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MDwise Formulary Introduction –

Hoosier Healthwise Hoosier Healthwise members must use MDwise network pharmacies to access their prescription drug benefit. How do I use the formulary? There are two ways to find your drug within the formulary: Medical Condition Drugs in this formulary are grouped into categories depending on the type of medical conditions that they are used to treat. For example, drugs used to treat a heart condition are listed under the category “Cardiovascular Disease”. Then look under the category name for your drug. Alphabetical Listing The Index provides an alphabetical list of all the drugs included in this formulary. Both brand name drugs and generic drugs are listed in the Index. Look in the Index and find your drug. Next to your drug, you will see the page number where you can find coverage information. Turn to the page listed in the Index and find the name of your drug in the first column of the list. The formulary provides coverage information about drugs covered by the plan. If you have trouble finding your drug in the list, turn to the Index. All drugs are listed by their generic names and most common proprietary (branded) name. The Formulary may be accessed by using the Index, either by generic or proprietary name or by therapeutic drug category. In situations where an FDA-approved generic equivalent is available, brand names are listed for reference purposes only, and do not denote coverage for the brand, unless specifically noted. All drugs are listed in each category in alphabetical order by generic name. Where an FDA-approved generic is available for the listed generic name, the generic name is bolded. A generic drug as the same active-ingredient as the brand name drug. Generic drugs usually cost less than brand name drugs and are approved by the Food and Drug Administration (FDA), which assures that the following conditions are met:

• The generic drug must contain the same active ingredients, be the same strength, and the same

dosage form as the brand name drug. • The FDA has given an “A” rating compared to the brand name drug and thus the generic drug is

determined to be therapeutically bioequivalent. • When the above two criteria are met, a generic can be substituted with the full expectation that

the substituted product will produce the same clinical effect and safety profile as the prescribed product.

Additional Requirements Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include:

• Prior Authorization: MDwise requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval from the pharmacy benefits manager (MedImpact) before you fill your prescriptions. If you don’t get approval, the drug may not be covered. Drugs that are subject to a prior authorization will have a “PA” symbol next to the drug. Physicians & Pharmacies call (844) 336-2677 or FAX: (858) 790-7100

• Quantity Limit: For certain drugs, the plan limits the amount of the drug that is covered. Drugs that are subject to a quantity limit will have a “QL” symbol next to the drug.

• Refill Limitation: Prescription may be refilled when 75% or more of the day’s supply has been used.

• Step Therapy: In some cases, the plan requires you to first try certain drugs to treat your medical condition before it 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 fist. If Drug A does not work for you, we will then cover Drug B. Drugs that are subject to Step Therapy will have a “ST” symbol next to the drug.

• Age Limit: In some cases, drugs are only available to a member in a select age category. Drugs that are subject to an Age Limit will have an “AGE” symbol next to the drug.

• Gender Limit: Some drugs are only available to members of a certain gender. Drugs that are available to only a certain gender will have a “G” symbol next to the drug. You can find out if your drug as any additional requirements or limits by looking in the formulary starting on the next page.

If you have any additional questions, please visit our website mdwise.org or contact the customer service center (844) 336-2677.

MDwise 2017 HCC HHW and HIP Basic FormularyLast Updated February 9 2017

Table of Contents

Table of Contents

ANALGESIC AND ANTIHISTAMINE COMBINATION ......................................................................................................................3ANALGESICS .............................................................................................................................................................................................. 3ANESTHETICS ..........................................................................................................................................................................................10ANTIALLERGY .........................................................................................................................................................................................12ANTIARTHRITICS ................................................................................................................................................................................... 12ANTIASTHMATICS ................................................................................................................................................................................. 14ANTIBIOTICS ............................................................................................................................................................................................16ANTICOAGULANTS ................................................................................................................................................................................ 23ANTIDOTES ...............................................................................................................................................................................................24ANTIFUNGALS ......................................................................................................................................................................................... 25ANTIHISTAMINE AND DECONGESTANT COMBINATION ..........................................................................................................27ANTIHISTAMINES ...................................................................................................................................................................................28ANTIHYPERGLYCEMICS ......................................................................................................................................................................31ANTIINFECTIVES ....................................................................................................................................................................................33ANTIINFECTIVES/MISCELLANEOUS ................................................................................................................................................33ANTINEOPLASTICS ................................................................................................................................................................................ 33ANTIPARKINSON DRUGS ..................................................................................................................................................................... 38ANTIPLATELET DRUGS ........................................................................................................................................................................ 39ANTIVIRALS ............................................................................................................................................................................................. 39AUTONOMIC DRUGS ..............................................................................................................................................................................42BIOLOGICALS ..........................................................................................................................................................................................44BLOOD ........................................................................................................................................................................................................46CARDIAC DRUGS .................................................................................................................................................................................... 48CARDIOVASCULAR ................................................................................................................................................................................50CNS DRUGS ............................................................................................................................................................................................... 54COLONY STIMULATING FACTORS ...................................................................................................................................................58CONTRACEPTIVES ................................................................................................................................................................................. 58COUGH/COLD PREPARATIONS .......................................................................................................................................................... 62DIAGNOSTIC .............................................................................................................................................................................................69DIURETICS ................................................................................................................................................................................................ 70EENT PREPS ..............................................................................................................................................................................................71ELECT/CALORIC/H2O ........................................................................................................................................................................... 75GASTROINTESTINAL .............................................................................................................................................................................82HERBALS ................................................................................................................................................................................................... 91HORMONES ...............................................................................................................................................................................................94IMMUNOSUPPRESANT .......................................................................................................................................................................... 98MISCELLANEOUS MEDICAL SUPPLIES, DEVICES, NON-DRUG ............................................................................................... 98MUSCLE RELAXANTS ..........................................................................................................................................................................113PRE-NATAL VITAMINS ........................................................................................................................................................................113PSYCHOTHERAPEUTIC DRUGS ....................................................................................................................................................... 116SEDATIVE/HYPNOTICS ....................................................................................................................................................................... 124SKIN PREPS .............................................................................................................................................................................................125SMOKING DETERRENTS .................................................................................................................................................................... 135THYROID PREPS ....................................................................................................................................................................................135UNCLASSIFIED DRUG PRODUCTS ...................................................................................................................................................135VITAMINS ................................................................................................................................................................................................145

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MDwise 2017 HCC HHW and HIP Basic FormularyLast Updated February 9 2017

Drug Name Tier Notes

ANALGESIC AND ANTIHISTAMINE COMBINATIONACETA-GESIC 1

ACETAMINOPHEN PM 1

diphenhydramine-acetaminophen 1

HEADACHE PM 1

MAPAP PM 1

NON-ASPIRIN NIGHTIME 1

NON-ASPIRIN PM 1

PAIN RELIEF PM 1

PAIN RELIEF PM RAPID RELEASE 1

PAIN RELIEVER PM EX-STRENGTH 1

PAIN RELIEVER PM ORAL TABLET 25-500 MG 1

STAFLEX (BROMPHENIRA-ACETAMIN) 2

TYLENOL PM EXTRA STRENGTH 1

ANALGESICS8 HOUR PAIN RELIEVER 1

ABSTRAL 2 PA; QL (4 EA per 1 day)

ACEPHEN 1

acetaminophen oral liquid 160 mg/5 ml 1

acetaminophen oral solution 1

acetaminophen oral tablet 1

acetaminophen oral tablet extended release 1

acetaminophen rectal 1

acetaminophen-caff-dihydrocod oral capsule 1 QL (10 EA per 1 day)

acetaminophen-codeine oral solution 120 mg-12 mg /5 ml (5 ml), 120-12 mg/5 ml, 240 mg-24 mg /10 ml (10 ml), 300 mg-30 mg /12.5 ml

1

acetaminophen-codeine oral tablet 1

ADDED STRENGTH HEADACHE RELIEF 1

alfentanil 1

almotriptan malate 1 ST; QL (2 EA per 5 days)

ALSUMA 2 QL (1 ML per 14 days)

ARTHRITIS PAIN RELIEF (ACETAM) 1

ARTHRITIS PAIN RELIEVER 1

ASCOMP WITH CODEINE 1

3

Drug Name Tier NotesASPIR-81 3

ASPIRIN LOW DOSE 3

aspirin oral tablet 3

aspirin oral tablet,chewable 3

aspirin oral tablet,delayed release (dr/ec) 325 mg, 81 mg 3

aspirin rectal 1

aspirin-acetaminophen-caffeine 1

aspirin-caffeine-dihydrocodein 1

ASPIR-LOW 3

BACKACHE RELIEF EXTRA STRENGTH 1

BELBUCA 2 PA

belladonna alkaloids-opium 1

BELLADONNA-OPIUM 1

BUFFERIN 1

BUPAP ORAL TABLET 50-300 MG 2

BUPRENEX 2

buprenorphine hcl injection 1

BUTALBITAL COMPOUND W/CODEINE 1

butalbital-acetaminop-caf-cod 1

butalbital-acetaminophen 1

butalbital-acetaminophen-caff oral capsule 1

butalbital-acetaminophen-caff oral tablet 50-325-40 mg 1

butalbital-aspirin-caffeine oral capsule 1

butorphanol tartrate 1

BUTRANS 2 PA; QL (1 EA per 7 days)

CAFERGOT 2 QL (10 EA per 7 days)

CAMBIA 2 QL (3 EA per 10 days)

CAPACET 1

CAPITAL WITH CODEINE 2

carisoprodol-asa-codeine 1

CHILDREN'S ACETAMINOPHEN ORAL SUSPENSION 160 MG/5 ML

1

CHILDREN'S ASPIRIN 3

CHILDREN'S MAPAP 1

CHILDREN'S PAIN RELIEF ORAL SUSPENSION 1

CHILDREN'S PAIN RELIEVER ORAL SUSPENSION 1

CHILDREN'S PAIN RELIEVER ORAL TABLET,DISINTEGRATING

1

CHILDREN'S PAIN-FEVER RELIEF ORAL SUSPENSION

1

CHILDREN'S PAIN-FEVER RELIEF ORAL TABLET,CHEWABLE

1

CHILDREN'S Q-PAP 1

CHILDREN'S SILAPAP 1

choline,magnesium salicylate 1

4

Drug Name Tier Notesclonidine (pf) 1

codeine sulfate oral tablet 1

codeine-butalbital-asa-caff 1

DEMEROL (PF) 2

diclofenac potassium 1

diflunisal 1

dihydroergotamine injection 1 QL (15 ML per 14 days)

dihydroergotamine nasal 1 QL (8 ML per 28 days)

E.C. PRIN 3

ECOTRIN 1

ED-APAP 1

EFFERVESCENT PAIN RELIEF 1

ELMIRON 2

EMBEDA ORAL CAPSULE,ORAL ONLY,EXT.REL PELL 100-4 MG

2 QL (4 EA per 1 day)

EMBEDA ORAL CAPSULE,ORAL ONLY,EXT.REL PELL 20-0.8 MG, 30-1.2 MG, 50-2 MG, 60-2.4 MG, 80-3.2 MG


ENDOCET ORAL TABLET 10-325 MG, 2.5-325 MG, 5-325 MG, 7.5-325 MG


EXCEDRIN MIGRAINE 1

fentanyl 1 PA; QL (1 EA per 3 days)

fentanyl citrate 1 PA; QL (4 EA per 1 day)

fentanyl citrate (pf) injection 1

fentanyl citrate (pf) intravenous pt controlled analgesia syring 2,750 mcg/55 ml (50 mcg/ml)

1

fentanyl citrate (pf) intravenous syringe 100 mcg/2 ml (50 mcg/ml)

1

fentanyl-bupivacaine-nacl (pf) injection solution 2 mcg/ml- 0.1 %, 2 mcg/ml- 0.125 %

1

fentanyl-ropivacaine-nacl (pf) epidural solution 2-0.1 mcg/ml-%

1

fentanyl-ropivacaine-nacl (pf) injection solution 2-0.2 mcg/ml-%

1

FENTORA 2 PA; QL (4 EA per 1 day)

FEVER REDUCER 1

FEVERALL RECTAL SUPPOSITORY 120 MG, 325 MG, 650 MG

1

FEVERALL RECTAL SUPPOSITORY 80 MG 2

FROVA 2 ST; QL (3 EA per 5 days)

HEADACHE RELIEF (ASA-ACET-CAF) 1

HISTAFLEX 2

hydrocodone-acetaminophen oral solution 10-325 mg/15 ml(15 ml), 5-163 mg/7.5ml(7.5ml), 7.5-325 mg/15 ml

1 QL (184 ML per 1 day)

hydrocodone-acetaminophen oral tablet 10-300 mg, 5-300 mg, 7.5-300 mg




5

Drug Name Tier Noteshydrocodone-acetaminophen oral tablet 10-500 mg, 5-500 mg, 7.5-500 mg




hydrocodone-acetaminophen oral tablet 2.5-325 mg 1

hydrocodone-acetaminophen oral tablet 7.5-750 mg 1 QL (5 EA per 1 day)

hydrocodone-ibuprofen oral tablet 10-200 mg, 5-200 mg, 7.5-200 mg

1

hydromorphone (pf) 1

hydromorphone (pf)-0.9% nacl intravenous patient control.analgesia soln

1

hydromorphone (pf)-0.9% nacl intravenous pt controlled analgesia syring 10 mg/50 ml (0.2 mg/ml), 6 mg/30 ml (0.2 mg/ml)

1

hydromorphone (pf)-0.9% nacl intravenous solution 0.2 mg/ml

1

hydromorphone injection solution 2 mg/ml 1

hydromorphone injection syringe 1

hydromorphone oral liquid 1

hydromorphone oral tablet 1

hydromorphone oral tablet extended release 24 hr 12 mg, 16 mg, 8 mg

1 PA; QL (1 EA per 1 day)

hydromorphone oral tablet extended release 24 hr 32 mg 1 PA; QL (2 EA per 1 day)

hydromorphone rectal 1

HYSINGLA ER 2 QL (1 EA per 1 day)

IBUPROFEN PM ORAL TABLET 1

ibuprofen-oxycodone 1

INFANT PAIN RELIEVER 1

INFANTS' PAIN AND FEVER 1

INFANTS' PAIN RELIEF 1

INFANT'S PAIN RELIEF ORAL DROPS,SUSPENSION 80 MG/0.8 ML

1

INFANT'S PAIN RELIEVER 1

INFUMORPH P/F 2

IONSYS 2

isometh-dichloral-acetaminophn 1

isomethepten-caf-acetaminophen oral tablet 65-20-325 mg 1

JR. STR NON-ASPIRIN PAIN 1

JUNIOR MAPAP 1

KADIAN ORAL CAPSULE,EXTEND.RELEASE PELLETS 200 MG


KADIAN ORAL CAPSULE,EXTEND.RELEASE PELLETS 40 MG


ketorolac injection cartridge 1

ketorolac injection solution 15 mg/ml, 30 mg/ml (1 ml) 1

ketorolac injection syringe 30 mg/ml 1

ketorolac intramuscular 1

6

Drug Name Tier Notesketorolac oral 1

LAZANDA NASAL SPRAY,NON-AEROSOL 100 MCG/SPRAY, 400 MCG/SPRAY

2 PA; QL (1 EA per 2 days)

levorphanol tartrate 1

LITE COAT ASPIRIN 3

LORCET (HYDROCODONE) 1 QL (12 EA per 1 day)

LORCET HD 1 QL (12 EA per 1 day)

LORCET PLUS ORAL TABLET 7.5-325 MG 1 QL (12 EA per 1 day)

LORTAB ELIXIR ORAL SOLUTION 10-300 MG/15 ML 2

MAPAP (ACETAMINOPHEN) ORAL CAPSULE 1

MAPAP (ACETAMINOPHEN) ORAL DROPS,SUSPENSION

1

MAPAP (ACETAMINOPHEN) ORAL LIQUID 1

MAPAP (ACETAMINOPHEN) ORAL SUSPENSION 1

MAPAP (ACETAMINOPHEN) ORAL TABLET 1

MAPAP (ACETAMINOPHEN) ORAL TABLET,CHEWABLE

1

MAPAP ARTHRITIS PAIN 1

MAPAP EXTRA STRENGTH 1

MARGESIC 1

MARTEN-TAB 1

mefenamic acid 1

MENSTRUAL COMPLETE 1

MENSTRUAL RELIEF 1

meperidine (pf) injection solution 100 mg/ml, 25 mg/ml, 50 mg/ml

1

meperidine injection cartridge 1

meperidine oral solution 1 QL (30 ML per 1 day)

meperidine oral tablet 1 QL (6 EA per 1 day)

methadone injection 1 PA

METHADONE INTENSOL 1 PA

methadone oral concentrate 1 PA

methadone oral solution 1 PA

methadone oral tablet 1 PA

methadone oral tablet,soluble 1 PA

METHADOSE ORAL TABLET,SOLUBLE 1 PA

MIGERGOT 2 QL (5 EA per 7 days)

MIGRAINE FORMULA 1

MIGRAINE RELIEF 1

morphine (pf) in 0.9 % nacl intravenous syringe 2 mg/2 ml (1 mg/ml)

1

morphine (pf) injection solution 0.5 mg/ml, 1 mg/ml 1

morphine (pf) intravenous patient control.analgesia soln 1

morphine concentrate oral solution 1

morphine in 0.9 % nacl intravenous solution 1 mg/ml 1

7

Drug Name Tier Notesmorphine injection solution 15 mg/ml, 8 mg/ml 1

morphine injection syringe 10 mg/ml, 2 mg/ml, 4 mg/ml, 5 mg/ml, 8 mg/ml

1

morphine intravenous 1

morphine oral capsule, er multiphase 24 hr 120 mg 1 QL (2 EA per 1 day)

morphine oral capsule, er multiphase 24 hr 30 mg, 45 mg, 60 mg, 75 mg, 90 mg


morphine oral capsule,extend.release pellets 1 QL (2 EA per 1 day)

morphine oral solution 1

morphine oral tablet 2

morphine oral tablet extended release 1 QL (3 EA per 1 day)

morphine rectal 1

nalbuphine 1

naratriptan 1 QL (3 EA per 5 days)

NODOLOR 1

NON-ASPIRIN EXTRA STRENGTH ORAL TABLET 1

NON-ASPIRIN ORAL TABLET 1

NON-ASPIRIN PAIN RELIEF ORAL TABLET 500 MG 1

NUCYNTA 2 QL (6 EA per 1 day)

NUCYNTA ER 2 QL (2 EA per 1 day)

OPANA INJECTION 2

oxycodone oral capsule 1

oxycodone oral concentrate 1

oxycodone oral solution 1

oxycodone oral tablet 1

oxycodone oral tablet,oral only,ext.rel.12 hr 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 60 mg


oxycodone oral tablet,oral only,ext.rel.12 hr 80 mg 1 QL (4 EA per 1 day)

oxycodone-acetaminophen oral capsule 1 QL (8 EA per 1 day)

oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg


oxycodone-acetaminophen oral tablet 10-650 mg 1 QL (6 EA per 1 day)

oxycodone-acetaminophen oral tablet 7.5-500 mg 1 QL (8 EA per 1 day)

oxycodone-aspirin 1

OXYCONTIN ORAL TABLET,ORAL ONLY,EXT.REL.12 HR 10 MG, 15 MG, 20 MG, 30 MG, 40 MG, 60 MG


OXYCONTIN ORAL TABLET,ORAL ONLY,EXT.REL.12 HR 80 MG


oxymorphone oral tablet 1

oxymorphone oral tablet extended release 12 hr 10 mg, 15 mg, 20 mg, 5 mg, 7.5 mg


oxymorphone oral tablet extended release 12 hr 30 mg, 40 mg


PAIN AND FEVER 1

PAIN RELIEF (ACETAMIN-ASP-CAF) 1

8

Drug Name Tier NotesPAIN RELIEF EXTRA STRENGTH 1

PAIN RELIEF ORAL TABLET 1

PAIN RELIEF ORAL TABLET EXTENDED RELEASE 1

PAIN RELIEF REGULAR STRENGTH 1

PAIN RELIEVER 1

PAIN RELIEVER EXTRA STRENGTH 1

PAIN RELIEVER PLUS 1

pentazocine-naloxone 1

PHARBETOL 1

PRE-MENSTRUAL RELIEF 1

PRIALT 2

PRIMLEV 2 QL (13 EA per 1 day)

Q-PAP 1

Q-PAP EXTRA STRENGTH 1

RELPAX 2 ST; QL (2 EA per 5 days)

REPREXAIN 1

RIMSO-50 2

rizatriptan 1 QL (3 EA per 5 days)

ROXICET ORAL SOLUTION 1 QL (61 ML per 1 day)

ROXICET ORAL TABLET 5-325 MG 1 QL (12 EA per 1 day)

ROXICET ORAL TABLET 5-500 MG 1 QL (8 EA per 1 day)

SUBSYS 2 PA; QL (4 EA per 1 day)

sufentanil citrate 1

sumatriptan 1 QL (6 EA per 15 days)

sumatriptan succinate oral 1 QL (3 EA per 5 days)

sumatriptan succinate subcutaneous cartridge 1 QL (1 ML per 14 days)

sumatriptan succinate subcutaneous pen injector 1 QL (1 ML per 14 days)

sumatriptan succinate subcutaneous solution 1 QL (1 ML per 14 days)

sumatriptan succinate subcutaneous syringe 6 mg/0.5 ml 1 QL (1 ML per 14 days)

SUMAVEL DOSEPRO SUBCUTANEOUS NEEDLE-FREE INJECTOR 4 MG/0.5 ML

2 ST; QL (4 ML per 28 days)

SUMAVEL DOSEPRO SUBCUTANEOUS NEEDLE-FREE INJECTOR 6 MG/0.5 ML


TACTINAL 1

TACTINAL EXTRA STRENGTH 1

TALWIN 2

TENSION HEADACHE 1

tramadol oral capsule,er biphase 24 hr 17-83 1 ST; QL (1 EA per 1 day)

tramadol oral capsule,er biphase 24 hr 25-75 100 mg, 200 mg

1 ST; QL (1 EA per 1 day)

tramadol oral tablet 1

tramadol oral tablet extended release 24 hr 1

tramadol oral tablet, er multiphase 24 hr 1

tramadol-acetaminophen 1

TREXIMET ORAL TABLET 85-500 MG 2 ST; QL (1 EA per 3 days)

9

Drug Name Tier NotesTRI-BUFFERED ASPIRIN 1

ULTIVA 2

VANATOL LQ 2

VICODIN 1 QL (13 EA per 1 day)

VICODIN ES 1 QL (13 EA per 1 day)

VICODIN HP 1 QL (13 EA per 1 day)

XARTEMIS XR 2 QL (12 EA per 1 day)

XYLON 10 1

ZAMICET 2 QL (184 ML per 1 day)

ZEBUTAL ORAL CAPSULE 50-325-40 MG 1

ZECUITY 2 ST; QL (4 EA per 28 days)

ZEMBRACE SYMTOUCH 2 ST

ZIPSOR 2 ST; QL (4 EA per 1 day)

ZOHYDRO ER ORAL CAPSULE, ORAL ONLY, ER 12HR


zolmitriptan 1 ST; QL (2 EA per 5 days)

ZOMIG NASAL SPRAY,NON-AEROSOL 2.5 MG 2 ST; QL (12 EA per 30 days)

ZOMIG NASAL SPRAY,NON-AEROSOL 5 MG 2 ST; QL (6 EA per 15 days)

ANESTHETICSAMIDATE 2

BREVITAL INJECTION RECON SOLN 2.5 GRAM, 500 MG

2

BUFFERED LIDOCAINE INJECTION SYRINGE 1 % (1 ML)

2

bupivacaine 1

bupivacaine (pf) injection solution 1

bupivacaine in nacl(pf) epidural solution 0.125 % (1,250 mcg/ml)

1

bupivacaine-dextrose-water(pf) 1

bupivacaine-epinephrine 1

bupivacaine-epinephrine (pf) 1

bupivacaine-epinephrine bitart 1

BURN RELIEF 1

CEPACOL SORE THROAT (BENZ-MEN) MUCOUS MEMBRANE LOZENGE 15-2.6 MG

2

cocaine 1

dibucaine 1

etomidate 1

GLYDO 1

ketamine in 0.9 % sod chloride intravenous syringe 50 mg/5 ml (10 mg/ml)

1

ketamine injection 1

LANACANE FIRST AID 2

lidocaine 1

lidocaine (pf) in d7.5w 1

10

Drug Name Tier Noteslidocaine (pf) injection solution 1

lidocaine hcl injection solution 1

lidocaine hcl laryngotracheal 1

lidocaine hcl mucous membrane 1

lidocaine hcl topical cream 3 % 1

LIDOCAINE VISCOUS 1

lidocaine-epinephrine (pf) 1

lidocaine-epinephrine bit injection cartridge 2 %-1:100,000 2

lidocaine-epinephrine bit injection cartridge 2 %-1:50,000 1

lidocaine-epinephrine injection solution 0.5 %-1:200,000, 1 %-1:100,000, 2 %-1:100,000

1

lidocaine-prilocaine 1

mepivacaine (pf) 1

midazolam (pf) injection 1

midazolam in 0.9 % nacl intravenous solution 1 mg/ml 1

midazolam in 0.9 % nacl intravenous syringe 2 mg/2 ml (1 mg/ml)

1

midazolam injection 1

NAROPIN (PF) 2

NESACAINE INJECTION SOLUTION 10 MG/ML (1 %) 2

NESACAINE-MPF INJECTION SOLUTION 20 MG/ML (2 %)

1

NESACAINE-MPF INJECTION SOLUTION 30 MG/ML (3 %)

2

ORAL PAIN RELIEF MUCOUS MEMBRANE GEL 1

ORASEP 2

PHENASEPTIC 1

phenazopyridine oral tablet 100 mg, 200 mg 1

POLOCAINE INJECTION SOLUTION 1

POLOCAINE-MPF 1

propofol intravenous emulsion 1

ropivacaine (pf) injection solution 1

SARNA SENSITIVE 1

SENSORCAINE/EPINEPHRINE 1

SENSORCAINE-MPF INJECTION SOLUTION 0.75 % (7.5 MG/ML)

1

SENSORCAINE-MPF SPINAL 1

SENSORCAINE-MPF/EPINEPHRINE INJECTION SOLUTION 0.25 %-1:200,000, 0.75 %-1:200,000

1

sevoflurane 1

SORE THROAT 1

SORE THROAT (BENZOCAINE-MENTH) MUCOUS MEMBRANE LOZENGE 15-3.6 MG

1

SORE THROAT (PHENOL) 1

SUPRANE 2

SYNERA 2

11

Drug Name Tier Notestetracaine hcl (pf) injection 1

URINARY PAIN RELIEF 1

XYLOCAINE INJECTION SOLUTION 5 MG/ML (0.5 %) 2

XYLOCAINE-MPF INJECTION SOLUTION 10 MG/ML (1 %), 20 MG/ML (2 %), 5 MG/ML (0.5 %)

1

XYLOCAINE-MPF INJECTION SOLUTION 15 MG/ML (1.5 %)

2

XYLOCAINE-MPF/EPINEPHRINE INJECTION SOLUTION 1 %-1:200,000

2

ZINGO 2

ANTIALLERGYcromolyn oral 1

ANTIARTHRITICSALL DAY PAIN RELIEF 1

ALL DAY RELIEF 1

allopurinol 1

ALOPRIM 2

CALDOLOR INTRAVENOUS RECON SOLN 800 MG/8 ML (100 MG/ML)

2

celecoxib 1

CHILD IBUPROFEN 1

CHILDREN'S IBUPROFEN 1

colchicine oral capsule 1

colchicine oral tablet 1 QL (4 EA per 1 day)

CUPRIMINE 2

DEPEN TITRATABS 2

diclofenac sodium oral 1

diclofenac-misoprostol 1

DUEXIS 2 ST; QL (3 EA per 1 day)

DYLOJECT 2

ELITEK 2

ENBREL 2 PA

ENBREL SURECLICK 2 PA

etodolac 1

fenoprofen oral capsule 400 mg 2

fenoprofen oral tablet 1

flurbiprofen 1

glucosam su dip-chondroit-c-mn 1

glucosamine sulfate oral capsule 500 mg 1

HUMIRA 2 PA

HUMIRA PEDIATRIC CROHN'S START 2 PA

HUMIRA PEN 2 PA

HUMIRA PEN CROHN'S-UC-HS START 2 PA

HUMIRA PEN PSORIASIS-UVEITIS 2 PA

IBU-DROPS 1

12

Drug Name Tier NotesIBUPROFEN IB 1

IBUPROFEN JR STRENGTH 1

ibuprofen oral capsule 1

ibuprofen oral suspension 1

ibuprofen oral tablet 200 mg, 400 mg, 600 mg, 800 mg 1

INDOCIN 2

indomethacin oral 1

INFANTS IBU-DROPS 1

INFANT'S IBUPROFEN 1

ketoprofen oral capsule 1

ketoprofen oral capsule,ext rel. pellets 24 hr 200 mg 1

KINERET 2 PA

leflunomide 1

meclofenamate oral 1

meloxicam 1

nabumetone 1

NAPRELAN CR ORAL TABLET, ER MULTIPHASE 24 HR 750 MG

2

naproxen 1

naproxen sodium oral capsule 1

naproxen sodium oral tablet 1

naproxen sodium oral tablet, er multiphase 24 hr 1

ORENCIA 2 PA

ORENCIA (WITH MALTOSE) 2 PA

OTEZLA 2 PA

OTEZLA STARTER 2 PA

OTREXUP (PF) SUBCUTANEOUS AUTO-INJECTOR 10 MG/0.4 ML, 15 MG/0.4 ML, 20 MG/0.4 ML, 25 MG/0.4 ML, 7.5 MG/0.4 ML

2 ST; QL (1.6 ML per 28 days)

oxaprozin 1

piroxicam 1

probenecid 1

probenecid-colchicine 1

PROVIL 1

RASUVO (PF) SUBCUTANEOUS AUTO-INJECTOR 10 MG/0.2 ML


RASUVO (PF) SUBCUTANEOUS AUTO-INJECTOR 12.5 MG/0.25 ML










13

Drug Name Tier NotesRASUVO (PF) SUBCUTANEOUS AUTO-INJECTOR 25 MG/0.5 ML








RHEUMATREX 2

RIDAURA 2

salsalate 1

SIMPONI 2 PA

SIMPONI ARIA 2 PA

sulindac oral 1

TIVORBEX 2 PA; ST; QL (3 EA per 1 day)

tolmetin 1

ULORIC 2 ST; QL (30 EA per 30 days)

VIMOVO 2 ST

VIVLODEX 2

XELJANZ 2 PA

XELJANZ XR 2 PA

ZORVOLEX 2 ST; QL (3 EA per 1 day)

ZURAMPIC 2 ST; QL (1 EA per 1 day)

ANTIASTHMATICSacetylcysteine 1

ADVAIR DISKUS 2

ADVAIR HFA 2 QL (12 GM per 30 days)

AEROSPAN 2 QL (17.8 GM per 30 days)

albuterol sulfate inhalation solution for nebulization 1

albuterol sulfate oral 1

ALVESCO 2 ST; QL (12.2 GM per 25 days)

aminophylline intravenous 1

ANORO ELLIPTA 2 QL (60 EA per 30 days)

ARCAPTA NEOHALER 2 ST; QL (1 EA per 1 day)

ARNUITY ELLIPTA 2 ST; QL (30 EA per 30 days)

ASMANEX HFA 2 ST; QL (13 GM per 30 days)

ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 110 MCG (30 DOSES), 220 MCG (120 DOSES), 220 MCG (14 DOSES), 220 MCG (30 DOSES), 220 MCG (60 DOSES)

2 ST; QL (1 EA per 30 days)

ASTHMANEFRIN REFILL 2

ATROVENT HFA 2 QL (25.8 GM per 28 days)

BREO ELLIPTA 2 QL (60 EA per 30 days)

BROVANA 2 QL (60 ML per 15 days)

budesonide inhalation suspension for nebulization 0.25 mg/2 ml, 0.5 mg/2 ml

1 QL (60 ML per 15 days)

14

Drug Name Tier Notesbudesonide inhalation suspension for nebulization 1 mg/2 ml


COMBIVENT RESPIMAT 2

cromolyn inhalation 1

cromolyn nasal 1

DALIRESP 2 ST; QL (1 EA per 1 day)

DULERA 2 QL (13 GM per 30 days)

ELIXOPHYLLIN ORAL ELIXIR 80 MG/15 ML 1

FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 100 MCG/ACTUATION, 50 MCG/ACTUATION


FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 250 MCG/ACTUATION


FLOVENT HFA INHALATION HFA AEROSOL INHALER 110 MCG/ACTUATION

2 ST; QL (12 GM per 30 days)


2 ST; QL (24 GM per 30 days)


2 ST; QL (21.2 GM per 30 days)

FORADIL AEROLIZER 2 ST; QL (60 EA per 30 days)

INCRUSE ELLIPTA 2 QL (30 EA per 30 days)

ipratropium bromide inhalation 1

ipratropium-albuterol 1

levalbuterol hcl 1

metaproterenol oral 1

montelukast 1

NUCALA 2 PA; QL (1 EA per 28 days)

PERFOROMIST 2 QL (120 ML per 30 days)

PROAIR HFA 2 ST

PROAIR RESPICLICK 2 ST

PROVENTIL HFA 2 ST

PULMICORT FLEXHALER 2 ST; QL (1 EA per 30 days)

QVAR 2 ST; QL (174 GM per 300 days)

racepinephrine 2

S2 RACEPINEPHRINE 2

SEEBRI NEOHALER 2 ST; QL (60 EA per 30 days)

SEREVENT DISKUS 2 ST; QL (60 EA per 30 days)

SPIRIVA RESPIMAT INHALATION MIST 1.25 MCG/ACTUATION

2

SPIRIVA RESPIMAT INHALATION MIST 2.5 MCG/ACTUATION

2 QL (4 GM per 30 days)

SPIRIVA WITH HANDIHALER 2 QL (1 EA per 1 day)

STIOLTO RESPIMAT 2 QL (4 GM per 30 days)

STRIVERDI RESPIMAT 2 QL (4 GM per 30 days)

SYMBICORT 2 ST; QL (10.2 GM per 30 days)

terbutaline oral 1

terbutaline subcutaneous 1

15

Drug Name Tier NotesTHEO-24 2

theophylline in dextrose 5 % intravenous parenteral solution 200 mg/100 ml, 200 mg/50 ml, 400 mg/250 ml, 400 mg/500 ml, 800 mg/250 ml

1

theophylline oral solution 1

theophylline oral tablet extended release 12 hr 1

TUDORZA PRESSAIR 2 ST; QL (1 EA per 30 days)

UTIBRON NEOHALER 2 ST; QL (60 EA per 30 days)

VENTOLIN HFA 2

XOLAIR 2 PA; QL (1 EA per 5 days)

XOPENEX HFA 2 ST

zafirlukast 1

ZYFLO 2

ZYFLO CR 2

ANTIBIOTICSamikacin injection solution 1,000 mg/4 ml, 500 mg/2 ml 1

amoxicillin oral capsule 1

amoxicillin oral suspension for reconstitution 1

amoxicillin oral tablet 1

amoxicillin oral tablet, er multiphase 24 hr 1

amoxicillin oral tablet,chewable 125 mg, 250 mg 1

amoxicillin-pot clavulanate 1

ampicillin 1

ampicillin sodium 1

ampicillin-sulbactam 1

ANTIBIOTIC (BACITRACIN ZINC) 1

ANTIBIOTIC PLUS (PRAMOXINE) 1

AUGMENTIN ORAL SUSPENSION FOR RECONSTITUTION 125-31.25 MG/5 ML

2

AVAR LS TOPICAL FOAM 2

AVAR LS TOPICAL PADS, MEDICATED 2

AVAR TOPICAL FOAM 2

AVAR TOPICAL PADS, MEDICATED 2

AVELOX IN NACL (ISO-OSMOTIC) 2

AVYCAZ 2

AZACTAM IN DEXTROSE (ISO-OSM) 2

AZASITE 2

azithromycin 1

aztreonam 1

AZUPHEN MB 1

BACIIM 1

bacitracin 1

bacitracin zinc 1

bacitracin-polymyxin b 1

BACTROBAN NASAL 2

16

Drug Name Tier NotesBESIVANCE 2

BETHKIS 2 PA

BICILLIN C-R 2

BICILLIN L-A 2

BLEPH-10 1

BLEPHAMIDE 2

BLEPHAMIDE S.O.P. 2

BP 10-1 1

CAPASTAT 2

CAYSTON 2 PA; QL (84 ML per 56 days)

cefaclor oral capsule 1

cefaclor oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml, 375 mg/5 ml

1

cefaclor oral tablet extended release 12 hr 1

cefadroxil oral capsule 1

cefadroxil oral suspension for reconstitution 250 mg/5 ml, 500 mg/5 ml

1

cefadroxil oral tablet 1

cefazolin in dextrose (iso-os) intravenous piggyback 1 gram/50 ml

2

cefazolin in dextrose (iso-os) intravenous piggyback 2 gram/100 ml, 2 gram/50 ml

1

cefazolin injection recon soln 1 gram, 10 gram, 20 gram, 500 mg

1

cefazolin intravenous 1

cefdinir 1

cefepime 1

cefepime in dextrose 5 % 2

cefepime in dextrose,iso-osm 2

cefixime 1

cefotaxime 1

cefotetan 1

cefotetan in dextrose, iso-osm 1

cefoxitin 1

cefoxitin in dextrose, iso-osm 1

cefpodoxime 1

cefprozil 1

ceftazidime 1

ceftazidime in d5w 2

ceftibuten 1

CEFTIN ORAL SUSPENSION FOR RECONSTITUTION 2

ceftriaxone in dextrose,iso-os 2

ceftriaxone injection recon soln 1 gram, 10 gram, 2 gram, 250 mg, 500 mg

1

ceftriaxone intravenous 1

cefuroxime axetil oral tablet 1

17

Drug Name Tier Notescefuroxime sodium injection recon soln 1.5 gram, 750 mg 1

cefuroxime sodium intravenous recon soln 7.5 gram 1

CENTANY AT 2

cephalexin 1

chloramphenicol sod succinate 1

CILOXAN OPHTHALMIC OINTMENT 2

CIPRO HC 2

CIPRODEX 2

ciprofloxacin 1

ciprofloxacin (mixture) 1

ciprofloxacin hcl 1

ciprofloxacin in 5 % dextrose 1

ciprofloxacin lactate 1

CLAFORAN IN DEXTROSE(ISO-OSM) 2

CLAFORAN INTRAVENOUS RECON SOLN 2

clarithromycin 1

CLEANSING WASH TOPICAL CLEANSER 1

CLEOCIN INJECTION 1

CLEOCIN VAGINAL SUPPOSITORY 2

CLINDACIN ETZ TOPICAL KIT 2

CLINDACIN PAC 2

clindamycin hcl 1

clindamycin in 5 % dextrose 1

clindamycin palmitate hcl 1

CLINDAMYCIN PEDIATRIC 1

clindamycin phosphate injection 1

clindamycin phosphate intravenous 1

clindamycin phosphate topical 1

clindamycin phosphate vaginal 1

CLINDESSE 2

colistin (colistimethate na) 1

COLY-MYCIN S 2

CORTISPORIN TOPICAL 2

CUBICIN 2

cycloserine 1

DALVANCE 2

dapsone 1

demeclocycline 1

dicloxacillin 1

DIFICID 2 ST; QL (20 EA per 30 days)

DORIBAX 2

DORYX ORAL TABLET,DELAYED RELEASE (DR/EC) 200 MG


18

Drug Name Tier NotesDORYX ORAL TABLET,DELAYED RELEASE (DR/EC) 50 MG


DOUBLE ANTIBIOTIC 1

DOUBLE ANTIBIOTIC (B.TRACN ZN) 1

DOXY-100 1

doxycycline hyclate intravenous 1

doxycycline hyclate oral capsule 1 ST; QL (2 EA per 1 day)

doxycycline hyclate oral tablet 100 mg 1 ST; QL (2 EA per 1 day)

doxycycline hyclate oral tablet,delayed release (dr/ec) 100 mg, 150 mg, 75 mg


doxycycline monohydrate oral capsule 1 QL (2 EA per 1 day)

doxycycline monohydrate oral capsule,ir - delay rel,biphase 1 ST; QL (1 EA per 1 day)

doxycycline monohydrate oral suspension for reconstitution 1

doxycycline monohydrate oral tablet 1 QL (2 EA per 1 day)

E.E.S. 400 ORAL TABLET 1

E.E.S. GRANULES 1

ERY PADS 1

ERYPED 400 2

ERY-TAB ORAL TABLET,DELAYED RELEASE (DR/EC) 250 MG, 500 MG

1

ERY-TAB ORAL TABLET,DELAYED RELEASE (DR/EC) 333 MG

2

ERYTHROCIN (AS STEARATE) ORAL TABLET 250 MG

1

ERYTHROCIN INTRAVENOUS RECON SOLN 500 MG 2

erythromycin ethylsuccinate oral tablet 1

erythromycin ophthalmic 1

erythromycin oral capsule,delayed release(dr/ec) 1

erythromycin oral tablet 1

erythromycin with ethanol 1

erythromycin-benzoyl peroxide 1

ethambutol 1

FORTAZ IN DEXTROSE 5 % 2

FORTAZ INJECTION RECON SOLN 500 MG 2

gatifloxacin 1

GENTAK OPHTHALMIC OINTMENT 1

gentamicin 1

gentamicin in nacl (iso-osm) intravenous piggyback 100 mg/100 ml, 100 mg/50 ml, 120 mg/100 ml, 60 mg/50 ml, 70 mg/50 ml, 80 mg/100 ml, 80 mg/50 ml, 90 mg/100 ml

1

gentamicin sulfate (ped) (pf) 1

gentamicin sulfate (pf) intravenous solution 100 mg/10 ml, 60 mg/6 ml

1

HYOLEV MB 1

imipenem-cilastatin 1

INDIOMIN MB 1

19

Drug Name Tier NotesINVANZ 2

isoniazid 1

KETEK 2

KITABIS PAK 2 PA

levofloxacin 1

levofloxacin in d5w 1

lincomycin injection 1

linezolid intravenous 1

linezolid oral suspension for reconstitution 1

linezolid oral tablet 1 PA

linezolid-0.9% sodium chloride 1

MAXIPIME INTRAVENOUS 2

MEFOXIN IN DEXTROSE (ISO-OSM) 2

meropenem 1

meropenem-0.9% sodium chloride 1

methenamine hippurate 1

methenamine mandelate 1

methen-sod phos-meth blue-hyos 1

metronidazole in nacl (iso-os) 1

metronidazole oral 1

metronidazole vaginal 1

MINOCIN INTRAVENOUS 2

minocycline oral capsule 1

minocycline oral tablet 1

minocycline oral tablet extended release 24 hr 1 ST; QL (1 EA per 1 day)

MONUROL 2

MORGIDOX 1X100 2 ST; QL (1 EA per 30 days)

MORGIDOX 2X100 2 ST; QL (1 EA per 30 days)

MOXEZA 2

moxifloxacin 1

moxifloxacin-sod.ace,sul-water 1

mupirocin 1

mupirocin calcium 1

nafcillin 1

nafcillin in dextrose iso-osm 1

neomycin 1

neomycin-bacitracin-poly-hc 1

neomycin-bacitracin-polymyxin 1

neomycin-polymyxin b-dexameth 1

neomycin-polymyxin-gramicidin 1

neomycin-polymyxin-hc 1

NEO-POLYCIN 1

NEO-POLYCIN HC 1

NEO-SYNALAR 2 ST

20

Drug Name Tier NotesNEO-SYNALAR KIT 2 ST

nitrofurantoin macrocrystal 1

nitrofurantoin monohyd/m-cryst 1

nitrofurantoin oral 1

NUVESSA 2

ofloxacin ophthalmic 1

ofloxacin oral tablet 400 mg 1

ofloxacin otic 1

ORBACTIV 2

OTIPRIO 2

oxacillin 1

oxacillin in dextrose(iso-osm) 1

PASER 2

PCE 2

penicillin g pot in dextrose 1

penicillin g potassium 1

penicillin g procaine 1

penicillin g sodium 1

penicillin v potassium 1

PFIZERPEN-G 1

piperacillin-tazobactam 1

POLYCIN 1

polymyxin b sulfate 1

polymyxin b sulf-trimethoprim 1

PRED-G 2

PRED-G S.O.P. 2

PRIFTIN 2

PRIMSOL 2

pyrazinamide 1

rifabutin 1

RIFAMATE 2

rifampin 1

RIFATER 2

ROSANIL 2

ROSULA 2

silver sulfadiazine 1

SIRTURO 2 PA

SIVEXTRO INTRAVENOUS 2

SIVEXTRO ORAL 2 PA

SOLODYN ORAL TABLET EXTENDED RELEASE 24 HR 105 MG, 115 MG, 55 MG, 65 MG, 80 MG


SSD 1

SSS 10-5 TOPICAL CREAM 1

streptomycin intramuscular 1

21

Drug Name Tier Notessulfacetamide sodium ophthalmic 1

sulfacetamide sodium-sulfur topical cleanser 10-2 %, 10-5 % (w/w), 9-4 %, 9-4.5 %

1

sulfacetamide sodium-sulfur topical cream 10-2 %, 10-5 % (w/w)

1

sulfacetamide sodium-sulfur topical lotion 10-5 % (w/v), 10-5 % (w/w)

1

sulfacetamide sodium-sulfur topical pads, medicated 10-4 %

1

sulfacetamide sodium-sulfur topical suspension 1

sulfacetamide sod-sulfur-urea topical cleanser 1

sulfacetamide-prednisolone 1

sulfacetamide-sulfur-cleansr23 1

SULFACLEANSE 8-4 1

sulfact na-sul-avobnz-otn-ocsa 1

sulfadiazine oral 1

sulfamethoxazole-trimethoprim 1

SULFAMYLON 2

SULFATRIM 1

SUMADAN TOPICAL KIT 2

SUMAXIN CP 2

SUPRAX ORAL CAPSULE 2

SUPRAX ORAL SUSPENSION FOR RECONSTITUTION 500 MG/5 ML

2

SUPRAX ORAL TABLET,CHEWABLE 2

SYNERCID 2

TAZICEF 1

TEFLARO 2

tetracycline 1

THALOMID 2 PA; QL (2 EA per 1 day)

TOBI PODHALER 2 PA

TOBRADEX OPHTHALMIC OINTMENT 2

TOBRADEX ST 2

tobramycin 1

tobramycin in 0.225 % nacl 1 PA; QL (5 ML per 1 day)

tobramycin sulfate 1

tobramycin-dexamethasone 1

TOBREX OPHTHALMIC OINTMENT 2

TRECATOR 2

trimethoprim 1

TRIPLE ANTIBIOTIC (PRAM) EXTRA 1

TRIPLE ANTIBIOTIC PLUS 1

TRIPLE ANTIBIOTIC TOPICAL OINTMENT 1

TRIPLE ANTIBIOTIC TOPICAL OINTMENT IN PACKET

1

TYGACIL 2

22

Drug Name Tier NotesUR N-C 1

URAMIT MB 1

URIMAR-T 1

URIN DS 2

UROGESIC-BLUE 1

URO-L 1

UROLET MB 1

URO-MP 1

UROPHEN MB 1

vancomycin in 0.9% sodium cl intravenous solution 1 gram/250 ml, 1.25 gram/250 ml, 1.5 gram/250 ml, 750 mg/250 ml

1

vancomycin in dextrose 5 % intravenous piggyback 1

vancomycin in dextrose 5 % intravenous solution 1.5 gram/250 ml

1

vancomycin intravenous 1

vancomycin oral capsule 1 QL (40 EA per 30 days)

VANDAZOLE 2

VIBATIV 2

VIBRAMYCIN ORAL SYRUP 2

VIGAMOX 2

XIFAXAN ORAL TABLET 200 MG 2 QL (9 EA per 9 PER FILLs)

XIFAXAN ORAL TABLET 550 MG 2 PA

ZERBAXA 2

ZINACEF IN STERILE WATER 2

ZINACEF INTRAVENOUS RECON SOLN 1.5 GRAM, 750 MG

2

ZMAX 2

ZOSYN IN DEXTROSE (ISO-OSM) 2

ZYLET 2

ZYVOX INTRAVENOUS PARENTERAL SOLUTION 200 MG/100 ML

2

ANTICOAGULANTSargatroban 2

argatroban in 0.9 % sod chlor 2

argatroban in nacl (iso-os) 2

bivalirudin 1

COUMADIN ORAL 2

ELIQUIS ORAL TABLET 2.5 MG 2 QL (60 EA per 30 days)

ELIQUIS ORAL TABLET 5 MG 2 QL (74 EA per 30 days)

enoxaparin subcutaneous solution 1 QL (30 ML per 30 days)

enoxaparin subcutaneous syringe 100 mg/ml, 150 mg/ml 1 QL (20 ML per 30 days)

enoxaparin subcutaneous syringe 120 mg/0.8 ml, 80 mg/0.8 ml


enoxaparin subcutaneous syringe 30 mg/0.3 ml 1 QL (6 ML per 30 days)

23

Drug Name Tier Notesenoxaparin subcutaneous syringe 40 mg/0.4 ml 1 QL (8 ML per 30 days)

enoxaparin subcutaneous syringe 60 mg/0.6 ml 1 QL (12 ML per 30 days)

fondaparinux subcutaneous syringe 10 mg/0.8 ml 1 QL (8 ML per 30 days)

fondaparinux subcutaneous syringe 2.5 mg/0.5 ml 1 QL (5 ML per 30 days)

fondaparinux subcutaneous syringe 5 mg/0.4 ml 1 QL (4 ML per 30 days)

fondaparinux subcutaneous syringe 7.5 mg/0.6 ml 1 QL (6 ML per 30 days)

FRAGMIN SUBCUTANEOUS SOLUTION 2 QL (7.6 ML per 30 days)

FRAGMIN SUBCUTANEOUS SYRINGE 10,000 ANTI-XA UNIT/ML


FRAGMIN SUBCUTANEOUS SYRINGE 12,500 ANTI-XA UNIT/0.5 ML





2 QL (7.2 ML per 30 days)

FRAGMIN SUBCUTANEOUS SYRINGE 2,500 ANTI-XA UNIT/0.2 ML, 5,000 ANTI-XA UNIT/0.2 ML




HEP FLUSH-10 (PF) 1

heparin (porcine) in 0.9% nacl intravenous parenteral solution 2,000 unit/500 ml (4 unit/ml)

1

heparin (porcine) in 5 % dex 1

heparin (porcine) in nacl (pf) intravenous parenteral solution 1,000 unit/500 ml, 2,000 unit/1,000 ml

1

heparin (porcine) injection cartridge 1

heparin (porcine) injection solution 1

heparin(porcine) in 0.45% nacl intravenous parenteral solution 12,500 unit/250 ml, 25,000 unit/500 ml

2

heparin(porcine) in 0.45% nacl intravenous parenteral solution 25,000 unit/250 ml

1

heparin, porcine (pf) injection 1

heparin, porcine (pf) intravenous solution 100 unit/ml (1 ml)

1

IPRIVASK 2 PA; QL (6 EA per 30 days)

JANTOVEN 1

PRADAXA 2 ST; QL (2 EA per 1 day)

SAVAYSA 2 ST; QL (30 EA per 30 days)

warfarin 1

XARELTO ORAL TABLET 10 MG, 20 MG 2 QL (1 EA per 1 day)

XARELTO ORAL TABLET 15 MG 2

XARELTO ORAL TABLETS,DOSE PACK 2 QL (51 EA per 30 days)

ANTIDOTESEVZIO 2 PA; QL (0.8 ML per 365 days)

MOVANTIK 2 QL (1 EA per 1 day)

naloxone 1

naltrexone 1

24

Drug Name Tier NotesNARCAN 2

RELISTOR ORAL 2 PA

RELISTOR SUBCUTANEOUS SOLUTION 2 PA

RELISTOR SUBCUTANEOUS SYRINGE 2 PA

ANTIFUNGALS3 DAY VAGINAL 1

3-DAY VAGINAL 1

ABELCET 2

ALEVAZOL 2

ALOE VESTA ANTIFUNGAL (MICON) 1

AMBISOME 2

amphotericin b 1

ANTIFUNGAL (CLOTRIMAZOLE) 1

ANTIFUNGAL (TOLNAFTATE) TOPICAL CREAM 1

ANTIFUNGAL (TOLNAFTATE) TOPICAL POWDER 1

ANTIFUNGAL CREAM 1

ANTIFUNGAL SPRAY 1

ANTIFUNGAL TOPICAL SOLUTION 1

ATHLETE'S FOOT (TERBINAFINE) 1

ATHLETE'S FOOT (TOLNAFTATE) TOPICAL AEROSOL,SPRAY

1

ATHLETE'S FOOT AF 1

BAZA ANTIFUNGAL 1

CANCIDAS 2

CICLODAN KIT TOPICAL COMBO PACK 2

ciclopirox 1

ciclopirox-ure-camph-menth-euc 1

clotrimazole mucous membrane 1

clotrimazole topical 1

clotrimazole vaginal cream 1

CLOTRIMAZOLE-3 1

clotrimazole-betamethasone 1

CNL 8 NAIL 2

CRESEMBA 2

CRITIC-AID CLEAR AF 1

DERMAFUNGAL 1

DESENEX TOPICAL POWDER 1

econazole topical 1

ERAXIS(WATER DILUENT) 2

ERTACZO 2

EXELDERM 2

EXTINA 2

fluconazole 1

fluconazole in dextrose(iso-o) 1

25

Drug Name Tier Notesfluconazole in nacl (iso-osm) intravenous piggyback 200 mg/100 ml, 400 mg/200 ml

1

flucytosine 1

FUNGOID TINCTURE TOPICAL KIT 2

FUNGOID-D 1

griseofulvin microsize 1

griseofulvin ultramicrosize 1

GYNAZOLE-1 2

INZO ANTIFUNGAL 1

itraconazole 1

JOCK ITCH 1

JUBLIA 2 PA

KERYDIN 2 PA

ketoconazole 1

LAMISIL (AEROSOL) 2

LAMISIL AF TOPICAL AEROSOL POWDER 1

LAMISIL AT TOPICAL GEL 2

LUZU 2 ST; QL (60 GM per 28 days)

MENTAX 2

MICONAZOLE 7 1

miconazole nitrate topical 1

miconazole nitrate vaginal comb pack,prefill appl, cream 1

miconazole nitrate vaginal cream 1

miconazole nitrate vaginal kit 1,200-2 mg-% 1

miconazole nitrate vaginal suppository 1

MICONAZOLE-3 1

MICONAZORB AF 1

MICRO-GUARD 1

MYCAMINE 2

naftifine 1

NAFTIN TOPICAL GEL 2

NATACYN 2

NOXAFIL 2

NYAMYC 1

nystatin oral suspension 1

nystatin oral tablet 1

nystatin topical 1

nystatin-triamcinolone 1

NYSTOP 1

ONMEL 2

ORAVIG 2

oxiconazole 1

OXISTAT TOPICAL LOTION 2

REMEDY ANTIFUNGAL 1

26

Drug Name Tier NotesREMEDY PHYTOPLEX ANTIFUNGAL 1

SECURA ANTIFUNGAL 1

SECURA ANTIFUNGAL EXTRA THICK 1

SPORANOX ORAL SOLUTION 2

terbinafine hcl 1

terconazole 1

tioconazole 1

TIOCONAZOLE-1 1

tolnaftate topical cream 1

tolnaftate topical powder 1

tolnaftate topical solution 1

VAGISTAT-1 1

VAGISTAT-3 1

voriconazole 1

VUSION 2

ZEASORB (MICONAZOLE) 1

ANTIHISTAMINE AND DECONGESTANT COMBINATIONALA-HIST PE 2

ALL DAY ALLERGY-D 1

ALLEGRA-D 24 HOUR 2

ALLERCLEAR D-24HR 1

ALLERFED COLD AND ALLERGY 1

ALLERGY AND CONGESTION RELIEF 1

ALLERGY COMPLETE-D 1

ALLERGY D-12 1

ALLERGY RELIEF D-24 1

ALLERGY RELIEF,NASAL DECONGEST 1

APRODINE 1

BROHIST D 1

BROTAPP 1

cetirizine-pseudoephedrine 1

CHILD TRIAMINIC COLD-ALLERGY 1

CHILDREN'S COLD-ALLERGY (PE) 1

CHILDS TRIACTING COLD-COUGH 1

CLARINEX-D 12 HOUR 2 ST; QL (2 EA per 1 day)

COLD AND ALLERGY 1

COLD AND ALLERGY (BROMPHEN-PE) 1

COLD AND ALLERGY PE 1

CONEX ORAL SOLUTION 2

CONEX ORAL TABLET 1

DALLERGY (CHLORPHENIRAMINE-PE) ORAL DROPS 1-2.5 MG/ML

1

DALLERGY (DEXBROMPHENIRAMN-PE) 2

27

Drug Name Tier NotesDIMAPHEN (PE) 1

ED A-HIST 1

ED A-HIST PSE 1

ED CHLORPED D 2

fexofenadine-pseudoephedrine 1

HISTEX PE 1

LODRANE D 2

LOHIST - D 1

LORATA-DINE D 1

LORATADINE-D 1

LORTUSS LQ 2

NASOPEN PE 2

NOHIST-LQ 1

POLY HIST FORTE (DOXYLAMINE) 2

PROMETHAZINE VC 1

promethazine-phenylephrine 1

pyrilamine-phenylephrine oral tablet 1

Q-TAPP 1

RESCON 2

RU-HIST D 1

RYMED (DEXCHLORPHENIRAMINE-PE) 2

RYNEX PE 1

RYNEX PSE 1

SEMPREX-D 2

SINUS AND ALLERGY PE 1

SINUS-ALLERGY (PHENYLEPHRINE) 1

STAHIST AD 2

SUDOGEST COLD AND ALLERGY 1

SUDOGEST SINUS AND ALLERGY 1

ANTIHISTAMINESAHIST (CHLORCYCLIZINE) 2

ALA-HIST IR 1

ALAWAY 1

ALL DAY ALLERGY (CETIRIZINE) ORAL SOLUTION 1

ALL DAY ALLERGY (CETIRIZINE) ORAL TABLET 1

ALL DAY ALLERGY (CETIRIZINE) ORAL TABLET,CHEWABLE

1

ALLER-CHLOR 1

ALLER-EASE 1

ALLER-G-TIME 1

ALLERGY (CHLORPHENIRAMINE) 1

ALLERGY (DIPHENHYDRAMINE) ORAL CAPSULE 1

ALLERGY (DIPHENHYDRAMINE) ORAL TABLET 1

ALLERGY 4-HOUR 1

28

Drug Name Tier NotesALLERGY EYE (KETOTIFEN) 1

ALLERGY MEDICINE ORAL CAPSULE 1

ALLERGY MEDICINE ORAL TABLET 1

ALLERGY RELIEF (CETIRIZINE) ORAL TABLET 1

ALLERGY RELIEF (CLEMASTINE) 1

ALLERGY RELIEF (FEXOFENADINE) ORAL TABLET 180 MG

1

ALLERGY RELIEF (LORATADINE) 1

ALLERGY RELIEF(CHLORPHENIRAMN) 1

ALLERGY RELIEF(DIPHENHYDRAMIN) 1

ALLERGY-TIME 1

ALLERHIST-1 1

ARBINOXA 1

azelastine ophthalmic 1

BANOPHEN 1

BANOPHEN ALLERGY 1

BENADRYL ALLERGY ORAL TABLET 1

BEPREVE 2

carbinoxamine maleate 1

cetirizine oral solution 1 mg/ml 1

cetirizine oral tablet 1

cetirizine oral tablet,chewable 1

CHILD ALLERGY RELF(CETIRIZINE) ORAL SOLUTION

1

CHILDREN'S ALAWAY 1

CHILDREN'S ALLERGY (DIPHENHYD) ORAL LIQUID 1

CHILDREN'S ALLERGY COMPLETE 1

CHILDREN'S CETIRIZINE 1

CHILD'S ALL DAY ALLERGY(CETIR) 1

CHLORPHEN SR 1

chlorpheniramine maleate oral tablet 1

chlorpheniramine maleate oral tablet extended release 1

CLARINEX ORAL SYRUP 2 ST; QL (10 ML per 1 day)

clemastine oral tablet 1

COMPLETE ALLERGY MEDICINE 1

COMPLETE ALLERGY ORAL CAPSULE 1

COMPLETE ALLERGY ORAL LIQUID 1

cyproheptadine 1

DAYHIST ALLERGY 1

desloratadine oral tablet 1 QL (1 EA per 1 day)

desloratadine oral tablet,disintegrating 1 ST; QL (1 EA per 1 day)

