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7 . , 1 , 4 1 , - 8 0 8 4 5 + - 0 9 : ; < 5 0 * 1 < 1 * = 8 : - . : ; - . , 9 0 1 2 * 3 4 1 5 >
? @ A B C D E F G H A B I B G H
J 1 * = + : ; - . : + 9 0 1 2 * 3 4 1 5 4 1 , = 1 0 * K , < : ; - 0 L 4 - , = 0 1 : , + < , K , ; < : ; = 0 ; - . , - 5 K , 0 9 2 , < : L 4 3 L 0 ; < : - : 0 ; +
- . 4 - - . , 5 4 1 , * + , < - 0 - 1 , 4 - M N O P Q R S T U V Q W X P Y Z [ Y [ Q X \ O \ P Q S \ S ] Q S P \ ^ O _ X ` \ ` O _ S P Q V ` [ \ Q X Y _ X Q P \ ] Q
^ S \ Q Z O P a b c S P X ` O d S [ ^ Y V S P e ` [ Q S [ Q f g 7 . , ; 3 0 0 h * ; < , 1 - . , L 4 - , = 0 1 5 ; 4 2 , 9 0 1 5 0 * 1 < 1 * = M
i
E j k D l @ I B C D E m B n I B H o
7 . , p ; < , q K 1 0 r : < , + 4 ; 4 3 K . 4 s , - : L 4 3 3 : + - 0 9 4 3 3 0 9 - . , < 1 * = + : ; L 3 * < , < : ; - . : + 9 0 1 2 * 3 4 1 5 M t 0 - . s 1 4 ; <
; 4 2 , < 1 * = + 4 ; < = , ; , 1 : L < 1 * = + 4 1 , 3 : + - , < : ; - . , p ; < , q M u 0 0 h : ; - . , p ; < , q 4 ; < 9 : ; < 5 0 * 1 < 1 * = M v , q - - 0
5 0 * 1 < 1 * = w 5 0 * 8 : 3 3 + , , - . , K 4 = , ; * 2 s , 1 8 . , 1 , 5 0 * L 4 ; 9 : ; < L 0 r , 1 4 = , : ; 9 0 1 2 4 - : 0 ; M 7 * 1 ; - 0 - . , K 4 = ,
3 : + - , < : ; - . , p ; < , q 4 ; < 9 : ; < - . , ; 4 2 , 0 9 5 0 * 1 < 1 * = : ; - . , 9 : 1 + - L 0 3 * 2 ; 0 9 - . , 3 : + - M 7 . , 9 0 1 2 * 3 4 1 5
K 1 0 r : < , + L 0 r , 1 4 = , : ; 9 0 1 2 4 - : 0 ; 4 s 0 * - < 1 * = + L 0 r , 1 , < s 5 - . , K 3 4 ; M p 9 5 0 * . 4 r , - 1 0 * s 3 , 9 : ; < : ; = 5 0 * 1
< 1 * = : ; - . , 3 : + - w - * 1 ; - 0 - . , p ; < , q M
x
3 3 < 1 * = + 4 1 , 3 : + - , < s 5 - . , : 1 = , ; , 1 : L ; 4 2 , + 4 ; < 2 0 + - L 0 2 2 0 ; K 1 0 K 1 : , - 4 1 5 y s 1 4 ; < , < z ; 4 2 , M 7 . ,
/ 0 1 2 * 3 4 1 5 2 4 5 s , 4 L L , + + , < s 5 * + : ; = - . , p ; < , q w , : - . , 1 s 5 = , ; , 1 : L 0 1 K 1 0 K 1 : , - 4 1 5 ; 4 2 , 0 1 s 5
x {
- . , 1 4 K , * - : L < 1 * = L 4 - , = 0 1 5 M p ; + : - * 4 - : 0 ; + 8 . , 1 , 4 ; / J 4 K K 1 0 r , < = , ; , 1 : L , | * : r 4 3 , ; - : + 4 r 4 : 3 4 s 3 , w
s 1 4 ; < ; 4 2 , + 4 1 , 3 : + - , < 9 0 1 1 , 9 , 1 , ; L , K * 1 K 0 + , + 0 ; 3 5 w 4 ; < < 0 ; 0 - < , ; 0 - , L 0 r , 1 4 = , 9 0 1 - . , s 1 4 ; < w * ; 3 , + +
x
+ K , L : 9 : L 4 3 3 5 ; 0 - , < M 3 3 < 1 * = + 4 1 , 3 : + - , < : ; , 4 L . L 4 - , = 0 1 5 : ; 4 3 K . 4 s , - : L 4 3 0 1 < , 1 s 5 = , ; , 1 : L ; 4 2 , M
x {
} . , 1 , 4 ; / J 4 K K 1 0 r , < = , ; , 1 : L : + 4 r 4 : 3 4 s 3 , 9 0 1 - . , 3 : + - , < = , ; , 1 : L ; 4 2 , w - . , = , ; , 1 : L ; 4 2 , : +
s 0 3 < , < M
} . 4 - 4 1 , = , ; , 1 : L < 1 * = + 6
x {
= , ; , 1 : L < 1 * = . 4 + - . , + 4 2 , 4 L - : r , : ; = 1 , < : , ; - 4 + - . , s 1 4 ; < ; 4 2 , < 1 * = M ~ , ; , 1 : L < 1 * = + * + * 4 3 3 5 L 0 + -
x x
3 , + + - . 4 ; s 1 4 ; < ; 4 2 , < 1 * = + 4 ; < 4 1 , 4 K K 1 0 r , < s 5 - . , / 0 0 < 4 ; < J 1 * = < 2 : ; : + - 1 4 - : 0 ; y / J z w 8 . : L .
4 + + * 1 , + - . 4 - - . , 9 0 3 3 0 8 : ; = L 0 ; < : - : 0 ; + 4 1 , 2 , - M
. , = , ; , 1 : L < 1 * = 2 * + - L 0 ; - 4 : ; - . , + 4 2 , 4 L - : r , : ; = 1 , < : , ; - + w s , - . , + 4 2 , + - 1 , ; = - . w 4 ; < - . , + 4 2 ,
• 7
< 0 + 4 = , 9 0 1 2 4 + - . , s 1 4 ; < ; 4 2 , < 1 * = M
x x
. , / J . 4 + = : r , ; 4 ; 1 4 - : ; = L 0 2 K 4 1 , < - 0 - . , s 1 4 ; < ; 4 2 , < 1 * = 4 ; < - . * + - . , = , ; , 1 : L < 1 * = : +
• 7
< , - , 1 2 : ; , < - 0 s , - . , 1 4 K , * - : L 4 3 3 5 s : 0 , | * : r 4 3 , ; - M
. , ; - . , 4 s 0 r , - 8 0 L 1 : - , 1 : 4 4 1 , 2 , - w 4 = , ; , 1 : L L 4 ; s , + * s + - : - * - , < 8 : - . - . , 9 * 3 3 , q K , L - 4 - : 0 ; - . 4 -
• }
- . , + * s + - : - * - , < K 1 0 < * L - 8 : 3 3 K 1 0 < * L , - . , + 4 2 , L 3 : ; : L 4 3 , 9 9 , L - 4 ; < + 4 9 , - 5 K 1 0 9 : 3 , 4 + - . , K 1 , + L 1 : s , <
K 1 0 < * L - M
i
A A B I B G H D E @ B @ @ H I n
0 2 , L 0 r , 1 , < < 1 * = + 2 4 5 . 4 r , 4 < < : - : 0 ; 4 3 1 , | * : 1 , 2 , ; - + 0 1 3 : 2 : - + 0 ; L 0 r , 1 4 = , M 7 . , + , 1 , | * : 1 , 2 , ; - +
4 ; < 3 : 2 : - + 2 4 5 : ; L 3 * < , >
i
B G I k G B D I B G H J 8 : + , 1 , | * : 1 , + 5 0 * 0 1 5 0 * 1 K . 5 + : L : 4 ; - 0 = , - K 1 : 0 1 4 * - . 0 1 : 4 - : 0 ; 9 0 1
L , 1 - 4 : ; < 1 * = + M 7 . : + 2 , 4 ; + - . 4 - 5 0 * 8 : 3 3 ; , , < - 0 = , - 4 K K 1 0 r 4 3 9 1 0 2 - . , K . 4 1 2 4 L 5 s , ; , 9 : - +
2 4 ; 4 = , 1 y , < p 2 K 4 L - z s , 9 0 1 , 5 0 * 9 : 3 3 5 0 * 1 K 1 , + L 1 : K - : 0 ; + M p 9 5 0 * < 0 ; - = , - 4 K K 1 0 r 4 3 w - . , < 1 * =
x
2 4 5 ; 0 - s , L 0 r , 1 , < M J 1 * = + - . 4 - 4 1 , + * s , L - - 0 4 K 1 : 0 1 4 * - . 0 1 : 4 - : 0 ; 8 : 3 3 . 4 r , 4 + 5 2 s 0 3
{ x {
; , q - - 0 - . , < 1 * = M . 5 + : L : 4 ; + . 4 1 2 4 L : , + L 4 3 3 y z 0 1 / > y z
D H I B I m B B I n / 0 1 L , 1 - 4 : ; < 1 * = + w - . , K 3 4 ; 3 : 2 : - + - . , 4 2 0 * ; - 0 9 - . , < 1 * = - . 4 - : + L 0 r , 1 , < M
J 1 * = + - . 4 - 4 1 , + * s , L - - 0 4 | * 4 ; - : - 5 3 : 2 : - 8 : 3 3 . 4 r , 4 u + 5 2 s 0 3 ; , q - - 0 - . , < 1 * = M
@ B E E m B B I D I B G H n 1 , + L 1 : K - : 0 ; + 2 4 5 s , 1 , 9 : 3 3 , < 8 . , ; 0 1 2 0 1 , 0 9 - . , < 4 5 + + * K K 3 5
. 4 + s , , ; * + , < M
I @ j ¢ k @ D j p ; + 0 2 , L 4 + , + w - . , K 3 4 ; 1 , | * : 1 , + 5 0 * - 0 9 : 1 + - - 1 5 L , 1 - 4 : ; < 1 * = + - 0 - 1 , 4 - 5 0 * 1
¡
2 , < : L 4 3 L 0 ; < : - : 0 ; s , 9 0 1 , : - 8 : 3 3 L 0 r , 1 4 ; 0 - . , 1 < 1 * = 9 0 1 - . 4 - L 0 ; < : - : 0 ; M / 0 1 , q 4 2 K 3 , w : 9 J 1 * =
x
4 ; < J 1 * = t s 0 - . - 1 , 4 - 5 0 * 1 2 , < : L 4 3 L 0 ; < : - : 0 ; w 8 , 2 4 5 ; 0 - L 0 r , 1 J 1 * = t * ; 3 , + + 5 0 * - 1 5
x x
J 1 * = 9 : 1 + - M p 9 J 1 * = < 0 , + ; 0 - 8 0 1 h 9 0 1 5 0 * w 8 , 8 : 3 3 - . , ; L 0 r , 1 J 1 * = t M J 1 * = + - . 4 - 4 1 ,
+ * s , L - - 0 - , K 7 . , 1 4 K 5 8 : 3 3 . 4 r , 4 7 + 5 2 s 0 3 ; , q - - 0 - . , < 1 * = M
i
o @ m B B I p ; + 0 2 , L 4 + , + w < 1 * = + 4 1 , 0 ; 3 5 4 r 4 : 3 4 s 3 , - 0 4 2 , 2 s , 1 : ; 4 + , 3 , L - 4 = , L 4 - , = 0 1 5 M
x x
J 1 * = + - . 4 - 4 1 , + * s , L - - 0 4 ; = , u : 2 : - 8 : 3 3 . 4 r , 4 ; ~ £ + 5 2 s 0 3 ; , q - - 0 - . , < 1 * = M
@ H A @ m B B I 0 2 , < 1 * = + 4 1 , 0 ; 3 5 4 r 4 : 3 4 s 3 , - 0 2 , 2 s , 1 + 0 9 4 L , 1 - 4 : ; = , ; < , 1 M J 1 * = + - . 4 -
¤
4 1 , 4 r 4 : 3 4 s 3 , - 0 0 ; 3 5 4 L , 1 - 4 : ; = , ; < , 1 8 : 3 3 . 4 r , 4 ~ + 5 2 s 0 3 ; , q - - 0 - . , < 1 * = M ¥ 0 * L 4 ; 9 : ; <
0 * - : 9 5 0 * 1 < 1 * = . 4 + 4 ; 5 4 < < : - : 0 ; 4 3 1 , | * : 1 , 2 , ; - + 0 1 3 : 2 : - + s 5 3 0 0 h : ; = : ; - . , 9 0 1 2 * 3 4 1 5
+ - 4 1 - : ; = 0 ; - . , ; , q - K 4 = , M
p 9 5 0 * . 4 r , 4 ; 5 4 < < : - : 0 ; 4 3 | * , + - : 0 ; + w K 3 , 4 + , r : + : - 0 * 1 8 , s + : - , 4 - 2 < 8 : + , M 0 1 = 0 1 L 0 ; - 4 L - - . , L * + - 0 2 , 1
{
+ , 1 r : L , L , ; - , 1 4 - y z M MDwise HIP Plus Formulary 2016
Table of Contents T a b l e o f C n t s ANALGESIC AND ANTIHISTAMINE COMBINATION ...... 3 ANALGESICS ...... 3 ANESTHETICS ...... 12 ANTIARTHRITICS ...... 14 ANTIASTHMATICS ...... 16 ANTIBIOTICS ...... 18 ANTICOAGULANTS ...... 28 ANTIDOTES ...... 29 ANTIFUNGALS ...... 29 ANTIHISTAMINE AND DECONGESTANT COMBINATION ...... 32 ANTIHISTAMINES ...... 34 ANTIHYPERGLYCEMICS ...... 36 ANTIINFECTIVES ...... 39 ANTIINFECTIVES/MISCELLANEOUS ...... 39 ANTINEOPLASTICS ...... 39 ANTIPARKINSON DRUGS ...... 45 ANTIPLATELET DRUGS ...... 46 ANTIVIRALS ...... 46 AUTONOMIC DRUGS ...... 49 BIOLOGICALS ...... 51 BLOOD ...... 56 CARDIAC DRUGS ...... 58 CARDIOVASCULAR ...... 60 CNS DRUGS ...... 66 COLONY STIMULATING FACTORS ...... 69 CONTRACEPTIVES ...... 69 COUGH/COLD PREPARATIONS ...... 74 DIAGNOSTIC ...... 83 DIURETICS ...... 85 EENT PREPS ...... 86 ELECT/CALORIC/H2O ...... 91 GASTROINTESTINAL ...... 99 HERBALS ...... 111 HORMONES ...... 114 IMMUNOSUPPRESANT ...... 118 MISCELLANEOUS MEDICAL SUPPLIES, DEVICES, NON-DRUG ...... 119 MUSCLE RELAXANTS ...... 134 PRE-NATAL VITAMINS ...... 135 PSYCHOTHERAPEUTIC DRUGS ...... 139 SEDATIVE/HYPNOTICS ...... 144 SKIN PREPS ...... 145 SMOKING DETERRENTS ...... 157 THYROID PREPS ...... 158 UNCLASSIFIED DRUG PRODUCTS ...... 158 VITAMINS ...... 168
1 2 MDwise HIP Plus Formulary 2016
Drug Name Tier Notes ANALGESIC AND ANTIHISTAMINE COMBINATION ACETA-GESIC 1 ACETAMINOPHEN PM 1 diphenhydramine-acetaminophen 1 DOLOGESIC 1 EXCEDRIN PM 2 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 ST 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 ZFLEX 1 ANALGESICS 8 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-codeine oral solution 1 acetaminophen-codeine oral tablet 1 ACTIQ 2 PA; QL (4 EA per 1 day) ADDED STRENGTH HEADACHE RELIEF 1 ALFENTA 2 alfentanil 1 ALSUMA 2 QL (1 ML per 14 days) AMERGE 2 QL (3 EA per 5 days) 3 Drug Name Tier Notes ARTHRITIS PAIN RELIEF (ACETAM) 1 ARTHRITIS PAIN RELIEVER 1 ASCOMP WITH CODEINE 1 ASCRIPTIN 2 ASPIR-81 3 ASPIRIN LOW DOSE 3 ASPIRIN LOW-STRENGTH 3 aspirin oral tablet 325 mg 3 aspirin oral tablet,chewable 3 aspirin oral tablet,delayed release (dr/ec) 325 mg, 81 mg 3 aspirin rectal 1 ASPIR-LOW 3 AVINZA ORAL CAPSULE, ER MULTIPHASE 24 HR 2 QL (2 EA per 1 day) 120 MG AVINZA ORAL CAPSULE, ER MULTIPHASE 24 HR 30 2 QL (1 EA per 1 day) MG, 45 MG, 60 MG, 75 MG, 90 MG AXERT 2 ST; QL (2 EA per 5 days) BACKACHE RELIEF EXTRA STRENGTH 1 belladonna alkaloids-opium 1 BELLADONNA-OPIUM 1 BUFFERIN EXTRA STRENGTH 1 BUFFERIN ORAL TABLET 325 MG 1 BUFFERIN ORAL TABLET 81 MG 2 BUPAP ORAL TABLET 50-300 MG 2 buprenorphine hcl injection 1 BUTALBITAL COMPOUND 1 BUTALBITAL COMPOUND W/CODEINE 1 butalbital-acetaminop-caf-cod 1 butalbital-acetaminophen 1 butalbital-acetaminophen-caff 1 butalbital-aspirin-caffeine 1 butorphanol tartrate 1 BUTRANS 2 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 CATAFLAM 2 CHILDREN'S ACETAMINOPHEN ORAL SUSPENSION 1 160 MG/5 ML CHILDREN'S ASPIRIN 3 CHILDREN'S MAPAP 1 CHILDREN'S PAIN & FEVER RELIEF 1 CHILDREN'S PAIN RELIEF ORAL SUSPENSION 1
4 Drug Name Tier Notes CHILDREN'S PAIN RELIEVER ORAL SUSPENSION 1 CHILDREN'S PAIN RELIEVER ORAL 1 TABLET,DISINTEGRATING CHILDREN'S Q-PAP 1 CHILDREN'S SILAPAP 1 CHILDREN'S TRIAMINIC FEVER 1 choline,magnesium salicylate 1 clonidine (pf) 1 codeine sulfate oral tablet 1 CONZIP ORAL CAPSULE,ER BIPHASE 24 HR 25-75 2 ST; QL (1 EA per 1 day) D.H.E.45 2 QL (15 ML per 14 days) DEMEROL (PF) 2 DEMEROL INJECTION 2 DEMEROL ORAL 2 QL (6 EA per 1 day) diclofenac potassium 1 diflunisal 1 dihydrocode-acetaminophen-caff oral capsule 1 QL (10 EA per 1 day) dihydrocodeine-aspirin-caff 1 dihydroergotamine injection 1 QL (15 ML per 14 days) dihydroergotamine nasal 1 QL (8 ML per 28 days) DILAUDID 2 DILAUDID (PF) 2 DILAUDID-HP (PF) 2 DISKETS 2 PA DOAN'S EXTRA STRENGTH 1 DOLOPHINE ORAL 2 PA DURACLON (PF) 2 DURAGESIC 2 PA; QL (1 EA per 3 days) DURAMORPH (PF) 2 E.C. PRIN 3 ED-APAP 1 EFFERVESCENT PAIN RELIEF 1 ELMIRON 2 EMBEDA ORAL CAPSULE,ORAL ONLY,EXT.REL 2 QL (4 EA per 1 day) PELL 100-4 MG EMBEDA ORAL CAPSULE,ORAL ONLY,EXT.REL PELL 20-0.8 MG, 30-1.2 MG, 50-2 MG, 60-2.4 MG, 2 QL (2 EA per 1 day) 80-3.2 MG ENDOCET ORAL TABLET 10-325 MG, 2.5-325 MG, 1 QL (12 EA per 1 day) 5-325 MG, 7.5-325 MG ENDODAN 1 ergotamine-caffeine 1 QL (10 EA per 7 days) ESGIC 2 EXALGO ER ORAL TABLET EXTENDED RELEASE 24 2 PA; QL (1 EA per 1 day) HR 12 MG, 16 MG, 8 MG
5 Drug Name Tier Notes EXALGO ER ORAL TABLET EXTENDED RELEASE 24 2 PA; QL (2 EA per 1 day) HR 32 MG EXCEDRIN BACK & BODY 2 EXCEDRIN EXTRA STRENGTH 2 EXCEDRIN MENSTRUAL COMPLETE 2 EXCEDRIN TENSION HEADACHE 2 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 syringe 100 mcg/2 ml (50 1 mcg/ml) FENTORA 2 PA; QL (4 EA per 1 day) FEVER REDUCER 1 FEVERALL RECTAL SUPPOSITORY 120 MG, 325 MG, 1 650 MG FEVERALL RECTAL SUPPOSITORY 80 MG 2 FIORICET ORAL CAPSULE 2 FIORICET WITH CODEINE ORAL CAPSULE 2 50-300-40-30 MG FIORINAL 2 FIORINAL-CODEINE #3 2 FROVA 2 ST; QL (3 EA per 5 days) HEADACHE FORMULA ADDED STR 1 HEADACHE RELIEF (ASA-ACET-CAF) 1 HISTAFLEX 2 HYCET 2 QL (184 ML per 1 day) hydrocodone-acetaminophen oral solution 10-325 mg/15 1 QL (184 ML per 1 day) ml(15 ml), 5-163 mg/7.5ml(7.5ml) hydrocodone-acetaminophen oral solution 2.5-167 mg/5 ml 1 QL (120 ML per 1 day) hydrocodone-acetaminophen oral tablet 10-300 mg, 5-300 1 QL (13 EA per 1 day) mg, 7.5-300 mg hydrocodone-acetaminophen oral tablet 10-325 mg, 5-325 1 QL (12 EA per 1 day) mg, 7.5-325 mg hydrocodone-acetaminophen oral tablet 10-500 mg, 5-500 1 QL (8 EA per 1 day) mg, 7.5-500 mg hydrocodone-acetaminophen oral tablet 10-650 mg, 10-660 1 QL (6 EA per 1 day) mg, 7.5-650 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 1 hydromorphone (pf) 1 hydromorphone in 0.9 % nacl intravenous pt controlled 1 analgesia syring 10 mg/50 ml (0.2 mg/ml) hydromorphone in 0.9 % nacl intravenous solution 0.2 1 mg/ml hydromorphone injection 1 hydromorphone oral liquid 1
6 Drug Name Tier Notes hydromorphone oral tablet 1 hydromorphone oral tablet extended release 24 hr 12 mg, 16 1 PA; QL (1 EA per 1 day) mg, 8 mg 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) IBUDONE 2 IBUPROFEN PM ORAL TABLET 1 ibuprofen-oxycodone 1 IMITREX NASAL 2 QL (6 EA per 15 days) IMITREX ORAL 2 QL (3 EA per 5 days) IMITREX STATDOSE KIT REFILL 2 QL (1 ML per 14 days) IMITREX STATDOSE PEN 2 QL (1 ML per 14 days) IMITREX SUBCUTANEOUS 2 QL (1 ML per 14 days) INFANT PAIN RELIEVER 1 INFANTS' PAIN & FEVER 1 INFANTS' PAIN RELIEF 1 INFANT'S PAIN RELIEF ORAL DROPS,SUSPENSION 1 80 MG/0.8 ML INFANT'S PAIN RELIEVER 1 INFANTS' TRIAMINIC FEVER 1 INFUMORPH P/F 2 IONSYS 2 isometh-dichloral-acetaminophn 1 isomethepten-caf-acetaminophen 1 JR. STR NON-ASPIRIN PAIN 1 JUNIOR MAPAP 1 KADIAN ORAL CAPSULE,EXTEND.RELEASE PELLETS 10 MG, 130 MG, 150 MG, 20 MG, 40 MG, 50 2 QL (2 EA per 1 day) MG, 60 MG, 70 MG, 80 MG KADIAN ORAL CAPSULE,EXTEND.RELEASE 2 QL (4 EA per 1 day) PELLETS 200 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 solution 1 ketorolac oral 1 LAZANDA 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 10-325 2 QL (12 EA per 1 day) LORTAB 5-325 2 QL (12 EA per 1 day)
7 Drug Name Tier Notes LORTAB 7.5-325 2 QL (12 EA per 1 day) LORTAB ELIXIR ORAL SOLUTION 10-300 MG/15 ML 2 MAPAP (ACETAMINOPHEN) ORAL CAPSULE 1 MAPAP (ACETAMINOPHEN) ORAL 1 DROPS,SUSPENSION MAPAP (ACETAMINOPHEN) ORAL ELIXIR 1 MAPAP (ACETAMINOPHEN) ORAL LIQUID 1 MAPAP (ACETAMINOPHEN) ORAL SUSPENSION 1 MAPAP (ACETAMINOPHEN) ORAL TABLET 1 MAPAP (ACETAMINOPHEN) ORAL 1 TABLET,CHEWABLE MAPAP ARTHRITIS PAIN 1 MAPAP EXTRA STRENGTH 1 MAPAP INFANTS' 1 MARGESIC 1 MARTEN-TAB 1 MAXALT 2 QL (3 EA per 5 days) MAXALT-MLT 2 QL (3 EA per 5 days) MAXIDONE 2 QL (5 EA per 1 day) mefenamic acid 1 MENSTRUAL RELIEF 1 meperidine (pf) injection solution 100 mg/ml, 25 mg/ml, 50 1 mg/ml meperidine in 0.9 % nacl intravenous pt controlled analgesia syring 250 mg/25 ml (10 mg/ml), 550 mg/55 ml 1 (10 mg/ml) meperidine in 0.9 % nacl intravenous solution 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) MEPERITAB 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 CONCENTRATE 2 PA METHADOSE ORAL TABLET,SOLUBLE 1 PA MIGERGOT 2 QL (5 EA per 7 days) MIGRAINE FORMULA 1 MIGRAINE RELIEF 1 MIGRANAL 2 QL (8 ML per 28 days) MINIPRIN 3 morphine (pf) injection solution 0.5 mg/ml, 1 mg/ml 1
8 Drug Name Tier Notes morphine (pf) intravenous 1 morphine concentrate oral solution 1 morphine in 0.9 % nacl intravenous solution 1 mg/ml 1 morphine injection solution 10 mg/ml, 15 mg/ml, 8 mg/ml 1 morphine injection syringe 10 mg/ml, 2 mg/ml, 4 mg/ml, 5 1 mg/ml, 8 mg/ml 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, 1 QL (1 EA per 1 day) 60 mg, 75 mg, 90 mg morphine oral capsule,extend.release pellets 10 mg, 20 mg, 1 QL (2 EA per 1 day) 50 mg, 60 mg, 80 mg morphine oral solution 1 morphine oral tablet 2 morphine oral tablet extended release 1 QL (3 EA per 1 day) morphine rectal 1 MS CONTIN 2 QL (3 EA per 1 day) 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 NORCO 2 QL (12 EA per 1 day) NUCYNTA 2 QL (6 EA per 1 day) NUCYNTA ER 2 QL (2 EA per 1 day) OPANA 2 OPANA ER ORAL TABLET,ORAL ONLY,EXT.REL.12 2 QL (2 EA per 1 day) HR 10 MG, 15 MG, 20 MG, 5 MG, 7.5 MG OPANA ER ORAL TABLET,ORAL ONLY,EXT.REL.12 2 QL (4 EA per 1 day) HR 30 MG, 40 MG OXECTA 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, 20 mg, 1 QL (2 EA per 1 day) 40 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 1 QL (12 EA per 1 day) 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
9 Drug Name Tier Notes OXYCONTIN ORAL TABLET,ORAL ONLY,EXT.REL.12 HR 10 MG, 15 MG, 20 MG, 30 MG, 2 QL (2 EA per 1 day) 40 MG, 60 MG OXYCONTIN ORAL TABLET,ORAL 2 QL (4 EA per 1 day) ONLY,EXT.REL.12 HR 80 MG oxymorphone oral tablet 1 oxymorphone oral tablet extended release 12 hr 10 mg, 15 1 QL (2 EA per 1 day) mg, 20 mg, 5 mg, 7.5 mg oxymorphone oral tablet extended release 12 hr 30 mg, 40 1 QL (4 EA per 1 day) mg PAIN & FEVER 1 PAIN 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-acetaminophen 1 pentazocine-naloxone 1 PERCOCET ORAL TABLET 10-325 MG, 2.5-325 MG, 2 QL (12 EA per 1 day) 5-325 MG, 7.5-325 MG PERCODAN 2 PHARBETOL 1 PHRENILIN FORTE 2 PONSTEL 2 PRE-MENSTRUAL RELIEF 1 PRIALT 2 PRIMLEV 2 QL (13 EA per 1 day) propoxyphene 1 propoxyphene n-acetaminophen oral tablet 100-650 mg 1 QL (6 EA per 1 day) propoxyphene-acetaminophen 1 Q-PAP 1 Q-PAP EXTRA STRENGTH 1 RELPAX ORAL TABLET 20 MG 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 1 QL (12 EA per 1 day) ROXICODONE 2 SILAPAP 1 SPRIX 2 QL (1 EA per 6 days) SUBLIMAZE (PF) 2 SUBSYS 2 PA; QL (4 EA per 1 day) SUFENTA 2 10 Drug Name Tier Notes 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 2 ST; QL (1 ML per 14 days) NEEDLE-FREE INJECTOR 6 MG/0.5 ML SYNALGOS-DC 2 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 1 ST; QL (1 EA per 1 day) mg tramadol oral tablet 1 tramadol oral tablet extended release 24 hr 1 tramadol oral tablet, er multiphase 24 hr 1 tramadol-acetaminophen 1 TRI-BUFFERED ASPIRIN 1 TYLENOL-CODEINE #3 2 TYLENOL-CODEINE #4 2 ULTIVA 2 ULTRACET 2 ULTRAM 2 ULTRAM ER 2 VANATOL LQ 2 VICODIN ES 1 QL (13 EA per 1 day) VICODIN HP ORAL TABLET 10-300 MG 1 QL (13 EA per 1 day) VICODIN ORAL TABLET 5-300 MG 1 QL (13 EA per 1 day) VICOPROFEN 2 XARTEMIS XR 2 QL (12 EA per 1 day) XODOL 10/300 2 QL (13 EA per 1 day) XODOL 5/300 2 QL (13 EA per 1 day) XODOL 7.5/300 2 QL (13 EA per 1 day) XYLON 10 1 ZAMICET 2 QL (184 ML per 1 day) ZEBUTAL ORAL CAPSULE 50-325-40 MG 1 ZEBUTAL ORAL CAPSULE 50-500-40 MG 2 ZECUITY 2 ZIPSOR 2 ST; QL (4 EA per 1 day) ZOHYDRO ER 2 QL (2 EA per 1 day)
11 Drug Name Tier Notes 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) ZOMIG ZMT 2 ST; QL (2 EA per 5 days) ANESTHETICS AMIDATE 2 AZO 1 AZO-GESIC 1 BABY TEETHING GEL 1 BREVITAL INJECTION RECON SOLN 2.5 GRAM, 500 2 MG BUFFERED LIDOCAINE INJECTION SYRINGE 1 % (1 2 ML) bupivacaine 1 bupivacaine (pf) injection solution 1 bupivacaine in nacl(pf) epidural solution 0.125 % (1,250 1 mcg/ml) bupivacaine-dextrose-water(pf) 1 bupivacaine-epinephrine 1 bupivacaine-epinephrine (pf) 1 bupivacaine-epinephrine bitart 1 BURN RELIEF 1 CARBOCAINE 2 CARBOCAINE (PF) 2 CEPACOL SENSATIONS COOLING 2 CEPACOL SENSATIONS HYDRA 2 CEPACOL SORE THROAT (BENZ-MEN) 2 CEPACOL ULTRA 1 chloroprocaine (pf) 1 cocaine 1 dibucaine 1 DIPRIVAN 2 EMLA 2 etomidate 1 FORANE 2 GLYDO 1 KETALAR 2 ketamine injection 1 LANACANE ANTI-ITCH 2 LANACANE FIRST AID 2 LDO PLUS 2 lidocaine 1 lidocaine (pf) in d7.5w 1 lidocaine (pf) injection solution 1 lidocaine hcl injection solution 1 lidocaine hcl laryngotracheal 1 12 Drug Name Tier Notes lidocaine hcl mucous membrane 1 lidocaine hcl topical cream 1 LIDOCAINE VISCOUS 1 lidocaine-epinephrine 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-prilocaine 1 LIDODERM 2 MARCAINE 2 MARCAINE (PF) 2 MARCAINE SPINAL (PF) 2 MARCAINE-EPINEPHRINE 2 MARCAINE-EPINEPHRINE (PF) 2 mepivacaine (pf) 1 midazolam (pf) in 0.9 % nacl 1 midazolam (pf) injection 1 midazolam in 0.9 % nacl intravenous syringe 2 mg/2 ml (1 1 mg/ml) midazolam injection 1 NAROPIN (PF) INJECTION SOLUTION 10 MG/ML (1 2 %), 2 MG/ML (0.2 %), 7.5 MG/ML (0.75 %) NESACAINE 2 NESACAINE-MPF INJECTION SOLUTION 20 MG/ML 1 (2 %) NESACAINE-MPF INJECTION SOLUTION 30 MG/ML 2 (3 %) NUPERCAINAL 2 ORAL PAIN RELIEF MUCOUS MEMBRANE GEL 1 ORAL PAIN RELIEF MUCOUS MEMBRANE LIQUID 1 ORASEP 2 PAIN RELIEF ANESTHETIC 1 PHENASEPTIC 1 phenazopyridine oral tablet 100 mg, 200 mg 1 PLIAGLIS 2 POLOCAINE 1 POLOCAINE-MPF 1 PONTOCAINE (PF) INJECTION RECON SOLN 2 propofol intravenous emulsion 1 PYRIDIUM 2 ropivacaine (pf) in 0.9 % nacl local infiltration elastomeric 1 pump,hi var rate ropivacaine (pf) injection 1 SARNA SENSITIVE 1 SENSORCAINE 2
13 Drug Name Tier Notes SENSORCAINE/EPINEPHRINE 1 SENSORCAINE-MPF INJECTION SOLUTION 0.25 % 2 (2.5 MG/ML), 0.5 % (5 MG/ML) SENSORCAINE-MPF INJECTION SOLUTION 0.75 % 1 (7.5 MG/ML) SENSORCAINE-MPF SPINAL 1 SENSORCAINE-MPF/EPINEPHRINE INJECTION 1 SOLUTION 0.25 %-1:200,000, 0.75 %-1:200,000 SENSORCAINE-MPF/EPINEPHRINE INJECTION 2 SOLUTION 0.5 %-1:200,000 sevoflurane 1 SORE THROAT 1 SORE THROAT (BENZOCAINE-MENTH) MUCOUS 1 MEMBRANE LOZENGE 15-3.6 MG SORE THROAT (PHENOL) 1 SUPRANE 2 SYNERA 2 tetracaine hcl (pf) injection 1 ULTANE 2 URINARY PAIN RELIEF 1 XYLOCAINE INJECTION 2 XYLOCAINE JELLY 2 XYLOCAINE MUCOUS MEMBRANE SOLUTION 2 XYLOCAINE-EPINEPHRINE 2 XYLOCAINE-MPF INJECTION SOLUTION 15 MG/ML 2 (1.5 %), 40 MG/ML (4 %) XYLOCAINE-MPF INJECTION SOLUTION 5 MG/ML 1 (0.5 %) XYLOCAINE-MPF/EPINEPHRINE INJECTION 2 SOLUTION 1 %-1:200,000, 2 %-1:200,000 ZINGO 2 ANTIARTHRITICS ALL DAY PAIN RELIEF 1 ALL DAY RELIEF 1 allopurinol 1 ALOPRIM 2 ANAPROX 2 ANAPROX DS 2 ARAVA 2 ARTHROTEC 50 2 ARTHROTEC 75 2 CALDOLOR INTRAVENOUS RECON SOLN 800 MG/8 2 ML (100 MG/ML) CELEBREX ORAL CAPSULE 100 MG, 200 MG, 50 MG 2 celecoxib oral capsule 100 mg, 200 mg, 50 mg 1 CHILD IBUPROFEN 1
14 Drug Name Tier Notes CHILDREN'S IBUPROFEN 1 colchicine oral capsule 1 QL (2 EA per 1 day) colchicine oral tablet 1 colchicine-probenecid 1 COLCRYS 2 CUPRIMINE 2 DAYPRO 2 DEPEN TITRATABS 2 diclofenac sodium oral 1 diclofenac-misoprostol 1 DISALCID 2 DUEXIS 2 ST; QL (3 EA per 1 day) DYLOJECT 2 EC-NAPROSYN 2 ELITEK 2 ENBREL 2 PA ENBREL SURECLICK 2 PA etodolac 1 FELDENE 2 fenoprofen oral capsule 2 fenoprofen oral tablet 1 flurbiprofen 1 glucosam su dip-chondroit-c-mn 1 glucosam-chondr msm#6-manganes 2 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 STARTER 2 PA IBU-DROPS 1 IBUPROFEN 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
15 Drug Name Tier Notes meclofenamate oral 1 meloxicam 1 MITIGARE 2 QL (2 EA per 1 day) MOBIC 2 nabumetone 1 NALFON ORAL CAPSULE 400 MG 2 NAPRELAN CR 2 NAPRELAN CR DOSE CARD 2 NAPROSYN 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 OTEZLA 2 PA OTEZLA STARTER 2 PA OTREXUP (PF) SUBCUTANEOUS AUTO-INJECTOR 2 ST; QL (1.6 ML per 28 days) 25 MG/0.4 ML oxaprozin 1 piroxicam 1 probenecid 1 PROVIL 1 RASUVO (PF) SUBCUTANEOUS AUTO-INJECTOR 2 ST; QL (1.4 ML per 28 days) 17.5 MG/0.35 ML RHEUMATREX 2 RIDAURA 2 salsalate 1 SIMPONI 2 PA SIMPONI ARIA 2 sulindac oral 1 TIVORBEX 2 tolmetin 1 ULORIC 2 ST; QL (30 EA per 30 days) VOLTAREN-XR 2 XELJANZ 2 PA ZORVOLEX 2 ST; QL (3 EA per 1 day) ZYLOPRIM 2 ANTIASTHMATICS ACCOLATE 2 acetylcysteine 1 ADVAIR DISKUS INHALATION BLISTER WITH 2 QL (2 EA per 30 days) DEVICE 100-50 MCG/DOSE, 250-50 MCG/DOSE ADVAIR DISKUS INHALATION BLISTER WITH 2 QL (60 EA per 1 day) DEVICE 500-50 MCG/DOSE
16 Drug Name Tier Notes 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 aminophylline oral tablet 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 QL (13 GM per 30 days) ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 110 MCG (30 DOSES), 2 ST; QL (1 EA per 30 days) 220 MCG (120 DOSES), 220 MCG (14 DOSES), 220 MCG (30 DOSES), 220 MCG (60 DOSES) 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 1 QL (60 ML per 15 days) mg/2 ml, 0.5 mg/2 ml budesonide inhalation suspension for nebulization 1 mg/2 1 QL (30 ML per 15 days) ml COMBIVENT RESPIMAT 2 cromolyn inhalation 1 cromolyn nasal 1 cromolyn oral 1 DULERA 2 QL (13 GM per 30 days) DUONEB 2 ELIXOPHYLLIN ORAL ELIXIR 80 MG/15 ML 1 FLOVENT DISKUS INHALATION BLISTER WITH 2 ST; QL (2 EA per 1 day) DEVICE 100 MCG/ACTUATION, 50 MCG/ACTUATION FLOVENT DISKUS INHALATION BLISTER WITH 2 ST; QL (4 EA per 1 day) DEVICE 250 MCG/ACTUATION FLOVENT HFA INHALATION HFA AEROSOL 2 ST; QL (12 GM per 30 days) INHALER 110 MCG/ACTUATION FLOVENT HFA INHALATION HFA AEROSOL 2 ST; QL (24 GM per 30 days) INHALER 220 MCG/ACTUATION FLOVENT HFA INHALATION HFA AEROSOL 2 ST; QL (21.2 GM per 30 days) INHALER 44 MCG/ACTUATION FORADIL AEROLIZER 2 ST; QL (60 EA per 30 days) GASTROCROM 2 INCRUSE ELLIPTA 2 QL (30 EA per 30 days) ipratropium bromide inhalation 1 ipratropium-albuterol 1 levalbuterol hcl 1 LUFYLLIN ORAL TABLET 200 MG 2 17 Drug Name Tier Notes metaproterenol oral 1 montelukast 1 PERFOROMIST 2 QL (120 ML per 30 days) PROAIR HFA 2 PROAIR RESPICLICK 2 PROVENTIL HFA 2 PULMICORT FLEXHALER 2 ST; QL (1 EA per 30 days) PULMICORT INHALATION SUSPENSION FOR 2 QL (60 ML per 15 days) NEBULIZATION 0.25 MG/2 ML, 0.5 MG/2 ML PULMICORT INHALATION SUSPENSION FOR 2 QL (30 ML per 15 days) NEBULIZATION 1 MG/2 ML QVAR 2 ST; QL (174 GM per 300 days) racepinephrine 2 S2 RACEPINEPHRINE 2 SEREVENT DISKUS 2 ST; QL (60 EA per 30 days) SINGULAIR 2 SPIRIVA RESPIMAT INHALATION MIST 1.25 2 MCG/ACTUATION SPIRIVA RESPIMAT INHALATION MIST 2.5 2 QL (4 GM per 30 days) MCG/ACTUATION SPIRIVA WITH HANDIHALER 2 QL (1 EA per 1 day) STIOLTO RESPIMAT 2 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 THEO-24 2 theophylline in dextrose 5 % 1 theophylline oral solution 1 theophylline oral tablet extended release 1 theophylline oral tablet extended release 12 hr 1 TUDORZA PRESSAIR 2 ST; QL (1 EA per 30 days) VENTOLIN HFA 2 VOSPIRE ER 2 XOLAIR 2 QL (1 EA per 5 days) XOPENEX 2 XOPENEX CONCENTRATE 2 XOPENEX HFA 2 zafirlukast 1 ZYFLO 2 ZYFLO CR 2 ANTIBIOTICS ADOXA ORAL CAPSULE 2 ST; QL (2 EA per 1 day) AK-POLY-BAC 1 amikacin injection solution 1,000 mg/4 ml, 500 mg/2 ml 1
18 Drug Name Tier Notes 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 ES-600 2 AUGMENTIN ORAL SUSPENSION FOR RECONSTITUTION 125-31.25 MG/5 ML, 250-62.5 MG/5 2 ML AUGMENTIN ORAL TABLET 500-125 MG, 875-125 2 MG AUGMENTIN XR 2 AVAR 2 AVAR LS 2 AVAR-E 2 AVAR-E GREEN 2 AVAR-E LS 2 AVELOX 2 AVELOX ABC PACK 2 AVELOX IN NACL (ISO-OSMOTIC) 2 AVYCAZ 2 AZACTAM 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 BACTRIM 2 BACTRIM DS 2 BACTROBAN 2 BACTROBAN NASAL 2 BENZAMYCIN 2 BESIVANCE 2 BETHKIS 2 PA
19 Drug Name Tier Notes BIAXIN ORAL SUSPENSION FOR RECONSTITUTION 2 250 MG/5 ML BIAXIN ORAL TABLET 2 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) CEDAX 2 cefaclor oral capsule 1 cefaclor oral suspension for reconstitution 125 mg/5 ml, 250 1 mg/5 ml, 375 mg/5 ml cefaclor oral tablet extended release 12 hr 1 cefadroxil oral capsule 1 cefadroxil oral suspension for reconstitution 250 mg/5 ml, 1 500 mg/5 ml cefadroxil oral tablet 1 cefazolin in 0.9% sod chloride intravenous solution 1 cefazolin in dextrose (iso-os) intravenous piggyback 2 1 gram/50 ml cefazolin in dextrose 5 % 1 cefazolin injection recon soln 1 gram, 10 gram, 20 gram, 1 500 mg cefazolin intravenous 1 cefdinir 1 cefepime 1 cefepime in dextrose 5 % 2 cefepime in dextrose,iso-osm 2 cefixime 1 cefotaxime injection recon soln 1 gram, 2 gram, 500 mg 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 CEFTIN ORAL TABLET 250 MG, 500 MG 2 ceftriaxone in dextrose,iso-os intravenous piggyback 2 2 gram/50 ml 20 Drug Name Tier Notes ceftriaxone injection recon soln 1 gram, 10 gram, 2 gram, 1 250 mg, 500 mg ceftriaxone intravenous recon soln 1 cefuroxime axetil oral tablet 1 cefuroxime sodium injection recon soln 1.5 gram, 750 mg 1 cefuroxime sodium injection recon soln 75 gram 2 cefuroxime sodium intravenous 1 CENTANY 2 CENTANY AT 2 cephalexin 1 chloramphenicol sod succinate 1 CILOXAN 2 CIPRO HC 2 CIPRO IN D5W INTRAVENOUS PIGGYBACK 400 2 MG/200 ML CIPRO ORAL SUSPENSION,MICROCAPSULE RECON 2 CIPRO ORAL TABLET 250 MG, 500 MG 2 CIPRO XR 2 CIPRODEX 2 ciprofloxacin 1 ciprofloxacin (mixture) 1 ciprofloxacin hcl 1 ciprofloxacin in 5 % dextrose 1 ciprofloxacin lactate 1 CLAFORAN INJECTION 2 CLAFORAN INTRAVENOUS RECON SOLN 2 clarithromycin 1 CLEANSING WASH TOPICAL CLEANSER 1 CLEOCIN 2 CLEOCIN IN 5 % DEXTROSE 2 CLEOCIN T 2 CLINDACIN ETZ 2 CLINDACIN P 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
21 Drug Name Tier Notes COLY-MYCIN M PARENTERAL 2 COLY-MYCIN S 2 CORTISPORIN TOPICAL 2 CORTISPORIN-TC 2 CORTOMYCIN 1 CUBICIN 2 cycloserine 1 DALVANCE 2 dapsone 1 demeclocycline oral 1 dicloxacillin 1 DIFICID 2 ST; QL (20 EA per 30 days) DORIBAX 2 DORYX ORAL TABLET,DELAYED RELEASE (DR/EC) 2 ST; QL (2 EA per 1 day) 150 MG, 50 MG DORYX ORAL TABLET,DELAYED RELEASE (DR/EC) 2 ST; QL (1 EA per 1 day) 200 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) 1 ST; QL (2 EA per 1 day) doxycycline monohydrate oral capsule 1 QL (2 EA per 1 day) doxycycline monohydrate oral capsule,ir & delay 1 ST; QL (1 EA per 1 day) rel,biphase doxycycline monohydrate oral suspension for reconstitution 1 doxycycline monohydrate oral tablet 1 QL (2 EA per 1 day) DYNACIN ORAL TABLET 100 MG 2 E.E.S. 400 ORAL TABLET 1 E.E.S. GRANULES 1 ERY PADS 1 ERYGEL 2 ERYPED 200 2 ERYPED 400 2 ERY-TAB ORAL TABLET,DELAYED RELEASE 1 (DR/EC) 250 MG, 500 MG ERY-TAB ORAL TABLET,DELAYED RELEASE 2 (DR/EC) 333 MG ERYTHROCIN (AS STEARATE) ORAL TABLET 250 1 MG ERYTHROCIN INTRAVENOUS RECON SOLN 500 MG 2 erythromycin ethylsuccinate oral tablet 1 erythromycin ophthalmic 1 erythromycin oral capsule,delayed release(dr/ec) 1 22 Drug Name Tier Notes erythromycin oral tablet 1 erythromycin with ethanol 1 erythromycin-benzoyl peroxide 1 ethambutol 1 EVOCLIN 2 FLAGYL 2 FORTAZ 2 FORTAZ IN DEXTROSE 5 % 2 FURADANTIN 2 GARAMYCIN 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 1 mg/50 ml, 80 mg/100 ml, 80 mg/50 ml, 90 mg/100 ml gentamicin sulfate (ped) (pf) 1 gentamicin sulfate (pf) 1 HIPREX 2 HYOLEV MB 1 ILOTYCIN 2 imipenem-cilastatin 1 INDIOMIN MB 1 INVANZ 2 IQUIX 2 ISONARIF 1 isoniazid 1 kanamycin 1 KEFLEX ORAL CAPSULE 2 KETEK 2 KITABIS PAK 2 PA LEVAQUIN IN 5 % DEXTROSE 2 LEVAQUIN ORAL 2 levofloxacin 1 levofloxacin in d5w 1 LINCOCIN 2 linezolid intravenous 1 linezolid oral tablet 1 PA linezolid-0.9% sodium chloride 1 MACROBID 2 MACRODANTIN 2 mafenide acetate 1 MAXIPIME 2 MAXITROL 2
23 Drug Name Tier Notes MEFOXIN IN DEXTROSE (ISO-OSM) 2 meropenem 1 meropenem-0.9% sodium chloride 1 MERREM 2 methenamine hippurate 1 methenamine mandelate 1 METRO I.V. 2 METROGEL VAGINAL 2 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 2 ST; QL (2 EA per 1 day) MORGIDOX 1X100 2 ST; QL (1 EA per 30 days) MORGIDOX 2X100 2 ST; QL (1 EA per 30 days) MOXATAG 2 MOXEZA 2 moxifloxacin 1 moxifloxacin-sod.ace,sul-water 1 mupirocin 1 mupirocin calcium 1 MYAMBUTOL 2 MYCOBUTIN 2 nafcillin 1 nafcillin in dextrose iso-osm 1 NEO-FRADIN 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 HC 1 NEOSPORIN (NEO-POLYM-GRAMICID) 2 NEO-SYNALAR 2 ST NEO-SYNALAR KIT 2 ST nitrofurantoin macrocrystal 1 nitrofurantoin monohyd/m-cryst 1 nitrofurantoin oral 1 NUVESSA 2
24 Drug Name Tier Notes OCUFLOX 2 ofloxacin 1 ORACEA 2 ST; QL (1 EA per 1 day) ORBACTIV 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 POLYTRIM 2 PRASCION 1 PRASCION RA 1 PRED-G 2 PRED-G S.O.P. 2 PRIFTIN 2 PRIMAXIN IV 2 PRIMSOL 2 pyrazinamide 1 QUIXIN 2 rifabutin 1 RIFADIN 2 RIFAMATE 2 rifampin intravenous 1 rifampin oral 1 RIFATER 2 ROCEPHIN INJECTION RECON SOLN 1 GRAM 2 ROSANIL 2 ROSULA 2 ROSULA CLEANSING CLOTHS 2 SEROMYCIN 2 SILVADENE 2 silver sulfadiazine 1 SIRTURO 2 PA SIVEXTRO INTRAVENOUS 2 SIVEXTRO ORAL 2 PA
25 Drug Name Tier Notes SOLODYN ORAL TABLET EXTENDED RELEASE 24 2 ST; QL (1 EA per 1 day) HR 105 MG, 115 MG, 55 MG, 65 MG, 80 MG SSD 1 SSS 10-5 TOPICAL CREAM 1 streptomycin intramuscular 1 sulfacetamide sodium ophthalmic 1 sulfacetamide sodium-sulfur topical cleanser 1 sulfacetamide sodium-sulfur topical cream 10-2 %, 10-5 % 1 (w/w) sulfacetamide sodium-sulfur topical lotion 10-5 % (w/v), 1 10-5 % (w/w) sulfacetamide sodium-sulfur topical pads, medicated 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 SULFAMIDE 1 SULFAMYLON 2 SULFATRIM 1 SUMADAN 2 SUMADAN XLT 2 SUMAXIN 2 SUMAXIN CP 2 SUMAXIN TS 2 SUPRAX 2 SYNERCID 2 TAZICEF 1 TEFLARO 2 tetracycline 1 THALOMID 2 PA; QL (2 EA per 1 day) TOBI 2 PA; QL (5 ML per 1 day) TOBI PODHALER 2 PA TOBRADEX 2 TOBRADEX ST 2 tobramycin 1 tobramycin in 0.225 % nacl 1 PA; QL (5 ML per 1 day) tobramycin in 0.9 % nacl intravenous piggyback 80 mg/100 1 ml tobramycin sulfate 1 tobramycin-dexamethasone 1 TOBREX 2
26 Drug Name Tier Notes TRECATOR 2 trimethoprim 1 TRIOXIN 2 TRIPLE ANTIBIOTIC (PRAM) EXTRA 1 TRIPLE ANTIBIOTIC PLUS 1 TRIPLE ANTIBIOTIC TOPICAL OINTMENT 1 TRIPLE ANTIBIOTIC TOPICAL OINTMENT IN 1 PACKET TYGACIL 2 UNASYN 2 UR N-C 1 URAMIT MB 1 URELLE 2 URIMAR-T 1 URIN DS 2 UROGESIC-BLUE 1 URO-L 1 UROLET MB 1 UROPHEN MB 1 UTIRA-C 2 VANCOCIN 2 QL (40 EA per 30 days) vancomycin in 0.9% sodium cl intravenous solution 1.25 1 gram/250 ml, 1.5 gram/250 ml vancomycin in d5w intravenous piggyback 1 vancomycin in d5w intravenous solution 1.5 gram/250 ml 1 vancomycin in dextrose iso-osm 1 vancomycin intravenous 1 vancomycin oral 1 QL (40 EA per 30 days) VANDAZOLE 2 VIBATIV 2 VIBRAMYCIN ORAL CAPSULE 100 MG 2 ST; QL (2 EA per 1 day) VIBRAMYCIN ORAL SUSPENSION FOR 2 RECONSTITUTION VIBRAMYCIN ORAL SYRUP 2 VIGAMOX 2 VIRTI-SULF 1 XIFAXAN ORAL TABLET 200 MG 2 XIFAXAN ORAL TABLET 550 MG 2 QL (2 EA per 1 day) ZERBAXA 2 ZINACEF 2 ZINACEF IN STERILE WATER 2 ZITHROMAX 2 ZITHROMAX TRI-PAK 2 ZITHROMAX Z-PAK 2 ZMAX 2
27 Drug Name Tier Notes ZOSYN 2 ZOSYN IN DEXTROSE (ISO-OSM) 2 ZYLET 2 ZYMAXID 2 ZYVOX INTRAVENOUS 2 ZYVOX ORAL SUSPENSION FOR RECONSTITUTION 2 ZYVOX ORAL TABLET 2 PA ANTICOAGULANTS ANGIOMAX 2 argatroban 2 argatroban in 0.9 % sod chlor 2 argatroban in nacl (iso-os) 2 ARIXTRA SUBCUTANEOUS SYRINGE 10 MG/0.8 ML 2 QL (8 ML per 30 days) ARIXTRA SUBCUTANEOUS SYRINGE 2.5 MG/0.5 ML 2 QL (5 ML per 30 days) ARIXTRA SUBCUTANEOUS SYRINGE 5 MG/0.4 ML 2 QL (4 ML per 30 days) ARIXTRA SUBCUTANEOUS SYRINGE 7.5 MG/0.6 ML 2 QL (6 ML per 30 days) bivalirudin 1 COUMADIN 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 1 QL (16 ML per 30 days) ml enoxaparin subcutaneous syringe 30 mg/0.3 ml 1 QL (6 ML per 30 days) enoxaparin 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 2 QL (10 ML per 30 days) ANTI-XA UNIT/ML FRAGMIN SUBCUTANEOUS SYRINGE 12,500 2 QL (5 ML per 30 days) ANTI-XA UNIT/0.5 ML FRAGMIN SUBCUTANEOUS SYRINGE 15,000 2 QL (6 ML per 30 days) ANTI-XA UNIT/0.6 ML FRAGMIN SUBCUTANEOUS SYRINGE 18,000 2 QL (7.2 ML per 30 days) ANTI-XA UNIT/0.72 ML FRAGMIN SUBCUTANEOUS SYRINGE 2,500 2 QL (2 ML per 30 days) ANTI-XA UNIT/0.2 ML, 5,000 ANTI-XA UNIT/0.2 ML FRAGMIN SUBCUTANEOUS SYRINGE 7,500 2 QL (3 ML per 30 days) ANTI-XA UNIT/0.3 ML HEP FLUSH-10 (PF) 1 heparin (porcine) in 5 % dex 1
28 Drug Name Tier Notes heparin (porcine) in nacl (pf) intravenous parenteral 1 solution 1,000 unit/500 ml, 2,000 unit/1,000 ml heparin (porcine) injection cartridge 1 heparin (porcine) injection solution 1 heparin(porcine) in 0.45% nacl intravenous parenteral 2 solution 12,500 unit/250 ml, 25,000 unit/500 ml heparin, porcine (pf) injection 1 heparin, porcine (pf) intravenous solution 1 INNOHEP 2 IPRIVASK 2 PA; QL (6 EA per 30 days) JANTOVEN 1 LOVENOX SUBCUTANEOUS SOLUTION 2 QL (30 ML per 30 days) LOVENOX SUBCUTANEOUS SYRINGE 100 MG/ML, 2 QL (20 ML per 30 days) 150 MG/ML LOVENOX SUBCUTANEOUS SYRINGE 120 MG/0.8 2 QL (16 ML per 30 days) ML, 80 MG/0.8 ML LOVENOX SUBCUTANEOUS SYRINGE 30 MG/0.3 ML 2 QL (6 ML per 30 days) LOVENOX SUBCUTANEOUS SYRINGE 40 MG/0.4 ML 2 QL (8 ML per 30 days) LOVENOX SUBCUTANEOUS SYRINGE 60 MG/0.6 ML 2 QL (12 ML per 30 days) PRADAXA ORAL CAPSULE 75 MG 2 ST; QL (2 EA per 1 day) SAVAYSA ORAL TABLET 15 MG 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) ANTIDOTES EVZIO 2 QL (0.8 ML per 365 days) MOVANTIK 2 QL (1 EA per 1 day) naloxone 1 naltrexone oral 1 RELISTOR 2 PA ANTIFUNGALS 3 DAY VAGINAL 1 3-DAY VAGINAL 1 ABELCET 2 ALEVAZOL 2 ALOE VESTA ANTIFUNGAL (MICON) 1 AMBISOME 2 AMPHOTEC 2 amphotericin b 1 ANCOBON 2 ANTIFUNGAL (CLOTRIMAZOLE) 1 ANTIFUNGAL (TOLNAFTATE) TOPICAL CREAM 1 ANTIFUNGAL (TOLNAFTATE) TOPICAL POWDER 1 ANTIFUNGAL CREAM 1
29 Drug Name Tier Notes ANTIFUNGAL SPRAY 1 ANTIFUNGAL TOPICAL SOLUTION 1 ATHLETE'S FOOT (CLOTRIMAZOLE) 1 ATHLETE'S FOOT (TERBINAFINE) 1 ATHLETE'S FOOT (TOLNAFTATE) TOPICAL 1 AEROSOL,SPRAY ATHLETE'S FOOT AF 1 BAZA ANTIFUNGAL 1 BENSAL HP TOPICAL OINTMENT 3-6 % 2 CANCIDAS 2 CICLODAN 2 CICLODAN KIT 2 ciclopirox 1 ciclopirox-ure-camph-menth-euc 1 ciclopirox-vite-nail lacq remo 1 CLOTRIMAZOLE 3 DAY 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 DIFLUCAN 2 econazole topical 1 ERAXIS(WATER DILUENT) 2 ERTACZO 2 EXELDERM 2 EXTINA 2 fluconazole 1 fluconazole in dextrose(iso-o) 1 fluconazole in nacl (iso-osm) intravenous piggyback 200 1 mg/100 ml, 400 mg/200 ml flucytosine 1 FUNGOID TINCTURE 2 FUNGOID-D 1 griseofulvin microsize 1 griseofulvin ultramicrosize 1 GRIS-PEG (ULTRAMICROSIZE) 2 GYNAZOLE-1 2 INZO ANTIFUNGAL 1
30 Drug Name Tier Notes itraconazole 1 JOCK ITCH 1 JUBLIA 2 PA KERYDIN 2 PA ketoconazole 1 KETODAN 1 KETODAN KIT 2 LAMISIL (AEROSOL) 2 LAMISIL AF TOPICAL AEROSOL POWDER 1 LAMISIL AT 2 LAMISIL ORAL 2 LOPROX TOPICAL SHAMPOO 2 LOTRISONE TOPICAL CREAM 2 LUZU 2 ST; QL (60 GM per 28 days) MENTAX 2 MICONAZOLE 7 1 miconazole nitrate topical 1 miconazole nitrate vaginal 1 MICONAZOLE-3 1 MICONAZORB AF 1 MICRO-GUARD 1 MYCAMINE 2 naftifine 1 NAFTIN 2 NATACYN 2 NIZORAL TOPICAL SHAMPOO 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 OXISTAT 2 PEDIADERM AF 2 PENLAC 2 REMEDY ANTIFUNGAL 1 REMEDY PHYTOPLEX ANTIFUNGAL 1 SECURA ANTIFUNGAL 1 SECURA ANTIFUNGAL EXTRA THICK 1 SPORANOX 2 SPORANOX PULSEPAK 2
31 Drug Name Tier Notes TERAZOL 3 2 TERAZOL 7 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 VFEND 2 VFEND IV 2 voriconazole 1 VUSION 2 ZEASORB (MICONAZOLE) 1 ANTIHISTAMINE AND DECONGESTANT COMBINATION ALA-HIST PE 2 ALL DAY ALLERGY-D 1 ALLEGRA-D 12 HOUR 2 ALLEGRA-D 24 HOUR 2 ALLERCLEAR D-12HR 1 ALLERCLEAR D-24HR 1 ALLERFED COLD & ALLERGY 1 ALLERGY & CONGESTION RELIEF 1 ALLERGY COMPLETE-D 1 ALLERGY D-12 1 ALLERGY RELIEF & NASAL DECONGE 1 ALLERGY RELIEF D-24 1 APRODINE 1 BROHIST D 1 BROTAPP 1 BROVEX PEB 2 BROVEX PSB ORAL LIQUID 4-20 MG/5 ML 2 cetirizine-pseudoephedrine 1 CHILD DELSYM NIGHTTIME C-C 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 & ALLERGY ORAL SOLUTION 1 COLD & ALLERGY ORAL TABLET 4-10 MG 1 COLD & ALLERGY PE 1
32 Drug Name Tier Notes CONEX ORAL SOLUTION 2 CONEX ORAL TABLET 1 DALLERGY (CHLORCYCLIZINE-PE) ORAL LIQUID 2 DALLERGY (CHLORCYCLIZINE-PE) ORAL 2 TABLET,CHEWABLE DALLERGY (CHLORPHENIRAMINE-PE) ORAL 1 DROPS 1-2.5 MG/ML DALLERGY (DEXBROMPHENIRAMN-PE) 2 DELSYM NIGHT TIME COUGH & COLD 1 DIMAPHEN (PE) 1 ED A-HIST 1 ED A-HIST PSE 1 ED CHLORPED D 2 fexofenadine-pseudoephedrine 1 HISTEX PE 1 J-TAN D PD 1 LODRANE D 2 LOHIST - D 1 LOHIST-PEB 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 1 Q-TAPP 1 RESCON 2 RU-HIST D 1 RU-HIST-D (WITH PYRILAMINE) ORAL LIQUID 2 RU-HIST-D (WITH PYRILAMINE) ORAL TABLET 1 RYMED (DEXCHLORPHENIRAMINE-PE) 2 RYNEX PE 1 RYNEX PSE 1 SEMPREX-D 2 SINUS & ALLERGY PE 1 SINUS & ALLERGY(PHENYLEPHRINE) 1 STAHIST AD 2 SUDOGEST COLD & ALLERGY 1 SUDOGEST SINUS & ALLERGY 1 TRIAMINIC COLD & COUGH NT (PE) 2 TRIAMINIC COLD- ALLERGY PE 2
33 Drug Name Tier Notes ANTIHISTAMINES AHIST (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 1 TABLET,CHEWABLE 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 ALLERGY 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 1 180 MG ALLERGY RELIEF (LORATADINE) 1 ALLERGY RELIEF(CHLORPHENIRAMN) 1 ALLERGY RELIEF(DIPHENHYDRAMIN) ORAL 1 LIQUID ALLERGY RELIEF(DIPHENHYDRAMIN) ORAL 1 TABLET ALLERGY-TIME 1 ALLERHIST-1 1 ARBINOXA 1 azelastine ophthalmic 1 BANOPHEN 1 BANOPHEN ALLERGY 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 1 SOLUTION CHILDREN'S ALAWAY 1 CHILDREN'S ALLERGY (DIPHENHYD) ORAL LIQUID 1 CHILDREN'S ALLERGY COMPLETE 1 CHILDREN'S ALLERGY MEDICINE 1
