kansas aca member prescription drug list...spanish: si usted, o alguien a quien usted está...

KANSAS ACA MEMBER 2020

PRESCRIPTION DRUG LIST

HIX 2019 BCBSKC KS eff dte 01-01-2020

Please see the benefit schedule in your member certificate for member cost sharing

associated with Generic and Brand (Preferred and Non Preferred) drugs.

List of Abbreviations for Prescription Drugs Drug Category:

1 Generic Drug and Generic Specialty Drug

2 Preferred Drug and Non Preferred Generic Drug

3 Non Preferred Drug and Preferred Specialty Drug

4 Non Preferred Specialty Drug

5 Zero Cost Share Preventive Drug

6 Medical Service Drugs

7 Infertility Drug

ACA* Affordable Care Act is a zero cost share preventive drug.

M Maintenance drug.

MSD Medical Service Drug. This drug is only covered under the medical benefit.

OTC* Over the Counter drug.

PA Prior Authorization. The Plan requires you or your physician to get prior authorization for certain drugs.

This means that you will need to get approval before you fill your prescriptions. If you don’t get

approval, we may not cover the drug.

QL Quantity Limit. For certain drugs, the Plan limits the amount of the drug that we will cover.

S Specialty drug.

ST Step Therapy. In some cases, the Plan requires you to first try certain drugs to treat your medical

condition before we will cover another drug for that condition. For example, if Drug A and Drug B both

treat your medical condition, we may not cover Drug B unless you try Drug A first.

*Your plan has tobacco use coverage through the Routine Preventive Care benefit. Tobacco use includes two tobacco cessation attempts per year (both prescription and over-the-counter medications) for a 90-day treatment regimen when prescribed by an in-network health care provider without prior authorization.

Discrimination is Against the Law

Blue KC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color,

national origin, age, disability, or sex. Blue KC does not exclude people or treat them differently because of race,

color, national origin, age, disability, or sex.

Blue KC:

• 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 Customer Service, 844-395-7126 (Toll free), [email protected].

If you believe that Blue KC has failed to provide these services or discriminated in another way on the basis

of race, color, national origin, age, disability, or sex, you can file a grievance with the Appeals Department, PO

Box 419169, Kansas City, MO 64141-6169, 816-395-3537, TTY: 816-842-5607, [email protected]. You can

file a grievance in person or by mail, or email. If you need help filing a grievance, the Appeals Department 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, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

If you, or someone you’re helping, has questions about Blue KC, you have the right to get help and information in

your language at no cost. To talk to an interpreter, call 1-844-395-7126.

Spanish: Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de Blue KC, tiene derecho a

obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al 1-844-395-7126.

Chinese: 如果您，或是您正在協助的對象，有關於 Blue KC方面的問題，您有權利免費以您的母語得到幫

助和訊息。洽詢一位翻譯員，請撥電話1-844-395-7126。

Vietnamese: Nếu quý vị, hay người mà quý vị đang giúp đỡ, có câu hỏi về Blue KC, quý vị sẽ có quyền được giúp và có thêm thông tin bằng ngôn ngữ của mình miễn phí. Để nói chuyện với một thông dịch viên, xin gọi 1-844-395-7126.

German: Falls Sie oder jemand, dem Sie helfen, Fragen zum Blue KC haben, haben Sie das Recht, kostenlose Hilfe

und Informationen in Ihrer Sprache zu erhalten. Um mit einem Dolmetscher zu sprechen, rufen Sie bitte die Nummer

1-844-395-7126 an.

Korean: 만약 귀하 또는 귀하가 돕고 있는 어떤 사람이 [Blue KC]에 관해서 질문이 있다면 귀하는 그러한 도움과 정보를 귀하의 언어로 비용 부담없이 얻을 수 있는 권리가 있습니다. 그렇게 통역사와 얘기하기 위해서는 1-844-395-7126 로 전화하십시오.

Serbo-Croatian: Ukoliko Vi ili neko kome Vi pomažete ima pitanje o Blue KC, imate pravo da besplatno dobijete pomoć i informacije na Vašem jeziku. Da biste razgovarali sa prevodiocem, nazovite 1-844-395-7126.

mailto:[email protected]

mailto:[email protected]

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

Arabic: فلديك الحق في الحصول على المساعدة والمعلومات الضرورية بلغتك من دون اية تكلفة. ، KC Blue إن كان لديك أو لدى شخص تساعده أسئلة بخصوص

للتحدث مع مترجم اتصل ب. 7126 -1-844-395.

Russian: Если у вас или лица, которому вы помогаете, имеются вопросы по поводу Blue KC, то вы имеете право на бесплатное получение помощи и информации на вашем языке. Для разговора с переводчиком позвоните по телефону1-844-395-7126.

French: Si vous, ou quelqu’un que vous êtes en train d’aider, a des questions à propos de Blue KC, vous avez

le droit d’obtenir de l’aide et l’information dans votre langue à aucun coût. Pour parler à un interprète, appelez 1-

844-395-7126.

Tagalog: Kung ikaw, o ang iyong tinutulangan, ay may mga katanungan tungkol sa Blue KC, may karapatan ka

na makakuha ng tulong at impormasyon sa iyong wika ng walang gastos. Upang makausap ang isang tagasalin,

tumawag sa1-844-395-7126.

Laotian: ຖ້ າທ່ ານ, ື ຫຼ ຄົ ນ ື່ືທທ່ ານກໍ າລັ ງຊ່ ວຍເຫ ືຼ ອ, ມ ືໍືຄາຖາມກ່ ຽວກັ ບ Blue KC, ທ່ ານມ ື ືສດ ື່ືທຈະໄດ້

ຮັ ບການຊ່ ວຍເຫ ືຼ ອແລະືໍືຂ້ ມູ ນຂ່ າວສານ ື່ືທເປັ ນພາສາຂອງທ່ າືໍນ ື່ືບມ ຄ່ າໃຊ້ ຈ່ າຍ. ການໂອ້ ລົ ມກັ ບນາຍພາສາ, ໃຫ້

ໂທຫາ 1-844-395-7126.

Pennsylvanian Dutch: Wann du hoscht en Froog, odder ebber, wu du helfscht, hot en Froog baut Blue KC, hoscht

du es Recht fer Hilf un Information in deinre eegne Schprooch griege, un die Hilf koschtet nix. Wann du mit me

Interpreter schwetze witt, kannscht du 1-844-395-7126 uffrufe.

Persian:

داشته باشيد حق اين را داريد که کمکو اطالعات به زبان خود را به طور ، KC Blue اگر شما، يا کسی که شما به او کمک ميکنيد ، سوال در مورد

.رايگان دريافت مناييد .1-844-395-7126متاس حاصل مناييد

Cushite: Isin yookan namni biraa isin deeggartan Blue KC irratti gaaffii yo qabaattan, kaffaltii irraa bilisa haala ta’een

afaan keessaniin odeeffannoo argachuu fi deeggarsa argachuuf mirga ni qabdu. Nama isiniif ibsu argachuuf, lakkoofsa

bilbilaa 1-844-395-7126 tiin bilbilaa.

Portuguese: Se você, ou alguém a quem você está ajudando, tem perguntas sobre o Blue KC, você tem o direito de

obter ajuda e informação em seu idioma e sem custos. Para falar com um intérprete, ligue para 1-844-395-7126.

For TTY services, please call 1-816-842-5607.

An Independent Licensee of the Blue Cross and Blue Shield Association

All Optum trademarks and logos are owned by Optum, Inc. All other trademarks are the property of their respective owners. M57313-A 9/19

5

Table of Contents

Analgesics - Drugs for Pain ................................................................................................................................. 7 Analgesics - Drugs for Pain and Inflammation ................................................................................................... 11 Anesthetics ........................................................................................................................................................ 13 Anti-Addiction / Substance Abuse Treatment Agents ......................................................................................... 16 Antibacterials ..................................................................................................................................................... 16 Anticoagulants ................................................................................................................................................... 21 Anticonvulsants - Drugs for Seizures ................................................................................................................. 22 Antidementia Agents - Drugs for Alzheimer's Disease and Dementia ................................................................ 24 Antidepressants ................................................................................................................................................. 24 Antiemetics - Drugs for Nausea and Vomiting.................................................................................................... 26 Antifungals ......................................................................................................................................................... 27 Antigout Agents ................................................................................................................................................. 28 Anti-inflammatory Agents ................................................................................................................................... 28 Antimigraine Agents ........................................................................................................................................... 29 Antimyasthenic Agents ...................................................................................................................................... 29 Antimycobacterials ............................................................................................................................................. 29 Antineoplastics - Drugs for Cancer .................................................................................................................... 30 Antiparasitics ..................................................................................................................................................... 34 Antiparkinson Agents ......................................................................................................................................... 35 Antiplatelets ....................................................................................................................................................... 36 Antipsychotics - Drugs for Mood Disorders ........................................................................................................ 36 Antivirals ............................................................................................................................................................ 37 Anxiolytics - Drugs for Anxiety ........................................................................................................................... 39 Bipolar Agents - Drugs for Mood Disorders ........................................................................................................ 40 Blood Products / Modifiers / Volume Expanders - Drugs for Bleeding Disorders ............................................... 40 Cardiovascular Agents - Drugs for Heart and Circulation Conditions ................................................................. 41 Central Nervous System Agents - Drugs for Attention Deficit Disorder ............................................................. 49 Central Nervous System Agents - Drugs for Multiple Sclerosis .......................................................................... 50 Central Nervous System Agents - Miscellaneous .............................................................................................. 50 Dental and Oral Agents - Drugs for Mouth and Throat Conditions ..................................................................... 51 Dermatological Agents - Drugs for Skin Conditions ........................................................................................... 52 Diabetes - Antidiabetic Agents ........................................................................................................................... 58 Diabetes - Glucose Monitoring ........................................................................................................................... 60 Diabetes - Glycemic Agents ............................................................................................................................... 63 Diabetes - Insulins ............................................................................................................................................. 63 Electrolytes / Minerals / Metals / Vitamins .......................................................................................................... 64 Gastrointestinal Agents - Drugs for Acid Reflux and Ulcer ................................................................................. 72 Gastrointestinal Agents - Drugs for Bowel, Intestine and Stomach Conditions .................................................. 73 Genetic or Enzyme Disorder - Drugs for Replacement, Modification, Treatment ............................................... 75 Genitourinary Agents - Drugs for Bladder, Genital and Kidney Conditions ........................................................ 76 Genitourinary Agents - Drugs for Prostate Conditions........................................................................................ 77 Hormonal Agents - Adrenal ................................................................................................................................ 77 Hormonal Agents - Men's Health ....................................................................................................................... 79 Hormonal Agents - Osteoporosis ....................................................................................................................... 80 Hormonal Agents - Parathyroid .......................................................................................................................... 80 Hormonal Agents - Pituitary ............................................................................................................................... 80 Hormonal Agents - Prostaglandins..................................................................................................................... 82 Hormonal Agents - Sex Hormones and Birth Control ......................................................................................... 82 Hormonal Agents - Thyroid ................................................................................................................................ 86 Immunological Agents - Drugs for Immune System Stimulation or Suppression ................................................ 87 Immunological Agents - Drugs for Vaccination ................................................................................................... 90

6

Inflammatory Bowel Disease Agents.................................................................................................................. 91 Metabolic Bone Disease Agents - Drugs for Osteoporosis ................................................................................. 92 Miscellaneous Therapeutic Agents .................................................................................................................... 92 Ophthalmic Agents - Drugs for Eye Allergy, Infection and Inflammation ...........................................................101 Ophthalmic Agents - Drugs for Glaucoma .........................................................................................................102 Ophthalmic Agents - Drugs for Miscellaneous Eye Conditions..........................................................................103 Otic Agents - Drugs for Ear Conditions .............................................................................................................105 Respiratory Tract / Pulmonary Agents - Drugs for Allergies, Cough, Cold ........................................................105 Respiratory Tract / Pulmonary Agents - Drugs for Asthma and Other Lung Conditions ....................................107 Respiratory Tract / Pulmonary Agents - Drugs for Cystic Fibrosis.....................................................................109 Respiratory Tract / Pulmonary Agents - Drugs for Pulmonary Hypertension .....................................................109 Skeletal Muscle Relaxants - Drugs for Muscle Pain and Spasm .......................................................................110 Sleep Disorder Agents ......................................................................................................................................111

Last Updated 10/1/19 7

Drug Name Drug

Category

Limits/

Required

butalbital-apap 1

butalbital-apap-caff-cod 1

butalbital-apap-caffeine 1

butalbital-asa-caff- codeine 1

butalbital-aspirin- caffeine 1

butorphanol tartrate injection 6 MSD

butorphanol tartrate nasal 1 QL

BUTRANS 3 ST; QL carisoprodol-aspirin- codeine 1

codeine sulfate 1 QL CONZIP 3 ST; QL DEMEROL 6 MSD DILAUDID INJECTION 6 MSD DILAUDID ORAL 3 QL DOLOPHINE 1 ST DSUVIA 3

DURAGESIC-100 3 ST; QL DURAGESIC-12 3 ST; QL DURAGESIC-25 3 ST; QL DURAGESIC-50 3 ST; QL DURAGESIC-75 3 ST; QL duramorph 6 MSD duraxin 1

DVORAH 1 QL EMBEDA 3 ST; QL endocet 1 QL esgic oral capsule 1

ESGIC ORAL TABLET 3 ST fentanyl 1 ST; QL fentanyl citrate (pf) injection solution 6 PA; MSD

fentanyl citrate (pf) injection solution cartridge

6

MSD

Drug Name Drug

Category

Limits/

Required

Analgesics - Drugs

for Pain

7T GUMMY ES 3

ABSTRAL 3 ST; QL acetaminophen- codeine 1 QL

acetaminophen- codeine #2 1 QL



ACTIQ 3 ST; QL alfentanil hcl 6 MSD ALLZITAL 3 ST APADAZ 3 QL apap-caff- dihydrocodeine 1 QL

ARYMO ER 3 ST; QL ascomp-codeine 1

BELBUCA 2 ST; QL BENZHYDROCODON E-ACETAMINOPHEN 3 QL

BUPAP 3 ST BUPRENEX 6 PA; MSD buprenorphine hcl injection 6 PA; MSD

buprenorphine transdermal patch weekly 10 mcg/hr, 15 mcg/hr, 20 mcg/hr, 5 mcg/hr

1

ST; QL

BUPRENORPHINE TRANSDERMAL PATCH WEEKLY 7.5 MCG/HR

3

ST; QL

BUTALBITAL- ACETAMINOPHEN ORAL CAPSULE

1

ST

butalbital- acetaminophen oral tablet

1


Drug Name Drug

Category

Limits/

Required

FIORINAL/CODEINE #3 3

hydrocodone- acetaminophen 1 QL

hydrocodone-ibuprofen 1 QL hydromorphone hcl er 1 ST; QL HYDROMORPHONE HCL INJECTION SOLUTION 0.2 MG/ML

3

hydromorphone hcl injection solution 2 mg/ml, 4 mg/ml

6

MSD

hydromorphone hcl oral 1 QL hydromorphone hcl pf 6 MSD hydromorphone hcl rectal 1 QL

HYDROMORPHONE HCL SOLUTION 1 MG/ML INJECTION

6

MSD

hydromorphone hcl solution 1 mg/ml injection

6

MSD

HYDROMORPHONE HCL-NACL INJECTION 6 MSD

HYDROMORPHONE HCL-NACL INTRAVENOUS SOLUTION 10-0.9 MG/50ML-%, 100-0.9 MG/100ML-%, 15-0.9 MG/30ML-%, 20-0.9 MG/100ML-%, 25-0.9 MG/50ML-%, 30-0.9 MG/30ML-%, 50-0.9 MG/50ML-%, 6-0.9 MG/30ML-%

6

MSD

Drug Name Drug

Category

Limits/

Required

fentanyl citrate buccal lozenge on a handle 1 ST; QL

FENTANYL CITRATE BUCCAL TABLET 3 ST; QL

FENTANYL CITRATE INJECTION SOLUTION PREFILLED SYRINGE

6

MSD

FENTANYL CITRATE INTRAVENOUS SOLUTION 5000 MCG/100ML

6

PA; MSD

FENTANYL CITRATE INTRAVENOUS SOLUTION PREFILLED SYRINGE

6

MSD

FENTANYL CITRATE- NACL INTRAVENOUS SOLUTION

6

MSD

FENTANYL CITRATE- NACL INTRAVENOUS SOLUTION PREFILLED SYRINGE 550-0.9 MCG/55ML-%

6

MSD

FENTANYL CIT- ROPIVACAINE-NACL EPIDURAL SOLUTION 0.2-0.2-0.9 MG/100ML- %, 0.4-0.2-0.9 MG/200ML-%

6

MSD

FENTANYL- BUPIVACAINE-NACL EPIDURAL SOLUTION 0.2-0.08-0.9 MG/100ML-%, 0.2-0.1- 0.9 MG/100ML-%, 0.2- 0.125-0.9 MG/100ML- %, 0.5-0.0625-0.9 MG/250ML-%, 0.5-0.1- 0.9 MG/250ML-%, 0.5- 0.125-0.9 MG/250ML- %

6

MSD

FENTORA 3 ST; QL FIORICET 3 ST FIORICET/CODEINE 3

FIORINAL 3 ST


Drug Name Drug

Category

Limits/

Required

MORPHABOND ER 3 ST; QL morphine sulfate (concentrate) oral solution 100 mg/5ml, 20 mg/ml

1

QL

morphine sulfate (pf) 6 MSD morphine sulfate er 1 ST; QL morphine sulfate er beads 1 ST; QL

MORPHINE SULFATE INJECTION 6 MSD

morphine sulfate intramuscular 6 MSD

MORPHINE SULFATE INTRAVENOUS SOLUTION 0.5 MG/ML

6

MSD

morphine sulfate intravenous solution 150 mg/30ml, 25 mg/ml, 50 mg/ml

6

MSD

morphine sulfate oral 1 QL morphine sulfate rectal 1 QL MORPHINE SULFATE SOLUTION 1 MG/ML INTRAVENOUS

6

MSD

morphine sulfate solution 1 mg/ml intravenous

6

MSD

MORPHINE SULFATE- NACL INJECTION 3

MORPHINE SULFATE- NACL INTRAVENOUS SOLUTION 100-0.9 MG/100ML-%, 50-0.9 MG/50ML-%, 500-0.9 MG/100ML-%

6

MSD

Drug Name Drug

Category

Limits/

Required

HYDROMORPHONE HCL-NACL INTRAVENOUS SOLUTION PREFILLED SYRINGE 0.5-0.9 MG/ML-%, 1- 0.9 MG/5ML-%, 1-0.9 MG/ML-%, 10-0.9 MG/50ML-%, 15-0.9 MG/30ML-%, 2-0.9 MG/10ML-%, 2-0.9 MG/ML-%, 5-0.9 MG/25ML-%, 50-0.9 MG/50ML-%, 55-0.9 MG/55ML-%, 6-0.9 MG/30ML-%

6

MSD

HYSINGLA ER 2 ST; QL INFUMORPH 200 6 MSD INFUMORPH 500 6 MSD IONSYS 6 MSD KADIAN 3 ST; QL LAZANDA 3 ST; QL levorphanol tartrate oral tablet 2 mg 1 QL

levorphanol tartrate oral tablet 3 mg 3

lorcet 1 QL lorcet hd 1 QL lorcet plus 1 QL LORTAB 1 QL MEDROX-RX 3

meperidine hcl injection 6 MSD meperidine hcl oral 1 QL methadone hcl injection 6 ST; MSD methadone hcl intensol 1 ST methadone hcl oral 1 ST methadose oral concentrate 10 mg/ml 1 ST

methadose oral tablet soluble 1 ST

methadose sugar-free 1 ST mitigo 6 MSD


Drug Name Drug

Category

Limits/

Required

PRIALT INTRATHECAL SOLUTION 100 MCG/ML, 500 MCG/5ML

6

MSD

PRIMLEV 3 QL PROBUPHINE IMPLANT KIT 6 MSD

remifentanil hcl 6 MSD ROXICODONE 3 QL SUBSYS 3 ST; QL SYNAPRYN FUSEPAQ 3

tencon 1

tramadol hcl er (biphasic) 1 ST; QL

TRAMADOL HCL ER ORAL CAPSULE EXTENDED RELEASE 24 HOUR 100 MG, 200 MG, 300 MG

3

ST; QL

tramadol hcl er oral capsule extended release 24 hour 150 mg

1

ST; QL

tramadol hcl er oral tablet extended release 24 hour

1

ST; QL

tramadol hcl ir 1 QL tramadol- acetaminophen 1 QL

TREZIX 3 QL TYLENOL WITH CODEINE #3 3 QL

TYLENOL WITH CODEINE #4 3 QL

ULTIVA 6 MSD ULTRACET 3 QL ULTRAM 3 QL VANATOL LQ 3 ST VANATOL S 3 ST vicodin es 1 QL vicodin hp 1 QL XTAMPZA ER 3 ST; QL

Drug Name Drug

Category

Limits/

Required

MORPHINE SULFATE- NACL INTRAVENOUS SOLUTION PREFILLED SYRINGE 0.5-0.9 MG/ML-%, 2- 0.9 MG/2ML-%, 2-0.9 MG/ML-%, 30-0.9 MG/30ML-%, 4-0.9 MG/ML-%, 5-0.9 MG/5ML-%, 50-0.9 MG/50ML-%, 55-0.9 MG/55ML-%

6

MSD

MS CONTIN 3 ST; QL nalbuphine hcl injection 6 MSD NALOCET 3 QL NORCO 3 ST; QL NUCYNTA 2 QL NUCYNTA ER 2 ST; QL OPANA 3 QL OXAYDO 3 QL OXYCODONE HCL ER 3 ST; QL oxycodone hcl oral capsule 1 QL

oxycodone hcl oral concentrate 100 mg/5ml

1

QL

oxycodone hcl oral solution 1 QL

oxycodone hcl oral tablet 1 QL

oxycodone- acetaminophen 1 QL

oxycodone-aspirin 1 QL oxycodone-ibuprofen 1 QL OXYCONTIN 2 ST; QL oxymorphone hcl 1 QL oxymorphone hcl er 1 ST; QL pentazocine-naloxone hcl 1 QL

PERCOCET 3 QL phrenilin forte 1


Drug Name Drug

Category

Limits/

Required

Drug Name Drug

Category

Limits/

Required

zebutal 1 DICLOFENAC EPOLAMINE 3 ST; QL

ZOHYDRO ER 3 ST; QL diclofenac potassium 1 M Analgesics - Drugs

for Pain and

Inflammation

diclofenac sodium er 1 M diclofenac sodium oral 1 M

ACTIVE INJECTION KET-L 3

diclofenac sodium transdermal gel 1 % 1 QL

ACTIVE INJECTION KETMARC-L 3

diclofenac sodium transdermal solution 1

ACTIVE- KETOPROFEN 3

diclofenac-misoprostol 1 M diflunisal oral 1 M

ACTIVE-PREP KIT I 3

DUAL COMPLEX FORMULA 1 KIT 3

ACTIVE-PREP KIT II 3

ACTIVE-PREP KIT III 3

DUEXIS 3 ST; M; QL AIF #2 DRUG PREPARATION KIT 3

EC-NAPROSYN 3 ST; M ec-naproxen 1 M

AIF #3 DRUG PREPARATION KIT 3

ENOVARX- DICLOFENAC SODIUM

3

ARTHROTEC 3 ST; M aspirin adult 5 ACA; OTC

ENOVARX- IBUPROFEN 3

aspirin adult low strength oral tablet delayed release

5

ACA; OTC ENOVARX-

NAPROXEN 3

aspirin childrens 5 ACA; OTC etodolac 1 M

aspirin ec low dose 5 ACA; OTC etodolac er 1 M

aspirin ec low strength 5 ACA; OTC FBL KIT 3

aspirin low dose 5 ACA; OTC FELDENE 3 ST; M

aspirin oral tablet 5 ACA; OTC fenoprofen calcium oral capsule 3 ST; M aspirin oral tablet

delayed release 325 mg

5

ACA; OTC fenoprofen calcium oral

tablet 1 ST; M

bayer aspirin 5 ACA; OTC fenortho 3 ST; M

bayer aspirin ec low dose 5 ACA; OTC FLECTOR 2 ST; QL

flurbiprofen oral 1 M


CAMBIA 3 ST; QL ibu 1 M

CELEBREX 3 ST; M; QL ibuprofen lysine 6 MSD

celecoxib oral 1 M; QL ibuprofen oral suspension 1

choline-mag trisalicylate 1

ibuprofen oral tablet 400 mg, 600 mg, 800 mg

1

M DAYPRO 3 ST; M


Drug Name Drug

Category

Limits/

Required

meloxicam oral tablet 15 mg 1 M

meloxicam oral tablet 7.5 mg 1 M; QL

MOBIC ORAL TABLET 15 MG 3 ST; M

MOBIC ORAL TABLET 7.5 MG 3 ST; M; QL

nabumetone oral 1 M NALFON 3 ST; M NAPRELAN 3 ST; M NAPRO 3

NAPROSYN ORAL SUSPENSION 3 ST; M

naproxen dr 1 M naproxen oral 1 M naproxen sodium er 1 M naproxen sodium oral tablet 275 mg, 550 mg 1 M

NEOPROFEN 6 MSD NP #2 DRUG PREPARATION KIT 3

oxaprozin 1 M PENNSAID 3 QL piroxicam oral 1 M PRASTERA 3

qc aspirin low dose oral tablet delayed release 5 ACA; OTC

QMIIZ ODT 3 ST; M READYSHARP ANESTH + KETOROLAC

3

READYSHARP KETOROLAC 6 MSD

RELAFEN DS 3 M salsalate oral 1 M SPRIX 3 ST; S; QL st joseph low dose oral tablet delayed release 5 ACA; OTC

sulindac oral 1 M

Drug Name Drug

Category

Limits/

Required

IC 400 3

IC 800 3

INDOCIN ORAL 3 ST; M INDOCIN RECTAL 3 M indomethacin er 1 M indomethacin oral 1 M indomethacin sodium 6 MSD K.B.G.L IN TERODERM 3

KETOPHENE RAPIDPAQ 3

ketoprofen er 1 M ketoprofen oral 1 M KETOROCAINE-L 3

KETOROCAINE-LM 3

KETOROLAC TROMETHAMINE EXTERNAL

3

ketorolac tromethamine injection 6 MSD

ketorolac tromethamine oral 1 QL

ketorolac tromethamine solution 60 mg/2ml intramuscular

6

MSD

KETOROLAC TROMETHAMINE SOLUTION 60 MG/2ML INTRAMUSCULAR

4

S

KETOROLAC-BUPIV- KETAMINE 6 MSD

KETOROLAC-ROPIV- KETAMINE 6 MSD

LIDOPROFEN 3

LODINE 3 M meclofenamate sodium oral 1 M

medique aspirin 5 ACA; OTC mefenamic acid oral 1 M


Drug Name Drug

Category

Limits/

Required

Drug Name Drug

Category

Limits/

Required

TIVORBEX 3 BUPIVACAINE HCL- NACL EPIDURAL 6 MSD

tolmetin sodium 1 M BUPIVACAINE HCL- NACL INJECTION SOLUTION 0.1-0.9 %, 0.2-0.9 %

3

TORONOVA II SUIK 6 MSD TORONOVA SUIK 6 MSD TRIPLE COMPLEX FORMULA 3 KIT 3

BUPIVACAINE HCL- NACL INJECTION SOLUTION 0.125-0.9 %

6

MSD VIMOVO 3 ST; M; QL

VIVLODEX 3 ST; M VOLTAREN 3 QL

BUPIVACAINE HCL- NACL INJECTION SOLUTION PREFILLED SYRINGE 0.0625-0.9 % (50 ML), 0.1-0.9 % (50 ML), 0.125-0.9 % (50 ML), 0.375-0.9 %

3

VOPAC GB 3

VOPAC KT 3

VP FC KIT 3

VP GKL KIT 3

ZIPSOR 3 ST; QL ZORVOLEX 3 M; QL

BUPIVACAINE HCL- NACL INJECTION SOLUTION PREFILLED SYRINGE 0.25-0.9 % (30 ML)

6

MSD

Anesthetics

ACTIVE INJECTION LM-2 3

bd pudendal/local tray/1% lido 1

bupivacaine in dextrose intrathecal 6 MSD BUFFERED

LIDOCAINE 6 MSD bupivacaine spinal 6 MSD

bupivacaine fisiopharma 6 MSD bupivacaine-

epinephrine 6 MSD

bupivacaine hcl (pf) 6 MSD bupivacaine- epinephrine (pf) 6 MSD bupivacaine hcl

injection solution 0.5 % 1

CADIRAMD 6 MSD BUPIVACAINE HCL INJECTION SOLUTION 312.5 MG/10ML

3

CARBOCAINE 3

CARBOCAINE PRESERVATIVE- FREE INJECTION SOLUTION 1 %, 2 %

6

MSD

BUPIVACAINE HCL INJECTION SOLUTION PREFILLED SYRINGE 0.125 % (50 ML), 0.5 % (60 ML)

3

CARBOCAINE PRESERVATIVE- FREE INJECTION SOLUTION 1.5 %

1

CETACAINE EXTERNAL AEROSOL 3

BUPIVACAINE HCL INJECTION SOLUTION

6

MSD chloroprocaine hcl (pf) 6 MSD


PREFILLED SYRINGE 0.5 % (30 ML)

CITANEST FORTE DENTAL 3


Drug Name Drug

Category

Limits/

Required

LIDOCAINE HCL- SODIUM CHLORIDE INJECTION SOLUTION

3

LIDOCAINE HCL- SODIUM CHLORIDE INJECTION SOLUTION PREFILLED SYRINGE 1-0.9 % (3 ML)

3

LIDOCAINE HCL- SODIUM CHLORIDE INJECTION SOLUTION PREFILLED SYRINGE 1-0.9 %, 1-0.9 % (1 ML)

6

MSD

lidocaine in d5w intravenous solution 4- 5 mg/ml-%, 8-5 mg/ml- %

6

MSD

LIDOCAINE IN DEXTROSE 6 MSD

lidocaine-epinephrine injection solution 0.5 %- 1:200000, 1 %- 1:100000, 1.5 %- 1:200000, 2 %- 1:100000, 2 %- 1:200000

6

MSD

lidocaine-prilocaine external cream 1

LIDOCAINE-SODIUM BICARBONATE 6 MSD

LIDOCAINE- TETRACAINE 6 PA; MSD

LIDODERM 3 ST MARCAINE INJECTION SOLUTION 0.25 %

3

MARCAINE INJECTION SOLUTION 0.75 %

6

MSD

MARCAINE PRESERVATIVE FREE

6

MSD

Drug Name Drug

Category

Limits/

Required

CITANEST PLAIN DENTAL 3

CLOROTEKAL 6 MSD cocaine hcl external 1

COCAINE HCL NASAL 6 MSD ENOVARX- LIDOCAINE HCL 3

ethyl chloride 1

EXPAREL 6 MSD GEBAUERS PAIN EASE 3

glydo external gel 2 % 1

GOPRELTO 6 MSD L.E.T. 3

LETS 3

lido bdk 6 MSD lidocaine external ointment 1

lidocaine external patch 1

lidocaine hcl (pf) 6 MSD lidocaine hcl external solution 1

lidocaine hcl injection solution 6 MSD

LIDOCAINE HCL INJECTION SOLUTION PREFILLED SYRINGE 10 MG/ML, 100 MG/5ML, 200 MG/10ML, 400 MG/20ML

6

MSD

LIDOCAINE HCL INJECTION SOLUTION PREFILLED SYRINGE 60 MG/3ML

3

LIDOCAINE HCL INTRADERMAL 6 MSD

lidocaine hcl urethral/mucosal external gel

1


Drug Name Drug

Category

Limits/

Required

ROPIVACAINE HCL INJECTION SOLUTION 33.4 MG/ML

3

ROPIVACAINE HCL INJECTION SOLUTION PREFILLED SYRINGE 0.5 %

6

MSD

ROPIVACAINE HCL- NACL EPIDURAL SOLUTION

6

MSD

ROPIVACAINE HCL- NACL INJECTION SOLUTION 0.2-0.9 %

6

MSD

ROPIVACAINE HCL- NACL INJECTION SOLUTION PREFILLED SYRINGE

6

MSD

ROPIV-CLONIDINE- KETOROLAC 6 MSD

sensorcaine injection solution 0.5 % 1

sensorcaine/epinephrin e 6 MSD

sensorcaine-mpf 6 MSD sensorcaine- mpf/epinephrine injection solution 0.25% -1:200000, 0.5% - 1:200000

6

MSD

SENSORCAINE- MPF/EPINEPHRINE INJECTION SOLUTION 0.75- 1:200000 %

6

MSD

SX1 MEDICATED POST-OPERATIVE 3

SYNERA 3

tetracaine hcl injection 1

VENIPUNCTURE PX1 PHLEBOTOMY 3

XYLOCAINE 6 MSD xylocaine dental 6 MSD

Drug Name Drug

Category

Limits/

Required

MARCAINE SPINAL 6 MSD MARCAINE/EPINEPH RINE 6 MSD

MARCAINE/EPINEPH RINE PF 6 MSD

marlido 1

MARLIDO-25 3

MARVONA SUIK 6 MSD NAROPIN 6 MSD NESACAINE 3

NESACAINE-MPF 6 MSD P-CARE 100MX 3

P-CARE M 6 MSD P-CARE MG 6 MSD P-CARE X 6 MSD PLIAGLIS 3 PA POINT OF CARE LM- 2.2 3

POINT OF CARE LM- 2.5 3

polocaine injection solution 1 % 1

polocaine injection solution 2 % 2

polocaine-mpf injection solution 1 %, 2 % 6 MSD

polocaine-mpf injection solution 1.5 % 1

READYSHARP LIDOCAINE 6 MSD

READYSHARP-A 3

RECK 6 MSD relador pak 1

relador pak plus 1

ROPIVACAINE HCL EPIDURAL 6 MSD

ropivacaine hcl injection solution 10 mg/ml, 2 mg/ml, 5 mg/ml, 7.5 mg/ml

6

MSD


Drug Name Drug

Category

Limits/

Required

nicotine step 1 5 ACA; OTC; QL nicotine step 2 5 ACA; OTC; QL nicotine step 3 5 ACA; OTC; QL NICOTROL 5 ACA; QL NICOTROL NS 5 ACA; QL SUBLOCADE 6 MSD SUBOXONE 1 QL VIVITROL 6 MSD ZUBSOLV 1 QL Antibacterials

ACTICLATE 3 ST AEMCOLO 3

ALTABAX 3

amikacin sulfate injection 6 MSD

amoxicillin 1

amoxicillin-potassium clavulanate er 1

amoxicillin-potassium clavulanate oral 1

ampicillin 1

ampicillin sodium 6 MSD ampicillin-sulbactam sodium 6 MSD

ARIKAYCE 3 PA; S AUGMENTIN ES-600 3

AUGMENTIN ORAL SUSPENSION RECONSTITUTED 125-31.25 MG/5ML

2

AUGMENTIN ORAL SUSPENSION RECONSTITUTED 250-62.5 MG/5ML

3

AUGMENTIN ORAL TABLET 3

AVELOX 6 MSD avidoxy 1

AVYCAZ 6 MSD AZACTAM 6 MSD

Drug Name Drug

Category

Limits/

Required

XYLOCAINE/EPINEPH RINE 6 MSD

XYLOCAINE-MPF 6 MSD XYLOCAINE- MPF/EPINEPHRINE 6 MSD

ZINGO 6 MSD ZTLIDO 2 ST Anti-Addiction /

Substance Abuse

Treatment Agents

acamprosate calcium 1 M ANTABUSE 3 M BUNAVAIL 1 QL buprenorphine hcl sublingual 1 QL

buprenorphine hcl- naloxone hcl 1 QL

bupropion hcl er (smoking det) 5 ACA; QL

CHANTIX 5 ACA; QL CHANTIX CONTINUING MONTH PAK

5

ACA; QL

CHANTIX STARTING MONTH PAK 5 ACA; QL

disulfiram oral 1 M EVZIO 1 ST LUCEMYRA 3 QL naloxone hcl injection 1

naltrexone hcl oral 1

NALTREXONE SUBCUTANEOUS 1

NARCAN 1

NICORETTE MOUTH/THROAT GUM 2 MG

5

ACA; OTC; QL

nicotine polacrilex mouth/throat gum 5 ACA; OTC; QL

nicotine polacrilex mouth/throat lozenge 2 mg

5

ACA; OTC; QL


Drug Name Drug

Category

Limits/

Required

cefotetan disodium 6 MSD cefoxitin sodium 6 MSD cefpodoxime proxetil 1

cefprozil 1

ceftazidime and dextrose 6 MSD

ceftriaxone sodium in dextrose 6 MSD

ceftriaxone sodium injection 6 MSD

ceftriaxone sodium intravenous 6 MSD

ceftriaxone sodium- dextrose 6 MSD

cefuroxime axetil 1

cefuroxime sodium 6 MSD CENTANY 3

cephalexin 1

chloramphenicol sod succinate 6 MSD

CIPRO 3

ciprofloxacin hcl oral 1

ciprofloxacin in d5w 6 MSD ciprofloxacin oral 1

clarithromycin er 1

clarithromycin oral 1

CLEOCIN 3

CLEOCIN PHOSPHATE 6 MSD

clindamycin hcl oral 1

clindamycin palmitate hcl 1

clindamycin phosphate in d5w 6 MSD

CLINDAMYCIN PHOSPHATE IN NACL 6 MSD

clindamycin phosphate injection 6 MSD

clindamycin phosphate intravenous 6 MSD

Drug Name Drug

Category

Limits/

Required

azithromycin intravenous 6 MSD

azithromycin oral 1

aztreonam 6 MSD bacitracin intramuscular 6 MSD BACTOCILL IN DEXTROSE 6 MSD

BACTRIM 3

BACTRIM DS 3

BAXDELA INTRAVENOUS 6 MSD

BAXDELA ORAL 3

benzalkonium chloride external solution 2

BICILLIN C-R 6 MSD BICILLIN C-R 900/300 6 MSD BICILLIN L-A 6 MSD cefaclor 1

cefaclor er 1

cefadroxil 1

cefazolin sodium injection 6 MSD

CEFAZOLIN SODIUM INTRAVENOUS SOLUTION PREFILLED SYRINGE

6

MSD

cefazolin sodium intravenous solution reconstituted

6

MSD

cefazolin sodium- dextrose 6 MSD

cefdinir 1

cefditoren pivoxil 1

cefepime hcl 6 MSD cefepime-dextrose 6 MSD cefixime 1

CEFOTAN 6 MSD cefotaxime sodium injection solution reconstituted 1 gm, 500 mg

6

MSD


Drug Name Drug

Category

Limits/

Required

erythromycin ethylsuccinate oral 1

FIRST- METRONIDAZOLE 3

FIRST-VANCOMYCIN 3

FIRVANQ 3

FLAGYL 3

FURADANTIN 3

gentamicin sulfate external 1

gentamicin sulfate injection solution 10 mg/ml

1

gentamicin sulfate injection solution 40 mg/ml

6

MSD

HIPREX 3

hydrogen peroxide 2

imipenem-cilastatin 6 MSD INVANZ 6 MSD KEFLEX 3

LEVAQUIN ORAL TABLET 500 MG, 750 MG

3

levofloxacin in d5w 6 MSD levofloxacin intravenous 6 MSD

levofloxacin oral solution 6 MSD

levofloxacin oral tablet 1

LINCOCIN 6 MSD lincomycin hcl injection 6 MSD linezolid intravenous 6 MSD linezolid oral 1 PA; QL lugols 1

MACROBID 3

MACRODANTIN 3

mafenide acetate external 1

MAXIPIME 6 MSD

Drug Name Drug

Category

Limits/

Required

clindamycin phosphate vaginal 1

CLINDESSE 3

colistimethate sodium (cba) 1

COLY-MYCIN M 3

coremino 1

CUBICIN 6 MSD CUBICIN RF 6 MSD DALVANCE 6 MSD daptomycin 6 MSD demeclocycline hcl 1

dicloxacillin sodium 1

DIFICID 3

DORYX 3 ST DORYX MPC 3 ST doxy 100 6 MSD doxycycline hyclate intravenous 6 MSD

doxycycline hyclate oral 1

doxycycline monohydrate oral 1

e.e.s. 400 1

E.E.S. GRANULES 3

ertapenem sodium 6 MSD ERYPED 200 3

ERYPED 400 3

ERY-TAB 1

erythrocin lactobionate solution reconstituted 500 mg intravenous

6

MSD

ERYTHROCIN LACTOBIONATE SOLUTION RECONSTITUTED 500 MG INTRAVENOUS

6

MSD

ERYTHROCIN STEARATE 1

erythromycin base 1


Drug Name Drug

Category

Limits/

Required

Drug Name Drug

Category

Limits/

Required

meropenem 6 MSD NAFCILLIN SODIUM IN DEXTROSE INTRAVENOUS SOLUTION 1 GM/50ML

6

MSD

MEROPENEM- SODIUM CHLORIDE INTRAVENOUS SOLUTION RECONSTITUTED 1 GM/50ML, 500-0.9 MG- %

6

MSD nafcillin sodium injection solution reconstituted 1 gm, 2 gm

6

MSD

MERREM 6 MSD nafcillin sodium intravenous solution reconstituted 10 gm, 2 gm

6

MSD

methenamine hippurate 1

methenamine mandelate oral 1

METRONIDAZOLE BENZO+SYRSPEND 3

neomycin sulfate oral 1

nitrofurantoin 1 metronidazole in nacl intravenous solution 5- 0.79 mg/ml-%, 500- 0.79 mg/100ml-%

6

MSD nitrofurantoin

macrocrystal oral 1

nitrofurantoin monohydrate macrocrystals

1

METRONIDAZOLE IN NACL INTRAVENOUS SOLUTION 500-0.74 MG/100ML-%

6

MSD NUTRIDOX 3 ST

NUVESSA 3

METRONIDAZOLE INTRAVENOUS 6 MSD NUZYRA

INTRAVENOUS 6 MSD

metronidazole oral 1

NUZYRA ORAL 3

metronidazole vaginal 1

ofloxacin oral 1

MINOCIN INTRAVENOUS 6 ST; MSD okebo 1

ORBACTIV 6 MSD MINOCIN ORAL CAPSULE 50 MG 3 ST oxacillin sodium 6 MSD

paromomycin sulfate oral 1

minocycline hcl er 1

minocycline hcl oral 1

PENICILLIN G POT IN DEXTROSE 6 MSD MINOLIRA 2 ST

mondoxyne nl 1

penicillin g potassium 6 MSD MONUROL 3

penicillin g procaine 6 MSD morgidox oral 1

penicillin g sodium 6 MSD moxifloxacin hcl in nacl 6 MSD

penicillin v potassium 1


MOXIFLOXACIN HCL INTRAVENOUS 6 MSD PFIZERPEN

INJECTION SOLUTION RECONSTITUTED 20000000 UNIT

6

MSD moxifloxacin hcl oral 1

mupirocin calcium 1

mupirocin external 1


Drug Name Drug

Category

Limits/

Required

tazicef injection 6 MSD TAZICEF SOLUTION RECONSTITUTED 1 GM INTRAVENOUS

6

MSD

tazicef solution reconstituted 1 gm intravenous

6

MSD

TAZICEF SOLUTION RECONSTITUTED 2 GM INTRAVENOUS

6

MSD

tazicef solution reconstituted 2 gm intravenous

6

MSD

TEFLARO 6 MSD tetracycline hcl oral 1

tigecycline 6 MSD tinidazole oral 1

tobramycin sulfate injection 6 MSD

trimethoprim oral 1

TYGACIL 6 MSD UNASYN INJECTION 6 MSD VABOMERE 6 MSD VANCOCIN HCL 3

VANCOMYCIN HCL IN DEXTROSE INTRAVENOUS SOLUTION 1-5 GM/100ML-%, 1-5 GM/250ML-%, 1.25-5 GM/250ML-%, 1.5-5 GM/250ML-%, 1.5-5 GM/500ML-%, 1.75-5 GM/500ML-%

6

MSD

vancomycin hcl in dextrose intravenous solution 1-5 gm/200ml- %, 500-5 mg/100ml-%, 750-5 mg/150ml-%

6

MSD

vancomycin hcl in nacl intravenous solution 1- 0.9 gm/200ml-%, 500- 0.9 mg/100ml-%

6

MSD

Drug Name Drug

Category

Limits/

Required

pfizerpen solution reconstituted 5000000 unit injection

6

MSD

PFIZERPEN SOLUTION RECONSTITUTED 5000000 UNIT INJECTION

6

MSD

piperacillin sod- tazobactam so 6 MSD

polymyxin b sulfate injection 6 MSD

PRIMAXIN IV 6 MSD PRIMSOL 3

SEYSARA 3

SILVADENE 3

silver nitrate external 1

silver sulfadiazine external 1

SIVEXTRO INTRAVENOUS 6 MSD; QL

SIVEXTRO ORAL 3 PA; QL SOLODYN 2 ST SPECTRACEF 3

ssd 1

streptomycin sulfate intramuscular 6 MSD

sulfadiazine oral 1

sulfamethoxazole- trimethoprim intravenous

6

MSD

sulfamethoxazole- trimethoprim oral 1

SULFAMYLON EXTERNAL CREAM 2

SULFAMYLON EXTERNAL PACKET 3

sulfatrim pediatric 1

SUPRAX 3

SYNERCID 6 MSD TARGADOX 3 ST


Drug Name Drug

Category

Limits/

Required

XIFAXAN ORAL TABLET 200 MG 2

XIFAXAN ORAL TABLET 550 MG 2 M

XIMINO 3 ST ZEMDRI 6 MSD ZERBAXA 6 MSD ZITHROMAX INTRAVENOUS 6 MSD

ZITHROMAX ORAL 3

ZITHROMAX TRI-PAK 3

ZITHROMAX Z-PAK 3

ZOSYN INTRAVENOUS SOLUTION RECONSTITUTED

6

MSD

ZYVOX INTRAVENOUS 6 MSD

ZYVOX ORAL 3 PA; QL Anticoagulants

acd formula a 2

acd-a noclot-50 2

ANGIOMAX 6 MSD anticoagulant cit dext soln a 2

anticoagulant sodium citrate 3

argatroban 6 MSD argatroban in sodium chloride intravenous solution 50 mg/50ml

6

MSD

ARIXTRA 3 QL BEVYXXA 3 M; QL bivalirudin trifluoroacetate 6 MSD

BIVALIRUDIN- SODIUM CHLORIDE 6 MSD

CATHFLO ACTIVASE 2

COUMADIN 3 M DEFITELIO 6 MSD ELIQUIS 2 PA; M; QL

Drug Name Drug

Category

Limits/

Required

VANCOMYCIN HCL IN NACL INTRAVENOUS SOLUTION 1-0.9 GM/250ML-%, 1.25-0.9 GM/250ML-%, 1.5-0.9 GM/250ML-%, 1.5-0.9 GM/300ML-%, 1.5-0.9 GM/500ML-%, 1.75-0.9 GM/250ML-%, 1.75-0.9 GM/500ML-%, 2-0.9 GM/500ML-%

6

MSD

VANCOMYCIN HCL IN NACL SOLUTION 750- 0.9 MG/150ML-% INTRAVENOUS

6

MSD

vancomycin hcl in nacl solution 750-0.9 mg/150ml-% intravenous

6

MSD

vancomycin hcl intravenous solution 1000 mg/200ml, 1500 mg/300ml, 2000 mg/400ml

6

MSD

VANCOMYCIN HCL INTRAVENOUS SOLUTION 1250 MG/12.5ML, 1500 MG/15ML, 1750 MG/17.5ML, 2000 MG/20ML

6

MSD

vancomycin hcl intravenous solution reconstituted 1 gm, 1.25 gm, 1.5 gm, 10 gm, 100 gm, 250 mg, 5 gm, 500 mg, 750 mg

6

MSD

vancomycin hcl oral 1

VANCOMYCIN+SYRS PEND SF 3

vandazole 1

VIBATIV 6 MSD VIBRAMYCIN 3 ST XEPI 3 PA XERAVA 6 MSD


Drug Name Drug

Category

Limits/

Required

SODIUM CITRATE LOCK FLUSH 6 MSD

SODIUM CITRATE- GENTAMICIN SULF 6 MSD

THROMBATE III INTRAVENOUS SOLUTION RECONSTITUTED 500 UNIT

6

MSD

TRICITRASOL 2

warfarin sodium oral 1 M XARELTO 2 PA; M; QL XARELTO STARTER PACK 2 PA; QL

Anticonvulsants -

Drugs for Seizures

APTIOM 3 M BANZEL 2 M BRIVIACT INTRAVENOUS 6 ST; MSD

BRIVIACT ORAL 3 ST; M carbamazepine er 1 M carbamazepine oral 1 M CARBATROL 3 M CELONTIN 2 M CEREBYX 6 MSD clobazam 1 M DEPACON 6 MSD DEPAKENE 3 ST; M DEPAKOTE 3 ST; M DEPAKOTE ER 3 ST; M DEPAKOTE SPRINKLES 3 ST; M

DIACOMIT 3 M DIASTAT ACUDIAL 3 QL DIASTAT PEDIATRIC 3 QL diazepam rectal 1 QL DILANTIN INFATABS 3 M DILANTIN ORAL CAPSULE 100 MG 3 M

Drug Name Drug

Category

Limits/

Required

ELIQUIS STARTER PACK 2 PA; M; QL

enoxaparin sodium injection 6 MSD; QL

enoxaparin sodium subcutaneous 1 QL

fondaparinux sodium 1 QL FRAGMIN 2 QL heparin (porcine) in nacl injection solution 100-0.45 unit/ml-%

6

MSD

heparin (porcine) in nacl intravenous solution 12500-0.45 ut/250ml-%, 25000- 0.45 ut/250ml-%, 25000-0.45 ut/500ml-%

6

MSD

HEPARIN (PORCINE) IN NACL INTRAVENOUS SOLUTION 30000-0.9 UNIT/L-%, 5000-0.9 UNIT/L-%, 5000-0.9 UT/500ML-%

6

MSD

heparin sod (porcine) in d5w 6 MSD

heparin sodium (porcine) 1

heparin sodium (porcine) pf 1

jantoven 1 M LOVENOX INJECTION 6 ST; MSD; QL LOVENOX SUBCUTANEOUS 3 ST; QL

PRADAXA 3 PA; M; QL RETAVASE 6 MSD RETAVASE HALF-KIT 6 MSD SAVAYSA 3 M; QL SODIUM CITRATE IN VITRO 6 MSD

SODIUM CITRATE INTRAVENOUS 6 MSD


Drug Name Drug

Category

Limits/

Required

lamotrigine starter kit- orange 1

levetiracetam er 1 M levetiracetam in nacl 6 MSD levetiracetam intravenous 6 MSD

levetiracetam oral 1 M MYSOLINE 3 M NEMBUTAL 6 MSD NEURONTIN 3 ST; M ONFI 3 M oxcarbazepine 1 M OXTELLAR XR 3 ST; M PEGANONE 2 M pentobarbital sodium injection 6 MSD

phenobarbital oral 1 M phenobarbital sodium injection 1

PHENYTEK 3 M phenytoin infatabs 1 M phenytoin oral 1 M phenytoin sodium extended 1 M

phenytoin sodium injection 6 MSD

primidone oral 1 M QUDEXY XR 2 ST; M roweepra 1 M roweepra xr 1 M SABRIL 3 PA; M; S SPRITAM 3 ST; M subvenite 1 M subvenite starter kit- blue 1

subvenite starter kit- green 1

subvenite starter kit- orange 1

SYMPAZAN 3 M

Drug Name Drug

Category

Limits/

Required

DILANTIN ORAL CAPSULE 30 MG 2 M

DILANTIN ORAL SUSPENSION 3 M

divalproex sodium er 1 M divalproex sodium oral 1 M EPIDIOLEX 3 PA; M; S epitol 1 M EQUETRO 3 M ethosuximide oral 1 M FANATREX FUSEPAQ 3

felbamate 1 M FELBATOL 3 M fosphenytoin sodium 6 MSD FYCOMPA 2 M gabapentin oral 1 M GABITRIL 3 M KEPPRA INTRAVENOUS 6 ST; MSD

KEPPRA ORAL 3 ST; M KEPPRA XR 3 ST; M LAMICTAL 3 ST; M LAMICTAL ODT ORAL KIT 3 ST

LAMICTAL ODT ORAL TABLET DISPERSIBLE

3

ST; M

LAMICTAL STARTER 3 ST LAMICTAL XR ORAL KIT 3 ST

LAMICTAL XR ORAL TABLET EXTENDED RELEASE 24 HOUR

3

ST; M

lamotrigine er 1 M lamotrigine oral 1 M lamotrigine starter kit- blue 1

lamotrigine starter kit- green 1


Drug Name Drug

Category

Limits/

Required

memantine hcl oral tablet 10 mg, 5 mg 1 M

memantine hcl oral tablet 28 x 5 mg & 21 x 10 mg

3

NAMENDA 3 ST; M NAMENDA TITRATION PAK 3 ST

NAMENDA XR 3 ST; M; QL NAMENDA XR TITRATION PACK 3 ST; QL

NAMZARIC ORAL CAPSULE ER 24 HOUR THERAPY PACK

2

ST; QL

NAMZARIC ORAL CAPSULE EXTENDED RELEASE 24 HOUR

2

ST; M; QL

RAZADYNE ER 3 ST; M; QL RAZADYNE ORAL TABLET 12 MG 3 ST; M

RAZADYNE ORAL TABLET 4 MG, 8 MG 3 ST; M; QL

rivastigmine 1 M; QL rivastigmine tartrate 1 M; QL Antidepressants

amitriptyline hcl oral 1 M amoxapine 1 M ANAFRANIL 3 M APLENZIN 3 ST; M; QL BRISDELLE 3 ST; M; QL bupropion hcl er (sr) 1 M; QL bupropion hcl er (xl) oral tablet extended release 24 hour 150 mg, 300 mg

1

M; QL

BUPROPION HCL ER (XL) ORAL TABLET EXTENDED RELEASE 24 HOUR 450 MG

3

ST; M; QL

bupropion hcl oral 1 M CELEXA 3 ST; M; QL

Drug Name Drug

Category

Limits/

Required

TEGRETOL 3 M TEGRETOL-XR 3 M tiagabine hcl 1 M TOPAMAX 3 ST; M TOPAMAX SPRINKLE 3 ST; M topiramate er 3 M topiramate oral 1 M TRILEPTAL 3 ST; M TROKENDI XR 3 ST; M valproate sodium intravenous 6 MSD

valproic acid oral 1 M vigabatrin 1 PA; M; S vigadrone 1 PA; M; S VIMPAT INTRAVENOUS 6 MSD

VIMPAT ORAL 2 M ZARONTIN 3 M ZONEGRAN 3 ST; M zonisamide oral 1 M Antidementia Agents

- Drugs for

Alzheimer's Disease

and Dementia

ARICEPT 3 ST; M donepezil hcl 1 M EXELON 3 ST; M; QL galantamine hydrobromide er 1 M; QL

galantamine hydrobromide oral solution

1

M; QL

galantamine hydrobromide oral tablet 12 mg

1

M

galantamine hydrobromide oral tablet 4 mg, 8 mg

1

M; QL

memantine hcl er 1 M; QL memantine hcl oral solution 1 M


Drug Name Drug

Category

Limits/

Required

fluoxetine hcl oral tablet 10 mg 1 M; QL

fluoxetine hcl oral tablet 20 mg, 60 mg 1 M

fluvoxamine maleate 1 M fluvoxamine maleate er 1 M; QL FORFIVO XL 3 ST; M; QL imipramine hcl oral 1 M imipramine pamoate 1 M KHEDEZLA 3 ST; M; QL LEXAPRO 3 ST; M; QL maprotiline hcl 1 M MARPLAN 3 M mirtazapine oral 1 M; QL NARDIL 3 M nefazodone hcl 1 M NORPRAMIN 3 M nortriptyline hcl oral capsule 1 M

nortriptyline hcl oral solution 6 M; MSD

olanzapine-fluoxetine hcl 1 M; QL

PAMELOR 3 M PARNATE 3 M paroxetine hcl 1 M; QL paroxetine hcl er 1 M; QL paroxetine mesylate 1 M; QL PAXIL CR 3 ST; M; QL PAXIL ORAL SUSPENSION 3 ST; M

