Injection 1 Vial (Dry)

1631-4218-002 0397-143201-0801 TIROTAX 1G Cefotaxime 1g Powder for Injection 1 Vial (Dry)

1631-4218-003 0397-143205-0801 TIROTAX 2G Cefotaxime 2g Powder for Injection 1 Vial (Dry)

1254-4220-001 0085-239201-0371 TOBRADEX Tobramycin, Dexamethasone 3mg, 1mg/ml Eye Drops 5ml Dropper Bottle

2041-5419-001 0129-277002-0511 TOBRAMYCIN Tobramycin 40mg/ml Injection 2ml Ampoule

1254-4221-001 0085-277004-0371 TOBREX 0.3% Tobramycin 3mg/ml Eye Drops 5ml Dropper Bottle

1252-4221-006 1312-383001-0381 TOBREX 0.3% Tobramycin 3mg/g Eye Ointment 3.5g Tube

1254-4221-002 0085-277004-0381 TOBREX 0.3% Tobramycin 3mg/g Eye Ointment 3.5g Tube

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1556-4224-002 0027-277202-1171 TOFRANIL 25MG Imipramine HCl 25mg Tablets 50's (10's Blister x 5)

1595-4225-001 0318-277301-0511 TOGAMYCIN 2G Spectinomycin HCl 2g Injection 1 Vial + 1 Solvent Ampoule (3.2ml)

1961-5170-001 0553-111903-1011 TONIMER (NS 5ML/ PIC)

0.09%

Sodium Chloride NORMAL SALINE 0.9% Inhalation Solution 5ml Vial x 12

1961-5170-006 0553-111903-1071 TONIMER NORMAL SPRAY Sodium Chloride 0.90% Spray 30ml

1466-4230-009 0829-277505-0392 TOPAMAX 100MG Topiramate 100mg Film Coated Tablets 60's Plastic Bottle

1466-4230-010 0829-277504-0391 TOPAMAX 200MG Topiramate 200mg Film Coated Tablets 60's Plastic Bottle

1466-4230-011 0829-277503-0391 TOPAMAX 25MG Topiramate 25mg Film Coated Tablets 60's Plastic Bottle

1466-4230-012 0829-277502-0391 TOPAMAX 50MG Topiramate 50mg Film Coated Tablets 60's Plastic Bottle

2344-6570-001 1200-211705-0391 TORVACOL 10 Atorvastatin (as calcium) 10mg Film Coated Tablets 30's (10's Blister x 3)

2344-6570-003 1200-211703-0391 TORVACOL 20 Atorvastatin (as calcium) 20mg Film Coated Tablets 30's (10's Blister x 3)

2344-6570-002 1200-211701-0391 TORVACOL 40 Atorvastatin (as calcium) 40mg Film Coated Tablets 30's (10's Blister x 3)

1680-6217-001 0252-211702-0391 TOVAST 10MG Atorvastatin (as calcium trihydrate) 10mg Film Coated Tablets 30's (15's Blister x 2)

1680-6217-002 0252-211703-0391 TOVAST 20MG Atorvastatin (as calcium trihydrate) 20mg Film Coated Tablets 30's (15's Blister x 2)

1680-6217-003 0252-211701-0391 TOVAST 40MG Atorvastatin (as calcium trihydrate) 40mg Film Coated Tablets 30's (10's Blister x 3)

2420-6646-001 1322-380401-0391 TRAJENTA 5 Linagliptin 5mg Film Coated Tablets 30's (10's Blister x 3)

1433-4246-004 0240-278402-1452 TRAMAL 50MG Tramadol HCl 50mg Capsules (Hard Gelatin) 10's Blister

1433-4247-001 0240-278405-2002 TRAMAL RETARD 100MG Tramadol HCl 100mg Film Coated Tablets 10's Blister

1538-4248-001 0250-278405-2001 TRAMUNDIN RETARD 100MG Tramadol HCl 100mg Modified Release Tablets 10's Blister

1538-4248-002 0250-278404-2001 TRAMUNDIN RETARD 150MG Tramadol HCl 150mg Modified Release Tablets 10's Blister

1538-4248-003 0250-278406-2001 TRAMUNDIN RETARD 200MG Tramadol HCl 200mg Modified Release Tablets 10's Blister

2522-4249-010 1319-409601-1171 TRANDATE 200MG Labetalol HCl 200mg Tablets 25's Plastic Bottle

2194-4251-002 0085-278701-0371 TRAVATAN 0.004% Travoprost 0.04mg/ml Eye Drops (Solution) 2.5ml Dropper Bottle

1472-4258-001 0005-107706-0801 TRIAXONE 0.25G I.M. Ceftriaxone (as sodium) 250mg Powder for Injection 1 Vial (Dry) + 1 Solvent Ampoule (2ml)

