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OptumRx Vigilant Drug Program

Non-essential drug strategy Effective January 1, 2021

Thousands of medications are available today with even more entering the market — sometimes at a higher cost without additional value. OptumRx can help ensure that your pharmacy benefit dollars cover only the most clinically appropriate and affordable medications.

Non-essential drug strategy* — Excludes select products that are available in the market but may not be approved by the U.S. Food and Drug Administration (FDA) or are deemed non-essential by the OptumRx Pharmacy & Therapeutics (P&T) Committee. These high-dollar products offer little clinical value versus other well-tested, FDA-approved agents.

*Programs are also available for clients who prefer prior authorization rather than an exclusion strategy. Drug Name Drug Name 1ST MEDX-PATCH/ EXTERNAL adenosine (diagnostic) PATCH 4-0.0375-5-20 % ADRENALIN NASAL 7T GUMMY ES ADVANCED ALLERGY COLLECTION 7T LIDO ADVANCED BASE PLUS ACACIA SUBCUTANEOUS ADYPHREN ACCUCAINE ADYPHREN AMP ACESO AG ADYPHREN AMP II ACREMONIUM ADYPHREN II ACTICOAT 7 AGONEAZE ACTICOAT ABSORBENT AKOVAZ ACTICOAT ANTIMICROBIAL ALA-QUIN ACTICOAT EXTERNAL SHEET 16"X16" , ALBA-DERM 4"X48" , 4"X8" , 5"X5" , 8"X16" ALBUTEROL SULFATE INHALATION ACTICOAT FLEX 3 NEBULIZATION SOLUTION (5 MG/ML) 0.5% ACTICOAT FLEX 3 4"X4" alcohol injection ACTICOAT FLEX 7 ALCORTIN A ACTICOAT MOISTURE CONTROL ALDER EXTERNAL PAD 4"X4" , 4"X8" ALEVAMAX ACTICOAT SITE ALEVICYN ANTIPRURITIC ACTIVASE ALEVICYN ANTIPRURITIC SG EXTERNAL ACTIVE INJECTION BLM-1 GEL ACTIVE INJECTION BM ALEVICYN DERMAL SPRAY ACTIVE INJECTION D ALLEVYN AG NON-ADHESIVE EXTERNAL ACTIVE INJECTION DL PAD 8"X8" ACTIVE INJECTION DLM ALMOND (DIAGNOSTIC) ACTIVE INJECTION KET-L ALPAWASH ACTIVE INJECTION KETMARC-L ALTADERM ACTIVE INJECTION KIT L ALTAFLUOR ACTIVE INJECTION KL-3 ALTERNARIA ACTIVE INJECTION KM ALZAIR ALLERGY NASAL SPRAY ACTIVE INJECTION LM-2 AMELUZ ACTIVE INJECTION LM-DEP-1 AMERICAN BEECH ACTIVE INJECTION LM-DEP-2 AMERICAN COCKROACH ACTIVE INJECTION M-1 AMERICAN ELM ACTIVE-PAC/GABAPENTIN AMERICAN SYCAMORE ACTIVITE aminoamrms ACUICYN EXTERNAL SOLUTION aminobenzoate potassium oral packet ACUNOL aminoreliefrms ADAPALENE-BENZOYL PER-CLINDAMY AMMONIA N 13 ADAPALENE-BENZOYL PER-NIACINAM AMYTAL SODIUM 2 Drug Name Drug Name ANACAINE ATRAPRO CP ana-lex ATRAPRO HYDROGEL ANALPRAM HC EXTERNAL atropine sulfate injection solution 0.4 mg/ml, 1 ANALPRAM HC SINGLES EXTERNAL mg/ml, 8 mg/20ml ANASTIA atropine sulfate injection solution prefilled syringe 0.5 mg/5ml, 1 mg/10ml ANDEXXA ATROPINE SULFATE OPHTHALMIC ANIMI-3 SOLUTION 0.01 % ANIMI-3/VITAMIN D AUREOBASIDIUM ANJESO AUREOBASIDIUM PULLULANS ANODYNE LPT AUSTRALIAN PINE anucort-hc AUXIPRO VANISHING ANUSOL-HC RECTAL SUPPOSITORY AVAR CLEANSER APOTHESAR 2 AVAR EXTERNAL FOAM APOTHESAR PLUS AVAR EXTERNAL PAD APOTHESIL AVAR LS APPLE (DIAGNOSTIC) AVAR LS CLEANSER APRIZIO PAK AVAR-E EMOLLIENT APRIZIO PAK II AVAR-E GREEN AQUORAL MOUTH/THROAT SOLUTION AVAR-E LS ARESTIN AVENOVA argatroban in sodium chloride intravenous AVIDOXY DK solution 125-0.9 mg/125ml-%, 50-0.9 mg/50ml- % AVOCADO (DIAGNOSTIC) ARIDA AXIFOL ARIDOL AZALGIA ARIZONA CYPRESS AZEDRA DOSIMETRIC ARZOL SILVER NIT APPLICATORS AZEDRA THERAPEUTIC ASCOR AZELAIC ACID-NIACINAMIDE ASCORBIC ACID INTRAVENOUS AZESCHEW PRENATAL/POSTNATAL ASCORBIC ACID SOLUTION 500 MG/ML AZESCO INJECTION B-12 COMPLIANCE INJECTION ascorbic acid solution 500 mg/ml injection BACTERIOSTATIC WATER(PARABENS) ASPERGILLUS FUMIGATUS INJECTION BAFIERTAM ASPERGILLUS FUMIGATUS INTRADERMAL BAHIA SOLUTION 1:20 BAL-CARE DHA ASTERO BALD CYPRESS ASTRINGYN BANANA (DIAGNOSTIC) ATOPADERM BASADROX ATOPAVO BASE W301 ATOPICLAIR BAYBERRY (WAX MYRTLE) 3 Drug Name Drug Name B-COMPLEX INJECTION BIO GLO BEAU RX BIOFREQUENCY INSOLES BEEF (DIAGNOSTIC) BIONECT EXTERNAL CREAM belladonna alkaloids-opium BIONECT EXTERNAL GEL BENSAL HP bio-statin oral powder BENZ PER-CLIND-NIACIN-TRETIN BIOSTEP BENZAC AC WASH EXTERNAL LIQUID BIVALIRUDIN RTU BENZEFOAM BIVALIRUDIN-SODIUM CHLORIDE BENZEFOAMULTRA BLACK WALNUT POLLEN BENZEPRO CREAMY WASH BLACK WILLOW BENZEPRO EXTERNAL BOCASAL BENZEPRO EXTERNAL FOAM 5.2 %, 9.7 % BOTRYTIS benzepro external foam 5.3 % BOTRYTIS CINEREA BENZEPRO EXTERNAL LIQUID BOX ELDER BENZEPRO FOAMING CLOTHS bp 10-1 BENZEPRO SHORT CONTACT BP CLEANSING WASH BENZODOX bp foam benzoin compound bp wash external liquid 2.5 %, 7 % benzoin external tincture bpo BENZO-LIDOCAINE- BRETYLIUM TOSYLATE INJECTION BENZOYL PEROX-HYDROCORTISONE BRIDION benzoyl peroxide external foam 9.8 % BRIMONIDINE-DORZOLAMIDE BENZOYL PEROXIDE EXTERNAL GEL 6.5 BROME %, 8 % BROMPHENIRAMINE MALEATE BENZOYL PEROXIDE FORTE- HC INTRAMUSCULAR BERMUDA GRASS BT INJECTION BESER EXTERNAL KIT BUPIVACAINE HCL INJECTION SOLUTION BETA 1 KIT 0.125 %, 312.5 MG/10ML BETALIDO BUPIVACAINE HCL INJECTION SOLUTION PREFILLED SYRINGE 0.125 % (50 ML), 125 BETALOAN SUIK MG/4ML, 250 MG/8ML, 312.5 MG/10ML, 625 COMBO MG/20ML BETAMETHASONE DIPROP-MINOXIDIL BUPIVILOG BETAMETHASONE SOD PHOS & ACET CADIRAMD BETAMETHASONE SODIUM PHOSPHATE CAFFEINE-SODIUM BENZOATE INJECTION CALCIPOTRIENE-CLOBETASOL PROP BEVACIZUMAB BHI URI-CONTROL CALCIUM GLUCONATE SOLUTION 10 % BIIFENAC 1000 INTRAVENOUS BIIFENAC 500 calcium gluconate solution 10 % intravenous

