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VIRGINIA PREMIER HEALTH PLAN

MEDICAID FORMULARY

PLEASE NOTE: Check your benefit materials for the specific drugs covered and the copayments for your program. For specific questions about your coverage, please call the phone number printed on your ID card. The list may not be all- inclusive. THIS LIST IS SUBJECT TO CHANGE.

For the member: Generic medications contain the same active ingredients as their corresponding brand-name medications, although they may look different in color or shape. They have been FDA-approved under strict standards. For the physician: Please prescribe preferred products and allow generic substitutions when medically appropriate. Thank you.

CURRENT AS OF 3/1/2019

Requirements/Limits AGE = Age limit requirement Custom = Drug has unique restrictions OTC = Over the Counter PA = Prior Authorization required QL = Quantity Level Limit lowercase italics = Generic Formulary SP = Specialty Drug. Preferred Specialty drugs Pharmacy will be listed if applicable UPPERCASE = Brand name Formulary Formulary Status ST = Step Therapy may apply to some or all drugs Formulary = Covered strengths of the drug Drug Name Formulary Status Requirements/Limits 1st relief spray external 4-1 % Formulary OTC 1st tier unifine pentips 29g x 12mm , 31g x 5 mm , 31g x 6 Formulary OTC; QL (200 EA per 30 days) mm , 31g x 8 mm , 32g x 4 mm 1st tier unilet comfortouch Formulary OTC; QL (150 EA per 30 days) 2-deoxy-d-glucose Formulary 50+ adult eye health oral Formulary OTC 7-keto dhea powder Formulary A & D ZINC OXIDE EXTERNAL Formulary OTC a thru z advanced oral Formulary OTC a thru z advantage oral tablet Formulary OTC a thru z select oral tablet chewable Formulary OTC A+D CRACKED SKIN RELIEF EXTERNAL CREAM 2- Formulary OTC 0.13 % a1c test at-home in vitro kit Formulary OTC a-25 oral capsule 25000 unit Formulary OTC abacavir sulfate oral 20 mg/ml Formulary abacavir sulfate oral tablet 300 mg Formulary abacavir sulfate-lamivudine oral tablet 600-300 mg Formulary abacavir-lamivudine-zidovudine oral tablet 300-150-300 Formulary mg ABANATUSS PED ORAL LIQUID 15-0.5-6.25 MG/ML, Formulary OTC 60-2-25 MG/5ML ABATRACE ORAL CAPSULE Formulary OTC ABATREX ORAL TABLET 8-200-4-100-600 MG Formulary OTC ABATRON AF ORAL TABLET 150-1 MG Formulary OTC ABATRON ORAL LIQUID Formulary OTC ABATUSS DMX ORAL LIQUID 30-1-15 MG/5ML Formulary OTC ABILIFY MAINTENA INTRAMUSCULAR PREFILLED Formulary AGE (Min 18 Years) 300 MG, 400 MG ABILIFY MAINTENA INTRAMUSCULAR Formulary AGE (Min 18 Years) RECONSTITUTED ER 300 MG, 400 MG abiraterone acetate oral tablet 250 mg Formulary ABRAXANE INTRAVENOUS SUSPENSION Formulary RECONSTITUTED 100 MG ABREVA EXTERNAL CREAM 10 % Formulary OTC acacia powder Formulary

1 Drug Name Formulary Status Requirements/Limits acamprosate calcium oral tablet delayed release 333 mg Formulary acarbose oral tablet 100 mg, 25 mg, 50 mg Formulary ACCU-CHEK FASTCLIX LANCET KIT Formulary OTC ACCU-CHEK SOFT TOUCH LANCETS Formulary OTC; QL (150 EA per 30 days) ACCU-CHEK SOFTCLIX LANCETS Formulary OTC; QL (150 EA per 30 days) ACCUTREND CHOLESTEROL CONTROL IN VITRO Formulary OTC SOLUTION ACCUTREND CHOLESTEROL IN VITRO STRIP Formulary OTC ACCUTREND PLUS DEVICE Formulary OTC ACE AEROSOL CLOUD ENHANCER Formulary QL (2 EA per 365 days) ACE KNEE BRACE W/STABILIZERS Formulary OTC acebutolol hcl oral capsule 200 mg, 400 mg Formulary ACEROLA C 500 ORAL WAFER 500 MG Formulary OTC acesulfame potassium powder Formulary ACETA-GESIC ORAL TABLET 12.5-325 MG Formulary OTC acetaminophen oral liquid 160 mg/5ml Formulary OTC acetaminophen oral solution 160 mg/5ml Formulary OTC acetaminophen oral tablet 325 mg Formulary OTC acetaminophen powder Formulary acetaminophen-codeine #2 oral tablet 300-15 mg Formulary PA; QL (280 EA per 7 days) acetaminophen-codeine #3 oral tablet 300-30 mg Formulary PA; QL (140 EA per 7 days) acetaminophen-codeine #4 oral tablet 300-60 mg Formulary PA; QL (70 EA per 7 days) acetaminophen-codeine oral solution 120-12 mg/5ml Formulary PA; QL (1750 ML per 7 days) ACETASOL HC OTIC SOLUTION 2-1 % Formulary acetazolamide crystals Formulary OTC acetazolamide er oral capsule extended release 12 hour 500 Formulary mg acetazolamide oral tablet 250 mg Formulary acetic acid glacial solution 99 % Formulary acetic acid irrigation solution 0.25 % Formulary acetic acid otic solution 2 % Formulary acetic acid solution 3 % Formulary OTC solution Formulary acetylcysteine solution 10 %, 20 % Formulary acetyl-l-carnitine hcl powder Formulary ACID GONE ORAL SUSPENSION 95-358 MG/15ML Formulary OTC acid reducer maximum strength oral tablet 20 mg Formulary OTC acidophilus oral capsule Formulary OTC acidophilus probiotic oral tablet 10 mg Formulary OTC acidophilus/bifidus oral tablet chewable Formulary OTC acidophilus/citrus pectin oral tablet Formulary OTC acidophilus/pectin oral capsule Formulary OTC acitretin oral capsule 10 mg, 17.5 mg, 25 mg Formulary PA; QL (68 EA per 34 days) acne medication 10 external 10 % Formulary OTC; AGE (Max 18 Years)

2 Drug Name Formulary Status Requirements/Limits acne medication 10 external 10 % Formulary OTC; AGE (Max 18 Years) acne medication 5 external gel 5 % Formulary AGE (Max 18 Years) acne medication 5 external lotion 5 % Formulary OTC; AGE (Max 18 Years) ACNEFREE ACNE CLEARING SYSTEM EXTERNAL Formulary OTC KIT 2.5 & 3.7 % ACNEFREE SEVERE CLEARING SYST EXTERNAL Formulary OTC KIT 2.5 & 10 % ACT TOTAL CARE MOUTH/THROAT SOLUTION 0.05 Formulary OTC % ACTHIB INTRAMUSCULAR SOLUTION Formulary AGE (Min 19 Years) RECONSTITUTED ACTICARNITINE SF ORAL SOLUTION 1 GM/10ML Formulary OTC ACTICON ORAL SOLUTION 1-30 MG/5ML Formulary OTC ACTICON ORAL TABLET 2-60 MG Formulary OTC actidom dmx oral liquid 10-30-200 mg/5ml Formulary OTC actidose/sorbitol oral liquid 50 gm/240ml Formulary OTC actidose-aqua oral liquid 15 gm/72ml Formulary OTC ACTIFLOVIT EAR HEALTH ORAL TABLET Formulary OTC ACTIFOAM COLLAGEN SPONGE EXTERNAL Formulary acti-lance lite lancets 28g Formulary OTC; QL (150 EA per 30 days) acti-lance special lancets 17g Formulary OTC; QL (150 EA per 30 days) acti-lance universal 23g Formulary OTC; QL (150 EA per 30 days) ACTIMMUNE SUBCUTANEOUS SOLUTION 2000000 Formulary UNIT/0.5ML ACTINEL ORAL LIQUID 30-15-200 MG/5ML Formulary OTC ACTISEP MOUTH/THROAT SOLUTION 2-0.5-0.1 % Formulary OTC ACTITROM ORAL CAPSULE Formulary OTC ACTIVE Q MAXIMUM STRENGTH ORAL CAPSULE Formulary OTC 300 MG ACTIVE Q ORAL 100 MG/5ML Formulary OTC ACTIVE-Q EXTRA STRENGTH ORAL CAPSULE 200 Formulary OTC MG ACTIVE-Q ORAL CAPSULE 200-30 MG Formulary OTC ACTIVITE EC ORAL TABLET 1 MG Formulary OTC ACTIVON ARTHRITIS ULTRA ST EXTERNAL STICK Formulary OTC 0.028-4.574 % acyclovir external ointment 5 % Formulary acyclovir oral capsule 200 mg Formulary acyclovir oral suspension 200 mg/5ml Formulary acyclovir oral tablet 400 mg, 800 mg Formulary ADACEL INTRAMUSCULAR SUSPENSION 5-2-15.5 Formulary LF-MCG/0.5 ADAGEN INTRAMUSCULAR SOLUTION 250 Formulary PA UNIT/ML adapalene external cream 0.1 % Formulary AGE (Max 18 Years) adapalene external gel 0.1 %, 0.3 % Formulary AGE (Max 18 Years)

3 Drug Name Formulary Status Requirements/Limits ADCIRCA ORAL TABLET 20 MG Formulary PA ADDERALL XR ORAL CAPSULE EXTENDED ST; QL (30 EA per 30 days); AGE (Min 4 Formulary RELEASE 24 HOUR 10 MG, 15 MG, 5 MG Years and Max 17 Years) ADDERALL XR ORAL CAPSULE EXTENDED ST; QL (60 EA per 30 days); AGE (Min 4 Formulary RELEASE 24 HOUR 20 MG, 25 MG, 30 MG Years and Max 17 Years) adefovir dipivoxil oral tablet 10 mg Formulary adenosylcobalamin powder Formulary OTC adhesive bandages sheer Formulary OTC adjustable lancing device Formulary OTC; QL (1 EA per 365 days) ADRENAL C FORMULA ORAL TABLET Formulary ADRENALIN SOLUTION 1 MG/ML, 30 Formulary MG/30ML ADRUCIL INTRAVENOUS SOLUTION 2.5 GM/50ML, 5 Formulary GM/100ML, 500 MG/10ML adult gummy oral tablet chewable Formulary OTC adult mask device Formulary QL (2 EA per 365 days) adult wash cloths with aloe external 3 % Formulary OTC adult-lock weekly pill remind Formulary OTC ADVAIR DISKUS INHALATION AEROSOL POWDER Formulary AGE (Min 4 Years) BREATH ACTIVATED 100-50 MCG/DOSE ADVAIR DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 250-50 MCG/DOSE, 500-50 Formulary AGE (Min 12 Years) MCG/DOSE advanced acne wash external liquid extended release 4.4 % Formulary OTC ADVANCED CALCIUM/D/MAGNESIUM ORAL Formulary OTC TABLET advanced hand sanitizer external liquid 70 % Formulary OTC ADVIL ALLERGY & CONGESTION ORAL TABLET 4- Formulary OTC 10-200 MG ADVIL ALLERGY SINUS ORAL TABLET 2-30-200 MG Formulary OTC ADVIL COLD & SINUS LIQUI- ORAL CAPSULE Formulary OTC 30-200 MG ADVIL COLD/SINUS ORAL TABLET 30-200 MG Formulary OTC ADVIL ORAL CAPSULE 200 MG Formulary OTC ADVIL ORAL TABLET 200 MG Formulary OTC ADVIL PM ORAL CAPSULE 200-25 MG Formulary OTC ADVIL PM ORAL TABLET 200-38 MG Formulary OTC ADVIL SINUS CONGESTION & PAIN ORAL TABLET Formulary OTC 10-200 MG ADVOCATE INSULIN SYRINGE 29G X 1/2" 0.5 ML Formulary OTC 29G X 1/2" 0.5 ML ADVOCATE INSULIN SYRINGE 30G X 5/16" 0.3 ML Formulary OTC 30G X 5/16" 0.3 ML ADVOCATE INSULIN SYRINGE 30G X 5/16" 1 ML 30G Formulary OTC X 5/16" 1 ML ADVOCATE INSULIN SYRINGE 31G X 5/16" 1 ML 31G Formulary OTC X 5/16" 1 ML AEROCHAMBER PLUS FLO-VU Formulary QL (2 EA per 365 days) 4 Drug Name Formulary Status Requirements/Limits AEROCHAMBER PLUS FLO-VU LARGE Formulary QL (2 EA per 365 days) AEROCHAMBER PLUS FLO-VU SMALL Formulary QL (2 EA per 365 days) AEROCHAMBER PLUS FLO-VU W/MASK Formulary QL (2 EA per 365 days) AFEDITAB CR ORAL TABLET EXTENDED RELEASE Formulary 24 HOUR 30 MG, 60 MG AFLURIA INTRAMUSCULAR SUSPENSION Formulary AGE (Min 19 Years) AFLURIA PRESERVATIVE FREE INTRAMUSCULAR Formulary AGE (Min 19 Years) SUSPENSION PREFILLED SYRINGE 0.5 ML AFREZZA INHALATION POWDER 12 UNIT, 8 UNIT Formulary AFRIN CHILDRENS NASAL SOLUTION 0.25 % Formulary OTC AFRIN MENTHOL SPRAY NASAL SOLUTION 0.05 % Formulary OTC AFTERA ORAL TABLET 1.5 MG Formulary OTC; QL (2 EA per 34 days) AGAMATRIX ULTRA-THIN LANCETS Formulary OTC; QL (150 EA per 30 days) AHIST ORAL TABLET 25 MG Formulary OTC aimsco lubricated Formulary OTC AIRAVITE ORAL TABLET 2.5-25-1 MG Formulary AIRBORNE ORAL LOZENGE Formulary OTC AIRS DISPOSABLE Formulary OTC; QL (2 EA per 365 days) AIRS DISPOSABLE NEBULIZER KIT Formulary QL (2 EA per 365 days) AIRZONE PEAK FLOW METER DEVICE Formulary OTC; QL (2 EA per 365 days) ak-poly-bac ophthalmic ointment 500-10000 unit/gm Formulary AL12 EXTERNAL LOTION 12 % Formulary OTC ALA SEB EXTERNAL 2-2 % Formulary OTC ALA SEB T EXTERNAL SHAMPOO 1-2-2 % Formulary OTC ALAHIST DM ORAL LIQUID 7.5-2-15 MG/5ML Formulary OTC ALA-HIST IR ORAL TABLET 2 MG Formulary OTC ALA-HIST PE ORAL TABLET 2-10 MG Formulary OTC alanine 1000 oral packet 1000 mg Formulary OTC alba-lybe nr oral liquid 325-10-50 mg/5ml Formulary OTC albendazole oral tablet 200 mg Formulary ALBOLENE EXTERNAL CREAM Formulary OTC; QL (454 GM per 34 days) ALBUKED 25 INTRAVENOUS SOLUTION 25 % Formulary ALBUKED 5 INTRAVENOUS SOLUTION 5 % Formulary albuterol sulfate er oral tablet extended release 12 hour 4 Formulary mg, 8 mg albuterol sulfate inhalation nebulization solution (2.5 mg/3ml) 0.083%, (5 mg/ml) 0.5%, 0.63 mg/3ml, 1.25 Formulary mg/3ml albuterol sulfate oral syrup 2 mg/5ml Formulary albuterol sulfate oral tablet 2 mg, 4 mg Formulary alclometasone dipropionate external cream 0.05 % Formulary alclometasone dipropionate external ointment 0.05 % Formulary alcohol (rubbing) solution 70 % Formulary OTC alcohol anhydrous liquid Formulary OTC alcohol prep pad 70 % Formulary OTC

5 Drug Name Formulary Status Requirements/Limits alcohol prep pad 70 % 70 % Formulary OTC alcohol swabs pad Formulary OTC alcohol swabs pad 70 % 70 % Formulary OTC alcohol wipes pad 70 % 70 % Formulary OTC alcohol, usp solution 95 % Formulary alendronate sodium oral tablet 10 mg, 35 mg, 40 mg, 5 mg, Formulary 70 mg aler-cap oral capsule 25 mg Formulary OTC aler-dryl oral tablet 50 mg Formulary OTC alertness aid oral tablet 200 mg Formulary OTC alevazol external ointment 1 % Formulary OTC ALEVE ORAL CAPSULE 220 MG Formulary OTC ALEVE ORAL TABLET 220 MG Formulary OTC ALFERON N INJECTION SOLUTION 5000000 Formulary PA UNIT/ML alfuzosin hcl er oral tablet extended release 24 hour 10 mg Formulary alga oral capsule 0.225-2000 mg-unit Formulary OTC ALGAL-900 DHA ORAL CAPSULE 300 MG Formulary OTC ALIMTA INTRAVENOUS SOLUTION Formulary RECONSTITUTED 100 MG, 500 MG ALIVE MULTI-VITAMIN CHILDRENS ORAL TABLET Formulary OTC CHEWABLE 60 MG ALIVIO EXTERNAL PATCH 0.03-5 % Formulary OTC alka-aid oral tablet 180-360 mg Formulary OTC ALKA-SELTZER HEARTBURN + GAS ORAL TABLET Formulary OTC CHEWABLE 750-80 MG ALKA-SELTZER ORAL TABLET EFFERVESCENT Formulary OTC 325-1000-1916 MG all day allergy childrens oral solution 5 mg/5ml Formulary OTC all day pain relief oral tablet 220 mg Formulary OTC allantoin powder Formulary ALL-DRY SIZE 3 Formulary OTC ALLEGRA ALLERGY CHILDRENS ORAL Formulary OTC SUSPENSION 30 MG/5ML ALLEGRA ALLERGY CHILDRENS ORAL TABLET Formulary OTC DISPERSIBLE 30 MG ALLEGRA ALLERGY ORAL TABLET 180 MG, 60 MG Formulary OTC ALLEGRA-D ALLERGY & CONGESTION ORAL Formulary OTC TABLET EXTENDED RELEASE 12 HOUR 60-120 MG ALLEGRA-D ALLERGY & CONGESTION ORAL Formulary OTC TABLET EXTENDED RELEASE 24 HOUR 180-240 MG aller-ease oral tablet 60 mg Formulary OTC; QL (68 EA per 34 days) allergy childrens oral liquid 12.5 mg/5ml Formulary OTC allergy eye ophthalmic solution 0.025-0.3 % Formulary OTC allergy multi-symptom day/nght oral Formulary OTC allergy spray 24 hour aerosol 55 mcg/act nasal 55 mcg/act Formulary OTC

6 Drug Name Formulary Status Requirements/Limits ALLEVYN PLUS CAVITY PAD 6"X8" Formulary OTC ALLI ORAL CAPSULE 60 MG Formulary OTC allopurinol oral tablet 100 mg, 300 mg Formulary ALMACONE ORAL TABLET CHEWABLE 200-200-25 Formulary OTC MG almond oil bitter flavor liquid Formulary ALOCANE PLUS EXTERNAL GEL 4-0.13 % Formulary OTC ALOE GRANDE EXTERNAL CREAM 100000-1500 Formulary OTC UNIT/GM ALOE GRANDE EXTERNAL LOTION 10000-1500 Formulary OTC UNIT/30ML aloe vera external cream 72 % Formulary OTC aloe vera external gel 99.5 % Formulary OTC aloe vera freeze dried powder Formulary aloe vera moisturizing external gel 99.5 % Formulary OTC ALOE VESTA 2-N-1 PROTECTIVE EXTERNAL Formulary OTC OINTMENT ALOE VESTA CLEAR EXTERNAL Formulary OTC OINTMENT 2 % ALOE VESTA MULTI PURPOSE EXTERNAL FOAM Formulary OTC ALOE VESTA PROTECTIVE EXTERNAL OINTMENT Formulary OTC ALOE VESTA SKIN PROTECTANT EXTERNAL Formulary OTC AEROSOL 36 % aloe/lidocaine pain reliever external gel 0.5 % Formulary OTC alosetron hcl oral tablet 0.5 mg, 1 mg Formulary PA alp high3 oral capsule delayed release 600 mg Formulary OTC ALPAWASH EXTERNAL OINTMENT Formulary ALPHAGAN P OPHTHALMIC SOLUTION 0.1 %, 0.15 Formulary % alpha- oral capsule 100 mg Formulary OTC alpha-lipoic acid oral tablet 200 mg Formulary OTC alpha-lipoic acid powder Formulary ALPHANATE/VWF COMPLEX/HUMAN INTRAVENOUS SOLUTION RECONSTITUTED 1000 Formulary UNIT, 1500 UNIT, 250 UNIT, 500 UNIT ALPHANINE SD INTRAVENOUS SOLUTION Formulary RECONSTITUTED 1000 UNIT, 500 UNIT alph-e oral capsule 400 unit Formulary OTC alph-e-mixed 1000 oral capsule 1000 unit Formulary OTC alph-e-mixed oral capsule 200 unit Formulary OTC alprazolam er oral tablet extended release 24 hour 0.5 mg, Formulary QL (170 EA per 30 days) 1 mg, 2 mg alprazolam er oral tablet extended release 24 hour 3 mg Formulary QL (170 EA per 34 days) ALPRAZOLAM INTENSOL ORAL CONCENTRATE 1 Formulary QL (170 ML per 34 days) MG/ML alprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg Formulary QL (170 EA per 34 days)

7 Drug Name Formulary Status Requirements/Limits alprazolam oral tablet dispersible 0.25 mg, 0.5 mg, 1 mg, 2 Formulary QL (170 EA per 34 days) mg ALTACAINE OPHTHALMIC SOLUTION 0.5 % Formulary ALTAFLUOR OPHTHALMIC SOLUTION 0.25-0.4 % Formulary ALTAVERA ORAL TABLET 0.15-30 MG-MCG Formulary QL (28 EA per 28 days) alum ammonium powder Formulary OTC aluminum acetate external solution Formulary OTC aluminum bottle seal Formulary OTC aluminum chloride hexahydrate crystals Formulary aluminum chloride hexahydrate powder Formulary aluminum chlorohydrate powder Formulary aluminum hydroxide dried gel powder Formulary aluminum hydroxide gel oral suspension 320 mg/5ml Formulary OTC ALVESCO INHALATION AEROSOL SOLUTION 160 Formulary MCG/ACT, 80 MCG/ACT ALWAYS MAXI MAXIMUM PROTECTION PAD Formulary OTC alyacen 1/35 oral tablet 1-35 mg-mcg Formulary QL (28 EA per 28 days) alyacen 7/7/7 oral tablet 0.5/0.75/1-35 mg-mcg Formulary QL (28 EA per 28 days) amantadine hcl oral capsule 100 mg Formulary amantadine hcl oral syrup 50 mg/5ml Formulary amantadine hcl oral tablet 100 mg Formulary ambi 12.5cpd/100gfn/30pse oral liquid 30-12.5-100 mg/5ml Formulary OTC ambi 12.5cpd/1dcpm/30pse oral liquid 30-1-12.5 mg/5ml Formulary OTC ambi 40pse/400gfn oral tablet 40-400 mg Formulary OTC ambi 60pse/400gfn oral tablet 60-400 mg Formulary OTC ambi 60pse/4cpm oral tablet 60-4 mg Formulary OTC AMBI FADE EXTERNAL CREAM 2 % Formulary OTC amcinonide external cream 0.1 % Formulary AMERICERIN EXTERNAL CREAM Formulary OTC AMERIWASH EXTERNAL LOTION Formulary OTC AMETHIA LO ORAL TABLET 0.1-0.02 & 0.01 MG Formulary QL (91 EA per 91 days) AMETHIA ORAL TABLET 0.15-0.03 &0.01 MG Formulary QL (91 EA per 91 days) AMETHYST ORAL TABLET 90-20 MCG Formulary QL (28 EA per 28 days) AMICAR ORAL SOLUTION 0.25 GM/ML Formulary amiloride hcl oral tablet 5 mg Formulary amiloride-hydrochlorothiazide oral tablet 5-50 mg Formulary aminoacetic acid irrigation solution 1.5 % Formulary AMINOPMRMS ORAL CAPSULE Formulary AMINORELIEF RMS ORAL CAPSULE Formulary aminosalicylic acid-5 powder Formulary hcl oral tablet 100 mg, 200 mg, 400 mg Formulary AMITIZA ORAL CAPSULE 24 MCG, 8 MCG Formulary PA; AGE (Min 18 Years) amitriptyline hcl oral tablet 10 mg, 100 mg, 150 mg, 25 mg, Formulary 50 mg, 75 mg

8 Drug Name Formulary Status Requirements/Limits besy-benazepril hcl oral capsule 10-20 mg, 10- Formulary 40 mg, 2.5-10 mg, 5-10 mg, 5-20 mg, 5-40 mg amlodipine besylate oral tablet 10 mg, 2.5 mg, 5 mg Formulary amlodipine besylate-valsartan oral tablet 10-160 mg, 10- Formulary 320 mg, 5-160 mg, 5-320 mg amlodipine-atorvastatin oral tablet 10-10 mg, 10-20 mg, Formulary 10-40 mg, 5-10 mg, 5-20 mg, 5-40 mg amlodipine-valsartan-hctz oral tablet 10-160-12.5 mg, 10- Formulary ST 160-25 mg, 10-320-25 mg, 5-160-12.5 mg, 5-160-25 mg ammonia aromatic inhalation Formulary OTC ammonia aromatic inhalation spirit Formulary OTC ammonium carbonate powder Formulary OTC ammonium chloride granules Formulary ammonium hydroxide solution Formulary ammonium lactate external cream 12 % Formulary amoxicillin oral capsule 250 mg, 500 mg Formulary amoxicillin oral suspension reconstituted 125 mg/5ml, 200 Formulary mg/5ml, 250 mg/5ml, 400 mg/5ml amoxicillin oral tablet 500 mg, 875 mg Formulary amoxicillin oral tablet chewable 125 mg, 250 mg Formulary amoxicillin-pot clavulanate oral suspension reconstituted 200-28.5 mg/5ml, 250-62.5 mg/5ml, 400-57 mg/5ml, 600- Formulary 42.9 mg/5ml amoxicillin-pot clavulanate oral tablet 250-125 mg, 500- Formulary 125 mg, 875-125 mg amoxicillin-pot clavulanate oral tablet chewable 200-28.5 Formulary mg, 400-57 mg amphetamine-dextroamphetamine oral tablet 10 mg, 12.5 Formulary AGE (Min 4 Years and Max 17 Years) mg, 15 mg, 20 mg, 30 mg, 5 mg, 7.5 mg ampicillin oral capsule 500 mg Formulary ANA-LEX RECTAL KIT 2-2 % Formulary ANASEPT ANTIMICROBIAL EXTERNAL GEL 0.057 % Formulary OTC ANASEPT EXTERNAL LIQUID 0.057 % Formulary oral tablet 1 mg Formulary ANBESOL MAXIMUM STRENGTH MOUTH/THROAT Formulary OTC LIQUID 20 % ANBESOL MOUTH/THROAT GEL 10 % Formulary OTC ANBESOL MOUTH/THROAT LIQUID 10 % Formulary OTC ANDROGEL PUMP GEL 20.25 Formulary PA MG/ACT (1.62%) ANDROGEL TRANSDERMAL GEL 20.25 MG/1.25GM (1.62%), 25 MG/2.5GM (1%), 40.5 MG/2.5GM (1.62%), Formulary PA 50 MG/5GM (1%) ANECREAM EXTERNAL CREAM 4 % Formulary OTC animal chews oral tablet chewable Formulary OTC anise oil Formulary OTC ANORO ELLIPTA INHALATION AEROSOL POWDER Formulary AGE (Min 18 Years) BREATH ACTIVATED 62.5-25 MCG/INH 9 Drug Name Formulary Status Requirements/Limits antacid anti-gas max strength oral suspension 400-400-40 Formulary OTC mg/5ml antacid anti-gas oral suspension 200-200-20 mg/5ml Formulary OTC antacid extra strength oral tablet chewable 675-135 mg Formulary OTC antacid multi-symptom oral tablet chewable 675-135-60 mg Formulary OTC antacid oral tablet chewable 500 mg Formulary OTC antacid soft chews oral tablet chewable 1177 mg Formulary OTC ANTARA ORAL CAPSULE 30 MG, 90 MG Formulary anthelios 50 mineral external liquid Formulary OTC anti-allergy oral tablet 100-100-50 mg Formulary OTC antibacterial liquid soap external liquid 0.15 % Formulary OTC anti-diarrheal oral liquid 1 mg/5ml Formulary OTC anti-diarrheal oral tablet 2 mg Formulary OTC antifungal external aerosol 1 % Formulary OTC antifungal external cream 2 % Formulary OTC anti-itch external cream 1-0.1 % Formulary OTC anti-itch external lotion 0.5-0.5 % Formulary OTC ANTI-ITCH INTENSIVE HEALING EXTERNAL Formulary OTC LOTION 1 % antioxidant formula sg oral capsule extended release Formulary OTC anti-oxidant oral tablet Formulary OTC antiseptic external aerosol 4.5-0.05-40.5 % Formulary OTC ANTISEPTIC HAND RINSE EXTERNAL GEL 62 % Formulary OTC antiseptic skin cleanser external solution 4 % Formulary OTC ANUSOL-HC RECTAL CREAM 2.5 % Formulary AO-SEPT CONTACT LENS HOLDER Formulary OTC APETIGEN ORAL Formulary OTC APETIGEN-PLUS ORAL SOLUTION Formulary OTC APETIGEN-PLUS ORAL TABLET Formulary OTC ap-hist dm oral liquid 7.5-4-15 mg/5ml Formulary OTC APLIGRAF EXTERNAL DISK Formulary apothesar external cream Formulary apraclonidine hcl ophthalmic solution 0.5 % Formulary aprepitant oral capsule 125 mg, 40 mg, 80 & 125 mg Formulary QL (1 EA per 34 days) aprepitant oral capsule 80 mg Formulary QL (2 EA per 34 days) APRI ORAL TABLET 0.15-30 MG-MCG Formulary QL (28 EA per 28 days) APRISO ORAL CAPSULE EXTENDED RELEASE 24 Formulary HOUR 0.375 GM APTIVUS ORAL CAPSULE 250 MG Formulary APTIVUS ORAL SOLUTION 100 MG/ML Formulary AQUA CARE EXTERNAL LOTION 10 % Formulary OTC aquabase external ointment Formulary OTC AQUADEKS ORAL LIQUID Formulary OTC AQUAFRESH DR SEUSS EXTRA SOFT Formulary OTC

10 Drug Name Formulary Status Requirements/Limits aquanaz oral tablet 10-15-400 mg Formulary OTC AQUAPHILIC EXTERNAL OINTMENT Formulary OTC AQUAPHILIC/CARBAMIDE EXTERNAL OINTMENT Formulary OTC 10 %, 20 % AQUASONIC 100 EXTERNAL GEL Formulary OTC AQUEOUS SELENIUM ORAL LIQUID 95 MCG/DROP Formulary OTC aqueous vitamin e oral solution 15 unit/0.3ml Formulary OTC AQUORAL MOUTH/THROAT SOLUTION Formulary ARANELLE ORAL TABLET 0.5/1/0.5-35 MG-MCG Formulary QL (28 EA per 28 days) ARANESP (ALBUMIN FREE) SOLUTION 100 MCG/ML Formulary INJECTION 100 MCG/ML ARANESP (ALBUMIN FREE) SOLUTION 200 MCG/ML Formulary INJECTION 200 MCG/ML ARANESP (ALBUMIN FREE) SOLUTION 25 MCG/ML Formulary INJECTION 25 MCG/ML ARANESP (ALBUMIN FREE) SOLUTION 300 MCG/ML Formulary INJECTION 300 MCG/ML ARANESP (ALBUMIN FREE) SOLUTION 40 MCG/ML Formulary INJECTION 40 MCG/ML ARANESP (ALBUMIN FREE) SOLUTION 60 MCG/ML Formulary INJECTION 60 MCG/ML ARANESP (ALBUMIN FREE) SOLUTION PREFILLED Formulary SYRINGE 10 MCG/0.4ML INJECTION 10 MCG/0.4ML ARANESP (ALBUMIN FREE) SOLUTION PREFILLED SYRINGE 100 MCG/0.5ML INJECTION 100 Formulary MCG/0.5ML ARANESP (ALBUMIN FREE) SOLUTION PREFILLED SYRINGE 150 MCG/0.3ML INJECTION 150 Formulary MCG/0.3ML ARANESP (ALBUMIN FREE) SOLUTION PREFILLED SYRINGE 200 MCG/0.4ML INJECTION 200 Formulary MCG/0.4ML ARANESP (ALBUMIN FREE) SOLUTION PREFILLED SYRINGE 25 MCG/0.42ML INJECTION 25 Formulary MCG/0.42ML ARANESP (ALBUMIN FREE) SOLUTION PREFILLED SYRINGE 300 MCG/0.6ML INJECTION 300 Formulary MCG/0.6ML ARANESP (ALBUMIN FREE) SOLUTION PREFILLED Formulary SYRINGE 40 MCG/0.4ML INJECTION 40 MCG/0.4ML ARANESP (ALBUMIN FREE) SOLUTION PREFILLED Formulary SYRINGE 500 MCG/ML INJECTION 500 MCG/ML ARANESP (ALBUMIN FREE) SOLUTION PREFILLED Formulary SYRINGE 60 MCG/0.3ML INJECTION 60 MCG/0.3ML ARCALYST SUBCUTANEOUS SOLUTION Formulary PA RECONSTITUTED 220 MG ARCAPTA NEOHALER INHALATION CAPSULE 75 Formulary MCG arctic relief pain relieving external gel 0.2-3.5 % Formulary OTC ARGIMENT AT ORAL PACKET Formulary OTC

11 Drug Name Formulary Status Requirements/Limits arginine oral packet 500 mg Formulary OTC arginine2000 oral packet 2000 mg Formulary OTC ARGYLE STERILE SALINE IRRIGATION SOLUTION Formulary 0.9 % ARGYLE STERILE WATER IRRIGATION SOLUTION Formulary aripiprazole oral tablet 10 mg, 15 mg, 2 mg, 20 mg, 30 mg, Formulary AGE (Min 18 Years) 5 mg ARISTADA INITIO INTRAMUSCULAR PREFILLED Formulary AGE (Min 18 Years) SYRINGE 675 MG/2.4ML ARISTADA INTRAMUSCULAR PREFILLED SYRINGE 1064 MG/3.9ML, 441 MG/1.6ML, 662 MG/2.4ML, 882 Formulary AGE (Min 18 Years) MG/3.2ML arkaliox oral capsule 200 mg Formulary OTC ARLASILK PHOSPHOLIPID PLN LIQUID Formulary OTC ARMOUR THYROID ORAL TABLET 120 MG, 15 MG, Formulary 180 MG, 240 MG, 30 MG, 300 MG, 60 MG, 90 MG arnica external 20 % Formulary OTC arnicare arthritis oral tablet dispersible Formulary OTC ARRANON INTRAVENOUS SOLUTION 5 MG/ML Formulary arthritis pain relieving external cream 0.075 % Formulary OTC artificial tears ophthalmic solution 1-0.3 %, 1.4 % Formulary OTC ARZERRA INTRAVENOUS CONCENTRATE 100 Formulary MG/5ML, 1000 MG/50ML ARZOL SILVER NIT APPLICATORS EXTERNAL 75-25 Formulary % asafetida tincture Formulary OTC ascocid-iso-ph oral powder effervescent Formulary OTC ASCOMP-CODEINE ORAL CAPSULE 50-325-40-30 MG Formulary PA ascorbic acid granules Formulary ascorbic acid oral granules Formulary OTC ascorbic acid oral tablet 1000 mg, 500 mg Formulary OTC ascorbic acid oral tablet chewable 250 mg Formulary OTC ascorbic acid powder Formulary ascorbyl palmitate powder Formulary ASCRIPTIN ORAL TABLET 325 MG Formulary OTC asepto oral thermometer kit Formulary OTC ASILNASAL RMS ORAL CAPSULE Formulary ASMANEX 120 METERED DOSES INHALATION AEROSOL POWDER BREATH ACTIVATED 220 Formulary MCG/INH ASMANEX 30 METERED DOSES INHALATION AEROSOL POWDER BREATH ACTIVATED 110 Formulary MCG/INH aspartame powder Formulary aspartate mg & k oral capsule 90-90 mg Formulary OTC ASPERCREME W/LIDOCAINE EXTERNAL CREAM 4 Formulary OTC %

12 Drug Name Formulary Status Requirements/Limits aspir-81 oral tablet delayed release 81 mg Formulary OTC aspirin oral tablet 325 mg Formulary OTC aspirin oral tablet chewable 81 mg Formulary OTC aspirin oral tablet delayed release 325 mg Formulary OTC aspirin powder Formulary aspirin rectal 300 mg, 600 mg Formulary OTC aspirin-dipyridamole er oral capsule extended release 12 Formulary hour 25-200 mg aspirtab maximum strength oral tablet 500 mg Formulary OTC ASSURE ID INSULIN SAFETY SYR 29G X 1/2" 0.5 ML Formulary (OTC) 29G X 1/2" 0.5 ML ASSURE ID INSULIN SAFETY SYR 29G X 1/2" 1 ML Formulary 29G X 1/2" 1 ML ASSURE LANCETS Formulary OTC; QL (150 EA per 30 days) ASTHMAPACK FOR CHILDREN KIT Formulary OTC; QL (2 EA per 365 days) atazanavir sulfate oral capsule 150 mg, 200 mg, 300 mg Formulary oral tablet 100 mg, 25 mg, 50 mg Formulary atenolol-chlorthalidone oral tablet 100-25 mg, 50-25 mg Formulary athletes foot maximum strength external ointment Formulary OTC atomoxetine hcl oral capsule 10 mg Formulary AGE (Min 4 Years and Max 17 Years) atomoxetine hcl oral capsule 100 mg, 18 mg, 25 mg, 40 mg, QL (30 EA per 30 days); AGE (Min 4 Formulary 60 mg, 80 mg Years and Max 17 Years) ATOPICLAIR EXTERNAL CREAM Formulary atorvastatin calcium oral tablet 10 mg, 20 mg, 40 mg, 80 Formulary mg atovaquone oral suspension 750 mg/5ml Formulary atovaquone-proguanil hcl oral tablet 250-100 mg, 62.5-25 Formulary mg ATRAC-TAIN EXTERNAL CREAM 10 % Formulary OTC ATRAC-TAIN EXTERNAL LOTION 5 % Formulary OTC ATRIPLA ORAL TABLET 600-200-300 MG Formulary ATROVENT HFA INHALATION AEROSOL Formulary SOLUTION 17 MCG/ACT atuss da oral liquid 30-2-12.5 mg/5ml Formulary OTC AUBRA ORAL TABLET 0.1-20 MG-MCG Formulary QL (28 EA per 28 days) auraphene-b otic solution 6.5 % Formulary OTC aurora lancet super thin 30g Formulary OTC; QL (150 EA per 30 days) aurora lancet thin 23g Formulary OTC; QL (150 EA per 30 days) AUTOJECT 2 Formulary OTC; QL (1 EA per 365 days) AUTOLET PLATFORMS Formulary OTC autopen device Formulary OTC; QL (1 EA per 365 days) avalin external patch 4-1 % Formulary OTC AVAR CLEANSER EXTERNAL 10-5 % Formulary AVAR-E EMOLLIENT EXTERNAL CREAM 10-5 % Formulary AVASTIN INTRAVENOUS SOLUTION 100 MG/4ML, Formulary PA 400 MG/16ML 13 Drug Name Formulary Status Requirements/Limits AVEENO BABY GENTLE CONDITION EXTERNAL Formulary OTC SHAMPOO AVEENO BABY SOOTHING WASH EXTERNAL Formulary OTC LIQUID AVEENO INTENSE RELIEF EXTERNAL CREAM 1.3 % Formulary OTC AVEENO POSITIVELY RADIANT WASH EXTERNAL Formulary OTC LIQUID AVENOVA/NEUTROX EXTERNAL SOLUTION 0.01 % Formulary AVERTEAX MOUTH/THROAT OINTMENT 1 % Formulary OTC AVITENE EXTERNAL PAD Formulary AVITENE FLOUR EXTERNAL POWDER Formulary AVO CREAM EXTERNAL EMULSION Formulary AVONEX INTRAMUSCULAR KIT 30 MCG Formulary AVONEX PEN INTRAMUSCULAR AUTO-INJECTOR Formulary KIT 30 MCG/0.5ML AVONEX PREFILLED INTRAMUSCULAR PREFILLED Formulary SYRINGE KIT 30 MCG/0.5ML av-phos 250 neutral oral tablet 155-852-130 mg Formulary axillary block needle 22g x 1" , 25g x 1" Formulary OTC AXSAIN EXTERNAL CREAM 0.25 % Formulary OTC AYR SALINE NASAL DROPS NASAL SOLUTION 0.65 Formulary OTC % AYR SALINE NASAL GEL NASAL SWAB Formulary OTC AYR SALINE NASAL NASAL GEL Formulary OTC AYR SALINE NASAL NO-DRIP NASAL GEL Formulary OTC AYR SALINE NASAL RINSE NASAL PACKET 1.57 Formulary OTC GM azacitidine injection suspension reconstituted 100 mg Formulary AZASAN ORAL TABLET 100 MG, 75 MG Formulary azathioprine oral tablet 50 mg Formulary azec oral capsule Formulary OTC azelaic acid flakes Formulary azelaic acid powder Formulary OTC hcl nasal solution 0.1 %, 0.15 % Formulary azithromycin oral packet 1 gm Formulary azithromycin oral suspension reconstituted 100 mg/5ml, Formulary 200 mg/5ml azithromycin oral tablet 250 mg, 500 mg, 600 mg Formulary AZOPT OPHTHALMIC SUSPENSION 1 % Formulary AZURETTE ORAL TABLET 0.15-0.02/0.01 MG (21/5) Formulary QL (28 EA per 28 days) b complete oral tablet Formulary OTC b complex formula 1 oral tablet Formulary OTC b complex oral capsule Formulary OTC b complex oral tablet Formulary OTC b complex-folic acid oral tablet 500-5-200 mcg-mg-mcg Formulary OTC b-1 oral tablet 100 mg, 250 mg Formulary OTC 14 Drug Name Formulary Status Requirements/Limits b-100 cr oral tablet extended release Formulary OTC b-12 oral tablet 2000 mcg, 250 mcg Formulary OTC b-12 sublingual tablet sublingual 1000 mcg, 2500 mcg, Formulary OTC 5000 mcg b-12 tr oral tablet extended release 2000 mcg Formulary OTC b-2 oral tablet 100 mg Formulary OTC B-2-400 ORAL CAPSULE 400 MG Formulary OTC b-6 oral tablet 250 mg, 50 mg, 500 mg Formulary OTC BABY ANBESOL MOUTH/THROAT GEL 7.5 % Formulary OTC baby lotion external lotion Formulary OTC baby super daily d3 oral liquid 400 ut/0.028ml Formulary OTC baby teething pain medicine mouth/throat gel 7.5 % Formulary OTC baby thermometer Formulary OTC baciim intramuscular solution reconstituted 50000 unit Formulary bacitracin ophthalmic ointment 500 unit/gm Formulary bacitracin zinc external ointment 500 unit/gm Formulary OTC bacitra-neomycin-polymyxin-hc ophthalmic ointment 1 % Formulary back pain-off oral tablet 250-50-290 mg Formulary OTC baclofen oral tablet 10 mg, 20 mg Formulary BACTROBAN NASAL NASAL OINTMENT 2 % Formulary balamine dm oral syrup 5-2-10 mg/5ml Formulary OTC balanced b-50 complex oral capsule Formulary OTC balanced b-50 oral tablet extended release Formulary OTC BAL-CARE DHA ORAL 27-1 & 430 MG Formulary BALNEOL EXTERNAL LOTION Formulary OTC balsalazide disodium oral capsule 750 mg Formulary BALZIVA ORAL TABLET 0.4-35 MG-MCG Formulary QL (28 EA per 28 days) BAND-AID SURGIPAD SURGICAL PAD 5"X9" Formulary OTC BANOPHEN ORAL CAPSULE 50 MG Formulary OTC BANZEL ORAL SUSPENSION 40 MG/ML Formulary PA BANZEL ORAL TABLET 200 MG, 400 MG Formulary PA BARACLUDE ORAL SOLUTION 0.05 MG/ML Formulary BASAGLAR KWIKPEN SUBCUTANEOUS SOLUTION Formulary QL (30 ML per 30 days) PEN-INJECTOR 100 UNIT/ML base g almond oil (sweet) oil Formulary basic fuchsin hcl powder Formulary BAYER BACK & BODY ORAL TABLET 500-32.5 MG Formulary OTC BAYER BREEZE 2 CONTROL LIQUID HIGH IN VITRO Formulary OTC; QL (100 EA per 30 days) HIGH BAYER BREEZE 2 CONTROL LIQUID LOW IN VITRO Formulary OTC; QL (100 EA per 30 days) LOW BAYER BREEZE 2 CONTROL LIQUID NORMAL IN Formulary OTC; QL (100 EA per 30 days) VITRO NORMAL BAYER BREEZE 2 SYSTEM KIT W/DEVICE Formulary OTC; QL (1 EA per 365 days) W/DEVICE

15 Drug Name Formulary Status Requirements/Limits BAYER BREEZE 2 TEST DISK IN VITRO Formulary OTC; QL (150 EA per 30 days) BAYER CONTOUR LINK MONITOR KIT W/DEVICE Formulary OTC; QL (1 EA per 365 days) W/DEVICE BAYER CONTOUR LIQUID HIGH IN VITRO HIGH Formulary OTC; QL (100 EA per 30 days) BAYER CONTOUR LIQUID LOW IN VITRO LOW Formulary OTC; QL (100 EA per 30 days) BAYER CONTOUR LIQUID NORMAL IN VITRO Formulary OTC; QL (100 EA per 30 days) NORMAL BAYER CONTOUR MONITOR DEVICE Formulary OTC; QL (1 EA per 365 days) BAYER CONTOUR MONITOR KIT W/DEVICE Formulary OTC; QL (1 EA per 365 days) W/DEVICE BAYER CONTOUR MONITOR KIT W/DEVICE Formulary OTC; QL (150 EA per 30 days) W/DEVICE BAYER CONTOUR TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) BAYER MICROLET LANCETS Formulary OTC; QL (150 EA per 30 days) BAYER WOMENS ORAL TABLET 81-777 MG Formulary OTC BAZA CLEANSE & PROTECT EXTERNAL LOTION 2 Formulary OTC % BC FAST PAIN RELIEF ARTHRITIS ORAL PACKET Formulary OTC 742-222-38 MG BC FAST PAIN RELIEF ORAL PACKET 650-195-33.3 Formulary OTC MG b-caro-t oral capsule 15 mg Formulary OTC b-complex high potency oral tablet extended release Formulary OTC BD ALLERGY SYRINGE 28G X 1/2" 1 ML Formulary OTC BD AUTOSHIELD 29G X 5MM , 29G X 8MM Formulary OTC BD AUTOSHIELD DUO 30G X 5 MM Formulary OTC BD BLUNT FILTER NEEDLE 18G X 1-1/2" Formulary OTC BD DISP NEEDLE 22G X 3/4" , 23G X 1-1/4" , 27G X 1- Formulary OTC 1/4" , 30G X 1" BD DISP NEEDLE TW 18G X 1" Formulary OTC BD DISP NEEDLES 16G X 1-1/2" , 19G X 1" , 20G X 1" , Formulary OTC 21G X 1-1/2" , 25G X 7/8" , 27G X 1/2" , 30G X 1/2" BD ECLIPSE NEEDLE 22G X 1-1/2" , 23G X 1" , 25G X Formulary OTC 1-1/2" , 25G X 5/8" BD ECLIPSE SYRINGE 25G X 5/8" 1 ML, 30G X 1/2" 1 Formulary OTC ML BD 23G X 1-1/2" , 26G X 5/8" Formulary OTC BD INSULIN SYR ULTRAFINE II 31G X 5/16" 0.3 ML Formulary OTC 31G X 5/16" 0.3 ML BD INSULIN SYR ULTRAFINE II 31G X 5/16" 0.5 ML Formulary OTC 31G X 5/16" 0.5 ML BD INSULIN SYR ULTRAFINE II 31G X 5/16" 1 ML Formulary OTC 31G X 5/16" 1 ML BD INSULIN SYRINGE 25G X 1" 1 ML 25G X 1" 1 ML Formulary OTC BD INSULIN SYRINGE 25G X 5/8" 1 ML 25G X 5/8" 1 Formulary OTC ML BD INSULIN SYRINGE 26G X 1/2" 1 ML 26G X 1/2" 1 Formulary OTC ML

16 Drug Name Formulary Status Requirements/Limits BD INSULIN SYRINGE 27.5G X 5/8" 2 ML 27.5G X 5/8" Formulary OTC 2 ML BD INSULIN SYRINGE 27G X 1/2" 1 ML 27G X 1/2" 1 Formulary OTC ML BD INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 Formulary OTC ML BD INSULIN SYRINGE HALF-UNIT 31G X 5/16" 0.3 Formulary OTC ML 31G X 5/16" 0.3 ML BD INSULIN SYRINGE MICROFINE 27G X 5/8" 1 ML Formulary OTC 27G X 5/8" 1 ML BD INSULIN SYRINGE MICROFINE 28G X 1/2" 0.5 ML Formulary OTC 28G X 1/2" 0.5 ML BD INSULIN SYRINGE MICROFINE 28G X 1/2" 1 ML Formulary OTC 28G X 1/2" 1 ML BD INSULIN SYRINGE U/F 1/2UNIT 31G X 5/16" 0.3 Formulary OTC ML 31G X 5/16" 0.3 ML BD INSULIN SYRINGE U/F 30G X 1/2" 0.3 ML 30G X Formulary OTC 1/2" 0.3 ML BD INSULIN SYRINGE U/F 30G X 1/2" 0.5 ML 30G X Formulary OTC 1/2" 0.5 ML BD INSULIN SYRINGE U/F 30G X 1/2" 1 ML 30G X Formulary OTC 1/2" 1 ML BD INSULIN SYRINGE U/F 31G X 5/16" 0.3 ML 31G X Formulary OTC 5/16" 0.3 ML BD INSULIN SYRINGE U/F 31G X 5/16" 0.5 ML 31G X Formulary OTC 5/16" 0.5 ML BD INSULIN SYRINGE U/F 31G X 5/16" 1 ML 31G X Formulary OTC 5/16" 1 ML BD INSULIN SYRINGE U-100 1 ML U-100 1 ML Formulary OTC BD INSULIN SYRINGE U-500 31G X 6MM 0.5 ML 31G Formulary X 6MM 0.5 ML BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 0.3 ML Formulary OTC 29G X 1/2" 0.3 ML BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 0.5 ML Formulary OTC 29G X 1/2" 0.5 ML BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 1 ML Formulary OTC 29G X 1/2" 1 ML BD INSULIN SYRINGE ULTRAFINE 30G X 1/2" 0.3 ML Formulary OTC 30G X 1/2" 0.3 ML BD INSULIN SYRINGE ULTRAFINE 30G X 1/2" 0.5 ML Formulary OTC 30G X 1/2" 0.5 ML BD INSULIN SYRINGE ULTRAFINE 31G X 5/16" 0.5 Formulary OTC ML 31G X 5/16" 0.5 ML BD LANCET ULTRAFINE 30G Formulary OTC; QL (150 EA per 30 days) BD LANCET ULTRAFINE 33G Formulary OTC; QL (150 EA per 30 days)

17 Drug Name Formulary Status Requirements/Limits BD LUER-LOK SYRINGE 18G X 1-1/2" 3 ML, 20G X 1" 1 ML, 20G X 1" 10 ML, 20G X 1" 3 ML, 20G X 1" 5 ML, 20G X 1-1/2" 10 ML, 20G X 1-1/2" 3 ML, 20G X 1-1/2" 5 ML, 21G X 1" 10 ML, 21G X 1" 3 ML, 21G X 1" 5 ML, Formulary OTC 21G X 1-1/2" 3 ML, 22G X 1" 10 ML, 22G X 1" 3 ML, 22G X 1" 5 ML, 22G X 1-1/2" 5 ML, 23G X 1" 3 ML, 23G X 1-1/2" 3 ML, 23G X 1-1/4" 10 ML, 25G X 1" 3 ML, 25G X 1-1/2" 3 ML, 25G X 5/8" 3 ML BD PEN NEEDLE ORIGINAL U/F 29G X 12.7MM Formulary OTC BD SAFETYGLIDE INSULIN SYRINGE 29G X 1/2" 0.3 Formulary OTC ML 29G X 1/2" 0.3 ML BD SAFETYGLIDE INSULIN SYRINGE 29G X 1/2" 0.5 Formulary OTC ML 29G X 1/2" 0.5 ML BD SAFETYGLIDE INSULIN SYRINGE 30G X 5/16" 0.5 Formulary OTC ML 30G X 5/16" 0.5 ML BD SAFETYGLIDE INSULIN SYRINGE 31G X 15/64" Formulary 0.3 ML 31G X 15/64" 0.3 ML BD SAFETYGLIDE INSULIN SYRINGE 31G X 5/16" 0.3 Formulary OTC ML 31G X 5/16" 0.3 ML BD SAFETYGLIDE NEEDLE 27G X 5/8" Formulary OTC BD SAFETYGLIDE SYRINGE/NEEDLE 27G X 5/8" 1 Formulary OTC ML BD SAFETY-LOK INSULIN SYRINGE 29G X 1/2" 1 ML Formulary OTC 29G X 1/2" 1 ML BD SHARPS COLLECTOR Formulary OTC BD SWAB SINGLE USE REGULAR PAD Formulary OTC BD SWABS SINGLE USE BUTTERFLY PAD Formulary OTC BD SYRINGE/NEEDLE SLIP TIP 26G X 5/8" 1 ML Formulary OTC BD TB SYRINGE 21G X 1" 1 ML, 27G X 1/2" 0.5 ML Formulary OTC BD VEO INSULIN SYRINGE U/F 31G X 15/64" 0.3 ML Formulary OTC 31G X 15/64" 0.3 ML BD VEO INSULIN SYRINGE U/F 31G X 15/64" 0.5 ML Formulary OTC 31G X 15/64" 0.5 ML BD VEO INSULIN SYRINGE U/F 31G X 15/64" 1 ML Formulary OTC 31G X 15/64" 1 ML BEBULIN INTRAVENOUS SOLUTION Formulary RECONSTITUTED 200-1200 UNIT bec/zinc oral tablet Formulary OTC bee pollen oral capsule 580 mg Formulary OTC bee pollen oral tablet chewable 500 mg Formulary OTC BEELITH ORAL TABLET 362-20 MG Formulary OTC BELBUCA BUCCAL FILM 150 MCG, 300 MCG, 450 Formulary PA; QL (68 EA per 34 days) MCG, 600 MCG, 75 MCG, 750 MCG, 900 MCG belladonna alkaloids-opium rectal suppository 16.2-60 mg Formulary belladonna-opium rectal suppository 16.2-30 mg Formulary BENADRYL ALLERGY CHILDRENS ORAL LIQUID Formulary OTC 12.5 MG/5ML BENADRYL ALLERGY CHILDRENS ORAL TABLET Formulary OTC CHEWABLE 12.5 MG BENADRYL ALLERGY ORAL TABLET 25 MG Formulary OTC 18 Drug Name Formulary Status Requirements/Limits BENADRYL ITCH RELIEF EXTERNAL STICK 2-0.1 % Formulary OTC BENADRYL ITCH STOPPING EXTERNAL CREAM 1- Formulary OTC 0.1 % BENADRYL-D ALLERGY/SINUS CHILD ORAL Formulary OTC SOLUTION 12.5-5 MG/5ML benazepril hcl oral tablet 10 mg, 20 mg, 40 mg, 5 mg Formulary benazepril-hydrochlorothiazide oral tablet 10-12.5 mg, 20- Formulary 12.5 mg, 20-25 mg, 5-6.25 mg BENEFIBER FOR CHILDREN ORAL POWDER Formulary OTC BENEFIBER ON THE GO ORAL PACKET Formulary OTC BENEFIBER ORAL POWDER Formulary OTC BENEFIBER PLUS B VITS & FA ORAL TABLET Formulary OTC BENEFIBER PLUS CALCIUM ORAL POWDER Formulary OTC BENEFIBER PLUS CALCIUM ORAL TABLET Formulary OTC CHEWABLE BENEFIBER PLUS HEART HEALTH ORAL POWDER Formulary OTC benfotiamine multi-b oral capsule Formulary OTC bentonite powder Formulary benzaldehyde oral elixir Formulary OTC benzalkonium chloride external concentrate 50 % Formulary OTC benzalkonium chloride external solution 50 % Formulary BENZEDREX NASAL INHALER Formulary OTC BENZEPRO CREAMY WASH EXTERNAL LIQUID 7 % Formulary BENZEPRO EXTERNAL FOAM 5.3 % Formulary BENZEPRO SHORT CONTACT EXTERNAL FOAM 9.8 Formulary % benzocaine powder Formulary BENZODENT MOUTH/THROAT CREAM 20 % Formulary OTC benzoic acid crystals Formulary benzoin external tincture Formulary benzonatate oral capsule 100 mg, 150 mg, 200 mg Formulary AGE (Min 6 Years) BENZ-O-STHETIC MOUTH/THROAT SWAB 20 % Formulary OTC benzoyl peroxide cleanser external lotion 6 % Formulary benzoyl peroxide external gel 2.5 % Formulary OTC; AGE (Max 18 Years) benzoyl peroxide wash external liquid 10 % Formulary AGE (Max 18 Years) benzoyl peroxide wash external liquid 5 % Formulary OTC; AGE (Max 18 Years) benzoyl peroxide- external gel 5-3 % Formulary benzphetamine hcl oral tablet 50 mg Formulary PA benztropine mesylate oral tablet 0.5 mg, 1 mg, 2 mg Formulary benzyl alcohol liquid Formulary benzyl benzoate liquid Formulary bergamot oil oil Formulary OTC BERINERT INTRAVENOUS KIT 500 UNIT Formulary PA; QL (8 EA per 30 days) BERRI-FREEZ PAIN RELIEVING EXTERNAL GEL 4.5 Formulary OTC %

19 Drug Name Formulary Status Requirements/Limits BERRI-FREEZ PAIN RELIEVING EXTERNAL LIQUID Formulary OTC 10 % BERRI-FREEZ PLUS EXTERNAL GEL 0.2-4-8 % Formulary OTC beta carotene provitamin a oral capsule 25000 unit Formulary OTC BETADINE EXTERNAL SOLUTION 10 %, 5 % Formulary OTC BETADINE SURGICAL SCRUB EXTERNAL Formulary OTC SOLUTION 7.5 % BETADINE SWABSTICKS EXTERNAL SWAB 10 % Formulary OTC betaine anhydrous powder Formulary betaine hcl oral tablet 300 mg Formulary OTC dipropionate aug external cream 0.05 % Formulary betamethasone dipropionate aug external lotion 0.05 % Formulary betamethasone dipropionate aug external ointment 0.05 % Formulary betamethasone dipropionate external cream 0.05 % Formulary betamethasone dipropionate external lotion 0.05 % Formulary betamethasone dipropionate external ointment 0.05 % Formulary betamethasone valerate external cream 0.1 % Formulary betamethasone valerate external lotion 0.1 % Formulary betamethasone valerate external ointment 0.1 % Formulary BETAQUIK ORAL EMULSION Formulary OTC BETASERON SUBCUTANEOUS KIT 0.3 MG Formulary betaxolol hcl ophthalmic solution 0.5 % Formulary betaxolol hcl oral tablet 10 mg, 20 mg Formulary bethanechol chloride oral tablet 10 mg, 25 mg, 5 mg, 50 mg Formulary BETHKIS INHALATION NEBULIZATION SOLUTION QL (280 ML per 28 days); AGE (Min 6 Formulary 300 MG/4ML Years) BEVESPI AEROSPHERE INHALATION AEROSOL 9- Formulary AGE (Min 17 Years) 4.8 MCG/ACT bexarotene oral capsule 75 mg Formulary PA BIATAIN HEEL ADH FOAM DRESSING PAD Formulary OTC 19CMX20CM BIATAIN SACRAL FOAM DRESSING PAD 9"X9" Formulary OTC oral tablet 50 mg Formulary BICARSIM FORTE ORAL TABLET 125 MG Formulary OTC BICARSIM ORAL TABLET 80 MG Formulary OTC BICNU INTRAVENOUS SOLUTION RECONSTITUTED Formulary 100 MG BIKTARVY ORAL TABLET 50-200-25 MG Formulary QL (30 EA per 30 days) biobron sf oral syrup 10-15-350 mg/5ml Formulary OTC biocotron oral liquid 10-100 mg/5ml Formulary OTC biodesp dm oral syrup 5-15-100 mg/5ml Formulary OTC bioflavonoid citrus powder Formulary OTC BIO-FLAX ORAL CAPSULE 1000 MG Formulary OTC BIOFLONEX ORAL TABLET 250-650 MG Formulary OTC BIOFREEZE EXTERNAL AEROSOL 10.5 % Formulary OTC

20 Drug Name Formulary Status Requirements/Limits BIOFREEZE ROLL-ON COLORLESS EXTERNAL GEL Formulary OTC 4 % BIOGAIA GASTRUS ORAL TABLET CHEWABLE Formulary OTC biogtuss oral liquid 10-28-388 mg/5ml Formulary OTC BIOGUARD NON-ADHERENT DRESSING PAD 3"X8" Formulary BIOLLE GEL TEARS OPHTHALMIC GEL 1 % Formulary OTC bionatuss dxp oral liquid 10-2-20 mg/5ml Formulary OTC BIOPATCH PROTECTIVE DISK/CHG EXTERNAL Formulary OTC (DRESSING) BIORX SPONIX ANTI-FUNGAL EXTERNAL Formulary OTC SOLUTION 22 % BIORX SPONIX ARTHR & MUSC EXTERNAL Formulary OTC SOLUTION 4-10-0.035 % biospec dmx oral liquid 15-25 mg/5ml Formulary OTC biotalan clear oral liquid Formulary OTC BIO-THERM PAIN RELIEVING EXTERNAL LOTION Formulary OTC 0.002-10-20 % biotin forte oral tablet 3 mg Formulary OTC biotin oral capsule 10 mg, 2500 mcg Formulary OTC biotin oral tablet 1000 mcg, 10000 mcg, 300 mcg, 800 mcg Formulary OTC biotin plus keratin oral tablet 10000-100 mcg-mg Formulary OTC biotin-d powder Formulary OTC biotuss oral liquid 10-15-300 mg/5ml Formulary biovol oral syrup Formulary OTC bisacodyl ec oral tablet delayed release 5 mg Formulary OTC bismatrol maximum strength oral suspension 525 mg/15ml Formulary OTC bismatrol oral tablet chewable 262 mg Formulary OTC bismuth citrate powder Formulary bismuth subcarbonate powder Formulary bismuth subgallate powder Formulary bismuth subnitrate powder Formulary bismuth subsalicylate powder Formulary bisoprolol fumarate oral tablet 10 mg, 5 mg Formulary bisoprolol-hydrochlorothiazide oral tablet 10-6.25 mg, 2.5- Formulary 6.25 mg, 5-6.25 mg bite/itch external lotion 1-2 % Formulary OTC BI-ZETS/BENZOTROCHES MOUTH/THROAT Formulary OTC LOZENGE 15 MG bladder 2.2 oral tablet Formulary OTC bleomycin sulfate injection solution reconstituted 15 unit, Formulary 30 unit BLINK TEARS OPHTHALMIC GEL 0.25 % Formulary OTC BLINK TEARS OPHTHALMIC SOLUTION 0.25 % Formulary OTC BLISOVI 24 FE ORAL TABLET 1-20 MG-MCG(24) Formulary BLISOVI FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG Formulary BLISOVI FE 1/20 ORAL TABLET 1-20 MG-MCG Formulary 21 Drug Name Formulary Status Requirements/Limits blood pressure monitor/wrist kit Formulary OTC BOIL EASE MAXIMUM STRENGTH EXTERNAL Formulary OTC OINTMENT 20 % BONE DENSITY ORAL TABLET 300-200 MG-UNIT Formulary OTC BOOST PUDDING ORAL PUDDING Formulary OTC BOOSTRIX INTRAMUSCULAR SUSPENSION 5-2.5- Formulary 18.5 borage oral capsule 1000-240-378 mg Formulary OTC borax granules Formulary OTC boric acid external granules Formulary boric acid powder Formulary boron oral capsule 3 mg Formulary OTC boron oral tablet 6 mg Formulary OTC BOTOX INJECTION SOLUTION RECONSTITUTED Formulary PA 100 UNIT, 200 UNIT BOUDREAUXS BABY KISSES EXTERNAL Formulary OTC OINTMENT BOUDREAUXS BUTT EXTERNAL OINTMENT Formulary OTC 16 %, 40 % BOUDREAUXS RASH PREVENTOR EXTERNAL Formulary OTC LIQUID 10 % bp 10-1 external emulsion 10-1 % Formulary QL (170.1 GM per 30 days) bp cleansing wash external emulsion 10-4 % Formulary bp wash external liquid 2.5 % Formulary BPROTECTED MULTI-VITE ORAL LIQUID Formulary OTC BPROTECTED PEDIA IRON ORAL SOLUTION 75 (15 Formulary OTC FE) MG/ML BPROTECTED PEDIA POLY-VITE ORAL SOLUTION Formulary OTC 35 MG/ML BRAINSTRONG PRENATAL ORAL 33-0.8 & 350 MG Formulary OTC BRASIVOL EXTERNAL PASTE Formulary OTC BRAUN NO TOUCH + FOREHEAD Formulary OTC BREVIBLOC IN NACL INTRAVENOUS SOLUTION Formulary 2000 MG/100ML, 2500 MG/250ML brewers yeast oral tablet Formulary OTC BRIJ 30 LIQUID Formulary OTC BRILINTA ORAL TABLET 60 MG, 90 MG Formulary brilliant green powder Formulary brimonidine tartrate ophthalmic solution 0.15 %, 0.2 % Formulary BRIVIACT INTRAVENOUS SOLUTION 50 MG/5ML Formulary brohist d oral tablet 4-10 mg Formulary OTC bromelain powder Formulary bromi-lotion external lotion Formulary OTC bromocriptine mesylate oral capsule 5 mg Formulary bromocriptine mesylate oral tablet 2.5 mg Formulary bronchial relief oral tablet 12.5-200 mg Formulary OTC

22 Drug Name Formulary Status Requirements/Limits BRONKAID ORAL TABLET 25-400 MG Formulary OTC bronkids oral liquid 1.5-0.6-2.75 mg/ml, 10-4-10 mg/5ml Formulary OTC brontuss dx oral liquid 10-20-200 mg/5ml Formulary OTC brotapp dm oral liquid 15-1-5 mg/5ml Formulary OTC BROVANA INHALATION NEBULIZATION Formulary AGE (Min 17 Years) SOLUTION 15 MCG/2ML btrex oral tablet extended release 8-200-4-100-600 mg Formulary OTC BUCKLEYS CHEST CONGESTION ORAL LIQUID 100 Formulary OTC MG/5ML BUCKLEYS COUGH ORAL LIQUID 12.5 MG/5ML Formulary OTC oral capsule delayed release particles 3 mg Formulary budesonide suspension 32 mcg/act nasal (otc) 32 mcg/act Formulary BUFFERIN EXTRA STRENGTH ORAL TABLET 500 Formulary OTC MG BUFFERIN LOW DOSE ORAL TABLET 81 MG Formulary OTC BUFFERIN ORAL TABLET 325 MG Formulary OTC BULL FROG WATER ARMOR SPORT EXTERNAL Formulary OTC GEL bumetanide oral tablet 0.5 mg, 1 mg, 2 mg Formulary BUPHENYL ORAL TABLET 500 MG Formulary buprenorphine hcl injection solution 0.3 mg/ml Formulary PA PA; QL (360 EA per 30 days); AGE (Min buprenorphine hcl sublingual tablet sublingual 2 mg Formulary 16 Years) PA; QL (90 EA per 30 days); AGE (Min buprenorphine hcl sublingual tablet sublingual 8 mg Formulary 16 Years) buprenorphine weekly 10 mcg/hr, 15 Formulary PA; QL (5 EA per 34 days) mcg/hr, 20 mcg/hr, 5 mcg/hr, 7.5 mcg/hr bupropion hcl er ( det) oral tablet extended release Formulary 12 hour 150 mg bupropion hcl er (sr) oral tablet extended release 12 hour Formulary 100 mg, 150 mg, 200 mg bupropion hcl er (xl) oral tablet extended release 24 hour Formulary 150 mg, 300 mg bupropion hcl oral tablet 100 mg, 75 mg Formulary burn relief/lidocaine/aloe external gel 0.5 % Formulary OTC buspirone hcl oral tablet 10 mg, 15 mg, 30 mg, 5 mg, 7.5 Formulary mg busulfan intravenous solution 6 mg/ml Formulary butalbital-acetaminophen oral tablet 50-325 mg Formulary butalbital-apap-caff-cod oral capsule 50-300-40-30 mg, 50- Formulary PA; QL (140 EA per 7 days) 325-40-30 mg butalbital-apap-caffeine oral tablet 50-325-40 mg Formulary butalbital-aspirin-caffeine oral capsule 50-325-40 mg Formulary butorphanol tartrate injection solution 1 mg/ml, 2 mg/ml Formulary butorphanol tartrate nasal solution 10 mg/ml Formulary PA; QL (5 ML per 34 days) BUTRANS TRANSDERMAL PATCH WEEKLY 10 MCG/HR, 15 MCG/HR, 20 MCG/HR, 5 MCG/HR, 7.5 Formulary PA; QL (5 EA per 34 days) MCG/HR 23 Drug Name Formulary Status Requirements/Limits butylated hydroxytoluene crystals Formulary OTC butylparaben powder Formulary OTC BYDUREON SUBCUTANEOUS PEN-INJECTOR 2 MG Formulary BYDUREON SUBCUTANEOUS SUSPENSION Formulary RECONSTITUTED ER 2 MG BYETTA 10 MCG PEN SUBCUTANEOUS SOLUTION Formulary PEN-INJECTOR 10 MCG/0.04ML BYETTA 5 MCG PEN SUBCUTANEOUS SOLUTION Formulary PEN-INJECTOR 5 MCG/0.02ML c-1500/rose hips sr oral tablet extended release 1500 mg Formulary OTC c1500/rose hips/bioflavonoid oral tablet extended release Formulary OTC ca phosphate dibasic dihyd powder Formulary OTC cabergoline oral tablet 0.5 mg Formulary QL (10 EA per 34 days) cadeau dha oral capsule 29-0.4-0.8-375 mg Formulary OTC caffeine anhydrous powder Formulary caffeine citrate oral solution 20 mg/ml Formulary cal/mag oral tablet 200-100 mg Formulary OTC CALADRYL CLEAR EXTERNAL LOTION 1-0.1 % Formulary OTC CALADRYL EXTERNAL LOTION 1-8 % Formulary OTC CALAGEL MAXIMUM STRENGTH EXTERNAL GEL Formulary OTC CALAGESIC EXTERNAL LOTION 1-8 % Formulary OTC calahist clear external lotion 1-0.1 % Formulary OTC calamine external lotion , 8-8 % Formulary OTC calamine phenolated external lotion Formulary OTC calamine powder Formulary calamine-zinc oxide external suspension 8-8 % Formulary OTC CAL-CARB FORTE ORAL TABLET 1250 (500 CA) MG Formulary OTC CALCET PETITES ORAL TABLET 200-250 MG-UNIT Formulary OTC CALCI-CHEW ORAL TABLET CHEWABLE 1250 (500 Formulary OTC CA) MG calci-max oral capsule Formulary OTC calcipotriene external cream 0.005 % Formulary calcipotriene external ointment 0.005 % Formulary calcipotriene external solution 0.005 % Formulary calcitonin (salmon) nasal solution 200 unit/act Formulary cal-citrate oral capsule 150 mg Formulary OTC CALCITRATE ORAL TABLET 950 MG Formulary OTC calcitriol oral capsule 0.25 mcg, 0.5 mcg Formulary calcitriol oral solution 1 mcg/ml Formulary calcium + d3 oral tablet 600-800 mg-unit Formulary OTC calcium 1200 oral tablet chewable 1200-1000 mg-unit Formulary OTC calcium 500 + d3 oral tablet 500-600 mg-unit Formulary OTC calcium 600 + d oral tablet 600-200 mg-unit Formulary OTC calcium 600 oral tablet 1500 (600 ca) mg Formulary OTC calcium 600+d3 oral tablet 600-400 mg-unit Formulary OTC 24 Drug Name Formulary Status Requirements/Limits calcium 600+d3 plus minerals oral tablet 600-800 mg-unit Formulary OTC calcium acetate (phos binder) oral capsule 667 mg Formulary calcium acetate (phos binder) oral tablet 667 mg Formulary calcium acetate oral tablet 668 (169 ca) mg Formulary OTC calcium ascorbate oral tablet 500 mg Formulary OTC calcium ascorbate powder Formulary calcium aspartate oral tablet 75 mg Formulary OTC calcium carbonate antacid oral tablet 648 mg Formulary OTC calcium carbonate oral powder 800 mg/2gm Formulary OTC calcium carbonate oral tablet 600 mg Formulary OTC calcium carbonate powder Formulary calcium carbonate-vitamin d oral capsule 600-200 mg-unit Formulary OTC calcium carbonate-vitamin d oral tablet 600-400 mg-unit Formulary OTC calcium citrate + d3 oral tablet 250-200 mg-unit Formulary OTC calcium citrate malate-vit d oral tablet 250-100 mg-unit Formulary OTC calcium citrate oral tablet 1040 mg, 200 mg, 250 mg Formulary OTC calcium citrate plus oral tablet Formulary OTC calcium citrate tetrahydrate powder Formulary calcium citrate-vitamin d oral tablet 200-125 mg-unit Formulary OTC calcium citrate-vitamin d3 oral liquid 1000-400 Formulary OTC calcium citrate-vitamin d3 oral tablet 315-250 mg-unit Formulary OTC calcium gluconate oral tablet 500 mg Formulary OTC calcium gluconate powder Formulary calcium gummies oral tablet chewable 250-100-500 mg- Formulary OTC unit calcium high potency/vitamin d oral tablet 600-200 mg-unit Formulary OTC calcium hydroxide powder Formulary calcium lactate oral tablet 100 mg, 648 mg Formulary OTC calcium oral tablet 500-125 mg-unit Formulary OTC calcium oral tablet chewable 500-100 mg-unit, 600-400 Formulary OTC mg-unit calcium oyster shell oral tablet 500 mg Formulary OTC calcium pantothenate oral tablet 100 mg, 200 mg, 500 mg Formulary OTC calcium pantothenate powder Formulary calcium phosphate tribasic powder Formulary calcium plus vitamin d3 oral capsule 600-500 mg-unit Formulary OTC calcium saccharate powder Formulary OTC calcium soft chews oral tablet chewable 500-1000-40 mg- Formulary OTC unt-mcg, 500-500-40 mg-unt-mcg calcium sulfate powder 90 % Formulary OTC calcium-magnesium-zinc oral tablet 333-133-5 mg Formulary OTC calcium-vitamin d oral tablet 600-200 mg-unit Formulary OTC calcium-vitamin d3 oral tablet 600-125 mg-unit Formulary OTC calcium-vitamin d-minerals oral tablet chewable 600-400 Formulary OTC mg-unit, 600-800 mg-unit 25 Drug Name Formulary Status Requirements/Limits calendula external lotion Formulary OTC calendula external ointment Formulary OTC cal-glu oral capsule 500 mg Formulary OTC cal-lac oral capsule 500 mg Formulary OTC calmag thins oral tablet 200-50 mg Formulary OTC cal- oral tablet chewable 260 mg Formulary OTC CALMOL-4 RECTAL SUPPOSITORY 76-10 % Formulary OTC calna oral tablet Formulary OTC CALTRATE 600+D ORAL TABLET 600-800 MG-UNIT Formulary OTC CALTRATE 600+D PLUS MINERALS ORAL TABLET Formulary OTC 600-800 MG-UNIT CALTRATE 600+D PLUS MINERALS ORAL TABLET Formulary OTC CHEWABLE 600-800 MG-UNIT CALTRATE 600+D3 SOFT ORAL TABLET Formulary OTC CHEWABLE 600-800 MG-UNIT CALTRATE GUMMY BITES ORAL TABLET Formulary OTC CHEWABLE 250-400 MG-UNIT CALTRATE MINIS PLUS MINERALS ORAL TABLET Formulary OTC 300-800 MG-UNIT CAMILA ORAL TABLET 0.35 MG Formulary QL (28 EA per 28 days) CAMPHO-PHENIQUE EXTERNAL GEL 10.8-4.7 % Formulary OTC CAMPHO-PHENIQUE EXTERNAL LIQUID 10.8-4.7 % Formulary OTC camphor blocks gum Formulary OTC camphor crystals Formulary camphor granules Formulary camphor spirit spirit Formulary OTC CAMPHOTREX EXTERNAL GEL 10-4 % Formulary OTC CAMPTOSAR INTRAVENOUS SOLUTION 300 Formulary MG/15ML CANASA RECTAL SUPPOSITORY 1000 MG Formulary candesartan cilexetil oral tablet 16 mg, 32 mg, 4 mg, 8 mg Formulary candesartan cilexetil-hctz oral tablet 16-12.5 mg, 32-12.5 Formulary mg CANKAID MOUTH/THROAT SOLUTION 10 % Formulary OTC capcof oral syrup 5-2-10 mg/5ml Formulary OTC capecitabine oral tablet 150 mg, 500 mg Formulary PA capmist dm oral tablet 60-15-400 mg Formulary OTC capron dm oral liquid 7.5-7.5 mg/5ml Formulary OTC capron dmt oral tablet 30-30 mg Formulary OTC capsaicin external cream 0.025 %, 0.1 % Formulary OTC capsaicin hot patch external pad 0.025 % Formulary OTC capsaicin powder Formulary CAPSIDERM EXTERNAL PATCH 0.0375-5 % Formulary OTC capsule 1 clear veggie capsule Formulary OTC oral tablet 100 mg, 12.5 mg, 25 mg, 50 mg Formulary CAPZASIN-HP EXTERNAL CREAM 0.1 % Formulary OTC 26 Drug Name Formulary Status Requirements/Limits CARAFATE ORAL SUSPENSION 1 GM/10ML Formulary caraway oil oil Formulary OTC CARBAGLU ORAL TABLET 200 MG Formulary er oral capsule extended release 12 hour Formulary 100 mg, 200 mg, 300 mg carbamazepine er oral tablet extended release 12 hour 100 Formulary mg, 200 mg, 400 mg carbamazepine oral suspension 100 mg/5ml Formulary carbamazepine oral tablet 200 mg Formulary carbamazepine oral tablet chewable 100 mg Formulary CARBAPHEN CH ORAL SUSPENSION 10-4-24 Formulary OTC MG/5ML CARBAPHEN PED CH ORAL SUSPENSION 2.5-1.25-8 Formulary OTC MG/ML carbidopa-levodopa er oral tablet extended release 25-100 Formulary mg, 50-200 mg carbidopa-levodopa oral tablet 10-100 mg, 25-100 mg, 25- Formulary 250 mg carbidopa-levodopa oral tablet dispersible 10-100 mg, 25- Formulary 100 mg, 25-250 mg carbidopa-levodopa-entacapone oral tablet 12.5-50-200 mg Formulary CARBOHOL 940 GEL Formulary carbopol 940 nf powder Formulary carboxymethylcellulose sodium granules Formulary carboxymethylcellulose sodium powder Formulary CARBZERO ORAL EMULSION Formulary OTC cardamom oil Formulary OTC CARDENZ ORAL TABLET Formulary OTC CAREFINE PEN NEEDLES 32G X 5 MM , 32G X 6 MM Formulary OTC careone insulin syringe 30g x 1/2" 0.3 ml 30g x 1/2" 0.3 ml Formulary OTC careone insulin syringe 30g x 1/2" 0.5 ml 30g x 1/2" 0.5 ml Formulary OTC careone insulin syringe 30g x 1/2" 1 ml 30g x 1/2" 1 ml Formulary OTC careone insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 Formulary OTC ml careone insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 Formulary OTC ml careone insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC careone lancet thin 23g Formulary OTC; QL (150 EA per 30 days) careone lancet ultra thin 28g Formulary OTC; QL (150 EA per 30 days) CA-REZZ EXTERNAL LIQUID 0.25 % Formulary OTC ca-rezz gentle external liquid 0.2 % Formulary OTC ca-rezz norisc external cream 0.2 % Formulary OTC CARNI Q-GEL FORTE ORAL CAPSULE 30-250 MG Formulary OTC CARRACOLLOID 4"X4" EXTERNAL PAD Formulary OTC CARRASMART EXTERNAL GEL Formulary OTC CARRASORB H EXTERNAL Formulary OTC