DIPHEDRYL 1

DIPHENHIST ORAL CAPSULE 1

DIPHENHIST ORAL LIQUID 1

29

Drug Name Tier NotesDIPHENHIST ORAL TABLET 25 MG 1

diphenhydramine hcl injection solution 50 mg/ml 1

diphenhydramine hcl injection syringe 1

diphenhydramine hcl oral capsule 1

diphenhydramine hcl oral tablet 25 mg 1

ED CHLORPED JR 1

ED-CHLORPED 1

ED-CHLORTAN 1

EMADINE 2

epinastine 1

EYE ITCH RELIEF 1

fexofenadine oral suspension 1 QL (10 ML per 1 day)

fexofenadine oral tablet 180 mg, 60 mg 1

HISTEX (TRIPROLIDINE) 2

HISTEX PD 2

hydroxyzine hcl intramuscular 1

hydroxyzine hcl oral solution 10 mg/5 ml 1 QL (100 ML per 1 day)

hydroxyzine hcl oral tablet 10 mg, 25 mg 1 QL (4 EA per 1 day)

hydroxyzine hcl oral tablet 50 mg 1 QL (8 EA per 1 day)

hydroxyzine pamoate 1 QL (4 EA per 1 day)

ITCHY EYE DROPS 1

J-TAN PD 2

KARBINAL ER 2 ST; QL (960 ML per 30 days)

ketotifen fumarate 1

LASTACAFT 2

levocetirizine oral solution 1 ST; QL (10 ML per 1 day)

levocetirizine oral tablet 1

loratadine 1

NON-DROWSY ALLERGY 1

olopatadine ophthalmic 1

PATADAY 2

PAZEO 2 ST; QL (2.5 ML per 30 days)

PEDIAVENT 2

PHARBEDRYL 1

promethazine injection solution 1

promethazine oral 1

Q-DRYL 1

QUENALIN 1

SILADRYL SA 1

SILPHEN COUGH 1

VALU-DRYL ALLERGY ORAL CAPSULE 1

VANAHIST PD 2

VICKS QLEARQUIL ALLERGY 1

VICKS QLEARQUIL NIGHTTIME RLF 1

30

Drug Name Tier NotesVISTARIL 2 PA; QL (4 EA per 1 day)

ANTIHYPERGLYCEMICSacarbose 1

ACTOPLUS MET XR 2 ST

AFREZZA INHALATION CARTRIDGE WITH INHALER 4 UNIT


AFREZZA INHALATION CARTRIDGE WITH INHALER 4 UNIT (30)/ 8 UNIT (60), 4 UNIT (60)/ 8 UNIT (30), 8 UNIT (60)/ 12 UNIT (30)


APIDRA 2 ST; QL (40 ML per 28 days)

APIDRA SOLOSTAR 2 ST; QL (30 ML per 28 days)

AVANDAMET ORAL TABLET 2-1,000 MG, 2-500 MG 2 ST

AVANDIA ORAL TABLET 2 MG, 4 MG 2 ST

BYDUREON 2 ST; QL (1 EA per 7 days)

BYETTA SUBCUTANEOUS PEN INJECTOR 10 MCG/DOSE(250 MCG/ML) 2.4 ML


BYETTA SUBCUTANEOUS PEN INJECTOR 5 MCG/DOSE (250 MCG/ML) 1.2 ML


chlorpropamide 1

CYCLOSET 2 ST

FARXIGA 2 ST; QL (1 EA per 1 day)

glimepiride 1

glipizide 1

glipizide-metformin 1

glyburide micronized 1

glyburide oral 1

glyburide-metformin 1

GLYSET 2

GLYXAMBI 2 ST; QL (1 EA per 1 day)

HUMALOG KWIKPEN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML


HUMALOG KWIKPEN SUBCUTANEOUS INSULIN PEN 200 UNIT/ML (3 ML)


HUMALOG MIX 50-50 2 QL (40 ML per 28 days)

HUMALOG MIX 50-50 KWIKPEN 2 QL (30 ML per 28 days)

HUMALOG MIX 75-25 2 QL (40 ML per 28 days)

HUMALOG MIX 75-25 KWIKPEN 2 QL (30 ML per 28 days)

HUMALOG SUBCUTANEOUS CARTRIDGE 2 QL (30 ML per 28 days)

HUMALOG SUBCUTANEOUS SOLUTION 2 QL (40 ML per 28 days)

HUMULIN 70/30 2 QL (40 ML per 28 days)

HUMULIN 70/30 KWIKPEN 2 QL (30 ML per 28 days)

HUMULIN N 2 QL (40 ML per 28 days)

HUMULIN N KWIKPEN 2 QL (30 ML per 28 days)

HUMULIN R 2 QL (40 ML per 28 days)

HUMULIN R U-500 (CONC) KWIKPEN 2

HUMULIN R U-500 (CONCENTRATED) 2 QL (40 ML per 28 days)

31

Drug Name Tier NotesINVOKAMET 2 ST; QL (2 EA per 1 day)

INVOKANA 2 ST; QL (30 EA per 30 days)

JANUMET 2 QL (2 EA per 1 day)

JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 100-1,000 MG


JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 50-1,000 MG, 50-500 MG


JANUVIA 2 QL (1 EA per 1 day)

JARDIANCE 2 ST; QL (1 EA per 1 day)

JENTADUETO 2 QL (2 EA per 1 day)

KAZANO 2 ST; QL (2 EA per 1 day)

KOMBIGLYZE XR ORAL TABLET, ER MULTIPHASE 24 HR 2.5-1,000 MG


KOMBIGLYZE XR ORAL TABLET, ER MULTIPHASE 24 HR 5-1,000 MG, 5-500 MG


KORLYM 2 PA; QL (4 EA per 1 day)

LANTUS 2 QL (40 ML per 28 days)

LANTUS SOLOSTAR 2 QL (30 ML per 28 days)

LEVEMIR 2 QL (40 ML per 28 days)

LEVEMIR FLEXTOUCH 2 QL (30 ML per 28 days)

metformin oral tablet 1

metformin oral tablet extended release 24 hr 1

metformin oral tablet extended release 24hr 1 ST

metformin oral tablet,er gast.retention 24 hr 1 ST

nateglinide 1

NESINA 2 ST; QL (1 EA per 1 day)

NOVOLIN 70/30 2 ST; QL (40 ML per 28 days)

NOVOLIN N 2 ST; QL (40 ML per 28 days)

NOVOLIN R 2 ST; QL (40 ML per 28 days)

NOVOLOG 2 ST; QL (40 ML per 28 days)

NOVOLOG FLEXPEN 2 ST; QL (30 ML per 28 days)

NOVOLOG MIX 70-30 2 ST; QL (40 ML per 28 days)

NOVOLOG MIX 70-30 FLEXPEN 2 ST; QL (30 ML per 28 days)

NOVOLOG PENFILL 2 ST; QL (30 ML per 28 days)

ONGLYZA 2 ST; QL (1 EA per 1 day)

OSENI 2 ST; QL (1 EA per 1 day)

pioglitazone 1

pioglitazone-glimepiride 1 ST

pioglitazone-metformin 1 ST

repaglinide 1

repaglinide-metformin 1

RIOMET 2

SYMLINPEN 120 2

SYMLINPEN 60 2

SYNJARDY 2 ST; QL (2 EA per 1 day)

32

Drug Name Tier NotesTANZEUM 2 ST; QL (4 EA per 28 days)

tolazamide 1

tolbutamide 1

TOUJEO SOLOSTAR 2 QL (7.5 ML per 28 days)

TRADJENTA 2 QL (1 EA per 1 day)

TRESIBA FLEXTOUCH U-100 2 QL (30 ML per 28 days)

TRESIBA FLEXTOUCH U-200 2 QL (18 ML per 28 days)

TRULICITY 2 ST; QL (2 ML per 28 days)

VICTOZA 2-PAK 2 ST; QL (9 ML per 30 days)

VICTOZA 3-PAK 2 ST; QL (9 ML per 30 days)

XIGDUO XR 2 ST; QL (2 EA per 1 day)

ANTIINFECTIVES/MISCELLANEOUSALBENZA 2

ALCOHOL-BENZOCAINE 1

ALINIA 2

atovaquone 1

atovaquone-proguanil 1

BILTRICIDE 2

chloroquine phosphate oral 1

COARTEM 2

COLD SORE TREATMENT TOPICAL SOLUTION 1

DARAPRIM 2 PA

EMVERM 1 PA

FEM PH 2

formaldehyde 1

glycine irrigation 1

hydroxychloroquine oral 1

isopropyl alcohol topical spray,non-aerosol 2

ivermectin oral 1

LICE BEDDING SPRAY 1

mefloquine 1

NEBUPENT 2

paromomycin 1

PENTAM 2

primaquine 2

quinine sulfate 1

SUMMER'S EVE DOUCHE 2

tinidazole 1

ANTIINFECTIVESAVC VAGINAL 2

ANTINEOPLASTICSABRAXANE 2

ACTIMMUNE 2

33

Drug Name Tier NotesADCETRIS 2

ADRUCIL 1

AFINITOR DISPERZ 2 PA

AFINITOR ORAL TABLET 10 MG, 2.5 MG, 5 MG 2 PA; QL (1 EA per 1 day)

AFINITOR ORAL TABLET 7.5 MG 2 PA

ALECENSA 2 PA; QL (240 EA per 30 days)

ALIMTA 2

ALKERAN ORAL 2

anastrozole 1

ARRANON 2

ARZERRA 2

AVASTIN 2

azacitidine 1

BELEODAQ 2

BENDEKA 2

bexarotene 1 PA

bicalutamide 1

BICNU 2

bleomycin 1

BLINCYTO 2

BOSULIF ORAL TABLET 100 MG 2 PA; QL (4 EA per 1 day)

BOSULIF ORAL TABLET 500 MG 2 PA; QL (1 EA per 1 day)

BUSULFEX 2

CAMPATH 2

CAMPTOSAR INTRAVENOUS SOLUTION 300 MG/15 ML

2

capecitabine oral tablet 150 mg 1 PA; QL (28 EA per 21 days)

capecitabine oral tablet 500 mg 1 PA; QL (112 EA per 21 days)

CAPRELSA ORAL TABLET 100 MG 2 PA; QL (2 EA per 1 day)

CAPRELSA ORAL TABLET 300 MG 2 PA; QL (1 EA per 1 day)

carboplatin intravenous solution 1

cisplatin 1

cladribine 1

CLOLAR 2

COMETRIQ 2 PA; QL (4 EA per 1 day)

COSMEGEN 2

COTELLIC 2 QL (63 EA per 28 days)

cyclophosphamide intravenous 1

cyclophosphamide oral capsule 2

CYRAMZA 2

cytarabine 1

cytarabine (pf) injection solution 1

dacarbazine 1

DARZALEX 2

34

Drug Name Tier Notesdaunorubicin intravenous solution 1

decitabine 1

DEPOCYT (PF) 2

diclofenac sodium topical gel 3 % 1 PA; QL (100 GM per 100 PER FILLs)

DOCEFREZ INTRAVENOUS RECON SOLN 20 MG 2

docetaxel intravenous solution 10 mg/ml 2

docetaxel intravenous solution 160 mg/16 ml (10 mg/ml), 160 mg/8 ml (20 mg/ml), 20 mg/2 ml (10 mg/ml), 20 mg/ml (1 ml), 80 mg/4 ml (20 mg/ml), 80 mg/8 ml (10 mg/ml)

1

doxorubicin 1

doxorubicin, peg-liposomal 1

ELIGARD 2 PA

ELIGARD (3 MONTH) 2 PA



EMCYT 2

EMPLICITI 2

epirubicin intravenous solution 1

ERBITUX 2

ERIVEDGE 2 PA; QL (1 EA per 1 day)

ERWINAZE 2

ETOPOPHOS 2

etoposide 1

exemestane 1 PA

FARESTON 2 PA

FARYDAK 2 PA

FASLODEX 2

FIRMAGON KIT W DILUENT SYRINGE SUBCUTANEOUS RECON SOLN 120 MG

2 QL (2 EA per 365 days)

FIRMAGON KIT W DILUENT SYRINGE SUBCUTANEOUS RECON SOLN 80 MG


floxuridine 1

fludarabine 1

fluorouracil 1

flutamide 1

FOLOTYN 2

GAZYVA 2

gemcitabine 1

GILOTRIF 2 PA

GLEOSTINE 2

GLIADEL WAFER 2

HALAVEN 2

HERCEPTIN 2

HEXALEN 2

HYCAMTIN ORAL 2

35

Drug Name Tier Noteshydroxyurea 1

IBRANCE 2 PA

ICLUSIG ORAL TABLET 15 MG 2 PA; QL (2 EA per 1 day)

ICLUSIG ORAL TABLET 45 MG 2 PA; QL (1 EA per 1 day)

idarubicin 1

ifosfamide 1

imatinib 1 PA; QL (2 EA per 1 day)

IMBRUVICA 2 PA

IMLYGIC 2

INLYTA ORAL TABLET 1 MG 2 PA; QL (6 EA per 1 day)

INLYTA ORAL TABLET 5 MG 2 PA; QL (2 EA per 1 day)

INTRON A INJECTION 2 PA

IRESSA 2 PA

irinotecan 1

ISTODAX 2

IXEMPRA 2

JAKAFI 2 PA; QL (2 EA per 1 day)

JEVTANA 2

KADCYLA 2

KEYTRUDA 2

KYPROLIS INTRAVENOUS RECON SOLN 60 MG 2

LENVIMA ORAL CAPSULE 10 MG/DAY (10 MG X 1/DAY), 14 MG/DAY(10 MG X 1-4 MG X 1), 20 MG/DAY (10 MG X 2), 24 MG/DAY(10 MG X 2-4 MG X 1)

2 PA

letrozole 1

LEUKERAN 2

leuprolide subcutaneous kit 1

LEVULAN 2

LIPODOX 1

LIPODOX 50 1

LONSURF 2 PA

LUPRON DEPOT (3 MONTH) INTRAMUSCULAR SYRINGE KIT 22.5 MG

2 PA

LUPRON DEPOT (4 MONTH) 2 PA

LUPRON DEPOT (6 MONTH) 2

LUPRON DEPOT INTRAMUSCULAR SYRINGE KIT 7.5 MG

2 PA

LYNPARZA 2 PA; QL (16 EA per 1 day)

LYSODREN 2

MARQIBO 2

MATULANE 2

megestrol oral tablet 1

MEKINIST 2 PA

melphalan hcl 1

36

Drug Name Tier Notesmercaptopurine 1

methotrexate sodium 1

methotrexate sodium (pf) 1

mitomycin 1

mitoxantrone 1

MUSTARGEN 2

MYLERAN 2

NEXAVAR 2 PA; QL (4 EA per 1 day)

NILANDRON 2

NINLARO 2 PA; QL (3 EA per 28 days)

NIPENT 2

ODOMZO 2 PA

ONCASPAR 2

ONIVYDE 2

OPDIVO 2

oxaliplatin 1

paclitaxel 1

PANRETIN 2

PERJETA 2

PICATO TOPICAL GEL 0.015 % 2 QL (3 EA per 28 days)

PICATO TOPICAL GEL 0.05 % 2 QL (2 EA per 28 days)

POMALYST 2 PA

PORTRAZZA 2

PROLEUKIN 2

PURIXAN 2 ST

REVLIMID 2 PA; QL (1 EA per 1 day)

RITUXAN 2 PA

SOLTAMOX 2

SPRYCEL ORAL TABLET 100 MG, 140 MG, 50 MG, 70 MG, 80 MG


SPRYCEL ORAL TABLET 20 MG 2 PA; QL (2 EA per 1 day)

STIVARGA 2 PA; QL (3 EA per 1 day)

SUTENT 2 PA; QL (1 EA per 1 day)

SYLATRON 2

SYLVANT 2 PA

SYNRIBO 2 PA

TABLOID 2

TAFINLAR 2 PA

TAGRISSO 2 PA; QL (1 EA per 1 day)

tamoxifen 1

TARCEVA 2 PA; QL (1 EA per 1 day)

TARGRETIN TOPICAL 2 PA

TASIGNA 2 PA; QL (4 EA per 1 day)

TEMODAR INTRAVENOUS 2

37

Drug Name Tier Notestemozolomide 1 PA

teniposide 1

thiotepa 1

TOPOSAR 1

topotecan 1

TORISEL 2

TREANDA INTRAVENOUS RECON SOLN 2

TRELSTAR INTRAMUSCULAR SYRINGE 2 PA

tretinoin (chemotherapy) 1

TREXALL 2

TRISENOX 2

TYKERB 2 PA

UNITUXIN 2

VALCHLOR 2 PA

VALSTAR 2

VANTAS 2

VECTIBIX 2

VELCADE 2

vinblastine intravenous solution 1

VINCASAR PFS 1

vincristine 1

vinorelbine 1

VOTRIENT 2 PA; QL (4 EA per 1 day)

XALKORI 2 PA; QL (2 EA per 1 day)

XTANDI 2 PA; QL (4 EA per 1 day)

YERVOY 2

YONDELIS 2

ZALTRAP 2

ZANOSAR 2

ZELBORAF 2 PA; QL (8 EA per 1 day)

ZEVALIN (Y-90) 2

ZOLADEX 2 PA

ZOLINZA 2

ZYDELIG 2 PA

ZYKADIA 2 PA

ZYTIGA 2 PA; QL (4 EA per 1 day)

ANTIPARKINSON DRUGSamantadine hcl 1

APOKYN 2 PA; QL (2 ML per 1 day)

AZILECT 2 QL (1 EA per 1 day)

benztropine 1

bromocriptine 1

carbidopa 1

carbidopa-levodopa 1

38

Drug Name Tier Notescarbidopa-levodopa-entacapone 1

DUOPA 2 PA

entacapone 1

MIRAPEX ER ORAL TABLET EXTENDED RELEASE 24 HR 3.75 MG


NEUPRO 2 ST; QL (1 EA per 1 day)

pramipexole oral tablet 1

pramipexole oral tablet extended release 24 hr 0.375 mg, 0.75 mg, 1.5 mg, 2.25 mg, 3 mg, 4.5 mg


ropinirole oral tablet 1

ropinirole oral tablet extended release 24 hr 1 ST; QL (1 EA per 1 day)

RYTARY 2 ST; QL (10 EA per 1 day)

selegiline hcl 1

tolcapone 1 ST; QL (3 EA per 1 day)

trihexyphenidyl 1

ZELAPAR 2 QL (2 EA per 1 day)

ANTIPLATELET DRUGSAGGRASTAT IN SODIUM CHLORIDE 2

anagrelide 1

aspirin-dipyridamole 1

BRILINTA 2 QL (2 EA per 1 day)

cilostazol 1

clopidogrel oral tablet 300 mg 1 QL (4 EA per 30 days)

clopidogrel oral tablet 75 mg 1

dipyridamole oral 1

DURLAZA ORAL CAPSULE,EXTENDED RELEASE 24HR 162.5 MG

2

DURLAZA ORAL CAPSULE,EXTENDED RELEASE 24HR 162.5 MG

2 PA

EFFIENT 2 QL (1 EA per 1 day)

eptifibatide 1

KENGREAL 2

REOPRO 2

ticlopidine 1

ZONTIVITY 2 QL (1 EA per 1 day)

ANTIVIRALSabacavir 1 QL (60 EA per 30 days)

abacavir-lamivudine-zidovudine 1

ABREVA 2

acyclovir oral capsule 1

acyclovir oral suspension 200 mg/5 ml 1

acyclovir oral tablet 1

acyclovir sodium intravenous recon soln 500 mg 1

acyclovir sodium intravenous solution 1

acyclovir topical 1

39

Drug Name Tier Notesadefovir 1

APTIVUS 2

ATRIPLA 2 QL (30 EA per 30 days)

BARACLUDE ORAL SOLUTION 2

cidofovir 1

COMPLERA 2

CRIXIVAN ORAL CAPSULE 200 MG, 400 MG 2

DAKLINZA ORAL TABLET 30 MG, 60 MG 2 PA

DENAVIR 2

DESCOVY 1 QL (1 EA per 1 day)

didanosine oral capsule,delayed release(dr/ec) 125 mg, 200 mg


didanosine oral capsule,delayed release(dr/ec) 250 mg, 400 mg

1

EDURANT 2

EMTRIVA ORAL CAPSULE 2 QL (30 EA per 30 days)

EMTRIVA ORAL SOLUTION 2 QL (720 ML per 30 days)

entecavir 1

EPIVIR HBV ORAL SOLUTION 2

EPZICOM 2 QL (30 EA per 30 days)

EVOTAZ 2 QL (1 EA per 1 day)

famciclovir 1

foscarnet 1

FUZEON SUBCUTANEOUS RECON SOLN 2 QL (60 EA per 30 days)

ganciclovir sodium 1

GENVOYA 2 QL (1 EA per 1 day)

HARVONI 2 PA

INTELENCE 2

INVIRASE ORAL CAPSULE 2 QL (300 EA per 30 days)

INVIRASE ORAL TABLET 2 QL (120 EA per 30 days)

ISENTRESS 2

KALETRA ORAL SOLUTION 2 QL (390 ML per 30 days)

KALETRA ORAL TABLET 100-25 MG 2 QL (300 EA per 30 days)

KALETRA ORAL TABLET 200-50 MG 2 QL (120 EA per 30 days)

lamivudine oral solution 1 QL (900 ML per 30 days)

lamivudine oral tablet 100 mg 1

lamivudine oral tablet 150 mg 1 QL (60 EA per 30 days)

lamivudine oral tablet 300 mg 1 QL (30 EA per 30 days)

lamivudine-zidovudine 1 QL (60 EA per 30 days)

LEXIVA 2

nevirapine oral suspension 1 QL (1200 ML per 30 days)

nevirapine oral tablet 1 QL (60 EA per 30 days)

nevirapine oral tablet extended release 24 hr 1

NORVIR ORAL CAPSULE 2 QL (360 EA per 30 days)

40

Drug Name Tier NotesNORVIR ORAL SOLUTION 2 QL (450 ML per 30 days)

NORVIR ORAL TABLET 2 QL (360 EA per 30 days)

ODEFSEY 2

OLYSIO 2 PA

PEGASYS 2 PA

PEGASYS PROCLICK 2 PA

PEGINTRON 2 PA

PEGINTRON REDIPEN 2 PA

PREZCOBIX 2 QL (1 EA per 1 day)

PREZISTA ORAL SUSPENSION 2 QL (240 ML per 30 days)

PREZISTA ORAL TABLET 150 MG 2 QL (240 EA per 30 days)




RAPIVAB 2

REBETOL ORAL SOLUTION 2

RELENZA DISKHALER 2 QL (40 EA per 183 days)

RESCRIPTOR 2

RETROVIR INTRAVENOUS 2

REYATAZ ORAL CAPSULE 150 MG, 200 MG, 300 MG 2

REYATAZ ORAL POWDER IN PACKET 2

RIBASPHERE ORAL CAPSULE 1

RIBASPHERE ORAL TABLET 200 MG 1

RIBASPHERE ORAL TABLET 400 MG, 600 MG 1 ST

RIBASPHERE RIBAPAK 1 ST

ribavirin oral capsule 1

ribavirin oral tablet 200 mg 1

rimantadine 1

SELZENTRY 2

SITAVIG 2 ST; QL (4 EA per 365 days)

SOVALDI 2 PA

stavudine oral capsule 1 QL (60 EA per 30 days)

stavudine oral recon soln 1 QL (2400 ML per 30 days)

STRIBILD 2 QL (30 EA per 30 days)

SUSTIVA 2

SYNAGIS 2 PA

TAMIFLU ORAL CAPSULE 30 MG 2 QL (40 EA per 183 days)

TAMIFLU ORAL CAPSULE 45 MG, 75 MG 2 QL (20 EA per 183 days)

TAMIFLU ORAL SUSPENSION FOR RECONSTITUTION


TECHNIVIE 2 PA

TIVICAY ORAL TABLET 50 MG 2

trifluridine 1

TRIUMEQ 2 QL (1 EA per 1 day)

41

Drug Name Tier NotesTRUVADA ORAL TABLET 200-300 MG 2 QL (30 EA per 30 days)

TYZEKA 2

valacyclovir 1

VALCYTE ORAL RECON SOLN 2

valganciclovir oral tablet 1

VEREGEN 2

VIDEX 2 GRAM PEDIATRIC 2 QL (1200 ML per 30 days)

VIDEX 4 GRAM PEDIATRIC 2 QL (1200 ML per 30 days)

VIEKIRA PAK 2 PA

VIRACEPT ORAL TABLET 2

VIRAZOLE 2

VIREAD ORAL POWDER 2 QL (225 GM per 30 days)

VIREAD ORAL TABLET 2 QL (30 EA per 30 days)

VITEKTA 2 QL (1 EA per 1 day)

XERESE 2 ST; QL (10 GM per 365 days)

ZEPATIER 2 PA

ZIAGEN ORAL SOLUTION 2 QL (900 ML per 30 days)

zidovudine oral capsule 1 QL (180 EA per 30 days)

zidovudine oral syrup 1 QL (1800 ML per 30 days)

zidovudine oral tablet 1 QL (60 EA per 30 days)

ZIRGAN 2

ZOVIRAX TOPICAL CREAM 2

AUTONOMIC DRUGSADDERALL 2 QL (3 EA per 1 day)

ADDERALL XR ORAL CAPSULE,EXTENDED RELEASE 24HR 10 MG, 15 MG, 5 MG


ADDERALL XR ORAL CAPSULE,EXTENDED RELEASE 24HR 20 MG, 25 MG, 30 MG


ADZENYS XR-ODT 2 QL (1 EA per 1 day)

ARICEPT 2 PA; QL (1 EA per 1 day)

atracurium 1

bethanechol chloride 1

BLOXIVERZ 2

BOTOX 2 PA

cevimeline 1

cisatracurium 1

DESOXYN 2 PA

DEXEDRINE ORAL TABLET 10 MG 2 PA; QL (4 EA per 1 day)

DEXEDRINE ORAL TABLET 10 MG, 5 MG 2 PA; QL (2 EA per 1 day)

DEXEDRINE ORAL TABLET 5 MG 2 PA; QL (1 EA per 1 day)

DEXEDRINE SPANSULE 2 PA; QL (2 EA per 1 day)

dextroamphetamine oral capsule, extended release 1 QL (2 EA per 1 day)

dextroamphetamine oral solution 1 QL (40 ML per 1 day)

dextroamphetamine oral tablet 10 mg 1 QL (4 EA per 1 day)

42

Drug Name Tier Notesdextroamphetamine oral tablet 5 mg 1 QL (1 EA per 1 day)

dextroamphetamine-amphetamine oral capsule,extended release 24hr 10 mg, 15 mg, 5 mg


dextroamphetamine-amphetamine oral capsule,extended release 24hr 20 mg, 25 mg, 30 mg


dextroamphetamine-amphetamine oral tablet 1 QL (3 EA per 1 day)

donepezil 1 QL (1 EA per 1 day)

dopamine in 5 % dextrose 1

dopamine intravenous solution 1

DYANAVEL XR 2 QL (8 ML per 1 day)

DYSPORT 2 PA

ENLON 1

ENLON-PLUS 2

epinephrine hcl (pf) 1

epinephrine injection auto-injector 1

epinephrine injection solution 1

epinephrine injection syringe 0.1 mg/ml 1

EPIPEN 2

EPIPEN 2-PAK 2

EPIPEN JR 2

EPIPEN JR 2-PAK 2

EVEKEO ORAL TABLET 10 MG 2 QL (6 EA per 1 day)

EVEKEO ORAL TABLET 5 MG 2 QL (1 EA per 1 day)

EXELON ORAL CAPSULE 1.5 MG 2 QL (2 EA per 1 day)

EXELON ORAL CAPSULE 3 MG, 4.5 MG, 6 MG 1 QL (2 EA per 1 day)

EXELON TRANSDERMAL 1 QL (1 EA per 1 day)

galantamine oral capsule,ext rel. pellets 24 hr 1 QL (30 EA per 30 days)

galantamine oral solution 1 QL (6 ML per 1 day)

galantamine oral tablet 1 QL (60 EA per 30 days)

guanidine 1

ISUPREL 2

MESTINON ORAL SYRUP 2

methamphetamine 1

midodrine 1

MYOBLOC 2 PA

neostigmine methylsulfate intravenous solution 2

neostigmine methylsulfate intravenous syringe 2 mg/2 ml (1 mg/ml)

1

norepinephrine bitartrate-d5w intravenous solution 4 mg/250 ml (16 mcg/ml)

1

norepinephrine bitartrate-nacl intravenous solution 4 mg/250 ml (16 mcg/ml)

1

NORTHERA 2 PA

pancuronium intravenous solution 1 mg/ml 1

phenoxybenzamine 1

43

Drug Name Tier Notesphentolamine injection recon soln 1

physostigmine salicylate 1

pilocarpine hcl oral 1

PROCENTRA 2 PA; QL (40 ML per 1 day)

pyridostigmine bromide 1

QUELICIN INJECTION SOLUTION 20 MG/ML 2

RAZADYNE ER 2 PA; QL (1 EA per 1 day)

RAZADYNE ORAL TABLET 2 PA; QL (2 EA per 1 day)

REGONOL 2

rivastigmine 1 QL (30 EA per 30 days)

rivastigmine tartrate 1 QL (2 EA per 1 day)

rocuronium 1

succinylcholine chloride intravenous syringe 200 mg/10 ml (20 mg/ml)

1

vecuronium bromide 1

XEOMIN 2 PA

ZENZEDI ORAL TABLET 10 MG 1 QL (4 EA per 1 day)

ZENZEDI ORAL TABLET 15 MG, 2.5 MG 2 QL (1 EA per 1 day)

ZENZEDI ORAL TABLET 20 MG, 30 MG, 7.5 MG 2 QL (2 EA per 1 day)

ZENZEDI ORAL TABLET 5 MG 1 QL (1 EA per 1 day)

BIOLOGICALSACTHIB (PF) 2

ADACEL(TDAP ADOLESN/ADULT)(PF) 3 QL (0.5 ML per 365 days)

adenovirus vac live type-4, 7 2

adenovirus vaccine live type-4 2

adenovirus vaccine live type-7 2

ANASCORP 2

antivenin latrodectus mactans 2

antivenin micrurus fulvius 2

APLISOL 2

ATGAM 2

BABYBIG 2

bcg vaccine, live (pf) 2

BEXSERO (PF) 2 QL (1 ML per 365 days)

BIOTHRAX 2

BIVIGAM 2 PA

BOOSTRIX TDAP 3 QL (0.5 ML per 365 days)

botulism antitoxin heptavalent 2

CARIMUNE NF NANOFILTERED INTRAVENOUS RECON SOLN 12 GRAM, 6 GRAM

2 PA

CERVARIX VACCINE (PF) 3 QL (1.5 ML per 365 days)

CYTOGAM INTRAVENOUS SOLUTION 50 MG/ML 2

DAPTACEL (DTAP PEDIATRIC) (PF) 2

ENGERIX-B (PF) 3 QL (3 ML per 365 days)

44

Drug Name Tier NotesENGERIX-B PEDIATRIC (PF) 2

FLEBOGAMMA DIF 2 PA

GAMASTAN S/D 2 PA

GAMMAGARD LIQUID 2 PA

GAMMAGARD S-D (IGA < 1 MCG/ML) 2 PA

GAMMAKED 2 PA

GAMMAPLEX 2 PA

GAMUNEX-C 2 PA

GARDASIL (PF) 3 QL (1.5 ML per 365 days)

GARDASIL 9 (PF) 3 QL (1.5 ML per 365 days)

GRASTEK 2 PA

HAVRIX (PF) 2

HEPAGAM B 2

HIBERIX (PF) 2

HIZENTRA 2 PA

HYPERHEP B S/D 2

HYPERHEP B S-D NEONATAL 2

HYPERRAB S/D (PF) 2

HYPERRHO S/D 2

HYPERTET S/D (PF) 2

HYQVIA 2 PA

IMOGAM RABIES-HT (PF) 2

IMOVAX RABIES VACCINE (PF) 2

INFANRIX (DTAP) (PF) 2

IPOL INJECTION SUSPENSION 2

IXIARO (PF) 2

KINRIX (PF) 2

MENACTRA (PF) INTRAMUSCULAR SOLUTION 2

MENHIBRIX (PF) 2

MENOMUNE - A/C/Y/W-135 2

MENOMUNE - A/C/Y/W-135 (PF) 2

MENVEO A-C-Y-W-135-DIP (PF) 2

MENVEO MENA COMPONENT (PF) 2

MENVEO MENCYW-135 COMPNT (PF) 2

MICRHOGAM ULTRA-FILTERED PLUS 2

M-M-R II (PF) 3 QL (2 EA per 365 days)

NABI-HB 2

OCTAGAM 2 PA

ORALAIR SUBLINGUAL TABLET 100 INDX REACTIVITY, 300 INDX REACTIVITY

2 PA

PEDIARIX (PF) 2

PEDVAX HIB (PF) 2

PENTACEL (PF) 2

PENTACEL ACTHIB COMPONENT (PF) 2

45

Drug Name Tier NotesPENTACEL DTAP-IPV COMPNT (PF) 2

PNEUMOVAX 23 3 QL (0.5 ML per 365 days)

PREVNAR 13 (PF) 3 QL (0.5 ML per 365 days)

PRIVIGEN 2 PA

PROQUAD (PF) 3 QL (2 EA per 365 days)

QUADRACEL (PF) 2

RABAVERT (PF) 2

RAGWITEK 2 PA

RECOMBIVAX HB (PF) INTRAMUSCULAR SUSPENSION 10 MCG/ML, 40 MCG/ML


RECOMBIVAX HB (PF) INTRAMUSCULAR SUSPENSION 5 MCG/0.5 ML

2

RECOMBIVAX HB (PF) INTRAMUSCULAR SYRINGE 10 MCG/ML


RECOMBIVAX HB (PF) INTRAMUSCULAR SYRINGE 5 MCG/0.5 ML

2

RHOGAM ULTRA-FILTERED PLUS 2

RHOPHYLAC 2

ROTARIX 2

ROTATEQ VACCINE 2

TENIVAC (PF) 3 QL (0.5 ML per 365 days)

tetanus,diphtheria tox ped(pf) 2

tetanus-diphtheria toxoids-td 3 QL (0.5 ML per 365 days)

THYMOGLOBULIN 2

TRUMENBA 2 QL (1.5 ML per 365 days)

TUBERSOL 2

TWINRIX (PF) 2

TYPHIM VI 2

VAQTA (PF) 2

VARIVAX (PF) 3 QL (2 EA per 365 days)

VARIZIG INTRAMUSCULAR RECON SOLN 2

VIVOTIF 2

VIVOTIF BERNA VACCINE 2

WINRHO SDF 2

YF-VAX (PF) 2

ZOSTAVAX (PF) 3 QL (1 EA per 365 days)

BLOODACTIVASE 2

ADVATE 2

ADYNOVATE 2

ALBUKED-25 2

ALBUKED-5 2

albumin, human 20 % 2



46

Drug Name Tier NotesALBUMINAR 25 % 2

ALBUMINAR 5 % 2

ALBURX (HUMAN) 25 % 2

ALBURX (HUMAN) 5 % 2

ALBUTEIN 25 % 2

ALBUTEIN 5 % 2

ALPHANATE 2

ALPHANINE SD 2

ALPROLIX INTRAVENOUS RECON SOLN 1,000 UNIT, 2,000 UNIT, 3,000 UNIT, 500 UNIT

2

AMICAR 2

aminocaproic acid intravenous 1

ATRYN INTRAVENOUS RECON SOLN 1,750 UNIT 2

BEBULIN 2

BENEFIX 2

BUMINATE 25 % 2

BUMINATE 5 % 2

CATHFLO ACTIVASE 2

CEPROTIN (BLUE BAR) 2

CEPROTIN (GREEN BAR) 2

COAGADEX 2

CORIFACT 2

DROXIA 2

ELOCTATE 2

FEIBA NF 2

FLEXBUMIN 25 % 2

FLEXBUMIN 5 % 2

HELIXATE FS 2

HEMOFIL M HIGH 2

HEMOFIL M LOW 2

HEMOFIL M MID 2

HEMOFIL M SUPER HIGH 2

hetastarch 6 % in 0.9 % nacl 1

HEXTEND 2

HUMATE-P 2

IDELVION 2

IXINITY 2

KCENTRA INTRAVENOUS KIT 2

KEDBUMIN 2

KOATE-DVI INTRAVENOUS RECON SOLN 2

KOGENATE FS 2

LMD 10 % IN 0.9 % SODIUM CHLOR 2

LMD 10 % IN 5 % DEXTROSE 2

47

Drug Name Tier NotesMONOCLATE-P INTRAVENOUS RECON SOLN 1,000 (+/-) UNIT

2

MONONINE 2

NOVOEIGHT 2

NOVOSEVEN RT 2

NUWIQ 2

OBIZUR 2

pentoxifylline 1

PLASBUMIN 25 % 2

PLASBUMIN 5 % 2

PLASMANATE 2

PRAXBIND 2

PROFILNINE 2

protamine 1

RECOMBINATE 2

RECOTHROM 2

RECOTHROM SPRAY KIT 2

RETAVASE INTRAVENOUS KIT 10 UNIT 2

RIASTAP 2

RIXUBIS 2

SOLIRIS 2 PA

TACHOSIL 2

THROMBATE III 2

THROMBIN-JMI 1

TISSEEL VHSD 2

TNKASE 2

tranexamic acid 1

TRETTEN 2

ULTRAFOAM 2

VOLUVEN 6 % 2

XYNTHA 2

XYNTHA SOLOFUSE 2

CARDIAC DRUGSadenosine 1

AFEDITAB CR 1

amiodarone 1

amiodarone in dextrose 5 % intravenous solution 150 mg/100 ml (1.5 mg/ml), 900 mg/500 ml (1.8 mg/ml)

1

amlodipine 1

CARDENE IV IN DEXTROSE 2

CARDENE IV IN SODIUM CHLORIDE 2

cardioplegic soln 1

CARDIZEM LA ORAL TABLET EXTENDED RELEASE 24 HR 120 MG

2

CARTIA XT 1

48

Drug Name Tier NotesCLEVIPREX 2

CORLANOR 2 PA; QL (2 EA per 1 day)

DIGITEK 1

DIGOX 1

digoxin injection solution 1

digoxin oral solution 50 mcg/ml 2

digoxin oral tablet 1

DILATRATE-SR 2

diltiazem hcl intravenous 1

diltiazem hcl oral 1

diltiazem in dextrose 5 % intravenous solution 125 mg/125 ml (1 mg/ml)

1

DILT-XR 1

disopyramide phosphate oral capsule 1

dobutamine 1

dobutamine in d5w intravenous parenteral solution 1,000 mg/250 ml (4,000 mcg/ml), 250 mg/250 ml (1 mg/ml), 500 mg/250 ml (2,000 mcg/ml)

1

felodipine 1

flecainide 1

ibutilide fumarate 1

ISORDIL 2

isosorbide dinitrate oral 1

isosorbide mononitrate 1

isradipine 1

LANOXIN 2

LANOXIN PEDIATRIC 2

lidocaine (pf) intravenous 1

lidocaine in 5 % dextrose (pf) intravenous parenteral solution 4 mg/ml (0.4 %), 8 mg/ml (0.8 %)

1

MATZIM LA 1

mexiletine 1

milrinone 1

milrinone in 5 % dextrose 1

MINITRAN 1

MULTAQ 2

NEXTERONE 2

nicardipine intravenous solution 1

nicardipine oral 1

NIFEDICAL XL 1

nifedipine 1

nimodipine 1

nisoldipine 1

NITRO-BID 2

49

Drug Name Tier NotesNITRO-DUR TRANSDERMAL PATCH 24 HOUR 0.3 MG/HR, 0.8 MG/HR

2

nitroglycerin in 5 % dextrose 1

nitroglycerin intravenous 1

nitroglycerin oral 1

nitroglycerin transdermal patch 24 hour 1

nitroglycerin translingual 1

NITROSTAT 2

NITRO-TIME 1

NORPACE CR 2

NYMALIZE 2 PA

PACERONE ORAL TABLET 100 MG, 200 MG, 400 MG 1

procainamide injection 1

propafenone 1

quinidine gluconate 1

quinidine sulfate oral tablet 1

RANEXA ORAL TABLET EXTENDED RELEASE 12 HR 1,000 MG


RANEXA ORAL TABLET EXTENDED RELEASE 12 HR 500 MG


TAZTIA XT 1

TIKOSYN 2

verapamil 1

XYLOCAINE (CARDIAC) (PF) 1

CARDIOVASCULARacebutolol 1

ADCIRCA 2 PA

ADEMPAS 2 PA

alprostadil 1

ALTOPREV 2 ST; QL (1 EA per 1 day)

amlodipine-atorvastatin 1 QL (1 EA per 1 day)

amlodipine-benazepril 1

amlodipine-valsartan 1 ST

amlodipine-valsartan-hcthiazid 1 ST

ANTARA ORAL CAPSULE 30 MG 2 ST

ANTARA ORAL CAPSULE 90 MG 2 ST-NSO

ASCLERA 2

atenolol 1

atenolol-chlorthalidone 1

atorvastatin 1

AZOR 2 ST

benazepril 1

benazepril-hydrochlorothiazide 1

BENICAR 2 ST

BENICAR HCT 2 ST

50

Drug Name Tier Notesbetaxolol oral 1

BIDIL 2

bisoprolol fumarate 1

bisoprolol-hydrochlorothiazide 1

BREVIBLOC IN NACL (ISO-OSM) 2

BYSTOLIC 2

candesartan 1

candesartan-hydrochlorothiazid 1

captopril 1

captopril-hydrochlorothiazide 1

CARDURA XL 2

carvedilol 1

CATAPRES ORAL TABLET 0.1 MG, 0.2 MG 2 PA; QL (10 EA per 1 day)

CATAPRES ORAL TABLET 0.3 MG 2 PA; QL (8 EA per 1 day)

CATAPRES-TTS-1 2 PA

CATAPRES-TTS-2 2 PA

CATAPRES-TTS-3 2 PA

cholestyramine (with sugar) 1

CHOLESTYRAMINE LIGHT 1

clonidine 1

clonidine hcl oral tablet 0.1 mg, 0.2 mg 1 QL (10 EA per 1 day)

clonidine hcl oral tablet 0.3 mg 1 QL (8 EA per 1 day)

CLORPRES 1

COLESTID FLAVORED ORAL PACKET 2

colestipol 1

COREG CR 2

CORLOPAM 2

CRESTOR 2 PA; ST; QL (1 EA per 1 day)

DEMSER 2

doxazosin 1

DUTOPROL 2

EDARBI 2 ST

EDARBYCLOR 2 ST

enalapril maleate 1

enalaprilat intravenous solution 1

enalapril-hydrochlorothiazide 1

ENTRESTO 2 PA

EPANED 2 ST; QL (1200 ML per 30 days)

ephedrine sulfate injection solution 1

epoprostenol (glycine) 1 PA

eprosartan 1 ST

ergoloid 1 QL (3 EA per 1 day)

esmolol intravenous solution 1

fenofibrate 1

51

Drug Name Tier Notesfenofibrate micronized 1

fenofibrate nanocrystallized 1

fenofibric acid 1

fenofibric acid (choline) 1

fluvastatin oral capsule 1 ST; QL (2 EA per 1 day)

fluvastatin oral tablet extended release 24 hr 1 ST; QL (1 EA per 1 day)

fosinopril 1

fosinopril-hydrochlorothiazide 1

gemfibrozil oral 1

guanfacine oral tablet 1

HEMANGEOL 2 ST; QL (360 ML per 30 days)

hydralazine 1

INDERAL LA 2

INDERAL XL 2

indomethacin sodium 1

INNOPRAN XL 2

irbesartan 1

irbesartan-hydrochlorothiazide 1

isoxsuprine oral tablet 10 mg 2

JUXTAPID ORAL CAPSULE 10 MG, 5 MG 2 PA; QL (1 EA per 1 day)

JUXTAPID ORAL CAPSULE 20 MG 2 PA; QL (3 EA per 1 day)

JUXTAPID ORAL CAPSULE 30 MG, 40 MG, 60 MG 2 PA

KYNAMRO 2 PA

labetalol intravenous solution 1

labetalol intravenous syringe 20 mg/4 ml (5 mg/ml) 1

labetalol oral 1

LETAIRIS 2 PA

lisinopril 1

lisinopril-hydrochlorothiazide 1

LIVALO 2 ST; QL (1 EA per 1 day)

losartan 1

losartan-hydrochlorothiazide 1

lovastatin 1

methyldopa 1

methyldopa-hydrochlorothiazide 1

methyldopate 1

metoprolol succinate 1

metoprolol ta-hydrochlorothiaz 1

metoprolol tartrate intravenous 1

metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg 1

MINIPRESS 2

minoxidil oral 1

moexipril 1

moexipril-hydrochlorothiazide 1

52

Drug Name Tier Notesnadolol 1

nadolol-bendroflumethiazide 1

NATRECOR 2

NEOPROFEN (IBUPROFEN LYSN)(PF) 2

niacin oral tablet extended release 24 hr 1 ST

NIACOR 1

NITROPRESS 2

OPSUMIT 2 PA

ORENITRAM 2 PA

papaverine injection solution 1

perindopril erbumine 1

phenylephrine hcl in 0.9% nacl intravenous solution 50 mg/250 ml (200 mcg/ml)

1

phenylephrine hcl in 0.9% nacl intravenous syringe 1 mg/10 ml (100 mcg/ml)

1

phenylephrine hcl injection 1

pindolol 1

PRALUENT PEN 2 PA

PRALUENT SYRINGE 2 PA

pravastatin 1

prazosin oral 1

PRESTALIA 2 PA; ST; QL (1 EA per 1 day)

PREVALITE 1

propranolol 1

propranolol-hydrochlorothiazid 1

PROSTIN VR PEDIATRIC 2

quinapril 1

quinapril-hydrochlorothiazide 1

ramipril 1

REMODULIN 2 PA

REPATHA SURECLICK 2 PA

REPATHA SYRINGE 2 PA

reserpine 1

REVATIO ORAL SUSPENSION FOR RECONSTITUTION


rosuvastatin 1 ST

sildenafil intravenous 1

sildenafil oral 1 QL (3 EA per 1 day)

simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg 1

simvastatin oral tablet 80 mg 1 ST

SORINE 1

SOTALOL AF 1

sotalol intravenous 2

sotalol oral 1

53

Drug Name Tier NotesSOTRADECOL INTRAVENOUS SOLUTION 1 % (10 MG/ML)

2

SOTRADECOL INTRAVENOUS SOLUTION 3 % (30 MG/ML)

1

SOTYLIZE 2 ST; QL (2000 ML per 30 days)

TEKAMLO ORAL TABLET 150-10 MG, 150-5 MG 2 PA

TEKTURNA 2 PA

TEKTURNA HCT 2 PA

telmisartan 1

telmisartan-amlodipine 1

telmisartan-hydrochlorothiazid 1

terazosin 1

timolol maleate oral 1

TRACLEER 2 PA

trandolapril 1

trandolapril-verapamil 1

TRIBENZOR 2 ST

TRIGLIDE ORAL TABLET 160 MG 2 ST

TYVASO 2 PA

TYVASO INSTITUTIONAL START KIT 2 PA

TYVASO REFILL KIT 2 PA

TYVASO STARTER KIT 2 PA

UPTRAVI 2 PA

valsartan 1

valsartan-hydrochlorothiazide 1

VECAMYL 2 PA

VELETRI 2 PA

VENTAVIS 2 PA

VYTORIN 10-10 2 ST; QL (1 EA per 1 day)




WELCHOL 2

ZETIA 2 QL (1 EA per 1 day)

CNS DRUGSALERTNESS AID 1

ammonia aromatic inhalation solution 1

AMPYRA 2 PA

APTIOM ORAL TABLET 200 MG, 400 MG 2 ST; QL (1 EA per 1 day)

APTIOM ORAL TABLET 600 MG, 800 MG 2 ST; QL (2 EA per 1 day)

AUBAGIO 2 PA

AVONEX (WITH ALBUMIN) 2 PA

AVONEX INTRAMUSCULAR PEN INJECTOR KIT 2 PA

AVONEX INTRAMUSCULAR SYRINGE KIT 2 PA

54

Drug Name Tier NotesBANZEL ORAL SUSPENSION 2 ST; QL (80 ML per 1 day)

BANZEL ORAL TABLET 200 MG 2 ST; QL (16 EA per 1 day)

BANZEL ORAL TABLET 400 MG 2 ST; QL (8 EA per 1 day)

BETASERON SUBCUTANEOUS KIT 2 PA

caffeine citrated intravenous 1

caffeine citrated oral 1

caffeine-sodium benzoate 1

carbamazepine oral capsule, er multiphase 12 hr 1

carbamazepine oral suspension 100 mg/5 ml 1

carbamazepine oral tablet 1

carbamazepine oral tablet extended release 12 hr 200 mg, 400 mg

1

carbamazepine oral tablet,chewable 1

CARBATROL 2

CELONTIN ORAL CAPSULE 300 MG 2

CEREBYX 2

clonazepam 1 QL (3 EA per 1 day)

COPAXONE SUBCUTANEOUS SYRINGE 40 MG/ML 2 PA

DEHYDRATED ALCOHOL 2

DEPACON 2

DEPAKENE 2

DEPAKOTE 2

DEPAKOTE ER 2

DEPAKOTE SPRINKLES 2

DIASTAT 2 QL (1 EA per 1 PER FILL)

DIASTAT ACUDIAL 2 QL (1 EA per 1 PER FILL)

diazepam rectal 1 QL (1 EA per 1 PER FILL)

DILANTIN 2

DILANTIN EXTENDED 2

DILANTIN INFATABS 2

DILANTIN-125 2

divalproex 1

EPITOL 1

ethanol (ethyl alcohol) 1

ethosuximide 1

EXTAVIA 2 PA

felbamate 1

FELBATOL ORAL SUSPENSION 2 ST; QL (30 ML per 1 day)

FELBATOL ORAL TABLET 400 MG 2 ST; QL (9 EA per 1 day)

FELBATOL ORAL TABLET 600 MG 2 ST; QL (6 EA per 1 day)

fosphenytoin 1

FYCOMPA ORAL TABLET 10 MG, 12 MG, 8 MG 2 QL (30 EA per 30 days)

FYCOMPA ORAL TABLET 2 MG 2 QL (120 EA per 30 days)

FYCOMPA ORAL TABLET 4 MG, 6 MG 2 QL (60 EA per 30 days)

55

Drug Name Tier Notesgabapentin oral capsule 1

gabapentin oral solution 1

gabapentin oral tablet 600 mg, 800 mg 1

GABITRIL ORAL TABLET 12 MG, 2 MG, 4 MG 2 QL (4 EA per 1 day)

GABITRIL ORAL TABLET 16 MG 2 QL (3 EA per 1 day)

GILENYA 2 PA

GLATOPA 1 PA

GRALISE 2 ST; QL (3 EA per 1 day)

GRALISE 30-DAY STARTER PACK 2 ST; QL (39 EA per 15 days)

HORIZANT ORAL TABLET EXTENDED RELEASE 300 MG

2 ST; QL (30 EA per 30 days)

HORIZANT ORAL TABLET EXTENDED RELEASE 600 MG


KEPPRA 2

KEPPRA XR 2

KLONOPIN 2 PA; QL (3 EA per 1 day)

LAMICTAL ODT 2

LAMICTAL ODT STARTER (BLUE) 2

LAMICTAL ODT STARTER (GREEN) 2

LAMICTAL ODT STARTER (ORANGE) 2

LAMICTAL ORAL TABLET 2

LAMICTAL ORAL TABLET, CHEWABLE DISPERSIBLE 25 MG, 5 MG

2

LAMICTAL STARTER (BLUE) KIT 2

LAMICTAL STARTER (GREEN) KIT 2

LAMICTAL STARTER (ORANGE) KIT 2

LAMICTAL XR 2

LAMICTAL XR STARTER (BLUE) 2

LAMICTAL XR STARTER (GREEN) 2

LAMICTAL XR STARTER (ORANGE) 2

lamotrigine oral tablet 1

lamotrigine oral tablet disintegrating, dose pk 1

lamotrigine oral tablet extended release 24hr 1

lamotrigine oral tablet, chewable dispersible 1

lamotrigine oral tablet,disintegrating 1

lamotrigine oral tablets,dose pack 25 mg (35) 1

LEMTRADA 2

levetiracetam 1

levetiracetam in nacl (iso-os) 1

LYRICA 2

memantine oral solution 1 QL (300 ML per 30 days)

memantine oral tablet 1 QL (60 EA per 30 days)

memantine oral tablets,dose pack 1 QL (2 EA per 1 day)

MYSOLINE 2

NAMENDA ORAL SOLUTION 2 PA; QL (10 ML per 1 day)

56

Drug Name Tier NotesNAMENDA ORAL TABLET 2 PA; QL (2 EA per 1 day)

NAMENDA TITRATION PAK 2 PA; QL (2 EA per 1 day)

NAMENDA XR ORAL CAP,SPRINKLE,ER 24HR DOSE PACK


NAMENDA XR ORAL CAPSULE,SPRINKLE,ER 24HR 2 QL (30 EA per 30 days)

NAMZARIC ORAL CAPSULE,SPRINKLE,ER 24HR 2 QL (1 EA per 1 day)

NEURONTIN 2

NO DOZ 1

NUEDEXTA 2 PA

ONFI ORAL SUSPENSION 2.5 MG/ML 2 QL (480 ML per 30 days)

ONFI ORAL SUSPENSION 2.5 MG/ML 2 QL (960 ML per 30 days)

ONFI ORAL TABLET 10 MG 2 QL (8 EA per 1 day)

ONFI ORAL TABLET 10 MG, 20 MG 2 QL (2 EA per 1 day)

ONFI ORAL TABLET 20 MG 2 QL (4 EA per 1 day)

oxcarbazepine 1

OXTELLAR XR 2

PEGANONE 2

PHENYTEK 2

phenytoin oral suspension 1

phenytoin oral tablet,chewable 1

phenytoin sodium 1

phenytoin sodium extended 1

PLEGRIDY 2 PA

POTIGA ORAL TABLET 200 MG, 300 MG, 400 MG 2 ST; QL (3 EA per 1 day)

POTIGA ORAL TABLET 50 MG 2 ST; QL (9 EA per 1 day)

primidone 1

QUDEXY XR 2 QL (2 EA per 1 day)

REBIF (WITH ALBUMIN) 2 PA

REBIF REBIDOSE 2 PA

REBIF TITRATION PACK 2 PA

riluzole 1

SABRIL 2 QL (6 EA per 1 day)

STAY AWAKE 1

STAY AWAKE MAXIMUM STRENGTH 1

TECFIDERA 2 PA

TEGRETOL ORAL SUSPENSION 2

TEGRETOL ORAL TABLET 2

TEGRETOL XR 2

tetrabenazine 1

tiagabine 1 QL (4 EA per 1 day)

TOPAMAX 2

topiramate oral capsule, sprinkle 1

topiramate oral capsule,sprinkle,er 24hr 1 QL (2 EA per 1 day)

topiramate oral tablet 1

57

Drug Name Tier NotesTRILEPTAL 2

TROKENDI XR 2 QL (2 EA per 1 day)

valproate sodium 1

valproic acid 1

valproic acid (as sodium salt) oral solution 1

VIMPAT INTRAVENOUS 2

VIMPAT ORAL SOLUTION 2 ST; QL (40 ML per 1 day)

VIMPAT ORAL TABLET 2 ST; QL (2 EA per 1 day)

XENAZINE 2 PA

ZARONTIN 2

ZONEGRAN ORAL CAPSULE 100 MG, 25 MG 2

zonisamide 1

COLONY STIMULATING FACTORSARANESP (IN POLYSORBATE) 2 PA

EPOGEN INJECTION SOLUTION 10,000 UNIT/ML, 2,000 UNIT/ML, 20,000 UNIT/2 ML, 20,000 UNIT/ML, 3,000 UNIT/ML, 4,000 UNIT/ML

2 PA

GRANIX 2 PA

LEUKINE INJECTION RECON SOLN 2 PA

MIRCERA 2 PA

MOZOBIL 2

NEULASTA SUBCUTANEOUS SYRINGE 2 PA

NEULASTA SUBCUTANEOUS SYRINGE, W/ WEARABLE INJECTOR

2

NEUPOGEN 2 PA

NPLATE 2

PROCRIT 2 PA

PROMACTA 2 PA; QL (1 EA per 1 day)

ZARXIO 2 PA

CONTRACEPTIVESALTAVERA (28) 3

ALYACEN 1/35 (28) 3

ALYACEN 7/7/7 (28) 3

AMETHIA 3 QL (91 EA per 84 days)

AMETHIA LO 3 QL (91 EA per 84 days)

APRI 3

ARANELLE (28) 3

ASHLYNA 3 QL (91 EA per 84 days)

AUBRA 3

AVIANE 3

AZURETTE (28) 3

BALZIVA (28) 3

BEKYREE (28) 3

BEYAZ 2 ST

58

Drug Name Tier NotesBLISOVI 24 FE 3

BLISOVI FE 1.5/30 (28) 3

BLISOVI FE 1/20 (28) 3

BREVICON (28) 3

BRIELLYN 3

CAMILA 3

CAMRESE 3 QL (91 EA per 84 days)

CAMRESE LO 3 QL (91 EA per 84 days)

CAYA CONTOURED 3

CAZIANT (28) 3

CHATEAL 3

CRYSELLE (28) 3

CYCLAFEM 1/35 (28) 3

CYCLAFEM 7/7/7 (28) 3

CYRED 3

DASETTA 1/35 (28) 3

DASETTA 7/7/7 (28) 3

DAYSEE 3 QL (91 EA per 84 days)

DEBLITANE 3

DELYLA (28) 3

DEPO-SUBQ PROVERA 104 2 QL (0.65 ML per 84 days)

desog-e.estradiol/e.estradiol 3

desogestrel-ethinyl estradiol 3

drospirenone-ethinyl estradiol 3 ST

ECONTRA EZ 3

ELINEST 3

ELLA 2

EMOQUETTE 3

ENPRESSE 3

ENSKYCE 3

ERRIN 3

ESTARYLLA 3

FALLBACK SOLO 3

FALMINA (28) 3

GIANVI (28) 3 ST

GILDAGIA 3

GILDESS 1.5/30 (21) 3

GILDESS 1/20 (21) 3

GILDESS 24 FE 3

GILDESS FE 1.5/30 (28) 3

GILDESS FE 1/20 (28) 3

HEATHER 3

INTROVALE 3 QL (91 EA per 84 days)

JENCYCLA 3

59

Drug Name Tier NotesJOLESSA 3 QL (91 EA per 84 days)

JOLIVETTE 3

JULEBER 3

JUNEL 1.5/30 (21) 3

JUNEL 1/20 (21) 3

JUNEL FE 1.5/30 (28) 3

JUNEL FE 1/20 (28) 3

JUNEL FE 24 3

KAITLIB FE 1

KARIVA (28) 3

KELNOR 1/35 (28) 3

KIMIDESS (28) 3

KURVELO 3

l norgest/e.estradiol-e.estrad 3 QL (91 EA per 84 days)

LARIN 1.5/30 (21) 3

LARIN 1/20 (21) 3

LARIN 24 FE 3

LARIN FE 1.5/30 (28) 3

LARIN FE 1/20 (28) 3

LAYOLIS FE 1

LEENA 28 3

LESSINA 3

LEVONEST (28) 3

levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg, 0.15-0.03 mg

3

levonorgestrel-ethinyl estrad oral tablet 90-20 mcg 1

levonorgestrel-ethinyl estrad oral tablets,dose pack,3 month 3 QL (91 EA per 84 days)

levonorg-eth estrad triphasic 3

LEVORA-28 3

LO LOESTRIN FE 2 ST

LOMEDIA 24 FE 3

LORYNA (28) 3 ST

LOW-OGESTREL (28) 3

LUTERA (28) 3

LYZA 3

MARLISSA 3

medroxyprogesterone intramuscular 1 QL (1 ML per 84 days)