34 Drug Name Tier Notes CHILDREN'S CETIRIZINE 1 CHILD'S ALL DAY ALLERGY(CETIR) 1 chlorpheniramine maleate oral tablet 1 chlorpheniramine maleate oral tablet extended release 1 CLARINEX ORAL SYRUP 2 ST; QL (10 ML per 1 day) CLARINEX ORAL TABLET 2 QL (1 EA per 1 day) clemastine oral 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) dexchlorpheniramine maleate 1 DIPHEDRYL 1 DIPHENHIST 1 diphenhydramine hcl injection solution 50 mg/ml 1 diphenhydramine hcl injection syringe 1 diphenhydramine hcl oral capsule 1 ED CHLORPED JR 1 ED-CHLORPED 1 ED-CHLORTAN 1 ELESTAT 2 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 hydroxyzine hcl oral tablet 1 hydroxyzine pamoate oral capsule 100 mg 1 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 MUCINEX ALLERGY 1
35 Drug Name Tier Notes NON-DROWSY ALLERGY 1 OPTIVAR 2 PATADAY 2 PATANOL 2 PAZEO 2 ST; QL (2.5 ML per 30 days) PEDIAVENT 2 PHARBEDRYL 1 PHENERGAN INJECTION 2 promethazine injection 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 VISTARIL 2 WAL-ITIN ORAL TABLET,DISINTEGRATING 1 XYZAL ORAL TABLET 2 ZADITOR 2 ANTIHYPERGLYCEMICS acarbose 1 ACTOPLUS MET XR 2 ST ACTOS 2 AFREZZA INHALATION CARTRIDGE, 2 PA; QL (180 EA per 28 days) W/INHALATION DEVICE 4 UNIT AFREZZA INHALATION CARTRIDGE, W/INHALATION DEVICE 4 UNIT (30)/ 8 UNIT (60), 4 2 PA; QL (450 EA per 28 days) UNIT (60)/ 8 UNIT (30) AFREZZA INHALATION CARTRIDGE, 2 PA; QL (360 EA per 28 days) W/INHALATION DEVICE 8 UNIT (60)/ 12 UNIT (30) AMARYL 2 APIDRA 2 ST; QL (40 ML per 28 days) APIDRA SOLOSTAR 2 ST; QL (30 ML per 28 days) AVANDAMET 2 ST AVANDARYL 2 ST AVANDIA 2 ST BYDUREON 2 ST; QL (1 EA per 7 days) BYETTA SUBCUTANEOUS PEN INJECTOR 10 2 ST; QL (2.4 ML per 30 days) MCG/DOSE(250 MCG/ML) 2.4 ML chlorpropamide 1 CYCLOSET 2 ST DIABETA 2
36 Drug Name Tier Notes DUETACT 2 ST FARXIGA ORAL TABLET 10 MG 2 ST; QL (1 EA per 1 day) FORTAMET 2 ST glimepiride 1 glipizide 1 glipizide-metformin 1 GLUCOPHAGE 2 GLUCOPHAGE XR 2 GLUCOTROL 2 GLUCOTROL XL 2 GLUCOVANCE 2 GLUMETZA 2 ST glyburide 1 glyburide micronized 1 glyburide-metformin 1 GLYNASE 2 GLYSET 2 GLYXAMBI 2 ST; QL (1 EA per 1 day) HUMALOG KWIKPEN SUBCUTANEOUS INSULIN 2 QL (30 ML per 28 days) PEN 100 UNIT/ML HUMALOG KWIKPEN SUBCUTANEOUS INSULIN 2 QL (12 ML per 28 days) 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 70/30 PEN 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 N PEN 2 QL (30 ML per 28 days) HUMULIN R 2 QL (40 ML per 28 days) HUMULIN R U-500 (CONCENTRATED) 2 QL (40 ML per 28 days) INVOKAMET 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 2 QL (1 EA per 1 day) HR 100-1,000 MG JANUMET XR ORAL TABLET, ER MULTIPHASE 24 2 QL (2 EA per 1 day) HR 50-1,000 MG, 50-500 MG JANUVIA 2 QL (1 EA per 1 day) JENTADUETO 2 QL (2 EA per 1 day)
37 Drug Name Tier Notes KAZANO 2 ST; QL (2 EA per 1 day) KOMBIGLYZE XR ORAL TABLET, ER MULTIPHASE 2 ST; QL (2 EA per 1 day) 24 HR 2.5-1,000 MG KOMBIGLYZE XR ORAL TABLET, ER MULTIPHASE 2 ST; QL (1 EA per 1 day) 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 FLEXPEN 2 QL (30 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 nateglinide 1 NESINA 2 ST; QL (1 EA per 1 day) NOVOLIN 70/30 2 QL (40 ML per 28 days) NOVOLIN N 2 QL (40 ML per 28 days) NOVOLIN R 2 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 PRANDIMET 2 PRANDIN 2 PRECOSE 2 repaglinide 1 RIOMET 2 STARLIX 2 SYMLINPEN 120 2 SYMLINPEN 60 2 SYNJARDY 2 TANZEUM 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) 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)
38 Drug Name Tier Notes XIGDUO XR ORAL TABLET, IR & ER, BIPHASIC 2 ST; QL (2 EA per 1 day) 24HR 10-1,000 MG, 10-500 MG, 5-500 MG ANTIINFECTIVES/MISCELLANEOUS ALBENZA 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 FEM PH 2 formaldehyde 1 GLYCINE UROLOGIC 2 hydroxychloroquine oral 1 isopropyl alcohol topical spray,non-aerosol 2 isopropyl alcohol-benzocaine 1 ivermectin oral 1 MALARONE 2 MALARONE PEDIATRIC 2 mefloquine 1 MEPRON 2 NEBUPENT 2 paromomycin 1 PENTAM 2 PLAQUENIL 2 primaquine 2 QUALAQUIN 2 quinine sulfate 1 STROMECTOL 2 sulfur 2 SUMMER'S EVE DOUCHE 2 TINDAMAX 2 tinidazole 1 ANTIINFECTIVES AVC VAGINAL 2 ANTINEOPLASTICS ABRAXANE 2 ACTIMMUNE 2 ADCETRIS 2 ADRUCIL 1 AFINITOR DISPERZ 2 PA
39 Drug Name Tier Notes 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 ALIMTA 2 ALKERAN 2 anastrozole 1 ARIMIDEX 2 AROMASIN 2 PA ARRANON 2 ARZERRA 2 AVASTIN 2 azacitidine 1 BELEODAQ 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 CAMPTOSAR 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) CARAC 2 carboplatin intravenous solution 1 CASODEX 2 CEENU ORAL CAPSULE 10 MG, 40 MG 2 cisplatin 1 cladribine 1 CLOLAR 2 COMETRIQ 2 PA; QL (4 EA per 1 day) COSMEGEN 2 cyclophosphamide intravenous 1 cyclophosphamide oral capsule 2 cyclophosphamide oral tablet 1 CYRAMZA 2 cytarabine 1 cytarabine (pf) injection solution 1 dacarbazine 1 DACOGEN 2 daunorubicin intravenous solution 1 DAUNOXOME 2
40 Drug Name Tier Notes decitabine 1 DEPOCYT (PF) 2 diclofenac sodium topical gel 1 PA; QL (100 GM per 1 FILL) DOCEFREZ INTRAVENOUS RECON SOLN 20 MG 2 docetaxel intravenous solution 10 mg/ml 2 docetaxel intravenous solution 140 mg/7 ml (20 mg/ml), 160 mg/16 ml (10 mg/ml), 160 mg/8 ml (20 mg/ml), 20 mg/2 ml (10 mg/ml), 20 mg/2 ml (final), 20 mg/ml (1 ml), 1 80 mg/4 ml (20 mg/ml), 80 mg/8 ml (10 mg/ml), 80 mg/8 ml (final) DOXIL 2 doxorubicin 1 doxorubicin, peg-liposomal 1 EFUDEX TOPICAL CREAM 2 ELIGARD 2 PA ELLENCE 2 ELOXATIN INTRAVENOUS SOLUTION 100 MG/20 2 ML, 50 MG/10 ML (5 MG/ML) EMCYT 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 FEMARA 2 FIRMAGON KIT W DILUENT SYRINGE 2 QL (2 EA per 365 days) SUBCUTANEOUS RECON SOLN 120 MG FIRMAGON KIT W DILUENT SYRINGE 2 QL (1 EA per 30 days) SUBCUTANEOUS RECON SOLN 80 MG floxuridine 1 fludarabine 1 fluorouracil 1 flutamide 1 FOLOTYN 2 GAZYVA 2 gemcitabine 1 GEMZAR 2 GILOTRIF 2 PA GLEEVEC 2 PA; QL (2 EA per 1 day) GLEOSTINE ORAL CAPSULE 10 MG, 100 MG, 40 MG 2 GLIADEL WAFER 2
41 Drug Name Tier Notes HALAVEN 2 HERCEPTIN 2 HEXALEN 2 HYCAMTIN 2 HYDREA 2 hydroxyurea 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) IDAMYCIN PFS 2 idarubicin 1 IFEX 2 ifosfamide 1 IMBRUVICA 2 PA 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 irinotecan 1 ISTODAX 2 IXEMPRA 2 JAKAFI 2 PA; QL (2 EA per 1 day) JEVTANA 2 KADCYLA 2 KEYTRUDA 2 KYPROLIS 2 LENVIMA 2 PA letrozole 1 LEUKERAN 2 leuprolide subcutaneous kit 1 LIPODOX 1 LIPODOX 50 1 lomustine 1 LUPRON DEPOT (3 MONTH) INTRAMUSCULAR 2 SYRINGE KIT 22.5 MG LUPRON DEPOT (4 MONTH) 2 LUPRON DEPOT (6 MONTH) 2 LUPRON DEPOT INTRAMUSCULAR SYRINGE KIT 2 7.5 MG LYNPARZA 2 PA; QL (16 EA per 1 day) LYSODREN 2 MARQIBO 2 MATULANE 2 megestrol oral tablet 1 MEKINIST 2 PA
42 Drug Name Tier Notes melphalan hcl 1 mercaptopurine 1 methotrexate sodium 1 methotrexate sodium (pf) 1 mitomycin 1 mitoxantrone 1 MUSTARGEN 2 MYLERAN 2 NAVELBINE 2 NEXAVAR 2 PA; QL (4 EA per 1 day) NILANDRON 2 NIPENT 2 ODOMZO 2 ONCASPAR 2 ONTAK 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 PROLEUKIN 2 PURIXAN 2 ST REVLIMID 2 PA; QL (1 EA per 1 day) RITUXAN 2 SOLARAZE 2 PA; QL (100 GM per 1 FILL) SOLTAMOX 2 SPRYCEL ORAL TABLET 100 MG, 140 MG, 50 MG, 70 2 PA; QL (1 EA per 1 day) 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 QL (1 EA per 28 days) SYLATRON 4-PACK SUBCUTANEOUS KIT 200 MCG, 2 QL (1 EA per 28 days) 300 MCG SYLVANT 2 SYNRIBO 2 PA TABLOID 2 TAFINLAR 2 PA tamoxifen 1 TARGRETIN 2 PA TASIGNA 2 PA; QL (4 EA per 1 day)
43 Drug Name Tier Notes TAXOTERE INTRAVENOUS SOLUTION 20 MG/ML (1 2 ML), 80 MG/4 ML (20 MG/ML) TEMODAR INTRAVENOUS 2 TEMODAR ORAL 2 PA temozolomide 1 PA teniposide 1 thiotepa 1 TOLAK 2 TOPOSAR 1 topotecan 1 TORISEL 2 TREANDA 2 TRELSTAR 2 TRELSTAR DEPOT 2 TRELSTAR LA 2 tretinoin (chemotherapy) 1 TREXALL 2 TRISENOX 2 TYKERB 2 PA UNITUXIN 2 VALCHLOR 2 PA VALSTAR 2 vandetanib oral tablet 100 mg 2 PA; QL (2 EA per 1 day) vandetanib oral tablet 300 mg 2 PA; QL (1 EA per 1 day) VANTAS 2 VECTIBIX 2 VELCADE 2 VIDAZA 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) XELODA ORAL TABLET 150 MG 2 PA; QL (28 EA per 21 days) XELODA ORAL TABLET 500 MG 2 PA; QL (112 EA per 21 days) XTANDI 2 PA; QL (4 EA per 1 day) YERVOY 2 ZALTRAP 2 ZANOSAR 2 ZELBORAF 2 PA; QL (8 EA per 1 day) ZEVALIN (Y-90) 2 ZOLADEX 2 ZOLINZA 2
44 Drug Name Tier Notes ZYDELIG 2 PA ZYKADIA 2 PA ZYTIGA 2 PA; QL (4 EA per 1 day) ANTIPARKINSON DRUGS amantadine 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 carbidopa-levodopa-entacapone 1 COMTAN 2 DUOPA 2 PA ELDEPRYL 2 entacapone 1 LODOSYN 2 MIRAPEX 2 MIRAPEX ER ORAL TABLET EXTENDED RELEASE 24 HR 0.375 MG, 1.5 MG, 2.25 MG, 3 MG, 3.75 MG, 4.5 2 ST; QL (1 EA per 1 day) MG NEUPRO 2 ST; QL (1 EA per 1 day) PARCOPA 2 pramipexole oral tablet 1 pramipexole oral tablet extended release 24 hr 0.375 mg, 1 ST; QL (1 EA per 1 day) 0.75 mg, 1.5 mg, 4.5 mg REQUIP 2 REQUIP XL ORAL TABLET EXTENDED RELEASE 24 2 ST; QL (1 EA per 1 day) HR 12 MG, 4 MG, 6 MG, 8 MG ropinirole oral tablet 1 RYTARY 2 ST; QL (10 EA per 1 day) selegiline hcl 1 SINEMET 2 SINEMET CR 2 STALEVO 100 2 STALEVO 125 2 STALEVO 150 2 STALEVO 200 2 STALEVO 50 2 STALEVO 75 2 TASMAR ORAL TABLET 100 MG 2 ST; QL (3 EA per 1 day) tolcapone 1 ST; QL (3 EA per 1 day) trihexyphenidyl 1 ZELAPAR 2 QL (2 EA per 1 day)
45 Drug Name Tier Notes ANTIPLATELET DRUGS AGGRASTAT IN SODIUM CHLORIDE 2 AGGRENOX 2 AGRYLIN 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 EFFIENT 2 QL (1 EA per 1 day) INTEGRILIN 2 KENGREAL 2 PERSANTINE 2 PLAVIX ORAL TABLET 300 MG 2 QL (4 EA per 30 days) PLAVIX ORAL TABLET 75 MG 2 PLETAL 2 REOPRO 2 ticlopidine 1 ZONTIVITY 2 QL (1 EA per 1 day) ANTIVIRALS abacavir 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 adefovir 1 APTIVUS 2 ATRIPLA 2 QL (30 EA per 30 days) BARACLUDE 2 cidofovir 1 COMBIVIR 2 QL (60 EA per 30 days) COMPLERA 2 COPEGUS 2 CRIXIVAN ORAL CAPSULE 200 MG, 400 MG 2 CYTOVENE 2 DAKLINZA 2 PA DENAVIR 2
46 Drug Name Tier Notes didanosine oral capsule,delayed release(dr/ec) 125 mg, 200 1 QL (60 EA per 30 days) mg didanosine oral capsule,delayed release(dr/ec) 250 mg, 400 1 mg 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 2 EPIVIR ORAL SOLUTION 2 QL (900 ML per 30 days) EPIVIR ORAL TABLET 150 MG 2 QL (60 EA per 30 days) EPIVIR ORAL TABLET 300 MG 2 QL (30 EA per 30 days) EPZICOM 2 QL (30 EA per 30 days) EVOTAZ 2 QL (1 EA per 1 day) famciclovir 1 FAMVIR 2 FLUMADINE ORAL TABLET 2 foscarnet 1 FUZEON SUBCUTANEOUS RECON SOLN 2 QL (60 EA per 30 days) ganciclovir sodium 1 HARVONI 2 PA HEPSERA 2 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 MODERIBA 2 MODERIBA DOSE PACK 2 ST 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 400 mg 1 NORVIR ORAL CAPSULE 2 QL (360 EA per 30 days) NORVIR ORAL SOLUTION 2 QL (450 ML per 30 days) NORVIR ORAL TABLET 2 QL (360 EA per 30 days) OLYSIO 2 PA
47 Drug Name Tier Notes 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) PREZISTA ORAL TABLET 600 MG 2 QL (60 EA per 30 days) PREZISTA ORAL TABLET 75 MG 2 QL (480 EA per 30 days) PREZISTA ORAL TABLET 800 MG 2 QL (30 EA per 30 days) RAPIVAB 2 REBETOL 2 RELENZA DISKHALER 2 QL (40 EA per 183 days) RESCRIPTOR 2 RETROVIR INTRAVENOUS 2 RETROVIR ORAL CAPSULE 2 QL (180 EA per 30 days) RETROVIR ORAL SYRUP 2 QL (1800 ML per 30 days) 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 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 2 QL (360 ML per 183 days) RECONSTITUTION TECHNIVIE 2 PA TIVICAY 2 trifluridine 1 TRIUMEQ 2 QL (1 EA per 1 day) TRIZIVIR 2 TRUVADA 2 QL (30 EA per 30 days)
48 Drug Name Tier Notes TYZEKA 2 valacyclovir 1 VALCYTE 2 valganciclovir 1 VALTREX 2 VEREGEN 2 VICTRELIS 2 PA VIDEX 2 GRAM PEDIATRIC 2 QL (1200 ML per 30 days) VIDEX 4 GRAM PEDIATRIC 2 QL (1200 ML per 30 days) VIDEX EC ORAL CAPSULE,DELAYED 2 QL (60 EA per 30 days) RELEASE(DR/EC) 125 MG, 200 MG VIDEX EC ORAL CAPSULE,DELAYED 2 RELEASE(DR/EC) 250 MG, 400 MG VIEKIRA PAK 2 PA VIRACEPT 2 VIRAMUNE ORAL SUSPENSION 2 QL (1200 ML per 30 days) VIRAMUNE ORAL TABLET 2 QL (60 EA per 30 days) VIRAMUNE XR 2 VIRAZOLE 2 VIREAD ORAL POWDER 2 QL (225 GM per 30 days) VIREAD ORAL TABLET 2 QL (30 EA per 30 days) VIROPTIC 2 VISTIDE 2 VITEKTA 2 QL (1 EA per 1 day) XERESE 2 ST; QL (10 GM per 365 days) ZERIT ORAL CAPSULE 2 QL (60 EA per 30 days) ZERIT ORAL RECON SOLN 2 QL (2400 ML per 30 days) ZIAGEN ORAL SOLUTION 2 QL (900 ML per 30 days) ZIAGEN ORAL TABLET 2 QL (60 EA 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 2 AUTONOMIC DRUGS ADDERALL 2 QL (3 EA per 1 day) ADDERALL XR ORAL CAPSULE,EXTENDED 2 QL (1 EA per 1 day) RELEASE 24HR 10 MG, 15 MG, 5 MG ADDERALL XR ORAL CAPSULE,EXTENDED 2 QL (2 EA per 1 day) RELEASE 24HR 20 MG, 25 MG, 30 MG ADRENACLICK 2 ADRENALIN INJECTION 2 AMPHETAMINE SALT COMBO 1 QL (3 EA per 1 day) ANECTINE 2 ARICEPT 2
49 Drug Name Tier Notes ARICEPT ODT 2 atracurium 1 AUVI-Q 2 ST bethanechol chloride 1 BOTOX 2 cevimeline 1 cisatracurium 1 DESOXYN 2 DEXEDRINE ORAL TABLET 10 MG 2 QL (180 EA per 30 days) DEXEDRINE ORAL TABLET 5 MG 2 QL (90 EA per 30 days) DEXEDRINE SPANSULE ORAL CAPSULE, 2 QL (60 EA per 30 days) EXTENDED RELEASE 10 MG DEXEDRINE SPANSULE ORAL CAPSULE, 2 QL (120 EA per 30 days) EXTENDED RELEASE 15 MG DEXEDRINE SPANSULE ORAL CAPSULE, 2 EXTENDED RELEASE 5 MG dexpanthenol 1 dextroamphetamine oral capsule, extended release 10 mg 1 QL (60 EA per 30 days) dextroamphetamine oral capsule, extended release 15 mg 1 QL (120 EA per 30 days) dextroamphetamine oral capsule, extended release 5 mg 1 dextroamphetamine oral solution 1 QL (1800 ML per 30 days) dextroamphetamine oral tablet 10 mg 1 QL (180 EA per 30 days) dextroamphetamine oral tablet 5 mg 1 QL (90 EA per 30 days) dextroamphetamine-amphetamine oral capsule,extended 1 QL (1 EA per 1 day) release 24hr 10 mg, 15 mg, 5 mg dextroamphetamine-amphetamine oral capsule,extended 1 QL (2 EA per 1 day) release 24hr 20 mg, 25 mg, 30 mg donepezil 1 dopamine in 5 % dextrose 1 dopamine intravenous solution 1 DYSPORT 2 ENLON 1 epinephrine hcl (pf) 1 epinephrine injection auto-injector 1 epinephrine injection solution 1 epinephrine injection syringe 0.1 mg/ml (1:10,000) 1 EPIPEN 2 EPIPEN 2-PAK 2 EPIPEN JR 2 EPIPEN JR 2-PAK 2 EPISNAP 2 EVEKEO 2 PA EVOXAC 2 EXELON ORAL CAPSULE 2 EXELON TRANSDERMAL 2 QL (30 EA per 30 days)
50 Drug Name Tier Notes galantamine oral capsule,ext rel. pellets 24 hr 1 QL (30 EA per 30 days) galantamine oral solution 1 QL (200 ML per 30 days) galantamine oral tablet 1 QL (60 EA per 30 days) guanidine 1 ISUPREL 2 LEVOPHED (BITARTRATE) 2 MESTINON ORAL 2 MESTINON TIMESPAN 2 methamphetamine 1 midodrine 1 MYOBLOC 2 neostigmine methylsulfate injection 1 neostigmine methylsulfate intravenous solution 2 NIMBEX 2 norepinephrine bitartrate 1 NORTHERA 2 PA pancuronium 1 phenoxybenzamine 1 physostigmine salicylate 1 pilocarpine hcl oral 1 PROCENTRA 2 QL (1800 ML per 30 days) pyridostigmine bromide 1 QUELICIN INJECTION SOLUTION 20 MG/ML 2 RAZADYNE ER 2 QL (30 EA per 30 days) RAZADYNE ORAL SOLUTION 2 QL (200 ML per 30 days) RAZADYNE ORAL TABLET 2 QL (60 EA per 30 days) REGONOL 2 rivastigmine 1 QL (30 EA per 30 days) rivastigmine tartrate 1 rocuronium 1 SALAGEN 2 URECHOLINE 2 vecuronium bromide 1 XEOMIN 2 ZEMURON 2 ZENZEDI ORAL TABLET 10 MG 1 QL (180 EA per 30 days) ZENZEDI ORAL TABLET 15 MG 2 QL (3 EA per 1 day) ZENZEDI ORAL TABLET 2.5 MG, 7.5 MG 2 QL (90 EA per 30 days) ZENZEDI ORAL TABLET 20 MG, 30 MG 2 QL (2 EA per 1 day) ZENZEDI ORAL TABLET 5 MG 1 QL (90 EA per 30 days) BIOLOGICALS ACTHIB (PF) 2 ADACEL(TDAP ADOLESN/ADULT)(PF) 3 QL (0.5 ML per 365 days) adenovirus vac live type-4, 7 2
51 Drug Name Tier Notes adenovirus vaccine live type-4 2 adenovirus vaccine live type-7 2 AFLURIA 2012-2013 2 AFLURIA 2012-2013 (PF) 2 AFLURIA 2013-2014 2 AFLURIA 2013-2014 (PF) 2 AFLURIA 2014-2015 3 QL (0.5 ML per 180 days) AFLURIA 2014-2015 (PF) 3 QL (0.5 ML per 180 days) AFLURIA 2015-2016 3 QL (0.5 ML per 180 days) AFLURIA 2015-2016 (PF) 3 QL (0.5 ML per 180 days) all xt-weed pol-russian thistl 2 aller ext-tree poll,black waln 2 aller ext-tree poll,red cedar 2 aller ext-tree pollen-bayberry 2 aller ext-tree pollen-mesquite 2 aller xt-tree poll,shagbk hick 2 aller xt-tree pollen-am.sycamo 2 aller xt-tree pollen-box elder 2 aller xt-tree pollen-red birch 2 aller xt-tree pollen-white ash 2 aller xt-weed pollen-sagebrush 2 allerg ext-tree pollen-pecan 2 allerg ext-weed pollen-mugwort 2 allerg ex-weed pol-rgh pigweed 2 allerg xt-sheep sor,yellw dock 2 allergen ext-candida albicans 2 allergen ext-english plantain 2 allergen ext-virginia live oak 2 allergen xt-grass pollen-bahia 2 allergenic ex-horse epithelium 2 allergen-weed-lambsquarters 2 ANASCORP 2 antivenin latrodectus mactans 2 antivenin micrurus fulvius 2 APLISOL 2 ATGAM 2 bcg vaccine, live (pf) 2 BEXSERO (PF) 2 BIOTHRAX 2 BIVIGAM 2 BOOSTRIX TDAP 3 QL (0.5 ML per 365 days) CARIMUNE NF NANOFILTERED 2 CERVARIX VACCINE (PF) 3 QL (1.5 ML per 365 days) COMVAX (PF) 2
52 Drug Name Tier Notes CYTOGAM INTRAVENOUS SOLUTION 50 MG/ML 2 DAPTACEL (DTAP PEDIATRIC) (PF) 2 ENGERIX-B (PF) 3 QL (3 ML per 365 days) ENGERIX-B PEDIATRIC (PF) 2 EZ FLU 2015-16(FLUCELVAX)(PF) 2 FLEBOGAMMA DIF 2 FLUARIX 2012-2013 (PF) 2 FLUARIX 2013-2014 (PF) 2 FLUARIX 2014-2015 (PF) 3 QL (0.5 ML per 180 days) FLUARIX QUAD 2013-2014 (PF) 2 FLUARIX QUAD 2014-2015 (PF) 3 QL (0.5 ML per 180 days) FLUARIX QUAD 2015-2016 (PF) 3 QL (0.5 ML per 180 days) FLUBLOK 2012-2013 (PF) 2 FLUBLOK 2013-2014 (PF) 2 FLUBLOK 2014-2015 (PF) 3 QL (0.5 ML per 180 days) FLUBLOK 2015-2016 (PF) 3 QL (0.5 ML per 180 days) FLUCELVAX (PF) 2 FLUCELVAX 2013-2014 (PF) 2 FLUCELVAX 2014-2015 (PF) 3 QL (0.5 ML per 180 days) FLUCELVAX 2015-2016 (PF) 3 QL (0.5 ML per 180 days) FLULAVAL 2012-2013 2 FLULAVAL 2013-2014 2 FLULAVAL 2014-2015 3 QL (0.5 ML per 180 days) FLULAVAL 2014-2015 (PF) 3 QL (0.5 ML per 180 days) FLULAVAL QUAD 2013-2014 2 FLULAVAL QUAD 2014-2015 3 QL (0.5 ML per 180 days) FLULAVAL QUAD 2014-2015 (PF) 3 QL (0.5 ML per 180 days) FLULAVAL QUAD 2015-2016 3 QL (0.5 ML per 180 days) FLUMIST 2012-2013 2 FLUMIST 2013-2014 2 FLUMIST QUAD 2014-2015 3 QL (1 EA per 180 days) FLUMIST QUAD 2015-2016 3 QL (1 EA per 180 days) FLUVIRIN 2012-2013 2 FLUVIRIN 2012-2013 (PF) 2 FLUVIRIN 2013-2014 2 FLUVIRIN 2013-2014 (PF) 2 FLUVIRIN 2014-2015 3 QL (0.5 ML per 180 days) FLUVIRIN 2014-2015 (PF) 3 QL (0.5 ML per 180 days) FLUVIRIN 2015-2016 3 QL (0.5 ML per 180 days) FLUVIRIN 2015-2016 (PF) 3 QL (0.5 ML per 180 days) FLUZONE 2012-2013 2 FLUZONE 2012-2013 (PF) 2 FLUZONE 2013-2014 2 FLUZONE 2013-2014 (PF) 2
53 Drug Name Tier Notes FLUZONE 2014-2015 3 QL (0.5 ML per 180 days) FLUZONE 2014-2015 (PF) 3 QL (0.5 ML per 180 days) FLUZONE 2015-2016 3 QL (0.5 ML per 180 days) FLUZONE HIGH-DOSE 2012-13 (PF) 2 FLUZONE HIGH-DOSE 2013-14 (PF) 2 FLUZONE HIGH-DOSE 2014-15 (PF) 3 QL (0.5 ML per 180 days) FLUZONE HIGH-DOSE 2015-16 (PF) 3 QL (0.5 ML per 180 days) FLUZONE INTRADERM 2012-13 (PF) 2 FLUZONE INTRADERM 2013-14 (PF) 2 FLUZONE INTRADERM 2014-15 (PF) 3 QL (0.1 ML per 180 days) FLUZONE INTRADERM QUAD 2015-16 3 QL (0.1 ML per 180 days) FLUZONE PEDI 2012 -2013 (PF) 2 FLUZONE PEDI 2013-2014 (PF) 2 FLUZONE QUAD 2013-2014 (PF) 2 FLUZONE QUAD 2014-2015 3 QL (0.5 ML per 180 days) FLUZONE QUAD 2014-2015 (PF) 3 QL (0.5 ML per 180 days) FLUZONE QUAD 2015-2016 3 QL (0.5 ML per 180 days) FLUZONE QUAD 2015-2016 (PF) 3 QL (0.5 ML per 180 days) FLUZONE QUAD PEDI 2013-14 (PF) 2 FLUZONE QUAD PEDI 2014-15 (PF) 2 FLUZONE QUAD PEDI 2015-16 (PF) 2 GAMASTAN S/D 2 GAMMAGARD S/D 2 GAMMAGARD S-D (IGA << 1 MCG/ML) 2 GAMMAKED 2 PA GAMMAPLEX 2 GAMUNEX 2 GAMUNEX-C INJECTION SOLUTION 1 GRAM/10 ML (10 %), 10 GRAM/100 ML (10 %), 2.5 GRAM/25 ML (10 2 PA %), 20 GRAM/200 ML (10 %), 5 GRAM/50 ML (10 %) GAMUNEX-C INJECTION SOLUTION 40 GRAM/400 2 ML (10 %) 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 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
54 Drug Name Tier Notes IMOVAX RABIES VACCINE (PF) 2 INFANRIX (DTAP) (PF) 2 IPOL 2 IXIARO (PF) 2 KINRIX (PF) 2 MENACTRA (PF) 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 ORALAIR 2 PA PEDIARIX (PF) 2 PEDVAX HIB (PF) 2 PENTACEL (PF) 2 PENTACEL ACTHIB COMPONENT (PF) 2 PENTACEL DTAP-IPV COMPNT (PF) 2 PHYSICIANS EZ USE FLU 2012-13 2 PNEUMOVAX 23 3 QL (0.5 ML per 365 days) PREVNAR 13 (PF) 3 QL (0.5 ML per 365 days) PRIVIGEN 2 PROQUAD (PF) 3 QL (2 EA per 365 days) QUADRACEL (PF) 2 RABAVERT (PF) 2 RAGWITEK 2 PA RECOMBIVAX HB (PF) INTRAMUSCULAR 3 QL (3 ML per 365 days) SUSPENSION 10 MCG/ML, 40 MCG/ML RECOMBIVAX HB (PF) INTRAMUSCULAR 2 SUSPENSION 5 MCG/0.5 ML RECOMBIVAX HB (PF) INTRAMUSCULAR SYRINGE 3 QL (3 ML per 365 days) 10 MCG/ML RECOMBIVAX HB (PF) INTRAMUSCULAR SYRINGE 2 5 MCG/0.5 ML RHOGAM ULTRA-FILTERED PLUS 2 RHOPHYLAC 2 ROTARIX 2 ROTATEQ VACCINE 2 SINGLE USE EZ FLU 2012-13 (PF) 2 SINGLE USE EZ FLU 2013-14 (PF) 2 SINGLE USE EZ FLU 2014-15(PF) 3 QL (0.5 EA per 180 days)
55 Drug Name Tier Notes TENIVAC (PF) 3 QL (0.5 ML per 365 days) tetanus toxoid,adsorbed (pf) 2 tetanus,diphtheria tox ped(pf) 2 tetanus-diphtheria toxoids-td 3 QL (0.5 ML per 365 days) THYMOGLOBULIN 2 TRIPEDIA (PF) 2 TRUMENBA 2 TUBERSOL 2 TWINRIX (PF) 2 TYPHIM VI 2 VAQTA (PF) 2 VARIVAX (PF) 3 QL (2 EA per 365 days) VARIZIG 2 VIVAGLOBIN 2 VIVOTIF BERNA VACCINE 2 WINRHO SDF 2 YF-VAX (PF) 2 ZOSTAVAX (PF) 3 QL (1 EA per 365 days) BLOOD ACTIVASE 2 ADVATE 2 ALBUKED-25 2 ALBUKED-5 2 albumin, human 25 % 2 albumin, human 5 % 2 ALBUMINAR 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 2 AMICAR 2 aminocaproic acid 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
56 Drug Name Tier Notes CORIFACT 2 CYKLOKAPRON 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 HESPAN 6 % IN NS 2 hetastarch 6 % in 0.9 % nacl 1 HEXTEND 2 HUMATE-P 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 LYSTEDA 2 MONOCLATE-P 2 MONONINE 2 NOVOEIGHT 2 NOVOSEVEN RT 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 2 RIASTAP 2 RIXUBIS 2 SOLIRIS 2 TACHOSIL 2
57 Drug Name Tier Notes THROMBATE III INTRAVENOUS RECON SOLN 500 2 (+/-) UNIT THROMBIN-JMI 1 TISSEEL VHSD 2 TNKASE 2 tranexamic acid 1 TRETTEN 2 ULTRAFOAM 2 VOLUVEN 6 % 2 WILATE INTRAVENOUS KIT 1,000-1,000 UNIT, 2 500-500 UNIT XYNTHA 2 XYNTHA SOLOFUSE 2 CARDIAC DRUGS ADALAT CC 2 ADENOCARD 2 adenosine 1 AFEDITAB CR 1 amiodarone 1 amiodarone in dextrose 5 % intravenous solution 150 1 mg/100 ml (1.5 mg/ml) amlodipine 1 CALAN 2 CALAN SR 2 CARDENE IV 2 CARDENE IV IN DEXTROSE 2 CARDENE IV IN SODIUM CHLORIDE 2 cardioplegic soln 1 CARDIZEM CD 2 CARDIZEM LA 2 CARDIZEM ORAL TABLET 120 MG, 30 MG, 60 MG 2 CARTIA XT 1 CLEVIPREX 2 CORDARONE 2 CORLANOR 2 CORVERT 2 COVERA-HS 2 DIGITEK 1 DIGOX 1 digoxin injection solution 1 digoxin oral solution 50 mcg/ml 2 digoxin oral tablet 1 DILACOR XR ORAL CAPSULE,EXT RELEASE 2 DEGRADABLE 240 MG DILATRATE-SR 2
58 Drug Name Tier Notes DILT-CD 1 DILTIA XT 1 diltiazem hcl intravenous 1 diltiazem hcl oral 1 diltiazem in dextrose 5 % intravenous solution 125 mg/125 1 ml (1 mg/ml) DILT-XR 1 DILTZAC ER 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 1 mg/250 ml (2,000 mcg/ml) felodipine 1 flecainide 1 ibutilide fumarate 1 IMDUR 2 ISORDIL 2 ISORDIL TITRADOSE ORAL TABLET 5 MG 2 isosorbide dinitrate 1 isosorbide mononitrate 1 isradipine 1 LANOXIN 2 LANOXIN PEDIATRIC 2 lidocaine (pf) intravenous 1 lidocaine in 5 % dextrose (pf) intravenous parenteral 1 solution 4 mg/ml (0.4 %), 8 mg/ml (0.8 %) MATZIM LA 1 mexiletine 1 milrinone 1 milrinone in 5 % dextrose 1 MINITRAN 1 MULTAQ 2 NEXTERONE 2 nicardipine 1 NIFEDICAL XL 1 nifedipine 1 nimodipine 1 nisoldipine 1 NITRO-BID 2 NITRO-DUR 2 nitroglycerin in 5 % dextrose 1 nitroglycerin intravenous 1 nitroglycerin oral 1 nitroglycerin transdermal patch 24 hour 1
59 Drug Name Tier Notes nitroglycerin translingual 1 NITROLINGUAL 2 NITROMIST 2 NITROSTAT 2 NITRO-TIME 1 NORPACE 2 NORPACE CR 2 NORVASC 2 NYMALIZE 2 PA PACERONE ORAL TABLET 100 MG, 200 MG, 400 MG 1 PLEGISOL 2 procainamide injection 1 PROCARDIA 2 PROCARDIA XL 2 propafenone 1 quinidine gluconate 1 quinidine sulfate oral tablet 1 RANEXA ORAL TABLET EXTENDED RELEASE 12 2 QL (60 EA per 30 days) HR 1,000 MG RANEXA ORAL TABLET EXTENDED RELEASE 12 2 QL (120 EA per 30 days) HR 500 MG RYTHMOL ORAL TABLET 150 MG, 225 MG 2 RYTHMOL SR 2 SULAR ORAL TABLET EXTENDED RELEASE 24 HR 2 17 MG, 34 MG, 8.5 MG TAZTIA XT 1 TIAZAC 2 TIKOSYN 2 verapamil 1 VERELAN 2 VERELAN PM 2 XYLOCAINE (CARDIAC) (PF) 1 CARDIOVASCULAR ACCUPRIL 2 ACCURETIC 2 acebutolol 1 ADCIRCA 2 PA ADEMPAS 2 PA ADVICOR ORAL TABLET, ER MULTIPHASE 24 HR 2 ST; QL (2 EA per 1 day) 1,000-20 MG, 750-20 MG ADVICOR ORAL TABLET, ER MULTIPHASE 24 HR 2 ST; QL (1 EA per 1 day) 1,000-40 MG, 500-20 MG alprostadil 1 ALTACE 2 ALTOPREV 2 ST; QL (1 EA per 1 day)
60 Drug Name Tier Notes amlodipine-atorvastatin 1 QL (1 EA per 1 day) amlodipine-benazepril 1 AMTURNIDE ORAL TABLET 300-10-12.5 MG, 2 PA 300-10-25 MG, 300-5-12.5 MG, 300-5-25 MG ANTARA 2 ASCLERA 2 ATACAND 2 ATACAND HCT 2 atenolol 1 atenolol-chlorthalidone 1 atorvastatin 1 AVALIDE 2 AVAPRO 2 AZOR ORAL TABLET 10-40 MG 2 ST benazepril 1 benazepril-hydrochlorothiazide 1 BENICAR ORAL TABLET 5 MG 2 ST BETAPACE AF 2 BETAPACE ORAL TABLET 120 MG, 160 MG, 80 MG 2 betaxolol oral 1 BIDIL 2 bisoprolol fumarate 1 bisoprolol-hydrochlorothiazide 1 BREVIBLOC IN NACL (ISO-OSM) 2 BREVIBLOC INTRAVENOUS SOLUTION 100 MG/10 2 ML (10 MG/ML) BYSTOLIC 2 CADUET 2 QL (1 EA per 1 day) candesartan 1 candesartan-hydrochlorothiazid 1 captopril 1 captopril-hydrochlorothiazide 1 CARDURA 2 CARDURA XL 2 carvedilol 1 CATAPRES 2 CATAPRES-TTS-1 2 CATAPRES-TTS-2 2 CATAPRES-TTS-3 2 cholestyramine (with sugar) 1 CHOLESTYRAMINE LIGHT 1 clonidine 1 clonidine hcl oral tablet 1 CLORPRES 1
61 Drug Name Tier Notes COLESTID 2 COLESTID FLAVORED 2 colestipol 1 COREG 2 COREG CR 2 CORGARD 2 CORLOPAM 2 CORZIDE 2 COZAAR 2 CRESTOR 2 QL (1 EA per 1 day) DEMSER 2 DIOVAN 2 DIOVAN HCT 2 doxazosin 1 DUTOPROL 2 enalapril maleate 1 enalaprilat intravenous solution 1 enalapril-hydrochlorothiazide 1 ENTRESTO 2 PA EPANED 2 ST; QL (1200 ML per 30 days) epoprostenol (glycine) 1 eprosartan 1 ST ergoloid 1 esmolol intravenous solution 1 EXFORGE 2 ST fenofibrate 1 fenofibrate micronized 1 fenofibrate nanocrystallized 1 fenofibric acid 1 fenofibric acid (choline) 1 FENOGLIDE 2 FIBRICOR 2 FLOLAN 2 fosinopril 1 fosinopril-hydrochlorothiazide 1 gemfibrozil oral 1 guanfacine oral tablet 1 HEMANGEOL 2 ST; QL (360 ML per 30 days) hydralazine 1 HYZAAR 2 INDERAL LA 2 INDERAL XL 2 ST indomethacin sodium 1 INNOPRAN XL 2 ST
62 Drug Name Tier Notes irbesartan 1 irbesartan-hydrochlorothiazide 1 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 LIPITOR 2 LIPOFEN 2 LIPTRUZET ORAL TABLET 10-20 MG, 10-40 MG, 2 ST; QL (30 EA per 30 days) 10-80 MG lisinopril 1 lisinopril-hydrochlorothiazide 1 LOFIBRA 2 LOPID 2 LOPRESSOR 2 LOPRESSOR HCT 2 losartan 1 losartan-hydrochlorothiazide 1 LOTENSIN HCT 2 LOTENSIN ORAL TABLET 20 MG, 40 MG 2 LOTREL 2 lovastatin 1 MAVIK 2 methyldopa 1 methyldopa-hydrochlorothiazide 1 methyldopate 1 metoprolol succinate 1 metoprolol ta-hydrochlorothiaz 1 metoprolol tartrate 1 MEVACOR 2 MICARDIS 2 MICARDIS HCT 2 MINIPRESS 2 minoxidil oral 1 moexipril 1 moexipril-hydrochlorothiazide 1 morrhuate sodium 1 nadolol 1 nadolol-bendroflumethiazide 1 NATRECOR 2
63 Drug Name Tier Notes NEOPROFEN (IBUPROFEN LYSN)(PF) 2 NIACOR 1 NIASPAN EXTENDED-RELEASE 2 ST NITROPRESS 2 OPSUMIT 2 PA ORENITRAM 2 PA papaverine injection solution 1 perindopril erbumine 1 phenylephrine hcl in 0.9% nacl intravenous solution 50 1 mg/250 ml (200 mcg/ml) phenylephrine hcl injection 1 pindolol 1 PRALUENT PEN 2 PA PRALUENT SYRINGE 2 PA PRAVACHOL 2 pravastatin 1 prazosin oral 1 PREVALITE 1 PRINIVIL ORAL TABLET 10 MG, 20 MG, 5 MG 2 propranolol 1 propranolol-hydrochlorothiazid 1 PROSTIN VR PEDIATRIC 2 QUESTRAN 2 QUESTRAN LIGHT 2 quinapril 1 quinapril-hydrochlorothiazide 1 ramipril 1 REMODULIN 2 PA REPATHA SURECLICK 2 PA reserpine 1 REVATIO INTRAVENOUS 2 REVATIO ORAL SUSPENSION FOR 2 ST; QL (224 ML per 30 days) RECONSTITUTION REVATIO ORAL TABLET 2 QL (3 EA per 1 day) SECTRAL 2 sildenafil intravenous 1 sildenafil oral 1 QL (3 EA per 1 day) SIMCOR ORAL TABLET, ER MULTIPHASE 24 HR 2 ST; QL (2 EA per 1 day) 1,000-20 MG, 750-20 MG SIMCOR ORAL TABLET, ER MULTIPHASE 24 HR 2 ST; QL (1 EA per 1 day) 1,000-40 MG, 500-20 MG, 500-40 MG simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg 1 simvastatin oral tablet 80 mg 1 ST SORINE 1 SOTALOL AF 1
64 Drug Name Tier Notes sotalol intravenous 2 sotalol oral 1 SOTRADECOL INTRAVENOUS SOLUTION 1 % (10 2 MG/ML) SOTRADECOL INTRAVENOUS SOLUTION 3 % (30 1 MG/ML) TARKA 2 TEKAMLO ORAL TABLET 150-10 MG, 150-5 MG, 2 PA 300-10 MG TEKTURNA 2 PA TEKTURNA HCT 2 PA telmisartan 1 telmisartan-amlodipine 1 telmisartan-hydrochlorothiazid 1 TENEX 2 TENORETIC 100 2 TENORETIC 50 2 TENORMIN 2 terazosin 1 TEVETEN 2 ST TEVETEN HCT 2 ST timolol maleate oral 1 TOPROL XL 2 TRACLEER 2 PA TRANDATE ORAL 2 trandolapril 1 trandolapril-verapamil 1 TRICOR 2 TRIGLIDE ORAL TABLET 160 MG 2 TRILIPIX 2 TWYNSTA 2 TYVASO 2 PA TYVASO INSTITUTIONAL START KIT 2 PA TYVASO REFILL KIT 2 PA TYVASO STARTER KIT 2 PA UNIVASC 2 valsartan 1 valsartan-hydrochlorothiazide 1 VASERETIC 2 VASOTEC 2 VECAMYL 2 PA VELETRI 2 VENTAVIS 2 PA VYTORIN 10-20 2 ST; QL (1 EA per 1 day) VYTORIN 10-40 2 ST; QL (1 EA per 1 day)
65 Drug Name Tier Notes VYTORIN 10-80 2 ST; QL (1 EA per 1 day) WELCHOL 2 ZEBETA 2 ZESTORETIC 2 ZESTRIL 2 ZETIA 2 QL (1 EA per 1 day) ZIAC 2 ZOCOR ORAL TABLET 10 MG, 20 MG, 40 MG, 5 MG 2 ZOCOR ORAL TABLET 80 MG 2 ST CNS DRUGS ALERTNESS AID 1 ammonia aromatic inhalation solution 1 AMPYRA 2 PA APTIOM ORAL TABLET 200 MG, 600 MG 2 ST; QL (2 EA per 1 day) APTIOM ORAL TABLET 400 MG 2 ST; QL (3 EA per 1 day) APTIOM ORAL TABLET 800 MG 2 ST; QL (1 EA per 1 day) AUBAGIO 2 PA AVONEX 2 PA AVONEX (WITH ALBUMIN) 2 PA BANZEL 2 ST BETASERON SUBCUTANEOUS KIT 2 PA CAFCIT 2 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 1 carbamazepine oral tablet,chewable 1 CARBATROL 2 CELONTIN ORAL CAPSULE 300 MG 2 CEREBYX 2 clonazepam 1 COPAXONE SUBCUTANEOUS SYRINGE 2 PA DEHYDRATED ALCOHOL 2 DEPACON 2 DEPAKENE 2 DEPAKOTE 2 DEPAKOTE ER 2 DEPAKOTE SPRINKLES 2 DIASTAT 2 QL (1 EA per 1 Fill) DIASTAT ACUDIAL 2 QL (1 EA per 1 FILL) diazepam rectal 1 QL (1 EA per 1 FILL)
66 Drug Name Tier Notes DILANTIN 2 DILANTIN EXTENDED 2 DILANTIN INFATABS 2 DILANTIN-125 2 divalproex 1 DOPRAM 2 EPITOL 1 ethanol (ethyl alcohol) 1 ethosuximide 1 EXTAVIA 2 PA felbamate oral tablet 400 mg 1 ST FELBATOL 2 ST fosphenytoin 1 FYCOMPA ORAL TABLET 10 MG, 12 MG, 8 MG 2 ST; QL (30 EA per 30 days) FYCOMPA ORAL TABLET 2 MG 2 ST; QL (120 EA per 30 days) FYCOMPA ORAL TABLET 4 MG, 6 MG 2 ST; QL (60 EA per 30 days) gabapentin 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 ST; QL (4 EA per 1 day) GABITRIL ORAL TABLET 16 MG 2 ST; 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 2 ST; QL (30 EA per 30 days) MG HORIZANT ORAL TABLET EXTENDED RELEASE 600 2 ST; QL (2 EA per 1 day) MG KEPPRA 2 KEPPRA XR 2 KLONOPIN 2 LAMICTAL 2 LAMICTAL ODT 2 ST LAMICTAL ODT STARTER (BLUE) 2 ST LAMICTAL ODT STARTER (GREEN) 2 ST LAMICTAL ODT STARTER (ORANGE) 2 ST LAMICTAL STARTER (BLUE) KIT 2 LAMICTAL STARTER (GREEN) KIT 2 LAMICTAL STARTER (ORANGE) KIT 2 LAMICTAL XR 2 ST LAMICTAL XR STARTER (BLUE) 2 ST LAMICTAL XR STARTER (GREEN) 2 ST LAMICTAL XR STARTER (ORANGE) 2 ST
67 Drug Name Tier Notes lamotrigine oral tablet 1 lamotrigine oral tablet extended release 24hr 250 mg 1 ST lamotrigine oral tablet, chewable dispersible 1 lamotrigine oral tablet,disintegrating 100 mg 1 ST 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 QL (300 ML per 30 days) NAMENDA ORAL TABLET 2 QL (60 EA per 30 days) NAMENDA TITRATION PAK 2 QL (2 EA per 1 day) NAMENDA XR ORAL CAP,SPRINKLE,ER 24HR DOSE 2 QL (28 EA per 28 days) PACK NAMENDA XR ORAL CAPSULE,SPRINKLE,ER 24HR 2 QL (30 EA per 30 days) NAMZARIC 2 ST; QL (1 EA per 1 day) NEURONTIN 2 NO DOZ 1 NUEDEXTA 2 PA ONFI ORAL SUSPENSION 2 ST; QL (480 ML per 30 days) ONFI ORAL TABLET 5 MG 2 ST; QL (2 EA per 1 day) oxcarbazepine 1 OXTELLAR XR 2 ST 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 primidone 1 QUDEXY XR 2 ST; QL (2 EA per 1 day) REBIF (WITH ALBUMIN) 2 PA REBIF REBIDOSE 2 PA REBIF TITRATION PACK 2 PA RILUTEK 2 riluzole 1 SABRIL 2 QL (6 EA per 1 day)
68 Drug Name Tier Notes STAY AWAKE 1 STAY AWAKE MAXIMUM STRENGTH 1 TECFIDERA 2 PA TEGRETOL ORAL SUSPENSION 2 TEGRETOL ORAL TABLET 2 TEGRETOL XR 2 tetrabenazine 1 TOPAMAX 2 topiramate oral capsule, sprinkle 1 topiramate oral capsule,sprinkle,er 24hr 1 ST; QL (2 EA per 1 day) topiramate oral tablet 1 TRILEPTAL 2 TROKENDI XR 2 ST; QL (2 EA per 1 day) valproate sodium 1 valproic acid 1 valproic acid (as sodium salt) oral solution 1 VIMPAT INTRAVENOUS 2 XENAZINE 2 ZARONTIN 2 ZONEGRAN ORAL CAPSULE 100 MG, 25 MG 2 zonisamide 1 COLONY STIMULATING FACTORS ARANESP (IN POLYSORBATE) 2 PA EPOGEN INJECTION SOLUTION 10,000 UNIT/ML, 2,000 UNIT/ML, 20,000 UNIT/2 ML, 20,000 UNIT/ML, 2 PA 3,000 UNIT/ML, 4,000 UNIT/ML GRANIX 2 PA LEUKINE INJECTION RECON SOLN 2 PA MIRCERA 2 PA MOZOBIL 2 NEULASTA SUBCUTANEOUS SYRINGE 2 PA NEULASTA SUBCUTANEOUS SYRINGE, W/ 2 WEARABLE INJECTOR NEUMEGA 2 NEUPOGEN 2 PA NPLATE 2 PROCRIT 2 PA PROMACTA 2 PA; QL (1 EA per 1 day) ZARXIO 2 CONTRACEPTIVES AFTERA 3 ALTAVERA (28) 3 ALYACEN 1/35 (28) 3 ALYACEN 7/7/7 (28) 3
69 Drug Name Tier Notes AMETHIA 3 QL (91 EA per 84 days) AMETHIA LO 3 QL (91 EA per 84 days) AMETHYST 2 ST APRI 3 ARANELLE (28) 3 ASHLYNA 3 QL (91 EA per 84 days) AUBRA 3 AVIANE 3 AZURETTE (28) 3 BALZIVA (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 CYCLESSA (28) 2 ST 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-PROVERA INTRAMUSCULAR SUSPENSION 2 QL (1 ML per 84 days) DEPO-PROVERA INTRAMUSCULAR SYRINGE 2 QL (1 ML per 84 days) DEPO-SUBQ PROVERA 104 2 QL (0.65 ML per 84 days) desog-e.estradiol/e.estradiol 3 DESOGEN 2 ST desogestrel-ethinyl estradiol 3 ECONTRA EZ 3 ELINEST 3 ELLA 2 EMOQUETTE 3 ENPRESSE 3 ENSKYCE 3 ERRIN 3 ESTARYLLA 3 ESTROSTEP FE-28 2 ST FALLBACK SOLO 3
70 Drug Name Tier Notes FALMINA (28) 3 FEMCON FE 2 ST GENERESS FE 2 GILDAGIA 3 GILDESS 3 GILDESS 24 FE 3 GILDESS FE 3 HEATHER 3 IMPLANON 2 INTROVALE 3 QL (91 EA per 84 days) JENCYCLA 3 JOLESSA 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 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 3 LAYOLIS FE 1 LEENA 28 3 LESSINA 3 LEVONEST (28) 3 levonorgestrel 3 levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg, 3 0.15-0.03 mg 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) LEVORA-28 3 LO LOESTRIN FE 2 ST LO MINASTRIN FE 2 LOESTRIN 1.5/30 (21) 2 ST LOESTRIN 1/20 (21) 2 ST LOESTRIN 24 FE 2 LOESTRIN FE 1.5/30 (28-DAY) 2 ST
71 Drug Name Tier Notes LOESTRIN FE 1/20 (28-DAY) 2 ST LOMEDIA 24 FE 3 LORYNA (28) 3 ST LOSEASONIQUE 2 ST; QL (91 EA per 84 days) 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 MIRCETTE (28) 2 ST MODICON (28) 2 ST MONO-LINYAH 3 MONONESSA (28) 3 MY WAY 3 MYZILRA 3 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 3 NEXT CHOICE ONE DOSE 3 NORA-BE 3 noreth-ethinyl estradiol-iron oral tablet,chewable 3 0.4mg-35mcg(21) and 75 mg (7) noreth-ethinyl estradiol-iron oral tablet,chewable 1 0.8mg-25mcg(24) and 75 mg (4) norethindrone (contraceptive) 3 norethindrone ac-eth estradiol oral tablet 1-20 mg-mcg 3 norethindrone-e.estradiol-iron 3 norgestimate-ethinyl estradiol 3 NORINYL 1+35 (28) 3 NORINYL 1+50 (28) 2 ST NORLYROC 3 NOR-QD 2 ST NORTREL 0.5/35 (28) 3 NORTREL 1/35 (21) 3 NORTREL 1/35 (28) 3
72 Drug Name Tier Notes NORTREL 7/7/7 (28) 3 NUVARING 2 ST; QL (1 EA per 28 days) OGESTREL (28) 3 OPCICON ONE-STEP 3 ORSYTHIA 3 ORTHO ALL-FLEX FITTING SET 3 ORTHO DIAPHRAGM ALL-FLEX 65 3 ORTHO DIAPHRAGM ALL-FLEX 70 3 ORTHO DIAPHRAGM ALL-FLEX 75 3 ORTHO DIAPHRAGM ALL-FLEX 80 3 ORTHO EVRA 2 ST; QL (3 EA per 28 days) ORTHO MICRONOR 2 ST ORTHO TRI-CYCLEN (28) 2 ST ORTHO-CEPT (28) 2 ST ORTHO-CYCLEN (28) 2 ST ORTHO-NOVUM 1/35 (28) 2 ST ORTHO-NOVUM 7/7/7 (28) 2 ST OVCON-35 (28) 2 ST 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 SEASONIQUE 2 ST; QL (91 EA per 84 days) SETLAKIN 3 QL (91 EA per 84 days) SHAROBEL 3 SPRINTEC (28) 3 SRONYX 3 SYEDA 3 ST TAKE ACTION 3 TARINA FE 3 TILIA FE 3 TRI-ESTARYLLA 3 TRI-LEGEST FE 3 TRI-LINYAH 3 TRINESSA (28) 3 TRI-NORINYL (28) 2 ST TRI-PREVIFEM (28) 3 TRI-SPRINTEC (28) 3
73 Drug Name Tier Notes TRIVORA (28) 3 VELIVET TRIPHASIC REGIMEN (28) 3 VIORELE (28) 3 VYFEMLA (28) 3 WERA (28) 3 WIDE-SEAL DIAPHRAGM 60 3 WIDE-SEAL DIAPHRAGM 65 3 WIDE-SEAL DIAPHRAGM 70 3 WIDE-SEAL DIAPHRAGM 75 3 WIDE-SEAL DIAPHRAGM 80 3 WIDE-SEAL DIAPHRAGM 85 3 WIDE-SEAL DIAPHRAGM 90 3 WIDE-SEAL DIAPHRAGM 95 3 WYMZYA FE 3 XULANE 1 QL (3 EA per 28 days) YASMIN (28) 2 ST YAZ (28) 2 ST ZARAH 3 ST ZENCHENT (28) 3 ZENCHENT FE 3 ZEOSA 3 ZOVIA 1/35E (28) 3 ZOVIA 1/50E (28) 3 COUGH/COLD PREPARATIONS ADULT TUSSIN CHEST CONGESTION 1 ADULT TUSSIN COUGH CONGEST DM 1 ADULT TUSSIN DM 1 ADULT TUSSIN MULTI-SYMP COLD 1 ALA-HIST AC 2 ALA-HIST DM 2 ALLERGY & COLD PE 1 ALLERGY MULTI-SYMPTOM 1 ALLERGY SINUS HEADACHE (PE) ORAL TABLET 1 12.5-5-325 MG ALLFEN DM 2 ALL-NITE COLD-FLU 1 AP-HIST DM 1 AQUANAZ 2 benzonatate 1 BICLORA 2 BROMFED DM 1 brompheniramine-pseudoeph-dm oral syrup 1 BROTAPP DM 1 BROVEX PEB DM 2
74 Drug Name Tier Notes BROVEX PSB ORAL LIQUID 4-20-20 MG/5 ML 2 CAPCOF 2 CAPMIST DM 2 CAPRON DM 2 CEPACOL SORETHROAT-COUGH 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 COLD-COUGH DAY-NIGHT 1 CHILD DELSYM COUGH+CHEST DM 1 CHILD DELSYM COUGH+COLD 2 CHILD MUCINEX CHEST CONGESTION 1 CHILD MUCINEX CONGESTION-COUGH 2 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 & RUNNY NOSE 1 CHILD TRIAMINIC COUGH-CONGEST 1 CHILD TRIAMINIC COUGH-SORE THR 1 CHILD TRIAMINIC MS FEVER-COLD 1 CHILDREN'S COLD & COUGH 1 CHILDREN'S COLD & COUGH DM 1 CHILDREN'S M-S COLD DAY-NIGHT 1 CHILDREN'S MUCINEX COLD-FEVER 2 CHILDREN'S MUCINEX COUGH 1 CHILDREN'S MUCINEX MULTI-SYMP 2 CHILDREN'S MUCINEX NIGHT TIME 2 CHILDRENS PLUS MULTI-SYMP COLD 1 CHILDREN'S SILFEDRINE 1 CHLO HIST 2 CHLO TUSS 2 CHLO TUSS EX 2 CLOFERA 2 codeine-guaifenesin 1 CODITUSS DM 1 COLD & COUGH DM 1 COLD & COUGH ELIXIR 1 COLD & COUGH ORAL LIQUID 2.5-5 MG/5 ML 1 COLD & FLU SEVERE 1
75 Drug Name Tier Notes COLD HEAD CONGESTION DAY/NITE 1 COLD HEAD CONGESTION DAYTIME 1 COLD HEAD CONGESTION NIGHTTIME 1 COLD 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 COMTREX COLD-COUGH 2 COMTREX DAY/NI SEV COLD-SINUS 2 COMTREX DAY/NIGHT COLD & COUGH 2 COMTREX FLU THERAPY 2 COMTREX NIGHTTIME COLD & COUGH 2 CONGESTAC 1 CONGESTION RELIEF (IBUPROF-PE) 1 COUGH & COLD BP 1 COUGH & COLD ORAL TABLET 1 COUGH CONTROL (DEXTROMETHORPH) 1 COUGH CONTROL (GUAIFENESIN) 1 COUGH CONTROL CF (PE) 1 COUGH CONTROL DM 1 COUGH CONTROL DM MAX 1 COUGH DM ER 1 COUGH DROPS MUCOUS MEMBRANE LOZENGE 5.4 1 MG, 5.8 MG 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 cpm-pseudoephed-hydrocodone 1 DAY TIME PE 1 DAYTIME COLD & FLU RELIEF (PE) ORAL LIQUID 1 DAYTIME COLD-FLU 1 DAY-TIME COUGH 1 DAYTIME MUCUS RELIEF DM 1 DAYTIME SINUS 1 DAYTIME SINUS RELIEF ORAL CAPSULE 5-325 MG 1 DAYTIME-NIGHTTIME 1 DECONEX 2
76 Drug Name Tier Notes DECONEX DM 2 DECONEX DMX 2 DECONEX IR 2 DELSYM 12 HOUR 2 DELSYM COUGH+CHEST CONGEST DM 1 DELSYM COUGH+COLD DAYTIME 2 DELSYM COUGH+COLD NIGHTTIME 2 DELSYM COUGH+SOOTHING ACTION 2 DELSYM NIGHTTIME MULTI-SYMPTOM 1 DESGEN DM (PSEUDOEPHEDRINE) 1 dextromethorphan polistirex 1 dextromethorphan-guaifenesin oral syrup 1 DIABETIC SILTUSSIN DAS-NA 1 DIABETIC SILTUSSIN-DM 1 DIABETIC SILTUSSIN-DM MAX STR 1 DICEL CD 2 DIMAPHEN DM 1 DIMETANE-DX 2 DIMETAPP DM COLD-COUGH (PE) 2 DONATUSS DC 2 DONATUSSIN 2 DONATUSSIN DM 2 DONATUSSIN PEDI (REFORMULATED) 2 DONATUSSIN PEDIATRIC 2 DRYMAX AF 2 DURAFLU ORAL TABLET 60-20-200-500 MG 2 DURAVENT DM 2 DURAVENT PE 2 ED A-HIST DM 1 ED BRON GP 1 ENDACOF - DM 1 ENDACOF-C 1 ENTRE-COUGH 1 ephedrine sulfate in 0.9% nacl intravenous syringe 50 mg/5 1 ml (10 mg/ml) ephedrine sulfate injection solution 1 ephedrine sulfate oral 1 EXCEDRIN SINUS HEADACHE 2 EXEFEN DMX 1 FLOWTUSS 2 ST; QL (600 ML per 10 days) FLU & SORE THROAT 1 FLU BP 1 FLU-SEVERE COLD-COUGH DAYTIME 1 FLU-SEVERE COLD-COUGH NIGHT 1
77 Drug Name Tier Notes GUAIATUSSIN AC 1 guaifenesin 1 GUAIFENESIN AC 1 GUAIFENESIN DAC 1 HISTEX DM 2 HISTEX-AC 2 HYCOFENIX 2 hydrocodone-chlorpheniramine 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 INTENSE COUGH RELIEVER ORAL LIQUID 20-300 1 MG/5 ML IOPHEN C-NR 1 IOPHEN DM-NR 1 IOPHEN-NR 1 J-COF DHC 1 J-MAX 1 J-MAX DHC 1 KIDKARE COUGH/COLD 1 LOHIST PEB DM 1 LOHIST-DM 1 LORTUSS DM 2 LORTUSS EX ORAL SYRUP 1 LUSAIR 1 MAPAP COLD FORMULA 1 MAPAP SINUS MAX STRENGTH (PE) 1 MAR-COF BP 1 MAR-COF CG 1 MAXIPHEN 2 MAXIPHEN DM 2 M-CLEAR WC 2 M-END DMX 2 M-END MAX D 2 M-END PE 2 M-END WC 2 MUCAPHED 1 MUCINEX 2 MUCINEX COLD & SINUS 2 MUCINEX COLD-FLU & SORE THROAT 2 MUCINEX COUGH MINI-MELTS 2 MUCINEX D 2