PAXIL ORAL TABLET 3 ST; M; QL perphenazine- amitriptyline 1 M

PEXEVA 3 ST; M; QL phenelzine sulfate oral 1 M PRISTIQ 3 ST; M; QL protriptyline hcl 1 M

Drug Name Drug

Category

Limits/

Required

chlordiazepoxide- amitriptyline 1 M

citalopram hydrobromide oral solution

1

M

citalopram hydrobromide oral tablet

1

M; QL

clomipramine hcl oral 1 M CYMBALTA 3 ST; M; QL desipramine hcl oral 1 M DESVENLAFAXINE ER 3 ST; M; QL

desvenlafaxine succinate er 1 M; QL

doxepin hcl oral 1 M duloxetine hcl oral 1 M; QL EFFEXOR XR 3 ST; M; QL EMSAM 3 M; QL escitalopram oxalate oral solution 1 M

escitalopram oxalate oral tablet 1 M; QL

FETZIMA 2 ST; M; QL FETZIMA TITRATION 2 ST; QL fluoxetine hcl (pmdd) oral capsule 10 mg 1 M; QL

fluoxetine hcl (pmdd) oral capsule 20 mg 1 M

fluoxetine hcl (pmdd) oral tablet 10 mg 1 M; QL

fluoxetine hcl (pmdd) oral tablet 20 mg 1 M

fluoxetine hcl oral capsule 10 mg, 40 mg 1 M; QL

fluoxetine hcl oral capsule 20 mg 1 M

fluoxetine hcl oral capsule delayed release

1

M; QL

fluoxetine hcl oral solution 1 M


Drug Name Drug

Category

Limits/

Required

ANZEMET 3 QL aprepitant 1 QL BONJESTA 3 QL CINVANTI 6 MSD compro 1

DICLEGIS 3 QL dimenhydrinate injection 1

doxylamine-pyridoxine 1 QL dronabinol 1 QL droperidol injection 1

EMEND INTRAVENOUS 6 MSD

EMEND ORAL 3 QL EMEND TRI-PACK 3 QL granisetron hcl intravenous 6 MSD

granisetron hcl oral 1 QL MARINOL 3 QL meclizine hcl oral tablet 1

metoclopramide hcl injection 6 MSD

metoclopramide hcl oral 1

ondansetron hcl injection solution 40 mg/20ml

6

MSD

ondansetron hcl oral 1 QL ONDANSETRON HCL SOLUTION 4 MG/2ML INJECTION

3

ondansetron hcl solution 4 mg/2ml injection

6

MSD

ondansetron odt 1 QL palonosetron hcl 6 MSD perphenazine oral 1 M prochlorperazine 1

prochlorperazine edisylate injection 6 MSD

Drug Name Drug

Category

Limits/

Required

PROZAC ORAL CAPSULE 10 MG, 40 MG

3

ST; M; QL

PROZAC ORAL CAPSULE 20 MG 3 ST; M

REMERON 3 M; QL REMERON SOLTAB 3 M; QL SARAFEM ORAL TABLET 10 MG 3 ST; M; QL

SARAFEM ORAL TABLET 20 MG 3 ST; M

sertraline hcl oral concentrate 1 M

sertraline hcl oral tablet 1 M; QL SPRAVATO (56 MG DOSE) 4 M; S

SPRAVATO (84 MG DOSE) 4 M; S

SYMBYAX 3 M; QL TOFRANIL 3 M tranylcypromine sulfate 1 M trazodone hcl oral 1 M trimipramine maleate oral 1 M

TRINTELLIX 3 ST; M; QL venlafaxine hcl 1 M; QL venlafaxine hcl er 1 M; QL VIIBRYD 2 ST; M; QL VIIBRYD STARTER PACK 2 ST; QL

WELLBUTRIN SR 3 ST; M; QL WELLBUTRIN XL 3 ST; M; QL ZOLOFT 3 ST; M; QL ZULRESSO 6 MSD Antiemetics - Drugs

for Nausea and

Vomiting

AKYNZEO INTRAVENOUS 6 MSD

AKYNZEO ORAL 2 QL ALOXI 6 MSD


Drug Name Drug

Category

Limits/

Required

clotrimazole powder 3

CLOTRIMAZOLE POWDER 3

CRESEMBA INTRAVENOUS 6 MSD

CRESEMBA ORAL 2

DIFLUCAN ORAL SUSPENSION RECONSTITUTED

3

DIFLUCAN ORAL TABLET 100 MG, 200 MG, 50 MG

3

DIFLUCAN ORAL TABLET 150 MG 3 QL

econazole nitrate external 1

ECOZA 3

ERAXIS 6 MSD ERTACZO 3

EXELDERM 3

exoderm external lotion 3

EXTINA 3

fluconazole in sodium chloride 6 MSD

fluconazole oral suspension reconstituted

1

fluconazole oral tablet 100 mg, 200 mg, 50 mg 1

fluconazole oral tablet 150 mg 1 QL

flucytosine oral 1

griseofulvin microsize oral 1

griseofulvin ultramicrosize 1

GYNAZOLE-1 3

itraconazole oral capsule 1 QL

itraconazole oral solution 1

JUBLIA 3 ST; QL

Drug Name Drug

Category

Limits/

Required

prochlorperazine maleate oral 1 M

REGLAN 3

SANCUSO 2 QL scopolamine 1

SUSTOL 6 MSD; QL SYNDROS 3 QL TIGAN INTRAMUSCULAR 6 MSD

TIGAN ORAL 3

TRANSDERM SCOP (1.5 MG) 3

TRANSDERM-SCOP (1.5 MG) 3

trimethobenzamide hcl oral 1

VARUBI 2 QL ZOFRAN 3 QL ZUPLENZ 3 QL Antifungals

ABELCET 6 MSD AMBISOME 6 MSD amphotericin b intravenous 6 MSD

ANCOBON 3

AVC VAGINAL 3

BIO-STATIN ORAL CAPSULE 3

bio-statin oral powder 1

CANCIDAS 6 MSD caspofungin acetate 6 MSD ciclodan 1

CICLODAN SOLUTION 3 ST ciclopirox 1

ciclopirox olamine external 1

clotrimazole crystals 3

clotrimazole external 1

clotrimazole mouth/throat 1


Drug Name Drug

Category

Limits/

Required

RECURA 3

SPORANOX ORAL CAPSULE 3 QL

SPORANOX ORAL SOLUTION 3

SPORANOX PULSEPAK 3 QL

terbinafine hcl oral 1 QL terconazole 1 QL TOLSURA 3 ST VFEND 3

VFEND IV 6 MSD voriconazole intravenous 6 MSD

voriconazole oral 1

VUSION 3

XOLEGEL 3

XOLEGEL COREPAK 3

XOLEGEL DUO/HEAD & SHOULDERS 3

XOLEGEL DUO/XOLEX 3

Antigout Agents

allopurinol oral 1 M allopurinol sodium 6 MSD ALOPRIM 6 MSD COLCHICINE ORAL 3 ST colchicine-probenecid 1 M COLCRYS 2 ST febuxostat 1 ST; M KRYSTEXXA 6 MSD MITIGARE 2 ST probenecid 1 M ULORIC 2 ST; M ZYLOPRIM 3 M Anti-inflammatory

Agents

EMFLAZA 3 PA; S

Drug Name Drug

Category

Limits/

Required

KERYDIN 3 ST; QL ketoconazole external 1

ketoconazole oral 1

LOPROX EXTERNAL CREAM 3

LOPROX EXTERNAL KIT 0.77 % (SUSP) 3

LOPROX EXTERNAL SHAMPOO 3

LOPROX EXTERNAL SUSPENSION 3

LULICONAZOLE 3 QL LUZU 3 QL MENTAX 3

miconazole 3 vaginal suppository 1 QL

MICONAZOLE-ZINC OXIDE-PETROLAT 3

MYCAMINE 6 MSD naftifine hcl 1

NAFTIN 3

NIZORAL 3

NOXAFIL INTRAVENOUS 6 M; MSD

NOXAFIL ORAL 2 M nyamyc 6 MSD nystatin external cream 1

nystatin external ointment 1

nystatin external powder 6 MSD

nystatin mouth/throat 1

nystatin oral 1

nystatin-triamcinolone 1

nystop 6 MSD ORAVIG 3

oxiconazole nitrate 1

OXISTAT 3

PENLAC 3 ST posaconazole 1 M


Drug Name Drug

Category

Limits/

Required

sumatriptan-naproxen sodium 1 QL

TREXIMET 3 ST; QL ZEMBRACE SYMTOUCH 3 ST; QL

zolmitriptan oral 1 QL ZOMIG NASAL 2 ST; QL ZOMIG ORAL 3 ST; QL ZOMIG ZMT 3 ST; QL Antimyasthenic

Agents

BLOXIVERZ 6 MSD GUANIDINE HCL 1

MESTINON ORAL SYRUP 60 MG/5ML 2

MESTINON ORAL TABLET 3

MESTINON ORAL TABLET EXTENDED RELEASE

3

neostigmine methylsulfate intravenous solution 10 mg/10ml, 5 mg/10ml

6

MSD

NEOSTIGMINE METHYLSULFATE INTRAVENOUS SOLUTION PREFILLED SYRINGE

6

MSD

pyridostigmine bromide er 1

pyridostigmine bromide oral 1

regonol solution 10 mg/2ml intravenous 6 MSD

REGONOL SOLUTION 10 MG/2ML INTRAVENOUS

6

MSD

Antimycobacterials

CAPASTAT SULFATE 6 MSD cycloserine oral 3

dapsone oral 1 M

Drug Name Drug

Category

Limits/

Required

Antimigraine Agents

AIMOVIG 2 PA; M AJOVY 2 PA; M almotriptan malate 1 QL AMERGE 3 ST; QL CAFERGOT 3

D.H.E. 45 3

dihydroergotamine mesylate injection 1

dihydroergotamine mesylate nasal 1 QL

eletriptan hydrobromide 1 QL EMGALITY 2 PA; M EMGALITY (300 MG DOSE) 2 PA; M

ERGOMAR 3

ergotamine-caffeine 1

FROVA 3 ST; QL frovatriptan succinate 1 QL IMITREX 3 ST; QL IMITREX STATDOSE REFILL 3 ST; QL

IMITREX STATDOSE SYSTEM 3 ST; QL

MAXALT 3 ST; QL MAXALT-MLT 3 ST; QL MIGERGOT 1

MIGRANAL 3 QL naratriptan hcl 1 QL ONZETRA XSAIL 3 ST; QL RELPAX 3 ST; QL rizatriptan benzoate 1 QL sumatriptan nasal 1 QL sumatriptan succinate oral 1 QL

sumatriptan succinate refill 1 QL

sumatriptan succinate subcutaneous 1 QL


Drug Name Drug

Category

Limits/

Required

ARRANON 6 MSD arsenic trioxide intravenous solution 10 mg/10ml

6

MSD

ARZERRA 6 MSD AVASTIN 6 MSD azacitidine 6 MSD AZEDRA DOSIMETRIC 6 MSD

AZEDRA THERAPEUTIC 6 MSD

BALVERSA 3

BAVENCIO 6 PA; MSD BELEODAQ 6 MSD BELRAPZO 6 MSD BENDAMUSTINE HCL 6 MSD BENDEKA 6 MSD BESPONSA 6 MSD bexarotene 1 S bicalutamide 1

BICNU 6 MSD bleomycin sulfate 6 MSD BLINCYTO 6 MSD BORTEZOMIB 6 MSD BOSULIF 3 S BRAFTOVI 3 PA; S busulfan 6 MSD BUSULFEX 6 MSD CABOMETYX 3 S; QL CALQUENCE 3 S CAMPATH 6 MSD CAMPTOSAR 6 MSD capecitabine 1 S CAPRELSA 3 S; QL carboplatin 6 MSD carmustine 6 MSD CASODEX 3

cisplatin intravenous solution 6 MSD

Drug Name Drug

Category

Limits/

Required

ethambutol hcl oral 1

isoniazid injection 6 MSD isoniazid oral 1 M MYAMBUTOL 3

MYCOBUTIN 3

PASER 3

PRIFTIN 2

pyrazinamide oral 1

rifabutin 1

RIFADIN INTRAVENOUS 6 MSD

RIFADIN ORAL 3

RIFAMATE 3

rifampin intravenous 6 MSD rifampin oral 1

RIFAMPIN+SYRSPEN D SF 3

RIFATER 3

SIRTURO 3 S TRECATOR 3

Antineoplastics -

Drugs for Cancer

abiraterone acetate 1 PA; S; QL ABRAXANE 6 MSD ADCETRIS 6 MSD adriamycin 6 MSD adrucil 6 MSD AFINITOR 3 S; QL AFINITOR DISPERZ 3 S; QL ALECENSA 3 S ALIQOPA 6 MSD ALKERAN INTRAVENOUS 6 MSD

ALKERAN ORAL 3

ALUNBRIG 4 PA; S; QL anastrozole oral 1 M ARIMIDEX 3 ST; M AROMASIN 3 M


Drug Name Drug

Category

Limits/

Required

ELLENCE 6 MSD ELZONRIS 6 MSD EMCYT 3 S EMPLICITI 6 MSD epirubicin hcl 6 MSD ERBITUX 6 MSD ERIVEDGE 3 S ERLEADA 3 PA; S erlotinib hcl oral tablet 100 mg, 150 mg 1

erlotinib hcl oral tablet 25 mg 1 QL

ERWINAZE 6 MSD ETHYOL 6 MSD ETOPOPHOS 6 MSD etoposide intravenous 6 MSD etoposide oral 1 S EVOMELA 6 MSD exemestane 1 M FARESTON 4 M; S FARYDAK 4 S FASLODEX 6 MSD FEMARA 3 M floxuridine injection 6 MSD fludarabine phosphate 6 MSD fluorouracil intravenous 6 MSD flutamide 1

FOLOTYN 6 MSD fulvestrant 6 MSD FUSILEV 6 MSD GAZYVA 6 MSD gemcitabine hcl 6 MSD GILOTRIF 3 S; QL GLEEVEC 4 ST; S; QL GLEOSTINE 3 S GLIADEL WAFER 6 MSD HALAVEN 6 MSD HERCEPTIN 6 PA; MSD

Drug Name Drug

Category

Limits/

Required

CISPLATIN INTRAVENOUS SOLUTION RECONSTITUTED

6

MSD

cladribine 6 MSD clofarabine 6 MSD CLOLAR 6 MSD COMETRIQ (100 MG DAILY DOSE) 3 S; QL

COMETRIQ (140 MG DAILY DOSE) 3 S; QL

COMETRIQ (60 MG DAILY DOSE) 3 S; QL

COPIKTRA 4 PA; S COSMEGEN 6 MSD COTELLIC 3 S cyclophosphamide injection 6 MSD

cyclophosphamide oral 1

CYRAMZA 6 MSD cytarabine 6 MSD cytarabine (pf) 6 MSD dacarbazine 6 MSD DACOGEN 6 MSD dactinomycin 6 MSD DARZALEX 6 MSD daunorubicin hcl 6 MSD DAURISMO 4 S decitabine 6 MSD dexrazoxane hcl 6 MSD dexrazoxane intravenous solution reconstituted 500 mg

6

MSD

docetaxel 6 MSD DOXIL 6 MSD doxorubicin hcl 6 MSD doxorubicin hcl liposomal 6 MSD

DROXIA 3 M; S ELITEK 6 MSD


Drug Name Drug

Category

Limits/

Required

KISQALI (400 MG DOSE) 4 PA; S

KISQALI (600 MG DOSE) 4 PA; S

KISQALI FEMARA (400 MG DOSE) 4 PA; S

KISQALI FEMARA (600 MG DOSE) 4 PA; S

KISQALI FEMARA(200 MG DOSE) 4 PA; S

KYPROLIS 6 MSD LARTRUVO 6 MSD LENVIMA (10 MG DAILY DOSE) 3 S

LENVIMA (12 MG DAILY DOSE) 3 S







letrozole oral 1 M leucovorin calcium injection 6 MSD

leucovorin calcium oral 1

LEUKERAN 2

levoleucovorin calcium 6 MSD levoleucovorin calcium pf 6 MSD

LIBTAYO 6 MSD LONSURF 3 S LORBRENA 3 S LUMOXITI 6 MSD LUTATHERA 6 MSD

Drug Name Drug

Category

Limits/

Required

HERCEPTIN HYLECTA 6 PA; MSD

HYCAMTIN INTRAVENOUS 6 MSD

HYCAMTIN ORAL 3 S HYDREA 3

hydroxyurea oral 1

IBRANCE 3 S ICLUSIG ORAL TABLET 15 MG 3 S; QL

ICLUSIG ORAL TABLET 45 MG 3 S

IDAMYCIN PFS 6 MSD idarubicin hcl 6 MSD IDHIFA 3 PA; S; QL IFEX 6 MSD ifosfamide 6 MSD imatinib mesylate 1 S; QL IMBRUVICA 3 S IMFINZI 6 MSD IMLYGIC 6 MSD INFUGEM 6 MSD INLYTA 3 S; QL IRESSA 3 S irinotecan hcl 6 MSD ISTODAX (OVERFILL) 6 MSD IXEMPRA KIT 6 MSD JAKAFI ORAL TABLET 10 MG 3 S; QL

JAKAFI ORAL TABLET 15 MG, 20 MG, 25 MG, 5 MG

3

S

JEVTANA 6 MSD KADCYLA 6 MSD KANJINTI 6 MSD KEYTRUDA 6 MSD KHAPZORY 6 MSD KISQALI (200 MG DOSE) 4 PA; S


Drug Name Drug Limits/

Category Required

PIQRAY (250 MG DAILY DOSE) PIQRAY (300 MG

3

3 TAGRISSO ORAL TABLET 40 MG TAGRISSO ORAL TABLET 80 MG TALZENNA tamoxifen citrate oral TARCEVA ORAL TABLET 100 MG, 150 MG TARCEVA ORAL TABLET 25 MG

3 S; QL

3 S

3 5

PA; S M; ACA

3 S

3 S; QL

DAILY DOSE)

POLIVY 6 MSD POMALYST 3 S; QL PORTRAZZA 6 MSD POTELIGEO 6 MSD PROLEUKIN 6 MSD PURIXAN 3 S QUADRAMET 6 MSD REVLIMID 3 S RITUXAN 6 PA; MSD RITUXAN HYCELA 6 PA; MSD ROMIDEPSIN 6 MSD RUBRACA 3 PA; S RYDAPT 3 PA; S SIKLOS 4 ST; S SOLTAMOX 5 M; ACA SPRYCEL 3 S; QL STIVARGA 3 S SUTENT 3 S; QL SYLATRON 3 PA; M; S; QL SYLVANT 6 MSD SYNRIBO 6 MSD TABLOID 3 S TAFINLAR 3 S

Drug Name Drug

Category

Limits/

Required

LYNPARZA 3 S LYSODREN 3 S MARQIBO 6 MSD MATULANE 3 S MEKINIST 3 S MEKTOVI 4 PA; S melphalan 1

melphalan hcl 6 MSD mercaptopurine oral 1

mesna 6 MSD MESNEX INTRAVENOUS 6 MSD

MESNEX ORAL 2

mitomycin intravenous 6 MSD MITOMYCIN INTRAVESICAL 6 MSD

mitoxantrone hcl 6 MSD mutamycin 6 MSD MVASI 6 MSD MYLERAN 3 S MYLOTARG 6 MSD NAVELBINE 6 MSD NERLYNX 3 PA; S; QL NEXAVAR 3 S; QL NILANDRON 4 S nilutamide 1 S NINLARO 3 S NIPENT 6 MSD ODOMZO 4 S ONCASPAR 6 MSD ONIVYDE 6 MSD OPDIVO 6 MSD oxaliplatin 6 MSD paclitaxel 6 MSD PANRETIN 3

PERJETA 6 MSD PIQRAY (200 MG DAILY DOSE) 3


Drug Name Drug

Category

Limits/

Required

VIZIMPRO 3 PA; S VORAXAZE 6 MSD VOTRIENT 3 S; QL VYXEOS 6 MSD XALKORI 3 S; QL XELODA 4 S XOFIGO 6 MSD XOSPATA 3 S XTANDI 3 S; QL YERVOY 6 MSD YESCARTA 6 MSD YONDELIS 6 MSD YONSA 3 PA; S ZALTRAP 6 MSD ZANOSAR 6 MSD ZEJULA 3 PA; S ZELBORAF 3 S; QL ZEVALIN Y-90 6 MSD ZINECARD 6 MSD ZOLINZA 3 S; QL ZYDELIG 3 S ZYKADIA ORAL CAPSULE 3 S

ZYKADIA ORAL TABLET 3

ZYTIGA 3 PA; S; QL Antiparasitics

albendazole oral 1

ALBENZA 3

ALINIA 2

ARAKODA 3

atovaquone oral 1

atovaquone-proguanil hcl 1

BENZNIDAZOLE 2

BILTRICIDE 3

chloroquine phosphate oral 1 M

Drug Name Drug

Category

Limits/

Required

TARGRETIN EXTERNAL 2

TARGRETIN ORAL 4 S TASIGNA 3 S; QL TAXOTERE 6 MSD TECENTRIQ 6 MSD TEMODAR INTRAVENOUS 6 MSD

TEMODAR ORAL 4 S temozolomide 1 S teniposide 6 MSD TEPADINA 6 MSD THALOMID 3 M; S thiotepa injection 6 MSD TIBSOVO 3 PA; S toposar 6 MSD topotecan hcl 6 MSD toremifene citrate 1 M; S TOTECT 6 MSD TREANDA 6 MSD tretinoin oral 1 S TRISENOX 6 MSD TYKERB 3 S; QL UNITUXIN 6 MSD VALCHLOR 3 S valrubicin 6 MSD VALSTAR 6 MSD VECTIBIX 6 MSD VELCADE 6 MSD VENCLEXTA 3 S VENCLEXTA STARTING PACK 3 S

VERZENIO 3 S VIDAZA 6 MSD vinblastine sulfate 6 MSD vincristine sulfate 6 MSD vinorelbine tartrate 6 MSD VITRAKVI 3 S


Drug Name Drug

Category

Limits/

Required

benztropine mesylate injection 6 MSD

benztropine mesylate oral 1 M

bromocriptine mesylate oral 1 M

carbidopa oral 1 M carbidopa-levodopa 1 M carbidopa-levodopa er 1 M carbidopa-levodopa- entacapone 1 M

COGENTIN 6 MSD COMTAN 3 M DUOPA 6 M; MSD entacapone 1 M GOCOVRI 3 PA; M; S INBRIJA 3 M LODOSYN 3 M MIRAPEX 3 M MIRAPEX ER 3 M NEUPRO 3 M NOURIANZ 3 M OSMOLEX ER 3 ST; M PARLODEL 3 M pramipexole dihydrochloride 1 M

pramipexole dihydrochloride er 1 M

rasagiline mesylate oral 1 M REQUIP XL 3 M ropinirole hcl 1 M ropinirole hcl er 1 M RYTARY 3 M selegiline hcl oral 1 M SINEMET 3 M SINEMET CR 3 M STALEVO 100 3 M STALEVO 125 3 M STALEVO 150 3 M

Drug Name Drug

Category

Limits/

Required

COARTEM 2

crotan 1

DARAPRIM 3 PA; S EGATEN 3

ELIMITE 3

EMVERM 2

EURAX 3

hydroxychloroquine sulfate oral 1 M

IMPAVIDO 3 S ivermectin oral 1

KRINTAFEL 3

lindane 1 QL MALARONE 3

malathion 1

mefloquine hcl 1 M MEPRON 3

NATROBA 3 QL NEBUPENT 2 QL OVIDE 3

PENTAM 6 MSD pentamidine isethionate 6 MSD permethrin external 1

PLAQUENIL 3 M praziquantel oral 1

primaquine phosphate 2

QUALAQUIN 3

quinine sulfate oral 1

SKLICE 3

SOLOSEC 3

spinosad 1 QL STROMECTOL 3

sulfurated lime 1

ULESFIA 3

Antiparkinson Agents

amantadine hcl oral 1 M APOKYN 3 S; QL AZILECT 3 M


Drug Name Drug

Category

Limits/

Required

ARISTADA 2 M ARISTADA INITIO 2

chlorpromazine hcl injection 1

chlorpromazine hcl oral 1 M clozapine oral tablet 1 QL clozapine oral tablet dispersible 100 mg, 12.5 mg, 25 mg

1

QL

clozapine oral tablet dispersible 150 mg, 200 mg

3

QL

CLOZARIL 3 QL FANAPT 3 QL FANAPT TITRATION PACK 3 QL

FAZACLO 3 QL fluphenazine decanoate injection 6 MSD

fluphenazine hcl injection 1

fluphenazine hcl oral 1 M GEODON INTRAMUSCULAR 3

GEODON ORAL 3 M; QL HALDOL 6 MSD HALDOL DECANOATE 3

haloperidol decanoate intramuscular 1

haloperidol lactate injection 6 MSD

haloperidol lactate oral 1 M haloperidol oral 1 M INVEGA 3 M; QL INVEGA SUSTENNA 3

INVEGA TRINZA 3

LATUDA 2 M; QL loxapine succinate 1 M molindone hcl 1 M NUPLAZID 4 M; S

Drug Name Drug

Category

Limits/

Required

STALEVO 200 3 M STALEVO 50 3 M STALEVO 75 3 M TASMAR 3 M tolcapone 1 M trihexyphenidyl hcl oral elixir 1 M

trihexyphenidyl hcl oral tablet 1 M

XADAGO 3 ST; M; QL ZELAPAR 3 M Antiplatelets

AGGRASTAT 6 MSD AGGRENOX 3 M aspirin-dipyridamole er 1 M BRILINTA 2 M cilostazol 1 M clopidogrel bisulfate oral tablet 300 mg 1

clopidogrel bisulfate oral tablet 75 mg 1 M

dipyridamole oral 1 M DURLAZA 3 ST; M EFFIENT 3 ST; M eptifibatide 6 MSD INTEGRILIN 6 MSD KENGREAL 6 MSD PLAVIX 3 ST; M prasugrel hcl 1 M REOPRO 6 MSD ZONTIVITY 2 M Antipsychotics -

Drugs for Mood

Disorders

ABILIFY 4 ST; M; S; QL ABILIFY MAINTENA 2 M ABILIFY MYCITE 3 M; S; QL ADASUVE 3

aripiprazole 1 M; QL


Drug Name Drug

Category

Limits/

Required

adefovir dipivoxil 1 M APTIVUS 3 M; QL atazanavir sulfate 1 M ATRIPLA 3 M; QL BARACLUDE ORAL SOLUTION 2 M; QL

BARACLUDE ORAL TABLET 3 M; QL

BIKTARVY 3 M cidofovir intravenous 6 MSD CIMDUO 3 M COMBIVIR 4 M; QL COMPLERA 3 M; QL CRIXIVAN 3 M; QL DELSTRIGO 4 M DENAVIR 3

DESCOVY 3 M didanosine 1 M; QL DOVATO 3 M EDURANT 3 M; QL efavirenz 1 M; QL EMTRIVA 3 M; QL entecavir 1 M; QL EPCLUSA 3 PA; S; QL EPIVIR 4 M; QL EPIVIR HBV ORAL SOLUTION 2 M

EPIVIR HBV ORAL TABLET 3 M; QL

EPZICOM 4 M; QL EVOTAZ 4 M; QL famciclovir 1

FLUMADINE 3

fosamprenavir calcium 1 M; QL FOSCAVIR 6 MSD FUZEON 3 M; S; QL GANCICLOVIR 6 MSD ganciclovir sodium intravenous solution 6 M; MSD

Drug Name Drug

Category

Limits/

Required

olanzapine oral 1 M; QL paliperidone er 1 M; QL PERSERIS 3 M pimozide 1 M quetiapine fumarate 1 M; QL quetiapine fumarate er 1 M; QL REXULTI 3 M; QL RISPERDAL 3 M; QL RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION RECONSTITUTED 12.5 MG, 25 MG, 37.5 MG, 50 MG

2

risperidone 1 M; QL SAPHRIS 3 M; QL SEROQUEL 3 ST; M; QL SEROQUEL XR 3 ST; M; QL thioridazine hcl oral 1 M thiothixene 1 M trifluoperazine hcl 1 M VERSACLOZ 3 QL VRAYLAR ORAL CAPSULE 3 M; QL

VRAYLAR ORAL CAPSULE THERAPY PACK

3

QL

ziprasidone hcl 1 M; QL ZYPREXA ORAL 3 M; QL ZYPREXA RELPREVV 3

ZYPREXA ZYDIS 3 M; QL Antivirals

abacavir sulfate 1 M; QL abacavir sulfate- lamivudine 1 M; QL

abacavir-lamivudine- zidovudine 1 M; QL

acyclovir external 1 QL acyclovir oral 1

acyclovir sodium 6 MSD


Drug Name Drug

Category

Limits/

Required

PEGINTRON 4 S; QL PIFELTRO 4 M PREVYMIS INTRAVENOUS 6 MSD

PREVYMIS ORAL 2 M PREZCOBIX 4 M PREZISTA 3 M; QL RELENZA DISKHALER 2 QL RESCRIPTOR 3 M; QL RETROVIR INTRAVENOUS 6 MSD

RETROVIR ORAL 4 M; QL REYATAZ ORAL CAPSULE 4 M

REYATAZ ORAL PACKET 3 M

ribasphere 1 ribasphere ribapak oral tablet 400 mg, 600 mg 1

RIBASPHERE RIBAPAK ORAL TABLET THERAPY PACK 200 & 400 MG, 400 & 600 MG

1

ribavirin inhalation 1 S ribavirin oral 1 rimantadine hcl 1

ritonavir 1 M; QL SELZENTRY ORAL SOLUTION 3 M

SELZENTRY ORAL TABLET 150 MG, 300 MG

3

M; QL

SELZENTRY ORAL TABLET 25 MG, 75 MG

3

M

SITAVIG 3 QL SOVALDI 4 PA; S; QL stavudine 1 M; QL STRIBILD 3 M; QL SUSTIVA 4 M; QL

Drug Name Drug

Category

Limits/

Required

ganciclovir sodium intravenous solution reconstituted

6

MSD

GENVOYA 3 M HARVONI 3 PA; S; QL HEPSERA 3 M INTELENCE 3 M; QL INTRON A 3 M; S INVIRASE 3 M; QL ISENTRESS 3 M; QL ISENTRESS HD 3 M JULUCA 4 M KALETRA ORAL SOLUTION 4 M; QL

KALETRA ORAL TABLET 3 M; QL

lamivudine oral solution 1 M; QL lamivudine oral tablet 100 mg 1 M; QL

lamivudine oral tablet 150 mg, 300 mg 1 M; QL

lamivudine-zidovudine 1 M; QL LEXIVA ORAL SUSPENSION 3 M; QL

LEXIVA ORAL TABLET 4 M; QL lopinavir-ritonavir 1 M; QL MAVYRET 4 PA; S; QL nevirapine 1 M; S; QL nevirapine er 1 M; S; QL NORVIR ORAL PACKET 3 M; S

NORVIR ORAL SOLUTION 3 M; S; QL

NORVIR ORAL TABLET 4 M; S; QL

ODEFSEY 3 M; S oseltamivir phosphate oral 1 QL

PEGASYS 3 S; QL PEGASYS PROCLICK 3 S; QL


Drug Name Drug

Category

Limits/

Required

ZIAGEN 4 M; QL zidovudine 1 M; QL ZOVIRAX EXTERNAL CREAM 2 QL

ZOVIRAX EXTERNAL OINTMENT 3 QL

ZOVIRAX ORAL 3

Anxiolytics - Drugs

for Anxiety

alprazolam er 1 QL ALPRAZOLAM INTENSOL 1 QL

alprazolam oral 1 QL alprazolam xr 1 QL ATIVAN INJECTION 6 MSD ATIVAN ORAL 3 QL buspirone hcl oral 1

chlordiazepoxide hcl 1 QL clonazepam oral 1 QL clorazepate dipotassium 1 QL

diazepam intensol 1

diazepam intramuscular 6 MSD

diazepam oral 1

diazepam solution 5 mg/ml injection 6 MSD

DIAZEPAM SOLUTION 5 MG/ML INJECTION 6 MSD

DORAL 3 QL estazolam 1 QL HALCION 3 QL hydroxyzine hcl intramuscular 6 MSD

hydroxyzine hcl oral 1

hydroxyzine pamoate oral 1

KLONOPIN 3 QL lorazepam injection 6 MSD lorazepam intensol 1 QL

Drug Name Drug

Category

Limits/

Required

SYMFI 3 M SYMFI LO 3 M SYMTUZA 4 M TAMIFLU 3 QL TEMIXYS 3 M tenofovir disoproxil fumarate 1 M; QL

TIVICAY ORAL TABLET 10 MG, 25 MG

3

M

TIVICAY ORAL TABLET 50 MG 3 M; QL

TRIUMEQ 3 M; QL TRIZIVIR 4 M; QL TROGARZO 6 M; MSD TRUVADA ORAL TABLET 100-150 MG, 133-200 MG, 167-250 MG

3

M

TRUVADA ORAL TABLET 200-300 MG 3 M; QL

TYBOST 4 M; QL valacyclovir hcl oral 1 QL VALCYTE 3 M valganciclovir hcl 1 M VALTREX 3 ST; QL VEMLIDY 2 M VIDEX 3 M; QL VIDEX EC 4 M; QL VIEKIRA PAK 4 PA; S; QL VIRACEPT 3 M; QL VIRAMUNE 4 M; QL VIRAMUNE XR 4 M; QL VIRAZOLE 4 S VIREAD 3 M; QL VOSEVI 3 PA; S XERESE 3 ST; QL XOFLUZA 2 QL ZEPATIER 3 PA; S; QL


Drug Name Drug

Category

Limits/

Required

ARANESP (ALBUMIN FREE) 6 MSD

BENEFIX 6 MSD CEPROTIN 6 MSD COAGADEX 6 MSD CORIFACT 6 MSD CYKLOKAPRON 6 MSD DOPTELET 3 PA; S ELOCTATE 6 MSD EPOGEN 6 PA; MSD FEIBA 6 MSD FIBRYGA 6 MSD FULPHILA 6 PA; MSD; QL GRANIX 6 MSD HEMLIBRA 6 M; MSD hemofil m intravenous solution reconstituted 1000 unit, 250 unit, 500 unit

6

MSD

HEMOFIL M INTRAVENOUS SOLUTION RECONSTITUTED 1700 UNIT

6

MSD

HESPAN 6 MSD hetastarch-nacl 6 MSD HUMATE-P 6 MSD IDELVION 6 MSD IXINITY 6 MSD JIVI 6 MSD KCENTRA INTRAVENOUS KIT 500 UNIT

6

MSD

KOATE 6 MSD KOATE-DVI INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT, 500 UNIT

6

MSD

Drug Name Drug

Category

Limits/

Required

lorazepam oral 1 QL meprobamate 1

midazolam hcl injection 6 MSD MIDAZOLAM HCL- SODIUM CHLORIDE 6 MSD

MIDAZOLAM-SODIUM CHLORIDE 6 MSD

oxazepam 1 QL quazepam 1 QL TRANXENE-T 3 QL triazolam 1 QL VALIUM 3 ST VISTARIL 3

XANAX 3 ST; QL XANAX XR 3 ST; QL Bipolar Agents -

Drugs for Mood

Disorders

lithium 1 M lithium carbonate er 1 M lithium carbonate oral 1 M LITHOBID 3 M Blood Products /

Modifiers / Volume

Expanders - Drugs for

Bleeding Disorders

ADVATE 6 MSD ADYNOVATE 6 MSD AFSTYLA 6 MSD AGRYLIN 3 M ALPHANATE/VWF COMPLEX/HUMAN 6 MSD

ALPHANINE SD 6 MSD ALPROLIX 6 MSD AMICAR 3

aminocaproic acid intravenous 6 MSD

aminocaproic acid oral 1

anagrelide hcl 1 M


Drug Name Drug

Category

Limits/

Required

protamine sulfate intravenous 6 MSD

REBINYN 6 MSD RECOMBINATE 6 MSD RECOTHROM 6 MSD RECOTHROM SPRAY KIT 6 MSD

RETACRIT 6 MSD RIASTAP 6 MSD RIXUBIS 6 MSD SOLIRIS 6 MSD TAVALISSE 3 PA; M; S THROMBIN-JMI 3

THROMBIN-JMI EPISTAXIS 3

THROMBOGEN 3

tranexamic acid intravenous 6 MSD

tranexamic acid oral 1

TRETTEN 6 MSD UDENYCA 6 PA; MSD; QL ULTOMIRIS 6 MSD VOLUVEN 6 MSD VONVENDI 6 MSD WILATE 6 MSD XYNTHA 6 MSD XYNTHA SOLOFUSE 6 MSD ZARXIO 6 MSD Cardiovascular

Agents - Drugs for

Heart and Circulation

Conditions

ABLYSINOL 6 MSD ACCUPRIL 3 M ACCURETIC 3 ST; M acebutolol hcl oral 1 M acetazolamide oral tablet 125 mg 1 M

acetazolamide sodium 6 MSD

Drug Name Drug

Category

Limits/

Required

koate-dvi intravenous solution reconstituted 250 unit

6

MSD

KOGENATE FS 6 MSD KOVALTRY 6 MSD LEUKINE INTRAVENOUS SOLUTION RECONSTITUTED 250 MCG

6

MSD

lmd in d5w solution 10- 5 % intravenous 6 MSD

LMD IN D5W SOLUTION 10-5 % INTRAVENOUS

6

MSD

lmd in nacl solution 10- 0.9 % intravenous 6 MSD

LMD IN NACL SOLUTION 10-0.9 % INTRAVENOUS

6

MSD

LYSTEDA 3

MIRCERA 6 MSD MONONINE 6 MSD MONSELS FERRIC SUBSULFATE 2

MOZOBIL 6 MSD; QL MULPLETA 3 PA; S NEULASTA 6 PA; MSD; QL NEULASTA ONPRO 6 PA; MSD; QL NEUPOGEN 6 PA; MSD NIVESTYM 6 MSD NOVOEIGHT 6 MSD NOVOSEVEN RT 6 MSD NPLATE 6 MSD NUWIQ 6 MSD OBIZUR 6 MSD PANHEMATIN 6 MSD PROCRIT 6 PA; MSD PROFILNINE 6 MSD PROFILNINE SD 6 MSD PROMACTA 2 PA; M


Drug Name Drug

Category

Limits/

Required

atorvastatin calcium oral tablet 10 mg, 20 mg

5

M; ACA; QL

atorvastatin calcium oral tablet 40 mg, 80 mg

1

M; QL

AVALIDE 3 ST; M AVAPRO 3 ST; M AZOR 3 ST; M benazepril hcl oral 1 M benazepril- hydrochlorothiazide 1 M

BENICAR 3 ST; M BENICAR HCT 3 ST; M BETAPACE 3 ST; M BETAPACE AF 3 ST; M betaxolol hcl oral 1 M BIDIL 3 M bisoprolol fumarate 1 M bisoprolol- hydrochlorothiazide 1 M

BREVIBLOC IN NACL 6 ST; MSD BREVIBLOC PREMIXED 6 ST; MSD

BREVIBLOC PREMIXED DS 6 ST; MSD

bumetanide injection 6 MSD bumetanide oral 1 M BUMEX 3 M BYSTOLIC 2 ST; M CADUET 3 ST; M; QL CALAN 3 ST; M CALAN SR 3 ST; M candesartan cilexetil 1 M candesartan cilexetil- hctz 1 M

captopril oral 1 M captopril- hydrochlorothiazide 1 M

CARDENE IV 6 ST; MSD

Drug Name Drug

Category

Limits/

Required

ADALAT CC 3 ST; M ADENOCARD 6 MSD adenosine intravenous solution 12 mg/4ml, 6 mg/2ml

6

MSD

AKOVAZ 6 MSD ALDACTAZIDE 3 M ALDACTONE 3 M aliskiren fumarate 1 M alprostadil injection 6 MSD ALTACE 3 M ALTOPREV 3 ST; M; QL amiloride hcl oral 1 M amiloride- hydrochlorothiazide 1 M

AMIODARONE HCL IN DEXTROSE 6 MSD

amiodarone hcl intravenous 6 MSD

amiodarone hcl oral 1 M AMLODIPINE BES+SYRSPEND SF 3 ST; M

amlodipine besylate oral 1 M

amlodipine besylate- benazepril hcl 1 M

amlodipine besylate- valsartan 1 M

amlodipine-atorvastatin 1 M; QL amlodipine-olmesartan 1 M amlodipine-valsartan- hctz 1 M

ANTARA 3 ST; M; QL ASCLERA 6 MSD ATACAND 3 ST; M ATACAND HCT 3 ST; M atenolol oral 1 M ATENOLOL+SYRSPE ND SF 3 ST; M

atenolol-chlorthalidone 1 M


Drug Name Drug

Category

Limits/

Required

digoxin injection 6 MSD digoxin oral 1 M DILATRATE-SR 2 M diltiazem hcl er beads 1 M diltiazem hcl er coated beads 1 M

diltiazem hcl er oral capsule extended release 12 hour

1

M

diltiazem hcl er oral capsule extended release 24 hour 180 mg, 240 mg

1

M

diltiazem hcl intravenous 6 MSD

diltiazem hcl oral 1 M DILTIAZEM HCL- DEXTROSE 6 ST; MSD

DILTIAZEM HCL- SODIUM CHLORIDE 6 ST; MSD

dilt-xr 1 M DIOVAN 3 ST; M DIOVAN HCT 3 ST; M disopyramide phosphate 1 M

DIURIL 3 M dobutamine hcl 6 MSD dofetilide 1 M dopamine hcl intravenous 6 MSD

dopamine in d5w 6 MSD doxazosin mesylate oral 1 M; QL

DUTOPROL 3 ST; M DYAZIDE 3 M DYRENIUM 3 M EDARBI 2 ST; M EDARBYCLOR 2 ST; M EDECRIN 3 M enalapril maleate oral 1 M

Drug Name Drug

Category

Limits/

Required

CARDIZEM 3 ST; M CARDIZEM CD 3 ST; M CARDIZEM LA 3 ST; M CARDURA 3 ST; M; QL CAROSPIR 3 ST; M cartia xt 1 M carvedilol 1 M carvedilol phosphate er 1 M CATAPRES 3 M CATAPRES-TTS-1 3 M; QL CATAPRES-TTS-2 3 M; QL CATAPRES-TTS-3 3 M; QL chlorothiazide 1 M chlorothiazide sodium 6 MSD chlorthalidone 1 M cholestyramine light 1 M cholestyramine oral 1 M choline fenofibrate 1 M; QL CLEVIPREX 6 ST; MSD clonidine 1 M; QL clonidine hcl oral 1 M colesevelam hcl 1 M COLESTID 3 ST; M COLESTID FLAVORED 3 ST; M

colestipol hcl 1 M COREG 3 ST; M COREG CR 3 ST; M CORGARD 3 ST; M CORLANOR ORAL TABLET 2 M; QL

CORLOPAM 6 MSD COZAAR 3 ST; M CRESTOR 3 ST; M; QL DEMSER 2

DIBENZYLINE 3

digitek 1 M digox 1 M


Drug Name Drug

Category

Limits/

Required

epinephrine pf injection solution prefilled syringe

1

EPINEPHRINE- DEXTROSE 6 MSD

EPINEPHRINE-NACL 6 MSD eplerenone 1 M eprosartan mesylate 1 M esmolol hcl intravenous solution 100 mg/10ml 6 MSD

ESMOLOL HCL INTRAVENOUS SOLUTION 2000 MG/100ML, 2500 MG/250ML

6

ST; MSD

esmolol hcl-sodium chloride 6 MSD

ethacrynate sodium 6 MSD ethacrynic acid 1 M EXFORGE 3 ST; M EXFORGE HCT 3 ST; M EZALLOR SPRINKLE 3 ST; M ezetimibe 1 M ezetimibe-simvastatin 1 M; QL felodipine er 1 M fenofibrate micronized 1 M; QL fenofibrate oral capsule 134 mg, 200 mg, 67 mg 1 M; QL

fenofibrate oral capsule 150 mg, 50 mg 3 M; QL

fenofibrate oral tablet 1 M; QL fenofibric acid 1 M; QL FENOGLIDE 3 ST; M; QL FIBRICOR 3 ST; M; QL FIRST - METOPROLOL 3 ST; M

FIRST-ATENOLOL 3 ST; M flecainide acetate 1 M FLOLIPID 3 ST; M fluvastatin sodium 5 M; ACA; QL

Drug Name Drug

Category

Limits/

Required

enalaprilat 6 MSD enalapril- hydrochlorothiazide 1 M

ENTRESTO 2 M; QL EPANED 3 M EPHEDRINE SULFATE (PRESSORS)

3

ephedrine sulfate injection 6 MSD

ephedrine sulfate intravenous solution 6 MSD

EPHEDRINE SULFATE INTRAVENOUS SOLUTION PREFILLED SYRINGE

6

MSD

EPHEDRINE SULFATE-NACL 6 MSD

EPINEPHRINE HCL- DEXTROSE 6 MSD

EPINEPHRINE HCL- NACL INTRAVENOUS SOLUTION 1-0.9 MG/250ML-%, 2-0.9 MG/250ML-%, 4-0.9 MG/250ML-%, 8-0.9 MG/250ML-%

6

MSD

EPINEPHRINE HCL- NACL INTRAVENOUS SOLUTION PREFILLED SYRINGE 100-0.9 MCG/10ML-%, 1000-0.9 MCG/10ML- %, 160-0.9 MCG/10ML- %

6

MSD

epinephrine injection solution 1

EPINEPHRINE INJECTION SOLUTION PREFILLED SYRINGE

3

epinephrine pf injection solution 6 MSD


Drug Name Drug

Category

Limits/

Required

KAPSPARGO SPRINKLE 3 ST; M

labetalol hcl intravenous solution 6 MSD

LABETALOL HCL INTRAVENOUS SOLUTION PREFILLED SYRINGE

6

ST; MSD

labetalol hcl oral 1 M LANOXIN INJECTION 6 MSD LANOXIN ORAL 3 M LANOXIN PEDIATRIC 6 MSD LASIX 3 M LESCOL XL 3 ST; M; QL LEVOPHED 6 MSD LIPITOR 3 ST; M; QL LIPOFEN 2 ST; M; QL lisinopril oral 1 M lisinopril- hydrochlorothiazide 1 M

LIVALO 2 ST; M; QL LOPID 3 ST; M; QL LOPRESSOR 3 ST; M LOPRESSOR HCT 3 ST; M losartan potassium 1 M losartan potassium-hctz 1 M LOTENSIN 3 M LOTENSIN HCT 3 ST; M LOTREL 3 ST; M lovastatin 5 M; ACA; QL LOVAZA 3 PA; M mannitol intravenous 6 MSD matzim la 1 M MAXZIDE 3 M MAXZIDE-25 3 M methyldopa 1 M methyldopa- hydrochlorothiazide 1 M

metolazone 1 M

Drug Name Drug

Category

Limits/

Required

fluvastatin sodium er 5 M; ACA; QL fosinopril sodium 1 M fosinopril sodium-hctz 1 M FUROSEMIDE IN SODIUM CHLORIDE 6 MSD

furosemide injection 6 MSD furosemide oral 1 M gemfibrozil oral 1 M; QL GIAPREZA 6 MSD GONITRO 3 M guanfacine hcl 1 M HEMANGEOL 3 ST; M; S hydralazine hcl injection 6 MSD

hydralazine hcl oral 1 M hydrochlorothiazide oral 1 M

HYZAAR 3 ST; M indapamide 1 M INDERAL LA 3 ST; M INDERAL XL 3 ST; M INNOPRAN XL 3 ST; M INSPRA 3 M irbesartan 1 M irbesartan- hydrochlorothiazide 1 M

isoproterenol hcl injection 6 MSD

ISORDIL TITRADOSE 3 M isosorbide dinitrate 1 M isosorbide dinitrate er 1 M isosorbide mononitrate 1 M isosorbide mononitrate er 1 M

isoxsuprine hcl oral 1 M isradipine 1 M ISUPREL 6 MSD JUXTAPID 3 PA; M; S; QL


Drug Name Drug

Category

Limits/

Required

nifedipine oral 1 M nimodipine oral 1 M NIPRIDE RTU 6 MSD nisoldipine er 1 M NITRO-BID 1 M NITRO-DUR 3 M nitroglycerin er oral capsule extended release 2.5 mg

1

M

nitroglycerin in d5w 6 MSD nitroglycerin intravenous 6 MSD

nitroglycerin sublingual 1 M nitroglycerin transdermal 1 M

nitroglycerin translingual 1 M

NITROLINGUAL 3 M NITROMIST 3 M NITROPRESS 6 MSD nitroprusside sodium 6 MSD NITROSTAT 3 M nitro-time 1 M norepinephrine bitartrate intravenous 6 MSD

NOREPINEPHRINE- DEXTROSE INTRAVENOUS SOLUTION

6

MSD

NOREPINEPHRINE- SODIUM CHLORIDE INTRAVENOUS SOLUTION 16-0.9 MG/250ML-%, 16-0.9 MG/500ML-%, 4-0.9 MG/250ML-%, 8-0.9 MG/250ML-%, 8-0.9 MG/500ML-%

6

MSD

Drug Name Drug

Category

Limits/

Required

metoprolol succinate er 1 M metoprolol tartrate intravenous 6 MSD

metoprolol tartrate oral 1 M METOPROLOL-HCTZ ER ORAL TABLET EXTENDED RELEASE 24 HOUR 100-12.5 MG, 50-12.5 MG

3

ST; M

metoprolol- hydrochlorothiazide 1 M

mexiletine hcl oral 1 M MICARDIS 3 ST; M MICARDIS HCT 3 ST; M midodrine hcl 1

milrinone lactate 6 MSD milrinone lactate in dextrose 6 MSD

MINIPRESS 3 M minitran 1 M minoxidil oral 1 M moexipril hcl 1 M MULTAQ 3 M nadolol oral 1 M NEXTERONE 6 MSD niacin (antihyperlipidemic) 1

niacin er (antihyperlipidemic) 1 M

NIACOR 3

NIASPAN 3 M NICARDIPINE HCL IN NACL INTRAVENOUS SOLUTION PREFILLED SYRINGE

6

ST; MSD

nicardipine hcl intravenous 6 MSD

nicardipine hcl oral 1 M nifedipine er 1 M nifedipine er osmotic release 1 M


Drug Name Drug

Category

Limits/

Required

PHENYLEPHRINE HCL-DEXTROSE INTRAVENOUS SOLUTION 20-5 MG/250ML-%, 8-5 MG/100ML-%

6

MSD

PHENYLEPHRINE HCL-NACL INTRAVENOUS SOLUTION 100-0.9 MG/100ML-%, 20-0.9 MG/250ML-%, 25-0.9 MG/250ML-%, 30-0.9 MG/250ML-%, 40-0.9 MG/250ML-%, 50-0.9 MG/250ML-%, 80-0.9 MG/250ML-%

6

MSD

PHENYLEPHRINE HCL-NACL INTRAVENOUS SOLUTION PREFILLED SYRINGE 0.2-0.9 MG/5ML-%, 0.4-0.9 MG/10ML-%, 0.5-0.9 MG/5ML-%, 0.8-0.9 MG/10ML-%, 1- 0.9 MG/10ML-%, 20- 0.9 MG/50ML-%, 5-0.9 MG/50ML-%

6

MSD

pindolol 1 M PRALUENT 2 PA; M; QL PRAVACHOL ORAL TABLET 20 MG, 40 MG

3

ST; M; QL

pravastatin sodium 5 M; ACA; QL prazosin hcl oral 1 M PRESTALIA 3 ST; M prevalite 1 M PRINIVIL 3 M procainamide hcl injection 6 MSD

PROCARDIA 3 ST; M PROCARDIA XL 3 ST; M propafenone hcl 1 M propafenone hcl er 1 M

Drug Name Drug

Category

Limits/

Required

NOREPINEPHRINE- SODIUM CHLORIDE INTRAVENOUS SOLUTION PREFILLED SYRINGE 0.16-0.9 MG/10ML-%

6

MSD

NORPACE 3 M NORPACE CR 3 M NORTHERA 4 PA; S NORVASC 3 ST; M NYMALIZE 3 ST; M olmesartan medoxomil oral 1 M

olmesartan medoxomil- hctz 1 M

olmesartan-amlodipine- hctz 1 M

OMEGA-3/D-3 WELLNESS PACK 3 M

omega-3-acid ethyl esters 1 PA; M

osmitrol 6 MSD pacerone 1 M papaverine hcl injection 1

pentoxifylline er 1 M perindopril erbumine 1 M phenoxybenzamine hcl oral 1

phentolamine mesylate injection 6 MSD

phenylephrine hcl injection solution 10 mg/ml

6

MSD

phenylephrine hcl intravenous solution 6 MSD

PHENYLEPHRINE HCL INTRAVENOUS SOLUTION PREFILLED SYRINGE

6

MSD


Drug Name Drug

Category

Limits/

Required

SOTALOL HCL INTRAVENOUS 6 ST; MSD

sotalol hcl oral 1 M SOTRADECOL 6 MSD SOTYLIZE 2 ST; M spironolactone oral 1 M spironolactone-hctz 1 M SULAR 3 ST; M SURE RESULT O3D3 SYSTEM 3 M

TARKA 3 ST; M taztia xt 1 M TEKTURNA 2 ST; M TEKTURNA HCT 2 ST; M telmisartan 1 M telmisartan-amlodipine 1 M telmisartan-hctz 1 M TENORETIC 100 3 ST; M TENORETIC 50 3 ST; M TENORMIN 3 ST; M TIAZAC 3 ST; M TIKOSYN 3 ST; M timolol maleate oral 1 M TOPROL XL 3 ST; M torsemide 1 M trandolapril 1 M trandolapril-verapamil hcl er 1 M

triamterene oral 1 M triamterene-hctz 1 M TRIBENZOR 3 ST; M TRICOR 3 ST; M; QL TRILIPIX 3 ST; M; QL TWYNSTA 3 ST; M valsartan 1 M valsartan- hydrochlorothiazide 1 M

VARITHENA 6 MSD

Drug Name Drug

Category

Limits/

Required

propranolol hcl er 1 M propranolol hcl intravenous 6 MSD

propranolol hcl oral 1 M propranolol-hctz 1 M PROSTIN VR 3

QBRELIS 3 M QUESTRAN 3 ST; M QUESTRAN LIGHT 3 ST; M quinapril hcl 1 M quinapril- hydrochlorothiazide 1 M

quinidine gluconate er 1 M quinidine sulfate 1 M ramipril 1 M RANEXA 2 M ranolazine er 1 M RECTIV 2

REPATHA 3 PA; M; QL REPATHA PUSHTRONEX SYSTEM

3

PA; M; QL

REPATHA SURECLICK 3 PA; M; QL

rosuvastatin calcium oral tablet 10 mg, 5 mg 5 M; ACA; QL

rosuvastatin calcium oral tablet 20 mg, 40 mg

1

M; QL

RYTHMOL SR 3 M simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg

5

M; ACA; QL

simvastatin oral tablet 80 mg 1 M; QL

SODIUM DIURIL 6 MSD SODIUM EDECRIN 6 MSD sorine 1 M sotalol hcl (af) 1 M


Drug Name Drug

Category

Limits/

Required

DAYTRANA 2 ST; M; QL DESOXYN 3 ST; M; QL DEXEDRINE 3 ST; M; QL dexmethylphenidate hcl 1 M; QL dexmethylphenidate hcl er 1 M; QL

dextroamphetamine sulfate 1 M; QL

dextroamphetamine sulfate er 1 M; QL

DYANAVEL XR 3 ST; M; QL EVEKEO 3 ST; M; QL EVEKEO ODT 3 ST; M; QL FOCALIN 3 ST; M; QL FOCALIN XR 3 ST; M; QL guanfacine hcl er 1 M; QL INTUNIV 3 ST; M; QL JORNAY PM 3 ST; M; QL KAPVAY 3 ST; M; QL metadate er 1 M; QL methamphetamine hcl 1 M; QL METHYLIN 3 ST; M; QL methylphenidate hcl er (cd) 1 M; QL

methylphenidate hcl er (la) 1 M; QL

methylphenidate hcl er oral tablet extended release 10 mg, 18 mg, 20 mg, 27 mg, 36 mg, 54 mg

