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VIRGINIA PREMIER HEALTH PLAN

FAMIS MEDICAID FORMULARY

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

For the member: Generic medications contain the same active ingredients as their corresponding brand-name medications, although they may look different in color or shape. They have been FDA-approved under strict standards. For the physician: Please prescribe preferred products and allow generic substitutions when medically appropriate. Thank you. CURRENT AS OF 10/1/2021

Requirements/Limits AGE = Age limit requirement Custom = Drug has unique restrictions OTC = Over the Counter PA = Prior Authorization required QL = Quantity Level Limit lowercase italics = Generic Formulary SP = Specialty Drug. Preferred Specialty drugs Pharmacy will be listed if applicable UPPERCASE = Brand name Formulary Formulary Status ST = Step Therapy may apply to some or all drugs Formulary = Covered strengths of the drug Drug Name Formulary Status Requirements/Limits 1st relief spray external 4-1 % Formulary OTC 1st tier unifine pentips 29g x 12mm , 31g x 5 mm , 31g x 6 Formulary OTC; QL (200 EA per 30 days) mm , 31g x 8 mm , 32g x 4 mm 1st tier unilet comfortouch Formulary OTC; QL (150 EA per 30 days) 4-N-1 EXTERNAL 1 % Formulary OTC 50+ adult eye health oral Formulary OTC A & D ZINC OXIDE EXTERNAL CREAM Formulary OTC a thru z advanced oral Formulary OTC a thru z advantage oral tablet Formulary OTC a thru z select oral tablet chewable Formulary OTC A+D CRACKED SKIN RELIEF EXTERNAL CREAM 2- Formulary OTC 0.13 % a1c test at-home in vitro kit Formulary OTC a-25 oral capsule 25000 unit Formulary OTC sulfate oral 20 mg/ml Formulary abacavir sulfate oral tablet 300 mg Formulary abacavir sulfate- oral tablet 600-300 mg Formulary abacavir-lamivudine- oral tablet 300-150-300 Formulary mg ABANATUSS PED ORAL LIQUID 15-0.5-6.25 MG/ML, Formulary OTC 60-2-25 MG/5ML ABATRACE ORAL CAPSULE Formulary OTC ABATREX ORAL TABLET 8-200-4-100-600 MG Formulary OTC ABATRON AF ORAL TABLET 150-1 MG Formulary OTC ABATRON ORAL LIQUID Formulary OTC ABATUSS DMX ORAL LIQUID 30-1-15 MG/5ML Formulary OTC ABILIFY MAINTENA INTRAMUSCULAR PREFILLED Formulary AGE (Min 18 Years) 300 MG, 400 MG ABILIFY MAINTENA INTRAMUSCULAR Formulary AGE (Min 18 Years) RECONSTITUTED 300 MG, 400 MG ABILIFY MAINTENA INTRAMUSCULAR Formulary AGE (Min 18 Years) SUSPENSION RECONSTITUTED ER 300 MG, 400 MG ABILIFY MYCITE ORAL TABLET 10 MG, 15 MG, 2 Formulary PA MG, 20 MG, 30 MG, 5 MG abiraterone acetate oral tablet 250 mg Formulary ABRAXANE INTRAVENOUS SUSPENSION Formulary RECONSTITUTED 100 MG 1 Drug Name Formulary Status Requirements/Limits ABREVA EXTERNAL CREAM 10 % Formulary OTC acamprosate calcium oral tablet delayed release 333 mg Formulary acarbose oral tablet 100 mg, 25 mg, 50 mg Formulary ACCU-CHEK FASTCLIX LANCET KIT Formulary OTC ACCU-CHEK SOFT TOUCH LANCETS Formulary OTC; QL (150 EA per 30 days) ACCU-CHEK SOFTCLIX LANCETS Formulary OTC; QL (150 EA per 30 days) ACCUTANE ORAL CAPSULE 20 MG, 30 MG, 40 MG Formulary ACCUTREND CHOLESTEROL CONTROL IN VITRO Formulary OTC SOLUTION ACCUTREND CHOLESTEROL IN VITRO STRIP Formulary OTC ACCUTREND PLUS DEVICE Formulary OTC ACE CLOUD ENHANCER Formulary QL (2 EA per 365 days) ACE KNEE BRACE W/STABILIZERS Formulary OTC acebutolol hcl oral capsule 200 mg, 400 mg Formulary ACEROLA C 500 ORAL WAFER 500 MG Formulary OTC ACETA-GESIC ORAL TABLET 12.5-325 MG Formulary OTC acetaminophen extra strength oral liquid 500 mg/15ml Formulary OTC acetaminophen junior strength oral tablet dispersible 160 Formulary OTC mg acetaminophen oral liquid 160 mg/5ml Formulary OTC acetaminophen oral solution 160 mg/5ml Formulary OTC acetaminophen oral tablet 325 mg Formulary OTC acetaminophen rapid tabs child oral tablet dispersible 80 Formulary OTC mg acetaminophen rectal 650 mg Formulary OTC acetaminophen-codeine #2 oral tablet 300-15 mg Formulary PA; QL (280 EA per 7 days) acetaminophen-codeine #3 oral tablet 300-30 mg Formulary PA; QL (140 EA per 7 days) acetaminophen-codeine #4 oral tablet 300-60 mg Formulary PA; QL (70 EA per 7 days) acetaminophen-codeine oral solution 120-12 mg/5ml Formulary PA; QL (1750 ML per 7 days) ACETASOL HC OTIC SOLUTION 2-1 % Formulary acetazolamide er oral capsule extended release 12 hour 500 Formulary mg acetazolamide oral tablet 250 mg Formulary acetic acid irrigation solution 0.25 % Formulary acetic acid otic solution 2 % Formulary acetylcysteine solution 10 %, 20 % Formulary ACID GONE ORAL SUSPENSION 95-358 MG/15ML Formulary OTC acid reducer maximum strength oral tablet 20 mg Formulary OTC acidophilus oral capsule Formulary OTC acidophilus probiotic oral tablet 10 mg Formulary OTC acidophilus/bifidus oral tablet chewable Formulary OTC acidophilus/citrus pectin oral tablet Formulary OTC acidophilus/pectin oral capsule Formulary OTC acitretin oral capsule 10 mg, 17.5 mg, 25 mg Formulary PA; QL (68 EA per 34 days) acne maximum strength external pad 2 % Formulary OTC 2 Drug Name Formulary Status Requirements/Limits acne medication 10 external 10 % Formulary OTC; AGE (Max 18 Years) acne medication 10 external 10 % Formulary OTC; AGE (Max 18 Years) acne medication 5 external gel 5 % Formulary AGE (Max 18 Years) acne medication 5 external lotion 5 % Formulary OTC; AGE (Max 18 Years) acne treatment external bar 10 % Formulary OTC; AGE (Max 18 Years) ACNEFREE ACNE CLEARING SYSTEM EXTERNAL Formulary OTC KIT 2.5 & 3.7 % ACNEFREE SEVERE CLEARING SYST EXTERNAL Formulary OTC KIT 2.5 & 10 % ACT TOTAL CARE MOUTH/THROAT SOLUTION 0.05 Formulary OTC % ACTHIB INTRAMUSCULAR SOLUTION Formulary AGE (Min 19 Years) RECONSTITUTED ACTICARNITINE SF ORAL SOLUTION 1 GM/10ML Formulary OTC ACTICON ORAL SOLUTION 1-30 MG/5ML Formulary OTC ACTICON ORAL TABLET 2-60 MG Formulary OTC actidom dmx oral liquid 10-30-200 mg/5ml Formulary OTC ACTIDOSE WITH SORBITOL ORAL LIQUID 50 Formulary OTC GM/240ML actidose-aqua oral liquid 15 gm/72ml Formulary OTC ACTIFLOVIT HEALTH ORAL TABLET Formulary OTC ACTIFOAM COLLAGEN SPONGE EXTERNAL Formulary acti-lance lite lancets 28g Formulary OTC; QL (150 EA per 30 days) acti-lance special lancets 17g Formulary OTC; QL (150 EA per 30 days) acti-lance universal 23g Formulary OTC; QL (150 EA per 30 days) ACTIMARIS WOUND EXTERNAL GEL Formulary OTC ACTIMMUNE SUBCUTANEOUS SOLUTION 2000000 Formulary UNIT/0.5ML ACTINEL ORAL LIQUID 30-15-200 MG/5ML Formulary OTC ACTISEP MOUTH/THROAT SOLUTION 2-0.5-0.1 % Formulary OTC ACTITROM ORAL CAPSULE Formulary OTC ACTIVE Q MAXIMUM STRENGTH ORAL CAPSULE Formulary OTC 300 MG ACTIVE Q ORAL 100 MG/5ML Formulary OTC ACTIVE-Q EXTRA STRENGTH ORAL CAPSULE 200 Formulary OTC MG ACTIVE-Q ORAL CAPSULE 200-30 MG Formulary OTC ACTIVITE EC ORAL TABLET 1 MG Formulary OTC ACTIVON ARTHRITIS ULTRA ST EXTERNAL STICK Formulary OTC 0.028-4.574 % acyclovir external ointment 5 % Formulary acyclovir oral capsule 200 mg Formulary acyclovir oral suspension 200 mg/5ml Formulary acyclovir oral tablet 400 mg, 800 mg Formulary ADACEL INTRAMUSCULAR SUSPENSION 5-2-15.5 Formulary LF-MCG/0.5

3 Drug Name Formulary Status Requirements/Limits ADAGEN INTRAMUSCULAR SOLUTION 250 Formulary PA UNIT/ML adapalene external cream 0.1 % Formulary AGE (Max 18 Years) adapalene external gel 0.1 %, 0.3 % Formulary AGE (Max 18 Years) adefovir dipivoxil oral tablet 10 mg Formulary adhesive bandages sheer Formulary OTC adjustable lancing device Formulary OTC; QL (1 EA per 365 days) ADMELOG SOLOSTAR SUBCUTANEOUS SOLUTION Formulary PEN-INJECTOR 100 UNIT/ML ADMELOG SUBCUTANEOUS SOLUTION 100 Formulary UNIT/ML ADRENAL C FORMULA ORAL TABLET Formulary ADRENALIN SOLUTION 1 MG/ML, 30 Formulary MG/30ML ADRUCIL INTRAVENOUS SOLUTION 2.5 GM/50ML, 5 Formulary GM/100ML, 500 MG/10ML ADULT ACNOMEL EXTERNAL CREAM 2-8 % Formulary OTC adult gummy oral tablet chewable Formulary OTC adult mask device Formulary QL (2 EA per 365 days) adult wash cloths with aloe external 3 % Formulary OTC adult-lock weekly pill remind Formulary OTC advanced acne wash external liquid extended release 4.4 % Formulary OTC ADVANCED CALCIUM/D/MAGNESIUM ORAL Formulary OTC TABLET advanced hand sanitizer external liquid 70 % Formulary OTC advanced lubricant ophthalmic solution 0.05-1 % Formulary OTC ADVIL ALLERGY & CONGESTION ORAL TABLET 4- Formulary OTC 10-200 MG ADVIL ALLERGY SINUS ORAL TABLET 2-30-200 MG Formulary OTC ADVIL COLD & SINUS LIQUI- ORAL CAPSULE Formulary OTC 30-200 MG ADVIL COLD/SINUS ORAL TABLET 30-200 MG Formulary OTC ADVIL ORAL CAPSULE 200 MG Formulary OTC ADVIL ORAL TABLET 200 MG Formulary OTC ADVIL PM ORAL CAPSULE 200-25 MG Formulary OTC ADVIL PM ORAL TABLET 200-38 MG Formulary OTC ADVIL SINUS CONGESTION & ORAL TABLET Formulary OTC 10-200 MG ADVOCATE INSULIN SYRINGE 29G X 1/2" 0.5 ML Formulary OTC 29G X 1/2" 0.5 ML ADVOCATE INSULIN SYRINGE 30G X 5/16" 0.3 ML Formulary OTC 30G X 5/16" 0.3 ML ADVOCATE INSULIN SYRINGE 30G X 5/16" 1 ML 30G Formulary OTC X 5/16" 1 ML ADVOCATE INSULIN SYRINGE 31G X 5/16" 1 ML 31G Formulary OTC X 5/16" 1 ML AEROCHAMBER MINI CHAMBER DEVICE Formulary QL (2 EA per 365 days)

4 Drug Name Formulary Status Requirements/Limits AFLURIA INTRAMUSCULAR SUSPENSION Formulary AGE (Min 19 Years) AFLURIA PRESERVATIVE FREE INTRAMUSCULAR Formulary AGE (Min 19 Years) SUSPENSION PREFILLED SYRINGE 0.5 ML AFLURIA QUADRIVALENT INTRAMUSCULAR Formulary AGE (Min 19 Years) SUSPENSION AFREZZA INHALATION 12 UNIT, 8 UNIT Formulary AFRIN CHILDRENS NASAL SOLUTION 0.25 % Formulary OTC AFRIN SPRAY NASAL SOLUTION 0.05 % Formulary OTC AFTERA ORAL TABLET 1.5 MG Formulary OTC; QL (2 EA per 34 days) AGAMATRIX ULTRA-THIN LANCETS Formulary OTC; QL (150 EA per 30 days) AHIST ORAL TABLET 25 MG Formulary OTC aimsco lubricated Formulary OTC AIRAVITE ORAL TABLET 2.5-25-1 MG Formulary AIRBORNE ORAL LOZENGE Formulary OTC AIRS DISPOSABLE Formulary OTC; QL (2 EA per 365 days) AIRS DISPOSABLE NEBULIZER KIT Formulary QL (2 EA per 365 days) AIRZONE PEAK FLOW METER DEVICE Formulary OTC; QL (2 EA per 365 days) AJOVY SUBCUTANEOUS SOLUTION AUTO- Formulary ST; AGE (Min 18 Years) INJECTOR 225 MG/1.5ML AJOVY SUBCUTANEOUS SOLUTION PREFILLED Formulary ST; AGE (Min 18 Years) SYRINGE 225 MG/1.5ML ak-poly-bac ophthalmic ointment 500-10000 unit/gm Formulary AL12 EXTERNAL LOTION 12 % Formulary OTC ALA SEB EXTERNAL 2-2 % Formulary OTC ALA SEB T EXTERNAL SHAMPOO 1-2-2 % Formulary OTC ALAHIST DM ORAL LIQUID 7.5-2-15 MG/5ML Formulary OTC ALA-HIST IR ORAL TABLET 2 MG Formulary OTC ALA-HIST PE ORAL TABLET 2-10 MG Formulary OTC alanine 1000 oral packet 1000 mg Formulary OTC alba-lybe nr oral liquid 325-10-50 mg/5ml Formulary OTC oral tablet 200 mg Formulary ALBOLENE EXTERNAL CREAM Formulary OTC; QL (454 GM per 34 days) ALBUKED 25 INTRAVENOUS SOLUTION 25 % Formulary ALBUKED 5 INTRAVENOUS SOLUTION 5 % Formulary albumin human intravenous solution 25 %, 5 % Formulary albumin-zlb intravenous solution 25 %, 5 % Formulary alburx intravenous solution 5 % Formulary ALBUTEIN INTRAVENOUS SOLUTION 25 %, 5 % Formulary albuterol sulfate er oral tablet extended release 12 hour 4 Formulary mg, 8 mg albuterol sulfate hfa inhalation aerosol solution 108 (90 Formulary base) mcg/act albuterol sulfate inhalation nebulization solution (2.5 mg/3ml) 0.083%, (5 mg/ml) 0.5%, 0.63 mg/3ml, 1.25 Formulary mg/3ml albuterol sulfate oral syrup 2 mg/5ml Formulary 5 Drug Name Formulary Status Requirements/Limits albuterol sulfate oral tablet 2 mg, 4 mg Formulary alcohol (rubbing) solution 70 % Formulary OTC alcohol prep pad 70 % Formulary OTC alcohol prep pad 70 % 70 % Formulary OTC alcohol swabs pad Formulary OTC alcohol swabs pad 70 % 70 % Formulary OTC alcohol wipes pad 70 % 70 % Formulary OTC alendronate sodium oral tablet 10 mg, 35 mg, 40 mg, 5 mg, Formulary 70 mg aler-cap oral capsule 25 mg Formulary OTC aler-dryl oral tablet 50 mg Formulary OTC alertness aid oral tablet 200 mg Formulary OTC alevazol external ointment 1 % Formulary OTC ALEVE ORAL CAPSULE 220 MG Formulary OTC ALEVE ORAL TABLET 220 MG Formulary OTC ALFERON N INJECTION SOLUTION 5000000 Formulary PA UNIT/ML alfuzosin hcl er oral tablet extended release 24 hour 10 mg Formulary alga oral capsule 0.225-2000 mg-unit Formulary OTC ALGAL-900 DHA ORAL CAPSULE 300 MG Formulary OTC ALIMTA INTRAVENOUS SOLUTION Formulary RECONSTITUTED 100 MG, 500 MG ALIVE MULTI-VITAMIN CHILDRENS ORAL TABLET Formulary OTC CHEWABLE 60 MG ALIVIO EXTERNAL PATCH 0.03-5 % Formulary OTC alka-aid oral tablet 180-360 mg Formulary OTC ALKA-SELTZER HEARTBURN + GAS ORAL TABLET Formulary OTC CHEWABLE 750-80 MG ALKA-SELTZER ORAL TABLET EFFERVESCENT Formulary OTC 325-1000-1916 MG ALKA-SELTZER PLUS DAY/NIGHT ORAL CAPSULE Formulary OTC all day allergy childrens oral solution 5 mg/5ml Formulary OTC all day pain relief oral tablet 220 mg Formulary OTC ALLEGRA ALLERGY CHILDRENS ORAL Formulary OTC SUSPENSION 30 MG/5ML ALLEGRA ALLERGY CHILDRENS ORAL TABLET Formulary OTC DISPERSIBLE 30 MG ALLEGRA ALLERGY ORAL TABLET 180 MG, 60 MG Formulary OTC ALLEGRA-D ALLERGY & CONGESTION ORAL Formulary OTC TABLET EXTENDED RELEASE 12 HOUR 60-120 MG ALLEGRA-D ALLERGY & CONGESTION ORAL Formulary OTC TABLET EXTENDED RELEASE 24 HOUR 180-240 MG aller-ease oral tablet 60 mg Formulary OTC; QL (68 EA per 34 days) allergy childrens oral liquid 12.5 mg/5ml Formulary OTC allergy eye ophthalmic solution 0.025-0.3 % Formulary OTC allergy multi-symptom day/nght oral Formulary OTC

6 Drug Name Formulary Status Requirements/Limits allergy multi-symptom night oral tablet 25-5-325 mg Formulary OTC allergy relief childrens oral tablet dispersible 10 mg Formulary OTC allergy relief oral tablet 5 mg Formulary OTC allergy spray 24 hour aerosol 55 mcg/act nasal 55 mcg/act Formulary OTC allevess external patch 0.05-5 % Formulary OTC ALLEVYN PLUS CAVITY PAD 6"X8" Formulary OTC ALLI ORAL CAPSULE 60 MG Formulary OTC allopurinol oral tablet 100 mg, 300 mg Formulary ALMACONE ORAL TABLET CHEWABLE 200-200-25 Formulary OTC MG ALOCANE PLUS EXTERNAL GEL 4-0.13 % Formulary OTC ALOE GRANDE EXTERNAL CREAM 100000-1500 Formulary OTC UNIT/GM ALOE GRANDE EXTERNAL LOTION 10000-1500 Formulary OTC UNIT/30ML aloe vera external cream 72 % Formulary OTC aloe vera external gel 99.5 % Formulary OTC aloe vera moisturizing external gel 99.5 % Formulary OTC ALOE VESTA 2-N-1 PROTECTIVE EXTERNAL Formulary OTC OINTMENT ALOE VESTA CLEAR ANTIFUNGAL EXTERNAL Formulary OTC OINTMENT 2 % ALOE VESTA MULTI PURPOSE EXTERNAL FOAM Formulary OTC ALOE VESTA PROTECTIVE EXTERNAL OINTMENT Formulary OTC ALOE VESTA SKIN PROTECTANT EXTERNAL Formulary OTC AEROSOL 36 % aloe/lidocaine pain reliever external gel 0.5 % Formulary OTC alosetron hcl oral tablet 0.5 mg, 1 mg Formulary PA alp high3 oral capsule delayed release 600 mg Formulary OTC ALPAWASH EXTERNAL OINTMENT Formulary ALPHAGAN P OPHTHALMIC SOLUTION 0.1 % Formulary alpha-lipoic acid oral capsule 100 mg Formulary OTC alpha-lipoic acid oral tablet 200 mg Formulary OTC ALPHANATE/VWF COMPLEX/HUMAN INTRAVENOUS SOLUTION RECONSTITUTED 1000 Formulary UNIT, 1500 UNIT, 250 UNIT, 500 UNIT ALPHANINE SD INTRAVENOUS SOLUTION Formulary RECONSTITUTED 1000 UNIT, 500 UNIT alph-e oral capsule 400 unit Formulary OTC alph-e-mixed 1000 oral capsule 1000 unit Formulary OTC alph-e-mixed oral capsule 200 unit Formulary OTC alprazolam er oral tablet extended release 24 hour 0.5 mg, Formulary QL (170 EA per 30 days) 1 mg, 2 mg alprazolam er oral tablet extended release 24 hour 3 mg Formulary QL (170 EA per 34 days) ALPRAZOLAM INTENSOL ORAL CONCENTRATE 1 Formulary QL (170 ML per 34 days) MG/ML alprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg Formulary QL (170 EA per 34 days) 7 Drug Name Formulary Status Requirements/Limits alprazolam oral tablet dispersible 0.25 mg, 0.5 mg, 1 mg, 2 Formulary QL (170 EA per 34 days) mg ALTACAINE OPHTHALMIC SOLUTION 0.5 % Formulary ALTAFLUOR OPHTHALMIC SOLUTION 0.25-0.4 % Formulary altarussin-pe oral syrup 100-30 mg/5ml Formulary OTC ALTAVERA ORAL TABLET 0.15-30 MG-MCG Formulary QL (28 EA per 28 days) aluminum acetate external solution Formulary OTC aluminum bottle seal Formulary OTC aluminum hydroxide gel oral suspension 320 mg/5ml Formulary OTC ALWAYS MAXI MAXIMUM PROTECTION PAD Formulary OTC alyacen 1/35 oral tablet 1-35 mg-mcg Formulary QL (28 EA per 28 days) alyacen 7/7/7 oral tablet 0.5/0.75/1-35 mg-mcg Formulary QL (28 EA per 28 days) ALYQ ORAL TABLET 20 MG Formulary PA; AGE (Min 18 Years) amantadine hcl oral capsule 100 mg Formulary amantadine hcl oral syrup 50 mg/5ml Formulary amantadine hcl oral tablet 100 mg Formulary ambi 12.5cpd/100gfn/30pse oral liquid 30-12.5-100 mg/5ml Formulary OTC ambi 12.5cpd/1dcpm/30pse oral liquid 30-1-12.5 mg/5ml Formulary OTC ambi 40pse/400gfn oral tablet 40-400 mg Formulary OTC ambi 60pse/400gfn oral tablet 60-400 mg Formulary OTC ambi 60pse/4cpm oral tablet 60-4 mg Formulary OTC AMBI FADE EXTERNAL CREAM 2 % Formulary OTC ambrisentan oral tablet 10 mg, 5 mg Formulary AGE (Min 18 Years) amcinonide external cream 0.1 % Formulary AMERICERIN EXTERNAL CREAM Formulary OTC AMERIGEL WOUND DRESSING EXTERNAL GEL Formulary OTC AMERIWASH EXTERNAL LOTION Formulary OTC AMETHIA LO ORAL TABLET 0.1-0.02 & 0.01 MG Formulary QL (91 EA per 91 days) AMETHIA ORAL TABLET 0.15-0.03 &0.01 MG Formulary QL (91 EA per 91 days) AMETHYST ORAL TABLET 90-20 MCG Formulary QL (28 EA per 28 days) amiloride hcl oral tablet 5 mg Formulary amiloride-hydrochlorothiazide oral tablet 5-50 mg Formulary aminoacetic acid irrigation solution 1.5 % Formulary aminocaproic acid oral solution 0.25 gm/ml Formulary AMINORELIEFRMS ORAL CAPSULE Formulary amiodarone hcl oral tablet 100 mg, 200 mg, 400 mg Formulary amitriptyline hcl oral tablet 10 mg, 100 mg, 150 mg, 25 mg, Formulary 50 mg, 75 mg amlodipine besy-benazepril hcl oral capsule 10-20 mg, 10- Formulary 40 mg, 2.5-10 mg, 5-10 mg, 5-20 mg, 5-40 mg amlodipine besylate oral tablet 10 mg, 2.5 mg, 5 mg Formulary amlodipine besylate-valsartan oral tablet 10-160 mg, 10- Formulary 320 mg, 5-160 mg, 5-320 mg amlodipine-atorvastatin oral tablet 10-10 mg, 10-20 mg, Formulary 10-40 mg, 5-10 mg, 5-20 mg, 5-40 mg

8 Drug Name Formulary Status Requirements/Limits amlodipine-olmesartan oral tablet 10-20 mg, 10-40 mg, 5- Formulary 20 mg, 5-40 mg amlodipine-valsartan-hctz oral tablet 10-160-12.5 mg, 10- Formulary ST 160-25 mg, 10-320-25 mg, 5-160-12.5 mg, 5-160-25 mg ammonia aromatic inhalation Formulary OTC ammonia aromatic inhalation spirit Formulary OTC ammonium lactate external cream 12 % Formulary AMNESTEEM ORAL CAPSULE 10 MG, 20 MG, 40 MG Formulary oral capsule 250 mg, 500 mg Formulary amoxicillin oral suspension reconstituted 125 mg/5ml, 200 Formulary mg/5ml, 250 mg/5ml, 400 mg/5ml amoxicillin oral tablet 500 mg, 875 mg Formulary amoxicillin oral tablet chewable 125 mg, 250 mg Formulary amoxicillin-pot clavulanate oral suspension reconstituted 200-28.5 mg/5ml, 250-62.5 mg/5ml, 400-57 mg/5ml, 600- Formulary 42.9 mg/5ml amoxicillin-pot clavulanate oral tablet 250-125 mg, 500- Formulary 125 mg, 875-125 mg amoxicillin-pot clavulanate oral tablet chewable 200-28.5 Formulary mg, 400-57 mg amphetamine-dextroamphet er oral capsule extended QL (30 EA per 30 days); AGE (Min 4 Formulary release 24 hour 10 mg, 15 mg, 5 mg Years and Max 17 Years) amphetamine-dextroamphet er oral capsule extended QL (60 EA per 30 days); AGE (Min 4 Formulary release 24 hour 20 mg, 25 mg, 30 mg Years and Max 17 Years) amphetamine- oral tablet 10 mg, 12.5 Formulary AGE (Min 4 Years and Max 17 Years) mg, 15 mg, 20 mg, 30 mg, 5 mg, 7.5 mg ampicillin oral capsule 500 mg Formulary ANA-LEX RECTAL KIT 2-2 % Formulary ANASEPT ANTIMICROBIAL EXTERNAL GEL 0.057 % Formulary OTC ANASEPT EXTERNAL LIQUID 0.057 % Formulary OTC anastrozole oral tablet 1 mg Formulary ANBESOL COLD SORE THERAPY EXTERNAL Formulary OTC OINTMENT ANBESOL MAXIMUM STRENGTH MOUTH/THROAT Formulary OTC LIQUID 20 % ANBESOL MOUTH/THROAT GEL 10 % Formulary OTC ANBESOL MOUTH/THROAT LIQUID 10 % Formulary OTC ANECREAM EXTERNAL CREAM 4 % Formulary OTC animal chews oral tablet chewable Formulary OTC ANORO ELLIPTA INHALATION AEROSOL POWDER Formulary BREATH ACTIVATED 62.5-25 MCG/INH antacid anti-gas max strength oral suspension 400-400-40 Formulary OTC mg/5ml antacid anti-gas oral suspension 200-200-20 mg/5ml Formulary OTC antacid extra strength oral tablet chewable 675-135 mg Formulary OTC antacid multi-symptom oral tablet chewable 675-135-60 mg Formulary OTC antacid oral tablet chewable 500 mg Formulary OTC antacid soft chews oral tablet chewable 1177 mg Formulary OTC 9 Drug Name Formulary Status Requirements/Limits ANTARA ORAL CAPSULE 30 MG, 90 MG Formulary anthelios 50 mineral external liquid Formulary OTC anti-allergy oral tablet 100-100-50 mg Formulary OTC antibacterial liquid soap external liquid 0.15 % Formulary OTC anti-diarrheal oral liquid 1 mg/5ml Formulary OTC anti-diarrheal oral tablet 2 mg Formulary OTC antifungal external aerosol 1 % Formulary OTC antifungal external cream 2 % Formulary OTC anti-fungal external powder 1 % Formulary OTC anti-itch external cream 1-0.1 % Formulary OTC anti-itch external lotion 0.5-0.5 % Formulary OTC ANTI-ITCH INTENSIVE HEALING EXTERNAL Formulary OTC LOTION 1 % antioxidant formula sg oral capsule extended release Formulary OTC anti-oxidant oral tablet Formulary OTC antiseptic external aerosol 4.5-0.05-40.5 % Formulary OTC ANTISEPTIC HAND RINSE EXTERNAL GEL 62 % Formulary OTC antiseptic pain relief external liquid 10.8-4.7 % Formulary OTC antiseptic skin cleanser external solution 4 % Formulary OTC antiseptic wound/skin cleanser external liquid 0.1 % Formulary OTC AO-SEPT CONTACT LENS HOLDER Formulary OTC APETIGEN ORAL Formulary OTC APETIGEN-PLUS ORAL SOLUTION Formulary OTC APETIGEN-PLUS ORAL TABLET Formulary OTC ap-hist dm oral liquid 7.5-4-15 mg/5ml Formulary OTC APLICARE POVIDONE-IODINE EXTERNAL GEL 10 % Formulary OTC APLIGRAF EXTERNAL DISK Formulary apothesar external cream Formulary apraclonidine hcl ophthalmic solution 0.5 % Formulary aprepitant oral capsule 125 mg, 40 mg, 80 & 125 mg Formulary QL (1 EA per 34 days) aprepitant oral capsule 80 mg Formulary QL (2 EA per 34 days) APRI ORAL TABLET 0.15-30 MG-MCG Formulary QL (28 EA per 28 days) APTIVUS ORAL CAPSULE 250 MG Formulary APTIVUS ORAL SOLUTION 100 MG/ML Formulary AQUA CARE EXTERNAL LOTION 10 % Formulary OTC aquabase external ointment Formulary OTC AQUADEKS ORAL LIQUID Formulary OTC AQUAFRESH DR SEUSS EXTRA SOFT Formulary OTC aquanaz oral tablet 10-15-400 mg Formulary OTC AQUAPHILIC EXTERNAL OINTMENT Formulary OTC AQUAPHILIC/CARBAMIDE EXTERNAL OINTMENT Formulary OTC 10 %, 20 % AQUASONIC 100 EXTERNAL GEL Formulary OTC AQUEOUS SELENIUM ORAL LIQUID 95 MCG/DROP Formulary OTC

10 Drug Name Formulary Status Requirements/Limits aqueous vitamin e oral solution 15 mg/0.67ml, 15 Formulary OTC unit/0.3ml AQUORAL MOUTH/THROAT SOLUTION Formulary ARANELLE ORAL TABLET 0.5/1/0.5-35 MG-MCG Formulary QL (28 EA per 28 days) ARCALYST SUBCUTANEOUS SOLUTION Formulary PA RECONSTITUTED 220 MG ARCAPTA NEOHALER INHALATION CAPSULE 75 Formulary MCG arctic relief pain relieving external gel 0.2-3.5 % Formulary OTC arformoterol tartrate inhalation nebulization solution 15 Formulary mcg/2ml ARGIMENT AT ORAL PACKET Formulary OTC arginine oral packet 500 mg Formulary OTC arginine oral tablet 500 mg Formulary OTC arginine2000 oral packet 2000 mg Formulary OTC ARGYLE STERILE SALINE IRRIGATION SOLUTION Formulary 0.9 % ARGYLE STERILE WATER IRRIGATION SOLUTION Formulary aripiprazole oral tablet 10 mg, 15 mg, 2 mg, 20 mg, 30 mg, Formulary AGE (Min 18 Years) 5 mg ARISTADA INITIO INTRAMUSCULAR PREFILLED Formulary AGE (Min 18 Years) SYRINGE 675 MG/2.4ML ARISTADA INTRAMUSCULAR PREFILLED SYRINGE 1064 MG/3.9ML, 441 MG/1.6ML, 662 MG/2.4ML, 882 Formulary AGE (Min 18 Years) MG/3.2ML arkaliox oral capsule 200 mg Formulary OTC ARMOUR THYROID ORAL TABLET 120 MG, 180 MG, Formulary 240 MG, 300 MG arnica external 20 % Formulary OTC arnicare arthritis oral tablet dispersible Formulary OTC arnicare external gel Formulary OTC ARRANON INTRAVENOUS SOLUTION 5 MG/ML Formulary arthritis pain relieving external cream 0.075 % Formulary OTC artificial tears ophthalmic solution 0.2-0.2-1 %, 1 %, 1-0.3 Formulary OTC %, 1.4 % ARZERRA INTRAVENOUS CONCENTRATE 100 Formulary MG/5ML, 1000 MG/50ML ARZOL SILVER NIT APPLICATORS EXTERNAL 75-25 Formulary % asafetida tincture Formulary OTC ascocid-iso-ph oral powder effervescent Formulary OTC ASCOMP-CODEINE ORAL CAPSULE 50-325-40-30 MG Formulary PA ascorbic acid oral tablet 1000 mg, 500 mg Formulary OTC ascorbic acid oral tablet chewable 250 mg Formulary OTC ASCRIPTIN ORAL TABLET 325 MG Formulary OTC asepto oral thermometer kit Formulary OTC

11 Drug Name Formulary Status Requirements/Limits ASMANEX (120 METERED DOSES) INHALATION AEROSOL POWDER BREATH ACTIVATED 220 Formulary MCG/INH ASMANEX (30 METERED DOSES) INHALATION AEROSOL POWDER BREATH ACTIVATED 110 Formulary MCG/INH aspartate mg & k oral capsule 90-90 mg Formulary OTC ASPERCREME W/LIDOCAINE EXTERNAL CREAM 4 Formulary OTC % aspirin 81 oral tablet delayed release 81 mg Formulary OTC aspirin oral tablet 325 mg Formulary OTC aspirin oral tablet chewable 81 mg Formulary OTC aspirin oral tablet delayed release 325 mg Formulary OTC aspirin rectal suppository 300 mg, 600 mg Formulary OTC aspirin-dipyridamole er oral capsule extended release 12 Formulary hour 25-200 mg aspirtab maximum strength oral tablet 500 mg Formulary OTC ASSURE ID INSULIN SAFETY SYR 29G X 1/2" 0.5 ML Formulary (OTC) 29G X 1/2" 0.5 ML ASSURE ID INSULIN SAFETY SYR 29G X 1/2" 1 ML Formulary 29G X 1/2" 1 ML ASSURE LANCETS Formulary OTC; QL (150 EA per 30 days) ASTHMANEFRIN REFILL INHALATION Formulary OTC NEBULIZATION SOLUTION 2.25 % ASTHMAPACK FOR CHILDREN KIT Formulary OTC; QL (2 EA per 365 days) ATABEX OB ORAL TABLET 29-1 MG Formulary atazanavir sulfate oral capsule 150 mg, 200 mg, 300 mg Formulary atenolol oral tablet 100 mg, 25 mg, 50 mg Formulary atenolol-chlorthalidone oral tablet 100-25 mg, 50-25 mg Formulary athletes foot maximum strength external ointment Formulary OTC atomoxetine hcl oral capsule 10 mg Formulary atomoxetine hcl oral capsule 100 mg, 18 mg, 25 mg, 40 mg, Formulary QL (30 EA per 30 days) 60 mg, 80 mg ATOPICLAIR EXTERNAL CREAM Formulary atorvastatin calcium oral tablet 10 mg, 20 mg, 40 mg, 80 Formulary mg atovaquone oral suspension 750 mg/5ml Formulary atovaquone-proguanil hcl oral tablet 250-100 mg, 62.5-25 Formulary mg ATRAC-TAIN EXTERNAL CREAM 10 % Formulary OTC ATRAC-TAIN EXTERNAL LOTION 5 % Formulary OTC ATROVENT HFA INHALATION AEROSOL Formulary SOLUTION 17 MCG/ACT atuss da oral liquid 30-2-12.5 mg/5ml Formulary OTC AUBRA ORAL TABLET 0.1-20 MG-MCG Formulary QL (28 EA per 28 days) auraphene-b otic solution 6.5 % Formulary OTC aurora lancet super thin 30g Formulary OTC; QL (150 EA per 30 days)