4 Drug Name Drug Name CALCIUM GLUCONATE-NACL CERIANNA INTRAVENOUS SOLUTION 2-0.675 cerovel external lotion GM/100ML-% cervical specimen collection CALCIUM-FOLIC ACID PLUS D CETACAINE EXTERNAL AEROSOL CALIFORNIA PEPPER TREE CETACAINE EXTERNAL LIQUID CANDIDA ALBICANS EXTRACT CHEW-HESIVE CANTALOUPE (DIAGNOSTIC) CHICKEN MEAT (DIAGNOSTIC) CANTHARIDIN EXTERNAL CHOLECAL DF CAPHOSOL MOUTH/THROAT SOLUTION CHONDROITIN SULFATE OPHTHALMIC CAPSFENAC PAK CHRYSADERM DAY CAPSINAC CHRYSADERM NIGHT CARDIOPLEGIA DEL NIDO FORMULA CICASIL CARDIOPLEGIA IND PLASMA HIGH K CICATRACE PAD CARDIOPLEGIA IND PLASMA-TROMET ciclopirox treatment CARDIOPLEGIA INDUCTION HIGH K CICLOPIROX-CLOBETASOL CARDIOPLEGIA INDUCTION LOW DEX CICLOPIROX-CLOBETASOL-SAL ACID CARDIOPLEGIA INDUCTION NON-ENR CICLOPIROX-SALICYLIC ACID CARDIOPLEGIA MAIN LOW DEXTROSE CIFEREX CARDIOPLEGIA MAIN LOW TROMETHA CIFRAZOL CARDIOPLEGIA MAIN PLASMA-TROME CIMETIDINE-LIDO-SALICYLIC ACID CARDIOPLEGIA MAINTENANCE cisatracurium besylate (pf) intravenous CARDIOPLEGIA REPERFUSATE 4:1 solution 10 mg/5ml CARDIOVID PLUS cisatracurium besylate intravenous solution 20 CARRASYN HYDROGEL WOUND DRESS mg/10ml, 200 mg/20ml CASEIN (DIAGNOSTIC) CITRANATAL 90 DHA ORAL 90-1 & 300 MG CAT HAIR EXTRACT CITRANATAL ASSURE ORAL 35-1 & 300 MG CATHFLO ACTIVASE CITRANATAL B-CALM CATTLE EPITHELIUM CITRANATAL BLOOM CEDAR ELM CITRANATAL BLOOM DHA CEFTRI-IM CITRANATAL DHA CEFTRISOL PLUS CITRANATAL ESSENCE CEFUROXIME SODIUM-NACL CITRANATAL HARMONY ORAL CAPSULE CELA BASE 27-1-260 MG CELACYN CITRANATAL MEDLEY CELLPAD CITRANATAL RX CEM- CLADOSPORIUM CLADOSPORIOIDES CENTANY AT CLADOSPORIUM SPHAEROSPERMUM CERACADE clariscan CERAMAX CLIN SINGLE USE CLINDACIN ETZ EXTERNAL KIT 5 Drug Name Drug Name CLINDACIN PAC DAPSONE-NIACINAMIDE-SPIRONOLAC CLINDAMY-BENZOYL PER-NIACINAM DAVITE CLINDAMYCIN PHOS-NIACINAMIDE DEBACTEROL CLINDAMYCIN-NIACIN-TRETINOIN DEFITELIO CLIND-NIACIN-SPIRONOLAC-TRETIN dehydrated alcohol injection CLINIMIX N9G20E DELUO CLOBETASOL PROP-LEVOCETIRIZINE DERMACINRX ANALGESIC COMBOPAK CLOBETASOL PROP-NIACINAMIDE DERMACINRX AZENASE PAK CLODAN EXTERNAL KIT DERMACINRX CINLONE-I CPI CLOPIDOGREL & ASPIRIN DERMACINRX CLORHEXACIN COATAMAX PATCH DERMACINRX DUOPATCH PHARMAPAK COCAINE HCL NASAL DERMACINRX EMPRICAINE COCKLEBUR DERMACINRX LEXITRAL PHARMAPAK COCOA BEAN (DIAGNOSTIC) DERMACINRX NEUROTRAL PHARMAPAK COLCIGEL DERMACINRX PHN COLLATYL DERMACINRX PRIZOPAK CONTRAST ALLERGY PREMED PACK DERMACINRX PUREFOLIX CONVENIENCE PAK DERMACINRX SURGICAL COMBOPAK COPASIL EXTERNAL DERMACINRX SURGICAL PHARMAPAK CORN POLLEN DERMACINRX THERAZOLE PAK CORTANE-B EXTERNAL DERMACINRX TICANASE PAK COVARYX DERMACINRX TOPICAL BASE COVARYX HS DERMACINRX ZRM CO-VERATROL DERMASORB HC CRAB (DIAGNOSTIC) DERMASORB TA CREAM BASE DERMASORB XM CREAM BASE NIOSOMES DERMAZENE CREAM CONCENTRATE DERMAZYL CREAM-HEAVY BASE NIOSOMES ACE & SOD PHOS C-TOPICAL DEXAMETHASONE SOD PHOS-BUPIV CURVULARIA DEXAMETHASONE-MOXIFLOXACIN CUSHING SYNDROME DIAGNOSTIC DEXAMETH-MOXIFLOX-KETOROLAC CUTIS PLUS DEXERYL cyclobenzaprine hcl oral tablet 10 mg DEXIFOL CYCLOSPORINE IN KLARITY DEXLIDO CYSTADANE DEXLIDO-M cytra k crystals dexmedetomidine hcl in nacl intravenous DANDELION solution 200 mcg/50ml, 400 mcg/100ml DAPSONE-NIACINAMIDE DEXOPIN