27 Drug Name Formulary Status Requirements/Limits CARRASYN V WOUND DRESSING EXTERNAL GEL Formulary OTC CARRINGTON DERMAL WOUND EXTERNAL GEL Formulary OTC carteolol hcl ophthalmic solution 1 % Formulary CARTIA XT ORAL CAPSULE EXTENDED RELEASE Formulary 24 HOUR 120 MG, 180 MG, 240 MG, 300 MG oral tablet 12.5 mg, 25 mg, 3.125 mg, 6.25 mg Formulary cascara sagrada oral capsule 450 mg Formulary OTC castellani paint modified external liquid 1.5 % Formulary OTC CASTIVA COOLING EXTERNAL LOTION 5-14 % Formulary OTC CASTIVA WARMING EXTERNAL LOTION 0.035 % Formulary OTC castor oil oil Formulary castor oil stimulant laxative oral oil 100 % Formulary OTC castor oil sulfated oil Formulary OTC CATAPRES-TTS-1 TRANSDERMAL PATCH WEEKLY Formulary 0.1 MG/24HR CATAPRES-TTS-2 TRANSDERMAL PATCH WEEKLY Formulary 0.2 MG/24HR CATAPRES-TTS-3 TRANSDERMAL PATCH WEEKLY Formulary 0.3 MG/24HR CAVAREST DENTAL GEL 1.1 % Formulary CAVILON EMOLLIENT EXTERNAL CREAM Formulary OTC CAVILON FOOT & DRY SKIN EXTERNAL CREAM Formulary OTC CAVILON NO STING BARRIER FILM EXTERNAL Formulary OTC LIQUID CAVILON ONE-STEP SKIN CARE EXTERNAL Formulary OTC LOTION CAVILON SKIN CLEANSER EXTERNAL LIQUID Formulary OTC CAZIANT ORAL TABLET 0.1/0.125/0.15 -0.025 MG Formulary QL (28 EA per 28 days) cefaclor oral capsule 250 mg, 500 mg Formulary cefaclor oral suspension reconstituted 125 mg/5ml Formulary cefadroxil oral capsule 500 mg Formulary cefadroxil oral suspension reconstituted 250 mg/5ml, 500 Formulary mg/5ml cefadroxil oral tablet 1 gm Formulary cefdinir oral capsule 300 mg Formulary cefdinir oral suspension reconstituted 125 mg/5ml, 250 Formulary mg/5ml cefixime oral suspension reconstituted 100 mg/5ml, 200 Formulary mg/5ml cefpodoxime proxetil oral suspension reconstituted 100 Formulary QL (200 ML per 34 days) mg/5ml, 50 mg/5ml cefpodoxime proxetil oral tablet 100 mg, 200 mg Formulary QL (28 EA per 34 days) cefprozil oral suspension reconstituted 125 mg/5ml, 250 Formulary mg/5ml cefprozil oral tablet 250 mg, 500 mg Formulary ceftriaxone sodium in dextrose intravenous solution 20 Formulary mg/ml, 40 mg/ml

28 Drug Name Formulary Status Requirements/Limits ceftriaxone sodium injection solution reconstituted 1 gm, 2 Formulary gm, 250 mg, 500 mg ceftriaxone sodium intravenous solution reconstituted 10 Formulary gm, 2 gm ceftriaxone sodium-dextrose intravenous solution Formulary reconstituted 1-3.74 gm-%, 2-2.22 gm-% cefuroxime axetil oral tablet 250 mg, 500 mg Formulary CELACYN EXTERNAL GEL Formulary celecoxib oral capsule 100 mg, 200 mg, 400 mg, 50 mg Formulary ST celery seed oil Formulary OTC cellulase powder Formulary OTC cellulose crystals Formulary cellulose powder Formulary CELONTIN ORAL CAPSULE 300 MG Formulary CENTRATEX ORAL CAPSULE 106-1 MG Formulary centravites adults oral tablet Formulary OTC CENTRUM FLAVOR BURST DRINK ORAL PACKET Formulary OTC CENTRUM ORAL LIQUID Formulary OTC CENTRUM SPECIALIST PRENATAL ORAL 27-0.8 & Formulary OTC 200 MG CEO-TWO RECTAL SUPPOSITORY Formulary OTC CEPACOL EXTRA STRENGTH MOUTH/THROAT Formulary OTC LOZENGE 15-2.6 MG CEPACOL SORE THROAT & COUGH Formulary OTC MOUTH/ 5-7.5 MG CEPACOL SORE THROAT EX ST MOUTH/THROAT Formulary OTC LOZENGE 15-3.6 MG CEPACOL SORE THROAT MOUTH/THROAT Formulary OTC LOZENGE 15-2.6 MG CEPASTAT MOUTH/THROAT LOZENGE 5-6-10 MG Formulary OTC cephalexin oral capsule 250 mg, 500 mg Formulary cephalexin oral suspension reconstituted 125 mg/5ml, 250 Formulary mg/5ml CERACADE EMULSION EXTERNAL Formulary CERALYTE 70 ORAL PACKET Formulary OTC CERAVE BABY EXTERNAL LOTION 1 % Formulary OTC CERAVE ITCH RELIEF EXTERNAL CREAM 1 % Formulary OTC CERAVE SUNSCREEN SPF50 EXTERNAL LOTION Formulary OTC CEROVEL EXTERNAL LOTION 40 % Formulary CESIUM 1000 ORAL CAPSULE 1000 MG Formulary OTC cesium 500 oral capsule 500 mg Formulary OTC cesium oral tablet 100 mg Formulary OTC CETAPHIL GENTLE CLEANSING EXTERNAL BAR Formulary OTC cetirizine hcl oral tablet 5 mg Formulary OTC CETRAXAL OTIC SOLUTION 0.2 % Formulary cetyl alcohol flakes Formulary

29 Drug Name Formulary Status Requirements/Limits CHANTIX CONTINUING MONTH PAK ORAL Formulary TABLET 1 MG CHANTIX ORAL TABLET 0.5 MG Formulary CHANTIX STARTING MONTH PAK ORAL TABLET Formulary 0.5 MG X 11 & 1 MG X 42 CHAP-EX TROPICALS EXTERNAL STICK Formulary OTC charcoal activated powder Formulary CHAR-FLO WITH SORBITOL ORAL SUSPENSION 25- Formulary OTC 48 GM/120ML chelated calcium oral tablet 200 mg Formulary OTC chelated magnesium oral tablet 100 mg Formulary OTC chelated zinc oral tablet 50 mg Formulary OTC CHEMSTRIP CALIBRATION IN VITRO STRIP Formulary OTC CHEMSTRIP UGK IN VITRO STRIP Formulary OTC CHENODAL ORAL TABLET 250 MG Formulary PA CHERACOL-D COUGH ORAL LIQUID 10-100 MG/5ML Formulary OTC cherry concentrate oral concentrate Formulary OTC cherry oral syrup Formulary chest rub external ointment 4.8-1.2-2.6 % Formulary OTC CHEW Q ORAL TABLET CHEWABLE 100 MG, 30 MG, Formulary OTC 600 MG chewable iron oral tablet chewable 30-10-25 mg Formulary OTC CHIGG AWAY EXTERNAL LOTION 5-10 % Formulary OTC childrens aspirin free oral elixir 80 mg/2.5ml Formulary OTC CHILDRENS MOTRIN ORAL SUSPENSION 100 Formulary OTC MG/5ML childrens pain reliever oral tablet chewable 80 mg Formulary OTC childrens plus multi-sympt cld oral suspension 2.5-1-5-160 Formulary OTC mg/5ml childrens silfedrine oral liquid 15 mg/5ml Formulary OTC CHILDRENS SOOTHE ORAL TABLET CHEWABLE Formulary OTC 400 MG chlo hist oral solution 12.5-1 mg/5ml Formulary OTC CHLO TUSS ORAL LIQUID 30-1-12.5 MG/5ML Formulary OTC chlophed oral liquid 5-12.5-100 mg/5ml Formulary OTC chloral hydrate crystals Formulary CHLORASEPTIC MOUTH/THROAT LOZENGE 6-10 Formulary OTC MG chlordiazepoxide hcl oral capsule 10 mg, 5 mg Formulary QL (170 EA per 34 days) chlordiazepoxide hcl oral capsule 25 mg Formulary QL (170 EA per 30 days) chlorella oral capsule Formulary OTC chlorhexidine gluconate cloth external pad 2 % Formulary OTC chlorhexidine gluconate external liquid 2 %, 4 % Formulary OTC chlorhexidine gluconate mouth/throat solution 0.12 % Formulary chloroform solution Formulary chlorophyll oral tablet 3-0.6 mg Formulary OTC 30 Drug Name Formulary Status Requirements/Limits chloroquine phosphate oral tablet 250 mg, 500 mg Formulary chlorothiazide oral tablet 250 mg, 500 mg Formulary CHLORPHEN SR ORAL TABLET EXTENDED Formulary OTC RELEASE 12 MG hcl injection solution 25 mg/ml, 50 mg/2ml Formulary AGE (Min 18 Years) chlorpromazine hcl oral tablet 10 mg, 100 mg, 200 mg, 25 Formulary AGE (Min 18 Years) mg, 50 mg chlorpromazine hcl powder Formulary chlorthalidone oral tablet 25 mg, 50 mg Formulary CHLOR-TRIMETON ALLERGY ORAL TABLET Formulary OTC EXTENDED RELEASE 12 MG CHLOR-TRIMETON ORAL SYRUP 2 MG/5ML Formulary OTC CHLOR-TRIMETON ORAL TABLET 4 MG Formulary OTC chlorzoxazone oral tablet 500 mg Formulary chocolated laxative oral tablet chewable 15 mg Formulary OTC cholecalciferol powder Formulary cholesterol acetate powder Formulary OTC cholesterol powder Formulary cholestyramine light oral packet 4 gm Formulary cholestyramine light oral powder 4 gm/dose Formulary cholestyramine oral packet 4 gm Formulary cholestyramine oral powder 4 gm/dose Formulary choline citrate oral tablet 650 mg Formulary OTC choline oral capsule 648 mg Formulary OTC choline sr oral tablet extended release 300 mg Formulary OTC choline-mag trisalicylate oral liquid 500 mg/5ml Formulary CHONDROITIN SULFATE COMPLEX ORAL Formulary OTC CAPSULE 400-60-2.5 MG CHROMACAPS ORAL CAPSULE 1 MG Formulary OTC chromium aspartate oral tablet 1000 mcg Formulary OTC chromium gtf oral tablet 200 mcg Formulary OTC chromium oral tablet 1000 mcg, 400 mcg Formulary OTC chromium picolate oral tablet 1000 mcg Formulary OTC chromium picolinate oral capsule 200 mcg Formulary OTC chromium picolinate oral tablet 200 mcg, 400 mcg Formulary OTC chromium picolinate powder Formulary powder Formulary CICLODAN EXTERNAL CREAM 0.77 % Formulary ciclopirox external gel 0.77 % Formulary ciclopirox external shampoo 1 % Formulary ciclopirox external solution 8 % Formulary ciclopirox olamine external suspension 0.77 % Formulary ciclopirox treatment external kit 8 % Formulary cilostazol oral tablet 100 mg, 50 mg Formulary cimetidine oral tablet 300 mg, 400 mg, 800 mg Formulary 31 Drug Name Formulary Status Requirements/Limits cinnamon oil oil Formulary OTC cinnamon oral capsule 500 mg Formulary OTC CINRYZE INTRAVENOUS SOLUTION Formulary PA; QL (20 EA per 34 days) RECONSTITUTED 500 UNIT CIPRODEX OTIC SUSPENSION 0.3-0.1 % Formulary ciprofloxacin hcl ophthalmic solution 0.3 % Formulary ciprofloxacin hcl oral tablet 100 mg, 250 mg, 500 mg, 750 Formulary mg ciprofloxacin hcl otic solution 0.2 % Formulary ciprofloxacin oral suspension reconstituted 500 mg/5ml Formulary (10%) cisplatin intravenous solution 50 mg/50ml Formulary citalopram hydrobromide oral solution 10 mg/5ml Formulary citalopram hydrobromide oral tablet 10 mg, 20 mg, 40 mg Formulary CITRA PH ORAL SOLUTION 2.7 GM/30ML Formulary OTC CITRANATAL 90 DHA ORAL 90-1 & 300 MG Formulary CITRANATAL ASSURE ORAL 35-1 & 300 MG Formulary CITRANATAL B-CALM ORAL 20-1 & 25 (2) MG Formulary CITRANATAL DHA ORAL 27-1 & 250 MG Formulary CITRANATAL HARMONY ORAL CAPSULE 27-1-260 Formulary MG CITRANATAL RX ORAL TABLET 27-1 MG Formulary citric acid anhydrous granules Formulary citric acid anhydrous powder Formulary citric acid monohydrate granules Formulary citronella oil oil Formulary CITRUCEL ORAL POWDER Formulary OTC CITRUCEL ORAL TABLET 500 MG Formulary OTC CITRULLINE 1000 ORAL PACKET 1 GM Formulary OTC CITRULLINE200 ORAL PACKET 200 MG Formulary OTC cladribine intravenous solution 10 mg/10ml Formulary clarithromycin er oral tablet extended release 24 hour 500 Formulary mg clarithromycin oral suspension reconstituted 125 mg/5ml, Formulary 250 mg/5ml clarithromycin oral tablet 250 mg, 500 mg Formulary CLARITIN CHILDRENS ORAL TABLET CHEWABLE 5 Formulary OTC MG CLARITIN ORAL CAPSULE 10 MG Formulary OTC CLARITIN ORAL SYRUP 5 MG/5ML Formulary OTC CLARITIN ORAL TABLET 10 MG Formulary OTC CLARITIN REDITABS ORAL TABLET DISPERSIBLE Formulary OTC 10 MG, 5 MG CLARITIN-D 12 HOUR ORAL TABLET EXTENDED Formulary OTC RELEASE 12 HOUR 5-120 MG

32 Drug Name Formulary Status Requirements/Limits CLARITIN-D 24 HOUR ORAL TABLET EXTENDED Formulary OTC RELEASE 24 HOUR 10-240 MG classic prenatal oral tablet 28-0.8 mg Formulary OTC CLEAN & CLEAR ACNE CLEANSER EXTERNAL Formulary OTC FOAM 2 % CLEAN & CLEAR ACNE CLEANSER EXTERNAL Formulary OTC LIQUID 2 % CLEAN & CLEAR ADVANTAGE MARK EXTERNAL Formulary OTC GEL 2 % CLEAN SIGHTS SOLUTION Formulary OTC CLEAN ZING MOUTH/THROAT LIQUID 0.06 % Formulary OTC CLEANLET LANCETS 28G Formulary OTC; QL (150 EA per 30 days) CLEAR EYES REDNESS RELIEF OPHTHALMIC Formulary OTC SOLUTION 0.012-0.2 % clear zinc spf 50 external lotion Formulary OTC CLEARASIL DAILY CLEAR ACNE EXTERNAL Formulary OTC CREAM 10 % CLEARCANAL EAR WAX REMOVAL OTIC KIT 6.5 % Formulary OTC CLEARLAX ORAL POWDER Formulary OTC CLEARLIFE ALLERGY RELIEF NASAL LIQUID Formulary OTC clemastine fumarate oral tablet 2.68 mg Formulary CLEOCIN VAGINAL SUPPOSITORY 100 MG Formulary CLERZ PLUS SOLUTION Formulary OTC CLEVER CHOICE BP MONITOR/WRIST DEVICE Formulary OTC CLINDACIN ETZ EXTERNAL SWAB 1 % Formulary hcl oral capsule 150 mg, 300 mg, 75 mg Formulary clindamycin palmitate hcl oral solution reconstituted 75 Formulary mg/5ml clindamycin phos-benzoyl perox external gel 1.2-5 % Formulary clindamycin phos-benzoyl perox external gel 1-5 % Formulary AGE (Max 18 Years) clindamycin phosphate external foam 1 % Formulary AGE (Max 18 Years) clindamycin phosphate external lotion 1 % Formulary AGE (Max 18 Years) clindamycin phosphate external solution 1 % Formulary AGE (Max 18 Years) clindamycin phosphate external swab 1 % Formulary AGE (Max 18 Years) clindamycin phosphate vaginal cream 2 % Formulary CLINDESSE VAGINAL CREAM 2 % Formulary clioquinol powder Formulary clobetasol propionate e external cream 0.05 % Formulary clobetasol propionate emulsion external foam 0.05 % Formulary clobetasol propionate external cream 0.05 % Formulary clobetasol propionate external foam 0.05 % Formulary clobetasol propionate external gel 0.05 % Formulary clobetasol propionate external ointment 0.05 % Formulary clobetasol propionate external solution 0.05 % Formulary clofarabine intravenous solution 1 mg/ml Formulary clomipramine hcl oral capsule 25 mg, 50 mg, 75 mg Formulary 33 Drug Name Formulary Status Requirements/Limits clonazepam oral tablet 0.5 mg, 1 mg, 2 mg Formulary clonazepam oral tablet dispersible 0.125 mg, 0.25 mg, 0.5 Formulary QL (170 EA per 34 days) mg, 1 mg, 2 mg clonidine hcl (analgesia) epidural solution 100 mcg/ml Formulary clonidine hcl oral tablet 0.1 mg, 0.2 mg, 0.3 mg Formulary clopidogrel bisulfate oral tablet 300 mg, 75 mg Formulary clorazepate dipotassium oral tablet 15 mg, 3.75 mg, 7.5 mg Formulary QL (170 EA per 30 days) CLORPACTIN POWDER 2 GM Formulary OTC 3 vaginal cream 2 % Formulary OTC clotrimazole anti-fungal external cream 1 % Formulary clotrimazole external cream 1 % Formulary clotrimazole mouth/throat lozenge 10 mg Formulary clotrimazole solution 1 % external (otc) 1 % Formulary clotrimazole vaginal cream 1 % Formulary OTC clotrimazole-betamethasone external cream 1-0.05 % Formulary clotrimazole-betamethasone external lotion 1-0.05 % Formulary clove oil oil Formulary clozapine oral tablet 100 mg, 200 mg, 25 mg, 50 mg Formulary AGE (Min 18 Years) clozapine oral tablet dispersible 100 mg, 12.5 mg, 150 mg, Formulary AGE (Min 18 Years) 200 mg, 25 mg co q-10 oral capsule 150 mg, 200 mg Formulary OTC COAGUCHEK XS PLUS SYSTEM KIT Formulary OTC COAGUCHEK XS PT TEST IN VITRO STRIP Formulary OTC coal tar liquid Formulary OTC coal tar solution Formulary coal tar tar Formulary COARTEM ORAL TABLET 20-120 MG Formulary COATS ALOE EXTERNAL CREAM 0.5 % Formulary OTC COATS ALOE EXTERNAL GEL 0.5 % Formulary OTC COATS ALOE EXTERNAL LOTION 0.5 % Formulary OTC COATS ALOE JUICE DRINK ORAL LIQUID Formulary OTC COATS ALOE EXTERNAL LOTION 10 % Formulary OTC cocoa butter Formulary cocoa butter skin external cream Formulary OTC cod oil oral capsule Formulary OTC cod liver oil oral oil Formulary codeine sulfate oral tablet 15 mg, 30 mg, 60 mg Formulary PA; QL (180 EA per 7 days) coditussin ac oral liquid 200-10 mg/5ml Formulary OTC coditussin dac oral liquid 30-10-200 mg/5ml Formulary OTC coenzyme q10 oral capsule 100 mg Formulary OTC coenzyme q-10 oral capsule 60 mg Formulary OTC coenzyme q10 oral liquid 30 mg/5ml Formulary OTC coenzyme q10 oral tablet 100 mg, 25 mg Formulary OTC coenzyme q10 oral tablet chewable 60 mg Formulary OTC

34 Drug Name Formulary Status Requirements/Limits co- q10-vitamin e oral wafer 200-400 mg-unit Formulary OTC cola syrup oral syrup Formulary OTC COLACE ORAL CAPSULE 100 MG Formulary OTC colchicine oral capsule 0.6 mg Formulary colchicine oral tablet 0.6 mg Formulary colchicine-probenecid oral tablet 0.5-500 mg Formulary cold & cough childrens oral liquid 2.5-1-5 mg/5ml Formulary OTC cold & cough day/night child oral 2.5-5 &2.5-6.25 mg/5ml Formulary OTC cold remedy oral tablet dispersible Formulary OTC cold sore treatment external gel 10.8-4.7 % Formulary OTC cold sore treatment external liquid Formulary OTC cold therapy pain relief external gel 3.1 % Formulary OTC COLD-EEZE MOUTH/THROAT LOZENGE 13.3 MG Formulary OTC colestipol hcl oral packet 5 gm Formulary colestipol hcl oral tablet 1 gm Formulary COLLASIL OSA POWDER Formulary collodion flexible external liquid Formulary collodion liquid Formulary COLOCORT RECTAL 100 MG/60ML Formulary COMBIGAN OPHTHALMIC SOLUTION 0.2-0.5 % Formulary COMBIVENT INHALATION AEROSOL Formulary SOLUTION 20-100 MCG/ACT COMFORT ASSIST INSULIN SYRINGE 29G X 1/2" 0.3 Formulary OTC ML 29G X 1/2" 0.3 ML COMFORT ASSIST INSULIN SYRINGE 29G X 1/2" 0.5 Formulary OTC ML 29G X 1/2" 0.5 ML COMFORT ASSIST INSULIN SYRINGE 29G X 1/2" 1 Formulary OTC ML 29G X 1/2" 1 ML COMFORT ASSIST INSULIN SYRINGE 30G X 5/16" 0.3 Formulary OTC ML 30G X 5/16" 0.3 ML COMFORT ASSIST INSULIN SYRINGE 30G X 5/16" 0.5 Formulary OTC ML 30G X 5/16" 0.5 ML COMFORT ASSIST INSULIN SYRINGE 30G X 5/16" 1 Formulary OTC ML 30G X 5/16" 1 ML COMFORT ASSIST INSULIN SYRINGE 31G X 5/16" 0.3 Formulary OTC ML 31G X 5/16" 0.3 ML COMFORT ASSIST INSULIN SYRINGE 31G X 5/16" 0.5 Formulary OTC ML 31G X 5/16" 0.5 ML COMFORT ASSIST INSULIN SYRINGE 31G X 5/16" 1 Formulary OTC ML 31G X 5/16" 1 ML comfort assured lancets 28g Formulary OTC; QL (150 EA per 30 days) comfort assured lancets 33g Formulary OTC; QL (150 EA per 30 days) COMFORT CLEAN/COMFORT SHIELD EXTERNAL 3 Formulary OTC % COMFORT EZ PEN NEEDLES 32G X 8 MM Formulary OTC COMPAT STAY-PUT NJ DOUBLE LUME Formulary OTC COMPLERA ORAL TABLET 200-25-300 MG Formulary 35 Drug Name Formulary Status Requirements/Limits complete lice treatment combination kit 0.33-4-0.5 % Formulary OTC complete natal dha oral 29-1-200 & 250 mg Formulary completenate oral tablet chewable 29-1 mg Formulary COMPOUND W MAXIMUM STRENGTH EXTERNAL Formulary OTC GEL 17 % COMPOUND W ONE STEP INVISIBLE EXTERNAL Formulary OTC STRIP 40 % compoz oral capsule 50 mg Formulary OTC COMTREX COLD & COUGH MAX ST ORAL TABLET Formulary OTC 10-5-325 MG COMTREX COLD/COUGH DAY/NITE MS ORAL 5-2- Formulary OTC 10-325 MG COMTREX DEEP CHEST COLD ORAL TABLET 325- Formulary OTC 200 MG CO-NATAL FA ORAL TABLET Formulary CONCEPT DHA ORAL CAPSULE 53.5-38-1 MG Formulary CONCEPT OB ORAL CAPSULE 130-92.4-1 MG Formulary CONCEPTIONXR MOTILITY SUPPORT ORAL Formulary OTC CONCERTA ORAL TABLET EXTENDED RELEASE 18 Formulary AGE (Min 4 Years and Max 17 Years) MG, 27 MG, 36 MG, 54 MG condoms Formulary OTC constulose oral solution 10 gm/15ml Formulary CONTAC COLD+FLU MAX ST ORAL TABLET 5-500 Formulary OTC MG CONTOUR NEXT CONTROL SOLUTION LOW IN Formulary OTC; QL (100 EA per 30 days) VITRO LOW CONTOUR NEXT CONTROL SOLUTION NORMAL IN Formulary OTC; QL (100 EA per 30 days) VITRO NORMAL CONTOUR NEXT EZ KIT W/DEVICE W/DEVICE Formulary OTC; QL (1 EA per 365 days) CONTOUR NEXT LINK KIT W/DEVICE W/DEVICE Formulary OTC; QL (1 EA per 365 days) CONTOUR NEXT MONITOR KIT W/DEVICE Formulary OTC; QL (1 EA per 365 days) W/DEVICE CONTOUR NEXT ONE KIT Formulary OTC; QL (1 EA per 365 days) CONTOUR NEXT TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) control denture adhesive cream Formulary OTC control syringe disposable 10 ml Formulary OTC convex eye protector Formulary OTC cool n heat ex st external patch 5 % Formulary OTC cool n heat maximum strength external liquid 16 % Formulary OTC COPAXONE SUBCUTANEOUS SOLUTION Formulary PREFILLED SYRINGE 20 MG/ML copper sulfate crystals Formulary OTC COPPERMIN ORAL TABLET 5 MG Formulary OTC co-q 10 omega-3 fish oil oral capsule Formulary OTC coq10 oral capsule 30 mg Formulary OTC coq-10 oral capsule 50 mg Formulary OTC coq10 oral powder 50 gm Formulary OTC 36 Drug Name Formulary Status Requirements/Limits coral calcium oral capsule 185-50-100 mg-mg-unit, 200- Formulary OTC 100-100 mg-unit CORICIDIN HBP COLD/FLU ORAL TABLET 2-325 MG Formulary OTC CORICIDIN HBP COUGH/COLD ORAL TABLET 4-30 Formulary OTC MG CORICIDIN HBP DAY/NIGHT COLD ORAL 10-20 &15- Formulary OTC 200-2 MG CORICIDIN HBP NIGHTTIME COLD ORAL LIQUID Formulary OTC 15-6.25-500 MG/15ML CORIFACT INTRAVENOUS KIT 1000-1600 UNIT Formulary corn oil oil Formulary corn oil oral oil Formulary OTC CORN REMOVER WATERPROOF EXTERNAL PAD 40 Formulary OTC % corn starch powder Formulary corn/callus remover external solution 12.6 % Formulary OTC CORRECTOL EXTRA GENTLE ORAL CAPSULE 100 Formulary OTC MG CORTIFOAM RECTAL FOAM 10 % Formulary cortisone acetate oral tablet 25 mg Formulary CORTIZONE-10/ALOE EXTERNAL CREAM 1 % Formulary OTC CORVITA 150 ORAL TABLET 150-1.25 MG Formulary COSAMIN ASU FOR JOINT HEALTH ORAL CAPSULE Formulary OTC COSAMIN VERDE FOR JOINT HEALTH ORAL Formulary OTC TABLET cottonseed oil oil Formulary COTTONTAILS DIAPER RASH CREAMY EXTERNAL Formulary OTC OINTMENT 10 % cough & chest congestion dm oral liquid 5-100 mg/5ml Formulary OTC cough & cold oral tablet 4-30 mg Formulary OTC cough drops mouth/throat lozenge 10 mg, 3.1 mg, 5 mg, 5.4 Formulary OTC mg, 6.5 mg, 7.5 mg, 7.6 mg, 8 mg, 9.1 mg cough relief oral liquid 15 mg/5ml Formulary OTC coughtab oral tablet 200 mg Formulary OTC cramp tabs oral tablet 325-25 mg Formulary OTC cranberry oral capsule 250 mg Formulary OTC cream base with external cream Formulary creatine monohydrate powder Formulary creatine oral powder Formulary OTC creatine5000 oral packet 5000 mg Formulary OTC CREON ORAL CAPSULE DELAYED RELEASE PARTICLES 12000 UNIT, 24000-76000 UNIT, 3000-9500 Formulary PA UNIT, 36000 UNIT, 6000 UNIT CR-GTF ORAL CAPSULE 200 MCG Formulary OTC CRITIC-AID CLEAR AF EXTERNAL OINTMENT 2 % Formulary OTC CRIXIVAN ORAL CAPSULE 200 MG, 400 MG Formulary

37 Drug Name Formulary Status Requirements/Limits cromolyn sodium inhalation nebulization solution 20 Formulary mg/2ml cromolyn sodium nasal aerosol solution 5.2 mg/act Formulary OTC cromolyn sodium ophthalmic solution 4 % Formulary cromolyn sodium oral concentrate 100 mg/5ml Formulary CROTAN EXTERNAL LOTION 10 % Formulary ST croton oil oil Formulary CR-PLUS ORAL TABLET 500 MCG Formulary OTC CRYOSERV SOLUTION Formulary CRYSELLE-28 ORAL TABLET 0.3-30 MG-MCG Formulary QL (28 EA per 28 days) cu-25 oral capsule 25 mg Formulary OTC cu-5 oral capsule 5 mg Formulary OTC CULTURELLE GENTLE-GO KIDS ORAL PACKET Formulary OTC CULTURELLE KIDS ORAL PACKET Formulary OTC cupric sulfate powder Formulary CURAD GERM SHIELD EXTERNAL GEL Formulary OTC CURAFIL WOUND DRESSING EXTERNAL GEL Formulary OTC CURASOL WOUND DRESSING EXTERNAL GEL Formulary OTC CURITY ALCOHOL PREPS PAD 70 % 70 % Formulary OTC CURITY ALCOHOL SWABS PAD Formulary OTC CURITY GAUZE SPONGE PAD 2"X2" Formulary OTC CURITY MESH GAUZE BNDG 4"X30' Formulary OTC CURITY NURSING PAD Formulary OTC CURX ANTIMICROBIAL EXTERNAL GEL 0.13 % Formulary OTC CUTINOVA HYDRO 2"X2-3/8" EXTERNAL Formulary OTC cvs adhesive gauze pad 2-3/8"x4" Formulary OTC cvs aftersun aloe/lidocaine external gel 0.5 % Formulary OTC CVS AIRSHIELD ORAL TABLET EFFERVESCENT Formulary OTC cvs alcohol prep pads pad 70 % 70 % Formulary OTC cvs allergy relief childrens oral tablet dispersible 12.5 mg Formulary OTC cvs allergy relief d oral tablet extended release 12 hour 60- Formulary OTC; QL (68 EA per 34 days) 120 mg cvs all-purpose skin protect external ointment Formulary OTC cvs antacid childrens oral liquid 400 mg/5ml Formulary OTC cvs anti-diarrheal oral capsule 2 mg Formulary OTC cvs anti-diarrheal oral suspension 262 mg/15ml Formulary OTC cvs anti-itch sensitive external lotion 1 % Formulary OTC cvs astringent solution external packet Formulary OTC cvs b complex plus c oral tablet Formulary OTC cvs baby safety swabs swab Formulary OTC cvs backache relief oral tablet 500 mg Formulary OTC cvs calcium 600 plus oral tablet chewable Formulary OTC cvs calcium oral tablet chewable 250-400 mg-unit Formulary OTC cvs cherry menthol drops mouth/throat lozenge Formulary OTC

38 Drug Name Formulary Status Requirements/Limits cvs chest rub medicated external ointment 4.7-1.2-2.6 % Formulary OTC cvs cleansing eyelid wipes external pad Formulary OTC cvs cleansing skin external cream Formulary OTC cvs cold remedy oral tablet dispersible Formulary OTC cvs corn/callus remover external kit 17 % Formulary OTC cvs creamy acne face wash external liquid 4 % Formulary OTC; AGE (Max 18 Years) cvs d3 oral capsule 1000 unit Formulary OTC cvs dairy relief ex st oral tablet 4500 unit Formulary OTC cvs daytime/nighttime cold/flu oral (liquid) Formulary OTC cvs daytime/nighttime cough oral liquid therapy pack 6.25- Formulary OTC 15 & 15 mg/15ml cvs diabetes health support oral Formulary OTC cvs digestive probiotic oral capsule Formulary OTC cvs diuretic maximum strength oral capsule 50 mg Formulary OTC cvs e oil oral oil 100 unt/0.25ml Formulary OTC cvs early result pregnancy in vitro diagnostic test Formulary OTC cvs easy fiber/calcium oral tablet chewable Formulary OTC cvs enema disposable rectal enema 19-7 gm/118ml Formulary OTC cvs epsom salt granules Formulary OTC cvs ethyl alcohol solution 70 % Formulary OTC cvs eye pad Formulary OTC cvs fiber gummies oral tablet chewable 2 gm Formulary OTC cvs gas relief extra strength oral tablet chewable 125 mg Formulary OTC cvs gas relief oral tablet chewable 80 mg Formulary OTC cvs gauze sterile pad 4"x4" Formulary OTC cvs gluco-chondroit plus uc-ii oral tablet 125-100-10 mg Formulary OTC cvs glucosamine-chondroitin oral tablet chewable 750-600 Formulary OTC mg cvs glucosamine-chondroit-msm oral tablet 375-300-250 Formulary OTC mg cvs glucose bits oral tablet chewable 1 gm Formulary OTC cvs glucose shot oral liquid Formulary OTC cvs glycerin adult rectal suppository 2.1 gm Formulary OTC cvs hair regrowth for women external foam 5 % Formulary OTC cvs hand wash advanced antibac external solution 2 % Formulary OTC cvs heartburn relief ex st oral suspension 254-237.5 mg/5ml Formulary OTC cvs heatwraps/back/hip Formulary OTC cvs hemorrhoidal rectal suppository 0.25-88.44 % Formulary OTC cvs hot steam inhalation liquid 6.2 % Formulary OTC cvs hydrocolloid pads pad Formulary OTC cvs inner ear plus oral tablet Formulary OTC cvs instant food thickener oral powder Formulary OTC cvs iron oral tablet 325 (65 fe) mg Formulary OTC cvs isopropyl alcohol wipes external 70 % Formulary OTC

39 Drug Name Formulary Status Requirements/Limits cvs itch relief external gel 2 % Formulary OTC cvs lancets 21g Formulary OTC; QL (150 EA per 30 days) cvs lancets micro thin 33g Formulary OTC; QL (150 EA per 30 days) cvs lancets original Formulary OTC; QL (150 EA per 30 days) cvs lancets thin 26g Formulary OTC; QL (150 EA per 30 days) cvs lancets ultra thin 30g Formulary OTC; QL (150 EA per 30 days) cvs lancets ultra-thin 30g Formulary OTC; QL (150 EA per 30 days) cvs laxative dietary supplemnt oral tablet 500 mg Formulary OTC cvs l-lysine oral tablet 500 mg Formulary OTC cvs lubricant drops ophthalmic gel 0.25-0.3 % Formulary OTC cvs magnesium citrate oral capsule 125 mg Formulary OTC cvs manuka honey wound external gel Formulary OTC cvs melatonin extra strength oral liquid 5 mg/15ml Formulary OTC cvs melatonin oral tablet chewable 5 mg Formulary OTC cvs melatonin sublingual tablet sublingual 5 mg Formulary OTC cvs miconazole 1 combo pack vaginal kit 1200 & 2 mg & % Formulary OTC cvs miconazole 3 combo pack vaginal kit 200 & 2 mg-% Formulary OTC (9gm) cvs mineral oil enema rectal enema Formulary OTC cvs mineral oil oral oil Formulary OTC cvs mini enema kids rectal enema 100 mg/5ml Formulary OTC cvs multi-purpose external ointment 15.5-53.4 % Formulary OTC cvs nasal allergy spray aerosol 55 mcg/act nasal 55 Formulary OTC mcg/act cvs nasal decongestant inhalation inhaler 50 mg Formulary OTC cvs nasal decongestant oral capsule 30 mg Formulary OTC cvs nasal mist nasal aerosol solution 3 % Formulary OTC cvs natural fiber supplement oral packet 58.6 % Formulary OTC cvs natural fish oil oral capsule 1000 mg Formulary OTC cvs nerve pain relief external ointment Formulary OTC cvs non-drying sinus pe oral tablet 5-200 mg Formulary OTC cvs oral tablet delayed release 20 mg Formulary OTC cvs oral pain reliever mouth/throat cream 20 % Formulary OTC cvs pain relief external cream 4 % Formulary OTC cvs pain relief regular st oral capsule 325 mg Formulary OTC cvs phosphate saline laxative oral solution 2.7-7.2 gm/15ml Formulary OTC cvs potassium gluconate oral tablet 2 meq Formulary OTC cvs prenatal gummy oral tablet chewable 0.4-113.5 mg Formulary OTC cvs prenatal oral tablet 28-0.8 mg Formulary OTC cvs prep pad 70 % 70 % Formulary OTC cvs protective external powder 81-15 % Formulary OTC cvs saline wound wash external solution 0.9 % Formulary OTC cvs selenium oral tablet 200 mcg Formulary OTC cvs silver external gel Formulary OTC

40 Drug Name Formulary Status Requirements/Limits cvs sinus relief day/night oral Formulary OTC cvs skin relief external lotion 1.3 % Formulary OTC cvs sore muscle rub external gel 2.5 % Formulary OTC cvs sore throat max strength mouth/throat lozenge 15-2.6 Formulary OTC mg cvs sore throat relief pops mouth/throat lozenge on a handle Formulary OTC 20 mg cvs steam inhaler Formulary OTC cvs stool softener oral capsule 50 mg Formulary OTC cvs stuffy nose & cold child oral liquid 2.5-100 mg/5ml Formulary OTC cvs super cranberry urinary oral capsule 140-100 mg Formulary OTC cvs tension headache oral capsule 500-65 mg Formulary OTC cvs therapeutic external shampoo 0.5 % Formulary OTC cvs triacting cough/runny nose oral liquid 1-5 mg/5ml Formulary OTC cvs triple magnesium complex oral capsule 400 mg Formulary OTC cvs ultra thin lancets Formulary OTC; QL (150 EA per 30 days) cvs vaporizer warm steam Formulary OTC cvs wound wash advanced external liquid Formulary OTC cvs yogurt+calcium gummies oral tablet chewable 250-100 Formulary OTC mg-unit cvs zinc oxide diaper external cream 1-10 % Formulary OTC cyanocobalamin crystals Formulary cyanocobalamin injection solution 1000 mcg/ml Formulary cyclobenzaprine hcl oral tablet 10 mg, 5 mg, 7.5 mg Formulary CYCLOMYDRIL OPHTHALMIC SOLUTION 0.2-1 % Formulary cyclopentolate hcl ophthalmic solution 1 % Formulary injection solution reconstituted 1 gm, 2 Formulary gm, 500 mg cyclophosphamide oral capsule 25 mg, 50 mg Formulary cyclosporine modified oral capsule 100 mg, 25 mg, 50 mg Formulary cyclosporine modified oral solution 100 mg/ml Formulary cyclosporine oral capsule 100 mg, 25 mg Formulary cyproheptadine hcl oral syrup 2 mg/5ml Formulary cyproheptadine hcl oral tablet 4 mg Formulary CYSTADANE ORAL POWDER Formulary PA CYSTAGON ORAL CAPSULE 150 MG, 50 MG Formulary CYSTECH ORAL CAPSULE 500 MG Formulary OTC cystine oral packet 500 mg Formulary OTC cytarabine (pf) injection solution 100 mg/ml, 20 mg/ml Formulary CYTO-Q MAX ORAL LIQUID 100 MG/ML Formulary OTC d 1000 oral tablet 1000 unit Formulary OTC d 2000 oral tablet 2000 unit Formulary OTC dacarbazine intravenous solution reconstituted 100 mg, 200 Formulary mg daily care skin protectant external ointment 30 % Formulary OTC

41 Drug Name Formulary Status Requirements/Limits daily ovulation predictor in vitro strip Formulary OTC daily vite multivitamin/iron oral tablet Formulary OTC dairy relief oral tablet 3000 unit Formulary OTC dakins (1/2 strength) external solution 0.25 % Formulary OTC dakins (1/4 strength) external solution 0.125 % Formulary OTC dakins external solution 0.4-0.5 % Formulary OTC DAKRINA OPHTHALMIC SOLUTION 2.7-2 % Formulary OTC danazol oral capsule 100 mg, 200 mg, 50 mg Formulary dandruff shampoo external lotion 1 % Formulary OTC dantrolene sodium oral capsule 100 mg, 25 mg, 50 mg Formulary dapsone oral tablet 100 mg, 25 mg Formulary DARAPRIM ORAL TABLET 25 MG Formulary PA daunorubicin hcl intravenous injectable 5 mg/ml Formulary day time multi-sympt cold/flu oral capsule 10-5-325 mg Formulary OTC DAYTIME COLD MEDICINE ORAL LIQUID 325-15 Formulary OTC MG/15ML daytime cough oral liquid 15 mg/15ml Formulary OTC daytime severe cold & flu oral liquid 5-10-200-325 Formulary OTC mg/15ml DAYTRANA TRANSDERMAL PATCH 10 MG/9HR, 15 QL (30 EA per 30 days); AGE (Min 4 Formulary MG/9HR, 20 MG/9HR, 30 MG/9HR Years and Max 17 Years) DDROPS ORAL LIQUID 2000 UT/0.028ML Formulary OTC DEBACTEROL MOUTH/THROAT SOLUTION 30-50 % Formulary DECARA ORAL CAPSULE 25000 UNIT Formulary OTC decitabine intravenous solution reconstituted 50 mg Formulary DECONEX DMX ORAL TABLET 10-17.5-385 MG Formulary OTC DECONEX IR ORAL TABLET 10-385 MG Formulary OTC powder Formulary del clens external gel Formulary OTC DELBASE COMPOUNDING EXTERNAL OINTMENT Formulary OTC DELSYM COUGH CHILDRENS ORAL SUSPENSION Formulary OTC EXTENDED RELEASE 30 MG/5ML DELTUSS DP ORAL LIQUID 1-30 MG/5ML Formulary OTC DELZICOL ORAL CAPSULE DELAYED RELEASE 400 Formulary MG demeclocycline hcl oral tablet 150 mg, 300 mg Formulary DEMEROL INJECTION SOLUTION 100 MG/2ML, 100 MG/ML, 25 MG/0.5ML, 25 MG/ML, 50 MG/ML, 75 Formulary MG/1.5ML, 75 MG/ML DEMSER ORAL CAPSULE 250 MG Formulary DENDRACIN NEURODENDRAXCIN EXTERNAL Formulary OTC LOTION 0.0375-10-30 % DENTAPAINE MOUTH/THROAT GEL 20 % Formulary OTC DEPACON INTRAVENOUS SOLUTION 100 MG/ML Formulary DEPEN TITRATABS ORAL TABLET 250 MG Formulary PA

42 Drug Name Formulary Status Requirements/Limits DEPO-PROVERA INTRAMUSCULAR SUSPENSION Formulary 400 MG/ML DEQUASINE ORAL TABLET Formulary OTC DERMA CIDOL 2000 EXTERNAL LIQUID 0.5 % Formulary OTC dermacloud external cream Formulary OTC DERMAGESIC EXTERNAL CREAM 1-0.4-0.4 % Formulary OTC DERMAGESIC EXTERNAL LIQUID 1-0.4-0.4 % Formulary OTC DERMAGRAN EXTERNAL GEL Formulary OTC DERMAL THERAPY FINGER CARE EXTERNAL Formulary OTC LOTION 20 % DERMAL WOUND CLEANSER EXTERNAL LIQUID Formulary OTC 0.13 % DERMAMED EXTERNAL OINTMENT Formulary OTC DERMAPLEX EXTERNAL GEL Formulary OTC DERMAREST PSORIASIS EXTERNAL GEL 3 % Formulary OTC DERMASTAT EXTERNAL FOAM 65 % Formulary OTC DERMASYN EXTERNAL GEL Formulary OTC DERMAZENE EXTERNAL CREAM 1-1 % Formulary DERMOPLAST EXTERNAL AEROSOL 20-0.5 % Formulary OTC DESCOVY ORAL TABLET 200-25 MG Formulary DESENEX FOOT/SNEAKER SPRAY EXTERNAL Formulary OTC AEROSOL DESGEN DM ORAL SYRUP 5-15-100 MG/5ML Formulary OTC DESGEN DM ORAL TABLET 30-10-200 MG Formulary OTC desipramine hcl oral tablet 10 mg, 100 mg, 150 mg, 25 mg, Formulary 50 mg, 75 mg DESITIN MAXIMUM STRENGTH EXTERNAL PASTE Formulary OTC 40 % desmopressin ace spray refrig nasal solution 0.01 % Formulary desmopressin acetate oral tablet 0.1 mg, 0.2 mg Formulary desmopressin acetate spray nasal solution 0.01 % Formulary desonide external cream 0.05 % Formulary desonide external lotion 0.05 % Formulary desonide external ointment 0.05 % Formulary despec dm-g oral syrup 5-10-100 mg/5ml Formulary OTC desvenlafaxine succinate er oral tablet extended release 24 Formulary ST hour 100 mg, 25 mg, 50 mg DEVROM ORAL TABLET CHEWABLE 200 MG Formulary OTC DEWEES CARMINATIVE ORAL LIQUID 6-250 Formulary OTC INTENSOL ORAL Formulary CONCENTRATE 1 MG/ML dexamethasone oral elixir 0.5 mg/5ml Formulary dexamethasone oral solution 0.5 mg/5ml Formulary dexamethasone oral tablet 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 Formulary mg, 4 mg, 6 mg

43 Drug Name Formulary Status Requirements/Limits dexamethasone sodium phosphate ophthalmic solution 0.1 Formulary % dexrazoxane intravenous solution reconstituted 250 mg, 500 Formulary mg dextroamphetamine sulfate oral tablet 10 mg, 5 mg Formulary AGE (Min 4 Years and Max 17 Years) dextrose anhydrous granules Formulary OTC dextrose powder Formulary dhea oral capsule 50 mg Formulary OTC dhea oral tablet 25 mg Formulary OTC DHS ZINC EXTERNAL SHAMPOO 2 % Formulary OTC DIAB DAILY CARE EXTERNAL GEL Formulary OTC DIABETIC BASICS HEALTHY FOOT EXTERNAL Formulary OTC LOTION 0.13 % DIABETIC TUSSIN ALLERGY ORAL SYRUP 2 Formulary OTC MG/5ML DIABETIC TUSSIN COLD/FLU ORAL CAPSULE 325-4- Formulary OTC 15 MG DIABETIC TUSSIN NIGHT COLD/FLU ORAL LIQUID Formulary OTC 10-12.5-325 MG/5ML DIABETISWEET ORAL POWDER Formulary OTC diabet-x daily prevention external cream 0.3 % Formulary OTC DIADERM FOOT REJUVENATING EXTERNAL Formulary OTC CREAM DIALYVITE 800 ORAL WAFER 0.8 MG Formulary OTC DIALYVITE 800 PLUS D ORAL WAFER 800 MCG Formulary OTC DIALYVITE 800/IRON ORAL TABLET 29-0.8 MG Formulary OTC DIALYVITE ORAL TABLET Formulary DIALYVITE/ZINC ORAL TABLET Formulary diaper rash external cream 10 % Formulary OTC diaper rash external paste 40 % Formulary OTC DIASTIX IN VITRO STRIP Formulary OTC DIAZEPAM INTENSOL ORAL CONCENTRATE 5 Formulary QL (136 ML per 34 days) MG/ML diazepam oral solution 1 mg/ml Formulary QL (136 EA per 34 days) diazepam oral tablet 10 mg Formulary QL (136 EA per 34 days) diazepam oral tablet 2 mg, 5 mg Formulary QL (136 EA per 30 days) diazepam rectal gel 10 mg, 2.5 mg, 20 mg Formulary dibucaine external ointment 1 % Formulary OTC diclofenac potassium oral tablet 50 mg Formulary diclofenac sodium er oral tablet extended release 24 hour Formulary 100 mg diclofenac sodium ophthalmic solution 0.1 % Formulary diclofenac sodium oral tablet delayed release 25 mg, 50 mg, Formulary 75 mg diclofenac sodium powder Formulary diclofenac sodium transdermal gel 1 % Formulary QL (200 GM per 30 days)

44 Drug Name Formulary Status Requirements/Limits sodium oral capsule 250 mg, 500 mg Formulary dicyclomine hcl oral capsule 10 mg Formulary dicyclomine hcl oral solution 10 mg/5ml Formulary dicyclomine hcl oral tablet 20 mg Formulary DI-DAK-SOL EXTERNAL SOLUTION 0.0125 % Formulary OTC didanosine oral capsule delayed release 200 mg, 250 mg, Formulary 400 mg dieters super tea oral Formulary OTC dietex forte oral capsule Formulary OTC diethylpropion hcl er oral tablet extended release 24 hour Formulary PA 75 mg diethylpropion hcl oral tablet 25 mg Formulary PA DIFFERIN GEL 0.1 % EXTERNAL (OTC) 0.1 % Formulary AGE (Max 18 Years) diflunisal oral tablet 500 mg Formulary digestive enzyme ultra oral capsule Formulary OTC DIGITEK ORAL TABLET 125 MCG, 250 MCG Formulary digoxin oral solution 0.05 mg/ml Formulary DILANTIN ORAL CAPSULE 100 MG, 30 MG Formulary DILAUDID INJECTION SOLUTION 1 MG/ML, 2 Formulary MG/ML, 4 MG/ML diltiazem cd oral capsule extended release 24 hour 120 mg, Formulary 180 mg, 240 mg, 300 mg diltiazem hcl er beads oral capsule extended release 24 Formulary hour 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg diltiazem hcl er coated beads oral capsule extended release Formulary 24 hour 120 mg, 180 mg, 240 mg, 300 mg, 360 mg diltiazem hcl er coated beads oral tablet extended release Formulary 24 hour 180 mg, 240 mg, 300 mg, 360 mg, 420 mg diltiazem hcl er oral capsule extended release 12 hour 120 Formulary mg, 60 mg, 90 mg diltiazem hcl er oral capsule extended release 24 hour 120 Formulary mg, 180 mg, 240 mg diltiazem hcl intravenous solution 125 mg/25ml, 25 mg/5ml, Formulary 50 mg/10ml diltiazem hcl intravenous solution reconstituted 100 mg Formulary diltiazem hcl oral tablet 120 mg, 30 mg, 60 mg, 90 mg Formulary dilt-xr oral capsule extended release 24 hour 120 mg, 180 Formulary mg, 240 mg dimenhydrinate oral tablet 50 mg Formulary DIMETAPP COLD/ALLERGY ORAL ELIXIR 1-2.5 Formulary OTC MG/5ML DIMETAPP DM COLD/COUGH ORAL LIQUID 2.5-1-5 Formulary OTC MG/5ML DIMETAPP LONG ACT COUGH/COLD ORAL SYRUP Formulary OTC 1-7.5 MG/5ML diphenhydramine hcl (sleep) oral tablet 50 mg Formulary OTC diphenhydramine hcl oral tablet 25 mg Formulary OTC diphenoxylate-atropine oral tablet 2.5-0.025 mg Formulary 45 Drug Name Formulary Status Requirements/Limits diphtheria-tetanus toxoids dt intramuscular suspension 25-5 Formulary AGE (Min 19 Years) lfu/0.5ml dipyridamole oral tablet 25 mg, 50 mg, 75 mg Formulary disulfiram oral tablet 250 mg, 500 mg Formulary divalproex sodium er oral tablet extended release 24 hour Formulary 250 mg, 500 mg divalproex sodium oral capsule delayed release sprinkle Formulary 125 mg divalproex sodium oral tablet delayed release 125 mg, 250 Formulary mg, 500 mg dl-leucine powder Formulary dl-pa-500 oral capsule 500 mg Formulary OTC DML EXTERNAL LOTION Formulary OTC DOANS PILLS ORAL TABLET 325 MG Formulary OTC DOANS PM EXTRA STRENGTH ORAL TABLET 580- Formulary OTC 25 MG DOC OMEGA ORAL PACKET 200 MG Formulary OTC intravenous concentrate 160 mg/8ml, 20 Formulary mg/0.5ml, 20 mg/ml, 80 mg/2ml, 80 mg/4ml docetaxel intravenous solution 160 mg/16ml, 20 mg/2ml, 80 Formulary mg/8ml sodium oral liquid 50 mg/5ml Formulary OTC docusate sodium oral tablet 100 mg Formulary OTC DOCUSOL KIDS RECTAL ENEMA 100 MG/5ML Formulary OTC DOCUSOL PLUS MINI-ENEMA RECTAL ENEMA 20- Formulary OTC 283 MG dofetilide oral capsule 125 mcg, 250 mcg, 500 mcg Formulary DOLOGEN ORAL TABLET 1-325 MG Formulary OTC dologesic-df oral tablet 1-500 mg Formulary OTC dolorex oral tablet 25-325 mg Formulary OTC DOMEBORO EXTERNAL PACKET Formulary OTC dometuss-da/children oral liquid 1-2.5 mg/5ml Formulary OTC donepezil hcl oral tablet 10 mg, 5 mg Formulary donepezil hcl oral tablet 23 mg Formulary QL (30 EA per 30 days) donepezil hcl oral tablet dispersible 10 mg, 5 mg Formulary dorzolamide hcl ophthalmic solution 2 % Formulary dorzolamide hcl-timolol mal ophthalmic solution 22.3-6.8 Formulary mg/ml DOUBLE-TUSSIN DM ORAL LIQUID 20-300 MG/5ML Formulary OTC DOVER IRRIGATION TRAY KIT Formulary OTC doxazosin mesylate oral tablet 1 mg, 2 mg, 4 mg Formulary QL (34 EA per 34 days) doxazosin mesylate oral tablet 8 mg Formulary QL (68 EA per 34 days) doxepin hcl oral capsule 10 mg, 100 mg, 150 mg, 25 mg, 50 Formulary mg doxepin hcl oral concentrate 10 mg/ml Formulary doxorubicin hcl intravenous solution 2 mg/ml Formulary

46 Drug Name Formulary Status Requirements/Limits doxorubicin hcl intravenous solution reconstituted 10 mg, Formulary 50 mg doxycycline hyclate oral capsule 100 mg, 50 mg Formulary doxycycline hyclate oral tablet 100 mg, 20 mg Formulary doxycycline monohydrate oral capsule 100 mg, 50 mg Formulary doxycycline monohydrate oral suspension reconstituted 25 Formulary mg/5ml doxycycline monohydrate oral tablet 150 mg, 50 mg, 75 mg Formulary doxylamine succinate powder Formulary DR BOLDTS HINEY HEALER EXTERNAL CREAM Formulary OTC DR SMITHS DIAPER EXTERNAL OINTMENT 10 % Formulary OTC DR SMITHS DIAPER RASH EXTERNAL AEROSOL 10 Formulary OTC % DR SMITHS RASH + SKIN EXTERNAL OINTMENT Formulary OTC 16-57 % DRAMAMINE ORAL TABLET 50 MG Formulary OTC DRAMAMINE ORAL TABLET CHEWABLE 50 MG Formulary OTC DRITHO-CREME HP EXTERNAL CREAM 1 % Formulary DRIXORAL COLD/ALLERGY ORAL TABLET Formulary OTC EXTENDED RELEASE 12 HOUR 6-120 MG DRIXORAL COUGH/SORE THROAT ORAL CAPSULE Formulary OTC 325-15 MG dronabinol oral capsule 10 mg, 2.5 mg, 5 mg Formulary PA DROPLET LANCETS ULTRA THIN 30G Formulary OTC; QL (150 EA per 30 days) drospirenone-ethinyl estradiol oral tablet 3-0.02 mg, 3-0.03 Formulary QL (28 EA per 28 days) mg DROXIA ORAL CAPSULE 200 MG, 300 MG, 400 MG Formulary drug mart lancets thin 26g Formulary OTC; QL (150 EA per 30 days) DRUG MART UNILET LANCETS 28G Formulary OTC; QL (150 EA per 30 days) DRUG MART UNILET LANCETS 30G Formulary OTC; QL (150 EA per 30 days) dry skin treatment adv therapy external ointment Formulary OTC drymax extra pad 8"x8" Formulary OTC DRYSOL EXTERNAL SOLUTION 20 % Formulary DULCOLAX MILK OF MAGNESIA ORAL Formulary OTC SUSPENSION 400 MG/5ML DULCOLAX ORAL TABLET DELAYED RELEASE 5 Formulary OTC MG DULCOLAX RECTAL SUPPOSITORY 10 MG Formulary OTC DULERA INHALATION AEROSOL 100-5 MCG/ACT, Formulary AGE (Min 12 Years) 200-5 MCG/ACT duloxetine hcl oral capsule delayed release particles 20 mg, Formulary 30 mg, 60 mg DURAFLEX COMFORT EXTERNAL GEL Formulary OTC DURAFLU ORAL TABLET 60-20-200-325 MG Formulary OTC DURAPROXIN ES TRANSDERMAL PATCH 3-1.25-10 Formulary OTC % DURAPROXIN TRANSDERMAL PATCH 1.25-3 % Formulary OTC

47 Drug Name Formulary Status Requirements/Limits DURASAFE SPINAL/EPIDURAL KIT Formulary DURATION SPRAY NASAL SOLUTION 0.05 % Formulary OTC DURAVENT DM ORAL TABLET 10-15-395 MG Formulary OTC DURAVENT PE ORAL TABLET 10-395 MG Formulary OTC DUREZOL OPHTHALMIC EMULSION 0.05 % Formulary dutasteride oral capsule 0.5 mg Formulary dutasteride-tamsulosin hcl oral capsule 0.5-0.4 mg Formulary D-VI-SOL ORAL LIQUID 400 UNIT/ML Formulary OTC d-xylose powder Formulary DY-O-DERM VITILIGO STAIN EXTERNAL Formulary OTC SOLUTION 6.55 % E.E.S. GRANULES ORAL SUSPENSION Formulary RECONSTITUTED 200 MG/5ML ear wax cleansing otic kit 6.5 % Formulary OTC EASIVENT Formulary QL (2 EA per 365 days) EASIVENT MASK LARGE Formulary QL (2 EA per 365 days) EASIVENT MASK MEDIUM Formulary QL (2 EA per 365 days) EASIVENT MASK SMALL Formulary QL (2 EA per 365 days) easy fiber oral powder Formulary OTC EASY TOUCH ALCOHOL PREP MEDIUM PAD 70 % Formulary OTC 70 % EASY TOUCH ALLERGY SYRINGE 26G X 3/8" 1 ML, Formulary OTC 27G X 1/2" 1 ML EASY TOUCH FLIPLOCK INSULIN SY 29G X 1/2" 1 Formulary OTC ML 29G X 1/2" 1 ML EASY TOUCH FLIPLOCK INSULIN SY 30G X 1/2" 1 Formulary OTC ML 30G X 1/2" 1 ML EASY TOUCH FLIPLOCK INSULIN SY 30G X 5/16" 1 Formulary OTC ML 30G X 5/16" 1 ML EASY TOUCH FLIPLOCK INSULIN SY 31G X 5/16" 1 Formulary OTC ML 31G X 5/16" 1 ML EASY TOUCH FLURINGE 25G X 1" 1 ML Formulary OTC EASY TOUCH INSULIN SAFETY SYR 29G X 1/2" 0.5 Formulary OTC ML 29G X 1/2" 0.5 ML EASY TOUCH INSULIN SAFETY SYR 29G X 1/2" 1 ML Formulary OTC 29G X 1/2" 1 ML EASY TOUCH INSULIN SAFETY SYR 30G X 1/2" 1 ML Formulary OTC 30G X 1/2" 1 ML EASY TOUCH INSULIN SAFETY SYR 30G X 5/16" 0.5 Formulary OTC ML 30G X 5/16" 0.5 ML EASY TOUCH INSULIN SYRINGE 27G X 1/2" 0.5 ML Formulary OTC 27G X 1/2" 0.5 ML EASY TOUCH INSULIN SYRINGE 27G X 1/2" 1 ML Formulary OTC 27G X 1/2" 1 ML EASY TOUCH INSULIN SYRINGE 28G X 1/2" 0.5 ML Formulary OTC 28G X 1/2" 0.5 ML EASY TOUCH INSULIN SYRINGE 28G X 1/2" 1 ML Formulary OTC 28G X 1/2" 1 ML

48 Drug Name Formulary Status Requirements/Limits EASY TOUCH INSULIN SYRINGE 29G X 1/2" 0.5 ML Formulary OTC 29G X 1/2" 0.5 ML EASY TOUCH INSULIN SYRINGE 29G X 1/2" 1 ML Formulary OTC 29G X 1/2" 1 ML EASY TOUCH INSULIN SYRINGE 30G X 1/2" 0.3 ML Formulary OTC 30G X 1/2" 0.3 ML EASY TOUCH INSULIN SYRINGE 30G X 1/2" 0.5 ML Formulary OTC 30G X 1/2" 0.5 ML EASY TOUCH INSULIN SYRINGE 30G X 1/2" 1 ML Formulary OTC 30G X 1/2" 1 ML EASY TOUCH INSULIN SYRINGE 30G X 5/16" 0.3 ML Formulary OTC 30G X 5/16" 0.3 ML EASY TOUCH INSULIN SYRINGE 30G X 5/16" 0.5 ML Formulary OTC 30G X 5/16" 0.5 ML EASY TOUCH INSULIN SYRINGE 30G X 5/16" 1 ML Formulary OTC 30G X 5/16" 1 ML EASY TOUCH INSULIN SYRINGE 31G X 5/16" 0.3 ML Formulary OTC 31G X 5/16" 0.3 ML EASY TOUCH INSULIN SYRINGE 31G X 5/16" 0.5 ML Formulary OTC 31G X 5/16" 0.5 ML EASY TOUCH INSULIN SYRINGE 31G X 5/16" 1 ML Formulary OTC 31G X 5/16" 1 ML EASY TOUCH LANCETS 26G Formulary OTC; QL (150 EA per 30 days) EASY TOUCH LANCETS 26G/TWIST Formulary OTC; QL (150 EA per 30 days) EASY TOUCH LANCETS 28G Formulary OTC; QL (150 EA per 30 days) EASY TOUCH LANCETS 28G/TWIST Formulary OTC; QL (150 EA per 30 days) EASY TOUCH LANCETS 30G Formulary OTC; QL (150 EA per 30 days) EASY TOUCH LANCETS 30G/TWIST Formulary OTC; QL (150 EA per 30 days) EASY TOUCH LANCETS 32G Formulary OTC; QL (150 EA per 30 days) EASY TOUCH LANCETS 32G/TWIST Formulary OTC; QL (150 EA per 30 days) EASY TOUCH LANCETS 33G/TWIST Formulary OTC; QL (150 EA per 30 days) EASY TOUCH SHEATHLOCK SYRINGE 29G X 1/2" 1 Formulary OTC ML 29G X 1/2" 1 ML EASY TOUCH SHEATHLOCK SYRINGE 30G X 1/2" 1 Formulary OTC ML 30G X 1/2" 1 ML EASY TOUCH SHEATHLOCK SYRINGE 30G X 5/16" 1 Formulary OTC ML 30G X 5/16" 1 ML EASY TOUCH SHEATHLOCK SYRINGE 31G X 5/16" 1 Formulary OTC ML 31G X 5/16" 1 ML EASY TWIST & CAP LANCETS Formulary OTC; QL (150 EA per 30 days) EASYGEL DENTAL GEL 0.4 % Formulary ecee plus oral tablet Formulary OTC econazole nitrate external cream 1 % Formulary ECOTRIN MAXIMUM STRENGTH ORAL TABLET Formulary OTC DELAYED RELEASE 500 MG ECOTRIN ORAL TABLET DELAYED RELEASE 325 Formulary OTC MG e-cream complex external cream Formulary OTC

49 Drug Name Formulary Status Requirements/Limits ed a-hist dm oral tablet 10-4-10 mg Formulary OTC ED A-HIST ORAL LIQUID 4-10 MG/5ML Formulary OTC ed bron gp oral liquid 5-100 mg/5ml Formulary OTC ED CHLORPED D ORAL LIQUID 2-5 MG/ML Formulary OTC ED CHLORPED ORAL LIQUID 2 MG/ML Formulary OTC edetate disodium powder Formulary ed-spaz oral tablet dispersible 0.125 mg Formulary EDURANT ORAL TABLET 25 MG Formulary oral capsule 200 mg, 50 mg Formulary efavirenz oral tablet 600 mg Formulary EFFER-K ORAL TABLET EFFERVESCENT 25 MEQ Formulary effervescent pain relief oral tablet effervescent 325 mg Formulary OTC effervescent pot chloride oral tablet effervescent 25 meq Formulary EGRIFTA SUBCUTANEOUS SOLUTION Formulary PA RECONSTITUTED 1 MG ELDERTONIC ORAL ELIXIR Formulary OTC ELIDEL EXTERNAL CREAM 1 % Formulary PA; AGE (Min 2 Years) ELIGARD SUBCUTANEOUS KIT 22.5 MG, 30 MG, 45 Formulary PA; QL (1 EA per 90 days) MG, 7.5 MG ELIQUIS ORAL TABLET 2.5 MG, 5 MG Formulary elite ca/mg oral tablet 100-50 mg Formulary OTC elite calcium oral tablet 150 mg Formulary OTC ELITE ZINC ORAL CAPSULE 15 MG Formulary OTC ELITEK INTRAVENOUS SOLUTION Formulary RECONSTITUTED 1.5 MG, 7.5 MG ELITE-OB ORAL TABLET 50-1.25 MG Formulary elite-thin insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC elite-thin insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC elite-thin insulin syringe 28g x 5/16" 0.5 ml 28g x 5/16" 0.5 Formulary OTC ml elite-thin insulin syringe 28g x 5/16" 1 ml 28g x 5/16" 1 ml Formulary OTC elite-thin insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC elite-thin insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC elite-thin insulin syringe 29g x 5/16" 0.5 ml 29g x 5/16" 0.5 Formulary OTC ml elite-thin insulin syringe 29g x 5/16" 1 ml 29g x 5/16" 1 ml Formulary OTC elite-thin insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 Formulary OTC ml elite-thin insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC elite-thin insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 Formulary OTC ml elite-thin insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 Formulary OTC ml elite-thin insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC ELIXOPHYLLIN ORAL ELIXIR 80 MG/15ML Formulary ELIXSURE COUGH ORAL GEL 7.5 MG/5ML Formulary OTC 50 Drug Name Formulary Status Requirements/Limits ELIXSURE FEVER/PAIN ORAL GEL 160 MG/5ML Formulary OTC ELLA ORAL TABLET 30 MG Formulary ELLURA ORAL CAPSULE 200 MG Formulary OTC ELMIRON ORAL CAPSULE 100 MG Formulary ELTA DERMAL EXTERNAL GEL Formulary OTC EMCYT ORAL CAPSULE 140 MG Formulary EMETROL ORAL SOLUTION 1.87-1.87-21.5 Formulary OTC EMJOI TENS DEVICE Formulary empty capsule size 1 clear capsule Formulary EMTRIVA ORAL CAPSULE 200 MG Formulary EMTRIVA ORAL SOLUTION 10 MG/ML Formulary EMULSION SB EMULSION EXTERNAL Formulary enalapril maleate oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg Formulary enalapril-hydrochlorothiazide oral tablet 10-25 mg, 5-12.5 Formulary mg ENBREL SUBCUTANEOUS SOLUTION PREFILLED Formulary AGE (Min 2 Years) SYRINGE 25 MG/0.5ML, 50 MG/ML ENBREL SUBCUTANEOUS SOLUTION Formulary AGE (Min 2 Years) RECONSTITUTED 25 MG ENBREL SURECLICK SUBCUTANEOUS SOLUTION Formulary AGE (Min 2 Years) AUTO-INJECTOR 50 MG/ML ENDOXCIN EXTERNAL PATCH 4-1 % Formulary OTC ENDUR-ACIN ORAL TABLET EXTENDED RELEASE Formulary OTC 500 MG ENEMEEZ MINI RECTAL ENEMA 283 MG Formulary OTC ENFAMIL ENFALYTE ORAL SOLUTION Formulary OTC ENFAMIL EXPECTA ORAL 28-0.8 & 200 MG Formulary OTC ENGERIX-B INJECTION SUSPENSION 10 MCG/0.5ML, Formulary AGE (Min 19 Years) 20 MCG/ML ENLITE GLUCOSE SENSOR Formulary enoxaparin sodium injection solution 300 mg/3ml Formulary enoxaparin sodium subcutaneous solution 100 mg/ml, 120 mg/0.8ml, 150 mg/ml, 30 mg/0.3ml, 40 mg/0.4ml, 60 Formulary mg/0.6ml, 80 mg/0.8ml ENPRESSE-28 ORAL TABLET Formulary QL (28 EA per 28 days) entecavir oral tablet 0.5 mg, 1 mg Formulary ENTEX T ORAL TABLET 60-375 MG Formulary OTC ENTRESTO ORAL TABLET 24-26 MG, 49-51 MG, 97- PA; QL (68 EA per 34 days); AGE (Min Formulary 103 MG 18 Years) ENTSOL NASAL NASAL SOLUTION 3 % Formulary OTC enulose oral solution 10 gm/15ml Formulary e-oil external oil 30000 unit Formulary OTC epa/gla oral capsule Formulary OTC ephedrine hcl oral tablet 25 mg Formulary OTC epidural needle 18g x 2" , 18g x 4" Formulary OTC epinastine hcl ophthalmic solution 0.05 % Formulary

51 Drug Name Formulary Status Requirements/Limits epinephrine injection solution 30 mg/30ml Formulary epinephrine injection solution auto-injector 0.15 mg/0.3ml, Formulary 0.3 mg/0.3ml epinephrine pf injection solution 1 mg/ml Formulary epinephrine pf injection solution prefilled syringe 1 Formulary mg/10ml epinephrine solution auto-injector 0.15 mg/0.15ml injection Formulary 0.15 mg/0.15ml epinephrine solution auto-injector 0.3 mg/0.3ml injection Formulary 0.3 mg/0.3ml EPIPEN 2-PAK SOLUTION AUTO-INJECTOR 0.3 Formulary MG/0.3ML INJECTION 0.3 MG/0.3ML EPIPEN JR 2-PAK SOLUTION AUTO-INJECTOR 0.15 Formulary MG/0.3ML INJECTION 0.15 MG/0.3ML epirubicin hcl intravenous solution 200 mg/100ml, 50 Formulary mg/25ml EPISORB TRANSDERMAL Formulary OTC EPITOL ORAL TABLET 200 MG Formulary EPIVIR HBV ORAL SOLUTION 5 MG/ML Formulary eplerenone oral tablet 25 mg, 50 mg Formulary eprosartan mesylate oral tablet 600 mg Formulary ST epsom salt oral granules Formulary OTC epsom salt powder Formulary OTC eq allergy relief childrens oral elixir 12.5 mg/5ml Formulary OTC eq allergy relief oral tablet 10 mg Formulary OTC eq allergy/sinus headache oral tablet 12.5-30-500 mg Formulary OTC eq aspirin oral tablet delayed release 500 mg Formulary OTC EQ BABY CHEST RUB EXTERNAL CREAM Formulary OTC eq calcium citrate+d3 petites oral tablet 200-250 mg-unit Formulary OTC eq cough sugar free mouth/throat lozenge 5.8 mg Formulary OTC eq cryogenic wart removal sys external aerosol Formulary OTC eq daily fiber oral capsule 400 mg Formulary OTC eq dairy digestive fast acting oral tablet 9000 unit Formulary OTC eq dairy digestive fast acting oral tablet chewable 9000 unit Formulary OTC eq feminine wash sensitive vaginal liquid Formulary OTC eq ibuprofen pm oral tablet 200-38 mg Formulary OTC EQ MUCUS ER ORAL TABLET EXTENDED RELEASE Formulary OTC 12 HOUR 600 MG eq multi-symptom cold children oral liquid 2.5-5-100 mg/ml Formulary OTC eq omeprazole oral tablet delayed release 20 mg Formulary OTC eq pain relief/rapid burst oral liquid 500 mg/15ml Formulary OTC eq sinus relief max st oral tablet 30-500 mg Formulary OTC eq tioconazole 1 vaginal ointment 6.5 % Formulary OTC eql 2 in 1 probiotic oral tablet Formulary OTC eql advanced relief ophthalmic solution 0.05-0.1-1-1 % Formulary OTC eql alcohol swabs pad 70 % 70 % Formulary OTC 52 Drug Name Formulary Status Requirements/Limits eql aller-ease oral tablet 180 mg Formulary OTC; QL (34 EA per 34 days) eql allergy oral tablet 4 mg Formulary OTC eql aloe vera after sun external gel Formulary OTC eql antacid ultra strength oral tablet chewable 1000 mg Formulary OTC eql antibacterial hand soap external liquid 0.13 % Formulary OTC eql anti-nausea oral solution 1.87-1.87-21.5 Formulary OTC eql biotin oral capsule 5000 mcg Formulary OTC eql color lancets 21g Formulary OTC; QL (150 EA per 30 days) eql color lancets micro 33g Formulary OTC; QL (150 EA per 30 days) eql congestion relief oral tablet 10-200 mg Formulary OTC eql denture brush/pick Formulary OTC eql denture cleanser tablet effervescent Formulary OTC eql digestive oral tablet Formulary OTC eql ear drops otic solution Formulary OTC eql effervescent cold relief oral tablet effervescent 2-7.8- Formulary OTC 325 mg eql ethyl alcohol (rubbing) solution 70 % Formulary OTC eql everyday clean external shampoo 1 % Formulary OTC eql eye drops ac ophthalmic solution 0.05-0.25 % Formulary OTC eql fiber therapy oral powder 48.57 % Formulary OTC eql gas prevention oral capsule Formulary OTC eql gentle skin cleanser external liquid Formulary OTC eql insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC eql insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC eql insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC eql insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml Formulary OTC eql insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC eql insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC eql insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC eql insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC eql insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC eql lutein oral capsule 20 mg Formulary OTC eql /gargle mouth/throat liquid Formulary OTC eql mucus-dm oral tablet extended release 12 hour 30-600 Formulary OTC mg eql multi-purpose solution Formulary OTC eql omega 3 fish oil oral capsule delayed release 1200 mg Formulary OTC eql omeprazole oral tablet delayed release 20 mg Formulary OTC eql one daily womens oral tablet Formulary OTC eql redness relief ophthalmic solution 0.012-0.2 % Formulary OTC eql scalp relief max strength external liquid 3 % Formulary OTC eql super thin lancets 30g Formulary OTC; QL (150 EA per 30 days) eql thin lancets 26g Formulary OTC; QL (150 EA per 30 days) eql ultra protection spf50 external aerosol Formulary OTC

53 Drug Name Formulary Status Requirements/Limits eql vitamin d3 oral capsule 400 unit Formulary OTC eql wet cleansing towelettes external Formulary OTC EQUALACTIN ORAL TABLET CHEWABLE 625 MG Formulary OTC ERBITUX INTRAVENOUS SOLUTION 100 MG/50ML, Formulary PA 200 MG/100ML ergocalciferol oral capsule 50000 unit Formulary ergocalciferol oral solution 8000 unit/ml Formulary OTC ergoloid mesylates oral tablet 1 mg Formulary ery external pad 2 % Formulary ERYPED 200 ORAL SUSPENSION RECONSTITUTED Formulary 200 MG/5ML ERY-TAB ORAL TABLET DELAYED RELEASE 250 Formulary MG ERYTHROCIN LACTOBIONATE INTRAVENOUS Formulary SOLUTION RECONSTITUTED 500 MG ERYTHROCIN STEARATE ORAL TABLET 250 MG Formulary erythromycin base oral capsule delayed release particles Formulary 250 mg erythromycin ethylsuccinate oral suspension reconstituted Formulary 200 mg/5ml erythromycin ethylsuccinate oral tablet 400 mg Formulary erythromycin external gel 2 % Formulary erythromycin external solution 2 % Formulary AGE (Max 18 Years) erythromycin ophthalmic ointment 5 mg/gm Formulary escavite lq oral liquid 0.25-6 mg/ml Formulary escitalopram oxalate oral tablet 10 mg, 20 mg, 5 mg Formulary esmolol hcl intravenous solution 100 mg/10ml Formulary magnesium oral capsule delayed release 20 Formulary QL (30 EA per 30 days) mg, 40 mg ESOTERICA FADE NIGHTTIME EXTERNAL CREAM Formulary OTC 2 % ESOTERICA SENSITIVE SKIN EXTERNAL CREAM Formulary OTC 1.5 % ESTARYLLA ORAL TABLET 0.25-35 MG-MCG Formulary QL (28 EA per 28 days) estazolam oral tablet 1 mg, 2 mg Formulary estradiol oral tablet 0.5 mg, 1 mg, 2 mg Formulary estradiol transdermal patch twice weekly 0.025 mg/24hr, Formulary QL (8 EA per 34 days) 0.0375 mg/24hr, 0.05 mg/24hr, 0.075 mg/24hr estradiol transdermal patch twice weekly 0.1 mg/24hr Formulary QL (8 EA per 28 days) estradiol transdermal patch weekly 0.025 mg/24hr, 0.0375 mg/24hr, 0.05 mg/24hr, 0.06 mg/24hr, 0.075 mg/24hr, 0.1 Formulary QL (5 EA per 34 days) mg/24hr estradiol valerate intramuscular oil 20 mg/ml, 40 mg/ml Formulary estradiol-norethindrone acet oral tablet 0.5-0.1 mg, 1-0.5 Formulary mg estro support es oral tablet Formulary OTC estropipate oral tablet 0.75 mg Formulary