12 Drug Name Formulary Status Requirements/Limits aurora lancet thin 23g Formulary OTC; QL (150 EA per 30 days) AUROVELA FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG Formulary AUTOJECT 2 Formulary OTC; QL (1 EA per 365 days) AUTOLET PLATFORMS Formulary OTC autopen device Formulary OTC; QL (1 EA per 365 days) avalin external patch 4-1 % Formulary OTC AVAR CLEANSER EXTERNAL 10-5 % Formulary AVAR-E EMOLLIENT EXTERNAL CREAM 10-5 % Formulary AVASTIN INTRAVENOUS SOLUTION 100 MG/4ML, Formulary PA 400 MG/16ML AVEENO BABY GENTLE CONDITION EXTERNAL Formulary OTC SHAMPOO AVEENO BABY SOOTHING WASH EXTERNAL Formulary OTC LIQUID AVEENO CREAMY MOISTURIZING EXTERNAL OIL Formulary OTC AVEENO INTENSE RELIEF EXTERNAL CREAM 1.3 % Formulary OTC AVEENO POSITIVELY RADIANT WASH EXTERNAL Formulary OTC LIQUID AVENOVA/NEUTROX EXTERNAL SOLUTION 0.01 % Formulary AVERTEAX MOUTH/THROAT OINTMENT 1 % Formulary OTC AVITENE EXTERNAL PAD Formulary AVITENE FLOUR EXTERNAL POWDER Formulary AVO CREAM EXTERNAL EMULSION Formulary AVONEX INTRAMUSCULAR KIT 30 MCG Formulary AVONEX PEN INTRAMUSCULAR AUTO-INJECTOR Formulary KIT 30 MCG/0.5ML AVONEX PREFILLED INTRAMUSCULAR PREFILLED Formulary SYRINGE KIT 30 MCG/0.5ML av-phos 250 neutral oral tablet 155-852-130 mg Formulary axillary block needle 22g x 1" , 25g x 1" Formulary OTC AXSAIN EXTERNAL CREAM 0.25 % Formulary OTC AYR SALINE NASAL DROPS NASAL SOLUTION 0.65 Formulary OTC % AYR SALINE NASAL GEL NASAL SWAB Formulary OTC AYR SALINE NASAL NASAL GEL Formulary OTC AYR SALINE NASAL NO-DRIP NASAL GEL Formulary OTC AYR SALINE NASAL RINSE NASAL PACKET 1.57 Formulary OTC GM azacitidine injection suspension reconstituted 100 mg Formulary azathioprine oral tablet 50 mg Formulary azec oral capsule Formulary OTC azelastine hcl nasal solution 0.1 %, 0.15 % Formulary azithromycin oral packet 1 gm Formulary azithromycin oral suspension reconstituted 100 mg/5ml, Formulary 200 mg/5ml azithromycin oral tablet 250 mg, 500 mg, 600 mg Formulary

13 Drug Name Formulary Status Requirements/Limits azithromycin tablet 250 mg oral 250 mg Formulary azithromycin tablet 500 mg oral 500 mg Formulary AZURETTE ORAL TABLET 0.15-0.02/0.01 MG (21/5) Formulary QL (28 EA per 28 days) b complete oral tablet Formulary OTC b complex formula 1 oral tablet Formulary OTC b complex oral capsule Formulary OTC b complex oral tablet Formulary OTC b complex-folic acid oral tablet 500-5-200 mcg-mg-mcg Formulary OTC b-1 oral tablet 100 mg, 250 mg Formulary OTC b-100 cr oral tablet extended release Formulary OTC b-12 oral tablet 2000 mcg, 250 mcg Formulary OTC b-12 sublingual tablet sublingual 1000 mcg, 2500 mcg, Formulary OTC 5000 mcg b-12 tr oral tablet extended release 2000 mcg Formulary OTC b-2 oral tablet 100 mg Formulary OTC B-2-400 ORAL CAPSULE 400 MG Formulary OTC b-6 oral tablet 250 mg, 50 mg, 500 mg Formulary OTC BABY ANBESOL MOUTH/THROAT GEL 7.5 % Formulary OTC BABY DDROPS ORAL LIQUID 400 UNT/0.03ML Formulary OTC baby diaper rash external cream 13 % Formulary OTC baby lotion external lotion Formulary OTC baby super daily d3 oral liquid 400 ut/0.028ml Formulary OTC baby teething pain medicine mouth/throat gel 7.5 % Formulary OTC baby thermometer Formulary OTC baciim intramuscular solution reconstituted 50000 unit Formulary bacitracin ophthalmic ointment 500 unit/gm Formulary bacitracin zinc external ointment 500 unit/gm Formulary bacitra-neomycin-polymyxin-hc ophthalmic ointment 1 % Formulary back pain-off oral tablet 250-50-290 mg Formulary OTC baclofen oral tablet 10 mg, 20 mg, 5 mg Formulary BACTROBAN NASAL NASAL OINTMENT 2 % Formulary balamine dm oral syrup 5-2-10 mg/5ml Formulary OTC balanced b-50 complex oral capsule Formulary OTC balanced b-50 oral tablet extended release Formulary OTC BAL-CARE DHA ORAL 27-1 & 430 MG Formulary BALNEOL EXTERNAL LOTION Formulary OTC balsalazide disodium oral capsule 750 mg Formulary BALZIVA ORAL TABLET 0.4-35 MG-MCG Formulary QL (28 EA per 28 days) BAND-AID GAUZE SMALL PAD 2"X2" Formulary OTC BAND-AID SURGIPAD SURGICAL PAD 5"X9" Formulary OTC BANOPHEN ORAL CAPSULE 50 MG Formulary OTC BAQSIMI ONE PACK NASAL POWDER 3 MG/DOSE Formulary QL (2 EA per 30 days) BAQSIMI TWO PACK NASAL POWDER 3 MG/DOSE Formulary QL (2 EA per 30 days) BARACLUDE ORAL SOLUTION 0.05 MG/ML Formulary

14 Drug Name Formulary Status Requirements/Limits BASAGLAR KWIKPEN SUBCUTANEOUS SOLUTION Formulary QL (30 ML per 30 days) PEN-INJECTOR 100 UNIT/ML BAYER BACK & BODY ORAL TABLET 500-32.5 MG Formulary OTC BAYER BREEZE 2 CONTROL LIQUID HIGH IN VITRO Formulary OTC; QL (100 EA per 30 days) HIGH BAYER BREEZE 2 CONTROL LIQUID LOW IN VITRO Formulary OTC; QL (100 EA per 30 days) LOW BAYER BREEZE 2 CONTROL LIQUID NORMAL IN Formulary OTC; QL (100 EA per 30 days) VITRO NORMAL BAYER BREEZE 2 SYSTEM KIT W/DEVICE Formulary OTC; QL (1 EA per 365 days) W/DEVICE BAYER BREEZE 2 TEST DISK IN VITRO Formulary OTC; QL (150 EA per 30 days) BAYER CONTOUR LINK MONITOR KIT W/DEVICE Formulary OTC; QL (1 EA per 365 days) W/DEVICE BAYER CONTOUR MONITOR DEVICE Formulary OTC; QL (1 EA per 365 days) BAYER MICROLET 2 LANCING DEVIC Formulary OTC BAYER MICROLET LANCETS Formulary OTC; QL (150 EA per 30 days) BAYER WOMENS ORAL TABLET 81-777 MG Formulary OTC BAZA CLEANSE & PROTECT EXTERNAL LOTION 2 Formulary OTC % BC FAST PAIN RELIEF ARTHRITIS ORAL PACKET Formulary OTC 742-222-38 MG BC FAST PAIN RELIEF ORAL PACKET 650-195-33.3 Formulary OTC MG b-caro-t oral capsule 15 mg Formulary OTC b-complex high potency oral tablet extended release Formulary OTC BD ALLERGY SYRINGE 28G X 1/2" 1 ML Formulary OTC BD AUTOSHIELD 29G X 5MM , 29G X 8MM Formulary OTC BD AUTOSHIELD DUO 30G X 5 MM Formulary OTC BD BLUNT FILTER NEEDLE 18G X 1-1/2" Formulary OTC BD DISP NEEDLE 22G X 3/4" , 23G X 1-1/4" , 27G X 1- Formulary OTC 1/4" , 30G X 1" BD DISP NEEDLE TW 18G X 1" Formulary OTC BD DISP NEEDLES 16G X 1-1/2" , 19G X 1" , 20G X 1" , Formulary OTC 21G X 1-1/2" , 25G X 7/8" , 27G X 1/2" , 30G X 1/2" BD ECLIPSE NEEDLE 22G X 1-1/2" , 23G X 1" , 25G X Formulary OTC 1-1/2" , 25G X 5/8" BD ECLIPSE SYRINGE 25G X 5/8" 1 ML, 30G X 1/2" 1 Formulary OTC ML BD 23G X 1-1/2" , 26G X 5/8" Formulary OTC BD INSULIN SYR ULTRAFINE II 31G X 5/16" 0.3 ML Formulary OTC 31G X 5/16" 0.3 ML BD INSULIN SYR ULTRAFINE II 31G X 5/16" 0.5 ML Formulary OTC 31G X 5/16" 0.5 ML BD INSULIN SYR ULTRAFINE II 31G X 5/16" 1 ML Formulary OTC 31G X 5/16" 1 ML BD INSULIN SYRINGE 25G X 1" 1 ML 25G X 1" 1 ML Formulary OTC

15 Drug Name Formulary Status Requirements/Limits BD INSULIN SYRINGE 25G X 5/8" 1 ML 25G X 5/8" 1 Formulary OTC ML BD INSULIN SYRINGE 26G X 1/2" 1 ML 26G X 1/2" 1 Formulary OTC ML BD INSULIN SYRINGE 27.5G X 5/8" 2 ML 27.5G X 5/8" Formulary OTC 2 ML BD INSULIN SYRINGE 27G X 1/2" 1 ML 27G X 1/2" 1 Formulary OTC ML BD INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 Formulary OTC ML BD INSULIN SYRINGE HALF-UNIT 31G X 5/16" 0.3 Formulary OTC ML 31G X 5/16" 0.3 ML BD INSULIN SYRINGE MICROFINE 27G X 5/8" 1 ML Formulary OTC 27G X 5/8" 1 ML BD INSULIN SYRINGE MICROFINE 28G X 1/2" 0.5 ML Formulary OTC 28G X 1/2" 0.5 ML BD INSULIN SYRINGE MICROFINE 28G X 1/2" 1 ML Formulary OTC 28G X 1/2" 1 ML BD INSULIN SYRINGE U/F 1/2UNIT 31G X 5/16" 0.3 Formulary OTC ML 31G X 5/16" 0.3 ML BD INSULIN SYRINGE U/F 30G X 1/2" 0.3 ML 30G X Formulary OTC 1/2" 0.3 ML BD INSULIN SYRINGE U/F 30G X 1/2" 0.5 ML 30G X Formulary OTC 1/2" 0.5 ML BD INSULIN SYRINGE U/F 30G X 1/2" 1 ML 30G X Formulary OTC 1/2" 1 ML BD INSULIN SYRINGE U/F 31G X 5/16" 0.3 ML 31G X Formulary OTC 5/16" 0.3 ML BD INSULIN SYRINGE U/F 31G X 5/16" 0.5 ML 31G X Formulary OTC 5/16" 0.5 ML BD INSULIN SYRINGE U/F 31G X 5/16" 1 ML 31G X Formulary OTC 5/16" 1 ML BD INSULIN SYRINGE U-100 1 ML U-100 1 ML Formulary OTC BD INSULIN SYRINGE U-500 31G X 6MM 0.5 ML 31G Formulary X 6MM 0.5 ML BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 0.3 ML Formulary OTC 29G X 1/2" 0.3 ML BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 0.5 ML Formulary OTC 29G X 1/2" 0.5 ML BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 1 ML Formulary OTC 29G X 1/2" 1 ML BD INSULIN SYRINGE ULTRAFINE 30G X 1/2" 0.3 ML Formulary OTC 30G X 1/2" 0.3 ML BD INSULIN SYRINGE ULTRAFINE 30G X 1/2" 0.5 ML Formulary OTC 30G X 1/2" 0.5 ML BD INSULIN SYRINGE ULTRAFINE 31G X 5/16" 0.5 Formulary OTC ML 31G X 5/16" 0.5 ML BD LANCET ULTRAFINE 30G Formulary OTC; QL (150 EA per 30 days) BD LANCET ULTRAFINE 33G Formulary OTC; QL (150 EA per 30 days)

16 Drug Name Formulary Status Requirements/Limits BD LUER-LOK SYRINGE 18G X 1-1/2" 3 ML, 20G X 1" 1 ML, 20G X 1" 10 ML, 20G X 1" 3 ML, 20G X 1" 5 ML, 20G X 1-1/2" 10 ML, 20G X 1-1/2" 3 ML, 20G X 1-1/2" 5 ML, 21G X 1" 10 ML, 21G X 1" 3 ML, 21G X 1" 5 ML, Formulary OTC 21G X 1-1/2" 3 ML, 22G X 1" 10 ML, 22G X 1" 3 ML, 22G X 1" 5 ML, 22G X 1-1/2" 5 ML, 23G X 1-1/2" 3 ML, 23G X 1-1/4" 10 ML, 25G X 1" 3 ML, 25G X 1-1/2" 3 ML, 25G X 5/8" 3 ML, 26G X 5/8" 3 ML BD LUER-LOK SYRINGE 23G X 1" 3 ML Formulary BD PEN NEEDLE ORIGINAL U/F 29G X 12.7MM Formulary OTC BD SAFETYGLIDE INSULIN SYRINGE 29G X 1/2" 0.3 Formulary OTC ML 29G X 1/2" 0.3 ML BD SAFETYGLIDE INSULIN SYRINGE 29G X 1/2" 0.5 Formulary OTC ML 29G X 1/2" 0.5 ML BD SAFETYGLIDE INSULIN SYRINGE 30G X 5/16" 0.5 Formulary OTC ML 30G X 5/16" 0.5 ML BD SAFETYGLIDE INSULIN SYRINGE 31G X 15/64" Formulary 0.3 ML 31G X 15/64" 0.3 ML BD SAFETYGLIDE INSULIN SYRINGE 31G X 5/16" 0.3 Formulary OTC ML 31G X 5/16" 0.3 ML BD SAFETYGLIDE NEEDLE 27G X 5/8" Formulary OTC BD SAFETYGLIDE SHIELDED NEEDLE 22G X 1-1/2" Formulary 10 ML BD SAFETYGLIDE SYRINGE/NEEDLE 27G X 5/8" 1 Formulary OTC ML BD SAFETY-LOK INSULIN SYRINGE 29G X 1/2" 1 ML Formulary OTC 29G X 1/2" 1 ML BD SHARPS COLLECTOR Formulary OTC BD SWAB SINGLE USE REGULAR PAD Formulary OTC BD SWABS SINGLE USE BUTTERFLY PAD Formulary OTC BD SYRINGE 50 ML Formulary OTC BD SYRINGE LUER-LOK 20 ML Formulary OTC BD SYRINGE SLIP TIP 5 ML Formulary OTC BD SYRINGE/NEEDLE SLIP TIP 26G X 5/8" 1 ML Formulary OTC BD TB SYRINGE 21G X 1" 1 ML, 27G X 1/2" 0.5 ML Formulary OTC BD VEO INSULIN SYR U/F 1/2UNIT 31G X 15/64" 0.3 Formulary OTC ML 31G X 15/64" 0.3 ML BD VEO INSULIN SYRINGE U/F 31G X 15/64" 0.3 ML Formulary OTC 31G X 15/64" 0.3 ML BD VEO INSULIN SYRINGE U/F 31G X 15/64" 0.5 ML Formulary OTC 31G X 15/64" 0.5 ML BD VEO INSULIN SYRINGE U/F 31G X 15/64" 1 ML Formulary OTC 31G X 15/64" 1 ML BEBULIN INTRAVENOUS SOLUTION Formulary RECONSTITUTED 200-1200 UNIT bec/zinc oral tablet Formulary OTC bedding spray lice treatment aerosol 0.5 % Formulary OTC bee pollen oral capsule 580 mg Formulary OTC bee pollen oral tablet chewable 500 mg Formulary OTC

17 Drug Name Formulary Status Requirements/Limits BEELITH ORAL TABLET 362-20 MG Formulary OTC BELBUCA BUCCAL FILM 150 MCG, 300 MCG, 450 Formulary PA; QL (68 EA per 34 days) MCG, 600 MCG, 75 MCG, 750 MCG, 900 MCG belladonna alkaloids-opium rectal suppository 16.2-60 mg Formulary belladonna-opium rectal suppository 16.2-30 mg Formulary BENADRYL ALLERGY CHILDRENS ORAL LIQUID Formulary OTC 12.5 MG/5ML BENADRYL ALLERGY CHILDRENS ORAL TABLET Formulary OTC CHEWABLE 12.5 MG BENADRYL ALLERGY CON ULTRATABS ORAL Formulary OTC TABLET 25-10 MG BENADRYL ALLERGY ORAL TABLET 25 MG Formulary OTC BENADRYL ALLERGY ULTRATABS ORAL TABLET Formulary OTC 25 MG BENADRYL ITCH RELIEF EXTERNAL STICK 2-0.1 % Formulary OTC BENADRYL ITCH STOPPING EXTERNAL CREAM 1- Formulary OTC 0.1 % BENADRYL-D ALLERGY/SINUS CHILD ORAL Formulary OTC SOLUTION 12.5-5 MG/5ML benazepril hcl oral tablet 10 mg, 20 mg, 40 mg, 5 mg Formulary benazepril-hydrochlorothiazide oral tablet 10-12.5 mg, 20- Formulary 12.5 mg, 20-25 mg, 5-6.25 mg BENEFIBER FOR CHILDREN ORAL POWDER Formulary OTC BENEFIBER ON THE GO ORAL PACKET Formulary OTC BENEFIBER ORAL POWDER Formulary OTC BENEFIBER PLUS B VITS & FA ORAL TABLET Formulary OTC BENEFIBER PLUS CALCIUM ORAL POWDER Formulary OTC BENEFIBER PLUS CALCIUM ORAL TABLET Formulary OTC CHEWABLE BENEFIBER PLUS HEART HEALTH ORAL POWDER Formulary OTC benfotiamine multi-b oral capsule Formulary OTC benzalkonium chloride external concentrate 50 % Formulary OTC benzalkonium chloride external solution 50 % Formulary BENZEDREX NASAL INHALER Formulary OTC BENZEPRO CREAMY WASH EXTERNAL LIQUID 7 % Formulary BENZEPRO EXTERNAL FOAM 5.3 % Formulary BENZEPRO SHORT CONTACT EXTERNAL FOAM 9.8 Formulary % BENZODENT MOUTH/THROAT CREAM 20 % Formulary OTC benzoin external tincture Formulary benzonatate oral capsule 100 mg, 150 mg, 200 mg Formulary AGE (Min 6 Years) BENZ-O-STHETIC MOUTH/THROAT SWAB 20 % Formulary OTC benzoyl peroxide cleanser external lotion 6 % Formulary benzoyl peroxide external gel 2.5 % Formulary OTC; AGE (Max 18 Years) benzoyl peroxide wash external liquid 10 % Formulary AGE (Max 18 Years) benzoyl peroxide wash external liquid 5 % Formulary OTC; AGE (Max 18 Years)

18 Drug Name Formulary Status Requirements/Limits benzoyl peroxide-erythromycin external gel 5-3 % Formulary benzphetamine hcl oral tablet 50 mg Formulary PA BENZ-PROTECT EXTERNAL SWAB Formulary OTC benztropine mesylate oral tablet 0.5 mg, 1 mg, 2 mg Formulary BERINERT INTRAVENOUS KIT 500 UNIT Formulary PA; QL (8 EA per 30 days) BERRI-FREEZ PAIN RELIEVING EXTERNAL GEL 4.5 Formulary OTC % BERRI-FREEZ PAIN RELIEVING EXTERNAL LIQUID Formulary OTC 10 % BERRI-FREEZ PLUS EXTERNAL GEL 0.2-4-8 % Formulary OTC BETA CARE BETATAR GEL EXTERNAL SHAMPOO Formulary OTC 2.5 % beta carotene provitamin a oral capsule 25000 unit Formulary OTC BETADINE EXTERNAL SOLUTION 10 %, 5 % Formulary OTC BETADINE SURGICAL SCRUB EXTERNAL Formulary OTC SOLUTION 7.5 % BETADINE SWABSTICKS EXTERNAL SWAB 10 % Formulary OTC betaine hcl oral tablet 300 mg Formulary OTC betamethasone dipropionate aug external cream 0.05 % Formulary betamethasone dipropionate aug external gel 0.05 % Formulary betamethasone dipropionate aug external lotion 0.05 % Formulary betamethasone dipropionate aug external ointment 0.05 % Formulary betamethasone dipropionate external cream 0.05 % Formulary betamethasone dipropionate external lotion 0.05 % Formulary betamethasone dipropionate external ointment 0.05 % Formulary betamethasone valerate external cream 0.1 % Formulary betamethasone valerate external lotion 0.1 % Formulary betamethasone valerate external ointment 0.1 % Formulary BETAQUIK ORAL EMULSION Formulary OTC BETASERON SUBCUTANEOUS KIT 0.3 MG Formulary betaxolol hcl ophthalmic solution 0.5 % Formulary betaxolol hcl oral tablet 10 mg, 20 mg Formulary bethanechol chloride oral tablet 10 mg, 25 mg, 5 mg, 50 mg Formulary BETHKIS INHALATION NEBULIZATION SOLUTION QL (280 ML per 28 days); AGE (Min 6 Formulary 300 MG/4ML Years) BEVESPI AEROSPHERE INHALATION AEROSOL 9- Formulary 4.8 MCG/ACT bexarotene oral capsule 75 mg Formulary PA BIATAIN HEEL ADH FOAM DRESSING PAD Formulary OTC 19CMX20CM BIATAIN SACRAL FOAM DRESSING PAD 9"X9" Formulary OTC bicalutamide oral tablet 50 mg Formulary BICARSIM FORTE ORAL TABLET 125 MG Formulary OTC BICARSIM ORAL TABLET 80 MG Formulary OTC BICNU INTRAVENOUS SOLUTION RECONSTITUTED Formulary 100 MG 19 Drug Name Formulary Status Requirements/Limits BIKTARVY ORAL TABLET 50-200-25 MG Formulary QL (30 EA per 30 days) biobron sf oral syrup 10-15-350 mg/5ml Formulary OTC biocotron oral liquid 10-100 mg/5ml Formulary OTC biodesp dm oral syrup 5-15-100 mg/5ml Formulary OTC bioflavonoid-1000 oral tablet 1000 mg Formulary OTC BIO-FLAX ORAL CAPSULE 1000 MG Formulary OTC BIOFLONEX ORAL TABLET 250-650 MG Formulary OTC BIOFREEZE EXTERNAL AEROSOL 10.5 % Formulary OTC BIOFREEZE ROLL-ON COLORLESS EXTERNAL GEL Formulary OTC 4 % BIOGAIA GASTRUS ORAL TABLET CHEWABLE Formulary OTC biogtuss oral liquid 10-28-388 mg/5ml Formulary OTC BIOGUARD NON-ADHERENT DRESSING PAD 3"X8" Formulary BIOLLE GEL TEARS OPHTHALMIC GEL 1 % Formulary OTC bionatuss dxp oral liquid 10-2-20 mg/5ml Formulary OTC BIOPATCH PROTECTIVE DISK/CHG EXTERNAL Formulary OTC (DRESSING) biopetit oral elixir Formulary OTC BIORX SPONIX ANTI-FUNGAL EXTERNAL Formulary OTC SOLUTION 22 % BIORX SPONIX ARTHR & MUSC EXTERNAL Formulary OTC SOLUTION 4-10-0.035 % biospec dmx oral liquid 15-25 mg/5ml Formulary OTC biotalan clear oral liquid Formulary OTC BIO-THERM PAIN RELIEVING EXTERNAL LOTION Formulary OTC 0.002-10-20 % biotin forte oral tablet 3 mg Formulary OTC biotin oral capsule 10 mg, 2500 mcg Formulary OTC biotin oral tablet 1000 mcg, 10000 mcg, 300 mcg, 800 mcg Formulary OTC biotin plus keratin oral tablet 10000-100 mcg-mg Formulary OTC biotuss oral liquid 10-15-300 mg/5ml Formulary biovol oral syrup Formulary OTC bisacodyl ec oral tablet delayed release 5 mg Formulary OTC bismatrol maximum strength oral suspension 525 mg/15ml Formulary OTC bismatrol oral tablet chewable 262 mg Formulary OTC bisoprolol fumarate oral tablet 10 mg, 5 mg Formulary bisoprolol-hydrochlorothiazide oral tablet 10-6.25 mg, 2.5- Formulary 6.25 mg, 5-6.25 mg bite/itch external lotion 1-2 % Formulary OTC BI-ZETS/BENZOTROCHES MOUTH/THROAT Formulary OTC LOZENGE 15 MG bleomycin sulfate injection solution reconstituted 15 unit, Formulary 30 unit BLINK TEARS OPHTHALMIC GEL 0.25 % Formulary OTC BLINK TEARS OPHTHALMIC SOLUTION 0.25 % Formulary OTC BLISOVI 24 FE ORAL TABLET 1-20 MG-MCG(24) Formulary 20 Drug Name Formulary Status Requirements/Limits BLISOVI FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG Formulary BLISOVI FE 1/20 ORAL TABLET 1-20 MG-MCG Formulary BLISTEX MEDICATED EXTERNAL OINTMENT Formulary OTC blood pressure monitor/wrist kit Formulary OTC BOIL EASE MAXIMUM STRENGTH EXTERNAL Formulary OTC OINTMENT 20 % BONE DENSITY ORAL TABLET 300-200 MG-UNIT Formulary OTC BOOSTRIX INTRAMUSCULAR SUSPENSION 5-2.5- Formulary 18.5 borage oral capsule 1000-240-378 mg Formulary OTC boric acid external granules Formulary boron oral capsule 3 mg Formulary OTC boron oral tablet 6 mg Formulary OTC BOTOX INJECTION SOLUTION RECONSTITUTED Formulary PA 100 UNIT, 200 UNIT BOUDREAUXS BABY KISSES EXTERNAL Formulary OTC OINTMENT BOUDREAUXS BUTT EXTERNAL OINTMENT Formulary OTC 16 %, 40 % BOUDREAUXS RASH PREVENTOR EXTERNAL Formulary OTC LIQUID 10 % bp 10-1 external emulsion 10-1 % Formulary QL (170.1 GM per 30 days) bp cleansing wash external emulsion 10-4 % Formulary bp wash external liquid 2.5 % Formulary BPROTECTED MULTI-VITE ORAL LIQUID Formulary OTC BPROTECTED PEDIA IRON ORAL SOLUTION 75 (15 Formulary OTC FE) MG/ML BPROTECTED PEDIA POLY-VITE ORAL SOLUTION , Formulary OTC 35 MG/ML BRAINSTRONG PRENATAL ORAL 33-0.8 & 350 MG Formulary OTC BRASIVOL EXTERNAL PASTE Formulary OTC BRAUN NO TOUCH + FOREHEAD Formulary OTC BREEZE 2 TEST DISK IN VITRO Formulary OTC; QL (150 EA per 30 days) BREVIBLOC IN NACL INTRAVENOUS SOLUTION Formulary 2000 MG/100ML, 2500 MG/250ML brewers yeast oral tablet Formulary OTC BRILINTA ORAL TABLET 60 MG, 90 MG Formulary brimonidine tartrate ophthalmic solution 0.15 %, 0.2 % Formulary brinzolamide ophthalmic suspension 1 % Formulary BRIVIACT INTRAVENOUS SOLUTION 50 MG/5ML Formulary brohist d oral tablet 4-10 mg Formulary OTC bromi-lotion external lotion Formulary OTC bromocriptine mesylate oral capsule 5 mg Formulary bromocriptine mesylate oral tablet 2.5 mg Formulary bronchial asthma relief oral tablet 12.5-200 mg Formulary OTC BRONKAID ORAL TABLET 25-400 MG Formulary OTC

21 Drug Name Formulary Status Requirements/Limits bronkids oral liquid 1.5-0.6-2.75 mg/ml, 10-4-10 mg/5ml Formulary OTC brontuss dx oral liquid 10-20-200 mg/5ml Formulary OTC brotapp dm oral liquid 15-1-5 mg/5ml Formulary OTC btrex oral tablet extended release 8-200-4-100-600 mg Formulary OTC BUCKLEYS CHEST CONGESTION ORAL LIQUID 100 Formulary OTC MG/5ML BUCKLEYS COUGH ORAL LIQUID 12.5 MG/5ML Formulary OTC budesonide inhalation suspension 0.25 mg/2ml, 0.5 mg/2ml, Formulary 1 mg/2ml budesonide oral capsule delayed release particles 3 mg Formulary budesonide suspension 32 mcg/act nasal (otc) 32 mcg/act Formulary budesonide-formoterol fumarate inhalation aerosol 160-4.5 Formulary mcg/act, 80-4.5 mcg/act BUFFERIN EXTRA STRENGTH ORAL TABLET 500 Formulary OTC MG BUFFERIN LOW DOSE ORAL TABLET 81 MG Formulary OTC BUFFERIN ORAL TABLET 325 MG Formulary OTC BULL FROG WATER ARMOR SPORT EXTERNAL Formulary OTC GEL bumetanide oral tablet 0.5 mg, 1 mg, 2 mg Formulary buprenorphine hcl injection solution 0.3 mg/ml Formulary PA PA; QL (360 EA per 30 days); AGE (Min buprenorphine hcl sublingual tablet sublingual 2 mg Formulary 16 Years) PA; QL (90 EA per 30 days); AGE (Min buprenorphine hcl sublingual tablet sublingual 8 mg Formulary 16 Years) buprenorphine hcl-naloxone hcl sublingual tablet QL (360 EA per 30 days); AGE (Min 16 Formulary sublingual 2-0.5 mg Years) buprenorphine hcl-naloxone hcl sublingual tablet QL (90 EA per 30 days); AGE (Min 16 Formulary sublingual 8-2 mg Years) buprenorphine patch weekly 10 mcg/hr, 5 Formulary PA; QL (8 EA per 28 days) mcg/hr, 7.5 mcg/hr buprenorphine weekly 15 mcg/hr, 20 Formulary PA; QL (4 EA per 28 days) mcg/hr hcl er ( det) oral tablet extended release Formulary 12 hour 150 mg bupropion hcl er (sr) oral tablet extended release 12 hour Formulary 100 mg, 150 mg, 200 mg bupropion hcl er (xl) oral tablet extended release 24 hour Formulary 150 mg, 300 mg bupropion hcl oral tablet 100 mg, 75 mg Formulary burn relief external aerosol 0.5 % Formulary OTC burn relief/lidocaine/aloe external gel 0.5 % Formulary OTC buspirone hcl oral tablet 10 mg, 15 mg, 30 mg, 5 mg, 7.5 Formulary mg busulfan intravenous solution 6 mg/ml Formulary butalbital-acetaminophen oral tablet 50-325 mg Formulary butalbital-apap-caff-cod oral capsule 50-300-40-30 mg, 50- Formulary PA; QL (140 EA per 7 days) 325-40-30 mg

22 Drug Name Formulary Status Requirements/Limits butalbital-apap-caffeine oral tablet 50-325-40 mg Formulary butalbital-aspirin-caffeine oral capsule 50-325-40 mg Formulary butorphanol tartrate injection solution 1 mg/ml, 2 mg/ml Formulary butorphanol tartrate nasal solution 10 mg/ml Formulary PA; QL (5 ML per 34 days) BYDUREON SUBCUTANEOUS PEN-INJECTOR 2 MG Formulary BYDUREON SUBCUTANEOUS SUSPENSION Formulary RECONSTITUTED ER 2 MG BYETTA 10 MCG PEN SUBCUTANEOUS SOLUTION Formulary PEN-INJECTOR 10 MCG/0.04ML BYETTA 5 MCG PEN SUBCUTANEOUS SOLUTION Formulary PEN-INJECTOR 5 MCG/0.02ML c & e oral capsule Formulary OTC c-1500/rose hips sr oral tablet extended release 1500 mg Formulary OTC c1500/rose hips/bioflavonoid oral tablet extended release Formulary OTC cabenuva intramuscular suspension extended release 400 & Formulary PA 600 mg/2ml, 600 & 900 mg/3ml cabergoline oral tablet 0.5 mg Formulary QL (10 EA per 34 days) cadeau dha oral capsule 29-0.4-0.8-375 mg Formulary OTC caffeine citrate oral solution 20 mg/ml Formulary cal/mag oral tablet 200-100 mg Formulary OTC CALADRYL CLEAR EXTERNAL LOTION 1-0.1 % Formulary OTC CALADRYL EXTERNAL LOTION 1-8 % Formulary OTC CALAGEL MAXIMUM STRENGTH EXTERNAL GEL Formulary OTC CALAGESIC EXTERNAL LOTION 1-8 % Formulary OTC calahist clear external lotion 1-0.1 % Formulary OTC calamine external lotion , 8-8 % Formulary OTC calamine phenolated external lotion Formulary OTC calamine-zinc oxide external lotion Formulary OTC calamine-zinc oxide external suspension 8-8 % Formulary OTC CALAZIME SKIN PROTECTANT EXTERNAL PASTE Formulary OTC CAL-CARB FORTE ORAL TABLET 1250 (500 CA) MG Formulary OTC CALCET PETITES ORAL TABLET 200-250 MG-UNIT Formulary OTC CALCI-CHEW ORAL TABLET CHEWABLE 1250 (500 Formulary OTC CA) MG calci-max oral capsule Formulary OTC calcipotriene external cream 0.005 % Formulary calcipotriene external ointment 0.005 % Formulary calcipotriene external solution 0.005 % Formulary calcitonin (salmon) nasal solution 200 unit/act Formulary cal-citrate oral capsule 150 mg Formulary OTC CALCITRATE ORAL TABLET 950 MG Formulary OTC calcitriol oral capsule 0.25 mcg, 0.5 mcg Formulary calcitriol oral solution 1 mcg/ml Formulary calcium + d3 oral tablet 600-800 mg-unit Formulary OTC calcium 1200 oral tablet chewable 1200-1000 mg-unit Formulary OTC

23 Drug Name Formulary Status Requirements/Limits calcium 500 + d3 oral tablet 500-600 mg-unit Formulary OTC calcium 600 + d oral tablet 600-200 mg-unit Formulary OTC calcium 600 oral tablet 1500 (600 ca) mg Formulary OTC calcium 600+d3 oral tablet 600-400 mg-unit Formulary OTC calcium 600+d3 plus minerals oral tablet 600-800 mg-unit Formulary OTC calcium acetate (phos binder) oral capsule 667 mg Formulary calcium acetate (phos binder) oral tablet 667 mg Formulary calcium acetate oral tablet 668 (169 ca) mg Formulary OTC calcium ascorbate oral tablet 500 mg Formulary OTC calcium aspartate oral tablet 75 mg Formulary OTC calcium carbonate antacid oral tablet 648 mg Formulary OTC calcium carbonate oral powder 800 mg/2gm Formulary OTC calcium carbonate oral tablet 1500 (600 ca) mg, 600 mg Formulary OTC calcium carbonate-vitamin d oral capsule 600-200 mg-unit Formulary OTC calcium carbonate-vitamin d oral tablet 600-400 mg-unit Formulary OTC calcium citrate + d3 oral tablet 250-200 mg-unit Formulary OTC calcium citrate + oral tablet 315-200 mg-unit Formulary OTC calcium citrate malate-vit d oral tablet 250-100 mg-unit Formulary OTC calcium citrate oral tablet 1040 mg, 200 mg, 250 mg Formulary OTC calcium citrate plus oral tablet Formulary OTC calcium citrate-vitamin d oral tablet 200-125 mg-unit Formulary OTC calcium citrate-vitamin d3 oral liquid 1000-400 Formulary OTC calcium citrate-vitamin d3 oral tablet 315-250 mg-unit Formulary OTC calcium gluconate oral tablet 500 mg Formulary OTC calcium gummies oral tablet chewable 250-100-500 mg- Formulary OTC unit calcium high potency/vitamin d oral tablet 600-200 mg-unit Formulary OTC calcium lactate oral tablet 100 mg, 648 mg Formulary OTC calcium oral tablet 500 mg, 500-125 mg-unit Formulary OTC calcium oral tablet chewable 500-100 mg-unit, 600-400 Formulary OTC mg-unit calcium oyster shell oral tablet 500 mg Formulary OTC calcium pantothenate oral tablet 100 mg, 200 mg, 500 mg Formulary OTC calcium plus vitamin d3 oral capsule 600-500 mg-unit Formulary OTC calcium soft chews oral tablet chewable 500-1000-40 mg- Formulary OTC unt-mcg, 500-500-40 mg-unt-mcg calcium-magnesium-zinc oral tablet 333-133-5 mg, 334- Formulary OTC 134-5 mg calcium-vitamin d oral tablet 600-200 mg-unit Formulary OTC calcium-vitamin d3 oral tablet 600-125 mg-unit Formulary OTC calcium-vitamin d-minerals oral tablet chewable 600-400 Formulary OTC mg-unit, 600-800 mg-unit calendula external lotion Formulary OTC calendula external ointment Formulary OTC cal-glu oral capsule 500 mg Formulary OTC

24 Drug Name Formulary Status Requirements/Limits cal-lac oral capsule 500 mg Formulary OTC calmag thins oral tablet 200-50 mg Formulary OTC cal-mint oral tablet chewable 260 mg Formulary OTC CALMOL-4 RECTAL SUPPOSITORY 76-10 % Formulary OTC calna oral tablet Formulary OTC CALTRATE 600+D ORAL TABLET 600-800 MG-UNIT Formulary OTC CALTRATE 600+D PLUS MINERALS ORAL TABLET Formulary OTC 600-800 MG-UNIT CALTRATE 600+D PLUS MINERALS ORAL TABLET Formulary OTC CHEWABLE 600-800 MG-UNIT CALTRATE 600+D3 SOFT ORAL TABLET Formulary OTC CHEWABLE 600-800 MG-UNIT CALTRATE GUMMY BITES ORAL TABLET Formulary OTC CHEWABLE 250-400 MG-UNIT CALTRATE MINIS PLUS MINERALS ORAL TABLET Formulary OTC 300-800 MG-UNIT CAMILA ORAL TABLET 0.35 MG Formulary QL (28 EA per 28 days) CAMPHO-PHENIQUE EXTERNAL GEL 10.8-4.7 % Formulary OTC CAMPHO-PHENIQUE EXTERNAL LIQUID 10.8-4.7 % Formulary OTC CAMPHOTREX EXTERNAL GEL 10-4 % Formulary OTC candesartan cilexetil oral tablet 16 mg, 32 mg, 4 mg, 8 mg Formulary candesartan cilexetil-hctz oral tablet 16-12.5 mg, 32-12.5 Formulary mg CANKAID MOUTH/THROAT SOLUTION 10 % Formulary OTC capcof oral syrup 5-2-10 mg/5ml Formulary OTC capecitabine oral tablet 150 mg, 500 mg Formulary PA capmist dm oral tablet 60-15-400 mg Formulary OTC capron dm oral liquid 7.5-7.5 mg/5ml Formulary OTC capron dmt oral tablet 30-30 mg Formulary OTC external cream 0.025 %, 0.1 % Formulary OTC capsaicin hot patch external pad 0.025 % Formulary OTC CAPSIDERM EXTERNAL PATCH 0.0375-5 % Formulary OTC capsule 1 clear veggie capsule Formulary OTC captopril oral tablet 100 mg, 12.5 mg, 25 mg, 50 mg Formulary CAPZASIN-HP EXTERNAL CREAM 0.1 % Formulary OTC CARBAGLU ORAL TABLET 200 MG Formulary carbamazepine er oral capsule extended release 12 hour Formulary 100 mg, 200 mg, 300 mg carbamazepine er oral tablet extended release 12 hour 100 Formulary mg, 200 mg, 400 mg carbamazepine oral suspension 100 mg/5ml Formulary carbamazepine oral tablet 200 mg Formulary carbamazepine oral tablet chewable 100 mg Formulary CARBAPHEN CH ORAL SUSPENSION 10-4-24 Formulary OTC MG/5ML