6 Drug Name Drug Name DEXTENZA DUET DHA 400 DFS DR/MS/MENTH/CAP PAK DUET DHA BALANCED ORAL 25-1 & 267 MG DFS/MS/MENTH/CAP PAK DURACHOL DIAB EXTERNAL GEL DURYSTA DIAB F.D.G. FREEZE-DRIED DUST MITE MIXED ALLERGEN EXT DICLO GEL DYNABAC 5.0 DICLO GEL WITH XRYLIX SHEETS DYURAL-40 TRANSDERMAL DYURAL-80 diclofenac sodium transdermal gel 3 % DYURAL-L DICLOFENAC-NA HYALURON-NIACIN DYURAL-LM diclofex dc EASTERN COTTONWOOD DICLOFONO ECONASIL diclopak ECONAZOLE NITRATE-NIACINAMIDE DICLOPR ECZEMOL diclosaicin EEMT DICLOSTREAM EEMT HS DICLOTREX effervescent pot chloride DICLOVIX EGG WHITE (DIAGNOSTIC) DICLOVIX M EHA DICLOZOR ELCYS DILTIAZEM HCL-DEXTROSE INTRAVENOUS ELETONE SOLUTION 125-5 MG/125ML-% ELETONE TWINPACK DIMENTHO ELLZIA PAK DIMERCAPTOPROPANE-SULFONATE EMERPHED DITHOL EMOLIVAN DIVISTA EMOLLIENT BASE DMSA EMPRICAINE-II DMT SUIK EMULSION SB DOG EPITHELIUM ENBRACE HR DOG FENNEL ENGLISH PLANTAIN DONNATAL ENGYSTOL INJECTION DOTAREM ENLYTE DOTATOC GA 68 ENTERO VU ORAL SUSPENSION 24 % DOUBLEDEX ENTTY SPRAY EMULSION DRECHSLERA ENZADYNE DRITHO-CREME HP ENZOCLEAR DS PREP PAK ephedrine sulfate injection DST PLUS PAK DSUVIA

7 Drug Name Drug Name EPHEDRINE SULFATE-NACL FENTANYL CITRATE INTRAVENOUS INTRAVENOUS SOLUTION PREFILLED SOLUTION PREFILLED SYRINGE 100 SYRINGE 50-0.9 MG/5ML-% MCG/2ML, 1500 MCG/30ML, 2500 EPICERAM MCG/50ML EPICOCCUM FENTANYL CITRATE-NACL EPIDURAL EPICOCCUM NIGRUM FENTANYL CITRATE-NACL INJECTION EPICYN FENTANYL CITRATE-NACL INTRAVENOUS SOLUTION 1-0.9 MG/100ML-%, 250-0.9 epinephrine hcl (nasal) MCG/50ML-%, 5-0.9 MG/250ML-% epinephrine injection solution 30 mg/30ml FENTANYL CITRATE-NACL INTRAVENOUS epinephrine injection solution prefilled syringe SOLUTION PREFILLED SYRINGE 15-0.9 1 mg/10ml MCG/3ML-% epinephrine pf injection solution FENTANYL CIT-ROPIVACAINE-NACL EPINEPHRINE PROFESSIONAL EPIDURAL SOLUTION 0.2-0.15-0.9 MG/100ML-%, 0.2-0.2-0.9 MG/100ML-%, 0.4- EPINEPHRINE-NACL INTRAVENOUS 0.1-0.9 MG/200ML-%, 0.4-0.2-0.9 MG/200ML- SOLUTION 5-0.9 MG/250ML-% %, 0.625-0.2-0.9 MG/250ML-%, 1.25-0.2-0.9 EPINEPHRINESNAP-EMS MG/250ML-% EPINEPHRINESNAP-V FENTANYL-BUPIVACAINE-NACL EPIDURAL EPISNAP SOLUTION 0.25-0.08-0.9 MG/125ML-%, 0.4- 0.15-0.9 MG/200ML-%, 0.5-0.0625-0.9 EQUAPAX/ATORVASTATIN/COQ10 MG/250ML-%, 0.5-0.125-0.9 MG/250ML-%, EQUAPAX/IBUPROFEN/MINREX 0.6-0.125-0.9 MG/200ML-%, 0.75-0.1-0.9 ERGOCAL MG/150ML-%, 0.75-0.125-0.9 MG/250ML-%, 1.25-0.075-0.9 MG/250ML-% ESCAVITE D FENTANYL-BUPIVACAINE-NACL INJECTION ESCAVITE LQ ORAL LIQUID FERIVA 21/7 ESKATA FERIVAFA ESOMEP-EZS FINASTERIDE-MINOXIDIL est estrogens-methyltest FIRE ANT est estrogens-methyltest ds FITALITE est estrogens-methyltest hs FLEXIN EXYDERM FLEXIPAK E-Z-CAT DRY FLORIVA E-Z-DISK FLORIVA PLUS E-Z-HD FLUCAINE E-Z-PAQUE FLUCON-IBUPROF-ITRACON-TERBINA E-Z-PASTE FLUOCINOLONE ACET-NIACINAMIDE FAGRON LS PLUS FLUOPAR FAGRON NATURAL FLUOVIX FAGRON SUPREME FLUOVIX PLUS FALESSA ORAL KIT 20-1-0.1 MCG-MG FOLET DHA FEM PH FOLET ONE

8 Drug Name Drug Name FOLIC D3 GENADUR FOLICA-V GENICIN VITA-D FOLIC-K GENICIN VITA-Q FOLI-D GENICIN VITA-S FOLIKA-D GERMAN COCKROACH FOLIKA-T GHRP2-GHRP6-SERMORELIN FOLIKA-V GHRP2-SERMORELIN FOLITE GIAPREZA FOLIXAPURE GLUTATHIONE INJECTION SOLUTION 6 FOLVIK-D GM/30ML FOLVITE-D glycolic acid solution FOLVITE-FE GLYTACTIN BURST FORAXA GLYTACTIN RESTORE LITE 10 formaldehyde GLYTACTIN RTD 10 FORMA-RAY GLYTACTIN RTD 15 FORTADERM GLYTACTIN RTD LITE 15 FORTADERM ANTIMICROBIAL PHMB GOLDENROD FOSTEUM PLUS GOPRELTO FOVEX GORDONS UREA EXTERNAL OINTMENT 40 % FREEDOM ADAPTADERM EXTERNAL GPL PAK FREEDOM DERMA SERUM grafco silver nit applicator FREEDOM DERMA-D GRAFIX CORE 1.5CM X 2CM FREEDOM DERMA-N GRAFIX CORE 16MM FRESENIUS PROPOVEN INTRAVENOUS EMULSION 2000 MG/100ML GRAFIX CORE 2CM X 3CM FUL-GLO GRAFIX CORE 3CM X 4CM FUNGIMEZ GRAFIX CORE 5CM X 5CM FUSARIUM GRAFIX PRIME 1.5CM X 2CM GABACAINE GRAFIX PRIME 16MM GABAPAL COMBINATION THERAPY PACK GRAFIX PRIME 2CM X 3CM 100 & 3.88 MG & % GRAFIX PRIME 3CM X 4CM GATIFLOXACIN-DEXAMETHASONE GRAFIX PRIME 5CM X 5CM GELCLAIR GRAFIX XC 7.5CM X 15CM GELFILM OPHTHALMIC GREEN GLO LISSAMINE GREEN GEL-FLOW HACKBERRY GELFOAM-JMI POWDER HALUCORT GELFOAM-JMI SPONGE HEALON PRO GEN7T HEALON5 PRO GEN7T PLUS hemenatal ob + dha

