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New York Medicaid

Medicaid-Approved Preferred Drug List

Effective August 26, 2021

Legend In each class, drugs are listed alphabetically by either brand name or generic name. Brand name drug: Uppercase in bold type Generic drug: Lowercase in plain type AL: Age Limit Restrictions DO: Dose Optimization Program GR: Gender Restriction OTC: Over the counter medication available with a prescription. (Prescribers please indicate OTC on the prescription) PA: Prior authorization is required. Prior authorization is the process of obtaining approval of benefits before certain prescriptions are filled. QL: Quantity limits; certain prescription medications have specific quantity limits per prescription or per month. SP: Specialty Pharmacy ST: Step therapy is required. You may need to use one medication before benefits for the use of another medication can be authorized. MAT: Medication Assisted Therapy https://newyork.fhsc.com/providers/mat.asp Drug Name Reference Notes *ADHD/ANTI-NARCOLEPSY/ANTI- OBESITY/ANOREXIANTS* amphetamine-dextroamphet er oral extended release 24 hour 10 mg, 15 mg, 5 Adderall XR DO; AL; QL mg amphetamine-dextroamphet er oral capsule extended release 24 hour 20 mg, 25 mg, 30 Adderall XR AL; QL mg amphetamine-dextroamphetamine oral Adderall DO; AL; QL 10 mg, 12.5 mg, 15 mg, 5 mg, 7.5 mg amphetamine-dextroamphetamine oral Adderall AL tablet 20 mg, 30 mg atomoxetine hcl oral capsule Strattera DO; AL; QL caffeine citrate intravenous Cafcit caffeine citrate oral solution clonidine hcl er oral tablet extended release Kapvay AL; QL 12 hour dexmethylphenidate hcl er oral capsule extended release 24 hour 10 mg, 15 mg, 20 Focalin XR DO; AL; QL mg, 5 mg dexmethylphenidate hcl er oral capsule extended release 24 hour 25 mg, 30 mg, 35 Focalin XR AL; QL mg, 40 mg dexmethylphenidate hcl oral tablet 10 mg Focalin AL; QL dexmethylphenidate hcl oral tablet 2.5 mg Focalin DO; AL; QL dexmethylphenidate hcl oral tablet 5 mg Focalin PA; DO; QL dextroamphetamine sulfate er oral capsule Dexedrine AL; QL extended release 24 hour dextroamphetamine sulfate oral tablet 10 mg Zenzedi PA; QL dextroamphetamine sulfate oral tablet 5 mg Zenzedi PA; DO; QL methylphenidate hcl er (cd) oral capsule DO; AL; QL extended release 10 mg, 20 mg, 30 mg methylphenidate hcl er (cd) oral capsule AL; QL extended release 40 mg, 50 mg, 60 mg methylphenidate hcl er (la) oral capsule Ritalin LA AL; QL extended release 24 hour methylphenidate hcl er oral tablet extended DO; AL; QL release 10 mg methylphenidate hcl er oral tablet extended Concerta DO; AL; QL release 18 mg, 27 mg

2 Drug Name Reference Notes methylphenidate hcl er oral tablet extended AL; QL release 20 mg methylphenidate hcl er oral tablet extended DO; AL; QL release 24 hour 18 mg, 27 mg methylphenidate hcl er oral tablet extended AL; QL release 24 hour 36 mg, 54 mg methylphenidate hcl er oral tablet extended Concerta AL; QL release 36 mg, 54 mg methylphenidate hcl oral solution Methylin AL methylphenidate hcl oral tablet 10 mg, 5 mg Ritalin DO; AL; QL methylphenidate hcl oral tablet 20 mg Ritalin AL *AMINOGLYCOSIDES* neomycin sulfate oral tablet paromomycin sulfate oral capsule Humatin tobramycin nebulization solution Kitabis Pak SP; QL *ANALGESICS - ANTI- INFLAMMATORY* childrens ibuprofen oral Childrens Advil OTC; QL diclofenac potassium oral tablet Cataflam diclofenac sodium er oral tablet extended PA; QL release 24 hour diclofenac sodium oral tablet delayed QL release ENBREL MINI SUBCUTANEOUS PA; SP; QL SOLUTION CARTRIDGE ENBREL SUBCUTANEOUS SOLUTION PA; SP; QL ENBREL SUBCUTANEOUS SOLUTION PA; SP; QL PREFILLED ENBREL SUBCUTANEOUS SOLUTION PA; SP; QL RECONSTITUTED ENBREL SURECLICK SUBCUTANEOUS PA; SP; QL SOLUTION AUTO-INJECTOR etodolac er oral tablet extended release 24 QL hour etodolac oral capsule QL etodolac oral tablet Lodine QL fenoprofen calcium oral capsule Nalfon PA fenoprofen calcium oral tablet Nalfon flurbiprofen oral tablet QL gnp childrens ibuprofen oral suspension Childrens Advil OTC; QL 3 Drug Name Reference Notes gnp ibuprofen oral tablet Addaprin OTC; QL goodsense ibuprofen childrens oral Childrens Advil OTC; QL suspension goodsense ibuprofen oral tablet Addaprin OTC; QL hm ibuprofen childrens oral suspension Childrens Advil OTC; QL hm ibuprofen ib oral tablet Addaprin OTC; QL hm ibuprofen oral tablet Addaprin OTC; QL HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE PA; SP; QL KIT HUMIRA PEN SUBCUTANEOUS PEN- PA; SP; QL INJECTOR KIT HUMIRA PEN-CD/UC/HS STARTER PA; SP; QL SUBCUTANEOUS PEN-INJECTOR KIT HUMIRA PEN-PEDIATRIC UC START PA; SP; QL SUBCUTANEOUS PEN-INJECTOR KIT HUMIRA PEN-PS/UV/ADOL HS START PA; SP; QL SUBCUTANEOUS PEN-INJECTOR KIT HUMIRA PEN-PSOR/UVEIT STARTER PA; SP; QL SUBCUTANEOUS PEN-INJECTOR KIT HUMIRA SUBCUTANEOUS PREFILLED PA; SP; QL SYRINGE KIT IBU ORAL TABLET QL ibu-200 oral tablet Addaprin OTC; QL ibuprofen childrens oral suspension Childrens Advil OTC; QL ibuprofen oral suspension Childrens Advil QL ibuprofen oral tablet 200 mg Addaprin OTC; QL ibuprofen oral tablet 400 mg, 600 mg, 800 IBU QL mg indomethacin er oral capsule extended release indomethacin oral capsule ketoprofen er oral capsule extended release QL 24 hour ketoprofen oral capsule 50 mg ketoprofen oral capsule 75 mg QL ketorolac tromethamine oral tablet QL leflunomide oral tablet Arava meclofenamate sodium oral capsule QL mefenamic acid oral capsule PA; QL

4 Drug Name Reference Notes meloxicam oral tablet 15 mg Mobic meloxicam oral tablet 7.5 mg Mobic PA nabumetone oral tablet 500 mg Relafen QL nabumetone oral tablet 750 mg Relafen naproxen oral suspension Naprosyn naproxen oral tablet Naprosyn naproxen sodium oral tablet QL OTEZLA ORAL TABLET PA; SP; QL OTEZLA ORAL TABLET THERAPY PACK PA; SP; QL oxaprozin oral tablet Daypro QL piroxicam oral capsule Feldene PA; QL qc childrens ibuprofen oral suspension Childrens Advil OTC; QL RIDAURA ORAL CAPSULE sm childrens ibuprofen oral suspension Childrens Advil OTC; QL sm ibuprofen ib oral tablet Addaprin OTC; QL sulindac oral tablet QL *ANALGESICS - NONNARCOTIC* 8 hour arthritis pain reliever oral tablet Midol OTC; QL extended release 8hr muscle aches & pain oral tablet Midol OTC; QL extended release acetaminophen childrens oral solution OTC; QL acetaminophen childrens oral suspension Panadol Childrens OTC; QL acetaminophen childrens oral tablet Mapap Childrens OTC chewable acetaminophen er oral tablet extended Midol OTC; QL release Healthy Mama Shake acetaminophen extra strength oral tablet OTC; QL That Ache acetaminophen infants oral suspension Panadol Childrens OTC; QL acetaminophen oral Little Remedies for Fever OTC; QL acetaminophen oral solution OTC; QL acetaminophen oral suspension Panadol Childrens OTC; QL acetaminophen oral tablet 325 mg Aphen OTC Healthy Mama Shake acetaminophen oral tablet 500 mg OTC; QL That Ache acetaminophen oral tablet chewable Mapap Childrens OTC acetaminophen rectal FeverAll Adults OTC

5 Drug Name Reference Notes adult aspirin regimen oral tablet delayed Aspir-Low OTC release arthritis pain relief oral tablet extended Midol OTC; QL release aspirin low dose oral tablet chewable Bayer Low Dose OTC; QL aspirin low dose oral tablet delayed release Aspir-Low OTC Bayer Advanced Aspirin aspirin oral tablet OTC Reg St aspirin oral tablet chewable Bayer Low Dose OTC; QL aspirin oral tablet delayed release Bayer Aspirin OTC aspirin rectal suppository OTC ASPIR-LOW ORAL TABLET DELAYED OTC RELEASE BAC ORAL TABLET QL back & body extra strength oral tablet Bayer Back & Body OTC butalbital-acetaminophen oral tablet Tencon QL butalbital-apap-caffeine oral capsule Esgic QL butalbital-apap-caffeine oral tablet Bac QL butalbital-aspirin-caffeine oral capsule QL childrens acetaminophen oral suspension Panadol Childrens OTC; QL childrens silapap oral liquid Little Remedies for Fever OTC; QL diflunisal oral tablet FEVERALL ADULTS RECTAL OTC SUPPOSITORY FEVERALL CHILDRENS RECTAL OTC SUPPOSITORY FEVERALL INFANTS RECTAL OTC SUPPOSITORY FEVERALL JUNIOR STRENGTH RECTAL OTC SUPPOSITORY gnp 8 hour arthritis relief oral tablet extended Midol OTC; QL release gnp 8 hour pain relief oral tablet extended Midol OTC; QL release gnp 8 hour pain reliever oral tablet extended Midol OTC; QL release gnp acetaminophen oral tablet Aphen OTC gnp acetaminophen oral tablet chewable Mapap Childrens OTC gnp adult aspirin low strength oral tablet Bayer Low Dose OTC; QL chewable

6 Drug Name Reference Notes gnp aspirin low dose oral tablet delayed Aspir-Low OTC release gnp aspirin oral tablet delayed release Aspir-Low OTC gnp headache relief extra str oral tablet Bayer Migraine OTC gnp pain & fever childrens oral suspension Panadol Childrens OTC; QL Healthy Mama Shake gnp pain relief extra strength oral tablet OTC; QL That Ache gnp pain relief oral tablet Aphen OTC goodsense arthritis pain oral tablet extended Midol OTC; QL release goodsense aspirin adult low st oral tablet Bayer Low Dose OTC; QL chewable Bayer Advanced Aspirin goodsense aspirin oral tablet OTC Reg St goodsense aspirin oral tablet chewable Bayer Low Dose OTC; QL goodsense migraine formula oral tablet Bayer Migraine OTC goodsense pain & fever child oral Panadol Childrens OTC; QL suspension goodsense pain & fever infants oral Panadol Childrens OTC; QL suspension Healthy Mama Shake goodsense pain relief extra st oral tablet OTC; QL That Ache goodsense pain relief oral tablet Aphen OTC headache relief oral tablet Bayer Migraine OTC hm acetaminophen childrens oral tablet Mapap Childrens OTC chewable hm arthritis pain relief oral tablet extended Midol OTC; QL release hm aspirin ec low dose oral tablet delayed Aspir-Low OTC release Bayer Advanced Aspirin hm aspirin oral tablet OTC Reg St hm aspirin oral tablet chewable Bayer Low Dose OTC; QL hm aspirin oral tablet delayed release Bayer Aspirin OTC hm pain & fever childrens oral suspension Panadol Childrens OTC; QL hm pain & fever infants oral suspension Panadol Childrens OTC; QL Healthy Mama Shake hm pain relief extra strength oral tablet OTC; QL That Ache hm pain relief oral tablet extended release Midol OTC; QL

7 Drug Name Reference Notes hm pain relieve child dye-free oral Panadol Childrens OTC; QL suspension hm pain reliever childrens oral suspension Panadol Childrens OTC; QL hm pain reliever infants oral suspension Panadol Childrens OTC; QL hm pain reliever oral tablet Aphen OTC mapap arthritis pain oral tablet extended Midol OTC; QL release MAPAP CHILDRENS ORAL TABLET OTC CHEWABLE mapap oral capsule OTC; QL mapap oral liquid Little Remedies for Fever OTC; QL mapap oral tablet Aphen OTC migraine relief oral tablet Bayer Migraine OTC m-pap oral liquid Little Remedies for Fever OTC; QL pain & fever childrens oral suspension Panadol Childrens OTC; QL pain & fever infants oral suspension Panadol Childrens OTC; QL qc arthritis pain relief oral tablet extended Midol OTC; QL release qc aspirin low dose oral tablet chewable Bayer Low Dose OTC; QL qc aspirin low dose oral tablet delayed Aspir-Low OTC release Bayer Advanced Aspirin qc aspirin oral tablet OTC Reg St Healthy Mama Shake qc non-aspirin extra strength oral tablet OTC; QL That Ache qc pain relief childrens oral suspension Panadol Childrens OTC; QL Healthy Mama Shake qc pain relief extra strength oral tablet OTC; QL That Ache qc pain relief oral tablet Aphen OTC sm aspirin adult low strength oral tablet Bayer Low Dose OTC; QL chewable sm aspirin adult low strength oral tablet Aspir-Low OTC delayed release sm aspirin ec oral tablet delayed release Bayer Aspirin OTC sm aspirin low dose oral tablet chewable Bayer Low Dose OTC; QL Bayer Advanced Aspirin sm aspirin oral tablet OTC Reg St sm childrens aspirin oral tablet chewable Bayer Low Dose OTC; QL sm pain & fever childrens oral suspension Panadol Childrens OTC; QL

8 Drug Name Reference Notes Healthy Mama Shake sm pain relief oral tablet OTC; QL That Ache Healthy Mama Shake sm pain reliever ex st oral tablet OTC; QL That Ache sm pain reliever oral tablet Aphen OTC ST JOSEPH LOW DOSE ORAL TABLET OTC DELAYED RELEASE tactinal oral tablet Aphen OTC TENCON ORAL TABLET QL Excedrin Tension tension headache oral tablet OTC Headache *ANALGESICS - OPIOID* acetaminophen-codeine #2 oral tablet AL; QL acetaminophen-codeine #3 oral tablet PA; AL; QL acetaminophen-codeine #4 oral tablet PA; AL; QL acetaminophen-codeine oral solution PA; AL; QL acetaminophen-codeine oral tablet 300-15 AL; QL mg acetaminophen-codeine oral tablet 300-30 PA; AL; QL mg, 300-60 mg ASCOMP-CODEINE ORAL CAPSULE PA; AL; QL buprenorphine hcl sublingual tablet MAT; QL sublingual buprenorphine hcl-naloxone hcl sublingual Suboxone MAT; QL film buprenorphine hcl-naloxone hcl sublingual MAT; QL tablet sublingual butalbital-apap-caff-cod oral capsule PA; AL; QL butalbital-asa-caff-codeine oral capsule Ascomp-Codeine PA; AL; QL butorphanol tartrate nasal solution QL codeine sulfate oral tablet PA; AL; QL ENDOCET ORAL TABLET PA; QL fentanyl citrate buccal lozenge on a handle Actiq PA; QL fentanyl patch 72 hour PA; QL hydrocodone-acetaminophen oral solution PA; QL hydrocodone-acetaminophen oral tablet PA; QL hydrocodone-ibuprofen oral tablet PA; QL hydromorphone hcl oral liquid Dilaudid PA; QL hydromorphone hcl oral tablet Dilaudid PA; QL

9 Drug Name Reference Notes meperidine hcl oral solution PA; QL meperidine hcl oral tablet PA; QL METHADONE HCL INTENSOL ORAL PA; QL CONCENTRATE methadone hcl oral concentrate Methadone HCl Intensol PA; QL methadone hcl oral solution PA; QL methadone hcl oral tablet PA; QL methadone hcl oral tablet soluble Methadose PA; QL METHADOSE ORAL TABLET SOLUBLE PA; QL sulfate (concentrate) oral solution PA; QL morphine sulfate er oral tablet extended MS Contin PA; QL release morphine sulfate oral solution PA; QL morphine sulfate oral tablet QL oxycodone hcl oral capsule PA; QL oxycodone hcl oral concentrate PA; QL oxycodone hcl oral solution PA; QL oxycodone hcl oral tablet Oxaydo PA; QL oxycodone-acetaminophen oral tablet Endocet PA; QL pentazocine-naloxone hcl oral tablet PA; QL tramadol hcl oral tablet Ultram PA; AL; QL tramadol-acetaminophen oral tablet Ultracet PA; AL; QL *ANDROGENS-ANABOLIC* testosterone cypionate intramuscular Depo-Testosterone PA solution testosterone enanthate intramuscular PA solution testosterone transdermal AndroGel PA; QL *ANORECTAL AND RELATED PRODUCTS* hydrocortisone (perianal) external Procto-Med HC QL hydrocortisone rectal Cortenema PROCTO-MED HC EXTERNAL CREAM QL PROCTOZONE-HC EXTERNAL CREAM QL *ANTACIDS* ACID GONE ORAL SUSPENSION OTC ALMACONE DOUBLE STRENGTH ORAL OTC SUSPENSION

10 Drug Name Reference Notes alum & mag hydroxide-simeth oral Almacone Double OTC suspension Strength alumina-magnesia-simethicone oral Mintox OTC suspension aluminum hydroxide gel oral suspension OTC antacid anti-gas max strength oral Almacone Double OTC suspension Strength antacid calcium oral tablet chewable Cal-Gest Antacid OTC; QL Almacone Double antacid maximum strength oral suspension OTC Strength antacid oral suspension Mintox OTC antacid plus anti-gas relief oral suspension Mintox OTC antacid regular strength oral suspension Mintox OTC antacid regular strength oral tablet chewable Cal-Gest Antacid OTC; QL antacid ultra strength oral tablet chewable Tums Ultra 1000 OTC; QL antacid/antigas oral suspension Mintox OTC Almacone Double antacid/anti-gas oral suspension OTC Strength calcium antacid oral tablet chewable Cal-Gest Antacid OTC; QL calcium carbonate antacid oral suspension OTC CAL-GEST ANTACID ORAL TABLET OTC; QL CHEWABLE Almacone Double gnp antacid & anti-gas oral suspension OTC Strength gnp antacid regular strength oral suspension Mintox OTC hm advanced antacid max st oral Almacone Double OTC suspension Strength Almacone Double hm antacid anti-gas ex st oral suspension OTC Strength hm antacid oral suspension Mintox OTC hm antacid regular strength oral tablet Cal-Gest Antacid OTC; QL chewable mag-al plus oral liquid Mintox OTC magnesium oxide oral tablet 400 mg OTC; QL magnesium oxide oral tablet 420 mg Maox OTC Almacone Double mintox maximum strength oral suspension OTC Strength qc antacid oral suspension Mintox OTC qc antacid oral tablet chewable Cal-Gest Antacid OTC; QL qc antacid/anti-gas oral suspension Mintox OTC 11 Drug Name Reference Notes sm antacid advanced oral suspension Mintox OTC sm antacid maximum strength oral Almacone Double OTC suspension Strength sm antacid oral tablet chewable Cal-Gest Antacid OTC; QL sm antacid/antigas oral suspension Mintox OTC sodium bicarbonate oral tablet OTC *ANTHELMINTICS* ivermectin oral tablet Stromectol PA; QL praziquantel oral tablet Biltricide *ANTIANGINAL AGENTS* isosorbide dinitrate oral tablet Isordil Titradose isosorbide mononitrate er oral tablet extended release 24 hour isosorbide mononitrate oral tablet MINITRAN 24 HOUR NITRO-BID TRANSDERMAL OINTMENT NITRO-DUR TRANSDERMAL PATCH 24 HOUR nitroglycerin sublingual tablet sublingual Nitrostat nitroglycerin transdermal patch 24 hour Minitran *ANTIANXIETY AGENTS* ALPRAZOLAM INTENSOL ORAL DO; QL CONCENTRATE alprazolam oral tablet Xanax DO; QL alprazolam oral tablet dispersible DO; QL buspirone hcl oral tablet DO; QL chlordiazepoxide hcl oral capsule DO; QL clorazepate dipotassium oral tablet DO; QL DIAZEPAM INTENSOL ORAL DO; QL CONCENTRATE diazepam oral concentrate Diazepam Intensol DO; QL diazepam oral solution diazepam oral tablet Valium DO; QL hydroxyzine hcl oral DO; QL hydroxyzine hcl oral tablet DO; QL hydroxyzine pamoate oral capsule Vistaril DO; QL lorazepam oral tablet Ativan QL

12 Drug Name Reference Notes oxazepam oral capsule QL *ANTIARRHYTHMICS* amiodarone hcl oral tablet 200 mg Pacerone QL amiodarone hcl oral tablet 400 mg Pacerone disopyramide phosphate oral capsule Norpace flecainide acetate oral tablet QL mexiletine hcl oral capsule PACERONE ORAL TABLET 200 MG QL PACERONE ORAL TABLET 400 MG propafenone hcl er oral capsule extended Rythmol SR release 12 hour propafenone hcl oral tablet quinidine gluconate er oral tablet extended release quinidine sulfate oral tablet *ANTIASTHMATIC AND BRONCHODILATOR AGENTS* albuterol sulfate hfa inhalation aerosol ProAir HFA QL solution albuterol sulfate inhalation nebulization QL solution albuterol sulfate oral syrup albuterol sulfate oral tablet ANORO ELLIPTA INHALATION AEROSOL BREATH ACTIVATED ARNUITY ELLIPTA INHALATION AEROSOL POWDER BREATH QL ACTIVATED ATROVENT HFA INHALATION AEROSOL QL SOLUTION budesonide inhalation suspension Pulmicort QL budesonide-formoterol fumarate inhalation Symbicort QL aerosol COMBIVENT INHALATION QL AEROSOL SOLUTION cromolyn sodium inhalation nebulization solution FLOVENT DISKUS INHALATION AEROSOL POWDER BREATH QL ACTIVATED

13 Drug Name Reference Notes FLOVENT HFA INHALATION AEROSOL QL fluticasone-salmeterol inhalation aerosol Wixela Inhub QL powder breath activated ipratropium bromide inhalation solution QL ipratropium-albuterol inhalation solution levalbuterol hcl inhalation nebulization Xopenex QL solution levalbuterol tartrate inhalation aerosol Xopenex HFA QL montelukast sodium oral packet Singulair QL montelukast sodium oral tablet Singulair montelukast sodium oral tablet chewable Singulair SEREVENT DISKUS INHALATION AEROSOL POWDER BREATH QL ACTIVATED SPIRIVA RESPIMAT INHALATION QL AEROSOL SOLUTION STIOLTO RESPIMAT INHALATION QL AEROSOL SOLUTION terbutaline sulfate oral tablet theophylline er oral tablet extended release 12 hour theophylline er oral tablet extended release 24 hour theophylline oral solution QL WIXELA INHUB INHALATION AEROSOL QL POWDER BREATH ACTIVATED XOLAIR SUBCUTANEOUS SOLUTION PA; SP PREFILLED SYRINGE XOLAIR SUBCUTANEOUS SOLUTION PA; SP RECONSTITUTED zafirlukast oral tablet Accolate QL *ANTICOAGULANTS* ELIQUIS DVT/PE STARTER PACK ORAL QL TABLET THERAPY PACK ELIQUIS ORAL TABLET QL enoxaparin sodium solution Lovenox SP; QL enoxaparin sodium subcutaneous solution Lovenox SP; QL heparin sodium (porcine) injection solution heparin sodium (porcine) pf injection solution JANTOVEN ORAL TABLET