25 Drug Name Formulary Status Requirements/Limits CARBAPHEN PED CH ORAL SUSPENSION 2.5-1.25-8 Formulary OTC MG/ML carbidopa-levodopa er oral tablet extended release 25-100 Formulary mg, 50-200 mg carbidopa-levodopa oral tablet 10-100 mg, 25-100 mg, 25- Formulary 250 mg carbidopa-levodopa oral tablet dispersible 10-100 mg, 25- Formulary 100 mg, 25-250 mg carbidopa-levodopa-entacapone oral tablet 12.5-50-200 mg Formulary carbinoxamine maleate oral solution 4 mg/5ml Formulary carbinoxamine maleate oral tablet 4 mg Formulary CARBOHOL 940 GEL Formulary CARBZERO ORAL EMULSION Formulary OTC CARDENZ ORAL TABLET Formulary OTC CAREFINE PEN NEEDLES 32G X 5 MM , 32G X 6 MM Formulary OTC careone insulin syringe 30g x 1/2" 0.3 ml 30g x 1/2" 0.3 ml Formulary OTC careone insulin syringe 30g x 1/2" 0.5 ml 30g x 1/2" 0.5 ml Formulary OTC careone insulin syringe 30g x 1/2" 1 ml 30g x 1/2" 1 ml Formulary OTC careone insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 Formulary OTC ml careone insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 Formulary OTC ml careone insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC CAREONE LANCET SUPER THIN 30G Formulary OTC; QL (150 EA per 30 days) careone lancet thin 23g Formulary OTC; QL (150 EA per 30 days) CA-REZZ EXTERNAL LIQUID 0.25 % Formulary OTC ca-rezz gentle external liquid 0.2 % Formulary OTC ca-rezz norisc external cream 0.2 % Formulary OTC CARRACOLLOID 4"X4" EXTERNAL PAD Formulary OTC CARRASMART EXTERNAL GEL Formulary OTC CARRASORB H EXTERNAL Formulary OTC CARRASYN V WOUND DRESSING EXTERNAL GEL Formulary OTC CARRINGTON DERMAL WOUND EXTERNAL GEL Formulary OTC carteolol hcl ophthalmic solution 1 % Formulary CARTIA XT ORAL CAPSULE EXTENDED RELEASE Formulary 24 HOUR 120 MG, 180 MG, 240 MG, 300 MG oral tablet 12.5 mg, 25 mg, 3.125 mg, 6.25 mg Formulary cascara sagrada oral capsule 450 mg Formulary OTC castellani paint modified external liquid 1.5 % Formulary OTC CASTIVA COOLING EXTERNAL LOTION 5-14 % Formulary OTC CASTIVA WARMING EXTERNAL LOTION 0.035 % Formulary OTC castor oil stimulant laxative oral oil 100 % Formulary OTC CAVAREST DENTAL GEL 1.1 % Formulary CAVILON EMOLLIENT EXTERNAL CREAM Formulary OTC CAVILON FOOT & DRY SKIN EXTERNAL CREAM Formulary OTC

26 Drug Name Formulary Status Requirements/Limits CAVILON NO STING BARRIER FILM EXTERNAL Formulary OTC LIQUID CAVILON ONE-STEP SKIN CARE EXTERNAL Formulary OTC LOTION CAVILON SKIN CLEANSER EXTERNAL LIQUID Formulary OTC CAYA VAGINAL DIAPHRAGM Formulary CAZIANT ORAL TABLET 0.1/0.125/0.15 -0.025 MG Formulary QL (28 EA per 28 days) cefaclor oral capsule 250 mg, 500 mg Formulary cefaclor oral suspension reconstituted 125 mg/5ml Formulary cefadroxil oral capsule 500 mg Formulary cefadroxil oral suspension reconstituted 250 mg/5ml, 500 Formulary mg/5ml cefadroxil oral tablet 1 gm Formulary cefdinir oral capsule 300 mg Formulary cefdinir oral suspension reconstituted 125 mg/5ml, 250 Formulary mg/5ml cefpodoxime proxetil oral suspension reconstituted 100 Formulary QL (200 ML per 34 days) mg/5ml, 50 mg/5ml cefpodoxime proxetil oral tablet 100 mg, 200 mg Formulary QL (28 EA per 34 days) cefprozil oral suspension reconstituted 125 mg/5ml, 250 Formulary mg/5ml cefprozil oral tablet 250 mg, 500 mg Formulary ceftriaxone sodium in dextrose intravenous solution 20 Formulary mg/ml, 40 mg/ml ceftriaxone sodium injection solution reconstituted 1 gm, 2 Formulary gm, 250 mg, 500 mg ceftriaxone sodium intravenous solution reconstituted 10 Formulary gm, 2 gm ceftriaxone sodium-dextrose intravenous solution Formulary reconstituted 1-3.74 gm-%, 2-2.22 gm-% axetil oral tablet 250 mg, 500 mg Formulary CELACYN EXTERNAL GEL Formulary celecoxib oral capsule 100 mg, 200 mg, 400 mg, 50 mg Formulary ST celery seed oil Formulary OTC CELONTIN ORAL CAPSULE 300 MG Formulary CENTRATEX ORAL CAPSULE 106-1 MG Formulary centravites adults oral tablet Formulary OTC CENTRUM FLAVOR BURST DRINK ORAL PACKET Formulary OTC CENTRUM ORAL LIQUID Formulary OTC CENTRUM SPECIALIST PRENATAL ORAL 27-0.8 & Formulary OTC 200 MG CEO-TWO RECTAL SUPPOSITORY Formulary OTC CEPACOL ANTIBACTERIAL MOUTH/THROAT Formulary OTC LIQUID 0.05 % CEPACOL EXTRA STRENGTH MOUTH/THROAT Formulary OTC LOZENGE 15-2.6 MG CEPACOL SORE THROAT & COUGH Formulary OTC MOUTH/ 5-7.5 MG 27 Drug Name Formulary Status Requirements/Limits CEPACOL SORE THROAT EX ST MOUTH/THROAT Formulary OTC LOZENGE 15-3.6 MG CEPACOL SORE THROAT MOUTH/THROAT Formulary OTC LOZENGE 15-2.6 MG CEPASTAT MOUTH/THROAT LOZENGE 5-6-10 MG Formulary OTC cephalexin oral capsule 250 mg, 500 mg Formulary cephalexin oral suspension reconstituted 125 mg/5ml, 250 Formulary mg/5ml CERACADE EMULSION EXTERNAL Formulary CERALYTE 70 ORAL PACKET Formulary OTC CERAVE BABY EXTERNAL LOTION 1 % Formulary OTC CERAVE ITCH RELIEF EXTERNAL CREAM 1 % Formulary OTC CERAVE SUNSCREEN SPF50 EXTERNAL LOTION Formulary OTC CEROVEL EXTERNAL LOTION 40 % Formulary CESIUM 1000 ORAL CAPSULE 1000 MG Formulary OTC cesium 500 oral capsule 500 mg Formulary OTC cesium oral tablet 100 mg Formulary OTC CETACAINE EXTERNAL LIQUID 2-2-14 % Formulary CETAPHIL GENTLE CLEANSING EXTERNAL BAR Formulary OTC cetirizine hcl oral tablet 5 mg Formulary OTC CETRAXAL OTIC SOLUTION 0.2 % Formulary CHANTIX CONTINUING MONTH PAK ORAL Formulary TABLET 1 MG CHANTIX ORAL TABLET 0.5 MG Formulary CHANTIX STARTING MONTH PAK ORAL TABLET Formulary 0.5 MG X 11 & 1 MG X 42 CHAP-EX TROPICALS EXTERNAL STICK Formulary OTC CHAPSTICK MOISTURIZER EXTERNAL OINTMENT Formulary OTC CHAPSTICK ULTRA RENEWAL EXTERNAL CREAM Formulary OTC 2 % CHAR-FLO WITH SORBITOL ORAL SUSPENSION 25- Formulary OTC 48 GM/120ML chelated calcium oral tablet 200 mg Formulary OTC chelated magnesium oral tablet 100 mg Formulary OTC chelated zinc oral tablet 50 mg Formulary OTC CHEMSTRIP 10 MD IN VITRO STRIP Formulary OTC CHEMSTRIP 10/SG IN VITRO STRIP Formulary OTC CHEMSTRIP 2 GP IN VITRO STRIP Formulary OTC CHEMSTRIP 5 OB IN VITRO STRIP Formulary OTC CHEMSTRIP 7 IN VITRO STRIP Formulary OTC CHEMSTRIP 9 IN VITRO STRIP Formulary OTC CHEMSTRIP CALIBRATION IN VITRO STRIP Formulary OTC CHEMSTRIP MICRAL IN VITRO STRIP Formulary OTC CHEMSTRIP UGK IN VITRO STRIP Formulary OTC CHENODAL ORAL TABLET 250 MG Formulary PA CHERACOL-D COUGH ORAL LIQUID 10-100 MG/5ML Formulary OTC 28 Drug Name Formulary Status Requirements/Limits cherry concentrate oral concentrate Formulary OTC cherry oral syrup Formulary chest rub external ointment 4.8-1.2-2.6 % Formulary OTC CHEW Q ORAL TABLET CHEWABLE 100 MG, 30 MG, Formulary OTC 600 MG chewable iron oral tablet chewable 30-10-25 mg Formulary OTC CHIGG AWAY EXTERNAL LOTION 5-10 % Formulary OTC childrens aspirin free oral elixir 80 mg/2.5ml Formulary OTC CHILDRENS MOTRIN ORAL SUSPENSION 100 Formulary OTC MG/5ML childrens pain reliever oral tablet chewable 80 mg Formulary OTC childrens plus multi-sympt cld oral suspension 2.5-1-5-160 Formulary OTC mg/5ml childrens silfedrine oral liquid 15 mg/5ml Formulary OTC CHILDRENS SOOTHE ORAL TABLET CHEWABLE Formulary OTC 400 MG chlo hist oral solution 12.5-1 mg/5ml Formulary OTC CHLO TUSS ORAL LIQUID 30-1-12.5 MG/5ML Formulary OTC chlophed oral liquid 5-12.5-100 mg/5ml Formulary OTC CHLORASEPTIC MOUTH/THROAT LOZENGE 6-10 Formulary OTC MG chlordiazepoxide hcl oral capsule 10 mg, 5 mg Formulary QL (170 EA per 34 days) chlordiazepoxide hcl oral capsule 25 mg Formulary QL (170 EA per 30 days) chlorella oral capsule Formulary OTC chlorhexidine gluconate cloth external pad 2 % Formulary OTC chlorhexidine gluconate external liquid 2 %, 4 % Formulary OTC chlorhexidine gluconate mouth/throat solution 0.12 % Formulary chlorophyll oral tablet 3-0.6 mg Formulary OTC chloroquine phosphate oral tablet 250 mg, 500 mg Formulary chlorothiazide oral tablet 250 mg, 500 mg Formulary CHLORPHEN SR ORAL TABLET EXTENDED Formulary OTC RELEASE 12 MG chlorpromazine hcl injection solution 25 mg/ml, 50 mg/2ml Formulary AGE (Min 18 Years) chlorpromazine hcl oral tablet 10 mg, 100 mg, 200 mg, 25 Formulary AGE (Min 18 Years) mg, 50 mg chlorthalidone oral tablet 25 mg, 50 mg Formulary CHLOR-TRIMETON ALLERGY ORAL TABLET Formulary OTC EXTENDED RELEASE 12 MG CHLOR-TRIMETON ORAL SYRUP 2 MG/5ML Formulary OTC CHLOR-TRIMETON ORAL TABLET 4 MG Formulary OTC chlorzoxazone oral tablet 250 mg, 375 mg, 500 mg, 750 mg Formulary chocolated laxative oral tablet chewable 15 mg Formulary OTC cholesterol acetate powder Formulary OTC cholestyramine light oral packet 4 gm Formulary cholestyramine light oral powder 4 gm/dose Formulary cholestyramine oral packet 4 gm Formulary 29 Drug Name Formulary Status Requirements/Limits cholestyramine oral powder 4 gm/dose Formulary choline citrate oral tablet 650 mg Formulary OTC choline oral capsule 648 mg Formulary OTC choline sr oral tablet extended release 300 mg Formulary OTC choline-mag trisalicylate oral liquid 500 mg/5ml Formulary CHONDROITIN SULFATE COMPLEX ORAL Formulary OTC CAPSULE 400-60-2.5 MG CHROMACAPS ORAL CAPSULE 1 MG Formulary OTC chromium aspartate oral tablet 1000 mcg Formulary OTC chromium gtf oral tablet 200 mcg Formulary OTC chromium oral tablet 1000 mcg, 400 mcg Formulary OTC chromium picolinate oral capsule 200 mcg Formulary OTC chromium picolinate oral tablet 1000 mcg, 200 mcg, 400 Formulary OTC mcg CICLODAN EXTERNAL CREAM 0.77 % Formulary CICLODAN EXTERNAL SOLUTION 8 % Formulary PA ciclopirox external gel 0.77 % Formulary PA ciclopirox external shampoo 1 % Formulary ciclopirox external solution 8 % Formulary PA ciclopirox olamine external suspension 0.77 % Formulary ciclopirox treatment external kit 8 % Formulary cilostazol oral tablet 100 mg, 50 mg Formulary oral tablet 200 mg, 300 mg, 400 mg, 800 mg Formulary cinnamon oral capsule 500 mg Formulary OTC CINRYZE INTRAVENOUS SOLUTION Formulary PA; QL (20 EA per 34 days) RECONSTITUTED 500 UNIT CIPRO ORAL SUSPENSION RECONSTITUTED 500 Formulary MG/5ML (10%) CIPRODEX OTIC SUSPENSION 0.3-0.1 % Formulary ciprofloxacin hcl ophthalmic solution 0.3 % Formulary ciprofloxacin hcl oral tablet 100 mg, 250 mg, 500 mg, 750 Formulary mg ciprofloxacin hcl otic solution 0.2 % Formulary ciprofloxacin oral suspension reconstituted 250 mg/5ml Formulary (5%), 500 mg/5ml (10%) ciprofloxacin-dexamethasone otic suspension 0.3-0.1 % Formulary cisplatin intravenous solution 50 mg/50ml Formulary citalopram hydrobromide oral solution 10 mg/5ml Formulary citalopram hydrobromide oral tablet 10 mg, 20 mg, 40 mg Formulary CITRA PH ORAL SOLUTION 2.7 GM/30ML Formulary OTC CITRANATAL 90 DHA ORAL 90-1 & 300 MG Formulary CITRANATAL ASSURE ORAL 35-1 & 300 MG Formulary CITRANATAL B-CALM ORAL 20-1 MG & 2 X 25 MG Formulary CITRANATAL DHA ORAL 27-1 & 250 MG Formulary CITRANATAL HARMONY ORAL CAPSULE 27-1-260 Formulary MG 30 Drug Name Formulary Status Requirements/Limits CITRANATAL RX ORAL TABLET 27-1 MG Formulary CITRUCEL ORAL POWDER Formulary OTC CITRUCEL ORAL TABLET 500 MG Formulary OTC CITRULLINE 1000 ORAL PACKET 1 GM Formulary OTC CITRULLINE200 ORAL PACKET 200 MG Formulary OTC cladribine intravenous solution 10 mg/10ml Formulary CLARAVIS ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 Formulary MG clarithromycin er oral tablet extended release 24 hour 500 Formulary mg clarithromycin oral suspension reconstituted 125 mg/5ml, Formulary 250 mg/5ml clarithromycin oral tablet 250 mg, 500 mg Formulary CLARITIN CHILDRENS ORAL TABLET CHEWABLE 5 Formulary OTC MG CLARITIN ORAL CAPSULE 10 MG Formulary OTC CLARITIN ORAL SYRUP 5 MG/5ML Formulary OTC CLARITIN ORAL TABLET 10 MG Formulary OTC CLARITIN REDITABS ORAL TABLET DISPERSIBLE Formulary OTC 10 MG, 5 MG CLARITIN-D 12 HOUR ORAL TABLET EXTENDED Formulary OTC RELEASE 12 HOUR 5-120 MG CLARITIN-D 24 HOUR ORAL TABLET EXTENDED Formulary OTC RELEASE 24 HOUR 10-240 MG classic prenatal oral tablet 28-0.8 mg Formulary OTC CLEAN & CLEAR ACNE CLEANSER EXTERNAL Formulary OTC FOAM 2 % CLEAN & CLEAR ACNE CLEANSER EXTERNAL Formulary OTC LIQUID 2 % CLEAN & CLEAR ADVANTAGE MARK EXTERNAL Formulary OTC GEL 2 % CLEAN ZING MOUTH/THROAT LIQUID 0.06 % Formulary OTC CLEANLET LANCETS 28G Formulary OTC; QL (150 EA per 30 days) cleansing external cream Formulary OTC CLEAR EYES REDNESS RELIEF OPHTHALMIC Formulary OTC SOLUTION 0.012-0.2 % clear zinc spf 50 external lotion Formulary OTC CLEARASIL DAILY CLEAN EXTERNAL LIQUID 1 % Formulary OTC CLEARASIL DAILY CLEAR ACNE EXTERNAL Formulary OTC CREAM 10 % CLEARASIL DAILY CLEAR EXTERNAL CREAM 2-8 Formulary OTC % CLEARCANAL EAR WAX REMOVAL OTIC KIT 6.5 % Formulary OTC CLEARLAX ORAL POWDER 17 GM/SCOOP Formulary OTC CLEARLIFE ALLERGY RELIEF NASAL LIQUID Formulary OTC clemastine fumarate oral tablet 2.68 mg Formulary CLEOCIN VAGINAL SUPPOSITORY 100 MG Formulary

31 Drug Name Formulary Status Requirements/Limits CLERZ PLUS SOLUTION Formulary OTC CLEVER CHOICE BP MONITOR/WRIST DEVICE Formulary OTC clindamycin hcl oral capsule 150 mg, 300 mg, 75 mg Formulary clindamycin palmitate hcl oral solution reconstituted 75 Formulary mg/5ml clindamycin phos-benzoyl perox external gel 1.2-5 % Formulary clindamycin phos-benzoyl perox external gel 1-5 % Formulary AGE (Max 18 Years) clindamycin phosphate external foam 1 % Formulary AGE (Max 18 Years) clindamycin phosphate external gel 1 % Formulary clindamycin phosphate external lotion 1 % Formulary AGE (Max 18 Years) clindamycin phosphate external solution 1 % Formulary AGE (Max 18 Years) clindamycin phosphate swab 1 % external 1 % Formulary AGE (Max 18 Years) clindamycin phosphate vaginal cream 2 % Formulary CLINDESSE VAGINAL CREAM 2 % Formulary clobazam oral suspension 2.5 mg/ml Formulary PA clobazam oral tablet 10 mg, 20 mg Formulary PA; AGE (Min 2 Years) clobetasol propionate e external cream 0.05 % Formulary clobetasol propionate emulsion external foam 0.05 % Formulary clobetasol propionate external cream 0.05 % Formulary clobetasol propionate external foam 0.05 % Formulary clobetasol propionate external gel 0.05 % Formulary clobetasol propionate external ointment 0.05 % Formulary clobetasol propionate external solution 0.05 % Formulary clofarabine intravenous solution 1 mg/ml Formulary clomipramine hcl oral capsule 25 mg, 50 mg, 75 mg Formulary clonazepam oral tablet 0.5 mg, 1 mg, 2 mg Formulary clonazepam oral tablet dispersible 0.125 mg, 0.25 mg, 0.5 Formulary QL (170 EA per 34 days) mg, 1 mg, 2 mg clonidine hcl (analgesia) epidural solution 100 mcg/ml Formulary clonidine hcl er oral tablet extended release 12 hour 0.1 mg Formulary clonidine hcl oral tablet 0.1 mg, 0.2 mg, 0.3 mg Formulary clonidine hcl transdermal patch weekly 0.1 mg/24hr, 0.2 Formulary mg/24hr, 0.3 mg/24hr clopidogrel bisulfate oral tablet 300 mg, 75 mg Formulary clorazepate dipotassium oral tablet 15 mg, 3.75 mg, 7.5 mg Formulary QL (170 EA per 30 days) clotrimazole 3 vaginal cream 2 % Formulary OTC clotrimazole anti-fungal external cream 1 % Formulary clotrimazole external cream 1 % Formulary clotrimazole mouth/throat lozenge 10 mg Formulary clotrimazole solution 1 % external (otc) 1 % Formulary clotrimazole vaginal cream 1 % Formulary OTC clotrimazole-betamethasone external cream 1-0.05 % Formulary clotrimazole-betamethasone external lotion 1-0.05 % Formulary clozapine oral tablet 100 mg, 200 mg, 25 mg, 50 mg Formulary AGE (Min 18 Years)

32 Drug Name Formulary Status Requirements/Limits clozapine oral tablet dispersible 100 mg, 12.5 mg, 150 mg, Formulary AGE (Min 18 Years) 200 mg, 25 mg co q 10 oral capsule 10 mg Formulary OTC co q-10 oral capsule 150 mg, 200 mg Formulary OTC COAGUCHEK XS PLUS SYSTEM KIT Formulary OTC COAGUCHEK XS PT TEST IN VITRO STRIP Formulary OTC COARTEM ORAL TABLET 20-120 MG Formulary COATS ALOE EXTERNAL CREAM 0.5 % Formulary OTC COATS ALOE EXTERNAL GEL 0.5 % Formulary OTC COATS ALOE EXTERNAL LIQUID Formulary OTC COATS ALOE EXTERNAL LOTION 0.5 % Formulary OTC COATS ALOE JUICE DRINK ORAL LIQUID Formulary OTC COATS ALOE EXTERNAL LOTION 10 % Formulary OTC cocoa butter skin external cream Formulary OTC cod liver oil oral capsule Formulary OTC cod liver oil oral oil Formulary codeine sulfate oral tablet 15 mg, 30 mg, 60 mg Formulary PA; QL (180 EA per 7 days) coditussin ac oral liquid 200-10 mg/5ml Formulary OTC coditussin dac oral liquid 30-10-200 mg/5ml Formulary OTC coenzyme q10 oral capsule 100 mg Formulary OTC coenzyme q-10 oral capsule 60 mg Formulary OTC coenzyme q10 oral liquid 30 mg/5ml Formulary OTC coenzyme q10 oral tablet 100 mg, 25 mg Formulary OTC coenzyme q10 oral tablet chewable 60 mg Formulary OTC coenzyme q10-levocarnitine oral capsule 30-250 mg Formulary OTC co-enzyme q10-vitamin e oral wafer 200-400 mg-unit Formulary OTC cola syrup oral syrup Formulary OTC COLACE ORAL CAPSULE 100 MG Formulary OTC colchicine oral tablet 0.6 mg Formulary colchicine-probenecid oral tablet 0.5-500 mg Formulary cold & allergy oral tablet 4-10 mg Formulary OTC cold & cough childrens oral liquid 2.5-1-5 mg/5ml Formulary OTC cold & cough day/night child oral 2.5-5 &2.5-6.25 mg/5ml Formulary OTC cold & flu relief nighttime d oral liquid 60-12.5-30-1000 Formulary OTC mg/30ml cold multi-symptom nighttime oral tablet 5-2-10-325 mg Formulary OTC cold remedy oral tablet dispersible Formulary OTC cold sore treatment external gel 10.8-4.7 % Formulary OTC cold sore treatment external liquid Formulary OTC cold therapy pain relief external gel 3.1 % Formulary OTC cold/cough childrens oral elixir 2.5-1-5 mg/5ml Formulary OTC cold/flu relief day/night oral Formulary OTC COLD-EEZE MOUTH/THROAT LOZENGE 13.3 MG Formulary OTC colesevelam hcl oral tablet 625 mg Formulary

33 Drug Name Formulary Status Requirements/Limits colestipol hcl oral packet 5 gm Formulary colestipol hcl oral tablet 1 gm Formulary collodion flexible external liquid Formulary COLOCORT RECTAL 100 MG/60ML Formulary COMBIGAN OPHTHALMIC SOLUTION 0.2-0.5 % Formulary COMBIVENT INHALATION AEROSOL Formulary SOLUTION 20-100 MCG/ACT COMFORT ASSIST INSULIN SYRINGE 29G X 1/2" 0.3 Formulary OTC ML 29G X 1/2" 0.3 ML COMFORT ASSIST INSULIN SYRINGE 29G X 1/2" 0.5 Formulary OTC ML 29G X 1/2" 0.5 ML COMFORT ASSIST INSULIN SYRINGE 29G X 1/2" 1 Formulary OTC ML 29G X 1/2" 1 ML COMFORT ASSIST INSULIN SYRINGE 30G X 5/16" 0.3 Formulary OTC ML 30G X 5/16" 0.3 ML COMFORT ASSIST INSULIN SYRINGE 30G X 5/16" 0.5 Formulary OTC ML 30G X 5/16" 0.5 ML COMFORT ASSIST INSULIN SYRINGE 30G X 5/16" 1 Formulary OTC ML 30G X 5/16" 1 ML COMFORT ASSIST INSULIN SYRINGE 31G X 5/16" 0.3 Formulary OTC ML 31G X 5/16" 0.3 ML COMFORT ASSIST INSULIN SYRINGE 31G X 5/16" 0.5 Formulary OTC ML 31G X 5/16" 0.5 ML COMFORT ASSIST INSULIN SYRINGE 31G X 5/16" 1 Formulary OTC ML 31G X 5/16" 1 ML comfort assured lancets 28g Formulary OTC; QL (150 EA per 30 days) comfort assured lancets 33g Formulary OTC; QL (150 EA per 30 days) COMFORT CLEAN/COMFORT SHIELD EXTERNAL 3 Formulary OTC % COMFORT EZ PEN NEEDLES 32G X 8 MM Formulary OTC COMPAT STAY-PUT NJ DOUBLE LUME Formulary OTC COMPLERA ORAL TABLET 200-25-300 MG Formulary complete lice treatment combination kit 0.33-4-0.5 % Formulary OTC complete natal dha oral 29-1-200 & 250 mg Formulary completenate oral tablet chewable 29-1 mg Formulary COMPOUND W MAXIMUM STRENGTH EXTERNAL Formulary OTC GEL 17 % COMPOUND W ONE STEP INVISIBLE EXTERNAL Formulary OTC STRIP 40 % compoz oral capsule 50 mg Formulary OTC COMPRO RECTAL SUPPOSITORY 25 MG Formulary COMTREX COLD & COUGH MAX ST ORAL TABLET Formulary OTC 10-5-325 MG COMTREX COLD/COUGH DAY/NITE MS ORAL 5-2- Formulary OTC 10-325 MG COMTREX DEEP CHEST COLD ORAL TABLET 325- Formulary OTC 200 MG CO-NATAL FA ORAL TABLET Formulary

34 Drug Name Formulary Status Requirements/Limits CONCEPT DHA ORAL CAPSULE 53.5-38-1 MG Formulary CONCEPT OB ORAL CAPSULE 130-92.4-1 MG Formulary CONCEPTIONXR MOTILITY SUPPORT ORAL Formulary OTC condoms Formulary OTC constulose oral solution 10 gm/15ml Formulary CONTAC COLD+FLU MAX ST ORAL TABLET 5-500 Formulary OTC MG CONTOUR BLOOD GLUCOSE SYSTEM KIT Formulary OTC; QL (150 EA per 30 days) W/DEVICE W/DEVICE CONTOUR CONTROL LIQUID HIGH IN VITRO HIGH Formulary OTC; QL (100 EA per 30 days) CONTOUR CONTROL LIQUID LOW IN VITRO LOW Formulary OTC; QL (100 EA per 30 days) CONTOUR CONTROL LIQUID NORMAL IN VITRO Formulary OTC; QL (100 EA per 30 days) NORMAL CONTOUR MONITOR DEVICE Formulary OTC; QL (1 EA per 365 days) CONTOUR MONITOR KIT W/DEVICE W/DEVICE Formulary OTC; QL (1 EA per 365 days) CONTOUR NEXT CONTROL SOLUTION LOW IN Formulary OTC; QL (100 EA per 30 days) VITRO LOW CONTOUR NEXT CONTROL SOLUTION NORMAL IN Formulary OTC; QL (100 EA per 30 days) VITRO NORMAL CONTOUR NEXT EZ KIT W/DEVICE W/DEVICE Formulary OTC; QL (1 EA per 365 days) CONTOUR NEXT LINK KIT W/DEVICE W/DEVICE Formulary OTC; QL (1 EA per 365 days) CONTOUR NEXT MONITOR KIT W/DEVICE Formulary OTC; QL (1 EA per 365 days) W/DEVICE CONTOUR NEXT ONE KIT Formulary OTC; QL (1 EA per 365 days) CONTOUR NEXT TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) CONTOUR TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) control denture adhesive cream Formulary OTC control syringe disposable 10 ml Formulary OTC convex eye protector Formulary OTC cool n heat ex st external patch 5 % Formulary OTC cool n heat maximum strength external liquid 16 % Formulary OTC COPPERMIN ORAL TABLET 5 MG Formulary OTC co-q 10 omega-3 fish oil oral capsule Formulary OTC coq10 oral capsule 30 mg Formulary OTC coq-10 oral capsule 50 mg Formulary OTC coq10 oral powder 50 gm Formulary OTC coral calcium oral capsule 185-50-100 mg-mg-unit, 200- Formulary OTC 100-100 mg-unit CORICIDIN HBP COLD/FLU ORAL TABLET 2-325 MG Formulary OTC CORICIDIN HBP COUGH/COLD ORAL TABLET 4-30 Formulary OTC MG CORICIDIN HBP DAY/NIGHT COLD ORAL 10-20 &15- Formulary OTC 200-2 MG CORICIDIN HBP NIGHTTIME COLD ORAL LIQUID Formulary OTC 15-6.25-500 MG/15ML CORIFACT INTRAVENOUS KIT 1000-1600 UNIT Formulary

35 Drug Name Formulary Status Requirements/Limits corn & callus remover external liquid 17 % Formulary OTC corn oil oral oil Formulary OTC CORN REMOVER WATERPROOF EXTERNAL PAD 40 Formulary OTC % corn/callus remover external solution 12.6 % Formulary OTC CORRECTOL EXTRA GENTLE ORAL CAPSULE 100 Formulary OTC MG CORTIC-ND OTIC SOLUTION 10-10-1 MG/ML Formulary CORTIFOAM RECTAL FOAM 10 % Formulary cortisone acetate oral tablet 25 mg Formulary CORTIZONE-10 EXTERNAL GEL 1 % Formulary OTC CORTIZONE-10/ALOE EXTERNAL CREAM 1 % Formulary OTC CORVITA 150 ORAL TABLET 150-1.25 MG Formulary COSAMIN ASU FOR JOINT HEALTH ORAL CAPSULE Formulary OTC COSAMIN VERDE FOR JOINT HEALTH ORAL Formulary OTC TABLET COTTONTAILS DIAPER RASH CREAMY EXTERNAL Formulary OTC OINTMENT 10 % cough & chest congestion dm oral liquid 5-100 mg/5ml Formulary OTC cough & cold oral tablet 4-30 mg Formulary OTC cough & sore throat nighttime oral liquid 30-12.5-1000 Formulary OTC mg/30ml cough drops mouth/throat lozenge 10 mg, 3.1 mg, 5 mg, 5.4 Formulary OTC mg, 6.5 mg, 7.5 mg, 7.6 mg, 8 mg, 9.1 mg cough relief oral liquid 15 mg/5ml Formulary OTC coughtab oral tablet 200 mg Formulary OTC cramp tabs oral tablet 325-25 mg Formulary OTC cranberry oral capsule 250 mg, 405 mg, 500 mg Formulary OTC cream base with external cream Formulary creatine oral powder Formulary OTC creatine5000 oral packet 5000 mg Formulary OTC CREON ORAL CAPSULE DELAYED RELEASE PARTICLES 12000-38000 UNIT, 24000-76000 UNIT, Formulary PA 3000-9500 UNIT, 36000-114000 UNIT, 6000-19000 UNIT CR-GTF ORAL CAPSULE 200 MCG Formulary OTC CRITIC-AID CLEAR AF EXTERNAL OINTMENT 2 % Formulary OTC CRIXIVAN ORAL CAPSULE 200 MG, 400 MG Formulary cromolyn sodium inhalation nebulization solution 20 Formulary mg/2ml cromolyn sodium nasal aerosol solution 5.2 mg/act Formulary OTC cromolyn sodium ophthalmic solution 4 % Formulary cromolyn sodium oral concentrate 100 mg/5ml Formulary CROTAN EXTERNAL LOTION 10 % Formulary ST CR-PLUS ORAL TABLET 500 MCG Formulary OTC CRYSELLE-28 ORAL TABLET 0.3-30 MG-MCG Formulary QL (28 EA per 28 days) cu-25 oral capsule 25 mg Formulary OTC

36 Drug Name Formulary Status Requirements/Limits cu-5 oral capsule 5 mg Formulary OTC CULTURELLE GENTLE-GO KIDS ORAL PACKET Formulary OTC CULTURELLE KIDS ORAL PACKET Formulary OTC CURAD GERM SHIELD EXTERNAL GEL Formulary OTC CURAFIL WOUND DRESSING EXTERNAL GEL Formulary OTC CURASOL WOUND DRESSING EXTERNAL GEL Formulary OTC CURITY ALCOHOL PREPS PAD 70 % 70 % Formulary OTC CURITY ALCOHOL SWABS PAD Formulary OTC CURITY GAUZE SPONGE PAD 2"X2" Formulary OTC CURITY GAUZE SPONGES PAD 3-1/2"X4" Formulary OTC CURITY MESH GAUZE BNDG 4"X30' Formulary OTC CURX ANTIMICROBIAL EXTERNAL GEL 0.13 % Formulary OTC CUTINOVA HYDRO 2"X2-3/8" EXTERNAL Formulary OTC cvs acetaminophen oral capsule 325 mg Formulary OTC cvs adhesive gauze pad 2-3/8"x4" Formulary OTC cvs aftersun aloe/lidocaine external gel 0.5 % Formulary OTC CVS AIRSHIELD ORAL TABLET EFFERVESCENT Formulary OTC cvs alcohol prep pads pad 70 % 70 % Formulary OTC cvs allergy relief childrens oral tablet dispersible 12.5 mg Formulary OTC cvs allergy relief d oral tablet extended release 12 hour 60- Formulary OTC; QL (68 EA per 34 days) 120 mg cvs allergy relief oral tablet 5 mg Formulary OTC cvs all-purpose skin protect external ointment Formulary OTC cvs antacid childrens oral liquid 400 mg/5ml Formulary OTC cvs antacid supreme oral suspension 400-135 mg/5ml Formulary OTC cvs anti-diarrheal oral capsule 2 mg Formulary OTC cvs anti-diarrheal oral suspension 262 mg/15ml Formulary OTC cvs anti-itch sensitive external lotion 1 % Formulary OTC cvs astringent solution external packet Formulary OTC cvs b complex plus c oral tablet Formulary OTC cvs backache relief oral tablet 500 mg Formulary OTC cvs beta carotene oral capsule 15 mg Formulary OTC cvs calcium 600 plus oral tablet chewable Formulary OTC cvs calcium oral tablet chewable 250-400 mg-unit Formulary OTC cvs cherry menthol drops mouth/throat lozenge Formulary OTC cvs chest rub medicated external ointment 4.7-1.2-2.6 % Formulary OTC cvs cleansing eyelid wipes external pad Formulary OTC cvs cleansing skin external cream Formulary OTC cvs cold & sinus relief oral capsule 30-200 mg Formulary OTC cvs cold remedy oral tablet dispersible Formulary OTC cvs corn/callus remover external kit 17 % Formulary OTC cvs cortisone maximum strength external gel 1 % Formulary OTC cvs creamy acne face wash external liquid 4 % Formulary OTC; AGE (Max 18 Years) cvs d3 oral capsule 25 mcg (1000 ut) Formulary OTC