1472-4258-002 0005-107706-0802 TRIAXONE 0.25G I.V. Ceftriaxone (as sodium) 250mg Powder for Injection 1 Vial (Dry) + 1 Solvent Ampoule (5ml)

1472-4258-006 0005-107705-0801 TRIAXONE 0.5G I.M. Ceftriaxone (as sodium) 500mg Powder for Injection 1 Vial (Dry) + 1 Solvent Ampoule (2ml)

1472-4258-007 0005-107705-0802 TRIAXONE 0.5G I.V. Ceftriaxone (as sodium) 500mg Powder for Injection 1 Vial (Dry) + 1 Solvent Ampoule (5ml)

1472-4258-012 0005-107704-0801 TRIAXONE 1G I.M. Ceftriaxone (as sodium) 1g Powder for Injection 1 Vial (Dry) + 1 Solvent Ampoule

(3.5ml)

1472-4258-011 0005-107704-0802 TRIAXONE 1G I.V. Ceftriaxone (as sodium) 1g Powder for Injection 1 Vial (Dry) + 1 Solvent Ampoule

(10ml)

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1250-4259-002 0135-103902-1171 TRIFED Pseudoephedrine HCl, Triprolidine HCl 60mg, 2.5mg Tablets 20's Blister

1250-4259-001 0135-379901-1161 TRIFED Pseudoephedrine HCl, Triprolidine HCl 30mg, 1.25mg/5ml Syrup 100ml Bottle

1489-4261-003 0138-100601-0391 TRILAGAVIT Thiamine (as nitrate), Pyridoxine,

Cyanocobalamin

200mg, 100mg, 1mg Film Coated Tablets 30's (15's Blister x 2)

1256-6586-002 0003-280204-1451 TRILTEC 10MG Ramipril 10mg Capsules (Hard Gelatin) 30's (10's Blister x 3)

1256-6586-003 0003-280201-1451 TRILTEC 2.5MG Ramipril 2.5mg Capsules (Hard Gelatin) 30's (10's Blister x 3)

1256-6586-004 0003-280206-1451 TRILTEC 5MG Ramipril 5mg Capsules (Hard Gelatin) 30's (10's Blister x 3)

1544-7319-001 0067-570701-0392 TRINURON Thiamine (as nitrate), Pyridoxine (as

HCl), Cyanocobalamin

100mg, 200mg, 200mcg Film Coated Tablets 20's (10's Blister x 2)

1283-4274-002 0114-280204-1171 TRITACE 10MG Ramipril 10mg Tablets 28's (14's Blister x 2)

2340-4274-010 1286-280204-1171 TRITACE 10MG Ramipril 10mg Tablets 28's (14's Blister x 2)

1969-4274-007 0115-280201-1171 TRITACE 2.5MG Ramipril 2.5mg Tablets 28's Blister

2340-4274-011 1286-280201-1171 TRITACE 2.5MG Ramipril 2.5mg Tablets 28's (14's Blister x 2)

1969-4274-008 0115-280202-1171 TRITACE 5MG Ramipril 5mg Tablets 28's (14's Blister x 2)

2340-4274-012 1286-280202-1171 TRITACE 5MG Ramipril 5mg Tablets 28's (14's Blister x 2)

1499-4277-001 0071-233607-1171 TRIVASTAL RETARD 50MG Piribedil 50mg Tablets 30's (15's Blister x 2)

2532-4280-001 1516-100604-1171 TRIVIT Thiamin (as mononitrate), Pyridoxine

(as HCl), Cyanocobalamin

100mg, 200mg, 200mcg Tablets 20's (10's Blister x 2)

1629-4283-001 0609-280801-0241 TROPEX Phenazone 50mg/ml Ear Drops 10ml Dropper Bottle

1529-4285-001 0090-281001-0372 TRUSOPT 2% Dorzolamide (as HCl) 20mg/ml Eye Drops (Solution) 5ml Dropper Bottle

1256-4286-001 0003-115801-1171 TRYPTIZOL 25MG Amitriptyline HCl 25mg Tablets 30's (10's Blister x 3)

1472-7536-001 0005-122302-0391 TUROX 120MG Etoricoxib 120mg Film Coated Tablets 7's Blister

1472-7536-002 0005-122301-0391 TUROX 60MG Etoricoxib 60mg Film Coated Tablets 28's (7's Blister x 4)

1472-7536-003 0005-122303-0392 TUROX 90MG Etoricoxib 90mg Film Coated Tablets 28's (7's Blister x 4)

1967-6903-001 0042-442201-1171 TWYNSTA 80/10MG Amlodipine (as besilate), Telmisartan 10mg, 80mg Tablets 28's (7's Blister x 4)

1967-6903-002 0042-442202-1171 TWYNSTA 80/5MG Amlodipine (as besilate), Telmisartan 5mg, 80mg Tablets 28's (7's Blister x 4)

1346-4292-002 0353-106612-2231 TYLENOL 200MG Paracetamol 200mg Rectal Suppositories 10's Blister