MICROGESTIN 1.5/30 (21) 3

MICROGESTIN 1/20 (21) 3

MICROGESTIN FE 1.5/30 (28) 3

MICROGESTIN FE 1/20 (28) 3

MINASTRIN 24 FE 2

MONO-LINYAH 3

MONONESSA (28) 3

60

Drug Name Tier NotesMY WAY 3

MYZILRA 3

NATAZIA 2 ST

NECON 0.5/35 (28) 3

NECON 1/35 (28) 3

NECON 1/50 (28) 3

NECON 10/11 (28) 3

NECON 7/7/7 (28) 3

NEXPLANON 2

NEXT CHOICE ONE DOSE 3

NIKKI (28) 3 ST

NORA-BE 3

noreth-ethinyl estradiol-iron oral tablet,chewable 0.8mg-25mcg(24) and 75 mg (4)

1

norethindrone (contraceptive) 3

norethindrone ac-eth estradiol oral tablet 1-20 mg-mcg 3

norethindrone-e.estradiol-iron 3

norgestimate-ethinyl estradiol oral tablet 0.18/0.215/0.25 mg-25 mcg

1

norgestimate-ethinyl estradiol oral tablet 0.18/0.215/0.25 mg-35 mcg (28), 0.25-35 mg-mcg

3

NORINYL 1+35 (28) 3

NORLYROC 3

NORTREL 0.5/35 (28) 3

NORTREL 1/35 (21) 3

NORTREL 1/35 (28) 3

NORTREL 7/7/7 (28) 3

NUVARING 2 ST; QL (1 EA per 28 days)

OCELLA 3 ST

OGESTREL (28) 3

OPCICON ONE-STEP 3

ORSYTHIA 3

PARAGARD T 380A 2

PHILITH 3

PIMTREA (28) 3

PIRMELLA 3

PORTIA 3

PREVIFEM 3

QUARTETTE 2

QUASENSE 3 QL (91 EA per 84 days)

RECLIPSEN (28) 3

SAFYRAL 2 ST

SETLAKIN 3 QL (91 EA per 84 days)

SHAROBEL 3

SPRINTEC (28) 3

61

Drug Name Tier NotesSRONYX 3

SYEDA 3 ST

TARINA FE 1/20 (28) 3

TILIA FE 3

TRI-ESTARYLLA 3

TRI-LEGEST FE 3

TRI-LINYAH 3

TRI-LO-ESTARYLLA 1

TRI-LO-MARZIA 1

TRI-LO-SPRINTEC 1

TRINESSA (28) 3

TRINESSA LO 1

TRI-PREVIFEM (28) 3

TRI-SPRINTEC (28) 3

TRIVORA (28) 3

VELIVET TRIPHASIC REGIMEN (28) 3

VESTURA (28) 3 ST

VIENVA 3

VIORELE (28) 3

VYFEMLA (28) 3

WERA (28) 3

WIDE-SEAL DIAPHRAGM 60 3








WYMZYA FE 3

XULANE 1 QL (3 EA per 28 days)

ZARAH 3 ST

ZENCHENT (28) 3

ZENCHENT FE 3

ZOVIA 1/35E (28) 3

ZOVIA 1/50E (28) 3

COUGH/COLD PREPARATIONS12 HOUR DECONGESTANT 1

ADULT TUSSIN CHEST CONGESTION 1

ADULT TUSSIN COUGH CONGEST DM 1

ADULT TUSSIN DM 1

ADULT TUSSIN MULTI-SYMP COLD 1

ALLERGY AND COLD PE 1

ALLERGY MULTI-SYMPTOM 1

62

Drug Name Tier NotesALLERGY SINUS HEADACHE (PE) 1

ALL-NITE COLD-FLU 1

AP-HIST DM 1

AQUANAZ 2

benzonatate 1

BROMFED DM 1

brompheniramine-pseudoeph-dm oral syrup 1

BROTAPP DM 1

CAPCOF 2

CAPMIST DM 2

CAPRON DM 2

CHERATUSSIN AC 1

CHERATUSSIN DAC 1

CHEST CONGESTION RELIEF 1

CHEST CONGESTION RELIEF + DM 1

CHEST CONGESTION RELIEF PE 1

CHEST CONGESTION-COUGH RELIEF 1

CHEST-SINUS CONGESTION RELIEF 1

CHILD DELSYM COUGH+CHEST DM 1

CHILD DELSYM COUGH+COLD 2

CHILD MUCINEX CHEST CONGESTION 1

CHILD MUCINEX M-S COLD DAY-NTE 2

CHILD MUCINEX STUFFY NOSE-COLD 2

CHILD MUCUS RELIEF COUGH 1

CHILD MUCUS RELIEF EXPECTORANT 1

CHILD PLUS COUGH AND RUNNYNOSE 1

CHILD TRIAMINIC COUGH-CONGEST 1

CHILD TRIAMINIC COUGH-SORE THR 1

CHILD TRIAMINIC MS FEVER-COLD 1

CHILDREN'S COLD AND COUGH (PE) 1

CHILDREN'S COLD AND COUGH DM 1

CHILDREN'S MUCINEX COUGH 1

CHILDREN'S MUCINEX NIGHT TIME 2

CHILDRENS PLUS MULTI-SYMP COLD 1

CHILDREN'S SILFEDRINE 1

CHLO HIST 2

CHLO TUSS 2

codeine-guaifenesin 1

COLD AND COUGH DM 1

COLD AND COUGH ELIXIR 1

COLD AND FLU SEVERE 1

COLD HEAD CONGESTION DAY/NITE 1

COLD HEAD CONGESTION DAYTIME 1

COLD HEAD CONGESTION NIGHTTIME 1

63

Drug Name Tier NotesCOLD HEAD CONGESTION SEVER DAY 1

COLD MULTI-SYMPTOM 1

COLD MULTI-SYMPTOM (CHLORPHEN) 1

COLD MULTI-SYMPTOM DAY/NIGHT 1

COLD RELIEF PLUS 1

COLD SEVERE CONGESTION 1

COLD-SINUS RELIEF 1

CONGESTAC 1

COUGH AND COLD BP 1

COUGH AND COLD ORAL TABLET 1

COUGH CONTROL (DEXTROMETHORPH) 1

COUGH CONTROL (GUAIFENESIN) 1

COUGH CONTROL CF (PE) 1

COUGH CONTROL DM 1

COUGH DM ER 1

COUGH DROPS MUCOUS MEMBRANE LOZENGE 5.4 MG, 5.8 MG

1

COUGH RELIEF ORAL LIQUID 1

COUGH SUPPRESSANT-EXPECTORANT 1

COUGH SYRUP 1

COUGH SYRUP DM 1

COUGH-SORE THROAT NIGHT 1

COUGHTAB 1

COUGHTAB 400 1

DAY TIME PE 1

DAYTIME 1

DAYTIME COLD-FLU 1

DAYTIME COLD-FLU RELIEF (PE) 1

DAY-TIME COUGH 1

DAYTIME SINUS 1

DAYTIME-NIGHTTIME 1

DELSYM COUGH-CHEST CONGEST DM 1

DELSYM COUGH-COLD DAYTIME 2

DELSYM COUGH-COLD NIGHTTIME 2

dextromethorphan polistirex 1

dextromethorphan-guaifenesin oral syrup 1

DIABETIC SILTUSSIN DAS-NA 1

DIABETIC SILTUSSIN-DM 1

DIABETIC SILTUSSIN-DM MAX STR 1

DIMAPHEN DM 1

DONATUSSIN 2

DURAFLU 2

DURAVENT DM 2

DURAVENT PE 2

64

Drug Name Tier NotesED A-HIST DM 1

ED BRON GP 1

ENDACOF - DM 1

ENTRE-COUGH 1

FLOWTUSS 2 ST; QL (600 ML per 10 days)

FLU-SEVERE COLD-COUGH DAYTIME 1

FLU-SEVERE COLD-COUGH NIGHT 1

GUAIFENESIN AC 1

GUAIFENESIN DAC 1

guaifenesin oral liquid 1

guaifenesin oral tablet 200 mg 1

guaifenesin oral tablet extended release 12hr 1

HISTEX DM 2

HISTEX-AC 2

HYCOFENIX 2 ST; QL (473 ML per 30 days)

hydrocodone-chlorpheniramine 1

hydrocodone-cpm-pseudoephed 1

hydrocodone-homatropine oral syrup 5-1.5 mg/5 ml 1

hydrocodone-homatropine oral tablet 1

HYDROMET 1

IBUPROFEN COLD 1

IBUPROFEN COLD-SINUS(WITH PSE) 1

IOPHEN C-NR 1

IOPHEN DM-NR 1

IOPHEN-NR 1

J-MAX 1

KIDKARE COUGH/COLD 1

LOHIST-DM 1

LORTUSS DM 2

LORTUSS EX ORAL SYRUP 1

MAPAP COLD FORMULA 1

MAPAP SINUS MAX STRENGTH (PE) 1

MAR-COF BP 1

MAR-COF CG 1

M-END DMX 2

M-END MAX D 2

M-END PE 2

MUCAPHED 1

MUCINEX COLD,FLU,SORE THROAT 2

MUCINEX COUGH MINI-MELTS 2

MUCINEX D MAXIMUM STRENGTH 2

MUCINEX DM ORAL TABLET, ER MULTIPHASE 12 HR

2

65

Drug Name Tier NotesMUCINEX FAST-MAX COLD-FLU-THRT ORAL CAPSULE

2

MUCINEX FAST-MAX COLD-FLU-THRT ORAL POWDER IN PACKET

2

MUCINEX FAST-MAX COLD-FLU-THRT ORAL TABLET

1

MUCINEX FAST-MAX COLD-SINUS 1

MUCINEX FAST-MAX CONGEST-COUGH ORAL TABLET

1

MUCINEX FAST-MAX DAY-NITE CONG 2

MUCINEX FAST-MAX DAY-NT(DOXYL) 2

MUCINEX FAST-MAX DM MAX 1

MUCINEX FAST-MAX NITE (DOXYL) 1

MUCINEX FAST-MAX NITE COLD-FLU ORAL LIQUID

2

MUCINEX FAST-MAX SEVERE COLD ORAL LIQUID 2

MUCINEX FAST-MAX SEVERE COLD ORAL TABLET 1

MUCINEX FST-MX DY-NT COLD(DPH) 2

MUCINEX MINI-MELTS ORAL GRANULES IN PACKET 100 MG

2

MUCINEX SINUS-MAX D-N (DIPHEN) ORAL TABLETS, SEQUENTIAL

2

MUCINEX SINUS-MAX PRESSUR-PAIN ORAL TABLET

1

MUCINEX SINUS-MAX SEV CONGESTN ORAL TABLET

1

MUCOSA 1

MUCOSA DM 1

MUCUS RELIEF 1

MUCUS RELIEF COLD AND SINUS ORAL TABLET 1

MUCUS RELIEF COLD-FLU-SORE THR ORAL TABLET

1

MUCUS RELIEF COUGH 1

MUCUS RELIEF DM 1

MUCUS RELIEF DM MAX 1

MUCUS RELIEF ER ORAL TABLET EXTENDED RELEASE 12HR 600 MG

1

MUCUS RELIEF PE 1

MUCUS RELIEF SEV CONGEST-COLD 1

MUCUS RELIEF SINUS 1

MUCUS-ER MAX 1

MULTI-SYMPTOM COLD (PE) 1

MULTI-SYMPTOM COLD NIGHT TIME 1

NASAL DECONGESTANT (PE) ORAL TABLET 10 MG 1

NASAL DECONGESTANT (PSEUDOEPH) ORAL LIQUID

1

NASAL DECONGESTANT (PSEUDOEPH) ORAL TABLET

1

66

Drug Name Tier NotesNASAL DECONGESTANT (PSEUDOEPH) ORAL TABLET EXTENDED RELEASE

1

NIGHT TIME COLD AND FLU RELIEF 1

NIGHT TIME COLD-FLU ORAL LIQUID 1

NIGHT TIME ORAL CAPSULE 6.25-15-325 MG 1

NIGHTTIME COLD-FLU 1

NIGHTTIME COLD-FLU RELIEF 1

NIGHTTIME COUGH 1

NINJACOF 2

NINJACOF-A 2

NINJACOF-XG 1

NITE TIME 1

NITE TIME COLD-FLU 1

NITE TIME COLD-FLU RELIEF 1

NITE TIME COUGH 1

NITE TIME-D COLD-FLU RELIEF 1

NITE-TIME COLD-FLU 1

NIVA-HIST DM 1

NIVANEX DMX 1

NOHIST-DM 1

NOREL AD 2

ORGAN-I NR 1

PAIN RELIEF ALLERGY SINUS 1

PAIN RELIEF COLD AND COUGH 1

PAIN RELIEF SINUS PE 1

PEDIA RELIEF COUGH-COLD 1

PEDIATRIC COUGH AND COLD ORAL LIQUID 1-15-5 MG/5 ML

1

PHENYLHISTINE DH 1

POLY HIST PD 2

POLY-HIST DM (THONZYLAMINE) 2

POLY-TUSSIN AC ORAL LIQUID 4-10-10 MG/5 ML 2

POLY-VENT DM ORAL TABLET 60-20-380 MG 2

POLY-VENT IR ORAL TABLET 60-380 MG 2

PROMETHAZINE VC-CODEINE 1

promethazine-codeine 1

promethazine-dm 1

promethazine-phenyleph-codeine 1

PRO-RED AC (W/ DEXCHLORPHENIR) 2

pseudoephedrine hcl 1

pseudoephedrine-guaifenesin 1

Q-TAPP DM 1

Q-TUSSIN 1

Q-TUSSIN DM 1

67

Drug Name Tier NotesRELCOF C 1

RESCON-DM 2

RESPAIRE-30 2

REZIRA 2

ROBAFEN 1

ROBAFEN CF (PHENYLEPHRINE) 1

ROBAFEN COUGH 1

ROBAFEN DM COUGH 1

ROBAFEN DM COUGH-CHEST CONGEST 1

RYDEX 1

RYNEX DM 1

SEVERE COLD AND FLU (PE) 1

SEVERE COLD PE 1

SILTUSSIN DM DAS 1

SILTUSSIN SA 1

SILTUSSIN-DM 1

SINUS 12 HOUR 1

SINUS AND COLD-D 1

SINUS CONGESTION AND PAIN 1

SINUS CONGESTION-PAIN(CHLORPH) 1

SINUS CONGESTION-PAIN(GUAIF) 1

SINUS CONGEST-PAIN DAY-NIGHT 1

SINUS PAIN RELIEF 1

SORE THROAT AND COUGH 1

SUDOGEST 1

SUDOGEST 12-HOUR 1

SUDOGEST PE 1

SUPHEDRIN 12 HOUR 1

SUPHEDRIN ORAL TABLET 1

SUPHEDRINE 1

SUPHEDRINE 12 HOUR 1

TAB TUSSIN 1

TAB TUSSIN DM 1

THERAFLU EXPRESSMAX COLD DAY 1

THERAFLU EXPRESSMAX COLD NIGHT 2

THERAFLU NIGHT SEVERE COLD-CGH 2

TRIAMINIC CHEST-NASAL CONGEST 2

TRIAMINIC COLD AND COUGH (PE) 1

TUSNEL DIABETIC 1

TUSNEL NEW FORMULA 2

TUSNEL PEDIATRIC ORAL DROPS 2

TUSNEL-DM PEDIATRIC 2

TUSSICAPS 2

TUSSIN 1

68

Drug Name Tier NotesTUSSIN CF (PE-DM-GUAIF) 1

TUSSIN CF COUGH-COLD 1

TUSSIN CF MAX 1

TUSSIN CHEST CONGESTION 1

TUSSIN COUGH (DM ONLY) ORAL LIQUID 1

TUSSIN DM CLEAR 1

TUSSIN DM COUGH AND CHEST ORAL SYRUP 1

TUSSIN DM MAX ORAL LIQUID 10-200 MG/5 ML 1

TUSSIN DM ORAL LIQUID 1

TUSSIN DM ORAL SYRUP 10-100 MG/5 ML 1

TUSSIN DM ORAL TABLET 1

TUSSIN EXPECTORANT 1

VANACOF DM 2

VANACOF-8 2

VICKS DAYQUIL COLD-FLU RELIEF 1

VICKS DAYQUIL COUGH 1

VICKS DAYQUIL MUCUS CONTROL DM 2

VICKS DAYQUIL SEVERE COLD-FLU 1

VICKS NYQUIL COLD/FLU (CPM) 2

VICKS NYQUIL COLD/FLU LIQUICAP 1

VICKS NYQUIL COUGH 2

VICKS NYQUIL SEVERE COLD-FLU ORAL LIQUID 1

VICKS NYQUIL SEVERE COLD-FLU ORAL TABLET 2

VICKS VAPODROPS 2

VIRTUSSIN AC 1

VIRTUSSIN DAC 1

VITUZ 2

Z-TUSS AC 2

DIAGNOSTICABLAVAR 2

ADENOSCAN 2

adenosine (diagnostic) 1

AK-FLUOR 2

ALBUSTIX REAGENT 2

AZO TEST STRIPS 2

CHEMSTRIP 2 2

CHEMSTRIP K 2

CHEMSTRIP MICRAL 2

CHEMSTRIP UGK 2

CYSVIEW 2

DEFINITY 2

DIASTIX 2

dipyridamole intravenous 1

EOVIST 2

69

Drug Name Tier NotesFUL-GLO 2

GADAVIST 2

GLUCAGEN DIAGNOSTIC KIT 2

glucagon hcl 2

IC GREEN 2

INDIGO CARMINE 1

isosulfan blue 1

KETO-DIASTIX 2

KETONE CARE 2

KETONE URINE TEST 2

KETOSTIX 2

LEXISCAN 2

MAGNEVIST 2

NITRATEST PAPER WITH DISPENSER 2

NO-STICK GLUCOSE 2

OMNIPAQUE 140 2

OMNIPAQUE 180 2

OMNIPAQUE 240 2

OMNIPAQUE 300 2

OMNIPAQUE 350 2

OMNISCAN 2

OMNISCAN PREFILL PLUS 2

OPTISON 2

PROSTASCINT 2

REVEAL COLON DISEASE TEST 2

REVEAL UTI TEST STRIP 2

R-GENE 10 2

ULTRAVIST 2

URINARY TRACT INF.TEST (WBCS) 2

VISIPAQUE 2

DIURETICSacetazolamide 1

acetazolamide sodium 1

ALDACTAZIDE ORAL TABLET 50-50 MG 2

amiloride 1

amiloride-hydrochlorothiazide 1

ammonium chloride 1

bumetanide 1

chlorothiazide 1

chlorothiazide sodium 1

chlorthalidone oral tablet 25 mg, 50 mg 1

DIURIL 2

DYRENIUM 2

EDECRIN 2

70

Drug Name Tier Noteseplerenone 1

ethacrynate sodium 1

furosemide injection 1

furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml) 1

furosemide oral tablet 1

hydrochlorothiazide 1

indapamide 1

mannitol 10 % 1

mannitol 20 % 1

mannitol 25 % intravenous solution 1

mannitol 5 % 1

methazolamide oral 1

methyclothiazide 1

metolazone 1

OSMITROL 15 % 2

RESECTISOL 2

SAMSCA ORAL TABLET 15 MG 2 QL (30 EA per 365 days)

SAMSCA ORAL TABLET 30 MG 2 QL (60 EA per 365 days)

spironolactone 1

spironolacton-hydrochlorothiaz 1

torsemide oral 1

triamterene-hydrochlorothiazid 1

VAPRISOL 2

EENT PREPS12 HOUR NASAL SPRAY 1

24 HOUR ALLERGY RELIEF 1 QL (16 ML per 30 days)

ACETASOL HC 1

acetic acid otic 1

acetic acid-aluminum acetate 1

ACUVAIL (PF) 2

ADVANCED FORMULA EYE DROPS 1

AKTEN (PF) 2

AKWA TEARS (POLYVINYL ALCOHOL) 1

ALCAINE 1

ALOCRIL 2

ALOMIDE 2

ALPHAGAN P OPHTHALMIC DROPS 0.1 % 2

ALREX 2

apraclonidine 1

ARTIFICIAL TEARS (PETRO/MIN) 1

ARTIFICIAL TEARS (POLYVIN ALC) 1

ARTIFICIAL TEARS(PVALCH-POVID) 1

atropine ophthalmic 1

azelastine nasal 1 QL (60 ML per 30 days)

71

Drug Name Tier NotesAZOPT 2

BALANCED SALT 1

BECONASE AQ 2 ST; QL (25 GM per 30 days)

BENZEDREX 2

BETADINE OPHTHALMIC PREP 2

betaxolol ophthalmic 1

BETIMOL 2

BETOPTIC S 2

bimatoprost ophthalmic 1 QL (1 ML per 12 days)

BION TEARS (PF) 1

brimonidine 1

bromfenac 1

BSS PLUS 2

budesonide nasal 1 ST; QL (43 GM per 75 days)

carteolol 1

CLEANSING EYELID 2

COMBIGAN 2

COSOPT (PF) 2 ST; QL (2 EA per 1 day)

cromolyn ophthalmic 1

CYCLOMYDRIL 2

cyclopentolate 1

CYSTARAN 2 PA

dexamethasone sodium phosphate ophthalmic 1

diclofenac sodium ophthalmic 1

dorzolamide 1

dorzolamide-timolol 1

DUREZOL 2

DYMISTA 2 ST; QL (23 GM per 30 days)

EAR DROPS (CARBAMIDE PEROXIDE) 1

EAR WAX REMOVAL DROPS 1

EAR WAX REMOVAL KIT 1

EAR WAX REMOVAL SYSTEM OTIC DROPS 1

EAR WAX TREATMENT 1

EYE DROPS (TETRAHYDROZOLINE) 1

EYE DROPS ADVANCED RELIEF 1

EYE DROPS ALLERGY RELIEF 1

EYE IRRIGATING SOLUTION 1

EYE STREAM 1

EYE WASH OPHTHALMIC IRRIGATION SOLUTION 1

EYELID WIPES 2

EYLEA 2

FLAREX 2

flunisolide nasal spray,non-aerosol 25 mcg (0.025 %) 1 QL (25 ML per 30 days)

fluocinolone acetonide oil 1

72

Drug Name Tier Notesfluorometholone 1

flurbiprofen sodium 1

fluticasone nasal 1 QL (16 GM per 30 days)

FML FORTE 2

FML S.O.P. 2

FRESHKOTE 2

GENTEAL GEL 2

GENTEAL MILD 2

GENTEAL SEVERE 2

GONAK 1

hydrocortisone-acetic acid 1

HYPOTEARS 1

ILEVRO 2

ILUVIEN 2

IOPIDINE OPHTHALMIC DROPPERETTE 2

ipratropium bromide nasal 1

ISOPTO TEARS 1

ISTALOL 2

JETREA (PF) 2

ketorolac ophthalmic 1

LACRISERT 2

latanoprost 1

levobunolol ophthalmic drops 0.5 % 1

LIQUITEARS 1

LOTEMAX 2

LUBRICANT EYE (CMC-GLYCERIN) 1

LUBRICANT EYE (PG-PEG 400) 1

LUBRICANT EYE DROPS OPHTHALMIC DROPS 1

LUBRICANT EYE OPHTHALMIC OINTMENT 57.3-42.5 %

1

LUBRICATING PLUS 1

LUBRIFRESH PM 1

LUCENTIS 2

LUMIGAN OPHTHALMIC DROPS 0.01 % 2 QL (1 ML per 12 days)

MACUGEN 2

MAXIDEX 2

metipranolol 1

MIOCHOL-E 2

MIOSTAT 2

MUCINEX SINUS-MAX 1

MURO 128 1

NASAL ALLERGY 1

NASAL DECONGESTANT (OXYMETAZL) 1

NASAL FOUR 1

73

Drug Name Tier NotesNASAL SPRAY (OXYMETAZOLINE) 1

NASAL SPRAY 12 HOUR 1

NASAL SPRAY EXTRA MOISTURIZING 1

NASAL SPRAY LONG ACTING 1

NASAL SPRAY SINUS 1

NASONEX 2 QL (17 GM per 30 days)

NATURAL BALANCE TEARS 1

NATURE'S TEARS 1

NEVANAC 2

NO DRIP 1

NOSE DROPS 1

NOSE DROPS EXTRA STRENGTH 1

NRS NASAL RELIEF 1

olopatadine nasal 1 ST; QL (30.5 GM per 30 days)

OMIDRIA 2

OMNARIS 2 ST; QL (5 GM per 12 days)

OPTI-CLEAR 1

ORIGINAL NASAL SPRAY 1

OZURDEX 2

PAREMYD 2

phenylephrine hcl ophthalmic 1

PHOSPHOLINE IODIDE 2

pilocarpine hcl ophthalmic drops 1 %, 2 %, 4 % 1

PRED MILD 2

prednisolone acetate 1

prednisolone sodium phosphate ophthalmic 1

PROLENSA 2

proparacaine 1

PURALUBE 1

QNASL NASAL HFA AEROSOL INHALER 40 MCG/ACTUATION


QNASL NASAL HFA AEROSOL INHALER 80 MCG/ACTUATION


REDNESS RELIEF OPHTHALMIC DROPS 0.012-0.2 % 1

REFRESH CELLUVISC 2

REFRESH CLASSIC (PF) 2

REFRESH LACRI-LUBE 2

REFRESH LIQUIGEL 2

REFRESH OPTIVE ADVANCED 2

REFRESH OPTIVE ADVANCED (PF) 2

REFRESH OPTIVE OPHTHALMIC DROPS,GEL 2

REFRESH OPTIVE SENSITIVE (PF) 2

RESTASIS 2 QL (64 EA per 30 days)

RETISERT 2

74

Drug Name Tier NotesSIMBRINZA 2

SINUS NASAL SPRAY 1

SINUS RELIEF (OXYMETAZOLINE) NASAL MIST 1

SINUS WASH NASAL PACKET 700-2,300 MG 1

sodium chloride ophthalmic 1

STERILE EYE DROPS OPHTHALMIC DROPS 0.05 % 1

SYSTANE BALANCE 2

SYSTANE GEL 2

SYSTANE NIGHTTIME 1

TEARS NATURALE FORTE 2

TEARS NATURALE FREE (PF) 1

TEARS PURE 1

tetracaine hcl 1

tetracaine hcl (pf) ophthalmic 1

tetrahydrozoline ophthalmic 1

timolol maleate ophthalmic 1

TIMOPTIC OCUDOSE (PF) 2 ST; QL (2 EA per 1 day)

TRAVATAN Z 2 QL (1 ML per 12 days)

travoprost (benzalkonium) 1 QL (1 ML per 12 days)

triamcinolone acetonide nasal 1 QL (11 ML per 20 days)

TRIESENCE (PF) 2

tropicamide ophthalmic 1

TYZINE NASAL DROPS 0.05 % 2

ULTRA LUBRICANT EYE 1

VERAMYST 2 ST; QL (10 GM per 30 days)

VEXOL 2

VICKS QLEARQUIL(OXYMETAZOLINE) 1

VICKS SINEX 12-HOUR 1

VICKS SINEX ULTRA FINE MIST 12 1

ZETONNA 2 ST; QL (6.1 GM per 30 days)

ZIOPTAN (PF) 2 ST; QL (1 EA per 1 day)

ELECT/CALORIC/H2Oacetylcarnitine 1

ACTIVE FE 2

ADDAMEL N 1

AMINO ACIDS 15 % 2

AMINOSYN 10 % 2

AMINOSYN 7 % WITH ELECTROLYTES 2

AMINOSYN 8.5 % 2

AMINOSYN 8.5 %-ELECTROLYTES 2

AMINOSYN II 10 % 2

AMINOSYN II 15 % 2

AMINOSYN II 7 % 2

AMINOSYN II 8.5 % 2

75

Drug Name Tier NotesAMINOSYN II 8.5 %-ELECTROLYTES 2

AMINOSYN M 3.5 % 2

AMINOSYN-HBC 7% 2

AMINOSYN-PF 10 % 2

AMINOSYN-PF 7 % (SULFITE-FREE) 2

AMINOSYN-RF 5.2 % 2

AURYXIA 2 QL (12 EA per 1 day)

CALCIUM 600 WITH VITAMIN D3 ORAL CAPSULE 600 MG(1,500MG) -400 UNIT

1

calcium acetate oral capsule 1

calcium acetate oral tablet 667 mg 1

calcium carbonate oral suspension 1

calcium carbonate oral tablet 500 mg calcium (1,250 mg) 1

calcium carbonate-vitamin d3 oral tablet 500 mg(1,250mg) -200 unit, 600 mg(1,500mg) -800 unit

1

calcium chloride intravenous 1

calcium gluconate intravenous 1

calcium gluconate oral tablet 45 mg (500 mg) 1

CALCIUM MAGNESIUM 1

CALCIUM-FOLIC ACID-VITAMIN D 1

CALPHRON 1

CENTRATEX 2

chromium chloride 1

CLINIMIX 5%/D15W SULFITE FREE 2

CLINIMIX 5%/D25W SULFITE-FREE 2

CLINIMIX 2.75%/D5W SULFIT FREE 2

CLINIMIX 4.25%/D10W SULF FREE 2

CLINIMIX 4.25%/D5W SULFIT FREE 2

CLINIMIX 4.25%-D20W SULF-FREE 2

CLINIMIX 4.25%-D25W SULF-FREE 2

CLINIMIX 5%-D20W(SULFITE-FREE) 2

CLINIMIX E 2.75%/D10W SUL FREE 2

CLINIMIX E 2.75%/D5W SULF FREE 2



CLINIMIX E 4.25%/D5W SULF FREE 2

CLINIMIX E 5%/D15W SULFIT FREE 2



CLINISOL SF 15 % 2

COPPER CHLORIDE 1

CORVITA 150 1

CORVITE 150 ORAL TABLET 150 MG IRON- 1 MG 2

CORVITE FE ORAL TABLET 150 MG IRON- 1 MG 2

76

Drug Name Tier Notescysteine (l-cysteine) intravenous solution 1

CYTRA K CRYSTALS 1

d10 %-0.45 % sodium chloride 1

d2.5 %-0.45 % sodium chloride 1

d5 % and 0.9 % sodium chloride 1

d5 %-0.45 % sodium chloride 1

DELFLEX WITH 2.5 % DEXTROSE 2

DELFLEX-LC/1.5% DEXTROSE 2



DELFLEX-SM WITH 1.5% DEXTROSE 2

DENTA 5000 PLUS 1

DENTAGEL 1

dextrose 10 % and 0.2 % nacl 1

dextrose 10 % in water (d10w) 1






dextrose 5 %-lactated ringers 1

dextrose 5%-0.2 % sod chloride 1

dextrose 5%-0.3 % sod.chloride 1



DIANEAL LOW CALCIUM/1.5% DEX 2

DIANEAL LOW CALCIUM/4.25% DEX 1

DIANEAL PD-2 WITH 2.5 % DEX 2

DIANEAL PD-2 WITH 4.25 % DEX 2

DIANEAL PD-2/1.5% DEXTROSE 2

DIANEAL WITH 1.5% DEXTROSE 2

DIANEAL WITH 2.5 % DEXTROSE 2

DIANEAL WITH 4.25 % DEXTROSE 2

EFFER-K ORAL TABLET, EFFERVESCENT 10 MEQ, 20 MEQ

2

EFFER-K ORAL TABLET, EFFERVESCENT 25 MEQ 1

electrolyte-48 in d5w 1

ELIPHOS 1

ENSURE COMPACT 1

EXTRANEAL 7.5 % 2

FE C 1

FERAHEME 2

FERIVA 2

FERIVA 21-7 TABLET 2

77

Drug Name Tier NotesFERIVA FA (SUMALATE) 2

FERRAPLUS 90 1

ferrous gluconate oral tablet 256 mg (28 mg iron), 324 mg (38 mg iron)

1

ferrous sulfate oral tablet 325 mg (65 mg iron) 1

ferrous sulfate oral tablet,delayed release (dr/ec) 324 mg (65 mg iron)

1

FLUOR-A-DAY 2

FLUOR-A-DAY (WITH XYLITOL) ORAL TABLET,CHEWABLE 0.25 MG F (0.55 MG)-236.79MG, 1 MG F (2.2 MG)-236.79 MG

2

FOCALGIN DSS 1

FOLIVANE-F 1

FOSRENOL 2

FREAMINE HBC 6.9 % 2

FREAMINE III 10 % 2

FUSION 2

FUSION PLUS 2

FUSION SPRINKLES 2

GLUCAGEN HYPOKIT 2

GLUCAGON EMERGENCY KIT (HUMAN) 2

GLYCOPHOS 1

HEMATOGEN 1

HEMATOGEN FA 1

HEMATOGEN FORTE 1

HEMOCYTE 1

HEPATAMINE 8% 2

HYPERLYTE CR 2

IFEREX 150 1

IFEREX 150 FORTE 1

INJECTAFER 2

INSTA-GLUCOSE 1

INTEGRA 2

IODOPEN 1

IONOSOL-B IN D5W 2

IONOSOL-MB IN D5W 2

IROSPAN 24/6 2

ISOLYTE S PH 7.4 2

ISOLYTE-P IN 5 % DEXTROSE 2

ISOLYTE-S 2

KABIVEN 2

K-EFFERVESCENT 1

KIONEX 1

KIONEX (WITH SORBITOL) 1

KLOR-CON M10 1

78

Drug Name Tier NotesKLOR-CON M15 1

KLOR-CON M20 1

KLOR-CON SPRINKLE 1

KLOR-CON/25 2

K-PHOS NO 2 2

K-PHOS ORIGINAL 2

lactated ringers intravenous 2

MAGNEBIND 300 2

MAGNEBIND 400 1

magnesium chloride injection 1

magnesium oxide oral tablet 400 mg, 420 mg 1

magnesium sulfate in d5w intravenous piggyback 1 gram/100 ml

1

magnesium sulfate in water 1

magnesium sulfate injection 1

manganese chloride 1

MULTITRACE-4 1

MULTITRACE-4 CONCENTRATE 1

MULTITRACE-4 NEONATAL 1

MULTITRACE-4 PEDIATRIC 1

MULTITRACE-5 1

MULTITRACE-5 CONCENTRATE 1

NEPHRAMINE 5.4 % 2

NEPHRON FA 1

NEUT 2

NORMOSOL-M IN 5 % DEXTROSE 2

NORMOSOL-R 2

NORMOSOL-R IN 5 % DEXTROSE 2

NORMOSOL-R PH 7.4 2

NOVASOURCE RENAL 2 CAL 1

NUFERA 1

NUTREN 1.5 2

NUTREN 2.0 2

NUTRESTORE 2

NUTRILYTE 2

ORACIT 2

OYSTERCAL-D 1

PEDITRACE 1

PERIKABIVEN 2

PHOSLYRA 2

PHOSPHA 250 NEUTRAL 1

PLASMA-LYTE 148 2

PLASMA-LYTE A 2

PLASMA-LYTE-56 IN 5 % DEXTROSE 2

79

Drug Name Tier Notespotassium acetate intravenous solution 2 meq/ml 1

potassium bicarb and chloride 1

potassium bicarb-citric acid 1

potassium chlorid-d5-0.45%nacl 1

potassium chloride 1

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

1

potassium chloride in 5 % dex intravenous parenteral solution 20 meq/l, 30 meq/l, 40 meq/l

1

potassium chloride in lr-d5 1

potassium chloride-0.45 % nacl 1

potassium chloride-d5-0.2%nacl intravenous parenteral solution 20 meq/l, 30 meq/l, 40 meq/l

1

potassium chloride-d5-0.3%nacl intravenous parenteral solution 20 meq/l

1

potassium chloride-d5-0.9%nacl 1

potassium citrate 1

potassium citrate-citric acid 1

potassium gluconate oral tablet 595 mg (99 mg) 1

potassium phosphate m-/d-basic 1

PREMASOL 10 % 2

PREMASOL 6 % 2

PROCALAMINE 3% 2

PROGLYCEM 2

PROSOL 20 % 2

RENAGEL 2

RENVELA 2

ringers intravenous 1

saccharin 2

saccharin sodium 2

selenium intravenous 1

SE-TAN PLUS 1

SF 1

SF 5000 PLUS 1

sodium acetate intravenous 1

sodium bicarbonate intravenous 1

sodium chloride 0.45 % intravenous 1

sodium chloride 0.9 % injection solution 1

sodium chloride 0.9 % injection syringe 1

sodium chloride 0.9 % intravenous 1

sodium chloride 3 % 1

sodium chloride 5 % 1

sodium chloride intravenous 1

sodium citrate-citric acid 1

sodium ferric gluconat-sucrose 1

80

Drug Name Tier Notessodium fluoride oral drops 3

sodium fluoride oral tablet,chewable 3

sodium lactate intravenous 1

sodium phosphate 1

SODIUM POLYSTYRENE (SORB FREE) 1

sodium polystyrene sulfonate 1

sorbitol powder 2

SPS (WITH SORBITOL) ORAL 1

SSKI 1

sucrose crystals 2

TANDEM DUAL ACTION 2

TARON FORTE 1

THAM 2

TL G-FOL OS 1

TL ICON 1

TL-HEM 150 1

TPN ELECTROLYTES 2

TRACE ELEMENTS 4/PEDIATRIC 1

TRAVASOL 10 % 2

TRICITRATES 1

TRICON 1

TRIFERIC 2

TRIGELS-F FORTE 1

TROPHAMINE 10 % 2

TROPHAMINE 6% 2

ULTRABAG/DIANEAL PD-2/1.5% DEX 2

ULTRABAG/DIANEAL PD-2/2.5% DEX 2

ULTRABAG/DIANEAL PD-2/4.25%DEX 2

ULTRABAG/DIANEAL/2.5% DEXTROSE 2

VELPHORO 2

VELTASSA 2

VENOFER 2

VIRT-PHOS 250 NEUTRAL 1

VIRTRATE-2 1

VIRTRATE-3 1

VIRTRATE-K 1

VITAFOL 1

VP-GSTN 1

WEE CARE 1

zinc chloride 1

zinc sulfate intravenous 1

zinc sulfate oral capsule 1

81


GASTROINTESTINALACID CONTROL (RANITIDINE) ORAL TABLET 150 MG

1

ACID CONTROLLER 1

ACID GONE ANTACID 1

ACID GONE ANTACID E.STRENGTH 1

ACID REDUCER (CIMETIDINE) 1

ACID REDUCER (FAMOTIDINE) 1

ACID REDUCER (RANITIDINE) 1

ACID REDUCER COMPLETE (FAMOT) 1

ACIPHEX SPRINKLE 2 ST; QL (1 EA per 1 day)

ADVANCED ANTACID-ANTIGAS 1

AKYNZEO 2 QL (1 EA per 28 days)

ALMACONE ORAL SUSPENSION 1

ALMACONE-2 1

alosetron 1

ALOXI 2

aluminum hydroxide gel oral suspension 320 mg/5 ml 1

AMITIZA 2 QL (2 EA per 1 day)

AMMONUL 2

amoxicil-clarithromy-lansopraz 1 QL (112 EA per 10 days)

ANA-LEX 2

ANA-LEX KIT 2

ANALPRAM ADVANCED 2

ANALPRAM-HC RECTAL CREAM 1-1 % 2

ANTACID 1

ANTACID (CALCIUM CARBONATE) ORAL TABLET,CHEWABLE 200 MG CALCIUM (500 MG)

1

ANTACID ANTI-GAS 1

ANTACID ANTI-GAS DOUBLE STR 1

ANTACID CALCIUM ORAL TABLET,CHEWABLE 215 MG CALCIUM (500 MG)

1

ANTACID EXST (CA CARB-MAG HYD) 1

ANTACID EXST (MAG CARB-AL HYD) 1

ANTACID EXT STR (CALCIUM CARB) 1

ANTACID EXTRA-STRENGTH ORAL SUSPENSION 200-200-20 MG/5 ML

1

ANTACID EXTRA-STRENGTH ORAL TABLET,CHEWABLE 300 MG (750 MG)

1

ANTACID MAXIMUM STRENGTH 1

ANTACID PLUS ANTI-GAS 1

ANTACID-ANTIGAS 1

ANTACID-SIMETHICONE 1

ANTI-DIARRHEA 1

ANTI-DIARRHEAL (LOPERAMIDE) ORAL CAPSULE 1

82

Drug Name Tier NotesANTI-DIARRHEAL (LOPERAMIDE) ORAL LIQUID 1 MG/5 ML

1

ANTI-DIARRHEAL (LOPERAMIDE) ORAL TABLET 1

ANTI-NAUSEA 1

ANUCORT-HC 1

ANU-MED 1

ANZEMET INTRAVENOUS 2

ANZEMET ORAL TABLET 100 MG 2 ST; QL (4 EA per 4 PER FILLs)

ANZEMET ORAL TABLET 50 MG 2 ST; QL (8 EA per 8 PER FILLs)

APRISO 2

ASACOL HD 2

atropine injection solution 1

atropine injection syringe 0.05 mg/ml, 0.1 mg/ml 1

atropine intravenous 1

balsalazide 1

BENTYL INTRAMUSCULAR 2

BISAC-EVAC 1

bisacodyl oral 1

bisacodyl rectal 1

BISCOLAX 1

BISMATROL 1

BISMUTH MAXIMUM STRENGTH 1

BISMUTH ORAL SUSPENSION 1

BUPHENYL ORAL TABLET 2

CALCIUM ANTACID ORAL TABLET,CHEWABLE 200 MG CALCIUM (500 MG), 300 MG (750 MG), 320 MG (750 MG), 400 MG (1,000 MG)

1

CALCIUM ANTACID ULTRA MAX ST 1

calcium carbonate oral tablet 260 mg calcium (648 mg) 1

CAL-GEST ANTACID 1

CANASA 2

CARAFATE ORAL SUSPENSION 2

castor oil oral oil 1

CESAMET 2 ST; QL (6 EA per 1 day)

CHENODAL 2

CHILDREN'S PEPTO 1

chlordiazepoxide-clidinium 1

CHOLBAM 2 PA

cimetidine 1

cimetidine hcl oral 1

CIMZIA 2 PA

CIMZIA POWDER FOR RECONST 2 PA

CIMZIA STARTER KIT 2 PA

CLEARLAX 1

COMPLETE ORAL TABLET,CHEWABLE 1

83

Drug Name Tier NotesCOMPRO 1

CONSTULOSE 1

CREON 2

CUVPOSA 2

DEWEE'S CARMINATIVE 2

DEXILANT 2 ST; QL (1 EA per 1 day)

DICLEGIS 2 QL (4 EA per 1 day)

dicyclomine oral capsule 1

dicyclomine oral solution 1

dicyclomine oral tablet 1

dimenhydrinate injection solution 1

dimenhydrinate oral 1

DIOCTO 1

DIPENTUM 2

diphenoxylate-atropine 1

DISPOSABLE ENEMA 1

DOC-Q-LACE 1

DOC-Q-LAX 1

DOCU 1

docusate calcium 1

docusate sodium oral capsule 1

docusate sodium oral liquid 1

docusate sodium oral tablet 1

DOCUSIL 1

DOCUSOL 1

DOCUSOL KIDS 2

DOK 1

DOK PLUS 1

DONNATAL ORAL ELIXIR 16.2-0.1037 -0.0194 MG/5 ML

2

DONNATAL ORAL TABLET 2

DRIMINATE 1

dronabinol 1 ST; QL (2 EA per 1 day)

DSS 1

DUCODYL 1

DUO FUSION 1

ED-SPAZ 1

EMEND INTRAVENOUS 2

EMEND ORAL CAPSULE 125 MG 2 QL (1 EA per 1 PER FILL)

EMEND ORAL CAPSULE 40 MG 2 QL (4 EA per 4 PER FILLs)

EMEND ORAL CAPSULE 80 MG 2 QL (2 EA per 2 PER FILLs)

EMEND ORAL CAPSULE,DOSE PACK 2 QL (3 EA per 3 PER FILLs)

ENEMA DISPOSABLE 1

ENEMA RECTAL ENEMA 19-7 GRAM/118 ML 1

84

Drug Name Tier NotesENEMEEZ 2

ENEMEEZ PLUS 1

ENTEREG 2

ENTYVIO 2 PA

ENULOSE 1

EPSOM SALT ORAL 1

esomeprazole magnesium 1 ST; QL (1 EA per 1 day)

esomeprazole sodium 1

EX-LAX (SENNOSIDES) 1

famotidine 1

famotidine (pf) 1

famotidine (pf)-nacl (iso-os) 1

FIBER (CALCIUM POLYCARBOPHIL) 1

FIBER (PSYLLIUM HUSK) 1

FIBER (PSYLLIUM HUSK/SUGAR) 1

FIBER (WITH ASPARTAME) 1

FIBER 6 2

FIBER LAXATIVE (CA POLYCARBO) 1

FIBER LAXATIVE (METHYLCELLULO) 1

FIBER LAXATIVE (PSYLLIUM HUSK) 1

FIBER ORAL POWDER 1

FIBER SMOOTH 1

FIBER SMOOTH (SUCROSE) 1

FIBER THERAPY (M-CELL/SUGAR) ORAL POWDER 2 GRAM/19 GRAM

1

FIBER THERAPY (PSYLLIUM SEED) 1

FIBER-LAX 1

FISH OIL ORAL CAPSULE 360-1,200 MG 1

FLEET BISACODYL 2

FLEET GLYCERIN (ADULT) 1

FLEET GLYCERIN (CHILD) 1

FLEET GLYCERIN LAXATIVE 2

FLEET LAXATIVE 1

FORMULA EM 1

FULYZAQ 2 ST; QL (2 EA per 1 day)

GAS RELIEF 1

GAS RELIEF EXTRA STRENGTH ORAL CAPSULE 1

GAS RELIEF ULTRA STRENGTH 1

GAS-X EXTRA STRENGTH ORAL CAPSULE 1

GAS-X ULTRA-STRENGTH 1

GATTEX 30-VIAL 2 PA; QL (1 EA per 30 days)

GATTEX ONE-VIAL 2 PA; QL (30 EA per 30 days)

GAVILYTE-C 1

GAVILYTE-G 1

85

Drug Name Tier NotesGAVILYTE-H AND BISACODYL 1

GAVILYTE-N 1

GAVISCON EXTRA STRENGTH ORAL SUSPENSION 2

GENERLAC 1

GENTLE LAXATIVE 1

GIAZO 2

glycerin (adult) 1

glycerin (child) 1

GLYCOLAX ORAL POWDER 1

glycopyrrolate injection 1

glycopyrrolate intravenous syringe 1 mg/5 ml (0.2 mg/ml) 1

glycopyrrolate oral 1

GOLYTELY ORAL POWDER IN PACKET 2

granisetron (pf) 1

granisetron hcl intravenous 1

granisetron hcl oral 1 ST; QL (8 EA per 30 days)

HEALTHYLAX 1

HEARTBURN RELIEF (CIMETIDINE) 1

HEARTBURN RELIEF (FAMOTIDINE) 1

HEARTBURN RELIEF (RANITIDINE) 1

HEARTBURN TREATMENT 24 HOUR 1

HEMORRHOID RECTAL OINTMENT 1

HEMORRHOIDAL (PHENYLEPH-COCOA) RECTAL SUPPOSITORY 0.25-88.44 %

1

HEMORRHOIDAL COOLING 1

HEMORRHOIDAL CREAM 1

HEMORRHOIDAL RECTAL OINTMENT 1

HEMORRHOIDAL RECTAL SUPPOSITORY 0.25-3 % 1

hydrocortisone acetate rectal 1

hydrocortisone-pramoxine rectal 1

hyoscyamine sulfate oral drops 1

hyoscyamine sulfate oral elixir 1

hyoscyamine sulfate oral tablet 1

hyoscyamine sulfate oral tablet,disintegrating 1

hyoscyamine sulfate sublingual 1

HYOSYNE 1

INFANTS GAS RELIEF 1

INTRALIPID INTRAVENOUS EMULSION 20 %, 30 % 2

KAO-TIN (BISMUTH SUBSALICYLAT) 1

KAO-TIN (DOCUSATE CALCIUM) 1

KEPIVANCE 2

KIDS MINI ENEMA 1

KONSYL (SUGAR) 1

KONSYL EASY MIX 2

86

Drug Name Tier NotesKONSYL FIBER 1

KONSYL FORMULA-D 2

KONSYL SUGAR-FREE 1

KONSYL SUGAR-FREE (ASPARTAME) 2

KRISTALOSE 2

lactulose 1

lansoprazole oral capsule,delayed release(dr/ec) 1

LAXATIVE (BISACODYL) 1

LAXATIVE (SENNOSIDES) ORAL TABLET 25 MG 1

LAXATIVE FEMININE 1

LAXATIVE MAXIMUM STRENGTH 1

LAXATIVE PLUS STOOL SOFTENER 1

LEVSIN INJECTION 2

LIALDA 2

lidocaine hcl-hydrocortison ac rectal 1

lidocaine-hydrocortisone-aloe 1

LINZESS 2 QL (1 EA per 1 day)

LIQUID ANTACID ORAL SUSPENSION 200-200-20 MG/5 ML

1

LITHOSTAT 2

loperamide oral capsule 1

loperamide oral liquid 1

MAALOX ADVANCED ORAL SUSPENSION 1

MAALOX ADVANCED ORAL TABLET,CHEWABLE 2

MAALOX MAXIMUM STRENGTH 1

MAG-AL 2

MAG-AL PLUS 1

MAG-AL PLUS EXTRA STRENGTH 1

magnesium citrate oral solution 1

MAJOR-PREP HEMORRHOIDAL RECTAL OINTMENT 0.25-14-74.9 %

1

MASANTI DOUBLE STRENGTH 1

meclizine oral tablet 12.5 mg, 25 mg 1

meclizine oral tablet,chewable 1

MEDICATED PADS TOPICAL PADS, MEDICATED 50 %

1

mesalamine rectal 1

mesalamine with cleansing wipe 1

METAMUCIL (WITH SUGAR) ORAL POWDER IN PACKET

2

METAMUCIL FIBER SINGLES 2

METAMUCIL MULTIHEALTH FIBER 2

methscopolamine oral 1

metoclopramide hcl 1

MI-ACID 1

87

Drug Name Tier NotesMI-ACID GAS RELIEF 1

MILK OF MAGNESIA 1

mineral oil oral 1

mineral oil rectal 1

MINTOX 1

MINTOX MAXIMUM STRENGTH 1

MINTOX PLUS 1

misoprostol 1

MOTION RELIEF (MECLIZINE) 1

MOTION SICKNESS 1

MOTION SICKNESS (MECLIZINE) 1

MOTION SICKNESS RELIEF 1

MOTION-TIME 1

MOVIPREP 2

MYTAB GAS 1

MYTAB GAS MAXIMUM STRENGTH 1

NATURAL FIBER LAXATIVE 1

NATURAL FIBER LAXATIVE (SUGAR) ORAL POWDER 3.4 GRAM/12 GRAM, 3.4 GRAM/7 GRAM

1

NATURAL FIBER LAXATIVE THERAPY 1

NATURAL VEG LAXATIVE(SENNOSID) 1

NEXIUM PACKET 2 ST; QL (1 EA per 1 day)

nizatidine 1

NUTRILIPID 2

OMECLAMOX-PAK 2

omega 3-dha-epa-fish oil oral capsule 60-90-500 mg 2

omega-3 acid ethyl esters 1 QL (4 EA per 1 day)

omega-3 fatty acids-fish oil oral capsule 300-1,000 mg 1

omeprazole 1

omeprazole magnesium 1

omeprazole-sodium bicarbonate oral capsule 1 ST; QL (1 EA per 1 day)

ondansetron 1

ondansetron hcl (pf) 1

ondansetron hcl intravenous 1

ondansetron hcl oral solution 1 QL (50 ML per 15 days)

ondansetron hcl oral tablet 1

opium tincture 1

OSCIMIN 1

OSCIMIN SL 1

OSCIMIN SR 1

OSMOPREP 2

pantoprazole oral 1

paregoric 1

PEDIA-LAX 2

88

Drug Name Tier NotesPEDIA-LAX STOOL SOFTENER 1

peg 3350-electrolytes 1

PEG3350 1

PEG-3350 WITH FLAVOR PACKS 1

peg-electrolyte soln 1

PENTASA 2

PEPTIC RELIEF 1

PERDIEM OVERNIGHT RELIEF 1

PERI-COLACE 1

PERTZYE ORAL CAPSULE,DELAYED RELEASE(DR/EC) 16,000-57,500- 60,500 UNIT, 8,000-28,750- 30,250 UNIT

2

PHAZYME ORAL CAPSULE 250 MG 2

PHENADOZ 1

phenobarb-hyoscy-atropine-scop oral tablet 1

PHENOHYTRO 2

PINK BISMUTH MAXIMUM STRENGTH 1

PINK BISMUTH ORAL SUSPENSION 1

PINK BISMUTH ORAL TABLET,CHEWABLE 1

polyethylene glycol 3350 oral 1

pramoxine topical 1

PREPARATION H(PE,CB) 2

PREPOPIK 2

PREVACID SOLUTAB 2 ST

PRILOSEC ORAL SUSP,DELAYED RELEASE FOR RECON

2

PRILOSEC OTC 2

prochlorperazine 1

prochlorperazine edisylate injection solution 10 mg/2 ml (5 mg/ml)

1

prochlorperazine maleate oral 1

PROCORT 2

PROCTOFOAM HC 2

PROCTOSOL HC RECTAL 1

promethazine rectal 1

PROMETHEGAN 1

propantheline 1

PROTONIX INTRAVENOUS 2

PROTONIX ORAL GRANULES DR FOR SUSP IN PACKET

2 ST

PYLERA 2

rabeprazole 1 QL (1 EA per 1 day)

ranitidine hcl oral 1

RAVICTI 2 PA

READY-TO-USE ENEMA 1

89

Drug Name Tier NotesREADY-TO-USE ENEMA (MIN OIL) 1

RECTIV 2

REGULOID 1

REGULOID, SUGAR FREE 1

REMICADE 2 PA

RESTORA RX 2

RESTORA SPRINKLES 2

RI-MAG PLUS 1

SANCUSO 2 ST; QL (1 EA per 7 days)

SANI-SUPP (ADULT) 1

SANI-SUPP (INFANT) 1

scopolamine hbr 1

SENEXON 1

SENEXON-S 1

SENNA LAX 1

SENNA LAXATIVE 1

SENNA ORAL SYRUP 8.8 MG/5 ML 1

SENNA ORAL TABLET 1

SENNA PLUS 1

SENNA PROMPT 2

SENNA WITH DOCUSATE SODIUM 1

SENNA-GEN 1

SENNALAX-S 1

SENNA-S 1

SENNA-TIME S 1

SENNO 1

sennosides-docusate sodium 1

SENOKOT-S 1

SILACE 1

simethicone oral capsule 180 mg 1

simethicone oral drops,suspension 1

simethicone oral tablet,chewable 1

SMOOTH ANTACID 1

sodium bicarbonate oral 1

sodium phenylbutyrate 1

STOMACH RELIEF 1

STOMACH RELIEF MAX STRENGTH 1

STOMACH RELIEF ORIGINAL 1

STOOL SOFTENER ORAL CAPSULE 100 MG, 240 MG, 250 MG

1

STOOL SOFTENER-LAXATIVE 1

STOOL SOFTENER-STIMULANT LAXAT 1

sucralfate oral tablet 1

sulfasalazine 1

90

Drug Name Tier NotesSUPREP BOWEL PREP KIT 2

TIGAN INTRAMUSCULAR 2

TRANSDERM-SCOP 2

TRAVEL SICKNESS 1

TRAVEL SICKNESS (MECLIZINE) 1

TRILYTE WITH FLAVOR PACKETS 1

trimethobenzamide oral 1

TUMS ULTRA ORAL TABLET,CHEWABLE 1,177 MG 1

ULTRA STRENGTH ANTACID 1

ursodiol 1

VARUBI 2 QL (2 EA per 14 days)

VASCEPA ORAL CAPSULE 1 GRAM 2 QL (4 EA per 1 day)

VIBERZI 2

VIOKACE 2

WAL-MUCIL FIBER (ASPARTAME) 2

WAL-MUCIL FIBER (SUGAR) 2

WOMEN'S GENTLE LAXATIVE(BISAC) 1

WOMEN'S LAXATIVE (BISACODYL) ORAL TABLET 1

ZEGERID ORAL PACKET 2 ST; QL (1 EA per 1 day)

ZENPEP 2

ZUPLENZ ORAL FILM 4 MG 2 ST; QL (2 EA per 3 days)

ZUPLENZ ORAL FILM 8 MG 2 ST; QL (1 EA per 3 days)

ZYPRAM 2

HERBALSalfalfa oral tablet 600 mg, 650 mg 2

aloe vera oral 2

ANTI-NAUSEA GINGER 2

arnica 2

asafetida 2

AZO BLADDER CONTROL 2

AZO CRANBERRY 2

AZO CRANBERRY + PROBIOTIC 2

bilberry fruit extract 2

bilberry oral capsule 100 mg 2

BILBERRY ORAL CAPSULE 500 MG 2

black cohosh oral capsule 540 mg 2

black cohosh root extract oral capsule 160 mg, 40 mg 2

blue-green algae (spirulina) 2

CARDIO TEA 2

cat's claw (uncaria tomentosa) oral capsule 350 mg, 400 mg 2

CHLOROPHYLL (WITH ALFALFA) 2

CINNAMON 2

cinnamon bark 2

CINNAMON OIL 2

91

Drug Name Tier Notescranberry conc-ascorbic acid oral capsule 4,200-20 mg, 6,000-100 mg

2

CRANBERRY CONCENTRATE ORAL CAPSULE 140-100 MG

2

cranberry extract oral capsule 200 mg, 425 mg 2

cranberry extract oral tablet 2

cranberry fruit oral tablet 400 mg 2

cranberry fruit oral tablet,chewable 2

cranberry oral capsule 500 mg 2

CRANBERRY ORAL TABLET 2

CRANBERRY PLUS VITAMIN C 2

DETOX DIETARY 2

DETOXAREX 2

DIURETIC 2

echinacea angust-purpr root xt 2

ECHINACEA HERB 2

echinacea oral capsule 2

echinacea oral tablet 167 mg 2

echinacea purpurea extract 2

echinacea purpurea root 2

echinacea-golden seal oral capsule 350-100 mg 2

echinacea-golden seal roots oral tablet 2

ELLURA 2

EVENING PRIMROSE 2

evening primrose oil 2

flaxseed oil oral capsule 1,000 mg 2

flaxseed oral powder 2

GARLIC OIL ORAL CAPSULE 1,000 MG 2

garlic oral capsule 1,500 mg, 580 mg 2

garlic oral tablet , 200 mg, 400 mg, 500 mg 2

GARLIPURE 2

GARLIQUE 2

ginger (zingiber officinalis) 2

GINGER EXTRACT 2

ginkgo biloba leaf extract oral capsule 30 mg 2

ginkgo biloba leaf extract oral tablet 2

ginkgo biloba oral capsule 40 mg, 500 mg, 60 mg 2

ginkgo biloba oral tablet 2

GINSENG KOREAN 2

grape seed extract oral tablet 2

grape seed xt-bioflav,citrus 2

GREEN COFFEE BEAN ORAL TABLET 2

GREEN TEA COMPLEX 2

GREEN TEA ORAL CAPSULE 2

92

Drug Name Tier Notesgreen tea-hoodia gordonii 2

hawthorn berry oral capsule 565 mg 2

hawthorn extract 2

IBGARD 2

IMUHANCE 2

INNERMOST NATURE FOR MEN 2

kava root extract 2

KOREAN GINSENG 2

korean ginseng root extract 2

lavender oil 2

LINSEED OIL 2

LIVER COMPLEX 2

MILK THISTLE EXTRACT 2

milk thistle oral capsule 150 mg 2

milk thistle oral tablet 2

milk thistle seed extract oral capsule 175 mg, 200 mg, 87.5 mg

2

NATURAL HERBAL DIURETIC 2

ODOR FREE GARLIC ORAL TABLET 100 MG 2

ODORLESS GARLIC ORAL CAPSULE 2

ODORLESS GARLIC ORAL TABLET 1250 MG 2

OMEGA-3 FLAXSEED OIL 2

peppermint oil 2

peppermint spirit 2

PETADOLEX 2

PETADOLEX 75 2

PHYTOFUSION 2

pomegranate fruit extract 2

POMEGRANATE-EGCG-GRAPE SEED 2

PRIMROSE OIL 2

PROBIOTIC PLUS AND CRANBERRY 2

raspberry ketone 2

red yeast rice oral capsule 2

REFEX 2

RETAINE FLAX 2

rosemary oil 2

saffron extract 2

sage leaf (bulk) 2

saw palmetto fruit 2

saw palmetto oral capsule 160 mg, 500 mg 2

saw palmetto-pumpkin seed oil 2

SERENAGEN 2

SOUTH AFRICAN HOODIA 2

SUPER POTENT YOHIMBE 2

93

Drug Name Tier NotesTART CHERRY EXTRACT 2

THERACRAN HP FOR KIDS 2

TOTAL BODY CLEANSE 2

TUMERSAID 2

turmeric root extract 2

valerian root oral capsule 250 mg, 450 mg, 500 mg 2

VP-PRECIP 2

WHOLE BODY JOINT SUPPORT 2

YOHIMBE 2

yohimbe bark 2

HORMONESACTHAR H.P. 2 PA

ACTHREL 2

A-HYDROCORT 1

ALORA 2 QL (2 EA per 7 days)