37 Drug Name Formulary Status Requirements/Limits cvs dairy relief ex st oral tablet 4500 unit Formulary OTC cvs daytime/nighttime cold/flu oral (liquid) Formulary OTC cvs daytime/nighttime cough oral liquid therapy pack 6.25- Formulary OTC 15 & 15 mg/15ml cvs diabetes health support oral Formulary OTC cvs digestive probiotic oral capsule Formulary OTC cvs diuretic maximum strength oral capsule 50 mg Formulary OTC cvs e oil oral oil 100 unt/0.25ml Formulary OTC cvs early result pregnancy in vitro diagnostic test Formulary OTC cvs easy fiber/calcium oral tablet chewable Formulary OTC cvs enema disposable rectal enema 19-7 gm/118ml Formulary OTC cvs ethyl alcohol solution 70 % Formulary OTC cvs eye pad Formulary OTC cvs feminine wipes max st external 1 % Formulary OTC cvs fiber gummies oral tablet chewable 2 gm Formulary OTC cvs flu relief oral pellet Formulary OTC cvs gas relief extra strength oral tablet chewable 125 mg Formulary OTC cvs gas relief oral tablet chewable 80 mg Formulary OTC cvs gauze sterile pad 4"x4" Formulary OTC cvs gluco-chondroit plus uc-ii oral tablet 125-100-10 mg Formulary OTC cvs glucosamine-chondroitin oral tablet chewable 750-600 Formulary OTC mg cvs glucosamine-chondroit-msm oral tablet 375-300-250 Formulary OTC mg cvs glucose bits oral tablet chewable 1 gm Formulary OTC cvs glucose shot oral liquid Formulary OTC cvs glycerin adult rectal suppository 2.1 gm Formulary OTC cvs hair regrowth for women external foam 5 % Formulary OTC cvs hand wash advanced antibac external solution 2 % Formulary OTC cvs heartburn relief ex st oral suspension 254-237.5 mg/5ml Formulary OTC cvs heatwraps/back/hip Formulary OTC cvs hemorrhoidal rectal suppository 0.25-88.44 % Formulary OTC cvs hot steam inhalation liquid 6.2 % Formulary OTC cvs hydrocolloid pads pad Formulary OTC cvs inner ear plus oral tablet Formulary OTC cvs instant food thickener oral powder Formulary OTC cvs iron oral tablet 325 (65 fe) mg Formulary OTC cvs irritated eye ophthalmic solution Formulary OTC cvs isopropyl alcohol wipes external 70 % Formulary OTC cvs itch relief external gel 2 % Formulary OTC cvs lancets 21g Formulary OTC; QL (150 EA per 30 days) cvs lancets micro thin 33g Formulary OTC; QL (150 EA per 30 days) cvs lancets original Formulary OTC; QL (150 EA per 30 days) cvs lancets thin 26g Formulary OTC; QL (150 EA per 30 days)

38 Drug Name Formulary Status Requirements/Limits cvs lancets ultra thin 30g Formulary OTC; QL (150 EA per 30 days) cvs lancets ultra-thin 30g Formulary OTC; QL (150 EA per 30 days) cvs laxative dietary supplemnt oral tablet 500 mg Formulary OTC CVS LICE SOLUTION 3-STEP COMBINATION KIT Formulary OTC cvs l-lysine oral tablet 500 mg Formulary OTC cvs lubricant drops ophthalmic gel 0.25-0.3 % Formulary OTC cvs magnesium citrate oral capsule 125 mg Formulary OTC cvs manuka honey wound external gel Formulary OTC cvs melatonin extra strength oral liquid 5 mg/15ml Formulary OTC cvs melatonin oral tablet chewable 5 mg Formulary OTC cvs melatonin sublingual tablet sublingual 5 mg Formulary OTC cvs miconazole 1 combo pack vaginal kit 1200 & 2 mg & % Formulary OTC cvs miconazole 3 combo pack vaginal kit 200 & 2 mg-% Formulary OTC (9gm) cvs mineral oil enema rectal enema Formulary OTC cvs mineral oil oral oil Formulary OTC cvs mini enema kids rectal enema 100 mg/5ml Formulary OTC cvs multi-purpose external ointment 15.5-53.4 % Formulary OTC cvs nasal allergy spray aerosol 55 mcg/act nasal 55 Formulary OTC mcg/act cvs nasal decongestant inhalation inhaler 50 mg Formulary OTC cvs nasal decongestant oral capsule 30 mg Formulary OTC cvs nasal mist nasal aerosol solution 3 % Formulary OTC cvs natural fiber supplement oral packet 58.6 % Formulary OTC cvs natural fish oil oral capsule 1000 mg Formulary OTC cvs nerve pain relief external ointment Formulary OTC cvs non-drying sinus pe oral tablet 5-200 mg Formulary OTC cvs omeprazole oral tablet delayed release 20 mg Formulary OTC cvs oral pain reliever mouth/throat cream 20 % Formulary OTC cvs pain relief external cream 4 % Formulary OTC cvs phosphate saline laxative oral solution 2.7-7.2 gm/15ml Formulary OTC cvs pinworm treatment oral suspension 144 (50 base) Formulary OTC mg/ml cvs potassium gluconate oral tablet 2 meq Formulary OTC cvs prenatal gummy oral tablet chewable 0.4-113.5 mg Formulary OTC cvs prenatal oral tablet 28-0.8 mg Formulary OTC cvs prep pad 70 % 70 % Formulary OTC cvs protective external powder 81-15 % Formulary OTC cvs saline wound wash external solution 0.9 % Formulary OTC cvs selenium oral tablet 200 mcg Formulary OTC cvs silver external gel Formulary OTC cvs sinus pe oral tablet 5-10-100-325 mg Formulary OTC cvs sinus relief day/night oral Formulary OTC cvs sinus relief day/night oral tablet therapy pack 5-200- Formulary OTC 325 & 5-25-325mg 39 Drug Name Formulary Status Requirements/Limits cvs skin relief external lotion 1.3 % Formulary OTC cvs sore muscle rub external gel 2.5 % Formulary OTC cvs sore throat max strength mouth/throat lozenge 15-2.6 Formulary OTC mg cvs sore throat relief pops mouth/throat lozenge on a handle Formulary OTC 20 mg cvs steam inhaler Formulary OTC cvs stool softener oral capsule 50 mg Formulary OTC cvs stuffy nose & cold child oral liquid 2.5-100 mg/5ml Formulary OTC cvs super cranberry urinary oral capsule 140-100 mg Formulary OTC cvs tension headache oral capsule 500-65 mg Formulary OTC cvs therapeutic dandruff external shampoo 1 % Formulary OTC cvs therapeutic external shampoo 0.5 % Formulary OTC cvs triacting cough/runny nose oral liquid 1-5 mg/5ml Formulary OTC cvs triple magnesium complex oral capsule 400 mg Formulary OTC cvs ultra thin lancets Formulary OTC; QL (150 EA per 30 days) cvs vaporizer warm steam Formulary OTC cvs wound wash advanced external liquid Formulary OTC cvs yogurt+calcium gummies oral tablet chewable 250-100 Formulary OTC mg-unit cvs zinc oxide diaper external cream 1-10 % Formulary OTC cyanocobalamin injection solution 1000 mcg/ml Formulary cyclobenzaprine hcl oral tablet 10 mg, 5 mg, 7.5 mg Formulary CYCLOMYDRIL OPHTHALMIC SOLUTION 0.2-1 % Formulary cyclopentolate hcl ophthalmic solution 1 % Formulary cyclophosphamide injection solution reconstituted 1 gm, 2 Formulary gm, 500 mg cyclophosphamide oral capsule 25 mg, 50 mg Formulary cyclosporine modified oral capsule 100 mg, 25 mg, 50 mg Formulary cyclosporine modified oral solution 100 mg/ml Formulary cyclosporine oral capsule 100 mg, 25 mg Formulary cyproheptadine hcl oral syrup 2 mg/5ml Formulary cyproheptadine hcl oral tablet 4 mg Formulary CYSTADANE ORAL POWDER Formulary PA CYSTAGON ORAL CAPSULE 150 MG, 50 MG Formulary CYSTECH ORAL CAPSULE 500 MG Formulary OTC cystine oral packet 500 mg Formulary OTC cytarabine (pf) injection solution 100 mg/ml, 20 mg/ml Formulary CYTO-Q MAX ORAL LIQUID 100 MG/ML Formulary OTC cytra k crystals oral packet 3300-1002 mg Formulary d 1000 oral tablet 25 mcg (1000 ut) Formulary OTC d 2000 oral tablet 50 mcg (2000 ut) Formulary OTC dacarbazine intravenous solution reconstituted 100 mg, 200 Formulary mg daily care skin protectant external ointment 30 % Formulary OTC

40 Drug Name Formulary Status Requirements/Limits daily ovulation predictor in vitro strip Formulary OTC daily vite multivitamin/iron oral tablet Formulary OTC dairy relief oral tablet 3000 unit Formulary OTC dakins (1/2 strength) external solution 0.25 % Formulary OTC dakins (1/4 strength) external solution 0.125 % Formulary OTC dakins external solution 0.4-0.5 % Formulary OTC DAKRINA OPHTHALMIC SOLUTION 2.7-2 % Formulary OTC danazol oral capsule 100 mg, 200 mg, 50 mg Formulary dandruff shampoo external lotion 1 % Formulary OTC dantrolene sodium oral capsule 100 mg, 25 mg, 50 mg Formulary dapsone oral tablet 100 mg, 25 mg Formulary daunorubicin hcl intravenous injectable 5 mg/ml Formulary day time multi-sympt cold/flu oral capsule 10-5-325 mg Formulary OTC DAYTIME COLD MEDICINE ORAL LIQUID 325-15 Formulary OTC MG/15ML daytime cough oral liquid 15 mg/15ml Formulary OTC daytime severe cold & flu oral liquid 5-10-200-325 Formulary OTC mg/15ml DAYTRANA TRANSDERMAL PATCH 10 MG/9HR, 15 QL (30 EA per 30 days); AGE (Min 4 Formulary MG/9HR, 20 MG/9HR, 30 MG/9HR Years and Max 17 Years) DDROPS ORAL LIQUID 2000 UNT/0.03ML, 2000 Formulary OTC UT/0.028ML DEBACTEROL MOUTH/THROAT SOLUTION 30-50 % Formulary DECARA ORAL CAPSULE 625 MCG (25000 UT) Formulary OTC decitabine intravenous solution reconstituted 50 mg Formulary DECONEX DMX ORAL TABLET 10-17.5-385 MG Formulary OTC DECONEX IR ORAL TABLET 10-385 MG Formulary OTC DEEP SLEEP ORAL LIQUID Formulary OTC deferasirox oral tablet soluble 125 mg, 250 mg, 500 mg Formulary PA del clens external gel Formulary OTC DELBASE COMPOUNDING EXTERNAL OINTMENT Formulary OTC DELSYM COUGH CHILDRENS ORAL SUSPENSION Formulary OTC EXTENDED RELEASE 30 MG/5ML DELTUSS DP ORAL LIQUID 1-30 MG/5ML Formulary OTC DELZICOL ORAL CAPSULE DELAYED RELEASE 400 Formulary MG demeclocycline hcl oral tablet 150 mg, 300 mg Formulary DEMEROL INJECTION SOLUTION 100 MG/2ML, 25 Formulary MG/0.5ML, 75 MG/1.5ML, 75 MG/ML DEMSER ORAL CAPSULE 250 MG Formulary DENDRACIN NEURODENDRAXCIN EXTERNAL Formulary OTC LOTION 0.0375-10-30 % DENTA 5000 PLUS DENTAL CREAM 1.1 % Formulary DENTAPAINE MOUTH/THROAT GEL 20 % Formulary OTC DEPACON INTRAVENOUS SOLUTION 100 MG/ML Formulary

41 Drug Name Formulary Status Requirements/Limits DEPO-PROVERA INTRAMUSCULAR SUSPENSION Formulary 400 MG/ML DEQUASINE ORAL TABLET Formulary OTC DERMA CIDOL 2000 EXTERNAL LIQUID 0.5 % Formulary OTC dermacloud external cream Formulary OTC DERMAGESIC EXTERNAL CREAM 1-0.4-0.4 % Formulary OTC DERMAGESIC EXTERNAL LIQUID 1-0.4-0.4 % Formulary OTC DERMAGRAN EXTERNAL GEL Formulary OTC DERMAGRAN HYDROGEL WOUND EXTERNAL GEL Formulary OTC DERMAL THERAPY FINGER CARE EXTERNAL Formulary OTC LOTION 20 % DERMAMED EXTERNAL OINTMENT Formulary OTC DERMAPLEX EXTERNAL GEL Formulary OTC DERMAREST PSORIASIS EXTERNAL GEL 3 % Formulary OTC DERMASTAT EXTERNAL FOAM 65 % Formulary OTC DERMASYN EXTERNAL GEL Formulary OTC DERMAZENE EXTERNAL CREAM 1-1 % Formulary DERMOPLAST EXTERNAL AEROSOL 20-0.5 % Formulary OTC dermovix external patch 2-30 % Formulary OTC DESCOVY ORAL TABLET 200-25 MG Formulary DESENEX FOOT/SNEAKER SPRAY EXTERNAL Formulary OTC AEROSOL DESGEN DM ORAL SYRUP 5-15-100 MG/5ML Formulary OTC DESGEN DM ORAL TABLET 30-10-200 MG Formulary OTC desipramine hcl oral tablet 10 mg, 100 mg, 150 mg, 25 mg, Formulary 50 mg, 75 mg DESITIN MAXIMUM STRENGTH EXTERNAL PASTE Formulary OTC 40 % desmopressin ace spray refrig nasal solution 0.01 % Formulary desmopressin acetate oral tablet 0.1 mg, 0.2 mg Formulary desmopressin acetate spray nasal solution 0.01 % Formulary desonide external cream 0.05 % Formulary desonide external lotion 0.05 % Formulary desonide external ointment 0.05 % Formulary despec dm-g oral syrup 5-10-100 mg/5ml Formulary OTC desvenlafaxine succinate er oral tablet extended release 24 Formulary ST hour 100 mg, 25 mg, 50 mg DEVROM ORAL TABLET CHEWABLE 200 MG Formulary OTC DEWEES CARMINATIVE ORAL LIQUID 6-250 Formulary OTC DEWITTS PAIN RELIEVER ORAL TABLET 325 MG Formulary OTC DEXAMETHASONE INTENSOL ORAL Formulary CONCENTRATE 1 MG/ML dexamethasone oral elixir 0.5 mg/5ml Formulary dexamethasone oral solution 0.5 mg/5ml Formulary dexamethasone oral tablet 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 Formulary mg, 4 mg, 6 mg 42 Drug Name Formulary Status Requirements/Limits dexamethasone sodium phosphate ophthalmic solution 0.1 Formulary % dexmethylphenidate hcl er oral capsule extended release 24 QL (30 EA per 30 days); AGE (Min 4 hour 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 5 Formulary Years and Max 17 Years) mg dexmethylphenidate hcl oral tablet 10 mg, 2.5 mg, 5 mg Formulary AGE (Min 4 Years and Max 17 Years) dexrazoxane intravenous solution reconstituted 250 mg, 500 Formulary mg dextroamphetamine sulfate oral tablet 10 mg, 5 mg Formulary AGE (Min 4 Years and Max 17 Years) dhea oral capsule 50 mg Formulary OTC dhea oral tablet 25 mg Formulary OTC DHS BODY WASH EXTERNAL LIQUID 0.5 % Formulary OTC DHS ZINC EXTERNAL SHAMPOO 2 % Formulary OTC DIAB DAILY CARE EXTERNAL GEL Formulary OTC DIABETIC BASICS HEALTHY FOOT EXTERNAL Formulary OTC LOTION 0.13 % DIABETIC TUSSIN ALLERGY ORAL SYRUP 2 Formulary OTC MG/5ML DIABETIC TUSSIN COLD/FLU ORAL CAPSULE 325-4- Formulary OTC 15 MG DIABETIC TUSSIN MAX ST ORAL LIQUID 10-200 Formulary OTC MG/5ML DIABETIC TUSSIN NIGHT COLD/FLU ORAL LIQUID Formulary OTC 10-12.5-325 MG/5ML DIABETIC TUSSIN ORAL LIQUID 100 MG/5ML Formulary OTC diabet-x daily prevention external cream 0.3 % Formulary OTC DIADERM FOOT REJUVENATING EXTERNAL Formulary OTC CREAM DIALYVITE 800 ORAL WAFER 0.8 MG Formulary OTC DIALYVITE 800 PLUS D ORAL WAFER 800 MCG Formulary OTC DIALYVITE 800/IRON ORAL TABLET 29-0.8 MG Formulary OTC DIALYVITE ORAL TABLET Formulary DIALYVITE/ZINC ORAL TABLET Formulary diaper rash external cream 10 % Formulary OTC diaper rash external paste 40 % Formulary OTC DIASTIX IN VITRO STRIP Formulary OTC DIAZEPAM INTENSOL ORAL CONCENTRATE 5 Formulary QL (136 ML per 34 days) MG/ML diazepam oral solution 5 mg/5ml Formulary QL (136 ML per 34 days) diazepam oral tablet 10 mg Formulary QL (136 EA per 34 days) diazepam oral tablet 2 mg, 5 mg Formulary QL (136 EA per 30 days) diazepam rectal gel 10 mg, 2.5 mg, 20 mg Formulary AGE (Min 2 Years) diazoxide oral suspension 50 mg/ml Formulary dibucaine external ointment 1 % Formulary OTC dibucaine rectal ointment 1 % Formulary OTC diclofenac potassium oral tablet 50 mg Formulary

43 Drug Name Formulary Status Requirements/Limits diclofenac sodium er oral tablet extended release 24 hour Formulary 100 mg diclofenac sodium external gel 1 % Formulary QL (200 GM per 30 days) diclofenac sodium ophthalmic solution 0.1 % Formulary diclofenac sodium oral tablet delayed release 25 mg, 50 mg, Formulary 75 mg dicloxacillin sodium oral capsule 250 mg, 500 mg Formulary dicyclomine hcl oral capsule 10 mg Formulary dicyclomine hcl oral solution 10 mg/5ml Formulary dicyclomine hcl oral tablet 20 mg Formulary DI-DAK-SOL EXTERNAL SOLUTION 0.0125 % Formulary OTC didanosine oral capsule delayed release 200 mg, 250 mg, Formulary 400 mg dieters super tea oral Formulary OTC dietex forte oral capsule Formulary OTC diethylpropion hcl er oral tablet extended release 24 hour Formulary PA 75 mg diethylpropion hcl oral tablet 25 mg Formulary PA DIFFERIN GEL 0.1 % EXTERNAL (OTC) 0.1 % Formulary AGE (Max 18 Years) diflorasone diacetate external ointment 0.05 % Formulary diflunisal oral tablet 500 mg Formulary digestive enzyme ultra oral capsule Formulary OTC DIGITEK ORAL TABLET 125 MCG, 250 MCG Formulary oral solution 0.05 mg/ml Formulary DILANTIN ORAL CAPSULE 30 MG Formulary diltiazem cd oral capsule extended release 24 hour 120 mg, Formulary 180 mg, 240 mg, 300 mg diltiazem hcl er beads oral capsule extended release 24 Formulary hour 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg diltiazem hcl er coated beads oral capsule extended release Formulary 24 hour 120 mg, 180 mg, 240 mg, 300 mg, 360 mg diltiazem hcl er coated beads oral tablet extended release Formulary 24 hour 180 mg, 240 mg, 300 mg, 360 mg, 420 mg diltiazem hcl er oral capsule extended release 12 hour 120 Formulary mg, 60 mg, 90 mg diltiazem hcl er oral capsule extended release 24 hour 120 Formulary mg, 180 mg, 240 mg diltiazem hcl intravenous solution 125 mg/25ml, 25 mg/5ml, Formulary 50 mg/10ml diltiazem hcl intravenous solution reconstituted 100 mg Formulary diltiazem hcl oral tablet 120 mg, 30 mg, 60 mg, 90 mg Formulary dilt-xr oral capsule extended release 24 hour 120 mg, 180 Formulary mg, 240 mg dimenhydrinate oral tablet 50 mg Formulary OTC DIMETAPP COLD/ALLERGY ORAL ELIXIR 1-2.5 Formulary OTC MG/5ML DIMETAPP DM COLD/COUGH ORAL LIQUID 2.5-1-5 Formulary OTC MG/5ML 44 Drug Name Formulary Status Requirements/Limits DIMETAPP LONG ACT COUGH/COLD ORAL SYRUP Formulary OTC 1-7.5 MG/5ML DIMETAPP NIGHT COLD/CONGESTION ORAL Formulary OTC LIQUID 6.25-2.5 MG/5ML dimethyl fumarate oral capsule delayed release 120 mg, Formulary 240 mg dimethyl fumarate starter pack oral 120 & 240 mg Formulary diphenhydramine hcl (sleep) oral tablet 50 mg Formulary OTC diphenhydramine hcl oral capsule 25 mg, 50 mg Formulary diphenhydramine hcl oral liquid 6.25 mg/ml Formulary OTC diphenhydramine hcl oral tablet 25 mg Formulary OTC diphenoxylate-atropine oral tablet 2.5-0.025 mg Formulary diphtheria-tetanus toxoids dt intramuscular suspension 25-5 Formulary AGE (Min 19 Years) lfu/0.5ml dipyridamole oral tablet 25 mg, 50 mg, 75 mg Formulary disulfiram oral tablet 250 mg, 500 mg Formulary divalproex sodium er oral tablet extended release 24 hour Formulary 250 mg, 500 mg divalproex sodium oral capsule delayed release sprinkle Formulary 125 mg divalproex sodium oral tablet delayed release 125 mg, 250 Formulary mg, 500 mg dl-pa-500 oral capsule 500 mg Formulary OTC DML EXTERNAL LOTION Formulary OTC DOANS EXTRA STRENGTH ORAL TABLET 580 MG Formulary OTC DOANS PILLS ORAL TABLET 325 MG Formulary OTC DOANS PM EXTRA STRENGTH ORAL TABLET 580- Formulary OTC 25 MG DOC OMEGA ORAL PACKET 200 MG Formulary OTC docetaxel intravenous concentrate 160 mg/8ml, 20 mg/ml, Formulary 80 mg/4ml docetaxel intravenous solution 160 mg/16ml, 20 mg/2ml, 80 Formulary mg/8ml docosanol external cream 10 % Formulary OTC docusate sodium oral capsule 250 mg Formulary docusate sodium oral liquid 50 mg/5ml Formulary OTC docusate sodium oral tablet 100 mg Formulary OTC DOCUSOL KIDS RECTAL ENEMA 100 MG/5ML Formulary OTC DOCUSOL PLUS MINI-ENEMA RECTAL ENEMA 20- Formulary OTC 283 MG dofetilide oral capsule 125 mcg, 250 mcg, 500 mcg Formulary DOLOGEN ORAL TABLET 1-325 MG Formulary OTC dologesic-df oral tablet 1-500 mg Formulary OTC dolorex oral tablet 25-325 mg Formulary OTC DOMEBORO EXTERNAL PACKET Formulary OTC dometuss-da/children oral liquid 1-2.5 mg/5ml Formulary OTC donepezil hcl oral tablet 10 mg, 5 mg Formulary 45 Drug Name Formulary Status Requirements/Limits donepezil hcl oral tablet 23 mg Formulary QL (30 EA per 30 days) donepezil hcl oral tablet dispersible 10 mg, 5 mg Formulary dorzolamide hcl ophthalmic solution 2 % Formulary dorzolamide hcl-timolol mal ophthalmic solution 22.3-6.8 Formulary mg/ml DOUBLE-TUSSIN DM ORAL LIQUID 20-300 MG/5ML Formulary OTC DOVER IRRIGATION TRAY KIT Formulary OTC doxazosin mesylate oral tablet 1 mg, 2 mg, 4 mg Formulary QL (34 EA per 34 days) doxazosin mesylate oral tablet 8 mg Formulary QL (68 EA per 34 days) doxepin hcl oral capsule 10 mg, 100 mg, 150 mg, 25 mg, 50 Formulary mg doxepin hcl oral concentrate 10 mg/ml Formulary doxorubicin hcl intravenous solution 2 mg/ml Formulary doxorubicin hcl intravenous solution reconstituted 10 mg, Formulary 50 mg doxycycline hyclate oral capsule 100 mg, 50 mg Formulary doxycycline hyclate oral tablet 100 mg, 20 mg Formulary doxycycline monohydrate oral capsule 100 mg, 50 mg Formulary doxycycline monohydrate oral suspension reconstituted 25 Formulary mg/5ml doxycycline monohydrate oral tablet 150 mg, 50 mg, 75 mg Formulary DR BOLDTS HINEY HEALER EXTERNAL CREAM Formulary OTC DR SMITHS DIAPER EXTERNAL OINTMENT 10 % Formulary OTC DR SMITHS DIAPER RASH EXTERNAL AEROSOL 10 Formulary OTC % DR SMITHS RASH + SKIN EXTERNAL OINTMENT Formulary OTC 16-57 % DRAMAMINE ORAL TABLET 50 MG Formulary OTC DRAMAMINE ORAL TABLET CHEWABLE 50 MG Formulary OTC DRITHO-CREME HP EXTERNAL CREAM 1 % Formulary DRIXORAL COLD/ALLERGY ORAL TABLET Formulary OTC EXTENDED RELEASE 12 HOUR 6-120 MG DRIXORAL COUGH/SORE THROAT ORAL CAPSULE Formulary OTC 325-15 MG dronabinol oral capsule 10 mg, 2.5 mg, 5 mg Formulary PA DROPLET LANCETS ULTRA THIN 30G Formulary OTC; QL (150 EA per 30 days) drospirenone-ethinyl estradiol oral tablet 3-0.02 mg, 3-0.03 Formulary QL (28 EA per 28 days) mg DROXIA ORAL CAPSULE 200 MG, 300 MG, 400 MG Formulary drug mart lancets thin 26g Formulary OTC; QL (150 EA per 30 days) DRUG MART UNILET LANCETS 28G Formulary OTC; QL (150 EA per 30 days) DRUG MART UNILET LANCETS 30G Formulary OTC; QL (150 EA per 30 days) dry skin treatment adv therapy external ointment Formulary OTC drymax extra pad 8"x8" Formulary OTC DRYSOL EXTERNAL SOLUTION 20 % Formulary

46 Drug Name Formulary Status Requirements/Limits DULCOLAX MILK OF MAGNESIA ORAL Formulary OTC SUSPENSION 400 MG/5ML DULCOLAX ORAL TABLET DELAYED RELEASE 5 Formulary OTC MG DULCOLAX RECTAL SUPPOSITORY 10 MG Formulary OTC DULERA INHALATION AEROSOL 100-5 MCG/ACT, Formulary 200-5 MCG/ACT, 50-5 MCG/ACT duloxetine hcl oral capsule delayed release particles 20 mg, Formulary 30 mg, 60 mg DUNLAP MOIST HEAT PACK COVER Formulary OTC DUOFILM EXTERNAL SOLUTION 17 % Formulary OTC DURAFLEX COMFORT EXTERNAL GEL Formulary OTC DURAFLU ORAL TABLET 60-20-200-325 MG Formulary OTC DURAPROXIN ES TRANSDERMAL PATCH 3-1.25-10 Formulary OTC % DURAPROXIN TRANSDERMAL PATCH 1.25-3 % Formulary OTC DURASAFE SPINAL/EPIDURAL KIT Formulary DURATION SPRAY NASAL SOLUTION 0.05 % Formulary OTC DURAVENT DM ORAL TABLET 10-15-395 MG Formulary OTC DURAVENT PE ORAL TABLET 10-395 MG Formulary OTC DUREZOL OPHTHALMIC EMULSION 0.05 % Formulary oral capsule 0.5 mg Formulary dutasteride-tamsulosin hcl oral capsule 0.5-0.4 mg Formulary D-VI-SOL ORAL LIQUID 400 UNIT/ML Formulary OTC d-xylose powder Formulary DY-O-DERM VITILIGO STAIN EXTERNAL Formulary OTC SOLUTION 6.55 % ear wax cleansing otic kit 6.5 % Formulary OTC easy fiber oral powder Formulary OTC EASY TOUCH ALCOHOL PREP MEDIUM PAD 70 % Formulary OTC 70 % EASY TOUCH ALLERGY SYRINGE 26G X 3/8" 1 ML, Formulary OTC 27G X 1/2" 1 ML EASY TOUCH FLIPLOCK INSULIN SY 29G X 1/2" 1 Formulary OTC ML 29G X 1/2" 1 ML EASY TOUCH FLIPLOCK INSULIN SY 30G X 1/2" 1 Formulary OTC ML 30G X 1/2" 1 ML EASY TOUCH FLIPLOCK INSULIN SY 30G X 5/16" 1 Formulary OTC ML 30G X 5/16" 1 ML EASY TOUCH FLIPLOCK INSULIN SY 31G X 5/16" 1 Formulary OTC ML 31G X 5/16" 1 ML EASY TOUCH FLURINGE 25G X 1" 1 ML Formulary OTC EASY TOUCH HYPODERMIC NEEDLE 24G X 1" Formulary OTC EASY TOUCH INSULIN SAFETY SYR 29G X 1/2" 0.5 Formulary OTC ML 29G X 1/2" 0.5 ML EASY TOUCH INSULIN SAFETY SYR 29G X 1/2" 1 ML Formulary OTC 29G X 1/2" 1 ML

47 Drug Name Formulary Status Requirements/Limits EASY TOUCH INSULIN SAFETY SYR 30G X 1/2" 1 ML Formulary OTC 30G X 1/2" 1 ML EASY TOUCH INSULIN SAFETY SYR 30G X 5/16" 0.5 Formulary OTC ML 30G X 5/16" 0.5 ML EASY TOUCH INSULIN SYRINGE 27G X 1/2" 0.5 ML Formulary OTC 27G X 1/2" 0.5 ML EASY TOUCH INSULIN SYRINGE 27G X 1/2" 1 ML Formulary OTC 27G X 1/2" 1 ML EASY TOUCH INSULIN SYRINGE 28G X 1/2" 0.5 ML Formulary OTC 28G X 1/2" 0.5 ML EASY TOUCH INSULIN SYRINGE 28G X 1/2" 1 ML Formulary OTC 28G X 1/2" 1 ML EASY TOUCH INSULIN SYRINGE 29G X 1/2" 0.5 ML Formulary OTC 29G X 1/2" 0.5 ML EASY TOUCH INSULIN SYRINGE 29G X 1/2" 1 ML Formulary OTC 29G X 1/2" 1 ML EASY TOUCH INSULIN SYRINGE 30G X 1/2" 0.3 ML Formulary OTC 30G X 1/2" 0.3 ML EASY TOUCH INSULIN SYRINGE 30G X 1/2" 0.5 ML Formulary OTC 30G X 1/2" 0.5 ML EASY TOUCH INSULIN SYRINGE 30G X 1/2" 1 ML Formulary OTC 30G X 1/2" 1 ML EASY TOUCH INSULIN SYRINGE 30G X 5/16" 0.3 ML Formulary OTC 30G X 5/16" 0.3 ML EASY TOUCH INSULIN SYRINGE 30G X 5/16" 0.5 ML Formulary OTC 30G X 5/16" 0.5 ML EASY TOUCH INSULIN SYRINGE 30G X 5/16" 1 ML Formulary OTC 30G X 5/16" 1 ML EASY TOUCH INSULIN SYRINGE 31G X 5/16" 0.3 ML Formulary OTC 31G X 5/16" 0.3 ML EASY TOUCH INSULIN SYRINGE 31G X 5/16" 0.5 ML Formulary OTC 31G X 5/16" 0.5 ML EASY TOUCH INSULIN SYRINGE 31G X 5/16" 1 ML Formulary OTC 31G X 5/16" 1 ML EASY TOUCH LANCETS 26G Formulary OTC; QL (150 EA per 30 days) EASY TOUCH LANCETS 28G Formulary OTC; QL (150 EA per 30 days) EASY TOUCH LANCETS 28G/TWIST Formulary OTC; QL (150 EA per 30 days) EASY TOUCH LANCETS 30G Formulary OTC; QL (150 EA per 30 days) EASY TOUCH LANCETS 30G/TWIST Formulary OTC; QL (150 EA per 30 days) EASY TOUCH LANCETS 32G Formulary OTC; QL (150 EA per 30 days) EASY TOUCH LANCETS 32G/TWIST Formulary OTC; QL (150 EA per 30 days) EASY TOUCH LANCETS 33G/TWIST Formulary OTC; QL (150 EA per 30 days) EASY TOUCH SHEATHLOCK SYRINGE 29G X 1/2" 1 Formulary OTC ML 29G X 1/2" 1 ML EASY TOUCH SHEATHLOCK SYRINGE 30G X 1/2" 1 Formulary OTC ML 30G X 1/2" 1 ML EASY TOUCH SHEATHLOCK SYRINGE 30G X 5/16" 1 Formulary OTC ML 30G X 5/16" 1 ML EASY TOUCH SHEATHLOCK SYRINGE 31G X 5/16" 1 Formulary OTC ML 31G X 5/16" 1 ML 48 Drug Name Formulary Status Requirements/Limits EASY TOUCH TB FLIPLOCK SYRINGE 26G X 5/8" 1 Formulary OTC ML EASY TWIST & CAP LANCETS Formulary OTC; QL (150 EA per 30 days) EASYGEL DENTAL GEL 0.4 % Formulary ecee plus oral tablet Formulary OTC econazole nitrate external cream 1 % Formulary ECOTRIN MAXIMUM STRENGTH ORAL TABLET Formulary OTC DELAYED RELEASE 500 MG ECOTRIN ORAL TABLET DELAYED RELEASE 325 Formulary OTC MG e-cream complex external cream Formulary OTC ed a-hist dm oral tablet 10-4-10 mg Formulary OTC ED A-HIST ORAL LIQUID 4-10 MG/5ML Formulary OTC ed a-hist pse oral tablet 2.5-60 mg Formulary OTC ed bron gp oral liquid 5-100 mg/5ml Formulary OTC ED CHLORPED D ORAL LIQUID 2-5 MG/ML Formulary OTC ED CHLORPED ORAL LIQUID 2 MG/ML Formulary OTC ed-a-hist dm oral liquid 10-4-15 mg/5ml Formulary OTC ed-spaz oral tablet dispersible 0.125 mg Formulary EDURANT ORAL TABLET 25 MG Formulary efavirenz oral capsule 200 mg, 50 mg Formulary efavirenz oral tablet 600 mg Formulary efavirenz-emtricitab-tenofovir oral tablet 600-200-300 mg Formulary EFFER-K ORAL TABLET EFFERVESCENT 25 MEQ Formulary effervescent pain relief oral tablet effervescent 325 mg Formulary OTC effervescent pot chloride oral tablet effervescent 25 meq Formulary EGRIFTA SUBCUTANEOUS SOLUTION Formulary PA RECONSTITUTED 1 MG ELDERTONIC ORAL ELIXIR Formulary OTC eletriptan hydrobromide oral tablet 20 mg, 40 mg Formulary ST; QL (6 EA per 34 days) ELIDEL EXTERNAL CREAM 1 % Formulary PA; AGE (Min 2 Years) ELIGARD SUBCUTANEOUS KIT 22.5 MG, 30 MG, 45 Formulary PA; QL (1 EA per 90 days) MG, 7.5 MG ELIQUIS ORAL TABLET 2.5 MG, 5 MG Formulary elite ca/mg oral tablet 100-50 mg Formulary OTC elite calcium oral tablet 150 mg Formulary OTC ELITE ZINC ORAL CAPSULE 15 MG Formulary OTC ELITEK INTRAVENOUS SOLUTION Formulary RECONSTITUTED 1.5 MG, 7.5 MG ELITE-OB ORAL TABLET 50-1.25 MG Formulary elite-thin insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC elite-thin insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC elite-thin insulin syringe 28g x 5/16" 0.5 ml 28g x 5/16" 0.5 Formulary OTC ml elite-thin insulin syringe 28g x 5/16" 1 ml 28g x 5/16" 1 ml Formulary OTC elite-thin insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC 49 Drug Name Formulary Status Requirements/Limits elite-thin insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC elite-thin insulin syringe 29g x 5/16" 0.5 ml 29g x 5/16" 0.5 Formulary OTC ml elite-thin insulin syringe 29g x 5/16" 1 ml 29g x 5/16" 1 ml Formulary OTC elite-thin insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 Formulary OTC ml elite-thin insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC elite-thin insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 Formulary OTC ml elite-thin insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 Formulary OTC ml elite-thin insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC ELIXOPHYLLIN ORAL ELIXIR 80 MG/15ML Formulary ELIXSURE COUGH ORAL GEL 7.5 MG/5ML Formulary OTC ELIXSURE FEVER/PAIN ORAL GEL 160 MG/5ML Formulary OTC ELLA ORAL TABLET 30 MG Formulary ELLURA ORAL CAPSULE 200 MG Formulary OTC ELMIRON ORAL CAPSULE 100 MG Formulary PA ELTA DERMAL EXTERNAL GEL Formulary OTC ELTA DERMAL WOUND EXTERNAL GEL Formulary OTC ELURYNG VAGINAL RING 0.12-0.015 MG/24HR Formulary QL (1 EA per 28 days) EMCYT ORAL CAPSULE 140 MG Formulary EMETROL ORAL SOLUTION 1.87-1.87-21.5 Formulary OTC EMGALITY SUBCUTANEOUS SOLUTION AUTO- Formulary ST; AGE (Min 18 Years) INJECTOR 120 MG/ML EMGALITY SUBCUTANEOUS SOLUTION Formulary ST; AGE (Min 18 Years) PREFILLED SYRINGE 120 MG/ML empty capsule size 1 clear capsule Formulary emtricitabine oral capsule 200 mg Formulary emtricitabine-tenofovir df oral tablet 200-300 mg Formulary EMTRIVA ORAL SOLUTION 10 MG/ML Formulary EMULSION SB EMULSION EXTERNAL Formulary enalapril maleate oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg Formulary enalapril-hydrochlorothiazide oral tablet 10-25 mg, 5-12.5 Formulary mg ENBREL MINI SUBCUTANEOUS SOLUTION Formulary CARTRIDGE 50 MG/ML ENBREL SUBCUTANEOUS SOLUTION 25 MG/0.5ML Formulary AGE (Min 2 Years) ENBREL SUBCUTANEOUS SOLUTION PREFILLED Formulary AGE (Min 2 Years) SYRINGE 25 MG/0.5ML, 50 MG/ML ENBREL SUBCUTANEOUS SOLUTION Formulary AGE (Min 2 Years) RECONSTITUTED 25 MG ENBREL SURECLICK SUBCUTANEOUS SOLUTION Formulary AGE (Min 2 Years) AUTO-INJECTOR 50 MG/ML ENDOXCIN EXTERNAL PATCH 4-1 % Formulary OTC ENDUR-ACIN ORAL TABLET EXTENDED RELEASE Formulary OTC 500 MG