1346-4292-003 0353-106613-2231 TYLENOL 350MG Paracetamol 350mg Rectal Suppositories 10's Blister

1516-4293-002 0536-106619-0362 TYLENOL ARTHRITIS PAIN

EXTENDED RELIEF 650MG

Paracetamol 650mg Extended Release Tablets

(Caplets)

24's Plastic Bottle

1256-4295-001 0003-281701-0241 TYOTOCIN Antipyrine, Benzocaine,

Hexylresorcinol, Tyrothricin

Combination Ear Drops 15ml Bottle + Dropper

1249-4301-001 0307-143601-0391 U-CEF 250MG Cefuroxime (as axetil) 250mg Film Coated Tablets 10's HDPE Bottle

1249-4301-002 0307-143602-0392 U-CEF 500MG Cefuroxime (as axetil) 500mg Film Coated Tablets 10's HDPE Bottle

1544-6682-006 0067-242801-0342 ULCIPAN 20MG Pantoprazole (as Sodium sesquihydrate) 20mg Enteric Coated Tablets 28's (7 Blister x 4)

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1544-6682-001 0067-242802-0342 ULCIPAN 40MG Pantoprazole (as Sodium sesquihydrate) 40mg Enteric Coated Tablets 28's (7 Blister x 4)

1556-4311-003 0164-119811-0371 ULTRACORTENOL 0.5% Prednisolone (as pivalate) 5mg/ml Eye Drops 5ml Dropper Bottle

1703-4321-001 0366-169101-1451 UNIDOX 100MG Doxycycline (as hyclate) 100mg Capsules (Hard Gelatin) 10's Blister

1703-4323-001 0366-103901-1161 UNIFED Pseudoephedrine HCl, Triprolidine HCl 30mg, 1.25mg/5ml Syrup 120ml Glass Bottle

1294-4327-001 0314-236105-2191 UNIPHYLLIN CONTINUS

200MG

Theophylline 200mg Prolonged Release Tablets 56's (14's Blister x 4)

1294-4327-002 0314-236104-2191 UNIPHYLLIN CONTINUS

300MG

Theophylline 300mg Prolonged Release Tablets 56's (14's Blister x 4)

2067-4330-002 1356-111705-0251 URAL Citric acid, Sodium bicarbonate, Sodium

citrate, Tartaric acid

0.72g, 1.76g, 0.63g, 0.89g Effervescent Granules 4g Sachet x 28 (2's x 14)

1508-4331-001 0077-282701-0451 URALYT-U Hexapotassium - HexaSodium

Pentacitrate Hydrate Complex

998mg/g Granules 280g Jar

1786-4642-001 0178-139601-0151 URECARE 10% Urea 10% Cream 100g

1256-4337-001 0003-282901-1171 URISPAS 200MG Flavoxate HCl 200mg Tablets 30's (10's Blister x 3)

1755-4621-001 0942-249004-1171 UROCIT-K Potassium Citrate 1080mg (10mEq) Tablets 100's Plastic Bottle

1525-4345-001 0095-187902-1451 UVAMIN RETARD 100MG Nitrofurantoin 100mg Capsules (Hard Gelatin) 20's

1125-6763-001 0013-166103-0391 VALIS 160 Valsartan 160mg Film Coated Tablets 30's (10's Blister x 3)

1125-6763-004 0013-166101-0391 VALIS 80 Valsartan 80mg Film Coated Tablets 30's (10's Blister x 3)

1392-4356-010 0035-164501-1172 VALIUM 5MG Diazepam 5mg Tablets 25's

1801-5250-001 0172-217102-0511 VALOID Cyclizine Lactate 50mg/ml Injection 1ml Ampoule x 5

1418-4360-002 0006-283601-0392 VALTREX 500MG Valaciclovir (as HCl) 500mg Film Coated Tablets 42's (6's Blister x 7)

1873-5488-001 0945-138304-1171 VALUPAK CALCIUM WITH

VITAMIN D

Calcium, Vitamin D 400mg/2.5mcg Tablets 30's Bottle

1361-4365-001 0125-284303-0491 VANCOMYCIN

HYDROCHLORIDE 500MG

Vancomycin (as HCl) 500mg Infusion 1 Vial

1641-4375-001 0137-118203-1171 VASOPRIL 10MG Enalapril Maleate 10mg Tablets 30's (10's Blister x 3)

1641-4375-002 0137-118201-1171 VASOPRIL 20MG Enalapril Maleate 20mg Tablets 30's (10's Blister x 3)

1641-4375-003 0137-118202-1171 VASOPRIL 5MG Enalapril Maleate 5mg Tablets 30's (10's Blister x 3)

1697-4377-001 0195-111402-0391 VASTA 10 Simvastatin 10mg Film Coated Tablets 30's (10's Blister x 3)

1697-4377-002 0195-111401-0391 VASTA 20 Simvastatin 20mg Film Coated Tablets 30's (10's Blister x 3)

