2021-2022 formulary formulario - health choice arizona

2021-2022 FormularyFormulario

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What is the Health Choice Arizona Formulary/Preferred Drug List (PDL)?

A Formulary / Preferred Drug List (PDL) is a list of drugs chosen by Health Choice Arizona and a team of doctors and pharmacists. Health Choice will cover the drugs listed in our PDL as long as they are medically necessary and appropriate. All Health Choice member prescriptions must be filled at a Health Choice Arizona network pharmacy, and other plan rules must be followed.

The Health Choice Complete formulary contains drugs used to treat physical conditions and behavioral health conditions.

What if a drug is not on the Formulary/ PDL?

If a drug you want to prescribe for your patient is not on this Formulary / PDL, the prescriber can:

Prescribe a similar drug that is Formulary / PDL covered, or

• Ask Health Choice Arizona to make an exception and cover the medically necessary, non-formulary drug through the prior authorization process.

Can the Formulary / PDF change?

Yes, Health Choice may add or take off drugs during the year. To get the latest information about

covered drugs, go to our website at www.HealthChoiceAZ.com or call Health Choice Member

Services at 480-968-6866 or 1-800-322-8670 (outside Maricopa County).

Product Selection Criteria

The Health Choice Arizona Pharmacy & Therapeutics Committee will consider and advise Health Choice on all new-to-market drugs and will continually review and evaluate existing market drugs for formulary/PDL inclusion. The committee’s evaluation includes a current literature review. Expert external opinion may also be sought. Formal reviews are prepared that typically address the following information:

• Safety & Efficacy

• Comparison studies

• Approved indications

• Adverse effects

• Contraindications, warnings and precautions

• Pharmacokinetics

• Cost-effectiveness

• Patient administration and compliance considerations

The Pharmacy & Therapeutics Committee reviews all AHCCCS drug coverage requirements as noted on the AHCCCS PDL lists and honors all requirements for preferred drug coverage.

When a new drug is considered for formulary inclusion, an attempt will be made to examine the drug relative to similar drugs currently on formulary. In addition, entire therapeutic classes are periodically reviewed. The class review process may result in deletion of one or more drugs in a particular therapeutic class in an effort to continually promote the most clinically useful and cost effective agents. Drug coverage within therapy classes is consistent with AHCCCS requirements for drug coverage.

http://www.healthchoiceaz.com/

http://www.healthchoiceaz.com/

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The entire formulary / PDL is reviewed and approved annually.

Prior authorization (PA) is required for two groups of medications and for two clinical formulary/ PDL override conditions:

1. Medication Groups

Medications noted with a PA in the formulary / PDL. Health Choice may require priorauthorization for certain drugs on the Preferred Drug List. This means that your doctor willneed to get approval from us before you can fill some of your prescriptions. If approval isn’tgiven, Health Choice will not cover the drug.

All unlisted medications.2. Clinical Override Conditions

To override a Step Therapy (ST) edit. In some cases, Steward Health Choice requires youto try certain drugs first to treat your medical condition before we will cover another drug forthat same condition. For example, if Drug A and Drug B both treat your medical condition,Health Choice may not cover Drug B unless you try Drug A first. If Drug A does not workfor you, we will then cover Drug B.

To override a Quantity Limit (QL) edit. For certain drugs, Health Choice limits the amountof the drug it will cover. For example, we provide <XX> pills in <XX> days per prescriptionfor <drug name>.

Health Choice anticipates that requests for an unlisted medication will be infrequent and providers will be able to prescribe a formulary / PDL medication for the vast majority of therapeutic needs. Providers are encouraged to use this formulary / PDL when prescribing medications for Health Choice Arizona members to avoid unnecessary delays in therapy.

The AHCCCS Minimum Required Prescription Drug List is included in the Health Choice Arizona Formulary. All AHCCCS Preferred drug are included in our formulary exactly as noted by AHCCCS.

Off label drugs may be prior authorized when the use of the drug has proven to be the community standard.

Health Choice Arizona uses a four (4) day override process to ensure that members can access immediately needed, non-formulary or prior authorization required drugs. The Health Choice network pharmacy can override the prior authorization requirement to provide the member with the immediately needed drug, such as an antibiotic or other emergent drug by calling us.

Health Choice providers may formally request the Health Choice Pharmacy & Therapeutics Committee consider a medication be considered for addition to the formulary / PDL. The instructions and required submission form(s) which indicate how to submit a formulary / PDL medication consideration request are detailed in the Health Choice Provider Manual. The instructions and materials are also available on the Health Choice website.

All the information in the Health Choice Arizona formulary is provided as a reference for drug therapy selection. Specific drug selection for an individual patient rests solely with the prescriber.

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Formulary Product Descriptions

To assist in understanding which specific strengths and dosage forms are on the formulary, examples are noted below. The general principles shown in the examples can then usually be extended to other entries in the book. Any exceptions are noted in the drug list. There may also be a statement associated with a drug list that gives additional information about which specific products or dosage forms are on formulary.

Generic drugs are identified in lower case type, whereas brand drugs are identified in all caps

allopurinol is a generic drug

ULORIC is a brand drug

The brand name products shown are for reference only; a different brand or a generic version may be dispensed.

simvastatin ZOCOR

Extended-release and delayed-release products require their own entry. Identified below, both propranolol and propranolol SR are on the formulary.

propranolol INDERAL

propranolol SR INDERAL LA

Dose forms on formulary will be consistent with the category and usewhere listed. Identified below from Otic group, the otic solution and ophthalmic ointment are on the formulary, and the ophthalmic products and topical cream cannot be assumed to be on formulary unless there are entries for these products in the OPHTHALMIC and DERMATOLOGY sections of the formulary.

neomycin/polymyxin B/hydrocortisone CORTISPORIN

Generic Substitution

AHCCCS health plans are required to utilize a mandatory generic drug substitution policy. Generic substitution is a pharmacy action whereby a generic version is dispensed rather than a prescribed brand name product. An important consideration for generic substitution is the knowledge that all approvals of generic drugs by the FDA since 1984, and many generic approvals prior to 1984, have a showing of bioequivalence between the generic versions and the reference brand name product.

To gain FDA approval:

1. The generic drug must contain the same active ingredient(s), be the same strength and thesame dosage form as the brand name product.

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2. The FDA has given the generic an "A" rating compared to the brand name product indicatingbioequivalence, and has determined the generic is therapeutically equivalent to the referencebrand name product. The ratings of generic drugs are available by referring to the FDAreference, Approved Drug Products with Therapeutic Equivalence Evaluations (Orange Book).

When the above two criteria are met, a generic can be substituted with the full expectation that the substituted product will produce the same clinical effect and safety profile as the prescribed product. Drug products that have a narrow therapeutic index (NTI) can also be guided by these principles. It is not necessary for the healthcare practitioner to approach any one therapeutic class of drug products (e.g., NTI drugs) differently from any other class, when there has been a determination of therapeutic equivalence by the FDA for the drug products under consideration. Also, additional clinical tests or examinations by the practitioner are not needed when a therapeutically equivalent generic drug product is substituted for the brand name product.

It is recommended that generic substitution not be exercised by the pharmacist with multisource products that appear in the Orange Book and carry a "B" rating, indicating that these products cannot be considered therapeutically equivalent to other products in the group. It is also recommended that generic substitution not be undertaken for any unrated multisource products that might be considered narrow therapeutic index, or maintenance drugs where it is known that unrated products from different labelers are not bioequivalent. State law or regulations may dictate the ability to practice generic substitution for selected products or categories of drugs.

Plan Exclusions

The following drug categories are excluded from coverage under the outpatient pharmacy benefit and are not part of the formulary/PDL

• Experimental / research drugs

• Cosmetic drugs

• Cosmetic drugs for hair growth

• Nutritional / diet supplements

• Blood and blood plasma products

• Erectile dysfunction drugs

• Drugs from manufacturers that do not participate in the FFS Medicaid Drug Rebate Program Diagnostic products

• Medical supplies except:

o Syringes o Needles o Lancets o Alcohol Swabs

o Spacers

o Blood glucose meters and test strips

• Intrauterine Devices

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Pharmacy Benefit Manager (PBM)

Health Choice Arizona uses CVS to process our prescription drug claims

LEGEND

Boldface Indicates generic availability

OTC Over-the-Counter

PA Prior Authorization Required

QL Quantity Level Limit

ST Step Therapy through prerequisite drug required

PREFERED AHCCCS Preferred Agent

Contact Health Choice Arizona

Your comments and suggestions regarding the Health Choice Arizona Formulary are encouraged. Your input is vital to this clinical formulary’s continued success. All responses will be reviewed and considered. Please send comments to:

Pharmacy Services Department

Health Choice Arizona

410 N 44th Street, Suite 405

Phoenix, AZ 85008

OTC - Over the counter PA - Prior Authorization QL - Quantity Limits ST - Step Therapy

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Health Choice AZ Complete Care Effective 04/01/2022 Drug Name Requirements/Limits

ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS AMPHETAMINES

ADDERALL TAB 5MG PA, QL (2 tabs / 1 day); PA Required for < 6 years of age

ADDERALL TAB 7.5MG PA, QL (2 tabs / 1 day); PA

Required for < 6 years of age


ADDERALL TAB 12.5MG PA, QL (2 tabs / 1 day); PA Required for < 6 years of

age


ADDERALL TAB 20MG PA, QL (2 tabs / 1 day); PA Required for < 6 years of

age

ADDERALL TAB 30MG PA, QL (2 tabs / 1 day); PA


ADDERALL XR CAP 5MG PA, QL (1 cap / 1 day); PA Required for < 6 years of

age

ADDERALL XR CAP 10MG PA, QL (1 cap / 1 day); PA



age




age



amphetamine-dextroamphetamine tab 5 mg (generic of ADDERALL)

PA, QL (2 tabs / 1 day); PA Required for < 6 years of

age


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Drug Name Requirements/Limits

amphetamine-dextroamphetamine tab 7.5 mg

(generic of ADDERALL)

PA, QL (2 tabs / 1 day); PA




age

amphetamine-dextroamphetamine tab 12.5 mg





PA, QL (2 tabs / 1 day); PA Required for < 6 years of age

amphetamine-dextroamphetamine tab 20 mg






dextroamphetamine sulfate tab 5 mg PA, QL (2 tabs / 1 day); PA Required for < 6 years of

age

dextroamphetamine sulfate tab 10 mg PA, QL (2 tabs / 1 day); PA



age

dextroamphetamine sulfate tab 20 mg PA, QL (2 tabs / 1 day); PA



age

VYVANSE CAP 10MG PA, QL (1 cap / 1 day); PA


VYVANSE CAP 20MG PA, QL (1 cap / 1 day); PA Required for < 6 years of

age




age




3





age

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) AGENTS atomoxetine hcl cap 10 mg (base equiv) (generic

of STRATTERA) PA, QL (1 cap / 1 day); PA Required for < 6 years of

age

atomoxetine hcl cap 18 mg (base equiv) (generic

of STRATTERA)

PA, QL (1 cap / 1 day); PA


atomoxetine hcl cap 25 mg (base equiv) (generic of STRATTERA)

PA, QL (1 cap / 1 day); PA Required for < 6 years of age

atomoxetine hcl cap 40 mg (base equiv) (generic

of STRATTERA)

PA, QL (1 cap / 1 day); PA





PA, QL (1 cap / 1 day); PA Required for < 6 years of

age



clonidine hcl tab er 12hr 0.1 mg (generic of KAPVAY)


age

guanfacine hcl tab er 24hr 1 mg (base equiv)

(generic of INTUNIV)

PA, QL (1 tab / 1 day); PA


guanfacine hcl tab er 24hr 2 mg (base equiv) (generic of INTUNIV)

PA, QL (1 tab / 1 day); PA Required for < 6 years of

age

guanfacine hcl tab er 24hr 3 mg (base equiv)

(generic of INTUNIV)



guanfacine hcl tab er 24hr 4 mg (base equiv) (generic of INTUNIV)


age

STIMULANTS - MISC. armodafinil tab 50 mg (generic of NUVIGIL) PA, QL (2 tabs / 1 day)

armodafinil tab 150 mg (generic of NUVIGIL) PA, QL (1 tab / 1 day)



4



CONCERTA TAB 18MG PA, QL (2 tabs / 1 day); PA


CONCERTA TAB 27MG PA, QL (2 tabs / 1 day); PA Required for < 6 years of

age

CONCERTA TAB 36MG PA, QL (2 tabs / 1 day); PA


CONCERTA TAB 54MG PA, QL (2 tabs / 1 day); PA Required for < 6 years of

age

DAYTRANA DIS 10MG/9HR PA, QL (1 patch / 1 day); PA


DAYTRANA DIS 15MG/9HR PA, QL (1 patch / 1 day); PA Required for < 6 years of

age

DAYTRANA DIS 20MG/9HR PA, QL (1 patch / 1 day); PA


DAYTRANA DIS 30MG/9HR PA, QL (1 patch / 1 day); PA Required for < 6 years of

age

dexmethylphenidate hcl tab 2.5 mg (generic of

FOCALIN)



dexmethylphenidate hcl tab 5 mg (generic of FOCALIN)


dexmethylphenidate hcl tab 10 mg (generic of

FOCALIN)



FOCALIN XR CAP 5MG PA, QL (2 caps / 1 day); PA Required for < 6 years of age

FOCALIN XR CAP 10MG PA, QL (2 caps / 1 day); PA Required for < 6 years of

age



age


5


FOCALIN XR CAP 25MG PA, QL (2 caps / 1 day); PA



age

FOCALIN XR CAP 35MG PA, QL (2 caps / 1 day); PA



METHYLIN SOL 5MG/5ML PA, QL (10 mL / 1 day); PA


METHYLIN SOL 10MG/5ML PA, QL (10 mL / 1 day); PA Required for < 6 years of age

methylphenidate hcl cap er 10 mg (cd) PA, QL (1 cap / 1 day); PA Required for < 6 years of

age

methylphenidate hcl cap er 20 mg (cd) PA, QL (1 cap / 1 day); PA



age




age



methylphenidate hcl tab 5 mg (generic of RITALIN) PA, QL (3 tabs / 1 day); PA Required for < 6 years of

age

methylphenidate hcl tab 10 mg (generic of

RITALIN)



methylphenidate hcl tab 20 mg (generic of RITALIN)


age

modafinil tab 100 mg (generic of PROVIGIL) PA, QL (2 tabs / 1 day)

modafinil tab 200 mg (generic of PROVIGIL) PA, QL (2 tabs / 1 day)


6


RITALIN LA CAP 10MG PA, QL (1 cap / 1 day); PA


RITALIN LA CAP 20MG PA, QL (1 cap / 1 day); PA Required for < 6 years of

age

RITALIN LA CAP 30MG PA, QL (1 cap / 1 day); PA


RITALIN LA CAP 40MG PA, QL (1 cap / 1 day); PA Required for < 6 years of age

ALTERNATIVE MEDICINES ALTERNATIVE MEDICINE - K'S

*krill oil cap 300 mg*** OTC

ALTERNATIVE MEDICINE - M'S MELATIONIN DRO 5MG/ML OTC

MELATONIN CAP 1MG OTC

MELATONIN CAP 2.5MG OTC

MELATONIN CAP 3MG OTC

MELATONIN CAP 3MG CR OTC

melatonin cap 5 mg OTC

melatonin cap 10 mg OTC

melatonin chew tab 1 mg OTC

melatonin chew tab 2.5 mg OTC

MELATONIN CHW OTC

MELATONIN CHW 5MG OTC

MELATONIN LIQ 1MG/4ML OTC

MELATONIN LIQ 2.5MG OTC

MELATONIN LIQ 3MG/0.9 OTC

MELATONIN LIQ 10MG/ML OTC

melatonin liquid 1 mg/ml OTC

melatonin liquid 5 mg/15ml OTC

MELATONIN LOZ 3MG OTC

MELATONIN LOZ 5MG OTC

melatonin sl tab 5 mg OTC

melatonin sl tab 10 mg OTC

MELATONIN SUB 3MG OTC

melatonin tab 1 mg OTC

MELATONIN TAB 1.5MG OTC

MELATONIN TAB 2.5MG OTC


MELATONIN TAB 3MG CR OTC


MELATONIN TAB 5MG OTC


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MELATONIN TAB 12MG OTC

MELATONIN TAB 200MCG OTC

melatonin tab 300 mcg OTC

MELATONIN TAB 500MCG OTC

melatonin tab er 10 mg OTC

melatonin tablet disintegrating 3 mg OTC




MELATONIN TR TAB 1MG OTC

RA MELATONIN SUB 1MG OTC

SLEEP CHILD/ CHW MELATONI OTC

SLEEP SOUNDL LIQ 3.5/2ML OTC

ALTERNATIVE MEDICINE COMBINATIONS FLAX + DHA CAP OTC

OMEGA 3-6-9 CAP COMPLEX OTC

OMEGA-3-6-9 CAP OTC

OMEGA-3-6-9 CAP 1200MG OTC

RA OMEGA CAP 3-6-9 OTC

SM OMEGA-3 CAP OTC

SUPER OMEGA CAP -3 OTC

AMINOGLYCOSIDES AMINOGLYCOSIDES

BETHKIS NEB 300/4ML PA

KITABIS PAK NEB 300/5ML PA

neomycin sulfate tab 500 mg

paromomycin sulfate cap 250 mg (generic of

HUMATIN)

ZEMDRI INJ 500MG/10 PA; Bill as Medical Claim Only

ANALGESICS - ANTI-INFLAMMATORY ANTI-TNF-ALPHA - MONOCLONAL ANTIBODIES

HUMIRA INJ 10/0.1ML PA



HUMIRA KIT 40MG/0.8 PA

HUMIRA PEDIA INJ CROHNS PA

HUMIRA PEN INJ 40/0.4ML PA

HUMIRA PEN INJ 40MG/0.8 PA

HUMIRA PEN INJ 80/0.8ML PA

HUMIRA PEN INJ CD/UC/HS PA

HUMIRA PEN INJ PS/UV PA

HUMIRA PEN KIT CD/UC/HS PA


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HUMIRA PEN KIT PED UC PA

HUMIRA PEN KIT PS/UV PA

SIMPONI ARIA SOL 50MG/4ML PA; Bill as Medical Claim Only

ANTIRHEUMATIC - ENZYME INHIBITORS XELJANZ TAB 5MG PA

XELJANZ TAB 10MG PA

GOLD COMPOUNDS RIDAURA CAP 3MG

INTERLEUKIN-1BETA BLOCKERS ILARIS INJ 150MG/ML PA; Bill as Medical Claim

Only

INTERLEUKIN-6 RECEPTOR INHIBITORS ACTEMRA INJ 80MG/4ML PA; Bill as Medical Claim

Only

ACTEMRA INJ 200/10ML PA; Bill as Medical Claim Only

ACTEMRA INJ 400/20ML PA; Bill as Medical Claim Only

NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS) celecoxib cap 50 mg (generic of CELEBREX) QL (2 caps / 1 day)

celecoxib cap 100 mg (generic of CELEBREX) QL (2 caps / 1 day)

celecoxib cap 200 mg (generic of CELEBREX) QL (2 caps / 1 day)

celecoxib cap 400 mg (generic of CELEBREX) QL (1 cap / 1 day)

diclofenac potassium tab 50 mg

diclofenac sodium tab delayed release 25 mg



diclofenac sodium tab er 24hr 100 mg

EC-NAPROSYN TAB 375MG

EC-NAPROSYN TAB 500MG

etodolac cap 200 mg

etodolac cap 300 mg

etodolac tab 400 mg (generic of LODINE)

etodolac tab 500 mg

etodolac tab er 24hr 400 mg



fenoprofen calcium tab 600 mg

flurbiprofen tab 100 mg

ibuprofen cap 200 mg OTC

ibuprofen chew tab 100 mg OTC

ibuprofen susp 40 mg/ml OTC

ibuprofen susp 100 mg/5ml

ibuprofen susp 100 mg/5ml OTC


9


ibuprofen tab 100 mg OTC

ibuprofen tab 200 mg OTC

ibuprofen tab 400 mg



INDOCIN SUP 50MG

INDOCIN SUS 25MG/5ML

indomethacin cap 25 mg

indomethacin cap 50 mg

indomethacin cap er 75 mg

ketorolac tromethamine tab 10 mg QL (20 tabs / 30 days)

meloxicam tab 7.5 mg (generic of MOBIC)

meloxicam tab 15 mg (generic of MOBIC)

nabumetone tab 500 mg

nabumetone tab 750 mg

naproxen sodium tab 220 mg OTC

naproxen sodium tab 275 mg

naproxen sodium tab 550 mg (generic of ANAPROX

DS)

naproxen susp 125 mg/5ml (generic of

NAPROSYN)

naproxen tab 250 mg

naproxen tab 375 mg

naproxen tab 500 mg (generic of NAPROSYN)

naproxen tab ec 375 mg (generic of EC-

NAPROSYN)

naproxen tab ec 500 mg (generic of EC-

NAPROSYN)

oxaprozin tab 600 mg (generic of DAYPRO)

piroxicam cap 10 mg (generic of FELDENE)

piroxicam cap 20 mg (generic of FELDENE)

sulindac tab 150 mg

sulindac tab 200 mg

PHOSPHODIESTERASE 4 (PDE4) INHIBITORS OTEZLA TAB 10/20/30 PA

OTEZLA TAB 30MG PA

PYRIMIDINE SYNTHESIS INHIBITORS leflunomide tab 10 mg (generic of ARAVA)

leflunomide tab 20 mg (generic of ARAVA)

SELECTIVE COSTIMULATION MODULATORS ORENCIA INJ 250MG PA; Bill as Medical Claim

Only

SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS ENBREL INJ 25/0.5ML PA

ENBREL INJ 25MG


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ENBREL INJ 25MG PA

ENBREL INJ 50MG/ML PA

ENBREL MINI INJ 50MG/ML PA

ENBREL SRCLK INJ 50MG/ML PA

ANALGESICS - NONNARCOTIC ANALGESIC COMBINATIONS

aspirin-acetaminophen-caffeine tab 250-250-65

mg

OTC

butalbital-acetaminophen tab 50-325 mg

butalbital-acetaminophen-caffeine tab 50-325-40

mg (generic of ESGIC)

QL (4 tabs / 1 day)

butalbital-aspirin-caffeine cap 50-325-40 mg

TENCON TAB 50-325MG

ANALGESICS OTHER acetaminophen cap 500 mg OTC

acetaminophen chew tab 80 mg OTC

acetaminophen chew tab 160 mg OTC

acetaminophen disintegrating tab 80 mg OTC

acetaminophen disintegrating tab 160 mg OTC

acetaminophen elixir 160 mg/5ml OTC

acetaminophen liquid 160 mg/5ml OTC

acetaminophen liquid 167 mg/5ml OTC

acetaminophen soln 160 mg/5ml OTC

acetaminophen suppos 120 mg OTC

acetaminophen suppos 650 mg OTC

acetaminophen susp 160 mg/5ml OTC

acetaminophen tab 325 mg OTC

acetaminophen tab 500 mg OTC

acetaminophen tab er 650 mg OTC

FEVERALL INF SUP 80MG OTC

FEVERALL SUP 325MG OTC

SALICYLATES aspirin buffered (ca carb-mg carb-mg ox) tab 325

mg

OTC

aspirin chew tab 81 mg OTC

ASPIRIN SUP 300MG OTC

aspirin tab 325 mg OTC

aspirin tab 500 mg OTC

aspirin tab delayed release 81 mg OTC

aspirin tab delayed release 325 mg OTC

diflunisal tab 500 mg

salsalate tab 500 mg

salsalate tab 750 mg


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ANALGESICS - OPIOID OPIOID AGONISTS

CODEINE SULF TAB 30MG QL (6 tabs / 1 day)

CODEINE SULF TAB 60MG QL (6 tabs / 1 day)

fentanyl td patch 72hr 12 mcg/hr PA, QL (5 patches / 1 day)





hydromorphone hcl liqd 1 mg/ml (generic of DILAUDID)

PA

hydromorphone hcl tab 2 mg (generic of DILAUDID)

PA, QL (6 tabs / 1 day); PA Required for > 2 Short Acting Opioid Medications in

a 30-day time period

hydromorphone hcl tab 4 mg (generic of DILAUDID)



hydromorphone hcl tab 8 mg (generic of

DILAUDID)


Required for > 2 Short Acting Opioid Medications in


MORPHINE SUL SOL 20MG/5ML PA; PA Required for > 2

Short Acting Opioid Medications in a 30-day time period

morphine sulfate oral soln 10 mg/5ml PA; PA Required for > 2


morphine sulfate oral soln 100 mg/5ml (20 mg/ml) PA; PA Required for > 2 Short Acting Opioid

Medications in a 30-day time period

morphine sulfate tab 15 mg PA, QL (6 tabs / 1 day); PA Required for > 2 Short

Acting Opioid Medications in a 30-day time period

morphine sulfate tab 30 mg PA, QL (6 tabs / 1 day); PA Required for > 2 Short


morphine sulfate tab er 15 mg (generic of MS CONTIN)

PA, QL (3 tabs / 1 day)

morphine sulfate tab er 30 mg (generic of MS CONTIN)



12


morphine sulfate tab er 60 mg (generic of MS

CONTIN)



CONTIN)



CONTIN)


oxycodone hcl cap 5 mg PA, QL (6 caps / 1 day); PA



oxycodone hcl conc 100 mg/5ml (20 mg/ml) PA; PA Required for > 2

Short Acting Opioid Medications in a 30-day

time period

oxycodone hcl soln 5 mg/5ml PA; PA Required for > 2


oxycodone hcl tab 5 mg (generic of ROXICODONE) PA, QL (6 tabs / 1 day); PA Required for > 2 Short


oxycodone hcl tab 10 mg PA, QL (6 tabs / 1 day); PA Required for > 2 Short


oxycodone hcl tab 15 mg (generic of ROXICODONE)

PA, QL (6 tabs / 1 day); PA Required for > 2 Short


oxycodone hcl tab 20 mg PA, QL (6 tabs / 1 day); PA Required for > 2 Short Acting Opioid Medications in


oxycodone hcl tab 30 mg (generic of ROXICODONE)



oxymorphone hcl tab 5 mg PA, QL (6 tabs / 1 day); PA



oxymorphone hcl tab 10 mg PA, QL (6 tabs / 1 day); PA

Required for > 2 Short Acting Opioid Medications in a 30-day time period


13


tramadol hcl tab 50 mg (generic of ULTRAM) PA, QL (6 tabs / 1 day); PA


tramadol hcl tab er 24hr 100 mg PA



XTAMPZA ER CAP 9MG PA

XTAMPZA ER CAP 13.5MG PA




OPIOID COMBINATIONS acetaminophen w/ codeine soln 120-12 mg/5ml PA; PA Required for > 2


time period

acetaminophen w/ codeine soln 120-12 mg/5ml PA; PA Required for > 2


time period

acetaminophen w/ codeine tab 300-15 mg PA, QL (6 tabs / 1 day); PA



acetaminophen w/ codeine tab 300-30 mg PA, QL (6 tabs / 1 day); PA


acetaminophen w/ codeine tab 300-60 mg PA, QL (6 tabs / 1 day); PA Required for > 2 Short


butalbital-acetaminophen-caff w/ cod cap 50-325-40-30 mg

PA, QL (6 caps / 1 day); PA Required for > 2 Short


butalbital-aspirin-caff w/ codeine cap 50-325-40-30 mg

PA, QL (6 caps / 1 day); PA Required for > 2 Short


hydrocodone-acetaminophen soln 7.5-325 mg/15ml

PA; PA Required for > 2 Short Acting Opioid

Medications in a 30-day time period


14


hydrocodone-acetaminophen tab 5-300 mg

(generic of XODOL)



hydrocodone-acetaminophen tab 5-325 mg PA, QL (6 tabs / 1 day); PA


hydrocodone-acetaminophen tab 7.5-300 mg PA, QL (6 tabs / 1 day); PA Required for > 2 Short


hydrocodone-acetaminophen tab 7.5-325 mg PA, QL (6 tabs / 1 day); PA Required for > 2 Short


hydrocodone-acetaminophen tab 10-300 mg PA, QL (6 tabs / 1 day); PA Required for > 2 Short


hydrocodone-acetaminophen tab 10-325 mg PA, QL (6 tabs / 1 day); PA Required for > 2 Short Acting Opioid Medications in


hydrocodone-ibuprofen tab 7.5-200 mg PA, QL (6 tabs / 1 day); PA



hydrocodone-ibuprofen tab 10-200 mg PA, QL (6 tabs / 1 day); PA



oxycodone w/ acetaminophen tab 2.5-325 mg

(generic of PERCOCET)



oxycodone w/ acetaminophen tab 5-325 mg (generic of PERCOCET)



oxycodone w/ acetaminophen tab 7.5-325 mg (generic of PERCOCET)



oxycodone w/ acetaminophen tab 10-325 mg (generic of PERCOCET)




15


tramadol-acetaminophen tab 37.5-325 mg

(generic of ULTRACET)

PA; PA Required for > 2


OPIOID PARTIAL AGONISTS buprenorphine hcl sl tab 2 mg (base equiv) PA; PA Required, unless

Pregnant or Nursing

buprenorphine hcl sl tab 8 mg (base equiv) PA; PA Required, unless Pregnant or Nursing

buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg (base equiv)

buprenorphine hcl-naloxone hcl sl tab 8-2 mg (base equiv)

BUTRANS DIS 5MCG/HR PA, QL (4 patches / 28 days)

BUTRANS DIS 7.5/HR PA, QL (4 patches / 28 days)

BUTRANS DIS 10MCG/HR PA, QL (4 patches / 28 days)

BUTRANS DIS 15MCG/HR PA, QL (4 patches / 28

days)

BUTRANS DIS 20MCG/HR PA, QL (4 patches / 28

days)

SUBLOCADE INJ 100/0.5 PA

SUBLOCADE INJ 300/1.5 PA

SUBOXONE MIS 2-0.5MG

SUBOXONE MIS 4-1MG

SUBOXONE MIS 8-2MG

SUBOXONE MIS 12-3MG

ANDROGENS-ANABOLIC ANDROGENS

ANDRODERM DIS 2MG/24HR PA

ANDRODERM DIS 4MG/24HR PA

ANDROGEL GEL 1%(25MG) PA

ANDROGEL GEL 1%(50MG) PA

ANDROGEL GEL 1.62% PA

danazol cap 50 mg

danazol cap 100 mg

danazol cap 200 mg

testosterone cypionate im inj in oil 100 mg/ml (generic of DEPO-TESTOSTERONE)

PA

testosterone cypionate im inj in oil 200 mg/ml (generic of DEPO-TESTOSTERONE)

PA

ANORECTAL AND RELATED PRODUCTS INTRARECTAL STEROIDS

CORTIFOAM AER 90MG


16


hydrocortisone enema 100 mg/60ml (generic of

CORTENEMA)

RECTAL COMBINATIONS hydrocortisone acetate w/ pramoxine perianal

cream 1-1%

lidocaine-hydrocortisone acetate perianal cream 3-0.5%

lidocaine-hydrocortisone acetate rectal cream kit 2-2%

PROCORT CRE

PROCTOFOAM AER HC 1%

RECTAL LOCAL ANESTHETICS pramoxine hcl perianal foam 1% OTC

RECTAL STEROIDS ANUSOL-HC CRE 2.5%

hydrocortisone perianal cream 1% (generic of

PROCTOCORT)

hydrocortisone perianal cream 2.5% (generic of

ANUSOL-HC)

PROCTOCORT CRE 1%

ANTACIDS ANTACID COMBINATIONS

alum & mag hydroxide-simethicone chew tab 200-

200-25 mg

OTC

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

OTC

aluminum hydroxide-magnesium carbonate chew tab 160-105 mg

OTC

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

OTC

calcium carbonate-mag hydroxide chew tab 550-110 mg

OTC

calcium carbonate-mag hydroxide chew tab 675-135 mg

OTC

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

OTC

FOAM ANTACID CHW 80-20MG OTC

ANTACIDS - ALUMINUM SALTS ALUM HYDROX SUS 320/5ML OTC

ANTACIDS - BICARBONATE sodium bicarbonate tab 325 mg OTC

sodium bicarbonate tab 650 mg OTC

ANTACIDS - CALCIUM SALTS ANTACID CHW 1177MG OTC

ANTACID SOFT CHW 1177MG OTC


17


calcium carbonate (antacid) chew tab 400 mg OTC




calcium carbonate (antacid) susp 1250 mg/5ml OTC

CVS ANTACID CHW 1177MG OTC

TUMS CHW 500MG OTC

TUMS CHW DEL CHW 1177MG OTC

TUMS LASTING CHW 500MG OTC

ANTACIDS - MAGNESIUM SALTS magnesium oxide tab 250 mg OTC

magnesium oxide tab 400 mg OTC

magnesium oxide tab 420 mg OTC

ANTHELMINTICS ANTHELMINTICS

albendazole tab 200 mg (generic of ALBENZA) PA

ivermectin tab 3 mg (generic of STROMECTOL) PA

praziquantel tab 600 mg (generic of BILTRICIDE)

pyrantel pamoate susp 144 mg/ml (50 mg/ml base

equiv)

OTC

ANTI-INFECTIVE AGENTS - MISC. ANTI-INFECTIVE AGENTS - MISC.

metronidazole cap 375 mg (generic of FLAGYL)

metronidazole tab 250 mg

metronidazole tab 500 mg

tinidazole tab 250 mg

tinidazole tab 500 mg

TRIMETHOPRIM TAB 100MG

XIFAXAN TAB 200MG PA

XIFAXAN TAB 550MG PA

ANTI-INFECTIVE MISC. - COMBINATIONS *methenamine-hyos-meth blue-sod phos-phen sal

tab 81.6 mg***

sulfamethoxazole-trimethoprim susp 200-40 mg/5ml

sulfamethoxazole-trimethoprim tab 400-80 mg (generic of BACTRIM)

sulfamethoxazole-trimethoprim tab 800-160 mg (generic of BACTRIM DS)

ANTIPROTOZOAL AGENTS ALINIA SUS 100/5ML PA, QL (150 mL / 30 days)

atovaquone susp 750 mg/5ml (generic of MEPRON)

nitazoxanide tab 500 mg (generic of ALINIA) PA, QL (6 tabs / 30 days)


18


CARBAPENEMS VABOMERE INJ 2GM(1-1) PA; Bill as Medical Claim

Only

CYCLIC LIPOPEPTIDES CUBICIN RF SOL 500MG PA; Bill as Medical Claim

Only

CUBICIN SOL 500MG PA; Bill as Medical Claim

Only

daptomycin for iv soln 500 mg (generic of

CUBICIN)

PA; Bill as Medical Claim

Only

GLYCOPEPTIDES DALVANCE SOL 500MG PA; Bill as Medical Claim

Only

FIRVANQ SOL 25MG/ML

FIRVANQ SOL 50MG/ML

ORBACTIV SOL 400MG PA; Bill as Medical Claim Only

vancomycin hcl cap 125 mg (base equivalent) (generic of VANCOCIN)

vancomycin hcl cap 250 mg (base equivalent) (generic of VANCOCIN)

LEPROSTATICS dapsone tab 25 mg

dapsone tab 100 mg

LINCOSAMIDES clindamycin hcl cap 75 mg (generic of CLEOCIN)

clindamycin hcl cap 150 mg (generic of CLEOCIN)

clindamycin hcl cap 300 mg (generic of CLEOCIN)

clindamycin palmitate hcl for soln 75 mg/5ml (base equiv) (generic of CLEOCIN PEDIATRIC

GRANULE)

OXAZOLIDINONES linezolid for susp 100 mg/5ml (generic of ZYVOX) PA

linezolid tab 600 mg (generic of ZYVOX) PA

SIVEXTRO TAB 200MG PA

URINARY ANTI-INFECTIVES methenamine hippurate tab 1 gm

methenamine mandelate tab 1 gm

nitrofurantoin macrocrystalline cap 50 mg (generic of MACRODANTIN)

nitrofurantoin macrocrystalline cap 100 mg (generic of MACRODANTIN)

nitrofurantoin monohydrate macrocrystalline cap 100 mg (generic of MACROBID)

nitrofurantoin susp 25 mg/5ml


19


ANTIANGINAL AGENTS ANTIANGINALS-OTHER

ranolazine tab er 12hr 500 mg (generic of RANEXA)

PA

ranolazine tab er 12hr 1000 mg (generic of RANEXA)

PA

NITRATES isosorbide dinitrate tab 5 mg (generic of ISORDIL

TITRADOSE)

isosorbide dinitrate tab 10 mg



isosorbide dinitrate tab 40 mg (generic of ISORDIL

TITRADOSE)

isosorbide mononitrate tab 10 mg

isosorbide mononitrate tab 20 mg

isosorbide mononitrate tab er 24hr 30 mg



NITRO-BID OIN 2%

nitroglycerin sl tab 0.3 mg (generic of NITROSTAT)



nitroglycerin td patch 24hr 0.1 mg/hr




ANTIANXIETY AGENTS ANTIANXIETY AGENTS - MISC.

buspirone hcl tab 5 mg PA, QL (4 tabs / 1 day); PA


buspirone hcl tab 7.5 mg PA, QL (4 tabs / 1 day); PA







20




hydroxyzine hcl syrup 10 mg/5ml QL (10 mL / 1 day)

hydroxyzine hcl tab 10 mg QL (8 tabs / 1 day)



hydroxyzine pamoate cap 25 mg QL (4 caps / 1 day)

hydroxyzine pamoate cap 50 mg (generic of

VISTARIL)

QL (8 caps / 1 day)

BENZODIAZEPINES ALPRAZOLAM CON 1 MG/ML PA, QL (4 mL / 1 day); PA

Required for < 6 years of

age; PA Required for > 1 Anxiolytic per 30 days

alprazolam orally disintegrating tab 0.5 mg PA, QL (4 tabs / 1 day); PA Required for < 6 years of


alprazolam orally disintegrating tab 0.25 mg PA, QL (4 tabs / 1 day); PA Required for < 6 years of


alprazolam orally disintegrating tab 1 mg PA, QL (4 tabs / 1 day); PA Required for < 6 years of age; PA Required for > 1

Anxiolytic per 30 days

alprazolam orally disintegrating tab 2 mg PA, QL (2 tabs / 1 day); PA

Required for < 6 years of age; PA Required for > 1


alprazolam tab 0.5 mg (generic of XANAX) PA, QL (4 tabs / 1 day); PA



alprazolam tab 0.25 mg (generic of XANAX) PA, QL (4 tabs / 1 day); PA

Required for < 6 years of age; PA Required for > 1 Anxiolytic per 30 days

alprazolam tab 1 mg (generic of XANAX) PA, QL (4 tabs / 1 day); PA Required for < 6 years of


alprazolam tab 2 mg (generic of XANAX) PA, QL (2 tabs / 1 day); PA Required for < 6 years of



21


alprazolam tab er 24hr 0.5 mg (generic of XANAX

XR)



alprazolam tab er 24hr 1 mg (generic of XANAX

XR)



alprazolam tab er 24hr 2 mg (generic of XANAX XR)



alprazolam tab er 24hr 3 mg (generic of XANAX XR)



chlordiazepoxide hcl cap 5 mg PA, QL (2 caps / 1 day); PA Required for < 6 years of


chlordiazepoxide hcl cap 10 mg PA, QL (2 caps / 1 day); PA Required for < 6 years of age; PA Required for > 1


chlordiazepoxide hcl cap 25 mg PA, QL (2 caps / 1 day); PA



clorazepate dipotassium tab 3.75 mg PA, QL (2 tabs / 1 day); PA



clorazepate dipotassium tab 7.5 mg PA, QL (4 tabs / 1 day); PA


clorazepate dipotassium tab 15 mg PA, QL (4 tabs / 1 day); PA Required for < 6 years of


diazepam conc 5 mg/ml PA, QL (2 mL / 1 day); PA Required for < 6 years of


diazepam oral soln 1 mg/ml PA, QL (10 mL / 1 day); PA Required for < 6 years of



22


diazepam tab 2 mg (generic of VALIUM) PA, QL (4 tabs / 1 day); PA


diazepam tab 5 mg (generic of VALIUM) PA, QL (4 tabs / 1 day); PA


diazepam tab 10 mg (generic of VALIUM) PA, QL (4 tabs / 1 day); PA Required for < 6 years of


lorazepam conc 2 mg/ml PA, QL (2 mL / 1 day); PA Required for < 6 years of


lorazepam tab 0.5 mg (generic of ATIVAN) PA, QL (4 tabs / 1 day); PA Required for < 6 years of


lorazepam tab 1 mg (generic of ATIVAN) PA, QL (4 tabs / 1 day); PA Required for < 6 years of age; PA Required for > 1


lorazepam tab 2 mg (generic of ATIVAN) PA, QL (2 tabs / 1 day); PA



oxazepam cap 10 mg PA, QL (2 caps / 1 day); PA



oxazepam cap 15 mg PA, QL (2 caps / 1 day); PA


oxazepam cap 30 mg PA, QL (2 caps / 1 day); PA Required for < 6 years of


ANTIARRHYTHMICS ANTIARRHYTHMICS TYPE I-A

disopyramide phosphate cap 100 mg (generic of NORPACE)

disopyramide phosphate cap 150 mg (generic of NORPACE)

NORPACE CAP 100MG CR

NORPACE CAP 150MG CR


23


quinidine gluconate tab er 324 mg

ANTIARRHYTHMICS TYPE I-B mexiletine hcl cap 150 mg

mexiletine hcl cap 200 mg

mexiletine hcl cap 250 mg

ANTIARRHYTHMICS TYPE I-C flecainide acetate tab 50 mg

flecainide acetate tab 100 mg

flecainide acetate tab 150 mg

propafenone hcl cap er 12hr 225 mg (generic of RYTHMOL SR)

propafenone hcl cap er 12hr 325 mg (generic of

RYTHMOL SR)

propafenone hcl cap er 12hr 425 mg (generic of

RYTHMOL SR)

propafenone hcl tab 150 mg



ANTIARRHYTHMICS TYPE III amiodarone hcl tab 100 mg

amiodarone hcl tab 200 mg

dofetilide cap 125 mcg (0.125 mg) (generic of TIKOSYN)

dofetilide cap 250 mcg (0.25 mg) (generic of

TIKOSYN)

dofetilide cap 500 mcg (0.5 mg) (generic of

TIKOSYN)

MULTAQ TAB 400MG

ANTIASTHMATIC AND BRONCHODILATOR AGENTS ANTI-INFLAMMATORY AGENTS

cromolyn sodium soln nebu 20 mg/2ml

ANTIASTHMATIC - MONOCLONAL ANTIBODIES FASENRA INJ 30MG/ML PA; Bill as Medical Claim

Only

NUCALA INJ 100MG PA; Bill as Medical Claim

Only

NUCALA INJ 100MG/ML PA; Bill as Medical Claim

Only

XOLAIR INJ 150MG/ML PA; Bill as Medical Claim

Only

XOLAIR SOL 150MG PA; Bill as Medical Claim

Only

BRONCHODILATORS - ANTICHOLINERGICS ATROVENT HFA AER 17MCG

ipratropium bromide inhal soln 0.02%


24


SPIRIVA CAP HANDIHLR

TUDORZA PRES AER 400/ACT

LEUKOTRIENE MODULATORS montelukast sodium chew tab 4 mg (base equiv)

(generic of SINGULAIR)

QL (1 tab / 1 day)

montelukast sodium chew tab 5 mg (base equiv)

(generic of SINGULAIR)

QL (1 tab / 1 day)

montelukast sodium oral granules packet 4 mg

(base equiv) (generic of SINGULAIR)

PA, QL (1 packet / 1 day);

PA Required for > 4 years of age

montelukast sodium tab 10 mg (base equiv) (generic of SINGULAIR)

QL (1 tab / 1 day)

STEROID INHALANTS ASMANEX 14 AER 220MCG

ASMANEX 30 AER 110MCG




budesonide inhalation susp 0.5 mg/2ml (generic of PULMICORT)

budesonide inhalation susp 0.25 mg/2ml (generic of PULMICORT)

budesonide inhalation susp 1 mg/2ml (generic of PULMICORT)

FLOVENT DISK AER 50MCG



FLOVENT HFA AER 44MCG



PULMICORT INH 90MCG

PULMICORT INH 180MCG

SYMPATHOMIMETICS ADVAIR DISKU AER 100/50 ST

ADVAIR DISKU AER 250/50 ST

ADVAIR DISKU AER 500/50 ST

ADVAIR HFA AER 45/21 ST



albuterol sulfate soln nebu 0.5% (5 mg/ml)

albuterol sulfate soln nebu 0.63 mg/3ml (base

equiv)

albuterol sulfate soln nebu 0.083% (2.5 mg/3ml)

albuterol sulfate soln nebu 1.25 mg/3ml (base

equiv)


25


albuterol sulfate syrup 2 mg/5ml

ANORO ELLIPT AER 62.5-25 PA

COMBIVENT AER 20-100

DULERA AER 50-5MCG ST



ipratropium-albuterol nebu soln 0.5-2.5(3) mg/3ml

PROAIR HFA AER

SEREVENT DIS AER 50MCG PA

STIOLTO AER 2.5-2.5 PA

SYMBICORT AER 80-4.5 ST

SYMBICORT AER 160-4.5 ST

XANTHINES theophylline soln 80 mg/15ml

theophylline tab er 24hr 400 mg

theophylline tab er 24hr 600 mg

ANTICOAGULANTS COUMARIN ANTICOAGULANTS

warfarin sodium tab 1 mg


warfarin sodium tab 2.5 mg





warfarin sodium tab 7.5 mg


DIRECT FACTOR XA INHIBITORS ELIQUIS ST P TAB 5MG QL (74 tabs / year)

ELIQUIS TAB 2.5MG QL (2 tabs / 1 day)

ELIQUIS TAB 5MG

XARELTO STAR TAB 15/20MG QL (51 tabs / 30 days)

XARELTO TAB 2.5MG QL (2 tabs / 1 day)

XARELTO TAB 10MG QL (2 tabs / 1 day)



HEPARINS AND HEPARINOID-LIKE AGENTS enoxaparin sodium inj 30 mg/0.3ml (generic of

LOVENOX) QL (2 syringes / 1 day)

enoxaparin sodium inj 40 mg/0.4ml (generic of LOVENOX)

QL (2 syringes / 1 day)

enoxaparin sodium inj 100 mg/ml (generic of LOVENOX)


enoxaparin sodium inj 120 mg/0.8ml (generic of LOVENOX)



26


enoxaparin sodium inj 150 mg/ml (generic of

LOVENOX)


enoxaparin sodium inj 300 mg/3ml (generic of

LOVENOX)

QL (2 vials / 1 day)

enoxaparin sodium subcutaneous soln 60

mg/0.6ml (generic of LOVENOX)


enoxaparin sodium subcutaneous soln 80

mg/0.8ml (generic of LOVENOX)


heparin sodium (porcine) inj 1000 unit/ml




heparin sodium (porcine) pf inj 5000 unit/0.5ml

THROMBIN INHIBITORS PRADAXA CAP 75MG QL (2 caps / 1 day)

PRADAXA CAP 110MG QL (2 caps / 1 day)

PRADAXA CAP 150MG QL (2 caps / 1 day)

ANTICONVULSANTS ANTICONVULSANTS - BENZODIAZEPINES

clobazam suspension 2.5 mg/ml (generic of ONFI) PA

clobazam tab 10 mg (generic of ONFI) PA

clobazam tab 20 mg (generic of ONFI) PA

clonazepam orally disintegrating tab 0.5 mg PA, QL (4 tabs / 1 day); PA Required for < 6 years of age; PA Required for > 1


clonazepam orally disintegrating tab 0.25 mg PA, QL (4 tabs / 1 day); PA



clonazepam orally disintegrating tab 0.125 mg PA, QL (4 tabs / 1 day); PA



clonazepam orally disintegrating tab 1 mg PA, QL (4 tabs / 1 day); PA


clonazepam orally disintegrating tab 2 mg PA, QL (2 tabs / 1 day); PA


clonazepam tab 0.5 mg (generic of KLONOPIN) PA, QL (4 tabs / 1 day); PA Required for < 6 years of



27


clonazepam tab 1 mg (generic of KLONOPIN) PA, QL (4 tabs / 1 day); PA


clonazepam tab 2 mg (generic of KLONOPIN) PA, QL (2 tabs / 1 day); PA


DIAZEPAM GEL 2.5MG QL (2 doses / 24 days)

DIAZEPAM GEL 10MG QL (2 doses / 24 days)

DIAZEPAM GEL 20MG QL (2 doses / 24 days)

ANTICONVULSANTS - MISC. BANZEL TAB 200MG PA

BANZEL TAB 400MG PA

carbamazepine cap er 12hr 100 mg (generic of CARBATROL)



carbamazepine chew tab 100 mg

carbamazepine susp 100 mg/5ml (generic of

TEGRETOL)

carbamazepine tab 200 mg (generic of TEGRETOL)

carbamazepine tab er 12hr 100 mg (generic of

TEGRETOL-XR)

carbamazepine tab er 12hr 200 mg (generic of TEGRETOL-XR)

carbamazepine tab er 12hr 400 mg (generic of TEGRETOL-XR)

gabapentin cap 100 mg (generic of NEURONTIN)



gabapentin oral soln 250 mg/5ml (generic of

NEURONTIN)

gabapentin tab 600 mg (generic of NEURONTIN)

gabapentin tab 800 mg (generic of NEURONTIN)

lamotrigine orally disintegrating tab 25 mg (generic of LAMICTAL ODT)



lamotrigine orally disintegrating tab 200 mg

(generic of LAMICTAL ODT)

lamotrigine tab 25 mg (generic of LAMICTAL)



28




lamotrigine tab chewable dispersible 5 mg (generic of LAMICTAL CHEWABLE DISPERS)

lamotrigine tab chewable dispersible 25 mg (generic of LAMICTAL CHEWABLE DISPERS)

lamotrigine tab er 24hr 25 mg (generic of LAMICTAL XR)





lamotrigine tab er 24hr 300 mg (generic of

LAMICTAL XR)

levetiracetam oral soln 100 mg/ml (generic of

KEPPRA)

levetiracetam tab 250 mg (generic of KEPPRA)




levetiracetam tab er 24hr 500 mg (generic of

KEPPRA XR)

levetiracetam tab er 24hr 750 mg (generic of

KEPPRA XR)

oxcarbazepine susp 300 mg/5ml (60 mg/ml)

(generic of TRILEPTAL)

oxcarbazepine tab 150 mg (generic of TRILEPTAL)



OXTELLAR XR TAB 150MG



pregabalin cap 25 mg (generic of LYRICA) ST, QL (3 caps / 1 day)








pregabalin soln 20 mg/ml (generic of LYRICA) ST

primidone tab 50 mg (generic of MYSOLINE)


29


primidone tab 250 mg (generic of MYSOLINE)

rufinamide susp 40 mg/ml (generic of BANZEL) PA

rufinamide tab 200 mg (generic of BANZEL) PA

rufinamide tab 400 mg (generic of BANZEL) PA

topiramate sprinkle cap 15 mg (generic of

TOPAMAX SPRINKLE)

topiramate sprinkle cap 25 mg (generic of

TOPAMAX SPRINKLE)

topiramate tab 25 mg (generic of TOPAMAX)




VIMPAT SOL 10MG/ML PA

VIMPAT TAB 50MG PA

VIMPAT TAB 100MG PA

VIMPAT TAB 150MG PA

VIMPAT TAB 200MG PA

zonisamide cap 25 mg (generic of ZONEGRAN)

zonisamide cap 50 mg

zonisamide cap 100 mg (generic of ZONEGRAN)

CARBAMATES felbamate susp 600 mg/5ml (generic of FELBATOL)

felbamate tab 400 mg (generic of FELBATOL)

felbamate tab 600 mg (generic of FELBATOL)

GABA MODULATORS tiagabine hcl tab 2 mg (generic of GABITRIL)

tiagabine hcl tab 4 mg (generic of GABITRIL)



HYDANTOINS phenytoin chew tab 50 mg (generic of DILANTIN

INFATABS)

phenytoin sodium extended cap 100 mg (generic of DILANTIN)

phenytoin sodium extended cap 200 mg (generic of PHENYTEK)

phenytoin sodium extended cap 300 mg (generic of PHENYTEK)

phenytoin susp 125 mg/5ml (generic of DILANTIN-125)

SUCCINIMIDES ethosuximide cap 250 mg

ethosuximide soln 250 mg/5ml (generic of ZARONTIN)


30


VALPROIC ACID divalproex sodium cap delayed release sprinkle

125 mg (generic of DEPAKOTE SPRINKLES)

divalproex sodium tab delayed release 125 mg (generic of DEPAKOTE)



divalproex sodium tab er 24 hr 250 mg (generic of DEPAKOTE ER)

divalproex sodium tab er 24 hr 500 mg (generic of DEPAKOTE ER)

valproate sodium oral soln 250 mg/5ml (base equiv)

valproic acid cap 250 mg

ANTIDEPRESSANTS ALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS)

mirtazapine orally disintegrating tab 15 mg

(generic of REMERON SOLTAB)



mirtazapine orally disintegrating tab 30 mg (generic of REMERON SOLTAB)

PA, QL (1 tab / 1 day); PA Required for < 6 years of age

mirtazapine orally disintegrating tab 45 mg (generic of REMERON SOLTAB)


age

mirtazapine tab 7.5 mg PA, QL (1 tab / 1 day); PA Required for < 6 years of age

mirtazapine tab 15 mg (generic of REMERON) PA, QL (1 tab / 1 day); PA Required for < 6 years of

age

mirtazapine tab 30 mg (generic of REMERON) PA, QL (1 tab / 1 day); PA


mirtazapine tab 45 mg PA, QL (1 tab / 1 day); PA Required for < 6 years of

age

ANTIDEPRESSANTS - MISC. bupropion hcl tab 75 mg PA, QL (4 tabs / 1 day); PA


age

bupropion hcl tab 100 mg PA, QL (4 tabs / 1 day); PA



31


bupropion hcl tab er 12hr 100 mg (generic of

WELLBUTRIN SR)



bupropion hcl tab er 12hr 150 mg (generic of WELLBUTRIN SR)


age


WELLBUTRIN SR)



bupropion hcl tab er 24hr 150 mg (generic of WELLBUTRIN XL)



WELLBUTRIN XL)



N-METHYL-D-ASPARTIC ACID (NMDA) RECEPTOR ANTAGONISTS SPRAVATO SOL 56MG DOS PA; Bill as Medical Claim

Only

SPRAVATO SOL 84MG DOS PA; Bill as Medical Claim

Only

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) citalopram hydrobromide oral soln 10 mg/5ml PA, QL (20 mL / 1 day); PA

Required for < 6 years and

> 12 years of age

citalopram hydrobromide tab 10 mg (base equiv)

(generic of CELEXA)



citalopram hydrobromide tab 20 mg (base equiv) (generic of CELEXA)


age

citalopram hydrobromide tab 40 mg (base equiv)

(generic of CELEXA)



escitalopram oxalate tab 5 mg (base equiv) (generic of LEXAPRO)


age

escitalopram oxalate tab 10 mg (base equiv)

(generic of LEXAPRO)



escitalopram oxalate tab 20 mg (base equiv) (generic of LEXAPRO)


fluoxetine hcl cap 10 mg (generic of PROZAC) PA, QL (2 caps / 1 day); PA



32


fluoxetine hcl cap 20 mg (generic of PROZAC) PA, QL (4 caps / 1 day); PA


fluoxetine hcl cap 40 mg (generic of PROZAC) PA, QL (2 caps / 1 day); PA Required for < 6 years of

age

fluoxetine hcl solution 20 mg/5ml PA, QL (20 mL / 1 day); PA

Required for < 6 years and > 12 years of age

fluvoxamine maleate tab 25 mg PA, QL (2 tabs / 1 day); PA Required for < 6 years of age

fluvoxamine maleate tab 50 mg PA, QL (6 tabs / 1 day); PA


fluvoxamine maleate tab 100 mg PA, QL (3 tabs / 1 day); PA Required for < 6 years of age

paroxetine hcl tab 10 mg (generic of PAXIL) PA, QL (1 tab / 1 day); PA Required for < 6 years of

age

paroxetine hcl tab 20 mg (generic of PAXIL) PA, QL (1 tab / 1 day); PA


paroxetine hcl tab 30 mg (generic of PAXIL) PA, QL (1 tab / 1 day); PA Required for < 6 years of

age

paroxetine hcl tab 40 mg (generic of PAXIL) PA, QL (45 tabs / 30 days);

PA Required for < 6 years of age

sertraline hcl oral concentrate for solution 20 mg/ml (generic of ZOLOFT)

PA, QL (10 mL / 1 day); PA Required for < 6 years and

> 12 years of age

sertraline hcl tab 25 mg (generic of ZOLOFT) PA, QL (3 tabs / 1 day); PA


sertraline hcl tab 50 mg (generic of ZOLOFT) PA, QL (4 tabs / 1 day); PA Required for < 6 years of

age

sertraline hcl tab 100 mg (generic of ZOLOFT) PA, QL (2 tabs / 1 day); PA


SEROTONIN MODULATORS trazodone hcl tab 50 mg PA, QL (3 tabs / 1 day); PA



33


trazodone hcl tab 100 mg PA, QL (4 tabs / 1 day); PA


trazodone hcl tab 150 mg PA, QL (2 tabs / 1 day); PA Required for < 6 years of

age

trazodone hcl tab 300 mg PA, QL (1 tab / 1 day); PA


SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) duloxetine hcl enteric coated pellets cap 20 mg

(base eq) (generic of CYMBALTA)

PA, QL (4 caps / 1 day); PA


duloxetine hcl enteric coated pellets cap 30 mg (base eq) (generic of CYMBALTA)

PA, QL (4 caps / 1 day); PA Required for < 6 years of age

duloxetine hcl enteric coated pellets cap 60 mg

(base eq) (generic of CYMBALTA)

PA, QL (2 caps / 1 day); PA


venlafaxine hcl cap er 24hr 37.5 mg (base equivalent) (generic of EFFEXOR XR)

PA, QL (3 caps / 1 day); PA Required for < 6 years of age

venlafaxine hcl cap er 24hr 75 mg (base equivalent) (generic of EFFEXOR XR)

PA, QL (3 caps / 1 day); PA Required for < 6 years of

age

venlafaxine hcl cap er 24hr 150 mg (base equivalent) (generic of EFFEXOR XR)


venlafaxine hcl tab 25 mg (base equivalent) PA, QL (4 tabs / 1 day); PA Required for < 6 years of

age

venlafaxine hcl tab 37.5 mg (base equivalent) PA, QL (3 tabs / 1 day); PA



age

venlafaxine hcl tab 75 mg (base equivalent) PA, QL (5 tabs / 1 day); PA



age

TRICYCLIC AGENTS amitriptyline hcl tab 10 mg PA; PA Required for < 6

years of age


34


amitriptyline hcl tab 25 mg PA; PA Required for < 6

years of age


years of age


years of age


years of age


years of age

clomipramine hcl cap 25 mg (generic of ANAFRANIL)

PA; PA Required for < 6 years of age





desipramine hcl tab 10 mg (generic of NORPRAMIN)


desipramine hcl tab 25 mg (generic of NORPRAMIN)


desipramine hcl tab 50 mg PA; PA Required for < 6 years of age




doxepin hcl cap 10 mg PA, QL (3 caps / 1 day); PA Required for < 6 years of

age

doxepin hcl cap 25 mg PA, QL (3 caps / 1 day); PA Required for < 6 years of age


age

doxepin hcl cap 75 mg PA, QL (3 caps / 1 day); PA



age

doxepin hcl conc 10 mg/ml PA, QL (6 mL / 1 day); PA


imipramine hcl tab 10 mg PA; PA Required for < 6 years of age


35


imipramine hcl tab 25 mg PA; PA Required for < 6

years of age

imipramine hcl tab 50 mg PA; PA Required for < 6

years of age

imipramine pamoate cap 75 mg PA; PA Required for < 6

years of age


years of age


years of age

imipramine pamoate cap 150 mg PA; PA Required for < 6 years of age

nortriptyline hcl cap 10 mg (generic of PAMELOR) PA; PA Required for < 6 years of age




protriptyline hcl tab 5 mg PA; PA Required for < 6 years of age

protriptyline hcl tab 10 mg PA; PA Required for < 6 years of age

trimipramine maleate cap 25 mg PA; PA Required for < 6 years of age



ANTIDIABETICS ALPHA-GLUCOSIDASE INHIBITORS

acarbose tab 25 mg (generic of PRECOSE)



ANTIDIABETIC - AMYLIN ANALOGS SYMLINPEN 60 INJ 1000MCG PA

SYMLNPEN 120 INJ 1000MCG PA

ANTIDIABETIC COMBINATIONS ALOG/PIOGLIT TAB 12.5-15

ALOG/PIOGLIT TAB 12.5-30

ALOG/PIOGLIT TAB 12.5-45

ALOG/PIOGLIT TAB 25-15MG

ALOGLIPTIN/ TAB METFORM

glyburide-metformin tab 1.25-250 mg

glyburide-metformin tab 2.5-500 mg


36


glyburide-metformin tab 5-500 mg

GLYXAMBI TAB 10-5 MG PA

GLYXAMBI TAB 25-5 MG PA

INVOKAMET TAB 50-500MG PA

INVOKAMET TAB 50-1000 PA



JANUMET TAB 50-500MG PA

JANUMET TAB 50-1000 PA

JANUMET XR TAB 50-500MG PA

JANUMET XR TAB 50-1000 PA

JANUMET XR TAB 100-1000 PA

JENTADUETO TAB 2.5-500 PA



JENTADUETO TAB XR

JENTADUETO TAB XR PA

KAZANO 12.5- TAB 500MG PA

KAZANO 12.5- TAB 1000MG PA

KOMBIGLYZ XR TAB 2.5-1000 PA

KOMBIGLYZ XR TAB 5-500MG PA

KOMBIGLYZ XR TAB 5-1000MG PA

OSENI TAB 12.5-15 PA



OSENI TAB 25-15MG PA



pioglitazone hcl-glimepiride tab 30-2 mg (generic of DUETACT)

pioglitazone hcl-glimepiride tab 30-4 mg (generic of DUETACT)

pioglitazone hcl-metformin hcl tab 15-500 mg (generic of ACTOPLUS MET)

pioglitazone hcl-metformin hcl tab 15-850 mg

(generic of ACTOPLUS MET)

SYNJARDY TAB PA

SYNJARDY TAB 5-500MG PA

SYNJARDY TAB 5-1000MG PA

SYNJARDY TAB 12.5-500 PA

TRIJARDY XR TAB PA

XIGDUO XR TAB 2.5-1000 PA

XIGDUO XR TAB 5-500MG PA




37


XIGDUO XR TAB 10-1000 PA

BIGUANIDES metformin hcl tab 500 mg

metformin hcl tab 850 mg

metformin hcl tab 1000 mg

metformin hcl tab er 24hr 500 mg

metformin hcl tab er 24hr 750 mg

DIABETIC OTHER CVS GLUCOSE CHW FRUIT OTC

CVS GLUCOSE CHW GRAPE OTC

CVS GLUCOSE CHW ORANGE OTC

CVS GLUCOSE CHW RASPBERY OTC

CVS GLUCOSE CHW TROP BLS OTC

DEX4 CHW FRUIT OTC

DEX4 CHW GRAPE OTC

DEX4 CHW ORANGE OTC

DEX4 CHW RASPBERR OTC

DEX4 CHW RASPBERY OTC

DEX4 CHW SOUR APL OTC

DEX4 CHW TROP FRT OTC

DEX4 CHW WATERMLN OTC

DEX4 GLUCOSE CHW OTC

DEX4 NATURAL CHW ORANGE OTC

DEX4 POUCH CHW PACK OTC

diazoxide susp 50 mg/ml (generic of PROGLYCEM)

GLUCAGEN INJ HYPOKIT

glucagon (rdna) for inj kit 1 mg (generic of

GLUCAGON EMERGENCY KIT)

GLUCAGON INJ 1MG

GLUCAGON KIT 1MG

GLUCOSE CHW 4-0.006 OTC

GLUCOSE CHW 4-.006GM OTC

GLUCOSE CHW 4GM OTC

GLUCOSE CHW FRT PNCH OTC

GLUCOSE CHW FRUIT OTC

GLUCOSE CHW GRAPE OTC

GLUCOSE CHW ORANGE OTC

GLUCOSE CHW RASPBERY OTC

GLUCOSE CHW RASPBRRY OTC

GLUCOSE CHW TROP FRT OTC

GLUCOSE CHW WATERMLN OTC

GNP GLUCOSE CHW GRAPE OTC

GNP GLUCOSE CHW ORANGE OTC

GNP GLUCOSE CHW RASPBERY OTC

GNP GLUCOSE CHW WATERMLN OTC


38


KROG GLUCOSE CHW GRAPE OTC

KROG GLUCOSE CHW ORANGE OTC

KROG GLUCOSE CHW RASPBERY OTC

KROG GLUCOSE CHW TROP FRT OTC

KROG GLUCOSE CHW WATERMLN OTC

PROGLYCEM SUS 50MG/ML

PX GLUCOSE CHW FRUIT OTC

PX GLUCOSE CHW ORANGE OTC

PX GLUCOSE CHW RASPBERY OTC

PX GLUCOSE CHW SOUR APL OTC

PX GLUCOSE CHW TROP FRU OTC

RA GLUCOSE CHW GRAPE OTC

RA GLUCOSE CHW ORANGE OTC

RA GLUCOSE CHW RASPBERY OTC

RA GLUCOSE CHW TROP FRT OTC

RELION GLUCO CHW 4GM OTC

SM GLUCOSE CHW ORANGE OTC

SM GLUCOSE CHW RASPBERY OTC

SMART SENSE CHW 4GM OTC

SMART SENSE CHW GLUCOSE OTC

TGT GLUCOSE CHW GRAPE OTC

TGT GLUCOSE CHW ORANGE OTC

TGT GLUCOSE CHW RASPBERY OTC

TGT GLUCOSE CHW TROP FRT OTC

UP&UP CHW GRAPE OTC

UP&UP CHW ORANGE OTC

UP&UP CHW RASPBERY OTC

VP GLUCOSE CHW FRUIT OTC

VP GLUCOSE CHW GRAPE OTC

DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS ALOGLIPTIN TAB 12.5MG

ALOGLIPTIN TAB 25MG

JANUVIA TAB 25MG PA

JANUVIA TAB 50MG PA

JANUVIA TAB 100MG PA

NESINA TAB 6.25MG PA

NESINA TAB 12.5MG PA

NESINA TAB 25MG PA

ONGLYZA TAB 2.5MG PA

ONGLYZA TAB 5MG PA

TRADJENTA TAB 5MG PA

INCRETIN MIMETIC AGENTS (GLP-1 RECEPTOR AGONISTS) BYETTA INJ 5MCG PA

BYETTA INJ 10MCG PA

TRULICITY INJ 0.75/0.5 PA


39



TRULICITY INJ 3/0.5 PA


VICTOZA INJ 18MG/3ML PA

INSULIN HUMALOG CARTRIDGE 100/ML

HUMALOG MIX INJ 50/50

HUMALOG MIX SUS 75/25

HUMULIN INJ 70/30 OTC

HUMULIN INJ 70/30KWP OTC

HUMULIN N INJ U-100 OTC

HUMULIN R INJ U-100 OTC

HUMULIN R INJ U-500, VIAL/KWIKPEN PA

INSULIN ASPART FLEXPEN

INSULIN ASPART PROT INJ 70/30, VIAL/FLEXPEN

INSULIN ASPART INJ 100 UNIT/ML

INSULIN ASPART CARTRIDGE 100 UNIT/ML

INSULIN LISPRO INJ 100 UNIT/ML

INSULIN LISPRO JUNIOR KWIKPEN

INSULIN LISPRO KWIKPEN

INSULIN LISP INJ 75/25 KWIKPEN

LANTUS INJ 100/ML

LANTUS SOLOS INJ 100/ML

LEVEMIR INJ

LEVEMIR INJ FLEXTOUC

INSULIN SENSITIZING AGENTS pioglitazone hcl tab 15 mg (base equiv) (generic of

ACTOS)

pioglitazone hcl tab 30 mg (base equiv) (generic of

ACTOS)

pioglitazone hcl tab 45 mg (base equiv) (generic of

ACTOS)

MEGLITINIDE ANALOGUES nateglinide tab 60 mg

nateglinide tab 120 mg

repaglinide tab 0.5 mg

repaglinide tab 1 mg

repaglinide tab 2 mg

SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS FARXIGA TAB 5MG PA

FARXIGA TAB 10MG PA

INVOKANA TAB 100MG PA

INVOKANA TAB 300MG PA

JARDIANCE TAB 10MG PA

JARDIANCE TAB 25MG PA


40


SULFONYLUREAS glimepiride tab 1 mg (generic of AMARYL)

glimepiride tab 2 mg (generic of AMARYL)

glimepiride tab 4 mg (generic of AMARYL)

glipizide tab 5 mg

glipizide tab 10 mg

glipizide tab er 24hr 2.5 mg (generic of GLUCOTROL XL)

glipizide tab er 24hr 5 mg (generic of GLUCOTROL XL)

glipizide tab er 24hr 10 mg (generic of GLUCOTROL XL)

glyburide micronized tab 1.5 mg (generic of GLYNASE)

glyburide micronized tab 3 mg (generic of GLYNASE)

glyburide micronized tab 6 mg (generic of GLYNASE)

glyburide tab 1.25 mg

glyburide tab 2.5 mg

glyburide tab 5 mg

ANTIDIARRHEAL/PROBIOTIC AGENTS ANTIDIARRHEAL - CHLORIDE CHANNEL ANTAGONISTS

MYTESI TAB 125MG PA, QL (2 tabs / 1 day)

ANTIDIARRHEAL/PROBIOTIC AGENTS - MISC. bismuth subsalicylate chew tab 262 mg OTC

bismuth subsalicylate susp 262 mg/15ml OTC

bismuth subsalicylate susp 525 mg/15ml OTC

bismuth subsalicylate tab 262 mg OTC

PEPTO-BISMOL SUS 262/15ML OTC

ANTIPERISTALTIC AGENTS ANTI-DIARRHE LIQ 1MG/5ML OTC

diphenoxylate w/ atropine tab 2.5-0.025 mg (generic of LOMOTIL)

loperamide hcl cap 2 mg

loperamide hcl cap 2 mg OTC

loperamide hcl liq 1 mg/7.5ml OTC

loperamide hcl tab 2 mg OTC

ANTIDOTES AND SPECIFIC ANTAGONISTS ANTIDOTES - CHELATING AGENTS

deferasirox granules packet 90 mg (generic of JADENU SPRINKLE)

PA

deferasirox granules packet 180 mg (generic of JADENU SPRINKLE)

PA


41


deferasirox granules packet 360 mg (generic of

JADENU SPRINKLE)

PA

deferasirox tab 90 mg (generic of JADENU) PA



deferasirox tab for oral susp 125 mg (generic of EXJADE)

PA

deferasirox tab for oral susp 250 mg (generic of EXJADE)

PA

deferasirox tab for oral susp 500 mg (generic of

EXJADE)

PA

ANTIDOTES AND SPECIFIC ANTAGONISTS deferoxamine mesylate for inj 500 mg (generic of

DESFERAL) PA; Bill as Medical Claim Only

DESFERAL INJ 500MG PA; Bill as Medical Claim Only

OPIOID ANTAGONISTS KLOXXADO SPR 8MG

naloxone hcl inj 0.4 mg/ml

naloxone hcl inj 4 mg/10ml

naloxone hcl soln prefilled syringe 2 mg/2ml

naltrexone hcl tab 50 mg

NARCAN SPR

VIVITROL INJ 380MG

ANTIEMETICS 5-HT3 RECEPTOR ANTAGONISTS

ALOXI INJ 0.25MG/5 PA; Bill as Medical Claim Only

granisetron hcl tab 1 mg

ondansetron hcl oral soln 4 mg/5ml

ondansetron hcl tab 4 mg QL (3 tabs / 1 day)

ondansetron hcl tab 8 mg QL (3 tabs / 1 day)

ondansetron orally disintegrating tab 4 mg QL (3 tabs / 1 day)

ondansetron orally disintegrating tab 8 mg QL (3 tabs / 1 day)

palonosetron hcl iv soln 0.25 mg/5ml (base equivalent) (generic of ALOXI)

PA; Bill as Medical Claim Only

SUSTOL INJ 10/0.4ML PA; Bill as Medical Claim Only

ANTIEMETICS - ANTICHOLINERGIC dimenhydrinate tab 50 mg OTC

meclizine hcl chew tab 25 mg OTC

meclizine hcl tab 12.5 mg

meclizine hcl tab 12.5 mg OTC

meclizine hcl tab 25 mg

meclizine hcl tab 25 mg OTC


42


trimethobenzamide hcl cap 300 mg

SUBSTANCE P/NEUROKININ 1 (NK1) RECEPTOR ANTAGONISTS aprepitant capsule 40 mg QL (6 caps / 21 days)

aprepitant capsule 80 mg (generic of EMEND) QL (6 caps / 21 days)

aprepitant capsule 125 mg

aprepitant capsule therapy pack 80 & 125 mg

CINVANTI INJ 130/18ML PA; Bill as Medical Claim Only

EMEND SOL 150MG PA; Bill as Medical Claim Only

FOSAPREPITAN SOL 150MG PA; Bill as Medical Claim

Only

fosaprepitant dimeglumine for iv infusion 150 mg

(base eq) (generic of EMEND)

PA; Bill as Medical Claim

Only

ANTIFUNGALS ANTIFUNGALS

griseofulvin microsize susp 125 mg/5ml

griseofulvin microsize tab 500 mg

nystatin tab 500000 unit

terbinafine hcl tab 250 mg QL (90 tabs / year)

IMIDAZOLE-RELATED ANTIFUNGALS fluconazole for susp 10 mg/ml (generic of

DIFLUCAN)

fluconazole for susp 40 mg/ml (generic of DIFLUCAN)

fluconazole tab 50 mg (generic of DIFLUCAN)




ANTIHISTAMINES ANTIHISTAMINES - ALKYLAMINES

chlorpheniramine maleate syrup 2 mg/5ml OTC

chlorpheniramine maleate tab 4 mg OTC

chlorpheniramine maleate tab er 12 mg OTC

ANTIHISTAMINES - ETHANOLAMINES carbinoxamine maleate tab 4 mg

clemastine fumarate tab 1.34 mg (1 mg base

equiv)