54 Drug Name Formulary Status Requirements/Limits eszopiclone oral tablet 1 mg, 2 mg, 3 mg Formulary QL (30 EA per 30 days) ethambutol hcl oral tablet 100 mg, 400 mg Formulary ethosuximide oral capsule 250 mg Formulary ethosuximide oral solution 250 mg/5ml Formulary ethoxy diglycol liquid Formulary ethyl alcohol (rubbing) solution 70 % Formulary OTC ethyl alcohol external solution 95 % Formulary OTC ethyl alcohol solution 100 % Formulary ethyl chloride external aerosol Formulary ethyl oleate liquid Formulary etidronate disodium oral tablet 200 mg, 400 mg Formulary etodolac er oral tablet extended release 24 hour 400 mg, Formulary 500 mg, 600 mg etodolac oral capsule 200 mg, 300 mg Formulary etodolac oral tablet 400 mg, 500 mg Formulary ETOPOPHOS INTRAVENOUS SOLUTION Formulary RECONSTITUTED 100 MG etoposide intravenous solution 1 gm/50ml, 100 mg/5ml Formulary etoposide oral capsule 50 mg Formulary eucalyptol liquid Formulary eucalyptus oil external oil Formulary OTC eucalyptus oil oil Formulary EUCERIN ECZEMA RELIEF EXTERNAL CREAM 1 % Formulary OTC EUCERIN EXTERNAL CREAM Formulary OTC EUCERIN ORIGINAL HEALING EXTERNAL LOTION Formulary OTC EUFLEXXA INTRA-ARTICULAR SOLUTION Formulary PA PREFILLED SYRINGE 20 MG/2ML eugenol solution Formulary EURAX EXTERNAL CREAM 10 % Formulary ST EVAC-U-GEN ORAL TABLET 8.6 MG Formulary OTC evening primrose oil oral capsule 1000 mg, 500 mg Formulary OTC EXACTECH R-S-G TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) EXACTECH TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) EXACTUSS TR ORAL TABLET 10-28-388 MG Formulary OTC EXAPHEN CH ORAL TABLET 10-3.5-24 MG Formulary OTC EXAPHEN ORAL TABLET 3.5-10 MG Formulary OTC EXAPHEX TR ORAL TABLET 10-388 MG Formulary OTC EXCEDRIN PM ORAL TABLET 500-38 MG Formulary OTC EXCEDRIN TENSION HEADACHE ORAL TABLET Formulary OTC 500-65 MG EXCEL AP EXTERNAL SWAB 7.5-72 % Formulary OTC EXCEL-GEL EXTERNAL GEL Formulary OTC EXEL COMFORT POINT INSULIN SYR 28G X 1/2" 0.5 Formulary OTC ML 28G X 1/2" 0.5 ML

55 Drug Name Formulary Status Requirements/Limits EXEL COMFORT POINT INSULIN SYR 28G X 1/2" 1 Formulary OTC ML 28G X 1/2" 1 ML EXEL COMFORT POINT INSULIN SYR 29G X 1/2" 0.3 Formulary OTC ML 29G X 1/2" 0.3 ML EXEL COMFORT POINT INSULIN SYR 29G X 1/2" 0.5 Formulary OTC ML 29G X 1/2" 0.5 ML EXEL COMFORT POINT INSULIN SYR 29G X 1/2" 1 Formulary OTC ML 29G X 1/2" 1 ML EXEL COMFORT POINT INSULIN SYR 30G X 5/16" 0.3 Formulary OTC ML 30G X 5/16" 0.3 ML EXEL COMFORT POINT INSULIN SYR 30G X 5/16" 0.5 Formulary OTC ML 30G X 5/16" 0.5 ML EXEL COMFORT POINT INSULIN SYR 30G X 5/16" 1 Formulary OTC ML 30G X 5/16" 1 ML EXELON TRANSDERMAL PATCH 24 HOUR 13.3 Formulary MG/24HR, 4.6 MG/24HR, 9.5 MG/24HR exemestane oral tablet 25 mg Formulary EXFOLIX EXFOLIATING FOOT SOAP EXTERNAL Formulary OTC BAR EXJADE ORAL TABLET SOLUBLE 125 MG, 250 MG, Formulary PA 500 MG EX-LAX MAXIMUM STRENGTH ORAL TABLET 25 Formulary OTC MG EX-LAX ORAL TABLET 15 MG Formulary OTC EX-LAX ORAL TABLET CHEWABLE 15 MG Formulary OTC exoten-c pain relief external lotion 0.001-10-20 %, 0.025- Formulary OTC 10-20 % exotic-hc otic solution 10-10-1 mg/ml Formulary EXTRESS-30 ORAL CAPSULE EXTENDED RELEASE Formulary OTC eye allergy relief ophthalmic solution 0.027-0.315 % Formulary OTC eye drops ophthalmic solution 0.012-0.2 % Formulary OTC eye itch relief ophthalmic solution 0.025 % Formulary OTC EYE STREAM OPHTHALMIC SOLUTION Formulary OTC E-Z JECT LANCET MICRO-THIN 33G Formulary OTC; QL (150 EA per 30 days) E-Z JECT LANCET SUPER THIN 30G Formulary OTC; QL (150 EA per 30 days) E-Z JECT LANCETS Formulary OTC; QL (150 EA per 30 days) E-Z JECT LANCETS 21G Formulary OTC; QL (150 EA per 30 days) E-Z JECT LANCETS THIN 26G Formulary OTC; QL (150 EA per 30 days) EZ SMART BLOOD GLUCOSE LANCETS Formulary OTC; QL (150 EA per 30 days) ezetimibe oral tablet 10 mg Formulary ezetimibe- oral tablet 10-10 mg, 10-20 mg, 10- Formulary ST 40 mg, 10-80 mg EZFE 200 ORAL CAPSULE 434.8 (200 FE) MG Formulary OTC E-Z-GAS II ORAL PACKET 2.21-1.53-0.04 GM Formulary OTC EZ-LETS LANCETS 21G Formulary OTC; QL (150 EA per 30 days) EZ-LETS LANCETS 23G Formulary OTC; QL (150 EA per 30 days) EZ-LETS LANCETS 28G Formulary OTC; QL (150 EA per 30 days)

56 Drug Name Formulary Status Requirements/Limits fabb oral tablet 2.2-25-1 mg Formulary face mask respirator r-95 part Formulary FAGRON VERSIFIX TRANSDERMAL LIQUID Formulary OTC famciclovir oral tablet 125 mg, 250 mg, 500 mg Formulary famotidine oral suspension reconstituted 40 mg/5ml Formulary famotidine oral tablet 10 mg Formulary OTC famotidine oral tablet 40 mg Formulary FARESTON ORAL TABLET 60 MG Formulary FARXIGA ORAL TABLET 10 MG, 5 MG Formulary AGE (Min 18 Years) FASLODEX INTRAMUSCULAR SOLUTION 250 Formulary MG/5ML FAST FREEZE PRO STYLE THERAPY EXTERNAL Formulary OTC GEL 3.5 % FAST FREEZE PRO STYLE THERAPY EXTERNAL Formulary OTC LIQUID 3.5 % fast-heat heating pad pad Formulary OTC father johns medicine oral syrup 10 mg/5ml Formulary OTC FATTYBLEND Formulary OTC fa-vitamin b-6-vitamin b-12 oral tablet 2.2-25-0.5 mg Formulary FAYOSIM ORAL TABLET 42-21-21-7 DAYS Formulary QL (91 EA per 91 days) FC FEMALE CONDOM Formulary OTC fd&c blue #2 powder Formulary OTC fd&c red #40 aluminum lake powder Formulary OTC fd&c yellow #5 powder Formulary fdc blue 1 powder Formulary fdc green #3 powder Formulary fdc red #3 powder Formulary fdc yellow 6 powder Formulary FEIBA INTRAVENOUS SOLUTION RECONSTITUTED Formulary felbamate oral suspension 600 mg/5ml Formulary felbamate oral tablet 400 mg, 600 mg Formulary er oral tablet extended release 24 hour 10 mg, Formulary 2.5 mg, 5 mg FEM PH VAGINAL GEL 0.9-0.025 % Formulary FEMINEASE VAGINAL CREAM Formulary OTC fenofibrate micronized oral capsule 134 mg, 200 mg, 67 mg Formulary fenofibrate oral tablet 145 mg, 160 mg, 48 mg, 54 mg Formulary fenofibric acid oral capsule delayed release 135 mg, 45 mg Formulary fenofibric acid tablet 105 mg oral 105 mg Formulary fenofibric acid tablet 35 mg oral 35 mg Formulary fenoprofen calcium capsule 200 mg oral 200 mg Formulary citrate (pf) injection solution cartridge 100 Formulary mcg/2ml fentanyl citrate buccal lozenge on a handle 1200 mcg, 1600 Formulary PA; QL (120 EA per 30 days) mcg, 200 mcg, 400 mcg, 600 mcg, 800 mcg

57 Drug Name Formulary Status Requirements/Limits fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, Formulary PA; QL (10 EA per 34 days) 25 mcg/hr, 50 mcg/hr, 75 mcg/hr FER-IN-SOL ORAL SOLUTION 75 (15 FE) MG/ML Formulary OTC ferocon oral capsule Formulary ferraplus 90 oral tablet 90-1 mg Formulary ferretts chewable iron oral tablet chewable 18 mg Formulary OTC ferretts ips oral solution 40 mg/15ml Formulary OTC ferretts oral tablet 325 (106 fe) mg Formulary OTC FERREX 150 FORTE PLUS ORAL CAPSULE 50-100 Formulary OTC MG ferrex 150 oral capsule 150 mg Formulary OTC FERREX 28 ORAL Formulary OTC ferric subsulfate powder Formulary OTC ferric subsulfate solution Formulary FERRIMIN 150 ORAL TABLET 150 MG Formulary OTC FERROCITE ORAL TABLET 324 MG Formulary OTC FERROCITE PLUS ORAL TABLET 106-1 MG Formulary ferrous gluconate oral tablet 324 (37.5 fe) mg, 324 (38 fe) Formulary OTC mg ferrous sulfate er oral tablet extended release 140 (45 fe) Formulary OTC mg ferrous sulfate granules Formulary ferrous sulfate oral elixir 220 (44 fe) mg/5ml Formulary OTC ferrous sulfate oral liquid 220 (44 fe) mg/5ml Formulary OTC ferrous sulfate oral syrup 300 (60 fe) mg/5ml Formulary OTC ferrous sulfate oral tablet delayed release 324 (65 fe) mg, Formulary OTC 325 (65 fe) mg ferrous sulfate powder Formulary FEVERALL INFANTS RECTAL SUPPOSITORY 80 MG Formulary OTC FEVERALL JUNIOR STRENGTH RECTAL Formulary OTC SUPPOSITORY 325 MG fexofenadine hcl childrens oral suspension 30 mg/5ml Formulary OTC fiber laxative oral tablet 625 mg Formulary OTC fiber oral powder Formulary OTC FIBERCON ORAL TABLET 625 MG Formulary OTC FIBEREX F15 ORAL LIQUID 15 GM/30ML Formulary OTC FIFTY50 ALCOHOL PREP PAD 70 % 70 % Formulary OTC FIFTY50 SUPERIOR COMFORT SYR 31G X 5/16" 0.3 Formulary OTC ML 31G X 5/16" 0.3 ML FIFTY50 SUPERIOR COMFORT SYR 31G X 5/16" 0.5 Formulary OTC ML 31G X 5/16" 0.5 ML FIFTY50 SUPERIOR COMFORT SYR 31G X 5/16" 1 ML Formulary OTC 31G X 5/16" 1 ML filter needle 18g x 1-1/2" Formulary finasteride oral tablet 5 mg Formulary FINE 30 Formulary OTC; QL (150 EA per 30 days)

58 Drug Name Formulary Status Requirements/Limits FIRAZYR SUBCUTANEOUS SOLUTION 30 MG/3ML Formulary PA; QL (24 ML per 14 days) first aid antibiotic external ointment 4 % Formulary OTC first aid antiseptic spray external aerosol 20-0.13 % Formulary OTC fish oil + d3 oral capsule 1000-1000 mg-unit Formulary OTC fish oil adult gummies oral tablet chewable 113.5 mg Formulary OTC fish oil oral capsule 1200 mg, 500 mg, 600 mg Formulary OTC fish oil oral capsule delayed release 1000 mg Formulary OTC fish oil-flax oil-borage oil oral capsule Formulary OTC flavor packets oral packet Formulary OTC flavoxate hcl oral tablet 100 mg Formulary flecainide acetate oral tablet 100 mg, 150 mg, 50 mg Formulary FLEET BISACODYL RECTAL ENEMA 10 MG/30ML Formulary OTC FLEET LIQUID GLYCERIN SUPP RECTAL ENEMA 5.4 Formulary OTC GM/DOSE FLEET NATURALS CLEANSING ENEMA RECTAL Formulary OTC ENEMA FLEET OIL RECTAL ENEMA Formulary OTC FLEET PEDIATRIC RECTAL ENEMA 3.5-9.5 GM/59ML Formulary OTC FLEXICHAMBER CHILD MASK/LARGE Formulary FLEXICHAMBER DEVICE Formulary QL (2 EA per 365 days) FLINTSTONES TODDLER ORAL TABLET Formulary OTC CHEWABLE 40 MG FLOGEN ORAL TABLET 250-650 MG Formulary OTC FLONASE ALLERGY RELIEF SUSPENSION 50 Formulary OTC MCG/ACT NASAL 50 MCG/ACT FLONASE SENSIMIST NASAL SUSPENSION 27.5 Formulary OTC MCG/SPRAY FLORA ASSIST ORAL PACKET Formulary OTC FLORANEX ORAL PACKET Formulary OTC FLORASTOR KIDS ORAL PACKET 250 MG Formulary OTC FLORASTOR ORAL CAPSULE 250 MG Formulary OTC FLORICAL ORAL CAPSULE 8.3-364 MG Formulary OTC FLORICAL ORAL TABLET 8.3-364 MG Formulary OTC FLOVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 100 MCG/BLIST, 250 Formulary MCG/BLIST, 50 MCG/BLIST FLOVENT HFA INHALATION AEROSOL 110 Formulary MCG/ACT, 220 MCG/ACT, 44 MCG/ACT flow-eze vented needle Formulary OTC floxuridine injection solution reconstituted 0.5 gm Formulary flu hbp oral tablet 15-500-2 mg Formulary OTC FLUCAINE OPHTHALMIC SOLUTION 0.25-0.5 % Formulary FLUCELVAX QUADRIVALENT INTRAMUSCULAR Formulary SUSPENSION PREFILLED SYRINGE 0.5 ML fluconazole oral suspension reconstituted 10 mg/ml, 40 Formulary mg/ml

59 Drug Name Formulary Status Requirements/Limits fluconazole oral tablet 100 mg, 150 mg, 200 mg, 50 mg Formulary fludarabine phosphate intravenous solution 50 mg/2ml Formulary fludarabine phosphate intravenous solution reconstituted 50 Formulary mg fludrocortisone acetate oral tablet 0.1 mg Formulary nasal solution 25 mcg/act (0.025%) Formulary QL (3 ML per 34 days) fluocinolone acetonide body external oil 0.01 % Formulary fluocinolone acetonide external cream 0.01 %, 0.025 % Formulary fluocinolone acetonide external ointment 0.025 % Formulary fluocinolone acetonide external solution 0.01 % Formulary fluocinolone acetonide otic oil 0.01 % Formulary fluocinolone acetonide scalp external oil 0.01 % Formulary fluocinonide external cream 0.05 %, 0.1 % Formulary fluocinonide external gel 0.05 % Formulary fluocinonide external ointment 0.05 % Formulary fluocinonide external solution 0.05 % Formulary fluoride mouth rinse mouth/throat solution 0.0221 (0.01 f) Formulary OTC % ophthalmic suspension 0.1 % Formulary fluorouracil external cream 5 % Formulary fluorouracil external solution 2 %, 5 % Formulary fluorouracil intravenous solution 1 gm/20ml Formulary fluoxetine hcl (pmdd) oral capsule 10 mg, 20 mg Formulary fluoxetine hcl oral capsule 10 mg, 20 mg, 40 mg Formulary fluoxetine hcl oral solution 20 mg/5ml Formulary fluoxetine hcl oral tablet 10 mg Formulary QL (34 EA per 34 days) fluphenazine decanoate injection solution 25 mg/ml Formulary AGE (Min 18 Years) fluphenazine hcl injection solution 2.5 mg/ml Formulary AGE (Min 18 Years) fluphenazine hcl oral concentrate 5 mg/ml Formulary AGE (Min 18 Years) fluphenazine hcl oral elixir 2.5 mg/5ml Formulary AGE (Min 18 Years) fluphenazine hcl oral tablet 1 mg, 10 mg, 2.5 mg, 5 mg Formulary AGE (Min 18 Years) flurazepam hcl oral capsule 15 mg, 30 mg Formulary QL (68 EA per 34 days) flurbiprofen oral tablet 100 mg, 50 mg Formulary flurbiprofen sodium ophthalmic solution 0.03 % Formulary flutamide oral capsule 125 mg Formulary propionate external cream 0.05 % Formulary external ointment 0.005 % Formulary fluticasone propionate nasal suspension 50 mcg/act Formulary fluticasone- inhalation aerosol powder breath Formulary AGE (Min 12 Years) activated 113-14 mcg/act, 232-14 mcg/act, 55-14 mcg/act FLUVIRIN INTRAMUSCULAR SUSPENSION Formulary AGE (Min 19 Years) fluvoxamine maleate oral tablet 100 mg, 25 mg, 50 mg Formulary FLUZONE HIGH-DOSE INTRAMUSCULAR Formulary AGE (Min 19 Years) SUSPENSION PREFILLED SYRINGE 0.5 ML

60 Drug Name Formulary Status Requirements/Limits FLUZONE QUADRIVALENT INTRAMUSCULAR Formulary AGE (Min 19 Years) SUSPENSION 0.5 ML FLUZONE QUADRIVALENT INTRAMUSCULAR Formulary AGE (Min 19 Years) SUSPENSION PREFILLED SYRINGE 0.25 ML, 0.5 ML FOCALIN ORAL TABLET 10 MG, 2.5 MG, 5 MG Formulary AGE (Min 4 Years and Max 17 Years) FOCALIN XR ORAL CAPSULE EXTENDED RELEASE QL (30 EA per 30 days); AGE (Min 4 24 HOUR 10 MG, 15 MG, 20 MG, 25 MG, 30 MG, 35 Formulary Years and Max 17 Years) MG, 40 MG, 5 MG FOILLE EXTERNAL OINTMENT 5-0.1 % Formulary OTC FOLET DHA ORAL THERAPY PACK 38-1 & 350 MG Formulary FOLGARD ORAL TABLET Formulary OTC FOLGARD OS ORAL TABLET 500-1.1 MG Formulary FOLIC + B12 ORAL TABLET 800-1000 MCG Formulary OTC folic acid oral capsule 0.8 mg, 20 mg, 5 mg Formulary OTC folic acid oral tablet 1 mg Formulary folic acid oral tablet 400 mcg, 800 mcg Formulary OTC folic acid powder Formulary folinic-plus oral tablet 4-50-2 mg Formulary OTC FOLITAB 500 ORAL TABLET EXTENDED RELEASE Formulary OTC 105-500-0.8 MG FOLIVANE-F ORAL CAPSULE 125-1 MG Formulary FOLIVANE-PLUS ORAL CAPSULE Formulary FOLOTYN INTRAVENOUS SOLUTION 20 MG/ML Formulary food color black powder Formulary food color blue powder Formulary food color blue royal powder Formulary OTC food color brown powder Formulary food color flesh powder Formulary OTC food color green powder Formulary food color lime green powder Formulary food color orange powder Formulary food color red powder Formulary food color yellow powder Formulary FORA D40 GLUCOSE/PRESSURE DEVICE Formulary OTC FORA LANCETS Formulary OTC; QL (150 EA per 30 days) FORMADON EXTERNAL SOLUTION 10 % Formulary formaldehyde external solution 37 % Formulary FORMA-RAY EXTERNAL SOLUTION 20 % Formulary FORTEO SUBCUTANEOUS SOLUTION 600 Formulary PA; QL (2.4 ML per 90 days) MCG/2.4ML fosamprenavir calcium oral tablet 700 mg Formulary sodium oral tablet 10 mg, 20 mg, 40 mg Formulary fosinopril sodium-hctz oral tablet 10-12.5 mg, 20-12.5 mg Formulary fosphenytoin sodium injection solution 100 mg pe/2ml, 500 Formulary mg pe/10ml freds pharmacy unilet lanc 28g Formulary OTC; QL (150 EA per 30 days) 61 Drug Name Formulary Status Requirements/Limits FREE & CLEAR EXTERNAL LIQUID Formulary OTC FREE & CLEAR EXTERNAL SHAMPOO Formulary OTC freedom cepapro gel Formulary FREEDOM ODT BASE POWDER Formulary FREESTYLE CONTROL SOLUTION LIQUID IN VITRO Formulary OTC; QL (100 EA per 30 days) FREESTYLE FLASH SYSTEM KIT Formulary OTC; QL (1 EA per 365 days) FREESTYLE FREEDOM KIT Formulary OTC; QL (1 EA per 365 days) FREESTYLE FREEDOM LITE KIT W/DEVICE Formulary OTC; QL (1 EA per 365 days) W/DEVICE FREESTYLE INSULINX SYSTEM KIT W/DEVICE Formulary OTC; QL (1 EA per 365 days) W/DEVICE FREESTYLE INSULINX TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) FREESTYLE LANCETS Formulary OTC; QL (150 EA per 30 days) FREESTYLE LIBRE 14 DAY READER DEVICE Formulary FREESTYLE LIBRE 14 DAY SENSOR Formulary FREESTYLE LIBRE READER DEVICE Formulary QL (1 EA per 365 days) FREESTYLE LIBRE SENSOR SYSTEM Formulary QL (3 EA per 30 days) FREESTYLE LITE TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) FREESTYLE PRECISION INS SYR 30G X 5/16" 0.5 ML Formulary OTC 30G X 5/16" 0.5 ML FREESTYLE PRECISION INS SYR 30G X 5/16" 1 ML Formulary OTC 30G X 5/16" 1 ML FREESTYLE PRECISION INS SYR 31G X 5/16" 0.5 ML Formulary OTC 31G X 5/16" 0.5 ML FREESTYLE PRECISION INS SYR 31G X 5/16" 1 ML Formulary OTC 31G X 5/16" 1 ML FREESTYLE PRECISION NEO SYSTEM KIT Formulary OTC; QL (1 EA per 365 days) W/DEVICE FREESTYLE SIDEKICK II KIT Formulary OTC; QL (1 EA per 365 days) FREESTYLE SYSTEM KIT Formulary OTC; QL (1 EA per 365 days) FREESTYLE TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) fructose granules Formulary fruit c oral tablet chewable 100 mg Formulary OTC fullers earth powder Formulary FUNGI-NAIL EXTERNAL SOLUTION 25 % Formulary OTC FUNGI-NAIL TOE & FOOT EXTERNAL OINTMENT 5- Formulary OTC 20 % FUNGOID TINCTURE EXTERNAL KIT 2 % Formulary OTC FUNGOID TINCTURE EXTERNAL SOLUTION 2 % Formulary OTC FUNGOID-D EXTERNAL CREAM 1 % Formulary OTC furosemide oral solution 10 mg/ml Formulary furosemide oral tablet 20 mg, 40 mg, 80 mg Formulary FUSION ORAL CAPSULE 65-65-25-30 MG Formulary OTC FUZEON SUBCUTANEOUS SOLUTION Formulary PA RECONSTITUTED 90 MG FYAVOLV ORAL TABLET 1-5 MG-MCG Formulary

62 Drug Name Formulary Status Requirements/Limits gabapentin oral capsule 100 mg, 300 mg, 400 mg Formulary gabapentin oral solution 250 mg/5ml Formulary gabapentin oral tablet 600 mg, 800 mg Formulary GABITRIL ORAL TABLET 12 MG, 16 MG, 2 MG, 4 MG Formulary galantamine hydrobromide er oral capsule extended release Formulary 24 hour 16 mg, 24 mg, 8 mg galantamine hydrobromide oral solution 4 mg/ml Formulary galantamine hydrobromide oral tablet 12 mg, 4 mg, 8 mg Formulary garlic/epa oral capsule 60-90-250 mg Formulary OTC garlic-lecithin oral capsule 192-650 mg Formulary OTC garlic-parsley oral tablet 100-175 mg Formulary OTC gas relief oral liquid 40 mg/0.6ml Formulary OTC GASTROCROM ORAL CONCENTRATE 100 MG/5ML Formulary GAS-X CHILDRENS ORAL STRIP 40 MG Formulary OTC GAS-X EXTRA STRENGTH ORAL STRIP 62.5 MG Formulary OTC GAS-X EXTRA STRENGTH ORAL TABLET Formulary OTC CHEWABLE 125 MG GAS-X ORAL TABLET CHEWABLE 80 MG Formulary OTC GAS-X PREVENTION ORAL CAPSULE Formulary OTC GAS-X WITH MAALOX EX ST ORAL TABLET Formulary OTC CHEWABLE 500-125 MG GAVILYTE-C ORAL SOLUTION RECONSTITUTED Formulary 240 GM GAVILYTE-G ORAL SOLUTION RECONSTITUTED Formulary 236 GM GAVILYTE-N WITH FLAVOR PACK ORAL Formulary SOLUTION RECONSTITUTED 420 GM GAVISCON EXTRA STRENGTH ORAL SUSPENSION Formulary OTC 254-237.5 MG/5ML GAVISCON EXTRA STRENGTH ORAL TABLET Formulary OTC CHEWABLE 160-105 MG GAVISCON ORAL SUSPENSION 95-358 MG/15ML Formulary OTC GAVISCON ORAL TABLET CHEWABLE 80-14.2 MG Formulary OTC G-BUCAL-C MOUTH/THROAT SOLUTION 0.15-0.1 % Formulary OTC G-DOLOGEN ORAL TABLET 2-650 MG Formulary OTC ge-150 oral capsule 150 mg Formulary OTC GEBAUERS INSTANT ICE EXTERNAL AEROSOL Formulary OTC gelatin oral capsule 650 mg Formulary OTC GELFOAM SPONGE EXTERNAL 12-7 MM Formulary GELFOAM SPONGE SIZE 100 EXTERNAL Formulary GEL-KAM DENTAL GEL 0.4 % Formulary OTC GELONASAL NASAL SOLUTION Formulary OTC GELUSIL ORAL TABLET CHEWABLE 200-200-25 MG Formulary OTC gemcitabine hcl intravenous solution 1 gm/26.3ml, 2 Formulary gm/52.6ml, 200 mg/5.26ml

63 Drug Name Formulary Status Requirements/Limits gemcitabine hcl intravenous solution reconstituted 1 gm, 2 Formulary gm, 200 mg gemfibrozil oral tablet 600 mg Formulary GENCONTUSS ORAL LIQUID 5-2-10 MG/5ML Formulary OTC GENOTROPIN MINIQUICK SOLUTION Formulary PA; AGE (Max 18 Years) RECONSTITUTED 0.2 MG SUBCUTANEOUS 0.2 MG GENOTROPIN MINIQUICK SOLUTION Formulary PA; AGE (Max 18 Years) RECONSTITUTED 0.4 MG SUBCUTANEOUS 0.4 MG GENOTROPIN MINIQUICK SOLUTION Formulary PA; AGE (Max 18 Years) RECONSTITUTED 0.6 MG SUBCUTANEOUS 0.6 MG GENOTROPIN MINIQUICK SOLUTION Formulary PA; AGE (Max 18 Years) RECONSTITUTED 0.8 MG SUBCUTANEOUS 0.8 MG GENOTROPIN MINIQUICK SOLUTION Formulary PA; AGE (Max 18 Years) RECONSTITUTED 1 MG SUBCUTANEOUS 1 MG GENOTROPIN MINIQUICK SOLUTION Formulary PA; AGE (Max 18 Years) RECONSTITUTED 1.2 MG SUBCUTANEOUS 1.2 MG GENOTROPIN MINIQUICK SOLUTION Formulary PA; AGE (Max 18 Years) RECONSTITUTED 1.4 MG SUBCUTANEOUS 1.4 MG GENOTROPIN MINIQUICK SOLUTION Formulary PA; AGE (Max 18 Years) RECONSTITUTED 1.6 MG SUBCUTANEOUS 1.6 MG GENOTROPIN MINIQUICK SOLUTION Formulary PA; AGE (Max 18 Years) RECONSTITUTED 1.8 MG SUBCUTANEOUS 1.8 MG GENOTROPIN MINIQUICK SOLUTION Formulary PA; AGE (Max 18 Years) RECONSTITUTED 2 MG SUBCUTANEOUS 2 MG GENOTROPIN SOLUTION RECONSTITUTED 12 MG Formulary PA; AGE (Max 18 Years) SUBCUTANEOUS 12 MG GENOTROPIN SOLUTION RECONSTITUTED 5 MG Formulary PA; AGE (Max 18 Years) SUBCUTANEOUS 5 MG gentamicin sulfate external cream 0.1 % Formulary gentamicin sulfate external ointment 0.1 % Formulary gentamicin sulfate ophthalmic solution 0.3 % Formulary GENTEAL MILD OPHTHALMIC SOLUTION 0.2 % Formulary OTC GENTEAL MILD TO MODERATE OPHTHALMIC Formulary OTC SOLUTION 0.3 % GENTEAL OPHTHALMIC GEL 0.25-0.3 % Formulary OTC GENTEAL TEARS PF OPHTHALMIC SOLUTION 0.1- Formulary OTC 0.3 % gentian violet external solution 1 %, 2 % Formulary OTC gentle laxative rectal suppository 10 mg Formulary OTC GENTLE RAIN EXTERNAL LIQUID 0.3 % Formulary OTC gentle skin cleanser external lotion Formulary OTC GENTLE-LET GP LANCETS Formulary OTC; QL (150 EA per 30 days) GENTLE-LET LANCETS Formulary OTC; QL (150 EA per 30 days) GENVOYA ORAL TABLET 150-150-200-10 MG Formulary geravine oral elixir Formulary OTC geriatric vitamin oral liquid 100-1-10 Formulary OTC gerisilk bath oil external oil Formulary OTC GERMBLOC HEALTH EXTERNAL FOAM 0.1 % Formulary OTC 64 Drug Name Formulary Status Requirements/Limits GILENYA ORAL CAPSULE 0.5 MG Formulary ST GILTUSS COUGH & COLD ORAL LIQUID 10-29-390 Formulary OTC MG/5ML ginger root oral capsule 500 mg Formulary OTC ginseng oral capsule 250 mg, 50 mg Formulary OTC gla-45 oral capsule 45 mg Formulary OTC glass syringe 3 ml kit Formulary glatiramer acetate subcutaneous solution prefilled syringe Formulary 20 mg/ml, 40 mg/ml glen pe oral liquid 16-5 mg/5ml Formulary OTC glenmax peb dm forte oral liquid 10-4-20 mg/5ml Formulary OTC glenmax peb dm oral liquid 5-2-10 mg/5ml Formulary OTC; AGE (Min 2 Years) glenmax peb oral liquid 4-10 mg/5ml Formulary OTC glentuss oral liquid 30-6.25-15 mg/5ml Formulary OTC g-levocarnitine s/f oral solution 1 gm/10ml Formulary OTC glimepiride oral tablet 1 mg, 2 mg, 4 mg Formulary glipizide er oral tablet extended release 24 hour 10 mg, 2.5 Formulary mg, 5 mg glipizide oral tablet 10 mg, 5 mg Formulary glipizide xl oral tablet extended release 24 hour 10 mg, 2.5 Formulary mg, 5 mg glipizide-metformin hcl oral tablet 2.5-250 mg, 2.5-500 mg, Formulary 5-500 mg global inject ease insulin syr 29g x 1/2" 1 ml 29g x 1/2" 1 Formulary OTC ml global inject ease insulin syr 30g x 1/2" 1 ml 30g x 1/2" 1 Formulary OTC ml global insulin 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 Formulary OTC ml GLUCAGEN HYPOKIT INJECTION SOLUTION Formulary QL (2 EA per 34 days) RECONSTITUTED 1 MG GLUCAGON EMERGENCY INJECTION KIT 1 MG Formulary QL (2 EA per 34 days) GLUCOCOM AUTOLINK TELEMONITOR Formulary OTC GLUCOCOM LANCETS 28G Formulary OTC; QL (150 EA per 30 days) GLUCOCOM LANCETS 30G Formulary OTC; QL (150 EA per 30 days) GLUCOCOM LANCETS 33G Formulary OTC; QL (150 EA per 30 days) GLUCOPRO INSULIN SYRINGE 30G X 1/2" 0.3 ML Formulary OTC 30G X 1/2" 0.3 ML GLUCOPRO INSULIN SYRINGE 30G X 1/2" 0.5 ML Formulary OTC 30G X 1/2" 0.5 ML GLUCOPRO INSULIN SYRINGE 30G X 1/2" 1 ML 30G Formulary OTC X 1/2" 1 ML GLUCOPRO INSULIN SYRINGE 30G X 5/16" 0.3 ML Formulary OTC 30G X 5/16" 0.3 ML GLUCOPRO INSULIN SYRINGE 30G X 5/16" 0.5 ML Formulary OTC 30G X 5/16" 0.5 ML GLUCOPRO INSULIN SYRINGE 30G X 5/16" 1 ML 30G Formulary OTC X 5/16" 1 ML 65 Drug Name Formulary Status Requirements/Limits GLUCOPRO INSULIN SYRINGE 31G X 5/16" 0.3 ML Formulary OTC 31G X 5/16" 0.3 ML GLUCOPRO INSULIN SYRINGE 31G X 5/16" 0.5 ML Formulary OTC 31G X 5/16" 0.5 ML GLUCOPRO INSULIN SYRINGE 31G X 5/16" 1 ML 31G Formulary OTC X 5/16" 1 ML glucosamine chond complex/msm oral tablet Formulary OTC glucosamine chondroitin complx oral capsule 500-250 mg Formulary OTC glucosamine complex/vitamin d3 oral tablet Formulary OTC glucosamine hcl oral tablet 1500 mg Formulary OTC glucosamine hcl powder Formulary glucosamine sulfate oral capsule 1000 mg, 500 mg Formulary OTC glucosamine sulfate oral tablet 1000 mg Formulary OTC glucosamine sulfate powder Formulary glucosamine-chondroitin oral capsule 250-200 mg, 500-400 Formulary OTC mg glucosamine-chondroitin oral liquid 1500-1200 mg/30ml Formulary OTC glucosamine-chondroitin oral tablet 500-400 mg, 750-600 Formulary OTC mg glucosamine-chondroitin-msm oral tablet 400-333.3-200 Formulary OTC mg, 500-400-167 mg glucosamine-chondroitin-vit d3 oral packet 1500-1200-800 Formulary OTC mg-mg-unit glucosamine-msm oral liquid 1500-500 mg/30ml Formulary OTC GLUCOSE NURSETTE ORAL SOLUTION 5 % Formulary OTC glucose oral gel 40 % Formulary OTC glucose oral liquid 15 gm/59ml Formulary OTC glucose oral tablet chewable 4 gm, 4-6 gm-mg Formulary OTC glutamine oral capsule 500 mg Formulary OTC glutamine powder Formulary glutathione oral tablet 50 mg Formulary OTC glutol oral liquid Formulary OTC glyburide micronized oral tablet 1.5 mg, 3 mg, 6 mg Formulary glyburide oral tablet 1.25 mg, 2.5 mg, 5 mg Formulary glyburide-metformin oral tablet 1.25-250 mg, 2.5-500 mg, Formulary 5-500 mg glycerin (adult) rectal suppository 2 gm Formulary OTC glycerin (infants & children) rectal suppository 1 gm, 1.2 Formulary OTC gm glycerin external liquid Formulary OTC glycerin liquid Formulary glycerin solution Formulary glyceryl monostearate flakes Formulary glycine powder Formulary glycine500 oral packet 500 mg Formulary OTC glycolic acid crystals Formulary

66 Drug Name Formulary Status Requirements/Limits glycolic acid solution 70 % Formulary glycopyrrolate oral tablet 1 mg, 2 mg Formulary GLYDO EXTERNAL GEL 2 % Formulary GLYXAMBI ORAL TABLET 10-5 MG, 25-5 MG Formulary PA g-myco nail external solution Formulary OTC gnp 24 hour nasal allergy aerosol 55 mcg/act nasal 55 Formulary OTC mcg/act gnp 4x probiotic oral tablet Formulary OTC gnp advanced eye health oral capsule 250-2.5-0.5 mg Formulary OTC gnp alcohol denatured solution Formulary OTC gnp alcohol swabs pad 70 % 70 % Formulary OTC gnp animal shapes plus iron oral tablet chewable 15 mg Formulary OTC gnp b-50 complex oral tablet extended release Formulary OTC gnp b-complex plus vitamin c oral tablet Formulary OTC gnp calamine external lotion 8-8 % Formulary OTC gnp calcium 600 plus d/mineral oral tablet 600-400 mg-unit Formulary OTC gnp calcium plus 600 +d oral tablet 600-200 mg-unit Formulary OTC gnp capsaicin external liquid 0.15 % Formulary OTC gnp childrens chewables/ex c oral tablet chewable Formulary OTC gnp coq-10 & fish oil oral capsule 120-180-50-30 Formulary OTC gnp ethyl alcohol solution 70 % Formulary OTC gnp fish oil oral capsule 435 mg Formulary OTC gnp gentian violet external solution 1 % Formulary OTC gnp glycerin/rose water external solution 10 % Formulary OTC gnp headache relief extra str oral tablet 250-250-65 mg Formulary OTC gnp insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC gnp insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC gnp insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC gnp insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC gnp insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC gnp insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml Formulary OTC gnp insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC gnp insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC gnp insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC gnp insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC gnp insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC gnp iodides external tincture Formulary OTC gnp iodine external tincture Formulary OTC gnp isopropyl alcohol wipes 70 % external 70 % Formulary OTC gnp lancets Formulary OTC; QL (150 EA per 30 days) gnp lancets 21g Formulary OTC; QL (150 EA per 30 days) gnp lancets micro thin 33g Formulary OTC; QL (150 EA per 30 days) gnp lancets super thin 30g Formulary OTC; QL (150 EA per 30 days) gnp lancets thin 26g Formulary OTC; QL (150 EA per 30 days)

67 Drug Name Formulary Status Requirements/Limits gnp lice egg remover external gel Formulary OTC gnp liquid bandage external liquid 0.75-0.2 % Formulary OTC gnp l-lysine oral tablet 600 mg Formulary OTC gnp micro thin lancets 33g Formulary OTC; QL (150 EA per 30 days) gnp niacin oral tablet 250 mg Formulary OTC gnp omeprazole oral tablet delayed release 20 mg Formulary OTC gnp pain relief/benzocaine external pad 6-70 % Formulary OTC gnp peppermint spirit spirit Formulary OTC gnp potassium oral tablet 99 mg Formulary OTC gnp shampoo & body wash external liquid Formulary OTC gnp sinus wash refill nasal packet 2300-700 mg Formulary OTC gnp sodium silicate solution Formulary OTC gnp super thin lancets 30g Formulary OTC; QL (150 EA per 30 days) gnp terbinafine hydrochloride external cream 1 % Formulary OTC gnp ultra com insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" Formulary OTC 0.5 ml gnp ultra com insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 Formulary OTC ml gnp ultra com insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" Formulary OTC 0.3 ml gnp ultra com insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" Formulary OTC 0.5 ml gnp ultra com insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 Formulary OTC ml gnp ultra com insulin syringe 30g x 5/16" 0.3 ml 30g x Formulary OTC 5/16" 0.3 ml gnp ultra com insulin syringe 30g x 5/16" 0.5 ml 30g x Formulary OTC 5/16" 0.5 ml gnp ultra com insulin syringe 30g x 5/16" 1 ml 30g x 5/16" Formulary OTC 1 ml gnp ultra com insulin syringe 31g x 5/16" 0.3 ml 31g x Formulary OTC 5/16" 0.3 ml gnp ultra com insulin syringe 31g x 5/16" 0.5 ml 31g x Formulary OTC 5/16" 0.5 ml gnp ultra com insulin syringe 31g x 5/16" 1 ml 31g x 5/16" Formulary OTC 1 ml gnp urinary pain relief oral tablet 97.5 mg Formulary OTC gnp vitamin d super strength oral tablet 5000 unit Formulary OTC gnp vitamin d-400 oral tablet 90-400 mg-unit Formulary OTC GOLD BOND MULTI-SYMPTOM EXTERNAL CREAM Formulary OTC 4 % GOLD BOND RAPID RELIEF EXTERNAL CREAM 1-1 Formulary OTC % GOLD BOND ULTIMATE EXTERNAL LOTION Formulary OTC GONIOSOL OPHTHALMIC SOLUTION 2.5 % Formulary OTC GONIOTAIRE OPHTHALMIC SOLUTION 2.5 % Formulary OTC GONIOVISC OPHTHALMIC SOLUTION 2 % Formulary OTC

68 Drug Name Formulary Status Requirements/Limits GOOD START 5% GLUCOSE WATER ORAL Formulary OTC SOLUTION 5 % goodsense all day allergy oral tablet 10 mg Formulary OTC goodsense cough dm oral suspension extended release 30 Formulary OTC mg/5ml goodsense eye drops ophthalmic solution 0.05 % Formulary OTC goodsense flu/cold/cough/night oral packet 25-10-650 mg Formulary OTC goodsense flu/cold/daytime oral packet 20-10-500 mg Formulary OTC goodsense ibuprofen childrens oral suspension 100 mg/5ml Formulary OTC goodsense ibuprofen infants oral suspension 50 mg/1.25ml Formulary OTC goodsense ibuprofen oral tablet 200 mg Formulary OTC goodsense lancets 30g Formulary OTC; QL (150 EA per 30 days) goodsense lancets 33g Formulary OTC; QL (150 EA per 30 days) goodsense lubricant eye drops ophthalmic solution 0.4-0.3 Formulary OTC % goodsense miconazole 1 vaginal kit 1200 & 2 mg & % Formulary OTC goodsense mouth/throat gum 4 mg Formulary OTC goodsense nighttime cold & flu oral liquid 5-6.25-10-325 Formulary OTC mg/15ml goodsense gel Formulary OTC goodsense redness relief plus ophthalmic solution 0.5-0.03 Formulary OTC % goodsense sinus congest/pain oral 2-5-325 & 5-325 mg Formulary OTC goodsense sleeptime oral liquid 50 mg/30ml Formulary OTC goodsense sore throat spray mouth/throat liquid 1.4 % Formulary OTC gordomatic external crystals Formulary OTC GORDONS NO 5 EXTERNAL AEROSOL POWDER Formulary OTC gordons urea external ointment 22 % Formulary OTC GORDONS-VITE A EXTERNAL CREAM 100000 Formulary OTC UNIT/GM GORDONS-VITE A EXTERNAL LOTION 100000 UNIT Formulary OTC GORDO-POOL CONCENTRATE Formulary OTC GRANDPAS OATMEAL SOAP EXTERNAL BAR Formulary OTC GRANDPAS THYLOX SOAP EXTERNAL BAR 3 % Formulary OTC GRANIX SUBCUTANEOUS SOLUTION PREFILLED Formulary PA SYRINGE 300 MCG/0.5ML, 480 MCG/0.8ML grape seed oil Formulary green soap external tincture Formulary OTC green tea extract liquid 90 % Formulary OTC microsize oral suspension 125 mg/5ml Formulary griseofulvin microsize oral tablet 500 mg Formulary grx wound external gel Formulary OTC G-TRON PED ORAL LIQUID 10-15-350 MG/5ML Formulary OTC G-TUSICOF ORAL LIQUID 10-20-400 MG/5ML Formulary OTC guaifenesin oral tablet 400 mg Formulary OTC guaifenesin-codeine oral solution 100-10 mg/5ml Formulary OTC; AGE (Min 6 Years) 69 Drug Name Formulary Status Requirements/Limits guanfacine hcl er oral tablet extended release 24 hour 1 Formulary AGE (Min 4 Years and Max 17 Years) mg, 2 mg, 3 mg, 4 mg guanfacine hcl oral tablet 1 mg, 2 mg Formulary guanidine hcl oral tablet 125 mg Formulary gumsol mouth/throat liquid 5-0.1 % Formulary OTC GYNE-LOTRIMIN 3 VAGINAL CREAM 2 % Formulary OTC GYNE-LOTRIMIN VAGINAL CREAM 1 % Formulary OTC H2Q ORAL POWDER 200 MG/GM Formulary OTC halobetasol propionate external cream 0.05 % Formulary halobetasol propionate external ointment 0.05 % Formulary haloperidol decanoate intramuscular solution 100 mg/ml, Formulary AGE (Min 18 Years) 50 mg/ml haloperidol lactate injection solution 5 mg/ml Formulary haloperidol lactate oral concentrate 2 mg/ml Formulary AGE (Min 18 Years) haloperidol oral tablet 0.5 mg, 1 mg, 10 mg, 2 mg, 20 mg, 5 Formulary AGE (Min 18 Years) mg haloperidol powder Formulary hand wipes external 0.13 % Formulary OTC HARD NAILS ORAL CAPSULE 2.5 MG Formulary OTC HAVRIX INTRAMUSCULAR SUSPENSION 1440 EL Formulary AGE (Min 19 Years) U/ML, 720 EL U/0.5ML HC DERMAPAX EXTERNAL LIQUID 0.5-0.5 % Formulary OTC H-CHLOR 12 EXTERNAL SOLUTION 0.125 % Formulary OTC H-CHLOR 6 EXTERNAL SOLUTION 0.062 % Formulary OTC headache relief pm oral tablet 500-38 mg Formulary OTC healthy accents unilet lancets Formulary OTC; QL (150 EA per 30 days) hearing aid batteries Formulary OTC heartburn antacid ex st oral tablet chewable 160-105 mg Formulary OTC heartburn treatment 24 hour oral capsule delayed release Formulary OTC; QL (34 EA per 34 days) 15 mg h-e-b incontrol alcohol pad Formulary OTC h-e-b incontrol lancets 28g Formulary OTC; QL (150 EA per 30 days) h-e-b incontrol lancets 30g Formulary OTC; QL (150 EA per 30 days) h-e-b incontrol lancets 33g Formulary OTC; QL (150 EA per 30 days) HEET TRIPLE ACTION EXTERNAL LIQUID Formulary OTC hematinic/folic acid oral tablet 324-1 mg Formulary HEMATOGEN FA ORAL CAPSULE 200-250-0.01-1 MG Formulary HEMATOGEN ORAL CAPSULE Formulary HEMOCYTE ORAL TABLET 324 (106 FE) MG Formulary OTC hemorrhoidal cooling rectal gel 0.25-50 % Formulary OTC hemorrhoidal max st/aloe rectal cream 1-0.25-14.4-15 % Formulary OTC hemorrhoidal rectal suppository 0.25-3-85.5 %, 0.25-85.39 Formulary OTC %, 0.25-88.44 % heparin (porcine) in nacl injection solution 100-0.45 Formulary unit/ml-%, 2-0.9 unit/ml-%, 50-0.45 unit/ml-%

70 Drug Name Formulary Status Requirements/Limits heparin sodium (porcine) injection solution 1000 unit/ml, Formulary 10000 unit/ml, 20000 unit/ml, 5000 unit/ml heparin sodium (porcine) pf injection solution 5000 Formulary unit/0.5ml HERCEPTIN INTRAVENOUS SOLUTION Formulary RECONSTITUTED 440 MG hetastarch-nacl intravenous solution 6-0.9 % Formulary HEXALEN ORAL CAPSULE 50 MG Formulary HIBICLENS EXTERNAL LIQUID 4 % Formulary OTC high potency iron oral tablet 27 mg Formulary OTC histaflex oral tablet 325-25 mg Formulary OTC HISTEX ORAL SYRUP 2.5 MG/5ML Formulary OTC HISTEX ORAL TABLET CHEWABLE 1.25 MG Formulary OTC HISTEX PD ORAL LIQUID 0.938 MG/ML Formulary OTC HISTEX PDX ORAL LIQUID 1.25 MG/ML Formulary OTC HISTEX-AC ORAL SYRUP 10-2.5-10 MG/5ML Formulary OTC HISTEX-DM ORAL SYRUP 10-2.5-20 MG/5ML Formulary OTC HISTEX-PE ORAL SYRUP 2.5-10 MG/5ML Formulary OTC hm calamine external lotion 8-8 % Formulary OTC hm castor oil oil Formulary OTC hm clear fiber oral powder Formulary OTC hm ethyl rubbing alcohol solution 70 % Formulary OTC hm iodides external tincture Formulary OTC hm iodine external tincture Formulary OTC hm iron oral tablet 200 (65 fe) mg Formulary OTC hm melatonin quick dissolve oral tablet dispersible 10 mg Formulary OTC hm nighttime sleep aid oral tablet 25 mg Formulary OTC hm omeprazole oral tablet delayed release 20 mg Formulary OTC hm probiotic digestive health oral capsule Formulary OTC hm rolled gauze bandage Formulary OTC HM SALONPAS PAIN RELIEF EXTERNAL PATCH 1.2- Formulary OTC 5.7-6.3 % hm severe cold/cough/flu oral packet 20-10-650 mg Formulary OTC hm super vitamin b12 oral tablet chewable 2500 mcg Formulary OTC hm vitamin b12 oral tablet extended release 1000 mcg Formulary OTC hm z-sleep oral capsule 25 mg Formulary OTC HOLD MOUTH/THROAT LOZENGE 5 MG Formulary OTC HOMATROPAIRE OPHTHALMIC SOLUTION 5 % Formulary HONEY BEARS W/IRON-ZINC ORAL TABLET Formulary OTC CHEWABLE 30-200-3 HPR PLUS HYDROGEL EXTERNAL KIT Formulary hrt essential cream Formulary huber needle 19g x 1-1/4" , 19g x 3/4" , 20g x 1-1/4" , 20g x Formulary OTC 3/4" , 22g x 1-1/4" HUGGIES NATURAL CARE WIPES Formulary OTC

71 Drug Name Formulary Status Requirements/Limits HUMALOG MIX 50/50 SUBCUTANEOUS Formulary SUSPENSION (50-50) 100 UNIT/ML HUMALOG MIX 75/25 SUBCUTANEOUS Formulary SUSPENSION (75-25) 100 UNIT/ML HUMALOG SUBCUTANEOUS SOLUTION 100 Formulary UNIT/ML HUMATE-P INTRAVENOUS SOLUTION RECONSTITUTED 1000-2400 UNIT, 250-600 UNIT, 500- Formulary 1200 UNIT humidifier Formulary OTC; QL (2 EA per 365 days) HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 40 Formulary AGE (Min 2 Years) MG/0.8ML HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 80 Formulary SP; AGE (Min 2 Years) MG/0.8ML HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 80 Formulary SP MG/0.8ML & 40MG/0.4ML HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT Formulary SP; AGE (Min 2 Years) 40 MG/0.4ML HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT Formulary AGE (Min 2 Years) 40 MG/0.8ML HUMIRA PEN-CD/UC/HS STARTER SUBCUTANEOUS Formulary AGE (Min 2 Years) PEN-INJECTOR KIT 40 MG/0.8ML HUMIRA PEN-CD/UC/HS STARTER SUBCUTANEOUS Formulary SP; AGE (Min 2 Years) PEN-INJECTOR KIT 80 MG/0.8ML HUMIRA PEN-PS/UV/ADOL HS START Formulary AGE (Min 2 Years) SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML HUMIRA PEN-PS/UV/ADOL HS START SUBCUTANEOUS PEN-INJECTOR KIT 80 MG/0.8ML Formulary SP; AGE (Min 2 Years) & 40MG/0.4ML HUMIRA SUBCUTANEOUS PREFILLED SYRINGE Formulary SP; AGE (Min 2 Years) KIT 10 MG/0.1ML, 20 MG/0.2ML, 40 MG/0.4ML HUMIRA SUBCUTANEOUS PREFILLED SYRINGE Formulary AGE (Min 2 Years) KIT 10 MG/0.2ML, 20 MG/0.4ML, 40 MG/0.8ML HUMULIN 70/30 KWIKPEN SUBCUTANEOUS Formulary OTC SUSPENSION PEN-INJECTOR (70-30) 100 UNIT/ML HUMULIN 70/30 SUBCUTANEOUS SUSPENSION (70- Formulary OTC 30) 100 UNIT/ML HUMULIN N KWIKPEN SUBCUTANEOUS Formulary OTC SUSPENSION PEN-INJECTOR 100 UNIT/ML HUMULIN N SUBCUTANEOUS SUSPENSION 100 Formulary OTC UNIT/ML HUMULIN R INJECTION SOLUTION 100 UNIT/ML Formulary OTC HUMULIN R U-500 (CONCENTRATED) Formulary SUBCUTANEOUS SOLUTION 500 UNIT/ML HUMULIN R U-500 KWIKPEN SOLUTION PEN- INJECTOR 500 UNIT/ML SUBCUTANEOUS 500 Formulary UNIT/ML HURRICAINE MOUTH/THROAT AEROSOL 20 % Formulary OTC

72 Drug Name Formulary Status Requirements/Limits HURRICAINE MOUTH/THROAT SOLUTION 20 % Formulary OTC HURRICAINE MOUTH/THROAT SWAB 20 % Formulary OTC HURRICAINE ONE MOUTH/THROAT SOLUTION 20 Formulary OTC % HURRIVIEW DENTAL SWAB 1.5 % Formulary OTC HURRIVIEW II DENTAL SWAB Formulary OTC HYALGAN INTRA-ARTICULAR SOLUTION 20 Formulary PA MG/2ML HYCAMTIN ORAL CAPSULE 0.25 MG, 1 MG Formulary hydralazine hcl oral tablet 10 mg, 100 mg, 25 mg, 50 mg Formulary HYDROCELL ADHESIVE DRESSING PAD 6"X6" Formulary OTC hydrocerin external cream Formulary OTC hydrocerin external lotion Formulary OTC hydrochloric acid liquid 37 % Formulary hydrochlorothiazide oral capsule 12.5 mg Formulary hydrochlorothiazide oral tablet 12.5 mg, 25 mg, 50 mg Formulary hydrocod polst-cpm polst er oral suspension extended Formulary AGE (Min 6 Years) release 10-8 mg/5ml hydrocodone-acetaminophen oral solution 7.5-325 mg/15ml Formulary PA; QL (1260 ML per 7 days) hydrocodone-acetaminophen oral tablet 10-300 mg, 10-325 Formulary PA; QL (63 EA per 7 days) mg hydrocodone-acetaminophen oral tablet 2.5-325 mg Formulary PA; QL (252 EA per 7 days) hydrocodone-acetaminophen oral tablet 5-300 mg, 5-325 Formulary PA; QL (126 EA per 7 days) mg hydrocodone-acetaminophen oral tablet 7.5-300 mg, 7.5- Formulary PA; QL (84 EA per 7 days) 325 mg hydrocodone-homatropine oral syrup 5-1.5 mg/5ml Formulary AGE (Min 6 Years) hydrocodone-homatropine oral tablet 5-1.5 mg Formulary hydrocodone-ibuprofen oral tablet 10-200 mg Formulary PA; QL (63 EA per 7 days) hydrocodone-ibuprofen oral tablet 5-200 mg Formulary PA; QL (126 EA per 7 days) hydrocodone-ibuprofen oral tablet 7.5-200 mg Formulary PA; QL (84 EA per 7 days) hydrocortisone ace-pramoxine rectal cream 1-1 %, 2.5-1 % Formulary hydrocortisone butyrate external cream 0.1 % Formulary hydrocortisone butyrate external ointment 0.1 % Formulary hydrocortisone butyrate external solution 0.1 % Formulary hydrocortisone external cream 0.5 % Formulary OTC hydrocortisone external cream 1 %, 2.5 % Formulary hydrocortisone external lotion 2.5 % Formulary hydrocortisone external ointment 0.5 % Formulary OTC hydrocortisone external ointment 1 %, 2.5 % Formulary hydrocortisone oral tablet 10 mg, 20 mg, 5 mg Formulary hydrocortisone rectal cream 1 % Formulary hydrocortisone valerate external cream 0.2 % Formulary hydrocortisone valerate external ointment 0.2 % Formulary HYDROGEL EXTERNAL GEL Formulary OTC

73 Drug Name Formulary Status Requirements/Limits hydromet oral syrup 5-1.5 mg/5ml Formulary AGE (Min 6 Years) hydromorphone hcl injection solution 1 mg/ml, 2 mg/ml, 4 Formulary mg/ml hydromorphone hcl oral tablet 2 mg Formulary PA; QL (79 EA per 7 days) hydromorphone hcl oral tablet 4 mg Formulary PA; QL (39 EA per 7 days) hydromorphone hcl oral tablet 8 mg Formulary PA; QL (20 EA per 7 days) hydromorphone hcl pf injection solution 10 mg/ml Formulary hydrophilic external ointment Formulary OTC hydrophilic petrolatum external ointment Formulary OTC hydroxychloroquine sulfate oral tablet 200 mg Formulary hydroxyprogesterone caproate intramuscular oil 250 mg/ml Formulary hydroxyprogesterone caproate intramuscular solution 1.25 Formulary gm/5ml hydroxypropyl cellulose powder Formulary hydroxyurea oral capsule 500 mg Formulary hydroxyzine hcl intramuscular solution 50 mg/ml Formulary hydroxyzine hcl oral tablet 10 mg, 25 mg, 50 mg Formulary hydroxyzine pamoate oral capsule 25 mg, 50 mg Formulary HYLATOPIC PLUS EXTERNAL LOTION Formulary HYOPHEN ORAL TABLET 81.6 MG Formulary hyoscyamine sulfate er oral tablet extended release 12 hour Formulary 0.375 mg hyoscyamine sulfate oral elixir 0.125 mg/5ml Formulary hyoscyamine sulfate oral solution 0.125 mg/ml Formulary hyoscyamine sulfate oral tablet 0.125 mg Formulary hyoscyamine sulfate sl sublingual tablet sublingual 0.125 Formulary mg HYPERCARE EXTERNAL SOLUTION 15 % Formulary OTC HYPERRHO S/D INTRAMUSCULAR SOLUTION Formulary PREFILLED SYRINGE 1500 UNIT, 250 UNIT hypodermic needle 21g x 1-1/4" , 25g x 3/4" , 26g x 3/8" Formulary OTC HYPOTEARS OPHTHALMIC SOLUTION 1-1 % Formulary OTC hypromellose powder Formulary HYSEPT EXTERNAL SOLUTION 0.25 %, 0.5 % Formulary OTC HYVEE ADVANCED ANTACID ORAL SUSPENSION Formulary OTC 400-400-40 MG/5ML HY-VEE LANCETS Formulary OTC; QL (150 EA per 30 days) hy-vee thin lancets Formulary OTC; QL (150 EA per 30 days) ibandronate sodium intravenous solution 3 mg/3ml Formulary PA; QL (1 ML per 90 days) ibuprofen 100 junior strength oral tablet chewable 100 mg Formulary OTC ibuprofen oral capsule 200 mg Formulary OTC ibuprofen oral tablet 400 mg, 600 mg, 800 mg Formulary ibuprofen pm oral capsule 200-25 mg Formulary OTC ICAR ORAL SUSPENSION 15 MG/1.25ML Formulary OTC ICAR-C ORAL TABLET 100-250 MG Formulary OTC

74 Drug Name Formulary Status Requirements/Limits ice blue external gel 2 % Formulary OTC ICY HOT EXTERNAL STICK 10-30 % Formulary OTC ICY HOT LIDOCAINE PLUS MENTHOL EXTERNAL Formulary OTC CREAM 4-1 % ICY HOT LIDOCAINE PLUS MENTHOL EXTERNAL Formulary OTC PATCH 4-1 % idarubicin hcl intravenous solution 10 mg/10ml, 20 Formulary mg/20ml, 5 mg/5ml IFEX INTRAVENOUS SOLUTION RECONSTITUTED 3 Formulary GM ifosfamide intravenous solution 1 gm/20ml, 3 gm/60ml Formulary ifosfamide intravenous solution reconstituted 1 gm Formulary imatinib mesylate oral tablet 100 mg, 400 mg Formulary PA imipramine hcl oral tablet 10 mg, 25 mg, 50 mg Formulary imipramine pamoate oral capsule 100 mg, 125 mg, 150 mg, Formulary 75 mg imiquimod external cream 5 % Formulary QL (2 EA per 34 days) immune support oral tablet chewable Formulary OTC IMODIUM A-D ORAL CAPSULE 2 MG Formulary OTC IMODIUM A-D ORAL LIQUID 1 MG/7.5ML Formulary OTC IMODIUM A-D ORAL TABLET 2 MG Formulary OTC IMODIUM MULTI-SYMPTOM RELIEF ORAL TABLET Formulary OTC 2-125 MG IMOVAX RABIES INTRAMUSCULAR INJECTABLE Formulary AGE (Min 19 Years) 2.5 UNIT/ML IMPROVUE OPHTHALMIC SOLUTION PREFILLED Formulary OTC SYRINGE 1.7 % indapamide oral tablet 1.25 mg, 2.5 mg Formulary indole-3-carbinol powder Formulary indomethacin er oral capsule extended release 75 mg Formulary indomethacin oral capsule 25 mg, 50 mg Formulary INFANRIX INTRAMUSCULAR SUSPENSION 25-58-10 Formulary infants gas relief oral suspension 40 mg/0.6ml Formulary OTC INFED INJECTION SOLUTION 50 MG/ML Formulary INFUMORPH 200 INJECTION SOLUTION 200 Formulary MG/20ML (10 MG/ML) INFUMORPH 500 INJECTION SOLUTION 500 Formulary MG/20ML (25 MG/ML) inositol hexanicotinate powder Formulary inositol oral tablet 500 mg, 650 mg Formulary OTC INOSITOL-5 ORAL TABLET 324 MG Formulary OTC INSPIRACHAMBER/LARGE DEVICE Formulary QL (2 EA per 365 days) INSPIRACHAMBER/MEDIUM DEVICE Formulary QL (2 EA per 365 days) INSPIRACHAMBER/MOUTHPIECE DEVICE Formulary QL (2 EA per 365 days) INSPIRACHAMBER/SMALL DEVICE Formulary QL (2 EA per 365 days) INSPIREASE Formulary QL (2 EA per 365 days)

75 Drug Name Formulary Status Requirements/Limits INSTACLEAN EXTERNAL LIQUID Formulary OTC INSTA-GLUCOSE ORAL GEL 77.4 % Formulary OTC instant ear-dry otic liquid 95-5 % Formulary OTC instant hand sanitizer external liquid 62 % Formulary OTC INSTAT EXTERNAL PAD Formulary INSUFLON 25G X 0.71" Formulary insulin syringe 27g x 1/2" 0.5 ml 27g x 1/2" 0.5 ml Formulary OTC insulin syringe 27g x 1/2" 1 ml 27g x 1/2" 1 ml Formulary OTC insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC insulin syringe 30g x 1/2" 1 ml 30g x 1/2" 1 ml Formulary OTC insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml Formulary OTC insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC insulin syringe/needle 27g x 1/2" 0.5 ml 27g x 1/2" 0.5 ml Formulary OTC insulin syringe/needle 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC insulin syringe/needle 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC INSUPEN ULTRAFIN 30G X 8 MM Formulary OTC INTEGRA ORAL CAPSULE 62.5-62.5-40-3 MG Formulary OTC INTELENCE ORAL TABLET 100 MG, 200 MG Formulary intense cough reliever ex st oral liquid 20-300 mg/5ml Formulary OTC INTERDRY AG TEXTILE 10"X144" EXTERNAL Formulary OTC SHEET INTRASITE GEL APPLIPAK EXTERNAL GEL Formulary OTC INTRON A INJECTION SOLUTION 10000000 Formulary PA UNIT/ML, 6000000 UNIT/ML INTRON A INJECTION SOLUTION RECONSTITUTED Formulary PA 10000000 UNIT, 18000000 UNIT, 50000000 UNIT INTROVALE ORAL TABLET 0.15-0.03 MG Formulary QL (91 EA per 91 days) INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION 117 MG/0.75ML, 156 MG/ML, 234 Formulary AGE (Min 18 Years) MG/1.5ML, 39 MG/0.25ML, 78 MG/0.5ML INVEGA TRINZA INTRAMUSCULAR SUSPENSION 273 MG/0.875ML, 410 MG/1.315ML, 546 MG/1.75ML, Formulary AGE (Min 18 Years) 819 MG/2.625ML INVIRASE ORAL CAPSULE 200 MG Formulary INVIRASE ORAL TABLET 500 MG Formulary INVOKANA ORAL TABLET 100 MG, 300 MG Formulary AGE (Min 18 Years) iodides tincture external tincture Formulary OTC iodine crystals Formulary OTC 76 Drug Name Formulary Status Requirements/Limits iodine external tincture , 2 % Formulary OTC iodine strong (lugol's) solution Formulary iodine strong external tincture 6.9-5 % Formulary OTC iodine strong oral solution 5 % Formulary iodine tincture external tincture Formulary OTC iodine tincture external tincture 2 % Formulary iodoform powder Formulary IONIL EXTERNAL SHAMPOO 2-0.2 % Formulary OTC IONIL-T EXTERNAL SHAMPOO 1 % Formulary OTC IONSYS TRANSDERMAL PATCH 40 MCG/ACT Formulary PA IPOL INJECTION INJECTABLE Formulary AGE (Min 19 Years) inhalation solution 0.02 % Formulary ipratropium bromide nasal solution 0.03 % Formulary QL (60 ML per 34 days) ipratropium bromide nasal solution 0.06 % Formulary QL (30 ML per 34 days) ipratropium-albuterol inhalation solution 0.5-2.5 (3) Formulary mg/3ml irinotecan hcl intravenous solution 100 mg/5ml, 40 mg/2ml, Formulary 500 mg/25ml IROFOL ORAL LIQUID 100-1000-15 MG-MCG/5ML Formulary OTC IROFOL ORAL TABLET 150-0.025-1 MG Formulary OTC iron (ferrous sulfate) oral tablet extended release 142 (45 Formulary OTC fe) mg iron 100 plus oral tablet 100-250-0.025-1 mg Formulary OTC iron 100/c oral tablet 100-250 mg Formulary OTC iron 21/7 oral Formulary OTC iron 27 oral tablet 240 (27 fe) mg Formulary OTC iron chews pediatric oral tablet chewable 15 mg Formulary OTC iron slow release oral tablet extended release 143 (45 fe) Formulary OTC mg irrigating eyewash ophthalmic solution Formulary OTC ISENTRESS HD ORAL TABLET 600 MG Formulary ISENTRESS ORAL TABLET 400 MG Formulary ISOLEUCINE 1000 ORAL PACKET 1 GM Formulary OTC isoleucine oral packet 50 mg Formulary OTC isomalt base powder Formulary isoniazid oral syrup 50 mg/5ml Formulary isoniazid oral tablet 100 mg, 300 mg Formulary isopropyl alcohol (rubbing) solution 70 % Formulary OTC isopropyl alcohol solution , 70 %, 99 % Formulary isopropyl alcohol solution 50 %, 91 % Formulary OTC isopropyl alcohol wipes 70 % external 70 % Formulary OTC isopropyl myristate solution Formulary isopropyl palmitate liquid Formulary ISOPTO TEARS OPHTHALMIC SOLUTION 0.5 % Formulary OTC isosorbide dinitrate er oral tablet extended release 40 mg Formulary 77 Drug Name Formulary Status Requirements/Limits isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg, 5 mg Formulary er oral tablet extended release 24 Formulary hour 120 mg, 30 mg, 60 mg isosorbide mononitrate oral tablet 10 mg, 20 mg Formulary isradipine oral capsule 2.5 mg, 5 mg Formulary itch relief external cream 2 % Formulary OTC ITCH-X EXTERNAL GEL 1-10 % Formulary OTC ITCH-X EXTERNAL SOLUTION 1-10 % Formulary OTC itraconazole oral capsule 100 mg Formulary QL (34 EA per 34 days) itraconazole oral solution 10 mg/ml Formulary IVAREST MEDICATED POISON IVY EXTERNAL Formulary OTC LIQUID 1 % IVAREST POISON IVY ITCH EXTERNAL CREAM 2- Formulary OTC 14-10.5 % ivermectin oral tablet 3 mg Formulary ivy wash poison ivy cleanser external lotion 1 % Formulary OTC IXEMPRA KIT INTRAVENOUS SOLUTION Formulary RECONSTITUTED 15 MG, 45 MG IXIARO INTRAMUSCULAR SUSPENSION Formulary AGE (Min 19 Years) J & J ALL-PURPOSE FIRST AID COMBINATION KIT Formulary OTC J & J DENTAL FLOSS FOR KIDS Formulary OTC JANTOVEN ORAL TABLET 1 MG, 10 MG, 2 MG, 2.5 Formulary MG, 3 MG, 4 MG, 5 MG, 6 MG, 7.5 MG JANUMET ORAL TABLET 50-1000 MG, 50-500 MG Formulary ST JANUMET XR ORAL TABLET EXTENDED RELEASE Formulary ST 24 HOUR 100-1000 MG, 50-1000 MG, 50-500 MG JANUVIA ORAL TABLET 100 MG, 25 MG, 50 MG Formulary ST JARDIANCE ORAL TABLET 10 MG, 25 MG Formulary AGE (Min 18 Years) JENTADUETO ORAL TABLET 2.5-1000 MG, 2.5-500 Formulary ST MG, 2.5-850 MG jessners external solution Formulary OTC jock itch spray external aerosol powder 1 % Formulary OTC JOHNSONS BABY CORNSTARCH EXTERNAL Formulary OTC POWDER JOHNSONS BABY OIL GEL EXTERNAL GEL Formulary OTC JOHNSONS BABY POWDER EXTERNAL POWDER Formulary OTC JUNEL 1/20 ORAL TABLET 1-20 MG-MCG Formulary JUVEN ORAL PACKET Formulary OTC k 100 oral tablet 100 mcg Formulary OTC k-99 oral capsule 595 mg Formulary OTC KAITLIB FE ORAL TABLET CHEWABLE 0.8-25 MG- Formulary MCG KALBITOR SUBCUTANEOUS SOLUTION 10 MG/ML Formulary PA; QL (6 ML per 34 days) KALETRA ORAL TABLET 100-25 MG, 200-50 MG Formulary KANGAROO ENTRIFLUSH PUMP SET Formulary KANGAROO JOEY PUMP SET Formulary

78 Drug Name Formulary Status Requirements/Limits KANK-A MOUTH PAIN MOUTH/THROAT SOLUTION Formulary OTC 20 % KANK-A SOFTBRUSH MOUTH/THROAT GEL 20-0.1 Formulary OTC % kaolin powder Formulary KAOPECTATE ORAL TABLET 262 MG Formulary OTC KAPVAY ORAL TABLET EXTENDED RELEASE 12 ST; AGE (Min 4 Years and Max 17 Formulary HOUR 0.1 MG Years) karaya gum gum Formulary KARBOZYME ORAL TABLET DELAYED RELEASE Formulary OTC 167-173-346 MG K-BICARB ORAL CAPSULE 99 MG Formulary OTC KELNOR 1/35 ORAL TABLET 1-35 MG-MCG Formulary QL (28 EA per 28 days) kelp oral tablet 150 mcg Formulary OTC kelp-b6-lecithin-vinegar oral capsule 5-0.75-200-50 mg Formulary OTC KENALOG INJECTION SUSPENSION 10 MG/ML Formulary KENDALL ALGINATE DRESS 8"X8" EXTERNAL PAD Formulary OTC KENDALL ANTIMICROBIAL BANDAGE EXTERNAL Formulary OTC KENDALL CA ALGINATE 6"X10" EXTERNAL Formulary OTC KENDALL HYDROPHILIC FOAM DRESS PAD 4"X8" , Formulary OTC 5"X5" KENDALL TRANSPARENT FILM DRESS Formulary OTC KEPIVANCE INTRAVENOUS SOLUTION Formulary RECONSTITUTED 6.25 MG KERAMATRIX REPLICINE 10CMX10CM EXTERNAL Formulary SHEET KERR TRIPLE DYE SWABS EXTERNAL SWAB Formulary OTC external cream 2 % Formulary ketoconazole external foam 2 % Formulary ketoconazole external shampoo 2 % Formulary ketoconazole oral tablet 200 mg Formulary ketorolac tromethamine injection solution 15 mg/ml, 30 Formulary mg/ml ketorolac tromethamine intramuscular solution 60 mg/2ml Formulary ketorolac tromethamine ophthalmic solution 0.4 %, 0.5 % Formulary ketorolac tromethamine oral tablet 10 mg Formulary QL (20 EA per 34 days) KETOSTIX IN VITRO STRIP Formulary OTC kettle neti pot sinus wash nasal kit 2300-700 mg Formulary OTC KEY OMEGA ORAL PACKET 200-100 MG Formulary OTC k-iii oral solution reconstituted 33.3-33.3-33.3 % Formulary OTC KINERASE EXTERNAL CREAM 0.1 %, 0.125 % Formulary OTC KINERASE EXTERNAL LOTION 0.1 % Formulary OTC kinney lancets Formulary OTC; QL (150 EA per 30 days) kinney thin lancets Formulary OTC kinray insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC kinray insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC 79 Drug Name Formulary Status Requirements/Limits kinray insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC kinray insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC KINRIX INTRAMUSCULAR SUSPENSION Formulary KIONEX ORAL SUSPENSION 15 GM/60ML Formulary AGE (Min 19 Years) KITABIS PAK NEBULIZATION SOLUTION 300 QL (280 ML per 28 days); AGE (Min 6 Formulary MG/5ML INHALATION 300 MG/5ML Years) KLOR-CON 10 ORAL TABLET EXTENDED RELEASE Formulary 10 MEQ KLOR-CON M10 ORAL TABLET EXTENDED Formulary RELEASE 10 MEQ KLOR-CON M15 ORAL TABLET EXTENDED Formulary RELEASE 15 MEQ KLOR-CON M20 ORAL TABLET EXTENDED Formulary RELEASE 20 MEQ KLOR-CON ORAL TABLET EXTENDED RELEASE 8 Formulary MEQ KLOR-CON SPRINKLE ORAL CAPSULE EXTENDED Formulary RELEASE 10 MEQ, 8 MEQ kls cold & flu ms day/night oral tablet therapy pack Formulary OTC kls esomeprazole magnesium oral capsule delayed release Formulary OTC 20 mg kls omeprazole oral tablet delayed release 20 mg Formulary OTC K-MAG ASPARTATE ORAL TABLET 250-250 MG Formulary OTC K-MAG ORAL CAPSULE 40-40 MG Formulary OTC K-MAG-70 ORAL CAPSULE 70-70 MG Formulary OTC kmart valu insulin syringe 29g u-100 0.5 ml u-100 0.5 ml Formulary OTC kmart valu insulin syringe 29g u-100 1 ml u-100 1 ml Formulary OTC kmart valu insulin syringe 30g u-100 0.3 ml u-100 0.3 ml Formulary OTC kmart valu insulin syringe 30g u-100 0.5 ml u-100 0.5 ml Formulary OTC kmart valu insulin syringe 30g u-100 1 ml u-100 1 ml Formulary OTC kojic acid powder Formulary konsyl daily fiber oral packet 100 % Formulary OTC konsyl daily fiber oral powder 100 % Formulary OTC KONSYL ORAL PACKET 28.3 %, 60.3 % Formulary OTC KONSYL ORAL POWDER 60.3 %, 71.67 % Formulary OTC KONSYL-D ORAL POWDER 52.3 % Formulary OTC korean ginseng oral capsule 350 mg Formulary OTC kp hydrocortisone-aloe external cream 0.5 % Formulary OTC kp mag-oxide magnesium oral tablet 200 mg Formulary OTC kp silicone scar therapy gel strip Formulary OTC K-PHOS NO 2 ORAL TABLET 305-700 MG Formulary K-PHOS ORAL TABLET 500 MG Formulary kpn prenatal oral tablet 0.1 mg Formulary OTC kroger insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC kroger insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC kroger insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC 80 Drug Name Formulary Status Requirements/Limits kroger insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml Formulary OTC kroger insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC kroger insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC kroger insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC kroger insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC kroger insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC kroger lancets Formulary OTC; QL (150 EA per 30 days) kroger lancets 21g Formulary OTC; QL (150 EA per 30 days) kroger lancets micro thin 33g Formulary OTC; QL (150 EA per 30 days) kroger lancets super thin Formulary OTC; QL (150 EA per 30 days) kroger lancets thin Formulary OTC; QL (150 EA per 30 days) kroger lancets thin 26g Formulary OTC; QL (150 EA per 30 days) kroger lancets ultrathin 30g Formulary OTC; QL (150 EA per 30 days) KT TAPE PRO TAPE Formulary OTC K-TAN PLUS ORAL CAPSULE 162-115.2-1 MG Formulary KUVAN ORAL TABLET SOLUBLE 100 MG Formulary PA KWAN LOONG PAIN RELIEVING EXTERNAL OIL Formulary OTC KYLEENA INTRAUTERINE Formulary 19.5 MG labetalol hcl intravenous solution 5 mg/ml Formulary labetalol hcl oral tablet 100 mg, 200 mg, 300 mg Formulary LAC-HYDRIN FIVE EXTERNAL LOTION 5 % Formulary OTC LAC-HYDRIN TWELVE EXTERNAL LOTION 12 % Formulary OTC lactated ringers irrigation solution Formulary lactic acid e external cream 10-3500 %-unt/30gm Formulary lactic acid external lotion 10 % Formulary lactic acid solution 85 % Formulary OTC lacto-bifidus-600 oral capsule Formulary OTC lactose monohydrate powder Formulary lactose powder Formulary l-alanine powder Formulary LAMISIL ADVANCED EXTERNAL GEL 1 % Formulary OTC LAMISIL AT EXTERNAL CREAM 1 % Formulary OTC LAMISIL AT EXTERNAL POWDER Formulary OTC LAMISIL AT SPRAY EXTERNAL SOLUTION 1 % Formulary OTC LAMISILK PROTECT EXTERNAL LIQUID Formulary OTC lamivudine oral solution 10 mg/ml Formulary lamivudine oral tablet 100 mg, 150 mg, 300 mg Formulary lamivudine-zidovudine oral tablet 150-300 mg Formulary lamotrigine er oral tablet extended release 24 hour 100 mg, Formulary 200 mg, 25 mg, 250 mg, 300 mg, 50 mg lamotrigine oral tablet 100 mg, 150 mg, 200 mg, 25 mg Formulary lamotrigine oral tablet chewable 25 mg, 5 mg Formulary