ANADROL-50 2 PA

ANDRODERM 2 PA; QL (1 EA per 1 day)

ANDROGEL TRANSDERMAL GEL IN METERED-DOSE PUMP 20.25 MG/1.25 GRAM (1.62 %)

2 PA; QL (5 GM per 1 day)

ANDROGEL TRANSDERMAL GEL IN PACKET 1.62 % (20.25 MG/1.25 GRAM)

2 PA; QL (1.25 GM per 1 day)

ANDROGEL TRANSDERMAL GEL IN PACKET 1.62 % (40.5 MG/2.5 GRAM)


ANDROXY 1 QL (120 EA per 30 days)

ANGELIQ 2

ARISTOSPAN INTRA-ARTICULAR 2

ARISTOSPAN INTRALESIONAL 2

AVEED 2

AXIRON 2 PA; QL (6 ML per 1 day)

betamethasone acet,sod phos 1

budesonide oral 1

cabergoline 1

calcitonin (salmon) 1

CERVIDIL 2

CLIMARA PRO 2 QL (1 EA per 7 days)

COLOCORT 1

COMBIPATCH 2 QL (2 EA per 7 days)

CORTIFOAM 2

cortisone 1

cosyntropin injection 1

COVARYX 1

COVARYX H.S. 1

CRINONE VAGINAL GEL 4 % 2

danazol oral 1

DELESTROGEN INTRAMUSCULAR OIL 10 MG/ML 2

94

Drug Name Tier NotesDEPO-ESTRADIOL 2

DEPO-MEDROL INJECTION SUSPENSION 20 MG/ML 2

DEPO-PROVERA INTRAMUSCULAR SOLUTION 2

desmopressin injection 1

desmopressin nasal 1

desmopressin oral 1

dexamethasone 1

DEXAMETHASONE INTENSOL 2

dexamethasone sodium phos (pf) 1

dexamethasone sodium phosphate injection 1

DEXPAK 10 DAY 2

DEXPAK 13 DAY 2

DEXPAK 6 DAY 2

DIVIGEL 2

DOUBLEDEX 2

DUAVEE 2

EEMT 1

EEMT HS 1

EGRIFTA 2 PA; QL (2 EA per 1 day)

ELESTRIN 2

ESTRACE VAGINAL 2

estradiol oral 1

estradiol transdermal patch semiweekly 1 QL (2 EA per 7 days)

estradiol transdermal patch weekly 1 QL (1 EA per 7 days)

estradiol valerate intramuscular oil 20 mg/ml, 40 mg/ml 1

estradiol-norethindrone acet 1

ESTRING 2 QL (1 EA per 90 days)

estrogens-methyltestosterone 1

estropipate 1

EVAMIST 2

FEMRING 2 QL (1 EA per 84 days)

fludrocortisone 1

FORTICAL 2

FYAVOLV 1

GENOTROPIN 2 PA

GENOTROPIN MINIQUICK 2 PA

HEMABATE 2

HUMATROPE 2 PA

hydrocortisone oral 1

hydrocortisone rectal 1

INCRELEX 2 PA

JINTELI 1

KENALOG INJECTION 2

LOPREEZA 1

95

Drug Name Tier NotesLUPANETA PACK (1 MONTH) 2

LUPANETA PACK (3 MONTH) 2

LUPRON DEPOT (3 MONTH) INTRAMUSCULAR SYRINGE KIT 11.25 MG

2 PA

LUPRON DEPOT INTRAMUSCULAR SYRINGE KIT 3.75 MG

2 PA

LUPRON DEPOT-PED 2 PA

LUPRON DEPOT-PED (3 MONTH) 2 PA

MAKENA 2 PA

MEDROL ORAL TABLET 2 MG 2

medroxyprogesterone oral 1

melatonin oral tablet,disintegrating 3 mg 1

melatonin-pyridoxine hcl (b6) oral tablet 3-1 mg 1

melatonin-pyridoxine hcl (b6) oral tablet 5-10 mg 2

MENEST 2

MENOSTAR 2 QL (1 EA per 7 days)

METHITEST 2

methylergonovine 1

methylprednisolone 1

methylprednisolone acetate 1

methylprednisolone sodium succ injection recon soln 125 mg, 40 mg

1

methylprednisolone sodium succ intravenous 1

methyltestosterone oral capsule 1

MIACALCIN INJECTION 2

MILLIPRED 2

MILLIPRED DP 2

MIMVEY 1

MIMVEY LO 1

MINIVELLE 2 QL (2 EA per 7 days)

MYALEPT 2 QL (1 EA per 1 day)

NATESTO 2

NATPARA 2 PA

NORDITROPIN FLEXPRO 2 PA

norethindrone acetate 1

norethindrone ac-eth estradiol oral tablet 0.5-2.5 mg-mcg, 1-5 mg-mcg

1

NUTROPIN AQ NUSPIN 2 PA

NUTROPIN AQ SUBCUTANEOUS CARTRIDGE 10 MG/2 ML (5 MG/ML)

2 PA

octreotide acetate injection solution 1,000 mcg/ml, 200 mcg/ml

1 PA

octreotide acetate injection solution 100 mcg/ml, 50 mcg/ml, 500 mcg/ml

1

octreotide acetate injection syringe 1

OMNITROPE 2 PA

96

Drug Name Tier Notesoxandrolone 1 PA

oxytocin in 0.9 % sod chloride intravenous solution 30 unit/500 ml

1

oxytocin in lactated ringers intravenous solution 20 unit/1,000 ml

1

oxytocin injection solution 2

PITOCIN 2

prednisolone oral solution 15 mg/5 ml 1

prednisolone sodium phosphate oral solution 15 mg/5 ml (3 mg/ml), 25 mg/5 ml (5 mg/ml), 5 mg base/5 ml (6.7 mg/5 ml)

1

prednisolone sodium phosphate oral tablet,disintegrating 1

PREDNISONE INTENSOL 2

prednisone oral 1

PREFEST 2

PREMARIN 2

PREMPHASE 2

PREMPRO 2

PREPIDIL 2

progesterone 1

PROGESTERONE IN OIL 1

progesterone micronized 1

PROSTIN E2 2

RAYOS 2 ST

SAIZEN 2 PA

SAIZEN CLICK.EASY 2 PA

SANDOSTATIN LAR DEPOT 2 PA

SEROSTIM SUBCUTANEOUS RECON SOLN 4 MG, 5 MG, 6 MG

2 PA

SIGNIFOR 2 PA

SIGNIFOR LAR 2

SOLU-CORTEF (PF) 2

SOLU-MEDROL (PF) 2

SOLU-MEDROL INTRAVENOUS RECON SOLN 2 GRAM, 500 MG

2

SOMATULINE DEPOT 2

STIMATE 2

STRIANT 2 PA; QL (2 EA per 1 day)

SUPPRELIN LA 2

SYNAREL 2

TESTOPEL 2

testosterone cypionate intramuscular oil 100 mg/ml 1 PA; QL (10 ML per 30 days)

testosterone cypionate intramuscular oil 200 mg/ml 1 PA; QL (1 ML per 7 days)

testosterone enanthate 1 PA; QL (5 ML per 30 days)

testosterone transdermal gel 1 PA; QL (300 GM per 30 days)

97

Drug Name Tier Notestestosterone transdermal gel in metered-dose pump 1.25 gram/ actuation (1 %)

1 PA; QL (300 GM per 30 days)

testosterone transdermal gel in metered-dose pump 10 mg/0.5 gram /actuation


testosterone transdermal gel in packet 1 % (25 mg/2.5gram) 1 PA; QL (5 GM per 1 day)

testosterone transdermal gel in packet 1 % (50 mg/5 gram) 1 PA; QL (300 GM per 30 days)

triamcinolone acetonide injection 1

UCERIS ORAL 2

UCERIS RECTAL 2 ST

VAGIFEM 2

vasopressin 1

VASOSTRICT 2

VERIPRED 20 2

ZOMACTON 2 PA

ZORBTIVE 2 PA

IMMUNOSUPPRESANTACTEMRA 2 PA

ASTAGRAF XL 2

AZASAN 2

azathioprine 1

CELLCEPT INTRAVENOUS 2

cyclosporine intravenous 1

cyclosporine modified 1

cyclosporine oral capsule 1

ELIDEL 2 ST

ENVARSUS XR 2

GENGRAF ORAL CAPSULE 100 MG, 25 MG 1

GENGRAF ORAL SOLUTION 1

mycophenolate mofetil 1

mycophenolate sodium 1

NEORAL 2

NULOJIX 2

PROGRAF 2

RAPAMUNE 2

SANDIMMUNE ORAL 2

SIMULECT 2

sirolimus 1

STELARA SUBCUTANEOUS SYRINGE 2 PA

tacrolimus oral 1

tacrolimus topical 1 ST

ZORTRESS 2

MISCELLANEOUS MEDICAL SUPPLIES, DEVICES, NON-DRUG1ST TIER UNIFINE PENTIPS 2

98

Drug Name Tier Notes1ST TIER UNIFINE PENTIPS PLUS NEEDLE 29 GAUGE X 1/2", 31 GAUGE X 1/4", 31 GAUGE X 3/16", 32 GAUGE X 5/32"

2

3M NEXCARE DURAPORE 2

ABSORBENT COTTON BALLS 2

ACCU-CHEK FASTCLIX KIT 2

ACCU-CHEK MULTICLIX LANCET KIT 2

ACCU-CHEK SOFT DEV LANCETS 2

ACCU-CHEK SOFTCLIX LANCET DEV 2

ACE AEROSOL CLOUD ENHANCER 2

adhesive bandage topical bandage , 1 ", 3 x 4 ", 3/4 ", 3/4 x 3 "

2

adhesive bandage-adhes remov#1 2

ADHESIVE GAUZE PAD TOPICAL BANDAGE 2.375 X 4 "

2

ADHESIVE PADS 2

adhesive remover 2

adhesive tape 2

ADVANCED ANTIBACTERIAL BANDAGE 2

ADVOCATE PEN NEEDLES 2

ADVOCATE SYRINGES 2

AEROCHAMBER MINI 2

AEROCHAMBER MV 2

AEROCHAMBER PLUS FLOW-VU 2

AEROCHAMBER PLUS FLOW-VU,L MSK 2

AEROCHAMBER PLUS FLOW-VU,M MSK 2

AEROCHAMBER PLUS FLOW-VU,S MSK 2

AEROCHAMBER PLUS Z STAT 2

AEROCHAMBER PLUS Z STAT LG MSK 2

AEROCHAMBER PLUS Z STAT MD MSK 2

AEROCHAMBER PLUS Z STAT SM MSK 2

AEROCHAMBER WITH FLOWSIGNAL 2

AEROCHAMBER Z-STAT PLUS-FLW SG 2

AEROTRACH PLUS 2

AEROVENT PLUS 2

ALLEVYN ADHESIVE DRESSING TOPICAL BANDAGE 9 X 9 "

2

ALLEVYN PLUS ADHESIVE 2

ALLKARE ADHESIVE REMOVER WIPES 2

ANTIBACTERIAL BANDAGES 2

ANTIBACTERIAL PAD 2

AQUACEL FOAM SACRAL 2

AQUACEL FOAM TOPICAL BANDAGE 3.2 X 3.2 ", 8 X 5.5 ", 8 X 7 "

2

AQUAFLO 2

ARCH BANDAGE 2

99

Drug Name Tier NotesARGLAES 3.25"X 14" FILM 2

ARTHRITIS HEATWRAPS 2

ASSURE ID INSULIN SAFETY 2

ATHLETIC TAPE 2

AVOGEL 2

AVOGEL DRESSING 2

BANDAGE 2

BANDAGES 2

BANDAGES FLEXIBLE FABRIC 2

BANDAGES SHEER 2

BANDAGES/FLEXIBLE/ASSORTED 2

BANDAGES/PLASTIC 2

BAND-AID ACTIVE FLEX 2

BAND-AID CLEAR SPOTS 2

BAND-AID CLOTH TAPE 2

BAND-AID FLEXIBLE 2

BAND-AID FLEXIBLE FABRIC 2

BAND-AID GAUZE PADS 2

BAND-AID HANDYMAN 2

BAND-AID HURT-FREE 2

BAND-AID MIRASORB GAUZE 2

BAND-AID NON-STICK PADS 2

BAND-AID PAPER TAPE 2

BAND-AID PLASTIC 2

BAND-AID PLUS ANTIBIOTIC 2

BAND-AID ROLLED GAUZE 2

BAND-AID SECURE-FLEX 2

BAND-AID SHEER STRIPS 2

BAND-AID SURGIPAD 2

BAND-AID TOUGH PADS 2

BAND-AID TOUGH STRIPS 2

BAND-AID WATERPROOF 2

BAND-AID WATERPROOF PAD 2

BARD ADHESIVE REMOVER WIPES 2

BD AUTOSHIELD DUO PEN NEEDLE 2

BD AUTOSHIELD PEN NEEDLE 2

BD ECLIPSE LUER-LOK SYRINGE 1 ML 30 GAUGE X 1/2"

2

BD INSULIN PEN NEEDLE UF MINI 2

BD INSULIN PEN NEEDLE UF ORIG 2

BD INSULIN PEN NEEDLE UF SHORT 2

BD INSULIN SYRINGE 2

BD INSULIN SYRINGE HALF UNIT 2

BD INSULIN SYRINGE MICRO-FINE 2

100

Drug Name Tier NotesBD INSULIN SYRINGE SAFETY-LOK 2

BD INSULIN SYRINGE SLIP TIP 2

BD INSULIN SYRINGE ULT-FINE II 2

BD INSULIN SYRINGE ULTRA-FINE 2

BD INTEGRA INSULIN SYRINGE 2

BD LO-DOSE MICRO-FINE IV 2

BD LO-DOSE ULTRA-FINE 2

BD SAFETYGLIDE INSULIN SYRINGE 2

BD SAFETYGLIDE SYRINGE SYRINGE 1 ML 27 GAUGE X 5/8"

2

BD ULTRA-FINE NANO PEN NEEDLES 2

BIATAIN HEEL ADH FOAM DRESSING 2

BIATAIN NON-ADHESIVEFOAM ROUND 2

BIO TRUE 2

BIOBRANE 2

BIOBRANE DRESSING 2

BIOBRANE-L 2

BIOBRANE-L DRESSING 2

BLENDERM SURGICAL 2

BLISTER RELIEF BANDAGES 2

BORDERED GAUZE 2

BOSTON CLEANER 2

BOSTON CONDITIONING 2

BOSTON ONE STEP (PF) 2

BOSTON REWETTING 2

BOSTON SIMPLUS 2

BREATHERITE MDI SPACER 2

BREATHERITE RIGID SPACER-MASK 2

BREATHERITE SPACER-MASK,ADULT 2

BREATHERITE SPACER-MASK,CHILD 2

BREATHERITE SPACER-MASK,INFANT 2

BREATHERITE SPACER-MASK,S.CHLD 2

BREATHERITE VALVED MDI CHAMBER 2

BREATHERITE VALVED MDI SPACER 2

BREATHERITE WITH MASK, LARGE 2

BREATHERITE WITH MASK, MEDIUM 2

BREATHERITE WITH MASK, SMALL 2

BULKEE II 2

BUTTERFLY CLOSURES 2

CALLUS CUSHION 2

CALLUS PADS 2

CARBOFLEX ODOR CONTROL DRESSIN 2

CAREFINE PEN NEEDLE 2

CARRASYN HYDROGEL WOUND DRESS 2

101

Drug Name Tier NotesCHEMSTRIP (CALIBRATION) 2

CLEAR BANDAGES 2

CLEAR SPOT BANDAGES 2

CLEAR TAPE 2

CLEAR WATERPROOF STRIPS 2

CLERZ PLUS 2

CLICKFINE 2

CLOTH FIRST AID TAPE 2

CLOTH TAPE 2

COBAN 2

COBAN ACTION WRAP 2

COBAN SELF-ADHERENT WRAP 2

COBAN STERILE SELF-ADHERENT 2

COMBINE ABD 2

COMFEEL PURILON 2

COMFORT EZ PEN NEEDLES 2

COMFORT EZ SYRINGE 2

COMPACT SPACE CHAMBER PLUS 2

CONFORM 2

CONFORMANT 2 2

CONTACT LENS RELIEF 2

COOLMAGIC 2

COOLMAGIC FENESTRATED 2

CORN CUSHION 2

COSMETIC BALLS 2

COSMETIC PUFFS 2

COSMETIC SQUARES 2

COTTON BALLS 2

COTTON BALLS STERILE 2

COTTON SQUARES 2

COTTON SWABS 2

COTTON, STERILE 2

COVRSITE 2

COVRSITE PLUS 2

CURAD GAUZE PAD 2

CURAD NON-STICK PAD 2

CURAFIL GEL WOUND 2

CURI-STRIP WOUND CLOSURES 2

CURITY ABDOMINAL PAD 2

CURITY ABSORBENT WADDING 2

CURITY AMD 2

CURITY AMD (WITH POLYHEXAMETH) 2

CURITY BANDAGE 2

CURITY COTTON PREP BALLS 2

102

Drug Name Tier NotesCURITY COTTON TIP APPLICATOR 2

CURITY COVER 2

CURITY DETECTABLE LAP 2

CURITY DISP LAP SPONGE POUCH 2

CURITY DISP LAP SPONGE TRAY 2

CURITY DRESSING TOPICAL BANDAGE 4 1/2 X 3600 ", 9 X 100 "-YARD

2

CURITY GAUZE 2

CURITY GAUZE BURN DRESSING 2

CURITY IODOFORM PACKING STRIP 2

CURITY MULTI-TRAUMA DRESSING 2

CURITY NON-ADHERENT STRIP 2

CURITY NON-ADHERING DRESSING 2

CURITY PLAIN PACKING STRIP 2

CURITY READY-CUT GAUZE 2

CURITY WET DRESSING 2

DENTAL TRAVEL PACK 2

denture care products 2

DERMACEA 2

DERMACEA I.V. 2

DERMACEA NON-WOVEN 2

DERMACEA STRETCH 2

DERMAGAUZE 2

DERMAGAUZE HYDROGEL DRESSING 2

DERMA-GEL 2

DERMAGRAN HYDROGEL DRESSING 2

DERMAGRAN HYDROPHILIC DRESSING 2

DERMASYN 2

DERMAVIEW 2

DERMAVIEW II 2

DISINFECTING SOLUTION 2

DROPLET PEN NEEDLE 2

DRYNET WOUND VEIL 2

DUODERM HYDROACTIVE TOPICAL GEL 2

DUODERM HYDROACTIVE TOPICAL PASTE 2

DURAPORE SURGICAL 2

EAR POPPER INFLATION DEVICE 2

EASIVENT HOLDING CHAMBER 2

EASIVENT MASK LARGE 2

EASIVENT MASK MEDIUM 2

EASIVENT MASK SMALL 2

EASY COMFORT INSULIN SYRINGE 2

EASY COMFORT PEN NEEDLES 2

EASY TOUCH FLIPLOCK INSULIN 2

103

Drug Name Tier NotesEASY TOUCH INSULIN SAFETY SYR 2

EASY TOUCH INSULIN SYRINGE 2

EASY TOUCH LUER LOCK INSULIN 2

EASY TOUCH NEEDLE 2

EASY TOUCH SHEATHLOCK INSULIN 2

EASY TOUCH SHEATHLOCK SYRG-NDL SYRINGE 10 ML 21 GAUGE X 1 1/2"

2

EASY TOUCH UNI-SLIP SYRINGE 1 ML 2

elastic bandage topical bandage 2 ", 3 ", 4 ", 6 x 1.8 "-yard 2

ELASTO-GEL 2

ELASTO-GEL CAST-SPLINT PADDING 2

ELASTO-GEL CIRCLE DRESSING 2

ELASTO-GEL FACE DRESSING 2

ELASTO-GEL PLUS 2

EXCILON 2

EXCILON AMD (WITH POLYHEXAMET) 2

EXCILON DRAIN 2

EXCILON I.V. 2

EXEL INSULIN 2

EXU-DRY ADULT DRESSING 2

EXU-DRY ARM DRESSING 2

EXU-DRY BOOT-FOOT DRESSING 2

EXU-DRY BURN JACKET-LARGE 2

EXU-DRY BURN JACKET-MEDIUM 2

EXU-DRY BURN JACKET-SMALL 2

EXU-DRY BURN VEST-LARGE 2

EXU-DRY BURN VEST-SMALL 2

EXU-DRY ELBOW-KNEE-HEEL 2

EXU-DRY FACE DRESSING 2

EXU-DRY HAND DRESSING, LARGE 2

EXU-DRY HAND DRESSING, MEDIUM 2

EXU-DRY HAND DRESSING, SMALL 2

EXU-DRY INCISION DRESSING 2

EXU-DRY LARGE BOOT DRESSING 2

EXU-DRY LEG DRESSING 2

EXU-DRY NECK DRESSING 2

EXU-DRY SCALP DRESSING 2

EXU-DRY WOUND DRESSING 2

E-Z SPACER 2

EZO CUSHIONS LOWER HEAVY 2

EZO CUSHIONS UPPER HEAVY 2

FABRIC BANDAGES 2

FABRIC KNUCKLE-FINGER BANDAGE 2

FABRIC STRIP EXTRA LARGE 2

104

Drug Name Tier NotesFINGER SLEEVES 2

FLEXIBLE 2

FLEXIBLE FABRIC BANDAGES 2

FLEXIBLE FOAM 2

FLEXICHAMBER 2

FLEXZAN WOUND DRESSING TOPICAL BANDAGE 2 X 3 ", 4 X 8 "

2

foam bandage 2

FOAM TOE BANDAGE 2

FREESTYLE PRECISION 2

gauze bandage 2

GAUZE PAD 2

GAUZE ROLL 2

GEL CORN PROTECTORS 2

GEL TOE PROTECTOR 2

GEL TOE SPACERS 2

GELPAD 2

GENTLE TAPE 2

GRX FOAM DRESSING 2

GRX WOUND GEL 2

HEALTHY ACCENTS UNIFINE PENTIP 2

HEAT THERAPY 2

HEATWRAPS 2

HEATWRAPS BACK AND HIP PADS 2

HURRIVIEW 2

HURRIVIEW II 2

HYDE-OUT ALDEHYDE NEUTRALIZER 2

HYDRESS 2

hydrocol dress-adhesive rem#1 2

HYPAFIX 2

HYPO-ALLERGENIC BANDAGES 2

IN-CHECK DIAL TRAINING DEVICE 2

INCONTROL PEN NEEDLE 2

INSPIRACHAMBER 2

INSPIRACHAMBER WITH MASK-MED 2

INSPIRACHAMBER WITH MASK-SMALL 2

INSULIN SYRINGE MICROFINE 2

insulin syringe needleless 2

INSULIN SYRINGE SYRINGE 0.5 ML 29 GAUGE X 1/2", 1 ML 29 GAUGE X 1/2"

2

INSULIN SYRINGE ULTRAFINE 2

insulin syringe-needle u-100 2

insulin syringes (disposable) 2

INSUPEN 2

105

Drug Name Tier NotesINTERSORB 2

INTRASITE GEL DRESSING 2

IV 3000 TOPICAL BANDAGE 2 3/8 X 2 3/4 " 2

IV3000 FRAME DELIVERY DRESSING 2

KENDALL 2

KENDALL CLOTH 2

KENDALL FOAM BORDER 2

KENDALL PAPER TAPE 2

KERLIX 2

KERLIX AMD 2

KERLIX BURN PACK 2

KERLIX PACKING SPONGE 2

LISCO 2

LITE TOUCH INSULIN PEN NEEDLES 2

LITE TOUCH INSULIN SYRINGE 2

LITE TOUCH-MEDIUM MASK 2

LITEAIRE MDI CHAMBER 2

LITETOUCH-LARGE MASK 2

LITETOUCH-SMALL MASK 2

MAGELLAN INSULIN SAFETY SYRNG 2

MAGELLAN SYRINGE SYRINGE 0.3 ML 30 X 5/16", 0.5 ML 30 GAUGE X 5/16"

2

MAXI-COMFORT INSULIN SYRINGE 2

MAXORB 2

MAXORB EXTRA DRESSING 2

MAXORB ROPE 2

MEDFIX 2

MEDFIX EZ DRESSING 2

MEDIGRIP 2

MEDIGRIP ELASTICATED SUPPORT 2

MEDIGRIP TUBULAR 2

MEDIPORE 2

MEDIPORE DRESS-IT COVER 2

MEDIPORE H 2

MEDIPORE PLUS PAD 2

MEDIPORE SOFT CLOTH TAPE 2

MEFIX 2

MEPILEX BORDER SACRUM 2

MEPILEX BORDER TOPICAL BANDAGE 4 X 10 ", 4 X 12 "

2

MEPITEL 2

MICROCHAMBER 2

MICROFOAM SURGICAL 2

MICROPORE SURGICAL 2

106

Drug Name Tier NotesMICROSPACER 2

MICROSPONGE 2

MINI ULTRA-THIN II 2

MISTASSIST 2

MONAGHAN Z STAT CHAMBER 2

MONAGHAN Z STAT CHAMBER-LG MSK 2

MONAGHAN Z STAT CHAMBER-MD MSK 2

MONAGHAN Z STAT CHAMBER-SM MSK 2

MONOJECT INSULIN SAFETY SYRING 2

MONOJECT INSULIN SYRINGE 2

MONOJECT SYRINGE SYRINGE 1/2 ML 28 GAUGE 2

MONOJECT ULTRA COMFORT INSULIN 2

MOUTHPIECE 2

MPM FOAM DRESSING TOPICAL BANDAGE 4 X 4 ", 6 X 6 "

2

MULTIPURPOSE CONTACT LENS 2

MULTI-PURPOSE SOFT CONTACT LEN 2

NEW GENERATION 2

NEXCARE GENTLE PAPER TAPE 2

NEXCARE TEGADERM 2

NON-STICK PAD 2

NO-STING SKIN-PREP 2

NOVOFINE 30 2

NOVOFINE 32 2

NOVOFINE AUTOCOVER 2

NOVOFINE PLUS 2

NOVOTWIST 2

ONE WAY VALVED MOUTHPIECE 2

OPSITE 2

OPSITE ADHESIVE DRESSING 2

OPSITE FLEXIFIX 2

OPSITE FLEXIGRID DRESSING 2

OPTICHAMBER ADULT MASK-LARGE 2

OPTICHAMBER DIAMOND LG MASK 2

OPTICHAMBER DIAMOND VHC 2

OPTICHAMBER DIAMOND-MED MSK 2

OPTICHAMBER DIAMOND-SML MASK 2

OPTI-FREE 2

OPTI-FREE EXPRESS 2

OPTI-FREE REPLENISH 2

OPTI-FREE REWETTING DROPS 2

PAIN FREE TAPE 2

PAIN FREE WRAP 2

PANDA MASK 2

107

Drug Name Tier NotesPAPER TAPE 2

PAPER TAPE, HYPOALLERGENIC 2

PEDIATRIC MEDIUM MASK 2

PEDIATRIC PANDA MASK 2

PEDIATRIC SMALL MASK 2

PEDI-PRE TAPE SPRAY 2

PEN NEEDLE NEEDLE 29 GAUGE X 1/2", 30 GAUGE X 5/16", 31 GAUGE X 1/4", 31 GAUGE X 3/16", 31 GAUGE X 5/16", 32 GAUGE X 5/32"

2

pen needle, diabetic needle 29 gauge x 1/2", 31 gauge x 1/3", 31 gauge x 1/4", 31 gauge x 1/6", 31 gauge x 3/16", 31 gauge x 5/16", 32 gauge x 1/4", 32 gauge x 5/32"

2

PENTIPS NEEDLE 31 GAUGE X 3/16", 31 GAUGE X 5/16", 32 GAUGE X 5/32"

2

PETROLATUM GAUZE 2

PFLEX INSPIRATORY TRAINER 2

PLASTIC STRIPS 2

PLASTIC SWABS 2

POCKET CHAMBER 2

POLYSKIN II 2

POWER CLEANER 2

PRIMEAIRE 2

PRIMER MODIFIED UNNA BOOT 2

PRO SPORTS TAPE 2

PROCHAMBER 2

PRODIGY INSULIN SYRINGE 2

Q-TIPS/SINGLE-TIP 2

Q-TIPS/SINGLE-TIP APPLICATOR 2

RADIADRES GEL 2

RELION NEEDLES 2

RELION PEN NEEDLES 2

REMOVE 2

RENU DISINFECTING 2

RENU MULTIPLUS 2

RENU REWETTING DROPS 2

RESTON HIGH SUPPORT PAD 2

RESTON LIGHT SUPPORT ROLL 2

RESTON MEDIUM SUPPORT PAD 2

RESTORE CONTACT LAYER SILVER 2

RESTORE FOAM HEEL DRESSING 2

RESTORE HYDROGEL DRESSING 2

RESTORE HYDROGEL GAUZE SPONGE 2

RESTORE TOPICAL BANDAGE 2 1/2 X 2 1/2 ", 2 X 2 ", 4 X 4 ", 4 X 5 "

2

RESTORE TRIO 2

RITEFLO AEROCHAMBER 2

108

Drug Name Tier NotesROLLED ABSORBENT COTTON 2

ROLLED GAUZE TOPICAL BANDAGE , 4 X 2.5 "-YARD, 4.5" X 3 YARD

2

RONDIC 2

SAFESNAP INSULIN SYRINGE 2

SAF-GEL 2

SALINE SENSITIVE EYES 2

SALINE SOLUTION 2

SALINE SOLUTION,STERILE PRESRV 2

SCANPOR TAPE 2

SELF ADHERENT WRAP 2

SELF-ADHERANT GENTLE WRAP 2

SELF-ADHERING BANDAGE 2

SELFGRIP 2

SELF-GRIP TOPICAL BANDAGE 2 X 66 ", 3 X 66 ", 4 X 66 "

2

SELF-GRIP TOPICAL TAPE 2

SENSI-CARE ADHESI REMOVER WIPE 2

SENSITIVE EYES 2

SENSITIVE EYES DAILY CLEANER 2

SENSITIVE EYES PLUS SALINE 2

SENSODYNE 2

SHEER BANDAGE 2

SHEER BANDAGES 2

SHEER PLASTIC STRIP 2

SHEER SPOT BANDAGES 2

SHEER STRIP 2

SHEER STRIP EXTRA LARGE 2

SHEER STRIPS 2

SHEER STRIPS ASSORTED 2

SIDESTREAM PEDIATRIC FACE MASK 2

SILICONE MASK - INFANT 2

SILICONE MASK - PEDIATRIC 2

SKIN CLOSURE STRIPS 2

SKINTEGRITY HYDROGEL 2

SKINTEGRITY HYDROGEL DRESSING 2

SOF-SET ADHESIVE PATCH 2

SOFT CLOTH 2

SOLOSITE TOPICAL BANDAGE 2

SOLOSITE WOUND GEL 2

SORESPOT 2

SPACE CHAMBER PLUS 2

SPECTRAGEL 2

SPORTS TAPE 2

109

Drug Name Tier NotesSTERILE GAUZE PAD TOPICAL BANDAGE 2 X 2 ", 3 X 3 "

2

STERILE PADS TOPICAL BANDAGE 2 X 2 ", 3 X 3 ", 4 X 4 "

2

STERILE STRETCH GAUZE BANDAGE 2

STERI-STRIP 2

STERI-STRIP DRESSING 2

STERI-STRIP SKIN CLOSURES 2

STIK IT 2

STRATASORB COMPOSITE WOUND 2

STRATASORB ISLAND DRESSING 2

STRETCH GAUZE BANDAGE 2

STRONG STRIPS X-LARGE 2

SUPER STRIP BANDAGES 2

SURE COMFORT INS. SYR. U-100 2

SURE COMFORT INSULIN SYRINGE SYRINGE 0.3 ML 29 GAUGE X 1/2", 0.3 ML 30 GAUGE X 1/2", 0.3 ML 30 GAUGE X 5/16, 0.3 ML 31 GAUGE X 5/16, 0.5 ML 31 GAUGE X 5/16, 1 ML 28 GAUGE X 1/2", 1 ML 29 GAUGE X 1/2", 1 ML 30 GAUGE X 1/2", 1 ML 30 GAUGE X 5/16, 1 ML 31 GAUGE X 5/16, 1/2 ML 28 GAUGE X 1/2", 1/2 ML 30 GAUGE X 1/2", 1/2 ML 30 GAUGE X 5/16

2

SURE COMFORT PEN NEEDLE 2

SURE-FINE PEN NEEDLES 2

SURE-JECT INSULIN SYRINGE 2

SUREPRESS ABSORBENT PADDING 2

SUREPRESS HIGH COMPRESSION 2

SURESITE 2

SURESITE FLEXIGRID 2

SURESITE IV 2

SURESITE MATRIX 2

SURESITE WINDOW 2

SURGICAL DRESSING 2

SURGICAL DRESSING EXTR PROTCT 2

SURGICAL PADS 2

SYSTANE CONTACTS 2

TECHLITE PEN NEEDLE 2

TEGADERM 2

TEGADERM ABSORBENT 2

TEGADERM FIRST AID STYLE 2

TEGADERM FRAME STYLE 2

TEGADERM HP FRAME STYLE 2

TEGADERM HYDROGEL 2

TEGADERM I.V. 2

TEGADERM PLUS PAD 2

110

Drug Name Tier NotesTEGADERM TRANSPARENT DRESSING 2

TELFA 2

TELFA (WITH POLYHEXAMETH) 2

TELFA AMD 2

TELFA CLEAR WOUND DRESSING 2

TELFA ISLAND DRESSING 2

TELFA OUCHLESS NON-ADHERENT 2

TENA SERENITY 2

TENDER TAPE 2

TENDERSORB 2

TENDERWET ACTIVE CAVITY DRESS 2

TENDERWET ACTIVE DRESSING 2

TENDERWET SYSTEM 2

TENDERWRAP UNNA BOOT 2

TENSOR 2

TERUMO INSULIN SYRINGE 2

THERMACARE KNEE/ELBOW 2

THERMACARE LARGE/XLGE BACK/HIP 2

THERMACARE MENSTRUAL 2

THERMACARE NECK/WRIST/SHOULDER 2

THERMACARE SMALL/MED BACK/HIP 2

THINPRO INSULIN SYRINGE 2

THRESHOLD IMT TRAINER 2

THRESHOLD PEP DEVICE 2

TOE AID DRESSING 2

TOOTHETTE 2

toothpaste 2

TOPCARE CLICKFINE 2

TOPCARE ULTRA COMFORT 2

transparent dressings 2

TRANSPARENT THIN FILM DRESSING 2

TRANSPORE SURGICAL 2

TRIPLE HELIX COLLAGEN TOPICAL BANDAGE 2

TRUEPLUS INSULIN 2

ULTICARE PEN NEEDLE 2

ULTICARE SYRINGE 0.3 ML 29 X 1/2", 0.3 ML 30 GAUGE X 1/2", 0.3 ML 30 X5/16 ", 0.3 ML 31 GAUGE X 5/16, 0.5 ML 31 GAUGE X 5/16, 1 ML 29 X 1/2", 1 ML 30 GAUGE X 1/2", 1 ML 30 GAUGE X 5/16", 1 ML 31 GAUGE X 5/16, 1/2 ML 29 X 1/2 ", 1/2 ML 30 GAUGE X 1/2", 1/2 ML 30 GAUGE X 5/16"

2

ULTILET INSULIN SYRINGE 2

ULTILET PEN NEEDLE 2

ULTRA CMFT INS SYR HALF UNIT 2

111

Drug Name Tier NotesULTRA COMFORT INSULIN SYRINGE SYRINGE 0.3 ML 29 GAUGE X 1/2", 0.3 ML 30, 0.3 ML 30 GAUGE X 5/16, 0.3 ML 31 GAUGE X 5/16, 0.5 ML 29 GAUGE X 1/2", 0.5 ML 31 GAUGE X 5/16, 1 ML 28 GAUGE, 1 ML 28 GAUGE X 1/2", 1 ML 29 GAUGE, 1 ML 29 GAUGE X 1/2", 1 ML 30 GAUGE X 5/16, 1 ML 30 GAUGE X 7/16", 1 ML 31 GAUGE X 5/16, 1/2 ML 28 GAUGE, 1/2 ML 28 GAUGE X 1/2", 1/2 ML 29 , 1/2 ML 30 GAUGE, 1/2 ML 30 GAUGE X 5/16

2

ULTRA-THIN II (SHORT) INS SYR 2

ULTRA-THIN II (SHORT) PEN NDL 2

ULTRA-THIN II INS PEN NEEDLES 2

ULTRA-THIN II INSULIN SYRINGE 2

UNIFINE PENTIPS 2

UNIFINE PENTIPS PLUS 2

UNISOL 4 2

UNI-SOLVE ADHESIVE REMOVER 2

UNISOLVE ADHESIVE REMOVER WIPE 2

UNISTIK 2 EXTRA 2

UNISTIK 2 NORMAL LANCET,DEVICE 2

UNIVERSAL REMOVER WIPES 2

UNNA-FLEX ELASTIC UNNA BOOT 2

VACUSTIM BLACK 2

VANISHPOINT SYRINGE SYRINGE 1 ML 29 GAUGE X 1/2", 1/2 ML 30 GAUGE X 1/2"

2

VARNAL 2

VASCUDERM HYDROGEL WOUND 2

VASELINE PETROLATUM GAUZE 2

VERSALON 2

VERSALON NONWOVEN ALL-PURPOSE 2

VERSIVA XC TOPICAL BANDAGE 10 X 8 ", 4 1/4 X 4 1/4 ", 5 1/2 X 5 1/2 ", 7 1/2 X 7 1/2 ", 8 X 7 "

2

VIGILON PRIMARY WOUND DRESSING 2

VISCOPASTE PB7 2

VISINE FOR CONTACTS 2

VISTEC X-RAY DETECT 2

VORTEX ADULT MASK 2

VORTEX FROG MASK-CHILD 2

VORTEX HOLDING CHAMBER 2

VORTEX HOLDING CHAMBER CHILD 2

VORTEX HOLDING CHAMBER TODDLER 2

VORTEX LADYBUG MASK-TODDLER 2

VORTEX VHC FROG MASK-CHILD 2

VORTEX VHC LADYBUG MASK-TODDLR 2

WATER SHIELD BANDAGES 2

WATERPROOF STRONG STRIPS 2

WEBRIL 2

112

Drug Name Tier NotesWEBRIL II 2

WINDMILL TRAINER 2

WINDOW BANDAGES 2

WOUNDGARD GAUZE 2

WOUN'DRES HYDROGEL WOUND DRESS 2

ZAROSEN DESENSITIZER 2

MUSCLE RELAXANTSAMRIX 2

baclofen 1

carisoprodol 1

carisoprodol-aspirin 1

chlorzoxazone 1

cyclobenzaprine oral tablet 1

dantrolene 1

GABLOFEN 2

LIORESAL 2

LORZONE 2

METAXALL 1

metaxalone 1

methocarbamol 1

orphenadrine citrate injection 1

orphenadrine citrate oral 1

REVONTO 1

RYANODEX 2

tizanidine 1

PRE-NATAL VITAMINSBAL-CARE DHA 1

BAL-CARE DHA ESSENTIAL 1

CALCIUM PNV 1

CITRANATAL (DUAL-IRON) 2

CITRANATAL DHA (ALGAL OIL) 2

C-NATE DHA 1

COMPLETE NATAL DHA 2

COMPLETENATE 1

DOTHELLE DHA 1

ENBRACE HR 2

EXTRA-VIRT PLUS DHA 1

FOCALGIN 90 DHA 1

FOCALGIN CA 1

FOLIVANE-OB 1

INATAL ADVANCE 1

INATAL ULTRA 1

MARNATAL-F 1

MTERYTI 2

113

Drug Name Tier NotesNESTABS ABC 2

NEXA PLUS 2

NIVA-PLUS 1

OB COMPLETE GOLD 2

OB COMPLETE ONE 2

OB COMPLETE PETITE 2

OB COMPLETE PREMIER 2

OB COMPLETE WITH DHA 2

O-CAL FA 1

O-CAL PRENATAL 1

PAIRE OB PLUS DHA 1

PNV 29-1 1

PNV-DHA 1

PNV-FERROUS FUMARATE-DOCU-FA 1

PNV-SELECT 1

PNV-VP-U 1

PR NATAL 400 1

PR NATAL 400 EC 1

PR NATAL 430 1

PR NATAL 430 EC 1

PREFERA-OB PLUS DHA 2

PRENAISSANCE 1

PRENAISSANCE PLUS 1

PRENATA 2

PRENATAL PLUS (CALCIUM CARB) 1

PRENATE AM 2

PRENATE CHEWABLE 2

PRENATE DHA 2

PRENATE DHA (FERR ASP GLYCIN) 2

PRENATE ELITE 2

PRENATE ELITE (IRON ASP GLYC) 2

PRENATE ENHANCE 2

PRENATE ESSENTIAL 2

PRENATE ESSENTIAL(IRON-ASP-GL) 2

PRENATE MINI 2

PRENATE MINI (FERR ASP GLYCIN) 2

PRENATE PIXIE 2

PRENATE RESTORE 2

PRENATE STAR 2

PREPLUS 1

PREQUE 10 2

PRETAB 1

PROVIDA DHA 2

PROVIDA OB 2

114

Drug Name Tier NotesPUREFE OB PLUS 1

PUREFE PLUS 1

RELNATE DHA 1

RULAVITE DHA 1

SELECT-OB 1

SELECT-OB (FOLIC ACID) 1

SELECT-OB + DHA 2

SE-NATAL 19 1

SE-NATAL 19 (WITH DOCUSATE) 1

SE-TAN DHA 1

TARON-C DHA 1

TARON-PREX PRENATAL-DHA 1

THRIVITE RX 2

THRIVITE-19 1

TL-SELECT 1

TRIADVANCE 1

TRICARE 2

TRICARE PRENATAL DHA ONE 2

TRINATAL GT 1

TRISTART DHA 2

TRIVEEN-DUO DHA 1

TRIVEEN-PRX RNF 1

ULTIMATECARE ONE 1

ULTIMATECARE ONE NF 1

VEMAVITE-PRX-2 1

VENA-BAL DHA 1

VINATE GT 1

VIRT-ADVANCE 1

VIRT-C DHA 1

VIRT-NATE 1

VIRT-NATE DHA 1

VIRT-PN 1

VIRT-PN DHA 1

VIRT-PN PLUS 1

VIRTPREX 1

VIRT-SELECT 1

VIRT-VITE GT 1

VITAFOL FE+ (WITH DOCUSATE) 2

VITAFOL NANO 1

VITAFOL ULTRA 2

VITAFOL-OB 2

VITAFOL-OB+DHA 1

VITAFOL-ONE 2

VOL-NATE 1

115

Drug Name Tier NotesVOL-PLUS 1

VP-CH PLUS 1

VP-CH-PNV 1

VP-GGR-B6 1

VP-HEME OB 1

VP-HEME ONE 1

VP-PNV-DHA 1

ZATEAN-CH 1

ZATEAN-PN DHA 1

ZATEAN-PN PLUS 1

ZINGIBER 1

PSYCHOTHERAPEUTIC DRUGSABILIFY MAINTENA 2 QL (1 EA per 28 days)

ABILIFY ORAL TABLET 10 MG, 15 MG, 2 MG, 30 MG 2 PA; QL (1 EA per 1 day)

ABILIFY ORAL TABLET 20 MG 2 PA; QL (2 EA per 1 day)

ABILIFY ORAL TABLET 5 MG 2 PA; QL (1.5 EA per 1 day)

ADASUVE 2

ALPRAZOLAM INTENSOL 2 QL (4 ML per 1 day)

alprazolam oral tablet 1 QL (4 EA per 1 day)

alprazolam oral tablet extended release 24 hr 1 QL (1 EA per 1 day)

alprazolam oral tablet,disintegrating 1 QL (4 EA per 1 day)

amitriptyline 1 QL (3 EA per 1 day)

amitriptyline-chlordiazepoxide 1

amoxapine oral tablet 100 mg, 50 mg 1 QL (4 EA per 1 day)

amoxapine oral tablet 150 mg, 25 mg 1 QL (2 EA per 1 day)

ANAFRANIL ORAL CAPSULE 25 MG 2 PA; QL (2 EA per 1 day)



APLENZIN 2 QL (1 EA per 1 day)

APTENSIO XR 2 QL (1 EA per 1 day)

aripiprazole oral solution 1 QL (30 ML per 1 day)

aripiprazole oral tablet 10 mg, 15 mg, 2 mg, 30 mg 1 QL (1 EA per 1 day)

aripiprazole oral tablet 20 mg 1 QL (2 EA per 1 day)

aripiprazole oral tablet 5 mg 1 QL (1.5 EA per 1 day)

aripiprazole oral tablet,disintegrating 1 QL (1 EA per 1 day)

ARISTADA 2 QL (1 EA per 28 days)

armodafinil oral tablet 150 mg, 200 mg, 250 mg 1 QL (1 EA per 1 day)

armodafinil oral tablet 50 mg 1 QL (2 EA per 1 day)

ATIVAN ORAL 2 PA; QL (4 EA per 1 day)

BRISDELLE 2 ST; QL (1 EA per 1 day)

bupropion hcl oral tablet 1 QL (4 EA per 1 day)

bupropion hcl oral tablet extended release 1 QL (2 EA per 1 day)

bupropion hcl oral tablet extended release 24 hr 1 QL (1 EA per 1 day)

buspirone oral tablet 10 mg, 15 mg, 5 mg, 7.5 mg 1 QL (3 EA per 1 day)

116

Drug Name Tier Notesbuspirone oral tablet 30 mg 1 QL (2 EA per 1 day)

CELEXA ORAL TABLET 2 PA; QL (1 EA per 1 day)

chlordiazepoxide hcl 1 QL (4 EA per 1 day)

chlorpromazine injection 1

chlorpromazine oral 1 QL (4 EA per 1 day)

citalopram oral solution 1 QL (20 ML per 1 day)

citalopram oral tablet 1 QL (1 EA per 1 day)

clomipramine oral capsule 25 mg 1 QL (2 EA per 1 day)



clonidine hcl oral tablet extended release 12 hr 1 QL (120 EA per 30 days)

clorazepate dipotassium 1 QL (4 EA per 1 day)

clozapine oral tablet 100 mg 1 QL (6 EA per 1 day)

clozapine oral tablet 200 mg, 25 mg, 50 mg 1 QL (3 EA per 1 day)

clozapine oral tablet,disintegrating 100 mg 1 QL (6 EA per 1 day)

clozapine oral tablet,disintegrating 12.5 mg, 150 mg, 200 mg, 25 mg


CLOZARIL ORAL TABLET 100 MG 2 PA; QL (6 EA per 1 day)

CLOZARIL ORAL TABLET 25 MG 2 PA; QL (3 EA per 1 day)

CONCERTA ORAL TABLET EXTENDED RELEASE 24HR 18 MG, 27 MG


CONCERTA ORAL TABLET EXTENDED RELEASE 24HR 36 MG, 54 MG


CYMBALTA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 20 MG, 30 MG


CYMBALTA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 60 MG


DAYTRANA 2 QL (1 EA per 1 day)

desipramine oral tablet 10 mg 1 QL (4 EA per 1 day)

desipramine oral tablet 100 mg 1 QL (3 EA per 1 day)

desipramine oral tablet 150 mg, 25 mg, 50 mg, 75 mg 1 QL (2 EA per 1 day)

desvenlafaxine fumarate oral tablet extended release 24hr 100 mg


desvenlafaxine fumarate oral tablet extended release 24hr 50 mg


desvenlafaxine oral tablet extended release 24 hr 100 mg 2 QL (2 EA per 1 day)

desvenlafaxine oral tablet extended release 24 hr 50 mg 2 QL (1 EA per 1 day)

desvenlafaxine oral tablet extended release 24hr 1 QL (1 EA per 1 day)

dexmethylphenidate oral capsule,er biphasic 50-50 1 QL (1 EA per 1 day)

dexmethylphenidate oral tablet 10 mg 1 QL (4 EA per 1 day)

dexmethylphenidate oral tablet 2.5 mg, 5 mg 1 QL (2 EA per 1 day)

diazepam injection 1

DIAZEPAM INTENSOL 1

diazepam oral concentrate 1

diazepam oral solution 5 mg/5 ml (1 mg/ml) 1 QL (8 ML per 1 day)

diazepam oral tablet 1 QL (4 EA per 1 day)

117

Drug Name Tier Notesdoxepin oral capsule 10 mg 1 QL (4 EA per 1 day)

doxepin oral capsule 100 mg, 150 mg, 25 mg, 50 mg, 75 mg 1 QL (2 EA per 1 day)

doxepin oral concentrate 1 QL (30 ML per 1 day)

droperidol injection solution 1

duloxetine 1 QL (2 EA per 1 day)

EFFEXOR XR ORAL CAPSULE,EXTENDED RELEASE 24HR 150 MG


EFFEXOR XR ORAL CAPSULE,EXTENDED RELEASE 24HR 37.5 MG


EFFEXOR XR ORAL CAPSULE,EXTENDED RELEASE 24HR 75 MG


EMSAM 2 QL (1 EA per 1 day)

EQUETRO ORAL CAPSULE, ER MULTIPHASE 12 HR 100 MG






escitalopram oxalate oral solution 1 QL (20 ML per 1 day)

escitalopram oxalate oral tablet 10 mg, 5 mg 1 QL (1 EA per 1 day)

escitalopram oxalate oral tablet 20 mg 1 QL (1.5 EA per 1 day)

FANAPT 2 QL (2 EA per 1 day)

FAZACLO ORAL TABLET,DISINTEGRATING 100 MG 2 PA; QL (6 EA per 1 day)

FAZACLO ORAL TABLET,DISINTEGRATING 12.5 MG, 150 MG, 200 MG, 25 MG


FETZIMA 2 QL (1 EA per 1 day)

fluoxetine oral capsule 10 mg 1 QL (1 EA per 1 day)



fluoxetine oral capsule,delayed release(dr/ec) 1 QL (4 EA per 28 days)

fluoxetine oral solution 1 QL (20 ML per 1 day)

fluoxetine oral tablet 10 mg 1 QL (1 EA per 1 day)



fluphenazine decanoate 1

fluphenazine hcl injection 1

fluphenazine hcl oral concentrate 1

fluphenazine hcl oral elixir 1

fluphenazine hcl oral tablet 1 QL (4 EA per 1 day)

fluvoxamine oral capsule,extended release 24hr 1 QL (2 EA per 1 day)

fluvoxamine oral tablet 100 mg 1 QL (3 EA per 1 day)

fluvoxamine oral tablet 25 mg, 50 mg 1 QL (1 EA per 1 day)

FOCALIN ORAL TABLET 10 MG 2 PA; QL (4 EA per 1 day)

FOCALIN ORAL TABLET 2.5 MG, 5 MG 2 PA; QL (2 EA per 1 day)

FOCALIN XR 2 PA; QL (1 EA per 1 day)

FORFIVO XL 2 QL (1 EA per 1 day)

118

Drug Name Tier NotesGEODON INTRAMUSCULAR 2

GEODON ORAL CAPSULE 20 MG, 40 MG 2 PA; QL (2 EA per 1 day)

GEODON ORAL CAPSULE 60 MG, 80 MG 2 PA; QL (3 EA per 1 day)

guanfacine oral tablet extended release 24 hr 1 QL (1 EA per 1 day)

HALDOL 2 PA

HALDOL DECANOATE 2 PA

haloperidol decanoate 1

haloperidol lactate 1

haloperidol oral tablet 0.5 mg, 1 mg, 10 mg, 2 mg, 5 mg 1 QL (3 EA per 1 day)

haloperidol oral tablet 20 mg 1

imipramine hcl oral tablet 10 mg 1 QL (2 EA per 1 day)



imipramine pamoate oral capsule 100 mg 1 QL (3 EA per 1 day)

imipramine pamoate oral capsule 125 mg, 150 mg 1 QL (2 EA per 1 day)

imipramine pamoate oral capsule 75 mg 1 QL (1 EA per 1 day)

INTUNIV ER 2 PA; QL (1 EA per 1 day)

INVEGA ORAL TABLET EXTENDED RELEASE 24HR 1.5 MG, 3 MG, 9 MG


INVEGA ORAL TABLET EXTENDED RELEASE 24HR 6 MG


INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 117 MG/0.75 ML

2 QL (117 MG per 28 days)

INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 156 MG/ML








INVEGA TRINZA INTRAMUSCULAR SYRINGE 273 MG/0.875 ML








IRENKA 2 PA; QL (2 EA per 1 day)

KAPVAY 2 PA; QL (4 EA per 1 day)

KHEDEZLA ORAL TABLET EXTENDED RELEASE 24HR 100 MG


KHEDEZLA ORAL TABLET EXTENDED RELEASE 24HR 50 MG


LATUDA ORAL TABLET 120 MG, 20 MG, 40 MG, 60 MG


LATUDA ORAL TABLET 80 MG 2 QL (60 EA per 30 days)

119

Drug Name Tier NotesLEXAPRO ORAL SOLUTION 2 PA; QL (20 ML per 1 day)

LEXAPRO ORAL TABLET 10 MG, 5 MG 2 PA; QL (1 EA per 1 day)

LEXAPRO ORAL TABLET 20 MG 2 PA; QL (1.5 EA per 1 day)

lithium carbonate 1

lithium citrate oral solution 8 meq/5 ml 1

LITHOBID 2

LORAZEPAM INTENSOL 1

lorazepam oral concentrate 1

lorazepam oral tablet 1 QL (4 EA per 1 day)

loxapine succinate 1 QL (4 EA per 1 day)

maprotiline 1 QL (3 EA per 1 day)

MARPLAN 2 QL (3 EA per 1 day)

meprobamate 1 QL (4 EA per 1 day)

METADATE CD 2 PA; QL (1 EA per 1 day)

METADATE ER 1 QL (90 EA per 30 days)

METHYLIN ORAL SOLUTION 10 MG/5 ML 2 PA; QL (30 ML per 1 day)

METHYLIN ORAL SOLUTION 5 MG/5 ML 2 PA; QL (60 ML per 1 day)

METHYLIN ORAL TABLET,CHEWABLE 10 MG 2 PA; QL (4 EA per 1 day)

METHYLIN ORAL TABLET,CHEWABLE 2.5 MG, 5 MG


methylphenidate oral capsule, er biphasic 30-70 1 QL (1 EA per 1 day)

methylphenidate oral capsule,er biphasic 50-50 1 QL (1 EA per 1 day)

methylphenidate oral solution 10 mg/5 ml 1 QL (30 ML per 1 day)

methylphenidate oral solution 5 mg/5 ml 1 QL (60 ML per 1 day)

methylphenidate oral tablet 10 mg, 5 mg 1 QL (3 EA per 1 day)

methylphenidate oral tablet 20 mg 1 QL (90 EA per 30 days)

methylphenidate oral tablet extended release 10 mg 1 QL (1 EA per 1 day)

methylphenidate oral tablet extended release 20 mg 1 QL (3 EA per 1 day)

methylphenidate oral tablet extended release 24hr 18 mg, 27 mg


methylphenidate oral tablet extended release 24hr 36 mg, 54 mg


methylphenidate oral tablet,chewable 1 QL (3 EA per 1 day)

mirtazapine 1 QL (1 EA per 1 day)

modafinil oral tablet 100 mg 1 QL (1 EA per 1 day)

modafinil oral tablet 200 mg 1 QL (2 EA per 1 day)

molindone oral tablet 10 mg, 5 mg 1 QL (4 EA per 1 day)

molindone oral tablet 25 mg 1 QL (9 EA per 1 day)

NARDIL 2 PA; QL (6 EA per 1 day)

nefazodone 1 QL (2 EA per 1 day)

NORPRAMIN ORAL TABLET 10 MG 2 PA; QL (4 EA per 1 day)

NORPRAMIN ORAL TABLET 100 MG 2 PA; QL (3 EA per 1 day)

NORPRAMIN ORAL TABLET 150 MG, 25 MG, 50 MG 2 PA; QL (2 EA per 1 day)

nortriptyline oral capsule 10 mg, 25 mg 1 QL (4 EA per 1 day)

nortriptyline oral capsule 50 mg 1 QL (3 EA per 1 day)

120

Drug Name Tier Notesnortriptyline oral capsule 75 mg 1 QL (2 EA per 1 day)

nortriptyline oral solution 1 QL (20 ML per 1 day)

NUPLAZID 2 QL (2 EA per 1 day)

NUVIGIL ORAL TABLET 150 MG, 200 MG, 250 MG 2 QL (1 EA per 1 day)

NUVIGIL ORAL TABLET 50 MG 2 QL (2 EA per 1 day)

olanzapine intramuscular 1

olanzapine oral tablet 10 mg, 15 mg 1 QL (2 EA per 1 day)

olanzapine oral tablet 2.5 mg, 5 mg, 7.5 mg 1 QL (1 EA per 1 day)

olanzapine oral tablet 20 mg 1 QL (3 EA per 1 day)

olanzapine oral tablet,disintegrating 10 mg, 15 mg 1 QL (2 EA per 1 day)

olanzapine oral tablet,disintegrating 20 mg 1 QL (3 EA per 1 day)

olanzapine oral tablet,disintegrating 5 mg 1 QL (1 EA per 1 day)

olanzapine-fluoxetine 1 QL (1 EA per 1 day)

OLEPTRO ER ORAL TABLET EXTENDED RELEASE 24 HR 150 MG

2 QL (1.5 EA per 1 day)

OLEPTRO ER ORAL TABLET EXTENDED RELEASE 24 HR 300 MG


ORAP ORAL TABLET 1 MG 2 PA; QL (10 EA per 1 day)

ORAP ORAL TABLET 2 MG 2 PA; QL (5 EA per 1 day)

oxazepam 1 QL (4 EA per 1 day)

paliperidone oral tablet extended release 24hr 1.5 mg, 3 mg, 9 mg


paliperidone oral tablet extended release 24hr 6 mg 1 QL (2 EA per 1 day)

PAMELOR ORAL CAPSULE 10 MG, 25 MG 2 PA; QL (4 EA per 1 day)

PAMELOR ORAL CAPSULE 50 MG 2 PA; QL (3 EA per 1 day)

PAMELOR ORAL CAPSULE 75 MG 2 PA; QL (2 EA per 1 day)

PARNATE 2 PA; QL (6 EA per 1 day)

paroxetine hcl oral tablet 10 mg, 20 mg 1 QL (1 EA per 1 day)

paroxetine hcl oral tablet 30 mg, 40 mg 1 QL (2 EA per 1 day)

paroxetine hcl oral tablet extended release 24 hr 1 QL (1 EA per 1 day)

PAXIL CR 2 PA; QL (1 EA per 1 day)

PAXIL ORAL SUSPENSION 2 QL (40 ML per 1 day)

PAXIL ORAL TABLET 10 MG, 20 MG 2 PA; QL (1 EA per 1 day)

PAXIL ORAL TABLET 30 MG, 40 MG 2 PA; QL (2 EA per 1 day)

perphenazine 1 QL (4 EA per 1 day)

perphenazine-amitriptyline 1

PEXEVA 2 QL (1 EA per 1 day)

phenelzine 1 QL (6 EA per 1 day)

pimozide oral tablet 1 mg 1 QL (10 EA per 1 day)

pimozide oral tablet 2 mg 1 QL (5 EA per 1 day)

PRISTIQ ORAL TABLET EXTENDED RELEASE 24 HR 100 MG


PRISTIQ ORAL TABLET EXTENDED RELEASE 24 HR 25 MG, 50 MG


protriptyline 1 QL (4 EA per 1 day)

121

Drug Name Tier NotesPROVIGIL ORAL TABLET 100 MG 2 PA; QL (1 EA per 1 day)

PROVIGIL ORAL TABLET 200 MG 2 PA; QL (2 EA per 1 day)

PROZAC ORAL CAPSULE 10 MG 2 PA; QL (1 EA per 1 day)