1499-4379-001 0071-285601-2001 VASTAREL MR Trimetazidine (as diHCl) 35mg Modified Release Tablets 60's (30's Blister x 2)

1552-4394-001 0027-286003-1171 VENORUTON FORTE 500MG Hydroxyethylrutosides (Oxerutins) 500mg Tablets 30's (10's Blister x 3)

1698-4395-001 0142-124507-1391 VENTAL 100MCG/DOSE Salbutamol (as sulfate) 100mcg Aerosol Inhaler 200 Dose Unit

2618-4395-002 0142-402802-1391 VENTAL 100MCG/DOSE Salbutamol (as sulfate) 100mcg Aerosol Inhaler 200 Dose Unit

1593-4396-001 0206-124502-1161 VENTAMOL 2MG/5ML Salbutamol (as sulfate) 2mg/5ml Syrup 120ml Glass Bottle

1417-4398-005 0006-124508-1172 VENTOLIN 2MG Salbutamol 2mg Tablets 20's

1422-4398-011 0006-402805-2071 VENTOLIN 5MG/ML Salbutamol (as sulfate) 5mg/ml Solution for Nebulization 20ml Bottle

1419-4399-001 0006-124503-0792 VENTOLIN DISKUS 200MCG Salbutamol (as sulfate) 200mcg Dry Powder Inhaler 60's Blister in Diskus

1419-4400-001 0006-124507-1392 VENTOLIN EVOHALER

100MCG

Salbutamol (as sulfate) 100mcg Aerosol Inhaler 200 Metered Actuations Inhaler

1103-4401-004 0011-178201-0061 VEPESID 100MG Etoposide 100mg Capsules 20's (10's Blister x 2)

2041-4902-004 0129-204107-0511 VERAPAMIL Verapamil 2.5mg/ml Injection 2ml Ampoule

1475-4406-001 0102-130502-1111 VERMONIL 100MG Mebendazole 100mg/5ml Suspension 30ml Bottle

1465-4407-001 0415-130501-1172 VERMOX 100MG Mebendazole 100mg Tablets 6's Blister

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1465-4407-002 0415-130503-1111 VERMOX 2% Mebendazole 20mg/ml Suspension 30ml Glass Bottle

1465-4407-003 0415-130504-1172 VERMOX 500MG Mebendazole 500mg Tablets 1's Blister

1641-6268-001 0137-338301-0391 VESICARE 10MG Solifenacin succinate 10mg Film Coated Tablets 30's (10's Blister x 3)

1641-6268-002 0137-338302-0391 VESICARE 5MG Solifenacin succinate 5mg Film Coated Tablets 30's (10's Blister x 3)

1582-4416-001 0186-169103-0511 VIBRAVENOUS 100MG Doxycycline 100mg Injection 5ml Ampoule x 2

1552-4417-004 0027-286801-1971 VIBROCIL Dimethindene Maleate, Phenylephrine 0.25mg, 2.5mg/ml Nasal Spray 10ml Spray Bottle

1552-4418-001 0027-286801-1973 VIBROCIL MICRODOSER Dimethindene Maleate, Phenylephrine 0.25mg, 2.5mg/ml Nasal Spray 15ml Metered Dose Spray Bottle

1279-6702-002 0188-386901-2001 VIMOVO 500MG/20MG Naproxen, Esomeprazole (magnesium

trihydrate)

500mg, 20mg Modified Release Tablets 60's Glass Bottle

1392-4435-003 0539-287703-0511 VIRACEPT Nelfinavir 7.2g/144g Injection 1 Vial

1125-7323-001 VIRTIGENE 16 Betahistine dihydrochloride 16mg Tablets 50's (10's Blister x 5)

1567-4444-001 0207-169703-1161 VISCODRIL (ALCOHOL FREE) Ammonium Chloride, Diphenhydramine

HCl

141.5mg, 14mg/5ml Syrup 100ml Glass Bottle

1542-4446-001 0696-111401-0392 VISCOR 20 Simvastatin 20mg Film Coated Tablets 30's (10's Blister x 3)

2499-6883-001 1499-375903-1171 VITA D 50000IU Cholecalciferol (Vit D3) 50000 IU Tablets 15's Blister

1141-5903-001 0735-138302-1171 VITAMEC CAL PLUS Calcium, Vitamin D Calcium 600mg/tab, Vitamin D

125 IU/tab

Tablets 60's Bottle

1591-4457-002 0159-121602-1481 VITAMIN A 50000 I.U. Vitamin - A 50000 IU Capsules (Soft Gelatin) 24's (12's Blister x 2)