78 Drug Name Tier Notes MUCINEX D MAXIMUM STRENGTH 2 MUCINEX DM 2 MUCINEX FAST-MAX COLD-FLU-THRT ORAL 2 CAPSULE MUCINEX FAST-MAX COLD-FLU-THRT ORAL 2 POWDER IN PACKET MUCINEX FAST-MAX COLD-FLU-THRT ORAL 1 TABLET MUCINEX FAST-MAX COLD-SINUS 1 MUCINEX FAST-MAX CONGEST-COUGH ORAL 2 LIQUID MUCINEX FAST-MAX CONGEST-COUGH ORAL 1 TABLET MUCINEX FAST-MAX DAY-NITE COLD 2 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 2 LIQUID MUCINEX FAST-MAX NITE COLD-FLU ORAL 1 TABLET MUCINEX FAST-MAX SEV CLD-SINUS 1 MUCINEX FAST-MAX SEVERE COLD ORAL LIQUID 2 MUCINEX FAST-MAX SEVERE COLD ORAL TABLET 1 MUCINEX FST-MX DY-NT CLD (DPH) 2 MUCINEX MINI-MELTS ORAL GRANULES IN 2 PACKET 100 MG MUCINEX SINUS-MAX D-N (DIPHEN) 2 MUCINEX SINUS-MAX DY-NT (DXYL) 2 MUCINEX SINUS-MAX NITE CONGEST 2 MUCINEX SINUS-MAX PRESSUR-PAIN ORAL 2 LIQUID MUCINEX SINUS-MAX PRESSUR-PAIN ORAL 1 TABLET MUCINEX SINUS-MAX SEV CONG(DM) 2 MUCINEX SINUS-MAX SEV CONGESTN ORAL 2 LIQUID MUCINEX SINUS-MAX SEV CONGESTN ORAL 1 TABLET MUCOSA 1 MUCOSA DM 1 MUCUS RELIEF 1 MUCUS RELIEF COLD & SINUS ORAL TABLET 1 MUCUS RELIEF COLD-FLU-SORE THR ORAL 1 TABLET MUCUS RELIEF COUGH 1 MUCUS RELIEF DM 1 79 Drug Name Tier Notes MUCUS RELIEF ER ORAL TABLET EXTENDED 1 RELEASE 12HR MUCUS RELIEF PE 1 MUCUS RELIEF SEV CONGEST-COLD 1 MUCUS RELIEF SINUS 1 MULTI-SYMPTOM COLD (PE) 1 MULTI-SYMPTOM COLD NIGHT TIME 1 NASAL DECONGESTANT (PE) ORAL TABLET 10 MG 1 NASAL DECONGESTANT (PSEUDOEPH) 1 NEO AC 2 NEO DM 2 NIGHT TIME (DOXY-DM-ACETAM) 1 NIGHT TIME COLD & FLU RELIEF 1 NIGHT TIME COLD ORAL LIQUID 1 NIGHT TIME COLD-FLU ORAL LIQUID 1 NIGHT TIME COLD-FLU RELIEF ORAL LIQUID 1 12.5-30-1,000 MG/30 ML NIGHTTIME COLD-FLU 1 NIGHTTIME COLD-FLU RELIEF 1 NIGHTTIME COUGH 1 NIGHTTIME SINUS 1 NINJACOF 2 NINJACOF-A 2 NINJACOF-XG 1 NITE TIME 1 NITE TIME COLD-FLU RELIEF ORAL LIQUID 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 NOREL CS 2 NU-COPD 1 NYQUIL D 1 ORGAN-I NR 1 PAIN RELIEF ALLERGY SINUS 1 PAIN RELIEF COLD 1 PAIN RELIEF COLD & COUGH 1 PAIN RELIEF SINUS PE 1 PEDIA RELIEF COUGH-COLD 1 PEDIATRIC COUGH & COLD ORAL LIQUID 1-15-5 1 MG/5 ML PHENYLHISTINE DH 1
80 Drug Name Tier Notes POLY HIST DHC 2 POLY HIST NC 2 POLY HIST PD 2 POLY-HIST DM (THONZYLAMINE) 2 POLY-TUSSIN 1 POLY-TUSSIN AC ORAL LIQUID 4-10-10 MG/5 ML 2 POLY-TUSSIN D 1 POLY-TUSSIN EX 2 POLY-VENT DM ORAL TABLET 60-20-380 MG 2 POLY-VENT IR ORAL TABLET 60-380 MG 2 PRO-CHLO 2 PRO-CLEAR AC 2 PROMETHAZINE VC-CODEINE 1 promethazine-codeine 1 promethazine-dm 1 promethazine-phenyleph-codeine 1 PRO-RED AC (W/ DEXCHLORPHENIR) 2 pseudoephedrine hcl oral liquid 1 pseudoephedrine hcl oral tablet 1 Q-TAPP DM 1 Q-TUSSIN 1 Q-TUSSIN DM 1 RELCOF C 1 RESCON-DM 2 RESCON-GG 2 RESPAIRE-30 2 REZIRA 2 ROBAFEN 1 ROBAFEN CF ORAL LIQUID 1 ROBAFEN COUGH 1 ROBAFEN DM 1 ROBAFEN DM CLEAR 1 ROBAFEN DM COUGH 1 RYDEX 1 RYNEX DM 1 SEVERE COLD & FLU (PE) ORAL TABLET 1 SEVERE COLD PE 1 SILTUSSIN DM DAS 1 SILTUSSIN SA 1 SILTUSSIN-DM 1 SINUS & COLD-D 1 SINUS 12 HOUR 1 SINUS CONG & PAIN DAY-NIGHT 1 SINUS CONGESTION & PAIN 1
81 Drug Name Tier Notes SINUS CONGESTION & PAIN(GUAIF) 1 SINUS CONGESTION&PAIN(CHLORPH) 1 SINUS PAIN RELIEF 1 SORE THROAT & COUGH 1 STATUSS GREEN (CODEINE) 2 SUDOGEST 12-HOUR 1 SUDOGEST ORAL TABLET 60 MG 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 TESSALON PERLES 2 THERAFLU COLD-SORE THROAT (PE) 2 THERAFLU FLU-SORE THROAT 2 THERAFLU MAX-D SEVERE COLD-FLU 2 THERAFLU MULTI-SYMPTOM COLD 2 THERAFLU NIGHT SEVERE COLD-CGH 2 THERAFLU SINUS & COLD 2 THERAFLU WARMING RELIEF 2 TRIAMINIC 2 TRIAMINIC CHEST &NASAL CONGEST 2 TRIAMINIC COLD & COUGH (PE) 1 TRIAMINIC COUGH 1 TRIAMINIC COUGH-SORE THROAT 2 TUSNEL C 2 TUSNEL NEW FORMULA ORAL TABLET 2 TUSNEL PEDIATRIC 2 TUSNEL-DM PEDIATRIC 2 TUSSICAPS 2 TUSSIGON 2 TUSSIN 1 TUSSIN CF COUGH-COLD 1 TUSSIN CF MAX 1 TUSSIN CF ORAL LIQUID 1 TUSSIN CHEST CONGESTION 1 TUSSIN COUGH (DM ONLY) ORAL LIQUID 1 TUSSIN DM CLEAR 1 TUSSIN DM COUGH & 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
82 Drug Name Tier Notes TUSSIN DM ORAL TABLET 1 TUSSIN EXPECTORANT 1 TUSSIONEX PENNKINETIC ER 2 VANACOF 2 VANACOF DM 2 VANACOF-8 2 VICKS CHILDREN'S NYQUIL COLD 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 NIGHTTIME RELIEF 2 VICKS NYQUIL SEVERE COLD-FLU ORAL LIQUID 1 VICKS NYQUIL SEVERE COLD-FLU ORAL TABLET 2 VICKS QLEARQUIL DAYTIME SINUS 2 VICKS QLEARQUIL NIGHTIME SINUS 2 VICKS VAPODROPS 2 VICKS VAPOSTEAM 2 VIRTUSSIN AC 1 VIRTUSSIN DAC 1 VITUZ 2 ZONATUSS 2 Z-TUSS AC 2 Z-TUSS E 2 ZUTRIPRO 2 DIAGNOSTIC ABLAVAR 2 ACETEST 2 ADENOSCAN 2 adenosine (diagnostic) 1 AK-FLUOR 2 ALBUSTIX REAGENT 2 aminohippurate sodium 2 AZO TEST STRIPS 2 CARDIOLITE 2 CHEMSTRIP 2 2 CHEMSTRIP K 2 CHEMSTRIP MICRAL 2 CHEMSTRIP UGK 2 CLINITEST REAGENT 2 CYSVIEW 2
83 Drug Name Tier Notes DEFINITY 2 DIASCREEN 10 2 DIASCREEN 1G REAGENT 2 DIASCREEN 1K REAGENT 2 DIASCREEN 2GK REAGENT 2 DIASCREEN 3 REAGENT 2 DIASCREEN 4OBL REAGENT 2 DIASCREEN 5 REAGENT 2 DIASCREEN 7 REAGENT 2 DIASCREEN 8 REAGENT 2 DIASCREEN 9 REAGENT 2 DIASTIX 2 dipyridamole intravenous 1 EOVIST 2 FUL-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 MICRO-BUMINTEST 2 NITRATEST PAPER 2 NITRATEST PAPER WITH DISPENSER 2 NO-STICK GLUCOSE 2 OMNIPAQUE 140 2 OMNIPAQUE 180 2 OMNIPAQUE 240 2 OMNIPAQUE 300 INTRAVENOUS 2 OMNIPAQUE 350 2 OMNISCAN 2 OMNISCAN PREFILL PLUS 2 OPTISON 2 PRO DNA COLLECTION 2 PROSTASCINT 2 REVEAL COLON DISEASE TEST 2 REVEAL UTI TEST STRIP 2 R-GENE 10 2
84 Drug Name Tier Notes ULTRAVIST 2 URINARY TRACT INF.TEST (WBCS) 2 VISIPAQUE INTRAVENOUS 2 DIURETICS acetazolamide 1 acetazolamide sodium 1 ALDACTAZIDE 2 ALDACTONE 2 amiloride oral 1 amiloride-hydrochlorothiazide 1 ammonium chloride 1 bumetanide 1 chlorothiazide 1 chlorothiazide sodium 1 chlorthalidone oral tablet 25 mg, 50 mg 1 DEMADEX 2 DIAMOX SEQUELS 2 DIURIL 2 DYAZIDE 2 EDECRIN 2 eplerenone 1 ethacrynate sodium 1 furosemide injection 1 furosemide oral solution 10 mg/ml, 40 mg/5 ml 1 furosemide oral tablet 1 hydrochlorothiazide 1 indapamide 1 INSPRA 2 LASIX 2 mannitol 10 % 1 mannitol 20 % 1 mannitol 25 % intravenous solution 1 mannitol 5 % 1 MAXZIDE 2 MAXZIDE-25MG 2 methazolamide oral 1 methyclothiazide 1 metolazone 1 MICROZIDE 2 NEPTAZANE 2 OSMITROL 10 % 2 OSMITROL 15 % 2 OSMITROL 20 % 2 OSMITROL 5 % 2
85 Drug Name Tier Notes 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) SODIUM EDECRIN 2 spironolactone 1 spironolacton-hydrochlorothiaz 1 THALITONE 2 torsemide 1 triamterene-hydrochlorothiazid 1 VAPRISOL 2 ZAROXOLYN ORAL TABLET 5 MG 2 EENT PREPS 12 HOUR NASAL SPRAY 1 ACETASOL HC 1 acetic acid otic 1 acetic acid-aluminum acetate 1 ACULAR 2 ACULAR LS 2 ACUVAIL (PF) 2 ADVANCED FORMULA EYE DROPS 1 AKORN BALANCED SALT 2 AKTEN (PF) 2 AKWA TEARS 1 AKWA TEARS (POLYVINYL ALCOHOL) 1 ALCAINE 1 ALOCRIL 2 ALOMIDE 2 ALPHAGAN P 2 ALREX 2 ANEFRIN NASAL SPRAY,NON-AEROSOL 1 antipyrine-benzocaine otic drops 5.4-1.4 % 1 apraclonidine 1 ARTIFICIAL TEARS (PETRO/MIN) 1 ARTIFICIAL TEARS (POLYVIN ALC) 1 ARTIFICIAL TEARS OPHTHALMIC DROPS 0.5-0.6 % 1 ASTELIN 2 QL (60 ML per 30 days) ASTEPRO NASAL SPRAY,NON-AEROSOL 2 ST; QL (60 ML per 30 days) atropine ophthalmic 1 ATROVENT 2 AURAX 1 AURODEX 1 AUROGUARD 1 azelastine nasal 1 QL (60 ML per 30 days) AZOPT 2
86 Drug Name Tier Notes BALANCED SALT 1 BECONASE AQ 2 ST; QL (25 GM per 30 days) BENZEDREX 2 BETADINE OPHTHALMIC PREP 2 BETAGAN OPHTHALMIC DROPS 0.5 % 2 betaxolol ophthalmic 1 BETIMOL 2 BETOPTIC S 2 bimatoprost 1 QL (1 ML per 12 days) BION TEARS (PF) 1 brimonidine 1 bromfenac 1 BSS 2 BSS PLUS 2 carteolol 1 CLEANSING EYELID 2 COMBIGAN 2 COSOPT 2 COSOPT (PF) 2 ST; QL (2 EA per 1 day) cromolyn ophthalmic 1 CYCLOGYL 2 CYCLOMYDRIL 2 cyclopentolate 1 CYSTARAN 2 PA DERMOTIC OIL 2 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 ENTSOL NASAL SPRAY 2 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
87 Drug Name Tier Notes EYLEA 2 FLAREX 2 FLONASE 2 QL (16 GM per 30 days) FLONASE ALLERGY RELIEF 2 QL (16 ML per 30 days) flunisolide nasal spray,non-aerosol 25 mcg (0.025 %) 1 QL (25 ML per 30 days) fluocinolone acetonide oil 1 fluorescein-benoxinate 2 fluorometholone 1 flurbiprofen sodium 1 FLURESS 2 fluticasone nasal 1 QL (16 GM per 30 days) FML FORTE 2 FML LIQUIFILM 2 FML S.O.P. 2 FRESHKOTE 2 GENTEAL MILD TO MODERATE 2 GENTEAL GEL 2 GENTEAL MILD 2 GENTEAL PM 2 GENTEAL SEVERE 2 GONAK 1 hydrocortisone-acetic acid 1 HYPOTEARS 1 ILEVRO 2 ILUVIEN 2 IOPIDINE 2 ipratropium bromide nasal 1 ISOPTO CARPINE 2 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 1 57.3-42.5 % LUBRICATING PLUS 1 LUBRIFRESH PM 1
88 Drug Name Tier Notes LUCENTIS 2 LUMIGAN 2 QL (1 ML per 12 days) MACUGEN 2 MAXIDEX 2 metipranolol 1 MIOCHOL-E 2 MIOSTAT 2 MUCINEX FULL FORCE 2 MUCINEX MOISTURE SMART 2 MUCINEX SINUS-MAX 1 MURO 128 1 MYDRIACYL 2 naphazoline 1 NAPHCON-A 2 NASACORT AQ 2 QL (11 GM per 20 days) NASAL ALLERGY 1 NASAL DECONGESTANT (OXYMETAZL) 1 NASAL FOUR 1 NASAL SPRAY (OXYMETAZOLINE) 1 NASAL SPRAY 12 HOUR 1 NASAL SPRAY EXTRA MOISTURIZING 1 NASAL SPRAY LONG ACTING 1 NASAL SPRAY SINUS 1 NASAL SPRAY X-MOIST 1 NASONEX 2 QL (17 GM per 30 days) NATURAL BALANCE 1 NATURE'S TEARS 1 NEVANAC 2 NO DRIP 1 NOSE DROPS 1 NOSE DROPS EXTRA STRENGTH 1 NRS NASAL RELIEF 1 OCUFEN 2 olopatadine 1 ST; QL (30.5 GM per 30 days) OMIDRIA 2 OMNARIS 2 ST; QL (5 GM per 12 days) OMNIPRED 2 OPTI-CLEAR 1 ORIGINAL NASAL SPRAY 1 OTIC CARE (ANTIPYRINE) 2 OTOZIN 2 OZURDEX 2 PAREMYD 2 PATANASE 2 ST; QL (30.5 GM per 30 days)
89 Drug Name Tier Notes phenylephrine hcl ophthalmic 1 PHOSPHOLINE IODIDE 2 pilocarpine hcl ophthalmic drops 1 %, 2 %, 4 % 1 PINNACAINE 1 PRAMOXINE-HC 1 PRED FORTE 2 PRED MILD 2 prednisolone acetate 1 prednisolone sodium phosphate ophthalmic 1 PROLENSA 2 proparacaine 1 PURALUBE 1 QNASL NASAL HFA AEROSOL INHALER 40 2 ST; QL (4.9 GM per 30 days) MCG/ACTUATION QNASL NASAL HFA AEROSOL INHALER 80 2 ST; QL (8.7 GM per 30 days) 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 2 REFRESH OPTIVE SENSITIVE (PF) 2 REFRESH P.M. 2 REFRESH PLUS 2 REFRESH TEARS 2 RESTASIS 2 QL (64 EA per 30 days) RETISERT 2 RHINOCORT AQUA 2 ST; QL (43 GM per 75 days) SIMBRINZA 2 SINEX ULTRA FINE MIST 12-HOUR 1 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 SWIM EAR 2 SYSTANE 2 SYSTANE (PF) 2 SYSTANE BALANCE 2 SYSTANE GEL 2 SYSTANE NIGHTTIME 1
90 Drug Name Tier Notes SYSTANE ULTRA 2 SYSTANE ULTRA (PF) 2 TEARS NATURALE FORTE 2 TEARS NATURALE FREE (PF) 1 TEARS NATURALE II 2 TEARS PURE 1 tetracaine hcl 1 tetracaine hcl (pf) ophthalmic 1 tetrahydrozoline ophthalmic 1 timolol maleate ophthalmic 1 TIMOPTIC 2 TIMOPTIC OCUDOSE (PF) 2 ST; QL (2 EA per 1 day) TIMOPTIC-XE 2 TRAVATAN Z 2 QL (1 ML per 12 days) travoprost (benzalkonium) 1 QL (1 ML per 12 days) triamcinolone acetonide nasal 1 QL (11 GM per 20 days) TRIESENCE (PF) 2 tropicamide ophthalmic 1 TRUSOPT 2 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 VOLTAREN OPHTHALMIC 2 VOSOL 2 VOSOL-HC 2 XALATAN 2 ZETONNA 2 ST; QL (6.1 GM per 30 days) ZIOPTAN (PF) 2 ST; QL (1 EA per 1 day) ELECT/CALORIC/H2O 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 AMINOSYN II 8.5 %-ELECTROLYTES 2
91 Drug Name Tier Notes AMINOSYN M 3.5 % 2 AMINOSYN-HBC 7% 2 AMINOSYN-PF 10 % 2 AMINOSYN-PF 7 % (SULFITE-FREE) 2 AMINOSYN-RF 5.2 % 2 ammonium molybdate 1 ANTICAVITY FLUORIDE RINSE 1 AURYXIA 2 QL (12 EA per 1 day) BIFERA RX 2 CALCARB 600 WITH VITAMIN D ORAL TABLET 600 1 MG(1,500MG) -400 UNIT CALCIUM 600 WITH VITAMIN D3 ORAL CAPSULE 1 600 MG(1,500MG) -400 UNIT 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) 1 -200 unit, 600 mg(1,500mg) -800 unit calcium chloride intravenous 1 calcium gluconate in 0.9% nacl intravenous solution 1 1 gram/100 ml 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%/D10W SUL FREE 2 CLINIMIX E 4.25%/D25W SUL FREE 2 CLINIMIX E 4.25%/D5W SULF FREE 2 CLINIMIX E 5%/D15W SULFIT FREE 2 CLINIMIX E 5%/D20W SULFIT FREE 2 CLINIMIX E 5%/D25W SULFIT FREE 2
92 Drug Name Tier Notes 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 cupric sulfate 1 cysteine (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-LC/2.5% DEXTROSE 2 DELFLEX-LC/4.25% DEXTROSE 2 DELFLEX-SM WITH 1.5% DEXTROSE 2 DENTA 5000 PLUS 1 DENTAGEL 1 DEX4 GLUCOSE ORAL TABLET,CHEWABLE 1 DEXFERRUM 1 dextrose 10 % and 0.2 % nacl 1 dextrose 10 % in water (d10w) 1 dextrose 20 % in water (d20w) 1 dextrose 25 % in water (d25w) 1 dextrose 30 % in water (d30w) 1 dextrose 40 % in water (d40w) 1 dextrose 5 % in water (d5w) 1 dextrose 5 %-lactated ringers 1 dextrose 5%-0.2 % sod chloride 1 dextrose 5%-0.3 % sod.chloride 1 dextrose 50 % in water (d50w) 1 dextrose 70 % in water (d70w) 1 dextrose oral gel in packet 1 dextrose oral liquid 15 gram/59 ml 1 DIABETISWEET 2 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 4.25 % DEXTROSE 2 EFFER-K ORAL TABLET, EFFERVESCENT 10 MEQ, 2 20 MEQ EFFER-K ORAL TABLET, EFFERVESCENT 25 MEQ 1
93 Drug Name Tier Notes electrolyte-48 in d5w 1 ELIPHOS 1 EXTRANEAL 7.5 % 2 FE C 1 FE C PLUS 1 FERAHEME 2 FERIVA 2 FERIVA 21-7 TABLET 2 FERIVA FA (SUMALATE) 2 FERIVA FA (WITH QUATREFOLIC) 2 FERRALET 90 DUAL-IRON DELIVERY 2 FERRAPLUS 90 1 FERRETTS 1 FERRLECIT 2 ferrous gluconate oral tablet 256 mg (28 mg iron), 324 mg 1 (38 mg iron) ferrous sulfate oral tablet 325 mg (65 mg iron) 1 ferrous sulfate oral tablet,delayed release (dr/ec) 324 mg (65 1 mg iron) FLUOR-A-DAY 2 FLUOR-A-DAY (WITH XYLITOL) 2 FOCALGIN DSS 1 FOLIVANE-F 1 FOSRENOL 2 FOSTEUM 2 FREAMINE HBC 6.9 % 2 FREAMINE III 10 % 2 FUSION PLUS 2 FUSION SPRINKLES 2 GLUCAGEN 2 GLUCAGEN HYPOKIT 2 GLUCAGON EMERGENCY KIT (HUMAN) 2 glucose oral tablet,chewable 4 gram 1 GLUCOSE POWDER 1 GLYCOPHOS 1 GLYTACTIN 20PE BETTERMILK LITE 2 HEMATOGEN 1 HEMATOGEN FA 1 HEMATOGEN FORTE 1 HEMETAB 1 HEMOCYTE 1 HEMOCYTE-F 2 HEMOCYTE-PLUS 2 HEPATAMINE 8% 2
94 Drug Name Tier Notes HYPERLYTE CR 2 IFEREX 150 1 IFEREX 150 FORTE 1 INFED 2 INJECTAFER 2 INSTA-GLUCOSE 1 INTEGRA 2 INTEGRA F 2 INTEGRA PLUS 2 IODOPEN 1 IONOSOL-B IN D5W 2 IONOSOL-MB IN D5W 2 iron aspgly&ps-c-b12-fa-ca-suc 1 iron aspgly-c-b12-ca-suc-stoma 1 iron fum & ag-c-b12-fa-ca-succ 1 IROSPAN 24/6 2 ISOLYTE S PH 7.4 2 ISOLYTE-P IN 5 % DEXTROSE 2 ISOLYTE-S 2 KABIVEN 2 KAYEXALATE 2 K-EFFERVESCENT 1 KIONEX 1 KLOR-CON 2 KLOR-CON 10 2 KLOR-CON 8 2 KLOR-CON M10 1 KLOR-CON M15 1 KLOR-CON M20 1 KLOR-CON SPRINKLE 1 KLOR-CON/25 2 KLOR-CON/EF 2 K-PHOS NO 2 2 K-PHOS ORIGINAL 2 K-PHOS-NEUTRAL 2 K-SOL 2 K-TAB 2 lactated ringers intravenous 2 LUDENT FLUORIDE 2 MAGNEBIND 300 2 MAGNEBIND 400 1 magnesium chloride injection 1 magnesium oxide oral tablet 400 mg, 420 mg 1
95 Drug Name Tier Notes magnesium sulfate in d5w intravenous piggyback 1 1 gram/100 ml magnesium sulfate in water 1 magnesium sulfate injection 1 manganese chloride 1 MAXFE 2 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 NIRON KOMPLETE 2 NORMOSOL-M IN 5 % DEXTROSE 2 NORMOSOL-R 2 NORMOSOL-R IN 5 % DEXTROSE 2 NORMOSOL-R PH 7.4 2 NULECIT 1 NUTRESTORE 2 NUTRILYTE 2 NUTRILYTE II 2 NUTRITIONAL SHAKE 1 NUTRITIONAL SHAKE PLUS ORAL LIQUID 0.05-1.5 1 GRAM-KCAL/ML ORACIT 2 OYSTERCAL-D 1 PEDIATRIC ELECTROLYTE ORAL SOLUTION 1 PEDITRACE 1 PERIKABIVEN 2 PHENACTIN AA PLUS 20 PE 2 PHOSLO 2 PHOSLYRA 2 PHOSPHA 250 NEUTRAL 1 PLASMA-LYTE 148 2 PLASMA-LYTE A 2 PLASMA-LYTE-56 IN 5 % DEXTROSE 2 POLYSACCHARIDE IRON 1 pot & sod citrate-citric acid 1 potassium acetate intravenous 1 potassium bicarb and chloride 1 potassium bicarb-citric acid 1
96 Drug Name Tier Notes potassium chlorid-d5-0.45%nacl 1 potassium chloride 1 potassium chloride in 0.9%nacl intravenous parenteral 1 solution 20 meq/l, 40 meq/l potassium chloride in 5 % dex intravenous parenteral 1 solution 20 meq/l, 30 meq/l, 40 meq/l potassium chloride in lr-d5 1 potassium chloride-0.45 % nacl 1 potassium chloride-d5-0.2%nacl intravenous parenteral 1 solution 20 meq/l, 30 meq/l, 40 meq/l potassium chloride-d5-0.3%nacl intravenous parenteral 1 solution 20 meq/l 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 PUREVIT DUALFE PLUS 2 RENACIDIN 2 RENAGEL 2 RENVELA 2 ringers intravenous 1 saccharin 2 saccharin sodium 2 selenium intravenous 1 SE-TAN PLUS 1 sevelamer carbonate 1 SF 1 SF 5000 PLUS 1 SLOW RELEASE IRON ORAL TABLET EXTENDED 1 RELEASE 160 MG (50 MG IRON) 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
97 Drug Name Tier Notes sodium citrate-citric acid 1 sodium ferric gluconat-sucrose 1 sodium 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 ORAL 1 SPS RECTAL 2 SSKI 1 stannous fluoride 1 sucrose crystals 2 TANDEM DUAL ACTION 2 TANDEM PLUS 2 TARON FORTE 1 THAM 2 TL G-FOL OS 1 TL ICON 1 TL-FOL 500 1 TL-HEM 150 1 TPN ELECTROLYTES 2 TRACE ELEMENTS 4/PEDIATRIC 1 TRAVASOL 10 % 2 TRICITRATES 1 TRICON 1 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 UROCIT-K 10 2 UROCIT-K 15 2 UROCIT-K 5 2 VELPHORO 2 VENOFER 2 VILACTIN AA PLUS 20 PE 2 VIRT-PHOS 250 NEUTRAL 1 VIRTRATE-2 1 VIRTRATE-3 1 VIRTRATE-K 1
98 Drug Name Tier Notes VITAFOL 1 VP-GSTN 1 WEE CARE 1 WHEY PROTEIN CONCENTRATE 2 zinc chloride 1 zinc sulfate intravenous 1 zinc sulfate oral capsule 1 GASTROINTESTINAL ABATINEX 2 ACID CONTROL (RANITIDINE) 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 ACIPHEX SPRINKLE 2 ST; QL (1 EA per 1 day) ACTIGALL 2 ADVANCED ANTACID-ANTIGAS 1 AKYNZEO 2 QL (1 EA per 28 days) ALMACONE MLT 1 ALMACONE ORAL SUSPENSION 1 ALMACONE ORAL TABLET,CHEWABLE 2 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 E 2 ANALPRAM-HC RECTAL CREAM 2 ANALPRAM-HC SINGLES RECTAL CREAM 2.5-1 % 2 (4G) ANASPAZ 2 ANTACID 1 ANTACID ANTI-GAS DOUBLE STR 1 ANTACID ANTI-GAS ORAL SUSPENSION 1 ANTACID CALCIUM ORAL TABLET,CHEWABLE 215 1 MG CALCIUM (500 MG) ANTACID EXST (CA CARB-MAG HYD) 1 ANTACID EXST (MAG CARB-AL HYD) 1
99 Drug Name Tier Notes ANTACID EXT STR (CALCIUM CARB) 1 ANTACID EXTRA-STRENGTH ORAL SUSPENSION 1 200-200-20 MG/5 ML ANTACID EXTRA-STRENGTH ORAL TABLET,CHEWABLE 200 MG CALCIUM (500 MG), 1 300 MG (750 MG) ANTACID MAXIMUM STRENGTH ORAL 1 SUSPENSION ANTACID PLUS ANTI-GAS 1 ANTACID ULTRA STRENGTH ORAL 1 TABLET,CHEWABLE 1,177 MG ANTACID-ANTIGAS 1 ANTACID-SIMETHICONE 1 ANTI-DIARRHEA 1 ANTI-DIARRHEAL (LOPERAMIDE) 1 ANTI-NAUSEA 1 ANTIVERT 2 ANUCORT-HC 1 ANU-MED 1 ANUSOL-HC 2 ANZEMET INTRAVENOUS 2 ANZEMET ORAL TABLET 50 MG 2 ST; QL (8 EA per 1 FILL) APRISO 2 ASACOL 2 ASACOL HD 2 atropine in 0.9 % sod chloride intravenous syringe 0.8 mg/2 1 ml (0.4 mg/ml) atropine injection solution 1 atropine injection syringe 0.05 mg/ml, 0.1 mg/ml 1 AZULFIDINE 2 AZULFIDINE EN-TABS 2 balsalazide 1 BENEFIBER SUGAR FREE (DEXTRIN) ORAL 2 POWDER 3 GRAM/4 GRAM BENTYL INTRAMUSCULAR 2 BENTYL ORAL CAPSULE 2 BENTYL ORAL TABLET 2 BISAC-EVAC 1 bisacodyl oral 1 bisacodyl rectal 1 BISCOLAX 1 BISMATROL 1 BISMUTH MAXIMUM STRENGTH 1 BISMUTH ORAL SUSPENSION 1 BUPHENYL 2 CALCIUM ANTACID 1
100 Drug Name Tier Notes CALCIUM ANTACID ULTRA MAX ST 1 calcium carbonate oral tablet 260 mg calcium (648 mg) 1 CAL-GEST ANTACID 1 CANASA 2 CANTIL 2 CARAFATE 2 castor oil oral oil , 100 % 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 CITRUCEL 2 CITRUCEL SUGAR FREE 2 CLEARLAX ORAL POWDER 1 COLACE 1 COLACE CLEAR 2 COLAZAL 2 COLYTE WITH FLAVOR PACKS 2 COMPLETE ORAL TABLET,CHEWABLE 1 COMPRO 1 CONSTULOSE 1 CREON 2 CUVPOSA 2 CYCLIVERT 2 CYTOTEC 2 DELZICOL 2 DEWEE'S CARMINATIVE 2 DEXILANT ORAL CAPSULE,BIPHASE DELAYED 2 ST; QL (1 EA per 1 day) RELEAS 30 MG 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
101 Drug Name Tier Notes 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 DOCUSOL PLUS 2 DOK 1 DOK PLUS 1 DONNATAL ORAL ELIXIR 16.2-0.1037 -0.0194 MG/5 2 ML DONNATAL ORAL TABLET 2 DRIMINATE 1 DUCODYL 1 DULCOLAX (BISACODYL) ORAL 2 ED-SPAZ 1 EMEND INTRAVENOUS 2 EMEND ORAL CAPSULE 125 MG 2 QL (1 EA per 1 FILL) EMEND ORAL CAPSULE 40 MG 2 QL (4 EA per 1 FILL) EMEND ORAL CAPSULE 80 MG 2 QL (2 EA per 1 FILL) EMEND ORAL CAPSULE,DOSE PACK 2 QL (3 EA per 1 FILL) ENEMA DISPOSABLE 1 ENEMA RECTAL ENEMA 19-7 GRAM/118 ML 1 ENTEREG 2 ENTYVIO 2 ENULOSE 1 esomeprazole magnesium 1 QL (1 EA per 1 day) esomeprazole sodium 1 esomeprazole strontium oral capsule,delayed release(dr/ec) 2 ST; QL (1 EA per 1 day) 24.65 mg EX-LAX (SENNOSIDES) ORAL TABLET 1 EX-LAX MAXIMUM STRENGTH 2 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
102 Drug Name Tier Notes 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 (PSYLLIUM SEED) 1 FIBER THERAPY ORAL POWDER 2 GRAM/19 GRAM 1 FIBER-LAX 1 FIBERTAB 1 FISH OIL ORAL CAPSULE 360-1,200 MG 1 FISH OIL ORAL CAPSULE,DELAYED 1 RELEASE(DR/EC) 300-1,000 MG FLEET BISACODYL 2 FLEET ENEMA 2 FLEET GLYCERIN (ADULT) 1 FLEET GLYCERIN (CHILD) 1 FLEET GLYCERIN LAXATIVE 2 FLEET LAXATIVE 1 FLEET MINERAL OIL 2 FLEET PEDIATRIC 2 FLORA-Q 2 FLORA-Q(2) 2 FORMULA EM 1 FULYZAQ 2 ST; QL (2 EA per 1 day) GAS FREE EXTRA STRENGTH 1 GAS RELIEF 1 GAS RELIEF EXTRA STRENGTH ORAL CAPSULE 1 GAS RELIEF MAXIMUM STRENGTH 1 GAS RELIEF ULTRA STRENGTH 1 GAS-X EXTRA STRENGTH ORAL 2 TABLET,CHEWABLE GAS-X ORAL TABLET,CHEWABLE 2 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) GAVILAX ORAL POWDER 2 GAVILYTE-C 1 GAVILYTE-G 1 GAVILYTE-H AND BISACODYL 1 GAVILYTE-N 1 GAVISCON 2 GAVISCON EXTRA STRENGTH 2 GENERLAC 1
103 Drug Name Tier Notes GENTLE LAXATIVE 1 GIAZO 2 glycerin (adult) 1 glycerin (child) 1 GLYCOLAX ORAL POWDER 1 glycopyrrolate injection 1 glycopyrrolate oral 1 GOLYTELY 2 granisetron (pf) 1 granisetron hcl intravenous 1 HEALTHYLAX 1 HEARTBURN RELIEF (CIMETIDINE) 1 HEARTBURN RELIEF (FAMOTIDINE) 1 HEARTBURN RELIEF (RANITIDINE) 1 HEARTBURN RELIEF 24 HOUR 1 HEARTBURN TREATMENT 24 HOUR 1 HEMMOREX-HC 2 HEMORRHOID RECTAL 1 HEMORRHOIDAL (PHENYLEPH-COCOA) RECTAL 1 SUPPOSITORY 0.25-88.44 % HEMORRHOIDAL COOLING 1 HEMORRHOIDAL CREAM 1 HEMORRHOIDAL RECTAL OINTMENT 1 HEMORRHOIDAL RECTAL SUPPOSITORY 0.25-3 % 1 HEMORRHOIDAL SUPPOSITORY 2 HEMRIL-30 1 hydrocortisone acetate rectal suppository 1 hydrocortisone-pramox-e-pram#1 1 hydrocortisone-pramoxine rectal 1 HYGIENIC (WITCH HAZEL) CLEANS 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 KONSYL (SUGAR) 1 KONSYL EASY MIX 2 KONSYL FIBER 1
104 Drug Name Tier Notes KONSYL FORMULA-D 2 KONSYL SUGAR-FREE (ASPARTAME) ORAL 2 POWDER IN PACKET KONSYL-D 2 KRISTALOSE 2 lactulose oral solution 10 gram/15 ml (15 ml), 20 gram/30 1 ml 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 2 LEVSIN/SL 2 LIALDA 2 LIBRAX (WITH CLIDINIUM) 2 lidocaine hcl-hydrocortison ac rectal 1 lidocaine-hydrocortisone-aloe 1 LINZESS 2 QL (1 EA per 1 day) LIPOSYN II 2 LIPOSYN III INTRAVENOUS EMULSION 10 %, 20 % 2 LIQUID ANTACID ORAL SUSPENSION 200-200-20 1 MG/5 ML LITHOSTAT 2 LOMOTIL 2 loperamide oral capsule 1 loperamide oral liquid 1 LOTRONEX 2 LOVAZA 2 QL (4 EA per 1 day) MAALOX ADVANCED ORAL SUSPENSION 1 MAALOX ADVANCED ORAL TABLET,CHEWABLE 2 MAG-AL 2 MAG-AL PLUS 1 MAG-AL PLUS EXTRA STRENGTH 1 magnesium citrate oral solution 1 MAJOR-PREP (PHENYLEPHRINE-FAT) 1 MAJOR-PREP HEMORRHOIDAL 1 MARINOL 2 ST; QL (2 EA per 1 day) 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 % ME-PB-HYOS 1
105 Drug Name Tier Notes mesalamine rectal 1 mesalamine with cleansing wipe 1 METAMUCIL (WITH SUGAR) ORAL POWDER 3.4 2 GRAM/7 GRAM METAMUCIL (WITH SUGAR) ORAL POWDER IN 2 PACKET METAMUCIL FIBER SINGLES 2 METAMUCIL MULTIHEALTH FIBER 2 METAMUCIL ORAL POWDER 2 METAMUCIL SUGAR FREE 2 METAMUCIL SUGAR-FREE (ASPART) ORAL 2 POWDER 3.3 GRAM/5.95 GRAM METAMUCIL SUNRISE 2 methscopolamine oral 1 metoclopramide hcl injection 1 metoclopramide hcl oral solution 1 metoclopramide hcl oral tablet 1 metoclopramide hcl oral tablet,disintegrating 5 mg 1 METOZOLV ODT 2 MI-ACID 1 MI-ACID GAS RELIEF 1 MILK OF MAGNESIA 1 MILK OF MAGNESIA CONCENTRATED 2 MINERAL OIL LAXATIVE 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 1 POWDER 3.4 GRAM/12 GRAM, 3.4 GRAM/7 GRAM NATURAL FIBER LAXATIVE THERAPY 1 NATURAL VEG LAXATIVE(SENNOSID) 1 NEXIUM 2 QL (1 EA per 1 day) NEXIUM IV 2 NEXIUM PACKET 2 QL (1 EA per 1 day)
106 Drug Name Tier Notes nizatidine 1 NULEV 2 NULYTELY WITH FLAVOR PACKS 2 NUTRILIPID 2 OMECLAMOX-PAK 2 omega-3 acid ethyl esters 1 QL (4 EA per 1 day) omeprazole 1 omeprazole magnesium 1 ondansetron 1 ondansetron (pf) in dextrose 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 PAMINE 2 PAMINE FORTE 2 PANCREAZE 2 PANCRELIPASE 5000 1 pantoprazole 1 paregoric 1 PEDIA-LAX 2 PEDIA-LAX STOOL SOFTENER 1 peg 3350-electrolytes 1 PEG3350 1 PEG-3350 WITH FLAVOR PACKS 1 peg-electrolyte soln 1 PENTASA 2 PEPCID 2 PEPCID COMPLETE 2 PEPTIC RELIEF 1 PEPTO-BISMOL 2 PEPTO-BISMOL MAX ST 2 PEPTO-BISMOL TO-GO 2 PERDIEM OVERNIGHT RELIEF 1 PERI-COLACE 1 PERTZYE 2 PHAZYME 2 PHENADOZ 1 PHENERGAN RECTAL 2
107 Drug Name Tier Notes phenobarb-hyoscy-atropine-scop oral tablet 1 PHOSPHATE LAXATIVE ORAL SOLUTION 1 PINK BISMUTH MAXIMUM STRENGTH 1 PINK BISMUTH ORAL SUSPENSION 1 PINK BISMUTH ORAL TABLET,CHEWABLE 1 polyethylene glycol 3350 oral 1 PRAMCORT 2 pramoxine topical 1 PREP-HEM (PHENYLEPHRINE) 2 PREPOPIK 2 PREVACID 2 PREVACID 24HR 2 PREVACID SOLUTAB 2 ST PREVPAC 2 QL (112 EA per 10 days) PRILOSEC 2 PRILOSEC OTC 2 prochlorperazine 1 prochlorperazine edisylate injection solution 10 mg/2 ml (5 1 mg/ml) prochlorperazine maleate oral 1 PROCORT 2 PROCTOCORT 2 PROCTOCREAM-HC 2 PROCTOFOAM 2 PROCTOFOAM HC 2 PROCTO-PAK 1 PROCTOSOL HC 1 PROCTOZONE-HC 1 promethazine rectal 1 PROMETHEGAN 1 propantheline 1 PROTONIX INTRAVENOUS 2 PROTONIX ORAL TABLET,DELAYED RELEASE 2 (DR/EC) PYLERA 2 QUADRAPAX 1 rabeprazole 1 QL (1 EA per 1 day) ranitidine hcl 1 RAVICTI 2 PA READY-TO-USE ENEMA 1 READY-TO-USE ENEMA (MIN OIL) 1 RECTIV 2 REGLAN ORAL 2 REGULOID 1
108 Drug Name Tier Notes REGULOID, SUGAR FREE 1 REMICADE 2 RESTORA RX 2 RESTORA SPRINKLES 2 RI-MAG PLUS 1 ROBINUL 2 ROBINUL FORTE 2 ROWASA 2 RULOX 2 SANCUSO 2 ST; QL (1 EA per 7 days) SANI-SUPP (ADULT) 1 SANI-SUPP (CHILD) 1 SANI-SUPP (INFANT) 1 scopolamine hbr 1 SENEXON 1 SENEXON-S 1 SENNA LAX 1 SENNA LAXATIVE ORAL TABLET 25 MG, 8.6 MG 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 2 SENOKOT TO GO 2 SENOKOT-S 1 SENOKOTXTRA 2 SFROWASA 2 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 SOF-LAX 2 STOMACH RELIEF 1 STOMACH RELIEF MAX STRENGTH 1
109 Drug Name Tier Notes STOMACH RELIEF ORIGINAL 1 STOOL SOFTENER ORAL CAPSULE 100 MG, 240 MG, 1 250 MG STOOL SOFTENER-LAXATIVE 1 STOOL SOFTENER-STIMULANT LAXAT 1 SUCLEAR 2 sucralfate oral tablet 1 sulfasalazine 1 SULFAZINE 1 SULFAZINE EC 1 SUPERIOR DIGESTIVE ENZYME 2 SUPREP BOWEL PREP KIT 2 SYMAX FASTABS 2 SYMAX-SL 2 TIGAN INTRAMUSCULAR 2 TIGAN ORAL CAPSULE 300 MG 2 TRANSDERM-SCOP 2 TRAVEL SICKNESS 1 TRAVEL SICKNESS (MECLIZINE) 1 TRILYTE WITH FLAVOR PACKETS 1 trimethobenzamide intramuscular solution 1 trimethobenzamide oral 1 TUMS 2 TUMS E-X 2 TUMS EXTRA STRENGTH SMOOTHIES 2 TUMS FRESHERS 2 TUMS ULTRA ORAL TABLET,CHEWABLE 1,177 MG 1 TUMS ULTRA ORAL TABLET,CHEWABLE 400 MG 2 (1,000 MG) ULTRA STRENGTH ANTACID 1 ULTRESA 2 URSO 250 2 URSO FORTE 2 ursodiol 1 VARUBI 2 VASCEPA 2 QL (4 EA per 1 day) VIOKACE 2 VISICOL 2 WAL-MUCIL FIBER (ASPARTAME) 2 WAL-MUCIL FIBER (SUGAR) 2 WAL-ZAN 75 1 WOMEN'S GENTLE LAXATIVE(BISAC) 1 WOMEN'S LAXATIVE (BISACODYL) ORAL TABLET 1 ZANTAC 75 2
110 Drug Name Tier Notes ZANTAC INJECTION 2 ZANTAC MAXIMUM STRENGTH 2 ZANTAC ORAL TABLET 2 ZEGERID ORAL CAPSULE 2 ST; QL (1 EA per 1 day) ZENPEP 2 ZOFRAN (AS HYDROCHLORIDE) INTRAVENOUS 2 ZOFRAN (AS HYDROCHLORIDE) ORAL SOLUTION 2 QL (50 ML per 15 days) ZOFRAN (AS HYDROCHLORIDE) ORAL TABLET 2 ZOFRAN ODT 2 ZUPLENZ ORAL FILM 8 MG 2 ST; QL (1 EA per 3 days) ZYPRAM 2 HERBALS alfalfa oral tablet 600 mg, 650 mg 2 aloe vera oral 2 ANAMU ORAL CAPSULE 450 MG 2 ANTI-NAUSEA GINGER 2 arnica 2 asafetida 2 AZO BLADDER CONTROL 2 AZO CRANBERRY 2 AZO CRANBERRY + PROBIOTIC 2 bilberry 2 bilberry fruit extract 2 black cohosh oral capsule 40 mg, 540 mg 2 black cohosh root extract oral capsule 160 mg 2 blue-green algae (spirulina) 2 calcium-cranberry fruit 2 CARDIO TEA 2 catnip 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 cranberry conc-ascorbic acid oral capsule 4,200-20 mg 2 CRANBERRY CONCENTRATE ORAL CAPSULE 2 140-100 MG cranberry extract oral capsule 200 mg, 425 mg 2 cranberry extract oral tablet 300 mg 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
111 Drug Name Tier Notes CRAN-MAX 500 MG 2 DETOX DIETARY 2 DETOXAREX 2 DIURETIC 2 ECHINACEA & GOLDENSEAL ORAL TABLET 2 ECHINACEA 1X 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 180-45 mg, 350-100 mg 2 echinacea-golden seal roots 2 ELLURA 2 EVENING PRIMROSE 2 evening primrose oil 2 flaxseed oil 2 flaxseed oral powder 2 GARLIC OIL ORAL CAPSULE 1,000 MG 2 garlic oral capsule , 2,000 mg, 345 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 2 ginkgo biloba 2 ginkgo biloba extract 2 ginkgo biloba leaf extract oral capsule 30 mg, 60 mg 2 ginkgo biloba-ginkgo biloba ex 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 ORAL TABLET 1,000 MG 2 green tea leaf ext-green tea 2 GREEN TEA ORAL CAPSULE 2 green tea-hoodia gordonii 2 hawthorn 2 IBGARD 2 IMUHANCE 2 INFLUDO 2 INNERMOST NATURE FOR MEN 2
112 Drug Name Tier Notes kava root extract 2 KOREAN GINSENG 2 korean ginseng root extract 2 lavender oil 2 licorice 2 LINSEED OIL 2 LIVER COMPLEX 2 MARJORAM 2 MILK THISTLE EXTRACT 2 milk thistle oral capsule 150 mg, 200 mg 2 milk thistle oral tablet 2 milk thistle seed extract oral capsule 175 mg, 200 mg, 87.5 2 mg myrrh 2 NATURAL HERBAL DIURETIC 2 NONI 2 ODOR FREE GARLIC ORAL TABLET 100 MG 2 ODORLESS GARLIC ORAL CAPSULE 2 ODORLESS GARLIC ORAL TABLET 1250 MG 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 & 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 TART CHERRY EXTRACT 2 THERACRAN HP FOR KIDS 2 TOTAL BODY CLEANSE 2
113 Drug Name Tier Notes 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 HORMONES ACTHAR H.P. 2 ACTHREL 2 ACTIVELLA 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 1.25 GRAM/ ACTUATION (1 2 PA; QL (300 GM per 30 days) %) ANDROGEL TRANSDERMAL GEL IN 2 PA; QL (5 GM per 1 day) METERED-DOSE PUMP 20.25 MG/1.25 GRAM (1.62 %) ANDROGEL TRANSDERMAL GEL IN PACKET 1 % 2 PA; QL (5 GM per 1 day) (25 MG/2.5GRAM), 1.62 % (40.5 MG/2.5 GRAM) ANDROGEL TRANSDERMAL GEL IN PACKET 1 % 2 PA; QL (300 GM per 30 days) (50 MG/5 GRAM) ANDROGEL TRANSDERMAL GEL IN PACKET 1.62 % 2 PA; QL (1.25 GM per 1 day) (20.25 MG/1.25 GRAM) ANDROID 2 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) AYGESTIN 2 BAYCADRON 1 betamethasone acet,sod phos 1 budesonide oral 1 cabergoline 1 calcitonin (salmon) 1 CELESTONE SOLUSPAN 2 CENESTIN ORAL TABLET 0.3 MG, 0.625 MG, 0.9 MG, 2 1.25 MG CERVIDIL 2 CLIMARA 2 QL (1 EA per 7 days) CLIMARA PRO 2 QL (1 EA per 7 days) COLOCORT 1
114 Drug Name Tier Notes COMBIPATCH 2 QL (2 EA per 7 days) CORTEF 2 CORTENEMA 2 CORTIFOAM 2 cortisone 1 CORTROSYN 2 cosyntropin injection 1 COVARYX 1 COVARYX H.S. 1 CRINONE VAGINAL GEL 4 % 2 danazol oral 1 DDAVP 2 DELATESTRYL 2 PA; QL (5 EA per 30 days) DELESTROGEN 2 DEPO-ESTRADIOL 2 DEPO-MEDROL 2 DEPO-PROVERA INTRAMUSCULAR SOLUTION 2 DEPO-TESTOSTERONE INTRAMUSCULAR OIL 100 2 PA; QL (10 ML per 30 days) MG/ML desmopressin injection 1 desmopressin nasal 1 desmopressin oral 1 dexamethasone 1 DEXAMETHASONE INTENSOL 2 dexamethasone sodium phos (pf) 1 dexamethasone sodium phosphate injection solution 1 DEXPAK 10 DAY 2 DEXPAK 13 DAY 2 DEXPAK 6 DAY 2 DIVIGEL 2 DUAVEE 2 EEMT 1 EEMT HS 1 EGRIFTA 2 PA; QL (2 EA per 1 day) ELESTRIN 2 ENJUVIA ORAL TABLET 0.3 MG, 0.45 MG, 0.9 MG, 2 1.25 MG ENTOCORT EC 2 ESTRACE 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 1 estradiol-norethindrone acet 1
115 Drug Name Tier Notes ESTRING 2 QL (1 EA per 90 days) estrogens-methyltestosterone 1 estropipate 1 EVAMIST 2 FEMHRT LOW DOSE 2 FEMRING 2 QL (1 EA per 84 days) FLO-PRED 2 fludrocortisone 1 FORTESTA 2 PA; QL (4 GM per 1 day) FORTICAL 2 GENOTROPIN 2 PA GENOTROPIN MINIQUICK 2 PA HEMABATE 2 HUMATROPE 2 PA hydrocortisone oral 1 hydrocortisone rectal enema 1 INCRELEX 2 PA JINTELI 1 KENALOG INJECTION 2 LOPREEZA 1 LUPANETA PACK (1 MONTH) 2 LUPANETA PACK (3 MONTH) 2 LUPRON DEPOT (3 MONTH) INTRAMUSCULAR 2 SYRINGE KIT 11.25 MG LUPRON DEPOT INTRAMUSCULAR SYRINGE KIT 2 3.75 MG LUPRON DEPOT-PED 2 LUPRON DEPOT-PED (3 MONTH) 2 MAKENA 2 MEDROL 2 MEDROL (PAK) 2 medroxyprogesterone oral 1 melatonin oral tablet 3 mg 1 melatonin oral tablet,disintegrating 3 mg 1 melatonin sublingual tablet 10 mg 1 melatonin-lemon balm leaf extr 1 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 1 mg, 40 mg methylprednisolone sodium succ intravenous 1
116 Drug Name Tier Notes methyltestosterone oral capsule 1 MIACALCIN 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 NORDITROPIN NORDIFLEX 2 PA norethindrone acetate 1 norethindrone ac-eth estradiol oral tablet 0.5-2.5 mg-mcg, 1 1-5 mg-mcg NUTROPIN 2 PA NUTROPIN AQ NUSPIN 2 PA NUTROPIN AQ SUBCUTANEOUS CARTRIDGE 2 PA octreotide acetate 1 OMNITROPE 2 PA ORAPRED 2 ORAPRED ODT 2 oxandrolone 1 PA oxytocin injection solution 2 PEDIAPRED 2 PITOCIN 2 PITRESSIN 2 prednisolone oral solution 15 mg/5 ml 1 prednisolone sodium phosphate oral solution 15 mg/5 ml, 1 25 mg/5 ml (5 mg/ml), 5 mg base/5 ml (6.7 mg/5 ml) 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 PROMETRIUM 2 PROSTIN E2 2 PROVERA 2
117 Drug Name Tier Notes RAYOS 2 ST SAIZEN 2 PA SAIZEN CLICK.EASY 2 PA SANDOSTATIN 2 SANDOSTATIN LAR DEPOT 2 SEROSTIM SUBCUTANEOUS RECON SOLN 4 MG, 5 2 PA MG, 6 MG SIGNIFOR 2 PA SIGNIFOR LAR 2 SOLU-CORTEF 2 SOLU-CORTEF (PF) 2 SOLU-MEDROL 2 SOLU-MEDROL (PF) 2 SOMATULINE DEPOT 2 STIMATE 2 STRIANT 2 PA; QL (2 EA per 1 day) SUPPRELIN LA 2 SYNAREL 2 TESTIM 2 PA; QL (300 GM per 30 days) TESTOPEL 2 testosterone cypionate intramuscular oil 100 mg/ml 1 PA; QL (10 ML per 30 days) testosterone enanthate 1 PA; QL (5 ML per 30 days) testosterone transdermal gel 1 PA; QL (300 GM per 30 days) testosterone transdermal gel in metered-dose pump 1.25 1 PA; QL (300 GM per 30 days) gram/ actuation (1 %) testosterone transdermal gel in metered-dose pump 10 1 PA; QL (4 GM per 1 day) 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) TESTRED 2 triamcinolone acetonide injection 1 UCERIS ORAL 2 VAGIFEM 2 vasopressin 1 VASOSTRICT 2 VERIPRED 20 2 VIVELLE-DOT 2 QL (2 EA per 7 days) VOGELXO 2 PA; QL (300 GM per 30 days) ZOMACTON 2 PA ZORBTIVE 2 PA IMMUNOSUPPRESANT ACTEMRA INTRAVENOUS 2 ACTEMRA SUBCUTANEOUS 2 PA ASTAGRAF XL 2 AZASAN 2 118 Drug Name Tier Notes azathioprine 1 CELLCEPT 2 CELLCEPT INTRAVENOUS 2 cyclosporine intravenous 1 cyclosporine modified 1 cyclosporine oral 1 ELIDEL 2 ST GENGRAF 1 HECORIA 2 IMURAN 2 mycophenolate mofetil 1 mycophenolate sodium 1 MYFORTIC 2 NEORAL 2 NULOJIX 2 ORTHOCLONE OKT3 2 PROGRAF 2 PROTOPIC TOPICAL OINTMENT 0.03 % 2 ST RAPAMUNE 2 SANDIMMUNE 2 SIMULECT 2 sirolimus 1 STELARA SUBCUTANEOUS SYRINGE 2 PA tacrolimus oral 1 tacrolimus topical 1 ST ZORTRESS 2 MISCELLANEOUS MEDICAL SUPPLIES, DEVICES, NON-DRUG 1ST TIER UNIFINE PENTIPS 2 1ST TIER UNIFINE PENTIPS PLUS 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 2 adhesive bandage-adhes remov#1 2 ADHESIVE GAUZE PAD 2 ADHESIVE PADS 2 adhesive remover 2 adhesive tape 2 ADVANCED ANTIBACTERIAL BANDAGE 2
119 Drug Name Tier Notes 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 AGIE-GRX 2 ALLEVYN ADHESIVE DRESSING TOPICAL 2 BANDAGE 9 X 9 " ALLEVYN CAVITY DRESSING 2 ALLEVYN CAVITY WOUND DRESS 2 ALLEVYN PLUS ADHESIVE 2 ALLEVYN SACRUM DRESSING 2 ALLEVYN TOPICAL BANDAGE 6 X 5.375 " 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 2 5.5 ", 8 X 7 " AQUAFLO 2 ARCH BANDAGE 2 ARGLAES 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
120 Drug Name Tier Notes BAND-AID BUTTERFLY CLOSURE 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 BARD TWO-SIDED ADHESIVE STRIP 2 BD AUTOSHIELD DUO PEN NEEDLE 2 BD AUTOSHIELD PEN NEEDLE 2 BD ECLIPSE LUER-LOK SYRINGE 1 ML 30 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 BD 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 X 2 5/8" BD ULTRA-FINE NANO PEN NEEDLES 2 BIATAIN HEEL ADH FOAM DRESSING 2
121 Drug Name Tier Notes 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 BLISTERFILM DRESSING 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 CAMO BANDAGES 2 CARBOFLEX ODOR CONTROL DRESSIN 2 CAREFINE PEN NEEDLE 2 CAREONE ULTIGUARD 2 CARRASYN HYDROGEL WOUND DRESS 2 CHEMSTRIP (CALIBRATION) 2 CLEAR BANDAGES 2 CLEAR SPOT BANDAGES 2 CLEAR STRIPS 2 CLEAR TAPE 2 CLEAR WATERPROOF STRIPS 2 CLERZ PLUS 2 CLICKFINE 2 CLOTH FIRST AID TAPE 2
122 Drug Name Tier Notes 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 CURASOL HYDROGEL DRESSING 2 CURASOL WOUND DRESSING 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 CURITY COTTON TIP APPLICATOR 2 CURITY COVER 2 CURITY DETECTABLE LAP 2 CURITY DISP LAP SPONGE POUCH 2 CURITY DISP LAP SPONGE TRAY 2
123 Drug Name Tier Notes CURITY DRESSING TOPICAL BANDAGE 4 1/2 X 3600 2 ", 9 X 100 "-YARD 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 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 INSULIN SAFETY SYR 2 EASY TOUCH INSULIN SYRINGE 2 EASY TOUCH NEEDLE 2 elastic bandage 2 ELASTO-GEL 2 ELASTO-GEL CAST-SPLINT PADDING 2 ELASTO-GEL CIRCLE DRESSING 2
124 Drug Name Tier Notes ELASTO-GEL FACE DRESSING 2 ELASTO-GEL PLUS 2 EVERYDAY LONG PANTILINERS 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 FINGER SLEEVES 2 FIRST AID CLOTH TAPE 2 FIRST AID HURT-FREE WRAP 2 FIRST AID PAPER TAPE 2 FLEXIBLE 2 FLEXIBLE FABRIC BANDAGES 2 FLEXIBLE FOAM 2 FLEXICHAMBER 2 FLEXIGEL 2 FLEXZAN WOUND DRESSING TOPICAL BANDAGE 2 2 X 3 ", 4 X 8 "
125 Drug Name Tier Notes 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 GLUCOPRO 2 GRX FOAM DRESSING 2 GRX HYDROGEL GAUZE 2 GRX WOUND GEL 2 HEALTHY ACCENTS UNIFINE PENTIP 2 HEAT THERAPY 2 HEATWRAPS 2 HEATWRAPS BACK & HIP PADS 2 HEAVY DUTY FABRIC STRIPS 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 INS SYRINGE/NEEDLE 0.5CC/27G 2 INSPIRACHAMBER 2 INSPIRACHAMBER WITH MASK-MED 2 INSPIRACHAMBER WITH MASK-SMALL 2 INSULIN SYRINGE MICROFINE 2 insulin syringe needleless 2 INSULIN SYRINGE SYRINGE 1 ML 28 X 1/2", 1 ML 29 X 1/2", 1 ML 30 X 5/16", 1/2 ML 28 X 1/2", 1/2 ML 29 X 2 1/2", 1/2 ML 30 X 5/16" INSULIN SYRINGE ULTRAFINE 2 insulin syringe-needle u-100 2 insulin syringes (disposable) 2 INSUPEN 2 INTERSORB 2 INTRASITE GEL DRESSING 2
126 Drug Name Tier Notes ISLAND GARD-GRX 2 IV 3000 2 IV3000 FRAME DELIVERY DRESSING 2 J & J FIRST AID TAPE PAPER 2 J & J NON-STICK PADS LARGE 2 J & J NON-STICK PADS MEDIUM 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 KLING ROLLS 2 KOTEX FRESH & DRY 2 KOTEX OVERNIGHT 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 LUBRICATING & REWETTING 2 MAGELLAN INSULIN SAFETY SYRNG 2 MAGELLAN SYRINGE SYRINGE 0.3 ML 30 X 5/16", 2 0.5 ML 30 X 5/16" MAXI DEODORANT 2 MAXI PAD REGULAR 2 MAXI PAD SUPER 2 MAXI-COMFORT INSULIN SYRINGE 2 MAXI-PADS 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
127 Drug Name Tier Notes MEDIPORE SOFT CLOTH TAPE 2 MEFIX 2 MEPILEX BORDER 2 MEPILEX BORDER SACRUM 2 MEPITEL 2 MICROCHAMBER 2 MICROFOAM SURGICAL 2 MICROPORE SURGICAL 2 MICROSPACER 2 MICROSPONGE 2 MINI ULTRA-THIN II 2 MIRASORB 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 2 MONOJECT ULTRA COMFORT INSULIN 2 MOUTHPIECE 2 MPM FOAM DRESSING TOPICAL BANDAGE 4 X 4 ", 2 6 X 6 " MULTIPURPOSE CONTACT LENS 2 MULTI-PURPOSE SOFT CONTACT LEN 2 NATURAL CARE BANDAGES 2 NESSI SPACER 2 NEW GENERATION 2 NEXCARE GENTLE PAPER TAPE 2 NEXCARE TEGADERM 2 non-adherent bandage 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 FLOW SPIROMETER PC CABLE 2 ONE FLOW SPIROMETER SOFTWARE 2 ONE FLOW TESTER MOUTHPIECE 2 ONE STEP AT A TIME 2 ONE WAY VALVED MOUTHPIECE 2
128 Drug Name Tier Notes OPSITE 2 OPSITE ADHESIVE DRESSING 2 OPSITE FLEXIFIX 2 OPSITE FLEXIGRID 2 OPSITE FLEXIGRID DRESSING 2 OPSITE IV 3000 2 OPTICHAMBER ADULT MASK-LARGE 2 OPTICHAMBER ADVANTAGE 2 OPTICHAMBER ADVANTAGE-LG MASK 2 OPTICHAMBER ADVANTAGE-MED MASK 2 OPTICHAMBER ADVANTAGE-SML MSK 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 ORSINI INSULIN SYRINGE 2 PAIN FREE TAPE 2 PAIN FREE WRAP 2 PANDA MASK 2 PANTILINERS 2 PAPER TAPE 2 PAPER TAPE, HYPOALLERGENIC 2 PEDIATRIC MEDIUM MASK 2 PEDIATRIC PANDA MASK 2 PEDIATRIC SMALL MASK 2 PEDI-PRE 2 PEDI-PRE TAPE SPRAY 2 PEDI-SKIN ADHERENT #2 2 PEN NEEDLE 2 pen needle, diabetic needle 29 gauge x 1/2", 31 gauge x 2 1/3", 31 gauge x 1/4", 31 gauge x 1/6", 31 gauge x 5/16" PENTIPS 2 PETROLATUM GAUZE 2 PFLEX INSPIRATORY TRAINER 2 PLASTIC STRIPS 2 PLASTIC SWABS 2 POCKET CHAMBER 2 POLYSKIN II 2 POWER CLEANER 2 PRIMAPORE IV 2