PROZAC ORAL CAPSULE 20 MG 2 PA; QL (4 EA per 1 day)

PROZAC ORAL CAPSULE 40 MG 2 QL (2 EA per 1 day)

PROZAC WEEKLY 2 PA; QL (4 EA per 28 days)

quetiapine oral tablet 100 mg, 200 mg, 25 mg, 50 mg 1 QL (3 EA per 1 day)

quetiapine oral tablet 300 mg, 400 mg 1 QL (4 EA per 1 day)

QUILLICHEW ER ORAL TABLET,CHEW,IR-ER.BIPHASIC24HR 20 MG, 40 MG


QUILLICHEW ER ORAL TABLET,CHEW,IR-ER.BIPHASIC24HR 30 MG


QUILLIVANT XR 2 QL (12 ML per 1 day)

REMERON 2 PA; QL (1 EA per 1 day)

REMERON SOLTAB 2 PA; QL (1 EA per 1 day)

REXULTI 2 QL (1 EA per 1 day)

RISPERDAL CONSTA 2 QL (2 EA per 28 days)

RISPERDAL M-TAB 2 PA; QL (2 EA per 1 day)

RISPERDAL ORAL SOLUTION 2 PA; QL (8 ML per 1 day)

RISPERDAL ORAL TABLET 2 PA; QL (2 EA per 1 day)

risperidone oral solution 1 QL (8 ML per 1 day)

risperidone oral tablet 1 QL (2 EA per 1 day)

risperidone oral tablet,disintegrating 1 QL (2 EA per 1 day)

RITALIN 2 PA; QL (3 EA per 1 day)

RITALIN LA ORAL CAPSULE,ER BIPHASIC 50-50 10 MG, 20 MG, 40 MG


RITALIN LA ORAL CAPSULE,ER BIPHASIC 50-50 30 MG


RITALIN LA ORAL CAPSULE,ER BIPHASIC 50-50 60 MG


SAPHRIS (BLACK CHERRY) 2 QL (2 EA per 1 day)

SARAFEM ORAL TABLET 10 MG 2 PA; QL (1.5 EA per 1 day)

SARAFEM ORAL TABLET 20 MG 2 PA; QL (4 EA per 1 day)

SEROQUEL ORAL TABLET 100 MG, 200 MG, 25 MG 2 PA; QL (3 EA per 1 day)

SEROQUEL ORAL TABLET 300 MG, 400 MG 2 PA; QL (4 EA per 1 day)

SEROQUEL ORAL TABLET 50 MG 2 QL (3 EA per 1 day)

SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HR 150 MG, 200 MG


SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HR 300 MG






SEROQUEL XR ORAL TABLET, EXT REL 24HR DOSE PACK

2

sertraline oral concentrate 1 QL (10 ML per 1 day)

122

Drug Name Tier Notessertraline oral tablet 100 mg 1 QL (3 EA per 1 day)

sertraline oral tablet 25 mg, 50 mg 1 QL (2 EA per 1 day)

STRATTERA ORAL CAPSULE 10 MG, 18 MG, 25 MG, 40 MG


STRATTERA ORAL CAPSULE 100 MG, 60 MG, 80 MG 2 QL (30 EA per 30 days)

SURMONTIL ORAL CAPSULE 100 MG 2 PA; QL (3 EA per 1 day)

SURMONTIL ORAL CAPSULE 25 MG, 50 MG 2 PA; QL (1 EA per 1 day)

SYMBYAX 2 PA; QL (1 EA per 1 day)

thioridazine 1 QL (4 EA per 1 day)

thiothixene 1 QL (3 EA per 1 day)

TOFRANIL ORAL TABLET 10 MG 2 PA; QL (2 EA per 1 day)



TRANXENE T-TAB ORAL TABLET 3.75 MG, 7.5 MG 2 PA; QL (4 EA per 1 day)

tranylcypromine 1 QL (6 EA per 1 day)

trazodone oral tablet 100 mg, 150 mg 1 QL (3 EA per 1 day)

trazodone oral tablet 300 mg, 50 mg 1 QL (2 EA per 1 day)

trifluoperazine oral tablet 1 mg, 2 mg, 5 mg 1 QL (2 EA per 1 day)

trifluoperazine oral tablet 10 mg 1 QL (4 EA per 1 day)

trimipramine oral capsule 100 mg 1 QL (3 EA per 1 day)

trimipramine oral capsule 25 mg, 50 mg 1 QL (1 EA per 1 day)

TRINTELLIX 2 QL (1 EA per 1 day)

VALIUM 2 PA; QL (4 EA per 1 day)

venlafaxine oral capsule,extended release 24hr 150 mg 1 QL (2 EA per 1 day)

venlafaxine oral capsule,extended release 24hr 37.5 mg 1 QL (1 EA per 1 day)

venlafaxine oral capsule,extended release 24hr 75 mg 1 QL (3 EA per 1 day)

venlafaxine oral tablet 1 QL (3 EA per 1 day)

venlafaxine oral tablet extended release 24hr 150 mg 1 QL (2 EA per 1 day)

venlafaxine oral tablet extended release 24hr 225 mg, 37.5 mg


venlafaxine oral tablet extended release 24hr 75 mg 1 QL (3 EA per 1 day)

VERSACLOZ 2 QL (12 ML per 1 day)

VIIBRYD ORAL TABLET 2 QL (1 EA per 1 day)

VIIBRYD ORAL TABLETS,DOSE PACK 10 MG (7)- 20 MG (23)


VRAYLAR ORAL CAPSULE 1.5 MG 2 QL (2 EA per 1 day)

VRAYLAR ORAL CAPSULE 3 MG, 4.5 MG, 6 MG 2 QL (1 EA per 1 day)

VRAYLAR ORAL CAPSULE,DOSE PACK 2 QL (1 EA per 28 days)

VYVANSE 2 QL (1 EA per 1 day)

WELLBUTRIN SR 2 PA; QL (2 EA per 1 day)

WELLBUTRIN XL 2 PA; QL (1 EA per 1 day)

XANAX 2 PA; QL (4 EA per 1 day)

XANAX XR 2 PA; QL (1 EA per 1 day)

ziprasidone hcl oral capsule 20 mg, 40 mg 1 QL (2 EA per 1 day)

ziprasidone hcl oral capsule 60 mg, 80 mg 1 QL (3 EA per 1 day)

123

Drug Name Tier NotesZOLOFT ORAL CONCENTRATE 2 PA; QL (10 ML per 1 day)

ZOLOFT ORAL TABLET 100 MG 2 PA; QL (3 EA per 1 day)

ZOLOFT ORAL TABLET 25 MG, 50 MG 2 PA; QL (2 EA per 1 day)

ZYPREXA ORAL TABLET 10 MG, 15 MG 2 PA; QL (2 EA per 1 day)

ZYPREXA ORAL TABLET 2.5 MG, 5 MG, 7.5 MG 2 PA; QL (1 EA per 1 day)

ZYPREXA ORAL TABLET 20 MG 2 PA; QL (3 EA per 1 day)

ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 210 MG, 300 MG


ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 405 MG


ZYPREXA ZYDIS ORAL TABLET,DISINTEGRATING 10 MG








SEDATIVE/HYPNOTICSAMBIEN 2 PA; QL (1 EA per 1 day)

AMBIEN CR 2 PA; QL (1 EA per 1 day)

AMYTAL 1

BELSOMRA 2 QL (1 EA per 1 day)

BUTISOL ORAL TABLET 30 MG 2 QL (3 EA per 1 day)

dexmedetomidine 1

DORAL 2 PA; QL (1 EA per 1 day)

EDLUAR 2 QL (1 EA per 1 day)

estazolam 1 QL (1 EA per 1 day)

eszopiclone 1 QL (1 EA per 1 day)

flurazepam 1 QL (1 EA per 1 day)

HALCION ORAL TABLET 0.25 MG 2 PA; QL (1 EA per 1 day)

HETLIOZ 2 QL (1 EA per 1 day)

INTERMEZZO 2 QL (1 EA per 1 day)

lorazepam injection 1

LUNESTA 2 PA; QL (1 EA per 1 day)

midazolam oral syrup 2 mg/ml 1

NEMBUTAL SODIUM 2

NIGHTTIME SLEEP AID (DIPHEN) ORAL CAPSULE 50 MG

1

NIGHTTIME SLEEP AID (DIPHEN) ORAL TABLET 1

NYTOL 1

phenobarbital 1

phenobarbital sodium injection solution 1

PRECEDEX 2 PA

PRECEDEX IN 0.9 % SODIUM CHLOR 2

124

Drug Name Tier Notesquazepam 1 QL (1 EA per 1 day)

RESTFULLY SLEEP 1

RESTORIL 2 PA; QL (1 EA per 1 day)

ROZEREM 2 QL (1 EA per 1 day)

SECONAL SODIUM 2

SILENOR 2 QL (1 EA per 1 day)

SLEEP 1

SLEEP AID (DIPHENHYDRAMINE) ORAL CAPSULE 50 MG

1

SLEEP AID (DIPHENHYDRAMINE) ORAL TABLET 1

SLEEP AID (DOXYLAMINE) 1

SLEEP AID MAX STR (DIPHENHYDR) 1

SLEEP TIME 1

SLEEP-TABS 1

SONATA 2 PA; QL (2 EA per 1 day)

temazepam 1 QL (1 EA per 1 day)

triazolam 1 QL (1 EA per 1 day)

XYREM 2 QL (18 ML per 1 day)

zaleplon 1 QL (2 EA per 1 day)

zolpidem oral 1 QL (1 EA per 1 day)

ZOLPIMIST 2 QL (5 MG per 1 day)

Z-SLEEP 1

ZZZQUIL ORAL CAPSULE 2

ZZZQUIL ORAL LIQUID 1

SKIN PREPS4-N-1 NO RINSE WASH 1

8-MOP 2

ABSORICA 2 ST

acetic acid irrigation 1

acitretin 1

ACLARO 2

ACNE MEDICATION TOPICAL GEL 10 % 1

ACNE MEDICATION TOPICAL LOTION 10 % 1

ACNE MEDICATION TOPICAL LOTION 5 % 2

ACNE TREATMENT (BENZOYL PEROX) TOPICAL CREAM

1

ACNEFREE ACNE CLEARING SYSTEM 1

ACNEFREE SEVERE ACNE CLEARING 2

ACZONE TOPICAL GEL 2

adapalene topical cream 1

adapalene topical gel 1

adapalene topical gel with pump 1

alclometasone 1

ALCOHOL PADS 2

125

Drug Name Tier NotesALCOHOL PREP PADS 2

ALCOHOL PREP SWABS 2

alcohol swabs 2

ALCOHOL WIPES 2

ALOE VESTA 2

ALOE VESTA SKIN CONDITIONER 2 1

ALTABAX 2

amcinonide 1

ammonium and potassium iodides 1

ammonium lactate 1

AMPHADASE 2

ANALGESIC CREME 1

ANALPRAM-HC TOPICAL 2

ANTI-DANDRUFF 1

ANTI-DANDRUFF (COAL TAR) 1

ANTI-ITCH (DIPHENHYDRAMINE) TOPICAL AEROSOL,SPRAY

1

ANTI-ITCH (HC) TOPICAL CREAM 1

ANTI-ITCH(DIPHENHYD) WITH ZINC TOPICAL AEROSOL,SPRAY

1

ANTI-ITCH(DIPHENHYD) WITH ZINC TOPICAL CREAM 2-0.1 %

1

ANTISEPTIC GEL 2

APEXICON E 2

AQUA GLYCOLIC CLEANSER 2

ARGLAES TOPICAL POWDER 2

ARTHRICREAM 1

ARTHRICREAM RUB 1

ARTHRITIS 1

ARTHRITIS PAIN RELIEF(CAPSAIC) 1

ARTISS 2

ASTRINGENT 1

AVEENO BABY TOPICAL CLEANSER 2

AVITA 1

AZELEX 2

BABY WASH 2

BANOPHEN ANTI-ITCH 1

BAZA CLEANSE AND PROTECT TOPICAL LOTION 1

BAZA CLEANSE AND PROTECT TOPICAL SPRAY,NON-AEROSOL

1

BAZA CLEAR 2

BAZA PROTECT 2

BD ALCOHOL SWABS 2

BEDSIDE-CARE 1

BENSAL HP TOPICAL OINTMENT 3 % 2

126

Drug Name Tier NotesBENZACLIN PUMP 2

BENZEPRO (MICROSPHERES) 1

BENZEPRO TOPICAL FOAM 1

BENZOIN COMPOUND TOPICAL TINCTURE 10-2-8-4 %

1

benzoyl peroxide topical cleanser 10 %, 3 %, 5 %, 6 %, 7 %, 9 %

1

benzoyl peroxide topical foam 1

benzoyl peroxide topical gel 10 %, 2.5 %, 5 % 1

benzoyl peroxide topical lotion 10 % 1

BETADINE SKIN CLEANSER 2

BETADINE TOPICAL SPRAY,NON-AEROSOL 2

betamethasone dipropionate 1

betamethasone valerate 1

betamethasone, augmented 1

BETASEPT SURGICAL SCRUB 1

BLUE GEL 1

BP-50% UREA 1

BPO CREAMY WASH PACK 1

BPO TOPICAL TOWELETTE 6 % 1

CALADRYL 1

calamine 1

CALAMINE MEDICATED 1

calamine phenolated 1

calamine-zinc oxide topical lotion 8-8 % 1

calamine-zinc oxide-phenol 1

calcipotriene 1 ST

calcipotriene-betamethasone 1 ST

CALCITRENE 1 ST

calcitriol topical 1 ST

CALDYPHEN CLEAR 1

CALDYPHEN TOPICAL LOTION 1-8 % 1

CALLERGY CLEAR 1

CAMPHOR BLOCKS 2

camphor topical 1

CAPEX 2

capsaicin topical cream 0.025 %, 0.1 % 1

CARRINGTON MOIST BARRIER-ZINC 2

CARRINGTON MOISTURE BARRIER CR 2

CASTELLANI PAINT MODIFIED 2

CAVILON SKIN CLEANSER 2

CEM-UREA 1

CERAVE BABY MOISTURIZING 2

CERAVE SUNSCREEN 2

127

Drug Name Tier NotesCETA-KLENZ GENTLE 2

CETAPHIL ANTIBACTERIAL 2

CETAPHIL DAILY FACIAL 2

CETAPHIL DERMACONTROL 2

CETAPHIL RESTORADERM TOPICAL CLEANSER 2

CETAPHIL TOPICAL CLEANSER 2

CHEST RUB TOPICAL OINTMENT 1

CHLOROPHYLL 2

CLARAVIS 1

clindamycin-benzoyl peroxide topical gel 1

clobetasol 1

clobetasol-emollient 1

clocortolone pivalate 1

CLODAN KIT 2

COATS ALOE ANALGESIC 2

COATS ALOE MOISTURIZING 2

COATS ALOE TOPICAL CREAM 2

COATS ALOE TOPICAL GEL 2

COLD AND HOT PAIN RELIEF TOPICAL ADHESIVE PATCH,MEDICATED

1

COLD SORE TREATMNT (CAMP-PHEN) 1

COMPLETE LICE TREATMENT 1

CONDYLOX TOPICAL GEL 2

CORDRAN TAPE LARGE ROLL 2

CORDRAN TAPE SMALL ROLL 2

CORMAX SCALP 1

COSENTYX 2 PA

COSENTYX (2 SYRINGES) 2 PA

COSENTYX PEN 2 PA

COSENTYX PEN (2 PENS) 2 PA

CRITIC-AID 1

CRITIC-AID CLEAR 2

CURITY ALCOHOL SWABS 2

DEODORANT SOAP 2

DERMA STAT 2

DERMAL WOUND CLEANSER TOPICAL CLEANSER 2

DERMAL WOUND CLEANSER TOPICAL CLEANSER 0.13 %

1

DERMASARRA 1

DERMASEPTIN 1

DESONATE 2

desonide 1

desoximetasone 1

DHS ZINC 1

128

Drug Name Tier NotesDIAPER RASH RELIEF 1

DIAPER RASH TOPICAL OINTMENT 1

diclofenac sodium topical drops 1

diflorasone 1

doxepin topical 1

DR. SMITH'S ADULT BARRIER 2

DR. SMITH'S DIAPER 1

DR. SMITH'S DIAPER RASH 2

DR. SMITH'S RASH-SKIN 2

DYNA-HEX 1

DYNA-HEX (ISOPROPYL ALCOHOL) 1

EASY TOUCH ALCOHOL PREP PADS 2

ELTA SEAL MOISTURE BARRIER 2

ENSTILAR 2 ST

EPI-CLENZ TOPICAL FOAM 2

EPIDUO 2 ST; QL (45 GM per 30 days)

EPIDUO FORTE 2 ST; QL (45 GM per 30 days)

EPIFOAM 2

ESOTERICA FADE 2

ethyl alcohol 2

EURAX 2

FABIOR 2

FINACEA 2

FLECTOR 2

fluocinolone 1

fluocinolone and shower cap 1

fluocinonide 1

FLUOCINONIDE-E 1

fluticasone topical 1

FRESHNET 2

GENTLE RAIN 1

guaiacol 2

halobetasol propionate 1

HALOG 2

HAND SANITIZER 2

HEX-ON LIGHT ODOR 2

hydrocortisone acetate topical cream 1

hydrocortisone butyrate 1

hydrocortisone butyr-emollient 1

HYDROCORTISONE PLUS 1

hydrocortisone topical cream 1

hydrocortisone topical lotion 1

hydrocortisone topical ointment 1

hydrocortisone valerate 1

129

Drug Name Tier Noteshydrocortisone-aloe vera topical cream 1 % 1

hydrocortisone-min oil-wht pet 1

hydrocortisone-pramoxine topical 1

hydrogen peroxide 1

hydrogen peroxide topical towelette 1

hydroquinone 1

hydroquinone microspheres 1

HYDROSKIN TOPICAL LOTION 1

HYDROSKIN WITH ALOE 1

HYGIENIC CLEANSING 1

ICY HOT MEDICATED SLEEVE 2

imiquimod 1 PA; QL (24 EA per 30 days)

IODIDES TINCTURE 1

iodine-sodium iodide topical tincture 2 % 1

iodoquinol-hc 1

ISAGEL 2

ISAGEL NO RINSE 2

ISOPROPYL ALCOHOL-WINTERGREEN 1

ITCH RELIEF TOPICAL CREAM 2-0.1 % 1

ITCH-X 2

IV PREP WIPES 2

lactated ringers irrigation 2

LICE KILLING 1

LICE SOLUTION 1

LICE TREATMENT (PERMETHRIN) 1

LICE TREATMENT TOPICAL LIQUID 1 % 1

LICE TREATMENT TOPICAL SHAMPOO 1

lidocaine hcl-hydrocortison ac topical 1

lindane topical shampoo 1

malathion 1

MEDI PADS 1

MEDICATED BODY 1

MEDICATED BODY POWDER TOPICAL POWDER 0.15 %

2

MEDICATED BODY POWDER TOPICAL POWDER 0.15-1 %

1

MEDICATED CHEST RUB 1

MEDICATED WIPES TOPICAL PADS, MEDICATED 1

MEDICATED WIPES WITH ALOE 1

MEDIPLAST CORN-CALLUS-WART 1

methoxsalen rapid 1

metronidazole topical 1

MIRVASO TOPICAL GEL 2 QL (30 GM per 30 days)

MOBISYL 1

130

Drug Name Tier NotesMOISTURE RECOVERY 2

mometasone topical 1

MUSCLE RUB (WITH CAMPHOR) 1

MUSCLE RUB TOPICAL CREAM 15-10 % 1

MUSCLE RUB ULTRA-STRENGTH 1

MYOFLEX 1

MYORISAN 1

neomycin-polymyxin b gu 1

NEUAC 1

NEUAC KIT 2

NEUTROGENA TONER 2

NO STING BARRIER FILM 2

NORITATE 2

OATMEAL BATH REGULAR 1

ODOR ELIMINATOR DROPS 2

ONEXTON TOPICAL GEL 2

OVACE PLUS SHAMPOO 2

OVACE PLUS TOPICAL CLEANSER,EXTENDED RELEASE

2

OVACE PLUS TOPICAL CREAM 2

OVACE PLUS TOPICAL FOAM 2

OVACE PLUS TOPICAL LOTION 2 ST

OXSORALEN 2

PACNEX HP 2

PACNEX LP 2

PACNEX MX 2

PAIN RELIEF INSTANT ANTISEPTIC 1

PANDEL 2

PANOXYL TOPICAL CLEANSER 1

PANOXYL TOPICAL CREAM 2

PANOXYL-4 1

PEDI-BORO SOAK 1

PENNSAID TOPICAL SOLUTION IN METERED-DOSE PUMP

2 ST

PERIFRESH 2

PERIGUARD 1

PERISCENT 2

permethrin 1

pine tar (bulk) 2

PODOCON 1

podofilox 1

povidone-iodine topical ointment 1

povidone-iodine topical solution 10 % 1

PRAMOSONE E 2

131

Drug Name Tier NotesPRAMOSONE TOPICAL CREAM 1-1 % 2

PRAMOSONE TOPICAL LOTION 2

PRAMOSONE TOPICAL OINTMENT 2

prednicarbate 1

PROCTO-PAK 1

PROCTOZONE-HC 1

PROSHIELD PLUS 1

QUTENZA 2 PA

REGRANEX 2

REHYLA HAIR-BODY 2

REMEDY 4-IN-1 CLEANSER 1

REMEDY CALAZIME PROTECT PASTE TOPICAL PASTE 3.5-0.2-69-16.5 %

2

REMEDY CLEANSING BODY 2

REMEDY CLEAR-AID PROTECT 2

REMEDY PHYTOPLEX Z-GUARD (ZN) 2

REMEDY SKIN REPAIR 2

RENEWAL HAND SANITIZER 2

RETIN-A MICRO PUMP TOPICAL GEL WITH PUMP 0.08 %

2

ringers irrigation 1

ROSADAN TOPICAL CREAM 1

ROSADAN TOPICAL KIT, CLEANSER AND GEL 2

ROSADAN TOPICAL KIT,CLEANSER AND CREAM 2

RUBBING ALCOHOL (ETHANOL) 2

SALACTIC FILM 1

salicylic acid er-ceramides topical kit,cleanser and cream er 1

salicylic acid topical cream 1

salicylic acid topical film forming liquid w/appl 1

salicylic acid topical foam 1

salicylic acid topical gel 1

salicylic acid topical liquid 26 % 1

salicylic acid topical lotion 1

salicylic acid topical shampoo 1

SAL-PLANT 1

SANTYL 2

SCALPICIN ANTI-ITCH 1

SEBEX 1

SEB-PREV 1

SECURA DIMETHICONE TOPICAL CREAM 1

SECURA EXTRA PROTECTIVE 2

SECURA MOISTURIZING TOPICAL CLEANSER 1

SECURA PERSONAL 1

SECURA PERSONAL SKIN CARE 2

132

Drug Name Tier NotesSECURA PROTECTIVE TOPICAL CREAM 2

SECURA PROTECTIVE TOPICAL OINTMENT 1

SECURA STARTER KIT 2

SECURA TOTAL BODY CLEANSER 2

SECURA TWO-STEP KIT 2

selenium sulfide topical lotion 1

selenium sulfide topical shampoo 2.25 % 1

SENSI-CARE (FOAM) 2

SENSI-CARE MOISTURIZING 2 2

SERNIVO 1 ST

silver nitrate topical solution 0.5 % 1

SILVERMED TOPICAL CLEANSER 2

SKIN CLEANSER 2

SKINTEGRITY WOUND CLEANSER 2

SKLICE 2

sodium chloride irrigation 1

SOOLANTRA 2

SOOTHE AND COOL BODY POWDER 2

SOOTHE AND COOL FREE MEDSEPTIC 2

SOOTHE AND COOL SKIN PASTE 1

SOOTHE AND COOL TOPICAL SOAP 2

SOOTHE-COOL MOISTURE BARRIER 2

sorbitol irrigation 1

sorbitol-mannitol 1

SORILUX 2 ST

spinosad 1

sulfacetamide sodium (acne) 1

sulfacetamide sodium topical 1

SURE COMFORT ALCOHOL PREP PADS 2

SURE-PREP ALCOHOL PREP PADS 2

SYNALAR CREAM KIT 2

SYNALAR OINTMENT KIT 2

SYNALAR TS 2

TACLONEX TOPICAL SUSPENSION 2 ST

TALTZ AUTOINJECTOR 2 PA

TALTZ AUTOINJECTOR (2 PACK) 2 PA

TALTZ AUTOINJECTOR (3 PACK) 2 PA

TALTZ SYRINGE 2 PA

TALTZ SYRINGE (2 PACK) 2 PA

TALTZ SYRINGE (3 PACK) 2 PA

TAZORAC 2

TEXACORT 2

THERA-GEL 1

THERA-GESIC PLUS 2

133

Drug Name Tier NotesTHERA-GESIC TOPICAL CREAM 15-1 % 1

THERAPEUTIC MINERAL ICE 1

THERASEAL 1

TOPICORT TOPICAL SPRAY,NON-AEROSOL 2 ST

tretinoin microspheres 1

tretinoin topical 1

triamcinolone acetonide topical aerosol 1

triamcinolone acetonide topical cream 1

triamcinolone acetonide topical lotion 1

triamcinolone acetonide topical ointment 0.025 %, 0.1 %, 0.5 %

1

TRIANEX 1

TRI-LUMA 2

TRIXAICIN 1

TRIXAICIN HP 1

trolamine salicylate 1

ULESFIA 2

ULTILET ALCOHOL SWAB 2

ULTRA-FRESH TOPICAL 2

ULTRAVATE X 2

UMECTA PD 2

UMECTA TOPICAL EMULSION 2

UMECTA TOPICAL FOAM 1

URAMAXIN GT TOPICAL KIT,CREAM AND GEL 2

URAMAXIN TOPICAL FOAM 2

urea topical cream 40 % 1

urea topical foam 1

urea topical gel 1

urea topical lotion 40 %, 45 % 1

VELTIN 2

VICKS VAPORUB TOPICAL OINTMENT 4.7-1.2-2.6 % 2

VICKS VAPORUB TOPICAL OINTMENT 4.8-1.2-2.6 % 1

vitamin a and d 1

VITRASE 2

vits a and d-white pet-lanolin 1

VOLTAREN TOPICAL 2

water for irrigation, sterile 1

WEBCOL 2

witch hazel leaf (hamamelis) 1

WITCH HAZEL TOPICAL LIQUID 1

witch hazel topical solution 1

WOUND AND SKIN CLEANSER 2

WOUND CLEANSER 2

WOUND GEL 2

134

Drug Name Tier NotesZENATANE 1

ZIANA 2

ZIKS ARTHRITIS PAIN RELIEF 2

zinc oxide topical ointment 20 % 1

ZYCLARA TOPICAL CREAM IN METERED-DOSE PUMP 2.5 %

2 PA; QL (7.5 GM per 1 day)

ZYCLARA TOPICAL CREAM IN METERED-DOSE PUMP 3.75 %

2 PA; QL (7.5 GM per 28 days)

ZYCLARA TOPICAL CREAM IN PACKET 2 PA; QL (1 EA per 1 day)

SMOKING DETERRENTSCHANTIX 2 QL (2 EA per 1 day)

CHANTIX CONTINUING MONTH BOX 2 QL (2 EA per 1 day)

CHANTIX STARTING MONTH BOX 2 QL (2 EA per 1 day)

NICODERM CQ TRANSDERMAL PATCH 24 HOUR 21 MG/24 HR

1

NICORELIEF 1

NICORETTE BUCCAL GUM 2 MG 1

nicotine (polacrilex) 1

nicotine transdermal patch 24 hour 14 mg/24 hr, 21 mg/24 hr, 7 mg/24 hr

1

nicotine transdermal patch, td daily, sequential 2

NICOTROL 2 QL (1008 EA per 90 days)

NICOTROL NS 2 QL (160 ML per 90 days)

THYROID PREPSARMOUR THYROID 2

CYTOMEL 2

levothyroxine 1

LEVOXYL ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 50 MCG, 75 MCG, 88 MCG

2

liothyronine 1

methimazole oral tablet 10 mg, 5 mg 1

NP THYROID ORAL TABLET 30 MG, 60 MG, 90 MG 1

propylthiouracil 1

SYNTHROID 2

THYROGEN 2

THYROLAR-1 2

THYROLAR-1/2 2

THYROLAR-1/4 2

THYROLAR-2 2

THYROLAR-3 2

TIROSINT 2

UNITHROID 2

UNCLASSIFIED DRUG PRODUCTSacamprosate 1

135

Drug Name Tier Notesacetone 2

acetylcysteine intravenous 1

ACTIDOSE/SORBITOL ORAL SUSPENSION 50 GRAM/240 ML

2

ACTIDOSE-AQUA 1

ADAGEN 2

ADVANCED EYE HEALTH 1

ALCOHOL, DENATURED 2

ALDURAZYME 2

alendronate oral solution 1 QL (75 ML per 7 days)

alendronate oral tablet 1

alfuzosin 1

almond oil, sweet (bulk) 2

amifostine crystalline 1

amitriptyline (bulk) 1

anise 2

APPLE FLAVORING 2

APPLE-ADE FLAVOR 2

AQUA LUBE 2

AQUABASE 2

AR CAPS 2

ARALAST NP 2 PA

ARCALYST 2

BACTERIOSTATIC WATER(PARABENS) 1

BAL IN OIL 2

BANANA CONCENTRATE 2

BANANA CREAM FLAVOR 2

banana flavor (bulk) 2

BASE, PCCA SYRUP VEHICLE 2

BENLYSTA 2 PA

bentonite 2

BERINERT INTRAVENOUS KIT 2 PA

BINOSTO 2 ST; QL (1 EA per 7 days)

bitter mask flavoring (bulk) 2

BITTERNESS MASK FLAVOR 2

BITTERNESS REDUCING AGENT 2

BLUEBERRY FLAVOR 2

BRIDION 2

BUBBLE GUM CONCENTRATE 2

bubblegum flavor (bulk) 2

BUNAVAIL BUCCAL FILM 2.1-0.3 MG 2 PA; QL (1 EA per 1 day)

BUNAVAIL BUCCAL FILM 4.2-0.7 MG, 6.3-1 MG 2 PA; QL (2 EA per 1 day)

buprenorphine hcl sublingual 1 PA; QL (3 EA per 1 day)

buprenorphine-naloxone 1 PA; QL (3 EA per 1 day)

136

Drug Name Tier NotesBUTTER RUM FLAVORING 2

BUTTERSCOTCH FLAVORING 2

butylated hydroxytoluene 2

CALCIUM DISODIUM VERSENATE 2

CAPSUBLEND-H 2

CAPSUBLEND-P 2

CAPSUBLEND-S 2

CAPSULE #0 2

CAPSULE #0 (CELLULOSE) 2

CAPSULE #0 (HYPROMELLOSE) 2

CAPSULE #0 DRCAPS 2

CAPSULE #00 2



CAPSULE #1 2



CAPSULE #1 DRCAPS 2

CAPSULE #10 2

CAPSULE #11 2

CAPSULE #13 2

CAPSULE #2 2

CAPSULE #3 2



CAPSULE #4 2

CAPSULE #5 2

CAPSULE #7 2

CAPSULE CONI-SNAP #0 (GELATIN) 2

CAPSULE CONI-SNAP #0(HYPROMEL) 2

CAPSULE CONI-SNAP #00 (GELATIN 2

CAPSULE CONI-SNAP #000 2







CARBAGLU 2

carbomer 940 (bulk) 2

carbomer homopolymer c (bulk) 2

CARNITOR (SUGAR-FREE) 2

CARTICEL 2

castor oil 2

137

Drug Name Tier Notescellulose (bulk) powder 2

CERDELGA 2 PA

CEREZYME INTRAVENOUS RECON SOLN 400 UNIT 2 PA

cheesecake flavor (bulk) 2

CHEMET 2

cherry flavor oral 2

chloral hydrate (bulk) 2

chlorhexidine gluconate mucous membrane 1

chocolate flavor (bulk) liquid 2

CIALIS ORAL TABLET 2.5 MG, 5 MG 2 PA; QL (1 EA per 1 day)

CINNAMON FLAVORING 2

CINRYZE 2 PA

citric acid (bulk) 2

citronella oil 2

CLOVE FLAVORING 2

CO Q-10 ORAL CAPSULE 100 MG 1

cocoa butter 2

coconut oil (bulk) 2

coenzyme q10 oral capsule 200 mg, 30 mg, 50 mg 1

cottonseed oil (bulk) 2

cpd vehicle sus.sugar-free #12 2

cream de menthe (bulk) 2

CREME DE MENTHE FLAVORING 2

CRYOSERV 2

CUROSURF 2

CYSTADANE 2

CYSTAGON 2

darifenacin oral tablet extended release 24 hr 15 mg 1 ST

darifenacin oral tablet extended release 24 hr 7.5 mg 1 ST-NSO

deferoxamine 1

DELBASE COMPOUNDING 2

DERMABASE 2

DERMAFIX TOPICAL OINTMENT 2

DERMANIC 2

dexrazoxane hcl 1

DIAFOODS THICK-IT 2

DIAFOODS THICK-IT #2 2

DILUENT FOR EPOPROSTENOL/FLOLA 1

DILUENT FOR YF-VAX (1 DOSE) 2

DILUENT FOR YF-VAX (5 DOSE) 2

DILUENT-MERCK LIVE VIRUS VACC 2

disulfiram 1

doxercalciferol 1

doxycycline hyclate oral tablet 20 mg 1

138

Drug Name Tier Notesdutasteride 1 ST

dutasteride-tamsulosin 1 ST

ELAPRASE 2

ELELYSO 2 PA

ENGLISH TOFFEE FLAVOR 2

ESBRIET 2 PA

ethyl acetate 2

etidronate disodium 1

eucalyptol 2

EUCALYPTUS FLAVOR 2

eucalyptus oil oil 100 % 2

EXJADE 2

EZ CHAR 2

FABRAZYME 2

FATTIBASE 2

FATTYBLEND 2

FERRIPROX 2

finasteride oral tablet 5 mg 1

FIRAZYR 2 PA

FLAVOR BLEND 2 IN 1 2

FLAVOR PACKETS 2

FLAVOR PLUS 2

FLAVOR SWEET 2

FLAVOR SWEET-SF 2

FLAVORX 2

FLAVOUR PAC 2

flavoxate 1

flumazenil 1

fluoxetine (bulk) 1

fomepizole 1

FORTEO 2 QL (2.4 ML per 28 days)

FOSAMAX PLUS D 2

FP NATURAL LOTION 2

FUSILEV 2

GALZIN 2

gelatin (bulk) 2

gelatin oral capsule 650 mg 2

GELFILM IMPLANT 2

GELNIQUE TRANSDERMAL GEL IN PACKET 2 ST

GLASSIA 2 PA

glutathione (bulk) 2

glyceryl monostearate 2

GRAPEFRUIT 2

guar gum 2

139

Drug Name Tier Notesguava flavor (bulk) 2

HECTOROL INTRAVENOUS SOLUTION 2 MCG/ML (1 ML)

2

hydrophilic 2

HYDROPHILIC OINTMENT BASE(FAG) 2

HYDROPHILIC PETROLATUM 2

hydroxypropyl cellulose 2

HYLENEX 2

hypromellose 2

ibandronate intravenous 1 ST

ibandronate oral 1

ILARIS (PF) 2 PA

INSTA-CHAR 1

INSTA-CHAR-SORBITOL 1

INSTACLEAN 2

isopropyl alcohol solution 70 %, 91 % 2

isopropyl palmitate 2

JADENU 2

KALBITOR 2

KALYDECO 2 PA; QL (2 EA per 1 day)

KANUMA 2

KEVEYIS 2 PA

KUVAN 2 PA

lactic acid (bulk) 2

lanolin anhydrous 2

LEMON EXTRACT FLAVOR 2

lemon flavor extract (bulk) 2

LEMON FLAVORING 2

leucovorin calcium injection recon soln 1

leucovorin calcium oral 1

levocarnitine (with sugar) 1

levocarnitine intravenous 1

levocarnitine oral tablet 1

levoleucovorin intravenous solution 1

licorice root extract (bulk) 2

LIME FLAVOR 2

LIP TREATMENT 2

LUMIZYME 2 PA

lutein oral capsule 20 mg 1

MAGNASWEET 110 2

MAGNASWEET 135 2

magnesium stearate 2

MANGO FLAVOR 2

marshmallow flavor (bulk) 2

140

Drug Name Tier Notesmegestrol oral suspension 1

mesna 1

MESNEX ORAL 2

METHOCEL E 4 M 2

methyl alcohol 2

methylcellulose 1500cps (bulk) 2

methylcellulose 4000cps (bulk) 2

methylene blue (antidote) 1

methylene blue (bulk-solid) 2

MINERAL OIL HEAVY 2

MURI-LUBE 2

MX-SOL 2

MX-SOL BLEND 2

MX-SOL BLEND SF 2

MX-SOL SF 2

MX-SOL SUSPEND 2

MYOZYME 2 PA

MYRBETRIQ 2 ST; QL (30 EA per 30 days)

NAGLAZYME 2

NIACIN-AZE AC-TURMER-FA-B6-ZN 1

NICADAN 2

OFEV 2 PA

oleic acid 2

ORAL MIX 2

ORAL MIX SF 2

ORAL SUSPEND 2

ORAL SYRUP 2

ORAL SYRUP SF 2

ORALONE 1

ORANGE CONCENTRATE 2

orange oil 2

ORA-PLUS 2

ORA-SWEET 2

ORA-SWEET SF 2

ORFADIN 2 PA

ORKAMBI ORAL TABLET 200-125 MG 2 PA

oxybutynin chloride oral 1

OXYTROL 2 ST

pamidronate 1 PA

PANHEMATIN 2

paraffin 2

paricalcitol hemodialysis port injection 2

paricalcitol oral 1

PCCA-PLUS BASE 2

141

Drug Name Tier NotesPEANUT BUTTER FLAVOR 2

pentobarbital sodium (bulk) 2

PENTRAVAN 2

PEPPERMINT FLAVORING 2

petrolatum, yellow (bulk) 2

PETROLEUM JELLY 2

PETROLEUM JELLY, WHITE 2

phenelzine (bulk) 1

phenobarbital (bulk) 2

polyethylene glycol 8000(bulk) powder 100 % 2

polyoxyl 40 stearate 2

polyoxyl 40 stearate (bulk) wax 2

polysorbate 60 2

polysorbate 80 2

prochlorperazine edisylt(bulk) 1

PROCYSBI 2 PA

PROLASTIN-C 2 PA

PROLIA 2 PA

propylene glycol 2

propylene glycol (bulk) 2

PROTOPAM CHLORIDE 2

PULMOZYME 2 PA; QL (5 ML per 1 day)

PUMPKIN FLAVOR 2

Q-CARE RX Q2 2

Q-CARE RX Q4 2

Q-GEL WITH ALPHA LIPOIC ACID 2

RADIAGEL 2

raloxifene 1 QL (1 EA per 1 day)

RAPAFLO 2 ST

raspberry 2

raspberry flavor, artificial 2

RASPBERRY FLAVORING 2

resveratrol oral capsule 250 mg 2

risedronate oral tablet 150 mg 1 ST; QL (1 EA per 30 days)

risedronate oral tablet 30 mg, 5 mg 1 ST; QL (1 EA per 1 day)

risedronate oral tablet 35 mg 1 ST; QL (1 EA per 7 days)

risedronate oral tablet,delayed release (dr/ec) 1 ST; QL (1 EA per 7 days)

root beer flavor (bulk) 2

rose oil 2

ROSE WATER 2

rosin (bulk) powder 2

RUCONEST 2 PA

sassafras oil 2

SAVELLA 2

142

Drug Name Tier Notesselegiline hcl (bulk) 1

SENSIPAR 2

sertraline (bulk) 1

sesame oil 2

silica 2

simple syrup 2

SIMPLYTHICK ORAL GEL 2

sodium bisulfite 2

sodium chlor 0.9% bacteriostat 2

sodium chloride inhalation 1

sodium silicate 2

sodium succinate 2

SOMAVERT 2

SORBIDON HYDRATE 2

sorbitol solution 2

SPEARMINT FLAVORING 2

spearmint oil 2

stearic acid 2

stearyl alcohol 2

STERILE WATER FOR INJECTION 1

STRAWBERRY CREAM FLAVOR 2

strawberry flavor (bulk) 2

STRAWBERRY FLAVORING 2

STRENSIQ 2

SUBOXONE SUBLINGUAL FILM 12-3 MG 2 PA; QL (2 EA per 1 day)

SUBOXONE SUBLINGUAL FILM 2-0.5 MG, 4-1 MG, 8-2 MG


SURFAXIN 2

SURVANTA 2

SUSPENDOL-S 2

SWEET-SF 2

SYPRINE 2

SYRPALTA VEHICLE 2

SYRSPEND SF 2

SYRSPEND SF ALKA 2

SYRSPEND SF LIQUID 2

SYRSPEND SF PH4 2

SYRUP VEHICLE SF 2

tamsulosin 1

TANGERINE OIL, NATURAL 2

THICK NOW 2

THICKEN UP CLEAR 2

THICKENUP LEMON HONEY 2

THICKENUP LEMON NECTAR 2

143

Drug Name Tier NotesTHICK-IT 2

THICK-IT #2 2

THIOLA 2

tolterodine 1 ST

TOVIAZ 2 ST

TOZAL 2

tragacanth 2

triamcinolone acetonide dental 1

trospium 1 ST

tutti-frutti flavor (bulk) 2

TYBOST 2 PA

TYSABRI 2 PA

valproate sodium (bulk) 1

VANILLA BUTTERNUT FLAVOR 2

vanilla butternut flavor(bulk) 2

VANILLA FLAVOR 2

vanillin (bulk) 2

VASELINE 2

VERSA FREE 2

VERSA PLUS 2

VESICARE 2 ST

VIMIZIM 2 PA

VISUDYNE 2

VIVITROL 2

VPRIV 2 PA

VP-ZEL 1

water for inject, bacteriostat 1

water for injection, sterile 1

WATERMELON FLAVORING 2

WHITE WAX (BEESWAX) 2

wild cherry flavor (bulk) 2

WINTERGREEN FLAVORING 2

WITEPSOL H-15 2

XGEVA 2 PA

XIAFLEX 2

XOFIGO 2

YELLOW WAX (BEESWAX) 2

ZAVESCA 2 PA

ZEMAIRA 2 PA

ZEMPLAR INTRAVENOUS 2

zoledronic acid 1

zoledronic acid-mannitol-water 1 PA

ZOMETA INTRAVENOUS SOLUTION 4 MG/100 ML 2 PA

ZUBSOLV 2 PA

144


VITAMINSADVANCED AM-PM 1

AQUASOL A 2

ascorbic acid (vitamin c) injection 1

B COMPLEX 100 INJECTION 1

BACMIN 1

calcitriol intravenous solution 1 mcg/ml 1

calcitriol oral 1

cholecalciferol (vitamin d3) oral capsule 10,000 unit 1

cholecalciferol (vitamin d3) oral tablet 1,000 unit 1

cod liver oil oral oil 1

CORVITA 2

CORVITE 2

CORVITE FREE 2

cyanocobalamin (vitamin b-12) injection 1

DECARA ORAL CAPSULE 25,000 UNIT 2

DECARA ORAL CAPSULE 50,000 UNIT 1

DIABETIC VITAMIN 2

DIALYVITE 1

DIALYVITE 3000 1

DIALYVITE 5000 2

DIALYVITE SUPREME D 2

ENLYTE (FERROUS GLYCINE) 2

ergocalciferol (vitamin d2) oral capsule 1

ergocalciferol (vitamin d2) oral drops 1

ESCAVITE 2

ESCAVITE D 2

ESCAVITE LQ 2

FABB 1

FOLGARD 2

folic acid injection 1

folic acid oral tablet 1 mg 1

hydroxocobalamin 1

INFUVITE ADULT 2

INFUVITE PEDIATRIC 2

levomefolate calcium 1

L-METHYL-B6-B12 1

L-METHYL-MC 1

L-METHYL-MC NAC 1

M.V.I. ADULT 2

M.V.I. PEDIATRIC 2

M.V.I.-12 (WITHOUT VITAMIN K) 2

MEPHYTON 2

MULTI-VIT WITH FLUORIDE-IRON 1

145

Drug Name Tier NotesMULTIVITAMIN WITH FLUORIDE 1

MULTI-VITAMIN WITH FLUORIDE 1

MULTIVITAMINS WITH FLUORIDE 1

MVC-FLUORIDE 1

NASCOBAL 2

NEPHPLEX RX 1

NEPHROCAPS 1

niacin oral capsule, extended release 250 mg, 500 mg 1

niacin oral tablet 500 mg 1

niacin oral tablet extended release 500 mg 1

NICOMIDE 2

NICOMIDE (SELENIUM-CHROMIUM) 2

phytonadione (vitamin k1) injection 1

PURALOR CI 2

pyridoxine (vitamin b6) injection 1

QUFLORA PEDIATRIC 1

QUFLORA PEDIATRIC DROPS 1

RENAL CAPS 1

RENO CAPS 1

STROVITE FORTE 1

STROVITE ONE 2

thiamine hcl (vitamin b1) injection 1

TL GARD RX 1

TRIPHROCAPS 1

TRIPLE VITAMIN WITH FLUORIDE 1

TRI-VIT WITH FLUORIDE AND IRON 1

TRI-VITAMIN WITH FLUORIDE 1

UDAMIN SP 2

VIRT-CAPS 1

VIRT-GARD 1

VIRT-VITE 1

VIRT-VITE FORTE 1

VIRT-VITE PLUS 1

VIT 3 1

VITAL-D RX 1

VITAMIN B-12 ORAL TABLET 1,000 MCG 1

VITAMIN D2 1

vitamin e (dl, acetate) oral capsule 400 unit 1

vitamin e oral drops 50 unit/ml 1

VITAMIN K 1

VITAMIN K1 INJECTION 1

VITAMINS A,C,D AND FLUORIDE 1

VOL-CARE RX 1

VP-VITE RX 1

146

IndexIndex

12 HOUR DECONGESTANT.............. 6212 HOUR NASAL SPRAY...................711ST TIER UNIFINE PENTIPS............. 981ST TIER UNIFINE PENTIPS PLUS.. 9924 HOUR ALLERGY RELIEF.............713 DAY VAGINAL................................ 253-DAY VAGINAL................................ 253M NEXCARE DURAPORE............... 994-N-1 NO RINSE WASH....................1258 HOUR PAIN RELIEVER.................... 38-MOP................................................. 125abacavir ..................................................39abacavir-lamivudine-zidovudine........... 39ABELCET............................................. 25ABILIFY..............................................116ABILIFY MAINTENA....................... 116ABLAVAR............................................ 69ABRAXANE......................................... 33ABREVA...............................................39ABSORBENT COTTON BALLS.........99ABSORICA......................................... 125ABSTRAL............................................... 3acamprosate ......................................... 135acarbose................................................. 31ACCU-CHEK FASTCLIX....................99ACCU-CHEK MULTICLIX LANCET 99ACCU-CHEK SOFT DEV LANCETS. 99ACCU-CHEK SOFTCLIX LANCET DEV....................................................... 99ACE AEROSOL CLOUD ENHANCER..........................................99acebutolol ...............................................50ACEPHEN...............................................3ACETA-GESIC....................................... 3acetaminophen......................................... 3ACETAMINOPHEN PM........................ 3acetaminophen-caff-dihydrocod.............. 3acetaminophen-codeine........................... 3ACETASOL HC....................................71acetazolamide........................................ 70acetazolamide sodium............................70acetic acid...................................... 71, 125acetic acid-aluminum acetate .................71acetone................................................. 136acetylcarnitine........................................75acetylcysteine.................................14, 136ACID CONTROL (RANITIDINE).......82ACID CONTROLLER.......................... 82ACID GONE ANTACID...................... 82ACID GONE ANTACID E.STRENGTH....................................... 82ACID REDUCER (CIMETIDINE).......82ACID REDUCER (FAMOTIDINE)..... 82ACID REDUCER (RANITIDINE)....... 82ACID REDUCER COMPLETE (FAMOT)...............................................82ACIPHEX SPRINKLE..........................82acitretin ................................................ 125ACLARO.............................................125ACNE MEDICATION........................ 125

Index

ACNE TREATMENT (BENZOYL PEROX)...............................................125ACNEFREE ACNE CLEARING SYSTEM..............................................125ACNEFREE SEVERE ACNE CLEARING......................................... 125ACTEMRA............................................98ACTHAR H.P. .......................................94ACTHIB (PF)........................................ 44ACTHREL.............................................94ACTIDOSE/SORBITOL.....................136ACTIDOSE-AQUA.............................136ACTIMMUNE.......................................33ACTIVASE............................................46ACTIVE FE........................................... 75ACTOPLUS MET XR...........................31ACUVAIL (PF)..................................... 71acyclovir ................................................ 39acyclovir sodium....................................39ACZONE............................................. 125ADACEL(TDAP ADOLESN/ADULT)(PF)......................44ADAGEN............................................ 136adapalene............................................. 125ADASUVE.......................................... 116ADCETRIS............................................34ADCIRCA............................................. 50ADDAMEL N....................................... 75ADDED STRENGTH HEADACHE RELIEF....................................................3ADDERALL..........................................42ADDERALL XR................................... 42adefovir .................................................. 40ADEMPAS............................................ 50ADENOSCAN.......................................69adenosine............................................... 48adenosine (diagnostic) ........................... 69adenovirus vac live type-4, 7 ................. 44adenovirus vaccine live type-4.............. 44adenovirus vaccine live type-7.............. 44adhesive bandage................................... 99adhesive bandage-adhes remov#1......... 99ADHESIVE GAUZE PAD....................99ADHESIVE PADS................................ 99adhesive remover ................................... 99adhesive tape..........................................99ADRUCIL..............................................34ADULT TUSSIN CHEST CONGESTION......................................62ADULT TUSSIN COUGH CONGEST DM.........................................................62ADULT TUSSIN DM........................... 62ADULT TUSSIN MULTI-SYMP COLD.................................................... 62ADVAIR DISKUS................................ 14ADVAIR HFA.......................................14ADVANCED AM-PM........................ 145ADVANCED ANTACID-ANTIGAS... 82ADVANCED ANTIBACTERIAL BANDAGE............................................99ADVANCED EYE HEALTH............. 136

Index

ADVANCED FORMULA EYE DROPS.................................................. 71ADVATE...............................................46ADVOCATE PEN NEEDLES.............. 99ADVOCATE SYRINGES.....................99ADYNOVATE...................................... 46ADZENYS XR-ODT.............................42AEROCHAMBER MINI.......................99AEROCHAMBER MV......................... 99AEROCHAMBER PLUS FLOW-VU.. 99AEROCHAMBER PLUS FLOW-VU,L MSK............................................ 99AEROCHAMBER PLUS FLOW-VU,M MSK........................................... 99AEROCHAMBER PLUS FLOW-VU,S MSK.......................................................99AEROCHAMBER PLUS Z STAT....... 99AEROCHAMBER PLUS Z STAT LG MSK.......................................................99AEROCHAMBER PLUS Z STAT MD MSK.......................................................99AEROCHAMBER PLUS Z STAT SM MSK.......................................................99AEROCHAMBER WITH FLOWSIGNAL..................................... 99AEROCHAMBER Z-STAT PLUS-FLW SG.................................................99AEROSPAN.......................................... 14AEROTRACH PLUS............................ 99AEROVENT PLUS............................... 99AFEDITAB CR..................................... 48AFINITOR.............................................34AFINITOR DISPERZ........................... 34AFREZZA............................................. 31AGGRASTAT IN SODIUM CHLORIDE........................................... 39AHIST (CHLORCYCLIZINE)............. 28A-HYDROCORT.................................. 94AK-FLUOR........................................... 69AKTEN (PF)..........................................71AKWA TEARS (POLYVINYL ALCOHOL)...........................................71AKYNZEO............................................ 82ALA-HIST IR........................................28ALA-HIST PE....................................... 27ALAWAY..............................................28ALBENZA.............................................33ALBUKED-25.......................................46ALBUKED-5.........................................46albumin, human 20 %............................ 46albumin, human 25 %............................ 46albumin, human 5 %.............................. 46ALBUMINAR 25 %..............................47ALBUMINAR 5 %................................47ALBURX (HUMAN) 25 %...................47ALBURX (HUMAN) 5 %.....................47ALBUSTIX REAGENT........................69ALBUTEIN 25 %.................................. 47ALBUTEIN 5 %.................................... 47albuterol sulfate ..................................... 14ALCAINE..............................................71

147

Index

alclometasone...................................... 125ALCOHOL PADS............................... 125ALCOHOL PREP PADS.................... 126ALCOHOL PREP SWABS.................126alcohol swabs.......................................126ALCOHOL WIPES............................. 126ALCOHOL, DENATURED................136ALCOHOL-BENZOCAINE................. 33ALDACTAZIDE................................... 70ALDURAZYME................................. 136ALECENSA.......................................... 34alendronate ...........................................136ALERTNESS AID.................................54ALEVAZOL.......................................... 25alfalfa ..................................................... 91alfentanil .................................................. 3alfuzosin...............................................136ALIMTA................................................34ALINIA..................................................33ALKERAN............................................ 34ALL DAY ALLERGY (CETIRIZINE).28ALL DAY ALLERGY-D...................... 27ALL DAY PAIN RELIEF..................... 12ALL DAY RELIEF............................... 12ALLEGRA-D 24 HOUR....................... 27ALLER-CHLOR....................................28ALLERCLEAR D-24HR.......................27ALLER-EASE....................................... 28ALLERFED COLD AND ALLERGY..27ALLER-G-TIME................................... 28ALLERGY (CHLORPHENIRAMINE) 28ALLERGY (DIPHENHYDRAMINE)..28ALLERGY 4-HOUR............................. 28ALLERGY AND COLD PE................. 62ALLERGY AND CONGESTION RELIEF..................................................27ALLERGY COMPLETE-D.................. 27ALLERGY D-12................................... 27ALLERGY EYE (KETOTIFEN).......... 29ALLERGY MEDICINE........................ 29ALLERGY MULTI-SYMPTOM..........62ALLERGY RELIEF (CETIRIZINE).... 29ALLERGY RELIEF (CLEMASTINE). 29ALLERGY RELIEF (FEXOFENADINE).............................. 29ALLERGY RELIEF (LORATADINE).29ALLERGY RELIEF D-24.....................27ALLERGY RELIEF(CHLORPHENIRAMN)..........29ALLERGY RELIEF(DIPHENHYDRAMIN).......... 29ALLERGY RELIEF,NASAL DECONGEST........................................27ALLERGY SINUS HEADACHE (PE).63ALLERGY-TIME..................................29ALLERHIST-1...................................... 29ALLEVYN ADHESIVE DRESSING...99ALLEVYN PLUS ADHESIVE.............99ALLKARE ADHESIVE REMOVER WIPES................................................... 99ALL-NITE COLD-FLU........................ 63allopurinol ..............................................12ALMACONE.........................................82

Index

ALMACONE-2..................................... 82almond oil, sweet (bulk) ...................... 136almotriptan malate ................................... 3ALOCRIL.............................................. 71aloe vera .................................................91ALOE VESTA.....................................126ALOE VESTA ANTIFUNGAL (MICON)............................................... 25ALOE VESTA SKIN CONDITIONER 2........................................................... 126ALOMIDE.............................................71ALOPRIM............................................. 12ALORA..................................................94alosetron.................................................82ALOXI...................................................82ALPHAGAN P...................................... 71ALPHANATE....................................... 47ALPHANINE SD.................................. 47alprazolam............................................116ALPRAZOLAM INTENSOL............. 116ALPROLIX............................................47alprostadil .............................................. 50ALREX.................................................. 71ALSUMA................................................ 3ALTABAX.......................................... 126ALTAVERA (28) .................................. 58ALTOPREV.......................................... 50aluminum hydroxide gel ........................ 82ALVESCO.............................................14ALYACEN 1/35 (28) ............................ 58ALYACEN 7/7/7 (28) ........................... 58amantadine hcl ....................................... 38AMBIEN..............................................124AMBIEN CR....................................... 124AMBISOME..........................................25amcinonide...........................................126AMETHIA.............................................58AMETHIA LO.......................................58AMICAR............................................... 47AMIDATE.............................................10amifostine crystalline...........................136amikacin.................................................16amiloride................................................ 70amiloride-hydrochlorothiazide.............. 70AMINO ACIDS 15 %........................... 75aminocaproic acid..................................47aminophylline........................................ 14AMINOSYN 10 %................................ 75AMINOSYN 7 % WITH ELECTROLYTES.................................75AMINOSYN 8.5 %............................... 75AMINOSYN 8.5 %-ELECTROLYTES 75AMINOSYN II 10 %.............................75AMINOSYN II 15 %.............................75AMINOSYN II 7 %...............................75AMINOSYN II 8.5 %............................75AMINOSYN II 8.5 %-ELECTROLYTES.................................76AMINOSYN M 3.5 %...........................76AMINOSYN-HBC 7%..........................76AMINOSYN-PF 10 %...........................76AMINOSYN-PF 7 % (SULFITE-FREE).................................................... 76

Index

AMINOSYN-RF 5.2 %......................... 76amiodarone............................................ 48amiodarone in dextrose 5 %.................. 48AMITIZA.............................................. 82amitriptyline.........................................116amitriptyline (bulk) ..............................136amitriptyline-chlordiazepoxide............116amlodipine............................................. 48amlodipine-atorvastatin ......................... 50amlodipine-benazepril ........................... 50amlodipine-valsartan..............................50amlodipine-valsartan-hcthiazid..............50ammonia aromatic ................................. 54ammonium and potassium iodides .......126ammonium chloride............................... 70ammonium lactate ................................126AMMONUL.......................................... 82amoxapine............................................116amoxicil-clarithromy-lansopraz.............82amoxicillin ............................................. 16amoxicillin-pot clavulanate ................... 16AMPHADASE.................................... 126amphotericin b ....................................... 25ampicillin ............................................... 16ampicillin sodium.................................. 16ampicillin-sulbactam..............................16AMPYRA.............................................. 54AMRIX................................................ 113AMYTAL............................................ 124ANADROL-50...................................... 94ANAFRANIL...................................... 116anagrelide...............................................39ANA-LEX..............................................82ANA-LEX KIT......................................82ANALGESIC CREME........................126ANALPRAM ADVANCED................. 82ANALPRAM-HC.......................... 82, 126ANASCORP.......................................... 44anastrozole ............................................. 34ANDRODERM......................................94ANDROGEL......................................... 94ANDROXY........................................... 94ANGELIQ..............................................94anise ..................................................... 136ANORO ELLIPTA................................14ANTACID............................................. 82ANTACID (CALCIUM CARBONATE)......................................82ANTACID ANTI-GAS......................... 82ANTACID ANTI-GAS DOUBLE STR 82ANTACID CALCIUM..........................82ANTACID EXST (CA CARB-MAG HYD)..................................................... 82ANTACID EXST (MAG CARB-AL HYD)..................................................... 82ANTACID EXT STR (CALCIUM CARB)................................................... 82ANTACID EXTRA-STRENGTH.........82ANTACID MAXIMUM STRENGTH..82ANTACID PLUS ANTI-GAS...............82ANTACID-ANTIGAS.......................... 82ANTACID-SIMETHICONE.................82ANTARA...............................................50