1472-4458-002 0005-130201-0391 VITAMIN B COMPLEX Vitamins - B1, B2, B6, Calcium

pantothenate, Nicotinamide

2mg, 2mg, 2mg, 3mg, 20mg Film Coated Tablets 20's Blister

1727-4460-001 0437-198901-1021 VITAMIN B12 DEPOT 1MG/ML Vitamin - B12 as Hydroxocobalamin

acetate

1mg/ml Solution for Injection 1ml Ampoule x 3

2411-6599-001 1311-111209-1021 VITAMIN B12 FORTE HEVERT Cyanocobalamin 3mg/2ml Solution for Injection 2ml Ampoule x 10

2266-6088-002 1053-348901-0511 VITAMIN D3 Cholecalciferol 300 000 I.U (Cholecalciferol/1

ml)

Injection (1ml Ampoules x 10)/Pack

2302-6341-001 1129-363701-0551 VITANE CALCICARE LIQUID Calcium, Zinc, Vitamin D, Magnesium (Calcium 250mg + Zinc 2mg +

Vitamin D 200 IU + Magnesium

75mg)/5ml

Liquid 200ml

2302-7002-001 1129-416902-0221 VITANE IROVIT DROPS Ferrous sulphate heptahydrate

(equivalent to Ferrous - 15mg)

75mg/1ml Oral Drops 30ml

2302-7003-001 1129-419301-0551 VITANE VITAGLOBIN LIQUID Multivitamins and Minerals Combination Liquid 200ml

1111-6089-001 0966-228902-1171 VITANES CALCIVYTE Sodium, Calcium, Vitamin D (Sodium 2.5mg + Calcium

600mg + Vitamin D 125 IU) / 1

tablet

Tablets 30's

1111-6758-001 0966-397301-1171 VITANES NATURE PREGVYTE Pregnancy Multivitamins Combination Tablets 30 Tablets

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1552-4476-001 0027-149901-0291 VOLTAREN 1% Diclofenac Sodium (as diethylamine) 10mg/g Gel (Emulgel) 20g Tube

1552-4476-002 0027-149901-0292 VOLTAREN 1% Diclofenac Sodium (as diethylamine) 10mg/g Gel (Emulgel) 50g Tube

1552-4476-013 0027-149910-0291 VOLTAREN 1% Diclofenac sodium (as diethylamine) 10mg/g Gel (Emulgel) 75g Dispenser

1556-4476-015 0027-378802-0432 VOLTAREN 1% EMULGEL Diclofenac Sodium (as diethylamine) 10mg/g Gel 20g Tube

1556-4476-014 0027-378802-0431 VOLTAREN 1% EMULGEL Diclofenac Sodium (as diethylamine) 10mg/g Gel 50g Tube

1556-4476-016 0027-378802-0433 VOLTAREN 1% EMULGEL Diclofenac sodium (as diethylamine) 10mg/g Gel 75g Dispenser

1556-4476-007 0027-149904-2231 VOLTAREN 50MG Diclofenac Sodium 50mg Rectal Suppositories 10's (5's Strip x 2)

1556-4476-011 0027-149904-0341 VOLTAREN 50MG Diclofenac Sodium 50mg Enteric Coated Tablets 20's (10's Blister x 2)

1556-4476-009 0027-149902-0511 VOLTAREN 75MG/3ML Diclofenac Sodium 75mg/3ml Solution for Injection 3ml Ampoule x 5

1556-4478-003 0027-149903-0391 VOLTAREN RETARD 100MG Diclofenac Sodium 100mg Film Coated Tablets 10's Blister

1344-4478-001 0183-149903-1171 VOLTAREN RETARD 100MG Diclofenac Sodium 100mg Tablets 10's Blister

1556-4479-002 0027-149907-0111 VOLTAREN SR 75MG Diclofenac Sodium 75mg Film Coated Tablets 10's Blister

1556-4622-003 0027-142201-0831 VOLTFAST 50MG Diclofenac potassium 50mg Powder for Solution (Oral) 30 Sachets

1276-4480-001 0147-149904-1171 VOLTFENAC 50MG Diclofenac Sodium 50mg Tablets 20's (10's Blister x 2)

1464-4481-001 0031-149906-1171 VOLTIC 25MG Diclofenac Sodium 25mg Tablets 30's (10's Blister x 3)

2412-6724-003 1308-394001-0392 VORIR 500MG Valaciclovir (as HCl monohydrate) 500mg Film Coated Tablets 40's (10's Blister x 4)

1250-4485-003 0135-149904-1171 VOTREX 50MG Diclofenac Sodium 50mg Tablets 20's (10's Blister x 2)

1250-4485-005 0135-149902-0512 VOTREX 75MG/3ML Diclofenac Sodium 25mg/ml Injection 3ml Ampoule x 5

1998-4898-006 0946-155004-1171 WARFARIN 1MG WARFARIN 1mg Tablets 28's

1998-4898-010 0946-155005-1171 WARFARIN 3MG WARFARIN 3mg Tablets 28's

1902-4898-017 0012-155001-1172 WARFARIN 5MG WARFARIN 5mg Tablets 28's

1998-4898-015 0946-155001-1171 WARFARIN 5MG WARFARIN 5mg Tablets 28's

1622-4386-001 0355-163001-0241 WAXSOL 0.5% Docusate Sodium 5mg/ml Ear Drops 10ml Glass Bottle with Dropper