OTC

diphenhydramine hcl cap 25 mg OTC

diphenhydramine hcl cap 50 mg OTC

diphenhydramine hcl chew tab 12.5 mg OTC

diphenhydramine hcl elixir 12.5 mg/5ml

diphenhydramine hcl liquid 12.5 mg/5ml OTC

diphenhydramine hcl tab 25 mg OTC

diphenhydramine hcl tab disint 12.5 mg OTC


43


ANTIHISTAMINES - NON-SEDATING ALLEGRA ALRG TAB 30MG OTC

cetirizine hcl cap 10 mg OTC

cetirizine hcl chew tab 5 mg OTC

cetirizine hcl chew tab 10 mg OTC

cetirizine hcl oral soln 1 mg/ml (5 mg/5ml)

cetirizine hcl oral soln 1 mg/ml (5 mg/5ml) OTC

cetirizine hcl tab 5 mg OTC

cetirizine hcl tab 10 mg OTC

CLARITIN RDT TAB 5MG OTC

fexofenadine hcl susp 30 mg/5ml (6 mg/ml) OTC

fexofenadine hcl tab 60 mg OTC

fexofenadine hcl tab 180 mg OTC

levocetirizine dihydrochloride soln 2.5 mg/5ml (0.5

mg/ml)

levocetirizine dihydrochloride tab 5 mg

levocetirizine dihydrochloride tab 5 mg OTC

loratadine cap 10 mg OTC

loratadine chew tab 5 mg OTC

loratadine rapidly-disintegrating tab 10 mg OTC

loratadine syrup 5 mg/5ml OTC

loratadine tab 10 mg OTC

ZYRTEC ALLGY TAB 10MG OTC

ZYRTEC CHILD TAB 10MG OTC

ANTIHISTAMINES - PHENOTHIAZINES promethazine hcl inj 25 mg/ml (generic of

PHENERGAN)

promethazine hcl inj 50 mg/ml (generic of

PHENERGAN)

promethazine hcl suppos 12.5 mg

promethazine hcl suppos 25 mg

promethazine hcl syrup 6.25 mg/5ml

promethazine hcl tab 12.5 mg

promethazine hcl tab 25 mg

promethazine hcl tab 50 mg

ANTIHISTAMINES - PIPERIDINES cyproheptadine hcl syrup 2 mg/5ml

cyproheptadine hcl tab 4 mg

ANTIHYPERLIPIDEMICS BILE ACID SEQUESTRANTS

cholestyramine light powder 4 gm/dose (generic of QUESTRAN LIGHT)

cholestyramine light powder packets 4 gm

cholestyramine powder 4 gm/dose (generic of

QUESTRAN)


44


cholestyramine powder packets 4 gm (generic of

QUESTRAN)

colestipol hcl tab 1 gm (generic of COLESTID)

FIBRIC ACID DERIVATIVES fenofibrate micronized cap 67 mg

fenofibrate micronized cap 134 mg

fenofibrate micronized cap 200 mg

fenofibrate tab 48 mg (generic of TRICOR)

fenofibrate tab 54 mg

fenofibrate tab 145 mg (generic of TRICOR)

fenofibrate tab 160 mg

gemfibrozil tab 600 mg (generic of LOPID)

HMG COA REDUCTASE INHIBITORS atorvastatin calcium tab 10 mg (base equivalent)

(generic of LIPITOR) QL (1 tab / 1 day)

atorvastatin calcium tab 20 mg (base equivalent) (generic of LIPITOR)

QL (1 tab / 1 day)


QL (1 tab / 1 day)


QL (1 tab / 1 day)

lovastatin tab 10 mg QL (1 tab / 1 day)



pravastatin sodium tab 10 mg QL (1 tab / 1 day)




rosuvastatin calcium tab 5 mg (generic of CRESTOR)

QL (1 tab / 1 day)


QL (1 tab / 1 day)


QL (1 tab / 1 day)


QL (1 tab / 1 day)

simvastatin tab 5 mg QL (1 tab / 1 day)

simvastatin tab 10 mg (generic of ZOCOR) QL (1 tab / 1 day)



simvastatin tab 80 mg QL (1 tab / 1 day)

INTESTINAL CHOLESTEROL ABSORPTION INHIBITORS ezetimibe tab 10 mg (generic of ZETIA) ST


45


ANTIHYPERTENSIVES ACE INHIBITORS

benazepril hcl tab 5 mg

benazepril hcl tab 10 mg (generic of LOTENSIN)



captopril tab 12.5 mg

captopril tab 25 mg

captopril tab 50 mg

captopril tab 100 mg

enalapril maleate tab 2.5 mg (generic of VASOTEC)

enalapril maleate tab 5 mg (generic of VASOTEC)



EPANED SOL 1MG/ML

fosinopril sodium tab 10 mg



lisinopril tab 2.5 mg (generic of ZESTRIL)

lisinopril tab 5 mg (generic of ZESTRIL)





moexipril hcl tab 7.5 mg

moexipril hcl tab 15 mg

perindopril erbumine tab 2 mg



quinapril hcl tab 5 mg (generic of ACCUPRIL)




ramipril cap 1.25 mg (generic of ALTACE)

ramipril cap 2.5 mg (generic of ALTACE)

ramipril cap 5 mg (generic of ALTACE)

ramipril cap 10 mg (generic of ALTACE)

trandolapril tab 1 mg

trandolapril tab 2 mg

trandolapril tab 4 mg (generic of MAVIK)

AGENTS FOR PHEOCHROMOCYTOMA metyrosine cap 250 mg PA


46


ANGIOTENSIN II RECEPTOR ANTAGONISTS irbesartan tab 75 mg (generic of AVAPRO)

irbesartan tab 150 mg (generic of AVAPRO)

irbesartan tab 300 mg (generic of AVAPRO)

losartan potassium tab 25 mg (generic of

COZAAR)


COZAAR)


COZAAR)

valsartan tab 40 mg (generic of DIOVAN)




ANTIADRENERGIC ANTIHYPERTENSIVES clonidine hcl tab 0.1 mg PA; PA Required for < 6

years of age

clonidine hcl tab 0.2 mg PA; PA Required for < 6 years of age

clonidine hcl tab 0.3 mg PA; PA Required for < 6

years of age

clonidine td patch weekly 0.1 mg/24hr (generic of

CATAPRES-TTS-1)

QL (4 patches / 28 days)


CATAPRES-TTS-2)



CATAPRES-TTS-3)


doxazosin mesylate tab 1 mg




guanfacine hcl tab 1 mg PA; PA Required for < 6

years of age

guanfacine hcl tab 2 mg PA; PA Required for < 6

years of age

METHYLDOPA TAB 250MG

METHYLDOPA TAB 500MG

prazosin hcl cap 1 mg (generic of MINIPRESS)



terazosin hcl cap 1 mg (base equivalent)




ANTIHYPERTENSIVE COMBINATIONS amlodipine besylate-benazepril hcl cap 2.5-10 mg


47


amlodipine besylate-benazepril hcl cap 5-10 mg

(generic of LOTREL)


(generic of LOTREL)


amlodipine besylate-benazepril hcl cap 10-20 mg (generic of LOTREL)

amlodipine besylate-benazepril hcl cap 10-40 mg (generic of LOTREL)

atenolol & chlorthalidone tab 50-25 mg (generic of TENORETIC 50)

atenolol & chlorthalidone tab 100-25 mg (generic of TENORETIC 100)

bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg (generic of ZIAC)

bisoprolol & hydrochlorothiazide tab 5-6.25 mg (generic of ZIAC)

bisoprolol & hydrochlorothiazide tab 10-6.25 mg (generic of ZIAC)

enalapril maleate & hydrochlorothiazide tab 5-12.5 mg

enalapril maleate & hydrochlorothiazide tab 10-25 mg (generic of VASERETIC)

fosinopril sodium & hydrochlorothiazide tab 10-

12.5 mg

fosinopril sodium & hydrochlorothiazide tab 20-

12.5 mg

irbesartan-hydrochlorothiazide tab 150-12.5 mg

(generic of AVALIDE)

irbesartan-hydrochlorothiazide tab 300-12.5 mg

(generic of AVALIDE)

lisinopril & hydrochlorothiazide tab 10-12.5 mg

(generic of ZESTORETIC)

lisinopril & hydrochlorothiazide tab 20-12.5 mg

(generic of ZESTORETIC)

lisinopril & hydrochlorothiazide tab 20-25 mg (generic of ZESTORETIC)

losartan potassium & hydrochlorothiazide tab 50-12.5 mg (generic of HYZAAR)

losartan potassium & hydrochlorothiazide tab 100-12.5 mg (generic of HYZAAR)

losartan potassium & hydrochlorothiazide tab 100-25 mg (generic of HYZAAR)

metoprolol & hydrochlorothiazide tab 50-25 mg

metoprolol & hydrochlorothiazide tab 100-25 mg

quinapril-hydrochlorothiazide tab 10-12.5 mg

(generic of ACCURETIC)


48


quinapril-hydrochlorothiazide tab 20-12.5 mg


quinapril-hydrochlorothiazide tab 20-25 mg


valsartan-hydrochlorothiazide tab 80-12.5 mg

(generic of DIOVAN HCT)

valsartan-hydrochlorothiazide tab 160-12.5 mg


valsartan-hydrochlorothiazide tab 160-25 mg


valsartan-hydrochlorothiazide tab 320-12.5 mg (generic of DIOVAN HCT)

valsartan-hydrochlorothiazide tab 320-25 mg (generic of DIOVAN HCT)

SELECTIVE ALDOSTERONE RECEPTOR ANTAGONISTS (SARAS) eplerenone tab 25 mg (generic of INSPRA)

eplerenone tab 50 mg (generic of INSPRA)

VASODILATORS hydralazine hcl tab 10 mg

hydralazine hcl tab 25 mg



minoxidil tab 2.5 mg

minoxidil tab 10 mg

ANTIMALARIALS ANTIMALARIAL COMBINATIONS

atovaquone-proguanil hcl tab 62.5-25 mg (generic of MALARONE)

atovaquone-proguanil hcl tab 250-100 mg (generic of MALARONE)

COARTEM TAB 20-120MG

ANTIMALARIALS chloroquine phosphate tab 250 mg

hydroxychloroquine sulfate tab 200 mg (generic of PLAQUENIL)

mefloquine hcl tab 250 mg

primaquine phosphate tab 26.3 mg (15 mg base)

(generic of PRIMAQUINE PHOSPHATE)

quinine sulfate cap 324 mg (generic of

QUALAQUIN)

ANTIMYASTHENIC/CHOLINERGIC AGENTS ANTIMYASTHENIC/CHOLINERGIC AGENTS

pyridostigmine bromide tab 60 mg (generic of

MESTINON)


49


pyridostigmine bromide tab er 180 mg (generic of

MESTINON TIMESPAN)

ANTIMYCOBACTERIAL AGENTS ANTIMYCOBACTERIAL AGENTS

ethambutol hcl tab 100 mg

ethambutol hcl tab 400 mg (generic of

MYAMBUTOL)

isoniazid tab 300 mg

pyrazinamide tab 500 mg

rifampin cap 150 mg

rifampin cap 300 mg

SIRTURO TAB 100MG

ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES ALKYLATING AGENTS

ALKERAN TAB 2MG PA

cyclophosphamide cap 25 mg PA

cyclophosphamide cap 50 mg PA

GLEOSTINE CAP 10MG PA



LEUKERAN TAB 2MG

ANTIMETABOLITES mercaptopurine tab 50 mg

methotrexate sodium for inj 1 gm

methotrexate sodium inj 50 mg/2ml (25 mg/ml)

methotrexate sodium inj pf 50 mg/2ml (25 mg/ml)

methotrexate sodium tab 2.5 mg (base equiv)

TABLOID TAB 40MG

ANTINEOPLASTIC - ANGIOGENESIS INHIBITORS AVASTIN INJ PA; Bill as Medical Claim

Only

AVASTIN INJ 400/16ML PA; Bill as Medical Claim Only

INLYTA TAB 1MG PA

INLYTA TAB 5MG PA

ANTINEOPLASTIC - ANTIBODIES BAVENCIO INJ 20MG/ML PA; Bill as Medical Claim

Only

BESPONSA INJ 0.9MG PA; Bill as Medical Claim

Only

LIBTAYO INJ 350/7ML PA; Bill as Medical Claim

Only

MYLOTARG INJ 4.5MG PA; Bill as Medical Claim

Only


50


POTELIGEO INJ 20MG/5ML PA; Bill as Medical Claim

Only

RITUXAN INJ 100MG PA; Bill as Medical Claim

Only

RITUXAN INJ 500MG PA; Bill as Medical Claim

Only

ANTINEOPLASTIC - EGFR INHIBITORS erlotinib hcl tab 25 mg (base equivalent) (generic

of TARCEVA) PA

erlotinib hcl tab 100 mg (base equivalent) (generic of TARCEVA)

PA

erlotinib hcl tab 150 mg (base equivalent) (generic

of TARCEVA)

PA

IRESSA TAB 250MG PA

ANTINEOPLASTIC - HORMONAL AND RELATED AGENTS abiraterone acetate tab 250 mg (generic of

ZYTIGA) PA

anastrozole tab 1 mg (generic of ARIMIDEX) PA

bicalutamide tab 50 mg (generic of CASODEX)

ELIGARD INJ 7.5MG PA

ELIGARD INJ 22.5MG PA

ELIGARD INJ 30MG PA

ELIGARD INJ 45MG PA

exemestane tab 25 mg (generic of AROMASIN) PA

FASLODEX INJ 250/5ML PA; Bill as Medical Claim Only

FIRMAGON INJ 80MG PA; Bill as Medical Claim Only

FIRMAGON INJ 120MG PA; Bill as Medical Claim Only

fulvestrant inj 250 mg/5ml (generic of FASLODEX) PA; Bill as Medical Claim Only

FULVESTRANT INJ 250/5ML PA; Bill as Medical Claim Only

letrozole tab 2.5 mg (generic of FEMARA)

leuprolide acetate inj kit 5 mg/ml

leuprolide acetate inj kit 5 mg/ml

LUPRON DEPOT INJ 3.75MG PA




LUPRON DEPOT INJ 30MG PA

LUPRON DEPOT INJ 45MG PA

LYSODREN TAB 500MG

megestrol acetate susp 40 mg/ml

megestrol acetate tab 20 mg


51


megestrol acetate tab 40 mg

tamoxifen citrate tab 10 mg (base equivalent)

tamoxifen citrate tab 20 mg (base equivalent)

toremifene citrate tab 60 mg (base equivalent) (generic of FARESTON)

PA

VANTAS KIT 50MG PA; Bill as Medical Claim Only

ZOLADEX IMP 3.6MG PA; Bill as Medical Claim Only

ZOLADEX IMP 10.8MG PA; Bill as Medical Claim

Only

ANTINEOPLASTIC - PDGFR-ALPHA INHIBITORS LARTRUVO INJ 10MG/ML PA; Bill as Medical Claim

Only

LARTRUVO INJ 190/19ML PA; Bill as Medical Claim Only

ANTINEOPLASTIC COMBINATIONS RITUXAN INJ HYCELA PA; Bill as Medical Claim

Only

ANTINEOPLASTIC ENZYME INHIBITORS ALIQOPA INJ 60MG PA; Bill as Medical Claim

Only

CAPRELSA TAB 100MG PA

CAPRELSA TAB 300MG PA

everolimus tab 2.5 mg (generic of AFINITOR) PA

everolimus tab 5 mg (generic of AFINITOR) PA

everolimus tab 7.5 mg (generic of AFINITOR) PA

everolimus tab 10 mg (generic of AFINITOR) PA

everolimus tab for oral susp 2 mg (generic of AFINITOR DISPERZ)

PA


PA


PA

GLEEVEC TAB 100MG PA

GLEEVEC TAB 400MG PA

ICLUSIG TAB 10MG PA

ICLUSIG TAB 15MG PA

ICLUSIG TAB 30MG PA

ICLUSIG TAB 45MG PA

IMBRUVICA CAP 70MG PA

IMBRUVICA CAP 140MG PA

IMBRUVICA TAB 140MG PA





52


JAKAFI TAB 5MG PA

JAKAFI TAB 10MG PA

JAKAFI TAB 15MG PA

JAKAFI TAB 20MG PA

JAKAFI TAB 25MG PA

lapatinib ditosylate tab 250 mg (base equiv)

(generic of TYKERB)

PA

NEXAVAR TAB 200MG PA

SPRYCEL TAB 20MG PA

SPRYCEL TAB 50MG PA

SPRYCEL TAB 70MG PA

SPRYCEL TAB 80MG PA

SPRYCEL TAB 100MG PA

SPRYCEL TAB 140MG PA

SUTENT CAP 12.5MG PA

SUTENT CAP 25MG PA

SUTENT CAP 37.5MG PA

SUTENT CAP 50MG PA

TASIGNA CAP 50MG PA

TASIGNA CAP 150MG PA

TASIGNA CAP 200MG PA

VOTRIENT TAB 200MG PA

XALKORI CAP 200MG PA

XALKORI CAP 250MG PA

ZELBORAF TAB 240MG PA

ZOLINZA CAP 100MG PA

ANTINEOPLASTIC RADIOPHARMACEUTICALS AZEDRA DOSIM INJ 15MCI/ML PA; Bill as Medical Claim

Only

AZEDRA THERA INJ 15MCI/ML PA; Bill as Medical Claim Only

ANTINEOPLASTICS MISC. ACTIMMUNE INJ 2MU/0.5 PA

ALFERON N INJ 5MU/ML PA

bexarotene cap 75 mg (generic of TARGRETIN) PA

hydroxyurea cap 500 mg (generic of HYDREA)

INTRON A INJ 10MU PA



MATULANE CAP 50MG

tretinoin cap 10 mg

CHEMOTHERAPY RESCUE/ANTIDOTE/PROTECTIVE AGENTS leucovorin calcium tab 5 mg PA

leucovorin calcium tab 10 mg PA



53



ANTIPARKINSON AND RELATED THERAPY AGENTS ANTIPARKINSON ANTICHOLINERGICS

benztropine mesylate tab 0.5 mg

benztropine mesylate tab 1 mg

benztropine mesylate tab 2 mg

trihexyphenidyl hcl oral soln 0.4 mg/ml

trihexyphenidyl hcl tab 2 mg

trihexyphenidyl hcl tab 5 mg

ANTIPARKINSON COMT INHIBITORS entacapone tab 200 mg (generic of COMTAN)

ANTIPARKINSON DOPAMINERGICS amantadine hcl cap 100 mg

amantadine hcl soln 50 mg/5ml

bromocriptine mesylate cap 5 mg (base equivalent) (generic of PARLODEL)

bromocriptine mesylate tab 2.5 mg (base equivalent) (generic of PARLODEL)

carbidopa & levodopa tab 10-100 mg (generic of SINEMET)

carbidopa & levodopa tab 25-100 mg (generic of SINEMET)

carbidopa & levodopa tab 25-250 mg

carbidopa & levodopa tab er 25-100 mg

carbidopa & levodopa tab er 50-200 mg

pramipexole dihydrochloride tab 0.5 mg




pramipexole dihydrochloride tab 1 mg


ropinirole hydrochloride tab 0.5 mg

ropinirole hydrochloride tab 0.25 mg

ropinirole hydrochloride tab 1 mg





ANTIPSYCHOTICS/ANTIMANIC AGENTS ANTIMANIC AGENTS

lithium carbonate cap 150 mg PA; PA Required for < 6 years of age

lithium carbonate cap 300 mg PA; PA Required for < 6 years of age


54


lithium carbonate cap 600 mg PA; PA Required for < 6

years of age

lithium carbonate tab 300 mg PA; PA Required for < 6

years of age

lithium carbonate tab er 300 mg (generic of

LITHOBID)

PA; PA Required for < 6

years of age

lithium carbonate tab er 450 mg PA; PA Required for < 6

years of age

ANTIPSYCHOTICS - MISC. EQUETRO CAP 100MG

EQUETRO CAP 200MG

EQUETRO CAP 300MG

LATUDA TAB 20MG PA, QL (1 tab / 1 day); PA Required for < 6 years of

age

LATUDA TAB 40MG PA, QL (1 tab / 1 day); PA


LATUDA TAB 60MG PA, QL (1 tab / 1 day); PA Required for < 6 years of

age

LATUDA TAB 80MG PA, QL (1 tab / 1 day); PA


LATUDA TAB 120MG PA, QL (1 tab / 1 day); PA Required for < 6 years of age

ziprasidone hcl cap 20 mg (generic of GEODON) PA, QL (2 caps / 1 day); PA


ziprasidone hcl cap 40 mg (generic of GEODON) PA, QL (2 caps / 1 day); PA Required for < 6 years of age

ziprasidone hcl cap 60 mg (generic of GEODON) PA, QL (2 caps / 1 day); PA Required for < 6 years of

age

ziprasidone hcl cap 80 mg (generic of GEODON) PA, QL (2 caps / 1 day); PA Required for < 6 years of age

BENZISOXAZOLES INVEGA SUST INJ 39/0.25 PA, QL (1 injection / 30

days); PA Required for < 18 years of age

INVEGA SUST INJ 78/0.5ML PA, QL (1 injection / 30 days); PA Required for < 18

years of age


55


INVEGA SUST INJ 117/0.75 PA, QL (1 injection / 30


INVEGA SUST INJ 156MG/ML PA, QL (1 injection / 30 days); PA Required for < 18

years of age

INVEGA SUST INJ 234/1.5 PA, QL (1 injection / 30


INVEGA TRINZ INJ 273MG PA, QL (1 injection / 82 days); PA Required for < 18 years of age

INVEGA TRINZ INJ 410MG PA, QL (1 injection / 82


INVEGA TRINZ INJ 546MG PA, QL (1 injection / 82 days); PA Required for < 18 years of age

INVEGA TRINZ INJ 819MG PA, QL (1 injection / 82 days); PA Required for < 18

years of age

PERSERIS INJ 90MG PA, QL (1 injection / 30


PERSERIS INJ 120MG PA, QL (1 injection / 30 days); PA Required for < 18

years of age

RISPERDAL INJ 12.5MG PA, QL (2 vials / 28 day);


RISPERDAL INJ 25MG PA, QL (2 vials / 28 day); PA Required for < 18 years

of age

RISPERDAL INJ 37.5MG PA, QL (2 vials / 28 day);


RISPERDAL INJ 50MG PA, QL (2 vials / 28 day); PA Required for < 18 years

of age

risperidone orally disintegrating tab 0.5 mg PA, QL (2 tabs / 1 day); PA


risperidone orally disintegrating tab 1 mg PA, QL (2 tabs / 1 day); PA Required for < 6 years of

age

risperidone orally disintegrating tab 2 mg PA, QL (2 tabs / 1 day); PA



56


risperidone orally disintegrating tab 3 mg PA, QL (2 tabs / 1 day); PA


risperidone orally disintegrating tab 4 mg PA, QL (2 tabs / 1 day); PA Required for < 6 years of

age

risperidone soln 1 mg/ml (generic of RISPERDAL) PA, QL (240 mL / 28 days);


risperidone tab 0.5 mg (generic of RISPERDAL) PA, QL (2 tabs / 1 day); PA Required for < 6 years of age

risperidone tab 0.25 mg PA, QL (2 tabs / 1 day); PA


risperidone tab 1 mg (generic of RISPERDAL) PA, QL (2 tabs / 1 day); PA Required for < 6 years of age

risperidone tab 2 mg (generic of RISPERDAL) PA, QL (2 tabs / 1 day); PA Required for < 6 years of

age

risperidone tab 3 mg (generic of RISPERDAL) PA, QL (2 tabs / 1 day); PA


risperidone tab 4 mg (generic of RISPERDAL) PA, QL (2 tabs / 1 day); PA Required for < 6 years of

age

BUTYROPHENONES haloperidol decanoate im soln 50 mg/ml (generic

of HALDOL DECANOATE 50) PA; PA Required for < 18 years of age

haloperidol decanoate im soln 100 mg/ml (generic of HALDOL DECANOATE 100)


haloperidol lactate oral conc 2 mg/ml PA; PA Required for < 6

years of age

haloperidol tab 0.5 mg PA; PA Required for < 6

years of age

haloperidol tab 1 mg PA; PA Required for < 6

years of age


years of age


years of age


years of age


years of age


57


DIBENZAPINES clozapine orally disintegrating tab 25 mg PA, QL (5 tabs / 1 day); PA


clozapine orally disintegrating tab 100 mg PA, QL (5 tabs / 1 day); PA Required for < 18 years of

age

clozapine tab 25 mg (generic of CLOZARIL) PA, QL (5 tabs / 1 day); PA


clozapine tab 50 mg (generic of CLOZARIL) PA, QL (5 tabs / 1 day); PA Required for < 18 years of

age

clozapine tab 100 mg (generic of CLOZARIL) PA, QL (5 tabs / 1 day); PA


clozapine tab 200 mg (generic of CLOZARIL) PA, QL (5 tabs / 1 day); PA Required for < 18 years of

age

loxapine succinate cap 5 mg PA; PA Required for < 6

years of age


years of age


years of age

loxapine succinate cap 50 mg PA; PA Required for < 6 years of age

olanzapine orally disintegrating tab 5 mg (generic of ZYPREXA ZYDIS)




age





age

olanzapine tab 2.5 mg (generic of ZYPREXA) PA; PA Required for < 6

years of age

olanzapine tab 5 mg (generic of ZYPREXA) PA, QL (2 tabs / 1 day); PA Required for < 6 years of age

olanzapine tab 7.5 mg (generic of ZYPREXA) PA; PA Required for < 6 years of age


58


olanzapine tab 10 mg (generic of ZYPREXA) PA, QL (2 tabs / 1 day); PA


olanzapine tab 15 mg (generic of ZYPREXA) PA, QL (1 tab / 1 day); PA Required for < 6 years of

age

olanzapine tab 20 mg (generic of ZYPREXA) PA, QL (1 tab / 1 day); PA


quetiapine fumarate tab 25 mg (generic of SEROQUEL)


quetiapine fumarate tab 50 mg (generic of

SEROQUEL)







age

quetiapine fumarate tab 300 mg (generic of

SEROQUEL)





age

PHENOTHIAZINES CHLORPROMAZ INJ 50MG/2ML PA; PA Required for < 6

years of age

chlorpromazine hcl inj 25 mg/ml PA; PA Required for < 6 years of age

chlorpromazine hcl tab 10 mg PA; PA Required for < 6

years of age


years of age


years of age


years of age


years of age

fluphenazine decanoate inj 25 mg/ml PA; PA Required for < 6

years of age

fluphenazine hcl tab 1 mg PA; PA Required for < 6

years of age

fluphenazine hcl tab 2.5 mg PA; PA Required for < 6 years of age


59



years of age


years of age

perphenazine tab 2 mg PA; PA Required for < 6

years of age


years of age


years of age

perphenazine tab 16 mg PA; PA Required for < 6 years of age

prochlorperazine maleate tab 5 mg (base equivalent)

prochlorperazine maleate tab 10 mg (base equivalent)

prochlorperazine suppos 25 mg

thioridazine hcl tab 10 mg PA; PA Required for < 6 years of age



thioridazine hcl tab 100 mg PA; PA Required for < 6

years of age

trifluoperazine hcl tab 1 mg (base equivalent) PA; PA Required for < 6

years of age


years of age


years of age


years of age

QUINOLINONE DERIVATIVES ABILIFY MAIN INJ 300MG PA, QL (1 injection / 30

days); PA Required for < 18

years of age

ABILIFY MAIN INJ 400MG PA, QL (1 injection / 30


aripiprazole tab 2 mg (generic of ABILIFY) PA, QL (1 tab / 1 day); PA Required for < 6 years of

age

aripiprazole tab 5 mg (generic of ABILIFY) PA, QL (1 tab / 1 day); PA



60




aripiprazole tab 15 mg (generic of ABILIFY) PA, QL (1 tab / 1 day); PA Required for < 6 years of

age



aripiprazole tab 30 mg (generic of ABILIFY) PA, QL (1 tab / 1 day); PA Required for < 6 years of age

ARISTADA INJ 441MG/1. PA, QL (1 injection / 30


ARISTADA INJ 662MG/2 PA, QL (1 injection / 30 days); PA Required for < 18 years of age

ARISTADA INJ 882MG/3 PA, QL (1 injection / 30 days); PA Required for < 18

years of age

ARISTADA INJ 1064MG PA, QL (1 injection / 48


ARISTADA INJ INITIO PA, QL (1 injection / year); PA Required for < 18 years

of age

THIOXANTHENES thiothixene cap 1 mg PA; PA Required for < 6

years of age

thiothixene cap 2 mg PA; PA Required for < 6 years of age

thiothixene cap 5 mg PA; PA Required for < 6

years of age

thiothixene cap 10 mg PA; PA Required for < 6

years of age

ANTISEPTICS & DISINFECTANTS IODINE ANTISEPTICS

BETADINE SOL 10% OTC

povidone-iodine soln 10% OTC

ANTIVIRALS ANTIRETROVIRALS

abacavir sulfate soln 20 mg/ml (base equiv) (generic of ZIAGEN)

abacavir sulfate tab 300 mg (base equiv) (generic of ZIAGEN)


61


abacavir sulfate-lamivudine tab 600-300 mg

(generic of EPZICOM)

abacavir sulfate-lamivudine-zidovudine tab 300-

150-300 mg (generic of TRIZIVIR)

APTIVUS CAP 250MG

atazanavir sulfate cap 150 mg (base equiv)

atazanavir sulfate cap 200 mg (base equiv) (generic of REYATAZ)

atazanavir sulfate cap 300 mg (base equiv) (generic of REYATAZ)

ATRIPLA TAB

BIKTARVY TAB QL (1 tab / 1 day)

COMPLERA TAB

DELSTRIGO TAB

DESCOVY TAB 200/25MG QL (1 tab / 1 day)

DOVATO TAB 50-300MG QL (1 tab / 1 day)

efavirenz cap 50 mg (generic of SUSTIVA)

efavirenz cap 200 mg (generic of SUSTIVA)

efavirenz tab 600 mg (generic of SUSTIVA)

efavirenz-emtricitabine-tenofovir df tab 600-200-

300 mg (generic of ATRIPLA)

emtricitabine caps 200 mg (generic of EMTRIVA)

EMTRIVA SOL 10MG/ML

etravirine tab 100 mg (generic of INTELENCE)

etravirine tab 200 mg (generic of INTELENCE)

EVOTAZ TAB 300-150

fosamprenavir calcium tab 700 mg (base equiv)

(generic of LEXIVA)

FUZEON INJ 90MG PA

GENVOYA TAB

INVIRASE TAB 500MG

ISENTRESS CHW 25MG

ISENTRESS CHW 100MG

ISENTRESS HD TAB 600MG

ISENTRESS POW 100MG

ISENTRESS TAB 400MG

JULUCA TAB 50-25MG

lamivudine oral soln 10 mg/ml (generic of EPIVIR)

lamivudine tab 150 mg (generic of EPIVIR)

lamivudine tab 300 mg (generic of EPIVIR)

lamivudine-zidovudine tab 150-300 mg (generic of

COMBIVIR)

LEXIVA SUS 50MG/ML

lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml) (generic of KALETRA)


62


lopinavir-ritonavir tab 100-25 mg (generic of

KALETRA)

lopinavir-ritonavir tab 200-50 mg (generic of

KALETRA)

NEVIRAPINE SUS 50MG/5ML

nevirapine tab 200 mg

nevirapine tab er 24hr 400 mg (generic of VIRAMUNE XR)

NORVIR POW 100MG

NORVIR SOL 80MG/ML

ODEFSEY TAB

PIFELTRO TAB 100MG

PREZCOBIX TAB 800-150

PREZISTA SUS 100MG/ML

PREZISTA TAB 75MG

PREZISTA TAB 150MG

PREZISTA TAB 600MG

PREZISTA TAB 800MG

REYATAZ POW 50MG

ritonavir tab 100 mg (generic of NORVIR)

SELZENTRY TAB 25MG PA




STRIBILD TAB

SYMTUZA TAB

tenofovir disoproxil fumarate tab 300 mg (generic

of VIREAD)

TIVICAY PD TAB 5MG

TIVICAY TAB 10MG

TIVICAY TAB 25MG

TIVICAY TAB 50MG

TRIUMEQ TAB

TROGARZO INJ 150MG/ML PA; Bill as Medical Claim

Only

TRUVADA TAB 100-150

TRUVADA TAB 133-200

TRUVADA TAB 167-250

TRUVADA TAB 200-300

TYBOST TAB 150MG

VIRACEPT TAB 250MG

VIRACEPT TAB 625MG

VIREAD POW 40MG/GM

zidovudine cap 100 mg (generic of RETROVIR)

zidovudine syrup 10 mg/ml (generic of RETROVIR)


63


zidovudine tab 300 mg

ANTIVIRAL COMBINATIONS PAXLOVID TAB QL (60 tabs / year)

CMV AGENTS cidofovir iv inj 75 mg/ml PA; Bill as Medical Claim

Only

FOSCAVIR INJ 24MG/ML PA; Bill as Medical Claim Only

ganciclovir sodium for inj 500 mg PA; Bill as Medical Claim Only

LIVTENCITY TAB 200MG PA

valganciclovir hcl for soln 50 mg/ml (base equiv)

(generic of VALCYTE)

PA

valganciclovir hcl tab 450 mg (base equivalent)

(generic of VALCYTE)

PA

HEPATITIS AGENTS adefovir dipivoxil tab 10 mg (generic of HEPSERA) PA

BARACLUDE SOL PA

entecavir tab 0.5 mg (generic of BARACLUDE) PA

entecavir tab 1 mg (generic of BARACLUDE) PA

EPIVIR HBV SOL 5MG/ML

lamivudine tab 100 mg (hbv) (generic of EPIVIR

HBV)

MAVYRET PAK 50-20MG PA

MAVYRET TAB 100-40MG PA

PEGASYS INJ PA

PEGASYS INJ 180MCG/M PA

ribavirin cap 200 mg PA

ribavirin tab 200 mg PA

SOFOS/VELPAT TAB 400-100 PA

HERPES AGENTS acyclovir cap 200 mg

acyclovir susp 200 mg/5ml (generic of ZOVIRAX)

acyclovir tab 400 mg

acyclovir tab 800 mg

famciclovir tab 125 mg



valacyclovir hcl tab 1 gm (generic of VALTREX)

valacyclovir hcl tab 500 mg (generic of VALTREX)

INFLUENZA AGENTS oseltamivir phosphate cap 30 mg (base equiv)

(generic of TAMIFLU)

QL (20 caps / 270 days)

oseltamivir phosphate cap 45 mg (base equiv)




64


oseltamivir phosphate cap 75 mg (base equiv)



oseltamivir phosphate for susp 6 mg/ml (base

equiv) (generic of TAMIFLU)

RELENZA MIS DISKHALE QL (2 inhalers / year)

MISC. ANTIVIRALS MOLNUPIRAVIR CAP 200MG QL (80 caps / year)

BETA BLOCKERS ALPHA-BETA BLOCKERS

carvedilol tab 3.125 mg (generic of COREG)



carvedilol tab 25 mg (generic of COREG)

labetalol hcl tab 100 mg



BETA BLOCKERS CARDIO-SELECTIVE atenolol tab 25 mg (generic of TENORMIN)

atenolol tab 50 mg (generic of TENORMIN)

atenolol tab 100 mg (generic of TENORMIN)

bisoprolol fumarate tab 5 mg

bisoprolol fumarate tab 10 mg

metoprolol succinate tab er 24hr 25 mg (tartrate equiv) (generic of TOPROL XL)




metoprolol tartrate tab 25 mg

metoprolol tartrate tab 37.5 mg

metoprolol tartrate tab 50 mg (generic of LOPRESSOR)

metoprolol tartrate tab 75 mg

metoprolol tartrate tab 100 mg (generic of LOPRESSOR)

BETA BLOCKERS NON-SELECTIVE nadolol tab 20 mg (generic of CORGARD) PA

nadolol tab 40 mg (generic of CORGARD) PA

nadolol tab 80 mg (generic of CORGARD) PA

propranolol hcl cap er 24hr 60 mg (generic of

INDERAL LA)


INDERAL LA)


65



INDERAL LA)


INDERAL LA)

propranolol hcl oral soln 20 mg/5ml

propranolol hcl tab 10 mg





sotalol hcl (afib/afl) tab 80 mg (generic of BETAPACE AF)



sotalol hcl tab 80 mg (generic of BETAPACE)



sotalol hcl tab 240 mg

CALCIUM CHANNEL BLOCKERS CALCIUM CHANNEL BLOCKERS

amlodipine besylate tab 2.5 mg (base equivalent) (generic of NORVASC)

QL (1 tab / 1 day)

amlodipine besylate tab 5 mg (base equivalent) (generic of NORVASC)

QL (1 tab / 1 day)

amlodipine besylate tab 10 mg (base equivalent) (generic of NORVASC)

QL (1 tab / 1 day)

diltiazem hcl cap er 12hr 60 mg






diltiazem hcl coated beads cap er 24hr 120 mg

(generic of CARDIZEM CD)

diltiazem hcl coated beads cap er 24hr 180 mg (generic of CARDIZEM CD)




diltiazem hcl extended release beads cap er 24hr 120 mg (generic of TIAZAC)


66


diltiazem hcl extended release beads cap er 24hr

180 mg (generic of TIAZAC)









diltiazem hcl tab 30 mg (generic of CARDIZEM)


diltiazem hcl tab 90 mg


felodipine tab er 24hr 2.5 mg

felodipine tab er 24hr 5 mg

felodipine tab er 24hr 10 mg

nifedipine cap 10 mg

nifedipine cap 20 mg

nifedipine tab er 24hr 30 mg



nifedipine tab er 24hr osmotic release 30 mg

(generic of PROCARDIA XL)

nifedipine tab er 24hr osmotic release 60 mg

(generic of PROCARDIA XL)

nifedipine tab er 24hr osmotic release 90 mg (generic of PROCARDIA XL)

verapamil hcl cap er 24hr 120 mg (generic of VERELAN)

QL (1 cap / 1 day)


QL (1 cap / 1 day)


QL (1 cap / 1 day)

verapamil hcl tab 40 mg



verapamil hcl tab er 120 mg (generic of CALAN SR)

QL (2 tabs / 1 day)

verapamil hcl tab er 180 mg QL (2 tabs / 1 day)

verapamil hcl tab er 240 mg (generic of CALAN SR)

QL (2 tabs / 1 day)

CARDIOTONICS CARDIAC GLYCOSIDES

digoxin oral soln 0.05 mg/ml


67


digoxin tab 125 mcg (0.125 mg) (generic of

LANOXIN)

digoxin tab 250 mcg (0.25 mg) (generic of

LANOXIN)

LANOXIN TAB 0.0625MG

CARDIOVASCULAR AGENTS - MISC. CARDIOVASCULAR AGENTS MISC. - COMBINATIONS

BIDIL TAB

ENTRESTO TAB 24-26MG PA



PROSTAGLANDIN VASODILATORS REMODULIN INJ 1MG/ML PA; Bill as Medical Claim

Only

REMODULIN INJ 2.5MG/ML PA; Bill as Medical Claim

Only

REMODULIN INJ 5MG/ML PA; Bill as Medical Claim

Only

REMODULIN INJ 10MG/ML PA; Bill as Medical Claim

Only

treprostinil inj soln 20 mg/20ml (1 mg/ml) PA; Bill as Medical Claim

Only

treprostinil inj soln 50 mg/20ml (2.5 mg/ml) PA; Bill as Medical Claim

Only


Only


Only

PULMONARY HYPERTENSION - ENDOTHELIN RECEPTOR

ANTAGONISTS LETAIRIS TAB 5MG PA

LETAIRIS TAB 10MG PA

TRACLEER TAB 62.5MG PA

TRACLEER TAB 125MG PA

PULMONARY HYPERTENSION - PHOSPHODIESTERASE INHIBITORS ADCIRCA TAB 20MG PA

REVATIO SUS 10MG/ML PA; PA Required for < 12

years of age

sildenafil citrate tab 20 mg (generic of REVATIO) PA

SINUS NODE INHIBITORS CORLANOR TAB 5MG PA

CORLANOR TAB 7.5MG PA

CEPHALOSPORINS CEPHALOSPORINS - 1ST GENERATION

cefadroxil cap 500 mg


68


cefadroxil for susp 250 mg/5ml

cefadroxil for susp 500 mg/5ml

cephalexin cap 250 mg

cephalexin cap 500 mg

CEPHALEXIN CAP 750MG

cephalexin for susp 125 mg/5ml

cephalexin for susp 250 mg/5ml

CEPHALOSPORINS - 2ND GENERATION CEFACLOR ER TAB 500MG

cefprozil for susp 125 mg/5ml

cefprozil for susp 250 mg/5ml

cefprozil tab 250 mg

cefprozil tab 500 mg

cefuroxime axetil tab 250 mg

cefuroxime axetil tab 500 mg

CEPHALOSPORINS - 3RD GENERATION cefdinir cap 300 mg

cefdinir for susp 125 mg/5ml

cefdinir for susp 250 mg/5ml

cefixime cap 400 mg QL (1 cap / 30 days)

cefixime for susp 100 mg/5ml

cefixime for susp 200 mg/5ml (generic of SUPRAX)

cefpodoxime proxetil for susp 50 mg/5ml

cefpodoxime proxetil for susp 100 mg/5ml

cefpodoxime proxetil tab 100 mg

cefpodoxime proxetil tab 200 mg

SUPRAX CHW 100MG QL (1 tab / 30 days)

SUPRAX CHW 200MG QL (1 tab / 30 days)

SUPRAX SUS 500/5ML

CONTRACEPTIVES COMBINATION CONTRACEPTIVES - ORAL

desogest-eth estrad & eth estrad tab 0.15-0.02/0.01 mg(21/5) (generic of MIRCETTE)

desogest-ethin est tab 0.1-0.025/0.125-0.025/0.15-0.025mg-mg

desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg

drospirenone-ethinyl estradiol tab 3-0.02 mg (generic of YAZ)

drospirenone-ethinyl estradiol tab 3-0.03 mg (generic of YASMIN 28)

ethynodiol diacetate & ethinyl estradiol tab 1 mg-

35 mcg

ethynodiol diacetate & ethinyl estradiol tab 1 mg-

50 mcg


69


levonorg-eth est tab 0.1-0.02mg(84) & eth est tab

0.01mg(7) (generic of LOSEASONIQUE)

QL (1 tab / 1 day)

levonorg-eth est tab 0.15-0.03mg(84) & eth est

tab 0.01mg(7) (generic of SEASONIQUE)

QL (1 tab / 1 day)

levonorgestrel & ethinyl estradiol (91-day) tab

0.15-0.03 mg

QL (1 tab / 1 day)

levonorgestrel & ethinyl estradiol tab 0.1 mg-20

mcg

levonorgestrel & ethinyl estradiol tab 0.15 mg-30

mcg

levonorgestrel-eth estra tab 0.05-30/0.075-40/0.125-30mg-mcg

levonorgestrel-ethinyl estradiol (continuous) tab 90-20 mcg

norethindrone & ethinyl estradiol tab 0.4 mg-35 mcg

norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg

norethindrone & ethinyl estradiol tab 1 mg-35 mcg

norethindrone & ethinyl estradiol-fe chew tab 0.4 mg-35 mcg

norethindrone & ethinyl estradiol-fe chew tab 0.8 mg-25 mcg (generic of GENERESS FE)

norethindrone ac-ethinyl estrad-fe tab 1-20/1-

30/1-35 mg-mcg (generic of ESTROSTEP FE)

norethindrone ace & ethinyl estradiol tab 1 mg-20

mcg

norethindrone ace & ethinyl estradiol tab 1.5 mg-

30 mcg

norethindrone ace & ethinyl estradiol-fe tab 1 mg-

20 mcg

norethindrone ace & ethinyl estradiol-fe tab 1.5

mg-30 mcg

norethindrone ace-eth estradiol-fe chew tab 1 mg-

20 mcg (24) (generic of MINASTRIN 24 FE)

norethindrone ace-ethinyl estradiol-fe cap 1 mg-20 mcg (24) (generic of TAYTULLA)

norethindrone ace-ethinyl estradiol-fe tab 1 mg-20 mcg (24)

norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35 mg-mcg

norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35 mg-mcg

norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg


70


norgestimate-eth estrad tab 0.18-25/0.215-

25/0.25-25 mg-mcg (generic of ORTHO TRI-CYCLEN LO)

norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35 mg-mcg

norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg

COMBINATION CONTRACEPTIVES - TRANSDERMAL norelgestromin-ethinyl estradiol td ptwk 150-35

mcg/24hr

COMBINATION CONTRACEPTIVES - VAGINAL etonogestrel-ethinyl estradiol va ring 0.120-0.015

mg/24hr (generic of NUVARING)

NUVARING MIS

COPPER CONTRACEPTIVES - IUD PARAGARD IUD T380A Bill as Medical Claim Only

EMERGENCY CONTRACEPTIVES levonorgestrel tab 1.5 mg OTC

PLAN B TAB 1.5MG OTC

PROGESTIN CONTRACEPTIVES - IMPLANTS NEXPLANON IMP 68MG Bill as Medical Claim Only

PROGESTIN CONTRACEPTIVES - INJECTABLE medroxyprogesterone acetate im susp 150 mg/ml

(generic of DEPO-PROVERA CONTRACEPTIV) QL (1 injection / 90 days)

medroxyprogesterone acetate im susp prefilled syr 150 mg/ml (generic of DEPO-PROVERA

CONTRACEPTIV)

PROGESTIN CONTRACEPTIVES - IUD KYLEENA IUD 19.5MG Bill as Medical Claim Only

LILETTA IUD 52MG Bill as Medical Claim Only

MIRENA IUD SYSTEM Bill as Medical Claim Only

SKYLA IUD 13.5MG Bill as Medical Claim Only

PROGESTIN CONTRACEPTIVES - ORAL norethindrone tab 0.35 mg

CORTICOSTEROIDS GLUCOCORTICOSTEROIDS

budesonide delayed release particles cap 3 mg

DEXAMETHASON CON 1MG/ML

dexamethasone elixir 0.5 mg/5ml

dexamethasone tab 0.5 mg



dexamethasone tab 4 mg

dexamethasone tab 6 mg

hydrocortisone tab 5 mg (generic of CORTEF)


71




KENALOG-10 INJ 10MG/ML PA; Bill as Medical Claim Only

methylprednisolone acetate inj susp 40 mg/ml (generic of DEPO-MEDROL)

PA

methylprednisolone acetate inj susp 80 mg/ml (generic of DEPO-MEDROL)

PA

methylprednisolone sod succ for inj 40 mg (base equiv) (generic of SOLU-MEDROL)








methylprednisolone tab 4 mg (generic of MEDROL)




methylprednisolone tab therapy pack 4 mg (21) (generic of MEDROL DOSEPAK)

prednisolone sod phosph oral soln 6.7 mg/5ml (5 mg/5ml base) (generic of PEDIAPRED)

prednisolone sod phosphate oral soln 15 mg/5ml (base equiv)

PREDNISOLONE TAB 10MG ODT



PREDNISONE CON 5MG/ML

prednisone tab 1 mg

prednisone tab 2.5 mg

prednisone tab 5 mg

prednisone tab 10 mg



prednisone tab therapy pack 5 mg (21)

prednisone tab therapy pack 10 mg (21)

SOLU-MEDROL INJ 1GM PA; Bill as Medical Claim Only

SOLU-MEDROL INJ 40MG PA; Bill as Medical Claim Only

SOLU-MEDROL INJ 125MG PA; Bill as Medical Claim Only


72


SOLU-MEDROL INJ 1000MG PA; Bill as Medical Claim

Only

TRIAMCINOLON INJ 40MG/ML PA; Bill as Medical Claim

Only

TRIAMCINOLON INJ 80MG/2ML PA; Bill as Medical Claim

Only

TRIAMCINOLON INJ 80MG/ML PA; Bill as Medical Claim

Only

MINERALOCORTICOIDS fludrocortisone acetate tab 0.1 mg

COUGH/COLD/ALLERGY ANTITUSSIVES

benzonatate cap 100 mg (generic of TESSALON

PERLES)

benzonatate cap 200 mg

dextromethorphan polistirex extended release susp 30 mg/5ml

OTC

hydrocodone w/ homatropine syrup 5-1.5 mg/5ml (generic of HYCODAN)

PA, QL (30 mL / 1 day); PA Required for < 18 years of age

hydrocodone w/ homatropine tab 5-1.5 mg (generic of HYCODAN)


COUGH/COLD/ALLERGY COMBINATIONS ACTIDOM DMX LIQ QL (30 mL / 1 day), OTC

AQUANAZ TAB OTC

BIODESP DM SYP QL (30 mL / 1 day), OTC

brompheniramine & pseudoephedrine elixir 1-15

mg/5ml

OTC

cetirizine-pseudoephedrine tab er 12hr 5-120 mg OTC

chlorpheniramine & pseudoephedrine tab 4-60 mg OTC

DECONEX DMX TAB OTC

DECONEX IR TAB 10-385MG OTC

dextromethorphan-guaifenesin cap 10-200 mg OTC

dextromethorphan-guaifenesin liquid 5-100 mg/5ml

QL (30 mL / 1 day), OTC









dextromethorphan-guaifenesin syrup 10-100 mg/5ml


dextromethorphan-guaifenesin tab 20-400 mg OTC


73


dextromethorphan-guaifenesin tab er 12hr 30-600

mg

OTC

dextromethorphan-guaifenesin tab er 12hr 60-

1200 mg

OTC

DOMETUSS-DMX LIQ QL (30 mL / 1 day), OTC

ED A-HIST DM TAB 10-4-10 OTC

ED BRON GP LIQ OTC

fexofenadine-pseudoephedrine tab er 12hr 60-120 mg

OTC

fexofenadine-pseudoephedrine tab er 24hr 180-

240 mg

OTC

G-TRON PED LIQ QL (30 mL / 1 day), OTC

GCON IR TAB 10-385MG OTC

GILPHEX TR TAB 10-388MG

GILTUSS CGH TAB & COLD OTC

GLENMAX PEB LIQ DM OTC

guaifenesin-codeine liquid 225-7.5 mg/5ml OTC

guaifenesin-codeine soln 100-10 mg/5ml OTC

LOHIST-D LIQ QL (30 mL / 1 day), OTC

LOHIST-DM SYP 5-2-10MG QL (30 mL / 1 day), OTC

loratadine & pseudoephedrine tab er 12hr 5-120

mg

OTC

loratadine & pseudoephedrine tab er 24hr 10-240

mg

OTC

M-CLEAR WC LIQ 100-6.3 OTC

MAXI-TUSS PE LIQ JR QL (30 mL / 1 day), OTC

MAXI-TUSS PE LIQ MAX OTC

MAXICHLOR TAB PEH DM OTC

MUCINEX D TAB 60-600MG OTC

MUCINEX D TAB 120-1200 OTC

MUCINEX FAST TAB 5-10-200 OTC

NIVANEX DMX TAB OTC

PECGEN DMX LIQ 10-187MG QL (30 mL / 1 day), OTC

phenylephrine w/ dm-gg liqd 2.5-5-50 mg/ml QL (30 mL / 1 day), OTC

phenylephrine w/ dm-gg liqd 2.5-5-75 mg/5ml QL (30 mL / 1 day), OTC

phenylephrine w/ dm-gg liqd 2.5-5-100 mg/5ml QL (30 mL / 1 day), OTC

phenylephrine w/ dm-gg liqd 5-10-100 mg/5ml QL (30 mL / 1 day), OTC



phenylephrine w/ dm-gg syrup 5-10-100 mg/5ml QL (30 mL / 1 day), OTC

phenylephrine w/ dm-gg tab 10-17.5-385 mg OTC

phenylephrine w/ dm-gg tab 10-20-400 mg OTC

phenylephrine-brompheniramine-dm liquid 2.5-1-5 mg/5ml


phenylephrine-brompheniramine-dm liquid 10-4-20 mg/5ml

OTC


74


phenylephrine-chlorphen-dm liquid 5-2-10 mg/5ml QL (30 mL / 1 day), OTC

phenylephrine-chlorphen-dm liquid 10-4-15

mg/5ml


phenylephrine-guaifenesin tab 10-400 mg OTC

promethazine & phenylephrine syrup 6.25-5 mg/5ml

QL (30 mL / 1 day)

promethazine w/ codeine syrup 6.25-10 mg/5ml PA; PA Required for < 18 years of age

promethazine-dm syrup 6.25-15 mg/5ml QL (30 mL / 1 day)

promethazine-phenylephrine-codeine syrup 6.25-

5-10 mg/5ml

PA

promethazine-phenylephrine-codeine syrup 6.25-

5-10 mg/5ml

PA; PA Required for < 18

years of age

pseudoephed-bromphen-dm syrup 30-2-10

mg/5ml

pseudoephedrine w/ dm-gg liquid 30-10-100

mg/5ml

OTC

pseudoephedrine-guaifenesin tab er 12hr 60-600

mg

OTC

pseudoephedrine-guaifenesin tab er 12hr 120-

1200 mg

OTC

ROBIT CGH DM LIQ 20-200 QL (30 mL / 1 day), OTC

ROBIT CGH DM LIQ 20-200SF QL (30 mL / 1 day), OTC

ROBITUSSIN LIQ CF QL (30 mL / 1 day), OTC

SCOT-TUSSIN LIQ SENIOR QL (30 mL / 1 day), OTC

SILTUSS SINU TAB & CONGES OTC

SUPRESS DM DRO 5-50/ML QL (30 mL / 1 day), OTC

TRIAMINIC LIQ CHST/NAS QL (30 mL / 1 day), OTC

TUSNEL C SYP PA, OTC

TUSSLIN LIQ PEDIATRI QL (30 mL / 1 day), OTC

VANATAB DM TAB 5-9-198 OTC

VCKS DAYQUIL LIQ MUCUS DM QL (30 mL / 1 day), OTC

EXPECTORANTS GILTUSS EX LIQ MAX STR QL (30 mL / 1 day), OTC

guaifenesin liquid 100 mg/5ml QL (30 mL / 1 day), OTC

guaifenesin syrup 100 mg/5ml QL (30 mL / 1 day), OTC

guaifenesin tab 200 mg OTC

guaifenesin tab 400 mg OTC

guaifenesin tab er 12hr 600 mg OTC

guaifenesin tab er 12hr 1200 mg OTC

HERBAL EXPEC LIQ 150/15ML QL (30 mL / 1 day), OTC

MISC. RESPIRATORY INHALANTS HYPERSAL NEB 3.5%

sodium chloride aero soln 0.9% OTC

sodium chloride soln nebu 0.9%

sodium chloride soln nebu 3%


75




MUCOLYTICS acetylcysteine inhal soln 10%

acetylcysteine inhal soln 20%

DERMATOLOGICALS ACNE PRODUCTS

ACNE MEDICAT LOT 5% OTC

ACNE MEDICAT LOT 10% OTC

benzoyl peroxide bar 10% OTC

benzoyl peroxide cream 2.5% OTC

benzoyl peroxide cream 10% OTC

benzoyl peroxide foam 5.3%

benzoyl peroxide foam 5.3% OTC

benzoyl peroxide foam 9.8%

benzoyl peroxide gel 2.5% OTC

benzoyl peroxide gel 5% OTC

benzoyl peroxide gel 10% OTC

benzoyl peroxide liq 2.5% OTC

benzoyl peroxide liq 5% OTC

benzoyl peroxide liq 7%



CLEAR PORE LIQ 3.5% OTC

clindamycin phosph-benzoyl peroxide (refrig) gel 1.2 (1)-5%

clindamycin phosphate gel 1%

clindamycin phosphate lotion 1% (generic of CLEOCIN-T)

clindamycin phosphate soln 1%

clindamycin phosphate swab 1%

erythromycin soln 2%

isotretinoin cap 10 mg




RETIN-A CRE 0.1% PA; PA Required for > 26 years of age



RETIN-A GEL 0.01% PA; PA Required for > 26 years of age


76


RETIN-A GEL 0.025% PA; PA Required for > 26

years of age

ANTI-INFLAMMATORY AGENTS - TOPICAL diclofenac sodium gel 1% QL (200 gm / 30 days)

diclofenac sodium gel 1% QL (200 gm / 30 days), OTC

ANTIBIOTICS - TOPICAL bacitracin oint 500 unit/gm OTC

bacitracin zinc oint 500 unit/gm OTC

*bacitracin-polymyxin b oint*** OTC

gentamicin sulfate cream 0.1%

gentamicin sulfate oint 0.1%

mupirocin calcium cream 2%

mupirocin oint 2%

*neomycin-bacitracin-polymyxin oint*** OTC

*neomycin-bacitracin-polymyxin w/ lidocaine oint 4%***

OTC

neomycin-bacitracin-polymyxin-pramoxine oint 1% OTC

neomycin-polymyxin w/ pramoxine cream 1% OTC

ANTIFUNGALS - TOPICAL ALOE VESTA OIN 2% OTC

ALOE VESTA OIN CLEAR 2% OTC

butenafine hcl cream 1% OTC

ciclopirox olamine cream 0.77% (base equiv) (generic of LOPROX)

ciclopirox solution 8%

clotrimazole cream 1%

clotrimazole cream 1% OTC

clotrimazole soln 1% OTC

clotrimazole w/ betamethasone cream 1-0.05%

ketoconazole cream 2%

ketoconazole shampoo 2%

miconazole nitrate cream 2% OTC

miconazole nitrate powder 2% OTC

nystatin cream 100000 unit/gm

nystatin oint 100000 unit/gm

nystatin topical powder 100000 unit/gm

terbinafine hcl cream 1% OTC

tolnaftate aerosol pow 1% OTC

tolnaftate cream 1% OTC

tolnaftate powder 1% OTC

tolnaftate soln 1% OTC

ANTIHISTAMINES-TOPICAL diphenhydramine hcl gel 2% OTC

diphenhydramine hcl soln 2% OTC

ITCH RELIEF CRE 2% OTC


77


ANTINEOPLASTIC OR PREMALIGNANT LESION AGENTS - TOPICAL FLUOROPLEX CRE 1%

fluorouracil cream 5% (generic of EFUDEX)

ANTIPSORIATICS calcipotriene cream 0.005% (generic of DOVONEX)

calcipotriene oint 0.005%

calcipotriene soln 0.005% (50 mcg/ml)

CALCITRIOL OIN 3MCG/GM

ILUMYA SOL 100MG/ML PA; Bill as Medical Claim Only

ANTISEBORRHEIC PRODUCTS selenium sulfide lotion 1% OTC

selenium sulfide lotion 2.5%

selenium sulfide shampoo 2.25%

ANTIVIRALS - TOPICAL ABREVA CRE 10% OTC

docosanol cream 10% OTC

ZOVIRAX CRE 5%

ZOVIRAX OIN 5%

BURN PRODUCTS silver sulfadiazine cream 1% (generic of

SILVADENE)

CORTICOSTEROIDS - TOPICAL ADV ALLERGY KIT COLLECTI

AMCINONIDE OIN 0.1%

betamethasone dipropionate augmented cream

0.05%

betamethasone dipropionate cream 0.05%

betamethasone dipropionate lotion 0.05%

betamethasone valerate cream 0.1% (base equivalent)

betamethasone valerate lotion 0.1% (base equivalent)

betamethasone valerate oint 0.1% (base equivalent)

clobetasol propionate cream 0.05% (generic of TEMOVATE)

QL (100 gm / 30 days)

clobetasol propionate emollient base cream 0.05% QL (100 gm / 30 days)

clobetasol propionate gel 0.05% QL (118 gm / 30 days)

clobetasol propionate oint 0.05% (generic of

TEMOVATE)

QL (60 gm / 30 days)

clobetasol propionate shampoo 0.05% (generic of CLOBEX)

clobetasol propionate soln 0.05% QL (100 gm / 30 days)

DERMA-SMOOTH OIL /FS BODY


78


DERMA-SMOOTH OIL /FS SCLP

fluocinonide cream 0.1% (generic of VANOS)

fluocinonide cream 0.05%

fluocinonide oint 0.05%

fluocinonide soln 0.05%

fluticasone propionate cream 0.05%

fluticasone propionate oint 0.005%

halobetasol propionate cream 0.05% QL (100 gm / 30 days)

halobetasol propionate oint 0.05% QL (100 gm / 30 days)

HC/ALOE CRE 0.5% OTC

HYDROCORT OIN 1% OTC

hydrocortisone acetate cream 1% OTC

hydrocortisone cream 0.5% OTC

hydrocortisone cream 1%

hydrocortisone cream 1% OTC

hydrocortisone cream 2.5%

hydrocortisone gel 1% OTC

hydrocortisone lotion 1% OTC

hydrocortisone lotion 2.5%

hydrocortisone oint 0.5% OTC

hydrocortisone oint 1%

hydrocortisone oint 1% OTC

hydrocortisone oint 2.5%

hydrocortisone-aloe vera cream 1% OTC

mometasone furoate cream 0.1%

mometasone furoate oint 0.1%

mometasone furoate solution 0.1% (lotion)

triamcinolone acetonide cream 0.1%



triamcinolone acetonide lotion 0.1%

triamcinolone acetonide lotion 0.025%

triamcinolone acetonide oint 0.1%




EMOLLIENT/KERATOLYTIC AGENTS urea cream 10% QL (85 gm / 30 days), OTC

urea cream 20% QL (85 gm / 30 days), OTC

urea gel 45%

urea lotion 10% OTC

urea lotion 25% OTC

urea lotion 40%

EMOLLIENTS AQUAPHILIC OIN OTC


79


AQUAPHOR ADV OIN HEALING OTC

AQUAPHOR ADV OIN THER BAB OTC

AQUAPHOR OIN OTC

AQUAPHOR OIN ADVANCED OTC

BAG BALM OIN OTC

BOUDREAUXS OIN BABY BUT OTC

CERAVE OIN HEALING OTC

*emollient - ointment** OTC

GOLD BOND OIN HEALING OTC

lactic acid (ammonium lactate) cream 12%

lactic acid (ammonium lactate) cream 12% OTC

lactic acid (ammonium lactate) lotion 12%

lactic acid (ammonium lactate) lotion 12% OTC

LACTIC ACID LOT 10%

LANAPHILIC OIN OTC

OINTMENT OIN BASE OTC

RA HYDRATING OIN HEALING OTC

VANICREAM OIN OTC

IMMUNOMODULATING AGENTS - TOPICAL imiquimod cream 5% (generic of ALDARA)

IMMUNOSUPPRESSIVE AGENTS - TOPICAL pimecrolimus cream 1% (generic of ELIDEL) PA, QL (30 gm / 30 days)

tacrolimus oint 0.1% (generic of PROTOPIC) PA, QL (30 gm / 30 days)

tacrolimus oint 0.03% (generic of PROTOPIC) PA, QL (30 gm / 30 days)

KERATOLYTIC/ANTIMITOTIC AGENTS CORN/CALLUS LIQ 12.6% OTC

DERMAREST GEL 3% OTC

DUOFILM SOL 17% OTC

GOLD BOND CRE PSORIASI OTC

KERALYT GEL 3% OTC

KERALYT KIT SCALP 6% PA

MG217 PSORIA CRE 3% OTC

podofilox soln 0.5%

salicylic acid cream 2% OTC

*salicylic acid cream 6% & cleanser liqd kit** PA

salicylic acid film forming liquid 27.5%

salicylic acid foam 6%

salicylic acid gel 2% OTC

salicylic acid gel 6%

salicylic acid gel 17% OTC

salicylic acid liquid 2% OTC



salicylic acid pad 2% OTC


80


salicylic acid pad 40% OTC

salicylic acid shampoo 6%

salicylic acid strip 40% OTC

LOCAL ANESTHETICS - TOPICAL LIDAFLEX PAD 4% OTC

lidocaine cream 4% OTC

lidocaine hcl cream 4% QL (278 gm / 30 days), OTC

lidocaine hcl gel 2% QL (2 gm / 1 day)

lidocaine hcl gel 2% QL (2 mL / 1 day), OTC

lidocaine hcl lotion 3% PA

lidocaine hcl soln 4%

lidocaine hcl urethral/mucosal gel prefilled syringe

2%

QL (2 injections / 1 day)

lidocaine oint 5% ST, QL (50 gm / 30 days)

lidocaine patch 4% OTC

lidocaine patch 5% (generic of LIDODERM) ST, QL (2 patches / 1 day)

lidocaine-prilocaine cream 2.5-2.5% QL (30 gm / 30 days)

MISC. TOPICAL DRYSOL SOL 20%

ROSACEA AGENTS metronidazole cream 0.75% (generic of

METROCREAM)

metronidazole gel 0.75%

metronidazole lotion 0.75% (generic of METROLOTION)

SCABICIDES & PEDICULICIDES IVERMECTIN LOT 0.5% PA, OTC

LICEMD GEL 0.33-4% OTC

malathion lotion 0.5%

NATROBA SUS 0.9% PA

*nit remover - gel*** OTC

permethrin aerosol 0.5% OTC

permethrin cream 5%

permethrin creme rinse 1% OTC

permethrin lotion 1% OTC

pyreth-piperonyl butox sham-permeth aero-nit remover gel kit

OTC

pyrethrins-piperonyl butoxide liq 0.3-3% OTC

pyrethrins-piperonyl butoxide liq 0.33-4% OTC

pyrethrins-piperonyl butoxide shampoo 0.33-4% OTC

VANALICE GEL 0.3-3.5% OTC

TAR PRODUCTS BETATAR GEL SHA 2.5% OTC

coal tar oint 2% OTC

coal tar shampoo 0.5% OTC


81


coal tar shampoo 1% OTC

PSORIASIN OIN DEEP MOI OTC

DIAGNOSTIC PRODUCTS DIAGNOSTIC TESTS

ACCU-CHEK TES AVIVA PL QL (500 strips / 90 days), OTC

ACCU-CHEK TES GUIDE QL (500 strips / 90 days), OTC

ACCU-CHEK TES SMART QL (500 strips / 90 days), OTC

BINAXNOW COV KIT HOME TES QL (2 kits / 30 days), OTC

CHEMSTRIP K TES OTC

ELLUME COV19 KIT HOME TES QL (2 kits / 30 days), OTC

FLOWFLEX KIT TEST QL (2 kits / 30 days), OTC

INTELISWAB KIT COVID-19 QL (2 kits / 30 days), OTC

KETONE TES OTC

KETONE TEST TES OTC

KETOSTIX TES STRIP OTC

ON/GO COVID KIT ANTIGEN QL (2 kits / 30 days), OTC

OTC ANTIGENT KIT 1-PACK QL (2 kits / 30 days), OTC

OTC ANTIGENT KIT 2-PACK QL (2 kits / 30 days), OTC

QUICKVUE HOM KIT COVID-19 QL (2 kits / 30 days), OTC

RELION TES KETONE OTC

DIGESTIVE AIDS DIGESTIVE ENZYMES

CREON CAP 3000UNIT QL (500 caps / 30 days)

CREON CAP 6000UNIT QL (500 caps / 30 days)

CREON CAP 12000UNT QL (500 caps / 30 days)



SUCRAID SOL 8500/ML PA

ZENPEP CAP 3000UNIT QL (500 caps / 30 days)

ZENPEP CAP 5000UNIT QL (500 caps / 30 days)

ZENPEP CAP 10000UNT QL (500 caps / 30 days)



ZENPEP CAP 25000 QL (500 caps / 30 days)

ZENPEP CAP 40000 QL (500 caps / 30 days)

DIURETICS CARBONIC ANHYDRASE INHIBITORS

acetazolamide cap er 12hr 500 mg

acetazolamide tab 125 mg

acetazolamide tab 250 mg

methazolamide tab 25 mg


82


methazolamide tab 50 mg

DIURETIC COMBINATIONS amiloride & hydrochlorothiazide tab 5-50 mg

spironolactone & hydrochlorothiazide tab 25-25 mg

(generic of ALDACTAZIDE)

triamterene & hydrochlorothiazide cap 37.5-25 mg

triamterene & hydrochlorothiazide tab 37.5-25 mg (generic of MAXZIDE-25)

triamterene & hydrochlorothiazide tab 75-50 mg (generic of MAXZIDE)

LOOP DIURETICS bumetanide tab 0.5 mg (generic of BUMEX)

bumetanide tab 1 mg

bumetanide tab 2 mg

furosemide oral soln 10 mg/ml

furosemide tab 20 mg (generic of LASIX)



torsemide tab 5 mg

torsemide tab 10 mg

torsemide tab 20 mg

torsemide tab 100 mg

POTASSIUM SPARING DIURETICS amiloride hcl tab 5 mg

spironolactone tab 25 mg (generic of ALDACTONE)

spironolactone tab 50 mg (generic of ALDACTONE)

spironolactone tab 100 mg (generic of

ALDACTONE)

THIAZIDES AND THIAZIDE-LIKE DIURETICS chlorthalidone tab 25 mg

chlorthalidone tab 50 mg

DIURIL SUS 250/5ML

hydrochlorothiazide cap 12.5 mg

hydrochlorothiazide tab 25 mg

hydrochlorothiazide tab 50 mg

indapamide tab 1.25 mg

indapamide tab 2.5 mg

metolazone tab 2.5 mg

metolazone tab 5 mg

metolazone tab 10 mg

ENDOCRINE AND METABOLIC AGENTS - MISC. BONE DENSITY REGULATORS

alendronate sodium oral soln 70 mg/75ml

alendronate sodium tab 10 mg


83


alendronate sodium tab 35 mg

alendronate sodium tab 70 mg (generic of

FOSAMAX)

BONIVA INJ 3MG/3ML PA; Bill as Medical Claim Only

calcitonin (salmon) nasal soln 200 unit/act (generic of MIACALCIN)

FORTEO INJ 620/2.48 PA

ibandronate sodium iv soln 3 mg/3ml (base equivalent)


ibandronate sodium tab 150 mg (base equivalent) (generic of BONIVA)

MIACALCIN INJ 200/ML

PAMIDRONATE INJ 30MG PA; Bill as Medical Claim

Only

PAMIDRONATE INJ 90MG PA; Bill as Medical Claim

Only

PROLIA SOL 60MG/ML PA; Bill as Medical Claim

Only

RECLAST INJ 5/100ML PA; Bill as Medical Claim

Only

XGEVA INJ PA; Bill as Medical Claim

Only

zoledronic acid inj conc for iv infusion 4 mg/5ml PA; Bill as Medical Claim Only

zoledronic acid iv soln 5 mg/100ml (generic of RECLAST)


ZOLEDRONIC INJ 4/100ML PA; Bill as Medical Claim Only

ZOLEDRONIC INJ 4MG/100 PA; Bill as Medical Claim Only

GNRH/LHRH ANTAGONISTS ORILISSA TAB 150MG PA

ORILISSA TAB 200MG PA

GROWTH HORMONES GENOTROPIN INJ 0.2MG PA

GENOTROPIN INJ 0.4MG PA







GENOTROPIN INJ 1MG PA




84



NORDITROPIN INJ 5/1.5ML PA



NORDITROPIN INJ 30/3ML PA

HORMONE RECEPTOR MODULATORS raloxifene hcl tab 60 mg (generic of EVISTA)

INSULIN-LIKE GROWTH FACTORS (SOMATOMEDINS) INCRELEX INJ 40MG/4ML PA

LHRH/GNRH AGONIST ANALOG PITUITARY SUPPRESSANTS LUPR DEP-PED INJ 3M 30MG PA

LUPR DEP-PED INJ 7.5MG PA

LUPR DEP-PED INJ 11.25MG PA

LUPR DEP-PED INJ 15MG PA

TRIPTODUR SUS 22.5MG PA; Bill as Medical Claim Only

METABOLIC MODIFIERS ALDURAZYME INJ 2.9MG/5M PA; Bill as Medical Claim

Only

BRINEURA KIT 150/5ML PA; Bill as Medical Claim

Only

calcitriol cap 0.5 mcg (generic of ROCALTROL) QL (1 cap / 1 day)

calcitriol cap 0.25 mcg (generic of ROCALTROL) QL (1 cap / 1 day)

calcitriol oral soln 1 mcg/ml (generic of ROCALTROL)

cinacalcet hcl tab 30 mg (base equiv) (generic of SENSIPAR)

PA


PA


PA

CRYSVITA INJ 10MG/ML PA; Bill as Medical Claim

Only


Only


Only

doxercalciferol cap 0.5 mcg

doxercalciferol cap 1 mcg

doxercalciferol cap 2.5 mcg

ELAPRASE INJ 6MG/3ML PA; Bill as Medical Claim Only

FABRAZYME INJ 5MG PA; Bill as Medical Claim Only

FABRAZYME INJ 35MG PA; Bill as Medical Claim

Only


85


KANUMA INJ 20/10ML PA; Bill as Medical Claim

Only

levocarnitine oral soln 1 gm/10ml (10%) (generic

of CARNITOR)

levocarnitine tab 330 mg (generic of CARNITOR)

LUMIZYME INJ 50MG PA; Bill as Medical Claim Only

MEPSEVII INJ 10MG/5ML PA; Bill as Medical Claim Only

MYALEPT INJ 11.3MG PA

NAGLAZYME INJ 1MG/ML PA; Bill as Medical Claim Only

PALYNZIQ INJ 2.5/0.5 PA; Bill as Medical Claim Only

PALYNZIQ INJ 10/0.5ML PA; Bill as Medical Claim Only

PALYNZIQ INJ 20MG/ML PA; Bill as Medical Claim

Only

REVCOVI INJ 1.6MG/ML PA; Bill as Medical Claim

Only

MINERALOCORTICOID RECEPTOR ANTAGONISTS KERENDIA TAB 10MG PA

KERENDIA TAB 20MG PA

POSTERIOR PITUITARY HORMONES desmopressin acetate nasal spray soln 0.01%

desmopressin acetate nasal spray soln 0.01%

(refrigerated)

desmopressin acetate tab 0.1 mg (generic of

DDAVP)

desmopressin acetate tab 0.2 mg (generic of

DDAVP)

DESMOPRESSIN SOL 1.5MG/ML PA

STIMATE SOL 1.5MG/ML PA

PROLACTIN INHIBITORS cabergoline tab 0.5 mg

SOMATOSTATIC AGENTS octreotide acetate inj 50 mcg/ml (0.05 mg/ml)

(generic of SANDOSTATIN)

octreotide acetate inj 100 mcg/ml (0.1 mg/ml)

(generic of SANDOSTATIN)

octreotide acetate inj 200 mcg/ml (0.2 mg/ml)

octreotide acetate inj 500 mcg/ml (0.5 mg/ml) (generic of SANDOSTATIN)

octreotide acetate inj 1000 mcg/ml (1 mg/ml) PA

OCTREOTIDE INJ 50MCG/ML

OCTREOTIDE INJ 100MCG


86


OCTREOTIDE INJ 500MCG

SANDOSTATIN INJ 50MCG/ML PA; Bill as Medical Claim

Only

SANDOSTATIN INJ 100MCG PA; Bill as Medical Claim Only

SANDOSTATIN INJ 500MCG PA; Bill as Medical Claim Only

SIGNIFOR INJ 0.3MG/ML PA, QL (2 ampules / 1 day)



ESTROGENS ESTROGEN COMBINATIONS

CLIMARA PRO DIS WEEKLY

estradiol & norethindrone acetate tab 0.5-0.1 mg

estradiol & norethindrone acetate tab 1-0.5 mg

estradiol & norethindrone acetate tab 1-0.5 mg (generic of ACTIVELLA)

norethindrone acetate-ethinyl estradiol tab 0.5 mg-2.5 mcg (generic of FEMHRT)

norethindrone acetate-ethinyl estradiol tab 1 mg-5

mcg

PREFEST TAB

PREMPRO TAB

PREMPRO TAB 0.3-1.5

PREMPRO TAB 0.45-1.5

PREMPRO TAB 0.625-5

ESTROGENS ALORA DIS 0.1MG

ALORA DIS 0.05MG

ALORA DIS 0.025MG

ALORA DIS 0.075MG

estradiol tab 0.5 mg (generic of ESTRACE)

estradiol tab 1 mg (generic of ESTRACE)

estradiol tab 2 mg (generic of ESTRACE)

estradiol td patch twice weekly 0.1 mg/24hr

estradiol td patch twice weekly 0.1 mg/24hr (generic of MINIVELLE)



(generic of MINIVELLE)