50 Drug Name Formulary Status Requirements/Limits ENEMEEZ MINI RECTAL ENEMA 283 MG/5ML Formulary OTC ENFAMIL ENFALYTE ORAL SOLUTION Formulary OTC ENFAMIL EXPECTA ORAL 28-0.8 & 200 MG Formulary OTC ENGERIX-B INJECTION SUSPENSION 10 MCG/0.5ML, Formulary AGE (Min 19 Years) 20 MCG/ML ENLITE GLUCOSE SENSOR Formulary enoxaparin sodium injection solution 300 mg/3ml Formulary enoxaparin sodium subcutaneous solution 100 mg/ml, 120 mg/0.8ml, 150 mg/ml, 30 mg/0.3ml, 40 mg/0.4ml, 60 Formulary mg/0.6ml, 80 mg/0.8ml ENPRESSE-28 ORAL TABLET 50-30/75-40/ 125-30 Formulary QL (28 EA per 28 days) MCG entecavir oral tablet 0.5 mg, 1 mg Formulary ENTEX T ORAL TABLET 60-375 MG Formulary OTC entre-hist pse oral liquid 0.938-10 mg/ml Formulary OTC ENTRESTO ORAL TABLET 24-26 MG, 49-51 MG, 97- Formulary QL (68 EA per 34 days) 103 MG ENTSOL NASAL NASAL SOLUTION 3 % Formulary OTC enulose oral solution 10 gm/15ml Formulary e-oil external oil 30000 unit Formulary OTC epa/gla oral capsule Formulary OTC EPANED ORAL SOLUTION 1 MG/ML Formulary AGE (Max 12 Years) ephedrine hcl oral tablet 25 mg Formulary OTC EPIDIOLEX ORAL SOLUTION 100 MG/ML Formulary PA epidural needle 18g x 2" , 18g x 4" Formulary OTC epinastine hcl ophthalmic solution 0.05 % Formulary epinephrine injection solution 30 mg/30ml Formulary epinephrine injection solution auto-injector 0.15 mg/0.3ml, Formulary 0.3 mg/0.3ml epinephrine injection solution prefilled syringe 1 mg/10ml Formulary epinephrine pf injection solution 1 mg/ml Formulary epinephrine pf injection solution prefilled syringe 1 Formulary mg/10ml epinephrine solution auto-injector 0.15 mg/0.15ml injection Formulary 0.15 mg/0.15ml epinephrine solution auto-injector 0.3 mg/0.3ml injection Formulary 0.3 mg/0.3ml EPIPEN 2-PAK SOLUTION AUTO-INJECTOR 0.3 Formulary MG/0.3ML INJECTION 0.3 MG/0.3ML EPIPEN JR 2-PAK SOLUTION AUTO-INJECTOR 0.15 Formulary MG/0.3ML INJECTION 0.15 MG/0.3ML epirubicin hcl intravenous solution 200 mg/100ml, 50 Formulary mg/25ml EPISORB TRANSDERMAL Formulary OTC EPITOL ORAL TABLET 200 MG Formulary EPIVIR HBV ORAL SOLUTION 5 MG/ML Formulary eplerenone oral tablet 25 mg, 50 mg Formulary

51 Drug Name Formulary Status Requirements/Limits eprosartan mesylate oral tablet 600 mg Formulary ST epsom salt oral granules Formulary OTC eq allergy relief childrens oral elixir 12.5 mg/5ml Formulary OTC eq allergy relief childrens oral liquid 12.5 mg/5ml Formulary OTC eq allergy relief oral tablet 10 mg Formulary OTC eq allergy/sinus headache oral tablet 12.5-30-500 mg Formulary OTC eq antibiotic + pain relief external cream 3.5-10000-10 Formulary OTC eq aspirin oral tablet delayed release 500 mg Formulary OTC EQ BABY CHEST RUB EXTERNAL CREAM Formulary OTC eq calcium citrate+d3 petites oral tablet 200-250 mg-unit Formulary OTC eq cough sugar free mouth/throat lozenge 5.8 mg Formulary OTC eq cryogenic wart removal sys external aerosol Formulary OTC eq daily fiber oral capsule 400 mg Formulary OTC eq dairy digestive fast acting oral tablet 9000 unit Formulary OTC eq dairy digestive fast acting oral tablet chewable 9000 unit Formulary OTC eq feminine wash sensitive vaginal liquid Formulary OTC eq ibuprofen pm oral tablet 200-38 mg Formulary OTC EQ MUCUS ER ORAL TABLET EXTENDED RELEASE Formulary OTC 12 HOUR 600 MG eq multi-symptom cold children oral liquid 2.5-5-100 mg/ml Formulary OTC eq omeprazole oral tablet delayed release 20 mg Formulary OTC eq pain relief/rapid burst oral liquid 500 mg/15ml Formulary OTC eq sinus relief max st oral tablet 30-500 mg Formulary OTC eq tioconazole 1 vaginal ointment 6.5 % Formulary OTC eq vitamins a & d external ointment Formulary OTC eql 2 in 1 probiotic oral tablet Formulary OTC eql advanced relief ophthalmic solution 0.05-0.1-1-1 % Formulary OTC eql alcohol swabs pad 70 % 70 % Formulary OTC eql aller-ease oral tablet 180 mg Formulary OTC; QL (34 EA per 34 days) eql allergy oral tablet 4 mg Formulary OTC eql aloe vera after sun external gel Formulary OTC eql antacid ultra strength oral tablet chewable 1000 mg Formulary OTC eql antibacterial hand soap external liquid 0.13 % Formulary OTC eql anti-nausea oral solution 1.87-1.87-21.5 Formulary OTC eql biotin oral capsule 5000 mcg Formulary OTC eql cold sore treatment external liquid 0.13-3 % Formulary OTC eql color lancets 21g Formulary OTC; QL (150 EA per 30 days) eql color lancets micro 33g Formulary OTC; QL (150 EA per 30 days) eql congestion relief oral tablet 10-200 mg Formulary OTC eql denture brush/pick Formulary OTC eql denture cleanser tablet effervescent Formulary OTC eql digestive enzymes oral tablet Formulary OTC eql ear drops otic solution Formulary OTC

52 Drug Name Formulary Status Requirements/Limits eql effervescent cold relief oral tablet effervescent 2-7.8- Formulary OTC 325 mg eql ethyl alcohol (rubbing) solution 70 % Formulary OTC eql everyday clean external shampoo 1 % Formulary OTC eql eye drops ac ophthalmic solution 0.05-0.25 % Formulary OTC eql fiber therapy oral powder 48.57 % Formulary OTC eql gas prevention oral capsule Formulary OTC eql gentle skin cleanser external liquid Formulary OTC eql insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC eql insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC eql insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC eql insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml Formulary OTC eql insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC eql insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC eql insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC eql insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC eql insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC eql lutein oral capsule 20 mg Formulary OTC eql /gargle mouth/throat liquid Formulary OTC eql mucus-dm oral tablet extended release 12 hour 30-600 Formulary OTC mg eql multi-purpose solution Formulary OTC eql omega 3 fish oil oral capsule delayed release 1200 mg Formulary OTC eql omeprazole oral tablet delayed release 20 mg Formulary OTC eql one daily womens oral tablet Formulary OTC eql redness relief ophthalmic solution 0.012-0.2 % Formulary OTC eql scalp relief max strength external liquid 3 % Formulary OTC eql super thin lancets 30g Formulary OTC; QL (150 EA per 30 days) eql thin lancets 26g Formulary OTC; QL (150 EA per 30 days) eql ultra protection spf50 external aerosol Formulary OTC eql vitamin d3 oral capsule 10 mcg (400 unit) Formulary OTC eql wet cleansing towelettes external Formulary OTC eql zinc cold relief mouth/throat lozenge Formulary OTC EQUALACTIN ORAL TABLET CHEWABLE 625 MG Formulary OTC ERBITUX INTRAVENOUS SOLUTION 100 MG/50ML, Formulary PA 200 MG/100ML ergocalciferol oral capsule 1.25 mg (50000 ut) Formulary ergocalciferol oral solution 8000 unit/ml Formulary OTC ergoloid mesylates oral tablet 1 mg Formulary ery external pad 2 % Formulary erythromycin base oral capsule delayed release particles Formulary 250 mg erythromycin ethylsuccinate oral suspension reconstituted Formulary 200 mg/5ml erythromycin ethylsuccinate oral tablet 400 mg Formulary

53 Drug Name Formulary Status Requirements/Limits erythromycin external gel 2 % Formulary erythromycin external solution 2 % Formulary AGE (Max 18 Years) erythromycin ophthalmic ointment 5 mg/gm Formulary escavite lq oral liquid 0.25-6 mg/ml Formulary escitalopram oxalate oral tablet 10 mg, 20 mg, 5 mg Formulary esmolol hcl intravenous solution 100 mg/10ml Formulary esomeprazole magnesium oral capsule delayed release 20 Formulary QL (30 EA per 30 days) mg, 40 mg ESOTERICA FADE NIGHTTIME EXTERNAL CREAM Formulary OTC 2 % ESOTERICA SENSITIVE SKIN EXTERNAL CREAM Formulary OTC 1.5 % ESTARYLLA ORAL TABLET 0.25-35 MG-MCG Formulary QL (28 EA per 28 days) estazolam oral tablet 1 mg, 2 mg Formulary estradiol oral tablet 0.5 mg, 1 mg, 2 mg Formulary estradiol transdermal patch twice weekly 0.025 mg/24hr, Formulary QL (8 EA per 34 days) 0.0375 mg/24hr, 0.05 mg/24hr, 0.075 mg/24hr estradiol transdermal patch twice weekly 0.1 mg/24hr Formulary QL (8 EA per 28 days) estradiol transdermal patch weekly 0.025 mg/24hr, 0.0375 mg/24hr, 0.05 mg/24hr, 0.06 mg/24hr, 0.075 mg/24hr, 0.1 Formulary QL (5 EA per 34 days) mg/24hr estradiol valerate intramuscular oil 20 mg/ml, 40 mg/ml Formulary estradiol-norethindrone acet oral tablet 0.5-0.1 mg, 1-0.5 Formulary mg estropipate oral tablet 0.75 mg Formulary eszopiclone oral tablet 1 mg, 2 mg, 3 mg Formulary QL (30 EA per 30 days) ethambutol hcl oral tablet 100 mg, 400 mg Formulary ethosuximide oral capsule 250 mg Formulary ethosuximide oral solution 250 mg/5ml Formulary ethyl alcohol (rubbing) solution 70 % Formulary OTC ethyl alcohol external solution 95 % Formulary OTC ethyl chloride external aerosol Formulary etidronate disodium oral tablet 200 mg, 400 mg Formulary etodolac er oral tablet extended release 24 hour 400 mg, Formulary 500 mg, 600 mg etodolac oral capsule 200 mg, 300 mg Formulary etodolac oral tablet 400 mg, 500 mg Formulary ETOPOPHOS INTRAVENOUS SOLUTION Formulary RECONSTITUTED 100 MG etoposide intravenous solution 1 gm/50ml, 100 mg/5ml Formulary etoposide oral capsule 50 mg Formulary etravirine oral tablet 100 mg, 200 mg Formulary eucalyptus oil external oil Formulary OTC EUCERIN ECZEMA RELIEF EXTERNAL CREAM 1 % Formulary OTC EUCERIN EXTERNAL CREAM Formulary OTC EUCERIN ORIGINAL HEALING EXTERNAL LOTION Formulary OTC

54 Drug Name Formulary Status Requirements/Limits EUFLEXXA INTRA-ARTICULAR SOLUTION Formulary PA PREFILLED SYRINGE 20 MG/2ML EURAX EXTERNAL CREAM 10 % Formulary ST EVAC-U-GEN ORAL TABLET 8.6 MG Formulary OTC evening primrose oil oral capsule 1000 mg, 500 mg Formulary OTC everolimus oral tablet 0.25 mg, 0.5 mg, 0.75 mg Formulary EXACTECH R-S-G TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) EXACTECH TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) EXACTUSS TR ORAL TABLET 10-28-388 MG Formulary OTC EXAPHEN CH ORAL TABLET 10-3.5-24 MG Formulary OTC EXAPHEN ORAL TABLET 3.5-10 MG Formulary OTC EXAPHEX TR ORAL TABLET 10-388 MG Formulary OTC EXCEDRIN EXTRA STRENGTH ORAL TABLET 250- Formulary OTC 250-65 MG EXCEDRIN PM ORAL TABLET 500-38 MG Formulary OTC EXCEDRIN TENSION HEADACHE ORAL TABLET Formulary OTC 500-65 MG EXCEL AP EXTERNAL SWAB 7.5-72 % Formulary OTC EXEL COMFORT POINT INSULIN SYR 28G X 1/2" 0.5 Formulary OTC ML 28G X 1/2" 0.5 ML EXEL COMFORT POINT INSULIN SYR 28G X 1/2" 1 Formulary OTC ML 28G X 1/2" 1 ML EXEL COMFORT POINT INSULIN SYR 29G X 1/2" 0.3 Formulary OTC ML 29G X 1/2" 0.3 ML EXEL COMFORT POINT INSULIN SYR 29G X 1/2" 0.5 Formulary OTC ML 29G X 1/2" 0.5 ML EXEL COMFORT POINT INSULIN SYR 29G X 1/2" 1 Formulary OTC ML 29G X 1/2" 1 ML EXEL COMFORT POINT INSULIN SYR 30G X 5/16" 0.3 Formulary OTC ML 30G X 5/16" 0.3 ML EXEL COMFORT POINT INSULIN SYR 30G X 5/16" 0.5 Formulary OTC ML 30G X 5/16" 0.5 ML EXEL COMFORT POINT INSULIN SYR 30G X 5/16" 1 Formulary OTC ML 30G X 5/16" 1 ML exemestane oral tablet 25 mg Formulary EXFOLIX EXFOLIATING FOOT SOAP EXTERNAL Formulary OTC BAR EX-LAX MAXIMUM STRENGTH ORAL TABLET 25 Formulary OTC MG EX-LAX ORAL TABLET 15 MG Formulary OTC EX-LAX ORAL TABLET CHEWABLE 15 MG Formulary OTC exoten-c pain relief external lotion 0.001-10-20 %, 0.025- Formulary OTC 10-20 % exotic-hc otic solution 10-10-1 mg/ml Formulary EXTRESS-30 ORAL CAPSULE EXTENDED RELEASE Formulary OTC eye allergy relief ophthalmic solution 0.027-0.315 % Formulary OTC eye drops ophthalmic solution 0.012-0.2 % Formulary OTC eye itch relief ophthalmic solution 0.025 % Formulary OTC 55 Drug Name Formulary Status Requirements/Limits EYE STREAM OPHTHALMIC SOLUTION Formulary OTC E-Z JECT LANCET MICRO-THIN 33G Formulary OTC; QL (150 EA per 30 days) E-Z JECT LANCET SUPER THIN 30G Formulary OTC; QL (150 EA per 30 days) E-Z JECT LANCETS Formulary OTC; QL (150 EA per 30 days) E-Z JECT LANCETS 21G Formulary OTC; QL (150 EA per 30 days) E-Z JECT LANCETS THIN 26G Formulary OTC; QL (150 EA per 30 days) EZ SMART BLOOD GLUCOSE LANCETS Formulary OTC; QL (150 EA per 30 days) ezetimibe oral tablet 10 mg Formulary ezetimibe-simvastatin oral tablet 10-10 mg, 10-20 mg, 10- Formulary ST 40 mg, 10-80 mg EZFE 200 ORAL CAPSULE 434.8 (200 FE) MG Formulary OTC ezfe forte oral capsule 155-1 mg Formulary OTC E-Z-GAS II ORAL PACKET 2.21-1.53-0.04 GM Formulary OTC EZ-LETS LANCETS 21G Formulary OTC; QL (150 EA per 30 days) EZ-LETS LANCETS 23G Formulary OTC; QL (150 EA per 30 days) EZ-LETS LANCETS 28G Formulary OTC; QL (150 EA per 30 days) fabb oral tablet 2.2-25-1 mg Formulary famciclovir oral tablet 125 mg, 250 mg, 500 mg Formulary famotidine oral suspension reconstituted 40 mg/5ml Formulary famotidine oral tablet 10 mg Formulary OTC famotidine oral tablet 20 mg, 40 mg Formulary FARESTON ORAL TABLET 60 MG Formulary FARXIGA ORAL TABLET 10 MG, 5 MG Formulary PA; AGE (Min 18 Years) FAST FREEZE PRO STYLE THERAPY EXTERNAL Formulary OTC GEL 3.5 % FAST FREEZE PRO STYLE THERAPY EXTERNAL Formulary OTC LIQUID 3.5 % fast-heat heating pad pad Formulary OTC father johns medicine oral syrup 10 mg/5ml Formulary OTC fa-vitamin b-6-vitamin b-12 oral tablet 2.2-25-0.5 mg Formulary FAYOSIM ORAL TABLET 42-21-21-7 DAYS Formulary QL (91 EA per 91 days) FC FEMALE CONDOM Formulary OTC febuxostat oral tablet 40 mg, 80 mg Formulary QL (34 EA per 34 days) feeding bottles/standard neck Formulary OTC FEIBA INTRAVENOUS SOLUTION RECONSTITUTED Formulary , 1000 UNIT, 2500 UNIT, 500 UNIT felbamate oral suspension 600 mg/5ml Formulary felbamate oral tablet 400 mg, 600 mg Formulary felodipine er oral tablet extended release 24 hour 10 mg, Formulary 2.5 mg, 5 mg FEM PH VAGINAL GEL 0.9-0.025 % Formulary FEMINEASE VAGINAL CREAM Formulary OTC fenofibrate micronized oral capsule 134 mg, 200 mg, 67 mg Formulary fenofibrate oral tablet 145 mg, 160 mg, 48 mg, 54 mg Formulary fenofibric acid oral capsule delayed release 135 mg, 45 mg Formulary

56 Drug Name Formulary Status Requirements/Limits fenofibric acid tablet 105 mg oral 105 mg Formulary fenofibric acid tablet 35 mg oral 35 mg Formulary fenoprofen calcium capsule 200 mg oral 200 mg Formulary fentanyl citrate (pf) injection solution cartridge 100 Formulary mcg/2ml fentanyl citrate buccal lozenge on a handle 1200 mcg, 1600 Formulary PA; QL (120 EA per 30 days) mcg, 200 mcg, 400 mcg, 600 mcg, 800 mcg fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, Formulary PA; QL (10 EA per 34 days) 25 mcg/hr, 50 mcg/hr, 75 mcg/hr FER-IN-SOL ORAL SOLUTION 75 (15 FE) MG/ML Formulary OTC ferocon oral capsule Formulary ferraplus 90 oral tablet 90-1 mg Formulary ferretts chewable iron oral tablet chewable 18 mg Formulary OTC ferretts ips oral solution 40 mg/15ml Formulary OTC ferretts oral tablet 325 (106 fe) mg Formulary OTC FERREX 150 FORTE PLUS ORAL CAPSULE 50-100 Formulary OTC MG FERREX 150 ORAL CAPSULE 150 MG Formulary OTC FERREX 28 ORAL Formulary OTC FERRIMIN 150 ORAL TABLET 150 MG Formulary OTC FERROCITE ORAL TABLET 324 MG Formulary OTC FERROCITE PLUS ORAL TABLET 106-1 MG Formulary ferrous gluconate oral tablet 324 (37.5 fe) mg, 324 (38 fe) Formulary OTC mg ferrous sulfate er oral tablet extended release 140 (45 fe) Formulary OTC mg ferrous sulfate oral elixir 220 (44 fe) mg/5ml Formulary OTC ferrous sulfate oral liquid 220 (44 fe) mg/5ml Formulary OTC ferrous sulfate oral syrup 300 (60 fe) mg/5ml Formulary OTC ferrous sulfate oral tablet delayed release 324 (65 fe) mg, Formulary OTC 325 (65 fe) mg FEVERALL INFANTS RECTAL SUPPOSITORY 80 MG Formulary OTC FEVERALL JUNIOR STRENGTH RECTAL Formulary OTC SUPPOSITORY 325 MG fexofenadine hcl childrens oral suspension 30 mg/5ml Formulary OTC fiber laxative oral tablet 625 mg Formulary OTC fiber oral powder Formulary OTC fiber therapy oral tablet 500 mg Formulary OTC FIBERCON ORAL TABLET 625 MG Formulary OTC FIBEREX F15 ORAL LIQUID 15 GM/30ML Formulary OTC FIFTY50 ALCOHOL PREP PAD 70 % 70 % Formulary OTC FIFTY50 SUPERIOR COMFORT SYR 31G X 5/16" 0.3 Formulary OTC ML 31G X 5/16" 0.3 ML FIFTY50 SUPERIOR COMFORT SYR 31G X 5/16" 0.5 Formulary OTC ML 31G X 5/16" 0.5 ML FIFTY50 SUPERIOR COMFORT SYR 31G X 5/16" 1 ML Formulary OTC 31G X 5/16" 1 ML 57 Drug Name Formulary Status Requirements/Limits filter needle 18g x 1-1/2" Formulary finasteride oral tablet 5 mg Formulary FINE 30 Formulary OTC; QL (150 EA per 30 days) first aid antibiotic external ointment 4 % Formulary OTC first aid antiseptic external ointment 10 % Formulary OTC first aid antiseptic spray external aerosol 20-0.13 % Formulary OTC FIRVANQ ORAL SOLUTION RECONSTITUTED 25 Formulary MG/ML, 50 MG/ML fish oil + d3 oral capsule 1000-1000 mg-unit Formulary OTC fish oil adult gummies oral tablet chewable 113.5 mg Formulary OTC fish oil oral capsule 1200 mg, 500 mg, 600 mg Formulary OTC fish oil oral capsule delayed release 1000 mg Formulary OTC fish oil-flax oil-borage oil oral capsule Formulary OTC flavor packets oral packet Formulary OTC flavoxate hcl oral tablet 100 mg Formulary flecainide acetate oral tablet 100 mg, 150 mg, 50 mg Formulary FLEET BISACODYL RECTAL ENEMA 10 MG/30ML Formulary OTC FLEET LIQUID GLYCERIN SUPP RECTAL ENEMA 5.4 Formulary OTC GM/DOSE FLEET NATURALS CLEANSING ENEMA RECTAL Formulary OTC ENEMA FLEET OIL RECTAL ENEMA Formulary OTC FLEET PEDIATRIC RECTAL ENEMA 3.5-9.5 GM/59ML Formulary OTC FLEXBUMIN INTRAVENOUS SOLUTION 25 %, 5 % Formulary FLEXICHAMBER CHILD MASK/LARGE Formulary FLINTSTONES TODDLER ORAL TABLET Formulary OTC CHEWABLE 40 MG FLOGEN ORAL TABLET 250-650 MG Formulary OTC FLONASE ALLERGY RELIEF SUSPENSION 50 Formulary OTC MCG/ACT NASAL 50 MCG/ACT FLONASE SENSIMIST NASAL SUSPENSION 27.5 Formulary OTC MCG/SPRAY FLORA ASSIST ORAL PACKET Formulary OTC FLORANEX ORAL PACKET Formulary OTC FLORASTOR KIDS ORAL PACKET 250 MG Formulary OTC FLORASTOR ORAL CAPSULE 250 MG Formulary OTC FLORICAL ORAL CAPSULE 8.3-364 MG Formulary OTC FLORICAL ORAL TABLET 8.3-364 MG Formulary OTC FLOVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 100 MCG/BLIST, 250 Formulary MCG/BLIST, 50 MCG/BLIST FLOVENT HFA INHALATION AEROSOL 110 Formulary MCG/ACT, 220 MCG/ACT, 44 MCG/ACT flow-eze vented needle Formulary OTC FLOWING VAPORS PAD Formulary OTC FLOWING VAPORS/VAPOR FAN PAD Formulary OTC

58 Drug Name Formulary Status Requirements/Limits floxuridine injection solution reconstituted 0.5 gm Formulary flu hbp oral tablet 15-500-2 mg Formulary OTC FLUAD QUADRIVALENT INTRAMUSCULAR Formulary AGE (Min 19 Years) PREFILLED SYRINGE 0.5 ML FLUCAINE OPHTHALMIC SOLUTION 0.25-0.5 % Formulary FLUCELVAX QUADRIVALENT INTRAMUSCULAR Formulary AGE (Min 19 Years) SUSPENSION FLUCELVAX QUADRIVALENT INTRAMUSCULAR Formulary AGE (Min 19 Years) SUSPENSION PREFILLED SYRINGE 0.5 ML fluconazole oral suspension reconstituted 10 mg/ml, 40 Formulary mg/ml fluconazole oral tablet 100 mg, 150 mg, 200 mg, 50 mg Formulary fludarabine phosphate intravenous solution 50 mg/2ml Formulary fludarabine phosphate intravenous solution reconstituted 50 Formulary mg fludrocortisone acetate oral tablet 0.1 mg Formulary flunisolide nasal solution 25 mcg/act (0.025%) Formulary QL (25 ML per 34 days) fluocinolone acetonide body external oil 0.01 % Formulary fluocinolone acetonide external cream 0.01 %, 0.025 % Formulary fluocinolone acetonide external ointment 0.025 % Formulary fluocinolone acetonide external solution 0.01 % Formulary fluocinolone acetonide otic oil 0.01 % Formulary fluocinolone acetonide scalp external oil 0.01 % Formulary fluocinonide emulsified base external cream 0.05 % Formulary fluocinonide external cream 0.05 %, 0.1 % Formulary fluocinonide external gel 0.05 % Formulary fluocinonide external ointment 0.05 % Formulary fluoride mouth rinse mouth/throat solution 0.0221 (0.01 f) Formulary OTC % fluoritab oral solution 0.275 (0.125 f) mg/drop Formulary fluorometholone ophthalmic suspension 0.1 % Formulary fluorouracil external cream 5 % Formulary fluorouracil external solution 2 %, 5 % Formulary fluorouracil intravenous solution 1 gm/20ml Formulary fluoxetine hcl oral capsule 10 mg, 20 mg, 40 mg Formulary fluoxetine hcl oral solution 20 mg/5ml Formulary fluoxetine hcl oral tablet 10 mg Formulary QL (34 EA per 34 days) fluphenazine decanoate injection solution 25 mg/ml Formulary AGE (Min 18 Years) fluphenazine hcl injection solution 2.5 mg/ml Formulary AGE (Min 18 Years) fluphenazine hcl oral concentrate 5 mg/ml Formulary AGE (Min 18 Years) fluphenazine hcl oral elixir 2.5 mg/5ml Formulary AGE (Min 18 Years) fluphenazine hcl oral tablet 1 mg, 10 mg, 2.5 mg, 5 mg Formulary AGE (Min 18 Years) flurazepam hcl oral capsule 15 mg, 30 mg Formulary QL (68 EA per 34 days) flurbiprofen oral tablet 100 mg, 50 mg Formulary flurbiprofen sodium ophthalmic solution 0.03 % Formulary

59 Drug Name Formulary Status Requirements/Limits flutamide oral capsule 125 mg Formulary propionate external cream 0.05 % Formulary fluticasone propionate external ointment 0.005 % Formulary fluticasone propionate nasal suspension 50 mcg/act Formulary fluticasone-salmeterol inhalation aerosol powder breath activated 100-50 mcg/dose, 250-50 mcg/dose, 500-50 Formulary mcg/dose fluvoxamine maleate oral tablet 100 mg, 25 mg, 50 mg Formulary FLUZONE HIGH-DOSE INTRAMUSCULAR Formulary AGE (Min 19 Years) SUSPENSION PREFILLED SYRINGE 0.5 ML FLUZONE HIGH-DOSE QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED Formulary AGE (Min 19 Years) SYRINGE 0.7 ML FLUZONE QUADRIVALENT INTRAMUSCULAR Formulary AGE (Min 19 Years) SUSPENSION , 0.5 ML FLUZONE QUADRIVALENT INTRAMUSCULAR Formulary AGE (Min 19 Years) SUSPENSION PREFILLED SYRINGE 0.25 ML, 0.5 ML FOILLE EXTERNAL OINTMENT 5-0.1 % Formulary OTC FOLET DHA ORAL THERAPY PACK 38-1 & 350 MG Formulary FOLGARD ORAL TABLET Formulary OTC FOLGARD OS ORAL TABLET 500-1.1 MG Formulary FOLIC + B12 ORAL TABLET 800-1000 MCG Formulary OTC folic acid oral capsule 0.8 mg, 20 mg, 5 mg Formulary OTC folic acid oral tablet 1 mg Formulary folic acid oral tablet 400 mcg, 800 mcg Formulary OTC folinic-plus oral tablet 4-50-2 mg Formulary OTC FOLITAB 500 ORAL TABLET EXTENDED RELEASE Formulary OTC 105-500-0.8 MG FOLIVANE-F ORAL CAPSULE 125-1 MG Formulary FOLIVANE-PLUS ORAL CAPSULE Formulary FOLOTYN INTRAVENOUS SOLUTION 20 MG/ML Formulary foot powder external powder Formulary OTC FORA D40 GLUCOSE/PRESSURE DEVICE Formulary OTC FORA LANCETS Formulary OTC; QL (150 EA per 30 days) FORADIL AEROLIZER INHALATION CAPSULE 12 Formulary MCG FORMADON EXTERNAL SOLUTION 10 % Formulary formaldehyde external solution 37 % Formulary FORMA-RAY EXTERNAL SOLUTION 20 % Formulary formoterol fumarate inhalation nebulization solution 20 Formulary QL (120 ML per 30 days) mcg/2ml FORTEO SUBCUTANEOUS SOLUTION 600 Formulary PA; QL (2.4 ML per 28 days) MCG/2.4ML FORTEO SUBCUTANEOUS SOLUTION PEN- Formulary QL (2.4 ML per 30 days) INJECTOR 620 MCG/2.48ML fosamprenavir calcium oral tablet 700 mg Formulary fosfomycin tromethamine oral packet 3 gm Formulary QL (3 EA per 30 days)

60 Drug Name Formulary Status Requirements/Limits fosinopril sodium oral tablet 10 mg, 20 mg, 40 mg Formulary fosinopril sodium-hctz oral tablet 10-12.5 mg, 20-12.5 mg Formulary fosphenytoin sodium injection solution 100 mg pe/2ml, 500 Formulary mg pe/10ml freds pharmacy unilet lanc 28g Formulary OTC; QL (150 EA per 30 days) FREE & CLEAR EXTERNAL LIQUID Formulary OTC FREE & CLEAR EXTERNAL SHAMPOO Formulary OTC FREESTYLE CONTROL SOLUTION LIQUID IN VITRO Formulary OTC; QL (100 EA per 30 days) FREESTYLE FLASH SYSTEM KIT Formulary OTC; QL (1 EA per 365 days) FREESTYLE FREEDOM KIT Formulary OTC; QL (1 EA per 365 days) FREESTYLE FREEDOM LITE KIT W/DEVICE Formulary OTC; QL (1 EA per 365 days) W/DEVICE FREESTYLE INSULINX SYSTEM KIT W/DEVICE Formulary OTC; QL (1 EA per 365 days) W/DEVICE FREESTYLE INSULINX TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) FREESTYLE LANCETS Formulary OTC; QL (150 EA per 30 days) FREESTYLE LIBRE 14 DAY READER DEVICE Formulary FREESTYLE LIBRE 14 DAY SENSOR Formulary FREESTYLE LIBRE 2 READER SYSTM DEVICE Formulary FREESTYLE LIBRE 2 SENSOR SYSTM Formulary FREESTYLE LIBRE READER DEVICE Formulary QL (1 EA per 365 days) FREESTYLE LIBRE SENSOR SYSTEM Formulary QL (3 EA per 30 days) FREESTYLE LITE TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) FREESTYLE PRECISION INS SYR 30G X 5/16" 0.5 ML Formulary OTC 30G X 5/16" 0.5 ML FREESTYLE PRECISION INS SYR 30G X 5/16" 1 ML Formulary OTC 30G X 5/16" 1 ML FREESTYLE PRECISION INS SYR 31G X 5/16" 0.5 ML Formulary OTC 31G X 5/16" 0.5 ML FREESTYLE PRECISION INS SYR 31G X 5/16" 1 ML Formulary OTC 31G X 5/16" 1 ML FREESTYLE PRECISION NEO SYSTEM KIT Formulary OTC; QL (1 EA per 365 days) W/DEVICE FREESTYLE PRECISION NEO TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) FREESTYLE SIDEKICK II KIT Formulary OTC; QL (1 EA per 365 days) FREESTYLE SYSTEM KIT Formulary OTC; QL (1 EA per 365 days) FREESTYLE TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) fruit c oral tablet chewable 100 mg Formulary OTC fulvestrant intramuscular solution 250 mg/5ml Formulary FUNGI-NAIL EXTERNAL SOLUTION 25 % Formulary OTC FUNGI-NAIL TOE & FOOT EXTERNAL OINTMENT 5- Formulary OTC 20 % FUNGOID TINCTURE EXTERNAL KIT 2 % Formulary OTC FUNGOID TINCTURE EXTERNAL SOLUTION 2 % Formulary OTC FUNGOID-D EXTERNAL CREAM 1 % Formulary OTC furosemide oral solution 10 mg/ml Formulary

61 Drug Name Formulary Status Requirements/Limits furosemide oral tablet 20 mg, 40 mg, 80 mg Formulary FUSION ORAL CAPSULE 65-65-25-30 MG Formulary OTC FUZEON SUBCUTANEOUS SOLUTION Formulary PA RECONSTITUTED 90 MG FYAVOLV ORAL TABLET 1-5 MG-MCG Formulary gabapentin oral capsule 100 mg, 300 mg, 400 mg Formulary gabapentin oral solution 250 mg/5ml Formulary gabapentin oral tablet 600 mg, 800 mg Formulary galantamine hydrobromide er oral capsule extended release Formulary 24 hour 16 mg, 24 mg, 8 mg galantamine hydrobromide oral solution 4 mg/ml Formulary galantamine hydrobromide oral tablet 12 mg, 4 mg, 8 mg Formulary GARDASIL 9 INTRAMUSCULAR SUSPENSION Formulary AGE (Min 19 Years) GARDASIL 9 INTRAMUSCULAR SUSPENSION Formulary AGE (Min 19 Years) PREFILLED SYRINGE garlic/epa oral capsule 60-90-250 mg Formulary OTC garlic-lecithin oral capsule 192-650 mg Formulary OTC garlic-parsley oral tablet 100-175 mg Formulary OTC gas relief oral liquid 40 mg/0.6ml Formulary OTC GAS-X CHILDRENS ORAL STRIP 40 MG Formulary OTC GAS-X EXTRA STRENGTH ORAL STRIP 62.5 MG Formulary OTC GAS-X EXTRA STRENGTH ORAL TABLET Formulary OTC CHEWABLE 125 MG GAS-X ORAL TABLET CHEWABLE 80 MG Formulary OTC GAS-X PREVENTION ORAL CAPSULE Formulary OTC GAS-X WITH MAALOX EX ST ORAL TABLET Formulary OTC CHEWABLE 500-125 MG GAVILYTE-C ORAL SOLUTION RECONSTITUTED Formulary 240 GM GAVILYTE-G ORAL SOLUTION RECONSTITUTED Formulary 236 GM GAVILYTE-N WITH FLAVOR PACK ORAL Formulary SOLUTION RECONSTITUTED 420 GM GAVISCON EXTRA STRENGTH ORAL SUSPENSION Formulary OTC 254-237.5 MG/5ML GAVISCON EXTRA STRENGTH ORAL TABLET Formulary OTC CHEWABLE 160-105 MG GAVISCON ORAL SUSPENSION 95-358 MG/15ML Formulary OTC GAVISCON ORAL TABLET CHEWABLE 80-14.2 MG Formulary OTC G-BUCAL-C MOUTH/THROAT SOLUTION 0.15-0.1 % Formulary OTC G-DOLOGEN ORAL TABLET 2-650 MG Formulary OTC ge-150 oral capsule 150 mg Formulary OTC GEBAUERS INSTANT ICE EXTERNAL AEROSOL Formulary OTC gelatin oral capsule 650 mg Formulary OTC GELFOAM SPONGE EXTERNAL 12-7 MM Formulary GELFOAM SPONGE SIZE 100 EXTERNAL Formulary

62 Drug Name Formulary Status Requirements/Limits GEL-KAM DENTAL GEL 0.4 % Formulary OTC GELONASAL NASAL SOLUTION Formulary OTC GELUSIL ORAL TABLET CHEWABLE 200-200-25 MG Formulary OTC gemcitabine hcl intravenous solution 1 gm/26.3ml, 2 Formulary gm/52.6ml, 200 mg/5.26ml gemcitabine hcl intravenous solution reconstituted 1 gm, 2 Formulary gm, 200 mg gemfibrozil oral tablet 600 mg Formulary GENCONTUSS ORAL LIQUID 5-2-10 MG/5ML Formulary OTC GENOTROPIN MINIQUICK SOLUTION Formulary PA RECONSTITUTED 0.2 MG SUBCUTANEOUS 0.2 MG GENOTROPIN MINIQUICK SOLUTION Formulary PA RECONSTITUTED 0.4 MG SUBCUTANEOUS 0.4 MG GENOTROPIN MINIQUICK SOLUTION Formulary PA RECONSTITUTED 0.6 MG SUBCUTANEOUS 0.6 MG GENOTROPIN MINIQUICK SOLUTION Formulary PA RECONSTITUTED 0.8 MG SUBCUTANEOUS 0.8 MG GENOTROPIN MINIQUICK SOLUTION Formulary PA RECONSTITUTED 1 MG SUBCUTANEOUS 1 MG GENOTROPIN MINIQUICK SOLUTION Formulary PA RECONSTITUTED 1.2 MG SUBCUTANEOUS 1.2 MG GENOTROPIN MINIQUICK SOLUTION Formulary PA RECONSTITUTED 1.4 MG SUBCUTANEOUS 1.4 MG GENOTROPIN MINIQUICK SOLUTION Formulary PA RECONSTITUTED 1.6 MG SUBCUTANEOUS 1.6 MG GENOTROPIN MINIQUICK SOLUTION Formulary PA RECONSTITUTED 1.8 MG SUBCUTANEOUS 1.8 MG GENOTROPIN MINIQUICK SOLUTION Formulary PA RECONSTITUTED 2 MG SUBCUTANEOUS 2 MG GENOTROPIN SOLUTION RECONSTITUTED 12 MG Formulary PA SUBCUTANEOUS 12 MG GENOTROPIN SOLUTION RECONSTITUTED 5 MG Formulary PA SUBCUTANEOUS 5 MG gentamicin sulfate external cream 0.1 % Formulary gentamicin sulfate external ointment 0.1 % Formulary gentamicin sulfate ophthalmic solution 0.3 % Formulary GENTEAL MILD OPHTHALMIC SOLUTION 0.2 % Formulary OTC GENTEAL MILD TO MODERATE OPHTHALMIC Formulary OTC SOLUTION 0.3 % GENTEAL OPHTHALMIC GEL 0.25-0.3 % Formulary OTC GENTEAL TEARS PF OPHTHALMIC SOLUTION 0.1- Formulary OTC 0.3 % gentian violet external solution 1 %, 2 % Formulary OTC gentle laxative rectal suppository 10 mg Formulary OTC GENTLE RAIN EXTERNAL LIQUID 0.3 % Formulary OTC gentle skin cleanser external lotion Formulary OTC GENTLE-LET GP LANCETS Formulary OTC; QL (150 EA per 30 days) GENTLE-LET LANCETS Formulary OTC; QL (150 EA per 30 days)