1697-4432-003 0195-142903-0851 WINEX 100MG/5ML Cefixime (as trihydrate) 100mg/5ml Powder for Suspension 60ml Glass Bottle

1697-4432-002 0195-142901-1451 WINEX 200 Cefixime (as Trihydrate) 200mg Capsules (Hard Gelatin) 8's Blister

1697-4432-001 0195-142902-1452 WINEX 400 Cefixime (as Trihydrate) 400mg Capsules (Hard Gelatin) 6's Blister

1472-7528-003 0005-395401-0451 XAIRA PAEDIATRIC 4MG Montelukast (as sodium) 4mg Granules for Liquid (Oral) 28 Sachets

1584-4490-006 1364-243502-1171 XANAX 0.25MG Alprazolam 0.25mg Tablets 30's (10's Blister x 3)

1584-4490-007 1364-243501-1171 XANAX 0.5MG Alprazolam 0.5mg Tablets 30's (10's Blister x 3)

1695-4493-001 0516-188101-2191 XATRAL XL 10MG Alfuzosin HCl 10mg Prolonged Release Tablets 30's (10's Blister x 3)

1390-4495-002 0539-289501-1172 XELODA 500MG Capecitabine 500mg Tablets 120's Bottle

1472-6649-001 0005-124406-0151 XEMADERM 0.1% Mometasone furoate 1mg/g Cream 30g Collapsible Tube

1472-6649-002 0005-124406-0651 XEMADERM 0.1% Mometasone furoate 1mg/g Ointment 30g Collapsible Tube

1464-5505-001 0031-154702-0371 XOLAMOL 20MG/5MG Dorzolamide (as HCl), Timolol (as

maleate)

20mg, 5mg/ml Eye Drops 5ml Dropper Bottle

1544-6197-001 0067-114509-2481 XPEL 15MG/5ML Ambroxol HCl 15mg/5ml Syrup (Sugar free) 100ml Glass Bottle

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1544-6197-002 0067-442001-2481 XPEL 30MG/5ML Ambroxol HCl 30mg/5ml Syrup (Sugar Free) 100ml Glass Bottle

1279-4500-008 0188-172301-1322 XYLOCAINE 2% Lidocaine HCl 20mg/g Jelly 30g Tube

1719-4502-001 0098-128802-2061 XYLO-COMOD 0.1% Xylometazoline HCl 1mg/ml Nasal Spray Pump 15ml Spray Bottle

1472-4503-002 0005-128802-1971 XYLOLIN 0.1% (ADULT) Xylometazoline HCl 1mg/ml Nasal Spray 10ml Metered Dose Spray Bottle (200

Dose)1622-4504-001 0355-128802-2021 XYLOMET ADULT 0.1% Xylometazoline HCl 1mg/ml Nasal Drops (Solution) 15ml Dropper Bottle

1622-4505-001 0355-128801-2021 XYLOMET PAED. 0.05% Xylometazoline HCl 0.5mg/ml Nasal Drops (Solution) 15ml Dropper Bottle

1279-4507-001 0188-290201-2221 XYLOPROCT Aluminium diacetate, Hydrocortisone

acetate, Lidocaine, Zinc oxide

35mg, 2.5mg, 50mg, 180mg/g Rectal Ointment 20g Tube

1710-4508-002 0205-290301-0391 XYZAL 5MG Levocetirizine 2HCl 5mg Film Coated Tablets 30's (10's Blister x 3)

1523-6484-001 0009-368801-0811 ZAKON 100 Cefpodoxime (as proxetil) 100mg/5ml Powder for Suspension 60ml Glass bottle

1523-6484-002 0009-368802-1171 ZAKON 200 Cefpodoxime (as proxetil) 200mg Tablets 10's (5's Blister x 2)

1525-4519-001 0095-143601-0391 ZAMUR 250 Cefuroxime (as axetil) 250mg Film Coated Tablets 10's Blister

2409-4519-003 0095-378201-0391 ZAMUR 250 Cefuroxime (as axetil) 250mg Film Coated Tablets 10's Blister

1525-4519-002 0095-143602-0391 ZAMUR 500 Cefuroxime (as axetil) 500mg Film Coated Tablets 10's Blister

2409-4519-004 0095-378202-0391 ZAMUR 500 Cefuroxime (as axetil) 500mg Film Coated Tablets 10's Blister

1125-6198-001 0013-155401-0391 ZARGO 50 Losartan potassium 50mg Film Coated Tablets 30's (10's Blister x 3)

1125-6672-001 0013-186701-0391 ZARGO HT 100/25MG Losartan potassium,

Hydrochlorothiazide

100mg, 25mg Film Coated Tablets 30's (10's Blister x 3)