87




(generic of MINIVELLE)

estradiol td patch weekly 0.1 mg/24hr (generic of CLIMARA)





estradiol td patch weekly 0.0375 mg/24hr (37.5 mcg/24hr) (generic of CLIMARA)

MENEST TAB 0.3MG

MENEST TAB 0.625MG

MENEST TAB 1.25MG

MENOSTAR DIS 14MCG

MINIVELLE DIS 0.1MG

MINIVELLE DIS 0.05MG



PREMARIN TAB 0.3MG

PREMARIN TAB 0.9MG

PREMARIN TAB 0.45MG

PREMARIN TAB 0.625MG

PREMARIN TAB 1.25MG

VIVELLE-DOT DIS 0.1MG




FLUOROQUINOLONES FLUOROQUINOLONES

ciprofloxacin hcl tab 250 mg (base equiv) (generic of CIPRO)

ciprofloxacin hcl tab 500 mg (base equiv) (generic of CIPRO)

ciprofloxacin hcl tab 750 mg (base equiv)

levofloxacin oral soln 25 mg/ml

levofloxacin tab 250 mg (generic of LEVAQUIN)

levofloxacin tab 500 mg

levofloxacin tab 750 mg (generic of LEVAQUIN)

ofloxacin tab 400 mg


88


GASTROINTESTINAL AGENTS - MISC. ANTIFLATULENTS

simethicone cap 125 mg OTC

simethicone cap 180 mg OTC

simethicone chew tab 80 mg OTC

simethicone chew tab 125 mg OTC

simethicone liquid 40 mg/0.6ml OTC

simethicone susp 40 mg/0.6ml OTC

GALLSTONE SOLUBILIZING AGENTS ursodiol cap 300 mg

ursodiol tab 250 mg (generic of URSO 250)

ursodiol tab 500 mg (generic of URSO FORTE)

GASTROINTESTINAL ANTIALLERGY AGENTS cromolyn sodium oral conc 100 mg/5ml (generic of

GASTROCROM)

GASTROINTESTINAL CHLORIDE CHANNEL ACTIVATORS LUBIPROSTONE CAP 8MCG QL (2 caps / 1 day)

LUBIPROSTONE CAP 24MCG QL (2 caps / 1 day)

GASTROINTESTINAL STIMULANTS METOCLOPRAMI TAB 10MG ODT

metoclopramide hcl soln 5 mg/5ml (10 mg/10ml)

(base equiv)

metoclopramide hcl tab 5 mg (base equivalent)

(generic of REGLAN)

metoclopramide hcl tab 10 mg (base equivalent)

(generic of REGLAN)

INFLAMMATORY BOWEL AGENTS APRISO CAP 0.375GM

ASACOL HD TAB 800MG QL (6 tabs / 1 day)

AVSOLA INJ 100MG PA; Bill as Medical Claim

Only

CANASA SUP 1000MG

DELZICOL CAP 400MG

ENTYVIO INJ 300MG PA; Bill as Medical Claim Only

LIALDA TAB 1.2GM

PENTASA CAP 250MG CR

PENTASA CAP 500MG CR

REMICADE INJ 100MG PA; Bill as Medical Claim Only

RENFLEXIS INJ 100MG PA; Bill as Medical Claim Only

SFROWASA ENE 4GM

STELARA INJ 5MG/ML PA; Bill as Medical Claim

Only


89


sulfasalazine tab 500 mg (generic of AZULFIDINE)

sulfasalazine tab delayed release 500 mg (generic

of AZULFIDINE EN-TABS)

INTESTINAL ACIDIFIERS lactulose (encephalopathy) solution 10 gm/15ml

IRRITABLE BOWEL SYNDROME (IBS) AGENTS LINZESS CAP 72MCG PA

LINZESS CAP 145MCG PA

LINZESS CAP 290MCG PA

PHOSPHATE BINDER AGENTS calcium acetate (phosphate binder) cap 667 mg

(169 mg ca) (generic of PHOSLO)

calcium acetate (phosphate binder) tab 667 mg

calcium acetate (phosphate binder) tab 667 mg OTC

sevelamer carbonate tab 800 mg (generic of RENVELA)

GENITOURINARY AGENTS - MISCELLANEOUS ALKALINIZERS

potassium citrate & citric acid soln 1100-334 mg/5ml

potassium citrate & citric acid soln 1100-334 mg/5ml

OTC

potassium citrate tab er 5 meq (540 mg) (generic of UROCIT-K 5)



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

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

INTERSTITIAL CYSTITIS AGENTS ELMIRON CAP 100MG PA

PROSTATIC HYPERTROPHY AGENTS alfuzosin hcl tab er 24hr 10 mg (generic of

UROXATRAL)

dutasteride cap 0.5 mg (generic of AVODART)

finasteride tab 5 mg (generic of PROSCAR)

tamsulosin hcl cap 0.4 mg (generic of FLOMAX)

URINARY ANALGESICS phenazopyridine hcl tab 95 mg OTC

phenazopyridine hcl tab 97.5 mg OTC

phenazopyridine hcl tab 100 mg

phenazopyridine hcl tab 200 mg

UTI RELIEF TAB 97.2MG OTC


90


GOUT AGENTS GOUT AGENT COMBINATIONS

colchicine w/ probenecid tab 0.5-500 mg

GOUT AGENTS allopurinol tab 100 mg (generic of ZYLOPRIM)

allopurinol tab 300 mg (generic of ZYLOPRIM)

colchicine tab 0.6 mg (generic of COLCRYS)

febuxostat tab 40 mg (generic of ULORIC) PA

febuxostat tab 80 mg (generic of ULORIC) PA

URICOSURICS probenecid tab 500 mg

HEMATOLOGICAL AGENTS - MISC. ANTIHEMOPHILIC PRODUCTS

ADVATE INJ 250UNIT

ADVATE INJ 500UNIT

ADVATE INJ 1000UNIT

ADVATE INJ 1500UNIT

ADVATE INJ 2000UNIT

ADVATE INJ 3000UNIT

ADVATE INJ 4000UNIT

ADYNOVATE INJ 250UNIT PA







AFSTYLA KIT 250UNIT PA







ALPHANATE INJ 250 UNIT

ALPHANATE INJ 500 UNIT

ALPHANATE INJ 1000UNIT



ALPHANINE SD INJ 500UNIT



ALPROLIX INJ 250UNIT PA



91






BENEFIX INJ 250UNIT

BENEFIX INJ 500UNIT

BENEFIX INJ 1000UNIT



CORIFACT KIT

ELOCTATE INJ 250UNIT







ELOCTATE INJ 4000UNIT PA



FEIBA INJ

FIBRYGA INJ 1GM PA; Bill as Medical Claim

Only

HEMLIBRA INJ 30MG/ML PA

HEMLIBRA INJ 60/0.4 PA

HEMLIBRA INJ 105/0.7 PA

HEMLIBRA INJ 150/ML PA

HEMOFIL M INJ 250UNIT




HUMATE-P SOL 250-600

HUMATE-P SOL 500-1200

HUMATE-P SOL 2400UNIT

IDELVION SOL 250UNIT PA




IDELVION SOL 3500UNIT

IXINITY INJ 250UNIT

IXINITY INJ 500UNIT

IXINITY INJ 1000UNIT





92


JIVI INJ 500 UNIT PA

JIVI INJ 1000UNIT PA



KOATE INJ 250UNIT

KOATE INJ 500 UNIT

KOATE INJ 1000UNIT

KOATE-DVI INJ 500UNIT

KOATE-DVI INJ 1000UNIT

KOGENATE FS INJ 250UNIT





KOVALTRY INJ 250UNIT PA





NOVOEIGHT INJ 250UNIT






NOVOSEVEN RT INJ 1MG




NUWIQ INJ 250UNIT

NUWIQ INJ 500UNIT

NUWIQ INJ 1000UNIT

NUWIQ INJ 2000UNIT

NUWIQ KIT 250UNIT

NUWIQ KIT 500UNIT

NUWIQ KIT 1000UNIT

NUWIQ KIT 2000UNIT

NUWIQ KIT 2500UNIT

NUWIQ KIT 3000UNIT

NUWIQ KIT 4000UNIT

OBIZUR INJ 500 UNIT

PROFILNINE INJ 500UNIT



RECOMBINATE INJ


93


RECOMBINATE INJ 220-400



RIASTAP SOL 1GM PA; Bill as Medical Claim Only

RIXUBIS INJ 250 UNIT

RIXUBIS INJ 500UNIT

RIXUBIS INJ 1000UNIT



TRETTEN INJ

VONVENDI INJ 650UNIT

VONVENDI INJ 1300UNIT

WILATE INJ

XYNTHA INJ 250UNIT

XYNTHA INJ 500UNIT

XYNTHA INJ 1000UNIT

XYNTHA INJ 2000UNIT

XYNTHA SOLOF INJ 500UNIT




XYNTHA SOLOF KIT 250UNIT

COMPLEMENT INHIBITORS SOLIRIS INJ 10MG/ML PA; Bill as Medical Claim

Only

ULTOMIRIS INJ 300/30ML PA; Bill as Medical Claim Only

HEMATORHEOLOGIC AGENTS pentoxifylline tab er 400 mg

HUMAN PROTEIN C CEPROTIN INJ 500 UNIT PA

CEPROTIN INJ 1000UNIT PA

PLATELET AGGREGATION INHIBITORS anagrelide hcl cap 0.5 mg (generic of AGRYLIN)

anagrelide hcl cap 1 mg

BRILINTA TAB 60MG PA

BRILINTA TAB 90MG PA

cilostazol tab 50 mg

cilostazol tab 100 mg

clopidogrel bisulfate tab 75 mg (base equiv) (generic of PLAVIX)

clopidogrel bisulfate tab 300 mg (base equiv)

dipyridamole tab 25 mg



94



HEMATOPOIETIC AGENTS AGENTS FOR GAUCHER DISEASE

CERDELGA CAP 84MG PA

CEREZYME INJ 400UNIT PA; Bill as Medical Claim Only

ELELYSO INJ 200UNIT PA; Bill as Medical Claim Only

miglustat cap 100 mg (generic of ZAVESCA) PA

VPRIV INJ 400UNIT PA; Bill as Medical Claim Only

COBALAMINS B-12 TAB 2000MCG OTC

B-12 TAB 2500MCG OTC

cyanocobalamin inj 1000 mcg/ml

cyanocobalamin tab 50 mcg OTC





cyanocobalamin tab er 1000 mcg OTC

FOLIC ACID/FOLATES folic acid cap 0.8 mg OTC

folic acid tab 1 mg

folic acid tab 1 mg OTC

folic acid tab 400 mcg OTC

folic acid tab 800 mcg OTC

HEMATOPOIETIC GROWTH FACTORS FULPHILA INJ 6/0.6ML PA; Bill as Medical Claim

Only

NEULASTA KIT 6MG/0.6M PA; Bill as Medical Claim

Only

NEUPOGEN INJ 300/0.5 PA

NEUPOGEN INJ 300MCG PA

NEUPOGEN INJ 480/0.8 PA

NEUPOGEN INJ 480MCG PA

NIVESTYM INJ 300/0.5 Bill as Medical Claim Only

NIVESTYM INJ 480/0.8 Bill as Medical Claim Only

NPLATE INJ 125MCG PA; Bill as Medical Claim Only



NYVEPRIA INJ 6/0.6ML Bill as Medical Claim Only


95


PROMACTA TAB 12.5MG PA

PROMACTA TAB 25MG PA



RETACRIT INJ 2000UNIT PA



RETACRIT INJ 10000UNT PA

RETACRIT INJ 20000UNI PA

RETACRIT INJ 40000UNT PA

UDENYCA INJ 6MG/.6ML PA; Bill as Medical Claim Only

HEMATOPOIETIC MIXTURES *fe fum-iron polysacch complex-fa-b cmplx-c-zn-

mn-cu cap***

fe fumarate-vit c-vit b12-fa cap 460 (151 fe)-60-

0.01-1 mg

fe fumarate-vit c-vit b12-fa cap 460 (151 fe)-60-

0.01-1 mg

OTC

folic acid-vitamin b6-vitamin b12 tab 0.8-10-0.115

mg

OTC

folic acid-vitamin b6-vitamin b12 tab 2.2-25-0.5 mg

folic acid-vitamin b6-vitamin b12 tab 2.2-25-1 mg

folic acid-vitamin b6-vitamin b12 tab 2.5-25-1 mg

FOLITAB 500 TAB OTC

iron polysacch complex-vit b12-fa cap 150-0.025-1

mg

iron-vit c-vit b12-folic acid tab 100-250-0.025-1

mg

OTC

IRON FEOSOL TAB 200MG OTC

FER-IN-SOL DRO 15MG/ML OTC

FERAHEME INJ 510/17ML PA; Bill as Medical Claim

Only

FERRLECIT INJ 12.5MG/M PA; Bill as Medical Claim Only

ferrous gluconate tab 240 mg (27 mg elemental fe)

OTC

ferrous gluconate tab 324 mg (37.5 mg elemental iron)

OTC

ferrous sulfate dried tab 200 mg (65 mg elemental fe)

OTC

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

OTC


96


ferrous sulfate soln 75 mg/ml (15 mg/ml

elemental fe)

OTC

ferrous sulfate tab 27 mg (elemental fe) OTC

ferrous sulfate tab 325 mg (65 mg elemental fe) OTC

ferrous sulfate tab ec 325 mg (65 mg fe equivalent)

OTC

ferrous sulfate tab er 50 mg (elemental fe) OTC

ferrous sulfate tab er 142 mg (45 mg fe equivalent)

OTC

ferrous sulfate tab er 143 mg (45 mg fe

equivalent)

OTC

INFED INJ 50MG/ML PA; Bill as Medical Claim

Only

INJECTAFER INJ 750/15ML PA; Bill as Medical Claim

Only

SLOW FE TAB 45MG OTC

SLOW RELEASE TAB 47.5MG OTC

sod ferric gluc cmplx in sucrose iv soln 12.5 mg/ml (fe eq) (generic of FERRLECIT)


VENOFER INJ 20MG/ML PA; Bill as Medical Claim Only

HEMOSTATICS HEMOSTATICS - SYSTEMIC

aminocaproic acid tab 500 mg (generic of AMICAR)

aminocaproic acid tab 1000 mg (generic of AMICAR)

tranexamic acid tab 650 mg (generic of LYSTEDA)

HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS ANTIHISTAMINE HYPNOTICS

diphenhydramine hcl (sleep) cap 25 mg OTC

diphenhydramine hcl (sleep) cap 50 mg OTC

diphenhydramine hcl (sleep) liquid 50 mg/30ml OTC

diphenhydramine hcl (sleep) tab 25 mg OTC

diphenhydramine hcl (sleep) tab 50 mg OTC

diphenhydramine hcl (sleep) tab disint 25 mg OTC

doxylamine succinate (sleep) tab 25 mg OTC

BARBITURATE HYPNOTICS phenobarbital elixir 20 mg/5ml

phenobarbital tab 15 mg

phenobarbital tab 16.2 mg







97



NON-BARBITURATE HYPNOTICS eszopiclone tab 1 mg (generic of LUNESTA) PA, QL (1 tab / 1 day); PA


age; PA Required for > 1 Hypnotic Drug

eszopiclone tab 2 mg (generic of LUNESTA) PA, QL (1 tab / 1 day); PA Required for < 6 years of


eszopiclone tab 3 mg (generic of LUNESTA) PA, QL (1 tab / 1 day); PA Required for < 6 years of


temazepam cap 15 mg (generic of RESTORIL) PA, QL (1 cap / 1 day); PA Required for < 6 years of age; PA Required for > 1

Hypnotic Drug

temazepam cap 30 mg (generic of RESTORIL) PA, QL (1 cap / 1 day); PA Required for < 6 years of age; PA Required for > 1

Hypnotic Drug

zolpidem tartrate tab 5 mg (generic of AMBIEN) PA, QL (2 tabs / 1 day); PA


Hypnotic Drug

zolpidem tartrate tab 10 mg (generic of AMBIEN) PA, QL (1 tab / 1 day); PA


Hypnotic Drug

ZOLPIMIST SPR 5MG PA; PA Required for < 6

years of age; PA Required for > 1 Hypnotic Drug

SELECTIVE MELATONIN RECEPTOR AGONISTS ROZEREM TAB 8MG PA, QL (1 tab / 1 day); PA


LAXATIVES BULK LAXATIVES

HYDROCIL INS POW 95% OTC

KONSYL DAILY POW 100% OTC

KONSYL POW 60.3% OTC

KONSYL POW 71.67% OTC

KONSYL-D POW 52.3% OTC

METAMUCIL POW 58.12% OTC

METAMUCIL WAF OTC

NAT FIBER POW 58.6% OTC


98


psyllium cap 0.52 gm OTC

psyllium powder 28.3% OTC



psyllium powder 49% OTC





LAXATIVE COMBINATIONS peg 3350-kcl-na bicarb-nacl-na sulfate for soln

236 gm (generic of GOLYTELY)

peg 3350-kcl-nacl-na sulfate-na ascorbate-c for soln 100 gm (generic of MOVIPREP)

peg 3350-kcl-sod bicarb-nacl for soln 420 gm

(generic of NULYTELY)

sennosides-docusate sodium tab 8.6-50 mg OTC

LAXATIVES - MISCELLANEOUS GLYCERIN SUP 2GM OTC

glycerin suppos 1 gm OTC

glycerin suppos 1.2 gm OTC

glycerin suppos 2 gm OTC

glycerin suppos 2.1 gm OTC

glycerin suppos 80.7% OTC

lactulose solution 10 gm/15ml

PEDIA-LAX SUP 1GM OTC

PEDIA-LAX SUP 2.8GM OTC

polyethylene glycol 3350 oral packet 17 gm OTC

polyethylene glycol 3350 oral powder 17 gm/scoop OTC

SALINE LAXATIVES magnesium citrate soln OTC

magnesium hydroxide susp 400 mg/5ml OTC

magnesium sulfate oral granules OTC

OSMOPREP TAB 1.5GM

*sodium phosphates - enema (pediatric)*** OTC

*sodium phosphates - enema*** OTC

STIMULANT LAXATIVES bisacodyl suppos 10 mg OTC

bisacodyl tab delayed release 5 mg OTC

sennosides cap 8.6 mg OTC

sennosides chew tab 15 mg OTC

sennosides syrup 8.8 mg/5ml OTC

sennosides tab 8.6 mg OTC

sennosides tab 15 mg OTC

sennosides tab 17.2 mg OTC


99


sennosides tab 25 mg OTC

SURFACTANT LAXATIVES docusate calcium cap 240 mg OTC

docusate sodium cap 50 mg OTC



docusate sodium enema 283 mg/5ml OTC

docusate sodium liquid 150 mg/15ml OTC

docusate sodium syrup 60 mg/15ml OTC

docusate sodium tab 100 mg OTC

MACROLIDES AZITHROMYCIN

azithromycin for susp 100 mg/5ml (generic of ZITHROMAX)

azithromycin for susp 200 mg/5ml (generic of ZITHROMAX)

azithromycin tab 250 mg (generic of ZITHROMAX)

azithromycin tab 500 mg (generic of ZITHROMAX)

azithromycin tab 600 mg

ZITHROMAX POW 1GM PAK

CLARITHROMYCIN clarithromycin tab 250 mg

clarithromycin tab 500 mg

clarithromycin tab er 24hr 500 mg (generic of BIAXIN XL)

ERYTHROMYCINS erythromycin ethylsuccinate for susp 400 mg/5ml

(generic of ERYPED 400)

FIDAXOMICIN DIFICID TAB 200MG PA

MEDICAL DEVICES AND SUPPLIES CONTRACEPTIVES

AIMSCO MIS LUBRICAT OTC

CAYA DPR

COLOR CONDOM MIS + LUBE OTC

CONDOMS MIS OTC

CONDOMS MIS LUBRICAT OTC

DUREX EXTRA MIS SENSITIV OTC

FANTASY LUBR MIS OTC

FANTASY LUBR MIS COLORS OTC

FANTASY LUBR MIS SPERMICI OTC

FANTASY MIS LUBRICAT OTC

FC2 FEMALE MIS CONDOM OTC

FC FEMALE MIS CONDOM OTC


100


K-Y ME & YOU MIS EX LUBRI OTC

K-Y ME & YOU MIS INTENSE OTC

KAMELEON LUB MIS COLORS OTC

KAMELEON MIS TRI-COLR OTC

KIMONO COLOR MIS OTC

KIMONO MICRO MIS THIN OTC

KIMONO MICRO MIS THIN + OTC

KIMONO MICRO MIS THIN PLS OTC

KIMONO MIS LUBRICAT OTC

KIMONO MIS SENSATIO OTC

KIMONO PLUS MIS LUBRICAT OTC

KIMONO PLUS MIS SPERMICI OTC

KIMONO PS MIS LUBRICAT OTC

KIMONO PS MIS PLUS OTC

KIMONO SENSA MIS PLUS OTC

KIMONO SPEC MIS OTC

MAXX MIS LUBRICAT OTC

MAXX PLUS MIS SPERMICI OTC

NATURAL COND MIS + LUBE OTC

OMNIFLEX DPR

REALITY MIS LUBRICAT OTC

REALITY ULTR MIS TEXTURED OTC

REALITY ULTR MIS THIN OTC

TRUSTEX LUBR MIS ASSORTED OTC

TRUSTEX LUBR MIS BANANA OTC

TRUSTEX LUBR MIS CHOC OTC

TRUSTEX LUBR MIS COLA OTC

TRUSTEX LUBR MIS COLORS OTC

TRUSTEX LUBR MIS EX LARGE OTC

TRUSTEX LUBR MIS EX STR OTC

TRUSTEX LUBR MIS GRAPE OTC

TRUSTEX LUBR MIS MINT OTC

TRUSTEX LUBR MIS RIB/STUD OTC

TRUSTEX LUBR MIS SPERMICI OTC

TRUSTEX LUBR MIS STRWBRY OTC

TRUSTEX LUBR MIS VANILLA OTC

TRUSTEX MIS BANANA OTC

TRUSTEX MIS CHOCOLAT OTC

TRUSTEX MIS FLAVORS OTC

TRUSTEX MIS MINT OTC

TRUSTEX MIS STRWBRY OTC

TRUSTEX MIS VANILLA OTC

TRUSTEX/RIA MIS LUBRICAT OTC

TRUSTEX/RIA MIS NON-LUB OTC

TRUSTEX/RIA MIS SPERMICI OTC


101


TRUSTX NON-9 MIS RIB/STUD OTC

WIDE-SEAL DPR KIT 60








DIABETIC SUPPLIES ACCU-CHEK KIT FASTCLIX OTC

ACCU-CHEK KIT SOFTCLIX OTC

ACTI-LANCE MIS 28G OTC

ACTI-LANCE MIS LITE 28G OTC

ACTI-LANCE MIS SPEC 17G OTC

ACTI-LANCE MIS UNIV 23G OTC

ADV TRAVEL MIS LANC 28G OTC

ADVCATE SAFE MIS LANC 26G OTC

ADVOCATE MIS LANC 30G OTC

ADVOCATE MIS LANCETS OTC

AGAMATRIX MIS 33G OTC

AIMSCO TWIST MIS 32G OTC

AIMSCO TWIST MIS 33G OTC

AQUALANCE MIS 30G OTC

ASSURE CMFRT MIS 28G OTC

ASSURE LANCE MIS 21G OTC

ASSURE LANCE MIS 28G OTC

ASSURE LANCE MIS LOW FLOW OTC

ASSURE LANCE MIS MICRO OTC

ASSURE LANCE MIS SAFE 25G OTC

ASSURE LANCE MIS SAFE 30G OTC

ASSURE PLUS MIS HIGH 18G OTC

ASSURE PLUS MIS LOW 25G OTC

ASSURE PLUS MIS MCRO 28G OTC

ASSURE PLUS MIS NORM 21G OTC

ASSURE PLUS MIS PEDIATRI OTC

AURORA LANCE MIS 30G OTC

AURORA LANCE MIS THIN 23G OTC

AUTO LANCET MIS OTC

AUTOLET II KIT CLINISAF OTC

AUTOLET LITE KIT OTC

AUTOLET LITE KIT CLINISAF OTC

AUTOLET LITE KIT STARTER OTC

BD LANCET UF MIS 30G OTC

BD LANCET UF MIS 33G OTC


102


BD MICROTAIN MIS LANCETS OTC

CAREONE LANC MIS 30G OTC

CAREONE LANC MIS THIN 23G OTC

CARESENS 30G MIS LANCETS OTC

CARETOUCH MIS LANC 26G OTC



CARETOUCH MIS TWIST 28 OTC



CLEANLET 28G MIS LANCETS OTC

CLEVER CHECK MIS OTC

CLEVER CHECK MIS 30G OTC

COAGUCHEK MIS LANCETS OTC

COMFORT ASSU MIS LANC 28G OTC

COMFORT ASSU MIS LANC 33G OTC

COMFORT EZ MIS 21G OTC



COMFORT MIS LANCETS OTC

COMFORT TCH MIS LANC 30G OTC

COMFORT TCH MIS LANC 31G OTC

COMFORTOUCH MIS LANCET OTC

CVS LANCETS MIS 21G OTC



CVS LANCETS MIS ORIGINAL OTC

CVS LANCETS MIS THIN 26G OTC



DEXCOM G6 MIS RECEIVER PA, QL (1 receiver / year)

DEXCOM G6 MIS SENSOR PA, QL (3 sensors / 30 days)

DEXCOM G6 MIS TRANSMIT PA, QL (1 transmitter / 90 days)

DIATHRIVE MIS LANCETS OTC

DIATHRIVE MIS UT 30G OTC

DROPLET LANC MIS 30G OTC

DROPLET PERS MIS LANC 30G OTC

E-Z JECT MIS 21G OTC

E-Z JECT MIS 21G COLR OTC

E-Z JECT MIS 30G OTC

E-Z JECT MIS 32G COLR OTC

E-Z JECT MIS LANC 21G OTC

E-Z JECT MIS THIN 26G OTC


103


E-ZJECT LANC MIS 33G OTC

EASY COMFORT MIS 30G OTC

EASY COMFORT MIS LANC/30G OTC

EASY COMFORT MIS TWIST OTC

EASY TOUCH MIS LANC/21G OTC







EMBRACE LANC MIS 21G OTC

EMBRACE LANC MIS 28G OTC

EMBRACE LANC MIS THIN 30G OTC

EQL LANCETS MIS 21G COLR OTC

EQL LANCETS MIS 33G COLR OTC

EQL LANCETS MIS THIN 26G OTC

EQL LANCETS MIS THIN 30G OTC

EZ-LETS 21G MIS LANCETS OTC




FASTCLIX MIS LANCETS OTC

FIFTY50 SAFE MIS LANCETS OTC

FINE 30 MIS OTC

FINGERSTIX MIS LANCETS OTC

FORA LANCETS MIS 30G OTC

FORA MIS LANCETS OTC

FREESTY LIBR KIT 2 SENSOR PA, QL (2 boxes / 28 days)

FREESTY LIBR MIS 2 READER PA, QL (1 reader / year)

FREESTYLE KIT SENSOR PA, QL (2 boxes / 28 days)

FREESTYLE MIS LANCETS OTC

FREESTYLE MIS READER PA, QL (1 reader / year)

GENTEEL LANC KIT BLUE OTC

GENTEEL MIS LANCETS OTC

GENTLE-LET MIS 26G OTC

GENTLE-LET MIS 28G OTC

GENTLE-LET MIS LANCETS OTC

GLOBAL 28G MIS LANCETS OTC

GLOBAL 30G MIS LANCETS OTC

GLUCOCOM MIS 28G OTC



GNP LANCETS MIS 21G OTC



104




GNP LANCETS MIS THIN 26G OTC

GOJJI LANCET MIS 30G OTC

GOODSENSE MIS LANC 26G OTC



HAEMOLANCE MIS HIGH FLO OTC

HAEMOLANCE MIS LOW FLOW OTC

HAEMOLANCE MIS PLUS OTC

HAEMOLANCE MIS PLUS LOW OTC

HAEMOLANCE MIS PLUS MAX OTC

HAEMOLANCE MIS PLUS PED OTC

HAEMOLANCE MIS RETRACT OTC

HLTHY ACCNTS MIS LANC 30G OTC

HYPOLANCE KIT LANCING OTC

IN TOUCH LAN MIS 30G OTC

INCONTROL MIS LANC 28G OTC



KINNEY MIS LANCETS OTC

KINNEY THIN MIS LANCETS OTC

KROGER LANCE MIS OTC

KROGER LANCE MIS 26G OTC

KROGER LANCE MIS THIN OTC

KROGER LANCE MIS THIN 30G OTC

LANCET MICRO MIS THIN 33G OTC

LANCET STAND MIS 21G OTC

LANCET SUPER MIS THIN 30G OTC

LANCET ULTRA MIS 28G OTC

LANCET ULTRA MIS THIN 30G OTC

LANCETS MICR MIS THIN 33G OTC

LANCETS MIS OTC

LANCETS MIS 21G OTC

LANCETS MIS 21G COLR OTC

LANCETS MIS 26G OTC

LANCETS MIS 28G OTC

LANCETS MIS 30G OTC

LANCETS MIS 33G OTC

LANCETS MIS ORANGE OTC

LANCETS MIS ORIGINAL OTC

LANCETS MIS THIN OTC

LANCETS MIS THIN 26G OTC

LANCETS MIS THIN 30G OTC

LANCETS SUPR MIS THIN 28G OTC


105


LANCETS THIN MIS OTC

LANCETS THIN MIS 26G OTC

LANCETS ULTR MIS THIN OTC

LB LANCET MIS 28G OTC

LIFESCAN MIS UNISTIK2 OTC

LITE TOUCH MIS LANCETS OTC

LITETOUCH MIS LANCETS OTC

LONGS LANCET MIS STANDARD OTC

LONGS LANCET MIS THIN OTC

LONGS LANCET MIS ULTRA TH OTC

MEDICHOICE MIS LANCET OTC

MEDLANCE MIS 30G PLUS OTC

MEDLANCE MIS EXTR 21G OTC

MEDLANCE MIS LITE 25G OTC

MEDLANCE MIS PLUS OTC

MEDLANCE MIS PLUS 30G OTC

MEDLANCE MIS UNV 21G OTC

MEDLANCE PLS MIS 0.8MM OTC

MEDLANCE PLS MIS EXTR 21G OTC

MEDLANCE PLS MIS LITE 25G OTC

MEDLANCE PLS MIS UNIV 21G OTC

MEIJER LANCE MIS COLOR OTC

MEIJER LANCE MIS UNIV 21G OTC

MEIJER LANCE MIS UNIV 30G OTC

MEIJER LANCE MIS UNIVERSA OTC

MEIJER MIS LANCETS OTC

MICRO THIN MIS LANC 33G OTC

MICROLET MIS LANCETS OTC

MM TWIST MIS LANCETS OTC

MOBILE LANCE MIS 30G OTC

MONOLET MIS LANCETS OTC

MONOLET OPD MIS LANCETS OTC

MONOLETTOR MIS LANCETS OTC

MPD SFTY LAN MIS 21G OTC




MULTI-LANCET KIT DEVICE OTC

MYGLUCOHEALT MIS LANC 30G OTC

NOVA SAFETY MIS LANC 23G OTC

NOVA SAFETY MIS LANC 28G OTC

NOVA SURE MIS LANCETS OTC

ON-THE-GO MIS LANC 30G OTC

ONETOUCH DEL MIS PLUS 30G OTC

ONETOUCH DEL MIS PLUS 33G OTC


106


ONETOUCH FP MIS LANCETS OTC

ONETOUCH MIS 30G OTC

ONETOUCH MIS LANCETS OTC

ONETOUCH US MIS LANCETS OTC

PC LANCETS MIS 30G OTC

PENLET II KIT BLOOD OTC

PERFECT 28G MIS LANCETS OTC

PERFECT 30G MIS LANCETS OTC

PHARMACY COU MIS LANCETS OTC

PIP LANCETS MIS 28G OTC

PIP LANCETS MIS 30G OTC

PRO COMFORT MIS 31G OTC

PRO COMFORT MIS LANCETS OTC

PRODIGY MIS 26G OTC

PRODIGY MIS 28G OTC

PSS SAFE LAN MIS OTC

PSS SEL LANC MIS OTC

PURE COMFORT MIS 30G LAN OTC

PX LANCETS MIS 28G OTC

PX LANCETS MIS 33G OTC

PX LANCETS MIS ULT THIN OTC

QC LANCETS MIS 28G OTC

QC LANCETS MIS 30G OTC

RA E-ZJECT MIS 28G OTC

RA E-ZJECT MIS THIN 26G OTC

RA E-ZJECT MIS THIN 28G OTC

RA E-ZJECT MIS ULT THIN OTC

READYLANCE MIS 21G OTC





REALITY MIS LANCETS OTC

REALITY TRIG MIS LANCETS OTC

RELION KIT LANCING OTC

RELION LANCE MIS THIN 26G OTC

RELION LANCE MIS THIN 30G OTC

RELION MICRO MIS THIN 33G OTC

RELION ULTRA MIS THIN 30G OTC

RELION ULTRA MIS THIN PLS OTC

RIGHTEST MIS GL300 OTC

SAFE-T-LANCE MIS 21G OTC

SAFE-T-LANCE MIS 25G OTC

SAFE-T-LANCE MIS HI FLOW OTC

SAFE-T-LANCE MIS LOW FLOW OTC


107


SAFE-T-LANCE MIS NOR FLOW OTC

SAFE-T-PRO MIS LANCETS OTC

SAFE-T-PRO MIS PLUS OTC

SAFETY 21G MIS LANCETS OTC



SAFETY MIS LANCETS OTC

SAPS HEALTH MIS TWIST OTC

SAPS TWIST MIS 30G OTC

SAPSCARE MIS TWIST OTC

SB LANCETS MIS THIN OTC

SB LANCETS MIS ULTR THN OTC

SELECT-LITE KIT DEV/LANC OTC

SINGLE-LET MIS 23G OTC

SM LANCETS MIS 33G OTC

SMART SENSE MIS LANC 21G OTC




SMARTEST MIS LANCETS OTC

SOFTCLIX MIS LANCETS OTC

SOLUS V2 MIS LANC 28G OTC

SOLUS V2 MIS LANC 30G OTC

STERILANCE MIS TL 28G OTC



SUPER THIN MIS LANC 28G OTC

SUPER THIN MIS LANCETS OTC

SURE COMFORT MIS LANC 18G OTC




SURE COMFORT MIS LANCETS OTC

SUREFLEX MIS LANCETS OTC

SURELITE MIS LANCETS OTC

TECHLITE AST MIS LANCETS OTC

TECHLITE MIS LANC 30G OTC

TECHLITE MIS LANCETS OTC

TGT LANCET MIS 26G OTC



THIN LANCETS MIS 26G OTC

THIN LANCETS MIS 30G OTC

THINLETS GP MIS 26G OTC

TOPCARE MIS LANC 33G OTC


108


TRAVEL LANCE MIS 30G OTC

TRAVEL LANCE MIS ADV 28G OTC

TRUE COMFORT MIS LANC 30G OTC

TRUPLUS LANC MIS 26G OTC




ULTILET MIS 26G OTC

ULTILET MIS 28G OTC

ULTILET MIS 30G OTC

ULTILET MIS 33G OTC

ULTILET MIS LANCETS OTC

ULTILET MIS SAFETY OTC

ULTILET SAFE MIS 21G OTC

ULTRA THIN MIS 28G OTC




ULTRA THIN MIS LAN 31G OTC

ULTRA THIN MIS LANC 28G OTC

ULTRA THIN MIS LANC 30G OTC

ULTRA THIN MIS LANCETS OTC

UNILET CMFR MIS TCH 28G OTC

UNILET CMFR MIS TCH 30G OTC

UNILET EX II MIS 28G OTC

UNILET EXCEL MIS 23G OTC

UNILET G.P MIS SUPR 23G OTC

UNILET G.P. MIS 21G OTC

UNILET GP 28 MIS ULT THIN OTC

UNILET LANC MIS 33G OTC

UNILET LANCE MIS 21G OTC



UNILET LANCT MIS 28G OTC



UNILET MICRO MIS 33G OTC

UNILET MIS 21G OTC

UNILET SUPER MIS 23G OTC

UNILET SUPER MIS G.P. 23G OTC

UNISTIK 3 MIS GENT 30G OTC

UNISTIK II MIS LANCETS OTC

UNISTIK PRO MIS LANC 21G OTC

UNISTIK PRO MIS LANC 28G OTC

UNISTIK SAFE MIS LANC 28G OTC


109


UNISTIK SAFE MIS LANC 30G OTC

UNISTIK TOUC MIS LANC 21G OTC




UNITSTIK PRO MIS LANC 25G OTC

UNIVERSAL 1 MIS 33G OTC

UNIVERSAL 1 MIS LANC 26G OTC

UNIVERSAL 1 MIS LANC 30G OTC

VIVAGUARD MIS 30G OTC

ZEVRX TWIST MIS LANC 30G OTC

MISC. DEVICES ALCOH-GLOVE PAD CONTOURE

ALCOHOL PAD OTC

ALCOHOL PAD 70% OTC

ALCOHOL PAD PREP OTC

ALCOHOL PADS PAD 70% OTC

ALCOHOL PREP PAD OTC

ALCOHOL PREP PAD 70% OTC

ALCOHOL PREP PAD MED 70% OTC

ALCOHOL PREP PAD PADS 70% OTC

ALCOHOL SWAB PAD OTC

ALCOHOL SWAB PAD 70% OTC

ALCOHOL SWAB PAD EX-THICK OTC

BD SWAB BFLY PAD SNGL USE OTC

BD SWAB REG PAD SNGL USE OTC

CARETOUCH PAD ALCOHOL OTC

COMFRT TOUCH PAD ALC PREP OTC

CURITY PREP PAD ALCOHOL OTC

CURITY SWABS PAD ALCOHOL OTC

EASY COMFORT PAD ALCOHOL OTC

FIFTY50 PREP PAD PADS OTC

GLOBAL PREP PAD PADS OTC

GNP ALCOHOL PAD SWABS OTC

HM STERILE PAD ALCHOL OTC

INCONTROL PAD ALCOHOL OTC

PREP PADS PAD OTC

PRO COMFORT PAD ALCOHOL OTC

PURE COMFORT PAD OTC

QC ALCOHOL PAD SWABS OTC

RA ALCOHOL PAD SWABS OTC

REALITY SWAB PAD OTC

SAPS CARE PAD ALCOHOL OTC

SAPS HEALTH PAD ALCOHOL OTC

SB ALCOHOL PAD PREP OTC


110


SM ALCOHOL PAD PREP OTC

TRUE COMFORT PAD PRO OTC

ULTICARE PAD ALCOHOL OTC

ULTILET PAD ALCOHOL OTC

WEBCOL PREP PAD LARGE OTC

WEBCOL PREP PAD MEDIUM OTC

ZEVRX STERIL PAD ALCHOL OTC

PARENTERAL THERAPY SUPPLIES ABOUTTIME MIS 30GX5/16 OTC

ABOUTTIME MIS 31GX3/16 OTC



ASSURE ID MIS 1ML/31G OTC

ASSURE ID MIS 30GX3/16 OTC



AUM MINI PEN MIS 32GX4MM OTC



AUTOPEN MIS 1 UNIT QL (3 boxes / 365 days),

OTC

AUTOPEN MIS 1-21UNIT QL (3 boxes / 365 days),

OTC

AUTOPEN MIS 2 UNIT QL (3 boxes / 365 days),

OTC

AUTOPEN MIS 2-42UNIT QL (3 boxes / 365 days),

OTC

AUTOSHIELD MIS 30GX5MM OTC

BD PEN MINI MIS QL (3 boxes / 365 days), OTC

BD PEN MIS QL (3 boxes / 365 days), OTC

BD PEN NEEDL MIS 29GX12.7 OTC

BD PEN NEEDL MIS 31GX5MM OTC


BD PEN NEEDL MIS 32GX4MM


BD PEN NEEDL MIS 32GX5/32 OTC


CAREFINE MIS 31GX8MM OTC




CARETOUCH MIS 31GX5MM OTC



111





CEQUR SIMPL KIT PATCH 2U QL (3 boxes / 365 days)

CLICKFINE MIS 31GX1/4" OTC

CLICKFINE MIS 31GX3/16 OTC


CLICKFINE MIS 31GX8MM OTC


COMFORT EZ MIS 29GX12MM OTC

COMFORT EZ MIS 31GX5/16 OTC







DIATHRIVE MIS 31GX5MM OTC




EASY COMFORT MIS 31GX1/4" OTC

EASY COMFORT MIS 31GX3/16 OTC



EASY TOUCH MIS 29GX1/2" OTC


EASY TOUCH MIS 31GX3/16 OTC





EASY TOUCH MIS 32GX5MM OTC

EASY TOUCH MIS 32GX6MM OTC

FIFTY50 MIS 31GX3/16 OTC

FIFTY50 MIS 31GX5/16 OTC

FIFTY50 MIS 31GX5MM OTC

FIFTY50 PEN MIS 31GX8MM OTC



GNP ULTICARE MIS 31GX5/16 OTC

GNP ULTICARE MIS 31GX5MM OTC

GNP ULTICARE MIS 32GX1/4" OTC

GNP ULTICARE MIS 32GX5/32 OTC

HM INSULIN S MIS 0.3/31G OTC


112


HM INSULIN S MIS 1ML/30G OTC

HM ULTICARE MIS 31GX8MM OTC

IN CONTROL MIS 31GX3/16 OTC

IN CONTROL MIS 31GX5MM OTC



INCONTROL MIS 29GX12MM OTC

INPEN 100EL MIS BLUE-HUM QL (3 boxes / 365 days)

INPEN 100EL MIS GREY-HUM QL (3 boxes / 365 days)

INPEN 100EL MIS PINK HUM QL (3 boxes / 365 days)

INPEN 100NN MIS BLUE NOV QL (3 boxes / 365 days)

INPEN 100NN MIS GREY NOV QL (3 boxes / 365 days)

INPEN 100NN MIS PINK NOV QL (3 boxes / 365 days)

INS SY 0.3ML MIS 30GX1/2" OTC

INS SY 0.3ML MIS 31GX5/16 OTC

INS SY 0.5ML MIS 30GX1/2" OTC

INS SY 0.5ML MIS 30GX5/16 OTC

INS SY 1/2ML MIS 30GX1/2" OTC

INS SYR 1ML MIS 30GX1/2" OTC

INS SYR 1ML MIS 30GX5/16 OTC

INS SYR 1ML MIS 31GX5/16 OTC

INS SYR .3ML MIS 30GX1/2" OTC

INSULIN PEN MIS 29GX12MM OTC

INSULIN PEN MIS 31GX8MM OTC

INSULIN SYRG MIS 0.3/29G

INSULIN SYRG MIS 0.3/29G OTC





INSULIN SYRG MIS 0.3ML/30 OTC

INSULIN SYRG MIS 0.3ML/31 OTC









INSULIN SYRG MIS 1/2ML/30 OTC

INSULIN SYRG MIS 1/2ML/31 OTC

INSULIN SYRG MIS 1ML/25G OTC


INSULIN SYRG MIS 1ML/27G


113










INSULIN SYRG MIS 27GX1/2" OTC




INSULIN SYRG MIS 30GX5/16 OTC

INSULIN SYRG MIS 31GX5/16 OTC

INSULIN SYRI MIS 0.3/31G OTC

INSUPEN MIS 29GX12MM OTC




INSUPEN SENS MIS 32GX6MM OTC

INSUPEN ULTR MIS 30GX8MM OTC



LITETOUCH MIS 29GX12.7 OTC

LITETOUCH MIS 31GX8MM OTC

MAXICOMFORT MIS 27GX1/2 OTC

MAXICOMFORT MIS 27GX1/2" OTC

MAXICOMFORT MIS 31GX1/4" OTC

MM PENTIPS MIS 29GX12MM




NOVOFINE AUT MIS 30GX8MM OTC

NOVOFINE MIS 32GX6MM OTC

NOVOFINE PLS MIS 32GX4MM OTC

NOVOPEN ECHO MIS QL (3 boxes / 365 days)

NOVOTWIST MIS 32GX5MM OTC

PEN NEEDLE MIS 29GX1/2" OTC

PEN NEEDLE MIS 31GX3/16 OTC


PEN NEEDLE MIS 31GX5MM OTC



PEN NEEDLE MIS 32GX1/4" OTC



114




PEN NEEDLES MIS 29GX1/2" OTC

PEN NEEDLES MIS 29GX12.7 OTC

PEN NEEDLES MIS 29GX12MM OTC

PEN NEEDLES MIS 30GX3/16 OTC

















PENTIPS MIS 29GX12MM

PENTIPS MIS 29GX12MM OTC

PENTIPS MIS 31GX5MM



PENTIPS MIS 31GX8MM


PENTIPS MIS 32GX4MM


PREVENT DROP MIS 31GX1/4" OTC

PREVENT DROP MIS 31GX5/16 OTC

PREVENT SAFE MIS 31GX1/4" OTC

PREVENT SAFE MIS 31GX5/16 OTC

PRO COMFORT MIS 0.5/30G OTC

PRO COMFORT MIS 0.5/31G OTC

PRO COMFORT MIS 1ML/30G OTC

PRO COMFORT MIS 1ML/31G OTC

PRO COMFORT MIS 31GX8MM



PRO COMFORT MIS 32GX6MM OTC

PURE COMFORT MIS 32GX4MM OTC



115



RA PEN NEEDL MIS 31GX3/16 OTC

RELION PEN MIS 29GX12MM OTC

RELION PEN MIS 31GX1/4" OTC

RELION PEN MIS 31GX5/16 OTC




RELION PEN MIS 32GX5/32 OTC

SECURESAFE MIS 0.5/29G OTC

SECURESAFE MIS 1ML/29G OTC

SECURESAFE MIS 30GX5/16 OTC

SURE COMFORT MIS 29GX1/2" OTC

SURE COMFORT MIS 30GX5/16 OTC




SURE COMFORT MIS 32GX6MM OTC

SYRINGE MIS 0.5/30G OTC

1ML SYRINGE MIS 30G OTC

1ST TIER UNI MIS 29GX12MM OTC





TIER UNI PLS MIS 31GX8MM OTC

ULTICARE MIC MIS 32GX4MM OTC

ULTICARE MIS 30GX3/16 OTC

ULTICARE MIS 30GX5/16 OTC

ULTICARE PEN MIS 31GX5MM OTC



ULTIGUARD MIS 31GX5MM OTC





ULTILET PEN MIS 29GX12.7 OTC

ULTILET PEN MIS 31GX5MM OTC



ULTRA FLO MIS 31GX5MM OTC

ULTRA FLO MIS 31GX8MM OTC

ULTRA FLO MIS PEN NEED OTC

UNFINE PNTP MIS 32GX4MM OTC


116


UNIFINE PLUS MIS 31GX1/4" OTC

UNIFINE PLUS MIS 31GX3/16 OTC



UNIFINE PNTP MIS 29GX1/2" OTC

UNIFINE PNTP MIS 29GX12MM OTC

UNIFINE PNTP MIS 30GX3/16 OTC









UNIFINE ULTR MIS 31GX5MM OTC




ZEVRX MIS 31GX5MM OTC




RESPIRATORY THERAPY SUPPLIES AERCHMBR PLS MIS FLOW-VU

AERCHMBR PLS MIS LRG MASK

AERCHMBR PLS MIS MED MASK

AERCHMBR PLS MIS SM MASK

AERCHMBR Z- MIS STAT PLS

AEROCHAMBER MIS CHAMBER

AEROCHAMBER MIS FLOSIGNA

AEROCHAMBER MIS MV

AEROCHAMBER MIS PLUS

AEROVENT MIS PLUS

BREATHE EASE MIS LG MASK

BREATHE EASE MIS MED MASK

BREATHE EASE MIS SM MASK

COMPACT SPAC MIS CHAMBER

COMPACT SPAC MIS LG MASK

COMPACT SPAC MIS MD MASK

COMPACT SPAC MIS SM MASK

EASIVENT MIS

EASIVENT MIS MASK LG

EASIVENT MIS MASK MED

EASIVENT MIS MASK SM


117


FLEXICHAMBER MIS

FLEXICHAMBER MIS MASK LRG

FLEXICHAMBER MIS MASK SM

HOLD CHAMBER MIS ADLT LG

HOLD CHAMBER MIS ADLT LG OTC

HOLD CHAMBER MIS MEDIUM

HOLD CHAMBER MIS MEDIUM OTC

HOLD CHAMBER MIS SMALL

HOLD CHAMBER MIS SMALL OTC

INSPIRACHAMB MIS LARGE

INSPIRACHAMB MIS MEDIUM

INSPIRACHAMB MIS MOUTHPCE

INSPIRACHAMB MIS SMALL

INSPIREASE MIS DD SYST

MASK VORTEX/ MIS FROG OTC

MASK VORTEX/ MIS LADY BUG OTC

MICROCHAMBER MIS

OPTICHAMBER MIS DIA LG

OPTICHAMBER MIS DIA MD

OPTICHAMBER MIS DIA SM

OPTICHAMBER MIS DIAMOND

PANDA MASK MIS LARGE OTC

PANDA MASK MIS MEDIUM OTC

PANDA MASK MIS PEDIATRI OTC

PANDA MASK MIS SMALL OTC

POCKET CHAMB MIS

POCKET SPACE MIS

PROCARE MIS ADULT OTC

PROCARE MIS CHILD OTC

RITEFLO MIS

SPACE CHAMBR MIS ANTI-STA OTC

SPACE CHAMBR MIS LARGE OTC

SPACE CHAMBR MIS MEDIUM OTC

SPACE CHAMBR MIS SMALL OTC

SPACER CHAMB MIS ADULT OTC

SPACER CHAMB MIS CHILD OTC

SPACER CHAMB MIS INFANT OTC

VORTEX VALVE MIS CHAMBER

MIGRAINE PRODUCTS CALCITONIN GENE-RELATED PEPTIDE (CGRP) RECEPTOR ANTAG

AIMOVIG INJ 70MG/ML PA

AIMOVIG INJ 140MG/ML PA

AJOVY INJ 225/1.5 PA

EMGALITY INJ 120MG/ML PA

UBRELVY TAB 50MG PA


118


UBRELVY TAB 100MG PA

VYEPTI INJ 100MG/ML Bill as Medical Claim Only

MIGRAINE COMBINATIONS CAFERGOT TAB 1-100MG

ergotamine w/ caffeine tab 1-100 mg

SEROTONIN AGONISTS IMITREX SPR 5MG/ACT QL (6 inhalations / 30 days)

IMITREX SPR 20MG/ACT QL (6 inhalations / 30 days)

naratriptan hcl tab 1 mg (base equiv) (generic of AMERGE)

QL (9 tabs / 30 days)

naratriptan hcl tab 2.5 mg (base equiv) (generic of AMERGE)


rizatriptan benzoate oral disintegrating tab 5 mg (base eq)


rizatriptan benzoate oral disintegrating tab 10 mg (base eq) (generic of MAXALT-MLT)


rizatriptan benzoate tab 5 mg (base equivalent) QL (9 tabs / 30 days)

rizatriptan benzoate tab 10 mg (base equivalent)

(generic of MAXALT)


SUMATRIPTAN INJ 4MG/0.5 QL (2 injections / 30 days)

SUMATRIPTAN INJ 6MG/0.5 QL (2 injections / 30 days)

sumatriptan succinate inj 6 mg/0.5ml QL (2 injections / 30 days)

sumatriptan succinate solution auto-injector 4

mg/0.5ml (generic of IMITREX STATDOSE SYSTEM)

QL (2 injections / 30 days)

sumatriptan succinate solution auto-injector 6 mg/0.5ml (generic of IMITREX STATDOSE SYSTEM)


sumatriptan succinate tab 25 mg (generic of IMITREX)


sumatriptan succinate tab 50 mg (generic of

IMITREX)


sumatriptan succinate tab 100 mg (generic of

IMITREX)


zolmitriptan orally disintegrating tab 2.5 mg QL (9 tabs / 30 days)

zolmitriptan orally disintegrating tab 5 mg QL (9 tabs / 30 days)

zolmitriptan tab 2.5 mg (generic of ZOMIG) QL (9 tabs / 30 days)

zolmitriptan tab 5 mg (generic of ZOMIG) QL (9 tabs / 30 days)

ZOMIG SPR 2.5MG ST, QL (6 inhalations / 30

days)

ZOMIG SPR 5MG ST, QL (6 inhalations / 30

days)

MINERALS & ELECTROLYTES CALCIUM

CA CITRATE TAB 250MG OTC

CALC ACETATE TAB 668MG OTC


119


CALCIUM CARB CHW 500MG OTC

*calcium carb-vit d w/ minerals tabs 600 mg-200

unit***

OTC

*calcium carb-vit d w/ minerals tabs 600 mg-400 unit***

OTC

*calcium carb-vit d w/ minerals tabs 600 mg-800 unit***

OTC

calcium carbonate tab 600 mg OTC

calcium carbonate tab 1250 mg (500 mg elemental ca)

OTC

calcium carbonate tab 1500 mg (600 mg elemental ca)

OTC

calcium carbonate-cholecalciferol tab 250 mg-125 unit

OTC

calcium carbonate-cholecalciferol tab 500 mg-125 unit

OTC

calcium carbonate-cholecalciferol tab 500 mg-200

unit

OTC


unit

OTC


unit

OTC


unit

OTC


unit

OTC


unit

OTC

calcium carbonate-vitamin d cap 600 mg-200 unit OTC

calcium carbonate-vitamin d tab 600 mg-400 unit OTC

CALCIUM CIT TAB 1040MG OTC

calcium citrate tab 950 mg (200 mg elemental ca) OTC

CALCIUM TAB 333MG OTC

calcium tab 600 mg OTC

NEOFLEX TAB CAL+ D OTC

oyster shell calcium tab 500 mg OTC

RA CALCIUM TAB 500MG OTC

ELECTROLYTE MIXTURES *oral electrolyte solution*** OTC

FLUORIDE sodium fluoride chew tab 0.5 mg f (from 1.1 mg

naf)

sodium fluoride chew tab 0.25 mg f (from 0.55 mg

naf)

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


120


sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml

naf)

sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml

naf)

OTC

sodium fluoride soln 0.125 mg/drop f (0.275

mg/drop naf)

MAGNESIUM MAG-200 TAB OTC

magnesium oxide cap 500 mg (elemental mg) OTC

magnesium oxide tab 250 mg (mg supplement) OTC

magnesium oxide tab 400 mg (240 mg elemental mg)

OTC

magnesium oxide tab 400 mg (241.3 mg elemental mg)

OTC

magnesium oxide tab 500 mg (mg supplement) OTC

POTASSIUM potassium bicarbonate effer tab 25 meq

potassium chloride cap er 8 meq

potassium chloride cap er 10 meq

potassium chloride microencapsulated crys er tab

10 meq

potassium chloride microencapsulated crys er tab

20 meq

potassium chloride oral soln 10% (20 meq/15ml)

potassium chloride oral soln 20% (40 meq/15ml)

potassium chloride powder packet 20 meq

potassium chloride tab er 8 meq (600 mg)

potassium chloride tab er 10 meq

potassium chloride tab er 20 meq (1500 mg) (generic of K-TAB)

SODIUM sodium chloride tab 1 gm OTC

ZINC ORAZINC TAB 110MG OTC

ZINC 15 TAB 66MG OTC

zinc gluconate tab 15 mg (elemental zn) OTC

zinc gluconate tab 30 mg OTC

zinc gluconate tab 50 mg (elemental zn) OTC

zinc gluconate tab 100 mg OTC

ZINC LOZ 10MG OTC

ZINC SULFATE CAP 50MG OTC

zinc sulfate cap 220 mg (50 mg elemental zn) OTC

ZINC SULFATE TAB OTC

zinc sulfate tab 220 mg (50 mg zinc equivalent) OTC

ZINC TAB 220MG OTC


121


ZN-50 CAP OTC

MISCELLANEOUS THERAPEUTIC CLASSES CHELATING AGENTS

penicillamine cap 250 mg (generic of CUPRIMINE)

HOMEOPATHIC PRODUCTS COLD-EEZE CHW PLS DEF OTC

CVS COLD CHW REMEDY OTC

MENTAL FOCUS CHW OTC

T-RELIEF CHW MOBILITY OTC

T-RELIEF CHW SAFE OTC

T-RELIEF EXT CHW OTC

ZINC COLD CHW 11MG OTC

IMMUNOMODULATORS REVLIMID CAP 2.5MG PA

REVLIMID CAP 5MG PA

REVLIMID CAP 10MG PA




THALOMID CAP 50MG PA




IMMUNOSUPPRESSIVE AGENTS ASTAGRAF XL CAP 0.5MG

ASTAGRAF XL CAP 1MG

ASTAGRAF XL CAP 5MG

azathioprine tab 50 mg (generic of IMURAN)

azathioprine tab 75 mg

azathioprine tab 100 mg

cyclosporine cap 25 mg (generic of SANDIMMUNE)

cyclosporine cap 100 mg (generic of

SANDIMMUNE)

cyclosporine modified cap 25 mg (generic of

NEORAL)

cyclosporine modified cap 50 mg

cyclosporine modified cap 100 mg (generic of NEORAL)

cyclosporine modified oral soln 100 mg/ml (generic of NEORAL)

GAMIFANT INJ 10MG/2ML PA; Bill as Medical Claim Only

GAMIFANT INJ 50/10ML PA; Bill as Medical Claim Only


122


mycophenolate mofetil cap 250 mg (generic of

CELLCEPT)

mycophenolate mofetil for oral susp 200 mg/ml

(generic of CELLCEPT)

mycophenolate mofetil tab 500 mg (generic of

CELLCEPT)

mycophenolate sodium tab dr 180 mg

(mycophenolic acid equiv) (generic of MYFORTIC)

mycophenolate sodium tab dr 360 mg

(mycophenolic acid equiv) (generic of MYFORTIC)

NULOJIX INJ 250MG PA; Bill as Medical Claim Only

REZUROCK TAB 200MG PA

SANDIMMUNE SOL 100MG/ML

SIMULECT INJ 10MG PA; Bill as Medical Claim Only

SIMULECT INJ 20MG PA; Bill as Medical Claim

Only

sirolimus oral soln 1 mg/ml (generic of

RAPAMUNE)

sirolimus tab 0.5 mg (generic of RAPAMUNE)

sirolimus tab 1 mg (generic of RAPAMUNE)

sirolimus tab 2 mg (generic of RAPAMUNE)

tacrolimus cap 0.5 mg (generic of PROGRAF)

tacrolimus cap 1 mg (generic of PROGRAF)

tacrolimus cap 5 mg (generic of PROGRAF)

ZORTRESS TAB 0.5MG PA



ZORTRESS TAB 1MG PA

POTASSIUM REMOVING AGENTS *sodium polystyrene sulfonate powder**

MOUTH/THROAT/DENTAL AGENTS ANESTHETICS TOPICAL ORAL

lidocaine hcl viscous soln 2% QL (100 mL / 30 days)

ANTI-INFECTIVES - THROAT clotrimazole troche 10 mg

GLY-OXIDE SOL 10% OTC

nystatin susp 100000 unit/ml

ANTISEPTICS - MOUTH/THROAT chlorhexidine gluconate soln 0.12% (generic of

PERIDEX)

DENTAL PRODUCTS PREVIDENT SOL 0.2%

sodium fluoride cream 1.1%


123


sodium fluoride gel 1.1% (0.5% f)

sodium fluoride paste 1.1%

sodium fluoride rinse 0.2%

sodium fluoride rinse 0.05% OTC

sodium fluoride rinse 0.0221% (0.01% f) OTC

stannous fluoride conc 0.63%

stannous fluoride conc 0.63% OTC

stannous fluoride gel 0.4%

stannous fluoride gel 0.4% OTC

STEROIDS - MOUTH/THROAT/DENTAL triamcinolone acetonide dental paste 0.1%

THROAT PRODUCTS - MISC. AQUORAL SPR

BIOTENE DRY SPR MOIST OTC

CAPHOSOL SOL OTC

cevimeline hcl cap 30 mg (generic of EVOXAC)

CVS DRY SPR MOUTH OTC

DRY MOUTH SOL ORAL RIN OTC

MOI-STIR SOL OTC

MOUTH KOTE SOL OTC

MOUTH KOTE SOL REMINT OTC

NUMOISYN LIQ

ORAL RELIEF SPR DRY MOUT OTC

pilocarpine hcl tab 5 mg (generic of SALAGEN)

pilocarpine hcl tab 7.5 mg (generic of SALAGEN)

RA DRY MOUTH SPR OTC

MULTIVITAMINS B-COMPLEX VITAMINS

*b-complex vitamin cap** OTC

*b-complex vitamin sublingual liquid** OTC

*b-complex vitamin tab er** OTC

*b-complex vitamin tab** OTC

B-COMPLEX W/ C *b-complex w/ c & e + zn tab*** OTC

B-COMPLEX W/ FOLIC ACID *b-complex w/ c & folic acid cap 1 mg***

*b-complex w/ c & folic acid cap 1 mg*** OTC

*b-complex w/ c & folic acid tab 0.8 mg*** OTC

*b-complex w/ c & folic acid tab 1 mg***

*b-complex w/ c & folic acid tab 1 mg*** OTC

*b-complex w/ c & folic acid tab 5 mg***

*b-complex w/ c & folic acid tab***

*b-complex w/ c & folic acid tab*** OTC

BIOTIN FORTE TAB OTC


124


FULL SPECT TAB B/ VIT C OTC

NEPHRO-VITE TAB OTC

NEPHRO-VITE TAB RX

NEPHROCAPS CAP

SM B-COMPLEX TAB /VIT C OTC

MULTIPLE VITAMINS W/ MINERALS ABC COMPLETE TAB WOMEN OTC

ACTIVE 55 LIQ PLUS OTC

ACTIVNUTRIEN CAP OTC

ADEK CHW PLUS ZN OTC

ADLT ONE DLY CHW GUMMIES OTC

ADULT 50+ CAP EYE HLTH OTC

ADULT 50+ CAP OCUVITE OTC

ADV DIABETIC TAB MULTIVIT OTC

AIRBORN+ POW REST OTC

AIRBORNE CHW OTC

AIRBORNE CHW KIDS OTC

AIRBORNE POW OTC

AIRBORNE+ CHW PROBIOTI OTC

AIRBORNE+ CHW REST OTC

AIRBORNE+ POW STRESS OTC

AIRBORNE+NAT LIQ ENERGY OTC

AIRSHIELD CHW IMMUNITY OTC

ALGAE BASED TAB CALCIUM OTC

ALIVE 50+ TAB ENERGY OTC

ALIVE 50+ TAB WOMENS OTC

ALIVE DAILY TAB WOMENS OTC

ALIVE ENERGY TAB MENS OTC

ALIVE ENERGY TAB WOMENS OTC

ALIVE LIQ MULT-VIT OTC

ALIVE MULTI CHW VITAMIN OTC

ALIVE WOMENS CHW 50+ OTC

ALIVE WOMENS CHW GUMMY OTC

ANTIOXIDANT TAB FORMULA OTC

AQUADEKS CHW OTC

AZO HORMONAL TAB HEALTH OTC

BARIATRIC CAP MULTIVIT OTC

BARIATRIC CHW FUSION OTC

BASIC AM TAB OTC

BASIC PM TAB OTC

BIO-35 GLUTE CAP FREE OTC

BIO-35 IRON CAP FREE OTC

BIOCAL CAP OTC

CAL-DAY 1000 TAB OTC

CELEBRATE CAP 18 OTC


125





CELEBRATE CHW 18 OTC




CENT MATURE TAB ADLT 50+ OTC

CENTRAL-VITE TAB OTC

CENTRAVITES TAB 50 PLUS OTC

CENTRAVITES TAB ADULTS OTC

CENTRUM 50+ CHW FRSH/FRU OTC

CENTRUM CHW ADULTS OTC

CENTRUM CHW FLAV BST OTC

CENTRUM CHW SILVER OTC

CENTRUM CHW VITAMINT OTC

CENTRUM LIQ OTC

CENTRUM MULT CHW OMEGA 3 OTC

CENTRUM POW DRINK OTC

CENTRUM SILV TAB 50+MEN OTC

CENTRUM SILV TAB 50+WOMEN OTC

CENTRUM SILV TAB ADULT 50 OTC

CENTRUM SPEC TAB HEART OTC

CENTRUM SPEC TAB IMMUNE OTC

CENTRUM SPEC TAB VISION OTC

CENTRUM TAB ADULTS OTC

CENTRUM TAB CARDIO OTC

CENTRUM TAB MEN OTC

CENTRUM TAB SILVER OTC

CENTRUM TAB ULTRA OTC

CENTRUM TAB WOMEN OTC

CERTAVITE TAB SENIOR OTC

CERTAVITE/ TAB ANTIOXID OTC

CHOICEFUL CAP MULTIVIT OTC

CHOICEFUL CHW MULTIVIT OTC

CORVITA TAB

CULTURELLE CHW MULTIVIT OTC

CVS VISION CAP HEALTH OTC

DECUBI-VITE CAP OTC

DEKAS CHW BARIATRI OTC

DEKAS PLUS CAP OTC

DEKAS PLUS CAP OCEAN OTC

DEKAS PLUS CHW OTC

DERMAVITE TAB OTC

EMERGEN-C CHW IMMUNE/D OTC


126


EMERGEN-C CHW VITA C OTC

EMERGEN-C PAK BLUE OTC

EMERGEN-C PAK FIVE OTC

EMERGEN-C PAK HEART OTC

EMERGEN-C PAK IMMUNE OTC

EMERGEN-C PAK JOINT OTC

EMERGEN-C PAK KIDZ OTC

EMERGEN-C PAK MSM LITE OTC

EMERGEN-C PAK PINK OTC

EMERGEN-C PAK SUPER FR OTC

EMERGEN-C PAK VIT D/CA OTC

EMERGEN-C PAK VITA C OTC

ENDUR-VM TAB OTC

ENDUR-VM TAB IRON OTC

ENERGY POW BOOSTER OTC

EQ COMPLETE TAB ADULT OTC

EQ ONE DAILY TAB MENS OTC

EQ ONE DAILY TAB WOMENS OTC

EQL CENTURY TAB MENS OTC

EQL CENTURY TAB WOMENS OTC

ESTROVEN MEN TAB SUPPLEM OTC

EVOLUTION60 POW OTC

EYE HEALTH CAP OTC

EYE HEALTH CAP ADLT 50+ OTC

EYE HEALTH TAB LUTEIN OTC

EYE MULTIVIT TAB SODIUM OTC

FITNESS TABS TAB MEN OTC

FITNESS TABS TAB WOMEN OTC

FOSFREE TAB OTC

FREEDAVITE TAB OTC

GENADEK CAP STEP 1 OTC

GENADEK CAP STEP 2 OTC

GERI-FREEDA TAB SENIOR OTC

GNP IMMUNE PAK OTC

GNP IMMUNE PAK SUPPORT OTC

HAIR SKIN & TAB NAILS AD OTC

HAIR/SKIN/ CAP NAILS OTC

HEALTHY EYES CAP SUPERVIS OTC

HI POT MV/ TAB BETA-CAR OTC

HIGH POTENCY TAB MV/FA OTC

HM COMPLETE TAB MEN OTC

HM HAIR/SKIN TAB /NAILS OTC

ICAPS AREDS TAB FORMULA OTC

IMMUBLAST-C POW ORANGE OTC

IMMUNE CHW SUPPORT OTC


127


IMMUNE SUPP POW VIT C OTC

K-PAX TAB PROF ST OTC

LUTEIN PLUS TAB ZEAXANTH OTC

MAXIMIN PAK OTC

MEGA MULTI TAB MEN OTC

MEGA MULTI TAB WOMEN OTC

MEGA MULTIVI TAB MEN OTC

MEGA MULTIVI TAB WOMEN OTC

MEGAVITE TAB FRT/VEG OTC

MEGAVITE TAB GOLD 55+ OTC

MENS 50+ CAP ADVANCED OTC

MENS MULTI CHW OTC

MENS MULTI TAB VIT/MIN OTC

MENS MULTIPL TAB OTC

MULTI ADULT CHW EXTRA C OTC

MULTI FOR POW HER OTC

MULTI FOR POW HIM OTC

MULTI VITAMN TAB MINERALS OTC

MULTI-BETIC TAB DIABETES OTC

MULTI-VITAMI TAB MONOCAPS OTC

MULTI-VITE LIQ OTC

*multiple vitamins w/ minerals cap** OTC

*multiple vitamins w/ minerals chew tab** OTC

*multiple vitamins w/ minerals liquid** OTC

*multiple vitamins w/ minerals tab er** OTC

*multiple vitamins w/ minerals tab** OTC

MULTIVITAMIN CHW ADLT GUM OTC

MULTIVITAMIN TAB OTC

MULTIVITAMIN TAB ADULT OTC

MULTIVITAMIN TAB ADULTS OTC

MULTIVITAMIN TAB MEN OTC

MULTIVITAMIN TAB WOMEN OTC

MULTIVITAMIN TAB ZINC STR OTC

MVW COMPLETE CAP D3000 OTC

MVW COMPLETE CAP D5000 OTC

MVW COMPLETE CAP FORMULAT OTC

MVW COMPLETE CAP MINIS OTC

NAT-RUL THER TAB M OTC

NATRUL-VITES TAB OTC

NUTRIENT 45+ TAB WOMEN OTC

NUTRIENT 50+ TAB MEN OTC

NUTRIENTS CAP ANTIOXID OTC

NUTRIENTS TAB MEN OTC

NUTRIENTS TAB TEENS OTC

NUTRIENTS TAB WOMEN OTC


128


OCUHEALTH CAP VISION 2 OTC

OCULAR TAB VITAMINS OTC

OCUVITE CAP ADULT OTC

OCUVITE LUTE CAP OTC

ONCOVITE TAB OTC

ONE DAILY CHW ADLT GUM OTC

ONE DAILY MN TAB W/O IRON OTC

ONE DAILY MV TAB WOMENS OTC

ONE DAILY TAB MENS OTC

ONE DAILY TAB MENS 50+ OTC

ONE DAILY TAB WMNS 50+ OTC

ONE DAILY TAB WOMENS OTC

ONE-A-DAY CHW IMMUNITY OTC

ONE-A-DAY CHW VITACRAV OTC

ONE-A-DAY TAB 50+ ADV OTC

ONE-A-DAY TAB 50+ MENS OTC

ONE-A-DAY TAB 50+ WMN OTC

ONE-A-DAY TAB 65+ OTC

ONE-A-DAY TAB ENERGY OTC

ONE-A-DAY TAB MENOPAUS OTC

ONE-A-DAY TAB MENS OTC

ONE-A-DAY TAB PETITES OTC

ONE-A-DAY TAB PROEDGE OTC

ONE-A-DAY TAB TEEN/HIM OTC

ONE-A-DAY TAB WOMENS OTC

ONE-DAILY CAP MULTI OTC

ONE-DAILY PAK VIT/MIN OTC

OPTIFAST POS CHW BARIATRI OTC

OPTIMUM CHW AIRVITES OTC

OPTISOURCE CHW BARIATRC OTC

OPTIVITE TAB P.M.T. OTC

OPURITY CHW BYPASS OTC

OPURITY TAB OTC

OSTEOPRIME TAB PLUS OTC

PARVLEX TAB OTC

PHYTOMULTI TAB OTC

PORENAL+D CAP OMEGA 3 OTC

PRESERVISION CAP AREDS OTC

PRESERVISION CAP AREDS 2 OTC

PRESERVISION CAP LUTEIN OTC

PRESERVISION CHW AREDS 2 OTC

PRESERVISION TAB AREDS OTC

PRO-CAL TAB OTC

PROCERV HP TAB OTC

PRORENAL +D TAB OTC


129


PRORENAL+D CAP OMEGA-3 OTC

PRORENAL+D TAB OTC

PROTECT CAP CARDIO OTC

PROTECT CAP PLUS SO OTC

PROTEGRA CAP OTC

PROVIT TAB OTC

QC MULTI-VIT TAB OTC

QUIN B TAB STRONG OTC

QUINTABS-M TAB OTC

RA ESSENCE-C POW ORANGE OTC

RA ESSENCE-C POW RASPBRY OTC

RA ESSENCE-C POW TNGERINE OTC

RENAPLEX-D TAB OTC

SENTRY SENIO TAB LUTEIN OTC

SENTRY TAB OTC

SENTRY TAB SENIOR OTC

SKIN BEAUTY/ PAK WELLNESS OTC

SM ONE DAILY TAB MENS OTC

SM ONE DAILY TAB WOMENS OTC

SOLO TAB OTC

SPECTRAVITE CHW ADLT 50+ OTC

SPECTRAVITE CHW WOMEN OTC

SPECTRAVITE TAB OTC

SPECTRAVITE TAB ADLT 50+ OTC

SPECTRAVITE TAB ADULTS OTC

SPECTRAVITE TAB MEN 50+ OTC

SPECTRAVITE TAB ULT MEN OTC

SPECTRAVITE TAB ULT WMN OTC

SUPER ANTIOX CAP OTC

SYSTANE ICAP CHW AREDS2 OTC

SYSTANE ICAP TAB AREDS2 OTC

T-VITES TAB OTC

THERA M PLUS TAB OTC

THERA-M TAB OTC

THERA-TABS M TAB OTC

THERABETIC TAB MULTIVIT OTC

THERAGRAN-M TAB OTC

THERAGRAN-M TAB 50 PLUS OTC

THERAGRAN-M TAB ADVANCED OTC

THERAGRAN-M TAB PREMIER OTC

THERAMILL CAP FORTE OTC

THERANATAL CAP LACTATIO OTC

THEREMS-M TAB OTC

ULTRA MEGA G TAB 75MG CR OTC

ULTRA MEGA G TAB 100MG OTC


130


ULTRA MEGA TAB 75MG CR OTC

ULTRA MEGA TAB TWO OTC

VISTA ADVAN CAP AREDS2 OTC

VISTA ADVAN CAP DRY EYE OTC

VITABEX CAP OTC

VITABEX PLUS CAP OTC

VITACRAVES CHW GUMMIES OTC

VITACRAVES CHW IMMUNITY OTC

VITACRAVES CHW MENS OTC

VITACRAVES CHW SOUR GUM OTC

VITACRAVES CHW WOMENS OTC

VITALINE TAB FORMULA2 OTC

VITALINE TAB FORMULA3 OTC

VITAMIN C PAK BLEND OTC

VITAMIN C POW ELECTROL OTC

VITAMIN D3 TAB COMPLETE OTC

VITASANA TAB OTC

VITATRUM TAB OTC

VITEYES CAP CLASSIC OTC

VITEYES CLAS CAP ADV OTC

VITEYES CLAS CAP ADVANCED OTC

VITEYES CLAS CAP MAC SUPP OTC

VITEYES CLAS CAP OMEGA-3 OTC

VITEYES CLAS TAB MULTIVIT OTC

VITEYES OPTI TAB NERV SUP OTC

VITRUM TAB ADULT OTC

VITRUM TAB SENIOR OTC

WAL-BORN CHW VIT C OTC

WEIGHT SMART TAB ADVANCED OTC

WHOLE FOOD TAB MULTIVIT OTC

WMNS MULTIVI CHW +COLLAGE OTC

WOMENS MULT CHW GUMMIES OTC

WOMENS MULTI TAB VIT/MIN OTC

YELETS TEEN TAB FORMULA OTC

YOUR LIFE CHW GUMMIES OTC

YOUR LIFE CHW MULTIVIT OTC

MULTIVITAMINS DAILY MULTI TAB VITAMINS OTC

DEKAS CAP ESSENTIA OTC

ESTROFACTORS TAB OTC

HIGH POTENCY TAB MULTIVIT OTC

MULTI VITAMI TAB OTC

MULTI VITAMI TAB D-3 OTC

*multiple vitamin cap** OTC

*multiple vitamin tab** OTC


131


MULTIVITAMIN TAB OTC

MULTIVITAMIN TAB ADULT OTC

NEOMULTIVITE TAB OTC

OMNICAP TAB OTC

ONE DAILY TAB ESSENTL OTC

ONE-A-DAY TAB ESSENT OTC

ONE-A-DAY TAB MENS OTC

QUINTABS TAB OTC

THERA TAB OTC

THEREMS TAB MULTIVIT OTC

ZE-PLUS CAP OTC

PED MULTI VITAMINS W/FL & FE *pediatric multiple vitamins w/ fl-fe drops 0.25-10

mg/ml**

*pediatric multiple vitamins w/ fl-fe drops 0.25-10 mg/ml**

OTC

PED MULTIPLE VITAMINS W/ MINERALS AQUADEKS DRO OTC

BABY IRON DRO IMMUNITY OTC

CENTRUM KIDS CHW OTC

CENTRUM KIDS CHW FLAV BST OTC

DEKAS PLUS LIQ OTC

FLINTSTONES CHW COMPLETE OTC

FLINTSTONES CHW GUMMIES OTC

FLINTSTONES CHW IMMUNITY OTC

FLINTSTONES CHW SOUR GUM OTC

FLINTSTONES CHW TODDLER OTC

GENADEK DRO OTC

HEALTHY KIDS CHW GUMMIES OTC

JOLLY RANCHR CHW ONE-A-DA OTC

KIDZ MULTVIT CHW PROBIOTI OTC

MVW COMPLETE CHW GRAPE OTC

NF FORMULAS CHW CHILDREN OTC

ONE-A-DAY CHW SCOOBY OTC

*pediatric multiple vitamin w/ minerals & c chew

tab**

OTC

UPSPRINGBABY DRO MV/IRON OTC

VITALETS CHW CHILD OTC

ZOO FRIENDS CHW COMPLETE OTC

PED MV W/ FLUORIDE MULTI-VIT-FL CHW 0.5MG

MULTI-VIT-FL CHW 0.25MG

MULTI-VIT-FL CHW 1MG

MULTIV+FLUOR CHW 0.5MG OTC

MULTIV+FLUOR CHW 0.25MG OTC


132


MULTIV+FLUOR CHW 1MG OTC

MULTIVIT/FL CHW 0.5MG

MULTIVIT/FL CHW 0.25MG

MULTIVIT/FL CHW 1MG

*pediatric multiple vitamins w/ fluoride soln 0.5

mg/ml***


mg/ml***

OTC


mg/ml***


mg/ml***

OTC

*pediatric vitamins acd w/ fluoride soln 0.5

mg/ml***

*pediatric vitamins acd w/ fluoride soln 0.25

mg/ml***

*pediatric vitamins acd w/ fluoride soln 0.25 mg/ml***

OTC

PED MV W/ IRON ANIMAL SHAPE CHW IRON OTC

DALYVITE/FE LIQ OTC

DINO-LIFE CHW IRON-ZIN OTC

HONEY BEARS CHW IRON-ZIN OTC

MULTIVITAMIN CHW IRON OTC

PED POLY-VIT DRO /IRON OTC

*pediatric multiple vitamins w/ iron chew tab 15 mg**

OTC

*pediatric multiple vitamins w/ iron chew tab 18 mg**

OTC

POLY-VI-SOL SOL IRON OTC

POLY-VITA/FE DRO OTC

POLY-VITE SOL /IRON OTC

POLY-VITE SOL IRON OTC

SCOOBY-DOO CHW OTC

PEDIATRIC MULTIPLE VITAMINS CULTURELLE CHW OTC

GERBER LIL CHW BRAINIES OTC

KIDS PROBIOT CHW MULTIVIT OTC

MULTIVITAMIN CHW CHILDREN OTC

NOVAMV PED DRO 10MG/ML OTC

PED POLY-VIT DRO OTC

*pediatric multiple vitamin w/ c & fa chew tab** OTC

*pediatric multiple vitamin w/ extra c & fa chew

tab**

OTC

POLY-VI-SOL SOL 50MG/ML OTC

POLY-VITA DRO OTC


133


POLY-VITE DRO OTC

POLY-VITE SOL 50MG/ML OTC

VITACRAVES CHW +OMEGA-3 OTC

PEDIATRIC VITAMINS HONEY BEARS CHW OTC

MULTIVITAMIN CHW CHILD OTC

*pediatric vitamins adc drops 750 unit-400 unit-35 mg/ml***

OTC

TRI-VI-SOL SOL A/C/D OTC

TRI-VITAMIN DRO OTC

PRENATAL VITAMINS CENTRUM SPEC PAK PRENATAL OTC

CL PRENATAL TAB 28-0.8MG OTC

CO-NATAL FA TAB 29-1MG

COMPLETENATE CHW

CVS PRENATAL CHW GUMMY OTC

CVS PRENATAL TAB 27-0.8MG OTC

ENFAMIL MIS EXPECTA OTC

EQL PRENATAL TAB FORMULA OTC

GNP PRENATAL TAB 28-0.8MG OTC

JENLIVA CAP

KP PRENATAL TAB MULTIVIT OTC

KPN PRENATAL TAB OTC

M-NATAL PLUS TAB

MASONATAL TAB OTC

MULTI PRENAT TAB OTC

NEONATAL PLS TAB 27-1MG

NEONATAL TAB COMPLETE

NEONATAL TAB COMPLTE

NEONATAL TAB PLUS

NEONATAL VIT TAB 27-0.8MG OTC

NIVA-PLUS TAB

ONE VITE TAB 1MG PLUS

ONE VITE TAB 27-0.8MG OTC

ONE-A-DAY PAK PRENATAL OTC

PNV TABS TAB 29-1MG

PRE-NATAL TAB FORMULA OTC

PRENATABS FA TAB 29-1MG OTC

PRENATAL 19 CHW 29-1MG

PRENATAL 19 TAB OTC

PRENATAL 19 TAB 29-1MG

PRENATAL MUL CAP +DHA OTC

PRENATAL MV MIS + DHA OTC

PRENATAL ONE TAB DAILY OTC

PRENATAL TAB OTC


134


PRENATAL TAB 27-0.8MG OTC

PRENATAL TAB 27-1MG

PRENATAL TAB 28-0.8MG OTC

PRENATAL TAB COMPLETE OTC

PRENATAL TAB FORTE OTC

PRENATAL TAB IRON OTC

PRENATAL TAB MULTIVIT OTC

PRENATAL VIT TAB 28-0.8MG OTC

PRENATAL VIT TAB LOW IRON

PRENATAL VIT TAB MINERALS OTC

PRENATAL+DHA MIS OTC

PRENATAL+DHA MIS WOMENS OTC

PRENATAL-U CAP 106.5-1

PRENATAL/FE TAB OTC

PRENATRIX TAB

PRENATRYL TAB

PRENATVITE TAB RX

PREPLUS TAB 27-1MG

PRETAB TAB 29-1MG

PX PRENATAL TAB MULTIVIT OTC

QC PRENATAL TAB 28-0.8MG OTC

RA PRENATAL TAB 28-0.8MG OTC

RA PRENATAL TAB FORMULA OTC

SE-NATAL 19 CHW

SE-NATAL 19 TAB

SIMILAC PREN PAK EARLY SH OTC

SM ONE DAILY MIS PRENATAL OTC

SM PRENATAL TAB VITAMINS OTC

THERANATAL TAB 27-1 OTC

THRIVITE RX TAB 29-1MG

TRICARE TAB PRENATAL

TRINATE TAB

VITAFOL-OB TAB 65-1MG

VITATHELY TAB

WESTAB PLUS TAB 27-1MG

SPECIALTY VITAMINS PRODUCTS ADRENOID CAP OTC

BILBERRY CAP PLUS OTC

CARDIOPRESS CAP OTC

CHOLASE CAP CONTROL OTC

COLLAGEN CAP ULTRA OTC

GLYCOTROL CAP OTC

GLYCOTROL CAP COMPLETE OTC

HEART SAVIOR CAP OTC

IMMUNERX CAP OTC


135


IMMUNICARE CAP OTC

INULOSE BLD CAP SUGAR OTC

LIPOTRIAD CAP VIS PLUS OTC

LIPOTRIAD CAP VISION OTC

LIPOTRIAD CAP VISIONAR OTC

METHYL-GUARD CAP OTC

METHYL-GUARD CAP PLUS OTC

MM BIOTIN CAP KERATIN OTC

PRO HERS RX CAP

PRO HIS RX CAP

PRO PCOS RX CAP

RETAINE CAP VISION OTC

SYNERTROPIN CAP OTC

VITAMINS FOR CAP HAIR OTC

MUSCULOSKELETAL THERAPY AGENTS CENTRAL MUSCLE RELAXANTS

baclofen tab 5 mg

baclofen tab 10 mg

baclofen tab 20 mg

chlorzoxazone tab 500 mg

cyclobenzaprine hcl tab 5 mg

cyclobenzaprine hcl tab 10 mg

methocarbamol tab 500 mg

methocarbamol tab 750 mg

tizanidine hcl tab 2 mg (base equivalent)

tizanidine hcl tab 4 mg (base equivalent) (generic of ZANAFLEX)