129 Drug Name Tier Notes PRIMEAIRE 2 PRIMER MODIFIED UNNA BOOT 2 PRO SPORTS TAPE 2 PROCHAMBER 2 PRODIGY INSULIN SYRINGE 2 PRODIGY PEN NEEDLE 2 PURE COTTON 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 2 RESTORE CONTACT LAYER SILVER 2 RESTORE DUO 2 RESTORE FOAM HEEL DRESSING 2 RESTORE HYDROGEL DRESSING 2 RESTORE HYDROGEL GAUZE 2 RESTORE HYDROGEL GAUZE SPONGE 2 RESTORE ODOR-ABSORBENT BANDAGE 6 X 10 " 2 RESTORE TOPICAL BANDAGE 2 1/2 X 2 1/2 ", 2 X 2 ", 2 4 X 4 ", 4 X 5 ", 8 X 12 " RESTORE TRIO 2 RITEFLO AEROCHAMBER 2 ROLLED ABSORBENT COTTON 2 ROLLED GAUZE 2 RONDIC 2 SAFESNAP INSULIN SYRINGE 2 SAF-GEL 2 SALINE 4 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
130 Drug Name Tier Notes SELFGRIP 2 SELF-GRIP 2 SENSI-CARE ADHESI REMOVER WIPE 2 SENSITIVE EYES 2 SENSITIVE EYES DAILY CLEANER 2 SENSITIVE EYES PLUS SALINE 2 SENSODYNE 2 SHEER ADHESIVE 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 2 SOLOSITE WOUND GEL 2 SOOTHING NON-STICK 2 SORESPOT 2 SPACE CHAMBER PLUS 2 SPECTRAGEL 2 SPORTS TAPE 2 STAYFREE MAXI-PAD 2 STAYFREE SUREFIT 2 STAYFREE ULTRA THIN 2 STERILE GAUZE PAD 2 STERILE PADS 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
131 Drug Name Tier Notes STRONG STRIPS 2 STRONG STRIPS X-LARGE 2 SUPER STRIP BANDAGES 2 SURE COMFORT INS. SYR. U-100 2 SURE COMFORT INSULIN SYRINGE 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 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 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 INS SYRINGE 0.5CC/27G 2 TERUMO INSULIN SYRINGE 2 THERMACARE KNEE/ELBOW 2
132 Drug Name Tier Notes THERMACARE LARGE/XLGE BACK/HIP 2 THERMACARE MENSTRUAL 2 THERMACARE NECK/WRIST/SHOULDER 2 THERMACARE SMALL/MED BACK/HIP 2 THINPRO INSULIN SYRINGE 2 THONG LINER 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 NEEDLE 2 ULTICARE SYRINGE 0.3 ML 29 X 1/2", 0.3 ML 30 X 1/2", 0.3 ML 30 X5/16 ", 0.3 ML 31 X 5/16", 1 ML 29 X 1/2", 1 ML 30 X 1/2", 1 ML 30 X 5/16 ", 1 ML 31 X 5/16", 2 1/2 ML 29 X 1/2 ", 1/2 ML 30 X 1/2", 1/2 ML 31 X 5/16", 1/2 ML30 X 5/16 " ULTILET INSULIN SYRINGE 2 ULTILET PEN NEEDLE 2 ULTRA CMFT INS SYR HALF UNIT 2 ULTRA COMFORT INSULIN SYRINGE 2 ULTRACOMFORT 2 ULTRACOMFORT W/ CONTAINER 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 2 UNIVERSAL REMOVER WIPES 2 UNNA-FLEX ELASTIC UNNA BOOT 2 VANISHPOINT SYRINGE SYRINGE 1 ML 29 X 1/2", 2 1/2 ML 30 X 1/2"
133 Drug Name Tier Notes 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 2 1/4 ", 5 1/2 X 5 1/2 ", 7 1/2 X 7 1/2 ", 8 X 7 " VIASORB ABSORBENT DRESSING 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 WATCHHALER 2 WATER SHIELD BANDAGES 2 WATERPROOF STRONG STRIPS 2 WEBRIL 2 WEBRIL II 2 WINDMILL TRAINER 2 WOUNDGARD GAUZE 2 WOUN'DRES HYDROGEL WOUND DRESS 2 ZAROSEN DESENSITIZER 2 MUSCLE RELAXANTS AMRIX 2 baclofen 1 carisoprodol 1 carisoprodol-aspirin 1 chlorzoxazone 1 cyclobenzaprine oral tablet 1 DANTRIUM 2 dantrolene 1 FEXMID 2 GABLOFEN 2 LIORESAL 2 LORZONE 2 metaxalone 1 methocarbamol 1
134 Drug Name Tier Notes orphenadrine citrate injection 1 orphenadrine citrate oral 1 PARAFON FORTE DSC 2 REVONTO 1 ROBAXIN 2 ROBAXIN-750 2 RYANODEX 2 SKELAXIN 2 SOMA 2 tizanidine 1 ZANAFLEX 2 PRE-NATAL VITAMINS ACTIVE OB 2 BAL-CARE DHA 1 BAL-CARE DHA ESSENTIAL 1 B-NEXA 2 CALCIUM PNV 1 CAVAN-ALPHA KIT 1 CAVAN-EC SOD DHA 1 CITRANATAL (DUAL-IRON) 2 CITRANATAL 90 DHA (ALGAL OIL) 2 CITRANATAL 90 DHA (NEW FORMULA 2 CITRANATAL ASSURE 2 CITRANATAL B-CALM (FE GLUC) 2 CITRANATAL DHA (ALGAL OIL) 2 CITRANATAL DHA (NEW FORMULA) 2 CITRANATAL HARMONY 2 CITRANATAL HARMONY (IRON FUM) 2 CITRANATAL RX (NEW FORMULA) 2 C-NATE DHA 1 COMPLETE NATAL DHA 2 COMPLETENATE 1 CONCEPT DHA 2 CONCEPT OB 2 DOTHELLE DHA 1 DUET DHA EC-OM 3 2 DUET DHA WITH OMEGA-3 2 ELITE-OB ORAL TABLET 2 ENBRACE HR 2 EXTRA-VIRT PLUS DHA 1 FOCALGIN 90 DHA 1 FOCALGIN CA 1 FOLCAL DHA 1 FOLCAPS OMEGA-3 (ASPARTO-GLY) 1
135 Drug Name Tier Notes FOLIVANE-OB 1 FOLIVANE-PRX DHA NF 1 GESTICARE DHA 2 HEMENATAL OB 1 HEMENATAL OB + DHA 1 INATAL ADVANCE 1 INATAL ULTRA 1 MARNATAL-F 1 NATA KOMPLETE 2 NATAFORT (NEW FORMULA 2011) 2 NATELLE ONE 2 NESTABS 2 NESTABS ABC 2 NESTABS DHA 2 NEXA PLUS 2 NEXA SELECT ORAL CAPSULE 29 MG IRON- 1.25 2 MG-55 MG NIVA-PLUS 1 NUTRI-TAB OB 1 NUTRI-TAB OB + DHA 1 OB COMPLETE 2 OB COMPLETE 400 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 FOLIC ACID + IRON 1 PNV OB+DHA ORAL COMBO PACK 27-1-50-250 MG 2 PNV-DHA 1 PNV-FERROUS FUMARATE-DOCU-FA 1 PNV-FIRST 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 2 PREFERA-OB ONE 2 PREFERA-OB PLUS DHA 2
136 Drug Name Tier Notes PRENAISSANCE 1 PRENAISSANCE PLUS 1 PRENATA 2 PRENATAL PLUS (CALCIUM CARB) 1 PRENATAL PLUS WITH IRON (CA) 1 PRENATAL WITH DHA & FOLIC ACID 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 PRENEXA 2 PREPLUS 1 PREQUE 10 2 PRETAB 1 PROVIDA DHA 2 PROVIDA OB 2 PUREFE OB PLUS 1 PUREFE PLUS 1 REAPHIRM 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-BC 1 TARON-C DHA 1 TARON-PREX PRENATAL-DHA 1 TL FOLATE 1 TL-CARE DHA 1 TL-SELECT 1 TL-SELECT DHA 1
137 Drug Name Tier Notes TRIADVANCE 1 TRICARE 2 TRICARE PRENATAL COMPLEAT 2 TRICARE PRENATAL DHA ONE 2 TRINATAL GT 1 TRINATAL RX 1 2 TRINATAL ULTRA 1 TRISTART DHA 2 TRIVEEN-DUO DHA 1 TRIVEEN-PRX RNF 1 ULTIMATE OB DHA 1 ULTIMATECARE ONE 1 ULTIMATECARE ONE NF 1 VEMAVITE-PRX-2 1 VENA-BAL DHA 1 VINATE GT 1 VIRT NATE 1 VIRT-ADVANCE 1 VIRT-BAL DHA PLUS 1 VIRT-C DHA 1 VIRT-CARE ONE 1 VIRT-NATE 1 VIRT-PN 1 VIRT-PN DHA 1 VIRT-PN PLUS 1 VIRTPREX 1 VIRT-SELECT 1 VIRT-VITE GT 1 VITAFOL NANO 1 VITAFOL ULTRA 2 VITAFOL-OB 2 VITAFOL-OB+DHA 1 VITAFOL-ONE 2 VITAFOL-PLUS 2 VIVA CT 1 V-NATAL 1 VOL-NATE 1 VOL-PLUS 1 VP CH ULTRA 1 VP-CH PLUS 1 VP-CH-PNV 1 VP-GGR-B6 1 VP-HEME OB 1 VP-HEME ONE 1
138 Drug Name Tier Notes VP-PNV-DHA 1 ZATEAN-CH 1 ZATEAN-PN 1 ZATEAN-PN DHA 1 ZATEAN-PN PLUS 1 ZINGIBER 1 PSYCHOTHERAPEUTIC DRUGS ABILIFY DISCMELT ORAL 2 QL (3 EA per 1 day) TABLET,DISINTEGRATING 10 MG ABILIFY DISCMELT ORAL 2 QL (2 EA per 1 day) TABLET,DISINTEGRATING 15 MG ABILIFY INTRAMUSCULAR 2 ABILIFY MAINTENA 2 ABILIFY ORAL SOLUTION 2 QL (30 ML per 1 day) ABILIFY ORAL TABLET 10 MG, 15 MG, 2 MG, 30 MG 2 QL (1 EA per 1 day) ABILIFY ORAL TABLET 20 MG, 5 MG 2 QL (2 EA per 1 day) ADASUVE 2 alprazolam 1 ALPRAZOLAM INTENSOL 2 amitriptyline 1 amitriptyline-chlordiazepoxide 1 amoxapine 1 ANAFRANIL 2 APLENZIN 2 QL (1 EA per 1 day) APTENSIO XR 2 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, 5 mg 1 QL (2 EA per 1 day) aripiprazole oral tablet,disintegrating 10 mg 1 QL (3 EA per 1 day) aripiprazole oral tablet,disintegrating 15 mg 1 QL (2 EA per 1 day) ARISTADA 2 ATIVAN ORAL 2 BRINTELLIX 2 QL (1 EA per 1 day) BRISDELLE 2 ST; QL (1 EA per 1 day) bupropion hcl oral tablet 1 bupropion hcl oral tablet extended release 100 mg, 200 mg 1 bupropion hcl oral tablet extended release 24 hr 1 buspirone 1 CELEXA ORAL TABLET 2 chlordiazepoxide hcl 1 chlorpromazine 1 citalopram 1 clomipramine 1 clonidine hcl oral tablet extended release 12 hr 1 QL (120 EA per 30 days)
139 Drug Name Tier Notes clorazepate dipotassium 1 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 1 QL (3 EA per 1 day) mg, 25 mg CLOZARIL ORAL TABLET 100 MG 2 QL (6 EA per 1 day) CLOZARIL ORAL TABLET 25 MG 2 QL (3 EA per 1 day) CONCERTA ORAL TABLET EXTENDED RELEASE 2 QL (1 EA per 1 day) 24HR 18 MG, 27 MG, 54 MG CONCERTA ORAL TABLET EXTENDED RELEASE 2 QL (2 EA per 1 day) 24HR 36 MG CYMBALTA 2 QL (2 EA per 1 day) DAYTRANA 2 QL (1 EA per 30 days) desipramine oral 1 desvenlafaxine fumarate oral tablet extended release 24hr 2 QL (2 EA per 1 day) 100 mg desvenlafaxine fumarate oral tablet extended release 24hr 2 QL (1 EA per 1 day) 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 diazepam oral tablet 1 doxepin oral 1 droperidol injection solution 1 duloxetine 1 QL (2 EA per 1 day) EFFEXOR XR 2 EMSAM 2 QL (1 EA per 1 day) EQUETRO 2 escitalopram oxalate 1 FANAPT 2 QL (2 EA per 1 day) FAZACLO ORAL TABLET,DISINTEGRATING 100 MG 2 QL (6 EA per 1 day) FAZACLO ORAL TABLET,DISINTEGRATING 12.5 2 QL (3 EA per 1 day) MG, 150 MG, 200 MG, 25 MG FETZIMA 2 QL (1 EA per 1 day) fluoxetine oral capsule 1 fluoxetine oral capsule,delayed release(dr/ec) 1 fluoxetine oral solution 1 fluoxetine oral tablet 10 mg, 20 mg 1 140 Drug Name Tier Notes fluoxetine oral tablet 60 mg 2 fluphenazine decanoate 1 fluphenazine hcl 1 fluvoxamine oral capsule,extended release 24hr 1 QL (2 EA per 1 day) fluvoxamine oral tablet 1 FOCALIN ORAL TABLET 10 MG 2 QL (4 EA per 1 day) FOCALIN ORAL TABLET 2.5 MG, 5 MG 2 QL (2 EA per 1 day) FOCALIN XR 2 QL (1 EA per 1 day) FORFIVO XL 2 QL (1 EA per 1 day) GEODON INTRAMUSCULAR 2 GEODON ORAL CAPSULE 20 MG, 40 MG 2 QL (2 EA per 1 day) GEODON ORAL CAPSULE 60 MG, 80 MG 2 QL (3 EA per 1 day) guanfacine oral tablet extended release 24 hr 1 QL (1 EA per 1 day) HALDOL 2 HALDOL DECANOATE 2 haloperidol 1 haloperidol decanoate 1 haloperidol lactate 1 imipramine hcl 1 imipramine pamoate 1 INTUNIV ER 2 QL (1 EA per 1 day) INVEGA ORAL TABLET EXTENDED RELEASE 24HR 2 QL (1 EA per 1 day) 1.5 MG, 3 MG, 9 MG INVEGA ORAL TABLET EXTENDED RELEASE 24HR 2 QL (2 EA per 1 day) 6 MG INVEGA SUSTENNA 2 INVEGA TRINZA 2 IRENKA 2 QL (2 EA per 1 day) KAPVAY 2 QL (120 EA per 30 days) KHEDEZLA 2 QL (1 EA per 1 day) LATUDA ORAL TABLET 120 MG, 20 MG, 40 MG, 60 2 QL (30 EA per 30 days) MG LATUDA ORAL TABLET 80 MG 2 QL (60 EA per 30 days) LEXAPRO 2 lithium carbonate 1 lithium citrate oral solution 8 meq/5 ml 1 LITHOBID 2 LORAZEPAM INTENSOL 1 lorazepam oral 1 loxapine succinate 1 LOXITANE 2 LUVOX CR 2 QL (2 EA per 1 day) maprotiline 1 MARPLAN 2 meprobamate 1
141 Drug Name Tier Notes METADATE CD ORAL CAPSULE, ER BIPHASIC 30-70 2 QL (1 EA per 1 day) 10 MG, 20 MG, 40 MG, 50 MG, 60 MG METADATE CD ORAL CAPSULE, ER BIPHASIC 30-70 2 QL (2 EA per 1 day) 30 MG METHYLIN ORAL SOLUTION 2 METHYLIN ORAL TABLET,CHEWABLE 2 QL (90 EA per 30 days) methylphenidate oral capsule, er biphasic 30-70 10 mg, 20 1 QL (1 EA per 1 day) mg, 40 mg, 50 mg, 60 mg methylphenidate oral capsule, er biphasic 30-70 30 mg 1 QL (2 EA per 1 day) methylphenidate oral capsule,er biphasic 50-50 1 methylphenidate oral solution 1 methylphenidate oral tablet 1 QL (90 EA per 30 days) methylphenidate oral tablet extended release 10 mg 1 methylphenidate oral tablet extended release 20 mg 1 QL (90 EA per 30 days) methylphenidate oral tablet extended release 24hr 18 mg, 27 1 QL (1 EA per 1 day) mg, 54 mg methylphenidate oral tablet extended release 24hr 36 mg 1 QL (2 EA per 1 day) methylphenidate oral tablet,chewable 1 QL (90 EA per 30 days) mirtazapine 1 modafinil 1 NARDIL 2 nefazodone 1 NIRAVAM 2 NORPRAMIN 2 nortriptyline 1 NUVIGIL 2 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 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 olanzapine-fluoxetine 1 QL (1 EA per 1 day) OLEPTRO ER 2 QL (3 EA per 2 days) ORAP 2 oxazepam 1 paliperidone oral tablet extended release 24hr 1.5 mg, 3 mg, 1 QL (1 EA per 1 day) 9 mg paliperidone oral tablet extended release 24hr 6 mg 1 QL (2 EA per 1 day) PAMELOR 2 PARNATE 2 paroxetine hcl oral tablet 1 paroxetine hcl oral tablet extended release 24 hr 1 PAXIL 2
142 Drug Name Tier Notes PAXIL CR 2 perphenazine 1 perphenazine-amitriptyline 1 PEXEVA 2 QL (1 EA per 1 day) phenelzine 1 pimozide 1 PRISTIQ ORAL TABLET EXTENDED RELEASE 24 HR 2 QL (2 EA per 1 day) 100 MG PRISTIQ ORAL TABLET EXTENDED RELEASE 24 HR 2 QL (1 EA per 1 day) 25 MG, 50 MG protriptyline 1 PROVIGIL 2 PROZAC ORAL CAPSULE 2 PROZAC WEEKLY 2 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) QUILLIVANT XR 2 QL (12 ML per 1 day) REMERON 2 REMERON SOLTAB 2 REXULTI 2 RISPERDAL CONSTA 2 RISPERDAL M-TAB 2 QL (2 EA per 1 day) RISPERDAL ORAL SOLUTION 2 RISPERDAL ORAL TABLET 2 QL (2 EA per 1 day) risperidone oral solution 1 risperidone oral tablet 1 QL (2 EA per 1 day) risperidone oral tablet,disintegrating 1 QL (2 EA per 1 day) RITALIN 2 QL (90 EA per 30 days) RITALIN LA 2 SAPHRIS 2 QL (2 EA per 1 day) SAPHRIS (BLACK CHERRY) 2 QL (2 EA per 1 day) SARAFEM ORAL TABLET 10 MG, 20 MG 2 SEROQUEL ORAL TABLET 100 MG, 200 MG, 25 MG, 2 QL (3 EA per 1 day) 50 MG SEROQUEL ORAL TABLET 300 MG, 400 MG 2 QL (4 EA per 1 day) SEROQUEL XR ORAL TABLET EXTENDED RELEASE 2 QL (1 EA per 1 day) 24 HR 150 MG, 200 MG SEROQUEL XR ORAL TABLET EXTENDED RELEASE 2 QL (3 EA per 1 day) 24 HR 300 MG SEROQUEL XR ORAL TABLET EXTENDED RELEASE 2 QL (4 EA per 1 day) 24 HR 400 MG SEROQUEL XR ORAL TABLET EXTENDED RELEASE 2 QL (2 EA per 1 day) 24 HR 50 MG sertraline 1 STRATTERA ORAL CAPSULE 10 MG, 18 MG, 25 MG, 2 QL (60 EA per 30 days) 40 MG
143 Drug Name Tier Notes STRATTERA ORAL CAPSULE 100 MG, 60 MG, 80 MG 2 QL (30 EA per 30 days) SURMONTIL 2 SYMBYAX 2 QL (1 EA per 1 day) thioridazine 1 thiothixene 1 TOFRANIL 2 TOFRANIL-PM 2 TRANXENE T-TAB 2 tranylcypromine 1 trazodone 1 trifluoperazine 1 trimipramine 1 venlafaxine oral capsule,extended release 24hr 1 venlafaxine oral tablet 1 VERSACLOZ 2 QL (18 ML per 1 day) VIIBRYD 2 QL (1 EA per 1 day) VYVANSE 2 QL (1 EA per 1 day) WELLBUTRIN 2 WELLBUTRIN SR 2 WELLBUTRIN XL 2 XANAX 2 XANAX XR 2 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) ZOLOFT 2 ZYPREXA INTRAMUSCULAR 2 ZYPREXA ORAL TABLET 10 MG, 15 MG 2 QL (2 EA per 1 day) ZYPREXA ORAL TABLET 2.5 MG, 5 MG, 7.5 MG 2 ZYPREXA ORAL TABLET 20 MG 2 QL (3 EA per 1 day) ZYPREXA RELPREVV 2 ZYPREXA ZYDIS ORAL TABLET,DISINTEGRATING 2 QL (2 EA per 1 day) 10 MG, 15 MG ZYPREXA ZYDIS ORAL TABLET,DISINTEGRATING 2 QL (3 EA per 1 day) 20 MG ZYPREXA ZYDIS ORAL TABLET,DISINTEGRATING 2 5 MG SEDATIVE/HYPNOTICS AMBIEN 2 QL (1 EA per 1 day) AMBIEN CR 2 QL (1 EA per 1 day) AMYTAL 1 ATIVAN INJECTION 2 BELSOMRA 2 QL (1 EA per 1 day) BUTISOL ORAL TABLET 30 MG 2 dexmedetomidine 1 EDLUAR 2 QL (1 EA per 1 day) 144 Drug Name Tier Notes estazolam 1 eszopiclone 1 QL (1 EA per 1 day) flurazepam 1 HALCION ORAL TABLET 0.25 MG 2 HETLIOZ 2 PA INTERMEZZO 2 QL (1 EA per 1 day) lorazepam injection solution 4 mg/ml 1 lorazepam injection syringe 1 LUNESTA 2 QL (1 EA per 1 day) midazolam oral syrup 2 mg/ml 1 NIGHTTIME SLEEP AID (DIPHEN) 1 NYTOL 1 phenobarbital 1 phenobarbital sodium injection solution 1 PRECEDEX 2 PRECEDEX IN 0.9 % SODIUM CHLOR 2 RESTFULLY SLEEP 1 RESTORIL 2 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 1 50 MG SLEEP AID (DIPHENHYDRAMINE) ORAL TABLET 1 SLEEP AID (DOXYLAMINE) 1 SLEEP AID MAX STR (DIPHENHYDR) 1 SLEEP TIME 1 SLEEP-TABS 1 SONATA 2 QL (1 EA per 1 day) temazepam 1 triazolam 1 XYREM 2 zaleplon 1 QL (1 EA per 1 day) zolpidem 1 QL (1 EA per 1 day) ZOLPIMIST 2 Z-SLEEP 1 ZZZQUIL 2 SKIN PREPS 4-N-1 NO RINSE WASH 1 8-MOP 2 ABSORICA 2 ST ACANYA 2 acetic acid irrigation 1
145 Drug Name Tier Notes acitretin 1 ACLARO 2 ACLOVATE 2 ACNE MEDICATION TOPICAL GEL 10 % 1 ACNE MEDICATION TOPICAL LOTION 10 % 1 ACNE MEDICATION TOPICAL LOTION 5 % 2 ACNE TREATMENT (BENZOYL PEROX) TOPICAL 1 CREAM ACNEFREE ACNE CLEARING SYSTEM 1 ACNEFREE SEVERE ACNE CLEARING 2 ACZONE 2 adapalene topical cream 1 adapalene topical gel 1 adapalene topical gel with pump 1 ALA-QUIN 2 alclometasone 1 ALCOHOL PADS 2 ALCOHOL PREP PADS 2 ALCOHOL PREP SWABS 2 alcohol swabs 2 ALCOHOL WIPES 2 ALCORTIN A TOPICAL GEL IN PACKET 2 ALDARA 2 PA; QL (24 EA per 30 days) ALOE VESTA 2 ALOE VESTA BATHING CLOTHS 2 ALOE VESTA SKIN CONDITIONER 2 1 ALOQUIN 2 ALTABAX 2 ALUVEA 2 A-MANTLE 2 amcinonide 1 ammonium and potassium iodides 1 ammonium lactate topical 1 AMNESTEEM 1 AMPHADASE 2 ANALGESIC CREME 1 ANALPRAM-HC TOPICAL 2 ANTI-DANDRUFF 1 ANTI-DANDRUFF (COAL TAR) 1 ANTI-ITCH (DIPHENHYDRAMINE) TOPICAL 1 AEROSOL,SPRAY ANTI-ITCH (HC) TOPICAL CREAM 1 ANTI-ITCH(DIPHENHYD) WITH ZINC TOPICAL 1 AEROSOL,SPRAY
146 Drug Name Tier Notes ANTI-ITCH(DIPHENHYD) WITH ZINC TOPICAL 1 CREAM 2-0.1 % ANTISEPTIC GEL 2 APEXICON 2 APEXICON E 2 AQUA GLYCOLIC CLEANSER 2 ARGLAES TOPICAL POWDER 2 ARTHRICREAM 1 ARTHRICREAM RUB 1 ARTHRITIS 1 ARTHRITIS PAIN RELIEF(CAPSAIC) TOPICAL 1 CREAM 0.1 % ARTISS 2 ASTRINGENT 1 ATRALIN 2 AVEENO BABY TOPICAL CLEANSER 2 AVITA 1 AZELEX 2 BABY WASH 2 BANOPHEN ANTI-ITCH 1 BAZA CLEANSE & PROTECT TOPICAL LOTION 1 BAZA CLEANSE & PROTECT TOPICAL 1 SPRAY,NON-AEROSOL BAZA CLEAR 2 BAZA PROTECT 2 BD ALCOHOL SWABS 2 BEDSIDE-CARE 1 BEDSIDE-CARE PERINEAL 2 BENSAL HP TOPICAL OINTMENT 3 % 2 BENZACLIN 2 BENZACLIN PUMP 2 BENZEPRO (MICROSPHERES) 1 BENZEPRO TOPICAL FOAM 1 BENZOIN COMPOUND TOPICAL TINCTURE 10-2-8-4 1 % benzoyl peroxide topical cleanser 10 %, 5 %, 6 %, 7 % 1 benzoyl peroxide topical foam 1 benzoyl peroxide topical gel 10 %, 2.5 %, 5 % 1 benzoyl peroxide topical lotion 1 BETADINE 2 BETADINE SKIN CLEANSER 2 BETADINE SPRAY 2 BETADINE SURGICAL SCRUB 2 BETADINE SWABSTICKS 2 betamethasone dipropionate 1
147 Drug Name Tier Notes betamethasone valerate 1 betamethasone, augmented 1 BETASEPT SURGICAL SCRUB 1 BLUE GEL 1 BODI BATH 2 BODI CARE 2 BODI LINE ALMOND SKIN CARE 2 BP TOPICAL CLEANSER 1 BP TOPICAL LOTION 1 BP TOPICAL SUSPENSION 1 BP-50% UREA 1 BPO CREAMY WASH PACK 1 BPO TOPICAL TOWELETTE 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 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 CARLESTA 2 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 CETA-KLENZ GENTLE 2 CETAPHIL ANTIBACTERIAL 2 CETAPHIL DAILY FACIAL 2 CETAPHIL DERMACONTROL 2 CETAPHIL RESTORADERM TOPICAL CLEANSER 2 CETAPHIL TOPICAL CLEANSER 2 CHEST RUB 1 CHLOROPHYLL 2
148 Drug Name Tier Notes CLARAVIS 1 clindamycin-benzoyl peroxide 1 clobetasol 1 clobetasol-emollient 1 CLOBEX 2 clocortolone pivalate 1 CLODAN 2 CLODAN KIT 2 CLODERM 2 COLD & HOT PAIN RELIEF TOPICAL ADHESIVE 1 PATCH,MEDICATED COLD SORE TREATMNT (CAMP-PHEN) 1 COMPLETE LICE TREATMENT 1 CONDYLOX 2 CORDRAN TAPE LARGE ROLL 2 CORDRAN TAPE SMALL ROLL 2 CORMAX TOPICAL OINTMENT 1 CORMAX TOPICAL SOLUTION 1 CORTIZONE-10 TOPICAL CREAM 1 COSENTYX 2 PA COSENTYX (2 SYRINGES) 2 PA COSENTYX PEN 2 PA COSENTYX PEN (2 PENS) 2 PA CRITIC-AID CLEAR 2 CURITY ALCOHOL SWABS 2 CUTIVATE TOPICAL CREAM 2 CUTIVATE TOPICAL LOTION 2 DEL-CLENS 2 DEODORANT SOAP 2 DERMA STAT 2 DERMACINRX SILAZONE 2 DERMAL WOUND CLEANSER TOPICAL CLEANSER 2 DERMAL WOUND CLEANSER TOPICAL CLEANSER 1 0.13 % DERMASARRA 1 DERMASEPTIN 1 DERMA-SMOOTHE/FS BODY OIL 2 DERMA-SMOOTHE/FS SCALP OIL 2 DERMATOP 2 DESONATE 2 desonide 1 DESOWEN 2 desoximetasone 1 DESQUAM-X TOPICAL CLEANSER 10 % 2
149 Drug Name Tier Notes DHS TAR 2 DHS TAR GEL 2 DHS ZINC 1 DIAPER RASH RELIEF 1 DIAPER RASH TOPICAL OINTMENT 1 diclofenac sodium topical drops 1 DIFFERIN 2 diflorasone 1 DIPROLENE 2 DIPROLENE AF 2 DOVONEX 2 ST DR. SMITH'S ADULT BARRIER 2 DR. SMITH'S DIAPER 1 DR. SMITH'S DIAPER RASH 2 DR. SMITH'S RASH-SKIN 2 DUAC 2 DYNA-HEX 1 DYNA-HEX (ISOPROPYL ALCOHOL) 1 EASY TOUCH ALCOHOL PREP PADS 2 ELIMITE 2 ELOCON 2 ELTA LITE TAR 1 ELTA SEAL MOISTURE BARRIER 2 ELTA TAR 2 EPI-CLENZ TOPICAL FOAM 2 EPIDUO 2 EPIDUO FORTE 2 EPIFOAM 2 ESOTERICA FADE 2 ethyl alcohol 2 EURAX 2 FABIOR 2 FINACEA 2 FINACEA PLUS 2 FLECTOR 2 fluocinolone 1 fluocinolone-shower cap 1 fluocinonide 1 FLUOCINONIDE-E 1 fluocinonide-emollient 1 fluticasone topical 1 FRESHNET 2 GEL-STAT 2 GENTLE RAIN 1
150 Drug Name Tier Notes GERI-LAV 2 GLUCOPRO ALCOHOL 2 GRANULEX 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 1 hydrocortisone valerate 1 hydrocortisone-aloe vera topical cream 1 % 1 hydrocortisone-min oil-wht pet 1 hydrocortisone-pramoxine topical 1 hydrogen peroxide solution 3 % 1 hydrogen peroxide topical towelette 1 hydroquinone 1 hydroquinone microspheres 1 HYDROSKIN 1 HYDROSKIN WITH ALOE 1 HYGIENIC CLEANSING 1 ICY HOT MEDICATED SLEEVE 2 imiquimod 1 PA; QL (24 EA per 30 days) INVISIBLE ACNE 1 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 TOPICAL GEL 2 ITCH-X TOPICAL SPRAY,NON-AEROSOL 2 IV PREP WIPES 2 KENALOG TOPICAL 2 KENDALL 2-IN-1 2 KLARON 2 LAC-HYDRIN 2 lactated ringers irrigation 2 lactic acid (bulk) liquid 2 LAZERCREME 2
151 Drug Name Tier Notes LICE EGG REMOVER 1 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 1 LUSTRA 2 LUSTRA-AF 2 LUXIQ 2 malathion 1 MEDI PADS 1 MEDICATED BODY 1 MEDICATED BODY POWDER TOPICAL POWDER 2 0.15 % MEDICATED BODY POWDER TOPICAL POWDER 1 0.15-1 % MEDICATED CHEST RUB 1 MEDICATED WIPES TOPICAL PAD 2 MEDICATED WIPES WITH ALOE 1 MEDIPLAST CORN-CALLUS-WART 1 MENCAPS 2 methoxsalen rapid 1 METROCREAM 2 METROGEL TOPICAL GEL 1 % 2 METROGEL TOPICAL GEL WITH PUMP 2 METROLOTION 2 metronidazole topical 1 MIRVASO 2 QL (30 GM per 30 days) MOBISYL 1 MOISTURE RECOVERY 2 mometasone 1 MUSCLE RUB (WITH CAMPHOR) 1 MUSCLE RUB TOPICAL CREAM 15-10 % 1 MUSCLE RUB ULTRA-STRENGTH 1 MYOFLEX 1 MYORISAN 1 NATROBA 2 NATURE'S WASH PLUS WHIRLPOOL 2 neomycin-polymyxin b gu 1 NEOSPORIN DAILY BODY 2 NEOSPORIN GU IRRIGANT 2 NEUAC 1
152 Drug Name Tier Notes NEUAC KIT 2 NEUTROGENA TONER 2 NO STING BARRIER FILM 2 NORITATE 2 OATMEAL BATH REGULAR 1 OCUSOFT FACIAL-SKIN CLEANSER 2 ODOR ELIMINATOR DROPS 2 OLUX 2 OLUX-E 2 ONEXTON 2 OVACE 2 OVACE PLUS SHAMPOO 2 OVACE PLUS TOPICAL CLEANSER,EXTENDED 2 RELEASE OVACE PLUS TOPICAL CREAM 2 OVACE PLUS TOPICAL FOAM 2 OVACE PLUS WASH 2 OVIDE 2 OXSORALEN 2 OXSORALEN ULTRA 2 PACNEX HP 2 PACNEX LP 2 PACNEX MX 2 PAIN RELIEF INSTANT ANTISEPTIC 1 PAIN RELIEVING (MENTHOL) TOPICAL GEL 3.5 % 2 PANDEL 2 PANOXYL TOPICAL BAR 2 PANOXYL TOPICAL CLEANSER 1 PANOXYL TOPICAL CREAM 2 PANOXYL-4 1 PEDIADERM HC 2 PEDIADERM TA 2 PEDI-BORO SOAK 1 PENNSAID 2 ST PERIFRESH 2 PERIGIENE 2 PERIGUARD 1 PERISCENT 2 permethrin 1 PHISOHEX 2 PHYSIOLYTE 2 PHYSIOSOL IRRIGATION 2 pine tar (bulk) 2 PODOCON 1
153 Drug Name Tier Notes podofilox 1 povidone-iodine topical ointment 1 povidone-iodine topical solution 10 % 1 PRAMEGEL ANTI-ITCH 2 PRAMOSONE 2 PRAMOSONE E 2 prednicarbate 1 PROSHIELD PLUS 1 PROSHIELD PLUS SKIN PROTECTANT 2 PROSHIELD PROTECTIVE HAND 2 PRUDOXIN 2 PSORCON 2 PYRETHRIN LICE TREATMENT M 1 QUTENZA 2 PA REA LO 30 2 REGRANEX 2 REHYLA HAIR-BODY 2 REMEDY 4-IN-1 CLEANSER 1 REMEDY CALAZIME PROTECT PASTE TOPICAL 2 PASTE 3.5-0.2-69-16.5 % REMEDY CLEAR-AID PROTECT 2 REMEDY DIMETHICONE CREAM 2 REMEDY NUTRASHIELD SKIN PROTEC 2 REMEDY PHYTOPLEX Z-GUARD 2 REMEDY PHYTOPLEX Z-GUARD (ZN) 2 REMEDY SKIN REPAIR 2 RENEWAL HAND SANITIZER 2 RETIN-A 2 RETIN-A MICRO 2 RETIN-A MICRO PUMP 2 ringers irrigation 1 ROSADAN TOPICAL CREAM 1 ROSADAN TOPICAL GEL 2 ROSADAN TOPICAL KIT, CLEANSER & GEL 2 ROSADAN TOPICAL KIT,CLEANSER AND CREAM 2 RUBBING ALCOHOL (ETHANOL) 2 SALACTIC FILM 1 SALEX 2 salicylic acid sr-ceramides topical kit,cleanser & cream er 1 salicylic acid topical cream 1 salicylic acid topical film forming liquid w/appl 27.5 % 1 salicylic acid topical foam 1 salicylic acid topical gel 1 salicylic acid topical liquid 26 % 1
154 Drug Name Tier Notes salicylic acid topical lotion 1 salicylic acid topical shampoo 1 SAL-PLANT 1 SANTYL 2 SARNA ANTI-ITCH 2 SCALPICIN ANTI-ITCH 1 SE BPO TOPICAL KIT,CLEANSER AND CREAM 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 SECURA 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 1 SELSUN BLUE (SALICYLIC ACID) 1 SELSUN BLUE MOISTURIZING 2 SELSUN BLUE NATURALS 1 SENSI-CARE (FOAM) 2 SENSI-CARE MOISTURIZING 2 2 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 & COOL BODY POWDER 2 SOOTHE & COOL FREE MEDSEPTIC 2 SOOTHE & COOL INZO BARRIER 2 SOOTHE & COOL MEDSEPTIC 2 SOOTHE & COOL MOISTURE BARRIER 2 SOOTHE & COOL SKIN PASTE 1 SOOTHE & COOL TOPICAL SOAP 2 sorbitol irrigation 1 sorbitol-mannitol 1 SORIATANE ORAL CAPSULE 10 MG, 17.5 MG, 25 MG 2 SORILUX 2 ST spinosad 1
155 Drug Name Tier Notes sulfacetamide sodium (acne) 1 sulfacetamide sodium topical 1 sulfacetamide sodium-urea 1 SURE COMFORT ALCOHOL PREP PADS 2 SURE-PREP ALCOHOL PREP PADS 2 SYNALAR 2 SYNALAR CREAM KIT 2 SYNALAR OINTMENT KIT 2 SYNALAR TS 2 TAZORAC 2 TEMOVATE 2 TEMOVATE E 2 TEXACORT 2 THERA-GEL 1 THERA-GESIC PLUS 2 THERA-GESIC TOPICAL CREAM 15-1 % 1 THERAPEUTIC MINERAL ICE 1 THERASEAL 1 TOPICORT TOPICAL CREAM 2 TOPICORT TOPICAL GEL 2 TOPICORT TOPICAL OINTMENT 2 TOPICORT TOPICAL SPRAY,NON-AEROSOL 2 ST tretinoin microspheres 1 tretinoin topical 1 triamcinolone acetonide topical 1 TRIANEX 1 TRI-LUMA 2 TRIXAICIN 1 TRIXAICIN HP 1 trolamine salicylate 1 U-CORT 1 ULESFIA 2 ULTILET ALCOHOL SWAB 2 ULTRACIN T 1 ULTRA-FRESH TOPICAL 2 ULTRAVATE 2 ULTRAVATE PAC 2 ULTRAVATE X 2 UMECTA NAIL FILM PEN 2 UMECTA PD 2 UMECTA TOPICAL EMULSION 2 UMECTA TOPICAL FOAM 1 UMECTA TOPICAL NAIL FILM SUSPENSION 2 URAMAXIN GT 2
156 Drug Name Tier Notes URAMAXIN TOPICAL CREAM 2 URAMAXIN TOPICAL FOAM 2 URAMAXIN TOPICAL LOTION 2 urea topical cream 39 %, 40 % 1 urea topical foam 1 urea topical gel 1 urea topical lotion 40 %, 45 % 1 urea topical nail film suspension 1 VANOS 2 VAPORX BALM 2 VECTICAL 2 ST 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 topical ointment in packet 1 VOLTAREN TOPICAL 2 water for irrigation, sterile 1 WEBCOL 2 WESTCORT TOPICAL OINTMENT 2 WITCH HAZEL 1 witch hazel leaf (hamamelis) 1 WOUND & SKIN CLEANSER 2 WOUND CLEANSER 2 WOUND GEL 2 XERAC AC 2 ZENATANE 1 ZIANA 2 ZIKS ARTHRITIS PAIN RELIEF 2 zinc oxide topical ointment 20 % 1 ZONALON 2 ZYCLARA TOPICAL CREAM IN METERED-DOSE 2 PA; QL (7.5 GM per 1 day) PUMP 2.5 % ZYCLARA TOPICAL CREAM IN METERED-DOSE 2 PA; QL (7.5 GM per 28 days) PUMP 3.75 % ZYCLARA TOPICAL CREAM IN PACKET 2 PA; QL (1 EA per 1 day) SMOKING DETERRENTS BUPROBAN 1 CHANTIX 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 14 2 MG/24 HR, 7 MG/24 HR NICORELIEF 1 157 Drug Name Tier Notes NICORETTE BUCCAL GUM 4 MG 2 NICORETTE BUCCAL LOZENGE 2 nicotine (polacrilex) 1 nicotine transdermal patch 24 hour 14 mg/24 hr, 21 mg/24 1 hr, 7 mg/24 hr nicotine transdermal patch, td daily, sequential 2 NICOTROL 2 QL (1008 EA per 90 days) NICOTROL NS 2 QL (160 ML per 90 days) ZYBAN 2 THYROID PREPS ARMOUR THYROID 2 CYTOMEL 2 levothyroxine 1 LEVOXYL ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 2 MCG, 50 MCG, 75 MCG, 88 MCG liothyronine 1 methimazole oral tablet 10 mg, 5 mg 1 NP THYROID 1 propylthiouracil 1 SYNTHROID 2 TAPAZOLE 2 THYROGEN 2 THYROLAR-1 2 THYROLAR-1/2 2 THYROLAR-1/4 2 THYROLAR-2 2 THYROLAR-3 2 TIROSINT 2 TRIOSTAT 2 UNITHROID 2 UNCLASSIFIED DRUG PRODUCTS acamprosate 1 ACETADOTE 2 acetone 2 acetylcysteine intravenous 1 ACTIDOSE/SORBITOL 2 ACTIDOSE-AQUA 1 ACTONEL ORAL TABLET 30 MG 2 ST; QL (1 EA per 1 day) ADAGEN 2 adipic acid 2 ADVANCED EYE HEALTH 1 ALCOHOL, DENATURED 2 alcohol, reagent 2
158 Drug Name Tier Notes ALDURAZYME 2 alendronate oral solution 1 QL (75 ML per 7 days) alendronate oral tablet 1 alfuzosin 1 almond oil, sweet (bulk) 2 aluminum monostearate 2 amaranth 2 amifostine crystalline 1 anise 2 ANTABUSE 2 APPLE FLAVORING 2 APPLE-ADE FLAVOR 2 AQUA LUBE 2 AQUA LUBE ADVANCED FORMULA GEL 2 AQUABASE 2 AR CAPS 2 ARALAST NP 2 ARCALYST 2 ATELVIA 2 ST; QL (1 EA per 7 days) AVODART 1 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 bentonite 2 benzaldehyde 2 BERINERT INTRAVENOUS KIT 2 PA BHT 2 BINOSTO 2 ST; QL (1 EA per 7 days) bitter mask flavoring (bulk) 2 BITTERNESS MASK FLAVOR 2 BLUEBERRY FLAVOR 2 BODI LOTION 2 BONIVA INTRAVENOUS 2 ST BONIVA ORAL 2 BRIJ 30 2 BRIJ 35 POWDER 2 BRIJ 58 2 BRIJ 78 2 BRIJ 99 2 BUBBLE GUM CONCENTRATE 2
159 Drug Name Tier Notes 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) BUTTER RUM FLAVORING 2 BUTTERSCOTCH FLAVORING 2 butylated hydroxytoluene 2 calcipotriene-betamethasone 1 ST CALCIUM DISODIUM VERSENATE 2 CAMPRAL 2 CAMPRAL DOSE PAK 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 #00 (CELLULOSE) 2 CAPSULE #00 (HYPROMELLOSE) 2 CAPSULE #1 2 CAPSULE #1 (CELLULOSE) 2 CAPSULE #1 (HYPROMELLOSE) 2 CAPSULE #1 DRCAPS 2 CAPSULE #10 2 CAPSULE #11 2 CAPSULE #13 2 CAPSULE #2 2 CAPSULE #2 (HYPROMELLOSE) 2 CAPSULE #3 2 CAPSULE #3 (CELLULOSE) 2 CAPSULE #3 (HYPROMELLOSE) 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 CAPSULE CONI-SNAP #1 (GELATIN) 2 CAPSULE CONI-SNAP #1(HYPROMEL) 2 CAPSULE CONI-SNAP #2 (GELATIN) 2
160 Drug Name Tier Notes CAPSULE CONI-SNAP #3 (GELATIN) 2 CAPSULE CONI-SNAP #3(HYPROMEL) 2 CAPSULE CONI-SNAP #4 (GELATIN) 2 CARBAGLU 2 CARBOMER 934P RESIN 2 carbomer 940 (bulk) 2 carbomer homopolymer c (bulk) 2 carmine 2 CARNITOR 2 CARNITOR SUGAR-FREE 2 CARTICEL 2 castor oil 2 cellulose (bulk) powder 2 CERDELGA 2 PA CEREZYME 2 cheesecake flavor (bulk) 2 CHEMET 2 chlorhexidine gluconate mucous membrane 1 chocolate flavor (bulk) liquid 2 cholesterol 2 CINNAMON FLAVORING 2 CINRYZE 2 PA citric acid 2 citronella oil 2 CLOVE FLAVORING 2 CO Q-10 ORAL CAPSULE 100 MG 1 cocoa butter 2 cocoa butter (bulk) 2 cocoa butter (bulk) topical bar 2 coconut oil (bulk) 2 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 deferoxamine 1 DELBASE COMPOUNDING 2 DERMABASE 2 DERMAFIX TOPICAL OINTMENT 2 DERMANIC 2 DESFERAL 2
161 Drug Name Tier Notes DETROL 2 DETROL LA 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 DITROPAN XL 2 doxercalciferol 1 doxycycline hyclate oral tablet 20 mg 1 dutasteride 1 ELAPRASE 2 ELELYSO 2 ENABLEX 2 ENGLISH TOFFEE FLAVOR 2 ESBRIET 2 PA ethyl acetate 2 ethyl vanillin 2 etidronate disodium 1 eucalyptol 2 EUCALYPTUS FLAVOR 2 eucalyptus oil oil 100 % 2 EVISTA 2 QL (1 EA per 1 day) 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 FLOMAX 2 flumazenil 1
162 Drug Name Tier Notes fomepizole 1 FORTEO 2 QL (2.4 ML per 28 days) FOSAMAX ORAL TABLET 70 MG 2 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 2 GLASSIA 2 glutathione (bulk) 2 glyceryl monostearate 2 GRAPEFRUIT 2 guar gum 2 guava flavor (bulk) 2 HECTOROL 2 HICON 2 hydrophilic 2 HYDROPHILIC OINTMENT BASE(FAG) 2 HYDROPHILIC PETROLATUM 2 hydroxypropyl cellulose 2 HYLENEX 2 hypromellose 2 ibandronate intravenous solution 1 ST ibandronate oral 1 ILARIS (PF) 2 INSTA-CHAR 1 INSTA-CHAR-SORBITOL 1 INSTACLEAN 2 INSTANT FOOD THICKENER 2 isopropyl alcohol solution 70 %, 91 % 2 isopropyl palmitate 2 JADENU 2 JOHNSON'S BODY CARE 2 KALBITOR 2 KALYDECO 2 PA; QL (2 EA per 1 day) KEVEYIS 2 KUVAN 2 lanolin anhydrous 2 LEMON EXTRACT FLAVOR 2 lemon flavor extract (bulk) 2 LEMON FLAVORING 2
163 Drug Name Tier Notes leucovorin calcium injection recon soln 1 leucovorin calcium oral 1 levocarnitine (with sugar) 1 levocarnitine intravenous 1 levocarnitine oral tablet 1 levoleucovorin calcium 1 LIME FLAVOR 2 LIP TREATMENT 2 LUMIZYME 2 MAGNASWEET 110 2 MAGNASWEET 135 2 magnesium stearate 2 marshmallow flavor (bulk) 2 MEGACE 2 MEGACE ES 2 megestrol oral suspension 1 mesna 1 MESNEX 2 METHAZEL 2 METHOCEL E 4 M 2 methyl alcohol 2 methylcellulose 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 mustard oil 2 MYOZYME 2 NAGLAZYME 2 NIACIN-AZE AC-TURMER-FA-B6-ZN 1 NICADAN 2 nutmeg oil 2 OFEV 2 PA oleic acid 2 OMEGA-3 IQ CHILDREN'S 2 ORAL MIX 2 ORAL MIX SF 2 ORAL SUSPEND 2 ORAL SYRUP 2 ORAL SYRUP SF 2 ORALONE 1 ORANGE CONCENTRATE 2
164 Drug Name Tier Notes orange oil 2 ORA-PLUS 2 ORA-SWEET 2 ORA-SWEET SF 2 ORFADIN 2 ORKAMBI 2 PA OSPHENA 2 QL (1 EA per 1 day) oxybutynin chloride oral 1 OXYTROL 2 pamidronate 1 PANHEMATIN 2 paraffin 2 paricalcitol hemodialysis port injection 2 paricalcitol oral 1 PCCA-PLUS BASE 2 PEANUT BUTTER FLAVOR 2 PENTRAVAN 2 PEPPERMINT FLAVORING 2 petrolatum, yellow (bulk) 2 PETROLEUM JELLY 2 PETROLEUM JELLY, WHITE 2 polyethylene glycol 8000(bulk) powder 100 % 2 polyoxyl 40 stearate 2 polyoxyl 40 stearate (bulk) 2 polysorbate 40 2 polysorbate 60 2 polysorbate 80 2 PROCYSBI 2 PA PRODERM 1 PROLASTIN-C 2 PROLIA 2 propylene glycol 2 propylene glycol (bulk) 2 PROSCAR 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 ORAL CAPSULE 4 MG 2 ST raspberry 2
165 Drug Name Tier Notes raspberry flavor, artificial 2 RASPBERRY FLAVORING 2 RECLAST 2 resveratrol oral capsule 250 mg 2 root beer flavor (bulk) 2 rose oil 2 ROSE WATER 2 rosin (bulk) powder 2 RUCONEST 2 PA sassafras oil 2 SAVELLA 2 SENSIPAR 2 sesame oil 2 silica 2 simple syrup 2 SIMPLYTHICK ORAL GEL 2 sodium bisulfite 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 flavor (bulk) 2 STRAWBERRY FLAVORING 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, 2 PA; QL (3 EA per 1 day) 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 SYRUP VEHICLE SF 2 TACLONEX 2 ST
166 Drug Name Tier Notes tamsulosin 1 TANGERINE OIL, NATURAL 2 THICK NOW 2 THICKEN UP CLEAR 2 THICKENUP LEMON HONEY 2 THICKENUP LEMON NECTAR 2 THICK-IT 2 THICK-IT #2 2 THIOLA 2 tolterodine 1 tolu balsam 2 TOVIAZ 2 TOZAL 2 tragacanth powder 2 triamcinolone acetonide dental 1 trospium 1 tutti-frutti flavor (bulk) 2 TYBOST 2 PA TYSABRI 2 UROXATRAL 2 VANILLA BUTTERNUT FLAVOR 2 vanilla butternut flavor(bulk) 2 vanillin (bulk) 2 VASELINE 2 VERSA FREE 2 VERSA PLUS 2 VESICARE 2 VIMIZIM 2 VISUDYNE 2 VIVITROL 2 VPRIV 2 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 XIAFLEX 2 XOFIGO 2 YELLOW WAX (BEESWAX) 2 ZAVESCA 2 PA
167 Drug Name Tier Notes ZEMAIRA 2 ZEMPLAR 2 zinc stearate 2 ZINECARD (AS HCL) 2 zoledronic acid 1 zoledronic acid-mannitol-water 1 ZOMETA 2 ZUBSOLV SUBLINGUAL TABLET 1.4-0.36 MG, 2 PA 11.4-2.9 MG, 5.7-1.4 MG, 8.6-2.1 MG VITAMINS ADULT MULTIVITAMIN (W-LUTEIN) 1 ADVANCED AM-PM 1 AQUASOL A 2 ascorbic acid injection 1 B COMPLEX 100 INJECTION 1 BABY VITAMIN D3 1 BACMIN 1 CALCIJEX 2 calcitriol intravenous solution 1 mcg/ml 1 calcitriol oral 1 CENTRUM FLAVOR BURST ADULT 2 cholecalciferol (vitamin d3) oral capsule 10,000 unit 1 cod liver oil oral oil 1 COD LIVER OIL PLUS VIT A & D3 1 CORVITE FREE 2 cyanocobalamin (vitamin b-12) injection 1 DECARA ORAL CAPSULE 25,000 UNIT 2 DECARA ORAL CAPSULE 50,000 UNIT 1 DIALYVITE 1 DIALYVITE 3000 1 DIALYVITE 5000 2 DIALYVITE SUPREME D 2 DRISDOL ORAL CAPSULE 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 FALESSA 2 FLORIVA ORAL TABLET,CHEWABLE 0.25MG 2 FLUORIDE (0.55 MG) FOLASTIN 1
168 Drug Name Tier Notes FOLCAPS 1 FOLGARD 2 folic acid injection 1 folic acid oral tablet 1 mg 1 FOLTRATE 2 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 MEN'S MULTIVITAMIN GUMMIES 1 MEPHYTON 2 MI-OMEGA NF 1 MULTI-VIT WITH FLUORIDE & IRON 1 MULTIVITAMIN WITH FLUORIDE 1 MULTI-VITAMIN WITH FLUORIDE 1 MULTIVITAMINS WITH FLUORIDE 1 multivit-min-iron fum-folic ac 2 MVC-FLUORIDE ORAL TABLET,CHEWABLE 0.25 1 MG, 0.5 MG NASCOBAL 2 NEPHPLEX RX 1 NEPHROCAPS 1 NEPHRONEX-SL 2 niacin oral capsule, extended release 250 mg, 500 mg 1 niacin oral powder 2 niacin oral tablet 500 mg 1 niacin oral tablet extended release 500 mg 1 NICOMIDE 2 NICOMIDE (SELENIUM-CHROMIUM) 2 NIVA-FOL 2 phytonadione injection 1 PURALOR CI 2 pyridoxine injection 1 QUFLORA PEDIATRIC 1 QUFLORA PEDIATRIC DROPS 1 RENAL CAPS 1 RENO CAPS 1 ROCALTROL 2
169 Drug Name Tier Notes STROVITE FORTE 1 STROVITE ONE 2 SUPER B MAXI COMPLEX 1 thiamine hcl injection 1 THRIVITE RX 2 TL GARD RX 1 TL-FLUORIVITE 1 TRIPHROCAPS 1 TRIPLE VITAMIN WITH FLUORIDE 1 TRI-VIT WITH FLUORIDE & IRON 1 TRI-VITAMIN WITH FLUORIDE 1 TROPICAL LIQUID NUTRITION 2 UDAMIN SP 2 VASCULERA 2 VIRT-CAPS 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 D3 ORAL TABLET 1,000 UNIT, 2,000 UNIT 1 vitamin e (dl, acetate) oral capsule 400 unit 1 VITAMIN K INJECTION 1 VITAMIN K1 INJECTION 1 VITAMINS A,C,D & FLUORIDE 1 VOL-CARE RX 1 VP-VITE RX 1 WOMEN'S MULTIVITAMIN GUMMIES 1 ZAVARA 2
170 Index
I n d e x I n d e x I n d e x 12 HOUR NASAL SPRAY ...... 86 ACLARO ...... 146 ADRUCIL ...... 39 1ST TIER UNIFINE PENTIPS ...... 119 ACLOVATE ...... 146 ADULT MULTIVITAMIN (W-LUTEIN) 1ST TIER UNIFINE PENTIPS PLUS ACNE MEDICATION ...... 146 ...... 168 ...... 119 ACNE TREATMENT (BENZOYL ADULT TUSSIN CHEST 3 DAY VAGINAL ...... 29 PEROX) ...... 146 CONGESTION ...... 74 3-DAY VAGINAL ...... 29 ACNEFREE ACNE CLEARING ADULT TUSSIN COUGH CONGEST 3M NEXCARE DURAPORE ...... 119 SYSTEM ...... 146 DM ...... 74 4-N-1 NO RINSE WASH ...... 145 ACNEFREE SEVERE ACNE ADULT TUSSIN DM ...... 74 8 HOUR PAIN RELIEVER ...... 3 CLEARING ...... 146 ADULT TUSSIN MULTI-SYMP COLD 8-MOP ...... 145 ACTEMRA ...... 118 ...... 74 abacavir ...... 46 ACTHAR H.P...... 114 ADVAIR DISKUS ...... 16 abacavir-lamivudine-zidovudine ...... 46 ACTHIB (PF) ...... 51 ADVAIR HFA ...... 17 ABATINEX ...... 99 ACTHREL ...... 114 ADVANCED AM-PM ...... 168 ABELCET ...... 29 ACTIDOSE/SORBITOL ...... 158 ADVANCED ANTACID-ANTIGAS ... 99 ABILIFY ...... 139 ACTIDOSE-AQUA ...... 158 ADVANCED ANTIBACTERIAL ABILIFY DISCMELT ...... 139 ACTIGALL ...... 99 BANDAGE ...... 119 ABILIFY MAINTENA ...... 139 ACTIMMUNE ...... 39 ADVANCED EYE HEALTH ...... 158 ABLAVAR ...... 83 ACTIQ ...... 3 ADVANCED FORMULA EYE DROPS ABRAXANE ...... 39 ACTIVASE ...... 56 ...... 86 ABREVA ...... 46 ACTIVE FE ...... 91 ADVATE ...... 56 ABSORBENT COTTON BALLS ...... 119 ACTIVE OB ...... 135 ADVICOR ...... 60 ABSORICA ...... 145 ACTIVELLA ...... 114 ADVOCATE PEN NEEDLES ...... 120 ABSTRAL ...... 3 ACTONEL ...... 158 ADVOCATE SYRINGES ...... 120 acamprosate ...... 158 ACTOPLUS MET XR ...... 36 AEROCHAMBER MINI ...... 120 ACANYA ...... 145 ACTOS ...... 36 AEROCHAMBER MV ...... 120 acarbose ...... 36 ACULAR ...... 86 AEROCHAMBER PLUS FLOW-VU ACCOLATE ...... 16 ACULAR LS ...... 86 ...... 120 ACCU-CHEK FASTCLIX ...... 119 ACUVAIL (PF) ...... 86 AEROCHAMBER PLUS FLOW-VU,L ACCU-CHEK MULTICLIX LANCET acyclovir ...... 46 MSK ...... 120 ...... 119 acyclovir sodium ...... 46 AEROCHAMBER PLUS FLOW-VU,M ACCU-CHEK SOFT DEV LANCETS ACZONE ...... 146 MSK ...... 120 ...... 119 ADACEL(TDAP AEROCHAMBER PLUS FLOW-VU,S ACCU-CHEK SOFTCLIX LANCET ADOLESN/ADULT)(PF) ...... 51 MSK ...... 120 DEV ...... 119 ADAGEN ...... 158 AEROCHAMBER PLUS Z STAT ...... 120 ACCUPRIL ...... 60 ADALAT CC ...... 58 AEROCHAMBER PLUS Z STAT LG ACCURETIC ...... 60 adapalene ...... 146 MSK ...... 120 ACE AEROSOL CLOUD ENHANCER ADASUVE ...... 139 AEROCHAMBER PLUS Z STAT MD ...... 119 ADCETRIS ...... 39 MSK ...... 120 acebutolol ...... 60 ADCIRCA ...... 60 AEROCHAMBER PLUS Z STAT SM ACEPHEN ...... 3 ADDAMEL N ...... 91 MSK ...... 120 ACETADOTE ...... 158 ADDED STRENGTH HEADACHE AEROCHAMBER WITH ACETA-GESIC ...... 3 RELIEF ...... 3 FLOWSIGNAL ...... 120 acetaminophen ...... 3 ADDERALL ...... 49 AEROCHAMBER Z-STAT PLUS-FLW ACETAMINOPHEN PM ...... 3 ADDERALL XR ...... 49 SG ...... 120 acetaminophen-codeine ...... 3 adefovir ...... 46 AEROSPAN ...... 17 ACETASOL HC ...... 86 ADEMPAS ...... 60 AEROTRACH PLUS ...... 120 acetazolamide ...... 85 ADENOCARD ...... 58 AFEDITAB CR ...... 58 acetazolamide sodium ...... 85 ADENOSCAN ...... 83 AFINITOR ...... 40 ACETEST ...... 83 adenosine ...... 58 AFINITOR DISPERZ ...... 39 acetic acid ...... 86, 145 adenosine (diagnostic) ...... 83 AFLURIA 2012-2013 ...... 52 acetic acid-aluminum acetate ...... 86 adenovirus vac live type-4, 7 ...... 51 AFLURIA 2012-2013 (PF) ...... 52 acetone ...... 158 adenovirus vaccine live type-4 ...... 52 AFLURIA 2013-2014 ...... 52 acetylcysteine ...... 16, 158 adenovirus vaccine live type-7 ...... 52 AFLURIA 2013-2014 (PF) ...... 52 ACID CONTROL (RANITIDINE) ...... 99 adhesive bandage ...... 119 AFLURIA 2014-2015 ...... 52 ACID CONTROLLER ...... 99 adhesive bandage-adhes remov#1 ...... 119 AFLURIA 2014-2015 (PF) ...... 52 ACID GONE ANTACID ...... 99 ADHESIVE GAUZE PAD ...... 119 AFLURIA 2015-2016 ...... 52 ACID GONE ANTACID E.STRENGTH ADHESIVE PADS ...... 119 AFLURIA 2015-2016 (PF) ...... 52 ...... 99 adhesive remover ...... 119 AFREZZA ...... 36 ACID REDUCER (CIMETIDINE) ...... 99 adhesive tape ...... 119 AFTERA ...... 69 ACID REDUCER (FAMOTIDINE) ...... 99 adipic acid ...... 158 AGGRASTAT IN SODIUM CHLORIDE ACID REDUCER (RANITIDINE) ...... 99 ADOXA ...... 18 ...... 46 ACIPHEX SPRINKLE ...... 99 ADRENACLICK ...... 49 AGGRENOX ...... 46 acitretin ...... 146 ADRENALIN ...... 49 AGIE-GRX ...... 120
171