14 Drug Name Reference Notes warfarin sodium oral tablet Jantoven *ANTICONVULSANTS* carbamazepine er oral capsule extended Carbatrol QL release 12 hour carbamazepine er oral tablet extended TEGretol-XR DO; QL release 12 hour carbamazepine oral suspension TEGretol DO; QL carbamazepine oral tablet Epitol DO; QL carbamazepine oral tablet chewable DO; QL clonazepam oral tablet KlonoPIN QL clonazepam oral tablet dispersible QL diazepam rectal gel Diastat Pediatric QL DILANTIN INFATABS ORAL TABLET CHEWABLE DILANTIN ORAL CAPSULE DILANTIN ORAL SUSPENSION divalproex sodium er oral tablet extended Depakote ER DO; QL release 24 hour divalproex sodium oral capsule delayed Depakote Sprinkles DO; QL release sprinkle divalproex sodium oral tablet delayed Depakote DO; QL release 125 mg, 250 mg divalproex sodium oral tablet delayed Depakote release 500 mg EPITOL ORAL TABLET DO; QL ethosuximide oral capsule Zarontin ethosuximide oral solution Zarontin felbamate oral suspension Felbatol felbamate oral tablet Felbatol gabapentin oral capsule Neurontin QL gabapentin oral solution Neurontin QL gabapentin oral tablet Neurontin QL lamotrigine er oral tablet extended release LaMICtal XR 24 hour lamotrigine oral kit LaMICtal ODT QL lamotrigine oral tablet Subvenite QL lamotrigine oral tablet chewable LaMICtal lamotrigine oral tablet dispersible 100 mg, LaMICtal ODT QL 50 mg

15 Drug Name Reference Notes lamotrigine oral tablet dispersible 200 mg, LaMICtal ODT 25 mg lamotrigine starter kit-blue oral kit Subvenite Starter Kit-Blue QL Subvenite Starter Kit- lamotrigine starter kit-green oral kit QL Green Subvenite Starter Kit- lamotrigine starter kit-orange oral kit QL Orange levetiracetam er oral tablet extended release Keppra XR QL 24 hour levetiracetam oral solution Keppra levetiracetam oral tablet Keppra QL oxcarbazepine oral suspension Trileptal DO; QL oxcarbazepine oral tablet 150 mg, 300 mg Trileptal oxcarbazepine oral tablet 600 mg Trileptal DO; QL PHENYTOIN INFATABS ORAL TABLET CHEWABLE phenytoin oral suspension Dilantin phenytoin oral tablet chewable Dilantin Infatabs phenytoin sodium extended oral capsule Dilantin pregabalin oral capsule Lyrica QL pregabalin oral solution Lyrica QL primidone oral tablet Mysoline ROWEEPRA ORAL TABLET QL SUBVENITE ORAL TABLET QL SUBVENITE STARTER KIT-BLUE ORAL QL KIT SUBVENITE STARTER KIT-GREEN ORAL QL KIT SUBVENITE STARTER KIT-ORANGE QL ORAL KIT TEGRETOL ORAL SUSPENSION DO; QL TEGRETOL ORAL TABLET DO; QL TEGRETOL-XR ORAL TABLET DO; QL EXTENDED RELEASE 12 HOUR tiagabine hcl oral tablet Gabitril topiramate oral capsule sprinkle Topamax Sprinkle topiramate oral tablet Topamax valproic acid oral capsule DO; QL valproic acid oral solution

16 Drug Name Reference Notes ZARONTIN ORAL CAPSULE PA ZARONTIN ORAL SOLUTION PA zonisamide oral capsule QL *ANTIDEPRESSANTS* amitriptyline hcl oral tablet DO; QL amoxapine oral tablet 100 mg, 150 mg QL amoxapine oral tablet 25 mg, 50 mg DO; QL bupropion hcl er (sr) oral tablet extended Wellbutrin SR DO; QL release 12 hour 100 mg bupropion hcl er (sr) oral tablet extended Wellbutrin SR release 12 hour 150 mg, 200 mg bupropion hcl er (xl) oral tablet extended Wellbutrin XL DO; QL release 24 hour 150 mg bupropion hcl er (xl) oral tablet extended Wellbutrin XL QL release 24 hour 300 mg bupropion hcl oral tablet 100 mg bupropion hcl oral tablet 75 mg DO; QL citalopram hydrobromide oral solution QL citalopram hydrobromide oral tablet 10 mg, CeleXA DO; QL 20 mg citalopram hydrobromide oral tablet 40 mg CeleXA clomipramine hcl oral capsule Anafranil DO; QL desipramine hcl oral tablet DO; QL doxepin hcl oral capsule DO; QL doxepin hcl oral concentrate DO; QL escitalopram oxalate oral solution escitalopram oxalate oral tablet 10 mg, 5 mg Lexapro DO; QL escitalopram oxalate oral tablet 20 mg Lexapro QL fluoxetine hcl oral capsule 10 mg, 20 mg PROzac DO; QL fluoxetine hcl oral capsule 40 mg PROzac QL fluoxetine hcl oral capsule delayed release fluoxetine hcl oral solution fluvoxamine maleate oral tablet 100 mg fluvoxamine maleate oral tablet 25 mg, 50 DO; QL mg imipramine hcl oral tablet DO; QL imipramine pamoate oral capsule DO; QL mirtazapine oral tablet DO; QL

17 Drug Name Reference Notes mirtazapine oral tablet dispersible Remeron SolTab DO; QL nefazodone hcl oral tablet DO; QL nortriptyline hcl oral capsule Pamelor DO; QL nortriptyline hcl oral solution DO; QL paroxetine hcl er oral tablet extended Paxil CR DO; QL release 24 hour 12.5 mg paroxetine hcl er oral tablet extended Paxil CR QL release 24 hour 25 mg paroxetine hcl er oral tablet extended Paxil CR release 24 hour 37.5 mg paroxetine hcl oral tablet 10 mg, 20 mg Paxil DO; QL paroxetine hcl oral tablet 30 mg, 40 mg Paxil QL phenelzine sulfate oral tablet Nardil DO; QL protriptyline hcl oral tablet DO; QL sertraline hcl oral concentrate Zoloft QL sertraline hcl oral tablet 100 mg Zoloft QL sertraline hcl oral tablet 25 mg, 50 mg Zoloft DO; QL tranylcypromine sulfate oral tablet Parnate DO; QL trazodone hcl oral tablet DO; QL trimipramine maleate oral capsule venlafaxine hcl er oral capsule extended Effexor XR QL release 24 hour 150 mg venlafaxine hcl er oral capsule extended Effexor XR DO; QL release 24 hour 37.5 mg, 75 mg venlafaxine hcl oral tablet 100 mg, 25 mg, QL 50 mg, 75 mg venlafaxine hcl oral tablet 37.5 mg DO; QL *ANTIDIABETICS* acarbose oral tablet 100 mg Precose acarbose oral tablet 25 mg, 50 mg Precose QL ADMELOG SOLOSTAR SUBCUTANEOUS QL SOLUTION PEN-INJECTOR ADMELOG SUBCUTANEOUS SOLUTION QL BASAGLAR KWIKPEN SUBCUTANEOUS QL SOLUTION PEN-INJECTOR cvs glucose bits oral tablet chewable OTC cvs glucose oral gel Gluco Burst OTC Dex4 Quick Dissolve cvs glucose oral tablet chewable OTC Glucose

18 Drug Name Reference Notes Dex4 Quick Dissolve cvs soft glucose oral tablet chewable OTC Glucose DEX4 GLUCOSE ORAL TABLET OTC CHEWABLE DEX4 NATURALS ORAL TABLET OTC CHEWABLE DEX4 ORAL TABLET CHEWABLE OTC DEX4 POUCH PACK ORAL TABLET OTC CHEWABLE DEX4 QUICK DISSOLVE GLUCOSE ORAL OTC TABLET CHEWABLE glimepiride oral tablet Amaryl PA glipizide er oral tablet extended release 24 Glucotrol XL PA hour glipizide oral tablet PA glipizide xl oral tablet extended release 24 Glucotrol XL PA hour glipizide-metformin hcl oral tablet PA GLUCAGEN HYPOKIT INJECTION QL SOLUTION RECONSTITUTED GLUCO BURST ORAL GEL OTC glucose instant energy oral tablet chewable Dex4 OTC glucose oral gel Gluco Burst OTC Dex4 Quick Dissolve glucose oral tablet chewable OTC Glucose glucose-vitamin c oral tablet chewable Dex4 OTC GLUTOSE 15 ORAL GEL OTC GLUTOSE 45 ORAL GEL OTC GLUTOSE 5 ORAL GEL OTC glyburide micronized oral tablet Glynase PA glyburide oral tablet PA glyburide-metformin oral tablet PA Dex4 Quick Dissolve gnp glucose oral tablet chewable OTC Glucose gnp quick dissolve glucose oral tablet Dex4 Quick Dissolve OTC chewable Glucose goodsense glucose oral tablet chewable Dex4 OTC hm glucose oral tablet chewable Dex4 OTC

19 Drug Name Reference Notes HUMALOG MIX 50/50 KWIKPEN SUBCUTANEOUS SUSPENSION PEN- QL INJECTOR HUMALOG MIX 50/50 SUBCUTANEOUS QL SUSPENSION HUMALOG MIX 75/25 SUBCUTANEOUS PA; QL SUSPENSION HUMULIN 70/30 KWIKPEN SUBCUTANEOUS SUSPENSION PEN- OTC; QL INJECTOR HUMULIN 70/30 SUBCUTANEOUS OTC; QL SUSPENSION HUMULIN N KWIKPEN SUBCUTANEOUS OTC; QL SUSPENSION PEN-INJECTOR HUMULIN N SUBCUTANEOUS OTC; QL SUSPENSION HUMULIN R INJECTION SOLUTION OTC; QL HUMULIN R U-500 (CONCENTRATED) PA; QL SUBCUTANEOUS SOLUTION HUMULIN R U-500 KWIKPEN SUBCUTANEOUS SOLUTION PEN- PA; QL INJECTOR hy-vee glucose oral tablet chewable Dex4 OTC insulin asp prot & asp flexpen subcutaneous NovoLOG 70/30 FlexPen QL suspension pen-injector ReliOn insulin aspart flexpen subcutaneous solution NovoLOG FlexPen QL pen-injector insulin aspart penfill subcutaneous solution NovoLOG PenFill QL cartridge insulin aspart prot & aspart subcutaneous NovoLOG Mix 70/30 QL suspension insulin aspart subcutaneous solution NovoLOG QL insulin lispro (1 unit dial) subcutaneous Admelog SoloStar QL solution pen-injector insulin lispro junior kwikpen subcutaneous HumaLOG Junior QL solution pen-injector KwikPen insulin lispro prot & lispro subcutaneous HumaLOG Mix 75/25 QL suspension pen-injector KwikPen insulin lispro subcutaneous solution Admelog QL JANUMET ORAL TABLET PA; QL JANUMET XR ORAL TABLET EXTENDED PA; QL RELEASE 24 HOUR

20 Drug Name Reference Notes JANUVIA ORAL TABLET PA; QL JARDIANCE ORAL TABLET PA; QL kroger glucose oral tablet chewable Dex4 OTC leader glucose oral tablet chewable Dex4 OTC leader quick dissolve glucose oral tablet Dex4 Quick Dissolve OTC chewable Glucose longs glucose oral tablet chewable Dex4 OTC meijer glucose oral tablet chewable Dex4 OTC metformin hcl er oral tablet extended release 24 hour metformin hcl oral tablet nateglinide oral tablet PA; QL NOVOLIN 70/30 FLEXPEN RELION SUBCUTANEOUS SUSPENSION PEN- OTC; QL INJECTOR NOVOLIN 70/30 FLEXPEN SUBCUTANEOUS SUSPENSION PEN- OTC; QL INJECTOR NOVOLIN 70/30 RELION OTC; QL SUBCUTANEOUS SUSPENSION NOVOLIN 70/30 SUBCUTANEOUS OTC; QL SUSPENSION NOVOLIN N FLEXPEN RELION SUBCUTANEOUS SUSPENSION PEN- OTC; QL INJECTOR NOVOLIN N FLEXPEN SUBCUTANEOUS OTC; QL SUSPENSION PEN-INJECTOR NOVOLIN N RELION SUBCUTANEOUS OTC; QL SUSPENSION NOVOLIN N SUBCUTANEOUS OTC; QL SUSPENSION NOVOLIN R FLEXPEN INJECTION OTC; QL SOLUTION PEN-INJECTOR NOVOLIN R FLEXPEN RELION OTC; QL INJECTION SOLUTION PEN-INJECTOR NOVOLIN R INJECTION SOLUTION OTC; QL NOVOLIN R RELION INJECTION OTC; QL SOLUTION OZEMPIC (0.25 OR 0.5 MG/DOSE) SUBCUTANEOUS SOLUTION PEN- PA; QL INJECTOR

21 Drug Name Reference Notes OZEMPIC (1 MG/DOSE) SUBCUTANEOUS PA; QL SOLUTION PEN-INJECTOR pioglitazone hcl oral tablet Actos PA; QL pioglitazone hcl-glimepiride oral tablet Duetact PA pioglitazone hcl-metformin hcl oral tablet Actoplus Met PA preferred plus glucose oral tablet chewable Dex4 OTC px glucose oral tablet chewable Dex4 OTC ra glucose oral tablet chewable Dex4 OTC RELION GLUCOSE ORAL GEL OTC RELION GLUCOSE ORAL TABLET OTC CHEWABLE repaglinide oral tablet PA SEMGLEE SUBCUTANEOUS SOLUTION QL SEMGLEE SUBCUTANEOUS SOLUTION QL PEN-INJECTOR Dex4 Quick Dissolve sm glucose oral tablet chewable OTC Glucose SMART SENSE GLUCOSE ORAL TABLET OTC CHEWABLE SWEET CHEEKS ORAL GEL OTC SYMLINPEN 120 SUBCUTANEOUS PA; QL SOLUTION PEN-INJECTOR SYMLINPEN 60 SUBCUTANEOUS PA SOLUTION PEN-INJECTOR SYNJARDY ORAL TABLET PA; QL SYNJARDY XR ORAL TABLET PA; QL EXTENDED RELEASE 24 HOUR tgt glucose oral tablet chewable Dex4 OTC TRULICITY SUBCUTANEOUS SOLUTION PA; QL PEN-INJECTOR up & up glucose oral tablet chewable Dex4 OTC value plus glucose oral gel Gluco Burst OTC value plus glucose oral tablet chewable Dex4 OTC VICTOZA SUBCUTANEOUS SOLUTION PA; QL PEN-INJECTOR Dex4 Quick Dissolve walgreens glucose oral tablet chewable OTC Glucose *ANTIDIARRHEAL/PROBIOTIC AGENTS* anti-diarrheal oral capsule Imodium A-D OTC; QL

22 Drug Name Reference Notes anti-diarrheal oral liquid Imodium A-D OTC; QL anti-diarrheal oral tablet Imodium A-D OTC; QL bismatrol oral suspension Kaopectate OTC; QL bismatrol oral tablet chewable Pepto-Bismol OTC bismuth subsalicylate oral suspension Kaopectate OTC; QL diphenoxylate-atropine oral liquid diphenoxylate-atropine oral tablet Lomotil gnp anti-diarrheal oral capsule Imodium A-D OTC; QL gnp loperamide hcl oral liquid Imodium A-D OTC; QL goodsense anti-diarrheal oral liquid Imodium A-D OTC; QL goodsense stomach relief oral tablet Pepto-Bismol OTC chewable hm anti-diarrheal oral capsule Imodium A-D OTC; QL hm anti-diarrheal oral tablet Imodium A-D OTC; QL hm stomach relief oral suspension Kaopectate OTC; QL loperamide hcl oral capsule Imodium A-D QL loperamide hcl oral liquid OTC; QL peptic relief oral tablet chewable Pepto-Bismol OTC sm anti-diarrheal oral tablet Imodium A-D OTC; QL sm stomach relief oral suspension Kaopectate OTC; QL sm stomach relief oral tablet chewable Pepto-Bismol OTC stomach relief oral suspension Kaopectate OTC; QL stomach relief oral tablet chewable Pepto-Bismol OTC *ANTIDOTES AND SPECIFIC ANTAGONISTS* deferoxamine mesylate injection solution SP reconstituted naloxone hcl injection solution MAT; QL naloxone hcl injection solution cartridge MAT; QL naloxone hcl injection solution prefilled MAT; QL syringe naltrexone hcl oral tablet NARCAN NASAL LIQUID MAT; QL *ANTIEMETICS* DRIMINATE ORAL TABLET OTC gnp motion sickness relief oral tablet Travel-Ease OTC hm motion sickness oral tablet Driminate OTC meclizine hcl oral tablet

23 Drug Name Reference Notes ondansetron hcl oral tablet QL ondansetron oral tablet dispersible QL sm motion sickness oral tablet Driminate OTC trimethobenzamide hcl oral capsule *ANTIFUNGALS* fluconazole oral suspension reconstituted 10 Diflucan mg/ml fluconazole oral suspension reconstituted 40 Diflucan QL mg/ml fluconazole oral tablet 100 mg, 150 mg, 50 Diflucan mg fluconazole oral tablet 200 mg Diflucan QL flucytosine oral capsule Ancobon PA griseofulvin microsize oral suspension griseofulvin ultramicrosize oral tablet itraconazole oral capsule Sporanox PA ketoconazole oral tablet nystatin oral tablet terbinafine hcl oral tablet QL voriconazole intravenous solution Vfend IV PA reconstituted voriconazole oral suspension reconstituted Vfend PA voriconazole oral tablet Vfend PA *ANTIHISTAMINES* 24hr allergy relief oral tablet Allegra Allergy PA; OTC; QL all day allergy childrens oral solution KLS Aller-Tec Childrens OTC; QL all day allergy oral tablet KLS Aller-Tec OTC; QL aller-chlor oral tablet Chlor-Trimeton OTC allergy childrens oral liquid Banophen OTC; QL allergy childrens oral syrup Claritin OTC; QL allergy oral tablet Chlor-Trimeton OTC allergy rel child (loratadine) oral solution Claritin OTC; QL allergy relief childrens oral liquid Banophen OTC; QL allergy relief childrens oral solution KLS Aller-Tec Childrens OTC; QL allergy relief oral tablet 10 mg Claritin OTC; QL allergy relief oral tablet 180 mg Allegra Allergy PA; OTC; QL allergy relief oral tablet 25 mg Banophen OTC allergy relief oral tablet 4 mg Chlor-Trimeton OTC

24 Drug Name Reference Notes allergy relief oral tablet 5 mg Xyzal Allergy 24HR OTC BANOPHEN ORAL CAPSULE OTC BANOPHEN ORAL LIQUID OTC; QL BANOPHEN ORAL TABLET OTC carbinoxamine maleate oral solution carbinoxamine maleate oral tablet cetirizine hcl allergy child oral solution KLS Aller-Tec Childrens OTC; QL cetirizine hcl childrens alrgy oral solution KLS Aller-Tec Childrens OTC; QL cetirizine hcl oral tablet KLS Aller-Tec OTC; QL childrens loratadine oral solution Claritin OTC; QL childrens loratadine oral syrup Claritin OTC; QL cyproheptadine hcl oral syrup cyproheptadine hcl oral tablet diphenhydramine hcl oral capsule Banophen OTC diphenhydramine hcl oral liquid Banophen OTC; QL diphenhydramine hcl oral tablet Banophen OTC fexofenadine hcl oral tablet Allegra Allergy PA; OTC; QL gnp all day allergy childrens oral solution KLS Aller-Tec Childrens OTC; QL gnp all day allergy oral tablet KLS Aller-Tec OTC; QL gnp allergy relief 24 hr oral tablet Xyzal Allergy 24HR OTC gnp allergy relief oral tablet 180 mg Allegra Allergy PA; OTC; QL gnp allergy relief oral tablet 4 mg Chlor-Trimeton OTC gnp loratadine childrens oral solution Claritin OTC; QL gnp loratadine oral syrup Claritin OTC; QL gnp loratadine oral tablet Claritin OTC; QL goodsense all day allergy oral solution KLS Aller-Tec Childrens OTC; QL goodsense all day allergy oral tablet KLS Aller-Tec OTC; QL goodsense aller-ease oral tablet Allegra Allergy PA; OTC; QL goodsense allergy relief oral tablet Claritin OTC; QL hm all day allergy childrens oral solution KLS Aller-Tec Childrens OTC; QL hm allergy relief childrens oral liquid Banophen OTC; QL hm allergy relief oral tablet Chlor-Trimeton OTC hm cetirizine hcl oral tablet KLS Aller-Tec OTC; QL hm fexofenadine hcl oral tablet Allegra Allergy PA; OTC; QL hm loratadine childrens oral syrup Claritin OTC; QL hm loratadine oral tablet Claritin OTC; QL levocetirizine dihydrochloride oral tablet Xyzal Allergy 24HR OTC

25 Drug Name Reference Notes loratadine childrens oral syrup Claritin OTC; QL loratadine oral syrup Claritin OTC; QL loratadine oral tablet Claritin OTC; QL m-dryl oral liquid Banophen OTC; QL promethazine hcl oral solution AL promethazine hcl oral syrup AL promethazine hcl oral tablet 12.5 mg, 50 mg AL promethazine hcl oral tablet 25 mg AL; QL promethazine hcl rectal suppository Promethegan AL PROMETHEGAN RECTAL SUPPOSITORY AL qc allergy childrens oral liquid Banophen OTC; QL qc fexofenadine hydrochloride oral tablet Allegra Allergy PA; OTC; QL qc loratadine allergy relief oral tablet Claritin OTC; QL sm all day allergy childrens oral solution KLS Aller-Tec Childrens OTC; QL sm all day allergy oral tablet KLS Aller-Tec OTC; QL sm allergy childrens oral syrup Claritin OTC; QL sm allergy relief oral liquid Banophen OTC; QL sm allergy relief oral tablet Banophen OTC sm fexofenadine hcl oral tablet Allegra Allergy PA; OTC; QL sm loratadine oral syrup Claritin OTC; QL sm loratadine oral tablet Claritin OTC; QL *ANTIHYPERLIPIDEMICS* atorvastatin calcium oral tablet 10 mg, 20 Lipitor DO; QL mg, 40 mg atorvastatin calcium oral tablet 80 mg Lipitor QL cholestyramine light oral packet Prevalite cholestyramine light oral powder Prevalite cholestyramine oral packet Questran cholestyramine oral powder Questran colestipol hcl oral granules Colestid colestipol hcl oral packet Colestid colestipol hcl oral tablet Colestid fenofibrate micronized oral capsule 134 mg fenofibrate micronized oral capsule 200 mg, QL 43 mg fenofibrate micronized oral capsule 67 mg PA; QL fenofibrate oral capsule 134 mg