DIRECT MUSCLE RELAXANTS dantrolene sodium cap 25 mg (generic of

DANTRIUM)

dantrolene sodium cap 50 mg

dantrolene sodium cap 100 mg

VISCOSUPPLEMENTS EUFLEXXA INJ 10MG/ML PA; Bill as Medical Claim

Only

GEL-ONE INJ 30MG/3ML PA; Bill as Medical Claim Only

GELSYN-3 INJ 16.8/2ML PA; Bill as Medical Claim Only

GENVISC 850 INJ 25/2.5 PA; Bill as Medical Claim Only

HYALGAN INJ 20MG/2ML PA; Bill as Medical Claim Only

MONOVISC INJ 88MG/4ML PA; Bill as Medical Claim Only


136


ORTHOVISC INJ 15MG/ML PA; Bill as Medical Claim

Only

SODIUM HYALU INJ 20MG/2ML PA; Bill as Medical Claim

Only

SUPARTZ FX INJ 25/2.5ML PA; Bill as Medical Claim

Only

SYNVISC INJ 8MG/ML PA; Bill as Medical Claim

Only

SYNVISC ONE INJ 8MG/ML PA; Bill as Medical Claim

Only

TRILURON INJ 20MG/2ML PA; Bill as Medical Claim Only

TRIVISC INJ 25/2.5ML PA; Bill as Medical Claim Only

VISCO-3 INJ 25/2.5ML PA; Bill as Medical Claim Only

NASAL AGENTS - SYSTEMIC AND TOPICAL NASAL AGENTS - MISC.

saline nasal spray 0.65% OTC

NASAL ANTIALLERGY azelastine hcl nasal spray 0.1% (137 mcg/spray)

cromolyn sodium nasal aerosol soln 5.2 mg/act (4%)

QL (1 bottle / 30 days), OTC

NASAL ANTICHOLINERGICS ipratropium bromide nasal soln 0.03% (21

mcg/spray)

ipratropium bromide nasal soln 0.06% (42

mcg/spray)

NASAL STEROIDS budesonide nasal susp 32 mcg/act QL (1 bottle / 30 days), OTC

fluticasone propionate nasal susp 50 mcg/act QL (1 bottle / 30 days)

fluticasone propionate nasal susp 50 mcg/act QL (1 bottle / 30 days), OTC

NASACORT ALR SPR 55MCG/AC QL (1 bottle / 30 days), OTC

SINUVA IMP 1350MCG Bill as Medical Claim Only

triamcinolone acetonide nasal aerosol suspension

55 mcg/act

QL (1 bottle / 30 days), OTC

SYMPATHOMIMETIC DECONGESTANTS oxymetazoline hcl nasal soln 0.05% OTC

phenylephrine hcl nasal soln 1% OTC

pseudoephedrine hcl tab 30 mg OTC

pseudoephedrine hcl tab 60 mg OTC

pseudoephedrine hcl tab abuse deter 30 mg OTC

pseudoephedrine hcl tab er 12hr 120 mg OTC

SUDAFED 24HR TAB 240MG OTC


137


NEUROMUSCULAR AGENTS ALS AGENTS

RADICAVA INJ 30MG PA; Bill as Medical Claim Only

riluzole tab 50 mg (generic of RILUTEK)

MUSCULAR DYSTROPHY AGENTS EXONDYS 51 SOL 100/2ML PA; Bill as Medical Claim

Only

EXONDYS 51 SOL 500/10ML PA; Bill as Medical Claim Only

NEUROMUSCULAR BLOCKING AGENT - NEUROTOXINS BOTOX INJ 100UNIT PA; Bill as Medical Claim

Only

BOTOX INJ 200UNIT PA; Bill as Medical Claim Only

XEOMIN INJ 50 UNIT PA; Bill as Medical Claim Only

XEOMIN INJ 100UNIT PA; Bill as Medical Claim Only

XEOMIN INJ 200UNIT PA; Bill as Medical Claim Only

SPINAL MUSCULAR ATROPHY AGENTS (SMA) SPINRAZA INJ 12MG/5ML PA; Bill as Medical Claim

Only

ZOLGENSMA INJ PA; Bill as Medical Claim

Only

NUTRIENTS MISC. NUTRITIONAL SUBSTANCES

MINI OMEGA-3 CAP 540MG OTC

OMEGA-3 CAP 1400MG OTC

*omega-3 fatty acids cap 300 mg** OTC






*omega-3 fatty acids cap delayed release 1000

mg**

OTC

VITEYES OMEG CAP TG OTC

PROTEINS acetylcysteine cap 600 mg OTC

L-THEANINE CAP 100MG OTC

theanine cap 100 mg OTC


138


OPHTHALMIC AGENTS ARTIFICIAL TEARS AND LUBRICANTS

*artificial tear ophth solution*** OTC

BLINK TEARS DRO 0.25% OP OTC

carboxymethylcellulose sodium (pf) ophth soln

0.5%

OTC

carboxymethylcellulose sodium ophth gel 1% OTC

carboxymethylcellulose sodium ophth soln 0.5% OTC

carboxymethylcellulose-glycerin ophth soln 0.5-0.9%

OTC

dextran 70-hypromellose (pf) ophth soln 0.1-0.3% OTC

dextran 70-hypromellose ophth soln 0.1-0.3% OTC

GENTEAL TEAR GEL SEV D/N OTC

glycerin-hypromellose-peg 400 ophth soln 0.2-0.2-1%

OTC

LUBRICNT GEL DRO 0.25-0.3 OTC

polyethylene glycol-propylene glycol ophth soln 0.4-0.3%

OTC

polyvinyl alcohol ophth soln 1.4% OTC

polyvinyl alcohol-povidone ophth soln 5-6 mg/ml

(0.5-0.6%)

OTC

propylene glycol ophth soln 0.6% OTC

propylene glycol-glycerin ophth soln 1-0.3% OTC

PURE & GENTL DRO 0.3% OTC

REFRESH TEAR DRO 0.5% OP OTC

SOOTHE DRO 0.6-0.6% OTC

STERILE LUBR DRO 0.7% OTC

SYSTANE GEL DRO 0.4-0.3% OTC

THERATEARS SOL 0.25% PF OTC

THERATEARS SOL OP OTC

*white petrolatum-mineral oil ophth ointment*** OTC

BETA-BLOCKERS - OPHTHALMIC betaxolol hcl ophth soln 0.5%

BETOPTIC-S SUS 0.25% OP

DORZOL/TIMOL SOL 22.3-6.8

dorzolamide hcl-timolol maleate ophth sol 22.3-6.8 mg/ml pf (generic of COSOPT PF)

dorzolamide hcl-timolol maleate ophth soln 22.3-

6.8 mg/ml (generic of COSOPT)

timolol maleate ophth gel forming soln 0.5%

(generic of TIMOPTIC-XE)

timolol maleate ophth gel forming soln 0.25%

(generic of TIMOPTIC-XE)

timolol maleate ophth soln 0.5% (generic of

TIMOPTIC)


139


timolol maleate ophth soln 0.25% (generic of

TIMOPTIC)

CYCLOPLEGIC MYDRIATICS ATROPINE SUL SOL 1% OP

atropine sulfate ophth oint 1%

cyclopentolate hcl ophth soln 0.5% (generic of

CYCLOGYL)

cyclopentolate hcl ophth soln 1% (generic of

CYCLOGYL)

cyclopentolate hcl ophth soln 2% (generic of

CYCLOGYL)

ISOPTO ATROP SOL 1% OP

phenylephrine hcl ophth soln 2.5%

phenylephrine hcl ophth soln 10%

tropicamide ophth soln 0.5%

tropicamide ophth soln 1% (generic of

MYDRIACYL)

MIOTICS pilocarpine hcl ophth soln 1% (generic of ISOPTO

CARPINE)

pilocarpine hcl ophth soln 2% (generic of ISOPTO

CARPINE)

pilocarpine hcl ophth soln 4%

OPHTHALMIC - ANGIOGENESIS INHIBITORS EYLEA INJ 2/0.05ML PA; Bill as Medical Claim

Only

OPHTHALMIC ADRENERGIC AGENTS ALPHAGAN P SOL 0.1%

apraclonidine hcl ophth soln 0.5% (base equivalent)

brimonidine tartrate ophth soln 0.2%

brimonidine tartrate ophth soln 0.15% (generic of

ALPHAGAN P)

OPHTHALMIC ANTI-INFECTIVES bacitracin-polymyxin b ophth oint

CILOXAN OIN 0.3% OP

ciprofloxacin hcl ophth soln 0.3% (base

equivalent) (generic of CILOXAN)

erythromycin ophth oint 5 mg/gm

gentamicin sulfate ophth soln 0.3%

levofloxacin ophth soln 0.5%

moxifloxacin hcl ophth soln 0.5% (base equiv)

(generic of VIGAMOX)

NATACYN SUS 5% OP

neomycin-bacitrac zn-polymyx 5(3.5)mg-400unt-

10000unt op oin


140


ofloxacin ophth soln 0.3% (generic of OCUFLOX)

polymyxin b-trimethoprim ophth soln 10000

unit/ml-0.1% (generic of POLYTRIM)

sulfacetamide sodium ophth soln 10% (generic of BLEPH-10)

tobramycin ophth soln 0.3%

TOBREX OIN 0.3% OP QL (3.5 gm / 5 days)

OPHTHALMIC DECONGESTANTS naphazoline w/ pheniramine ophth soln 0.025-

0.3% OTC

naphazoline w/ pheniramine ophth soln 0.027-0.315%

OTC

OPHTHALMIC GENE THERAPY LUXTURNA SUS PA; Bill as Medical Claim

Only

OPHTHALMIC IMMUNOMODULATORS RESTASIS EMU 0.05% PA

OPHTHALMIC LOCAL ANESTHETICS proparacaine hcl ophth soln 0.5% (generic of

ALCAINE)

tetracaine hcl ophth soln 0.5%

OPHTHALMIC PHOTOENHANCERS PHOTREXA VIS SOL 0.146-20 PA; Bill as Medical Claim

Only

OPHTHALMIC STEROIDS bacitracin-polymyxin-neomycin-hc ophth oint 1%

BLEPHAMIDE OIN S.O.P.

BLEPHAMIDE SUS OP

fluorometholone ophth susp 0.1%

FML OIN 0.1% OP

MAXIDEX SUS 0.1% OP

neomycin-polymyxin-dexamethasone ophth oint 0.1% (generic of MAXITROL)

neomycin-polymyxin-dexamethasone ophth susp 0.1% (generic of MAXITROL)

OZURDEX IMP 0.7MG PA; Bill as Medical Claim Only

PRED FORTE SUS 1% OP

PRED MILD SUS 0.12% OP

PRED SOD PHO SOL 1% OP

PRED-G S.O.P OIN OP

PRED-G SUS OP

PREDNISOLONE SUS 1%

PREDNISOLONE SUS 1% OP

TOBRADEX OIN 0.3-0.1%


141


TOBRADEX ST SUS 0.3-0.05

tobramycin-dexamethasone ophth susp 0.3-0.1%

(generic of TOBRADEX)

OPHTHALMICS - MISC. azelastine hcl ophth soln 0.05%

brinzolamide ophth susp 1% (generic of AZOPT) QL (0.33 mL / 1 day)

cromolyn sodium ophth soln 4%

diclofenac sodium ophth soln 0.1%

dorzolamide hcl ophth soln 2% (generic of TRUSOPT)

epinastine hcl ophth soln 0.05%

ketorolac tromethamine ophth soln 0.4% (generic

of ACULAR LS)

ketorolac tromethamine ophth soln 0.5% (generic

of ACULAR)

ketotifen fumarate ophth soln 0.025% (base

equiv)

OTC

NEVANAC SUS 0.1% PA, QL (3 mL / 30 days)

olopatadine hcl ophth soln 0.1% (base equivalent)

olopatadine hcl ophth soln 0.1% (base equivalent) OTC

olopatadine hcl ophth soln 0.2% (base equivalent) OTC

PATADAY SOL 0.1% OTC



PROSTAGLANDINS - OPHTHALMIC bimatoprost ophth soln 0.03% QL (0.33 mL / 1 day)

latanoprost ophth soln 0.005% (generic of XALATAN)

LATANOPROST SOL 0.005%

travoprost ophth soln 0.004% (benzalkonium free)

(bak free) (generic of TRAVATAN Z)

QL (0.125 mL / 1 day)

ZIOPTAN DRO 0.0015% QL (0.33 mL / 1 day)

OTIC AGENTS OTIC AGENTS - MISCELLANEOUS

acetic acid otic soln 2%

carbamide peroxide 6.5% otic soln OTC

OTIC ANTI-INFECTIVES CIPROFLOXACN SOL 0.2%

ofloxacin otic soln 0.3%

OTIC COMBINATIONS CIPRO HC SUS OTIC

CIPRODEX SUS 0.3-0.1%

ciprofloxacin-dexamethasone otic susp 0.3-0.1%

(generic of CIPRODEX)

neomycin-polymyxin-hc otic soln 1%


142


neomycin-polymyxin-hc otic susp 3.5 mg/ml-

10000 unit/ml-1%

OTIC STEROIDS fluocinolone acetonide (otic) oil 0.01% (generic of

DERMOTIC)

hydrocortisone w/ acetic acid otic soln 1-2%

OXYTOCICS OXYTOCICS

methylergonovine maleate tab 0.2 mg

PASSIVE IMMUNIZING AND TREATMENT AGENTS IMMUNE SERUMS

FLEBOGAMMA INJ 5GM/50ML PA; Bill as Medical Claim

Only

FLEBOGAMMA INJ 10/100ML PA; Bill as Medical Claim

Only


Only


Only

GAMMAGARD INJ 1GM/10ML PA; Bill as Medical Claim

Only

GAMMAGARD INJ 2.5GM/25 PA; Bill as Medical Claim Only

GAMMAGARD INJ 5GM/50ML PA; Bill as Medical Claim Only

GAMMAGARD INJ 10GM/100 PA; Bill as Medical Claim Only



GAMMAGARD SD INJ 5GM HU PA; Bill as Medical Claim Only

GAMMAGARD SD INJ 10GM HU PA; Bill as Medical Claim Only

GAMUNEX-C INJ 1GM/10ML PA; Bill as Medical Claim Only

GAMUNEX-C INJ 2.5GM/25 PA; Bill as Medical Claim Only

GAMUNEX-C INJ 5GM/50ML PA; Bill as Medical Claim

Only

GAMUNEX-C INJ 10GM/100 PA; Bill as Medical Claim

Only

GAMUNEX-C INJ 20GM/200 PA; Bill as Medical Claim

Only


143


GAMUNEX-C INJ 40/400ML PA; Bill as Medical Claim

Only

HIZENTRA INJ 1GM/5ML PA; Bill as Medical Claim

Only


Only


Only

HIZENTRA INJ 10/50ML PA; Bill as Medical Claim

Only

PRIVIGEN INJ 5 GRAMS PA; Bill as Medical Claim Only

PRIVIGEN INJ 10GRAMS PA; Bill as Medical Claim Only



MONOCLONAL ANTIBODIES SYNAGIS INJ 50MG PA; Bill as Medical Claim

Only

SYNAGIS INJ 100MG/ML PA; Bill as Medical Claim

Only

ZINPLAVA SOL 25MG/ML PA; Bill as Medical Claim

Only

PENICILLINS AMINOPENICILLINS

amoxicillin (trihydrate) cap 250 mg

amoxicillin (trihydrate) cap 500 mg

amoxicillin (trihydrate) for susp 125 mg/5ml




amoxicillin (trihydrate) tab 500 mg

amoxicillin (trihydrate) tab 875 mg

NATURAL PENICILLINS penicillin v potassium tab 250 mg

penicillin v potassium tab 500 mg

PENICILLIN COMBINATIONS amoxicillin & k clavulanate for susp 200-28.5

mg/5ml

amoxicillin & k clavulanate for susp 250-62.5 mg/5ml

amoxicillin & k clavulanate for susp 400-57

mg/5ml


144


amoxicillin & k clavulanate for susp 600-42.9

mg/5ml (generic of AUGMENTIN ES-600)

amoxicillin & k clavulanate tab 250-125 mg

amoxicillin & k clavulanate tab 500-125 mg (generic of AUGMENTIN)

amoxicillin & k clavulanate tab 875-125 mg

PENICILLINASE-RESISTANT PENICILLINS dicloxacillin sodium cap 250 mg

dicloxacillin sodium cap 500 mg

PROGESTINS PROGESTINS

MAKENA INJ 250MG/ML PA

MAKENA INJ 275MG PA

medroxyprogesterone acetate tab 2.5 mg (generic

of PROVERA)

medroxyprogesterone acetate tab 5 mg (generic of

PROVERA)

medroxyprogesterone acetate tab 10 mg (generic

of PROVERA)

progesterone cap 100 mg (generic of

PROMETRIUM)

progesterone cap 200 mg (generic of PROMETRIUM)

PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. AGENTS FOR CHEMICAL DEPENDENCY

acamprosate calcium tab delayed release 333 mg

disulfiram tab 250 mg

disulfiram tab 500 mg

ANTIDEMENTIA AGENTS donepezil hydrochloride orally disintegrating tab 5

mg PA

donepezil hydrochloride orally disintegrating tab 10 mg

PA

donepezil hydrochloride tab 5 mg (generic of ARICEPT)

PA


PA


PA

galantamine hydrobromide cap er 24hr 8 mg

(generic of RAZADYNE ER)

PA



PA



PA

galantamine hydrobromide tab 4 mg PA


145




memantine hcl oral solution 2 mg/ml PA

memantine hcl tab 5 mg (generic of NAMENDA) PA

memantine hcl tab 10 mg (generic of NAMENDA) PA

memantine hcl tab 28 x 5 mg & 21 x 10 mg

titration pack (generic of NAMENDA TITRATION PAK)

PA

rivastigmine tartrate cap 1.5 mg (base equivalent) PA

rivastigmine tartrate cap 3 mg (base equivalent) PA

rivastigmine tartrate cap 4.5 mg (base equivalent) PA

rivastigmine tartrate cap 6 mg (base equivalent) PA

rivastigmine td patch 24hr 4.6 mg/24hr (generic of EXELON)

PA


PA


PA

FIBROMYALGIA AGENTS SAVELLA MIS TITR PAK

SAVELLA TAB 12.5MG QL (2 tabs / 1 day)

SAVELLA TAB 25MG QL (2 tabs / 1 day)



MOVEMENT DISORDER DRUG THERAPY AUSTEDO TAB 6MG PA

AUSTEDO TAB 9MG PA

AUSTEDO TAB 12MG PA

INGREZZA CAP 40MG PA



MULTIPLE SCLEROSIS AGENTS AUBAGIO TAB 7MG PA

AUBAGIO TAB 14MG PA

AVONEX PEN KIT 30MCG PA

AVONEX PREFL KIT 30MCG PA

BETASERON INJ 0.3MG PA

COPAXONE INJ 20MG/ML PA

dimethyl fumarate capsule delayed release 120 mg (generic of TECFIDERA)

PA, QL (2 caps / 1 day)

dimethyl fumarate capsule delayed release 240 mg (generic of TECFIDERA)


dimethyl fumarate capsule dr starter pack 120 mg & 240 mg (generic of TECFIDERA STARTER PACK)


EXTAVIA INJ 0.3MG PA


146


GILENYA CAP 0.5MG PA

glatiramer acetate soln prefilled syringe 40 mg/ml

(generic of COPAXONE)

PA

LEMTRADA INJ 12/1.2ML PA; Bill as Medical Claim Only

OCREVUS INJ 300/10ML PA; Bill as Medical Claim Only

PLEGRIDY INJ PA

PLEGRIDY INJ PEN PA

PLEGRIDY INJ STARTER PA

PLEGRIDY PEN INJ STARTER PA

REBIF INJ 22/0.5 PA

REBIF INJ 44/0.5 PA

REBIF REBIDO INJ 22/0.5 PA

REBIF REBIDO INJ 44/0.5 PA

TECFIDERA CAP 120MG PA, QL (2 caps / 1 day)

TECFIDERA CAP 240MG PA, QL (2 caps / 1 day)

TECFIDERA MIS STARTER PA, QL (2 caps / 1 day)

TYSABRI INJ 300/15ML PA; Bill as Medical Claim

Only

POSTHERPETIC NEURALGIA (PHN)/NEUROPATHIC PAIN AGENTS GRALISE TAB 300MG PA

GRALISE TAB 600MG PA

RESTLESS LEG SYNDROME (RLS) AGENTS HORIZANT TAB 300MG ER PA

HORIZANT TAB 600MG ER PA

SMOKING DETERRENTS APO-VARENICL TAB 0.5MG

APO-VARENICL TAB 1MG

bupropion hcl (smoking deterrent) tab er 12hr 150 mg

QL (84 days supply in 180 days)

NICODERM CQ DIS 7MG/24HR QL (84 days supply in 180 days), OTC

NICODERM CQ DIS 14MG/24H QL (84 days supply in 180 days), OTC

NICODERM CQ DIS 21MG/24H QL (84 days supply in 180 days), OTC

NICORETTE GUM 2MG QL (84 days supply in 180 days), OTC

NICORETTE GUM 2MG CINN QL (84 days supply in 180 days), OTC

NICORETTE GUM 2MG MINT QL (84 days supply in 180 days), OTC

NICORETTE GUM 2MG ORIG QL (84 days supply in 180 days), OTC


147


NICORETTE GUM 2MGFRUIT QL (84 days supply in 180

days), OTC

NICORETTE GUM 4MG QL (84 days supply in 180

days), OTC

NICORETTE GUM 4MG CINN QL (84 days supply in 180

days), OTC

NICORETTE GUM 4MG MINT QL (84 days supply in 180

days), OTC

NICORETTE GUM 4MG ORIG QL (84 days supply in 180

days), OTC

NICORETTE GUM 4MGFRUIT QL (84 days supply in 180 days), OTC

NICORETTE LOZ 2MG MINT QL (84 days supply in 180 days), OTC

NICORETTE LOZ 4MG OTC

NICORETTE LOZ 4MG MINT QL (84 days supply in 180 days), OTC

NICORETTE ST GUM 2MG MINT QL (84 days supply in 180 days), OTC

NICORETTE ST GUM 2MG ORIG QL (84 days supply in 180 days), OTC

NICORETTE ST GUM 4MG ORIG QL (84 days supply in 180 days), OTC

nicotine polacrilex gum 2 mg QL (84 days supply in 180

days), OTC

nicotine polacrilex gum 4 mg QL (84 days supply in 180

days), OTC

nicotine polacrilex lozenge 2 mg QL (84 days supply in 180

days), OTC

nicotine polacrilex lozenge 4 mg QL (84 days supply in 180

days), OTC

nicotine td patch 24hr 7 mg/24hr QL (84 days supply in 180

days), OTC

nicotine td patch 24hr 14 mg/24hr QL (84 days supply in 180

days), OTC

nicotine td patch 24hr 21 mg/24hr OTC

nicotine td patch 24hr 21 mg/24hr QL (84 days supply in 180 days), OTC

NICOTROL INH QL (84 days supply in 180 days)

NICOTROL NS SPR 10MG/ML QL (84 days supply in 180 days)

VARENICLINE TAB 0.5MG

VARENICLINE TAB 1MG

TRANSTHYRETIN AMYLOIDOSIS AGENTS ONPATTRO SOL 10MG/5ML PA; Bill as Medical Claim

Only


148


TEGSEDI INJ 284/1.5 PA; Bill as Medical Claim

Only

RESPIRATORY AGENTS - MISC. ALPHA-PROTEINASE INHIBITOR (HUMAN)

ARALAST NP INJ 1000MG PA; Bill as Medical Claim

Only

GLASSIA INJ PA; Bill as Medical Claim

Only

PROLASTIN-C INJ 1000MG PA; Bill as Medical Claim

Only

ZEMAIRA INJ 1000MG PA; Bill as Medical Claim

Only

CYSTIC FIBROSIS AGENTS PULMOZYME SOL 1MG/ML PA

PULMONARY FIBROSIS AGENTS ESBRIET CAP 267MG PA

ESBRIET TAB 267MG PA

ESBRIET TAB 801MG PA

TETRACYCLINES GLYCYLCYCLINES

tigecycline for iv soln 50 mg (generic of TYGACIL) PA; Bill as Medical Claim

Only

TIGECYCLINE INJ 50MG PA; Bill as Medical Claim Only

TYGACIL INJ 50MG PA; Bill as Medical Claim Only

TETRACYCLINES demeclocycline hcl tab 150 mg PA

demeclocycline hcl tab 300 mg PA

doxycycline hyclate cap 50 mg

doxycycline hyclate cap 100 mg (generic of VIBRAMYCIN)

doxycycline hyclate tab 20 mg

doxycycline hyclate tab 100 mg

doxycycline monohydrate cap 50 mg

doxycycline monohydrate cap 100 mg

doxycycline monohydrate for susp 25 mg/5ml (generic of VIBRAMYCIN)

doxycycline monohydrate tab 100 mg

minocycline hcl cap 50 mg

minocycline hcl cap 75 mg

minocycline hcl cap 100 mg (generic of MINOCIN)

tetracycline hcl cap 250 mg QL (4 caps / 1 day)

tetracycline hcl cap 500 mg QL (4 caps / 1 day)


149


THYROID AGENTS ANTITHYROID AGENTS

methimazole tab 5 mg

methimazole tab 10 mg

propylthiouracil tab 50 mg

THYROID HORMONES ARMOUR THYRO TAB 120MG

ARMOUR THYRO TAB 180MG



levothyroxine sodium tab 25 mcg (generic of

SYNTHROID)


SYNTHROID)


SYNTHROID)


SYNTHROID)


SYNTHROID)


SYNTHROID)

levothyroxine sodium tab 125 mcg (generic of SYNTHROID)






liothyronine sodium tab 5 mcg (generic of CYTOMEL)



NATURE THROI TAB 162.5MG

NATURE-THROI TAB 16.25MG



NATURE-THROI TAB 65MG



150









thyroid tab 15 mg (1/4 grain)

thyroid tab 30 mg (1/2 grain)

thyroid tab 60 mg (1 grain)

thyroid tab 90 mg (1 1/2 grain)

thyroid tab 120 mg (2 grain)

WESTHROID TAB 32.5MG

WESTHROID TAB 65MG

WESTHROID TAB 97.5MG

WESTHROID TAB 130MG

WESTHROID TAB 195MG

WP THYROID TAB 16.25MG



WP THYROID TAB 65MG




WP THYROID TAB 130MG

TOXOIDS TOXOID COMBINATIONS

ADACEL INJ

BOOSTRIX INJ

DAPTACEL INJ

TDVAX INJ 2-2 LF

TENIVAC INJ 5-2LF

ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS ANTISPASMODICS

dicyclomine hcl cap 10 mg

dicyclomine hcl oral soln 10 mg/5ml

dicyclomine hcl tab 20 mg

glycopyrrolate oral soln 1 mg/5ml (generic of CUVPOSA)

glycopyrrolate tab 1 mg (generic of ROBINUL)

glycopyrrolate tab 2 mg (generic of ROBINUL

FORTE)

hyoscyamine sulfate elixir 0.125 mg/5ml

hyoscyamine sulfate sl tab 0.125 mg

hyoscyamine sulfate soln 0.125 mg/ml


151


hyoscyamine sulfate tab 0.125 mg

hyoscyamine sulfate tab disint 0.125 mg

hyoscyamine sulfate tab er 12hr 0.375 mg

methscopolamine bromide tab 2.5 mg

methscopolamine bromide tab 5 mg

H-2 ANTAGONISTS cimetidine hcl soln 300 mg/5ml

cimetidine tab 200 mg

cimetidine tab 200 mg OTC




famotidine for susp 40 mg/5ml

famotidine tab 10 mg OTC

famotidine tab 20 mg OTC

famotidine tab 20 mg (generic of PEPCID)

famotidine tab 40 mg (generic of PEPCID)

MISC. ANTI-ULCER CARAFATE SUS 1GM/10ML

sucralfate tab 1 gm (generic of CARAFATE)

PROTON PUMP INHIBITORS esomeprazole magnesium cap delayed release 20

mg (base eq)

OTC

esomeprazole magnesium cap delayed release 20

mg (base eq) (generic of NEXIUM)

esomeprazole magnesium cap delayed release 40

mg (base eq) (generic of NEXIUM)

esomeprazole magnesium for delayed release susp

packet 10 mg (generic of NEXIUM)


years old

esomeprazole magnesium for delayed release susp packet 20 mg (generic of NEXIUM)

PA; PA Required for > 18 years old

esomeprazole magnesium for delayed release susp packet 40 mg (generic of NEXIUM)


FIRST-OMEPRA SUS 2MG/ML

lansoprazole cap delayed release 15 mg

lansoprazole cap delayed release 30 mg (generic

of PREVACID)

LANSOPRAZOLE SUS 3MG/ML

lansoprazole tab delayed release orally

disintegrating 15 mg

PA, OTC

lansoprazole tab delayed release orally disintegrating 15 mg (generic of PREVACID SOLUTAB)


lansoprazole tab delayed release orally disintegrating 15 mg (generic of PREVACID

SOLUTAB)

PA


152


lansoprazole tab delayed release orally

disintegrating 30 mg (generic of PREVACID SOLUTAB)


years old

lansoprazole tab delayed release orally disintegrating 30 mg (generic of PREVACID

SOLUTAB)

PA

OMEPRAZOLE + SUS SYRSPEND

omeprazole cap delayed release 10 mg


omeprazole cap delayed release 20 mg OTC


omeprazole magnesium cap dr 20.6 mg (20 mg

base equiv)

OTC

omeprazole magnesium delayed release tab 20 mg

(base equiv)

OTC

omeprazole tablet delayed release disintegrating

20 mg

OTC

pantoprazole sodium ec tab 20 mg (base equiv) (generic of PROTONIX)

pantoprazole sodium ec tab 40 mg (base equiv) (generic of PROTONIX)

PROTONIX PAK 40MG PA; PA Required for > 18 years old

ULCER DRUGS - PROSTAGLANDINS misoprostol tab 100 mcg

misoprostol tab 200 mcg

URINARY ANTISPASMODICS URINARY ANTISPASMODIC - ANTIMUSCARINICS

(ANTICHOLINERGIC) DETROL LA CAP 2MG

DETROL LA CAP 4MG

DETROL TAB 1MG

DETROL TAB 2MG

oxybutynin chloride syrup 5 mg/5ml

oxybutynin chloride tab 5 mg

oxybutynin chloride tab er 24hr 5 mg (generic of

DITROPAN XL)

oxybutynin chloride tab er 24hr 10 mg (generic of DITROPAN XL)

oxybutynin chloride tab er 24hr 15 mg

TOVIAZ TAB 4MG

TOVIAZ TAB 8MG

URINARY ANTISPASMODICS - CHOLINERGIC AGONISTS bethanechol chloride tab 5 mg

bethanechol chloride tab 10 mg


153




VACCINES BACTERIAL VACCINES

BCG VACCINE INJ PA; Bill as Medical Claim Only

PNEUMOVAX 23 INJ 25/0.5

PREVNAR 13 INJ

VIRAL VACCINES AFLURIA QUAD INJ 2020-21

ENGERIX-B INJ 20MCG/ML

FLUCLVX QUAD INJ 2020-21

FLUMIST QUAD SUS 2020-21

FLUZONE QUAD INJ 2020-21

GARDASIL 9 INJ Covered for ages 11 to 45

HAVRIX INJ 1440UNIT

M-M-R II INJ

RECOMBIVA-HB INJ 40MCG/ML

SHINGRIX INJ 50/0.5ML QL (2 per Lifetime); Covered for ages 50 and

older

VAQTA INJ 50UNT/ML

VAGINAL AND RELATED PRODUCTS SPERMICIDES

GYNOL II GEL 3% OTC

SHUR-SEAL GEL 2% OTC

VCF VAGINAL AER CONTRACP OTC

VCF VAGINAL GEL CONTRACE OTC

VCF VAGINAL MIS CONTRACP OTC

VAGINAL ANTI-INFECTIVES CLEOCIN SUP 100MG

clindamycin phosphate vaginal cream 2% (generic of CLEOCIN)

clotrimazole vaginal cream 1% OTC

clotrimazole vaginal cream 2% OTC

metronidazole vaginal gel 0.75%

miconazole nitrate vaginal app 200 mg & 2%

cream 9 gm kit

OTC

miconazole nitrate vaginal cream 2% OTC

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

OTC

miconazole nitrate vaginal supp 200 mg & 2% cream 9 gm kit

OTC

miconazole nitrate vaginal supp 1200 mg & 2% cream kit

OTC


154


miconazole nitrate vaginal suppos 100 mg OTC

MONISTAT 3 KIT COMBO PK OTC

terconazole vaginal cream 0.4%

terconazole vaginal cream 0.8%

terconazole vaginal suppos 80 mg

VAGINAL ESTROGENS estradiol vaginal cream 0.1 mg/gm (generic of

ESTRACE)

estradiol vaginal tab 10 mcg (generic of VAGIFEM)

ESTRING MIS 2MG

FEMRING MIS 0.1MG/24 PA, QL (1 ring / 90 days)

FEMRING MIS 0.05/24H PA, QL (1 ring / 90 days)

PREMARIN VAG CRE 0.625MG

VAGINAL PROGESTINS PROGESTERONE SUP VGS 100

PROGESTERONE SUP VGS 200

VASOPRESSORS ANAPHYLAXIS THERAPY AGENTS

epinephrine solution auto-injector 0.3 mg/0.3ml

(1:1000) (generic of EPIPEN 2-PAK)


epinephrine solution auto-injector 0.15 mg/0.3ml

(1:2000) (generic of EPIPEN-JR 2-PAK)


NEUROGENIC ORTHOSTATIC HYPOTENSION (NOH) - AGENTS droxidopa cap 100 mg (generic of NORTHERA) PA

droxidopa cap 200 mg (generic of NORTHERA) PA

droxidopa cap 300 mg (generic of NORTHERA) PA

VASOPRESSORS midodrine hcl tab 2.5 mg

midodrine hcl tab 5 mg

midodrine hcl tab 10 mg

VITAMINS OIL SOLUBLE VITAMINS

cholecalciferol cap 1.25 mg (50000 unit) OTC

cholecalciferol cap 10 mcg (400 unit) OTC





cholecalciferol drops 125 mcg/ml (5000 unit/ml) OTC

cholecalciferol oral liquid 10 mcg/ml (400 unit/ml) OTC

cholecalciferol tab 10 mcg (400 unit) OTC





155


D-VI-SOL LIQ 400UNIT OTC

DECARA CAP 25000UNT OTC

DRISDOL CAP 50000UNT

ergocalciferol cap 1.25 mg (50000 unit) (generic of DRISDOL)

THERA-D TAB 4000UNIT OTC

VITAMIN D3 CAP 4000UNIT OTC

VITAMIN D3 TAB 3000UNIT OTC

VITAMIN D3 TAB 10000UNT OTC

vitamin e cap 45 mg (100 unit) OTC


vitamin e cap 100 unit OTC









vitamin e oral oil 45 mg/0.25ml (100 unit/0.25ml) OTC

vitamin e oral oil 67 mg/0.25ml (100 unit/0.25ml) OTC

vitamin e soln 6.75 mg/0.3ml (15 unit/0.3ml) OTC

VITAMIN E TAB 200UNIT OTC

VITAMIN E TAB 400UNIT OTC

WATER SOLUBLE VITAMINS ACEROLA C WAF 500MG OTC

ASCORBIC ACD POW OTC

ascorbic acid cap er 500 mg OTC

ascorbic acid chew tab 100 mg OTC




ascorbic acid liquid 500 mg/5ml OTC

ascorbic acid lozenge 60 mg OTC

ascorbic acid tab 250 mg OTC



ascorbic acid tab er 500 mg OTC



B-6 TAB 500MG OTC

B-NATAL LOZ 25MG OTC

BUFFERED VIT CAP C 1000MG OTC

CYTO C POW OTC


156


LIQUID C 500 LIQ 500/15ML OTC

niacin cap er 250 mg OTC

niacin cap er 500 mg OTC

niacin tab 50 mg OTC



niacin tab er 250 mg OTC



NIACIN TR TAB 1000MG OTC

pyridoxine hcl tab 25 mg OTC




PYRIDOXINE INJ 100MG/ML

thiamine hcl tab 50 mg OTC



thiamine mononitrate tab 100 mg OTC

VITA-C CRY OTC

VITAMIN B-6 TAB 200MG TR OTC

VITAMIN C CAP 500MG OTC

VITAMIN C CHW GUMMIE OTC

VITAMIN C LOZ 53 MG OTC

VITAMIN C LOZ 53MG OTC

VITAMIN C PAK 500MG OTC

VITAMIN C POW OTC

VITAMIN C TAB 60MG OTC

VITAMIN C TAB 100MG OTC

157

Index * *artificial tear ophth solution*** .... 138 *bacitracin-polymyxin b oint*** ...... 76

*b-complex vitamin cap**............. 123 *b-complex vitamin sublingual liquid**

............................................... 123

*b-complex vitamin tab er** ......... 123 *b-complex vitamin tab** ............. 123

*b-complex w/ c & e + zn tab*** .. 123 *b-complex w/ c & folic acid cap 1

mg*** ..................................... 123 *b-complex w/ c & folic acid tab 0.8

mg*** ..................................... 123 *b-complex w/ c & folic acid tab 1

mg*** ..................................... 123 *b-complex w/ c & folic acid tab 5

mg*** ..................................... 123 *b-complex w/ c & folic acid tab*** 123

*calcium carb-vit d w/ minerals tabs 600 mg-200 unit*** .................. 119

*calcium carb-vit d w/ minerals tabs

600 mg-400 unit*** .................. 119 *calcium carb-vit d w/ minerals tabs

600 mg-800 unit*** .................. 119 *emollient - ointment** .................. 79

*fe fum-iron polysacch complex-fa-b cmplx-c-zn-mn-cu cap*** ............ 95

*krill oil cap 300 mg*** ................... 6 *methenamine-hyos-meth blue-sod

phos-phen sal tab 81.6 mg*** ...... 17 *multiple vitamin cap** ................ 130

*multiple vitamin tab** ................ 130 *multiple vitamins w/ minerals cap**

............................................... 127 *multiple vitamins w/ minerals chew

tab** ....................................... 127

*multiple vitamins w/ minerals liquid** ............................................... 127

*multiple vitamins w/ minerals tab er** ........................................ 127

*multiple vitamins w/ minerals tab** ............................................... 127

*neomycin-bacitracin-polymyxin oint*** ...................................... 76

*neomycin-bacitracin-polymyxin w/ lidocaine oint 4%*** ................... 76

*nit remover - gel*** ..................... 80

*omega-3 fatty acids cap 1000 mg** ............................................... 137

*omega-3 fatty acids cap 1200 mg** ............................................... 137

*omega-3 fatty acids cap 300 mg**

............................................... 137 *omega-3 fatty acids cap 435 mg**



............................................... 137 *omega-3 fatty acids cap delayed

release 1000 mg** .................... 137 *oral electrolyte solution*** .......... 119

*pediatric multiple vitamin w/ c & fa chew tab** ............................... 132

*pediatric multiple vitamin w/ extra c & fa chew tab** ........................... 132

*pediatric multiple vitamin w/ minerals

& c chew tab** ......................... 131 *pediatric multiple vitamins w/ fl-fe

drops 0.25-10 mg/ml** ............. 131 *pediatric multiple vitamins w/ fluoride

soln 0.25 mg/ml*** .................. 132 *pediatric multiple vitamins w/ fluoride

soln 0.5 mg/ml*** .................... 132 *pediatric multiple vitamins w/ iron

chew tab 15 mg** ..................... 132 *pediatric multiple vitamins w/ iron

chew tab 18 mg** ..................... 132 *pediatric vitamins acd w/ fluoride soln

0.25 mg/ml*** ......................... 132 *pediatric vitamins acd w/ fluoride soln

0.5 mg/ml*** ........................... 132

*pediatric vitamins adc drops 750 unit-400 unit-35 mg/ml*** ............... 133

*salicylic acid cream 6% & cleanser liqd kit** .................................... 79

*sodium phosphates - enema (pediatric)*** ............................. 98

*sodium phosphates - enema*** ..... 98 *sodium polystyrene sulfonate

powder** ................................. 122

158

*white petrolatum-mineral oil ophth ointment*** ............................. 138

1 1ML SYRINGE MIS 30G ................. 115

1ST TIER UNI MIS 29GX12MM ....... 115 1ST TIER UNI MIS 31GX5MM ......... 115

1ST TIER UNI MIS 31GX6MM ......... 115 1ST TIER UNI MIS 31GX8MM ......... 115

1ST TIER UNI MIS 32GX4MM ......... 115 A abacavir sulfate soln 20 mg/ml (base

equiv) ........................................ 60

abacavir sulfate tab 300 mg (base equiv) ........................................ 60

abacavir sulfate-lamivudine tab 600-

300 mg ...................................... 61 abacavir sulfate-lamivudine-zidovudine

tab 300-150-300 mg .................... 61 ABC COMPLETE TAB WOMEN ......... 124

ABILIFY see aripiprazole tab 10 mg ........... 60

see aripiprazole tab 15 mg ........... 60 see aripiprazole tab 2 mg ............. 59

see aripiprazole tab 20 mg ........... 60 see aripiprazole tab 30 mg ........... 60

see aripiprazole tab 5 mg ............. 59 ABILIFY MAIN INJ 300MG ................ 59

ABILIFY MAIN INJ 400MG ................ 59 abiraterone acetate tab 250 mg ....... 50

ABOUTTIME MIS 30GX5/16 ........... 110

ABOUTTIME MIS 31GX3/16 ........... 110 ABOUTTIME MIS 31GX5/16 ........... 110

ABOUTTIME MIS 32GX5/32 ........... 110 ABREVA CRE 10% .......................... 77

acamprosate calcium tab delayed release 333 mg ......................... 144

acarbose tab 100 mg ...................... 35 acarbose tab 25 mg ........................ 35

acarbose tab 50 mg ........................ 35 ACCU-CHEK KIT FASTCLIX ............ 101

ACCU-CHEK KIT SOFTCLIX ............ 101 ACCU-CHEK TES AVIVA PL ............... 81

ACCU-CHEK TES GUIDE .................. 81 ACCU-CHEK TES SMART .................. 81

ACCUPRIL

see quinapril hcl tab 10 mg ........... 45 see quinapril hcl tab 20 mg ........... 45

see quinapril hcl tab 40 mg ........... 45 see quinapril hcl tab 5 mg ............ 45

ACCURETIC see quinapril-hydrochlorothiazide tab

10-12.5 mg ............................. 47 see quinapril-hydrochlorothiazide tab

20-12.5 mg ............................. 48 see quinapril-hydrochlorothiazide tab

20-25 mg ................................ 48 ACEROLA C WAF 500MG ............... 155

acetaminophen cap 500 mg ............. 10 acetaminophen chew tab 160 mg ..... 10

acetaminophen chew tab 80 mg ....... 10 acetaminophen disintegrating tab 160

mg ............................................ 10

acetaminophen disintegrating tab 80 mg ............................................ 10

acetaminophen elixir 160 mg/5ml .... 10 acetaminophen liquid 160 mg/5ml ... 10

acetaminophen liquid 167 mg/5ml ... 10 acetaminophen soln 160 mg/5ml ..... 10

acetaminophen suppos 120 mg ........ 10 acetaminophen suppos 650 mg ........ 10

acetaminophen susp 160 mg/5ml ..... 10 acetaminophen tab 325 mg ............. 10

acetaminophen tab 500 mg ............. 10 acetaminophen tab er 650 mg ......... 10

acetaminophen w/ codeine soln 120-12 mg/5ml ...................................... 13

acetaminophen w/ codeine tab 300-15

mg ............................................ 13 acetaminophen w/ codeine tab 300-30

mg ............................................ 13 acetaminophen w/ codeine tab 300-60

mg ............................................ 13 acetazolamide cap er 12hr 500 mg ... 81

acetazolamide tab 125 mg .............. 81 acetazolamide tab 250 mg .............. 81

acetic acid otic soln 2% ................. 141 acetylcysteine cap 600 mg ............ 137

acetylcysteine inhal soln 10% .......... 75 acetylcysteine inhal soln 20% .......... 75

ACNE MEDICAT LOT 10% ................ 75 ACNE MEDICAT LOT 5% .................. 75

ACTEMRA INJ 200/10ML ................... 8

ACTEMRA INJ 400/20ML ................... 8 ACTEMRA INJ 80MG/4ML .................. 8

159

ACTIDOM DMX LIQ ......................... 72 ACTI-LANCE MIS 28G ................... 101

ACTI-LANCE MIS LITE 28G ............ 101 ACTI-LANCE MIS SPEC 17G ........... 101

ACTI-LANCE MIS UNIV 23G ........... 101 ACTIMMUNE INJ 2MU/0.5 ................ 52

ACTIVE 55 LIQ PLUS ..................... 124 ACTIVELLA

see estradiol & norethindrone acetate tab 1-0.5 mg ............................ 86

ACTIVNUTRIEN CAP ...................... 124 ACTOPLUS MET

see pioglitazone hcl-metformin hcl tab 15-500 mg ......................... 36

see pioglitazone hcl-metformin hcl

tab 15-850 mg ......................... 36 ACTOS

see pioglitazone hcl tab 15 mg (base equiv) ..................................... 39



ACULAR see ketorolac tromethamine ophth

soln 0.5% .............................. 141 ACULAR LS

see ketorolac tromethamine ophth soln 0.4% .............................. 141

acyclovir cap 200 mg ...................... 63

acyclovir susp 200 mg/5ml .............. 63 acyclovir tab 400 mg ...................... 63

acyclovir tab 800 mg ...................... 63 ADACEL INJ ................................. 150

ADCIRCA TAB 20MG ....................... 67 ADDERALL

see amphetamine-dextroamphetamine tab 10 mg.... 2

see amphetamine-dextroamphetamine tab 12.5 mg . 2



see amphetamine-

dextroamphetamine tab 30 mg.... 2

see amphetamine-dextroamphetamine tab 5 mg ..... 1

see amphetamine-dextroamphetamine tab 7.5 mg .. 2

ADDERALL TAB 10MG ...................... 1 ADDERALL TAB 12.5MG ................... 1

ADDERALL TAB 15MG ...................... 1 ADDERALL TAB 20MG ...................... 1

ADDERALL TAB 30MG ...................... 1 ADDERALL TAB 5MG ........................ 1

ADDERALL TAB 7.5MG ..................... 1 ADDERALL XR CAP 10MG ................. 1

ADDERALL XR CAP 15MG ................. 1 ADDERALL XR CAP 20MG ................. 1

ADDERALL XR CAP 25MG ................. 1

ADDERALL XR CAP 30MG ................. 1 ADDERALL XR CAP 5MG ................... 1

adefovir dipivoxil tab 10 mg ............ 63 ADEK CHW PLUS ZN ..................... 124

ADLT ONE DLY CHW GUMMIES ...... 124 ADRENOID CAP ............................ 134

ADULT 50+ CAP EYE HLTH ............ 124 ADULT 50+ CAP OCUVITE ............. 124

ADV ALLERGY KIT COLLECTI ........... 77 ADV DIABETIC TAB MULTIVIT ........ 124

ADV TRAVEL MIS LANC 28G .......... 101 ADVAIR DISKU AER 100/50 ............. 24

ADVAIR DISKU AER 250/50 ............. 24 ADVAIR DISKU AER 500/50 ............. 24

ADVAIR HFA AER 115/21 ................ 24

ADVAIR HFA AER 230/21 ................ 24 ADVAIR HFA AER 45/21 .................. 24

ADVATE INJ 1000UNIT .................... 90 ADVATE INJ 1500UNIT .................... 90

ADVATE INJ 2000UNIT .................... 90 ADVATE INJ 250UNIT ..................... 90

ADVATE INJ 3000UNIT .................... 90 ADVATE INJ 4000UNIT .................... 90

ADVATE INJ 500UNIT ..................... 90 ADVCATE SAFE MIS LANC 26G ....... 101

ADVOCATE MIS LANC 30G ............. 101 ADVOCATE MIS LANCETS .............. 101

ADYNOVATE INJ 1000UNIT .............. 90 ADYNOVATE INJ 1500UNIT .............. 90

ADYNOVATE INJ 2000UNIT .............. 90

ADYNOVATE INJ 250UNIT ............... 90 ADYNOVATE INJ 3000UNIT .............. 90

160

ADYNOVATE INJ 500UNIT ................ 90 ADYNOVATE INJ 750UNIT ................ 90

AERCHMBR PLS MIS FLOW-VU ....... 116 AERCHMBR PLS MIS LRG MASK ...... 116

AERCHMBR PLS MIS MED MASK ..... 116 AERCHMBR PLS MIS SM MASK ....... 116

AERCHMBR Z- MIS STAT PLS ......... 116 AEROCHAMBER MIS CHAMBER ....... 116

AEROCHAMBER MIS FLOSIGNA ...... 116 AEROCHAMBER MIS MV ................ 116

AEROCHAMBER MIS PLUS ............. 116 AEROVENT MIS PLUS .................... 116

AFINITOR see everolimus tab 10 mg ............ 51

see everolimus tab 2.5 mg ........... 51

see everolimus tab 5 mg .............. 51 see everolimus tab 7.5 mg ........... 51

AFINITOR DISPERZ see everolimus tab for oral susp 2

mg .......................................... 51 see everolimus tab for oral susp 3

mg .......................................... 51 see everolimus tab for oral susp 5

mg .......................................... 51 AFLURIA QUAD INJ 2020-21 .......... 153

AFSTYLA KIT 1000UNIT ................... 90 AFSTYLA KIT 1500UNIT ................... 90

AFSTYLA KIT 2000UNIT ................... 90 AFSTYLA KIT 2500UNIT ................... 90

AFSTYLA KIT 250UNIT .................... 90

AFSTYLA KIT 3000UNIT ................... 90 AFSTYLA KIT 500UNIT .................... 90

AGAMATRIX MIS 33G .................... 101 AGRYLIN

see anagrelide hcl cap 0.5 mg ....... 93 AIMOVIG INJ 140MG/ML ............... 117

AIMOVIG INJ 70MG/ML ................. 117 AIMSCO MIS LUBRICAT ................... 99

AIMSCO TWIST MIS 32G ............... 101 AIMSCO TWIST MIS 33G ............... 101

AIRBORN+ POW REST .................. 124 AIRBORNE CHW ........................... 124

AIRBORNE CHW KIDS ................... 124 AIRBORNE POW ........................... 124

AIRBORNE+ CHW PROBIOTI .......... 124

AIRBORNE+ CHW REST ................ 124 AIRBORNE+ POW STRESS ............. 124

AIRBORNE+NAT LIQ ENERGY ........ 124 AIRSHIELD CHW IMMUNITY ........... 124

AJOVY INJ 225/1.5 ....................... 117 albendazole tab 200 mg .................. 17

ALBENZA see albendazole tab 200 mg ......... 17

albuterol sulfate soln nebu 0.083% (2.5 mg/3ml) .............................. 24

albuterol sulfate soln nebu 0.5% (5 mg/ml) ...................................... 24

albuterol sulfate soln nebu 0.63 mg/3ml (base equiv) ................... 24

albuterol sulfate soln nebu 1.25 mg/3ml (base equiv) ................... 24

albuterol sulfate syrup 2 mg/5ml ..... 25

ALCAINE see proparacaine hcl ophth soln 0.5%

............................................ 140 ALCOH-GLOVE PAD CONTOURE ...... 109

ALCOHOL PAD ............................. 109 ALCOHOL PAD 70% ...................... 109

ALCOHOL PAD PREP ..................... 109 ALCOHOL PADS PAD 70% ............. 109

ALCOHOL PREP PAD ..................... 109 ALCOHOL PREP PAD 70% .............. 109

ALCOHOL PREP PAD MED 70% ....... 109 ALCOHOL PREP PAD PADS 70% ..... 109

ALCOHOL SWAB PAD .................... 109 ALCOHOL SWAB PAD 70%............. 109

ALCOHOL SWAB PAD EX-THICK ..... 109

ALDACTAZIDE see spironolactone &

hydrochlorothiazide tab 25-25 mg .............................................. 82

ALDACTONE see spironolactone tab 100 mg...... 82

see spironolactone tab 25 mg ....... 82 see spironolactone tab 50 mg ....... 82

ALDARA see imiquimod cream 5% ............. 79

ALDURAZYME INJ 2.9MG/5M ........... 84 alendronate sodium oral soln 70

mg/75ml .................................... 82 alendronate sodium tab 10 mg ........ 82

alendronate sodium tab 35 mg ........ 83

alendronate sodium tab 70 mg ........ 83 ALFERON N INJ 5MU/ML .................. 52

161

alfuzosin hcl tab er 24hr 10 mg ........ 89 ALGAE BASED TAB CALCIUM ......... 124

ALINIA see nitazoxanide tab 500 mg ........ 17

ALINIA SUS 100/5ML ...................... 17 ALIQOPA INJ 60MG ......................... 51

ALIVE 50+ TAB ENERGY ................ 124 ALIVE 50+ TAB WOMENS .............. 124

ALIVE DAILY TAB WOMENS ........... 124 ALIVE ENERGY TAB MENS ............. 124

ALIVE ENERGY TAB WOMENS......... 124 ALIVE LIQ MULT-VIT ..................... 124

ALIVE MULTI CHW VITAMIN ........... 124 ALIVE WOMENS CHW 50+ ............. 124

ALIVE WOMENS CHW GUMMY ........ 124

ALKERAN TAB 2MG ......................... 49 ALLEGRA ALRG TAB 30MG ............... 43

allopurinol tab 100 mg .................... 90 allopurinol tab 300 mg .................... 90

ALOE VESTA OIN 2% ...................... 76 ALOE VESTA OIN CLEAR 2% ............ 76

ALOG/PIOGLIT TAB 12.5-15 ............ 35 ALOG/PIOGLIT TAB 12.5-30 ............ 35

ALOG/PIOGLIT TAB 12.5-45 ............ 35 ALOG/PIOGLIT TAB 25-15MG ........... 35

ALOGLIPTIN TAB 12.5MG ................ 38 ALOGLIPTIN TAB 25MG ................... 38

ALOGLIPTIN/ TAB METFORM ............ 35 ALORA DIS 0.025MG ...................... 86

ALORA DIS 0.05MG ........................ 86

ALORA DIS 0.075MG ...................... 86 ALORA DIS 0.1MG .......................... 86

ALOXI see palonosetron hcl iv soln 0.25

mg/5ml (base equivalent) .......... 41 ALOXI INJ 0.25MG/5 ....................... 41

ALPHAGAN P see brimonidine tartrate ophth soln

0.15% ................................... 139 ALPHAGAN P SOL 0.1% ................. 139

ALPHANATE INJ 1000UNIT ............... 90 ALPHANATE INJ 1500UNIT ............... 90

ALPHANATE INJ 2000UNIT ............... 90 ALPHANATE INJ 250 UNIT ............... 90

ALPHANATE INJ 500 UNIT ............... 90

ALPHANINE SD INJ 1000UNIT .......... 90 ALPHANINE SD INJ 1500UNIT .......... 90

ALPHANINE SD INJ 500UNIT ............ 90 ALPRAZOLAM CON 1 MG/ML ............ 20

alprazolam orally disintegrating tab 0.25 mg ..................................... 20

alprazolam orally disintegrating tab 0.5 mg ............................................ 20

alprazolam orally disintegrating tab 1 mg ............................................ 20

alprazolam orally disintegrating tab 2 mg ............................................ 20

alprazolam tab 0.25 mg .................. 20 alprazolam tab 0.5 mg .................... 20

alprazolam tab 1 mg ....................... 20 alprazolam tab 2 mg ....................... 20

alprazolam tab er 24hr 0.5 mg ......... 21

alprazolam tab er 24hr 1 mg ........... 21 alprazolam tab er 24hr 2 mg ........... 21

alprazolam tab er 24hr 3 mg ........... 21 ALPROLIX INJ 1000UNIT ................. 91

ALPROLIX INJ 2000UNIT ................. 91 ALPROLIX INJ 250UNIT ................... 90

ALPROLIX INJ 3000UNIT ................. 91 ALPROLIX INJ 4000UNIT ................. 91

ALPROLIX INJ 500UNIT ................... 90 ALTACE

see ramipril cap 1.25 mg .............. 45 see ramipril cap 10 mg................. 45

see ramipril cap 2.5 mg ............... 45 see ramipril cap 5 mg .................. 45

alum & mag hydroxide-simethicone

chew tab 200-200-25 mg ............. 16 alum & mag hydroxide-simethicone

susp 400-400-40 mg/5ml ............. 16 ALUM HYDROX SUS 320/5ML ........... 16

aluminum hydroxide-magnesium carbonate chew tab 160-105 mg ... 16

aluminum hydroxide-magnesium carbonate susp 95-358 mg/15ml ... 16

amantadine hcl cap 100 mg ............. 53 amantadine hcl soln 50 mg/5ml ....... 53

AMARYL see glimepiride tab 1 mg .............. 40

see glimepiride tab 2 mg .............. 40 see glimepiride tab 4 mg .............. 40

AMBIEN

see zolpidem tartrate tab 10 mg.... 97 see zolpidem tartrate tab 5 mg ..... 97

162

AMCINONIDE OIN 0.1% .................. 77 AMERGE

see naratriptan hcl tab 1 mg (base equiv) ................................... 118

see naratriptan hcl tab 2.5 mg (base equiv) ................................... 118

AMICAR see aminocaproic acid tab 1000 mg

.............................................. 96 see aminocaproic acid tab 500 mg . 96

amiloride & hydrochlorothiazide tab 5-50 mg ........................................ 82

amiloride hcl tab 5 mg .................... 82 aminocaproic acid tab 1000 mg ........ 96

aminocaproic acid tab 500 mg ......... 96

amiodarone hcl tab 100 mg ............. 23 amiodarone hcl tab 200 mg ............. 23

amitriptyline hcl tab 10 mg .............. 33 amitriptyline hcl tab 100 mg ............ 34

amitriptyline hcl tab 150 mg ............ 34 amitriptyline hcl tab 25 mg .............. 34

amitriptyline hcl tab 50 mg .............. 34 amitriptyline hcl tab 75 mg .............. 34

amlodipine besylate tab 10 mg (base equivalent) ................................. 65

amlodipine besylate tab 2.5 mg (base equivalent) ................................. 65

amlodipine besylate tab 5 mg (base equivalent) ................................. 65

amlodipine besylate-benazepril hcl cap

10-20 mg ................................... 47 amlodipine besylate-benazepril hcl cap

10-40 mg ................................... 47 amlodipine besylate-benazepril hcl cap

2.5-10 mg .................................. 46 amlodipine besylate-benazepril hcl cap

5-10 mg ..................................... 47 amlodipine besylate-benazepril hcl cap

5-20 mg ..................................... 47 amlodipine besylate-benazepril hcl cap

5-40 mg ..................................... 47 amoxicillin & k clavulanate for susp

200-28.5 mg/5ml ...................... 143 amoxicillin & k clavulanate for susp

250-62.5 mg/5ml ...................... 143

amoxicillin & k clavulanate for susp 400-57 mg/5ml ......................... 143

amoxicillin & k clavulanate for susp 600-42.9 mg/5ml ...................... 144

amoxicillin & k clavulanate tab 250-125 mg .......................................... 144



amoxicillin (trihydrate) cap 250 mg 143 amoxicillin (trihydrate) cap 500 mg 143

amoxicillin (trihydrate) for susp 125 mg/5ml .................................... 143

amoxicillin (trihydrate) for susp 200 mg/5ml .................................... 143

amoxicillin (trihydrate) for susp 250

mg/5ml .................................... 143 amoxicillin (trihydrate) for susp 400

mg/5ml .................................... 143 amoxicillin (trihydrate) tab 500 mg 143

amoxicillin (trihydrate) tab 875 mg 143 amphetamine-dextroamphetamine tab

10 mg ......................................... 2 amphetamine-dextroamphetamine tab

12.5 mg ...................................... 2 amphetamine-dextroamphetamine tab



30 mg ......................................... 2

amphetamine-dextroamphetamine tab 5 mg ........................................... 1

amphetamine-dextroamphetamine tab 7.5 mg ........................................ 2

ANAFRANIL see clomipramine hcl cap 25 mg ... 34

see clomipramine hcl cap 50 mg ... 34 see clomipramine hcl cap 75 mg ... 34

anagrelide hcl cap 0.5 mg ............... 93 anagrelide hcl cap 1 mg .................. 93

ANAPROX DS see naproxen sodium tab 550 mg ... 9

anastrozole tab 1 mg ...................... 50 ANDRODERM DIS 2MG/24HR ........... 15

ANDRODERM DIS 4MG/24HR ........... 15

ANDROGEL GEL 1%(25MG) ............. 15 ANDROGEL GEL 1%(50MG) ............. 15

163

ANDROGEL GEL 1.62% ................... 15 ANIMAL SHAPE CHW IRON ............ 132

ANORO ELLIPT AER 62.5-25 ............ 25 ANTACID CHW 1177MG................... 16

ANTACID SOFT CHW 1177MG .......... 16 ANTI-DIARRHE LIQ 1MG/5ML ........... 40

ANTIOXIDANT TAB FORMULA ......... 124 ANUSOL-HC

see hydrocortisone perianal cream 2.5% ....................................... 16

ANUSOL-HC CRE 2.5% .................... 16 APO-VARENICL TAB 0.5MG ............ 146

APO-VARENICL TAB 1MG ............... 146 apraclonidine hcl ophth soln 0.5%

(base equivalent) ...................... 139

aprepitant capsule 125 mg .............. 42 aprepitant capsule 40 mg ................ 42

aprepitant capsule 80 mg ................ 42 aprepitant capsule therapy pack 80 &

125 mg ...................................... 42 APRISO CAP 0.375GM ..................... 88

APTIVUS CAP 250MG ...................... 61 AQUADEKS CHW .......................... 124

AQUADEKS DRO ........................... 131 AQUALANCE MIS 30G ................... 101

AQUANAZ TAB ............................... 72 AQUAPHILIC OIN ............................ 78

AQUAPHOR ADV OIN HEALING ......... 79 AQUAPHOR ADV OIN THER BAB ....... 79

AQUAPHOR OIN ............................. 79

AQUAPHOR OIN ADVANCED ............. 79 AQUORAL SPR ............................. 123

ARALAST NP INJ 1000MG .............. 148 ARAVA

see leflunomide tab 10 mg............. 9 see leflunomide tab 20 mg............. 9

ARICEPT see donepezil hydrochloride tab 10

mg ........................................ 144 see donepezil hydrochloride tab 23

mg ........................................ 144 see donepezil hydrochloride tab 5 mg

............................................ 144 ARIMIDEX

see anastrozole tab 1 mg ............. 50

aripiprazole tab 10 mg .................... 60 aripiprazole tab 15 mg .................... 60

aripiprazole tab 2 mg ...................... 59 aripiprazole tab 20 mg .................... 60

aripiprazole tab 30 mg .................... 60 aripiprazole tab 5 mg ...................... 59

ARISTADA INJ 1064MG ................... 60 ARISTADA INJ 441MG/1. ................. 60

ARISTADA INJ 662MG/2 .................. 60 ARISTADA INJ 882MG/3 .................. 60

ARISTADA INJ INITIO ..................... 60 armodafinil tab 150 mg .................... 3

armodafinil tab 200 mg .................... 3 armodafinil tab 250 mg .................... 4

armodafinil tab 50 mg ..................... 3 ARMOUR THYRO TAB 120MG ......... 149

ARMOUR THYRO TAB 180MG ......... 149

ARMOUR THYRO TAB 240MG ......... 149 ARMOUR THYRO TAB 300MG ......... 149

AROMASIN see exemestane tab 25 mg ........... 50

ASACOL HD TAB 800MG .................. 88 ASCORBIC ACD POW .................... 155

ascorbic acid cap er 500 mg .......... 155 ascorbic acid chew tab 100 mg ...... 155

ascorbic acid chew tab 125 mg ...... 155 ascorbic acid chew tab 250 mg ...... 155

ascorbic acid chew tab 500 mg ...... 155 ascorbic acid liquid 500 mg/5ml ..... 155

ascorbic acid lozenge 60 mg .......... 155 ascorbic acid tab 1000 mg ............. 155

ascorbic acid tab 250 mg .............. 155

ascorbic acid tab 500 mg .............. 155 ascorbic acid tab er 1000 mg ......... 155

ascorbic acid tab er 1500 mg ......... 155 ascorbic acid tab er 500 mg ........... 155

ASMANEX 120 AER 220MCG ............ 24 ASMANEX 14 AER 220MCG .............. 24

ASMANEX 30 AER 110MCG .............. 24 ASMANEX 30 AER 220MCG .............. 24

ASMANEX 60 AER 220MCG .............. 24 aspirin buffered (ca carb-mg carb-mg

ox) tab 325 mg ........................... 10 aspirin chew tab 81 mg ................... 10

ASPIRIN SUP 300MG ...................... 10 aspirin tab 325 mg ......................... 10

aspirin tab 500 mg ......................... 10

aspirin tab delayed release 325 mg .. 10 aspirin tab delayed release 81 mg .... 10

164

aspirin-acetaminophen-caffeine tab 250-250-65 mg ........................... 10

ASSURE CMFRT MIS 28G ............... 101 ASSURE ID MIS 1ML/31G .............. 110

ASSURE ID MIS 30GX3/16 ............ 110 ASSURE ID MIS 30GX5/16 ............ 110

ASSURE ID MIS 31GX3/16 ............ 110 ASSURE LANCE MIS 21G ............... 101

ASSURE LANCE MIS 28G ............... 101 ASSURE LANCE MIS LOW FLOW ..... 101

ASSURE LANCE MIS MICRO ........... 101 ASSURE LANCE MIS SAFE 25G ....... 101

ASSURE LANCE MIS SAFE 30G ....... 101 ASSURE PLUS MIS HIGH 18G ......... 101

ASSURE PLUS MIS LOW 25G .......... 101

ASSURE PLUS MIS MCRO 28G ........ 101 ASSURE PLUS MIS NORM 21G........ 101

ASSURE PLUS MIS PEDIATRI ......... 101 ASTAGRAF XL CAP 0.5MG .............. 121

ASTAGRAF XL CAP 1MG ................ 121 ASTAGRAF XL CAP 5MG ................ 121

atazanavir sulfate cap 150 mg (base equiv) ........................................ 61



atenolol & chlorthalidone tab 100-25 mg ............................................ 47

atenolol & chlorthalidone tab 50-25 mg

................................................. 47 atenolol tab 100 mg ....................... 64

atenolol tab 25 mg ......................... 64 atenolol tab 50 mg ......................... 64