9 Drug Name Drug Name HEMETAB HYDROQUINONE-HC-TRETINOIN HEMMOREX-HC RECTAL SUPPOSITORY 25 HYDROQUINONE-HYDROCORTISONE MG HYGEL EXTERNAL GEL 2.5 % HEPMED HYLAGUARD HONEY BEE VENOM PROTEIN HYLAMIX HONEY BEE VENOM SUBCUTANEOUS HYLATOPIC PLUS HORMONE CR HEAVY BASE NIOSOMES HYLAVITE HORMONE CREAM BASE NIOSOMES HYLINATE HORSE EPITHELIUM HYOPHEN HPR hyoscyamine sulfate er oral tablet extended HPR PLUS release 12 hour HPR PLUS HYDROGEL hyoscyamine sulfate injection HPR PLUS-MB HYDROGEL hyoscyamine sulfate oral solution HYALURONATE-NIACINAM-TRETINOIN hyoscyamine sulfate sublingual HYALURONATE-NIACIN-TACROLIMUS HYPERLYTE-CR INTRAVENOUS HYALURONIC ACID-HYDROQUINONE CONCENTRATE HYCLODEX HYPERRAB HYDRO 35 HYPERRAB S/D INJECTION HYDRO 40 HYPERTENSA hydrocortisone ace-pramoxine external cream HYPOCYN EXTERNAL SOLUTION 2.5-1 % IBU 600-EZS hydrocortisone acetate rectal IFE-PG20 hydrocortisone-iodoquinol external cream 1-1 ILIDERM % ILUVIEN INTRAVITREAL hydrocort-pramoxine (perianal) IMIQUIMOD-LEVOCETIRIZIN-NIACIN HYDROGEL IMIQUIMOD-LEVOCET-TRETINOIN HYDROMORPHONE HCL INJECTION IMOGAM RABIES-HT INJECTION SOLUTION 1 MG/ML inavix hydromorphone hcl injection solution 2 mg/ml INFLAMMACIN hydromorphone hcl rectal INFLAMMA-K HYDROMORPHONE HCL-NACL INTRAVENOUS SOLUTION 10-0.9 INFLATHERM COMBINATION THERAPY MG/100ML-%, 18-0.9 MG/30ML-%, 25-0.9 PACK MG/50ML-%, 5-0.9 MG/50ML-%, 50-0.9 INOVA MG/50ML-%, 6-0.9 MG/30ML-% INOVA 4/1 ACNE CONTROL THERAPY HYDROMORPHONE-BUPIVACAINE-NACL INOVA 8/2 ACNE CONTROL THERAPY EPIDURAL SOLUTION 2.5-0.1-0.9 MG/250ML-% IODOFLEX HYDROMORPHONE-ROPIVACAINE-NACL IODOQUIMEZ-HC EPIDURAL SOLUTION 2-0.1-0.9 MG/200ML- iodoquinol-hc-aloe polysacch % IODOQUINOL-HC-KETOCONAZOLE HYDROQUINONE EXTERNAL EMULSION iodoquinol-hydrocortisone-aloe 10 Drug Name Drug Name IODOSORB K-PHOS IONSYS K-PHOS NO 2 IPAMORELIN ACETATE KYBELLA IROSPAN 24/6 LACTIC ACID-NIACINAMIDE ISOVUE-300 LACTOJEN isoxsuprine hcl oral LAMBS QUARTERS IVERMECTIN-METRONIDAZOL-NIACIN LATANOPROST-TIMOLOL MALEATE JELMYTO LATRIX XM JOHNSON GRASS LAVARE WOUND WASH JTT PHYSICIANS l-cysteine hcl intravenous JUNE GRASS POLLEN STANDARDIZED LDO PLUS KAMDOY lecithin oral granules KAPOK LENSCALE KCL (IN NACL 0.9%) INTRAVENOUS LEU TECHNELITE SOLUTION 40 MEQ/500ML LEVATIO KEDRAB INJECTION LEVBID k-effervescent LEVICYN KELARX LEVICYN DERMAL SPRAY KELOTOP LEVSIN INJECTION KENDALL AMORPHOUS WOUND LEVSIN ORAL TABLET KENGREAL LEVSIN/SL KERAGEL LEXIXRYL KERAGELT LIDO BDK KERALAC EXTERNAL CREAM 47 % LIDO GB-300 KERALYT EXTERNAL GEL 6 % lidocaine external ointment KERALYT SCALP lidocaine hcl external cream 3 %, 3.88 % KETOCONAZOLE-HYDROCORTISONE LIDOCAINE HCL EXTERNAL CREAM 4.12 % KETODAN EXTERNAL KIT lidocaine hcl external lotion KETOROCAINE-L LIDOCAINE-EPINEPHRINE INTRAOCULAR KETOROCAINE-LM lidocaine-hydrocort (perianal) KETOROLAC-BUPIV- LIDOCAINE-HYDROCORTISONE ACE KETOROLAC-ROPIV-KETAMINE EXTERNAL CREAM 1-1 % KETOVIE lidocaine-hydrocortisone ace rectal cream KIVIK LIDOCAINE-HYDROCORTISONE ACE KLARITY-A RECTAL GEL KLARITY-B lidocaine-hydrocortisone ace rectal kit KLARITY-L LIDOCAINE-PHENYLEPHRINE KOCHIA LIDOCAINE-PHENYLEPHRINE-BSS kosher prenatal plus iron lidocaine-prilocaine external kit