81 Drug Name Formulary Status Requirements/Limits LANACANE ANTI-BACTERIAL EXTERNAL Formulary OTC AEROSOL 20-0.2 % LANACANE MAXIMUM STRENGTH EXTERNAL Formulary OTC CREAM 20-0.2 % lancets Formulary OTC; QL (150 EA per 30 days) lancets 28g Formulary OTC; QL (150 EA per 30 days) lancets 30g Formulary OTC; QL (150 EA per 30 days) lancets micro thin 33g Formulary OTC; QL (150 EA per 30 days) lancets super thin 28g Formulary OTC; QL (150 EA per 30 days) lancets thin Formulary OTC; QL (150 EA per 30 days) LANCETS ULTRA THIN Formulary OTC; QL (150 EA per 30 days) lancets ultra thin 30g Formulary OTC; QL (150 EA per 30 days) lanolin anhydrous external ointment Formulary lanolin external ointment Formulary lanolin hydrous-grx external ointment 72 % Formulary OTC lansoprazole oral capsule delayed release 15 mg Formulary lansoprazole oral capsule delayed release 30 mg Formulary QL (34 EA per 34 days) lansoprazole oral tablet dispersible 15 mg, 30 mg Formulary PA LANTUS SOLOSTAR SOLUTION PEN-INJECTOR 100 Formulary UNIT/ML SUBCUTANEOUS 100 UNIT/ML LANTUS SUBCUTANEOUS SOLUTION 100 UNIT/ML Formulary l-arginine hcl powder Formulary l-arginine oral capsule 500 mg Formulary OTC l-arginine oral tablet 1000 mg Formulary OTC l-arginine powder Formulary LARIN 1/20 ORAL TABLET 1-20 MG-MCG Formulary l-aspartic acid powder Formulary latanoprost ophthalmic solution 0.005 % Formulary LATUDA ORAL TABLET 120 MG, 20 MG, 40 MG, 60 Formulary AGE (Min 18 Years) MG, 80 MG lavender oil oil Formulary laxative oral tablet 25 mg Formulary OTC laxative pills oral tablet 15 mg Formulary OTC LAZANDA NASAL SOLUTION 100 MCG/ACT, 400 Formulary PA; QL (120 EA per 30 days) MCG/ACT l-carnitine hcl powder Formulary OTC l-carnitine oral capsule 250 mg, 500 mg Formulary OTC l-carnitine oral tablet 250 mg, 500 mg Formulary OTC l-carnitine powder Formulary l-citrulline powder Formulary l- hcl powder Formulary l-cysteine powder Formulary l-cystine powder Formulary leader insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC leader insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC

82 Drug Name Formulary Status Requirements/Limits leader insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC leader insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC leader insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC leader insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml Formulary OTC leader insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC leader insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC leader insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC leader insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC lecithin granules Formulary lecithin-kelp-b6-cider vinegar oral capsule 200-0.075-5-50 Formulary OTC mg leflunomide oral tablet 10 mg, 20 mg Formulary lemon bioflavanoid powder Formulary OTC lemon oil oil Formulary OTC lemon-glycerin mouth/throat swab Formulary OTC LENZAPATCH EXTERNAL PATCH 4-1 % Formulary LETAIRIS ORAL TABLET 10 MG, 5 MG Formulary PA; AGE (Min 18 Years) letrozole oral tablet 2.5 mg Formulary leucine oral packet 100 mg Formulary OTC leucovorin calcium injection solution reconstituted 100 mg, Formulary 200 mg, 350 mg, 50 mg, 500 mg leucovorin calcium oral tablet 10 mg, 15 mg, 25 mg, 5 mg Formulary LEUKERAN ORAL TABLET 2 MG Formulary leuprolide acetate injection kit 1 mg/0.2ml Formulary PA levalbuterol hcl inhalation nebulization solution 0.31 Formulary PA mg/3ml, 0.63 mg/3ml, 1.25 mg/0.5ml, 1.25 mg/3ml levalbuterol tartrate inhalation aerosol 45 mcg/act Formulary LEVEMIR FLEXTOUCH SOLUTION PEN-INJECTOR Formulary 100 UNIT/ML SUBCUTANEOUS 100 UNIT/ML LEVEMIR SUBCUTANEOUS SOLUTION 100 UNIT/ML Formulary levetiracetam er oral tablet extended release 24 hour 500 Formulary mg, 750 mg levetiracetam in nacl intravenous solution 1000 mg/100ml, Formulary 1500 mg/100ml, 500 mg/100ml levetiracetam intravenous solution 500 mg/5ml Formulary levetiracetam oral solution 100 mg/ml Formulary levetiracetam oral tablet 1000 mg, 250 mg, 500 mg, 750 mg Formulary levobunolol hcl ophthalmic solution 0.5 % Formulary levocarnitine (dietary) oral tablet 330 mg Formulary OTC levocarnitine oral solution 1 gm/10ml Formulary levocarnitine oral tablet 330 mg Formulary levocarnitine-b5-taurine oral liquid 1000-10-150 mg/15ml Formulary OTC levocetirizine dihydrochloride oral solution 2.5 mg/5ml Formulary levocetirizine dihydrochloride oral tablet 5 mg Formulary levofloxacin intravenous solution 25 mg/ml Formulary

83 Drug Name Formulary Status Requirements/Limits levofloxacin ophthalmic solution 0.5 % Formulary levofloxacin oral solution 25 mg/ml Formulary levofloxacin oral tablet 250 mg, 500 mg, 750 mg Formulary levoleucovorin calcium intravenous solution reconstituted Formulary 50 mg LEVO-T ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 Formulary MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG LEXIVA ORAL SUSPENSION 50 MG/ML Formulary l-glutamic acid powder Formulary l-glutamine oral capsule 500 mg Formulary OTC l-glutamine oral tablet 500 mg Formulary OTC l-glutathione crystals Formulary OTC l-histidine powder Formulary LIALDA ORAL TABLET DELAYED RELEASE 1.2 GM Formulary LICE B GONE CAP SATURATED EXTERNAL KIT Formulary OTC LICE B GONE EXTERNAL SHAMPOO Formulary OTC lice cure external solution Formulary OTC lice killing maximum strength external shampoo 0.33-4 % Formulary OTC LICEFREEE EXTERNAL SOLUTION Formulary OTC LICEMD COMPLETE EXTERNAL KIT 0.33-4 % Formulary OTC LICIDE TREATMENT COMBINATION KIT Formulary OTC lidocaine external cream 5 % Formulary OTC; QL (60 GM per 30 days) lidocaine external ointment 5 % Formulary ST; QL (30 GM per 34 days) lidocaine external patch 5 % Formulary QL (90 EA per 30 days) lidocaine hcl external solution 4 % Formulary lidocaine hcl mouth/throat solution 4 % Formulary lidocaine viscous mouth/throat solution 2 % Formulary lidocaine-hydrocortisone ace rectal kit 3-1 %, 3-2.5 % Formulary lidocaine-prilocaine external cream 2.5-2.5 % Formulary lidocaine-transparent dressing external kit 4 % Formulary OTC LIDOPATCH PAIN RELIEF EXTERNAL PATCH 3.99- Formulary OTC 1.25 % LIDOPRO TRANSDERMAL PATCH 4-4-5 % Formulary OTC LIDOZENGEL EXTERNAL GEL 4-1 % Formulary OTC LILETTA (52 MG) INTRAUTERINE INTRAUTERINE Formulary DEVICE 18.6 MCG/DAY lime oil oil Formulary limencin external patch 4-4 % Formulary OTC lindane external shampoo 1 % Formulary ST; QL (60 ML per 30 days) linezolid oral suspension reconstituted 100 mg/5ml Formulary PA linezolid oral tablet 600 mg Formulary PA LINZESS ORAL CAPSULE 145 MCG, 290 MCG, 72 Formulary PA; AGE (Min 18 Years) MCG liothyronine sodium oral tablet 25 mcg, 5 mcg, 50 mcg Formulary

84 Drug Name Formulary Status Requirements/Limits base natural ointment Formulary OTC lip balm external ointment Formulary OTC lip balm external stick Formulary OTC LIP MEDEX EXTERNAL OINTMENT Formulary OTC lipochol nr oral capsule Formulary OTC lipochol plus oral tablet Formulary OTC LIPO-GEL ORAL CAPSULE 100-30 MG-UNIT Formulary OTC lipoic acid oral capsule 150 mg Formulary OTC LIPOIL OIL Formulary OTC LIPOTRIAD ORAL TABLET Formulary OTC LIPOTRIAD VISIONARY ORAL CAPSULE Formulary OTC lipovan base external cream Formulary OTC LIQ-10 ORAL SYRUP 100-1 MG-UNT/5ML, 50-15 Formulary OTC LIQSORB ORAL LIQUID 100 MG/ML Formulary OTC LIQUACEL ORAL LIQUID Formulary OTC LIQUIMAT EXTERNAL LOTION 5 % Formulary OTC lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 30 mg, 40 mg, 5 Formulary mg lisinopril-hydrochlorothiazide oral tablet 10-12.5 mg, 20- Formulary 12.5 mg, 20-25 mg l-isoleucine powder Formulary LISTERINE NATURALS ANTISEPTIC Formulary OTC MOUTH/THROAT LIQUID lite touch lancets Formulary OTC; QL (150 EA per 30 days) LITETOUCH INSULIN SYRINGE 28G X 1/2" 0.5 ML Formulary OTC 28G X 1/2" 0.5 ML LITETOUCH INSULIN SYRINGE 28G X 1/2" 1 ML 28G Formulary OTC X 1/2" 1 ML LITETOUCH INSULIN SYRINGE 29G X 1/2" 0.3 ML Formulary OTC 29G X 1/2" 0.3 ML LITETOUCH INSULIN SYRINGE 29G X 1/2" 0.5 ML Formulary OTC 29G X 1/2" 0.5 ML LITETOUCH INSULIN SYRINGE 29G X 1/2" 1 ML 29G Formulary OTC X 1/2" 1 ML LITETOUCH INSULIN SYRINGE 30G X 5/16" 0.3 ML Formulary OTC 30G X 5/16" 0.3 ML LITETOUCH INSULIN SYRINGE 30G X 5/16" 0.5 ML Formulary OTC 30G X 5/16" 0.5 ML LITETOUCH INSULIN SYRINGE 30G X 5/16" 1 ML Formulary OTC 30G X 5/16" 1 ML LITETOUCH INSULIN SYRINGE 31G X 5/16" 0.3 ML Formulary OTC 31G X 5/16" 0.3 ML LITETOUCH INSULIN SYRINGE 31G X 5/16" 0.5 ML Formulary OTC 31G X 5/16" 0.5 ML LITETOUCH INSULIN SYRINGE 31G X 5/16" 1 ML Formulary OTC 31G X 5/16" 1 ML LITETOUCH LANCETS Formulary OTC; QL (150 EA per 30 days)

85 Drug Name Formulary Status Requirements/Limits lithium carbonate er oral tablet extended release 300 mg, Formulary 450 mg lithium carbonate oral capsule 150 mg, 300 mg, 600 mg Formulary lithium carbonate oral tablet 300 mg Formulary lithium oral solution 8 meq/5ml Formulary LITTLE COLDS COUGH FORMULA ORAL LIQUID 7.5 Formulary OTC MG/ML LITTLE COLDS DECONGESTANT ORAL LIQUID 2.5 Formulary OTC MG/ML LITTLE REMEDIES POISON TREAT ORAL Formulary OTC SUSPENSION RECONSTITUTED 15 GM/120ML LITTLE TUMMYS LAXATIVE ORAL LIQUID 8.8 Formulary OTC MG/ML LIVALO ORAL TABLET 1 MG, 2 MG, 4 MG Formulary ST live better lancet super thin Formulary OTC; QL (150 EA per 30 days) live better lancet ultra thin Formulary OTC; QL (150 EA per 30 days) liver extract oral tablet 455 mg Formulary OTC liver oral capsule 500 mg Formulary OTC l-lysine hcl oral capsule 500 mg Formulary OTC l-lysine hcl oral tablet 1000 mg Formulary OTC l-lysine hcl powder Formulary l-lysine oral capsule 500 mg Formulary OTC l-lysine oral tablet 1000 mg, 500 mg Formulary OTC l-methionine powder Formulary LMX 4 EXTERNAL CREAM 4 % Formulary OTC LMX 4 PLUS EXTERNAL KIT 4 % Formulary OTC LO LOESTRIN FE ORAL TABLET 1 MG-10 MCG / 10 Formulary QL (28 EA per 28 days) MCG local anesthesia needle 20g x 4" , 22 x 4" , 22g x 3" Formulary OTC LODRANE D ORAL CAPSULE 4-60 MG Formulary OTC LOHIST-D ORAL LIQUID 2-30 MG/5ML Formulary OTC lohist-dm oral syrup 5-2-10 mg/5ml Formulary OTC; AGE (Min 2 Years) longs insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC longs lancets thin Formulary OTC; QL (150 EA per 30 days) loperamide hcl oral suspension 1 mg/7.5ml Formulary OTC lopinavir- oral solution 400-100 mg/5ml Formulary childrens oral solution 5 mg/5ml Formulary OTC loratadine oral capsule 10 mg Formulary OTC LORAZEPAM INTENSOL ORAL CONCENTRATE 2 Formulary QL (170 ML per 30 days) MG/ML lorazepam oral tablet 0.5 mg, 1 mg, 2 mg Formulary QL (170 EA per 30 days) l-ornithine hydrochloride powder Formulary l-ornithine powder Formulary OTC LORTUSS DM ORAL LIQUID 30-6.25-15 MG/5ML Formulary OTC LORTUSS EX ORAL LIQUID 30-10-100 MG/5ML Formulary OTC LORTUSS LQ ORAL LIQUID 6.25-30 MG/5ML Formulary OTC 86 Drug Name Formulary Status Requirements/Limits losartan potassium oral tablet 100 mg, 25 mg, 50 mg Formulary losartan potassium-hctz oral tablet 100-12.5 mg, 100-25 Formulary mg, 50-12.5 mg LOTRIMIN AF EXTERNAL AEROSOL 2 % Formulary OTC LOTRIMIN AF EXTERNAL CREAM 1 % Formulary OTC LOTRIMIN ULTRA EXTERNAL CREAM 1 % Formulary OTC oral tablet 10 mg, 20 mg, 40 mg Formulary loxapine succinate oral capsule 10 mg, 25 mg, 5 mg, 50 mg Formulary AGE (Min 18 Years) LOZIBASE S Formulary l-phenylalanine oral tablet 500 mg Formulary OTC l-phenylalanine powder Formulary l-proline powder Formulary l-serine powder Formulary l-tyrosine oral capsule 500 mg Formulary OTC l-tyrosine oral tablet 500 mg Formulary OTC l-tyrosine powder Formulary lubricant drops/dual-action ophthalmic solution 0.5-0.9 % Formulary OTC lubricant eye drops ophthalmic solution 0.4-0.3 % Formulary OTC LUBRISKIN EXTERNAL LOTION Formulary OTC LUCENTIS INTRAVITREAL SOLUTION 0.5 Formulary PA; QL (0.05 ML per 28 days) MG/0.05ML LUDENS COUGH DROPS MOUTH/THROAT Formulary OTC LOZENGE 3-60 MG LUDENS THROAT DROPS MOUTH/THROAT LOZENGE 1 MG, 1.6 MG, 1.7 MG, 2.4 MG, 2.5 MG, 2.8 Formulary OTC MG, 4 MG LUPRON DEPOT (1-MONTH) INTRAMUSCULAR KIT Formulary PA; QL (1 EA per 90 days) 3.75 MG, 7.5 MG LUPRON DEPOT (3-MONTH) INTRAMUSCULAR KIT Formulary PA; QL (1 EA per 90 days) 11.25 MG, 22.5 MG LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT Formulary PA; QL (1 EA per 90 days) 30 MG LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT Formulary PA; QL (1 EA per 90 days) 45 MG LUPRON DEPOT-PED (1-MONTH) INTRAMUSCULAR Formulary PA; QL (1 EA per 90 days) KIT 11.25 MG, 15 MG, 7.5 MG LUPRON DEPOT-PED (3-MONTH) INTRAMUSCULAR Formulary PA; QL (1 EA per 90 days) KIT 11.25 MG (PED), 30 MG (PED) lutein oral capsule 15-0.7 mg, 40 mg, 6 mg Formulary OTC lutein oral tablet 10 mg, 20 mg, 6 mg Formulary OTC LUVENA FEMININE WIPES EXTERNAL 1 % Formulary OTC LYCELLE EXTERNAL GEL Formulary LYRICA ORAL CAPSULE 100 MG, 150 MG, 200 MG, Formulary ST 225 MG, 25 MG, 300 MG, 50 MG, 75 MG lysine4000 oral packet 4000 mg Formulary OTC LYSODREN ORAL TABLET 500 MG Formulary M2 C ORAL CAPSULE EXTENDED RELEASE 500 MG Formulary OTC

87 Drug Name Formulary Status Requirements/Limits MAALOX ADVANCED MAX ST ORAL TABLET Formulary OTC CHEWABLE 1000-60 MG MAALOX JUNIOR PLUS ANTIGAS ORAL TABLET Formulary OTC CHEWABLE 400-24 MG MAALOX ORAL TABLET CHEWABLE 600 MG Formulary OTC MACUGEN INTRAOCULAR SOLUTION 0.3 MG Formulary mafenide hcl powder Formulary OTC MAG-200 ORAL TABLET 200 MG Formulary OTC mag-al oral liquid 200-200 mg/5ml Formulary OTC magdelay oral tablet delayed release 70 mg Formulary OTC MAGELLAN INSULIN SAFETY SYR 29G X 1/2" 0.3 Formulary ML 29G X 1/2" 0.3 ML MAGELLAN INSULIN SAFETY SYR 29G X 1/2" 0.5 Formulary ML 29G X 1/2" 0.5 ML MAGELLAN INSULIN SAFETY SYR 29G X 1/2" 1 ML Formulary 29G X 1/2" 1 ML MAGELLAN INSULIN SAFETY SYR 30G X 5/16" 0.3 Formulary ML 30G X 5/16" 0.3 ML MAGELLAN INSULIN SAFETY SYR 30G X 5/16" 0.5 Formulary ML 30G X 5/16" 0.5 ML MAGELLAN INSULIN SAFETY SYR 30G X 5/16" 1 ML Formulary 30G X 5/16" 1 ML MAGIC3 INTERMITTENT CATHETER Formulary OTC MAGIMIN ORAL TABLET 80 MG Formulary OTC magnacaps oral capsule 100 mg Formulary OTC MAGNEBIND 200 ORAL TABLET 450-200 MG Formulary OTC MAGNEBIND 300 ORAL TABLET 250-300 MG Formulary OTC magnesium aspartate oral tablet 65 mg Formulary OTC magnesium carbonate granules Formulary OTC magnesium carbonate heavy powder Formulary magnesium carbonate oral powder 250 mg/gm Formulary OTC magnesium chloride powder Formulary magnesium chloride-calcium oral tablet 64-112 mg Formulary OTC magnesium citrate oral solution 1.745 gm/30ml Formulary OTC magnesium citrate powder Formulary magnesium fizz-plus oral powder effervescent 300-500 Formulary OTC mg/6.1gm magnesium gluconate oral tablet 27.5 mg Formulary OTC magnesium oral capsule 300 mg Formulary OTC magnesium oral tablet 200 mg, 250 mg, 30 mg Formulary OTC magnesium oxide oral capsule 500 mg Formulary OTC magnesium oxide oral powder Formulary OTC magnesium oxide oral tablet 400 (240 mg) mg, 400 (241.3 Formulary OTC mg) mg, 400 mg, 420 mg, 500 mg magnesium oxide powder Formulary magnesium stearate powder Formulary

88 Drug Name Formulary Status Requirements/Limits magnesium sulfate oral capsule 70 mg Formulary OTC magnesium sulfate powder Formulary magnum-75 oral tablet extended release Formulary OTC MAGONATE ORAL TABLET 500 (27 MG) MG Formulary OTC mag-sr plus calcium oral tablet delayed release 64-106 mg Formulary OTC MAG-TAB SR ORAL TABLET EXTENDED RELEASE Formulary OTC 84 MG (7MEQ) MAKENA OIL 250 MG/ML INTRAMUSCULAR 250 Formulary MG/ML MAKENA SUBCUTANEOUS SOLUTION AUTO- Formulary INJECTOR 275 MG/1.1ML malathion external lotion 0.5 % Formulary ST malic acid powder Formulary manganese aspartate oral tablet 93 mg Formulary OTC manganese gluconate oral tablet 50 mg Formulary OTC manganese oral tablet 15 mg Formulary OTC MANGIMIN ORAL TABLET 10 MG Formulary OTC mannitol powder Formulary MAOX ORAL TABLET 420 MG Formulary OTC MAPAP HEADACHE PLUS ORAL TABLET 500-250 Formulary OTC MG MAR-COF BP ORAL LIQUID 30-2-7.5 MG/5ML Formulary OTC MAR-COF CG EXPECTORANT ORAL LIQUID 225-7.5 Formulary OTC MG/5ML marshmallow artificial flavor concentrate Formulary OTC MASTISOL ADHESIVE EXTERNAL LIQUID Formulary OTC MATULANE ORAL CAPSULE 50 MG Formulary MAVYRET ORAL TABLET 100-40 MG Formulary PA MAXI-COMFORT INSULIN SYRINGE 28G X 1/2" 0.5 Formulary OTC ML 28G X 1/2" 0.5 ML MAXI-COMFORT INSULIN SYRINGE 28G X 1/2" 1 ML Formulary OTC 28G X 1/2" 1 ML MAXIMUM D3 ORAL CAPSULE 10000 UNIT Formulary OTC ME-500 ORAL CAPSULE 500 MG Formulary OTC mecholyl external ointment 0.25 % Formulary OTC hcl oral tablet 12.5 mg, 25 mg Formulary MEDADYNE ORAL PAIN RELIEF MOUTH/THROAT Formulary OTC LIQUID 10-0.13-70 % MEDERMA AG FACIAL CLEANSER EXTERNAL Formulary OTC LIQUID MEDERMA EXTERNAL GEL Formulary OTC MEDERMA PM EXTERNAL CREAM 2 % Formulary OTC medic insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml Formulary OTC medic insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC medicated body external powder Formulary OTC medicated vaginal solution 0.3 % Formulary OTC

89 Drug Name Formulary Status Requirements/Limits medicated wipes external pad 50 % Formulary OTC MEDICONE RECTAL SUPPOSITORY 0.25 % Formulary OTC MEDI-DERM/L-RX EXTERNAL CREAM 2-0.035-5-20 Formulary % MEDI-DERM-RX EXTERNAL CREAM 0.035-5-20 % Formulary MEDI-FIRST ANTISEPTIC CLEANER EXTERNAL GEL Formulary OTC 66.5 % MEDI-FIRST/LIDOCAINE EXTERNAL CREAM 0.5- Formulary OTC 0.13 % MEDIHONEY WOUND/BURN DRESSING EXTERNAL Formulary OTC GEL MEDIHONEY WOUND/BURN DRESSING EXTERNAL Formulary OTC PASTE medi-laxx oral capsule 8.6-50 mg Formulary OTC MEDI-LYTE ORAL TABLET 18-9-40 MG Formulary OTC medi-patch-lidocaine external patch 0.5-0.035-5-20 % Formulary OTC MEDIPLAST EXTERNAL 40 % Formulary OTC MEDIPORE + PAD ADHESIVE DRESS PAD 2"X2-3/4" , Formulary OTC 3-1/2"X10" , 3-1/2"X13-3/4" MEDISENSE GLUCOSE KETONE CONTR LIQUID IN Formulary OTC; QL (100 EA per 30 days) VITRO MEDISENSE HI/MID/LOW CONTROL LIQUID IN Formulary OTC; QL (100 EA per 30 days) VITRO MEDISENSE HIGH/LOW CONTROL LIQUID IN VITRO Formulary OTC; QL (100 EA per 30 days) MEDISENSE MID CONTROL LIQUID IN VITRO Formulary OTC; QL (100 EA per 30 days) MEDISENSE THIN LANCETS Formulary OTC; QL (150 EA per 30 days) medi-tussin dm double strength oral liquid 30-200 mg/5ml Formulary OTC MEDROX EXTERNAL OINTMENT 0.0375-5-20 % Formulary OTC MEDROX EXTERNAL PATCH 0.0375-5-20 % Formulary OTC medroxyprogesterone acetate intramuscular suspension 150 Formulary QL (1 ML per 90 days) mg/ml medroxyprogesterone acetate intramuscular suspension Formulary prefilled syringe 150 mg/ml medroxyprogesterone acetate oral tablet 10 mg, 2.5 mg, 5 Formulary mg mefenamic acid oral capsule 250 mg Formulary mefloquine hcl oral tablet 250 mg Formulary mega coq10 oral capsule 400 mg Formulary OTC MEGA MULTIVITAMIN ORAL POWDER Formulary OTC megestrol acetate oral suspension 40 mg/ml Formulary megestrol acetate oral tablet 20 mg, 40 mg Formulary meijer alcohol swabs pad 70 % 70 % Formulary OTC MEIJER LANCETS Formulary OTC; QL (150 EA per 30 days) MEIJER LANCETS THIN Formulary OTC; QL (150 EA per 30 days) MEIJER LANCETS UNIVERSAL 21G Formulary OTC; QL (150 EA per 30 days) MEIJER LANCETS UNIVERSAL 33G Formulary OTC; QL (150 EA per 30 days) MEIJER SUPER THIN LANCETS Formulary OTC; QL (150 EA per 30 days) 90 Drug Name Formulary Status Requirements/Limits melatonin er oral tablet extended release 3 mg Formulary OTC melatonin oral capsule 1 mg, 10 mg, 3 mg, 5 mg Formulary OTC melatonin oral tablet 1 mg, 10 mg, 3 mg, 300 mcg, 5 mg Formulary OTC melatonin oral tablet dispersible 5 mg Formulary OTC melatonin powder Formulary melatonin sublingual tablet sublingual 10 mg Formulary OTC melatonin tr oral tablet extended release 1 mg Formulary OTC MELLOW-TONE ORAL STRIP Formulary OTC meloxicam oral tablet 15 mg, 7.5 mg Formulary melphalan hcl intravenous solution reconstituted 50 mg Formulary melphalan oral tablet 2 mg Formulary memantine hcl er oral capsule extended release 24 hour 14 Formulary mg, 21 mg, 28 mg, 7 mg memantine hcl oral solution 2 mg/ml Formulary memantine hcl oral tablet 10 mg, 5 (28)-10 (21) mg, 5 mg Formulary MENACTRA INTRAMUSCULAR INJECTABLE Formulary AGE (Min 19 Years) mencaps external patch 0.0225-4.5 % Formulary OTC m-end dmx oral liquid 20-0.667-10 mg/5ml Formulary OTC M-END PE ORAL LIQUID 3.33-1.33-6.33 MG/5ML Formulary OTC MENEST ORAL TABLET 0.3 MG, 0.625 MG, 1.25 MG Formulary menstrual pain relief oral tablet 500-25-15 mg Formulary OTC menstrual relief max strength oral tablet 500-60-15 mg Formulary OTC menthol crystals Formulary MENVEO INTRAMUSCULAR SOLUTION Formulary AGE (Min 19 Years) RECONSTITUTED meperidine hcl injection solution 10 mg/ml, 100 mg/ml, 25 Formulary mg/ml, 50 mg/ml mercaptopurine oral tablet 50 mg Formulary mesalamine oral tablet delayed release 1.2 gm Formulary mesalamine rectal enema 4 gm Formulary mesalamine rectal suppository 1000 mg Formulary mesalamine-cleanser rectal kit 4 gm Formulary mesna intravenous solution 100 mg/ml Formulary MESNEX ORAL TABLET 400 MG Formulary MESTINON ORAL SYRUP 60 MG/5ML Formulary METAMUCIL MULTIHEALTH FIBER ORAL PACKET Formulary OTC 58.12 % METAMUCIL MULTIHEALTH FIBER ORAL POWDER Formulary OTC 63 % METAMUCIL ORAL CAPSULE 0.52 GM Formulary OTC METAMUCIL ORAL POWDER 48.57 % Formulary OTC METAMUCIL SMOOTH TEXTURE ORAL PACKET 28 Formulary OTC % metaproterenol sulfate oral syrup 10 mg/5ml Formulary METAXALL ORAL TABLET 800 MG Formulary ST

91 Drug Name Formulary Status Requirements/Limits metformin hcl er oral tablet extended release 24 hour 500 Formulary mg, 750 mg metformin hcl oral solution 500 mg/5ml Formulary ST metformin hcl oral tablet 1000 mg, 500 mg, 850 mg Formulary METHADONE HCL INTENSOL ORAL Formulary PA; QL (90 ML per 30 days) CONCENTRATE 10 MG/ML methadone hcl oral solution 10 mg/5ml Formulary PA; QL (450 ML per 30 days) methadone hcl oral solution 5 mg/5ml Formulary PA; QL (900 ML per 30 days) methadone hcl oral tablet 10 mg Formulary PA; QL (90 EA per 30 days) methadone hcl oral tablet 5 mg Formulary PA; QL (180 EA per 30 days) methadone hcl oral tablet soluble 40 mg Formulary PA; QL (22.5 EA per 30 days) methazolamide oral tablet 25 mg, 50 mg Formulary methenamine hippurate oral tablet 1 gm Formulary methenamine mandelate oral tablet 1 gm Formulary methimazole oral tablet 10 mg, 5 mg Formulary methionine oral packet 100 mg Formulary OTC methionine oral tablet 500 mg Formulary OTC methitest oral tablet 10 mg Formulary methocarbamol injection solution 1000 mg/10ml Formulary methocarbamol oral tablet 500 mg, 750 mg Formulary methotrexate oral tablet 2.5 mg Formulary methotrexate sodium (pf) injection solution 1 gm/40ml, 250 Formulary mg/10ml, 50 mg/2ml methotrexate sodium injection solution 250 mg/10ml, 50 Formulary mg/2ml methotrexate sodium injection solution reconstituted 1 gm Formulary methyl alcohol solution Formulary OTC methyl salicylate external liquid Formulary methyl salicylate external oil Formulary OTC methyl sulfone crystals Formulary methylcellulose gel 1 % Formulary methylcellulose gel 2 %, 3 % Formulary OTC methylcellulose powder Formulary methylcobalamin powder Formulary methyldopa oral tablet 250 mg, 500 mg Formulary methylparaben powder Formulary methylphenidate hcl er oral tablet extended release 10 mg Formulary AGE (Min 6 Years) methylphenidate hcl er oral tablet extended release 24 hour Formulary AGE (Min 6 Years and Max 19 Years) 18 mg, 27 mg, 36 mg, 54 mg methylphenidate hcl oral tablet 10 mg, 20 mg, 5 mg Formulary AGE (Min 4 Years and Max 17 Years) acetate injection suspension 40 mg/ml, Formulary 80 mg/ml methylprednisolone oral tablet 16 mg, 32 mg, 4 mg, 8 mg Formulary methylprednisolone oral tablet therapy pack 4 mg Formulary methylprednisolone sodium succ injection solution Formulary reconstituted 1000 mg, 125 mg, 40 mg 92 Drug Name Formulary Status Requirements/Limits metipranolol ophthalmic solution 0.3 % Formulary metoclopramide hcl oral solution 5 mg/5ml Formulary metoclopramide hcl oral tablet 10 mg, 5 mg Formulary metolazone oral tablet 10 mg, 2.5 mg, 5 mg Formulary metoprolol succinate er oral tablet extended release 24 Formulary hour 100 mg, 200 mg, 25 mg, 50 mg metoprolol tartrate intravenous solution 5 mg/5ml Formulary metoprolol tartrate intravenous solution cartridge 5 mg/5ml Formulary metoprolol tartrate oral tablet 100 mg, 25 mg, 37.5 mg, 50 Formulary mg, 75 mg metoprolol-hydrochlorothiazide oral tablet 100-25 mg, 100- Formulary 50 mg, 50-25 mg METRO INTRAVENOUS SOLUTION 500-0.74 Formulary MG/100ML-% METROCREAM EXTERNAL CREAM 0.75 % Formulary METROGEL EXTERNAL GEL 1 % Formulary METROLOTION EXTERNAL LOTION 0.75 % Formulary metronidazole external cream 0.75 % Formulary metronidazole external gel 0.75 % Formulary metronidazole external lotion 0.75 % Formulary metronidazole in nacl intravenous solution 500-0.79 Formulary mg/100ml-% metronidazole oral capsule 375 mg Formulary metronidazole oral tablet 250 mg, 500 mg Formulary metronidazole vaginal gel 0.75 % Formulary mexiletine hcl oral capsule 150 mg, 200 mg, 250 mg Formulary MEXSANA EXTERNAL POWDER 10.8 % Formulary OTC MG/TAURINE FORTE ORAL CAPSULE Formulary OTC MI PASTE PLUS DENTAL PASTE Formulary MIBELAS 24 FE ORAL TABLET CHEWABLE 1-20 MG- Formulary PA; QL (28 EA per 28 days) MCG(24) MICATIN EXTERNAL CREAM 2 % Formulary OTC miconazole 3 vaginal cream 4 % Formulary OTC miconazole 7 vaginal suppository 100 mg Formulary OTC miconazole nitrate vaginal cream 2 % Formulary OTC; QL (45 GM per 34 days) microfiber cleaning cloths Formulary OTC MICROGESTIN 1/20 ORAL TABLET 1-20 MG-MCG Formulary MICROKLENZ EXTERNAL LIQUID 0.1 % Formulary OTC MICROLET LANCETS Formulary OTC; QL (150 EA per 30 days) midazolam hcl oral syrup 2 mg/ml Formulary midodrine hcl oral tablet 10 mg, 2.5 mg, 5 mg Formulary MIDOL CAFFEINE FREE ORAL TABLET 500-25 MG Formulary OTC MIDOL COMPLETE ORAL TABLET 500-60-15 MG Formulary OTC MIGERGOT RECTAL SUPPOSITORY 2-100 MG Formulary miglitol oral tablet 100 mg, 50 mg Formulary

93 Drug Name Formulary Status Requirements/Limits miglustat oral capsule 100 mg Formulary MIL-A-MULSION ORAL EMULSION 10-15000 Formulary OTC UNIT/DROP MILCO-ZYME ORAL TABLET Formulary OTC milk of magnesia concentrate oral suspension 2400 Formulary OTC mg/10ml MILLGUARD ORAL TABLET 800-10-115 MCG-MG- Formulary OTC MCG MILTAB #1 ORAL TABLET Formulary OTC mineral oil light external oil 100 % Formulary OTC mineral oil oil Formulary mineral oil-hydrophil petrolat external ointment Formulary OTC MINIMED GUARDIAN LINK 3 Formulary MINIMED PRO-SET INFUSION 42" Formulary MINITRAN TRANSDERMAL PATCH 24 HOUR 0.1 Formulary MG/HR, 0.2 MG/HR, 0.4 MG/HR, 0.6 MG/HR hcl oral capsule 100 mg, 50 mg, 75 mg Formulary minocycline hcl oral tablet 100 mg, 50 mg, 75 mg Formulary minoxidil for women external solution 2 % Formulary OTC minoxidil oral tablet 10 mg, 2.5 mg Formulary MIRALAX ORAL PACKET Formulary OTC MIRALAX ORAL POWDER Formulary OTC MIRCERA INJECTION SOLUTION PREFILLED SYRINGE 150 MCG/0.3ML, 200 MCG/0.3ML, 30 Formulary MCG/0.3ML MIRENA (52 MG) INTRAUTERINE INTRAUTERINE Formulary QL (1 EA per 365 days) DEVICE 20 MCG/24HR mirtazapine oral tablet 15 mg, 30 mg, 45 mg, 7.5 mg Formulary mirtazapine oral tablet dispersible 15 mg, 30 mg, 45 mg Formulary misoprostol oral tablet 100 mcg, 200 mcg Formulary mitomycin intravenous solution reconstituted 20 mg, 40 mg, Formulary 5 mg mitoxantrone hcl intravenous concentrate 20 mg/10ml, 25 Formulary mg/12.5ml, 30 mg/15ml M-M-R II SUBCUTANEOUS INJECTABLE Formulary AGE (Min 19 Years) mn-50 oral capsule 16.67 mg Formulary OTC moexipril hcl oral tablet 15 mg, 7.5 mg Formulary moexipril-hydrochlorothiazide oral tablet 15-12.5 mg, 15- Formulary 25 mg, 7.5-12.5 mg moisture barrier external ointment , 0.44-20.6 % Formulary OTC MOISTURE GUARD EXTERNAL CREAM 5 % Formulary OTC MOISTUREL EXTERNAL LOTION 3 % Formulary OTC moisturizing skin protectant external cream 8 % Formulary OTC molybdenum oral capsule 30 mcg Formulary OTC furoate external cream 0.1 % Formulary mometasone furoate external ointment 0.1 % Formulary

94 Drug Name Formulary Status Requirements/Limits mometasone furoate external solution 0.1 % Formulary mometasone furoate nasal suspension 50 mcg/act Formulary QL (17 GM per 30 days) MONOCAL ORAL TABLET 625-22.75 MG Formulary OTC MONOJECT ALLERGIST TRAY KIT 28G X 1/2" 1 ML Formulary MONOJECT BLUNTIP CANNULA 21G X 1" Formulary MONOJECT HYPODERMIC NEEDLE 14G X 1-1/2" , 14G X 2" , 16G X 3/4" , 16G X 5/8" , 21G X 2" , 25G X 1- Formulary 1/4" , 25G X 2" , 26G X 1-1/2" , 26G X 1/2" , 27G X 1-1/2" , 30G X 3/4" MONOJECT INSULIN SYRINGE 25G X 5/8" 1 ML 25G Formulary OTC X 5/8" 1 ML MONOJECT INSULIN SYRINGE 27G X 1/2" 1 ML Formulary (OTC) 27G X 1/2" 1 ML MONOJECT INSULIN SYRINGE 27G X 1/2" 1 ML (RX) Formulary 27G X 1/2" 1 ML MONOJECT INSULIN SYRINGE 28G X 1/2" 0.5 ML Formulary (OTC) 28G X 1/2" 0.5 ML MONOJECT INSULIN SYRINGE 28G X 1/2" 0.5 ML Formulary (RX) 28G X 1/2" 0.5 ML MONOJECT INSULIN SYRINGE 28G X 1/2" 1 ML Formulary (OTC) 28G X 1/2" 1 ML MONOJECT INSULIN SYRINGE 28G X 1/2" 1 ML (RX) Formulary 28G X 1/2" 1 ML MONOJECT INSULIN SYRINGE 29G X 1/2" 0.3 ML Formulary 29G X 1/2" 0.3 ML MONOJECT INSULIN SYRINGE 29G X 1/2" 0.5 ML Formulary 29G X 1/2" 0.5 ML MONOJECT INSULIN SYRINGE 29G X 1/2" 1 ML (RX) Formulary 29G X 1/2" 1 ML MONOJECT INSULIN SYRINGE 30G X 5/16" 0.3 ML Formulary 30G X 5/16" 0.3 ML MONOJECT INSULIN SYRINGE 30G X 5/16" 0.5 ML Formulary (RX) 30G X 5/16" 0.5 ML MONOJECT INSULIN SYRINGE 30G X 5/16" 1 ML Formulary (OTC) 30G X 5/16" 1 ML MONOJECT INSULIN SYRINGE 30G X 5/16" 1 ML Formulary (RX) 30G X 5/16" 1 ML MONOJECT INSULIN SYRINGE 31G X 5/16" 1 ML 31G Formulary OTC X 5/16" 1 ML MONOJECT INSULIN SYRINGE U-100 1 ML U-100 1 Formulary ML MONOJECT LIFESHIELD SYRINGE 18G X 1" 3 ML Formulary MONOJECT MAGELLAN SAFETY NDL 21G X 5/8" , Formulary 23G X 5/8" MONOJECT MAGELLAN SYRINGE 20G X 1-1/2" 12 Formulary ML, 21G X 1" 12 ML, 21G X 1-1/2" 12 ML MONOJECT SYRINGE 18G X 1" 12 ML, 20G X 3/4" 3 Formulary ML, 21G X 1-1/2" 6 ML MONOJECT ULTRA COMFORT SYRINGE 28G X 1/2" Formulary 0.5 ML (OTC) 28G X 1/2" 0.5 ML

95 Drug Name Formulary Status Requirements/Limits MONOJECT ULTRA COMFORT SYRINGE 28G X 1/2" Formulary 0.5 ML (RX) 28G X 1/2" 0.5 ML MONOJECT ULTRA COMFORT SYRINGE 28G X 1/2" Formulary 1 ML (OTC) 28G X 1/2" 1 ML MONOJECT ULTRA COMFORT SYRINGE 28G X 1/2" Formulary 1 ML (RX) 28G X 1/2" 1 ML MONOJECT ULTRA COMFORT SYRINGE 29G X 1/2" Formulary OTC 0.3 ML 29G X 1/2" 0.3 ML MONOJECT ULTRA COMFORT SYRINGE 29G X 1/2" Formulary OTC 0.5 ML 29G X 1/2" 0.5 ML MONOJECT ULTRA COMFORT SYRINGE 29G X 1/2" Formulary OTC 1 ML 29G X 1/2" 1 ML MONOJECT ULTRA COMFORT SYRINGE 30G X 5/16" Formulary 0.3 ML (OTC) 30G X 5/16" 0.3 ML MONOJECT ULTRA COMFORT SYRINGE 30G X 5/16" Formulary 0.3 ML (RX) 30G X 5/16" 0.3 ML MONOJECT ULTRA COMFORT SYRINGE 30G X 5/16" Formulary 0.5 ML (OTC) 30G X 5/16" 0.5 ML MONOJECT ULTRA COMFORT SYRINGE 30G X 5/16" Formulary 0.5 ML (RX) 30G X 5/16" 0.5 ML MONOJECT ULTRA COMFORT SYRINGE 31G X 5/16" Formulary OTC 0.3 ML 31G X 5/16" 0.3 ML MONOJECT ULTRA COMFORT SYRINGE 31G X 5/16" Formulary OTC 0.5 ML 31G X 5/16" 0.5 ML MONOLET LANCETS Formulary OTC; QL (150 EA per 30 days) MONOLET OPD LANCETS Formulary OTC; QL (150 EA per 30 days) MONOVISC INTRA-ARTICULAR SOLUTION Formulary PA PREFILLED SYRINGE 88 MG/4ML sodium oral packet 4 mg Formulary montelukast sodium oral tablet 10 mg Formulary montelukast sodium oral tablet chewable 4 mg, 5 mg Formulary MONUROL ORAL PACKET 3 GM Formulary QL (3 EA per 30 days) MORPHABOND ER ORAL TABLET ER 12 HOUR Formulary PA ABUSE-DETERRENT 60 MG morphine sulfate (concentrate) oral solution 100 mg/5ml Formulary PA; QL (32 ML per 7 days) morphine sulfate (pf) injection solution 0.5 mg/ml, 1 mg/ml Formulary morphine sulfate (pf) intravenous solution 10 mg/ml, 2 Formulary mg/ml, 4 mg/ml, 8 mg/ml morphine sulfate er beads oral capsule extended release 24 Formulary PA hour 120 mg, 30 mg, 45 mg, 60 mg, 75 mg, 90 mg morphine sulfate er oral tablet extended release 100 mg Formulary PA; QL (34 EA per 34 days) morphine sulfate er oral tablet extended release 15 mg Formulary PA; QL (204 EA per 34 days) morphine sulfate er oral tablet extended release 200 mg Formulary PA; QL (15.3 EA per 34 days) morphine sulfate er oral tablet extended release 30 mg Formulary PA; QL (102 EA per 34 days) morphine sulfate er oral tablet extended release 60 mg Formulary PA; QL (47 EA per 34 days) morphine sulfate injection solution 10 mg/ml, 2 mg/ml, 4 Formulary mg/ml, 5 mg/ml, 8 mg/ml morphine sulfate intravenous solution 1 mg/ml, 150 Formulary mg/30ml, 25 mg/ml, 50 mg/ml 96 Drug Name Formulary Status Requirements/Limits morphine sulfate oral solution 10 mg/5ml Formulary PA; QL (315 ML per 7 days) morphine sulfate oral solution 20 mg/5ml Formulary PA; QL (158 ML per 7 days) morphine sulfate oral tablet 15 mg Formulary PA; QL (42 EA per 7 days) morphine sulfate oral tablet 30 mg Formulary PA; QL (21 EA per 7 days) morphine sulfate rectal suppository 30 mg Formulary MOTRIN INFANTS DROPS ORAL SUSPENSION 50 Formulary OTC MG/1.25ML mouth rinse mouth/throat liquid 0.07 % Formulary OTC MOVANTIK ORAL TABLET 12.5 MG, 25 MG Formulary PA; AGE (Min 18 Years) MOXEZA OPHTHALMIC SOLUTION 0.5 % Formulary moxifloxacin hcl ophthalmic solution 0.5 % Formulary moxifloxacin hcl oral tablet 400 mg Formulary MOZOBIL SUBCUTANEOUS SOLUTION 24 MG/1.2ML Formulary ms insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC ms insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC ms insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC MUCINEX COUGH CHILDRENS ORAL LIQUID 5-100 Formulary OTC MG/5ML MUCINEX COUGH FOR KIDS ORAL PACKET 5-100 Formulary OTC MG MUCINEX D MAX STRENGTH ORAL TABLET Formulary OTC EXTENDED RELEASE 12 HOUR 120-1200 MG MUCINEX D ORAL TABLET EXTENDED RELEASE 12 Formulary HOUR 60-600 MG MUCINEX DM MAXIMUM STRENGTH ORAL Formulary OTC TABLET EXTENDED RELEASE 12 HOUR 60-1200 MG MUCINEX DM ORAL TABLET EXTENDED RELEASE Formulary 12 HOUR 30-600 MG MUCINEX FAST-MAX COLD & SINUS ORAL LIQUID Formulary OTC 10-650-400 MG/20ML MUCINEX FAST-MAX COLD & SINUS ORAL Formulary OTC TABLET 5-325-200 MG MUCINEX FAST-MAX COLD FLU ORAL LIQUID 5- Formulary OTC 10-200-325 MG/10ML MUCINEX FAST-MAX CONGEST COUGH ORAL Formulary OTC LIQUID 2.5-5-100 MG/5ML MUCINEX FAST-MAX CONGEST COUGH ORAL Formulary OTC TABLET 5-10-200 MG MUCINEX FAST-MAX DAY/NIGHT M/S ORAL Formulary OTC (TABLET) MUCINEX FAST-MAX DAY/NIGHT ORAL Formulary OTC MUCINEX FAST-MAX DAY/NIGHT ORAL CAPSULE Formulary OTC THERAPY PACK MUCINEX FAST-MAX DAY/NIGHT TAB ORAL Formulary OTC MUCINEX FAST-MAX ORAL CAPSULE 5-10-200-325 Formulary OTC MG MUCINEX FOR KIDS ORAL PACKET 100 MG Formulary OTC

97 Drug Name Formulary Status Requirements/Limits MUCINEX MAXIMUM STRENGTH ORAL TABLET Formulary OTC EXTENDED RELEASE 12 HOUR 1200 MG MUCINEX ORAL TABLET EXTENDED RELEASE 12 Formulary OTC HOUR 600 MG MUCINEX SINUS-MAX CONGESTION ORAL TABLET Formulary OTC 5-325-200 MG MUCINEX SINUS-MAX DAY/NIGHT ORAL LIQUID Formulary OTC MUCINEX SINUS-MAX PRESS & PAIN ORAL Formulary OTC TABLET 5-325-200 MG MUCINEX STUFFY NOSE/COLD CHILD ORAL Formulary OTC LIQUID 2.5-100 MG/5ML mucus relief cold/sinus max st oral liquid 10-650-400 Formulary OTC mg/20ml mucus relief d oral tablet extended release 12 hour 60-600 Formulary OTC mg mucus relief er oral tablet extended release 12 hour 1200 Formulary OTC mg mucus relief pe oral tablet 10-400 mg Formulary OTC mucus-dm max oral tablet extended release 12 hour 60- Formulary OTC 1200 mg multi-delyn/iron oral liquid Formulary OTC multi-draw needle 20g x 1" , 21g x 1" , 22g x 1" Formulary MULTIGEN FOLIC ORAL TABLET 70-150-2-1 MG Formulary MULTIGEN ORAL TABLET 70 MG Formulary MULTIGEN PLUS ORAL TABLET 50-101-1 MG Formulary multi-minerals oral tablet Formulary OTC multi-purpose cold compress Formulary OTC multi-symptom cold plus child oral liquid 2.5-5-100 mg/5ml Formulary OTC multi-vit/fluoride oral solution 0.25 mg/ml Formulary multivitamin gummies childrens oral tablet chewable Formulary OTC multivitamins/fluoride oral tablet chewable 0.5 mg Formulary mupirocin external ointment 2 % Formulary mupirocin powder Formulary MURI-LUBE OIL Formulary MURO 128 OPHTHALMIC OINTMENT 5 % Formulary OTC MURO 128 OPHTHALMIC SOLUTION 2 %, 5 % Formulary OTC muscle rub ultra strength external cream 4-10-30 % Formulary OTC mustard oil oil Formulary OTC MUSTARGEN INJECTION SOLUTION Formulary RECONSTITUTED 10 MG M-VIT ORAL TABLET Formulary QL (34 EA per 34 days) MYCOCIDE CX CALLUS EXFOLIATOR EXTERNAL Formulary OTC CREAM 12-0.1 % mycophenolate mofetil oral capsule 250 mg Formulary mycophenolate mofetil oral suspension reconstituted 200 Formulary mg/ml mycophenolate mofetil oral tablet 500 mg Formulary

98 Drug Name Formulary Status Requirements/Limits mycophenolate sodium oral tablet delayed release 180 mg, Formulary 360 mg MYGLUCOHEALTH LANCETS 30G Formulary OTC; QL (150 EA per 30 days) MYLANTA ORAL SUSPENSION 200-200-20 MG/5ML Formulary OTC MYLERAN ORAL TABLET 2 MG Formulary MYNATAL ORAL CAPSULE Formulary mynate 90 plus oral tablet extended release Formulary mynephrocaps oral capsule 1 mg Formulary MYOBLOC INTRAMUSCULAR SOLUTION 10000 Formulary PA UNIT/2ML, 2500 UNIT/0.5ML, 5000 UNIT/ML MYORISAN ORAL CAPSULE 10 MG, 20 MG, 30 MG, Formulary 40 MG nabumetone oral tablet 500 mg, 750 mg Formulary nac oral capsule 600 mg Formulary OTC nadolol oral tablet 20 mg, 40 mg, 80 mg Formulary nadolol-bendroflumethiazide oral tablet 40-5 mg, 80-5 mg Formulary NAIL SCRUB EXTERNAL LIQUID Formulary OTC NAIL-EX ORAL TABLET 2.5 MG Formulary OTC nalbuphine hcl injection solution 10 mg/ml, 20 mg/ml Formulary naloxone hcl injection solution 0.4 mg/ml, 4 mg/10ml Formulary naloxone hcl injection solution cartridge 0.4 mg/ml Formulary naloxone hcl injection solution prefilled syringe 2 mg/2ml Formulary naltrexone hcl oral tablet 50 mg Formulary NAMENDA XR TITRATION PACK ORAL CAPSULE Formulary EXTENDED RELEASE 24 HOUR 7 & 14 & 21 NAMZARIC ORAL CAPSULE EXTENDED RELEASE Formulary 24 HOUR 14-10 MG NAPHCON-A OPHTHALMIC SOLUTION 0.025-0.3 % Formulary OTC naproxen dr oral tablet delayed release 375 mg, 500 mg Formulary naproxen oral suspension 125 mg/5ml Formulary naproxen oral tablet 250 mg, 375 mg, 500 mg Formulary naproxen sodium oral capsule 220 mg Formulary OTC naratriptan hcl oral tablet 1 mg, 2.5 mg Formulary NARCAN NASAL LIQUID 4 MG/0.1ML Formulary NASACORT ALLERGY 24HR AEROSOL 55 MCG/ACT Formulary OTC NASAL 55 MCG/ACT NASACORT ALLERGY 24HR CHILDREN AEROSOL Formulary OTC 55 MCG/ACT NASAL 55 MCG/ACT nasal allergy 24 hour aerosol 55 mcg/act nasal 55 mcg/act Formulary OTC nasal aspirator Formulary OTC nasal decongestant oral liquid 30 mg/5ml Formulary OTC nasal decongestant oral syrup 30 mg/5ml Formulary OTC nasal decongestant spray nasal solution 0.05 % Formulary OTC NASAL EASE ALLERGY RELIEVER NASAL POWDER Formulary OTC NASALCROM NASAL AEROSOL SOLUTION 5.2 Formulary OTC MG/ACT 99 Drug Name Formulary Status Requirements/Limits NASOGEL NASAL GEL Formulary OTC NASONEB NEBULIZER STARTER Formulary OTC; QL (2 EA per 365 days) NASOPEN PE ORAL LIQUID 50-10 MG/15ML Formulary OTC NATACYN OPHTHALMIC SUSPENSION 5 % Formulary natapres liquid Formulary nateglinide oral tablet 120 mg, 60 mg Formulary NATROBA EXTERNAL SUSPENSION 0.9 % Formulary natural bitterness powder Formulary OTC natural fiber laxative oral powder 28.3 % Formulary OTC natural vitamin e moisturizing external gel Formulary OTC NATURAL WHEY ORAL POWDER Formulary OTC NATURE-THROID ORAL TABLET 130 MG, 16.25 MG, 162.5 MG, 195 MG, 260 MG, 32.5 MG, 325 MG, 48.75 Formulary MG, 65 MG, 97.5 MG NEBUPENT INHALATION SOLUTION Formulary RECONSTITUTED 300 MG NECON 0.5/35 (28) ORAL TABLET 0.5-35 MG-MCG Formulary QL (28 EA per 28 days) neomycin sulfate oral tablet 500 mg Formulary neomycin-bacitracin zn-polymyx ophthalmic ointment 5- Formulary 400-10000 neomycin-polymyxin b gu irrigation solution 40-200000 Formulary neomycin-polymyxin-dexameth ophthalmic ointment 3.5- Formulary 10000-0.1 neomycin-polymyxin-dexameth ophthalmic suspension 3.5- Formulary 10000-0.1 neomycin-polymyxin-gramicidin ophthalmic solution 1.75- Formulary 10000-.025 neomycin-polymyxin-hc otic solution 3.5-10000-1 Formulary neomycin-polymyxin-hc otic suspension 3.5-10000-1 Formulary NEOSPORIN + PAIN RELIEF MAX ST EXTERNAL Formulary OTC OINTMENT 1 % NEOSPORIN ORIGINAL EXTERNAL OINTMENT 3.5- Formulary OTC 400-5000 NEOSPORIN PLUS MAX ST EXTERNAL OINTMENT 4 Formulary OTC % NEOSPORIN PLUS PAIN RELIEF MS EXTERNAL Formulary OTC CREAM 3.5-10000-10 NEOSTRATA FACIAL CLEANSER EXTERNAL Formulary OTC LIQUID 0.3 % NEOTUSS-D ORAL LIQUID 7.5-30-200 MG/5ML Formulary OTC NEPHRONEX ORAL LIQUID 0.9 MG/5ML Formulary OTC NEPHRO-VITE ORAL TABLET 0.8 MG Formulary OTC NEULASTA SUBCUTANEOUS SOLUTION Formulary PA; QL (2 ML per 34 days) PREFILLED SYRINGE 6 MG/0.6ML NEUPOGEN INJECTION SOLUTION 300 MCG/ML, 480 Formulary PA MCG/1.6ML NEUPOGEN INJECTION SOLUTION PREFILLED Formulary PA SYRINGE 300 MCG/0.5ML, 480 MCG/0.8ML 100 Drug Name Formulary Status Requirements/Limits NEURO-K-250 T.D. ORAL CAPSULE 250 MG Formulary OTC neuromax external gel 20 % Formulary OTC NEUROPEN KIT Formulary OTC NEUROTIPS Formulary OTC NEUTROGENA BODY EXTERNAL OIL Formulary OTC NEUTROGENA CLEAR PORE EXTERNAL LIQUID 3.5 Formulary OTC % NEUTROGENA T/GEL STUBBORN ITCH EXTERNAL Formulary OTC SHAMPOO 0.5 % er oral tablet extended release 24 hour 100 mg, Formulary 400 mg nevirapine oral suspension 50 mg/5ml Formulary nevirapine oral tablet 200 mg Formulary NEW DIGNITY ODOR ELIMINATOR EXTERNAL Formulary OTC SOLUTION NEW IMAGE SKIN BARRIER/FLANGE WAFER Formulary OTC NEW IMAGE SKIN/FLANGE/TAPE Formulary OTC new terocin external lotion 0.025-10-25 % Formulary OTC NEXAFED ORAL TABLET ABUSE-DETERRENT 30 Formulary OTC MG NEXAFED SINUS PRESSURE + PAIN ORAL TABLET Formulary OTC 30-325 MG NEXAVAR ORAL TABLET 200 MG Formulary PA NEXCARE PREMIUM ADHESIVE GAUZE PAD 3- Formulary OTC 1/2"X6" , 3-1/2"X8" NEXIUM 24HR CAPSULE DELAYED RELEASE 20 MG Formulary OTC; QL (68 EA per 34 days) ORAL 20 MG NEXIUM 24HR TABLET DELAYED RELEASE 20 MG Formulary OTC; QL (68 EA per 34 days) ORAL 20 MG NEXPLANON SUBCUTANEOUS IMPLANT 68 MG Formulary niacin er (antihyperlipidemic) oral tablet extended release Formulary 1000 mg, 500 mg, 750 mg niacin er oral capsule extended release 250 mg, 500 mg Formulary OTC niacin er oral tablet extended release 1000 mg, 250 mg, 750 Formulary OTC mg niacin flush free oral capsule 400-100 mg, 500 mg Formulary OTC niacin oral tablet 100 mg, 50 mg, 500 mg Formulary OTC niacin powder Formulary niacinamide oral tablet 100 mg, 500 mg Formulary OTC niacinamide powder Formulary hcl intravenous solution 2.5 mg/ml Formulary nicardipine hcl oral capsule 20 mg, 30 mg Formulary NICODERM CQ TRANSDERMAL PATCH 24 HOUR 14 Formulary OTC MG/24HR, 21 MG/24HR, 7 MG/24HR NICORETTE MOUTH/THROAT GUM 2 MG, 4 MG Formulary OTC NICORETTE MOUTH/THROAT LOZENGE 2 MG, 4 MG Formulary OTC nicotinamide dinucleo powder Formulary

101 Drug Name Formulary Status Requirements/Limits nicotine polacrilex mouth/throat gum 2 mg Formulary OTC nicotine polacrilex mouth/throat lozenge 2 mg, 4 mg Formulary OTC nicotine step 1 transdermal patch 24 hour 21 mg/24hr Formulary OTC nicotine step 2 transdermal patch 24 hour 14 mg/24hr Formulary OTC nicotine step 3 transdermal patch 24 hour 7 mg/24hr Formulary OTC nicotine transdermal kit 21-14-7 mg/24hr Formulary OTC NICOTROL INHALATION INHALER 10 MG Formulary NIFEDICAL XL ORAL TABLET EXTENDED RELEASE Formulary 24 HOUR 60 MG er oral tablet extended release 24 hour 30 mg, 60 Formulary mg, 90 mg nifedipine er osmotic release oral tablet extended release Formulary 24 hour 30 mg, 90 mg nifedipine oral capsule 10 mg, 20 mg Formulary nilutamide oral tablet 150 mg Formulary nimodipine oral capsule 30 mg Formulary NINJACOF ORAL LIQUID 12.5-12.5 MG/5ML Formulary OTC NINJACOF-A ORAL LIQUID 12.5-12.5-160 MG/5ML Formulary OTC NINJACOF-XG ORAL LIQUID 200-8 MG/5ML Formulary OTC NIPENT INTRAVENOUS SOLUTION Formulary RECONSTITUTED 10 MG NISEKO SUNSCREEN SPF 25 EXTERNAL CREAM Formulary OTC er oral tablet extended release 24 hour 17 mg, Formulary 25.5 mg, 34 mg, 8.5 mg NITEBITE ORAL BAR Formulary OTC nite-time cold/flu relief oral liquid 5-6.25-15-500 mg/15ml Formulary OTC NITRO-BID TRANSDERMAL OINTMENT 2 % Formulary nitrofurantoin macrocrystal oral capsule 100 mg, 50 mg Formulary nitrofurantoin monohyd macro oral capsule 100 mg Formulary nitrofurantoin oral suspension 25 mg/5ml Formulary nitroglycerin er oral capsule extended release 2.5 mg, 6.5 Formulary mg, 9 mg nitroglycerin sublingual tablet sublingual 0.3 mg, 0.4 mg, Formulary 0.6 mg NIVANEX DMX ORAL TABLET 10-15-380 MG Formulary OTC NIX CREME RINSE EXTERNAL LIQUID 1 % Formulary OTC nizatidine oral capsule 150 mg, 300 mg Formulary nizatidine oral solution 15 mg/ml Formulary NIZORAL A-D EXTERNAL SHAMPOO 1 % Formulary OTC NOBLE FORMULA EXTERNAL SHAMPOO 2 % Formulary OTC NOBLE FORMULA HC EXTERNAL SOLUTION 1 % Formulary OTC nohist-lq oral liquid 4-10 mg/5ml Formulary OTC NOKOR ADMIX NEEDLE 18G X 1-1/2" Formulary OTC non-stick pad 2"x3" Formulary OTC NOREL AD ORAL TABLET 4-10-325 MG Formulary OTC NOREL CS ORAL LIQUID 10-4-12.5 MG/5ML Formulary OTC 102 Drug Name Formulary Status Requirements/Limits norethindrone acetate oral tablet 5 mg Formulary norethindrone acet-ethinyl est oral tablet 1-20 mg-mcg Formulary norgestim-eth estrad triphasic oral tablet 0.18/0.215/0.25 Formulary QL (28 EA per 28 days) mg-35 mcg NORMLSHIELD EXTERNAL CREAM 4.5 % Formulary OTC nortriptyline hcl oral capsule 10 mg, 25 mg, 50 mg, 75 mg Formulary NORVIR ORAL CAPSULE 100 MG Formulary NORVIR ORAL SOLUTION 80 MG/ML Formulary NO-STING SKIN-PREP EXTERNAL Formulary OTC NOVA SUREFLEX LANCETS Formulary OTC; QL (150 EA per 30 days) NOVAFERRUM 125 ORAL LIQUID 125-100 MG- Formulary OTC UNT/5ML NOVAFERRUM 50 ORAL CAPSULE 50 MG Formulary OTC NOVAFERRUM PEDIATRIC DROPS ORAL LIQUID 15 Formulary OTC MG/ML NOVOLOG FLEXPEN SOLUTION PEN-INJECTOR 100 Formulary UNIT/ML SUBCUTANEOUS 100 UNIT/ML NOVOLOG MIX 70/30 FLEXPEN SUSPENSION PEN- INJECTOR (70-30) 100 UNIT/ML SUBCUTANEOUS Formulary (70-30) 100 UNIT/ML NOVOLOG MIX 70/30 SUBCUTANEOUS Formulary SUSPENSION (70-30) 100 UNIT/ML NOVOLOG PENFILL SOLUTION CARTRIDGE 100 Formulary UNIT/ML SUBCUTANEOUS 100 UNIT/ML NOVOLOG SUBCUTANEOUS SOLUTION 100 Formulary UNIT/ML NOXICARE EXTERNAL CREAM Formulary OTC np thyroid oral tablet 30 mg, 60 mg, 90 mg Formulary NPLATE SUBCUTANEOUS SOLUTION Formulary PA RECONSTITUTED 250 MCG, 500 MCG NUEDEXTA ORAL CAPSULE 20-10 MG Formulary PA NUFERA ORAL TABLET Formulary NU-GEL EXTERNAL GEL Formulary OTC NU-MAG ORAL TABLET DELAYED RELEASE 71.5- Formulary OTC 119 MG NUPERCAINAL RECTAL OINTMENT 1 % Formulary OTC NUTRA BALANCE PROTEIN COOKIE ORAL Formulary OTC NUTRA SHAKE ORAL LIQUID (FROZEN) Formulary OTC NUTRA/PRO ORAL PACKET Formulary OTC NUTRATEAR OPHTHALMIC SOLUTION 0.6 % Formulary OTC NUTR-E-SOL ORAL LIQUID 400 UNIT/15ML Formulary OTC nutritional shake high protein oral liquid Formulary OTC NUTROPIN AQ NUSPIN 10 SOLUTION 10 MG/2ML Formulary PA; AGE (Max 18 Years) SUBCUTANEOUS 10 MG/2ML NUTROPIN AQ NUSPIN 20 SOLUTION 20 MG/2ML Formulary PA; AGE (Max 18 Years) SUBCUTANEOUS 20 MG/2ML NUTROPIN AQ NUSPIN 5 SOLUTION 5 MG/2ML Formulary PA; AGE (Max 18 Years) SUBCUTANEOUS 5 MG/2ML 103 Drug Name Formulary Status Requirements/Limits NUVARING VAGINAL RING 0.12-0.015 MG/24HR Formulary QL (1 EA per 28 days) NYAMYC EXTERNAL POWDER 100000 UNIT/GM Formulary NYMALIZE ORAL SOLUTION 30 MG/10ML, 60 Formulary MG/20ML nystatin external cream 100000 unit/gm Formulary nystatin external ointment 100000 unit/gm Formulary nystatin external powder 100000 unit/gm Formulary nystatin mouth/throat suspension 100000 unit/ml Formulary nystatin oral tablet 500000 unit Formulary nystatin- external cream 100000-0.1 unit/gm- Formulary % nystatin-triamcinolone external ointment 100000-0.1 Formulary unit/gm-% NYSTOP EXTERNAL POWDER 100000 UNIT/GM Formulary NYTOL MAXIMUM STRENGTH ORAL TABLET 50 Formulary OTC MG OASIS MOISTURIZING MOUTHWASH Formulary OTC MOUTH/THROAT LIQUID OBSTETRIX DHA ORAL 29-1 & 387 MG Formulary OBSTETRIX EC ORAL TABLET 29-1 MG Formulary OC8 EXTERNAL GEL 7 % Formulary OTC OCEAN BLUE MINICAPS D/OMEGA3 ORAL Formulary OTC CAPSULE 350-1000 MG-UNIT OCEAN BLUE MINICAPS OMEGA-3 ORAL CAPSULE Formulary OTC 350 MG OCEAN BLUE OPTIMAL HEALTH ORAL CAPSULE Formulary OTC 250 MG OCEAN COMPLETE SINUS RINSE NASAL AEROSOL Formulary OTC SOLUTION OCEAN NASAL SOLUTION 0.65 % Formulary OTC oceanic selenium oral tablet 50 mcg Formulary OTC OCUSOFT LID SCRUB COMPLIANCE KIT Formulary OTC ODEFSEY ORAL TABLET 200-25-25 MG Formulary ODOR EATERS ANTIFUNGAL EXTERNAL POWDER Formulary OTC 1 % odor spray liquid Formulary OTC OFF ACTIVE EXTERNAL AEROSOL 15 % Formulary OTC OFF FAMILYCARE CLEAN FEEL EXTERNAL LIQUID Formulary OTC 5 % ofloxacin ophthalmic solution 0.3 % Formulary ofloxacin oral tablet 400 mg Formulary QL (68 EA per 34 days) ofloxacin otic solution 0.3 % Formulary OGESTREL ORAL TABLET 0.5-50 MG-MCG Formulary olanzapine intramuscular solution reconstituted 10 mg Formulary AGE (Min 18 Years) olanzapine oral tablet 10 mg, 15 mg, 2.5 mg, 20 mg, 5 mg, Formulary AGE (Min 18 Years) 7.5 mg

104 Drug Name Formulary Status Requirements/Limits olanzapine oral tablet dispersible 10 mg, 15 mg, 20 mg, 5 Formulary AGE (Min 18 Years) mg olive oil oil Formulary olmesartan medoxomil oral tablet 20 mg, 40 mg, 5 mg Formulary QL (34 EA per 34 days) olmesartan medoxomil-hctz oral tablet 20-12.5 mg, 40-12.5 Formulary QL (34 EA per 34 days) mg, 40-25 mg olopatadine hcl nasal solution 0.6 % Formulary olopatadine hcl ophthalmic solution 0.1 % Formulary omega dha oral tablet chewable Formulary OTC OMEGA POWER ORAL CAPSULE 1050 MG Formulary OTC omega-3 fish oil ex st oral capsule 880 mg Formulary OTC omega-3 fish oil oral capsule 300 mg Formulary OTC omega-3 fish oil-vitamin d3 oral capsule 1200-1000 mg- Formulary OTC unit OMEGA-3 IQ ORAL TABLET CHEWABLE 240 MG Formulary OTC omega-3 oral capsule 1400 mg Formulary OTC omega-3-acid ethyl esters oral capsule 1 gm Formulary omeprazole magnesium oral capsule delayed release 20.6 Formulary OTC (20 base) mg omeprazole oral capsule delayed release 10 mg, 20 mg, 40 Formulary mg omeprazole oral tablet delayed release 20 mg Formulary OTC omeprazole-sodium bicarbonate capsule 20-1100 mg oral Formulary QL (34 EA per 34 days) (otc) 20-1100 mg OMNIFLEX DIAPHRAGM VAGINAL DIAPHRAGM Formulary ONCASPAR INJECTION SOLUTION 750 UNIT/ML Formulary ondansetron hcl oral solution 4 mg/5ml Formulary QL (150 ML per 30 days) ondansetron hcl oral tablet 24 mg Formulary QL (1 EA per 30 days) ondansetron hcl oral tablet 4 mg, 8 mg Formulary QL (15 EA per 34 days) ondansetron oral tablet dispersible 4 mg, 8 mg Formulary QL (15 EA per 34 days) one step pregnancy in vitro diagnostic test Formulary OTC ONE-A-DAY ADULT VITACRAVES+DHA ORAL Formulary OTC TABLET CHEWABLE ONE-A-DAY WOMENS 50+ ADVANTAGE ORAL Formulary OTC TABLET ONETOUCH DELICA LANCETS 33G Formulary OTC; QL (150 EA per 30 days) ONETOUCH DELICA LANCETS FINE Formulary OTC; QL (150 EA per 30 days) ONETOUCH FINEPOINT LANCETS Formulary OTC; QL (150 EA per 30 days) ONETOUCH PING METER REMOTE SUPPLIES Formulary OTC ONETOUCH ULTRASOFT LANCETS Formulary OTC; QL (150 EA per 30 days) ONEXTON EXTERNAL GEL 1.2-3.75 % Formulary AGE (Max 19 Years) ONFI ORAL SUSPENSION 2.5 MG/ML Formulary ONFI ORAL TABLET 10 MG, 20 MG Formulary opium oral tincture 10 mg/ml (1%) Formulary OPTICLEANSE GHI ORAL POWDER Formulary OTC OPTIONS CONCEPTROL VAGINAL GEL 4 % Formulary OTC 105 Drug Name Formulary Status Requirements/Limits OPTIONS GYNOL II CONTRACEPTIVE VAGINAL Formulary OTC GEL 3 % OPTIUM BLOOD GLUCOSE MONITOR KIT Formulary OTC; QL (1 EA per 365 days) W/DEVICE W/DEVICE OPTIUM GLUCOSE MONITOR SYSTEM DEVICE Formulary OTC; QL (150 EA per 30 days) OPTIUM TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) OPTIUMEZ TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) ORA-FILM MOUTH/THROAT STRIP 6 % Formulary OTC ORA-HESIVE BASE PASTE Formulary OTC oral max st mouth/throat gel 20 % Formulary OTC oral anesthetic mouth/throat paste 20 % Formulary OTC oral electrolytes oral solution Formulary OTC ORAL SWAB PETITE MOUTH/THROAT SWAB Formulary OTC oral syringe bottle adapter Formulary OTC ORALONE MOUTH/THROAT PASTE 0.1 % Formulary ORAMAGIC PLUS MOUTH/THROAT SUSPENSION Formulary OTC RECONSTITUTED 10 % orange oil oil Formulary OTC ORAZINC ORAL CAPSULE 220 (50 ZN) MG Formulary OTC ORAZINC ORAL TABLET 110 MG Formulary OTC ORFADIN ORAL CAPSULE 10 MG, 2 MG, 5 MG Formulary organic coconut oil oil Formulary OTC ornithine oral capsule 500 mg Formulary OTC orphenadrine citrate er oral tablet extended release 12 hour Formulary 100 mg orphenadrine citrate injection solution 30 mg/ml Formulary ORTHOVISC INTRA-ARTICULAR SOLUTION Formulary PA PREFILLED SYRINGE 30 MG/2ML OS-CAL EXTRA D3 ORAL TABLET 500-600 MG-UNIT Formulary OTC OS-CAL ORAL TABLET CHEWABLE 500-600 MG- Formulary OTC UNIT OS-CAL ULTRA ORAL TABLET 600 MG Formulary OTC oseltamivir phosphate oral capsule 30 mg, 45 mg, 75 mg Formulary QL (20 EA per 180 days) oseltamivir phosphate oral suspension reconstituted 6 Formulary mg/ml OSTEO-PORETICAL ORAL TABLET 600-1000 MG- Formulary OTC UNIT ostomy protective powder Formulary OTC ovulation predictor in vitro kit Formulary OTC oxalic acid crystals Formulary OTC oxaliplatin intravenous solution 100 mg/20ml, 50 mg/10ml Formulary oxaliplatin intravenous solution reconstituted 100 mg Formulary oxandrolone oral tablet 10 mg, 2.5 mg Formulary oxaprozin oral tablet 600 mg Formulary oxazepam oral capsule 10 mg, 15 mg, 30 mg Formulary QL (136 EA per 34 days) oxcarbazepine oral suspension 300 mg/5ml Formulary 106 Drug Name Formulary Status Requirements/Limits oxcarbazepine oral tablet 150 mg, 300 mg, 600 mg Formulary oxybutynin chloride er oral tablet extended release 24 hour Formulary 10 mg, 15 mg oxybutynin chloride er oral tablet extended release 24 hour Formulary QL (34 EA per 34 days) 5 mg oxybutynin chloride oral syrup 5 mg/5ml Formulary oxybutynin chloride oral tablet 5 mg Formulary oxycodone hcl er oral tablet er 12 hour abuse-deterrent 10 Formulary PA; QL (68 EA per 34 days) mg, 20 mg, 40 mg oxycodone hcl er oral tablet er 12 hour abuse-deterrent 80 Formulary PA; QL (102 EA per 34 days) mg oxycodone hcl oral capsule 5 mg Formulary PA; QL (84 EA per 7 days) oxycodone hcl oral concentrate 10 mg/0.5ml, 100 mg/5ml Formulary PA oxycodone hcl oral solution 5 mg/5ml Formulary PA; QL (420 ML per 7 days) oxycodone hcl oral tablet 10 mg Formulary PA; QL (42 EA per 7 days) oxycodone hcl oral tablet 15 mg Formulary PA; QL (28 EA per 7 days) oxycodone hcl oral tablet 20 mg Formulary PA; QL (21 EA per 7 days) oxycodone hcl oral tablet 30 mg Formulary PA; QL (14 EA per 7 days) oxycodone hcl oral tablet 5 mg Formulary PA; QL (84 EA per 7 days) oxycodone-acetaminophen oral tablet 10-325 mg Formulary PA; QL (42 EA per 7 days) oxycodone-acetaminophen oral tablet 2.5-325 mg Formulary PA; QL (168 EA per 7 days) oxycodone-acetaminophen oral tablet 5-325 mg Formulary PA; QL (84 EA per 7 days) oxycodone-acetaminophen oral tablet 7.5-325 mg Formulary PA; QL (56 EA per 7 days) oxycodone-ibuprofen oral tablet 5-400 mg Formulary PA OXYCONTIN ORAL TABLET ER 12 HOUR ABUSE- Formulary PA; QL (102 EA per 34 days) DETERRENT 15 MG, 30 MG, 60 MG oxymorphone hcl er oral tablet extended release 12 hour 10 Formulary PA; QL (68 EA per 34 days) mg, 15 mg, 20 mg, 5 mg, 7.5 mg oxymorphone hcl er oral tablet extended release 12 hour 30 Formulary PA; QL (102 EA per 34 days) mg oxymorphone hcl er oral tablet extended release 12 hour 40 Formulary PA; QL (34 EA per 34 days) mg oxymorphone hcl oral tablet 10 mg Formulary PA; QL (90 EA per 30 days) oxymorphone hcl oral tablet 5 mg Formulary PA; QL (180 EA per 30 days) OXYTROL FOR WOMEN TRANSDERMAL PATCH Formulary OTC TWICE WEEKLY 3.9 MG/24HR OXYZAL WET DRESSING EXTERNAL SOLUTION Formulary OTC 1:2000 oyster calcium + d oral tablet 250-125 mg-unit Formulary OTC oyster calcium/d3 oral tablet 500-200 mg-unit Formulary OTC oyster shell calcium 250+d oral tablet 250-125 mg-unit Formulary OTC oyster shell calcium 500+d oral tablet chewable 500-400 Formulary OTC mg-unit oyster shell calcium oral tablet 500-400 mg-unit Formulary OTC oyster shell calcium plus d oral tablet 500-125 mg-unit Formulary OTC oyster shell calcium/d oral tablet 250-250 mg-unit, 500-200 Formulary OTC mg-unit