1125-6672-002 0013-186702-0391 ZARGO HT 50/12.5MG Losartan potassium,

Hydrochlorothiazide

50mg, 12.5mg Film Coated Tablets 30's (10's Blister x 3)

1523-4528-001 0009-143609-0851 ZENON 125MG/5ML Cefuroxime (as axetil) 125mg/5ml Powder for Suspension 100ml Glass Bottle

1523-4528-002 0009-143607-0851 ZENON 250MG/5ML Cefuroxime (as axetil) 250mg/5ml Powder for Suspension 50ml Glass Bottle

1663-4529-001 0215-109803-1111 ZENTEL 100MG/5ML Albendazole 100mg/5ml Suspension 20ml Bottle

1419-4529-002 0189-109801-0391 ZENTEL 200MG Albendazole 200mg Film Coated Tablets 2's Blister

1622-4532-001 0355-123701-0392 ZERTAZINE 10MG Cetirizine HCl 10mg Film Coated Tablets 20's (10's Blister x 2)

1280-4533-001 0188-291801-1171 ZESTORETIC Lisinopril (as dihydrate), HCTZ 20mg, 12.5mg Tablets 28's Blister (Calendar Pack)

1280-4534-009 0188-159702-1173 ZESTRIL Lisinopril 5mg Tablets 98's (14's Blister x 7)

1280-4534-008 0188-159701-1173 ZESTRIL Lisinopril 20mg Tablets 98's (14's Blister x 7)

1280-4534-001 0188-159703-1171 ZESTRIL 10MG Lisinopril (as dihydrate) 10mg Tablets 28's Blister (Calendar Pack)

1280-4534-002 0188-159701-1172 ZESTRIL 20MG Lisinopril (as dihydrate) 20mg Tablets 28's Blister (Calendar Pack)

1280-4534-003 0188-159702-1171 ZESTRIL 5MG Lisinopril (as dihydrate) 5mg Tablets 28's Blister (Calendar Pack)

1697-4538-001 0195-127401-0852 ZETRON 200MG/5ML Azithromycin (as dihydrate) 200mg/5ml Powder for Suspension 15ml Plastic Bottle + 9ml Water

(Plastic Ampoule) + 10ml Plastic Oral

Syringe1697-4538-002 0195-127402-1451 ZETRON 250MG Azithromycin (as dihydrate) 250mg Capsules (Hard Gelatin) 6's Blister

1697-4538-003 0195-127403-0852 ZETRON 300MG/7.5ML Azithromycin (as dihydrate) 200mg/5ml Powder for Suspension 22.5ml Plastic Bottle + 12ml Water

(Plastic Ampoule) + 10ml Plastic Oral 1680-4541-001 0252-127401-0851 ZIMAX 200MG/5ML Azithromycin dihydrate 200mg/5ml Powder for Suspension 15ml Glass Bottle

1680-4541-003 0252-127402-1451 ZIMAX 250MG Azithromycin dihydrate 250mg Capsules (Hard Gelatin) 6's Blister

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

1680-4541-004 0252-127403-0851 ZIMAX 300MG/7.5ML Azithromycin dihydrate 200mg/5ml Powder for Suspension 22.5ml Glass Bottle

1418-4545-004 0006-143609-0463 ZINNAT 125MG/5ML Cefuroxime (as axetil) 125mg/5ml Granules for Suspension 50ml Bottle

1750-4545-009 0006-143601-1171 ZINNAT 250MG Cefuroxime (as axetil) 250mg Tablets 10's Blister

1418-4545-008 0006-143607-0462 ZINNAT 250MG/5ML Cefuroxime (as axetil) 250mg/5ml Granules for Suspension 50ml Bottle

1750-4545-012 0006-143602-1172 ZINNAT 500MG Cefuroxime (as axetil) 500mg Tablets 10's Blister

1697-4548-002 0195-143601-0391 ZINOXIMOR 250 Cefuroxime (as axetil) 250mg Film Coated Tablets 14's (2's Strip x 7)

1697-4548-003 0195-143602-0391 ZINOXIMOR 500 Cefuroxime (as axetil) 500mg Film Coated Tablets 14's (7's Blister x 2)

2469-6950-003 1394-274301-0392 ZIQUIN 500MG Levofloxacin (as hemihydrate) 500mg Film Coated Tablets 5's Blister

1125-7073-002 0013-127405-0391 ZITHROCON 500 Azithromycin (as dihydrate) 500mg Film Coated Tablets 3's Blister

1584-4549-008 1307-127402-1451 ZITHROMAX 250MG Azithromycin (as dihydrate) 250mg Capsules (Hard Gelatin) 6's Blister

1442-4549-003 ZITHROMAX 250MG Azithromycin (as dihydrate) 250mg Capsules (Hard Gelatin) 6's Blister