1

M; QL

methylphenidate hcl er oral tablet extended release 24 hour

1

M; QL

methylphenidate hcl er oral tablet extended release 72 mg

3

M; QL

methylphenidate hcl oral 1 M; QL

MYDAYIS 2 M; QL PROCENTRA 1 ST; M; QL

Drug Name Drug

Category

Limits/

Required

VASCEPA 2 PA; M VASERETIC 3 ST; M VASOTEC 3 M VAZCULEP 6 MSD VECAMYL 3 M; S verapamil hcl er 1 M verapamil hcl intravenous 6 MSD

verapamil hcl oral 1 M VERELAN 3 ST; M VERELAN PM 3 ST; M VYNDAQEL 3 M; QL VYTORIN 3 ST; M; QL WELCHOL 3 ST; M ZESTORETIC 3 ST; M ZESTRIL 3 M ZETIA 3 ST; M ZIAC 3 ST; M ZOCOR 3 ST; M; QL ZYPITAMAG 3 ST; M Central Nervous

System Agents -

Drugs for Attention

Deficit Disorder

ADDERALL 3 ST; M; QL ADDERALL XR 3 ST; M; QL ADHANSIA XR 3 ST; M; QL ADZENYS ER 3 ST; M; QL ADZENYS XR-ODT 3 ST; M; QL amphetamine sulfate 1 PA; M; QL amphetamine- dextroamphetamine 1 M; QL

amphetamine- dextroamphetamine er 1 M; QL

APTENSIO XR 3 ST; M; QL atomoxetine hcl 1 M; QL clonidine hcl er 1 M; QL CONCERTA 3 ST; M; QL COTEMPLA XR-ODT 3 ST; M; QL


Drug Name Drug

Category

Limits/

Required

MAVENCLAD (9 TABS) 3

MAYZENT 4 PA; M; S; QL MAYZENT STARTER PACK 4 PA; S; QL

OCREVUS 6 MSD; QL PLEGRIDY 3 M; S; QL PLEGRIDY STARTER PACK 3 S; QL

REBIF 3 M; S; QL REBIF REBIDOSE 3 M; S; QL REBIF REBIDOSE TITRATION PACK 3 M; S; QL

REBIF TITRATION PACK 3 M; S; QL

TECFIDERA STARTER PACK 3 S; QL

TECFIDERA ORAL CAPSULE DELAYED RELEASE

3

M; S; QL

TYSABRI 6 MSD; QL Central Nervous

System Agents -

Miscellaneous

ADDYI 3 PA; M; QL ANECTINE 6 MSD atracurium besylate 6 MSD AUSTEDO 3 PA; M; S; QL CAFCIT 6 MSD caffeine citrate intravenous 6 MSD

caffeine citrate oral 1

CAFFEINE-SODIUM BENZOATE 6 MSD

cisatracurium besylate (pf) 6 MSD

cisatracurium besylate intravenous solution 20 mg/10ml

6

MSD

GRALISE 2 ST; M; QL GRALISE STARTER 2 ST; QL

Drug Name Drug

Category

Limits/

Required

QUILLICHEW ER 2 ST; M; QL QUILLIVANT XR 2 ST; M; QL relexxii 3 M; QL RITALIN 3 ST; M; QL RITALIN LA 3 ST; M; QL STRATTERA 3 ST; M; QL VYVANSE 2 M; QL zenzedi oral tablet 10 mg, 5 mg 1 M; QL

ZENZEDI ORAL TABLET 15 MG, 2.5 MG, 20 MG, 30 MG, 7.5 MG

3

ST; M; QL

Central Nervous

System Agents -

Drugs for Multiple

Sclerosis

AMPYRA 4 ST; M; S; QL AUBAGIO 4 M; S; QL AVONEX PEN 3 M; S; QL AVONEX PREFILLED 3 M; S; QL BETASERON 3 ST; M; S; QL COPAXONE 3 ST; M; S; QL dalfampridine er 1 PA; M; S; QL EXTAVIA 4 ST; M; S; QL GILENYA 3 M; S; QL glatiramer acetate 1 M; S; QL glatopa 1 M; S; QL LEMTRADA 6 MSD MAVENCLAD (10 TABS) 3 PA







Drug Name Drug

Category

Limits/

Required

VECURONIUM BROMIDE INTRAVENOUS SOLUTION PREFILLED SYRINGE

6

MSD

vecuronium bromide intravenous solution reconstituted

6

MSD

XENAZINE 3 ST; M; S Dental and Oral

Agents - Drugs for

Mouth and Throat

Conditions

ARESTIN 6 MSD cavarest 1 M cevimeline hcl 1 M chlorhexidine gluconate mouth/throat 1

clinpro 5000 3 M DEBACTEROL 3

denta 5000 plus 1 M dentagel 1 M easygel 1

EVOXAC 3 M FIRST-MOUTHWASH BLM 2

fluoridex 3 M fluoridex daily renewal 1 M fluoridex enhanced whitening 3 M

fluoridex sensitivity relief 1

KEPIVANCE 6 MSD lidocaine hcl mouth/throat 1

lidocaine viscous mouth/throat solution 2 %

1

NAFRINSE DAILY ACIDULATED 3

NAFRINSE DAILY/NEUTRAL 3 M

Drug Name Drug

Category

Limits/

Required

HORIZANT 3 ST; M; QL INGREZZA ORAL CAPSULE 3 PA; M; S; QL

INGREZZA ORAL CAPSULE THERAPY PACK

3

PA; QL

LYRICA 2 ST; M; QL LYRICA CR 3 ST; M; QL NIMBEX 6 MSD NUEDEXTA 2 M ONPATTRO 6 M; MSD pancuronium bromide 6 MSD pregabalin oral 1 M; QL QUELICIN 6 MSD RADICAVA 6 M; MSD RILUTEK 3 M; QL riluzole 1 M; QL rocuronium bromide intravenous solution 6 MSD

ROCURONIUM BROMIDE INTRAVENOUS SOLUTION PREFILLED SYRINGE 100 MG/10ML, 50 MG/5ML, 75 MG/7.5ML

6

MSD

SAVELLA 2 M; QL SAVELLA TITRATION PACK 2 QL

succinylcholine chloride injection solution 6 MSD

SUCCINYLCHOLINE CHLORIDE INJECTION SOLUTION PREFILLED SYRINGE

3

SUCCINYLCHOLINE CHLORIDE INTRAVENOUS

6

MSD

TEGSEDI 4 PA; M; S tetrabenazine 3 PA; M; S TIGLUTIK 3 M; QL


Drug Name Drug

Category

Limits/

Required

acitretin 1

ACTIVE-PREP KIT IV 3

ACTIVE-PREP KIT V 3

ACTIVE-TRAMADOL 3

ACZONE 3 ST adapalene external cream 1 QL

adapalene external gel 1 QL ADAPALENE EXTERNAL LOTION 3 ST; QL

ADAPALENE EXTERNAL PAD 3 ST

ADAPALENE EXTERNAL SOLUTION

1

ST

adapalene-benzoyl peroxide 1 QL

AKTIPAK 3 ST ALA SCALP 3 ST ala-cort 1

alclometasone dipropionate 1

ALCOHOL PREP PADS EXTERNAL 70 %

2

ALDARA 3 QL ALTRENO 3

amcinonide 1

AMELUZ 6 MSD ammonium lactate external 1

amnesteem 1 QL APEXICON E 1 ST; QL AQUACEL AG BURN 3

arzol silver nit applicators 1

ATRALIN 3 QL AVAR LS CLEANSER 3 ST AVAR-E LS 3 ST avita external cream 1 QL

Drug Name Drug

Category

Limits/

Required

NAFRINSE WEEKLY 3 M neutral sodium fluoride 1 M NUMOISYN MOUTH/THROAT LOZENGE

3

oralone 1

paroex 1

PERIDEX 3

periogard 1

pilocarpine hcl oral 1 M PREVIDENT 5000 BOOSTER PLUS 3 M

PREVIDENT 5000 DRY MOUTH 3 M

PREVIDENT 5000 ENAMEL PROTECT 3

PREVIDENT 5000 ORTHO DEFENSE 3 M

PREVIDENT 5000 PLUS 3 M

PREVIDENT 5000 SENSITIVE 3

PREVIDENT DENTAL 3 M prevident mouth/throat 1 M REMESENSE 3

SALAGEN 3 M sf 1 M sf 5000 plus 1 M sodium fluoride 5000 plus 1 M

sodium fluoride dental 1 M topex topical anesthetic 1

triamcinolone acetonide mouth/throat 1

Dermatological

Agents - Drugs for

Skin Conditions

A.A.G.C. KIT IN TERODERM 3

ABSORICA 2 QL ACANYA 2 ST; QL


Drug Name Drug

Category

Limits/

Required

bpo 1

BRYHALI 3 ST calcipotriene 1 QL calcipotriene-betameth diprop 1 QL

calcitrene 1 QL calcitriol external 1 QL CANTHARIDIN EXTERNAL 3

CAPEX 3 ST; QL CARAC 2 QL claravis 1 QL CLEOCIN-T 3 ST clindacin etz external swab 1

clindacin-p 1

CLINDAGEL 3 ST clindamycin phosphate- benzoyl peroxide 1 QL

clindamycin phosphate external foam 1

clindamycin phosphate external lotion 1

clindamycin phosphate external solution 1

clindamycin phosphate external swab 1

CLINDAMYCIN PHOSPHATE GEL 1 % EXTERNAL

3

ST

clindamycin phosphate gel 1 % external 1

clindamycin-tretinoin 1

CLINOIN 3

clobetasol prop emollient base 1

clobetasol propionate e 1

clobetasol propionate emulsion 1

clobetasol propionate external 1

Drug Name Drug

Category

Limits/

Required

avita external gel 3

azelaic acid external 1

AZELEX 3 ST; QL balsam peru-castor oil 3

BENZAC AC WASH 3 ST BENZACLIN 3 ST; QL BENZACLIN WITH PUMP 3 ST; QL

BENZAMYCIN 3 ST benzepro external foam 5.3 % 1

benzepro foaming cloths 1

benzepro short contact 1

BENZIQ 3 ST BENZIQ LS 3 ST benziq wash 3

BENZOYL PEROX- HYDROCORTISONE 3 ST

benzoyl peroxide external foam 9.8 % 1

BENZOYL PEROXIDE EXTERNAL GEL 6.5 %, 8 %

3

BENZOYL PEROXIDE FORTE- HC 3

benzoyl peroxide- erythromycin 1

beser external lotion 1

betamethasone dipropionate aug 1

betamethasone dipropionate external 1

betamethasone valerate external 1

BOTOX COSMETIC 6 MSD bp cleansing wash 1

bp foam 1

bp wash external liquid 2.5 % 3

BPCO 3


Drug Name Drug

Category

Limits/

Required

diclofenac sodium transdermal gel 3 % 1 PA; QL

DIFFERIN 3 ST; QL diflorasone diacetate external cream 1 QL

diflorasone diacetate external ointment 1

DIPROLENE 3 ST DIPROLENE AF 3 ST DOVONEX 3 QL doxepin hcl external 1 QL doxycycline 3 ST dritho-creme hp 1

DRYSOL 3

DUAC 3 ST; QL DUOBRII 3

DUPIXENT SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 200 MG/1.14ML

3

PA; M; S; QL

DUPIXENT SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 300 MG/2ML

3

PA; S; QL

EFUDEX 3

ELIDEL 2 ST; QL ELOCON 3 ST ENOVARX- TRAMADOL 3

ENSTILAR 2 QL ENZOCLEAR 3

EPIDUO 3 ST; QL EPIDUO FORTE 2 ST EPIFOAM 3 ST ery 1

ERYGEL 1

erythromycin external 1

EUCRISA 3 ST; QL

Drug Name Drug

Category

Limits/

Required

CLOBEX 3 ST CLOBEX SPRAY 3 ST clocortolone pivalate 3 QL clodan external shampoo 1

CLODERM 3 ST; QL clotrimazole- betamethasone 1

coal tar external 2

CONDYLOX 3

CORDRAN EXTERNAL CREAM 3 ST

CORDRAN EXTERNAL LOTION 3 ST

CORDRAN EXTERNAL OINTMENT

3

ST

CORDRAN EXTERNAL TAPE 3 ST; QL

CORTANE-B 3

CORTISPORIN 3

curad hydrocortisone 1 OTC CUTIVATE 3 ST dapsone external 1

DERMA-SMOOTHE/FS BODY 3 ST; QL

DERMA-SMOOTHE/FS SCALP 3 ST; QL

DERMULCERA 3

DESONATE 3 ST desonide external 1 QL DESOWEN 3 ST; QL desoximetasone external cream 1 QL

desoximetasone external gel 1 QL

desoximetasone external liquid 1

desoximetasone external ointment 1 QL


Drug Name Drug

Category

Limits/

Required

GORDOFILM 3

grafco silver nit applicator 1

halcinonide 1

halobetasol propionate external cream 1 QL

HALOBETASOL PROPIONATE EXTERNAL FOAM

3

ST

halobetasol propionate external ointment 1 QL

HALOG 3 ST HYALUCIL-4 3

HYDRO 35 3

HYDRO 40 3

hydrocortisone ace- pramoxine external 1

hydrocortisone butyr lipo base 1

hydrocortisone butyrate 1

hydrocortisone external cream 1 %, 2.5 % 1

hydrocortisone external lotion 2.5 % 1

hydrocortisone external ointment 1 %, 2.5 % 1

hydrocortisone valerate 1

imiquimod external 1 QL IMIQUIMOD PUMP 3 ST; QL IMPOYZ 3 ST INOVA 4/1 ACNE CONTROL THERAPY 3 ST

INOVA EXTERNAL KIT 4 & 5 % 3 ST

isotretinoin oral 1 QL kelo-cote external gel 6 MSD; OTC KENALOG EXTERNAL 3 ST KERAGEL 6 MSD KERALYT EXTERNAL GEL 6 % 3

Drug Name Drug

Category

Limits/

Required

EVOCLIN 3 ST FABIOR 3 PA; QL FINACEA EXTERNAL FOAM 2 ST

FINACEA EXTERNAL GEL 3 ST

fluocinolone acetonide body 1 QL

fluocinolone acetonide external cream 0.01 % 1

fluocinolone acetonide external cream 0.025 % 1 QL

fluocinolone acetonide external ointment 1 QL

fluocinolone acetonide external solution 1 QL

fluocinolone acetonide scalp 1 QL

fluocinonide emulsified base 1

fluocinonide external cream 0.05 % 1

fluocinonide external cream 0.1 % 1 QL

fluocinonide external gel 1

fluocinonide external ointment 1

fluocinonide external solution 1

FLUOROPLEX 3 QL FLUOROURACIL EXTERNAL CREAM 0.5 %

3

ST; QL

fluorouracil external cream 5 % 1

fluorouracil external solution 1 QL

flurandrenolide 1

fluticasone propionate external 1

glycolic acid solution 2


Drug Name Drug

Category

Limits/

Required

ONEXTON 2 ST; QL ORACEA 2 ST OVACE PLUS EXTERNAL LOTION 3 ST

OVACE PLUS EXTERNAL SHAMPOO

3

OVACE PLUS WASH EXTERNAL LIQUID 3

OVACE WASH 3

OXSORALEN ULTRA 3

PANDEL 3 ST PICATO 2 QL pimecrolimus 1 QL PLEXION CLEANSER 3 ST PLEXION EXTERNAL LOTION 3 ST

podocon 3

podofilox external 1

PRAMOSONE 3 ST prednicarbate 1

PROTOPIC 3 ST; QL PRUDOXIN 1 ST; QL PSORCON 3 ST; QL pyrogallic acid 3

QBREXZA 2 PA; QL REGRANEX 2 QL RETIN-A EXTERNAL CREAM 0.025 % 3 QL

RETIN-A EXTERNAL CREAM 0.05 %, 0.1 % 3

RETIN-A EXTERNAL GEL 3

RETIN-A MICRO GEL 0.04 %, 0.1 % 3

RETIN-A MICRO PUMP 3

RHOFADE 3 PA RIAX 3

rosadan external cream 1

Drug Name Drug

Category

Limits/

Required

KERAMATRIX REPLICINE 5CMX5CM 6 MSD

KLARON 3 ST LAC-HYDRIN 3

lactic acid e 1

lactic acid external 1

latrix xm 1

LAVARE WOUND WASH 3

LEVULAN KERASTICK 6 MSD LEXETTE 3 ST LOCOID 3 ST LOCOID LIPOCREAM 3 ST LOTRISONE 3

LUXIQ 3 ST methoxsalen oral 1

methoxsalen rapid 1

methyl salicylate external liquid 1

METROCREAM 3 ST METROGEL 3 ST METROLOTION 3 ST metronidazole external 1

MICORT-HC 3 ST MICROCYN EXTERNAL GEL 3

MICROCYN SKIN AND WOUND 3

MIRVASO 2 PA mometasone furoate external 1

myorisan 1 QL NEO-SYNALAR EXTERNAL CREAM 3

neuac external gel 1 QL nolix 1

NORITATE 3 ST OLUX 3 ST OLUX-E 3 ST


Drug Name Drug

Category

Limits/

Required

sulfacetamide sodium- sulfur external liquid 10-2 %, 9-4 %, 9.8-4.8 %

1

sulfacetamide sodium- sulfur external lotion 10-5 %

1

sulfacetamide sodium- sulfur external pad 1

sulfacetamide sodium- sulfur external suspension

1

sulfacetamide-sulfur in urea 1

sulfacleanse 8/4 1

synalar external cream 1 QL synalar external ointment 3 QL

SYNALAR EXTERNAL SOLUTION 3 ST; QL

TACLONEX EXTERNAL OINTMENT

3

QL

TACLONEX EXTERNAL SUSPENSION

2

QL

tacrolimus external 1 QL tazarotene external 1 PA; QL TAZORAC CREAM 0.05 % EXTERNAL 2 PA; QL

TAZORAC EXTERNAL CREAM 0.1 % 3 PA; QL

TAZORAC EXTERNAL GEL 2 PA; QL

TEMOVATE 3 ST TEXACORT 3 ST TOLAK 3 QL TOPICORT 3 ST; QL TOPICORT SPRAY 3 ST tretinoin external cream 0.025 % 1 QL

Drug Name Drug

Category

Limits/

Required

rosadan external gel 1

SALEX 3

salicylic acid er 1

salicylic acid external foam 1

salicylic acid external gel 1

salicylic acid external lotion 1

salicylic acid external shampoo 1

salicylic acid-cleanser external kit 6 % (lotion) 1

SALVAX 1

SALVAX DUO PLUS 3

SANTYL 2

selenium sulfide external 1

SERNIVO 3 ST sm hydrocortisone external cream 1 % 1 OTC

sodium hyaluronate external 1

sodium sulfacetamide 1

sodium sulfacetamide wash liquid 10 % external

1

SODIUM SULFACETAMIDE WASH LIQUID 10 % EXTERNAL

1

SOOLANTRA 2 ST SORIATANE 3

SORILUX 3 QL sss 10-5 external foam 1

sulfacetamide sodium (acne) 1

sulfacetamide sodium external 1

sulfacetamide sodium- sulfur external cream 10-2 %

1


Drug Name Drug

Category

Limits/

Required

XEROFORM OIL EMULSION STRIP 3

XEROFORM PETROLAT GAUZE 1"X8"

3

XEROFORM PETROLAT GAUZE 5"X9"

3

XEROFORM PETROLAT PATCH 2"X2"

3

XEROFORM PETROLAT PATCH 4"X4"

3

XEROFORM PETROLATUM ROLL 4"X9'

3

ZACARE 3 ST zaclir cleansing 1

zenatane 1 QL ZIANA 3 ST ZONALON 3 ST; QL ZYCLARA 3 ST; QL ZYCLARA PUMP 3 ST; QL Diabetes -

Antidiabetic Agents

acarbose oral 1 M ACTOPLUS MET 3 ST; M; QL ACTOS 3 M; QL ADLYXIN 3 M; QL ADLYXIN STARTER PACK 3 QL

ALOGLIPTIN BENZOATE 3 ST; M; QL

ALOGLIPTIN- METFORMIN HCL 3 ST; M; QL

ALOGLIPTIN- PIOGLITAZONE 3 M; QL

AMARYL 3 M AVANDIA 3 ST; M; QL BYDUREON 2 ST; M; QL

Drug Name Drug

Category

Limits/

Required

tretinoin external cream 0.05 %, 0.1 % 1

tretinoin external gel 0.01 %, 0.025 % 1

tretinoin external gel 0.05 % 1 QL

tretinoin microsphere 1

tretinoin microsphere pump 1

triamcinolone acetonide external 1

TRIANEX 1

TRI-CHLOR 1

triderm 1

TRIDESILON 3 ST; QL turpentine external 2

ULTRAVATE 3 ST umecta mousse 1

urea external cream 39 %, 45 % 1

urea hydrating 1

urea in zn undecyl- lactic acid 1

urea nail 1

VANOS 3 ST; QL VANOXIDE-HC 3 ST vashe cleansing 6 MSD VECTICAL 3 QL VELTIN 3 ST VENELEX 3

VERDESO 3 ST VEREGEN 3

VIRASAL 3

XERAC AC 3

XERFORM OIL EMULSION ROLL 3

XEROFORM OIL EMULSION 2"X2" 3

XEROFORM OIL EMULSION GAUZE 3


Drug Name Drug

Category

Limits/

Required

METFORMIN HCL ORAL SOLUTION 3 ST; M; QL

metformin hcl oral tablet 1 M

miglitol 1 M nateglinide 1 M NESINA 3 ST; M; QL ONGLYZA 3 ST; M; QL OSENI 3 M; QL OZEMPIC 2 ST; M; QL pioglitazone hcl 1 M; QL pioglitazone hcl- glimepiride 1 M; QL

pioglitazone hcl- metformin hcl 1 M; QL

PRECOSE 3 M QTERN 3 ST; M repaglinide 1 M repaglinide-metformin hcl 1 M; QL

RIOMET 3 ST; M; QL SEGLUROMET 2 ST; M SOLIQUA 2 ST; M; QL STARLIX 3 M STEGLATRO 2 ST; M STEGLUJAN 3 ST; M SYMLINPEN 120 2 ST; M; QL SYMLINPEN 60 2 ST; M; QL SYNJARDY 2 ST; M SYNJARDY XR 2 ST; M tolbutamide 1 M TRADJENTA 2 ST; M; QL TRULICITY 2 ST; M; QL VICTOZA 3 M; QL XIGDUO XR ORAL TABLET EXTENDED RELEASE 24 HOUR 10-1000 MG, 10-500 MG, 5-1000 MG, 5-500 MG

2

ST; M; QL

Drug Name Drug

Category

Limits/

Required

BYDUREON BCISE AUTOINJECTOR 2 ST; M; QL

BYETTA 10 MCG PEN 2 ST; M; QL BYETTA 5 MCG PEN 2 ST; M; QL CYCLOSET 3 M; QL DUETACT 3 ST; M; QL FARXIGA 2 ST; M; QL FORTAMET 3 ST; M glimepiride 1 M glipizide er 1 M glipizide ir 1 M glipizide xl 1 M glipizide-metformin hcl 1 M GLUCOPHAGE 3 ST; M GLUCOPHAGE XR 3 ST; M GLUCOTROL 3 M GLUCOTROL XL 3 M GLUMETZA 3 ST; M; QL glyburide micronized 1 M glyburide oral 1 M glyburide-metformin 1 M GLYNASE 3 M GLYSET 3 M GLYXAMBI 2 ST; M INVOKAMET 2 ST; M; QL INVOKAMET XR 2 ST; M; QL INVOKANA 2 ST; M; QL JANUMET 2 ST; M; QL JANUMET XR 2 ST; M; QL JANUVIA 2 ST; M; QL JARDIANCE 2 ST; M; QL JENTADUETO 2 ST; M; QL JENTADUETO XR 2 ST; M KAZANO 3 ST; M; QL KOMBIGLYZE XR 3 ST; M; QL metformin hcl er 1 M metformin hcl er (mod) 1 ST; M; QL metformin hcl er (osm) 1 ST; M


Drug Name Drug

Category

Limits/

Required

ACCU-CHEK SMARTVIEW CONTROL

3

OTC

ACCU-CHEK SMARTVIEW TEST STRIPS

3

ST; OTC; QL

ACCU-CHEK SOFTCLIX LANCET DEVICE KIT

2

OTC

AUTOLET LANCING DEVICE 2 OTC

BAYER CONTOUR IN VITRO LIQUID HIGH , LOW , NORMAL

3

OTC

BIOTEL CARE BLOOD GLUCOSE SYST 3 ST; OTC; QL

CARETOUCH LANCING/EJECTOR 2 OTC

CHEMSTRIP UGK 2 OTC CONTOUR NEXT CONTROL 3 OTC

CONTOUR NEXT MONITOR 3 ST; OTC; QL

CONTOUR NEXT TEST 3 ST; OTC; QL

CONTOUR TEST 3 ST; OTC; QL DEXCOM G4 / G5 / G6 RECEIVER, TRANSMITTER, SENSOR (INCLUDING PLATINUM, PLATINUM PEDIATRIC)

6

MSD; QL

DEXCOM G4 / G5 / G6 RECEIVER, TRANSMITTER, SENSOR (INCLUDING PLATINUM, PLATINUM PEDIATRIC) DEVICE

6

MSD; QL

DIATHRIVE BLOOD GLUCOSE METER 3 ST; OTC; QL

DIATHRIVE BLOOD GLUCOSE TEST 3 ST; OTC; QL

Drug Name Drug

Category

Limits/

Required

XIGDUO XR ORAL TABLET EXTENDED RELEASE 24 HOUR 2.5-1000 MG

2

ST; M

XULTOPHY 2 ST; M; QL Diabetes - Glucose

Monitoring

ACCU-CHEK AVIVA DEVICE 3 OTC; QL

ACCU-CHEK AVIVA CONNECT KIT W/DEVICE

3

ST; OTC; QL

ACCU-CHEK AVIVA IN VITRO 3 OTC

ACCU-CHEK AVIVA PLUS 3 ST; OTC; QL

ACCU-CHEK COMPACT PLUS CARE KIT

3

OTC; QL

ACCU-CHEK COMPACT PLUS CONTROL

3

OTC

ACCU-CHEK COMPACT PLUS TEST STRIPS

3

ST; OTC; QL

ACCU-CHEK FASTCLIX LANCET KIT

2

OTC

ACCU-CHEK GUIDE 3 ST; OTC; QL ACCU-CHEK GUIDE CONTROL 3 OTC

ACCU-CHEK GUIDE ME 3 ST; OTC; QL

ACCU-CHEK GUIDE STRIP IN VITRO 3 OTC; QL

ACCU-CHEK GUIDE STRIP IN VITRO 3 ST; OTC; QL

ACCU-CHEK MULTICLIX LANCET DEVICE KIT

2

OTC

ACCU-CHEK NANO SMARTVIEW KIT W/DEVICE

3

ST; OTC; QL


Drug Name Drug

Category

Limits/

Required

FREESTYLE LIBRE SENSOR SYSTEM 6 MSD; QL

FREESTYLE LITE TEST 3 ST; OTC; QL

FREESTYLE PRECISION NEO TEST

3

ST; OTC; QL

FREESTYLE TEST 3 ST; OTC; QL GENTEEL LANCING KIT (BLUE) 2 OTC

GLUCOCARD 01 SENSOR PLUS 3 ST; OTC; QL

GLUCOCARD EXPRESSION TEST 3 ST; OTC; QL

GLUCOCARD SHINE CONNEX 3 ST; OTC; QL

GLUCOCARD SHINE EXPRESS 3 ST; OTC; QL

GLUCOCARD SHINE TEST 3 ST; OTC; QL

GLUCOCARD VITAL TEST 3 ST; OTC; QL

GUARDIAN CONNECT TRANSMITTER 6 MSD; QL

GUARDIAN LINK 3 TRANSMITTER 6 MSD; QL

GUARDIAN REAL- TIME SYSTEM 2 QL

HW EMBRACE PRO GLUCOSE METER 3 ST; OTC; QL

HW EMBRACE PRO GLUCOSE TEST 3 ST; OTC; QL

HW EMBRACE TALK BLOOD GLUCOSE 3 ST; OTC; QL

HW EMBRACE TALK GLUCOSE TEST 3 ST; OTC; QL

KETOCARE IN VITRO STRIP 2 OTC

KETOSTIX 2 OTC LANCETS 2 OTC LANCETS KIT 2 OTC

Drug Name Drug

Category

Limits/

Required

DIATHRIVE GLUCOSE CONTROL SOLN 3 ST; OTC

DIATHRIVE GLUCOSE TEST 3 ST; OTC; QL

DIATHRIVE LANCING DEVICE 2 ST; OTC

EASYMAX CONTROL 3 ST; OTC EASYPLUS BLOOD GLUCOSE TEST 3 ST; OTC; QL

EMBRACE TALK BLOOD GLUCOSE 3 ST; OTC; QL

EMBRACE TALK GLUCOSE CONTROL 3 ST; OTC

EMBRACE TALK GLUCOSE TEST 3 ST; OTC; QL

EMBRACE TALK MONITORING SYSTEM

3

ST; OTC; QL

ENLITE GLUCOSE SENSOR 6 MSD; QL

EVERSENSE SENSOR/HOLDER 6 MSD; QL

EVERSENSE SMART TRANSMITTER 6 MSD; QL

FORA GTEL BLOOD GLUCOSE SYSTEM 3 ST; OTC; QL

FORA GTEL BLOOD GLUCOSE TEST 3 ST; OTC; QL

FORTISCARE CONTROL 3 ST; OTC

FREESTYLE FREEDOM LITE 3 ST; OTC; QL

FREESTYLE INSULINX SYSTEM 3 ST; OTC; QL

FREESTYLE INSULINX TEST 3 ST; OTC; QL

FREESTYLE LIBRE 14 DAY READER 6 MSD; QL

FREESTYLE LIBRE 14 DAY SENSOR 6 MSD; QL

FREESTYLE LIBRE READER 6 MSD; QL


Drug Name Drug

Category

Limits/

Required

PRECISION SOF- TACT TEST 3 ST; OTC; QL

PRECISION XTRA BLOOD GLUCOSE 3 ST; OTC; QL

PRECISION XTRA DEVICE 3 OTC; QL

PRECISION XTRA KIT 3 OTC; QL PRECISION XTRA MONITOR 3 OTC; QL

PRODIGY NO CODING BLOOD GLUC

3

OTC; QL

RELION BLOOD GLUCOSE TEST 3 ST; OTC; QL

RELION PREMIER CLASSIC 3 OTC; QL

RELION PREMIER TEST 3 ST; OTC; QL

RELION ULTIMA TEST 3 ST; OTC; QL SOF-SENSOR 6 MSD; QL SURESTEP PRO HIGH GLUCOSE 3 OTC

SURESTEP PRO LOW GLUCOSE 3 OTC

SURESTEP PRO NORMAL GLUCOSE 3 OTC

TRUE FOCUS BLOOD GLUCOSE METER 3 ST; OTC; QL

TRUE METRIX BLOOD GLUCOSE TEST 3 ST; OTC; QL

TRUE METRIX LEVEL 1 3 OTC



TRUETRACK TEST 3 ST; OTC; QL UNISTRIP CONTROL IN VITRO SOLUTION LOW

3

OTC

V-GO 20 2 OTC

Drug Name Drug

Category

Limits/

Required

MICROLET NEXT LANCING DEVICE 2 OTC

MINIMED GUARDIAN SENSOR 3 6 MSD; QL

NOVOPEN ECHO 3

ONE DROP BLOOD GLUCOSE MONITOR 3 ST; OTC; QL

ONE DROP TEST 3 ST; OTC; QL ONETOUCH DELICA LANCING DEV 2 OTC

ONETOUCH DELICA PLUS LANCING 2 OTC

ONETOUCH ULTRA 2 2 OTC; QL ONETOUCH ULTRA BLUE TEST STRIPS 2 OTC; QL

ONETOUCH ULTRA MINI 2 OTC; QL

ONE TOUCH VERIO KIT W/DEVICE 2 OTC; QL

ONETOUCH VERIO FLEX SYSTEM KIT W/DEVICE

2

OTC; QL

ONETOUCH VERIO IN VITRO SOLUTION HIGH

2

OTC

ONETOUCH VERIO TEST STRIPS 2 OTC; QL

ONETOUCH VERIO IQ SYSTEM 2 OTC; QL

ONETOUCH VERIO SYNC SYSTEM KIT W/DEVICE

2

OTC; QL

PARADIGM REAL- TIME STARTER 2 QL

PRECISION LINK 3 ST; OTC; QL PRECISION PCX PLUS TEST 3 ST; OTC; QL

PRECISION QID MONITOR 3 OTC; QL

PRECISION QID TEST 3 ST; OTC; QL PRECISION SOF- TACT MONITOR 3 OTC; QL


Drug Name Drug

Category

Limits/

Required

BD ULTRA-FINE INSULIN SYRINGES 2

BD ULTRA-FINE PEN NEEDLES 2 ST; OTC

BD ULTRA-FINE PEN NEEDLES 2 ST

FIASP 3 ST; M; QL FIASP FLEXTOUCH 3 ST; M; QL FIASP PENFILL 3 ST; M; QL HUMALOG KWIKPEN 2 M; QL HUMALOG MIX 50/50 KWIKPEN 2 M; QL

HUMALOG MIX 50/50 VIAL 2 M; QL

HUMALOG MIX 75/25 KWIKPEN 2 M; QL

HUMALOG MIX 75/25 VIAL 2 M; QL

HUMALOG U-100 JUNIOR KWIKPEN 2 M; QL

HUMALOG U-100 VIAL AND CARTRIDGE 2 M; QL

HUMULIN 70/30 KWIKPEN 2 M; OTC; QL

HUMULIN 70/30 VIAL 2 M; OTC; QL HUMULIN N KWIKPEN 2 M; OTC HUMULIN N VIAL 2 M; OTC; QL HUMULIN R U-500 KWIKPEN 2 M; QL

HUMULIN R U-500 VIAL (CONCENTRATED)

2

M; QL

HUMULIN R VIAL 2 M; OTC; QL INSULIN LISPRO 3 M; QL INSULIN LISPRO SUBCUTANEOUS SOLUTION PEN- INJECTOR 100 UNIT/ML

3

M; QL

Drug Name Drug

Category

Limits/

Required

VIVAGUARD INO CONTROL SOLUTION 3 ST; OTC

VIVAGUARD INO GLUCOSE METER 3 ST; OTC; QL

VIVAGUARD INO TEST STRIPS 3 ST; OTC; QL

VIVAGUARD LANCING DEVICE 2 ST; OTC

Diabetes - Glycemic

Agents

GLUCAGEN HYPOKIT 2

GLUCAGON EMERGENCY 3

PROGLYCEM 2 M Diabetes - Insulins

ADMELOG 3 ST; M; QL ADMELOG SOLOSTAR 3 ST; M; QL

AFREZZA INHALATION POWDER 12 UNIT, 4 & 8 & 12 UNIT, 8 UNIT, 90 X 4 UNIT & 90X8 UNIT, 90 X 8 UNIT & 90X12 UNIT

3

M

AFREZZA INHALATION POWDER 4 UNIT

3

M; QL

APIDRA SOLOSTAR 3 ST; M; QL APIDRA VIAL 3 ST; M; QL BASAGLAR KWIKPEN 2 M; QL BD AUTOSHIELD DUO PEN NEEDLES 2 ST; OTC

BD ULTRA-FINE INSULIN SYRINGES 29G X 1/2" 1 ML, 30G X 1/2" 0.3 ML, 30G X 1/2" 0.5 ML, 30G X 1/2" 1 ML, 31G X 15/64" 0.3 ML, 31G X 15/64" 0.5 ML, 31G X 15/64" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML

2

ST; OTC


Drug Name Drug

Category

Limits/

Required

NOVOLIN R RELION 3 ST; M; OTC; QL

NOVOLIN R VIAL 3 ST; M; OTC; QL

NOVOLOG FLEXPEN 3 ST; M; QL NOVOLOG MIX 70/30 FLEXPEN 3 ST; M

NOVOLOG MIX 70/30 VIAL 3 ST; M

NOVOLOG PENFILL 3 ST; M; QL NOVOLOG U-100 VIAL 3 ST; M NOVOTWIST PEN NEEDLE 2 ST; OTC

TOUJEO MAX SOLOSTAR 2 M; QL

TOUJEO SOLOSTAR 2 M; QL TRESIBA 2 M; QL TRESIBA FLEXTOUCH 2 M; QL

Electrolytes / Minerals

/ Metals / Vitamins

ACTIVE FE 3

adc/f (0.5mg/ml) 5 ACA alcohol 6 MSD AMINO ACID INTRAVENOUS SOLUTION 5 %

6

MSD

aminobenzoate potassium 1 M

AMINOPROTECT 6 MSD AMINOSYN II 6 MSD AMINOSYN-PF 6 MSD AQUASOL A 2

ARGININE HCL INJECTION 3

ascorbic acid injection 6 MSD AXIFOL 3

B-12 COMPLIANCE INJECTION 6 MSD

BCAA INJECTION 3

CALCIFOL 3

Drug Name Drug

Category

Limits/

Required

INSULIN PEN NEEDLES 29G X 12.7MM , 29G X 12MM , 29G X 5MM , 29G X 8MM , 30G X 8 MM , 31G X 5 MM , 31G X 6 MM , 31G X 8 MM , 32G X 4 MM , 32G X 5 MM , 32G X 6 MM , 33G X 4 MM , 33G X 5 MM , 33G X 6 MM

2

ST; OTC

INSULIN PEN NEEDLES 29G X 12.7MM , 31G X 5 MM , 31G X 6 MM , 31G X 8 MM , 32G X 4 MM

2

ST

INSULIN SYRINGES 2 ST; OTC LANTUS SOLOSTAR 2 M; QL LANTUS U-100 VIAL 2 M; QL LEVEMIR U-100 FLEXTOUCH 2 M; QL

LEVEMIR U-100 VIAL 2 M; QL MAXICOMFORT SYR 27G X 1/2" 2 ST; OTC

NOVOFINE AUTOCOVER PEN NEEDLE

2

ST; OTC

NOVOFINE PEN NEEDLE 2 ST; OTC

NOVOFINE PLUS PEN NEEDLE 2 ST; OTC

NOVOLIN 70/30 FLEXPEN 3 ST; M; OTC;

QL NOVOLIN 70/30 FLEXPEN RELION 3 ST; M; OTC;

QL NOVOLIN 70/30 RELION 3 ST; M; OTC;

QL

NOVOLIN 70/30 VIAL 3 ST; M; OTC; QL

NOVOLIN N RELION 3 ST; M; OTC; QL

NOVOLIN N VIAL 3 ST; M; OTC; QL


Drug Name Drug

Category

Limits/

Required

CLINIMIX E/DEXTROSE (5/15) 6 MSD

CLINIMIX E/DEXTROSE (5/20) 6 MSD

CLINIMIX N14G30E 6 MSD CLINIMIX N9G15E 6 MSD CLINIMIX N9G20E 6 MSD clinimix/dextrose (4.25/10) solution 4.25 % intravenous

6

MSD

CLINIMIX/DEXTROSE (4.25/10) SOLUTION 4.25 % INTRAVENOUS

6

MSD

clinimix/dextrose (4.25/25) 6 MSD

CLINIMIX/DEXTROSE (4.25/5) 6 MSD

CLINIMIX/DEXTROSE (5/15) 6 MSD



clinisol sf 6 MSD COPPER CHLORIDE 6 MSD corvita 150 1

CORVITE 150 3

CORVITE FE 3

cyanocobalamin injection solution 1000 mcg/ml

1

CYANOCOBALAMIN INJECTION SOLUTION 2000 MCG/ML

2

cytra k crystals 1

deferasirox 1 M; S dehydrated alcohol 6 MSD delflex-lc/1.5% dextrose 6 MSD

Drug Name Drug

Category

Limits/

Required

CALCIUM CHLORIDE SOLUTION 10 % INTRAVENOUS

6

MSD

calcium chloride solution 10 % intravenous

6

MSD

calcium gluconate 6 MSD calcium gluconate anhydrous 6 MSD

calcium gluconate intravenous solution 6 MSD

CALCIUM GLUCONATE INTRAVENOUS SOLUTION PREFILLED SYRINGE

6

MSD

CALCIUM GLUCONATE-NACL INTRAVENOUS SOLUTION 1-0.675 GM/50ML-%, 1-0.9 GM/100ML-%, 2-0.675 GM/100ML-%

6

MSD

calcium-folic acid plus d 1

CALM 3

CARBAGLU 3 PA; M; S CARDIOPLEGIC 6 MSD CARNITOR ORAL 3 M CARNITOR SF 3 M CENTRATEX 3

CHEMET 2

chromic chloride intravenous 6 MSD

CITRANATAL MEDLEY 3

CLINIMIX E/DEXTROSE (2.75/5) 6 MSD

CLINIMIX E/DEXTROSE (4.25/10)

6

MSD

CLINIMIX E/DEXTROSE (4.25/5) 6 MSD


Drug Name Drug

Category

Limits/

Required

ERGOCAL 3 M ergocalciferol oral capsule 1 M

ESCAVITE 3

ESCAVITE D 3

ESCAVITE LQ 3

EXJADE 3 M; S FERIVA 21/7 3

FERIVAFA 3

ferocon 1

ferotrinsic 1

FERRALET 90 3

ferraplus 90 1

FERRIPROX 3 M; S FERRLECIT 6 MSD ferrocite plus 1

FERRO-PLEX HEMATINIC 3

FERROTRIN 3

FLORIVA ORAL LIQUID 5 ACA

floriva oral tablet chewable 0.25 mg 3

FLORIVA ORAL TABLET CHEWABLE 0.5 MG, 1 MG

3

FLORIVA PLUS 5 ACA FLUORABON 5 M; ACA fluoritab oral solution 5 M; ACA fluoritab oral tablet chewable 0.55 (0.25 f) mg, 1.1 (0.5 f) mg

5

M; ACA

fluoritab oral tablet chewable 2.2 (1 f) mg 1 M

FLURA-DROPS 5 M; ACA folic acid injection 1

folic acid oral tablet 1 mg 1 M

folic acid oral tablet 400 mcg 5 ACA; OTC

Drug Name Drug

Category

Limits/

Required

delflex-lc/2.5% dextrose 6 MSD

delflex-lc/4.25% dextrose solution 483 mosm/l intraperitoneal

6

MSD

DELFLEX-LC/4.25% DEXTROSE SOLUTION 483 MOSM/L INTRAPERITONEAL

6

MSD

delflex-sm/1.5% dextrose 6 MSD

DEXPANTHENOL INJECTION 3

dextrose intravenous solution 10 %, 20 %, 30 %, 40 %, 5 %, 70 %

6

MSD

DEXTROSE SOLUTION 250 MG/ML INTRAVENOUS

6

MSD

dextrose solution 250 mg/ml intravenous 6 MSD

DEXTROSE SOLUTION 50 % INTRAVENOUS

6

MSD

dextrose solution 50 % intravenous 6 MSD

DIANEAL LOW CALCIUM/1.5% DEX 6 MSD



DRISDOL 3 M EFFER-K ORAL TABLET EFFERVESCENT 10 MEQ, 20 MEQ

3

effer-k oral tablet effervescent 25 meq 1 M

elite-ob 3

ELLIOTTS B 6 MSD ENBRACE HR 3


Drug Name Drug

Category

Limits/

Required

infuvite pediatric solution intravenous 6 MSD

INFUVITE PEDIATRIC SOLUTION INTRAVENOUS

6

MSD

INJECTAFER 6 MSD INTEGRA F 3

intralipid intravenous emulsion 20 % 6 MSD

INTRALIPID INTRAVENOUS EMULSION 30 %

6

MSD

iodine strong oral 1

IONOSOL-MB IN D5W 6 MSD IROSPAN 24/6 3

IS 24/6 3

ISOLYTE-S 6 MSD JADENU 3 M; S JADENU SPRINKLE 3 M; S JYNARQUE 3 PA; S; QL KABIVEN 6 MSD KCL (IN NACL 0.9%) INTRAVENOUS SOLUTION 10 MEQ/100ML, 20 MEQ/250ML

6

MSD

KCL-LIDOCAINE- NACL 6 MSD

kionex 1

klor-con 1 M klor-con 10 1 M klor-con m10 1 M KLOR-CON M15 1 M klor-con m20 1 M klor-con sprinkle 1 M klor-con/ef 1 M K-PHOS 2 M K-PHOS NO 2 3

K-PHOS-NEUTRAL 1 M k-prime 1 M

Drug Name Drug

Category

Limits/

Required

folic acid oral tablet 800 mcg 5 M; ACA; OTC

FOLI-D 3

FOLITE 3

FOLIVANE-F 3

foltrin 1

FOLVITE-D 3

FREAMINE HBC 6 MSD FREAMINE III 6 MSD FUSION PLUS 3

FUSION SPRINKLES 3

GABA 3

GALZIN 3

GENICIN VITA-D 3

glucose intravenous 6 MSD GLUTATHIONE INJECTION 3

GLYCINE INJECTION 3

gnp folic acid 5 ACA; OTC hematinic plus vit/minerals 1

hematogen fa 1

hematogen forte 1

HEMATRON-AF 3

HEMETAB 1

HEMOCYTE PLUS 3

hemocyte-plus 1

hepatamine 6 MSD hydroxocobalamin acetate 1

hyperlyte-cr 6 MSD ICAR-C PLUS 3

iferex 150 forte 1

infuvite adult injectable intravenous 6 MSD

INFUVITE ADULT INJECTABLE INTRAVENOUS

6

MSD


Drug Name Drug

Category

Limits/

Required

magnesium sulfate intravenous solution 2 gm/50ml, 20 gm/500ml, 4 gm/100ml, 4 gm/50ml, 40 gm/1000ml

6

MSD

MAGNESIUM SULFATE SOLUTION 50 % INJECTION

3

magnesium sulfate solution 50 % injection 6 MSD

MAGNESIUM SULFATE-LACT RINGERS

6

MSD

MAGNESIUM SULFATE-NACL 6 MSD

MANGANESE CHLORIDE 6 MSD

MAXFE ORAL TABLET 3

MEPHYTON 3

METHYLCOBALAMIN INJECTION 3

M-NATAL PLUS 1

multi prenatal 5 ACA; OTC multigen 1

multigen folic 1

multigen plus 1

multi-vit/iron/fluoride 5 ACA multi-vitamin/fluoride 5 ACA multivitamin/fluoride oral solution 5 ACA

multivitamin/fluoride oral tablet chewable 0.25 mg, 0.5 mg

5

ACA

MULTIVITAMIN/FLUO RIDE ORAL TABLET CHEWABLE 0.25-0.3 MG, 0.5-0.3 MG, 1-0.3 MG

3

multivitamin/fluoride oral tablet chewable 1 mg

1

Drug Name Drug

Category

Limits/

Required

K-TAB 1 M k-tan plus 1

lactated ringers intravenous 6 MSD

LEVOCARNITINE INJECTION 3

levocarnitine oral solution 1 M

levocarnitine oral tablet 1 M LIPO 3

LIPO-C 3

LIQUIVIDA HYDRATION 6 MSD

LOKELMA 2 M ludent oral tablet chewable 0.55 (0.25 f) mg, 1.1 (0.5 f) mg

5

M; ACA

ludent oral tablet chewable 2.2 (1 f) mg 1 M

LYSINE HCL INJECTION 3

M.V.I. ADULT 6 MSD M.V.I. PEDIATRIC 6 MSD MAGNEBIND 400 3

magnesium chloride injection 1

magnesium sulfate in d5w intravenous solution 1-5 gm/100ml- %

6

MSD

MAGNESIUM SULFATE IN D5W INTRAVENOUS SOLUTION 1-5 GM/50ML-%, 2-5 GM/100ML-%, 2-5 GM/50ML-%, 3-5 GM/50ML-%, 4-5 GM/50ML-%, 50-5 GM/500ML-%, 6-5 GM/100ML-%, 6-5 GM/50ML-%

6

MSD


Drug Name Drug

Category

Limits/

Required

Drug Name Drug

Category

Limits/

Required

multivitamin/fluoride/iro n 5 ACA plenamine 6 MSD

pnv prenatal plus multivit+dha 3

multivitamin/fluoride/iron 5 ACA

poly-iron 150 forte 1

multivitamins/fluoride 5 ACA polysaccharide iron forte 1

mvc-fluoride oral tablet chewable 0.25 mg, 0.5 mg

5

ACA POLY-VI-FLOR 3

POLY-VI-FLOR FS 3 mvc-fluoride oral tablet chewable 1 mg 1

POLY-VI-FLOR/IRON 3

pot bicarb-pot chloride 1 M myferon 150 forte 1

POTABA 3 M na ferric gluc cplx in sucrose 6 MSD potassium acetate

intravenous 6 MSD n-acetyl-l-cysteine oral 2

potassium bicarbonate oral 1 M nafrinse 1 M

nafrinse drops 5 M; ACA potassium chloride crys er 1 M NASCOBAL 2 M

NEOKE ALCAR 3

potassium chloride er 1 M NEPHRAMINE 6 MSD

potassium chloride in nacl intravenous solution 20-0.9 meq/l- %, 40-0.9 meq/l-%

6

MSD NEPHRON FA 3

NESTABS 3

NEUT 6 MSD potassium chloride intravenous solution 6 MSD NICOMIDE 3

NIFEREX 3

POTASSIUM CHLORIDE INTRAVENOUS SOLUTION PREFILLED SYRINGE

6

MSD

NUFERA 3

nutrilipid 6 MSD NUTRIVIT 2

OMEGAVEN 6 MSD potassium chloride oral 1 M

ONE-A-DAY WOMENS PRENATAL 1 5 ACA; OTC potassium citrate er 1

potassium citrate-citric acid 1

ORACIT 3

PERIKABIVEN 6 MSD potassium phosphates 6 MSD

phospha 250 neutral 1 M PREGENNA 3

phosphorous 1 M PREMASOL 6 MSD


phospho-trin 250 neutral 1 M PRENAISSANCE 3

PRENATA 3 PHYSICIANS EZ USE B-12 6 MSD prenatal multi +dha 5 ACA; OTC

prenatal oral tablet 27- 0.8 mg 5 ACA phytonadione injection 6 MSD

phytonadione oral 1


Drug Name Drug

Category

Limits/

Required

SELECT-OB ORAL TABLET CHEWABLE 29-1 MG

3

se-tan plus 1

SMOFLIPID 6 MSD sod citrate-citric acid 1

sodium acetate intravenous 6 MSD

sodium bicarbonate intravenous solution 4.2 %, 7.5 %

6

MSD

SODIUM BICARBONATE SOLUTION 8.4 % INTRAVENOUS

6

MSD

sodium bicarbonate solution 8.4 % intravenous

6

MSD

SODIUM BICARBONATE- DEXTROSE

6

MSD

sodium chloride bacteriostatic 6 MSD

sodium chloride injection 6 MSD

sodium chloride intravenous 6 MSD

sodium fluoride oral solution 5 M; ACA

sodium fluoride oral tablet 1.1 (0.5 f) mg 5 M; ACA

sodium fluoride oral tablet 2.2 (1 f) mg 1 M

sodium fluoride oral tablet chewable 0.55 (0.25 f) mg, 1.1 (0.5 f) mg

5

M; ACA

sodium fluoride oral tablet chewable 2.2 (1 f) mg

1

M

sodium lactate intravenous 6 MSD

Drug Name Drug

Category

Limits/

Required

prenatal oral tablet 27-1 mg 3

prenatal oral tablet 28- 0.8 mg 5 ACA; OTC

prenatal plus iron 1

PRISMASOL B22GK 4/0 6 MSD

PRISMASOL BGK 0/2.5 6 MSD

PRISMASOL BGK 2/0 6 MSD PRISMASOL BGK 2/3.5 6 MSD

PRISMASOL BGK 4/2.5 6 MSD

PRISMASOL BK 0/0/1.2 6 MSD

PROCALAMINE 6 MSD PROSOL 6 MSD purevit dualfe plus 1

PYRIDOXINE HCL SOLUTION 100 MG/ML INJECTION

3

pyridoxine hcl solution 100 mg/ml injection 1

QUFLORA FE 3

QUFLORA FE PEDIATRIC 5 ACA

QUFLORA GUMMIES 3

quflora pediatric oral solution 5 ACA

quflora pediatric oral tablet chewable 0.25 mg, 0.5 mg

5

ACA

quflora pediatric oral tablet chewable 1 mg 1

RELNATE DHA 3

RENATABS WITH IRON 3

saline bacteriostatic 6 MSD SALINE-PHENOL 3

SAMSCA 3 PA; S; QL


Drug Name Drug

Category

Limits/

Required

trientine hcl 1 PA; QL TRIFERIC HEMODIALYSIS PACKET

6

MSD

trigels-f forte 1

trinate 1

TRINAZ 3

TRISODIUM CITRATE/CRRT 6 MSD

TRI-VI-FLOR 3

TRI-VI-FLORO 3

tri-vitamin/fluoride 5 ACA tri-vite/fluoride 5 ACA TROPHAMINE 6 MSD tryptophan oral 1

ULTRABAG/DIANEAL/ 1.5% DEXTROSE 6 MSD

ULTRABAG/DIANEAL/ 2.5% DEXTROSE 6 MSD

ULTRABAG/DIANEAL/ 4.25% DEX 6 MSD

UROCIT-K 10 3

UROCIT-K 15 3

UROCIT-K 5 3

VELTASSA 3 M; S VENOFER 6 MSD virt-phos 250 neutral 1 M VITAFOL 3

VITAFOL-OB+DHA 3

vitamin b complex 100 6 MSD vitamin b-complex 100 6 MSD vitamin d (ergocalciferol) oral capsule 1.25 mg (50000 ut)

1

M

vitamin k1 injection 6 MSD vitamins acd-fluoride 5 ACA vp-pnv-dha 3

wheat germ oil 2

ZINC TRACE METAL 6 MSD

Drug Name Drug

Category

Limits/

Required

SODIUM PHOSPHATE-NACL INTRAVENOUS SOLUTION 15 MMOL/100ML, 15 MMOL/250ML, 30 MMOL/250ML

6

MSD

sodium phosphates 6 MSD SODIUM PHOSPHATES- DEXTROSE INTRAVENOUS SOLUTION 15 MMOL/250ML

6

MSD

sodium polystyrene sulfonate oral 1

sodium polystyrene sulfonate rectal suspension 30 gm/120ml

1

sodium polystyrene sulfonate rectal suspension 50 gm/200ml

3

sps 1

swabflush saline flush 6 MSD SYNTHAMIN 17 6 MSD SYPRINE 3 ST; QL TARON FORTE 1

taron-crystals 1

TAURINE INJECTION 3

TEXAVITE LQ 3

thiamine hcl injection 1

tl icon 1

TL-FLUORIVITE 3

tpn electrolytes 6 MSD TRAVASOL 6 MSD TRI-AMINO 3

TRICARE PRENATAL DHA ONE 3

tricitrates 1

tricon 1


Drug Name Drug

Category

Limits/

Required

NEXIUM ORAL CAPSULE DELAYED RELEASE 40 MG

3

ST; M; QL

NEXIUM ORAL PACKET 2 ST; M; QL

nizatidine 1 M omeppi 2 M; QL omeprazole oral capsule delayed release

1

M; QL

omeprazole oral tablet delayed release 1 OTC; QL

omeprazole oral tablet delayed release dispersible

1

OTC; QL

omeprazole-sodium bicarbonate 2 M; QL

pantoprazole sodium intravenous 6 MSD; QL

pantoprazole sodium oral tablet delayed release 20 mg

1

M; QL

pantoprazole sodium tablet delayed release 40 mg oral

2

M; QL

pantoprazole sodium tablet delayed release 40 mg oral

1

M; QL

PEPCID 3 M PREVACID ORAL CAPSULE DELAYED RELEASE 30 MG

3

ST; M; QL

PREVACID SOLUTAB ORAL TABLET DISPERSIBLE 15 MG, 30 MG

3

ST; M; QL

PRILOSEC 3 ST; M; QL PROTONIX INTRAVENOUS 6 MSD; QL

PROTONIX ORAL 3 ST; M; QL rabeprazole sodium oral tablet delayed release

1

M; QL

Drug Name Drug

Category

Limits/

Required

Gastrointestinal

Agents - Drugs for

Acid Reflux and Ulcer

ACIPHEX 3 ST; M; QL ACIPHEX SPRINKLE 3 ST; M; QL CARAFATE ORAL SUSPENSION 2 M

CARAFATE ORAL TABLET 3 M

cimetidine hcl 1 M cimetidine oral tablet 200 mg 1

cimetidine oral tablet 300 mg, 400 mg, 800 mg

1

M

CYTOTEC 3 M DEPRIZINE FUSEPAQ 3 M DEXILANT 3 ST; M; QL esomeprazole magnesium 1 M; QL

esomeprazole sodium 6 MSD; QL FAMOTIDINE IN NACL 6 MSD famotidine intravenous 6 MSD famotidine oral suspension reconstituted