26 Drug Name Reference Notes fenofibrate oral capsule 200 mg QL fenofibrate oral capsule 67 mg PA; QL fenofibrate oral tablet QL fenofibric acid oral capsule delayed release Trilipix PA; QL gemfibrozil oral tablet Lopid lovastatin oral tablet 10 mg, 20 mg DO; QL lovastatin oral tablet 40 mg QL pravastatin sodium oral tablet QL PREVALITE ORAL PACKET PREVALITE ORAL POWDER REPATHA PUSHTRONEX SYSTEM SUBCUTANEOUS SOLUTION PA; QL CARTRIDGE REPATHA SUBCUTANEOUS SOLUTION PA; QL PREFILLED SYRINGE REPATHA SURECLICK SUBCUTANEOUS PA; QL SOLUTION AUTO-INJECTOR simvastatin oral tablet 10 mg, 20 mg, 40 mg Zocor DO; QL simvastatin oral tablet 5 mg DO; QL simvastatin oral tablet 80 mg Zocor PA; QL *ANTIHYPERTENSIVES* amlodipine besy-benazepril hcl oral capsule Lotrel QL atenolol-chlorthalidone oral tablet Tenoretic 100 benazepril hcl oral tablet Lotensin QL benazepril-hydrochlorothiazide oral tablet Lotensin HCT QL bisoprolol-hydrochlorothiazide oral tablet Ziac candesartan cilexetil oral tablet Atacand candesartan cilexetil-hctz oral tablet 16-12.5 Atacand HCT mg candesartan cilexetil-hctz oral tablet 32-12.5 Atacand HCT QL mg, 32-25 mg captopril oral tablet QL clonidine hcl oral tablet DO; QL doxazosin mesylate oral tablet Cardura QL enalapril maleate oral tablet Vasotec QL enalapril-hydrochlorothiazide oral tablet QL fosinopril sodium oral tablet QL fosinopril sodium-hctz oral tablet QL

27 Drug Name Reference Notes guanfacine hcl oral tablet 1 mg DO; QL guanfacine hcl oral tablet 2 mg QL hydralazine hcl oral tablet irbesartan oral tablet 150 mg, 75 mg Avapro DO; QL irbesartan oral tablet 300 mg Avapro QL irbesartan-hydrochlorothiazide oral tablet Avalide QL lisinopril oral tablet 10 mg, 2.5 mg, 5 mg Zestril DO; QL lisinopril oral tablet 20 mg Prinivil DO; QL lisinopril oral tablet 30 mg, 40 mg Zestril QL lisinopril-hydrochlorothiazide oral tablet 10- Zestoretic DO; QL 12.5 mg lisinopril-hydrochlorothiazide oral tablet 20- Zestoretic QL 12.5 mg, 20-25 mg losartan potassium oral tablet Cozaar QL losartan potassium-hctz oral tablet 100-12.5 Hyzaar QL mg, 100-25 mg losartan potassium-hctz oral tablet 50-12.5 Hyzaar DO; QL mg methyldopa oral tablet metoprolol-hydrochlorothiazide oral tablet QL minoxidil oral tablet moexipril hcl oral tablet perindopril erbumine oral tablet QL prazosin hcl oral capsule Minipress quinapril hcl oral tablet Accupril QL quinapril-hydrochlorothiazide oral tablet Accuretic QL ramipril oral capsule Altace QL terazosin hcl oral capsule QL trandolapril oral tablet valsartan oral tablet Diovan QL valsartan-hydrochlorothiazide oral tablet Diovan HCT QL *ANTI-INFECTIVE AGENTS - MISC.* clindamycin hcl oral capsule Cleocin clindamycin palmitate hcl oral solution Cleocin reconstituted dapsone oral tablet linezolid oral suspension reconstituted Zyvox PA; QL linezolid oral tablet Zyvox PA; QL

28 Drug Name Reference Notes methenamine hippurate oral tablet Hiprex metronidazole oral capsule Flagyl metronidazole oral tablet nitrofurantoin macrocrystal oral capsule Macrodantin nitrofurantoin monohyd macro oral capsule Macrobid sulfamethoxazole-trimethoprim oral Sulfatrim Pediatric suspension sulfamethoxazole-trimethoprim oral tablet Bactrim DS SULFATRIM PEDIATRIC ORAL SUSPENSION tinidazole oral tablet QL trimethoprim oral tablet vancomycin hcl oral capsule Vancocin PA; QL *ANTIMALARIALS* atovaquone-proguanil hcl oral tablet Malarone chloroquine phosphate oral tablet hydroxychloroquine sulfate oral tablet Plaquenil QL mefloquine hcl oral tablet QL primaquine phosphate oral tablet *ANTIMYASTHENIC/CHOLINERGIC AGENTS* pyridostigmine bromide er oral tablet Mestinon extended release pyridostigmine bromide oral solution Mestinon pyridostigmine bromide oral tablet Mestinon *ANTIMYCOBACTERIAL AGENTS* ethambutol hcl oral tablet isoniazid oral syrup isoniazid oral tablet PRIFTIN ORAL TABLET pyrazinamide oral tablet rifabutin oral capsule Mycobutin rifampin oral capsule *ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES* anastrozole oral tablet Arimidex QL bicalutamide oral tablet Casodex cyclophosphamide oral capsule SP

29 Drug Name Reference Notes EMCYT ORAL CAPSULE PA; SP etoposide oral capsule SP exemestane oral tablet Aromasin QL flutamide oral capsule hydroxyprogesterone caproate intramuscular PA; SP; QL solution hydroxyurea oral capsule Hydrea imatinib mesylate oral tablet Gleevec PA; SP; QL IRESSA ORAL TABLET PA; SP; QL letrozole oral tablet Femara QL leucovorin calcium injection solution reconstituted leucovorin calcium oral tablet LEUKERAN ORAL TABLET megestrol acetate oral suspension PA megestrol acetate oral tablet PA mercaptopurine oral tablet MESNEX ORAL TABLET PA methotrexate oral tablet methotrexate sodium (pf) injection solution methotrexate sodium injection solution methotrexate sodium injection solution reconstituted methotrexate sodium oral tablet MYLERAN ORAL TABLET SP TABLOID ORAL TABLET tamoxifen citrate oral tablet tretinoin oral capsule TREXALL ORAL TABLET VANTAS SUBCUTANEOUS KIT PA; SP; QL VELCADE INJECTION SOLUTION PA; SP RECONSTITUTED *ANTIPARKINSON AND RELATED THERAPY AGENTS* amantadine hcl oral capsule QL amantadine hcl oral syrup QL amantadine hcl oral tablet benztropine mesylate oral tablet

30 Drug Name Reference Notes bromocriptine mesylate oral capsule Parlodel bromocriptine mesylate oral tablet Parlodel carbidopa-levodopa er oral tablet extended release carbidopa-levodopa oral tablet Sinemet carbidopa-levodopa oral tablet dispersible carbidopa-levodopa-entacapone oral tablet Stalevo 100 entacapone oral tablet Comtan pramipexole dihydrochloride oral tablet QL ropinirole hcl oral tablet selegiline hcl oral capsule selegiline hcl oral tablet trihexyphenidyl hcl oral solution trihexyphenidyl hcl oral tablet *ANTIPSYCHOTICS/ANTIMANIC AGENTS* ABILIFY MAINTENA INTRAMUSCULAR PA; AL PREFILLED SYRINGE ABILIFY MAINTENA INTRAMUSCULAR PA; AL; QL SUSPENSION RECONSTITUTED ER aripiprazole oral tablet 10 mg, 2 mg, 5 mg Abilify DO; AL; QL aripiprazole oral tablet 15 mg, 20 mg, 30 mg Abilify AL; QL ARISTADA INTRAMUSCULAR PA; AL PREFILLED SYRINGE asenapine maleate sublingual tablet Saphris QL sublingual 10 mg asenapine maleate sublingual tablet Saphris DO; QL sublingual 2.5 mg, 5 mg chlorpromazine hcl oral tablet 10 mg, 25 mg, DO; AL; QL 50 mg chlorpromazine hcl oral tablet 100 mg, 200 AL mg clozapine oral tablet 100 mg, 25 mg, 50 mg Clozaril DO; AL; QL clozapine oral tablet 200 mg Clozaril AL; QL CLOZARIL ORAL TABLET PA; DO; AL; QL COMPRO RECTAL SUPPOSITORY fluphenazine decanoate injection solution AL fluphenazine hcl injection solution AL fluphenazine hcl oral concentrate AL

31 Drug Name Reference Notes fluphenazine hcl oral AL fluphenazine hcl oral tablet 1 mg, 2.5 mg DO; AL; QL fluphenazine hcl oral tablet 10 mg, 5 mg AL haloperidol decanoate intramuscular solution Haldol Decanoate AL; QL 100 mg/ml haloperidol decanoate intramuscular solution Haldol Decanoate AL 50 mg/ml haloperidol lactate injection solution AL haloperidol lactate oral concentrate AL haloperidol oral tablet 0.5 mg, 1 mg, 2 mg DO; AL; QL haloperidol oral tablet 10 mg, 20 mg, 5 mg AL INVEGA SUSTENNA INTRAMUSCULAR PA; AL; QL SUSPENSION PREFILLED SYRINGE INVEGA TRINZA INTRAMUSCULAR PA; AL; QL SUSPENSION PREFILLED SYRINGE lithium carbonate er oral tablet extended DO; QL release lithium carbonate oral capsule DO; QL lithium carbonate oral tablet loxapine succinate oral capsule 10 mg, 25 DO; AL; QL mg, 5 mg loxapine succinate oral capsule 50 mg AL olanzapine intramuscular solution ZyPREXA AL reconstituted olanzapine oral tablet 10 mg, 15 mg, 20 mg ZyPREXA AL; QL olanzapine oral tablet 2.5 mg, 5 mg, 7.5 mg ZyPREXA DO; AL; QL paliperidone er oral tablet extended release Invega AL 24 hour 1.5 mg, 6 mg, 9 mg paliperidone er oral tablet extended release Invega DO; AL; QL 24 hour 3 mg perphenazine oral tablet 16 mg, 4 mg, 8 mg AL perphenazine oral tablet 2 mg DO; AL; QL prochlorperazine edisylate injection solution prochlorperazine maleate oral tablet prochlorperazine rectal suppository Compro quetiapine fumarate er oral tablet extended release 24 hour 150 mg, 300 mg, 400 mg, SEROquel XR 50 mg quetiapine fumarate er oral tablet extended SEROquel XR DO; QL release 24 hour 200 mg

32 Drug Name Reference Notes quetiapine fumarate oral tablet 100 mg, 25 SEROquel DO; AL; QL mg, 50 mg quetiapine fumarate oral tablet 200 mg, 300 SEROquel AL; QL mg, 400 mg RISPERDAL CONSTA INTRAMUSCULAR PA; AL; QL SUSPENSION RECONSTITUTED ER risperidone oral solution RisperDAL AL; QL risperidone oral tablet 0.25 mg DO; AL; QL risperidone oral tablet 0.5 mg, 1 mg, 2 mg RisperDAL DO; AL; QL risperidone oral tablet 3 mg, 4 mg RisperDAL AL; QL thioridazine hcl oral tablet 10 mg, 25 mg DO; QL thioridazine hcl oral tablet 100 mg, 50 mg thiothixene oral capsule 1 mg, 2 mg, 5 mg DO; AL; QL thiothixene oral capsule 10 mg AL trifluoperazine hcl oral tablet 1 mg, 2 mg DO; AL; QL trifluoperazine hcl oral tablet 10 mg, 5 mg AL ziprasidone hcl oral capsule 20 mg, 40 mg Geodon DO; AL; QL ziprasidone hcl oral capsule 60 mg, 80 mg Geodon AL; QL ZYPREXA RELPREVV INTRAMUSCULAR PA; AL SUSPENSION RECONSTITUTED *ANTISEPTICS & DISINFECTANTS* eq hydrogen peroxide external solution OTC hm hydrogen peroxide external solution OTC hydrogen peroxide external solution OTC hydrogen peroxide solution meijer hydrogen peroxide external solution OTC ra hydrogen peroxide external solution OTC *ANTIVIRALS* abacavir sulfate oral solution Ziagen SP; QL abacavir sulfate oral tablet Ziagen SP; QL abacavir sulfate-lamivudine oral tablet Epzicom SP; QL abacavir-lamivudine-zidovudine oral tablet Trizivir SP; QL acyclovir oral capsule acyclovir oral suspension Zovirax acyclovir oral tablet adefovir dipivoxil oral tablet Hepsera PA; SP APTIVUS ORAL CAPSULE PA; SP; QL atazanavir sulfate oral capsule Reyataz SP; QL

33 Drug Name Reference Notes BARACLUDE ORAL SOLUTION PA; SP BIKTARVY ORAL TABLET SP; QL CIMDUO ORAL TABLET SP; QL DOVATO ORAL TABLET SP EDURANT ORAL TABLET SP; QL emtricitabine oral capsule Emtriva SP; QL emtricitabine-tenofovir df oral tablet Truvada SP; QL EMTRIVA ORAL SOLUTION SP; QL entecavir oral tablet Baraclude PA; SP; QL EPIVIR HBV ORAL SOLUTION PA; SP; QL etravirine oral tablet Intelence PA; SP; AL; QL EVOTAZ ORAL TABLET SP; QL famciclovir oral tablet QL FUZEON SUBCUTANEOUS SOLUTION PA; SP; QL RECONSTITUTED GENVOYA ORAL TABLET SP; QL INTELENCE ORAL TABLET PA; SP; AL; QL ISENTRESS HD ORAL TABLET SP; QL ISENTRESS ORAL PACKET SP; QL ISENTRESS ORAL TABLET SP; QL ISENTRESS ORAL TABLET CHEWABLE SP; QL JULUCA ORAL TABLET PA; SP; QL lamivudine oral solution Epivir SP; AL; QL lamivudine oral tablet 100 mg Epivir HBV PA; SP; QL lamivudine oral tablet 150 mg, 300 mg Epivir SP; QL lamivudine-zidovudine oral tablet Combivir SP; QL lopinavir-ritonavir oral solution Kaletra SP; QL MAVYRET ORAL TABLET SP; QL nevirapine er oral tablet extended release 24 Viramune XR SP; QL hour nevirapine oral suspension Viramune SP; QL nevirapine oral tablet SP; QL NORVIR ORAL SOLUTION SP; QL ODEFSEY ORAL TABLET SP; QL oseltamivir phosphate oral capsule Tamiflu QL oseltamivir phosphate oral suspension Tamiflu QL reconstituted

34 Drug Name Reference Notes PEGASYS SUBCUTANEOUS SOLUTION SP 180 MCG/0.5ML PEGASYS SUBCUTANEOUS SOLUTION SP; QL 180 MCG/ML PREZCOBIX ORAL TABLET SP; QL PREZISTA ORAL SUSPENSION SP; QL PREZISTA ORAL TABLET SP; QL RELENZA DISKHALER INHALATION AEROSOL POWDER BREATH QL ACTIVATED RETROVIR INTRAVENOUS SOLUTION SP REYATAZ ORAL PACKET SP; QL ribavirin oral capsule SP ribavirin oral tablet SP; QL rimantadine hcl oral tablet ritonavir oral tablet Norvir SP; QL RUKOBIA ORAL TABLET EXTENDED SP RELEASE 12 HOUR SELZENTRY ORAL SOLUTION SP; QL SELZENTRY ORAL TABLET SP; QL sofosbuvir-velpatasvir oral tablet Epclusa SP; QL stavudine oral capsule SP; QL STRIBILD ORAL TABLET SP; QL TEMIXYS ORAL TABLET SP; QL tenofovir disoproxil fumarate oral tablet Viread PA; SP; QL TIVICAY ORAL TABLET SP; QL TIVICAY PD ORAL TABLET SOLUBLE SP; QL TRIUMEQ ORAL TABLET SP; QL TROGARZO INTRAVENOUS SOLUTION PA; SP; QL TRUVADA ORAL TABLET SP; QL TYBOST ORAL TABLET SP; QL valacyclovir hcl oral tablet Valtrex QL valganciclovir hcl oral solution reconstituted Valcyte SP valganciclovir hcl oral tablet Valcyte SP VIREAD ORAL POWDER PA; SP; QL VIREAD ORAL TABLET PA; SP; QL XOFLUZA (40 MG DOSE) ORAL TABLET QL THERAPY PACK

35 Drug Name Reference Notes XOFLUZA (80 MG DOSE) ORAL TABLET QL THERAPY PACK zidovudine oral capsule Retrovir SP; QL zidovudine oral syrup Retrovir SP; QL zidovudine oral tablet SP *BETA BLOCKERS* acebutolol hcl oral capsule atenolol oral tablet Tenormin betaxolol hcl oral tablet bisoprolol fumarate oral tablet carvedilol oral tablet Coreg QL labetalol hcl oral tablet metoprolol succinate er oral tablet extended Toprol XL release 24 hour metoprolol tartrate oral tablet 100 mg, 50 mg Lopressor QL metoprolol tartrate oral tablet 25 mg, 37.5 mg, 75 mg nadolol oral tablet Corgard pindolol oral tablet propranolol hcl er oral capsule extended Inderal LA release 24 hour propranolol hcl oral solution propranolol hcl oral tablet SORINE ORAL TABLET sotalol hcl (af) oral tablet 120 mg Betapace AF QL sotalol hcl (af) oral tablet 160 mg, 80 mg Betapace AF sotalol hcl oral tablet Sorine timolol maleate oral tablet *CALCIUM CHANNEL BLOCKERS* AFEDITAB CR ORAL TABLET EXTENDED DO; QL RELEASE 24 HOUR 30 MG AFEDITAB CR ORAL TABLET EXTENDED QL RELEASE 24 HOUR 60 MG amlodipine besylate oral tablet 10 mg Norvasc QL amlodipine besylate oral tablet 2.5 mg, 5 mg Norvasc DO; QL CARTIA XT ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG, 180 MG, 240 DO; QL MG

36 Drug Name Reference Notes CARTIA XT ORAL CAPSULE EXTENDED QL RELEASE 24 HOUR 300 MG diltiazem hcl er beads oral capsule extended Taztia XT DO; QL release 24 hour 120 mg, 180 mg diltiazem hcl er beads oral capsule extended Taztia XT QL release 24 hour 240 mg, 300 mg, 360 mg diltiazem hcl er beads oral capsule extended Tiadylt ER QL release 24 hour 420 mg diltiazem hcl er coated beads oral capsule extended release 24 hour 120 mg, 180 mg, Cartia XT DO; QL 240 mg diltiazem hcl er coated beads oral capsule Cartia XT QL extended release 24 hour 300 mg diltiazem hcl er coated beads oral capsule Cardizem CD QL extended release 24 hour 360 mg diltiazem hcl er oral capsule extended DO; QL release 24 hour 120 mg, 180 mg diltiazem hcl er oral capsule extended QL release 24 hour 240 mg diltiazem hcl oral tablet 120 mg Cardizem QL diltiazem hcl oral tablet 30 mg, 60 mg Cardizem DO; QL diltiazem hcl oral tablet 90 mg QL dilt-xr oral capsule extended release 24 hour DO; QL 120 mg, 180 mg dilt-xr oral capsule extended release 24 hour QL 240 mg felodipine er oral tablet extended release 24 QL hour 10 mg felodipine er oral tablet extended release 24 DO; QL hour 2.5 mg, 5 mg isradipine oral capsule QL nicardipine hcl oral capsule QL nifedipine er oral tablet extended release 24 Afeditab CR DO; QL hour 30 mg nifedipine er oral tablet extended release 24 Afeditab CR QL hour 60 mg nifedipine er oral tablet extended release 24 QL hour 90 mg nifedipine er osmotic release oral tablet Procardia XL DO; QL extended release 24 hour 30 mg nifedipine er osmotic release oral tablet Procardia XL QL extended release 24 hour 60 mg, 90 mg 37 Drug Name Reference Notes nifedipine oral capsule QL TAZTIA XT ORAL CAPSULE EXTENDED DO; QL RELEASE 24 HOUR 120 MG, 180 MG TAZTIA XT ORAL CAPSULE EXTENDED RELEASE 24 HOUR 240 MG, 300 MG, 360 QL MG TIADYLT ER ORAL CAPSULE EXTENDED DO; QL RELEASE 24 HOUR 120 MG, 180 MG TIADYLT ER ORAL CAPSULE EXTENDED RELEASE 24 HOUR 240 MG, 300 MG, 360 QL MG, 420 MG verapamil hcl er oral capsule extended Verelan PM DO; QL release 24 hour 100 mg verapamil hcl er oral capsule extended Verelan DO; QL release 24 hour 120 mg, 180 mg verapamil hcl er oral capsule extended Verelan PM QL release 24 hour 200 mg, 300 mg verapamil hcl er oral capsule extended Verelan QL release 24 hour 240 mg, 360 mg verapamil hcl er oral tablet extended release Calan SR QL verapamil hcl oral tablet QL *CARDIOTONICS* DIGITEK ORAL TABLET DIGOX ORAL TABLET digoxin injection solution Lanoxin digoxin oral solution digoxin oral tablet Digitek LANOXIN INJECTION SOLUTION LANOXIN ORAL TABLET *CARDIOVASCULAR AGENTS - MISC.* ALYQ ORAL TABLET PA; SP; QL ambrisentan oral tablet Letairis PA; SP; QL sildenafil citrate oral tablet Revatio PA; SP; QL tadalafil (pah) oral tablet Alyq PA; SP; QL *CEPHALOSPORINS* cefaclor er oral tablet extended release 12 hour cefaclor oral capsule cefaclor oral suspension reconstituted 38 Drug Name Reference Notes cefadroxil oral capsule cefadroxil oral suspension reconstituted cefadroxil oral tablet cefdinir oral capsule QL cefdinir oral suspension reconstituted QL cefpodoxime proxetil oral suspension reconstituted cefpodoxime proxetil oral tablet cefprozil oral suspension reconstituted cefprozil oral tablet ceftriaxone sodium injection solution QL reconstituted ceftriaxone sodium intravenous solution reconstituted cefuroxime axetil oral tablet cephalexin oral capsule cephalexin oral suspension reconstituted cephalexin oral tablet *CHEMICALS* eql isopropyl rubbing alcohol solution OTC hm isopropyl alcohol solution OTC isopropanol solution isopropyl alcohol (rubbing) solution OTC isopropyl alcohol solution OTC ra isopropyl rubbing alcohol solution OTC sm isopropyl alcohol solution OTC *CONTRACEPTIVES* AFIRMELLE ORAL TABLET AL; QL AFTERA ORAL TABLET OTC; QL AFTERPILL ORAL TABLET OTC; QL ALTAVERA ORAL TABLET AL; QL alyacen 1/35 oral tablet Cyclafem 1/35 AL; QL alyacen 7/7/7 oral tablet Cyclafem 7/7/7 AL; QL AMETHIA ORAL TABLET AL; QL AMETHYST ORAL TABLET AL; QL APRI ORAL TABLET AL; QL ARANELLE ORAL TABLET AL; QL ASHLYNA ORAL TABLET AL; QL 39 Drug Name Reference Notes AUBRA EQ ORAL TABLET AL; QL AUBRA ORAL TABLET AL; QL AUROVELA 1.5/30 ORAL TABLET AL; QL AUROVELA 1/20 ORAL TABLET AL; QL AUROVELA 24 FE ORAL TABLET AL; QL AUROVELA FE 1.5/30 ORAL TABLET AL; QL AUROVELA FE 1/20 ORAL TABLET AL; QL AVIANE ORAL TABLET AL; QL AYUNA ORAL TABLET AL; QL AZURETTE ORAL TABLET AL; QL BALZIVA ORAL TABLET AL; QL BLISOVI 24 FE ORAL TABLET AL; QL BLISOVI FE 1.5/30 ORAL TABLET AL; QL BLISOVI FE 1/20 ORAL TABLET AL; QL briellyn oral tablet Balziva AL; QL CAMILA ORAL TABLET AL CAMRESE LO ORAL TABLET AL; QL CAMRESE ORAL TABLET AL; QL CAZIANT ORAL TABLET AL; QL CHARLOTTE 24 FE ORAL TABLET AL; QL CHEWABLE CHATEAL EQ ORAL TABLET AL; QL CHATEAL ORAL TABLET AL; QL CRYSELLE-28 ORAL TABLET AL; QL CYCLAFEM 1/35 ORAL TABLET AL; QL CYCLAFEM 7/7/7 ORAL TABLET AL; QL CYRED EQ ORAL TABLET AL; QL CYRED ORAL TABLET AL; QL DASETTA 1/35 ORAL TABLET AL; QL DASETTA 7/7/7 ORAL TABLET AL; QL DAYSEE ORAL TABLET AL; QL DEBLITANE ORAL TABLET AL DELYLA ORAL TABLET AL; QL desogestrel-ethinyl estradiol oral tablet Apri AL; QL DOLISHALE ORAL TABLET AL; QL drospiren-eth estrad-levomefol oral tablet Beyaz AL; QL drospirenone-ethinyl estradiol oral tablet Ocella AL; QL