107 Drug Name Formulary Status Requirements/Limits oyster shell calcium/d3 oral tablet 500-400 mg-unit Formulary OTC P & S EXTERNAL LIQUID Formulary OTC P & S EXTERNAL SHAMPOO 2 % Formulary OTC p-1000 oral capsule 500 mg Formulary OTC PA CLA ORAL CAPSULE 1000 MG Formulary OTC pa fish oil/vit d3 triple st oral capsule delayed release 900- Formulary OTC 1000 mg-unit pa glucosamine-chondroitin oral capsule 166.7-133.3 mg Formulary OTC pa prenatal formula oral tablet 9-0.5 mg Formulary OTC pa probiotic complex oral tablet Formulary OTC intravenous concentrate 100 mg/16.7ml, 150 Formulary mg/25ml, 30 mg/5ml, 300 mg/50ml pain & fever childrens oral tablet chewable 160 mg Formulary OTC pain relief day & night ex st oral 25-500 & 500 mg Formulary OTC pain relief oral tablet Formulary OTC pain relief roll-on external liquid 4 % Formulary OTC pain reliever extra strength oral tablet 500 mg Formulary OTC pain reliever pm ex st oral tablet 25-500 mg Formulary OTC pain reliever pm oral tablet 25-500 mg Formulary OTC pain reliever/fever reducer rectal suppository 120 mg Formulary OTC pain relieving external gel 3.5 % Formulary OTC PALADIN EXTERNAL OINTMENT Formulary OTC pamidronate disodium intravenous solution 30 mg/10ml, 6 Formulary PA mg/ml, 90 mg/10ml pamidronate disodium intravenous solution reconstituted 30 Formulary PA mg, 90 mg pancreatin oral tablet 325 mg Formulary OTC PANCREAZE ORAL CAPSULE DELAYED RELEASE Formulary PARTICLES 4200 UNIT PANOXYL EXTERNAL LIQUID 2.5 % Formulary OTC PANOXYL WASH EXTERNAL LIQUID 10 % Formulary OTC; AGE (Max 18 Years) PANOXYL-4 CREAMY WASH EXTERNAL LIQUID 4 Formulary OTC; AGE (Max 18 Years) % panto-250 oral capsule 250 mg Formulary OTC pantoprazole sodium oral tablet delayed release 20 mg, 40 Formulary mg pantothenic acid oral tablet 500 mg Formulary OTC papaya enzyme oral tablet chewable Formulary OTC paraffin wax beads wax Formulary OTC PARAGARD INTRAUTERINE COPPER Formulary INTRAUTERINE INTRAUTERINE DEVICE paricalcitol intravenous solution 2 mcg/ml, 5 mcg/ml Formulary PA paricalcitol oral capsule 1 mcg, 2 mcg, 4 mcg Formulary PA PARODONTAX MOUTH/THROAT PASTE 0.454 % Formulary OTC paromomycin sulfate oral capsule 250 mg Formulary

108 Drug Name Formulary Status Requirements/Limits paroxetine hcl er oral tablet extended release 24 hour 12.5 Formulary QL (68 EA per 34 days) mg, 25 mg, 37.5 mg paroxetine hcl oral tablet 10 mg, 20 mg, 30 mg, 40 mg Formulary parvenzyme digestive enzyme oral tablet Formulary OTC PAZEO OPHTHALMIC SOLUTION 0.7 % Formulary pc lancets super thin 30g Formulary OTC; QL (150 EA per 30 days) PCCA MBK (FATTY ACID) BASE Formulary OTC peanut oil oil Formulary pearberry fragrance liquid Formulary OTC PECGEN DMX ORAL LIQUID 10-187 MG/5ML, 15-125 Formulary OTC MG/5ML pectin powder Formulary PEDIACARE CHILDRENS LONG-ACT ORAL LIQUID Formulary OTC 7.5 MG/5ML PEDIACARE CHILDRENS MULTI-SYMP ORAL Formulary OTC LIQUID 2.5-5 MG/5ML PEDIACARE MULTI-SYMPTOM ORAL LIQUID 2.5-1- Formulary OTC 5-160 MG/5ML PEDIA-LAX FIBER GUMMIES ORAL TABLET Formulary OTC CHEWABLE PEDIA-LAX ORAL LIQUID 50 MG/15ML Formulary OTC PEDIA-LAX ORAL TABLET CHEWABLE 400 MG Formulary OTC PEDIA-LAX RECTAL SUPPOSITORY 1 GM, 2.8 GM Formulary OTC PEDIALYTE ADVANCED CARE ORAL SOLUTION Formulary OTC PEDIARIX INTRAMUSCULAR SUSPENSION Formulary PEDIAVENT ORAL SYRUP 2 MG/5ML Formulary OTC PEDIAVENT ORAL TABLET CHEWABLE 1 MG Formulary OTC PEDIAVIT ORAL LIQUID Formulary OTC PEDVAX HIB INTRAMUSCULAR SUSPENSION 7.5 Formulary AGE (Min 19 Years) MCG/0.5ML peg 300 liquid Formulary PEGANONE ORAL TABLET 250 MG Formulary PEGASYS PROCLICK SUBCUTANEOUS SOLUTION Formulary PA 135 MCG/0.5ML, 180 MCG/0.5ML PEGASYS SUBCUTANEOUS SOLUTION 180 MCG/ML Formulary PA; QL (1 ML per 34 days) PEGINTRON SUBCUTANEOUS KIT 50 MCG/0.5ML Formulary penicillin g potassium injection solution reconstituted Formulary 20000000 unit, 5000000 unit penicillin v potassium oral solution reconstituted 125 Formulary mg/5ml, 250 mg/5ml penicillin v potassium oral tablet 250 mg, 500 mg Formulary PENTACEL INTRAMUSCULAR SUSPENSION Formulary RECONSTITUTED PENTASA ORAL CAPSULE EXTENDED RELEASE 250 Formulary MG, 500 MG pentoxifylline er oral tablet extended release 400 mg Formulary PENTRAX GOLD EXTERNAL SHAMPOO 4 % Formulary OTC

109 Drug Name Formulary Status Requirements/Limits peppermint oil oil Formulary peppermint spirit spirit Formulary OTC PEPTO-BISMOL MAX STRENGTH ORAL Formulary OTC SUSPENSION 525 MG/15ML PEPTO-BISMOL ORAL SUSPENSION 262 MG/15ML Formulary OTC PEPTO-BISMOL ORAL TABLET 262 MG Formulary OTC PEPTO-BISMOL TO-GO ORAL TABLET CHEWABLE Formulary OTC 262 MG PERFORM ATOMIC HEAT EXTERNAL CREAM 0.034- Formulary OTC 10 % PERFORM ATOMIC HEAT EXTERNAL LIQUID 0.034- Formulary OTC 10 % PERFORM PAIN RELIEVING EXTERNAL LIQUID 10.4 Formulary OTC % PERFORM PAIN RELIEVING ROLL-ON EXTERNAL Formulary OTC LIQUID 3.1 % PERFOROMIST INHALATION NEBULIZATION Formulary QL (120 ML per 30 days) SOLUTION 20 MCG/2ML PERIDIN-C ORAL TABLET 200-50-150 MG Formulary OTC perindopril erbumine oral tablet 2 mg, 4 mg, 8 mg Formulary PERIOMED MOUTH/THROAT CONCENTRATE 0.63 % Formulary OTC external cream 5 % Formulary PERNOX EXTERNAL LOTION 1.5-2 % Formulary OTC PEROXYL EXTERNAL SOLUTION 1.5-6 % Formulary OTC PEROXYL MOUTH/THROAT SOLUTION 1.5 % Formulary OTC PEROXYL SPOT TREATMENT MOUTH/THROAT GEL Formulary OTC 1.5 % perphenazine oral tablet 16 mg, 2 mg, 4 mg, 8 mg Formulary AGE (Min 18 Years) perphenazine-amitriptyline oral tablet 2-10 mg, 2-25 mg, 4- Formulary AGE (Min 18 Years) 10 mg, 4-25 mg, 4-50 mg PERRY PRENATAL ORAL CAPSULE 13.5-0.4 MG Formulary OTC peruvian balsam liquid Formulary OTC petroleum jelly external aerosol Formulary OTC petroleum jelly external ointment Formulary OTC PHARMABASE BARRIER EXTERNAL OINTMENT Formulary OTC 9.38 % PHARMACY COUNTER LANCETS Formulary OTC; QL (150 EA per 30 days) PHAZYME MAXIMUM STRENGTH ORAL CAPSULE Formulary OTC 250 MG PHAZYME ULTRA STRENGTH ORAL CAPSULE 180 Formulary OTC MG PHENADOZ RECTAL SUPPOSITORY 12.5 MG, 25 MG Formulary AGE (Min 2 Years) PHENAZO ORAL TABLET 200 MG Formulary phenazopyridine hcl oral tablet 100 mg Formulary phenelzine sulfate oral tablet 15 mg Formulary oral elixir 20 mg/5ml Formulary phenobarbital oral solution 20 mg/5ml Formulary

110 Drug Name Formulary Status Requirements/Limits phenobarbital oral tablet 100 mg, 15 mg, 16.2 mg, 30 mg, Formulary 32.4 mg, 60 mg, 64.8 mg, 97.2 mg phenol external liquid Formulary OTC PHENOL EZ SWABS EXTERNAL SWAB 89 % Formulary OTC phenoxybenzamine hcl oral capsule 10 mg Formulary phentermine hcl oral capsule 15 mg, 30 mg, 37.5 mg Formulary PA phentermine hcl oral tablet 37.5 mg Formulary PA phenylalanine oral packet 50 mg Formulary OTC INFATABS ORAL TABLET CHEWABLE Formulary 50 MG phenytoin oral suspension 125 mg/5ml Formulary phenytoin oral tablet chewable 50 mg Formulary phenytoin sodium extended oral capsule 100 mg, 200 mg, Formulary 300 mg phenytoin sodium injection solution 50 mg/ml Formulary PHLEXY-10 ORAL TABLET Formulary OTC PHOS-FLUR ORTHO DEFENSE MOUTH/THROAT Formulary OTC SOLUTION 0.044 % phos-nak oral packet 280-160-250 mg Formulary OTC PHOSPHASAL ORAL TABLET 81.6 MG Formulary phosphatidyl choline oral tablet 65 mg Formulary OTC phosphatidylcholine powder Formulary phosphatidylserine powder Formulary OTC PHOSPHOLINE IODIDE OPHTHALMIC SOLUTION Formulary RECONSTITUTED 0.125 % PHOTOFRIN INTRAVENOUS SOLUTION Formulary RECONSTITUTED 75 MG phytonadione liquid Formulary phytonadione oral tablet 5 mg Formulary PHYTOPLEX Z-GUARD EXTERNAL PASTE 57-17 % Formulary OTC PIFELTRO ORAL TABLET 100 MG Formulary QL (30 EA per 30 days) pilocarpine hcl oral tablet 5 mg, 7.5 mg Formulary pimecrolimus external cream 1 % Formulary PA; AGE (Min 2 Years) pindolol oral tablet 10 mg, 5 mg Formulary pioglitazone hcl oral tablet 15 mg, 30 mg, 45 mg Formulary pioglitazone hcl-glimepiride oral tablet 30-2 mg, 30-4 mg Formulary ST; QL (34 EA per 34 days) pioglitazone hcl-metformin hcl oral tablet 15-500 mg, 15- Formulary 850 mg piroxicam oral capsule 10 mg, 20 mg Formulary PLAN B ONE-STEP ORAL TABLET 1.5 MG Formulary OTC; QL (2 EA per 34 days) plasticized base ointment Formulary PLIAGEL GEL 0.5-0.5-0.25 % Formulary OTC PLO ULTRAMAX EXTERNAL GEL Formulary OTC PLURONIC GEL 20 %, 30 % Formulary pmx-1184 silicone liquid Formulary

111 Drug Name Formulary Status Requirements/Limits PNEUMOVAX 23 INJECTION INJECTABLE 25 Formulary AGE (Min 19 Years) MCG/0.5ML pnv-dha oral capsule 27-0.6-0.4-300 mg Formulary pnv-omega oral capsule 28-0.6-0.4-340 mg Formulary pnv-select oral tablet 27-0.6-0.4 mg Formulary podofilox external solution 0.5 % Formulary podophyllum resin powder Formulary poison ivy wash fast acting external Formulary OTC POLAR FREEZE EXTERNAL GEL 3.5-0.8 % Formulary OTC poloxamer 188 powder Formulary poly bacitracin external ointment 500-10000 unit/gm Formulary OTC POLY HIST FORTE ORAL TABLET 7.5-10 MG Formulary OTC polyethylene glycol 1000 liquid Formulary OTC polyethylene glycol 1450 liquid Formulary polyethylene glycol 3350 powder Formulary polyethylene glycol 400 liquid Formulary polyethylene glycol 8000 powder Formulary poly-hist dm oral liquid 5-25-10 mg/5ml Formulary OTC poly-hist pd oral liquid 6.25-6.25 mg/ml Formulary OTC polymyxin b sulfate powder Formulary polymyxin b-trimethoprim ophthalmic solution 10000-0.1 Formulary unit/ml-% polyoxyl 40 stearate powder Formulary polysorbate 20 solution Formulary polysorbate 80 oral liquid Formulary POLYSPORIN EXTERNAL OINTMENT 500-10000 Formulary OTC UNIT/GM poly-tussin ac oral liquid 10-4-10 mg/5ml Formulary OTC POLY-VENT DM ORAL TABLET 60-20-380 MG Formulary OTC POLY-VENT IR ORAL TABLET 60-380 MG Formulary OTC POLY-VI-SOL ORAL SOLUTION Formulary OTC POLY-VI-SOL/IRON ORAL SOLUTION Formulary OTC potassimin oral tablet 75 mg Formulary OTC potassium bitartrate powder Formulary potassium bromide crystals Formulary potassium chloride crystals Formulary OTC potassium chloride granules Formulary potassium citrate er oral tablet extended release 10 meq Formulary (1080 mg), 5 meq (540 mg) potassium citrate granules Formulary OTC potassium citrate-citric acid oral solution 1100-334 mg/5ml Formulary potassium gluconate anhydrous powder Formulary potassium gluconate oral tablet 2.5 meq, 595 (99 k) mg Formulary OTC potassium hydroxide pellet Formulary potassium hydroxide solution 10 %, 20 % Formulary OTC 112 Drug Name Formulary Status Requirements/Limits potassium iodide (antidote) oral solution 65 mg/ml Formulary OTC potassium iodide crystals Formulary potassium nitrate granules Formulary OTC potassium permanganate granules Formulary potassium sodium tartrate powder Formulary OTC potassium sorbate crystals Formulary OTC povidone-iodine external ointment 10 % Formulary OTC povidone-iodine external solution 10 % Formulary OTC povidone-iodine external swab 7.5 % Formulary OTC povidone-iodine paint sponge external swab 10 % Formulary OTC povidone-iodine prep external pad 10 % Formulary OTC povidone-iodine scrub sponge external 10 % Formulary OTC power oral care system mouth/throat kit Formulary OTC PR NATAL 400 EC ORAL 29-1-200 & 400 MG (DR) Formulary PR NATAL 400 ORAL 29-1-200 & 400 MG Formulary PR NATAL 430 EC ORAL 29-1-200 & 430 MG (DR) Formulary PR NATAL 430 ORAL 29-1-200 & 430 MG Formulary PRADAXA ORAL CAPSULE 110 MG, 150 MG, 75 MG Formulary PRALUENT SUBCUTANEOUS SOLUTION PEN- Formulary PA INJECTOR 150 MG/ML, 75 MG/ML PRAMEGEL EXTERNAL GEL 1 % Formulary OTC pramipexole dihydrochloride oral tablet 0.125 mg, 0.25 mg, Formulary 0.5 mg, 0.75 mg, 1 mg, 1.5 mg pramoxine hcl rectal foam 1 % Formulary OTC prasugrel hcl oral tablet 10 mg, 5 mg Formulary pravastatin sodium oral tablet 10 mg, 20 mg, 40 mg, 80 mg Formulary prazosin hcl oral capsule 1 mg, 2 mg, 5 mg Formulary PRECISION GLUCOSE CONTROL LIQUID IN VITRO Formulary OTC; QL (100 EA per 30 days) PRECISION GLUCOSE CONTROL SOLN SOLUTION Formulary OTC; QL (150 EA per 30 days) IN VITRO PRECISION GLUCOSE KETONE CONTR LIQUID IN Formulary OTC; QL (100 EA per 30 days) VITRO PRECISION GLUCOSE/KETONE CONTR LIQUID IN Formulary OTC; QL (100 EA per 30 days) VITRO PRECISION LINK KIT Formulary OTC; QL (1 EA per 365 days) PRECISION PCX PLUS TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) PRECISION PCX STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) PRECISION POINT OF CARE TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) PRECISION QID MONITOR DEVICE Formulary OTC; QL (1 EA per 365 days) PRECISION QID MONITOR DEVICE Formulary OTC; QL (150 EA per 30 days) PRECISION QID TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) PRECISION SOF-TACT MONITOR DEVICE Formulary OTC; QL (1 EA per 365 days) PRECISION SOF-TACT TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) PRECISION SUREDOSE PLUS SYR 29G X 1/2" 0.3 ML Formulary OTC 29G X 1/2" 0.3 ML

113 Drug Name Formulary Status Requirements/Limits PRECISION SUREDOSE PLUS SYR 29G X 1/2" 1 ML Formulary OTC 29G X 1/2" 1 ML PRECISION SURE-DOSE SYRINGE 28G X 1/2" 0.5 ML Formulary OTC 28G X 1/2" 0.5 ML PRECISION SURE-DOSE SYRINGE 28G X 1/2" 1 ML Formulary OTC 28G X 1/2" 1 ML PRECISION SURE-DOSE SYRINGE 29G X 1/2" 0.5 ML Formulary OTC 29G X 1/2" 0.5 ML PRECISION SURE-DOSE SYRINGE 30G X 3/8" 0.5 ML Formulary OTC 30G X 3/8" 0.5 ML PRECISION THINS GP LANCETS Formulary OTC; QL (150 EA per 30 days) PRECISION XTRA BLOOD GLUCOSE STRIP IN Formulary OTC; QL (150 EA per 30 days) VITRO PRECISION XTRA DEVICE Formulary OTC; QL (1 EA per 365 days) PRECISION XTRA DEVICE Formulary OTC; QL (150 EA per 30 days) PRECISION XTRA KETONE STRIP IN VITRO Formulary OTC; QL (100 EA per 30 days) PRECISION XTRA KIT Formulary OTC; QL (1 EA per 365 days) PRECISION XTRA MONITOR DEVICE Formulary OTC; QL (1 EA per 365 days) PRED MILD OPHTHALMIC SUSPENSION 0.12 % Formulary prednicarbate external cream 0.1 % Formulary prednicarbate external ointment 0.1 % Formulary acetate ophthalmic suspension 1 % Formulary prednisolone oral solution 15 mg/5ml Formulary prednisolone sodium phosphate oral solution 15 mg/5ml, 20 Formulary mg/5ml, 25 mg/5ml, 6.7 (5 base) mg/5ml PREDNISONE INTENSOL ORAL CONCENTRATE 5 Formulary MG/ML prednisone oral solution 5 mg/5ml Formulary prednisone oral tablet 1 mg, 10 mg, 2.5 mg, 20 mg, 5 mg, Formulary 50 mg prednisone oral tablet therapy pack 10 mg (21), 10 mg (48), Formulary 5 mg (21), 5 mg (48) preferred plus insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" Formulary OTC 0.5 ml preferred plus insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 Formulary OTC ml preferred plus insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" Formulary OTC 0.3 ml preferred plus insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" Formulary OTC 0.5 ml preferred plus insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 Formulary OTC ml preferred plus insulin syringe 30g x 5/16" 0.3 ml 30g x Formulary OTC 5/16" 0.3 ml preferred plus insulin syringe 30g x 5/16" 0.5 ml 30g x Formulary OTC 5/16" 0.5 ml preferred plus insulin syringe 30g x 5/16" 1 ml 30g x 5/16" Formulary OTC 1 ml preferred plus lancets colored Formulary OTC; QL (150 EA per 30 days) 114 Drug Name Formulary Status Requirements/Limits preferred plus lancets thin Formulary OTC; QL (150 EA per 30 days) PREGNITUDE ORAL PACKET 2000-200 MG-MCG Formulary OTC PREMARIN VAGINAL CREAM 0.625 MG/GM Formulary PREMIER UROSTOMY POUCH Formulary OTC PREMPHASE ORAL TABLET 0.625-5 MG Formulary PREMPRO ORAL TABLET 0.3-1.5 MG, 0.45-1.5 MG, Formulary 0.625-2.5 MG, 0.625-5 MG prenatal formula a-free oral tablet 9-0.267 mg Formulary OTC prenatal formula oral capsule 28-0.8-235 mg Formulary OTC prenatal low iron oral tablet 27-0.8 mg Formulary OTC prenatal multi +dha oral capsule 27-0.8-200 mg Formulary OTC prenatal multivitamin plus dha oral capsule 27-0.8-250 mg Formulary OTC prenatal oral tablet 27-0.8 mg Formulary prenatal oral tablet 28-0.8 mg, 6.75-0.2 mg Formulary OTC PRENATE ORAL TABLET CHEWABLE 0.6-0.4 MG Formulary PRENATE PIXIE ORAL CAPSULE 10-0.6-0.4-200 MG Formulary prep protective skin barrier external pad 0.5 % Formulary OTC PREPARATION H RECTAL CREAM 1-0.25-14.4-15 %, Formulary OTC 5-14.4 % PREPARATION H RECTAL GEL 0.25-50 % Formulary OTC PREPARATION H RECTAL OINTMENT 0.25-14-74.9 % Formulary OTC PREPARATION H TOTABLES RECTAL CREAM 1- Formulary OTC 0.25-14.4-15 % pres gen pediatric oral liquid 2.5-5-75 mg/5ml Formulary OTC PRESGEN B ORAL LIQUID 10-4-20 MG/5ML Formulary OTC PRETZ NASAL SOLUTION Formulary OTC PRETZ SOLUTION 10 % Formulary OTC PREVACARE ANTIMICROBIAL EXTERNAL GEL 60 Formulary OTC % PREVACARE EXTRA PROTECTIVE EXTERNAL Formulary OTC OINTMENT PREVACARE PERSONAL PROTECT EXTERNAL Formulary OTC CREAM PREVACARE TOTAL SKIN CARE EXTERNAL Formulary OTC SOLUTION PREVACID 24HR ORAL CAPSULE DELAYED Formulary OTC RELEASE 15 MG PREVALITE ORAL PACKET 4 GM Formulary PREVALITE ORAL POWDER 4 GM/DOSE Formulary PREVNAR 13 INTRAMUSCULAR SUSPENSION Formulary AGE (Min 19 Years) PREZCOBIX ORAL TABLET 800-150 MG Formulary PREZISTA ORAL TABLET 150 MG, 600 MG, 75 MG, Formulary 800 MG PRIFTIN ORAL TABLET 150 MG Formulary PRILOSEC OTC ORAL TABLET DELAYED RELEASE Formulary OTC 20 MG

115 Drug Name Formulary Status Requirements/Limits PRIMATENE ASTHMA ORAL TABLET 12.5-200 MG Formulary OTC oral tablet 250 mg, 50 mg Formulary PRO NUTRIENTS OMEGA 3 ORAL CAPSULE Formulary OTC DELAYED RELEASE 332.5 MG PROAIR HFA INHALATION AEROSOL SOLUTION Formulary 108 (90 BASE) MCG/ACT probenecid oral tablet 500 mg Formulary PROBIOMAX PLUS DF ORAL PACKET Formulary OTC probiotic digestive support oral capsule Formulary OTC probiotic oral capsule 250 mg Formulary OTC probiotic oral tablet delayed release Formulary OTC probiotic-prebiotic oral capsule 1-250 billion-mg Formulary OTC PROCARE PLUS UNDERWEAR MEDIUM Formulary OTC PRO-CEPTION VAGINAL KIT Formulary OTC prochlorperazine maleate oral tablet 10 mg, 5 mg Formulary prochlorperazine rectal suppository 25 mg Formulary PROCOMYCIN EXTERNAL CREAM 4 % Formulary OTC PROCRIT SOLUTION 10000 UNIT/ML INJECTION Formulary 10000 UNIT/ML PROCRIT SOLUTION 2000 UNIT/ML INJECTION 2000 Formulary UNIT/ML PROCRIT SOLUTION 20000 UNIT/ML INJECTION Formulary 20000 UNIT/ML PROCRIT SOLUTION 3000 UNIT/ML INJECTION 3000 Formulary UNIT/ML PROCRIT SOLUTION 4000 UNIT/ML INJECTION 4000 Formulary UNIT/ML PROCRIT SOLUTION 40000 UNIT/ML INJECTION Formulary 40000 UNIT/ML PROCTOCORT RECTAL CREAM 1 % Formulary PROCTOFOAM RECTAL FOAM 1 % Formulary OTC PROCTOSOL HC RECTAL CREAM 2.5 % Formulary PRODIGY INSULIN SYRINGE 28G X 1/2" 1 ML 28G X Formulary OTC 1/2" 1 ML PRODIGY INSULIN SYRINGE 31G X 5/16" 0.3 ML 31G Formulary OTC X 5/16" 0.3 ML PRODIGY INSULIN SYRINGE 31G X 5/16" 0.5 ML 31G Formulary OTC X 5/16" 0.5 ML PRODIGY NO CODING BLOOD GLUC STRIP IN Formulary PA; OTC; QL (150 EA per 30 days) VITRO PRODIGY TWIST TOP LANCETS 28G Formulary OTC; QL (150 EA per 30 days) PROFE ORAL CAPSULE 391.3 (180 FE) MG Formulary OTC PROFERRIN ES ORAL TABLET 12 MG Formulary OTC PROFERRIN-FORTE ORAL TABLET 12-1 MG Formulary OTC PROFILNINE SD INTRAVENOUS SOLUTION Formulary RECONSTITUTED 500 UNIT intramuscular oil 50 mg/ml Formulary

116 Drug Name Formulary Status Requirements/Limits progesterone micronized oral capsule 100 mg, 200 mg Formulary progesterone micronized powder Formulary PROGLYCEM ORAL SUSPENSION 50 MG/ML Formulary PROLENSA OPHTHALMIC SOLUTION 0.07 % Formulary PROLIA SUBCUTANEOUS SOLUTION 60 MG/ML Formulary PA PROLIDA EXTERNAL PATCH 4-1 % Formulary OTC PROMACTA ORAL TABLET 12.5 MG Formulary PA; QL (240 EA per 30 days) PROMACTA ORAL TABLET 25 MG Formulary PA; QL (120 EA per 30 days) PROMACTA ORAL TABLET 50 MG Formulary PA; QL (60 EA per 30 days) PROMACTA ORAL TABLET 75 MG Formulary PA; QL (30 EA per 30 days) promethazine hcl oral syrup 6.25 mg/5ml Formulary AGE (Min 2 Years) promethazine hcl oral tablet 12.5 mg, 25 mg, 50 mg Formulary AGE (Min 2 Years) promethazine hcl rectal suppository 12.5 mg, 50 mg Formulary AGE (Min 2 Years) promethazine hcl rectal suppository 25 mg Formulary promethazine vc/codeine oral syrup 6.25-5-10 mg/5ml Formulary AGE (Min 6 Years) promethazine-codeine oral syrup 6.25-10 mg/5ml Formulary AGE (Min 6 Years) promethazine-dm oral syrup 6.25-15 mg/5ml Formulary AGE (Min 6 Years) PROMETHEGAN RECTAL SUPPOSITORY 25 MG Formulary PROMOLAXIN ORAL TABLET 100 MG Formulary OTC PRONUTRIENTS CALCIUM+D3 ORAL TABLET 600- Formulary OTC 800 MG-UNIT PRONUTRIENTS SUPER B COMPLEX ORAL TABLET Formulary OTC propafenone hcl er oral capsule extended release 12 hour Formulary 225 mg, 325 mg, 425 mg propafenone hcl oral tablet 150 mg, 225 mg, 300 mg Formulary propranolol hcl er oral capsule extended release 24 hour Formulary 120 mg, 160 mg, 60 mg, 80 mg propranolol hcl intravenous solution 1 mg/ml Formulary propranolol hcl oral solution 20 mg/5ml, 40 mg/5ml Formulary propranolol hcl oral tablet 10 mg, 20 mg, 40 mg, 60 mg, 80 Formulary mg propranolol-hctz oral tablet 40-25 mg, 80-25 mg Formulary propylene glycol external solution Formulary propylene glycol liquid Formulary propylparaben powder Formulary propylthiouracil oral tablet 50 mg Formulary PRO-RED AC ORAL SYRUP 5-1-9 MG/5ML Formulary OTC PROSHIELD SKIN CARE EXTERNAL KIT Formulary OTC protein oral powder 80 % Formulary OTC protein oral tablet 975 mg Formulary OTC PROTEINEX ORAL LIQUID Formulary OTC PROTEINEX P100 ORAL LIQUID Formulary OTC protriptyline hcl oral tablet 10 mg, 5 mg Formulary PROVENT SLEEP APNEA THERAPY Formulary

117 Drug Name Formulary Status Requirements/Limits PROVENTIL HFA INHALATION AEROSOL Formulary SOLUTION 108 (90 BASE) MCG/ACT PROVIDA DHA ORAL CAPSULE 16-16-1.25-110 MG Formulary PROVIEW KIT Formulary OTC pseudoeph-bromphen-dm oral syrup 30-2-10 mg/5ml Formulary pseudoephedrine hcl er oral tablet extended release 12 hour Formulary OTC 120 mg pseudoephedrine hcl oral syrup 30 mg/5ml Formulary OTC pseudoephedrine hcl oral tablet 30 mg Formulary OTC pseudoephedrine hcl oral tablet 60 mg Formulary psorcon external cream 0.05 % Formulary PSS SELECT GP LANCETS Formulary OTC; QL (150 EA per 30 days) PSS SELECT SAFETY LANCETS Formulary OTC; QL (150 EA per 30 days) psyllium husk powder Formulary PULMICORT FLEXHALER INHALATION AEROSOL POWDER BREATH ACTIVATED 180 MCG/ACT, 90 Formulary MCG/ACT PULMICORT INHALATION SUSPENSION 0.25 Formulary MG/2ML, 0.5 MG/2ML, 1 MG/2ML PULMOZYME INHALATION SOLUTION 1 MG/ML Formulary PURACYN PLUS DUO-CARE EXTERNAL LIQUID Formulary OTC pure l-citrulline oral capsule 600 mg Formulary OTC pure l-citrulline oral powder Formulary OTC purefe ob plus oral capsule 162-115.2-1 mg Formulary purified water oral liquid Formulary PURILON EXTERNAL GEL Formulary OTC px allergy relief d oral tablet extended release 12 hour 5- Formulary OTC 120 mg px allergy sinus pe oral tablet 2-5-325 mg Formulary OTC px antacid extra strength oral tablet chewable 750 mg Formulary OTC px artificial tears ophthalmic solution 5-6 mg/ml Formulary OTC px daytime cold oral tablet 10-5-325 mg Formulary OTC px daytime multi-symptom oral capsule 30-325-15 mg Formulary OTC px gas relief extra strength oral capsule 125 mg Formulary OTC px ibuprofen cold & sinus oral tablet 30-200 mg Formulary OTC px insulin syringe 30g x 1/2" 0.5 ml 30g x 1/2" 0.5 ml Formulary OTC px lancets ultra thin Formulary OTC; QL (150 EA per 30 days) px minoxidil for men external solution 5 % Formulary OTC px nasal four nasal solution 1 % Formulary OTC px nitetime multi-symptom oral capsule 30-6.25-15-325 mg Formulary OTC px omeprazole oral tablet delayed release 20 mg Formulary OTC PYLERA ORAL CAPSULE 140-125-125 MG Formulary pyrazinamide oral tablet 500 mg Formulary pyridostigmine bromide er oral tablet extended release 180 Formulary mg pyridostigmine bromide oral tablet 60 mg Formulary 118 Drug Name Formulary Status Requirements/Limits pyridoxal-5 phosphate powder Formulary pyridoxine hcl oral tablet 25 mg Formulary OTC pyridoxine hcl powder Formulary PYRIDOXINE/MINERALS ORAL CAPSULE 100-99-200 Formulary OTC MG pyrilamine-phenylephrine oral tablet 25-10 mg Formulary OTC pyruvic acid liquid Formulary qc alcohol swabs pad 70 % 70 % Formulary OTC qc arthritis external cream 10 % Formulary OTC qc calamine external lotion Formulary OTC qc castor oil oil Formulary OTC qc iodides external tincture Formulary OTC qc iodine tincture external tincture Formulary OTC qc lancets super thin 30g Formulary OTC; QL (150 EA per 30 days) qc lancets ultra thin Formulary OTC; QL (150 EA per 30 days) QC MEDIFIN PE ORAL TABLET 10-400 MG Formulary OTC qc natural vegetable oral powder 95 % Formulary OTC qc non-adherent pad 3"x4" Formulary OTC qc unilet lancets 28g Formulary OTC; QL (150 EA per 30 days) qc unilet lancets micro thin Formulary OTC; QL (150 EA per 30 days) Q-GEL ORAL CAPSULE 15 MG Formulary OTC quercetin oral tablet 250 mg, 50 mg Formulary OTC quetiapine fumarate er oral tablet extended release 24 hour QL (30 EA per 30 days); AGE (Min 18 Formulary 150 mg, 200 mg Years) quetiapine fumarate er oral tablet extended release 24 hour Formulary AGE (Min 18 Years) 300 mg, 400 mg, 50 mg quetiapine fumarate oral tablet 100 mg, 200 mg, 25 mg, 300 Formulary AGE (Min 18 Years) mg, 400 mg, 50 mg QUILLICHEW ER ORAL TABLET CHEWABLE Formulary AGE (Min 4 Years and Max 17 Years) EXTENDED RELEASE 20 MG, 30 MG, 40 MG QUILLIVANT XR ORAL SUSPENSION Formulary AGE (Min 4 Years and Max 17 Years) RECONSTITUTED 25 MG/5ML quinapril hcl oral tablet 10 mg, 20 mg, 40 mg, 5 mg Formulary quinapril-hydrochlorothiazide oral tablet 10-12.5 mg, 20- Formulary 12.5 mg, 20-25 mg quinidine gluconate er oral tablet extended release 324 mg Formulary quinidine sulfate oral tablet 200 mg, 300 mg Formulary quinine sulfate oral capsule 324 mg Formulary ra 8 hour pain relief oral tablet extended release 650 mg Formulary OTC ra acetaminophen flu cold oral tablet 30-500-15 mg Formulary OTC ra acid reducer plus antacid oral tablet chewable 10-800- Formulary OTC 165 mg ra acne maximum external pad 2 % Formulary OTC ra advanced eye health oral capsule 250-2.5-0.5 mg, 500-5- Formulary OTC 1 mg ra alcohol swabs pad 70 % 70 % Formulary OTC

119 Drug Name Formulary Status Requirements/Limits ra anorectal external cream 5 % Formulary OTC ra antifungal pen external liquid 25 % Formulary OTC ra b-12 mouth/throat lozenge 1000-400 mcg Formulary OTC ra back & body pain relief oral tablet 500-32.5 mg Formulary OTC ra b-complex/vitamin c cr oral tablet extended release Formulary OTC ra ca/mg/zn/cu oral tablet Formulary OTC ra calamine external lotion 6.971-6.971 % Formulary OTC ra calamine external suspension 8-8 % Formulary OTC ra calcium hi-cal oral tablet 500 mg Formulary OTC ra calcium hi-cal/vitamin d oral tablet 250-125 mg-unit, Formulary OTC 500-125 mg-unit, 500-200 mg-unit ra calcium high potency oral tablet 600 mg Formulary OTC ra calcium-boron oral tablet 500-1.5 mg Formulary OTC ra cold remedy multi-symptom oral tablet dispersible Formulary OTC ra cold/sinus max oral tablet 5-325-200 mg Formulary OTC ra corn cushions small pad Formulary OTC ra corn removers ultra thin external pad 40 % Formulary OTC ra dark tanning external oil Formulary OTC ra day/night/cold/flu relief oral Formulary OTC ra daytime cold/flu relief oral liquid 10-5-325 mg/15ml Formulary OTC ra ear wax cleansing system otic kit 6.5 % Formulary OTC ra ethyl alcohol solution 70 % Formulary OTC ra exfoliating moisturizer external ointment 5-10 % Formulary OTC RA E-ZJECT COLOR LANCETS 33G Formulary OTC; QL (150 EA per 30 days) RA E-ZJECT LANCETS 28G Formulary OTC; QL (150 EA per 30 days) RA E-ZJECT LANCETS THIN 26G Formulary OTC; QL (150 EA per 30 days) RA E-ZJECT LANCETS THIN 28G Formulary OTC; QL (150 EA per 30 days) RA E-ZJECT LANCETS ULTRA THIN Formulary OTC; QL (150 EA per 30 days) ra feminine care douche vaginal solution Formulary OTC ra fever reducer/pain reliever oral suspension 160 mg/5ml Formulary OTC ra fiber weight management oral tablet chewable Formulary OTC ra first aid iodine external tincture Formulary OTC ra first aid non-stick pad Formulary OTC ra first aid saline wound wash external liquid 0.13 % Formulary OTC RA FISH OIL EXTRA STRENGTH ORAL CAPSULE 870 Formulary OTC MG ra fish oil oral capsule 900 mg Formulary OTC ra fish oil oral capsule delayed release 1400 mg Formulary OTC ra foaming hand soap refill external liquid 0.6 % Formulary OTC ra gel toe separator Formulary OTC ra glucosamine-chondroitin oral capsule 166.7-133.3 mg Formulary OTC ra glucosamine-chondroitin-d3 oral tablet 750-600-500 mg- Formulary OTC mg-unit ra glucosamine-chondroit-msm oral tablet , 500-400-300 Formulary OTC mg 120 Drug Name Formulary Status Requirements/Limits ra hot/cold gel sleeve Formulary OTC ra hydrogen peroxide external solution 3 % Formulary OTC ra insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC ra insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC ra insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC ra insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC ra intimacy gels/him/her external gel Formulary OTC ra isopropyl alcohol wipes external 70 % Formulary OTC ra lice solution combination kit 0.5-0.33-4 % Formulary OTC RA LOTION EXTERNAL LOTION Formulary OTC ra lubricant eye drops ophthalmic solution 0.6 % Formulary OTC ra lutein oral capsule 20-1 mg Formulary OTC RA LYCOPENE ORAL CAPSULE 15 MG Formulary OTC ra melatonin sublingual tablet sublingual 1 mg Formulary OTC ra miconazole 3 combo pack vaginal kit 200 & 2 mg-% Formulary OTC (9gm) ra mouth pain anesthetic mouth/throat liquid 20 % Formulary OTC ra mucus relief d max strength oral tablet extended release Formulary OTC 12 hour 120-1200 mg ra multihealth fiber oral powder 58.6 % Formulary OTC ra nasal strip/drug free/large strip Formulary OTC ra nighttime cold/flu relief oral liquid 30-12.5-650 mg/30ml Formulary OTC ra oatmeal moisturizing external lotion 1.6 % Formulary OTC ra omega 3-6-9 oral capsule Formulary OTC ra omeprazole oral tablet delayed release 20 mg Formulary OTC ra omeprazole-sodium bicarb capsule 20-1100 mg oral 20- Formulary OTC; QL (34 EA per 34 days) 1100 mg ra oyster shell calcium/d oral tablet 250-125 mg-unit, 500- Formulary OTC 200 mg-unit ra pain relief external cream 4 % Formulary OTC ra personal lubricant external liquid Formulary OTC ra prenatal oral tablet 28-0.8 mg Formulary OTC ra probiotic complex oral tablet Formulary OTC ra probiotic digestive care oral tablet Formulary OTC ra probiotic gummies oral tablet chewable Formulary OTC RA RENEWAL ACNE TREATMENT EXTERNAL GEL Formulary OTC 10 % RA RENEWAL SHOWER & BATH EXTERNAL OIL Formulary OTC ra saccharin oral tablet 15 mg Formulary OTC ra saline nasal spray nasal solution 0.65 % Formulary OTC ra saline wound wash external solution 0.9 % Formulary OTC ra sensitive anti-itch external lotion 1 % Formulary OTC ra severe cold/night cold&flu oral Formulary OTC ra severe congestion/cold max oral tablet 5-10-200-325 mg Formulary OTC ra shower & bath body external powder Formulary OTC

121 Drug Name Formulary Status Requirements/Limits ra silky lubricant moisturizer vaginal gel Formulary OTC ra sinus wash nasal relief nasal packet 1685-515 mg Formulary OTC ra sinus wash neti pot nasal packet 1685-515 mg Formulary OTC ra slow release iron oral tablet extended release 45 mg Formulary OTC ra stay awake oral tablet 100 mg Formulary OTC ra sterile saline nasal mist nasal solution 0.9 % Formulary OTC ra therapeutic external shampoo 2.5 % Formulary OTC ra triple antibiotic external aerosol 3.5-400-5000 Formulary OTC RA TUGABOOS BABY EXTERNAL OIL Formulary OTC ra vaginal infection screening in vitro kit Formulary OTC ra vitamin b-12 oral liquid 1000 mcg/ml Formulary OTC ra vitamin c oral tablet chewable 300 mg Formulary OTC ra wart remover external solution 17 % Formulary OTC ra yeast relief plus oral tablet Formulary OTC rabano yodado oral liquid Formulary OTC RABAVERT INTRAMUSCULAR SUSPENSION Formulary AGE (Min 19 Years) RECONSTITUTED rabeprazole sodium oral tablet delayed release 20 mg Formulary racepinephrine hcl powder Formulary RADIACARE POST HEALING EXTERNAL CREAM Formulary OTC raloxifene hcl oral tablet 60 mg Formulary ramipril oral capsule 1.25 mg, 10 mg, 2.5 mg, 5 mg Formulary ranitidine hcl oral syrup 75 mg/5ml Formulary ranitidine hcl oral tablet 150 mg, 300 mg Formulary ranitidine hcl oral tablet 75 mg Formulary OTC RAPAMUNE ORAL SOLUTION 1 MG/ML Formulary RASH AWAY EXTERNAL AEROSOL 33 % Formulary OTC RASH RELIEF EXTERNAL LIQUID 20-25 % Formulary OTC raspberry flavor powder Formulary raspberry syrup oral syrup Formulary reality insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC reality insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC reality insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC reality insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC reality lancets Formulary OTC; QL (150 EA per 30 days) reality swabs pad Formulary OTC reality trigger lancets Formulary OTC; QL (150 EA per 30 days) REA-LO EXTERNAL CREAM 30 % Formulary OTC REBETOL ORAL CAPSULE 200 MG Formulary PA REBETOL ORAL SOLUTION 40 MG/ML Formulary PA REBIF REBIDOSE SUBCUTANEOUS SOLUTION Formulary AUTO-INJECTOR 22 MCG/0.5ML, 44 MCG/0.5ML REBIF REBIDOSE TITRATION PACK SUBCUTANEOUS SOLUTION AUTO-INJECTOR 6X8.8 Formulary & 6X22 MCG 122 Drug Name Formulary Status Requirements/Limits REBIF SUBCUTANEOUS SOLUTION PREFILLED Formulary SYRINGE 22 MCG/0.5ML, 44 MCG/0.5ML REBIF TITRATION PACK SUBCUTANEOUS Formulary SOLUTION PREFILLED SYRINGE 6X8.8 & 6X22 MCG RECOMBIVAX HB INJECTION SUSPENSION 10 Formulary AGE (Min 19 Years) MCG/ML, 40 MCG/ML, 5 MCG/0.5ML RECTICARE EXTERNAL CREAM 5 % Formulary OTC red cross cotton sterile Formulary OTC red yeast rice extract powder Formulary OTC REDNESS RELIEF OPHTHALMIC SOLUTION 0.012- Formulary OTC 0.25 % reeses pinworm medicine oral tablet 180 mg Formulary OTC REFENESEN CHEST CONG/PAIN RLF ORAL TABLET Formulary OTC 650-400 MG REFENESEN CHST CONG/PAIN PE ORAL TABLET Formulary OTC 10-650-400 MG REFRESH LACRI-LUBE OPHTHALMIC OINTMENT Formulary OTC REFRESH LIQUIGEL OPHTHALMIC SOLUTION 1 % Formulary OTC REFRESH OPHTHALMIC SOLUTION 1.4-0.6 % Formulary OTC REFRESH OPTIVE MEGA-3 OPHTHALMIC Formulary OTC SOLUTION 0.5-1-0.5 % REFRESH OPTIVE OPHTHALMIC GEL 1-0.9 % Formulary OTC REFRESH OPTIVE OPHTHALMIC SOLUTION 0.5-0.9 Formulary OTC % REFRESH OPTIVE SENSITIVE OPHTHALMIC Formulary OTC SOLUTION 0.5-0.9 % REFRESH P.M. OPHTHALMIC OINTMENT Formulary OTC REFRESH TEARS OPHTHALMIC SOLUTION 0.5 % Formulary OTC REGENECARE HA EXTERNAL LIQUID 2 % Formulary OTC REGRANEX EXTERNAL GEL 0.01 % Formulary PA; QL (15 GM per 34 days) relagesic oral tablet 29-500 mg Formulary OTC relcof c oral solution 100-6.3 mg/5ml Formulary OTC; AGE (Min 6 Years) RELENZA DISKHALER INHALATION AEROSOL Formulary POWDER BREATH ACTIVATED 5 MG/BLISTER RELIADERM EXTERNAL CREAM 0.035-10-25 % Formulary OTC RELIEF PAIN RELIEVING EXTERNAL CREAM 3 % Formulary OTC RELION ALCOHOL SWABS PAD Formulary OTC RELION ALCOHOL SWABS PAD 70 % 70 % Formulary OTC RELION ALL-IN-ONE DEVICE Formulary OTC RELION BLOOD GLUCOSE TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) RELION GLUCOSE SHOT ORAL LIQUID Formulary OTC RELI-ON INSULIN SYRINGE 29G 0.3 ML 29G 0.3 ML Formulary OTC RELI-ON INSULIN SYRINGE 29G 0.5 ML 29G 0.5 ML Formulary OTC RELION INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G X Formulary OTC 1/2" 0.3 ML RELION INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G X Formulary OTC 1/2" 0.5 ML

123 Drug Name Formulary Status Requirements/Limits RELION INSULIN SYRINGE 29G X 1/2" 1 ML 29G X Formulary OTC 1/2" 1 ML RELI-ON INSULIN SYRINGE 29G X 1/2" 1 ML 29G X Formulary OTC 1/2" 1 ML RELI-ON INSULIN SYRINGE 30G 0.3 ML 30G 0.3 ML Formulary OTC RELI-ON INSULIN SYRINGE 30G 0.5 ML 30G 0.5 ML Formulary OTC RELI-ON INSULIN SYRINGE 30G 1 ML 30G 1 ML Formulary OTC RELION INSULIN SYRINGE 30G X 5/16" 0.3 ML 30G X Formulary OTC 5/16" 0.3 ML RELION INSULIN SYRINGE 30G X 5/16" 0.5 ML 30G X Formulary OTC 5/16" 0.5 ML RELION INSULIN SYRINGE 30G X 5/16" 1 ML 30G X Formulary OTC 5/16" 1 ML RELION INSULIN SYRINGE 31G X 15/64" 0.3 ML 31G Formulary OTC X 15/64" 0.3 ML RELION INSULIN SYRINGE 31G X 15/64" 0.5 ML 31G Formulary OTC X 15/64" 0.5 ML RELION INSULIN SYRINGE 31G X 15/64" 1 ML 31G X Formulary OTC 15/64" 1 ML RELION INSULIN SYRINGE 31G X 5/16" 0.3 ML 31G X Formulary OTC 5/16" 0.3 ML RELION INSULIN SYRINGE 31G X 5/16" 0.5 ML 31G X Formulary OTC 5/16" 0.5 ML RELION INSULIN SYRINGE 31G X 5/16" 1 ML 31G X Formulary OTC 5/16" 1 ML RELION LANCETS MICRO-THIN 33G Formulary OTC; QL (150 EA per 30 days) RELION LANCETS STANDARD 21G Formulary OTC; QL (150 EA per 30 days) RELION LANCETS THIN 26G Formulary OTC; QL (150 EA per 30 days) RELION LANCETS ULTRA-THIN 30G Formulary OTC; QL (150 EA per 30 days) RELION ULTRA THIN LANCETS 30G Formulary OTC; QL (150 EA per 30 days) RELION ULTRA THIN PLUS LANCETS Formulary OTC; QL (150 EA per 30 days) RELISTOR ORAL TABLET 150 MG Formulary PA; QL (90 EA per 30 days) RELISTOR SUBCUTANEOUS SOLUTION 12 Formulary PA MG/0.6ML RELPAX ORAL TABLET 20 MG, 40 MG Formulary QL (6 EA per 34 days) REMEDY ANTIMICROBIAL CLEANSER EXTERNAL Formulary OTC LIQUID 0.12 % REMEDY CALAZIME EXTERNAL PASTE 0.4-20.5 % Formulary OTC REMEDY CLEANSING BODY EXTERNAL LOTION Formulary OTC 1.5 % REMEDY PHYTOPLEX ANTIFUNGAL EXTERNAL Formulary OTC POWDER 2 % REMEDY SKIN REPAIR EXTERNAL CREAM 1.5 % Formulary OTC REMODULIN INJECTION SOLUTION 1 MG/ML, 10 Formulary PA MG/ML, 2.5 MG/ML, 5 MG/ML REMOVE ADHESIVE REMOVER WIPES EXTERNAL Formulary OTC RENACIDIN IRRIGATION SOLUTION Formulary RENAGEL ORAL TABLET 800 MG Formulary

124 Drug Name Formulary Status Requirements/Limits renal vitamin oral tablet 0.8 mg Formulary OTC renuu nl external patch 2-30 % Formulary repaglinide oral tablet 0.5 mg, 1 mg, 2 mg Formulary REPATHA SOLUTION PREFILLED SYRINGE 140 Formulary PA MG/ML SUBCUTANEOUS 140 MG/ML REPATHA SURECLICK SOLUTION AUTO-INJECTOR Formulary PA 140 MG/ML SUBCUTANEOUS 140 MG/ML REPLACE SR ORAL TABLET EXTENDED RELEASE Formulary OTC RESCON ORAL TABLET 2-60 MG Formulary OTC RESCRIPTOR ORAL TABLET 100 MG, 200 MG Formulary oral tablet 0.1 mg, 0.25 mg Formulary resorcinol crystals Formulary resorcinol powder Formulary RESOURCE THICKENUP WATER ORAL LIQUID Formulary OTC RESPAIRE-30 ORAL CAPSULE 30-150 MG Formulary OTC RESTASIS OPHTHALMIC EMULSION 0.05 % Formulary PA; QL (60 EA per 30 days) RESTORE CLEANSER & MOISTURIZER EXTERNAL Formulary OTC LIQUID 2 % RETAINE PM OPHTHALMIC OINTMENT Formulary OTC RETIN-A EXTERNAL CREAM 0.025 %, 0.05 %, 0.1 % Formulary AGE (Max 18 Years) RETIN-A EXTERNAL GEL 0.01 %, 0.025 % Formulary AGE (Max 18 Years) REVEAL COLON DISEASE IN VITRO DIAGNOSTIC Formulary OTC TEST REVEAL DNA PATERNITY TEST IN VITRO KIT Formulary OTC REVEAL GET PREGNANT QUICK IN VITRO KIT Formulary OTC REVEAL MULTI-DRUG TESTING CUP IN VITRO Formulary OTC REVEAL URINARY TRACT IN VITRO STRIP Formulary OTC REVITADERM WOUND CARE EXTERNAL GEL Formulary OTC REVLIMID ORAL CAPSULE 10 MG, 15 MG, 2.5 MG, 20 Formulary PA MG, 25 MG, 5 MG REVONTO INTRAVENOUS SOLUTION Formulary RECONSTITUTED 20 MG REXALL LANCETS ULTRA THIN 30G Formulary OTC; QL (150 EA per 30 days) REZAMID EXTERNAL LOTION 2-5 % Formulary OTC RHINARIS NASAL SOLUTION 0.2 % Formulary OTC RHINASE NASAL GEL Formulary OTC RHINASE NASAL SOLUTION Formulary OTC RIASTAP INTRAVENOUS SOLUTION Formulary RECONSTITUTED RIAX EXTERNAL FOAM 5.5 %, 9.5 % Formulary AGE (Max 19 Years) RIBASPHERE ORAL TABLET 400 MG, 600 MG Formulary PA riboflavin oral capsule 50 mg Formulary OTC riboflavin powder Formulary riboflavin-5-phosphate sodium powder Formulary RICOLA CHERRY HONEY HERB MOUTH/THROAT Formulary OTC LOZENGE 2 MG 125 Drug Name Formulary Status Requirements/Limits RICOLA HERB MOUTH/THROAT LOZENGE 1.1 MG, Formulary OTC 2.6 MG RICOLA LEMON MINT MOUTH/THROAT LOZENGE Formulary OTC 1.5 MG RICOLA W/ECHINACEA MOUTH/THROAT LOZENGE Formulary OTC 3.5 MG RIDAURA ORAL CAPSULE 3 MG Formulary rifabutin oral capsule 150 mg Formulary rifampin oral capsule 150 mg, 300 mg Formulary RIGHTEST GL300 LANCETS Formulary OTC; QL (150 EA per 30 days) riluzole oral tablet 50 mg Formulary rimantadine hcl oral tablet 100 mg Formulary ringers irrigation irrigation solution Formulary RISAMINE EXTERNAL OINTMENT 0.44-20.625 % Formulary OTC RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION RECONSTITUTED 12.5 MG, 25 MG, 37.5 Formulary AGE (Min 18 Years) MG, 50 MG risperidone oral solution 1 mg/ml Formulary AGE (Min 18 Years) risperidone oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 Formulary AGE (Min 18 Years) mg risperidone oral tablet dispersible 0.25 mg, 0.5 mg, 1 mg, 2 Formulary AGE (Min 18 Years) mg, 3 mg, 4 mg ritonavir oral tablet 100 mg Formulary RITUXAN INTRAVENOUS SOLUTION 100 MG/10ML, Formulary PA 500 MG/50ML rivastigmine tartrate oral capsule 1.5 mg, 3 mg, 4.5 mg, 6 Formulary mg rivastigmine transdermal patch 24 hour 13.3 mg/24hr, 4.6 Formulary mg/24hr, 9.5 mg/24hr rixubis intravenous solution reconstituted 3000 unit Formulary rizatriptan benzoate oral tablet 10 mg, 5 mg Formulary QL (12 EA per 34 days) rizatriptan benzoate oral tablet dispersible 10 mg, 5 mg Formulary QL (12 EA per 34 days) ROBATHOL EXTERNAL OIL Formulary OTC ROBITUSSIN CHILD COUGH/COLD CF ORAL LIQUID Formulary OTC 2.5-5-50 MG/5ML ROBITUSSIN COUGH+CHEST CONG DM ORAL Formulary OTC CAPSULE 10-200 MG ROBITUSSIN DAY/NIGHT VALUE PAK ORAL Formulary OTC ROBITUSSIN LINGERING COUGHGELS ORAL Formulary OTC CAPSULE 15 MG ROBITUSSIN MULTI-SYMPTOM MAX ORAL LIQUID Formulary OTC 5-10-200 MG/5ML ROBITUSSIN NIGHTTIME COUGH DM ORAL LIQUID Formulary OTC 12.5-30 MG/10ML ROBITUSSIN NIGHTTIME COUGH ORAL LIQUID 1- Formulary OTC 7.5 MG/5ML ROBITUSSIN PK COLD DAY/NGHT DM ORAL Formulary OTC ROBITUSSIN PK COLD DAY/NGHT MS ORAL Formulary OTC

126 Drug Name Formulary Status Requirements/Limits ROBITUSSIN SEVERE NIGHTTIME ORAL LIQUID Formulary OTC 12.5-5-325 MG/10ML ROBITUSSIN TO GO COUGH/COLD CF ORAL LIQUID Formulary OTC 5-10-100 MG/5ML ROLAIDS ORAL TABLET CHEWABLE 550-110 MG Formulary OTC ropinirole hcl oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 Formulary mg, 4 mg, 5 mg rose oil oil Formulary rose water external liquid Formulary OTC rosin powder Formulary OTC calcium oral tablet 10 mg, 20 mg, 40 mg, 5 mg Formulary ROTARIX ORAL SUSPENSION RECONSTITUTED Formulary AGE (Min 19 Years) ROTATEQ ORAL SOLUTION Formulary AGE (Min 19 Years) rotex external cream 0.038-4-35 % Formulary OTC ROZEREM ORAL TABLET 8 MG Formulary ST; QL (34 EA per 34 days) ru-hist d oral tablet 4-10 mg Formulary OTC rutin oral tablet 50 mg Formulary OTC rydex g oral tablet 38.5-398 mg Formulary OTC rymed oral tablet 2-10 mg Formulary OTC rynex pse oral liquid 1-15 mg/5ml Formulary OTC SABRIL ORAL TABLET 500 MG Formulary PA saccharin powder Formulary SAFE TUSSIN PM ORAL LIQUID 3.125-7.5 MG/5ML Formulary OTC SAFELET IV CATHETER Formulary OTC safety insulin syringes 27g x 1/2" 1 ml 27g x 1/2" 1 ml Formulary OTC safety insulin syringes 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC safety insulin syringes 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC safety insulin syringes 30g x 1/2" 1 ml 30g x 1/2" 1 ml Formulary OTC safety insulin syringes 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC SAFETY SEAL LANCETS Formulary OTC; QL (150 EA per 30 days) SAFETY-GARD NEEDLE 18G Formulary OTC SAFETY-LOK SYRINGE 21G X 1-1/2" 10 ML, 21G X 1- Formulary OTC 1/2" 5 ML safflower oil oil Formulary SAF-GEL EXTERNAL GEL Formulary OTC SALEM SUMP TUBE 12FR Formulary salicylic acid external foam 6 % Formulary salicylic acid external gel 6 % Formulary salicylic acid powder Formulary salicylic acid wart remover external liquid 27.5 % Formulary salicylic acid-cleanser external kit 6 % (lotion) Formulary saline nasal gel Formulary OTC saline solution Formulary OTC SALMON ORAL CAPSULE 200 MG Formulary OTC

127 Drug Name Formulary Status Requirements/Limits SAM-E COMPLETE ORAL TABLET DELAYED Formulary OTC RELEASE 200 MG sam-e oral tablet delayed release 400 mg Formulary OTC sam-g.l.a. oral capsule 100-150-40 mg Formulary OTC SAMSCA ORAL TABLET 15 MG Formulary PA; QL (34 EA per 34 days) SAMSCA ORAL TABLET 30 MG Formulary PA; QL (68 EA per 34 days) SANTYL EXTERNAL OINTMENT 250 UNIT/GM Formulary QL (60 GM per 34 days) SARNA EXTERNAL LOTION 0.5-0.5 % Formulary OTC SASTID SOAP EXTERNAL BAR 3-5 % Formulary OTC SAVELLA ORAL TABLET 100 MG, 12.5 MG, 25 MG, 50 Formulary PA; QL (68 EA per 34 days) MG SAVELLA TITRATION PACK ORAL 12.5 & 25 & 50 Formulary PA; QL (55 EA per 30 days) MG sb alcohol prep pad 70 % 70 % Formulary OTC sb bacitracin external ointment 500 unit/gm Formulary OTC sb cold & flu hbp oral tablet 2-325 mg Formulary OTC sb fib lax orange oral powder 30 % Formulary OTC sb insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC sb insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC sb insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC sb insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC sb insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC sb lancets thin Formulary OTC; QL (150 EA per 30 days) sb lancets ultra thin Formulary OTC; QL (150 EA per 30 days) sb lice treatment external liquid 0.3-3 %, 1 % Formulary OTC sb omeprazole oral tablet delayed release 20 mg Formulary OTC sb stool softener oral capsule 240 mg Formulary OTC scarcin external cream Formulary OTC SCYTERA EXTERNAL FOAM 2 % Formulary OTC se-100 oral capsule 100 mcg Formulary OTC SEBUDERM EXTERNAL GEL Formulary SEBULEX EXTERNAL SHAMPOO 2-2 % Formulary OTC SECONAL ORAL CAPSULE 100 MG Formulary SECURA EPC SKIN CARE STARTER EXTERNAL KIT Formulary OTC 0.13 & 30.6 % SECURA EXTRA PROTECTIVE EXTERNAL CREAM Formulary OTC 30.6 % SECURA MOISTURIZING CLEANSER EXTERNAL Formulary OTC LIQUID 0.13 % SECURA PERSONAL CLEANSER EXTERNAL LIQUID Formulary OTC 0.13 % SECURA TOTAL BODY CLEANSER EXTERNAL Formulary OTC FOAM 0.13 % SECURA TWO-STEP EXTERNAL KIT 0.13 & 10 % Formulary OTC SELECT-OB ORAL TABLET CHEWABLE 29-1 MG Formulary selegiline hcl oral capsule 5 mg Formulary 128 Drug Name Formulary Status Requirements/Limits selegiline hcl oral tablet 5 mg Formulary selenicaps-200 oral capsule 200 mcg Formulary OTC selenimin oral tablet 125 mcg Formulary OTC selenium er oral tablet extended release 200 mcg Formulary OTC selenium sulfide external lotion 2.5 % Formulary SELSUN BLUE DEEP CLEANSING EXTERNAL Formulary OTC SHAMPOO 3 % SELZENTRY ORAL TABLET 150 MG, 300 MG Formulary senna leaves oral leaves Formulary OTC senna oral capsule 8.6 mg Formulary OTC senna oral syrup 176 mg/5ml, 8.8 mg/5ml Formulary OTC senna oral tablet 8.6 mg Formulary OTC SENNA PROMPT ORAL CAPSULE 9-500 MG Formulary OTC senna s oral tablet 8.6-50 mg Formulary OTC SENOKOT EXTRA STRENGTH ORAL TABLET 17.2 Formulary OTC MG SENOKOT S ORAL TABLET 8.6-50 MG Formulary OTC SENSI-CARE BODY EXTERNAL CREAM 1-30 % Formulary OTC SENSI-CARE PERINEAL/SKIN EXTERNAL LIQUID Formulary OTC SENSI-CARE PROTECTIVE BARRIER EXTERNAL Formulary OTC OINTMENT 49-15 % SENSIPAR ORAL TABLET 30 MG, 60 MG, 90 MG Formulary PA SENSITIVE EYES ENZYME CLEANER TABLET Formulary OTC EFFERVESCENT SENSODYNE MAXIMUM STRENGTH DENTAL GEL Formulary OTC SE-PLUS PROTEIN ORAL TABLET 200 MCG Formulary OTC SEREVENT DISKUS INHALATION AEROSOL Formulary AGE (Min 4 Years) POWDER BREATH ACTIVATED 50 MCG/DOSE sertraline hcl oral concentrate 20 mg/ml Formulary sertraline hcl oral tablet 100 mg, 25 mg, 50 mg Formulary sesame oil oil Formulary sevelamer carbonate oral packet 0.8 gm, 2.4 gm Formulary severe cold & flu day/night oral liquid therapy pack Formulary OTC shampoo & body wash rinse-free external foam Formulary OTC SHAMROCK LATEX EXAM GLOVES Formulary OTC shea butter Formulary SHINGRIX INTRAMUSCULAR SUSPENSION Formulary RECONSTITUTED 50 MCG SHOPKO ALCOHOL SWABS PAD 70 % 70 % Formulary OTC SHOPKO UNILET LANCETS 30G Formulary OTC; QL (150 EA per 30 days) SHUR-SEAL CONTRACEPTIVE VAGINAL GEL 2 % Formulary OTC silace oral syrup 60 mg/15ml Formulary OTC sildenafil citrate oral tablet 20 mg Formulary PA; AGE (Min 18 Years) silica gel Formulary silodosin oral capsule 4 mg, 8 mg Formulary

129 Drug Name Formulary Status Requirements/Limits silver nitrate crystals Formulary silver nitrate external ointment 10 % Formulary silver nitrate external solution 0.5 %, 10 %, 25 %, 50 % Formulary silver sulfadiazine external cream 1 % Formulary SIMBRINZA OPHTHALMIC SUSPENSION 1-0.2 % Formulary simethicone liquid Formulary SIMILAC GO & GROW TODDLER ORAL PACKET Formulary OTC SIMILAC GO & GROW TODDLER ORAL POWDER Formulary OTC SIMILAC HUMAN MILK FORTIFIER ORAL Formulary OTC CONCENTRATE SIMILAC PRO-SENSITIVE OPTIGRO ORAL LIQUID Formulary OTC SIMILAC STERILIZED WATER ORAL LIQUID Formulary OTC simple syrup oral syrup Formulary simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg, 80 mg Formulary SINADRIN PE COMPLETE SINUS REL ORAL TABLET Formulary OTC 2-10-650 MG sinus & cold-d oral tablet extended release 12 hour 120- Formulary OTC 220 mg sinus & congestion day/night oral Formulary OTC sinus congestion/pain daytime oral tablet 5-325 mg Formulary OTC sinus relief sublingual tablet sublingual Formulary OTC oral tablet 0.5 mg, 1 mg, 2 mg Formulary siterol external patch 3.99-1 % Formulary OTC skin protectant external cream 12 % Formulary OTC skin tag remover external liquid Formulary OTC SKINTEGRITY HYDROGEL EXTERNAL GEL Formulary OTC SKYLA INTRAUTERINE INTRAUTERINE DEVICE Formulary 13.5 MG sleep aid oral tablet 25 mg Formulary OTC SLEEP-N-HEEL EXTERNAL KIT 20 % Formulary OTC SLO-NIACIN ORAL TABLET EXTENDED RELEASE Formulary OTC 500 MG, 750 MG SLOW FE ORAL TABLET EXTENDED RELEASE 142 Formulary OTC (45 FE) MG slow iron oral tablet extended release 160 (50 fe) mg Formulary OTC slow magnesium/calcium oral tablet delayed release 70-117 Formulary OTC mg slow release iron oral tablet extended release 47.5 mg Formulary OTC sm alcohol prep pad Formulary OTC sm alcohol prep pad 70 % 70 % Formulary OTC sm allergy relief oral tablet 1.34 mg Formulary OTC sm b super vitamin complex oral tablet Formulary OTC sm biotin oral tablet 5000 mcg Formulary OTC sm calamine external lotion Formulary OTC sm chest congestion relief dm oral tablet 20-400 mg Formulary OTC

130 Drug Name Formulary Status Requirements/Limits SM CORAL CALCIUM ORAL TABLET 1000 (390 CA) Formulary OTC MG sm cosmetic puffs jumbo Formulary OTC sm cough drops mouth/throat lozenge 7 mg Formulary OTC sm daytime cold & cough child oral solution 2.5-5 mg/5ml Formulary OTC sm dental rinse anti-plaque mouth/throat liquid Formulary OTC sm ethyl alcohol (rubbing) solution 70 % Formulary OTC sm foaming antacid oral tablet chewable 80-20 mg Formulary OTC sm fruit coolers mouth/throat lozenge 7 mg Formulary OTC sm glucosamine hcl-msm oral tablet 750-750 mg Formulary OTC SM GLUCOSAMINE/CALCIUM + D ORAL TABLET Formulary OTC 500-333-250 MG-MG-UNIT sm hemorrhoidal rectal ointment 0.25-14-74.9 % Formulary OTC sm ibuprofen jr oral tablet 100 mg Formulary OTC sm iodides external tincture Formulary OTC sm iodine tincture external tincture Formulary OTC sm lancets 33g Formulary OTC; QL (150 EA per 30 days) sm melatonin oral tablet dispersible 5 mg Formulary OTC sm natural herb cough drops mouth/throat lozenge 4.8 mg Formulary OTC sm omega-3-6-9 fatty acids oral capsule Formulary OTC sm omeprazole oral tablet delayed release 20 mg Formulary OTC sm one daily prenatal oral 28-0.8 & 440 mg Formulary OTC sm pain relief/menthol external gel Formulary OTC sm prenatal vitamins oral tablet 28-0.8 mg Formulary OTC sm slow release iron oral tablet extended release 143 (45 Formulary OTC fe) mg sm vitamin b1 oral tablet 100 mg Formulary OTC SMART SENSE COLOR LANCETS 33G Formulary OTC; QL (150 EA per 30 days) SMART SENSE STANDARD LANCETS Formulary OTC; QL (150 EA per 30 days) SMART SENSE SUPER THIN LANCETS Formulary OTC; QL (150 EA per 30 days) SMART SENSE THIN LANCETS 26G Formulary OTC; QL (150 EA per 30 days) smoothfit cuff Formulary OTC sod citrate-citric acid oral solution 500-334 mg/5ml Formulary sodium acetate powder Formulary sodium ascorbate powder Formulary sodium benzoate powder Formulary sodium bicarbonate oral powder Formulary sodium bicarbonate oral tablet 325 mg, 650 mg Formulary OTC sodium bicarbonate powder Formulary sodium bisulfite granules Formulary sodium borate powder Formulary OTC sodium bromide granules Formulary sodium butyrate powder Formulary sodium chloride (hypertonic) ophthalmic ointment 5 % Formulary OTC

131 Drug Name Formulary Status Requirements/Limits sodium chloride (hypertonic) ophthalmic solution 5 % Formulary OTC sodium chloride granules Formulary sodium chloride inhalation nebulization solution 0.9 %, 3 Formulary %, 7 % sodium chloride oral solution 4 meq/ml Formulary OTC sodium chloride oral tablet 1 gm Formulary OTC sodium citrate dihydrate granules Formulary OTC sodium citrate granules Formulary OTC sodium fluoride oral solution 1.1 (0.5 f) mg/ml Formulary sodium fluoride oral tablet chewable 0.55 (0.25 f) mg, 1.1 Formulary (0.5 f) mg, 2.2 (1 f) mg sodium hydroxide pellet Formulary sodium metabisulfite granules Formulary sodium nitrate granules Formulary OTC sodium nitrite granules Formulary sodium perborate crystals Formulary OTC sodium perborate granules Formulary OTC sodium perborate powder Formulary sodium phosphate dibasic granules Formulary sodium phosphate monobasic powder Formulary sodium polystyrene sulfonate oral suspension 15 gm/60ml Formulary sodium polystyrene sulfonate rectal suspension 30 Formulary gm/120ml sodium propionate powder Formulary sodium saccharin granules Formulary sodium saccharin powder Formulary sodium silicate solution 40 % Formulary OTC sodium starch glycolate powder Formulary OTC sodium sulfite powder Formulary SOLIRIS INTRAVENOUS SOLUTION 300 MG/30ML Formulary PA SOLOSITE WOUND GEL EXTERNAL GEL Formulary OTC solvatech plus oral suspension Formulary SOMBRA COOL THERAPY EXTERNAL GEL 6 % Formulary OTC SOMBRA WARM THERAPY EXTERNAL GEL 3-3 % Formulary OTC SOOTHE & COOL INZO BARRIER EXTERNAL Formulary OTC CREAM 5-5 % SOOTHE XP XTRA PROTECTION OPHTHALMIC Formulary OTC SOLUTION sorbic acid powder Formulary sorbitol oral solution 70 % Formulary OTC sorbitol rectal solution 70 % Formulary OTC sorbitol solution Formulary sorbutuss nr oral liquid 15-150-127.5 mg/7.5ml Formulary OTC sore throat lozenges mouth/throat lozenge 6-10 mg Formulary OTC sore throat mouth/throat lozenge 15-3.6 mg Formulary OTC

132 Drug Name Formulary Status Requirements/Limits SORINE ORAL TABLET 120 MG, 160 MG, 240 MG, 80 Formulary MG sotalol hcl (af) oral tablet 120 mg, 160 mg, 80 mg Formulary sotalol hcl oral tablet 120 mg, 160 mg, 240 mg, 80 mg Formulary soya lecithin oral capsule 1200 mg Formulary OTC soybean oil oil Formulary spearmint oil oil Formulary spinosad external suspension 0.9 % Formulary SPIRIVA HANDIHALER INHALATION CAPSULE 18 Formulary MCG oral tablet 100 mg, 25 mg, 50 mg Formulary spironolactone-hctz oral tablet 25-25 mg Formulary sportbalm external lotion Formulary OTC SPORTSCREME EXTERNAL CREAM 10 % Formulary OTC spot acne treatment external cream 2.5 % Formulary OTC SPRAYZOIN EXTERNAL LIQUID Formulary OTC squaric acid di-n-butyl ester powder Formulary OTC squaric acid in butanol liquid Formulary OTC stahist ad oral liquid 25-60 mg/5ml Formulary OTC stahist ad oral tablet 25-60 mg Formulary OTC STALEVO 100 ORAL TABLET 25-100-200 MG Formulary STALEVO 125 ORAL TABLET 31.25-125-200 MG Formulary STALEVO 150 ORAL TABLET 37.5-150-200 MG Formulary STALEVO 200 ORAL TABLET 50-200-200 MG Formulary STALEVO 75 ORAL TABLET 18.75-75-200 MG Formulary STANBACK HEADACHE ORAL PACKET Formulary OTC 650-200-32 MG stavudine oral capsule 15 mg, 20 mg, 30 mg, 40 mg Formulary stearic acid powder Formulary stearyl alcohol powder Formulary STERILANCE TL Formulary OTC; QL (150 EA per 30 days) STERILE LUBRICANT OPHTHALMIC LIQUID 0.7 % Formulary OTC sterile pad 3"x3" Formulary OTC STERI-STRIP COMPOUND BENZOIN EXTERNAL Formulary OTC TINCTURE STERI-TAMP SEALS BOTTLES/VIALS Formulary OTC STERI-TAMP SEALS/BAGS Formulary OTC STERI-TAMP SEALS/SYRINGES Formulary OTC stevia extract powder 90 % Formulary STIMATE NASAL SOLUTION 1.5 MG/ML Formulary STIMEX INSULATED NEEDLE 22G X 2-1/8" , 22G X 4- Formulary OTC 1/4" STIMULEN EXTERNAL GEL Formulary OTC STIOLTO RESPIMAT INHALATION AEROSOL Formulary AGE (Min 18 Years) SOLUTION 2.5-2.5 MCG/ACT

133 Drug Name Formulary Status Requirements/Limits STOMAHESIVE MOLDABLE ADHESIVE STRIP Formulary OTC STOMAHESIVE PASTE PASTE Formulary OTC STRIANT BUCCAL 30 MG Formulary STRIBILD ORAL TABLET 150-150-200-300 MG Formulary STRIDEX ESSENTIAL EXTERNAL PAD 1 % Formulary OTC STRI-DEX SENSITIVE SKIN EXTERNAL PAD 0.5 % Formulary OTC STUART ONE ORAL CAPSULE 27-0.8-200 MG Formulary OTC QL (60 EA per 30 days); AGE (Min 16 SUBOXONE SUBLINGUAL FILM 12-3 MG Formulary Years) QL (360 EA per 30 days); AGE (Min 16 SUBOXONE SUBLINGUAL FILM 2-0.5 MG Formulary Years) QL (180 EA per 30 days); AGE (Min 16 SUBOXONE SUBLINGUAL FILM 4-1 MG Formulary Years) QL (90 EA per 30 days); AGE (Min 16 SUBOXONE SUBLINGUAL FILM 8-2 MG Formulary Years) SUBSYS SUBLINGUAL LIQUID 100 MCG, 1200 (600 X 2) MCG, 1600 (800 X 2) MCG, 200 MCG, 400 MCG, 600 Formulary PA; QL (120 EA per 30 days) MCG, 800 MCG sucralfate oral tablet 1 gm Formulary crystals Formulary OTC SUDAFED 24 HOUR ORAL TABLET EXTENDED Formulary OTC RELEASE 24 HOUR 240 MG SUDAFED CHILDRENS ORAL LIQUID 15 MG/5ML Formulary OTC SUDAFED ORAL TABLET 30 MG Formulary OTC SUDAFED PE CHILDRENS ORAL SOLUTION 2.5 Formulary OTC MG/5ML SUDAFED PE COLD & COUGH CHILD ORAL Formulary OTC SOLUTION 2.5-5 MG/5ML SUDAFED PE DAY & NIGHT ORAL 25-10 & 10 MG Formulary OTC SUDAFED PE MAXIMUM STRENGTH ORAL TABLET Formulary OTC 10 MG SUDAFED PRESSURE+PAIN 12 HR ORAL TABLET Formulary OTC EXTENDED RELEASE 12 HOUR 120-220 MG sulfacetamide sodium (acne) external lotion 10 % Formulary sulfacetamide sodium ophthalmic ointment 10 % Formulary sulfacetamide sodium ophthalmic solution 10 % Formulary sulfacetamide sodium-sulfur external liquid 9-4 % Formulary sulfacetamide sodium-sulfur external lotion 10-5 % Formulary sulfacetamide sodium-sulfur external pad 10-4 % Formulary sulfacetamide sodium-sulfur external suspension 8-4 % Formulary sulfacetamide-prednisolone ophthalmic solution 10-0.23 % Formulary sulfadiazine oral tablet 500 mg Formulary sulfamethoxazole-trimethoprim oral tablet 400-80 mg, 800- Formulary 160 mg SULFAMYLON EXTERNAL CREAM 85 MG/GM Formulary SULFAMYLON EXTERNAL PACKET 5 % Formulary sulfasalazine oral tablet 500 mg Formulary