1

M

famotidine oral tablet 20 mg, 40 mg 1 M

famotidine premixed 6 MSD gnp lansoprazole 1 M; OTC; QL heartburn treatment 24 hour 1 M; OTC; QL

lansoprazole oral capsule delayed release

1

M; QL

lansoprazole oral tablet dispersible 15 mg, 30 mg

1

M; QL

misoprostol oral 1 M NEXIUM I.V. 6 MSD; QL


Drug Name Drug

Category

Limits/

Required

citroma 5 ST; ACA; OTC clearlax 5 ST; ACA; OTC CLENPIQ 5 ACA COLYTE WITH FLAVOR PACKS 3

constulose 1 M cromolyn sodium oral 1 M CUVPOSA 3 M dicyclomine hcl intramuscular 6 MSD

dicyclomine hcl oral 1

diphenoxylate-atropine 1

DONNATAL 3

ENTEREG 3

enulose 1 M ex-lax ultra 5 ST; ACA; OTC GASTROCROM 3 M GATTEX 4 M; S gavilax oral powder 5 ST; ACA; OTC gavilyte-c 5 ACA gavilyte-g 5 ACA gavilyte-h 5 ACA gavilyte-n with flavor pack 5 ACA

generlac 1 M gentle laxative oral 5 ST; ACA; OTC GIALAX 5 ACA GLYCATE 3

glycolax 5 ST; ACA; OTC glycopyrrolate injection solution 6 MSD

GLYCOPYRROLATE INJECTION SOLUTION PREFILLED SYRINGE

6

MSD

GLYCOPYRROLATE INTRAVENOUS 6 MSD

glycopyrrolate oral tablet 1 mg, 2 mg 1

Drug Name Drug

Category

Limits/

Required

ranitidine hcl injection 6 MSD ranitidine hcl oral capsule 1 M

ranitidine hcl oral syrup 1 M ranitidine hcl oral tablet 150 mg, 300 mg 1 M

sm esomeprazole magnesium 1 M; OTC; QL

sucralfate oral tablet 1 M YOSPRALA 3 ST; M; QL ZANTAC INJECTION 6 MSD ZEGERID 3 ST; M; QL Gastrointestinal

Agents - Drugs for

Bowel, Intestine and

Stomach Conditions

ACTIGALL 3 M alosetron hcl 1 M AMITIZA 2 M; QL amoxicill-clarithro- lansopraz 1 QL

ANASPAZ 1 M ATROPEN 3

atropine sulfate injection 6 MSD

ATROPINE SULFATE INTRAVENOUS SOLUTION PREFILLED SYRINGE 0.8 MG/2ML, 1 MG/2.5ML, 2 MG/5ML

6

MSD

belladonna alkaloids- opium 1

BENTYL 6 MSD bisacodyl ec 5 ST; ACA; OTC cascara sagrada oral fluid extract 3

CHENODAL 3 PA; S chlordiazepoxide- clidinium 1

CHOLBAM 3 PA; M; S


Drug Name Drug

Category

Limits/

Required

methscopolamine bromide oral 1

milk of magnesia oral suspension 1200 mg/15ml, 400 mg/5ml

5

ST; ACA; OTC

mineral oil heavy oral 2

MOTEGRITY 3 M MOTOFEN 3

MOVANTIK 2 QL MOVIPREP 5 ACA MYTESI 3 M; QL NULYTELY WITH FLAVOR PACKS 3

OMECLAMOX-PAK 3 QL opium 1

oscimin oral tablet 1 M oscimin sr 1 M oscimin sublingual 1 M OSMOPREP 5 ACA paregoric 1

PCP 100 3

peg 3350 oral packet 5 ST; ACA; OTC peg 3350/electrolytes 5 ACA peg 3350-kcl-na bicarb- nacl 5 ACA

peg-3350/electrolytes 5 ACA peg-prep 5 ACA phenobarbital- belladonna alk 1

phenohytro 1

PLENVU 5 ACA polyethylene glycol 3350 oral packet 5 ST; ACA

PREPOPIK 5 ACA PRODIGEN 3

propantheline bromide oral 1

PYLERA 2

RELISTOR ORAL 3 QL

Drug Name Drug

Category

Limits/

Required

GLYCOPYRROLATE ORAL TABLET 1.5 MG 1

glycopyrrolate pf 6 MSD GLYRX-PF 6 MSD GOLYTELY ORAL SOLUTION RECONSTITUTED 227.1 GM

5

ACA

GOLYTELY ORAL SOLUTION RECONSTITUTED 236 GM

3

healthylax 5 ST; ACA; OTC hyoscyamine sulfate er 1 M hyoscyamine sulfate oral elixir 1 M

hyoscyamine sulfate oral solution 1 M

hyoscyamine sulfate oral tablet 1 M

hyoscyamine sulfate sl 1 M hyoscyamine sulfate sublingual 1 M

hyosyne 1 M KRISTALOSE 3 M lactulose 1 M lactulose encephalopathy 1 M

LEVBID 3 M LEVSIN INJECTION 6 MSD LEVSIN ORAL 3 M LEVSIN/SL 3 M LIBRAX 3 ST LINZESS 2 M; QL LOMOTIL 3

loperamide hcl oral capsule 1

LOTRONEX 3 M magnesium citrate oral solution 5 ST; ACA; OTC


Drug Name Drug

Category

Limits/

Required

ELAPRASE 6 MSD ELELYSO 6 MSD ENZADYNE 3

EXONDYS 51 6 MSD FABRAZYME 6 MSD GALAFOLD 4 PA; M; S; QL KANUMA 6 MSD KUVAN 3 PA; M; S LUMIZYME 6 MSD MEPSEVII 6 MSD miglustat 1 M; S MYALEPT 3 PA; M; S NAGLAZYME 6 MSD nitisinone 1 M NITYR 3 M; S OCALIVA 3 PA; M; S; QL ORFADIN 3 M; S PALYNZIQ 3 PA; M; S; QL PANCREAZE 3 ST; M PERTZYE 3 ST; M PROCYSBI 4 ST; M; S RAVICTI 3 M; S REVCOVI 3 S sod benz-sod phenylacet 6 MSD

sodium phenylbutyrate oral 1 M

STRENSIQ 3 M; S SUCRAID 3 M; S VIMIZIM 6 MSD VIOKACE 2 M VPRIV 6 MSD XURIDEN 3 M; S; QL ZAVESCA 4 M; S ZENPEP 2 M

Drug Name Drug

Category

Limits/

Required

RELISTOR SUBCUTANEOUS 2 QL

RESTORA RX 3

SEROSTIM 3 PA; M; S sodium bicarbonate oral powder 1

SUPREP BOWEL PREP KIT 5 ACA

SYMAX DUOTAB 3 M symax-sl 1 M symax-sr 1 M SYMPROIC 2 QL trilyte 5 ACA TRULANCE 2 M; QL URSO 250 3 M URSO FORTE 3 M ursodiol oral 1 M URSODIOL+SYRSPE ND SF 3 M

VIBERZI 2 M; QL VSL#3 DS 3

XERMELO 3 PA; M; S; QL ZELAC 3

ZORBTIVE 3 PA; M; S Genetic or Enzyme

Disorder - Drugs for

Replacement,

Modification,

Treatment

ALDURAZYME 6 MSD AMMONUL 6 MSD BRINEURA 6 M; MSD BUPHENYL 3 M CERDELGA 3 M; S CEREZYME 6 MSD CREON 2 M CRYSVITA 6 M; MSD CYSTADANE 3 M; S CYSTAGON 3 PA; M; S


Drug Name Drug

Category

Limits/

Required

oxybutynin chloride er oral tablet extended release 24 hour 5 mg

1

M; QL

oxybutynin chloride oral 1 M OXYTROL 3 ST; M; QL penicillamine oral 1

phenazo oral tablet 200 mg 1

phenazopyridine hcl oral tablet 100 mg, 200 mg

1

PHOSLYRA 2 M phosphasal 1

PYRIDIUM 3

RENACIDIN 6 MSD RENAGEL 3 ST; M RENVELA 3 M sevelamer carbonate 1 M sevelamer hcl 1 M solifenacin succinate 1 M THIOLA 4 M; S THIOLA EC 3 M tolterodine tartrate 1 M tolterodine tartrate er 1 M TOVIAZ 2 ST; M trospium chloride 1 M trospium chloride er 1 M URECHOLINE 3

uretron d/s 1

urimar-t 1

urin ds 1

UROGESIC-BLUE 1

uryl 1

ustell 1

uticap 1

utira-c 1

utrona-c 1

VELPHORO 2 M VESICARE 2 ST; M

Drug Name Drug

Category

Limits/

Required

Genitourinary Agents

- Drugs for Bladder,

Genital and Kidney

Conditions

AURYXIA 3 M bethanechol chloride oral 1

calcium acetate (phos binder) 1 M

CUPRIMINE 3 ST darifenacin hydrobromide er 1 M

DEPEN TITRATABS 2

DETROL 3 ST; M DETROL LA 3 ST; M DITROPAN XL ORAL TABLET EXTENDED RELEASE 24 HOUR 10 MG

3

ST; M

DITROPAN XL ORAL TABLET EXTENDED RELEASE 24 HOUR 5 MG

3

ST; M; QL

D-PENAMINE 2

ELMIRON 2

ENABLEX 3 ST; M FEM PH 1

flavoxate hcl 1 M FOSRENOL 3 ST; M GELNIQUE 2 ST; M; QL GELNIQUE PUMP 2 ST; M; QL hyophen 1

INTRAROSA 3 M lanthanum carbonate 1 M LITHOSTAT 3 M me/naphos/mb/hyo1 1

MYRBETRIQ 2 ST; M oxybutynin chloride er oral tablet extended release 24 hour 10 mg, 15 mg

1

M


Drug Name Drug

Category

Limits/

Required

BETAMETHASONE SOD PHOS & ACET INJECTION SUSPENSION 7 (4-3) MG/ML

6

MSD

BETAMETHASONE SOD PHOS & ACET SUSPENSION 6 (3-3) MG/ML INJECTION

6

MSD

betamethasone sod phos & acet suspension 6 (3-3) mg/ml injection

6

MSD

BETAMETHASONE SODIUM PHOSPHATE INJECTION

6

MSD

BUPIVILOG 3

CELESTONE SOLUSPAN 6 MSD

CONTRAST ALLERGY PREMED PACK 3

CORTEF 3

cortisone acetate oral 1

DECADRON ORAL TABLET 1

DEPO-MEDROL 6 MSD DEXAMETHASONE (LA) 6 MSD

DEXAMETHASONE ACE & SOD PHOS 6 MSD

DEXAMETHASONE INTENSOL 1

dexamethasone oral elixir 1

dexamethasone oral solution 1

dexamethasone oral tablet 1

dexamethasone oral tablet therapy pack 1 ST

DEXAMETHASONE SOD PHOS-BUPIV 3

Drug Name Drug

Category

Limits/

Required

Genitourinary Agents

- Drugs for Prostate

Conditions

alfuzosin hcl er 1 M AVODART 3 ST; M CARDURA XL 3 M; QL dutasteride oral 1 M dutasteride-tamsulosin hcl 1 M

finasteride oral tablet 5 mg 1 M

FLOMAX 3 ST; M JALYN 3 ST; M PROSCAR 3 ST; M RAPAFLO 3 ST; M silodosin 1 M tamsulosin hcl 1 M terazosin hcl 1 M; QL UROXATRAL 3 ST; M Hormonal Agents -

Adrenal

ACTIVE INJECTION BLM-1 3

ACTIVE INJECTION BM 3

ACTIVE INJECTION DL 3

ACTIVE INJECTION DLM 3

ACTIVE INJECTION KIT L 3

ACTIVE INJECTION KM 3

ACTIVE INJECTION LM-DEP-2 3

ACTIVE INJECTION M-1 3

BETA 1 KIT 6 MSD BETALIDO 3


Drug Name Drug

Category

Limits/

Required

METHYLPREDNISOL ONE ACETATE INJECTION SUSPENSION 50 MG/ML

6

MSD

METHYLPREDNISOL ONE ACETATE SUSPENSION 40 MG/ML INJECTION

6

MSD

methylprednisolone acetate suspension 40 mg/ml injection

6

MSD

METHYLPREDNISOL ONE ACETATE SUSPENSION 80 MG/ML INJECTION

6

MSD

methylprednisolone acetate suspension 80 mg/ml injection

6

MSD

methylprednisolone oral 1

methylprednisolone sodium succ 6 MSD

METHYLPREDNISOL ONE-BUPIVACAINE 6 MSD

MILLIPRED 1

MILLIPRED DP 1

MILLIPRED DP 12- DAY 1

MULTI-SPECIALTY 3

ORAPRED ODT 3

P-CARE D40MX 3

P-CARE D80MX 3

P-CARE K40 6 MSD P-CARE K40G 6 MSD P-CARE K40MX 3

P-CARE K80 6 MSD P-CARE K80G 6 MSD P-CARE K80MX 3

PEDIAPRED 1

POD-CARE 100K 6 MSD POINT OF CARE KM 3

Drug Name Drug

Category

Limits/

Required

DEXAMETHASONE SOD PHOS-NACL INTRAVENOUS SOLUTION 10-0.9 MG/50ML-%

6

MSD

dexamethasone sod phosphate pf 6 MSD

dexamethasone sodium phosphate injection

6

MSD

DEXLIDO 3

DEXLIDO-M 3

DEXOPIN 3

DEXPAK 10 DAY 3 ST DEXPAK 13 DAY 3 ST DEXPAK 6 DAY 3 ST DXEVO 11-DAY 3

DYURAL-40 3

DYURAL-80 3

DYURAL-L 3

DYURAL-LM 3

fludrocortisone acetate oral 1 M

HIDEX 6-DAY 2 ST hydrocortisone oral 1

KENALOG INJECTION 6 MSD KENALOG-80 6 MSD lidolog 1

LT INJECTION KIT 3

MARBETA-25 3

MARBETA-L 3

MARDEX-25 3

MEDROL 3

MEDROLOAN II SUIK 6 MSD MEDROLOAN SUIK 6 MSD METHYLPREDNISOL ONE ACE-LIDO 3


Drug Name Drug

Category

Limits/

Required

Drug Name Drug

Category

Limits/

Required

POINT OF CARE L.2 3 triamcinolone acetonide suspension 40 mg/ml injection

6

MSD POINT OF CARE L.5 3

POINT OF CARE LM DEP 2 3

TRIAMCINOLONE DIACETATE INJECTION

6

MSD

prednisolone oral solution 1

TRIAMCINOLONE- BUPIVACAINE 6 MSD prednisolone sodium

phosphate oral 1

TRILOAN II SUIK 6 MSD PREDNISONE INTENSOL 1

TRILOAN SUIK 6 MSD ZILRETTA 6 MSD prednisone oral 1

Hormonal Agents -

Men's Health

PRO-C-DURE 5 6 MSD PRO-C-DURE 6 6 MSD

ANADROL-50 3 RAYOS 3 ST

ANDRODERM 2 PA; M READYSHARP ANESTH + BETAMETH

3

ANDROGEL PUMP 3 PA; M ANDROGEL TRANSDERMAL GEL 20.25 MG/1.25GM (1.62%), 40.5 MG/2.5GM (1.62%)

3

PA; M

READYSHARP ANESTH + DEXAMETH

3

READYSHARP ANESTH + METHYLPRED

3

ANDROGEL TRANSDERMAL GEL 25 MG/2.5GM (1%), 50 MG/5GM (1%)

3

ST; M

READYSHARP BETAMETHASONE 6 MSD

AVEED 6 PA; MSD READYSHARP DEXAMETHASONE 6 MSD danazol oral 1

DEPO- TESTOSTERONE 3 PA ROPIDEX 3

SOLU-CORTEF 6 MSD EC-RX TESTOSTERONE 3 M SOLU-MEDROL 6 MSD

TAPERDEX 12-DAY 3 ST FORTESTA 3 ST; M

TAPERDEX 6-DAY 3 ST METHITEST 2 M

TAPERDEX 7-DAY 3 ST methyltestosterone oral 1 M

TRIAMCINOLONE ACETONIDE INJECTION SUSPENSION 50 MG/ML

6

MSD

NANDROLONE DECANOATE INJECTION

3

NANDROLONE- 3


TRIAMCINOLONE ACETONIDE SUSPENSION 40 MG/ML INJECTION

6

MSD

TESTOSTERONE CYP NATESTO 3 ST; M oxandrolone oral 1 QL STRIANT 3 PA; M


Drug Name Drug

Category

Limits/

Required

Hormonal Agents -

Parathyroid

cinacalcet hcl 1 M SENSIPAR 2 M Hormonal Agents -

Pituitary

ACTHAR 6 PA; MSD cabergoline 1 QL CETROTIDE 7

chorionic gonadotropin intramuscular 7 ST; QL

DDAVP INJECTION 6 MSD DDAVP NASAL 3 M DDAVP ORAL 3 M DDAVP RHINAL TUBE 3 M desmopressin ace spray refrig 1 M

desmopressin acetate injection 6 MSD

desmopressin acetate oral 1 M

desmopressin acetate spray 1 M

EGRIFTA 3 PA; M; S; QL ELIGARD 3 S; QL FIRMAGON 3 S; QL FOLLISTIM AQ 7 ST ganirelix acetate subcutaneous solution 250 mcg/0.5ml

7

ST

GENOTROPIN 3 PA; M; S GENOTROPIN MINIQUICK 3 PA; M; S

GHRP2-GHRP6- SERMORELIN 3

GHRP2-SERMORELIN 3

GONAL-F 7 ST GONAL-F RFF 7 ST GONAL-F RFF REDIJECT 7 ST

Drug Name Drug

Category

Limits/

Required

TESTIM 3 ST; M TESTOPEL 3 PA TESTOSTERONE COMPOUNDING KIT 3 M

TESTOSTERONE CYPIONATE & PROP 3

TESTOSTERONE CYPIONATE INJECTION

3

PA

testosterone cypionate intramuscular 1 PA

TESTOSTERONE ENANTHATE INJECTION

1

PA

testosterone enanthate intramuscular 1 PA

TESTOSTERONE IMPLANT 3 PA

TESTOSTERONE PROPIONATE INJECTION

3

testosterone transdermal gel 10 mg/act (2%), 12.5 mg/act (1%), 20.25 mg/1.25gm (1.62%), 20.25 mg/act (1.62%), 25 mg/2.5gm (1%), 40.5 mg/2.5gm (1.62%), 50 mg/5gm (1%)

1

PA; M

testosterone transdermal solution 1 PA; M

VOGELXO 3 ST; M VOGELXO PUMP 3 ST; M XYOSTED 3 PA; M Hormonal Agents -

Osteoporosis

clomiphene citrate oral 7

EVISTA 3 PA; M OSPHENA 3 M raloxifene hcl 1 PA; M


Drug Name Drug

Category

Limits/

Required

OMNITROPE SUBCUTANEOUS SOLUTION

4

PA; M; S

OMNITROPE SUBCUTANEOUS SOLUTION RECONSTITUTED

3

PA; M; S

ORILISSA 2 PA; QL OVIDREL 7

oxytocin injection 6 MSD OXYTOCIN- DEXTROSE 6 MSD

OXYTOCIN- LACTATED RINGERS 6 MSD

OXYTOCIN-SODIUM CHLORIDE INTRAVENOUS SOLUTION 20-0.9 UNT/L-%, 20-0.9 UT/500ML-%, 30-0.9 UNIT/L-%, 30-0.9 UT/500ML-%, 40-0.9 UNIT/L-%

6

MSD

PITOCIN 6 MSD pregnyl 7 ST; QL SAIZEN 3 PA; M; S SAIZENPREP 3 PA; M; S SANDOSTATIN 4 M; S SANDOSTATIN LAR DEPOT 6 MSD; QL

SIGNIFOR 6 M; MSD; QL SIGNIFOR LAR 6 M; MSD; QL SOMATULINE DEPOT 3 S SOMAVERT 3 M; S STIMATE 2 M SUPPRELIN LA 6 MSD; QL SYNAREL 2

TRELSTAR MIXJECT 6 MSD; QL TRIPTODUR 6 MSD; QL VANTAS 6 MSD; QL

Drug Name Drug

Category

Limits/

Required

HCG 7

HUMATROPE 3 PA; M; S INCRELEX 3 PA; M; S IPAMORELIN ACETATE 3

leuprolide acetate injection 1 S

LEUPROLIDE ACETATE- BUPIVACAINE

3

LUPANETA PACK 2 QL LUPRON DEPOT (1- MONTH) 3 S

LUPRON DEPOT (3- MONTH) 3 S

LUPRON DEPOT (4- MONTH) INTRAMUSCULAR KIT 30MG

3

S

LUPRON DEPOT (6- MONTH) INTRAMUSCULAR KIT 45MG

3

S

LUPRON DEPOT-PED (1-MONTH) 3 PA; S

LUPRON DEPOT-PED (3-MONTH) 2 PA

MENOPUR 7

NOCDURNA 3 M NOCTIVA 3 ST; M NORDITROPIN FLEXPRO 3 PA; M; S

NOVAREL 7

NUTROPIN AQ NUSPIN 10 4 PA; M; S



octreotide acetate 1 M; S


Drug Name Drug

Category

Limits/

Required

aurovela fe 1.5/30 5 M; ACA aurovela fe 1/20 5 M; ACA aviane 5 M; ACA AYGESTIN 3 M ayuna 5 M; ACA azurette 5 M; ACA BALCOLTRA 5 M; ACA balziva 5 M; ACA bekyree 5 M; ACA BEYAZ 3 ST; M BI-EST 80:20 PROGESTERONE 3

BIEST/PROGESTERO NE 3

BIJUVA 3 M blisovi 24 fe 5 M; ACA blisovi fe 1.5/30 5 M; ACA blisovi fe 1/20 5 M; ACA briellyn 5 M; ACA camila 5 M; ACA camrese 5 M; ACA; QL camrese lo 5 M; ACA; QL caziant 5 M; ACA chateal 5 M; ACA chateal eq 5 M; ACA CLIMARA 3 M; QL CLIMARA PRO 3 ST; M; QL COMBIPATCH 2 M covaryx 1 M covaryx hs 1 M CRINONE VAGINAL GEL 4 % 2 QL

CRINONE VAGINAL GEL 8 % 7 QL

cryselle-28 5 M; ACA cyclafem 1/35 5 M; ACA cyclafem 7/7/7 5 M; ACA cyred 5 M; ACA

Drug Name Drug

Category

Limits/

Required

VASOPRESSIN- SODIUM CHLORIDE INTRAVENOUS SOLUTION 100-0.9 UT/100ML-%, 100-0.9 UT/250ML-%, 40-0.9 UT/100ML-%

6

MSD

VASOSTRICT 6 MSD ZOLADEX 6 MSD; QL ZOMACTON 3 PA; M; S Hormonal Agents -

Prostaglandins

carboprost tromethamine 6 MSD

CERVIDIL 3

HEMABATE 6 MSD KORLYM 4 PA; M; S; QL Hormonal Agents -

Sex Hormones and

Birth Control

ACTIVELLA 3 M afirmelle 5 M; ACA ALORA 3 M; QL altavera 5 M; ACA alyacen 1/35 5 M; ACA alyacen 7/7/7 5 M; ACA amabelz 1 M amethia 5 M; ACA; QL amethia lo 5 M; ACA; QL amethyst 5 M; ACA ANGELIQ 3 M ANNOVERA 5 M; ACA apri 5 M; ACA aranelle 5 M; ACA ashlyna 5 M; ACA; QL aubra 5 M; ACA aubra eq 5 M; ACA aurovela 1.5/30 5 M; ACA aurovela 1/20 5 M; ACA aurovela 24 fe 5 M; ACA


Drug Name Drug

Category

Limits/

Required

ELESTRIN 3 M; QL elinest 5 M; ACA ELLA 5 ACA; QL emoquette 5 M; ACA ENDOMETRIN 7 ST enpresse-28 5 M; ACA enskyce 5 M; ACA errin 5 M; ACA est estrogens- methyltest 1 M

est estrogens- methyltest ds 1 M

est estrogens- methyltest hs 1 M

estarylla 5 M; ACA ESTRACE 3 M estradiol oral 1 M estradiol transdermal 1 M; QL estradiol vaginal 1 M estradiol valerate intramuscular 1

estradiol-norethindrone acet 1 M

ESTRING 2 M; QL ESTROGEL 3 ST; M; QL ESTROSTEP FE 3 ST; M ethynodiol diac-eth estradiol 5 M; ACA

EVAMIST 3 M; QL FALESSA 5 M; ACA falmina 5 M; ACA fayosim 5 M; ACA; QL FEMHRT LOW DOSE 3 M FEMRING 3 ST; M; QL femynor 5 M; ACA fyavolv 1 M GENERESS FE 3 ST; M gianvi 5 M; ACA hailey 1.5/30 5 M; ACA

Drug Name Drug

Category

Limits/

Required

cyred eq 5 M; ACA dasetta 1/35 5 M; ACA dasetta 7/7/7 5 M; ACA daysee 5 M; ACA; QL deblitane 5 M; ACA DELESTROGEN 3

delyla 5 M; ACA DEPO-ESTRADIOL 2

DEPO-PROVERA INTRAMUSCULAR SUSPENSION 150 MG/ML

3

QL

DEPO-PROVERA INTRAMUSCULAR SUSPENSION 400 MG/ML

6

MSD

DEPO-PROVERA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

3

QL

DEPO-SUBQ PROVERA 104 5 ACA; QL

desogestrel-ethinyl estradiol 5 M; ACA

DIVIGEL TRANSDERMAL GEL 0.25 MG/0.25GM, 0.5 MG/0.5GM, 1 MG/GM

2

M; QL

DIVIGEL TRANSDERMAL GEL 0.75 MG/0.75GM

2

M

dotti 1 M; QL drospiren-eth estrad- levomefol 5 M; ACA

drospirenone-ethinyl estradiol 5 M; ACA

DUAVEE 2 M EC-RX ESTRADIOL 3 M EC-RX PROGESTERONE 3

eemt 1 M eemt hs 1 M


Drug Name Drug

Category

Limits/

Required

Drug Name Drug

Category

Limits/

Required

hailey 24 fe 5 M; ACA levonorgest-eth est & eth est 5 M; ACA; QL

heather 5 M; ACA levonorgest-eth estrad 91-day 5 M; ACA; QL hydroxyprogesterone

caproate intramuscular 6 MSD

levonorgestrel 5 ACA; OTC; QL IMVEXXY MAINTENANCE PACK 3 M levonorgestrel-ethinyl

estrad 5 M; ACA IMVEXXY STARTER PACK 3 M levonorg-eth estrad

triphasic 5 M; ACA incassia 5 M; ACA

levora 0.15/30 (28) 5 M; ACA introvale 5 M; ACA; QL LILETTA (52 MG) 6 MSD isibloom 5 M; ACA lillow 5 M; ACA jasmiel 5 M; ACA LO LOESTRIN FE 5 M; ACA jencycla 5 M; ACA LOESTRIN 1.5/30 (21) 3 ST; M jinteli 1 M LOESTRIN 1/20 (21) 3 ST; M jolessa 5 M; ACA; QL LOESTRIN FE 1.5/30 3 ST; M juleber 5 M; ACA LOESTRIN FE 1/20 3 ST; M junel 1.5/30 5 M; ACA lopreeza 1 M junel 1/20 5 M; ACA loryna 5 M; ACA junel fe 1.5/30 5 M; ACA LOSEASONIQUE 3 ST; M; QL junel fe 1/20 5 M; ACA low-ogestrel 5 M; ACA junel fe 24 5 M; ACA lo-zumandimine 5 M; ACA kaitlib fe 5 M; ACA lutera 5 M; ACA kalliga 5 M; ACA lyza 5 M; ACA kariva 5 M; ACA MAKENA 6 MSD kelnor 1/35 5 M; ACA marlissa 5 M; ACA kelnor 1/50 5 M; ACA medroxyprogesterone acetate intramuscular 5 ACA; QL kurvelo 5 M; ACA

KYLEENA 6 MSD medroxyprogesterone acetate oral 1 M larin 1.5/30 5 M; ACA

larin 1/20 5 M; ACA MEGACE ES 3 M

larin 24 fe 5 M; ACA megestrol acetate oral suspension 40 mg/ml, 400 mg/10ml

1

larin fe 1.5/30 5 M; ACA larin fe 1/20 5 M; ACA

megestrol acetate oral suspension 625 mg/5ml 1 M larissia 5 M; ACA

layolis fe 5 M; ACA megestrol acetate oral tablet 1 S leena 5 M; ACA

lessina 5 M; ACA


melodetta 24 fe 5 M; ACA levonest 5 M; ACA

MENEST 3 M


Drug Name Drug

Category

Limits/

Required

NUVARING 5 M; ACA; QL ocella 5 M; ACA ogestrel 5 M; ACA orsythia 5 M; ACA ORTHO MICRONOR 3 ST; M ORTHO TRI-CYCLEN LO 3 ST; M

ORTHO-NOVUM 1/35 (28) 3 ST; M

ORTHO-NOVUM 7/7/7 (28) 3 ST; M

PARAGARD INTRAUTERINE COPPER

6

MSD

philith 5 M; ACA pimtrea 5 M; ACA pirmella 1/35 5 M; ACA pirmella 7/7/7 5 M; ACA portia-28 5 M; ACA PREFEST 3 M PREMARIN INJECTION 6 MSD

PREMARIN ORAL 2 M PREMARIN VAGINAL 2 M PREMPHASE 2 M PREMPRO 2 M preventeza 5 ACA; OTC; QL previfem 5 M; ACA PROGESTERONE COMPOUNDING KIT 3

progesterone intramuscular 7

progesterone micronized oral 1 M

progesterone micronized transdermal 1

PROMETRIUM 3 M PROVERA 3 M QUARTETTE 3 ST; M; QL reclipsen 5 M; ACA

Drug Name Drug

Category

Limits/

Required

MENOSTAR 3 M; QL mibelas 24 fe 5 M; ACA microgestin 1.5/30 5 M; ACA microgestin 1/20 5 M; ACA microgestin fe 1.5/30 5 M; ACA microgestin fe 1/20 5 M; ACA mili 5 M; ACA mimvey 1 M mimvey lo 1 M MINASTRIN 24 FE 3 ST; M MINIVELLE 3 ST; M; QL MIRCETTE 3 ST; M MIRENA (52 MG) 6 MSD mono-linyah 5 M; ACA NATAZIA 5 M; ACA necon 0.5/35 (28) 5 M; ACA NEXPLANON 6 MSD nikki 5 M; ACA nora-be 5 M; ACA norethin ace-eth estrad-fe 5 M; ACA

norethindrone acetate oral 1 M

norethindrone acet- ethinyl est 5 M; ACA

norethindrone oral 5 M; ACA norethindrone-eth estradiol 1 M

norethin-eth estradiol-fe 5 M; ACA norgestimate-eth estradiol 5 M; ACA

norgestimate-ethinyl estradiol triphasic 5 M; ACA

norlyda 5 M; ACA norlyroc 5 M; ACA nortrel 0.5/35 (28) 5 M; ACA nortrel 1/35 (21) 5 M; ACA nortrel 1/35 (28) 5 M; ACA nortrel 7/7/7 5 M; ACA


Drug Name Drug

Category

Limits/

Required

VIVELLE-DOT 3 ST; M; QL vyfemla 5 M; ACA vylibra 5 M; ACA wera 5 M; ACA wymzya fe 5 M; ACA xulane 5 M; ACA YASMIN 28 3 ST; M YAZ 3 ST; M yuvafem 1 M zarah 5 M; ACA zovia 1/35e (28) 5 M; ACA zumandimine 5 M; ACA Hormonal Agents -

Thyroid

ARMOUR THYROID 1 M CYTOMEL 3 ST; M euthyrox 3 M levo-t 3 M levothyroxine sodium intravenous 6 MSD

levothyroxine sodium oral 1 M

levothyroxine- liothyronine oral tablet 120 mg, 15 mg, 30 mg, 60 mg, 90 mg

1

M

levoxyl 1 M liothyronine sodium intravenous 6 MSD

liothyronine sodium oral 1 M methimazole oral 1 M NATURE-THROID ORAL TABLET 113.75 MG, 146.25 MG, 162.5 MG, 260 MG, 325 MG, 48.75 MG, 81.25 MG, 97.5 MG

1

M

nature-throid oral tablet 130 mg, 16.25 mg, 195 mg, 32.5 mg, 65 mg

1

M

np thyroid 1 M

Drug Name Drug

Category

Limits/

Required

rivelsa 5 M; ACA; QL SAFYRAL 3 ST; M SEASONIQUE 3 ST; M; QL setlakin 5 M; ACA; QL sharobel 5 M; ACA simliya 5 M; ACA simpesse 5 M; ACA; QL SKYLA 6 MSD SLYND 5 M; ACA sprintec 28 5 M; ACA sronyx 5 M; ACA syeda 5 M; ACA tarina 24 fe 5 M; ACA tarina fe 1/20 5 M; ACA tarina fe 1/20 eq 5 M; ACA TAYTULLA 5 M; ACA tilia fe 5 M; ACA tri femynor 5 M; ACA tri-estarylla 5 M; ACA tri-legest fe 5 M; ACA tri-linyah 5 M; ACA tri-lo-estarylla 5 M; ACA tri-lo-marzia 5 M; ACA tri-lo-mili 5 M; ACA tri-lo-sprintec 5 M; ACA tri-mili 5 M; ACA tri-previfem 5 M; ACA tri-sprintec 5 M; ACA trivora (28) 5 M; ACA tri-vylibra 5 M; ACA tri-vylibra lo 5 M; ACA tulana 5 M; ACA tydemy 5 M; ACA VAGIFEM 3 ST; M velivet 5 M; ACA vienva 5 M; ACA viorele 5 M; ACA


Drug Name Drug

Category

Limits/

Required

CARIMUNE NF SOLUTION RECONSTITUTED 12 GM INTRAVENOUS

6

PA; MSD

carimune nf solution reconstituted 12 gm intravenous

6

PA; MSD

CARIMUNE NF SOLUTION RECONSTITUTED 6 GM INTRAVENOUS

6

PA; MSD

carimune nf solution reconstituted 6 gm intravenous

6

PA; MSD

CELLCEPT 3 M CELLCEPT INTRAVENOUS 6 MSD

CIMZIA 3 PA; S CIMZIA PREFILLED KIT 3 PA; M; S

CIMZIA STARTER KIT 3 PA; M; S CINRYZE 6 MSD COSENTYX (300 MG DOSE) 3 PA; M; S; QL

COSENTYX 150 MG/ML 3 PA; M; S; QL

COSENTYX SENSOREADY (300 MG)

3

PA; M; S; QL

COSENTYX SENSOREADY PEN 3 PA; M; S; QL

CUTAQUIG SOLUTION 1 GM/6ML SUBCUTANEOUS

3

PA


6

PA; MSD


3

PA

Drug Name Drug

Category

Limits/

Required

PARSABIV 6 M; MSD propylthiouracil oral 1 M SYNTHROID 3 M TAPAZOLE 3 M TIROSINT 3 M TIROSINT-SOL 6 M; MSD TRIOSTAT 6 ST; MSD unithroid 1 M westhroid oral tablet 130 mg, 32.5 mg, 65 mg

1

M

WESTHROID ORAL TABLET 195 MG, 97.5 MG

1

M

WP THYROID 1 M Immunological

Agents - Drugs for

Immune System

Stimulation or

Suppression

ACTEMRA ACTPEN 4 PA; M; S ACTEMRA INTRAVENOUS 6 PA; MSD

ACTEMRA SUBCUTANEOUS 4 PA; M; S; QL

ACTIMMUNE 6 M; MSD ALFERON N 6 MSD ARAVA 3 M; QL ARCALYST 4 PA; M; S ASTAGRAF XL 3 ST; M ATGAM 6 MSD AZASAN 3 M azathioprine oral 1 M azathioprine sodium 6 MSD BENLYSTA INTRAVENOUS 6 MSD

BENLYSTA SUBCUTANEOUS 3 PA; M; S

BERINERT 6 MSD BIVIGAM 6 PA; MSD


Drug Name Drug Limits/ Drug Name Drug Limits/

Category Required Category Required

CUTAQUIG GAMASTAN S/D

SOLUTION 2 GM/12ML 6 PA; MSD INJECTABLE

INTRAMUSCULAR 6 MSD

SUBCUTANEOUS

GAMIFANT 6 MSD CUTAQUIG

GAMMAGARD 6 PA; MSD SOLUTION 4 GM/24ML SUBCUTANEOUS

3 PA GAMMAGARD S/D LESS IGA 6 PA; MSD

GAMMAKED 6 PA; MSD CUTAQUIG

GAMMAPLEX 6 PA; MSD SOLUTION 4 GM/24ML 6 PA; MSD

GAMUNEX-C 6 PA; MSD SUBCUTANEOUS

gengraf 1 M CUTAQUIG

HAEGARDA 6 MSD SOLUTION 8 GM/48ML 3 PA HEPAGAM B 6 MSD SUBCUTANEOUS

HIZENTRA 6 PA; MSD CUTAQUIG

HUMIRA 3 PA; M; S; QL SOLUTION 8 GM/48ML 6 PA; MSD HUMIRA PEDIATRIC

CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 40 MG/0.8ML, 80 MG/0.8ML & 40MG/0.4ML

SUBCUTANEOUS

CUTAQUIG SUBCUTANEOUS

3 PA; M; S; QL

SOLUTION 1.65 6 PA; MSD

GM/10ML, 3.3

GM/20ML

HUMIRA PEDIATRIC CUVITRU 6 PA; MSD

CROHNS START

6 MSD cyclosporine SUBCUTANEOUS 3 PA; M; S intravenous PREFILLED SYRINGE

KIT 80 MG/0.8ML cyclosporine modified 1 M HUMIRA PEN 3 PA; M; S; QL cyclosporine oral 1 M HUMIRA PEN- CD/UC/HS STARTER SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML

3

PA; M; S; QL

CYTOGAM 6 MSD ENBREL 4 PA; M; S; QL ENBREL MINI 4 PA; M; S; QL ENBREL SURECLICK 4 PA; M; S; QL

HUMIRA PEN- CD/UC/HS STARTER SUBCUTANEOUS PEN-INJECTOR KIT 80 MG/0.8ML

3

PA; M; S

ENTYVIO 6 MSD ENVARSUS XR 3 ST; M FIRAZYR 3 PA; S FLEBOGAMMA DIF 6 PA; MSD

HUMIRA PEN-

GAMASTAN 6 MSD


gamastan s/d injectable intramuscular 6 MSD

PS/UV/ADOL HS START SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML

3

PA; M; S; QL


Drug Name Drug

Category

Limits/

Required

NULOJIX 6 MSD OCTAGAM 6 PA; MSD OLUMIANT 4 PA; M; S ORENCIA CLICKJECT 4 PA; M; S ORENCIA INTRAVENOUS 6 PA; M; MSD

ORENCIA SUBCUTANEOUS 4 PA; M; S

OTEZLA ORAL TABLET 3 PA; M; S; QL

OTEZLA ORAL TABLET THERAPY PACK

3

PA; S; QL

OTREXUP 3 M; S; QL PANZYGA 6 PA; MSD PRIVIGEN 6 PA; MSD PROGRAF INTRAVENOUS 6 MSD

PROGRAF ORAL 3 M PROVENGE 6 MSD RAPAMUNE ORAL SOLUTION 2 M

RAPAMUNE ORAL TABLET 3 M

RASUVO 3 M; S; QL REMICADE 6 PA; MSD RENFLEXIS 6 PA; MSD RHOGAM ULTRA- FILTERED PLUS 6 MSD

RHOPHYLAC 6 MSD RIDAURA 2 M RUCONEST 6 MSD SANDIMMUNE INTRAVENOUS 6 MSD

SANDIMMUNE ORAL CAPSULE 3 M

SANDIMMUNE ORAL SOLUTION 2 M

SILIQ 4 PA; M; S SIMPONI 3 PA; M; S; QL

Drug Name Drug

Category

Limits/

Required

HUMIRA PEN- PS/UV/ADOL HS START SUBCUTANEOUS PEN-INJECTOR KIT 80 MG/0.8ML & 40MG/0.4ML

3

PA; M; S

HYPERHEP B S/D 6 MSD HYPERRAB 6 MSD HYPERRAB S/D 6 MSD HYPERRHO S/D 6 MSD HYPERTET S/D 6 MSD HYQVIA 6 PA; MSD icatibant acetate 1 PA ILARIS 6 PA; MSD; QL ILUMYA 4 M; S IMOGAM RABIES-HT INJECTION SOLUTION 300 UNIT/2ML

6

MSD

IMURAN 3 M INFLECTRA 6 PA; MSD KEDRAB 6 MSD KEVZARA 4 PA; M; S KINERET 4 PA; M; S; QL KYMRIAH 6 MSD leflunomide oral 1 M; QL methotrexate oral 1

methotrexate sodium 1

methotrexate sodium (pf) 1

MICRHOGAM ULTRA- FILTERED PLUS 6 MSD

mycophenolate mofetil 1 M mycophenolate mofetil hcl 6 MSD

mycophenolate sodium 1 M MYFORTIC 3 M nabi-hb 6 MSD NEORAL 3 M


Drug Name Drug

Category

Limits/

Required

DIPHTHERIA- TETANUS TOXOIDS DT

5

ACA

ENGERIX-B 5 ACA EZ FLU SHOT- FLUCELVAX QUAD 5 ACA

FLUAD 5 ACA FLUARIX QUADRIVALENT 5 ACA

FLUBLOK QUADRIVALENT 5 ACA

FLUCELVAX QUADRIVALENT 5 ACA

FLULAVAL QUADRIVALENT 5 ACA

FLUMIST QUADRIVALENT 5 ACA

FLUZONE HIGH- DOSE 5 ACA

FLUZONE QUADRIVALENT 5 ACA

GARDASIL 9 5 ACA HAVRIX 5 ACA HEPLISAV-B 5 ACA HIBERIX 5 ACA IMOVAX RABIES 6 MSD INFANRIX 5 ACA IPOL 5 ACA IXIARO 6 MSD KINRIX 5 ACA MENACTRA 5 ACA MENVEO 5 ACA M-M-R II SUBCUTANEOUS INJECTABLE

5

ACA

PEDIARIX 5 ACA PEDVAX HIB 5 ACA PENTACEL 5 ACA pneumovax 23 injectable 25 mcg/0.5ml injection

5

ACA

Drug Name Drug

Category

Limits/

Required

SIMPONI ARIA 6 PA; M; MSD SIMULECT 6 MSD sirolimus oral 1 M SKYRIZI (150 MG DOSE) 3 PA; M

STELARA INTRAVENOUS 6 PA; MSD

STELARA SUBCUTANEOUS 3 PA; M; S

SYNAGIS 6 PA; MSD tacrolimus oral 1 M TALTZ 4 PA; M; S temsirolimus 6 MSD THYMOGLOBULIN 6 MSD TICE BCG 6 MSD TORISEL 6 MSD TREMFYA 3 PA; M; S TREXALL 3

VARIZIG 2

WINRHO SDF 6 MSD XATMEP 4 PA; S XELJANZ 3 PA; M; S; QL XELJANZ XR 3 PA; M; S; QL ZINPLAVA 6 PA; MSD ZORTRESS 2 M Immunological

Agents - Drugs for

Vaccination

ACTHIB 5 ACA ADACEL 5 ACA AFLURIA QUADRIVALENT 5 ACA

BCG VACCINE 6 MSD BEXSERO 5 ACA BIOTHRAX 6 MSD BOOSTRIX 5 ACA DAPTACEL 5 ACA


Drug Name Drug

Category

Limits/

Required

AZULFIDINE 3 M AZULFIDINE EN-TABS 3 M balsalazide disodium 1

budesonide er 1

budesonide oral 1

CANASA 3

COLAZAL 3

colocort 1

CORTENEMA 3

CORTIFOAM 3 ST DELZICOL 3 ST; M DIPENTUM 3 ST; M ENTOCORT EC 3

hemmorex-hc 1

hydrocortisone ace- pramoxine rectal 1

hydrocortisone acetate rectal 1

hydrocortisone rectal 1

LIALDA 3 M mesalamine oral capsule delayed release

1

M

mesalamine oral tablet delayed release 1.2 gm 1 M

mesalamine oral tablet delayed release 800 mg

1

mesalamine rectal 1

mesalamine-cleanser 1

PENTASA 2 M PROCORT 3

PROCTOCORT RECTAL CREAM 3 ST

PROCTOCORT RECTAL SUPPOSITORY

3

PROCTOFOAM HC 3

procto-med hc 1

procto-pak 1

Drug Name Drug

Category

Limits/

Required

PNEUMOVAX 23 INJECTABLE 25 MCG/0.5ML INJECTION

5

ACA

PREVNAR 13 5 ACA PROQUAD 5 ACA QUADRACEL 5 ACA RABAVERT 6 MSD RECOMBIVAX HB 5 ACA ROTARIX 5 ACA ROTATEQ 5 ACA SHINGRIX 5 ACA STAMARIL 6 MSD TDVAX 5 ACA TENIVAC 5 ACA TRUMENBA 5 ACA TWINRIX 5 ACA TYPHIM VI 6 MSD VAQTA 5 ACA VARIVAX 5 ACA VAXCHORA 6 MSD VIVOTIF 6 MSD yf-vax injectable subcutaneous 6 MSD

YF-VAX INJECTABLE SUBCUTANEOUS 6 MSD

ZOSTAVAX 5 ACA Inflammatory Bowel

Disease Agents

ANALPRAM HC 3

ANALPRAM HC SINGLES 3

ANALPRAM-HC 3

anucort-hc 1

ANUSOL-HC RECTAL CREAM 3 ST

anusol-hc rectal suppository 3

APRISO 2 M ASACOL HD 3 ST


Drug Name Drug

Category

Limits/

Required

ibandronate sodium intravenous 6 PA; MSD; QL

ibandronate sodium oral 1 M; QL

MIACALCIN INJECTION 6 MSD

NATPARA 3 PA; M; S; QL pamidronate disodium 6 MSD paricalcitol intravenous 6 MSD paricalcitol oral 1 M PROLIA 6 PA; MSD; QL RAYALDEE 3 M RECLAST 6 PA; MSD risedronate sodium oral tablet 150 mg, 35 mg, 5 mg

1

M; QL

risedronate sodium oral tablet 30 mg 1

risedronate sodium oral tablet delayed release 1 M; QL

ROCALTROL 3 M TYMLOS 3 PA; M; S ZEMPLAR INTRAVENOUS 6 MSD

ZEMPLAR ORAL 3 M zoledronic acid intravenous concentrate

6

MSD

zoledronic acid intravenous solution 6 PA; MSD

Miscellaneous

Therapeutic Agents

ACACIA SUBCUTANEOUS 3

ACETADOTE 6 MSD acetylcysteine intravenous 6 MSD

ACREMONIUM 6 MSD adenosine (diagnostic) 6 MSD adenosine intravenous solution 3 mg/ml 6 MSD

Drug Name Drug

Category

Limits/

Required

proctosol hc 1

proctozone-hc 1

ROWASA 3

SFROWASA 3

sulfasalazine oral 1 M UCERIS ORAL 3

UCERIS RECTAL 2

Metabolic Bone

Disease Agents -

Drugs for

Osteoporosis

ACTONEL ORAL TABLET 150 MG, 35 MG, 5 MG

3

ST; M; QL

ACTONEL ORAL TABLET 30 MG 3 ST

alendronate sodium oral solution 1 M; QL

alendronate sodium oral tablet 10 mg, 35 mg, 5 mg, 70 mg

1

M; QL

alendronate sodium oral tablet 40 mg 1 QL

ATELVIA 3 ST; M; QL BINOSTO 3 ST; M; QL BONIVA INTRAVENOUS 6 PA; MSD; QL

BONIVA ORAL 3 ST; M; QL calcitonin (salmon) 1 M; QL calcitriol intravenous 6 MSD calcitriol oral 1 M doxercalciferol intravenous 6 MSD

doxercalciferol oral 1 M etidronate disodium 1

EVENITY 6 MSD; QL FORTEO 3 ST; M; S; QL FOSAMAX 3 ST; M; QL FOSAMAX PLUS D 3 ST; M; QL HECTOROL 6 MSD


Drug Name Drug

Category

Limits/

Required

APPLE (DIAGNOSTIC) 6 MSD ARIZONA CYPRESS 6 MSD ARTISS 6 MSD asilnasalrms 1

AURA PORTANEB 6 MSD AUREOBASIDIUM 6 MSD AUSTRALIAN PINE 6 MSD AVOCADO (DIAGNOSTIC) 6 MSD

AXUMIN 6 MSD BACTERIOSTATIC WATER(BENZ ALC) SOLUTION INJECTION

3

bacteriostatic water(benz alc) solution injection

6

MSD

BAHIA 6 MSD bal in oil 2

BALD CYPRESS 6 MSD BANANA (DIAGNOSTIC) 6 MSD

BAYBERRY (WAX MYRTLE) 6 MSD

BD SYRINGE LUER- LOK 30 ML 2

BEEF (DIAGNOSTIC) 6 MSD BENTLEY THE BEAR PED NEBULIZER 6 MSD

BERMUDA GRASS 6 MSD BIOFREQUENCY INSOLES 3

BIOGUARD ISLAND DRESSINGS PAD 4"X10" , 4"X14"

3

BIOGUARD NON- ADHERENT DRESSING

3

BLACK WALNUT POLLEN 6 MSD

BLACK WILLOW 6 MSD

Drug Name Drug

Category

Limits/

Required

ALBUKED 25 6 MSD ALBUKED 5 6 MSD albumin human 6 MSD ALBUMINEX 6 MSD alburx 6 MSD ALBUTEIN 6 MSD alcohol prep pads pad , 70 % 2 OTC

ALCOHOL PREP PADS PAD 70 % 2 OTC

ALDER 3

ALPHA-LIPOIC ACID INJECTION 3

ALTERNARIA 6 MSD AMD FOAM DRESSING PAD 3- 1/2"X3"

3

AMERICAN BEECH 3

AMERICAN COCKROACH 6 MSD

AMERICAN ELM 6 MSD AMERICAN SYCAMORE 6 MSD

AMIDATE 6 MSD AMINOPMRMS 3

AMPHADASE 6 MSD ANASCORP 6 MSD ANAVIP 6 MSD ANDEXXA 6 MSD ANESTHESIA S/I-40 6 MSD ANESTHESIA S/I-40A 6 MSD ANESTHESIA S/I-40H 6 MSD ANESTHESIA S/I-40S 6 MSD ANESTHESIA S/I-60 6 MSD ANTIVENIN LATRODECTUS MACTANS

3

ANTIVENIN MICRURUS FULVIUS 6 MSD

APP SLIM RMS 3


Drug Name Drug

Category

Limits/

Required

COCOA BEAN (DIAGNOSTIC) 6 MSD

COENZYME Q-10 INJECTION 3

CORN POLLEN 6 MSD CORTROSYN 6 MSD cosyntropin 6 MSD CRAB (DIAGNOSTIC) 6 MSD CURITY AMD ANTIMICROBIAL STRIP

3

CURITY IODOFORM PACKING STRIP 3

CURVULARIA 6 MSD CYSVIEW 6 MSD deferoxamine mesylate 6 MSD DESFERAL 6 MSD desflurane 6 MSD dexmedetomidine hcl in nacl 6 MSD

DEXMEDETOMIDINE HCL INTRAVENOUS SOLUTION 1000 MCG/10ML, 400 MCG/4ML

6

MSD

dexmedetomidine hcl intravenous solution 200 mcg/2ml

6

MSD

DEXMEDETOMIDINE HCL-DEXTROSE 6 MSD

diluent for treprostinil 6 MSD DIPRIVAN 6 MSD DOG EPITHELIUM 6 MSD DOG FENNEL 3

DOTAREM INTRAVENOUS SOLUTION 2.5 MMOL/5ML, 5 MMOL/10ML, 50 MMOL/100ML

6

MSD

DOVER URETHRAL CATHETER 6 MSD

Drug Name Drug

Category

Limits/

Required

BOTOX 6 PA; MSD BOTRYTIS 6 MSD BOX ELDER 6 MSD BREATHERITE 6 MSD BREATHERITE VALVED MDI CHAMBER

6

MSD

BREVITAL SODIUM 6 MSD BRIDION 6 MSD BROME 6 MSD CALCIUM DISODIUM VERSENATE 2

CALIFORNIA PEPPER TREE 3

CANDIDA ALBICANS EXTRACT 6 MSD

CANTALOUPE (DIAGNOSTIC) 6 MSD

CAPTAIN EAGLE PED NEBULIZER 6 MSD

CARDIOVID PLUS 3

CASEIN (DIAGNOSTIC) 6 MSD

CAT HAIR EXTRACT 6 MSD CATTLE EPITHELIUM 3

CAYA 5 ACA CEDAR ELM 6 MSD CEFALY KIT 6 MSD CHICKEN MEAT (DIAGNOSTIC) 6 MSD

chlorhexidine gluconate solution 20 % 2

CHLORHEXIDINE GLUCONATE SOLUTION 20 %

3

CHOLETEC 6 MSD CLADOSPORIUM CLADOSPORIOIDES 6 MSD

CLADOSPORIUM SPHAEROSPERMUM 6 MSD

COCKLEBUR 3


Drug Name Drug

Category

Limits/

Required

GEL-FLOW 6 MSD GELFOAM COMPRESSED SIZE 100

6

MSD

GELFOAM DENTAL PACK SIZE 4 6 MSD

GELFOAM SPONGE 6 MSD GELFOAM SPONGE SIZE 100 6 MSD

GELFOAM SPONGE SIZE 200 6 MSD

GELFOAM SPONGE SIZE 50 6 MSD

GELFOAM-JMI POWDER 6 MSD

GELFOAM-JMI SPONGE 6 MSD

GEL-ONE 6 MSD GELSYN-3 6 MSD GENTLECATH URINARY CATHETER 6 MSD; OTC

GENVISC 850 6 MSD GERMAN COCKROACH 3

GLUCAGON HCL (DIAGNOSTIC) 3

glutaraldehyde external 2

GOLDENROD 6 MSD GRASTEK 2 M; QL HACKBERRY 3

HCU EASY 3

HISTATROL INJECTION 6 MSD

HONEY BEE VENOM 6 MSD HONEY BEE VENOM PROTEIN INJECTION SOLUTION RECONSTITUTED 1300 MCG

3

Drug Name Drug

Category

Limits/

Required

DRECHSLERA 6 MSD DUODOTE 3

DUROLANE 6 MSD DUST MITE MIXED ALLERGEN EXT 6 MSD

DYSPORT 6 PA; MSD EASIVENT 6 MSD EASTERN COTTONWOOD 6 MSD

EASY COMFORT ALCOHOL PADS 2 OTC

EASY GLIDE LUER LOCK SYRINGE 3 OTC

EC-RX DHEA 3

EGG WHITE (DIAGNOSTIC) 6 MSD

ELCYS 6 MSD ENDARI 3 PA; S ENGLISH PLANTAIN 6 MSD EPICOCCUM 6 MSD ergoloid mesylates oral 1 M EROS-CTD 3

etomidate intravenous 6 MSD EUFLEXXA 6 MSD E-Z-DISK 6 MSD E-Z-HD 6 MSD E-Z-PAQUE 6 MSD E-Z-PASTE 6 MSD FEMCAP 5 ACA FIRDAPSE 3 S FIRE ANT 6 MSD FLEXBUMIN 6 MSD flumazenil intravenous 6 MSD FLYP NEBULIZER 6 MSD fomepizole 6 MSD formaldehyde external solution 37 % 2