40 Drug Name Reference Notes ECONTRA EZ ORAL TABLET OTC; QL ECONTRA ONE-STEP ORAL TABLET OTC; QL ELINEST ORAL TABLET AL; QL ELLA ORAL TABLET QL ELURYNG VAGINAL RING AL; QL EMOQUETTE ORAL TABLET AL; QL ENPRESSE-28 ORAL TABLET AL; QL ENSKYCE ORAL TABLET AL; QL ERRIN ORAL TABLET AL ESTARYLLA ORAL TABLET AL; QL ethynodiol diac-eth estradiol oral tablet Kelnor 1/50 AL; QL etonogestrel-ethinyl estradiol vaginal ring EluRyng AL; QL FALMINA ORAL TABLET AL; QL FAYOSIM ORAL TABLET AL; QL FEMYNOR ORAL TABLET AL; QL GEMMILY ORAL CAPSULE AL; QL HAILEY 1.5/30 ORAL TABLET AL; QL HAILEY 24 FE ORAL TABLET AL; QL HAILEY FE 1.5/30 ORAL TABLET AL; QL HAILEY FE 1/20 ORAL TABLET AL; QL HEATHER ORAL TABLET AL ICLEVIA ORAL TABLET AL; QL INCASSIA ORAL TABLET AL INTROVALE ORAL TABLET AL; QL ISIBLOOM ORAL TABLET AL; QL JAIMIESS ORAL TABLET AL; QL JASMIEL ORAL TABLET AL; QL JENCYCLA ORAL TABLET AL JOLESSA ORAL TABLET AL; QL JULEBER ORAL TABLET AL; QL JUNEL 1.5/30 ORAL TABLET AL; QL JUNEL 1/20 ORAL TABLET AL; QL JUNEL FE 1.5/30 ORAL TABLET AL; QL JUNEL FE 1/20 ORAL TABLET AL; QL JUNEL FE 24 ORAL TABLET AL; QL KAITLIB FE ORAL TABLET CHEWABLE AL; QL KALLIGA ORAL TABLET AL; QL

41 Drug Name Reference Notes KARIVA ORAL TABLET AL; QL KELNOR 1/35 ORAL TABLET AL; QL KELNOR 1/50 ORAL TABLET AL; QL KURVELO ORAL TABLET AL; QL LARIN 1.5/30 ORAL TABLET AL; QL LARIN 1/20 ORAL TABLET AL; QL LARIN 24 FE ORAL TABLET AL; QL LARIN FE 1.5/30 ORAL TABLET AL; QL LARIN FE 1/20 ORAL TABLET AL; QL LARISSIA ORAL TABLET AL; QL LAYOLIS FE ORAL TABLET CHEWABLE AL; QL LEENA ORAL TABLET AL; QL LESSINA ORAL TABLET AL; QL LEVONEST ORAL TABLET AL; QL levonorgest-eth est & eth est oral tablet Fayosim AL; QL levonorgest-eth estrad 91-day oral tablet Iclevia AL; QL levonorgestrel oral tablet Aftera OTC; QL levonorgestrel-ethinyl estrad oral tablet Afirmelle AL; QL levonorg-eth estrad triphasic oral tablet Enpresse-28 AL; QL LEVORA 0.15/30 (28) ORAL TABLET AL; QL LILLOW ORAL TABLET AL; QL LOESTRIN 1.5/30 (21) ORAL TABLET AL; QL LOESTRIN 1/20 (21) ORAL TABLET AL; QL LOESTRIN FE 1.5/30 ORAL TABLET AL; QL LOESTRIN FE 1/20 ORAL TABLET AL; QL LOJAIMIESS ORAL TABLET AL; QL LORYNA ORAL TABLET AL; QL LOW-OGESTREL ORAL TABLET AL; QL LO-ZUMANDIMINE ORAL TABLET AL; QL LUTERA ORAL TABLET AL; QL LYLEQ ORAL TABLET AL LYZA ORAL TABLET AL marlissa oral tablet Altavera AL; QL medroxyprogesterone acetate intramuscular Depo-Provera AL; QL suspension medroxyprogesterone acetate intramuscular Depo-Provera AL; QL suspension prefilled syringe

42 Drug Name Reference Notes MERZEE ORAL CAPSULE AL; QL MIBELAS 24 FE ORAL TABLET AL; QL CHEWABLE MICROGESTIN 1.5/30 ORAL TABLET AL; QL MICROGESTIN 1/20 ORAL TABLET AL; QL MICROGESTIN 24 FE ORAL TABLET AL; QL MICROGESTIN FE 1.5/30 ORAL TABLET AL; QL MICROGESTIN FE 1/20 ORAL TABLET AL; QL MILI ORAL TABLET AL; QL MONO-LINYAH ORAL TABLET AL; QL MY CHOICE ORAL TABLET OTC; QL MY WAY ORAL TABLET OTC; QL NECON 0.5/35 (28) ORAL TABLET AL; QL NEW DAY ORAL TABLET OTC; QL NIKKI ORAL TABLET AL; QL NORA-BE ORAL TABLET AL norethin ace-eth estrad-fe oral capsule Gemmily AL; QL norethin ace-eth estrad-fe oral tablet Aurovela FE 1/20 AL; QL norethin ace-eth estrad-fe oral tablet Charlotte 24 Fe AL; QL chewable norethindrone acet-ethinyl est oral tablet Aurovela 1/20 AL; QL norethindrone oral tablet Camila AL norethin-eth estradiol-fe oral tablet chewable Kaitlib Fe AL; QL norgestimate-eth estradiol oral tablet Estarylla AL; QL norgestim-eth estrad triphasic oral tablet Tri-Lo-Estarylla AL; QL NORLYDA ORAL TABLET AL NORLYROC ORAL TABLET AL NORTREL 0.5/35 (28) ORAL TABLET AL; QL NORTREL 1/35 (21) ORAL TABLET AL; QL NORTREL 1/35 (28) ORAL TABLET AL; QL NORTREL 7/7/7 ORAL TABLET AL; QL NYLIA 7/7/7 ORAL TABLET AL; QL NYMYO ORAL TABLET AL; QL OCELLA ORAL TABLET AL; QL OPCICON ONE-STEP ORAL TABLET OTC; QL OPTION 2 ORAL TABLET OTC; QL ORSYTHIA ORAL TABLET AL; QL

43 Drug Name Reference Notes PHILITH ORAL TABLET AL; QL PIMTREA ORAL TABLET AL; QL PIRMELLA 1/35 ORAL TABLET AL; QL PIRMELLA 7/7/7 ORAL TABLET AL; QL PORTIA-28 ORAL TABLET AL; QL PREVENTEZA ORAL TABLET OTC; QL PREVIFEM ORAL TABLET AL; QL REACT ORAL TABLET OTC; QL RECLIPSEN ORAL TABLET AL; QL RIVELSA ORAL TABLET AL; QL SETLAKIN ORAL TABLET AL; QL SHAROBEL ORAL TABLET AL SIMLIYA ORAL TABLET AL; QL SIMPESSE ORAL TABLET AL; QL SPRINTEC 28 ORAL TABLET AL; QL SRONYX ORAL TABLET AL; QL SYEDA ORAL TABLET AL; QL TAKE ACTION ORAL TABLET OTC; QL TARINA 24 FE ORAL TABLET AL; QL TARINA FE 1/20 EQ ORAL TABLET AL; QL TARINA FE 1/20 ORAL TABLET AL; QL TAYSOFY ORAL CAPSULE AL; QL TILIA FE ORAL TABLET AL; QL TRI FEMYNOR ORAL TABLET AL; QL TRI-ESTARYLLA ORAL TABLET AL; QL TRI-LEGEST FE ORAL TABLET AL; QL TRI-LINYAH ORAL TABLET AL; QL TRI-LO-ESTARYLLA ORAL TABLET AL; QL TRI-LO-MARZIA ORAL TABLET AL; QL TRI-LO-MILI ORAL TABLET AL; QL TRI-LO-SPRINTEC ORAL TABLET AL; QL TRI-MILI ORAL TABLET AL; QL TRINESSA (28) ORAL TABLET AL; QL TRI-NYMYO ORAL TABLET AL; QL TRI-PREVIFEM ORAL TABLET AL; QL TRI-SPRINTEC ORAL TABLET AL; QL TRIVORA (28) ORAL TABLET AL; QL

44 Drug Name Reference Notes TRI-VYLIBRA LO ORAL TABLET AL; QL TRI-VYLIBRA ORAL TABLET AL; QL TULANA ORAL TABLET AL TYDEMY ORAL TABLET AL; QL VELIVET ORAL TABLET AL; QL VESTURA ORAL TABLET AL; QL VIENVA ORAL TABLET AL; QL viorele oral tablet Azurette AL; QL VOLNEA ORAL TABLET AL; QL VYFEMLA ORAL TABLET AL; QL VYLIBRA ORAL TABLET AL; QL WERA ORAL TABLET AL; QL WYMZYA FE ORAL TABLET CHEWABLE AL; QL XULANE TRANSDERMAL PATCH AL; QL WEEKLY ZAFEMY TRANSDERMAL PATCH AL; QL WEEKLY ZARAH ORAL TABLET AL; QL ZOVIA 1/35 (28) ORAL TABLET AL; QL ZOVIA 1/35E (28) ORAL TABLET AL; QL ZUMANDIMINE ORAL TABLET AL; QL *CORTICOSTEROIDS* betamethasone sod phos & acet injection Celestone Soluspan suspension budesonide oral capsule delayed release Entocort EC QL particles DECADRON ORAL TABLET DEXAMETHASONE INTENSOL ORAL CONCENTRATE dexamethasone oral elixir dexamethasone oral solution dexamethasone oral tablet Decadron dexamethasone oral tablet therapy pack TaperDex 6-Day dexamethasone sod phosphate pf injection solution dexamethasone sodium phosphate injection solution fludrocortisone acetate oral tablet hydrocortisone oral tablet Cortef 45 Drug Name Reference Notes methylprednisolone acetate injection DEPO-Medrol suspension methylprednisolone oral tablet Medrol methylprednisolone oral tablet therapy pack Medrol methylprednisolone sodium succ injection SOLU-medrol solution reconstituted MILLIPRED ORAL TABLET prednisolone oral solution prednisolone sodium phosphate oral solution prednisolone sodium phosphate oral tablet Orapred ODT QL dispersible PREDNISONE INTENSOL ORAL CONCENTRATE prednisone oral solution prednisone oral tablet prednisone oral tablet therapy pack TAPERDEX 12-DAY ORAL TABLET THERAPY PACK TAPERDEX 6-DAY ORAL TABLET THERAPY PACK TAPERDEX 7-DAY ORAL TABLET THERAPY PACK triamcinolone acetonide injection suspension Kenalog *COUGH/COLD/ALLERGY* all day allergy-d oral tablet extended release KLS Aller-Tec D PA; AL; OTC; QL 12 hour allergy relief d-12 oral tablet extended Alavert Allergy/Sinus AL; OTC; QL release 12 hour allergy relief d-24 oral tablet extended Claritin-D 24 Hour OTC; QL release 24 hour allergy relief/nasal decongest oral tablet Claritin-D 24 Hour OTC; QL extended release 24 hour allergy/congestion relief oral tablet extended Alavert Allergy/Sinus OTC; QL release 12 hour APRODINE ORAL TABLET OTC benzonatate oral capsule cetirizine-pseudoephedrine er oral tablet KLS Aller-Tec D PA; AL; OTC; QL extended release 12 hour chest congestion relief dm oral syrup Robafen DM Cough Clear OTC; QL chest congestion relief oral syrup Diabetic Tussin EX OTC

46 Drug Name Reference Notes chest congestion relief oral tablet Xpect OTC Dimaphen DM cold & cough childrens oral liquid OTC Cold/Cough cough dm childrens oral suspension Delsym AL; OTC extended release cough dm oral suspension extended release Delsym AL; OTC cough/chest congestion dm oral syrup Robafen DM Cough Clear AL; OTC; QL DELSYM CGH/CHEST CONG DM CHILD AL; OTC ORAL LIQUID polistirex er oral Delsym AL; OTC suspension extended release DIMAPHEN DM COLD/COUGH ORAL AL; OTC LIQUID ENDACOF-DM ORAL LIQUID OTC gnp all day allergy-d oral tablet extended KLS Aller-Tec D PA; AL; OTC; QL release 12 hour Dimaphen DM gnp cold/cough childrens oral liquid AL; OTC Cold/Cough Delsym Cgh/Chest Cong gnp mucus relief dm max oral liquid AL; OTC DM Child gnp mucus relief dm oral tablet Fenesin DM IR AL; OTC gnp mucus relief pe oral tablet QC Medifin PE OTC gnp tussin cf cough & cold oral syrup OTC Robafen DM Cgh/Chest gnp tussin dm oral liquid AL; OTC; QL Congest Mucinex Fast-Max Chest gnp tussin mucus & chest cong oral liquid OTC Cong MS goodsense cough dm childrens oral Delsym AL; OTC suspension extended release goodsense cough dm oral suspension Delsym AL; OTC extended release guaifenesin er oral tablet extended release EQ Mucus ER OTC 12 hour hm allergy & congestion oral tablet extended Alavert Allergy/Sinus OTC; QL release 12 hour hm allergy complete-d oral tablet extended KLS Aller-Tec D PA; AL; OTC; QL release 12 hour hm allergy relief/nasal decong oral tablet Claritin-D 24 Hour OTC; QL extended release 24 hour hm chest congestion relief oral tablet Xpect OTC hm daytime cold & flu oral liquid Theraflu ExpressMax OTC

47 Drug Name Reference Notes Delsym Cgh/Chest Cong hm mucus relief cough children oral liquid OTC DM Child hm mucus relief dm oral tablet extended Mucinex DM Maximum OTC release 12 hour Strength hm mucus relief max st oral tablet extended EQ Mucus ER OTC release 12 hour loratadine-d 12hr oral tablet extended Alavert Allergy/Sinus OTC; QL release 12 hour loratadine-d 24hr oral tablet extended Claritin-D 24 Hour OTC; QL release 24 hour Robafen DM Cgh/Chest maxi-tuss g oral liquid OTC Congest MUCINEX CHILDRENS FREEFROM ORAL OTC LIQUID MUCINEX DM ORAL TABLET EXTENDED OTC RELEASE 12 HOUR MUCINEX FAST-MAX CHEST CONG MS OTC ORAL LIQUID MUCINEX FAST-MAX DM MAX ORAL AL; OTC LIQUID Mucinex Fast-Max Chest mucus & chest congestion oral liquid OTC Cong MS Delsym Cgh/Chest Cong mucus & cough relief childrens oral liquid AL; OTC DM Child mucus relief dm max oral tablet extended Mucinex DM Maximum AL; OTC release 12 hour Strength mucus relief dm oral tablet extended release Mucinex DM OTC 12 hour mucus relief er oral tablet extended release EQ Mucus ER OTC 12 hour mucus relief max st oral tablet extended EQ Mucus ER AL; OTC release 12 hour mucus relief oral tablet extended release 12 EQ Mucus ER OTC hour mucusrelief dm cough oral tablet Fenesin DM IR AL; OTC mucusrelief sinus oral tablet QC Medifin PE OTC promethazine vc oral syrup AL; QL pseudoephedrine-guaifenesin er oral tablet Mucinex D OTC extended release 12 hour qc medifin 400 oral tablet Xpect OTC qc mucus relief er oral tablet extended EQ Mucus ER AL; OTC release 12 hour 48 Drug Name Reference Notes robafen cf multi-symptom cold oral liquid Desgen DM AL; OTC ROBAFEN DM CGH/CHEST CONGEST AL; OTC; QL ORAL LIQUID ROBAFEN DM COUGH ORAL LIQUID AL; OTC; QL ROBAFEN MUCUS/CHEST CONGESTION OTC ORAL LIQUID Robafen DM Cgh/Chest siltussin dm das oral liquid AL; OTC; QL Congest siltussin sa oral syrup Diabetic Tussin EX OTC siltussin-dm alcohol free oral syrup Robafen DM Cough Clear AL; OTC; QL sm all day allergy-d oral tablet extended KLS Aller-Tec D PA; AL; OTC; QL release 12 hour sm chest congestion relief dm oral tablet Fenesin DM IR AL; OTC sm chest congestion relief oral tablet Xpect OTC sm chest congestion relief pe oral tablet QC Medifin PE OTC sm cough dm oral suspension extended Delsym OTC release sm lorata-dine d oral tablet extended release Claritin-D 24 Hour OTC; QL 24 hour Delsym Cgh/Chest Cong sm mucus relief cough children oral liquid AL; OTC DM Child sm mucus relief d oral tablet extended Mucinex D AL; OTC release 12 hour sm mucus relief max strength oral tablet EQ Mucus ER AL; OTC extended release 12 hour sm tussin cough/chest congest oral syrup Robafen DM Cough Clear AL; OTC; QL sm tussin dm oral syrup Robafen DM Cough Clear AL; OTC; QL sodium chloride inhalation nebulization solution Robafen DM Cgh/Chest tusnel diabetic oral liquid AL; OTC; QL Congest Robafen DM Cgh/Chest tussin dm cough + chest oral liquid AL; OTC; QL Congest Delsym Cgh/Chest Cong tussin dm max adult oral liquid AL; OTC DM Child tussin dm oral syrup Robafen DM Cough Clear AL; OTC; QL Mucinex Fast-Max Chest tussin mucus+chest congestion oral liquid OTC Cong MS tussin mucus+chest congestion oral syrup Diabetic Tussin EX OTC

49 Drug Name Reference Notes *DERMATOLOGICALS* ACCUTANE ORAL CAPSULE PA Clean & Clear Persa-Gel acne medication 10 external gel OTC; QL Max St acne medication 5 external gel OTC; QL acyclovir external cream Zovirax PA; QL acyclovir external ointment Zovirax PA; QL adapalene external gel Differin OTC; QL ala-cort external cream 1 % Aveeno Anti-Itch Max St QL ala-cort external cream 2.5 % PA; QL allevess external patch OTC alum sulfate-ca acetate external packet Domeboro OTC amcinonide external ointment PA; QL AMNESTEEM ORAL CAPSULE PA; QL antifungal (tolnaftate) external cream Tinactin OTC; QL antifungal clotrimazole external cream Desenex OTC; QL antifungal external cream Tinactin OTC; QL anti-fungal external powder Lotrimin AF OTC; QL arthritis pain reliever external gel Aspercreme Arthritis Pain OTC; QL arthritis pain relieving external cream OTC ASPERCREME PAIN RELIEF PATCH OTC EXTERNAL PAD athletes foot (terbinafine) external cream LamISIL AT OTC; QL AVITA EXTERNAL GEL PA; QL bacitracin external ointment Bacitraycin Plus OTC; QL bacitracin external ointment OTC; QL BENGAY ULTRA STRENGTH EXTERNAL OTC PATCH Clean & Clear Persa-Gel benzoyl peroxide external gel OTC; QL Max St betamethasone dipropionate aug external Diprolene AF QL cream betamethasone dipropionate external QL betamethasone valerate external cream QL betamethasone valerate external ointment QL bp gel external gel OTC butenafine hcl external cream Lotrimin Ultra OTC; QL calcipotriene external cream Dovonex QL

50 Drug Name Reference Notes calcipotriene external ointment Calcitrene QL calcipotriene external solution QL CALCITRENE EXTERNAL OINTMENT QL capsaicin external cream DermacinRx Penetral OTC Aspercreme Pain Relief capsaicin external pad OTC Patch Aspercreme Pain Relief capsaicin heat patch external pad OTC Patch Aspercreme Pain Relief capsaicin hot patch external pad OTC Patch capzix external cream Zostrix HP OTC ciclopirox external solution Ciclodan PA; QL ciclopirox olamine external cream Loprox QL ciclopirox olamine external suspension Loprox QL CLARAVIS ORAL CAPSULE PA; QL CLEAN & CLEAR PERSA-GEL MAX ST OTC; QL EXTERNAL GEL CLINDACIN ETZ EXTERNAL SWAB QL CLINDACIN-P EXTERNAL SWAB QL clindamycin phos-benzoyl perox external gel Neuac QL clindamycin phosphate external gel Clindagel QL clindamycin phosphate external solution QL clindamycin phosphate external swab Clindacin ETZ QL clobetasol prop emollient base external QL cream clobetasol propionate e external cream QL clobetasol propionate external cream Temovate QL clobetasol propionate external gel QL clobetasol propionate external ointment Temovate QL clobetasol propionate external solution QL clotrimazole anti-fungal external cream Desenex OTC; QL clotrimazole external cream Desenex QL clotrimazole-betamethasone external cream QL clotrimazole-betamethasone external lotion QL cold & hot medicated external patch Bengay Ultra Strength OTC CUTTER LEMON EUCALYPTUS OTC EXTERNAL LIQUID cvs capsaicin hp external cream Zostrix HP OTC

51 Drug Name Reference Notes cvs insect repellent external aerosol Repel Hunters Formula OTC Aspercreme Pain Relief cvs medicated heat patch external pad OTC Patch cvs total home insect repel external aerosol Repel Hunters Formula OTC DESRX EXTERNAL GEL QL diclofenac sodium external gel Aspercreme Arthritis Pain QL diclofenac sodium external solution QL docosanol external cream Abreva OTC; QL DOULEURIN EXTERNAL LOTION OTC Aspercreme Pain Relief eq capsaicin patch external pad OTC Patch ery external pad QL erythromycin external solution QL first aid antibiotic external ointment Lanabiotic OTC; QL fluocinonide emulsified base external cream QL fluocinonide external cream QL fluocinonide external gel QL fluocinonide external ointment QL fluocinonide external solution QL fluorouracil external cream Efudex QL fluorouracil external solution QL fluticasone propionate external cream QL fluticasone propionate external ointment QL gentamicin sulfate external cream QL gentamicin sulfate external ointment QL gnp arthritis pain external gel Aspercreme Arthritis Pain OTC; QL gnp athletes foot external cream Desenex OTC; QL gnp bacitracin zinc external ointment OTC; QL gnp docosanol external cream Abreva OTC; QL gnp lice treatment external liquid Nix Creme Rinse OTC; QL gnp lice treatment external Rid Lice Killing Shampoo OTC gnp lidocaine pain relief external patch Aspercreme Lidocaine OTC gnp lidocaine pain relieving external cream Aspercreme Lidocaine OTC gnp terbinafine hydrochloride external cream LamISIL AT OTC; QL gnp triple antibiotic external ointment Lanabiotic OTC; QL goodsense arthritis pain external gel Aspercreme Arthritis Pain OTC; QL halobetasol propionate external cream QL