11 Drug Name Drug Name LIDOCAINE-TETRACAINE EXTERNAL LIQUIVIDA HYDRATION CREAM 23-7 % LIVIXIL PAK LIDOCANNA LMR PLUS LIDOCIDEX I loperamide hcl oral solution LIDO-EPINEPHRINE-TETRACAINE LOPROX EXTERNAL KIT LIDO-K LORAZEPAM-DEXTROSE lidolog LORAZEPAM-SODIUM CHLORIDE LIDOMAR INTRAVENOUS SOLUTION 100-0.9 LIDOPAC MG/100ML-% lidopin external cream 3 % LORID LIDOPIN EXTERNAL CREAM 3.25 % LORMATE LIDOPRIL EXTERNAL KIT LOYON LIDOPRIL XR LT INJECTION KIT LIDO-PRILO CAINE PACK LUMASON LIDOPURE PATCH LUTATHERA LIDORX LUXAMEND LIDOSOL-HC LYDEXA LIDO-SORB LYMPHOMYOSOT X LIDOSTREAM MACI LIDOTHOL MACRILEN LIDOTIN manganese sulfate intravenous LIDOTRAL MARBETA-25 LIDOTRANS 5 PAK MARBETA-L LIDOTREX GEL 2 % EXTERNAL MARDEX-25 LIDOVIX marlido LIDOZION MARLIDO-25 LIOPEN ABSORPTION ENHANCING MARNATAL-F LIPO CREAM BASE MARVONA SUIK LIPOFOAM RX MAS CARE-PAK LIPOPEN ULTRA BASE MB HYDROGEL LIPOSOMAL HEAVY me/naphos/mb/hyo1 LIPOSOMAL REGULAR MEADOW FESCUE GRASS POLLEN LIPOZYME MEDIDERM LIPRITIN MEDI-DERM/L-RX LIPRITIN II COMBINATION THERAPY PACK MEDI-DERM-RX 100 MG MEDIHONEY CA ALGINATE 2"X2" LIPROZONEPAK MEDIHONEY CA ALGINATE 4"X5" LIQUID E-Z-PAQUE MEDIHONEY WOUND/BURN DRESSING LIQUID POLIBAR PLUS MEDI-PATCH RX

12 Drug Name Drug Name MEDOLOR PAK MIXED RAGWEED MEDROLOAN II SUIK MIXED VESPID VENOM PROTEIN MEDROLOAN SUIK INJECTION SOLUTION RECONSTITUTED MELALEUCA mixed vespid venom protein subcutaneous solution reconstituted 1100-1100-1100 mcg MENTHO-CAINE MIXED VESPID VENOM PROTEIN MESQUITE SUBCUTANEOUS SOLUTION METAXALL CP RECONSTITUTED 120-120-120 MCG METHAVER MKO MELT DOSE PACK METHAZEL mlk f1 methenamine mandelate oral mlk f2 methyl salicylate external liquid mlk f3 METHYLCOBALAMIN INJECTION MLK F4 SOLUTION MONSELS FERRIC SUBSULFATE methylene blue injection EXTERNAL METHYLPREDNISOLONE ACE-LIDO MORCIN METOPIC MORGIDOX COMBINATION METOPIRONE morphine sulfate intravenous solution 1 mg/ml, MIC-L-CARNITINE 25 mg/ml, 50 mg/ml MICROCYN EXTERNAL GEL morphine sulfate rectal MICROCYN SKIN AND WOUND MOSQUITO (DIAGNOSTIC) MICROPLEGIA MSA-MSG MOUNTAIN CEDAR MICROVIX LP MOUSE EPITHELIUM MIDAZOLAM HCL INTRAVENOUS MOXIFLOXACIN HCL INTRAOCULAR SOLUTION 150 MG/30ML MOXIFLOXACIN HCL-BSS MIDAZOLAM HCL-NACL MUCOR MIDAZOLAM HCL-SODIUM CHLORIDE MUCOSITISRX INTRAVENOUS SOLUTION 100-0.9 MUGARD MG/100ML-%, 25-0.9 MG/100ML-% MUGWORT MIDAZOLAM-KETAMINE-ONDANSETRON MULTIBASE MIGRAINE PACK MULTIPRO MIGRANOW MULTI-SPECIALTY MIMYX multitrace-4 MINOXIDIL-PROGEST-TRETINOIN multitrace-4 concentrate MIRODERM BIOLOGIC MATRIX FENES multitrace-4 neonatal MIRODERM BIOLOGIC WOUND MATRIX MULTITRACE-4 PEDIATRIC MITE (D. FARINAE) multitrace-5 MITE (D. PTERONYSSINUS) multitrace-5 concentrate MITOMYCIN INTRAVESICAL multivitamin/fluoride oral solution MIXED ASPERGILLUS MY MDI FINGER PULSE OXIMETER MIXED FEATHERS

13 Drug Name Drug Name MY MDI PORTABLE NEBULISER nitroprusside sodium mynephrocaps NITRO-TIME ORAL CAPSULE EXTENDED NALTREXONE SUBCUTANEOUS RELEASE 6.5 MG, 9 MG NANDROLONE-TESTOSTERONE CYP NIVATOPIC PLUS NATACHEW ORAL TABLET CHEWABLE 28- NOPIOID-TC KIT 1 MG NOREPINEPHRINE-SODIUM CHLORIDE NATELLE ONE ORAL CAPSULE 28-1-250 INTRAVENOUS SOLUTION 16-0.9 MG MG/250ML-%, 4-0.9 MG/250ML-%, 8-0.9 MG/250ML-% NEEVO DHA ORAL CAPSULE 27-1.13 MG NORMOSOL-R PH 7.4 NEOCERA NOURILITE NEONATAL COMPLETE ORAL TABLET 27-1 MG NOURIVAN ANTIOX BASE NEOSALUS NOVACORT EXTERNAL GEL 1-2 % NEOSALUS CP NOXIFOL-D NEOSTIGMINE METHYLSULFATE NOXI-K INTRAVENOUS SOLUTION PREFILLED NOXIPAK SYRINGE 5 MG/5ML NUCARACLINPAK NEO-SYNALAR EXTERNAL KIT NUCARARXPAK NESTABS ABC NUCORT NESTABS DHA NUDERMRXPAK 120 NESTABS ONE NUDERMRXPAK 60 NETSPOT NUDICLO SOLUPAK NEUAC EXTERNAL KIT NUDICLO TABPAK NEURALGO-RHEUM NUDROXIPAK NEURCAINE NUDROXIPAK DSDR-50 NEUT NUDROXIPAK DSDR-75 NEUTRASAL NUDROXIPAK E-400 NIACIN NUDROXIPAK I-800 NIACINAMIDE-SPIRONOLACTONE NUDROXIPAK M-15 NIACINAMIDE-SULFACETAMIDE NUDROXIPAK N-500 NIACINAMIDE-TACROLIMUS NUMBONEX NIACINAMIDE-TAZAROTENE NUMBRINO NIACINAMIDE-TRETINOIN NUMOISYN NIACINAMIDE-TRIAMCINOLONE ACET NUSURGEPAK SURGICAL PREP/CARE NIACIN-SPIRONOLACTON-TRETINOIN NUTRASEB NICADAN NUTRIARX CREAMPAK NICAZEL NUTRIDOX NICAZEL FORTE NUVAIL NIPRIDE RTU NUVAKAAN nitroglycerin er NUVAKAAN-II