148

Index

ANTIBACTERIAL BANDAGES.........99ANTIBACTERIAL PAD...................... 99ANTIBIOTIC (BACITRACIN ZINC).. 16ANTIBIOTIC PLUS (PRAMOXINE).. 16ANTI-DANDRUFF.............................126ANTI-DANDRUFF (COAL TAR)..... 126ANTI-DIARRHEA................................82ANTI-DIARRHEAL (LOPERAMIDE)..........................................................82, 83ANTIFUNGAL......................................25ANTIFUNGAL (CLOTRIMAZOLE)...25ANTIFUNGAL (TOLNAFTATE)........25ANTIFUNGAL CREAM...................... 25ANTIFUNGAL SPRAY........................25ANTI-ITCH (DIPHENHYDRAMINE)..............................................................126ANTI-ITCH (HC)................................126ANTI-ITCH(DIPHENHYD) WITH ZINC.................................................... 126ANTI-NAUSEA.................................... 83ANTI-NAUSEA GINGER.................... 91ANTISEPTIC GEL..............................126antivenin latrodectus mactans................44antivenin micrurus fulvius ..................... 44ANUCORT-HC..................................... 83ANU-MED............................................ 83ANZEMET............................................ 83APEXICON E......................................126AP-HIST DM.........................................63APIDRA................................................ 31APIDRA SOLOSTAR...........................31APLENZIN..........................................116APLISOL...............................................44APOKYN...............................................38APPLE FLAVORING......................... 136APPLE-ADE FLAVOR.......................136apraclonidine..........................................71APRI...................................................... 58APRISO................................................. 83APRODINE........................................... 27APTENSIO XR................................... 116APTIOM................................................ 54APTIVUS.............................................. 40AQUA GLYCOLIC CLEANSER.......126AQUA LUBE...................................... 136AQUABASE........................................136AQUACEL FOAM................................99AQUACEL FOAM SACRAL...............99AQUAFLO............................................ 99AQUANAZ............................................63AQUASOL A...................................... 145AR CAPS.............................................136ARALAST NP.....................................136ARANELLE (28) ...................................58ARANESP (IN POLYSORBATE)........58ARBINOXA.......................................... 29ARCALYST........................................ 136ARCAPTA NEOHALER...................... 14ARCH BANDAGE................................99argatroban.............................................. 23argatroban in 0.9 % sod chlor ................ 23argatroban in nacl (iso-os) ..................... 23ARGLAES...........................................126

Index

ARGLAES 3.25"X 14" FILM............. 100ARICEPT...............................................42aripiprazole .......................................... 116ARISTADA......................................... 116ARISTOSPAN INTRA-ARTICULAR. 94ARISTOSPAN INTRALESIONAL......94armodafinil ...........................................116ARMOUR THYROID.........................135arnica......................................................91ARNUITY ELLIPTA............................ 14ARRANON............................................34ARTHRICREAM................................ 126ARTHRICREAM RUB....................... 126ARTHRITIS........................................ 126ARTHRITIS HEATWRAPS............... 100ARTHRITIS PAIN RELIEF (ACETAM)..............................................3ARTHRITIS PAIN RELIEF(CAPSAIC)............................ 126ARTHRITIS PAIN RELIEVER..............3ARTIFICIAL TEARS (PETRO/MIN).. 71ARTIFICIAL TEARS (POLYVIN ALC)...................................................... 71ARTIFICIAL TEARS(PVALCH-POVID)..................................................71ARTISS................................................126ARZERRA.............................................34ASACOL HD.........................................83asafetida................................................. 91ASCLERA............................................. 50ASCOMP WITH CODEINE...................3ascorbic acid (vitamin c) ......................145ASHLYNA............................................ 58ASMANEX HFA...................................14ASMANEX TWISTHALER................. 14ASPIR-81.................................................4aspirin ...................................................... 4ASPIRIN LOW DOSE............................ 4aspirin-acetaminophen-caffeine...............4aspirin-caffeine-dihydrocodein................4aspirin-dipyridamole..............................39ASPIR-LOW............................................4ASSURE ID INSULIN SAFETY........100ASTAGRAF XL....................................98ASTHMANEFRIN REFILL................. 14ASTRINGENT.................................... 126atenolol .................................................. 50atenolol-chlorthalidone.......................... 50ATGAM.................................................44ATHLETE'S FOOT (TERBINAFINE). 25ATHLETE'S FOOT (TOLNAFTATE). 25ATHLETE'S FOOT AF.........................25ATHLETIC TAPE...............................100ATIVAN.............................................. 116atorvastatin .............................................50atovaquone.............................................33atovaquone-proguanil ............................ 33atracurium.............................................. 42ATRIPLA.............................................. 40atropine............................................ 71, 83ATROVENT HFA.................................14ATRYN..................................................47AUBAGIO.............................................54

Index

AUBRA................................................. 58AUGMENTIN....................................... 16AURYXIA.............................................76AVANDAMET......................................31AVANDIA.............................................31AVAR.................................................... 16AVAR LS.............................................. 16AVASTIN..............................................34AVC VAGINAL....................................33AVEED..................................................94AVEENO BABY.................................126AVELOX IN NACL (ISO-OSMOTIC) 16AVIANE................................................ 58AVITA.................................................126AVOGEL.............................................100AVOGEL DRESSING........................ 100AVONEX.............................................. 54AVONEX (WITH ALBUMIN).............54AVYCAZ...............................................16AXIRON................................................94azacitidine.............................................. 34AZACTAM IN DEXTROSE (ISO-OSM)..................................................... 16AZASAN............................................... 98AZASITE...............................................16azathioprine............................................98azelastine..........................................29, 71AZELEX..............................................126AZILECT...............................................38azithromycin.......................................... 16AZO BLADDER CONTROL............... 91AZO CRANBERRY..............................91AZO CRANBERRY + PROBIOTIC.... 91AZO TEST STRIPS.............................. 69AZOPT.................................................. 72AZOR.................................................... 50aztreonam...............................................16AZUPHEN MB..................................... 16AZURETTE (28) ................................... 58B COMPLEX 100................................145BABY WASH..................................... 126BABYBIG............................................. 44BACIIM.................................................16bacitracin................................................16bacitracin zinc........................................16bacitracin-polymyxin b..........................16BACKACHE RELIEF EXTRA STRENGTH............................................ 4baclofen................................................113BACMIN............................................. 145BACTERIOSTATIC WATER(PARABENS)........................136BACTROBAN NASAL........................ 16BAL IN OIL........................................ 136BALANCED SALT...............................72BAL-CARE DHA................................113BAL-CARE DHA ESSENTIAL......... 113balsalazide..............................................83BALZIVA (28) ...................................... 58BANANA CONCENTRATE..............136BANANA CREAM FLAVOR............ 136banana flavor (bulk) .............................136BANDAGE..........................................100

149

Index

BANDAGES........................................100BANDAGES FLEXIBLE FABRIC.... 100BANDAGES SHEER..........................100BANDAGES/FLEXIBLE/ASSORTED..............................................................100BANDAGES/PLASTIC...................... 100BAND-AID ACTIVE FLEX...............100BAND-AID CLEAR SPOTS.............. 100BAND-AID CLOTH TAPE................ 100BAND-AID FLEXIBLE......................100BAND-AID FLEXIBLE FABRIC...... 100BAND-AID GAUZE PADS................100BAND-AID HANDYMAN.................100BAND-AID HURT-FREE...................100BAND-AID MIRASORB GAUZE..... 100BAND-AID NON-STICK PADS........100BAND-AID PAPER TAPE................. 100BAND-AID PLASTIC........................ 100BAND-AID PLUS ANTIBIOTIC.......100BAND-AID ROLLED GAUZE.......... 100BAND-AID SECURE-FLEX..............100BAND-AID SHEER STRIPS..............100BAND-AID SURGIPAD.....................100BAND-AID TOUGH PADS............... 100BAND-AID TOUGH STRIPS............ 100BAND-AID WATERPROOF............. 100BAND-AID WATERPROOF PAD.... 100BANOPHEN..........................................29BANOPHEN ALLERGY......................29BANOPHEN ANTI-ITCH.................. 126BANZEL................................................55BARACLUDE.......................................40BARD ADHESIVE REMOVER WIPES................................................. 100BASE, PCCA SYRUP VEHICLE.......136BAZA ANTIFUNGAL..........................25BAZA CLEANSE AND PROTECT... 126BAZA CLEAR.................................... 126BAZA PROTECT................................126bcg vaccine, live (pf) ............................. 44BD ALCOHOL SWABS.....................126BD AUTOSHIELD DUO PEN NEEDLE..............................................100BD AUTOSHIELD PEN NEEDLE.... 100BD ECLIPSE LUER-LOK.................. 100BD INSULIN PEN NEEDLE UF MINI..............................................................100BD INSULIN PEN NEEDLE UF ORIG....................................................100BD INSULIN PEN NEEDLE UF SHORT................................................ 100BD INSULIN SYRINGE.................... 100BD INSULIN SYRINGE HALF UNIT..............................................................100BD INSULIN SYRINGE MICRO-FINE.................................................... 100BD INSULIN SYRINGE SAFETY-LOK..................................................... 101BD INSULIN SYRINGE SLIP TIP.... 101BD INSULIN SYRINGE ULT-FINE II..............................................................101BD INSULIN SYRINGE ULTRA-FINE.................................................... 101

Index

BD INTEGRA INSULIN SYRINGE..101BD LO-DOSE MICRO-FINE IV........ 101BD LO-DOSE ULTRA-FINE............. 101BD SAFETYGLIDE INSULIN SYRINGE............................................ 101BD SAFETYGLIDE SYRINGE......... 101BD ULTRA-FINE NANO PEN NEEDLES............................................101BEBULIN.............................................. 47BECONASE AQ................................... 72BEDSIDE-CARE................................ 126BEKYREE (28) ..................................... 58BELBUCA...............................................4BELEODAQ..........................................34belladonna alkaloids-opium.....................4BELLADONNA-OPIUM........................4BELSOMRA........................................124BENADRYL ALLERGY......................29benazepril ...............................................50benazepril-hydrochlorothiazide............. 50BENDEKA............................................ 34BENEFIX.............................................. 47BENICAR..............................................50BENICAR HCT.....................................50BENLYSTA........................................ 136BENSAL HP........................................126bentonite .............................................. 136BENTYL................................................83BENZACLIN PUMP...........................127BENZEDREX........................................72BENZEPRO.........................................127BENZEPRO (MICROSPHERES).......127BENZOIN COMPOUND....................127benzonatate ............................................ 63benzoyl peroxide..................................127benztropine............................................ 38BEPREVE..............................................29BERINERT..........................................136BESIVANCE.........................................17BETADINE......................................... 127BETADINE OPHTHALMIC PREP......72BETADINE SKIN CLEANSER......... 127betamethasone acet,sod phos................. 94betamethasone dipropionate ................ 127betamethasone valerate ........................127betamethasone, augmented.................. 127BETASEPT SURGICAL SCRUB...... 127BETASERON........................................55betaxolol .......................................... 51, 72bethanechol chloride..............................42BETHKIS.............................................. 17BETIMOL..............................................72BETOPTIC S......................................... 72bexarotene..............................................34BEXSERO (PF)..................................... 44BEYAZ.................................................. 58BIATAIN HEEL ADH FOAM DRESSING..........................................101BIATAIN NON-ADHESIVEFOAM ROUND............................................... 101bicalutamide...........................................34BICILLIN C-R.......................................17BICILLIN L-A.......................................17

Index

BICNU...................................................34BIDIL.....................................................51bilberry...................................................91BILBERRY............................................91bilberry fruit extract ...............................91BILTRICIDE......................................... 33bimatoprost ............................................ 72BINOSTO............................................ 136BIO TRUE........................................... 101BIOBRANE.........................................101BIOBRANE DRESSING.................... 101BIOBRANE-L..................................... 101BIOBRANE-L DRESSING.................101BION TEARS (PF)................................72BIOTHRAX...........................................44BISAC-EVAC....................................... 83bisacodyl ................................................ 83BISCOLAX........................................... 83BISMATROL........................................ 83BISMUTH............................................. 83BISMUTH MAXIMUM STRENGTH..83bisoprolol fumarate ................................51bisoprolol-hydrochlorothiazide..............51bitter mask flavoring (bulk) ................. 136BITTERNESS MASK FLAVOR........ 136BITTERNESS REDUCING AGENT. 136bivalirudin..............................................23BIVIGAM..............................................44black cohosh.......................................... 91black cohosh root extract ....................... 91BLENDERM SURGICAL.................. 101bleomycin.............................................. 34BLEPH-10............................................. 17BLEPHAMIDE......................................17BLEPHAMIDE S.O.P. .......................... 17BLINCYTO........................................... 34BLISOVI 24 FE.....................................59BLISOVI FE 1.5/30 (28) ....................... 59BLISOVI FE 1/20 (28) .......................... 59BLISTER RELIEF BANDAGES........101BLOXIVERZ.........................................42BLUE GEL.......................................... 127BLUEBERRY FLAVOR.....................136blue-green algae (spirulina) ................... 91BOOSTRIX TDAP................................44BORDERED GAUZE......................... 101BOSTON CLEANER..........................101BOSTON CONDITIONING............... 101BOSTON ONE STEP (PF)..................101BOSTON REWETTING..................... 101BOSTON SIMPLUS........................... 101BOSULIF...............................................34BOTOX..................................................42botulism antitoxin heptavalent ...............44BP 10-1.................................................. 17BP-50% UREA....................................127BPO......................................................127BPO CREAMY WASH PACK........... 127BREATHERITE MDI SPACER......... 101BREATHERITE RIGID SPACER-MASK..................................................101BREATHERITE SPACER-MASK,ADULT................................... 101

150

Index

BREATHERITE SPACER-MASK,CHILD.....................................101BREATHERITE SPACER-MASK,INFANT.................................. 101BREATHERITE SPACER-MASK,S.CHLD...................................101BREATHERITE VALVED MDI CHAMBER..........................................101BREATHERITE VALVED MDI SPACER.............................................. 101BREATHERITE WITH MASK, LARGE................................................ 101BREATHERITE WITH MASK, MEDIUM.............................................101BREATHERITE WITH MASK, SMALL................................................101BREO ELLIPTA................................... 14BREVIBLOC IN NACL (ISO-OSM)... 51BREVICON (28) ................................... 59BREVITAL............................................10BRIDION.............................................136BRIELLYN............................................59BRILINTA.............................................39brimonidine............................................72BRISDELLE........................................116BROHIST D.......................................... 27BROMFED DM.....................................63bromfenac.............................................. 72bromocriptine.........................................38brompheniramine-pseudoeph-dm.......... 63BROTAPP............................................. 27BROTAPP DM......................................63BROVANA............................................14BSS PLUS............................................. 72BUBBLE GUM CONCENTRATE.....136bubblegum flavor (bulk) ...................... 136budesonide........................... 14, 15, 72, 94BUFFERED LIDOCAINE.................... 10BUFFERIN.............................................. 4BULKEE II ..........................................101bumetanide.............................................70BUMINATE 25 %.................................47BUMINATE 5 %...................................47BUNAVAIL........................................ 136BUPAP.................................................... 4BUPHENYL.......................................... 83bupivacaine............................................ 10bupivacaine (pf) ..................................... 10bupivacaine in nacl(pf) .......................... 10bupivacaine-dextrose-water(pf) .............10bupivacaine-epinephrine........................10bupivacaine-epinephrine (pf) .................10bupivacaine-epinephrine bitart .............. 10BUPRENEX............................................ 4buprenorphine hcl ............................ 4, 136buprenorphine-naloxone...................... 136bupropion hcl ....................................... 116BURN RELIEF......................................10buspirone......................................116, 117BUSULFEX...........................................34BUTALBITAL COMPOUND W/CODEINE...........................................4butalbital-acetaminop-caf-cod................. 4

Index

butalbital-acetaminophen.........................4butalbital-acetaminophen-caff ................. 4butalbital-aspirin-caffeine........................4BUTISOL............................................ 124butorphanol tartrate ..................................4BUTRANS...............................................4BUTTER RUM FLAVORING............137BUTTERFLY CLOSURES.................101BUTTERSCOTCH FLAVORING......137butylated hydroxytoluene.................... 137BYDUREON......................................... 31BYETTA................................................31BYSTOLIC............................................51cabergoline.............................................94CAFERGOT............................................ 4caffeine citrated..................................... 55caffeine-sodium benzoate ...................... 55CALADRYL........................................127calamine...............................................127CALAMINE MEDICATED................127calamine phenolated............................ 127calamine-zinc oxide............................. 127calamine-zinc oxide-phenol .................127calcipotriene.........................................127calcipotriene-betamethasone................127calcitonin (salmon)................................ 94CALCITRENE.................................... 127calcitriol ....................................... 127, 145CALCIUM 600 WITH VITAMIN D3.. 76calcium acetate .......................................76CALCIUM ANTACID..........................83CALCIUM ANTACID ULTRA MAX ST...........................................................83calcium carbonate ............................ 76, 83calcium carbonate-vitamin d3................76calcium chloride.....................................76CALCIUM DISODIUM VERSENATE..............................................................137calcium gluconate .................................. 76CALCIUM MAGNESIUM................... 76CALCIUM PNV..................................113CALCIUM-FOLIC ACID-VITAMIN D............................................................ 76CALDOLOR..........................................12CALDYPHEN..................................... 127CALDYPHEN CLEAR....................... 127CAL-GEST ANTACID......................... 83CALLERGY CLEAR..........................127CALLUS CUSHION........................... 101CALLUS PADS...................................101CALPHRON..........................................76CAMBIA................................................. 4CAMILA................................................59CAMPATH............................................34camphor............................................... 127CAMPHOR BLOCKS.........................127CAMPTOSAR.......................................34CAMRESE............................................ 59CAMRESE LO...................................... 59CANASA...............................................83CANCIDAS...........................................25candesartan............................................ 51candesartan-hydrochlorothiazid.............51

Index

CAPACET............................................... 4CAPASTAT...........................................17CAPCOF................................................63capecitabine........................................... 34CAPEX................................................ 127CAPITAL WITH CODEINE.................. 4CAPMIST DM.......................................63CAPRELSA...........................................34CAPRON DM........................................63capsaicin.............................................. 127CAPSUBLEND-H...............................137CAPSUBLEND-P................................137CAPSUBLEND-S................................137CAPSULE #0.......................................137CAPSULE #0 (CELLULOSE)............ 137CAPSULE #0 (HYPROMELLOSE)...137CAPSULE #0 DRCAPS...................... 137CAPSULE #00.....................................137CAPSULE #00 (CELLULOSE).......... 137CAPSULE #00 (HYPROMELLOSE).137CAPSULE #1.......................................137CAPSULE #1 (CELLULOSE)............ 137CAPSULE #1 (HYPROMELLOSE)...137CAPSULE #1 DRCAPS...................... 137CAPSULE #10.....................................137CAPSULE #11.....................................137CAPSULE #13.....................................137CAPSULE #2.......................................137CAPSULE #3.......................................137CAPSULE #3 (CELLULOSE)............ 137CAPSULE #3 (HYPROMELLOSE)...137CAPSULE #4.......................................137CAPSULE #5.......................................137CAPSULE #7.......................................137CAPSULE CONI-SNAP #0 (GELATIN)......................................... 137CAPSULE CONI-SNAP #0(HYPROMEL).................................137CAPSULE CONI-SNAP #00 (GELATIN...........................................137CAPSULE CONI-SNAP #000............ 137CAPSULE CONI-SNAP #1 (GELATIN)......................................... 137CAPSULE CONI-SNAP #1(HYPROMEL).................................137CAPSULE CONI-SNAP #2 (GELATIN)......................................... 137CAPSULE CONI-SNAP #3 (GELATIN)......................................... 137CAPSULE CONI-SNAP #3(HYPROMEL).................................137CAPSULE CONI-SNAP #4 (GELATIN)......................................... 137captopril ................................................. 51captopril-hydrochlorothiazide................51CARAFATE.......................................... 83CARBAGLU....................................... 137carbamazepine....................................... 55CARBATROL....................................... 55carbidopa................................................38carbidopa-levodopa................................38carbidopa-levodopa-entacapone............ 39carbinoxamine maleate .......................... 29

151

Index

CARBOFLEX ODOR CONTROL DRESSIN.............................................101carbomer 940 (bulk) ............................ 137carbomer homopolymer c (bulk) ......... 137carboplatin ............................................. 34CARDENE IV IN DEXTROSE............ 48CARDENE IV IN SODIUM CHLORIDE........................................... 48CARDIO TEA....................................... 91cardioplegic soln....................................48CARDIZEM LA.................................... 48CARDURA XL..................................... 51CAREFINE PEN NEEDLE.................101CARIMUNE NF NANOFILTERED.... 44carisoprodol ......................................... 113carisoprodol-asa-codeine......................... 4carisoprodol-aspirin ............................. 113CARNITOR (SUGAR-FREE).............137CARRASYN HYDROGEL WOUND DRESS.................................................101CARRINGTON MOIST BARRIER-ZINC.................................................... 127CARRINGTON MOISTURE BARRIER CR......................................127carteolol ................................................. 72CARTIA XT.......................................... 48CARTICEL..........................................137carvedilol ............................................... 51CASTELLANI PAINT MODIFIED... 127castor oil .........................................83, 137CATAPRES...........................................51CATAPRES-TTS-1............................... 51CATAPRES-TTS-2............................... 51CATAPRES-TTS-3............................... 51CATHFLO ACTIVASE........................ 47cat's claw (uncaria tomentosa) ............... 91CAVILON SKIN CLEANSER........... 127CAYA CONTOURED.......................... 59CAYSTON............................................ 17CAZIANT (28) ...................................... 59cefaclor .................................................. 17cefadroxil ............................................... 17cefazolin .................................................17cefazolin in dextrose (iso-os) .................17cefdinir ...................................................17cefepime.................................................17cefepime in dextrose 5 %.......................17cefepime in dextrose,iso-osm................ 17cefixime................................................. 17cefotaxime..............................................17cefotetan.................................................17cefotetan in dextrose, iso-osm............... 17cefoxitin ................................................. 17cefoxitin in dextrose, iso-osm................17cefpodoxime.......................................... 17cefprozil ................................................. 17ceftazidime.............................................17ceftazidime in d5w.................................17ceftibuten............................................... 17CEFTIN................................................. 17ceftriaxone............................................. 17ceftriaxone in dextrose,iso-os ................ 17cefuroxime axetil ................................... 17

Index

cefuroxime sodium................................ 18celecoxib................................................ 12CELEXA..............................................117CELLCEPT INTRAVENOUS.............. 98cellulose (bulk) .................................... 138CELONTIN........................................... 55CEM-UREA........................................ 127CENTANY AT......................................18CENTRATEX........................................76CEPACOL SORE THROAT (BENZ-MEN)..................................................... 10cephalexin.............................................. 18CEPROTIN (BLUE BAR).................... 47CEPROTIN (GREEN BAR)..................47CERAVE BABY MOISTURIZING... 127CERAVE SUNSCREEN..................... 127CERDELGA........................................ 138CEREBYX.............................................55CEREZYME........................................138CERVARIX VACCINE (PF)................ 44CERVIDIL.............................................94CESAMET.............................................83CETA-KLENZ GENTLE....................128CETAPHIL.......................................... 128CETAPHIL ANTIBACTERIAL......... 128CETAPHIL DAILY FACIAL............. 128CETAPHIL DERMACONTROL........128CETAPHIL RESTORADERM........... 128cetirizine................................................ 29cetirizine-pseudoephedrine.................... 27cevimeline..............................................42CHANTIX........................................... 135CHANTIX CONTINUING MONTH BOX.....................................................135CHANTIX STARTING MONTH BOX..............................................................135CHATEAL.............................................59cheesecake flavor (bulk) ...................... 138CHEMET.............................................138CHEMSTRIP (CALIBRATION)........ 102CHEMSTRIP 2......................................69CHEMSTRIP K..................................... 69CHEMSTRIP MICRAL........................ 69CHEMSTRIP UGK............................... 69CHENODAL......................................... 83CHERATUSSIN AC............................. 63CHERATUSSIN DAC.......................... 63cherry flavor .........................................138CHEST CONGESTION RELIEF..........63CHEST CONGESTION RELIEF + DM.........................................................63CHEST CONGESTION RELIEF PE....63CHEST CONGESTION-COUGH RELIEF..................................................63CHEST RUB....................................... 128CHEST-SINUS CONGESTION RELIEF..................................................63CHILD ALLERGY RELF(CETIRIZINE).............................29CHILD DELSYM COUGH+CHEST DM.........................................................63CHILD DELSYM COUGH+COLD..... 63CHILD IBUPROFEN............................12

Index

CHILD MUCINEX CHEST CONGESTION......................................63CHILD MUCINEX M-S COLD DAY-NTE........................................................63CHILD MUCINEX STUFFY NOSE-COLD.................................................... 63CHILD MUCUS RELIEF COUGH...... 63CHILD MUCUS RELIEF EXPECTORANT.................................. 63CHILD PLUS COUGH AND RUNNYNOSE.......................................63CHILD TRIAMINIC COLD-ALLERGY.............................................27CHILD TRIAMINIC COUGH-CONGEST.............................................63CHILD TRIAMINIC COUGH-SORE THR....................................................... 63CHILD TRIAMINIC MS FEVER-COLD.................................................... 63CHILDREN'S ACETAMINOPHEN.......4CHILDREN'S ALAWAY..................... 29CHILDREN'S ALLERGY (DIPHENHYD)..................................... 29CHILDREN'S ALLERGY COMPLETE.......................................... 29CHILDREN'S ASPIRIN..........................4CHILDREN'S CETIRIZINE................. 29CHILDREN'S COLD AND COUGH (PE)........................................................ 63CHILDREN'S COLD AND COUGH DM.........................................................63CHILDREN'S COLD-ALLERGY (PE) 27CHILDREN'S IBUPROFEN................. 12CHILDREN'S MAPAP........................... 4CHILDREN'S MUCINEX COUGH..... 63CHILDREN'S MUCINEX NIGHT TIME......................................................63CHILDREN'S PAIN RELIEF................. 4CHILDREN'S PAIN RELIEVER............4CHILDREN'S PAIN-FEVER RELIEF... 4CHILDREN'S PEPTO........................... 83CHILDRENS PLUS MULTI-SYMP COLD.................................................... 63CHILDREN'S Q-PAP..............................4CHILDREN'S SILAPAP......................... 4CHILDREN'S SILFEDRINE................ 63CHILD'S ALL DAY ALLERGY(CETIR).............................. 29CHILDS TRIACTING COLD-COUGH................................................. 27CHLO HIST...........................................63CHLO TUSS..........................................63chloral hydrate (bulk) .......................... 138chloramphenicol sod succinate .............. 18chlordiazepoxide hcl ............................117chlordiazepoxide-clidinium................... 83chlorhexidine gluconate .......................138CHLOROPHYLL................................ 128CHLOROPHYLL (WITH ALFALFA).91chloroquine phosphate ........................... 33chlorothiazide........................................ 70chlorothiazide sodium............................70CHLORPHEN SR................................. 29

152

Index

chlorpheniramine maleate ......................29chlorpromazine.................................... 117chlorpropamide...................................... 31chlorthalidone........................................ 70chlorzoxazone...................................... 113chocolate flavor (bulk) .........................138CHOLBAM........................................... 83cholecalciferol (vitamin d3) .................145cholestyramine (with sugar) .................. 51CHOLESTYRAMINE LIGHT..............51choline,magnesium salicylate .................. 4chromium chloride.................................76CIALIS................................................ 138CICLODAN KIT................................... 25ciclopirox............................................... 25ciclopirox-ure-camph-menth-euc.......... 25cidofovir .................................................40cilostazol ................................................ 39CILOXAN............................................. 18cimetidine.............................................. 83cimetidine hcl .........................................83CIMZIA................................................. 83CIMZIA POWDER FOR RECONST... 83CIMZIA STARTER KIT.......................83CINNAMON......................................... 91cinnamon bark....................................... 91CINNAMON FLAVORING............... 138CINNAMON OIL..................................91CINRYZE............................................ 138CIPRO HC............................................. 18CIPRODEX........................................... 18ciprofloxacin.......................................... 18ciprofloxacin (mixture) ..........................18ciprofloxacin hcl .................................... 18ciprofloxacin in 5 % dextrose................ 18ciprofloxacin lactate ...............................18cisatracurium..........................................42cisplatin ..................................................34citalopram............................................ 117CITRANATAL (DUAL-IRON)..........113CITRANATAL DHA (ALGAL OIL). 113citric acid (bulk) ...................................138citronella oil ......................................... 138cladribine............................................... 34CLAFORAN..........................................18CLAFORAN IN DEXTROSE(ISO-OSM)..................................................... 18CLARAVIS......................................... 128CLARINEX........................................... 29CLARINEX-D 12 HOUR......................27clarithromycin........................................18CLEANSING EYELID......................... 72CLEANSING WASH............................18CLEAR BANDAGES......................... 102CLEAR SPOT BANDAGES...............102CLEAR TAPE..................................... 102CLEAR WATERPROOF STRIPS...... 102CLEARLAX.......................................... 83clemastine.............................................. 29CLEOCIN.............................................. 18CLERZ PLUS......................................102CLEVIPREX......................................... 49CLICKFINE........................................ 102

Index

CLIMARA PRO.................................... 94CLINDACIN ETZ................................. 18CLINDACIN PAC.................................18clindamycin hcl ......................................18clindamycin in 5 % dextrose..................18clindamycin palmitate hcl ......................18CLINDAMYCIN PEDIATRIC............. 18clindamycin phosphate .......................... 18clindamycin-benzoyl peroxide.............128CLINDESSE..........................................18CLINIMIX 5%/D15W SULFITE FREE......................................................76CLINIMIX 5%/D25W SULFITE-FREE......................................................76CLINIMIX 2.75%/D5W SULFIT FREE......................................................76CLINIMIX 4.25%/D10W SULF FREE 76CLINIMIX 4.25%/D5W SULFIT FREE......................................................76CLINIMIX 4.25%-D20W SULF-FREE 76CLINIMIX 4.25%-D25W SULF-FREE 76CLINIMIX 5%-D20W(SULFITE-FREE).................................................... 76CLINIMIX E 2.75%/D10W SUL FREE......................................................76CLINIMIX E 2.75%/D5W SULF FREE......................................................76CLINIMIX E 4.25%/D10W SUL FREE......................................................76CLINIMIX E 4.25%/D25W SUL FREE......................................................76CLINIMIX E 4.25%/D5W SULF FREE......................................................76CLINIMIX E 5%/D15W SULFIT FREE......................................................76CLINIMIX E 5%/D20W SULFIT FREE......................................................76CLINIMIX E 5%/D25W SULFIT FREE......................................................76CLINISOL SF 15 %.............................. 76clobetasol ............................................. 128clobetasol-emollient .............................128clocortolone pivalate ............................128CLODAN KIT..................................... 128CLOLAR............................................... 34clomipramine....................................... 117clonazepam............................................ 55clonidine................................................ 51clonidine (pf) ........................................... 5clonidine hcl ...................................51, 117clopidogrel ............................................. 39clorazepate dipotassium.......................117CLORPRES........................................... 51CLOTH FIRST AID TAPE................. 102CLOTH TAPE..................................... 102clotrimazole ........................................... 25CLOTRIMAZOLE-3.............................25clotrimazole-betamethasone.................. 25CLOVE FLAVORING........................138clozapine.............................................. 117CLOZARIL..........................................117C-NATE DHA..................................... 113CNL 8 NAIL..........................................25

Index

CO Q-10...............................................138COAGADEX.........................................47COARTEM............................................33COATS ALOE.....................................128COATS ALOE ANALGESIC.............128COATS ALOE MOISTURIZING.......128COBAN............................................... 102COBAN ACTION WRAP...................102COBAN SELF-ADHERENT WRAP..102COBAN STERILE SELF-ADHERENT..............................................................102cocaine................................................... 10cocoa butter ..........................................138coconut oil (bulk) .................................138cod liver oil .......................................... 145codeine sulfate ......................................... 5codeine-butalbital-asa-caff ...................... 5codeine-guaifenesin............................... 63coenzyme q10...................................... 138colchicine...............................................12COLD AND ALLERGY....................... 27COLD AND ALLERGY (BROMPHEN-PE)................................ 27COLD AND ALLERGY PE................. 27COLD AND COUGH DM.................... 63COLD AND COUGH ELIXIR............. 63COLD AND FLU SEVERE.................. 63COLD AND HOT PAIN RELIEF.......128COLD HEAD CONGESTION DAY/NITE............................................ 63COLD HEAD CONGESTION DAYTIME.............................................63COLD HEAD CONGESTION NIGHTTIME......................................... 63COLD HEAD CONGESTION SEVER DAY.......................................................64COLD MULTI-SYMPTOM..................64COLD MULTI-SYMPTOM (CHLORPHEN).....................................64COLD MULTI-SYMPTOM DAY/NIGHT......................................... 64COLD RELIEF PLUS........................... 64COLD SEVERE CONGESTION..........64COLD SORE TREATMENT................ 33COLD SORE TREATMNT (CAMP-PHEN)..................................................128COLD-SINUS RELIEF......................... 64COLESTID FLAVORED......................51colestipol ................................................51colistin (colistimethate na) .....................18COLOCORT..........................................94COLY-MYCIN S...................................18COMBIGAN..........................................72COMBINE ABD................................. 102COMBIPATCH..................................... 94COMBIVENT RESPIMAT...................15COMETRIQ.......................................... 34COMFEEL PURILON........................ 102COMFORT EZ PEN NEEDLES.........102COMFORT EZ SYRINGE..................102COMPACT SPACE CHAMBER PLUS....................................................102COMPLERA..........................................40

153

Index

COMPLETE.......................................... 83COMPLETE ALLERGY.......................29COMPLETE ALLERGY MEDICINE.. 29COMPLETE LICE TREATMENT..... 128COMPLETE NATAL DHA................ 113COMPLETENATE..............................113COMPRO.............................................. 84CONCERTA........................................117CONDYLOX.......................................128CONEX..................................................27CONFORM..........................................102CONFORMANT 2.............................. 102CONGESTAC....................................... 64CONSTULOSE..................................... 84CONTACT LENS RELIEF.................102COOLMAGIC..................................... 102COOLMAGIC FENESTRATED........ 102COPAXONE..........................................55COPPER CHLORIDE........................... 76CORDRAN TAPE LARGE ROLL..... 128CORDRAN TAPE SMALL ROLL.....128COREG CR........................................... 51CORIFACT............................................47CORLANOR......................................... 49CORLOPAM......................................... 51CORMAX............................................128CORN CUSHION............................... 102CORTIFOAM........................................94cortisone.................................................94CORTISPORIN..................................... 18CORVITA............................................145CORVITA 150.......................................76CORVITE............................................ 145CORVITE 150....................................... 76CORVITE FE........................................ 76CORVITE FREE................................. 145COSENTYX........................................ 128COSENTYX (2 SYRINGES)..............128COSENTYX PEN............................... 128COSENTYX PEN (2 PENS)............... 128COSMEGEN......................................... 34COSMETIC BALLS........................... 102COSMETIC PUFFS............................ 102COSMETIC SQUARES......................102COSOPT (PF)........................................72cosyntropin............................................ 94COTELLIC............................................ 34COTTON BALLS............................... 102COTTON BALLS STERILE.............. 102COTTON SQUARES..........................102COTTON SWABS.............................. 102COTTON, STERILE........................... 102cottonseed oil (bulk) ............................ 138COUGH AND COLD............................64COUGH AND COLD BP......................64COUGH CONTROL (DEXTROMETHORPH)...................... 64COUGH CONTROL (GUAIFENESIN)64COUGH CONTROL CF (PE)............... 64COUGH CONTROL DM......................64COUGH DM ER....................................64COUGH DROPS................................... 64COUGH RELIEF...................................64

Index

COUGH SUPPRESSANT-EXPECTORANT.................................. 64COUGH SYRUP................................... 64COUGH SYRUP DM............................64COUGH-SORE THROAT NIGHT.......64COUGHTAB......................................... 64COUGHTAB 400.................................. 64COUMADIN......................................... 23COVARYX............................................94COVARYX H.S. ................................... 94COVRSITE..........................................102COVRSITE PLUS............................... 102cpd vehicle sus.sugar-free #12.............138cranberry................................................ 92CRANBERRY.......................................92cranberry conc-ascorbic acid................. 92CRANBERRY CONCENTRATE.........92cranberry extract .................................... 92cranberry fruit ........................................ 92CRANBERRY PLUS VITAMIN C...... 92cream de menthe (bulk) ....................... 138CREME DE MENTHE FLAVORING138CREON..................................................84CRESEMBA..........................................25CRESTOR............................................. 51CRINONE..............................................94CRITIC-AID........................................128CRITIC-AID CLEAR..........................128CRITIC-AID CLEAR AF......................25CRIXIVAN............................................40cromolyn.................................... 12, 15, 72CRYOSERV........................................ 138CRYSELLE (28) ................................... 59CUBICIN...............................................18CUPRIMINE......................................... 12CURAD GAUZE PAD........................102CURAD NON-STICK PAD................102CURAFIL GEL WOUND................... 102CURI-STRIP WOUND CLOSURES..102CURITY ABDOMINAL PAD............ 102CURITY ABSORBENT WADDING. 102CURITY ALCOHOL SWABS............128CURITY AMD.................................... 102CURITY AMD (WITH POLYHEXAMETH)........................... 102CURITY BANDAGE..........................102CURITY COTTON PREP BALLS..... 102CURITY COTTON TIP APPLICATOR.....................................103CURITY COVER................................103CURITY DETECTABLE LAP........... 103CURITY DISP LAP SPONGE POUCH..............................................................103CURITY DISP LAP SPONGE TRAY 103CURITY DRESSING..........................103CURITY GAUZE................................103CURITY GAUZE BURN DRESSING103CURITY IODOFORM PACKING STRIP.................................................. 103CURITY MULTI-TRAUMA DRESSING..........................................103CURITY NON-ADHERENT STRIP.. 103

Index

CURITY NON-ADHERING DRESSING..........................................103CURITY PLAIN PACKING STRIP... 103CURITY READY-CUT GAUZE........103CURITY WET DRESSING................ 103CUROSURF........................................ 138CUVPOSA.............................................84cyanocobalamin (vitamin b-12) ...........145CYCLAFEM 1/35 (28) ..........................59CYCLAFEM 7/7/7 (28) .........................59cyclobenzaprine................................... 113CYCLOMYDRIL.................................. 72cyclopentolate ........................................ 72cyclophosphamide................................. 34cycloserine............................................. 18CYCLOSET...........................................31cyclosporine...........................................98cyclosporine modified........................... 98CYMBALTA.......................................117cyproheptadine.......................................29CYRAMZA........................................... 34CYRED..................................................59CYSTADANE..................................... 138CYSTAGON........................................138CYSTARAN..........................................72cysteine (l-cysteine) ............................... 77CYSVIEW............................................. 69cytarabine...............................................34cytarabine (pf) ........................................34CYTOGAM........................................... 44CYTOMEL.......................................... 135CYTRA K CRYSTALS........................ 77d10 %-0.45 % sodium chloride............. 77d2.5 %-0.45 % sodium chloride............ 77d5 % and 0.9 % sodium chloride........... 77d5 %-0.45 % sodium chloride............... 77dacarbazine............................................ 34DAKLINZA...........................................40DALIRESP............................................ 15DALLERGY (CHLORPHENIRAMINE-PE)..............27DALLERGY (DEXBROMPHENIRAMN-PE)...........27DALVANCE......................................... 18danazol ...................................................94dantrolene............................................ 113dapsone.................................................. 18DAPTACEL (DTAP PEDIATRIC) (PF)........................................................ 44DARAPRIM.......................................... 33darifenacin........................................... 138DARZALEX..........................................34DASETTA 1/35 (28) ............................. 59DASETTA 7/7/7 (28) ............................ 59daunorubicin.......................................... 35DAY TIME PE...................................... 64DAYHIST ALLERGY.......................... 29DAYSEE................................................59DAYTIME.............................................64DAYTIME COLD-FLU........................ 64DAYTIME COLD-FLU RELIEF (PE). 64DAY-TIME COUGH............................ 64DAYTIME SINUS................................ 64

154

Index

DAYTIME-NIGHTTIME..................... 64DAYTRANA.......................................117DEBLITANE.........................................59DECARA.............................................145decitabine...............................................35deferoxamine....................................... 138DEFINITY.............................................69DEHYDRATED ALCOHOL................55DELBASE COMPOUNDING............ 138DELESTROGEN...................................94DELFLEX WITH 2.5 % DEXTROSE..77DELFLEX-LC/1.5% DEXTROSE........77DELFLEX-LC/2.5% DEXTROSE........77DELFLEX-LC/4.25% DEXTROSE......77DELFLEX-SM WITH 1.5% DEXTROSE.......................................... 77DELSYM COUGH-CHEST CONGEST DM..................................... 64DELSYM COUGH-COLD DAYTIME 64DELSYM COUGH-COLD NIGHTTIME......................................... 64DELYLA (28) ........................................59demeclocycline...................................... 18DEMEROL (PF)......................................5DEMSER............................................... 51DENAVIR............................................. 40DENTA 5000 PLUS.............................. 77DENTAGEL.......................................... 77DENTAL TRAVEL PACK.................103denture care products ...........................103DEODORANT SOAP......................... 128DEPACON............................................ 55DEPAKENE.......................................... 55DEPAKOTE.......................................... 55DEPAKOTE ER.................................... 55DEPAKOTE SPRINKLES....................55DEPEN TITRATABS........................... 12DEPOCYT (PF).....................................35DEPO-ESTRADIOL............................. 95DEPO-MEDROL...................................95DEPO-PROVERA.................................95DEPO-SUBQ PROVERA 104.............. 59DERMA STAT....................................128DERMABASE.....................................138DERMACEA.......................................103DERMACEA I.V. ................................103DERMACEA NON-WOVEN............. 103DERMACEA STRETCH.................... 103DERMAFIX........................................ 138DERMAFUNGAL.................................25DERMAGAUZE................................. 103DERMAGAUZE HYDROGEL DRESSING..........................................103DERMA-GEL......................................103DERMAGRAN HYDROGEL DRESSING..........................................103DERMAGRAN HYDROPHILIC DRESSING..........................................103DERMAL WOUND CLEANSER...... 128DERMANIC........................................ 138DERMASARRA..................................128DERMASEPTIN................................. 128DERMASYN.......................................103

Index

DERMAVIEW.................................... 103DERMAVIEW II .................................103DESCOVY............................................ 40DESENEX............................................. 25desipramine..........................................117desloratadine.......................................... 29desmopressin..........................................95desog-e.estradiol/e.estradiol .................. 59desogestrel-ethinyl estradiol .................. 59DESONATE........................................ 128desonide............................................... 128desoximetasone....................................128DESOXYN............................................ 42desvenlafaxine..................................... 117desvenlafaxine fumarate ...................... 117DETOX DIETARY............................... 92DETOXAREX.......................................92DEWEE'S CARMINATIVE................. 84dexamethasone.......................................95DEXAMETHASONE INTENSOL....... 95dexamethasone sodium phos (pf) .......... 95dexamethasone sodium phosphate ...72, 95DEXEDRINE........................................ 42DEXEDRINE SPANSULE................... 42DEXILANT........................................... 84dexmedetomidine.................................124dexmethylphenidate .............................117DEXPAK 10 DAY................................ 95DEXPAK 13 DAY................................ 95DEXPAK 6 DAY.................................. 95dexrazoxane hcl ................................... 138dextroamphetamine..........................42, 43dextroamphetamine-amphetamine.........43dextromethorphan polistirex..................64dextromethorphan-guaifenesin.............. 64dextrose 10 % and 0.2 % nacl ................77dextrose 10 % in water (d10w)..............77dextrose 20 % in water (d20w)..............77dextrose 25 % in water (d25w)..............77dextrose 30 % in water (d30w)..............77dextrose 40 % in water (d40w)..............77dextrose 5 % in water (d5w)..................77dextrose 5 %-lactated ringers .................77dextrose 5%-0.2 % sod chloride............ 77dextrose 5%-0.3 % sod.chloride............ 77dextrose 50 % in water (d50w)..............77dextrose 70 % in water (d70w)..............77DHS ZINC........................................... 128DIABETIC SILTUSSIN DAS-NA........64DIABETIC SILTUSSIN-DM................64DIABETIC SILTUSSIN-DM MAX STR........................................................ 64DIABETIC VITAMIN........................ 145DIAFOODS THICK-IT.......................138DIAFOODS THICK-IT #2..................138DIALYVITE........................................145DIALYVITE 3000...............................145DIALYVITE 5000...............................145DIALYVITE SUPREME D................ 145DIANEAL LOW CALCIUM/1.5% DEX....................................................... 77DIANEAL LOW CALCIUM/4.25% DEX....................................................... 77

Index

DIANEAL PD-2 WITH 2.5 % DEX..... 77DIANEAL PD-2 WITH 4.25 % DEX... 77DIANEAL PD-2/1.5% DEXTROSE.....77DIANEAL WITH 1.5% DEXTROSE...77DIANEAL WITH 2.5 % DEXTROSE..77DIANEAL WITH 4.25 % DEXTROSE 77DIAPER RASH................................... 129DIAPER RASH RELIEF.....................129DIASTAT.............................................. 55DIASTAT ACUDIAL........................... 55DIASTIX............................................... 69diazepam........................................ 55, 117DIAZEPAM INTENSOL.................... 117dibucaine................................................10DICLEGIS............................................. 84diclofenac potassium............................... 5diclofenac sodium..............12, 35, 72, 129diclofenac-misoprostol .......................... 12dicloxacillin ........................................... 18dicyclomine............................................84didanosine.............................................. 40DIFICID.................................................18diflorasone........................................... 129diflunisal .................................................. 5DIGITEK............................................... 49DIGOX.................................................. 49digoxin................................................... 49dihydroergotamine...................................5DILANTIN............................................ 55DILANTIN EXTENDED......................55DILANTIN INFATABS........................55DILANTIN-125.....................................55DILATRATE-SR...................................49diltiazem hcl ...........................................49diltiazem in dextrose 5 %...................... 49DILT-XR............................................... 49DILUENT FOR EPOPROSTENOL/FLOLA.................138DILUENT FOR YF-VAX (1 DOSE).. 138DILUENT FOR YF-VAX (5 DOSE).. 138DILUENT-MERCK LIVE VIRUS VACC.................................................. 138DIMAPHEN (PE)..................................28DIMAPHEN DM...................................64dimenhydrinate ...................................... 84DIOCTO................................................ 84DIPENTUM...........................................84DIPHEDRYL.........................................29DIPHENHIST..................................29, 30diphenhydramine hcl ............................. 30diphenhydramine-acetaminophen............3diphenoxylate-atropine.......................... 84dipyridamole.................................... 39, 69DISINFECTING SOLUTION.............103disopyramide phosphate ........................ 49DISPOSABLE ENEMA........................84disulfiram.............................................138DIURETIC.............................................92DIURIL..................................................70divalproex.............................................. 55DIVIGEL............................................... 95dobutamine............................................ 49dobutamine in d5w................................ 49

155

Index

DOCEFREZ...........................................35docetaxel ................................................ 35DOC-Q-LACE.......................................84DOC-Q-LAX......................................... 84DOCU.................................................... 84docusate calcium....................................84docusate sodium.....................................84DOCUSIL.............................................. 84DOCUSOL............................................ 84DOCUSOL KIDS.................................. 84DOK.......................................................84DOK PLUS............................................84DONATUSSIN......................................64donepezil ................................................43DONNATAL......................................... 84dopamine................................................43dopamine in 5 % dextrose......................43DORAL................................................124DORIBAX............................................. 18DORYX........................................... 18, 19dorzolamide........................................... 72dorzolamide-timolol .............................. 72DOTHELLE DHA...............................113DOUBLE ANTIBIOTIC....................... 19DOUBLE ANTIBIOTIC (B.TRACN ZN).........................................................19DOUBLEDEX.......................................95doxazosin............................................... 51doxepin........................................ 118, 129doxercalciferol ..................................... 138doxorubicin............................................ 35doxorubicin, peg-liposomal ................... 35DOXY-100............................................ 19doxycycline hyclate ....................... 19, 138doxycycline monohydrate ......................19DR. SMITH'S ADULT BARRIER......129DR. SMITH'S DIAPER....................... 129DR. SMITH'S DIAPER RASH........... 129DR. SMITH'S RASH-SKIN................ 129DRIMINATE.........................................84dronabinol .............................................. 84droperidol .............................................118DROPLET PEN NEEDLE.................. 103drospirenone-ethinyl estradiol ............... 59DROXIA................................................47DRYNET WOUND VEIL...................103DSS........................................................ 84DUAVEE...............................................95DUCODYL............................................84DUEXIS.................................................12DULERA............................................... 15duloxetine............................................ 118DUO FUSION....................................... 84DUODERM HYDROACTIVE........... 103DUOPA..................................................39DURAFLU............................................ 64DURAPORE SURGICAL...................103DURAVENT DM..................................64DURAVENT PE....................................64DUREZOL.............................................72DURLAZA............................................ 39dutasteride............................................139dutasteride-tamsulosin......................... 139

Index

DUTOPROL.......................................... 51DYANAVEL XR...................................43DYLOJECT........................................... 12DYMISTA............................................. 72DYNA-HEX........................................ 129DYNA-HEX (ISOPROPYL ALCOHOL).........................................129DYRENIUM..........................................70DYSPORT............................................. 43E.C. PRIN................................................ 5E.E.S. 400.............................................. 19E.E.S. GRANULES...............................19EAR DROPS (CARBAMIDE PEROXIDE).......................................... 72EAR POPPER INFLATION DEVICE 103EAR WAX REMOVAL DROPS.......... 72EAR WAX REMOVAL KIT................ 72EAR WAX REMOVAL SYSTEM....... 72EAR WAX TREATMENT....................72EASIVENT HOLDING CHAMBER..103EASIVENT MASK LARGE...............103EASIVENT MASK MEDIUM............103EASIVENT MASK SMALL...............103EASY COMFORT INSULIN SYRINGE............................................ 103EASY COMFORT PEN NEEDLES... 103EASY TOUCH.................................... 104EASY TOUCH ALCOHOL PREP PADS................................................... 129EASY TOUCH FLIPLOCK INSULIN..............................................................103EASY TOUCH INSULIN SAFETY SYR......................................................104EASY TOUCH INSULIN SYRINGE.104EASY TOUCH LUER LOCK INSULIN............................................. 104EASY TOUCH SHEATHLOCK INSULIN............................................. 104EASY TOUCH SHEATHLOCK SYRG-NDL......................................... 104EASY TOUCH UNI-SLIP.................. 104echinacea................................................92echinacea angust-purpr root xt ...............92ECHINACEA HERB.............................92echinacea purpurea extract .................... 92echinacea purpurea root .........................92echinacea-golden seal ............................ 92echinacea-golden seal roots ................... 92econazole ............................................... 25ECONTRA EZ.......................................59ECOTRIN................................................ 5ED A-HIST............................................28ED A-HIST DM.................................... 65ED A-HIST PSE.................................... 28ED BRON GP........................................65ED CHLORPED D................................ 28ED CHLORPED JR...............................30ED-APAP................................................ 5EDARBI................................................ 51EDARBYCLOR.................................... 51ED-CHLORPED....................................30ED-CHLORTAN...................................30EDECRIN.............................................. 70

Index

EDLUAR............................................. 124ED-SPAZ...............................................84EDURANT............................................ 40EEMT.................................................... 95EEMT HS.............................................. 95EFFER-K............................................... 77EFFERVESCENT PAIN RELIEF.......... 5EFFEXOR XR..................................... 118EFFIENT............................................... 39EGRIFTA.............................................. 95ELAPRASE......................................... 139elastic bandage.....................................104ELASTO-GEL.....................................104ELASTO-GEL CAST-SPLINT PADDING........................................... 104ELASTO-GEL CIRCLE DRESSING. 104ELASTO-GEL FACE DRESSING..... 104ELASTO-GEL PLUS.......................... 104electrolyte-48 in d5w............................. 77ELELYSO............................................139ELESTRIN............................................ 95ELIDEL................................................. 98ELIGARD..............................................35ELIGARD (3 MONTH)........................ 35ELIGARD (4 MONTH)........................ 35ELIGARD (6 MONTH)........................ 35ELINEST............................................... 59ELIPHOS...............................................77ELIQUIS................................................23ELITEK................................................. 12ELIXOPHYLLIN.................................. 15ELLA..................................................... 59ELLURA................................................92ELMIRON............................................... 5ELOCTATE...........................................47ELTA SEAL MOISTURE BARRIER 129EMADINE.............................................30EMBEDA................................................ 5EMCYT................................................. 35EMEND................................................. 84EMOQUETTE.......................................59EMPLICITI............................................35EMSAM...............................................118EMTRIVA............................................. 40EMVERM..............................................33enalapril maleate ....................................51enalaprilat .............................................. 51enalapril-hydrochlorothiazide................51ENBRACE HR.................................... 113ENBREL................................................12ENBREL SURECLICK.........................12ENDACOF - DM...................................65ENDOCET...............................................5ENEMA................................................. 84ENEMA DISPOSABLE........................84ENEMEEZ.............................................85ENEMEEZ PLUS..................................85ENGERIX-B (PF)..................................44ENGERIX-B PEDIATRIC (PF)............45ENGLISH TOFFEE FLAVOR............139ENLON..................................................43ENLON-PLUS.......................................43ENLYTE (FERROUS GLYCINE)......145

156

Index

enoxaparin........................................23, 24ENPRESSE............................................59ENSKYCE.............................................59ENSTILAR.......................................... 129ENSURE COMPACT........................... 77entacapone............................................. 39entecavir .................................................40ENTEREG............................................. 85ENTRE-COUGH...................................65ENTRESTO...........................................51ENTYVIO..............................................85ENULOSE............................................. 85ENVARSUS XR....................................98EOVIST................................................. 69EPANED................................................51ephedrine sulfate ....................................51EPI-CLENZ......................................... 129EPIDUO...............................................129EPIDUO FORTE................................. 129EPIFOAM............................................129epinastine............................................... 30epinephrine............................................ 43epinephrine hcl (pf) ................................43EPIPEN..................................................43EPIPEN 2-PAK..................................... 43EPIPEN JR.............................................43EPIPEN JR 2-PAK................................ 43epirubicin............................................... 35EPITOL..................................................55EPIVIR HBV......................................... 40eplerenone..............................................71EPOGEN................................................58epoprostenol (glycine) ........................... 51eprosartan...............................................51EPSOM SALT....................................... 85eptifibatide............................................. 39EPZICOM..............................................40EQUETRO...........................................118ERAXIS(WATER DILUENT)..............25ERBITUX.............................................. 35ergocalciferol (vitamin d2) .................. 145ergoloid.................................................. 51ERIVEDGE........................................... 35ERRIN................................................... 59ERTACZO.............................................25ERWINAZE.......................................... 35ERY PADS............................................ 19ERYPED 400.........................................19ERY-TAB.............................................. 19ERYTHROCIN......................................19ERYTHROCIN (AS STEARATE)....... 19erythromycin..........................................19erythromycin ethylsuccinate ..................19erythromycin with ethanol .....................19erythromycin-benzoyl peroxide.............19ESBRIET............................................. 139ESCAVITE.......................................... 145ESCAVITE D...................................... 145ESCAVITE LQ....................................145escitalopram oxalate ............................ 118esmolol ...................................................51esomeprazole magnesium......................85esomeprazole sodium.............................85

Index

ESOTERICA FADE............................129ESTARYLLA........................................ 59estazolam............................................. 124ESTRACE..............................................95estradiol ..................................................95estradiol valerate ....................................95estradiol-norethindrone acet .................. 95ESTRING.............................................. 95estrogens-methyltestosterone.................95estropipate ..............................................95eszopiclone.......................................... 124ethacrynate sodium................................ 71ethambutol ............................................. 19ethanol (ethyl alcohol) ........................... 55ethosuximide..........................................55ethyl acetate ......................................... 139ethyl alcohol .........................................129etidronate disodium............................. 139etodolac..................................................12etomidate ................................................10ETOPOPHOS........................................ 35etoposide................................................ 35eucalyptol .............................................139EUCALYPTUS FLAVOR.................. 139eucalyptus oil ....................................... 139EURAX................................................129EVAMIST..............................................95EVEKEO............................................... 43EVENING PRIMROSE.........................92evening primrose oil .............................. 92EVOTAZ............................................... 40EVZIO................................................... 24EXCEDRIN MIGRAINE........................ 5EXCILON............................................104EXCILON AMD (WITH POLYHEXAMET).............................. 104EXCILON DRAIN.............................. 104EXCILON I.V. .....................................104EXEL INSULIN.................................. 104EXELDERM..........................................25EXELON............................................... 43exemestane.............................................35EXJADE.............................................. 139EX-LAX (SENNOSIDES).................... 85EXTAVIA..............................................55EXTINA................................................ 25EXTRANEAL 7.5 %............................. 77EXTRA-VIRT PLUS DHA.................113EXU-DRY ADULT DRESSING........ 104EXU-DRY ARM DRESSING.............104EXU-DRY BOOT-FOOT DRESSING104EXU-DRY BURN JACKET-LARGE.104EXU-DRY BURN JACKET-MEDIUM..............................................................104EXU-DRY BURN JACKET-SMALL 104EXU-DRY BURN VEST-LARGE......104EXU-DRY BURN VEST-SMALL..... 104EXU-DRY ELBOW-KNEE-HEEL.....104EXU-DRY FACE DRESSING............104EXU-DRY HAND DRESSING, LARGE................................................ 104EXU-DRY HAND DRESSING, MEDIUM.............................................104

Index

EXU-DRY HAND DRESSING, SMALL................................................104EXU-DRY INCISION DRESSING.... 104EXU-DRY LARGE BOOT DRESSING..........................................104EXU-DRY LEG DRESSING.............. 104EXU-DRY NECK DRESSING...........104EXU-DRY SCALP DRESSING......... 104EXU-DRY WOUND DRESSING...... 104EYE DROPS (TETRAHYDROZOLINE)................... 72EYE DROPS ADVANCED RELIEF....72EYE DROPS ALLERGY RELIEF....... 72EYE IRRIGATING SOLUTION.......... 72EYE ITCH RELIEF...............................30EYE STREAM...................................... 72EYE WASH...........................................72EYELID WIPES....................................72EYLEA.................................................. 72EZ CHAR............................................ 139E-Z SPACER....................................... 104EZO CUSHIONS LOWER HEAVY.. 104EZO CUSHIONS UPPER HEAVY.... 104FABB...................................................145FABIOR...............................................129FABRAZYME.....................................139FABRIC BANDAGES........................ 104FABRIC KNUCKLE-FINGER BANDAGE..........................................104FABRIC STRIP EXTRA LARGE...... 104FALLBACK SOLO...............................59FALMINA (28) ..................................... 59famciclovir .............................................40famotidine.............................................. 85famotidine (pf) ....................................... 85famotidine (pf)-nacl (iso-os) .................85FANAPT..............................................118FARESTON...........................................35FARXIGA..............................................31FARYDAK............................................ 35FASLODEX.......................................... 35FATTIBASE........................................139FATTYBLEND................................... 139FAZACLO...........................................118FE C....................................................... 77FEIBA NF..............................................47felbamate................................................55FELBATOL...........................................55felodipine............................................... 49FEM PH................................................. 33FEMRING............................................. 95fenofibrate ..............................................51fenofibrate micronized...........................52fenofibrate nanocrystallized...................52fenofibric acid........................................52fenofibric acid (choline) ........................ 52fenoprofen..............................................12fentanyl .................................................... 5fentanyl citrate ......................................... 5fentanyl citrate (pf) .................................. 5fentanyl-bupivacaine-nacl (pf) .................5fentanyl-ropivacaine-nacl (pf) ................. 5FENTORA...............................................5

157

Index

FERAHEME..........................................77FERIVA.................................................77FERIVA 21-7 TABLET........................ 77FERIVA FA (SUMALATE)................. 78FERRAPLUS 90....................................78FERRIPROX....................................... 139ferrous gluconate ................................... 78ferrous sulfate ........................................ 78FETZIMA............................................ 118FEVER REDUCER................................. 5FEVERALL.............................................5fexofenadine.......................................... 30fexofenadine-pseudoephedrine.............. 28FIBER.................................................... 85FIBER (CALCIUM POLYCARBOPHIL).............................85FIBER (PSYLLIUM HUSK)................ 85FIBER (PSYLLIUM HUSK/SUGAR)..85FIBER (WITH ASPARTAME).............85FIBER 6................................................. 85FIBER LAXATIVE (CA POLYCARBO)......................................85FIBER LAXATIVE (METHYLCELLULO)..........................85FIBER LAXATIVE (PSYLLIUM HUSK)................................................... 85FIBER SMOOTH.................................. 85FIBER SMOOTH (SUCROSE)............ 85FIBER THERAPY (M-CELL/SUGAR)85FIBER THERAPY (PSYLLIUM SEED).................................................... 85FIBER-LAX.......................................... 85FINACEA............................................ 129finasteride............................................ 139FINGER SLEEVES.............................105FIRAZYR............................................ 139FIRMAGON KIT W DILUENT SYRINGE.............................................. 35FISH OIL............................................... 85FLAREX................................................72FLAVOR BLEND 2 IN 1....................139FLAVOR PACKETS...........................139FLAVOR PLUS...................................139FLAVOR SWEET............................... 139FLAVOR SWEET-SF......................... 139FLAVORX.......................................... 139FLAVOUR PAC..................................139flavoxate .............................................. 139flaxseed.................................................. 92flaxseed oil .............................................92FLEBOGAMMA DIF........................... 45flecainide................................................49FLECTOR............................................129FLEET BISACODYL........................... 85FLEET GLYCERIN (ADULT).............85FLEET GLYCERIN (CHILD).............. 85FLEET GLYCERIN LAXATIVE.........85FLEET LAXATIVE.............................. 85FLEXBUMIN 25 %...............................47FLEXBUMIN 5 %.................................47FLEXIBLE.......................................... 105FLEXIBLE FABRIC BANDAGES.... 105FLEXIBLE FOAM..............................105