ATIVAN see lorazepam tab 0.5 mg ............ 22

see lorazepam tab 1 mg ............... 22 see lorazepam tab 2 mg ............... 22

atomoxetine hcl cap 10 mg (base equiv) ......................................... 3



atomoxetine hcl cap 25 mg (base

equiv) ......................................... 3




atorvastatin calcium tab 10 mg (base equivalent) ................................. 44




atovaquone susp 750 mg/5ml .......... 17

atovaquone-proguanil hcl tab 250-100 mg ............................................ 48

atovaquone-proguanil hcl tab 62.5-25 mg ............................................ 48

ATRIPLA see efavirenz-emtricitabine-tenofovir

df tab 600-200-300 mg ............. 61 ATRIPLA TAB ................................. 61

ATROPINE SUL SOL 1% OP ........... 139 atropine sulfate ophth oint 1% ....... 139

ATROVENT HFA AER 17MCG ............ 23 AUBAGIO TAB 14MG ..................... 145

AUBAGIO TAB 7MG ....................... 145 AUGMENTIN

see amoxicillin & k clavulanate tab

500-125 mg ........................... 144 AUGMENTIN ES-600

see amoxicillin & k clavulanate for susp 600-42.9 mg/5ml ............ 144

AUM MINI PEN MIS 32GX4MM ........ 110 AUM MINI PEN MIS 32GX5MM ........ 110

AUM MINI PEN MIS 32GX6MM ........ 110 AURORA LANCE MIS 30G .............. 101

AURORA LANCE MIS THIN 23G ...... 101 AUSTEDO TAB 12MG .................... 145

AUSTEDO TAB 6MG ...................... 145 AUSTEDO TAB 9MG ...................... 145

AUTO LANCET MIS ....................... 101 AUTOLET II KIT CLINISAF ............. 101

AUTOLET LITE KIT ........................ 101

AUTOLET LITE KIT CLINISAF ......... 101 AUTOLET LITE KIT STARTER .......... 101

165

AUTOPEN MIS 1 UNIT ................... 110 AUTOPEN MIS 1-21UNIT ............... 110

AUTOPEN MIS 2 UNIT ................... 110 AUTOPEN MIS 2-42UNIT ............... 110

AUTOSHIELD MIS 30GX5MM .......... 110 AVALIDE

see irbesartan-hydrochlorothiazide tab 150-12.5 mg ...................... 47

see irbesartan-hydrochlorothiazide tab 300-12.5 mg ...................... 47

AVAPRO see irbesartan tab 150 mg ............ 46

see irbesartan tab 300 mg ............ 46 see irbesartan tab 75 mg .............. 46

AVASTIN INJ .................................. 49

AVASTIN INJ 400/16ML ................... 49 AVODART

see dutasteride cap 0.5 mg ........... 89 AVONEX PEN KIT 30MCG ............... 145

AVONEX PREFL KIT 30MCG ............ 145 AVSOLA INJ 100MG ........................ 88

azathioprine tab 100 mg ............... 121 azathioprine tab 50 mg ................. 121

azathioprine tab 75 mg ................. 121 AZEDRA DOSIM INJ 15MCI/ML ......... 52

AZEDRA THERA INJ 15MCI/ML ......... 52 azelastine hcl nasal spray 0.1% (137

mcg/spray) ............................... 136 azelastine hcl ophth soln 0.05% ..... 141

azithromycin for susp 100 mg/5ml ... 99

azithromycin for susp 200 mg/5ml ... 99 azithromycin tab 250 mg ................. 99

azithromycin tab 500 mg ................. 99 azithromycin tab 600 mg ................. 99

AZO HORMONAL TAB HEALTH ........ 124 AZOPT

see brinzolamide ophth susp 1% . 141 AZULFIDINE

see sulfasalazine tab 500 mg ........ 89 AZULFIDINE EN-TABS

see sulfasalazine tab delayed release 500 mg ................................... 89

B B-12 TAB 2000MCG ........................ 94

B-12 TAB 2500MCG ........................ 94

B-6 TAB 500MG ........................... 155 BABY IRON DRO IMMUNITY ........... 131

bacitracin oint 500 unit/gm ............. 76 bacitracin zinc oint 500 unit/gm ....... 76

bacitracin-polymyxin b ophth oint .. 139 bacitracin-polymyxin-neomycin-hc

ophth oint 1% ........................... 140 baclofen tab 10 mg ...................... 135

baclofen tab 20 mg ...................... 135 baclofen tab 5 mg ........................ 135

BACTRIM see sulfamethoxazole-trimethoprim

tab 400-80 mg ......................... 17 BACTRIM DS

see sulfamethoxazole-trimethoprim tab 800-160 mg ....................... 17

BAG BALM OIN .............................. 79

BANZEL see rufinamide susp 40 mg/ml ...... 29

see rufinamide tab 200 mg ........... 29 see rufinamide tab 400 mg ........... 29

BANZEL TAB 200MG ....................... 27 BANZEL TAB 400MG ....................... 27

BARACLUDE see entecavir tab 0.5 mg .............. 63

see entecavir tab 1 mg ................. 63 BARACLUDE SOL ............................ 63

BARIATRIC CAP MULTIVIT ............. 124 BARIATRIC CHW FUSION .............. 124

BASIC AM TAB ............................. 124 BASIC PM TAB ............................. 124

BAVENCIO INJ 20MG/ML ................. 49

BCG VACCINE INJ ........................ 153 BD LANCET UF MIS 30G ................ 101

BD LANCET UF MIS 33G ................ 101 BD MICROTAIN MIS LANCETS ........ 102

BD PEN MINI MIS ......................... 110 BD PEN MIS ................................. 110

BD PEN NEEDL MIS 29GX12.7 ....... 110 BD PEN NEEDL MIS 31GX5MM ....... 110

BD PEN NEEDL MIS 31GX8MM ....... 110 BD PEN NEEDL MIS 32GX4MM ....... 110

BD PEN NEEDL MIS 32GX5/32 ....... 110 BD PEN NEEDL MIS 32GX6MM ....... 110

BD SWAB BFLY PAD SNGL USE ...... 109 BD SWAB REG PAD SNGL USE ....... 109

benazepril hcl tab 10 mg ................. 45

benazepril hcl tab 20 mg ................. 45 benazepril hcl tab 40 mg ................. 45

166

benazepril hcl tab 5 mg ................... 45 BENEFIX INJ 1000UNIT ................... 91

BENEFIX INJ 2000UNIT ................... 91 BENEFIX INJ 250UNIT ..................... 91

BENEFIX INJ 3000UNIT ................... 91 BENEFIX INJ 500UNIT ..................... 91

benzonatate cap 100 mg ................. 72 benzonatate cap 200 mg ................. 72

benzoyl peroxide bar 10% ............... 75 benzoyl peroxide cream 10% ........... 75

benzoyl peroxide cream 2.5% .......... 75 benzoyl peroxide foam 5.3% ........... 75

benzoyl peroxide foam 9.8% ........... 75 benzoyl peroxide gel 10% ............... 75

benzoyl peroxide gel 2.5% .............. 75

benzoyl peroxide gel 5% ................. 75 benzoyl peroxide liq 10% ................ 75

benzoyl peroxide liq 2.5% ............... 75 benzoyl peroxide liq 5% .................. 75

benzoyl peroxide liq 7% .................. 75 benztropine mesylate tab 0.5 mg ..... 53

benztropine mesylate tab 1 mg ........ 53 benztropine mesylate tab 2 mg ........ 53

BESPONSA INJ 0.9MG ..................... 49 BETADINE SOL 10% ....................... 60

betamethasone dipropionate augmented cream 0.05% ............. 77

betamethasone dipropionate cream 0.05% ........................................ 77

betamethasone dipropionate lotion

0.05% ........................................ 77 betamethasone valerate cream 0.1%

(base equivalent) ........................ 77 betamethasone valerate lotion 0.1%

(base equivalent) ........................ 77 betamethasone valerate oint 0.1%

(base equivalent) ........................ 77 BETAPACE

see sotalol hcl tab 120 mg ............ 65 see sotalol hcl tab 160 mg ............ 65

see sotalol hcl tab 80 mg .............. 65 BETAPACE AF

see sotalol hcl (afib/afl) tab 120 mg .............................................. 65

see sotalol hcl (afib/afl) tab 160 mg

.............................................. 65 see sotalol hcl (afib/afl) tab 80 mg 65

BETASERON INJ 0.3MG ................. 145 BETATAR GEL SHA 2.5% ................. 80

betaxolol hcl ophth soln 0.5% ........ 138 bethanechol chloride tab 10 mg ..... 152

bethanechol chloride tab 25 mg ..... 153 bethanechol chloride tab 5 mg ....... 152

bethanechol chloride tab 50 mg ..... 153 BETHKIS NEB 300/4ML .................... 7

BETOPTIC-S SUS 0.25% OP .......... 138 bexarotene cap 75 mg .................... 52

BIAXIN XL see clarithromycin tab er 24hr 500

mg .......................................... 99 bicalutamide tab 50 mg .................. 50

BIDIL TAB ..................................... 67

BIKTARVY TAB ............................... 61 BILBERRY CAP PLUS ..................... 134

BILTRICIDE see praziquantel tab 600 mg ......... 17

bimatoprost ophth soln 0.03% ....... 141 BINAXNOW COV KIT HOME TES ....... 81

BIO-35 GLUTE CAP FREE ............... 124 BIO-35 IRON CAP FREE ................. 124

BIOCAL CAP ................................ 124 BIODESP DM SYP ........................... 72

BIOTENE DRY SPR MOIST ............. 123 BIOTIN FORTE TAB ....................... 123

bisacodyl suppos 10 mg .................. 98 bisacodyl tab delayed release 5 mg .. 98

bismuth subsalicylate chew tab 262 mg

................................................. 40 bismuth subsalicylate susp 262

mg/15ml .................................... 40 bismuth subsalicylate susp 525

mg/15ml .................................... 40 bismuth subsalicylate tab 262 mg .... 40

bisoprolol & hydrochlorothiazide tab 10-6.25 mg ................................ 47

bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg ............................... 47

bisoprolol & hydrochlorothiazide tab 5-6.25 mg ..................................... 47

bisoprolol fumarate tab 10 mg ......... 64 bisoprolol fumarate tab 5 mg ........... 64

BLEPH-10

see sulfacetamide sodium ophth soln 10% ..................................... 140

167

BLEPHAMIDE OIN S.O.P. ............... 140 BLEPHAMIDE SUS OP .................... 140

BLINK TEARS DRO 0.25% OP ........ 138 B-NATAL LOZ 25MG ...................... 155

BONIVA see ibandronate sodium tab 150 mg

(base equivalent) ...................... 83 BONIVA INJ 3MG/3ML ..................... 83

BOOSTRIX INJ ............................. 150 BOTOX INJ 100UNIT ..................... 137

BOTOX INJ 200UNIT ..................... 137 BOUDREAUXS OIN BABY BUT .......... 79

BREATHE EASE MIS LG MASK ........ 116 BREATHE EASE MIS MED MASK ...... 116

BREATHE EASE MIS SM MASK ........ 116

BRILINTA TAB 60MG ....................... 93 BRILINTA TAB 90MG ....................... 93

brimonidine tartrate ophth soln 0.15% ............................................... 139

brimonidine tartrate ophth soln 0.2% ............................................... 139

BRINEURA KIT 150/5ML .................. 84 brinzolamide ophth susp 1% .......... 141

bromocriptine mesylate cap 5 mg (base equivalent) ................................. 53

bromocriptine mesylate tab 2.5 mg (base equivalent) ........................ 53

brompheniramine & pseudoephedrine elixir 1-15 mg/5ml ....................... 72

budesonide delayed release particles

cap 3 mg .................................... 70 budesonide inhalation susp 0.25

mg/2ml ...................................... 24 budesonide inhalation susp 0.5 mg/2ml

................................................. 24 budesonide inhalation susp 1 mg/2ml

................................................. 24 budesonide nasal susp 32 mcg/act . 136

BUFFERED VIT CAP C 1000MG ....... 155 bumetanide tab 0.5 mg ................... 82

bumetanide tab 1 mg ..................... 82 bumetanide tab 2 mg ..................... 82

BUMEX see bumetanide tab 0.5 mg .......... 82

buprenorphine hcl sl tab 2 mg (base

equiv) ........................................ 15

buprenorphine hcl sl tab 8 mg (base equiv) ........................................ 15

buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg (base equiv) ................. 15

buprenorphine hcl-naloxone hcl sl tab 8-2 mg (base equiv) .................... 15

bupropion hcl (smoking deterrent) tab er 12hr 150 mg ......................... 146

bupropion hcl tab 100 mg ............... 30 bupropion hcl tab 75 mg ................. 30

bupropion hcl tab er 12hr 100 mg .... 31 bupropion hcl tab er 12hr 150 mg .... 31

bupropion hcl tab er 12hr 200 mg .... 31 bupropion hcl tab er 24hr 150 mg .... 31

bupropion hcl tab er 24hr 300 mg .... 31

buspirone hcl tab 10 mg ................. 19 buspirone hcl tab 15 mg ................. 19

buspirone hcl tab 30 mg ................. 20 buspirone hcl tab 5 mg ................... 19

buspirone hcl tab 7.5 mg ................ 19 butalbital-acetaminophen tab 50-325

mg ............................................ 10 butalbital-acetaminophen-caff w/ cod

cap 50-325-40-30 mg .................. 13 butalbital-acetaminophen-caffeine tab

50-325-40 mg ............................ 10 butalbital-aspirin-caff w/ codeine cap

50-325-40-30 mg ........................ 13 butalbital-aspirin-caffeine cap 50-325-

40 mg ........................................ 10

butenafine hcl cream 1% ................ 76 BUTRANS DIS 10MCG/HR ................ 15

BUTRANS DIS 15MCG/HR ................ 15 BUTRANS DIS 20MCG/HR ................ 15

BUTRANS DIS 5MCG/HR ................. 15 BUTRANS DIS 7.5/HR ..................... 15

BYETTA INJ 10MCG ........................ 38 BYETTA INJ 5MCG .......................... 38

C CA CITRATE TAB 250MG ............... 118

cabergoline tab 0.5 mg ................... 85 CAFERGOT TAB 1-100MG .............. 118

CALAN SR see verapamil hcl tab er 120 mg ... 66

see verapamil hcl tab er 240 mg ... 66

CALC ACETATE TAB 668MG ........... 118 calcipotriene cream 0.005% ............ 77

168

calcipotriene oint 0.005% ................ 77 calcipotriene soln 0.005% (50 mcg/ml)

................................................. 77 calcitonin (salmon) nasal soln 200

unit/act ...................................... 83 calcitriol cap 0.25 mcg .................... 84

calcitriol cap 0.5 mcg ...................... 84 CALCITRIOL OIN 3MCG/GM ............. 77

calcitriol oral soln 1 mcg/ml ............. 84 calcium acetate (phosphate binder) cap

667 mg (169 mg ca) .................... 89 calcium acetate (phosphate binder) tab

667 mg ...................................... 89 CALCIUM CARB CHW 500MG .......... 119

calcium carbonate (antacid) chew tab

1000 mg .................................... 17 calcium carbonate (antacid) chew tab

400 mg ...................................... 17 calcium carbonate (antacid) chew tab

500 mg ...................................... 17 calcium carbonate (antacid) chew tab

750 mg ...................................... 17 calcium carbonate (antacid) susp 1250

mg/5ml ...................................... 17 calcium carbonate tab 1250 mg (500

mg elemental ca) ...................... 119 calcium carbonate tab 1500 mg (600

mg elemental ca) ...................... 119 calcium carbonate tab 600 mg ....... 119

calcium carbonate-cholecalciferol tab

250 mg-125 unit ....................... 119 calcium carbonate-cholecalciferol tab







600 mg-800 unit ....................... 119

calcium carbonate-mag hydroxide chew tab 550-110 mg .......................... 16

calcium carbonate-mag hydroxide chew tab 675-135 mg .......................... 16

calcium carbonate-mag hydroxide susp 400-135 mg/5ml ......................... 16

calcium carbonate-vitamin d cap 600 mg-200 unit ............................. 119

calcium carbonate-vitamin d tab 600 mg-400 unit ............................. 119

CALCIUM CIT TAB 1040MG ............ 119 calcium citrate tab 950 mg (200 mg

elemental ca) ............................ 119 CALCIUM TAB 333MG ................... 119

calcium tab 600 mg ...................... 119 CAL-DAY 1000 TAB ....................... 124

CANASA SUP 1000MG ..................... 88

CAPHOSOL SOL ........................... 123 CAPRELSA TAB 100MG .................... 51

CAPRELSA TAB 300MG .................... 51 captopril tab 100 mg ...................... 45

captopril tab 12.5 mg ..................... 45 captopril tab 25 mg ........................ 45

captopril tab 50 mg ........................ 45 CARAFATE

see sucralfate tab 1 gm .............. 151 CARAFATE SUS 1GM/10ML ............ 151

carbamazepine cap er 12hr 100 mg .. 27 carbamazepine cap er 12hr 200 mg .. 27

carbamazepine cap er 12hr 300 mg .. 27 carbamazepine chew tab 100 mg ..... 27

carbamazepine susp 100 mg/5ml ..... 27

carbamazepine tab 200 mg ............. 27 carbamazepine tab er 12hr 100 mg .. 27

carbamazepine tab er 12hr 200 mg .. 27 carbamazepine tab er 12hr 400 mg .. 27

carbamide peroxide 6.5% otic soln . 141 CARBATROL

see carbamazepine cap er 12hr 100 mg .......................................... 27



carbidopa & levodopa tab 10-100 mg 53 carbidopa & levodopa tab 25-100 mg 53

carbidopa & levodopa tab 25-250 mg 53

carbidopa & levodopa tab er 25-100 mg ............................................ 53

169

carbidopa & levodopa tab er 50-200 mg ............................................ 53

carbinoxamine maleate tab 4 mg ..... 42 carboxymethylcellulose sodium (pf)

ophth soln 0.5% ........................ 138 carboxymethylcellulose sodium ophth

gel 1% ..................................... 138 carboxymethylcellulose sodium ophth

soln 0.5% ................................. 138 carboxymethylcellulose-glycerin ophth

soln 0.5-0.9% ........................... 138 CARDIOPRESS CAP ....................... 134

CARDIZEM see diltiazem hcl tab 120 mg ........ 66

see diltiazem hcl tab 30 mg .......... 66

see diltiazem hcl tab 60 mg .......... 66 CARDIZEM CD

see diltiazem hcl coated beads cap er 24hr 120 mg ............................ 65





CAREFINE MIS 31GX8MM .............. 110 CAREFINE MIS 32GX4MM .............. 110

CAREFINE MIS 32GX5MM .............. 110

CAREFINE MIS 32GX6MM .............. 110 CAREONE LANC MIS 30G ............... 102

CAREONE LANC MIS THIN 23G ....... 102 CARESENS 30G MIS LANCETS ........ 102

CARETOUCH MIS 31GX5MM ........... 110 CARETOUCH MIS 31GX6MM ........... 110

CARETOUCH MIS 31GX8MM ........... 111 CARETOUCH MIS 32GX4MM ........... 111

CARETOUCH MIS 32GX5MM ........... 111 CARETOUCH MIS LANC 26G ........... 102

CARETOUCH MIS LANC 28G ........... 102 CARETOUCH MIS LANC 30G ........... 102

CARETOUCH MIS TWIST 28 ........... 102 CARETOUCH MIS TWIST 30 ........... 102

CARETOUCH MIS TWIST 33 ........... 102

CARETOUCH PAD ALCOHOL ........... 109 CARNITOR

see levocarnitine oral soln 1 gm/10ml (10%) ..................................... 85

see levocarnitine tab 330 mg ........ 85 carvedilol tab 12.5 mg .................... 64

carvedilol tab 25 mg ....................... 64 carvedilol tab 3.125 mg .................. 64

carvedilol tab 6.25 mg .................... 64 CASODEX

see bicalutamide tab 50 mg .......... 50 CATAPRES-TTS-1

see clonidine td patch weekly 0.1 mg/24hr .................................. 46

CATAPRES-TTS-2 see clonidine td patch weekly 0.2

mg/24hr .................................. 46

CATAPRES-TTS-3 see clonidine td patch weekly 0.3

mg/24hr .................................. 46 CAYA DPR ..................................... 99

CEFACLOR ER TAB 500MG ............... 68 cefadroxil cap 500 mg..................... 67

cefadroxil for susp 250 mg/5ml ........ 68 cefadroxil for susp 500 mg/5ml ........ 68

cefdinir cap 300 mg ........................ 68 cefdinir for susp 125 mg/5ml ........... 68

cefdinir for susp 250 mg/5ml ........... 68 cefixime cap 400 mg ...................... 68

cefixime for susp 100 mg/5ml .......... 68 cefixime for susp 200 mg/5ml .......... 68

cefpodoxime proxetil for susp 100

mg/5ml ...................................... 68 cefpodoxime proxetil for susp 50

mg/5ml ...................................... 68 cefpodoxime proxetil tab 100 mg ..... 68

cefpodoxime proxetil tab 200 mg ..... 68 cefprozil for susp 125 mg/5ml ......... 68

cefprozil for susp 250 mg/5ml ......... 68 cefprozil tab 250 mg ....................... 68

cefprozil tab 500 mg ....................... 68 cefuroxime axetil tab 250 mg .......... 68

cefuroxime axetil tab 500 mg .......... 68 CELEBRATE CAP 18 ...................... 124

CELEBRATE CAP 36 ...................... 125 CELEBRATE CAP 45 ...................... 125

CELEBRATE CAP 60 ...................... 125

CELEBRATE CHW 18 ..................... 125 CELEBRATE CHW 36 ..................... 125

170

CELEBRATE CHW 45 ..................... 125 CELEBRATE CHW 60 ..................... 125

CELEBREX see celecoxib cap 100 mg .............. 8

see celecoxib cap 200 mg .............. 8 see celecoxib cap 400 mg .............. 8

see celecoxib cap 50 mg ................ 8 celecoxib cap 100 mg ...................... 8

celecoxib cap 200 mg ...................... 8 celecoxib cap 400 mg ...................... 8

celecoxib cap 50 mg ........................ 8 CELEXA

see citalopram hydrobromide tab 10 mg (base equiv) ....................... 31

see citalopram hydrobromide tab 20

mg (base equiv) ....................... 31 see citalopram hydrobromide tab 40

mg (base equiv) ....................... 31 CELLCEPT

see mycophenolate mofetil cap 250 mg ........................................ 122

see mycophenolate mofetil for oral susp 200 mg/ml ..................... 122

see mycophenolate mofetil tab 500 mg ........................................ 122

CENT MATURE TAB ADLT 50+ ........ 125 CENTRAL-VITE TAB ...................... 125

CENTRAVITES TAB 50 PLUS ........... 125 CENTRAVITES TAB ADULTS ........... 125

CENTRUM 50+ CHW FRSH/FRU ...... 125

CENTRUM CHW ADULTS ................ 125 CENTRUM CHW FLAV BST .............. 125

CENTRUM CHW SILVER ................. 125 CENTRUM CHW VITAMINT ............. 125

CENTRUM KIDS CHW .................... 131 CENTRUM KIDS CHW FLAV BST ...... 131

CENTRUM LIQ .............................. 125 CENTRUM MULT CHW OMEGA 3 ..... 125

CENTRUM POW DRINK .................. 125 CENTRUM SILV TAB 50+MEN ......... 125

CENTRUM SILV TAB 50+WOMEN .... 125 CENTRUM SILV TAB ADULT 50 ....... 125

CENTRUM SPEC PAK PRENATAL ...... 133 CENTRUM SPEC TAB HEART ........... 125

CENTRUM SPEC TAB IMMUNE ........ 125

CENTRUM SPEC TAB VISION .......... 125 CENTRUM TAB ADULTS ................. 125

CENTRUM TAB CARDIO ................. 125 CENTRUM TAB MEN ...................... 125

CENTRUM TAB SILVER .................. 125 CENTRUM TAB ULTRA ................... 125

CENTRUM TAB WOMEN ................. 125 cephalexin cap 250 mg ................... 68

cephalexin cap 500 mg ................... 68 CEPHALEXIN CAP 750MG ................ 68

cephalexin for susp 125 mg/5ml ...... 68 cephalexin for susp 250 mg/5ml ...... 68

CEPROTIN INJ 1000UNIT ................. 93 CEPROTIN INJ 500 UNIT ................. 93

CEQUR SIMPL KIT PATCH 2U ......... 111 CERAVE OIN HEALING .................... 79

CERDELGA CAP 84MG ..................... 94

CEREZYME INJ 400UNIT .................. 94 CERTAVITE TAB SENIOR ............... 125

CERTAVITE/ TAB ANTIOXID ........... 125 cetirizine hcl cap 10 mg .................. 43

cetirizine hcl chew tab 10 mg ........... 43 cetirizine hcl chew tab 5 mg ............ 43

cetirizine hcl oral soln 1 mg/ml (5 mg/5ml) ..................................... 43

cetirizine hcl tab 10 mg ................... 43 cetirizine hcl tab 5 mg .................... 43

cetirizine-pseudoephedrine tab er 12hr 5-120 mg ................................... 72

cevimeline hcl cap 30 mg .............. 123 CHEMSTRIP K TES .......................... 81

chlordiazepoxide hcl cap 10 mg ....... 21

chlordiazepoxide hcl cap 25 mg ....... 21 chlordiazepoxide hcl cap 5 mg ......... 21

chlorhexidine gluconate soln 0.12% 122 chloroquine phosphate tab 250 mg ... 48

chlorpheniramine & pseudoephedrine tab 4-60 mg ............................... 72

chlorpheniramine maleate syrup 2 mg/5ml ...................................... 42

chlorpheniramine maleate tab 4 mg . 42 chlorpheniramine maleate tab er 12 mg

................................................. 42 CHLORPROMAZ INJ 50MG/2ML ........ 58

chlorpromazine hcl inj 25 mg/ml ...... 58 chlorpromazine hcl tab 10 mg .......... 58

chlorpromazine hcl tab 100 mg ........ 58

chlorpromazine hcl tab 200 mg ........ 58 chlorpromazine hcl tab 25 mg .......... 58

171

chlorpromazine hcl tab 50 mg .......... 58 chlorthalidone tab 25 mg ................. 82

chlorthalidone tab 50 mg ................. 82 chlorzoxazone tab 500 mg ............. 135

CHOICEFUL CAP MULTIVIT ............ 125 CHOICEFUL CHW MULTIVIT ........... 125

CHOLASE CAP CONTROL ............... 134 cholecalciferol cap 1.25 mg (50000

unit) ........................................ 154 cholecalciferol cap 10 mcg (400 unit)

............................................... 154 cholecalciferol cap 125 mcg (5000 unit)

............................................... 154 cholecalciferol cap 25 mcg (1000 unit)

............................................... 154

cholecalciferol cap 250 mcg (10000 unit) ........................................ 154

cholecalciferol cap 50 mcg (2000 unit) ............................................... 154

cholecalciferol drops 125 mcg/ml (5000 unit/ml) ................................... 154

cholecalciferol oral liquid 10 mcg/ml (400 unit/ml) ............................ 154

cholecalciferol tab 10 mcg (400 unit) ............................................... 154



cholecalciferol tab 50 mcg (2000 unit)

............................................... 154 cholestyramine light powder 4 gm/dose

................................................. 43 cholestyramine light powder packets 4

gm ............................................ 43 cholestyramine powder 4 gm/dose ... 43

cholestyramine powder packets 4 gm44 ciclopirox olamine cream 0.77% (base

equiv) ........................................ 76 ciclopirox solution 8% ..................... 76

cidofovir iv inj 75 mg/ml ................. 63 cilostazol tab 100 mg ...................... 93

cilostazol tab 50 mg ....................... 93 CILOXAN

see ciprofloxacin hcl ophth soln 0.3%

(base equivalent) .................... 139 CILOXAN OIN 0.3% OP ................. 139

cimetidine hcl soln 300 mg/5ml ..... 151 cimetidine tab 200 mg .................. 151

cimetidine tab 300 mg .................. 151 cimetidine tab 400 mg .................. 151

cimetidine tab 800 mg .................. 151 cinacalcet hcl tab 30 mg (base equiv)

................................................. 84 cinacalcet hcl tab 60 mg (base equiv)

................................................. 84 cinacalcet hcl tab 90 mg (base equiv)

................................................. 84 CINVANTI INJ 130/18ML ................. 42

CIPRO see ciprofloxacin hcl tab 250 mg

(base equiv) ............................ 87

see ciprofloxacin hcl tab 500 mg (base equiv) ............................ 87

CIPRO HC SUS OTIC ..................... 141 CIPRODEX

see ciprofloxacin-dexamethasone otic susp 0.3-0.1% ....................... 141

CIPRODEX SUS 0.3-0.1% .............. 141 ciprofloxacin hcl ophth soln 0.3% (base

equivalent) ............................... 139 ciprofloxacin hcl tab 250 mg (base

equiv) ........................................ 87 ciprofloxacin hcl tab 500 mg (base

equiv) ........................................ 87 ciprofloxacin hcl tab 750 mg (base

equiv) ........................................ 87

ciprofloxacin-dexamethasone otic susp 0.3-0.1% ................................. 141

CIPROFLOXACN SOL 0.2% ............ 141 citalopram hydrobromide oral soln 10

mg/5ml ...................................... 31 citalopram hydrobromide tab 10 mg

(base equiv) ............................... 31 citalopram hydrobromide tab 20 mg

(base equiv) ............................... 31 citalopram hydrobromide tab 40 mg

(base equiv) ............................... 31 CL PRENATAL TAB 28-0.8MG ......... 133

clarithromycin tab 250 mg .............. 99 clarithromycin tab 500 mg .............. 99

clarithromycin tab er 24hr 500 mg ... 99

CLARITIN RDT TAB 5MG .................. 43 CLEANLET 28G MIS LANCETS ........ 102

172

CLEAR PORE LIQ 3.5% .................... 75 clemastine fumarate tab 1.34 mg (1

mg base equiv) ........................... 42 CLEOCIN

see clindamycin hcl cap 150 mg .... 18 see clindamycin hcl cap 300 mg .... 18

see clindamycin hcl cap 75 mg ...... 18 see clindamycin phosphate vaginal

cream 2% .............................. 153 CLEOCIN PEDIATRIC GRANULE

see clindamycin palmitate hcl for soln 75 mg/5ml (base equiv) ............ 18

CLEOCIN SUP 100MG .................... 153 CLEOCIN-T

see clindamycin phosphate lotion 1%

.............................................. 75 CLEVER CHECK MIS ...................... 102

CLEVER CHECK MIS 30G ............... 102 CLICKFINE MIS 31GX1/4 ............... 111

CLICKFINE MIS 31GX3/16 ............. 111 CLICKFINE MIS 31GX5/16 ............. 111

CLICKFINE MIS 31GX8MM ............. 111 CLICKFINE MIS 32GX5/32 ............. 111

CLIMARA see estradiol td patch weekly 0.025

mg/24hr .................................. 87 see estradiol td patch weekly 0.0375

mg/24hr (37.5 mcg/24hr).......... 87 see estradiol td patch weekly 0.05

mg/24hr .................................. 87

see estradiol td patch weekly 0.06 mg/24hr .................................. 87



CLIMARA PRO DIS WEEKLY.............. 86 clindamycin hcl cap 150 mg ............. 18

clindamycin hcl cap 300 mg ............. 18 clindamycin hcl cap 75 mg .............. 18

clindamycin palmitate hcl for soln 75 mg/5ml (base equiv) ................... 18

clindamycin phosphate gel 1% ......... 75 clindamycin phosphate lotion 1% ..... 75

clindamycin phosphate soln 1% ....... 75

clindamycin phosphate swab 1% ...... 75

clindamycin phosphate vaginal cream 2% .......................................... 153

clindamycin phosph-benzoyl peroxide (refrig) gel 1.2 (1)-5% ................. 75

clobazam suspension 2.5 mg/ml ...... 26 clobazam tab 10 mg ....................... 26

clobazam tab 20 mg ....................... 26 clobetasol propionate cream 0.05% .. 77

clobetasol propionate emollient base cream 0.05% .............................. 77

clobetasol propionate gel 0.05% ...... 77 clobetasol propionate oint 0.05% ..... 77

clobetasol propionate shampoo 0.05% ................................................. 77

clobetasol propionate soln 0.05% ..... 77

CLOBEX see clobetasol propionate shampoo

0.05% ..................................... 77 clomipramine hcl cap 25 mg ............ 34

clomipramine hcl cap 50 mg ............ 34 clomipramine hcl cap 75 mg ............ 34

clonazepam orally disintegrating tab 0.125 mg ................................... 26

clonazepam orally disintegrating tab 0.25 mg ..................................... 26

clonazepam orally disintegrating tab 0.5 mg ....................................... 26

clonazepam orally disintegrating tab 1 mg ............................................ 26

clonazepam orally disintegrating tab 2

mg ............................................ 26 clonazepam tab 0.5 mg ................... 26

clonazepam tab 1 mg ..................... 27 clonazepam tab 2 mg ..................... 27

clonidine hcl tab 0.1 mg .................. 46 clonidine hcl tab 0.2 mg .................. 46

clonidine hcl tab 0.3 mg .................. 46 clonidine hcl tab er 12hr 0.1 mg ........ 3

clonidine td patch weekly 0.1 mg/24hr ................................................. 46



clopidogrel bisulfate tab 300 mg (base

equiv) ........................................ 93

173

clopidogrel bisulfate tab 75 mg (base equiv) ........................................ 93

clorazepate dipotassium tab 15 mg .. 21 clorazepate dipotassium tab 3.75 mg 21

clorazepate dipotassium tab 7.5 mg . 21 clotrimazole cream 1% ................... 76

clotrimazole soln 1% ...................... 76 clotrimazole troche 10 mg ............. 122

clotrimazole vaginal cream 1% ...... 153 clotrimazole vaginal cream 2% ...... 153

clotrimazole w/ betamethasone cream 1-0.05%..................................... 76

clozapine orally disintegrating tab 100 mg ............................................ 57

clozapine orally disintegrating tab 25

mg ............................................ 57 clozapine tab 100 mg ...................... 57

clozapine tab 200 mg ...................... 57 clozapine tab 25 mg ....................... 57

clozapine tab 50 mg ....................... 57 CLOZARIL

see clozapine tab 100 mg ............. 57 see clozapine tab 200 mg ............. 57

see clozapine tab 25 mg ............... 57 see clozapine tab 50 mg ............... 57

COAGUCHEK MIS LANCETS............ 102 coal tar oint 2% ............................. 80

coal tar shampoo 0.5% ................... 80 coal tar shampoo 1% ...................... 81

COARTEM TAB 20-120MG ................ 48

CODEINE SULF TAB 30MG ............... 11 CODEINE SULF TAB 60MG ............... 11

colchicine tab 0.6 mg ...................... 90 colchicine w/ probenecid tab 0.5-500

mg ............................................ 90 COLCRYS

see colchicine tab 0.6 mg ............. 90 COLD-EEZE CHW PLS DEF ............. 121

COLESTID see colestipol hcl tab 1 gm............ 44

colestipol hcl tab 1 gm .................... 44 COLLAGEN CAP ULTRA .................. 134

COLOR CONDOM MIS + LUBE .......... 99 COMBIVENT AER 20-100 ................. 25

COMBIVIR

see lamivudine-zidovudine tab 150-300 mg ................................... 61

COMFORT ASSU MIS LANC 28G ..... 102 COMFORT ASSU MIS LANC 33G ..... 102

COMFORT EZ MIS 21G .................. 102 COMFORT EZ MIS 23G .................. 102

COMFORT EZ MIS 28G .................. 102 COMFORT EZ MIS 29GX12MM ........ 111

COMFORT EZ MIS 31GX5/16 ......... 111 COMFORT EZ MIS 31GX5MM .......... 111

COMFORT EZ MIS 31GX6MM .......... 111 COMFORT EZ MIS 31GX8MM .......... 111

COMFORT EZ MIS 32GX4MM .......... 111 COMFORT EZ MIS 32GX5MM .......... 111

COMFORT EZ MIS 32GX6MM .......... 111 COMFORT MIS LANCETS ............... 102

COMFORT TCH MIS LANC 30G ....... 102

COMFORT TCH MIS LANC 31G ....... 102 COMFORTOUCH MIS LANCET ......... 102

COMFRT TOUCH PAD ALC PREP ...... 109 COMPACT SPAC MIS CHAMBER ...... 116

COMPACT SPAC MIS LG MASK ....... 116 COMPACT SPAC MIS MD MASK ....... 116

COMPACT SPAC MIS SM MASK ....... 116 COMPLERA TAB .............................. 61

COMPLETENATE CHW ................... 133 COMTAN

see entacapone tab 200 mg .......... 53 CO-NATAL FA TAB 29-1MG ............ 133

CONCERTA TAB 18MG ...................... 4 CONCERTA TAB 27MG ...................... 4

CONCERTA TAB 36MG ...................... 4

CONCERTA TAB 54MG ...................... 4 CONDOMS MIS .............................. 99

CONDOMS MIS LUBRICAT ............... 99 COPAXONE

see glatiramer acetate soln prefilled syringe 40 mg/ml ................... 146

COPAXONE INJ 20MG/ML .............. 145 COREG

see carvedilol tab 12.5 mg ............ 64 see carvedilol tab 25 mg .............. 64

see carvedilol tab 3.125 mg .......... 64 see carvedilol tab 6.25 mg ............ 64

CORGARD see nadolol tab 20 mg .................. 64

see nadolol tab 40 mg .................. 64

see nadolol tab 80 mg .................. 64 CORIFACT KIT ............................... 91

174

CORLANOR TAB 5MG ...................... 67 CORLANOR TAB 7.5MG ................... 67

CORN/CALLUS LIQ 12.6% ............... 79 CORTEF

see hydrocortisone tab 10 mg ....... 71 see hydrocortisone tab 20 mg ....... 71

see hydrocortisone tab 5 mg ......... 70 CORTENEMA

see hydrocortisone enema 100 mg/60ml ................................. 16

CORTIFOAM AER 90MG ................... 15 CORVITA TAB .............................. 125

COSOPT see dorzolamide hcl-timolol maleate

ophth soln 22.3-6.8 mg/ml ...... 138

COSOPT PF see dorzolamide hcl-timolol maleate

ophth sol 22.3-6.8 mg/ml pf .... 138 COZAAR

see losartan potassium tab 100 mg46 see losartan potassium tab 25 mg . 46

see losartan potassium tab 50 mg . 46 CREON CAP 12000UNT .................... 81

CREON CAP 24000UNT .................... 81 CREON CAP 3000UNIT .................... 81

CREON CAP 36000UNT .................... 81 CREON CAP 6000UNIT .................... 81

CRESTOR see rosuvastatin calcium tab 10 mg

.............................................. 44

see rosuvastatin calcium tab 20 mg .............................................. 44

see rosuvastatin calcium tab 40 mg .............................................. 44

see rosuvastatin calcium tab 5 mg . 44 cromolyn sodium nasal aerosol soln 5.2

mg/act (4%) ............................. 136 cromolyn sodium ophth soln 4% .... 141

cromolyn sodium oral conc 100 mg/5ml ................................................. 88

cromolyn sodium soln nebu 20 mg/2ml ................................................. 23

CRYSVITA INJ 10MG/ML .................. 84 CRYSVITA INJ 20MG/ML .................. 84

CRYSVITA INJ 30MG/ML .................. 84

CUBICIN see daptomycin for iv soln 500 mg 18

CUBICIN RF SOL 500MG ................. 18 CUBICIN SOL 500MG ...................... 18

CULTURELLE CHW ........................ 132 CULTURELLE CHW MULTIVIT ......... 125

CUPRIMINE see penicillamine cap 250 mg ..... 121

CURITY PREP PAD ALCOHOL .......... 109 CURITY SWABS PAD ALCOHOL ....... 109

CUVPOSA see glycopyrrolate oral soln 1

mg/5ml ................................. 150 CVS ANTACID CHW 1177MG ............ 17

CVS COLD CHW REMEDY ............... 121 CVS DRY SPR MOUTH ................... 123

CVS GLUCOSE CHW FRUIT .............. 37

CVS GLUCOSE CHW GRAPE ............. 37 CVS GLUCOSE CHW ORANGE ........... 37

CVS GLUCOSE CHW RASPBERY ........ 37 CVS GLUCOSE CHW TROP BLS ......... 37

CVS LANCETS MIS 21G ................. 102 CVS LANCETS MIS 30G ................. 102

CVS LANCETS MIS 33G ................. 102 CVS LANCETS MIS ORIGINAL ........ 102

CVS LANCETS MIS THIN 26G ......... 102 CVS LANCETS MIS THIN 30G ......... 102

CVS LANCETS MIS THIN 33G ......... 102 CVS PRENATAL CHW GUMMY ......... 133

CVS PRENATAL TAB 27-0.8MG ....... 133 CVS VISION CAP HEALTH .............. 125

cyanocobalamin inj 1000 mcg/ml ..... 94

cyanocobalamin tab 100 mcg........... 94 cyanocobalamin tab 1000 mcg ......... 94

cyanocobalamin tab 250 mcg........... 94 cyanocobalamin tab 50 mcg ............ 94

cyanocobalamin tab 500 mcg........... 94 cyanocobalamin tab er 1000 mcg ..... 94

cyclobenzaprine hcl tab 10 mg ....... 135 cyclobenzaprine hcl tab 5 mg ......... 135

CYCLOGYL see cyclopentolate hcl ophth soln

0.5% .................................... 139 see cyclopentolate hcl ophth soln 1%

............................................ 139 see cyclopentolate hcl ophth soln 2%

............................................ 139

cyclopentolate hcl ophth soln 0.5% 139 cyclopentolate hcl ophth soln 1% ... 139

175

cyclopentolate hcl ophth soln 2% ... 139 cyclophosphamide cap 25 mg .......... 49

cyclophosphamide cap 50 mg .......... 49 cyclosporine cap 100 mg ............... 121

cyclosporine cap 25 mg ................. 121 cyclosporine modified cap 100 mg .. 121

cyclosporine modified cap 25 mg .... 121 cyclosporine modified cap 50 mg .... 121

cyclosporine modified oral soln 100 mg/ml ...................................... 121

CYMBALTA see duloxetine hcl enteric coated

pellets cap 20 mg (base eq) ....... 33 see duloxetine hcl enteric coated

pellets cap 30 mg (base eq) ....... 33

see duloxetine hcl enteric coated pellets cap 60 mg (base eq) ....... 33

cyproheptadine hcl syrup 2 mg/5ml .. 43 cyproheptadine hcl tab 4 mg ............ 43

CYTO C POW ................................ 155 CYTOMEL

see liothyronine sodium tab 25 mcg ............................................ 149



D DAILY MULTI TAB VITAMINS .......... 130

DALVANCE SOL 500MG ................... 18

DALYVITE/FE LIQ ......................... 132 danazol cap 100 mg ....................... 15

danazol cap 200 mg ....................... 15 danazol cap 50 mg ......................... 15

DANTRIUM see dantrolene sodium cap 25 mg 135

dantrolene sodium cap 100 mg ...... 135 dantrolene sodium cap 25 mg ........ 135

dantrolene sodium cap 50 mg ........ 135 dapsone tab 100 mg ....................... 18

dapsone tab 25 mg ......................... 18 DAPTACEL INJ .............................. 150

daptomycin for iv soln 500 mg ......... 18 DAYPRO

see oxaprozin tab 600 mg ............. 9

DAYTRANA DIS 10MG/9HR ............... 4 DAYTRANA DIS 15MG/9HR ............... 4

DAYTRANA DIS 20MG/9HR ............... 4 DAYTRANA DIS 30MG/9HR ............... 4

DDAVP see desmopressin acetate tab 0.1 mg

.............................................. 85 see desmopressin acetate tab 0.2 mg

.............................................. 85 DECARA CAP 25000UNT ................ 155

DECONEX DMX TAB ........................ 72 DECONEX IR TAB 10-385MG ............ 72

DECUBI-VITE CAP ........................ 125 deferasirox granules packet 180 mg . 40

deferasirox granules packet 360 mg . 41 deferasirox granules packet 90 mg ... 40

deferasirox tab 180 mg ................... 41

deferasirox tab 360 mg ................... 41 deferasirox tab 90 mg ..................... 41

deferasirox tab for oral susp 125 mg 41 deferasirox tab for oral susp 250 mg 41

deferasirox tab for oral susp 500 mg 41 deferoxamine mesylate for inj 500 mg

................................................. 41 DEKAS CAP ESSENTIA .................. 130

DEKAS CHW BARIATRI .................. 125 DEKAS PLUS CAP ......................... 125

DEKAS PLUS CAP OCEAN .............. 125 DEKAS PLUS CHW ........................ 125

DEKAS PLUS LIQ .......................... 131 DELSTRIGO TAB............................. 61

DELZICOL CAP 400MG .................... 88

demeclocycline hcl tab 150 mg ...... 148 demeclocycline hcl tab 300 mg ...... 148

DEPAKOTE see divalproex sodium tab delayed

release 125 mg ........................ 30 see divalproex sodium tab delayed

release 250 mg ........................ 30 see divalproex sodium tab delayed

release 500 mg ........................ 30 DEPAKOTE ER

see divalproex sodium tab er 24 hr 250 mg ................................... 30

see divalproex sodium tab er 24 hr 500 mg ................................... 30

DEPAKOTE SPRINKLES

see divalproex sodium cap delayed release sprinkle 125 mg ............ 30

176

DEPO-MEDROL see methylprednisolone acetate inj

susp 40 mg/ml ......................... 71 see methylprednisolone acetate inj

susp 80 mg/ml ......................... 71 DEPO-PROVERA CONTRACEPTIV

see medroxyprogesterone acetate im susp 150 mg/ml ....................... 70

see medroxyprogesterone acetate im susp prefilled syr 150 mg/ml ...... 70

DEPO-TESTOSTERONE see testosterone cypionate im inj in

oil 100 mg/ml .......................... 15 see testosterone cypionate im inj in

oil 200 mg/ml .......................... 15

DERMAREST GEL 3% ...................... 79 DERMA-SMOOTH OIL /FS BODY ....... 77

DERMA-SMOOTH OIL /FS SCLP ........ 78 DERMAVITE TAB........................... 125

DERMOTIC see fluocinolone acetonide (otic) oil

0.01% ................................... 142 DESCOVY TAB 200/25MG ................ 61

DESFERAL see deferoxamine mesylate for inj

500 mg ................................... 41 DESFERAL INJ 500MG ..................... 41

desipramine hcl tab 10 mg .............. 34 desipramine hcl tab 100 mg ............ 34

desipramine hcl tab 150 mg ............ 34

desipramine hcl tab 25 mg .............. 34 desipramine hcl tab 50 mg .............. 34

desipramine hcl tab 75 mg .............. 34 desmopressin acetate nasal spray soln

0.01% ........................................ 85 desmopressin acetate nasal spray soln

0.01% (refrigerated) .................... 85 desmopressin acetate tab 0.1 mg ..... 85

desmopressin acetate tab 0.2 mg ..... 85 DESMOPRESSIN SOL 1.5MG/ML ....... 85

desogest-eth estrad & eth estrad tab 0.15-0.02/0.01 mg(21/5) ............. 68

desogest-ethin est tab 0.1-0.025/0.125-0.025/0.15-0.025mg-

mg ............................................ 68

desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg ................................. 68

DETROL LA CAP 2MG .................... 152 DETROL LA CAP 4MG .................... 152

DETROL TAB 1MG......................... 152 DETROL TAB 2MG......................... 152

DEX4 CHW FRUIT ........................... 37 DEX4 CHW GRAPE .......................... 37

DEX4 CHW ORANGE ....................... 37 DEX4 CHW RASPBERR .................... 37

DEX4 CHW RASPBERY..................... 37 DEX4 CHW SOUR APL ..................... 37

DEX4 CHW TROP FRT ..................... 37 DEX4 CHW WATERMLN ................... 37

DEX4 GLUCOSE CHW ...................... 37 DEX4 NATURAL CHW ORANGE ......... 37

DEX4 POUCH CHW PACK ................. 37

DEXAMETHASON CON 1MG/ML ........ 70 dexamethasone elixir 0.5 mg/5ml .... 70

dexamethasone tab 0.5 mg ............. 70 dexamethasone tab 0.75 mg ........... 70

dexamethasone tab 1.5 mg ............. 70 dexamethasone tab 4 mg ................ 70

dexamethasone tab 6 mg ................ 70 DEXCOM G6 MIS RECEIVER ........... 102

DEXCOM G6 MIS SENSOR ............. 102 DEXCOM G6 MIS TRANSMIT .......... 102

dexmethylphenidate hcl tab 10 mg .... 4 dexmethylphenidate hcl tab 2.5 mg ... 4

dexmethylphenidate hcl tab 5 mg ..... 4 dextran 70-hypromellose (pf) ophth

soln 0.1-0.3% ........................... 138

dextran 70-hypromellose ophth soln 0.1-0.3% ................................. 138

dextroamphetamine sulfate tab 10 mg 2 dextroamphetamine sulfate tab 15 mg 2

dextroamphetamine sulfate tab 20 mg 2 dextroamphetamine sulfate tab 30 mg 2

dextroamphetamine sulfate tab 5 mg 2 dextromethorphan polistirex extended

release susp 30 mg/5ml ............... 72 dextromethorphan-guaifenesin cap 10-

200 mg ...................................... 72 dextromethorphan-guaifenesin liquid

10-100 mg/5ml ........................... 72 dextromethorphan-guaifenesin liquid

10-200 mg/5ml ........................... 72

dextromethorphan-guaifenesin liquid 20-300 mg/5ml ........................... 72

177

dextromethorphan-guaifenesin liquid 30-200 mg/5ml ........................... 72

dextromethorphan-guaifenesin liquid 5-100 mg/5ml ................................ 72

dextromethorphan-guaifenesin syrup 10-100 mg/5ml ........................... 72

dextromethorphan-guaifenesin tab 20-400 mg ...................................... 72

dextromethorphan-guaifenesin tab er 12hr 30-600 mg .......................... 73

dextromethorphan-guaifenesin tab er 12hr 60-1200 mg ........................ 73

DIATHRIVE MIS 31GX5MM ............ 111 DIATHRIVE MIS 31GX6MM ............ 111

DIATHRIVE MIS 31GX8MM ............ 111

DIATHRIVE MIS 32GX4MM ............ 111 DIATHRIVE MIS LANCETS .............. 102

DIATHRIVE MIS UT 30G ................ 102 diazepam conc 5 mg/ml .................. 21

DIAZEPAM GEL 10MG ..................... 27 DIAZEPAM GEL 2.5MG .................... 27

DIAZEPAM GEL 20MG ..................... 27 diazepam oral soln 1 mg/ml ............ 21

diazepam tab 10 mg ....................... 22 diazepam tab 2 mg ......................... 22

diazepam tab 5 mg ......................... 22 diazoxide susp 50 mg/ml................. 37

diclofenac potassium tab 50 mg ........ 8 diclofenac sodium gel 1% ................ 76

diclofenac sodium ophth soln 0.1% . 141

diclofenac sodium tab delayed release 25 mg ......................................... 8



diclofenac sodium tab er 24hr 100 mg 8 dicloxacillin sodium cap 250 mg ..... 144

dicloxacillin sodium cap 500 mg ..... 144 dicyclomine hcl cap 10 mg ............. 150

dicyclomine hcl oral soln 10 mg/5ml ............................................... 150

dicyclomine hcl tab 20 mg ............. 150 DIFICID TAB 200MG ....................... 99

DIFLUCAN

see fluconazole for susp 10 mg/ml . 42 see fluconazole for susp 40 mg/ml . 42

see fluconazole tab 100 mg .......... 42 see fluconazole tab 150 mg .......... 42

see fluconazole tab 200 mg .......... 42 see fluconazole tab 50 mg ............ 42

diflunisal tab 500 mg ...................... 10 digoxin oral soln 0.05 mg/ml ........... 66

digoxin tab 125 mcg (0.125 mg) ...... 67 digoxin tab 250 mcg (0.25 mg) ........ 67

DILANTIN see phenytoin sodium extended cap

100 mg ................................... 29 DILANTIN INFATABS

see phenytoin chew tab 50 mg ...... 29 DILANTIN-125

see phenytoin susp 125 mg/5ml .... 29

DILAUDID see hydromorphone hcl liqd 1 mg/ml

.............................................. 11 see hydromorphone hcl tab 2 mg .. 11

see hydromorphone hcl tab 4 mg .. 11 see hydromorphone hcl tab 8 mg .. 11

diltiazem hcl cap er 12hr 120 mg ..... 65 diltiazem hcl cap er 12hr 60 mg ....... 65

diltiazem hcl cap er 12hr 90 mg ....... 65 diltiazem hcl cap er 24hr 120 mg ..... 65

diltiazem hcl cap er 24hr 180 mg ..... 65 diltiazem hcl cap er 24hr 240 mg ..... 65

diltiazem hcl coated beads cap er 24hr 120 mg ...................................... 65

diltiazem hcl coated beads cap er 24hr

180 mg ...................................... 65 diltiazem hcl coated beads cap er 24hr



360 mg ...................................... 65 diltiazem hcl extended release beads

cap er 24hr 120 mg ..................... 65 diltiazem hcl extended release beads



cap er 24hr 300 mg ..................... 66

diltiazem hcl extended release beads cap er 24hr 360 mg ..................... 66

178

diltiazem hcl extended release beads cap er 24hr 420 mg ..................... 66

diltiazem hcl tab 120 mg ................. 66 diltiazem hcl tab 30 mg ................... 66

diltiazem hcl tab 60 mg ................... 66 diltiazem hcl tab 90 mg ................... 66

dimenhydrinate tab 50 mg .............. 41 dimethyl fumarate capsule delayed

release 120 mg ......................... 145 dimethyl fumarate capsule delayed

release 240 mg ......................... 145 dimethyl fumarate capsule dr starter

pack 120 mg & 240 mg .............. 145 DINO-LIFE CHW IRON-ZIN ............ 132

DIOVAN

see valsartan tab 160 mg ............. 46 see valsartan tab 320 mg ............. 46

see valsartan tab 40 mg ............... 46 see valsartan tab 80 mg ............... 46

DIOVAN HCT see valsartan-hydrochlorothiazide tab

160-12.5 mg ............................ 48 see valsartan-hydrochlorothiazide tab

160-25 mg ............................... 48 see valsartan-hydrochlorothiazide tab

320-12.5 mg ............................ 48 see valsartan-hydrochlorothiazide tab

320-25 mg ............................... 48 see valsartan-hydrochlorothiazide tab

80-12.5 mg .............................. 48

diphenhydramine hcl (sleep) cap 25 mg ................................................. 96

diphenhydramine hcl (sleep) cap 50 mg ................................................. 96

diphenhydramine hcl (sleep) liquid 50 mg/30ml .................................... 96

diphenhydramine hcl (sleep) tab 25 mg ................................................. 96

diphenhydramine hcl (sleep) tab 50 mg ................................................. 96

diphenhydramine hcl (sleep) tab disint 25 mg ........................................ 96

diphenhydramine hcl cap 25 mg ....... 42 diphenhydramine hcl cap 50 mg ....... 42

diphenhydramine hcl chew tab 12.5 mg

................................................. 42

diphenhydramine hcl elixir 12.5 mg/5ml ...................................... 42

diphenhydramine hcl gel 2% ........... 76 diphenhydramine hcl liquid 12.5

mg/5ml ...................................... 42 diphenhydramine hcl soln 2% .......... 76

diphenhydramine hcl tab 25 mg ....... 42 diphenhydramine hcl tab disint 12.5

mg ............................................ 42 diphenoxylate w/ atropine tab 2.5-

0.025 mg ................................... 40 dipyridamole tab 25 mg .................. 93

dipyridamole tab 50 mg .................. 93 dipyridamole tab 75 mg .................. 94

disopyramide phosphate cap 100 mg 22

disopyramide phosphate cap 150 mg 22 disulfiram tab 250 mg ................... 144

disulfiram tab 500 mg ................... 144 DITROPAN XL

see oxybutynin chloride tab er 24hr 10 mg ................................... 152

see oxybutynin chloride tab er 24hr 5 mg ........................................ 152

DIURIL SUS 250/5ML...................... 82 divalproex sodium cap delayed release

sprinkle 125 mg .......................... 30 divalproex sodium tab delayed release

125 mg ...................................... 30 divalproex sodium tab delayed release

250 mg ...................................... 30

divalproex sodium tab delayed release 500 mg ...................................... 30

divalproex sodium tab er 24 hr 250 mg ................................................. 30

divalproex sodium tab er 24 hr 500 mg ................................................. 30

docosanol cream 10% .................... 77 docusate calcium cap 240 mg .......... 99

docusate sodium cap 100 mg .......... 99 docusate sodium cap 250 mg .......... 99

docusate sodium cap 50 mg ............ 99 docusate sodium enema 283 mg/5ml 99

docusate sodium liquid 150 mg/15ml 99 docusate sodium syrup 60 mg/15ml . 99

docusate sodium tab 100 mg ........... 99

dofetilide cap 125 mcg (0.125 mg) ... 23 dofetilide cap 250 mcg (0.25 mg) ..... 23

179

dofetilide cap 500 mcg (0.5 mg) ...... 23 DOMETUSS-DMX LIQ ...................... 73

donepezil hydrochloride orally disintegrating tab 10 mg ............ 144

donepezil hydrochloride orally disintegrating tab 5 mg .............. 144

donepezil hydrochloride tab 10 mg . 144 donepezil hydrochloride tab 23 mg . 144

donepezil hydrochloride tab 5 mg ... 144 DORZOL/TIMOL SOL 22.3-6.8 ........ 138

dorzolamide hcl ophth soln 2% ...... 141 dorzolamide hcl-timolol maleate ophth

sol 22.3-6.8 mg/ml pf ................ 138 dorzolamide hcl-timolol maleate ophth

soln 22.3-6.8 mg/ml .................. 138

DOVATO TAB 50-300MG .................. 61 DOVONEX

see calcipotriene cream 0.005% .... 77 doxazosin mesylate tab 1 mg ........... 46

doxazosin mesylate tab 2 mg ........... 46 doxazosin mesylate tab 4 mg ........... 46

doxazosin mesylate tab 8 mg ........... 46 doxepin hcl cap 10 mg .................... 34

doxepin hcl cap 100 mg .................. 34 doxepin hcl cap 25 mg .................... 34

doxepin hcl cap 50 mg .................... 34 doxepin hcl cap 75 mg .................... 34

doxepin hcl conc 10 mg/ml .............. 34 doxercalciferol cap 0.5 mcg ............. 84

doxercalciferol cap 1 mcg ................ 84

doxercalciferol cap 2.5 mcg ............. 84 doxycycline hyclate cap 100 mg ..... 148

doxycycline hyclate cap 50 mg ....... 148 doxycycline hyclate tab 100 mg ..... 148

doxycycline hyclate tab 20 mg ....... 148 doxycycline monohydrate cap 100 mg

............................................... 148 doxycycline monohydrate cap 50 mg

............................................... 148 doxycycline monohydrate for susp 25

mg/5ml .................................... 148 doxycycline monohydrate tab 100 mg

............................................... 148 doxylamine succinate (sleep) tab 25

mg ............................................ 96

DRISDOL

see ergocalciferol cap 1.25 mg (50000 unit) .......................... 155

DRISDOL CAP 50000UNT .............. 155 DROPLET LANC MIS 30G ............... 102

DROPLET PERS MIS LANC 30G ....... 102 drospirenone-ethinyl estradiol tab 3-

0.02 mg ..................................... 68 drospirenone-ethinyl estradiol tab 3-

0.03 mg ..................................... 68 droxidopa cap 100 mg .................. 154

droxidopa cap 200 mg .................. 154 droxidopa cap 300 mg .................. 154

DRY MOUTH SOL ORAL RIN ........... 123 DRYSOL SOL 20% .......................... 80

DUETACT

see pioglitazone hcl-glimepiride tab 30-2 mg .................................. 36

see pioglitazone hcl-glimepiride tab 30-4 mg .................................. 36

DULERA AER 100-5MCG .................. 25 DULERA AER 200-5MCG .................. 25

DULERA AER 50-5MCG .................... 25 duloxetine hcl enteric coated pellets

cap 20 mg (base eq) .................... 33 duloxetine hcl enteric coated pellets

cap 30 mg (base eq) .................... 33 duloxetine hcl enteric coated pellets

cap 60 mg (base eq) .................... 33 DUOFILM SOL 17% ........................ 79

DUREX EXTRA MIS SENSITIV ........... 99

dutasteride cap 0.5 mg ................... 89 D-VI-SOL LIQ 400UNIT ................. 155

E EASIVENT MIS ............................. 116

EASIVENT MIS MASK LG ............... 116 EASIVENT MIS MASK MED ............. 116

EASIVENT MIS MASK SM ............... 116 EASY COMFORT MIS 30G .............. 103

EASY COMFORT MIS 31GX1/4 ........ 111 EASY COMFORT MIS 31GX3/16 ...... 111

EASY COMFORT MIS 31GX5/16 ...... 111 EASY COMFORT MIS 32GX5/32 ...... 111

EASY COMFORT MIS LANC/30G ...... 103 EASY COMFORT MIS TWIST ........... 103

EASY COMFORT PAD ALCOHOL ...... 109

EASY TOUCH MIS 29GX1/2 ............ 111 EASY TOUCH MIS 31GX1/4 ............ 111

180

EASY TOUCH MIS 31GX3/16 .......... 111 EASY TOUCH MIS 31GX5/16 .......... 111

EASY TOUCH MIS 32GX1/4 ............ 111 EASY TOUCH MIS 32GX3/16 .......... 111

EASY TOUCH MIS 32GX5/32 .......... 111 EASY TOUCH MIS 32GX5MM .......... 111

EASY TOUCH MIS 32GX6MM .......... 111 EASY TOUCH MIS LANC/21G .......... 103

EASY TOUCH MIS LANC/23G .......... 103 EASY TOUCH MIS LANC/26G .......... 103



EC-NAPROSYN

see naproxen tab ec 375 mg .......... 9 see naproxen tab ec 500 mg .......... 9

EC-NAPROSYN TAB 375MG ............... 8 EC-NAPROSYN TAB 500MG ............... 8

ED A-HIST DM TAB 10-4-10 ............ 73 ED BRON GP LIQ ............................ 73

efavirenz cap 200 mg ..................... 61 efavirenz cap 50 mg ....................... 61

efavirenz tab 600 mg ...................... 61 efavirenz-emtricitabine-tenofovir df tab

600-200-300 mg ......................... 61 EFFEXOR XR

see venlafaxine hcl cap er 24hr 150 mg (base equivalent) ................ 33

see venlafaxine hcl cap er 24hr 37.5

mg (base equivalent) ................ 33 see venlafaxine hcl cap er 24hr 75

mg (base equivalent) ................ 33 EFUDEX

see fluorouracil cream 5% ............ 77 ELAPRASE INJ 6MG/3ML .................. 84

ELELYSO INJ 200UNIT .................... 94 ELIDEL

see pimecrolimus cream 1% ......... 79 ELIGARD INJ 22.5MG ...................... 50

ELIGARD INJ 30MG ......................... 50 ELIGARD INJ 45MG ......................... 50

ELIGARD INJ 7.5MG........................ 50 ELIQUIS ST P TAB 5MG ................... 25

ELIQUIS TAB 2.5MG ....................... 25

ELIQUIS TAB 5MG .......................... 25 ELLUME COV19 KIT HOME TES ......... 81

ELMIRON CAP 100MG ..................... 89 ELOCTATE INJ 1000UNIT ................ 91

ELOCTATE INJ 1500UNIT ................ 91 ELOCTATE INJ 2000UNIT ................ 91

ELOCTATE INJ 250UNIT .................. 91 ELOCTATE INJ 3000UNIT ................ 91

ELOCTATE INJ 4000UNIT ................ 91 ELOCTATE INJ 5000UNIT ................ 91

ELOCTATE INJ 500UNIT .................. 91 ELOCTATE INJ 6000UNIT ................ 91

ELOCTATE INJ 750UNIT .................. 91 EMBRACE LANC MIS 21G .............. 103

EMBRACE LANC MIS 28G .............. 103 EMBRACE LANC MIS THIN 30G ...... 103

EMEND

see aprepitant capsule 80 mg ....... 42 see fosaprepitant dimeglumine for iv

infusion 150 mg (base eq) ......... 42 EMEND SOL 150MG ........................ 42

EMERGEN-C CHW IMMUNE/D ......... 125 EMERGEN-C CHW VITA C .............. 126

EMERGEN-C PAK BLUE .................. 126 EMERGEN-C PAK FIVE ................... 126

EMERGEN-C PAK HEART ................ 126 EMERGEN-C PAK IMMUNE ............. 126

EMERGEN-C PAK JOINT ................. 126 EMERGEN-C PAK KIDZ .................. 126

EMERGEN-C PAK MSM LITE ........... 126 EMERGEN-C PAK PINK .................. 126

EMERGEN-C PAK SUPER FR ........... 126

EMERGEN-C PAK VIT D/CA ............ 126 EMERGEN-C PAK VITA C ............... 126

EMGALITY INJ 120MG/ML .............. 117 emtricitabine caps 200 mg .............. 61

EMTRIVA see emtricitabine caps 200 mg ...... 61

EMTRIVA SOL 10MG/ML .................. 61 enalapril maleate & hydrochlorothiazide

tab 10-25 mg .............................. 47 enalapril maleate & hydrochlorothiazide

tab 5-12.5 mg............................. 47 enalapril maleate tab 10 mg ............ 45

enalapril maleate tab 2.5 mg ........... 45 enalapril maleate tab 20 mg ............ 45

enalapril maleate tab 5 mg .............. 45

ENBREL INJ 25/0.5ML ...................... 9 ENBREL INJ 25MG ...................... 9, 10

181

ENBREL INJ 50MG/ML ..................... 10 ENBREL MINI INJ 50MG/ML ............. 10

ENBREL SRCLK INJ 50MG/ML ........... 10 ENDUR-VM TAB ............................ 126

ENDUR-VM TAB IRON ................... 126 ENERGY POW BOOSTER ................ 126

ENFAMIL MIS EXPECTA ................. 133 ENGERIX-B INJ 20MCG/ML ............ 153

enoxaparin sodium inj 100 mg/ml .... 25 enoxaparin sodium inj 120 mg/0.8ml 25

enoxaparin sodium inj 150 mg/ml .... 26 enoxaparin sodium inj 30 mg/0.3ml . 25

enoxaparin sodium inj 300 mg/3ml .. 26 enoxaparin sodium inj 40 mg/0.4ml . 25

enoxaparin sodium subcutaneous soln

60 mg/0.6ml ............................... 26 enoxaparin sodium subcutaneous soln

80 mg/0.8ml ............................... 26 entacapone tab 200 mg .................. 53

entecavir tab 0.5 mg ...................... 63 entecavir tab 1 mg ......................... 63

ENTRESTO TAB 24-26MG ................ 67 ENTRESTO TAB 49-51MG ................ 67

ENTRESTO TAB 97-103MG............... 67 ENTYVIO INJ 300MG ....................... 88

EPANED SOL 1MG/ML ..................... 45 epinastine hcl ophth soln 0.05% .... 141

epinephrine solution auto-injector 0.15 mg/0.3ml (1:2000) .................... 154

epinephrine solution auto-injector 0.3

mg/0.3ml (1:1000) .................... 154 EPIPEN 2-PAK

see epinephrine solution auto-injector 0.3 mg/0.3ml (1:1000) 154

EPIPEN-JR 2-PAK see epinephrine solution auto-

injector 0.15 mg/0.3ml (1:2000) ............................................ 154

EPIVIR see lamivudine oral soln 10 mg/ml 61

see lamivudine tab 150 mg ........... 61 see lamivudine tab 300 mg ........... 61

EPIVIR HBV see lamivudine tab 100 mg (hbv) .. 63

EPIVIR HBV SOL 5MG/ML ................ 63

eplerenone tab 25 mg ..................... 48 eplerenone tab 50 mg ..................... 48

EPZICOM see abacavir sulfate-lamivudine tab

600-300 mg ............................. 61 EQ COMPLETE TAB ADULT ............. 126

EQ ONE DAILY TAB MENS .............. 126 EQ ONE DAILY TAB WOMENS ......... 126

EQL CENTURY TAB MENS .............. 126 EQL CENTURY TAB WOMENS ......... 126

EQL LANCETS MIS 21G COLR ......... 103 EQL LANCETS MIS 33G COLR ......... 103

EQL LANCETS MIS THIN 26G ......... 103 EQL LANCETS MIS THIN 30G ......... 103

EQL PRENATAL TAB FORMULA ........ 133 EQUETRO CAP 100MG ..................... 54

EQUETRO CAP 200MG ..................... 54

EQUETRO CAP 300MG ..................... 54 ergocalciferol cap 1.25 mg (50000 unit)

............................................... 155 ergotamine w/ caffeine tab 1-100 mg

............................................... 118 erlotinib hcl tab 100 mg (base

equivalent) ................................. 50 erlotinib hcl tab 150 mg (base

equivalent) ................................. 50 erlotinib hcl tab 25 mg (base

equivalent) ................................. 50 ERYPED 400

see erythromycin ethylsuccinate for susp 400 mg/5ml ..................... 99

erythromycin ethylsuccinate for susp

400 mg/5ml ................................ 99 erythromycin ophth oint 5 mg/gm .. 139

erythromycin soln 2% ..................... 75 ESBRIET CAP 267MG .................... 148

ESBRIET TAB 267MG .................... 148 ESBRIET TAB 801MG .................... 148

escitalopram oxalate tab 10 mg (base equiv) ........................................ 31



ESGIC see butalbital-acetaminophen-

caffeine tab 50-325-40 mg ........ 10

esomeprazole magnesium cap delayed release 20 mg (base eq) ............ 151

182

esomeprazole magnesium cap delayed release 40 mg (base eq) ............. 151

esomeprazole magnesium for delayed release susp packet 10 mg ......... 151



ESTRACE see estradiol tab 0.5 mg ............... 86

see estradiol tab 1 mg.................. 86 see estradiol tab 2 mg.................. 86

see estradiol vaginal cream 0.1 mg/gm .................................. 154

estradiol & norethindrone acetate tab

0.5-0.1 mg ................................. 86 estradiol & norethindrone acetate tab

1-0.5 mg .................................... 86 estradiol tab 0.5 mg ....................... 86

estradiol tab 1 mg .......................... 86 estradiol tab 2 mg .......................... 86

estradiol td patch twice weekly 0.025 mg/24hr ..................................... 86




estradiol td patch twice weekly 0.1

mg/24hr ..................................... 86 estradiol td patch weekly 0.025

mg/24hr ..................................... 87 estradiol td patch weekly 0.0375

mg/24hr (37.5 mcg/24hr) ............ 87 estradiol td patch weekly 0.05 mg/24hr

................................................. 87 estradiol td patch weekly 0.06 mg/24hr

................................................. 87 estradiol td patch weekly 0.075

mg/24hr ..................................... 87 estradiol td patch weekly 0.1 mg/24hr

................................................. 87 estradiol vaginal cream 0.1 mg/gm 154

estradiol vaginal tab 10 mcg .......... 154

ESTRING MIS 2MG ....................... 154 ESTROFACTORS TAB .................... 130

ESTROSTEP FE see norethindrone ac-ethinyl estrad-

fe tab 1-20/1-30/1-35 mg-mcg .. 69 ESTROVEN MEN TAB SUPPLEM ....... 126

eszopiclone tab 1 mg ...................... 97 eszopiclone tab 2 mg ...................... 97

eszopiclone tab 3 mg ...................... 97 ethambutol hcl tab 100 mg.............. 49

ethambutol hcl tab 400 mg.............. 49 ethosuximide cap 250 mg ............... 29

ethosuximide soln 250 mg/5ml ........ 29 ethynodiol diacetate & ethinyl estradiol

tab 1 mg-35 mcg ........................ 68 ethynodiol diacetate & ethinyl estradiol

tab 1 mg-50 mcg ........................ 68

etodolac cap 200 mg ....................... 8 etodolac cap 300 mg ....................... 8

etodolac tab 400 mg ........................ 8 etodolac tab 500 mg ........................ 8

etodolac tab er 24hr 400 mg ............ 8 etodolac tab er 24hr 500 mg ............ 8

etodolac tab er 24hr 600 mg ............ 8 etonogestrel-ethinyl estradiol va ring

0.120-0.015 mg/24hr .................. 70 etravirine tab 100 mg ..................... 61

etravirine tab 200 mg ..................... 61 EUFLEXXA INJ 10MG/ML ............... 135

everolimus tab 10 mg ..................... 51 everolimus tab 2.5 mg .................... 51

everolimus tab 5 mg ....................... 51

everolimus tab 7.5 mg .................... 51 everolimus tab for oral susp 2 mg .... 51

everolimus tab for oral susp 3 mg .... 51 everolimus tab for oral susp 5 mg .... 51

EVISTA see raloxifene hcl tab 60 mg ......... 84

EVOLUTION60 POW ...................... 126 EVOTAZ TAB 300-150 ..................... 61

EVOXAC see cevimeline hcl cap 30 mg...... 123

EXELON see rivastigmine td patch 24hr 13.3

mg/24hr ................................ 145 see rivastigmine td patch 24hr 4.6

mg/24hr ................................ 145

see rivastigmine td patch 24hr 9.5 mg/24hr ................................ 145

183

exemestane tab 25 mg ................... 50 EXJADE

see deferasirox tab for oral susp 125 mg .......................................... 41



EXONDYS 51 SOL 100/2ML ............ 137 EXONDYS 51 SOL 500/10ML .......... 137

EXTAVIA INJ 0.3MG ...................... 145 EYE HEALTH CAP .......................... 126

EYE HEALTH CAP ADLT 50+ ........... 126 EYE HEALTH TAB LUTEIN ............... 126

EYE MULTIVIT TAB SODIUM ........... 126

EYLEA INJ 2/0.05ML ..................... 139 E-Z JECT MIS 21G ........................ 102

E-Z JECT MIS 21G COLR ............... 102 E-Z JECT MIS 30G ........................ 102

E-Z JECT MIS 32G COLR ............... 102 E-Z JECT MIS LANC 21G ................ 102

E-Z JECT MIS THIN 26G ................ 102 ezetimibe tab 10 mg ....................... 44

E-ZJECT LANC MIS 33G ................. 103 EZ-LETS 21G MIS LANCETS ........... 103

EZ-LETS 26G MIS LANCETS ........... 103 EZ-LETS 28G MIS LANCETS ........... 103

EZ-LETS 30G MIS LANCETS ........... 103 F FABRAZYME INJ 35MG .................... 84

FABRAZYME INJ 5MG ...................... 84 famciclovir tab 125 mg ................... 63

famciclovir tab 250 mg ................... 63 famciclovir tab 500 mg ................... 63

famotidine for susp 40 mg/5ml ...... 151 famotidine tab 10 mg ................... 151

famotidine tab 20 mg ................... 151 famotidine tab 40 mg ................... 151