63 Drug Name Formulary Status Requirements/Limits GENVOYA ORAL TABLET 150-150-200-10 MG Formulary geravine oral elixir Formulary OTC geriatric vitamin oral liquid 100-1-10 Formulary OTC geri-lanta supreme oral suspension 400-135 mg/5ml Formulary OTC gerisilk bath oil external oil Formulary OTC GERMBLOC HEALTH EXTERNAL FOAM 0.1 % Formulary OTC GILTUSS COUGH & COLD ORAL LIQUID 10-29-390 Formulary OTC MG/5ML ginger root oral capsule 500 mg Formulary OTC ginseng oral capsule 100 mg, 250 mg, 50 mg Formulary OTC gla-45 oral capsule 45 mg Formulary OTC glass syringe 3 ml kit Formulary glatiramer acetate subcutaneous solution prefilled syringe Formulary 20 mg/ml, 40 mg/ml glen pe oral liquid 16-5 mg/5ml Formulary OTC glenmax peb dm forte oral liquid 10-4-20 mg/5ml Formulary OTC glenmax peb dm oral liquid 5-2-10 mg/5ml Formulary OTC; AGE (Min 2 Years) glenmax peb oral liquid 4-10 mg/5ml Formulary OTC glentuss oral liquid 30-6.25-15 mg/5ml Formulary OTC g-levocarnitine s/f oral solution 1 gm/10ml Formulary OTC glimepiride oral tablet 1 mg, 2 mg, 4 mg Formulary glipizide er oral tablet extended release 24 hour 10 mg, 2.5 Formulary mg, 5 mg glipizide oral tablet 10 mg, 5 mg Formulary glipizide xl oral tablet extended release 24 hour 10 mg, 2.5 Formulary mg, 5 mg glipizide-metformin hcl oral tablet 2.5-250 mg, 2.5-500 mg, Formulary 5-500 mg global inject ease insulin syr 29g x 1/2" 1 ml 29g x 1/2" 1 Formulary OTC ml global inject ease insulin syr 30g x 1/2" 1 ml 30g x 1/2" 1 Formulary OTC ml global insulin 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 Formulary OTC ml GLUCAGEN HYPOKIT INJECTION SOLUTION Formulary QL (2 EA per 34 days) RECONSTITUTED 1 MG glucagon emergency injection kit 1 mg Formulary QL (2 EA per 34 days) GLUCOCOM AUTOLINK TELEMONITOR Formulary OTC GLUCOCOM LANCETS 28G Formulary OTC; QL (150 EA per 30 days) GLUCOCOM LANCETS 30G Formulary OTC; QL (150 EA per 30 days) GLUCOCOM LANCETS 33G Formulary OTC; QL (150 EA per 30 days) GLUCOPRO INSULIN SYRINGE 30G X 1/2" 0.3 ML Formulary OTC 30G X 1/2" 0.3 ML GLUCOPRO INSULIN SYRINGE 30G X 1/2" 0.5 ML Formulary OTC 30G X 1/2" 0.5 ML GLUCOPRO INSULIN SYRINGE 30G X 1/2" 1 ML 30G Formulary OTC X 1/2" 1 ML

64 Drug Name Formulary Status Requirements/Limits GLUCOPRO INSULIN SYRINGE 30G X 5/16" 0.3 ML Formulary OTC 30G X 5/16" 0.3 ML GLUCOPRO INSULIN SYRINGE 30G X 5/16" 0.5 ML Formulary OTC 30G X 5/16" 0.5 ML GLUCOPRO INSULIN SYRINGE 30G X 5/16" 1 ML 30G Formulary OTC X 5/16" 1 ML GLUCOPRO INSULIN SYRINGE 31G X 5/16" 0.3 ML Formulary OTC 31G X 5/16" 0.3 ML GLUCOPRO INSULIN SYRINGE 31G X 5/16" 0.5 ML Formulary OTC 31G X 5/16" 0.5 ML GLUCOPRO INSULIN SYRINGE 31G X 5/16" 1 ML 31G Formulary OTC X 5/16" 1 ML glucosamine chond complex/msm oral tablet Formulary OTC glucosamine chondroitin complx oral capsule 500-250 mg Formulary OTC glucosamine complex/vitamin d3 oral tablet Formulary OTC glucosamine hcl oral tablet 1500 mg Formulary OTC glucosamine sulfate oral capsule 1000 mg, 500 mg Formulary OTC glucosamine sulfate oral tablet 1000 mg, 500 mg Formulary OTC glucosamine-chondroitin oral capsule 250-200 mg, 500-400 Formulary OTC mg glucosamine-chondroitin oral liquid 1500-1200 mg/30ml Formulary OTC glucosamine-chondroitin oral tablet 500-400 mg, 750-600 Formulary OTC mg glucosamine-chondroitin-msm oral tablet 400-333.3-200 Formulary OTC mg, 500-400-167 mg glucosamine-chondroitin-vit d3 oral packet 1500-1200-800 Formulary OTC mg-mg-unit glucosamine-msm oral liquid 1500-500 mg/30ml Formulary OTC GLUCOSE NURSETTE ORAL SOLUTION 5 % Formulary OTC glucose oral gel 40 % Formulary OTC glucose oral liquid 15 gm/59ml Formulary OTC glucose oral tablet chewable 4 gm, 4-6 gm-mg Formulary OTC glutamine oral capsule 500 mg Formulary OTC glutathione oral tablet 50 mg Formulary OTC glutol oral liquid Formulary OTC glyburide micronized oral tablet 1.5 mg, 3 mg, 6 mg Formulary glyburide oral tablet 1.25 mg, 2.5 mg, 5 mg Formulary glyburide-metformin oral tablet 1.25-250 mg, 2.5-500 mg, Formulary 5-500 mg glycerin (adult) rectal suppository 2 gm Formulary OTC glycerin (infants & children) rectal suppository 1 gm, 1.2 Formulary OTC gm glycerin external liquid Formulary OTC glycine500 oral packet 500 mg Formulary OTC glycolic acid solution 70 % Formulary glycopyrrolate oral tablet 1 mg, 2 mg Formulary GLYDO EXTERNAL GEL 2 % Formulary

65 Drug Name Formulary Status Requirements/Limits GLYXAMBI ORAL TABLET 10-5 MG, 25-5 MG Formulary ST; AGE (Min 18 Years) g-myco nail external solution Formulary OTC gnp 24 hour nasal allergy aerosol 55 mcg/act nasal 55 Formulary OTC mcg/act gnp 4x probiotic oral tablet Formulary OTC gnp advanced eye health oral capsule 250-2.5-0.5 mg Formulary OTC gnp alcohol denatured solution Formulary OTC gnp alcohol swabs pad 70 % 70 % Formulary OTC gnp allergy & sinus headache oral tablet 25-10-650 mg Formulary OTC gnp allergy pls sinus headache oral tablet 12.5-5-325 mg Formulary OTC gnp animal shapes plus iron oral tablet chewable 15 mg Formulary OTC gnp antacid & anti-gas oral tablet chewable 1000-60 mg Formulary OTC gnp antacid oral tablet chewable 550-110 mg Formulary OTC gnp b-50 complex oral tablet extended release Formulary OTC gnp b-complex plus vitamin c oral tablet Formulary OTC gnp calamine external lotion 8-8 % Formulary OTC gnp calcium 600 plus d/mineral oral tablet 600-400 mg-unit Formulary OTC gnp calcium plus 600 +d oral tablet 600-200 mg-unit Formulary OTC gnp capsaicin external liquid 0.15 % Formulary OTC gnp childrens chewables/ex c oral tablet chewable Formulary OTC gnp cold & hot extra strength external ointment 7.6-29 % Formulary OTC gnp cold sore treatment external liquid 0.13 % Formulary OTC gnp coq-10 & fish oil oral capsule 120-180-50-30 Formulary OTC gnp ethyl alcohol solution 70 % Formulary OTC gnp fish oil oral capsule 435 mg Formulary OTC gnp flu/severe cold daytime oral packet 10-650 mg Formulary OTC gnp gentian violet external solution 1 % Formulary OTC gnp glycerin/rose water external solution 10 % Formulary OTC gnp headache relief extra str oral tablet 250-250-65 mg Formulary OTC gnp hydrogen peroxide wipes external 3 % Formulary OTC gnp insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC gnp insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC gnp insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC gnp insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC gnp insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC gnp insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml Formulary OTC gnp insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC gnp insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC gnp insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC gnp insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC gnp insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC gnp iodides external tincture Formulary OTC gnp iodine external tincture Formulary OTC gnp isopropyl alcohol wipes 70 % external 70 % Formulary OTC

66 Drug Name Formulary Status Requirements/Limits gnp lancets Formulary OTC; QL (150 EA per 30 days) gnp lancets 21g Formulary OTC; QL (150 EA per 30 days) gnp lancets micro thin 33g Formulary OTC; QL (150 EA per 30 days) gnp lancets super thin 30g Formulary OTC; QL (150 EA per 30 days) gnp lancets thin 26g Formulary OTC; QL (150 EA per 30 days) gnp lice egg remover external gel Formulary OTC gnp liquid bandage external liquid 0.75-0.2 % Formulary OTC gnp l-lysine oral tablet 600 mg Formulary OTC gnp micro thin lancets 33g Formulary OTC; QL (150 EA per 30 days) gnp natural fiber oral capsule 0.52 gm Formulary OTC gnp niacin oral tablet 250 mg Formulary OTC gnp night time cold & flu oral capsule 15-6.25-325 mg Formulary OTC gnp omeprazole oral tablet delayed release 20 mg Formulary OTC gnp pain relief/benzocaine external pad 6-70 % Formulary OTC gnp potassium oral tablet 99 mg Formulary OTC gnp shampoo & body wash external liquid Formulary OTC gnp sinus wash refill nasal packet 2300-700 mg Formulary OTC gnp super thin lancets 30g Formulary OTC; QL (150 EA per 30 days) gnp terbinafine hydrochloride external cream 1 % Formulary OTC gnp ultra com insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" Formulary OTC 0.5 ml gnp ultra com insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 Formulary OTC ml gnp ultra com insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" Formulary OTC 0.3 ml gnp ultra com insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" Formulary OTC 0.5 ml gnp ultra com insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 Formulary OTC ml gnp ultra com insulin syringe 30g x 5/16" 0.3 ml 30g x Formulary OTC 5/16" 0.3 ml gnp ultra com insulin syringe 30g x 5/16" 0.5 ml 30g x Formulary OTC 5/16" 0.5 ml gnp ultra com insulin syringe 30g x 5/16" 1 ml 30g x 5/16" Formulary OTC 1 ml gnp ultra com insulin syringe 31g x 5/16" 0.3 ml 31g x Formulary OTC 5/16" 0.3 ml gnp ultra com insulin syringe 31g x 5/16" 0.5 ml 31g x Formulary OTC 5/16" 0.5 ml gnp ultra com insulin syringe 31g x 5/16" 1 ml 31g x 5/16" Formulary OTC 1 ml gnp urinary pain relief oral tablet 97.5 mg Formulary OTC gnp vitamin a & d external ointment 15.5-53.4 % Formulary OTC gnp vitamin d super strength oral tablet 125 mcg (5000 ut) Formulary OTC gnp vitamin d-400 oral tablet 90-400 mg-unit Formulary OTC GOLD BOND FOOT POWDER MAX ST EXTERNAL Formulary OTC POWDER

67 Drug Name Formulary Status Requirements/Limits GOLD BOND MULTI-SYMPTOM EXTERNAL CREAM Formulary OTC 4 % GOLD BOND RAPID RELIEF EXTERNAL CREAM 1-1 Formulary OTC % GOLD BOND ULTIMATE EXTERNAL LOTION Formulary OTC GONIOSOL OPHTHALMIC SOLUTION 2.5 % Formulary OTC GONIOTAIRE OPHTHALMIC SOLUTION 2.5 % Formulary OTC GONIOVISC OPHTHALMIC SOLUTION 2 % Formulary OTC GOOD START 5% GLUCOSE WATER ORAL Formulary OTC SOLUTION 5 % goodsense all day allergy oral tablet 10 mg Formulary OTC goodsense cough dm oral suspension extended release 30 Formulary OTC mg/5ml goodsense eye drops ophthalmic solution 0.05 % Formulary OTC goodsense flu/cold/cough/night oral packet 25-10-650 mg Formulary OTC goodsense flu/cold/daytime oral packet 20-10-500 mg Formulary OTC goodsense ibuprofen childrens oral suspension 100 mg/5ml Formulary OTC goodsense ibuprofen infants oral suspension 50 mg/1.25ml Formulary OTC goodsense ibuprofen oral tablet 200 mg Formulary OTC goodsense lancets 30g Formulary OTC; QL (150 EA per 30 days) goodsense lancets 33g Formulary OTC; QL (150 EA per 30 days) goodsense lubricant eye drops ophthalmic solution 0.4-0.3 Formulary OTC % goodsense miconazole 1 vaginal kit 1200 & 2 mg & % Formulary OTC goodsense nicotine mouth/throat gum 4 mg Formulary OTC goodsense nighttime cold & flu oral liquid 5-6.25-10-325 Formulary OTC mg/15ml goodsense redness relief plus ophthalmic solution 0.5-0.03 Formulary OTC % goodsense severe sinus congest oral capsule 5-6.25-10-325 Formulary OTC mg goodsense sinus congest/pain oral 2-5-325 & 5-325 mg Formulary OTC goodsense sleeptime oral liquid 50 mg/30ml Formulary OTC goodsense sore throat spray mouth/throat liquid 1.4 % Formulary OTC gordomatic external crystals Formulary OTC GORDONS NO 5 EXTERNAL AEROSOL POWDER Formulary OTC gordons urea external ointment 22 % Formulary OTC GORDONS-VITE A EXTERNAL CREAM 100000 Formulary OTC UNIT/GM GORDONS-VITE A EXTERNAL LOTION 100000 UNIT Formulary OTC GORDO-POOL CONCENTRATE Formulary OTC GRANDPAS OATMEAL SOAP EXTERNAL BAR Formulary OTC GRANDPAS THYLOX SOAP EXTERNAL BAR 3 % Formulary OTC GRANIX SUBCUTANEOUS SOLUTION PREFILLED Formulary PA SYRINGE 300 MCG/0.5ML, 480 MCG/0.8ML green soap external tincture Formulary OTC

68 Drug Name Formulary Status Requirements/Limits griseofulvin microsize oral suspension 125 mg/5ml Formulary griseofulvin microsize oral tablet 500 mg Formulary grx hemorrhoidal rectal ointment 0.25-14-71.9 % Formulary OTC grx wound external gel Formulary OTC g-supress dx pediatric oral liquid 2.5-5-50 mg/ml Formulary OTC G-TRON PED ORAL LIQUID 10-15-350 MG/5ML Formulary OTC G-TUSICOF ORAL LIQUID 10-20-400 MG/5ML Formulary OTC guaifenesin oral tablet 400 mg Formulary OTC guaifenesin-codeine oral solution 100-10 mg/5ml Formulary OTC; AGE (Min 6 Years) guanfacine hcl er oral tablet extended release 24 hour 1 Formulary mg, 2 mg, 3 mg, 4 mg guanfacine hcl oral tablet 1 mg, 2 mg Formulary guanidine hcl oral tablet 125 mg Formulary gumsol mouth/throat liquid 5-0.1 % Formulary OTC GYNE-LOTRIMIN 3 VAGINAL CREAM 2 % Formulary OTC GYNE-LOTRIMIN VAGINAL CREAM 1 % Formulary OTC H2Q ORAL POWDER 200 MG/GM Formulary OTC HAILEY FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG Formulary halobetasol propionate external cream 0.05 % Formulary haloperidol decanoate intramuscular solution 100 mg/ml, Formulary AGE (Min 18 Years) 50 mg/ml haloperidol lactate injection solution 5 mg/ml Formulary haloperidol lactate oral concentrate 2 mg/ml Formulary AGE (Min 18 Years) haloperidol oral tablet 0.5 mg, 1 mg, 10 mg, 2 mg, 20 mg, 5 Formulary AGE (Min 18 Years) mg hand wipes external 0.13 % Formulary OTC HARD NAILS ORAL CAPSULE 2.5 MG Formulary OTC HAVRIX INTRAMUSCULAR SUSPENSION 1440 EL Formulary AGE (Min 19 Years) U/ML, 720 EL U/0.5ML HC DERMAPAX EXTERNAL LIQUID 0.5-0.5 % Formulary OTC H-CHLOR 12 EXTERNAL SOLUTION 0.125 % Formulary OTC H-CHLOR 6 EXTERNAL SOLUTION 0.062 % Formulary OTC headache relief pm oral tablet 500-38 mg Formulary OTC healthy accents unilet lancets Formulary OTC; QL (150 EA per 30 days) hearing aid batteries Formulary OTC heartburn antacid ex st oral tablet chewable 160-105 mg Formulary OTC heartburn treatment 24 hour oral capsule delayed release Formulary OTC; QL (34 EA per 34 days) 15 mg h-e-b incontrol alcohol pad Formulary OTC h-e-b incontrol lancets 28g Formulary OTC; QL (150 EA per 30 days) h-e-b incontrol lancets 30g Formulary OTC; QL (150 EA per 30 days) h-e-b incontrol lancets 33g Formulary OTC; QL (150 EA per 30 days) HEET TRIPLE ACTION EXTERNAL LIQUID Formulary OTC hematinic/folic acid oral tablet 324-1 mg Formulary HEMATOGEN FA ORAL CAPSULE 200-250-0.01-1 MG Formulary

69 Drug Name Formulary Status Requirements/Limits HEMATOGEN ORAL CAPSULE Formulary HEMOCYTE ORAL TABLET 324 (106 FE) MG Formulary OTC hemorrhoidal cooling rectal gel 0.25-50 % Formulary OTC hemorrhoidal max st/aloe rectal cream 1-0.25-14.4-15 % Formulary OTC hemorrhoidal rectal ointment 0.25-3-14-71.9 % Formulary OTC hemorrhoidal rectal suppository 0.25-3-85.5 %, 0.25-85.39 Formulary OTC %, 0.25-88.44 % heparin (porcine) in nacl injection solution 100-0.45 Formulary unit/ml-%, 2-0.9 unit/ml-%, 50-0.45 unit/ml-% heparin sodium (porcine) injection solution 1000 unit/ml, Formulary 10000 unit/ml, 20000 unit/ml, 5000 unit/ml heparin sodium (porcine) pf injection solution 5000 Formulary unit/0.5ml HERCEPTIN INTRAVENOUS SOLUTION Formulary RECONSTITUTED 440 MG hetastarch-nacl intravenous solution 6-0.9 % Formulary HETLIOZ LQ ORAL SUSPENSION 4 MG/ML Formulary PA HEXALEN ORAL CAPSULE 50 MG Formulary HIBICLENS EXTERNAL LIQUID 4 % Formulary OTC high potency iron oral tablet 27 mg Formulary OTC histaflex oral tablet 325-25 mg Formulary OTC HISTEX ORAL SYRUP 2.5 MG/5ML Formulary OTC HISTEX ORAL TABLET CHEWABLE 1.25 MG Formulary OTC HISTEX PD ORAL LIQUID 0.938 MG/ML Formulary OTC HISTEX PDX ORAL LIQUID 1.25 MG/ML Formulary OTC HISTEX-AC ORAL SYRUP 10-2.5-10 MG/5ML Formulary OTC HISTEX-DM ORAL SYRUP 10-2.5-20 MG/5ML Formulary OTC HISTEX-PE ORAL SYRUP 2.5-10 MG/5ML Formulary OTC hm 24 hour nasal allergy aerosol 55 mcg/act nasal 55 Formulary OTC mcg/act hm calamine external lotion 8-8 % Formulary OTC hm clear fiber oral powder Formulary OTC hm ethyl solution 70 % Formulary OTC hm iodides external tincture Formulary OTC hm iodine external tincture Formulary OTC hm iron oral tablet 200 (65 fe) mg Formulary OTC hm melatonin quick dissolve oral tablet dispersible 10 mg Formulary OTC hm nighttime sleep aid oral tablet 25 mg Formulary OTC hm omeprazole oral tablet delayed release 20 mg Formulary OTC hm probiotic digestive health oral capsule Formulary OTC hm rolled gauze bandage Formulary OTC HM SALONPAS PAIN RELIEF EXTERNAL PATCH 1.2- Formulary OTC 5.7-6.3 % hm severe cold/cough/flu oral packet 20-10-650 mg Formulary OTC hm super vitamin b12 oral tablet chewable 2500 mcg Formulary OTC hm vitamin b12 oral tablet extended release 1000 mcg Formulary OTC 70 Drug Name Formulary Status Requirements/Limits hm z-sleep oral capsule 25 mg Formulary OTC HOLD MOUTH/THROAT LOZENGE 5 MG Formulary OTC HOMATROPAIRE OPHTHALMIC SOLUTION 5 % Formulary HONEY BEARS W/IRON-ZINC ORAL TABLET Formulary OTC CHEWABLE 30-200-3 HPR PLUS HYDROGEL EXTERNAL KIT Formulary huber needle 19g x 1-1/4" , 19g x 3/4" , 20g x 1-1/4" , 20g x Formulary OTC 3/4" , 22g x 1-1/4" HUGGIES NATURAL CARE WIPES Formulary OTC HUMALOG JUNIOR KWIKPEN SUBCUTANEOUS Formulary SOLUTION PEN-INJECTOR 100 UNIT/ML HUMALOG KWIKPEN SUBCUTANEOUS SOLUTION Formulary PEN-INJECTOR 100 UNIT/ML HUMALOG MIX 50/50 KWIKPEN SUBCUTANEOUS Formulary SUSPENSION PEN-INJECTOR (50-50) 100 UNIT/ML HUMALOG MIX 50/50 SUBCUTANEOUS Formulary SUSPENSION (50-50) 100 UNIT/ML HUMALOG MIX 75/25 KWIKPEN SUBCUTANEOUS Formulary SUSPENSION PEN-INJECTOR (75-25) 100 UNIT/ML HUMALOG MIX 75/25 SUBCUTANEOUS Formulary SUSPENSION (75-25) 100 UNIT/ML HUMALOG SUBCUTANEOUS SOLUTION 100 Formulary UNIT/ML HUMALOG SUBCUTANEOUS SOLUTION Formulary CARTRIDGE 100 UNIT/ML HUMAN ALBUMIN GRIFOLS INTRAVENOUS Formulary SOLUTION 25 % HUMATE-P INTRAVENOUS SOLUTION RECONSTITUTED 1000-2400 UNIT, 250-600 UNIT, 500- Formulary 1200 UNIT humidifier Formulary OTC; QL (2 EA per 365 days) HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 40 Formulary AGE (Min 2 Years) MG/0.8ML HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT SP; QL (2 EA per 28 days); AGE (Min 2 Formulary 40 MG/0.4ML, 40 MG/0.8ML Years) HUMIRA PEN-CD/UC/HS STARTER SUBCUTANEOUS SP; QL (2 EA per 28 days); AGE (Min 2 Formulary PEN-INJECTOR KIT 40 MG/0.8ML, 80 MG/0.8ML Years) HUMIRA PEN-PS/UV/ADOL HS START SP; QL (2 EA per 28 days); AGE (Min 2 SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML, Formulary Years) 80 MG/0.8ML & 40MG/0.4ML HUMIRA SUBCUTANEOUS PREFILLED SYRINGE SP; QL (2 EA per 28 days); AGE (Min 2 Formulary KIT 10 MG/0.2ML, 20 MG/0.4ML Years) HUMIRA SUBCUTANEOUS PREFILLED SYRINGE Formulary QL (2 EA per 28 days) KIT 40 MG/0.4ML HUMIRA SUBCUTANEOUS PREFILLED SYRINGE Formulary AGE (Min 2 Years) KIT 40 MG/0.8ML HUMPHREYS #1 SIMPLE FEVER ORAL PELLET Formulary OTC HUMULIN 70/30 KWIKPEN SUBCUTANEOUS Formulary OTC SUSPENSION PEN-INJECTOR (70-30) 100 UNIT/ML

71 Drug Name Formulary Status Requirements/Limits HUMULIN 70/30 SUBCUTANEOUS SUSPENSION (70- Formulary OTC 30) 100 UNIT/ML HUMULIN N KWIKPEN SUBCUTANEOUS Formulary OTC SUSPENSION PEN-INJECTOR 100 UNIT/ML HUMULIN N SUBCUTANEOUS SUSPENSION 100 Formulary OTC UNIT/ML HUMULIN R INJECTION SOLUTION 100 UNIT/ML Formulary OTC HUMULIN R U-500 (CONCENTRATED) Formulary SUBCUTANEOUS SOLUTION 500 UNIT/ML HUMULIN R U-500 KWIKPEN SOLUTION PEN- INJECTOR 500 UNIT/ML SUBCUTANEOUS 500 Formulary UNIT/ML HURRICAINE MOUTH/THROAT AEROSOL 20 % Formulary OTC HURRICAINE MOUTH/THROAT SOLUTION 20 % Formulary OTC HURRICAINE MOUTH/THROAT SWAB 20 % Formulary OTC HURRICAINE ONE MOUTH/THROAT SOLUTION 20 Formulary OTC % HURRIVIEW DENTAL SWAB 1.5 % Formulary OTC HURRIVIEW II DENTAL SWAB Formulary OTC HYALGAN INTRA-ARTICULAR SOLUTION 20 Formulary PA MG/2ML HYCAMTIN ORAL CAPSULE 0.25 MG, 1 MG Formulary hydralazine hcl oral tablet 10 mg, 100 mg, 25 mg, 50 mg Formulary HYDROCELL ADHESIVE DRESSING PAD 6"X6" Formulary OTC hydrocerin external cream Formulary OTC hydrocerin external lotion Formulary OTC hydrochlorothiazide oral capsule 12.5 mg Formulary hydrochlorothiazide oral tablet 12.5 mg, 25 mg, 50 mg Formulary hydrocod polst-cpm polst er oral suspension extended Formulary AGE (Min 6 Years) release 10-8 mg/5ml hydrocodone-acetaminophen oral solution 7.5-325 mg/15ml Formulary PA; QL (1260 ML per 7 days) hydrocodone-acetaminophen oral tablet 10-300 mg, 10-325 Formulary PA; QL (63 EA per 7 days) mg hydrocodone-acetaminophen oral tablet 2.5-325 mg Formulary PA; QL (252 EA per 7 days) hydrocodone-acetaminophen oral tablet 5-300 mg, 5-325 Formulary PA; QL (126 EA per 7 days) mg hydrocodone-acetaminophen oral tablet 7.5-300 mg, 7.5- Formulary PA; QL (84 EA per 7 days) 325 mg hydrocodone-homatropine oral syrup 5-1.5 mg/5ml Formulary AGE (Min 6 Years) hydrocodone-homatropine oral tablet 5-1.5 mg Formulary hydrocodone-ibuprofen oral tablet 10-200 mg Formulary PA; QL (63 EA per 7 days) hydrocodone-ibuprofen oral tablet 5-200 mg Formulary PA; QL (126 EA per 7 days) hydrocodone-ibuprofen oral tablet 7.5-200 mg Formulary PA; QL (84 EA per 7 days) hydrocortisone ace-pramoxine rectal cream 1-1 % Formulary hydrocortisone butyrate external cream 0.1 % Formulary hydrocortisone butyrate external ointment 0.1 % Formulary hydrocortisone butyrate external solution 0.1 % Formulary

72 Drug Name Formulary Status Requirements/Limits hydrocortisone external cream 0.5 % Formulary OTC hydrocortisone external cream 1 %, 2.5 % Formulary hydrocortisone external lotion 2.5 % Formulary hydrocortisone external ointment 0.5 % Formulary OTC hydrocortisone external ointment 1 %, 2.5 % Formulary hydrocortisone oral tablet 10 mg, 20 mg, 5 mg Formulary hydrocortisone rectal cream 1 % Formulary hydrocortisone valerate external cream 0.2 % Formulary hydrocortisone valerate external ointment 0.2 % Formulary HYDROGEL AG EXTERNAL GEL Formulary OTC HYDROGEL EXTERNAL GEL Formulary OTC hydromet oral syrup 5-1.5 mg/5ml Formulary AGE (Min 6 Years) hydromorphone hcl injection solution 1 mg/ml, 2 mg/ml, 4 Formulary mg/ml hydromorphone hcl oral tablet 2 mg Formulary PA; QL (79 EA per 7 days) hydromorphone hcl oral tablet 4 mg Formulary PA; QL (39 EA per 7 days) hydromorphone hcl oral tablet 8 mg Formulary PA; QL (20 EA per 7 days) hydromorphone hcl pf injection solution 10 mg/ml Formulary hydrophilic external ointment Formulary OTC hydrophilic petrolatum external ointment Formulary OTC hydroxychloroquine sulfate oral tablet 200 mg Formulary hydroxyurea oral capsule 500 mg Formulary hydroxyzine hcl intramuscular solution 50 mg/ml Formulary hydroxyzine hcl oral syrup 10 mg/5ml Formulary hydroxyzine hcl oral tablet 10 mg, 25 mg, 50 mg Formulary hydroxyzine pamoate oral capsule 25 mg, 50 mg Formulary HYLATOPIC PLUS EXTERNAL LOTION Formulary hyoscyamine sulfate er oral tablet extended release 12 hour Formulary 0.375 mg hyoscyamine sulfate oral elixir 0.125 mg/5ml Formulary hyoscyamine sulfate oral solution 0.125 mg/ml Formulary hyoscyamine sulfate oral tablet 0.125 mg Formulary hyoscyamine sulfate sl sublingual tablet sublingual 0.125 Formulary mg HYPERCARE EXTERNAL SOLUTION 15 % Formulary OTC HYPERRHO S/D INTRAMUSCULAR SOLUTION Formulary PREFILLED SYRINGE 1500 UNIT, 250 UNIT hypodermic needle 21g x 1-1/4" , 25g x 3/4" , 26g x 3/8" Formulary OTC HYPOTEARS OPHTHALMIC SOLUTION 1-1 % Formulary OTC HYSEPT EXTERNAL SOLUTION 0.25 %, 0.5 % Formulary OTC HYVEE ADVANCED ANTACID ORAL SUSPENSION Formulary OTC 400-400-40 MG/5ML HY-VEE LANCETS Formulary OTC; QL (150 EA per 30 days) hy-vee thin lancets Formulary OTC; QL (150 EA per 30 days) ibandronate sodium intravenous solution 3 mg/3ml Formulary PA; QL (1 ML per 90 days)

73 Drug Name Formulary Status Requirements/Limits ibandronate sodium oral tablet 150 mg Formulary ibuprofen 100 junior strength oral tablet chewable 100 mg Formulary OTC ibuprofen oral capsule 200 mg Formulary OTC ibuprofen oral tablet 400 mg, 600 mg, 800 mg Formulary ibuprofen pm oral capsule 200-25 mg Formulary OTC ICAR ORAL SUSPENSION 15 MG/1.25ML Formulary OTC ICAR-C ORAL TABLET 100-250 MG Formulary OTC icatibant acetate subcutaneous solution 30 mg/3ml Formulary PA; QL (24 ML per 14 days) ice blue external gel 2 % Formulary OTC ICY HOT EXTERNAL STICK 10-30 % Formulary OTC ICY HOT LIDOCAINE PLUS MENTHOL EXTERNAL Formulary OTC CREAM 4-1 % ICY HOT LIDOCAINE PLUS MENTHOL EXTERNAL Formulary OTC PATCH 4-1 % idarubicin hcl intravenous solution 10 mg/10ml, 20 Formulary mg/20ml, 5 mg/5ml IFEX INTRAVENOUS SOLUTION RECONSTITUTED 3 Formulary GM ifosfamide intravenous solution 1 gm/20ml, 3 gm/60ml Formulary ifosfamide intravenous solution reconstituted 1 gm Formulary imatinib mesylate oral tablet 100 mg, 400 mg Formulary PA imipramine hcl oral tablet 10 mg, 25 mg, 50 mg Formulary imipramine pamoate oral capsule 100 mg, 125 mg, 150 mg, Formulary 75 mg imiquimod external cream 3.75 % Formulary imiquimod external cream 5 % Formulary QL (12 EA per 34 days) imiquimod pump external cream 3.75 % Formulary immune support oral tablet chewable Formulary OTC IMODIUM A-D ORAL CAPSULE 2 MG Formulary OTC IMODIUM A-D ORAL LIQUID 1 MG/7.5ML Formulary OTC IMODIUM A-D ORAL TABLET 2 MG Formulary OTC IMODIUM MULTI-SYMPTOM RELIEF ORAL TABLET Formulary OTC 2-125 MG IMOVAX RABIES INTRAMUSCULAR INJECTABLE Formulary AGE (Min 19 Years) 2.5 UNIT/ML IMPROVUE OPHTHALMIC SOLUTION PREFILLED Formulary OTC SYRINGE 1.7 % indapamide oral tablet 1.25 mg, 2.5 mg Formulary indomethacin er oral capsule extended release 75 mg Formulary indomethacin oral capsule 25 mg, 50 mg Formulary INFANRIX INTRAMUSCULAR SUSPENSION 25-58-10 Formulary infants gas relief oral suspension 40 mg/0.6ml Formulary OTC INFED INJECTION SOLUTION 50 MG/ML Formulary INFUMORPH 200 INJECTION SOLUTION 200 Formulary MG/20ML (10 MG/ML)

74 Drug Name Formulary Status Requirements/Limits INFUMORPH 500 INJECTION SOLUTION 500 Formulary MG/20ML (25 MG/ML) inject-ease Formulary OTC INJECT-EASE AUTOMATIC INJECTOR Formulary OTC inositol oral tablet 500 mg, 650 mg Formulary OTC INOSITOL-5 ORAL TABLET 324 MG Formulary OTC INSTACLEAN EXTERNAL LIQUID Formulary OTC INSTA-GLUCOSE ORAL GEL 77.4 % Formulary OTC instant ear-dry otic liquid 95-5 % Formulary OTC instant hand sanitizer external liquid 62 % Formulary OTC INSTAT EXTERNAL PAD Formulary INSUFLON 25G X 0.71" Formulary insulin asp prot & asp flexpen suspension pen-injector (70- Formulary 30) 100 unit/ml subcutaneous (70-30) 100 unit/ml insulin aspart flexpen solution pen-injector 100 unit/ml Formulary subcutaneous 100 unit/ml insulin aspart penfill solution cartridge 100 unit/ml Formulary subcutaneous 100 unit/ml insulin aspart prot & aspart suspension (70-30) 100 unit/ml Formulary subcutaneous (70-30) 100 unit/ml insulin aspart subcutaneous solution 100 unit/ml Formulary insulin lispro (1 unit dial) subcutaneous solution pen- Formulary injector 100 unit/ml insulin lispro junior kwikpen subcutaneous solution pen- Formulary injector 100 unit/ml insulin lispro prot & lispro subcutaneous suspension pen- Formulary injector (75-25) 100 unit/ml insulin lispro subcutaneous solution 100 unit/ml Formulary insulin syringe 27g x 1/2" 0.5 ml 27g x 1/2" 0.5 ml Formulary OTC insulin syringe 27g x 1/2" 1 ml 27g x 1/2" 1 ml Formulary OTC insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC insulin syringe 30g x 1/2" 1 ml 30g x 1/2" 1 ml Formulary OTC insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml Formulary OTC insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC insulin syringe/needle 27g x 1/2" 0.5 ml 27g x 1/2" 0.5 ml Formulary OTC insulin syringe/needle 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC insulin syringe/needle 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC INSUPEN ULTRAFIN 30G X 8 MM Formulary OTC 75 Drug Name Formulary Status Requirements/Limits INTEGRA ORAL CAPSULE 62.5-62.5-40-3 MG Formulary OTC intense cough reliever ex st oral liquid 20-300 mg/5ml Formulary OTC INTERDRY AG TEXTILE 10"X144" EXTERNAL Formulary OTC SHEET INTRON A INJECTION SOLUTION 10000000 Formulary PA UNIT/ML, 6000000 UNIT/ML INTRON A INJECTION SOLUTION RECONSTITUTED Formulary PA 10000000 UNIT, 18000000 UNIT, 50000000 UNIT INTROVALE ORAL TABLET 0.15-0.03 MG Formulary QL (91 EA per 91 days) INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION 117 MG/0.75ML, 156 MG/ML, 234 Formulary AGE (Min 18 Years) MG/1.5ML, 39 MG/0.25ML, 78 MG/0.5ML INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 117 MG/0.75ML, Formulary AGE (Min 18 Years) 156 MG/ML, 234 MG/1.5ML, 39 MG/0.25ML, 78 MG/0.5ML INVEGA TRINZA INTRAMUSCULAR SUSPENSION 273 MG/0.875ML, 410 MG/1.315ML, 546 MG/1.75ML, Formulary AGE (Min 18 Years) 819 MG/2.625ML INVEGA TRINZA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 273 MG/0.875ML, 410 Formulary AGE (Min 18 Years) MG/1.315ML, 546 MG/1.75ML, 819 MG/2.625ML INVIRASE ORAL CAPSULE 200 MG Formulary INVIRASE ORAL TABLET 500 MG Formulary INVOKAMET ORAL TABLET 150-1000 MG, 150-500 Formulary ST; AGE (Min 18 Years) MG, 50-1000 MG, 50-500 MG INVOKAMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 150-1000 MG, 150-500 MG, 50-1000 Formulary ST; AGE (Min 18 Years) MG, 50-500 MG INVOKANA ORAL TABLET 100 MG, 300 MG Formulary PA; AGE (Min 18 Years) iodides tincture external tincture Formulary OTC iodine external tincture , 2 % Formulary OTC iodine strong external tincture 6.9-5 % Formulary OTC iodine strong oral solution 5 % Formulary iodine tincture external tincture Formulary OTC iodine tincture external tincture 2 % Formulary IONIL EXTERNAL SHAMPOO 2-0.2 % Formulary OTC IONIL-T EXTERNAL SHAMPOO 1 % Formulary OTC IONSYS TRANSDERMAL PATCH 40 MCG/ACT Formulary PA IPOL INJECTION INJECTABLE Formulary AGE (Min 19 Years) ipratropium bromide inhalation solution 0.02 % Formulary ipratropium bromide nasal solution 0.03 % Formulary QL (60 ML per 34 days) ipratropium bromide nasal solution 0.06 % Formulary QL (30 ML per 34 days) ipratropium-albuterol inhalation solution 0.5-2.5 (3) Formulary mg/3ml irbesartan oral tablet 150 mg, 300 mg, 75 mg Formulary irbesartan-hydrochlorothiazide oral tablet 150-12.5 mg, Formulary 300-12.5 mg