52 Drug Name Reference Notes halobetasol propionate external ointment QL hm bacitracin zinc external ointment OTC; QL hm docosanol external cream Abreva OTC; QL Cortizone-10 Intensive hm hydrocortisone plus external cream OTC; QL Healing hm hydrocortisone-aloe max st external Cortizone-10 Intensive OTC; QL cream Healing hm lice treatment external liquid Nix Creme Rinse OTC; QL hm lidocaine patch external patch Aspercreme Lidocaine OTC hm triple antibiotic external ointment Lanabiotic OTC; QL hydrocortisone acetate external ointment OTC hydrocortisone external cream QL hydrocortisone external lotion PA; QL hydrocortisone external ointment QL hydrocortisone max st external cream Aveeno Anti-Itch Max St OTC; QL ICY HOT BACK EXTERNAL PATCH OTC ICY HOT BACK EXTRA STRENGTH OTC EXTERNAL PATCH ICY HOT EXTERNAL PATCH OTC ICY HOT EXTRA STRENGTH EXTERNAL OTC CREAM imiquimod external cream Aldara PA; QL isotretinoin oral capsule Accutane PA; QL ketoconazole external cream QL ketoconazole external shampoo QL lice killing external shampoo Rid Lice Killing Shampoo OTC lice killing maximum strength external Rid Lice Killing Shampoo OTC shampoo lice treatment creme rinse external liquid Nix Creme Rinse OTC; QL lidocaine external patch Lidoderm PA; QL lidocaine hcl external solution PA; QL lidocaine hcl urethral/mucosal external gel lidocaine pain relief external patch Aspercreme Lidocaine OTC lidocaine pain relieving external patch Aspercreme Lidocaine OTC lidocaine-prilocaine external cream QL MENTHOZEN EXTERNAL CREAM OTC metronidazole external cream Rosadan QL metronidazole external gel Rosadan QL

53 Drug Name Reference Notes metronidazole external lotion MetroLotion QL miconazole nitrate external cream Cavilon OTC; QL mometasone furoate external cream QL mometasone furoate external ointment QL mometasone furoate external solution QL mupirocin external ointment Centany QL MYORISAN ORAL CAPSULE PA; QL NATRAPEL 12-HOUR TICK/INSECT OTC EXTERNAL AEROSOL NYAMYC EXTERNAL POWDER QL nystatin external cream QL nystatin external ointment QL nystatin external powder Nyamyc QL NYSTOP EXTERNAL POWDER QL permethrin external cream QL pimecrolimus external cream Elidel PA; AL; QL podofilox external solution PA qc diclofenac sodium external gel Aspercreme Arthritis Pain OTC; QL qc tolnaftate external cream Tinactin OTC; QL Aspercreme Pain Relief ra capsicum hot patch external pad OTC Patch REGRANEX EXTERNAL GEL PA reliever external patch OTC REPEL HUNTERS FORMULA EXTERNAL OTC AEROSOL REPEL LEMON EUCALYPTUS OTC EXTERNAL AEROSOL ROSADAN EXTERNAL CREAM QL ROSADAN EXTERNAL GEL QL selenium sulfide external lotion QL silver sulfadiazine external cream SSD sm antibiotic external ointment OTC; QL sm antifungal clotrimazole external cream Desenex OTC; QL sm antifungal tolnaftate external cream Tinactin OTC; QL sm athletes foot external cream LamISIL AT OTC; QL sm lice killing max strength external Rid Lice Killing Shampoo OTC shampoo spinosad external suspension Natroba

54 Drug Name Reference Notes SSD EXTERNAL CREAM sure result sr relief external cream DermacinRx Penetral OTC tacrolimus external ointment Protopic PA; AL; QL terbinafine hcl external cream LamISIL AT OTC; QL tolnaftate antifungal external cream Tinactin OTC; QL tolnaftate external cream Tinactin OTC; QL tolnaftate external powder Lotrimin AF OTC; QL tretinoin external cream Retin-A PA; QL tretinoin external gel Retin-A PA; QL tretinoin microsphere external gel Retin-A Micro PA; AL; QL triamcinolone acetonide external cream Triderm QL triamcinolone acetonide external lotion 0.025 PA; QL % triamcinolone acetonide external lotion 0.1 QL % triamcinolone acetonide external ointment QL TRIDERM EXTERNAL CREAM 0.1 % QL TRIDERM EXTERNAL CREAM 0.5 % PA; QL triple antibiotic external ointment Lanabiotic OTC; QL ULTRATHON INSECT REPELLENT 8 OTC EXTERNAL AEROSOL VANALICE EXTERNAL GEL OTC ZENATANE ORAL CAPSULE PA; QL zinc oxide external ointment OTC; QL ZOSTRIX HP EXTERNAL CREAM OTC ZOSTRIX NATURAL PAIN RELIEF OTC EXTERNAL CREAM *DIAGNOSTIC PRODUCTS* CHEMSTRIP UGK IN VITRO STRIP OTC cosyntropin injection solution reconstituted Cortrosyn CVS KETONE CARE IN VITRO STRIP OTC DIASTIX IN VITRO STRIP OTC; QL FORA GTEL BLOOD KETONE TEST IN OTC; QL VITRO STRIP GLUCAGEN DIAGNOSTIC INJECTION SOLUTION RECONSTITUTED KETO-DIASTIX IN VITRO STRIP OTC NOVA MAX PLUS KETONE TEST IN OTC; QL VITRO STRIP 55 Drug Name Reference Notes PRECISION XTRA KETONE IN VITRO OTC; QL STRIP PTS PANELS KETONE TEST IN VITRO OTC; QL STRIP RELION TRUE METRIX TEST STRIPS IN OTC; QL VITRO STRIP TRUE METRIX BLOOD GLUCOSE TEST OTC; QL IN VITRO STRIP *DIGESTIVE AIDS* CREON ORAL CAPSULE DELAYED RELEASE PARTICLES 12000-38000 UNIT, PA; QL 24000-76000 UNIT, 6000-19000 UNIT CREON ORAL CAPSULE DELAYED RELEASE PARTICLES 3000-9500 UNIT, PA 36000-114000 UNIT *DIURETICS* acetazolamide er oral capsule extended release 12 hour acetazolamide oral tablet amiloride hcl oral tablet amiloride-hydrochlorothiazide oral tablet bumetanide oral tablet chlorthalidone oral tablet furosemide oral solution furosemide oral tablet Lasix hydrochlorothiazide oral capsule hydrochlorothiazide oral tablet indapamide oral tablet methazolamide oral tablet metolazone oral tablet spironolactone oral tablet Aldactone spironolactone-hctz oral tablet Aldactazide torsemide oral tablet triamterene-hctz oral capsule triamterene-hctz oral tablet Maxzide-25 *ENDOCRINE AND METABOLIC AGENTS - MISC.* alendronate sodium oral solution QL alendronate sodium oral tablet Fosamax QL

56 Drug Name Reference Notes cabergoline oral tablet QL calcitonin (salmon) nasal solution Miacalcin calcitriol oral capsule Rocaltrol PA calcitriol oral solution Rocaltrol PA desmopressin ace spray refrig nasal solution desmopressin acetate oral tablet DDAVP QL desmopressin acetate spray nasal solution HUMATROPE INJECTION SOLUTION PA; SP; QL RECONSTITUTED levocarnitine oral tablet Carnitor octreotide acetate injection solution SandoSTATIN PA; SP raloxifene hcl oral tablet Evista sodium phenylbutyrate oral powder Buphenyl PA; SP; QL sodium phenylbutyrate oral tablet Buphenyl PA; SP; QL *ESTROGENS* AMABELZ ORAL TABLET estradiol oral tablet Estrace estradiol transdermal patch weekly Climara QL estradiol-norethindrone acet oral tablet Amabelz FYAVOLV ORAL TABLET JINTELI ORAL TABLET MIMVEY ORAL TABLET norethindrone-eth estradiol oral tablet Fyavolv PREMARIN ORAL TABLET QL *FLUOROQUINOLONES* ciprofloxacin hcl oral tablet Cipro QL levofloxacin oral solution QL levofloxacin oral tablet Levaquin QL ofloxacin oral tablet QL *GASTROINTESTINAL AGENTS - MISC.* AVSOLA INTRAVENOUS SOLUTION PA; SP RECONSTITUTED balsalazide disodium oral capsule Colazal QL calcium acetate (phos binder) oral capsule PhosLo calcium acetate oral tablet Calphron enulose oral solution QL

57 Drug Name Reference Notes gas relief extra strength oral tablet chewable Gas-X Extra Strength OTC Little Remedies for gas relief infants oral suspension OTC Tummys gas relief oral tablet chewable OTC generlac oral solution QL Little Remedies for hm gas relief infants drops oral suspension OTC Tummys hm gas relief oral tablet chewable Gas-X Extra Strength OTC lactulose encephalopathy oral solution QL lanthanum carbonate oral tablet chewable Fosrenol mesalamine er oral capsule extended Apriso QL release 24 hour mesalamine rectal enema QL mesalamine-cleanser rectal kit Rowasa QL metoclopramide hcl oral solution QL metoclopramide hcl oral tablet Reglan QL mi-acid gas relief oral tablet chewable OTC sevelamer carbonate oral packet Renvela sevelamer carbonate oral tablet Renvela QL simethicone drops infants oral liquid Gas-X Infant Drops OTC simethicone oral tablet chewable Gas-X Extra Strength OTC sm gas relief oral tablet chewable OTC sulfasalazine oral tablet Azulfidine QL sulfasalazine oral tablet delayed release Azulfidine EN-tabs QL ursodiol oral capsule ursodiol oral tablet Urso 250 *GENITOURINARY AGENTS - MISCELLANEOUS* alfuzosin hcl er oral tablet extended release Uroxatral QL 24 hour ARGYLE STERILE SALINE IRRIGATION SOLUTION CURITY STERILE SALINE IRRIGATION SOLUTION finasteride oral tablet Proscar QL pot & sod cit-cit ac oral solution OTC potassium citrate er oral tablet extended Urocit-K 5 release potassium citrate-citric acid oral solution

58 Drug Name Reference Notes sodium chloride irrigation solution Argyle Sterile Saline tamsulosin hcl oral capsule Flomax QL *GOUT AGENTS* allopurinol oral tablet Zyloprim colchicine-probenecid oral tablet probenecid oral tablet *HEMATOLOGICAL AGENTS - MISC.* anagrelide hcl oral capsule Agrylin BERINERT INTRAVENOUS KIT PA; SP; QL cilostazol oral tablet clopidogrel bisulfate oral tablet 300 mg clopidogrel bisulfate oral tablet 75 mg Plavix QL dipyridamole oral tablet HAEGARDA SUBCUTANEOUS PA; SP; QL SOLUTION RECONSTITUTED icatibant acetate subcutaneous solution Sajazir PA; SP; QL KALBITOR SUBCUTANEOUS SOLUTION PA; SP; QL pentoxifylline er oral tablet extended release RUCONEST INTRAVENOUS SOLUTION PA; SP; QL RECONSTITUTED SAJAZIR SUBCUTANEOUS SOLUTION PA; SP; QL TAKHZYRO SUBCUTANEOUS SOLUTION PA; SP; QL *HEMATOPOIETIC AGENTS* ARANESP (ALBUMIN FREE) INJECTION PA; SP; QL SOLUTION ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED SYRINGE 10 MCG/0.4ML, 100 MCG/0.5ML, 150 PA; SP; QL MCG/0.3ML, 200 MCG/0.4ML, 25 MCG/0.42ML, 300 MCG/0.6ML, 500 MCG/ML, 60 MCG/0.3ML ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED SYRINGE 40 PA; SP MCG/0.4ML cyanocobalamin injection solution DROXIA ORAL CAPSULE EPOGEN INJECTION SOLUTION PA; SP; QL fa-vitamin b-6-vitamin b-12 oral tablet FERATE ORAL TABLET OTC; QL

59 Drug Name Reference Notes FEROSUL ORAL TABLET OTC; QL FERREX 150 ORAL CAPSULE OTC ferrous gluconate oral tablet 324 (37.5 fe) OTC mg ferrous gluconate oral tablet 324 (38 fe) mg OTC; QL ferrous sulfate oral elixir OTC ferrous sulfate oral solution BProtected Pedia Iron OTC ferrous sulfate oral tablet FeroSul OTC; QL ferrous sulfate oral tablet delayed release OTC; QL folic acid injection solution folic acid oral tablet 1 mg folic acid oral tablet 400 mcg OTC hydroxocobalamin acetate intramuscular solution INFED INJECTION SOLUTION PA; SP na ferric gluc cplx in sucrose intravenous Ferrlecit PA; SP; QL solution NEULASTA ONPRO SUBCUTANEOUS PA; SP; QL PREFILLED SYRINGE KIT NEULASTA SUBCUTANEOUS SOLUTION PA; SP; QL PREFILLED SYRINGE POLY-IRON 150 ORAL CAPSULE OTC RETACRIT INJECTION SOLUTION PA; SP; QL UDENYCA SUBCUTANEOUS SOLUTION PA; SP; QL PREFILLED SYRINGE VENOFER INTRAVENOUS SOLUTION PA; SP; QL vitamin b-12 oral tablet OTC ZARXIO INJECTION SOLUTION PA; SP PREFILLED SYRINGE *HEMOSTATICS* aminocaproic acid oral tablet Amicar QL tranexamic acid oral tablet Lysteda QL *HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS* estazolam oral tablet DO; QL flurazepam hcl oral capsule DO; QL phenobarbital oral elixir phenobarbital oral tablet 100 mg, 15 mg, 16.2 mg, 60 mg, 64.8 mg, 97.2 mg

60 Drug Name Reference Notes phenobarbital oral tablet 30 mg, 32.4 mg QL temazepam oral capsule Restoril DO; QL triazolam oral tablet DO; QL zaleplon oral capsule DO; QL zolpidem tartrate oral tablet Ambien DO; QL *LAXATIVES* bisacodyl ec oral tablet delayed release Alophen OTC; QL bisacodyl rectal suppository Dulcolax OTC CLEARLAX ORAL POWDER OTC constulose oral solution QL docu oral liquid Docu Liquid OTC docusate mini rectal enema Enemeez Mini OTC docusate sodium oral capsule 100 mg DOK OTC; QL docusate sodium oral capsule 250 mg OTC docusate sodium oral liquid Docu Liquid OTC DOK ORAL CAPSULE OTC; QL DOK ORAL TABLET OTC enema ready-to-use rectal enema Fleet Enema OTC enema rectal enema Fleet Enema OTC ENEMEEZ MINI RECTAL ENEMA OTC ENEMEEZ PLUS RECTAL ENEMA OTC fiber oral tablet OTC; QL fiber-lax oral tablet OTC; QL FLEET BISACODYL RECTAL ENEMA OTC gavilax oral powder ClearLax OTC GAVILYTE-C ORAL SOLUTION QL RECONSTITUTED GAVILYTE-G ORAL SOLUTION QL RECONSTITUTED GAVILYTE-N WITH FLAVOR PACK ORAL QL SOLUTION RECONSTITUTED gentle laxative oral tablet delayed release Alophen OTC; QL gentle laxative rectal suppository Dulcolax OTC glycerin childrens rectal suppository Pedia-Lax OTC GLYCOLAX ORAL POWDER OTC GNP CLEARLAX ORAL POWDER OTC gnp fiber-caps oral tablet OTC; QL

61 Drug Name Reference Notes gnp gentle laxative oral tablet delayed Alophen OTC; QL release gnp gentle laxative rectal suppository Dulcolax OTC gnp milk of magnesia oral suspension Dulcolax OTC gnp natural fiber oral powder Reguloid OTC gnp senna lax oral tablet Evac-U-Gen OTC gnp stool softener oral capsule DOK OTC; QL gnp stool softener/laxative oral tablet Senexon-S OTC GOODSENSE CLEARLAX ORAL OTC POWDER HEALTHYLAX ORAL PACKET OTC; QL HM CLEARLAX ORAL POWDER OTC hm enema rectal enema Fleet Enema OTC hm fiber oral tablet Citrucel OTC hm laxative oral tablet delayed release Alophen OTC; QL hm magnesium citrate oral solution Citroma OTC hm milk of magnesia oral suspension Dulcolax OTC hm senna oral tablet Evac-U-Gen OTC hm senna-s oral tablet Senexon-S OTC hm stool softener oral capsule DOK OTC; QL hm stool softener/laxative oral tablet Senexon-S OTC konsyl original daily fiber oral packet OTC lactulose oral solution QL laxative max str oral tablet OTC; QL magnesium citrate oral solution Citroma OTC milk of magnesia oral suspension Dulcolax OTC peg 3350 oral packet HealthyLax OTC; QL peg 3350 oral powder ClearLax OTC peg 3350-kcl-na bicarb-nacl oral solution GaviLyte-N with Flavor QL reconstituted Pack peg-3350/electrolytes oral solution GaviLyte-G QL reconstituted polyethylene glycol 3350 oral packet HealthyLax OTC; QL polyethylene glycol 3350 oral powder ClearLax qc enema rectal enema Fleet Enema OTC qc magnesium citrate oral solution Citroma OTC qc milk of magnesia oral suspension Dulcolax OTC qc natural vegetable laxative oral tablet Evac-U-Gen OTC

62 Drug Name Reference Notes qc natura-lax oral powder ClearLax OTC qc stool softener oral capsule DOK OTC; QL qc stool softener pls laxative oral tablet Senexon-S OTC REGULOID ORAL POWDER OTC SENEXON-S ORAL TABLET OTC senna oral liquid OTC senna oral tablet Evac-U-Gen OTC senna plus oral tablet Senexon-S OTC senna-lax oral tablet Evac-U-Gen OTC silace oral liquid Docu Liquid OTC SM CLEARLAX ORAL POWDER OTC sm enema rectal enema Fleet Enema OTC sm fiber laxative oral tablet Citrucel OTC sm gentle laxative oral tablet delayed Alophen OTC; QL release sm magnesium citrate oral solution Citroma OTC sm milk of magnesia oral suspension Dulcolax OTC sm senna-s oral tablet Senexon-S OTC sm stool softener oral capsule DOK OTC; QL sm stool softener oral tablet DOK OTC sm stool softener/laxative oral tablet Senexon-S OTC stimulant laxative oral tablet Senexon-S OTC stool softener oral capsule DOK OTC; QL stool softener plus laxative oral tablet Senexon-S OTC *MACROLIDES* azithromycin oral packet Zithromax QL azithromycin oral suspension reconstituted Zithromax QL azithromycin oral tablet QL clarithromycin er oral tablet extended release 24 hour clarithromycin oral suspension reconstituted QL clarithromycin oral tablet QL E.E.S. 400 ORAL TABLET ERY-TAB ORAL TABLET DELAYED RELEASE ERYTHROCIN STEARATE ORAL TABLET erythromycin base oral capsule delayed release particles

63 Drug Name Reference Notes erythromycin base oral tablet erythromycin base oral tablet delayed Ery-Tab release erythromycin ethylsuccinate oral tablet E.E.S. 400 erythromycin oral tablet delayed release Ery-Tab *MEDICAL DEVICES AND SUPPLIES* AgaMatrix Ultra-Thin 1st tier unilet comfortouch OTC; QL Lancets AgaMatrix Ultra-Thin acti-lance 28g OTC; QL Lancets AgaMatrix Ultra-Thin acti-lance lite lancets 28g OTC; QL Lancets AgaMatrix Ultra-Thin acti-lance special lancets 17g OTC; QL Lancets AgaMatrix Ultra-Thin acti-lance universal 23g OTC; QL Lancets adult mask device All Flow 1000 PFT Filter QL AgaMatrix Ultra-Thin advanced mobile lancet OTC; QL Lancets ADVOCATE CONTROL SOLUTION IN OTC VITRO LIQUID ADVOCATE LANCING DEVICE OTC; QL ADVOCATE REDI-CODE+ CONTROL IN OTC VITRO SOLUTION AEROGEAR ACTION ASTHMA KIT KIT AEROVENT PLUS DEVICE QL AGAMATRIX CONTROL IN VITRO OTC SOLUTION AGAMATRIX ULTRA-THIN LANCETS OTC; QL aimsco lubricated Durex Extra Sensitive OTC AgaMatrix Ultra-Thin aimsco twist lancets 32g OTC; QL Lancets AIMSCO TWIST LANCETS 33G OTC; QL AIRZONE PEAK FLOW METER DEVICE OTC BD Swab Single Use alcohol prep pad OTC Regular ALL FLOW 1000 PFT FILTER DEVICE QL ALL FLOW 2000 PFT FILTER DEVICE QL ALL FLOW 3000 PFT FILTER DEVICE QL ALL FLOW 4000 PFT FILTER DEVICE QL

64 Drug Name Reference Notes ALL FLOW 5000 PFT FILTER DEVICE QL ALL FLOW 6000 PFT FILTER DEVICE QL ALL FLOW 7000 PFT FILTER DEVICE QL ARGYLE TRACHEOSTOMY CARE TRAY KIT ASSURE HAEMOLANCE PLUS HIGH OTC; QL ASSURE HAEMOLANCE PLUS LOW OTC; QL ASSURE HAEMOLANCE PLUS MICRO OTC; QL ASSURE HAEMOLANCE PLUS NORMAL OTC; QL ASSURE HAEMOLANCE PLUS PED OTC; QL ASSURE LANCE LANCETS OTC; QL ASSURE LANCE LANCETS 21G OTC; QL ASSURE LANCE PLUS SAFETY 25G OTC; QL ASSURE LANCE PLUS SAFETY 30G OTC; QL ASSURE LANCE SAFETY LANCET 28G OTC; QL AgaMatrix Ultra-Thin aurora lancet super thin 30g OTC; QL Lancets AgaMatrix Ultra-Thin aurora lancet thin 23g OTC; QL Lancets AUTO-LANCET OTC; QL AUTO-LANCET MINI OTC; QL AUTOLET II CLINISAFE KIT OTC AUTOLET LANCING DEVICE OTC; QL AUTOLET LITE CLINISAFE KIT OTC AUTOLET LITE STARTER PACK KIT OTC AUTOLET MINI OTC; QL AUTOLET PLATFORMS OTC AUTOLET PLUS OTC; QL BD AUTOSHIELD OTC; QL BD AUTOSHIELD DUO OTC; QL BD INSULIN SYR ULTRAFINE II QL BD INSULIN SYRINGE QL BD INSULIN SYRINGE HALF-UNIT QL BD INSULIN SYRINGE MICROFINE QL BD INSULIN SYRINGE U/F QL BD INSULIN SYRINGE U/F 1/2UNIT QL BD INSULIN SYRINGE U-500 QL BD INSULIN SYRINGE ULTRAFINE QL 65 Drug Name Reference Notes BD PEN NEEDLE MICRO U/F OTC; QL BD PEN NEEDLE MINI U/F OTC; QL BD PEN NEEDLE NANO 2ND GEN OTC; QL BD PEN NEEDLE NANO U/F OTC; QL BD PEN NEEDLE ORIGINAL U/F OTC; QL BD PEN NEEDLE SHORT U/F OTC; QL BD SAFETYGLIDE INSULIN SYRINGE QL BD SAFETY-LOK INSULIN SYRINGE QL BD SWAB SINGLE USE REGULAR PAD OTC BD SWABS SINGLE USE BUTTERFLY OTC PAD BD VEO INSULIN SYR U/F 1/2UNIT QL BD VEO INSULIN SYRINGE U/F QL breathe ease peak flow meter device TruZone Peak Flow Meter OTC BREATHERITE VALVED MDI CHAMBER QL DEVICE CARDIOCOM LANCING DEVICE OTC; QL careone advanced lancing dev Advocate Lancing Device OTC; QL CAREONE LANCET SUPER THIN 30G OTC; QL AgaMatrix Ultra-Thin careone lancet thin 23g OTC; QL Lancets CARESENS LANCETS OTC; QL CAYA VAGINAL DIAPHRAGM CLEANLET LANCETS 28G OTC; QL CLEVER CHOICE GLUCOSE CONTROL OTC IN VITRO LIQUID CLEVER CHOICE PEAK FLOW METER OTC DEVICE AgaMatrix Ultra-Thin comfort assured lancets 28g OTC; QL Lancets AgaMatrix Ultra-Thin comfort assured lancets 33g OTC; QL Lancets AgaMatrix Ultra-Thin comfort lancets OTC; QL Lancets COMPACT SPACE CHAMBER DEVICE QL COMPACT SPACE CHAMBER/LG MASK QL DEVICE COMPACT SPACE CHAMBER/MED QL MASK DEVICE