I n d e x I n d e x I n d e x AGRYLIN ...... 46 aller ext-tree pollen-mesquite ...... 52 allopurinol ...... 14 AHIST (CHLORCYCLIZINE) ...... 34 aller xt-tree poll,shagbk hick ...... 52 ALMACONE ...... 99 A-HYDROCORT ...... 114 aller xt-tree pollen-am.sycamo ...... 52 ALMACONE MLT ...... 99 AK-FLUOR ...... 83 aller xt-tree pollen-box elder ...... 52 ALMACONE-2 ...... 99 AKORN BALANCED SALT ...... 86 aller xt-tree pollen-red birch ...... 52 almond oil, sweet (bulk) ...... 159 AK-POLY-BAC ...... 18 aller xt-tree pollen-white ash ...... 52 ALOCRIL ...... 86 AKTEN (PF) ...... 86 aller xt-weed pollen-sagebrush ...... 52 aloe vera ...... 111 AKWA TEARS ...... 86 ALLER-CHLOR ...... 34 ALOE VESTA ...... 146 AKWA TEARS (POLYVINYL ALLERCLEAR D-12HR ...... 32 ALOE VESTA ANTIFUNGAL ALCOHOL) ...... 86 ALLERCLEAR D-24HR ...... 32 (MICON) ...... 29 AKYNZEO ...... 99 ALLER-EASE ...... 34 ALOE VESTA BATHING CLOTHS ALA-HIST AC ...... 74 ALLERFED COLD & ALLERGY ...... 32 ...... 146 ALA-HIST DM ...... 74 allerg ext-tree pollen-pecan ...... 52 ALOE VESTA SKIN CONDITIONER 2 ALA-HIST IR ...... 34 allerg ext-weed pollen-mugwort ...... 52 ...... 146 ALA-HIST PE ...... 32 allerg ex-weed pol-rgh pigweed ...... 52 ALOMIDE ...... 86 ALA-QUIN ...... 146 allerg xt-sheep sor,yellw dock ...... 52 ALOPRIM ...... 14 ALAWAY ...... 34 allergen ext-candida albicans ...... 52 ALOQUIN ...... 146 ALBENZA ...... 39 allergen ext-english plantain ...... 52 ALORA ...... 114 ALBUKED-25 ...... 56 allergen ext-virginia live oak ...... 52 alosetron ...... 99 ALBUKED-5 ...... 56 allergen xt-grass pollen-bahia ...... 52 ALOXI ...... 99 albumin, human 25 % ...... 56 allergenic ex-horse epithelium ...... 52 ALPHAGAN P ...... 86 albumin, human 5 % ...... 56 allergen-weed-lambsquarters ...... 52 ALPHANATE ...... 56 ALBUMINAR 25 % ...... 56 ALLER-G-TIME ...... 34 ALPHANINE SD ...... 56 ALBUMINAR 5 % ...... 56 ALLERGY & COLD PE ...... 74 alprazolam ...... 139 ALBURX (HUMAN) 25 % ...... 56 ALLERGY & CONGESTION RELIEF ALPRAZOLAM INTENSOL ...... 139 ALBURX (HUMAN) 5 % ...... 56 ...... 32 ALPROLIX ...... 56 ALBUSTIX REAGENT ...... 83 ALLERGY (CHLORPHENIRAMINE) alprostadil ...... 60 ALBUTEIN 25 % ...... 56 ...... 34 ALREX ...... 86 ALBUTEIN 5 % ...... 56 ALLERGY (DIPHENHYDRAMINE) ALSUMA ...... 3 albuterol sulfate ...... 17 ...... 34 ALTABAX ...... 146 ALCAINE ...... 86 ALLERGY 4-HOUR ...... 34 ALTACE ...... 60 alclometasone ...... 146 ALLERGY COMPLETE-D ...... 32 ALTAVERA (28) ...... 69 ALCOHOL PADS ...... 146 ALLERGY D-12 ...... 32 ALTOPREV ...... 60 ALCOHOL PREP PADS ...... 146 ALLERGY EYE (KETOTIFEN) ...... 34 aluminum hydroxide gel ...... 99 ALCOHOL PREP SWABS ...... 146 ALLERGY MEDICINE ...... 34 aluminum monostearate ...... 159 alcohol swabs ...... 146 ALLERGY MULTI-SYMPTOM ...... 74 ALUVEA ...... 146 ALCOHOL WIPES ...... 146 ALLERGY RELIEF & NASAL ALVESCO ...... 17 ALCOHOL, DENATURED ...... 158 DECONGE ...... 32 ALYACEN 1/35 (28) ...... 69 alcohol, reagent ...... 158 ALLERGY RELIEF (CETIRIZINE) ...... 34 ALYACEN 7/7/7 (28) ...... 69 ALCOHOL-BENZOCAINE ...... 39 ALLERGY RELIEF (CLEMASTINE) amantadine hcl ...... 45 ALCORTIN A ...... 146 ...... 34 A-MANTLE ...... 146 ALDACTAZIDE ...... 85 ALLERGY RELIEF (FEXOFENADINE) amaranth ...... 159 ALDACTONE ...... 85 ...... 34 AMARYL ...... 36 ALDARA ...... 146 ALLERGY RELIEF (LORATADINE) AMBIEN ...... 144 ALDURAZYME ...... 159 ...... 34 AMBIEN CR ...... 144 alendronate ...... 159 ALLERGY RELIEF D-24 ...... 32 AMBISOME ...... 29 ALERTNESS AID ...... 66 ALLERGY amcinonide ...... 146 ALEVAZOL ...... 29 RELIEF(CHLORPHENIRAMN) ...... 34 AMERGE ...... 3 alfalfa ...... 111 ALLERGY AMETHIA ...... 70 ALFENTA ...... 3 RELIEF(DIPHENHYDRAMIN) ...... 34 AMETHIA LO ...... 70 alfentanil ...... 3 ALLERGY SINUS HEADACHE (PE) AMETHYST ...... 70 alfuzosin ...... 159 ...... 74 AMICAR ...... 56 ALIMTA ...... 40 ALLERGY-TIME ...... 34 AMIDATE ...... 12 ALINIA ...... 39 ALLERHIST-1 ...... 34 amifostine crystalline ...... 159 ALKERAN ...... 40 ALLEVYN ...... 120 amikacin ...... 18 ALL DAY ALLERGY (CETIRIZINE) ALLEVYN ADHESIVE DRESSING amiloride ...... 85 ...... 34 ...... 120 amiloride-hydrochlorothiazide ...... 85 ALL DAY ALLERGY-D ...... 32 ALLEVYN CAVITY DRESSING ...... 120 AMINO ACIDS 15 % ...... 91 ALL DAY PAIN RELIEF ...... 14 ALLEVYN CAVITY WOUND DRESS aminocaproic acid ...... 56 ALL DAY RELIEF ...... 14 ...... 120 aminohippurate sodium ...... 83 all xt-weed pol-russian thistl ...... 52 ALLEVYN PLUS ADHESIVE ...... 120 aminophylline ...... 17 ALLEGRA-D 12 HOUR ...... 32 ALLEVYN SACRUM DRESSING ..... 120 AMINOSYN 10 % ...... 91 ALLEGRA-D 24 HOUR ...... 32 ALLFEN DM ...... 74 AMINOSYN 7 % WITH aller ext-tree poll,black waln ...... 52 ALLKARE ADHESIVE REMOVER ELECTROLYTES ...... 91 aller ext-tree poll,red cedar ...... 52 WIPES ...... 120 AMINOSYN 8.5 % ...... 91 aller ext-tree pollen-bayberry ...... 52 ALL-NITE COLD-FLU ...... 74 172
I n d e x I n d e x I n d e x AMINOSYN 8.5 %-ELECTROLYTES ANGELIQ ...... 114 APPLE-ADE FLAVOR ...... 159 ...... 91 ANGIOMAX ...... 28 apraclonidine ...... 86 AMINOSYN II 10 % ...... 91 anise ...... 159 APRI ...... 70 AMINOSYN II 15 % ...... 91 ANORO ELLIPTA ...... 17 APRISO ...... 100 AMINOSYN II 7 % ...... 91 ANTABUSE ...... 159 APRODINE ...... 32 AMINOSYN II 8.5 % ...... 91 ANTACID ...... 99 APTENSIO XR ...... 139 AMINOSYN II 8.5 %-ELECTROLYTES ANTACID ANTI-GAS ...... 99 APTIOM ...... 66 ...... 91 ANTACID ANTI-GAS DOUBLE STR APTIVUS ...... 46 AMINOSYN M 3.5 % ...... 92 ...... 99 AQUA GLYCOLIC CLEANSER ...... 147 AMINOSYN-HBC 7% ...... 92 ANTACID CALCIUM ...... 99 AQUA LUBE ...... 159 AMINOSYN-PF 10 % ...... 92 ANTACID EXST (CA CARB-MAG AQUA LUBE ADVANCED FORMULA AMINOSYN-PF 7 % (SULFITE-FREE) HYD) ...... 99 GEL ...... 159 ...... 92 ANTACID EXST (MAG CARB-AL AQUABASE ...... 159 AMINOSYN-RF 5.2 % ...... 92 HYD) ...... 99 AQUACEL FOAM ...... 120 amiodarone ...... 58 ANTACID EXT STR (CALCIUM AQUACEL FOAM SACRAL ...... 120 amiodarone in dextrose 5 % ...... 58 CARB) ...... 100 AQUAFLO ...... 120 AMITIZA ...... 99 ANTACID EXTRA-STRENGTH ...... 100 AQUANAZ ...... 74 amitriptyline ...... 139 ANTACID MAXIMUM STRENGTH AQUASOL A ...... 168 amitriptyline-chlordiazepoxide ...... 139 ...... 100 AR CAPS ...... 159 amlodipine ...... 58 ANTACID PLUS ANTI-GAS ...... 100 ARALAST NP ...... 159 amlodipine-atorvastatin ...... 61 ANTACID ULTRA STRENGTH ...... 100 ARANELLE (28) ...... 70 amlodipine-benazepril ...... 61 ANTACID-ANTIGAS ...... 100 ARANESP (IN POLYSORBATE) ...... 69 ammonia aromatic ...... 66 ANTACID-SIMETHICONE ...... 100 ARAVA ...... 14 ammonium and potassium iodides ...... 146 ANTARA ...... 61 ARBINOXA ...... 34 ammonium chloride ...... 85 ANTIBACTERIAL BANDAGES ...... 120 ARCALYST ...... 159 ammonium lactate ...... 146 ANTIBACTERIAL PAD ...... 120 ARCAPTA NEOHALER ...... 17 ammonium molybdate ...... 92 ANTIBIOTIC (BACITRACIN ZINC) ARCH BANDAGE ...... 120 AMMONUL ...... 99 ...... 19 argatroban ...... 28 AMNESTEEM ...... 146 ANTIBIOTIC PLUS (PRAMOXINE) argatroban in 0.9 % sod chlor ...... 28 amoxapine ...... 139 ...... 19 argatroban in nacl (iso-os) ...... 28 amoxicil-clarithromy-lansopraz ...... 99 ANTICAVITY FLUORIDE RINSE ...... 92 ARGLAES ...... 147 amoxicillin ...... 19 ANTI-DANDRUFF ...... 146 ARGLAES 3.25"X 14" FILM ...... 120 amoxicillin-pot clavulanate ...... 19 ANTI-DANDRUFF (COAL TAR) ...... 146 ARICEPT ...... 49 AMPHADASE ...... 146 ANTI-DIARRHEA ...... 100 ARICEPT ODT ...... 50 AMPHETAMINE SALT COMBO ...... 49 ANTI-DIARRHEAL (LOPERAMIDE) ARIMIDEX ...... 40 AMPHOTEC ...... 29 ...... 100 aripiprazole ...... 139 amphotericin b ...... 29 ANTIFUNGAL ...... 30 ARISTADA ...... 139 ampicillin ...... 19 ANTIFUNGAL (CLOTRIMAZOLE) ... 29 ARISTOSPAN INTRA-ARTICULAR ampicillin sodium ...... 19 ANTIFUNGAL (TOLNAFTATE) ...... 29 ...... 114 ampicillin-sulbactam ...... 19 ANTIFUNGAL CREAM ...... 29 ARISTOSPAN INTRALESIONAL ..... 114 AMPYRA ...... 66 ANTIFUNGAL SPRAY ...... 30 ARIXTRA ...... 28 AMRIX ...... 134 ANTI-ITCH (DIPHENHYDRAMINE) ARMOUR THYROID ...... 158 AMTURNIDE ...... 61 ...... 146 arnica ...... 111 AMYTAL ...... 144 ANTI-ITCH (HC) ...... 146 ARNUITY ELLIPTA ...... 17 ANADROL-50 ...... 114 ANTI-ITCH(DIPHENHYD) WITH ZINC AROMASIN ...... 40 ANAFRANIL ...... 139 ...... 146, 147 ARRANON ...... 40 anagrelide ...... 46 ANTI-NAUSEA ...... 100 ARTHRICREAM ...... 147 ANA-LEX ...... 99 ANTI-NAUSEA GINGER ...... 111 ARTHRICREAM RUB ...... 147 ANA-LEX KIT ...... 99 antipyrine-benzocaine ...... 86 ARTHRITIS ...... 147 ANALGESIC CREME ...... 146 ANTISEPTIC GEL ...... 147 ARTHRITIS HEATWRAPS ...... 120 ANALPRAM E ...... 99 antivenin latrodectus mactans ...... 52 ARTHRITIS PAIN RELIEF (ACETAM) ANALPRAM-HC ...... 99, 146 antivenin micrurus fulvius ...... 52 ...... 4 ANALPRAM-HC SINGLES ...... 99 ANTIVERT ...... 100 ARTHRITIS PAIN RELIEF(CAPSAIC) ANAMU ...... 111 ANUCORT-HC ...... 100 ...... 147 ANAPROX ...... 14 ANU-MED ...... 100 ARTHRITIS PAIN RELIEVER ...... 4 ANAPROX DS ...... 14 ANUSOL-HC ...... 100 ARTHROTEC 50 ...... 14 ANASCORP ...... 52 ANZEMET ...... 100 ARTHROTEC 75 ...... 14 ANASPAZ ...... 99 APEXICON ...... 147 ARTIFICIAL TEARS ...... 86 anastrozole ...... 40 APEXICON E ...... 147 ARTIFICIAL TEARS (PETRO/MIN) ANCOBON ...... 29 AP-HIST DM ...... 74 ...... 86 ANDRODERM ...... 114 APIDRA ...... 36 ARTIFICIAL TEARS (POLYVIN ALC) ANDROGEL ...... 114 APIDRA SOLOSTAR ...... 36 ...... 86 ANDROID ...... 114 APLENZIN ...... 139 ARTISS ...... 147 ANDROXY ...... 114 APLISOL ...... 52 ARZERRA ...... 40 ANECTINE ...... 49 APOKYN ...... 45 ASACOL ...... 100 ANEFRIN ...... 86 APPLE FLAVORING ...... 159 ASACOL HD ...... 100 173
I n d e x I n d e x I n d e x asafetida ...... 111 AVASTIN ...... 40 BAL-CARE DHA ESSENTIAL ...... 135 ASCLERA ...... 61 AVC VAGINAL ...... 39 balsalazide ...... 100 ASCOMP WITH CODEINE ...... 4 AVEED ...... 114 BALZIVA (28) ...... 70 ascorbic acid ...... 168 AVEENO BABY ...... 147 BANANA CONCENTRATE ...... 159 ASCRIPTIN ...... 4 AVELOX ...... 19 BANANA CREAM FLAVOR ...... 159 ASHLYNA ...... 70 AVELOX ABC PACK ...... 19 banana flavor (bulk) ...... 159 ASMANEX HFA ...... 17 AVELOX IN NACL (ISO-OSMOTIC) BANDAGE ...... 120 ASMANEX TWISTHALER ...... 17 ...... 19 BANDAGES ...... 120 ASPIR-81 ...... 4 AVIANE ...... 70 BANDAGES FLEXIBLE FABRIC ..... 120 aspirin ...... 4 AVINZA ...... 4 BANDAGES SHEER ...... 120 ASPIRIN LOW DOSE ...... 4 AVITA ...... 147 BANDAGES/FLEXIBLE/ASSORTED ASPIRIN LOW-STRENGTH ...... 4 AVODART ...... 159 ...... 120 aspirin-dipyridamole ...... 46 AVOGEL ...... 120 BANDAGES/PLASTIC ...... 120 ASPIR-LOW ...... 4 AVOGEL DRESSING ...... 120 BAND-AID ACTIVE FLEX ...... 120 ASSURE ID INSULIN SAFETY ...... 120 AVONEX ...... 66 BAND-AID BUTTERFLY CLOSURE ASTAGRAF XL ...... 118 AVONEX (WITH ALBUMIN) ...... 66 ...... 121 ASTELIN ...... 86 AVYCAZ ...... 19 BAND-AID CLEAR SPOTS ...... 121 ASTEPRO ...... 86 AXERT ...... 4 BAND-AID CLOTH TAPE ...... 121 ASTHMANEFRIN REFILL ...... 17 AXIRON ...... 114 BAND-AID FLEXIBLE ...... 121 ASTRINGENT ...... 147 AYGESTIN ...... 114 BAND-AID FLEXIBLE FABRIC ...... 121 ATACAND ...... 61 azacitidine ...... 40 BAND-AID GAUZE PADS ...... 121 ATACAND HCT ...... 61 AZACTAM ...... 19 BAND-AID HANDYMAN ...... 121 ATELVIA ...... 159 AZACTAM IN DEXTROSE (ISO-OSM) BAND-AID HURT-FREE ...... 121 atenolol ...... 61 ...... 19 BAND-AID MIRASORB GAUZE ...... 121 atenolol-chlorthalidone ...... 61 AZASAN ...... 118 BAND-AID NON-STICK PADS ...... 121 ATGAM ...... 52 AZASITE ...... 19 BAND-AID PAPER TAPE ...... 121 ATHLETE'S FOOT (CLOTRIMAZOLE) azathioprine ...... 119 BAND-AID PLASTIC ...... 121 ...... 30 azelastine ...... 34, 86 BAND-AID PLUS ANTIBIOTIC ...... 121 ATHLETE'S FOOT (TERBINAFINE) AZELEX ...... 147 BAND-AID ROLLED GAUZE ...... 121 ...... 30 AZILECT ...... 45 BAND-AID SECURE-FLEX ...... 121 ATHLETE'S FOOT (TOLNAFTATE) azithromycin ...... 19 BAND-AID SHEER STRIPS ...... 121 ...... 30 AZO ...... 12 BAND-AID SURGIPAD ...... 121 ATHLETE'S FOOT AF ...... 30 AZO BLADDER CONTROL ...... 111 BAND-AID TOUGH PADS ...... 121 ATHLETIC TAPE ...... 120 AZO CRANBERRY ...... 111 BAND-AID TOUGH STRIPS ...... 121 ATIVAN ...... 139, 144 AZO CRANBERRY + PROBIOTIC BAND-AID WATERPROOF ...... 121 atorvastatin ...... 61 ...... 111 BAND-AID WATERPROOF PAD ...... 121 atovaquone ...... 39 AZO TEST STRIPS ...... 83 BANOPHEN ...... 34 atovaquone-proguanil ...... 39 AZO-GESIC ...... 12 BANOPHEN ALLERGY ...... 34 atracurium ...... 50 AZOPT ...... 86 BANOPHEN ANTI-ITCH ...... 147 ATRALIN ...... 147 AZOR ...... 61 BANZEL ...... 66 ATRIPLA ...... 46 aztreonam ...... 19 BARACLUDE ...... 46 atropine ...... 86, 100 AZULFIDINE ...... 100 BARD ADHESIVE REMOVER WIPES atropine in 0.9 % sod chloride ...... 100 AZULFIDINE EN-TABS ...... 100 ...... 121 ATROVENT ...... 86 AZUPHEN MB ...... 19 BARD TWO-SIDED ADHESIVE STRIP ATROVENT HFA ...... 17 AZURETTE (28) ...... 70 ...... 121 ATRYN ...... 56 B COMPLEX 100 ...... 168 BASE, PCCA SYRUP VEHICLE ...... 159 AUBAGIO ...... 66 BABY TEETHING GEL ...... 12 BAYCADRON ...... 114 AUBRA ...... 70 BABY VITAMIN D3 ...... 168 BAZA ANTIFUNGAL ...... 30 AUGMENTIN ...... 19 BABY WASH ...... 147 BAZA CLEANSE & PROTECT ...... 147 AUGMENTIN ES-600 ...... 19 BACIIM ...... 19 BAZA CLEAR ...... 147 AUGMENTIN XR ...... 19 bacitracin ...... 19 BAZA PROTECT ...... 147 AURAX ...... 86 bacitracin zinc ...... 19 bcg vaccine, live (pf) ...... 52 AURODEX ...... 86 bacitracin-polymyxin b ...... 19 BD ALCOHOL SWABS ...... 147 AUROGUARD ...... 86 BACKACHE RELIEF EXTRA BD AUTOSHIELD DUO PEN NEEDLE AURYXIA ...... 92 STRENGTH ...... 4 ...... 121 AUVI-Q ...... 50 baclofen ...... 134 BD AUTOSHIELD PEN NEEDLE ...... 121 AVALIDE ...... 61 BACMIN ...... 168 BD ECLIPSE LUER-LOK ...... 121 AVANDAMET ...... 36 BACTERIOSTATIC BD INSULIN PEN NEEDLE UF MINI AVANDARYL ...... 36 WATER(PARABENS) ...... 159 ...... 121 AVANDIA ...... 36 BACTRIM ...... 19 BD INSULIN PEN NEEDLE UF ORIG AVAPRO ...... 61 BACTRIM DS ...... 19 ...... 121 AVAR ...... 19 BACTROBAN ...... 19 BD INSULIN PEN NEEDLE UF SHORT AVAR LS ...... 19 BACTROBAN NASAL ...... 19 ...... 121 AVAR-E ...... 19 BAL IN OIL ...... 159 BD INSULIN SYRINGE ...... 121 AVAR-E GREEN ...... 19 BALANCED SALT ...... 87 BD INSULIN SYRINGE HALF UNIT AVAR-E LS ...... 19 BAL-CARE DHA ...... 135 ...... 121 174
I n d e x I n d e x I n d e x BD INSULIN SYRINGE MICRO-FINE bethanechol chloride ...... 50 BOSTON CLEANER ...... 122 ...... 121 BETHKIS ...... 19 BOSTON CONDITIONING ...... 122 BD INSULIN SYRINGE SAFETY-LOK BETIMOL ...... 87 BOSTON ONE STEP (PF) ...... 122 ...... 121 BETOPTIC S ...... 87 BOSTON REWETTING ...... 122 BD INSULIN SYRINGE SLIP TIP ..... 121 bexarotene ...... 40 BOSTON SIMPLUS ...... 122 BD INSULIN SYRINGE ULT-FINE II BEXSERO (PF) ...... 52 BOSULIF ...... 40 ...... 121 BHT ...... 159 BOTOX ...... 50 BD INSULIN SYRINGE ULTRA-FINE BIATAIN HEEL ADH FOAM BP ...... 148 ...... 121 DRESSING ...... 121 BP 10-1 ...... 20 BD INTEGRA INSULIN SYRINGE BIATAIN NON-ADHESIVEFOAM BP-50% UREA ...... 148 ...... 121 ROUND ...... 122 BPO ...... 148 BD LO-DOSE MICRO-FINE IV ...... 121 BIAXIN ...... 20 BPO CREAMY WASH PACK ...... 148 BD LO-DOSE ULTRA-FINE ...... 121 bicalutamide ...... 40 BREATHERITE MDI SPACER ...... 122 BD SAFETYGLIDE INSULIN BICILLIN C-R ...... 20 BREATHERITE RIGID SPACER& SYRINGE ...... 121 BICILLIN L-A ...... 20 MASK ...... 122 BD SAFETYGLIDE SYRINGE ...... 121 BICLORA ...... 74 BREATHERITE SPACER& BD ULTRA-FINE NANO PEN BICNU ...... 40 MASK,ADULT ...... 122 NEEDLES ...... 121 BIDIL ...... 61 BREATHERITE SPACER& BEBULIN ...... 56 BIFERA RX ...... 92 MASK,CHILD ...... 122 BECONASE AQ ...... 87 bilberry ...... 111 BREATHERITE BEDSIDE-CARE ...... 147 bilberry fruit extract ...... 111 SPACER&MASK,INFANT ...... 122 BEDSIDE-CARE PERINEAL ...... 147 BILTRICIDE ...... 39 BREATHERITE BELEODAQ ...... 40 bimatoprost ...... 87 SPACER&MASK,S.CHLD ...... 122 belladonna alkaloids-opium ...... 4 BINOSTO ...... 159 BREATHERITE VALVED MDI BELLADONNA-OPIUM ...... 4 BIO TRUE ...... 122 CHAMBER ...... 122 BELSOMRA ...... 144 BIOBRANE ...... 122 BREATHERITE VALVED MDI benazepril ...... 61 BIOBRANE DRESSING ...... 122 SPACER ...... 122 benazepril-hydrochlorothiazide ...... 61 BIOBRANE-L ...... 122 BREATHERITE WITH MASK, LARGE BENEFIBER SUGAR FREE BIOBRANE-L DRESSING ...... 122 ...... 122 (DEXTRIN) ...... 100 BION TEARS (PF) ...... 87 BREATHERITE WITH MASK, BENEFIX ...... 56 BIOTHRAX ...... 52 MEDIUM ...... 122 BENICAR ...... 61 BISAC-EVAC ...... 100 BREATHERITE WITH MASK, SMALL BENLYSTA ...... 159 bisacodyl ...... 100 ...... 122 BENSAL HP ...... 30, 147 BISCOLAX ...... 100 BREO ELLIPTA ...... 17 bentonite ...... 159 BISMATROL ...... 100 BREVIBLOC ...... 61 BENTYL ...... 100 BISMUTH ...... 100 BREVIBLOC IN NACL (ISO-OSM) .... 61 BENZACLIN ...... 147 BISMUTH MAXIMUM STRENGTH BREVICON (28) ...... 70 BENZACLIN PUMP ...... 147 ...... 100 BREVITAL ...... 12 benzaldehyde ...... 159 bisoprolol fumarate ...... 61 BRIELLYN ...... 70 BENZAMYCIN ...... 19 bisoprolol-hydrochlorothiazide ...... 61 BRIJ 30 ...... 159 BENZEDREX ...... 87 bitter mask flavoring (bulk) ...... 159 BRIJ 35 ...... 159 BENZEPRO ...... 147 BITTERNESS MASK FLAVOR ...... 159 BRIJ 58 ...... 159 BENZEPRO (MICROSPHERES) ...... 147 bivalirudin ...... 28 BRIJ 78 ...... 159 BENZOIN COMPOUND ...... 147 BIVIGAM ...... 52 BRIJ 99 ...... 159 benzonatate ...... 74 black cohosh ...... 111 BRILINTA ...... 46 benzoyl peroxide ...... 147 black cohosh root extract ...... 111 brimonidine ...... 87 benztropine ...... 45 BLENDERM SURGICAL ...... 122 BRINTELLIX ...... 139 BEPREVE ...... 34 bleomycin ...... 40 BRISDELLE ...... 139 BERINERT ...... 159 BLEPH-10 ...... 20 BROHIST D ...... 32 BESIVANCE ...... 19 BLEPHAMIDE ...... 20 BROMFED DM ...... 74 BETADINE ...... 147 BLEPHAMIDE S.O.P...... 20 bromfenac ...... 87 BETADINE OPHTHALMIC PREP ...... 87 BLINCYTO ...... 40 bromocriptine ...... 45 BETADINE SKIN CLEANSER ...... 147 BLISTER RELIEF BANDAGES ...... 122 brompheniramine-pseudoeph-dm ...... 74 BETADINE SPRAY ...... 147 BLISTERFILM DRESSING ...... 122 BROTAPP ...... 32 BETADINE SURGICAL SCRUB ...... 147 BLUE GEL ...... 148 BROTAPP DM ...... 74 BETADINE SWABSTICKS ...... 147 BLUEBERRY FLAVOR ...... 159 BROVANA ...... 17 BETAGAN ...... 87 blue-green algae (spirulina) ...... 111 BROVEX PEB ...... 32 betamethasone acet,sod phos ...... 114 B-NEXA ...... 135 BROVEX PEB DM ...... 74 betamethasone dipropionate ...... 147 BODI BATH ...... 148 BROVEX PSB ...... 32, 75 betamethasone valerate ...... 148 BODI CARE ...... 148 BSS ...... 87 betamethasone, augmented ...... 148 BODI LINE ALMOND SKIN CARE BSS PLUS ...... 87 BETAPACE ...... 61 ...... 148 BUBBLE GUM CONCENTRATE ...... 159 BETAPACE AF ...... 61 BODI LOTION ...... 159 bubblegum flavor (bulk) ...... 160 BETASEPT SURGICAL SCRUB ...... 148 BONIVA ...... 159 budesonide ...... 17, 114 BETASERON ...... 66 BOOSTRIX TDAP ...... 52 BUFFERED LIDOCAINE ...... 12 betaxolol ...... 61, 87 BORDERED GAUZE ...... 122 BUFFERIN ...... 4 175
I n d e x I n d e x I n d e x BUFFERIN EXTRA STRENGTH ...... 4 calcium carbonate-vitamin d3 ...... 92 CAPSULE #3 (HYPROMELLOSE) ... 160 BULKEE II ...... 122 calcium chloride ...... 92 CAPSULE #4 ...... 160 bumetanide ...... 85 CALCIUM DISODIUM VERSENATE CAPSULE #5 ...... 160 BUMINATE 25 % ...... 56 ...... 160 CAPSULE #7 ...... 160 BUMINATE 5 % ...... 56 calcium gluconate ...... 92 CAPSULE CONI-SNAP #0 (GELATIN) BUNAVAIL ...... 160 calcium gluconate in 0.9% nacl ...... 92 ...... 160 BUPAP ...... 4 CALCIUM MAGNESIUM ...... 92 CAPSULE CONI-SNAP BUPHENYL ...... 100 CALCIUM PNV ...... 135 #0(HYPROMEL) ...... 160 bupivacaine ...... 12 calcium-cranberry fruit ...... 111 CAPSULE CONI-SNAP #00 (GELATIN bupivacaine (pf) ...... 12 CALCIUM-FOLIC ACID-VITAMIN D ...... 160 bupivacaine in nacl(pf) ...... 12 ...... 92 CAPSULE CONI-SNAP #000 ...... 160 bupivacaine-dextrose-water(pf) ...... 12 CALDOLOR ...... 14 CAPSULE CONI-SNAP #1 (GELATIN) bupivacaine-epinephrine ...... 12 CALDYPHEN ...... 148 ...... 160 bupivacaine-epinephrine (pf) ...... 12 CALDYPHEN CLEAR ...... 148 CAPSULE CONI-SNAP bupivacaine-epinephrine bitart ...... 12 CAL-GEST ANTACID ...... 101 #1(HYPROMEL) ...... 160 buprenorphine hcl ...... 4, 160 CALLERGY CLEAR ...... 148 CAPSULE CONI-SNAP #2 (GELATIN) buprenorphine-naloxone ...... 160 CALLUS CUSHION ...... 122 ...... 160 BUPROBAN ...... 157 CALLUS PADS ...... 122 CAPSULE CONI-SNAP #3 (GELATIN) bupropion hcl ...... 139 CALPHRON ...... 92 ...... 161 BURN RELIEF ...... 12 CAMBIA ...... 4 CAPSULE CONI-SNAP buspirone ...... 139 CAMILA ...... 70 #3(HYPROMEL) ...... 161 BUSULFEX ...... 40 CAMO BANDAGES ...... 122 CAPSULE CONI-SNAP #4 (GELATIN) BUTALBITAL COMPOUND ...... 4 camphor ...... 148 ...... 161 BUTALBITAL COMPOUND CAMPHOR BLOCKS ...... 148 captopril ...... 61 W/CODEINE ...... 4 CAMPRAL ...... 160 captopril-hydrochlorothiazide ...... 61 butalbital-acetaminop-caf-cod ...... 4 CAMPRAL DOSE PAK ...... 160 CARAC ...... 40 butalbital-acetaminophen ...... 4 CAMPTOSAR ...... 40 CARAFATE ...... 101 butalbital-acetaminophen-caff ...... 4 CAMRESE ...... 70 CARBAGLU ...... 161 butalbital-aspirin-caffeine ...... 4 CAMRESE LO ...... 70 carbamazepine ...... 66 BUTISOL ...... 144 CANASA ...... 101 CARBATROL ...... 66 butorphanol tartrate ...... 4 CANCIDAS ...... 30 carbidopa ...... 45 BUTRANS ...... 4 candesartan ...... 61 carbidopa-levodopa ...... 45 BUTTER RUM FLAVORING ...... 160 candesartan-hydrochlorothiazid ...... 61 carbidopa-levodopa-entacapone ...... 45 BUTTERFLY CLOSURES ...... 122 CANTIL ...... 101 carbinoxamine maleate ...... 34 BUTTERSCOTCH FLAVORING ...... 160 CAPACET ...... 4 CARBOCAINE ...... 12 butylated hydroxytoluene ...... 160 CAPASTAT ...... 20 CARBOCAINE (PF) ...... 12 BYDUREON ...... 36 CAPCOF ...... 75 CARBOFLEX ODOR CONTROL BYETTA ...... 36 capecitabine ...... 40 DRESSIN ...... 122 BYSTOLIC ...... 61 CAPEX ...... 148 CARBOMER 934P RESIN ...... 161 cabergoline ...... 114 CAPITAL WITH CODEINE ...... 4 carbomer 940 (bulk) ...... 161 CADUET ...... 61 CAPMIST DM ...... 75 carbomer homopolymer c (bulk) ...... 161 CAFCIT ...... 66 CAPRELSA ...... 40 carboplatin ...... 40 CAFERGOT ...... 4 CAPRON DM ...... 75 CARDENE IV ...... 58 caffeine citrated ...... 66 capsaicin ...... 148 CARDENE IV IN DEXTROSE ...... 58 caffeine-sodium benzoate ...... 66 CAPSUBLEND-H ...... 160 CARDENE IV IN SODIUM CHLORIDE calamine ...... 148 CAPSUBLEND-P ...... 160 ...... 58 CALAMINE MEDICATED ...... 148 CAPSUBLEND-S ...... 160 CARDIO TEA ...... 111 calamine phenolated ...... 148 CAPSULE #0 ...... 160 CARDIOLITE ...... 83 calamine-zinc oxide ...... 148 CAPSULE #0 (CELLULOSE) ...... 160 cardioplegic soln ...... 58 calamine-zinc oxide-phenol ...... 148 CAPSULE #0 (HYPROMELLOSE) ... 160 CARDIZEM ...... 58 CALAN ...... 58 CAPSULE #0 DRCAPS ...... 160 CARDIZEM CD ...... 58 CALAN SR ...... 58 CAPSULE #00 ...... 160 CARDIZEM LA ...... 58 CALCARB 600 WITH VITAMIN D ..... 92 CAPSULE #00 (CELLULOSE) ...... 160 CARDURA ...... 61 CALCIJEX ...... 168 CAPSULE #00 (HYPROMELLOSE) CARDURA XL ...... 61 calcipotriene ...... 148 ...... 160 CAREFINE PEN NEEDLE ...... 122 calcipotriene-betamethasone ...... 160 CAPSULE #1 ...... 160 CAREONE ULTIGUARD ...... 122 calcitonin (salmon) ...... 114 CAPSULE #1 (CELLULOSE) ...... 160 CARIMUNE NF NANOFILTERED ...... 52 CALCITRENE ...... 148 CAPSULE #1 (HYPROMELLOSE) ... 160 carisoprodol ...... 134 calcitriol ...... 148, 168 CAPSULE #1 DRCAPS ...... 160 carisoprodol-asa-codeine ...... 4 CALCIUM 600 WITH VITAMIN D3 CAPSULE #10 ...... 160 carisoprodol-aspirin ...... 134 ...... 92 CAPSULE #11 ...... 160 CARLESTA ...... 148 calcium acetate ...... 92 CAPSULE #13 ...... 160 carmine ...... 161 CALCIUM ANTACID ...... 100 CAPSULE #2 ...... 160 CARNITOR ...... 161 CALCIUM ANTACID ULTRA MAX ST CAPSULE #2 (HYPROMELLOSE) ... 160 CARNITOR SUGAR-FREE ...... 161 ...... 101 CAPSULE #3 ...... 160 CARRASYN HYDROGEL WOUND calcium carbonate ...... 92, 101 CAPSULE #3 (CELLULOSE) ...... 160 DRESS ...... 122 176
I n d e x I n d e x I n d e x CARRINGTON MOIST CENTRUM FLAVOR BURST ADULT CHILD MUCINEX BARRIER-ZINC ...... 148 ...... 168 CONGESTION-COUGH ...... 75 CARRINGTON MOISTURE BARRIER CEPACOL SENSATIONS COOLING CHILD MUCINEX M-S COLD CR ...... 148 ...... 12 DAY-NTE ...... 75 carteolol ...... 87 CEPACOL SENSATIONS HYDRA ...... 12 CHILD MUCINEX STUFFY CARTIA XT ...... 58 CEPACOL SORE THROAT NOSE-COLD ...... 75 CARTICEL ...... 161 (BENZ-MEN) ...... 12 CHILD MUCUS RELIEF COUGH ...... 75 carvedilol ...... 61 CEPACOL SORETHROAT-COUGH CHILD MUCUS RELIEF CASODEX ...... 40 ...... 75 EXPECTORANT ...... 75 CASTELLANI PAINT MODIFIED .... 148 CEPACOL ULTRA ...... 12 CHILD PLUS COUGH & RUNNY castor oil ...... 101, 161 cephalexin ...... 21 NOSE ...... 75 CATAFLAM ...... 4 CEPROTIN (BLUE BAR) ...... 56 CHILD TRIAMINIC COLD & CATAPRES ...... 61 CEPROTIN (GREEN BAR) ...... 56 ALLERGY ...... 32 CATAPRES-TTS-1 ...... 61 CERAVE BABY MOISTURIZING .... 148 CHILD TRIAMINIC CATAPRES-TTS-2 ...... 61 CERAVE SUNSCREEN ...... 148 COUGH-CONGEST ...... 75 CATAPRES-TTS-3 ...... 61 CERDELGA ...... 161 CHILD TRIAMINIC COUGH-SORE CATHFLO ACTIVASE ...... 56 CEREBYX ...... 66 THR ...... 75 catnip ...... 111 CEREZYME ...... 161 CHILD TRIAMINIC MS FEVER-COLD cat's claw (uncaria tomentosa) ...... 111 CERVARIX VACCINE (PF) ...... 52 ...... 75 CAVAN-ALPHA KIT ...... 135 CERVIDIL ...... 114 CHILDREN'S ACETAMINOPHEN ...... 4 CAVAN-EC SOD DHA ...... 135 CESAMET ...... 101 CHILDREN'S ALAWAY ...... 34 CAVILON SKIN CLEANSER ...... 148 CETA-KLENZ GENTLE ...... 148 CHILDREN'S ALLERGY CAYA CONTOURED ...... 70 CETAPHIL ...... 148 (DIPHENHYD) ...... 34 CAYSTON ...... 20 CETAPHIL ANTIBACTERIAL ...... 148 CHILDREN'S ALLERGY COMPLETE CAZIANT (28) ...... 70 CETAPHIL DAILY FACIAL ...... 148 ...... 34 CEDAX ...... 20 CETAPHIL DERMACONTROL ...... 148 CHILDREN'S ALLERGY MEDICINE CEENU ...... 40 CETAPHIL RESTORADERM ...... 148 ...... 34 cefaclor ...... 20 cetirizine ...... 34 CHILDREN'S ASPIRIN ...... 4 cefadroxil ...... 20 cetirizine-pseudoephedrine ...... 32 CHILDREN'S CETIRIZINE ...... 35 cefazolin ...... 20 cevimeline ...... 50 CHILDREN'S COLD & COUGH ...... 75 cefazolin in 0.9% sod chloride ...... 20 CHANTIX ...... 157 CHILDREN'S COLD & COUGH DM cefazolin in dextrose (iso-os) ...... 20 CHANTIX CONTINUING MONTH ...... 75 cefazolin in dextrose 5 % ...... 20 BOX ...... 157 CHILDREN'S COLD-ALLERGY (PE) cefdinir ...... 20 CHANTIX STARTING MONTH BOX ...... 32 cefepime ...... 20 ...... 157 CHILDREN'S IBUPROFEN ...... 15 cefepime in dextrose 5 % ...... 20 CHATEAL ...... 70 CHILDREN'S MAPAP ...... 4 cefepime in dextrose,iso-osm ...... 20 cheesecake flavor (bulk) ...... 161 CHILDREN'S M-S COLD DAY-NIGHT cefixime ...... 20 CHEMET ...... 161 ...... 75 cefotaxime ...... 20 CHEMSTRIP (CALIBRATION) ...... 122 CHILDREN'S MUCINEX cefotetan ...... 20 CHEMSTRIP 2 ...... 83 COLD-FEVER ...... 75 cefotetan in dextrose, iso-osm ...... 20 CHEMSTRIP K ...... 83 CHILDREN'S MUCINEX COUGH ...... 75 cefoxitin ...... 20 CHEMSTRIP MICRAL ...... 83 CHILDREN'S MUCINEX cefoxitin in dextrose, iso-osm ...... 20 CHEMSTRIP UGK ...... 83 MULTI-SYMP ...... 75 cefpodoxime ...... 20 CHENODAL ...... 101 CHILDREN'S MUCINEX NIGHT TIME cefprozil ...... 20 CHERATUSSIN AC ...... 75 ...... 75 ceftazidime ...... 20 CHERATUSSIN DAC ...... 75 CHILDREN'S PAIN & FEVER RELIEF ceftazidime in d5w ...... 20 CHEST CONGESTION RELIEF ...... 75 ...... 4 ceftibuten ...... 20 CHEST CONGESTION RELIEF + DM CHILDREN'S PAIN RELIEF ...... 4 CEFTIN ...... 20 ...... 75 CHILDREN'S PAIN RELIEVER ...... 5 ceftriaxone ...... 21 CHEST CONGESTION RELIEF PE ..... 75 CHILDREN'S PEPTO ...... 101 ceftriaxone in dextrose,iso-os ...... 20 CHEST CONGESTION-COUGH CHILDRENS PLUS MULTI-SYMP cefuroxime axetil ...... 21 RELIEF ...... 75 COLD ...... 75 cefuroxime sodium ...... 21 CHEST RUB ...... 148 CHILDREN'S Q-PAP ...... 5 CELEBREX ...... 14 CHEST-SINUS CONGESTION RELIEF CHILDREN'S SILAPAP ...... 5 celecoxib ...... 14 ...... 75 CHILDREN'S SILFEDRINE ...... 75 CELESTONE SOLUSPAN ...... 114 CHILD ALLERGY RELF(CETIRIZINE) CHILDREN'S TRIAMINIC FEVER ...... 5 CELEXA ...... 139 ...... 34 CHILD'S ALL DAY ALLERGY(CETIR) CELLCEPT ...... 119 CHILD COLD-COUGH DAY-NIGHT ...... 35 CELLCEPT INTRAVENOUS ...... 119 ...... 75 CHILDS TRIACTING COLD & COUGH cellulose (bulk) ...... 161 CHILD DELSYM COUGH+CHEST DM ...... 32 CELONTIN ...... 66 ...... 75 CHLO HIST ...... 75 CEM-UREA ...... 148 CHILD DELSYM COUGH+COLD ...... 75 CHLO TUSS ...... 75 CENESTIN ...... 114 CHILD DELSYM NIGHTTIME C-C ... 32 CHLO TUSS EX ...... 75 CENTANY ...... 21 CHILD IBUPROFEN ...... 14 chloramphenicol sod succinate ...... 21 CENTANY AT ...... 21 CHILD MUCINEX CHEST chlordiazepoxide hcl ...... 139 CENTRATEX ...... 92 CONGESTION ...... 75 chlordiazepoxide-clidinium ...... 101 177
I n d e x I n d e x I n d e x chlorhexidine gluconate ...... 161 CITRANATAL HARMONY (IRON CLINIMIX E 4.25%/D5W SULF FREE CHLOROPHYLL ...... 148 FUM) ...... 135 ...... 92 CHLOROPHYLL (WITH ALFALFA) CITRANATAL RX (NEW FORMULA) CLINIMIX E 5%/D15W SULFIT FREE ...... 111 ...... 135 ...... 92 chloroprocaine (pf) ...... 12 citric acid ...... 161 CLINIMIX E 5%/D20W SULFIT FREE chloroquine phosphate ...... 39 citronella oil ...... 161 ...... 92 chlorothiazide ...... 85 CITRUCEL ...... 101 CLINIMIX E 5%/D25W SULFIT FREE chlorothiazide sodium ...... 85 CITRUCEL SUGAR FREE ...... 101 ...... 92 chlorpheniramine maleate ...... 35 cladribine ...... 40 CLINISOL SF 15 % ...... 93 chlorpromazine ...... 139 CLAFORAN ...... 21 CLINITEST REAGENT ...... 83 chlorpropamide ...... 36 CLARAVIS ...... 149 clobetasol ...... 149 chlorthalidone ...... 85 CLARINEX ...... 35 clobetasol-emollient ...... 149 chlorzoxazone ...... 134 CLARINEX-D 12 HOUR ...... 32 CLOBEX ...... 149 chocolate flavor (bulk) ...... 161 clarithromycin ...... 21 clocortolone pivalate ...... 149 CHOLBAM ...... 101 CLEANSING EYELID ...... 87 CLODAN ...... 149 cholecalciferol (vitamin d3) ...... 168 CLEANSING WASH ...... 21 CLODAN KIT ...... 149 cholesterol ...... 161 CLEAR BANDAGES ...... 122 CLODERM ...... 149 cholestyramine (with sugar) ...... 61 CLEAR SPOT BANDAGES ...... 122 CLOFERA ...... 75 CHOLESTYRAMINE LIGHT ...... 61 CLEAR STRIPS ...... 122 CLOLAR ...... 40 choline,magnesium salicylate ...... 5 CLEAR TAPE ...... 122 clomipramine ...... 139 chromium chloride ...... 92 CLEAR WATERPROOF STRIPS ...... 122 clonazepam ...... 66 CICLODAN ...... 30 CLEARLAX ...... 101 clonidine ...... 61 CICLODAN KIT ...... 30 clemastine ...... 35 clonidine (pf) ...... 5 ciclopirox ...... 30 CLEOCIN ...... 21 clonidine hcl ...... 61, 139 ciclopirox-ure-camph-menth-euc ...... 30 CLEOCIN IN 5 % DEXTROSE ...... 21 clopidogrel ...... 46 ciclopirox-vite-nail lacq remo ...... 30 CLEOCIN T ...... 21 clorazepate dipotassium ...... 140 cidofovir ...... 46 CLERZ PLUS ...... 122 CLORPRES ...... 61 cilostazol ...... 46 CLEVIPREX ...... 58 CLOTH FIRST AID TAPE ...... 122 CILOXAN ...... 21 CLICKFINE ...... 122 CLOTH TAPE ...... 123 cimetidine ...... 101 CLIMARA ...... 114 clotrimazole ...... 30 cimetidine hcl ...... 101 CLIMARA PRO ...... 114 CLOTRIMAZOLE 3 DAY ...... 30 CIMZIA ...... 101 CLINDACIN ETZ ...... 21 CLOTRIMAZOLE-3 ...... 30 CIMZIA POWDER FOR RECONST CLINDACIN P ...... 21 clotrimazole-betamethasone ...... 30 ...... 101 CLINDACIN PAC ...... 21 CLOVE FLAVORING ...... 161 CIMZIA STARTER KIT ...... 101 clindamycin hcl ...... 21 clozapine ...... 140 CINNAMON ...... 111 clindamycin in 5 % dextrose ...... 21 CLOZARIL ...... 140 cinnamon bark ...... 111 clindamycin palmitate hcl ...... 21 C-NATE DHA ...... 135 CINNAMON FLAVORING ...... 161 CLINDAMYCIN PEDIATRIC ...... 21 CNL 8 NAIL ...... 30 CINNAMON OIL ...... 111 clindamycin phosphate ...... 21 CO Q-10 ...... 161 CINRYZE ...... 161 clindamycin-benzoyl peroxide ...... 149 COARTEM ...... 39 CIPRO ...... 21 CLINDESSE ...... 21 COBAN ...... 123 CIPRO HC ...... 21 CLINIMIX 5%/D15W SULFITE FREE COBAN ACTION WRAP ...... 123 CIPRO IN D5W ...... 21 ...... 92 COBAN SELF-ADHERENT WRAP CIPRO XR ...... 21 CLINIMIX 5%/D25W SULFITE-FREE ...... 123 CIPRODEX ...... 21 ...... 92 COBAN STERILE SELF-ADHERENT ciprofloxacin ...... 21 CLINIMIX 2.75%/D5W SULFIT FREE ...... 123 ciprofloxacin (mixture) ...... 21 ...... 92 cocaine ...... 12 ciprofloxacin hcl ...... 21 CLINIMIX 4.25%/D10W SULF FREE cocoa butter ...... 161 ciprofloxacin in 5 % dextrose ...... 21 ...... 92 cocoa butter (bulk) ...... 161 ciprofloxacin lactate ...... 21 CLINIMIX 4.25%/D5W SULFIT FREE coconut oil (bulk) ...... 161 cisatracurium ...... 50 ...... 92 cod liver oil ...... 168 cisplatin ...... 40 CLINIMIX 4.25%-D20W SULF-FREE COD LIVER OIL PLUS VIT A & D3 citalopram ...... 139 ...... 92 ...... 168 CITRANATAL (DUAL-IRON) ...... 135 CLINIMIX 4.25%-D25W SULF-FREE codeine sulfate ...... 5 CITRANATAL 90 DHA (ALGAL OIL) ...... 92 codeine-guaifenesin ...... 75 ...... 135 CLINIMIX 5%-D20W(SULFITE-FREE) CODITUSS DM ...... 75 CITRANATAL 90 DHA (NEW ...... 92 COLACE ...... 101 FORMULA ...... 135 CLINIMIX E 2.75%/D10W SUL FREE COLACE CLEAR ...... 101 CITRANATAL ASSURE ...... 135 ...... 92 COLAZAL ...... 101 CITRANATAL B-CALM (FE GLUC) CLINIMIX E 2.75%/D5W SULF FREE colchicine ...... 15 ...... 135 ...... 92 colchicine-probenecid ...... 15 CITRANATAL DHA (ALGAL OIL) CLINIMIX E 4.25%/D10W SUL FREE COLCRYS ...... 15 ...... 135 ...... 92 COLD & ALLERGY ...... 32 CITRANATAL DHA (NEW CLINIMIX E 4.25%/D25W SUL FREE COLD & ALLERGY PE ...... 32 FORMULA) ...... 135 ...... 92 COLD & COUGH ...... 75 CITRANATAL HARMONY ...... 135 COLD & COUGH DM ...... 75 178
I n d e x I n d e x I n d e x COLD & COUGH ELIXIR ...... 75 CONFORMANT 2 ...... 123 COUGH RELIEF ...... 76 COLD & FLU SEVERE ...... 75 CONGESTAC ...... 76 COUGH COLD & HOT PAIN RELIEF ...... 149 CONGESTION RELIEF (IBUPROF-PE) SUPPRESSANT-EXPECTORANT ...... 76 COLD HEAD CONGESTION ...... 76 COUGH SYRUP ...... 76 DAY/NITE ...... 76 CONSTULOSE ...... 101 COUGH SYRUP DM ...... 76 COLD HEAD CONGESTION CONTACT LENS RELIEF ...... 123 COUGH-SORE THROAT NIGHT ...... 76 DAYTIME ...... 76 CONZIP ...... 5 COUGHTAB ...... 76 COLD HEAD CONGESTION COOLMAGIC ...... 123 COUGHTAB 400 ...... 76 NIGHTTIME ...... 76 COOLMAGIC FENESTRATED ...... 123 COUMADIN ...... 28 COLD HEAD CONGESTION SEVER COPAXONE ...... 66 COVARYX ...... 115 DAY ...... 76 COPEGUS ...... 46 COVARYX H.S...... 115 COLD MULTI-SYMPTOM ...... 76 COPPER CHLORIDE ...... 93 COVERA-HS ...... 58 COLD MULTI-SYMPTOM CORDARONE ...... 58 COVRSITE ...... 123 (CHLORPHEN) ...... 76 CORDRAN TAPE LARGE ROLL ...... 149 COVRSITE PLUS ...... 123 COLD MULTI-SYMPTOM CORDRAN TAPE SMALL ROLL ...... 149 COZAAR ...... 62 DAY/NIGHT ...... 76 COREG ...... 62 cpd vehicle sus.sugar-free #12 ...... 161 COLD RELIEF PLUS ...... 76 COREG CR ...... 62 cpm-pseudoephed-hydrocodone ...... 76 COLD SEVERE CONGESTION ...... 76 CORGARD ...... 62 cranberry ...... 111 COLD SORE TREATMENT ...... 39 CORIFACT ...... 57 CRANBERRY ...... 111 COLD SORE TREATMNT CORLANOR ...... 58 cranberry conc-ascorbic acid ...... 111 (CAMP-PHEN) ...... 149 CORLOPAM ...... 62 CRANBERRY CONCENTRATE ...... 111 COLD-SINUS RELIEF ...... 76 CORMAX ...... 149 cranberry extract ...... 111 COLESTID ...... 62 CORN CUSHION ...... 123 cranberry fruit ...... 111 COLESTID FLAVORED ...... 62 CORTEF ...... 115 CRANBERRY PLUS VITAMIN C ..... 111 colestipol ...... 62 CORTENEMA ...... 115 CRAN-MAX 500 MG ...... 112 colistin (colistimethate na) ...... 21 CORTIFOAM ...... 115 cream de menthe (bulk) ...... 161 COLOCORT ...... 114 cortisone ...... 115 CREME DE MENTHE FLAVORING COLY-MYCIN M PARENTERAL ...... 22 CORTISPORIN ...... 22 ...... 161 COLY-MYCIN S ...... 22 CORTISPORIN-TC ...... 22 CREON ...... 101 COLYTE WITH FLAVOR PACKS .... 101 CORTIZONE-10 ...... 149 CRESEMBA ...... 30 COMBIGAN ...... 87 CORTOMYCIN ...... 22 CRESTOR ...... 62 COMBINE ABD ...... 123 CORTROSYN ...... 115 CRINONE ...... 115 COMBIPATCH ...... 115 CORVERT ...... 58 CRITIC-AID CLEAR ...... 149 COMBIVENT RESPIMAT ...... 17 CORVITA 150 ...... 93 CRITIC-AID CLEAR AF ...... 30 COMBIVIR ...... 46 CORVITE 150 ...... 93 CRIXIVAN ...... 46 COMETRIQ ...... 40 CORVITE FE ...... 93 cromolyn ...... 17, 87 COMFEEL PURILON ...... 123 CORVITE FREE ...... 168 CRYOSERV ...... 161 COMFORT EZ PEN NEEDLES ...... 123 CORZIDE ...... 62 CRYSELLE (28) ...... 70 COMFORT EZ SYRINGE ...... 123 COSENTYX ...... 149 CUBICIN ...... 22 COMPACT SPACE CHAMBER PLUS COSENTYX (2 SYRINGES) ...... 149 cupric sulfate ...... 93 ...... 123 COSENTYX PEN ...... 149 CUPRIMINE ...... 15 COMPLERA ...... 46 COSENTYX PEN (2 PENS) ...... 149 CURAD GAUZE PAD ...... 123 COMPLETE ...... 101 COSMEGEN ...... 40 CURAD NON-STICK PAD ...... 123 COMPLETE ALLERGY ...... 35 COSMETIC BALLS ...... 123 CURAFIL GEL WOUND ...... 123 COMPLETE ALLERGY MEDICINE COSMETIC PUFFS ...... 123 CURASOL HYDROGEL DRESSING ...... 35 COSMETIC SQUARES ...... 123 ...... 123 COMPLETE LICE TREATMENT ...... 149 COSOPT ...... 87 CURASOL WOUND DRESSING ...... 123 COMPLETE NATAL DHA ...... 135 COSOPT (PF) ...... 87 CURI-STRIP WOUND CLOSURES COMPLETENATE ...... 135 cosyntropin ...... 115 ...... 123 COMPRO ...... 101 COTTON BALLS ...... 123 CURITY ABDOMINAL PAD ...... 123 COMTAN ...... 45 COTTON BALLS STERILE ...... 123 CURITY ABSORBENT WADDING COMTREX COLD-COUGH ...... 76 COTTON SQUARES ...... 123 ...... 123 COMTREX DAY/NI SEV COLD-SINUS COTTON SWABS ...... 123 CURITY ALCOHOL SWABS ...... 149 ...... 76 COTTON, STERILE ...... 123 CURITY AMD ...... 123 COMTREX DAY/NIGHT COLD & cottonseed oil (bulk) ...... 161 CURITY AMD (WITH COUGH ...... 76 COUGH & COLD ...... 76 POLYHEXAMETH) ...... 123 COMTREX FLU THERAPY ...... 76 COUGH & COLD BP ...... 76 CURITY BANDAGE ...... 123 COMTREX NIGHTTIME COLD & COUGH CONTROL CURITY COTTON PREP BALLS ...... 123 COUGH ...... 76 (DEXTROMETHORPH) ...... 76 CURITY COTTON TIP APPLICATOR COMVAX (PF) ...... 52 COUGH CONTROL (GUAIFENESIN) ...... 123 CONCEPT DHA ...... 135 ...... 76 CURITY COVER ...... 123 CONCEPT OB ...... 135 COUGH CONTROL CF (PE) ...... 76 CURITY DETECTABLE LAP ...... 123 CONCERTA ...... 140 COUGH CONTROL DM ...... 76 CURITY DISP LAP SPONGE POUCH CONDYLOX ...... 149 COUGH CONTROL DM MAX ...... 76 ...... 123 CONEX ...... 33 COUGH DM ER ...... 76 CURITY DISP LAP SPONGE TRAY CONFORM ...... 123 COUGH DROPS ...... 76 ...... 123 179
I n d e x I n d e x I n d e x CURITY DRESSING ...... 124 dantrolene ...... 134 DENTAGEL ...... 93 CURITY GAUZE ...... 124 dapsone ...... 22 DENTAL TRAVEL PACK ...... 124 CURITY GAUZE BURN DRESSING DAPTACEL (DTAP PEDIATRIC) (PF) denture care products ...... 124 ...... 124 ...... 53 DEODORANT SOAP ...... 149 CURITY IODOFORM PACKING STRIP DARAPRIM ...... 39 DEPACON ...... 66 ...... 124 DASETTA 1/35 (28) ...... 70 DEPAKENE ...... 66 CURITY MULTI-TRAUMA DRESSING DASETTA 7/7/7 (28) ...... 70 DEPAKOTE ...... 66 ...... 124 daunorubicin ...... 40 DEPAKOTE ER ...... 66 CURITY NON-ADHERENT STRIP DAUNOXOME ...... 40 DEPAKOTE SPRINKLES ...... 66 ...... 124 DAY TIME PE ...... 76 DEPEN TITRATABS ...... 15 CURITY NON-ADHERING DRESSING DAYHIST ALLERGY ...... 35 DEPOCYT (PF) ...... 41 ...... 124 DAYPRO ...... 15 DEPO-ESTRADIOL ...... 115 CURITY PLAIN PACKING STRIP ... 124 DAYSEE ...... 70 DEPO-MEDROL ...... 115 CURITY READY-CUT GAUZE ...... 124 DAYTIME COLD & FLU RELIEF (PE) DEPO-PROVERA ...... 70, 115 CURITY WET DRESSING ...... 124 ...... 76 DEPO-SUBQ PROVERA 104 ...... 70 CUROSURF ...... 161 DAYTIME COLD-FLU ...... 76 DEPO-TESTOSTERONE ...... 115 CUTIVATE ...... 149 DAY-TIME COUGH ...... 76 DERMA STAT ...... 149 CUVPOSA ...... 101 DAYTIME MUCUS RELIEF DM ...... 76 DERMABASE ...... 161 cyanocobalamin (vitamin b-12) ...... 168 DAYTIME SINUS ...... 76 DERMACEA ...... 124 CYCLAFEM 1/35 (28) ...... 70 DAYTIME SINUS RELIEF ...... 76 DERMACEA I.V...... 124 CYCLAFEM 7/7/7 (28) ...... 70 DAYTIME-NIGHTTIME ...... 76 DERMACEA NON-WOVEN ...... 124 CYCLESSA (28) ...... 70 DAYTRANA ...... 140 DERMACEA STRETCH ...... 124 CYCLIVERT ...... 101 DDAVP ...... 115 DERMACINRX SILAZONE ...... 149 cyclobenzaprine ...... 134 DEBLITANE ...... 70 DERMAFIX ...... 161 CYCLOGYL ...... 87 DECARA ...... 168 DERMAFUNGAL ...... 30 CYCLOMYDRIL ...... 87 decitabine ...... 41 DERMAGAUZE ...... 124 cyclopentolate ...... 87 DECONEX ...... 76 DERMAGAUZE HYDROGEL cyclophosphamide ...... 40 DECONEX DM ...... 77 DRESSING ...... 124 cycloserine ...... 22 DECONEX DMX ...... 77 DERMA-GEL ...... 124 CYCLOSET ...... 36 DECONEX IR ...... 77 DERMAGRAN HYDROGEL cyclosporine ...... 119 deferoxamine ...... 161 DRESSING ...... 124 cyclosporine modified ...... 119 DEFINITY ...... 84 DERMAGRAN HYDROPHILIC CYKLOKAPRON ...... 57 DEHYDRATED ALCOHOL ...... 66 DRESSING ...... 124 CYMBALTA ...... 140 DELATESTRYL ...... 115 DERMAL WOUND CLEANSER ...... 149 cyproheptadine ...... 35 DELBASE COMPOUNDING ...... 161 DERMANIC ...... 161 CYRAMZA ...... 40 DEL-CLENS ...... 149 DERMASARRA ...... 149 CYRED ...... 70 DELESTROGEN ...... 115 DERMASEPTIN ...... 149 CYSTADANE ...... 161 DELFLEX WITH 2.5 % DEXTROSE DERMA-SMOOTHE/FS BODY OIL CYSTAGON ...... 161 ...... 93 ...... 149 CYSTARAN ...... 87 DELFLEX-LC/1.5% DEXTROSE ...... 93 DERMA-SMOOTHE/FS SCALP OIL cysteine (l-cysteine) ...... 93 DELFLEX-LC/2.5% DEXTROSE ...... 93 ...... 149 CYSVIEW ...... 83 DELFLEX-LC/4.25% DEXTROSE ...... 93 DERMASYN ...... 124 cytarabine ...... 40 DELFLEX-SM WITH 1.5% DEXTROSE DERMATOP ...... 149 cytarabine (pf) ...... 40 ...... 93 DERMAVIEW ...... 124 CYTOGAM ...... 53 DELSYM 12 HOUR ...... 77 DERMAVIEW II ...... 124 CYTOMEL ...... 158 DELSYM COUGH+CHEST CONGEST DERMOTIC OIL ...... 87 CYTOTEC ...... 101 DM ...... 77 DESENEX ...... 30 CYTOVENE ...... 46 DELSYM COUGH+COLD DAYTIME DESFERAL ...... 161 CYTRA K CRYSTALS ...... 93 ...... 77 DESGEN DM (PSEUDOEPHEDRINE) D.H.E.45 ...... 5 DELSYM COUGH+COLD NIGHTTIME ...... 77 d10 % & 0.45 % sodium chloride ...... 93 ...... 77 desipramine ...... 140 d2.5 %-0.45 % sodium chloride ...... 93 DELSYM COUGH+SOOTHING desloratadine ...... 35 d5 % and 0.9 % sodium chloride ...... 93 ACTION ...... 77 desmopressin ...... 115 d5 %-0.45 % sodium chloride ...... 93 DELSYM NIGHT TIME COUGH & desog-e.estradiol/e.estradiol ...... 70 dacarbazine ...... 40 COLD ...... 33 DESOGEN ...... 70 DACOGEN ...... 40 DELSYM NIGHTTIME desogestrel-ethinyl estradiol ...... 70 DAKLINZA ...... 46 MULTI-SYMPTOM ...... 77 DESONATE ...... 149 DALLERGY (CHLORCYCLIZINE-PE) DELYLA (28) ...... 70 desonide ...... 149 ...... 33 DELZICOL ...... 101 DESOWEN ...... 149 DALLERGY DEMADEX ...... 85 desoximetasone ...... 149 (CHLORPHENIRAMINE-PE) ...... 33 demeclocycline ...... 22 DESOXYN ...... 50 DALLERGY DEMEROL ...... 5 DESQUAM-X ...... 149 (DEXBROMPHENIRAMN-PE) ...... 33 DEMEROL (PF) ...... 5 desvenlafaxine ...... 140 DALVANCE ...... 22 DEMSER ...... 62 desvenlafaxine fumarate ...... 140 danazol ...... 115 DENAVIR ...... 46 DETOX DIETARY ...... 112 DANTRIUM ...... 134 DENTA 5000 PLUS ...... 93 DETOXAREX ...... 112 180