1584-4549-005 0186-127401-0853 ZITHROMAX 600MG Azithromycin 200mg/5ml Powder for Suspension 15ml Bottle

1584-4549-006 0186-127401-0851 ZITHROMAX 900MG Azithromycin 200mg/5ml Powder for Suspension 22.5ml Bottle

1590-4550-001 0186-127408-0851 ZITHROMAX SD 2G Azithromycin 2g Powder for Suspension 2g Plastic Bottle

1523-6595-001 0009-127405-0391 Z-MYCIN 500MG Azithromycin (as dihydrate) 500mg Film Coated Tablets 3's Blister

2342-6603-002 1313-304502-0801 ZOCEF 750MG IM/IV Cefuroxime (as sodium) 750mg Powder for Injection 1 Glass Vial (Powder)

1249-4551-001 0307-127402-1451 ZOCIN 250MG Azithromycin 250mg Capsules (Hard Gelatin) 6's Blister

1280-4560-001 0188-292801-0111 ZOMIG 2.5MG Zolmitriptan 2.5mg Coated Tablets 3's Blister

1417-4562-002 0006-102409-1111 ZOVIRAX 200MG/5ML Aciclovir 200mg/5ml Suspension 125ml Glass Bottle

1705-4562-004 0041-102407-0381 ZOVIRAX 3% Aciclovir 30mg/g Eye Ointment 4.5g Tube

1418-4562-008 0006-102403-0151 ZOVIRAX 5% Aciclovir 50mg/g Cream 2g Tube

1420-4562-009 0006-102401-1172 ZOVIRAX 800MG Aciclovir 800mg Tablets 35's (5's Blister x 7)

2522-4566-005 1319-112401-1173 ZYLORIC 100MG Allopurinol 100mg Tablets 50's (25's Blister x 2)

2522-4566-006 1319-112402-1171 ZYLORIC 300MG Allopurinol 300mg Tablets 28's (14's Blister x 2)

1710-4572-005 0205-123701-0391 ZYRTEC 10MG Cetirizine diHCl 10mg Film Coated Tablets 20's (10's Blister x 2)

1597-5443-001 0403-293401-0511 ZYVOX Linezolid 2mg/ml Injection 300ml Vial

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Greenrain code DDC Code Package Name Generic Name Strength Dosage Form Package Size

ADNIC bronze policy drug list

2682-7432-001 2141-574201-0993 ALFALYTE PEDIATRIC

ELECTROLYTE APRICOT

FLAVOR

Sodium Chloride USP, Fructose USP,

Dextrose Hydrous USP, Potassium

Citrate, H2O USP, Citric Acid USP,

Sodium Citrate, 2H2O USP

2.0454g, 5.1g, 22.4g, 2.1627g,

57.64mg, 0.98g/ 1000ml

Solution 240ml Plastic Bottle

2682-7433-001 2141-574201-0992 ALFALYTE PEDIATRIC

ELECTROLYTE BUBBLE GUM

Sodium Citrate, 2H2O USP, Fructose

USP, Potassium Citrate, H2O USP, Citric

0.98g, 5.1g, 2.1627g, 57.64mg,

22.4g, 2.0454g/ 1000ml

Solution 240ml Plastic Bottle

2682-7434-001 2141-574201-0991 ALFALYTE PEDIATRIC

ELECTROLYTE STRAWBERRY

Citric Acid USP, Sodium Chloride USP,

Potassium Citrate, H2O USP, Fructose

57.64g, 2.0454g, 2.1627g, 5.1g,

0.98g, 22.4g/ 1000ml

Solution 240ml Plastic Bottle

1937-4702-012 0250-125810-2631 BETADINE DRY POWDER

SPRAY

Povidone iodine 2.5g/100g Dusting Topical Powder 55g Spray

1544-7368-001 0067-175605-1651 LEMOMAG EFFERVESCENT

POWDER FOR ORAL

Magnesium Citrate USP 2.125g Effervescent Powder 5g Sachet x 10

1116-7031-001 0707-176509-0551 MARVIT D Vitamin D3 (Cholecalciferol) 5mcg/0.5ml Liquid 30ml Bottle

2627-7221-001 1688-125812-0731 POVID VAGINAL PESSARIES Povidone Iodine USP 200 mg Pessary 7's Strip

1348-5837-002 1348-230604-2091 PROLYTE LIME FLAVOUR Oral Rehydration Salts Combination Powder 10 Sachets

2507-6865-001 1490-408701-0221 SUNDROPS Vitmain D3 (Colecalciferol) 400 IU/ml Drops 50ml Glass Bottle

1912-7237-001 1639-113002-0391 THIOTACID 300MG Thioctic Acid (Alpha Lipoic Acid) 300 mg Tablets 30's (3 x 10's Blister)

1912-7237-002 1639-113001-0391 THIOTACID 600MG Thioctic Acid (Alpha Lipoic Acid) 600 mg Tablets 20's (2 x 10's Blister)