14 Drug Name Drug Name NUVAZIL P-CARE D40G OASIS ULTRA MATRIX FENESTRATED P-CARE D40MX OASIS ULTRA TRI-LAYER MATRIX P-CARE D80 OASIS WOUND MATRIX FENESTRATED P-CARE D80G COMBINATION EXTERNAL SHEET 3X3.5CM , 3X7CM P-CARE D80MX OAT GRAIN (DIAGNOSTIC) P-CARE K40 OB COMPLETE ONE P-CARE K40G OB COMPLETE PETITE P-CARE K40MX OB COMPLETE PREMIER P-CARE K80 OCUVEL ORAL CAPSULE 0.5 MG P-CARE K80G OLIVE TREE P-CARE K80MX OMEGA-3 RX COMPLETE P-CARE M OMEGA-3/D-3 WELLNESS PACK P-CARE MG OMEGAVEN P-CARE X ONEVITE PCCA ALADERM BASE ONYCHO-MED PCCA ANHYDROUS LIPODERM BASE opium PCCA BIOPEPTIDE BASE ORACIT PCCA LIPODERM BASE ORAFATE PCCA MVC BASE ORANGE (DIAGNOSTIC) PCCA NATACREAM ORCHARD GRASS POLLEN PCCA POLYPEG BASE ORMECA PCCA VANISHING CREAM BASE ORTHO DF PCCA VANISHING CREAM LIGHT oscimin sr PCCA VANPEN BASE OTIPRIO PCP 100 OVACE PLUS PEANUT (DIAGNOSTIC) OVACE PLUS WASH PECAN NUT (DIAGNOSTIC) OVACE WASH PECAN POLLEN OVEEZA PEDIZOLPAK OXYTOCIN-SODIUM CHLORIDE PENCREAM INTRAVENOUS SOLUTION 30-0.9 UT/500ML-% PENDERM PAINGO KFT PENICILLIUM NOTATUM papaverine hcl injection PENLEN PAPAVERINE-PHENTOLAMINE PENTAPHENE BASE PAPAV-PHENTOLAMINE-ALPROSTADIL PENTICAN paregoric PENTOSAN POLYSULFATE SODIUM ORAL pb-hyoscy-atropine-scopolamine PERCURA P-CARE 100MX PERENNIAL RYE GRASS POLLEN P-CARE D40 PHARMABASE COSMETIC 15 Drug Name Drug Name PHARMABASE HEAVY phenobarbital-belladonna alk oral elixir POLYOXYL 40 STEARATE PELLET PHENOHYTRO POLY-PREP INJECTION POLYTOZA PATCH PHENYLBUTAZONE POLY-VI-FLOR ORAL TABLET CHEWABLE PHENYLEPHRINE HCL-NACL POLY-VI-FLOR/IRON ORAL TABLET INTRAVENOUS SOLUTION 10-0.9 CHEWABLE MG/250ML-%, 25-0.9 MG/250ML-%, 50-0.9 PORK (DIAGNOSTIC) MG/500ML-% PORT-PREP PHLAG SPRAY POTABA ORAL CAPSULE PHOMA EXIGUA POTASSIUM CHLORIDE IN D5W PHOSPHASAL INTRAVENOUS SOLUTION 20 MEQ/250ML PHOXILLUM B22K4/0 potassium citrate-citric acid oral solution PHOXILLUM BK4/2.5 potassium phosphates PHYSICIANS EZ USE B-12 potassium phosphates(66 meq k) PHYSICIANS EZ USE JOINT/TUNNEL POTASSIUM PHOSPHATES-NACL PHYSICIANS EZ USE M-PRED INTRAVENOUS SOLUTION 10 PHYSOSTIGMINE SALICYLATE INJECTION MMOL/100ML, 15 MMOL/150ML PHYTOBASE PR BENZOYL PEROXIDE PICO WOUND THERAPY SYSTEM PR BENZOYL PEROXIDE WASH PISTACHIO NUT (DIAGNOSTIC) PR CREAM PLEXION PR NATAL 400 PLEXION CLEANSER EXTERNAL LIQUID PR NATAL 400 EC PLEXION CLEANSING CLOTH EXTERNAL PR NATAL 430 PAD PRAMOSONE E pnv folic acid + iron PRAMOSONE EXTERNAL CREAM 1-2.5 % pnv ob+dha PRAMOSONE EXTERNAL OINTMENT POD-CARE 100C pramox POD-CARE 100CG PRASTERA POD-CARE 100CMX PRAXBIND POD-CARE 100K PRE & POST SX POUCH POD-CARE 100KG PRECEDEX INTRAVENOUS SOLUTION POD-CARE 100KMX 1000 MCG/250ML, 200 MCG/50ML, 400 MCG/100ML, 80 MCG/20ML podocon PREDNISOL ACE-MOXIFLOX-BROMFEN POINT OF CARE KM acetate p-f POINT OF CARE L.2 PREDNISOLONE ACETATE-NEPAFENAC POINT OF CARE L.5 PREDNISOLONE ACET-MOXIFLOXACIN POINT OF CARE LM DEP 2 PREDNISOLONE-BROMFENAC POINT OF CARE LM-2.2 PREDNISOLONE-GATIFLOXACIN POINT OF CARE LM-2.5

16 Drug Name Drug Name PREDNISOLONE-MOXIFLOXACIN PRILOVIX ULTRALITE PREDNISOLON-GATIFLOX-BROMFENAC PRILOVIX ULTRALITE PLUS PREDNISOLON-MOXIFLOX-BROMFENAC PRILOVIXIL OPHTHALMIC SOLUTION 1-0.5-0.075 % PRILOXX LP PREDNISOLON-MOXIFLOX-NEPAFENAC PRIMACARE ORAL CAPSULE PREGENNA PRIVET PREMESISRX PRIZOPAK II premium lidocaine PRIZOTRAL PREMIUM SCAR PRIZOTRAL-II PRENAISSANCE PROBICHEW PRENARA PROBUPHINE IMPLANT KIT prenatal oral tablet 27-1 mg PRO-C-DURE 5 PRENATE PRO-C-DURE 6 PRENATE AM PROCORT EXTERNAL PRENATE DHA ORAL CAPSULE 18-0.6-0.4- PRO-CRITIC 300 MG PROCTOCORT RECTAL SUPPOSITORY PRENATE ELITE ORAL TABLET 20-0.6-0.4 MG PRODIGEN PRENATE ENHANCE PROGESTERONE-MINOXIDIL PRENATE ESSENTIAL ORAL CAPSULE 18- PROMACTIN AA PLUS 20PE 0.6-0.4-300 MG PROMELLA IN PREBIOTIC PRENATE MINI ORAL CAPSULE 18-0.6-0.4- PROMISEB 350 MG PROMISEB COMPLETE PRENATE PIXIE PROPEL PRENATE RESTORE PROPEL MINI PRENATRIX PROSILK PRENATVITE COMPLETE PROTEXA PRESERA PROTHELIAL PREVELEAK SURGICAL SEALANT PROTYL AG PREVIDOLRX ANALGESIC PROVAD previdolrx plus analgesic PRUCLAIR PRIKAAN PRUMYX PRIKAAN LITE PRUTECT PRILO PATCH P-SILOXAN DS PRILOLID PSORIZIDE FORTE PRILOPENTIN PSORIZIDE ULTRA PRILOVIX PURAPLY PRILOVIX LITE PURAPLY 1.6CM PRILOVIX LITE PLUS PURAPLY ANTIMICROBIAL 2X2CM PRILOVIX PLUS PURAPLY ANTIMICROBIAL 2X4CM