FANTASY LUBR MIS ........................ 99 FANTASY LUBR MIS COLORS ........... 99

FANTASY LUBR MIS SPERMICI ......... 99 FANTASY MIS LUBRICAT ................. 99

FARESTON see toremifene citrate tab 60 mg

(base equivalent) ...................... 51

FARXIGA TAB 10MG ........................ 39 FARXIGA TAB 5MG ......................... 39

FASENRA INJ 30MG/ML ................... 23 FASLODEX

see fulvestrant inj 250 mg/5ml ..... 50 FASLODEX INJ 250/5ML .................. 50

FASTCLIX MIS LANCETS ................ 103 FC FEMALE MIS CONDOM ................ 99

FC2 FEMALE MIS CONDOM .............. 99 fe fumarate-vit c-vit b12-fa cap 460

(151 fe)-60-0.01-1 mg................. 95 febuxostat tab 40 mg ..................... 90

febuxostat tab 80 mg ..................... 90 FEIBA INJ ...................................... 91

felbamate susp 600 mg/5ml ............ 29 felbamate tab 400 mg .................... 29

felbamate tab 600 mg .................... 29

FELBATOL see felbamate susp 600 mg/5ml .... 29

see felbamate tab 400 mg ............ 29 see felbamate tab 600 mg ............ 29

FELDENE see piroxicam cap 10 mg ............... 9

see piroxicam cap 20 mg ............... 9 felodipine tab er 24hr 10 mg ........... 66

felodipine tab er 24hr 2.5 mg .......... 66 felodipine tab er 24hr 5 mg ............. 66

FEMARA see letrozole tab 2.5 mg ............... 50

FEMHRT see norethindrone acetate-ethinyl

estradiol tab 0.5 mg-2.5 mcg ..... 86

FEMRING MIS 0.05/24H ................ 154 FEMRING MIS 0.1MG/24 ............... 154

fenofibrate micronized cap 134 mg ... 44 fenofibrate micronized cap 200 mg ... 44

fenofibrate micronized cap 67 mg..... 44 fenofibrate tab 145 mg ................... 44

fenofibrate tab 160 mg ................... 44 fenofibrate tab 48 mg ..................... 44

fenofibrate tab 54 mg ..................... 44 fenoprofen calcium tab 600 mg ......... 8

fentanyl td patch 72hr 100 mcg/hr ... 11 fentanyl td patch 72hr 12 mcg/hr ..... 11

fentanyl td patch 72hr 25 mcg/hr ..... 11 fentanyl td patch 72hr 50 mcg/hr ..... 11

fentanyl td patch 72hr 75 mcg/hr ..... 11

FEOSOL TAB 200MG ....................... 95 FERAHEME INJ 510/17ML ................ 95

184

FER-IN-SOL DRO 15MG/ML .............. 95 FERRLECIT

see sod ferric gluc cmplx in sucrose iv soln 12.5 mg/ml (fe eq) ......... 96

FERRLECIT INJ 12.5MG/M ............... 95 ferrous gluconate tab 240 mg (27 mg

elemental fe) .............................. 95 ferrous gluconate tab 324 mg (37.5 mg

elemental iron)............................ 95 ferrous sulfate dried tab 200 mg (65

mg elemental fe) ......................... 95 ferrous sulfate elixir 220 mg/5ml (44

mg/5ml elemental fe) .................. 95 ferrous sulfate soln 75 mg/ml (15

mg/ml elemental fe) .................... 96

ferrous sulfate tab 27 mg (elemental fe) ............................................. 96

ferrous sulfate tab 325 mg (65 mg elemental fe) .............................. 96

ferrous sulfate tab ec 325 mg (65 mg fe equivalent) ............................. 96

ferrous sulfate tab er 142 mg (45 mg fe equivalent) ............................. 96

ferrous sulfate tab er 143 mg (45 mg fe equivalent) ............................. 96

ferrous sulfate tab er 50 mg (elemental fe) ............................................. 96

FEVERALL INF SUP 80MG ................ 10 FEVERALL SUP 325MG .................... 10

fexofenadine hcl susp 30 mg/5ml (6

mg/ml) ...................................... 43 fexofenadine hcl tab 180 mg ............ 43

fexofenadine hcl tab 60 mg ............. 43 fexofenadine-pseudoephedrine tab er

12hr 60-120 mg .......................... 73 fexofenadine-pseudoephedrine tab er

24hr 180-240 mg ........................ 73 FIBRYGA INJ 1GM ........................... 91

FIFTY50 MIS 31GX3/16 ................. 111 FIFTY50 MIS 31GX5/16 ................. 111

FIFTY50 MIS 31GX5MM ................. 111 FIFTY50 PEN MIS 31GX8MM .......... 111

FIFTY50 PEN MIS 32GX4MM .......... 111 FIFTY50 PEN MIS 32GX6MM .......... 111

FIFTY50 PREP PAD PADS ............... 109

FIFTY50 SAFE MIS LANCETS .......... 103 finasteride tab 5 mg ....................... 89

FINE 30 MIS ................................ 103 FINGERSTIX MIS LANCETS ............ 103

FIRMAGON INJ 120MG .................... 50 FIRMAGON INJ 80MG ...................... 50

FIRST-OMEPRA SUS 2MG/ML ......... 151 FIRVANQ SOL 25MG/ML .................. 18

FIRVANQ SOL 50MG/ML .................. 18 FITNESS TABS TAB MEN ............... 126

FITNESS TABS TAB WOMEN .......... 126 FLAGYL

see metronidazole cap 375 mg ...... 17 FLAX + DHA CAP ............................. 7

FLEBOGAMMA INJ 10/100ML ......... 142 FLEBOGAMMA INJ 20/200ML ......... 142

FLEBOGAMMA INJ 20/400ML ......... 142

FLEBOGAMMA INJ 5GM/50ML ........ 142 flecainide acetate tab 100 mg .......... 23

flecainide acetate tab 150 mg .......... 23 flecainide acetate tab 50 mg ............ 23

FLEXICHAMBER MIS ..................... 117 FLEXICHAMBER MIS MASK LRG ...... 117

FLEXICHAMBER MIS MASK SM ....... 117 FLINTSTONES CHW COMPLETE ...... 131

FLINTSTONES CHW GUMMIES ....... 131 FLINTSTONES CHW IMMUNITY ....... 131

FLINTSTONES CHW SOUR GUM ...... 131 FLINTSTONES CHW TODDLER ........ 131

FLOMAX see tamsulosin hcl cap 0.4 mg ...... 89

FLOVENT DISK AER 100MCG ........... 24

FLOVENT DISK AER 250MCG ........... 24 FLOVENT DISK AER 50MCG ............. 24

FLOVENT HFA AER 110MCG ............. 24 FLOVENT HFA AER 220MCG ............. 24

FLOVENT HFA AER 44MCG ............... 24 FLOWFLEX KIT TEST ....................... 81

FLUCLVX QUAD INJ 2020-21 ......... 153 fluconazole for susp 10 mg/ml ......... 42

fluconazole for susp 40 mg/ml ......... 42 fluconazole tab 100 mg ................... 42

fluconazole tab 150 mg ................... 42 fluconazole tab 200 mg ................... 42

fluconazole tab 50 mg..................... 42 fludrocortisone acetate tab 0.1 mg ... 72

FLUMIST QUAD SUS 2020-21 ........ 153

fluocinolone acetonide (otic) oil 0.01% ............................................... 142

185

fluocinonide cream 0.05% ............... 78 fluocinonide cream 0.1% ................. 78

fluocinonide oint 0.05% .................. 78 fluocinonide soln 0.05% .................. 78

fluorometholone ophth susp 0.1% .. 140 FLUOROPLEX CRE 1% ..................... 77

fluorouracil cream 5% ..................... 77 fluoxetine hcl cap 10 mg ................. 31

fluoxetine hcl cap 20 mg ................. 32 fluoxetine hcl cap 40 mg ................. 32

fluoxetine hcl solution 20 mg/5ml ..... 32 fluphenazine decanoate inj 25 mg/ml 58

fluphenazine hcl tab 1 mg ............... 58 fluphenazine hcl tab 10 mg .............. 59

fluphenazine hcl tab 2.5 mg ............. 58

fluphenazine hcl tab 5 mg ............... 59 flurbiprofen tab 100 mg ................... 8

fluticasone propionate cream 0.05% . 78 fluticasone propionate nasal susp 50

mcg/act ................................... 136 fluticasone propionate oint 0.005% .. 78

fluvoxamine maleate tab 100 mg ..... 32 fluvoxamine maleate tab 25 mg ....... 32

fluvoxamine maleate tab 50 mg ....... 32 FLUZONE QUAD INJ 2020-21 ......... 153

FML OIN 0.1% OP ........................ 140 FOAM ANTACID CHW 80-20MG ........ 16

FOCALIN see dexmethylphenidate hcl tab 10

mg ........................................... 4

see dexmethylphenidate hcl tab 2.5 mg ........................................... 4

see dexmethylphenidate hcl tab 5 mg ............................................... 4

FOCALIN XR CAP 10MG .................... 4 FOCALIN XR CAP 15MG .................... 4



FOCALIN XR CAP 40MG .................... 5 FOCALIN XR CAP 5MG ...................... 4

folic acid cap 0.8 mg ....................... 94 folic acid tab 1 mg .......................... 94

folic acid tab 400 mcg ..................... 94

folic acid tab 800 mcg ..................... 94

folic acid-vitamin b6-vitamin b12 tab 0.8-10-0.115 mg ......................... 95

folic acid-vitamin b6-vitamin b12 tab 2.2-25-0.5 mg ............................ 95

folic acid-vitamin b6-vitamin b12 tab 2.2-25-1 mg ............................... 95

folic acid-vitamin b6-vitamin b12 tab 2.5-25-1 mg ............................... 95

FOLITAB 500 TAB ........................... 95 FORA LANCETS MIS 30G ............... 103

FORA MIS LANCETS ...................... 103 FORTEO INJ 620/2.48 ..................... 83

FOSAMAX see alendronate sodium tab 70 mg 83

fosamprenavir calcium tab 700 mg

(base equiv) ............................... 61 FOSAPREPITAN SOL 150MG ............. 42

fosaprepitant dimeglumine for iv infusion 150 mg (base eq) ............ 42

FOSCAVIR INJ 24MG/ML ................. 63 FOSFREE TAB .............................. 126

fosinopril sodium & hydrochlorothiazide tab 10-12.5 mg ........................... 47

fosinopril sodium & hydrochlorothiazide tab 20-12.5 mg ........................... 47

fosinopril sodium tab 10 mg ............ 45 fosinopril sodium tab 20 mg ............ 45

fosinopril sodium tab 40 mg ............ 45 FREEDAVITE TAB ......................... 126

FREESTY LIBR KIT 2 SENSOR ........ 103

FREESTY LIBR MIS 2 READER ........ 103 FREESTYLE KIT SENSOR ............... 103

FREESTYLE MIS LANCETS .............. 103 FREESTYLE MIS READER ............... 103

FULL SPECT TAB B/ VIT C.............. 124 FULPHILA INJ 6/0.6ML .................... 94

fulvestrant inj 250 mg/5ml .............. 50 FULVESTRANT INJ 250/5ML ............. 50

furosemide oral soln 10 mg/ml ........ 82 furosemide tab 20 mg ..................... 82

furosemide tab 40 mg ..................... 82 furosemide tab 80 mg ..................... 82

FUZEON INJ 90MG ......................... 61 G gabapentin cap 100 mg .................. 27

gabapentin cap 300 mg .................. 27 gabapentin cap 400 mg .................. 27

186

gabapentin oral soln 250 mg/5ml ..... 27 gabapentin tab 600 mg ................... 27

gabapentin tab 800 mg ................... 27 GABITRIL

see tiagabine hcl tab 12 mg .......... 29 see tiagabine hcl tab 16 mg .......... 29

see tiagabine hcl tab 2 mg ............ 29 see tiagabine hcl tab 4 mg ............ 29

galantamine hydrobromide cap er 24hr 16 mg ...................................... 144

galantamine hydrobromide cap er 24hr 24 mg ...................................... 144

galantamine hydrobromide cap er 24hr 8 mg ........................................ 144

galantamine hydrobromide tab 12 mg

............................................... 145 galantamine hydrobromide tab 4 mg

............................................... 144 galantamine hydrobromide tab 8 mg

............................................... 145 GAMIFANT INJ 10MG/2ML ............. 121

GAMIFANT INJ 50/10ML ................ 121 GAMMAGARD INJ 10GM/100 .......... 142

GAMMAGARD INJ 1GM/10ML ......... 142 GAMMAGARD INJ 2.5GM/25 ........... 142

GAMMAGARD INJ 20GM/200 .......... 142 GAMMAGARD INJ 30GM/300 .......... 142

GAMMAGARD INJ 5GM/50ML ......... 142 GAMMAGARD SD INJ 10GM HU ...... 142

GAMMAGARD SD INJ 5GM HU ........ 142

GAMUNEX-C INJ 10GM/100 ........... 142 GAMUNEX-C INJ 1GM/10ML ........... 142

GAMUNEX-C INJ 2.5GM/25 ............ 142 GAMUNEX-C INJ 20GM/200 ........... 142

GAMUNEX-C INJ 40/400ML ............ 143 GAMUNEX-C INJ 5GM/50ML ........... 142

ganciclovir sodium for inj 500 mg ..... 63 GARDASIL 9 INJ ........................... 153

GASTROCROM see cromolyn sodium oral conc 100

mg/5ml ................................... 88 GCON IR TAB 10-385MG ................. 73

GEL-ONE INJ 30MG/3ML ............... 135 GELSYN-3 INJ 16.8/2ML ................ 135

gemfibrozil tab 600 mg ................... 44

GENADEK CAP STEP 1 ................... 126 GENADEK CAP STEP 2 ................... 126

GENADEK DRO ............................. 131 GENERESS FE

see norethindrone & ethinyl estradiol-fe chew tab 0.8 mg-25

mcg ........................................ 69 GENOTROPIN INJ 0.2MG ................. 83

GENOTROPIN INJ 0.4MG ................. 83 GENOTROPIN INJ 0.6MG ................. 83



GENOTROPIN INJ 1.8MG ................. 83 GENOTROPIN INJ 12MG .................. 84

GENOTROPIN INJ 1MG .................... 83

GENOTROPIN INJ 2MG .................... 83 GENOTROPIN INJ 5MG .................... 83

gentamicin sulfate cream 0.1% ........ 76 gentamicin sulfate oint 0.1% ........... 76

gentamicin sulfate ophth soln 0.3% 139 GENTEAL TEAR GEL SEV D/N ......... 138

GENTEEL LANC KIT BLUE .............. 103 GENTEEL MIS LANCETS ................. 103

GENTLE-LET MIS 26G ................... 103 GENTLE-LET MIS 28G ................... 103

GENTLE-LET MIS LANCETS ............ 103 GENVISC 850 INJ 25/2.5 ............... 135

GENVOYA TAB ............................... 61 GEODON

see ziprasidone hcl cap 20 mg ...... 54

see ziprasidone hcl cap 40 mg ...... 54 see ziprasidone hcl cap 60 mg ...... 54

see ziprasidone hcl cap 80 mg ...... 54 GERBER LIL CHW BRAINIES .......... 132

GERI-FREEDA TAB SENIOR ............ 126 GILENYA CAP 0.5MG ..................... 146

GILPHEX TR TAB 10-388MG ............. 73 GILTUSS CGH TAB & COLD .............. 73

GILTUSS EX LIQ MAX STR ............... 74 GLASSIA INJ ................................ 148

glatiramer acetate soln prefilled syringe 40 mg/ml ................................. 146

GLEEVEC TAB 100MG ..................... 51 GLEEVEC TAB 400MG ..................... 51

GLENMAX PEB LIQ DM .................... 73

GLEOSTINE CAP 100MG .................. 49 GLEOSTINE CAP 10MG .................... 49

187

GLEOSTINE CAP 40MG .................... 49 glimepiride tab 1 mg ....................... 40

glimepiride tab 2 mg ....................... 40 glimepiride tab 4 mg ....................... 40

glipizide tab 10 mg ......................... 40 glipizide tab 5 mg ........................... 40

glipizide tab er 24hr 10 mg .............. 40 glipizide tab er 24hr 2.5 mg ............. 40

glipizide tab er 24hr 5 mg ............... 40 GLOBAL 28G MIS LANCETS ............ 103

GLOBAL 30G MIS LANCETS ............ 103 GLOBAL PREP PAD PADS ............... 109

GLUCAGEN INJ HYPOKIT ................. 37 glucagon (rdna) for inj kit 1 mg ....... 37

GLUCAGON EMERGENCY KIT

see glucagon (rdna) for inj kit 1 mg .............................................. 37

GLUCAGON INJ 1MG ....................... 37 GLUCAGON KIT 1MG ....................... 37

GLUCOCOM MIS 28G .................... 103 GLUCOCOM MIS 30G .................... 103

GLUCOCOM MIS 33G .................... 103 GLUCOSE CHW 4-.006GM ................ 37

GLUCOSE CHW 4-0.006 .................. 37 GLUCOSE CHW 4GM ....................... 37

GLUCOSE CHW FRT PNCH ............... 37 GLUCOSE CHW FRUIT ..................... 37

GLUCOSE CHW GRAPE .................... 37 GLUCOSE CHW ORANGE ................. 37

GLUCOSE CHW RASPBERY ............... 37

GLUCOSE CHW RASPBRRY............... 37 GLUCOSE CHW TROP FRT ................ 37

GLUCOSE CHW WATERMLN ............. 37 GLUCOTROL XL

see glipizide tab er 24hr 10 mg ..... 40 see glipizide tab er 24hr 2.5 mg .... 40

see glipizide tab er 24hr 5 mg ....... 40 glyburide micronized tab 1.5 mg ...... 40

glyburide micronized tab 3 mg ......... 40 glyburide micronized tab 6 mg ......... 40

glyburide tab 1.25 mg..................... 40 glyburide tab 2.5 mg ...................... 40

glyburide tab 5 mg ......................... 40 glyburide-metformin tab 1.25-250 mg

................................................. 35

glyburide-metformin tab 2.5-500 mg 35 glyburide-metformin tab 5-500 mg ... 36

GLYCERIN SUP 2GM ....................... 98 glycerin suppos 1 gm ...................... 98

glycerin suppos 1.2 gm ................... 98 glycerin suppos 2 gm ...................... 98

glycerin suppos 2.1 gm ................... 98 glycerin suppos 80.7% .................... 98

glycerin-hypromellose-peg 400 ophth soln 0.2-0.2-1% ........................ 138

glycopyrrolate oral soln 1 mg/5ml .. 150 glycopyrrolate tab 1 mg ................ 150

glycopyrrolate tab 2 mg ................ 150 GLYCOTROL CAP .......................... 134

GLYCOTROL CAP COMPLETE .......... 134 GLYNASE

see glyburide micronized tab 1.5 mg

.............................................. 40 see glyburide micronized tab 3 mg 40

see glyburide micronized tab 6 mg 40 GLY-OXIDE SOL 10% .................... 122

GLYXAMBI TAB 10-5 MG ................. 36 GLYXAMBI TAB 25-5 MG ................. 36

GNP ALCOHOL PAD SWABS ........... 109 GNP GLUCOSE CHW GRAPE ............. 37

GNP GLUCOSE CHW ORANGE .......... 37 GNP GLUCOSE CHW RASPBERY ........ 37

GNP GLUCOSE CHW WATERMLN ...... 37 GNP IMMUNE PAK ........................ 126

GNP IMMUNE PAK SUPPORT .......... 126 GNP LANCETS MIS 21G ................. 103

GNP LANCETS MIS 28G ................. 103

GNP LANCETS MIS 30G ................. 104 GNP LANCETS MIS 33G ................. 104

GNP LANCETS MIS THIN 26G ......... 104 GNP PRENATAL TAB 28-0.8MG ....... 133

GNP ULTICARE MIS 31GX5/16 ....... 111 GNP ULTICARE MIS 31GX5MM ....... 111

GNP ULTICARE MIS 32GX1/4 ......... 111 GNP ULTICARE MIS 32GX5/32 ....... 111

GOJJI LANCET MIS 30G................. 104 GOLD BOND CRE PSORIASI ............. 79

GOLD BOND OIN HEALING .............. 79 GOLYTELY

see peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm ............. 98

GOODSENSE MIS LANC 26G .......... 104

GOODSENSE MIS LANC 30G .......... 104 GOODSENSE MIS LANC 33G .......... 104

188

GRALISE TAB 300MG .................... 146 GRALISE TAB 600MG .................... 146

granisetron hcl tab 1 mg ................. 41 griseofulvin microsize susp 125 mg/5ml

................................................. 42 griseofulvin microsize tab 500 mg .... 42

G-TRON PED LIQ ............................ 73 guaifenesin liquid 100 mg/5ml ......... 74

guaifenesin syrup 100 mg/5ml ......... 74 guaifenesin tab 200 mg ................... 74

guaifenesin tab 400 mg ................... 74 guaifenesin tab er 12hr 1200 mg...... 74

guaifenesin tab er 12hr 600 mg ....... 74 guaifenesin-codeine liquid 225-7.5

mg/5ml ...................................... 73

guaifenesin-codeine soln 100-10 mg/5ml ...................................... 73

guanfacine hcl tab 1 mg .................. 46 guanfacine hcl tab 2 mg .................. 46

guanfacine hcl tab er 24hr 1 mg (base equiv) ......................................... 3




GYNOL II GEL 3% ........................ 153 H HAEMOLANCE MIS HIGH FLO ......... 104

HAEMOLANCE MIS LOW FLOW ....... 104 HAEMOLANCE MIS PLUS ................ 104

HAEMOLANCE MIS PLUS LOW ........ 104 HAEMOLANCE MIS PLUS MAX ........ 104

HAEMOLANCE MIS PLUS PED ......... 104 HAEMOLANCE MIS RETRACT .......... 104

HAIR SKIN & TAB NAILS AD .......... 126 HAIR/SKIN/ CAP NAILS ................. 126

HALDOL DECANOATE 100 see haloperidol decanoate im soln

100 mg/ml ............................... 56 HALDOL DECANOATE 50

see haloperidol decanoate im soln 50 mg/ml ..................................... 56

halobetasol propionate cream 0.05% 78

halobetasol propionate oint 0.05% ... 78

haloperidol decanoate im soln 100 mg/ml ........................................ 56

haloperidol decanoate im soln 50 mg/ml ........................................ 56

haloperidol lactate oral conc 2 mg/ml56 haloperidol tab 0.5 mg .................... 56

haloperidol tab 1 mg....................... 56 haloperidol tab 10 mg ..................... 56

haloperidol tab 2 mg....................... 56 haloperidol tab 20 mg ..................... 56

haloperidol tab 5 mg....................... 56 HAVRIX INJ 1440UNIT .................. 153

HC/ALOE CRE 0.5% ........................ 78 HEALTHY EYES CAP SUPERVIS ....... 126

HEALTHY KIDS CHW GUMMIES ...... 131

HEART SAVIOR CAP ...................... 134 HEMLIBRA INJ 105/0.7 ................... 91

HEMLIBRA INJ 150/ML .................... 91 HEMLIBRA INJ 30MG/ML ................. 91

HEMLIBRA INJ 60/0.4 ..................... 91 HEMOFIL M INJ 1000UNIT ............... 91

HEMOFIL M INJ 1700UNIT ............... 91 HEMOFIL M INJ 250UNIT ................. 91

HEMOFIL M INJ 500UNIT ................. 91 heparin sodium (porcine) inj 1000

unit/ml ....................................... 26 heparin sodium (porcine) inj 10000

unit/ml ....................................... 26 heparin sodium (porcine) inj 20000

unit/ml ....................................... 26

heparin sodium (porcine) inj 5000 unit/ml ....................................... 26

heparin sodium (porcine) pf inj 5000 unit/0.5ml .................................. 26

HEPSERA see adefovir dipivoxil tab 10 mg .... 63

HERBAL EXPEC LIQ 150/15ML .......... 74 HI POT MV/ TAB BETA-CAR ........... 126

HIGH POTENCY TAB MULTIVIT ....... 130 HIGH POTENCY TAB MV/FA............ 126

HIZENTRA INJ 10/50ML ................ 143 HIZENTRA INJ 1GM/5ML ............... 143

HIZENTRA INJ 2GM/10ML .............. 143 HIZENTRA INJ 4GM/20ML .............. 143

HLTHY ACCNTS MIS LANC 30G ...... 104

HM COMPLETE TAB MEN ................ 126 HM HAIR/SKIN TAB /NAILS ........... 126

189

HM INSULIN S MIS 0.3/31G........... 111 HM INSULIN S MIS 1ML/30G ......... 112

HM STERILE PAD ALCHOL .............. 109 HM ULTICARE MIS 31GX8MM ......... 112

HOLD CHAMBER MIS ADLT LG ....... 117 HOLD CHAMBER MIS MEDIUM ........ 117

HOLD CHAMBER MIS SMALL .......... 117 HONEY BEARS CHW ...................... 133

HONEY BEARS CHW IRON-ZIN ....... 132 HORIZANT TAB 300MG ER ............. 146

HORIZANT TAB 600MG ER ............. 146 HUMALOG INJ 100/ML .................... 39

HUMALOG MIX INJ 50/50 ................ 39 HUMALOG MIX SUS 75/25 ............... 39

HUMATE-P SOL 2400UNIT ............... 91

HUMATE-P SOL 250-600 ................. 91 HUMATE-P SOL 500-1200 ................ 91

HUMATIN see paromomycin sulfate cap 250 mg

............................................... 7 HUMIRA INJ 10/0.1ML ..................... 7

HUMIRA INJ 20/0.2ML ..................... 7 HUMIRA INJ 40/0.4ML ..................... 7

HUMIRA KIT 40MG/0.8 ..................... 7 HUMIRA PEDIA INJ CROHNS ............. 7

HUMIRA PEN INJ 40/0.4ML ............... 7 HUMIRA PEN INJ 40MG/0.8 .............. 7

HUMIRA PEN INJ 80/0.8ML ............... 7 HUMIRA PEN INJ CD/UC/HS .............. 7

HUMIRA PEN INJ PS/UV ................... 7

HUMIRA PEN KIT CD/UC/HS ............. 7 HUMIRA PEN KIT PED UC ................. 8

HUMIRA PEN KIT PS/UV ................... 8 HUMULIN INJ 70/30 ........................ 39

HUMULIN INJ 70/30KWP ................. 39 HUMULIN N INJ U-100 .................... 39

HUMULIN R INJ U-100 .................... 39 HUMULIN R INJ U-500 .................... 39

HYALGAN INJ 20MG/2ML ............... 135 HYCODAN

see hydrocodone w/ homatropine syrup 5-1.5 mg/5ml .................. 72

see hydrocodone w/ homatropine tab 5-1.5 mg ................................. 72

hydralazine hcl tab 10 mg ............... 48

hydralazine hcl tab 100 mg ............. 48 hydralazine hcl tab 25 mg ............... 48

hydralazine hcl tab 50 mg ............... 48 HYDREA

see hydroxyurea cap 500 mg ........ 52 hydrochlorothiazide cap 12.5 mg ...... 82

hydrochlorothiazide tab 25 mg ......... 82 hydrochlorothiazide tab 50 mg ......... 82

HYDROCIL INS POW 95% ................ 97 hydrocodone w/ homatropine syrup 5-

1.5 mg/5ml ................................ 72 hydrocodone w/ homatropine tab 5-1.5

mg ............................................ 72 hydrocodone-acetaminophen soln 7.5-

325 mg/15ml .............................. 13 hydrocodone-acetaminophen tab 10-

300 mg ...................................... 14

hydrocodone-acetaminophen tab 10-325 mg ...................................... 14

hydrocodone-acetaminophen tab 5-300 mg ............................................ 14

hydrocodone-acetaminophen tab 5-325 mg ............................................ 14

hydrocodone-acetaminophen tab 7.5-300 mg ...................................... 14

hydrocodone-acetaminophen tab 7.5-325 mg ...................................... 14

hydrocodone-ibuprofen tab 10-200 mg ................................................. 14

hydrocodone-ibuprofen tab 7.5-200 mg ................................................. 14

HYDROCORT OIN 1% ...................... 78

hydrocortisone acetate cream 1% .... 78 hydrocortisone acetate w/ pramoxine

perianal cream 1-1% ................... 16 hydrocortisone cream 0.5% ............. 78

hydrocortisone cream 1% ............... 78 hydrocortisone cream 2.5% ............. 78

hydrocortisone enema 100 mg/60ml 16 hydrocortisone gel 1% .................... 78

hydrocortisone lotion 1% ................ 78 hydrocortisone lotion 2.5% .............. 78

hydrocortisone oint 0.5% ................ 78 hydrocortisone oint 1% ................... 78

hydrocortisone oint 2.5% ................ 78 hydrocortisone perianal cream 1% ... 16

hydrocortisone perianal cream 2.5% 16

hydrocortisone tab 10 mg ............... 71 hydrocortisone tab 20 mg ............... 71

190

hydrocortisone tab 5 mg ................. 70 hydrocortisone w/ acetic acid otic soln

1-2% ....................................... 142 hydrocortisone-aloe vera cream 1% . 78

hydromorphone hcl liqd 1 mg/ml ...... 11 hydromorphone hcl tab 2 mg ........... 11

hydromorphone hcl tab 4 mg ........... 11 hydromorphone hcl tab 8 mg ........... 11

hydroxychloroquine sulfate tab 200 mg ................................................. 48

hydroxyurea cap 500 mg ................. 52 hydroxyzine hcl syrup 10 mg/5ml ..... 20

hydroxyzine hcl tab 10 mg .............. 20 hydroxyzine hcl tab 25 mg .............. 20

hydroxyzine hcl tab 50 mg .............. 20

hydroxyzine pamoate cap 25 mg ...... 20 hydroxyzine pamoate cap 50 mg ...... 20

hyoscyamine sulfate elixir 0.125 mg/5ml .................................... 150

hyoscyamine sulfate sl tab 0.125 mg ............................................... 150

hyoscyamine sulfate soln 0.125 mg/ml ............................................... 150

hyoscyamine sulfate tab 0.125 mg . 151 hyoscyamine sulfate tab disint 0.125

mg .......................................... 151 hyoscyamine sulfate tab er 12hr 0.375

mg .......................................... 151 HYPERSAL NEB 3.5% ...................... 74

HYPOLANCE KIT LANCING ............. 104

HYZAAR see losartan potassium &

hydrochlorothiazide tab 100-12.5 mg .......................................... 47

see losartan potassium & hydrochlorothiazide tab 100-25 mg

.............................................. 47 see losartan potassium &

hydrochlorothiazide tab 50-12.5 mg .......................................... 47

I ibandronate sodium iv soln 3 mg/3ml

(base equivalent) ........................ 83 ibandronate sodium tab 150 mg (base

equivalent) ................................. 83

ibuprofen cap 200 mg ...................... 8 ibuprofen chew tab 100 mg .............. 8

ibuprofen susp 100 mg/5ml .............. 8 ibuprofen susp 40 mg/ml ................. 8

ibuprofen tab 100 mg ...................... 9 ibuprofen tab 200 mg ...................... 9

ibuprofen tab 400 mg ...................... 9 ibuprofen tab 600 mg ...................... 9

ibuprofen tab 800 mg ...................... 9 ICAPS AREDS TAB FORMULA ......... 126

ICLUSIG TAB 10MG ........................ 51 ICLUSIG TAB 15MG ........................ 51

ICLUSIG TAB 30MG ........................ 51 ICLUSIG TAB 45MG ........................ 51

IDELVION SOL 1000UNIT ................ 91 IDELVION SOL 2000UNIT ................ 91

IDELVION SOL 250UNIT .................. 91

IDELVION SOL 3500UNIT ................ 91 IDELVION SOL 500UNIT .................. 91

ILARIS INJ 150MG/ML ..................... 8 ILUMYA SOL 100MG/ML .................. 77

IMBRUVICA CAP 140MG .................. 51 IMBRUVICA CAP 70MG .................... 51

IMBRUVICA TAB 140MG .................. 51 IMBRUVICA TAB 280MG .................. 51

IMBRUVICA TAB 420MG .................. 51 IMBRUVICA TAB 560MG .................. 51

imipramine hcl tab 10 mg ............... 34 imipramine hcl tab 25 mg ............... 35

imipramine hcl tab 50 mg ............... 35 imipramine pamoate cap 100 mg ..... 35

imipramine pamoate cap 125 mg ..... 35

imipramine pamoate cap 150 mg ..... 35 imipramine pamoate cap 75 mg ....... 35

imiquimod cream 5% ...................... 79 IMITREX

see sumatriptan succinate tab 100 mg ........................................ 118

see sumatriptan succinate tab 25 mg ............................................ 118

see sumatriptan succinate tab 50 mg ............................................ 118

IMITREX SPR 20MG/ACT ............... 118 IMITREX SPR 5MG/ACT ................. 118

IMITREX STATDOSE SYSTEM see sumatriptan succinate solution

auto-injector 4 mg/0.5ml ......... 118

see sumatriptan succinate solution auto-injector 6 mg/0.5ml ......... 118

191

IMMUBLAST-C POW ORANGE ......... 126 IMMUNE CHW SUPPORT ................ 126

IMMUNE SUPP POW VIT C ............. 127 IMMUNERX CAP ............................ 134

IMMUNICARE CAP ........................ 135 IMURAN

see azathioprine tab 50 mg ......... 121 IN CONTROL MIS 31GX3/16 .......... 112

IN CONTROL MIS 31GX5MM .......... 112 IN CONTROL MIS 31GX6MM .......... 112

IN CONTROL MIS 31GX8MM .......... 112 IN TOUCH LAN MIS 30G ................ 104

INCONTROL MIS 29GX12MM .......... 112 INCONTROL MIS LANC 28G ........... 104

INCONTROL MIS LANC 30G ........... 104

INCONTROL MIS LANC 33G ........... 104 INCONTROL PAD ALCOHOL ............ 109

INCRELEX INJ 40MG/4ML ................ 84 indapamide tab 1.25 mg ................. 82

indapamide tab 2.5 mg ................... 82 INDERAL LA

see propranolol hcl cap er 24hr 120 mg .......................................... 65




INDOCIN SUP 50MG ........................ 9

INDOCIN SUS 25MG/5ML ................. 9 indomethacin cap 25 mg .................. 9

indomethacin cap 50 mg .................. 9 indomethacin cap er 75 mg .............. 9

INFED INJ 50MG/ML ....................... 96 INGREZZA CAP 40MG ................... 145

INGREZZA CAP 60MG ................... 145 INGREZZA CAP 80MG ................... 145

INJECTAFER INJ 750/15ML .............. 96 INLYTA TAB 1MG ............................ 49

INLYTA TAB 5MG ............................ 49 INPEN 100EL MIS BLUE-HUM ......... 112

INPEN 100EL MIS GREY-HUM ......... 112 INPEN 100EL MIS PINK HUM .......... 112

INPEN 100NN MIS BLUE NOV ......... 112

INPEN 100NN MIS GREY NOV ........ 112 INPEN 100NN MIS PINK NOV ......... 112

INS ASP PROT INJ FLEXPEN ............. 39 INS SY 0.3ML MIS 30GX1/2 ........... 112

INS SY 0.3ML MIS 31GX5/16 ......... 112 INS SY 0.5ML MIS 30GX1/2 ........... 112

INS SY 0.5ML MIS 30GX5/16 ......... 112 INS SY 1/2ML MIS 30GX1/2 .......... 112

INS SYR .3ML MIS 30GX1/2 .......... 112 INS SYR 1ML MIS 30GX1/2 ........... 112

INS SYR 1ML MIS 30GX5/16 .......... 112 INS SYR 1ML MIS 31GX5/16 .......... 112

INSPIRACHAMB MIS LARGE ........... 117 INSPIRACHAMB MIS MEDIUM ........ 117

INSPIRACHAMB MIS MOUTHPCE .... 117 INSPIRACHAMB MIS SMALL ........... 117

INSPIREASE MIS DD SYST ............ 117

INSPRA see eplerenone tab 25 mg ............ 48

see eplerenone tab 50 mg ............ 48 INSULIN ASPA INJ 100/ML .............. 39

INSULIN ASPA INJ 70/30 ................ 39 INSULIN ASPA INJ FLEXPEN ............ 39

INSULIN ASPA INJ PENFILL ............. 39 INSULIN LISP INJ 100/ML ............... 39

INSULIN LISP INJ JUNIOR ............... 39 INSULIN LISP INJ PROTAMIN ........... 39

INSULIN PEN MIS 29GX12MM ........ 112 INSULIN PEN MIS 31GX8MM .......... 112

INSULIN SYRG MIS 0.3/29G .......... 112 INSULIN SYRG MIS 0.3/30G .......... 112

INSULIN SYRG MIS 0.3/31G .......... 112

INSULIN SYRG MIS 0.3ML/30 ........ 112 INSULIN SYRG MIS 0.3ML/31 ........ 112



INSULIN SYRG MIS 0.5/31G .......... 112 INSULIN SYRG MIS 1/2ML/30 ........ 112

INSULIN SYRG MIS 1/2ML/31 ........ 112 INSULIN SYRG MIS 1ML/25G ......... 112

INSULIN SYRG MIS 1ML/26G ......... 112 INSULIN SYRG MIS 1ML/27G .. 112, 113

INSULIN SYRG MIS 1ML/28G ......... 113 INSULIN SYRG MIS 1ML/29G ......... 113

INSULIN SYRG MIS 1ML/30G ......... 113

INSULIN SYRG MIS 1ML/31G ......... 113 INSULIN SYRG MIS 27GX1/2 ......... 113

192

INSULIN SYRG MIS 28GX1/2 ......... 113 INSULIN SYRG MIS 29GX1/2 ......... 113

INSULIN SYRG MIS 30GX1/2 ......... 113 INSULIN SYRG MIS 30GX5/16 ....... 113

INSULIN SYRG MIS 31GX5/16 ....... 113 INSULIN SYRI MIS 0.3/31G ........... 113

INSUPEN MIS 29GX12MM .............. 113 INSUPEN MIS 31GX5MM ................ 113

INSUPEN MIS 31GX8MM ................ 113 INSUPEN MIS 32GX4MM ................ 113

INSUPEN SENS MIS 32GX6MM ....... 113 INSUPEN ULTR MIS 30GX8MM ....... 113

INSUPEN ULTR MIS 31GX6MM ....... 113 INSUPEN ULTR MIS 31GX8MM ....... 113

INTELENCE

see etravirine tab 100 mg ............. 61 see etravirine tab 200 mg ............. 61

INTELISWAB KIT COVID-19 ............. 81 INTRON A INJ 10MU ....................... 52

INTRON A INJ 18MU ....................... 52 INTRON A INJ 50MU ....................... 52

INTUNIV see guanfacine hcl tab er 24hr 1 mg

(base equiv).............................. 3 see guanfacine hcl tab er 24hr 2 mg



(base equiv).............................. 3

INULOSE BLD CAP SUGAR ............. 135 INVEGA SUST INJ 117/0.75 ............. 55

INVEGA SUST INJ 156MG/ML ........... 55 INVEGA SUST INJ 234/1.5 ............... 55

INVEGA SUST INJ 39/0.25 ............... 54 INVEGA SUST INJ 78/0.5ML ............ 54

INVEGA TRINZ INJ 273MG ............... 55 INVEGA TRINZ INJ 410MG ............... 55

INVEGA TRINZ INJ 546MG ............... 55 INVEGA TRINZ INJ 819MG ............... 55

INVIRASE TAB 500MG ..................... 61 INVOKAMET TAB 150-1000 .............. 36

INVOKAMET TAB 150-500 ............... 36 INVOKAMET TAB 50-1000 ............... 36

INVOKAMET TAB 50-500MG ............. 36

INVOKANA TAB 100MG ................... 39 INVOKANA TAB 300MG ................... 39

ipratropium bromide inhal soln 0.02% ................................................. 23

ipratropium bromide nasal soln 0.03% (21 mcg/spray) ......................... 136

ipratropium bromide nasal soln 0.06% (42 mcg/spray) ......................... 136

ipratropium-albuterol nebu soln 0.5-2.5(3) mg/3ml ............................ 25

irbesartan tab 150 mg .................... 46 irbesartan tab 300 mg .................... 46

irbesartan tab 75 mg ...................... 46 irbesartan-hydrochlorothiazide tab

150-12.5 mg .............................. 47 irbesartan-hydrochlorothiazide tab

300-12.5 mg .............................. 47

IRESSA TAB 250MG ........................ 50 iron polysacch complex-vit b12-fa cap

150-0.025-1 mg .......................... 95 iron-vit c-vit b12-folic acid tab 100-

250-0.025-1 mg .......................... 95 ISENTRESS CHW 100MG ................. 61

ISENTRESS CHW 25MG ................... 61 ISENTRESS HD TAB 600MG ............. 61

ISENTRESS POW 100MG ................. 61 ISENTRESS TAB 400MG .................. 61

isoniazid tab 300 mg ...................... 49 ISOPTO ATROP SOL 1% OP ........... 139

ISOPTO CARPINE see pilocarpine hcl ophth soln 1% 139

see pilocarpine hcl ophth soln 2% 139

ISORDIL TITRADOSE see isosorbide dinitrate tab 40 mg . 19

see isosorbide dinitrate tab 5 mg ... 19 isosorbide dinitrate tab 10 mg ......... 19

isosorbide dinitrate tab 20 mg ......... 19 isosorbide dinitrate tab 30 mg ......... 19

isosorbide dinitrate tab 40 mg ......... 19 isosorbide dinitrate tab 5 mg ........... 19

isosorbide mononitrate tab 10 mg .... 19 isosorbide mononitrate tab 20 mg .... 19

isosorbide mononitrate tab er 24hr 120 mg ............................................ 19

isosorbide mononitrate tab er 24hr 30 mg ............................................ 19

isosorbide mononitrate tab er 24hr 60

mg ............................................ 19 isotretinoin cap 10 mg .................... 75

193

isotretinoin cap 20 mg .................... 75 isotretinoin cap 30 mg .................... 75

isotretinoin cap 40 mg .................... 75 ITCH RELIEF CRE 2% ...................... 76

IVERMECTIN LOT 0.5% ................... 80 ivermectin tab 3 mg ....................... 17

IXINITY INJ 1000UNIT .................... 91 IXINITY INJ 1500UNIT .................... 91

IXINITY INJ 2000UNIT .................... 91 IXINITY INJ 250UNIT ...................... 91

IXINITY INJ 3000UNIT .................... 91 IXINITY INJ 500UNIT ...................... 91

J JADENU

see deferasirox tab 180 mg .......... 41

see deferasirox tab 360 mg .......... 41 see deferasirox tab 90 mg ............ 41

JADENU SPRINKLE see deferasirox granules packet 180

mg .......................................... 40 see deferasirox granules packet 360

mg .......................................... 41 see deferasirox granules packet 90

mg .......................................... 40 JAKAFI TAB 10MG .......................... 52

JAKAFI TAB 15MG .......................... 52 JAKAFI TAB 20MG .......................... 52

JAKAFI TAB 25MG .......................... 52 JAKAFI TAB 5MG ............................ 52

JANUMET TAB 50-1000 ................... 36

JANUMET TAB 50-500MG ................ 36 JANUMET XR TAB 100-1000 ............. 36

JANUMET XR TAB 50-1000 .............. 36 JANUMET XR TAB 50-500MG ............ 36

JANUVIA TAB 100MG ...................... 38 JANUVIA TAB 25MG ........................ 38

JANUVIA TAB 50MG ........................ 38 JARDIANCE TAB 10MG .................... 39

JARDIANCE TAB 25MG .................... 39 JENLIVA CAP................................ 133

JENTADUETO TAB 2.5-1000 ............. 36 JENTADUETO TAB 2.5-500............... 36

JENTADUETO TAB 2.5-850............... 36 JENTADUETO TAB XR ...................... 36

JIVI INJ 1000UNIT .......................... 92

JIVI INJ 2000UNIT .......................... 92 JIVI INJ 3000UNIT .......................... 92

JIVI INJ 500 UNIT .......................... 92 JOLLY RANCHR CHW ONE-A-DA ..... 131

JULUCA TAB 50-25MG..................... 61 K KALETRA

see lopinavir-ritonavir soln 400-100

mg/5ml (80-20 mg/ml) ............. 61 see lopinavir-ritonavir tab 100-25 mg

.............................................. 62 see lopinavir-ritonavir tab 200-50 mg

.............................................. 62 KAMELEON LUB MIS COLORS......... 100

KAMELEON MIS TRI-COLR ............. 100 KANUMA INJ 20/10ML ..................... 85

KAPVAY

see clonidine hcl tab er 12hr 0.1 mg 3 KAZANO 12.5- TAB 1000MG ............ 36

KAZANO 12.5- TAB 500MG .............. 36 KENALOG-10 INJ 10MG/ML .............. 71

KEPPRA see levetiracetam oral soln 100

mg/ml ..................................... 28 see levetiracetam tab 1000 mg ..... 28

see levetiracetam tab 250 mg ....... 28 see levetiracetam tab 500 mg ....... 28

see levetiracetam tab 750 mg ....... 28 KEPPRA XR

see levetiracetam tab er 24hr 500 mg .......................................... 28

see levetiracetam tab er 24hr 750

mg .......................................... 28 KERALYT GEL 3% ........................... 79

KERALYT KIT SCALP 6% .................. 79 KERENDIA TAB 10MG ..................... 85

KERENDIA TAB 20MG ..................... 85 ketoconazole cream 2% .................. 76

ketoconazole shampoo 2% .............. 76 KETONE TES .................................. 81

KETONE TEST TES .......................... 81 ketorolac tromethamine ophth soln

0.4% ....................................... 141 ketorolac tromethamine ophth soln

0.5% ....................................... 141 ketorolac tromethamine tab 10 mg .... 9

KETOSTIX TES STRIP ...................... 81

ketotifen fumarate ophth soln 0.025% (base equiv) ............................. 141

194

KIDS PROBIOT CHW MULTIVIT ...... 132 KIDZ MULTVIT CHW PROBIOTI ...... 131

KIMONO COLOR MIS ..................... 100 KIMONO MICRO MIS THIN ............. 100

KIMONO MICRO MIS THIN + .......... 100 KIMONO MICRO MIS THIN PLS ....... 100

KIMONO MIS LUBRICAT ................ 100 KIMONO MIS SENSATIO ................ 100

KIMONO PLUS MIS LUBRICAT ........ 100 KIMONO PLUS MIS SPERMICI ........ 100

KIMONO PS MIS LUBRICAT ............ 100 KIMONO PS MIS PLUS ................... 100

KIMONO SENSA MIS PLUS ............. 100 KIMONO SPEC MIS ....................... 100

KINNEY MIS LANCETS ................... 104

KINNEY THIN MIS LANCETS ........... 104 KITABIS PAK NEB 300/5ML ............... 7

KLONOPIN see clonazepam tab 0.5 mg .......... 26

see clonazepam tab 1 mg ............. 27 see clonazepam tab 2 mg ............. 27

KLOXXADO SPR 8MG ...................... 41 KOATE INJ 1000UNIT ...................... 92

KOATE INJ 250UNIT ....................... 92 KOATE INJ 500 UNIT ...................... 92

KOATE-DVI INJ 1000UNIT ............... 92 KOATE-DVI INJ 500UNIT ................. 92

KOGENATE FS INJ 1000UNIT ........... 92 KOGENATE FS INJ 2000UNIT ........... 92

KOGENATE FS INJ 250UNIT ............. 92

KOGENATE FS INJ 3000UNIT ........... 92 KOGENATE FS INJ 500UNIT ............. 92

KOMBIGLYZ XR TAB 2.5-1000 .......... 36 KOMBIGLYZ XR TAB 5-1000MG ........ 36

KOMBIGLYZ XR TAB 5-500MG .......... 36 KONSYL DAILY POW 100% .............. 97

KONSYL POW 60.3% ...................... 97 KONSYL POW 71.67% ..................... 97

KONSYL-D POW 52.3% ................... 97 KOVALTRY INJ 1000UNIT ................ 92

KOVALTRY INJ 2000UNIT ................ 92 KOVALTRY INJ 250UNIT .................. 92

KOVALTRY INJ 3000UNIT ................ 92 KOVALTRY INJ 500UNIT .................. 92

KP PRENATAL TAB MULTIVIT ......... 133

K-PAX TAB PROF ST...................... 127 KPN PRENATAL TAB ...................... 133

KROG GLUCOSE CHW GRAPE ........... 38 KROG GLUCOSE CHW ORANGE ........ 38

KROG GLUCOSE CHW RASPBERY ..... 38 KROG GLUCOSE CHW TROP FRT ...... 38

KROG GLUCOSE CHW WATERMLN .... 38 KROGER LANCE MIS ..................... 104

KROGER LANCE MIS 26G .............. 104 KROGER LANCE MIS THIN ............. 104

KROGER LANCE MIS THIN 30G ...... 104 K-TAB

see potassium chloride tab er 20 meq (1500 mg) ............................. 120

K-Y ME & YOU MIS EX LUBRI ......... 100 K-Y ME & YOU MIS INTENSE .......... 100

KYLEENA IUD 19.5MG ..................... 70

L labetalol hcl tab 100 mg .................. 64

labetalol hcl tab 200 mg .................. 64 labetalol hcl tab 300 mg .................. 64

lactic acid (ammonium lactate) cream 12% .......................................... 79

lactic acid (ammonium lactate) lotion 12% .......................................... 79

LACTIC ACID LOT 10% ................... 79 lactulose (encephalopathy) solution 10

gm/15ml .................................... 89 lactulose solution 10 gm/15ml ......... 98

LAMICTAL see lamotrigine tab 100 mg .......... 27

see lamotrigine tab 150 mg .......... 28

see lamotrigine tab 200 mg .......... 28 see lamotrigine tab 25 mg ............ 27

LAMICTAL CHEWABLE DISPERS see lamotrigine tab chewable

dispersible 25 mg ..................... 28 see lamotrigine tab chewable

dispersible 5 mg ....................... 28 LAMICTAL ODT

see lamotrigine orally disintegrating tab 100 mg .............................. 27

see lamotrigine orally disintegrating tab 200 mg .............................. 27

see lamotrigine orally disintegrating tab 25 mg ................................ 27

see lamotrigine orally disintegrating

tab 50 mg ................................ 27 LAMICTAL XR

195

see lamotrigine tab er 24hr 100 mg .............................................. 28

see lamotrigine tab er 24hr 200 mg .............................................. 28

see lamotrigine tab er 24hr 25 mg . 28 see lamotrigine tab er 24hr 250 mg

.............................................. 28 see lamotrigine tab er 24hr 300 mg

.............................................. 28 see lamotrigine tab er 24hr 50 mg . 28

lamivudine oral soln 10 mg/ml ......... 61 lamivudine tab 100 mg (hbv) ........... 63

lamivudine tab 150 mg ................... 61 lamivudine tab 300 mg ................... 61

lamivudine-zidovudine tab 150-300 mg

................................................. 61 lamotrigine orally disintegrating tab

100 mg ...................................... 27 lamotrigine orally disintegrating tab

200 mg ...................................... 27 lamotrigine orally disintegrating tab 25

mg ............................................ 27 lamotrigine orally disintegrating tab 50

mg ............................................ 27 lamotrigine tab 100 mg ................... 27

lamotrigine tab 150 mg ................... 28 lamotrigine tab 200 mg ................... 28

lamotrigine tab 25 mg .................... 27 lamotrigine tab chewable dispersible 25

mg ............................................ 28

lamotrigine tab chewable dispersible 5 mg ............................................ 28

lamotrigine tab er 24hr 100 mg ....... 28 lamotrigine tab er 24hr 200 mg ....... 28

lamotrigine tab er 24hr 25 mg ......... 28 lamotrigine tab er 24hr 250 mg ....... 28

lamotrigine tab er 24hr 300 mg ....... 28 lamotrigine tab er 24hr 50 mg ......... 28

LANAPHILIC OIN ............................ 79 LANCET MICRO MIS THIN 33G ....... 104

LANCET STAND MIS 21G ............... 104 LANCET SUPER MIS THIN 30G ....... 104

LANCET ULTRA MIS 28G ................ 104 LANCET ULTRA MIS THIN 30G........ 104

LANCETS MICR MIS THIN 33G ....... 104

LANCETS MIS .............................. 104 LANCETS MIS 21G ........................ 104

LANCETS MIS 21G COLR ............... 104 LANCETS MIS 26G ........................ 104

LANCETS MIS 28G ........................ 104 LANCETS MIS 30G ........................ 104

LANCETS MIS 33G ........................ 104 LANCETS MIS ORANGE ................. 104

LANCETS MIS ORIGINAL ............... 104 LANCETS MIS THIN ...................... 104

LANCETS MIS THIN 26G ................ 104 LANCETS MIS THIN 30G ................ 104

LANCETS SUPR MIS THIN 28G ....... 104 LANCETS THIN MIS ...................... 105

LANCETS THIN MIS 26G ................ 105 LANCETS ULTR MIS THIN .............. 105

LANOXIN

see digoxin tab 125 mcg (0.125 mg) .............................................. 67

see digoxin tab 250 mcg (0.25 mg) .............................................. 67

LANOXIN TAB 0.0625MG ................. 67 lansoprazole cap delayed release 15

mg .......................................... 151 lansoprazole cap delayed release 30

mg .......................................... 151 LANSOPRAZOLE SUS 3MG/ML ........ 151

lansoprazole tab delayed release orally disintegrating 15 mg .................. 151

lansoprazole tab delayed release orally disintegrating 30 mg .................. 152

LANTUS INJ 100/ML ....................... 39

LANTUS SOLOS INJ 100/ML ............. 39 lapatinib ditosylate tab 250 mg (base

equiv) ........................................ 52 LARTRUVO INJ 10MG/ML ................. 51

LARTRUVO INJ 190/19ML ................ 51 LASIX

see furosemide tab 20 mg ............ 82 see furosemide tab 40 mg ............ 82

see furosemide tab 80 mg ............ 82 latanoprost ophth soln 0.005% ...... 141

LATANOPROST SOL 0.005% .......... 141 LATUDA TAB 120MG ....................... 54

LATUDA TAB 20MG ......................... 54 LATUDA TAB 40MG ......................... 54

LATUDA TAB 60MG ......................... 54

LATUDA TAB 80MG ......................... 54 LB LANCET MIS 28G ..................... 105

196

leflunomide tab 10 mg ..................... 9 leflunomide tab 20 mg ..................... 9

LEMTRADA INJ 12/1.2ML ............... 146 LETAIRIS TAB 10MG ....................... 67

LETAIRIS TAB 5MG ......................... 67 letrozole tab 2.5 mg ....................... 50

leucovorin calcium tab 10 mg .......... 52 leucovorin calcium tab 15 mg .......... 52

leucovorin calcium tab 25 mg .......... 53 leucovorin calcium tab 5 mg ............ 52

LEUKERAN TAB 2MG ....................... 49 leuprolide acetate inj kit 5 mg/ml ..... 50

LEVAQUIN see levofloxacin tab 250 mg ......... 87

see levofloxacin tab 750 mg ......... 87

LEVEMIR INJ .................................. 39 LEVEMIR INJ FLEXTOUC .................. 39

levetiracetam oral soln 100 mg/ml ... 28 levetiracetam tab 1000 mg .............. 28

levetiracetam tab 250 mg ............... 28 levetiracetam tab 500 mg ............... 28

levetiracetam tab 750 mg ............... 28 levetiracetam tab er 24hr 500 mg .... 28

levetiracetam tab er 24hr 750 mg .... 28 levocarnitine oral soln 1 gm/10ml

(10%) ........................................ 85 levocarnitine tab 330 mg ................. 85

levocetirizine dihydrochloride soln 2.5 mg/5ml (0.5 mg/ml) .................... 43

levocetirizine dihydrochloride tab 5 mg

................................................. 43 levofloxacin ophth soln 0.5% ......... 139

levofloxacin oral soln 25 mg/ml ........ 87 levofloxacin tab 250 mg .................. 87

levofloxacin tab 500 mg .................. 87 levofloxacin tab 750 mg .................. 87

levonorgestrel & ethinyl estradiol (91-day) tab 0.15-0.03 mg ................. 69

levonorgestrel & ethinyl estradiol tab 0.1 mg-20 mcg ........................... 69

levonorgestrel & ethinyl estradiol tab 0.15 mg-30 mcg ......................... 69

levonorgestrel tab 1.5 mg ............... 70 levonorgestrel-eth estra tab 0.05-

30/0.075-40/0.125-30mg-mcg ..... 69

levonorgestrel-ethinyl estradiol (continuous) tab 90-20 mcg .......... 69

levonorg-eth est tab 0.1-0.02mg(84) & eth est tab 0.01mg(7) .................. 69

levonorg-eth est tab 0.15-0.03mg(84) & eth est tab 0.01mg(7) ............... 69

levothyroxine sodium tab 100 mcg . 149 levothyroxine sodium tab 112 mcg . 149



levothyroxine sodium tab 200 mcg . 149 levothyroxine sodium tab 25 mcg ... 149

levothyroxine sodium tab 300 mcg . 149 levothyroxine sodium tab 50 mcg ... 149

levothyroxine sodium tab 75 mcg ... 149

levothyroxine sodium tab 88 mcg ... 149 LEXAPRO

see escitalopram oxalate tab 10 mg (base equiv) ............................ 31



LEXIVA see fosamprenavir calcium tab 700

mg (base equiv) ....................... 61 LEXIVA SUS 50MG/ML .................... 61

LIALDA TAB 1.2GM ......................... 88 LIBTAYO INJ 350/7ML ..................... 49

LICEMD GEL 0.33-4% ..................... 80

LIDAFLEX PAD 4% .......................... 80 lidocaine cream 4% ........................ 80

lidocaine hcl cream 4% ................... 80 lidocaine hcl gel 2% ....................... 80

lidocaine hcl lotion 3% .................... 80 lidocaine hcl soln 4% ...................... 80

lidocaine hcl urethral/mucosal gel prefilled syringe 2% ..................... 80

lidocaine hcl viscous soln 2% ......... 122 lidocaine oint 5% ........................... 80

lidocaine patch 4% ......................... 80 lidocaine patch 5% ......................... 80

lidocaine-hydrocortisone acetate perianal cream 3-0.5% ................ 16

lidocaine-hydrocortisone acetate rectal

cream kit 2-2% ........................... 16 lidocaine-prilocaine cream 2.5-2.5% . 80

197

LIDODERM see lidocaine patch 5% ................ 80

LIFESCAN MIS UNISTIK2 ............... 105 LILETTA IUD 52MG ......................... 70

linezolid for susp 100 mg/5ml .......... 18 linezolid tab 600 mg ....................... 18

LINZESS CAP 145MCG .................... 89 LINZESS CAP 290MCG .................... 89

LINZESS CAP 72MCG ...................... 89 liothyronine sodium tab 25 mcg ..... 149

liothyronine sodium tab 5 mcg ....... 149 liothyronine sodium tab 50 mcg ..... 149

LIPITOR see atorvastatin calcium tab 10 mg

(base equivalent) ...................... 44

see atorvastatin calcium tab 20 mg (base equivalent) ...................... 44



LIPOTRIAD CAP VIS PLUS .............. 135 LIPOTRIAD CAP VISION ................ 135

LIPOTRIAD CAP VISIONAR ............ 135 LIQUID C 500 LIQ 500/15ML ......... 156

lisinopril & hydrochlorothiazide tab 10-12.5 mg ..................................... 47

lisinopril & hydrochlorothiazide tab 20-12.5 mg ..................................... 47

lisinopril & hydrochlorothiazide tab 20-

25 mg ........................................ 47 lisinopril tab 10 mg ......................... 45

lisinopril tab 2.5 mg ........................ 45 lisinopril tab 20 mg ......................... 45

lisinopril tab 30 mg ......................... 45 lisinopril tab 40 mg ......................... 45

lisinopril tab 5 mg .......................... 45 LITE TOUCH MIS LANCETS ............ 105

LITETOUCH MIS 29GX12.7 ............ 113 LITETOUCH MIS 31GX8MM ............ 113

LITETOUCH MIS LANCETS ............. 105 lithium carbonate cap 150 mg .......... 53

lithium carbonate cap 300 mg .......... 53 lithium carbonate cap 600 mg .......... 54

lithium carbonate tab 300 mg .......... 54

lithium carbonate tab er 300 mg ...... 54 lithium carbonate tab er 450 mg ...... 54

LITHOBID see lithium carbonate tab er 300 mg

.............................................. 54 LIVTENCITY TAB 200MG .................. 63

LODINE see etodolac tab 400 mg ............... 8

LOHIST-D LIQ ................................ 73 LOHIST-DM SYP 5-2-10MG .............. 73

LOMOTIL see diphenoxylate w/ atropine tab

2.5-0.025 mg ........................... 40 LONGS LANCET MIS STANDARD ..... 105

LONGS LANCET MIS THIN ............. 105 LONGS LANCET MIS ULTRA TH ...... 105

loperamide hcl cap 2 mg ................. 40

loperamide hcl liq 1 mg/7.5ml ......... 40 loperamide hcl tab 2 mg ................. 40

LOPID see gemfibrozil tab 600 mg .......... 44

lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml) ................ 61

lopinavir-ritonavir tab 100-25 mg ..... 62 lopinavir-ritonavir tab 200-50 mg ..... 62

LOPRESSOR see metoprolol tartrate tab 100 mg64

see metoprolol tartrate tab 50 mg . 64 LOPROX

see ciclopirox olamine cream 0.77% (base equiv) ............................ 76

loratadine & pseudoephedrine tab er

12hr 5-120 mg ............................ 73 loratadine & pseudoephedrine tab er

24hr 10-240 mg .......................... 73 loratadine cap 10 mg ...................... 43

loratadine chew tab 5 mg ................ 43 loratadine rapidly-disintegrating tab 10

mg ............................................ 43 loratadine syrup 5 mg/5ml .............. 43

loratadine tab 10 mg ...................... 43 lorazepam conc 2 mg/ml ................. 22

lorazepam tab 0.5 mg ..................... 22 lorazepam tab 1 mg ....................... 22

lorazepam tab 2 mg ....................... 22 losartan potassium &

hydrochlorothiazide tab 100-12.5 mg

................................................. 47

198

losartan potassium & hydrochlorothiazide tab 100-25 mg 47

losartan potassium & hydrochlorothiazide tab 50-12.5 mg

................................................. 47 losartan potassium tab 100 mg ........ 46

losartan potassium tab 25 mg .......... 46 losartan potassium tab 50 mg .......... 46

LOSEASONIQUE see levonorg-eth est tab 0.1-

0.02mg(84) & eth est tab 0.01mg(7) ............................... 69

LOTENSIN see benazepril hcl tab 10 mg ........ 45

see benazepril hcl tab 20 mg ........ 45

see benazepril hcl tab 40 mg ........ 45 LOTREL

see amlodipine besylate-benazepril hcl cap 10-20 mg ...................... 47

see amlodipine besylate-benazepril hcl cap 10-40 mg ...................... 47

see amlodipine besylate-benazepril hcl cap 5-10 mg ....................... 47

see amlodipine besylate-benazepril hcl cap 5-20 mg ....................... 47

lovastatin tab 10 mg ....................... 44 lovastatin tab 20 mg ....................... 44

lovastatin tab 40 mg ....................... 44 LOVENOX

see enoxaparin sodium inj 100

mg/ml ..................................... 25 see enoxaparin sodium inj 120

mg/0.8ml ................................ 25 see enoxaparin sodium inj 150

mg/ml ..................................... 26 see enoxaparin sodium inj 30

mg/0.3ml ................................ 25 see enoxaparin sodium inj 300

mg/3ml ................................... 26 see enoxaparin sodium inj 40

mg/0.4ml ................................ 25 see enoxaparin sodium subcutaneous

soln 60 mg/0.6ml ..................... 26 see enoxaparin sodium subcutaneous

soln 80 mg/0.8ml ..................... 26

loxapine succinate cap 10 mg .......... 57 loxapine succinate cap 25 mg .......... 57

loxapine succinate cap 5 mg ............ 57 loxapine succinate cap 50 mg .......... 57

L-THEANINE CAP 100MG ............... 137 LUBIPROSTONE CAP 24MCG ............ 88

LUBIPROSTONE CAP 8MCG .............. 88 LUBRICNT GEL DRO 0.25-0.3 ........ 138

LUMIZYME INJ 50MG ...................... 85 LUNESTA

see eszopiclone tab 1 mg ............. 97 see eszopiclone tab 2 mg ............. 97

see eszopiclone tab 3 mg ............. 97 LUPR DEP-PED INJ 11.25MG ............ 84

LUPR DEP-PED INJ 15MG ................ 84 LUPR DEP-PED INJ 3M 30MG ........... 84

LUPR DEP-PED INJ 7.5MG ............... 84

LUPRON DEPOT INJ 11.25MG ........... 50 LUPRON DEPOT INJ 22.5MG ............ 50

LUPRON DEPOT INJ 3.75MG ............ 50 LUPRON DEPOT INJ 30MG ............... 50

LUPRON DEPOT INJ 45MG ............... 50 LUPRON DEPOT INJ 7.5MG .............. 50

LUTEIN PLUS TAB ZEAXANTH ........ 127 LUXTURNA SUS ............................ 140

LYRICA see pregabalin cap 100 mg ........... 28

see pregabalin cap 150 mg ........... 28 see pregabalin cap 200 mg ........... 28

see pregabalin cap 225 mg ........... 28 see pregabalin cap 25 mg ............. 28

see pregabalin cap 300 mg ........... 28

see pregabalin cap 50 mg ............. 28 see pregabalin cap 75 mg ............. 28

see pregabalin soln 20 mg/ml ....... 28 LYSODREN TAB 500MG ................... 50

LYSTEDA see tranexamic acid tab 650 mg .... 96

M MACROBID

see nitrofurantoin monohydrate macrocrystalline cap 100 mg ...... 18

MACRODANTIN see nitrofurantoin macrocrystalline

cap 100 mg ............................. 18 see nitrofurantoin macrocrystalline

cap 50 mg ............................... 18

MAG-200 TAB .............................. 120 magnesium citrate soln ................... 98

199

magnesium hydroxide susp 400 mg/5ml ...................................... 98

magnesium oxide cap 500 mg (elemental mg) ......................... 120

magnesium oxide tab 250 mg .......... 17 magnesium oxide tab 250 mg (mg

supplement) ............................. 120 magnesium oxide tab 400 mg .......... 17

magnesium oxide tab 400 mg (240 mg elemental mg) .......................... 120

magnesium oxide tab 400 mg (241.3 mg elemental mg) ..................... 120

magnesium oxide tab 420 mg .......... 17 magnesium oxide tab 500 mg (mg

supplement) ............................. 120

magnesium sulfate oral granules ...... 98 MAKENA INJ 250MG/ML ................ 144

MAKENA INJ 275MG ..................... 144 MALARONE

see atovaquone-proguanil hcl tab 250-100 mg ............................. 48

see atovaquone-proguanil hcl tab 62.5-25 mg .............................. 48

malathion lotion 0.5%..................... 80 MASK VORTEX/ MIS FROG ............. 117

MASK VORTEX/ MIS LADY BUG ...... 117 MASONATAL TAB .......................... 133

MATULANE CAP 50MG ..................... 52 MAVIK

see trandolapril tab 4 mg.............. 45

MAVYRET PAK 50-20MG .................. 63 MAVYRET TAB 100-40MG ................ 63

MAXALT see rizatriptan benzoate tab 10 mg

(base equivalent) .................... 118 MAXALT-MLT

see rizatriptan benzoate oral disintegrating tab 10 mg (base eq)

............................................ 118 MAXICHLOR TAB PEH DM ................ 73

MAXICOMFORT MIS 27GX1/2 ......... 113 MAXICOMFORT MIS 31GX1/4 ......... 113

MAXIDEX SUS 0.1% OP ................ 140 MAXIMIN PAK .............................. 127

MAXITROL

see neomycin-polymyxin-dexamethasone ophth oint 0.1%

............................................ 140 see neomycin-polymyxin-

dexamethasone ophth susp 0.1% ............................................ 140

MAXI-TUSS PE LIQ JR ..................... 73 MAXI-TUSS PE LIQ MAX .................. 73

MAXX MIS LUBRICAT .................... 100 MAXX PLUS MIS SPERMICI ............ 100

MAXZIDE see triamterene &

hydrochlorothiazide tab 75-50 mg .............................................. 82

MAXZIDE-25

see triamterene & hydrochlorothiazide tab 37.5-25

mg .......................................... 82 M-CLEAR WC LIQ 100-6.3 ............... 73

meclizine hcl chew tab 25 mg .......... 41 meclizine hcl tab 12.5 mg ............... 41

meclizine hcl tab 25 mg .................. 41 MEDICHOICE MIS LANCET ............. 105

MEDLANCE MIS 30G PLUS ............. 105 MEDLANCE MIS EXTR 21G ............. 105

MEDLANCE MIS LITE 25G .............. 105 MEDLANCE MIS PLUS .................... 105

MEDLANCE MIS PLUS 30G ............. 105 MEDLANCE MIS UNV 21G .............. 105

MEDLANCE PLS MIS 0.8MM ........... 105

MEDLANCE PLS MIS EXTR 21G ....... 105 MEDLANCE PLS MIS LITE 25G ........ 105

MEDLANCE PLS MIS UNIV 21G ....... 105 MEDROL

see methylprednisolone tab 16 mg 71 see methylprednisolone tab 32 mg 71

see methylprednisolone tab 4 mg .. 71 see methylprednisolone tab 8 mg .. 71

MEDROL DOSEPAK see methylprednisolone tab therapy

pack 4 mg (21) ........................ 71 medroxyprogesterone acetate im susp

150 mg/ml ................................. 70 medroxyprogesterone acetate im susp

prefilled syr 150 mg/ml ................ 70

medroxyprogesterone acetate tab 10 mg .......................................... 144

200

medroxyprogesterone acetate tab 2.5 mg .......................................... 144

medroxyprogesterone acetate tab 5 mg ............................................... 144

mefloquine hcl tab 250 mg .............. 48 MEGA MULTI TAB MEN .................. 127

MEGA MULTI TAB WOMEN ............. 127 MEGA MULTIVI TAB MEN ............... 127

MEGA MULTIVI TAB WOMEN .......... 127 MEGAVITE TAB FRT/VEG ............... 127

MEGAVITE TAB GOLD 55+ ............. 127 megestrol acetate susp 40 mg/ml .... 50

megestrol acetate tab 20 mg ........... 50 megestrol acetate tab 40 mg ........... 51

MEIJER LANCE MIS COLOR ............ 105

MEIJER LANCE MIS UNIV 21G ........ 105 MEIJER LANCE MIS UNIV 30G ........ 105

MEIJER LANCE MIS UNIVERSA ....... 105 MEIJER MIS LANCETS ................... 105

MELATIONIN DRO 5MG/ML ............... 6 melatonin cap 10 mg ....................... 6

MELATONIN CAP 1MG ...................... 6 MELATONIN CAP 2.5MG ................... 6

MELATONIN CAP 3MG ...................... 6 MELATONIN CAP 3MG CR ................. 6

melatonin cap 5 mg ......................... 6 melatonin chew tab 1 mg ................. 6

melatonin chew tab 2.5 mg .............. 6 MELATONIN CHW ............................ 6

MELATONIN CHW 5MG ..................... 6

MELATONIN LIQ 10MG/ML ................ 6 MELATONIN LIQ 1MG/4ML ................ 6

MELATONIN LIQ 2.5MG .................... 6 MELATONIN LIQ 3MG/0.9 ................. 6

melatonin liquid 1 mg/ml ................. 6 melatonin liquid 5 mg/15ml .............. 6

MELATONIN LOZ 3MG ...................... 6 MELATONIN LOZ 5MG ...................... 6

melatonin sl tab 10 mg .................... 6 melatonin sl tab 5 mg ...................... 6

MELATONIN SUB 3MG ...................... 6 melatonin tab 1 mg ......................... 6

MELATONIN TAB 1.5MG ................... 6 melatonin tab 10 mg ....................... 7

MELATONIN TAB 12MG .................... 7

MELATONIN TAB 2.5MG ................... 6 MELATONIN TAB 200MCG ................. 7

melatonin tab 3 mg ......................... 6 melatonin tab 300 mcg .................... 7

MELATONIN TAB 3MG CR ................. 6 melatonin tab 5 mg ......................... 6

MELATONIN TAB 500MCG ................. 7 MELATONIN TAB 5MG ...................... 6

melatonin tab er 10 mg ................... 7 melatonin tablet disintegrating 10 mg 7

melatonin tablet disintegrating 12 mg 7 melatonin tablet disintegrating 3 mg . 7

melatonin tablet disintegrating 5 mg . 7 MELATONIN TR TAB 1MG ................. 7

meloxicam tab 15 mg ...................... 9 meloxicam tab 7.5 mg ..................... 9

memantine hcl oral solution 2 mg/ml

............................................... 145 memantine hcl tab 10 mg ............. 145

memantine hcl tab 28 x 5 mg & 21 x 10 mg titration pack .................. 145

memantine hcl tab 5 mg ............... 145 MENEST TAB 0.3MG ....................... 87

MENEST TAB 0.625MG .................... 87 MENEST TAB 1.25MG ...................... 87

MENOSTAR DIS 14MCG ................... 87 MENS 50+ CAP ADVANCED ........... 127

MENS MULTI CHW ........................ 127 MENS MULTI TAB VIT/MIN ............. 127

MENS MULTIPL TAB ...................... 127 MENTAL FOCUS CHW .................... 121

MEPRON

see atovaquone susp 750 mg/5ml . 17 MEPSEVII INJ 10MG/5ML ................ 85

mercaptopurine tab 50 mg .............. 49 MESTINON

see pyridostigmine bromide tab 60 mg .......................................... 48

MESTINON TIMESPAN see pyridostigmine bromide tab er

180 mg ................................... 49 METAMUCIL POW 58.12% ............... 97

METAMUCIL WAF ............................ 97 metformin hcl tab 1000 mg ............. 37

metformin hcl tab 500 mg ............... 37 metformin hcl tab 850 mg ............... 37

metformin hcl tab er 24hr 500 mg .... 37

metformin hcl tab er 24hr 750 mg .... 37 methazolamide tab 25 mg ............... 81

201

methazolamide tab 50 mg ............... 82 methenamine hippurate tab 1 gm..... 18

methenamine mandelate tab 1 gm ... 18 methimazole tab 10 mg ................ 149

methimazole tab 5 mg .................. 149 methocarbamol tab 500 mg ........... 135

methocarbamol tab 750 mg ........... 135 methotrexate sodium for inj 1 gm .... 49

methotrexate sodium inj 50 mg/2ml (25 mg/ml) ................................. 49

methotrexate sodium inj pf 50 mg/2ml (25 mg/ml) ................................. 49

methotrexate sodium tab 2.5 mg (base equiv) ........................................ 49

methscopolamine bromide tab 2.5 mg

............................................... 151 methscopolamine bromide tab 5 mg