Index

FLEXICHAMBER.............................. 105FLEXZAN WOUND DRESSING...... 105FLOVENT DISKUS..............................15FLOVENT HFA.................................... 15FLOWTUSS.......................................... 65floxuridine..............................................35fluconazole .............................................25fluconazole in dextrose(iso-o) ............... 25fluconazole in nacl (iso-osm).................26flucytosine..............................................26fludarabine............................................. 35fludrocortisone.......................................95flumazenil ............................................ 139flunisolide.............................................. 72fluocinolone......................................... 129fluocinolone acetonide oil ......................72fluocinolone and shower cap............... 129fluocinonide......................................... 129FLUOCINONIDE-E............................129FLUOR-A-DAY.................................... 78FLUOR-A-DAY (WITH XYLITOL)....78fluorometholone.....................................73fluorouracil ............................................ 35fluoxetine............................................. 118fluoxetine (bulk) .................................. 139fluphenazine decanoate ........................118fluphenazine hcl ...................................118flurazepam........................................... 124flurbiprofen............................................ 12flurbiprofen sodium............................... 73FLU-SEVERE COLD-COUGH DAYTIME.............................................65FLU-SEVERE COLD-COUGH NIGHT...................................................65flutamide................................................ 35fluticasone......................................73, 129fluvastatin .............................................. 52fluvoxamine......................................... 118FML FORTE......................................... 73FML S.O.P. ............................................73foam bandage.......................................105FOAM TOE BANDAGE.................... 105FOCALGIN 90 DHA.......................... 113FOCALGIN CA...................................113FOCALGIN DSS...................................78FOCALIN............................................ 118FOCALIN XR..................................... 118FOLGARD.......................................... 145folic acid.............................................. 145FOLIVANE-F........................................78FOLIVANE-OB.................................. 113FOLOTYN.............................................35fomepizole ........................................... 139fondaparinux.......................................... 24FORADIL AEROLIZER.......................15FORFIVO XL......................................118formaldehyde......................................... 33FORMULA EM.....................................85FORTAZ................................................19FORTAZ IN DEXTROSE 5 %............. 19FORTEO..............................................139FORTICAL............................................95FOSAMAX PLUS D........................... 139

Index

foscarnet .................................................40fosinopril ................................................52fosinopril-hydrochlorothiazide.............. 52fosphenytoin.......................................... 55FOSRENOL...........................................78FP NATURAL LOTION.....................139FRAGMIN.............................................24FREAMINE HBC 6.9 %....................... 78FREAMINE III 10 %.............................78FREESTYLE PRECISION................. 105FRESHKOTE........................................ 73FRESHNET......................................... 129FROVA....................................................5FUL-GLO.............................................. 70FULYZAQ.............................................85FUNGOID TINCTURE.........................26FUNGOID-D......................................... 26furosemide............................................. 71FUSILEV.............................................139FUSION.................................................78FUSION PLUS...................................... 78FUSION SPRINKLES...........................78FUZEON................................................40FYAVOLV............................................ 95FYCOMPA............................................ 55gabapentin ..............................................56GABITRIL.............................................56GABLOFEN........................................ 113GADAVIST...........................................70galantamine............................................43GALZIN.............................................. 139GAMASTAN S/D................................. 45GAMMAGARD LIQUID..................... 45GAMMAGARD S-D (IGA < 1 MCG/ML)..............................................45GAMMAKED....................................... 45GAMMAPLEX......................................45GAMUNEX-C.......................................45ganciclovir sodium.................................40GARDASIL (PF)................................... 45GARDASIL 9 (PF)................................ 45garlic ...................................................... 92GARLIC OIL.........................................92GARLIPURE.........................................92GARLIQUE...........................................92GAS RELIEF.........................................85GAS RELIEF EXTRA STRENGTH.....85GAS RELIEF ULTRA STRENGTH.....85GAS-X EXTRA STRENGTH...............85GAS-X ULTRA-STRENGTH...............85gatifloxacin............................................ 19GATTEX 30-VIAL............................... 85GATTEX ONE-VIAL........................... 85gauze bandage......................................105GAUZE PAD.......................................105GAUZE ROLL.................................... 105GAVILYTE-C....................................... 85GAVILYTE-G.......................................85GAVILYTE-H AND BISACODYL..... 86GAVILYTE-N.......................................86GAVISCON EXTRA STRENGTH...... 86GAZYVA.............................................. 35GEL CORN PROTECTORS...............105

158

Index

GEL TOE PROTECTOR.................... 105GEL TOE SPACERS.......................... 105gelatin .................................................. 139gelatin (bulk) ........................................139GELFILM............................................ 139GELNIQUE......................................... 139GELPAD..............................................105gemcitabine............................................35gemfibrozil .............................................52GENERLAC.......................................... 86GENGRAF............................................ 98GENOTROPIN......................................95GENOTROPIN MINIQUICK............... 95GENTAK...............................................19gentamicin..............................................19gentamicin in nacl (iso-osm)................. 19gentamicin sulfate (ped) (pf) ................. 19gentamicin sulfate (pf) ...........................19GENTEAL GEL.................................... 73GENTEAL MILD..................................73GENTEAL SEVERE.............................73GENTLE LAXATIVE...........................86GENTLE RAIN................................... 129GENTLE TAPE...................................105GENVOYA............................................40GEODON............................................ 119GIANVI (28) ......................................... 59GIAZO...................................................86GILDAGIA............................................59GILDESS 1.5/30 (21) ............................ 59GILDESS 1/20 (21) ............................... 59GILDESS 24 FE.................................... 59GILDESS FE 1.5/30 (28) ...................... 59GILDESS FE 1/20 (28) ......................... 59GILENYA..............................................56GILOTRIF............................................. 35ginger (zingiber officinalis) ................... 92GINGER EXTRACT.............................92ginkgo biloba......................................... 92ginkgo biloba leaf extract ...................... 92GINSENG KOREAN............................ 92GLASSIA............................................ 139GLATOPA.............................................56GLEOSTINE......................................... 35GLIADEL WAFER............................... 35glimepiride.............................................31glipizide................................................. 31glipizide-metformin............................... 31GLUCAGEN DIAGNOSTIC KIT........ 70GLUCAGEN HYPOKIT.......................78GLUCAGON EMERGENCY KIT (HUMAN)..............................................78glucagon hcl ...........................................70glucosam su dip-chondroit-c-mn........... 12glucosamine sulfate ............................... 12glutathione (bulk) .................................139glyburide................................................ 31glyburide micronized............................. 31glyburide-metformin..............................31glycerin (adult) .......................................86glycerin (child) .......................................86glyceryl monostearate ..........................139glycine....................................................33

Index

GLYCOLAX......................................... 86GLYCOPHOS....................................... 78glycopyrrolate ........................................ 86GLYDO................................................. 10GLYSET................................................ 31GLYXAMBI..........................................31GOLYTELY.......................................... 86GONAK.................................................73GRALISE.............................................. 56GRALISE 30-DAY STARTER PACK. 56granisetron (pf) ...................................... 86granisetron hcl ....................................... 86GRANIX................................................58grape seed extract .................................. 92grape seed xt-bioflav,citrus ....................92GRAPEFRUIT.....................................139GRASTEK.............................................45GREEN COFFEE BEAN...................... 92GREEN TEA......................................... 92GREEN TEA COMPLEX..................... 92green tea-hoodia gordonii ...................... 93griseofulvin microsize........................... 26griseofulvin ultramicrosize.................... 26GRX FOAM DRESSING....................105GRX WOUND GEL............................105guaiacol ................................................129guaifenesin.............................................65GUAIFENESIN AC.............................. 65GUAIFENESIN DAC........................... 65guanfacine......................................52, 119guanidine................................................43guar gum.............................................. 139guava flavor (bulk) .............................. 140GYNAZOLE-1...................................... 26HALAVEN............................................ 35HALCION........................................... 124HALDOL.............................................119HALDOL DECANOATE................... 119halobetasol propionate ......................... 129HALOG............................................... 129haloperidol ........................................... 119haloperidol decanoate .......................... 119haloperidol lactate ................................119HAND SANITIZER............................ 129HARVONI.............................................40HAVRIX (PF)........................................45hawthorn berry.......................................93hawthorn extract .................................... 93HEADACHE PM.....................................3HEADACHE RELIEF (ASA-ACET-CAF)........................................................ 5HEALTHY ACCENTS UNIFINE PENTIP................................................105HEALTHYLAX.................................... 86HEARTBURN RELIEF (CIMETIDINE)..................................... 86HEARTBURN RELIEF (FAMOTIDINE)....................................86HEARTBURN RELIEF (RANITIDINE)......................................86HEARTBURN TREATMENT 24 HOUR.................................................... 86HEAT THERAPY............................... 105

Index

HEATHER.............................................59HEATWRAPS.....................................105HEATWRAPS BACK AND HIP PADS................................................... 105HECTOROL........................................ 140HELIXATE FS...................................... 47HEMABATE......................................... 95HEMANGEOL...................................... 52HEMATOGEN...................................... 78HEMATOGEN FA................................78HEMATOGEN FORTE........................ 78HEMOCYTE......................................... 78HEMOFIL M HIGH.............................. 47HEMOFIL M LOW...............................47HEMOFIL M MID................................ 47HEMOFIL M SUPER HIGH.................47HEMORRHOID.................................... 86HEMORRHOIDAL...............................86HEMORRHOIDAL (PHENYLEPH-COCOA)................................................ 86HEMORRHOIDAL COOLING............86HEMORRHOIDAL CREAM................86HEP FLUSH-10 (PF).............................24HEPAGAM B........................................45heparin (porcine) ....................................24heparin (porcine) in 0.9% nacl ...............24heparin (porcine) in 5 % dex................. 24heparin (porcine) in nacl (pf) .................24heparin(porcine) in 0.45% nacl ..............24heparin, porcine (pf) .............................. 24HEPATAMINE 8%............................... 78HERCEPTIN......................................... 35hetastarch 6 % in 0.9 % nacl ..................47HETLIOZ............................................ 124HEXALEN............................................ 35HEX-ON LIGHT ODOR.....................129HEXTEND............................................ 47HIBERIX (PF)....................................... 45HISTAFLEX............................................5HISTEX (TRIPROLIDINE)..................30HISTEX DM..........................................65HISTEX PD........................................... 30HISTEX PE........................................... 28HISTEX-AC.......................................... 65HIZENTRA........................................... 45HORIZANT...........................................56HUMALOG...........................................31HUMALOG KWIKPEN....................... 31HUMALOG MIX 50-50........................31HUMALOG MIX 50-50 KWIKPEN.... 31HUMALOG MIX 75-25........................31HUMALOG MIX 75-25 KWIKPEN.... 31HUMATE-P...........................................47HUMATROPE...................................... 95HUMIRA............................................... 12HUMIRA PEDIATRIC CROHN'S START...................................................12HUMIRA PEN.......................................12HUMIRA PEN CROHN'S-UC-HS START...................................................12HUMIRA PEN PSORIASIS-UVEITIS.12HUMULIN 70/30.................................. 31HUMULIN 70/30 KWIKPEN...............31

159

Index

HUMULIN N.........................................31HUMULIN N KWIKPEN..................... 31HUMULIN R.........................................31HUMULIN R U-500 (CONC) KWIKPEN.............................................31HUMULIN R U-500 (CONCENTRATED)............................ 31HURRIVIEW...................................... 105HURRIVIEW II ...................................105HYCAMTIN..........................................35HYCOFENIX........................................ 65HYDE-OUT ALDEHYDE NEUTRALIZER..................................105hydralazine.............................................52HYDRESS........................................... 105hydrochlorothiazide............................... 71hydrocodone-acetaminophen...............5, 6hydrocodone-chlorpheniramine.............65hydrocodone-cpm-pseudoephed............ 65hydrocodone-homatropine.....................65hydrocodone-ibuprofen............................6hydrocol dress-adhesive rem#1........... 105hydrocortisone............................... 95, 129hydrocortisone acetate ................... 86, 129hydrocortisone butyrate ....................... 129hydrocortisone butyr-emollient ........... 129HYDROCORTISONE PLUS..............129hydrocortisone valerate ........................129hydrocortisone-acetic acid..................... 73hydrocortisone-aloe vera ..................... 130hydrocortisone-min oil-wht pet ........... 130hydrocortisone-pramoxine.............86, 130hydrogen peroxide............................... 130HYDROMET.........................................65hydromorphone........................................6hydromorphone (pf) .................................6hydromorphone (pf)-0.9% nacl ............... 6hydrophilic ...........................................140HYDROPHILIC OINTMENT BASE(FAG)........................................ 140HYDROPHILIC PETROLATUM...... 140hydroquinone....................................... 130hydroquinone microspheres .................130HYDROSKIN......................................130HYDROSKIN WITH ALOE...............130hydroxocobalamin............................... 145hydroxychloroquine...............................33hydroxypropyl cellulose...................... 140hydroxyurea........................................... 36hydroxyzine hcl ..................................... 30hydroxyzine pamoate .............................30HYGIENIC CLEANSING.................. 130HYLENEX.......................................... 140HYOLEV MB........................................19hyoscyamine sulfate ...............................86HYOSYNE............................................ 86HYPAFIX............................................ 105HYPERHEP B S/D................................45HYPERHEP B S-D NEONATAL.........45HYPERLYTE CR..................................78HYPERRAB S/D (PF)...........................45HYPERRHO S/D...................................45HYPERTET S/D (PF)............................45

Index

HYPO-ALLERGENIC BANDAGES. 105HYPOTEARS........................................73hypromellose........................................140HYQVIA................................................45HYSINGLA ER.......................................6ibandronate .......................................... 140IBGARD................................................ 93IBRANCE..............................................36IBU-DROPS.......................................... 12ibuprofen................................................13IBUPROFEN COLD............................. 65IBUPROFEN COLD-SINUS(WITH PSE)....................................................... 65IBUPROFEN IB.................................... 13IBUPROFEN JR STRENGTH.............. 13IBUPROFEN PM.................................... 6ibuprofen-oxycodone...............................6ibutilide fumarate ...................................49IC GREEN............................................. 70ICLUSIG................................................36ICY HOT MEDICATED SLEEVE.....130idarubicin............................................... 36IDELVION............................................ 47IFEREX 150.......................................... 78IFEREX 150 FORTE.............................78ifosfamide.............................................. 36ILARIS (PF)........................................ 140ILEVRO.................................................73ILUVIEN............................................... 73imatinib.................................................. 36IMBRUVICA........................................ 36imipenem-cilastatin ................................19imipramine hcl ..................................... 119imipramine pamoate ............................ 119imiquimod............................................130IMLYGIC.............................................. 36IMOGAM RABIES-HT (PF)................ 45IMOVAX RABIES VACCINE (PF).....45IMUHANCE..........................................93INATAL ADVANCE..........................113INATAL ULTRA................................ 113IN-CHECK DIAL TRAINING DEVICE...............................................105INCONTROL PEN NEEDLE............. 105INCRELEX............................................95INCRUSE ELLIPTA............................. 15indapamide.............................................71INDERAL LA....................................... 52INDERAL XL....................................... 52INDIGO CARMINE..............................70INDIOMIN MB..................................... 19INDOCIN.............................................. 13indomethacin..........................................13indomethacin sodium.............................52INFANRIX (DTAP) (PF)...................... 45INFANT PAIN RELIEVER.................... 6INFANTS GAS RELIEF.......................86INFANTS IBU-DROPS........................ 13INFANT'S IBUPROFEN.......................13INFANTS' PAIN AND FEVER.............. 6INFANTS' PAIN RELIEF.......................6INFANT'S PAIN RELIEF.......................6INFANT'S PAIN RELIEVER................. 6

Index

INFUMORPH P/F................................... 6INFUVITE ADULT............................ 145INFUVITE PEDIATRIC..................... 145INJECTAFER........................................78INLYTA................................................ 36INNERMOST NATURE FOR MEN.... 93INNOPRAN XL.................................... 52INSPIRACHAMBER.......................... 105INSPIRACHAMBER WITH MASK-MED.................................................... 105INSPIRACHAMBER WITH MASK-SMALL................................................105INSTA-CHAR..................................... 140INSTA-CHAR-SORBITOL................ 140INSTACLEAN.................................... 140INSTA-GLUCOSE................................78INSULIN SYRINGE........................... 105INSULIN SYRINGE MICROFINE.... 105insulin syringe needleless .................... 105INSULIN SYRINGE ULTRAFINE....105insulin syringe-needle u-100................105insulin syringes (disposable) ................105INSUPEN............................................ 105INTEGRA..............................................78INTELENCE......................................... 40INTERMEZZO....................................124INTERSORB....................................... 106INTRALIPID.........................................86INTRASITE GEL DRESSING........... 106INTRON A............................................ 36INTROVALE........................................ 59INTUNIV ER.......................................119INVANZ................................................ 20INVEGA.............................................. 119INVEGA SUSTENNA........................ 119INVEGA TRINZA.............................. 119INVIRASE.............................................40INVOKAMET....................................... 32INVOKANA..........................................32INZO ANTIFUNGAL........................... 26IODIDES TINCTURE.........................130iodine-sodium iodide........................... 130IODOPEN..............................................78iodoquinol-hc.......................................130IONOSOL-B IN D5W...........................78IONOSOL-MB IN D5W....................... 78IONSYS...................................................6IOPHEN C-NR...................................... 65IOPHEN DM-NR.................................. 65IOPHEN-NR..........................................65IOPIDINE.............................................. 73IPOL...................................................... 45ipratropium bromide........................ 15, 73ipratropium-albuterol .............................15IPRIVASK.............................................24irbesartan................................................52irbesartan-hydrochlorothiazide.............. 52IRENKA.............................................. 119IRESSA..................................................36irinotecan............................................... 36IROSPAN 24/6...................................... 78ISAGEL............................................... 130ISAGEL NO RINSE............................130

160

Index

ISENTRESS.......................................... 40ISOLYTE S PH 7.4............................... 78ISOLYTE-P IN 5 % DEXTROSE.........78ISOLYTE-S........................................... 78isometh-dichloral-acetaminophn............. 6isomethepten-caf-acetaminophen............ 6isoniazid.................................................20isopropyl alcohol ........................... 33, 140ISOPROPYL ALCOHOL-WINTERGREEN................................ 130isopropyl palmitate .............................. 140ISOPTO TEARS....................................73ISORDIL................................................49isosorbide dinitrate .................................49isosorbide mononitrate ...........................49isosulfan blue......................................... 70isoxsuprine.............................................52isradipine................................................49ISTALOL...............................................73ISTODAX..............................................36ISUPREL............................................... 43ITCH RELIEF..................................... 130ITCH-X................................................130ITCHY EYE DROPS............................ 30itraconazole ............................................26IV 3000................................................ 106IV PREP WIPES..................................130IV3000 FRAME DELIVERY DRESSING..........................................106ivermectin .............................................. 33IXEMPRA............................................. 36IXIARO (PF)......................................... 45IXINITY................................................ 47JADENU..............................................140JAKAFI..................................................36JANTOVEN.......................................... 24JANUMET.............................................32JANUMET XR...................................... 32JANUVIA.............................................. 32JARDIANCE......................................... 32JENCYCLA...........................................59JENTADUETO......................................32JETREA (PF).........................................73JEVTANA............................................. 36JINTELI.................................................95J-MAX................................................... 65JOCK ITCH........................................... 26JOLESSA...............................................60JOLIVETTE.......................................... 60JR. STR NON-ASPIRIN PAIN...............6J-TAN PD.............................................. 30JUBLIA..................................................26JULEBER.............................................. 60JUNEL 1.5/30 (21) ................................ 60JUNEL 1/20 (21) ................................... 60JUNEL FE 1.5/30 (28) ...........................60JUNEL FE 1/20 (28) ..............................60JUNEL FE 24........................................ 60JUNIOR MAPAP.................................... 6JUXTAPID............................................ 52KABIVEN............................................. 78KADCYLA............................................36KADIAN..................................................6

Index

KAITLIB FE..........................................60KALBITOR......................................... 140KALETRA.............................................40KALYDECO....................................... 140KANUMA........................................... 140KAO-TIN (BISMUTH SUBSALICYLAT)................................ 86KAO-TIN (DOCUSATE CALCIUM).. 86KAPVAY.............................................119KARBINAL ER.....................................30KARIVA (28) ........................................ 60kava root extract .................................... 93KAZANO.............................................. 32KCENTRA............................................ 47KEDBUMIN..........................................47K-EFFERVESCENT............................. 78KELNOR 1/35 (28) ............................... 60KENALOG............................................ 95KENDALL.......................................... 106KENDALL CLOTH............................ 106KENDALL FOAM BORDER.............106KENDALL PAPER TAPE.................. 106KENGREAL..........................................39KEPIVANCE.........................................86KEPPRA................................................ 56KEPPRA XR......................................... 56KERLIX...............................................106KERLIX AMD.................................... 106KERLIX BURN PACK.......................106KERLIX PACKING SPONGE........... 106KERYDIN............................................. 26ketamine.................................................10ketamine in 0.9 % sod chloride..............10KETEK.................................................. 20ketoconazole .......................................... 26KETO-DIASTIX................................... 70KETONE CARE....................................70KETONE URINE TEST........................70ketoprofen.............................................. 13ketorolac........................................ 6, 7, 73KETOSTIX............................................70ketotifen fumarate ..................................30KEVEYIS............................................ 140KEYTRUDA......................................... 36KHEDEZLA........................................ 119KIDKARE COUGH/COLD.................. 65KIDS MINI ENEMA.............................86KIMIDESS (28) .....................................60KINERET.............................................. 13KINRIX (PF)......................................... 45KIONEX................................................ 78KIONEX (WITH SORBITOL)............. 78KITABIS PAK.......................................20KLONOPIN...........................................56KLOR-CON M10.................................. 78KLOR-CON M15.................................. 79KLOR-CON M20.................................. 79KLOR-CON SPRINKLE.......................79KLOR-CON/25......................................79KOATE-DVI......................................... 47KOGENATE FS.................................... 47KOMBIGLYZE XR.............................. 32KONSYL (SUGAR)..............................86

Index

KONSYL EASY MIX...........................86KONSYL FIBER...................................87KONSYL FORMULA-D...................... 87KONSYL SUGAR-FREE..................... 87KONSYL SUGAR-FREE (ASPARTAME).................................... 87KOREAN GINSENG............................ 93korean ginseng root extract ....................93KORLYM.............................................. 32K-PHOS NO 2....................................... 79K-PHOS ORIGINAL.............................79KRISTALOSE.......................................87KURVELO............................................ 60KUVAN...............................................140KYNAMRO...........................................52KYPROLIS............................................36l norgest/e.estradiol-e.estrad.................. 60labetalol ..................................................52LACRISERT..........................................73lactated ringers ...............................79, 130lactic acid (bulk) .................................. 140lactulose................................................. 87LAMICTAL...........................................56LAMICTAL ODT................................. 56LAMICTAL ODT STARTER (BLUE).56LAMICTAL ODT STARTER (GREEN)............................................... 56LAMICTAL ODT STARTER (ORANGE)............................................ 56LAMICTAL STARTER (BLUE) KIT.. 56LAMICTAL STARTER (GREEN) KIT56LAMICTAL STARTER (ORANGE) KIT.........................................................56LAMICTAL XR.................................... 56LAMICTAL XR STARTER (BLUE)... 56LAMICTAL XR STARTER (GREEN) 56LAMICTAL XR STARTER (ORANGE)............................................ 56LAMISIL (AEROSOL)......................... 26LAMISIL AF......................................... 26LAMISIL AT.........................................26lamivudine............................................. 40lamivudine-zidovudine.......................... 40lamotrigine.............................................56LANACANE FIRST AID..................... 10lanolin anhydrous.................................140LANOXIN............................................. 49LANOXIN PEDIATRIC....................... 49lansoprazole ........................................... 87LANTUS................................................32LANTUS SOLOSTAR..........................32LARIN 1.5/30 (21) ................................ 60LARIN 1/20 (21) ................................... 60LARIN 24 FE........................................ 60LARIN FE 1.5/30 (28) ...........................60LARIN FE 1/20 (28) ..............................60LASTACAFT........................................ 30latanoprost ..............................................73LATUDA.............................................119lavender oil ............................................ 93LAXATIVE (BISACODYL).................87LAXATIVE (SENNOSIDES)............... 87LAXATIVE FEMININE....................... 87

161

Index

LAXATIVE MAXIMUM STRENGTH87LAXATIVE PLUS STOOL SOFTENER........................................... 87LAYOLIS FE.........................................60LAZANDA.............................................. 7LEENA 28............................................. 60leflunomide............................................ 13LEMON EXTRACT FLAVOR...........140lemon flavor extract (bulk) .................. 140LEMON FLAVORING....................... 140LEMTRADA......................................... 56LENVIMA.............................................36LESSINA...............................................60LETAIRIS..............................................52letrozole ................................................. 36leucovorin calcium...............................140LEUKERAN..........................................36LEUKINE.............................................. 58leuprolide............................................... 36levalbuterol hcl ...................................... 15LEVEMIR..............................................32LEVEMIR FLEXTOUCH.....................32levetiracetam..........................................56levetiracetam in nacl (iso-os) .................56levobunolol ............................................ 73levocarnitine........................................ 140levocarnitine (with sugar) .................... 140levocetirizine..........................................30levofloxacin........................................... 20levofloxacin in d5w............................... 20levoleucovorin..................................... 140levomefolate calcium...........................145LEVONEST (28) ................................... 60levonorgestrel-ethinyl estrad................. 60levonorg-eth estrad triphasic ..................60LEVORA-28..........................................60levorphanol tartrate ..................................7levothyroxine....................................... 135LEVOXYL.......................................... 135LEVSIN................................................. 87LEVULAN............................................ 36LEXAPRO...........................................120LEXISCAN............................................70LEXIVA................................................ 40LIALDA................................................ 87LICE BEDDING SPRAY......................33LICE KILLING................................... 130LICE SOLUTION............................... 130LICE TREATMENT........................... 130LICE TREATMENT (PERMETHRIN)..............................................................130licorice root extract (bulk) ................... 140lidocaine.................................................10lidocaine (pf) in d7.5w..........................10lidocaine (pf) ....................................11, 49lidocaine hcl ...........................................11lidocaine hcl-hydrocortison ac.......87, 130lidocaine in 5 % dextrose (pf) ................49LIDOCAINE VISCOUS....................... 11lidocaine-epinephrine............................ 11lidocaine-epinephrine (pf) ..................... 11lidocaine-epinephrine bit ....................... 11lidocaine-hydrocortisone-aloe............... 87

Index

lidocaine-prilocaine............................... 11LIME FLAVOR...................................140lincomycin............................................. 20lindane..................................................130linezolid ................................................. 20linezolid-0.9% sodium chloride.............20LINSEED OIL....................................... 93LINZESS............................................... 87LIORESAL.......................................... 113liothyronine..........................................135LIP TREATMENT.............................. 140LIPODOX..............................................36LIPODOX 50.........................................36LIQUID ANTACID...............................87LIQUITEARS........................................73LISCO..................................................106lisinopril .................................................52lisinopril-hydrochlorothiazide............... 52LITE COAT ASPIRIN............................ 7LITE TOUCH INSULIN PEN NEEDLES............................................106LITE TOUCH INSULIN SYRINGE...106LITE TOUCH-MEDIUM MASK....... 106LITEAIRE MDI CHAMBER..............106LITETOUCH-LARGE MASK............106LITETOUCH-SMALL MASK........... 106lithium carbonate ................................. 120lithium citrate .......................................120LITHOBID.......................................... 120LITHOSTAT......................................... 87LIVALO................................................ 52LIVER COMPLEX............................... 93LMD 10 % IN 0.9 % SODIUM CHLOR..................................................47LMD 10 % IN 5 % DEXTROSE...........47L-METHYL-B6-B12...........................145L-METHYL-MC................................. 145L-METHYL-MC NAC........................145LO LOESTRIN FE................................ 60LODRANE D........................................ 28LOHIST - D...........................................28LOHIST-DM......................................... 65LOMEDIA 24 FE.................................. 60LONSURF............................................. 36loperamide............................................. 87LOPREEZA...........................................95loratadine............................................... 30LORATA-DINE D................................ 28LORATADINE-D................................. 28lorazepam.....................................120, 124LORAZEPAM INTENSOL................ 120LORCET (HYDROCODONE)............... 7LORCET HD........................................... 7LORCET PLUS....................................... 7LORTAB ELIXIR................................... 7LORTUSS DM...................................... 65LORTUSS EX....................................... 65LORTUSS LQ....................................... 28LORYNA (28) ....................................... 60LORZONE...........................................113losartan...................................................52losartan-hydrochlorothiazide................. 52LOTEMAX............................................73

Index

lovastatin ................................................52LOW-OGESTREL (28) .........................60loxapine succinate ................................120LUBRICANT EYE................................73LUBRICANT EYE (CMC-GLYCERIN)..........................................73LUBRICANT EYE (PG-PEG 400) ....... 73LUBRICANT EYE DROPS..................73LUBRICATING PLUS......................... 73LUBRIFRESH PM................................ 73LUCENTIS............................................ 73LUMIGAN............................................ 73LUMIZYME........................................140LUNESTA........................................... 124LUPANETA PACK (1 MONTH)......... 96LUPANETA PACK (3 MONTH)......... 96LUPRON DEPOT........................... 36, 96LUPRON DEPOT (3 MONTH)...... 36, 96LUPRON DEPOT (4 MONTH)............ 36LUPRON DEPOT (6 MONTH)............ 36LUPRON DEPOT-PED.........................96LUPRON DEPOT-PED (3 MONTH)... 96lutein.................................................... 140LUTERA (28) ........................................60LUZU.....................................................26LYNPARZA.......................................... 36LYRICA................................................ 56LYSODREN.......................................... 36LYZA.....................................................60M.V.I. ADULT.................................... 145M.V.I. PEDIATRIC.............................145M.V.I.-12 (WITHOUT VITAMIN K).145MAALOX ADVANCED...................... 87MAALOX MAXIMUM STRENGTH.. 87MACUGEN........................................... 73MAG-AL............................................... 87MAG-AL PLUS.....................................87MAG-AL PLUS EXTRA STRENGTH 87MAGELLAN INSULIN SAFETY SYRNG................................................106MAGELLAN SYRINGE.....................106MAGNASWEET 110..........................140MAGNASWEET 135..........................140MAGNEBIND 300................................79MAGNEBIND 400................................79magnesium chloride...............................79magnesium citrate ..................................87magnesium oxide................................... 79magnesium stearate ..............................140magnesium sulfate ................................. 79magnesium sulfate in d5w..................... 79magnesium sulfate in water ................... 79MAGNEVIST........................................70MAJOR-PREP HEMORRHOIDAL..... 87MAKENA..............................................96malathion............................................. 130manganese chloride............................... 79MANGO FLAVOR............................. 140mannitol 10 %........................................71mannitol 20 %........................................71mannitol 25 %........................................71mannitol 5 %..........................................71MAPAP (ACETAMINOPHEN)............. 7

162

Index

MAPAP ARTHRITIS PAIN................... 7MAPAP COLD FORMULA................. 65MAPAP EXTRA STRENGTH............... 7MAPAP PM.............................................3MAPAP SINUS MAX STRENGTH (PE)........................................................ 65maprotiline...........................................120MAR-COF BP....................................... 65MAR-COF CG.......................................65MARGESIC.............................................7MARLISSA........................................... 60MARNATAL-F................................... 113MARPLAN..........................................120MARQIBO............................................ 36marshmallow flavor (bulk) .................. 140MARTEN-TAB....................................... 7MASANTI DOUBLE STRENGTH...... 87MATULANE.........................................36MATZIM LA.........................................49MAXI-COMFORT INSULIN SYRINGE............................................ 106MAXIDEX............................................ 73MAXIPIME........................................... 20MAXORB............................................106MAXORB EXTRA DRESSING.........106MAXORB ROPE.................................106meclizine................................................87meclofenamate.......................................13MEDFIX.............................................. 106MEDFIX EZ DRESSING....................106MEDI PADS........................................130MEDICATED BODY......................... 130MEDICATED BODY POWDER........130MEDICATED CHEST RUB...............130MEDICATED PADS.............................87MEDICATED WIPES.........................130MEDICATED WIPES WITH ALOE..130MEDIGRIP.......................................... 106MEDIGRIP ELASTICATED SUPPORT............................................106MEDIGRIP TUBULAR...................... 106MEDIPLAST CORN-CALLUS-WART..................................................130MEDIPORE.........................................106MEDIPORE DRESS-IT COVER........106MEDIPORE H..................................... 106MEDIPORE PLUS PAD..................... 106MEDIPORE SOFT CLOTH TAPE.....106MEDROL.............................................. 96medroxyprogesterone...................... 60, 96mefenamic acid........................................7MEFIX.................................................106mefloquine............................................. 33MEFOXIN IN DEXTROSE (ISO-OSM)..................................................... 20megestrol ........................................36, 141MEKINIST............................................ 36melatonin............................................... 96melatonin-pyridoxine hcl (b6) ............... 96meloxicam..............................................13melphalan hcl .........................................36memantine..............................................56MENACTRA (PF).................................45

Index

M-END DMX........................................65M-END MAX D.................................... 65M-END PE.............................................65MENEST............................................... 96MENHIBRIX (PF).................................45MENOMUNE - A/C/Y/W-135..............45MENOMUNE - A/C/Y/W-135 (PF)..... 45MENOSTAR......................................... 96MENSTRUAL COMPLETE...................7MENSTRUAL RELIEF.......................... 7MENTAX.............................................. 26MENVEO A-C-Y-W-135-DIP (PF)......45MENVEO MENA COMPONENT (PF)45MENVEO MENCYW-135 COMPNT (PF)........................................................ 45meperidine............................................... 7meperidine (pf) ........................................ 7MEPHYTON....................................... 145MEPILEX BORDER...........................106MEPILEX BORDER SACRUM.........106MEPITEL............................................ 106mepivacaine (pf) .................................... 11meprobamate........................................120mercaptopurine...................................... 37meropenem............................................ 20meropenem-0.9% sodium chloride........20mesalamine............................................ 87mesalamine with cleansing wipe........... 87mesna................................................... 141MESNEX.............................................141MESTINON...........................................43METADATE CD.................................120METADATE ER................................. 120METAMUCIL (WITH SUGAR).......... 87METAMUCIL FIBER SINGLES......... 87METAMUCIL MULTIHEALTH FIBER.................................................... 87metaproterenol ....................................... 15METAXALL....................................... 113metaxalone...........................................113metformin.............................................. 32methadone................................................7METHADONE INTENSOL................... 7METHADOSE.........................................7methamphetamine..................................43methazolamide.......................................71methenamine hippurate ..........................20methenamine mandelate ........................ 20methen-sod phos-meth blue-hyos.......... 20methimazole .........................................135METHITEST......................................... 96methocarbamol.................................... 113METHOCEL E 4 M.............................141methotrexate sodium..............................37methotrexate sodium (pf) .......................37methoxsalen rapid................................130methscopolamine................................... 87methyclothiazide....................................71methyl alcohol ..................................... 141methylcellulose 1500cps (bulk) ...........141methylcellulose 4000cps (bulk) ...........141methyldopa............................................ 52methyldopa-hydrochlorothiazide...........52

Index

methyldopate ..........................................52methylene blue (antidote) .................... 141methylene blue (bulk-solid) .................141methylergonovine.................................. 96METHYLIN........................................ 120methylphenidate ...................................120methylprednisolone................................96methylprednisolone acetate ................... 96methylprednisolone sodium succ...........96methyltestosterone................................. 96metipranolol ...........................................73metoclopramide hcl ............................... 87metolazone.............................................71metoprolol succinate ..............................52metoprolol ta-hydrochlorothiaz............. 52metoprolol tartrate ................................. 52metronidazole ................................ 20, 130metronidazole in nacl (iso-os) ............... 20mexiletine.............................................. 49MIACALCIN.........................................96MI-ACID............................................... 87MI-ACID GAS RELIEF........................88MICONAZOLE 7..................................26miconazole nitrate ..................................26MICONAZOLE-3..................................26MICONAZORB AF.............................. 26MICRHOGAM ULTRA-FILTERED PLUS......................................................45MICROCHAMBER............................ 106MICROFOAM SURGICAL................106MICROGESTIN 1.5/30 (21) ................. 60MICROGESTIN 1/20 (21) .................... 60MICROGESTIN FE 1.5/30 (28) ............60MICROGESTIN FE 1/20 (28) ...............60MICRO-GUARD...................................26MICROPORE SURGICAL................. 106MICROSPACER................................. 107MICROSPONGE.................................107midazolam......................................11, 124midazolam (pf) .......................................11midazolam in 0.9 % nacl ....................... 11midodrine...............................................43MIGERGOT............................................ 7MIGRAINE FORMULA.........................7MIGRAINE RELIEF...............................7MILK OF MAGNESIA.........................88milk thistle ............................................. 93MILK THISTLE EXTRACT................ 93milk thistle seed extract ......................... 93MILLIPRED.......................................... 96MILLIPRED DP....................................96milrinone................................................49milrinone in 5 % dextrose......................49MIMVEY...............................................96MIMVEY LO........................................ 96MINASTRIN 24 FE.............................. 60mineral oil ..............................................88MINERAL OIL HEAVY.................... 141MINI ULTRA-THIN II ....................... 107MINIPRESS.......................................... 52MINITRAN........................................... 49MINIVELLE..........................................96MINOCIN..............................................20

163

Index

minocycline............................................20minoxidil ................................................52MINTOX............................................... 88MINTOX MAXIMUM STRENGTH....88MINTOX PLUS.....................................88MIOCHOL-E.........................................73MIOSTAT..............................................73MIRAPEX ER....................................... 39MIRCERA............................................. 58mirtazapine.......................................... 120MIRVASO...........................................130misoprostol ............................................ 88MISTASSIST...................................... 107mitomycin.............................................. 37mitoxantrone.......................................... 37M-M-R II (PF) ....................................... 45MOBISYL........................................... 130modafinil ..............................................120moexipril ................................................52moexipril-hydrochlorothiazide.............. 52MOISTURE RECOVERY.................. 131molindone............................................ 120mometasone......................................... 131MONAGHAN Z STAT CHAMBER.. 107MONAGHAN Z STAT CHAMBER-LG MSK.............................................. 107MONAGHAN Z STAT CHAMBER-MD MSK............................................. 107MONAGHAN Z STAT CHAMBER-SM MSK..............................................107MONOCLATE-P...................................48MONOJECT INSULIN SAFETY SYRING.............................................. 107MONOJECT INSULIN SYRINGE.....107MONOJECT SYRINGE......................107MONOJECT ULTRA COMFORT INSULIN............................................. 107MONO-LINYAH.................................. 60MONONESSA (28) ...............................60MONONINE..........................................48montelukast ............................................15MONUROL........................................... 20MORGIDOX 1X100............................. 20MORGIDOX 2X100............................. 20morphine.................................................. 8morphine (pf) ........................................... 7morphine (pf) in 0.9 % nacl .....................7morphine concentrate ...............................7morphine in 0.9 % nacl ............................7MOTION RELIEF (MECLIZINE)........88MOTION SICKNESS........................... 88MOTION SICKNESS (MECLIZINE).. 88MOTION SICKNESS RELIEF.............88MOTION-TIME.................................... 88MOUTHPIECE....................................107MOVANTIK..........................................24MOVIPREP........................................... 88MOXEZA.............................................. 20moxifloxacin.......................................... 20moxifloxacin-sod.ace,sul-water .............20MOZOBIL............................................. 58MPM FOAM DRESSING...................107MTERYTI............................................113

Index

MUCAPHED.........................................65MUCINEX COLD,FLU,SORE THROAT............................................... 65MUCINEX COUGH MINI-MELTS.....65MUCINEX D MAXIMUM STRENGTH.......................................... 65MUCINEX DM..................................... 65MUCINEX FAST-MAX COLD-FLU-THRT.....................................................66MUCINEX FAST-MAX COLD-SINUS....................................................66MUCINEX FAST-MAX CONGEST-COUGH................................................. 66MUCINEX FAST-MAX DAY-NITE CONG.................................................... 66MUCINEX FAST-MAX DAY-NT(DOXYL)......................................... 66MUCINEX FAST-MAX DM MAX..... 66MUCINEX FAST-MAX NITE (DOXYL)...............................................66MUCINEX FAST-MAX NITE COLD-FLU........................................................66MUCINEX FAST-MAX SEVERE COLD.................................................... 66MUCINEX FST-MX DY-NT COLD(DPH)..........................................66MUCINEX MINI-MELTS.................... 66MUCINEX SINUS-MAX..................... 73MUCINEX SINUS-MAX D-N (DIPHEN).............................................. 66MUCINEX SINUS-MAX PRESSUR-PAIN...................................................... 66MUCINEX SINUS-MAX SEV CONGESTN.......................................... 66MUCOSA.............................................. 66MUCOSA DM.......................................66MUCUS RELIEF...................................66MUCUS RELIEF COLD AND SINUS 66MUCUS RELIEF COLD-FLU-SORE THR....................................................... 66MUCUS RELIEF COUGH................... 66MUCUS RELIEF DM........................... 66MUCUS RELIEF DM MAX.................66MUCUS RELIEF ER............................ 66MUCUS RELIEF PE.............................66MUCUS RELIEF SEV CONGEST-COLD.................................................... 66MUCUS RELIEF SINUS...................... 66MUCUS-ER MAX................................ 66MULTAQ.............................................. 49MULTIPURPOSE CONTACT LENS 107MULTI-PURPOSE SOFT CONTACT LEN......................................................107MULTI-SYMPTOM COLD (PE)......... 66MULTI-SYMPTOM COLD NIGHT TIME......................................................66MULTITRACE-4.................................. 79MULTITRACE-4 CONCENTRATE....79MULTITRACE-4 NEONATAL........... 79MULTITRACE-4 PEDIATRIC............ 79MULTITRACE-5.................................. 79MULTITRACE-5 CONCENTRATE....79

Index

MULTI-VIT WITH FLUORIDE-IRON..............................................................145MULTIVITAMIN WITH FLUORIDE146MULTI-VITAMIN WITH FLUORIDE..............................................................146MULTIVITAMINS WITH FLUORIDE..........................................146mupirocin...............................................20mupirocin calcium................................. 20MURI-LUBE....................................... 141MURO 128............................................ 73MUSCLE RUB....................................131MUSCLE RUB (WITH CAMPHOR). 131MUSCLE RUB ULTRA-STRENGTH131MUSTARGEN...................................... 37MVC-FLUORIDE............................... 146MX-SOL.............................................. 141MX-SOL BLEND................................141MX-SOL BLEND SF.......................... 141MX-SOL SF.........................................141MX-SOL SUSPEND........................... 141MY WAY.............................................. 61MYALEPT............................................ 96MYCAMINE......................................... 26mycophenolate mofetil .......................... 98mycophenolate sodium.......................... 98MYLERAN............................................37MYOBLOC........................................... 43MYOFLEX.......................................... 131MYORISAN........................................ 131MYOZYME.........................................141MYRBETRIQ......................................141MYSOLINE...........................................56MYTAB GAS........................................88MYTAB GAS MAXIMUM STRENGTH.......................................... 88MYZILRA............................................. 61NABI-HB...............................................45nabumetone............................................13nadolol ................................................... 53nadolol-bendroflumethiazide.................53nafcillin .................................................. 20nafcillin in dextrose iso-osm..................20naftifine..................................................26NAFTIN.................................................26NAGLAZYME.................................... 141nalbuphine................................................8naloxone.................................................24naltrexone.............................................. 24NAMENDA.....................................56, 57NAMENDA TITRATION PAK............57NAMENDA XR.................................... 57NAMZARIC.......................................... 57NAPRELAN CR....................................13naproxen................................................ 13naproxen sodium....................................13naratriptan................................................ 8NARCAN.............................................. 25NARDIL.............................................. 120NAROPIN (PF)..................................... 11NASAL ALLERGY.............................. 73NASAL DECONGESTANT (OXYMETAZL)....................................73

164

Index

NASAL DECONGESTANT (PE).........66NASAL DECONGESTANT (PSEUDOEPH)................................66, 67NASAL FOUR...................................... 73NASAL SPRAY (OXYMETAZOLINE).......................... 74NASAL SPRAY 12 HOUR...................74NASAL SPRAY EXTRA MOISTURIZING.................................. 74NASAL SPRAY LONG ACTING........74NASAL SPRAY SINUS........................74NASCOBAL........................................146NASONEX............................................ 74NASOPEN PE....................................... 28NATACYN............................................26NATAZIA..............................................61nateglinide..............................................32NATESTO............................................. 96NATPARA............................................ 96NATRECOR..........................................53NATURAL BALANCE TEARS...........74NATURAL FIBER LAXATIVE...........88NATURAL FIBER LAXATIVE (SUGAR)............................................... 88NATURAL FIBER LAXATIVE THERAPY.............................................88NATURAL HERBAL DIURETIC........93NATURAL VEG LAXATIVE(SENNOSID).....................88NATURE'S TEARS...............................74NEBUPENT.......................................... 33NECON 0.5/35 (28) ...............................61NECON 1/35 (28) ..................................61NECON 1/50 (28) ..................................61NECON 10/11 (28) ................................61NECON 7/7/7 (28) .................................61nefazodone...........................................120NEMBUTAL SODIUM...................... 124neomycin................................................20neomycin-bacitracin-poly-hc.................20neomycin-bacitracin-polymyxin............20neomycin-polymyxin b gu...................131neomycin-polymyxin b-dexameth......... 20neomycin-polymyxin-gramicidin.......... 20neomycin-polymyxin-hc........................20NEO-POLYCIN.................................... 20NEO-POLYCIN HC..............................20NEOPROFEN (IBUPROFEN LYSN)(PF)............................................ 53NEORAL............................................... 98neostigmine methylsulfate ..................... 43NEO-SYNALAR...................................20NEO-SYNALAR KIT........................... 21NEPHPLEX RX.................................. 146NEPHRAMINE 5.4 %...........................79NEPHROCAPS................................... 146NEPHRON FA...................................... 79NESACAINE.........................................11NESACAINE-MPF............................... 11NESINA.................................................32NESTABS ABC.................................. 114NEUAC................................................131NEUAC KIT........................................131

Index

NEULASTA.......................................... 58NEUPOGEN..........................................58NEUPRO............................................... 39NEURONTIN........................................ 57NEUT.....................................................79NEUTROGENA TONER....................131NEVANAC............................................74nevirapine.............................................. 40NEW GENERATION......................... 107NEXA PLUS....................................... 114NEXAVAR............................................37NEXCARE GENTLE PAPER TAPE. 107NEXCARE TEGADERM................... 107NEXIUM PACKET...............................88NEXPLANON.......................................61NEXT CHOICE ONE DOSE................ 61NEXTERONE....................................... 49niacin..............................................53, 146NIACIN-AZE AC-TURMER-FA-B6-ZN........................................................ 141NIACOR................................................ 53NICADAN...........................................141nicardipine............................................. 49NICODERM CQ................................. 135NICOMIDE......................................... 146NICOMIDE (SELENIUM-CHROMIUM)......................................146NICORELIEF...................................... 135NICORETTE....................................... 135nicotine................................................ 135nicotine (polacrilex) .............................135NICOTROL......................................... 135NICOTROL NS................................... 135NIFEDICAL XL....................................49nifedipine............................................... 49NIGHT TIME........................................ 67NIGHT TIME COLD AND FLU RELIEF..................................................67NIGHT TIME COLD-FLU................... 67NIGHTTIME COLD-FLU.................... 67NIGHTTIME COLD-FLU RELIEF......67NIGHTTIME COUGH..........................67NIGHTTIME SLEEP AID (DIPHEN) 124NIKKI (28) ............................................ 61NILANDRON........................................37nimodipine............................................. 49NINJACOF............................................ 67NINJACOF-A........................................67NINJACOF-XG.....................................67NINLARO............................................. 37NIPENT................................................. 37nisoldipine..............................................49NITE TIME........................................... 67NITE TIME COLD-FLU.......................67NITE TIME COLD-FLU RELIEF........ 67NITE TIME COUGH............................ 67NITE TIME-D COLD-FLU RELIEF....67NITE-TIME COLD-FLU...................... 67NITRATEST PAPER WITH DISPENSER.......................................... 70NITRO-BID...........................................49NITRO-DUR......................................... 50nitrofurantoin......................................... 21

Index

nitrofurantoin macrocrystal ................... 21nitrofurantoin monohyd/m-cryst ............21nitroglycerin ...........................................50nitroglycerin in 5 % dextrose.................50NITROPRESS....................................... 53NITROSTAT......................................... 50NITRO-TIME........................................ 50NIVA-HIST DM....................................67NIVANEX DMX...................................67NIVA-PLUS........................................ 114nizatidine................................................88NO DOZ................................................ 57NO DRIP............................................... 74NO STING BARRIER FILM..............131NODOLOR..............................................8NOHIST-DM.........................................67NOHIST-LQ.......................................... 28NON-ASPIRIN........................................8NON-ASPIRIN EXTRA STRENGTH....8NON-ASPIRIN NIGHTIME................... 3NON-ASPIRIN PAIN RELIEF...............8NON-ASPIRIN PM................................. 3NON-DROWSY ALLERGY................ 30NON-STICK PAD...............................107NORA-BE..............................................61NORDITROPIN FLEXPRO................. 96NOREL AD........................................... 67norepinephrine bitartrate-d5w............... 43norepinephrine bitartrate-nacl ................43noreth-ethinyl estradiol-iron.................. 61norethindrone (contraceptive) ................61norethindrone acetate .............................96norethindrone ac-eth estradiol ......... 61, 96norethindrone-e.estradiol-iron............... 61norgestimate-ethinyl estradiol ............... 61NORINYL 1+35 (28) ............................ 61NORITATE......................................... 131NORLYROC......................................... 61NORMOSOL-M IN 5 % DEXTROSE..79NORMOSOL-R.....................................79NORMOSOL-R IN 5 % DEXTROSE.. 79NORMOSOL-R PH 7.4.........................79NORPACE CR...................................... 50NORPRAMIN..................................... 120NORTHERA..........................................43NORTREL 0.5/35 (28) .......................... 61NORTREL 1/35 (21) ............................. 61NORTREL 1/35 (28) ............................. 61NORTREL 7/7/7 (28) ............................ 61nortriptyline................................. 120, 121NORVIR.......................................... 40, 41NOSE DROPS....................................... 74NOSE DROPS EXTRA STRENGTH...74NO-STICK GLUCOSE......................... 70NO-STING SKIN-PREP..................... 107NOVASOURCE RENAL 2 CAL..........79NOVOEIGHT........................................48NOVOFINE 30....................................107NOVOFINE 32....................................107NOVOFINE AUTOCOVER............... 107NOVOFINE PLUS.............................. 107NOVOLIN 70/30................................... 32NOVOLIN N......................................... 32

165

Index

NOVOLIN R......................................... 32NOVOLOG............................................32NOVOLOG FLEXPEN......................... 32NOVOLOG MIX 70-30........................ 32NOVOLOG MIX 70-30 FLEXPEN......32NOVOLOG PENFILL...........................32NOVOSEVEN RT.................................48NOVOTWIST......................................107NOXAFIL..............................................26NP THYROID..................................... 135NPLATE................................................ 58NRS NASAL RELIEF...........................74NUCALA...............................................15NUCYNTA..............................................8NUCYNTA ER........................................8NUEDEXTA..........................................57NUFERA............................................... 79NULOJIX.............................................. 98NUPLAZID......................................... 121NUTREN 1.5......................................... 79NUTREN 2.0......................................... 79NUTRESTORE..................................... 79NUTRILIPID.........................................88NUTRILYTE.........................................79NUTROPIN AQ.................................... 96NUTROPIN AQ NUSPIN.....................96NUVARING.......................................... 61NUVESSA.............................................21NUVIGIL.............................................121NUWIQ..................................................48NYAMYC..............................................26NYMALIZE.......................................... 50nystatin ...................................................26nystatin-triamcinolone........................... 26NYSTOP................................................26NYTOL................................................124OATMEAL BATH REGULAR.......... 131OB COMPLETE GOLD......................114OB COMPLETE ONE........................ 114OB COMPLETE PETITE................... 114OB COMPLETE PREMIER............... 114OB COMPLETE WITH DHA.............114OBIZUR................................................ 48O-CAL FA........................................... 114O-CAL PRENATAL........................... 114OCELLA................................................61OCTAGAM........................................... 45octreotide acetate ................................... 96ODEFSEY............................................. 41ODOMZO..............................................37ODOR ELIMINATOR DROPS.......... 131ODOR FREE GARLIC......................... 93ODORLESS GARLIC...........................93OFEV...................................................141ofloxacin................................................ 21OGESTREL (28) ................................... 61olanzapine............................................ 121olanzapine-fluoxetine.......................... 121oleic acid..............................................141OLEPTRO ER..................................... 121olopatadine.......................................30, 74OLYSIO.................................................41OMECLAMOX-PAK............................88

Index

omega 3-dha-epa-fish oil ....................... 88omega-3 acid ethyl esters .......................88omega-3 fatty acids-fish oil ................... 88OMEGA-3 FLAXSEED OIL................ 93omeprazole .............................................88omeprazole magnesium......................... 88omeprazole-sodium bicarbonate ............88OMIDRIA..............................................74OMNARIS.............................................74OMNIPAQUE 140................................ 70OMNIPAQUE 180................................ 70OMNIPAQUE 240................................ 70OMNIPAQUE 300................................ 70OMNIPAQUE 350................................ 70OMNISCAN.......................................... 70OMNISCAN PREFILL PLUS.............. 70OMNITROPE........................................ 96ONCASPAR.......................................... 37ondansetron............................................88ondansetron hcl ......................................88ondansetron hcl (pf) ...............................88ONE WAY VALVED MOUTHPIECE..............................................................107ONEXTON.......................................... 131ONFI...................................................... 57ONGLYZA............................................ 32ONIVYDE............................................. 37ONMEL................................................. 26OPANA....................................................8OPCICON ONE-STEP..........................61OPDIVO................................................ 37opium tincture ........................................88OPSITE................................................107OPSITE ADHESIVE DRESSING...... 107OPSITE FLEXIFIX............................. 107OPSITE FLEXIGRID DRESSING..... 107OPSUMIT..............................................53OPTICHAMBER ADULT MASK-LARGE................................................ 107OPTICHAMBER DIAMOND LG MASK..................................................107OPTICHAMBER DIAMOND VHC...107OPTICHAMBER DIAMOND-MED MSK.....................................................107OPTICHAMBER DIAMOND-SML MASK..................................................107OPTI-CLEAR........................................ 74OPTI-FREE......................................... 107OPTI-FREE EXPRESS....................... 107OPTI-FREE REPLENISH...................107OPTI-FREE REWETTING DROPS... 107OPTISON.............................................. 70ORACIT................................................ 79ORAL MIX..........................................141ORAL MIX SF.................................... 141ORAL PAIN RELIEF............................11ORAL SUSPEND................................141ORAL SYRUP.....................................141ORAL SYRUP SF............................... 141ORALAIR..............................................45ORALONE.......................................... 141ORANGE CONCENTRATE.............. 141orange oil ............................................. 141

Index

ORAP...................................................121ORA-PLUS..........................................141ORASEP................................................ 11ORA-SWEET...................................... 141ORA-SWEET SF.................................141ORAVIG................................................26ORBACTIV...........................................21ORENCIA..............................................13ORENCIA (WITH MALTOSE)............13ORENITRAM........................................53ORFADIN............................................141ORGAN-I NR........................................67ORIGINAL NASAL SPRAY................74ORKAMBI.......................................... 141orphenadrine citrate ............................. 113ORSYTHIA........................................... 61OSCIMIN.............................................. 88OSCIMIN SL.........................................88OSCIMIN SR.........................................88OSENI....................................................32OSMITROL 15 %..................................71OSMOPREP.......................................... 88OTEZLA................................................13OTEZLA STARTER............................. 13OTIPRIO................................................21OTREXUP (PF).....................................13OVACE PLUS.....................................131OVACE PLUS SHAMPOO................ 131oxacillin ................................................. 21oxacillin in dextrose(iso-osm)............... 21oxaliplatin .............................................. 37oxandrolone........................................... 97oxaprozin............................................... 13oxazepam............................................. 121oxcarbazepine........................................ 57oxiconazole ............................................ 26OXISTAT.............................................. 26OXSORALEN..................................... 131OXTELLAR XR....................................57oxybutynin chloride............................. 141oxycodone................................................8oxycodone-acetaminophen...................... 8oxycodone-aspirin ....................................8OXYCONTIN..........................................8oxymorphone........................................... 8oxytocin................................................. 97oxytocin in 0.9 % sod chloride.............. 97oxytocin in lactated ringers ....................97OXYTROL.......................................... 141OYSTERCAL-D....................................79OZURDEX............................................ 74PACERONE.......................................... 50paclitaxel ................................................37PACNEX HP....................................... 131PACNEX LP........................................131PACNEX MX......................................131PAIN AND FEVER.................................8PAIN FREE TAPE.............................. 107PAIN FREE WRAP.............................107PAIN RELIEF......................................... 9PAIN RELIEF (ACETAMIN-ASP-CAF)........................................................ 8PAIN RELIEF ALLERGY SINUS....... 67

166

Index

PAIN RELIEF COLD AND COUGH...67PAIN RELIEF EXTRA STRENGTH..... 9PAIN RELIEF INSTANT ANTISEPTIC...................................... 131PAIN RELIEF PM...................................3PAIN RELIEF PM RAPID RELEASE... 3PAIN RELIEF REGULAR STRENGTH............................................ 9PAIN RELIEF SINUS PE..................... 67PAIN RELIEVER....................................9PAIN RELIEVER EXTRA STRENGTH............................................ 9PAIN RELIEVER PLUS.........................9PAIN RELIEVER PM.............................3PAIN RELIEVER PM EX-STRENGTH............................................ 3PAIRE OB PLUS DHA.......................114paliperidone......................................... 121PAMELOR.......................................... 121pamidronate ......................................... 141pancuronium.......................................... 43PANDA MASK................................... 107PANDEL..............................................131PANHEMATIN...................................141PANOXYL.......................................... 131PANOXYL-4.......................................131PANRETIN............................................37pantoprazole ...........................................88papaverine..............................................53PAPER TAPE......................................108PAPER TAPE, HYPOALLERGENIC 108paraffin .................................................141PARAGARD T 380A............................ 61paregoric ................................................ 88PAREMYD............................................74paricalcitol ........................................... 141PARNATE...........................................121paromomycin......................................... 33paroxetine hcl .......................................121PASER...................................................21PATADAY............................................ 30PAXIL..................................................121PAXIL CR........................................... 121PAZEO.................................................. 30PCCA-PLUS BASE.............................141PCE........................................................ 21PEANUT BUTTER FLAVOR............ 142PEDIA RELIEF COUGH-COLD..........67PEDIA-LAX.......................................... 88PEDIA-LAX STOOL SOFTENER.......89PEDIARIX (PF).....................................45PEDIATRIC COUGH AND COLD......67PEDIATRIC MEDIUM MASK.......... 108PEDIATRIC PANDA MASK............. 108PEDIATRIC SMALL MASK............. 108PEDIAVENT.........................................30PEDI-BORO SOAK............................ 131PEDI-PRE TAPE SPRAY...................108PEDITRACE......................................... 79PEDVAX HIB (PF)............................... 45peg 3350-electrolytes .............................89PEG3350................................................89PEG-3350 WITH FLAVOR PACKS.... 89