66 Drug Name Reference Notes CONTOUR CONTROL IN VITRO LIQUID OTC CONTOUR NEXT CONTROL IN VITRO OTC SOLUTION CURITY ALCOHOL PREPS PAD OTC CURITY BURN DRESSING PAD OTC BD Swab Single Use cvs alcohol prep pads pad OTC Regular AgaMatrix Ultra-Thin cvs lancets 21g OTC; QL Lancets AgaMatrix Ultra-Thin cvs lancets micro thin 33g OTC; QL Lancets AgaMatrix Ultra-Thin cvs lancets original OTC; QL Lancets AgaMatrix Ultra-Thin cvs lancets thin 26g OTC; QL Lancets AgaMatrix Ultra-Thin cvs lancets ultra thin 30g OTC; QL Lancets AgaMatrix Ultra-Thin cvs lancets ultra-thin 30g OTC; QL Lancets cvs lancing device Advocate Lancing Device OTC; QL BD Swab Single Use cvs prep pad OTC Regular AgaMatrix Ultra-Thin cvs ultra thin lancets OTC; QL Lancets DEXCOM G4 PLAT PED RCV/SHARE PA DEVICE DEXCOM G4 PLAT PED RECEIVER PA DEVICE DEXCOM G4 PLATINUM RCV/SHARE PA DEVICE DEXCOM G4 PLATINUM RECEIVER PA DEVICE DEXCOM G4 PLATINUM TRANSMITTER PA DEXCOM G4 SENSOR PA DEXCOM G5 MOB/G4 PLAT SENSOR PA DEXCOM G5 MOBILE RECEIVER DEVICE PA; QL DEXCOM G5 MOBILE TRANSMITTER PA DEXCOM G5 RECEIVER KIT DEVICE PA; QL DEXCOM G6 RECEIVER DEVICE PA DEXCOM G6 SENSOR PA

67 Drug Name Reference Notes DEXCOM G6 TRANSMITTER PA DIATHRIVE LANCET ULTRA THIN 30 OTC; QL DIATHRIVE LANCETS OTC; QL DIATHRIVE LANCING DEVICE OTC; QL diatrue control level 1 in vitro solution Advocate Control Solution OTC diatrue control level 3 in vitro solution Advocate Control Solution OTC DROPLET LANCETS ULTRA THIN 30G OTC; QL DROPLET LANCING DEVICE OTC; QL DROPLET PERSONAL LANCETS 30G OTC; QL AgaMatrix Ultra-Thin drug mart lancets thin 26g OTC; QL Lancets DRUG MART LANCING DEVICE OTC; QL DRUG MART ON-THE-GO LANCET 30G OTC; QL DRUG MART UNILET LANCETS 28G OTC; QL DRUG MART UNILET LANCETS 30G OTC; QL DRUG MART UNILET LANCETS 33G OTC; QL DUREX EXTRA SENSITIVE DEVICE OTC DUREX REALFEEL DEVICE OTC EASIVENT MASK LARGE QL EASIVENT MASK MEDIUM QL EASIVENT MASK SMALL QL easy plus ii control in vitro solution Advocate Control Solution OTC EASY STEP CONTROL IN VITRO OTC SOLUTION easy talk control in vitro solution Advocate Control Solution OTC EASY TOUCH ALCOHOL PREP MEDIUM OTC PAD EASY TOUCH LANCETS 21G OTC; QL EASY TOUCH LANCETS 23G OTC; QL EASY TOUCH LANCETS 26G OTC; QL EASY TOUCH LANCETS 28G OTC; QL EASY TOUCH LANCETS 28G/TWIST OTC; QL EASY TOUCH LANCETS 30G OTC; QL EASY TOUCH LANCETS 30G/TWIST OTC; QL EASY TOUCH LANCETS 32G OTC; QL EASY TOUCH LANCETS 32G/TWIST OTC; QL EASY TOUCH LANCETS 33G/TWIST OTC; QL EASY TOUCH LANCING DEVICE OTC; QL 68 Drug Name Reference Notes EASY TOUCH SAFETY LANCETS 21G OTC; QL EASY TOUCH SAFETY LANCETS 23G OTC; QL EASY TOUCH SAFETY LANCETS 26G OTC; QL EASY TOUCH SAFETY LANCETS 28G OTC; QL easy trak control in vitro solution Advocate Control Solution OTC ELEMENT CONTROL IN VITRO LIQUID OTC EMBRACE CONTROL IN VITRO OTC SOLUTION EMBRACE EVO CONTROL LEVEL 1 IN OTC VITRO LIQUID EMBRACE GLUCOSE CONTROL IN OTC VITRO LIQUID EMBRACE TALK GLUCOSE CONTROL IN OTC VITRO SOLUTION AgaMatrix Ultra-Thin eql color lancets 21g OTC; QL Lancets AgaMatrix Ultra-Thin eql color lancets micro 33g OTC; QL Lancets AgaMatrix Ultra-Thin eql super thin lancets 30g OTC; QL Lancets AgaMatrix Ultra-Thin eql thin lancets 26g OTC; QL Lancets E-Z JECT LANCET MICRO-THIN 33G OTC; QL E-Z JECT LANCET SUPER THIN 30G OTC; QL E-Z JECT LANCETS OTC; QL E-Z JECT LANCETS 21G OTC; QL E-Z JECT LANCETS THIN 26G OTC; QL EZ-LETS LANCETS 21G OTC; QL EZ-LETS LANCETS 26G OTC; QL EZ-LETS LANCETS 28G OTC; QL EZ-LETS LANCETS 30G OTC; QL FANTASY LUBRICATED OTC FANTASY LUBRICATED/SPERMICIDE OTC FC FEMALE CONDOM OTC; QL FC2 FEMALE CONDOM OTC; QL FIFTY50 ALCOHOL PREP PAD OTC FIFTY50 SAFETY SEAL LANCETS OTC; QL FIFTY50 UNILET LANCETS 33G OTC; QL FINE 30 OTC; QL

69 Drug Name Reference Notes FLEXICHAMBER ADULT MASK/SMALL QL FLEXICHAMBER CHILD MASK/LARGE QL FLEXICHAMBER CHILD MASK/SMALL QL FORA CONTROL IN VITRO SOLUTION OTC FORA LANCETS OTC; QL FORA LANCING DEVICE OTC; QL FORACARE GDH CONTROL IN VITRO OTC SOLUTION FORTISCARE CONTROL IN VITRO OTC SOLUTION freds pharmacy autolet lancing Advocate Lancing Device OTC; QL AgaMatrix Ultra-Thin freds pharmacy unilet lanc 28g OTC; QL Lancets AgaMatrix Ultra-Thin freds pharmacy unilet lanc 30g OTC; QL Lancets FREESTYLE LIBRE 14 DAY READER PA; QL DEVICE FREESTYLE LIBRE 14 DAY SENSOR PA; QL FREESTYLE LIBRE 2 READER DEVICE PA; QL FREESTYLE LIBRE 2 SENSOR PA; QL FREESTYLE LIBRE READER DEVICE PA; QL GENTEEL BUTTERFLY TOUCH LANCET OTC; QL GENTEEL CONTACT TIPS (BLUE) OTC GENTEEL CONTACT TIPS (CLEAR) OTC GENTEEL CONTACT TIPS (GREEN) OTC GENTEEL CONTACT TIPS (ORANGE) OTC GENTEEL CONTACT TIPS (RAINBOW) OTC GENTEEL CONTACT TIPS (VIOLET) OTC GENTEEL CONTACT TIPS (YELLOW) OTC GENTEEL LANCING KIT (BLUE) KIT OTC GENTEEL NOZZLES OTC GENTEEL PLUS LANCING (BLACK) OTC GENTEEL PLUS LANCING (PURPLE) OTC GENTEEL PLUS LANCING (WHITE) OTC GENTEEL PLUS LANCING DEV(BLUE) OTC GENTEEL PLUS LANCING DEV(PINK) OTC GENTLE-LET GP LANCETS OTC; QL GENTLE-LET LANCETS OTC; QL

70 Drug Name Reference Notes GENTLE-LET PLATFORMS OTC GLUCOCOM CONTROL IN VITRO LIQUID OTC GLUCOCOM LANCETS 28G OTC; QL GLUCOCOM LANCETS 30G OTC; QL GLUCOCOM LANCETS 33G OTC; QL BD Swab Single Use gnp alcohol swabs pad OTC Regular AgaMatrix Ultra-Thin gnp lancets 21g OTC; QL Lancets AgaMatrix Ultra-Thin gnp lancets micro thin 33g OTC; QL Lancets AgaMatrix Ultra-Thin gnp lancets super thin 30g OTC; QL Lancets AgaMatrix Ultra-Thin gnp lancets thin OTC; QL Lancets AgaMatrix Ultra-Thin gnp lancets thin 26g OTC; QL Lancets AgaMatrix Ultra-Thin goodsense color lancets 33g OTC; QL Lancets AgaMatrix Ultra-Thin goodsense lancets 26g univ OTC; QL Lancets AgaMatrix Ultra-Thin goodsense lancets 30g OTC; QL Lancets AgaMatrix Ultra-Thin goodsense lancets 30g univ OTC; QL Lancets AgaMatrix Ultra-Thin goodsense lancets 33g OTC; QL Lancets AgaMatrix Ultra-Thin goodsense lancets 33g univ OTC; QL Lancets goodsense lancing device Advocate Lancing Device OTC; QL HAEMOLANCE OTC; QL HAEMOLANCE LOW FLOW LANCETS OTC; QL HAEMOLANCE PLUS OTC; QL HAEMOLANCE PLUS HIGH FLOW OTC; QL HAEMOLANCE PLUS LOW FLOW OTC; QL HAEMOLANCE PLUS MAX FLOW OTC; QL HAEMOLANCE PLUS PEDIATRIC FLOW OTC; QL HEALTH CARE LANCING DEVICE OTC; QL healthy accents lancing device Advocate Lancing Device OTC; QL

71 Drug Name Reference Notes AgaMatrix Ultra-Thin healthy accents unilet lancets OTC; QL Lancets h-e-b incontrol adv lancing Advocate Lancing Device OTC; QL AgaMatrix Ultra-Thin h-e-b incontrol lancets 28g OTC; QL Lancets AgaMatrix Ultra-Thin h-e-b incontrol lancets 30g OTC; QL Lancets AgaMatrix Ultra-Thin h-e-b incontrol lancets 33g OTC; QL Lancets BD Swab Single Use hm sterile alcohol prep pad OTC Regular HYPOLANCE AST LANCING KIT OTC HY-VEE LANCETS OTC; QL AgaMatrix Ultra-Thin hy-vee thin lancets OTC; QL Lancets IN TOUCH LANCING DEVICE OTC; QL IN TOUCH STERILE LANCETS 30G OTC; QL IN-CHECK DIAL FLOW TRAINER DEVICE QL IN-CHECK INSPIRATORY FLOW MTR QL DEVICE KAMELEON LUBRICATED OTC kimono Durex Extra Sensitive OTC KIMONO COLORS DEVICE OTC kimono micro thin Trustex Non-Lubricated OTC kimono micro thin plus Durex Extra Sensitive OTC kimono plus Durex Extra Sensitive OTC kimono ps Durex Extra Sensitive OTC kimono ps plus Durex Extra Sensitive OTC kimono sensation Durex Extra Sensitive OTC kimono sensation plus Durex Extra Sensitive OTC KIMONO SPECIAL DEVICE OTC AgaMatrix Ultra-Thin kinney lancets OTC; QL Lancets AgaMatrix Ultra-Thin kinney thin lancets OTC; QL Lancets KROGER AUTOLET LANCING DEVICE OTC; QL KROGER HEALTHPRO LANCET 26G OTC; QL AgaMatrix Ultra-Thin kroger lancets OTC; QL Lancets

72 Drug Name Reference Notes AgaMatrix Ultra-Thin kroger lancets 21g OTC; QL Lancets AgaMatrix Ultra-Thin kroger lancets micro thin 33g OTC; QL Lancets AgaMatrix Ultra-Thin kroger lancets super thin OTC; QL Lancets AgaMatrix Ultra-Thin kroger lancets thin OTC; QL Lancets AgaMatrix Ultra-Thin kroger lancets thin 26g OTC; QL Lancets AgaMatrix Ultra-Thin kroger lancets ultrathin 30g OTC; QL Lancets kroger lancing device Advocate Lancing Device OTC; QL K-Y ME & YOU EXTRA LUBRICATED OTC DEVICE K-Y ME & YOU INTENSE DEVICE OTC lancet device Advocate Lancing Device OTC; QL lancet transporter case Autolet Platforms OTC AgaMatrix Ultra-Thin lancets OTC; QL Lancets AgaMatrix Ultra-Thin lancets 33g OTC; QL Lancets AgaMatrix Ultra-Thin lancets micro thin 33g OTC; QL Lancets AgaMatrix Ultra-Thin lancets super thin 28g OTC; QL Lancets AgaMatrix Ultra-Thin lancets thin OTC; QL Lancets LANCETS ULTRA THIN OTC; QL lancing device Advocate Lancing Device OTC; QL LANZO OTC; QL leader advanced lancing device Advocate Lancing Device OTC; QL LIBERTY GLUCOSE CONTROL IN VITRO OTC SOLUTION LIBERTY MINI LANCING DEVICE OTC; QL AgaMatrix Ultra-Thin lite touch lancets OTC; QL Lancets LITE TOUCH LANCING PEN OTC; QL LITETOUCH LANCETS OTC; QL live better adv lancing device Advocate Lancing Device OTC; QL

73 Drug Name Reference Notes AgaMatrix Ultra-Thin live better lancet super thin OTC; QL Lancets AgaMatrix Ultra-Thin live better lancet ultra thin OTC; QL Lancets AgaMatrix Ultra-Thin longs lancets standard OTC; QL Lancets AgaMatrix Ultra-Thin longs lancets thin OTC; QL Lancets AgaMatrix Ultra-Thin longs lancets ultra thin OTC; QL Lancets lung perform peak flow meter device TruZone Peak Flow Meter OTC MASK VORTEX/CHILD/FROG OTC; QL MASK VORTEX/TODDLER/LADYBUG OTC; QL maxx Durex Extra Sensitive OTC maxx plus Durex Extra Sensitive OTC AgaMatrix Ultra-Thin medichoice safety lancet OTC; QL Lancets AgaMatrix Ultra-Thin medichoice safety lancet extra OTC; QL Lancets AgaMatrix Ultra-Thin medichoice safety lancet norm OTC; QL Lancets MEDLANCE EXTRA 21G OTC; QL MEDLANCE LITE 25G OTC; QL MEDLANCE PLUS EXTRA 21G OTC; QL MEDLANCE PLUS LANCETS OTC; QL MEDLANCE PLUS LITE 25G OTC; QL MEDLANCE PLUS SPECIAL 0.8MM OTC; QL MEDLANCE PLUS SUPERLITE 30G OTC; QL MEDLANCE PLUS UNIVERSAL 21G OTC; QL MEDLANCE UNIVERSAL 21G OTC; QL MEIJER LANCETS OTC; QL MEIJER LANCETS THIN OTC; QL MEIJER LANCETS UNIVERSAL 21G OTC; QL MEIJER LANCETS UNIVERSAL 30G OTC; QL MEIJER LANCETS UNIVERSAL 33G OTC; QL MEIJER SUPER THIN LANCETS OTC; QL MICROCHAMBER DEVICE MICROLIFE DIGITAL PEAK FLOW OTC DEVICE

74 Drug Name Reference Notes mini lancing device Advocate Lancing Device OTC; QL MM LANCING DEVICE OTC; QL MM TWIST LANCETS OTC; QL MONOLET LANCETS OTC; QL MONOLET OPD LANCETS OTC; QL MONOLETTOR SAFETY LANCETS OTC; QL AgaMatrix Ultra-Thin mpd safety lancet 21g OTC; QL Lancets AgaMatrix Ultra-Thin mpd safety lancet 23g OTC; QL Lancets AgaMatrix Ultra-Thin mpd safety lancet 28g OTC; QL Lancets AgaMatrix Ultra-Thin mpd safety lancet 30g OTC; QL Lancets multi-lancet device Advocate Lancing Device OTC; QL MULTI-LANCET DEVICE 2 KIT OTC MYGLUCOHEALTH LANCETS 30G OTC; QL NOVA SAFETY LANCETS 23G OTC; QL NOVA SAFETY LANCETS 28G OTC; QL NOVA SUREFLEX LANCETS OTC; QL NOVA SUREFLEX LANCING DEVICE OTC; QL OMNIFLEX DIAPHRAGM VAGINAL DIAPHRAGM OMNIPOD 5 PACK PA; QL OMNIPOD DASH 5 PACK PODS PA; QL OMNIPOD STARTER KIT PA ONETOUCH VERIO IN VITRO SOLUTION OTC OPTICHAMBER DIAMOND QL OPTICHAMBER DIAMOND-LG MASK QL DEVICE OPTICHAMBER DIAMOND-MD MASK QL OPTICHAMBER DIAMOND-SM MASK QL PANDA MASK LARGE OTC; QL PANDA MASK MEDIUM OTC; QL PANDA MASK SMALL OTC; QL PARI TREK S COMBO PACK DEVICE QL AgaMatrix Ultra-Thin pc lancets super thin 30g OTC; QL Lancets peak a-i-r flow meter device TruZone Peak Flow Meter OTC 75 Drug Name Reference Notes PEAK AIR PEAK FLOW METER DEVICE OTC peak flow meter universal rang device TruZone Peak Flow Meter OTC PEDIATRIC PANDA MASK OTC; QL PERFECT LANCETS 28G OTC; QL PERFECT LANCETS 30G OTC; QL PHARMACY COUNTER LANCETS OTC; QL AgaMatrix Ultra-Thin pip lancets 28g OTC; QL Lancets AgaMatrix Ultra-Thin pip lancets 30g OTC; QL Lancets POCKET CHAMBER DEVICE QL POCKETPEAK PEAK FLOW METER OTC DEVICE PRECISION THINS GP LANCETS OTC; QL AgaMatrix Ultra-Thin preferred plus lancets colored OTC; QL Lancets AgaMatrix Ultra-Thin preferred plus lancets thin OTC; QL Lancets premium condoms lubricated Durex Extra Sensitive OTC PRODIGY CONTROL SOLUTION IN OTC VITRO SOLUTION PSS SELECT GP LANCETS OTC; QL PSS SELECT PLATFORMS OTC PSS SELECT SAFETY LANCETS OTC; QL pure comfort flow meter adult device TruZone Peak Flow Meter OTC pure comfort flow meter child device TruZone Peak Flow Meter OTC px advanced lancing device Advocate Lancing Device OTC; QL AgaMatrix Ultra-Thin px lancets ultra thin OTC; QL Lancets AgaMatrix Ultra-Thin px lancets ultra thin 28g OTC; QL Lancets qc advanced lancing device Advocate Lancing Device OTC; QL BD Swab Single Use qc alcohol swabs pad OTC Regular AgaMatrix Ultra-Thin qc lancets super thin 30g OTC; QL Lancets AgaMatrix Ultra-Thin qc lancets ultra thin OTC; QL Lancets AgaMatrix Ultra-Thin qc unilet lancets 28g OTC; QL Lancets

76 Drug Name Reference Notes AgaMatrix Ultra-Thin qc unilet lancets micro thin OTC; QL Lancets RA E-ZJECT LANCETS 28G OTC; QL RA E-ZJECT LANCETS THIN 26G OTC; QL RA E-ZJECT LANCETS THIN 28G OTC; QL RA E-ZJECT LANCETS ULTRA THIN OTC; QL READYLANCE SAFETY LANCETS OTC; QL AgaMatrix Ultra-Thin reality lancets OTC; QL Lancets REALITY LATEX CONDOMS OTC REALITY LATEX/ULTRA TEXTURED OTC DEVICE REALITY LATEX/ULTRA THIN DEVICE OTC AgaMatrix Ultra-Thin reality trigger lancets OTC; QL Lancets RELION ALCOHOL SWABS PAD OTC RELION LANCET DEVICES 30G OTC; QL RELION LANCETS MICRO-THIN 33G OTC; QL RELION LANCETS THIN 26G OTC; QL RELION LANCETS ULTRA-THIN 30G OTC; QL RELION LANCING DEVICE OTC; QL RELION LANCING DEVICE KIT OTC RELION TRUE MET AIR GLUC METER OTC KIT RELION ULTRA THIN LANCETS 30G OTC; QL RELION ULTRA THIN PLUS LANCETS OTC; QL REXALL LANCETS ULTRA THIN 30G OTC; QL RIGHTEST ALTERNATE SITE ADAPT OTC RIGHTEST GC300 CONTROL IN VITRO OTC LIQUID RIGHTEST GD500 LANCING DEVICE OTC; QL RIGHTEST GL300 LANCETS OTC; QL RITEFLO DEVICE QL SAFE-T-LANCE OTC; QL SAFE-T-LANCE PLUS OTC; QL SAFETY LANCETS 21G OTC; QL AgaMatrix Ultra-Thin sb lancets thin OTC; QL Lancets

77 Drug Name Reference Notes AgaMatrix Ultra-Thin sb lancets ultra thin OTC; QL Lancets select-lite device/lancets kit Autolet II Clinisafe OTC select-lite lancing device Advocate Lancing Device OTC; QL SHOPKO AUTOLET LANCING DEVICE OTC; QL SHOPKO ON-THE-GO LANCETS 30G OTC; QL SHOPKO UNILET LANCETS 28G OTC; QL SHOPKO UNILET LANCETS 30G OTC; QL BD Swab Single Use sm alcohol prep pad OTC Regular AgaMatrix Ultra-Thin sm lancets 33g OTC; QL Lancets SMART SENSE COLOR LANCETS 33G OTC; QL SMART SENSE STANDARD LANCETS OTC; QL SMART SENSE SUPER THIN LANCETS OTC; QL SMART SENSE THIN LANCETS 26G OTC; QL SMARTEST LANCETS 28G OTC; QL SOLUS V2 CONTROL IN VITRO OTC SOLUTION STERILANCE PA OTC STERILANCE TL OTC; QL AgaMatrix Ultra-Thin super thin lancets OTC; QL Lancets AgaMatrix Ultra-Thin sure comfort lancets 18g OTC; QL Lancets AgaMatrix Ultra-Thin sure comfort lancets 21g OTC; QL Lancets AgaMatrix Ultra-Thin sure comfort lancets 23g OTC; QL Lancets AgaMatrix Ultra-Thin sure comfort lancets 28g OTC; QL Lancets AgaMatrix Ultra-Thin sure comfort lancets 30g OTC; QL Lancets sure comfort lancing pen Advocate Lancing Device OTC; QL SURELITE LANCETS OTC; QL SURESTEP PRO HIGH GLUCOSE IN OTC VITRO LIQUID SURESTEP PRO LOW GLUCOSE IN OTC VITRO LIQUID TECHLITE AST LANCETS OTC; QL