FUSARIUM 6 MSD GADAVIST 6 MSD


Drug Name Drug

Category

Limits/

Required

KETAMINE HCL INJECTION SOLUTION PREFILLED SYRINGE

6

MSD

KETAMINE HCL INTRAVENOUS 6 MSD

KETAMINE HCL- SODIUM CHLORIDE 6 MSD

KOCHIA 6 MSD LAMBS QUARTERS 6 MSD l-cysteine hcl intravenous 6 MSD

LENSCALE 3

LIPIODOL 6 MSD LIQUID E-Z-PAQUE 6 MSD LIQUID POLIBAR PLUS 6 MSD

MACI 6 MSD MACRILEN 6 MSD MAGNEVIST 6 MSD MEADOW FESCUE GRASS POLLEN 6 MSD

MELALEUCA 3

MESQUITE 6 MSD methergine 1

METHOHEXITAL SODIUM 6 MSD

methylene blue injection 6 MSD

methylergonovine maleate injection 6 MSD

methylergonovine maleate oral 1

MINIMED 530G INSULIN PUMP 6 MSD

MITE (D. FARINAE) 6 MSD MITE (D. PTERONYSSINUS) 6 MSD

MIXED ASPERGILLUS 6 MSD MIXED FEATHERS 6 MSD MIXED RAGWEED 6 MSD

Drug Name Drug

Category

Limits/

Required

HONEY BEE VENOM PROTEIN INJECTION SOLUTION RECONSTITUTED 550 MCG

6

MSD

HORSE EPITHELIUM 6 MSD HYALGAN 6 MSD HYLENEX 3

HYMOVIS 6 MSD IC GREEN 6 MSD indigo carmine 6 MSD indocyanine green intravenous 6 MSD

INFED 6 MSD infusion set 6 MSD INNOSPIRE GO PORTABLE MESH NEB

6

MSD; OTC

INSPIREASE RESERVOIR BAGS 3

insulin pump ir2020 3

isosulfan blue 6 MSD JOHNSON GRASS 6 MSD J-TIP KIT W/VIAL ADAPTERS 3

JUNE GRASS POLLEN STANDARDIZED

6

MSD

KALBITOR 6 MSD KAPOK 6 MSD kedbumin 6 MSD KERLIX AMD ANTIMICROBIAL 3

KERLIX AMD SUPER SPONGES 3

KETALAR 6 MSD ketamine hcl injection solution 10 mg/ml, 100 mg/ml, 50 mg/ml

6

MSD


Drug Name Drug

Category

Limits/

Required

OMNIPOD STARTER 6 MSD OPTIONS CONCEPTROL 5 ACA; OTC

OPTIRAY 350 6 MSD OPTISON 6 MSD ORAFATE 4 S ORALAIR 4 M; S; QL ORALAIR ADULT SAMPLE KIT 4 M; S; QL

ORALAIR ADULT STARTER PACK 4 M; S; QL

ORALAIR CHILDRENS STARTER PACK 4 M; S; QL

ORANGE (DIAGNOSTIC) 6 MSD

ORCHARD GRASS POLLEN 6 MSD

ORTHOVISC 6 MSD PARI ALTERA NEBULIZER HANDSET

6

MSD

PARI TREK S COMBO PACK 6 MSD

PEANUT (DIAGNOSTIC) 6 MSD

PECAN NUT (DIAGNOSTIC) 6 MSD

PECAN POLLEN 6 MSD PENICILLIUM NOTATUM 6 MSD

PENTETATE CALCIUM TRISODIUM 6 MSD

PENTETATE ZINC TRISODIUM 6 MSD

PERENNIAL RYE GRASS POLLEN 3

PHOMA EXIGUA 6 MSD PHOTREXA VISCOUS 6 MSD PHOTREXA- PHOTREXA VISCOUS KIT

6

MSD

Drug Name Drug

Category

Limits/

Required

MIXED VESPID VENOM PROTEIN INJECTION SOLUTION RECONSTITUTED 1300-1300-1300 MCG

3

MIXED VESPID VENOM PROTEIN INJECTION SOLUTION RECONSTITUTED 550-550-550 MCG

6

MSD

MIXED VESPID VENOM PROTEIN SUBCUTANEOUS

6

MSD

mlk f1 1

mlk f2 1

mlk f3 1

MLK F4 3

MONOVISC 6 MSD MOUNTAIN CEDAR 6 MSD MOUSE EPITHELIUM 6 MSD MSUD EASY 3

MUCOR 6 MSD MUGWORT 6 MSD MYOBLOC 6 PA; MSD NEOKE RA LIPOIC 3

NETSPOT 6 MSD NEXAVIR 3

NORM-JECT LUER SLIP SYRINGE 2

OAT GRAIN (DIAGNOSTIC) 6 MSD

ODACTRA 2 M; QL OLIVE TREE 6 MSD OMNIPAQUE INTRAVENOUS SOLUTION 350 MG/ML

6

MSD

OMNIPOD 5 PACK 6 MSD OMNIPOD DASH 5 PACK 6 MSD


Drug Name Drug

Category

Limits/

Required

RED CEDAR 6 MSD RED MAPLE 6 MSD RED MULBERRY 6 MSD RED TOP GRASS POLLEN 6 MSD

RESET FOR ANDROID APP 3

RESET FOR IOS APP 3

RESET FOR IOS OR ANDROID APP 3

RESET-O FOR ANDROID APP 3

RESET-O FOR IOS APP 3

RESET-O FOR IOS OR ANDROID APP 3

RHIZOPUS 6 MSD RICE (DIAGNOSTIC) 6 MSD ROUGH MARSH ELDER 3

ROUGH PIGWEED 6 MSD RUSSIAN THISTLE 6 MSD RUZURGI 3 M SACCHAROMYCES CEREVISIAE 6 MSD

SAGEBRUSH 6 MSD SAPS HEALTH CARE ALCOHOL PREP 2 OTC

sash kit 6 MSD SESAME SEED (DIAGNOSTIC) 6 MSD

sevoflurane 6 MSD SHAGBARK HICKORY 6 MSD SHEEP SORREL 6 MSD SHORT RAGWEED POLLEN EXT 6 MSD

SHRIMP (DIAGNOSTIC) 6 MSD

SODIUM HYALURONATE INTRA-ARTICULAR

6

MSD

Drug Name Drug

Category

Limits/

Required

PISTACHIO NUT (DIAGNOSTIC) 6 MSD

PKU EASY 3

PKU EASY MICROTABS 3

PLASBUMIN-25 6 MSD PLASBUMIN-5 6 MSD PORK (DIAGNOSTIC) 6 MSD pralidoxime chloride intramuscular 3

PRAXBIND 6 MSD PRECEDEX 6 MSD PRIVET 6 MSD PRO COMFORT SPACER ADULT 6 MSD; OTC

PRO COMFORT SPACER CHILD 6 MSD; OTC

PRO COMFORT TENS UNIT 6 MSD

PROCARE COMPRESSOR NEBULIZER

6

MSD; OTC

PROCARE SPACER/ADULT MASK

6

MSD; OTC

PROCARE SPACER/CHILD MASK 6 MSD; OTC

PROFESSIONAL DNA COLLECTION 6 MSD

PROMACTIN AA PLUS 20PE 3

propofol 6 MSD PROTHELIAL 4 S PROVAYBLUE 6 MSD PROVOCHOLINE 6 MSD QUEEN PALM 3

RABBIT EPITHELIUM 6 MSD RADIOGARDASE 6 MSD RAGWITEK 2 M; QL READI-CAT 2 6 MSD RED BIRCH 6 MSD


Drug Name Drug

Category

Limits/

Required

TECHNETIUM TC 99M MEDRONATE 6 MSD

TECHNETIUM TC 99M PYROPHOS 6 MSD

technetium tc 99m sestamibi 6 MSD

TELFA AMD NON- ADHERENT 3

thallous chloride tl 201 intravenous solution 1 mci/ml

6

MSD

THALLOUS CHLORIDE TL 201 INTRAVENOUS SOLUTION 2 MCI/ML

6

MSD

THYROGEN 6 MSD TIMOTHY GRASS POLLEN ALLERGEN 6 MSD

TISSEEL 6 MSD toxicology saliva collection 6 MSD

TRICHOPHYTON 6 MSD TRIVISC 6 MSD TRUE COMFORT ALCOHOL PREP PADS

2

OTC

TYR EASY 3

ULTANE 6 MSD ULTRAVIST INJECTION SOLUTION 77 %

6

MSD

VARIBAR HONEY 6 MSD VARIBAR NECTAR 6 MSD VARIBAR PUDDING 6 MSD VARIBAR THIN HONEY 6 MSD

VARIBAR THIN LIQUID 6 MSD

vcf vaginal contraceptive vaginal gel

5

ACA; OTC

Drug Name Drug

Category

Limits/

Required

SOLESTA 6 MSD SORREL/DOCK MIX 6 MSD SOYBEAN (DIAGNOSTIC) 6 MSD

SPARKY THE DOG PED NEBULIZER 6 MSD

SPINRAZA 6 PA; M; MSD SPINY PIGWEED 6 MSD STEMPHYLIUM 3

STERILE DILUENT FLOLAN PH 12 6 MSD

STERILE DILUENT FOR FLOLAN 6 MSD

sterile diluent/epoprostenol 6 MSD

sterile water for injection 6 MSD

STRAWBERRY (DIAGNOSTIC) 6 MSD

SUPARTZ FX 6 MSD SUPRANE 6 MSD SURGISEAL 6 MSD SURGISEAL STYLUS 6 MSD SURGISEAL TWIST 6 MSD SWEET CORN (DIAGNOSTIC) 6 MSD

SWEET GUM 3

SWEET VERNAL GRASS POLLEN 6 MSD

SYNVISC 6 MSD SYNVISC ONE 6 MSD TACHOSIL 6 MSD TAGITOL V 6 MSD TAKHZYRO 4 PA; M; S TALL RAGWEED 6 MSD TECHNET TC 99M SULFUR COLLOID 6 MSD

technetium tc 99m mebrofenin 6 MSD


Drug Name Drug

Category

Limits/

Required

WHITE MULBERRY 6 MSD WHITE OAK 6 MSD WHITE PINE 6 MSD WHITE-FACED HORNET VENOM INJECTION SOLUTION RECONSTITUTED 1300 MCG

3

WHITE-FACED HORNET VENOM INJECTION SOLUTION RECONSTITUTED 550 MCG

6

MSD

WHOLE EGG (DIAGNOSTIC) 6 MSD

WIDE-SEAL DIAPHRAGM 60 5 ACA

XEOMIN INTRAMUSCULAR SOLUTION RECONSTITUTED 200 UNIT

6

MSD

XIAFLEX 6 MSD YELLOW DOCK 6 MSD YELLOW HORNET VENOM PROTEIN 6 MSD

YELLOW JACKET VENOM PROTEIN INJECTION SOLUTION RECONSTITUTED 1300 MCG

3

YELLOW JACKET VENOM PROTEIN INJECTION SOLUTION RECONSTITUTED 550 MCG

6

MSD

YELLOW JACKET VENOM PROTEIN SUBCUTANEOUS

6

MSD

Drug Name Drug

Category

Limits/

Required

VENOMIL HONEY BEE VENOM 3

VENOMIL WASP VENOM 3

VENOMIL WHITE FACED HORNET 3

VENOMIL YELLOW HORNET VENOM 3

VENOMIL YELLOW JACKET VENOM 3

V-GO 20 6 MSD V-GO 30 6 MSD V-GO 40 6 MSD VIRGINIA LIVE OAK 6 MSD VISCO-3 6 MSD VISIPAQUE INTRAVENOUS SOLUTION 320 MG/ML

6

MSD

VISTOGARD 3 S VITRASE 6 MSD VOLUMEN 6 MSD VORTEX HOLDING CHAMBER/MASK 6 MSD

WASP VENOM PROTEIN INJECTION SOLUTION RECONSTITUTED 1300 MCG

3

WASP VENOM PROTEIN INJECTION SOLUTION RECONSTITUTED 550 MCG

6

MSD

WASP VENOM PROTEIN SUBCUTANEOUS

6

MSD

WESTERN JUNIPER 3

WHITE ASH 6 MSD WHITE BIRCH 6 MSD WHITE FACED HORNET VENOM 6 MSD


Drug Name Drug

Category

Limits/

Required

FLAREX 3

fluorometholone 1

flurbiprofen sodium 1

FML 3

FML FORTE 3

FML LIQUIFILM 3

gatifloxacin ophthalmic 1

gentak 1

gentamicin sulfate ophthalmic 1

ILEVRO 2 QL ILUVIEN 6 MSD INVELTYS 2

ketorolac tromethamine ophthalmic 1

KLARITY-A 2

KLARITY-B 3

KLARITY-L 3

levofloxacin ophthalmic 1

LOTEMAX OPHTHALMIC GEL 2 QL

LOTEMAX OPHTHALMIC OINTMENT

2

QL

LOTEMAX OPHTHALMIC SUSPENSION

2

LOTEMAX SM 2

loteprednol etabonate 1

MAXIDEX 3

MITOSOL 3

MOXEZA 2

MOXIFLOXACIN HCL INTRAOCULAR 6 MSD

moxifloxacin hcl ophthalmic 1

NATACYN 2

NEVANAC 3 QL OCUFLOX 3

ofloxacin ophthalmic 1

Drug Name Drug

Category

Limits/

Required

Ophthalmic Agents -

Drugs for Eye Allergy,

Infection and

Inflammation

ACULAR 3

ACULAR LS 3

ACUVAIL 3

ALOCRIL 3

ALOMIDE 3

ALREX 2

AZASITE 2

azelastine hcl ophthalmic 1

bacitracin ophthalmic 1

BEPREVE 2

BESIVANCE 3

BETADINE OPHTHALMIC PREP 3

BLEPH-10 3

bromfenac sodium (once-daily) 1 QL

BROMSITE 3 QL CEFUROXIME SODIUM-NACL INTRAVITREAL

6

MSD

CILOXAN 3

ciprofloxacin hcl ophthalmic 1

cromolyn sodium ophthalmic 1

dexamethasone sodium phosphate ophthalmic

1

DEXTENZA 6 MSD DEXYCU 6 MSD diclofenac sodium ophthalmic 1

DUREZOL 3

epinastine hcl 1

erythromycin ophthalmic 1


Drug Name Drug

Category

Limits/

Required

ALPHAGAN P OPHTHALMIC SOLUTION 0.1 %

2

M

ALPHAGAN P OPHTHALMIC SOLUTION 0.15 %

3

M

apraclonidine hcl 1

AZOPT 3 M betaxolol hcl ophthalmic 1 M

BETIMOL 3 M BETOPTIC-S 3 M bimatoprost ophthalmic 1 M; QL brimonidine tartrate ophthalmic 1 M

carteolol hcl 1 M COMBIGAN 2 M COSOPT 3 ST; M COSOPT PF OPHTHALMIC SOLUTION 22.3-6.8 MG/ML

3

M

DORZOLAMIDE HCL SOLUTION 2 % OPHTHALMIC

3

M

dorzolamide hcl solution 2 % ophthalmic 1 M

dorzolamide hcl-timolol mal pf ophthalmic solution 22.3-6.8 mg/ml

1

M

DORZOLAMIDE HCL- TIMOLOL MAL SOLUTION 22.3-6.8 MG/ML OPHTHALMIC

3

ST; M

dorzolamide hcl-timolol mal solution 22.3-6.8 mg/ml ophthalmic

1

M

IOPIDINE 3

ISOPTO CARPINE 3 M ISTALOL 3 M KEVEYIS 3 PA; S; QL

Drug Name Drug

Category

Limits/

Required

olopatadine hcl ophthalmic 1

OZURDEX 6 MSD PATADAY 3 ST PATANOL 3 ST PAZEO 2

POVIDONE-IODINE OPHTHALMIC 3

PRED FORTE 3

PRED MILD 3

PREDNISOL ACE- MOXIFLOX-BROMFEN 3

prednisolone acetate ophthalmic 1

prednisolone acetate p- f 1

prednisolone sodium phosphate ophthalmic 1

PREDNISOLON- MOXIFLOX- NEPAFENAC

3

PROLENSA 2 QL RETISERT 6 MSD sulfacetamide sodium ophthalmic 1

tobramycin ophthalmic 1

TOBREX 3

trifluridine 1

TRIPLE PMB 3

TRIPLE PMK 3

VIGAMOX 3

YUTIQ 6 MSD ZIRGAN 3

ZYMAXID 3

Ophthalmic Agents -

Drugs for Glaucoma

acetazolamide er 1 M acetazolamide oral tablet 250 mg 1 M


Drug Name Drug

Category

Limits/

Required

ATROPINE SULFATE OPHTHALMIC EMULSION

3

M

atropine sulfate ophthalmic ointment 1 M

atropine sulfate ophthalmic solution 1 M

bacitracin-polymyxin b ophthalmic 1

bacitra-neomycin- polymyxin-hc 1

BEVACIZUMAB INTRAOCULAR 6 MSD

BEVACIZUMAB INTRAVITREAL SOLUTION PREFILLED SYRINGE 2.5 MG/0.1ML, 3.25 MG/0.13ML

6

MSD

BIOLON 6 MSD BLEPHAMIDE 3

BLEPHAMIDE S.O.P. 3

CEQUA 3 PA CYCLOGYL 3 M CYCLOMYDRIL 3 M cyclopentolate hcl ophthalmic 1 M

CYSTARAN 3 PA; M; S; QL DEXAMETHASONE- MOXIFLOXACIN 6 MSD

DEXAMETH- MOXIFLOX- KETOROLAC

6

MSD

DOUBLE PM 3

EYLEA 6 MSD GELFILM OPHTHALMIC 3

homatropaire 1 M homatropine hbr 1 M HYALURONIDASE (INTRAOCULAR) 6 MSD

ISOPTO ATROPINE 3 M

Drug Name Drug

Category

Limits/

Required

LATANOPROST SOLUTION 0.005 % OPHTHALMIC

3

ST; M

latanoprost solution 0.005 % ophthalmic 1 M

levobunolol hcl 1 M LUMIGAN 2 M; QL methazolamide oral 1 M PHOSPHOLINE IODIDE 2 M

pilocarpine hcl ophthalmic 1 M

RHOPRESSA 2 M ROCKLATAN 3 M SIMBRINZA 3 M timolol maleate ophthalmic 1 M

TIMOPTIC 3 M TIMOPTIC OCUDOSE 3 M TIMOPTIC-XE 3 M TRAVATAN Z 2 M; QL TRUSOPT 3 M VYZULTA 3 M; QL XALATAN 3 ST; M XELPROS 3 ST; M; QL ZIOPTAN 3 M; QL Ophthalmic Agents -

Drugs for

Miscellaneous Eye

Conditions

ak-poly-bac 1

AKTEN 3

ALCAINE 3

altacaine 1

altafluor 6 MSD altafluor benox 6 MSD altafrin 1

AMVISC 6 MSD AMVISC PLUS 6 MSD


Drug Name Drug

Category

Limits/

Required

PRED-G 3

PRED-G S.O.P. 3

PREDNISOLONE ACETATE- NEPAFENAC

3

PREDNISOLONE ACET-MOXIFLOXACIN 3

PREDNISOLONE- BROMFENAC OPHTHALMIC SOLUTION

3

PREDNISOLONE- GATIFLOXACIN 3

PREDNISOLONE- MOXIFLOXACIN 3

PREDNISOLON- GATIFLOX- BROMFENAC OPHTHALMIC SOLUTION

3

PREDNISOLON- MOXIFLOX- BROMFENAC

3

proparacaine hcl ophthalmic 1

PROVISC 6 MSD RESTASIS 2 PA; M; QL RESTASIS MULTIDOSE OPHTHALMIC EMULSION 0.05 %

2

PA; M; QL

sulfacetamide- prednisolone ophthalmic solution

1

tetcaine 1

tetracaine hcl solution 0.5 % ophthalmic 3

tetracaine hcl solution 0.5 % ophthalmic 1

tetravisc 3

tetravisc forte 3

Drug Name Drug

Category

Limits/

Required

JETREA 6 MSD LACRISERT 3

LASTACAFT 3

LIDOCAINE- EPINEPHRINE INTRAOCULAR

6

MSD

LIDOCAINE- PHENYLEPHRINE 6 MSD

LIDOCAINE- PHENYLEPHRINE- BSS

6

MSD

LUCENTIS 6 MSD LUXTURNA 6 MSD MACUGEN 6 MSD MAXITROL 3

MOXIFLOXACIN HCL- BSS 6 MSD

MYDRIACYL 3 M neomycin-bacitracin zn- polymyx 1

neomycin-polymyxin- dexameth ophthalmic ointment

1

neomycin-polymyxin- dexameth ophthalmic suspension 3.5-10000- 0.1

1

neomycin-polymyxin- gramicidin 1

neomycin-polymyxin-hc ophthalmic 1

neo-polycin 1

neo-polycin hc 1

OMIDRIA 6 MSD OXERVATE 3 S; QL phenylephrine hcl ophthalmic 1

polycin 1

polymyxin b- trimethoprim 1

POLYTRIM 3


Drug Name Drug

Category

Limits/

Required

PRAMOTIC 3

Respiratory Tract /

Pulmonary Agents -

Drugs for Allergies,

Cough, Cold

ADRENALIN NASAL 3

ASTEPRO 3 QL azelastine hcl nasal 1 QL BECONASE AQ 3 QL benzonatate 1

bromfed dm 1

BROMPHENIRAMINE MALEATE INTRAMUSCULAR

3

brompheniramine tannate 1

carbinoxamine maleate 1

cetirizine hcl oral solution 2 QL

CINQAIR 6 M; MSD CLARINEX 3 QL CLARINEX-D 12 HOUR 3 QL

clemastine fumarate oral tablet 2.68 mg 1

cyproheptadine hcl oral 1

desloratadine 1 QL dexchlorpheniramine maleate oral 1

DICOPANOL FUSEPAQ 3

DICOPANOL RAPIDPAQ 3

diphenhydramine hcl injection 6 MSD

diphenhydramine hcl oral elixir 1

DYMISTA 2 QL FASENRA 6 M; MSD flunisolide nasal 1 QL

Drug Name Drug

Category

Limits/

Required

TOBRADEX OPHTHALMIC OINTMENT

2

TOBRADEX OPHTHALMIC SUSPENSION

3

TOBRADEX ST 2

tobramycin- dexamethasone 1

TRIAMCINOLONE- MOXIFLOXACIN 6 MSD

tropicamide ophthalmic 1 M TROPICAMIDE- PHENYLEPHRINE 3 M

VISUDYNE 6 MSD XIIDRA 2 M ZYLET 2

Otic Agents - Drugs

for Ear Conditions

acetic acid otic 1

CETRAXAL 3

CIPRO HC 3

CIPRODEX 2

ciprofloxacin hcl otic 1

COLY-MYCIN S 3

cortic-nd 1

DERMOTIC 3

exotic-hc 1

flac 1

FLOXIN OTIC 1

fluocinolone acetonide otic 1

hydrocortisone-acetic acid 1

neomycin-polymyxin-hc otic 1

ofloxacin otic 1

OTICIN HC NR 3

OTIPRIO 3

OTOVEL 2


Drug Name Drug

Category

Limits/

Required

NUCALA SUBCUTANEOUS SOLUTION RECONSTITUTED

6

M; MSD; QL

olopatadine hcl nasal 1 QL OMNARIS 3 QL PATANASE 3 QL phenadoz 1

PHENERGAN 6 MSD phenylephrine- guaifenesin oral liquid 1

promethazine hcl injection 6 MSD

promethazine hcl oral syrup 1

promethazine hcl oral tablet 1

promethazine hcl rectal 1

promethazine-codeine 1 QL promethazine-dm 1

promethazine- phenyleph-codeine 1 QL

promethazine- phenylephrine 1

promethegan 1

pseudoeph-chlorphen- hydrocod 1 QL

pseudoephedrine- bromphen-dm 1

pulmosal 1

QNASL 2 QL QNASL CHILDRENS 2 QL RYCLORA 3

ryvent 3

SEMPREX-D 3

SINUVA 6 MSD sodium chloride inhalation 1

SSKI 3

SURVANTA 6 MSD

Drug Name Drug

Category

Limits/

Required

fluticasone propionate nasal 2

GILPHEX TR 3

GILTUSS TR 3

guaiatussin ac 1 OTC; QL guaifenesin ac 1 OTC; QL hydrocodone polst-cpm polst er 1 PA; QL

hydrocodone- homatropine 1 QL

hydromet 1 QL HYPERSAL 3

INFASURF 6 MSD ipratropium bromide nasal 1 M

KARBINAL ER 3

levocetirizine dihydrochloride oral solution

2

levocetirizine dihydrochloride oral tablet

2

QL

mometasone furoate nasal 1 QL

NASONEX 3 ST; QL nebusal inhalation nebulization solution 3 %

1

NEBUSAL INHALATION NEBULIZATION SOLUTION 6 %

3

NEOTUSS PLUS 2

NUCALA SUBCUTANEOUS SOLUTION AUTO- INJECTOR

3

M; S; QL

NUCALA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3

M; S; QL


Drug Name Drug

Category

Limits/

Required

ANORO ELLIPTA 2 M; QL ARALAST NP 6 PA; MSD ARCAPTA NEOHALER 2 M; QL ARNUITY ELLIPTA 2 M; QL ASMANEX (120 METERED DOSES) 2 M; QL

ASMANEX (14 METERED DOSES) 2 M; QL




ASMANEX HFA 2 M; QL ATROVENT HFA 2 M; QL AUVI-Q INJECTION SOLUTION AUTO- INJECTOR 0.1 MG/0.1ML

3

QL

AUVI-Q INJECTION SOLUTION AUTO- INJECTOR 0.15 MG/0.15ML, 0.3 MG/0.3ML

3

BEVESPI AEROSPHERE 2 M; QL

BREO ELLIPTA 2 M; QL BROVANA 3 M; QL budesonide inhalation 1 M; QL COMBIVENT RESPIMAT 2 M; QL

cromolyn sodium inhalation 1 M

DALIRESP ORAL TABLET 250 MCG 2 PA; M

DALIRESP ORAL TABLET 500 MCG 2 PA; M; QL

difil-g forte 1

DUAKLIR PRESSAIR 3 M DULERA 2 M; QL ELIXOPHYLLIN 3 M

Drug Name Drug

Category

Limits/

Required

TESSALON PERLES 3

TUSSICAPS 3 PA; QL TUXARIN ER 3 QL TUZISTRA XR 3 PA; QL XHANCE 3 QL XOLAIR SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

6

PA; MSD

XOLAIR SUBCUTANEOUS SOLUTION RECONSTITUTED

6

PA; MSD; QL

ZETONNA 3 QL Z-TUSS AC 3 OTC; QL Respiratory Tract /

Pulmonary Agents -

Drugs for Asthma and

Other Lung

Conditions

ACCOLATE 3 M; QL acetylcysteine inhalation 1

ADRENALIN INJECTION 6 MSD

ADVAIR DISKUS 3 M; QL ADVAIR HFA 2 M; QL AIRDUO RESPICLICK 113/14 2 M; QL

AIRDUO RESPICLICK 232/14 2 M; QL

AIRDUO RESPICLICK 55/14 2 M; QL

albuterol sulfate er 1 M ALBUTEROL SULFATE HFA 3 M; QL

albuterol sulfate inhalation 1 M; QL

albuterol sulfate oral 1 M ALVESCO 3 M; QL aminophylline intravenous 6 MSD


Drug Name Drug

Category

Limits/

Required

LEVALBUTEROL HFA INHALATION AEROSOL 45 MCG/ACT

3

M; QL

LONHALA MAGNAIR REFILL KIT 3 M; QL

LONHALA MAGNAIR STARTER KIT 3 M; QL

metaproterenol sulfate oral 1 M

montelukast sodium oral packet 1 M

montelukast sodium oral tablet 1 M; QL

montelukast sodium oral tablet chewable 1 M; QL

OFEV 3 PA; M; S; QL PERFOROMIST 2 M; QL PROAIR DIGIHALER 2 M; QL PROAIR HFA 1 M; QL PROAIR RESPICLICK 2 M; QL PROLASTIN-C INTRAVENOUS SOLUTION

6

MSD

PROLASTIN-C INTRAVENOUS SOLUTION RECONSTITUTED

6

PA; MSD

PROVENTIL HFA 3 M; QL PULMICORT FLEXHALER 2 M; QL

PULMICORT SUSPENSION 3 ST; M; QL

QVAR REDIHALER 2 M; QL SCLEROSOL INTRAPLEURAL 6 MSD

SEEBRI NEOHALER 3 M; QL SEREVENT DISKUS 2 M; QL SINGULAIR ORAL PACKET 3 ST; M

SINGULAIR ORAL TABLET 3 ST; M; QL

Drug Name Drug

Category

Limits/

Required

epinephrine injection solution 0.3 mg/0.3ml 3

epinephrine injection solution auto-injector 0.15 mg/0.15ml

3


2

QL


1

EPIPEN 2-PAK 3

EPIPEN JR 2-PAK 2 QL EPISNAP 6 MSD ESBRIET ORAL CAPSULE 3 PA; M; S; QL

ESBRIET ORAL TABLET 267 MG 3 PA; M; S; QL

ESBRIET ORAL TABLET 801 MG 3 PA; M; S

FLOVENT DISKUS 2 M; QL FLOVENT HFA 2 M; QL fluticasone-salmeterol inhalation aerosol powder breath activated 100-50 mcg/dose, 250-50 mcg/dose, 500-50 mcg/dose

1

M; QL

FLUTICASONE- SALMETEROL INHALATION AEROSOL POWDER BREATH ACTIVATED 113-14 MCG/ACT, 232- 14 MCG/ACT, 55-14 MCG/ACT

2

M; QL

GLASSIA 6 MSD INCRUSE ELLIPTA 2 M; QL ipratropium bromide inhalation 1 M; QL

ipratropium-albuterol 1 M; QL levalbuterol hcl inhalation 1 M; QL


Drug Name Drug

Category

Limits/

Required

KALYDECO 3 PA; M; S KITABIS PAK 2 M; QL ORKAMBI 3 PA; M; S; QL PULMOZYME 2 M SYMDEKO 3 PA; M; S; QL TOBI NEBULIZER 3 M; QL TOBI PODHALER 2 M; QL tobramycin nebulization solution 300 mg/5ml inhalation

1

M; QL

TOBRAMYCIN NEBULIZATION SOLUTION 300 MG/5ML INHALATION

3

M; QL

Respiratory Tract /

Pulmonary Agents -

Drugs for Pulmonary

Hypertension

ADCIRCA 4 PA; M; S; QL ADEMPAS 3 PA; M; S; QL alyq 1 PA; M; S; QL ambrisentan 1 PA; M; QL bosentan 1 PA; M; QL epoprostenol sodium 6 MSD FLOLAN 6 MSD LETAIRIS 3 PA; M; S; QL OPSUMIT 3 PA; M; S; QL ORENITRAM 4 PA; M; S REMODULIN 6 PA; MSD; QL REVATIO INTRAVENOUS 6 PA; MSD

REVATIO ORAL 4 PA; M; S; QL sildenafil citrate intravenous 6 PA; MSD

sildenafil citrate oral suspension reconstituted

1

PA; M; QL

sildenafil citrate oral tablet 20 mg 1 PA; M; S; QL

tadalafil (pah) 1 PA; M; S; QL TRACLEER 3 PA; M; S; QL

Drug Name Drug

Category

Limits/

Required

SINGULAIR ORAL TABLET CHEWABLE 3 ST; M; QL

SPIRIVA HANDIHALER 2 M; QL

SPIRIVA RESPIMAT 2 M; QL STERILE TALC POWDER 6 MSD

STERITALC 6 MSD STIOLTO RESPIMAT 2 M; QL STRIVERDI RESPIMAT 2 M; QL

SYMBICORT 2 M; QL SYMJEPI 3

terbutaline sulfate injection 6 MSD

terbutaline sulfate oral 1 M THEO-24 3 M theochron 1 M theophylline 1 M theophylline er 1 M TRELEGY ELLIPTA 2 M; QL TUDORZA PRESSAIR 2 M; QL UTIBRON NEOHALER 3 M; QL VENTOLIN HFA 2 M; QL wixela inhub 1 M; QL XOPENEX 3 M; QL XOPENEX CONCENTRATE 3 M; QL

XOPENEX HFA 3 M; QL YUPELRI 2 M; QL zafirlukast 1 M; QL ZEMAIRA 6 PA; MSD zileuton er 1 M; QL ZYFLO 3 M Respiratory Tract /

Pulmonary Agents -

Drugs for Cystic

Fibrosis

BETHKIS 6 M; MSD; QL CAYSTON 3 S; QL


Drug Name Drug

Category

Limits/

Required

ENOVARX- BACLOFEN 3

enovarx- cyclobenzaprine hcl cream 20 mg/gm transdermal

1

ENOVARX- CYCLOBENZAPRINE HCL CREAM 20 MG/GM TRANSDERMAL

3

FEXMID 3 ST FIRST-BACLOFEN 3

GABLOFEN INTRATHECAL SOLUTION 10000 MCG/20ML, 40000 MCG/20ML

6

MSD; QL

GABLOFEN INTRATHECAL SOLUTION 20000 MCG/20ML

6

MSD

GABLOFEN INTRATHECAL SOLUTION PREFILLED SYRINGE

6

MSD

LIORESAL INTRATHECAL INTRATHECAL SOLUTION 2000 MCG/ML, 40 MG/20ML, 500 MCG/ML

6

MSD; QL

LIORESAL INTRATHECAL SOLUTION 0.05 MG/ML, 10 MG/20ML, 40 MG/20ML

6

MSD; QL

LORZONE 3 ST METAXALL CP 3

metaxalone 1

methocarbamol injection 6 MSD

methocarbamol oral 1

NORGESIC FORTE 3

Drug Name Drug

Category

Limits/

Required

treprostinil 6 PA; MSD; QL

TYVASO 6 PA; M; MSD; QL

TYVASO REFILL 6 PA; M; MSD; QL

TYVASO STARTER 6 PA; M; MSD; QL

UPTRAVI ORAL TABLET 3 PA; M; S; QL

UPTRAVI ORAL TABLET THERAPY PACK

3

PA; S; QL

VELETRI 6 MSD VENTAVIS 4 PA; M; S; QL Skeletal Muscle

Relaxants - Drugs for

Muscle Pain and

Spasm

ACTIVE- CYCLOBENZAPRINE 3

AMRIX 3 ST baclofen external 1

baclofen intrathecal solution 10 mg/20ml, 40 mg/20ml

6

MSD; QL

baclofen intrathecal solution 20000 mcg/20ml

6

MSD

baclofen oral tablet 10 mg, 20 mg 1

baclofen oral tablet 5 mg 3

carisoprodol oral 1

carisoprodol-aspirin 1

chlorzoxazone 1 PA cyclobenzaprine hcl er 1

cyclobenzaprine hcl oral 1

CYCLOPHENE RAPIDPAQ 3

DANTRIUM ORAL 3 ST dantrolene sodium oral 1


Drug Name Drug

Category

Limits/

Required

temazepam 1 QL WAKIX 3 M XYREM 3 PA; S; QL zaleplon 1 QL zolpidem tartrate 1 QL zolpidem tartrate er 1 QL ZOLPIMIST 3 ST; QL

Drug Name Drug

Category

Limits/

Required

orphenadrine citrate er 1

orphenadrine citrate injection 6 MSD

orphenadrine-aspirin- caffeine 1

ORPHENGESIC FORTE 3

ROBAXIN 6 MSD ROBAXIN-750 3 ST RYANODEX 6 MSD SKELAXIN 3 ST SOMA 3 ST TABRADOL FUSEPAQ 3

TABRADOL RAPIDPAQ 3

tizanidine hcl oral 1

ZANAFLEX 3 ST Sleep Disorder

Agents

AMBIEN 3 ST; QL AMBIEN CR 3 ST; QL AMYTAL SODIUM 2

armodafinil 1 PA; M; QL BELSOMRA 3 ST; QL BUTISOL SODIUM 3

EDLUAR 3 ST; QL eszopiclone 1 QL flurazepam hcl 1 QL HETLIOZ 4 ST; M; S; QL INTERMEZZO 3 ST; QL LUNESTA 3 ST; QL modafinil 1 PA; M; QL NUVIGIL 3 PA; M; QL PROVIGIL 3 PA; M; QL ramelteon 1 QL RESTORIL 3 QL ROZEREM 2 ST; QL SECONAL 1

SILENOR 3 ST; QL

SMARTVIEW KIT W/DEVICE... 60 ACCU-CHEK SMARTVIEW CONTROL ................................. 60 ACCU-CHEK SMARTVIEW TEST STRIPS ........................... 60 ACCU-CHEK SOFTCLIX LANCET DEVICE KIT ............... 60 ACCUPRIL ................................ 41 ACCURETIC .............................. 41 acd formula a ............................. 21 acd-a noclot-50 .......................... 21 acebutolol hcl ............................. 41 ACETADOTE ............................. 92 acetaminophen-codeine ............... 7

ACTIVE-PREP KIT II ................. 11 ACTIVE-PREP KIT III ................ 11 ACTIVE-PREP KIT IV ................ 52 ACTIVE-PREP KIT V ................. 52 ACTIVE-TRAMADOL ................. 52 ACTONEL .................................. 92 ACTOPLUS MET ....................... 58 ACTOS ...................................... 58 ACULAR .................................. 101 ACULAR LS ............................. 101 ACUVAIL ................................. 101 acyclovir ..................................... 37 acyclovir sodium ........................ 37 ACZONE .................................... 52

113

AGGRENOX ............................. 36 AGRYLIN .................................. 40 AIF #2 DRUG PREPARATION KIT ............................................ 11 AIF #3 DRUG PREPARATION KIT ............................................ 11 AIMOVIG................................... 29 AIRDUO RESPICLICK 113/14 107 AIRDUO RESPICLICK 232/14 107 AIRDUO RESPICLICK 55/14 107 AJOVY ...................................... 29 AKOVAZ ................................... 42 ak-poly-bac ............................. 103 AKTEN .................................... 103

Index of Drugs

7T GUMMY ES ............................ 7 A.A.G.C. KIT IN TERODERM .... 52 abacavir sulfate ......................... 37 abacavir sulfate-lamivudine ....... 37 abacavir-lamivudine- zidovudine ................................. 37 ABELCET .................................. 27 ABILIFY ..................................... 36 ABILIFY MAINTENA .................. 36 ABILIFY MYCITE ....................... 36 abiraterone acetate .................... 30 ABLYSINOL ............................... 41 ABRAXANE ............................... 30 ABSORICA ................................ 52 ABSTRAL .................................... 7 ACACIA ..................................... 92 acamprosate calcium ................. 16 ACANYA .................................... 52 acarbose .................................... 58 ACCOLATE ............................. 107 ACCU-CHEK AVIVA CONNECT KIT W/DEVICE ....... 60 ACCU-CHEK AVIVA DEVICE ... 60 ACCU-CHEK AVIVA PLUS ....... 60 ACCU-CHEK COMPACT PLUS CARE KIT ....................... 60 ACCU-CHEK COMPACT PLUS CONTROL ....................... 60 ACCU-CHEK COMPACT PLUS TEST STRIPS ................. 60 ACCU-CHEK FASTCLIX LANCET KIT .............................. 60 ACCU-CHEK GUIDE ................. 60 ACCU-CHEK GUIDE CONTROL ................................. 60 ACCU-CHEK GUIDE ME .......... 60 ACCU-CHEK MULTICLIX LANCET DEVICE KIT ............... 60 ACCU-CHEK NANO

acetaminophen-codeine #2 .......... 7 acetaminophen-codeine #3 .......... 7 acetaminophen-codeine #4 .......... 7 acetazolamide .................... 41, 102 acetazolamide er ..................... 102 acetazolamide sodium ............... 41 acetic acid ................................ 105 acetylcysteine .................... 92, 107 ACIPHEX ................................... 72 ACIPHEX SPRINKLE ................ 72 acitretin ...................................... 52 ACREMONIUM .......................... 92 ACTEMRA ................................. 87 ACTEMRA ACTPEN .................. 87 ACTHAR .................................... 80 ACTHIB...................................... 90 ACTICLATE ............................... 16 ACTIGALL ................................. 73 ACTIMMUNE ............................. 87 ACTIQ .......................................... 7 ACTIVE FE ................................ 64 ACTIVE INJECTION BLM-1 ...... 77 ACTIVE INJECTION BM ........... 77 ACTIVE INJECTION DL ............ 77 ACTIVE INJECTION DLM ......... 77 ACTIVE INJECTION KET-L ....... 11 ACTIVE INJECTION KETMARC-L .............................. 11 ACTIVE INJECTION KIT L ........ 77 ACTIVE INJECTION KM ........... 77 ACTIVE INJECTION LM-2 ......... 13 ACTIVE INJECTION LM-DEP- 2 ................................................ 77 ACTIVE INJECTION M-1 ........... 77 ACTIVE-CYCLOBENZAPRINE ................................................ 110 ACTIVE-KETOPROFEN ............ 11 ACTIVELLA ............................... 82 ACTIVE-PREP KIT I .................. 11

ADACEL.................................... 90 ADALAT CC .............................. 42 adapalene ................................. 52 ADAPALENE ............................ 52 adapalene-benzoyl peroxide ..... 52 ADASUVE ................................. 36 adc/f (0.5mg/ml) ........................ 64 ADCETRIS ................................ 30 ADCIRCA ................................ 109 ADDERALL ............................... 49 ADDERALL XR ......................... 49 ADDYI ....................................... 50 adefovir dipivoxil........................ 37 ADEMPAS .............................. 109 ADENOCARD ........................... 42 adenosine ........................... 42, 92 adenosine (diagnostic) .............. 92 ADHANSIA XR .......................... 49 ADLYXIN ................................... 58 ADLYXIN STARTER PACK ...... 58 ADMELOG ................................ 63 ADMELOG SOLOSTAR ............ 63 ADRENALIN ................... 105, 107 adriamycin ................................. 30 adrucil ....................................... 30 ADVAIR DISKUS .................... 107 ADVAIR HFA .......................... 107 ADVATE.................................... 40 ADYNOVATE ............................ 40 ADZENYS ER ........................... 49 ADZENYS XR-ODT .................. 49 AEMCOLO ................................ 16 AFINITOR ................................. 30 AFINITOR DISPERZ ................. 30 afirmelle .................................... 82 AFLURIA QUADRIVALENT ...... 90 AFREZZA .................................. 63 AFSTYLA .................................. 40 AGGRASTAT ............................ 36

ALOGLIPTIN BENZOATE ......... 58 ALOGLIPTIN-METFORMIN HCL ........................................... 58 ALOGLIPTIN-PIOGLITAZONE. 58 ALOMIDE ................................ 101 ALOPRIM .................................. 28 ALORA ...................................... 82 alosetron hcl .............................. 73 ALOXI ........................................ 26 ALPHAGAN P .......................... 102 ALPHA-LIPOIC ACID ................ 93 ALPHANATE/VWF COMPLEX/HUMAN ................... 40 ALPHANINE SD ........................ 40

amethyst .................................... 82 AMICAR ..................................... 40 AMIDATE ................................... 93 amikacin sulfate ......................... 16 amiloride hcl............................... 42 amiloride-hydrochlorothiazide .... 42 AMINO ACID ............................. 64 aminobenzoate potassium ......... 64 aminocaproic acid ...................... 40 aminophylline ........................... 107 AMINOPMRMS .......................... 93 AMINOPROTECT ...................... 64 AMINOSYN II............................. 64 AMINOSYN-PF .......................... 64

ANADROL-50 ............................79 ANAFRANIL .............................. 24 anagrelide hcl ........................... 40 ANALPRAM HC .........................91 ANALPRAM HC SINGLES .........91 ANALPRAM-HC .........................91 ANASCORP ...............................93 ANASPAZ ................................. 73 anastrozole ............................... 30 ANAVIP ......................................93 ANCOBON ................................ 27 ANDEXXA ..................................93 ANDRODERM .......................... 79 ANDROGEL .............................. 79

114

AKTIPAK ................................... 52 AKYNZEO ................................. 26 ALA SCALP ............................... 52 ala-cort ...................................... 52 albendazole ............................... 34 ALBENZA .................................. 34 ALBUKED 25 ............................. 93 ALBUKED 5 ............................... 93 albumin human .......................... 93 ALBUMINEX .............................. 93 alburx ......................................... 93 ALBUTEIN ................................. 93 albuterol sulfate ....................... 107 albuterol sulfate er ................... 107 ALBUTEROL SULFATE HFA. 107 ALCAINE ................................. 103 alclometasone dipropionate ....... 52 alcohol ....................................... 64 ALCOHOL PREP PADS ...... 52, 93 alcohol prep pads ...................... 93 ALDACTAZIDE .......................... 42 ALDACTONE ............................. 42 ALDARA .................................... 52 ALDER ...................................... 93 ALDURAZYME .......................... 75 ALECENSA ............................... 30 alendronate sodium ................... 92 alfentanil hcl ................................. 7 ALFERON N .............................. 87 alfuzosin hcl er .......................... 77 ALINIA ....................................... 34 ALIQOPA ................................... 30 aliskiren fumarate ...................... 42 ALKERAN .................................. 30 allopurinol .................................. 28 allopurinol sodium ...................... 28 ALLZITAL .................................... 7 almotriptan malate ..................... 29 ALOCRIL ................................. 101

alprazolam ................................. 39 alprazolam er ............................. 39 ALPRAZOLAM INTENSOL ........ 39 alprazolam xr ............................. 39 ALPROLIX ................................. 40 alprostadil .................................. 42 ALREX ..................................... 101 ALTABAX ................................... 16 altacaine .................................. 103 ALTACE ..................................... 42 altafluor .................................... 103 altafluor benox ......................... 103 altafrin ...................................... 103 altavera ...................................... 82 ALTERNARIA ............................ 93 ALTOPREV ................................ 42 ALTRENO .................................. 52 ALUNBRIG ................................ 30 ALVESCO ................................ 107 alyacen 1/35 .............................. 82 alyacen 7/7/7 ............................. 82 alyq .......................................... 109 amabelz ..................................... 82 amantadine hcl .......................... 35 AMARYL .................................... 58 AMBIEN ................................... 111 AMBIEN CR ............................. 111 AMBISOME ............................... 27 ambrisentan ............................. 109 amcinonide ................................ 52 AMD FOAM DRESSING ............ 93 AMELUZ .................................... 52 AMERGE ................................... 29 AMERICAN BEECH .................. 93 AMERICAN COCKROACH ........ 93 AMERICAN ELM ....................... 93 AMERICAN SYCAMORE .......... 93 amethia ...................................... 82 amethia lo .................................. 82

amiodarone hcl ......................... 42 AMIODARONE HCL IN DEXTROSE .............................. 42 AMITIZA .................................... 73 amitriptyline hcl ......................... 24 AMLODIPINE BES+SYRSPEND SF ............... 42 amlodipine besylate .................. 42 amlodipine besylate-benazepril hcl ............................................. 42 amlodipine besylate-valsartan 42 amlodipine-atorvastatin ............. 42 amlodipine-olmesartan .............. 42 amlodipine-valsartan-hctz ......... 42 ammonium lactate ..................... 52 AMMONUL ................................ 75 amnesteem ............................... 52 amoxapine ................................ 24 amoxicill-clarithro-lansopraz ...... 73 amoxicillin ................................. 16 amoxicillin-potassium clavulanate ................................ 16 amoxicillin-potassium clavulanate er............................ 16 AMPHADASE ........................... 93 amphetamine sulfate ................. 49 amphetamine- dextroamphetamine .................. 49 amphetamine- dextroamphetamine er .............. 49 amphotericin b .......................... 27 ampicillin ................................... 16 ampicillin sodium ....................... 16 ampicillin-sulbactam sodium ..... 16 AMPYRA ................................... 50 AMRIX .................................... 110 AMVISC .................................. 103 AMVISC PLUS ........................ 103 AMYTAL SODIUM .................. 111

ANDROGEL PUMP ................... 79 ANECTINE ................................ 50 ANESTHESIA S/I-40 ................. 93 ANESTHESIA S/I-40A ............... 93 ANESTHESIA S/I-40H ............... 93 ANESTHESIA S/I-40S ............... 93 ANESTHESIA S/I-60 ................. 93 ANGELIQ ................................... 82 ANGIOMAX ............................... 21 ANNOVERA .............................. 82 ANORO ELLIPTA .................... 107 ANTABUSE ............................... 16 ANTARA .................................... 42 anticoagulant cit dext soln a ...... 21 anticoagulant sodium citrate ...... 21 ANTIVENIN LATRODECTUS MACTANS ................................. 93 ANTIVENIN MICRURUS FULVIUS ................................... 93 anucort-hc .................................. 91 ANUSOL-HC ............................. 91 anusol-hc ................................... 91 ANZEMET ................................. 26 APADAZ ...................................... 7 apap-caff-dihydrocodeine ............ 7 APEXICON E............................. 52 APIDRA SOLOSTAR ................. 63 APIDRA VIAL ............................ 63 APLENZIN ................................. 24 APOKYN .................................... 35 APP SLIM RMS ......................... 93 APPLE (DIAGNOSTIC) ............. 93 apraclonidine hcl ...................... 102 aprepitant ................................... 26 apri ............................................ 82 APRISO ..................................... 91 APTENSIO XR .......................... 49 APTIOM ..................................... 22 APTIVUS ................................... 37 AQUACEL AG BURN ................ 52 AQUASOL A .............................. 64 ARAKODA ................................. 34 ARALAST NP .......................... 107 aranelle ...................................... 82 ARANESP (ALBUMIN FREE) ... 40 ARAVA ...................................... 87 ARCALYST ................................ 87 ARCAPTA NEOHALER ........... 107 ARESTIN ................................... 51 argatroban ................................. 21 argatroban in sodium chloride 21 ARGININE HCL ......................... 64 ARICEPT ................................... 24

ARIKAYCE ................................. 16 ARIMIDEX ................................. 30 aripiprazole ................................ 36 ARISTADA ................................. 36 ARISTADA INITIO ..................... 36 ARIXTRA ................................... 21 ARIZONA CYPRESS ................. 93 armodafinil ............................... 111 ARMOUR THYROID .................. 86 ARNUITY ELLIPTA .................. 107 AROMASIN ................................ 30 ARRANON ................................. 30 arsenic trioxide ........................... 30 ARTHROTEC............................. 11 ARTISS ...................................... 93 ARYMO ER .................................. 7 ARZERRA .................................. 30 arzol silver nit applicators ........... 52 ASACOL HD .............................. 91 ASCLERA .................................. 42 ascomp-codeine ........................... 7 ascorbic acid .............................. 64 ashlyna ...................................... 82 asilnasalrms ............................... 93 ASMANEX (120 METERED DOSES) ................................... 107 ASMANEX (14 METERED DOSES) ................................... 107 ASMANEX (30 METERED DOSES) ................................... 107 ASMANEX (60 METERED DOSES) ................................... 107 ASMANEX (7 METERED DOSES) ................................... 107 ASMANEX HFA ....................... 107 aspirin ........................................ 11 aspirin adult ............................... 11 aspirin adult low strength ........... 11 aspirin childrens ......................... 11 aspirin ec low dose .................... 11 aspirin ec low strength ............... 11 aspirin low dose ......................... 11 aspirin-dipyridamole er ............... 36 ASTAGRAF XL .......................... 87 ASTEPRO ................................ 105 ATACAND .................................. 42 ATACAND HCT ......................... 42 atazanavir sulfate ....................... 37 ATELVIA .................................... 92 atenolol ...................................... 42 ATENOLOL+SYRSPEND SF .... 42 atenolol-chlorthalidone ............... 42 ATGAM ...................................... 87

ATIVAN ..................................... 39 atomoxetine hcl ......................... 49 atorvastatin calcium .................. 42 atovaquone ............................... 34 atovaquone-proguanil hcl .......... 34 atracurium besylate ................... 50 ATRALIN ................................... 52 ATRIPLA ................................... 37 ATROPEN ................................. 73 atropine sulfate ................. 73, 103 ATROPINE SULFATE....... 73, 103 ATROVENT HFA .................... 107 AUBAGIO .................................. 50 aubra ......................................... 82 aubra eq .................................... 82 AUGMENTIN ............................ 16 AUGMENTIN ES-600 ............... 16 AURA PORTANEB ................... 93 AUREOBASIDIUM .................... 93 aurovela 1.5/30 ......................... 82 aurovela 1/20 ............................ 82 aurovela 24 fe ........................... 82 aurovela fe 1.5/30 ..................... 82 aurovela fe 1/20 ........................ 82 AURYXIA .................................. 76 AUSTEDO ................................. 50 AUSTRALIAN PINE .................. 93 AUTOLET LANCING DEVICE 60 AUVI-Q ................................... 107 AVALIDE ................................... 42 AVANDIA .................................. 58 AVAPRO ................................... 42 AVAR LS CLEANSER .............. 52 AVAR-E LS ............................... 52 AVASTIN ................................... 30 AVC VAGINAL .......................... 27 AVEED ...................................... 79 AVELOX.................................... 16 aviane ....................................... 82 avidoxy ...................................... 16 avita .................................... 52, 53 AVOCADO (DIAGNOSTIC) ...... 93 AVODART ................................. 77 AVONEX PEN........................... 50 AVONEX PREFILLED .............. 50 AVYCAZ.................................... 16 AXIFOL ..................................... 64 AXUMIN .................................... 93 AYGESTIN ................................ 82 ayuna ........................................ 82 azacitidine ................................. 30 AZACTAM ................................. 16 AZASAN.................................... 87

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AZASITE .................................. 101 azathioprine ............................... 87 azathioprine sodium ................... 87 AZEDRA DOSIMETRIC ............. 30 AZEDRA THERAPEUTIC .......... 30 azelaic acid ................................ 53 azelastine hcl ................... 101, 105 AZELEX ..................................... 53 AZILECT .................................... 35 azithromycin .............................. 17 AZOPT .................................... 102 AZOR ........................................ 42 aztreonam .................................. 17 AZULFIDINE .............................. 91 AZULFIDINE EN-TABS ............. 91 azurette...................................... 82 B-12 COMPLIANCE INJECTION ................................ 64 bacitracin ........................... 17, 101 bacitracin-polymyxin b ............. 103 bacitra-neomycin-polymyxin-hc ................................................ 103 baclofen ................................... 110 BACTERIOSTATIC WATER(BENZ ALC) .................. 93 bacteriostatic water(benz alc) .... 93 BACTOCILL IN DEXTROSE ..... 17 BACTRIM .................................. 17 BACTRIM DS ............................ 17 BAHIA ........................................ 93 bal in oil ..................................... 93 BALCOLTRA ............................. 82 BALD CYPRESS ....................... 93 balsalazide disodium ................. 91 balsam peru-castor oil ............... 53 BALVERSA ................................ 30 balziva ....................................... 82 BANANA (DIAGNOSTIC) .......... 93 BANZEL..................................... 22 BARACLUDE ............................. 37 BASAGLAR KWIKPEN .............. 63 BAVENCIO ................................ 30 BAXDELA .................................. 17 BAYBERRY (WAX MYRTLE) .... 93 bayer aspirin .............................. 11 bayer aspirin ec low dose .......... 11 BAYER CONTOUR ................... 60 BCAA ......................................... 64 BCG VACCINE .......................... 90 BD AUTOSHIELD DUO PEN NEEDLES .................................. 63 bd pudendal/local tray/1% lido 13 BD SYRINGE LUER-LOK .......... 93