............................................... 151 METHYLDOPA TAB 250MG ............... 46

METHYLDOPA TAB 500MG ............... 46 methylergonovine maleate tab 0.2 mg

............................................... 142 METHYL-GUARD CAP ..................... 135

METHYL-GUARD CAP PLUS ............ 135 METHYLIN SOL 10MG/5ML ................ 5

METHYLIN SOL 5MG/5ML ................. 5 methylphenidate hcl cap er 10 mg (cd)

.................................................. 5 methylphenidate hcl cap er 20 mg (cd)

.................................................. 5

methylphenidate hcl cap er 30 mg (cd) .................................................. 5




methylphenidate hcl tab 10 mg ......... 5 methylphenidate hcl tab 20 mg ......... 5

methylphenidate hcl tab 5 mg ........... 5 methylprednisolone acetate inj susp 40

mg/ml ........................................ 71 methylprednisolone acetate inj susp 80

mg/ml ........................................ 71

methylprednisolone sod succ for inj 1000 mg (base equiv) .................. 71

methylprednisolone sod succ for inj 125 mg (base equiv).................... 71

methylprednisolone sod succ for inj 40 mg (base equiv) .......................... 71

methylprednisolone sod succ for inj 500 mg (base equiv).................... 71

methylprednisolone tab 16 mg ......... 71 methylprednisolone tab 32 mg ......... 71

methylprednisolone tab 4 mg .......... 71 methylprednisolone tab 8 mg .......... 71

methylprednisolone tab therapy pack 4 mg (21) ..................................... 71

METOCLOPRAMI TAB 10MG ODT ...... 88 metoclopramide hcl soln 5 mg/5ml (10

mg/10ml) (base equiv) ................ 88

metoclopramide hcl tab 10 mg (base equivalent) ................................. 88

metoclopramide hcl tab 5 mg (base equivalent) ................................. 88

metolazone tab 10 mg .................... 82 metolazone tab 2.5 mg ................... 82

metolazone tab 5 mg ...................... 82 metoprolol & hydrochlorothiazide tab

100-25 mg ................................. 47 metoprolol & hydrochlorothiazide tab

50-25 mg ................................... 47 metoprolol succinate tab er 24hr 100

mg (tartrate equiv) ...................... 64 metoprolol succinate tab er 24hr 200

mg (tartrate equiv) ...................... 64

metoprolol succinate tab er 24hr 25 mg (tartrate equiv) ........................... 64

metoprolol succinate tab er 24hr 50 mg (tartrate equiv) ........................... 64

metoprolol tartrate tab 100 mg ........ 64 metoprolol tartrate tab 25 mg .......... 64

metoprolol tartrate tab 37.5 mg ....... 64 metoprolol tartrate tab 50 mg .......... 64

metoprolol tartrate tab 75 mg .......... 64 METROCREAM

see metronidazole cream 0.75% ... 80 METROLOTION

see metronidazole lotion 0.75% .... 80 metronidazole cap 375 mg .............. 17

metronidazole cream 0.75% ............ 80

metronidazole gel 0.75% ................ 80 metronidazole lotion 0.75% ............. 80

202

metronidazole tab 250 mg ............... 17 metronidazole tab 500 mg ............... 17

metronidazole vaginal gel 0.75% ... 153 metyrosine cap 250 mg................... 45

mexiletine hcl cap 150 mg ............... 23 mexiletine hcl cap 200 mg ............... 23

mexiletine hcl cap 250 mg ............... 23 MG217 PSORIA CRE 3% .................. 79

MIACALCIN see calcitonin (salmon) nasal soln

200 unit/act ............................. 83 MIACALCIN INJ 200/ML ................... 83

miconazole nitrate cream 2% .......... 76 miconazole nitrate powder 2% ......... 76

miconazole nitrate vaginal app 200 mg

& 2% cream 9 gm kit ................. 153 miconazole nitrate vaginal cream 2%

............................................... 153 miconazole nitrate vaginal cream 4%

(200 mg/5gm) .......................... 153 miconazole nitrate vaginal supp 1200

mg & 2% cream kit .................... 153 miconazole nitrate vaginal supp 200

mg & 2% cream 9 gm kit ........... 153 miconazole nitrate vaginal suppos 100

mg .......................................... 154 MICRO THIN MIS LANC 33G ........... 105

MICROCHAMBER MIS .................... 117 MICROLET MIS LANCETS ............... 105

midodrine hcl tab 10 mg ............... 154

midodrine hcl tab 2.5 mg .............. 154 midodrine hcl tab 5 mg ................. 154

miglustat cap 100 mg ..................... 94 MINASTRIN 24 FE

see norethindrone ace-eth estradiol-fe chew tab 1 mg-20 mcg (24) ... 69

MINI OMEGA-3 CAP 540MG ........... 137 MINIPRESS

see prazosin hcl cap 1 mg............. 46 see prazosin hcl cap 2 mg............. 46

see prazosin hcl cap 5 mg............. 46 MINIVELLE

see estradiol td patch twice weekly 0.025 mg/24hr ......................... 86

see estradiol td patch twice weekly

0.0375 mg/24hr ....................... 87

see estradiol td patch twice weekly 0.05 mg/24hr........................... 86

see estradiol td patch twice weekly 0.075 mg/24hr ......................... 86

see estradiol td patch twice weekly 0.1 mg/24hr ............................ 86

MINIVELLE DIS 0.025MG................. 87 MINIVELLE DIS 0.05MG .................. 87

MINIVELLE DIS 0.075MG................. 87 MINIVELLE DIS 0.1MG .................... 87

MINOCIN see minocycline hcl cap 100 mg .. 148

minocycline hcl cap 100 mg ........... 148 minocycline hcl cap 50 mg ............ 148

minocycline hcl cap 75 mg ............ 148

minoxidil tab 10 mg ........................ 48 minoxidil tab 2.5 mg ....................... 48

MIRCETTE see desogest-eth estrad & eth estrad

tab 0.15-0.02/0.01 mg(21/5) ..... 68 MIRENA IUD SYSTEM ...................... 70

mirtazapine orally disintegrating tab 15 mg ............................................ 30



mirtazapine tab 15 mg .................... 30 mirtazapine tab 30 mg .................... 30

mirtazapine tab 45 mg .................... 30

mirtazapine tab 7.5 mg ................... 30 misoprostol tab 100 mcg ............... 152

misoprostol tab 200 mcg ............... 152 MM BIOTIN CAP KERATIN .............. 135

MM PENTIPS MIS 29GX12MM ......... 113 MM PENTIPS MIS 31GX5MM .......... 113

MM PENTIPS MIS 31GX8MM .......... 113 MM PENTIPS MIS 32GX4MM .......... 113

MM TWIST MIS LANCETS .............. 105 M-M-R II INJ ................................ 153

M-NATAL PLUS TAB ...................... 133 MOBIC

see meloxicam tab 15 mg .............. 9 see meloxicam tab 7.5 mg ............. 9

MOBILE LANCE MIS 30G ............... 105

modafinil tab 100 mg ....................... 5 modafinil tab 200 mg ....................... 5

203

moexipril hcl tab 15 mg .................. 45 moexipril hcl tab 7.5 mg ................. 45

MOI-STIR SOL ............................. 123 MOLNUPIRAVIR CAP 200MG ............ 64

mometasone furoate cream 0.1% .... 78 mometasone furoate oint 0.1% ........ 78

mometasone furoate solution 0.1% (lotion) ....................................... 78

MONISTAT 3 KIT COMBO PK .......... 154 MONOLET MIS LANCETS ................ 105

MONOLET OPD MIS LANCETS ......... 105 MONOLETTOR MIS LANCETS .......... 105

MONOVISC INJ 88MG/4ML ............. 135 montelukast sodium chew tab 4 mg

(base equiv) ............................... 24

montelukast sodium chew tab 5 mg (base equiv) ............................... 24

montelukast sodium oral granules packet 4 mg (base equiv) ............. 24

montelukast sodium tab 10 mg (base equiv) ........................................ 24

MORPHINE SUL SOL 20MG/5ML ....... 11 morphine sulfate oral soln 10 mg/5ml

................................................. 11 morphine sulfate oral soln 100 mg/5ml

(20 mg/ml) ................................. 11 morphine sulfate tab 15 mg ............. 11

morphine sulfate tab 30 mg ............. 11 morphine sulfate tab er 100 mg ....... 12

morphine sulfate tab er 15 mg ......... 11

morphine sulfate tab er 200 mg ....... 12 morphine sulfate tab er 30 mg ......... 11

morphine sulfate tab er 60 mg ......... 12 MOUTH KOTE SOL ........................ 123

MOUTH KOTE SOL REMINT ............ 123 MOVIPREP

see peg 3350-kcl-nacl-na sulfate-na ascorbate-c for soln 100 gm ....... 98

moxifloxacin hcl ophth soln 0.5% (base equiv) ...................................... 139

MPD SFTY LAN MIS 21G ................ 105 MPD SFTY LAN MIS 23G ................ 105

MPD SFTY LAN MIS 28G ................ 105 MPD SFTY LAN MIS 30G ................ 105

MS CONTIN

see morphine sulfate tab er 100 mg .............................................. 12

see morphine sulfate tab er 15 mg 11 see morphine sulfate tab er 200 mg

.............................................. 12 see morphine sulfate tab er 30 mg 11

see morphine sulfate tab er 60 mg 12 MUCINEX D TAB 120-1200 .............. 73

MUCINEX D TAB 60-600MG ............. 73 MUCINEX FAST TAB 5-10-200 .......... 73

MULTAQ TAB 400MG....................... 23 MULTI ADULT CHW EXTRA C .......... 127

MULTI FOR POW HER .................... 127 MULTI FOR POW HIM .................... 127

MULTI PRENAT TAB ...................... 133 MULTI VITAMI TAB ....................... 130

MULTI VITAMI TAB D-3 ................. 130

MULTI VITAMN TAB MINERALS ....... 127 MULTI-BETIC TAB DIABETES ......... 127

MULTI-LANCET KIT DEVICE ........... 105 MULTIV+FLUOR CHW 0.25MG ........ 131

MULTIV+FLUOR CHW 0.5MG ......... 131 MULTIV+FLUOR CHW 1MG ............ 132

MULTIVIT/FL CHW 0.25MG ............ 132 MULTIVIT/FL CHW 0.5MG .............. 132

MULTIVIT/FL CHW 1MG ................. 132 MULTI-VITAMI TAB MONOCAPS ...... 127

MULTIVITAMIN CHW ADLT GUM ..... 127 MULTIVITAMIN CHW CHILD ........... 133

MULTIVITAMIN CHW CHILDREN ..... 132 MULTIVITAMIN CHW IRON ............ 132

MULTIVITAMIN TAB ............... 127, 131

MULTIVITAMIN TAB ADULT ..... 127, 131 MULTIVITAMIN TAB ADULTS .......... 127

MULTIVITAMIN TAB MEN ............... 127 MULTIVITAMIN TAB WOMEN .......... 127

MULTIVITAMIN TAB ZINC STR ....... 127 MULTI-VITE LIQ ........................... 127

MULTI-VIT-FL CHW 0.25MG ........... 131 MULTI-VIT-FL CHW 0.5MG............. 131

MULTI-VIT-FL CHW 1MG ............... 131 mupirocin calcium cream 2% ........... 76

mupirocin oint 2% .......................... 76 MVW COMPLETE CAP D3000 .......... 127

MVW COMPLETE CAP D5000 .......... 127 MVW COMPLETE CAP FORMULAT .... 127

MVW COMPLETE CAP MINIS........... 127

MVW COMPLETE CHW GRAPE ........ 131 MYALEPT INJ 11.3MG ...................... 85

204

MYAMBUTOL see ethambutol hcl tab 400 mg ..... 49

mycophenolate mofetil cap 250 mg 122 mycophenolate mofetil for oral susp

200 mg/ml ............................... 122 mycophenolate mofetil tab 500 mg . 122

mycophenolate sodium tab dr 180 mg (mycophenolic acid equiv) .......... 122

mycophenolate sodium tab dr 360 mg (mycophenolic acid equiv) .......... 122

MYDRIACYL see tropicamide ophth soln 1% ... 139

MYFORTIC see mycophenolate sodium tab dr

180 mg (mycophenolic acid equiv)

............................................ 122 see mycophenolate sodium tab dr

360 mg (mycophenolic acid equiv) ............................................ 122

MYGLUCOHEALT MIS LANC 30G ..... 105 MYLOTARG INJ 4.5MG ..................... 49

MYSOLINE see primidone tab 250 mg ............ 29

see primidone tab 50 mg .............. 28 MYTESI TAB 125MG ........................ 40

N nabumetone tab 500 mg .................. 9

nabumetone tab 750 mg .................. 9 nadolol tab 20 mg .......................... 64

nadolol tab 40 mg .......................... 64

nadolol tab 80 mg .......................... 64 NAGLAZYME INJ 1MG/ML ................ 85

naloxone hcl inj 0.4 mg/ml .............. 41 naloxone hcl inj 4 mg/10ml ............. 41

naloxone hcl soln prefilled syringe 2 mg/2ml ...................................... 41

naltrexone hcl tab 50 mg ................ 41 NAMENDA

see memantine hcl tab 10 mg ..... 145 see memantine hcl tab 5 mg ....... 145

NAMENDA TITRATION PAK see memantine hcl tab 28 x 5 mg &

21 x 10 mg titration pack ........ 145 naphazoline w/ pheniramine ophth soln

0.025-0.3% .............................. 140

naphazoline w/ pheniramine ophth soln 0.027-0.315% .......................... 140

NAPROSYN see naproxen susp 125 mg/5ml ..... 9

see naproxen tab 500 mg .............. 9 naproxen sodium tab 220 mg ........... 9

naproxen sodium tab 275 mg ........... 9 naproxen sodium tab 550 mg ........... 9

naproxen susp 125 mg/5ml .............. 9 naproxen tab 250 mg ...................... 9

naproxen tab 375 mg ...................... 9 naproxen tab 500 mg ...................... 9

naproxen tab ec 375 mg .................. 9 naproxen tab ec 500 mg .................. 9

naratriptan hcl tab 1 mg (base equiv) ............................................... 118

naratriptan hcl tab 2.5 mg (base equiv)

............................................... 118 NARCAN SPR ................................. 41

NASACORT ALR SPR 55MCG/AC ..... 136 NAT FIBER POW 58.6% ................... 97

NATACYN SUS 5% OP ................... 139 nateglinide tab 120 mg ................... 39

nateglinide tab 60 mg ..................... 39 NATROBA SUS 0.9% ....................... 80

NAT-RUL THER TAB M ................... 127 NATRUL-VITES TAB ...................... 127

NATURAL COND MIS + LUBE ......... 100 NATURE THROI TAB 162.5MG ........ 149

NATURE-THROI TAB 113.75MG ...... 150 NATURE-THROI TAB 130MG .......... 150

NATURE-THROI TAB 146.25MG ...... 150

NATURE-THROI TAB 16.25MG ........ 149 NATURE-THROI TAB 195MG .......... 150

NATURE-THROI TAB 260MG .......... 150 NATURE-THROI TAB 32.5MG ......... 149

NATURE-THROI TAB 325MG .......... 150 NATURE-THROI TAB 48.75MG ........ 149

NATURE-THROI TAB 65MG ............ 149 NATURE-THROI TAB 81.25MG ........ 149

NATURE-THROI TAB 97.5MG ......... 150 NEOFLEX TAB CAL+ D .................. 119

NEOMULTIVITE TAB ...................... 131 neomycin sulfate tab 500 mg ............ 7

neomycin-bacitrac zn-polymyx 5(3.5)mg-400unt-10000unt op oin

............................................... 139

neomycin-bacitracin-polymyxin-pramoxine oint 1% ...................... 76

205

neomycin-polymyxin w/ pramoxine cream 1% .................................. 76

neomycin-polymyxin-dexamethasone ophth oint 0.1% ........................ 140

neomycin-polymyxin-dexamethasone ophth susp 0.1% ....................... 140

neomycin-polymyxin-hc otic soln 1% ............................................... 141

neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000 unit/ml-1%........... 142

NEONATAL PLS TAB 27-1MG .......... 133 NEONATAL TAB COMPLETE ............ 133

NEONATAL TAB COMPLTE .............. 133 NEONATAL TAB PLUS .................... 133

NEONATAL VIT TAB 27-0.8MG ....... 133

NEORAL see cyclosporine modified cap 100

mg ........................................ 121 see cyclosporine modified cap 25 mg

............................................ 121 see cyclosporine modified oral soln

100 mg/ml ............................. 121 NEPHROCAPS CAP ........................ 124

NEPHRO-VITE TAB ........................ 124 NEPHRO-VITE TAB RX ................... 124

NESINA TAB 12.5MG ...................... 38 NESINA TAB 25MG ......................... 38

NESINA TAB 6.25MG ...................... 38 NEULASTA KIT 6MG/0.6M ................ 94

NEUPOGEN INJ 300/0.5 .................. 94

NEUPOGEN INJ 300MCG .................. 94 NEUPOGEN INJ 480/0.8 .................. 94

NEUPOGEN INJ 480MCG .................. 94 NEURONTIN

see gabapentin cap 100 mg .......... 27 see gabapentin cap 300 mg .......... 27

see gabapentin cap 400 mg .......... 27 see gabapentin oral soln 250 mg/5ml

.............................................. 27 see gabapentin tab 600 mg .......... 27

see gabapentin tab 800 mg .......... 27 NEVANAC SUS 0.1% ..................... 141

NEVIRAPINE SUS 50MG/5ML ........... 62 nevirapine tab 200 mg .................... 62

nevirapine tab er 24hr 400 mg ......... 62

NEXAVAR TAB 200MG ..................... 52 NEXIUM

see esomeprazole magnesium cap delayed release 20 mg (base eq)

............................................ 151 see esomeprazole magnesium cap

delayed release 40 mg (base eq) ............................................ 151

see esomeprazole magnesium for delayed release susp packet 10 mg

............................................ 151 see esomeprazole magnesium for

delayed release susp packet 20 mg ............................................ 151

see esomeprazole magnesium for delayed release susp packet 40 mg

............................................ 151

NEXPLANON IMP 68MG ................... 70 NF FORMULAS CHW CHILDREN ...... 131

niacin cap er 250 mg .................... 156 niacin cap er 500 mg .................... 156

niacin tab 100 mg ........................ 156 niacin tab 250 mg ........................ 156

niacin tab 50 mg .......................... 156 niacin tab er 250 mg .................... 156

niacin tab er 500 mg .................... 156 niacin tab er 750 mg .................... 156

NIACIN TR TAB 1000MG ................ 156 NICODERM CQ DIS 14MG/24H ....... 146

NICODERM CQ DIS 21MG/24H ....... 146 NICODERM CQ DIS 7MG/24HR ....... 146

NICORETTE GUM 2MG................... 146

NICORETTE GUM 2MG CINN .......... 146 NICORETTE GUM 2MG MINT .......... 146

NICORETTE GUM 2MG ORIG .......... 146 NICORETTE GUM 2MGFRUIT .......... 147

NICORETTE GUM 4MG................... 147 NICORETTE GUM 4MG CINN .......... 147

NICORETTE GUM 4MG MINT .......... 147 NICORETTE GUM 4MG ORIG .......... 147

NICORETTE GUM 4MGFRUIT .......... 147 NICORETTE LOZ 2MG MINT ........... 147

NICORETTE LOZ 4MG ................... 147 NICORETTE LOZ 4MG MINT ........... 147

NICORETTE ST GUM 2MG MINT ...... 147 NICORETTE ST GUM 2MG ORIG...... 147

NICORETTE ST GUM 4MG ORIG...... 147

nicotine polacrilex gum 2 mg ......... 147 nicotine polacrilex gum 4 mg ......... 147

206

nicotine polacrilex lozenge 2 mg ..... 147 nicotine polacrilex lozenge 4 mg ..... 147

nicotine td patch 24hr 14 mg/24hr . 147 nicotine td patch 24hr 21 mg/24hr . 147

nicotine td patch 24hr 7 mg/24hr ... 147 NICOTROL INH ............................. 147

NICOTROL NS SPR 10MG/ML ......... 147 nifedipine cap 10 mg ...................... 66

nifedipine cap 20 mg ...................... 66 nifedipine tab er 24hr 30 mg ........... 66

nifedipine tab er 24hr 60 mg ........... 66 nifedipine tab er 24hr 90 mg ........... 66

nifedipine tab er 24hr osmotic release 30 mg ........................................ 66

nifedipine tab er 24hr osmotic release

60 mg ........................................ 66 nifedipine tab er 24hr osmotic release

90 mg ........................................ 66 nitazoxanide tab 500 mg ................. 17

NITRO-BID OIN 2% ........................ 19 nitrofurantoin macrocrystalline cap 100

mg ............................................ 18 nitrofurantoin macrocrystalline cap 50

mg ............................................ 18 nitrofurantoin monohydrate

macrocrystalline cap 100 mg ........ 18 nitrofurantoin susp 25 mg/5ml ......... 18

nitroglycerin sl tab 0.3 mg ............... 19 nitroglycerin sl tab 0.4 mg ............... 19

nitroglycerin sl tab 0.6 mg ............... 19

nitroglycerin td patch 24hr 0.1 mg/hr ................................................. 19




NITROSTAT see nitroglycerin sl tab 0.3 mg ...... 19

see nitroglycerin sl tab 0.4 mg ...... 19 see nitroglycerin sl tab 0.6 mg ...... 19

NIVANEX DMX TAB ......................... 73 NIVA-PLUS TAB ............................ 133

NIVESTYM INJ 300/0.5 ................... 94

NIVESTYM INJ 480/0.8 ................... 94 NORDITROPIN INJ 10/1.5ML ............ 84

NORDITROPIN INJ 15/1.5ML ............ 84 NORDITROPIN INJ 30/3ML .............. 84

NORDITROPIN INJ 5/1.5ML ............. 84 norelgestromin-ethinyl estradiol td

ptwk 150-35 mcg/24hr ................ 70 norethindrone & ethinyl estradiol tab

0.4 mg-35 mcg ........................... 69 norethindrone & ethinyl estradiol tab

0.5 mg-35 mcg ........................... 69 norethindrone & ethinyl estradiol tab 1

mg-35 mcg ................................. 69 norethindrone & ethinyl estradiol-fe

chew tab 0.4 mg-35 mcg .............. 69 norethindrone & ethinyl estradiol-fe

chew tab 0.8 mg-25 mcg .............. 69

norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg ........................ 69

norethindrone ace & ethinyl estradiol tab 1.5 mg-30 mcg ...................... 69

norethindrone ace & ethinyl estradiol-fe tab 1 mg-20 mcg ........................ 69

norethindrone ace & ethinyl estradiol-fe tab 1.5 mg-30 mcg ...................... 69

norethindrone ace-eth estradiol-fe chew tab 1 mg-20 mcg (24) ......... 69

norethindrone ace-ethinyl estradiol-fe cap 1 mg-20 mcg (24) ................. 69

norethindrone ace-ethinyl estradiol-fe tab 1 mg-20 mcg (24) ................. 69

norethindrone acetate-ethinyl estradiol

tab 0.5 mg-2.5 mcg ..................... 86 norethindrone acetate-ethinyl estradiol

tab 1 mg-5 mcg .......................... 86 norethindrone ac-ethinyl estrad-fe tab

1-20/1-30/1-35 mg-mcg .............. 69 norethindrone tab 0.35 mg .............. 70

norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35 mg-mcg ............ 69

norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35 mg-mcg .............. 69

norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg ......................... 69

norgestimate-eth estrad tab 0.18-25/0.215-25/0.25-25 mg-mcg ...... 70

norgestimate-eth estrad tab 0.18-

35/0.215-35/0.25-35 mg-mcg ...... 70

207

norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg ................................. 70

NORPACE see disopyramide phosphate cap 100

mg .......................................... 22 see disopyramide phosphate cap 150

mg .......................................... 22 NORPACE CAP 100MG CR ................ 22

NORPACE CAP 150MG CR ................ 22 NORPRAMIN

see desipramine hcl tab 10 mg ...... 34 see desipramine hcl tab 25 mg ...... 34

NORTHERA see droxidopa cap 100 mg .......... 154

see droxidopa cap 200 mg .......... 154

see droxidopa cap 300 mg .......... 154 nortriptyline hcl cap 10 mg .............. 35

nortriptyline hcl cap 25 mg .............. 35 nortriptyline hcl cap 50 mg .............. 35

nortriptyline hcl cap 75 mg .............. 35 NORVASC

see amlodipine besylate tab 10 mg (base equivalent) ...................... 65

see amlodipine besylate tab 2.5 mg (base equivalent) ...................... 65

see amlodipine besylate tab 5 mg (base equivalent) ...................... 65

NORVIR see ritonavir tab 100 mg .............. 62

NORVIR POW 100MG ...................... 62

NORVIR SOL 80MG/ML .................... 62 NOVA SAFETY MIS LANC 23G......... 105

NOVA SAFETY MIS LANC 28G......... 105 NOVA SURE MIS LANCETS ............. 105

NOVAMV PED DRO 10MG/ML ......... 132 NOVOEIGHT INJ 1000UNIT .............. 92

NOVOEIGHT INJ 1500UNIT .............. 92 NOVOEIGHT INJ 2000UNIT .............. 92

NOVOEIGHT INJ 250UNIT ................ 92 NOVOEIGHT INJ 3000UNIT .............. 92

NOVOEIGHT INJ 500UNIT ................ 92 NOVOFINE AUT MIS 30GX8MM ....... 113

NOVOFINE MIS 32GX6MM ............. 113 NOVOFINE PLS MIS 32GX4MM ....... 113

NOVOPEN ECHO MIS .................... 113

NOVOSEVEN RT INJ 1MG ................. 92 NOVOSEVEN RT INJ 2MG ................. 92

NOVOSEVEN RT INJ 5MG ................ 92 NOVOSEVEN RT INJ 8MG ................ 92

NOVOTWIST MIS 32GX5MM........... 113 NPLATE INJ 125MCG ....................... 94

NPLATE INJ 250MCG ....................... 94 NPLATE INJ 500MCG ....................... 94

NUCALA INJ 100MG ........................ 23 NUCALA INJ 100MG/ML ................... 23

NULOJIX INJ 250MG ..................... 122 NULYTELY

see peg 3350-kcl-sod bicarb-nacl for soln 420 gm ............................. 98

NUMOISYN LIQ ............................ 123 NUTRIENT 45+ TAB WOMEN .......... 127

NUTRIENT 50+ TAB MEN ............... 127

NUTRIENTS CAP ANTIOXID ........... 127 NUTRIENTS TAB MEN ................... 127

NUTRIENTS TAB TEENS ................ 127 NUTRIENTS TAB WOMEN ............... 127

NUVARING see etonogestrel-ethinyl estradiol va

ring 0.120-0.015 mg/24hr ......... 70 NUVARING MIS .............................. 70

NUVIGIL see armodafinil tab 150 mg ........... 3

see armodafinil tab 200 mg ........... 3 see armodafinil tab 250 mg ........... 4

see armodafinil tab 50 mg ............. 3 NUWIQ INJ 1000UNIT ..................... 92

NUWIQ INJ 2000UNIT ..................... 92

NUWIQ INJ 250UNIT ....................... 92 NUWIQ INJ 500UNIT ....................... 92

NUWIQ KIT 1000UNIT .................... 92 NUWIQ KIT 2000UNIT .................... 92

NUWIQ KIT 2500UNIT .................... 92 NUWIQ KIT 250UNIT ...................... 92

NUWIQ KIT 3000UNIT .................... 92 NUWIQ KIT 4000UNIT .................... 92

NUWIQ KIT 500UNIT ...................... 92 nystatin cream 100000 unit/gm ....... 76

nystatin oint 100000 unit/gm .......... 76 nystatin susp 100000 unit/ml ........ 122

nystatin tab 500000 unit ................. 42 nystatin topical powder 100000

unit/gm ...................................... 76

NYVEPRIA INJ 6/0.6ML ................... 94

208

O OBIZUR INJ 500 UNIT ..................... 92

OCREVUS INJ 300/10ML ................ 146 octreotide acetate inj 100 mcg/ml (0.1

mg/ml) ...................................... 85 octreotide acetate inj 1000 mcg/ml (1

mg/ml) ...................................... 85 octreotide acetate inj 200 mcg/ml (0.2



mg/ml) ...................................... 85 OCTREOTIDE INJ 100MCG ............... 85

OCTREOTIDE INJ 500MCG ............... 86

OCTREOTIDE INJ 50MCG/ML ............ 85 OCUFLOX

see ofloxacin ophth soln 0.3% ..... 140 OCUHEALTH CAP VISION 2 ............ 128

OCULAR TAB VITAMINS ................ 128 OCUVITE CAP ADULT .................... 128

OCUVITE LUTE CAP ...................... 128 ODEFSEY TAB ................................ 62

ofloxacin ophth soln 0.3% ............. 140 ofloxacin otic soln 0.3% ................ 141

ofloxacin tab 400 mg ...................... 87 OINTMENT OIN BASE ...................... 79

olanzapine orally disintegrating tab 10 mg ............................................ 57

olanzapine orally disintegrating tab 15

mg ............................................ 57 olanzapine orally disintegrating tab 20

mg ............................................ 57 olanzapine orally disintegrating tab 5

mg ............................................ 57 olanzapine tab 10 mg ..................... 58

olanzapine tab 15 mg ..................... 58 olanzapine tab 2.5 mg .................... 57

olanzapine tab 20 mg ..................... 58 olanzapine tab 5 mg ....................... 57

olanzapine tab 7.5 mg .................... 57 olopatadine hcl ophth soln 0.1% (base

equivalent) ............................... 141 olopatadine hcl ophth soln 0.2% (base

equivalent) ............................... 141

OMEGA 3-6-9 CAP COMPLEX ............. 7 OMEGA-3 CAP 1400MG ................. 137

OMEGA-3-6-9 CAP ........................... 7 OMEGA-3-6-9 CAP 1200MG .............. 7

OMEPRAZOLE + SUS SYRSPEND .... 152 omeprazole cap delayed release 10 mg

............................................... 152 omeprazole cap delayed release 20 mg

............................................... 152 omeprazole cap delayed release 40 mg

............................................... 152 omeprazole magnesium cap dr 20.6 mg

(20 mg base equiv) ................... 152 omeprazole magnesium delayed

release tab 20 mg (base equiv) ... 152 omeprazole tablet delayed release

disintegrating 20 mg .................. 152

OMNICAP TAB .............................. 131 OMNIFLEX DPR ............................ 100

ON/GO COVID KIT ANTIGEN ............ 81 ONCOVITE TAB ............................ 128

ondansetron hcl oral soln 4 mg/5ml .. 41 ondansetron hcl tab 4 mg ................ 41

ondansetron hcl tab 8 mg ................ 41 ondansetron orally disintegrating tab 4

mg ............................................ 41 ondansetron orally disintegrating tab 8

mg ............................................ 41 ONE DAILY CHW ADLT GUM ........... 128

ONE DAILY MN TAB W/O IRON ....... 128 ONE DAILY MV TAB WOMENS ........ 128

ONE DAILY TAB ESSENTL .............. 131

ONE DAILY TAB MENS................... 128 ONE DAILY TAB MENS 50+ ............ 128

ONE DAILY TAB WMNS 50+ ........... 128 ONE DAILY TAB WOMENS .............. 128

ONE VITE TAB 1MG PLUS .............. 133 ONE VITE TAB 27-0.8MG ............... 133

ONE-A-DAY CHW IMMUNITY .......... 128 ONE-A-DAY CHW SCOOBY ............. 131

ONE-A-DAY CHW VITACRAV .......... 128 ONE-A-DAY PAK PRENATAL ........... 133

ONE-A-DAY TAB 50+ ADV ............. 128 ONE-A-DAY TAB 50+ MENS ........... 128

ONE-A-DAY TAB 50+ WMN ............ 128 ONE-A-DAY TAB 65+ .................... 128

ONE-A-DAY TAB ENERGY .............. 128

ONE-A-DAY TAB ESSENT ............... 131 ONE-A-DAY TAB MENOPAUS .......... 128

209

ONE-A-DAY TAB MENS ...........128, 131 ONE-A-DAY TAB PETITES .............. 128

ONE-A-DAY TAB PROEDGE ............ 128 ONE-A-DAY TAB TEEN/HIM ............ 128

ONE-A-DAY TAB WOMENS ............. 128 ONE-DAILY CAP MULTI .................. 128

ONE-DAILY PAK VIT/MIN ............... 128 ONETOUCH DEL MIS PLUS 30G ...... 105

ONETOUCH DEL MIS PLUS 33G ...... 105 ONETOUCH FP MIS LANCETS ......... 106

ONETOUCH MIS 30G ..................... 106 ONETOUCH MIS LANCETS ............. 106

ONETOUCH US MIS LANCETS ......... 106 ONFI

see clobazam suspension 2.5 mg/ml

.............................................. 26 see clobazam tab 10 mg ............... 26

see clobazam tab 20 mg ............... 26 ONGLYZA TAB 2.5MG ...................... 38

ONGLYZA TAB 5MG ........................ 38 ONPATTRO SOL 10MG/5ML ............ 147

ON-THE-GO MIS LANC 30G ........... 105 OPTICHAMBER MIS DIA LG ............ 117

OPTICHAMBER MIS DIA MD ........... 117 OPTICHAMBER MIS DIA SM ........... 117

OPTICHAMBER MIS DIAMOND ........ 117 OPTIFAST POS CHW BARIATRI ....... 128

OPTIMUM CHW AIRVITES .............. 128 OPTISOURCE CHW BARIATRC ........ 128

OPTIVITE TAB P.M.T. .................... 128

OPURITY CHW BYPASS ................. 128 OPURITY TAB ............................... 128

ORAL RELIEF SPR DRY MOUT ......... 123 ORAZINC TAB 110MG ................... 120

ORBACTIV SOL 400MG .................... 18 ORENCIA INJ 250MG ....................... 9

ORILISSA TAB 150MG ..................... 83 ORILISSA TAB 200MG ..................... 83

ORTHO TRI-CYCLEN LO see norgestimate-eth estrad tab

0.18-25/0.215-25/0.25-25 mg-mcg .............................................. 70

ORTHOVISC INJ 15MG/ML ............. 136 oseltamivir phosphate cap 30 mg (base

equiv) ........................................ 63

oseltamivir phosphate cap 45 mg (base equiv) ........................................ 63

oseltamivir phosphate cap 75 mg (base equiv) ........................................ 64

oseltamivir phosphate for susp 6 mg/ml (base equiv) ..................... 64

OSENI TAB 12.5-15 ........................ 36 OSENI TAB 12.5-30 ........................ 36

OSENI TAB 12.5-45 ........................ 36 OSENI TAB 25-15MG ...................... 36

OSENI TAB 25-30MG ...................... 36 OSENI TAB 25-45MG ...................... 36

OSMOPREP TAB 1.5GM ................... 98 OSTEOPRIME TAB PLUS ................ 128

OTC ANTIGENT KIT 1-PACK ............. 81 OTC ANTIGENT KIT 2-PACK ............. 81

OTEZLA TAB 10/20/30 ..................... 9

OTEZLA TAB 30MG .......................... 9 oxaprozin tab 600 mg ...................... 9

oxazepam cap 10 mg ...................... 22 oxazepam cap 15 mg ...................... 22

oxazepam cap 30 mg ...................... 22 oxcarbazepine susp 300 mg/5ml (60

mg/ml) ...................................... 28 oxcarbazepine tab 150 mg .............. 28

oxcarbazepine tab 300 mg .............. 28 oxcarbazepine tab 600 mg .............. 28

OXTELLAR XR TAB 150MG ............... 28 OXTELLAR XR TAB 300MG ............... 28

OXTELLAR XR TAB 600MG ............... 28 oxybutynin chloride syrup 5 mg/5ml

............................................... 152

oxybutynin chloride tab 5 mg ........ 152 oxybutynin chloride tab er 24hr 10 mg

............................................... 152 oxybutynin chloride tab er 24hr 15 mg

............................................... 152 oxybutynin chloride tab er 24hr 5 mg

............................................... 152 oxycodone hcl cap 5 mg .................. 12

oxycodone hcl conc 100 mg/5ml (20 mg/ml) ...................................... 12

oxycodone hcl soln 5 mg/5ml .......... 12 oxycodone hcl tab 10 mg ................ 12

oxycodone hcl tab 15 mg ................ 12 oxycodone hcl tab 20 mg ................ 12

oxycodone hcl tab 30 mg ................ 12

oxycodone hcl tab 5 mg .................. 12

210

oxycodone w/ acetaminophen tab 10-325 mg ...................................... 14

oxycodone w/ acetaminophen tab 2.5-325 mg ...................................... 14

oxycodone w/ acetaminophen tab 5-325 mg ...................................... 14

oxycodone w/ acetaminophen tab 7.5-325 mg ...................................... 14

oxymetazoline hcl nasal soln 0.05% 136 oxymorphone hcl tab 10 mg ............ 12

oxymorphone hcl tab 5 mg .............. 12 oyster shell calcium tab 500 mg ..... 119

OZURDEX IMP 0.7MG .................... 140 P palonosetron hcl iv soln 0.25 mg/5ml

(base equivalent) ........................ 41 PALYNZIQ INJ 10/0.5ML .................. 85

PALYNZIQ INJ 2.5/0.5 ..................... 85 PALYNZIQ INJ 20MG/ML .................. 85

PAMELOR see nortriptyline hcl cap 10 mg ..... 35

see nortriptyline hcl cap 25 mg ..... 35 see nortriptyline hcl cap 50 mg ..... 35

see nortriptyline hcl cap 75 mg ..... 35 PAMIDRONATE INJ 30MG ................ 83

PAMIDRONATE INJ 90MG ................ 83 PANDA MASK MIS LARGE .............. 117

PANDA MASK MIS MEDIUM ............ 117 PANDA MASK MIS PEDIATRI .......... 117

PANDA MASK MIS SMALL .............. 117

pantoprazole sodium ec tab 20 mg (base equiv) ............................. 152

pantoprazole sodium ec tab 40 mg (base equiv) ............................. 152

PARAGARD IUD T380A .................... 70 PARLODEL

see bromocriptine mesylate cap 5 mg (base equivalent) ...................... 53

see bromocriptine mesylate tab 2.5 mg (base equivalent) ................ 53

paromomycin sulfate cap 250 mg ...... 7 paroxetine hcl tab 10 mg ................ 32

paroxetine hcl tab 20 mg ................ 32 paroxetine hcl tab 30 mg ................ 32

paroxetine hcl tab 40 mg ................ 32

PARVLEX TAB............................... 128 PATADAY SOL 0.1% ...................... 141

PATADAY SOL 0.2% ..................... 141 PATADAY SOL 0.7% ..................... 141

PAXIL see paroxetine hcl tab 10 mg ........ 32

see paroxetine hcl tab 20 mg ........ 32 see paroxetine hcl tab 30 mg ........ 32

see paroxetine hcl tab 40 mg ........ 32 PAXLOVID TAB ............................... 63

PC LANCETS MIS 30G ................... 106 PECGEN DMX LIQ 10-187MG ........... 73

PED POLY-VIT DRO ....................... 132 PED POLY-VIT DRO /IRON ............. 132

PEDIA-LAX SUP 1GM ...................... 98 PEDIA-LAX SUP 2.8GM .................... 98

PEDIAPRED

see prednisolone sod phosph oral soln 6.7 mg/5ml (5 mg/5ml base)

.............................................. 71 peg 3350-kcl-na bicarb-nacl-na sulfate

for soln 236 gm ........................... 98 peg 3350-kcl-nacl-na sulfate-na

ascorbate-c for soln 100 gm ......... 98 peg 3350-kcl-sod bicarb-nacl for soln

420 gm ...................................... 98 PEGASYS INJ ................................. 63

PEGASYS INJ 180MCG/M ................. 63 PEN NEEDLE MIS 29GX1/2 ............ 113

PEN NEEDLE MIS 31GX3/16 .......... 113 PEN NEEDLE MIS 31GX5/16 .......... 113

PEN NEEDLE MIS 31GX5MM ........... 113

PEN NEEDLE MIS 31GX6MM ........... 113 PEN NEEDLE MIS 31GX8MM ........... 113

PEN NEEDLE MIS 32GX1/4 ............ 113 PEN NEEDLE MIS 32GX4MM ........... 113

PEN NEEDLE MIS 32GX5/32 .......... 114 PEN NEEDLE MIS 32GX6MM ........... 114

PEN NEEDLES MIS 29GX1/2 .......... 114 PEN NEEDLES MIS 29GX12.7 ......... 114

PEN NEEDLES MIS 29GX12MM ....... 114 PEN NEEDLES MIS 30GX3/16 ......... 114

PEN NEEDLES MIS 30GX5/16 ......... 114 PEN NEEDLES MIS 30GX5MM ......... 114

PEN NEEDLES MIS 30GX8MM ......... 114 PEN NEEDLES MIS 31GX1/4 .......... 114

PEN NEEDLES MIS 31GX3/16 ......... 114

PEN NEEDLES MIS 31GX5/16 ......... 114 PEN NEEDLES MIS 31GX5MM ......... 114

211

PEN NEEDLES MIS 31GX6MM ......... 114 PEN NEEDLES MIS 31GX8MM ......... 114

PEN NEEDLES MIS 32GX1/4 .......... 114 PEN NEEDLES MIS 32GX3/16 ......... 114

PEN NEEDLES MIS 32GX4MM ......... 114 PEN NEEDLES MIS 32GX5/32 ......... 114

PEN NEEDLES MIS 32GX5MM ......... 114 PEN NEEDLES MIS 32GX6MM ......... 114

penicillamine cap 250 mg .............. 121 penicillin v potassium tab 250 mg .. 143

penicillin v potassium tab 500 mg .. 143 PENLET II KIT BLOOD ................... 106

PENTASA CAP 250MG CR ................. 88 PENTASA CAP 500MG CR ................. 88

PENTIPS MIS 29GX12MM .............. 114

PENTIPS MIS 31GX5MM ................ 114 PENTIPS MIS 31GX6MM ................ 114

PENTIPS MIS 31GX8MM ................ 114 PENTIPS MIS 32GX4MM ................ 114

pentoxifylline tab er 400 mg ............ 93 PEPCID

see famotidine tab 20 mg ........... 151 see famotidine tab 40 mg ........... 151

PEPTO-BISMOL SUS 262/15ML ......... 40 PERCOCET

see oxycodone w/ acetaminophen tab 10-325 mg ............................... 14

see oxycodone w/ acetaminophen tab 2.5-325 mg .............................. 14

see oxycodone w/ acetaminophen tab

5-325 mg ................................ 14 see oxycodone w/ acetaminophen tab

7.5-325 mg .............................. 14 PERFECT 28G MIS LANCETS .......... 106

PERFECT 30G MIS LANCETS .......... 106 PERIDEX

see chlorhexidine gluconate soln 0.12% ................................... 122

perindopril erbumine tab 2 mg ......... 45 perindopril erbumine tab 4 mg ......... 45

perindopril erbumine tab 8 mg ......... 45 permethrin aerosol 0.5% ................. 80

permethrin cream 5% ..................... 80 permethrin creme rinse 1% ............. 80

permethrin lotion 1% ...................... 80

perphenazine tab 16 mg ................. 59 perphenazine tab 2 mg ................... 59

perphenazine tab 4 mg ................... 59 perphenazine tab 8 mg ................... 59

PERSERIS INJ 120MG ..................... 55 PERSERIS INJ 90MG ....................... 55

PHARMACY COU MIS LANCETS ....... 106 phenazopyridine hcl tab 100 mg ...... 89

phenazopyridine hcl tab 200 mg ...... 89 phenazopyridine hcl tab 95 mg ........ 89

phenazopyridine hcl tab 97.5 mg ..... 89 PHENERGAN

see promethazine hcl inj 25 mg/ml 43 see promethazine hcl inj 50 mg/ml 43

phenobarbital elixir 20 mg/5ml ........ 96 phenobarbital tab 100 mg ............... 97

phenobarbital tab 15 mg ................. 96

phenobarbital tab 16.2 mg .............. 96 phenobarbital tab 30 mg ................. 96

phenobarbital tab 32.4 mg .............. 96 phenobarbital tab 60 mg ................. 96

phenobarbital tab 64.8 mg .............. 96 phenobarbital tab 97.2 mg .............. 96

phenylephrine hcl nasal soln 1% .... 136 phenylephrine hcl ophth soln 10% .. 139

phenylephrine hcl ophth soln 2.5% . 139 phenylephrine w/ dm-gg liqd 10-15-

300 mg/5ml ................................ 73 phenylephrine w/ dm-gg liqd 2.5-5-100

mg/5ml ...................................... 73 phenylephrine w/ dm-gg liqd 2.5-5-50

mg/ml ........................................ 73

phenylephrine w/ dm-gg liqd 2.5-5-75 mg/5ml ...................................... 73

phenylephrine w/ dm-gg liqd 5-10-100 mg/5ml ...................................... 73

phenylephrine w/ dm-gg liqd 5-10-200 mg/5ml ...................................... 73

phenylephrine w/ dm-gg syrup 5-10-100 mg/5ml ................................ 73

phenylephrine w/ dm-gg tab 10-17.5-385 mg ...................................... 73

phenylephrine w/ dm-gg tab 10-20-400 mg ............................................ 73

phenylephrine-brompheniramine-dm liquid 10-4-20 mg/5ml ................. 73

phenylephrine-brompheniramine-dm

liquid 2.5-1-5 mg/5ml .................. 73

212

phenylephrine-chlorphen-dm liquid 10-4-15 mg/5ml .............................. 74

phenylephrine-chlorphen-dm liquid 5-2-10 mg/5ml .............................. 74

phenylephrine-guaifenesin tab 10-400 mg ............................................ 74

PHENYTEK see phenytoin sodium extended cap

200 mg ................................... 29 see phenytoin sodium extended cap

300 mg ................................... 29 phenytoin chew tab 50 mg .............. 29

phenytoin sodium extended cap 100 mg ............................................ 29

phenytoin sodium extended cap 200

mg ............................................ 29 phenytoin sodium extended cap 300

mg ............................................ 29 phenytoin susp 125 mg/5ml ............ 29

PHOSLO see calcium acetate (phosphate

binder) cap 667 mg (169 mg ca) 89 PHOTREXA VIS SOL 0.146-20 ........ 140

PHYTOMULTI TAB ......................... 128 PIFELTRO TAB 100MG ..................... 62

pilocarpine hcl ophth soln 1% ........ 139 pilocarpine hcl ophth soln 2% ........ 139

pilocarpine hcl ophth soln 4% ........ 139 pilocarpine hcl tab 5 mg ................ 123

pilocarpine hcl tab 7.5 mg ............. 123

pimecrolimus cream 1% .................. 79 pioglitazone hcl tab 15 mg (base equiv)

................................................. 39 pioglitazone hcl tab 30 mg (base equiv)

................................................. 39 pioglitazone hcl tab 45 mg (base equiv)

................................................. 39 pioglitazone hcl-glimepiride tab 30-2

mg ............................................ 36 pioglitazone hcl-glimepiride tab 30-4

mg ............................................ 36 pioglitazone hcl-metformin hcl tab 15-

500 mg ...................................... 36 pioglitazone hcl-metformin hcl tab 15-

850 mg ...................................... 36

PIP LANCETS MIS 28G .................. 106 PIP LANCETS MIS 30G .................. 106

piroxicam cap 10 mg ....................... 9 piroxicam cap 20 mg ....................... 9

PLAN B TAB 1.5MG ......................... 70 PLAQUENIL

see hydroxychloroquine sulfate tab 200 mg ................................... 48

PLAVIX see clopidogrel bisulfate tab 75 mg

(base equiv) ............................ 93 PLEGRIDY INJ .............................. 146

PLEGRIDY INJ PEN ....................... 146 PLEGRIDY INJ STARTER ................ 146

PLEGRIDY PEN INJ STARTER .......... 146 PNEUMOVAX 23 INJ 25/0.5 ........... 153

PNV TABS TAB 29-1MG ................. 133

POCKET CHAMB MIS ..................... 117 POCKET SPACE MIS ...................... 117

podofilox soln 0.5% ........................ 79 polyethylene glycol 3350 oral packet

17 gm ........................................ 98 polyethylene glycol 3350 oral powder

17 gm/scoop ............................... 98 polyethylene glycol-propylene glycol

ophth soln 0.4-0.3% .................. 138 polymyxin b-trimethoprim ophth soln

10000 unit/ml-0.1% .................. 140 POLYTRIM

see polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1% ......... 140

polyvinyl alcohol ophth soln 1.4% .. 138

polyvinyl alcohol-povidone ophth soln 5-6 mg/ml (0.5-0.6%) ............... 138

POLY-VI-SOL SOL 50MG/ML .......... 132 POLY-VI-SOL SOL IRON ................ 132

POLY-VITA DRO ........................... 132 POLY-VITA/FE DRO ....................... 132

POLY-VITE DRO ........................... 133 POLY-VITE SOL /IRON .................. 132

POLY-VITE SOL 50MG/ML .............. 133 POLY-VITE SOL IRON .................... 132

PORENAL+D CAP OMEGA 3 ........... 128 potassium bicarbonate effer tab 25

meq ......................................... 120 potassium chloride cap er 10 meq .. 120

potassium chloride cap er 8 meq .... 120

potassium chloride microencapsulated crys er tab 10 meq .................... 120

213

potassium chloride microencapsulated crys er tab 20 meq .................... 120

potassium chloride oral soln 10% (20 meq/15ml) ............................... 120

potassium chloride oral soln 20% (40 meq/15ml) ............................... 120

potassium chloride powder packet 20 meq ......................................... 120

potassium chloride tab er 10 meq... 120 potassium chloride tab er 20 meq

(1500 mg) ................................ 120 potassium chloride tab er 8 meq (600

mg) ......................................... 120 potassium citrate & citric acid soln

1100-334 mg/5ml ....................... 89

potassium citrate tab er 10 meq (1080 mg) ........................................... 89



POTELIGEO INJ 20MG/5ML .............. 50 povidone-iodine soln 10% ............... 60

PRADAXA CAP 110MG ..................... 26 PRADAXA CAP 150MG ..................... 26

PRADAXA CAP 75MG ....................... 26 pramipexole dihydrochloride tab 0.125

mg ............................................ 53 pramipexole dihydrochloride tab 0.25

mg ............................................ 53

pramipexole dihydrochloride tab 0.5 mg ............................................ 53


pramipexole dihydrochloride tab 1 mg ................................................. 53


pramoxine hcl perianal foam 1% ...... 16 pravastatin sodium tab 10 mg ......... 44

pravastatin sodium tab 20 mg ......... 44 pravastatin sodium tab 40 mg ......... 44

pravastatin sodium tab 80 mg ......... 44 praziquantel tab 600 mg ................. 17

prazosin hcl cap 1 mg ..................... 46

prazosin hcl cap 2 mg ..................... 46 prazosin hcl cap 5 mg ..................... 46

PRECOSE see acarbose tab 100 mg ............. 35

see acarbose tab 25 mg ............... 35 see acarbose tab 50 mg ............... 35

PRED FORTE SUS 1% OP .............. 140 PRED MILD SUS 0.12% OP ............ 140

PRED SOD PHO SOL 1% OP ........... 140 PRED-G S.O.P OIN OP ................... 140

PRED-G SUS OP ........................... 140 prednisolone sod phosph oral soln 6.7

mg/5ml (5 mg/5ml base) ............. 71 prednisolone sod phosphate oral soln

15 mg/5ml (base equiv) ............... 71 PREDNISOLONE SUS 1% ............... 140

PREDNISOLONE SUS 1% OP .......... 140

PREDNISOLONE TAB 10MG ODT ....... 71 PREDNISOLONE TAB 15MG ODT ....... 71

PREDNISOLONE TAB 30MG ODT ....... 71 PREDNISONE CON 5MG/ML ............. 71

prednisone tab 1 mg ....................... 71 prednisone tab 10 mg ..................... 71

prednisone tab 2.5 mg .................... 71 prednisone tab 20 mg ..................... 71

prednisone tab 5 mg ....................... 71 prednisone tab 50 mg ..................... 71

prednisone tab therapy pack 10 mg (21) ........................................... 71

prednisone tab therapy pack 5 mg (21) ................................................. 71

PREFEST TAB ................................. 86

pregabalin cap 100 mg ................... 28 pregabalin cap 150 mg ................... 28

pregabalin cap 200 mg ................... 28 pregabalin cap 225 mg ................... 28

pregabalin cap 25 mg ..................... 28 pregabalin cap 300 mg ................... 28

pregabalin cap 50 mg ..................... 28 pregabalin cap 75 mg ..................... 28

pregabalin soln 20 mg/ml ................ 28 PREMARIN TAB 0.3MG .................... 87

PREMARIN TAB 0.45MG .................. 87 PREMARIN TAB 0.625MG ................. 87

PREMARIN TAB 0.9MG .................... 87 PREMARIN TAB 1.25MG .................. 87

PREMARIN VAG CRE 0.625MG ........ 154

PREMPRO TAB................................ 86 PREMPRO TAB 0.3-1.5 .................... 86

214

PREMPRO TAB 0.45-1.5 ................... 86 PREMPRO TAB 0.625-5 .................... 86

PRENATABS FA TAB 29-1MG .......... 133 PRENATAL 19 CHW 29-1MG ........... 133

PRENATAL 19 TAB ........................ 133 PRENATAL 19 TAB 29-1MG ............ 133

PRENATAL MUL CAP +DHA ............ 133 PRENATAL MV MIS + DHA ............. 133

PRENATAL ONE TAB DAILY ............ 133 PRENATAL TAB ............................. 133

PRENATAL TAB 27-0.8MG .............. 134 PRENATAL TAB 27-1MG ................. 134

PRENATAL TAB 28-0.8MG .............. 134 PRENATAL TAB COMPLETE ............. 134

PRE-NATAL TAB FORMULA ............. 133

PRENATAL TAB FORTE .................. 134 PRENATAL TAB IRON .................... 134

PRENATAL TAB MULTIVIT .............. 134 PRENATAL VIT TAB 28-0.8MG ........ 134

PRENATAL VIT TAB LOW IRON ....... 134 PRENATAL VIT TAB MINERALS ....... 134

PRENATAL/FE TAB ........................ 134 PRENATAL+DHA MIS .................... 134

PRENATAL+DHA MIS WOMENS ...... 134 PRENATAL-U CAP 106.5-1 ............. 134

PRENATRIX TAB ........................... 134 PRENATRYL TAB ........................... 134

PRENATVITE TAB RX ..................... 134 PREP PADS PAD ........................... 109

PREPLUS TAB 27-1MG ................... 134

PRESERVISION CAP AREDS ........... 128 PRESERVISION CAP AREDS 2 ........ 128

PRESERVISION CAP LUTEIN........... 128 PRESERVISION CHW AREDS 2 ....... 128

PRESERVISION TAB AREDS ........... 128 PRETAB TAB 29-1MG .................... 134

PREVACID see lansoprazole cap delayed release

30 mg ................................... 151 PREVACID SOLUTAB

see lansoprazole tab delayed release orally disintegrating 15 mg ...... 151

see lansoprazole tab delayed release orally disintegrating 30 mg ...... 152

PREVENT DROP MIS 31GX1/4 ........ 114

PREVENT DROP MIS 31GX5/16 ...... 114 PREVENT SAFE MIS 31GX1/4 ......... 114

PREVENT SAFE MIS 31GX5/16 ....... 114 PREVIDENT SOL 0.2% .................. 122

PREVNAR 13 INJ .......................... 153 PREZCOBIX TAB 800-150 ................ 62

PREZISTA SUS 100MG/ML ............... 62 PREZISTA TAB 150MG .................... 62

PREZISTA TAB 600MG .................... 62 PREZISTA TAB 75MG ...................... 62

PREZISTA TAB 800MG .................... 62 PRIMAQUINE PHOSPHATE

see primaquine phosphate tab 26.3 mg (15 mg base) ...................... 48

primaquine phosphate tab 26.3 mg (15 mg base) .................................... 48

primidone tab 250 mg .................... 29

primidone tab 50 mg ...................... 28 PRIVIGEN INJ 10GRAMS ............... 143

PRIVIGEN INJ 20GRAMS ............... 143 PRIVIGEN INJ 40GRAMS ............... 143

PRIVIGEN INJ 5 GRAMS ................ 143 PRO COMFORT MIS 0.5/30G .......... 114

PRO COMFORT MIS 0.5/31G .......... 114 PRO COMFORT MIS 1ML/30G ......... 114

PRO COMFORT MIS 1ML/31G ......... 114 PRO COMFORT MIS 31G ................ 106

PRO COMFORT MIS 31GX8MM ....... 114 PRO COMFORT MIS 32GX4MM ....... 114

PRO COMFORT MIS 32GX5MM ....... 114 PRO COMFORT MIS 32GX6MM ....... 114

PRO COMFORT MIS LANCETS ......... 106

PRO COMFORT PAD ALCOHOL ........ 109 PRO HERS RX CAP ........................ 135

PRO HIS RX CAP .......................... 135 PRO PCOS RX CAP ........................ 135

PROAIR HFA AER ............................ 25 probenecid tab 500 mg ................... 90

PRO-CAL TAB ............................... 128 PROCARDIA XL

see nifedipine tab er 24hr osmotic release 30 mg .......................... 66



PROCARE MIS ADULT ................... 117

PROCARE MIS CHILD .................... 117 PROCERV HP TAB ......................... 128

215

prochlorperazine maleate tab 10 mg (base equivalent) ........................ 59

prochlorperazine maleate tab 5 mg (base equivalent) ........................ 59

prochlorperazine suppos 25 mg ........ 59 PROCORT CRE ............................... 16

PROCTOCORT see hydrocortisone perianal cream

1% ......................................... 16 PROCTOCORT CRE 1% .................... 16

PROCTOFOAM AER HC 1% ............... 16 PRODIGY MIS 26G ........................ 106

PRODIGY MIS 28G ........................ 106 PROFILNINE INJ 1000UNIT .............. 92

PROFILNINE INJ 1500UNIT .............. 92

PROFILNINE INJ 500UNIT ................ 92 progesterone cap 100 mg .............. 144

progesterone cap 200 mg .............. 144 PROGESTERONE SUP VGS 100 ....... 154

PROGESTERONE SUP VGS 200 ....... 154 PROGLYCEM

see diazoxide susp 50 mg/ml ........ 37 PROGLYCEM SUS 50MG/ML ............. 38

PROGRAF see tacrolimus cap 0.5 mg .......... 122

see tacrolimus cap 1 mg ............. 122 see tacrolimus cap 5 mg ............. 122

PROLASTIN-C INJ 1000MG ............ 148 PROLIA SOL 60MG/ML .................... 83

PROMACTA TAB 12.5MG .................. 95

PROMACTA TAB 25MG ..................... 95 PROMACTA TAB 50MG ..................... 95

PROMACTA TAB 75MG ..................... 95 promethazine & phenylephrine syrup

6.25-5 mg/5ml ............................ 74 promethazine hcl inj 25 mg/ml ........ 43

promethazine hcl inj 50 mg/ml ........ 43 promethazine hcl suppos 12.5 mg .... 43

promethazine hcl suppos 25 mg ....... 43 promethazine hcl syrup 6.25 mg/5ml 43

promethazine hcl tab 12.5 mg ......... 43 promethazine hcl tab 25 mg ............ 43

promethazine hcl tab 50 mg ............ 43 promethazine w/ codeine syrup 6.25-

10 mg/5ml ................................. 74

promethazine-dm syrup 6.25-15 mg/5ml ...................................... 74

promethazine-phenylephrine-codeine syrup 6.25-5-10 mg/5ml .............. 74

PROMETRIUM see progesterone cap 100 mg ..... 144

see progesterone cap 200 mg ..... 144 propafenone hcl cap er 12hr 225 mg 23

propafenone hcl cap er 12hr 325 mg 23 propafenone hcl cap er 12hr 425 mg 23

propafenone hcl tab 150 mg ............ 23 propafenone hcl tab 225 mg ............ 23

propafenone hcl tab 300 mg ............ 23 proparacaine hcl ophth soln 0.5% .. 140

propranolol hcl cap er 24hr 120 mg .. 65 propranolol hcl cap er 24hr 160 mg .. 65

propranolol hcl cap er 24hr 60 mg .... 64

propranolol hcl cap er 24hr 80 mg .... 64 propranolol hcl oral soln 20 mg/5ml . 65

propranolol hcl tab 10 mg ............... 65 propranolol hcl tab 20 mg ............... 65

propranolol hcl tab 40 mg ............... 65 propranolol hcl tab 60 mg ............... 65

propranolol hcl tab 80 mg ............... 65 propylene glycol ophth soln 0.6% ... 138

propylene glycol-glycerin ophth soln 1-0.3% ....................................... 138

propylthiouracil tab 50 mg............. 149 PRORENAL +D TAB ....................... 128

PRORENAL+D CAP OMEGA-3 ......... 129 PRORENAL+D TAB ........................ 129

PROSCAR

see finasteride tab 5 mg ............... 89 PROTECT CAP CARDIO .................. 129

PROTECT CAP PLUS SO ................. 129 PROTEGRA CAP ............................ 129

PROTONIX see pantoprazole sodium ec tab 20

mg (base equiv) ..................... 152 see pantoprazole sodium ec tab 40

mg (base equiv) ..................... 152 PROTONIX PAK 40MG ................... 152

PROTOPIC see tacrolimus oint 0.03% ............ 79

see tacrolimus oint 0.1% .............. 79 protriptyline hcl tab 10 mg .............. 35

protriptyline hcl tab 5 mg ................ 35

PROVERA

216

see medroxyprogesterone acetate tab 10 mg .............................. 144

see medroxyprogesterone acetate tab 2.5 mg ............................. 144

see medroxyprogesterone acetate tab 5 mg ............................... 144

PROVIGIL see modafinil tab 100 mg .............. 5

see modafinil tab 200 mg .............. 5 PROVIT TAB ................................. 129

PROZAC see fluoxetine hcl cap 10 mg ......... 31

see fluoxetine hcl cap 20 mg ......... 32 see fluoxetine hcl cap 40 mg ......... 32

pseudoephed-bromphen-dm syrup 30-

2-10 mg/5ml .............................. 74 pseudoephedrine hcl tab 30 mg ..... 136

pseudoephedrine hcl tab 60 mg ..... 136 pseudoephedrine hcl tab abuse deter

30 mg ...................................... 136 pseudoephedrine hcl tab er 12hr 120

mg .......................................... 136 pseudoephedrine w/ dm-gg liquid 30-

10-100 mg/5ml ........................... 74 pseudoephedrine-guaifenesin tab er

12hr 120-1200 mg ...................... 74 pseudoephedrine-guaifenesin tab er

12hr 60-600 mg .......................... 74 PSORIASIN OIN DEEP MOI .............. 81

PSS SAFE LAN MIS ....................... 106

PSS SEL LANC MIS ....................... 106 psyllium cap 0.52 gm ...................... 98

psyllium powder 100% .................... 98 psyllium powder 28.3% ................... 98

psyllium powder 30.9% ................... 98 psyllium powder 48.57% ................. 98

psyllium powder 49% ..................... 98 psyllium powder 58.6% ................... 98

psyllium powder 68% ..................... 98 psyllium powder 95% ..................... 98

PULMICORT see budesonide inhalation susp 0.25

mg/2ml ................................... 24 see budesonide inhalation susp 0.5

mg/2ml ................................... 24

see budesonide inhalation susp 1 mg/2ml ................................... 24

PULMICORT INH 180MCG ................ 24 PULMICORT INH 90MCG .................. 24

PULMOZYME SOL 1MG/ML ............. 148 PURE & GENTL DRO 0.3% ............. 138

PURE COMFORT MIS 30G LAN ........ 106 PURE COMFORT MIS 32GX4MM ...... 114

PURE COMFORT MIS 32GX5MM ...... 114 PURE COMFORT MIS 32GX6MM ...... 115

PURE COMFORT PAD ..................... 109 PX GLUCOSE CHW FRUIT ................ 38

PX GLUCOSE CHW ORANGE ............. 38 PX GLUCOSE CHW RASPBERY .......... 38

PX GLUCOSE CHW SOUR APL ........... 38 PX GLUCOSE CHW TROP FRU ........... 38

PX LANCETS MIS 28G ................... 106

PX LANCETS MIS 33G ................... 106 PX LANCETS MIS ULT THIN ........... 106

PX PRENATAL TAB MULTIVIT ......... 134 pyrantel pamoate susp 144 mg/ml (50

mg/ml base equiv) ...................... 17 pyrazinamide tab 500 mg ................ 49

pyreth-piperonyl butox sham-permeth aero-nit remover gel kit ............... 80

pyrethrins-piperonyl butoxide liq 0.3-3% ............................................ 80

pyrethrins-piperonyl butoxide liq 0.33-4% ............................................ 80

pyrethrins-piperonyl butoxide shampoo 0.33-4% .................................... 80

pyridostigmine bromide tab 60 mg ... 48

pyridostigmine bromide tab er 180 mg ................................................. 49

pyridoxine hcl tab 100 mg ............. 156 pyridoxine hcl tab 25 mg ............... 156

pyridoxine hcl tab 250 mg ............. 156 pyridoxine hcl tab 50 mg ............... 156

PYRIDOXINE INJ 100MG/ML .......... 156 Q QC ALCOHOL PAD SWABS ............. 109 QC LANCETS MIS 28G ................... 106

QC LANCETS MIS 30G ................... 106 QC MULTI-VIT TAB ....................... 129

QC PRENATAL TAB 28-0.8MG ......... 134 QUALAQUIN

see quinine sulfate cap 324 mg ..... 48

QUESTRAN

217

see cholestyramine powder 4 gm/dose .................................. 43

see cholestyramine powder packets 4 gm .......................................... 44

QUESTRAN LIGHT see cholestyramine light powder 4

gm/dose .................................. 43 quetiapine fumarate tab 100 mg ...... 58

quetiapine fumarate tab 200 mg ...... 58 quetiapine fumarate tab 25 mg ........ 58

quetiapine fumarate tab 300 mg ...... 58 quetiapine fumarate tab 400 mg ...... 58

quetiapine fumarate tab 50 mg ........ 58 QUICKVUE HOM KIT COVID-19 ........ 81

QUIN B TAB STRONG .................... 129

quinapril hcl tab 10 mg ................... 45 quinapril hcl tab 20 mg ................... 45

quinapril hcl tab 40 mg ................... 45 quinapril hcl tab 5 mg ..................... 45

quinapril-hydrochlorothiazide tab 10-12.5 mg ..................................... 47

quinapril-hydrochlorothiazide tab 20-12.5 mg ..................................... 48

quinapril-hydrochlorothiazide tab 20-25 mg ............................................ 48

quinidine gluconate tab er 324 mg ... 23 quinine sulfate cap 324 mg .............. 48

QUINTABS TAB ............................ 131 QUINTABS-M TAB ......................... 129

R RA ALCOHOL PAD SWABS ............. 109 RA CALCIUM TAB 500MG ............... 119

RA DRY MOUTH SPR ..................... 123 RA ESSENCE-C POW ORANGE ........ 129

RA ESSENCE-C POW RASPBRY ....... 129 RA ESSENCE-C POW TNGERINE ..... 129

RA E-ZJECT MIS 28G .................... 106 RA E-ZJECT MIS THIN 26G ............ 106

RA E-ZJECT MIS THIN 28G ............ 106 RA E-ZJECT MIS ULT THIN ............. 106

RA GLUCOSE CHW GRAPE ............... 38 RA GLUCOSE CHW ORANGE ............. 38

RA GLUCOSE CHW RASPBERY .......... 38 RA GLUCOSE CHW TROP FRT ........... 38

RA HYDRATING OIN HEALING .......... 79

RA MELATONIN SUB 1MG ................. 7 RA OMEGA CAP 3-6-9 ...................... 7

RA PEN NEEDL MIS 31GX3/16 ....... 115 RA PRENATAL TAB 28-0.8MG ......... 134

RA PRENATAL TAB FORMULA ......... 134 RADICAVA INJ 30MG .................... 137

raloxifene hcl tab 60 mg ................. 84 ramipril cap 1.25 mg ...................... 45

ramipril cap 10 mg ......................... 45 ramipril cap 2.5 mg ........................ 45

ramipril cap 5 mg ........................... 45 RANEXA

see ranolazine tab er 12hr 1000 mg .............................................. 19

see ranolazine tab er 12hr 500 mg 19 ranolazine tab er 12hr 1000 mg ....... 19

ranolazine tab er 12hr 500 mg ......... 19

RAPAMUNE see sirolimus oral soln 1 mg/ml ... 122

see sirolimus tab 0.5 mg ............ 122 see sirolimus tab 1 mg ............... 122

see sirolimus tab 2 mg ............... 122 RAZADYNE ER

see galantamine hydrobromide cap er 24hr 16 mg ........................ 144

see galantamine hydrobromide cap er 24hr 24 mg ........................ 144

see galantamine hydrobromide cap er 24hr 8 mg.......................... 144

READYLANCE MIS 21G .................. 106 READYLANCE MIS 23G .................. 106

READYLANCE MIS 26G .................. 106

READYLANCE MIS 28G .................. 106 READYLANCE MIS 30G .................. 106

REALITY MIS LANCETS .................. 106 REALITY MIS LUBRICAT ................ 100

REALITY SWAB PAD ...................... 109 REALITY TRIG MIS LANCETS .......... 106

REALITY ULTR MIS TEXTURED ....... 100 REALITY ULTR MIS THIN ............... 100

REBIF INJ 22/0.5 ......................... 146 REBIF INJ 44/0.5 ......................... 146

REBIF REBIDO INJ 22/0.5 ............. 146 REBIF REBIDO INJ 44/0.5 ............. 146

RECLAST see zoledronic acid iv soln 5

mg/100ml................................ 83

RECLAST INJ 5/100ML .................... 83 RECOMBINATE INJ ......................... 92

218

RECOMBINATE INJ 220-400 ............. 93 RECOMBINATE INJ 401-800 ............. 93

RECOMBINATE INJ 801-1240 ........... 93 RECOMBIVA-HB INJ 40MCG/ML ...... 153

REFRESH TEAR DRO 0.5% OP ........ 138 REGLAN

see metoclopramide hcl tab 10 mg (base equivalent) ...................... 88

see metoclopramide hcl tab 5 mg (base equivalent) ...................... 88

RELENZA MIS DISKHALE ................. 64 RELION GLUCO CHW 4GM ............... 38

RELION KIT LANCING ................... 106 RELION LANCE MIS THIN 26G ........ 106

RELION LANCE MIS THIN 30G ........ 106

RELION MICRO MIS THIN 33G ....... 106 RELION PEN MIS 29GX12MM ......... 115

RELION PEN MIS 31GX1/4 ............. 115 RELION PEN MIS 31GX5/16 ........... 115

RELION PEN MIS 31GX6MM ........... 115 RELION PEN MIS 31GX8MM ........... 115

RELION PEN MIS 32GX4MM ........... 115 RELION PEN MIS 32GX5/32 ........... 115

RELION TES KETONE ...................... 81 RELION ULTRA MIS THIN 30G ........ 106

RELION ULTRA MIS THIN PLS ........ 106 REMERON

see mirtazapine tab 15 mg ........... 30 see mirtazapine tab 30 mg ........... 30

REMERON SOLTAB

see mirtazapine orally disintegrating tab 15 mg ................................ 30



REMICADE INJ 100MG .................... 88 REMODULIN INJ 10MG/ML ............... 67

REMODULIN INJ 1MG/ML ................. 67 REMODULIN INJ 2.5MG/ML .............. 67

REMODULIN INJ 5MG/ML ................. 67 RENAPLEX-D TAB ......................... 129

RENFLEXIS INJ 100MG .................... 88 RENVELA

see sevelamer carbonate tab 800 mg

.............................................. 89 repaglinide tab 0.5 mg .................... 39

repaglinide tab 1 mg....................... 39 repaglinide tab 2 mg....................... 39

RESTASIS EMU 0.05% .................. 140 RESTORIL

see temazepam cap 15 mg ........... 97 see temazepam cap 30 mg ........... 97

RETACRIT INJ 10000UNT ................ 95 RETACRIT INJ 20000UNI ................. 95

RETACRIT INJ 2000UNIT ................. 95 RETACRIT INJ 3000UNIT ................. 95

RETACRIT INJ 40000UNT ................ 95 RETACRIT INJ 4000UNIT ................. 95

RETAINE CAP VISION ................... 135 RETIN-A CRE 0.025% ..................... 75

RETIN-A CRE 0.05% ....................... 75

RETIN-A CRE 0.1% ......................... 75 RETIN-A GEL 0.01% ....................... 75

RETIN-A GEL 0.025% ..................... 76 RETROVIR

see zidovudine cap 100 mg ........... 62 see zidovudine syrup 10 mg/ml ..... 62

REVATIO see sildenafil citrate tab 20 mg ..... 67

REVATIO SUS 10MG/ML .................. 67 REVCOVI INJ 1.6MG/ML .................. 85

REVLIMID CAP 10MG .................... 121 REVLIMID CAP 15MG .................... 121

REVLIMID CAP 2.5MG ................... 121 REVLIMID CAP 20MG .................... 121

REVLIMID CAP 25MG .................... 121

REVLIMID CAP 5MG ...................... 121 REYATAZ

see atazanavir sulfate cap 200 mg (base equiv) ............................ 61

see atazanavir sulfate cap 300 mg (base equiv) ............................ 61

REYATAZ POW 50MG ...................... 62 REZUROCK TAB 200MG ................. 122

RIASTAP SOL 1GM ......................... 93 ribavirin cap 200 mg ....................... 63

ribavirin tab 200 mg ....................... 63 RIDAURA CAP 3MG .......................... 8

rifampin cap 150 mg ...................... 49 rifampin cap 300 mg ...................... 49

RIGHTEST MIS GL300 ................... 106

RILUTEK see riluzole tab 50 mg ................ 137

219

riluzole tab 50 mg ........................ 137 RISPERDAL

see risperidone soln 1 mg/ml ........ 56 see risperidone tab 0.5 mg ........... 56

see risperidone tab 1 mg .............. 56 see risperidone tab 2 mg .............. 56

see risperidone tab 3 mg .............. 56 see risperidone tab 4 mg .............. 56

RISPERDAL INJ 12.5MG .................. 55 RISPERDAL INJ 25MG ..................... 55

RISPERDAL INJ 37.5MG .................. 55 RISPERDAL INJ 50MG ..................... 55

risperidone orally disintegrating tab 0.5 mg ............................................ 55

risperidone orally disintegrating tab 1

mg ............................................ 55 risperidone orally disintegrating tab 2



mg ............................................ 56 risperidone soln 1 mg/ml ................. 56

risperidone tab 0.25 mg .................. 56 risperidone tab 0.5 mg .................... 56

risperidone tab 1 mg ...................... 56 risperidone tab 2 mg ...................... 56

risperidone tab 3 mg ...................... 56 risperidone tab 4 mg ...................... 56

RITALIN

see methylphenidate hcl tab 10 mg 5 see methylphenidate hcl tab 20 mg 5

see methylphenidate hcl tab 5 mg .. 5 RITALIN LA CAP 10MG ..................... 6

RITALIN LA CAP 20MG ..................... 6 RITALIN LA CAP 30MG ..................... 6

RITALIN LA CAP 40MG ..................... 6 RITEFLO MIS ............................... 117

ritonavir tab 100 mg ....................... 62 RITUXAN INJ 100MG ....................... 50