78 Drug Name Reference Notes TECHLITE LANCETS OTC; QL TECHLITE LANCETS 30G OTC; QL AgaMatrix Ultra-Thin tgt lancet micro thin 33g OTC; QL Lancets AgaMatrix Ultra-Thin tgt lancet thin 26g OTC; QL Lancets AgaMatrix Ultra-Thin tgt lancet ultra thin 30g OTC; QL Lancets tgt lancing device Advocate Lancing Device OTC; QL THINLETS GP LANCETS OTC; QL THRESHOLD PEP DEVICE QL todays health lancing device Advocate Lancing Device OTC; QL AgaMatrix Ultra-Thin todays health thin lancets 28g OTC; QL Lancets AgaMatrix Ultra-Thin todays health thin lancets 30g OTC; QL Lancets AgaMatrix Ultra-Thin topcare lancets micro-thin 33g OTC; QL Lancets AgaMatrix Ultra-Thin travel lancets OTC; QL Lancets TRAVEL LANCETS ADVANCED 28G OTC; QL BD Swab Single Use true comfort alcohol prep pads pad OTC Regular TRUE METRIX AIR GLUCOSE METER KIT OTC TRUE METRIX LEVEL 1 IN VITRO OTC SOLUTION TRUE METRIX LEVEL 3 IN VITRO OTC SOLUTION TRUEDRAW LANCING DEVICE OTC; QL TRUEPLUS LANCETS 26G OTC; QL TRUEPLUS LANCETS 28G OTC; QL TRUEPLUS LANCETS 30G OTC; QL TRUEPLUS LANCETS 33G OTC; QL TRUEPLUS SAFETY LANCETS 28G OTC; QL TRUSTEX COLOR CONDOMS + LUBE OTC TRUSTEX LUB/RIBBED/STUDDED OTC TRUSTEX LUB/SPERMICIDE EX ST OTC TRUSTEX LUB/SPERMICIDE XL OTC TRUSTEX LUBRICATED OTC

79 Drug Name Reference Notes TRUSTEX LUBRICATED EX LARGE OTC TRUSTEX LUBRICATED EXTRA ST OTC TRUSTEX LUBRICATED/SPERMICIDE OTC TRUSTEX NATURAL CONDOMS + LUBE OTC TRUSTEX NON-LUBRICATED OTC TRUSTEX RIA LUB/SPERMICIDE OTC TRUSTEX RIA LUBRICATED OTC TRUSTEX RIA NON-LUBRICATED OTC TRUSTEX-NONOXYNOL-9/RIB/STUD OTC TRUZONE PEAK FLOW METER DEVICE ULTICARE ALCOHOL SWABS PAD OTC ULTRA-THIN II AUTO LANCET OTC; QL ULTRA-THIN II LANCETS OTC; QL UNILET COMFORTOUCH LANCET OTC; QL UNILET EXCELITE OTC; QL UNILET EXCELITE II OTC; QL UNILET G.P. LANCET OTC; QL UNILET G.P. SUPERLITE LANCET OTC; QL UNILET GP 28 ULTRA THIN OTC; QL UNILET LANCET OTC; QL UNILET MICRO-THIN 33G OTC; QL UNILET SUPERLITE LANCET OTC; QL UNILET SUPER-THIN 30G OTC; QL UNILET ULTRA-THIN 28G OTC; QL UNISTIK 1 OTC UNISTIK 2 OTC UNISTIK 2 COMFORT OTC UNISTIK 2 EXTRA OTC UNISTIK 2 NEONATAL OTC UNISTIK 2 NORMAL OTC UNISTIK 2 SUPER OTC UNISTIK 3 OTC UNISTIK 3 COMFORT OTC UNISTIK 3 EXTRA OTC UNISTIK 3 GENTLE OTC; QL UNISTIK 3 NEONATAL OTC UNISTIK 3 NORMAL OTC

80 Drug Name Reference Notes UNISTIK CZT COMFORT OTC UNISTIK CZT NORMAL OTC UNISTIK NORMAL OTC UNISTIK PRO SAFETY LANCET OTC; QL UNISTIK SAFETY LANCETS 28G OTC; QL UNISTIK SAFETY LANCETS 30G OTC; QL UNISTIK TOUCH SAFETY LANC 21G OTC; QL UNISTIK TOUCH SAFETY LANC 23G OTC; QL UNISTIK TOUCH SAFETY LANC 28G OTC; QL UNISTIK TOUCH SAFETY LANC 30G OTC; QL UNISTRIP CONTROL IN VITRO OTC SOLUTION UNIVERSAL 1 LANCETS THIN 26G OTC; QL UNIVERSAL 1 LANCETS THIN 33G OTC; QL UNIVERSAL 1 LANCETS ULTRA THIN OTC; QL AgaMatrix Ultra-Thin value plus lancet standard 21g OTC; QL Lancets AgaMatrix Ultra-Thin value plus lancets super thin OTC; QL Lancets AgaMatrix Ultra-Thin value plus lancets thin 26g OTC; QL Lancets value plus lancing device Advocate Lancing Device OTC; QL AgaMatrix Ultra-Thin valumark lancet super thin 30g OTC; QL Lancets AgaMatrix Ultra-Thin valumark lancet ultra thin 28g OTC; QL Lancets VIDA MIA AUTOLET LANCING DEV OTC; QL VIDA MIA UNILET LANCETS 28G OTC; QL VIDA MIA UNILET LANCETS 30G OTC; QL VIVAGUARD LANCETS OTC; QL VIVAGUARD LANCING DEVICE OTC; QL VORTEX HOLD CHMBR/MASK/CHILD QL DEVICE VORTEX HOLD CHMBR/MASK/TODDLER QL DEVICE VORTEX VALVED HOLDING CHAMBER QL DEVICE AgaMatrix Ultra-Thin walgreens adv travel lancets OTC; QL Lancets

81 Drug Name Reference Notes WALGREENS LANCETS OTC; QL AgaMatrix Ultra-Thin walgreens lancets micro thin OTC; QL Lancets AgaMatrix Ultra-Thin walgreens lancets super thin OTC; QL Lancets WALGREENS THIN LANCETS OTC; QL WALGREENS ULTRA THIN LANCETS OTC; QL WEBCOL ALCOHOL PREP LARGE PAD OTC WEBCOL ALCOHOL PREP MEDIUM PAD OTC WIDE-SEAL DIAPHRAGM 60 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 65 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 70 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 75 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 80 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 85 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 90 VAGINAL DIAPHRAGM WIDE-SEAL DIAPHRAGM 95 VAGINAL DIAPHRAGM *MIGRAINE PRODUCTS* AIMOVIG SUBCUTANEOUS SOLUTION PA; QL AUTO-INJECTOR EMGALITY (300 MG DOSE) SUBCUTANEOUS SOLUTION PREFILLED PA; QL SYRINGE EMGALITY SUBCUTANEOUS SOLUTION PA; QL AUTO-INJECTOR EMGALITY SUBCUTANEOUS SOLUTION PA; QL PREFILLED SYRINGE ergotamine-caffeine oral tablet Cafergot MIGERGOT RECTAL SUPPOSITORY naratriptan hcl oral tablet Amerge QL NURTEC ORAL TABLET DISPERSIBLE PA; QL sumatriptan nasal solution Imitrex PA; QL

82 Drug Name Reference Notes sumatriptan succinate oral tablet Imitrex QL sumatriptan succinate refill subcutaneous Imitrex STATdose Refill PA; QL solution cartridge sumatriptan succinate subcutaneous Imitrex PA; QL solution sumatriptan succinate subcutaneous Imitrex STATdose System PA; QL solution auto-injector *MINERALS & ELECTROLYTES* calcium + vitamin d3 oral tablet 600-10 mg- OTC; QL mcg calcium + vitamin d3 oral tablet 600-5 mg- OTC mcg calcium carb-cholecalciferol oral tablet OTC; QL calcium carb-cholecalciferol oral tablet OTC chewable calcium carbonate oral tablet OTC calcium carbonate-vitamin d3 oral tablet OTC; QL fluoritab oral solution NaFrinse Drops gnp calcium oral tablet OTC KLOR-CON 10 ORAL TABLET EXTENDED RELEASE KLOR-CON M10 ORAL TABLET EXTENDED RELEASE KLOR-CON M15 ORAL TABLET EXTENDED RELEASE KLOR-CON M20 ORAL TABLET EXTENDED RELEASE KLOR-CON ORAL PACKET KLOR-CON ORAL TABLET EXTENDED RELEASE magnesium oxide oral tablet 400 (241.3 mg) MAGnesium-Oxide OTC; QL mg magnesium oxide oral tablet 500 mg OTC NAFRINSE DROPS ORAL SOLUTION NAFRINSE ORAL TABLET CHEWABLE OS-CAL EXTRA D3 ORAL TABLET OTC OYSCO 500+D ORAL TABLET OTC oyster shell calcium oral tablet Oystercal OTC; QL oyster shell calcium/d oral tablet RA Hi Cal OTC

83 Drug Name Reference Notes PEDIALYTE FREEZER POPS ORAL OTC; QL SOLUTION PEDIALYTE ORAL SOLUTION OTC; QL PEDIALYTE SINGLES ORAL SOLUTION OTC; QL PHOSPHA 250 NEUTRAL ORAL TABLET phosphorous oral tablet Phospha 250 Neutral PHOSPHO-TRIN 250 NEUTRAL ORAL TABLET potassium chloride crys er oral tablet Klor-Con M20 extended release potassium chloride er oral capsule extended release potassium chloride er oral tablet extended Klor-Con 10 release potassium chloride oral packet Klor-Con potassium chloride oral solution sm pediatric electrolyte oral solution Pedialyte OTC; QL sodium fluoride oral solution sodium fluoride oral tablet chewable NaFrinse virt-phos 250 neutral oral tablet Phospha 250 Neutral *MISCELLANEOUS THERAPEUTIC CLASSES* ARGYLE STERILE WATER IRRIGATION SOLUTION azathioprine oral tablet Imuran CLOVIQUE ORAL CAPSULE PA; SP; QL cyclosporine modified oral capsule SP cyclosporine modified oral solution Gengraf SP cyclosporine oral capsule SandIMMUNE SP GENGRAF ORAL CAPSULE SP GENGRAF ORAL SOLUTION SP mycophenolate mofetil oral capsule CellCept SP mycophenolate mofetil oral suspension CellCept SP reconstituted mycophenolate mofetil oral tablet CellCept SP mycophenolate sodium oral tablet delayed Myfortic SP release penicillamine oral tablet Depen Titratabs PA; QL PHYSIOLYTE IRRIGATION SOLUTION

84 Drug Name Reference Notes PHYSIOSOL IRRIGATION IRRIGATION SOLUTION SANDIMMUNE ORAL SOLUTION SP sirolimus oral solution Rapamune SP sirolimus oral tablet Rapamune SP SPS ORAL SUSPENSION sterile water for irrigation irrigation solution Argyle Sterile Water tacrolimus oral capsule Prograf SP trientine hcl oral capsule Clovique PA; SP; QL water for irrigation, sterile irrigation solution Argyle Sterile Water *MOUTH/THROAT/DENTAL AGENTS* CAVAREST DENTAL GEL chlorhexidine gluconate mouth/throat Paroex QL solution clotrimazole mouth/throat troche QL DENTA 5000 PLUS DENTAL CREAM DENTAGEL DENTAL GEL lidocaine hcl mouth/throat solution QL lidocaine viscous hcl mouth/throat solution QL nystatin mouth/throat suspension QL ORALONE MOUTH/THROAT PAROEX MOUTH/THROAT SOLUTION QL PERIOGARD MOUTH/THROAT QL SOLUTION pilocarpine hcl oral tablet Salagen QL sf 5000 plus dental cream Denta 5000 Plus sf dental gel Cavarest sodium fluoride 5000 plus dental cream Denta 5000 Plus sodium fluoride 5000 ppm dental cream Denta 5000 Plus sodium fluoride dental cream Denta 5000 Plus sodium fluoride dental gel Cavarest triamcinolone acetonide mouth/throat paste Oralone *MULTIVITAMINS* adc/f (0.5mg/ml) oral solution ALIVE PRENATAL ORAL TABLET AL; OTC CHEWABLE animal shapes/iron oral tablet chewable Cerovite Jr OTC AQUADEKS ORAL LIQUID OTC

85 Drug Name Reference Notes ATABEX ORAL TABLET CHEWABLE OTC b complex oral capsule OTC b complex vitamins (w/ fa) oral capsule OTC b complex-c oral tablet Allbee/C OTC; QL b-complex/b-12 oral tablet OTC BRAINSTRONG PRENATAL ORAL OTC; QL cadeau dha oral capsule OTC; QL CENTRUM SPECIALIST PRENATAL OTC ORAL CERTAVITE SENIOR/ANTIOXIDANT OTC; QL ORAL TABLET CERTAVITE/ANTIOXIDANTS ORAL OTC; QL TABLET childrens chew multivitamin oral tablet Bounty Bears/C OTC chewable classic prenatal oral tablet AL; OTC; QL CLINICAL NUTRIENTS PRENATAL ORAL OTC TABLET cvs prenatal gummy oral tablet chewable 0.4 OTC mg, 0.4-113.5 mg cvs prenatal gummy oral tablet chewable Alive Prenatal AL; OTC 0.4-25 mg cvs prenatal multi+dha oral capsule OTC cvs prenatal oral tablet NeoNatal Vitamin AL; OTC; QL cvs womens prenatal+dha oral AL; OTC; QL daily-vite multivitamin oral tablet Tab-A-Vite OTC; QL dekas essential oral capsule Chlorocaps OTC Mommy's Bliss MV dekas essential oral liquid OTC Organic Drops dekas plus oral capsule ActivNutrients OTC; QL UpSpring Baby Iron- dekas plus oral liquid OTC Immunity dekas plus oral tablet chewable Advanced Multi EA OTC ENFAMIL EXPECTA ORAL OTC eql prenatal formula oral tablet AL; OTC; QL FLORIVA ORAL TABLET CHEWABLE gnp prenatal oral tablet AL; OTC; QL HEALTHY MAMA BE WELL ROUNDED OTC ORAL THERAPY PACK

86 Drug Name Reference Notes high potency multivitamin oral tablet Tab-A-Vite OTC; QL One-A-Day Womens hm one daily prenatal oral AL; OTC; QL Prenatal hm prenatal oral tablet AL; OTC; QL ICAPS MV ORAL TABLET OTC; QL kp prenatal multivitamins oral tablet AL; OTC; QL kpn prenatal oral tablet AL; OTC; QL multi prenatal oral tablet NeoNatal Vitamin AL; OTC; QL multivitamin childrens oral tablet chewable Culturelle Kids Complete OTC multivitamin oral tablet Tab-A-Vite OTC; QL multivitamin/fluoride oral solution Floriva Plus multi-vitamin/fluoride oral solution Floriva Plus multivitamin/fluoride oral tablet chewable Quflora Pediatric multi-vitamin/fluoride/iron oral solution NEONATAL VITAMIN ORAL TABLET AL; OTC; QL NESTABS ORAL TABLET AL; QL OBTREX ORAL TABLET AL; OTC; QL OCUVITE-LUTEIN ORAL TABLET OTC; QL ONCOVITE ORAL TABLET OTC; QL ONE A DAY PRENATAL ORAL TABLET AL; OTC CHEWABLE one vite womens oral tablet NeoNatal Vitamin AL; OTC; QL ONE-A-DAY WOMENS PRENATAL 1 OTC ORAL CAPSULE ONE-A-DAY WOMENS PRENATAL ORAL OTC 28-0.8 & 223 MG ONE-A-DAY WOMENS PRENATAL ORAL AL; OTC; QL 28-0.8 & 440 MG PERRY PRENATAL ORAL CAPSULE AL; OTC; QL POLY-VI-FLOR ORAL SUSPENSION POLY-VI-FLOR ORAL TABLET CHEWABLE POLY-VI-FLOR/IRON ORAL SUSPENSION POLY-VI-FLOR/IRON ORAL TABLET CHEWABLE POLY-VI-SOL ORAL SOLUTION OTC POLY-VI-SOL/IRON ORAL SOLUTION OTC; QL prenatabs fa oral tablet Co-Natal FA AL; OTC; QL prenatal (w/iron & fa) oral tablet AL; OTC; QL 87 Drug Name Reference Notes prenatal + complete multi oral therapy pack OTC prenatal 19 oral tablet AL; OTC; QL prenatal adult gummy/dha/fa oral tablet Alive Prenatal AL; OTC chewable prenatal complete oral tablet AL; OTC; QL prenatal formula a-free oral tablet OTC prenatal formula oral capsule OTC pre-natal formula oral tablet AL; OTC; QL prenatal forte oral tablet AL; OTC; QL prenatal gummies/dha & fa oral tablet OTC chewable prenatal multi +dha oral capsule OTC PRENATAL MULTIVITAMIN + DHA ORAL OTC prenatal multivitamin plus dha oral capsule OTC prenatal one daily oral tablet NeoNatal Vitamin AL; OTC; QL prenatal oral tablet 27-0.8 mg NeoNatal Vitamin AL; OTC; QL prenatal oral tablet 28-0.8 mg AL; OTC; QL prenatal oral tablet 6.75-0.2 mg OTC prenatal vitamin and mineral oral tablet AL; OTC; QL prenatal vitamin oral tablet NeoNatal Vitamin AL; OTC; QL prenatal vitamin/min +dha oral capsule OTC; QL prenatal vitamins oral tablet AL; OTC; QL prenatal/iron oral tablet AL; OTC; QL prenatal/omega-3/fa/iron oral capsule Your Life Multi Prenatal OTC prenatal+dha oral AL; OTC; QL PROSIGHT ORAL TABLET OTC; QL px prenatal multivitamins oral tablet AL; OTC; QL qc prenatal oral tablet AL; OTC; QL QUFLORA FE PEDIATRIC ORAL LIQUID ra prenatal formula oral tablet AL; OTC; QL ra prenatal oral tablet AL; OTC; QL RIGHT STEP PRENATAL ORAL TABLET AL; OTC; QL SIMILAC PRENATAL EARLY SHIELD OTC ORAL One-A-Day Womens sm one daily prenatal oral AL; OTC; QL Prenatal sm prenatal vitamins oral tablet AL; OTC; QL

88 Drug Name Reference Notes CertaVite stress formula/zinc oral tablet OTC; QL Senior/Antioxidant STUART ONE ORAL CAPSULE OTC TAB-A-VITE ORAL TABLET OTC; QL TAB-A-VITE/BETA CAROTENE ORAL OTC; QL TABLET Tab-A-Vite/Iron/Beta tab-a-vite/iron oral tablet OTC; QL Carotene TAB-A-VITE/IRON/BETA CAROTENE OTC; QL ORAL TABLET THERA M PLUS ORAL TABLET OTC; QL THERA ORAL TABLET OTC; QL CertaVite thera-m oral tablet OTC; QL Senior/Antioxidant THERANATAL COMPLETE ORAL OTC; QL THERANATAL CORE NUTRITION ORAL AL; OTC; QL TABLET THERANATAL ONE ORAL CAPSULE OTC THERANATAL OVAVITE ORAL THERAPY OTC PACK THEREMS ORAL TABLET OTC; QL TRI-VI-FLOR ORAL SUSPENSION TRI-VI-SOL A/C/D ORAL SOLUTION OTC tri-vitamin/fluoride oral solution tri-vite/fluoride oral solution ultra prenatal + dha oral capsule OTC; QL VINATE CARE ORAL TABLET AL; OTC; QL CHEWABLE vitamin b + c complex oral tablet Allbee/C OTC; QL vitamins acd-fluoride oral solution YOUR LIFE MULTI PRENATAL ORAL OTC CAPSULE *MUSCULOSKELETAL THERAPY AGENTS* baclofen oral tablet QL carisoprodol oral tablet Soma QL carisoprodol-aspirin-codeine oral tablet AL; QL chlorzoxazone oral tablet QL cyclobenzaprine hcl oral tablet QL

89 Drug Name Reference Notes dantrolene sodium oral capsule Dantrium GELSYN-3 INTRA-ARTICULAR PA; SP SOLUTION PREFILLED SYRINGE methocarbamol oral tablet QL orphenadrine citrate er oral tablet extended QL release 12 hour tizanidine hcl oral tablet Zanaflex QL *NASAL AGENTS - SYSTEMIC AND TOPICAL* Mucinex Childrens Stuffy 12 hour nasal decongestant nasal solution OTC Nose AFRIN SALINE NASAL MIST NASAL AL; OTC SOLUTION allergy relief nasal suspension ClariSpray OTC; QL allergy spray 24 hour nasal aerosol KLS Aller-Cort OTC; QL allergy spray 24 hour nasal suspension ClariSpray OTC; QL altamist spray nasal solution Afrin Saline Nasal Mist AL; OTC AYR NASAL SOLUTION AL; OTC azelastine hcl nasal solution QL BABY AYR SALINE NASAL SOLUTION AL; OTC budesonide nasal suspension OTC; QL CLARISPRAY NASAL SUSPENSION OTC; QL cromolyn sodium nasal aerosol solution NasalCrom OTC cvs budesonide nasal suspension OTC; QL cvs fluticasone propionate nasal suspension ClariSpray OTC; QL cvs nasal allergy spray nasal aerosol KLS Aller-Cort OTC; QL cvs saline nasal solution Afrin Saline Nasal Mist AL; OTC deep sea nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC eq allergy relief nasal suspension ClariSpray OTC; QL eq budesonide nasal nasal suspension OTC; QL eq nasal allergy nasal aerosol KLS Aller-Cort OTC; QL eq saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC eql fluticasone childrens nasal suspension ClariSpray OTC; QL eql fluticasone propionate nasal suspension ClariSpray OTC; QL eql saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC fluticasone propionate nasal suspension ClariSpray OTC; QL gnp 24 hour nasal allergy nasal aerosol KLS Aller-Cort OTC; QL

90 Drug Name Reference Notes gnp budesonide nasal spray nasal OTC; QL suspension gnp fluticasone propionate nasal suspension ClariSpray OTC; QL gnp nasal decongestant oral tablet SudoGest AL; OTC gnp nasal decongestant pe oral tablet Sudogest PE OTC gnp nasal moisturizing nasal solution Afrin Saline Nasal Mist AL; OTC goodsense nasal allergy spray nasal aerosol KLS Aller-Cort OTC; QL hm 24 hour nasal allergy nasal aerosol KLS Aller-Cort OTC; QL hm allergy relief nasal suspension ClariSpray OTC; QL hm nasal decongestant oral tablet SudoGest AL; OTC hm nasal decongestant pe oral tablet Sudogest PE OTC hm saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC ipratropium bromide nasal solution KLS ALLER-CORT NASAL AEROSOL OTC; QL KLS ALLER-FLO NASAL SUSPENSION OTC; QL meijer saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC MUCINEX CHILDRENS STUFFY NOSE OTC NASAL SOLUTION MUCINEX SINUS-MAX CLEAR & COOL OTC NASAL SOLUTION MUCINEX SINUS-MAX SINUS/ALLRGY OTC NASAL SOLUTION nasal allergy 24 hour nasal aerosol KLS Aller-Cort OTC; QL nasal decongestant oral tablet SudoGest AL; OTC nasal decongestant pe max st oral tablet Sudogest PE OTC nasal decongestant pe oral tablet Sudogest PE OTC Mucinex Childrens Stuffy nasal decongestant spray nasal solution OTC Nose NASAL MOIST NASAL SOLUTION AL; OTC nasal moisturizing spray nasal solution Afrin Saline Nasal Mist AL; OTC Mucinex Childrens Stuffy nasal spray no drip nasal solution OTC Nose OCEAN FOR KIDS NASAL SOLUTION AL; OTC OCEAN NASAL SPRAY NASAL OTC SOLUTION phenylephrine hcl oral tablet Sudogest PE OTC pseudoephedrine hcl oral tablet SudoGest AL; OTC px saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC qc allergy relief nasal suspension ClariSpray OTC; QL 91 Drug Name Reference Notes qc saline nasal relief nasal solution Afrin Saline Nasal Mist AL; OTC ra budesonide nasal suspension OTC; QL ra nasal allergy nasal aerosol KLS Aller-Cort OTC; QL ra saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC saline mist spray nasal solution Afrin Saline Nasal Mist AL; OTC saline nasal spray nasal solution Afrin Saline Nasal Mist AL; OTC sb saline nose nasal solution Afrin Saline Nasal Mist AL; OTC sm allergy relief nasal suspension ClariSpray OTC; QL sm nasal decongestant max st oral tablet SudoGest AL; OTC Mucinex Childrens Stuffy sm nasal spray 12 hour nasal solution OTC Nose sm nasal spray saline nasal solution Afrin Saline Nasal Mist AL; OTC SUDOGEST MAXIMUM STRENGTH ORAL AL; OTC TABLET SUDOGEST ORAL TABLET AL; OTC SUDOGEST PE ORAL TABLET OTC triamcinolone acetonide nasal aerosol KLS Aller-Cort OTC; QL *NEUROMUSCULAR AGENTS* riluzole oral tablet Rilutek PA; SP *OPHTHALMIC AGENTS* ak-poly-bac ophthalmic ointment Polycin ALAWAY CHILDRENS ALLERGY OTC; QL OPHTHALMIC SOLUTION ALAWAY OPHTHALMIC SOLUTION OTC; QL ALTAFRIN OPHTHALMIC SOLUTION apraclonidine hcl ophthalmic solution atropine sulfate ophthalmic solution Isopto Atropine QL azelastine hcl ophthalmic solution QL bacitracin ophthalmic ointment QL bacitracin-polymyxin b ophthalmic ointment Polycin bacitra-neomycin-polymyxin-hc ophthalmic Neo-Polycin HC ointment betaxolol hcl ophthalmic solution QL brimonidine tartrate ophthalmic solution QL carboxymethylcellulose sodium ophthalmic Refresh Tears OTC solution carteolol hcl ophthalmic solution ciprofloxacin hcl ophthalmic solution Ciloxan