BD ULTRA-FINE INSULIN SYRINGES ................................ 63 BD ULTRA-FINE PEN NEEDLES .................................. 63 BECONASE AQ ....................... 105 BEEF (DIAGNOSTIC) ................ 93 bekyree ...................................... 82 BELBUCA .................................... 7 BELEODAQ ............................... 30 belladonna alkaloids-opium ........ 73 BELRAPZO ................................ 30 BELSOMRA ............................. 111 benazepril hcl............................. 42 benazepril-hydrochlorothiazide. 42 BENDAMUSTINE HCL .............. 30 BENDEKA .................................. 30 BENEFIX ................................... 40 BENICAR ................................... 42 BENICAR HCT .......................... 42 BENLYSTA ................................ 87 BENTLEY THE BEAR PED NEBULIZER ............................... 93 BENTYL ..................................... 73 BENZAC AC WASH .................. 53 BENZACLIN ............................... 53 BENZACLIN WITH PUMP ......... 53 benzalkonium chloride ............... 17 BENZAMYCIN ........................... 53 benzepro .................................... 53 benzepro foaming cloths ............ 53 benzepro short contact .............. 53 BENZHYDROCODONE- ACETAMINOPHEN ...................... 7 BENZIQ ..................................... 53 BENZIQ LS ................................ 53 benziq wash ............................... 53 BENZNIDAZOLE ....................... 34 benzonatate ............................. 105 BENZOYL PEROX- HYDROCORTISONE ................. 53 benzoyl peroxide ........................ 53 BENZOYL PEROXIDE............... 53 BENZOYL PEROXIDE FORTE- HC ............................... 53 benzoyl peroxide-erythromycin. 53 benztropine mesylate ................. 35 BEPREVE ................................ 101 BERINERT ................................. 87 BERMUDA GRASS ................... 93 beser .......................................... 53 BESIVANCE ............................ 101 BESPONSA ............................... 30 BETA 1 KIT ................................ 77

BETADINE OPHTHALMIC PREP ...................................... 101 BETALIDO ................................ 77 betamethasone dipropionate ..... 53 betamethasone dipropionate aug ............................................ 53 BETAMETHASONE SOD PHOS & ACET .......................... 77 betamethasone sod phos & acet ........................................... 77 BETAMETHASONE SODIUM PHOSPHATE ............................ 77 betamethasone valerate............ 53 BETAPACE ............................... 42 BETAPACE AF ......................... 42 BETASERON ............................ 50 betaxolol hcl ...................... 42, 102 bethanechol chloride ................. 76 BETHKIS ................................. 109 BETIMOL ................................ 102 BETOPTIC-S .......................... 102 BEVACIZUMAB ...................... 103 BEVESPI AEROSPHERE ....... 107 BEVYXXA ................................. 21 bexarotene ................................ 30 BEXSERO ................................. 90 BEYAZ ...................................... 82 bicalutamide .............................. 30 BICILLIN C-R ............................ 17 BICILLIN C-R 900/300 .............. 17 BICILLIN L-A ............................. 17 BICNU ....................................... 30 BIDIL ......................................... 42 BI-EST 80:20 PROGESTERONE .................... 82 BIEST/PROGESTERONE ......... 82 BIJUVA ..................................... 82 BIKTARVY ................................ 37 BILTRICIDE .............................. 34 bimatoprost ............................. 102 BINOSTO .................................. 92 BIOFREQUENCY INSOLES ..... 93 BIOGUARD ISLAND DRESSINGS ............................. 93 BIOGUARD NON-ADHERENT DRESSING ............................... 93 BIOLON .................................. 103 BIO-STATIN .............................. 27 bio-statin ................................... 27 BIOTEL CARE BLOOD GLUCOSE SYST ...................... 60 BIOTHRAX ................................ 90 bisacodyl ec .............................. 73

116

bisoprolol fumarate .................... 42 bisoprolol-hydrochlorothiazide 42 bivalirudin trifluoroacetate .......... 21 BIVALIRUDIN-SODIUM CHLORIDE ................................ 21 BIVIGAM .................................... 87 BLACK WALNUT POLLEN ....... 93 BLACK WILLOW ....................... 93 bleomycin sulfate ....................... 30 BLEPH-10 ................................ 101 BLEPHAMIDE.......................... 103 BLEPHAMIDE S.O.P. .............. 103 BLINCYTO ................................. 30 blisovi 24 fe ............................... 82 blisovi fe 1.5/30 ......................... 82 blisovi fe 1/20 ............................ 82 BLOXIVERZ .............................. 29 BONIVA ..................................... 92 BONJESTA ................................ 26 BOOSTRIX ................................ 90 BORTEZOMIB ........................... 30 bosentan .................................. 109 BOSULIF ................................... 30 BOTOX ...................................... 94 BOTOX COSMETIC .................. 53 BOTRYTIS ................................. 94 BOX ELDER .............................. 94 bp cleansing wash ..................... 53 bp foam ..................................... 53 bp wash ..................................... 53 BPCO ........................................ 53 bpo ............................................ 53 BRAFTOVI ................................. 30 BREATHERITE .......................... 94 BREATHERITE VALVED MDI CHAMBER ................................. 94 BREO ELLIPTA ....................... 107 BREVIBLOC IN NACL ............... 42 BREVIBLOC PREMIXED .......... 42 BREVIBLOC PREMIXED DS .... 42 BREVITAL SODIUM .................. 94 BRIDION .................................... 94 briellyn ....................................... 82 BRILINTA .................................. 36 brimonidine tartrate .................. 102 BRINEURA ................................ 75 BRISDELLE ............................... 24 BRIVIACT .................................. 22 BROME ..................................... 94 bromfed dm ............................. 105 bromfenac sodium (once-daily) ................................................ 101 bromocriptine mesylate.............. 35

BROMPHENIRAMINE MALEATE ................................ 105 brompheniramine tannate ........ 105 BROMSITE .............................. 101 BROVANA ............................... 107 BRYHALI ................................... 53 budesonide ........................ 91, 107 budesonide er ............................ 91 BUFFERED LIDOCAINE ........... 13 bumetanide ................................ 42 BUMEX ...................................... 42 BUNAVAIL ................................. 16 BUPAP ........................................ 7 BUPHENYL ............................... 75 bupivacaine fisiopharma ............ 13 bupivacaine hcl .......................... 13 BUPIVACAINE HCL .................. 13 bupivacaine hcl (pf).................... 13 BUPIVACAINE HCL-NACL ........ 13 bupivacaine in dextrose ............. 13 bupivacaine spinal ..................... 13 bupivacaine-epinephrine ............ 13 bupivacaine-epinephrine (pf) ..... 13 BUPIVILOG ............................... 77 BUPRENEX ................................. 7 buprenorphine .............................. 7 BUPRENORPHINE ...................... 7 buprenorphine hcl .................. 7, 16 buprenorphine hcl-naloxone hcl .............................................. 16 bupropion hcl ............................. 24 bupropion hcl er (smoking det). 16 bupropion hcl er (sr) .................. 24 bupropion hcl er (xl) ................... 24 BUPROPION HCL ER (XL) ....... 24 buspirone hcl ............................. 39 busulfan ..................................... 30 BUSULFEX ................................ 30 BUTALBITAL- ACETAMINOPHEN ...................... 7 butalbital-acetaminophen ............. 7 butalbital-apap ............................. 7 butalbital-apap-caff-cod ................ 7 butalbital-apap-caffeine ................ 7 butalbital-asa-caff-codeine ........... 7 butalbital-aspirin-caffeine ............. 7 BUTISOL SODIUM .................. 111 butorphanol tartrate ..................... 7 BUTRANS .................................... 7 BYDUREON .............................. 58 BYDUREON BCISE AUTOINJECTOR ....................... 59 BYETTA 10 MCG PEN .............. 59

BYETTA 5 MCG PEN ............... 59 BYSTOLIC ................................ 42 cabergoline ............................... 80 CABOMETYX ........................... 30 CADIRAMD ............................... 13 CADUET ................................... 42 CAFCIT ..................................... 50 CAFERGOT .............................. 29 caffeine citrate........................... 50 CAFFEINE-SODIUM BENZOATE ............................... 50 CALAN ...................................... 42 CALAN SR ................................ 42 CALCIFOL ................................ 64 calcipotriene .............................. 53 calcipotriene-betameth diprop ... 53 calcitonin (salmon) .................... 92 calcitrene ................................... 53 calcitriol ............................... 53, 92 calcium acetate (phos binder) ... 76 CALCIUM CHLORIDE .............. 65 calcium chloride ........................ 65 CALCIUM DISODIUM VERSENATE ............................ 94 calcium gluconate ..................... 65 CALCIUM GLUCONATE ........... 65 calcium gluconate anhydrous ... 65 CALCIUM GLUCONATE- NACL ........................................ 65 calcium-folic acid plus d ............ 65 CALIFORNIA PEPPER TREE 94 CALM ........................................ 65 CALQUENCE ............................ 30 CAMBIA .................................... 11 camila ....................................... 82 CAMPATH ................................ 30 CAMPTOSAR ........................... 30 camrese .................................... 82 camrese lo ................................ 82 CANASA ................................... 91 CANCIDAS ............................... 27 candesartan cilexetil ................. 42 candesartan cilexetil-hctz .......... 42 CANDIDA ALBICANS EXTRACT ................................. 94 CANTALOUPE (DIAGNOSTIC) ......................... 94 CANTHARIDIN .......................... 53 CAPASTAT SULFATE .............. 29 capecitabine .............................. 30 CAPEX ...................................... 53 CAPRELSA ............................... 30

117

CAPTAIN EAGLE PED NEBULIZER .............................. 94 captopril ..................................... 42 captopril-hydrochlorothiazide ..... 42 CARAC ...................................... 53 CARAFATE ............................... 72 CARBAGLU ............................... 65 carbamazepine .......................... 22 carbamazepine er ...................... 22 CARBATROL ............................. 22 carbidopa ................................... 35 carbidopa-levodopa ................... 35 carbidopa-levodopa er ............... 35 carbidopa-levodopa- entacapone ................................ 35 carbinoxamine maleate............ 105 CARBOCAINE ........................... 13 CARBOCAINE PRESERVATIVE-FREE ............. 13 carboplatin ................................. 30 carboprost tromethamine ........... 82 CARDENE IV............................. 42 CARDIOPLEGIC ........................ 65 CARDIOVID PLUS .................... 94 CARDIZEM ................................ 43 CARDIZEM CD .......................... 43 CARDIZEM LA .......................... 43 CARDURA ................................. 43 CARDURA XL ........................... 77 CARETOUCH LANCING/EJECTOR ................. 60 CARIMUNE NF .......................... 87 carimune nf ................................ 87 carisoprodol ............................. 110 carisoprodol-aspirin ................. 110 carisoprodol-aspirin-codeine ........ 7 carmustine ................................. 30 CARNITOR ................................ 65 CARNITOR SF .......................... 65 CAROSPIR ................................ 43 carteolol hcl ............................. 102 cartia xt ...................................... 43 carvedilol ................................... 43 carvedilol phosphate er ............. 43 cascara sagrada ........................ 73 CASEIN (DIAGNOSTIC) ............ 94 CASODEX ................................. 30 caspofungin acetate .................. 27 CAT HAIR EXTRACT ................ 94 CATAPRES ............................... 43 CATAPRES-TTS-1 .................... 43 CATAPRES-TTS-2 .................... 43 CATAPRES-TTS-3 .................... 43

CATHFLO ACTIVASE ............... 21 CATTLE EPITHELIUM............... 94 cavarest ..................................... 51 CAYA ......................................... 94 CAYSTON ............................... 109 caziant ....................................... 82 CEDAR ELM .............................. 94 cefaclor ...................................... 17 cefaclor er .................................. 17 cefadroxil ................................... 17 CEFALY KIT .............................. 94 cefazolin sodium ........................ 17 CEFAZOLIN SODIUM ............... 17 cefazolin sodium-dextrose ......... 17 cefdinir ....................................... 17 cefditoren pivoxil ........................ 17 cefepime hcl............................... 17 cefepime-dextrose ..................... 17 cefixime...................................... 17 CEFOTAN .................................. 17 cefotaxime sodium ..................... 17 cefotetan disodium ..................... 17 cefoxitin sodium ......................... 17 cefpodoxime proxetil .................. 17 cefprozil ..................................... 17 ceftazidime and dextrose ........... 17 ceftriaxone sodium ..................... 17 ceftriaxone sodium in dextrose. 17 ceftriaxone sodium-dextrose ...... 17 cefuroxime axetil ........................ 17 cefuroxime sodium ..................... 17 CEFUROXIME SODIUM- NACL ....................................... 101 CELEBREX ................................ 11 celecoxib .................................... 11 CELESTONE SOLUSPAN ......... 77 CELEXA..................................... 24 CELLCEPT ................................ 87 CELLCEPT INTRAVENOUS ..... 87 CELONTIN ................................. 22 CENTANY .................................. 17 CENTRATEX ............................. 65 cephalexin .................................. 17 CEPROTIN ................................ 40 CEQUA .................................... 103 CERDELGA ............................... 75 CEREBYX .................................. 22 CEREZYME ............................... 75 CERVIDIL .................................. 82 CETACAINE .............................. 13 cetirizine hcl ............................. 105 CETRAXAL .............................. 105 CETROTIDE .............................. 80

cevimeline hcl ........................... 51 CHANTIX .................................. 16 CHANTIX CONTINUING MONTH PAK............................. 16 CHANTIX STARTING MONTH PAK ........................................... 16 chateal ...................................... 82 chateal eq ................................. 82 CHEMET ................................... 65 CHEMSTRIP UGK .................... 60 CHENODAL .............................. 73 CHICKEN MEAT (DIAGNOSTIC) ......................... 94 chloramphenicol sod succinate. 17 chlordiazepoxide hcl ................. 39 chlordiazepoxide-amitriptyline ... 25 chlordiazepoxide-clidinium ........ 73 chlorhexidine gluconate ...... 51, 94 CHLORHEXIDINE GLUCONATE ............................ 94 chloroprocaine hcl (pf) .............. 13 chloroquine phosphate .............. 34 chlorothiazide ............................ 43 chlorothiazide sodium ............... 43 chlorpromazine hcl .................... 36 chlorthalidone ............................ 43 chlorzoxazone ......................... 110 CHOLBAM ................................ 73 cholestyramine .......................... 43 cholestyramine light .................. 43 CHOLETEC .............................. 94 choline fenofibrate ..................... 43 choline-mag trisalicylate ............ 11 chorionic gonadotropin .............. 80 chromic chloride ........................ 65 ciclodan ..................................... 27 CICLODAN SOLUTION ............ 27 ciclopirox ................................... 27 ciclopirox olamine ..................... 27 cidofovir..................................... 37 cilostazol ................................... 36 CILOXAN ................................ 101 CIMDUO ................................... 37 cimetidine .................................. 72 cimetidine hcl ............................ 72 CIMZIA ...................................... 87 CIMZIA PREFILLED KIT ........... 87 CIMZIA STARTER KIT ............. 87 cinacalcet hcl ............................ 80 CINQAIR ................................. 105 CINRYZE .................................. 87 CINVANTI ................................. 26 CIPRO ...................................... 17

118

CIPRO HC ............................... 105 CIPRODEX .............................. 105 ciprofloxacin ............................... 17 ciprofloxacin hcl ......... 17, 101, 105 ciprofloxacin in d5w ................... 17 cisatracurium besylate ............... 50 cisatracurium besylate (pf) ........ 50 cisplatin...................................... 30 CISPLATIN ................................ 31 citalopram hydrobromide ........... 25 CITANEST FORTE DENTAL .... 13 CITANEST PLAIN DENTAL ...... 14 CITRANATAL MEDLEY ............. 65 citroma ....................................... 73 CLADOSPORIUM CLADOSPORIOIDES ................ 94 CLADOSPORIUM SPHAEROSPERMUM ............... 94 cladribine ................................... 31 claravis ...................................... 53 CLARINEX ............................... 105 CLARINEX-D 12 HOUR .......... 105 clarithromycin............................. 17 clarithromycin er ........................ 17 clearlax ...................................... 73 clemastine fumarate ................ 105 CLENPIQ ................................... 73 CLEOCIN ................................... 17 CLEOCIN PHOSPHATE ............ 17 CLEOCIN-T ............................... 53 CLEVIPREX .............................. 43 CLIMARA ................................... 82 CLIMARA PRO .......................... 82 clindacin etz ............................... 53 clindacin-p ................................. 53 CLINDAGEL .............................. 53 clindamycin hcl .......................... 17 clindamycin palmitate hcl ........... 17 clindamycin phosphate. 17, 18, 53 CLINDAMYCIN PHOSPHATE 53 clindamycin phosphate in d5w 17 CLINDAMYCIN PHOSPHATE IN NACL .................................... 17 clindamycin phosphate- benzoyl peroxide ....................... 53 clindamycin-tretinoin .................. 53 CLINDESSE .............................. 18 CLINIMIX E/DEXTROSE (2.75/5) ...................................... 65 CLINIMIX E/DEXTROSE (4.25/10) .................................... 65 CLINIMIX E/DEXTROSE (4.25/5) ...................................... 65

CLINIMIX E/DEXTROSE (5/15) ......................................... 65 CLINIMIX E/DEXTROSE (5/20) ......................................... 65 CLINIMIX N14G30E .................. 65 CLINIMIX N9G15E .................... 65 CLINIMIX N9G20E .................... 65 clinimix/dextrose (4.25/10) ......... 65 CLINIMIX/DEXTROSE (4.25/10) .................................... 65 clinimix/dextrose (4.25/25) ......... 65 CLINIMIX/DEXTROSE (4.25/5) 65 CLINIMIX/DEXTROSE (5/15) .... 65 CLINIMIX/DEXTROSE (5/20) .... 65 CLINIMIX/DEXTROSE (5/25) .... 65 clinisol sf .................................... 65 CLINOIN .................................... 53 clinpro 5000 ............................... 51 clobazam ................................... 22 clobetasol prop emollient base. 53 clobetasol propionate ................. 53 clobetasol propionate e .............. 53 clobetasol propionate emulsion 53 CLOBEX .................................... 54 CLOBEX SPRAY ....................... 54 clocortolone pivalate .................. 54 clodan ........................................ 54 CLODERM ................................. 54 clofarabine ................................. 31 CLOLAR .................................... 31 clomiphene citrate ...................... 80 clomipramine hcl ........................ 25 clonazepam ............................... 39 clonidine..................................... 43 clonidine hcl ............................... 43 clonidine hcl er ........................... 49 clopidogrel bisulfate ................... 36 clorazepate dipotassium ............ 39 CLOROTEKAL ........................... 14 clotrimazole ................................ 27 CLOTRIMAZOLE ....................... 27 clotrimazole-betamethasone ...... 54 clozapine .................................... 36 CLOZARIL ................................. 36 COAGADEX .............................. 40 coal tar ....................................... 54 COARTEM ................................. 35 cocaine hcl ................................. 14 COCAINE HCL .......................... 14 COCKLEBUR ............................ 94 COCOA BEAN (DIAGNOSTIC) 94 codeine sulfate ............................. 7 COENZYME Q-10 ...................... 94

COGENTIN ............................... 35 COLAZAL .................................. 91 COLCHICINE ............................ 28 colchicine-probenecid................ 28 COLCRYS ................................. 28 colesevelam hcl ........................ 43 COLESTID ................................ 43 COLESTID FLAVORED ............ 43 colestipol hcl ............................. 43 colistimethate sodium (cba) ...... 18 colocort ..................................... 91 COLY-MYCIN M ....................... 18 COLY-MYCIN S ...................... 105 COLYTE WITH FLAVOR PACKS ...................................... 73 COMBIGAN ............................ 102 COMBIPATCH .......................... 82 COMBIVENT RESPIMAT ....... 107 COMBIVIR ................................ 37 COMETRIQ (100 MG DAILY DOSE) ...................................... 31 COMETRIQ (140 MG DAILY DOSE) ...................................... 31 COMETRIQ (60 MG DAILY DOSE) ...................................... 31 COMPLERA .............................. 37 compro ...................................... 26 COMTAN .................................. 35 CONCERTA .............................. 49 CONDYLOX .............................. 54 constulose ................................. 73 CONTOUR NEXT CONTROL ... 60 CONTOUR NEXT MONITOR ... 60 CONTOUR NEXT TEST ........... 60 CONTOUR TEST ...................... 60 CONTRAST ALLERGY PREMED PACK ........................ 77 CONZIP ...................................... 7 COPAXONE .............................. 50 COPIKTRA ................................ 31 COPPER CHLORIDE ............... 65 CORDRAN ................................ 54 COREG ..................................... 43 COREG CR .............................. 43 coremino ................................... 18 CORGARD ................................ 43 CORIFACT ................................ 40 CORLANOR .............................. 43 CORLOPAM ............................. 43 CORN POLLEN ........................ 94 CORTANE-B ............................. 54 CORTEF ................................... 77 CORTENEMA ........................... 91

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cortic-nd ................................... 105 CORTIFOAM ............................. 91 cortisone acetate ....................... 77 CORTISPORIN .......................... 54 CORTROSYN ............................ 94 corvita 150 ................................. 65 CORVITE 150 ............................ 65 CORVITE FE ............................. 65 COSENTYX (300 MG DOSE) ... 87 COSENTYX 150 MG/ML ........... 87 COSENTYX SENSOREADY (300 MG) ................................... 87 COSENTYX SENSOREADY PEN ........................................... 87 COSMEGEN .............................. 31 COSOPT ................................. 102 COSOPT PF ............................ 102 cosyntropin ................................ 94 COTELLIC ................................. 31 COTEMPLA XR-ODT ................ 49 COUMADIN ............................... 21 covaryx ...................................... 82 covaryx hs ................................. 82 COZAAR .................................... 43 CRAB (DIAGNOSTIC) ............... 94 CREON...................................... 75 CRESEMBA .............................. 27 CRESTOR ................................. 43 CRINONE .................................. 82 CRIXIVAN .................................. 37 cromolyn sodium ....... 73, 101, 107 crotan ........................................ 35 cryselle-28 ................................. 82 CRYSVITA ................................. 75 CUBICIN .................................... 18 CUBICIN RF .............................. 18 CUPRIMINE .............................. 76 curad hydrocortisone ................. 54 CURITY AMD ANTIMICROBIAL STRIP ........... 94 CURITY IODOFORM PACKING STRIP ....................... 94 CURVULARIA............................ 94 CUTAQUIG .......................... 87, 88 CUTIVATE ................................. 54 CUVITRU ................................... 88 CUVPOSA ................................. 73 cyanocobalamin ......................... 65 CYANOCOBALAMIN ................. 65 cyclafem 1/35 ............................ 82 cyclafem 7/7/7 ........................... 82 cyclobenzaprine hcl ................. 110 cyclobenzaprine hcl er ............. 110

CYCLOGYL ............................. 103 CYCLOMYDRIL ....................... 103 cyclopentolate hcl .................... 103 CYCLOPHENE RAPIDPAQ ..... 110 cyclophosphamide ..................... 31 cycloserine ................................. 29 CYCLOSET ............................... 59 cyclosporine ............................... 88 cyclosporine modified ................ 88 CYKLOKAPRON ........................ 40 CYMBALTA ............................... 25 cyproheptadine hcl ................... 105 CYRAMZA ................................. 31 cyred .......................................... 82 cyred eq ..................................... 83 CYSTADANE ............................. 75 CYSTAGON ............................... 75 CYSTARAN ............................. 103 CYSVIEW .................................. 94 cytarabine .................................. 31 cytarabine (pf) ............................ 31 CYTOGAM ................................. 88 CYTOMEL ................................. 86 CYTOTEC .................................. 72 cytra k crystals ........................... 65 D.H.E. 45 ................................... 29 dacarbazine ............................... 31 DACOGEN ................................. 31 dactinomycin .............................. 31 dalfampridine er ......................... 50 DALIRESP ............................... 107 DALVANCE ............................... 18 danazol ...................................... 79 DANTRIUM .............................. 110 dantrolene sodium ................... 110 dapsone ............................... 29, 54 DAPTACEL ................................ 90 daptomycin ................................ 18 DARAPRIM ................................ 35 darifenacin hydrobromide er ...... 76 DARZALEX ................................ 31 dasetta 1/35 ............................... 83 dasetta 7/7/7 .............................. 83 daunorubicin hcl ......................... 31 DAURISMO ............................... 31 DAYPRO .................................... 11 daysee ....................................... 83 DAYTRANA ............................... 49 DDAVP ...................................... 80 DDAVP RHINAL TUBE .............. 80 DEBACTEROL ........................... 51 deblitane .................................... 83 DECADRON .............................. 77

decitabine .................................. 31 deferasirox ................................ 65 deferoxamine mesylate ............. 94 DEFITELIO ............................... 21 dehydrated alcohol .................... 65 DELESTROGEN ....................... 83 delflex-lc/1.5% dextrose ............ 65 delflex-lc/2.5% dextrose ............ 66 delflex-lc/4.25% dextrose .......... 66 DELFLEX-LC/4.25% DEXTROSE .............................. 66 delflex-sm/1.5% dextrose .......... 66 DELSTRIGO ............................. 37 delyla ........................................ 83 DELZICOL ................................ 91 demeclocycline hcl .................... 18 DEMEROL .................................. 7 DEMSER ................................... 43 DENAVIR .................................. 37 denta 5000 plus ........................ 51 dentagel .................................... 51 DEPACON ................................ 22 DEPAKENE .............................. 22 DEPAKOTE .............................. 22 DEPAKOTE ER ........................ 22 DEPAKOTE SPRINKLES ......... 22 DEPEN TITRATABS ................. 76 DEPO-ESTRADIOL .................. 83 DEPO-MEDROL ....................... 77 DEPO-PROVERA ..................... 83 DEPO-SUBQ PROVERA 104 ... 83 DEPO-TESTOSTERONE .......... 79 DEPRIZINE FUSEPAQ ............. 72 DERMA-SMOOTHE/FS BODY. 54 DERMA-SMOOTHE/FS SCALP ...................................... 54 DERMOTIC ............................. 105 DERMULCERA ......................... 54 DESCOVY ................................ 37 DESFERAL ............................... 94 desflurane ................................. 94 desipramine hcl ......................... 25 desloratadine .......................... 105 desmopressin ace spray refrig 80 desmopressin acetate ............... 80 desmopressin acetate spray ..... 80 desogestrel-ethinyl estradiol ..... 83 DESONATE .............................. 54 desonide ................................... 54 DESOWEN ............................... 54 desoximetasone ........................ 54 DESOXYN ................................ 49 DESVENLAFAXINE ER ............ 25

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desvenlafaxine succinate er ...... 25 DETROL .................................... 76 DETROL LA............................... 76 dexamethasone ......................... 77 DEXAMETHASONE (LA) .......... 77 DEXAMETHASONE ACE & SOD PHOS ............................... 77 DEXAMETHASONE INTENSOL ................................. 77 DEXAMETHASONE SOD PHOS-BUPIV............................. 77 DEXAMETHASONE SOD PHOS-NACL .............................. 78 dexamethasone sod phosphate pf .............................. 78 dexamethasone sodium phosphate .......................... 78, 101 DEXAMETHASONE- MOXIFLOXACIN ...................... 103 DEXAMETH-MOXIFLOX- KETOROLAC........................... 103 dexchlorpheniramine maleate. 105 DEXCOM G4 / G5 / G6 RECEIVER, TRANSMITTER, SENSOR (INCLUDING PLATINUM, PLATINUM PEDIATRIC) .............................. 60 DEXEDRINE .............................. 49 DEXILANT ................................. 72 DEXLIDO ................................... 78 DEXLIDO-M ............................... 78 DEXMEDETOMIDINE HCL ....... 94 dexmedetomidine hcl ................. 94 dexmedetomidine hcl in nacl ..... 94 DEXMEDETOMIDINE HCL- DEXTROSE ............................... 94 dexmethylphenidate hcl ............. 49 dexmethylphenidate hcl er ......... 49 DEXOPIN .................................. 78 DEXPAK 10 DAY ....................... 78 DEXPAK 13 DAY ....................... 78 DEXPAK 6 DAY ......................... 78 DEXPANTHENOL ..................... 66 dexrazoxane .............................. 31 dexrazoxane hcl ........................ 31 DEXTENZA ............................. 101 dextroamphetamine sulfate ....... 49 dextroamphetamine sulfate er 49 dextrose ..................................... 66 DEXTROSE ............................... 66 DEXYCU .................................. 101 DIACOMIT ................................. 22

DIANEAL LOW CALCIUM/1.5% DEX ................. 66 DIANEAL LOW CALCIUM/2.5% DEX ................. 66 DIANEAL LOW CALCIUM/4.25% DEX ............... 66 DIASTAT ACUDIAL ................... 22 DIASTAT PEDIATRIC................ 22 DIATHRIVE BLOOD GLUCOSE METER .................... 60 DIATHRIVE BLOOD GLUCOSE TEST ....................... 60 DIATHRIVE GLUCOSE CONTROL SOLN ...................... 61 DIATHRIVE GLUCOSE TEST 61 DIATHRIVE LANCING DEVICE ..................................... 61 diazepam ............................. 22, 39 DIAZEPAM ................................ 39 diazepam intensol ...................... 39 DIBENZYLINE ........................... 43 DICLEGIS .................................. 26 DICLOFENAC EPOLAMINE ...... 11 diclofenac potassium ................. 11 diclofenac sodium ........11, 54, 101 diclofenac sodium er .................. 11 diclofenac-misoprostol ............... 11 dicloxacillin sodium .................... 18 DICOPANOL FUSEPAQ .......... 105 DICOPANOL RAPIDPAQ ........ 105 dicyclomine hcl .......................... 73 didanosine ................................. 37 DIFFERIN .................................. 54 DIFICID ...................................... 18 difil-g forte ................................ 107 diflorasone diacetate .................. 54 DIFLUCAN ................................. 27 diflunisal ..................................... 11 digitek ........................................ 43 digox .......................................... 43 digoxin ....................................... 43 dihydroergotamine mesylate ...... 29 DILANTIN ............................ 22, 23 DILANTIN INFATABS ................ 22 DILATRATE-SR ......................... 43 DILAUDID .................................... 7 diltiazem hcl ............................... 43 diltiazem hcl er ........................... 43 diltiazem hcl er beads ................ 43 diltiazem hcl er coated beads .... 43 DILTIAZEM HCL-DEXTROSE 43 DILTIAZEM HCL-SODIUM CHLORIDE ................................ 43

dilt-xr ......................................... 43 diluent for treprostinil................. 94 dimenhydrinate.......................... 26 DIOVAN .................................... 43 DIOVAN HCT ............................ 43 DIPENTUM ............................... 91 diphenhydramine hcl ............... 105 diphenoxylate-atropine .............. 73 DIPHTHERIA-TETANUS TOXOIDS DT ............................ 90 DIPRIVAN ................................. 94 DIPROLENE ............................. 54 DIPROLENE AF ........................ 54 dipyridamole .............................. 36 disopyramide phosphate ........... 43 disulfiram ................................... 16 DITROPAN XL .......................... 76 DIURIL ...................................... 43 divalproex sodium ..................... 23 divalproex sodium er ................. 23 DIVIGEL .................................... 83 dobutamine hcl .......................... 43 docetaxel ................................... 31 dofetilide.................................... 43 DOG EPITHELIUM ................... 94 DOG FENNEL........................... 94 DOLOPHINE ............................... 7 donepezil hcl ............................. 24 DONNATAL .............................. 73 dopamine hcl............................. 43 dopamine in d5w ....................... 43 DOPTELET ............................... 40 DORAL ..................................... 39 DORYX ..................................... 18 DORYX MPC ............................ 18 DORZOLAMIDE HCL ............. 102 dorzolamide hcl ....................... 102 DORZOLAMIDE HCL- TIMOLOL MAL ........................ 102 dorzolamide hcl-timolol mal .... 102 dorzolamide hcl-timolol mal pf 102 DOTAREM ................................ 94 dotti ........................................... 83 DOUBLE PM ........................... 103 DOVATO ................................... 37 DOVER URETHRAL CATHETER ............................... 94 DOVONEX ................................ 54 doxazosin mesylate .................. 43 doxepin hcl .......................... 25, 54 doxercalciferol ........................... 92 DOXIL ....................................... 31 doxorubicin hcl .......................... 31

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doxorubicin hcl liposomal ........... 31 doxy 100 .................................... 18 doxycycline ................................ 54 doxycycline hyclate .................... 18 doxycycline monohydrate .......... 18 doxylamine-pyridoxine ............... 26 D-PENAMINE ............................ 76 DRECHSLERA .......................... 95 DRISDOL ................................... 66 dritho-creme hp ......................... 54 dronabinol .................................. 26 droperidol ................................... 26 drospiren-eth estrad-levomefol. 83 drospirenone-ethinyl estradiol .... 83 DROXIA ..................................... 31 DRYSOL .................................... 54 DSUVIA ....................................... 7 DUAC ........................................ 54 DUAKLIR PRESSAIR .............. 107 DUAL COMPLEX FORMULA 1 KIT ............................................. 11 DUAVEE .................................... 83 DUETACT .................................. 59 DUEXIS ..................................... 11 DULERA .................................. 107 duloxetine hcl............................. 25 DUOBRII .................................... 54 DUODOTE ................................. 95 DUOPA ...................................... 35 DUPIXENT ................................ 54 DURAGESIC-100 ........................ 7 DURAGESIC-12 .......................... 7 DURAGESIC-25 .......................... 7 DURAGESIC-50 .......................... 7 DURAGESIC-75 .......................... 7 duramorph ................................... 7 duraxin ......................................... 7 DUREZOL ............................... 101 DURLAZA .................................. 36 DUROLANE ............................... 95 DUST MITE MIXED ALLERGEN EXT ........................ 95 dutasteride ................................. 77 dutasteride-tamsulosin hcl ......... 77 DUTOPROL ............................... 43 DVORAH ..................................... 7 DXEVO 11-DAY ......................... 78 DYANAVEL XR ......................... 49 DYAZIDE ................................... 43 DYMISTA ................................. 105 DYRENIUM ............................... 43 DYSPORT ................................. 95 DYURAL-40 ............................... 78

DYURAL-80 ............................... 78 DYURAL-L ................................. 78 DYURAL-LM .............................. 78 e.e.s. 400 ................................... 18 E.E.S. GRANULES .................... 18 EASIVENT ................................. 95 EASTERN COTTONWOOD ...... 95 EASY COMFORT ALCOHOL PADS ......................................... 95 EASY GLIDE LUER LOCK SYRINGE ................................... 95 easygel ...................................... 51 EASYMAX CONTROL ............... 61 EASYPLUS BLOOD GLUCOSE TEST ....................... 61 EC-NAPROSYN ......................... 11 ec-naproxen ............................... 11 econazole nitrate ....................... 27 ECOZA ...................................... 27 EC-RX DHEA............................. 95 EC-RX ESTRADIOL .................. 83 EC-RX PROGESTERONE ........ 83 EC-RX TESTOSTERONE ......... 79 EDARBI ..................................... 43 EDARBYCLOR .......................... 43 EDECRIN ................................... 43 EDLUAR .................................. 111 EDURANT ................................. 37 eemt ........................................... 83 eemt hs ...................................... 83 efavirenz .................................... 37 EFFER-K ................................... 66 effer-k ........................................ 66 EFFEXOR XR ............................ 25 EFFIENT .................................... 36 EFUDEX .................................... 54 EGATEN .................................... 35 EGG WHITE (DIAGNOSTIC) .... 95 EGRIFTA ................................... 80 ELAPRASE ................................ 75 ELCYS ....................................... 95 ELELYSO .................................. 75 ELESTRIN ................................. 83 eletriptan hydrobromide ............. 29 ELIDEL ...................................... 54 ELIGARD ................................... 80 ELIMITE ..................................... 35 elinest ........................................ 83 ELIQUIS..................................... 21 ELIQUIS STARTER PACK ........ 22 ELITEK ...................................... 31 elite-ob ....................................... 66 ELIXOPHYLLIN ....................... 107

ELLA ......................................... 83 ELLENCE .................................. 31 ELLIOTTS B.............................. 66 ELMIRON .................................. 76 ELOCON ................................... 54 ELOCTATE ............................... 40 ELZONRIS ................................ 31 EMBEDA ..................................... 7 EMBRACE TALK BLOOD GLUCOSE ................................ 61 EMBRACE TALK GLUCOSE CONTROL ................................ 61 EMBRACE TALK GLUCOSE TEST ......................................... 61 EMBRACE TALK MONITORING SYSTEM ........... 61 EMCYT ..................................... 31 EMEND ..................................... 26 EMEND TRI-PACK ................... 26 EMFLAZA ................................. 28 EMGALITY ................................ 29 EMGALITY (300 MG DOSE) .... 29 emoquette ................................. 83 EMPLICITI ................................ 31 EMSAM ..................................... 25 EMTRIVA .................................. 37 EMVERM .................................. 35 ENABLEX ................................. 76 enalapril maleate ....................... 43 enalaprilat ................................. 44 enalapril-hydrochlorothiazide ..... 44 ENBRACE HR .......................... 66 ENBREL.................................... 88 ENBREL MINI ........................... 88 ENBREL SURECLICK .............. 88 ENDARI .................................... 95 endocet ....................................... 7 ENDOMETRIN .......................... 83 ENGERIX-B .............................. 90 ENGLISH PLANTAIN ................ 95 ENLITE GLUCOSE SENSOR ... 61 ENOVARX-BACLOFEN .......... 110 enovarx-cyclobenzaprine hcl 110 ENOVARX- CYCLOBENZAPRINE HCL ..... 110 ENOVARX-DICLOFENAC SODIUM.................................... 11 ENOVARX-IBUPROFEN ........... 11 ENOVARX-LIDOCAINE HCL .... 14 ENOVARX-NAPROXEN ........... 11 ENOVARX-TRAMADOL ............ 54 enoxaparin sodium .................... 22 enpresse-28 .............................. 83

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enskyce ..................................... 83 ENSTILAR ................................. 54 entacapone ................................ 35 entecavir .................................... 37 ENTEREG ................................. 73 ENTOCORT EC ......................... 91 ENTRESTO ............................... 44 ENTYVIO ................................... 88 enulose ...................................... 73 ENVARSUS XR ......................... 88 ENZADYNE ............................... 75 ENZOCLEAR ............................. 54 EPANED .................................... 44 EPCLUSA .................................. 37 ephedrine sulfate ....................... 44 EPHEDRINE SULFATE ............. 44 EPHEDRINE SULFATE (PRESSORS) ............................ 44 EPHEDRINE SULFATE-NACL. 44 EPICOCCUM ............................. 95 EPIDIOLEX ................................ 23 EPIDUO ..................................... 54 EPIDUO FORTE ........................ 54 EPIFOAM .................................. 54 epinastine hcl ........................... 101 epinephrine ........................ 44, 108 EPINEPHRINE .......................... 44 EPINEPHRINE HCL- DEXTROSE ............................... 44 EPINEPHRINE HCL-NACL ....... 44 epinephrine pf ............................ 44 EPINEPHRINE-DEXTROSE ...... 44 EPINEPHRINE-NACL ................ 44 EPIPEN 2-PAK ........................ 108 EPIPEN JR 2-PAK................... 108 epirubicin hcl.............................. 31 EPISNAP ................................. 108 epitol .......................................... 23 EPIVIR ....................................... 37 EPIVIR HBV .............................. 37 eplerenone ................................. 44 EPOGEN ................................... 40 epoprostenol sodium ............... 109 eprosartan mesylate .................. 44 eptifibatide ................................. 36 EPZICOM .................................. 37 EQUETRO ................................. 23 ERAXIS ..................................... 27 ERBITUX ................................... 31 ERGOCAL ................................. 66 ergocalciferol ............................. 66 ergoloid mesylates ..................... 95 ERGOMAR ................................ 29

ergotamine-caffeine ................... 29 ERIVEDGE ................................ 31 ERLEADA .................................. 31 erlotinib hcl ................................ 31 EROS-CTD ................................ 95 errin ........................................... 83 ERTACZO .................................. 27 ertapenem sodium ..................... 18 ERWINAZE ................................ 31 ery .............................................. 54 ERYGEL .................................... 54 ERYPED 200 ............................. 18 ERYPED 400 ............................. 18 ERY-TAB ................................... 18 erythrocin lactobionate ............... 18 ERYTHROCIN LACTOBIONATE ....................... 18 ERYTHROCIN STEARATE ....... 18 erythromycin ...................... 54, 101 erythromycin base ..................... 18 erythromycin ethylsuccinate ....... 18 ESBRIET ................................. 108 ESCAVITE ................................. 66 ESCAVITE D ............................. 66 ESCAVITE LQ ........................... 66 escitalopram oxalate .................. 25 esgic ............................................ 7 ESGIC ......................................... 7 esmolol hcl ................................. 44 ESMOLOL HCL ......................... 44 esmolol hcl-sodium chloride ...... 44 esomeprazole magnesium ......... 72 esomeprazole sodium ................ 72 est estrogens-methyltest ............ 83 est estrogens-methyltest ds ....... 83 est estrogens-methyltest hs ....... 83 estarylla ..................................... 83 estazolam .................................. 39 ESTRACE .................................. 83 estradiol ..................................... 83 estradiol valerate ....................... 83 estradiol-norethindrone acet ...... 83 ESTRING ................................... 83 ESTROGEL ............................... 83 ESTROSTEP FE ....................... 83 eszopiclone .............................. 111 ethacrynate sodium ................... 44 ethacrynic acid ........................... 44 ethambutol hcl ........................... 30 ethosuximide .............................. 23 ethyl chloride.............................. 14 ethynodiol diac-eth estradiol ...... 83 ETHYOL .................................... 31

etidronate disodium ................... 92 etodolac .................................... 11 etodolac er ................................ 11 etomidate .................................. 95 ETOPOPHOS ........................... 31 etoposide .................................. 31 EUCRISA .................................. 54 EUFLEXXA ............................... 95 EURAX ..................................... 35 euthyrox .................................... 86 EVAMIST .................................. 83 EVEKEO ................................... 49 EVEKEO ODT........................... 49 EVENITY ................................... 92 EVERSENSE SENSOR/HOLDER ................... 61 EVERSENSE SMART TRANSMITTER ......................... 61 EVISTA ..................................... 80 EVOCLIN .................................. 55 EVOMELA ................................. 31 EVOTAZ.................................... 37 EVOXAC ................................... 51 EVZIO ....................................... 16 EXELDERM .............................. 27 EXELON ................................... 24 exemestane .............................. 31 EXFORGE ................................ 44 EXFORGE HCT ........................ 44 EXJADE .................................... 66 ex-lax ultra ................................ 73 exoderm .................................... 27 EXONDYS 51 ........................... 75 exotic-hc.................................. 105 EXPAREL ................................. 14 EXTAVIA ................................... 50 EXTINA ..................................... 27 EYLEA .................................... 103 EZ FLU SHOT-FLUCELVAX QUAD ....................................... 90 EZALLOR SPRINKLE ............... 44 E-Z-DISK ................................... 95 ezetimibe ................................... 44 ezetimibe-simvastatin ................ 44 E-Z-HD ...................................... 95 E-Z-PAQUE .............................. 95 E-Z-PASTE ............................... 95 FABIOR..................................... 55 FABRAZYME ............................ 75 FALESSA .................................. 83 falmina ...................................... 83 famciclovir ................................. 37 famotidine ................................. 72

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FAMOTIDINE IN NACL ............. 72 famotidine premixed .................. 72 FANAPT .................................... 36 FANAPT TITRATION PACK ...... 36 FANATREX FUSEPAQ ............. 23 FARESTON ............................... 31 FARXIGA ................................... 59 FARYDAK .................................. 31 FASENRA ................................ 105 FASLODEX ............................... 31 fayosim ...................................... 83 FAZACLO .................................. 36 FBL KIT ..................................... 11 febuxostat .................................. 28 FEIBA ........................................ 40 felbamate ................................... 23 FELBATOL ................................ 23 FELDENE .................................. 11 felodipine er ............................... 44 FEM PH ..................................... 76 FEMARA .................................... 31 FEMCAP .................................... 95 FEMHRT LOW DOSE ............... 83 FEMRING .................................. 83 femynor...................................... 83 fenofibrate .................................. 44 fenofibrate micronized ............... 44 fenofibric acid ............................ 44 FENOGLIDE .............................. 44 fenoprofen calcium .................... 11 fenortho ..................................... 11 fentanyl ........................................ 7 fentanyl citrate ............................. 8 FENTANYL CITRATE.................. 8 fentanyl citrate (pf) ....................... 7 FENTANYL CITRATE-NACL ....... 8 FENTANYL CIT- ROPIVACAINE-NACL .................. 8 FENTANYL-BUPIVACAINE- NACL ........................................... 8 FENTORA ................................... 8 FERIVA 21/7.............................. 66 FERIVAFA ................................. 66 ferocon ...................................... 66 ferotrinsic ................................... 66 FERRALET 90 ........................... 66 ferraplus 90 ............................... 66 FERRIPROX .............................. 66 FERRLECIT ............................... 66 ferrocite plus .............................. 66 FERRO-PLEX HEMATINIC ....... 66 FERROTRIN .............................. 66 FETZIMA ................................... 25

FETZIMA TITRATION ................ 25 FEXMID ................................... 110 FIASP ........................................ 63 FIASP FLEXTOUCH .................. 63 FIASP PENFILL ......................... 63 FIBRICOR .................................. 44 FIBRYGA ................................... 40 FINACEA ................................... 55 finasteride .................................. 77 FIORICET .................................... 8 FIORICET/CODEINE ................... 8 FIORINAL .................................... 8 FIORINAL/CODEINE #3 .............. 8 FIRAZYR ................................... 88 FIRDAPSE ................................. 95 FIRE ANT .................................. 95 FIRMAGON ............................... 80 FIRST - METOPROLOL ............ 44 FIRST-ATENOLOL .................... 44 FIRST-BACLOFEN .................. 110 FIRST-METRONIDAZOLE ......... 18 FIRST-MOUTHWASH BLM ....... 51 FIRST-VANCOMYCIN ............... 18 FIRVANQ ................................... 18 flac ........................................... 105 FLAGYL ..................................... 18 FLAREX ................................... 101 flavoxate hcl ............................... 76 FLEBOGAMMA DIF ................... 88 flecainide acetate ....................... 44 FLECTOR .................................. 11 FLEXBUMIN .............................. 95 FLOLAN ................................... 109 FLOLIPID ................................... 44 FLOMAX .................................... 77 FLORIVA ................................... 66 floriva ......................................... 66 FLORIVA PLUS ......................... 66 FLOVENT DISKUS .................. 108 FLOVENT HFA ........................ 108 FLOXIN OTIC .......................... 105 floxuridine .................................. 31 FLUAD ....................................... 90 FLUARIX QUADRIVALENT ....... 90 FLUBLOK QUADRIVALENT ...... 90 FLUCELVAX QUADRIVALENT ....................... 90 fluconazole ................................. 27 fluconazole in sodium chloride 27 flucytosine .................................. 27 fludarabine phosphate ............... 31 fludrocortisone acetate ............... 78 FLULAVAL QUADRIVALENT .... 90

FLUMADINE ............................. 37 flumazenil .................................. 95 FLUMIST QUADRIVALENT ...... 90 flunisolide ................................ 105 fluocinolone acetonide ...... 55, 105 fluocinolone acetonide body ..... 55 fluocinolone acetonide scalp ..... 55 fluocinonide ............................... 55 fluocinonide emulsified base ..... 55 FLUORABON ............................ 66 fluoridex .................................... 51 fluoridex daily renewal .............. 51 fluoridex enhanced whitening ... 51 fluoridex sensitivity relief ........... 51 fluoritab ..................................... 66 fluorometholone ...................... 101 FLUOROPLEX .......................... 55 fluorouracil .......................... 31, 55 FLUOROURACIL ...................... 55 fluoxetine hcl ............................. 25 fluoxetine hcl (pmdd) ................. 25 fluphenazine decanoate ............ 36 fluphenazine hcl ........................ 36 FLURA-DROPS ........................ 66 flurandrenolide .......................... 55 flurazepam hcl ......................... 111 flurbiprofen ................................ 11 flurbiprofen sodium ................. 101 flutamide ................................... 31 fluticasone propionate ....... 55, 106 fluticasone-salmeterol ............. 108 FLUTICASONE- SALMETEROL ........................ 108 fluvastatin sodium ..................... 44 fluvastatin sodium er ................. 45 fluvoxamine maleate ................. 25 fluvoxamine maleate er ............. 25 FLUZONE HIGH-DOSE ............ 90 FLUZONE QUADRIVALENT ..... 90 FLYP NEBULIZER .................... 95 FML ......................................... 101 FML FORTE ............................ 101 FML LIQUIFILM ...................... 101 FOCALIN .................................. 49 FOCALIN XR ............................ 49 folic acid .............................. 66, 67 FOLI-D ...................................... 67 FOLITE ..................................... 67 FOLIVANE-F ............................. 67 FOLLISTIM AQ ......................... 80 FOLOTYN ................................. 31 foltrin ......................................... 67 FOLVITE-D ............................... 67

124

fomepizole ................................. 95 fondaparinux sodium ................. 22 FORA GTEL BLOOD GLUCOSE SYSTEM ................. 61 FORA GTEL BLOOD GLUCOSE TEST ....................... 61 FORFIVO XL ............................. 25 formaldehyde ............................. 95 FORTAMET ............................... 59 FORTEO .................................... 92 FORTESTA ............................... 79 FORTISCARE CONTROL ......... 61 FOSAMAX ................................. 92 FOSAMAX PLUS D ................... 92 fosamprenavir calcium ............... 37 FOSCAVIR ................................ 37 fosinopril sodium ........................ 45 fosinopril sodium-hctz ................ 45 fosphenytoin sodium .................. 23 FOSRENOL ............................... 76 FRAGMIN .................................. 22 FREAMINE HBC ....................... 67 FREAMINE III ............................ 67 FREESTYLE FREEDOM LITE. 61 FREESTYLE INSULINX SYSTEM .................................... 61 FREESTYLE INSULINX TEST. 61 FREESTYLE LIBRE 14 DAY READER .................................... 61 FREESTYLE LIBRE 14 DAY SENSOR ................................... 61 FREESTYLE LIBRE READER 61 FREESTYLE LIBRE SENSOR SYSTEM .................................... 61 FREESTYLE LITE TEST ........... 61 FREESTYLE PRECISION NEO TEST ................................ 61 FREESTYLE TEST ................... 61 FROVA ...................................... 29 frovatriptan succinate ................ 29 FULPHILA ................................. 40 fulvestrant .................................. 31 FURADANTIN............................ 18 furosemide ................................. 45 FUROSEMIDE IN SODIUM CHLORIDE ................................ 45 FUSARIUM ................................ 95 FUSILEV .................................... 31 FUSION PLUS ........................... 67 FUSION SPRINKLES ................ 67 FUZEON .................................... 37 fyavolv ....................................... 83 FYCOMPA ................................. 23

GABA ......................................... 67 gabapentin ................................. 23 GABITRIL .................................. 23 GABLOFEN ............................. 110 GADAVIST ................................. 95 GALAFOLD ................................ 75 galantamine hydrobromide ........ 24 galantamine hydrobromide er .... 24 GALZIN ...................................... 67 GAMASTAN ............................... 88 gamastan s/d ............................. 88 GAMASTAN S/D ........................ 88 GAMIFANT ................................ 88 GAMMAGARD ........................... 88 GAMMAGARD S/D LESS IGA 88 GAMMAKED .............................. 88 GAMMAPLEX ............................ 88 GAMUNEX-C ............................. 88 GANCICLOVIR .......................... 37 ganciclovir sodium ............... 37, 38 ganirelix acetate ......................... 80 GARDASIL 9.............................. 90 GASTROCROM ......................... 73 gatifloxacin ............................... 101 GATTEX .................................... 73 gavilax ....................................... 73 gavilyte-c .................................... 73 gavilyte-g ................................... 73 gavilyte-h ................................... 73 gavilyte-n with flavor pack.......... 73 GAZYVA .................................... 31 GEBAUERS PAIN EASE ........... 14 GELFILM ................................. 103 GEL-FLOW ................................ 95 GELFOAM COMPRESSED SIZE 100 .................................... 95 GELFOAM DENTAL PACK SIZE 4 ........................................ 95 GELFOAM SPONGE ................. 95 GELFOAM SPONGE SIZE 100 ............................................. 95 GELFOAM SPONGE SIZE 200 ............................................. 95 GELFOAM SPONGE SIZE 50 95 GELFOAM-JMI POWDER ......... 95 GELFOAM-JMI SPONGE .......... 95 GELNIQUE ................................ 76 GELNIQUE PUMP ..................... 76 GEL-ONE ................................... 95 GELSYN-3 ................................. 95 gemcitabine hcl .......................... 31 gemfibrozil ................................. 45 GENERESS FE ......................... 83

generlac .................................... 73 gengraf ...................................... 88 GENICIN VITA-D ...................... 67 GENOTROPIN .......................... 80 GENOTROPIN MINIQUICK ...... 80 gentak ..................................... 101 gentamicin sulfate ............. 18, 101 GENTEEL LANCING KIT (BLUE) ...................................... 61 gentle laxative ........................... 73 GENTLECATH URINARY CATHETER ............................... 95 GENVISC 850 ........................... 95 GENVOYA ................................ 38 GEODON .................................. 36 GERMAN COCKROACH .......... 95 GHRP2-GHRP6- SERMORELIN .......................... 80 GHRP2-SERMORELIN ............. 80 GIALAX ..................................... 73 gianvi ........................................ 83 GIAPREZA ................................ 45 GILENYA .................................. 50 GILOTRIF ................................. 31 GILPHEX TR ........................... 106 GILTUSS TR ........................... 106 GLASSIA ................................. 108 glatiramer acetate ..................... 50 glatopa ...................................... 50 GLEEVEC ................................. 31 GLEOSTINE ............................. 31 GLIADEL WAFER ..................... 31 glimepiride ................................. 59 glipizide er ................................. 59 glipizide ir .................................. 59 glipizide xl ................................. 59 glipizide-metformin hcl .............. 59 GLUCAGEN HYPOKIT ............. 63 GLUCAGON EMERGENCY ..... 63 GLUCAGON HCL (DIAGNOSTIC) ......................... 95 GLUCOCARD 01 SENSOR PLUS ........................................ 61 GLUCOCARD EXPRESSION TEST ......................................... 61 GLUCOCARD SHINE CONNEX ................................... 61 GLUCOCARD SHINE EXPRESS ................................. 61 GLUCOCARD SHINE TEST ..... 61 GLUCOCARD VITAL TEST ...... 61 GLUCOPHAGE ......................... 59 GLUCOPHAGE XR ................... 59

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glucose ...................................... 67 GLUCOTROL ............................ 59 GLUCOTROL XL ....................... 59 GLUMETZA ............................... 59 glutaraldehyde ........................... 95 GLUTATHIONE ......................... 67 glyburide .................................... 59 glyburide micronized .................. 59 glyburide-metformin ................... 59 GLYCATE .................................. 73 GLYCINE ................................... 67 glycolax...................................... 73 glycolic acid ............................... 55 glycopyrrolate ............................ 73 GLYCOPYRROLATE ........... 73, 74 glycopyrrolate pf ........................ 74 glydo .......................................... 14 GLYNASE .................................. 59 GLYRX-PF ................................. 74 GLYSET .................................... 59 GLYXAMBI ................................ 59 gnp folic acid ............................. 67 gnp lansoprazole ....................... 72 GOCOVRI .................................. 35 GOLDENROD............................ 95 GOLYTELY ................................ 74 GONAL-F ................................... 80 GONAL-F RFF ........................... 80 GONAL-F RFF REDIJECT ........ 80 GONITRO .................................. 45 GOPRELTO ............................... 14 GORDOFILM ............................. 55 grafco silver nit applicator .......... 55 GRALISE ................................... 50 GRALISE STARTER ................. 50 granisetron hcl ........................... 26 GRANIX ..................................... 40 GRASTEK ................................. 95 griseofulvin microsize ................ 27 griseofulvin ultramicrosize ......... 27 guaiatussin ac .......................... 106 guaifenesin ac ......................... 106 guanfacine hcl ........................... 45 guanfacine hcl er ....................... 49 GUANIDINE HCL ...................... 29 GUARDIAN CONNECT TRANSMITTER ......................... 61 GUARDIAN LINK 3 TRANSMITTER ......................... 61 GUARDIAN REAL-TIME SYSTEM .................................... 61 GYNAZOLE-1 ............................ 27 HACKBERRY ............................ 95