Index

PEGANONE..........................................57PEGASYS..............................................41PEGASYS PROCLICK.........................41peg-electrolyte soln................................89PEGINTRON.........................................41PEGINTRON REDIPEN.......................41PEN NEEDLE..................................... 108pen needle, diabetic ............................. 108penicillin g pot in dextrose.................... 21penicillin g potassium............................ 21penicillin g procaine.............................. 21penicillin g sodium................................ 21penicillin v potassium............................ 21PENNSAID..........................................131PENTACEL (PF)...................................45PENTACEL ACTHIB COMPONENT (PF)........................................................ 45PENTACEL DTAP-IPV COMPNT (PF)........................................................ 46PENTAM...............................................33PENTASA............................................. 89pentazocine-naloxone.............................. 9PENTIPS..............................................108pentobarbital sodium (bulk) .................142pentoxifylline.........................................48PENTRAVAN..................................... 142PEPPERMINT FLAVORING.............142peppermint oil ........................................93peppermint spirit ....................................93PEPTIC RELIEF................................... 89PERDIEM OVERNIGHT RELIEF.......89PERFOROMIST....................................15PERI-COLACE..................................... 89PERIFRESH........................................ 131PERIGUARD...................................... 131PERIKABIVEN.....................................79perindopril erbumine............................. 53PERISCENT........................................ 131PERJETA...............................................37permethrin............................................131perphenazine........................................ 121perphenazine-amitriptyline.................. 121PERTZYE..............................................89PETADOLEX........................................93PETADOLEX 75...................................93PETROLATUM GAUZE....................108petrolatum, yellow (bulk) .................... 142PETROLEUM JELLY.........................142PETROLEUM JELLY, WHITE..........142PEXEVA..............................................121PFIZERPEN-G...................................... 21PFLEX INSPIRATORY TRAINER... 108PHARBEDRYL.....................................30PHARBETOL..........................................9PHAZYME............................................ 89PHENADOZ..........................................89PHENASEPTIC.....................................11phenazopyridine.....................................11phenelzine............................................ 121phenelzine (bulk) ................................. 142phenobarb-hyoscy-atropine-scop...........89phenobarbital ....................................... 124phenobarbital (bulk) .............................142

Index

phenobarbital sodium...........................124PHENOHYTRO.................................... 89phenoxybenzamine................................ 43phentolamine..........................................44phenylephrine hcl .............................53, 74phenylephrine hcl in 0.9% nacl ............. 53PHENYLHISTINE DH......................... 67PHENYTEK.......................................... 57phenytoin............................................... 57phenytoin sodium...................................57phenytoin sodium extended................... 57PHILITH................................................61PHOSLYRA.......................................... 79PHOSPHA 250 NEUTRAL.................. 79PHOSPHOLINE IODIDE..................... 74physostigmine salicylate ........................44PHYTOFUSION....................................93phytonadione (vitamin k1) ...................146PICATO.................................................37pilocarpine hcl ................................. 44, 74pimozide.............................................. 121PIMTREA (28) ...................................... 61pindolol .................................................. 53pine tar (bulk) ...................................... 131PINK BISMUTH................................... 89PINK BISMUTH MAXIMUM STRENGTH.......................................... 89pioglitazone............................................32pioglitazone-glimepiride........................32pioglitazone-metformin......................... 32piperacillin-tazobactam..........................21PIRMELLA........................................... 61piroxicam............................................... 13PITOCIN................................................97PLASBUMIN 25 %...............................48PLASBUMIN 5 %.................................48PLASMA-LYTE 148.............................79PLASMA-LYTE A................................79PLASMA-LYTE-56 IN 5 % DEXTROSE.......................................... 79PLASMANATE.................................... 48PLASTIC STRIPS............................... 108PLASTIC SWABS.............................. 108PLEGRIDY............................................57PNEUMOVAX 23.................................46PNV 29-1............................................. 114PNV-DHA........................................... 114PNV-FERROUS FUMARATE-DOCU-FA............................................114PNV-SELECT..................................... 114PNV-VP-U...........................................114POCKET CHAMBER......................... 108PODOCON.......................................... 131podofilox..............................................131POLOCAINE.........................................11POLOCAINE-MPF............................... 11POLY HIST FORTE (DOXYLAMINE)..................................28POLY HIST PD.....................................67POLYCIN.............................................. 21polyethylene glycol 3350.......................89polyethylene glycol 8000(bulk) ...........142POLY-HIST DM (THONZYLAMINE) 67

167

Index

polymyxin b sulfate ............................... 21polymyxin b sulf-trimethoprim..............21polyoxyl 40 stearate .............................142polyoxyl 40 stearate (bulk) .................. 142POLYSKIN II ......................................108polysorbate 60......................................142polysorbate 80......................................142POLY-TUSSIN AC............................... 67POLY-VENT DM................................. 67POLY-VENT IR....................................67POMALYST..........................................37pomegranate fruit extract .......................93POMEGRANATE-EGCG-GRAPE SEED..................................................... 93PORTIA.................................................61PORTRAZZA........................................37potassium acetate ................................... 80potassium bicarb and chloride............... 80potassium bicarb-citric acid...................80potassium chlorid-d5-0.45%nacl ........... 80potassium chloride................................. 80potassium chloride in 0.9%nacl .............80potassium chloride in 5 % dex...............80potassium chloride in lr-d5.................... 80potassium chloride-0.45 % nacl .............80potassium chloride-d5-0.2%nacl ........... 80potassium chloride-d5-0.3%nacl ........... 80potassium chloride-d5-0.9%nacl ........... 80potassium citrate .................................... 80potassium citrate-citric acid...................80potassium gluconate ...............................80potassium phosphate m-/d-basic ............80POTIGA.................................................57povidone-iodine................................... 131POWER CLEANER............................108PR NATAL 400...................................114PR NATAL 400 EC.............................114PR NATAL 430...................................114PR NATAL 430 EC.............................114PRADAXA............................................ 24PRALUENT PEN..................................53PRALUENT SYRINGE........................ 53pramipexole ........................................... 39PRAMOSONE.....................................132PRAMOSONE E................................. 131pramoxine.............................................. 89pravastatin ..............................................53PRAXBIND...........................................48prazosin..................................................53PRECEDEX.........................................124PRECEDEX IN 0.9 % SODIUM CHLOR................................................124PRED MILD..........................................74PRED-G.................................................21PRED-G S.O.P. ......................................21prednicarbate ........................................132prednisolone...........................................97prednisolone acetate ...............................74prednisolone sodium phosphate .......74, 97prednisone..............................................97PREDNISONE INTENSOL..................97PREFERA-OB PLUS DHA................ 114PREFEST...............................................97

Index

PREMARIN...........................................97PREMASOL 10 %.................................80PREMASOL 6 %...................................80PRE-MENSTRUAL RELIEF..................9PREMPHASE........................................97PREMPRO.............................................97PRENAISSANCE................................114PRENAISSANCE PLUS.....................114PRENATA...........................................114PRENATAL PLUS (CALCIUM CARB)................................................. 114PRENATE AM....................................114PRENATE CHEWABLE.................... 114PRENATE DHA..................................114PRENATE DHA (FERR ASP GLYCIN).............................................114PRENATE ELITE............................... 114PRENATE ELITE (IRON ASP GLYC)..............................................................114PRENATE ENHANCE....................... 114PRENATE ESSENTIAL..................... 114PRENATE ESSENTIAL(IRON-ASP-GL).......................................................114PRENATE MINI................................. 114PRENATE MINI (FERR ASP GLYCIN).............................................114PRENATE PIXIE................................ 114PRENATE RESTORE.........................114PRENATE STAR................................ 114PREPARATION H(PE,CB).................. 89PREPIDIL..............................................97PREPLUS............................................ 114PREPOPIK............................................ 89PREQUE 10.........................................114PRESTALIA..........................................53PRETAB.............................................. 114PREVACID SOLUTAB........................89PREVALITE..........................................53PREVIFEM............................................61PREVNAR 13 (PF)................................46PREZCOBIX......................................... 41PREZISTA.............................................41PRIALT................................................... 9PRIFTIN................................................ 21PRILOSEC............................................ 89PRILOSEC OTC................................... 89primaquine............................................. 33PRIMEAIRE........................................108PRIMER MODIFIED UNNA BOOT. 108primidone...............................................57PRIMLEV................................................9PRIMROSE OIL....................................93PRIMSOL.............................................. 21PRISTIQ.............................................. 121PRIVIGEN.............................................46PRO SPORTS TAPE...........................108PROAIR HFA........................................15PROAIR RESPICLICK.........................15probenecid..............................................13probenecid-colchicine............................13PROBIOTIC PLUS AND CRANBERRY.......................................93procainamide..........................................50

Index

PROCALAMINE 3%............................ 80PROCENTRA........................................44PROCHAMBER..................................108prochlorperazine.................................... 89prochlorperazine edisylate ..................... 89prochlorperazine edisylt(bulk) .............142prochlorperazine maleate .......................89PROCORT.............................................89PROCRIT.............................................. 58PROCTOFOAM HC............................. 89PROCTO-PAK.................................... 132PROCTOSOL HC................................. 89PROCTOZONE-HC............................ 132PROCYSBI..........................................142PRODIGY INSULIN SYRINGE........ 108PROFILNINE........................................ 48progesterone...........................................97PROGESTERONE IN OIL................... 97progesterone micronized........................97PROGLYCEM.......................................80PROGRAF.............................................98PROLASTIN-C................................... 142PROLENSA...........................................74PROLEUKIN.........................................37PROLIA...............................................142PROMACTA......................................... 58promethazine....................................30, 89PROMETHAZINE VC..........................28PROMETHAZINE VC-CODEINE.......67promethazine-codeine............................67promethazine-dm................................... 67promethazine-phenyleph-codeine..........67promethazine-phenylephrine................. 28PROMETHEGAN................................. 89propafenone........................................... 50propantheline......................................... 89proparacaine...........................................74propofol ..................................................11propranolol .............................................53propranolol-hydrochlorothiazid.............53propylene glycol .................................. 142propylene glycol (bulk) ........................142propylthiouracil ....................................135PROQUAD (PF)....................................46PRO-RED AC (W/ DEXCHLORPHENIR)..........................67PROSHIELD PLUS.............................132PROSOL 20 %.......................................80PROSTASCINT.................................... 70PROSTIN E2......................................... 97PROSTIN VR PEDIATRIC.................. 53protamine............................................... 48PROTONIX........................................... 89PROTOPAM CHLORIDE.................. 142protriptyline......................................... 121PROVENTIL HFA................................ 15PROVIDA DHA..................................114PROVIDA OB..................................... 114PROVIGIL...........................................122PROVIL.................................................13PROZAC..............................................122PROZAC WEEKLY............................122pseudoephedrine hcl .............................. 67

168

Index

pseudoephedrine-guaifenesin................ 67PULMICORT FLEXHALER................15PULMOZYME.................................... 142PUMPKIN FLAVOR.......................... 142PURALOR CI......................................146PURALUBE.......................................... 74PUREFE OB PLUS............................. 115PUREFE PLUS....................................115PURIXAN..............................................37PYLERA................................................89pyrazinamide..........................................21pyridostigmine bromide.........................44pyridoxine (vitamin b6) ....................... 146pyrilamine-phenylephrine......................28Q-CARE RX Q2.................................. 142Q-CARE RX Q4.................................. 142Q-DRYL................................................ 30Q-GEL WITH ALPHA LIPOIC ACID..............................................................142QNASL.................................................. 74Q-PAP......................................................9Q-PAP EXTRA STRENGTH..................9Q-TAPP................................................. 28Q-TAPP DM..........................................67Q-TIPS/SINGLE-TIP.......................... 108Q-TIPS/SINGLE-TIP APPLICATOR.108Q-TUSSIN............................................. 67Q-TUSSIN DM......................................67QUADRACEL (PF)...............................46QUARTETTE........................................61QUASENSE.......................................... 61quazepam............................................. 125QUDEXY XR........................................57QUELICIN............................................ 44QUENALIN...........................................30quetiapine.............................................122QUFLORA PEDIATRIC.....................146QUFLORA PEDIATRIC DROPS.......146QUILLICHEW ER.............................. 122QUILLIVANT XR.............................. 122quinapril .................................................53quinapril-hydrochlorothiazide............... 53quinidine gluconate ................................50quinidine sulfate .....................................50quinine sulfate ........................................33QUTENZA.......................................... 132QVAR.................................................... 15RABAVERT (PF)..................................46rabeprazole .............................................89racepinephrine........................................15RADIADRES GEL..............................108RADIAGEL.........................................142RAGWITEK.......................................... 46raloxifene............................................. 142ramipril .................................................. 53RANEXA...............................................50ranitidine hcl .......................................... 89RAPAFLO........................................... 142RAPAMUNE.........................................98RAPIVAB..............................................41raspberry.............................................. 142raspberry flavor, artificial .................... 142RASPBERRY FLAVORING..............142

Index

raspberry ketone.....................................93RASUVO (PF).................................13, 14RAVICTI............................................... 89RAYOS..................................................97RAZADYNE......................................... 44RAZADYNE ER................................... 44READY-TO-USE ENEMA...................89READY-TO-USE ENEMA (MIN OIL) 90REBETOL............................................. 41REBIF (WITH ALBUMIN).................. 57REBIF REBIDOSE............................... 57REBIF TITRATION PACK.................. 57RECLIPSEN (28) .................................. 61RECOMBINATE.................................. 48RECOMBIVAX HB (PF)......................46RECOTHROM...................................... 48RECOTHROM SPRAY KIT.................48RECTIV.................................................90red yeast rice .......................................... 93REDNESS RELIEF............................... 74REFEX...................................................93REFRESH CELLUVISC.......................74REFRESH CLASSIC (PF).................... 74REFRESH LACRI-LUBE..................... 74REFRESH LIQUIGEL.......................... 74REFRESH OPTIVE...............................74REFRESH OPTIVE ADVANCED....... 74REFRESH OPTIVE ADVANCED (PF)........................................................ 74REFRESH OPTIVE SENSITIVE (PF). 74REGONOL............................................ 44REGRANEX........................................132REGULOID...........................................90REGULOID, SUGAR FREE.................90REHYLA HAIR-BODY......................132RELCOF C............................................ 68RELENZA DISKHALER..................... 41RELION NEEDLES............................108RELION PEN NEEDLES................... 108RELISTOR............................................ 25RELNATE DHA................................. 115RELPAX..................................................9REMEDY 4-IN-1 CLEANSER...........132REMEDY ANTIFUNGAL....................26REMEDY CALAZIME PROTECT PASTE................................................. 132REMEDY CLEANSING BODY........ 132REMEDY CLEAR-AID PROTECT... 132REMEDY PHYTOPLEX ANTIFUNGAL......................................27REMEDY PHYTOPLEX Z-GUARD (ZN)..................................................... 132REMEDY SKIN REPAIR...................132REMERON..........................................122REMERON SOLTAB......................... 122REMICADE.......................................... 90REMODULIN....................................... 53REMOVE............................................ 108RENAGEL.............................................80RENAL CAPS..................................... 146RENEWAL HAND SANITIZER........132RENO CAPS....................................... 146RENU DISINFECTING......................108

Index

RENU MULTIPLUS........................... 108RENU REWETTING DROPS............ 108RENVELA.............................................80REOPRO................................................39repaglinide............................................. 32repaglinide-metformin........................... 32REPATHA SURECLICK......................53REPATHA SYRINGE...........................53REPREXAIN...........................................9RESCON................................................28RESCON-DM........................................68RESCRIPTOR....................................... 41RESECTISOL........................................71reserpine.................................................53RESPAIRE-30....................................... 68RESTASIS.............................................74RESTFULLY SLEEP..........................125RESTON HIGH SUPPORT PAD....... 108RESTON LIGHT SUPPORT ROLL...108RESTON MEDIUM SUPPORT PAD.108RESTORA RX.......................................90RESTORA SPRINKLES.......................90RESTORE............................................108RESTORE CONTACT LAYER SILVER............................................... 108RESTORE FOAM HEEL DRESSING108RESTORE HYDROGEL DRESSING 108RESTORE HYDROGEL GAUZE SPONGE..............................................108RESTORE TRIO................................. 108RESTORIL.......................................... 125resveratrol ............................................ 142RETAINE FLAX...................................93RETAVASE.......................................... 48RETIN-A MICRO PUMP................... 132RETISERT.............................................74RETROVIR........................................... 41REVATIO..............................................53REVEAL COLON DISEASE TEST.....70REVEAL UTI TEST STRIP................. 70REVLIMID............................................37REVONTO.......................................... 113REXULTI............................................ 122REYATAZ.............................................41REZIRA.................................................68R-GENE 10............................................70RHEUMATREX....................................14RHOGAM ULTRA-FILTERED PLUS 46RHOPHYLAC.......................................46RIASTAP...............................................48RIBASPHERE.......................................41RIBASPHERE RIBAPAK.................... 41ribavirin ..................................................41RIDAURA............................................. 14rifabutin ..................................................21RIFAMATE...........................................21rifampin..................................................21RIFATER...............................................21riluzole ................................................... 57RI-MAG PLUS......................................90rimantadine............................................ 41RIMSO-50............................................... 9ringers ............................................ 80, 132

169

Index

RIOMET................................................ 32risedronate ............................................142RISPERDAL........................................122RISPERDAL CONSTA.......................122RISPERDAL M-TAB..........................122risperidone........................................... 122RITALIN............................................. 122RITALIN LA....................................... 122RITEFLO AEROCHAMBER............. 108RITUXAN............................................. 37rivastigmine........................................... 44rivastigmine tartrate ............................... 44RIXUBIS............................................... 48rizatriptan.................................................9ROBAFEN.............................................68ROBAFEN CF (PHENYLEPHRINE).. 68ROBAFEN COUGH............................. 68ROBAFEN DM COUGH...................... 68ROBAFEN DM COUGH-CHEST CONGEST.............................................68rocuronium.............................................44ROLLED ABSORBENT COTTON....109ROLLED GAUZE............................... 109RONDIC.............................................. 109root beer flavor (bulk) ..........................142ropinirole ................................................39ropivacaine (pf) ......................................11ROSADAN.......................................... 132ROSANIL.............................................. 21rose oil ................................................. 142ROSE WATER....................................142rosemary oil ........................................... 93rosin (bulk) ...........................................142ROSULA............................................... 21rosuvastatin ............................................ 53ROTARIX..............................................46ROTATEQ VACCINE..........................46ROXICET................................................ 9ROZEREM.......................................... 125RUBBING ALCOHOL (ETHANOL).132RUCONEST........................................ 142RU-HIST D............................................28RULAVITE DHA................................115RYANODEX.......................................113RYDEX..................................................68RYMED (DEXCHLORPHENIRAMINE-PE)..... 28RYNEX DM.......................................... 68RYNEX PE............................................28RYNEX PSE..........................................28RYTARY...............................................39S2 RACEPINEPHRINE........................ 15SABRIL................................................. 57saccharin................................................ 80saccharin sodium................................... 80SAFESNAP INSULIN SYRINGE...... 109saffron extract ........................................ 93SAF-GEL.............................................109SAFYRAL............................................. 61sage leaf (bulk) ...................................... 93SAIZEN................................................. 97SAIZEN CLICK.EASY.........................97SALACTIC FILM............................... 132

Index

salicylic acid........................................ 132salicylic acid er-ceramides...................132SALINE SENSITIVE EYES...............109SALINE SOLUTION.......................... 109SALINE SOLUTION,STERILE PRESRV.............................................. 109SAL-PLANT........................................132salsalate ..................................................14SAMSCA...............................................71SANCUSO.............................................90SANDIMMUNE....................................98SANDOSTATIN LAR DEPOT............ 97SANI-SUPP (ADULT)..........................90SANI-SUPP (INFANT).........................90SANTYL..............................................132SAPHRIS (BLACK CHERRY).......... 122SARAFEM.......................................... 122SARNA SENSITIVE.............................11sassafras oil ..........................................142SAVAYSA............................................ 24SAVELLA........................................... 142saw palmetto.......................................... 93saw palmetto fruit .................................. 93saw palmetto-pumpkin seed oil ............. 93SCALPICIN ANTI-ITCH................... 132SCANPOR TAPE................................109scopolamine hbr .....................................90SEBEX.................................................132SEB-PREV.......................................... 132SECONAL SODIUM.......................... 125SECURA ANTIFUNGAL.....................27SECURA ANTIFUNGAL EXTRA THICK................................................... 27SECURA DIMETHICONE.................132SECURA EXTRA PROTECTIVE......132SECURA MOISTURIZING................132SECURA PERSONAL........................132SECURA PERSONAL SKIN CARE..132SECURA PROTECTIVE.................... 133SECURA STARTER KIT................... 133SECURA TOTAL BODY CLEANSER..............................................................133SECURA TWO-STEP KIT................. 133SEEBRI NEOHALER........................... 15SELECT-OB........................................115SELECT-OB (FOLIC ACID)..............115SELECT-OB + DHA...........................115selegiline hcl .......................................... 39selegiline hcl (bulk) ............................. 143selenium.................................................80selenium sulfide................................... 133SELF ADHERENT WRAP.................109SELF-ADHERANT GENTLE WRAP109SELF-ADHERING BANDAGE......... 109SELFGRIP...........................................109SELF-GRIP..........................................109SELZENTRY........................................ 41SEMPREX-D.........................................28SE-NATAL 19.....................................115SE-NATAL 19 (WITH DOCUSATE) 115SENEXON.............................................90SENEXON-S......................................... 90SENNA.................................................. 90

Index

SENNA LAX.........................................90SENNA LAXATIVE.............................90SENNA PLUS....................................... 90SENNA PROMPT................................. 90SENNA WITH DOCUSATE SODIUM90SENNA-GEN........................................ 90SENNALAX-S...................................... 90SENNA-S.............................................. 90SENNA-TIME S....................................90SENNO.................................................. 90sennosides-docusate sodium..................90SENOKOT-S......................................... 90SENSI-CARE (FOAM)....................... 133SENSI-CARE ADHESI REMOVER WIPE....................................................109SENSI-CARE MOISTURIZING 2..... 133SENSIPAR.......................................... 143SENSITIVE EYES.............................. 109SENSITIVE EYES DAILY CLEANER..............................................................109SENSITIVE EYES PLUS SALINE.... 109SENSODYNE......................................109SENSORCAINE/EPINEPHRINE.........11SENSORCAINE-MPF.......................... 11SENSORCAINE-MPF SPINAL........... 11SENSORCAINE-MPF/EPINEPHRINE11SERENAGEN........................................93SEREVENT DISKUS........................... 15SERNIVO............................................ 133SEROQUEL........................................ 122SEROQUEL XR..................................122SEROSTIM............................................97sertraline...................................... 122, 123sertraline (bulk) ....................................143sesame oil .............................................143SE-TAN DHA..................................... 115SE-TAN PLUS...................................... 80SETLAKIN............................................61SEVERE COLD AND FLU (PE)..........68SEVERE COLD PE...............................68sevoflurane.............................................11SF...........................................................80SF 5000 PLUS....................................... 80SHAROBEL.......................................... 61SHEER BANDAGE............................ 109SHEER BANDAGES..........................109SHEER PLASTIC STRIP....................109SHEER SPOT BANDAGES............... 109SHEER STRIP.....................................109SHEER STRIP EXTRA LARGE........ 109SHEER STRIPS...................................109SHEER STRIPS ASSORTED.............109SIDESTREAM PEDIATRIC FACE MASK..................................................109SIGNIFOR.............................................97SIGNIFOR LAR....................................97SILACE................................................. 90SILADRYL SA..................................... 30sildenafil ................................................ 53SILENOR............................................ 125silica .....................................................143SILICONE MASK - INFANT.............109SILICONE MASK - PEDIATRIC...... 109

170

Index

SILPHEN COUGH................................30SILTUSSIN DM DAS...........................68SILTUSSIN SA..................................... 68SILTUSSIN-DM....................................68silver nitrate ......................................... 133silver sulfadiazine.................................. 21SILVERMED...................................... 133SIMBRINZA......................................... 75simethicone............................................ 90simple syrup.........................................143SIMPLYTHICK.................................. 143SIMPONI...............................................14SIMPONI ARIA.................................... 14SIMULECT........................................... 98simvastatin ............................................. 53SINUS 12 HOUR.................................. 68SINUS AND ALLERGY PE.................28SINUS AND COLD-D.......................... 68SINUS CONGESTION AND PAIN..... 68SINUS CONGESTION-PAIN(CHLORPH).................................68SINUS CONGESTION-PAIN(GUAIF) 68SINUS CONGEST-PAIN DAY-NIGHT...................................................68SINUS NASAL SPRAY........................75SINUS PAIN RELIEF...........................68SINUS RELIEF (OXYMETAZOLINE)75SINUS WASH....................................... 75SINUS-ALLERGY (PHENYLEPHRINE)............................ 28sirolimus................................................ 98SIRTURO.............................................. 21SITAVIG............................................... 41SIVEXTRO............................................21SKIN CLEANSER.............................. 133SKIN CLOSURE STRIPS...................109SKINTEGRITY HYDROGEL............109SKINTEGRITY HYDROGEL DRESSING..........................................109SKINTEGRITY WOUND CLEANSER.........................................133SKLICE............................................... 133SLEEP..................................................125SLEEP AID (DIPHENHYDRAMINE)..............................................................125SLEEP AID (DOXYLAMINE)...........125SLEEP AID MAX STR (DIPHENHYDR).................................125SLEEP TIME.......................................125SLEEP-TABS...................................... 125SMOOTH ANTACID........................... 90sodium acetate ....................................... 80sodium bicarbonate ..........................80, 90sodium bisulfite ................................... 143sodium chlor 0.9% bacteriostat ............143sodium chloride............... 75, 80, 133, 143sodium chloride 0.45 %......................... 80sodium chloride 0.9 %........................... 80sodium chloride 3 %.............................. 80sodium chloride 5 %.............................. 80sodium citrate-citric acid....................... 80sodium ferric gluconat-sucrose..............80sodium fluoride......................................81

Index

sodium lactate ........................................ 81sodium phenylbutyrate ...........................90sodium phosphate .................................. 81SODIUM POLYSTYRENE (SORB FREE).................................................... 81sodium polystyrene sulfonate ................ 81sodium silicate ..................................... 143sodium succinate ..................................143SOF-SET ADHESIVE PATCH.......... 109SOFT CLOTH..................................... 109SOLIRIS................................................ 48SOLODYN............................................ 21SOLOSITE.......................................... 109SOLOSITE WOUND GEL................. 109SOLTAMOX......................................... 37SOLU-CORTEF (PF)............................ 97SOLU-MEDROL...................................97SOLU-MEDROL (PF)...........................97SOMATULINE DEPOT....................... 97SOMAVERT....................................... 143SONATA............................................. 125SOOLANTRA..................................... 133SOOTHE AND COOL........................ 133SOOTHE AND COOL BODY POWDER............................................ 133SOOTHE AND COOL FREE MEDSEPTIC....................................... 133SOOTHE AND COOL SKIN PASTE 133SOOTHE-COOL MOISTURE BARRIER............................................ 133SORBIDON HYDRATE.....................143sorbitol ................................... 81, 133, 143sorbitol-mannitol ..................................133SORE THROAT....................................11SORE THROAT (BENZOCAINE-MENTH)................................................11SORE THROAT (PHENOL)................ 11SORE THROAT AND COUGH........... 68SORESPOT......................................... 109SORILUX............................................ 133SORINE.................................................53sotalol .....................................................53SOTALOL AF....................................... 53SOTRADECOL.....................................54SOTYLIZE............................................ 54SOUTH AFRICAN HOODIA...............93SOVALDI..............................................41SPACE CHAMBER PLUS................. 109SPEARMINT FLAVORING...............143spearmint oil ........................................ 143SPECTRAGEL.................................... 109spinosad............................................... 133SPIRIVA RESPIMAT........................... 15SPIRIVA WITH HANDIHALER......... 15spironolactone........................................71spironolacton-hydrochlorothiaz.............71SPORANOX..........................................27SPORTS TAPE....................................109SPRINTEC (28) .....................................61SPRYCEL..............................................37SPS (WITH SORBITOL)...................... 81SRONYX...............................................62SSD........................................................ 21

Index

SSKI.......................................................81SSS 10-5................................................ 21STAFLEX (BROMPHENIRA-ACETAMIN)...........................................3STAHIST AD........................................ 28stavudine................................................ 41STAY AWAKE..................................... 57STAY AWAKE MAXIMUM STRENGTH.......................................... 57stearic acid........................................... 143stearyl alcohol ......................................143STELARA............................................. 98STERILE EYE DROPS.........................75STERILE GAUZE PAD......................110STERILE PADS.................................. 110STERILE STRETCH GAUZE BANDAGE..........................................110STERILE WATER FOR INJECTION 143STERI-STRIP...................................... 110STERI-STRIP DRESSING................. 110STERI-STRIP SKIN CLOSURES...... 110STIK IT................................................110STIMATE.............................................. 97STIOLTO RESPIMAT..........................15STIVARGA........................................... 37STOMACH RELIEF............................. 90STOMACH RELIEF MAX STRENGTH.......................................... 90STOMACH RELIEF ORIGINAL.........90STOOL SOFTENER............................. 90STOOL SOFTENER-LAXATIVE........90STOOL SOFTENER-STIMULANT LAXAT..................................................90STRATASORB COMPOSITE WOUND.............................................. 110STRATASORB ISLAND DRESSING110STRATTERA...................................... 123STRAWBERRY CREAM FLAVOR..143strawberry flavor (bulk) .......................143STRAWBERRY FLAVORING..........143STRENSIQ.......................................... 143streptomycin.......................................... 21STRETCH GAUZE BANDAGE........ 110STRIANT.............................................. 97STRIBILD............................................. 41STRIVERDI RESPIMAT......................15STRONG STRIPS X-LARGE.............110STROVITE FORTE............................ 146STROVITE ONE.................................146SUBOXONE........................................143SUBSYS.................................................. 9succinylcholine chloride........................ 44sucralfate ................................................90sucrose................................................... 81SUDOGEST.......................................... 68SUDOGEST 12-HOUR.........................68SUDOGEST COLD AND ALLERGY. 28SUDOGEST PE.....................................68SUDOGEST SINUS AND ALLERGY.28sufentanil citrate .......................................9sulfacetamide sodium.................... 22, 133sulfacetamide sodium (acne) ............... 133sulfacetamide sodium-sulfur ..................22

171

Index

sulfacetamide sod-sulfur-urea................22sulfacetamide-prednisolone................... 22sulfacetamide-sulfur-cleansr23..............22SULFACLEANSE 8-4.......................... 22sulfact na-sul-avobnz-otn-ocsa.............. 22sulfadiazine............................................ 22sulfamethoxazole-trimethoprim.............22SULFAMYLON.................................... 22sulfasalazine...........................................90SULFATRIM.........................................22sulindac.................................................. 14SUMADAN........................................... 22sumatriptan.............................................. 9sumatriptan succinate ...............................9SUMAVEL DOSEPRO...........................9SUMAXIN CP.......................................22SUMMER'S EVE DOUCHE.................33SUPER POTENT YOHIMBE...............93SUPER STRIP BANDAGES.............. 110SUPHEDRIN.........................................68SUPHEDRIN 12 HOUR........................68SUPHEDRINE...................................... 68SUPHEDRINE 12 HOUR..................... 68SUPPRELIN LA....................................97SUPRANE............................................. 11SUPRAX................................................22SUPREP BOWEL PREP KIT............... 91SURE COMFORT ALCOHOL PREP PADS................................................... 133SURE COMFORT INS. SYR. U-100. 110SURE COMFORT INSULIN SYRINGE............................................ 110SURE COMFORT PEN NEEDLE......110SURE-FINE PEN NEEDLES..............110SURE-JECT INSULIN SYRINGE..... 110SURE-PREP ALCOHOL PREP PADS..............................................................133SUREPRESS ABSORBENT PADDING........................................... 110SUREPRESS HIGH COMPRESSION110SURESITE...........................................110SURESITE FLEXIGRID.....................110SURESITE IV..................................... 110SURESITE MATRIX..........................110SURESITE WINDOW........................ 110SURFAXIN......................................... 143SURGICAL DRESSING.....................110SURGICAL DRESSING EXTR PROTCT.............................................. 110SURGICAL PADS.............................. 110SURMONTIL...................................... 123SURVANTA........................................143SUSPENDOL-S...................................143SUSTIVA.............................................. 41SUTENT................................................ 37SWEET-SF.......................................... 143SYEDA.................................................. 62SYLATRON.......................................... 37SYLVANT.............................................37SYMBICORT........................................ 15SYMBYAX......................................... 123SYMLINPEN 120................................. 32SYMLINPEN 60................................... 32

Index

SYNAGIS.............................................. 41SYNALAR CREAM KIT....................133SYNALAR OINTMENT KIT.............133SYNALAR TS.....................................133SYNAREL.............................................97SYNERA............................................... 11SYNERCID........................................... 22SYNJARDY.......................................... 32SYNRIBO..............................................37SYNTHROID...................................... 135SYPRINE.............................................143SYRPALTA VEHICLE.......................143SYRSPEND SF................................... 143SYRSPEND SF ALKA....................... 143SYRSPEND SF LIQUID.....................143SYRSPEND SF PH4........................... 143SYRUP VEHICLE SF.........................143SYSTANE BALANCE......................... 75SYSTANE CONTACTS..................... 110SYSTANE GEL.....................................75SYSTANE NIGHTTIME...................... 75TAB TUSSIN........................................ 68TAB TUSSIN DM.................................68TABLOID..............................................37TACHOSIL............................................48TACLONEX........................................133tacrolimus.............................................. 98TACTINAL............................................. 9TACTINAL EXTRA STRENGTH......... 9TAFINLAR............................................37TAGRISSO............................................37TALTZ AUTOINJECTOR..................133TALTZ AUTOINJECTOR (2 PACK) 133TALTZ AUTOINJECTOR (3 PACK) 133TALTZ SYRINGE.............................. 133TALTZ SYRINGE (2 PACK)............. 133TALTZ SYRINGE (3 PACK)............. 133TALWIN..................................................9TAMIFLU..............................................41tamoxifen............................................... 37tamsulosin............................................ 143TANDEM DUAL ACTION.................. 81TANGERINE OIL, NATURAL..........143TANZEUM............................................33TARCEVA............................................ 37TARGRETIN.........................................37TARINA FE 1/20 (28) ...........................62TARON FORTE....................................81TARON-C DHA..................................115TARON-PREX PRENATAL-DHA.... 115TART CHERRY EXTRACT................ 94TASIGNA..............................................37TAZICEF...............................................22TAZORAC.......................................... 133TAZTIA XT...........................................50TEARS NATURALE FORTE.............. 75TEARS NATURALE FREE (PF)......... 75TEARS PURE....................................... 75TECFIDERA......................................... 57TECHLITE PEN NEEDLE................. 110TECHNIVIE.......................................... 41TEFLARO............................................. 22TEGADERM....................................... 110

Index

TEGADERM ABSORBENT.............. 110TEGADERM FIRST AID STYLE......110TEGADERM FRAME STYLE...........110TEGADERM HP FRAME STYLE.....110TEGADERM HYDROGEL................ 110TEGADERM I.V. ................................110TEGADERM PLUS PAD................... 110TEGADERM TRANSPARENT DRESSING..........................................111TEGRETOL...........................................57TEGRETOL XR.................................... 57TEKAMLO............................................54TEKTURNA..........................................54TEKTURNA HCT.................................54TELFA.................................................111TELFA (WITH POLYHEXAMETH).111TELFA AMD.......................................111TELFA CLEAR WOUND DRESSING..............................................................111TELFA ISLAND DRESSING.............111TELFA OUCHLESS NON-ADHERENT........................................111telmisartan..............................................54telmisartan-amlodipine.......................... 54telmisartan-hydrochlorothiazid..............54temazepam........................................... 125TEMODAR............................................37temozolomide........................................ 38TENA SERENITY.............................. 111TENDER TAPE...................................111TENDERSORB................................... 111TENDERWET ACTIVE CAVITY DRESS.................................................111TENDERWET ACTIVE DRESSING.111TENDERWET SYSTEM.................... 111TENDERWRAP UNNA BOOT..........111teniposide...............................................38TENIVAC (PF)......................................46TENSION HEADACHE......................... 9TENSOR..............................................111terazosin.................................................54terbinafine hcl ........................................ 27terbutaline.............................................. 15terconazole .............................................27TERUMO INSULIN SYRINGE......... 111TESTOPEL............................................97testosterone...................................... 97, 98testosterone cypionate ............................97testosterone enanthate ............................97tetanus,diphtheria tox ped(pf) ................46tetanus-diphtheria toxoids-td ................. 46tetrabenazine.......................................... 57tetracaine hcl ..........................................75tetracaine hcl (pf) .............................12, 75tetracycline.............................................22tetrahydrozoline..................................... 75TEXACORT........................................ 133THALOMID.......................................... 22THAM....................................................81THEO-24............................................... 16theophylline........................................... 16theophylline in dextrose 5 %................. 16THERACRAN HP FOR KIDS..............94

172

Index

THERAFLU EXPRESSMAX COLD DAY.......................................................68THERAFLU EXPRESSMAX COLD NIGHT...................................................68THERAFLU NIGHT SEVERE COLD-CGH.......................................................68THERA-GEL.......................................133THERA-GESIC................................... 134THERA-GESIC PLUS........................ 133THERAPEUTIC MINERAL ICE....... 134THERASEAL...................................... 134THERMACARE KNEE/ELBOW.......111THERMACARE LARGE/XLGE BACK/HIP...........................................111THERMACARE MENSTRUAL........ 111THERMACARE NECK/WRIST/SHOULDER.............. 111THERMACARE SMALL/MED BACK/HIP...........................................111thiamine hcl (vitamin b1) .....................146THICK NOW.......................................143THICKEN UP CLEAR........................143THICKENUP LEMON HONEY........ 143THICKENUP LEMON NECTAR...... 143THICK-IT............................................ 144THICK-IT #2....................................... 144THINPRO INSULIN SYRINGE.........111THIOLA.............................................. 144thioridazine.......................................... 123thiotepa.................................................. 38thiothixene........................................... 123THRESHOLD IMT TRAINER...........111THRESHOLD PEP DEVICE.............. 111THRIVITE RX.................................... 115THRIVITE-19......................................115THROMBATE III ................................. 48THROMBIN-JMI.................................. 48THYMOGLOBULIN............................ 46THYROGEN....................................... 135THYROLAR-1.................................... 135THYROLAR-1/2................................. 135THYROLAR-1/4................................. 135THYROLAR-2.................................... 135THYROLAR-3.................................... 135tiagabine.................................................57ticlopidine.............................................. 39TIGAN...................................................91TIKOSYN..............................................50TILIA FE............................................... 62timolol maleate ................................ 54, 75TIMOPTIC OCUDOSE (PF)................ 75tinidazole ................................................33tioconazole .............................................27TIOCONAZOLE-1................................27TIROSINT........................................... 135TISSEEL VHSD....................................48TIVICAY...............................................41TIVORBEX........................................... 14tizanidine..............................................113TL GARD RX......................................146TL G-FOL OS........................................81TL ICON................................................81TL-HEM 150......................................... 81

Index

TL-SELECT........................................ 115TNKASE................................................48TOBI PODHALER................................22TOBRADEX..........................................22TOBRADEX ST....................................22tobramycin............................................. 22tobramycin in 0.225 % nacl ................... 22tobramycin sulfate ................................. 22tobramycin-dexamethasone................... 22TOBREX............................................... 22TOE AID DRESSING.........................111TOFRANIL..........................................123tolazamide..............................................33tolbutamide............................................ 33tolcapone................................................39tolmetin.................................................. 14tolnaftate ................................................ 27tolterodine............................................ 144TOOTHETTE...................................... 111toothpaste .............................................111TOPAMAX............................................57TOPCARE CLICKFINE..................... 111TOPCARE ULTRA COMFORT........ 111TOPICORT..........................................134topiramate.............................................. 57TOPOSAR............................................. 38topotecan................................................38TORISEL...............................................38torsemide................................................71TOTAL BODY CLEANSE...................94TOUJEO SOLOSTAR...........................33TOVIAZ.............................................. 144TOZAL................................................ 144TPN ELECTROLYTES........................ 81TRACE ELEMENTS 4/PEDIATRIC... 81TRACLEER...........................................54TRADJENTA........................................ 33tragacanth.............................................144tramadol ................................................... 9tramadol-acetaminophen..........................9trandolapril .............................................54trandolapril-verapamil ........................... 54tranexamic acid......................................48TRANSDERM-SCOP........................... 91transparent dressings............................111TRANSPARENT THIN FILM DRESSING..........................................111TRANSPORE SURGICAL................. 111TRANXENE T-TAB........................... 123tranylcypromine...................................123TRAVASOL 10 %.................................81TRAVATAN Z......................................75TRAVEL SICKNESS............................91TRAVEL SICKNESS (MECLIZINE).. 91travoprost (benzalkonium).....................75trazodone..............................................123TREANDA............................................ 38TRECATOR.......................................... 22TRELSTAR........................................... 38TRESIBA FLEXTOUCH U-100...........33TRESIBA FLEXTOUCH U-200...........33tretinoin................................................134tretinoin (chemotherapy) ....................... 38

Index

tretinoin microspheres ......................... 134TRETTEN..............................................48TREXALL............................................. 38TREXIMET............................................. 9TRIADVANCE................................... 115triamcinolone acetonide...75, 98, 134, 144TRIAMINIC CHEST-NASAL CONGEST.............................................68TRIAMINIC COLD AND COUGH (PE)........................................................ 68triamterene-hydrochlorothiazid............. 71TRIANEX............................................134triazolam.............................................. 125TRIBENZOR.........................................54TRI-BUFFERED ASPIRIN...................10TRICARE............................................ 115TRICARE PRENATAL DHA ONE... 115TRICITRATES......................................81TRICON................................................ 81TRIESENCE (PF)..................................75TRI-ESTARYLLA................................ 62TRIFERIC..............................................81trifluoperazine......................................123trifluridine.............................................. 41TRIGELS-F FORTE..............................81TRIGLIDE.............................................54trihexyphenidyl ...................................... 39TRI-LEGEST FE................................... 62TRILEPTAL.......................................... 58TRI-LINYAH........................................ 62TRI-LO-ESTARYLLA..........................62TRI-LO-MARZIA................................. 62TRI-LO-SPRINTEC.............................. 62TRI-LUMA..........................................134TRILYTE WITH FLAVOR PACKETS91trimethobenzamide................................ 91trimethoprim.......................................... 22trimipramine........................................ 123TRINATAL GT................................... 115TRINESSA (28) .....................................62TRINESSA LO......................................62TRINTELLIX...................................... 123TRIPHROCAPS.................................. 146TRIPLE ANTIBIOTIC..........................22TRIPLE ANTIBIOTIC (PRAM) EXTRA.................................................. 22TRIPLE ANTIBIOTIC PLUS............... 22TRIPLE HELIX COLLAGEN............ 111TRIPLE VITAMIN WITH FLUORIDE..............................................................146TRI-PREVIFEM (28) ............................ 62TRISENOX............................................38TRI-SPRINTEC (28) ............................. 62TRISTART DHA.................................115TRIUMEQ............................................. 41TRIVEEN-DUO DHA.........................115TRIVEEN-PRX RNF.......................... 115TRI-VIT WITH FLUORIDE AND IRON....................................................146TRI-VITAMIN WITH FLUORIDE.... 146TRIVORA (28) ......................................62TRIXAICIN.........................................134TRIXAICIN HP...................................134

173

Index

TROKENDI XR.................................... 58trolamine salicylate ..............................134TROPHAMINE 10 %............................81TROPHAMINE 6%...............................81tropicamide............................................ 75trospium............................................... 144TRUEPLUS INSULIN........................ 111TRULICITY.......................................... 33TRUMENBA.........................................46TRUVADA............................................42TUBERSOL...........................................46TUDORZA PRESSAIR.........................16TUMERSAID........................................ 94TUMS ULTRA......................................91turmeric root extract .............................. 94TUSNEL DIABETIC............................ 68TUSNEL NEW FORMULA................. 68TUSNEL PEDIATRIC.......................... 68TUSNEL-DM PEDIATRIC.................. 68TUSSICAPS.......................................... 68TUSSIN................................................. 68TUSSIN CF (PE-DM-GUAIF)..............69TUSSIN CF COUGH-COLD................ 69TUSSIN CF MAX................................. 69TUSSIN CHEST CONGESTION......... 69TUSSIN COUGH (DM ONLY)............69TUSSIN DM..........................................69TUSSIN DM CLEAR............................69TUSSIN DM COUGH AND CHEST... 69TUSSIN DM MAX................................69TUSSIN EXPECTORANT................... 69tutti-frutti flavor (bulk) ........................ 144TWINRIX (PF)......................................46TYBOST..............................................144TYGACIL..............................................22TYKERB............................................... 38TYLENOL PM EXTRA STRENGTH....3TYPHIM VI...........................................46TYSABRI............................................ 144TYVASO............................................... 54TYVASO INSTITUTIONAL START KIT.........................................................54TYVASO REFILL KIT.........................54TYVASO STARTER KIT.....................54TYZEKA............................................... 42TYZINE.................................................75UCERIS................................................. 98UDAMIN SP....................................... 146ULESFIA.............................................134ULORIC................................................ 14ULTICARE..........................................111ULTICARE PEN NEEDLE................ 111ULTILET ALCOHOL SWAB............ 134ULTILET INSULIN SYRINGE..........111ULTILET PEN NEEDLE....................111ULTIMATECARE ONE..................... 115ULTIMATECARE ONE NF...............115ULTIVA................................................ 10ULTRA CMFT INS SYR HALF UNIT..............................................................111ULTRA COMFORT INSULIN SYRINGE............................................ 112ULTRA LUBRICANT EYE................. 75

Index

ULTRA STRENGTH ANTACID......... 91ULTRABAG/DIANEAL PD-2/1.5% DEX....................................................... 81ULTRABAG/DIANEAL PD-2/2.5% DEX....................................................... 81ULTRABAG/DIANEAL PD-2/4.25%DEX..........................................81ULTRABAG/DIANEAL/2.5% DEXTROSE.......................................... 81ULTRAFOAM...................................... 48ULTRA-FRESH.................................. 134ULTRA-THIN II (SHORT) INS SYR 112ULTRA-THIN II (SHORT) PEN NDL..............................................................112ULTRA-THIN II INS PEN NEEDLES..............................................................112ULTRA-THIN II INSULIN SYRINGE..............................................................112ULTRAVATE X................................. 134ULTRAVIST......................................... 70UMECTA............................................ 134UMECTA PD...................................... 134UNIFINE PENTIPS.............................112UNIFINE PENTIPS PLUS..................112UNISOL 4............................................112UNI-SOLVE ADHESIVE REMOVER..............................................................112UNISOLVE ADHESIVE REMOVER WIPE....................................................112UNISTIK 2 EXTRA............................ 112UNISTIK 2 NORMAL LANCET,DEVICE..............................112UNITHROID....................................... 135UNITUXIN............................................38UNIVERSAL REMOVER WIPES..... 112UNNA-FLEX ELASTIC UNNA BOOT.................................................. 112UPTRAVI.............................................. 54UR N-C..................................................23URAMAXIN....................................... 134URAMAXIN GT................................. 134URAMIT MB........................................ 23urea...................................................... 134URIMAR-T............................................23URIN DS............................................... 23URINARY PAIN RELIEF.................... 12URINARY TRACT INF.TEST (WBCS)................................................. 70UROGESIC-BLUE................................23URO-L................................................... 23UROLET MB........................................ 23URO-MP................................................23UROPHEN MB..................................... 23ursodiol .................................................. 91UTIBRON NEOHALER....................... 16VACUSTIM BLACK..........................112VAGIFEM............................................. 98VAGISTAT-1........................................ 27VAGISTAT-3........................................ 27valacyclovir ............................................42VALCHLOR..........................................38VALCYTE.............................................42valerian root ........................................... 94

Index

valganciclovir ........................................ 42VALIUM............................................. 123valproate sodium....................................58valproate sodium (bulk) .......................144valproic acid...........................................58valproic acid (as sodium salt) ................ 58valsartan.................................................54valsartan-hydrochlorothiazide............... 54VALSTAR.............................................38VALU-DRYL ALLERGY.................... 30VANACOF DM.....................................69VANACOF-8.........................................69VANAHIST PD.....................................30VANATOL LQ......................................10vancomycin............................................23vancomycin in 0.9% sodium cl ..............23vancomycin in dextrose 5 %..................23VANDAZOLE.......................................23VANILLA BUTTERNUT FLAVOR..144vanilla butternut flavor(bulk) ...............144VANILLA FLAVOR...........................144vanillin (bulk) ...................................... 144VANISHPOINT SYRINGE................ 112VANTAS............................................... 38VAPRISOL............................................71VAQTA (PF)......................................... 46VARIVAX (PF).....................................46VARIZIG...............................................46VARNAL.............................................112VARUBI................................................ 91VASCEPA............................................. 91VASCUDERM HYDROGEL WOUND.............................................. 112VASELINE..........................................144VASELINE PETROLATUM GAUZE112vasopressin.............................................98VASOSTRICT.......................................98VECAMYL............................................54VECTIBIX.............................................38vecuronium bromide..............................44VELCADE.............................................38VELETRI...............................................54VELIVET TRIPHASIC REGIMEN (28) .........................................................62VELPHORO.......................................... 81VELTASSA...........................................81VELTIN...............................................134VEMAVITE-PRX-2............................ 115VENA-BAL DHA............................... 115venlafaxine...........................................123VENOFER.............................................81VENTAVIS........................................... 54VENTOLIN HFA.................................. 16VERAMYST......................................... 75verapamil ............................................... 50VEREGEN.............................................42VERIPRED 20.......................................98VERSA FREE..................................... 144VERSA PLUS..................................... 144VERSACLOZ......................................123VERSALON........................................ 112VERSALON NONWOVEN ALL-PURPOSE............................................112

174

Index

VERSIVA XC..................................... 112VESICARE..........................................144VESTURA (28) ..................................... 62VEXOL..................................................75VIBATIV...............................................23VIBERZI................................................91VIBRAMYCIN......................................23VICKS DAYQUIL COLD-FLU RELIEF..................................................69VICKS DAYQUIL COUGH.................69VICKS DAYQUIL MUCUS CONTROL DM..................................... 69VICKS DAYQUIL SEVERE COLD-FLU........................................................69VICKS NYQUIL COLD/FLU (CPM).. 69VICKS NYQUIL COLD/FLU LIQUICAP.............................................69VICKS NYQUIL COUGH....................69VICKS NYQUIL SEVERE COLD-FLU........................................................69VICKS QLEARQUIL ALLERGY........30VICKS QLEARQUIL NIGHTTIME RLF........................................................ 30VICKS QLEARQUIL(OXYMETAZOLINE)... 75VICKS SINEX 12-HOUR.....................75VICKS SINEX ULTRA FINE MIST 12........................................................... 75VICKS VAPODROPS...........................69VICKS VAPORUB............................. 134VICODIN.............................................. 10VICODIN ES.........................................10VICODIN HP........................................ 10VICTOZA 2-PAK................................. 33VICTOZA 3-PAK................................. 33VIDEX 2 GRAM PEDIATRIC............. 42VIDEX 4 GRAM PEDIATRIC............. 42VIEKIRA PAK......................................42VIENVA................................................ 62VIGAMOX............................................ 23VIGILON PRIMARY WOUND DRESSING..........................................112VIIBRYD.............................................123VIMIZIM.............................................144VIMOVO...............................................14VIMPAT................................................ 58VINATE GT........................................ 115vinblastine..............................................38VINCASAR PFS................................... 38vincristine.............................................. 38vinorelbine............................................. 38VIOKACE............................................. 91VIORELE (28) .......................................62VIRACEPT............................................42VIRAZOLE........................................... 42VIREAD................................................ 42VIRT-ADVANCE............................... 115VIRT-C DHA...................................... 115VIRT-CAPS.........................................146VIRT-GARD....................................... 146VIRT-NATE........................................ 115VIRT-NATE DHA.............................. 115VIRT-PHOS 250 NEUTRAL................81

Index

VIRT-PN..............................................115VIRT-PN DHA....................................115VIRT-PN PLUS...................................115VIRTPREX..........................................115VIRTRATE-2........................................ 81VIRTRATE-3........................................ 81VIRTRATE-K....................................... 81VIRT-SELECT.................................... 115VIRTUSSIN AC....................................69VIRTUSSIN DAC................................. 69VIRT-VITE..........................................146VIRT-VITE FORTE............................146VIRT-VITE GT................................... 115VIRT-VITE PLUS...............................146VISCOPASTE PB7............................. 112VISINE FOR CONTACTS................. 112VISIPAQUE.......................................... 70VISTARIL............................................. 31VISTEC X-RAY DETECT................. 112VISUDYNE.........................................144VIT 3....................................................146VITAFOL.............................................. 81VITAFOL FE+ (WITH DOCUSATE) 115VITAFOL NANO................................115VITAFOL ULTRA..............................115VITAFOL-OB..................................... 115VITAFOL-OB+DHA.......................... 115VITAFOL-ONE...................................115VITAL-D RX.......................................146vitamin a and d.....................................134VITAMIN B-12................................... 146VITAMIN D2...................................... 146vitamin e .............................................. 146vitamin e (dl, acetate) .......................... 146VITAMIN K........................................ 146VITAMIN K1...................................... 146VITAMINS A,C,D AND FLUORIDE 146VITEKTA.............................................. 42VITRASE............................................ 134vits a and d-white pet-lanolin .............. 134VITUZ................................................... 69VIVITROL.......................................... 144VIVLODEX...........................................14VIVOTIF............................................... 46VIVOTIF BERNA VACCINE.............. 46VOL-CARE RX...................................146VOL-NATE......................................... 115VOL-PLUS.......................................... 116VOLTAREN........................................134VOLUVEN 6 %.....................................48voriconazole ...........................................27VORTEX ADULT MASK.................. 112VORTEX FROG MASK-CHILD....... 112VORTEX HOLDING CHAMBER..... 112VORTEX HOLDING CHAMBER CHILD................................................. 112VORTEX HOLDING CHAMBER TODDLER...........................................112VORTEX LADYBUG MASK-TODDLER...........................................112VORTEX VHC FROG MASK-CHILD..............................................................112

Index

VORTEX VHC LADYBUG MASK-TODDLR............................................. 112VOTRIENT........................................... 38VP-CH PLUS.......................................116VP-CH-PNV........................................ 116VP-GGR-B6........................................ 116VP-GSTN.............................................. 81VP-HEME OB..................................... 116VP-HEME ONE.................................. 116VP-PNV-DHA.....................................116VP-PRECIP........................................... 94VPRIV................................................. 144VP-VITE RX....................................... 146VP-ZEL................................................144VRAYLAR.......................................... 123VUSION................................................ 27VYFEMLA (28) .................................... 62VYTORIN 10-10................................... 54VYTORIN 10-20................................... 54VYTORIN 10-40................................... 54VYTORIN 10-80................................... 54VYVANSE.......................................... 123WAL-MUCIL FIBER (ASPARTAME) 91WAL-MUCIL FIBER (SUGAR).......... 91warfarin ..................................................24water for inject, bacteriostat ................ 144water for injection, sterile .................... 144water for irrigation, sterile ................... 134WATER SHIELD BANDAGES......... 112WATERMELON FLAVORING.........144WATERPROOF STRONG STRIPS... 112WEBCOL............................................ 134WEBRIL.............................................. 112WEBRIL II .......................................... 113WEE CARE........................................... 81WELCHOL............................................54WELLBUTRIN SR............................. 123WELLBUTRIN XL............................. 123WERA (28) ............................................62WHITE WAX (BEESWAX)...............144WHOLE BODY JOINT SUPPORT......94WIDE-SEAL DIAPHRAGM 60........... 62WIDE-SEAL DIAPHRAGM 65........... 62WIDE-SEAL DIAPHRAGM 70........... 62WIDE-SEAL DIAPHRAGM 75........... 62WIDE-SEAL DIAPHRAGM 80........... 62WIDE-SEAL DIAPHRAGM 85........... 62WIDE-SEAL DIAPHRAGM 90........... 62WIDE-SEAL DIAPHRAGM 95........... 62wild cherry flavor (bulk) ......................144WINDMILL TRAINER...................... 113WINDOW BANDAGES..................... 113WINRHO SDF.......................................46WINTERGREEN FLAVORING........ 144WITCH HAZEL.................................. 134witch hazel ........................................... 134witch hazel leaf (hamamelis) ............... 134WITEPSOL H-15................................ 144WOMEN'S GENTLE LAXATIVE(BISAC).............................91WOMEN'S LAXATIVE (BISACODYL)......................................91WOUND AND SKIN CLEANSER.... 134

175

Index

WOUND CLEANSER........................ 134WOUND GEL..................................... 134WOUNDGARD GAUZE.................... 113WOUN'DRES HYDROGEL WOUND DRESS.................................................113WYMZYA FE....................................... 62XALKORI............................................. 38XANAX...............................................123XANAX XR........................................ 123XARELTO.............................................24XARTEMIS XR.................................... 10XELJANZ..............................................14XELJANZ XR....................................... 14XENAZINE........................................... 58XEOMIN............................................... 44XERESE................................................ 42XGEVA............................................... 144XIAFLEX............................................ 144XIFAXAN............................................. 23XIGDUO XR......................................... 33XOFIGO.............................................. 144XOLAIR................................................ 16XOPENEX HFA....................................16XTANDI................................................ 38XULANE...............................................62XYLOCAINE........................................ 12XYLOCAINE (CARDIAC) (PF).......... 50XYLOCAINE-MPF...............................12XYLOCAINE-MPF/EPINEPHRINE....12XYLON 10............................................ 10XYNTHA.............................................. 48XYNTHA SOLOFUSE......................... 48XYREM...............................................125YELLOW WAX (BEESWAX)...........144YERVOY...............................................38YF-VAX (PF)........................................ 46YOHIMBE.............................................94yohimbe bark......................................... 94YONDELIS........................................... 38zafirlukast .............................................. 16zaleplon................................................125ZALTRAP............................................. 38ZAMICET..............................................10ZANOSAR............................................ 38ZARAH..................................................62ZARONTIN...........................................58ZAROSEN DESENSITIZER.............. 113ZARXIO................................................ 58ZATEAN-CH...................................... 116ZATEAN-PN DHA............................. 116ZATEAN-PN PLUS............................ 116ZAVESCA...........................................144ZEASORB (MICONAZOLE)............... 27ZEBUTAL............................................. 10ZECUITY.............................................. 10ZEGERID.............................................. 91ZELAPAR............................................. 39ZELBORAF...........................................38ZEMAIRA........................................... 144ZEMBRACE SYMTOUCH.................. 10ZEMPLAR...........................................144ZENATANE........................................ 135ZENCHENT (28) ...................................62

Index

ZENCHENT FE.....................................62ZENPEP.................................................91ZENZEDI.............................................. 44ZEPATIER............................................ 42ZERBAXA............................................ 23ZETIA....................................................54ZETONNA............................................ 75ZEVALIN (Y-90) .................................. 38ZIAGEN................................................ 42ZIANA.................................................135zidovudine..............................................42ZIKS ARTHRITIS PAIN RELIEF......135ZINACEF.............................................. 23ZINACEF IN STERILE WATER......... 23zinc chloride...........................................81zinc oxide.............................................135zinc sulfate ............................................. 81ZINGIBER...........................................116ZINGO...................................................12ZIOPTAN (PF)...................................... 75ziprasidone hcl ..................................... 123ZIPSOR..................................................10ZIRGAN................................................ 42ZMAX....................................................23ZOHYDRO ER......................................10ZOLADEX............................................ 38zoledronic acid.....................................144zoledronic acid-mannitol-water ........... 144ZOLINZA.............................................. 38zolmitriptan............................................10ZOLOFT.............................................. 124zolpidem.............................................. 125ZOLPIMIST........................................ 125ZOMACTON.........................................98ZOMETA.............................................144ZOMIG.................................................. 10ZONEGRAN......................................... 58zonisamide............................................. 58ZONTIVITY..........................................39ZORBTIVE............................................98ZORTRESS........................................... 98ZORVOLEX..........................................14ZOSTAVAX (PF)..................................46ZOSYN IN DEXTROSE (ISO-OSM)...23ZOVIA 1/35E (28) .................................62ZOVIA 1/50E (28) .................................62ZOVIRAX............................................. 42Z-SLEEP..............................................125Z-TUSS AC........................................... 69ZUBSOLV...........................................144ZUPLENZ..............................................91ZURAMPIC...........................................14ZYCLARA.......................................... 135ZYDELIG.............................................. 38ZYFLO.................................................. 16ZYFLO CR............................................ 16ZYKADIA............................................. 38ZYLET...................................................23ZYPRAM...............................................91ZYPREXA...........................................124ZYPREXA RELPREVV..................... 124ZYPREXA ZYDIS.............................. 124ZYTIGA................................................ 38

Index

ZYVOX................................................. 23ZZZQUIL............................................ 125

176

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