76 Drug Name Formulary Status Requirements/Limits irinotecan hcl intravenous solution 100 mg/5ml, 300 Formulary mg/15ml, 40 mg/2ml, 500 mg/25ml IROFOL ORAL LIQUID 100-1000-15 MG-MCG/5ML Formulary OTC IROFOL ORAL TABLET 150-0.025-1 MG Formulary OTC iron (ferrous sulfate) oral tablet extended release 142 (45 Formulary OTC fe) mg iron 100 plus oral tablet 100-250-0.025-1 mg Formulary OTC iron 100/c oral tablet 100-250 mg Formulary OTC iron 21/7 oral Formulary OTC iron 27 oral tablet 240 (27 fe) mg Formulary OTC iron chews pediatric oral tablet chewable 15 mg Formulary OTC iron oral tablet 28 mg Formulary OTC iron slow release oral tablet extended release 143 (45 fe) Formulary OTC mg irrigating eyewash ophthalmic solution Formulary OTC ISAGEL EXTERNAL GEL 60 % Formulary OTC ISENTRESS HD ORAL TABLET 600 MG Formulary ISENTRESS ORAL TABLET 400 MG Formulary ISOLEUCINE 1000 ORAL PACKET 1 GM Formulary OTC isoleucine oral packet 50 mg Formulary OTC isoniazid oral syrup 50 mg/5ml Formulary isoniazid oral tablet 100 mg, 300 mg Formulary isopropyl alcohol (rubbing) solution 70 % Formulary OTC isopropyl alcohol solution 50 % Formulary OTC isopropyl alcohol solution 70 % Formulary isopropyl alcohol wipes 70 % external 70 % Formulary OTC ISOPTO TEARS OPHTHALMIC SOLUTION 0.5 % Formulary OTC isosorbide dinitrate er oral tablet extended release 40 mg Formulary isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg, 5 mg Formulary isosorbide mononitrate er oral tablet extended release 24 Formulary hour 120 mg, 30 mg, 60 mg isosorbide mononitrate oral tablet 10 mg, 20 mg Formulary isotretinoin oral capsule 10 mg, 20 mg, 30 mg, 40 mg Formulary isradipine oral capsule 2.5 mg, 5 mg Formulary itch relief external cream 2 % Formulary OTC ITCH-X EXTERNAL GEL 1-10 % Formulary OTC ITCH-X EXTERNAL SOLUTION 1-10 % Formulary OTC itraconazole oral capsule 100 mg Formulary QL (34 EA per 34 days) itraconazole oral solution 10 mg/ml Formulary IVAREST MEDICATED POISON IVY EXTERNAL Formulary OTC LIQUID 1 % IVAREST POISON IVY ITCH EXTERNAL CREAM 2- Formulary OTC 14-10.5 % ivermectin oral tablet 3 mg Formulary ivy wash poison ivy cleanser external lotion 1 % Formulary OTC

77 Drug Name Formulary Status Requirements/Limits IVY-RID EXTERNAL AEROSOL Formulary OTC IXEMPRA KIT INTRAVENOUS SOLUTION Formulary RECONSTITUTED 15 MG, 45 MG IXIARO INTRAMUSCULAR SUSPENSION Formulary AGE (Min 19 Years) J & J DENTAL FLOSS FOR KIDS Formulary OTC JANTOVEN ORAL TABLET 1 MG, 10 MG, 2 MG, 2.5 Formulary MG, 3 MG, 4 MG, 5 MG, 6 MG, 7.5 MG JANUMET ORAL TABLET 50-1000 MG, 50-500 MG Formulary ST; AGE (Min 18 Years) JANUMET XR ORAL TABLET EXTENDED RELEASE Formulary ST; AGE (Min 18 Years) 24 HOUR 100-1000 MG, 50-1000 MG, 50-500 MG JANUVIA ORAL TABLET 100 MG, 25 MG, 50 MG Formulary ST; AGE (Min 18 Years) JARDIANCE ORAL TABLET 10 MG, 25 MG Formulary ST; AGE (Min 18 Years) JENTADUETO ORAL TABLET 2.5-1000 MG, 2.5-500 Formulary ST; AGE (Min 18 Years) MG, 2.5-850 MG jessners external solution Formulary OTC jock itch spray external aerosol powder 1 % Formulary OTC JOHNSONS BABY CORNSTARCH EXTERNAL Formulary OTC POWDER JOHNSONS BABY OIL GEL EXTERNAL GEL Formulary OTC JOHNSONS BABY POWDER EXTERNAL POWDER Formulary OTC JULUCA ORAL TABLET 50-25 MG Formulary JUNEL 1.5/30 ORAL TABLET 1.5-30 MG-MCG Formulary JUNEL 1/20 ORAL TABLET 1-20 MG-MCG Formulary JUNEL FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG Formulary k 100 oral tablet 100 mcg Formulary OTC k-99 oral capsule 595 mg Formulary OTC KAITLIB FE ORAL TABLET CHEWABLE 0.8-25 MG- Formulary MCG KALBITOR SUBCUTANEOUS SOLUTION 10 MG/ML Formulary PA; QL (6 ML per 34 days) KANGAROO ENTRIFLUSH PUMP SET Formulary KANGAROO JOEY PUMP SET Formulary KANK-A MOUTH PAIN MOUTH/THROAT SOLUTION Formulary OTC 20 % KANK-A SOFTBRUSH MOUTH/THROAT GEL 20-0.1 Formulary OTC % KAOPECTATE ORAL TABLET 262 MG Formulary OTC KARBOZYME ORAL TABLET DELAYED RELEASE Formulary OTC 167-173-346 MG K-BICARB ORAL CAPSULE 99 MG Formulary OTC kedbumin intravenous solution 25 % Formulary KELNOR 1/35 ORAL TABLET 1-35 MG-MCG Formulary QL (28 EA per 28 days) kelp oral tablet 150 mcg Formulary OTC kelp-b6-lecithin-vinegar oral capsule 5-0.75-200-50 mg Formulary OTC KENALOG INJECTION SUSPENSION 10 MG/ML Formulary KENDALL ALGINATE DRESS 8"X8" EXTERNAL PAD Formulary OTC KENDALL ANTIMICROBIAL BANDAGE EXTERNAL Formulary OTC

78 Drug Name Formulary Status Requirements/Limits KENDALL CA ALGINATE 6"X10" EXTERNAL Formulary OTC KENDALL HYDROPHILIC FOAM DRESS PAD 4"X8" , Formulary OTC 5"X5" KENDALL TRANSPARENT FILM DRESS Formulary OTC KEPIVANCE INTRAVENOUS SOLUTION Formulary RECONSTITUTED 6.25 MG KERAMATRIX REPLICINE 10CMX10CM EXTERNAL Formulary SHEET KERR TRIPLE DYE SWABS EXTERNAL SWAB Formulary OTC KESIMPTA SUBCUTANEOUS SOLUTION AUTO- Formulary PA INJECTOR 20 MG/0.4ML ketoconazole external cream 2 % Formulary ketoconazole external foam 2 % Formulary ketoconazole external shampoo 2 % Formulary ketoconazole oral tablet 200 mg Formulary ketorolac tromethamine injection solution 15 mg/ml, 30 Formulary mg/ml ketorolac tromethamine intramuscular solution 60 mg/2ml Formulary ketorolac tromethamine ophthalmic solution 0.4 %, 0.5 % Formulary ketorolac tromethamine oral tablet 10 mg Formulary QL (20 EA per 34 days) KETOSTIX IN VITRO STRIP Formulary OTC kettle neti pot sinus wash nasal kit 2300-700 mg Formulary OTC KEY OMEGA ORAL PACKET 200-100 MG Formulary OTC k-iii oral solution reconstituted 33.3-33.3-33.3 % Formulary OTC kimono micro thin Formulary OTC KINERASE EXTERNAL CREAM 0.1 %, 0.125 % Formulary OTC KINERASE EXTERNAL LOTION 0.1 % Formulary OTC kinney lancets Formulary OTC; QL (150 EA per 30 days) kinney thin lancets Formulary OTC kinray insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC kinray insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC kinray insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC kinray insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC KINRIX INTRAMUSCULAR SUSPENSION Formulary KIONEX ORAL SUSPENSION 15 GM/60ML Formulary AGE (Min 19 Years) KITABIS PAK NEBULIZATION SOLUTION 300 QL (280 ML per 28 days); AGE (Min 6 Formulary MG/5ML INHALATION 300 MG/5ML Years) KLOR-CON 10 ORAL TABLET EXTENDED RELEASE Formulary 10 MEQ KLOR-CON ORAL TABLET EXTENDED RELEASE 8 Formulary MEQ KLOR-CON SPRINKLE ORAL CAPSULE EXTENDED Formulary RELEASE 10 MEQ, 8 MEQ KLS ALLER-CORT AEROSOL 55 MCG/ACT NASAL 55 Formulary OTC MCG/ACT kls cold & flu ms day/night oral tablet therapy pack Formulary OTC

79 Drug Name Formulary Status Requirements/Limits kls esomeprazole magnesium oral capsule delayed release Formulary OTC 20 mg kls natural psyllium fiber oral powder 58.6 % Formulary OTC kls omeprazole oral tablet delayed release 20 mg Formulary OTC K-MAG ASPARTATE ORAL TABLET 250-250 MG Formulary OTC K-MAG ORAL CAPSULE 40-40 MG Formulary OTC K-MAG-70 ORAL CAPSULE 70-70 MG Formulary OTC kmart valu insulin syringe 29g u-100 0.5 ml u-100 0.5 ml Formulary OTC kmart valu insulin syringe 29g u-100 1 ml u-100 1 ml Formulary OTC kmart valu insulin syringe 30g u-100 0.3 ml u-100 0.3 ml Formulary OTC kmart valu insulin syringe 30g u-100 0.5 ml u-100 0.5 ml Formulary OTC kmart valu insulin syringe 30g u-100 1 ml u-100 1 ml Formulary OTC konsyl daily fiber oral packet 100 % Formulary OTC konsyl daily fiber oral powder 100 % Formulary OTC KONSYL ORAL PACKET 28.3 %, 60.3 % Formulary OTC KONSYL ORAL POWDER 60.3 %, 71.67 % Formulary OTC KONSYL-D ORAL POWDER 52.3 % Formulary OTC korean ginseng oral capsule 350 mg Formulary OTC kp hydrocortisone-aloe external cream 0.5 % Formulary OTC kp mag-oxide magnesium oral tablet 200 mg Formulary OTC kp silicone scar therapy gel strip Formulary OTC K-PHOS NO 2 ORAL TABLET 305-700 MG Formulary K-PHOS ORAL TABLET 500 MG Formulary kpn prenatal oral tablet 0.1 mg Formulary OTC krill oil oral capsule 300 mg Formulary OTC KROGER HEALTHPRO LANCET 26G Formulary OTC; QL (150 EA per 30 days) kroger insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC kroger insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC kroger insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC kroger insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml Formulary OTC kroger insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC kroger insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC kroger insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC kroger insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC kroger insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC kroger lancets Formulary OTC; QL (150 EA per 30 days) kroger lancets 21g Formulary OTC; QL (150 EA per 30 days) kroger lancets micro thin 33g Formulary OTC; QL (150 EA per 30 days) kroger lancets super thin Formulary OTC; QL (150 EA per 30 days) kroger lancets thin Formulary OTC; QL (150 EA per 30 days) kroger lancets thin 26g Formulary OTC; QL (150 EA per 30 days) kroger lancets ultrathin 30g Formulary OTC; QL (150 EA per 30 days) KT TAPE PRO TAPE Formulary OTC K-TAN PLUS ORAL CAPSULE 162-115.2-1 MG Formulary

80 Drug Name Formulary Status Requirements/Limits KWAN LOONG PAIN RELIEVING EXTERNAL OIL Formulary OTC KYLEENA INTRAUTERINE Formulary 19.5 MG labetalol hcl intravenous solution 5 mg/ml Formulary labetalol hcl oral tablet 100 mg, 200 mg, 300 mg Formulary LAC-HYDRIN FIVE EXTERNAL LOTION 5 % Formulary OTC LAC-HYDRIN TWELVE EXTERNAL LOTION 12 % Formulary OTC lactated ringers irrigation solution Formulary lactic acid e external cream 10-3500 %-unt/30gm Formulary lactic acid external lotion 10 % Formulary lacto-bifidus-600 oral capsule Formulary OTC LAMISIL ADVANCED EXTERNAL GEL 1 % Formulary OTC LAMISIL AT EXTERNAL CREAM 1 % Formulary OTC LAMISIL AT EXTERNAL POWDER Formulary OTC LAMISIL AT SPRAY EXTERNAL SOLUTION 1 % Formulary OTC LAMISILK PROTECT EXTERNAL LIQUID Formulary OTC lamivudine oral solution 10 mg/ml Formulary lamivudine oral tablet 100 mg, 150 mg, 300 mg Formulary lamivudine-zidovudine oral tablet 150-300 mg Formulary er oral tablet extended release 24 hour 100 mg, Formulary 200 mg, 25 mg, 250 mg, 300 mg, 50 mg lamotrigine oral tablet 100 mg, 150 mg, 200 mg, 25 mg Formulary lamotrigine oral tablet chewable 25 mg, 5 mg Formulary LANACANE ANTI-BACTERIAL EXTERNAL Formulary OTC AEROSOL 20-0.2 % LANACANE MAXIMUM STRENGTH EXTERNAL Formulary OTC CREAM 20-0.2 % LANACORT 10 EXTERNAL CREAM 1 % Formulary OTC lancets Formulary OTC; QL (150 EA per 30 days) lancets 28g Formulary OTC; QL (150 EA per 30 days) lancets 30g Formulary OTC; QL (150 EA per 30 days) lancets micro thin 33g Formulary OTC; QL (150 EA per 30 days) lancets super thin 28g Formulary OTC; QL (150 EA per 30 days) lancets thin Formulary OTC; QL (150 EA per 30 days) LANCETS ULTRA THIN Formulary OTC; QL (150 EA per 30 days) lancets ultra thin 30g Formulary OTC; QL (150 EA per 30 days) lanolin anhydrous external ointment Formulary lanolin external ointment Formulary OTC lanolin hydrous-grx external ointment 72 % Formulary OTC lansoprazole oral capsule delayed release 15 mg Formulary lansoprazole oral capsule delayed release 30 mg Formulary QL (34 EA per 34 days) lansoprazole oral tablet dispersible 15 mg, 30 mg Formulary PA LANTISEPTIC MULTI-PURPOSE EXTERNAL Formulary OTC OINTMENT 0.45-20 %

81 Drug Name Formulary Status Requirements/Limits LANTUS SOLOSTAR SUBCUTANEOUS SOLUTION Formulary PEN-INJECTOR 100 UNIT/ML LANTUS SUBCUTANEOUS SOLUTION 100 UNIT/ML Formulary l-arginine oral capsule 500 mg Formulary OTC l-arginine oral tablet 1000 mg Formulary OTC LARIN 1/20 ORAL TABLET 1-20 MG-MCG Formulary LARIN FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG Formulary latanoprost ophthalmic solution 0.005 % Formulary LATUDA ORAL TABLET 120 MG, 20 MG, 40 MG, 60 Formulary AGE (Min 18 Years) MG, 80 MG laxative oral tablet 25 mg Formulary OTC laxative pills oral tablet 15 mg Formulary OTC LAZANDA NASAL SOLUTION 100 MCG/ACT, 400 Formulary PA; QL (120 EA per 30 days) MCG/ACT l-carnitine oral capsule 250 mg, 500 mg Formulary OTC l-carnitine oral tablet 250 mg, 500 mg Formulary OTC leader insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC leader insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC leader insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC leader insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC leader insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC leader insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml Formulary OTC leader insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC leader insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC leader insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC leader insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC lecithin-kelp-b6-cider vinegar oral capsule 200-0.075-5-50 Formulary OTC mg leflunomide oral tablet 10 mg, 20 mg Formulary leg-gesic oral suspension Formulary OTC lemon-glycerin mouth/throat swab Formulary OTC LENZAPATCH EXTERNAL PATCH 4-1 % Formulary letrozole oral tablet 2.5 mg Formulary leucine oral packet 100 mg Formulary OTC leucovorin calcium injection solution reconstituted 100 mg, Formulary 200 mg, 350 mg, 50 mg, 500 mg leucovorin calcium oral tablet 10 mg, 15 mg, 25 mg, 5 mg Formulary LEUKERAN ORAL TABLET 2 MG Formulary leuprolide acetate injection kit 1 mg/0.2ml Formulary PA levalbuterol hcl inhalation nebulization solution 0.31 Formulary PA mg/3ml, 0.63 mg/3ml, 1.25 mg/0.5ml, 1.25 mg/3ml levalbuterol tartrate inhalation aerosol 45 mcg/act Formulary LEVEMIR FLEXTOUCH SOLUTION PEN-INJECTOR Formulary 100 UNIT/ML SUBCUTANEOUS 100 UNIT/ML LEVEMIR SUBCUTANEOUS SOLUTION 100 UNIT/ML Formulary

82 Drug Name Formulary Status Requirements/Limits levetiracetam er oral tablet extended release 24 hour 500 Formulary mg, 750 mg levetiracetam in nacl intravenous solution 1000 mg/100ml, Formulary 1500 mg/100ml, 500 mg/100ml levetiracetam intravenous solution 500 mg/5ml Formulary levetiracetam oral solution 100 mg/ml Formulary levetiracetam oral tablet 1000 mg, 250 mg, 500 mg, 750 mg Formulary levobunolol hcl ophthalmic solution 0.5 % Formulary levocarnitine (dietary) oral tablet 330 mg Formulary OTC levocarnitine fumarate oral capsule 250 mg Formulary OTC levocarnitine oral solution 1 gm/10ml Formulary levocarnitine oral tablet 330 mg Formulary levocarnitine-b5-taurine oral liquid 1000-10-150 mg/15ml Formulary OTC levocetirizine dihydrochloride oral solution 2.5 mg/5ml Formulary levocetirizine dihydrochloride oral tablet 5 mg Formulary levofloxacin intravenous solution 25 mg/ml Formulary levofloxacin ophthalmic solution 0.5 % Formulary levofloxacin oral solution 25 mg/ml Formulary levofloxacin oral tablet 250 mg, 500 mg, 750 mg Formulary levoleucovorin calcium intravenous solution reconstituted Formulary 50 mg LEVO-T ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 Formulary MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG LEXIVA ORAL SUSPENSION 50 MG/ML Formulary l-glutamine oral capsule 500 mg Formulary OTC l-glutamine oral tablet 500 mg Formulary OTC LICE B GONE CAP SATURATED EXTERNAL KIT Formulary OTC LICE B GONE EXTERNAL SHAMPOO Formulary OTC lice cure external solution Formulary OTC lice killing maximum strength external shampoo 0.33-4 % Formulary OTC lice treatment external lotion 1 % Formulary OTC LICEFREEE EXTERNAL SOLUTION Formulary OTC LICEMD COMPLETE EXTERNAL KIT 0.33-4 % Formulary OTC LICIDE TREATMENT COMBINATION KIT Formulary OTC lidocaine external cream 5 % Formulary OTC; QL (60 GM per 30 days) lidocaine external ointment 5 % Formulary ST; QL (30 GM per 34 days) lidocaine external patch 5 % Formulary QL (90 EA per 30 days) lidocaine hcl external cream 3 % Formulary lidocaine hcl external solution 4 % Formulary lidocaine hcl mouth/throat solution 4 % Formulary lidocaine viscous mouth/throat solution 2 % Formulary lidocaine-hydrocortisone ace rectal cream 3-0.5 % Formulary lidocaine-hydrocortisone ace rectal kit 3-1 %, 3-2.5 % Formulary lidocaine-menthol external gel 4-1 % Formulary OTC

83 Drug Name Formulary Status Requirements/Limits lidocaine-prilocaine external cream 2.5-2.5 % Formulary lidocaine-transparent dressing external kit 4 % Formulary OTC LIDOPATCH PAIN RELIEF EXTERNAL PATCH 3.99- Formulary OTC 1.25 % lidopin external cream 3 % Formulary LIDOPRO TRANSDERMAL PATCH 4-4-5 % Formulary OTC LIDOZENGEL EXTERNAL GEL 4-1 % Formulary OTC LILETTA (52 MG) INTRAUTERINE INTRAUTERINE Formulary DEVICE 18.6 MCG/DAY, 19.5 MCG/DAY limencin external patch 4-4 % Formulary OTC lindane external shampoo 1 % Formulary ST; QL (60 ML per 30 days) linezolid oral suspension reconstituted 100 mg/5ml Formulary PA linezolid oral tablet 600 mg Formulary PA LINZESS ORAL CAPSULE 145 MCG, 290 MCG, 72 Formulary PA; AGE (Min 18 Years) MCG liothyronine sodium oral tablet 25 mcg, 5 mcg, 50 mcg Formulary external ointment Formulary OTC lip balm external stick Formulary OTC LIP MEDEX EXTERNAL OINTMENT Formulary OTC lip-guard external ointment Formulary OTC lipochol nr oral capsule Formulary OTC lipochol plus oral tablet Formulary OTC LIPO-GEL ORAL CAPSULE 100-30 MG-UNIT Formulary OTC lipoic acid oral capsule 150 mg Formulary OTC LIPOTRIAD ORAL TABLET Formulary OTC LIPOTRIAD VISIONARY ORAL CAPSULE Formulary OTC LIQ-10 ORAL SYRUP 100-1 MG-UNT/5ML, 50-15 Formulary OTC LIQSORB ORAL LIQUID 100 MG/ML Formulary OTC LIQUACEL ORAL LIQUID Formulary OTC LIQUIMAT EXTERNAL LOTION 5 % Formulary OTC lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 30 mg, 40 mg, 5 Formulary mg lisinopril-hydrochlorothiazide oral tablet 10-12.5 mg, 20- Formulary 12.5 mg, 20-25 mg LISTERINE NATURALS ANTISEPTIC Formulary OTC MOUTH/THROAT LIQUID lite touch lancets Formulary OTC; QL (150 EA per 30 days) LITETOUCH INSULIN SYRINGE 28G X 1/2" 0.5 ML Formulary OTC 28G X 1/2" 0.5 ML LITETOUCH INSULIN SYRINGE 28G X 1/2" 1 ML 28G Formulary OTC X 1/2" 1 ML LITETOUCH INSULIN SYRINGE 29G X 1/2" 0.3 ML Formulary OTC 29G X 1/2" 0.3 ML LITETOUCH INSULIN SYRINGE 29G X 1/2" 0.5 ML Formulary OTC 29G X 1/2" 0.5 ML LITETOUCH INSULIN SYRINGE 29G X 1/2" 1 ML 29G Formulary OTC X 1/2" 1 ML 84 Drug Name Formulary Status Requirements/Limits LITETOUCH INSULIN SYRINGE 30G X 5/16" 0.3 ML Formulary OTC 30G X 5/16" 0.3 ML LITETOUCH INSULIN SYRINGE 30G X 5/16" 0.5 ML Formulary OTC 30G X 5/16" 0.5 ML LITETOUCH INSULIN SYRINGE 30G X 5/16" 1 ML Formulary OTC 30G X 5/16" 1 ML LITETOUCH INSULIN SYRINGE 31G X 5/16" 0.3 ML Formulary OTC 31G X 5/16" 0.3 ML LITETOUCH INSULIN SYRINGE 31G X 5/16" 0.5 ML Formulary OTC 31G X 5/16" 0.5 ML LITETOUCH INSULIN SYRINGE 31G X 5/16" 1 ML Formulary OTC 31G X 5/16" 1 ML LITETOUCH LANCETS Formulary OTC; QL (150 EA per 30 days) lithium carbonate er oral tablet extended release 300 mg, Formulary 450 mg lithium carbonate oral capsule 150 mg, 300 mg, 600 mg Formulary lithium carbonate oral tablet 300 mg Formulary lithium oral solution 8 meq/5ml Formulary LITTLE COLDS COUGH FORMULA ORAL LIQUID 7.5 Formulary OTC MG/ML LITTLE COLDS DECONGESTANT ORAL LIQUID 2.5 Formulary OTC MG/ML LITTLE REMEDIES POISON TREAT ORAL Formulary OTC SUSPENSION RECONSTITUTED 15 GM/120ML LITTLE TUMMYS LAXATIVE ORAL LIQUID 8.8 Formulary OTC MG/ML LIVALO ORAL TABLET 1 MG, 2 MG, 4 MG Formulary ST live better lancet super thin Formulary OTC; QL (150 EA per 30 days) live better lancet ultra thin Formulary OTC; QL (150 EA per 30 days) liver extract oral tablet 455 mg Formulary OTC liver oral capsule 500 mg Formulary OTC l-lysine external ointment Formulary OTC l-lysine hcl oral capsule 500 mg Formulary OTC l-lysine hcl oral tablet 1000 mg Formulary OTC l-lysine oral capsule 500 mg Formulary OTC l-lysine oral tablet 1000 mg, 500 mg Formulary OTC LMX 4 EXTERNAL CREAM 4 % Formulary OTC LMX 4 PLUS EXTERNAL KIT 4 % Formulary OTC LO LOESTRIN FE ORAL TABLET 1 MG-10 MCG / 10 Formulary QL (28 EA per 28 days) MCG local anesthesia needle 20g x 4" , 22 x 4" , 22g x 3" Formulary OTC LODRANE D ORAL CAPSULE 4-60 MG Formulary OTC LOESTRIN FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG Formulary LOHIST-D ORAL LIQUID 2-30 MG/5ML Formulary OTC lohist-dm oral syrup 5-2-10 mg/5ml Formulary OTC; AGE (Min 2 Years) longs insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC longs lancets thin Formulary OTC; QL (150 EA per 30 days)

85 Drug Name Formulary Status Requirements/Limits loperamide hcl oral suspension 1 mg/7.5ml Formulary OTC lopinavir-ritonavir oral solution 400-100 mg/5ml Formulary lopinavir-ritonavir oral tablet 100-25 mg, 200-50 mg Formulary loratadine childrens oral solution 5 mg/5ml Formulary OTC loratadine oral capsule 10 mg Formulary OTC loratadine-d 24hr oral tablet extended release 24 hour 10- Formulary OTC 240 mg LORAZEPAM INTENSOL ORAL CONCENTRATE 2 Formulary QL (170 ML per 30 days) MG/ML lorazepam oral tablet 0.5 mg, 1 mg, 2 mg Formulary QL (170 EA per 30 days) LORTUSS DM ORAL LIQUID 30-6.25-15 MG/5ML Formulary OTC LORTUSS EX ORAL LIQUID 30-10-100 MG/5ML Formulary OTC LORTUSS LQ ORAL LIQUID 6.25-30 MG/5ML Formulary OTC losartan potassium oral tablet 100 mg, 25 mg, 50 mg Formulary losartan potassium-hctz oral tablet 100-12.5 mg, 100-25 Formulary mg, 50-12.5 mg LOTRIMIN AF EXTERNAL AEROSOL 2 % Formulary OTC LOTRIMIN AF EXTERNAL CREAM 1 % Formulary OTC LOTRIMIN ULTRA EXTERNAL CREAM 1 % Formulary OTC lovastatin oral tablet 10 mg, 20 mg, 40 mg Formulary loxapine succinate oral capsule 10 mg, 25 mg, 5 mg, 50 mg Formulary AGE (Min 18 Years) LOZIBASE S Formulary l-phenylalanine oral tablet 500 mg Formulary OTC l-tyrosine oral capsule 500 mg Formulary OTC l-tyrosine oral tablet 500 mg Formulary OTC lubiprostone oral capsule 24 mcg, 8 mcg Formulary PA; AGE (Min 18 Years) lubricant drops/dual-action ophthalmic solution 0.5-0.9 % Formulary OTC lubricant eye drops ophthalmic solution 0.4-0.3 % Formulary OTC LUBRISKIN EXTERNAL LOTION Formulary OTC LUCENTIS INTRAVITREAL SOLUTION 0.5 Formulary PA; QL (0.05 ML per 28 days) MG/0.05ML LUDENS COUGH DROPS MOUTH/THROAT Formulary OTC LOZENGE 3-60 MG LUDENS THROAT DROPS MOUTH/THROAT LOZENGE 1 MG, 1.6 MG, 1.7 MG, 2.4 MG, 2.5 MG, 2.8 Formulary OTC MG, 4 MG LUPKYNIS ORAL CAPSULE 7.9 MG Formulary PA; QL (180 EA per 30 days) LUPRON DEPOT (1-MONTH) INTRAMUSCULAR KIT Formulary PA; QL (1 EA per 90 days) 3.75 MG, 7.5 MG LUPRON DEPOT (3-MONTH) INTRAMUSCULAR KIT Formulary PA; QL (1 EA per 90 days) 11.25 MG, 22.5 MG LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT Formulary PA; QL (1 EA per 90 days) 30 MG LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT Formulary PA; QL (1 EA per 90 days) 45 MG LUPRON DEPOT-PED (1-MONTH) INTRAMUSCULAR Formulary PA; QL (1 EA per 90 days) KIT 11.25 MG, 15 MG, 7.5 MG

86 Drug Name Formulary Status Requirements/Limits LUPRON DEPOT-PED (3-MONTH) INTRAMUSCULAR Formulary PA; QL (1 EA per 90 days) KIT 11.25 MG (PED), 30 MG (PED) lutein oral capsule 15-0.7 mg, 40 mg, 6 mg Formulary OTC lutein oral tablet 10 mg, 20 mg, 6 mg Formulary OTC LUVENA FEMININE WIPES EXTERNAL 1 % Formulary OTC LYCELLE EXTERNAL GEL Formulary OTC lysine4000 oral packet 4000 mg Formulary OTC LYSODREN ORAL TABLET 500 MG Formulary M2 C ORAL CAPSULE EXTENDED RELEASE 500 MG Formulary OTC MAALOX ADVANCED MAX ST ORAL TABLET Formulary OTC CHEWABLE 1000-60 MG MAALOX JUNIOR PLUS ANTIGAS ORAL TABLET Formulary OTC CHEWABLE 400-24 MG MAALOX ORAL TABLET CHEWABLE 600 MG Formulary OTC MACUGEN INTRAOCULAR SOLUTION 0.3 MG Formulary mafenide acetate external packet 5 % Formulary MAG-200 ORAL TABLET 200 MG Formulary OTC mag-al oral liquid 200-200 mg/5ml Formulary OTC magdelay oral tablet delayed release 70 mg Formulary OTC MAGELLAN INSULIN SAFETY SYR 29G X 1/2" 0.3 Formulary ML 29G X 1/2" 0.3 ML MAGELLAN INSULIN SAFETY SYR 29G X 1/2" 0.5 Formulary ML 29G X 1/2" 0.5 ML MAGELLAN INSULIN SAFETY SYR 29G X 1/2" 1 ML Formulary 29G X 1/2" 1 ML MAGELLAN INSULIN SAFETY SYR 30G X 5/16" 0.3 Formulary ML 30G X 5/16" 0.3 ML MAGELLAN INSULIN SAFETY SYR 30G X 5/16" 0.5 Formulary ML 30G X 5/16" 0.5 ML MAGELLAN INSULIN SAFETY SYR 30G X 5/16" 1 ML Formulary 30G X 5/16" 1 ML MAGIMIN ORAL TABLET 80 MG Formulary OTC magnacaps oral capsule 100 mg Formulary OTC MAGNEBIND 200 ORAL TABLET 450-200 MG Formulary OTC MAGNEBIND 300 ORAL TABLET 250-300 MG Formulary OTC magnesium aspartate oral tablet 65 mg Formulary OTC magnesium carbonate oral powder 250 mg/gm Formulary OTC magnesium chloride oral tablet delayed release 64 mg Formulary OTC magnesium chloride-calcium oral tablet 64-112 mg Formulary OTC magnesium citrate oral solution 1.745 gm/30ml Formulary OTC magnesium fizz-plus oral powder effervescent 300-500 Formulary OTC mg/6.1gm magnesium gluconate oral tablet 27.5 mg Formulary OTC magnesium oral capsule 300 mg Formulary OTC magnesium oral tablet 200 mg, 250 mg, 30 mg Formulary OTC magnesium oxide oral capsule 500 mg Formulary OTC

87 Drug Name Formulary Status Requirements/Limits magnesium oxide oral powder Formulary OTC magnesium oxide oral tablet 400 (240 mg) mg, 400 (241.3 Formulary OTC mg) mg, 400 mg, 420 mg, 500 mg magnesium sulfate oral capsule 70 mg Formulary OTC magnum-75 oral tablet extended release Formulary OTC MAGONATE ORAL TABLET 500 (27 MG) MG Formulary OTC mag-sr plus calcium oral tablet delayed release 64-106 mg Formulary OTC MAG-TAB SR ORAL TABLET EXTENDED RELEASE Formulary OTC 84 MG (7MEQ) MAKENA SUBCUTANEOUS SOLUTION AUTO- Formulary INJECTOR 275 MG/1.1ML malathion external lotion 0.5 % Formulary ST manganese aspartate oral tablet 93 mg Formulary OTC manganese gluconate oral tablet 50 mg Formulary OTC manganese oral tablet 15 mg Formulary OTC MANGIMIN ORAL TABLET 10 MG Formulary OTC MAOX ORAL TABLET 420 MG Formulary OTC MAPAP HEADACHE PLUS ORAL TABLET 500-250 Formulary OTC MG mapap oral capsule 500 mg Formulary OTC MAR-COF BP ORAL LIQUID 30-2-7.5 MG/5ML Formulary OTC MAR-COF CG EXPECTORANT ORAL LIQUID 225-7.5 Formulary OTC MG/5ML MASTISOL ADHESIVE EXTERNAL LIQUID Formulary OTC MATULANE ORAL CAPSULE 50 MG Formulary MAVYRET ORAL TABLET 100-40 MG Formulary PA; AGE (Min 12 Years) MAXI-COMFORT INSULIN SYRINGE 28G X 1/2" 0.5 Formulary OTC ML 28G X 1/2" 0.5 ML MAXI-COMFORT INSULIN SYRINGE 28G X 1/2" 1 ML Formulary OTC 28G X 1/2" 1 ML MAXIMUM D3 ORAL CAPSULE 10000 UNIT Formulary OTC ME-500 ORAL CAPSULE 500 MG Formulary OTC mecholyl external ointment 0.25 % Formulary OTC meclizine hcl oral tablet 12.5 mg, 25 mg Formulary MEDADYNE ORAL PAIN RELIEF MOUTH/THROAT Formulary OTC LIQUID 10-0.13-70 % MEDERMA AG FACIAL CLEANSER EXTERNAL Formulary OTC LIQUID MEDERMA EXTERNAL GEL Formulary OTC MEDERMA PM EXTERNAL CREAM 2 % Formulary OTC medic insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml Formulary OTC medic insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC medicated body external powder Formulary OTC medicated vaginal solution 0.3 % Formulary OTC medicated wipes external pad 50 % Formulary OTC MEDICONE RECTAL SUPPOSITORY 0.25 % Formulary OTC