RITUXAN INJ 500MG ....................... 50 RITUXAN INJ HYCELA...................... 51

rivastigmine tartrate cap 1.5 mg (base equivalent) ............................... 145

rivastigmine tartrate cap 3 mg (base

equivalent) ............................... 145

rivastigmine tartrate cap 4.5 mg (base equivalent) ............................... 145

rivastigmine tartrate cap 6 mg (base equivalent) ............................... 145

rivastigmine td patch 24hr 13.3 mg/24hr ................................... 145

rivastigmine td patch 24hr 4.6 mg/24hr ............................................... 145

rivastigmine td patch 24hr 9.5 mg/24hr ............................................... 145

RIXUBIS INJ 1000UNIT ................... 93 RIXUBIS INJ 2000UNIT ................... 93

RIXUBIS INJ 250 UNIT .................... 93 RIXUBIS INJ 3000UNIT ................... 93

RIXUBIS INJ 500UNIT ..................... 93

rizatriptan benzoate oral disintegrating tab 10 mg (base eq) .................. 118

rizatriptan benzoate oral disintegrating tab 5 mg (base eq) .................... 118

rizatriptan benzoate tab 10 mg (base equivalent) ............................... 118

rizatriptan benzoate tab 5 mg (base equivalent) ............................... 118

ROBINUL see glycopyrrolate tab 1 mg........ 150

ROBINUL FORTE see glycopyrrolate tab 2 mg........ 150

ROBIT CGH DM LIQ 20-200 ............. 74 ROBIT CGH DM LIQ 20-200SF .......... 74

ROBITUSSIN LIQ CF ....................... 74

ROCALTROL see calcitriol cap 0.25 mcg ........... 84

see calcitriol cap 0.5 mcg ............. 84 see calcitriol oral soln 1 mcg/ml .... 84

ropinirole hydrochloride tab 0.25 mg 53 ropinirole hydrochloride tab 0.5 mg .. 53

ropinirole hydrochloride tab 1 mg ..... 53 ropinirole hydrochloride tab 2 mg ..... 53

ropinirole hydrochloride tab 3 mg ..... 53 ropinirole hydrochloride tab 4 mg ..... 53

ropinirole hydrochloride tab 5 mg ..... 53 rosuvastatin calcium tab 10 mg ....... 44

rosuvastatin calcium tab 20 mg ....... 44 rosuvastatin calcium tab 40 mg ....... 44

rosuvastatin calcium tab 5 mg ......... 44

ROXICODONE see oxycodone hcl tab 15 mg ........ 12

220

see oxycodone hcl tab 30 mg ........ 12 see oxycodone hcl tab 5 mg .......... 12

ROZEREM TAB 8MG ........................ 97 rufinamide susp 40 mg/ml ............... 29

rufinamide tab 200 mg.................... 29 rufinamide tab 400 mg.................... 29

RYTHMOL SR see propafenone hcl cap er 12hr 225

mg .......................................... 23 see propafenone hcl cap er 12hr 325

mg .......................................... 23 see propafenone hcl cap er 12hr 425

mg .......................................... 23 S SAFE-T-LANCE MIS 21G ................ 106

SAFE-T-LANCE MIS 25G ................ 106 SAFE-T-LANCE MIS HI FLOW ......... 106

SAFE-T-LANCE MIS LOW FLOW ...... 106 SAFE-T-LANCE MIS NOR FLOW ...... 107

SAFE-T-PRO MIS LANCETS ............ 107 SAFE-T-PRO MIS PLUS .................. 107

SAFETY 21G MIS LANCETS ............ 107 SAFETY 28G MIS LANCETS ............ 107

SAFETY 30G MIS LANCETS ............ 107 SAFETY MIS LANCETS ................... 107

SALAGEN see pilocarpine hcl tab 5 mg ....... 123

see pilocarpine hcl tab 7.5 mg ..... 123 salicylic acid cream 2% ................... 79

salicylic acid film forming liquid 27.5%

................................................. 79 salicylic acid foam 6% ..................... 79

salicylic acid gel 17% ...................... 79 salicylic acid gel 2% ....................... 79

salicylic acid gel 6% ....................... 79 salicylic acid liquid 17% .................. 79

salicylic acid liquid 2% .................... 79 salicylic acid liquid 3% .................... 79

salicylic acid pad 2% ...................... 79 salicylic acid pad 40% ..................... 80

salicylic acid shampoo 6% ............... 80 salicylic acid strip 40% .................... 80

saline nasal spray 0.65% .............. 136 salsalate tab 500 mg ...................... 10

salsalate tab 750 mg ...................... 10

SANDIMMUNE see cyclosporine cap 100 mg ...... 121

see cyclosporine cap 25 mg ........ 121 SANDIMMUNE SOL 100MG/ML ....... 122

SANDOSTATIN see octreotide acetate inj 100

mcg/ml (0.1 mg/ml) ................. 85 see octreotide acetate inj 50 mcg/ml

(0.05 mg/ml) ........................... 85 see octreotide acetate inj 500

mcg/ml (0.5 mg/ml) ................. 85 SANDOSTATIN INJ 100MCG ............. 86

SANDOSTATIN INJ 500MCG ............. 86 SANDOSTATIN INJ 50MCG/ML ......... 86

SAPS CARE PAD ALCOHOL ............. 109 SAPS HEALTH MIS TWIST ............. 107

SAPS HEALTH PAD ALCOHOL ......... 109

SAPS TWIST MIS 30G ................... 107 SAPSCARE MIS TWIST .................. 107

SAVELLA MIS TITR PAK ................. 145 SAVELLA TAB 100MG .................... 145

SAVELLA TAB 12.5MG ................... 145 SAVELLA TAB 25MG ...................... 145

SAVELLA TAB 50MG ...................... 145 SB ALCOHOL PAD PREP ................. 109

SB LANCETS MIS THIN ................. 107 SB LANCETS MIS ULTR THN .......... 107

SCOOBY-DOO CHW ...................... 132 SCOT-TUSSIN LIQ SENIOR .............. 74

SEASONIQUE see levonorg-eth est tab 0.15-

0.03mg(84) & eth est tab

0.01mg(7) ............................... 69 SECURESAFE MIS 0.5/29G ............ 115

SECURESAFE MIS 1ML/29G ........... 115 SECURESAFE MIS 30GX5/16 .......... 115

SELECT-LITE KIT DEV/LANC .......... 107 selenium sulfide lotion 1% .............. 77

selenium sulfide lotion 2.5% ............ 77 selenium sulfide shampoo 2.25% ..... 77

SELZENTRY TAB 150MG .................. 62 SELZENTRY TAB 25MG .................... 62

SELZENTRY TAB 300MG .................. 62 SELZENTRY TAB 75MG .................... 62

SE-NATAL 19 CHW ....................... 134 SE-NATAL 19 TAB ........................ 134

sennosides cap 8.6 mg ................... 98

sennosides chew tab 15 mg ............. 98 sennosides syrup 8.8 mg/5ml .......... 98

221

sennosides tab 15 mg ..................... 98 sennosides tab 17.2 mg .................. 98

sennosides tab 25 mg ..................... 99 sennosides tab 8.6 mg .................... 98

sennosides-docusate sodium tab 8.6-50 mg ........................................ 98

SENSIPAR see cinacalcet hcl tab 30 mg (base

equiv) ..................................... 84 see cinacalcet hcl tab 60 mg (base

equiv) ..................................... 84 see cinacalcet hcl tab 90 mg (base

equiv) ..................................... 84 SENTRY SENIO TAB LUTEIN ........... 129

SENTRY TAB ................................ 129

SENTRY TAB SENIOR .................... 129 SEREVENT DIS AER 50MCG ............. 25

SEROQUEL see quetiapine fumarate tab 100 mg

.............................................. 58 see quetiapine fumarate tab 200 mg

.............................................. 58 see quetiapine fumarate tab 25 mg58

see quetiapine fumarate tab 300 mg .............................................. 58

see quetiapine fumarate tab 400 mg .............................................. 58

see quetiapine fumarate tab 50 mg58 sertraline hcl oral concentrate for

solution 20 mg/ml ....................... 32

sertraline hcl tab 100 mg ................ 32 sertraline hcl tab 25 mg .................. 32

sertraline hcl tab 50 mg .................. 32 sevelamer carbonate tab 800 mg ..... 89

SFROWASA ENE 4GM ...................... 88 SHINGRIX INJ 50/0.5ML ................ 153

SHUR-SEAL GEL 2% ..................... 153 SIGNIFOR INJ 0.3MG/ML ................. 86

SIGNIFOR INJ 0.6MG/ML ................. 86 SIGNIFOR INJ 0.9MG/ML ................. 86

sildenafil citrate tab 20 mg .............. 67 SILTUSS SINU TAB & CONGES ......... 74

SILVADENE see silver sulfadiazine cream 1% ... 77

silver sulfadiazine cream 1% ........... 77

simethicone cap 125 mg ................. 88 simethicone cap 180 mg ................. 88

simethicone chew tab 125 mg.......... 88 simethicone chew tab 80 mg ........... 88

simethicone liquid 40 mg/0.6ml ....... 88 simethicone susp 40 mg/0.6ml ........ 88

SIMILAC PREN PAK EARLY SH ........ 134 SIMPONI ARIA SOL 50MG/4ML .......... 8

SIMULECT INJ 10MG ..................... 122 SIMULECT INJ 20MG ..................... 122

simvastatin tab 10 mg .................... 44 simvastatin tab 20 mg .................... 44

simvastatin tab 40 mg .................... 44 simvastatin tab 5 mg ...................... 44

simvastatin tab 80 mg .................... 44 SINEMET

see carbidopa & levodopa tab 10-100

mg .......................................... 53 see carbidopa & levodopa tab 25-100

mg .......................................... 53 SINGLE-LET MIS 23G .................... 107

SINGULAIR see montelukast sodium chew tab 4

mg (base equiv) ....................... 24 see montelukast sodium chew tab 5

mg (base equiv) ....................... 24 see montelukast sodium oral

granules packet 4 mg (base equiv) .............................................. 24

see montelukast sodium tab 10 mg (base equiv) ............................ 24

SINUVA IMP 1350MCG .................. 136

sirolimus oral soln 1 mg/ml ........... 122 sirolimus tab 0.5 mg ..................... 122

sirolimus tab 1 mg ....................... 122 sirolimus tab 2 mg ....................... 122

SIRTURO TAB 100MG ..................... 49 SIVEXTRO TAB 200MG .................... 18

SKIN BEAUTY/ PAK WELLNESS....... 129 SKYLA IUD 13.5MG ........................ 70

SLEEP CHILD/ CHW MELATONI ......... 7 SLEEP SOUNDL LIQ 3.5/2ML ............. 7

SLOW FE TAB 45MG ....................... 96 SLOW RELEASE TAB 47.5MG ........... 96

SM ALCOHOL PAD PREP ................ 110 SM B-COMPLEX TAB /VIT C ........... 124

SM GLUCOSE CHW ORANGE ............ 38

SM GLUCOSE CHW RASPBERY ......... 38 SM LANCETS MIS 33G .................. 107

222

SM OMEGA-3 CAP ............................ 7 SM ONE DAILY MIS PRENATAL ....... 134

SM ONE DAILY TAB MENS ............. 129 SM ONE DAILY TAB WOMENS ........ 129

SM PRENATAL TAB VITAMINS ........ 134 SMART SENSE CHW 4GM ................ 38

SMART SENSE CHW GLUCOSE ......... 38 SMART SENSE MIS LANC 21G ........ 107

SMART SENSE MIS LANC 26G ........ 107 SMART SENSE MIS LANC 30G ........ 107

SMART SENSE MIS LANC 33G ........ 107 SMARTEST MIS LANCETS .............. 107

sod ferric gluc cmplx in sucrose iv soln 12.5 mg/ml (fe eq) ...................... 96

sodium bicarbonate tab 325 mg ....... 16

sodium bicarbonate tab 650 mg ....... 16 sodium chloride aero soln 0.9% ....... 74

sodium chloride soln nebu 0.9% ....... 74 sodium chloride soln nebu 10% ........ 75

sodium chloride soln nebu 3% ......... 74 sodium chloride soln nebu 7% ......... 75

sodium chloride tab 1 gm .............. 120 sodium citrate & citric acid soln 500-

334 mg/5ml ................................ 89 sodium fluoride chew tab 0.25 mg f

(from 0.55 mg naf) .................... 119 sodium fluoride chew tab 0.5 mg f

(from 1.1 mg naf) ..................... 119 sodium fluoride chew tab 1 mg f (from

2.2 mg naf) .............................. 119

sodium fluoride cream 1.1% .......... 122 sodium fluoride gel 1.1% (0.5% f) . 123

sodium fluoride paste 1.1% ........... 123 sodium fluoride rinse 0.0221% (0.01%

f) ............................................. 123 sodium fluoride rinse 0.05% .......... 123

sodium fluoride rinse 0.2% ............ 123 sodium fluoride soln 0.125 mg/drop f

(0.275 mg/drop naf) .................. 120 sodium fluoride soln 0.5 mg/ml f (from

1.1 mg/ml naf) .......................... 120 SODIUM HYALU INJ 20MG/2ML ...... 136

SOFOS/VELPAT TAB 400-100 ........... 63 SOFTCLIX MIS LANCETS ............... 107

SOLIRIS INJ 10MG/ML .................... 93

SOLO TAB ................................... 129 SOLU-MEDROL

see methylprednisolone sod succ for inj 1000 mg (base equiv) .......... 71

see methylprednisolone sod succ for inj 125 mg (base equiv) ............ 71

see methylprednisolone sod succ for inj 40 mg (base equiv) .............. 71

see methylprednisolone sod succ for inj 500 mg (base equiv) ............ 71

SOLU-MEDROL INJ 1000MG ............. 72 SOLU-MEDROL INJ 125MG .............. 71

SOLU-MEDROL INJ 1GM .................. 71 SOLU-MEDROL INJ 40MG ................ 71

SOLUS V2 MIS LANC 28G .............. 107 SOLUS V2 MIS LANC 30G .............. 107

SOOTHE DRO 0.6-0.6% ................ 138

sotalol hcl (afib/afl) tab 120 mg ....... 65 sotalol hcl (afib/afl) tab 160 mg ....... 65

sotalol hcl (afib/afl) tab 80 mg ......... 65 sotalol hcl tab 120 mg .................... 65

sotalol hcl tab 160 mg .................... 65 sotalol hcl tab 240 mg .................... 65

sotalol hcl tab 80 mg ...................... 65 SPACE CHAMBR MIS ANTI-STA ...... 117

SPACE CHAMBR MIS LARGE ........... 117 SPACE CHAMBR MIS MEDIUM ........ 117

SPACE CHAMBR MIS SMALL ........... 117 SPACER CHAMB MIS ADULT ........... 117

SPACER CHAMB MIS CHILD ........... 117 SPACER CHAMB MIS INFANT ......... 117

SPECTRAVITE CHW ADLT 50+ ....... 129

SPECTRAVITE CHW WOMEN .......... 129 SPECTRAVITE TAB ........................ 129

SPECTRAVITE TAB ADLT 50+ ......... 129 SPECTRAVITE TAB ADULTS ........... 129

SPECTRAVITE TAB MEN 50+ .......... 129 SPECTRAVITE TAB ULT MEN .......... 129

SPECTRAVITE TAB ULT WMN ......... 129 SPINRAZA INJ 12MG/5ML .............. 137

SPIRIVA CAP HANDIHLR ................. 24 spironolactone & hydrochlorothiazide

tab 25-25 mg .............................. 82 spironolactone tab 100 mg .............. 82

spironolactone tab 25 mg ................ 82 spironolactone tab 50 mg ................ 82

SPRAVATO SOL 56MG DOS .............. 31

SPRAVATO SOL 84MG DOS .............. 31 SPRYCEL TAB 100MG ...................... 52

223

SPRYCEL TAB 140MG ...................... 52 SPRYCEL TAB 20MG ........................ 52

SPRYCEL TAB 50MG ........................ 52 SPRYCEL TAB 70MG ........................ 52

SPRYCEL TAB 80MG ........................ 52 stannous fluoride conc 0.63% ........ 123

stannous fluoride gel 0.4% ............ 123 STELARA INJ 5MG/ML ..................... 88

STERILANCE MIS TL 28G ............... 107 STERILANCE MIS TL 30G ............... 107

STERILANCE MIS TL 32G ............... 107 STERILE LUBR DRO 0.7% .............. 138

STIMATE SOL 1.5MG/ML ................. 85 STIOLTO AER 2.5-2.5 ..................... 25

STRATTERA

see atomoxetine hcl cap 10 mg (base equiv) ...................................... 3

see atomoxetine hcl cap 100 mg (base equiv).............................. 3






STRIBILD TAB ................................ 62

STROMECTOL see ivermectin tab 3 mg ............... 17

SUBLOCADE INJ 100/0.5 ................. 15 SUBLOCADE INJ 300/1.5 ................. 15

SUBOXONE MIS 12-3MG ................. 15 SUBOXONE MIS 2-0.5MG ................ 15

SUBOXONE MIS 4-1MG ................... 15 SUBOXONE MIS 8-2MG ................... 15

SUCRAID SOL 8500/ML ................... 81 sucralfate tab 1 gm ...................... 151

SUDAFED 24HR TAB 240MG .......... 136 sulfacetamide sodium ophth soln 10%

............................................... 140 sulfamethoxazole-trimethoprim susp

200-40 mg/5ml ........................... 17

sulfamethoxazole-trimethoprim tab 400-80 mg ................................. 17

sulfamethoxazole-trimethoprim tab 800-160 mg ............................... 17

sulfasalazine tab 500 mg ................. 89 sulfasalazine tab delayed release 500

mg ............................................ 89 sulindac tab 150 mg ........................ 9

sulindac tab 200 mg ........................ 9 SUMATRIPTAN INJ 4MG/0.5 ........... 118

SUMATRIPTAN INJ 6MG/0.5 ........... 118 sumatriptan succinate inj 6 mg/0.5ml

............................................... 118 sumatriptan succinate solution auto-

injector 4 mg/0.5ml ................... 118 sumatriptan succinate solution auto-

injector 6 mg/0.5ml ................... 118

sumatriptan succinate tab 100 mg . 118 sumatriptan succinate tab 25 mg ... 118

sumatriptan succinate tab 50 mg ... 118 SUPARTZ FX INJ 25/2.5ML ............ 136

SUPER ANTIOX CAP ...................... 129 SUPER OMEGA CAP -3 ..................... 7

SUPER THIN MIS LANC 28G ........... 107 SUPER THIN MIS LANCETS ............ 107

SUPRAX see cefixime for susp 200 mg/5ml . 68

SUPRAX CHW 100MG ...................... 68 SUPRAX CHW 200MG ...................... 68

SUPRAX SUS 500/5ML .................... 68 SUPRESS DM DRO 5-50/ML ............. 74

SURE COMFORT MIS 29GX1/2 ....... 115

SURE COMFORT MIS 30GX5/16...... 115 SURE COMFORT MIS 31GX3/16...... 115

SURE COMFORT MIS 31GX5/16...... 115 SURE COMFORT MIS 32GX5/32...... 115

SURE COMFORT MIS 32GX6MM ...... 115 SURE COMFORT MIS LANC 18G ...... 107

SURE COMFORT MIS LANC 21G ...... 107 SURE COMFORT MIS LANC 23G ...... 107

SURE COMFORT MIS LANC 30G ...... 107 SURE COMFORT MIS LANCETS ....... 107

SUREFLEX MIS LANCETS ............... 107 SURELITE MIS LANCETS................ 107

SUSTIVA see efavirenz cap 200 mg ............. 61

see efavirenz cap 50 mg............... 61

see efavirenz tab 600 mg ............. 61 SUSTOL INJ 10/0.4ML ..................... 41

224

SUTENT CAP 12.5MG ...................... 52 SUTENT CAP 25MG ......................... 52

SUTENT CAP 37.5MG ...................... 52 SUTENT CAP 50MG ......................... 52

SYMBICORT AER 160-4.5 ................ 25 SYMBICORT AER 80-4.5 .................. 25

SYMLINPEN 60 INJ 1000MCG ........... 35 SYMLNPEN 120 INJ 1000MCG .......... 35

SYMTUZA TAB ................................ 62 SYNAGIS INJ 100MG/ML ............... 143

SYNAGIS INJ 50MG ...................... 143 SYNERTROPIN CAP ....................... 135

SYNJARDY TAB............................... 36 SYNJARDY TAB 12.5-500 ................. 36

SYNJARDY TAB 5-1000MG ............... 36

SYNJARDY TAB 5-500MG ................. 36 SYNTHROID

see levothyroxine sodium tab 100 mcg ...................................... 149






see levothyroxine sodium tab 200

mcg ...................................... 149 see levothyroxine sodium tab 25 mcg

............................................ 149 see levothyroxine sodium tab 300

mcg ...................................... 149 see levothyroxine sodium tab 50 mcg

............................................ 149 see levothyroxine sodium tab 75 mcg

............................................ 149 see levothyroxine sodium tab 88 mcg

............................................ 149 SYNVISC INJ 8MG/ML ................... 136

SYNVISC ONE INJ 8MG/ML ............ 136 SYRINGE MIS 0.5/30G .................. 115

SYSTANE GEL DRO 0.4-0.3% ......... 138

SYSTANE ICAP CHW AREDS2 ......... 129 SYSTANE ICAP TAB AREDS2 .......... 129

T TABLOID TAB 40MG ....................... 49

tacrolimus cap 0.5 mg .................. 122 tacrolimus cap 1 mg ..................... 122

tacrolimus cap 5 mg ..................... 122 tacrolimus oint 0.03% .................... 79

tacrolimus oint 0.1% ...................... 79 TAMIFLU

see oseltamivir phosphate cap 30 mg (base equiv) ............................ 63



see oseltamivir phosphate for susp 6

mg/ml (base equiv) .................. 64 tamoxifen citrate tab 10 mg (base

equivalent) ................................. 51 tamoxifen citrate tab 20 mg (base

equivalent) ................................. 51 tamsulosin hcl cap 0.4 mg ............... 89

TARCEVA see erlotinib hcl tab 100 mg (base

equivalent) .............................. 50 see erlotinib hcl tab 150 mg (base

equivalent) .............................. 50 see erlotinib hcl tab 25 mg (base

equivalent) .............................. 50 TARGRETIN

see bexarotene cap 75 mg............ 52

TASIGNA CAP 150MG ..................... 52 TASIGNA CAP 200MG ..................... 52

TASIGNA CAP 50MG ....................... 52 TAYTULLA

see norethindrone ace-ethinyl estradiol-fe cap 1 mg-20 mcg (24)

.............................................. 69 TDVAX INJ 2-2 LF ......................... 150

TECFIDERA see dimethyl fumarate capsule

delayed release 120 mg .......... 145 see dimethyl fumarate capsule

delayed release 240 mg .......... 145 TECFIDERA CAP 120MG ................ 146

TECFIDERA CAP 240MG ................ 146

TECFIDERA MIS STARTER ............. 146 TECFIDERA STARTER PACK

225

see dimethyl fumarate capsule dr starter pack 120 mg & 240 mg . 145

TECHLITE AST MIS LANCETS ......... 107 TECHLITE MIS LANC 30G .............. 107

TECHLITE MIS LANCETS ................ 107 TEGRETOL

see carbamazepine susp 100 mg/5ml .............................................. 27

see carbamazepine tab 200 mg ..... 27 TEGRETOL-XR

see carbamazepine tab er 12hr 100 mg .......................................... 27

see carbamazepine tab er 12hr 200 mg .......................................... 27

see carbamazepine tab er 12hr 400

mg .......................................... 27 TEGSEDI INJ 284/1.5 ................... 148

temazepam cap 15 mg .................... 97 temazepam cap 30 mg .................... 97

TEMOVATE see clobetasol propionate cream

0.05% ..................................... 77 see clobetasol propionate oint 0.05%

.............................................. 77 TENCON TAB 50-325MG .................. 10

TENIVAC INJ 5-2LF ....................... 150 tenofovir disoproxil fumarate tab 300

mg ............................................ 62 TENORETIC 100

see atenolol & chlorthalidone tab

100-25 mg ............................... 47 TENORETIC 50

see atenolol & chlorthalidone tab 50-25 mg ..................................... 47

TENORMIN see atenolol tab 100 mg ............... 64

see atenolol tab 25 mg ................. 64 see atenolol tab 50 mg ................. 64

terazosin hcl cap 1 mg (base equivalent) ................................. 46



terazosin hcl cap 5 mg (base

equivalent) ................................. 46 terbinafine hcl cream 1% ................ 76

terbinafine hcl tab 250 mg .............. 42 terconazole vaginal cream 0.4% .... 154

terconazole vaginal cream 0.8% .... 154 terconazole vaginal suppos 80 mg .. 154

TESSALON PERLES see benzonatate cap 100 mg ........ 72

testosterone cypionate im inj in oil 100 mg/ml ........................................ 15

testosterone cypionate im inj in oil 200 mg/ml ........................................ 15

tetracaine hcl ophth soln 0.5% ...... 140 tetracycline hcl cap 250 mg ........... 148

tetracycline hcl cap 500 mg ........... 148 TGT GLUCOSE CHW GRAPE ............. 38

TGT GLUCOSE CHW ORANGE ........... 38

TGT GLUCOSE CHW RASPBERY ........ 38 TGT GLUCOSE CHW TROP FRT ......... 38

TGT LANCET MIS 26G ................... 107 TGT LANCET MIS 30G ................... 107

TGT LANCET MIS 33G ................... 107 THALOMID CAP 100MG ................. 121

THALOMID CAP 150MG ................. 121 THALOMID CAP 200MG ................. 121

THALOMID CAP 50MG ................... 121 theanine cap 100 mg .................... 137

theophylline soln 80 mg/15ml .......... 25 theophylline tab er 24hr 400 mg ...... 25

theophylline tab er 24hr 600 mg ...... 25 THERA M PLUS TAB ...................... 129

THERA TAB .................................. 131

THERABETIC TAB MULTIVIT ........... 129 THERA-D TAB 4000UNIT ............... 155

THERAGRAN-M TAB ...................... 129 THERAGRAN-M TAB 50 PLUS ......... 129

THERAGRAN-M TAB ADVANCED ..... 129 THERAGRAN-M TAB PREMIER ........ 129

THERA-M TAB .............................. 129 THERAMILL CAP FORTE ................. 129

THERANATAL CAP LACTATIO ......... 129 THERANATAL TAB 27-1 ................. 134

THERA-TABS M TAB ...................... 129 THERATEARS SOL 0.25% PF .......... 138

THERATEARS SOL OP ................... 138 THEREMS TAB MULTIVIT ............... 131

THEREMS-M TAB .......................... 129

thiamine hcl tab 100 mg ............... 156 thiamine hcl tab 250 mg ............... 156

226

thiamine hcl tab 50 mg ................. 156 thiamine mononitrate tab 100 mg .. 156

THIN LANCETS MIS 26G ................ 107 THIN LANCETS MIS 30G ................ 107

THINLETS GP MIS 26G .................. 107 thioridazine hcl tab 10 mg ............... 59

thioridazine hcl tab 100 mg ............. 59 thioridazine hcl tab 25 mg ............... 59

thioridazine hcl tab 50 mg ............... 59 thiothixene cap 1 mg ...................... 60

thiothixene cap 10 mg .................... 60 thiothixene cap 2 mg ...................... 60

thiothixene cap 5 mg ...................... 60 THRIVITE RX TAB 29-1MG ............. 134

thyroid tab 120 mg (2 grain) ......... 150

thyroid tab 15 mg (1/4 grain) ........ 150 thyroid tab 30 mg (1/2 grain) ........ 150

thyroid tab 60 mg (1 grain) ........... 150 thyroid tab 90 mg (1 1/2 grain) ..... 150

tiagabine hcl tab 12 mg .................. 29 tiagabine hcl tab 16 mg .................. 29

tiagabine hcl tab 2 mg .................... 29 tiagabine hcl tab 4 mg .................... 29

TIAZAC see diltiazem hcl extended release

beads cap er 24hr 120 mg ......... 65 see diltiazem hcl extended release

beads cap er 24hr 180 mg ......... 66 see diltiazem hcl extended release

beads cap er 24hr 240 mg ......... 66

see diltiazem hcl extended release beads cap er 24hr 300 mg ......... 66



TIER UNI PLS MIS 31GX8MM ......... 115 tigecycline for iv soln 50 mg .......... 148

TIGECYCLINE INJ 50MG ................ 148 TIKOSYN

see dofetilide cap 125 mcg (0.125 mg) ........................................ 23

see dofetilide cap 250 mcg (0.25 mg) .............................................. 23

see dofetilide cap 500 mcg (0.5 mg)

.............................................. 23

timolol maleate ophth gel forming soln 0.25% ..................................... 138

timolol maleate ophth gel forming soln 0.5% ....................................... 138

timolol maleate ophth soln 0.25% .. 139 timolol maleate ophth soln 0.5% .... 138

TIMOPTIC see timolol maleate ophth soln

0.25% ................................... 139 see timolol maleate ophth soln 0.5%

............................................ 138 TIMOPTIC-XE

see timolol maleate ophth gel forming soln 0.25% ................ 138

see timolol maleate ophth gel

forming soln 0.5% .................. 138 tinidazole tab 250 mg ..................... 17

tinidazole tab 500 mg ..................... 17 TIVICAY PD TAB 5MG ..................... 62

TIVICAY TAB 10MG......................... 62 TIVICAY TAB 25MG......................... 62

TIVICAY TAB 50MG......................... 62 tizanidine hcl tab 2 mg (base

equivalent) ............................... 135 tizanidine hcl tab 4 mg (base

equivalent) ............................... 135 TOBRADEX

see tobramycin-dexamethasone ophth susp 0.3-0.1% .............. 141

TOBRADEX OIN 0.3-0.1% ............. 140

TOBRADEX ST SUS 0.3-0.05 .......... 141 tobramycin ophth soln 0.3% .......... 140

tobramycin-dexamethasone ophth susp 0.3-0.1% ................................. 141

TOBREX OIN 0.3% OP .................. 140 tolnaftate aerosol pow 1% ............... 76

tolnaftate cream 1% ....................... 76 tolnaftate powder 1% ..................... 76

tolnaftate soln 1% .......................... 76 TOPAMAX

see topiramate tab 100 mg ........... 29 see topiramate tab 200 mg ........... 29

see topiramate tab 25 mg ............ 29 see topiramate tab 50 mg ............ 29

TOPAMAX SPRINKLE

see topiramate sprinkle cap 15 mg 29 see topiramate sprinkle cap 25 mg 29

227

TOPCARE MIS LANC 33G ............... 107 topiramate sprinkle cap 15 mg ......... 29

topiramate sprinkle cap 25 mg ......... 29 topiramate tab 100 mg ................... 29

topiramate tab 200 mg ................... 29 topiramate tab 25 mg ..................... 29

topiramate tab 50 mg ..................... 29 TOPROL XL

see metoprolol succinate tab er 24hr 100 mg (tartrate equiv) ............. 64

see metoprolol succinate tab er 24hr 200 mg (tartrate equiv) ............. 64

see metoprolol succinate tab er 24hr 25 mg (tartrate equiv) .............. 64

see metoprolol succinate tab er 24hr

50 mg (tartrate equiv) .............. 64 toremifene citrate tab 60 mg (base

equivalent) ................................. 51 torsemide tab 10 mg ...................... 82

torsemide tab 100 mg ..................... 82 torsemide tab 20 mg ...................... 82

torsemide tab 5 mg ........................ 82 TOVIAZ TAB 4MG ......................... 152

TOVIAZ TAB 8MG ......................... 152 TRACLEER TAB 125MG .................... 67

TRACLEER TAB 62.5MG ................... 67 TRADJENTA TAB 5MG ..................... 38

tramadol hcl tab 50 mg ................... 13 tramadol hcl tab er 24hr 100 mg ...... 13

tramadol hcl tab er 24hr 200 mg ...... 13

tramadol hcl tab er 24hr 300 mg ...... 13 tramadol-acetaminophen tab 37.5-325

mg ............................................ 15 trandolapril tab 1 mg ...................... 45

trandolapril tab 2 mg ...................... 45 trandolapril tab 4 mg ...................... 45

tranexamic acid tab 650 mg ............ 96 TRAVATAN Z

see travoprost ophth soln 0.004% (benzalkonium free) (bak free) . 141

TRAVEL LANCE MIS 30G ................ 108 TRAVEL LANCE MIS ADV 28G ......... 108

travoprost ophth soln 0.004% (benzalkonium free) (bak free) .... 141

trazodone hcl tab 100 mg ................ 33

trazodone hcl tab 150 mg ................ 33 trazodone hcl tab 300 mg ................ 33

trazodone hcl tab 50 mg ................. 32 T-RELIEF CHW MOBILITY .............. 121

T-RELIEF CHW SAFE ..................... 121 T-RELIEF EXT CHW ....................... 121

treprostinil inj soln 100 mg/20ml (5 mg/ml) ...................................... 67



treprostinil inj soln 50 mg/20ml (2.5 mg/ml) ...................................... 67

tretinoin cap 10 mg ........................ 52 TRETTEN INJ ................................. 93

TRIAMCINOLON INJ 40MG/ML .......... 72

TRIAMCINOLON INJ 80MG/2ML ........ 72 TRIAMCINOLON INJ 80MG/ML .......... 72

triamcinolone acetonide cream 0.025% ................................................. 78

triamcinolone acetonide cream 0.1% 78 triamcinolone acetonide cream 0.5% 78

triamcinolone acetonide dental paste 0.1% ....................................... 123

triamcinolone acetonide lotion 0.025% ................................................. 78

triamcinolone acetonide lotion 0.1% . 78 triamcinolone acetonide nasal aerosol

suspension 55 mcg/act .............. 136 triamcinolone acetonide oint 0.025% 78

triamcinolone acetonide oint 0.05% .. 78

triamcinolone acetonide oint 0.1% ... 78 triamcinolone acetonide oint 0.5% ... 78

TRIAMINIC LIQ CHST/NAS .............. 74 triamterene & hydrochlorothiazide cap

37.5-25 mg ................................ 82 triamterene & hydrochlorothiazide tab

37.5-25 mg ................................ 82 triamterene & hydrochlorothiazide tab

75-50 mg ................................... 82 TRICARE TAB PRENATAL ............... 134

TRICOR see fenofibrate tab 145 mg ........... 44

see fenofibrate tab 48 mg ............ 44 trifluoperazine hcl tab 1 mg (base

equivalent) ................................. 59

trifluoperazine hcl tab 10 mg (base equivalent) ................................. 59

228



trihexyphenidyl hcl oral soln 0.4 mg/ml ................................................. 53

trihexyphenidyl hcl tab 2 mg............ 53 trihexyphenidyl hcl tab 5 mg............ 53

TRIJARDY XR TAB ........................... 36 TRILEPTAL

see oxcarbazepine susp 300 mg/5ml (60 mg/ml) .............................. 28

see oxcarbazepine tab 150 mg ...... 28 see oxcarbazepine tab 300 mg ...... 28

see oxcarbazepine tab 600 mg ...... 28

TRILURON INJ 20MG/2ML .............. 136 trimethobenzamide hcl cap 300 mg .. 42

TRIMETHOPRIM TAB 100MG ............ 17 trimipramine maleate cap 100 mg .... 35

trimipramine maleate cap 25 mg ...... 35 trimipramine maleate cap 50 mg ...... 35

TRINATE TAB ............................... 134 TRIPTODUR SUS 22.5MG ................. 84

TRIUMEQ TAB ................................ 62 TRIVISC INJ 25/2.5ML .................. 136

TRI-VI-SOL SOL A/C/D.................. 133 TRI-VITAMIN DRO ........................ 133

TRIZIVIR see abacavir sulfate-lamivudine-

zidovudine tab 300-150-300 mg . 61

TROGARZO INJ 150MG/ML .............. 62 tropicamide ophth soln 0.5% ......... 139

tropicamide ophth soln 1% ............ 139 TRUE COMFORT MIS LANC 30G ...... 108

TRUE COMFORT PAD PRO .............. 110 TRULICITY INJ 0.75/0.5 .................. 38

TRULICITY INJ 1.5/0.5 .................... 39 TRULICITY INJ 3/0.5 ....................... 39

TRULICITY INJ 4.5/0.5 .................... 39 TRUPLUS LANC MIS 26G ............... 108

TRUPLUS LANC MIS 28G ............... 108 TRUPLUS LANC MIS 30G ............... 108

TRUPLUS LANC MIS 33G ............... 108 TRUSOPT

see dorzolamide hcl ophth soln 2%

............................................ 141 TRUSTEX LUBR MIS ASSORTED...... 100

TRUSTEX LUBR MIS BANANA ......... 100 TRUSTEX LUBR MIS CHOC ............. 100

TRUSTEX LUBR MIS COLA ............. 100 TRUSTEX LUBR MIS COLORS ......... 100

TRUSTEX LUBR MIS EX LARGE ....... 100 TRUSTEX LUBR MIS EX STR ........... 100

TRUSTEX LUBR MIS GRAPE ........... 100 TRUSTEX LUBR MIS MINT.............. 100

TRUSTEX LUBR MIS RIB/STUD ....... 100 TRUSTEX LUBR MIS SPERMICI ....... 100

TRUSTEX LUBR MIS STRWBRY ....... 100 TRUSTEX LUBR MIS VANILLA ......... 100

TRUSTEX MIS BANANA ................. 100 TRUSTEX MIS CHOCOLAT .............. 100

TRUSTEX MIS FLAVORS ................ 100

TRUSTEX MIS MINT ...................... 100 TRUSTEX MIS STRWBRY ............... 100

TRUSTEX MIS VANILLA ................. 100 TRUSTEX/RIA MIS LUBRICAT ......... 100

TRUSTEX/RIA MIS NON-LUB .......... 100 TRUSTEX/RIA MIS SPERMICI ......... 100

TRUSTX NON-9 MIS RIB/STUD ....... 101 TRUVADA TAB 100-150 ................... 62

TRUVADA TAB 133-200 ................... 62 TRUVADA TAB 167-250 ................... 62

TRUVADA TAB 200-300 ................... 62 TUDORZA PRES AER 400/ACT .......... 24

TUMS CHW 500MG ......................... 17 TUMS CHW DEL CHW 1177MG ......... 17

TUMS LASTING CHW 500MG ............ 17

TUSNEL C SYP ............................... 74 TUSSLIN LIQ PEDIATRI ................... 74

T-VITES TAB ................................ 129 TYBOST TAB 150MG ....................... 62

TYGACIL see tigecycline for iv soln 50 mg .. 148

TYGACIL INJ 50MG ....................... 148 TYKERB

see lapatinib ditosylate tab 250 mg (base equiv) ............................ 52

TYSABRI INJ 300/15ML ................. 146 U UBRELVY TAB 100MG ................... 118 UBRELVY TAB 50MG ..................... 117

UDENYCA INJ 6MG/.6ML ................. 95

ULORIC see febuxostat tab 40 mg ............. 90

229

see febuxostat tab 80 mg ............. 90 ULTICARE MIC MIS 32GX4MM ........ 115

ULTICARE MIS 30GX3/16 .............. 115 ULTICARE MIS 30GX5/16 .............. 115

ULTICARE PAD ALCOHOL ............... 110 ULTICARE PEN MIS 31GX5MM ........ 115

ULTICARE PEN MIS 31GX6MM ........ 115 ULTICARE PEN MIS 31GX8MM ........ 115

ULTIGUARD MIS 31GX5MM ............ 115 ULTIGUARD MIS 31GX6MM ............ 115

ULTIGUARD MIS 31GX8MM ............ 115 ULTIGUARD MIS 32GX4MM ............ 115

ULTIGUARD MIS 32GX6MM ............ 115 ULTILET MIS 26G ......................... 108

ULTILET MIS 28G ......................... 108

ULTILET MIS 30G ......................... 108 ULTILET MIS 33G ......................... 108

ULTILET MIS LANCETS .................. 108 ULTILET MIS SAFETY .................... 108

ULTILET PAD ALCOHOL ................. 110 ULTILET PEN MIS 29GX12.7 .......... 115

ULTILET PEN MIS 31GX5MM .......... 115 ULTILET PEN MIS 31GX8MM .......... 115

ULTILET PEN MIS 32GX4MM .......... 115 ULTILET SAFE MIS 21G ................. 108

ULTOMIRIS INJ 300/30ML ............... 93 ULTRA FLO MIS 31GX5MM ............. 115

ULTRA FLO MIS 31GX8MM ............. 115 ULTRA FLO MIS PEN NEED ............. 115

ULTRA MEGA G TAB 100MG ........... 129

ULTRA MEGA G TAB 75MG CR ........ 129 ULTRA MEGA TAB 75MG CR ........... 130

ULTRA MEGA TAB TWO ................. 130 ULTRA THIN MIS 28G ................... 108

ULTRA THIN MIS 30G ................... 108 ULTRA THIN MIS 31G ................... 108

ULTRA THIN MIS 33G ................... 108 ULTRA THIN MIS LAN 31G ............. 108

ULTRA THIN MIS LANC 28G ........... 108 ULTRA THIN MIS LANC 30G ........... 108

ULTRA THIN MIS LANCETS ............ 108 ULTRACET

see tramadol-acetaminophen tab 37.5-325 mg ............................ 15

ULTRAM

see tramadol hcl tab 50 mg .......... 13 UNFINE PNTP MIS 32GX4MM ......... 115

UNIFINE PLUS MIS 31GX1/4 .......... 116 UNIFINE PLUS MIS 31GX3/16 ........ 116

UNIFINE PLUS MIS 31GX5/16 ........ 116 UNIFINE PLUS MIS 32GX5/32 ........ 116

UNIFINE PNTP MIS 29GX1/2 .......... 116 UNIFINE PNTP MIS 29GX12MM ...... 116

UNIFINE PNTP MIS 30GX3/16 ........ 116 UNIFINE PNTP MIS 31GX3/16 ........ 116

UNIFINE PNTP MIS 31GX5/16 ........ 116 UNIFINE PNTP MIS 31GX5MM ........ 116

UNIFINE PNTP MIS 31GX6MM ........ 116 UNIFINE PNTP MIS 31GX8MM ........ 116

UNIFINE PNTP MIS 32GX4MM ........ 116 UNIFINE PNTP MIS 32GX5/32 ........ 116

UNIFINE PNTP MIS 32GX6MM ........ 116

UNIFINE ULTR MIS 31GX5MM ........ 116 UNIFINE ULTR MIS 31GX6MM ........ 116

UNIFINE ULTR MIS 31GX8MM ........ 116 UNIFINE ULTR MIS 32GX4MM ........ 116

UNILET CMFR MIS TCH 28G ........... 108 UNILET CMFR MIS TCH 30G ........... 108

UNILET EX II MIS 28G .................. 108 UNILET EXCEL MIS 23G ................ 108

UNILET G.P MIS SUPR 23G ............ 108 UNILET G.P. MIS 21G ................... 108

UNILET GP 28 MIS ULT THIN ......... 108 UNILET LANC MIS 33G .................. 108

UNILET LANCE MIS 21G ................ 108 UNILET LANCE MIS 28G ................ 108

UNILET LANCE MIS 33G ................ 108

UNILET LANCT MIS 28G ................ 108 UNILET LANCT MIS 30G ................ 108

UNILET LANCT MIS 33G ................ 108 UNILET MICRO MIS 33G ................ 108

UNILET MIS 21G .......................... 108 UNILET SUPER MIS 23G ................ 108

UNILET SUPER MIS G.P. 23G ......... 108 UNISTIK 3 MIS GENT 30G ............. 108

UNISTIK II MIS LANCETS .............. 108 UNISTIK PRO MIS LANC 21G ......... 108

UNISTIK PRO MIS LANC 28G ......... 108 UNISTIK SAFE MIS LANC 28G ........ 108

UNISTIK SAFE MIS LANC 30G ........ 109 UNISTIK TOUC MIS LANC 21G ....... 109

UNISTIK TOUC MIS LANC 23G ....... 109

UNISTIK TOUC MIS LANC 28G ....... 109 UNISTIK TOUC MIS LANC 30G ....... 109

230

UNITSTIK PRO MIS LANC 25G ........ 109 UNIVERSAL 1 MIS 33G .................. 109

UNIVERSAL 1 MIS LANC 26G ......... 109 UNIVERSAL 1 MIS LANC 30G ......... 109

UP&UP CHW GRAPE ........................ 38 UP&UP CHW ORANGE ..................... 38

UP&UP CHW RASPBERY ................... 38 UPSPRINGBABY DRO MV/IRON....... 131

urea cream 10% ............................ 78 urea cream 20% ............................ 78

urea gel 45% ................................. 78 urea lotion 10% ............................. 78

urea lotion 25% ............................. 78 urea lotion 40% ............................. 78

UROCIT-K 10

see potassium citrate tab er 10 meq (1080 mg) ............................... 89

UROCIT-K 15 see potassium citrate tab er 15 meq

(1620 mg) ............................... 89 UROCIT-K 5

see potassium citrate tab er 5 meq (540 mg) ................................. 89

UROXATRAL see alfuzosin hcl tab er 24hr 10 mg

.............................................. 89 URSO 250

see ursodiol tab 250 mg ............... 88 URSO FORTE

see ursodiol tab 500 mg ............... 88

ursodiol cap 300 mg ....................... 88 ursodiol tab 250 mg ....................... 88

ursodiol tab 500 mg ....................... 88 UTI RELIEF TAB 97.2MG .................. 89

V VABOMERE INJ 2GM(1-1) ................ 18

VAGIFEM see estradiol vaginal tab 10 mcg . 154

valacyclovir hcl tab 1 gm ................. 63 valacyclovir hcl tab 500 mg ............. 63

VALCYTE see valganciclovir hcl for soln 50

mg/ml (base equiv) .................. 63 see valganciclovir hcl tab 450 mg

(base equivalent) ...................... 63

valganciclovir hcl for soln 50 mg/ml (base equiv) ............................... 63

valganciclovir hcl tab 450 mg (base equivalent) ................................. 63

VALIUM see diazepam tab 10 mg .............. 22

see diazepam tab 2 mg ................ 22 see diazepam tab 5 mg ................ 22

valproate sodium oral soln 250 mg/5ml (base equiv) ............................... 30

valproic acid cap 250 mg ................. 30 valsartan tab 160 mg ..................... 46

valsartan tab 320 mg ..................... 46 valsartan tab 40 mg ....................... 46

valsartan tab 80 mg ....................... 46 valsartan-hydrochlorothiazide tab 160-

12.5 mg ..................................... 48

valsartan-hydrochlorothiazide tab 160-25 mg ........................................ 48

valsartan-hydrochlorothiazide tab 320-12.5 mg ..................................... 48

valsartan-hydrochlorothiazide tab 320-25 mg ........................................ 48

valsartan-hydrochlorothiazide tab 80-12.5 mg ..................................... 48

VALTREX see valacyclovir hcl tab 1 gm ........ 63

see valacyclovir hcl tab 500 mg ..... 63 VANALICE GEL 0.3-3.5% ................. 80

VANATAB DM TAB 5-9-198 .............. 74 VANCOCIN

see vancomycin hcl cap 125 mg

(base equivalent) ..................... 18 see vancomycin hcl cap 250 mg

(base equivalent) ..................... 18 vancomycin hcl cap 125 mg (base

equivalent) ................................. 18 vancomycin hcl cap 250 mg (base

equivalent) ................................. 18 VANICREAM OIN ............................ 79

VANOS see fluocinonide cream 0.1% ........ 78

VANTAS KIT 50MG ......................... 51 VAQTA INJ 50UNT/ML ................... 153

VARENICLINE TAB 0.5MG .............. 147 VARENICLINE TAB 1MG ................. 147

VASERETIC

231

see enalapril maleate & hydrochlorothiazide tab 10-25 mg

.............................................. 47 VASOTEC

see enalapril maleate tab 10 mg .... 45 see enalapril maleate tab 2.5 mg ... 45

see enalapril maleate tab 20 mg .... 45 see enalapril maleate tab 5 mg ..... 45

VCF VAGINAL AER CONTRACP ........ 153 VCF VAGINAL GEL CONTRACE ........ 153

VCF VAGINAL MIS CONTRACP ........ 153 VCKS DAYQUIL LIQ MUCUS DM ........ 74

venlafaxine hcl cap er 24hr 150 mg (base equivalent) ........................ 33

venlafaxine hcl cap er 24hr 37.5 mg

(base equivalent) ........................ 33 venlafaxine hcl cap er 24hr 75 mg

(base equivalent) ........................ 33 venlafaxine hcl tab 100 mg (base

equivalent) ................................. 33 venlafaxine hcl tab 25 mg (base

equivalent) ................................. 33 venlafaxine hcl tab 37.5 mg (base



equivalent) ................................. 33 VENOFER INJ 20MG/ML ................... 96

verapamil hcl cap er 24hr 120 mg .... 66

verapamil hcl cap er 24hr 180 mg .... 66 verapamil hcl cap er 24hr 240 mg .... 66

verapamil hcl tab 120 mg ................ 66 verapamil hcl tab 40 mg.................. 66

verapamil hcl tab 80 mg.................. 66 verapamil hcl tab er 120 mg ............ 66

verapamil hcl tab er 180 mg ............ 66 verapamil hcl tab er 240 mg ............ 66

VERELAN see verapamil hcl cap er 24hr 120

mg .......................................... 66 see verapamil hcl cap er 24hr 180

mg .......................................... 66 see verapamil hcl cap er 24hr 240

mg .......................................... 66

VIBRAMYCIN

see doxycycline hyclate cap 100 mg ............................................ 148

see doxycycline monohydrate for susp 25 mg/5ml ..................... 148

VICTOZA INJ 18MG/3ML ................. 39 VIGAMOX

see moxifloxacin hcl ophth soln 0.5% (base equiv) .......................... 139

VIMPAT SOL 10MG/ML .................... 29 VIMPAT TAB 100MG ........................ 29

VIMPAT TAB 150MG ........................ 29 VIMPAT TAB 200MG ........................ 29

VIMPAT TAB 50MG ......................... 29 VIRACEPT TAB 250MG .................... 62

VIRACEPT TAB 625MG .................... 62

VIRAMUNE XR see nevirapine tab er 24hr 400 mg 62

VIREAD see tenofovir disoproxil fumarate tab

300 mg ................................... 62 VIREAD POW 40MG/GM .................. 62

VISCO-3 INJ 25/2.5ML .................. 136 VISTA ADVAN CAP AREDS2 ........... 130

VISTA ADVAN CAP DRY EYE ........... 130 VISTARIL

see hydroxyzine pamoate cap 50 mg .............................................. 20

VITABEX CAP ............................... 130 VITABEX PLUS CAP ....................... 130

VITA-C CRY ................................. 156

VITACRAVES CHW +OMEGA-3 ....... 133 VITACRAVES CHW GUMMIES ......... 130

VITACRAVES CHW IMMUNITY ........ 130 VITACRAVES CHW MENS ............... 130

VITACRAVES CHW SOUR GUM ....... 130 VITACRAVES CHW WOMENS .......... 130

VITAFOL-OB TAB 65-1MG .............. 134 VITALETS CHW CHILD .................. 131

VITALINE TAB FORMULA2.............. 130 VITALINE TAB FORMULA3.............. 130

VITAMIN B-6 TAB 200MG TR ......... 156 VITAMIN C CAP 500MG ................. 156

VITAMIN C CHW GUMMIE .............. 156 VITAMIN C LOZ 53 MG .................. 156

VITAMIN C LOZ 53MG ................... 156

VITAMIN C PAK 500MG ................. 156 VITAMIN C PAK BLEND ................. 130

232

VITAMIN C POW ........................... 156 VITAMIN C POW ELECTROL ........... 130

VITAMIN C TAB 100MG ................. 156 VITAMIN C TAB 60MG ................... 156

VITAMIN D3 CAP 4000UNIT ........... 155 VITAMIN D3 TAB 10000UNT .......... 155

VITAMIN D3 TAB 3000UNIT ........... 155 VITAMIN D3 TAB COMPLETE .......... 130

vitamin e cap 100 unit .................. 155 vitamin e cap 1000 unit ................ 155

vitamin e cap 134 mg (200 unit) .... 155 vitamin e cap 180 mg (400 unit) .... 155

vitamin e cap 200 unit .................. 155 vitamin e cap 268 mg (400 unit) .... 155

vitamin e cap 400 unit .................. 155

vitamin e cap 45 mg (100 unit) ...... 155 vitamin e cap 450 mg (1000 unit) .. 155

vitamin e cap 670 mg (1000 unit) .. 155 vitamin e cap 90 mg (200 unit) ...... 155

vitamin e oral oil 45 mg/0.25ml (100 unit/0.25ml) ............................. 155

vitamin e oral oil 67 mg/0.25ml (100 unit/0.25ml) ............................. 155

vitamin e soln 6.75 mg/0.3ml (15 unit/0.3ml) ............................... 155

VITAMIN E TAB 200UNIT ............... 155 VITAMIN E TAB 400UNIT ............... 155

VITAMINS FOR CAP HAIR .............. 135 VITASANA TAB ............................. 130

VITATHELY TAB ............................ 134

VITATRUM TAB ............................ 130 VITEYES CAP CLASSIC .................. 130

VITEYES CLAS CAP ADV ................ 130 VITEYES CLAS CAP ADVANCED ...... 130

VITEYES CLAS CAP MAC SUPP ........ 130 VITEYES CLAS CAP OMEGA-3 ......... 130

VITEYES CLAS TAB MULTIVIT ........ 130 VITEYES OMEG CAP TG ................. 137

VITEYES OPTI TAB NERV SUP ........ 130 VITRUM TAB ADULT ...................... 130

VITRUM TAB SENIOR .................... 130 VIVAGUARD MIS 30G .................... 109

VIVELLE-DOT DIS 0.025MG ............. 87 VIVELLE-DOT DIS 0.05MG ............... 87

VIVELLE-DOT DIS 0.075MG ............. 87

VIVELLE-DOT DIS 0.1MG ................. 87 VIVITROL INJ 380MG ...................... 41

VONVENDI INJ 1300UNIT ................ 93 VONVENDI INJ 650UNIT .................. 93

VORTEX VALVE MIS CHAMBER ....... 117 VOTRIENT TAB 200MG .................... 52

VP GLUCOSE CHW FRUIT ................ 38 VP GLUCOSE CHW GRAPE ............... 38

VPRIV INJ 400UNIT ........................ 94 VYEPTI INJ 100MG/ML .................. 118

VYVANSE CAP 10MG ........................ 2 VYVANSE CAP 20MG ........................ 2



VYVANSE CAP 70MG ........................ 3

W WAL-BORN CHW VIT C.................. 130

warfarin sodium tab 1 mg ............... 25 warfarin sodium tab 10 mg .............. 25

warfarin sodium tab 2 mg ............... 25 warfarin sodium tab 2.5 mg ............. 25

warfarin sodium tab 3 mg ............... 25 warfarin sodium tab 4 mg ............... 25

warfarin sodium tab 5 mg ............... 25 warfarin sodium tab 6 mg ............... 25

warfarin sodium tab 7.5 mg ............. 25 WEBCOL PREP PAD LARGE ............ 110

WEBCOL PREP PAD MEDIUM .......... 110 WEIGHT SMART TAB ADVANCED .... 130

WELLBUTRIN SR

see bupropion hcl tab er 12hr 100 mg .......................................... 31



WELLBUTRIN XL see bupropion hcl tab er 24hr 150

mg .......................................... 31 see bupropion hcl tab er 24hr 300

mg .......................................... 31 WESTAB PLUS TAB 27-1MG ........... 134

WESTHROID TAB 130MG ............... 150 WESTHROID TAB 195MG ............... 150

WESTHROID TAB 32.5MG .............. 150

WESTHROID TAB 65MG ................ 150 WESTHROID TAB 97.5MG .............. 150

233

WHOLE FOOD TAB MULTIVIT ......... 130 WIDE-SEAL DPR KIT 60 ................ 101

WIDE-SEAL DPR KIT 65 ................ 101 WIDE-SEAL DPR KIT 70 ................ 101



WIDE-SEAL DPR KIT 95 ................ 101 WILATE INJ ................................... 93

WMNS MULTIVI CHW +COLLAGE .... 130 WOMENS MULT CHW GUMMIES ...... 130

WOMENS MULTI TAB VIT/MIN ........ 130 WP THYROID TAB 113.75MG ......... 150

WP THYROID TAB 130MG .............. 150

WP THYROID TAB 16.25MG ........... 150 WP THYROID TAB 32.5MG ............. 150

WP THYROID TAB 48.75MG ........... 150 WP THYROID TAB 65MG ................ 150

WP THYROID TAB 81.25MG ........... 150 WP THYROID TAB 97.5MG ............. 150

X XALATAN

see latanoprost ophth soln 0.005% ............................................ 141

XALKORI CAP 200MG ...................... 52 XALKORI CAP 250MG ...................... 52

XANAX see alprazolam tab 0.25 mg .......... 20

see alprazolam tab 0.5 mg ........... 20

see alprazolam tab 1 mg .............. 20 see alprazolam tab 2 mg .............. 20

XANAX XR see alprazolam tab er 24hr 0.5 mg 21

see alprazolam tab er 24hr 1 mg ... 21 see alprazolam tab er 24hr 2 mg ... 21

see alprazolam tab er 24hr 3 mg ... 21 XARELTO STAR TAB 15/20MG .......... 25

XARELTO TAB 10MG ....................... 25 XARELTO TAB 15MG ....................... 25

XARELTO TAB 2.5MG ...................... 25 XARELTO TAB 20MG ....................... 25

XELJANZ TAB 10MG ......................... 8 XELJANZ TAB 5MG ........................... 8

XEOMIN INJ 100UNIT ................... 137

XEOMIN INJ 200UNIT ................... 137 XEOMIN INJ 50 UNIT .................... 137

XGEVA INJ .................................... 83 XIFAXAN TAB 200MG ...................... 17

XIFAXAN TAB 550MG ...................... 17 XIGDUO XR TAB 10-1000 ................ 37

XIGDUO XR TAB 10-500MG ............. 36 XIGDUO XR TAB 2.5-1000 ............... 36

XIGDUO XR TAB 5-1000MG ............. 36 XIGDUO XR TAB 5-500MG ............... 36

XODOL see hydrocodone-acetaminophen tab

5-300 mg ................................ 14 XOLAIR INJ 150MG/ML ................... 23

XOLAIR SOL 150MG ....................... 23 XTAMPZA ER CAP 13.5MG ............... 13

XTAMPZA ER CAP 18MG .................. 13

XTAMPZA ER CAP 27MG .................. 13 XTAMPZA ER CAP 36MG .................. 13

XTAMPZA ER CAP 9MG .................... 13 XYNTHA INJ 1000UNIT .................... 93

XYNTHA INJ 2000UNIT .................... 93 XYNTHA INJ 250UNIT ..................... 93

XYNTHA INJ 500UNIT ..................... 93 XYNTHA SOLOF INJ 1000UNIT ......... 93

XYNTHA SOLOF INJ 2000UNIT ......... 93 XYNTHA SOLOF INJ 3000UNIT ......... 93

XYNTHA SOLOF INJ 500UNIT ........... 93 XYNTHA SOLOF KIT 250UNIT ........... 93

Y YASMIN 28

see drospirenone-ethinyl estradiol

tab 3-0.03 mg .......................... 68 YAZ

see drospirenone-ethinyl estradiol tab 3-0.02 mg .......................... 68

YELETS TEEN TAB FORMULA .......... 130 YOUR LIFE CHW GUMMIES ............ 130

YOUR LIFE CHW MULTIVIT ............ 130 Z ZANAFLEX

see tizanidine hcl tab 4 mg (base

equivalent) ............................ 135 ZARONTIN

see ethosuximide soln 250 mg/5ml 29 ZAVESCA

see miglustat cap 100 mg ............ 94

ZELBORAF TAB 240MG.................... 52 ZEMAIRA INJ 1000MG ................... 148

234

ZEMDRI INJ 500MG/10 .................... 7 ZENPEP CAP 10000UNT ................... 81

ZENPEP CAP 15000UNT ................... 81 ZENPEP CAP 20000UNT ................... 81

ZENPEP CAP 25000 ........................ 81 ZENPEP CAP 3000UNIT ................... 81

ZENPEP CAP 40000 ........................ 81 ZENPEP CAP 5000UNIT ................... 81

ZE-PLUS CAP ............................... 131 ZESTORETIC

see lisinopril & hydrochlorothiazide tab 10-12.5 mg ........................ 47

see lisinopril & hydrochlorothiazide tab 20-12.5 mg ........................ 47

see lisinopril & hydrochlorothiazide

tab 20-25 mg ........................... 47 ZESTRIL

see lisinopril tab 10 mg ................ 45 see lisinopril tab 2.5 mg ............... 45

see lisinopril tab 20 mg ................ 45 see lisinopril tab 30 mg ................ 45

see lisinopril tab 40 mg ................ 45 see lisinopril tab 5 mg .................. 45

ZETIA see ezetimibe tab 10 mg .............. 44

ZEVRX MIS 31GX5MM ................... 116 ZEVRX MIS 31GX6MM ................... 116

ZEVRX MIS 31GX8MM ................... 116 ZEVRX MIS 32GX4MM ................... 116

ZEVRX STERIL PAD ALCHOL .......... 110

ZEVRX TWIST MIS LANC 30G......... 109 ZIAC

see bisoprolol & hydrochlorothiazide tab 10-6.25 mg ........................ 47

see bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg ....................... 47

see bisoprolol & hydrochlorothiazide tab 5-6.25 mg .......................... 47

ZIAGEN see abacavir sulfate soln 20 mg/ml

(base equiv)............................. 60 see abacavir sulfate tab 300 mg

(base equiv)............................. 60 zidovudine cap 100 mg ................... 62

zidovudine syrup 10 mg/ml ............. 62

zidovudine tab 300 mg .................... 63 ZINC 15 TAB 66MG ....................... 120

ZINC COLD CHW 11MG ................. 121 zinc gluconate tab 100 mg ............ 120

zinc gluconate tab 15 mg (elemental zn) .......................................... 120

zinc gluconate tab 30 mg .............. 120 zinc gluconate tab 50 mg (elemental

zn) .......................................... 120 ZINC LOZ 10MG ........................... 120

zinc sulfate cap 220 mg (50 mg elemental zn) ............................ 120

ZINC SULFATE CAP 50MG.............. 120 ZINC SULFATE TAB....................... 120

zinc sulfate tab 220 mg (50 mg zinc equivalent) ............................... 120

ZINC TAB 220MG ......................... 120

ZINPLAVA SOL 25MG/ML ............... 143 ZIOPTAN DRO 0.0015% ................ 141

ziprasidone hcl cap 20 mg ............... 54 ziprasidone hcl cap 40 mg ............... 54

ziprasidone hcl cap 60 mg ............... 54 ziprasidone hcl cap 80 mg ............... 54

ZITHROMAX see azithromycin for susp 100

mg/5ml ................................... 99 see azithromycin for susp 200

mg/5ml ................................... 99 see azithromycin tab 250 mg ........ 99

see azithromycin tab 500 mg ........ 99 ZITHROMAX POW 1GM PAK ............. 99

ZN-50 CAP .................................. 121

ZOCOR see simvastatin tab 10 mg ............ 44

see simvastatin tab 20 mg ............ 44 see simvastatin tab 40 mg ............ 44

ZOLADEX IMP 10.8MG .................... 51 ZOLADEX IMP 3.6MG ...................... 51

zoledronic acid inj conc for iv infusion 4 mg/5ml ...................................... 83

zoledronic acid iv soln 5 mg/100ml ... 83 ZOLEDRONIC INJ 4/100ML .............. 83

ZOLEDRONIC INJ 4MG/100 ............. 83 ZOLGENSMA INJ .......................... 137

ZOLINZA CAP 100MG ...................... 52 zolmitriptan orally disintegrating tab

2.5 mg ..................................... 118

zolmitriptan orally disintegrating tab 5 mg .......................................... 118

235

zolmitriptan tab 2.5 mg ................. 118 zolmitriptan tab 5 mg ................... 118

ZOLOFT see sertraline hcl oral concentrate for

solution 20 mg/ml .................... 32 see sertraline hcl tab 100 mg ........ 32

see sertraline hcl tab 25 mg .......... 32 see sertraline hcl tab 50 mg .......... 32

zolpidem tartrate tab 10 mg ............ 97 zolpidem tartrate tab 5 mg .............. 97

ZOLPIMIST SPR 5MG ...................... 97 ZOMIG

see zolmitriptan tab 2.5 mg ........ 118 see zolmitriptan tab 5 mg ........... 118

ZOMIG SPR 2.5MG ....................... 118

ZOMIG SPR 5MG .......................... 118 ZONEGRAN

see zonisamide cap 100 mg .......... 29 see zonisamide cap 25 mg ............ 29

zonisamide cap 100 mg .................. 29 zonisamide cap 25 mg .................... 29

zonisamide cap 50 mg .................... 29 ZOO FRIENDS CHW COMPLETE ...... 131

ZORTRESS TAB 0.25MG ................ 122 ZORTRESS TAB 0.5MG .................. 122

ZORTRESS TAB 0.75MG ................ 122 ZORTRESS TAB 1MG ..................... 122

ZOVIRAX see acyclovir susp 200 mg/5ml ..... 63

ZOVIRAX CRE 5% .......................... 77 ZOVIRAX OIN 5% .......................... 77

ZYLOPRIM see allopurinol tab 100 mg ........... 90

see allopurinol tab 300 mg ........... 90 ZYPREXA

see olanzapine tab 10 mg ............. 58 see olanzapine tab 15 mg ............. 58

see olanzapine tab 2.5 mg ............ 57 see olanzapine tab 20 mg ............. 58

see olanzapine tab 5 mg .............. 57 see olanzapine tab 7.5 mg ............ 57

ZYPREXA ZYDIS see olanzapine orally disintegrating

tab 10 mg ................................ 57

see olanzapine orally disintegrating tab 15 mg ................................ 57

see olanzapine orally disintegrating tab 20 mg ................................ 57

see olanzapine orally disintegrating tab 5 mg ................................. 57

ZYRTEC ALLGY TAB 10MG ............... 43 ZYRTEC CHILD TAB 10MG ............... 43

ZYTIGA see abiraterone acetate tab 250 mg

.............................................. 50 ZYVOX

see linezolid for susp 100 mg/5ml . 18 see linezolid tab 600 mg............... 18

Notice of Non-Discrimination In Compliance with Section 1557 of the Affordable Care Act

Health Choice Arizona complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, and gender identity). Health Choice Arizona does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, and gender identity).

Health Choice Arizona:

Provides free aids and services to people with disabilities to communicate effectively with us, such as:

• Qualified sign language interpreters

• Written information in other formats (large print, audio, accessible electronic formats, other formats)

Provides free language services to people whose primary language is not English, such as:

• Qualified interpreters

• Information written in other languages

If you need these services, contact:

Health Choice Arizona Address: 410 N. 44th Street, Ste. 900, Phoenix, AZ 85008 Phone: 1-800-322-8670, TTY: 711 Fax: 480-760-4739 Email: [email protected]

If you believe that Health Choice Arizona has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, and gender identity). You can file a grievance with:

Health Choice Arizona Address: 410 N. 44th Street, Ste. 900, Phoenix, AZ 85008 Phone: 1-800-322-8670, TTY: 711 Fax: 480-760-4739 Email: [email protected]

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Grievance Manager/Civil Rights Coordinator is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 1-800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Health Choice Arizona is a subsidiary of Blue Cross® Blue Shield® of Arizona. 976549-22

Notificación de no discriminación En cumplimiento con la Sección 1557 de la Ley de Cuidado de Salud de Bajo Costo

Health Choice Arizona cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo (incluido el embarazo, la orientación sexual y la identidad de género). Health Choice Arizona no excluye a las personas ni las trata de forma diferente debido a su origen étnico, color, nacionalidad, edad, discapacidad o sexo (incluido el embarazo, la orientación sexual y la identidad de género).

Health Choice Arizona:

Proporciona asistencia y servicios gratuitos a las personas con discapacidades para que se comuniquen de manera eficaz con nosotros, como los siguientes:

• Intérpretes de lenguaje de señas capacitados.

• Información escrita en otros formatos (letra grande, audio, formatos electrónicos accesibles, otros formatos).

Proporciona servicios lingüísticos gratuitos a personas cuya lengua materna no es el inglés, como los siguientes:

• Intérpretes capacitados.

• Información escrita en otros idiomas.

Si necesita recibir estos servicios, con el Coordinador de Derechos Civiles, 410 N. 44th Street, Ste. 900, Phoenix, AZ 85008, Teléfono: 1-800-322-8670, TTY: 711 Fax: 480-760-4739 Email: [email protected]

Si considera que Health Choice Arizona no le proporcionó estos servicios o lo discriminó de otra manera por motivos de origen étnico, color, nacionalidad, edad, discapacidad o sexo (incluido el embarazo, la orientación sexual y la identidad de género). Puede presentar un reclamo a la siguiente persona:

Coordinador de Derechos Civiles, 410 N. 44th Street, Ste. 900, Phoenix, AZ 85008, Teléfono: 1-800-322-8670, TTY: 711 Fax: 480-760-4739 Email: HCH.GrievanceForms@@azblue.com

Puede presentar el reclamo en persona o por correo postal, fax o correo electrónico. Si necesita ayuda para hacerlo, el Coordinador de Derechos Civiles está a su disposición para brindársela.

También puede presentar un reclamo de derechos civiles ante la Office for Civil Rights (Oficina de Derechos Civiles) del Department of Health and Human Services (Departamento de Salud y Servicios Humanos) de EE. UU. de manera electrónica a través de Office for Civil Rights Complaint Portal, disponible en https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, o bien, por correo postal a la siguiente dirección o por teléfono a los números que figuran a continuación:

U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 1-800-537-7697 (TDD)

Puede obtener los formularios de reclamo en el sitio web http://www.hhs.gov/ocr/office/file/index.html.

Multi-Language Interpreter Services as required by Section 1557 of the Affordable Care Act

ATENCIÓN: Si usted habla español, tiene a su disposición servicios de asistencia lingüística sin cargo. Llame al 1-800-322-8670 (TTY: 711).

請注意：若您使用繁體中文，您可以接受免費的語言協助服務。請致電 1-800-322-8670 (TTY: 711)。

Bilag1ana bizaad doo bee y1n7[ti' dago d00 saad n11n1 [a' bee y1n7[ti'go, saad bee ata' hane', t'1 1 n77k'e h, n1 bee ah00t'i' . Koj8' hod77lnih 1-800-322-8670 (TTY: 711).

ATENÇÃO: Se você fala português brasileiro, oferecemos serviços gratuitos de assistência para idiomas. Ligue para 1-800-322-8670 (TTY: 711).

CHÚ Ý: Nếu quý vị nói [Tiếng Việt], chúng tôi sẽ cung cấp các dịch vụ hỗ trợ ngôn ngữ miễn phí cho quý vị. Hãy gọi số 1-800-322-8670 (TTY: 711).

(ھاتف نصي: 867-322-800-1تنبیھ: إذا كنت تتحدث العربیة، فسوف تتوفر لدیك خدمات المساعدة اللغویة، مجانا. اتصل على 711(

ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-800-322-8670 (TTY: 711).

ATANSYON: Si ou pale Kreyòl Ayisyen, sèvis asistans lang, gratis, disponib pou ou. Rele 1-800-322-8670 (TTY: 711).

ACHTUNG: Wenn Sie Deutsch sprechen, steht Ihnen ein kostenloser Fremdsprachenservice zur Verfügung. Rufen Sie 1-800-322-8670 (TTY: 711) an.

ΠΡΟΣΟΧΗ: εάν μιλάτε Ελληνικά, μπορείτε να λάβετε δωρεάν υπηρεσίες γλωσσικής βοήθειας. Καλέστε τον αριθμό 1-800-322-8670 (TTY: 711).

�ચના: જો તમ બોલતા હોવ, તો તમારા માટ� મફત ભાષા સહાયતા સવાઓ ઉપલબધ છ. સપકર 1-800-322-8670 (TTY: 711).

धयान द�: य�द आप �हनद� बोलत ह�, तो आपक �लए भाषा सहायता सवाए �नःशलक उपलबध ह�। 1-800-322-8670

(TTY: 711) पर कॉल कर�। ATTENZIONE: Se parla italiano, sono disponibili per lei servizi gratuiti di assistenza linguistica. Chiami il numero 1-800-322-8670 (TTY: 711).

ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-800-322-8670 (TTY: 711), 8 a.m. – 5 p.m., Monday through Friday (except holidays).

注意：日本語を話される場合、無料で言語支援サービスをご利用いただけます。次の番号までお電話

してください：1-800-322-8670 (TTY: 711) 주의: 한국어를 사용하는 경우, 언어 지원 서비스가 무료로 제공됩니다. 1-800-322-8670 (TTY: 711) 번으로 전화하십시오.

សមយកចត�ទកដោក៖ របសនេបើេលាកអ�កនយោយភាសា ែខ�រ េយើងខ��មានេសវោកម�ជនយភាសាដលេលាកអ�កេដោយមនគតៃថ�េនោះេទ។ សមេហៅទរសព�មកេលខ 11--880000--332222--88667700 (TTY៖ 771111)។

धयान �दनहोस: तपा� नपाली – बोलनहनछ भन तपा�का ला�ग �न:शलक रपमा भाषा सहायता सवाहर उपलबध छन ।

1-800-322-8670 (TTY: 711) मा कल गनरहोस ।

تماس ).TTY: 711( 8670-322-800-1شود.با کنید، خدمات زبانی رایگان بھ شما ارائھ می صحبت می فارسی توجھ: اگر بھ زبان بگیرید.

UWAGA: Jeżeli mówi Pan/Pani po polsku, oferujemy bezpłatne usługi pomocy językowej. Prosimy o kontakt pod numerem 1-800-322-8670 (telefon tekstowy (TTY: 711). ВНИМАНИЕ! Если вы говорите на Русский, вам бесплатно доступны услуги языковой поддержки. Звоните 1-800-322-8670 (телетайп: 711). PAŽNJA: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su Vam besplatno. Pozovite 1-800-322-8670 (TTY: 711).

نا معیرنوةا ا دةـشمـشةا وعدرنةا.: این بعالىوك دمخكة (لشـ ) عبود ـشقلیىب◌لةا بىن TTY:711( 8670-322-800-1 اـسورییا) وبمجن دال اجرا بنیشـ منینا.

ATENSIYON: Kung nagsasalita ka ng Tagalog, ang mga serbisyong tulong sa wika, na walang singil, ay magagamit mo. Tumawag sa 1-800-322-8670 (TTY: 711). โปรดทราบ: หากคณพดภาษา ไทย คณจะสามารถใชบรการความชวยเหลอดานภาษาไดโดยไมมคาใชจาย โทร 1-800-322-8670 (TTY: 711) FAKATOKANGA’I: Kapau ‘oku ke Lea-Fakatonga, ko e kau tokoni fakatonu lea ‘oku nau fai atu ha tokoni ta’etotongi, pea teke lava ‘o ma’u ia. Telefoni mai 1-800-322-8670 (TTY: 711).

Multi-Language Interpreter Services as required by Section 1557 of the Affordable Care Act

Member Services / Servicios Para Miembros:

410 N. 44th Street, Suite 900 Phoenix, Arizona 85008

Phone: 480-968-6866

Toll-free: 1-800-322-8670 | TTY/TDD: 711 8 a.m. – 5 p.m. Monday-Friday (except holidays).

HealthChoiceAZ.com

976735-22

2021-2022 formulary formulario - health choice arizona

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