HAEGARDA ............................... 88 hailey 1.5/30 .............................. 83 hailey 24 fe ................................ 84 HALAVEN .................................. 31 halcinonide ................................. 55 HALCION ................................... 39 HALDOL .................................... 36 HALDOL DECANOATE ............. 36 halobetasol propionate .............. 55 HALOBETASOL PROPIONATE ........................... 55 HALOG ...................................... 55 haloperidol ................................. 36 haloperidol decanoate ............... 36 haloperidol lactate ...................... 36 HARVONI .................................. 38 HAVRIX ..................................... 90 HCG ........................................... 81 HCU EASY ................................ 95 healthylax ................................... 74 heartburn treatment 24 hour ...... 72 heather ...................................... 84 HECTOROL ............................... 92 HEMABATE ............................... 82 HEMANGEOL ............................ 45 hematinic plus vit/minerals ......... 67 hematogen fa ............................. 67 hematogen forte ......................... 67 HEMATRON-AF ......................... 67 HEMETAB ................................. 67 HEMLIBRA ................................ 40 hemmorex-hc ............................. 91 HEMOCYTE PLUS .................... 67 hemocyte-plus............................ 67 hemofil m ................................... 40 HEMOFIL M ............................... 40 HEPAGAM B ............................. 88 heparin (porcine) in nacl ............ 22 HEPARIN (PORCINE) IN NACL ......................................... 22 heparin sod (porcine) in d5w ..... 22 heparin sodium (porcine) ........... 22 heparin sodium (porcine) pf ....... 22 hepatamine ................................ 67 HEPLISAV-B .............................. 90 HEPSERA .................................. 38 HERCEPTIN .............................. 31 HERCEPTIN HYLECTA............. 32 HESPAN .................................... 40 hetastarch-nacl .......................... 40 HETLIOZ .................................. 111 HIBERIX .................................... 90 HIDEX 6-DAY ............................ 78

HIPREX..................................... 18 HISTATROL .............................. 95 HIZENTRA ................................ 88 homatropaire ........................... 103 homatropine hbr ...................... 103 HONEY BEE VENOM ............... 95 HONEY BEE VENOM PROTEIN ............................ 95, 96 HORIZANT ................................ 51 HORSE EPITHELIUM ............... 96 HUMALOG KWIKPEN .............. 63 HUMALOG MIX 50/50 KWIKPEN ................................. 63 HUMALOG MIX 50/50 VIAL...... 63 HUMALOG MIX 75/25 KWIKPEN ................................. 63 HUMALOG MIX 75/25 VIAL...... 63 HUMALOG U-100 JUNIOR KWIKPEN ................................. 63 HUMALOG U-100 VIAL AND CARTRIDGE ............................. 63 HUMATE-P ............................... 40 HUMATROPE ........................... 81 HUMIRA .................................... 88 HUMIRA PEDIATRIC CROHNS START ...................... 88 HUMIRA PEN ........................... 88 HUMIRA PEN-CD/UC/HS STARTER ................................. 88 HUMIRA PEN-PS/UV/ADOL HS START .......................... 88, 89 HUMULIN 70/30 KWIKPEN ...... 63 HUMULIN 70/30 VIAL ............... 63 HUMULIN N KWIKPEN ............ 63 HUMULIN N VIAL ..................... 63 HUMULIN R U-500 KWIKPEN 63 HUMULIN R U-500 VIAL (CONCENTRATED) .................. 63 HUMULIN R VIAL ..................... 63 HW EMBRACE PRO GLUCOSE METER ................... 61 HW EMBRACE PRO GLUCOSE TEST ...................... 61 HW EMBRACE TALK BLOOD GLUCOSE ................................ 61 HW EMBRACE TALK GLUCOSE TEST ...................... 61 HYALGAN ................................. 96 HYALUCIL-4 ............................. 55 HYALURONIDASE (INTRAOCULAR) .................... 103 HYCAMTIN ............................... 32 hydralazine hcl .......................... 45

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HYDREA .................................... 32 HYDRO 35 ................................ 55 HYDRO 40 ................................ 55 hydrochlorothiazide .................... 45 hydrocodone polst-cpm polst er ............................................. 106 hydrocodone-acetaminophen ....... 8 hydrocodone-homatropine ....... 106 hydrocodone-ibuprofen ................ 8 hydrocortisone ............... 55, 78, 91 hydrocortisone ace-pramoxine ............................................ 55, 91 hydrocortisone acetate............... 91 hydrocortisone butyr lipo base 55 hydrocortisone butyrate ............. 55 hydrocortisone valerate ............. 55 hydrocortisone-acetic acid ....... 105 hydrogen peroxide ..................... 18 hydromet .................................. 106 HYDROMORPHONE HCL .......... 8 hydromorphone hcl ...................... 8 hydromorphone hcl er .................. 8 hydromorphone hcl pf .................. 8 HYDROMORPHONE HCL- NACL ....................................... 8, 9 hydroxocobalamin acetate ......... 67 hydroxychloroquine sulfate ........ 35 hydroxyprogesterone caproate. 84 hydroxyurea ............................... 32 hydroxyzine hcl .......................... 39 hydroxyzine pamoate ................ 39 HYLENEX .................................. 96 HYMOVIS .................................. 96 hyophen ..................................... 76 hyoscyamine sulfate .................. 74 hyoscyamine sulfate er .............. 74 hyoscyamine sulfate sl .............. 74 hyosyne ..................................... 74 HYPERHEP B S/D .................... 89 hyperlyte-cr ................................ 67 HYPERRAB ............................... 89 HYPERRAB S/D ........................ 89 HYPERRHO S/D ....................... 89 HYPERSAL ............................. 106 HYPERTET S/D ........................ 89 HYQVIA ..................................... 89 HYSINGLA ER ............................ 9 HYZAAR .................................... 45 ibandronate sodium ................... 92 IBRANCE ................................... 32 ibu .............................................. 11 ibuprofen .................................... 11 ibuprofen lysine ......................... 11

IC 400 ........................................ 12 IC 800 ........................................ 12 IC GREEN ................................. 96 ICAR-C PLUS ............................ 67 icatibant acetate ......................... 89 ICLUSIG .................................... 32 IDAMYCIN PFS ......................... 32 idarubicin hcl .............................. 32 IDELVION .................................. 40 IDHIFA ....................................... 32 iferex 150 forte ........................... 67 IFEX ........................................... 32 ifosfamide .................................. 32 ILARIS ....................................... 89 ILEVRO.................................... 101 ILUMYA ..................................... 89 ILUVIEN ................................... 101 imatinib mesylate ....................... 32 IMBRUVICA ............................... 32 IMFINZI ...................................... 32 imipenem-cilastatin .................... 18 imipramine hcl............................ 25 imipramine pamoate .................. 25 imiquimod .................................. 55 IMIQUIMOD PUMP .................... 55 IMITREX .................................... 29 IMITREX STATDOSE REFILL 29 IMITREX STATDOSE SYSTEM .................................... 29 IMLYGIC .................................... 32 IMOGAM RABIES-HT ................ 89 IMOVAX RABIES ....................... 90 IMPAVIDO ................................. 35 IMPOYZ ..................................... 55 IMURAN..................................... 89 IMVEXXY MAINTENANCE PACK ......................................... 84 IMVEXXY STARTER PACK ...... 84 INBRIJA ..................................... 35 incassia ...................................... 84 INCRELEX ................................. 81 INCRUSE ELLIPTA ................. 108 indapamide ................................ 45 INDERAL LA .............................. 45 INDERAL XL .............................. 45 indigo carmine ........................... 96 INDOCIN .................................... 12 indocyanine green ..................... 96 indomethacin ............................. 12 indomethacin er ......................... 12 indomethacin sodium ................. 12 INFANRIX .................................. 90 INFASURF ............................... 106

INFED ....................................... 96 INFLECTRA .............................. 89 INFUGEM ................................. 32 INFUMORPH 200 ....................... 9 INFUMORPH 500 ....................... 9 infusion set ................................ 96 infuvite adult .............................. 67 INFUVITE ADULT ..................... 67 infuvite pediatric ........................ 67 INFUVITE PEDIATRIC.............. 67 INGREZZA ................................ 51 INJECTAFER ............................ 67 INLYTA ..................................... 32 INNOPRAN XL .......................... 45 INNOSPIRE GO PORTABLE MESH NEB ............................... 96 INOVA ....................................... 55 INOVA 4/1 ACNE CONTROL THERAPY ................................. 55 INSPIREASE RESERVOIR BAGS ........................................ 96 INSPRA..................................... 45 INSULIN LISPRO ...................... 63 INSULIN PEN NEEDLES .......... 64 insulin pump ir2020 ................... 96 INSULIN SYRINGES ................ 64 INTEGRA F ............................... 67 INTEGRILIN .............................. 36 INTELENCE .............................. 38 INTERMEZZO ......................... 111 intralipid..................................... 67 INTRALIPID .............................. 67 INTRAROSA ............................. 76 INTRON A ................................. 38 introvale .................................... 84 INTUNIV.................................... 49 INVANZ ..................................... 18 INVEGA .................................... 36 INVEGA SUSTENNA ................ 36 INVEGA TRINZA ...................... 36 INVELTYS ............................... 101 INVIRASE ................................. 38 INVOKAMET ............................. 59 INVOKAMET XR ....................... 59 INVOKANA ............................... 59 iodine strong ............................. 67 IONOSOL-MB IN D5W ............. 67 IONSYS ...................................... 9 IOPIDINE ................................ 102 IPAMORELIN ACETATE .......... 81 IPOL .......................................... 90 ipratropium bromide ........ 106, 108 ipratropium-albuterol ............... 108

127

irbesartan ................................... 45 irbesartan-hydrochlorothiazide 45 IRESSA ..................................... 32 irinotecan hcl ............................. 32 IROSPAN 24/6........................... 67 IS 24/6 ....................................... 67 ISENTRESS .............................. 38 ISENTRESS HD ........................ 38 isibloom ..................................... 84 ISOLYTE-S ................................ 67 isoniazid..................................... 30 isoproterenol hcl ........................ 45 ISOPTO ATROPINE ................ 103 ISOPTO CARPINE .................. 102 ISORDIL TITRADOSE ............... 45 isosorbide dinitrate ..................... 45 isosorbide dinitrate er ................ 45 isosorbide mononitrate............... 45 isosorbide mononitrate er .......... 45 isosulfan blue ............................. 96 isotretinoin ................................. 55 isoxsuprine hcl ........................... 45 isradipine ................................... 45 ISTALOL .................................. 102 ISTODAX (OVERFILL) .............. 32 ISUPREL ................................... 45 itraconazole ............................... 27 ivermectin .................................. 35 IXEMPRA KIT ............................ 32 IXIARO ...................................... 90 IXINITY ...................................... 40 JADENU .................................... 67 JADENU SPRINKLE .................. 67 JAKAFI ...................................... 32 JALYN ....................................... 77 jantoven ..................................... 22 JANUMET .................................. 59 JANUMET XR ............................ 59 JANUVIA ................................... 59 JARDIANCE .............................. 59 jasmiel ....................................... 84 jencycla...................................... 84 JENTADUETO ........................... 59 JENTADUETO XR ..................... 59 JETREA ................................... 104 JEVTANA .................................. 32 jinteli .......................................... 84 JIVI ............................................ 40 JOHNSON GRASS .................... 96 jolessa ....................................... 84 JORNAY PM .............................. 49 J-TIP KIT W/VIAL ADAPTERS. 96 JUBLIA ...................................... 27

juleber ........................................ 84 JULUCA ..................................... 38 JUNE GRASS POLLEN STANDARDIZED ....................... 96 junel 1.5/30 ................................ 84 junel 1/20 ................................... 84 junel fe 1.5/30 ............................ 84 junel fe 1/20 ............................... 84 junel fe 24 .................................. 84 JUXTAPID ................................. 45 JYNARQUE ............................... 67 K.B.G.L IN TERODERM ............ 12 KABIVEN ................................... 67 KADCYLA .................................. 32 KADIAN ....................................... 9 kaitlib fe ..................................... 84 KALBITOR ................................. 96 KALETRA .................................. 38 kalliga ........................................ 84 KALYDECO ............................. 109 KANJINTI ................................... 32 KANUMA ................................... 75 KAPOK ...................................... 96 KAPSPARGO SPRINKLE .......... 45 KAPVAY .................................... 49 KARBINAL ER ......................... 106 kariva ......................................... 84 KAZANO .................................... 59 KCENTRA .................................. 40 KCL (IN NACL 0.9%) ................. 67 KCL-LIDOCAINE-NACL ............. 67 kedbumin ................................... 96 KEDRAB .................................... 89 KEFLEX ..................................... 18 kelnor 1/35 ................................. 84 kelnor 1/50 ................................. 84 kelo-cote .................................... 55 KENALOG ........................... 55, 78 KENALOG-80 ............................ 78 KENGREAL ............................... 36 KEPIVANCE .............................. 51 KEPPRA .................................... 23 KEPPRA XR .............................. 23 KERAGEL .................................. 55 KERALYT .................................. 55 KERAMATRIX REPLICINE 5CMX5CM ................................. 56 KERLIX AMD ANTIMICROBIAL ....................... 96 KERLIX AMD SUPER SPONGES ................................. 96 KERYDIN ................................... 28 KETALAR .................................. 96

ketamine hcl .............................. 96 KETAMINE HCL ....................... 96 KETAMINE HCL-SODIUM CHLORIDE ............................... 96 KETOCARE .............................. 61 ketoconazole ............................. 28 KETOPHENE RAPIDPAQ ........ 12 ketoprofen ................................. 12 ketoprofen er ............................. 12 KETOROCAINE-L ..................... 12 KETOROCAINE-LM .................. 12 KETOROLAC TROMETHAMINE ..................... 12 ketorolac tromethamine..... 12, 101 KETOROLAC-BUPIV- KETAMINE ................................ 12 KETOROLAC-ROPIV- KETAMINE ................................ 12 KETOSTIX ................................ 61 KEVEYIS ................................. 102 KEVZARA ................................. 89 KEYTRUDA .............................. 32 KHAPZORY .............................. 32 KHEDEZLA ............................... 25 KINERET .................................. 89 KINRIX ...................................... 90 kionex ....................................... 67 KISQALI (200 MG DOSE)......... 32 KISQALI (400 MG DOSE)......... 32 KISQALI (600 MG DOSE)......... 32 KISQALI FEMARA (400 MG DOSE) ...................................... 32 KISQALI FEMARA (600 MG DOSE) ...................................... 32 KISQALI FEMARA(200 MG DOSE) ...................................... 32 KITABIS PAK .......................... 109 KLARITY-A ............................. 101 KLARITY-B ............................. 101 KLARITY-L .............................. 101 KLARON ................................... 56 KLONOPIN ............................... 39 klor-con ..................................... 67 klor-con 10 ................................ 67 klor-con m10 ............................. 67 KLOR-CON M15 ....................... 67 klor-con m20 ............................. 67 klor-con sprinkle ........................ 67 klor-con/ef ................................. 67 KOATE ...................................... 40 KOATE-DVI ............................... 40 koate-dvi ................................... 41 KOCHIA .................................... 96

128

KOGENATE FS ......................... 41 KOMBIGLYZE XR ..................... 59 KORLYM ................................... 82 KOVALTRY ............................... 41 K-PHOS ..................................... 67 K-PHOS NO 2 ........................... 67 K-PHOS-NEUTRAL ................... 67 k-prime ...................................... 67 KRINTAFEL ............................... 35 KRISTALOSE ............................ 74 KRYSTEXXA ............................. 28 K-TAB ........................................ 68 k-tan plus ................................... 68 kurvelo ....................................... 84 KUVAN ...................................... 75 KYLEENA .................................. 84 KYMRIAH .................................. 89 KYPROLIS ................................. 32 L.E.T. ......................................... 14 labetalol hcl ............................... 45 LABETALOL HCL ...................... 45 LAC-HYDRIN ............................. 56 LACRISERT ............................ 104 lactated ringers .......................... 68 lactic acid ................................... 56 lactic acid e ................................ 56 lactulose .................................... 74 lactulose encephalopathy .......... 74 LAMBS QUARTERS ................. 96 LAMICTAL ................................. 23 LAMICTAL ODT ........................ 23 LAMICTAL STARTER ............... 23 LAMICTAL XR ........................... 23 lamivudine ................................. 38 lamivudine-zidovudine ............... 38 lamotrigine ................................. 23 lamotrigine er ............................. 23 lamotrigine starter kit-blue ......... 23 lamotrigine starter kit-green ....... 23 lamotrigine starter kit-orange ..... 23 LANCETS .................................. 61 LANOXIN ................................... 45 LANOXIN PEDIATRIC ............... 45 lansoprazole .............................. 72 lanthanum carbonate ................. 76 LANTUS SOLOSTAR ................ 64 LANTUS U-100 VIAL ................. 64 larin 1.5/30 ................................. 84 larin 1/20 .................................... 84 larin 24 fe ................................... 84 larin fe 1.5/30 ............................. 84 larin fe 1/20 ................................ 84 larissia ....................................... 84

LARTRUVO ............................... 32 LASIX ........................................ 45 LASTACAFT ............................ 104 LATANOPROST ...................... 103 latanoprost ............................... 103 latrix xm ..................................... 56 LATUDA..................................... 36 LAVARE WOUND WASH .......... 56 layolis fe ..................................... 84 LAZANDA .................................... 9 l-cysteine hcl .............................. 96 leena .......................................... 84 leflunomide ................................ 89 LEMTRADA ............................... 50 LENSCALE ................................ 96 LENVIMA (10 MG DAILY DOSE) ....................................... 32 LENVIMA (12 MG DAILY DOSE) ....................................... 32 LENVIMA (14 MG DAILY DOSE) ....................................... 32 LENVIMA (18 MG DAILY DOSE) ....................................... 32 LENVIMA (20 MG DAILY DOSE) ....................................... 32 LENVIMA (24 MG DAILY DOSE) ....................................... 32 LENVIMA (4 MG DAILY DOSE) ....................................... 32 LENVIMA (8 MG DAILY DOSE) ....................................... 32 LESCOL XL ............................... 45 lessina ....................................... 84 LETAIRIS ................................. 109 letrozole ..................................... 32 LETS .......................................... 14 leucovorin calcium ..................... 32 LEUKERAN ............................... 32 LEUKINE ................................... 41 leuprolide acetate ...................... 81 LEUPROLIDE ACETATE- BUPIVACAINE ........................... 81 levalbuterol hcl ......................... 108 LEVALBUTEROL HFA............. 108 LEVAQUIN ................................. 18 LEVBID ...................................... 74 LEVEMIR U-100 FLEXTOUCH.64 LEVEMIR U-100 VIAL ............... 64 levetiracetam ............................. 23 levetiracetam er ......................... 23 levetiracetam in nacl .................. 23 levobunolol hcl ......................... 103 LEVOCARNITINE ...................... 68

levocarnitine .............................. 68 levocetirizine dihydrochloride 106 levofloxacin ....................... 18, 101 levofloxacin in d5w .................... 18 levoleucovorin calcium .............. 32 levoleucovorin calcium pf .......... 32 levonest..................................... 84 levonorgest-eth est & eth est .... 84 levonorgest-eth estrad 91-day 84 levonorgestrel ........................... 84 levonorgestrel-ethinyl estrad ..... 84 levonorg-eth estrad triphasic ..... 84 LEVOPHED .............................. 45 levora 0.15/30 (28) .................... 84 levorphanol tartrate ..................... 9 levo-t ......................................... 86 levothyroxine sodium ................ 86 levothyroxine-liothyronine .......... 86 levoxyl ....................................... 86 LEVSIN ..................................... 74 LEVSIN/SL ................................ 74 LEVULAN KERASTICK ............ 56 LEXAPRO ................................. 25 LEXETTE .................................. 56 LEXIVA ..................................... 38 LIALDA ..................................... 91 LIBRAX ..................................... 74 LIBTAYO ................................... 32 lido bdk ..................................... 14 lidocaine .................................... 14 lidocaine hcl ........................ 14, 51 LIDOCAINE HCL ...................... 14 lidocaine hcl (pf) ........................ 14 lidocaine hcl urethral/mucosal ... 14 LIDOCAINE HCL-SODIUM CHLORIDE ............................... 14 lidocaine in d5w ........................ 14 LIDOCAINE IN DEXTROSE ..... 14 lidocaine viscous ....................... 51 lidocaine-epinephrine ................ 14 LIDOCAINE-EPINEPHRINE .... 104 LIDOCAINE- PHENYLEPHRINE .................. 104 LIDOCAINE- PHENYLEPHRINE-BSS .......... 104 lidocaine-prilocaine ................... 14 LIDOCAINE-SODIUM BICARBONATE ........................ 14 LIDOCAINE-TETRACAINE ....... 14 LIDODERM ............................... 14 lidolog ....................................... 78 LIDOPROFEN ........................... 12 LILETTA (52 MG) ..................... 84

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lillow ........................................... 84 LINCOCIN ................................. 18 lincomycin hcl ............................ 18 lindane ....................................... 35 linezolid...................................... 18 LINZESS .................................... 74 LIORESAL ............................... 110 LIORESAL INTRATHECAL ..... 110 liothyronine sodium .................... 86 LIPIODOL .................................. 96 LIPITOR..................................... 45 LIPO .......................................... 68 LIPO-C ...................................... 68 LIPOFEN ................................... 45 LIQUID E-Z-PAQUE .................. 96 LIQUID POLIBAR PLUS ............ 96 LIQUIVIDA HYDRATION ........... 68 lisinopril...................................... 45 lisinopril-hydrochlorothiazide ...... 45 lithium ........................................ 40 lithium carbonate ....................... 40 lithium carbonate er ................... 40 LITHOBID .................................. 40 LITHOSTAT ............................... 76 LIVALO ...................................... 45 lmd in d5w ................................. 41 LMD IN D5W ............................. 41 lmd in nacl ................................. 41 LMD IN NACL ............................ 41 LO LOESTRIN FE ..................... 84 LOCOID ..................................... 56 LOCOID LIPOCREAM ............... 56 LODINE ..................................... 12 LODOSYN ................................. 35 LOESTRIN 1.5/30 (21) .............. 84 LOESTRIN 1/20 (21) ................. 84 LOESTRIN FE 1.5/30 ................ 84 LOESTRIN FE 1/20 ................... 84 LOKELMA .................................. 68 LOMOTIL ................................... 74 LONHALA MAGNAIR REFILL KIT ........................................... 108 LONHALA MAGNAIR STARTER KIT ......................... 108 LONSURF ................................. 32 loperamide hcl ........................... 74 LOPID ........................................ 45 lopinavir-ritonavir ....................... 38 lopreeza ..................................... 84 LOPRESSOR ............................ 45 LOPRESSOR HCT .................... 45 LOPROX .................................... 28 lorazepam ............................ 39, 40

lorazepam intensol ..................... 39 LORBRENA ............................... 32 lorcet ............................................ 9 lorcet hd ....................................... 9 lorcet plus .................................... 9 LORTAB ...................................... 9 loryna ......................................... 84 LORZONE ............................... 110 losartan potassium ..................... 45 losartan potassium-hctz ............. 45 LOSEASONIQUE ...................... 84 LOTEMAX ................................ 101 LOTEMAX SM ......................... 101 LOTENSIN ................................. 45 LOTENSIN HCT ........................ 45 loteprednol etabonate .............. 101 LOTREL ..................................... 45 LOTRISONE .............................. 56 LOTRONEX ............................... 74 lovastatin .................................... 45 LOVAZA..................................... 45 LOVENOX ................................. 22 low-ogestrel ............................... 84 loxapine succinate ..................... 36 lo-zumandimine .......................... 84 LT INJECTION KIT .................... 78 LUCEMYRA ............................... 16 LUCENTIS ............................... 104 ludent ......................................... 68 lugols ......................................... 18 LULICONAZOLE ........................ 28 LUMIGAN ................................ 103 LUMIZYME ................................ 75 LUMOXITI .................................. 32 LUNESTA ................................ 111 LUPANETA PACK ..................... 81 LUPRON DEPOT (1-MONTH) 81 LUPRON DEPOT (3-MONTH) 81 LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG 81 LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG 81 LUPRON DEPOT-PED (1- MONTH) .................................... 81 LUPRON DEPOT-PED (3- MONTH) .................................... 81 LUTATHERA ............................. 32 lutera .......................................... 84 LUXIQ ........................................ 56 LUXTURNA ............................. 104 LUZU ......................................... 28 LYNPARZA ................................ 33 LYRICA ...................................... 51

LYRICA CR ............................... 51 LYSINE HCL ............................. 68 LYSODREN .............................. 33 LYSTEDA .................................. 41 lyza ........................................... 84 M.V.I. ADULT ............................ 68 M.V.I. PEDIATRIC .................... 68 MACI ......................................... 96 MACRILEN ............................... 96 MACROBID ............................... 18 MACRODANTIN ....................... 18 MACUGEN .............................. 104 mafenide acetate ...................... 18 MAGNEBIND 400 ..................... 68 magnesium chloride .................. 68 magnesium citrate ..................... 74 magnesium sulfate .................... 68 MAGNESIUM SULFATE ........... 68 magnesium sulfate in d5w ........ 68 MAGNESIUM SULFATE IN D5W .......................................... 68 MAGNESIUM SULFATE-LACT RINGERS .................................. 68 MAGNESIUM SULFATE- NACL ........................................ 68 MAGNEVIST ............................. 96 MAKENA ................................... 84 MALARONE .............................. 35 malathion .................................. 35 MANGANESE CHLORIDE ........ 68 mannitol .................................... 45 maprotiline hcl ........................... 25 MARBETA-25 ........................... 78 MARBETA-L ............................. 78 MARCAINE ............................... 14 MARCAINE PRESERVATIVE FREE ........................................ 14 MARCAINE SPINAL ................. 15 MARCAINE/EPINEPHRINE ...... 15 MARCAINE/EPINEPHRINE PF ............................................. 15 MARDEX-25 ............................. 78 MARINOL .................................. 26 marlido ...................................... 15 MARLIDO-25 ............................ 15 marlissa..................................... 84 MARPLAN ................................. 25 MARQIBO ................................. 33 MARVONA SUIK ...................... 15 MATULANE .............................. 33 matzim la .................................. 45 MAVENCLAD (10 TABS) .......... 50 MAVENCLAD (4 TABS) ............ 50

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MAVENCLAD (5 TABS) ............. 50 MAVENCLAD (6 TABS) ............. 50 MAVENCLAD (7 TABS) ............. 50 MAVENCLAD (8 TABS) ............. 50 MAVENCLAD (9 TABS) ............. 50 MAVYRET ................................. 38 MAXALT .................................... 29 MAXALT-MLT ............................ 29 MAXFE ...................................... 68 MAXICOMFORT SYR 27G X 1/2" ............................................ 64 MAXIDEX ................................ 101 MAXIPIME ................................. 18 MAXITROL .............................. 104 MAXZIDE ................................... 45 MAXZIDE-25 ............................. 45 MAYZENT ................................. 50 MAYZENT STARTER PACK ..... 50 me/naphos/mb/hyo1 .................. 76 MEADOW FESCUE GRASS POLLEN .................................... 96 meclizine hcl .............................. 26 meclofenamate sodium.............. 12 medique aspirin ......................... 12 MEDROL ................................... 78 MEDROLOAN II SUIK ............... 78 MEDROLOAN SUIK .................. 78 MEDROX-RX ............................... 9 medroxyprogesterone acetate 84 mefenamic acid ......................... 12 mefloquine hcl ........................... 35 MEGACE ES ............................. 84 megestrol acetate ...................... 84 MEKINIST .................................. 33 MEKTOVI .................................. 33 MELALEUCA ............................. 96 melodetta 24 fe .......................... 84 meloxicam ................................. 12 melphalan .................................. 33 melphalan hcl ............................ 33 memantine hcl ........................... 24 memantine hcl er ....................... 24 MENACTRA .............................. 90 MENEST .................................... 84 MENOPUR ................................ 81 MENOSTAR .............................. 85 MENTAX .................................... 28 MENVEO ................................... 90 meperidine hcl ............................. 9 MEPHYTON .............................. 68 meprobamate ............................ 40 MEPRON ................................... 35 MEPSEVII .................................. 75

mercaptopurine .......................... 33 meropenem ................................ 19 MEROPENEM-SODIUM CHLORIDE ................................ 19 MERREM ................................... 19 mesalamine ............................... 91 mesalamine-cleanser ................. 91 mesna ........................................ 33 MESNEX .................................... 33 MESQUITE ................................ 96 MESTINON ................................ 29 metadate er ............................... 49 metaproterenol sulfate ............. 108 METAXALL CP ........................ 110 metaxalone .............................. 110 metformin hcl er ......................... 59 metformin hcl er (mod) .............. 59 metformin hcl er (osm) ............... 59 METFORMIN HCL IR ................ 59 metformin hcl ir .......................... 59 methadone hcl ............................. 9 methadone hcl intensol ................ 9 methadose ................................... 9 methadose sugar-free .................. 9 methamphetamine hcl ............... 49 methazolamide......................... 103 methenamine hippurate ............. 19 methenamine mandelate ........... 19 methergine ................................. 96 methimazole .............................. 86 METHITEST .............................. 79 methocarbamol ........................ 110 METHOHEXITAL SODIUM ........ 96 methotrexate .............................. 89 methotrexate sodium ................. 89 methotrexate sodium (pf) ........... 89 methoxsalen .............................. 56 methoxsalen rapid ..................... 56 methscopolamine bromide ......... 74 methyl salicylate ........................ 56 METHYLCOBALAMIN ............... 68 methyldopa ................................ 45 methyldopa- hydrochlorothiazide .................... 45 methylene blue .......................... 96 methylergonovine maleate ......... 96 METHYLIN ................................. 49 methylphenidate hcl ................... 49 methylphenidate hcl er ............... 49 methylphenidate hcl er (cd) ....... 49 methylphenidate hcl er (la) ........ 49 methylprednisolone .................... 78

METHYLPREDNISOLONE ACE-LIDO ................................. 78 METHYLPREDNISOLONE ACETATE ................................. 78 methylprednisolone acetate ...... 78 methylprednisolone sodium succ .......................................... 78 METHYLPREDNISOLONE- BUPIVACAINE .......................... 78 methyltestosterone .................... 79 metoclopramide hcl ................... 26 metolazone ............................... 45 metoprolol succinate er ............. 46 metoprolol tartrate ..................... 46 METOPROLOL-HCTZ ER ........ 46 metoprolol-hydrochlorothiazide. 46 METROCREAM ........................ 56 METROGEL .............................. 56 METROLOTION ........................ 56 METRONIDAZOLE ................... 19 metronidazole ..................... 19, 56 METRONIDAZOLE BENZO+SYRSPEND ................ 19 metronidazole in nacl ................ 19 METRONIDAZOLE IN NACL .... 19 mexiletine hcl ............................ 46 MIACALCIN .............................. 92 mibelas 24 fe ............................ 85 MICARDIS ................................ 46 MICARDIS HCT ........................ 46 miconazole 3 ............................. 28 MICONAZOLE-ZINC OXIDE- PETROLAT ............................... 28 MICORT-HC ............................. 56 MICRHOGAM ULTRA- FILTERED PLUS ...................... 89 MICROCYN .............................. 56 MICROCYN SKIN AND WOUND .................................... 56 microgestin 1.5/30 ..................... 85 microgestin 1/20 ........................ 85 microgestin fe 1.5/30................. 85 microgestin fe 1/20.................... 85 MICROLET NEXT LANCING DEVICE..................................... 62 midazolam hcl ........................... 40 MIDAZOLAM HCL-SODIUM CHLORIDE ............................... 40 MIDAZOLAM-SODIUM CHLORIDE ............................... 40 midodrine hcl............................. 46 MIGERGOT .............................. 29 miglitol ....................................... 59

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miglustat .................................... 75 MIGRANAL ................................ 29 mili ............................................. 85 milk of magnesia ....................... 74 MILLIPRED ................................ 78 MILLIPRED DP .......................... 78 MILLIPRED DP 12-DAY ............ 78 milrinone lactate ........................ 46 milrinone lactate in dextrose ...... 46 mimvey ...................................... 85 mimvey lo .................................. 85 MINASTRIN 24 FE .................... 85 mineral oil heavy ....................... 74 MINIMED 530G INSULIN PUMP ........................................ 96 MINIMED GUARDIAN SENSOR 3 ................................ 62 MINIPRESS ............................... 46 minitran ...................................... 46 MINIVELLE ................................ 85 MINOCIN ................................... 19 minocycline hcl .......................... 19 minocycline hcl er ...................... 19 MINOLIRA ................................. 19 minoxidil..................................... 46 MIRAPEX .................................. 35 MIRAPEX ER ............................ 35 MIRCERA .................................. 41 MIRCETTE ................................ 85 MIRENA (52 MG) ....................... 85 mirtazapine ................................ 25 MIRVASO .................................. 56 misoprostol ................................ 72 MITE (D. FARINAE) ................... 96 MITE (D. PTERONYSSINUS) ... 96 MITIGARE ................................. 28 mitigo ........................................... 9 mitomycin .................................. 33 MITOMYCIN .............................. 33 MITOSOL ................................ 101 mitoxantrone hcl ........................ 33 MIXED ASPERGILLUS ............. 96 MIXED FEATHERS ................... 96 MIXED RAGWEED .................... 96 MIXED VESPID VENOM PROTEIN ................................... 97 mlk f1 ......................................... 97 mlk f2 ......................................... 97 mlk f3 ......................................... 97 MLK F4 ...................................... 97 M-M-R II .................................... 90 M-NATAL PLUS ........................ 68 MOBIC ....................................... 12

modafinil .................................. 111 moexipril hcl ............................... 46 molindone hcl............................. 36 mometasone furoate .......... 56, 106 mondoxyne nl ............................ 19 mono-linyah ............................... 85 MONONINE ............................... 41 MONOVISC ............................... 97 MONSELS FERRIC SUBSULFATE ........................... 41 montelukast sodium ................. 108 MONUROL ................................ 19 morgidox .................................... 19 MORPHABOND ER ..................... 9 MORPHINE SULFATE................. 9 morphine sulfate .......................... 9 morphine sulfate (concentrate) .... 9 morphine sulfate (pf) .................... 9 morphine sulfate er ...................... 9 morphine sulfate er beads ........... 9 MORPHINE SULFATE-NACL .............................................. 9, 10 MOTEGRITY ............................. 74 MOTOFEN ................................. 74 MOUNTAIN CEDAR .................. 97 MOUSE EPITHELIUM ............... 97 MOVANTIK ................................ 74 MOVIPREP ................................ 74 MOXEZA .................................. 101 MOXIFLOXACIN HCL........ 19, 101 moxifloxacin hcl ................. 19, 101 moxifloxacin hcl in nacl .............. 19 MOXIFLOXACIN HCL-BSS ..... 104 MOZOBIL ................................... 41 MS CONTIN............................... 10 MSUD EASY.............................. 97 MUCOR ..................................... 97 MUGWORT ............................... 97 MULPLETA ................................ 41 MULTAQ .................................... 46 multi prenatal ............................. 68 multigen ..................................... 68 multigen folic .............................. 68 multigen plus .............................. 68 MULTI-SPECIALTY ................... 78 multi-vit/iron/fluoride ................... 68 multivitamin/fluoride ................... 68 MULTIVITAMIN/FLUORIDE ....... 68 multi-vitamin/fluoride .................. 68 multivitamin/fluoride/iron ............ 69 multi-vitamin/fluoride/iron ........... 69 multivitamins/fluoride.................. 69 mupirocin ................................... 19

mupirocin calcium ..................... 19 mutamycin ................................. 33 MVASI ....................................... 33 mvc-fluoride .............................. 69 MYALEPT ................................. 75 MYAMBUTOL ........................... 30 MYCAMINE ............................... 28 MYCOBUTIN ............................ 30 mycophenolate mofetil .............. 89 mycophenolate mofetil hcl ........ 89 mycophenolate sodium ............. 89 MYDAYIS .................................. 49 MYDRIACYL ........................... 104 myferon 150 forte ...................... 69 MYFORTIC ............................... 89 MYLERAN ................................. 33 MYLOTARG .............................. 33 MYOBLOC ................................ 97 myorisan ................................... 56 MYRBETRIQ ............................. 76 MYSOLINE ............................... 23 MYTESI..................................... 74 na ferric gluc cplx in sucrose .... 69 nabi-hb ...................................... 89 nabumetone .............................. 12 n-acetyl-l-cysteine ..................... 69 nadolol ...................................... 46 nafcillin sodium ......................... 19 NAFCILLIN SODIUM IN DEXTROSE .............................. 19 nafrinse ..................................... 69 NAFRINSE DAILY ACIDULATED ........................... 51 NAFRINSE DAILY/NEUTRAL ... 51 nafrinse drops ........................... 69 NAFRINSE WEEKLY ................ 52 naftifine hcl ................................ 28 NAFTIN ..................................... 28 NAGLAZYME ............................ 75 nalbuphine hcl ........................... 10 NALFON ................................... 12 NALOCET ................................. 10 naloxone hcl .............................. 16 NALTREXONE .......................... 16 naltrexone hcl............................ 16 NAMENDA ................................ 24 NAMENDA TITRATION PAK .... 24 NAMENDA XR .......................... 24 NAMENDA XR TITRATION PACK ........................................ 24 NAMZARIC ............................... 24 NANDROLONE DECANOATE. 79

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neomycin-polymyxin-hc.. 104, 105 neo-polycin .............................. 104 neo-polycin hc.......................... 104 NEOPROFEN ............................ 12 NEORAL .................................... 89 neostigmine methylsulfate ......... 29 NEOSTIGMINE METHYLSULFATE .................... 29 NEO-SYNALAR ......................... 56 NEOTUSS PLUS ..................... 106 NEPHRAMINE ........................... 69 NEPHRON FA ........................... 69 NERLYNX .................................. 33 NESACAINE .............................. 15

nikki ........................................... 85 NILANDRON .............................. 33 nilutamide .................................. 33 NIMBEX ..................................... 51 nimodipine ................................. 46 NINLARO ................................... 33 NIPENT...................................... 33 NIPRIDE RTU ............................ 46 nisoldipine er .............................. 46 nitisinone .................................... 75 NITRO-BID ................................ 46 NITRO-DUR ............................... 46 nitrofurantoin .............................. 19 nitrofurantoin macrocrystal ......... 19

NORM-JECT LUER SLIP SYRINGE ...................................97 NORPACE .................................47 NORPACE CR ...........................47 NORPRAMIN .............................25 NORTHERA ...............................47 nortrel 0.5/35 (28) ......................85 nortrel 1/35 (21) .........................85 nortrel 1/35 (28) .........................85 nortrel 7/7/7 ................................85 nortriptyline hcl ...........................25 NORVASC .................................47 NORVIR .....................................38 NOURIANZ ................................35

133

NANDROLONE- TESTOSTERONE CYP ............. 79 NAPRELAN ............................... 12 NAPRO ...................................... 12 NAPROSYN .............................. 12 naproxen .................................... 12 naproxen dr ............................... 12 naproxen sodium ....................... 12 naproxen sodium er ................... 12 naratriptan hcl ............................ 29 NARCAN ................................... 16 NARDIL ..................................... 25 NAROPIN .................................. 15 NASCOBAL ............................... 69 NASONEX ............................... 106 NATACYN ............................... 101 NATAZIA ................................... 85 nateglinide ................................. 59 NATESTO .................................. 79 NATPARA .................................. 92 NATROBA ................................. 35 NATURE-THROID ..................... 86 nature-throid .............................. 86 NAVELBINE .............................. 33 NEBUPENT ............................... 35 nebusal .................................... 106 NEBUSAL ................................ 106 necon 0.5/35 (28) ...................... 85 nefazodone hcl .......................... 25 NEMBUTAL ............................... 23 NEOKE ALCAR ......................... 69 NEOKE RA LIPOIC ................... 97 neomycin sulfate ........................ 19 neomycin-bacitracin zn- polymyx ................................... 104 neomycin-polymyxin-dexameth ................................................ 104 neomycin-polymyxin- gramicidin ................................ 104

NESACAINE-MPF ..................... 15 NESINA ..................................... 59 NESTABS .................................. 69 NETSPOT .................................. 97 neuac ......................................... 56 NEULASTA ................................ 41 NEULASTA ONPRO .................. 41 NEUPOGEN .............................. 41 NEUPRO ................................... 35 NEURONTIN ............................. 23 NEUT ......................................... 69 neutral sodium fluoride .............. 52 NEVANAC ............................... 101 nevirapine .................................. 38 nevirapine er .............................. 38 NEXAVAR .................................. 33 NEXAVIR ................................... 97 NEXIUM ..................................... 72 NEXIUM I.V. .............................. 72 NEXPLANON ............................. 85 NEXTERONE............................. 46 niacin (antihyperlipidemic) ......... 46 niacin er (antihyperlipidemic) ..... 46 NIACOR ..................................... 46 NIASPAN ................................... 46 nicardipine hcl ............................ 46 NICARDIPINE HCL IN NACL .... 46 NICOMIDE ................................. 69 NICORETTE .............................. 16 nicotine polacrilex ...................... 16 nicotine step 1 ........................... 16 nicotine step 2 ........................... 16 nicotine step 3 ........................... 16 NICOTROL ................................ 16 NICOTROL NS .......................... 16 nifedipine ................................... 46 nifedipine er ............................... 46 nifedipine er osmotic release ..... 46 NIFEREX ................................... 69

nitrofurantoin monohydrate macrocrystals ............................ 19 nitroglycerin ............................... 46 nitroglycerin er .......................... 46 nitroglycerin in d5w ................... 46 NITROLINGUAL ........................ 46 NITROMIST .............................. 46 NITROPRESS ........................... 46 nitroprusside sodium ................. 46 NITROSTAT .............................. 46 nitro-time ................................... 46 NITYR ....................................... 75 NIVESTYM ................................ 41 nizatidine ................................... 72 NIZORAL .................................. 28 NOCDURNA ............................. 81 NOCTIVA .................................. 81 nolix .......................................... 56 nora-be ..................................... 85 NORCO..................................... 10 NORDITROPIN FLEXPRO ....... 81 norepinephrine bitartrate ........... 46 NOREPINEPHRINE- DEXTROSE .............................. 46 NOREPINEPHRINE-SODIUM CHLORIDE ......................... 46, 47 norethin ace-eth estrad-fe ......... 85 norethindrone ............................ 85 norethindrone acetate ............... 85 norethindrone acet-ethinyl est 85 norethindrone-eth estradiol ....... 85 norethin-eth estradiol-fe ............ 85 NORGESIC FORTE ................ 110 norgestimate-eth estradiol ......... 85 norgestimate-ethinyl estradiol triphasic..................................... 85 NORITATE ................................ 56 norlyda ...................................... 85 norlyroc ..................................... 85

NUPLAZID ................................. 36 NUTRIDOX ................................ 19 nutrilipid ..................................... 69 NUTRIVIT .................................. 69 NUTROPIN AQ NUSPIN 10 ...... 81 NUTROPIN AQ NUSPIN 20 ...... 81 NUTROPIN AQ NUSPIN 5 ........ 81 NUVARING ................................ 85 NUVESSA ................................. 19 NUVIGIL .................................. 111 NUWIQ ...................................... 41 NUZYRA .................................... 19 nyamyc ...................................... 28 NYMALIZE ................................. 47

OMNIPAQUE ............................. 97 OMNIPOD 5 PACK .................... 97 OMNIPOD DASH 5 PACK ......... 97 OMNIPOD STARTER ................ 97 OMNITROPE ............................. 81 ONCASPAR ............................... 33 ondansetron hcl ......................... 26 ONDANSETRON HCL ............... 26 ondansetron odt ......................... 26 ONE DROP BLOOD GLUCOSE MONITOR................ 62 ONE DROP TEST ...................... 62 ONE TOUCH VERIO KIT W/DEVICE ................................. 62

oralone .......................................52 ORANGE (DIAGNOSTIC) ..........97 ORAPRED ODT .........................78 ORAVIG .....................................28 ORBACTIV .................................19 ORCHARD GRASS POLLEN ....97 ORENCIA...................................89 ORENCIA CLICKJECT ..............89 ORENITRAM ........................... 109 ORFADIN ...................................75 ORILISSA ..................................81 ORKAMBI ................................ 109 orphenadrine citrate ................. 111 orphenadrine citrate er ............. 111

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NOVAREL ................................. 81 NOVOEIGHT ............................. 41 NOVOFINE AUTOCOVER PEN NEEDLE ............................ 64 NOVOFINE PEN NEEDLE ........ 64 NOVOFINE PLUS PEN NEEDLE .................................... 64 NOVOLIN 70/30 FLEXPEN ....... 64 NOVOLIN 70/30 FLEXPEN RELION ..................................... 64 NOVOLIN 70/30 RELION .......... 64 NOVOLIN 70/30 VIAL ................ 64 NOVOLIN N RELION ................ 64 NOVOLIN N VIAL ...................... 64 NOVOLIN R RELION ................ 64 NOVOLIN R VIAL ...................... 64 NOVOLOG FLEXPEN ............... 64 NOVOLOG MIX 70/30 FLEXPEN .................................. 64 NOVOLOG MIX 70/30 VIAL ...... 64 NOVOLOG PENFILL ................. 64 NOVOLOG U-100 VIAL ............. 64 NOVOPEN ECHO ..................... 62 NOVOSEVEN RT ...................... 41 NOVOTWIST PEN NEEDLE ..... 64 NOXAFIL ................................... 28 NP #2 DRUG PREPARATION KIT ............................................. 12 np thyroid ................................... 86 NPLATE..................................... 41 NUCALA .................................. 106 NUCYNTA ................................. 10 NUCYNTA ER ........................... 10 NUEDEXTA ............................... 51 NUFERA .................................... 69 NULOJIX ................................... 89 NULYTELY WITH FLAVOR PACKS ...................................... 74 NUMOISYN ............................... 52

nystatin ...................................... 28 nystatin-triamcinolone ................ 28 nystop ........................................ 28 OAT GRAIN (DIAGNOSTIC) ..... 97 OBIZUR ..................................... 41 OCALIVA ................................... 75 ocella ......................................... 85 OCREVUS ................................. 50 OCTAGAM ................................. 89 octreotide acetate ...................... 81 OCUFLOX ............................... 101 ODACTRA ................................. 97 ODEFSEY .................................. 38 ODOMZO ................................... 33 OFEV ....................................... 108 ofloxacin.....................19, 101, 105 ogestrel ...................................... 85 okebo ......................................... 19 olanzapine ................................. 37 olanzapine-fluoxetine hcl ........... 25 OLIVE TREE.............................. 97 olmesartan medoxomil ............... 47 olmesartan medoxomil-hctz ....... 47 olmesartan-amlodipine-hctz ....... 47 olopatadine hcl .................102, 106 OLUMIANT ................................ 89 OLUX ......................................... 56 OLUX-E ..................................... 56 OMECLAMOX-PAK ................... 74 OMEGA-3/D-3 WELLNESS PACK ......................................... 47 omega-3-acid ethyl esters ......... 47 OMEGAVEN .............................. 69 omeppi ....................................... 72 omeprazole ................................ 72 omeprazole-sodium bicarbonate ................................ 72 OMIDRIA ................................. 104 OMNARIS ................................ 106

ONE-A-DAY WOMENS PRENATAL 1 ............................ 69 ONETOUCH DELICA LANCING DEV .......................... 62 ONETOUCH DELICA PLUS LANCING .................................. 62 ONETOUCH ULTRA 2 .............. 62 ONETOUCH ULTRA BLUE TEST STRIPS ........................... 62 ONETOUCH ULTRA MINI ........ 62 ONETOUCH VERIO FLEX SYSTEM KIT W/DEVICE .......... 62 ONETOUCH VERIO IQ SYSTEM ................................... 62 ONETOUCH VERIO SYNC SYSTEM KIT W/DEVICE .......... 62 ONEXTON ................................ 56 ONFI ......................................... 23 ONGLYZA ................................. 59 ONIVYDE .................................. 33 ONPATTRO .............................. 51 ONZETRA XSAIL ...................... 29 OPANA ..................................... 10 OPDIVO .................................... 33 opium ........................................ 74 OPSUMIT ................................ 109 OPTIONS CONCEPTROL ........ 97 OPTIRAY 350 ........................... 97 OPTISON .................................. 97 ORACEA ................................... 56 ORACIT .................................... 69 ORAFATE ................................. 97 ORALAIR .................................. 97 ORALAIR ADULT SAMPLE KIT ............................................ 97 ORALAIR ADULT STARTER PACK ........................................ 97 ORALAIR CHILDRENS STARTER PACK ...................... 97

orphenadrine-aspirin-caffeine. 111 ORPHENGESIC FORTE ......... 111 orsythia ...................................... 85 ORTHO MICRONOR ................. 85 ORTHO TRI-CYCLEN LO ......... 85 ORTHO-NOVUM 1/35 (28) ........ 85 ORTHO-NOVUM 7/7/7 (28) ....... 85 ORTHOVISC ............................. 97 oscimin ...................................... 74 oscimin sr .................................. 74 oseltamivir phosphate ................ 38 OSENI ....................................... 59 osmitrol ...................................... 47 OSMOLEX ER ........................... 35 OSMOPREP .............................. 74 OSPHENA ................................. 80 OTEZLA..................................... 89 OTICIN HC NR ........................ 105 OTIPRIO .................................. 105 OTOVEL .................................. 105 OTREXUP ................................. 89 OVACE PLUS ............................ 56 OVACE PLUS WASH ................ 56 OVACE WASH .......................... 56 OVIDE ....................................... 35 OVIDREL ................................... 81 oxacillin sodium ......................... 19 oxaliplatin ................................... 33 oxandrolone ............................... 79 oxaprozin ................................... 12 OXAYDO ................................... 10 oxazepam .................................. 40 oxcarbazepine ........................... 23 OXERVATE ............................. 104 oxiconazole nitrate ..................... 28 OXISTAT ................................... 28 OXSORALEN ULTRA................ 56 OXTELLAR XR .......................... 23 oxybutynin chloride .................... 76 oxybutynin chloride er ................ 76 oxycodone hcl ............................ 10 OXYCODONE HCL ER ............. 10 oxycodone-acetaminophen ........ 10 oxycodone-aspirin ...................... 10 oxycodone-ibuprofen ................. 10 OXYCONTIN ............................. 10 oxymorphone hcl ....................... 10 oxymorphone hcl er ................... 10 oxytocin ..................................... 81 OXYTOCIN-DEXTROSE ........... 81 OXYTOCIN-LACTATED RINGERS .................................. 81

OXYTOCIN-SODIUM CHLORIDE ................................ 81 OXYTROL .................................. 76 OZEMPIC .................................. 59 OZURDEX ............................... 102 pacerone .................................... 47 paclitaxel .................................... 33 paliperidone er ........................... 37 palonosetron hcl......................... 26 PALYNZIQ ................................. 75 PAMELOR ................................. 25 pamidronate disodium ................ 92 PANCREAZE ............................. 75 pancuronium bromide ................ 51 PANDEL .................................... 56 PANHEMATIN ........................... 41 PANRETIN ................................. 33 pantoprazole sodium .................. 72 PANZYGA .................................. 89 papaverine hcl ........................... 47 PARADIGM REAL-TIME STARTER .................................. 62 PARAGARD INTRAUTERINE COPPER .................................... 85 paregoric .................................... 74 PARI ALTERA NEBULIZER HANDSET .................................. 97 PARI TREK S COMBO PACK 97 paricalcitol .................................. 92 PARLODEL ................................ 35 PARNATE .................................. 25 paroex ........................................ 52 paromomycin sulfate .................. 19 paroxetine hcl ............................ 25 paroxetine hcl er ........................ 25 paroxetine mesylate ................... 25 PARSABIV ................................. 87 PASER ...................................... 30 PATADAY ................................ 102 PATANASE .............................. 106 PATANOL ................................ 102 PAXIL ........................................ 25 PAXIL CR .................................. 25 PAZEO .................................... 102 P-CARE 100MX ......................... 15 P-CARE D40MX ........................ 78 P-CARE D80MX ........................ 78 P-CARE K40 .............................. 78 P-CARE K40G ........................... 78 P-CARE K40MX ......................... 78 P-CARE K80 .............................. 78 P-CARE K80G ........................... 78 P-CARE K80MX ......................... 78

P-CARE M ................................ 15 P-CARE MG.............................. 15 P-CARE X ................................. 15 PCP 100 ................................... 74 PEANUT (DIAGNOSTIC) .......... 97 PECAN NUT (DIAGNOSTIC) ... 97 PECAN POLLEN ...................... 97 PEDIAPRED ............................. 78 PEDIARIX ................................. 90 PEDVAX HIB ............................ 90 peg 3350 ................................... 74 peg 3350/electrolytes ................ 74 peg 3350-kcl-na bicarb-nacl ...... 74 peg-3350/electrolytes ................ 74 PEGANONE .............................. 23 PEGASYS ................................. 38 PEGASYS PROCLICK.............. 38 PEGINTRON ............................. 38 peg-prep.................................... 74 penicillamine ............................. 76 PENICILLIN G POT IN DEXTROSE .............................. 19 penicillin g potassium ................ 19 penicillin g procaine .................. 19 penicillin g sodium..................... 19 penicillin v potassium ................ 19 PENICILLIUM NOTATUM ......... 97 PENLAC.................................... 28 PENNSAID ................................ 12 PENTACEL ............................... 90 PENTAM ................................... 35 pentamidine isethionate ............ 35 PENTASA ................................. 91 pentazocine-naloxone hcl ......... 10 PENTETATE CALCIUM TRISODIUM .............................. 97 PENTETATE ZINC TRISODIUM .............................. 97 pentobarbital sodium ................. 23 pentoxifylline er ......................... 47 PEPCID..................................... 72 PERCOCET .............................. 10 PERENNIAL RYE GRASS POLLEN .................................... 97 PERFOROMIST ...................... 108 PERIDEX .................................. 52 PERIKABIVEN .......................... 69 perindopril erbumine ................. 47 periogard ................................... 52 PERJETA .................................. 33 permethrin ................................. 35 perphenazine ............................ 26 perphenazine-amitriptyline ........ 25

135

PERSERIS ................................ 37 PERTZYE .................................. 75 PEXEVA .................................... 25 PFIZERPEN ........................ 19, 20 pfizerpen .................................... 20 phenadoz ................................. 106 phenazo ..................................... 76 phenazopyridine hcl ................... 76 phenelzine sulfate ...................... 25 PHENERGAN .......................... 106 phenobarbital ............................. 23 phenobarbital sodium ................ 23 phenobarbital-belladonna alk ..... 74 phenohytro ................................. 74 phenoxybenzamine hcl .............. 47 phentolamine mesylate .............. 47 phenylephrine hcl .............. 47, 104 PHENYLEPHRINE HCL ............ 47 PHENYLEPHRINE HCL- DEXTROSE ............................... 47 PHENYLEPHRINE HCL-NACL.47 phenylephrine-guaifenesin ....... 106 PHENYTEK ............................... 23 phenytoin ................................... 23 phenytoin infatabs ..................... 23 phenytoin sodium ...................... 23 phenytoin sodium extended ....... 23 philith ......................................... 85 PHOMA EXIGUA ....................... 97 PHOSLYRA ............................... 76 phospha 250 neutral .................. 69 phosphasal ................................ 76 PHOSPHOLINE IODIDE ......... 103 phosphorous .............................. 69 phospho-trin 250 neutral ............ 69 PHOTREXA VISCOUS .............. 97 PHOTREXA-PHOTREXA VISCOUS KIT ............................ 97 phrenilin forte ............................. 10 PHYSICIANS EZ USE B-12 ...... 69 phytonadione ............................. 69 PICATO ..................................... 56 PIFELTRO ................................. 38 pilocarpine hcl .................... 52, 103 pimecrolimus ............................. 56 pimozide .................................... 37 pimtrea ...................................... 85 pindolol ...................................... 47 pioglitazone hcl .......................... 59 pioglitazone hcl-glimepiride ....... 59 pioglitazone hcl-metformin hcl 59 piperacillin sod-tazobactam so 20