134 Drug Name Formulary Status Requirements/Limits sulfasalazine oral tablet delayed release 500 mg Formulary sulfo-lo external bar 5 % Formulary OTC sulfur external bar 10 % Formulary OTC sulfur precipitated powder Formulary sulindac oral tablet 150 mg, 200 mg Formulary sumatriptan nasal solution 20 mg/act, 5 mg/act Formulary sumatriptan succinate oral tablet 100 mg Formulary QL (9 EA per 34 days) sumatriptan succinate oral tablet 25 mg, 50 mg Formulary QL (18 EA per 34 days) sumatriptan succinate refill subcutaneous solution cartridge Formulary 4 mg/0.5ml, 6 mg/0.5ml sumatriptan succinate subcutaneous solution 6 mg/0.5ml Formulary sumatriptan succinate subcutaneous solution auto-injector Formulary 4 mg/0.5ml, 6 mg/0.5ml SUMMERS EVE DEODORANT ULTRA EXTERNAL Formulary OTC AEROSOL super b-50 complex oral capsule Formulary OTC super c-500 complex oral tablet extended release Formulary OTC super cal/mag oral tablet 333.333-166.667 mg Formulary OTC super moleskin pad Formulary OTC SUPER OMEGA-3 ORAL CAPSULE Formulary OTC super thin lancets Formulary OTC; QL (150 EA per 30 days) supposibase f powder Formulary OTC SUPPOSIBLEND PELLET Formulary OTC SUPPRELIN LA SUBCUTANEOUS KIT 50 MG Formulary PA SUPREP BOWEL PREP KIT ORAL SOLUTION 17.5- Formulary 3.13-1.6 GM/177ML supress a pediatric oral liquid 5-1-10 mg/ml Formulary OTC supress dm pediatric oral liquid 5-50 mg/ml Formulary OTC SUPRESS-PE PEDIATRIC ORAL LIQUID 2.5-50 Formulary OTC MG/ML sure comfort alcohol prep pad 70 % 70 % Formulary OTC sure comfort insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" Formulary OTC 0.5 ml sure comfort insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC sure comfort insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" Formulary OTC 0.3 ml sure comfort insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" Formulary OTC 0.5 ml sure comfort insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC sure comfort insulin syringe 30g x 1/2" 0.3 ml 30g x 1/2" Formulary OTC 0.3 ml sure comfort insulin syringe 30g x 1/2" 0.5 ml 30g x 1/2" Formulary OTC 0.5 ml sure comfort insulin syringe 30g x 1/2" 1 ml 30g x 1/2" 1 ml Formulary OTC sure comfort insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" Formulary OTC 0.3 ml

135 Drug Name Formulary Status Requirements/Limits sure comfort insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" Formulary OTC 0.5 ml sure comfort insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 Formulary OTC ml sure comfort insulin syringe 31g x 1/4" 0.3 ml 31g x 1/4" Formulary OTC 0.3 ml sure comfort insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" Formulary OTC 0.3 ml sure comfort insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" Formulary OTC 0.5 ml sure comfort insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 Formulary OTC ml sure comfort lancets 28g Formulary OTC; QL (150 EA per 30 days) sure comfort lancets 30g Formulary OTC; QL (150 EA per 30 days) SURE-JECT INSULIN SYRINGE 28G X 1/2" 0.5 ML 28G Formulary OTC X 1/2" 0.5 ML SURE-JECT INSULIN SYRINGE 28G X 1/2" 1 ML 28G Formulary OTC X 1/2" 1 ML SURE-JECT INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G Formulary OTC X 1/2" 0.3 ML SURE-JECT INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G Formulary OTC X 1/2" 0.5 ML SURE-JECT INSULIN SYRINGE 29G X 1/2" 1 ML 29G Formulary OTC X 1/2" 1 ML SURE-JECT INSULIN SYRINGE 30G X 5/16" 0.3 ML Formulary OTC 30G X 5/16" 0.3 ML SURE-JECT INSULIN SYRINGE 30G X 5/16" 0.5 ML Formulary OTC 30G X 5/16" 0.5 ML SURE-JECT INSULIN SYRINGE 30G X 5/16" 1 ML 30G Formulary OTC X 5/16" 1 ML SURE-JECT INSULIN SYRINGE 31G X 5/16" 0.3 ML Formulary OTC 31G X 5/16" 0.3 ML SURE-JECT INSULIN SYRINGE 31G X 5/16" 0.5 ML Formulary OTC 31G X 5/16" 0.5 ML SURE-JECT INSULIN SYRINGE 31G X 5/16" 1 ML 31G Formulary OTC X 5/16" 1 ML SURE-LANCE ULTRA THIN LANCETS Formulary OTC; QL (150 EA per 30 days) SURELITE LANCETS Formulary OTC; QL (150 EA per 30 days) SUSPENDOL-S LIQUID Formulary OTC SUTENT ORAL CAPSULE 12.5 MG, 50 MG Formulary PA SWEEN EXTERNAL CREAM Formulary OTC SWEEN PREP EXTERNAL SOLUTION Formulary OTC SWEETA ORAL SOLUTION Formulary OTC SWIM EAR OTIC LIQUID 95 % Formulary OTC swimmers instant ear dry otic liquid 95 % Formulary OTC SYLATRON SUBCUTANEOUS KIT 200 MCG, 300 Formulary MCG, 600 MCG SYMBICORT INHALATION AEROSOL 160-4.5 Formulary AGE (Min 12 Years) MCG/ACT, 80-4.5 MCG/ACT

136 Drug Name Formulary Status Requirements/Limits sympathetic nerve needle 19g x 5" , 20g x 5" Formulary OTC SYNAGIS INTRAMUSCULAR SOLUTION 100 MG/ML, Formulary PA 50 MG/0.5ML SYNJARDY ORAL TABLET 12.5-1000 MG, 12.5-500 Formulary AGE (Min 18 Years) MG, 5-1000 MG, 5-500 MG SYNVISC INTRA-ARTICULAR SOLUTION Formulary PA PREFILLED SYRINGE 16 MG/2ML SYNVISC ONE INTRA-ARTICULAR SOLUTION Formulary PA PREFILLED SYRINGE 48 MG/6ML syringe 10-12 ml 12 ml Formulary OTC syringe 20-25 ml 25 ml Formulary OTC syringe 20g x 1" 12 ml, 20g x 1" 6 ml, 21g x 1" 6 ml, 21g x 1-1/4" 6 ml, 22g x 1" 12 ml, 22g x 1" 6 ml, 22g x 1-1/2" 6 Formulary OTC ml, 22g x 1-1/4" 6 ml, 22g x 3/4" 3 ml, 27g x 1-1/4" 3 ml syringe 2-3 ml 3 ml Formulary OTC syringe 30-35 ml 35 ml Formulary OTC syringe 50-60 ml 60 ml Formulary OTC syringe 5-6 ml 6 ml Formulary OTC syringe luer slip 1 ml Formulary syringe luer slip 26g x 3/8" 1 ml, 27g x 1/2" 1 ml Formulary OTC syringe precisedose dispenser Formulary SYRSPEND SF ORAL LIQUID Formulary SYRSPEND SF PH4 ORAL SUSPENSION Formulary RECONSTITUTED syrup nf oral syrup 85 % Formulary OTC SYSTANE BALANCE OPHTHALMIC SOLUTION 0.6 % Formulary OTC SYSTANE LID WIPES EXTERNAL PAD Formulary OTC SYSTANE OPHTHALMIC GEL 0.4-0.3 % Formulary OTC SYSTANE OPHTHALMIC SOLUTION 0.4-0.3 % Formulary OTC SYSTANE OVERNIGHT THERAPY OPHTHALMIC Formulary OTC GEL 0.3 % SYSTANE PRESERVATIVE FREE OPHTHALMIC Formulary OTC SOLUTION 0.4-0.3 % SYSTANE ULTRA OPHTHALMIC SOLUTION 0.4-0.3 Formulary OTC % SYSTANE ULTRA PF OPHTHALMIC SOLUTION 0.4- Formulary OTC 0.3 % TABLOID ORAL TABLET 40 MG Formulary external ointment 0.03 %, 0.1 % Formulary PA tacrolimus oral capsule 0.5 mg, 1 mg, 5 mg Formulary tadalafil (pah) oral tablet 20 mg Formulary PA talc powder Formulary TAMIFLU ORAL CAPSULE 30 MG, 45 MG, 75 MG Formulary citrate oral tablet 10 mg, 20 mg Formulary tamsulosin hcl oral capsule 0.4 mg Formulary TANDEM ORAL CAPSULE 162-115.2 MG Formulary OTC tangerine oil Formulary OTC 137 Drug Name Formulary Status Requirements/Limits tannic acid powder Formulary TARGRETIN EXTERNAL GEL 1 % Formulary taron forte oral capsule Formulary TARON-CRYSTALS ORAL PACKET 3300-1002 MG Formulary TARON-PREX ORAL CAPSULE 30-1.2-265 MG Formulary TARSUM EXTERNAL SHAMPOO 10-5 % Formulary OTC tartaric acid granules Formulary taurine oral capsule 500 mg Formulary OTC taurine powder Formulary tazarotene external cream 0.1 % Formulary PA TAZORAC EXTERNAL CREAM 0.05 % Formulary PA TAZORAC EXTERNAL GEL 0.05 %, 0.1 % Formulary PA TAZTIA XT ORAL CAPSULE EXTENDED RELEASE Formulary 24 HOUR 120 MG, 180 MG, 240 MG, 300 MG, 360 MG tb syringe 1 ml Formulary tdm solution external solution Formulary tea tree oil oil Formulary TEAR FLO OPHTHALMIC STRIP Formulary OTC TEARS NATURALE PM OPHTHALMIC OINTMENT 3- Formulary OTC 94 % TECHLITE AST LANCETS Formulary OTC; QL (150 EA per 30 days) TECHLITE LANCETS Formulary OTC; QL (150 EA per 30 days) TECHLITE LANCETS 30G Formulary OTC; QL (150 EA per 30 days) TECNU FIRST AID EXTERNAL GEL 0.2-2.5 % Formulary OTC TEGADERM CONTACT LAYER PAD 8"X10" Formulary OTC TEGADERM FOAM ADHESIVE PAD 2-3/4"X2-3/4" , 2- 3/4"X3" , 4"X4-1/2" , 5-5/8"X5-5/8" , 5-5/8"X6-1/8" , 7- Formulary OTC 1/2"X8-3/4" TEGADERM HYDROGEL WOUND FILLER Formulary OTC EXTERNAL GEL oral tablet 20 mg, 40 mg, 80 mg Formulary telmisartan-hctz oral tablet 40-12.5 mg, 80-12.5 mg, 80-25 Formulary mg temazepam oral capsule 15 mg, 22.5 mg, 30 mg, 7.5 mg Formulary temozolomide oral capsule 100 mg, 140 mg, 180 mg, 20 mg, Formulary 250 mg, 5 mg temsirolimus intravenous solution 25 mg/ml Formulary tenofovir disoproxil fumarate oral tablet 300 mg Formulary terazosin hcl oral capsule 1 mg, 2 mg, 5 mg Formulary QL (34 EA per 34 days) terazosin hcl oral capsule 10 mg Formulary QL (68 EA per 34 days) terbinafine hcl oral tablet 250 mg Formulary sulfate oral tablet 2.5 mg, 5 mg Formulary vaginal cream 0.4 % Formulary QL (45 GM per 30 days) terconazole vaginal cream 0.8 % Formulary QL (20 GM per 30 days) terconazole vaginal suppository 80 mg Formulary QL (3 EA per 30 days) terocin external lotion 2.5-0.025-10-25 % Formulary OTC 138 Drug Name Formulary Status Requirements/Limits terocin external patch 4-4 % Formulary OTC teroderm-plus external cream Formulary TESTOPEL IMPLANT PELLET 75 MG Formulary testosterone cypionate intramuscular solution 100 mg/ml, Formulary 200 mg/ml testosterone enanthate intramuscular solution 200 mg/ml Formulary testosterone transdermal gel 12.5 mg/act (1%), 25 Formulary mg/2.5gm (1%), 50 mg/5gm (1%) testosterone transdermal gel 20.25 mg/1.25gm (1.62%), Formulary PA 20.25 mg/act (1.62%), 40.5 mg/2.5gm (1.62%) tetanus-diphtheria toxoids td intramuscular suspension 2-2 Formulary AGE (Min 19 Years) lf/0.5ml tetrabenazine oral tablet 12.5 mg, 25 mg Formulary PA hcl oral capsule 250 mg, 500 mg Formulary TETRA-FORMULA CGH/SORE THROAT Formulary OTC MOUTH/THROAT LOZENGE 10-15 MG tgt alcohol swabs pad 70 % 70 % Formulary OTC tgt first aid cleansing external liquid 2.5-0.13 % Formulary OTC tgt lancet micro thin 33g Formulary OTC; QL (150 EA per 30 days) tgt lancet thin 26g Formulary OTC; QL (150 EA per 30 days) tgt lancet ultra thin 30g Formulary OTC; QL (150 EA per 30 days) tgt lubricant eye drops ophthalmic solution 0.95 % Formulary OTC tgt lubricant redness reliever ophthalmic solution 0.03-0.5 Formulary OTC % tgt omeprazole oral tablet delayed release 20 mg Formulary OTC THALOMID ORAL CAPSULE 100 MG, 150 MG, 200 Formulary PA MG, 50 MG THE ITCH ERASER EXTERNAL SOLUTION 2 % Formulary OTC THEOCHRON ORAL TABLET EXTENDED RELEASE Formulary 12 HOUR 100 MG, 200 MG, 300 MG anhydrous powder Formulary theophylline er oral tablet extended release 12 hour 450 mg Formulary theophylline er oral tablet extended release 24 hour 400 Formulary mg, 600 mg THERACOF PLUS COUGH/COLD REL ORAL LIQUID Formulary OTC 5-10-100-325 MG/5ML THERACYS INTRAVESICAL SUSPENSION Formulary RECONSTITUTED 81 MG/VIAL THERA-D 4000 ORAL TABLET 4000 UNIT Formulary OTC THERAFLU COLD & COUGH ORAL PACKET 10-20-20 Formulary OTC MG THERAFLU EXPRESSMAX ORAL LIQUID 12.5-5-325 Formulary OTC MG/15ML THERAFLU SEVERE COLD & COUGH ORAL PACKET Formulary OTC THERAFLU SEVERE COLD DAYTIME ORAL TABLET Formulary OTC 15-5-325 MG THERAFLU SEVERE COLD NIGHTTIME ORAL Formulary OTC PACKET 25-10-500 MG 139 Drug Name Formulary Status Requirements/Limits THERAFLU SEVERE COLD NIGHTTIME ORAL Formulary OTC TABLET 5-2-10-325 MG THERAFLU SEVERE COLD ORAL PACKET 20-10-500 Formulary OTC MG THERAFLU SEVERE COLD/CGH NIGHT ORAL Formulary OTC PACKET 25-10-650 MG THERAFLU WARMING RELIEF SINUS ORAL LIQUID Formulary OTC 12.5-5-325 MG/15ML THERA-GESIC EXTERNAL CREAM 0.5-15 % Formulary OTC THERANATAL COMPLETE ORAL 27-1 & 300 MG Formulary OTC THERANATAL OVAVITE ORAL THERAPY PACK 18- Formulary OTC 1 & 125 MG THERAPLEX T EXTERNAL SHAMPOO 1 % Formulary OTC THERASEAL HAND PROTECTION EXTERNAL Formulary OTC LOTION 1 % THERATEARS NUTRITION ORAL CAPSULE Formulary OTC THERATEARS OPHTHALMIC GEL 1 % Formulary OTC THERATEARS OPHTHALMIC SOLUTION 0.25 % Formulary OTC thiamine hcl powder Formulary thiamine oral capsule 50 mg Formulary OTC THINLETS GP LANCETS Formulary OTC; QL (150 EA per 30 days) thioridazine hcl oral tablet 10 mg, 100 mg, 25 mg, 50 mg Formulary AGE (Min 18 Years) thiotepa injection solution reconstituted 15 mg Formulary thiothixene oral capsule 1 mg, 10 mg, 2 mg, 5 mg Formulary AGE (Min 18 Years) threonine powder Formulary thymol crystals Formulary THYROLAR-1 ORAL TABLET 60 (12.5-50) MG (MCG) Formulary THYROLAR-1/2 ORAL TABLET 30 (6.25-25) MG Formulary (MCG) THYROLAR-1/4 ORAL TABLET 15 (3.1-12.5) MG Formulary (MCG) THYROLAR-2 ORAL TABLET 120 (25-100) MG (MCG) Formulary THYROLAR-3 ORAL TABLET 180 (37.5-150) MG Formulary (MCG) tiagabine hcl oral tablet 2 mg, 4 mg Formulary ticlopidine hcl oral tablet 250 mg Formulary TIGER BALM LINIMENT EXTERNAL LIQUID 16-28 % Formulary OTC TIGER BALM MUSCLE RUB EXTERNAL CREAM 3-5- Formulary OTC 15 % TIGER BALM NECK & SHOULDER RUB EXTERNAL Formulary OTC CREAM 10-11 % TIGER BALM PAIN RELIEVING EXTERNAL PATCH Formulary OTC 80-24-16 MG TIGER BALM PAIN RELIEVING LG EXTERNAL Formulary OTC PATCH 70-230 MG TILIA FE ORAL TABLET 1-20/1-30/1-35 MG-MCG Formulary QL (28 EA per 28 days) timolol maleate ophthalmic gel forming solution 0.25 %, 0.5 Formulary % 140 Drug Name Formulary Status Requirements/Limits timolol maleate ophthalmic solution 0.25 %, 0.5 % Formulary timolol maleate oral tablet 10 mg, 20 mg, 5 mg Formulary TINACTIN EXTERNAL AEROSOL 1 % Formulary OTC TINACTIN EXTERNAL AEROSOL POWDER 1 % Formulary OTC TINACTIN JOCK ITCH EXTERNAL CREAM 1 % Formulary OTC TIVICAY ORAL TABLET 10 MG, 25 MG, 50 MG Formulary tizanidine hcl oral capsule 2 mg, 4 mg, 6 mg Formulary tizanidine hcl oral tablet 2 mg, 4 mg Formulary TN DICKINSONS WITCH HAZEL EXTERNAL PAD Formulary OTC ST; QL (56 EA per 28 days); AGE (Min 6 TOBI PODHALER INHALATION CAPSULE 28 MG Formulary Years) TOBRADEX OPHTHALMIC OINTMENT 0.3-0.1 % Formulary TOBRADEX OPHTHALMIC SUSPENSION 0.3-0.1 % Formulary tobramycin ophthalmic solution 0.3 % Formulary tobramycin-dexamethasone ophthalmic suspension 0.3-0.1 Formulary % TODAY SPONGE VAGINAL 1000 MG Formulary OTC todays health thin lancets 28g Formulary OTC; QL (150 EA per 30 days) todays health thin lancets 30g Formulary OTC; QL (150 EA per 30 days) tolazamide oral tablet 250 mg, 500 mg Formulary tolbutamide oral tablet 500 mg Formulary tolmetin sodium oral capsule 400 mg Formulary external cream 1 % Formulary OTC tolnaftate external powder 1 % Formulary OTC tolnaftate external solution 1 % Formulary OTC tolterodine tartrate er oral capsule extended release 24 Formulary QL (30 EA per 30 days) hour 2 mg, 4 mg tolterodine tartrate oral tablet 1 mg, 2 mg Formulary QL (60 EA per 30 days) toomey syringe 70 ml Formulary topcare lancets micro-thin 33g Formulary OTC; QL (150 EA per 30 days) topcare ultra comfort ins syr 29g x 1/2" 0.3 ml 29g x 1/2" Formulary OTC 0.3 ml topcare ultra comfort ins syr 29g x 1/2" 0.5 ml 29g x 1/2" Formulary OTC 0.5 ml topcare ultra comfort ins syr 29g x 1/2" 1 ml 29g x 1/2" 1 Formulary OTC ml topcare ultra comfort ins syr 30g x 5/16" 0.3 ml 30g x 5/16" Formulary OTC 0.3 ml topcare ultra comfort ins syr 30g x 5/16" 0.5 ml 30g x 5/16" Formulary OTC 0.5 ml topcare ultra comfort ins syr 30g x 5/16" 1 ml 30g x 5/16" 1 Formulary OTC ml topcare ultra comfort ins syr 31g x 5/16" 0.3 ml 31g x 5/16" Formulary OTC 0.3 ml topcare ultra comfort ins syr 31g x 5/16" 0.5 ml 31g x 5/16" Formulary OTC 0.5 ml

141 Drug Name Formulary Status Requirements/Limits topcare ultra comfort ins syr 31g x 5/16" 1 ml 31g x 5/16" 1 Formulary OTC ml TOPICAINE 5 EXTERNAL GEL 5 % Formulary OTC topiramate oral capsule sprinkle 15 mg, 25 mg Formulary topiramate oral tablet 100 mg, 200 mg, 25 mg, 50 mg Formulary topotecan hcl intravenous solution 4 mg/4ml Formulary topotecan hcl intravenous solution reconstituted 4 mg Formulary torsemide oral tablet 10 mg, 100 mg, 20 mg, 5 mg Formulary TOVIAZ ORAL TABLET EXTENDED RELEASE 24 Formulary HOUR 4 MG, 8 MG TRACLEER ORAL TABLET 125 MG, 62.5 MG Formulary PA TRACLEER ORAL TABLET SOLUBLE 32 MG Formulary PA TRADJENTA ORAL TABLET 5 MG Formulary ST tragacanth powder Formulary tramadol hcl er (biphasic) oral tablet extended release 24 Formulary PA; QL (34 EA per 34 days) hour 100 mg, 200 mg tramadol hcl er oral tablet extended release 24 hour 100 Formulary PA; QL (34 EA per 34 days) mg, 200 mg, 300 mg tramadol hcl oral tablet 50 mg Formulary PA; QL (126 EA per 7 days) trandolapril oral tablet 1 mg, 2 mg, 4 mg Formulary tranexamic acid oral tablet 650 mg Formulary QL (30 EA per 30 days) TRANQUILITY BRIEFS KIT Formulary OTC TRANSANOSIL EXTERNAL LOTION 0.025-10-30 % Formulary OTC transderm-iq external ointment 4-0.0375-10-20 % Formulary OTC tranylcypromine sulfate oral tablet 10 mg Formulary TRANZAREL EXTERNAL GEL 4 % Formulary TRAVATAN Z OPHTHALMIC SOLUTION 0.004 % Formulary travel sickness oral tablet chewable 25 mg Formulary OTC trazodone hcl oral tablet 100 mg, 150 mg, 300 mg, 50 mg Formulary TREANDA INTRAVENOUS SOLUTION Formulary RECONSTITUTED 100 MG, 25 MG T-RELIEF PAIN ARNICA + 12 EXTERNAL OINTMENT Formulary OTC T-RELIEF PAIN RELIEF EXTERNAL CREAM Formulary OTC TRELSTAR MIXJECT INTRAMUSCULAR SUSPENSION RECONSTITUTED 11.25 MG, 22.5 MG, Formulary PA 3.75 MG tretinoin external cream 0.025 %, 0.05 %, 0.1 % Formulary AGE (Max 18 Years) tretinoin external gel 0.01 %, 0.025 % Formulary AGE (Max 18 Years) tretinoin oral capsule 10 mg Formulary TREXALL ORAL TABLET 10 MG, 15 MG, 5 MG, 7.5 Formulary MG triamcinolone acetonide aerosol 55 mcg/act nasal (otc) 55 Formulary mcg/act triamcinolone acetonide external cream 0.025 %, 0.1 %, 0.5 Formulary % triamcinolone acetonide external lotion 0.025 %, 0.1 % Formulary

142 Drug Name Formulary Status Requirements/Limits triamcinolone acetonide external ointment 0.025 %, 0.1 %, Formulary 0.5 % triamcinolone acetonide injection suspension 40 mg/ml Formulary TRIAMINIC CHEST/NASAL CONGEST ORAL LIQUID Formulary OTC 2.5-50 MG/5ML TRIAMINIC COLD & ALLERGY ORAL SYRUP 1-2.5 Formulary OTC MG/5ML TRIAMINIC COLD/COUGH DAY TIME ORAL SYRUP Formulary OTC 2.5-5 MG/5ML TRIAMINIC COLD/COUGH ORAL 2.5-5 &2.5-6.25 Formulary OTC MG/5ML TRIAMINIC COUGH/RUNNY NOSE ORAL TABLET Formulary OTC CHEWABLE 1-5 MG TRIAMINIC COUGH/SORE THROAT ORAL TABLET Formulary OTC CHEWABLE 160-5 MG TRIAMINIC FEVER REDUCER ORAL SYRUP 160 Formulary OTC MG/5ML TRIAMINIC FLU/COUGH/FEVER ORAL LIQUID 7.5- Formulary OTC 160-1 MG/5ML TRIAMINIC LONG ACTING COUGH ORAL LIQUID Formulary OTC 7.5 MG/5ML TRIAMINIC LONG ACTING COUGH ORAL STRIP 7.5 Formulary OTC MG TRIAMINIC NIGHT TIME COLD/CGH ORAL SYRUP Formulary OTC 6.25-2.5 MG/5ML TRIAMINIC SORE THROAT MOUTH/THROAT Formulary OTC SOLUTION 0.5 % triamino oral tablet Formulary OTC triamterene-hctz oral capsule 37.5-25 mg Formulary triamterene-hctz oral tablet 37.5-25 mg, 75-50 mg Formulary triazolam oral tablet 0.125 mg, 0.25 mg Formulary QL (34 EA per 34 days) tri-buffered aspirin oral tablet 325 mg Formulary OTC trichloroacetic acid crystals Formulary tricitrates oral solution 550-500-334 mg/5ml Formulary trifluoperazine hcl oral tablet 1 mg, 10 mg, 2 mg, 5 mg Formulary AGE (Min 18 Years) trifluridine ophthalmic solution 1 % Formulary trihexyphenidyl hcl oral elixir 0.4 mg/ml Formulary trihexyphenidyl hcl oral tablet 2 mg, 5 mg Formulary TRI-LO-SPRINTEC ORAL TABLET 0.18/0.215/0.25 MG- Formulary PA 25 MCG trimethobenzamide hcl oral capsule 300 mg Formulary trimethoprim oral tablet 100 mg Formulary trimipramine maleate oral capsule 100 mg, 25 mg, 50 mg Formulary TRINATE ORAL TABLET Formulary triple antibiotic external ointment 3.5-400-5000 Formulary OTC TRIPLE FLEX ORAL TABLET 750-400-375 MG Formulary OTC triple helix collagen external powder Formulary OTC TRIPLE PASTE EXTERNAL OINTMENT 12.8 % Formulary OTC 143 Drug Name Formulary Status Requirements/Limits triprolidine hcl oral liquid 0.625 mg/ml Formulary OTC TRISPEC PSE PEDIATRIC ORAL LIQUID 30-10-187 Formulary OTC MG/5ML TRIUMEQ ORAL TABLET 600-50-300 MG Formulary TRI-VI-SOL ORAL SOLUTION 750-400-35 UNIT- Formulary OTC MG/ML TROCAINE THROAT MOUTH/THROAT LOZENGE 10 Formulary OTC MG TROCAL COUGH SUPPRESSANT MOUTH/THROAT Formulary OTC LOZENGE 7.5 MG TROCHIBASE CLASSIC FLAKES Formulary OTC trochibase s flakes Formulary OTC TROGARZO INTRAVENOUS SOLUTION 200 Formulary PA MG/1.33ML trolamine liquid 99 % Formulary TROMBONEX-D ORAL CAPSULE Formulary OTC trospium chloride oral tablet 20 mg Formulary TRUEPLUS GLUCOSE ORAL GEL Formulary OTC TRUEPLUS GLUCOSE ORAL TABLET CHEWABLE Formulary OTC TRUEPLUS INSULIN SYRINGE 28G X 1/2" 0.5 ML 28G Formulary OTC X 1/2" 0.5 ML TRUEPLUS INSULIN SYRINGE 28G X 1/2" 1 ML 28G Formulary OTC X 1/2" 1 ML TRUEPLUS INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G Formulary OTC X 1/2" 0.3 ML TRUEPLUS INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G Formulary OTC X 1/2" 0.5 ML TRUEPLUS INSULIN SYRINGE 29G X 1/2" 1 ML 29G Formulary OTC X 1/2" 1 ML TRUEPLUS INSULIN SYRINGE 30G X 5/16" 0.3 ML Formulary OTC 30G X 5/16" 0.3 ML TRUEPLUS INSULIN SYRINGE 30G X 5/16" 0.5 ML Formulary OTC 30G X 5/16" 0.5 ML TRUEPLUS INSULIN SYRINGE 30G X 5/16" 1 ML 30G Formulary OTC X 5/16" 1 ML TRUEPLUS INSULIN SYRINGE 31G X 5/16" 0.3 ML Formulary OTC 31G X 5/16" 0.3 ML TRUEPLUS INSULIN SYRINGE 31G X 5/16" 0.5 ML Formulary OTC 31G X 5/16" 0.5 ML TRUEPLUS INSULIN SYRINGE 31G X 5/16" 1 ML 31G Formulary OTC X 5/16" 1 ML TRUEPLUS LANCETS 26G Formulary OTC; QL (150 EA per 30 days) TRUEPLUS LANCETS 28G Formulary OTC; QL (150 EA per 30 days) TRUEPLUS LANCETS 30G Formulary OTC; QL (150 EA per 30 days) TRUEPLUS LANCETS 33G Formulary OTC; QL (150 EA per 30 days) TRU-FIT ICE/HEAT ANKLE/GEL PAK PAD Formulary OTC TRUVADA ORAL TABLET 200-300 MG Formulary trymine cg oral liquid 225-7.5 mg/5ml Formulary OTC

144 Drug Name Formulary Status Requirements/Limits tryptophan powder Formulary TUMS E-X 750 ORAL TABLET CHEWABLE 750 MG Formulary OTC TUMS LASTING EFFECTS ORAL TABLET Formulary OTC CHEWABLE 500 MG TUMS ULTRA 1000 ORAL TABLET CHEWABLE 1000 Formulary OTC MG tuohy epidural needle tw 14g x 3" , 17g x 3-1/2" , 20g x 3- Formulary OTC 1/2" turpentine liquid Formulary OTC turpentine oil oil Formulary OTC TUSICOF ORAL TABLET 10-20-400 MG Formulary OTC TUSNEL C ORAL SYRUP 30-10-100 MG/5ML Formulary OTC TUSNEL PEDIATRIC ORAL LIQUID 15-5-50 MG/5ML, Formulary OTC; AGE (Min 6 Years) 7.5-50 MG/ML TUSNEL-DM PEDIATRIC ORAL LIQUID 7.5-2.5-25 Formulary OTC MG/ML tussin cf max multi-symptom oral liquid 5-10-200 mg/5ml Formulary OTC tussin cough dm oral syrup 100-10 mg/5ml Formulary OTC tussin cough long-acting oral syrup 15 mg/5ml Formulary OTC tussin dm max oral liquid 10-200 mg/5ml Formulary OTC TUSSI-PRES ORAL LIQUID 5-10-200 MG/5ML Formulary OTC TUSSI-PRES PE PEDIATRIC ORAL LIQUID 2.5-100 Formulary OTC MG/5ML TUSSI-PRES PEDIATRIC ORAL LIQUID 2.5-5-75 Formulary OTC MG/5ML TUSSLIN PEDIATRIC ORAL LIQUID 2.5-7.5-88 Formulary OTC MG/ML TWINRIX INTRAMUSCULAR SUSPENSION 720-20 Formulary AGE (Min 19 Years) TYLENOL CHILDRENS PLUS MS COLD ORAL Formulary OTC SUSPENSION 2.5-1-5-160 MG/5ML TYLENOL COLD & HEAD ORAL TABLET 5-325-200 Formulary OTC MG TYLENOL COLD MAX ORAL LIQUID 10-5-325 Formulary OTC MG/15ML TYLENOL COLD MULTI-SYMPTOM ORAL LIQUID 5- Formulary OTC 6.25-10-325 MG/15ML TYLENOL COLD/FLU SEVERE ORAL TABLET 5-10- Formulary OTC 200-325 MG TYLENOL COLD/FLU SEVERE ORAL TABLET Formulary OTC THERAPY PACK TYLENOL EXTRA STRENGTH ORAL TABLET 500 Formulary OTC MG TYLENOL INFANTS ORAL SUSPENSION 160 Formulary OTC MG/5ML TYLENOL ORAL CAPSULE 325 MG Formulary OTC TYLENOL ORAL TABLET 325 MG Formulary OTC TYLENOL PM EXTRA STRENGTH ORAL TABLET Formulary OTC 500-25 MG

145 Drug Name Formulary Status Requirements/Limits TYLENOL SINUS SEVERE ORAL TABLET 5-325-200 Formulary OTC MG TYLENOL WARMING COUGH/CONGEST ORAL Formulary OTC LIQUID 5-10-200-325 MG/15ML TYPHIM VI INTRAMUSCULAR SOLUTION 25 Formulary AGE (Min 19 Years) MCG/0.5ML tyrosine oral packet 1000 mg Formulary OTC TYVASO REFILL INHALATION SOLUTION 0.6 Formulary PA MG/ML ubidecarenone powder Formulary ULCEREASE MOUTH/THROAT LIQUID 0.6 % Formulary OTC ULCEREASE MOUTH/THROAT SOLUTION 0.6-1.5 % Formulary OTC ULORIC ORAL TABLET 40 MG, 80 MG Formulary QL (34 EA per 34 days) ULTICARE ALCOHOL SWABS PAD Formulary OTC ULTICARE ALCOHOL SWABS PAD 70 % 70 % Formulary OTC ULTICARE INSULIN SAFETY SYR 29G X 1/2" 0.5 ML Formulary 29G X 1/2" 0.5 ML ULTICARE INSULIN SAFETY SYR 29G X 1/2" 1 ML Formulary 29G X 1/2" 1 ML ULTICARE INSULIN SYRINGE 28G X 1/2" 0.5 ML 28G Formulary OTC X 1/2" 0.5 ML ULTICARE INSULIN SYRINGE 28G X 1/2" 1 ML 28G X Formulary OTC 1/2" 1 ML ULTICARE INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G Formulary OTC X 1/2" 0.3 ML ULTICARE INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G Formulary OTC X 1/2" 0.5 ML ULTICARE INSULIN SYRINGE 29G X 1/2" 1 ML 29G X Formulary OTC 1/2" 1 ML ULTICARE INSULIN SYRINGE 30G X 1/2" 0.3 ML 30G Formulary OTC X 1/2" 0.3 ML ULTICARE INSULIN SYRINGE 30G X 1/2" 0.5 ML 30G Formulary OTC X 1/2" 0.5 ML ULTICARE INSULIN SYRINGE 30G X 1/2" 1 ML 30G X Formulary OTC 1/2" 1 ML ULTICARE INSULIN SYRINGE 30G X 5/16" 0.3 ML Formulary OTC 30G X 5/16" 0.3 ML ULTICARE INSULIN SYRINGE 30G X 5/16" 0.5 ML Formulary OTC 30G X 5/16" 0.5 ML ULTICARE INSULIN SYRINGE 30G X 5/16" 1 ML 30G Formulary OTC X 5/16" 1 ML ULTICARE INSULIN SYRINGE 31G X 1/4" 0.3 ML 31G Formulary OTC X 1/4" 0.3 ML ULTICARE INSULIN SYRINGE 31G X 1/4" 0.5 ML 31G Formulary OTC X 1/4" 0.5 ML ULTICARE INSULIN SYRINGE 31G X 1/4" 1 ML 31G X Formulary OTC 1/4" 1 ML ULTICARE INSULIN SYRINGE 31G X 5/16" 0.3 ML Formulary OTC 31G X 5/16" 0.3 ML

146 Drug Name Formulary Status Requirements/Limits ULTICARE INSULIN SYRINGE 31G X 5/16" 0.5 ML Formulary OTC 31G X 5/16" 0.5 ML ULTICARE INSULIN SYRINGE 31G X 5/16" 1 ML 31G Formulary OTC X 5/16" 1 ML ULTICARE SYRINGE 22G X 1-1/2" 3 ML Formulary OTC ULTICARE TUBERCULIN SAFETY SYR 25G X 1" 1 Formulary OTC ML, 25G X 5/8" 1 ML ultilet alcohol swabs pad Formulary OTC ULTILET CLASSIC LANCETS Formulary OTC; QL (150 EA per 30 days) ULTILET INSULIN SYRINGE 30G X 1/2" 0.5 ML 30G X Formulary OTC 1/2" 0.5 ML ULTILET INSULIN SYRINGE 30G X 1/2" 1 ML 30G X Formulary OTC 1/2" 1 ML ULTILET INSULIN SYRINGE 30G X 5/16" 0.3 ML 30G Formulary OTC X 5/16" 0.3 ML ULTILET INSULIN SYRINGE 30G X 5/16" 0.5 ML 30G Formulary OTC X 5/16" 0.5 ML ULTILET INSULIN SYRINGE 30G X 5/16" 1 ML 30G X Formulary OTC 5/16" 1 ML ULTILET INSULIN SYRINGE 31G X 1/4" 0.3 ML 31G X Formulary OTC 1/4" 0.3 ML ULTILET INSULIN SYRINGE 31G X 1/4" 1 ML 31G X Formulary OTC 1/4" 1 ML ULTILET INSULIN SYRINGE 31G X 15/64" 0.3 ML Formulary (OTC) 31G X 15/64" 0.3 ML ULTILET INSULIN SYRINGE 31G X 15/64" 0.3 ML Formulary (RX) 31G X 15/64" 0.3 ML ULTILET INSULIN SYRINGE 31G X 15/64" 0.5 ML 31G Formulary OTC X 15/64" 0.5 ML ULTILET INSULIN SYRINGE 31G X 5/16" 0.3 ML 31G Formulary OTC X 5/16" 0.3 ML ULTILET INSULIN SYRINGE 31G X 5/16" 1 ML 31G X Formulary OTC 5/16" 1 ML ULTILET INSULIN SYRINGE SHORT 30G X 1/2" 0.3 Formulary OTC ML 30G X 1/2" 0.3 ML ULTILET INSULIN SYRINGE SHORT 30G X 5/16" 0.3 Formulary OTC ML 30G X 5/16" 0.3 ML ULTILET INSULIN SYRINGE SHORT 30G X 5/16" 0.5 Formulary OTC ML 30G X 5/16" 0.5 ML ULTILET INSULIN SYRINGE SHORT 30G X 5/16" 1 Formulary OTC ML 30G X 5/16" 1 ML ULTILET INSULIN SYRINGE SHORT 31G X 5/16" 0.3 Formulary OTC ML 31G X 5/16" 0.3 ML ULTILET INSULIN SYRINGE SHORT 31G X 5/16" 0.5 Formulary OTC ML 31G X 5/16" 0.5 ML ULTILET INSULIN SYRINGE SHORT 31G X 5/16" 1 Formulary OTC ML 31G X 5/16" 1 ML ULTILET LANCETS Formulary OTC; QL (150 EA per 30 days) ultra comfort insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" Formulary OTC 0.3 ml

147 Drug Name Formulary Status Requirements/Limits ULTRA FRESH OPHTHALMIC SOLUTION 0.5 % Formulary OTC ULTRA FRESH PM OPHTHALMIC OINTMENT Formulary OTC ULTRA MEGA GOLD ORAL TABLET EXTENDED Formulary OTC RELEASE ULTRA MIDE 25 EXTERNAL LOTION 25 % Formulary OTC ultracin external lotion 0.025-10-28 % Formulary OTC ULTRACIN M EXTERNAL GEL 5 % Formulary OTC ULTRACIN T EXTERNAL LOTION 10 % Formulary OTC ULTRACIN-M EXTERNAL GEL 10 % Formulary OTC ultra-comfort insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" Formulary OTC 0.5 ml ultra-comfort insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 Formulary OTC ml ultra-comfort insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" Formulary OTC 0.3 ml ultra-comfort insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" Formulary OTC 0.5 ml ultra-comfort insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 Formulary OTC ml ultra-comfort insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" Formulary OTC 0.3 ml ultra-comfort insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" Formulary OTC 0.5 ml ultra-comfort insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 Formulary OTC ml ultra-comfort insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" Formulary OTC 0.3 ml ultra-comfort insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" Formulary OTC 0.5 ml ultra-comfort insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 Formulary OTC ml ultrasone external cream Formulary OTC ULTRA-THIN II INS SYR SHORT 30G X 5/16" 0.3 ML Formulary OTC 30G X 5/16" 0.3 ML ULTRA-THIN II INS SYR SHORT 30G X 5/16" 0.5 ML Formulary OTC 30G X 5/16" 0.5 ML ULTRA-THIN II INS SYR SHORT 30G X 5/16" 1 ML Formulary OTC 30G X 5/16" 1 ML ULTRA-THIN II INS SYR SHORT 31G X 5/16" 0.3 ML Formulary OTC 31G X 5/16" 0.3 ML ULTRA-THIN II INS SYR SHORT 31G X 5/16" 0.5 ML Formulary OTC 31G X 5/16" 0.5 ML ULTRA-THIN II INS SYR SHORT 31G X 5/16" 1 ML Formulary OTC 31G X 5/16" 1 ML ULTRA-THIN II INSULIN SYRINGE 29G X 1/2" 0.3 ML Formulary OTC 29G X 1/2" 0.3 ML ULTRA-THIN II INSULIN SYRINGE 29G X 1/2" 0.5 ML Formulary OTC 29G X 1/2" 0.5 ML ULTRA-THIN II INSULIN SYRINGE 29G X 1/2" 1 ML Formulary OTC 29G X 1/2" 1 ML 148 Drug Name Formulary Status Requirements/Limits ULTRA-THIN II LANCETS Formulary OTC; QL (150 EA per 30 days) UMCKA ELDERBERRY COLD+FLU ORAL SYRUP Formulary OTC UMCKA FASTACTIVES COLD+FLU ORAL PACKET Formulary OTC UMECTA MOUSSE EXTERNAL FOAM 40 % Formulary undecylenic acid liquid Formulary UNDELENIC EXTERNAL TINCTURE Formulary OTC unibase external cream Formulary OTC UNILET COMFORTOUCH LANCET Formulary OTC; QL (150 EA per 30 days) UNILET EXCELITE Formulary OTC; QL (150 EA per 30 days) UNILET EXCELITE II Formulary OTC; QL (150 EA per 30 days) UNILET G.P. LANCET Formulary OTC; QL (150 EA per 30 days) UNILET G.P. SUPERLITE LANCET Formulary OTC; QL (150 EA per 30 days) UNILET GP 28 ULTRA THIN Formulary OTC; QL (150 EA per 30 days) UNILET LANCET Formulary OTC; QL (150 EA per 30 days) UNILET MICRO-THIN 33G Formulary OTC; QL (150 EA per 30 days) UNILET SUPERLITE LANCET Formulary OTC; QL (150 EA per 30 days) UNILET SUPER-THIN 30G Formulary OTC; QL (150 EA per 30 days) UNILET ULTRA-THIN 28G Formulary OTC; QL (150 EA per 30 days) UNI-SOLVE EXTERNAL PAD Formulary OTC UNIVERSAL 1 LANCETS THIN 26G Formulary OTC; QL (150 EA per 30 days) UNIVERSAL 1 LANCETS THIN 33G Formulary OTC; QL (150 EA per 30 days) UNIVERSAL 1 LANCETS ULTRA THIN Formulary OTC; QL (150 EA per 30 days) universal ph in vitro strip Formulary OTC urea 20 intensive hydrating external cream 20 % Formulary OTC urea beads Formulary OTC urea external cream 40 %, 45 % Formulary urea hydrating external foam 35 % Formulary urea nail external gel 45 % Formulary urea nail external stick 50 % Formulary urea peroxide powder Formulary OTC urea powder Formulary urinary pain relief oral tablet 95 mg Formulary OTC URO-MAG ORAL CAPSULE 140 MG Formulary OTC ursodiol oral capsule 300 mg Formulary ursodiol oral tablet 250 mg, 500 mg Formulary vagicaine vaginal cream 20-3 % Formulary OTC VAGIFEM VAGINAL TABLET 10 MCG Formulary valacyclovir hcl oral tablet 1 gm, 500 mg Formulary valerian oral capsule 500 mg Formulary OTC valerian root oral capsule 450 mg Formulary OTC valganciclovir hcl oral solution reconstituted 50 mg/ml Formulary valganciclovir hcl oral tablet 450 mg Formulary VALINE 1000 ORAL PACKET 1 GM Formulary OTC valine oral packet 50 mg Formulary OTC 149 Drug Name Formulary Status Requirements/Limits valine powder Formulary sodium intravenous solution 100 mg/ml, 500 Formulary mg/5ml valproate sodium oral solution 250 mg/5ml Formulary valproic acid oral capsule 250 mg Formulary valsartan oral tablet 160 mg, 320 mg, 40 mg, 80 mg Formulary QL (34 EA per 34 days) valsartan-hydrochlorothiazide oral tablet 160-12.5 mg, Formulary 160-25 mg, 320-12.5 mg, 320-25 mg, 80-12.5 mg VALSTAR INTRAVESICAL SOLUTION 40 MG/ML Formulary value health insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 Formulary OTC ml value health insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC value plus lancet standard 21g Formulary OTC; QL (150 EA per 30 days) value plus lancets super thin Formulary OTC; QL (150 EA per 30 days) value plus lancets thin 26g Formulary OTC; QL (150 EA per 30 days) valumark lancet super thin 30g Formulary OTC; QL (150 EA per 30 days) valumark lancet ultra thin 28g Formulary OTC; QL (150 EA per 30 days) VAMOUSSE LICE TREATMENT EXTERNAL FOAM Formulary OTC VANACHOL ORAL CAPSULE Formulary OTC VANACLEAR PD ORAL LIQUID 0.313 MG/ML Formulary OTC VANACOF AC ORAL LIQUID 12.5-25 MG/30ML Formulary OTC VANACOF DM ORAL LIQUID 10-18-200 MG/15ML Formulary OTC VANACOF ORAL LIQUID 30-1-12.5 MG/5ML Formulary OTC VANACOF-8 ORAL LIQUID 25-50 MG/15ML Formulary OTC vanadium oral capsule 7.5 mg Formulary OTC VANAMINE PD ORAL LIQUID 6.25 MG/ML Formulary OTC VANATAB AC ORAL TABLET 12.5-25 MG Formulary OTC VANATAB DM ORAL TABLET 5-9-198 MG Formulary OTC vancomycin hcl in dextrose intravenous solution 1-5 gm/200ml-%, 1-5 gm/250ml-%, 500-5 mg/100ml-%, 750-5 Formulary mg/150ml-% vancomycin hcl in nacl intravenous solution 1-0.9 Formulary gm/200ml-%, 500-0.9 mg/100ml-%, 750-0.9 mg/150ml-% vancomycin hcl intravenous solution reconstituted 10 gm, Formulary 1000 mg, 500 mg, 5000 mg, 750 mg vancomycin hcl oral capsule 125 mg, 250 mg Formulary VANDAZOLE VAGINAL GEL 0.75 % Formulary VANICREAM DIAPER RASH EXTERNAL OINTMENT Formulary OTC 1.1-40 % VANIPLY EXTERNAL OINTMENT 1 % Formulary OTC VANISHPOINT SAFETY SYRINGE 25G X 1-1/2" 10 ML, 25G X 1-1/2" 5 ML, 27G X 1-1/2" 10 ML, 27G X 1- Formulary OTC 1/2" 5 ML VANTAS SUBCUTANEOUS KIT 50 MG Formulary PA VAPOR PATCH EXTERNAL PATCH Formulary OTC VAQTA INTRAMUSCULAR SUSPENSION 25 Formulary AGE (Min 19 Years) UNIT/0.5ML, 50 UNIT/ML 150 Drug Name Formulary Status Requirements/Limits VARIVAX SUBCUTANEOUS INJECTABLE 1350 Formulary AGE (Min 19 Years) PFU/0.5ML VASHE WOUND THERAPY EXTERNAL SOLUTION Formulary OTC VASOCLEAR-A OPHTHALMIC SOLUTION 0.02-0.25 Formulary OTC % VASOFLEX D1 ORAL TABLET 900-100 MG Formulary OTC VCF VAGINAL CONTRACEPTIVE VAGINAL FILM 28 Formulary OTC % VCF VAGINAL CONTRACEPTIVE VAGINAL FOAM Formulary OTC 12.5 % VCF VAGINAL CONTRACEPTIVE VAGINAL GEL 4 % Formulary OTC VECTIBIX INTRAVENOUS SOLUTION 100 MG/5ML, Formulary 400 MG/20ML veegum Formulary OTC VELCADE INJECTION SOLUTION RECONSTITUTED Formulary 3.5 MG venaliv oral tablet 900-100-100 mg Formulary OTC VENIA EXTERNAL PATCH 4-4 % Formulary OTC venlafaxine hcl er oral capsule extended release 24 hour Formulary 150 mg, 37.5 mg, 75 mg venlafaxine hcl er oral tablet extended release 24 hour 150 Formulary ST mg, 37.5 mg, 75 mg venlafaxine hcl oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg, Formulary 75 mg VENTAVIS INHALATION SOLUTION 10 MCG/ML, 20 Formulary MCG/ML verapamil hcl er oral capsule extended release 24 hour 100 Formulary mg, 120 mg, 180 mg, 200 mg, 240 mg, 300 mg, 360 mg verapamil hcl er oral tablet extended release 120 mg, 180 Formulary mg, 240 mg verapamil hcl intravenous solution 2.5 mg/ml Formulary verapamil hcl oral tablet 120 mg, 40 mg, 80 mg Formulary versabase cream Formulary versabase gel Formulary VERSAPLUS ORAL SYRUP Formulary VERSIVA XC PAD 5-1/2"X5-1/2" Formulary OTC VESICARE ORAL TABLET 10 MG, 5 MG Formulary VIBERZI ORAL TABLET 100 MG, 75 MG Formulary PA VIBRAMYCIN ORAL SYRUP 50 MG/5ML Formulary VICKS DAYQUIL MUCUS CONTROL DM ORAL Formulary OTC LIQUID 10-200 MG/15ML VICKS NYQUIL CHILDRENS CLD/CGH ORAL Formulary OTC LIQUID 2-15 MG/15ML VICKS NYQUIL COLD & FLU NIGHT ORAL LIQUID Formulary OTC 15-6.25-325 MG/15ML, 30-650-4 MG/30ML VICKS NYQUIL COUGH ORAL LIQUID 12.5-30 Formulary OTC MG/30ML

151 Drug Name Formulary Status Requirements/Limits VICKS NYQUIL SEVERE COLD & FLU ORAL Formulary OTC TABLET 5-6.25-10-325 MG VICKS SINEX DAYQUIL/NYQUIL ORAL Formulary OTC VICKS VAPO STEAM INHALATION LIQUID 6.2 % Formulary OTC VICKS VAPODROPS MOUTH/THROAT LOZENGE 1.7 Formulary OTC MG, 3.3 MG VICKS VAPOINHALER INHALATION INHALER Formulary OTC VICKS VAPORUB EXTERNAL OINTMENT 4.73-1.2-2.6 Formulary OTC % VICODIN ES ORAL TABLET 7.5-300 MG Formulary PA; QL (84 EA per 7 days) VICODIN HP ORAL TABLET 10-300 MG Formulary PA; QL (63 EA per 7 days) VICODIN ORAL TABLET 5-300 MG Formulary PA; QL (126 EA per 7 days) VICTOZA SUBCUTANEOUS SOLUTION PEN- Formulary INJECTOR 18 MG/3ML VIDA MIA UNILET LANCETS 28G Formulary OTC; QL (150 EA per 30 days) VIDEX ORAL SOLUTION RECONSTITUTED 2 GM, 4 Formulary GM vigabatrin oral packet 500 mg Formulary PA VIGAMOX OPHTHALMIC SOLUTION 0.5 % Formulary VIIBRYD ORAL TABLET 10 MG Formulary PA; QL (68 EA per 34 days) VIIBRYD ORAL TABLET 20 MG, 40 MG Formulary PA; QL (34 EA per 34 days) VIMPAT INTRAVENOUS SOLUTION 200 MG/20ML Formulary VIMPAT ORAL SOLUTION 10 MG/ML Formulary VIMPAT ORAL TABLET 100 MG, 150 MG, 200 MG, 50 Formulary MG VINATE M ORAL TABLET 27-1 MG Formulary vinblastine sulfate intravenous solution 1 mg/ml Formulary VINCASAR PFS INTRAVENOUS SOLUTION 1 MG/ML Formulary VINCE DENTAL POWDER Formulary OTC vinorelbine tartrate intravenous solution 10 mg/ml, 50 Formulary mg/5ml VIRACEPT ORAL TABLET 250 MG, 625 MG Formulary virtussin dac oral solution 30-10-100 mg/5ml Formulary OTC VISI-FLOW IRRIGATION STARTER KIT Formulary OTC vita-c oral crystals Formulary OTC VITA-CALCIUM ORAL WAFER 333-133 MG-UNIT Formulary OTC VITADYE EXTERNAL LOTION 5 % Formulary OTC VITAFOL ULTRA ORAL CAPSULE 29-0.6-0.4-200 MG Formulary VITALINE BIOTIN FORTE/ZINC ORAL TABLET 0.8 Formulary OTC MG VITALINE COQ10 ORAL TABLET 200 MG, 60 MG Formulary OTC VITA-MAG ORAL TABLET 133-5-10 MG Formulary OTC VITAMAX ORAL TABLET CHEWABLE 60 MG Formulary OTC VITAMELTS ENERGY VITAMIN B-12 ORAL TABLET Formulary OTC DISPERSIBLE 1500 MCG vitamin a & d oral capsule 5000-400 unit Formulary OTC

152 Drug Name Formulary Status Requirements/Limits vitamin a & d oral tablet 10000-400 unit Formulary OTC VITAMIN A FISH ORAL CAPSULE 7500 UNIT Formulary OTC vitamin a oral capsule 10000 unit, 8000 unit Formulary OTC vitamin a palmitate liquid Formulary vitamin a palmitate oral tablet 10000 unit, 15000 unit Formulary OTC vitamin a wrinkle treatment external gel Formulary OTC vitamin a-beta carotene oral tablet 10000-1000 unit, Formulary OTC 15000-10000 unit vitamin b complex-c oral capsule Formulary OTC vitamin b-1 oral tablet 50 mg Formulary OTC vitamin b-12 oral liquid 1000 mcg/15ml Formulary OTC vitamin b-12 oral lozenge 50 mcg, 500 mcg Formulary OTC vitamin b-12 oral tablet 100 mcg, 1000 mcg, 500 mcg Formulary OTC vitamin b12 sublingual liquid 3000 mcg/ml Formulary OTC vitamin b-12 sublingual tablet sublingual 500 mcg Formulary OTC vitamin b-2 oral tablet 25 mg, 50 mg Formulary OTC vitamin b-6 er oral tablet extended release 200 mg Formulary OTC vitamin b-6 oral tablet 100 mg Formulary OTC vitamin c (calcium ascorbate) oral solution reconstituted Formulary OTC vitamin c drops mouth/throat lozenge 60 mg Formulary OTC vitamin c gummies oral tablet chewable 125 mg Formulary OTC vitamin c oral liquid , 500 mg/5ml Formulary OTC vitamin c oral powder Formulary OTC vitamin c oral tablet 100 mg, 250 mg Formulary OTC vitamin c oral tablet chewable Formulary OTC vitamin c plus wild rose hips oral tablet chewable 500 mg Formulary OTC vitamin c-rose hips er oral tablet extended release 1000 mg, Formulary OTC 500 mg vitamin d2 oral tablet 2000 unit Formulary OTC vitamin d3 oral capsule 10000 unit, 2000 unit, 5000 unit, Formulary OTC 50000 unit vitamin d3 oral liquid 5000 unit/ml Formulary OTC vitamin d3 oral tablet 50000 unit Formulary OTC vitamin d3 oral tablet chewable 1000 unit, 400 unit Formulary OTC vitamin d-400 oral tablet 400 unit Formulary OTC VITAMIN E & C BEAUTY LOTION EXTERNAL Formulary OTC LOTION VITAMIN E & K BEAUTIFUL SKIN EXTERNAL OIL Formulary OTC vitamin e acetate liquid 1 unit/mg Formulary vitamin e beauty external oil 24000 unit/52ml Formulary OTC vitamin e external cream Formulary OTC vitamin e external liquid 24000 unit Formulary OTC vitamin e oral capsule 100 unit Formulary OTC vitamin e oral tablet 400 unit Formulary OTC vitamin e succinate powder Formulary 153 Drug Name Formulary Status Requirements/Limits vitamin e/selenium oral capsule 400-50 unit-mcg Formulary OTC vitamin k1 powder Formulary OTC vitamins acd-fluoride oral solution 0.25 mg/ml Formulary VITAMINS E & A BEAUTY OIL EXTERNAL OIL 1000- Formulary OTC 14000 UNIT/52ML VITAMINS E & D BEAUTY OIL EXTERNAL OIL 400- Formulary OTC 14000 UNIT/52ML VITA-RAY EXTERNAL CREAM 10-200000-3000 Formulary OTC VITONIC ORAL LIQUID Formulary OTC VIVA DROPS OPHTHALMIC SOLUTION 1 % Formulary OTC viva external patch 2.5-4-2 % Formulary OTC VIVABEN ORAL CAPSULE Formulary OTC VIVITROL INTRAMUSCULAR SUSPENSION Formulary RECONSTITUTED 380 MG VIVOTIF ORAL CAPSULE DELAYED RELEASE Formulary AGE (Min 19 Years) VOGELXO PUMP TRANSDERMAL GEL 12.5 MG/ACT Formulary PA (1%) VOGELXO TRANSDERMAL GEL 50 MG/5GM (1%) Formulary PA VOLTAREN TRANSDERMAL GEL 1 % Formulary VOPAC 5 EXTERNAL CREAM 5 % Formulary OTC voriconazole oral suspension reconstituted 40 mg/ml Formulary PA voriconazole oral tablet 200 mg, 50 mg Formulary PA vp insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC VYVANSE ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 QL (30 EA per 30 days); AGE (Min 4 Formulary MG, 50 MG, 60 MG, 70 MG Years and Max 17 Years) VYVANSE ORAL TABLET CHEWABLE 10 MG, 20 Formulary AGE (Min 4 Years and Max 17 Years) MG, 30 MG, 40 MG, 50 MG, 60 MG WAL-DRYL ANTI-ITCH EXTERNAL LIQUID 2-0.1 % Formulary OTC WAL-DRYL EXTERNAL CREAM 2-0.1 % Formulary OTC WAL-DRYL PE ALLERGY & SINUS ORAL TABLET Formulary OTC 25-10 MG WAL-FEX D ALLERGY & CONGESTION ORAL Formulary OTC TABLET EXTENDED RELEASE 24 HOUR 180-240 MG WAL-FLU COLD & SORE THROAT ORAL PACKET Formulary OTC 20-10-325 MG WAL-FLU SEV COLD/CGH DAY/NIGHT ORAL Formulary OTC PACKET WALGREENS LANCETS Formulary OTC; QL (150 EA per 30 days) walgreens lancets micro thin Formulary OTC; QL (150 EA per 30 days) walgreens lancets super thin Formulary OTC; QL (150 EA per 30 days) WALGREENS THIN LANCETS Formulary OTC; QL (150 EA per 30 days) WALGREENS ULTRA THIN LANCETS Formulary OTC; QL (150 EA per 30 days) WAL-ITIN D ORAL TABLET EXTENDED RELEASE 12 Formulary OTC HOUR 5-120 MG WAL-PHED PE DAYTIME/NIGHTTIME ORAL Formulary OTC WAL-SLEEP Z LIQUID SHOTS ORAL LIQUID 50 Formulary OTC MG/50ML

154 Drug Name Formulary Status Requirements/Limits WAL-SLEEP Z ORAL TABLET DISPERSIBLE 25 MG Formulary OTC wal-tap cold/allergy oral liquid 2-5 mg/10ml Formulary OTC WAL-TUSSIN CF MAX ORAL LIQUID 5-10-200-325 Formulary OTC MG/10ML wal-tussin cough relief oral tablet chewable 7.5 mg Formulary OTC WAL-ZYR CHILDRENS ORAL TABLET CHEWABLE Formulary OTC 10 MG, 5 MG WAL-ZYR ORAL CAPSULE 10 MG Formulary OTC sodium oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 Formulary mg, 4 mg, 5 mg, 6 mg, 7.5 mg wart remover maximum strength external gel 17 % Formulary OTC wart remover maximum strength external liquid 17 % Formulary OTC WATCHHALER DEVICE Formulary QL (2 EA per 365 days) water oral oral liquid Formulary OTC water tabs oral tablet Formulary OTC wax for braces wax Formulary OTC wax, white wax Formulary WEBCOL ALCOHOL PREP LARGE PAD 70 % 70 % Formulary OTC WEBCOL ALCOHOL PREP MEDIUM PAD 70 % 70 % Formulary OTC wee care oral suspension 15 mg/1.25ml Formulary OTC wegmans complete prenatal+dha oral 28-0.975 & 200 mg Formulary OTC WEISS EPIDURAL NEEDLE 20G X 2" Formulary OTC WEISS EPIDURAL NEEDLE TW 17G X 5" , 18G X 3- Formulary OTC 1/2" , 18G X 5" WELCHOL ORAL TABLET 625 MG Formulary WELLMIND MENTAL FOCUS ORAL TABLET Formulary OTC CHEWABLE WHITE PED ARTERIAL NEEDLE 19G X 1-1/2" , 20G X Formulary OTC 1-1/2" white petrolatum external ointment Formulary WIDE-SEAL DIAPHRAGM 60 VAGINAL DIAPHRAGM Formulary 2 % WIDE-SEAL DIAPHRAGM 65 VAGINAL DIAPHRAGM Formulary 2 % WIDE-SEAL DIAPHRAGM 70 VAGINAL DIAPHRAGM Formulary 2 % WIDE-SEAL DIAPHRAGM 75 VAGINAL DIAPHRAGM Formulary 2 % WIDE-SEAL DIAPHRAGM 80 VAGINAL DIAPHRAGM Formulary 2 % WIDE-SEAL DIAPHRAGM 85 VAGINAL DIAPHRAGM Formulary 2 % WIDE-SEAL DIAPHRAGM 90 VAGINAL DIAPHRAGM Formulary 2 % WIDE-SEAL DIAPHRAGM 95 VAGINAL DIAPHRAGM Formulary 2 % WINGS MATERNITY PANTS 2X-3X Formulary OTC

155 Drug Name Formulary Status Requirements/Limits WINRHO SDF INJECTION SOLUTION 1500 UNIT/1.3ML, 15000 UNIT/13ML, 2500 UNIT/2.2ML, Formulary 5000 UNIT/4.4ML wintergreen oil oil Formulary OTC witch hazel external liquid Formulary OTC witch hazel external solution 86 % Formulary OTC WITEPSOL PELLET Formulary wound gel external gel Formulary OTC wound gel spray external gel Formulary OTC WYMZYA FE ORAL TABLET CHEWABLE 0.4-35 MG- Formulary QL (28 EA per 28 days) MCG xanthan gum powder Formulary XARELTO ORAL TABLET 10 MG, 15 MG, 20 MG Formulary XEOMIN INTRAMUSCULAR SOLUTION Formulary PA RECONSTITUTED 100 UNIT, 50 UNIT XERAC AC EXTERNAL SOLUTION 6.25 % Formulary XEROFORM PETROLAT GAUZE 1"X8" EXTERNAL Formulary XGEVA SUBCUTANEOUS SOLUTION 120 MG/1.7ML Formulary XIAFLEX INJECTION SOLUTION RECONSTITUTED Formulary PA 0.9 MG XIFAXAN ORAL TABLET 200 MG, 550 MG Formulary PA XOLAIR SUBCUTANEOUS SOLUTION Formulary PA; QL (2 EA per 30 days) RECONSTITUTED 150 MG xolido external cream 2 % Formulary OTC X-SEB T PEARL EXTERNAL SHAMPOO 10 % Formulary OTC XTRA-CARE EXTERNAL LOTION Formulary OTC XULANE TRANSDERMAL PATCH WEEKLY 150-35 Formulary MCG/24HR xylitol powder Formulary XYREM ORAL SOLUTION 500 MG/ML Formulary PA; QL (540 ML per 30 days) YES FOR WOMEN EXTERNAL GEL Formulary OTC YF-VAX SUBCUTANEOUS INJECTABLE Formulary AGE (Min 19 Years) YUVAFEM VAGINAL TABLET 10 MCG Formulary ZADITOR OPHTHALMIC SOLUTION 0.025 % Formulary OTC zafirlukast oral tablet 10 mg, 20 mg Formulary zaleplon oral capsule 10 mg Formulary QL (68 EA per 34 days) zaleplon oral capsule 5 mg Formulary QL (34 EA per 34 days) ZANOSAR INTRAVENOUS SOLUTION Formulary RECONSTITUTED 1 GM ZANTAC 150 MAXIMUM STRENGTH ORAL TABLET Formulary OTC 150 MG ZANTAC 75 ORAL TABLET 75 MG Formulary OTC Z-BUM EXTERNAL CREAM 22.5 % Formulary OTC ZEASORB EXTERNAL POWDER Formulary OTC ZEGERID OTC CAPSULE 20-1100 MG ORAL 20-1100 Formulary OTC; QL (34 EA per 34 days) MG

156 Drug Name Formulary Status Requirements/Limits ZELBORAF ORAL TABLET 240 MG Formulary ZENPEP ORAL CAPSULE DELAYED RELEASE PARTICLES 10000 UNIT, 15000-51000 UNIT, 20000- Formulary PA 68000 UNIT, 25000 UNIT, 3000-10000 UNIT, 40000- 136000 UNIT, 5000 UNIT ZEPHREX-D ORAL TABLET ABUSE-DETERRENT 30 Formulary OTC MG ZE-PLUS ORAL CAPSULE Formulary OTC ZEVALIN Y-90 INTRAVENOUS KIT 3.2 MG/2ML Formulary ZICAM ALLERGY RELIEF NASAL GEL Formulary OTC ZICAM COLD REMEDY ORAL TABLET DISPERSIBLE Formulary OTC zidovudine oral capsule 100 mg Formulary zidovudine oral syrup 50 mg/5ml Formulary zidovudine oral tablet 300 mg Formulary ZIKS ARTHRITIS PAIN RELIEF EXTERNAL CREAM Formulary OTC 0.025-1-12 % ZILACTIN MOUTH/THROAT GEL 10 % Formulary OTC ZILACTIN-B MOUTH/THROAT GEL 10 % Formulary OTC ZIMS MAX-FREEZE EXTERNAL GEL 3.7 % Formulary OTC zinc + vitamin c mouth/throat lozenge 20-120 mg Formulary OTC ZINC 15 ORAL TABLET 66 MG Formulary OTC zinc acetate powder Formulary zinc aspartate oral tablet 40 mg Formulary OTC zinc chloride granules Formulary zinc gluconate oral tablet 15 mg, 50 mg Formulary OTC zinc methionate oral capsule 50 mg Formulary OTC zinc mouth/throat lozenge 10 mg Formulary OTC zinc oral tablet 100 mg, 30 mg Formulary OTC zinc oxide external ointment 20 % Formulary OTC zinc oxide external paste 25 % Formulary OTC zinc oxide powder Formulary zinc stearate powder Formulary OTC zinc sulfate heptahydrate powder Formulary zinc sulfate oral tablet 220 (50 zn) mg Formulary OTC zinc-c-b6 mouth/throat lozenge 15-60-5 mg Formulary OTC zincolate oral capsule 10-20 mg Formulary OTC ZINC-OXYDE PLUS EXTERNAL OINTMENT 0.44-20 Formulary OTC % zinc-vitamin c oral tablet dispersible 15-60 mg Formulary OTC ziprasidone hcl oral capsule 20 mg, 40 mg, 60 mg, 80 mg Formulary AGE (Min 18 Years) ZITHROMAX ORAL PACKET 1 GM Formulary QL (8 EA per 34 days) ZITHROMAX ORAL SUSPENSION RECONSTITUTED Formulary 100 MG/5ML zn-50 oral capsule 50 mg Formulary OTC ZOLADEX SUBCUTANEOUS IMPLANT 10.8 MG Formulary PA; QL (1 EA per 90 days) ZOLADEX SUBCUTANEOUS IMPLANT 3.6 MG Formulary PA 157 Drug Name Formulary Status Requirements/Limits zoledronic acid intravenous concentrate 4 mg/5ml Formulary PA zoledronic acid intravenous solution 4 mg/100ml, 5 Formulary PA mg/100ml ZOLINZA ORAL CAPSULE 100 MG Formulary PA oral tablet 2.5 mg, 5 mg Formulary ST; QL (6 EA per 34 days) zolmitriptan oral tablet dispersible 2.5 mg, 5 mg Formulary ST; QL (6 EA per 34 days) zolpidem tartrate er oral tablet extended release 12.5 mg, Formulary QL (30 EA per 30 days) 6.25 mg zolpidem tartrate oral tablet 10 mg, 5 mg Formulary ZOMIG NASAL SOLUTION 2.5 MG Formulary ST ZOMIG NASAL SOLUTION 5 MG Formulary ST; QL (36 EA per 34 days) zonisamide oral capsule 100 mg, 25 mg, 50 mg Formulary ZORTRESS ORAL TABLET 0.25 MG, 0.5 MG, 0.75 MG Formulary ZOSTAVAX SUBCUTANEOUS SUSPENSION Formulary AGE (Min 19 Years) RECONSTITUTED 19400 UNT/0.65ML ZOSTRIX HOT & COLD THERAPY EXTERNAL KIT Formulary OTC 0.025 & 4 % ZOSTRIX HP EXTERNAL CREAM 0.1 % Formulary OTC ZOSTRIX-HP EXTERNAL STICK 0.075 % Formulary OTC ZOVIRAX EXTERNAL CREAM 5 % Formulary PA; QL (5 GM per 34 days) Z-TUSS AC ORAL LIQUID 2-9 MG/5ML Formulary OTC ZYCLARA EXTERNAL CREAM 3.75 % Formulary ZYLET OPHTHALMIC SUSPENSION 0.5-0.3 % Formulary ZYNCOF ORAL SYRUP 20-400 MG/5ML Formulary OTC ZYRTEC ALLERGY ORAL CAPSULE 10 MG Formulary OTC ZYRTEC ALLERGY ORAL TABLET 10 MG Formulary OTC ZYRTEC ALLERGY ORAL TABLET DISPERSIBLE 10 Formulary OTC MG ZYRTEC-D ALLERGY & CONGESTION ORAL Formulary OTC TABLET EXTENDED RELEASE 12 HOUR 5-120 MG ZYTAZE ORAL CAPSULE 25-500 MG Formulary OTC ZZZQUIL ORAL LIQUID 50 MG/30ML Formulary OTC

158 Index 1st relief spray...... 1 acidophilus probiotic...... 2 ADVIL PM...... 4 1st tier unifine pentips...... 1 acidophilus/bifidus...... 2 ADVIL SINUS CONGESTION & 1st tier unilet comfortouch...... 1 acidophilus/citrus pectin...... 2 PAIN...... 4 2-deoxy-d-glucose...... 1 acidophilus/pectin...... 2 ADVOCATE INSULIN SYRINGE...... 4 50+ adult eye health...... 1 acitretin...... 2 AEROCHAMBER PLUS FLO-VU...... 4 7-keto dhea...... 1 acne medication 10...... 2, 3 AEROCHAMBER PLUS FLO-VU A & D ZINC OXIDE...... 1 acne medication 5...... 3 LARGE...... 5 a thru z advanced...... 1 ACNEFREE ACNE CLEARING AEROCHAMBER PLUS FLO-VU a thru z advantage...... 1 SYSTEM...... 3 SMALL...... 5 a thru z select...... 1 ACNEFREE SEVERE CLEARING AEROCHAMBER PLUS FLO-VU A+D CRACKED SKIN RELIEF...... 1 SYST...... 3 W/MASK...... 5 a1c test at-home...... 1 ACT TOTAL CARE...... 3 AFEDITAB CR...... 5 a-25...... 1 ACTHIB...... 3 AFLURIA...... 5 abacavir sulfate...... 1 ACTICARNITINE SF...... 3 AFLURIA PRESERVATIVE FREE...... 5 abacavir sulfate-lamivudine...... 1 ACTICON...... 3 AFREZZA...... 5 abacavir-lamivudine-zidovudine...... 1 actidom dmx...... 3 AFRIN CHILDRENS...... 5 ABANATUSS PED...... 1 actidose/sorbitol...... 3 AFRIN MENTHOL SPRAY...... 5 ABATRACE...... 1 actidose-aqua...... 3 AFTERA...... 5 ABATREX...... 1 ACTIFLOVIT EAR HEALTH...... 3 AGAMATRIX ULTRA-THIN ABATRON...... 1 ACTIFOAM COLLAGEN SPONGE...... 3 LANCETS...... 5 ABATRON AF...... 1 acti-lance lite lancets 28g...... 3 AHIST...... 5 ABATUSS DMX...... 1 acti-lance special lancets 17g...... 3 aimsco lubricated...... 5 ABILIFY MAINTENA...... 1 acti-lance universal 23g...... 3 AIRAVITE...... 5 abiraterone acetate...... 1 ACTIMMUNE...... 3 AIRBORNE...... 5 ABRAXANE...... 1 ACTINEL...... 3 AIRS DISPOSABLE NEBULIZER...... 5 ABREVA...... 1 ACTISEP...... 3 AIRZONE PEAK FLOW METER...... 5 acacia...... 1 ACTITROM...... 3 ak-poly-bac...... 5 acamprosate calcium...... 2 ACTIVE Q...... 3 AL12...... 5 acarbose...... 2 ACTIVE Q MAXIMUM STRENGTH....3 ALA SEB...... 5 ACCU-CHEK FASTCLIX LANCET...... 2 ACTIVE-Q...... 3 ALA SEB T...... 5 ACCU-CHEK SOFT TOUCH ACTIVE-Q EXTRA STRENGTH...... 3 ALAHIST DM...... 5 LANCETS...... 2 ACTIVITE EC...... 3 ALA-HIST IR...... 5 ACCU-CHEK SOFTCLIX LANCETS....2 ACTIVON ARTHRITIS ULTRA ST...... 3 ALA-HIST PE...... 5 ACCUTREND CHOLESTEROL...... 2 acyclovir...... 3 alanine 1000...... 5 ACCUTREND CHOLESTEROL ADACEL...... 3 alba-lybe nr...... 5 CONTROL...... 2 ADAGEN...... 3 albendazole...... 5 ACCUTREND PLUS...... 2 adapalene...... 3 ALBOLENE...... 5 ACE AEROSOL CLOUD ADCIRCA...... 4 ALBUKED 25...... 5 ENHANCER...... 2 ADDERALL XR...... 4 ALBUKED 5...... 5 ACE KNEE BRACE adefovir dipivoxil...... 4 albuterol sulfate...... 5 W/STABILIZERS...... 2 adenosylcobalamin...... 4 albuterol sulfate er...... 5 acebutolol hcl...... 2 adhesive bandages sheer...... 4 alclometasone dipropionate...... 5 ACEROLA C 500...... 2 adjustable lancing device...... 4 alcohol (rubbing)...... 5 acesulfame potassium...... 2 ADRENAL C FORMULA...... 4 alcohol anhydrous...... 5 ACETA-GESIC...... 2 ADRENALIN...... 4 alcohol prep...... 5, 6 acetaminophen...... 2 ADRUCIL...... 4 alcohol swabs...... 6 acetaminophen-codeine...... 2 adult gummy...... 4 alcohol wipes...... 6 acetaminophen-codeine #2...... 2 adult mask...... 4 alcohol, usp...... 6 acetaminophen-codeine #3...... 2 adult wash cloths with aloe...... 4 alendronate sodium...... 6 acetaminophen-codeine #4...... 2 adult-lock weekly pill remind...... 4 aler-cap...... 6 ACETASOL HC...... 2 ADVAIR DISKUS...... 4 aler-dryl...... 6 acetazolamide...... 2 advanced acne wash...... 4 alertness aid...... 6 acetazolamide er...... 2 ADVANCED alevazol...... 6 acetic acid...... 2 CALCIUM/D/MAGNESIUM...... 4 ALEVE...... 6 acetic acid glacial...... 2 advanced hand sanitizer...... 4 ALFERON N...... 6 acetone...... 2 ADVIL...... 4 alfuzosin hcl er...... 6 acetylcysteine...... 2 ADVIL ALLERGY & CONGESTION... 4 alga...... 6 acetyl-l-carnitine hcl...... 2 ADVIL ALLERGY SINUS...... 4 ALGAL-900 DHA...... 6 ACID GONE...... 2 ADVIL COLD & SINUS LIQUI- ALIMTA...... 6 acid reducer maximum strength...... 2 GELS...... 4 ALIVE MULTI-VITAMIN acidophilus...... 2 ADVIL COLD/SINUS...... 4 CHILDRENS...... 6