17 Drug Name Drug Name PURAPLY ANTIMICROBIAL 5X5CM RED TOP GRASS POLLEN PURAPLY ANTIMICROBIAL 6X9CM REJUVACARE PLUS PURAPLY ANTIMICROBIAL 8X16CM RELADOR PAK EXTERNAL KIT PURAPLY XT ANTIMICROBIAL 5X5CM RELADOR PAK PLUS PURAPLY XT ANTIMICROBIAL 6X9CM RELAGARD PUREFE OB PLUS RELIZORB PUREFE PLUS REMIFENTANIL HCL-NACL PYRIDIUM REMIGEN PYRIDOXAL-5 PHOSPHATE INJECTION RENOVO QUEEN PALM RESET FOR ANDROID APP QUFLORA FE PEDIATRIC RESET FOR IOS APP QUFLORA GUMMIES RESET FOR IOS OR ANDROID APP QUFLORA PEDIATRIC RESET-O FOR ANDROID APP QUINIXIL RESET-O FOR IOS APP QUINJA RESET-O FOR IOS OR ANDROID APP QUTENZA RESORCINOL-SULFUR QUTENZA (2 PATCH) RESTORA SPRINKLES QUZYTTIR RETISERT INTRAVITREAL RABBIT EPITHELIUM REVESTA RADIAGEL REXAPHENAC RADIAPLEXRX REXASIL PATCH & VITAMIN E LIQ RAPID GEL RX REZESOL READYSHARP ANESTH + BETAMETH RHEUMATE READYSHARP ANESTH + DEXAMETH RHIZOPUS READYSHARP ANESTH + KETOROLAC RIBOZEL READYSHARP ANESTH + METHYLPRED RICE (DIAGNOSTIC) READYSHARP BETAMETHASONE ROPIDEX READYSHARP DEXAMETHASONE ROPIVACAINE HCL INJECTION SOLUTION READYSHARP KETOROLAC 2 MG/ML READYSHARP LIDOCAINE ROPIVACAINE HCL INJECTION SOLUTION 33.4 MG/ML READYSHARP-A ROPIVACAINE HCL INJECTION SOLUTION READYSHARP-K PREFILLED SYRINGE RECEDO ROPIVACAINE HCL-NACL INJECTION RECK SOLUTION 0.2-0.9 % RECURA ROPIV-CLONIDINE-KETOROLAC RED BIRCH ROSADAN EXTERNAL KIT RED CEDAR ROSANIL CLEANSER RED MAPLE ROUGH MARSH ELDER RED MULBERRY ROUGH PIGWEED

18 Drug Name Drug Name ROXIFOL-D SCARCARE GEL-PAD KIT/LARGE RRB PAK SCARCIN EXTERNAL GEL RUSSIAN THISTLE SCARCIN EXTERNAL LIQUID RYNODERM SCARCINPAD SA3 DERM SCARSILK SACCHAROMYCES CEREVISIAE SCARZEN SKIN REPAIR SAGEBRUSH SEBUDERM SALEX EXTERNAL KIT 6 % (CREAM), 6 % SEDANARE (LOTION) SELECT-OB SALEX EXTERNAL SHAMPOO SELECT-OB+DHA salicylic acid er SELENIOUS ACID INTRAVENOUS salicylic acid external cream SELENIUM INTRAVENOUS salicylic acid external foam selenium sulfide external shampoo salicylic acid external gel SELRX salicylic acid external liquid 27.5 % SENTRA AM salicylic acid external lotion SENTRA PM salicylic acid external shampoo SERAQUA salicylic acid external solution 26 % SESAME SEED (DIAGNOSTIC) salicylic acid wart remover SHAGBARK HICKORY salicylic acid-cleanser SHEEP SORREL SALICYLIC ACID-SULFACETAMIDE SHORT RAGWEED POLLEN EXT salimez SHRIMP (DIAGNOSTIC) SALIMEZ FORTE SILA III saline bacteriostatic SILALITE PAK SALISOL SILIPAC salisol forte SILIVEX SALITECH SIL-K PAD LARGE salitech forte SIL-K PAD MEDIUM SALIVAMAX SIL-K PAD SMALL SALRIX SILPROTEX PLUS salsalate oral SILTREX SALT DURABLE CREAM silver nitrate external solution SALT STABLE LS ADVANCED SITZMARKS SALTSTABLE LO SITZMARKS COMBO PACKAGE SALVAX sod citrate-citric acid SALVAX DUO PLUS sodium acetate intravenous solution 4 meq/ml SANADERMRX SKIN REPAIR sodium bicarbonate intravenous solution 4.2 SANARE SCAR THERAPY %, 8.4 % SCALACORT DK

19 Drug Name Drug Name SODIUM BICARBONATE-DEXTROSE STRATA XRT INTRAVENOUS SOLUTION 150-5 MEQ/L-% STRAWBERRY (DIAGNOSTIC) sodium chloride (pf) STRONTIUM CHLORIDE SR-89 sodium chloride intravenous solution 4 meq/ml STROVITE FORTE ORAL TABLET SODIUM CITRATE-GENTAMICIN SULF STROVITE ONE sodium hyaluronate external gel SUCCINYLCHOLINE CHLORIDE sodium phosphates intravenous solution 45 INTRAVENOUS SOLUTION PREFILLED mmole/15ml SYRINGE 100 MG/5ML sodium sulfacetamide external shampoo sulfacetamide sodium external gel sodium sulfacetamide wash liquid 10 % sulfacetamide sodium external liquid external sulfacetamide sodium-sulfur external cream SODIUM SULFACETAMIDE WASH LIQUID sulfacetamide sodium-sulfur external emulsion 10 % EXTERNAL sulfacetamide sodium-sulfur external liquid sodium tetradecyl sulfate intravenous sulfacetamide sodium-sulfur external lotion SOLARAVIX sulfacetamide sodium-sulfur external pad 10-4 SOLOX % SOLU-K sulfacetamide sodium-sulfur external SOLULINE suspension SOLUPAK sulfacetamide sod-sulfur wash external kit SOLUPICC sulfacetamide-sulfur in urea external emulsion SOLU-PREF sulfacetamide-sulfur-sunscreen SOLYDRA SULFACLEANSE 8/4 SOOTHEE EXTERNAL PATCH 0.5-0.0375-5- sulfamez wash 2 % SUMADAN SORREL/DOCK MIX SUMADAN WASH SOTRADECOL SUMADAN XLT SOYBEAN (DIAGNOSTIC) SUMAXIN SPASCUPREEL INJECTION SUMAXIN CP SPECIMEN COLLECTION SUMAXIN WASH SPEEDGEL RX SUPER TRI-MIX SPINY PIGWEED sure result dss premium pack SSKI SURE RESULT O3D3 SYSTEM sss 10-5 external cream SUVICORT SSS 10-5 EXTERNAL FOAM SWEET CORN (DIAGNOSTIC) STEMPHYLIUM SWEET GUM sterile water for injection injection SWEET VERNAL GRASS POLLEN STRATA CTX SX1 MEDICATED POST-OPERATIVE STRATA GRT SYMAX DUOTAB STRATA MARK SYMAX-SL STRATA TRIZ SYMAX-SR