I n d e x I n d e x I n d e x DETROL ...... 162 DIASCREEN 3 REAGENT ...... 84 diphenhydramine hcl ...... 35 DETROL LA ...... 162 DIASCREEN 4OBL REAGENT ...... 84 diphenhydramine-acetaminophen ...... 3 DEWEE'S CARMINATIVE ...... 101 DIASCREEN 5 REAGENT ...... 84 diphenoxylate-atropine ...... 101 DEX4 GLUCOSE ...... 93 DIASCREEN 7 REAGENT ...... 84 DIPRIVAN ...... 12 dexamethasone ...... 115 DIASCREEN 8 REAGENT ...... 84 DIPROLENE ...... 150 DEXAMETHASONE INTENSOL ...... 115 DIASCREEN 9 REAGENT ...... 84 DIPROLENE AF ...... 150 dexamethasone sodium phos (pf) ...... 115 DIASTAT ...... 66 dipyridamole ...... 46, 84 dexamethasone sodium phosphate DIASTAT ACUDIAL ...... 66 DISALCID ...... 15 ...... 87, 115 DIASTIX ...... 84 DISINFECTING SOLUTION ...... 124 dexchlorpheniramine maleate ...... 35 diazepam ...... 66, 140 DISKETS ...... 5 DEXEDRINE ...... 50 DIAZEPAM INTENSOL ...... 140 disopyramide phosphate ...... 59 DEXEDRINE SPANSULE ...... 50 dibucaine ...... 12 DISPOSABLE ENEMA ...... 102 DEXFERRUM ...... 93 DICEL CD ...... 77 disulfiram ...... 162 DEXILANT ...... 101 DICLEGIS ...... 101 DITROPAN XL ...... 162 dexmedetomidine ...... 144 diclofenac potassium ...... 5 DIURETIC ...... 112 dexmethylphenidate ...... 140 diclofenac sodium ...... 15, 41, 87, 150 DIURIL ...... 85 DEXPAK 10 DAY ...... 115 diclofenac-misoprostol ...... 15 divalproex ...... 67 DEXPAK 13 DAY ...... 115 dicloxacillin ...... 22 DIVIGEL ...... 115 DEXPAK 6 DAY ...... 115 dicyclomine ...... 101 DOAN'S EXTRA STRENGTH ...... 5 dexpanthenol ...... 50 didanosine ...... 47 dobutamine ...... 59 dexrazoxane hcl ...... 162 DIFFERIN ...... 150 dobutamine in d5w ...... 59 dextroamphetamine ...... 50 DIFICID ...... 22 DOCEFREZ ...... 41 dextroamphetamine-amphetamine ...... 50 diflorasone ...... 150 docetaxel ...... 41 dextromethorphan polistirex ...... 77 DIFLUCAN ...... 30 DOC-Q-LACE ...... 102 dextromethorphan-guaifenesin ...... 77 diflunisal ...... 5 DOC-Q-LAX ...... 102 dextrose ...... 93 DIGITEK ...... 58 DOCU ...... 102 dextrose 10 % and 0.2 % nacl ...... 93 DIGOX ...... 58 docusate calcium ...... 102 dextrose 10 % in water (d10w) ...... 93 digoxin ...... 58 docusate sodium ...... 102 dextrose 20 % in water (d20w) ...... 93 dihydrocode-acetaminophen-caff ...... 5 DOCUSIL ...... 102 dextrose 25 % in water (d25w) ...... 93 dihydrocodeine-aspirin-caff ...... 5 DOCUSOL ...... 102 dextrose 30 % in water (d30w) ...... 93 dihydroergotamine ...... 5 DOCUSOL KIDS ...... 102 dextrose 40 % in water (d40w) ...... 93 DILACOR XR ...... 58 DOCUSOL PLUS ...... 102 dextrose 5 % in water (d5w) ...... 93 DILANTIN ...... 67 DOK ...... 102 dextrose 5 %-lactated ringers ...... 93 DILANTIN EXTENDED ...... 67 DOK PLUS ...... 102 dextrose 5%-0.2 % sod chloride ...... 93 DILANTIN INFATABS ...... 67 DOLOGESIC ...... 3 dextrose 5%-0.3 % sod.chloride ...... 93 DILANTIN-125 ...... 67 DOLOPHINE ...... 5 dextrose 50 % in water (d50w) ...... 93 DILATRATE-SR ...... 58 DONATUSS DC ...... 77 dextrose 70 % in water (d70w) ...... 93 DILAUDID ...... 5 DONATUSSIN ...... 77 DHS TAR ...... 150 DILAUDID (PF) ...... 5 DONATUSSIN DM ...... 77 DHS TAR GEL ...... 150 DILAUDID-HP (PF) ...... 5 DONATUSSIN PEDI DHS ZINC ...... 150 DILT-CD ...... 59 (REFORMULATED) ...... 77 DIABETA ...... 36 DILTIA XT ...... 59 DONATUSSIN PEDIATRIC ...... 77 DIABETIC SILTUSSIN DAS-NA ...... 77 diltiazem hcl ...... 59 donepezil ...... 50 DIABETIC SILTUSSIN-DM ...... 77 diltiazem in dextrose 5 % ...... 59 DONNATAL ...... 102 DIABETIC SILTUSSIN-DM MAX STR DILT-XR ...... 59 dopamine ...... 50 ...... 77 DILTZAC ER ...... 59 dopamine in 5 % dextrose ...... 50 DIABETISWEET ...... 93 DILUENT FOR DOPRAM ...... 67 DIAFOODS THICK-IT ...... 162 EPOPROSTENOL/FLOLA ...... 162 DORIBAX ...... 22 DIAFOODS THICK-IT #2 ...... 162 DILUENT FOR YF-VAX (1 DOSE) DORYX ...... 22 DIALYVITE ...... 168 ...... 162 dorzolamide ...... 87 DIALYVITE 3000 ...... 168 DILUENT FOR YF-VAX (5 DOSE) dorzolamide-timolol ...... 87 DIALYVITE 5000 ...... 168 ...... 162 DOTHELLE DHA ...... 135 DIALYVITE SUPREME D ...... 168 DILUENT-MERCK LIVE VIRUS VACC DOUBLE ANTIBIOTIC ...... 22 DIAMOX SEQUELS ...... 85 ...... 162 DOUBLE ANTIBIOTIC (B.TRACN ZN) DIANEAL PD-2 WITH 2.5 % DEX ...... 93 DIMAPHEN (PE) ...... 33 ...... 22 DIANEAL PD-2 WITH 4.25 % DEX .... 93 DIMAPHEN DM ...... 77 DOVONEX ...... 150 DIANEAL PD-2/1.5% DEXTROSE ...... 93 dimenhydrinate ...... 101 doxazosin ...... 62 DIANEAL WITH 1.5% DEXTROSE ... 93 DIMETANE-DX ...... 77 doxepin ...... 140 DIANEAL WITH 4.25 % DEXTROSE DIMETAPP DM COLD-COUGH (PE) doxercalciferol ...... 162 ...... 93 ...... 77 DOXIL ...... 41 DIAPER RASH ...... 150 DIOCTO ...... 101 doxorubicin ...... 41 DIAPER RASH RELIEF ...... 150 DIOVAN ...... 62 doxorubicin, peg-liposomal ...... 41 DIASCREEN 10 ...... 84 DIOVAN HCT ...... 62 DOXY-100 ...... 22 DIASCREEN 1G REAGENT ...... 84 DIPENTUM ...... 101 doxycycline hyclate ...... 22, 162 DIASCREEN 1K REAGENT ...... 84 DIPHEDRYL ...... 35 doxycycline monohydrate ...... 22 DIASCREEN 2GK REAGENT ...... 84 DIPHENHIST ...... 35 DR. SMITH'S ADULT BARRIER ...... 150 181
I n d e x I n d e x I n d e x DR. SMITH'S DIAPER ...... 150 echinacea ...... 112 ELTA TAR ...... 150 DR. SMITH'S DIAPER RASH ...... 150 ECHINACEA & GOLDENSEAL ...... 112 EMADINE ...... 35 DR. SMITH'S RASH-SKIN ...... 150 ECHINACEA 1X ...... 112 EMBEDA ...... 5 DRIMINATE ...... 102 echinacea angust-purpr root xt ...... 112 EMCYT ...... 41 DRISDOL ...... 168 ECHINACEA HERB ...... 112 EMEND ...... 102 droperidol ...... 140 echinacea purpurea extract ...... 112 EMLA ...... 12 DROXIA ...... 57 echinacea purpurea root ...... 112 EMOQUETTE ...... 70 DRYMAX AF ...... 77 echinacea-golden seal ...... 112 EMSAM ...... 140 DRYNET WOUND VEIL ...... 124 echinacea-golden seal roots ...... 112 EMTRIVA ...... 47 DUAC ...... 150 EC-NAPROSYN ...... 15 ENABLEX ...... 162 DUAVEE ...... 115 econazole ...... 30 enalapril maleate ...... 62 DUCODYL ...... 102 ECONTRA EZ ...... 70 enalaprilat ...... 62 DUET DHA EC-OM 3 ...... 135 ED A-HIST ...... 33 enalapril-hydrochlorothiazide ...... 62 DUET DHA WITH OMEGA-3 ...... 135 ED A-HIST DM ...... 77 ENBRACE HR ...... 135 DUETACT ...... 37 ED A-HIST PSE ...... 33 ENBREL ...... 15 DUEXIS ...... 15 ED BRON GP ...... 77 ENBREL SURECLICK ...... 15 DULCOLAX (BISACODYL) ...... 102 ED CHLORPED D ...... 33 ENDACOF - DM ...... 77 DULERA ...... 17 ED CHLORPED JR ...... 35 ENDACOF-C ...... 77 duloxetine ...... 140 ED-APAP ...... 5 ENDOCET ...... 5 DUODERM HYDROACTIVE ...... 124 ED-CHLORPED ...... 35 ENDODAN ...... 5 DUONEB ...... 17 ED-CHLORTAN ...... 35 ENEMA ...... 102 DUOPA ...... 45 EDECRIN ...... 85 ENEMA DISPOSABLE ...... 102 DURACLON (PF) ...... 5 EDLUAR ...... 144 ENGERIX-B (PF) ...... 53 DURAFLU ...... 77 ED-SPAZ ...... 102 ENGERIX-B PEDIATRIC (PF) ...... 53 DURAGESIC ...... 5 EDURANT ...... 47 ENGLISH TOFFEE FLAVOR ...... 162 DURAMORPH (PF) ...... 5 EEMT ...... 115 ENJUVIA ...... 115 DURAPORE SURGICAL ...... 124 EEMT HS ...... 115 ENLON ...... 50 DURAVENT DM ...... 77 EFFER-K ...... 93 ENLYTE (FERROUS GLYCINE) ...... 168 DURAVENT PE ...... 77 EFFERVESCENT PAIN RELIEF ...... 5 enoxaparin ...... 28 DUREZOL ...... 87 EFFEXOR XR ...... 140 ENPRESSE ...... 70 dutasteride ...... 162 EFFIENT ...... 46 ENSKYCE ...... 70 DUTOPROL ...... 62 EFUDEX ...... 41 entacapone ...... 45 DYAZIDE ...... 85 EGRIFTA ...... 115 entecavir ...... 47 DYLOJECT ...... 15 ELAPRASE ...... 162 ENTEREG ...... 102 DYMISTA ...... 87 elastic bandage ...... 124 ENTOCORT EC ...... 115 DYNACIN ...... 22 ELASTO-GEL ...... 124 ENTRE-COUGH ...... 77 DYNA-HEX ...... 150 ELASTO-GEL CAST-SPLINT ENTRESTO ...... 62 DYNA-HEX (ISOPROPYL ALCOHOL) PADDING ...... 124 ENTSOL NASAL SPRAY ...... 87 ...... 150 ELASTO-GEL CIRCLE DRESSING ENTYVIO ...... 102 DYSPORT ...... 50 ...... 124 ENULOSE ...... 102 E.C. PRIN ...... 5 ELASTO-GEL FACE DRESSING ...... 125 EOVIST ...... 84 E.E.S. 400 ...... 22 ELASTO-GEL PLUS ...... 125 EPANED ...... 62 E.E.S. GRANULES ...... 22 ELDEPRYL ...... 45 ephedrine sulfate ...... 77 EAR DROPS (CARBAMIDE electrolyte-48 in d5w ...... 94 ephedrine sulfate in 0.9% nacl ...... 77 PEROXIDE) ...... 87 ELELYSO ...... 162 EPI-CLENZ ...... 150 EAR POPPER INFLATION DEVICE ELESTAT ...... 35 EPIDUO ...... 150 ...... 124 ELESTRIN ...... 115 EPIDUO FORTE ...... 150 EAR WAX REMOVAL DROPS ...... 87 ELIDEL ...... 119 EPIFOAM ...... 150 EAR WAX REMOVAL KIT ...... 87 ELIGARD ...... 41 epinastine ...... 35 EAR WAX REMOVAL SYSTEM ...... 87 ELIMITE ...... 150 epinephrine ...... 50 EAR WAX TREATMENT ...... 87 ELINEST ...... 70 epinephrine hcl (pf) ...... 50 EASIVENT HOLDING CHAMBER ELIPHOS ...... 94 EPIPEN ...... 50 ...... 124 ELIQUIS ...... 28 EPIPEN 2-PAK ...... 50 EASIVENT MASK LARGE ...... 124 ELITEK ...... 15 EPIPEN JR ...... 50 EASIVENT MASK MEDIUM ...... 124 ELITE-OB ...... 135 EPIPEN JR 2-PAK ...... 50 EASIVENT MASK SMALL ...... 124 ELIXOPHYLLIN ...... 17 epirubicin ...... 41 EASY COMFORT INSULIN SYRINGE ELLA ...... 70 EPISNAP ...... 50 ...... 124 ELLENCE ...... 41 EPITOL ...... 67 EASY COMFORT PEN NEEDLES .... 124 ELLURA ...... 112 EPIVIR ...... 47 EASY TOUCH ...... 124 ELMIRON ...... 5 EPIVIR HBV ...... 47 EASY TOUCH ALCOHOL PREP PADS ELOCON ...... 150 eplerenone ...... 85 ...... 150 ELOCTATE ...... 57 EPOGEN ...... 69 EASY TOUCH INSULIN SAFETY SYR ELOXATIN ...... 41 epoprostenol (glycine) ...... 62 ...... 124 ELTA LITE TAR ...... 150 eprosartan ...... 62 EASY TOUCH INSULIN SYRINGE ELTA SEAL MOISTURE BARRIER EPZICOM ...... 47 ...... 124 ...... 150 EQUETRO ...... 140 182
I n d e x I n d e x I n d e x ERAXIS(WATER DILUENT) ...... 30 EVOTAZ ...... 47 EZ CHAR ...... 162 ERBITUX ...... 41 EVOXAC ...... 50 EZ FLU 2015-16(FLUCELVAX)(PF) ergocalciferol (vitamin d2) ...... 168 EVZIO ...... 29 ...... 53 ergoloid ...... 62 EXALGO ER ...... 5, 6 E-Z SPACER ...... 125 ergotamine-caffeine ...... 5 EXCEDRIN BACK & BODY ...... 6 EZO CUSHIONS LOWER HEAVY ERIVEDGE ...... 41 EXCEDRIN EXTRA STRENGTH ...... 6 ...... 125 ERRIN ...... 70 EXCEDRIN MENSTRUAL COMPLETE EZO CUSHIONS UPPER HEAVY ..... 125 ERTACZO ...... 30 ...... 6 FABB ...... 168 ERWINAZE ...... 41 EXCEDRIN PM ...... 3 FABIOR ...... 150 ERY PADS ...... 22 EXCEDRIN SINUS HEADACHE ...... 77 FABRAZYME ...... 162 ERYGEL ...... 22 EXCEDRIN TENSION HEADACHE ..... 6 FABRIC BANDAGES ...... 125 ERYPED 200 ...... 22 EXCILON ...... 125 FABRIC KNUCKLE-FINGER ERYPED 400 ...... 22 EXCILON AMD (WITH BANDAGE ...... 125 ERY-TAB ...... 22 POLYHEXAMET) ...... 125 FABRIC STRIP EXTRA LARGE ...... 125 ERYTHROCIN ...... 22 EXCILON DRAIN ...... 125 FALESSA ...... 168 ERYTHROCIN (AS STEARATE) ...... 22 EXCILON I.V...... 125 FALLBACK SOLO ...... 70 erythromycin ...... 22, 23 EXEFEN DMX ...... 77 FALMINA (28) ...... 71 erythromycin ethylsuccinate ...... 22 EXEL INSULIN ...... 125 famciclovir ...... 47 erythromycin with ethanol ...... 23 EXELDERM ...... 30 famotidine ...... 102 erythromycin-benzoyl peroxide ...... 23 EXELON ...... 50 famotidine (pf) ...... 102 ESBRIET ...... 162 exemestane ...... 41 famotidine (pf)-nacl (iso-os) ...... 102 ESCAVITE ...... 168 EXFORGE ...... 62 FAMVIR ...... 47 ESCAVITE D ...... 168 EXJADE ...... 162 FANAPT ...... 140 ESCAVITE LQ ...... 168 EX-LAX (SENNOSIDES) ...... 102 FARESTON ...... 41 escitalopram oxalate ...... 140 EX-LAX MAXIMUM STRENGTH ... 102 FARXIGA ...... 37 ESGIC ...... 5 EXTAVIA ...... 67 FARYDAK ...... 41 esmolol ...... 62 EXTINA ...... 30 FASLODEX ...... 41 esomeprazole magnesium ...... 102 EXTRANEAL 7.5 % ...... 94 FATTIBASE ...... 162 esomeprazole sodium ...... 102 EXTRA-VIRT PLUS DHA ...... 135 FATTYBLEND ...... 162 esomeprazole strontium ...... 102 EXU-DRY ADULT DRESSING ...... 125 FAZACLO ...... 140 ESOTERICA FADE ...... 150 EXU-DRY ARM DRESSING ...... 125 FE C ...... 94 ESTARYLLA ...... 70 EXU-DRY BOOT-FOOT DRESSING FE C PLUS ...... 94 estazolam ...... 145 ...... 125 FEIBA NF ...... 57 ESTRACE ...... 115 EXU-DRY BURN JACKET-LARGE felbamate ...... 67 estradiol ...... 115 ...... 125 FELBATOL ...... 67 estradiol valerate ...... 115 EXU-DRY BURN JACKET-MEDIUM FELDENE ...... 15 estradiol-norethindrone acet ...... 115 ...... 125 felodipine ...... 59 ESTRING ...... 116 EXU-DRY BURN JACKET-SMALL FEM PH ...... 39 estrogens-methyltestosterone ...... 116 ...... 125 FEMARA ...... 41 estropipate ...... 116 EXU-DRY BURN VEST-LARGE ...... 125 FEMCON FE ...... 71 ESTROSTEP FE-28 ...... 70 EXU-DRY BURN VEST-SMALL ...... 125 FEMHRT LOW DOSE ...... 116 eszopiclone ...... 145 EXU-DRY ELBOW-KNEE-HEEL ...... 125 FEMRING ...... 116 ethacrynate sodium ...... 85 EXU-DRY FACE DRESSING ...... 125 fenofibrate ...... 62 ethambutol ...... 23 EXU-DRY HAND DRESSING, LARGE fenofibrate micronized ...... 62 ethanol (ethyl alcohol) ...... 67 ...... 125 fenofibrate nanocrystallized ...... 62 ethosuximide ...... 67 EXU-DRY HAND DRESSING, fenofibric acid ...... 62 ethyl acetate ...... 162 MEDIUM ...... 125 fenofibric acid (choline) ...... 62 ethyl alcohol ...... 150 EXU-DRY HAND DRESSING, SMALL FENOGLIDE ...... 62 ethyl vanillin ...... 162 ...... 125 fenoprofen ...... 15 etidronate disodium ...... 162 EXU-DRY INCISION DRESSING ..... 125 fentanyl ...... 6 etodolac ...... 15 EXU-DRY LARGE BOOT DRESSING fentanyl citrate ...... 6 etomidate ...... 12 ...... 125 fentanyl citrate (pf) ...... 6 ETOPOPHOS ...... 41 EXU-DRY LEG DRESSING ...... 125 FENTORA ...... 6 etoposide ...... 41 EXU-DRY NECK DRESSING ...... 125 FERAHEME ...... 94 eucalyptol ...... 162 EXU-DRY SCALP DRESSING ...... 125 FERIVA ...... 94 EUCALYPTUS FLAVOR ...... 162 EXU-DRY WOUND DRESSING ...... 125 FERIVA 21-7 TABLET ...... 94 eucalyptus oil ...... 162 EYE DROPS (TETRAHYDROZOLINE) FERIVA FA (SUMALATE) ...... 94 EURAX ...... 150 ...... 87 FERIVA FA (WITH QUATREFOLIC) EVAMIST ...... 116 EYE DROPS ADVANCED RELIEF ..... 87 ...... 94 EVEKEO ...... 50 EYE DROPS ALLERGY RELIEF ...... 87 FERRALET 90 DUAL-IRON EVENING PRIMROSE ...... 112 EYE IRRIGATING SOLUTION ...... 87 DELIVERY ...... 94 evening primrose oil ...... 112 EYE ITCH RELIEF ...... 35 FERRAPLUS 90 ...... 94 EVERYDAY LONG PANTILINERS EYE STREAM ...... 87 FERRETTS ...... 94 ...... 125 EYE WASH ...... 87 FERRIPROX ...... 162 EVISTA ...... 162 EYELID WIPES ...... 87 FERRLECIT ...... 94 EVOCLIN ...... 23 EYLEA ...... 88 ferrous gluconate ...... 94 183
I n d e x I n d e x I n d e x ferrous sulfate ...... 94 FLEXBUMIN 25 % ...... 57 fluorometholone ...... 88 FETZIMA ...... 140 FLEXBUMIN 5 % ...... 57 fluorouracil ...... 41 FEVER REDUCER ...... 6 FLEXIBLE ...... 125 fluoxetine ...... 140, 141 FEVERALL ...... 6 FLEXIBLE FABRIC BANDAGES ..... 125 fluphenazine decanoate ...... 141 FEXMID ...... 134 FLEXIBLE FOAM ...... 125 fluphenazine hcl ...... 141 fexofenadine ...... 35 FLEXICHAMBER ...... 125 flurazepam ...... 145 fexofenadine-pseudoephedrine ...... 33 FLEXIGEL ...... 125 flurbiprofen ...... 15 FIBER ...... 103 FLEXZAN WOUND DRESSING ...... 125 flurbiprofen sodium ...... 88 FIBER (CALCIUM POLYCARBOPHIL) FLOLAN ...... 62 FLURESS ...... 88 ...... 102 FLOMAX ...... 162 FLU-SEVERE COLD-COUGH FIBER (PSYLLIUM HUSK) ...... 102 FLONASE ...... 88 DAYTIME ...... 77 FIBER (PSYLLIUM HUSK/SUGAR) FLONASE ALLERGY RELIEF ...... 88 FLU-SEVERE COLD-COUGH NIGHT ...... 102 FLO-PRED ...... 116 ...... 77 FIBER (WITH ASPARTAME) ...... 102 FLORA-Q ...... 103 flutamide ...... 41 FIBER LAXATIVE (CA POLYCARBO) FLORA-Q(2) ...... 103 fluticasone ...... 88, 150 ...... 103 FLORIVA ...... 168 FLUVIRIN 2012-2013 ...... 53 FIBER LAXATIVE FLOVENT DISKUS ...... 17 FLUVIRIN 2012-2013 (PF) ...... 53 (METHYLCELLULO) ...... 103 FLOVENT HFA ...... 17 FLUVIRIN 2013-2014 ...... 53 FIBER LAXATIVE (PSYLLIUM HUSK) FLOWTUSS ...... 77 FLUVIRIN 2013-2014 (PF) ...... 53 ...... 103 floxuridine ...... 41 FLUVIRIN 2014-2015 ...... 53 FIBER SMOOTH ...... 103 FLU & SORE THROAT ...... 77 FLUVIRIN 2014-2015 (PF) ...... 53 FIBER SMOOTH (SUCROSE) ...... 103 FLU BP ...... 77 FLUVIRIN 2015-2016 ...... 53 FIBER THERAPY ...... 103 FLUARIX 2012-2013 (PF) ...... 53 FLUVIRIN 2015-2016 (PF) ...... 53 FIBER THERAPY (PSYLLIUM SEED) FLUARIX 2013-2014 (PF) ...... 53 fluvoxamine ...... 141 ...... 103 FLUARIX 2014-2015 (PF) ...... 53 FLUZONE 2012-2013 ...... 53 FIBER-LAX ...... 103 FLUARIX QUAD 2013-2014 (PF) ...... 53 FLUZONE 2012-2013 (PF) ...... 53 FIBERTAB ...... 103 FLUARIX QUAD 2014-2015 (PF) ...... 53 FLUZONE 2013-2014 ...... 53 FIBRICOR ...... 62 FLUARIX QUAD 2015-2016 (PF) ...... 53 FLUZONE 2013-2014 (PF) ...... 53 FINACEA ...... 150 FLUBLOK 2012-2013 (PF) ...... 53 FLUZONE 2014-2015 ...... 54 FINACEA PLUS ...... 150 FLUBLOK 2013-2014 (PF) ...... 53 FLUZONE 2014-2015 (PF) ...... 54 finasteride ...... 162 FLUBLOK 2014-2015 (PF) ...... 53 FLUZONE 2015-2016 ...... 54 FINGER SLEEVES ...... 125 FLUBLOK 2015-2016 (PF) ...... 53 FLUZONE HIGH-DOSE 2012-13 (PF) FIORICET ...... 6 FLUCELVAX (PF) ...... 53 ...... 54 FIORICET WITH CODEINE ...... 6 FLUCELVAX 2013-2014 (PF) ...... 53 FLUZONE HIGH-DOSE 2013-14 (PF) FIORINAL ...... 6 FLUCELVAX 2014-2015 (PF) ...... 53 ...... 54 FIORINAL-CODEINE #3 ...... 6 FLUCELVAX 2015-2016 (PF) ...... 53 FLUZONE HIGH-DOSE 2014-15 (PF) FIRAZYR ...... 162 fluconazole ...... 30 ...... 54 FIRMAGON KIT W DILUENT fluconazole in dextrose(iso-o) ...... 30 FLUZONE HIGH-DOSE 2015-16 (PF) SYRINGE ...... 41 fluconazole in nacl (iso-osm) ...... 30 ...... 54 FIRST AID CLOTH TAPE ...... 125 flucytosine ...... 30 FLUZONE INTRADERM 2012-13 (PF) FIRST AID HURT-FREE WRAP ...... 125 fludarabine ...... 41 ...... 54 FIRST AID PAPER TAPE ...... 125 fludrocortisone ...... 116 FLUZONE INTRADERM 2013-14 (PF) FISH OIL ...... 103 FLULAVAL 2012-2013 ...... 53 ...... 54 FLAGYL ...... 23 FLULAVAL 2013-2014 ...... 53 FLUZONE INTRADERM 2014-15 (PF) FLAREX ...... 88 FLULAVAL 2014-2015 ...... 53 ...... 54 FLAVOR BLEND 2 IN 1 ...... 162 FLULAVAL 2014-2015 (PF) ...... 53 FLUZONE INTRADERM QUAD FLAVOR PACKETS ...... 162 FLULAVAL QUAD 2013-2014 ...... 53 2015-16 ...... 54 FLAVOR PLUS ...... 162 FLULAVAL QUAD 2014-2015 ...... 53 FLUZONE PEDI 2012 -2013 (PF) ...... 54 FLAVOR SWEET ...... 162 FLULAVAL QUAD 2014-2015 (PF) .... 53 FLUZONE PEDI 2013-2014 (PF) ...... 54 FLAVOR SWEET-SF ...... 162 FLULAVAL QUAD 2015-2016 ...... 53 FLUZONE QUAD 2013-2014 (PF) ...... 54 FLAVORX ...... 162 FLUMADINE ...... 47 FLUZONE QUAD 2014-2015 ...... 54 FLAVOUR PAC ...... 162 flumazenil ...... 162 FLUZONE QUAD 2014-2015 (PF) ...... 54 flavoxate ...... 162 FLUMIST 2012-2013 ...... 53 FLUZONE QUAD 2015-2016 ...... 54 flaxseed ...... 112 FLUMIST 2013-2014 ...... 53 FLUZONE QUAD 2015-2016 (PF) ...... 54 flaxseed oil ...... 112 FLUMIST QUAD 2014-2015 ...... 53 FLUZONE QUAD PEDI 2013-14 (PF) FLEBOGAMMA DIF ...... 53 FLUMIST QUAD 2015-2016 ...... 53 ...... 54 flecainide ...... 59 flunisolide ...... 88 FLUZONE QUAD PEDI 2014-15 (PF) FLECTOR ...... 150 fluocinolone ...... 150 ...... 54 FLEET BISACODYL ...... 103 fluocinolone acetonide oil ...... 88 FLUZONE QUAD PEDI 2015-16 (PF) FLEET ENEMA ...... 103 fluocinolone-shower cap ...... 150 ...... 54 FLEET GLYCERIN (ADULT) ...... 103 fluocinonide ...... 150 FML FORTE ...... 88 FLEET GLYCERIN (CHILD) ...... 103 FLUOCINONIDE-E ...... 150 FML LIQUIFILM ...... 88 FLEET GLYCERIN LAXATIVE ...... 103 fluocinonide-emollient ...... 150 FML S.O.P...... 88 FLEET LAXATIVE ...... 103 FLUOR-A-DAY ...... 94 foam bandage ...... 126 FLEET MINERAL OIL ...... 103 FLUOR-A-DAY (WITH XYLITOL) .... 94 FOAM TOE BANDAGE ...... 126 FLEET PEDIATRIC ...... 103 fluorescein-benoxinate ...... 88 FOCALGIN 90 DHA ...... 135 184
I n d e x I n d e x I n d e x FOCALGIN CA ...... 135 GAMMAKED ...... 54 GEODON ...... 141 FOCALGIN DSS ...... 94 GAMMAPLEX ...... 54 GERI-LAV ...... 151 FOCALIN ...... 141 GAMUNEX ...... 54 GESTICARE DHA ...... 136 FOCALIN XR ...... 141 GAMUNEX-C ...... 54 GIAZO ...... 104 FOLASTIN ...... 168 ganciclovir sodium ...... 47 GILDAGIA ...... 71 FOLCAL DHA ...... 135 GARAMYCIN ...... 23 GILDESS ...... 71 FOLCAPS ...... 169 GARDASIL (PF) ...... 54 GILDESS 24 FE ...... 71 FOLCAPS OMEGA-3 (ASPARTO-GLY) GARDASIL 9 (PF) ...... 54 GILDESS FE ...... 71 ...... 135 garlic ...... 112 GILENYA ...... 67 FOLGARD ...... 169 GARLIC OIL ...... 112 GILOTRIF ...... 41 folic acid ...... 169 GARLIPURE ...... 112 ginger (zingiber officinalis) ...... 112 FOLIVANE-F ...... 94 GARLIQUE ...... 112 GINGER EXTRACT ...... 112 FOLIVANE-OB ...... 136 GAS FREE EXTRA STRENGTH ...... 103 GINKGO ...... 112 FOLIVANE-PRX DHA NF ...... 136 GAS RELIEF ...... 103 ginkgo biloba ...... 112 FOLOTYN ...... 41 GAS RELIEF EXTRA STRENGTH ... 103 ginkgo biloba extract ...... 112 FOLTRATE ...... 169 GAS RELIEF MAXIMUM STRENGTH ginkgo biloba leaf extract ...... 112 fomepizole ...... 163 ...... 103 ginkgo biloba-ginkgo biloba ex ...... 112 fondaparinux ...... 28 GAS RELIEF ULTRA STRENGTH ... 103 GINSENG KOREAN ...... 112 FORADIL AEROLIZER ...... 17 GASTROCROM ...... 17 GLASSIA ...... 163 FORANE ...... 12 GAS-X ...... 103 GLATOPA ...... 67 FORFIVO XL ...... 141 GAS-X EXTRA STRENGTH ...... 103 GLEEVEC ...... 41 formaldehyde ...... 39 GAS-X ULTRA-STRENGTH ...... 103 GLEOSTINE ...... 41 FORMULA EM ...... 103 gatifloxacin ...... 23 GLIADEL WAFER ...... 41 FORTAMET ...... 37 GATTEX 30-VIAL ...... 103 glimepiride ...... 37 FORTAZ ...... 23 GATTEX ONE-VIAL ...... 103 glipizide ...... 37 FORTAZ IN DEXTROSE 5 % ...... 23 gauze bandage ...... 126 glipizide-metformin ...... 37 FORTEO ...... 163 GAUZE PAD ...... 126 GLUCAGEN ...... 94 FORTESTA ...... 116 GAUZE ROLL ...... 126 GLUCAGEN DIAGNOSTIC KIT ...... 84 FORTICAL ...... 116 GAVILAX ...... 103 GLUCAGEN HYPOKIT ...... 94 FOSAMAX ...... 163 GAVILYTE-C ...... 103 GLUCAGON EMERGENCY KIT FOSAMAX PLUS D ...... 163 GAVILYTE-G ...... 103 (HUMAN) ...... 94 foscarnet ...... 47 GAVILYTE-H AND BISACODYL .... 103 glucagon hcl ...... 84 fosinopril ...... 62 GAVILYTE-N ...... 103 GLUCOPHAGE ...... 37 fosinopril-hydrochlorothiazide ...... 62 GAVISCON ...... 103 GLUCOPHAGE XR ...... 37 fosphenytoin ...... 67 GAVISCON EXTRA STRENGTH ...... 103 GLUCOPRO ...... 126 FOSRENOL ...... 94 GAZYVA ...... 41 GLUCOPRO ALCOHOL ...... 151 FOSTEUM ...... 94 GEL CORN PROTECTORS ...... 126 glucosam su dip-chondroit-c-mn ...... 15 FP NATURAL LOTION ...... 163 GEL TOE PROTECTOR ...... 126 glucosam-chondr msm#6-manganes ...... 15 FRAGMIN ...... 28 GEL TOE SPACERS ...... 126 glucosamine sulfate ...... 15 FREAMINE HBC 6.9 % ...... 94 gelatin ...... 163 glucose ...... 94 FREAMINE III 10 % ...... 94 gelatin (bulk) ...... 163 GLUCOSE POWDER ...... 94 FREESTYLE PRECISION ...... 126 GELFILM ...... 163 GLUCOTROL ...... 37 FRESHKOTE ...... 88 GELNIQUE ...... 163 GLUCOTROL XL ...... 37 FRESHNET ...... 150 GELPAD ...... 126 GLUCOVANCE ...... 37 FROVA ...... 6 GEL-STAT ...... 150 GLUMETZA ...... 37 FUL-GLO ...... 84 gemcitabine ...... 41 glutathione (bulk) ...... 163 FULYZAQ ...... 103 gemfibrozil ...... 62 glyburide ...... 37 FUNGOID TINCTURE ...... 30 GEMZAR ...... 41 glyburide micronized ...... 37 FUNGOID-D ...... 30 GENERESS FE ...... 71 glyburide-metformin ...... 37 FURADANTIN ...... 23 GENERLAC ...... 103 glycerin (adult) ...... 104 furosemide ...... 85 GENGRAF ...... 119 glycerin (child) ...... 104 FUSILEV ...... 163 GENOTROPIN ...... 116 glyceryl monostearate ...... 163 FUSION PLUS ...... 94 GENOTROPIN MINIQUICK ...... 116 GLYCINE UROLOGIC ...... 39 FUSION SPRINKLES ...... 94 GENTAK ...... 23 GLYCOLAX ...... 104 FUZEON ...... 47 gentamicin ...... 23 GLYCOPHOS ...... 94 FYCOMPA ...... 67 gentamicin in nacl (iso-osm) ...... 23 glycopyrrolate ...... 104 gabapentin ...... 67 gentamicin sulfate (ped) (pf) ...... 23 GLYDO ...... 12 GABITRIL ...... 67 gentamicin sulfate (pf) ...... 23 GLYNASE ...... 37 GABLOFEN ...... 134 GENTEAL MILD TO MODERATE .... 88 GLYSET ...... 37 GADAVIST ...... 84 GENTEAL GEL ...... 88 GLYTACTIN 20PE BETTERMILK galantamine ...... 51 GENTEAL MILD ...... 88 LITE ...... 94 GALZIN ...... 163 GENTEAL PM ...... 88 GLYXAMBI ...... 37 GAMASTAN S/D ...... 54 GENTEAL SEVERE ...... 88 GOLYTELY ...... 104 GAMMAGARD S/D ...... 54 GENTLE LAXATIVE ...... 104 GONAK ...... 88 GAMMAGARD S-D (IGA < 1 GENTLE RAIN ...... 150 GRALISE ...... 67 MCG/ML) ...... 54 GENTLE TAPE ...... 126 185
I n d e x I n d e x I n d e x GRALISE 30-DAY STARTER PACK HEAVY DUTY FABRIC STRIPS ...... 126 HUMIRA PEN ...... 15 ...... 67 HECORIA ...... 119 HUMIRA PEN CROHN'S-UC-HS granisetron (pf) ...... 104 HECTOROL ...... 163 START ...... 15 granisetron hcl ...... 104 HELIXATE FS ...... 57 HUMIRA PEN PSORIASIS STARTER GRANIX ...... 69 HEMABATE ...... 116 ...... 15 GRANULEX ...... 151 HEMANGEOL ...... 62 HUMULIN 70/30 ...... 37 grape seed extract ...... 112 HEMATOGEN ...... 94 HUMULIN 70/30 KWIKPEN ...... 37 grape seed xt-bioflav,citrus ...... 112 HEMATOGEN FA ...... 94 HUMULIN 70/30 PEN ...... 37 GRAPEFRUIT ...... 163 HEMATOGEN FORTE ...... 94 HUMULIN N ...... 37 GRASTEK ...... 54 HEMENATAL OB ...... 136 HUMULIN N KWIKPEN ...... 37 GREEN COFFEE BEAN ...... 112 HEMENATAL OB + DHA ...... 136 HUMULIN N PEN ...... 37 GREEN TEA ...... 112 HEMETAB ...... 94 HUMULIN R ...... 37 GREEN TEA COMPLEX ...... 112 HEMMOREX-HC ...... 104 HUMULIN R U-500 green tea leaf ext-green tea ...... 112 HEMOCYTE ...... 94 (CONCENTRATED) ...... 37 green tea-hoodia gordonii ...... 112 HEMOCYTE-F ...... 94 HURRIVIEW ...... 126 griseofulvin microsize ...... 30 HEMOCYTE-PLUS ...... 94 HURRIVIEW II ...... 126 griseofulvin ultramicrosize ...... 30 HEMOFIL M HIGH ...... 57 HYCAMTIN ...... 42 GRIS-PEG (ULTRAMICROSIZE) ...... 30 HEMOFIL M LOW ...... 57 HYCET ...... 6 GRX FOAM DRESSING ...... 126 HEMOFIL M MID ...... 57 HYCOFENIX ...... 78 GRX HYDROGEL GAUZE ...... 126 HEMOFIL M SUPER HIGH ...... 57 HYDE-OUT ALDEHYDE GRX WOUND GEL ...... 126 HEMORRHOID ...... 104 NEUTRALIZER ...... 126 guaiacol ...... 151 HEMORRHOIDAL ...... 104 hydralazine ...... 62 GUAIATUSSIN AC ...... 78 HEMORRHOIDAL HYDREA ...... 42 guaifenesin ...... 78 (PHENYLEPH-COCOA) ...... 104 HYDRESS ...... 126 GUAIFENESIN AC ...... 78 HEMORRHOIDAL COOLING ...... 104 hydrochlorothiazide ...... 85 GUAIFENESIN DAC ...... 78 HEMORRHOIDAL CREAM ...... 104 hydrocodone-acetaminophen ...... 6 guanfacine ...... 62, 141 HEMORRHOIDAL SUPPOSITORY hydrocodone-chlorpheniramine ...... 78 guanidine ...... 51 ...... 104 hydrocodone-homatropine ...... 78 guar gum ...... 163 HEMRIL-30 ...... 104 hydrocodone-ibuprofen ...... 6 guava flavor (bulk) ...... 163 HEP FLUSH-10 (PF) ...... 28 hydrocol dress-adhesive rem#1 ...... 126 GYNAZOLE-1 ...... 30 HEPAGAM B ...... 54 hydrocortisone ...... 116, 151 HALAVEN ...... 42 heparin (porcine) ...... 29 hydrocortisone acetate ...... 104, 151 HALCION ...... 145 heparin (porcine) in 5 % dex ...... 28 hydrocortisone butyrate ...... 151 HALDOL ...... 141 heparin (porcine) in nacl (pf) ...... 29 hydrocortisone butyr-emollient ...... 151 HALDOL DECANOATE ...... 141 heparin(porcine) in 0.45% nacl ...... 29 HYDROCORTISONE PLUS ...... 151 halobetasol propionate ...... 151 heparin, porcine (pf) ...... 29 hydrocortisone valerate ...... 151 HALOG ...... 151 HEPATAMINE 8% ...... 94 hydrocortisone-acetic acid ...... 88 haloperidol ...... 141 HEPSERA ...... 47 hydrocortisone-aloe vera ...... 151 haloperidol decanoate ...... 141 HERCEPTIN ...... 42 hydrocortisone-min oil-wht pet ...... 151 haloperidol lactate ...... 141 HESPAN 6 % IN NS ...... 57 hydrocortisone-pramox-e-pram#1 ...... 104 HAND SANITIZER ...... 151 hetastarch 6 % in 0.9 % nacl ...... 57 hydrocortisone-pramoxine ...... 104, 151 HARVONI ...... 47 HETLIOZ ...... 145 hydrogen peroxide ...... 151 HAVRIX (PF) ...... 54 HEXALEN ...... 42 HYDROMET ...... 78 hawthorn ...... 112 HEX-ON LIGHT ODOR ...... 151 hydromorphone ...... 6, 7 HEADACHE FORMULA ADDED STR HEXTEND ...... 57 hydromorphone (pf) ...... 6 ...... 6 HICON ...... 163 hydromorphone in 0.9 % nacl ...... 6 HEADACHE PM ...... 3 HIPREX ...... 23 hydrophilic ...... 163 HEADACHE RELIEF HISTAFLEX ...... 6 HYDROPHILIC OINTMENT (ASA-ACET-CAF) ...... 6 HISTEX (TRIPROLIDINE) ...... 35 BASE(FAG) ...... 163 HEALTHY ACCENTS UNIFINE HISTEX DM ...... 78 HYDROPHILIC PETROLATUM ...... 163 PENTIP ...... 126 HISTEX PD ...... 35 hydroquinone ...... 151 HEALTHYLAX ...... 104 HISTEX PE ...... 33 hydroquinone microspheres ...... 151 HEARTBURN RELIEF (CIMETIDINE) HISTEX-AC ...... 78 HYDROSKIN ...... 151 ...... 104 HIZENTRA ...... 54 HYDROSKIN WITH ALOE ...... 151 HEARTBURN RELIEF (FAMOTIDINE) HORIZANT ...... 67 hydroxocobalamin ...... 169 ...... 104 HUMALOG ...... 37 hydroxychloroquine ...... 39 HEARTBURN RELIEF (RANITIDINE) HUMALOG KWIKPEN ...... 37 hydroxypropyl cellulose ...... 163 ...... 104 HUMALOG MIX 50-50 ...... 37 hydroxyurea ...... 42 HEARTBURN RELIEF 24 HOUR ...... 104 HUMALOG MIX 50-50 KWIKPEN ...... 37 hydroxyzine hcl ...... 35 HEARTBURN TREATMENT 24 HOUR HUMALOG MIX 75-25 ...... 37 hydroxyzine pamoate ...... 35 ...... 104 HUMALOG MIX 75-25 KWIKPEN ...... 37 HYGIENIC (WITCH HAZEL) CLEANS HEAT THERAPY ...... 126 HUMATE-P ...... 57 ...... 104 HEATHER ...... 71 HUMATROPE ...... 116 HYGIENIC CLEANSING ...... 151 HEATWRAPS ...... 126 HUMIRA ...... 15 HYLENEX ...... 163 HEATWRAPS BACK & HIP PADS HUMIRA PEDIATRIC CROHN'S HYOLEV MB ...... 23 ...... 126 START ...... 15 hyoscyamine sulfate ...... 104 186
I n d e x I n d e x I n d e x HYOSYNE ...... 104 INDIGO CARMINE ...... 84 INVOKANA ...... 37 HYPAFIX ...... 126 INDIOMIN MB ...... 23 INZO ANTIFUNGAL ...... 30 HYPERHEP B S/D ...... 54 INDOCIN ...... 15 IODIDES TINCTURE ...... 151 HYPERHEP B S-D NEONATAL ...... 54 indomethacin ...... 15 iodine-sodium iodide ...... 151 HYPERLYTE CR ...... 95 indomethacin sodium ...... 62 IODOPEN ...... 95 HYPERRAB S/D (PF) ...... 54 INFANRIX (DTAP) (PF) ...... 55 iodoquinol-hc ...... 151 HYPERRHO S/D ...... 54 INFANT PAIN RELIEVER ...... 7 IONOSOL-B IN D5W ...... 95 HYPERTET S/D (PF) ...... 54 INFANTS GAS RELIEF ...... 104 IONOSOL-MB IN D5W ...... 95 HYPO-ALLERGENIC BANDAGES INFANTS IBU-DROPS ...... 15 IONSYS ...... 7 ...... 126 INFANT'S IBUPROFEN ...... 15 IOPHEN C-NR ...... 78 HYPOTEARS ...... 88 INFANTS' PAIN & FEVER ...... 7 IOPHEN DM-NR ...... 78 hypromellose ...... 163 INFANTS' PAIN RELIEF ...... 7 IOPHEN-NR ...... 78 HYQVIA ...... 54 INFANT'S PAIN RELIEF ...... 7 IOPIDINE ...... 88 HYSINGLA ER ...... 7 INFANT'S PAIN RELIEVER ...... 7 IPOL ...... 55 HYZAAR ...... 62 INFANTS' TRIAMINIC FEVER ...... 7 ipratropium bromide ...... 17, 88 ibandronate ...... 163 INFED ...... 95 ipratropium-albuterol ...... 17 IBGARD ...... 112 INFLUDO ...... 112 IPRIVASK ...... 29 IBRANCE ...... 42 INFUMORPH P/F ...... 7 IQUIX ...... 23 IBUDONE ...... 7 INFUVITE ADULT ...... 169 irbesartan ...... 63 IBU-DROPS ...... 15 INFUVITE PEDIATRIC ...... 169 irbesartan-hydrochlorothiazide ...... 63 ibuprofen ...... 15 INJECTAFER ...... 95 IRENKA ...... 141 IBUPROFEN COLD ...... 78 INLYTA ...... 42 irinotecan ...... 42 IBUPROFEN COLD-SINUS(WITH PSE) INNERMOST NATURE FOR MEN iron aspgly&ps-c-b12-fa-ca-suc ...... 95 ...... 78 ...... 112 iron aspgly-c-b12-ca-suc-stoma ...... 95 IBUPROFEN IB ...... 15 INNOHEP ...... 29 iron fum & ag-c-b12-fa-ca-succ ...... 95 IBUPROFEN JR STRENGTH ...... 15 INNOPRAN XL ...... 62 IROSPAN 24/6 ...... 95 IBUPROFEN PM ...... 7 INS SYRINGE/NEEDLE 0.5CC/27G ISAGEL ...... 151 ibuprofen-oxycodone ...... 7 ...... 126 ISAGEL NO RINSE ...... 151 ibutilide fumarate ...... 59 INSPIRACHAMBER ...... 126 ISENTRESS ...... 47 IC GREEN ...... 84 INSPIRACHAMBER WITH ISLAND GARD-GRX ...... 127 ICLUSIG ...... 42 MASK-MED ...... 126 ISOLYTE S PH 7.4 ...... 95 ICY HOT MEDICATED SLEEVE ...... 151 INSPIRACHAMBER WITH ISOLYTE-P IN 5 % DEXTROSE ...... 95 IDAMYCIN PFS ...... 42 MASK-SMALL ...... 126 ISOLYTE-S ...... 95 idarubicin ...... 42 INSPRA ...... 85 isometh-dichloral-acetaminophn ...... 7 IFEREX 150 ...... 95 INSTA-CHAR ...... 163 isomethepten-caf-acetaminophen ...... 7 IFEREX 150 FORTE ...... 95 INSTA-CHAR-SORBITOL ...... 163 ISONARIF ...... 23 IFEX ...... 42 INSTACLEAN ...... 163 isoniazid ...... 23 ifosfamide ...... 42 INSTA-GLUCOSE ...... 95 isopropyl alcohol ...... 39, 163 ILARIS (PF) ...... 163 INSTANT FOOD THICKENER ...... 163 isopropyl alcohol-benzocaine ...... 39 ILEVRO ...... 88 INSULIN SYRINGE ...... 126 ISOPROPYL ILOTYCIN ...... 23 INSULIN SYRINGE MICROFINE ..... 126 ALCOHOL-WINTERGREEN ...... 151 ILUVIEN ...... 88 insulin syringe needleless ...... 126 isopropyl palmitate ...... 163 IMBRUVICA ...... 42 INSULIN SYRINGE ULTRAFINE ..... 126 ISOPTO CARPINE ...... 88 IMDUR ...... 59 insulin syringe-needle u-100 ...... 126 ISOPTO TEARS ...... 88 imipenem-cilastatin ...... 23 insulin syringes (disposable) ...... 126 ISORDIL ...... 59 imipramine hcl ...... 141 INSUPEN ...... 126 ISORDIL TITRADOSE ...... 59 imipramine pamoate ...... 141 INTEGRA ...... 95 isosorbide dinitrate ...... 59 imiquimod ...... 151 INTEGRA F ...... 95 isosorbide mononitrate ...... 59 IMITREX ...... 7 INTEGRA PLUS ...... 95 isosulfan blue ...... 84 IMITREX STATDOSE KIT REFILL ...... 7 INTEGRILIN ...... 46 isradipine ...... 59 IMITREX STATDOSE PEN ...... 7 INTELENCE ...... 47 ISTALOL ...... 88 IMOGAM RABIES-HT (PF) ...... 54 INTENSE COUGH RELIEVER ...... 78 ISTODAX ...... 42 IMOVAX RABIES VACCINE (PF) ...... 55 INTERMEZZO ...... 145 ISUPREL ...... 51 IMPLANON ...... 71 INTERSORB ...... 126 ITCH RELIEF ...... 151 IMUHANCE ...... 112 INTRALIPID ...... 104 ITCH-X ...... 151 IMURAN ...... 119 INTRASITE GEL DRESSING ...... 126 ITCHY EYE DROPS ...... 35 INATAL ADVANCE ...... 136 INTRON A ...... 42 itraconazole ...... 31 INATAL ULTRA ...... 136 INTROVALE ...... 71 IV 3000 ...... 127 IN-CHECK DIAL TRAINING DEVICE INTUNIV ER ...... 141 IV PREP WIPES ...... 151 ...... 126 INVANZ ...... 23 IV3000 FRAME DELIVERY INCONTROL PEN NEEDLE ...... 126 INVEGA ...... 141 DRESSING ...... 127 INCRELEX ...... 116 INVEGA SUSTENNA ...... 141 ivermectin ...... 39 INCRUSE ELLIPTA ...... 17 INVEGA TRINZA ...... 141 IXEMPRA ...... 42 indapamide ...... 85 INVIRASE ...... 47 IXIARO (PF) ...... 55 INDERAL LA ...... 62 INVISIBLE ACNE ...... 151 IXINITY ...... 57 INDERAL XL ...... 62 INVOKAMET ...... 37 J & J FIRST AID TAPE PAPER ...... 127 187
I n d e x I n d e x I n d e x J & J NON-STICK PADS LARGE ...... 127 KERLIX AMD ...... 127 LACRISERT ...... 88 J & J NON-STICK PADS MEDIUM KERLIX BURN PACK ...... 127 lactated ringers ...... 95, 151 ...... 127 KERLIX PACKING SPONGE ...... 127 lactic acid (bulk) ...... 151 JADENU ...... 163 KERYDIN ...... 31 lactulose ...... 105 JAKAFI ...... 42 KETALAR ...... 12 LAMICTAL ...... 67 JANTOVEN ...... 29 ketamine ...... 12 LAMICTAL ODT ...... 67 JANUMET ...... 37 KETEK ...... 23 LAMICTAL ODT STARTER (BLUE) JANUMET XR ...... 37 ketoconazole ...... 31 ...... 67 JANUVIA ...... 37 KETODAN ...... 31 LAMICTAL ODT STARTER (GREEN) J-COF DHC ...... 78 KETODAN KIT ...... 31 ...... 67 JENCYCLA ...... 71 KETO-DIASTIX ...... 84 LAMICTAL ODT STARTER JENTADUETO ...... 37 KETONE CARE ...... 84 (ORANGE) ...... 67 JETREA (PF) ...... 88 KETONE URINE TEST ...... 84 LAMICTAL STARTER (BLUE) KIT JEVTANA ...... 42 ketoprofen ...... 15 ...... 67 JINTELI ...... 116 ketorolac ...... 7, 88 LAMICTAL STARTER (GREEN) KIT J-MAX ...... 78 KETOSTIX ...... 84 ...... 67 J-MAX DHC ...... 78 ketotifen fumarate ...... 35 LAMICTAL STARTER (ORANGE) KIT JOCK ITCH ...... 31 KEVEYIS ...... 163 ...... 67 JOHNSON'S BODY CARE ...... 163 KEYTRUDA ...... 42 LAMICTAL XR ...... 67 JOLESSA ...... 71 KHEDEZLA ...... 141 LAMICTAL XR STARTER (BLUE) .... 67 JOLIVETTE ...... 71 KIDKARE COUGH/COLD ...... 78 LAMICTAL XR STARTER (GREEN) JR. STR NON-ASPIRIN PAIN ...... 7 KIMIDESS (28) ...... 71 ...... 67 J-TAN D PD ...... 33 KINERET ...... 15 LAMICTAL XR STARTER (ORANGE) J-TAN PD ...... 35 KINRIX (PF) ...... 55 ...... 67 JUBLIA ...... 31 KIONEX ...... 95 LAMISIL ...... 31 JULEBER ...... 71 KITABIS PAK ...... 23 LAMISIL (AEROSOL) ...... 31 JUNEL 1.5/30 (21) ...... 71 KLARON ...... 151 LAMISIL AF ...... 31 JUNEL 1/20 (21) ...... 71 KLING ROLLS ...... 127 LAMISIL AT ...... 31 JUNEL FE 1.5/30 (28) ...... 71 KLONOPIN ...... 67 lamivudine ...... 47 JUNEL FE 1/20 (28) ...... 71 KLOR-CON ...... 95 lamivudine-zidovudine ...... 47 JUNEL FE 24 ...... 71 KLOR-CON 10 ...... 95 lamotrigine ...... 68 JUNIOR MAPAP ...... 7 KLOR-CON 8 ...... 95 LANACANE ANTI-ITCH ...... 12 JUXTAPID ...... 63 KLOR-CON M10 ...... 95 LANACANE FIRST AID ...... 12 KABIVEN ...... 95 KLOR-CON M15 ...... 95 lanolin anhydrous ...... 163 KADCYLA ...... 42 KLOR-CON M20 ...... 95 LANOXIN ...... 59 KADIAN ...... 7 KLOR-CON SPRINKLE ...... 95 LANOXIN PEDIATRIC ...... 59 KALBITOR ...... 163 KLOR-CON/25 ...... 95 lansoprazole ...... 105 KALETRA ...... 47 KLOR-CON/EF ...... 95 LANTUS ...... 38 KALYDECO ...... 163 KOATE-DVI ...... 57 LANTUS SOLOSTAR ...... 38 kanamycin ...... 23 KOGENATE FS ...... 57 LARIN 1.5/30 (21) ...... 71 KAO-TIN (BISMUTH KOMBIGLYZE XR ...... 38 LARIN 1/20 (21) ...... 71 SUBSALICYLAT) ...... 104 KONSYL (SUGAR) ...... 104 LARIN 24 FE ...... 71 KAO-TIN (DOCUSATE CALCIUM) KONSYL EASY MIX ...... 104 LARIN FE ...... 71 ...... 104 KONSYL FIBER ...... 104 LASIX ...... 85 KAPVAY ...... 141 KONSYL FORMULA-D ...... 105 LASTACAFT ...... 35 KARBINAL ER ...... 35 KONSYL SUGAR-FREE latanoprost ...... 88 KARIVA (28) ...... 71 (ASPARTAME) ...... 105 LATUDA ...... 141 kava root extract ...... 113 KONSYL-D ...... 105 lavender oil ...... 113 KAYEXALATE ...... 95 KOREAN GINSENG ...... 113 LAXATIVE (BISACODYL) ...... 105 KAZANO ...... 38 korean ginseng root extract ...... 113 LAXATIVE (SENNOSIDES) ...... 105 KCENTRA ...... 57 KORLYM ...... 38 LAXATIVE FEMININE ...... 105 KEDBUMIN ...... 57 KOTEX FRESH & DRY ...... 127 LAXATIVE MAXIMUM STRENGTH K-EFFERVESCENT ...... 95 KOTEX OVERNIGHT ...... 127 ...... 105 KEFLEX ...... 23 K-PHOS NO 2 ...... 95 LAXATIVE PLUS STOOL SOFTENER KELNOR 1/35 (28) ...... 71 K-PHOS ORIGINAL ...... 95 ...... 105 KENALOG ...... 116, 151 K-PHOS-NEUTRAL ...... 95 LAYOLIS FE ...... 71 KENDALL ...... 127 KRISTALOSE ...... 105 LAZANDA ...... 7 KENDALL 2-IN-1 ...... 151 K-SOL ...... 95 LAZERCREME ...... 151 KENDALL CLOTH ...... 127 K-TAB ...... 95 LDO PLUS ...... 12 KENDALL FOAM BORDER ...... 127 KURVELO ...... 71 LEENA 28 ...... 71 KENDALL PAPER TAPE ...... 127 KUVAN ...... 163 leflunomide ...... 15 KENGREAL ...... 46 KYNAMRO ...... 63 LEMON EXTRACT FLAVOR ...... 163 KEPIVANCE ...... 104 KYPROLIS ...... 42 lemon flavor extract (bulk) ...... 163 KEPPRA ...... 67 l norgest/e.estradiol-e.estrad ...... 71 LEMON FLAVORING ...... 163 KEPPRA XR ...... 67 labetalol ...... 63 LEMTRADA ...... 68 KERLIX ...... 127 LAC-HYDRIN ...... 151 LENVIMA ...... 42 188