159 ALIVIO...... 6 alyacen 7/7/7...... 8 ANTI-ITCH INTENSIVE HEALING... 10 alka-aid...... 6 amantadine hcl...... 8 anti-oxidant...... 10 ALKA-SELTZER...... 6 ambi 12.5cpd/100gfn/30pse...... 8 antioxidant formula sg...... 10 ALKA-SELTZER HEARTBURN + ambi 12.5cpd/1dcpm/30pse...... 8 antiseptic...... 10 GAS...... 6 ambi 40pse/400gfn...... 8 ANTISEPTIC HAND RINSE...... 10 all day allergy childrens...... 6 ambi 60pse/400gfn...... 8 antiseptic skin cleanser...... 10 all day pain relief...... 6 ambi 60pse/4cpm...... 8 ANUSOL-HC...... 10 allantoin...... 6 AMBI FADE...... 8 AO-SEPT CONTACT LENS ALL-DRY SIZE 3...... 6 amcinonide...... 8 HOLDER...... 10 ALLEGRA ALLERGY...... 6 AMERICERIN...... 8 APETIGEN...... 10 ALLEGRA ALLERGY CHILDRENS.... 6 AMERIWASH...... 8 APETIGEN-PLUS...... 10 ALLEGRA-D ALLERGY & AMETHIA...... 8 ap-hist dm...... 10 CONGESTION...... 6 AMETHIA LO...... 8 APLIGRAF...... 10 aller-ease...... 6 AMETHYST...... 8 apothesar...... 10 allergy childrens...... 6 AMICAR...... 8 apraclonidine hcl...... 10 allergy eye...... 6 amiloride hcl...... 8 aprepitant...... 10 allergy multi-symptom day/nght...... 6 amiloride-hydrochlorothiazide...... 8 APRI...... 10 allergy spray 24 hour...... 6 aminoacetic acid...... 8 APRISO...... 10 ALLEVYN PLUS CAVITY...... 7 AMINOPMRMS...... 8 APTIVUS...... 10 ALLI...... 7 AMINORELIEF RMS...... 8 AQUA CARE...... 10 allopurinol...... 7 aminosalicylic acid-5...... 8 aquabase...... 10 ALMACONE...... 7 amiodarone hcl...... 8 AQUADEKS...... 10 almond oil bitter flavor...... 7 AMITIZA...... 8 AQUAFRESH DR SEUSS EXTRA ALOCANE PLUS...... 7 amitriptyline hcl...... 8 SOFT...... 10 ALOE GRANDE...... 7 amlodipine besy-benazepril hcl...... 9 aquanaz...... 11 aloe vera...... 7 amlodipine besylate...... 9 AQUAPHILIC...... 11 aloe vera freeze dried...... 7 amlodipine besylate-valsartan...... 9 AQUAPHILIC/CARBAMIDE...... 11 aloe vera moisturizing...... 7 amlodipine-atorvastatin...... 9 AQUASONIC 100...... 11 ALOE VESTA 2-N-1 PROTECTIVE..... 7 amlodipine-valsartan-hctz...... 9 AQUEOUS SELENIUM...... 11 ALOE VESTA CLEAR ammonia aromatic...... 9 aqueous vitamin e...... 11 ANTIFUNGAL...... 7 ammonium carbonate...... 9 AQUORAL...... 11 ALOE VESTA MULTI PURPOSE...... 7 ammonium chloride...... 9 ARANELLE...... 11 ALOE VESTA PROTECTIVE...... 7 ammonium hydroxide...... 9 ARANESP (ALBUMIN FREE)...... 11 ALOE VESTA SKIN PROTECTANT.... 7 ammonium lactate...... 9 ARCALYST...... 11 aloe/lidocaine pain reliever...... 7 amoxicillin...... 9 ARCAPTA NEOHALER...... 11 alosetron hcl...... 7 amoxicillin-pot clavulanate...... 9 arctic relief pain relieving...... 11 alp high3...... 7 amphetamine-dextroamphetamine...... 9 ARGIMENT AT...... 11 ALPAWASH...... 7 ampicillin...... 9 arginine...... 12 ALPHAGAN P...... 7 ANA-LEX...... 9 arginine2000...... 12 alpha-lipoic acid...... 7 ANASEPT...... 9 ARGYLE STERILE SALINE...... 12 ALPHANATE/VWF ANASEPT ANTIMICROBIAL...... 9 ARGYLE STERILE WATER...... 12 COMPLEX/HUMAN...... 7 anastrozole...... 9 aripiprazole...... 12 ALPHANINE SD...... 7 ANBESOL...... 9 ARISTADA...... 12 alph-e...... 7 ANBESOL MAXIMUM STRENGTH....9 ARISTADA INITIO...... 12 alph-e-mixed...... 7 ANDROGEL...... 9 arkaliox...... 12 alph-e-mixed 1000...... 7 ANDROGEL PUMP...... 9 ARLASILK PHOSPHOLIPID PLN...... 12 alprazolam...... 7, 8 ANECREAM...... 9 ARMOUR THYROID...... 12 alprazolam er...... 7 animal chews...... 9 arnica...... 12 ALPRAZOLAM INTENSOL...... 7 anise...... 9 arnicare arthritis...... 12 ALTACAINE...... 8 ANORO ELLIPTA...... 9 ARRANON...... 12 ALTAFLUOR...... 8 antacid...... 10 arthritis pain relieving...... 12 ALTAVERA...... 8 antacid anti-gas...... 10 artificial tears...... 12 alum ammonium...... 8 antacid anti-gas max strength...... 10 ARZERRA...... 12 aluminum acetate...... 8 antacid extra strength...... 10 ARZOL SILVER NIT aluminum bottle seal...... 8 antacid multi-symptom...... 10 APPLICATORS...... 12 aluminum chloride hexahydrate...... 8 antacid soft chews...... 10 asafetida...... 12 aluminum chlorohydrate...... 8 ANTARA...... 10 ascocid-iso-ph...... 12 aluminum hydroxide dried gel...... 8 anthelios 50 mineral...... 10 ASCOMP-CODEINE...... 12 aluminum hydroxide gel...... 8 anti-allergy...... 10 ascorbic acid...... 12 ALVESCO...... 8 antibacterial liquid soap...... 10 ascorbyl palmitate...... 12 ALWAYS MAXI MAXIMUM anti-diarrheal...... 10 ASCRIPTIN...... 12 PROTECTION...... 8 antifungal...... 10 asepto oral thermometer...... 12 alyacen 1/35...... 8 anti-itch...... 10 ASILNASAL RMS...... 12 160 ASMANEX 120 METERED DOSES....12 azelastine hcl...... 14 BD DISP NEEDLES...... 16 ASMANEX 30 METERED DOSES...... 12 azithromycin...... 14 BD ECLIPSE NEEDLE...... 16 aspartame...... 12 AZOPT...... 14 BD ECLIPSE SYRINGE...... 16 aspartate mg & k...... 12 AZURETTE...... 14 BD HYPODERMIC NEEDLE...... 16 ASPERCREME W/LIDOCAINE...... 12 b complete...... 14 BD INSULIN SYR ULTRAFINE II...... 16 aspir-81...... 13 b complex...... 14 BD INSULIN SYRINGE...... 16, 17 aspirin...... 13 b complex formula 1...... 14 BD INSULIN SYRINGE HALF-UNIT.17 aspirin-dipyridamole er...... 13 b complex-folic acid...... 14 BD INSULIN SYRINGE aspirtab maximum strength...... 13 b-1...... 14 MICROFINE...... 17 ASSURE ID INSULIN SAFETY SYR..13 b-100 cr...... 15 BD INSULIN SYRINGE U/F...... 17 ASSURE LANCETS...... 13 b-12...... 15 BD INSULIN SYRINGE U/F 1/2UNIT 17 ASTHMAPACK FOR CHILDREN...... 13 b-12 tr...... 15 BD INSULIN SYRINGE U-500...... 17 atazanavir sulfate...... 13 b-2...... 15 BD INSULIN SYRINGE atenolol...... 13 B-2-400...... 15 ULTRAFINE...... 17 atenolol-chlorthalidone...... 13 b-6...... 15 BD LANCET ULTRAFINE 30G...... 17 athletes foot maximum strength...... 13 BABY ANBESOL...... 15 BD LANCET ULTRAFINE 33G...... 17 atomoxetine hcl...... 13 baby lotion...... 15 BD LUER-LOK SYRINGE...... 18 ATOPICLAIR...... 13 baby super daily d3...... 15 BD PEN NEEDLE ORIGINAL U/F...... 18 atorvastatin calcium...... 13 baby teething pain medicine...... 15 BD SAFETYGLIDE INSULIN atovaquone...... 13 baby thermometer...... 15 SYRINGE...... 18 atovaquone-proguanil hcl...... 13 baciim...... 15 BD SAFETYGLIDE NEEDLE...... 18 ATRAC-TAIN...... 13 bacitracin...... 15 BD SAFETYGLIDE ATRIPLA...... 13 bacitracin zinc...... 15 SYRINGE/NEEDLE...... 18 ATROVENT HFA...... 13 bacitra-neomycin-polymyxin-hc...... 15 BD SAFETY-LOK INSULIN atuss da...... 13 back pain-off...... 15 SYRINGE...... 18 AUBRA...... 13 baclofen...... 15 BD SHARPS COLLECTOR...... 18 auraphene-b...... 13 BACTROBAN NASAL...... 15 BD SWAB SINGLE USE REGULAR.. 18 aurora lancet super thin 30g...... 13 balamine dm...... 15 BD SWABS SINGLE USE aurora lancet thin 23g...... 13 balanced b-50...... 15 BUTTERFLY...... 18 AUTOJECT 2...... 13 balanced b-50 complex...... 15 BD SYRINGE/NEEDLE SLIP TIP...... 18 AUTOLET PLATFORMS...... 13 BAL-CARE DHA...... 15 BD TB SYRINGE...... 18 autopen...... 13 BALNEOL...... 15 BD VEO INSULIN SYRINGE U/F...... 18 avalin...... 13 balsalazide disodium...... 15 BEBULIN...... 18 AVAR CLEANSER...... 13 BALZIVA...... 15 bec/zinc...... 18 AVAR-E EMOLLIENT...... 13 BAND-AID SURGIPAD SURGICAL.. 15 bee pollen...... 18 AVASTIN...... 13 BANOPHEN...... 15 BEELITH...... 18 AVEENO BABY GENTLE BANZEL...... 15 BELBUCA...... 18 CONDITION...... 14 BARACLUDE...... 15 belladonna alkaloids-opium...... 18 AVEENO BABY SOOTHING WASH. 14 BASAGLAR KWIKPEN...... 15 belladonna-opium...... 18 AVEENO INTENSE RELIEF...... 14 base g almond oil (sweet)...... 15 BENADRYL ALLERGY...... 18 AVEENO POSITIVELY RADIANT basic fuchsin hcl...... 15 BENADRYL ALLERGY WASH...... 14 BAYER BACK & BODY...... 15 CHILDRENS...... 18 AVENOVA/NEUTROX...... 14 BAYER BREEZE 2 CONTROL...... 15 BENADRYL ITCH RELIEF...... 19 AVERTEAX...... 14 BAYER BREEZE 2 SYSTEM...... 15 BENADRYL ITCH STOPPING...... 19 AVITENE...... 14 BAYER BREEZE 2 TEST...... 16 BENADRYL-D ALLERGY/SINUS AVITENE FLOUR...... 14 BAYER CONTOUR...... 16 CHILD...... 19 AVO CREAM...... 14 BAYER CONTOUR LINK benazepril hcl...... 19 AVONEX...... 14 MONITOR...... 16 benazepril-hydrochlorothiazide...... 19 AVONEX PEN...... 14 BAYER CONTOUR MONITOR...... 16 BENEFIBER...... 19 AVONEX PREFILLED...... 14 BAYER CONTOUR TEST...... 16 BENEFIBER FOR CHILDREN...... 19 av-phos 250 neutral...... 14 BAYER MICROLET LANCETS...... 16 BENEFIBER ON THE GO...... 19 axillary block needle...... 14 BAYER WOMENS...... 16 BENEFIBER PLUS B VITS & FA...... 19 AXSAIN...... 14 BAZA CLEANSE & PROTECT...... 16 BENEFIBER PLUS CALCIUM...... 19 AYR SALINE NASAL...... 14 BC FAST PAIN RELIEF...... 16 BENEFIBER PLUS HEART AYR SALINE NASAL DROPS...... 14 BC FAST PAIN RELIEF ARTHRITIS. 16 HEALTH...... 19 AYR SALINE NASAL GEL...... 14 b-caro-t...... 16 benfotiamine multi-b...... 19 AYR SALINE NASAL NO-DRIP...... 14 b-complex high potency...... 16 bentonite...... 19 AYR SALINE NASAL RINSE...... 14 BD ALLERGY SYRINGE...... 16 benzaldehyde...... 19 azacitidine...... 14 BD AUTOSHIELD...... 16 benzalkonium chloride...... 19 AZASAN...... 14 BD AUTOSHIELD DUO...... 16 BENZEDREX...... 19 azathioprine...... 14 BD BLUNT FILTER NEEDLE...... 16 BENZEPRO...... 19 azec...... 14 BD DISP NEEDLE...... 16 BENZEPRO CREAMY WASH...... 19 azelaic acid...... 14 BD DISP NEEDLE TW...... 16 BENZEPRO SHORT CONTACT...... 19 161 benzocaine...... 19 biotalan clear...... 21 brontuss dx...... 23 BENZODENT...... 19 BIO-THERM PAIN RELIEVING...... 21 brotapp dm...... 23 benzoic acid...... 19 biotin...... 21 BROVANA...... 23 benzoin...... 19 biotin forte...... 21 btrex...... 23 benzonatate...... 19 biotin plus keratin...... 21 BUCKLEYS CHEST CONGESTION...23 BENZ-O-STHETIC...... 19 biotin-d...... 21 BUCKLEYS COUGH...... 23 benzoyl peroxide...... 19 biotuss...... 21 budesonide...... 23 benzoyl peroxide cleanser...... 19 biovol...... 21 BUFFERIN...... 23 benzoyl peroxide wash...... 19 bisacodyl ec...... 21 BUFFERIN EXTRA STRENGTH...... 23 benzoyl peroxide-erythromycin...... 19 bismatrol...... 21 BUFFERIN LOW DOSE...... 23 benzphetamine hcl...... 19 bismatrol maximum strength...... 21 BULL FROG WATER ARMOR benztropine mesylate...... 19 bismuth citrate...... 21 SPORT...... 23 benzyl alcohol...... 19 bismuth subcarbonate...... 21 bumetanide...... 23 benzyl benzoate...... 19 bismuth subgallate...... 21 BUPHENYL...... 23 bergamot oil...... 19 bismuth subnitrate...... 21 buprenorphine...... 23 BERINERT...... 19 bismuth subsalicylate...... 21 buprenorphine hcl...... 23 BERRI-FREEZ PAIN RELIEVING 19, 20 bisoprolol fumarate...... 21 bupropion hcl...... 23 BERRI-FREEZ PLUS...... 20 bisoprolol-hydrochlorothiazide...... 21 bupropion hcl er (smoking det)...... 23 beta carotene provitamin a...... 20 bite/itch...... 21 bupropion hcl er (sr)...... 23 BETADINE...... 20 BI-ZETS/BENZOTROCHES...... 21 bupropion hcl er (xl)...... 23 BETADINE SURGICAL SCRUB...... 20 bladder 2.2...... 21 burn relief/lidocaine/aloe...... 23 BETADINE SWABSTICKS...... 20 bleomycin sulfate...... 21 buspirone hcl...... 23 betaine anhydrous...... 20 BLINK TEARS...... 21 busulfan...... 23 betaine hcl...... 20 BLISOVI 24 FE...... 21 butalbital-acetaminophen...... 23 betamethasone dipropionate...... 20 BLISOVI FE 1.5/30...... 21 butalbital-apap-caff-cod...... 23 betamethasone dipropionate aug...... 20 BLISOVI FE 1/20...... 21 butalbital-apap-caffeine...... 23 betamethasone valerate...... 20 blood pressure monitor/wrist...... 22 butalbital-aspirin-caffeine...... 23 BETAQUIK...... 20 BOIL EASE MAXIMUM butorphanol tartrate...... 23 BETASERON...... 20 STRENGTH...... 22 BUTRANS...... 23 betaxolol hcl...... 20 BONE DENSITY...... 22 butylated hydroxytoluene...... 24 bethanechol chloride...... 20 BOOST PUDDING...... 22 butylparaben...... 24 BETHKIS...... 20 BOOSTRIX...... 22 BYDUREON...... 24 BEVESPI AEROSPHERE...... 20 borage...... 22 BYETTA 10 MCG PEN...... 24 bexarotene...... 20 borax...... 22 BYETTA 5 MCG PEN...... 24 BIATAIN HEEL ADH FOAM boric acid...... 22 c-1500/rose hips sr...... 24 DRESSING...... 20 boron...... 22 c1500/rose hips/bioflavonoid...... 24 BIATAIN SACRAL FOAM BOTOX...... 22 ca phosphate dibasic dihyd...... 24 DRESSING...... 20 BOUDREAUXS BABY KISSES...... 22 cabergoline...... 24 bicalutamide...... 20 BOUDREAUXS BUTT PASTE...... 22 cadeau dha...... 24 BICARSIM...... 20 BOUDREAUXS RASH PREVENTOR 22 caffeine anhydrous...... 24 BICARSIM FORTE...... 20 bp 10-1...... 22 caffeine citrate...... 24 BICNU...... 20 bp cleansing wash...... 22 cal/mag...... 24 BIKTARVY...... 20 bp wash...... 22 CALADRYL...... 24 biobron sf...... 20 BPROTECTED MULTI-VITE...... 22 CALADRYL CLEAR...... 24 biocotron...... 20 BPROTECTED PEDIA IRON...... 22 CALAGEL MAXIMUM STRENGTH..24 biodesp dm...... 20 BPROTECTED PEDIA POLY-VITE....22 CALAGESIC...... 24 bioflavonoid citrus...... 20 BRAINSTRONG PRENATAL...... 22 calahist clear...... 24 BIO-FLAX...... 20 BRASIVOL...... 22 calamine...... 24 BIOFLONEX...... 20 BRAUN NO TOUCH + FOREHEAD...22 calamine phenolated...... 24 BIOFREEZE...... 20 BREVIBLOC IN NACL...... 22 calamine-zinc oxide...... 24 BIOFREEZE ROLL-ON brewers yeast...... 22 CAL-CARB FORTE...... 24 COLORLESS...... 21 BRIJ 30...... 22 CALCET PETITES...... 24 BIOGAIA GASTRUS...... 21 BRILINTA...... 22 CALCI-CHEW...... 24 biogtuss...... 21 brilliant green...... 22 calci-max...... 24 BIOGUARD NON-ADHERENT brimonidine tartrate...... 22 calcipotriene...... 24 DRESSING...... 21 BRIVIACT...... 22 calcitonin (salmon)...... 24 BIOLLE GEL TEARS...... 21 brohist d...... 22 CALCITRATE...... 24 bionatuss dxp...... 21 bromelain...... 22 cal-citrate...... 24 BIOPATCH PROTECTIVE bromi-lotion...... 22 calcitriol...... 24 DISK/CHG...... 21 bromocriptine mesylate...... 22 calcium...... 25 BIORX SPONIX ANTI-FUNGAL...... 21 bronchial asthma relief...... 22 calcium + d3...... 24 BIORX SPONIX ARTHR & MUSC..... 21 BRONKAID...... 23 calcium 1200...... 24 biospec dmx...... 21 bronkids...... 23 calcium 500 + d3...... 24 162 calcium 600...... 24 capron dmt...... 26 ceftriaxone sodium...... 29 calcium 600 + d...... 24 capsaicin...... 26 ceftriaxone sodium in dextrose...... 28 calcium 600+d3...... 24 capsaicin hot patch...... 26 ceftriaxone sodium-dextrose...... 29 calcium 600+d3 plus minerals...... 25 CAPSIDERM...... 26 cefuroxime axetil...... 29 calcium acetate...... 25 capsule 1 clear veggie...... 26 CELACYN...... 29 calcium acetate (phos binder)...... 25 captopril...... 26 celecoxib...... 29 calcium ascorbate...... 25 CAPZASIN-HP...... 26 celery seed...... 29 calcium aspartate...... 25 CARAFATE...... 27 cellulase...... 29 calcium carbonate...... 25 caraway oil...... 27 cellulose...... 29 calcium carbonate antacid...... 25 CARBAGLU...... 27 CELONTIN...... 29 calcium carbonate-vitamin d...... 25 carbamazepine...... 27 CENTRATEX...... 29 calcium citrate...... 25 carbamazepine er...... 27 centravites adults...... 29 calcium citrate + d3...... 25 CARBAPHEN CH...... 27 CENTRUM...... 29 calcium citrate malate-vit d...... 25 CARBAPHEN PED CH...... 27 CENTRUM FLAVOR BURST calcium citrate plus...... 25 carbidopa-levodopa...... 27 DRINK...... 29 calcium citrate tetrahydrate...... 25 carbidopa-levodopa er...... 27 CENTRUM SPECIALIST calcium citrate-vitamin d...... 25 carbidopa-levodopa-entacapone...... 27 PRENATAL...... 29 calcium citrate-vitamin d3...... 25 CARBOHOL 940...... 27 CEO-TWO...... 29 calcium gluconate...... 25 carbopol 940 nf...... 27 CEPACOL EXTRA STRENGTH...... 29 calcium gummies...... 25 carboxymethylcellulose sodium...... 27 CEPACOL SORE THROAT...... 29 calcium high potency/vitamin d...... 25 CARBZERO...... 27 CEPACOL SORE THROAT & calcium hydroxide...... 25 cardamom...... 27 COUGH...... 29 calcium lactate...... 25 CARDENZ...... 27 CEPACOL SORE THROAT EX ST..... 29 calcium oyster shell...... 25 CAREFINE PEN NEEDLES...... 27 CEPASTAT...... 29 calcium pantothenate...... 25 careone insulin syringe...... 27 cephalexin...... 29 calcium phosphate tribasic...... 25 careone lancet thin 23g...... 27 CERACADE...... 29 calcium plus vitamin d3...... 25 careone lancet ultra thin 28g...... 27 CERALYTE 70...... 29 calcium saccharate...... 25 CA-REZZ...... 27 CERAVE BABY...... 29 calcium soft chews...... 25 ca-rezz gentle...... 27 CERAVE ITCH RELIEF...... 29 calcium sulfate...... 25 ca-rezz norisc...... 27 CERAVE SUNSCREEN SPF50...... 29 calcium-magnesium-zinc...... 25 CARNI Q-GEL FORTE...... 27 CEROVEL...... 29 calcium-vitamin d...... 25 CARRACOLLOID 4"X4"...... 27 cesium...... 29 calcium-vitamin d3...... 25 CARRASMART...... 27 CESIUM 1000...... 29 calcium-vitamin d-minerals...... 25 CARRASORB H...... 27 cesium 500...... 29 calendula...... 26 CARRASYN V WOUND DRESSING. 28 CETAPHIL GENTLE CLEANSING.... 29 cal-glu...... 26 CARRINGTON DERMAL WOUND....28 cetirizine hcl...... 29 cal-lac...... 26 carteolol hcl...... 28 CETRAXAL...... 29 calmag thins...... 26 CARTIA XT...... 28 cetyl alcohol...... 29 cal-mint...... 26 carvedilol...... 28 CHANTIX...... 30 CALMOL-4...... 26 cascara sagrada...... 28 CHANTIX CONTINUING MONTH calna...... 26 castellani paint modified...... 28 PAK...... 30 CALTRATE 600+D...... 26 CASTIVA COOLING...... 28 CHANTIX STARTING MONTH PAK.30 CALTRATE 600+D PLUS CASTIVA WARMING...... 28 CHAP-EX TROPICALS...... 30 MINERALS...... 26 castor oil...... 28 charcoal activated...... 30 CALTRATE 600+D3 SOFT...... 26 castor oil stimulant laxative...... 28 CHAR-FLO WITH SORBITOL...... 30 CALTRATE GUMMY BITES...... 26 castor oil sulfated...... 28 chelated calcium...... 30 CALTRATE MINIS PLUS CATAPRES-TTS-1...... 28 chelated magnesium...... 30 MINERALS...... 26 CATAPRES-TTS-2...... 28 chelated zinc...... 30 CAMILA...... 26 CATAPRES-TTS-3...... 28 CHEMSTRIP CALIBRATION...... 30 CAMPHO-PHENIQUE...... 26 CAVAREST...... 28 CHEMSTRIP UGK...... 30 camphor...... 26 CAVILON EMOLLIENT...... 28 CHENODAL...... 30 camphor blocks...... 26 CAVILON FOOT & DRY SKIN...... 28 CHERACOL-D COUGH...... 30 camphor spirit...... 26 CAVILON NO STING BARRIER cherry...... 30 CAMPHOTREX...... 26 FILM...... 28 cherry concentrate...... 30 CAMPTOSAR...... 26 CAVILON ONE-STEP SKIN CARE.... 28 chest rub...... 30 CANASA...... 26 CAVILON SKIN CLEANSER...... 28 CHEW Q...... 30 candesartan cilexetil...... 26 CAZIANT...... 28 chewable iron...... 30 candesartan cilexetil-hctz...... 26 cefaclor...... 28 CHIGG AWAY...... 30 CANKAID...... 26 cefadroxil...... 28 childrens aspirin free...... 30 capcof...... 26 cefdinir...... 28 CHILDRENS MOTRIN...... 30 capecitabine...... 26 cefixime...... 28 childrens pain reliever...... 30 capmist dm...... 26 cefpodoxime proxetil...... 28 childrens plus multi-sympt cld...... 30 capron dm...... 26 cefprozil...... 28 childrens silfedrine...... 30 163 CHILDRENS SOOTHE...... 30 CITRUCEL...... 32 cocoa butter...... 34 chlo hist...... 30 CITRULLINE 1000...... 32 cocoa butter skin...... 34 CHLO TUSS...... 30 CITRULLINE200...... 32 cod liver oil...... 34 chlophed...... 30 cladribine...... 32 codeine sulfate...... 34 chloral hydrate...... 30 clarithromycin...... 32 coditussin ac...... 34 CHLORASEPTIC...... 30 clarithromycin er...... 32 coditussin dac...... 34 chlordiazepoxide hcl...... 30 CLARITIN...... 32 coenzyme q10...... 34 chlorella...... 30 CLARITIN CHILDRENS...... 32 coenzyme q-10...... 34 chlorhexidine gluconate...... 30 CLARITIN REDITABS...... 32 co-enzyme q10-vitamin e...... 35 chlorhexidine gluconate cloth...... 30 CLARITIN-D 12 HOUR...... 32 cola syrup...... 35 chloroform...... 30 CLARITIN-D 24 HOUR...... 33 COLACE...... 35 chlorophyll...... 30 classic prenatal...... 33 colchicine...... 35 chloroquine phosphate...... 31 CLEAN & CLEAR ACNE colchicine-probenecid...... 35 chlorothiazide...... 31 CLEANSER...... 33 cold & cough childrens...... 35 CHLORPHEN SR...... 31 CLEAN & CLEAR ADVANTAGE cold & cough day/night child...... 35 chlorpromazine hcl...... 31 MARK...... 33 cold remedy...... 35 chlorthalidone...... 31 CLEAN SIGHTS...... 33 cold sore treatment...... 35 CHLOR-TRIMETON...... 31 CLEAN ZING...... 33 cold therapy pain relief...... 35 CHLOR-TRIMETON ALLERGY...... 31 CLEANLET LANCETS 28G...... 33 COLD-EEZE...... 35 chlorzoxazone...... 31 CLEAR EYES REDNESS RELIEF...... 33 colestipol hcl...... 35 chocolated laxative...... 31 clear zinc spf 50...... 33 COLLASIL OSA...... 35 cholecalciferol...... 31 CLEARASIL DAILY CLEAR ACNE...33 collodion...... 35 cholesterol...... 31 CLEARCANAL EAR WAX collodion flexible...... 35 cholesterol acetate...... 31 REMOVAL...... 33 COLOCORT...... 35 cholestyramine...... 31 CLEARLAX...... 33 COMBIGAN...... 35 cholestyramine light...... 31 CLEARLIFE ALLERGY RELIEF...... 33 COMBIVENT RESPIMAT...... 35 choline...... 31 clemastine fumarate...... 33 COMFORT ASSIST INSULIN choline citrate...... 31 CLEOCIN...... 33 SYRINGE...... 35 choline sr...... 31 CLERZ PLUS...... 33 comfort assured lancets 28g...... 35 choline-mag trisalicylate...... 31 CLEVER CHOICE BP comfort assured lancets 33g...... 35 CHONDROITIN SULFATE MONITOR/WRIST...... 33 COMFORT CLEAN/COMFORT COMPLEX...... 31 CLINDACIN ETZ...... 33 SHIELD...... 35 CHROMACAPS...... 31 clindamycin hcl...... 33 COMFORT EZ PEN NEEDLES...... 35 chromium...... 31 clindamycin palmitate hcl...... 33 COMPAT STAY-PUT NJ DOUBLE chromium aspartate...... 31 clindamycin phos-benzoyl perox...... 33 LUME...... 35 chromium gtf...... 31 clindamycin phosphate...... 33 COMPLERA...... 35 chromium picolate...... 31 CLINDESSE...... 33 complete lice treatment...... 36 chromium picolinate...... 31 clioquinol...... 33 complete natal dha...... 36 chrysin...... 31 clobetasol propionate...... 33 completenate...... 36 CICLODAN...... 31 clobetasol propionate e...... 33 COMPOUND W MAXIMUM ciclopirox...... 31 clobetasol propionate emulsion...... 33 STRENGTH...... 36 ciclopirox olamine...... 31 clofarabine...... 33 COMPOUND W ONE STEP ciclopirox treatment...... 31 clomipramine hcl...... 33 INVISIBLE...... 36 cilostazol...... 31 clonazepam...... 34 compoz...... 36 cimetidine...... 31 clonidine hcl...... 34 COMTREX COLD & COUGH MAX cinnamon...... 32 clonidine hcl (analgesia)...... 34 ST...... 36 cinnamon oil...... 32 clopidogrel bisulfate...... 34 COMTREX COLD/COUGH CINRYZE...... 32 clorazepate dipotassium...... 34 DAY/NITE MS...... 36 CIPRODEX...... 32 CLORPACTIN...... 34 COMTREX DEEP CHEST COLD...... 36 ciprofloxacin...... 32 clotrimazole...... 34 CO-NATAL FA...... 36 ciprofloxacin hcl...... 32 clotrimazole 3...... 34 CONCEPT DHA...... 36 cisplatin...... 32 clotrimazole anti-fungal...... 34 CONCEPT OB...... 36 citalopram hydrobromide...... 32 clotrimazole-betamethasone...... 34 CONCEPTIONXR MOTILITY CITRA PH...... 32 clove oil...... 34 SUPPORT...... 36 CITRANATAL 90 DHA...... 32 clozapine...... 34 CONCERTA...... 36 CITRANATAL ASSURE...... 32 co q-10...... 34 condoms...... 36 CITRANATAL B-CALM...... 32 COAGUCHEK XS PLUS SYSTEM..... 34 constulose...... 36 CITRANATAL DHA...... 32 COAGUCHEK XS PT TEST...... 34 CONTAC COLD+FLU MAX ST...... 36 CITRANATAL HARMONY...... 32 coal tar...... 34 CONTOUR NEXT CONTROL...... 36 CITRANATAL RX...... 32 COARTEM...... 34 CONTOUR NEXT EZ...... 36 citric acid anhydrous...... 32 COATS ALOE...... 34 CONTOUR NEXT LINK...... 36 citric acid monohydrate...... 32 COATS ALOE JUICE DRINK...... 34 CONTOUR NEXT MONITOR...... 36 citronella oil...... 32 COATS ALOE LINIMENT...... 34 CONTOUR NEXT ONE...... 36 164 CONTOUR NEXT TEST...... 36 CURAFIL WOUND DRESSING...... 38 cvs hydrocolloid pads...... 39 control denture adhesive...... 36 CURASOL WOUND DRESSING...... 38 cvs inner ear plus...... 39 control syringe disposable...... 36 CURITY ALCOHOL PREPS...... 38 cvs instant food thickener...... 39 convex eye protector...... 36 CURITY ALCOHOL SWABS...... 38 cvs iron...... 39 cool n heat ex st...... 36 CURITY GAUZE SPONGE...... 38 cvs isopropyl alcohol wipes...... 39 cool n heat maximum strength...... 36 CURITY MESH GAUZE BNDG cvs itch relief...... 40 COPAXONE...... 36 4"X30'...... 38 cvs lancets 21g...... 40 copper sulfate...... 36 CURITY NURSING...... 38 cvs lancets micro thin 33g...... 40 COPPERMIN...... 36 CURX ANTIMICROBIAL...... 38 cvs lancets original...... 40 co-q 10 omega-3 fish oil...... 36 CUTINOVA HYDRO 2"X2-3/8"...... 38 cvs lancets thin 26g...... 40 coq10...... 36 cvs adhesive gauze...... 38 cvs lancets ultra thin 30g...... 40 coq-10...... 36 cvs aftersun aloe/lidocaine...... 38 cvs lancets ultra-thin 30g...... 40 coral calcium...... 37 CVS AIRSHIELD...... 38 cvs laxative dietary supplemnt...... 40 CORICIDIN HBP COLD/FLU...... 37 cvs alcohol prep pads...... 38 cvs l-lysine...... 40 CORICIDIN HBP COUGH/COLD...... 37 cvs allergy relief childrens...... 38 cvs lubricant drops...... 40 CORICIDIN HBP DAY/NIGHT cvs allergy relief d...... 38 cvs magnesium citrate...... 40 COLD...... 37 cvs all-purpose skin protect...... 38 cvs manuka honey wound...... 40 CORICIDIN HBP NIGHTTIME cvs antacid childrens...... 38 cvs melatonin...... 40 COLD...... 37 cvs anti-diarrheal...... 38 cvs melatonin extra strength...... 40 CORIFACT...... 37 cvs anti-itch sensitive...... 38 cvs miconazole 1 combo pack...... 40 corn oil...... 37 cvs astringent solution...... 38 cvs miconazole 3 combo pack...... 40 CORN REMOVER WATERPROOF.... 37 cvs b complex plus c...... 38 cvs mineral oil...... 40 corn starch...... 37 cvs baby safety swabs...... 38 cvs mineral oil enema...... 40 corn/callus remover...... 37 cvs backache relief...... 38 cvs mini enema kids...... 40 CORRECTOL EXTRA GENTLE...... 37 cvs calcium...... 38 cvs multi-purpose...... 40 CORTIFOAM...... 37 cvs calcium 600 plus...... 38 cvs nasal allergy spray...... 40 cortisone acetate...... 37 cvs cherry menthol drops...... 38 cvs nasal decongestant...... 40 CORTIZONE-10/ALOE...... 37 cvs chest rub medicated...... 39 cvs nasal mist...... 40 CORVITA 150...... 37 cvs cleansing eyelid wipes...... 39 cvs natural fiber supplement...... 40 COSAMIN ASU FOR JOINT cvs cleansing skin...... 39 cvs natural fish oil...... 40 HEALTH...... 37 cvs cold remedy...... 39 cvs nerve pain relief...... 40 COSAMIN VERDE FOR JOINT cvs corn/callus remover...... 39 cvs non-drying sinus pe...... 40 HEALTH...... 37 cvs creamy acne face wash...... 39 cvs omeprazole...... 40 cottonseed oil...... 37 cvs d3...... 39 cvs oral pain reliever...... 40 COTTONTAILS DIAPER RASH cvs dairy relief ex st...... 39 cvs pain relief...... 40 CREAMY...... 37 cvs daytime/nighttime cold/flu...... 39 cvs pain relief regular st...... 40 cough & chest congestion dm...... 37 cvs daytime/nighttime cough...... 39 cvs phosphate saline laxative...... 40 cough & cold...... 37 cvs diabetes health support...... 39 cvs potassium gluconate...... 40 cough drops...... 37 cvs digestive probiotic...... 39 cvs prenatal...... 40 cough relief...... 37 cvs diuretic maximum strength...... 39 cvs prenatal gummy...... 40 coughtab...... 37 cvs e oil...... 39 cvs prep...... 40 cramp tabs...... 37 cvs early result pregnancy...... 39 cvs protective...... 40 cranberry...... 37 cvs easy fiber/calcium...... 39 cvs saline wound wash...... 40 cream base with liposome...... 37 cvs enema disposable...... 39 cvs selenium...... 40 creatine...... 37 cvs epsom salt...... 39 cvs silver...... 40 creatine monohydrate...... 37 cvs ethyl alcohol...... 39 cvs sinus relief day/night...... 41 creatine5000...... 37 cvs eye...... 39 cvs skin relief...... 41 CREON...... 37 cvs fiber gummies...... 39 cvs sore muscle rub...... 41 CR-GTF...... 37 cvs gas relief...... 39 cvs sore throat max strength...... 41 CRITIC-AID CLEAR AF...... 37 cvs gas relief extra strength...... 39 cvs sore throat relief pops...... 41 CRIXIVAN...... 37 cvs gauze sterile...... 39 cvs steam inhaler...... 41 cromolyn sodium...... 38 cvs gluco-chondroit plus uc-ii...... 39 cvs stool softener...... 41 CROTAN...... 38 cvs glucosamine-chondroitin...... 39 cvs stuffy nose & cold child...... 41 croton oil...... 38 cvs glucosamine-chondroit-msm...... 39 cvs super cranberry urinary...... 41 CR-PLUS...... 38 cvs glucose bits...... 39 cvs tension headache...... 41 CRYOSERV...... 38 cvs glucose shot...... 39 cvs therapeutic...... 41 CRYSELLE-28...... 38 cvs glycerin adult...... 39 cvs triacting cough/runny nose...... 41 cu-25...... 38 cvs hair regrowth for women...... 39 cvs triple magnesium complex...... 41 cu-5...... 38 cvs hand wash advanced antibac...... 39 cvs ultra thin lancets...... 41 CULTURELLE GENTLE-GO KIDS.... 38 cvs heartburn relief ex st...... 39 cvs vaporizer warm steam...... 41 CULTURELLE KIDS...... 38 cvs heatwraps/back/hip...... 39 cvs wound wash advanced...... 41 cupric sulfate...... 38 cvs hemorrhoidal...... 39 cvs yogurt+calcium gummies...... 41 CURAD GERM SHIELD...... 38 cvs hot steam...... 39 cvs zinc oxide diaper...... 41 165 cyanocobalamin...... 41 DERMAL WOUND CLEANSER...... 43 digestive enzyme ultra...... 45 cyclobenzaprine hcl...... 41 DERMAMED...... 43 DIGITEK...... 45 CYCLOMYDRIL...... 41 DERMAPLEX...... 43 digoxin...... 45 cyclopentolate hcl...... 41 DERMAREST PSORIASIS...... 43 DILANTIN...... 45 cyclophosphamide...... 41 DERMASTAT...... 43 DILAUDID...... 45 cyclosporine...... 41 DERMASYN...... 43 diltiazem cd...... 45 cyclosporine modified...... 41 DERMAZENE...... 43 diltiazem hcl...... 45 cyproheptadine hcl...... 41 DERMOPLAST...... 43 diltiazem hcl er...... 45 CYSTADANE...... 41 DESCOVY...... 43 diltiazem hcl er beads...... 45 CYSTAGON...... 41 DESENEX FOOT/SNEAKER SPRAY.43 diltiazem hcl er coated beads...... 45 CYSTECH...... 41 DESGEN DM...... 43 dilt-xr...... 45 cystine...... 41 desipramine hcl...... 43 dimenhydrinate...... 45 cytarabine (pf)...... 41 DESITIN MAXIMUM STRENGTH.....43 DIMETAPP COLD/ALLERGY...... 45 CYTO-Q MAX...... 41 desmopressin ace spray refrig...... 43 DIMETAPP DM COLD/COUGH...... 45 d 1000...... 41 desmopressin acetate...... 43 DIMETAPP LONG ACT d 2000...... 41 desmopressin acetate spray...... 43 COUGH/COLD...... 45 dacarbazine...... 41 desonide...... 43 diphenhydramine hcl...... 45 daily care skin protectant...... 41 despec dm-g...... 43 diphenhydramine hcl (sleep)...... 45 daily ovulation predictor...... 42 desvenlafaxine succinate er...... 43 diphenoxylate-atropine...... 45 daily vite multivitamin/iron...... 42 DEVROM...... 43 diphtheria-tetanus toxoids dt...... 46 dairy relief...... 42 DEWEES CARMINATIVE...... 43 dipyridamole...... 46 dakins...... 42 dexamethasone...... 43 disulfiram...... 46 dakins (1/2 strength)...... 42 DEXAMETHASONE INTENSOL...... 43 divalproex sodium...... 46 dakins (1/4 strength)...... 42 dexamethasone sodium phosphate...... 44 divalproex sodium er...... 46 DAKRINA...... 42 dexrazoxane...... 44 dl-leucine...... 46 danazol...... 42 dextroamphetamine sulfate...... 44 dl-pa-500...... 46 dandruff shampoo...... 42 dextrose...... 44 DML...... 46 dantrolene sodium...... 42 dextrose anhydrous...... 44 DOANS PILLS...... 46 dapsone...... 42 dhea...... 44 DOANS PM EXTRA STRENGTH...... 46 DARAPRIM...... 42 DHS ZINC...... 44 DOC OMEGA...... 46 daunorubicin hcl...... 42 DIAB DAILY CARE...... 44 docetaxel...... 46 day time multi-sympt cold/flu...... 42 DIABETIC BASICS HEALTHY docusate sodium...... 46 DAYTIME COLD MEDICINE...... 42 FOOT...... 44 DOCUSOL KIDS...... 46 daytime cough...... 42 DIABETIC TUSSIN ALLERGY...... 44 DOCUSOL PLUS MINI-ENEMA...... 46 daytime severe cold & flu...... 42 DIABETIC TUSSIN COLD/FLU...... 44 dofetilide...... 46 DAYTRANA...... 42 DIABETIC TUSSIN NIGHT DOLOGEN...... 46 DDROPS...... 42 COLD/FLU...... 44 dologesic-df...... 46 DEBACTEROL...... 42 DIABETISWEET...... 44 dolorex...... 46 DECARA...... 42 diabet-x daily prevention...... 44 DOMEBORO...... 46 decitabine...... 42 DIADERM FOOT REJUVENATING...44 dometuss-da/children...... 46 DECONEX DMX...... 42 DIALYVITE...... 44 donepezil hcl...... 46 DECONEX IR...... 42 DIALYVITE 800...... 44 dorzolamide hcl...... 46 dehydroepiandrosterone...... 42 DIALYVITE 800 PLUS D...... 44 dorzolamide hcl-timolol mal...... 46 del clens...... 42 DIALYVITE 800/IRON...... 44 DOUBLE-TUSSIN DM...... 46 DELBASE COMPOUNDING...... 42 DIALYVITE/ZINC...... 44 DOVER IRRIGATION TRAY...... 46 DELSYM COUGH CHILDRENS...... 42 diaper rash...... 44 doxazosin mesylate...... 46 DELTUSS DP...... 42 DIASTIX...... 44 doxepin hcl...... 46 DELZICOL...... 42 diazepam...... 44 doxorubicin hcl...... 46, 47 demeclocycline hcl...... 42 DIAZEPAM INTENSOL...... 44 doxycycline hyclate...... 47 DEMEROL...... 42 dibucaine...... 44 doxycycline monohydrate...... 47 DEMSER...... 42 diclofenac potassium...... 44 doxylamine succinate...... 47 DENDRACIN diclofenac sodium...... 44 DR BOLDTS HINEY HEALER...... 47 NEURODENDRAXCIN...... 42 diclofenac sodium er...... 44 DR SMITHS DIAPER...... 47 DENTAPAINE...... 42 dicloxacillin sodium...... 45 DR SMITHS DIAPER RASH...... 47 DEPACON...... 42 dicyclomine hcl...... 45 DR SMITHS RASH + SKIN...... 47 DEPEN TITRATABS...... 42 DI-DAK-SOL...... 45 DRAMAMINE...... 47 DEPO-PROVERA...... 43 didanosine...... 45 DRITHO-CREME HP...... 47 DEQUASINE...... 43 dieters super tea...... 45 DRIXORAL COLD/ALLERGY...... 47 DERMA CIDOL 2000...... 43 dietex forte...... 45 DRIXORAL COUGH/SORE dermacloud...... 43 diethylpropion hcl...... 45 THROAT...... 47 DERMAGESIC...... 43 diethylpropion hcl er...... 45 dronabinol...... 47 DERMAGRAN...... 43 DIFFERIN...... 45 DROPLET LANCETS ULTRA THIN DERMAL THERAPY FINGER CARE.43 diflunisal...... 45 30G...... 47 166 drospirenone-ethinyl estradiol...... 47 ecee plus...... 49 epinastine hcl...... 51 DROXIA...... 47 econazole nitrate...... 49 epinephrine...... 52 drug mart lancets thin 26g...... 47 ECOTRIN...... 49 epinephrine pf...... 52 DRUG MART UNILET LANCETS ECOTRIN MAXIMUM STRENGTH... 49 EPIPEN 2-PAK...... 52 28G...... 47 e-cream complex...... 49 EPIPEN JR 2-PAK...... 52 DRUG MART UNILET LANCETS ED A-HIST...... 50 epirubicin hcl...... 52 30G...... 47 ed a-hist dm...... 50 EPISORB...... 52 dry skin treatment adv therapy...... 47 ed bron gp...... 50 EPITOL...... 52 drymax extra...... 47 ED CHLORPED...... 50 EPIVIR HBV...... 52 DRYSOL...... 47 ED CHLORPED D...... 50 eplerenone...... 52 DULCOLAX...... 47 edetate disodium...... 50 eprosartan mesylate...... 52 DULCOLAX MILK OF MAGNESIA...47 ed-spaz...... 50 epsom salt...... 52 DULERA...... 47 EDURANT...... 50 eq allergy relief...... 52 duloxetine hcl...... 47 efavirenz...... 50 eq allergy relief childrens...... 52 DURAFLEX COMFORT...... 47 EFFER-K...... 50 eq allergy/sinus headache...... 52 DURAFLU...... 47 effervescent pain relief...... 50 eq aspirin...... 52 DURAPROXIN...... 47 effervescent pot chloride...... 50 EQ BABY CHEST RUB...... 52 DURAPROXIN ES...... 47 EGRIFTA...... 50 eq calcium citrate+d3 petites...... 52 DURASAFE SPINAL/EPIDURAL...... 48 ELDERTONIC...... 50 eq cough sugar free...... 52 DURATION SPRAY...... 48 ELIDEL...... 50 eq cryogenic wart removal sys...... 52 DURAVENT DM...... 48 ELIGARD...... 50 eq daily fiber...... 52 DURAVENT PE...... 48 ELIQUIS...... 50 eq dairy digestive fast acting...... 52 DUREZOL...... 48 elite ca/mg...... 50 eq feminine wash sensitive...... 52 dutasteride...... 48 elite calcium...... 50 eq ibuprofen pm...... 52 dutasteride-tamsulosin hcl...... 48 ELITE ZINC...... 50 EQ MUCUS ER...... 52 D-VI-SOL...... 48 ELITEK...... 50 eq multi-symptom cold children...... 52 d-xylose...... 48 ELITE-OB...... 50 eq omeprazole...... 52 DY-O-DERM VITILIGO STAIN...... 48 elite-thin insulin syringe...... 50 eq pain relief/rapid burst...... 52 E.E.S. GRANULES...... 48 ELIXOPHYLLIN...... 50 eq sinus relief max st...... 52 ear wax cleansing...... 48 ELIXSURE COUGH...... 50 eq tioconazole 1...... 52 EASIVENT...... 48 ELIXSURE FEVER/PAIN...... 51 eql 2 in 1 probiotic...... 52 EASIVENT MASK LARGE...... 48 ELLA...... 51 eql advanced relief...... 52 EASIVENT MASK MEDIUM...... 48 ELLURA...... 51 eql alcohol swabs...... 52 EASIVENT MASK SMALL...... 48 ELMIRON...... 51 eql aller-ease...... 53 easy fiber...... 48 ELTA DERMAL...... 51 eql allergy...... 53 EASY TOUCH ALCOHOL PREP EMCYT...... 51 eql aloe vera after sun...... 53 MEDIUM...... 48 EMETROL...... 51 eql antacid ultra strength...... 53 EASY TOUCH ALLERGY SYRINGE.48 EMJOI TENS...... 51 eql antibacterial hand soap...... 53 EASY TOUCH FLIPLOCK INSULIN empty capsule size 1 clear...... 51 eql anti-nausea...... 53 SY...... 48 EMTRIVA...... 51 eql biotin...... 53 EASY TOUCH FLURINGE...... 48 EMULSION SB...... 51 eql color lancets 21g...... 53 EASY TOUCH INSULIN SAFETY enalapril maleate...... 51 eql color lancets micro 33g...... 53 SYR...... 48 enalapril-hydrochlorothiazide...... 51 eql congestion relief...... 53 EASY TOUCH INSULIN SYRINGE ENBREL...... 51 eql denture brush/pick...... 53 ...... 48, 49 ENBREL SURECLICK...... 51 eql denture cleanser...... 53 EASY TOUCH LANCETS 26G...... 49 ENDOXCIN...... 51 eql digestive enzymes...... 53 EASY TOUCH LANCETS ENDUR-ACIN...... 51 eql ear drops...... 53 26G/TWIST...... 49 ENEMEEZ MINI...... 51 eql effervescent cold relief...... 53 EASY TOUCH LANCETS 28G...... 49 ENFAMIL ENFALYTE...... 51 eql ethyl alcohol (rubbing)...... 53 EASY TOUCH LANCETS ENFAMIL EXPECTA...... 51 eql everyday clean...... 53 28G/TWIST...... 49 ENGERIX-B...... 51 eql eye drops ac...... 53 EASY TOUCH LANCETS 30G...... 49 ENLITE GLUCOSE SENSOR...... 51 eql fiber therapy...... 53 EASY TOUCH LANCETS enoxaparin sodium...... 51 eql gas prevention...... 53 30G/TWIST...... 49 ENPRESSE-28...... 51 eql gentle skin cleanser...... 53 EASY TOUCH LANCETS 32G...... 49 entecavir...... 51 eql insulin syringe...... 53 EASY TOUCH LANCETS ENTEX T...... 51 eql lutein...... 53 32G/TWIST...... 49 ENTRESTO...... 51 eql mouthwash/gargle...... 53 EASY TOUCH LANCETS ENTSOL NASAL...... 51 eql mucus-dm...... 53 33G/TWIST...... 49 enulose...... 51 eql multi-purpose...... 53 EASY TOUCH SHEATHLOCK e-oil...... 51 eql omega 3 fish oil...... 53 SYRINGE...... 49 epa/gla...... 51 eql omeprazole...... 53 EASY TWIST & CAP LANCETS...... 49 ephedrine hcl...... 51 eql one daily womens...... 53 EASYGEL...... 49 epidural needle...... 51 eql redness relief...... 53 167 eql scalp relief max strength...... 53 EXCEL-GEL...... 55 fenofibric acid...... 57 eql super thin lancets 30g...... 53 EXEL COMFORT POINT INSULIN fenoprofen calcium...... 57 eql thin lancets 26g...... 53 SYR...... 55, 56 fentanyl...... 58 eql ultra protection spf50...... 53 EXELON...... 56 fentanyl citrate...... 57 eql vitamin d3...... 54 exemestane...... 56 fentanyl citrate (pf)...... 57 eql wet cleansing towelettes...... 54 EXFOLIX EXFOLIATING FOOT FER-IN-SOL...... 58 EQUALACTIN...... 54 SOAP...... 56 ferocon...... 58 ERBITUX...... 54 EXJADE...... 56 ferraplus 90...... 58 ergocalciferol...... 54 EX-LAX...... 56 ferretts...... 58 ergoloid mesylates...... 54 EX-LAX MAXIMUM STRENGTH...... 56 ferretts chewable iron...... 58 ery...... 54 exoten-c pain relief...... 56 ferretts ips...... 58 ERYPED 200...... 54 exotic-hc...... 56 ferrex 150...... 58 ERY-TAB...... 54 EXTRESS-30...... 56 FERREX 150 FORTE PLUS...... 58 ERYTHROCIN LACTOBIONATE...... 54 eye allergy relief...... 56 FERREX 28...... 58 ERYTHROCIN STEARATE...... 54 eye drops...... 56 ferric subsulfate...... 58 erythromycin...... 54 eye itch relief...... 56 FERRIMIN 150...... 58 erythromycin base...... 54 EYE STREAM...... 56 FERROCITE...... 58 erythromycin ethylsuccinate...... 54 E-Z JECT LANCET MICRO-THIN FERROCITE PLUS...... 58 escavite lq...... 54 33G...... 56 ferrous gluconate...... 58 escitalopram oxalate...... 54 E-Z JECT LANCET SUPER THIN ferrous sulfate...... 58 esmolol hcl...... 54 30G...... 56 ferrous sulfate er...... 58 esomeprazole magnesium...... 54 E-Z JECT LANCETS...... 56 FEVERALL INFANTS...... 58 ESOTERICA FADE NIGHTTIME...... 54 E-Z JECT LANCETS 21G...... 56 FEVERALL JUNIOR STRENGTH...... 58 ESOTERICA SENSITIVE SKIN...... 54 E-Z JECT LANCETS THIN 26G...... 56 fexofenadine hcl childrens...... 58 ESTARYLLA...... 54 EZ SMART BLOOD GLUCOSE fiber...... 58 estazolam...... 54 LANCETS...... 56 fiber laxative...... 58 estradiol...... 54 ezetimibe...... 56 FIBERCON...... 58 estradiol valerate...... 54 ezetimibe-simvastatin...... 56 FIBEREX F15...... 58 estradiol-norethindrone acet...... 54 EZFE 200...... 56 FIFTY50 ALCOHOL PREP...... 58 estro support es...... 54 E-Z-GAS II...... 56 FIFTY50 SUPERIOR COMFORT estropipate...... 54 EZ-LETS LANCETS 21G...... 56 SYR...... 58 eszopiclone...... 55 EZ-LETS LANCETS 23G...... 56 filter needle...... 58 ethambutol hcl...... 55 EZ-LETS LANCETS 28G...... 56 finasteride...... 58 ethosuximide...... 55 fabb...... 57 FINE 30...... 58 ethoxy diglycol...... 55 face mask respirator r-95 part...... 57 FIRAZYR...... 59 ethyl alcohol...... 55 FAGRON VERSIFIX...... 57 first aid antibiotic...... 59 ethyl alcohol (rubbing)...... 55 famciclovir...... 57 first aid antiseptic spray...... 59 ethyl chloride...... 55 famotidine...... 57 fish oil...... 59 ethyl oleate...... 55 FARESTON...... 57 fish oil + d3...... 59 etidronate disodium...... 55 FARXIGA...... 57 fish oil adult gummies...... 59 etodolac...... 55 FASLODEX...... 57 fish oil-flax oil-borage oil...... 59 etodolac er...... 55 FAST FREEZE PRO STYLE flavor packets...... 59 ETOPOPHOS...... 55 THERAPY...... 57 flavoxate hcl...... 59 etoposide...... 55 fast-heat heating pad...... 57 flecainide acetate...... 59 eucalyptol...... 55 father johns medicine...... 57 FLEET BISACODYL...... 59 eucalyptus oil...... 55 FATTYBLEND...... 57 FLEET LIQUID GLYCERIN SUPP..... 59 EUCERIN...... 55 fa-vitamin b-6-vitamin b-12...... 57 FLEET NATURALS CLEANSING EUCERIN ECZEMA RELIEF...... 55 FAYOSIM...... 57 ENEMA...... 59 EUCERIN ORIGINAL HEALING...... 55 FC FEMALE CONDOM...... 57 FLEET OIL...... 59 EUFLEXXA...... 55 fd&c blue #2...... 57 FLEET PEDIATRIC...... 59 eugenol...... 55 fd&c red #40 aluminum lake...... 57 FLEXICHAMBER...... 59 EURAX...... 55 fd&c yellow #5...... 57 FLEXICHAMBER CHILD EVAC-U-GEN...... 55 fdc blue 1...... 57 MASK/LARGE...... 59 evening primrose oil...... 55 fdc green #3...... 57 FLINTSTONES TODDLER...... 59 EXACTECH R-S-G TEST...... 55 fdc red #3...... 57 FLOGEN...... 59 EXACTECH TEST...... 55 fdc yellow 6...... 57 FLONASE ALLERGY RELIEF...... 59 EXACTUSS TR...... 55 FEIBA...... 57 FLONASE SENSIMIST...... 59 EXAPHEN...... 55 felbamate...... 57 FLORA ASSIST...... 59 EXAPHEN CH...... 55 felodipine er...... 57 FLORANEX...... 59 EXAPHEX TR...... 55 FEM PH...... 57 FLORASTOR...... 59 EXCEDRIN PM...... 55 FEMINEASE...... 57 FLORASTOR KIDS...... 59 EXCEDRIN TENSION HEADACHE...55 fenofibrate...... 57 FLORICAL...... 59 EXCEL AP...... 55 fenofibrate micronized...... 57 FLOVENT DISKUS...... 59 168 FLOVENT HFA...... 59 fosphenytoin sodium...... 61 GELFOAM SPONGE SIZE 100...... 63 flow-eze vented needle...... 59 freds pharmacy unilet lanc 28g...... 61 GEL-KAM...... 63 floxuridine...... 59 FREE & CLEAR...... 62 GELONASAL...... 63 flu hbp...... 59 freedom cepapro...... 62 GELUSIL...... 63 FLUCAINE...... 59 FREEDOM ODT BASE...... 62 gemcitabine hcl...... 63, 64 FLUCELVAX QUADRIVALENT...... 59 FREESTYLE CONTROL SOLUTION.62 gemfibrozil...... 64 fluconazole...... 59, 60 FREESTYLE FLASH SYSTEM...... 62 GENCONTUSS...... 64 fludarabine phosphate...... 60 FREESTYLE FREEDOM...... 62 GENOTROPIN...... 64 fludrocortisone acetate...... 60 FREESTYLE FREEDOM LITE...... 62 GENOTROPIN MINIQUICK...... 64 flunisolide...... 60 FREESTYLE INSULINX SYSTEM..... 62 gentamicin sulfate...... 64 fluocinolone acetonide...... 60 FREESTYLE INSULINX TEST...... 62 GENTEAL...... 64 fluocinolone acetonide body...... 60 FREESTYLE LANCETS...... 62 GENTEAL MILD...... 64 fluocinolone acetonide scalp...... 60 FREESTYLE LIBRE 14 DAY GENTEAL MILD TO MODERATE.....64 fluocinonide...... 60 READER...... 62 GENTEAL TEARS PF...... 64 fluoride mouth rinse...... 60 FREESTYLE LIBRE 14 DAY gentian violet...... 64 fluorometholone...... 60 SENSOR...... 62 gentle laxative...... 64 fluorouracil...... 60 FREESTYLE LIBRE READER...... 62 GENTLE RAIN...... 64 fluoxetine hcl...... 60 FREESTYLE LIBRE SENSOR gentle skin cleanser...... 64 fluoxetine hcl (pmdd)...... 60 SYSTEM...... 62 GENTLE-LET GP LANCETS...... 64 fluphenazine decanoate...... 60 FREESTYLE LITE TEST...... 62 GENTLE-LET LANCETS...... 64 fluphenazine hcl...... 60 FREESTYLE PRECISION INS SYR....62 GENVOYA...... 64 flurazepam hcl...... 60 FREESTYLE PRECISION NEO geravine...... 64 flurbiprofen...... 60 SYSTEM...... 62 geriatric vitamin...... 64 flurbiprofen sodium...... 60 FREESTYLE SIDEKICK II...... 62 gerisilk bath oil...... 64 flutamide...... 60 FREESTYLE SYSTEM...... 62 GERMBLOC HEALTH...... 64 fluticasone propionate...... 60 FREESTYLE TEST...... 62 GILENYA...... 65 fluticasone-salmeterol...... 60 fructose...... 62 GILTUSS COUGH & COLD...... 65 FLUVIRIN...... 60 fruit c...... 62 ginger root...... 65 fluvoxamine maleate...... 60 fullers earth...... 62 ginseng...... 65 FLUZONE HIGH-DOSE...... 60 FUNGI-NAIL...... 62 gla-45...... 65 FLUZONE QUADRIVALENT...... 61 FUNGI-NAIL TOE & FOOT...... 62 glass syringe 3 ml...... 65 FOCALIN...... 61 FUNGOID TINCTURE...... 62 glatiramer acetate...... 65 FOCALIN XR...... 61 FUNGOID-D...... 62 glen pe...... 65 FOILLE...... 61 furosemide...... 62 glenmax peb...... 65 FOLET DHA...... 61 FUSION...... 62 glenmax peb dm...... 65 FOLGARD...... 61 FUZEON...... 62 glenmax peb dm forte...... 65 FOLGARD OS...... 61 FYAVOLV...... 62 glentuss...... 65 FOLIC + B12...... 61 gabapentin...... 63 g-levocarnitine s/f...... 65 folic acid...... 61 GABITRIL...... 63 glimepiride...... 65 folinic-plus...... 61 galantamine hydrobromide...... 63 glipizide...... 65 FOLITAB 500...... 61 galantamine hydrobromide er...... 63 glipizide er...... 65 FOLIVANE-F...... 61 garlic/epa...... 63 glipizide xl...... 65 FOLIVANE-PLUS...... 61 garlic-lecithin...... 63 glipizide-metformin hcl...... 65 FOLOTYN...... 61 garlic-parsley...... 63 global inject ease insulin syr...... 65 food color black...... 61 gas relief...... 63 global insulin syringes...... 65 food color blue...... 61 GASTROCROM...... 63 GLUCAGEN HYPOKIT...... 65 food color blue royal...... 61 GAS-X...... 63 GLUCAGON EMERGENCY...... 65 food color brown...... 61 GAS-X CHILDRENS...... 63 GLUCOCOM AUTOLINK food color flesh...... 61 GAS-X EXTRA STRENGTH...... 63 TELEMONITOR...... 65 food color green...... 61 GAS-X PREVENTION...... 63 GLUCOCOM LANCETS 28G...... 65 food color lime green...... 61 GAS-X WITH MAALOX EX ST...... 63 GLUCOCOM LANCETS 30G...... 65 food color orange...... 61 GAVILYTE-C...... 63 GLUCOCOM LANCETS 33G...... 65 food color red...... 61 GAVILYTE-G...... 63 GLUCOPRO INSULIN SYRINGE. 65, 66 food color yellow...... 61 GAVILYTE-N WITH FLAVOR glucosamine chond complex/msm...... 66 FORA D40 GLUCOSE/PRESSURE..... 61 PACK...... 63 glucosamine chondroitin complx...... 66 FORA LANCETS...... 61 GAVISCON...... 63 glucosamine complex/vitamin d3...... 66 FORMADON...... 61 GAVISCON EXTRA STRENGTH...... 63 glucosamine hcl...... 66 formaldehyde...... 61 G-BUCAL-C...... 63 glucosamine sulfate...... 66 FORMA-RAY...... 61 G-DOLOGEN...... 63 glucosamine-chondroitin...... 66 FORTEO...... 61 ge-150...... 63 glucosamine-chondroitin-msm...... 66 fosamprenavir calcium...... 61 GEBAUERS INSTANT ICE...... 63 glucosamine-chondroitin-vit d3...... 66 fosinopril sodium...... 61 gelatin...... 63 glucosamine-msm...... 66 fosinopril sodium-hctz...... 61 GELFOAM SPONGE...... 63 glucose...... 66 169 GLUCOSE NURSETTE...... 66 gnp vitamin d-400...... 68 healthy accents unilet lancets...... 70 glutamine...... 66 GOLD BOND MULTI-SYMPTOM...... 68 hearing aid batteries...... 70 glutathione...... 66 GOLD BOND RAPID RELIEF...... 68 heartburn antacid ex st...... 70 glutol...... 66 GOLD BOND ULTIMATE...... 68 heartburn treatment 24 hour...... 70 glyburide...... 66 GONIOSOL...... 68 h-e-b incontrol alcohol...... 70 glyburide micronized...... 66 GONIOTAIRE...... 68 h-e-b incontrol lancets 28g...... 70 glyburide-metformin...... 66 GONIOVISC...... 68 h-e-b incontrol lancets 30g...... 70 glycerin...... 66 GOOD START 5% GLUCOSE h-e-b incontrol lancets 33g...... 70 glycerin (adult)...... 66 WATER...... 69 HEET TRIPLE ACTION...... 70 glycerin (infants & children)...... 66 goodsense all day allergy...... 69 hematinic/folic acid...... 70 glyceryl monostearate...... 66 goodsense cough dm...... 69 HEMATOGEN...... 70 glycine...... 66 goodsense eye drops...... 69 HEMATOGEN FA...... 70 glycine500...... 66 goodsense flu/cold/cough/night...... 69 HEMOCYTE...... 70 glycolic acid...... 66, 67 goodsense flu/cold/daytime...... 69 hemorrhoidal...... 70 glycopyrrolate...... 67 goodsense ibuprofen...... 69 hemorrhoidal cooling...... 70 GLYDO...... 67 goodsense ibuprofen childrens...... 69 hemorrhoidal max st/aloe...... 70 GLYXAMBI...... 67 goodsense ibuprofen infants...... 69 heparin (porcine) in nacl...... 70 g-myco nail...... 67 goodsense lancets 30g...... 69 heparin sodium (porcine)...... 71 gnp 24 hour nasal allergy...... 67 goodsense lancets 33g...... 69 heparin sodium (porcine) pf...... 71 gnp 4x probiotic...... 67 goodsense lubricant eye drops...... 69 HERCEPTIN...... 71 gnp advanced eye health...... 67 goodsense miconazole 1...... 69 hetastarch-nacl...... 71 gnp alcohol denatured...... 67 goodsense nicotine...... 69 HEXALEN...... 71 gnp alcohol swabs...... 67 goodsense nighttime cold & flu...... 69 HIBICLENS...... 71 gnp animal shapes plus iron...... 67 goodsense petroleum jelly...... 69 high potency iron...... 71 gnp b-50 complex...... 67 goodsense redness relief plus...... 69 histaflex...... 71 gnp b-complex plus vitamin c...... 67 goodsense sinus congest/pain...... 69 HISTEX...... 71 gnp calamine...... 67 goodsense sleeptime...... 69 HISTEX PD...... 71 gnp calcium 600 plus d/mineral...... 67 goodsense sore throat spray...... 69 HISTEX PDX...... 71 gnp calcium plus 600 +d...... 67 gordomatic...... 69 HISTEX-AC...... 71 gnp capsaicin...... 67 GORDONS NO 5...... 69 HISTEX-DM...... 71 gnp childrens chewables/ex c...... 67 gordons urea...... 69 HISTEX-PE...... 71 gnp coq-10 & fish oil...... 67 GORDONS-VITE A...... 69 hm calamine...... 71 gnp ethyl alcohol...... 67 GORDO-POOL...... 69 hm castor oil...... 71 gnp fish oil...... 67 GRANDPAS OATMEAL SOAP...... 69 hm clear fiber...... 71 gnp gentian violet...... 67 GRANDPAS THYLOX SOAP...... 69 hm ethyl rubbing alcohol...... 71 gnp glycerin/rose water...... 67 GRANIX...... 69 hm iodides...... 71 gnp headache relief extra str...... 67 grape seed...... 69 hm iodine...... 71 gnp insulin syringe...... 67 green soap...... 69 hm iron...... 71 gnp iodides...... 67 green tea extract...... 69 hm melatonin quick dissolve...... 71 gnp iodine...... 67 griseofulvin microsize...... 69 hm nighttime sleep aid...... 71 gnp isopropyl alcohol wipes...... 67 grx wound...... 69 hm omeprazole...... 71 gnp lancets...... 67 G-TRON PED...... 69 hm probiotic digestive health...... 71 gnp lancets 21g...... 67 G-TUSICOF...... 69 hm rolled gauze bandage...... 71 gnp lancets micro thin 33g...... 67 guaifenesin...... 69 HM SALONPAS PAIN RELIEF...... 71 gnp lancets super thin 30g...... 67 guaifenesin-codeine...... 69 hm severe cold/cough/flu...... 71 gnp lancets thin 26g...... 67 guanfacine hcl...... 70 hm super vitamin b12...... 71 gnp lice egg remover...... 68 guanfacine hcl er...... 70 hm vitamin b12...... 71 gnp liquid bandage...... 68 guanidine hcl...... 70 hm z-sleep...... 71 gnp l-lysine...... 68 gumsol...... 70 HOLD...... 71 gnp micro thin lancets 33g...... 68 GYNE-LOTRIMIN...... 70 HOMATROPAIRE...... 71 gnp niacin...... 68 GYNE-LOTRIMIN 3...... 70 HONEY BEARS W/IRON-ZINC...... 71 gnp omeprazole...... 68 H2Q...... 70 HPR PLUS HYDROGEL...... 71 gnp pain relief/benzocaine...... 68 halobetasol propionate...... 70 hrt essential...... 71 gnp peppermint spirit...... 68 haloperidol...... 70 huber needle...... 71 gnp potassium...... 68 haloperidol decanoate...... 70 HUGGIES NATURAL CARE WIPES..71 gnp shampoo & body wash...... 68 haloperidol lactate...... 70 HUMALOG...... 72 gnp sinus wash refill...... 68 hand wipes...... 70 HUMALOG MIX 50/50...... 72 gnp sodium silicate...... 68 HARD NAILS...... 70 HUMALOG MIX 75/25...... 72 gnp super thin lancets 30g...... 68 HAVRIX...... 70 HUMATE-P...... 72 gnp terbinafine hydrochloride...... 68 HC DERMAPAX...... 70 humidifier...... 72 gnp ultra com insulin syringe...... 68 H-CHLOR 12...... 70 HUMIRA...... 72 gnp urinary pain relief...... 68 H-CHLOR 6...... 70 HUMIRA PEDIATRIC CROHNS gnp vitamin d super strength...... 68 headache relief pm...... 70 START...... 72 170 HUMIRA PEN...... 72 ICAR-C...... 74 IONSYS...... 77 HUMIRA PEN-CD/UC/HS STARTER.72 ice blue...... 75 IPOL...... 77 HUMIRA PEN-PS/UV/ADOL HS ICY HOT...... 75 ipratropium bromide...... 77 START...... 72 ICY HOT LIDOCAINE PLUS ipratropium-albuterol...... 77 HUMULIN 70/30...... 72 MENTHOL...... 75 irinotecan hcl...... 77 HUMULIN 70/30 KWIKPEN...... 72 idarubicin hcl...... 75 IROFOL...... 77 HUMULIN N...... 72 IFEX...... 75 iron (ferrous sulfate)...... 77 HUMULIN N KWIKPEN...... 72 ifosfamide...... 75 iron 100 plus...... 77 HUMULIN R...... 72 imatinib mesylate...... 75 iron 100/c...... 77 HUMULIN R U-500 imipramine hcl...... 75 iron 21/7...... 77 (CONCENTRATED)...... 72 imipramine pamoate...... 75 iron 27...... 77 HUMULIN R U-500 KWIKPEN...... 72 imiquimod...... 75 iron chews pediatric...... 77 HURRICAINE...... 72, 73 immune support...... 75 iron slow release...... 77 HURRICAINE ONE...... 73 IMODIUM A-D...... 75 irrigating eyewash...... 77 HURRIVIEW...... 73 IMODIUM MULTI-SYMPTOM ISENTRESS...... 77 HURRIVIEW II...... 73 RELIEF...... 75 ISENTRESS HD...... 77 HYALGAN...... 73 IMOVAX RABIES...... 75 isoleucine...... 77 HYCAMTIN...... 73 IMPROVUE...... 75 ISOLEUCINE 1000...... 77 hydralazine hcl...... 73 indapamide...... 75 isomalt lollipop base...... 77 HYDROCELL ADHESIVE indole-3-carbinol...... 75 isoniazid...... 77 DRESSING...... 73 indomethacin...... 75 isopropyl alcohol...... 77 hydrocerin...... 73 indomethacin er...... 75 isopropyl alcohol (rubbing)...... 77 hydrochloric acid...... 73 INFANRIX...... 75 isopropyl alcohol wipes...... 77 hydrochlorothiazide...... 73 infants gas relief...... 75 isopropyl myristate...... 77 hydrocod polst-cpm polst er...... 73 INFED...... 75 isopropyl palmitate...... 77 hydrocodone-acetaminophen...... 73 INFUMORPH 200...... 75 ISOPTO TEARS...... 77 hydrocodone-homatropine...... 73 INFUMORPH 500...... 75 isosorbide dinitrate...... 78 hydrocodone-ibuprofen...... 73 inositol...... 75 isosorbide dinitrate er...... 77 hydrocortisone...... 73 inositol hexanicotinate...... 75 isosorbide mononitrate...... 78 hydrocortisone ace-pramoxine...... 73 INOSITOL-5...... 75 isosorbide mononitrate er...... 78 hydrocortisone butyrate...... 73 INSPIRACHAMBER/LARGE...... 75 isradipine...... 78 hydrocortisone valerate...... 73 INSPIRACHAMBER/MEDIUM...... 75 itch relief...... 78 HYDROGEL...... 73 INSPIRACHAMBER/MOUTHPIECE..75 ITCH-X...... 78 hydromet...... 74 INSPIRACHAMBER/SMALL...... 75 itraconazole...... 78 hydromorphone hcl...... 74 INSPIREASE...... 75 IVAREST MEDICATED POISON hydromorphone hcl pf...... 74 INSTACLEAN...... 76 IVY...... 78 hydrophilic...... 74 INSTA-GLUCOSE...... 76 IVAREST POISON IVY ITCH...... 78 hydrophilic petrolatum...... 74 instant ear-dry...... 76 ivermectin...... 78 hydroxychloroquine sulfate...... 74 instant hand sanitizer...... 76 ivy wash poison ivy cleanser...... 78 hydroxyprogesterone caproate...... 74 INSTAT...... 76 IXEMPRA KIT...... 78 hydroxypropyl cellulose...... 74 INSUFLON...... 76 IXIARO...... 78 hydroxyurea...... 74 insulin syringe...... 76 J & J ALL-PURPOSE FIRST AID...... 78 hydroxyzine hcl...... 74 insulin syringe/needle...... 76 J & J DENTAL FLOSS FOR KIDS...... 78 hydroxyzine pamoate...... 74 INSUPEN ULTRAFIN...... 76 JANTOVEN...... 78 HYLATOPIC PLUS...... 74 INTEGRA...... 76 JANUMET...... 78 HYOPHEN...... 74 INTELENCE...... 76 JANUMET XR...... 78 hyoscyamine sulfate...... 74 intense cough reliever ex st...... 76 JANUVIA...... 78 hyoscyamine sulfate er...... 74 INTERDRY AG TEXTILE 10"X144".. 76 JARDIANCE...... 78 hyoscyamine sulfate sl...... 74 INTRASITE GEL APPLIPAK...... 76 JENTADUETO...... 78 HYPERCARE...... 74 INTRON A...... 76 jessners...... 78 HYPERRHO S/D...... 74 INTROVALE...... 76 jock itch spray...... 78 hypodermic needle...... 74 INVEGA SUSTENNA...... 76 JOHNSONS BABY CORNSTARCH....78 HYPOTEARS...... 74 INVEGA TRINZA...... 76 JOHNSONS BABY OIL GEL...... 78 hypromellose...... 74 INVIRASE...... 76 JOHNSONS BABY POWDER...... 78 HYSEPT...... 74 INVOKANA...... 76 JUNEL 1/20...... 78 HYVEE ADVANCED ANTACID...... 74 iodides tincture...... 76 JUVEN...... 78 HY-VEE LANCETS...... 74 iodine...... 76, 77 k 100...... 78 hy-vee thin lancets...... 74 iodine strong...... 77 k-99...... 78 ibandronate sodium...... 74 iodine strong (lugol's)...... 77 KAITLIB FE...... 78 ibuprofen...... 74 iodine tincture...... 77 KALBITOR...... 78 ibuprofen 100 junior strength...... 74 iodoform...... 77 KALETRA...... 78 ibuprofen pm...... 74 IONIL...... 77 KANGAROO ENTRIFLUSH PUMP ICAR...... 74 IONIL-T...... 77 SET...... 78 171 KANGAROO JOEY PUMP SET...... 78 kpn prenatal...... 80 l-cysteine hcl...... 82 KANK-A MOUTH PAIN...... 79 kroger insulin syringe...... 80, 81 l-cystine...... 82 KANK-A SOFTBRUSH...... 79 kroger lancets...... 81 leader insulin syringe...... 82, 83 kaolin...... 79 kroger lancets 21g...... 81 lecithin...... 83 KAOPECTATE...... 79 kroger lancets micro thin 33g...... 81 lecithin-kelp-b6-cider vinegar...... 83 KAPVAY...... 79 kroger lancets super thin...... 81 leflunomide...... 83 karaya gum...... 79 kroger lancets thin...... 81 lemon bioflavanoid...... 83 KARBOZYME...... 79 kroger lancets thin 26g...... 81 lemon oil...... 83 K-BICARB...... 79 kroger lancets ultrathin 30g...... 81 lemon-glycerin...... 83 KELNOR 1/35...... 79 KT TAPE PRO...... 81 LENZAPATCH...... 83 kelp...... 79 K-TAN PLUS...... 81 LETAIRIS...... 83 kelp-b6-lecithin-vinegar...... 79 KUVAN...... 81 letrozole...... 83 KENALOG...... 79 KWAN LOONG PAIN RELIEVING....81 leucine...... 83 KENDALL ALGINATE DRESS KYLEENA...... 81 leucovorin calcium...... 83 8"X8"...... 79 labetalol hcl...... 81 LEUKERAN...... 83 KENDALL ANTIMICROBIAL LAC-HYDRIN FIVE...... 81 leuprolide acetate...... 83 BANDAGE...... 79 LAC-HYDRIN TWELVE...... 81 levalbuterol hcl...... 83 KENDALL CA ALGINATE 6"X10".... 79 lactated ringers...... 81 levalbuterol tartrate...... 83 KENDALL HYDROPHILIC FOAM lactic acid...... 81 LEVEMIR...... 83 DRESS...... 79 lactic acid e...... 81 LEVEMIR FLEXTOUCH...... 83 KENDALL TRANSPARENT FILM lacto-bifidus-600...... 81 levetiracetam...... 83 DRESS...... 79 lactose...... 81 levetiracetam er...... 83 KEPIVANCE...... 79 lactose monohydrate...... 81 levetiracetam in nacl...... 83 KERAMATRIX REPLICINE l-alanine...... 81 levobunolol hcl...... 83 10CMX10CM...... 79 LAMISIL ADVANCED...... 81 levocarnitine...... 83 KERR TRIPLE DYE SWABS...... 79 LAMISIL AT...... 81 levocarnitine (dietary)...... 83 ketoconazole...... 79 LAMISIL AT SPRAY...... 81 levocarnitine-b5-taurine...... 83 ketorolac tromethamine...... 79 LAMISILK PROTECT...... 81 levocetirizine dihydrochloride...... 83 KETOSTIX...... 79 lamivudine...... 81 levofloxacin...... 83, 84 kettle neti pot sinus wash...... 79 lamivudine-zidovudine...... 81 levoleucovorin calcium...... 84 KEY OMEGA...... 79 lamotrigine...... 81 LEVO-T...... 84 k-iii...... 79 lamotrigine er...... 81 LEXIVA...... 84 KINERASE...... 79 LANACANE ANTI-BACTERIAL...... 82 l-glutamic acid...... 84 kinney lancets...... 79 LANACANE MAXIMUM l-glutamine...... 84 kinney thin lancets...... 79 STRENGTH...... 82 l-glutathione...... 84 kinray insulin syringe...... 79, 80 lancets...... 82 l-histidine...... 84 KINRIX...... 80 lancets 28g...... 82 LIALDA...... 84 KIONEX...... 80 lancets 30g...... 82 LICE B GONE...... 84 KITABIS PAK...... 80 lancets micro thin 33g...... 82 LICE B GONE CAP SATURATED...... 