20 Drug Name Drug Name SYNALAR (CREAM) TORONOVA II SUIK SYNALAR (OINTMENT) TORONOVA SUIK SYNALAR TS TOVET EXTERNAL KIT SYNERDERM TRACE ELEMENTS 4/PEDIATRIC SYNTHAMIN 17 TRANSCYTE SYNVEXIA TC TRANZGEL SZOSIL 15 DAY SUPPLY TRAUMEEL EXTERNAL OINTMENT SZOSIL 8 DAY SUPPLY TRAUMEEL INJECTION TACROLIMUS EXTERNAL CREAM TRAUMEEL ORAL TABLET TALIVA TREPADONE TALL RAGWEED TRIAMCINOLONE ACETONIDE INJECTION TANDEM F SUSPENSION 40 MG/ML taron-crystals TRIAMCINOLONE ACETONIDE INJECTION SUSPENSION 50 MG/ML TASOPROL TRIAMCINOLONE DIACETATE INJECTION TECHNELITE SUSPENSION 40 MG/ML TESTONE CIK TRIAMCINOLONE DIACETATE PF TESTOSTERONE CYPIONATE & PROP INJECTION SUSPENSION 80 MG/2ML TESTOSTERONE CYPIONATE INJECTION TRIAMCINOLONE-MOXIFLOXACIN TESTOSTERONE ENANTHATE INJECTION TRIAMSIL COMBIPAK EXTERNAL THERAPY TESTOSTERONE IMPLANT PELLET 100 PACK MG, 200 MG, 25 MG, 50 MG TRIAMSIL MULTIPAK TESTOSTERONE PROPIONATE INJECTION TRICHOPHYTON SUBCUTANEOUS tetracaine hcl injection tricitrates TETRIX EXTERNAL CREAM TRILOAN II SUIK THERAHONEY EXTERNAL GEL TRILOAN SUIK THERAMINE TRI-MIX THRIVACIN 30 TRINAZ THRIVACIN DETOX TRISTART DHA TICALAST TRISTART ONE TICASPRAY TRIVIX TIGHTENING BASE TRIXYLITRAL TIMOLOL-BRIMON-DORZOL-LATANOPR TRONVITE TIMOLOL-BRIMONIDINE-DORZOLAMID TROPICAMIDE-CYCLOPENTOLATE-PE TIMOLOL-DORZOLAMID-LATANOPROST TROPICAMIDE-PHENYLEPHRINE TIMOTHY GRASS POLLEN ALLERGEN TROPIC-PROPARACA-PE-KETOROLAC TISSUEBLUE TRUSKIN TOBAKIENT tryptophan oral TOMATO (DIAGNOSTIC) T-SUPPORT MAX TOPIDEX turpentine external

21 Drug Name Drug Name TYLACTIN RESTORE 10 VARIBAR THIN HONEY TYLACTIN RTD 15 VARIBAR THIN LIQUID ULTRADERM VAROPHEN ULTRASAL-ER VASCUDERM HYDROGEL UMECTA MOUSSE VENIPUNCTURE CPI URALISS VENOMIL HONEY BEE VENOM URAMAXIN EXTERNAL GEL VENOMIL MIXED VESPID VENOM urea external cream 39 %, 40 %, 41 %, 45 %, VENOMIL WASP VENOM 47 % VENOMIL WHITE FACED HORNET UREA EXTERNAL FOAM VENOMIL YELLOW HORNET VENOM urea external lotion 40 % VENOMIL YELLOW JACKET VENOM urea external suspension 40 % VERSAJET EXACT 14MM urea hydrating VERSAJET EXACT 8MM urea nail external gel 45 % VERSAJET II EXACT 14MM urea-c40 VERSAJET II EXACT 8MM uredeb VERSAJET II PLUS 14MM ure-k VERSAJET II PLUS 8MM URELLE VERSAJET PLUS 14MM UREMEZ-40 VERSAJET PLUS 8MM URESOL VERSAPRO EXTERNAL CREAM URIBEL VEXASYN URIMAR-T VEXATROL URO-458 VILAMIT MB UROGESIC-BLUE VILEVEV MB uro-mp VINATE DHA RF URYL VIRASAL USTELL VIRGINIA LIVE OAK UTA VISBIOME UTICAP VITAFOL FE+ UTIRA-C VITAFOL GUMMIES UTOPIC VITAFOL ORAL TABLET VANCOSOL PACK VITAFOL ULTRA VANISHING VITAFOL-NANO VANISHING CREAM BOTANICAL BASE VITAFOL-OB VANISH-PEN VITAFOL-OB+DHA VANOXIDE-HC VITAFOL-ONE VARIBAR HONEY VITAMEDMD ONE RX/QUATREFOLIC VARIBAR NECTAR VITAMEDMD REDICHEW RX ORAL TABLET VARIBAR PUDDING CHEWABLE 1.4 MG

22 Drug Name Drug Name VITAMEZ XOLEGEL COREPAK vitamin b complex 100 XOLEGEL DUO/HEAD & SHOULDERS VITAMIN B COMPLEX-HYDROXOCOBAL XOLEGEL DUO/XOLEX vitamin b-complex 100 XRYLIDERM VITAMIN DEFICIENCY SYSTEM-B12 XRYLIX VITAPEARL xurea VITA-RX DIABETIC VITAMIN XVITE VITASURE XYZMUNE VITATHELY WITH GINGER YBUPHEN VITATRUE YELLOW DOCK VITAXYME YELLOW HORNET VENOM PROTEIN VITREXYL INJECTION SOLUTION RECONSTITUTED 550 MCG VITREXYL + IRON YELLOW HORNET VENOM PROTEIN VIZAMYL SUBCUTANEOUS VOLUMEN YELLOW JACKET VENOM PROTEIN VP DERMABASE INJECTION SOLUTION RECONSTITUTED VSL#3 DS 1300 MCG, 550 MCG VYTONE YELLOW JACKET VENOM PROTEIN SUBCUTANEOUS WASP VENOM PROTEIN INJECTION SOLUTION RECONSTITUTED 1300 MCG, YUTIQ 550 MCG ZACARE WASP VENOM PROTEIN SUBCUTANEOUS ZACLIR CLEANSING EXTERNAL LOTION 8 WESTERN JUNIPER % wheat germ oil oral oil ZALVIT WHITE ASH ZANABIN HYDROGEL WHITE BIRCH ZAVARA WHITE FACED HORNET VENOM ZEEL INJECTION WHITE MULBERRY ZELAC WHITE OAK ZENEVIX WHITE PINE ZERUVIA WHITE-FACED HORNET VENOM ZEYOCAINE WHOLE EGG (DIAGNOSTIC) ZILACAINE PATCH WPR PLUS WOUND HEALING SYSTEM ZINC SULFATE INTRAVENOUS xelitral ZIONODIL XEMATOP BASE ZIONODIL 100 xenaflamm ZITHRANOL XERALUX ZOE SCRIPTS IDEALBASE XEROSTOMIA RELIEF SPRAY ZOLPAK XILAPAK

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