I n d e x I n d e x I n d e x LESSINA ...... 71 liothyronine ...... 158 LORTAB 7.5-325 ...... 8 LETAIRIS ...... 63 LIP TREATMENT ...... 164 LORTAB ELIXIR ...... 8 letrozole ...... 42 LIPITOR ...... 63 LORTUSS DM ...... 78 leucovorin calcium ...... 164 LIPODOX ...... 42 LORTUSS EX ...... 78 LEUKERAN ...... 42 LIPODOX 50 ...... 42 LORTUSS LQ ...... 33 LEUKINE ...... 69 LIPOFEN ...... 63 LORYNA (28) ...... 72 leuprolide ...... 42 LIPOSYN II ...... 105 LORZONE ...... 134 levalbuterol hcl ...... 17 LIPOSYN III ...... 105 losartan ...... 63 LEVAQUIN ...... 23 LIPTRUZET ...... 63 losartan-hydrochlorothiazide ...... 63 LEVAQUIN IN 5 % DEXTROSE ...... 23 LIQUID ANTACID ...... 105 LOSEASONIQUE ...... 72 LEVEMIR ...... 38 LIQUITEARS ...... 88 LOTEMAX ...... 88 LEVEMIR FLEXPEN ...... 38 LISCO ...... 127 LOTENSIN ...... 63 LEVEMIR FLEXTOUCH ...... 38 lisinopril ...... 63 LOTENSIN HCT ...... 63 levetiracetam ...... 68 lisinopril-hydrochlorothiazide ...... 63 LOTREL ...... 63 levetiracetam in nacl (iso-os) ...... 68 LITE COAT ASPIRIN ...... 7 LOTRISONE ...... 31 levobunolol ...... 88 LITE TOUCH INSULIN PEN NEEDLES LOTRONEX ...... 105 levocarnitine ...... 164 ...... 127 lovastatin ...... 63 levocarnitine (with sugar) ...... 164 LITE TOUCH INSULIN SYRINGE ... 127 LOVAZA ...... 105 levocetirizine ...... 35 LITE TOUCH-MEDIUM MASK ...... 127 LOVENOX ...... 29 levofloxacin ...... 23 LITEAIRE MDI CHAMBER ...... 127 LOW-OGESTREL (28) ...... 72 levofloxacin in d5w ...... 23 LITETOUCH-LARGE MASK ...... 127 loxapine succinate ...... 141 levoleucovorin calcium ...... 164 LITETOUCH-SMALL MASK ...... 127 LOXITANE ...... 141 levomefolate calcium ...... 169 lithium carbonate ...... 141 LUBRICANT EYE ...... 88 LEVONEST (28) ...... 71 lithium citrate ...... 141 LUBRICANT EYE (CMC-GLYCERIN) levonorgestrel ...... 71 LITHOBID ...... 141 ...... 88 levonorgestrel-ethinyl estrad ...... 71 LITHOSTAT ...... 105 LUBRICANT EYE (PG-PEG 400) ...... 88 LEVOPHED (BITARTRATE) ...... 51 LIVER COMPLEX ...... 113 LUBRICANT EYE DROPS ...... 88 LEVORA-28 ...... 71 LMD 10 % IN 0.9 % SODIUM CHLOR LUBRICATING & REWETTING ...... 127 levorphanol tartrate ...... 7 ...... 57 LUBRICATING PLUS ...... 88 levothyroxine ...... 158 LMD 10 % IN 5 % DEXTROSE ...... 57 LUBRIFRESH PM ...... 88 LEVOXYL ...... 158 L-METHYL-B6-B12 ...... 169 LUCENTIS ...... 89 LEVSIN ...... 105 L-METHYL-MC ...... 169 LUDENT FLUORIDE ...... 95 LEVSIN/SL ...... 105 L-METHYL-MC NAC ...... 169 LUFYLLIN ...... 17 LEXAPRO ...... 141 LO LOESTRIN FE ...... 71 LUMIGAN ...... 89 LEXISCAN ...... 84 LO MINASTRIN FE ...... 71 LUMIZYME ...... 164 LEXIVA ...... 47 LODOSYN ...... 45 LUNESTA ...... 145 LIALDA ...... 105 LODRANE D ...... 33 LUPANETA PACK (1 MONTH) ...... 116 LIBRAX (WITH CLIDINIUM) ...... 105 LOESTRIN 1.5/30 (21) ...... 71 LUPANETA PACK (3 MONTH) ...... 116 LICE EGG REMOVER ...... 152 LOESTRIN 1/20 (21) ...... 71 LUPRON DEPOT ...... 42, 116 LICE KILLING ...... 152 LOESTRIN 24 FE ...... 71 LUPRON DEPOT (3 MONTH) ..... 42, 116 LICE SOLUTION ...... 152 LOESTRIN FE 1.5/30 (28-DAY) ...... 71 LUPRON DEPOT (4 MONTH) ...... 42 LICE TREATMENT ...... 152 LOESTRIN FE 1/20 (28-DAY) ...... 72 LUPRON DEPOT (6 MONTH) ...... 42 LICE TREATMENT (PERMETHRIN) LOFIBRA ...... 63 LUPRON DEPOT-PED ...... 116 ...... 152 LOHIST - D ...... 33 LUPRON DEPOT-PED (3 MONTH) licorice ...... 113 LOHIST PEB DM ...... 78 ...... 116 lidocaine ...... 12 LOHIST-DM ...... 78 LUSAIR ...... 78 lidocaine (pf) in d7.5w ...... 12 LOHIST-PEB ...... 33 LUSTRA ...... 152 lidocaine (pf) ...... 12, 59 LOMEDIA 24 FE ...... 72 LUSTRA-AF ...... 152 lidocaine hcl ...... 12, 13 LOMOTIL ...... 105 LUTERA (28) ...... 72 lidocaine hcl-hydrocortison ac ...... 105, 152 lomustine ...... 42 LUVOX CR ...... 141 lidocaine in 5 % dextrose (pf) ...... 59 loperamide ...... 105 LUXIQ ...... 152 LIDOCAINE VISCOUS ...... 13 LOPID ...... 63 LUZU ...... 31 lidocaine-epinephrine ...... 13 LOPREEZA ...... 116 LYNPARZA ...... 42 lidocaine-epinephrine (pf) ...... 13 LOPRESSOR ...... 63 LYRICA ...... 68 lidocaine-epinephrine bit ...... 13 LOPRESSOR HCT ...... 63 LYSODREN ...... 42 lidocaine-hydrocortisone-aloe ...... 105 LOPROX ...... 31 LYSTEDA ...... 57 lidocaine-prilocaine ...... 13 loratadine ...... 35 LYZA ...... 72 LIDODERM ...... 13 LORATA-DINE D ...... 33 M.V.I. ADULT ...... 169 LIME FLAVOR ...... 164 LORATADINE-D ...... 33 M.V.I. PEDIATRIC ...... 169 LINCOCIN ...... 23 lorazepam ...... 141, 145 M.V.I.-12 (WITHOUT VITAMIN K) lindane ...... 152 LORAZEPAM INTENSOL ...... 141 ...... 169 linezolid ...... 23 LORCET (HYDROCODONE) ...... 7 MAALOX ADVANCED ...... 105 linezolid-0.9% sodium chloride ...... 23 LORCET HD ...... 7 MACROBID ...... 23 LINSEED OIL ...... 113 LORCET PLUS ...... 7 MACRODANTIN ...... 23 LINZESS ...... 105 LORTAB 10-325 ...... 7 MACUGEN ...... 89 LIORESAL ...... 134 LORTAB 5-325 ...... 7 mafenide acetate ...... 23 189
I n d e x I n d e x I n d e x MAG-AL ...... 105 MAXI-COMFORT INSULIN SYRINGE MEN'S MULTIVITAMIN GUMMIES MAG-AL PLUS ...... 105 ...... 127 ...... 169 MAG-AL PLUS EXTRA STRENGTH MAXIDEX ...... 89 MENSTRUAL RELIEF ...... 8 ...... 105 MAXIDONE ...... 8 MENTAX ...... 31 MAGELLAN INSULIN SAFETY MAXI-PADS ...... 127 MENVEO A-C-Y-W-135-DIP (PF) ...... 55 SYRNG ...... 127 MAXIPHEN ...... 78 MENVEO MENA COMPONENT (PF) MAGELLAN SYRINGE ...... 127 MAXIPHEN DM ...... 78 ...... 55 MAGNASWEET 110 ...... 164 MAXIPIME ...... 23 MENVEO MENCYW-135 COMPNT MAGNASWEET 135 ...... 164 MAXITROL ...... 23 (PF) ...... 55 MAGNEBIND 300 ...... 95 MAXORB ...... 127 ME-PB-HYOS ...... 105 MAGNEBIND 400 ...... 95 MAXORB EXTRA DRESSING ...... 127 meperidine ...... 8 magnesium chloride ...... 95 MAXORB ROPE ...... 127 meperidine (pf) ...... 8 magnesium citrate ...... 105 MAXZIDE ...... 85 meperidine in 0.9 % nacl ...... 8 magnesium oxide ...... 95 MAXZIDE-25MG ...... 85 MEPERITAB ...... 8 magnesium stearate ...... 164 M-CLEAR WC ...... 78 MEPHYTON ...... 169 magnesium sulfate ...... 96 meclizine ...... 105 MEPILEX BORDER ...... 128 magnesium sulfate in d5w ...... 96 meclofenamate ...... 16 MEPILEX BORDER SACRUM ...... 128 magnesium sulfate in water ...... 96 MEDFIX ...... 127 MEPITEL ...... 128 MAGNEVIST ...... 84 MEDFIX EZ DRESSING ...... 127 mepivacaine (pf) ...... 13 MAJOR-PREP MEDI PADS ...... 152 meprobamate ...... 141 (PHENYLEPHRINE-FAT) ...... 105 MEDICATED BODY ...... 152 MEPRON ...... 39 MAJOR-PREP HEMORRHOIDAL .... 105 MEDICATED BODY POWDER ...... 152 mercaptopurine ...... 43 MAKENA ...... 116 MEDICATED CHEST RUB ...... 152 meropenem ...... 24 MALARONE ...... 39 MEDICATED PADS ...... 105 meropenem-0.9% sodium chloride ...... 24 MALARONE PEDIATRIC ...... 39 MEDICATED WIPES ...... 152 MERREM ...... 24 malathion ...... 152 MEDICATED WIPES WITH ALOE mesalamine ...... 106 manganese chloride ...... 96 ...... 152 mesalamine with cleansing wipe ...... 106 mannitol 10 % ...... 85 MEDIGRIP ...... 127 mesna ...... 164 mannitol 20 % ...... 85 MEDIGRIP ELASTICATED SUPPORT MESNEX ...... 164 mannitol 25 % ...... 85 ...... 127 MESTINON ...... 51 mannitol 5 % ...... 85 MEDIGRIP TUBULAR ...... 127 MESTINON TIMESPAN ...... 51 MAPAP (ACETAMINOPHEN) ...... 8 MEDIPLAST CORN-CALLUS-WART METADATE CD ...... 142 MAPAP ARTHRITIS PAIN ...... 8 ...... 152 METAMUCIL ...... 106 MAPAP COLD FORMULA ...... 78 MEDIPORE ...... 127 METAMUCIL (WITH SUGAR) ...... 106 MAPAP EXTRA STRENGTH ...... 8 MEDIPORE DRESS-IT COVER ...... 127 METAMUCIL FIBER SINGLES ...... 106 MAPAP INFANTS' ...... 8 MEDIPORE H ...... 127 METAMUCIL MULTIHEALTH FIBER MAPAP PM ...... 3 MEDIPORE SOFT CLOTH TAPE ...... 128 ...... 106 MAPAP SINUS MAX STRENGTH (PE) MEDROL ...... 116 METAMUCIL SUGAR FREE ...... 106 ...... 78 MEDROL (PAK) ...... 116 METAMUCIL SUGAR-FREE maprotiline ...... 141 medroxyprogesterone ...... 72, 116 (ASPART) ...... 106 MARCAINE ...... 13 mefenamic acid ...... 8 METAMUCIL SUNRISE ...... 106 MARCAINE (PF) ...... 13 MEFIX ...... 128 metaproterenol ...... 18 MARCAINE SPINAL (PF) ...... 13 mefloquine ...... 39 metaxalone ...... 134 MARCAINE-EPINEPHRINE ...... 13 MEFOXIN IN DEXTROSE (ISO-OSM) metformin ...... 38 MARCAINE-EPINEPHRINE (PF) ...... 13 ...... 24 methadone ...... 8 MAR-COF BP ...... 78 MEGACE ...... 164 METHADONE INTENSOL ...... 8 MAR-COF CG ...... 78 MEGACE ES ...... 164 METHADOSE ...... 8 MARGESIC ...... 8 megestrol ...... 42, 164 methamphetamine ...... 51 MARINOL ...... 105 MEKINIST ...... 42 METHAZEL ...... 164 MARJORAM ...... 113 melatonin ...... 116 methazolamide ...... 85 MARLISSA ...... 72 melatonin-lemon balm leaf extr ...... 116 methenamine hippurate ...... 24 MARNATAL-F ...... 136 meloxicam ...... 16 methenamine mandelate ...... 24 MARPLAN ...... 141 melphalan hcl ...... 43 methimazole ...... 158 MARQIBO ...... 42 memantine ...... 68 METHITEST ...... 116 marshmallow flavor (bulk) ...... 164 MENACTRA (PF) ...... 55 methocarbamol ...... 134 MARTEN-TAB ...... 8 MENCAPS ...... 152 METHOCEL E 4 M ...... 164 MASANTI DOUBLE STRENGTH ..... 105 M-END DMX ...... 78 methotrexate sodium ...... 43 MATULANE ...... 42 M-END MAX D ...... 78 methotrexate sodium (pf) ...... 43 MATZIM LA ...... 59 M-END PE ...... 78 methoxsalen rapid ...... 152 MAVIK ...... 63 M-END WC ...... 78 methscopolamine ...... 106 MAXALT ...... 8 MENEST ...... 116 methyclothiazide ...... 85 MAXALT-MLT ...... 8 MENHIBRIX (PF) ...... 55 methyl alcohol ...... 164 MAXFE ...... 96 MENOMUNE - A/C/Y/W-135 ...... 55 methylcellulose ...... 164 MAXI DEODORANT ...... 127 MENOMUNE - A/C/Y/W-135 (PF) ...... 55 methylcellulose 1500cps (bulk) ...... 164 MAXI PAD REGULAR ...... 127 MENOSTAR ...... 116 methylcellulose 4000cps (bulk) ...... 164 MAXI PAD SUPER ...... 127 methyldopa ...... 63 190
I n d e x I n d e x I n d e x methyldopa-hydrochlorothiazide ...... 63 MILLIPRED DP ...... 117 MONUROL ...... 24 methyldopate ...... 63 milrinone ...... 59 MORGIDOX ...... 24 methylene blue (antidote) ...... 164 milrinone in 5 % dextrose ...... 59 MORGIDOX 1X100 ...... 24 methylene blue (bulk-solid) ...... 164 MIMVEY ...... 117 MORGIDOX 2X100 ...... 24 methylergonovine ...... 116 MIMVEY LO ...... 117 morphine ...... 9 METHYLIN ...... 142 MINASTRIN 24 FE ...... 72 morphine (pf) ...... 8, 9 methylphenidate ...... 142 mineral oil ...... 106 morphine concentrate ...... 9 methylprednisolone ...... 116 MINERAL OIL HEAVY ...... 164 morphine in 0.9 % nacl ...... 9 methylprednisolone acetate ...... 116 MINERAL OIL LAXATIVE ...... 106 morrhuate sodium ...... 63 methylprednisolone sodium succ ...... 116 MINI ULTRA-THIN II ...... 128 MOTION RELIEF (MECLIZINE) ...... 106 methyltestosterone ...... 117 MINIPRESS ...... 63 MOTION SICKNESS ...... 106 metipranolol ...... 89 MINIPRIN ...... 8 MOTION SICKNESS (MECLIZINE) metoclopramide hcl ...... 106 MINITRAN ...... 59 ...... 106 metolazone ...... 85 MINIVELLE ...... 117 MOTION SICKNESS RELIEF ...... 106 metoprolol succinate ...... 63 MINOCIN ...... 24 MOTION-TIME ...... 106 metoprolol ta-hydrochlorothiaz ...... 63 minocycline ...... 24 MOUTHPIECE ...... 128 metoprolol tartrate ...... 63 minoxidil ...... 63 MOVANTIK ...... 29 METOZOLV ODT ...... 106 MINTOX ...... 106 MOVIPREP ...... 106 METRO I.V...... 24 MINTOX MAXIMUM STRENGTH MOXATAG ...... 24 METROCREAM ...... 152 ...... 106 MOXEZA ...... 24 METROGEL ...... 152 MINTOX PLUS ...... 106 moxifloxacin ...... 24 METROGEL VAGINAL ...... 24 MIOCHOL-E ...... 89 moxifloxacin-sod.ace,sul-water ...... 24 METROLOTION ...... 152 MI-OMEGA NF ...... 169 MOZOBIL ...... 69 metronidazole ...... 24, 152 MIOSTAT ...... 89 MPM FOAM DRESSING ...... 128 metronidazole in nacl (iso-os) ...... 24 MIRAPEX ...... 45 MS CONTIN ...... 9 MEVACOR ...... 63 MIRAPEX ER ...... 45 MUCAPHED ...... 78 mexiletine ...... 59 MIRASORB ...... 128 MUCINEX ...... 78 MIACALCIN ...... 117 MIRCERA ...... 69 MUCINEX ALLERGY ...... 35 MI-ACID ...... 106 MIRCETTE (28) ...... 72 MUCINEX COLD & SINUS ...... 78 MI-ACID GAS RELIEF ...... 106 mirtazapine ...... 142 MUCINEX COLD-FLU & SORE MICARDIS ...... 63 MIRVASO ...... 152 THROAT ...... 78 MICARDIS HCT ...... 63 misoprostol ...... 106 MUCINEX COUGH MINI-MELTS ...... 78 MICONAZOLE 7 ...... 31 MISTASSIST ...... 128 MUCINEX D ...... 78 miconazole nitrate ...... 31 MITIGARE ...... 16 MUCINEX D MAXIMUM STRENGTH MICONAZOLE-3 ...... 31 mitomycin ...... 43 ...... 79 MICONAZORB AF ...... 31 mitoxantrone ...... 43 MUCINEX DM ...... 79 MICRHOGAM ULTRA-FILTERED M-M-R II (PF) ...... 55 MUCINEX FAST-MAX PLUS ...... 55 MOBIC ...... 16 COLD-FLU-THRT ...... 79 MICRO-BUMINTEST ...... 84 MOBISYL ...... 152 MUCINEX FAST-MAX COLD-SINUS MICROCHAMBER ...... 128 modafinil ...... 142 ...... 79 MICROFOAM SURGICAL ...... 128 MODERIBA ...... 47 MUCINEX FAST-MAX MICROGESTIN 1.5/30 (21) ...... 72 MODERIBA DOSE PACK ...... 47 CONGEST-COUGH ...... 79 MICROGESTIN 1/20 (21) ...... 72 MODICON (28) ...... 72 MUCINEX FAST-MAX DAY-NITE MICROGESTIN FE 1.5/30 (28) ...... 72 moexipril ...... 63 COLD ...... 79 MICROGESTIN FE 1/20 (28) ...... 72 moexipril-hydrochlorothiazide ...... 63 MUCINEX FAST-MAX DAY-NITE MICRO-GUARD ...... 31 MOISTURE RECOVERY ...... 152 CONG ...... 79 MICROPORE SURGICAL ...... 128 mometasone ...... 152 MUCINEX FAST-MAX MICROSPACER ...... 128 MONAGHAN Z STAT CHAMBER DAY-NT(DOXYL) ...... 79 MICROSPONGE ...... 128 ...... 128 MUCINEX FAST-MAX DM MAX ...... 79 MICROZIDE ...... 85 MONAGHAN Z STAT CHAMBER-LG MUCINEX FAST-MAX NITE (DOXYL) midazolam ...... 13, 145 MSK ...... 128 ...... 79 midazolam (pf) ...... 13 MONAGHAN Z STAT CHAMBER-MD MUCINEX FAST-MAX NITE midazolam (pf) in 0.9 % nacl ...... 13 MSK ...... 128 COLD-FLU ...... 79 midazolam in 0.9 % nacl ...... 13 MONAGHAN Z STAT CHAMBER-SM MUCINEX FAST-MAX SEV midodrine ...... 51 MSK ...... 128 CLD-SINUS ...... 79 MIGERGOT ...... 8 MONOCLATE-P ...... 57 MUCINEX FAST-MAX SEVERE COLD MIGRAINE FORMULA ...... 8 MONOJECT INSULIN SAFETY ...... 79 MIGRAINE RELIEF ...... 8 SYRING ...... 128 MUCINEX FST-MX DY-NT CLD MIGRANAL ...... 8 MONOJECT INSULIN SYRINGE ...... 128 (DPH) ...... 79 MILK OF MAGNESIA ...... 106 MONOJECT SYRINGE ...... 128 MUCINEX FULL FORCE ...... 89 MILK OF MAGNESIA MONOJECT ULTRA COMFORT MUCINEX MINI-MELTS ...... 79 CONCENTRATED ...... 106 INSULIN ...... 128 MUCINEX MOISTURE SMART ...... 89 milk thistle ...... 113 MONO-LINYAH ...... 72 MUCINEX SINUS-MAX ...... 89 MILK THISTLE EXTRACT ...... 113 MONONESSA (28) ...... 72 MUCINEX SINUS-MAX D-N milk thistle seed extract ...... 113 MONONINE ...... 57 (DIPHEN) ...... 79 MILLIPRED ...... 117 montelukast ...... 18 191
I n d e x I n d e x I n d e x MUCINEX SINUS-MAX DY-NT MYFORTIC ...... 119 NATRECOR ...... 63 (DXYL) ...... 79 MYLERAN ...... 43 NATROBA ...... 152 MUCINEX SINUS-MAX NITE MYOBLOC ...... 51 NATURAL BALANCE ...... 89 CONGEST ...... 79 MYOFLEX ...... 152 NATURAL CARE BANDAGES ...... 128 MUCINEX SINUS-MAX MYORISAN ...... 152 NATURAL FIBER LAXATIVE ...... 106 PRESSUR-PAIN ...... 79 MYOZYME ...... 164 NATURAL FIBER LAXATIVE MUCINEX SINUS-MAX SEV myrrh ...... 113 (SUGAR) ...... 106 CONG(DM) ...... 79 MYSOLINE ...... 68 NATURAL FIBER LAXATIVE MUCINEX SINUS-MAX SEV MYTAB GAS ...... 106 THERAPY ...... 106 CONGESTN ...... 79 MYTAB GAS MAXIMUM STRENGTH NATURAL HERBAL DIURETIC ...... 113 MUCOSA ...... 79 ...... 106 NATURAL VEG MUCOSA DM ...... 79 MYZILRA ...... 72 LAXATIVE(SENNOSID) ...... 106 MUCUS RELIEF ...... 79 NABI-HB ...... 55 NATURE'S TEARS ...... 89 MUCUS RELIEF COLD & SINUS ...... 79 nabumetone ...... 16 NATURE'S WASH PLUS WHIRLPOOL MUCUS RELIEF COLD-FLU-SORE nadolol ...... 63 ...... 152 THR ...... 79 nadolol-bendroflumethiazide ...... 63 NAVELBINE ...... 43 MUCUS RELIEF COUGH ...... 79 nafcillin ...... 24 NEBUPENT ...... 39 MUCUS RELIEF DM ...... 79 nafcillin in dextrose iso-osm ...... 24 NECON 0.5/35 (28) ...... 72 MUCUS RELIEF ER ...... 80 naftifine ...... 31 NECON 1/35 (28) ...... 72 MUCUS RELIEF PE ...... 80 NAFTIN ...... 31 NECON 1/50 (28) ...... 72 MUCUS RELIEF SEV NAGLAZYME ...... 164 NECON 10/11 (28) ...... 72 CONGEST-COLD ...... 80 nalbuphine ...... 9 NECON 7/7/7 (28) ...... 72 MUCUS RELIEF SINUS ...... 80 NALFON ...... 16 nefazodone ...... 142 MULTAQ ...... 59 naloxone ...... 29 NEO AC ...... 80 MULTIPURPOSE CONTACT LENS naltrexone ...... 29 NEO DM ...... 80 ...... 128 NAMENDA ...... 68 NEO-FRADIN ...... 24 MULTI-PURPOSE SOFT CONTACT NAMENDA TITRATION PAK ...... 68 neomycin ...... 24 LEN ...... 128 NAMENDA XR ...... 68 neomycin-bacitracin-poly-hc ...... 24 MULTI-SYMPTOM COLD (PE) ...... 80 NAMZARIC ...... 68 neomycin-bacitracin-polymyxin ...... 24 MULTI-SYMPTOM COLD NIGHT naphazoline ...... 89 neomycin-polymyxin b gu ...... 152 TIME ...... 80 NAPHCON-A ...... 89 neomycin-polymyxin b-dexameth ...... 24 MULTITRACE-4 ...... 96 NAPRELAN CR ...... 16 neomycin-polymyxin-gramicidin ...... 24 MULTITRACE-4 CONCENTRATE ..... 96 NAPRELAN CR DOSE CARD ...... 16 neomycin-polymyxin-hc ...... 24 MULTITRACE-4 NEONATAL ...... 96 NAPROSYN ...... 16 NEO-POLYCIN HC ...... 24 MULTITRACE-4 PEDIATRIC ...... 96 naproxen ...... 16 NEOPROFEN (IBUPROFEN LYSN)(PF) MULTITRACE-5 ...... 96 naproxen sodium ...... 16 ...... 64 MULTITRACE-5 CONCENTRATE ..... 96 naratriptan ...... 9 NEORAL ...... 119 MULTI-VIT WITH FLUORIDE & IRON NARDIL ...... 142 NEOSPORIN ...... 169 NAROPIN (PF) ...... 13 (NEO-POLYM-GRAMICID) ...... 24 MULTIVITAMIN WITH FLUORIDE NASACORT AQ ...... 89 NEOSPORIN DAILY BODY ...... 152 ...... 169 NASAL ALLERGY ...... 89 NEOSPORIN GU IRRIGANT ...... 152 MULTI-VITAMIN WITH FLUORIDE NASAL DECONGESTANT neostigmine methylsulfate ...... 51 ...... 169 (OXYMETAZL) ...... 89 NEO-SYNALAR ...... 24 MULTIVITAMINS WITH FLUORIDE NASAL DECONGESTANT (PE) ...... 80 NEO-SYNALAR KIT ...... 24 ...... 169 NASAL DECONGESTANT NEPHPLEX RX ...... 169 multivit-min-iron fum-folic ac ...... 169 (PSEUDOEPH) ...... 80 NEPHRAMINE 5.4 % ...... 96 mupirocin ...... 24 NASAL FOUR ...... 89 NEPHROCAPS ...... 169 mupirocin calcium ...... 24 NASAL SPRAY (OXYMETAZOLINE) NEPHRON FA ...... 96 MURI-LUBE ...... 164 ...... 89 NEPHRONEX-SL ...... 169 MURO 128 ...... 89 NASAL SPRAY 12 HOUR ...... 89 NEPTAZANE ...... 85 MUSCLE RUB ...... 152 NASAL SPRAY EXTRA NESACAINE ...... 13 MUSCLE RUB (WITH CAMPHOR) MOISTURIZING ...... 89 NESACAINE-MPF ...... 13 ...... 152 NASAL SPRAY LONG ACTING ...... 89 NESINA ...... 38 MUSCLE RUB ULTRA-STRENGTH NASAL SPRAY SINUS ...... 89 NESSI SPACER ...... 128 ...... 152 NASAL SPRAY X-MOIST ...... 89 NESTABS ...... 136 mustard oil ...... 164 NASCOBAL ...... 169 NESTABS ABC ...... 136 MUSTARGEN ...... 43 NASONEX ...... 89 NESTABS DHA ...... 136 MVC-FLUORIDE ...... 169 NASOPEN PE ...... 33 NEUAC ...... 152 MY WAY ...... 72 NATA KOMPLETE ...... 136 NEUAC KIT ...... 153 MYALEPT ...... 117 NATACYN ...... 31 NEULASTA ...... 69 MYAMBUTOL ...... 24 NATAFORT (NEW FORMULA 2011) NEUMEGA ...... 69 MYCAMINE ...... 31 ...... 136 NEUPOGEN ...... 69 MYCOBUTIN ...... 24 nateglinide ...... 38 NEUPRO ...... 45 mycophenolate mofetil ...... 119 NATELLE ONE ...... 136 NEURONTIN ...... 68 mycophenolate sodium ...... 119 NATESTO ...... 117 NEUT ...... 96 MYDRIACYL ...... 89 NATPARA ...... 117 NEUTROGENA TONER ...... 153 192
I n d e x I n d e x I n d e x NEVANAC ...... 89 NITRO-BID ...... 59 NORVASC ...... 60 nevirapine ...... 47 NITRO-DUR ...... 59 NORVIR ...... 47 NEW GENERATION ...... 128 nitrofurantoin ...... 24 NOSE DROPS ...... 89 NEXA PLUS ...... 136 nitrofurantoin macrocrystal ...... 24 NOSE DROPS EXTRA STRENGTH ... 89 NEXA SELECT ...... 136 nitrofurantoin monohyd/m-cryst ...... 24 NO-STICK GLUCOSE ...... 84 NEXAVAR ...... 43 nitroglycerin ...... 59, 60 NO-STING SKIN-PREP ...... 128 NEXCARE GENTLE PAPER TAPE nitroglycerin in 5 % dextrose ...... 59 NOVOEIGHT ...... 57 ...... 128 NITROLINGUAL ...... 60 NOVOFINE 30 ...... 128 NEXCARE TEGADERM ...... 128 NITROMIST ...... 60 NOVOFINE 32 ...... 128 NEXIUM ...... 106 NITROPRESS ...... 64 NOVOFINE AUTOCOVER ...... 128 NEXIUM IV ...... 106 NITROSTAT ...... 60 NOVOFINE PLUS ...... 128 NEXIUM PACKET ...... 106 NITRO-TIME ...... 60 NOVOLIN 70/30 ...... 38 NEXPLANON ...... 72 NIVA-FOL ...... 169 NOVOLIN N ...... 38 NEXT CHOICE ...... 72 NIVA-HIST DM ...... 80 NOVOLIN R ...... 38 NEXT CHOICE ONE DOSE ...... 72 NIVANEX DMX ...... 80 NOVOLOG ...... 38 NEXTERONE ...... 59 NIVA-PLUS ...... 136 NOVOLOG FLEXPEN ...... 38 niacin ...... 169 nizatidine ...... 107 NOVOLOG MIX 70-30 ...... 38 NIACIN-AZE AC-TURMER-FA-B6-ZN NIZORAL ...... 31 NOVOLOG MIX 70-30 FLEXPEN ...... 38 ...... 164 NO DOZ ...... 68 NOVOLOG PENFILL ...... 38 NIACOR ...... 64 NO DRIP ...... 89 NOVOSEVEN RT ...... 57 NIASPAN EXTENDED-RELEASE ...... 64 NO STING BARRIER FILM ...... 153 NOVOTWIST ...... 128 NICADAN ...... 164 NODOLOR ...... 9 NOXAFIL ...... 31 nicardipine ...... 59 NOHIST-DM ...... 80 NP THYROID ...... 158 NICODERM CQ ...... 157 NOHIST-LQ ...... 33 NPLATE ...... 69 NICOMIDE ...... 169 non-adherent bandage ...... 128 NRS NASAL RELIEF ...... 89 NICOMIDE (SELENIUM-CHROMIUM) NON-ASPIRIN ...... 9 NU-COPD ...... 80 ...... 169 NON-ASPIRIN EXTRA STRENGTH .... 9 NUCYNTA ...... 9 NICORELIEF ...... 157 NON-ASPIRIN NIGHTIME ...... 3 NUCYNTA ER ...... 9 NICORETTE ...... 158 NON-ASPIRIN PAIN RELIEF ...... 9 NUEDEXTA ...... 68 nicotine ...... 158 NON-ASPIRIN PM ...... 3 NULECIT ...... 96 nicotine (polacrilex) ...... 158 NON-DROWSY ALLERGY ...... 36 NULEV ...... 107 NICOTROL ...... 158 NONI ...... 113 NULOJIX ...... 119 NICOTROL NS ...... 158 NON-STICK PAD ...... 128 NULYTELY WITH FLAVOR PACKS NIFEDICAL XL ...... 59 NORA-BE ...... 72 ...... 107 nifedipine ...... 59 NORCO ...... 9 NUPERCAINAL ...... 13 NIGHT TIME (DOXY-DM-ACETAM) NORDITROPIN FLEXPRO ...... 117 nutmeg oil ...... 164 ...... 80 NORDITROPIN NORDIFLEX ...... 117 NUTRESTORE ...... 96 NIGHT TIME COLD ...... 80 NOREL AD ...... 80 NUTRILIPID ...... 107 NIGHT TIME COLD & FLU RELIEF NOREL CS ...... 80 NUTRILYTE ...... 96 ...... 80 norepinephrine bitartrate ...... 51 NUTRILYTE II ...... 96 NIGHT TIME COLD-FLU ...... 80 noreth-ethinyl estradiol-iron ...... 72 NUTRI-TAB OB ...... 136 NIGHT TIME COLD-FLU RELIEF ...... 80 norethindrone (contraceptive) ...... 72 NUTRI-TAB OB + DHA ...... 136 NIGHTTIME COLD-FLU ...... 80 norethindrone acetate ...... 117 NUTRITIONAL SHAKE ...... 96 NIGHTTIME COLD-FLU RELIEF ...... 80 norethindrone ac-eth estradiol ...... 72, 117 NUTRITIONAL SHAKE PLUS ...... 96 NIGHTTIME COUGH ...... 80 norethindrone-e.estradiol-iron ...... 72 NUTROPIN ...... 117 NIGHTTIME SINUS ...... 80 norgestimate-ethinyl estradiol ...... 72 NUTROPIN AQ ...... 117 NIGHTTIME SLEEP AID (DIPHEN) NORINYL 1+35 (28) ...... 72 NUTROPIN AQ NUSPIN ...... 117 ...... 145 NORINYL 1+50 (28) ...... 72 NUVARING ...... 73 NILANDRON ...... 43 NORITATE ...... 153 NUVESSA ...... 24 NIMBEX ...... 51 NORLYROC ...... 72 NUVIGIL ...... 142 nimodipine ...... 59 NORMOSOL-M IN 5 % DEXTROSE NYAMYC ...... 31 NINJACOF ...... 80 ...... 96 NYMALIZE ...... 60 NINJACOF-A ...... 80 NORMOSOL-R ...... 96 NYQUIL D ...... 80 NINJACOF-XG ...... 80 NORMOSOL-R IN 5 % DEXTROSE nystatin ...... 31 NIPENT ...... 43 ...... 96 nystatin-triamcinolone ...... 31 NIRAVAM ...... 142 NORMOSOL-R PH 7.4 ...... 96 NYSTOP ...... 31 NIRON KOMPLETE ...... 96 NORPACE ...... 60 NYTOL ...... 145 nisoldipine ...... 59 NORPACE CR ...... 60 OATMEAL BATH REGULAR ...... 153 NITE TIME ...... 80 NORPRAMIN ...... 142 OB COMPLETE ...... 136 NITE TIME COLD-FLU RELIEF ...... 80 NOR-QD ...... 72 OB COMPLETE 400 ...... 136 NITE TIME COUGH ...... 80 NORTHERA ...... 51 OB COMPLETE ONE ...... 136 NITE TIME-D COLD-FLU RELIEF ..... 80 NORTREL 0.5/35 (28) ...... 72 OB COMPLETE PETITE ...... 136 NITE-TIME COLD-FLU ...... 80 NORTREL 1/35 (21) ...... 72 OB COMPLETE PREMIER ...... 136 NITRATEST PAPER ...... 84 NORTREL 1/35 (28) ...... 72 OB COMPLETE WITH DHA ...... 136 NITRATEST PAPER WITH NORTREL 7/7/7 (28) ...... 73 OBIZUR ...... 57 DISPENSER ...... 84 nortriptyline ...... 142 O-CAL FA ...... 136 193
I n d e x I n d e x I n d e x O-CAL PRENATAL ...... 136 OPSITE FLEXIGRID DRESSING ...... 129 ORTHO EVRA ...... 73 OCTAGAM ...... 55 OPSITE IV 3000 ...... 129 ORTHO MICRONOR ...... 73 octreotide acetate ...... 117 OPSUMIT ...... 64 ORTHO TRI-CYCLEN (28) ...... 73 OCUFEN ...... 89 OPTICHAMBER ADULT ORTHO-CEPT (28) ...... 73 OCUFLOX ...... 25 MASK-LARGE ...... 129 ORTHOCLONE OKT3 ...... 119 OCUSOFT FACIAL-SKIN CLEANSER OPTICHAMBER ADVANTAGE ...... 129 ORTHO-CYCLEN (28) ...... 73 ...... 153 OPTICHAMBER ADVANTAGE-LG ORTHO-NOVUM 1/35 (28) ...... 73 ODOMZO ...... 43 MASK ...... 129 ORTHO-NOVUM 7/7/7 (28) ...... 73 ODOR ELIMINATOR DROPS ...... 153 OPTICHAMBER ADVANTAGE-MED OSCIMIN ...... 107 ODOR FREE GARLIC ...... 113 MASK ...... 129 OSCIMIN SL ...... 107 ODORLESS GARLIC ...... 113 OPTICHAMBER ADVANTAGE-SML OSCIMIN SR ...... 107 OFEV ...... 164 MSK ...... 129 OSENI ...... 38 ofloxacin ...... 25 OPTICHAMBER DIAMOND LG MASK OSMITROL 10 % ...... 85 OGESTREL (28) ...... 73 ...... 129 OSMITROL 15 % ...... 85 olanzapine ...... 142 OPTICHAMBER DIAMOND VHC ... 129 OSMITROL 20 % ...... 85 olanzapine-fluoxetine ...... 142 OPTICHAMBER DIAMOND-MED OSMITROL 5 % ...... 85 oleic acid ...... 164 MSK ...... 129 OSMOPREP ...... 107 OLEPTRO ER ...... 142 OPTICHAMBER DIAMOND-SML OSPHENA ...... 165 olopatadine ...... 89 MASK ...... 129 OTEZLA ...... 16 OLUX ...... 153 OPTI-CLEAR ...... 89 OTEZLA STARTER ...... 16 OLUX-E ...... 153 OPTI-FREE ...... 129 OTIC CARE (ANTIPYRINE) ...... 89 OLYSIO ...... 47 OPTI-FREE EXPRESS ...... 129 OTOZIN ...... 89 OMECLAMOX-PAK ...... 107 OPTI-FREE REPLENISH ...... 129 OTREXUP (PF) ...... 16 omega-3 acid ethyl esters ...... 107 OPTI-FREE REWETTING DROPS .... 129 OVACE ...... 153 OMEGA-3 IQ CHILDREN'S ...... 164 OPTISON ...... 84 OVACE PLUS ...... 153 omeprazole ...... 107 OPTIVAR ...... 36 OVACE PLUS SHAMPOO ...... 153 omeprazole magnesium ...... 107 ORACEA ...... 25 OVACE PLUS WASH ...... 153 OMIDRIA ...... 89 ORACIT ...... 96 OVCON-35 (28) ...... 73 OMNARIS ...... 89 ORAL MIX ...... 164 OVIDE ...... 153 OMNIPAQUE 140 ...... 84 ORAL MIX SF ...... 164 oxacillin ...... 25 OMNIPAQUE 180 ...... 84 ORAL PAIN RELIEF ...... 13 oxacillin in dextrose(iso-osm) ...... 25 OMNIPAQUE 240 ...... 84 ORAL SUSPEND ...... 164 oxaliplatin ...... 43 OMNIPAQUE 300 ...... 84 ORAL SYRUP ...... 164 oxandrolone ...... 117 OMNIPAQUE 350 ...... 84 ORAL SYRUP SF ...... 164 oxaprozin ...... 16 OMNIPRED ...... 89 ORALAIR ...... 55 oxazepam ...... 142 OMNISCAN ...... 84 ORALONE ...... 164 oxcarbazepine ...... 68 OMNISCAN PREFILL PLUS ...... 84 ORANGE CONCENTRATE ...... 164 OXECTA ...... 9 OMNITROPE ...... 117 orange oil ...... 165 OXISTAT ...... 31 ONCASPAR ...... 43 ORAP ...... 142 OXSORALEN ...... 153 ondansetron ...... 107 ORA-PLUS ...... 165 OXSORALEN ULTRA ...... 153 ondansetron (pf) in dextrose ...... 107 ORAPRED ...... 117 OXTELLAR XR ...... 68 ondansetron hcl ...... 107 ORAPRED ODT ...... 117 oxybutynin chloride ...... 165 ondansetron hcl (pf) ...... 107 ORASEP ...... 13 oxycodone ...... 9 ONE FLOW SPIROMETER PC CABLE ORA-SWEET ...... 165 oxycodone-acetaminophen ...... 9 ...... 128 ORA-SWEET SF ...... 165 oxycodone-aspirin ...... 9 ONE FLOW SPIROMETER ORAVIG ...... 31 OXYCONTIN ...... 10 SOFTWARE ...... 128 ORBACTIV ...... 25 oxymorphone ...... 10 ONE FLOW TESTER MOUTHPIECE ORENCIA ...... 16 oxytocin ...... 117 ...... 128 ORENCIA (WITH MALTOSE) ...... 16 OXYTROL ...... 165 ONE STEP AT A TIME ...... 128 ORENITRAM ...... 64 OYSTERCAL-D ...... 96 ONE WAY VALVED MOUTHPIECE ORFADIN ...... 165 OZURDEX ...... 89 ...... 128 ORGAN-I NR ...... 80 PACERONE ...... 60 ONEXTON ...... 153 ORIGINAL NASAL SPRAY ...... 89 paclitaxel ...... 43 ONFI ...... 68 ORKAMBI ...... 165 PACNEX HP ...... 153 ONGLYZA ...... 38 orphenadrine citrate ...... 135 PACNEX LP ...... 153 ONMEL ...... 31 ORSINI INSULIN SYRINGE ...... 129 PACNEX MX ...... 153 ONTAK ...... 43 ORSYTHIA ...... 73 PAIN & FEVER ...... 10 OPANA ...... 9 ORTHO ALL-FLEX FITTING SET ...... 73 PAIN FREE TAPE ...... 129 OPANA ER ...... 9 ORTHO DIAPHRAGM ALL-FLEX 65 PAIN FREE WRAP ...... 129 OPCICON ONE-STEP ...... 73 ...... 73 PAIN RELIEF ...... 10 OPDIVO ...... 43 ORTHO DIAPHRAGM ALL-FLEX 70 PAIN RELIEF ALLERGY SINUS ...... 80 opium tincture ...... 107 ...... 73 PAIN RELIEF ANESTHETIC ...... 13 OPSITE ...... 129 ORTHO DIAPHRAGM ALL-FLEX 75 PAIN RELIEF COLD ...... 80 OPSITE ADHESIVE DRESSING ...... 129 ...... 73 PAIN RELIEF COLD & COUGH ...... 80 OPSITE FLEXIFIX ...... 129 ORTHO DIAPHRAGM ALL-FLEX 80 PAIN RELIEF EXTRA STRENGTH .... 10 OPSITE FLEXIGRID ...... 129 ...... 73 194
I n d e x I n d e x I n d e x PAIN RELIEF INSTANT ANTISEPTIC PEDIATRIC ELECTROLYTE ...... 96 PERSANTINE ...... 46 ...... 153 PEDIATRIC MEDIUM MASK ...... 129 PERTZYE ...... 107 PAIN RELIEF PM ...... 3 PEDIATRIC PANDA MASK ...... 129 PETADOLEX ...... 113 PAIN RELIEF PM RAPID RELEASE .... 3 PEDIATRIC SMALL MASK ...... 129 PETADOLEX 75 ...... 113 PAIN RELIEF REGULAR STRENGTH PEDIAVENT ...... 36 PETROLATUM GAUZE ...... 129 ...... 10 PEDI-BORO SOAK ...... 153 petrolatum, yellow (bulk) ...... 165 PAIN RELIEF SINUS PE ...... 80 PEDI-PRE ...... 129 PETROLEUM JELLY ...... 165 PAIN RELIEVER ...... 10 PEDI-PRE TAPE SPRAY ...... 129 PETROLEUM JELLY, WHITE ...... 165 PAIN RELIEVER EXTRA STRENGTH PEDI-SKIN ADHERENT #2 ...... 129 PEXEVA ...... 143 ...... 10 PEDITRACE ...... 96 PFIZERPEN-G ...... 25 PAIN RELIEVER PLUS ...... 10 PEDVAX HIB (PF) ...... 55 PFLEX INSPIRATORY TRAINER .... 129 PAIN RELIEVER PM ...... 3 peg 3350-electrolytes ...... 107 PHARBEDRYL ...... 36 PAIN RELIEVER PM EX ST ...... 3 PEG3350 ...... 107 PHARBETOL ...... 10 PAIN RELIEVER PM EX-STRENGTH PEG-3350 WITH FLAVOR PACKS PHAZYME ...... 107 ...... 3 ...... 107 PHENACTIN AA PLUS 20 PE ...... 96 PAIN RELIEVING (MENTHOL) ...... 153 PEGANONE ...... 68 PHENADOZ ...... 107 PAIRE OB PLUS DHA ...... 136 PEGASYS ...... 48 PHENASEPTIC ...... 13 paliperidone ...... 142 PEGASYS PROCLICK ...... 48 phenazopyridine ...... 13 PAMELOR ...... 142 peg-electrolyte soln ...... 107 phenelzine ...... 143 pamidronate ...... 165 PEGINTRON ...... 48 PHENERGAN ...... 36, 107 PAMINE ...... 107 PEGINTRON REDIPEN ...... 48 phenobarb-hyoscy-atropine-scop ...... 108 PAMINE FORTE ...... 107 PEN NEEDLE ...... 129 phenobarbital ...... 145 PANCREAZE ...... 107 pen needle, diabetic ...... 129 phenobarbital sodium ...... 145 PANCRELIPASE 5000 ...... 107 penicillin g pot in dextrose ...... 25 phenoxybenzamine ...... 51 pancuronium ...... 51 penicillin g potassium ...... 25 phenylephrine hcl ...... 64, 90 PANDA MASK ...... 129 penicillin g procaine ...... 25 phenylephrine hcl in 0.9% nacl ...... 64 PANDEL ...... 153 penicillin g sodium ...... 25 PHENYLHISTINE DH ...... 80 PANHEMATIN ...... 165 penicillin v potassium ...... 25 PHENYTEK ...... 68 PANOXYL ...... 153 PENLAC ...... 31 phenytoin ...... 68 PANOXYL-4 ...... 153 PENNSAID ...... 153 phenytoin sodium ...... 68 PANRETIN ...... 43 PENTACEL (PF) ...... 55 phenytoin sodium extended ...... 68 PANTILINERS ...... 129 PENTACEL ACTHIB COMPONENT PHILITH ...... 73 pantoprazole ...... 107 (PF) ...... 55 PHISOHEX ...... 153 papaverine ...... 64 PENTACEL DTAP-IPV COMPNT (PF) PHOSLO ...... 96 PAPER TAPE ...... 129 ...... 55 PHOSLYRA ...... 96 PAPER TAPE, HYPOALLERGENIC PENTAM ...... 39 PHOSPHA 250 NEUTRAL ...... 96 ...... 129 PENTASA ...... 107 PHOSPHATE LAXATIVE ...... 108 paraffin ...... 165 pentazocine-acetaminophen ...... 10 PHOSPHOLINE IODIDE ...... 90 PARAFON FORTE DSC ...... 135 pentazocine-naloxone ...... 10 PHRENILIN FORTE ...... 10 PARAGARD T 380A ...... 73 PENTIPS ...... 129 PHYSICIANS EZ USE FLU 2012-13 PARCOPA ...... 45 pentoxifylline ...... 57 ...... 55 paregoric ...... 107 PENTRAVAN ...... 165 PHYSIOLYTE ...... 153 PAREMYD ...... 89 PEPCID ...... 107 PHYSIOSOL IRRIGATION ...... 153 paricalcitol ...... 165 PEPCID COMPLETE ...... 107 physostigmine salicylate ...... 51 PARNATE ...... 142 PEPPERMINT FLAVORING ...... 165 PHYTOFUSION ...... 113 paromomycin ...... 39 peppermint oil ...... 113 phytonadione ...... 169 paroxetine hcl ...... 142 peppermint spirit ...... 113 PICATO ...... 43 PASER ...... 25 PEPTIC RELIEF ...... 107 pilocarpine hcl ...... 51, 90 PATADAY ...... 36 PEPTO-BISMOL ...... 107 pimozide ...... 143 PATANASE ...... 89 PEPTO-BISMOL MAX ST ...... 107 PIMTREA (28) ...... 73 PATANOL ...... 36 PEPTO-BISMOL TO-GO ...... 107 pindolol ...... 64 PAXIL ...... 142 PERCOCET ...... 10 pine tar (bulk) ...... 153 PAXIL CR ...... 143 PERCODAN ...... 10 PINK BISMUTH ...... 108 PAZEO ...... 36 PERDIEM OVERNIGHT RELIEF ...... 107 PINK BISMUTH MAXIMUM PCCA-PLUS BASE ...... 165 PERFOROMIST ...... 18 STRENGTH ...... 108 PCE ...... 25 PERI-COLACE ...... 107 PINNACAINE ...... 90 PEANUT BUTTER FLAVOR ...... 165 PERIFRESH ...... 153 pioglitazone ...... 38 PEDIA RELIEF COUGH-COLD ...... 80 PERIGIENE ...... 153 piperacillin-tazobactam ...... 25 PEDIADERM AF ...... 31 PERIGUARD ...... 153 PIRMELLA ...... 73 PEDIADERM HC ...... 153 PERIKABIVEN ...... 96 piroxicam ...... 16 PEDIADERM TA ...... 153 perindopril erbumine ...... 64 PITOCIN ...... 117 PEDIA-LAX ...... 107 PERISCENT ...... 153 PITRESSIN ...... 117 PEDIA-LAX STOOL SOFTENER ...... 107 PERJETA ...... 43 PLAQUENIL ...... 39 PEDIAPRED ...... 117 permethrin ...... 153 PLASBUMIN 25 % ...... 57 PEDIARIX (PF) ...... 55 perphenazine ...... 143 PLASBUMIN 5 % ...... 57 PEDIATRIC COUGH & COLD ...... 80 perphenazine-amitriptyline ...... 143 PLASMA-LYTE 148 ...... 96 195
I n d e x I n d e x I n d e x PLASMA-LYTE A ...... 96 potassium chloride in 5 % dex ...... 97 PRENATAL WITH DHA & FOLIC PLASMA-LYTE-56 IN 5 % DEXTROSE potassium chloride in lr-d5 ...... 97 ACID ...... 137 ...... 96 potassium chloride-0.45 % nacl ...... 97 PRENATE AM ...... 137 PLASMANATE ...... 57 potassium chloride-d5-0.2%nacl ...... 97 PRENATE CHEWABLE ...... 137 PLASTIC STRIPS ...... 129 potassium chloride-d5-0.3%nacl ...... 97 PRENATE DHA ...... 137 PLASTIC SWABS ...... 129 potassium chloride-d5-0.9%nacl ...... 97 PRENATE DHA (FERR ASP GLYCIN) PLAVIX ...... 46 potassium citrate ...... 97 ...... 137 PLEGISOL ...... 60 potassium citrate-citric acid ...... 97 PRENATE ELITE ...... 137 PLEGRIDY ...... 68 potassium gluconate ...... 97 PRENATE ELITE (IRON ASP GLYC) PLETAL ...... 46 potassium phosphate m-/d-basic ...... 97 ...... 137 PLIAGLIS ...... 13 POTIGA ...... 68 PRENATE ENHANCE ...... 137 PNEUMOVAX 23 ...... 55 povidone-iodine ...... 154 PRENATE ESSENTIAL ...... 137 PNV 29-1 ...... 136 POWER CLEANER ...... 129 PRENATE ESSENTIAL(IRON-ASP-GL) PNV FOLIC ACID + IRON ...... 136 PR NATAL 400 ...... 136 ...... 137 PNV OB+DHA ...... 136 PR NATAL 400 EC ...... 136 PRENATE MINI ...... 137 PNV-DHA ...... 136 PR NATAL 430 ...... 136 PRENATE MINI (FERR ASP GLYCIN) PNV-FERROUS PR NATAL 430 EC ...... 136 ...... 137 FUMARATE-DOCU-FA ...... 136 PRADAXA ...... 29 PRENATE PIXIE ...... 137 PNV-FIRST ...... 136 PRALUENT PEN ...... 64 PRENATE RESTORE ...... 137 PNV-SELECT ...... 136 PRALUENT SYRINGE ...... 64 PRENATE STAR ...... 137 PNV-VP-U ...... 136 PRAMCORT ...... 108 PRENEXA ...... 137 POCKET CHAMBER ...... 129 PRAMEGEL ANTI-ITCH ...... 154 PREP-HEM (PHENYLEPHRINE) ...... 108 PODOCON ...... 153 pramipexole ...... 45 PREPIDIL ...... 117 podofilox ...... 154 PRAMOSONE ...... 154 PREPLUS ...... 137 POLOCAINE ...... 13 PRAMOSONE E ...... 154 PREPOPIK ...... 108 POLOCAINE-MPF ...... 13 pramoxine ...... 108 PREQUE 10 ...... 137 POLY HIST DHC ...... 81 PRAMOXINE-HC ...... 90 PRETAB ...... 137 POLY HIST FORTE (DOXYLAMINE) PRANDIMET ...... 38 PREVACID ...... 108 ...... 33 PRANDIN ...... 38 PREVACID 24HR ...... 108 POLY HIST NC ...... 81 PRASCION ...... 25 PREVACID SOLUTAB ...... 108 POLY HIST PD ...... 81 PRASCION RA ...... 25 PREVALITE ...... 64 POLYCIN ...... 25 PRAVACHOL ...... 64 PREVIFEM ...... 73 polyethylene glycol 3350 ...... 108 pravastatin ...... 64 PREVNAR 13 (PF) ...... 55 polyethylene glycol 8000(bulk) ...... 165 PRAXBIND ...... 57 PREVPAC ...... 108 POLY-HIST DM (THONZYLAMINE) prazosin ...... 64 PREZCOBIX ...... 48 ...... 81 PRECEDEX ...... 145 PREZISTA ...... 48 polymyxin b sulfate ...... 25 PRECEDEX IN 0.9 % SODIUM CHLOR PRIALT ...... 10 polymyxin b sulf-trimethoprim ...... 25 ...... 145 PRIFTIN ...... 25 polyoxyl 40 stearate ...... 165 PRECOSE ...... 38 PRILOSEC ...... 108 polyoxyl 40 stearate (bulk) ...... 165 PRED FORTE ...... 90 PRILOSEC OTC ...... 108 POLYSACCHARIDE IRON ...... 96 PRED MILD ...... 90 PRIMAPORE IV ...... 129 POLYSKIN II ...... 129 PRED-G ...... 25 primaquine ...... 39 polysorbate 40 ...... 165 PRED-G S.O.P...... 25 PRIMAXIN IV ...... 25 polysorbate 60 ...... 165 prednicarbate ...... 154 PRIMEAIRE ...... 130 polysorbate 80 ...... 165 prednisolone ...... 117 PRIMER MODIFIED UNNA BOOT POLYTRIM ...... 25 prednisolone acetate ...... 90 ...... 130 POLY-TUSSIN ...... 81 prednisolone sodium phosphate ...... 90, 117 primidone ...... 68 POLY-TUSSIN AC ...... 81 prednisone ...... 117 PRIMLEV ...... 10 POLY-TUSSIN D ...... 81 PREDNISONE INTENSOL ...... 117 PRIMROSE OIL ...... 113 POLY-TUSSIN EX ...... 81 PREFERA-OB ...... 136 PRIMSOL ...... 25 POLY-VENT DM ...... 81 PREFERA-OB ONE ...... 136 PRINIVIL ...... 64 POLY-VENT IR ...... 81 PREFERA-OB PLUS DHA ...... 136 PRISTIQ ...... 143 POMALYST ...... 43 PREFEST ...... 117 PRIVIGEN ...... 55 pomegranate fruit extract ...... 113 PREMARIN ...... 117 PRO DNA COLLECTION ...... 84 POMEGRANATE-EGCG & GRAPE PREMASOL 10 % ...... 97 PRO SPORTS TAPE ...... 130 SEED ...... 113 PREMASOL 6 % ...... 97 PROAIR HFA ...... 18 PONSTEL ...... 10 PRE-MENSTRUAL RELIEF ...... 10 PROAIR RESPICLICK ...... 18 PONTOCAINE (PF) ...... 13 PREMPHASE ...... 117 probenecid ...... 16 PORTIA ...... 73 PREMPRO ...... 117 PROBIOTIC PLUS & CRANBERRY pot & sod citrate-citric acid ...... 96 PRENAISSANCE ...... 137 ...... 113 potassium acetate ...... 96 PRENAISSANCE PLUS ...... 137 procainamide ...... 60 potassium bicarb and chloride ...... 96 PRENATA ...... 137 PROCALAMINE 3% ...... 97 potassium bicarb-citric acid ...... 96 PRENATAL PLUS (CALCIUM CARB) PROCARDIA ...... 60 potassium chlorid-d5-0.45%nacl ...... 97 ...... 137 PROCARDIA XL ...... 60 potassium chloride ...... 97 PRENATAL PLUS WITH IRON (CA) PROCENTRA ...... 51 potassium chloride in 0.9%nacl ...... 97 ...... 137 PROCHAMBER ...... 130 196
I n d e x I n d e x I n d e x PRO-CHLO ...... 81 PROTOPIC ...... 119 QUIXIN ...... 25 prochlorperazine ...... 108 protriptyline ...... 143 QUTENZA ...... 154 prochlorperazine edisylate ...... 108 PROVENTIL HFA ...... 18 QVAR ...... 18 prochlorperazine maleate ...... 108 PROVERA ...... 117 RABAVERT (PF) ...... 55 PRO-CLEAR AC ...... 81 PROVIDA DHA ...... 137 rabeprazole ...... 108 PROCORT ...... 108 PROVIDA OB ...... 137 racepinephrine ...... 18 PROCRIT ...... 69 PROVIGIL ...... 143 RADIADRES GEL ...... 130 PROCTOCORT ...... 108 PROVIL ...... 16 RADIAGEL ...... 165 PROCTOCREAM-HC ...... 108 PROZAC ...... 143 RAGWITEK ...... 55 PROCTOFOAM ...... 108 PROZAC WEEKLY ...... 143 raloxifene ...... 165 PROCTOFOAM HC ...... 108 PRUDOXIN ...... 154 ramipril ...... 64 PROCTO-PAK ...... 108 pseudoephedrine hcl ...... 81 RANEXA ...... 60 PROCTOSOL HC ...... 108 PSORCON ...... 154 ranitidine hcl ...... 108 PROCTOZONE-HC ...... 108 PULMICORT ...... 18 RAPAFLO ...... 165 PROCYSBI ...... 165 PULMICORT FLEXHALER ...... 18 RAPAMUNE ...... 119 PRODERM ...... 165 PULMOZYME ...... 165 RAPIVAB ...... 48 PRODIGY INSULIN SYRINGE ...... 130 PUMPKIN FLAVOR ...... 165 raspberry ...... 165 PRODIGY PEN NEEDLE ...... 130 PURALOR CI ...... 169 raspberry flavor, artificial ...... 166 PROFILNINE ...... 57 PURALUBE ...... 90 RASPBERRY FLAVORING ...... 166 progesterone ...... 117 PURE COTTON ...... 130 raspberry ketone ...... 113 PROGESTERONE IN OIL ...... 117 PUREFE OB PLUS ...... 137 RASUVO (PF) ...... 16 progesterone micronized ...... 117 PUREFE PLUS ...... 137 RAVICTI ...... 108 PROGLYCEM ...... 97 PUREVIT DUALFE PLUS ...... 97 RAYOS ...... 118 PROGRAF ...... 119 PURIXAN ...... 43 RAZADYNE ...... 51 PROLASTIN-C ...... 165 PYLERA ...... 108 RAZADYNE ER ...... 51 PROLENSA ...... 90 pyrazinamide ...... 25 REA LO 30 ...... 154 PROLEUKIN ...... 43 PYRETHRIN LICE TREATMENT M READY-TO-USE ENEMA ...... 108 PROLIA ...... 165 ...... 154 READY-TO-USE ENEMA (MIN OIL) PROMACTA ...... 69 PYRIDIUM ...... 13 ...... 108 promethazine ...... 36, 108 pyridostigmine bromide ...... 51 REAPHIRM ...... 137 PROMETHAZINE VC ...... 33 pyridoxine ...... 169 REBETOL ...... 48 PROMETHAZINE VC-CODEINE ...... 81 pyrilamine-phenylephrine ...... 33 REBIF (WITH ALBUMIN) ...... 68 promethazine-codeine ...... 81 Q-CARE RX Q2 ...... 165 REBIF REBIDOSE ...... 68 promethazine-dm ...... 81 Q-CARE RX Q4 ...... 165 REBIF TITRATION PACK ...... 68 promethazine-phenyleph-codeine ...... 81 Q-DRYL ...... 36 RECLAST ...... 166 promethazine-phenylephrine ...... 33 Q-GEL WITH ALPHA LIPOIC ACID RECLIPSEN (28) ...... 73 PROMETHEGAN ...... 108 ...... 165 RECOMBINATE ...... 57 PROMETRIUM ...... 117 QNASL ...... 90 RECOMBIVAX HB (PF) ...... 55 propafenone ...... 60 Q-PAP ...... 10 RECOTHROM ...... 57 propantheline ...... 108 Q-PAP EXTRA STRENGTH ...... 10 RECOTHROM SPRAY KIT ...... 57 proparacaine ...... 90 Q-TAPP ...... 33 RECTIV ...... 108 propofol ...... 13 Q-TAPP DM ...... 81 red yeast rice ...... 113 propoxyphene ...... 10 Q-TIPS/SINGLE-TIP ...... 130 REDNESS RELIEF ...... 90 propoxyphene n-acetaminophen ...... 10 Q-TIPS/SINGLE-TIP APPLICATOR REFEX ...... 113 propoxyphene-acetaminophen ...... 10 ...... 130 REFRESH CELLUVISC ...... 90 propranolol ...... 64 Q-TUSSIN ...... 81 REFRESH CLASSIC (PF) ...... 90 propranolol-hydrochlorothiazid ...... 64 Q-TUSSIN DM ...... 81 REFRESH LACRI-LUBE ...... 90 propylene glycol ...... 165 QUADRACEL (PF) ...... 55 REFRESH LIQUIGEL ...... 90 propylene glycol (bulk) ...... 165 QUADRAPAX ...... 108 REFRESH OPTIVE ...... 90 propylthiouracil ...... 158 QUALAQUIN ...... 39 REFRESH OPTIVE ADVANCED ...... 90 PROQUAD (PF) ...... 55 QUARTETTE ...... 73 REFRESH OPTIVE ADVANCED (PF) PRO-RED AC (W/ QUASENSE ...... 73 ...... 90 DEXCHLORPHENIR) ...... 81 QUDEXY XR ...... 68 REFRESH OPTIVE SENSITIVE (PF) PROSCAR ...... 165 QUELICIN ...... 51 ...... 90 PROSHIELD PLUS ...... 154 QUENALIN ...... 36 REFRESH P.M...... 90 PROSHIELD PLUS SKIN QUESTRAN ...... 64 REFRESH PLUS ...... 90 PROTECTANT ...... 154 QUESTRAN LIGHT ...... 64 REFRESH TEARS ...... 90 PROSHIELD PROTECTIVE HAND quetiapine ...... 143 REGLAN ...... 108 ...... 154 QUFLORA PEDIATRIC ...... 169 REGONOL ...... 51 PROSOL 20 % ...... 97 QUFLORA PEDIATRIC DROPS ...... 169 REGRANEX ...... 154 PROSTASCINT ...... 84 QUILLIVANT XR ...... 143 REGULOID ...... 108 PROSTIN E2 ...... 117 quinapril ...... 64 REGULOID, SUGAR FREE ...... 109 PROSTIN VR PEDIATRIC ...... 64 quinapril-hydrochlorothiazide ...... 64 REHYLA HAIR-BODY ...... 154 protamine ...... 57 quinidine gluconate ...... 60 RELCOF C ...... 81 PROTONIX ...... 108 quinidine sulfate ...... 60 RELENZA DISKHALER ...... 48 PROTOPAM CHLORIDE ...... 165 quinine sulfate ...... 39 RELION NEEDLES ...... 130 197