92 Drug Name Reference Notes cromolyn sodium ophthalmic solution QL dexamethasone sodium phosphate ophthalmic solution diclofenac sodium ophthalmic solution dorzolamide hcl ophthalmic solution Trusopt QL dorzolamide hcl-timolol mal ophthalmic Cosopt QL solution dry eye relief drops ophthalmic solution Visine Dry Eye OTC epinastine hcl ophthalmic solution QL erythromycin ophthalmic ointment QL eye allergy itch relief ophthalmic solution Pataday OTC; QL eye allergy itch/redness rel ophthalmic Pataday OTC; QL solution eye itch relief ophthalmic solution Alaway OTC; QL fluorometholone ophthalmic suspension FML Liquifilm flurbiprofen sodium ophthalmic solution FRESHKOTE PF OPHTHALMIC OTC SOLUTION gatifloxacin ophthalmic solution Zymaxid GENTAK OPHTHALMIC OINTMENT QL gentamicin sulfate ophthalmic solution QL GENTEAL SEVERE OPHTHALMIC GEL OTC GENTEAL TEARS SEVERE DAY/NIGHT OTC OPHTHALMIC GEL gnp olopatadine hcl ophthalmic solution Pataday OTC; QL hm dry eye relief ophthalmic solution Visine Dry Eye OTC hm lubricating plus ophthalmic solution Biolle Tears OTC ISOPTO ATROPINE OPHTHALMIC QL SOLUTION ketotifen fumarate ophthalmic solution Alaway OTC; QL latanoprost ophthalmic solution Xalatan QL levobunolol hcl ophthalmic solution levofloxacin ophthalmic solution lubricant eye drops ophthalmic solution Systane OTC lubricant eye drops pf ophthalmic solution Biolle Tears OTC lubricant eye nighttime ophthalmic ointment Puralube OTC lubricating eye drops ophthalmic solution Systane OTC moxifloxacin hcl ophthalmic solution Vigamox QL

93 Drug Name Reference Notes MURO 128 OPHTHALMIC SOLUTION OTC neomycin-bacitracin zn-polymyx ophthalmic Neo-Polycin QL ointment neomycin-polymyxin-dexameth ophthalmic Maxitrol ointment neomycin-polymyxin-dexameth ophthalmic Maxitrol suspension neomycin-polymyxin-gramicidin ophthalmic QL solution neomycin-polymyxin-hc ophthalmic suspension NEO-POLYCIN HC OPHTHALMIC OINTMENT NEO-POLYCIN OPHTHALMIC OINTMENT QL ofloxacin ophthalmic solution Ocuflox QL olopatadine hcl ophthalmic solution Pataday OTC; QL PATADAY OPHTHALMIC SOLUTION 0.1 PA; OTC; QL % PATADAY OPHTHALMIC SOLUTION 0.2 OTC; QL %, 0.7 % phenylephrine hcl ophthalmic solution Altafrin pilocarpine hcl ophthalmic solution Isopto Carpine POLYCIN OPHTHALMIC OINTMENT polymyxin b-trimethoprim ophthalmic Polytrim QL solution polyvinyl alcohol ophthalmic solution OTC prednisolone acetate ophthalmic suspension Pred Forte prednisolone sodium phosphate ophthalmic QL solution PURALUBE OPHTHALMIC OINTMENT OTC REFRESH CELLUVISC OPHTHALMIC OTC GEL REFRESH LACRI-LUBE OPHTHALMIC OTC OINTMENT REFRESH OPHTHALMIC SOLUTION OTC REFRESH OPTIVE PF OPHTHALMIC OTC SOLUTION REFRESH P.M. OPHTHALMIC OINTMENT OTC sodium chloride (hypertonic) ophthalmic Altachlore OTC ointment

94 Drug Name Reference Notes sodium chloride (hypertonic) ophthalmic Altachlore OTC solution sulfacetamide sodium ophthalmic ointment QL sulfacetamide sodium ophthalmic solution Bleph-10 QL sulfacetamide-prednisolone ophthalmic QL solution SYSTANE OPHTHALMIC GEL OTC SYSTANE OVERNIGHT THERAPY OTC OPHTHALMIC GEL timolol maleate ophthalmic gel forming Timoptic-XE QL solution timolol maleate ophthalmic solution 0.25 % Timoptic QL timolol maleate ophthalmic solution 0.5 % Timoptic tobramycin ophthalmic solution Tobrex QL tobramycin-dexamethasone ophthalmic TobraDex QL suspension trifluridine ophthalmic solution QL ultra lubricating eye drops ophthalmic Systane OTC solution XIIDRA OPHTHALMIC SOLUTION PA; QL *OTIC AGENTS* acetic acid otic solution ciprofloxacin hcl otic solution Cetraxal PA; QL ear drops earwax aid otic solution Murine Ear OTC earwax removal otic solution Murine Ear OTC gnp earwax removal drops otic solution Murine Ear OTC MURINE EAR OTIC SOLUTION OTC neomycin-polymyxin-hc otic solution neomycin-polymyxin-hc otic suspension ofloxacin otic solution QL *OXYTOCICS* METHERGINE ORAL TABLET methylergonovine maleate injection solution methylergonovine maleate oral tablet Methergine *PASSIVE IMMUNIZING AND TREATMENT AGENTS* GAMUNEX-C INJECTION SOLUTION PA; SP OCTAGAM INTRAVENOUS SOLUTION PA; SP

95 Drug Name Reference Notes SYNAGIS INTRAMUSCULAR SOLUTION PA; SP *PENICILLINS* amoxicillin oral capsule amoxicillin oral suspension reconstituted QL amoxicillin oral tablet amoxicillin oral tablet chewable amoxicillin-pot clavulanate er oral tablet QL extended release 12 hour amoxicillin-pot clavulanate oral suspension Augmentin reconstituted amoxicillin-pot clavulanate oral tablet Augmentin amoxicillin-pot clavulanate oral tablet chewable ampicillin oral capsule dicloxacillin sodium oral capsule penicillin v potassium oral solution reconstituted penicillin v potassium oral tablet *PHARMACEUTICAL ADJUVANTS* sterile water for injection injection solution sterile water for injection intravenous solution SUSPENDOL-S LIQUID OTC SYRSPEND SF ORAL LIQUID *PROGESTINS* hydroxyprogesterone caproate intramuscular Makena PA; SP; QL oil MAKENA SUBCUTANEOUS SOLUTION PA; SP; QL AUTO-INJECTOR medroxyprogesterone acetate oral tablet Provera QL norethindrone acetate oral tablet Aygestin progesterone oral capsule Prometrium QL *PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.* acamprosate calcium oral tablet delayed QL release AUBAGIO ORAL TABLET PA; SP; QL AVONEX PEN INTRAMUSCULAR AUTO- PA; SP; QL INJECTOR KIT

96 Drug Name Reference Notes AVONEX PREFILLED INTRAMUSCULAR PA; SP; QL PREFILLED SYRINGE KIT BETASERON SUBCUTANEOUS KIT PA; SP; QL bupropion hcl er ( det) oral tablet QL extended release 12 hour CHANTIX CONTINUING MONTH PAK AL; QL ORAL TABLET CHANTIX ORAL TABLET AL; QL CHANTIX STARTING MONTH PAK ORAL QL TABLET chlordiazepoxide-amitriptyline oral tablet dimethyl fumarate oral capsule delayed Tecfidera PA; SP; QL release dimethyl fumarate starter pack oral Tecfidera PA; SP; QL disulfiram oral tablet donepezil hcl oral tablet 10 mg, 5 mg Aricept DO; QL donepezil hcl oral tablet 23 mg Aricept PA; QL donepezil hcl oral tablet dispersible DO; QL EXTAVIA SUBCUTANEOUS KIT PA; SP; QL galantamine hydrobromide er oral capsule Razadyne ER DO; QL extended release 24 hour galantamine hydrobromide oral solution DO; QL galantamine hydrobromide oral tablet DO; QL glatiramer acetate subcutaneous solution Glatopa PA; SP; QL prefilled syringe GLATOPA SUBCUTANEOUS SOLUTION PA; SP; QL PREFILLED SYRINGE gnp nicotine mini mouth/throat lozenge KLS Quit4 OTC; QL gnp nicotine mouth/throat gum KLS Quit2 OTC; QL gnp nicotine polacrilex mouth/throat gum KLS Quit4 OTC; QL gnp nicotine polacrilex mouth/throat lozenge KLS Quit4 OTC; QL gnp nicotine transdermal patch 24 hour Habitrol OTC; QL goodsense nicotine mouth/throat gum KLS Quit2 OTC; QL goodsense nicotine mouth/throat lozenge KLS Quit4 OTC; QL hm nicotine polacrilex mouth/throat gum KLS Quit4 OTC; QL hm nicotine polacrilex mouth/throat lozenge KLS Quit2 OTC; QL hm nicotine transdermal patch 24 hour Nicoderm CQ OTC; QL memantine hcl oral solution 10 mg/5ml DO; QL memantine hcl oral solution 2 mg/ml

97 Drug Name Reference Notes memantine hcl oral tablet 10 mg QL memantine hcl oral tablet 28 x 5 mg & 21 x Namenda Titration Pak DO; QL 10 mg memantine hcl oral tablet 5 mg DO; QL nicotine mini mouth/throat lozenge KLS Quit4 OTC; QL nicotine polacrilex mini mouth/throat lozenge KLS Quit2 OTC; QL nicotine polacrilex mouth/throat gum KLS Quit2 OTC; QL nicotine polacrilex mouth/throat lozenge KLS Quit4 OTC; QL nicotine step 1 transdermal patch 24 hour Habitrol OTC; QL nicotine step 2 transdermal patch 24 hour Nicoderm CQ OTC; QL nicotine step 3 transdermal patch 24 hour Nicoderm CQ OTC; QL nicotine transdermal patch 24 hour Nicoderm CQ OTC; QL NICOTROL INHALATION NICOTROL NS NASAL SOLUTION perphenazine-amitriptyline oral tablet pimozide oral tablet PA; DO; QL REBIF REBIDOSE SUBCUTANEOUS PA; SP; QL SOLUTION AUTO-INJECTOR REBIF REBIDOSE TITRATION PACK SUBCUTANEOUS SOLUTION AUTO- PA; SP; QL INJECTOR REBIF SUBCUTANEOUS SOLUTION PA; SP; QL PREFILLED SYRINGE REBIF TITRATION PACK SUBCUTANEOUS SOLUTION PREFILLED PA; SP; QL SYRINGE rivastigmine tartrate oral capsule DO; QL sm nicotine mouth/throat gum KLS Quit4 OTC; QL sm nicotine mouth/throat lozenge KLS Quit2 OTC; QL sm nicotine polacrilex mouth/throat gum KLS Quit2 OTC; QL sm nicotine polacrilex mouth/throat lozenge KLS Quit4 OTC; QL *RESPIRATORY AGENTS - MISC.* PULMOZYME INHALATION SOLUTION PA; SP; QL *SULFONAMIDES* sulfadiazine oral tablet *TETRACYCLINES* demeclocycline hcl oral tablet doxycycline monohydrate oral capsule 100 Mondoxyne NL QL mg 98 Drug Name Reference Notes doxycycline monohydrate oral capsule 150 QL mg, 50 mg doxycycline monohydrate oral capsule 75 Mondoxyne NL mg doxycycline monohydrate oral suspension Vibramycin QL reconstituted minocycline hcl oral capsule minocycline hcl oral tablet MONDOXYNE NL ORAL CAPSULE 100 PA; QL MG MONDOXYNE NL ORAL CAPSULE 75 MG PA *THYROID AGENTS* EUTHYROX ORAL TABLET LEVO-T ORAL TABLET levothyroxine sodium oral tablet Euthyrox LEVOXYL ORAL TABLET liothyronine sodium oral tablet Cytomel methimazole oral tablet Tapazole propylthiouracil oral tablet SYNTHROID ORAL TABLET UNITHROID ORAL TABLET *ULCER DRUGS/ANTISPASMODICS/ANTICHO LINERGICS* MM Acid-Pep Maximum acid reducer maximum strength oral tablet OTC; QL Strength acid reducer oral capsule delayed release OTC acid reducer oral tablet Pepcid AC DO; OTC; QL acid reducer oral tablet delayed release PriLOSEC OTC OTC; QL cvs esomeprazole magnesium oral capsule GoodSense OTC; QL delayed release Esomeprazole cvs lansoprazole oral capsule delayed Prevacid 24HR OTC; QL release cvs lansoprazole oral tablet delayed release Prevacid SoluTab OTC; QL dispersible cvs omeprazole magnesium oral capsule OTC delayed release cvs omeprazole oral tablet delayed release OTC cvs omeprazole oral tablet delayed release OTC dispersible 99 Drug Name Reference Notes cvs omeprazole-sod bicarbonate oral Zegerid OTC; QL capsule dicyclomine hcl oral capsule dicyclomine hcl oral solution dicyclomine hcl oral tablet eq lansoprazole oral capsule delayed Prevacid 24HR OTC; QL release eq omeprazole magnesium oral capsule OTC delayed release eq omeprazole oral tablet delayed release OTC eq omeprazole oral tablet delayed release OTC dispersible eql lansoprazole oral capsule delayed Prevacid 24HR OTC; QL release eql omeprazole oral tablet delayed release OTC esomeprazole magnesium oral capsule GoodSense OTC; QL delayed release Esomeprazole famotidine intravenous solution MM Acid-Pep Maximum famotidine maximum strength oral tablet OTC; QL Strength famotidine oral suspension reconstituted PA; QL MM Acid-Pep Maximum famotidine oral tablet 20 mg QL Strength famotidine oral tablet 40 mg Pepcid QL famotidine orig st oral tablet Pepcid AC DO; OTC; QL glycopyrrolate oral tablet MM Acid-Pep Maximum gnp acid reducer max st oral tablet OTC; QL Strength gnp acid reducer oral tablet Pepcid AC OTC; QL gnp esomeprazole magnesium oral capsule GoodSense OTC; QL delayed release Esomeprazole gnp lansoprazole oral capsule delayed Prevacid 24HR OTC; QL release gnp omeprazole oral tablet delayed release OTC gnp omeprazole oral tablet delayed release OTC dispersible GOODSENSE ESOMEPRAZOLE ORAL OTC; QL CAPSULE DELAYED RELEASE goodsense lansoprazole oral capsule Prevacid 24HR OTC; QL delayed release

100 Drug Name Reference Notes MM Acid-Pep Maximum heartburn relief max st oral tablet OTC; QL Strength heartburn relief oral tablet Pepcid AC DO; OTC; QL hm esomeprazole magnesium dr oral GoodSense OTC; QL capsule delayed release Esomeprazole hm famotidine oral tablet Pepcid AC DO; OTC; QL hm lansoprazole oral capsule delayed Prevacid 24HR OTC; QL release hm omeprazole oral tablet delayed release OTC kls esomeprazole magnesium oral capsule GoodSense OTC; QL delayed release Esomeprazole kp omeprazole magnesium oral capsule OTC delayed release lansoprazole oral capsule delayed release Prevacid 24HR OTC; QL misoprostol oral tablet Cytotec NEXIUM 24HR ORAL TABLET DELAYED OTC; QL RELEASE nizatidine oral capsule QL nizatidine oral solution PA; QL omeprazole magnesium oral capsule OTC delayed release omeprazole magnesium oral tablet delayed PriLOSEC OTC OTC release omeprazole oral capsule delayed release PA omeprazole oral tablet delayed release OTC omeprazole oral tablet delayed release OTC dispersible omeprazole-sodium bicarbonate oral Zegerid OTC; QL capsule PREVACID 24HR ORAL CAPSULE OTC; QL DELAYED RELEASE PRILOSEC OTC ORAL TABLET OTC; QL DELAYED RELEASE px omeprazole oral tablet delayed release OTC qc esomeprazole magnesium oral capsule GoodSense OTC; QL delayed release Esomeprazole qc lansoprazole oral capsule delayed Prevacid 24HR OTC; QL release qc omeprazole magnesium oral capsule OTC delayed release

101 Drug Name Reference Notes ra esomeprazole magnesium oral capsule GoodSense OTC; QL delayed release Esomeprazole ra omeprazole oral tablet delayed release OTC sb omeprazole oral tablet delayed release OTC MM Acid-Pep Maximum sm acid reducer max st oral tablet OTC; QL Strength sm acid reducer oral tablet 10 mg Pepcid AC DO; OTC; QL sm acid reducer oral tablet 200 mg Tagamet HB OTC; QL sm esomeprazole magnesium oral capsule GoodSense OTC; QL delayed release Esomeprazole sm lansoprazole oral capsule delayed Prevacid 24HR OTC; QL release sm omeprazole oral tablet delayed release OTC sucralfate oral tablet Carafate *URINARY ANTISPASMODICS* bethanechol chloride oral tablet darifenacin hydrobromide er oral tablet Enablex QL extended release 24 hour flavoxate hcl oral tablet oxybutynin chloride er oral tablet extended Ditropan XL release 24 hour 10 mg oxybutynin chloride er oral tablet extended release 24 hour 15 mg oxybutynin chloride er oral tablet extended Ditropan XL QL release 24 hour 5 mg oxybutynin chloride oral syrup oxybutynin chloride oral tablet QL OXYTROL FOR WOMEN TRANSDERMAL OTC; QL PATCH TWICE WEEKLY tolterodine tartrate er oral capsule extended Detrol LA QL release 24 hour tolterodine tartrate oral tablet Detrol QL trospium chloride er oral capsule extended QL release 24 hour trospium chloride oral tablet QL *VACCINES* AFLURIA QUADRIVALENT QL INTRAMUSCULAR SUSPENSION

102 Drug Name Reference Notes AFLURIA QUADRIVALENT INTRAMUSCULAR SUSPENSION QL PREFILLED SYRINGE FLUAD QUADRIVALENT QL INTRAMUSCULAR PREFILLED SYRINGE FLUARIX QUADRIVALENT INTRAMUSCULAR SUSPENSION QL PREFILLED SYRINGE FLUBLOK QUADRIVALENT INTRAMUSCULAR SOLUTION QL PREFILLED SYRINGE FLUCELVAX QUADRIVALENT QL INTRAMUSCULAR SUSPENSION FLUCELVAX QUADRIVALENT INTRAMUSCULAR SUSPENSION QL PREFILLED SYRINGE FLULAVAL QUADRIVALENT INTRAMUSCULAR SUSPENSION QL PREFILLED SYRINGE FLUMIST QUADRIVALENT NASAL QL SUSPENSION FLUZONE HIGH-DOSE QUADRIVALENT INTRAMUSCULAR SUSPENSION QL PREFILLED SYRINGE FLUZONE QUADRIVALENT QL INTRAMUSCULAR SUSPENSION FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION QL PREFILLED SYRINGE janssen covid-19 vaccine intramuscular suspension moderna covid-19 vaccine intramuscular AL suspension pfizer-biontech covid-19 vacc intramuscular AL suspension PNEUMOVAX 23 INJECTION INJECTABLE PREVNAR 13 INTRAMUSCULAR SUSPENSION *VAGINAL AND RELATED PRODUCTS* CLEOCIN VAGINAL SUPPOSITORY clindamycin phosphate vaginal cream Cleocin 103 Drug Name Reference Notes clotrimazole vaginal cream Gyne-Lotrimin OTC Monistat 3 Combination cvs miconazole 3 combo-supp vaginal kit OTC Pack Monistat 3 Combination eql miconazole 3 vaginal kit OTC Pack estradiol vaginal tablet Yuvafem Monistat 3 Combination gnp miconazole 3 vaginal kit OTC Pack gnp miconazole 7 vaginal cream Monistat 7 Simply Cure OTC metronidazole vaginal gel Vandazole Monistat 3 Combination miconazole 3 combo-supp vaginal kit OTC Pack miconazole 3 vaginal suppository miconazole 7 vaginal cream Monistat 7 Simply Cure OTC miconazole 7 vaginal suppository OTC miconazole nitrate vaginal cream Monistat 7 Simply Cure OTC MONISTAT 3 COMBINATION PACK OTC VAGINAL KIT OPTIONS GYNOL II CONTRACEPTIVE OTC VAGINAL GEL PREMARIN VAGINAL CREAM PA Monistat 3 Combination px miconazole 3-day combo vaginal kit OTC Pack Monistat 3 Combination ra miconazole 3 combo pack vaginal kit OTC Pack Monistat 3 Combination sm miconazole 3 vaginal kit OTC Pack sm miconazole 7 vaginal cream Monistat 7 Simply Cure OTC sm miconazole 7 vaginal suppository OTC terconazole vaginal cream 0.4 % terconazole vaginal cream 0.8 % QL terconazole vaginal suppository QL VAGISTAT-3 VAGINAL KIT OTC VANDAZOLE VAGINAL GEL VCF VAGINAL CONTRACEPTIVE OTC VAGINAL FILM VCF VAGINAL CONTRACEPTIVE OTC VAGINAL FOAM YUVAFEM VAGINAL TABLET

104 Drug Name Reference Notes *VASOPRESSORS* epinephrine injection solution auto-injector EpiPen Jr 2-Pak QL midodrine hcl oral tablet SYMJEPI INJECTION SOLUTION QL PREFILLED SYRINGE *VITAMINS* AQUA-E ORAL LIQUID OTC ascorbic acid oral tablet PureWay-C OTC; QL biotin maximum strength oral capsule Meribin OTC biotin oral capsule Meribin OTC biotin oral tablet OTC ergocalciferol oral capsule Drisdol ergocalciferol oral solution Calcidol OTC gnp vitamin b-1 oral tablet OTC gnp vitamin d oral tablet Vitamin D-1000 Max St OTC MERIBIN ORAL CAPSULE OTC niacin er oral tablet extended release Endur-Acin OTC niacin oral tablet OTC niacinamide oral tablet OTC phytonadione injection solution phytonadione oral tablet Mephyton pyridoxine hcl injection solution thiamine hcl injection solution thiamine hcl oral tablet OTC vitamin a oral capsule OTC vitamin b6 oral tablet OTC vitamin b-6 oral tablet OTC vitamin c oral tablet OTC; QL vitamin c oral tablet chewable OTC vitamin d (ergocalciferol) oral capsule Drisdol vitamin d oral liquid BProtected Pedia D-Vite OTC; QL vitamin d oral tablet Thera-D 2000 OTC vitamin d3 oral capsule OTC; QL vitamin d3 oral tablet Thera-D 2000 OTC vitamin d3 super strength oral tablet Thera-D 2000 OTC vitamin k1 injection solution

105