PIQRAY (200 MG DAILY DOSE) ....................................... 33 PIQRAY (250 MG DAILY DOSE) ....................................... 33 PIQRAY (300 MG DAILY DOSE) ....................................... 33 pirmella 1/35 .............................. 85 pirmella 7/7/7 ............................. 85 piroxicam ................................... 12 PISTACHIO NUT (DIAGNOSTIC) .......................... 98 PITOCIN .................................... 81 PKU EASY ................................. 98 PKU EASY MICROTABS .......... 98 PLAQUENIL ............................... 35 PLASBUMIN-25 ......................... 98 PLASBUMIN-5 ........................... 98 PLAVIX ...................................... 36 PLEGRIDY ................................. 50 PLEGRIDY STARTER PACK .... 50 plenamine .................................. 69 PLENVU .................................... 74 PLEXION ................................... 56 PLEXION CLEANSER ............... 56 PLIAGLIS ................................... 15 pneumovax 23 ........................... 90 PNEUMOVAX 23 ....................... 91 pnv prenatal plus multivit+dha 69 POD-CARE 100K ...................... 78 podocon ..................................... 56 podofilox .................................... 56 POINT OF CARE KM ................. 78 POINT OF CARE L.2 ................. 79 POINT OF CARE L.5 ................. 79 POINT OF CARE LM DEP 2 ..... 79 POINT OF CARE LM-2.2........... 15 POINT OF CARE LM-2.5........... 15 POLIVY ...................................... 33 polocaine ................................... 15 polocaine-mpf ............................ 15 polycin ..................................... 104 polyethylene glycol 3350 ........... 74 poly-iron 150 forte ...................... 69 polymyxin b sulfate .................... 20 polymyxin b-trimethoprim ......... 104 polysaccharide iron forte ............ 69 POLYTRIM .............................. 104 POLY-VI-FLOR .......................... 69 POLY-VI-FLOR FS .................... 69 POLY-VI-FLOR/IRON ................ 69 POMALYST ............................... 33 PORK (DIAGNOSTIC) ............... 98 portia-28..................................... 85

PORTRAZZA ............................ 33 posaconazole ............................ 28 pot bicarb-pot chloride .............. 69 POTABA ................................... 69 potassium acetate ..................... 69 potassium bicarbonate .............. 69 potassium chloride .................... 69 POTASSIUM CHLORIDE ......... 69 potassium chloride crys er ........ 69 potassium chloride er ................ 69 potassium chloride in nacl......... 69 potassium citrate er................... 69 potassium citrate-citric acid ....... 69 potassium phosphates .............. 69 POTELIGEO ............................. 33 POVIDONE-IODINE ................ 102 PRADAXA ................................. 22 pralidoxime chloride .................. 98 PRALUENT ............................... 47 pramipexole dihydrochloride ..... 35 pramipexole dihydrochloride er. 35 PRAMOSONE ........................... 56 PRAMOTIC ............................. 105 PRASTERA ............................... 12 prasugrel hcl ............................. 36 PRAVACHOL ............................ 47 pravastatin sodium .................... 47 PRAXBIND ................................ 98 praziquantel .............................. 35 prazosin hcl ............................... 47 PRECEDEX .............................. 98 PRECISION LINK ..................... 62 PRECISION PCX PLUS TEST. 62 PRECISION QID MONITOR ..... 62 PRECISION QID TEST ............. 62 PRECISION SOF-TACT MONITOR ................................. 62 PRECISION SOF-TACT TEST. 62 PRECISION XTRA .................... 62 PRECISION XTRA BLOOD GLUCOSE ................................ 62 PRECISION XTRA MONITOR 62 PRECOSE ................................ 59 PRED FORTE ......................... 102 PRED MILD ............................ 102 PRED-G .................................. 104 PRED-G S.O.P. ...................... 104 prednicarbate ............................ 56 PREDNISOL ACE- MOXIFLOX-BROMFEN ........... 102 prednisolone ............................. 79 prednisolone acetate ............... 102 prednisolone acetate p-f ......... 102

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prevident .................................... 52 PREVIDENT 5000 BOOSTER PLUS ......................................... 52 PREVIDENT 5000 DRY MOUTH ..................................... 52 PREVIDENT 5000 ENAMEL PROTECT ................................. 52 PREVIDENT 5000 ORTHO DEFENSE .................................. 52 PREVIDENT 5000 PLUS ........... 52 PREVIDENT 5000 SENSITIVE.52 previfem ..................................... 85 PREVNAR 13 ............................ 91

MASK ........................................ 98 PRO-C-DURE 5 ......................... 79 PRO-C-DURE 6 ......................... 79 PROCENTRA ............................ 49 prochlorperazine ........................ 26 prochlorperazine edisylate ......... 26 prochlorperazine maleate ........... 27 PROCORT ................................. 91 PROCRIT ................................... 41 PROCTOCORT ......................... 91 PROCTOFOAM HC ................... 91 procto-med hc ............................ 91 procto-pak .................................. 91

PROSCAR .................................77 PROSOL ....................................70 PROSTIN VR .............................48 protamine sulfate........................41 PROTHELIAL .............................98 PROTONIX ................................72 PROTOPIC ................................56 protriptyline hcl ...........................25 PROVAYBLUE ...........................98 PROVENGE ...............................89 PROVENTIL HFA..................... 108 PROVERA .................................85 PROVIGIL ................................ 111

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PREDNISOLONE ACETATE- NEPAFENAC ........................... 104 PREDNISOLONE ACET- MOXIFLOXACIN ...................... 104 prednisolone sodium phosphate .......................... 79, 102 PREDNISOLONE- BROMFENAC .......................... 104 PREDNISOLONE- GATIFLOXACIN ...................... 104 PREDNISOLONE- MOXIFLOXACIN ...................... 104 PREDNISOLON-GATIFLOX- BROMFENAC .......................... 104 PREDNISOLON-MOXIFLOX- BROMFENAC .......................... 104 PREDNISOLON-MOXIFLOX- NEPAFENAC ........................... 102 prednisone ................................. 79 PREDNISONE INTENSOL ........ 79 PREFEST .................................. 85 pregabalin .................................. 51 PREGENNA .............................. 69 pregnyl ....................................... 81 PREMARIN ................................ 85 PREMASOL ............................... 69 PREMPHASE ............................ 85 PREMPRO ................................ 85 PRENAISSANCE ....................... 69 PRENATA .................................. 69 prenatal................................ 69, 70 prenatal multi +dha .................... 69 prenatal plus iron ....................... 70 PREPOPIK ................................ 74 PRESTALIA ............................... 47 PREVACID ................................ 72 PREVACID SOLUTAB............... 72 prevalite ..................................... 47 preventeza ................................. 85 PREVIDENT .............................. 52

PREVYMIS ................................ 38 PREZCOBIX .............................. 38 PREZISTA ................................. 38 PRIALT ...................................... 10 PRIFTIN ..................................... 30 PRILOSEC ................................. 72 primaquine phosphate ............... 35 PRIMAXIN IV ............................. 20 primidone ................................... 23 PRIMLEV ................................... 10 PRIMSOL ................................... 20 PRINIVIL .................................... 47 PRISMASOL B22GK 4/0 ........... 70 PRISMASOL BGK 0/2.5 ............ 70 PRISMASOL BGK 2/0 ............... 70 PRISMASOL BGK 2/3.5 ............ 70 PRISMASOL BGK 4/2.5 ............ 70 PRISMASOL BK 0/0/1.2 ............ 70 PRISTIQ .................................... 25 PRIVET ...................................... 98 PRIVIGEN .................................. 89 PRO COMFORT SPACER ADULT ....................................... 98 PRO COMFORT SPACER CHILD ........................................ 98 PRO COMFORT TENS UNIT .... 98 PROAIR DIGIHALER ............... 108 PROAIR HFA ........................... 108 PROAIR RESPICLICK ............. 108 probenecid ................................. 28 PROBUPHINE IMPLANT KIT .... 10 procainamide hcl ........................ 47 PROCALAMINE ......................... 70 PROCARDIA ............................. 47 PROCARDIA XL ........................ 47 PROCARE COMPRESSOR NEBULIZER ............................... 98 PROCARE SPACER/ADULT MASK ........................................ 98 PROCARE SPACER/CHILD

proctosol hc .............................. 92 proctozone-hc ........................... 92 PROCYSBI ............................... 75 PRODIGEN ............................... 74 PRODIGY NO CODING BLOOD GLUC .......................... 62 PROFESSIONAL DNA COLLECTION ........................... 98 PROFILNINE ............................ 41 PROFILNINE SD ...................... 41 progesterone ............................. 85 PROGESTERONE COMPOUNDING KIT ................ 85 progesterone micronized ........... 85 PROGLYCEM ........................... 63 PROGRAF ................................ 89 PROLASTIN-C ........................ 108 PROLENSA ............................ 102 PROLEUKIN ............................. 33 PROLIA ..................................... 92 PROMACTA .............................. 41 PROMACTIN AA PLUS 20PE 98 promethazine hcl ..................... 106 promethazine-codeine ............. 106 promethazine-dm .................... 106 promethazine-phenyleph- codeine ................................... 106 promethazine-phenylephrine 106 promethegan ........................... 106 PROMETRIUM .......................... 85 propafenone hcl ........................ 47 propafenone hcl er .................... 47 propantheline bromide .............. 74 proparacaine hcl ..................... 104 propofol ..................................... 98 propranolol hcl .......................... 48 propranolol hcl er ...................... 48 propranolol-hctz ........................ 48 propylthiouracil .......................... 87 PROQUAD ................................ 91

QUESTRAN LIGHT ................... 48 quetiapine fumarate ................... 37 quetiapine fumarate er ............... 37 QUFLORA FE ............................ 70 QUFLORA FE PEDIATRIC ....... 70 QUFLORA GUMMIES ............... 70 quflora pediatric ......................... 70 QUILLICHEW ER ...................... 50 QUILLIVANT XR ........................ 50 quinapril hcl ............................... 48 quinapril-hydrochlorothiazide ..... 48 quinidine gluconate er ............... 48 quinidine sulfate ......................... 48 quinine sulfate ........................... 35

REBIF REBIDOSE ..................... 50 REBIF REBIDOSE TITRATION PACK ..................... 50 REBIF TITRATION PACK .......... 50 REBINYN ................................... 41 RECK ......................................... 15 RECLAST .................................. 92 reclipsen .................................... 85 RECOMBINATE ......................... 41 RECOMBIVAX HB ..................... 91 RECOTHROM ........................... 41 RECOTHROM SPRAY KIT ........ 41 RECTIV...................................... 48 RECURA .................................... 28

REPATHA SURECLICK .............48 REQUIP XL ................................35 RESCRIPTOR ...........................38 RESET FOR ANDROID APP .....98 RESET FOR IOS APP ...............98 RESET FOR IOS OR ANDROID APP ..........................98 RESET-O FOR ANDROID APP ............................................98 RESET-O FOR IOS APP ...........98 RESET-O FOR IOS OR ANDROID APP ..........................98 RESTASIS ............................... 104 RESTASIS MULTIDOSE ......... 104

138

PROVISC ................................ 104 PROVOCHOLINE ...................... 98 PROZAC .................................... 26 PRUDOXIN ................................ 56 pseudoeph-chlorphen- hydrocod .................................. 106 pseudoephedrine-bromphen- dm ........................................... 106 PSORCON ................................ 56 PULMICORT FLEXHALER ...... 108 PULMICORT SUSPENSION 108 pulmosal .................................. 106 PULMOZYME .......................... 109 purevit dualfe plus ..................... 70 PURIXAN ................................... 33 PYLERA .................................... 74 pyrazinamide ............................. 30 PYRIDIUM ................................. 76 pyridostigmine bromide.............. 29 pyridostigmine bromide er ......... 29 PYRIDOXINE HCL .................... 70 pyridoxine hcl............................. 70 pyrogallic acid ............................ 56 QBRELIS ................................... 48 QBREXZA ................................. 56 qc aspirin low dose .................... 12 QMIIZ ODT ................................ 12 QNASL .................................... 106 QNASL CHILDRENS ............... 106 QTERN ...................................... 59 QUADRACEL ............................ 91 QUADRAMET ............................ 33 QUALAQUIN ............................. 35 QUARTETTE ............................. 85 quazepam .................................. 40 QUDEXY XR ............................. 23 QUEEN PALM ........................... 98 QUELICIN .................................. 51 QUESTRAN ............................... 48

QVAR REDIHALER ................. 108 RABAVERT ............................... 91 RABBIT EPITHELIUM ............... 98 rabeprazole sodium ................... 72 RADICAVA ................................ 51 RADIOGARDASE ...................... 98 RAGWITEK ................................ 98 raloxifene hcl.............................. 80 ramelteon ................................. 111 ramipril ....................................... 48 RANEXA .................................... 48 ranitidine hcl............................... 73 ranolazine er .............................. 48 RAPAFLO .................................. 77 RAPAMUNE .............................. 89 rasagiline mesylate .................... 35 RASUVO .................................... 89 RAVICTI..................................... 75 RAYALDEE ................................ 92 RAYOS ...................................... 79 RAZADYNE ............................... 24 RAZADYNE ER ......................... 24 READI-CAT 2 ............................ 98 READYSHARP ANESTH + BETAMETH ............................... 79 READYSHARP ANESTH + DEXAMETH ............................... 79 READYSHARP ANESTH + KETOROLAC ............................. 12 READYSHARP ANESTH + METHYLPRED .......................... 79 READYSHARP BETAMETHASONE ................... 79 READYSHARP DEXAMETHASONE................... 79 READYSHARP KETOROLAC 12 READYSHARP LIDOCAINE ...... 15 READYSHARP-A ....................... 15 REBIF ........................................ 50

RED BIRCH .............................. 98 RED CEDAR ............................. 98 RED MAPLE ............................. 98 RED MULBERRY ...................... 98 RED TOP GRASS POLLEN ..... 98 REGLAN ................................... 27 regonol ...................................... 29 REGONOL ................................ 29 REGRANEX .............................. 56 relador pak ................................ 15 relador pak plus ........................ 15 RELAFEN DS ........................... 12 RELENZA DISKHALER ............ 38 relexxii ....................................... 50 RELION BLOOD GLUCOSE TEST ......................................... 62 RELION PREMIER CLASSIC ... 62 RELION PREMIER TEST ......... 62 RELION ULTIMA TEST ............ 62 RELISTOR .......................... 74, 75 RELNATE DHA ......................... 70 RELPAX .................................... 29 REMERON ................................ 26 REMERON SOLTAB ................ 26 REMESENSE ........................... 52 REMICADE ............................... 89 remifentanil hcl .......................... 10 REMODULIN .......................... 109 RENACIDIN .............................. 76 RENAGEL ................................. 76 RENATABS WITH IRON .......... 70 RENFLEXIS .............................. 89 RENVELA ................................. 76 REOPRO .................................. 36 repaglinide ................................ 59 repaglinide-metformin hcl .......... 59 REPATHA ................................. 48 REPATHA PUSHTRONEX SYSTEM ................................... 48

RESTORA RX ........................... 75 RESTORIL ............................... 111 RETACRIT ................................. 41 RETAVASE ............................... 22 RETAVASE HALF-KIT............... 22 RETIN-A .................................... 56 RETIN-A MICRO GEL 0.04 %, 0.1 % ......................................... 56 RETIN-A MICRO PUMP ............ 56 RETISERT ............................... 102 RETROVIR ................................ 38 REVATIO ................................. 109 REVCOVI .................................. 75 REVLIMID .................................. 33 REXULTI ................................... 37 REYATAZ .................................. 38 RHIZOPUS ................................ 98 RHOFADE ................................. 56 RHOGAM ULTRA-FILTERED PLUS ......................................... 89 RHOPHYLAC ............................ 89 RHOPRESSA .......................... 103 RIASTAP ................................... 41 RIAX .......................................... 56 ribasphere .................................. 38 ribasphere ribapak ..................... 38 RIBASPHERE RIBAPAK ........... 38 ribavirin ...................................... 38 RICE (DIAGNOSTIC)................. 98 RIDAURA .................................. 89 rifabutin ...................................... 30 RIFADIN .................................... 30 RIFAMATE ................................ 30 rifampin ...................................... 30 RIFAMPIN+SYRSPEND SF ...... 30 RIFATER ................................... 30 RILUTEK ................................... 51 riluzole ....................................... 51 rimantadine hcl .......................... 38 RIOMET ..................................... 59 risedronate sodium .................... 92 RISPERDAL .............................. 37 RISPERDAL CONSTA .............. 37 risperidone ................................. 37 RITALIN ..................................... 50 RITALIN LA ............................... 50 ritonavir ...................................... 38 RITUXAN ................................... 33 RITUXAN HYCELA ................... 33 rivastigmine ............................... 24 rivastigmine tartrate ................... 24 rivelsa ........................................ 86 RIXUBIS .................................... 41

rizatriptan benzoate ................... 29 ROBAXIN ................................. 111 ROBAXIN-750.......................... 111 ROCALTROL ............................. 92 ROCKLATAN ........................... 103 rocuronium bromide ................... 51 ROCURONIUM BROMIDE ........ 51 ROMIDEPSIN ............................ 33 ROPIDEX ................................... 79 ropinirole hcl .............................. 35 ropinirole hcl er .......................... 35 ROPIVACAINE HCL .................. 15 ropivacaine hcl ........................... 15 ROPIVACAINE HCL-NACL ....... 15 ROPIV-CLONIDINE- KETOROLAC ............................. 15 rosadan ................................ 56, 57 rosuvastatin calcium .................. 48 ROTARIX ................................... 91 ROTATEQ ................................. 91 ROUGH MARSH ELDER .......... 98 ROUGH PIGWEED ................... 98 ROWASA ................................... 92 roweepra .................................... 23 roweepra xr ................................ 23 ROXICODONE .......................... 10 ROZEREM ............................... 111 RUBRACA ................................. 33 RUCONEST ............................... 89 RUSSIAN THISTLE ................... 98 RUZURGI .................................. 98 RYANODEX ............................. 111 RYCLORA ............................... 106 RYDAPT .................................... 33 RYTARY .................................... 35 RYTHMOL SR ........................... 48 ryvent ....................................... 106 SABRIL ...................................... 23 SACCHAROMYCES CEREVISIAE ............................. 98 SAFYRAL .................................. 86 SAGEBRUSH ............................ 98 SAIZEN ...................................... 81 SAIZENPREP ............................ 81 SALAGEN .................................. 52 SALEX ....................................... 57 salicylic acid ............................... 57 salicylic acid er ........................... 57 salicylic acid-cleanser ................ 57 saline bacteriostatic ................... 70 SALINE-PHENOL ...................... 70 salsalate..................................... 12 SALVAX ..................................... 57

SALVAX DUO PLUS ................. 57 SAMSCA ................................... 70 SANCUSO ................................ 27 SANDIMMUNE .......................... 89 SANDOSTATIN ......................... 81 SANDOSTATIN LAR DEPOT ... 81 SANTYL .................................... 57 SAPHRIS .................................. 37 SAPS HEALTH CARE ALCOHOL PREP ...................... 98 SARAFEM ................................. 26 sash kit ...................................... 98 SAVAYSA ................................. 22 SAVELLA .................................. 51 SAVELLA TITRATION PACK ... 51 SCLEROSOL INTRAPLEURAL ..................... 108 scopolamine .............................. 27 SEASONIQUE .......................... 86 SECONAL ............................... 111 SEEBRI NEOHALER .............. 108 SEGLUROMET ......................... 59 SELECT-OB .............................. 70 selegiline hcl ............................. 35 selenium sulfide ........................ 57 SELZENTRY ............................. 38 SEMPREX-D ........................... 106 SENSIPAR ................................ 80 sensorcaine ............................... 15 sensorcaine/epinephrine ........... 15 sensorcaine-mpf ........................ 15 sensorcaine-mpf/epinephrine .... 15 SENSORCAINE- MPF/EPINEPHRINE ................. 15 SEREVENT DISKUS .............. 108 SERNIVO .................................. 57 SEROQUEL .............................. 37 SEROQUEL XR ........................ 37 SEROSTIM ............................... 75 sertraline hcl.............................. 26 SESAME SEED (DIAGNOSTIC) ......................... 98 se-tan plus ................................ 70 setlakin ...................................... 86 sevelamer carbonate ................ 76 sevelamer hcl ............................ 76 sevoflurane ............................... 98 SEYSARA ................................. 20 sf ............................................... 52 sf 5000 plus .............................. 52 SFROWASA ............................. 92 SHAGBARK HICKORY ............. 98 sharobel .................................... 86

139

SHEEP SORREL ....................... 98 SHINGRIX ................................. 91 SHORT RAGWEED POLLEN EXT ........................................... 98 SHRIMP (DIAGNOSTIC) ........... 98 SIGNIFOR ................................. 81 SIGNIFOR LAR ......................... 81 SIKLOS...................................... 33 sildenafil citrate ........................ 109 SILENOR ................................. 111 SILIQ ......................................... 89 silodosin..................................... 77 SILVADENE .............................. 20 silver nitrate ............................... 20 silver sulfadiazine ...................... 20 SIMBRINZA ............................. 103 simliya ....................................... 86 simpesse ................................... 86 SIMPONI ................................... 89 SIMPONI ARIA .......................... 90 SIMULECT ................................ 90 simvastatin ................................. 48 SINEMET ................................... 35 SINEMET CR ............................ 35 SINGULAIR ..................... 108, 109 SINUVA ................................... 106 sirolimus .................................... 90 SIRTURO .................................. 30 SITAVIG .................................... 38 SIVEXTRO ................................ 20 SKELAXIN ............................... 111 SKLICE ...................................... 35 SKYLA ....................................... 86 SKYRIZI (150 MG DOSE) ......... 90 SLYND ...................................... 86 sm esomeprazole magnesium 73 sm hydrocortisone ..................... 57 SMOFLIPID ............................... 70 sod benz-sod phenylacet ........... 75 sod citrate-citric acid .................. 70 sodium acetate .......................... 70 sodium bicarbonate ............. 70, 75 SODIUM BICARBONATE .......... 70 SODIUM BICARBONATE- DEXTROSE ............................... 70 sodium chloride ................. 70, 106 sodium chloride bacteriostatic ... 70 SODIUM CITRATE .................... 22 SODIUM CITRATE LOCK FLUSH ....................................... 22 SODIUM CITRATE- GENTAMICIN SULF .................. 22 SODIUM DIURIL ....................... 48

SODIUM EDECRIN ................... 48 sodium fluoride .................... 52, 70 sodium fluoride 5000 plus .......... 52 sodium hyaluronate .................... 57 SODIUM HYALURONATE ......... 98 sodium lactate............................ 70 sodium phenylbutyrate ............... 75 SODIUM PHOSPHATE-NACL 71 sodium phosphates .................... 71 SODIUM PHOSPHATES- DEXTROSE ............................... 71 sodium polystyrene sulfonate .... 71 sodium sulfacetamide ................ 57 sodium sulfacetamide wash ....... 57 SODIUM SULFACETAMIDE WASH ........................................ 57 SOF-SENSOR ........................... 62 SOLESTA .................................. 99 solifenacin succinate .................. 76 SOLIQUA ................................... 59 SOLIRIS..................................... 41 SOLODYN ................................. 20 SOLOSEC ................................. 35 SOLTAMOX ............................... 33 SOLU-CORTEF ......................... 79 SOLU-MEDROL ......................... 79 SOMA ...................................... 111 SOMATULINE DEPOT .............. 81 SOMAVERT ............................... 81 SOOLANTRA ............................. 57 SORIATANE .............................. 57 SORILUX ................................... 57 sorine ......................................... 48 SORREL/DOCK MIX ................. 99 SOTALOL HCL .......................... 48 sotalol hcl ................................... 48 sotalol hcl (af) ............................ 48 SOTRADECOL .......................... 48 SOTYLIZE ................................. 48 SOVALDI ................................... 38 SOYBEAN (DIAGNOSTIC) ........ 99 SPARKY THE DOG PED NEBULIZER ............................... 99 SPECTRACEF ........................... 20 spinosad .................................... 35 SPINRAZA ................................. 99 SPINY PIGWEED ...................... 99 SPIRIVA HANDIHALER........... 109 SPIRIVA RESPIMAT ............... 109 spironolactone............................ 48 spironolactone-hctz .................... 48 SPORANOX .............................. 28 SPORANOX PULSEPAK ........... 28

SPRAVATO (56 MG DOSE) ..... 26 SPRAVATO (84 MG DOSE) ..... 26 sprintec 28 ................................ 86 SPRITAM .................................. 23 SPRIX ....................................... 12 SPRYCEL ................................. 33 sps ............................................ 71 sronyx ....................................... 86 ssd ............................................ 20 SSKI ........................................ 106 sss 10-5 .................................... 57 st joseph low dose .................... 12 STALEVO 100 .......................... 35 STALEVO 125 .......................... 35 STALEVO 150 .......................... 35 STALEVO 200 .......................... 36 STALEVO 50 ............................ 36 STALEVO 75 ............................ 36 STAMARIL ................................ 91 STARLIX ................................... 59 stavudine ................................... 38 STEGLATRO ............................ 59 STEGLUJAN ............................. 59 STELARA .................................. 90 STEMPHYLIUM ........................ 99 STERILE DILUENT FLOLAN PH 12 ........................................ 99 STERILE DILUENT FOR FLOLAN .................................... 99 sterile diluent/epoprostenol ....... 99 STERILE TALC POWDER ...... 109 sterile water for injection ........... 99 STERITALC ............................ 109 STIMATE .................................. 81 STIOLTO RESPIMAT ............. 109 STIVARGA ................................ 33 STRATTERA ............................. 50 STRAWBERRY (DIAGNOSTIC) ......................... 99 STRENSIQ ................................ 75 streptomycin sulfate .................. 20 STRIANT ................................... 79 STRIBILD .................................. 38 STRIVERDI RESPIMAT.......... 109 STROMECTOL ......................... 35 SUBLOCADE ............................ 16 SUBOXONE .............................. 16 SUBSYS ................................... 10 subvenite ................................... 23 subvenite starter kit-blue ........... 23 subvenite starter kit-green ......... 23 subvenite starter kit-orange ....... 23 succinylcholine chloride............. 51

140

SUCCINYLCHOLINE CHLORIDE ................................ 51 SUCRAID .................................. 75 sucralfate ................................... 73 SULAR ...................................... 48 sulfacetamide sodium ........ 57, 102 sulfacetamide sodium (acne) ..... 57 sulfacetamide sodium-sulfur ...... 57 sulfacetamide-prednisolone ..... 104 sulfacetamide-sulfur in urea ...... 57 sulfacleanse 8/4 ......................... 57 sulfadiazine ................................ 20 sulfamethoxazole-trimethoprim. 20 SULFAMYLON .......................... 20 sulfasalazine .............................. 92 sulfatrim pediatric ...................... 20 sulfurated lime ........................... 35 sulindac ..................................... 12 sumatriptan ................................ 29 sumatriptan succinate ................ 29 sumatriptan succinate refill ........ 29 sumatriptan-naproxen sodium 29 SUPARTZ FX ............................ 99 SUPPRELIN LA ......................... 81 SUPRANE ................................. 99 SUPRAX .................................... 20 SUPREP BOWEL PREP KIT .... 75 SURE RESULT O3D3 SYSTEM .................................... 48 SURESTEP PRO HIGH GLUCOSE ................................. 62 SURESTEP PRO LOW GLUCOSE ................................. 62 SURESTEP PRO NORMAL GLUCOSE ................................. 62 SURGISEAL .............................. 99 SURGISEAL STYLUS ............... 99 SURGISEAL TWIST .................. 99 SURVANTA ............................. 106 SUSTIVA ................................... 38 SUSTOL .................................... 27 SUTENT .................................... 33 swabflush saline flush ................ 71 SWEET CORN (DIAGNOSTIC) .......................... 99 SWEET GUM ............................ 99 SWEET VERNAL GRASS POLLEN .................................... 99 SX1 MEDICATED POST- OPERATIVE .............................. 15 syeda ......................................... 86 SYLATRON ............................... 33 SYLVANT .................................. 33

SYMAX DUOTAB ...................... 75 symax-sl..................................... 75 symax-sr .................................... 75 SYMBICORT ........................... 109 SYMBYAX ................................. 26 SYMDEKO ............................... 109 SYMFI ........................................ 39 SYMFI LO .................................. 39 SYMJEPI ................................. 109 SYMLINPEN 120 ....................... 59 SYMLINPEN 60 ......................... 59 SYMPAZAN ............................... 23 SYMPROIC ................................ 75 SYMTUZA .................................. 39 SYNAGIS ................................... 90 synalar ....................................... 57 SYNALAR .................................. 57 SYNAPRYN FUSEPAQ ............. 10 SYNAREL .................................. 81 SYNDROS ................................. 27 SYNERA .................................... 15 SYNERCID ................................ 20 SYNJARDY ................................ 59 SYNJARDY XR .......................... 59 SYNRIBO ................................... 33 SYNTHAMIN 17 ......................... 71 SYNTHROID .............................. 87 SYNVISC ................................... 99 SYNVISC ONE .......................... 99 SYPRINE ................................... 71 TABLOID ................................... 33 TABRADOL FUSEPAQ............ 111 TABRADOL RAPIDPAQ .......... 111 TACHOSIL ................................. 99 TACLONEX ............................... 57 tacrolimus ............................ 57, 90 tadalafil (pah) ........................... 109 TAFINLAR ................................. 33 TAGITOL V ................................ 99 TAGRISSO ................................ 33 TAKHZYRO ............................... 99 TALL RAGWEED ....................... 99 TALTZ ........................................ 90 TALZENNA ................................ 33 TAMIFLU ................................... 39 tamoxifen citrate ......................... 33 tamsulosin hcl ............................ 77 TAPAZOLE ................................ 87 TAPERDEX 12-DAY .................. 79 TAPERDEX 6-DAY .................... 79 TAPERDEX 7-DAY .................... 79 TARCEVA .................................. 33 TARGADOX ............................... 20

TARGRETIN ............................. 34 tarina 24 fe ................................ 86 tarina fe 1/20 ............................. 86 tarina fe 1/20 eq ........................ 86 TARKA ...................................... 48 TARON FORTE ........................ 71 taron-crystals ............................ 71 TASIGNA .................................. 34 TASMAR ................................... 36 TAURINE .................................. 71 TAVALISSE .............................. 41 TAXOTERE ............................... 34 TAYTULLA ................................ 86 tazarotene ................................. 57 tazicef ....................................... 20 TAZICEF ................................... 20 TAZORAC ................................. 57 taztia xt ..................................... 48 TDVAX ...................................... 91 TECENTRIQ ............................. 34 TECFIDERA .............................. 50 TECHNET TC 99M SULFUR COLLOID .................................. 99 technetium tc 99m mebrofenin 99 TECHNETIUM TC 99M MEDRONATE ........................... 99 TECHNETIUM TC 99M PYROPHOS .............................. 99 technetium tc 99m sestamibi .... 99 TEFLARO ................................. 20 TEGRETOL ............................... 24 TEGRETOL-XR ......................... 24 TEGSEDI .................................. 51 TEKTURNA ............................... 48 TEKTURNA HCT ...................... 48 TELFA AMD NON- ADHERENT .............................. 99 telmisartan ................................ 48 telmisartan-amlodipine .............. 48 telmisartan-hctz ......................... 48 temazepam ............................. 111 TEMIXYS .................................. 39 TEMODAR ................................ 34 TEMOVATE .............................. 57 temozolomide ............................ 34 temsirolimus .............................. 90 tencon ....................................... 10 teniposide .................................. 34 TENIVAC .................................. 91 tenofovir disoproxil fumarate ..... 39 TENORETIC 100 ...................... 48 TENORETIC 50 ........................ 48 TENORMIN ............................... 48

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TEPADINA ................................. 34 terazosin hcl .............................. 77 terbinafine hcl ............................ 28 terbutaline sulfate .................... 109 terconazole ................................ 28 TESSALON PERLES .............. 107 TESTIM ..................................... 80 TESTOPEL ................................ 80 TESTOSTERONE ..................... 80 testosterone ............................... 80 TESTOSTERONE COMPOUNDING KIT ................ 80 TESTOSTERONE CYPIONATE .............................. 80 testosterone cypionate .............. 80 TESTOSTERONE CYPIONATE & PROP ............... 80 TESTOSTERONE ENANTHATE ............................. 80 testosterone enanthate .............. 80 TESTOSTERONE PROPIONATE ........................... 80 tetcaine .................................... 104 tetrabenazine ............................. 51 tetracaine hcl ..................... 15, 104 tetracycline hcl ........................... 20 tetravisc ................................... 104 tetravisc forte ........................... 104 TEXACORT ............................... 57 TEXAVITE LQ ........................... 71 thallous chloride tl 201 ............... 99 THALLOUS CHLORIDE TL 201 ............................................ 99 THALOMID ................................ 34 THEO-24 ................................. 109 theochron ................................. 109 theophylline ............................. 109 theophylline er ......................... 109 thiamine hcl ............................... 71 THIOLA...................................... 76 THIOLA EC ............................... 76 thioridazine hcl ........................... 37 thiotepa ...................................... 34 thiothixene ................................. 37 THROMBATE III ........................ 22 THROMBIN-JMI ......................... 41 THROMBIN-JMI EPISTAXIS ..... 41 THROMBOGEN ......................... 41 THYMOGLOBULIN .................... 90 THYROGEN .............................. 99 tiagabine hcl .............................. 24 TIAZAC ...................................... 48 TIBSOVO ................................... 34

TICE BCG .................................. 90 TIGAN ........................................ 27 tigecycline .................................. 20 TIGLUTIK ................................... 51 TIKOSYN ................................... 48 tilia fe ......................................... 86 timolol maleate ................... 48, 103 TIMOPTIC ................................ 103 TIMOPTIC OCUDOSE............. 103 TIMOPTIC-XE .......................... 103 TIMOTHY GRASS POLLEN ALLERGEN ................................ 99 tinidazole .................................... 20 TIROSINT .................................. 87 TIROSINT-SOL .......................... 87 TISSEEL .................................... 99 TIVICAY ..................................... 39 TIVORBEX ................................. 13 tizanidine hcl ............................ 111 tl icon ......................................... 71 TL-FLUORIVITE ........................ 71 TOBI NEBULIZER ................... 109 TOBI PODHALER .................... 109 TOBRADEX ............................. 105 TOBRADEX ST ....................... 105 tobramycin .......................102, 109 TOBRAMYCIN ......................... 109 tobramycin sulfate ...................... 20 tobramycin-dexamethasone ..... 105 TOBREX .................................. 102 TOFRANIL ................................. 26 TOLAK ....................................... 57 tolbutamide ................................ 59 tolcapone ................................... 36 tolmetin sodium .......................... 13 TOLSURA .................................. 28 tolterodine tartrate ...................... 76 tolterodine tartrate er ................. 76 TOPAMAX ................................. 24 TOPAMAX SPRINKLE............... 24 topex topical anesthetic ............. 52 TOPICORT ................................ 57 TOPICORT SPRAY ................... 57 topiramate .................................. 24 topiramate er.............................. 24 toposar ....................................... 34 topotecan hcl ............................. 34 TOPROL XL............................... 48 toremifene citrate ....................... 34 TORISEL ................................... 90 TORONOVA II SUIK .................. 13 TORONOVA SUIK ..................... 13 torsemide ................................... 48

TOTECT.................................... 34 TOUJEO MAX SOLOSTAR ...... 64 TOUJEO SOLOSTAR ............... 64 TOVIAZ ..................................... 76 toxicology saliva collection ........ 99 tpn electrolytes .......................... 71 TRACLEER ............................. 109 TRADJENTA ............................. 59 TRAMADOL HCL ER ................ 10 tramadol hcl er .......................... 10 tramadol hcl er (biphasic).......... 10 tramadol hcl ir ........................... 10 tramadol-acetaminophen ........... 10 trandolapril ................................ 48 trandolapril-verapamil hcl er ...... 48 tranexamic acid ......................... 41 TRANSDERM SCOP (1.5 MG). 27 TRANSDERM-SCOP (1.5 MG).27 TRANXENE-T ........................... 40 tranylcypromine sulfate ............. 26 TRAVASOL ............................... 71 TRAVATAN Z.......................... 103 trazodone hcl ............................ 26 TREANDA ................................. 34 TRECATOR .............................. 30 TRELEGY ELLIPTA ................ 109 TRELSTAR MIXJECT ............... 81 TREMFYA ................................. 90 treprostinil ............................... 110 TRESIBA ................................... 64 TRESIBA FLEXTOUCH ............ 64 tretinoin ......................... 34, 57, 58 tretinoin microsphere ................ 58 tretinoin microsphere pump ...... 58 TRETTEN ................................. 41 TREXALL .................................. 90 TREXIMET ................................ 29 TREZIX ..................................... 10 tri femynor ................................. 86 triamcinolone acetonide 52, 58, 79 TRIAMCINOLONE ACETONIDE ............................. 79 TRIAMCINOLONE DIACETATE .............................. 79 TRIAMCINOLONE- BUPIVACAINE .......................... 79 TRIAMCINOLONE- MOXIFLOXACIN ..................... 105 TRI-AMINO ............................... 71 triamterene ................................ 48 triamterene-hctz ........................ 48 TRIANEX .................................. 58 triazolam ................................... 40

142

TRIPLE PMB ........................... 102 TRIPLE PMK ........................... 102 tri-previfem ................................. 86 TRIPTODUR .............................. 81 TRISENOX ................................ 34 TRISODIUM CITRATE/CRRT 71 tri-sprintec .................................. 86 TRIUMEQ .................................. 39 TRI-VI-FLOR.............................. 71 TRI-VI-FLORO ........................... 71 TRIVISC .................................... 99 tri-vitamin/fluoride ...................... 71 tri-vite/fluoride ............................ 71 trivora (28) ................................. 86

TYLENOL WITH CODEINE #3 . 10 TYLENOL WITH CODEINE #4 . 10 TYMLOS .................................... 92 TYPHIM VI ................................. 91 TYR EASY ................................. 99 TYSABRI ................................... 50 TYVASO .................................. 110 TYVASO REFILL ..................... 110 TYVASO STARTER ................ 110 UCERIS ..................................... 92 UDENYCA ................................. 41 ULESFIA .................................... 35 ULORIC ..................................... 28 ULTANE..................................... 99

utira-c .........................................76 utrona-c ......................................76 VABOMERE .............................. 20 VAGIFEM ...................................86 valacyclovir hcl .......................... 39 VALCHLOR ............................... 34 VALCYTE.................................. 39 valganciclovir hcl ........................39 VALIUM .....................................40 valproate sodium ....................... 24 valproic acid .............................. 24 valrubicin ................................... 34 valsartan ....................................48 valsartan-hydrochlorothiazide .....48

143

TRIBENZOR .............................. 48 TRICARE PRENATAL DHA ONE ........................................... 71 TRI-CHLOR ............................... 58 TRICHOPHYTON ...................... 99 TRICITRASOL ........................... 22 tricitrates .................................... 71 tricon .......................................... 71 TRICOR ..................................... 48 triderm ....................................... 58 TRIDESILON ............................. 58 trientine hcl ................................ 71 tri-estarylla ................................. 86 TRIFERIC .................................. 71 trifluoperazine hcl ...................... 37 trifluridine ................................. 102 trigels-f forte............................... 71 trihexyphenidyl hcl ..................... 36 tri-legest fe ................................. 86 TRILEPTAL ............................... 24 tri-linyah ..................................... 86 TRILIPIX .................................... 48 TRILOAN II SUIK....................... 79 TRILOAN SUIK .......................... 79 tri-lo-estarylla ............................. 86 tri-lo-marzia ................................ 86 tri-lo-mili ..................................... 86 tri-lo-sprintec .............................. 86 trilyte .......................................... 75 trimethobenzamide hcl............... 27 trimethoprim ............................... 20 tri-mili ......................................... 86 trimipramine maleate ................. 26 trinate ........................................ 71 TRINAZ...................................... 71 TRINTELLIX .............................. 26 TRIOSTAT ................................. 87 TRIPLE COMPLEX FORMULA 3 KIT .......................................... 13

tri-vylibra .................................... 86 tri-vylibra lo ................................ 86 TRIZIVIR .................................... 39 TROGARZO .............................. 39 TROKENDI XR .......................... 24 TROPHAMINE ........................... 71 tropicamide .............................. 105 TROPICAMIDE- PHENYLEPHRINE ................... 105 trospium chloride ....................... 76 trospium chloride er ................... 76 TRUE COMFORT ALCOHOL PREP PADS .............................. 99 TRUE FOCUS BLOOD GLUCOSE METER .................... 62 TRUE METRIX BLOOD GLUCOSE TEST ....................... 62 TRUE METRIX LEVEL 1 ........... 62 TRUE METRIX LEVEL 2 ........... 62 TRUE METRIX LEVEL 3 ........... 62 TRUETRACK TEST ................... 62 TRULANCE ............................... 75 TRULICITY ................................ 59 TRUMENBA ............................... 91 TRUSOPT ................................ 103 TRUVADA .................................. 39 tryptophan .................................. 71 TUDORZA PRESSAIR ............ 109 tulana ......................................... 86 turpentine ................................... 58 TUSSICAPS ............................ 107 TUXARIN ER ........................... 107 TUZISTRA XR ......................... 107 TWINRIX .................................... 91 TWYNSTA ................................. 48 TYBOST .................................... 39 tydemy ....................................... 86 TYGACIL ................................... 20 TYKERB .................................... 34

ULTIVA ..................................... 10 ULTOMIRIS .............................. 41 ULTRABAG/DIANEAL/1.5% DEXTROSE .............................. 71 ULTRABAG/DIANEAL/2.5% DEXTROSE .............................. 71 ULTRABAG/DIANEAL/4.25% DEX .......................................... 71 ULTRACET ............................... 10 ULTRAM ................................... 10 ULTRAVATE ............................. 58 ULTRAVIST .............................. 99 umecta mousse ......................... 58 UNASYN ................................... 20 UNISTRIP CONTROL ............... 62 unithroid .................................... 87 UNITUXIN ................................. 34 UPTRAVI ................................ 110 urea ........................................... 58 urea hydrating ........................... 58 urea in zn undecyl-lactic acid .... 58 urea nail .................................... 58 URECHOLINE........................... 76 uretron d/s ................................. 76 urimar-t ..................................... 76 urin ds ....................................... 76 UROCIT-K 10............................ 71 UROCIT-K 15............................ 71 UROCIT-K 5.............................. 71 UROGESIC-BLUE .................... 76 UROXATRAL ............................ 77 URSO 250 ................................ 75 URSO FORTE .......................... 75 ursodiol ..................................... 75 URSODIOL+SYRSPEND SF .... 75 uryl ............................................ 76 ustell ......................................... 76 UTIBRON NEOHALER ........... 109 uticap ........................................ 76

VECTIBIX .................................. 34 VECTICAL ................................. 58 VECURONIUM BROMIDE ........ 51 vecuronium bromide .................. 51 VELCADE .................................. 34 VELETRI .................................. 110 velivet ........................................ 86 VELPHORO ............................... 76 VELTASSA ................................ 71 VELTIN ...................................... 58 VEMLIDY ................................... 39 VENCLEXTA ............................. 34 VENCLEXTA STARTING PACK ......................................... 34

VIDEX EC .................................. 39 VIEKIRA PAK ............................ 39 vienva ........................................ 86 vigabatrin ................................... 24 vigadrone ................................... 24 VIGAMOX ................................ 102 VIIBRYD .................................... 26 VIIBRYD STARTER PACK ........ 26 VIMIZIM ..................................... 75 VIMOVO .................................... 13 VIMPAT ..................................... 24 vinblastine sulfate ...................... 34 vincristine sulfate ....................... 34 vinorelbine tartrate ..................... 34

VOLTAREN ............................... 13 VOLUMEN .............................. 100 VOLUVEN ................................. 41 VONVENDI ............................... 41 VOPAC GB ............................... 13 VOPAC KT ................................ 13 VORAXAZE .............................. 34 voriconazole .............................. 28 VORTEX HOLDING CHAMBER/MASK ................... 100 VOSEVI .................................... 39 VOTRIENT ................................ 34 VP FC KIT ................................. 13 VP GKL KIT .............................. 13

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VALSTAR .................................. 34 VALTREX .................................. 39 VANATOL LQ ............................ 10 VANATOL S .............................. 10 VANCOCIN HCL ....................... 20 vancomycin hcl .......................... 21 VANCOMYCIN HCL .................. 21 VANCOMYCIN HCL IN DEXTROSE ............................... 20 vancomycin hcl in dextrose ....... 20 vancomycin hcl in nacl ........ 20, 21 VANCOMYCIN HCL IN NACL 21 VANCOMYCIN+SYRSPEND SF .............................................. 21 vandazole .................................. 21 VANOS ...................................... 58 VANOXIDE-HC .......................... 58 VANTAS .................................... 81 VAQTA ...................................... 91 VARIBAR HONEY ..................... 99 VARIBAR NECTAR ................... 99 VARIBAR PUDDING ................. 99 VARIBAR THIN HONEY ............ 99 VARIBAR THIN LIQUID ............ 99 VARITHENA .............................. 48 VARIVAX ................................... 91 VARIZIG .................................... 90 VARUBI ..................................... 27 VASCEPA .................................. 49 VASERETIC .............................. 49 vashe cleansing ......................... 58 VASOPRESSIN-SODIUM CHLORIDE ................................ 82 VASOSTRICT ............................ 82 VASOTEC ................................. 49 VAXCHORA .............................. 91 VAZCULEP ................................ 49 vcf vaginal contraceptive ........... 99 VECAMYL ................................. 49

VENELEX .................................. 58 VENIPUNCTURE PX1 PHLEBOTOMY .......................... 15 venlafaxine hcl ........................... 26 venlafaxine hcl er ....................... 26 VENOFER ................................. 71 VENOMIL HONEY BEE VENOM.................................... 100 VENOMIL WASP VENOM ....... 100 VENOMIL WHITE FACED HORNET .................................. 100 VENOMIL YELLOW HORNET VENOM.................................... 100 VENOMIL YELLOW JACKET VENOM.................................... 100 VENTAVIS ............................... 110 VENTOLIN HFA ....................... 109 verapamil hcl.............................. 49 verapamil hcl er ......................... 49 VERDESO ................................. 58 VEREGEN ................................. 58 VERELAN .................................. 49 VERELAN PM............................ 49 VERSACLOZ ............................. 37 VERZENIO ................................ 34 VESICARE ................................. 76 VFEND ...................................... 28 VFEND IV .................................. 28 V-GO 20 ............................ 62, 100 V-GO 30................................... 100 V-GO 40................................... 100 VIBATIV ..................................... 21 VIBERZI ..................................... 75 VIBRAMYCIN............................. 21 vicodin es ................................... 10 vicodin hp ................................... 10 VICTOZA ................................... 59 VIDAZA ...................................... 34 VIDEX ........................................ 39

VIOKACE .................................. 75 viorele ....................................... 86 VIRACEPT ................................ 39 VIRAMUNE ............................... 39 VIRAMUNE XR ......................... 39 VIRASAL ................................... 58 VIRAZOLE ................................ 39 VIREAD..................................... 39 VIRGINIA LIVE OAK ............... 100 virt-phos 250 neutral ................. 71 VISCO-3.................................. 100 VISIPAQUE ............................. 100 VISTARIL .................................. 40 VISTOGARD ........................... 100 VISUDYNE .............................. 105 VITAFOL ................................... 71 VITAFOL-OB+DHA ................... 71 vitamin b complex 100 .............. 71 vitamin b-complex 100 .............. 71 vitamin d (ergocalciferol) ........... 71 vitamin k1 .................................. 71 vitamins acd-fluoride ................. 71 VITRAKVI .................................. 34 VITRASE ................................. 100 VIVAGUARD INO CONTROL SOLUTION ................................ 63 VIVAGUARD INO GLUCOSE METER ..................................... 63 VIVAGUARD INO TEST STRIPS ..................................... 63 VIVAGUARD LANCING DEVICE..................................... 63 VIVELLE-DOT ........................... 86 VIVITROL .................................. 16 VIVLODEX ................................ 13 VIVOTIF .................................... 91 VIZIMPRO ................................. 34 VOGELXO ................................ 80 VOGELXO PUMP ..................... 80

vp-pnv-dha ................................. 71 VPRIV ........................................ 75 VRAYLAR .................................. 37 VSL#3 DS .................................. 75 VUSION ..................................... 28 vyfemla ...................................... 86 vylibra ........................................ 86 VYNDAQEL ............................... 49 VYTORIN ................................... 49 VYVANSE .................................. 50 VYXEOS .................................... 34 VYZULTA ................................ 103 WAKIX ..................................... 111 warfarin sodium ......................... 22 WASP VENOM PROTEIN ....... 100 WELCHOL ................................. 49 WELLBUTRIN SR ..................... 26 WELLBUTRIN XL ...................... 26 wera ........................................... 86 WESTERN JUNIPER .............. 100 westhroid ................................... 87 WESTHROID ............................. 87 wheat germ oil ........................... 71 WHITE ASH............................. 100 WHITE BIRCH ......................... 100 WHITE FACED HORNET VENOM ................................... 100 WHITE MULBERRY ................ 100 WHITE OAK ............................ 100 WHITE PINE............................ 100 WHITE-FACED HORNET VENOM ................................... 100 WHOLE EGG (DIAGNOSTIC) 100 WIDE-SEAL DIAPHRAGM 60 100 WILATE ..................................... 41 WINRHO SDF ........................... 90 wixela inhub ............................. 109 WP THYROID ............................ 87 wymzya fe ................................. 86 XADAGO ................................... 36 XALATAN ................................ 103 XALKORI ................................... 34 XANAX ...................................... 40 XANAX XR ................................ 40 XARELTO .................................. 22 XARELTO STARTER PACK ..... 22 XATMEP .................................... 90 XELJANZ ................................... 90 XELJANZ XR ............................. 90 XELODA .................................... 34 XELPROS ................................ 103 XENAZINE ................................. 51 XEOMIN .................................. 100

XEPI .......................................... 21 XERAC AC ................................ 58 XERAVA .................................... 21 XERESE .................................... 39 XERFORM OIL EMULSION ROLL ......................................... 58 XERMELO ................................. 75 XEROFORM OIL EMULSION 2"X2" .......................................... 58 XEROFORM OIL EMULSION GAUZE ...................................... 58 XEROFORM OIL EMULSION STRIP ........................................ 58 XEROFORM PETROLAT GAUZE 1"X8" ............................ 58 XEROFORM PETROLAT GAUZE 5"X9" ............................ 58 XEROFORM PETROLAT PATCH 2"X2" ............................. 58 XEROFORM PETROLAT PATCH 4"X4" ............................. 58 XEROFORM PETROLATUM ROLL 4"X9' ................................ 58 XHANCE .................................. 107 XIAFLEX .................................. 100 XIFAXAN ................................... 21 XIGDUO XR......................... 59, 60 XIIDRA ..................................... 105 XIMINO ...................................... 21 XOFIGO ..................................... 34 XOFLUZA .................................. 39 XOLAIR.................................... 107 XOLEGEL .................................. 28 XOLEGEL COREPAK................ 28 XOLEGEL DUO/HEAD & SHOULDERS ............................ 28 XOLEGEL DUO/XOLEX ............ 28 XOPENEX ............................... 109 XOPENEX CONCENTRATE 109 XOPENEX HFA ....................... 109 XOSPATA .................................. 34 XTAMPZA ER ............................ 10 XTANDI...................................... 34 xulane ........................................ 86 XULTOPHY ............................... 60 XURIDEN ................................... 75 XYLOCAINE .............................. 15 xylocaine dental ......................... 15 XYLOCAINE/EPINEPHRINE ..... 16 XYLOCAINE-MPF ...................... 16 XYLOCAINE- MPF/EPINEPHRINE .................. 16 XYNTHA .................................... 41

XYNTHA SOLOFUSE ............... 41 XYOSTED ................................. 80 XYREM ................................... 111 YASMIN 28 ............................... 86 YAZ ........................................... 86 YELLOW DOCK ...................... 100 YELLOW HORNET VENOM PROTEIN ................................ 100 YELLOW JACKET VENOM PROTEIN ................................ 100 YERVOY ................................... 34 YESCARTA ............................... 34 yf-vax ........................................ 91 YF-VAX ..................................... 91 YONDELIS ................................ 34 YONSA ..................................... 34 YOSPRALA ............................... 73 YUPELRI ................................. 109 YUTIQ ..................................... 102 yuvafem .................................... 86 ZACARE ................................... 58 zaclir cleansing ......................... 58 zafirlukast ................................ 109 zaleplon................................... 111 ZALTRAP .................................. 34 ZANAFLEX ............................. 111 ZANOSAR ................................. 34 ZANTAC.................................... 73 zarah ......................................... 86 ZARONTIN ................................ 24 ZARXIO..................................... 41 ZAVESCA ................................. 75 zebutal ...................................... 11 ZEGERID .................................. 73 ZEJULA..................................... 34 ZELAC ...................................... 75 ZELAPAR .................................. 36 ZELBORAF ............................... 34 ZEMAIRA ................................ 109 ZEMBRACE SYMTOUCH ......... 29 ZEMDRI .................................... 21 ZEMPLAR ................................. 92 zenatane ................................... 58 ZENPEP.................................... 75 zenzedi ..................................... 50 ZENZEDI ................................... 50 ZEPATIER ................................ 39 ZERBAXA ................................. 21 ZESTORETIC ........................... 49 ZESTRIL ................................... 49 ZETIA ........................................ 49 ZETONNA ............................... 107 ZEVALIN Y-90 .......................... 34

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ZIAC .......................................... 49 ZIAGEN ..................................... 39 ZIANA ........................................ 58 zidovudine ................................. 39 zileuton er ................................ 109 ZILRETTA .................................. 79 ZINC TRACE METAL ................ 71 ZINECARD ................................ 34 ZINGO ....................................... 16 ZINPLAVA ................................. 90 ZIOPTAN ................................. 103 ziprasidone hcl ........................... 37 ZIPSOR ..................................... 13 ZIRGAN ................................... 102 ZITHROMAX ............................. 21 ZITHROMAX TRI-PAK .............. 21 ZITHROMAX Z-PAK .................. 21 ZOCOR...................................... 49 ZOFRAN .................................... 27 ZOHYDRO ER ........................... 11 ZOLADEX .................................. 82 zoledronic acid ........................... 92 ZOLINZA ................................... 34 zolmitriptan ................................ 29 ZOLOFT .................................... 26 zolpidem tartrate ...................... 111 zolpidem tartrate er .................. 111 ZOLPIMIST .............................. 111 ZOMACTON .............................. 82 ZOMIG ....................................... 29 ZOMIG ZMT .............................. 29 ZONALON ................................. 58 ZONEGRAN .............................. 24 zonisamide ................................ 24 ZONTIVITY ................................ 36 ZORBTIVE ................................. 75 ZORTRESS ............................... 90 ZORVOLEX ............................... 13 ZOSTAVAX ............................... 91 ZOSYN ...................................... 21 zovia 1/35e (28) ......................... 86 ZOVIRAX ................................... 39 ZTLIDO ...................................... 16 Z-TUSS AC ............................. 107 ZUBSOLV .................................. 16 ZULRESSO ............................... 26 zumandimine ............................. 86 ZUPLENZ .................................. 27 ZYCLARA .................................. 58 ZYCLARA PUMP ....................... 58 ZYDELIG ................................... 34 ZYFLO ..................................... 109 ZYKADIA ................................... 34

ZYLET ..................................... 105 ZYLOPRIM ................................ 28 ZYMAXID ................................. 102 ZYPITAMAG .............................. 49 ZYPREXA .................................. 37 ZYPREXA RELPREVV .............. 37 ZYPREXA ZYDIS ....................... 37 ZYTIGA ...................................... 34 ZYVOX ...................................... 21

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