84 KLOR-CON...... 80 lancets super thin 28g...... 82 lice cure...... 84 KLOR-CON 10...... 80 lancets thin...... 82 lice killing maximum strength...... 84 KLOR-CON M10...... 80 LANCETS ULTRA THIN...... 82 LICEFREEE...... 84 KLOR-CON M15...... 80 lancets ultra thin 30g...... 82 LICEMD COMPLETE...... 84 KLOR-CON M20...... 80 lanolin...... 82 LICIDE TREATMENT...... 84 KLOR-CON SPRINKLE...... 80 lanolin anhydrous...... 82 lidocaine...... 84 kls cold & flu ms day/night...... 80 lanolin hydrous-grx...... 82 lidocaine hcl...... 84 kls esomeprazole magnesium...... 80 lansoprazole...... 82 lidocaine viscous...... 84 kls omeprazole...... 80 LANTUS...... 82 lidocaine-hydrocortisone ace...... 84 K-MAG...... 80 LANTUS SOLOSTAR...... 82 lidocaine-prilocaine...... 84 K-MAG ASPARTATE...... 80 l-arginine...... 82 lidocaine-transparent dressing...... 84 K-MAG-70...... 80 l-arginine hcl...... 82 LIDOPATCH PAIN RELIEF...... 84 kmart valu insulin syringe 29g...... 80 LARIN 1/20...... 82 LIDOPRO...... 84 kmart valu insulin syringe 30g...... 80 l-aspartic acid...... 82 LIDOZENGEL...... 84 kojic acid...... 80 latanoprost...... 82 LILETTA (52 MG)...... 84 KONSYL...... 80 LATUDA...... 82 lime oil...... 84 konsyl daily fiber...... 80 lavender oil...... 82 limencin...... 84 KONSYL-D...... 80 laxative...... 82 lindane...... 84 korean ginseng...... 80 laxative pills...... 82 linezolid...... 84 kp hydrocortisone-aloe...... 80 LAZANDA...... 82 LINZESS...... 84 kp mag-oxide magnesium...... 80 l-carnitine...... 82 liothyronine sodium...... 84 kp silicone scar therapy gel...... 80 l-carnitine hcl...... 82 lip balm...... 85 K-PHOS...... 80 l-citrulline...... 82 lip balm base natural...... 85 K-PHOS NO 2...... 80 l-cysteine...... 82 LIP MEDEX...... 85 172 lipochol nr...... 85 l-phenylalanine...... 87 MAOX...... 89 lipochol plus...... 85 l-proline...... 87 MAPAP HEADACHE PLUS...... 89 LIPO-GEL...... 85 l-serine...... 87 MAR-COF BP...... 89 lipoic acid...... 85 l-tyrosine...... 87 MAR-COF CG EXPECTORANT...... 89 LIPOIL...... 85 lubricant drops/dual-action...... 87 marshmallow artificial flavor...... 89 LIPOTRIAD...... 85 lubricant eye drops...... 87 MASTISOL ADHESIVE...... 89 LIPOTRIAD VISIONARY...... 85 LUBRISKIN...... 87 MATULANE...... 89 lipovan base...... 85 LUCENTIS...... 87 MAVYRET...... 89 LIQ-10...... 85 LUDENS COUGH DROPS...... 87 MAXI-COMFORT INSULIN LIQSORB...... 85 LUDENS THROAT DROPS...... 87 SYRINGE...... 89 LIQUACEL...... 85 LUPRON DEPOT (1-MONTH)...... 87 MAXIMUM D3...... 89 LIQUIMAT...... 85 LUPRON DEPOT (3-MONTH)...... 87 ME-500...... 89 lisinopril...... 85 LUPRON DEPOT (4-MONTH)...... 87 mecholyl...... 89 lisinopril-hydrochlorothiazide...... 85 LUPRON DEPOT (6-MONTH)...... 87 meclizine hcl...... 89 l-isoleucine...... 85 LUPRON DEPOT-PED (1-MONTH)....87 MEDADYNE ORAL PAIN RELIEF.... 89 LISTERINE NATURALS LUPRON DEPOT-PED (3-MONTH)....87 MEDERMA...... 89 ANTISEPTIC...... 85 lutein...... 87 MEDERMA AG FACIAL lite touch lancets...... 85 LUVENA FEMININE WIPES...... 87 CLEANSER...... 89 LITETOUCH INSULIN SYRINGE...... 85 LYCELLE...... 87 MEDERMA PM...... 89 LITETOUCH LANCETS...... 85 LYRICA...... 87 medic insulin syringe...... 89 lithium...... 86 lysine4000...... 87 medicated body...... 89 lithium carbonate...... 86 LYSODREN...... 87 medicated douche...... 89 lithium carbonate er...... 86 M2 C...... 87 medicated wipes...... 90 LITTLE COLDS COUGH FORMULA.86 MAALOX...... 88 MEDICONE...... 90 LITTLE COLDS DECONGESTANT... 86 MAALOX ADVANCED MAX ST...... 88 MEDI-DERM/L-RX...... 90 LITTLE REMEDIES POISON MAALOX JUNIOR PLUS ANTIGAS..88 MEDI-DERM-RX...... 90 TREAT...... 86 MACUGEN...... 88 MEDI-FIRST ANTISEPTIC LITTLE TUMMYS LAXATIVE...... 86 mafenide hcl...... 88 CLEANER...... 90 LIVALO...... 86 MAG-200...... 88 MEDI-FIRST/LIDOCAINE...... 90 live better lancet super thin...... 86 mag-al...... 88 MEDIHONEY WOUND/BURN live better lancet ultra thin...... 86 magdelay...... 88 DRESSING...... 90 liver...... 86 MAGELLAN INSULIN SAFETY medi-laxx...... 90 liver extract...... 86 SYR...... 88 MEDI-LYTE...... 90 l-lysine...... 86 MAGIC3 INTERMITTENT medi-patch-lidocaine...... 90 l-lysine hcl...... 86 CATHETER...... 88 MEDIPLAST...... 90 l-methionine...... 86 MAGIMIN...... 88 MEDIPORE + PAD ADHESIVE LMX 4...... 86 magnacaps...... 88 DRESS...... 90 LMX 4 PLUS...... 86 MAGNEBIND 200...... 88 MEDISENSE GLUCOSE KETONE LO LOESTRIN FE...... 86 MAGNEBIND 300...... 88 CONTR...... 90 local anesthesia needle...... 86 magnesium...... 88 MEDISENSE HI/MID/LOW LODRANE D...... 86 magnesium aspartate...... 88 CONTROL...... 90 LOHIST-D...... 86 magnesium carbonate...... 88 MEDISENSE HIGH/LOW CONTROL 90 lohist-dm...... 86 magnesium carbonate heavy...... 88 MEDISENSE MID CONTROL...... 90 longs insulin syringe...... 86 magnesium chloride...... 88 MEDISENSE THIN LANCETS...... 90 longs lancets thin...... 86 magnesium chloride-calcium...... 88 medi-tussin dm double strength...... 90 loperamide hcl...... 86 magnesium citrate...... 88 MEDROX...... 90 lopinavir-ritonavir...... 86 magnesium fizz-plus...... 88 medroxyprogesterone acetate...... 90 loratadine...... 86 magnesium gluconate...... 88 mefenamic acid...... 90 loratadine childrens...... 86 magnesium oxide...... 88 mefloquine hcl...... 90 lorazepam...... 86 magnesium stearate...... 88 mega coq10...... 90 LORAZEPAM INTENSOL...... 86 magnesium sulfate...... 89 MEGA MULTIVITAMIN...... 90 l-ornithine...... 86 magnum-75...... 89 megestrol acetate...... 90 l-ornithine hydrochloride...... 86 MAGONATE...... 89 meijer alcohol swabs...... 90 LORTUSS DM...... 86 mag-sr plus calcium...... 89 MEIJER LANCETS...... 90 LORTUSS EX...... 86 MAG-TAB SR...... 89 MEIJER LANCETS THIN...... 90 LORTUSS LQ...... 86 MAKENA...... 89 MEIJER LANCETS UNIVERSAL losartan potassium...... 87 malathion...... 89 21G...... 90 losartan potassium-hctz...... 87 malic acid...... 89 MEIJER LANCETS UNIVERSAL LOTRIMIN AF...... 87 manganese...... 89 33G...... 90 LOTRIMIN ULTRA...... 87 manganese aspartate...... 89 MEIJER SUPER THIN LANCETS...... 90 lovastatin...... 87 manganese gluconate...... 89 melatonin...... 91 loxapine succinate...... 87 MANGIMIN...... 89 melatonin er...... 91 LOZIBASE S...... 87 mannitol...... 89 melatonin tr...... 91 173 MELLOW-TONE...... 91 METROLOTION...... 93 MONOJECT MAGELLAN SYRINGE.95 meloxicam...... 91 metronidazole...... 93 MONOJECT SYRINGE...... 95 melphalan...... 91 metronidazole in nacl...... 93 MONOJECT ULTRA COMFORT melphalan hcl...... 91 mexiletine hcl...... 93 SYRINGE...... 95, 96 memantine hcl...... 91 MEXSANA...... 93 MONOLET LANCETS...... 96 memantine hcl er...... 91 MG/TAURINE FORTE...... 93 MONOLET OPD LANCETS...... 96 MENACTRA...... 91 MI PASTE PLUS...... 93 MONOVISC...... 96 mencaps...... 91 MIBELAS 24 FE...... 93 montelukast sodium...... 96 m-end dmx...... 91 MICATIN...... 93 MONUROL...... 96 M-END PE...... 91 miconazole 3...... 93 MORPHABOND ER...... 96 MENEST...... 91 miconazole 7...... 93 morphine sulfate...... 96, 97 menstrual pain relief...... 91 miconazole nitrate...... 93 morphine sulfate (concentrate)...... 96 menstrual relief max strength...... 91 microfiber cleaning cloths...... 93 morphine sulfate (pf)...... 96 menthol...... 91 MICROGESTIN 1/20...... 93 morphine sulfate er...... 96 MENVEO...... 91 MICROKLENZ...... 93 morphine sulfate er beads...... 96 meperidine hcl...... 91 MICROLET LANCETS...... 93 MOTRIN INFANTS DROPS...... 97 mercaptopurine...... 91 midazolam hcl...... 93 mouth rinse...... 97 mesalamine...... 91 midodrine hcl...... 93 MOVANTIK...... 97 mesalamine-cleanser...... 91 MIDOL CAFFEINE FREE...... 93 MOXEZA...... 97 mesna...... 91 MIDOL COMPLETE...... 93 moxifloxacin hcl...... 97 MESNEX...... 91 MIGERGOT...... 93 MOZOBIL...... 97 MESTINON...... 91 miglitol...... 93 ms insulin syringe...... 97 METAMUCIL...... 91 miglustat...... 94 MUCINEX...... 98 METAMUCIL MULTIHEALTH MIL-A-MULSION...... 94 MUCINEX COUGH CHILDRENS...... 97 FIBER...... 91 MILCO-ZYME...... 94 MUCINEX COUGH FOR KIDS...... 97 METAMUCIL SMOOTH TEXTURE...91 milk of magnesia concentrate...... 94 MUCINEX D...... 97 metaproterenol sulfate...... 91 MILLGUARD...... 94 MUCINEX D MAX STRENGTH...... 97 METAXALL...... 91 MILTAB #1...... 94 MUCINEX DM...... 97 metformin hcl...... 92 mineral oil...... 94 MUCINEX DM MAXIMUM metformin hcl er...... 92 mineral oil light...... 94 STRENGTH...... 97 methadone hcl...... 92 mineral oil-hydrophil petrolat...... 94 MUCINEX FAST-MAX...... 97 METHADONE HCL INTENSOL...... 92 MINIMED GUARDIAN LINK 3...... 94 MUCINEX FAST-MAX COLD & methazolamide...... 92 MINIMED PRO-SET INFUSION 42".. 94 SINUS...... 97 methenamine hippurate...... 92 MINITRAN...... 94 MUCINEX FAST-MAX COLD FLU... 97 methenamine mandelate...... 92 minocycline hcl...... 94 MUCINEX FAST-MAX CONGEST methimazole...... 92 minoxidil...... 94 COUGH...... 97 methionine...... 92 minoxidil for women...... 94 MUCINEX FAST-MAX DAY/NIGHT.97 methitest...... 92 MIRALAX...... 94 MUCINEX FAST-MAX DAY/NIGHT methocarbamol...... 92 MIRCERA...... 94 M/S...... 97 methotrexate...... 92 MIRENA (52 MG)...... 94 MUCINEX FAST-MAX DAY/NIGHT methotrexate sodium...... 92 mirtazapine...... 94 TAB...... 97 methotrexate sodium (pf)...... 92 misoprostol...... 94 MUCINEX FOR KIDS...... 97 methyl alcohol...... 92 mitomycin...... 94 MUCINEX MAXIMUM STRENGTH..98 methyl salicylate...... 92 mitoxantrone hcl...... 94 MUCINEX SINUS-MAX methyl sulfone...... 92 M-M-R II...... 94 CONGESTION...... 98 methylcellulose...... 92 mn-50...... 94 MUCINEX SINUS-MAX methylcobalamin...... 92 moexipril hcl...... 94 DAY/NIGHT...... 98 methyldopa...... 92 moexipril-hydrochlorothiazide...... 94 MUCINEX SINUS-MAX PRESS & methylparaben...... 92 moisture barrier...... 94 PAIN...... 98 methylphenidate hcl...... 92 MOISTURE GUARD...... 94 MUCINEX STUFFY NOSE/COLD methylphenidate hcl er...... 92 MOISTUREL...... 94 CHILD...... 98 methylprednisolone...... 92 moisturizing skin protectant...... 94 mucus relief cold/sinus max st...... 98 methylprednisolone acetate...... 92 molybdenum...... 94 mucus relief d...... 98 methylprednisolone sodium succ...... 92 mometasone furoate...... 94, 95 mucus relief er...... 98 metipranolol...... 93 MONOCAL...... 95 mucus relief pe...... 98 metoclopramide hcl...... 93 MONOJECT ALLERGIST TRAY...... 95 mucus-dm max...... 98 metolazone...... 93 MONOJECT BLUNTIP CANNULA.... 95 multi-delyn/iron...... 98 metoprolol succinate er...... 93 MONOJECT HYPODERMIC multi-draw needle...... 98 metoprolol tartrate...... 93 NEEDLE...... 95 MULTIGEN...... 98 metoprolol-hydrochlorothiazide...... 93 MONOJECT INSULIN SYRINGE...... 95 MULTIGEN FOLIC...... 98 METRO...... 93 MONOJECT LIFESHIELD SYRINGE.95 MULTIGEN PLUS...... 98 METROCREAM...... 93 MONOJECT MAGELLAN SAFETY multi-minerals...... 98 METROGEL...... 93 NDL...... 95 multi-purpose cold compress...... 98 174 multi-symptom cold plus child...... 98 NECON 0.5/35 (28)...... 100 nimodipine...... 102 multi-vit/fluoride...... 98 neomycin sulfate...... 100 NINJACOF...... 102 multivitamin gummies childrens...... 98 neomycin-bacitracin zn-polymyx...... 100 NINJACOF-A...... 102 multivitamins/fluoride...... 98 neomycin-polymyxin b gu...... 100 NINJACOF-XG...... 102 mupirocin...... 98 neomycin-polymyxin-dexameth...... 100 NIPENT...... 102 MURI-LUBE...... 98 neomycin-polymyxin-gramicidin...... 100 NISEKO SUNSCREEN SPF 25...... 102 MURO 128...... 98 neomycin-polymyxin-hc...... 100 nisoldipine er...... 102 muscle rub ultra strength...... 98 NEOSPORIN + PAIN RELIEF MAX NITEBITE...... 102 mustard oil...... 98 ST...... 100 nite-time cold/flu relief...... 102 MUSTARGEN...... 98 NEOSPORIN ORIGINAL...... 100 NITRO-BID...... 102 M-VIT...... 98 NEOSPORIN PLUS MAX ST...... 100 nitrofurantoin...... 102 MYCOCIDE CX CALLUS NEOSPORIN PLUS PAIN RELIEF nitrofurantoin macrocrystal...... 102 EXFOLIATOR...... 98 MS...... 100 nitrofurantoin monohyd macro...... 102 mycophenolate mofetil...... 98 NEOSTRATA FACIAL CLEANSER. 100 nitroglycerin...... 102 mycophenolate sodium...... 99 NEOTUSS-D...... 100 nitroglycerin er...... 102 MYGLUCOHEALTH LANCETS 30G.99 NEPHRONEX...... 100 NIVANEX DMX...... 102 MYLANTA...... 99 NEPHRO-VITE...... 100 NIX CREME RINSE...... 102 MYLERAN...... 99 NEULASTA...... 100 nizatidine...... 102 MYNATAL...... 99 NEUPOGEN...... 100 NIZORAL A-D...... 102 mynate 90 plus...... 99 NEURO-K-250 T.D...... 101 NOBLE FORMULA...... 102 mynephrocaps...... 99 neuromax...... 101 NOBLE FORMULA HC...... 102 MYOBLOC...... 99 NEUROPEN...... 101 nohist-lq...... 102 MYORISAN...... 99 NEUROTIPS...... 101 NOKOR ADMIX NEEDLE...... 102 nabumetone...... 99 NEUTROGENA BODY...... 101 non-stick...... 102 nac...... 99 NEUTROGENA CLEAR PORE...... 101 NOREL AD...... 102 nadolol...... 99 NEUTROGENA T/GEL STUBBORN NOREL CS...... 102 nadolol-bendroflumethiazide...... 99 ITCH...... 101 norethindrone acetate...... 103 NAIL SCRUB...... 99 nevirapine...... 101 norethindrone acet-ethinyl est...... 103 NAIL-EX...... 99 nevirapine er...... 101 norgestim-eth estrad triphasic...... 103 nalbuphine hcl...... 99 NEW DIGNITY ODOR NORMLSHIELD...... 103 naloxone hcl...... 99 ELIMINATOR...... 101 nortriptyline hcl...... 103 naltrexone hcl...... 99 NEW IMAGE SKIN NORVIR...... 103 NAMENDA XR TITRATION PACK...99 BARRIER/FLANGE...... 101 NO-STING SKIN-PREP...... 103 NAMZARIC...... 99 NEW IMAGE SKIN/FLANGE/TAPE 101 NOVA SUREFLEX LANCETS...... 103 NAPHCON-A...... 99 new terocin...... 101 NOVAFERRUM 125...... 103 naproxen...... 99 NEXAFED...... 101 NOVAFERRUM 50...... 103 naproxen dr...... 99 NEXAFED SINUS PRESSURE + NOVAFERRUM PEDIATRIC DROPS naproxen sodium...... 99 PAIN...... 101 ...... 103 naratriptan hcl...... 99 NEXAVAR...... 101 NOVOLOG...... 103 NARCAN...... 99 NEXCARE PREMIUM ADHESIVE NOVOLOG FLEXPEN...... 103 NASACORT ALLERGY 24HR...... 99 GAUZE...... 101 NOVOLOG MIX 70/30...... 103 NASACORT ALLERGY 24HR NEXIUM 24HR...... 101 NOVOLOG MIX 70/30 FLEXPEN.....103 CHILDREN...... 99 NEXPLANON...... 101 NOVOLOG PENFILL...... 103 nasal allergy 24 hour...... 99 niacin...... 101 NOXICARE...... 103 nasal aspirator...... 99 niacin er...... 101 np thyroid...... 103 nasal decongestant...... 99 niacin er (antihyperlipidemic)...... 101 NPLATE...... 103 nasal decongestant spray...... 99 niacin flush free...... 101 NUEDEXTA...... 103 NASAL EASE ALLERGY niacinamide...... 101 NUFERA...... 103 RELIEVER...... 99 nicardipine hcl...... 101 NU-GEL...... 103 NASALCROM...... 99 NICODERM CQ...... 101 NU-MAG...... 103 NASOGEL...... 100 NICORETTE...... 101 NUPERCAINAL...... 103 NASONEB NEBULIZER STARTER. 100 nicotinamide adenine dinucleo...... 101 NUTRA BALANCE PROTEIN NASOPEN PE...... 100 nicotine...... 102 COOKIE...... 103 NATACYN...... 100 nicotine polacrilex...... 102 NUTRA SHAKE...... 103 natapres...... 100 nicotine step 1...... 102 NUTRA/PRO CHOCOLATE...... 103 nateglinide...... 100 nicotine step 2...... 102 NUTRATEAR...... 103 NATROBA...... 100 nicotine step 3...... 102 NUTR-E-SOL...... 103 natural bitterness...... 100 NICOTROL...... 102 nutritional shake high protein...... 103 natural fiber laxative...... 100 NIFEDICAL XL...... 102 NUTROPIN AQ NUSPIN 10...... 103 natural vitamin e moisturizing...... 100 nifedipine...... 102 NUTROPIN AQ NUSPIN 20...... 103 NATURAL WHEY...... 100 nifedipine er...... 102 NUTROPIN AQ NUSPIN 5...... 103 NATURE-THROID...... 100 nifedipine er osmotic release...... 102 NUVARING...... 104 NEBUPENT...... 100 nilutamide...... 102 NYAMYC...... 104 175 NYMALIZE...... 104 opium...... 105 pa fish oil/vit d3 triple st...... 108 nystatin...... 104 OPTICLEANSE GHI...... 105 pa glucosamine-chondroitin...... 108 nystatin-triamcinolone...... 104 OPTIONS CONCEPTROL...... 105 pa prenatal formula...... 108 NYSTOP...... 104 OPTIONS GYNOL II pa probiotic complex...... 108 NYTOL MAXIMUM STRENGTH.....104 CONTRACEPTIVE...... 106 paclitaxel...... 108 OASIS MOISTURIZING OPTIUM BLOOD GLUCOSE pain & fever childrens...... 108 MOUTHWASH...... 104 MONITOR...... 106 pain relief...... 108 OBSTETRIX DHA...... 104 OPTIUM GLUCOSE MONITOR pain relief day & night ex st...... 108 OBSTETRIX EC...... 104 SYSTEM...... 106 pain relief roll-on...... 108 OC8...... 104 OPTIUM TEST...... 106 pain reliever extra strength...... 108 OCEAN BLUE MINICAPS OPTIUMEZ TEST...... 106 pain reliever pm...... 108 D/OMEGA3...... 104 ORA-FILM...... 106 pain reliever pm ex st...... 108 OCEAN BLUE MINICAPS OMEGA- ORA-HESIVE BASE...... 106 pain reliever/fever reducer...... 108 3...... 104 oral analgesic max st...... 106 pain relieving...... 108 OCEAN BLUE OPTIMAL HEALTH.104 oral anesthetic...... 106 PALADIN...... 108 OCEAN COMPLETE SINUS RINSE.104 oral electrolytes...... 106 pamidronate disodium...... 108 OCEAN NASAL SPRAY...... 104 ORAL SWAB PETITE...... 106 pancreatin...... 108 oceanic selenium...... 104 oral syringe bottle adapter...... 106 PANCREAZE...... 108 OCUSOFT LID SCRUB ORALONE...... 106 PANOXYL...... 108 COMPLIANCE...... 104 ORAMAGIC PLUS...... 106 PANOXYL WASH...... 108 ODEFSEY...... 104 orange oil...... 106 PANOXYL-4 CREAMY WASH...... 108 ODOR EATERS ANTIFUNGAL...... 104 ORAZINC...... 106 panto-250...... 108 odor spray...... 104 ORFADIN...... 106 pantoprazole sodium...... 108 OFF ACTIVE...... 104 organic coconut oil...... 106 pantothenic acid...... 108 OFF FAMILYCARE CLEAN FEEL...104 ornithine...... 106 papaya enzyme...... 108 ofloxacin...... 104 orphenadrine citrate...... 106 paraffin wax beads...... 108 OGESTREL...... 104 orphenadrine citrate er...... 106 PARAGARD INTRAUTERINE olanzapine...... 104, 105 ORTHOVISC...... 106 COPPER...... 108 olive oil...... 105 OS-CAL...... 106 paricalcitol...... 108 olmesartan medoxomil...... 105 OS-CAL EXTRA D3...... 106 PARODONTAX...... 108 olmesartan medoxomil-hctz...... 105 OS-CAL ULTRA...... 106 paromomycin sulfate...... 108 olopatadine hcl...... 105 oseltamivir phosphate...... 106 paroxetine hcl...... 109 omega dha...... 105 OSTEO-PORETICAL...... 106 paroxetine hcl er...... 109 OMEGA POWER...... 105 ostomy protective...... 106 parvenzyme digestive enzyme...... 109 omega-3...... 105 ovulation predictor...... 106 PAZEO...... 109 omega-3 fish oil...... 105 oxalic acid...... 106 pc lancets super thin 30g...... 109 omega-3 fish oil ex st...... 105 oxaliplatin...... 106 PCCA MBK (FATTY ACID) BASE...109 omega-3 fish oil-vitamin d3...... 105 oxandrolone...... 106 peanut oil...... 109 OMEGA-3 IQ...... 105 oxaprozin...... 106 pearberry fragrance...... 109 omega-3-acid ethyl esters...... 105 oxazepam...... 106 PECGEN DMX...... 109 omeprazole...... 105 oxcarbazepine...... 106, 107 pectin...... 109 omeprazole magnesium...... 105 oxybutynin chloride...... 107 PEDIACARE CHILDRENS LONG- omeprazole-sodium bicarbonate...... 105 oxybutynin chloride er...... 107 ACT...... 109 OMNIFLEX DIAPHRAGM...... 105 oxycodone hcl...... 107 PEDIACARE CHILDRENS MULTI- ONCASPAR...... 105 oxycodone hcl er...... 107 SYMP...... 109 ondansetron...... 105 oxycodone-acetaminophen...... 107 PEDIACARE MULTI-SYMPTOM.....109 ondansetron hcl...... 105 oxycodone-ibuprofen...... 107 PEDIA-LAX...... 109 one step pregnancy...... 105 OXYCONTIN...... 107 PEDIA-LAX FIBER GUMMIES...... 109 ONE-A-DAY ADULT oxymorphone hcl...... 107 PEDIALYTE ADVANCED CARE.....109 VITACRAVES+DHA...... 105 oxymorphone hcl er...... 107 PEDIARIX...... 109 ONE-A-DAY WOMENS 50+ OXYTROL FOR WOMEN...... 107 PEDIAVENT...... 109 ADVANTAGE...... 105 OXYZAL WET DRESSING...... 107 PEDIAVIT...... 109 ONETOUCH DELICA LANCETS oyster calcium + d...... 107 PEDVAX HIB...... 109 33G...... 105 oyster calcium/d3...... 107 peg 300...... 109 ONETOUCH DELICA LANCETS oyster shell calcium...... 107 PEGANONE...... 109 FINE...... 105 oyster shell calcium 250+d...... 107 PEGASYS...... 109 ONETOUCH FINEPOINT LANCETS105 oyster shell calcium 500+d...... 107 PEGASYS PROCLICK...... 109 ONETOUCH PING METER oyster shell calcium plus d...... 107 PEGINTRON...... 109 REMOTE...... 105 oyster shell calcium/d...... 107 penicillin g potassium...... 109 ONETOUCH ULTRASOFT oyster shell calcium/d3...... 108 penicillin v potassium...... 109 LANCETS...... 105 P & S...... 108 PENTACEL...... 109 ONEXTON...... 105 p-1000...... 108 PENTASA...... 109 ONFI...... 105 PA CLA...... 108 pentoxifylline er...... 109 176 PENTRAX GOLD...... 109 PLIAGEL...... 111 prasugrel hcl...... 113 peppermint oil...... 110 PLO ULTRAMAX...... 111 pravastatin sodium...... 113 peppermint spirit...... 110 PLURONIC...... 111 prazosin hcl...... 113 PEPTO-BISMOL...... 110 pmx-1184 silicone...... 111 PRECISION GLUCOSE CONTROL..113 PEPTO-BISMOL MAX STRENGTH. 110 PNEUMOVAX 23...... 112 PRECISION GLUCOSE CONTROL PEPTO-BISMOL TO-GO...... 110 pnv-dha...... 112 SOLN...... 113 PERFORM ATOMIC HEAT...... 110 pnv-omega...... 112 PRECISION GLUCOSE KETONE PERFORM PAIN RELIEVING...... 110 pnv-select...... 112 CONTR...... 113 PERFORM PAIN RELIEVING podofilox...... 112 PRECISION GLUCOSE/KETONE ROLL-ON...... 110 podophyllum resin...... 112 CONTR...... 113 PERFOROMIST...... 110 poison ivy wash fast acting...... 112 PRECISION LINK...... 113 PERIDIN-C...... 110 POLAR FREEZE...... 112 PRECISION PCX...... 113 perindopril erbumine...... 110 poloxamer 188...... 112 PRECISION PCX PLUS TEST...... 113 PERIOMED...... 110 poly bacitracin...... 112 PRECISION POINT OF CARE TEST 113 permethrin...... 110 POLY HIST FORTE...... 112 PRECISION QID MONITOR...... 113 PERNOX...... 110 polyethylene glycol 1000...... 112 PRECISION QID TEST...... 113 PEROXYL...... 110 polyethylene glycol 1450...... 112 PRECISION SOF-TACT MONITOR..113 PEROXYL SPOT TREATMENT...... 110 polyethylene glycol 3350...... 112 PRECISION SOF-TACT TEST...... 113 perphenazine...... 110 polyethylene glycol 400...... 112 PRECISION SUREDOSE PLUS SYR perphenazine-amitriptyline...... 110 polyethylene glycol 8000...... 112 ...... 113, 114 PERRY PRENATAL...... 110 poly-hist dm...... 112 PRECISION SURE-DOSE SYRINGE 114 peruvian balsam...... 110 poly-hist pd...... 112 PRECISION THINS GP LANCETS... 114 petroleum jelly...... 110 polymyxin b sulfate...... 112 PRECISION XTRA...... 114 PHARMABASE BARRIER...... 110 polymyxin b-trimethoprim...... 112 PRECISION XTRA BLOOD PHARMACY COUNTER LANCETS 110 polyoxyl 40 stearate...... 112 GLUCOSE...... 114 PHAZYME MAXIMUM STRENGTH polysorbate 20...... 112 PRECISION XTRA KETONE...... 114 ...... 110 polysorbate 80...... 112 PRECISION XTRA MONITOR...... 114 PHAZYME ULTRA STRENGTH...... 110 POLYSPORIN...... 112 PRED MILD...... 114 PHENADOZ...... 110 poly-tussin ac...... 112 prednicarbate...... 114 PHENAZO...... 110 POLY-VENT DM...... 112 prednisolone...... 114 phenazopyridine hcl...... 110 POLY-VENT IR...... 112 prednisolone acetate...... 114 phenelzine sulfate...... 110 POLY-VI-SOL...... 112 prednisolone sodium phosphate...... 114 phenobarbital...... 110, 111 POLY-VI-SOL/IRON...... 112 prednisone...... 114 phenol...... 111 potassimin...... 112 PREDNISONE INTENSOL...... 114 PHENOL EZ SWABS...... 111 potassium bitartrate...... 112 preferred plus insulin syringe...... 114 phenoxybenzamine hcl...... 111 potassium bromide...... 112 preferred plus lancets colored...... 114 phentermine hcl...... 111 potassium chloride...... 112 preferred plus lancets thin...... 115 phenylalanine...... 111 potassium citrate...... 112 PREGNITUDE...... 115 phenytoin...... 111 potassium citrate er...... 112 PREMARIN...... 115 PHENYTOIN INFATABS...... 111 potassium citrate-citric acid...... 112 PREMIER UROSTOMY...... 115 phenytoin sodium...... 111 potassium gluconate...... 112 PREMPHASE...... 115 phenytoin sodium extended...... 111 potassium gluconate anhydrous...... 112 PREMPRO...... 115 PHLEXY-10...... 111 potassium hydroxide...... 112 prenatal...... 115 PHOS-FLUR ORTHO DEFENSE...... 111 potassium iodide...... 113 prenatal formula...... 115 phos-nak...... 111 potassium iodide (antidote)...... 113 prenatal formula a-free...... 115 PHOSPHASAL...... 111 potassium nitrate...... 113 prenatal low iron...... 115 phosphatidyl choline...... 111 potassium permanganate...... 113 prenatal multi +dha...... 115 phosphatidylcholine...... 111 potassium sodium tartrate...... 113 prenatal multivitamin plus dha...... 115 phosphatidylserine...... 111 potassium sorbate...... 113 PRENATE...... 115 PHOSPHOLINE IODIDE...... 111 povidone-iodine...... 113 PRENATE PIXIE...... 115 PHOTOFRIN...... 111 povidone-iodine paint sponge...... 113 prep protective skin barrier...... 115 phytonadione...... 111 povidone-iodine prep...... 113 PREPARATION H...... 115 PHYTOPLEX Z-GUARD...... 111 povidone-iodine scrub sponge...... 113 PREPARATION H TOTABLES...... 115 PIFELTRO...... 111 power oral care system...... 113 pres gen pediatric...... 115 pilocarpine hcl...... 111 PR NATAL 400...... 113 PRESGEN B...... 115 pimecrolimus...... 111 PR NATAL 400 EC...... 113 PRETZ...... 115 pindolol...... 111 PR NATAL 430...... 113 PREVACARE ANTIMICROBIAL..... 115 pioglitazone hcl...... 111 PR NATAL 430 EC...... 113 PREVACARE EXTRA PROTECTIVE pioglitazone hcl-glimepiride...... 111 PRADAXA...... 113 ...... 115 pioglitazone hcl-metformin hcl...... 111 PRALUENT...... 113 PREVACARE PERSONAL piroxicam...... 111 PRAMEGEL...... 113 PROTECT...... 115 PLAN B ONE-STEP...... 111 pramipexole dihydrochloride...... 113 PREVACARE TOTAL SKIN CARE.. 115 plasticized base...... 111 pramoxine hcl...... 113 PREVACID 24HR...... 115 177 PREVALITE...... 115 protriptyline hcl...... 117 quinapril hcl...... 119 PREVNAR 13...... 115 PROVENT SLEEP APNEA quinapril-hydrochlorothiazide...... 119 PREZCOBIX...... 115 THERAPY...... 117 quinidine gluconate er...... 119 PREZISTA...... 115 PROVENTIL HFA...... 118 quinidine sulfate...... 119 PRIFTIN...... 115 PROVIDA DHA...... 118 quinine sulfate...... 119 PRILOSEC OTC...... 115 PROVIEW...... 118 ra 8 hour pain relief...... 119 PRIMATENE ASTHMA...... 116 pseudoeph-bromphen-dm...... 118 ra acetaminophen flu cold...... 119 primidone...... 116 pseudoephedrine hcl...... 118 ra acid reducer plus antacid...... 119 PRO NUTRIENTS OMEGA 3...... 116 pseudoephedrine hcl er...... 118 ra acne maximum...... 119 PROAIR HFA...... 116 psorcon...... 118 ra advanced eye health...... 119 probenecid...... 116 PSS SELECT GP LANCETS...... 118 ra alcohol swabs...... 119 PROBIOMAX PLUS DF...... 116 PSS SELECT SAFETY LANCETS.....118 ra anorectal...... 120 probiotic...... 116 psyllium husk...... 118 ra antifungal pen...... 120 probiotic digestive support...... 116 PULMICORT...... 118 ra b-12...... 120 probiotic-prebiotic...... 116 PULMICORT FLEXHALER...... 118 ra back & body pain relief...... 120 PROCARE PLUS UNDERWEAR PULMOZYME...... 118 ra b-complex/vitamin c cr...... 120 MEDIUM...... 116 PURACYN PLUS DUO-CARE...... 118 ra ca/mg/zn/cu...... 120 PRO-CEPTION...... 116 pure l-citrulline...... 118 ra calamine...... 120 prochlorperazine...... 116 purefe ob plus...... 118 ra calcium hi-cal...... 120 prochlorperazine maleate...... 116 purified water...... 118 ra calcium hi-cal/vitamin d...... 120 PROCOMYCIN...... 116 PURILON...... 118 ra calcium high potency...... 120 PROCRIT...... 116 px allergy relief d...... 118 ra calcium-boron...... 120 PROCTOCORT...... 116 px allergy sinus pe...... 118 ra cold remedy multi-symptom...... 120 PROCTOFOAM...... 116 px antacid extra strength...... 118 ra cold/sinus max...... 120 PROCTOSOL HC...... 116 px artificial tears...... 118 ra corn cushions small...... 120 PRODIGY INSULIN SYRINGE...... 116 px daytime cold...... 118 ra corn removers ultra thin...... 120 PRODIGY NO CODING BLOOD px daytime multi-symptom...... 118 ra dark tanning...... 120 GLUC...... 116 px gas relief extra strength...... 118 ra day/night/cold/flu relief...... 120 PRODIGY TWIST TOP LANCETS px ibuprofen cold & sinus...... 118 ra daytime cold/flu relief...... 120 28G...... 116 px insulin syringe...... 118 ra ear wax cleansing system...... 120 PROFE...... 116 px lancets ultra thin...... 118 ra ethyl alcohol...... 120 PROFERRIN ES...... 116 px minoxidil for men...... 118 ra exfoliating moisturizer...... 120 PROFERRIN-FORTE...... 116 px nasal four...... 118 RA E-ZJECT COLOR LANCETS 33G PROFILNINE SD...... 116 px nitetime multi-symptom...... 118 ...... 120 progesterone...... 116 px omeprazole...... 118 RA E-ZJECT LANCETS 28G...... 120 progesterone micronized...... 117 PYLERA...... 118 RA E-ZJECT LANCETS THIN 26G...120 PROGLYCEM...... 117 pyrazinamide...... 118 RA E-ZJECT LANCETS THIN 28G...120 PROLENSA...... 117 pyridostigmine bromide...... 118 RA E-ZJECT LANCETS ULTRA PROLIA...... 117 pyridostigmine bromide er...... 118 THIN...... 120 PROLIDA...... 117 pyridoxal-5 phosphate...... 119 ra feminine care douche...... 120 PROMACTA...... 117 pyridoxine hcl...... 119 ra fever reducer/pain reliever...... 120 promethazine hcl...... 117 PYRIDOXINE/MINERALS...... 119 ra fiber weight management...... 120 promethazine vc/codeine...... 117 pyrilamine-phenylephrine...... 119 ra first aid iodine...... 120 promethazine-codeine...... 117 pyruvic acid...... 119 ra first aid non-stick...... 120 promethazine-dm...... 117 qc alcohol swabs...... 119 ra first aid saline wound wash...... 120 PROMETHEGAN...... 117 qc arthritis...... 119 ra fish oil...... 120 PROMOLAXIN...... 117 qc calamine...... 119 RA FISH OIL EXTRA STRENGTH...120 PRONUTRIENTS CALCIUM+D3..... 117 qc castor oil...... 119 ra foaming hand soap refill...... 120 PRONUTRIENTS SUPER B qc iodides...... 119 ra gel toe separator...... 120 COMPLEX...... 117 qc iodine tincture...... 119 ra glucosamine-chondroitin...... 120 propafenone hcl...... 117 qc lancets super thin 30g...... 119 ra glucosamine-chondroitin-d3...... 120 propafenone hcl er...... 117 qc lancets ultra thin...... 119 ra glucosamine-chondroit-msm...... 120 propranolol hcl...... 117 QC MEDIFIN PE...... 119 ra hot/cold gel sleeve...... 121 propranolol hcl er...... 117 qc natural vegetable...... 119 ra hydrogen peroxide...... 121 propranolol-hctz...... 117 qc non-adherent...... 119 ra insulin syringe...... 121 propylene glycol...... 117 qc unilet lancets 28g...... 119 ra intimacy gels/him/her...... 121 propylparaben...... 117 qc unilet lancets micro thin...... 119 ra isopropyl alcohol wipes...... 121 propylthiouracil...... 117 Q-GEL...... 119 ra lice solution...... 121 PRO-RED AC...... 117 quercetin...... 119 RA LOTION...... 121 PROSHIELD SKIN CARE...... 117 quetiapine fumarate...... 119 ra lubricant eye drops...... 121 protein...... 117 quetiapine fumarate er...... 119 ra lutein...... 121 PROTEINEX...... 117 QUILLICHEW ER...... 119 RA LYCOPENE...... 121 PROTEINEX P100...... 117 QUILLIVANT XR...... 119 ra melatonin...... 121 178 ra miconazole 3 combo pack...... 121 REBIF REBIDOSE TITRATION REPLACE SR...... 125 ra mouth pain anesthetic...... 121 PACK...... 122 RESCON...... 125 ra mucus relief d max strength...... 121 REBIF TITRATION PACK...... 123 RESCRIPTOR...... 125 ra multihealth fiber...... 121 RECOMBIVAX HB...... 123 reserpine...... 125 ra nasal strip/drug free/large...... 121 RECTICARE...... 123 resorcinol...... 125 ra nighttime cold/flu relief...... 121 red cross cotton sterile...... 123 RESOURCE THICKENUP WATER.. 125 ra oatmeal moisturizing...... 121 red yeast rice extract...... 123 RESPAIRE-30...... 125 ra omega 3-6-9...... 121 REDNESS RELIEF...... 123 RESTASIS...... 125 ra omeprazole...... 121 reeses pinworm medicine...... 123 RESTORE CLEANSER & ra omeprazole-sodium bicarb...... 121 REFENESEN CHEST CONG/PAIN MOISTURIZER...... 125 ra oyster shell calcium/d...... 121 RLF...... 123 RETAINE PM...... 125 ra pain relief...... 121 REFENESEN CHST CONG/PAIN PE 123 RETIN-A...... 125 ra personal lubricant...... 121 REFRESH...... 123 REVEAL COLON DISEASE...... 125 ra prenatal...... 121 REFRESH LACRI-LUBE...... 123 REVEAL DNA PATERNITY TEST...125 ra probiotic complex...... 121 REFRESH LIQUIGEL...... 123 REVEAL GET PREGNANT QUICK. 125 ra probiotic digestive care...... 121 REFRESH OPTIVE...... 123 REVEAL MULTI-DRUG TESTING ra probiotic gummies...... 121 REFRESH OPTIVE MEGA-3...... 123 CUP...... 125 RA RENEWAL ACNE TREATMENT REFRESH OPTIVE SENSITIVE...... 123 REVEAL URINARY TRACT...... 125 ...... 121 REFRESH P.M...... 123 REVITADERM WOUND CARE...... 125 RA RENEWAL SHOWER & BATH..121 REFRESH TEARS...... 123 REVLIMID...... 125 ra saccharin...... 121 REGENECARE HA...... 123 REVONTO...... 125 ra saline nasal spray...... 121 REGRANEX...... 123 REXALL LANCETS ULTRA THIN ra saline wound wash...... 121 relagesic...... 123 30G...... 125 ra sensitive anti-itch...... 121 relcof c...... 123 REZAMID...... 125 ra severe cold/night cold&flu...... 121 RELENZA DISKHALER...... 123 RHINARIS...... 125 ra severe congestion/cold max...... 121 RELIADERM...... 123 RHINASE...... 125 ra shower & bath body...... 121 RELIEF PAIN RELIEVING...... 123 RIASTAP...... 125 ra silky lubricant moisturizer...... 122 RELION ALCOHOL SWABS...... 123 RIAX...... 125 ra sinus wash nasal relief...... 122 RELION ALL-IN-ONE...... 123 RIBASPHERE...... 125 ra sinus wash neti pot...... 122 RELION BLOOD GLUCOSE TEST...123 riboflavin...... 125 ra slow release iron...... 122 RELION GLUCOSE SHOT...... 123 riboflavin-5-phosphate sodium...... 125 ra stay awake...... 122 RELION INSULIN SYRINGE....123, 124 RICOLA CHERRY HONEY HERB... 125 ra sterile saline nasal mist...... 122 RELI-ON INSULIN SYRINGE...123, 124 RICOLA HERB...... 126 ra therapeutic...... 122 RELION LANCETS MICRO-THIN RICOLA LEMON MINT...... 126 ra triple antibiotic...... 122 33G...... 124 RICOLA W/ECHINACEA...... 126 RA TUGABOOS BABY...... 122 RELION LANCETS STANDARD RIDAURA...... 126 ra vaginal infection screening...... 122 21G...... 124 rifabutin...... 126 ra vitamin b-12...... 122 RELION LANCETS THIN 26G...... 124 rifampin...... 126 ra vitamin c...... 122 RELION LANCETS ULTRA-THIN RIGHTEST GL300 LANCETS...... 126 ra wart remover...... 122 30G...... 124 riluzole...... 126 ra yeast relief plus...... 122 RELION ULTRA THIN LANCETS rimantadine hcl...... 126 rabano yodado...... 122 30G...... 124 ringers irrigation...... 126 RABAVERT...... 122 RELION ULTRA THIN PLUS RISAMINE...... 126 rabeprazole sodium...... 122 LANCETS...... 124 RISPERDAL CONSTA...... 126 racepinephrine hcl...... 122 RELISTOR...... 124 risperidone...... 126 RADIACARE POST HEALING...... 122 RELPAX...... 124 ritonavir...... 126 raloxifene hcl...... 122 REMEDY ANTIMICROBIAL RITUXAN...... 126 ramipril...... 122 CLEANSER...... 124 rivastigmine...... 126 ranitidine hcl...... 122 REMEDY CALAZIME...... 124 rivastigmine tartrate...... 126 RAPAMUNE...... 122 REMEDY CLEANSING BODY...... 124 rixubis...... 126 RASH AWAY...... 122 REMEDY PHYTOPLEX rizatriptan benzoate...... 126 RASH RELIEF...... 122 ANTIFUNGAL...... 124 ROBATHOL...... 126 raspberry flavor...... 122 REMEDY SKIN REPAIR...... 124 ROBITUSSIN CHILD raspberry syrup...... 122 REMODULIN...... 124 COUGH/COLD CF...... 126 reality insulin syringe...... 122 REMOVE ADHESIVE REMOVER ROBITUSSIN COUGH+CHEST reality lancets...... 122 WIPES...... 124 CONG DM...... 126 reality swabs...... 122 RENACIDIN...... 124 ROBITUSSIN DAY/NIGHT VALUE reality trigger lancets...... 122 RENAGEL...... 124 PAK...... 126 REA-LO...... 122 renal vitamin...... 125 ROBITUSSIN LINGERING REBETOL...... 122 renuu nl...... 125 COUGHGELS...... 126 REBIF...... 123 repaglinide...... 125 ROBITUSSIN MULTI-SYMPTOM REBIF REBIDOSE...... 122 REPATHA...... 125 MAX...... 126 REPATHA SURECLICK...... 125 ROBITUSSIN NIGHTTIME COUGH 126 179 ROBITUSSIN NIGHTTIME COUGH SEBUDERM...... 128 simple syrup...... 130 DM...... 126 SEBULEX...... 128 simvastatin...... 130 ROBITUSSIN PK COLD DAY/NGHT SECONAL...... 128 SINADRIN PE COMPLETE SINUS DM...... 126 SECURA EPC SKIN CARE REL...... 130 ROBITUSSIN PK COLD DAY/NGHT STARTER...... 128 sinus & cold-d...... 130 MS...... 126 SECURA EXTRA PROTECTIVE...... 128 sinus & congestion day/night...... 130 ROBITUSSIN SEVERE NIGHTTIME SECURA MOISTURIZING sinus congestion/pain daytime...... 130 ...... 127 CLEANSER...... 128 sinus relief...... 130 ROBITUSSIN TO GO SECURA PERSONAL CLEANSER...128 sirolimus...... 130 COUGH/COLD CF...... 127 SECURA TOTAL BODY siterol...... 130 ROLAIDS...... 127 CLEANSER...... 128 skin protectant...... 130 ropinirole hcl...... 127 SECURA TWO-STEP...... 128 skin tag remover...... 130 rose oil...... 127 SELECT-OB...... 128 SKINTEGRITY HYDROGEL...... 130 rose water...... 127 selegiline hcl...... 128, 129 SKYLA...... 130 rosin...... 127 selenicaps-200...... 129 sleep aid...... 130 rosuvastatin calcium...... 127 selenimin...... 129 SLEEP-N-HEEL...... 130 ROTARIX...... 127 selenium er...... 129 SLO-NIACIN...... 130 ROTATEQ...... 127 selenium sulfide...... 129 SLOW FE...... 130 rotex...... 127 SELSUN BLUE DEEP CLEANSING.129 slow iron...... 130 ROZEREM...... 127 SELZENTRY...... 129 slow magnesium/calcium...... 130 ru-hist d...... 127 senna...... 129 slow release iron...... 130 rutin...... 127 senna leaves...... 129 sm alcohol prep...... 130 rydex g...... 127 SENNA PROMPT...... 129 sm allergy relief...... 130 rymed...... 127 senna s...... 129 sm b super vitamin complex...... 130 rynex pse...... 127 SENOKOT EXTRA STRENGTH...... 129 sm biotin...... 130 SABRIL...... 127 SENOKOT S...... 129 sm calamine...... 130 saccharin...... 127 SENSI-CARE BODY...... 129 sm chest congestion relief dm...... 130 SAFE TUSSIN PM...... 127 SENSI-CARE PERINEAL/SKIN...... 129 SM CORAL CALCIUM...... 131 SAFELET IV CATHETER...... 127 SENSI-CARE PROTECTIVE sm cosmetic puffs jumbo...... 131 safety insulin syringes...... 127 BARRIER...... 129 sm cough drops...... 131 SAFETY SEAL LANCETS...... 127 SENSIPAR...... 129 sm daytime cold & cough child...... 131 SAFETY-GARD NEEDLE 18G...... 127 SENSITIVE EYES ENZYME sm dental rinse anti-plaque...... 131 SAFETY-LOK SYRINGE...... 127 CLEANER...... 129 sm ethyl alcohol (rubbing)...... 131 safflower oil...... 127 SENSODYNE MAXIMUM sm foaming antacid...... 131 SAF-GEL...... 127 STRENGTH...... 129 sm fruit coolers...... 131 SALEM SUMP TUBE 12FR...... 127 SE-PLUS PROTEIN...... 129 sm glucosamine hcl-msm...... 131 salicylic acid...... 127 SEREVENT DISKUS...... 129 SM GLUCOSAMINE/CALCIUM + D131 salicylic acid wart remover...... 127 sertraline hcl...... 129 sm hemorrhoidal...... 131 salicylic acid-cleanser...... 127 sesame oil...... 129 sm ibuprofen jr...... 131 saline...... 127 sevelamer carbonate...... 129 sm iodides...... 131 SALMON...... 127 severe cold & flu day/night...... 129 sm iodine tincture...... 131 sam-e...... 128 shampoo & body wash rinse-free...... 129 sm lancets 33g...... 131 SAM-E COMPLETE...... 128 SHAMROCK LATEX EXAM sm melatonin...... 131 sam-g.l.a...... 128 GLOVES...... 129 sm natural herb cough drops...... 131 SAMSCA...... 128 shea butter...... 129 sm omega-3-6-9 fatty acids...... 131 SANTYL...... 128 SHINGRIX...... 129 sm omeprazole...... 131 SARNA...... 128 SHOPKO ALCOHOL SWABS...... 129 sm one daily prenatal...... 131 SASTID SOAP...... 128 SHOPKO UNILET LANCETS 30G....129 sm pain relief/menthol...... 131 SAVELLA...... 128 SHUR-SEAL CONTRACEPTIVE...... 129 sm prenatal vitamins...... 131 SAVELLA TITRATION PACK...... 128 silace...... 129 sm slow release iron...... 131 sb alcohol prep...... 128 sildenafil citrate...... 129 sm vitamin b1...... 131 sb bacitracin...... 128 silica...... 129 SMART SENSE COLOR LANCETS sb cold & flu hbp...... 128 silodosin...... 129 33G...... 131 sb fib lax orange...... 128 silver nitrate...... 130 SMART SENSE STANDARD sb insulin syringe...... 128 silver sulfadiazine...... 130 LANCETS...... 131 sb lancets thin...... 128 SIMBRINZA...... 130 SMART SENSE SUPER THIN sb lancets ultra thin...... 128 simethicone...... 130 LANCETS...... 131 sb lice treatment...... 128 SIMILAC GO & GROW TODDLER..130 SMART SENSE THIN LANCETS sb omeprazole...... 128 SIMILAC HUMAN MILK 26G...... 131 sb stool softener...... 128 FORTIFIER...... 130 smoothfit cuff...... 131 scarcin...... 128 SIMILAC PRO-SENSITIVE sod citrate-citric acid...... 131 SCYTERA...... 128 OPTIGRO...... 130 sodium acetate...... 131 se-100...... 128 SIMILAC STERILIZED WATER...... 130 sodium ascorbate...... 131 180 sodium benzoate...... 131 STERILANCE TL...... 133 supress a pediatric...... 135 sodium bicarbonate...... 131 sterile...... 133 supress dm pediatric...... 135 sodium bisulfite...... 131 STERILE LUBRICANT...... 133 SUPRESS-PE PEDIATRIC...... 135 sodium borate...... 131 STERI-STRIP COMPOUND sure comfort alcohol prep...... 135 sodium bromide...... 131 BENZOIN...... 133 sure comfort insulin syringe...... 135, 136 sodium butyrate...... 131 STERI-TAMP SEALS sure comfort lancets 28g...... 136 sodium chloride...... 132 BOTTLES/VIALS...... 133 sure comfort lancets 30g...... 136 sodium chloride (hypertonic)...... 131, 132 STERI-TAMP SEALS/BAGS...... 133 SURE-JECT INSULIN SYRINGE...... 136 sodium citrate...... 132 STERI-TAMP SEALS/SYRINGES.....133 SURE-LANCE ULTRA THIN sodium citrate dihydrate...... 132 stevia extract...... 133 LANCETS...... 136 sodium fluoride...... 132 STIMATE...... 133 SURELITE LANCETS...... 136 sodium hydroxide...... 132 STIMEX INSULATED NEEDLE...... 133 SUSPENDOL-S...... 136 sodium metabisulfite...... 132 STIMULEN...... 133 SUTENT...... 136 sodium nitrate...... 132 STIOLTO RESPIMAT...... 133 SWEEN...... 136 sodium nitrite...... 132 STOMAHESIVE MOLDABLE SWEEN PREP...... 136 sodium perborate...... 132 ADHESIVE...... 134 SWEETA...... 136 sodium phosphate dibasic...... 132 STOMAHESIVE PASTE...... 134 SWIM EAR...... 136 sodium phosphate monobasic...... 132 STRIANT...... 134 swimmers instant ear dry...... 136 sodium polystyrene sulfonate...... 132 STRIBILD...... 134 SYLATRON...... 136 sodium propionate...... 132 STRIDEX ESSENTIAL...... 134 SYMBICORT...... 136 sodium saccharin...... 132 STRI-DEX SENSITIVE SKIN...... 134 sympathetic nerve needle...... 137 sodium silicate...... 132 STUART ONE...... 134 SYNAGIS...... 137 sodium starch glycolate...... 132 SUBOXONE...... 134 SYNJARDY...... 137 sodium sulfite...... 132 SUBSYS...... 134 SYNVISC...... 137 SOLIRIS...... 132 sucralfate...... 134 SYNVISC ONE...... 137 SOLOSITE WOUND GEL...... 132 sucrose...... 134 syringe...... 137 solvatech plus...... 132 SUDAFED...... 134 syringe 10-12 ml...... 137 SOMBRA COOL THERAPY...... 132 SUDAFED 24 HOUR...... 134 syringe 20-25 ml...... 137 SOMBRA WARM THERAPY...... 132 SUDAFED CHILDRENS...... 134 syringe 2-3 ml...... 137 SOOTHE & COOL INZO BARRIER. 132 SUDAFED PE CHILDRENS...... 134 syringe 30-35 ml...... 137 SOOTHE XP XTRA PROTECTION.. 132 SUDAFED PE COLD & COUGH syringe 50-60 ml...... 137 sorbic acid...... 132 CHILD...... 134 syringe 5-6 ml...... 137 sorbitol...... 132 SUDAFED PE DAY & NIGHT...... 134 syringe luer slip...... 137 sorbutuss nr...... 132 SUDAFED PE MAXIMUM syringe precisedose dispenser...... 137 sore throat...... 132 STRENGTH...... 134 SYRSPEND SF...... 137 sore throat lozenges...... 132 SUDAFED PRESSURE+PAIN 12 HR134 SYRSPEND SF PH4...... 137 SORINE...... 133 sulfacetamide sodium...... 134 syrup nf...... 137 sotalol hcl...... 133 sulfacetamide sodium (acne)...... 134 SYSTANE...... 137 sotalol hcl (af)...... 133 sulfacetamide sodium-sulfur...... 134 SYSTANE BALANCE...... 137 soya lecithin...... 133 sulfacetamide-prednisolone...... 134 SYSTANE LID WIPES...... 137 soybean oil...... 133 sulfadiazine...... 134 SYSTANE OVERNIGHT THERAPY 137 spearmint oil...... 133 sulfamethoxazole-trimethoprim...... 134 SYSTANE PRESERVATIVE FREE...137 spinosad...... 133 SULFAMYLON...... 134 SYSTANE ULTRA...... 137 SPIRIVA HANDIHALER...... 133 sulfasalazine...... 134, 135 SYSTANE ULTRA PF...... 137 spironolactone...... 133 sulfo-lo...... 135 TABLOID...... 137 spironolactone-hctz...... 133 sulfur...... 135 tacrolimus...... 137 sportbalm...... 133 sulfur precipitated...... 135 tadalafil (pah)...... 137 SPORTSCREME...... 133 sulindac...... 135 talc...... 137 spot acne treatment...... 133 sumatriptan...... 135 TAMIFLU...... 137 SPRAYZOIN...... 133 sumatriptan succinate...... 135 tamoxifen citrate...... 137 squaric acid di-n-butyl ester...... 133 sumatriptan succinate refill...... 135 tamsulosin hcl...... 137 squaric acid in butanol...... 133 SUMMERS EVE DEODORANT TANDEM...... 137 stahist ad...... 133 ULTRA...... 135 tangerine...... 137 STALEVO 100...... 133 super b-50 complex...... 135 tannic acid...... 138 STALEVO 125...... 133 super c-500 complex...... 135 TARGRETIN...... 138 STALEVO 150...... 133 super cal/mag...... 135 taron forte...... 138 STALEVO 200...... 133 super moleskin...... 135 TARON-CRYSTALS...... 138 STALEVO 75...... 133 SUPER OMEGA-3...... 135 TARON-PREX...... 138 STANBACK HEADACHE super thin lancets...... 135 TARSUM...... 138 POWDERS...... 133 supposibase f...... 135 tartaric acid...... 138 stavudine...... 133 SUPPOSIBLEND...... 135 taurine...... 138 stearic acid...... 133 SUPPRELIN LA...... 135 tazarotene...... 138 stearyl alcohol...... 133 SUPREP BOWEL PREP KIT...... 135 TAZORAC...... 138 181 TAZTIA XT...... 138 THERAFLU WARMING RELIEF tramadol hcl er...... 142 tb syringe 1 ml...... 138 SINUS...... 140 tramadol hcl er (biphasic)...... 142 tdm solution...... 138 THERA-GESIC...... 140 trandolapril...... 142 tea tree oil...... 138 THERANATAL COMPLETE...... 140 tranexamic acid...... 142 TEAR FLO...... 138 THERANATAL OVAVITE...... 140 TRANQUILITY BRIEFS...... 142 TEARS NATURALE PM...... 138 THERAPLEX T...... 140 TRANSANOSIL...... 142 TECHLITE AST LANCETS...... 138 THERASEAL HAND PROTECTION 140 transderm-iq...... 142 TECHLITE LANCETS...... 138 THERATEARS...... 140 tranylcypromine sulfate...... 142 TECHLITE LANCETS 30G...... 138 THERATEARS NUTRITION...... 140 TRANZAREL...... 142 TECNU FIRST AID...... 138 thiamine...... 140 TRAVATAN Z...... 142 TEGADERM CONTACT LAYER...... 138 thiamine hcl...... 140 travel sickness...... 142 TEGADERM FOAM ADHESIVE...... 138 THINLETS GP LANCETS...... 140 trazodone hcl...... 142 TEGADERM HYDROGEL WOUND thioridazine hcl...... 140 TREANDA...... 142 FILLER...... 138 thiotepa...... 140 T-RELIEF PAIN ARNICA + 12...... 142 telmisartan...... 138 thiothixene...... 140 T-RELIEF PAIN RELIEF...... 142 telmisartan-hctz...... 138 threonine...... 140 TRELSTAR MIXJECT...... 142 temazepam...... 138 thymol...... 140 tretinoin...... 142 temozolomide...... 138 THYROLAR-1...... 140 TREXALL...... 142 temsirolimus...... 138 THYROLAR-1/2...... 140 triamcinolone acetonide...... 142, 143 tenofovir disoproxil fumarate...... 138 THYROLAR-1/4...... 140 TRIAMINIC CHEST/NASAL terazosin hcl...... 138 THYROLAR-2...... 140 CONGEST...... 143 terbinafine hcl...... 138 THYROLAR-3...... 140 TRIAMINIC COLD & ALLERGY..... 143 terbutaline sulfate...... 138 tiagabine hcl...... 140 TRIAMINIC COLD/COUGH...... 143 terconazole...... 138 ticlopidine hcl...... 140 TRIAMINIC COLD/COUGH DAY terocin...... 138, 139 TIGER BALM LINIMENT...... 140 TIME...... 143 teroderm-plus...... 139 TIGER BALM MUSCLE RUB...... 140 TRIAMINIC COUGH/RUNNY NOSE TESTOPEL...... 139 TIGER BALM NECK & SHOULDER ...... 143 testosterone...... 139 RUB...... 140 TRIAMINIC COUGH/SORE testosterone cypionate...... 139 TIGER BALM PAIN RELIEVING.....140 THROAT...... 143 testosterone enanthate...... 139 TIGER BALM PAIN RELIEVING LG TRIAMINIC FEVER REDUCER...... 143 tetanus-diphtheria toxoids td...... 139 ...... 140 TRIAMINIC FLU/COUGH/FEVER... 143 tetrabenazine...... 139 TILIA FE...... 140 TRIAMINIC LONG ACTING tetracycline hcl...... 139 timolol maleate...... 140, 141 COUGH...... 143 TETRA-FORMULA CGH/SORE TINACTIN...... 141 TRIAMINIC NIGHT TIME THROAT...... 139 TINACTIN JOCK ITCH...... 141 COLD/CGH...... 143 tgt alcohol swabs...... 139 TIVICAY...... 141 TRIAMINIC SORE THROAT...... 143 tgt first aid cleansing...... 139 tizanidine hcl...... 141 triamino...... 143 tgt lancet micro thin 33g...... 139 TN DICKINSONS WITCH HAZEL... 141 triamterene-hctz...... 143 tgt lancet thin 26g...... 139 TOBI PODHALER...... 141 triazolam...... 143 tgt lancet ultra thin 30g...... 139 TOBRADEX...... 141 tri-buffered aspirin...... 143 tgt lubricant eye drops...... 139 tobramycin...... 141 trichloroacetic acid...... 143 tgt lubricant redness reliever...... 139 tobramycin-dexamethasone...... 141 tricitrates...... 143 tgt omeprazole...... 139 TODAY SPONGE...... 141 trifluoperazine hcl...... 143 THALOMID...... 139 todays health thin lancets 28g...... 141 trifluridine...... 143 THE ITCH ERASER...... 139 todays health thin lancets 30g...... 141 trihexyphenidyl hcl...... 143 THEOCHRON...... 139 tolazamide...... 141 TRI-LO-SPRINTEC...... 143 theophylline anhydrous...... 139 tolbutamide...... 141 trimethobenzamide hcl...... 143 theophylline er...... 139 tolmetin sodium...... 141 trimethoprim...... 143 THERACOF PLUS COUGH/COLD tolnaftate...... 141 trimipramine maleate...... 143 REL...... 139 tolterodine tartrate...... 141 TRINATE...... 143 THERACYS...... 139 tolterodine tartrate er...... 141 triple antibiotic...... 143 THERA-D 4000...... 139 toomey syringe...... 141 TRIPLE FLEX...... 143 THERAFLU COLD & COUGH...... 139 topcare lancets micro-thin 33g...... 141 triple helix collagen...... 143 THERAFLU EXPRESSMAX...... 139 topcare ultra comfort ins syr...... 141, 142 TRIPLE PASTE...... 143 THERAFLU SEVERE COLD...... 140 TOPICAINE 5...... 142 triprolidine hcl...... 144 THERAFLU SEVERE COLD & topiramate...... 142 TRISPEC PSE PEDIATRIC...... 144 COUGH...... 139 topotecan hcl...... 142 TRIUMEQ...... 144 THERAFLU SEVERE COLD torsemide...... 142 TRI-VI-SOL...... 144 DAYTIME...... 139 TOVIAZ...... 142 TROCAINE THROAT...... 144 THERAFLU SEVERE COLD TRACLEER...... 142 TROCAL COUGH SUPPRESSANT.. 144 NIGHTTIME...... 139, 140 TRADJENTA...... 142 TROCHIBASE CLASSIC...... 144 THERAFLU SEVERE COLD/CGH tragacanth...... 142 trochibase s...... 144 NIGHT...... 140 tramadol hcl...... 142 TROGARZO...... 144 182 trolamine...... 144 ULTILET INSULIN SYRINGE valproic acid...... 150 TROMBONEX-D...... 144 SHORT...... 147 valsartan...... 150 trospium chloride...... 144 ULTILET LANCETS...... 147 valsartan-hydrochlorothiazide...... 150 TRUEPLUS GLUCOSE...... 144 ultra comfort insulin syringe...... 147 VALSTAR...... 150 TRUEPLUS INSULIN SYRINGE...... 144 ULTRA FRESH...... 148 value health insulin syringe...... 150 TRUEPLUS LANCETS 26G...... 144 ULTRA FRESH PM...... 148 value plus lancet standard 21g...... 150 TRUEPLUS LANCETS 28G...... 144 ULTRA MEGA GOLD...... 148 value plus lancets super thin...... 150 TRUEPLUS LANCETS 30G...... 144 ULTRA MIDE 25...... 148 value plus lancets thin 26g...... 150 TRUEPLUS LANCETS 33G...... 144 ultracin...... 148 valumark lancet super thin 30g...... 150 TRU-FIT ICE/HEAT ANKLE/GEL ULTRACIN M...... 148 valumark lancet ultra thin 28g...... 150 PAK...... 144 ULTRACIN T...... 148 VAMOUSSE LICE TREATMENT.....150 TRUVADA...... 144 ULTRACIN-M...... 148 VANACHOL...... 150 trymine cg...... 144 ultra-comfort insulin syringe...... 148 VANACLEAR PD...... 150 tryptophan...... 145 ultrasone...... 148 VANACOF...... 150 TUMS E-X 750...... 145 ULTRA-THIN II INS SYR SHORT....148 VANACOF AC...... 150 TUMS LASTING EFFECTS...... 145 ULTRA-THIN II INSULIN SYRINGE VANACOF DM...... 150 TUMS ULTRA 1000...... 145 ...... 148 VANACOF-8...... 150 tuohy epidural needle tw...... 145 ULTRA-THIN II LANCETS...... 149 vanadium...... 150 turpentine...... 145 UMCKA ELDERBERRY COLD+FLU VANAMINE PD...... 150 turpentine oil...... 145 ...... 149 VANATAB AC...... 150 TUSICOF...... 145 UMCKA FASTACTIVES VANATAB DM...... 150 TUSNEL C...... 145 COLD+FLU...... 149 vancomycin hcl...... 150 TUSNEL PEDIATRIC...... 145 UMECTA MOUSSE...... 149 vancomycin hcl in dextrose...... 150 TUSNEL-DM PEDIATRIC...... 145 undecylenic acid...... 149 vancomycin hcl in nacl...... 150 tussin cf max multi-symptom...... 145 UNDELENIC...... 149 VANDAZOLE...... 150 tussin cough dm...... 145 unibase...... 149 VANICREAM DIAPER RASH...... 150 tussin cough long-acting...... 145 UNILET COMFORTOUCH LANCET VANIPLY...... 150 tussin dm max...... 145 ...... 149 VANISHPOINT SAFETY SYRINGE.150 TUSSI-PRES...... 145 UNILET EXCELITE...... 149 VANTAS...... 150 TUSSI-PRES PE PEDIATRIC...... 145 UNILET EXCELITE II...... 149 VAPOR PATCH...... 150 TUSSI-PRES PEDIATRIC...... 145 UNILET G.P. LANCET...... 149 VAQTA...... 150 TUSSLIN PEDIATRIC...... 145 UNILET G.P. SUPERLITE LANCET.149 VARIVAX...... 151 TWINRIX...... 145 UNILET GP 28 ULTRA THIN...... 149 VASHE WOUND THERAPY...... 151 TYLENOL...... 145 UNILET LANCET...... 149 VASOCLEAR-A...... 151 TYLENOL CHILDRENS PLUS MS UNILET MICRO-THIN 33G...... 149 VASOFLEX D1...... 151 COLD...... 145 UNILET SUPERLITE LANCET...... 149 VCF VAGINAL CONTRACEPTIVE. 151 TYLENOL COLD & HEAD...... 145 UNILET SUPER-THIN 30G...... 149 VECTIBIX...... 151 TYLENOL COLD MAX...... 145 UNILET ULTRA-THIN 28G...... 149 veegum...... 151 TYLENOL COLD MULTI- UNI-SOLVE...... 149 VELCADE...... 151 SYMPTOM...... 145 UNIVERSAL 1 LANCETS THIN 26G venaliv...... 151 TYLENOL COLD/FLU SEVERE...... 145 ...... 149 VENIA...... 151 TYLENOL EXTRA STRENGTH...... 145 UNIVERSAL 1 LANCETS THIN 33G venlafaxine hcl...... 151 TYLENOL INFANTS...... 145 ...... 149 venlafaxine hcl er...... 151 TYLENOL PM EXTRA STRENGTH.145 UNIVERSAL 1 LANCETS ULTRA VENTAVIS...... 151 TYLENOL SINUS SEVERE...... 146 THIN...... 149 verapamil hcl...... 151 TYLENOL WARMING universal ph...... 149 verapamil hcl er...... 151 COUGH/CONGEST...... 146 urea...... 149 versabase...... 151 TYPHIM VI...... 146 urea 20 intensive hydrating...... 149 VERSAPLUS...... 151 tyrosine...... 146 urea hydrating...... 149 VERSIVA XC...... 151 TYVASO REFILL...... 146 urea nail...... 149 VESICARE...... 151 ubidecarenone...... 146 urea peroxide...... 149 VIBERZI...... 151 ULCEREASE...... 146 urinary pain relief...... 149 VIBRAMYCIN...... 151 ULORIC...... 146 URO-MAG...... 149 VICKS DAYQUIL MUCUS ULTICARE ALCOHOL SWABS...... 146 ursodiol...... 149 CONTROL DM...... 151 ULTICARE INSULIN SAFETY SYR 146 vagicaine...... 149 VICKS NYQUIL CHILDRENS ULTICARE INSULIN SYRINGE VAGIFEM...... 149 CLD/CGH...... 151 ...... 146, 147 valacyclovir hcl...... 149 VICKS NYQUIL COLD & FLU ULTICARE SYRINGE...... 147 valerian...... 149 NIGHT...... 151 ULTICARE TUBERCULIN SAFETY valerian root...... 149 VICKS NYQUIL COUGH...... 151 SYR...... 147 valganciclovir hcl...... 149 VICKS NYQUIL SEVERE COLD & ultilet alcohol swabs...... 147 valine...... 149, 150 FLU...... 152 ULTILET CLASSIC LANCETS...... 147 VALINE 1000...... 149 VICKS SINEX DAYQUIL/NYQUIL..152 ULTILET INSULIN SYRINGE...... 147 valproate sodium...... 150 VICKS VAPO STEAM...... 152 183 VICKS VAPODROPS...... 152 VITAMINS E & A BEAUTY OIL...... 154 WIDE-SEAL DIAPHRAGM 80...... 155 VICKS VAPOINHALER...... 152 VITAMINS E & D BEAUTY OIL...... 154 WIDE-SEAL DIAPHRAGM 85...... 155 VICKS VAPORUB...... 152 VITA-RAY...... 154 WIDE-SEAL DIAPHRAGM 90...... 155 VICODIN...... 152 VITONIC...... 154 WIDE-SEAL DIAPHRAGM 95...... 155 VICODIN ES...... 152 viva...... 154 WINGS MATERNITY PANTS 2X-3X VICODIN HP...... 152 VIVA DROPS...... 154 ...... 155 VICTOZA...... 152 VIVABEN...... 154 WINRHO SDF...... 156 VIDA MIA UNILET LANCETS 28G.152 VIVITROL...... 154 wintergreen oil...... 156 VIDEX...... 152 VIVOTIF...... 154 witch hazel...... 156 vigabatrin...... 152 VOGELXO...... 154 WITEPSOL...... 156 VIGAMOX...... 152 VOGELXO PUMP...... 154 wound gel...... 156 VIIBRYD...... 152 VOLTAREN...... 154 wound gel spray...... 156 VIMPAT...... 152 VOPAC 5...... 154 WYMZYA FE...... 156 VINATE M...... 152 voriconazole...... 154 xanthan gum...... 156 vinblastine sulfate...... 152 vp insulin syringe...... 154 XARELTO...... 156 VINCASAR PFS...... 152 VYVANSE...... 154 XEOMIN...... 156 VINCE...... 152 WAL-DRYL...... 154 XERAC AC...... 156 vinorelbine tartrate...... 152 WAL-DRYL ANTI-ITCH...... 154 XEROFORM PETROLAT GAUZE VIRACEPT...... 152 WAL-DRYL PE ALLERGY & SINUS 1"X8"...... 156 virtussin dac...... 152 ...... 154 XGEVA...... 156 VISI-FLOW IRRIGATION STARTER WAL-FEX D ALLERGY & XIAFLEX...... 156 ...... 152 CONGESTION...... 154 XIFAXAN...... 156 vita-c...... 152 WAL-FLU COLD & SORE THROAT154 XOLAIR...... 156 VITA-CALCIUM...... 152 WAL-FLU SEV COLD/CGH xolido...... 156 VITADYE...... 152 DAY/NIGHT...... 154 X-SEB T PEARL...... 156 VITAFOL ULTRA...... 152 WALGREENS LANCETS...... 154 XTRA-CARE...... 156 VITALINE BIOTIN FORTE/ZINC.....152 walgreens lancets micro thin...... 154 XULANE...... 156 VITALINE COQ10...... 152 walgreens lancets super thin...... 154 xylitol...... 156 VITA-MAG...... 152 WALGREENS THIN LANCETS...... 154 XYREM...... 156 VITAMAX...... 152 WALGREENS ULTRA THIN YES FOR WOMEN...... 156 VITAMELTS ENERGY VITAMIN B- LANCETS...... 154 YF-VAX...... 156 12...... 152 WAL-ITIN D...... 154 YUVAFEM...... 156 vitamin a...... 153 WAL-PHED PE ZADITOR...... 156 vitamin a & d...... 152, 153 DAYTIME/NIGHTTIME...... 154 zafirlukast...... 156 VITAMIN A FISH...... 153 WAL-SLEEP Z...... 155 zaleplon...... 156 vitamin a palmitate...... 153 WAL-SLEEP Z LIQUID SHOTS...... 154 ZANOSAR...... 156 vitamin a wrinkle treatment...... 153 wal-tap cold/allergy...... 155 ZANTAC 150 MAXIMUM vitamin a-beta carotene...... 153 WAL-TUSSIN CF MAX...... 155 STRENGTH...... 156 vitamin b complex-c...... 153 wal-tussin cough relief...... 155 ZANTAC 75...... 156 vitamin b-1...... 153 WAL-ZYR...... 155 Z-BUM...... 156 vitamin b12...... 153 WAL-ZYR CHILDRENS...... 155 ZEASORB...... 156 vitamin b-12...... 153 warfarin sodium...... 155 ZEGERID OTC...... 156 vitamin b-2...... 153 wart remover maximum strength...... 155 ZELBORAF...... 157 vitamin b-6...... 153 WATCHHALER...... 155 ZENPEP...... 157 vitamin b-6 er...... 153 water oral...... 155 ZEPHREX-D...... 157 vitamin c...... 153 water tabs...... 155 ZE-PLUS...... 157 vitamin c (calcium ascorbate)...... 153 wax for braces...... 155 ZEVALIN Y-90...... 157 vitamin c drops...... 153 wax, white...... 155 ZICAM ALLERGY RELIEF...... 157 vitamin c gummies...... 153 WEBCOL ALCOHOL PREP LARGE 155 ZICAM COLD REMEDY...... 157 vitamin c plus wild rose hips...... 153 WEBCOL ALCOHOL PREP zidovudine...... 157 vitamin c-rose hips er...... 153 MEDIUM...... 155 ZIKS ARTHRITIS PAIN RELIEF...... 157 vitamin d2...... 153 wee care...... 155 ZILACTIN...... 157 vitamin d3...... 153 wegmans complete prenatal+dha...... 155 ZILACTIN-B...... 157 vitamin d-400...... 153 WEISS EPIDURAL NEEDLE...... 155 ZIMS MAX-FREEZE...... 157 vitamin e...... 153 WEISS EPIDURAL NEEDLE TW..... 155 zinc...... 157 VITAMIN E & C BEAUTY LOTION 153 WELCHOL...... 155 zinc + vitamin c...... 157 VITAMIN E & K BEAUTIFUL SKIN 153 WELLMIND MENTAL FOCUS...... 155 ZINC 15...... 157 vitamin e acetate...... 153 WHITE PED ARTERIAL NEEDLE... 155 zinc acetate...... 157 vitamin e beauty...... 153 white petrolatum...... 155 zinc aspartate...... 157 vitamin e succinate...... 153 WIDE-SEAL DIAPHRAGM 60...... 155 zinc chloride...... 157 vitamin e/selenium...... 154 WIDE-SEAL DIAPHRAGM 65...... 155 zinc gluconate...... 157 vitamin k1...... 154 WIDE-SEAL DIAPHRAGM 70...... 155 zinc methionate...... 157 vitamins acd-fluoride...... 154 WIDE-SEAL DIAPHRAGM 75...... 155 zinc oxide...... 157 184 zinc stearate...... 157 zinc sulfate...... 157 zinc sulfate heptahydrate...... 157 zinc-c-b6...... 157 zincolate...... 157 ZINC-OXYDE PLUS...... 157 zinc-vitamin c...... 157 ziprasidone hcl...... 157 ZITHROMAX...... 157 zn-50...... 157 ZOLADEX...... 157 zoledronic acid...... 158 ZOLINZA...... 158 zolmitriptan...... 158 zolpidem tartrate...... 158 zolpidem tartrate er...... 158 ZOMIG...... 158 zonisamide...... 158 ZORTRESS...... 158 ZOSTAVAX...... 158 ZOSTRIX HOT & COLD THERAPY 158 ZOSTRIX HP...... 158 ZOSTRIX-HP...... 158 ZOVIRAX...... 158 Z-TUSS AC...... 158 ZYCLARA...... 158 ZYLET...... 158 ZYNCOF...... 158 ZYRTEC ALLERGY...... 158 ZYRTEC-D ALLERGY & CONGESTION...... 158 ZYTAZE...... 158 ZZZQUIL...... 158

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