I n d e x I n d e x I n d e x RELION PEN NEEDLES ...... 130 RESTORE HYDROGEL GAUZE ROCALTROL ...... 169 RELISTOR ...... 29 SPONGE ...... 130 ROCEPHIN ...... 25 RELNATE DHA ...... 137 RESTORE ODOR-ABSORBENT ...... 130 rocuronium ...... 51 RELPAX ...... 10 RESTORE TRIO ...... 130 ROLLED ABSORBENT COTTON .... 130 REMEDY 4-IN-1 CLEANSER ...... 154 RESTORIL ...... 145 ROLLED GAUZE ...... 130 REMEDY ANTIFUNGAL ...... 31 resveratrol ...... 166 RONDIC ...... 130 REMEDY CALAZIME PROTECT RETAINE FLAX ...... 113 root beer flavor (bulk) ...... 166 PASTE ...... 154 RETAVASE ...... 57 ropinirole ...... 45 REMEDY CLEAR-AID PROTECT .... 154 RETIN-A ...... 154 ropivacaine (pf) ...... 13 REMEDY DIMETHICONE CREAM RETIN-A MICRO ...... 154 ropivacaine (pf) in 0.9 % nacl ...... 13 ...... 154 RETIN-A MICRO PUMP ...... 154 ROSADAN ...... 154 REMEDY NUTRASHIELD SKIN RETISERT ...... 90 ROSANIL ...... 25 PROTEC ...... 154 RETROVIR ...... 48 rose oil ...... 166 REMEDY PHYTOPLEX ANTIFUNGAL REVATIO ...... 64 ROSE WATER ...... 166 ...... 31 REVEAL COLON DISEASE TEST ...... 84 rosemary oil ...... 113 REMEDY PHYTOPLEX Z-GUARD REVEAL UTI TEST STRIP ...... 84 rosin (bulk) ...... 166 ...... 154 REVLIMID ...... 43 ROSULA ...... 25 REMEDY PHYTOPLEX Z-GUARD REVONTO ...... 135 ROSULA CLEANSING CLOTHS ...... 25 (ZN) ...... 154 REXULTI ...... 143 ROTARIX ...... 55 REMEDY SKIN REPAIR ...... 154 REYATAZ ...... 48 ROTATEQ VACCINE ...... 55 REMERON ...... 143 REZIRA ...... 81 ROWASA ...... 109 REMERON SOLTAB ...... 143 R-GENE 10 ...... 84 ROXICET ...... 10 REMICADE ...... 109 RHEUMATREX ...... 16 ROXICODONE ...... 10 REMODULIN ...... 64 RHINOCORT AQUA ...... 90 ROZEREM ...... 145 REMOVE ...... 130 RHOGAM ULTRA-FILTERED PLUS RUBBING ALCOHOL (ETHANOL) RENACIDIN ...... 97 ...... 55 ...... 154 RENAGEL ...... 97 RHOPHYLAC ...... 55 RUCONEST ...... 166 RENAL CAPS ...... 169 RIASTAP ...... 57 RU-HIST D ...... 33 RENEWAL HAND SANITIZER ...... 154 RIBASPHERE ...... 48 RU-HIST-D (WITH PYRILAMINE) .... 33 RENO CAPS ...... 169 RIBASPHERE RIBAPAK ...... 48 RULAVITE DHA ...... 137 RENU DISINFECTING ...... 130 ribavirin ...... 48 RULOX ...... 109 RENU MULTIPLUS ...... 130 RIDAURA ...... 16 RYANODEX ...... 135 RENU REWETTING DROPS ...... 130 rifabutin ...... 25 RYDEX ...... 81 RENVELA ...... 97 RIFADIN ...... 25 RYMED REOPRO ...... 46 RIFAMATE ...... 25 (DEXCHLORPHENIRAMINE-PE) ...... 33 repaglinide ...... 38 rifampin ...... 25 RYNEX DM ...... 81 REPATHA SURECLICK ...... 64 RIFATER ...... 25 RYNEX PE ...... 33 REPREXAIN ...... 10 RILUTEK ...... 68 RYNEX PSE ...... 33 REQUIP ...... 45 riluzole ...... 68 RYTARY ...... 45 REQUIP XL ...... 45 RI-MAG PLUS ...... 109 RYTHMOL ...... 60 RESCON ...... 33 rimantadine ...... 48 RYTHMOL SR ...... 60 RESCON-DM ...... 81 RIMSO-50 ...... 10 S2 RACEPINEPHRINE ...... 18 RESCON-GG ...... 81 ringers ...... 97, 154 SABRIL ...... 68 RESCRIPTOR ...... 48 RIOMET ...... 38 saccharin ...... 97 RESECTISOL ...... 86 RISPERDAL ...... 143 saccharin sodium ...... 97 reserpine ...... 64 RISPERDAL CONSTA ...... 143 SAFESNAP INSULIN SYRINGE ...... 130 RESPAIRE-30 ...... 81 RISPERDAL M-TAB ...... 143 saffron extract ...... 113 RESTASIS ...... 90 risperidone ...... 143 SAF-GEL ...... 130 RESTFULLY SLEEP ...... 145 RITALIN ...... 143 SAFYRAL ...... 73 RESTON HIGH SUPPORT PAD ...... 130 RITALIN LA ...... 143 sage leaf (bulk) ...... 113 RESTON LIGHT SUPPORT ROLL ... 130 RITEFLO AEROCHAMBER ...... 130 SAIZEN ...... 118 RESTON MEDIUM SUPPORT PAD RITUXAN ...... 43 SAIZEN CLICK.EASY ...... 118 ...... 130 rivastigmine ...... 51 SALACTIC FILM ...... 154 RESTORA RX ...... 109 rivastigmine tartrate ...... 51 SALAGEN ...... 51 RESTORA SPRINKLES ...... 109 RIXUBIS ...... 57 SALEX ...... 154 RESTORE ...... 130 rizatriptan ...... 10 salicylic acid ...... 154, 155 RESTORE CONTACT LAYER ...... 130 ROBAFEN ...... 81 salicylic acid sr-ceramides ...... 154 RESTORE CONTACT LAYER SILVER ROBAFEN CF ...... 81 SALINE 4 ...... 130 ...... 130 ROBAFEN COUGH ...... 81 SALINE SENSITIVE EYES ...... 130 RESTORE DUO ...... 130 ROBAFEN DM ...... 81 SALINE SOLUTION ...... 130 RESTORE FOAM HEEL DRESSING ROBAFEN DM CLEAR ...... 81 SALINE SOLUTION,STERILE ...... 130 ROBAFEN DM COUGH ...... 81 PRESRV ...... 130 RESTORE HYDROGEL DRESSING ROBAXIN ...... 135 SAL-PLANT ...... 155 ...... 130 ROBAXIN-750 ...... 135 salsalate ...... 16 RESTORE HYDROGEL GAUZE ...... 130 ROBINUL ...... 109 SAMSCA ...... 86 ROBINUL FORTE ...... 109 SANCUSO ...... 109 198
I n d e x I n d e x I n d e x SANDIMMUNE ...... 119 SENNA LAXATIVE ...... 109 sildenafil ...... 64 SANDOSTATIN ...... 118 SENNA PLUS ...... 109 SILENOR ...... 145 SANDOSTATIN LAR DEPOT ...... 118 SENNA PROMPT ...... 109 silica ...... 166 SANI-SUPP (ADULT) ...... 109 SENNA WITH DOCUSATE SODIUM SILICONE MASK - INFANT ...... 131 SANI-SUPP (CHILD) ...... 109 ...... 109 SILICONE MASK - PEDIATRIC ...... 131 SANI-SUPP (INFANT) ...... 109 SENNA-GEN ...... 109 SILPHEN COUGH ...... 36 SANTYL ...... 155 SENNALAX-S ...... 109 SILTUSSIN DM DAS ...... 81 SAPHRIS ...... 143 SENNA-S ...... 109 SILTUSSIN SA ...... 81 SAPHRIS (BLACK CHERRY) ...... 143 SENNA-TIME S ...... 109 SILTUSSIN-DM ...... 81 SARAFEM ...... 143 SENNO ...... 109 SILVADENE ...... 25 SARNA ANTI-ITCH ...... 155 sennosides-docusate sodium ...... 109 silver nitrate ...... 155 SARNA SENSITIVE ...... 13 SENOKOT ...... 109 silver sulfadiazine ...... 25 sassafras oil ...... 166 SENOKOT TO GO ...... 109 SILVERMED ...... 155 SAVAYSA ...... 29 SENOKOT-S ...... 109 SIMBRINZA ...... 90 SAVELLA ...... 166 SENOKOTXTRA ...... 109 SIMCOR ...... 64 saw palmetto ...... 113 SENSI-CARE (FOAM) ...... 155 simethicone ...... 109 saw palmetto fruit ...... 113 SENSI-CARE ADHESI REMOVER simple syrup ...... 166 saw palmetto-pumpkin seed oil ...... 113 WIPE ...... 131 SIMPLYTHICK ...... 166 SCALPICIN ANTI-ITCH ...... 155 SENSI-CARE MOISTURIZING 2 ...... 155 SIMPONI ...... 16 SCANPOR TAPE ...... 130 SENSIPAR ...... 166 SIMPONI ARIA ...... 16 scopolamine hbr ...... 109 SENSITIVE EYES ...... 131 SIMULECT ...... 119 SE BPO ...... 155 SENSITIVE EYES DAILY CLEANER simvastatin ...... 64 SEASONIQUE ...... 73 ...... 131 SINEMET ...... 45 SEBEX ...... 155 SENSITIVE EYES PLUS SALINE ..... 131 SINEMET CR ...... 45 SEB-PREV ...... 155 SENSODYNE ...... 131 SINEX ULTRA FINE MIST 12-HOUR SECONAL SODIUM ...... 145 SENSORCAINE ...... 13 ...... 90 SECTRAL ...... 64 SENSORCAINE/EPINEPHRINE ...... 14 SINGLE USE EZ FLU 2012-13 (PF) ..... 55 SECURA ANTIFUNGAL ...... 31 SENSORCAINE-MPF ...... 14 SINGLE USE EZ FLU 2013-14 (PF) ..... 55 SECURA ANTIFUNGAL EXTRA SENSORCAINE-MPF SPINAL ...... 14 SINGLE USE EZ FLU 2014-15(PF) ...... 55 THICK ...... 31 SENSORCAINE-MPF/EPINEPHRINE SINGULAIR ...... 18 SECURA DIMETHICONE ...... 155 ...... 14 SINUS & ALLERGY PE ...... 33 SECURA EXTRA PROTECTIVE ...... 155 SERENAGEN ...... 113 SINUS & SECURA MOISTURIZING ...... 155 SEREVENT DISKUS ...... 18 ALLERGY(PHENYLEPHRINE) ...... 33 SECURA PERSONAL ...... 155 SEROMYCIN ...... 25 SINUS & COLD-D ...... 81 SECURA PERSONAL SKIN CARE SEROQUEL ...... 143 SINUS 12 HOUR ...... 81 ...... 155 SEROQUEL XR ...... 143 SINUS CONG & PAIN DAY-NIGHT SECURA PROTECTIVE ...... 155 SEROSTIM ...... 118 ...... 81 SECURA STARTER KIT ...... 155 sertraline ...... 143 SINUS CONGESTION & PAIN ...... 81 SECURA TOTAL BODY CLEANSER sesame oil ...... 166 SINUS CONGESTION & PAIN(GUAIF) ...... 155 SE-TAN DHA ...... 137 ...... 82 SECURA TWO-STEP KIT ...... 155 SE-TAN PLUS ...... 97 SINUS SELECT-OB ...... 137 SETLAKIN ...... 73 CONGESTION&PAIN(CHLORPH) ..... 82 SELECT-OB (FOLIC ACID) ...... 137 sevelamer carbonate ...... 97 SINUS NASAL SPRAY ...... 90 SELECT-OB + DHA ...... 137 SEVERE COLD & FLU (PE) ...... 81 SINUS PAIN RELIEF ...... 82 selegiline hcl ...... 45 SEVERE COLD PE ...... 81 SINUS RELIEF (OXYMETAZOLINE) selenium ...... 97 sevoflurane ...... 14 ...... 90 selenium sulfide ...... 155 SF ...... 97 SINUS WASH ...... 90 SELF ADHERENT WRAP ...... 130 SF 5000 PLUS ...... 97 sirolimus ...... 119 SELF-ADHERANT GENTLE WRAP SFROWASA ...... 109 SIRTURO ...... 25 ...... 130 SHAROBEL ...... 73 SITAVIG ...... 48 SELF-ADHERING BANDAGE ...... 130 SHEER ADHESIVE ...... 131 SIVEXTRO ...... 25 SELFGRIP ...... 131 SHEER BANDAGE ...... 131 SKELAXIN ...... 135 SELF-GRIP ...... 131 SHEER BANDAGES ...... 131 SKIN CLEANSER ...... 155 SELSUN BLUE (SALICYLIC ACID) SHEER PLASTIC STRIP ...... 131 SKIN CLOSURE STRIPS ...... 131 ...... 155 SHEER SPOT BANDAGES ...... 131 SKINTEGRITY HYDROGEL ...... 131 SELSUN BLUE MOISTURIZING ...... 155 SHEER STRIP ...... 131 SKINTEGRITY HYDROGEL SELSUN BLUE NATURALS ...... 155 SHEER STRIP EXTRA LARGE ...... 131 DRESSING ...... 131 SELZENTRY ...... 48 SHEER STRIPS ...... 131 SKINTEGRITY WOUND CLEANSER SEMPREX-D ...... 33 SHEER STRIPS ASSORTED ...... 131 ...... 155 SE-NATAL 19 ...... 137 SIDESTREAM PEDIATRIC FACE SKLICE ...... 155 SE-NATAL 19 (WITH DOCUSATE) MASK ...... 131 SLEEP ...... 145 ...... 137 SIGNIFOR ...... 118 SLEEP AID (DIPHENHYDRAMINE) SENEXON ...... 109 SIGNIFOR LAR ...... 118 ...... 145 SENEXON-S ...... 109 SILACE ...... 109 SLEEP AID (DOXYLAMINE) ...... 145 SENNA ...... 109 SILADRYL SA ...... 36 SLEEP AID MAX STR (DIPHENHYDR) SENNA LAX ...... 109 SILAPAP ...... 10 ...... 145 199
I n d e x I n d e x I n d e x SLEEP TIME ...... 145 sotalol ...... 65 STOOL SOFTENER-LAXATIVE ...... 110 SLEEP-TABS ...... 145 SOTALOL AF ...... 64 STOOL SOFTENER-STIMULANT SLOW RELEASE IRON ...... 97 SOTRADECOL ...... 65 LAXAT ...... 110 SMOOTH ANTACID ...... 109 SOUTH AFRICAN HOODIA ...... 113 STRATASORB COMPOSITE WOUND sodium acetate ...... 97 SOVALDI ...... 48 ...... 131 sodium bicarbonate ...... 97, 109 SPACE CHAMBER PLUS ...... 131 STRATASORB ISLAND DRESSING sodium bisulfite ...... 166 SPEARMINT FLAVORING ...... 166 ...... 131 sodium chloride ...... 90, 97, 155, 166 spearmint oil ...... 166 STRATTERA ...... 143, 144 sodium chloride 0.45 % ...... 97 SPECTRAGEL ...... 131 strawberry flavor (bulk) ...... 166 sodium chloride 0.9 % ...... 97 spinosad ...... 155 STRAWBERRY FLAVORING ...... 166 sodium chloride 3 % ...... 97 SPIRIVA RESPIMAT ...... 18 streptomycin ...... 26 sodium chloride 5 % ...... 97 SPIRIVA WITH HANDIHALER ...... 18 STRETCH GAUZE BANDAGE ...... 131 sodium citrate-citric acid ...... 98 spironolactone ...... 86 STRIANT ...... 118 SODIUM EDECRIN ...... 86 spironolacton-hydrochlorothiaz ...... 86 STRIBILD ...... 48 sodium ferric gluconat-sucrose ...... 98 SPORANOX ...... 31 STRIVERDI RESPIMAT ...... 18 sodium fluoride ...... 98 SPORANOX PULSEPAK ...... 31 STROMECTOL ...... 39 sodium lactate ...... 98 SPORTS TAPE ...... 131 STRONG STRIPS ...... 132 sodium phenylbutyrate ...... 109 SPRINTEC (28) ...... 73 STRONG STRIPS X-LARGE ...... 132 sodium phosphate ...... 98 SPRIX ...... 10 STROVITE FORTE ...... 170 SODIUM POLYSTYRENE (SORB SPRYCEL ...... 43 STROVITE ONE ...... 170 FREE) ...... 98 SPS ...... 98 SUBLIMAZE (PF) ...... 10 sodium polystyrene sulfonate ...... 98 SRONYX ...... 73 SUBOXONE ...... 166 sodium silicate ...... 166 SSD ...... 26 SUBSYS ...... 10 sodium succinate ...... 166 SSKI ...... 98 SUCLEAR ...... 110 SOF-LAX ...... 109 SSS 10-5 ...... 26 sucralfate ...... 110 SOF-SET ADHESIVE PATCH ...... 131 STAFLEX sucrose ...... 98 SOFT CLOTH ...... 131 (BROMPHENIRA-ACETAMIN) ...... 3 SUDOGEST ...... 82 SOLARAZE ...... 43 STAHIST AD ...... 33 SUDOGEST 12-HOUR ...... 82 SOLIRIS ...... 57 STALEVO 100 ...... 45 SUDOGEST COLD & ALLERGY ...... 33 SOLODYN ...... 26 STALEVO 125 ...... 45 SUDOGEST PE ...... 82 SOLOSITE ...... 131 STALEVO 150 ...... 45 SUDOGEST SINUS & ALLERGY ...... 33 SOLOSITE WOUND GEL ...... 131 STALEVO 200 ...... 45 SUFENTA ...... 10 SOLTAMOX ...... 43 STALEVO 50 ...... 45 sufentanil citrate ...... 11 SOLU-CORTEF ...... 118 STALEVO 75 ...... 45 SULAR ...... 60 SOLU-CORTEF (PF) ...... 118 stannous fluoride ...... 98 sulfacetamide sodium ...... 26, 156 SOLU-MEDROL ...... 118 STARLIX ...... 38 sulfacetamide sodium (acne) ...... 156 SOLU-MEDROL (PF) ...... 118 STATUSS GREEN (CODEINE) ...... 82 sulfacetamide sodium-sulfur ...... 26 SOMA ...... 135 stavudine ...... 48 sulfacetamide sodium-urea ...... 156 SOMATULINE DEPOT ...... 118 STAY AWAKE ...... 69 sulfacetamide sod-sulfur-urea ...... 26 SOMAVERT ...... 166 STAY AWAKE MAXIMUM sulfacetamide-prednisolone ...... 26 SONATA ...... 145 STRENGTH ...... 69 sulfacetamide-sulfur-cleansr23 ...... 26 SOOLANTRA ...... 155 STAYFREE MAXI-PAD ...... 131 SULFACLEANSE 8-4 ...... 26 SOOTHE & COOL ...... 155 STAYFREE SUREFIT ...... 131 sulfact na-sul-avobnz-otn-ocsa ...... 26 SOOTHE & COOL BODY POWDER STAYFREE ULTRA THIN ...... 131 sulfadiazine ...... 26 ...... 155 stearic acid ...... 166 sulfamethoxazole-trimethoprim ...... 26 SOOTHE & COOL FREE MEDSEPTIC stearyl alcohol ...... 166 SULFAMIDE ...... 26 ...... 155 STELARA ...... 119 SULFAMYLON ...... 26 SOOTHE & COOL INZO BARRIER STERILE EYE DROPS ...... 90 sulfasalazine ...... 110 ...... 155 STERILE GAUZE PAD ...... 131 SULFATRIM ...... 26 SOOTHE & COOL MEDSEPTIC ...... 155 STERILE PADS ...... 131 SULFAZINE ...... 110 SOOTHE & COOL MOISTURE STERILE STRETCH GAUZE SULFAZINE EC ...... 110 BARRIER ...... 155 BANDAGE ...... 131 sulfur ...... 39 SOOTHE & COOL SKIN PASTE ...... 155 STERILE WATER FOR INJECTION sulindac ...... 16 SOOTHING NON-STICK ...... 131 ...... 166 SUMADAN ...... 26 SORBIDON HYDRATE ...... 166 STERI-STRIP ...... 131 SUMADAN XLT ...... 26 sorbitol ...... 98, 155, 166 STERI-STRIP DRESSING ...... 131 sumatriptan ...... 11 sorbitol-mannitol ...... 155 STERI-STRIP SKIN CLOSURES ...... 131 sumatriptan succinate ...... 11 SORE THROAT ...... 14 STIK IT ...... 131 SUMAVEL DOSEPRO ...... 11 SORE THROAT & COUGH ...... 82 STIMATE ...... 118 SUMAXIN ...... 26 SORE THROAT STIOLTO RESPIMAT ...... 18 SUMAXIN CP ...... 26 (BENZOCAINE-MENTH) ...... 14 STIVARGA ...... 43 SUMAXIN TS ...... 26 SORE THROAT (PHENOL) ...... 14 STOMACH RELIEF ...... 109 SUMMER'S EVE DOUCHE ...... 39 SORESPOT ...... 131 STOMACH RELIEF MAX STRENGTH SUPER B MAXI COMPLEX ...... 170 SORIATANE ...... 155 ...... 109 SUPER POTENT YOHIMBE ...... 113 SORILUX ...... 155 STOMACH RELIEF ORIGINAL ...... 110 SUPER STRIP BANDAGES ...... 132 SORINE ...... 64 STOOL SOFTENER ...... 110 200
I n d e x I n d e x I n d e x SUPERIOR DIGESTIVE ENZYME SYRSPEND SF ...... 166 TELFA ...... 132 ...... 110 SYRSPEND SF ALKA ...... 166 TELFA (WITH POLYHEXAMETH) SUPHEDRIN ...... 82 SYRSPEND SF LIQUID ...... 166 ...... 132 SUPHEDRIN 12 HOUR ...... 82 SYRUP VEHICLE SF ...... 166 TELFA AMD ...... 132 SUPHEDRINE ...... 82 SYSTANE ...... 90 TELFA CLEAR WOUND DRESSING SUPHEDRINE 12 HOUR ...... 82 SYSTANE (PF) ...... 90 ...... 132 SUPPRELIN LA ...... 118 SYSTANE BALANCE ...... 90 TELFA ISLAND DRESSING ...... 132 SUPRANE ...... 14 SYSTANE CONTACTS ...... 132 TELFA OUCHLESS NON-ADHERENT SUPRAX ...... 26 SYSTANE GEL ...... 90 ...... 132 SUPREP BOWEL PREP KIT ...... 110 SYSTANE NIGHTTIME ...... 90 telmisartan ...... 65 SURE COMFORT ALCOHOL PREP SYSTANE ULTRA ...... 91 telmisartan-amlodipine ...... 65 PADS ...... 156 SYSTANE ULTRA (PF) ...... 91 telmisartan-hydrochlorothiazid ...... 65 SURE COMFORT INS. SYR. U-100 TAB TUSSIN ...... 82 temazepam ...... 145 ...... 132 TAB TUSSIN DM ...... 82 TEMODAR ...... 44 SURE COMFORT INSULIN SYRINGE TABLOID ...... 43 TEMOVATE ...... 156 ...... 132 TACHOSIL ...... 57 TEMOVATE E ...... 156 SURE COMFORT PEN NEEDLE ...... 132 TACLONEX ...... 166 temozolomide ...... 44 SURE-FINE PEN NEEDLES ...... 132 tacrolimus ...... 119 TENA SERENITY ...... 132 SURE-JECT INSULIN SYRINGE ...... 132 TACTINAL ...... 11 TENDER TAPE ...... 132 SURE-PREP ALCOHOL PREP PADS TACTINAL EXTRA STRENGTH ...... 11 TENDERSORB ...... 132 ...... 156 TAFINLAR ...... 43 TENDERWET ACTIVE CAVITY SUREPRESS ABSORBENT PADDING TAKE ACTION ...... 73 DRESS ...... 132 ...... 132 TALWIN ...... 11 TENDERWET ACTIVE DRESSING SUREPRESS HIGH COMPRESSION TAMIFLU ...... 48 ...... 132 ...... 132 tamoxifen ...... 43 TENDERWET SYSTEM ...... 132 SURESITE ...... 132 tamsulosin ...... 167 TENDERWRAP UNNA BOOT ...... 132 SURESITE FLEXIGRID ...... 132 TANDEM DUAL ACTION ...... 98 TENEX ...... 65 SURESITE IV ...... 132 TANDEM PLUS ...... 98 teniposide ...... 44 SURESITE MATRIX ...... 132 TANGERINE OIL, NATURAL ...... 167 TENIVAC (PF) ...... 56 SURESITE WINDOW ...... 132 TANZEUM ...... 38 TENORETIC 100 ...... 65 SURFAXIN ...... 166 TAPAZOLE ...... 158 TENORETIC 50 ...... 65 SURGICAL DRESSING ...... 132 TARGRETIN ...... 43 TENORMIN ...... 65 SURGICAL DRESSING EXTR TARINA FE ...... 73 TENSION HEADACHE ...... 11 PROTCT ...... 132 TARKA ...... 65 TENSOR ...... 132 SURGICAL PADS ...... 132 TARON FORTE ...... 98 TERAZOL 3 ...... 32 SURMONTIL ...... 144 TARON-BC ...... 137 TERAZOL 7 ...... 32 SURVANTA ...... 166 TARON-C DHA ...... 137 terazosin ...... 65 SUSPENDOL-S ...... 166 TARON-PREX PRENATAL-DHA ..... 137 terbinafine hcl ...... 32 SUSTIVA ...... 48 TART CHERRY EXTRACT ...... 113 terbutaline ...... 18 SUTENT ...... 43 TASIGNA ...... 43 terconazole ...... 32 SWEET-SF ...... 166 TASMAR ...... 45 TERUMO INS SYRINGE 0.5CC/27G SWIM EAR ...... 90 TAXOTERE ...... 44 ...... 132 SYEDA ...... 73 TAZICEF ...... 26 TERUMO INSULIN SYRINGE ...... 132 SYLATRON ...... 43 TAZORAC ...... 156 TESSALON PERLES ...... 82 SYLATRON 4-PACK ...... 43 TAZTIA XT ...... 60 TESTIM ...... 118 SYLVANT ...... 43 TEARS NATURALE FORTE ...... 91 TESTOPEL ...... 118 SYMAX FASTABS ...... 110 TEARS NATURALE FREE (PF) ...... 91 testosterone ...... 118 SYMAX-SL ...... 110 TEARS NATURALE II ...... 91 testosterone cypionate ...... 118 SYMBICORT ...... 18 TEARS PURE ...... 91 testosterone enanthate ...... 118 SYMBYAX ...... 144 TECFIDERA ...... 69 TESTRED ...... 118 SYMLINPEN 120 ...... 38 TECHNIVIE ...... 48 tetanus toxoid,adsorbed (pf) ...... 56 SYMLINPEN 60 ...... 38 TEFLARO ...... 26 tetanus,diphtheria tox ped(pf) ...... 56 SYNAGIS ...... 48 TEGADERM ...... 132 tetanus-diphtheria toxoids-td ...... 56 SYNALAR ...... 156 TEGADERM ABSORBENT ...... 132 tetrabenazine ...... 69 SYNALAR CREAM KIT ...... 156 TEGADERM FIRST AID STYLE ...... 132 tetracaine hcl ...... 91 SYNALAR OINTMENT KIT ...... 156 TEGADERM FRAME STYLE ...... 132 tetracaine hcl (pf) ...... 14, 91 SYNALAR TS ...... 156 TEGADERM HP FRAME STYLE ...... 132 tetracycline ...... 26 SYNALGOS-DC ...... 11 TEGADERM HYDROGEL ...... 132 tetrahydrozoline ...... 91 SYNAREL ...... 118 TEGADERM I.V...... 132 TEVETEN ...... 65 SYNERA ...... 14 TEGADERM TRANSPARENT TEVETEN HCT ...... 65 SYNERCID ...... 26 DRESSING ...... 132 TEXACORT ...... 156 SYNJARDY ...... 38 TEGRETOL ...... 69 THALITONE ...... 86 SYNRIBO ...... 43 TEGRETOL XR ...... 69 THALOMID ...... 26 SYNTHROID ...... 158 TEKAMLO ...... 65 THAM ...... 98 SYPRINE ...... 166 TEKTURNA ...... 65 THEO-24 ...... 18 SYRPALTA VEHICLE ...... 166 TEKTURNA HCT ...... 65 theophylline ...... 18 201
I n d e x I n d e x I n d e x theophylline in dextrose 5 % ...... 18 TIVICAY ...... 48 TRANSPORE SURGICAL ...... 133 THERACRAN HP FOR KIDS ...... 113 TIVORBEX ...... 16 TRANXENE T-TAB ...... 144 THERAFLU COLD-SORE THROAT tizanidine ...... 135 tranylcypromine ...... 144 (PE) ...... 82 TL FOLATE ...... 137 TRAVASOL 10 % ...... 98 THERAFLU FLU-SORE THROAT ...... 82 TL GARD RX ...... 170 TRAVATAN Z ...... 91 THERAFLU MAX-D SEVERE TL G-FOL OS ...... 98 TRAVEL SICKNESS ...... 110 COLD-FLU ...... 82 TL ICON ...... 98 TRAVEL SICKNESS (MECLIZINE) THERAFLU MULTI-SYMPTOM COLD TL-CARE DHA ...... 137 ...... 110 ...... 82 TL-FLUORIVITE ...... 170 travoprost (benzalkonium) ...... 91 THERAFLU NIGHT SEVERE TL-FOL 500 ...... 98 trazodone ...... 144 COLD-CGH ...... 82 TL-HEM 150 ...... 98 TREANDA ...... 44 THERAFLU SINUS & COLD ...... 82 TL-SELECT ...... 137 TRECATOR ...... 27 THERAFLU WARMING RELIEF ...... 82 TL-SELECT DHA ...... 137 TRELSTAR ...... 44 THERA-GEL ...... 156 TNKASE ...... 58 TRELSTAR DEPOT ...... 44 THERA-GESIC ...... 156 TOBI ...... 26 TRELSTAR LA ...... 44 THERA-GESIC PLUS ...... 156 TOBI PODHALER ...... 26 tretinoin ...... 156 THERAPEUTIC MINERAL ICE ...... 156 TOBRADEX ...... 26 tretinoin (chemotherapy) ...... 44 THERASEAL ...... 156 TOBRADEX ST ...... 26 tretinoin microspheres ...... 156 THERMACARE KNEE/ELBOW ...... 132 tobramycin ...... 26 TRETTEN ...... 58 THERMACARE LARGE/XLGE tobramycin in 0.225 % nacl ...... 26 TREXALL ...... 44 BACK/HIP ...... 133 tobramycin in 0.9 % nacl ...... 26 TRIADVANCE ...... 138 THERMACARE MENSTRUAL ...... 133 tobramycin sulfate ...... 26 triamcinolone acetonide THERMACARE tobramycin-dexamethasone ...... 26 ...... 91, 118, 156, 167 NECK/WRIST/SHOULDER ...... 133 TOBREX ...... 26 TRIAMINIC ...... 82 THERMACARE SMALL/MED TOE AID DRESSING ...... 133 TRIAMINIC CHEST &NASAL BACK/HIP ...... 133 TOFRANIL ...... 144 CONGEST ...... 82 thiamine hcl ...... 170 TOFRANIL-PM ...... 144 TRIAMINIC COLD & COUGH (PE) ... 82 THICK NOW ...... 167 TOLAK ...... 44 TRIAMINIC COLD & COUGH NT (PE) THICKEN UP CLEAR ...... 167 tolazamide ...... 38 ...... 33 THICKENUP LEMON HONEY ...... 167 tolbutamide ...... 38 TRIAMINIC COLD- ALLERGY PE ..... 33 THICKENUP LEMON NECTAR ...... 167 tolcapone ...... 45 TRIAMINIC COUGH ...... 82 THICK-IT ...... 167 tolmetin ...... 16 TRIAMINIC COUGH-SORE THROAT THICK-IT #2 ...... 167 tolnaftate ...... 32 ...... 82 THINPRO INSULIN SYRINGE ...... 133 tolterodine ...... 167 triamterene-hydrochlorothiazid ...... 86 THIOLA ...... 167 tolu balsam ...... 167 TRIANEX ...... 156 thioridazine ...... 144 TOOTHETTE ...... 133 triazolam ...... 145 thiotepa ...... 44 toothpaste ...... 133 TRI-BUFFERED ASPIRIN ...... 11 thiothixene ...... 144 TOPAMAX ...... 69 TRICARE ...... 138 THONG LINER ...... 133 TOPCARE CLICKFINE ...... 133 TRICARE PRENATAL COMPLEAT THRESHOLD IMT TRAINER ...... 133 TOPCARE ULTRA COMFORT ...... 133 ...... 138 THRESHOLD PEP DEVICE ...... 133 TOPICORT ...... 156 TRICARE PRENATAL DHA ONE .... 138 THRIVITE RX ...... 170 topiramate ...... 69 TRICITRATES ...... 98 THROMBATE III ...... 58 TOPOSAR ...... 44 TRICON ...... 98 THROMBIN-JMI ...... 58 topotecan ...... 44 TRICOR ...... 65 THYMOGLOBULIN ...... 56 TOPROL XL ...... 65 TRIESENCE (PF) ...... 91 THYROGEN ...... 158 TORISEL ...... 44 TRI-ESTARYLLA ...... 73 THYROLAR-1 ...... 158 torsemide ...... 86 trifluoperazine ...... 144 THYROLAR-1/2 ...... 158 TOTAL BODY CLEANSE ...... 113 trifluridine ...... 48 THYROLAR-1/4 ...... 158 TOUJEO SOLOSTAR ...... 38 TRIGELS-F FORTE ...... 98 THYROLAR-2 ...... 158 TOVIAZ ...... 167 TRIGLIDE ...... 65 THYROLAR-3 ...... 158 TOZAL ...... 167 trihexyphenidyl ...... 45 TIAZAC ...... 60 TPN ELECTROLYTES ...... 98 TRI-LEGEST FE ...... 73 ticlopidine ...... 46 TRACE ELEMENTS 4/PEDIATRIC .... 98 TRILEPTAL ...... 69 TIGAN ...... 110 TRACLEER ...... 65 TRI-LINYAH ...... 73 TIKOSYN ...... 60 TRADJENTA ...... 38 TRILIPIX ...... 65 TILIA FE ...... 73 tragacanth ...... 167 TRI-LUMA ...... 156 timolol maleate ...... 65, 91 tramadol ...... 11 TRILYTE WITH FLAVOR PACKETS TIMOPTIC ...... 91 tramadol-acetaminophen ...... 11 ...... 110 TIMOPTIC OCUDOSE (PF) ...... 91 TRANDATE ...... 65 trimethobenzamide ...... 110 TIMOPTIC-XE ...... 91 trandolapril ...... 65 trimethoprim ...... 27 TINDAMAX ...... 39 trandolapril-verapamil ...... 65 trimipramine ...... 144 tinidazole ...... 39 tranexamic acid ...... 58 TRINATAL GT ...... 138 tioconazole ...... 32 TRANSDERM-SCOP ...... 110 TRINATAL RX 1 ...... 138 TIOCONAZOLE-1 ...... 32 transparent dressings ...... 133 TRINATAL ULTRA ...... 138 TIROSINT ...... 158 TRANSPARENT THIN FILM TRINESSA (28) ...... 73 TISSEEL VHSD ...... 58 DRESSING ...... 133 TRI-NORINYL (28) ...... 73 202
I n d e x I n d e x I n d e x TRIOSTAT ...... 158 TWINRIX (PF) ...... 56 ULTRESA ...... 110 TRIOXIN ...... 27 TWYNSTA ...... 65 UMECTA ...... 156 TRIPEDIA (PF) ...... 56 TYBOST ...... 167 UMECTA NAIL FILM PEN ...... 156 TRIPHROCAPS ...... 170 TYGACIL ...... 27 UMECTA PD ...... 156 TRIPLE ANTIBIOTIC ...... 27 TYKERB ...... 44 UNASYN ...... 27 TRIPLE ANTIBIOTIC (PRAM) EXTRA TYLENOL PM EXTRA STRENGTH ..... 3 UNIFINE PENTIPS ...... 133 ...... 27 TYLENOL-CODEINE #3 ...... 11 UNIFINE PENTIPS PLUS ...... 133 TRIPLE ANTIBIOTIC PLUS ...... 27 TYLENOL-CODEINE #4 ...... 11 UNISOL 4 ...... 133 TRIPLE HELIX COLLAGEN ...... 133 TYPHIM VI ...... 56 UNI-SOLVE ADHESIVE REMOVER TRIPLE VITAMIN WITH FLUORIDE TYSABRI ...... 167 ...... 133 ...... 170 TYVASO ...... 65 UNISOLVE ADHESIVE REMOVER TRI-PREVIFEM (28) ...... 73 TYVASO INSTITUTIONAL START WIPE ...... 133 TRISENOX ...... 44 KIT ...... 65 UNISTIK 2 EXTRA ...... 133 TRI-SPRINTEC (28) ...... 73 TYVASO REFILL KIT ...... 65 UNISTIK 2 NORMAL TRISTART DHA ...... 138 TYVASO STARTER KIT ...... 65 LANCET&DEVICE ...... 133 TRIUMEQ ...... 48 TYZEKA ...... 49 UNITHROID ...... 158 TRIVEEN-DUO DHA ...... 138 TYZINE ...... 91 UNITUXIN ...... 44 TRIVEEN-PRX RNF ...... 138 UCERIS ...... 118 UNIVASC ...... 65 TRI-VIT WITH FLUORIDE & IRON U-CORT ...... 156 UNIVERSAL REMOVER WIPES ...... 133 ...... 170 UDAMIN SP ...... 170 UNNA-FLEX ELASTIC UNNA BOOT TRI-VITAMIN WITH FLUORIDE ..... 170 ULESFIA ...... 156 ...... 133 TRIVORA (28) ...... 74 ULORIC ...... 16 UR N-C ...... 27 TRIXAICIN ...... 156 ULTANE ...... 14 URAMAXIN ...... 157 TRIXAICIN HP ...... 156 ULTICARE ...... 133 URAMAXIN GT ...... 156 TRIZIVIR ...... 48 ULTILET ALCOHOL SWAB ...... 156 URAMIT MB ...... 27 TROKENDI XR ...... 69 ULTILET INSULIN SYRINGE ...... 133 urea ...... 157 trolamine salicylate ...... 156 ULTILET PEN NEEDLE ...... 133 URECHOLINE ...... 51 TROPHAMINE 10 % ...... 98 ULTIMATE OB DHA ...... 138 URELLE ...... 27 TROPHAMINE 6% ...... 98 ULTIMATECARE ONE ...... 138 URIMAR-T ...... 27 TROPICAL LIQUID NUTRITION ..... 170 ULTIMATECARE ONE NF ...... 138 URIN DS ...... 27 tropicamide ...... 91 ULTIVA ...... 11 URINARY PAIN RELIEF ...... 14 trospium ...... 167 ULTRA CMFT INS SYR HALF UNIT URINARY TRACT INF.TEST (WBCS) TRUEPLUS INSULIN ...... 133 ...... 133 ...... 85 TRULICITY ...... 38 ULTRA COMFORT INSULIN UROCIT-K 10 ...... 98 TRUMENBA ...... 56 SYRINGE ...... 133 UROCIT-K 15 ...... 98 TRUSOPT ...... 91 ULTRA LUBRICANT EYE ...... 91 UROCIT-K 5 ...... 98 TRUVADA ...... 48 ULTRA STRENGTH ANTACID ...... 110 UROGESIC-BLUE ...... 27 TUBERSOL ...... 56 ULTRABAG/DIANEAL PD-2/1.5% URO-L ...... 27 TUDORZA PRESSAIR ...... 18 DEX ...... 98 UROLET MB ...... 27 TUMERSAID ...... 114 ULTRABAG/DIANEAL PD-2/2.5% UROPHEN MB ...... 27 TUMS ...... 110 DEX ...... 98 UROXATRAL ...... 167 TUMS E-X ...... 110 ULTRABAG/DIANEAL URSO 250 ...... 110 TUMS EXTRA STRENGTH PD-2/4.25%DEX ...... 98 URSO FORTE ...... 110 SMOOTHIES ...... 110 ULTRABAG/DIANEAL/2.5% ursodiol ...... 110 TUMS FRESHERS ...... 110 DEXTROSE ...... 98 UTIRA-C ...... 27 TUMS ULTRA ...... 110 ULTRACET ...... 11 VAGIFEM ...... 118 turmeric root extract ...... 114 ULTRACIN T ...... 156 VAGISTAT-1 ...... 32 TUSNEL C ...... 82 ULTRACOMFORT ...... 133 VAGISTAT-3 ...... 32 TUSNEL NEW FORMULA ...... 82 ULTRACOMFORT W/ CONTAINER valacyclovir ...... 49 TUSNEL PEDIATRIC ...... 82 ...... 133 VALCHLOR ...... 44 TUSNEL-DM PEDIATRIC ...... 82 ULTRAFOAM ...... 58 VALCYTE ...... 49 TUSSICAPS ...... 82 ULTRA-FRESH ...... 156 valerian root ...... 114 TUSSIGON ...... 82 ULTRAM ...... 11 valganciclovir ...... 49 TUSSIN ...... 82 ULTRAM ER ...... 11 valproate sodium ...... 69 TUSSIN CF ...... 82 ULTRA-THIN II (SHORT) INS SYR valproic acid ...... 69 TUSSIN CF COUGH-COLD ...... 82 ...... 133 valproic acid (as sodium salt) ...... 69 TUSSIN CF MAX ...... 82 ULTRA-THIN II (SHORT) PEN NDL valsartan ...... 65 TUSSIN CHEST CONGESTION ...... 82 ...... 133 valsartan-hydrochlorothiazide ...... 65 TUSSIN COUGH (DM ONLY) ...... 82 ULTRA-THIN II INS PEN NEEDLES VALSTAR ...... 44 TUSSIN DM ...... 82, 83 ...... 133 VALTREX ...... 49 TUSSIN DM CLEAR ...... 82 ULTRA-THIN II INSULIN SYRINGE VALU-DRYL ALLERGY ...... 36 TUSSIN DM COUGH & CHEST ...... 82 ...... 133 VANACOF ...... 83 TUSSIN DM MAX ...... 82 ULTRAVATE ...... 156 VANACOF DM ...... 83 TUSSIN EXPECTORANT ...... 83 ULTRAVATE PAC ...... 156 VANACOF-8 ...... 83 TUSSIONEX PENNKINETIC ER ...... 83 ULTRAVATE X ...... 156 VANAHIST PD ...... 36 tutti-frutti flavor (bulk) ...... 167 ULTRAVIST ...... 85 VANATOL LQ ...... 11 203
I n d e x I n d e x I n d e x VANCOCIN ...... 27 VIASORB ABSORBENT DRESSING VIROPTIC ...... 49 vancomycin ...... 27 ...... 134 VIRT NATE ...... 138 vancomycin in 0.9% sodium cl ...... 27 VIBATIV ...... 27 VIRT-ADVANCE ...... 138 vancomycin in d5w ...... 27 VIBRAMYCIN ...... 27 VIRT-BAL DHA PLUS ...... 138 vancomycin in dextrose iso-osm ...... 27 VICKS CHILDREN'S NYQUIL VIRT-C DHA ...... 138 VANDAZOLE ...... 27 COLD&C ...... 83 VIRT-CAPS ...... 170 vandetanib ...... 44 VICKS DAYQUIL COLD&FLU VIRT-CARE ONE ...... 138 VANILLA BUTTERNUT FLAVOR RELIEF ...... 83 VIRTI-SULF ...... 27 ...... 167 VICKS DAYQUIL COUGH ...... 83 VIRT-NATE ...... 138 vanilla butternut flavor(bulk) ...... 167 VICKS DAYQUIL MUCUS CONTROL VIRT-PHOS 250 NEUTRAL ...... 98 vanillin (bulk) ...... 167 DM ...... 83 VIRT-PN ...... 138 VANISHPOINT SYRINGE ...... 133 VICKS DAYQUIL SEVERE COLD-FLU VIRT-PN DHA ...... 138 VANOS ...... 157 ...... 83 VIRT-PN PLUS ...... 138 VANTAS ...... 44 VICKS NYQUIL COLD/FLU (CPM) VIRTPREX ...... 138 VAPORX BALM ...... 157 ...... 83 VIRTRATE-2 ...... 98 VAPRISOL ...... 86 VICKS NYQUIL COLD/FLU VIRTRATE-3 ...... 98 VAQTA (PF) ...... 56 LIQUICAP ...... 83 VIRTRATE-K ...... 98 VARIVAX (PF) ...... 56 VICKS NYQUIL COUGH ...... 83 VIRT-SELECT ...... 138 VARIZIG ...... 56 VICKS NYQUIL NIGHTTIME RELIEF VIRTUSSIN AC ...... 83 VARNAL ...... 134 ...... 83 VIRTUSSIN DAC ...... 83 VARUBI ...... 110 VICKS NYQUIL SEVERE COLD-FLU VIRT-VITE ...... 170 VASCEPA ...... 110 ...... 83 VIRT-VITE FORTE ...... 170 VASCUDERM HYDROGEL WOUND VICKS QLEARQUIL ALLERGY ...... 36 VIRT-VITE GT ...... 138 ...... 134 VICKS QLEARQUIL DAYTIME SINUS VIRT-VITE PLUS ...... 170 VASCULERA ...... 170 ...... 83 VISCOPASTE PB7 ...... 134 VASELINE ...... 167 VICKS QLEARQUIL NIGHTIME VISICOL ...... 110 VASELINE PETROLATUM GAUZE SINUS ...... 83 VISINE FOR CONTACTS ...... 134 ...... 134 VICKS QLEARQUIL NIGHTTIME RLF VISIPAQUE ...... 85 VASERETIC ...... 65 ...... 36 VISTARIL ...... 36 vasopressin ...... 118 VICKS VISTEC X-RAY DETECT ...... 134 VASOSTRICT ...... 118 QLEARQUIL(OXYMETAZOLINE) .... 91 VISTIDE ...... 49 VASOTEC ...... 65 VICKS SINEX 12-HOUR ...... 91 VISUDYNE ...... 167 VECAMYL ...... 65 VICKS VAPODROPS ...... 83 VIT 3 ...... 170 VECTIBIX ...... 44 VICKS VAPORUB ...... 157 VITAFOL ...... 99 VECTICAL ...... 157 VICKS VAPOSTEAM ...... 83 VITAFOL NANO ...... 138 vecuronium bromide ...... 51 VICODIN ...... 11 VITAFOL ULTRA ...... 138 VELCADE ...... 44 VICODIN ES ...... 11 VITAFOL-OB ...... 138 VELETRI ...... 65 VICODIN HP ...... 11 VITAFOL-OB+DHA ...... 138 VELIVET TRIPHASIC REGIMEN (28) VICOPROFEN ...... 11 VITAFOL-ONE ...... 138 ...... 74 VICTOZA 2-PAK ...... 38 VITAFOL-PLUS ...... 138 VELPHORO ...... 98 VICTOZA 3-PAK ...... 38 VITAL-D RX ...... 170 VELTIN ...... 157 VICTRELIS ...... 49 vitamin a and d ...... 157 VEMAVITE-PRX-2 ...... 138 VIDAZA ...... 44 VITAMIN B-12 ...... 170 VENA-BAL DHA ...... 138 VIDEX 2 GRAM PEDIATRIC ...... 49 VITAMIN D2 ...... 170 venlafaxine ...... 144 VIDEX 4 GRAM PEDIATRIC ...... 49 VITAMIN D3 ...... 170 VENOFER ...... 98 VIDEX EC ...... 49 vitamin e (dl, acetate) ...... 170 VENTAVIS ...... 65 VIEKIRA PAK ...... 49 VITAMIN K ...... 170 VENTOLIN HFA ...... 18 VIGAMOX ...... 27 VITAMIN K1 ...... 170 VERAMYST ...... 91 VIGILON PRIMARY WOUND VITAMINS A,C,D & FLUORIDE ...... 170 verapamil ...... 60 DRESSING ...... 134 VITEKTA ...... 49 VEREGEN ...... 49 VIIBRYD ...... 144 VITRASE ...... 157 VERELAN ...... 60 VILACTIN AA PLUS 20 PE ...... 98 vits a and d-white pet-lanolin ...... 157 VERELAN PM ...... 60 VIMIZIM ...... 167 VITUZ ...... 83 VERIPRED 20 ...... 118 VIMPAT ...... 69 VIVA CT ...... 138 VERSA FREE ...... 167 VINATE GT ...... 138 VIVAGLOBIN ...... 56 VERSA PLUS ...... 167 vinblastine ...... 44 VIVELLE-DOT ...... 118 VERSACLOZ ...... 144 VINCASAR PFS ...... 44 VIVITROL ...... 167 VERSALON ...... 134 vincristine ...... 44 VIVOTIF BERNA VACCINE ...... 56 VERSALON NONWOVEN vinorelbine ...... 44 V-NATAL ...... 138 ALL-PURPOSE ...... 134 VIOKACE ...... 110 VOGELXO ...... 118 VERSIVA XC ...... 134 VIORELE (28) ...... 74 VOL-CARE RX ...... 170 VESICARE ...... 167 VIRACEPT ...... 49 VOL-NATE ...... 138 VEXOL ...... 91 VIRAMUNE ...... 49 VOL-PLUS ...... 138 VFEND ...... 32 VIRAMUNE XR ...... 49 VOLTAREN ...... 91, 157 VFEND IV ...... 32 VIRAZOLE ...... 49 VOLTAREN-XR ...... 16 VIREAD ...... 49 VOLUVEN 6 % ...... 58 204
I n d e x I n d e x I n d e x voriconazole ...... 32 WIDE-SEAL DIAPHRAGM 80 ...... 74 YF-VAX (PF) ...... 56 VORTEX ADULT MASK ...... 134 WIDE-SEAL DIAPHRAGM 85 ...... 74 YOHIMBE ...... 114 VORTEX FROG MASK-CHILD ...... 134 WIDE-SEAL DIAPHRAGM 90 ...... 74 yohimbe bark ...... 114 VORTEX HOLDING CHAMBER ...... 134 WIDE-SEAL DIAPHRAGM 95 ...... 74 ZADITOR ...... 36 VORTEX HOLDING CHAMBER WILATE ...... 58 zafirlukast ...... 18 CHILD ...... 134 wild cherry flavor (bulk) ...... 167 zaleplon ...... 145 VORTEX HOLDING CHAMBER WINDMILL TRAINER ...... 134 ZALTRAP ...... 44 TODDLER ...... 134 WINRHO SDF ...... 56 ZAMICET ...... 11 VORTEX LADYBUG WINTERGREEN FLAVORING ...... 167 ZANAFLEX ...... 135 MASK-TODDLER ...... 134 WITCH HAZEL ...... 157 ZANOSAR ...... 44 VORTEX VHC FROG MASK-CHILD witch hazel leaf (hamamelis) ...... 157 ZANTAC ...... 111 ...... 134 WITEPSOL H-15 ...... 167 ZANTAC 75 ...... 110 VORTEX VHC LADYBUG WOMEN'S GENTLE ZANTAC MAXIMUM STRENGTH MASK-TODDLR ...... 134 LAXATIVE(BISAC) ...... 110 ...... 111 VOSOL ...... 91 WOMEN'S LAXATIVE (BISACODYL) ZARAH ...... 74 VOSOL-HC ...... 91 ...... 110 ZARONTIN ...... 69 VOSPIRE ER ...... 18 WOMEN'S MULTIVITAMIN ZAROSEN DESENSITIZER ...... 134 VOTRIENT ...... 44 GUMMIES ...... 170 ZAROXOLYN ...... 86 VP CH ULTRA ...... 138 WOUND & SKIN CLEANSER ...... 157 ZARXIO ...... 69 VP-CH PLUS ...... 138 WOUND CLEANSER ...... 157 ZATEAN-CH ...... 139 VP-CH-PNV ...... 138 WOUND GEL ...... 157 ZATEAN-PN ...... 139 VP-GGR-B6 ...... 138 WOUNDGARD GAUZE ...... 134 ZATEAN-PN DHA ...... 139 VP-GSTN ...... 99 WOUN'DRES HYDROGEL WOUND ZATEAN-PN PLUS ...... 139 VP-HEME OB ...... 138 DRESS ...... 134 ZAVARA ...... 170 VP-HEME ONE ...... 138 WYMZYA FE ...... 74 ZAVESCA ...... 167 VP-PNV-DHA ...... 139 XALATAN ...... 91 ZEASORB (MICONAZOLE) ...... 32 VP-PRECIP ...... 114 XALKORI ...... 44 ZEBETA ...... 66 VPRIV ...... 167 XANAX ...... 144 ZEBUTAL ...... 11 VP-VITE RX ...... 170 XANAX XR ...... 144 ZECUITY ...... 11 VP-ZEL ...... 167 XARELTO ...... 29 ZEGERID ...... 111 VUSION ...... 32 XARTEMIS XR ...... 11 ZELAPAR ...... 45 VYFEMLA (28) ...... 74 XELJANZ ...... 16 ZELBORAF ...... 44 VYTORIN 10-20 ...... 65 XELODA ...... 44 ZEMAIRA ...... 168 VYTORIN 10-40 ...... 65 XENAZINE ...... 69 ZEMPLAR ...... 168 VYTORIN 10-80 ...... 66 XEOMIN ...... 51 ZEMURON ...... 51 VYVANSE ...... 144 XERAC AC ...... 157 ZENATANE ...... 157 WAL-ITIN ...... 36 XERESE ...... 49 ZENCHENT (28) ...... 74 WAL-MUCIL FIBER (ASPARTAME) XGEVA ...... 167 ZENCHENT FE ...... 74 ...... 110 XIAFLEX ...... 167 ZENPEP ...... 111 WAL-MUCIL FIBER (SUGAR) ...... 110 XIFAXAN ...... 27 ZENZEDI ...... 51 WAL-ZAN 75 ...... 110 XIGDUO XR ...... 39 ZEOSA ...... 74 warfarin ...... 29 XODOL 10/300 ...... 11 ZERBAXA ...... 27 WATCHHALER ...... 134 XODOL 5/300 ...... 11 ZERIT ...... 49 water for inject, bacteriostat ...... 167 XODOL 7.5/300 ...... 11 ZESTORETIC ...... 66 water for injection, sterile ...... 167 XOFIGO ...... 167 ZESTRIL ...... 66 water for irrigation, sterile ...... 157 XOLAIR ...... 18 ZETIA ...... 66 WATER SHIELD BANDAGES ...... 134 XOPENEX ...... 18 ZETONNA ...... 91 WATERMELON FLAVORING ...... 167 XOPENEX CONCENTRATE ...... 18 ZEVALIN (Y-90) ...... 44 WATERPROOF STRONG STRIPS .... 134 XOPENEX HFA ...... 18 ZFLEX ...... 3 WEBCOL ...... 157 XTANDI ...... 44 ZIAC ...... 66 WEBRIL ...... 134 XULANE ...... 74 ZIAGEN ...... 49 WEBRIL II ...... 134 XYLOCAINE ...... 14 ZIANA ...... 157 WEE CARE ...... 99 XYLOCAINE (CARDIAC) (PF) ...... 60 zidovudine ...... 49 WELCHOL ...... 66 XYLOCAINE JELLY ...... 14 ZIKS ARTHRITIS PAIN RELIEF ...... 157 WELLBUTRIN ...... 144 XYLOCAINE-EPINEPHRINE ...... 14 ZINACEF ...... 27 WELLBUTRIN SR ...... 144 XYLOCAINE-MPF ...... 14 ZINACEF IN STERILE WATER ...... 27 WELLBUTRIN XL ...... 144 XYLOCAINE-MPF/EPINEPHRINE ..... 14 zinc chloride ...... 99 WERA (28) ...... 74 XYLON 10 ...... 11 zinc oxide ...... 157 WESTCORT ...... 157 XYNTHA ...... 58 zinc stearate ...... 168 WHEY PROTEIN CONCENTRATE .... 99 XYNTHA SOLOFUSE ...... 58 zinc sulfate ...... 99 WHITE WAX (BEESWAX) ...... 167 XYREM ...... 145 ZINECARD (AS HCL) ...... 168 WHOLE BODY JOINT SUPPORT ..... 114 XYZAL ...... 36 ZINGIBER ...... 139 WIDE-SEAL DIAPHRAGM 60 ...... 74 YASMIN (28) ...... 74 ZINGO ...... 14 WIDE-SEAL DIAPHRAGM 65 ...... 74 YAZ (28) ...... 74 ZIOPTAN (PF) ...... 91 WIDE-SEAL DIAPHRAGM 70 ...... 74 YELLOW WAX (BEESWAX) ...... 167 ziprasidone hcl ...... 144 WIDE-SEAL DIAPHRAGM 75 ...... 74 YERVOY ...... 44 ZIPSOR ...... 11 205
I n d e x
ZIRGAN ...... 49 ZITHROMAX ...... 27 ZITHROMAX TRI-PAK ...... 27 ZITHROMAX Z-PAK ...... 27 ZMAX ...... 27 ZOCOR ...... 66 ZOFRAN (AS HYDROCHLORIDE) ...... 111 ZOFRAN ODT ...... 111 ZOHYDRO ER ...... 11 ZOLADEX ...... 44 zoledronic acid ...... 168 zoledronic acid-mannitol-water ...... 168 ZOLINZA ...... 44 ZOLOFT ...... 144 zolpidem ...... 145 ZOLPIMIST ...... 145 ZOMACTON ...... 118 ZOMETA ...... 168 ZOMIG ...... 12 ZOMIG ZMT ...... 12 ZONALON ...... 157 ZONATUSS ...... 83 ZONEGRAN ...... 69 zonisamide ...... 69 ZONTIVITY ...... 46 ZORBTIVE ...... 118 ZORTRESS ...... 119 ZORVOLEX ...... 16 ZOSTAVAX (PF) ...... 56 ZOSYN ...... 28 ZOSYN IN DEXTROSE (ISO-OSM) ... 28 ZOVIA 1/35E (28) ...... 74 ZOVIA 1/50E (28) ...... 74 ZOVIRAX ...... 49 Z-SLEEP ...... 145 Z-TUSS AC ...... 83 Z-TUSS E ...... 83 ZUBSOLV ...... 168 ZUPLENZ ...... 111 ZUTRIPRO ...... 83 ZYBAN ...... 158 ZYCLARA ...... 157 ZYDELIG ...... 45 ZYFLO ...... 18 ZYFLO CR ...... 18 ZYKADIA ...... 45 ZYLET ...... 28 ZYLOPRIM ...... 16 ZYMAXID ...... 28 ZYPRAM ...... 111 ZYPREXA ...... 144 ZYPREXA RELPREVV ...... 144 ZYPREXA ZYDIS ...... 144 ZYTIGA ...... 45 ZYVOX ...... 28 ZZZQUIL ...... 145
206