88 Drug Name Formulary Status Requirements/Limits MEDI-DERM/L-RX EXTERNAL CREAM 2-0.035-5-20 Formulary % MEDI-DERM-RX EXTERNAL CREAM 0.035-5-20 % Formulary MEDI-FIRST ANTISEPTIC CLEANER EXTERNAL GEL Formulary OTC 66.5 % medi-first hydrocortisone external cream 1 % Formulary OTC MEDI-FIRST/LIDOCAINE EXTERNAL CREAM 0.5- Formulary OTC 0.13 % MEDIHONEY WOUND/BURN DRESSING EXTERNAL Formulary GEL MEDIHONEY WOUND/BURN DRESSING EXTERNAL Formulary PASTE medi-laxx oral capsule 8.6-50 mg Formulary OTC MEDI-LYTE ORAL TABLET 18-9-40 MG Formulary OTC medi-patch-lidocaine external patch 0.5-0.035-5-20 % Formulary OTC MEDIPLAST EXTERNAL 40 % Formulary OTC MEDIPORE + PAD ADHESIVE DRESS PAD 2"X2-3/4" , Formulary OTC 3-1/2"X10" , 3-1/2"X13-3/4" MEDISENSE GLUCOSE KETONE CONTR LIQUID IN Formulary OTC; QL (100 EA per 30 days) VITRO MEDISENSE HI/MID/LOW CONTROL LIQUID IN Formulary OTC; QL (100 EA per 30 days) VITRO MEDISENSE HIGH/LOW CONTROL LIQUID IN VITRO Formulary OTC; QL (100 EA per 30 days) MEDISENSE MID CONTROL LIQUID IN VITRO Formulary OTC; QL (100 EA per 30 days) MEDISENSE THIN LANCETS Formulary OTC; QL (150 EA per 30 days) medi-tussin dm double strength oral liquid 30-200 mg/5ml Formulary OTC MEDROX EXTERNAL OINTMENT 0.0375-5-20 % Formulary OTC MEDROX EXTERNAL PATCH 0.0375-5-20 % Formulary OTC medroxyprogesterone acetate intramuscular suspension 150 Formulary QL (1 ML per 90 days) mg/ml medroxyprogesterone acetate intramuscular suspension Formulary prefilled syringe 150 mg/ml medroxyprogesterone acetate oral tablet 10 mg, 2.5 mg, 5 Formulary mg mefenamic acid oral capsule 250 mg Formulary mefloquine hcl oral tablet 250 mg Formulary mega coq10 oral capsule 400 mg Formulary OTC MEGA MULTIVITAMIN ORAL POWDER Formulary OTC megestrol acetate oral suspension 40 mg/ml Formulary megestrol acetate oral tablet 20 mg, 40 mg Formulary meijer alcohol swabs pad 70 % 70 % Formulary OTC MEIJER LANCETS Formulary OTC; QL (150 EA per 30 days) MEIJER LANCETS THIN Formulary OTC; QL (150 EA per 30 days) MEIJER LANCETS UNIVERSAL 21G Formulary OTC; QL (150 EA per 30 days) MEIJER LANCETS UNIVERSAL 33G Formulary OTC; QL (150 EA per 30 days) MEIJER SUPER THIN LANCETS Formulary OTC; QL (150 EA per 30 days) melatonin er oral tablet extended release 3 mg Formulary OTC 89 Drug Name Formulary Status Requirements/Limits melatonin oral capsule 1 mg, 10 mg, 3 mg, 5 mg Formulary OTC melatonin oral tablet 1 mg, 10 mg, 3 mg, 300 mcg, 5 mg Formulary OTC melatonin oral tablet dispersible 5 mg Formulary OTC melatonin sublingual tablet sublingual 10 mg Formulary OTC melatonin tr oral tablet extended release 1 mg Formulary OTC melatonin-pyridoxine oral tablet 1-10 mg Formulary OTC MELLOW-TONE ORAL STRIP Formulary OTC meloxicam oral tablet 15 mg, 7.5 mg Formulary melphalan hcl intravenous solution reconstituted 50 mg Formulary melphalan oral tablet 2 mg Formulary memantine hcl er oral capsule extended release 24 hour 14 Formulary mg, 21 mg, 28 mg, 7 mg memantine hcl oral solution 2 mg/ml Formulary memantine hcl oral tablet 10 mg, 28 x 5 mg & 21 x 10 mg, 5 Formulary mg MENACTRA INTRAMUSCULAR INJECTABLE Formulary AGE (Min 19 Years) mencaps external patch 0.0225-4.5 % Formulary OTC m-end dmx oral liquid 20-0.667-10 mg/5ml Formulary OTC M-END PE ORAL LIQUID 3.33-1.33-6.33 MG/5ML Formulary OTC MENEST ORAL TABLET 0.3 MG, 0.625 MG, 1.25 MG Formulary menstrual pain relief oral tablet 500-25-15 mg Formulary OTC menstrual relief max strength oral tablet 500-60-15 mg Formulary OTC MENVEO INTRAMUSCULAR SOLUTION Formulary AGE (Min 19 Years) RECONSTITUTED meperidine hcl injection solution 10 mg/ml, 100 mg/ml, 25 Formulary mg/ml, 50 mg/ml mercaptopurine oral tablet 50 mg Formulary mesalamine er oral capsule extended release 24 hour 0.375 Formulary gm mesalamine oral tablet delayed release 1.2 gm Formulary mesalamine rectal enema 4 gm Formulary mesalamine rectal suppository 1000 mg Formulary mesalamine-cleanser rectal kit 4 gm Formulary mesna intravenous solution 100 mg/ml Formulary MESNEX ORAL TABLET 400 MG Formulary MESTINON ORAL SYRUP 60 MG/5ML Formulary METAMUCIL MULTIHEALTH FIBER ORAL PACKET Formulary OTC 58.12 % METAMUCIL MULTIHEALTH FIBER ORAL POWDER Formulary OTC 63 % METAMUCIL ORAL CAPSULE 0.52 GM Formulary OTC METAMUCIL ORAL POWDER 48.57 % Formulary OTC METAMUCIL SMOOTH TEXTURE ORAL PACKET 28 Formulary OTC % metaproterenol sulfate oral syrup 10 mg/5ml Formulary METAXALL ORAL TABLET 800 MG Formulary ST 90 Drug Name Formulary Status Requirements/Limits metformin hcl er oral tablet extended release 24 hour 500 Formulary AGE (Min 10 Years) mg, 750 mg metformin hcl oral solution 500 mg/5ml Formulary ST; AGE (Min 10 Years) metformin hcl oral tablet 1000 mg, 500 mg, 850 mg Formulary AGE (Min 10 Years) METHADONE HCL INTENSOL ORAL Formulary PA; QL (120 ML per 30 days) CONCENTRATE 10 MG/ML methadone hcl oral concentrate 10 mg/ml Formulary PA; QL (120 EA per 30 days) methadone hcl oral solution 10 mg/5ml Formulary PA; QL (450 ML per 30 days) methadone hcl oral solution 5 mg/5ml Formulary PA; QL (1200 ML per 30 days) methadone hcl oral tablet 10 mg Formulary PA; QL (90 EA per 30 days) methadone hcl oral tablet 5 mg Formulary PA; QL (180 EA per 30 days) methadone hcl oral tablet soluble 40 mg Formulary PA; QL (22.5 EA per 30 days) methazolamide oral tablet 25 mg, 50 mg Formulary methenamine hippurate oral tablet 1 gm Formulary methenamine mandelate oral tablet 1 gm Formulary methimazole oral tablet 10 mg, 5 mg Formulary methionine oral packet 100 mg Formulary OTC methionine oral tablet 500 mg Formulary OTC methitest oral tablet 10 mg Formulary methocarbamol injection solution 1000 mg/10ml Formulary methocarbamol oral tablet 500 mg, 750 mg Formulary methotrexate oral tablet 2.5 mg Formulary methotrexate sodium (pf) injection solution 1 gm/40ml, 250 Formulary mg/10ml, 50 mg/2ml methotrexate sodium injection solution 250 mg/10ml, 50 Formulary mg/2ml methotrexate sodium injection solution reconstituted 1 gm Formulary methoxsalen oral capsule 10 mg Formulary external liquid Formulary methyl salicylate external oil Formulary OTC methyldopa oral tablet 250 mg, 500 mg Formulary methylphenidate hcl er oral tablet extended release 18 mg, Formulary AGE (Min 4 Years and Max 17 Years) 27 mg, 36 mg, 54 mg methylphenidate hcl oral tablet 10 mg, 20 mg, 5 mg Formulary AGE (Min 4 Years and Max 17 Years) methylprednisolone acetate injection suspension 40 mg/ml, Formulary 80 mg/ml methylprednisolone oral tablet 16 mg, 32 mg, 4 mg, 8 mg Formulary methylprednisolone oral tablet therapy pack 4 mg Formulary methylprednisolone sodium succ injection solution Formulary reconstituted 1000 mg, 125 mg, 40 mg metipranolol ophthalmic solution 0.3 % Formulary metoclopramide hcl oral solution 5 mg/5ml Formulary metoclopramide hcl oral tablet 10 mg, 5 mg Formulary metolazone oral tablet 10 mg, 2.5 mg, 5 mg Formulary metoprolol succinate er oral tablet extended release 24 Formulary hour 100 mg, 200 mg, 25 mg, 50 mg 91 Drug Name Formulary Status Requirements/Limits metoprolol tartrate intravenous solution 5 mg/5ml Formulary metoprolol tartrate intravenous solution cartridge 5 mg/5ml Formulary metoprolol tartrate oral tablet 100 mg, 25 mg, 37.5 mg, 50 Formulary mg, 75 mg metoprolol-hydrochlorothiazide oral tablet 100-25 mg, 100- Formulary 50 mg, 50-25 mg metronidazole external cream 0.75 % Formulary metronidazole external gel 0.75 %, 1 % Formulary metronidazole external lotion 0.75 % Formulary metronidazole in nacl intravenous solution 500-0.79 Formulary mg/100ml-% metronidazole oral capsule 375 mg Formulary metronidazole oral tablet 250 mg, 500 mg Formulary metronidazole vaginal gel 0.75 % Formulary mexiletine hcl oral capsule 150 mg, 200 mg, 250 mg Formulary MEXSANA EXTERNAL POWDER 10.8 % Formulary OTC MG/TAURINE FORTE ORAL CAPSULE Formulary OTC MG217 PSORIASIS ANIT-ITCH EXTERNAL GEL 1 % Formulary OTC MI PASTE PLUS DENTAL PASTE Formulary MIBELAS 24 FE ORAL TABLET CHEWABLE 1-20 MG- Formulary PA; QL (28 EA per 28 days) MCG(24) MICATIN EXTERNAL CREAM 2 % Formulary OTC miconazole 3 vaginal cream 4 % Formulary OTC miconazole 7 vaginal suppository 100 mg Formulary OTC miconazole nitrate vaginal cream 2 % Formulary OTC; QL (45 GM per 34 days) MICORT-HC EXTERNAL CREAM 2.5 % Formulary microfiber cleaning cloths Formulary OTC MICROGESTIN 1/20 ORAL TABLET 1-20 MG-MCG Formulary MICROGESTIN FE 1.5/30 ORAL TABLET 1.5-30 MG- Formulary MCG MICROKLENZ EXTERNAL LIQUID 0.1 % Formulary OTC MICROLET LANCETS Formulary OTC; QL (150 EA per 30 days) MICROLET NEXT LANCING DEVICE Formulary OTC midazolam hcl oral syrup 2 mg/ml Formulary midodrine hcl oral tablet 10 mg, 2.5 mg, 5 mg Formulary MIDOL CAFFEINE FREE ORAL TABLET 500-25 MG Formulary OTC MIDOL COMPLETE ORAL TABLET 500-60-15 MG Formulary OTC MIGERGOT RECTAL SUPPOSITORY 2-100 MG Formulary miglitol oral tablet 100 mg, 50 mg Formulary miglustat oral capsule 100 mg Formulary MIL-A-MULSION ORAL EMULSION 10-15000 Formulary OTC UNIT/DROP MILCO-ZYME ORAL TABLET Formulary OTC milk of magnesia concentrate oral suspension 2400 Formulary OTC mg/10ml

92 Drug Name Formulary Status Requirements/Limits MILLGUARD ORAL TABLET 800-10-115 MCG-MG- Formulary OTC MCG MILTAB #1 ORAL TABLET Formulary OTC mineral oil light external oil 100 % Formulary OTC mineral oil-hydrophil petrolat external ointment Formulary OTC MINIMED GUARDIAN LINK 3 Formulary MINIMED PRO-SET INFUSION 42" Formulary MINITRAN TRANSDERMAL PATCH 24 HOUR 0.1 Formulary MG/HR, 0.2 MG/HR, 0.4 MG/HR, 0.6 MG/HR minocycline hcl oral capsule 100 mg, 50 mg, 75 mg Formulary minocycline hcl oral tablet 100 mg, 50 mg, 75 mg Formulary minoxidil for women external solution 2 % Formulary OTC minoxidil oral tablet 10 mg, 2.5 mg Formulary MIRALAX ORAL PACKET 17 GM Formulary OTC MIRALAX ORAL POWDER 17 GM/SCOOP Formulary OTC MIRCERA INJECTION SOLUTION PREFILLED SYRINGE 150 MCG/0.3ML, 200 MCG/0.3ML, 30 Formulary MCG/0.3ML MIRENA (52 MG) INTRAUTERINE INTRAUTERINE Formulary QL (1 EA per 365 days) DEVICE 20 MCG/24HR mirtazapine oral tablet 15 mg, 30 mg, 45 mg, 7.5 mg Formulary mirtazapine oral tablet dispersible 15 mg, 30 mg, 45 mg Formulary misoprostol oral tablet 100 mcg, 200 mcg Formulary mitomycin intravenous solution reconstituted 20 mg, 40 mg, Formulary 5 mg mitoxantrone hcl intravenous concentrate 20 mg/10ml, 25 Formulary mg/12.5ml, 30 mg/15ml M-M-R II SUBCUTANEOUS INJECTABLE Formulary AGE (Min 19 Years) mn-50 oral capsule 16.67 mg Formulary OTC MODERIBA ORAL TABLET 200 MG Formulary PA moexipril hcl oral tablet 15 mg, 7.5 mg Formulary moisture barrier external ointment , 0.44-20.6 % Formulary OTC MOISTURE GUARD EXTERNAL CREAM 5 % Formulary OTC MOISTUREL EXTERNAL LOTION 3 % Formulary OTC moisturizing skin protectant external cream 8 % Formulary OTC molybdenum oral capsule 30 mcg Formulary OTC mometasone furoate external cream 0.1 % Formulary mometasone furoate external ointment 0.1 % Formulary mometasone furoate external solution 0.1 % Formulary mometasone furoate nasal suspension 50 mcg/act Formulary QL (17 GM per 30 days) MONOCAL ORAL TABLET 625-22.75 MG Formulary OTC MONOJECT ALLERGIST TRAY KIT 28G X 1/2" 1 ML Formulary MONOJECT BLUNTIP CANNULA 21G X 1" Formulary

93 Drug Name Formulary Status Requirements/Limits MONOJECT HYPODERMIC NEEDLE 14G X 1-1/2" , 14G X 2" , 16G X 1" , 16G X 3/4" , 16G X 5/8" , 21G X 2" Formulary , 25G X 1-1/4" , 25G X 2" , 26G X 1-1/2" , 26G X 1/2" , 27G X 1-1/2" , 30G X 3/4" MONOJECT INSULIN SYRINGE 25G X 5/8" 1 ML 25G Formulary OTC X 5/8" 1 ML MONOJECT INSULIN SYRINGE 27G X 1/2" 1 ML Formulary (OTC) 27G X 1/2" 1 ML MONOJECT INSULIN SYRINGE 27G X 1/2" 1 ML (RX) Formulary 27G X 1/2" 1 ML MONOJECT INSULIN SYRINGE 28G X 1/2" 0.5 ML Formulary (OTC) 28G X 1/2" 0.5 ML MONOJECT INSULIN SYRINGE 28G X 1/2" 0.5 ML Formulary (RX) 28G X 1/2" 0.5 ML MONOJECT INSULIN SYRINGE 28G X 1/2" 1 ML Formulary (OTC) 28G X 1/2" 1 ML MONOJECT INSULIN SYRINGE 28G X 1/2" 1 ML (RX) Formulary 28G X 1/2" 1 ML MONOJECT INSULIN SYRINGE 29G X 1/2" 0.3 ML Formulary 29G X 1/2" 0.3 ML MONOJECT INSULIN SYRINGE 29G X 1/2" 0.5 ML Formulary 29G X 1/2" 0.5 ML MONOJECT INSULIN SYRINGE 29G X 1/2" 1 ML (RX) Formulary 29G X 1/2" 1 ML MONOJECT INSULIN SYRINGE 30G X 5/16" 0.3 ML Formulary 30G X 5/16" 0.3 ML MONOJECT INSULIN SYRINGE 30G X 5/16" 0.5 ML Formulary (RX) 30G X 5/16" 0.5 ML MONOJECT INSULIN SYRINGE 30G X 5/16" 1 ML Formulary (OTC) 30G X 5/16" 1 ML MONOJECT INSULIN SYRINGE 30G X 5/16" 1 ML Formulary (RX) 30G X 5/16" 1 ML MONOJECT INSULIN SYRINGE 31G X 5/16" 1 ML 31G Formulary OTC X 5/16" 1 ML MONOJECT INSULIN SYRINGE U-100 1 ML U-100 1 Formulary ML MONOJECT LIFESHIELD SYRINGE 18G X 1" 3 ML Formulary MONOJECT MAGELLAN SAFETY NDL 21G X 5/8" , Formulary 23G X 5/8" MONOJECT MAGELLAN SYRINGE 20G X 1-1/2" 12 Formulary ML, 21G X 1" 12 ML, 21G X 1-1/2" 12 ML MONOJECT SYRINGE 18G X 1" 12 ML, 20G X 1-1/2" 6 Formulary ML, 20G X 3/4" 3 ML, 21G X 1-1/2" 6 ML MONOJECT ULTRA COMFORT SYRINGE 28G X 1/2" Formulary 0.5 ML (OTC) 28G X 1/2" 0.5 ML MONOJECT ULTRA COMFORT SYRINGE 28G X 1/2" Formulary 0.5 ML (RX) 28G X 1/2" 0.5 ML MONOJECT ULTRA COMFORT SYRINGE 28G X 1/2" Formulary 1 ML (OTC) 28G X 1/2" 1 ML MONOJECT ULTRA COMFORT SYRINGE 28G X 1/2" Formulary 1 ML (RX) 28G X 1/2" 1 ML

94 Drug Name Formulary Status Requirements/Limits MONOJECT ULTRA COMFORT SYRINGE 29G X 1/2" Formulary OTC 0.3 ML 29G X 1/2" 0.3 ML MONOJECT ULTRA COMFORT SYRINGE 29G X 1/2" Formulary OTC 0.5 ML 29G X 1/2" 0.5 ML MONOJECT ULTRA COMFORT SYRINGE 29G X 1/2" Formulary OTC 1 ML 29G X 1/2" 1 ML MONOJECT ULTRA COMFORT SYRINGE 30G X 5/16" Formulary 0.3 ML (OTC) 30G X 5/16" 0.3 ML MONOJECT ULTRA COMFORT SYRINGE 30G X 5/16" Formulary 0.3 ML (RX) 30G X 5/16" 0.3 ML MONOJECT ULTRA COMFORT SYRINGE 30G X 5/16" Formulary 0.5 ML (OTC) 30G X 5/16" 0.5 ML MONOJECT ULTRA COMFORT SYRINGE 30G X 5/16" Formulary 0.5 ML (RX) 30G X 5/16" 0.5 ML MONOJECT ULTRA COMFORT SYRINGE 31G X 5/16" Formulary OTC 0.3 ML 31G X 5/16" 0.3 ML MONOJECT ULTRA COMFORT SYRINGE 31G X 5/16" Formulary OTC 0.5 ML 31G X 5/16" 0.5 ML MONOLET LANCETS Formulary OTC; QL (150 EA per 30 days) MONOLET OPD LANCETS Formulary OTC; QL (150 EA per 30 days) MONONINE INTRAVENOUS SOLUTION Formulary RECONSTITUTED 1000 UNIT MONOVISC INTRA-ARTICULAR SOLUTION Formulary PA PREFILLED SYRINGE 88 MG/4ML montelukast sodium oral packet 4 mg Formulary montelukast sodium oral tablet 10 mg Formulary montelukast sodium oral tablet chewable 4 mg, 5 mg Formulary MORPHABOND ER ORAL TABLET ER 12 HOUR Formulary PA ABUSE-DETERRENT 60 MG morphine sulfate (concentrate) oral solution 100 mg/5ml Formulary PA; QL (32 ML per 7 days) morphine sulfate (pf) injection solution 0.5 mg/ml, 1 mg/ml Formulary morphine sulfate (pf) intravenous solution 10 mg/ml, 2 Formulary mg/ml, 4 mg/ml, 8 mg/ml morphine sulfate er beads oral capsule extended release 24 Formulary PA hour 120 mg, 30 mg, 45 mg, 60 mg, 75 mg, 90 mg morphine sulfate er oral tablet extended release 100 mg Formulary PA; QL (34 EA per 34 days) morphine sulfate er oral tablet extended release 15 mg Formulary PA; QL (204 EA per 34 days) morphine sulfate er oral tablet extended release 200 mg Formulary PA; QL (15.3 EA per 34 days) morphine sulfate er oral tablet extended release 30 mg Formulary PA; QL (102 EA per 34 days) morphine sulfate er oral tablet extended release 60 mg Formulary PA; QL (47 EA per 34 days) morphine sulfate injection solution 10 mg/ml, 2 mg/ml, 4 Formulary mg/ml, 5 mg/ml, 8 mg/ml morphine sulfate intravenous solution 1 mg/ml, 150 Formulary mg/30ml, 25 mg/ml, 50 mg/ml morphine sulfate oral solution 10 mg/5ml Formulary PA; QL (315 ML per 7 days) morphine sulfate oral solution 20 mg/5ml Formulary PA; QL (158 ML per 7 days) morphine sulfate oral tablet 15 mg Formulary PA; QL (42 EA per 7 days) morphine sulfate oral tablet 30 mg Formulary PA; QL (21 EA per 7 days)

95 Drug Name Formulary Status Requirements/Limits morphine sulfate rectal suppository 30 mg Formulary MOTRIN INFANTS DROPS ORAL SUSPENSION 50 Formulary OTC MG/1.25ML mouth rinse mouth/throat liquid 0.07 % Formulary OTC MOVANTIK ORAL TABLET 12.5 MG, 25 MG Formulary PA; AGE (Min 18 Years) moxifloxacin hcl (2x day) ophthalmic solution 0.5 % Formulary moxifloxacin hcl ophthalmic solution 0.5 % Formulary moxifloxacin hcl oral tablet 400 mg Formulary MOZOBIL SUBCUTANEOUS SOLUTION 24 MG/1.2ML Formulary ms insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC ms insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC ms insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC MUCINEX COUGH CHILDRENS ORAL LIQUID 5-100 Formulary OTC MG/5ML MUCINEX COUGH FOR KIDS ORAL PACKET 5-100 Formulary OTC MG MUCINEX D MAX STRENGTH ORAL TABLET Formulary OTC EXTENDED RELEASE 12 HOUR 120-1200 MG MUCINEX D ORAL TABLET EXTENDED RELEASE 12 Formulary OTC HOUR 60-600 MG MUCINEX DM MAXIMUM STRENGTH ORAL Formulary OTC TABLET EXTENDED RELEASE 12 HOUR 60-1200 MG MUCINEX DM ORAL TABLET EXTENDED RELEASE Formulary OTC 12 HOUR 30-600 MG MUCINEX FAST-MAX COLD & SINUS ORAL LIQUID Formulary OTC 10-650-400 MG/20ML MUCINEX FAST-MAX COLD & SINUS ORAL Formulary OTC TABLET 5-325-200 MG MUCINEX FAST-MAX COLD FLU ORAL LIQUID 5- Formulary OTC 10-200-325 MG/10ML MUCINEX FAST-MAX CONGEST COUGH ORAL Formulary OTC LIQUID 2.5-5-100 MG/5ML MUCINEX FAST-MAX CONGEST COUGH ORAL Formulary OTC TABLET 5-10-200 MG MUCINEX FAST-MAX DAY/NIGHT M/S ORAL Formulary OTC (TABLET) MUCINEX FAST-MAX DAY/NIGHT ORAL Formulary OTC MUCINEX FAST-MAX DAY/NIGHT ORAL CAPSULE Formulary OTC THERAPY PACK MUCINEX FAST-MAX DAY/NIGHT TAB ORAL Formulary OTC MUCINEX FAST-MAX ORAL CAPSULE 5-10-200-325 Formulary OTC MG MUCINEX FOR KIDS ORAL PACKET 100 MG Formulary OTC MUCINEX MAXIMUM STRENGTH ORAL TABLET Formulary OTC EXTENDED RELEASE 12 HOUR 1200 MG MUCINEX ORAL TABLET EXTENDED RELEASE 12 Formulary OTC HOUR 600 MG MUCINEX SINUS-MAX CONGESTION ORAL TABLET Formulary OTC 5-325-200 MG 96 Drug Name Formulary Status Requirements/Limits MUCINEX SINUS-MAX DAY/NIGHT ORAL LIQUID Formulary OTC MUCINEX SINUS-MAX DAY/NIGHT ORAL LIQUID Formulary OTC THERAPY PACK MUCINEX SINUS-MAX DAY/NIGHT ORAL TABLET Formulary OTC THERAPY PACK 5-200-325 & 5- 12.5-325MG MUCINEX SINUS-MAX PRESS & PAIN ORAL Formulary OTC TABLET 5-325-200 MG MUCINEX STUFFY NOSE/COLD CHILD ORAL Formulary OTC LIQUID 2.5-100 MG/5ML mucus congest & cough child oral liquid 2.5-5-100 mg/5ml Formulary OTC mucus relief cold/sinus max st oral liquid 10-650-400 Formulary OTC mg/20ml mucus relief d oral tablet extended release 12 hour 60-600 Formulary OTC mg mucus relief er oral tablet extended release 12 hour 1200 Formulary OTC mg mucus relief pe oral tablet 10-400 mg Formulary OTC mucus relief severe cong/cold oral tablet 5-10-200-325 mg Formulary OTC mucus-dm max oral tablet extended release 12 hour 60- Formulary OTC 1200 mg multi-delyn/iron oral liquid Formulary OTC multi-draw needle 20g x 1" , 21g x 1" , 22g x 1" Formulary MULTIGEN FOLIC ORAL TABLET 70-150-2-1 MG Formulary MULTIGEN ORAL TABLET 70 MG Formulary MULTIGEN PLUS ORAL TABLET 50-101-1 MG Formulary multi-minerals oral tablet Formulary OTC multi-purpose cold compress Formulary OTC multi-symptom cold plus child oral liquid 2.5-5-100 mg/5ml Formulary OTC multi-vit/fluoride oral solution 0.25 mg/ml Formulary multivitamin gummies childrens oral tablet chewable Formulary OTC multivitamin/fluoride oral solution 0.5 mg/ml Formulary multivitamin/fluoride oral tablet chewable 0.25 mg, 1 mg Formulary multivitamin/fluoride/iron oral solution 0.25-10 mg/ml Formulary multivitamins/fluoride oral tablet chewable 0.5 mg Formulary mupirocin external ointment 2 % Formulary MURO 128 OPHTHALMIC OINTMENT 5 % Formulary OTC MURO 128 OPHTHALMIC SOLUTION 2 %, 5 % Formulary OTC muscle rub ultra strength external cream 4-10-30 % Formulary OTC MUSTARGEN INJECTION SOLUTION Formulary RECONSTITUTED 10 MG M-VIT ORAL TABLET Formulary QL (34 EA per 34 days) MYCOCIDE CX CALLUS EXFOLIATOR EXTERNAL Formulary OTC CREAM 12-0.1 % mycophenolate mofetil oral capsule 250 mg Formulary mycophenolate mofetil oral suspension reconstituted 200 Formulary mg/ml mycophenolate mofetil oral tablet 500 mg Formulary 97 Drug Name Formulary Status Requirements/Limits mycophenolate sodium oral tablet delayed release 180 mg, Formulary 360 mg MYGLUCOHEALTH LANCETS 30G Formulary OTC; QL (150 EA per 30 days) MYLANTA ORAL SUSPENSION 200-200-20 MG/5ML Formulary OTC MYLERAN ORAL TABLET 2 MG Formulary MYNATAL ORAL CAPSULE Formulary mynate 90 plus oral tablet extended release Formulary mynephrocaps oral capsule 1 mg Formulary MYOBLOC INTRAMUSCULAR SOLUTION 10000 Formulary PA UNIT/2ML, 2500 UNIT/0.5ML, 5000 UNIT/ML MYORISAN ORAL CAPSULE 10 MG, 20 MG, 30 MG, Formulary 40 MG nabumetone oral tablet 500 mg, 750 mg Formulary nac oral capsule 600 mg Formulary OTC nadolol oral tablet 40 mg Formulary NAIL SCRUB EXTERNAL LIQUID Formulary OTC NAIL-EX ORAL TABLET 2.5 MG Formulary OTC nalbuphine hcl injection solution 10 mg/ml, 20 mg/ml Formulary naloxone hcl injection solution 0.4 mg/ml, 4 mg/10ml Formulary naloxone hcl injection solution cartridge 0.4 mg/ml Formulary naloxone hcl injection solution prefilled syringe 2 mg/2ml Formulary naltrexone hcl oral tablet 50 mg Formulary NAMENDA XR TITRATION PACK ORAL CAPSULE Formulary EXTENDED RELEASE 24 HOUR 7 & 14 & 21 NAMZARIC ORAL CAPSULE EXTENDED RELEASE Formulary 24 HOUR 14-10 MG NAPHCON-A OPHTHALMIC SOLUTION 0.025-0.3 % Formulary OTC naproxen dr oral tablet delayed release 375 mg, 500 mg Formulary naproxen oral suspension 125 mg/5ml Formulary naproxen oral tablet 250 mg, 375 mg, 500 mg Formulary naproxen sodium oral capsule 220 mg Formulary OTC hcl oral tablet 1 mg, 2.5 mg Formulary ST NARCAN NASAL LIQUID 4 MG/0.1ML Formulary NASACORT ALLERGY 24HR AEROSOL 55 MCG/ACT Formulary OTC NASAL 55 MCG/ACT NASACORT ALLERGY 24HR CHILDREN AEROSOL Formulary OTC 55 MCG/ACT NASAL 55 MCG/ACT nasal allergy 24 hour aerosol 55 mcg/act nasal 55 mcg/act Formulary OTC nasal aspirator Formulary OTC nasal decongestant oral liquid 30 mg/5ml Formulary OTC nasal decongestant oral syrup 30 mg/5ml Formulary OTC nasal decongestant spray nasal solution 0.05 % Formulary OTC NASAL EASE ALLERGY RELIEVER NASAL POWDER Formulary OTC nasal mist inhalation aerosol solution 0.9 % Formulary OTC NASALCROM NASAL AEROSOL SOLUTION 5.2 Formulary OTC MG/ACT 98 Drug Name Formulary Status Requirements/Limits NASOGEL NASAL GEL Formulary OTC NASONEB NEBULIZER STARTER Formulary OTC; QL (2 EA per 365 days) NASOPEN PE ORAL LIQUID 50-10 MG/15ML Formulary OTC NATACYN OPHTHALMIC SUSPENSION 5 % Formulary nateglinide oral tablet 120 mg, 60 mg Formulary NATELLE ONE ORAL CAPSULE 28-1-250 MG Formulary NATROBA EXTERNAL SUSPENSION 0.9 % Formulary natural fiber laxative oral powder 28.3 %, 30.9 % Formulary OTC natural vitamin e moisturizing external gel Formulary OTC NATURAL WHEY ORAL POWDER Formulary OTC NECON 0.5/35 (28) ORAL TABLET 0.5-35 MG-MCG Formulary QL (28 EA per 28 days) neomycin sulfate oral tablet 500 mg Formulary neomycin-bacitracin zn-polymyx ophthalmic ointment 5- Formulary 400-10000 neomycin-polymyxin b gu irrigation solution 40-200000 Formulary neomycin-polymyxin-dexameth ophthalmic ointment 3.5- Formulary 10000-0.1 neomycin-polymyxin-dexameth ophthalmic suspension 3.5- Formulary 10000-0.1 neomycin-polymyxin-gramicidin ophthalmic solution 1.75- Formulary 10000-.025 neomycin-polymyxin-hc otic solution 3.5-10000-1 Formulary neomycin-polymyxin-hc otic suspension 3.5-10000-1 Formulary NEOSPORIN + PAIN RELIEF MAX ST EXTERNAL Formulary OTC OINTMENT 1 % NEOSPORIN ORIGINAL EXTERNAL OINTMENT 3.5- Formulary OTC 400-5000 NEOSPORIN PLUS MAX ST EXTERNAL OINTMENT 4 Formulary OTC % NEOSPORIN PLUS PAIN RELIEF MS EXTERNAL Formulary OTC CREAM 3.5-10000-10 NEOSTRATA FACIAL CLEANSER EXTERNAL Formulary OTC LIQUID 0.3 % NEOTUSS-D ORAL LIQUID 7.5-30-200 MG/5ML Formulary OTC NEPHRONEX ORAL LIQUID 0.9 MG/5ML Formulary OTC NEPHRO-VITE ORAL TABLET 0.8 MG Formulary OTC NEULASTA SUBCUTANEOUS SOLUTION Formulary PA; QL (2 ML per 34 days) PREFILLED SYRINGE 6 MG/0.6ML NEUPOGEN INJECTION SOLUTION 300 MCG/ML, 480 Formulary PA MCG/1.6ML NEUPOGEN INJECTION SOLUTION PREFILLED Formulary PA SYRINGE 300 MCG/0.5ML, 480 MCG/0.8ML NEURO-K-250 T.D. ORAL CAPSULE 250 MG Formulary OTC neuromax external gel 20 % Formulary OTC NEUROPEN KIT Formulary OTC NEUROTIPS Formulary OTC NEUTROGENA BODY EXTERNAL OIL Formulary OTC

99 Drug Name Formulary Status Requirements/Limits NEUTROGENA CLEAR PORE EXTERNAL LIQUID 3.5 Formulary OTC % NEUTROGENA T/GEL EXTERNAL SHAMPOO 4 % Formulary OTC NEUTROGENA T/GEL STUBBORN ITCH EXTERNAL Formulary OTC SHAMPOO 0.5 % nevirapine er oral tablet extended release 24 hour 100 mg, Formulary 400 mg nevirapine oral suspension 50 mg/5ml Formulary nevirapine oral tablet 200 mg Formulary NEW DIGNITY ODOR ELIMINATOR EXTERNAL Formulary OTC SOLUTION NEW IMAGE SKIN/FLANGE/TAPE Formulary OTC new terocin external lotion 0.025-10-25 % Formulary OTC NEXAFED ORAL TABLET ABUSE-DETERRENT 30 Formulary OTC MG NEXAFED SINUS PRESSURE + PAIN ORAL TABLET Formulary OTC 30-325 MG NEXAVAR ORAL TABLET 200 MG Formulary PA NEXCARE PREMIUM ADHESIVE GAUZE PAD 3- Formulary OTC 1/2"X6" , 3-1/2"X8" NEXIUM 24HR CAPSULE DELAYED RELEASE 20 MG Formulary OTC; QL (68 EA per 34 days) ORAL 20 MG NEXIUM 24HR TABLET DELAYED RELEASE 20 MG Formulary OTC; QL (68 EA per 34 days) ORAL 20 MG NEXPLANON SUBCUTANEOUS IMPLANT 68 MG Formulary NEXT CHOICE ONE DOSE ORAL TABLET 1.5 MG Formulary OTC niacin er (antihyperlipidemic) oral tablet extended release Formulary 1000 mg, 500 mg, 750 mg niacin er oral capsule extended release 250 mg, 500 mg Formulary OTC niacin er oral tablet extended release 1000 mg, 250 mg, 750 Formulary OTC mg niacin flush free oral capsule 400-100 mg, 500 mg Formulary OTC niacin oral tablet 100 mg, 50 mg, 500 mg Formulary OTC niacinamide oral tablet 100 mg, 500 mg Formulary OTC nicardipine hcl in dextrose intravenous solution 25-5 Formulary mg/250ml-% nicardipine hcl intravenous solution 2.5 mg/ml Formulary nicardipine hcl oral capsule 20 mg, 30 mg Formulary NICODERM CQ TRANSDERMAL PATCH 24 HOUR 14 Formulary OTC MG/24HR, 21 MG/24HR, 7 MG/24HR MOUTH/THROAT GUM 2 MG, 4 MG Formulary OTC NICORETTE MOUTH/THROAT LOZENGE 2 MG, 4 MG Formulary OTC nicotine polacrilex mouth/throat gum 2 mg Formulary OTC nicotine polacrilex mouth/throat lozenge 2 mg, 4 mg Formulary OTC nicotine step 1 transdermal patch 24 hour 21 mg/24hr Formulary OTC nicotine step 2 transdermal patch 24 hour 14 mg/24hr Formulary OTC nicotine step 3 transdermal patch 24 hour 7 mg/24hr Formulary OTC

100 Drug Name Formulary Status Requirements/Limits nicotine transdermal kit 21-14-7 mg/24hr Formulary OTC NICOTROL INHALATION INHALER 10 MG Formulary NIFEDICAL XL ORAL TABLET EXTENDED RELEASE Formulary 24 HOUR 60 MG nifedipine er oral tablet extended release 24 hour 30 mg, 60 Formulary mg, 90 mg nifedipine er osmotic release oral tablet extended release Formulary 24 hour 30 mg, 90 mg nifedipine oral capsule 10 mg, 20 mg Formulary nighttime cough oral liquid 12.5-30 mg/30ml Formulary OTC nilutamide oral tablet 150 mg Formulary nimodipine oral capsule 30 mg Formulary NINJACOF ORAL LIQUID 12.5-12.5 MG/5ML Formulary OTC NINJACOF-A ORAL LIQUID 12.5-12.5-160 MG/5ML Formulary OTC NINJACOF-XG ORAL LIQUID 200-8 MG/5ML Formulary OTC NIPENT INTRAVENOUS SOLUTION Formulary RECONSTITUTED 10 MG NISEKO SUNSCREEN SPF 25 EXTERNAL CREAM Formulary OTC nisoldipine er oral tablet extended release 24 hour 17 mg, Formulary 25.5 mg, 34 mg, 8.5 mg NITEBITE ORAL BAR Formulary OTC nite-time cold/flu relief oral liquid 5-6.25-15-500 mg/15ml Formulary OTC NITRO-BID TRANSDERMAL OINTMENT 2 % Formulary nitrofurantoin macrocrystal oral capsule 100 mg, 50 mg Formulary nitrofurantoin monohyd macro oral capsule 100 mg Formulary nitrofurantoin oral suspension 25 mg/5ml Formulary nitroglycerin er oral capsule extended release 2.5 mg, 6.5 Formulary mg, 9 mg nitroglycerin sublingual tablet sublingual 0.3 mg, 0.4 mg, Formulary 0.6 mg NIVANEX DMX ORAL TABLET 10-15-380 MG Formulary OTC NIX CREME RINSE EXTERNAL LIQUID 1 % Formulary OTC nizatidine oral capsule 150 mg, 300 mg Formulary nizatidine oral solution 15 mg/ml Formulary NIZORAL A-D EXTERNAL SHAMPOO 1 % Formulary OTC NOBLE FORMULA EXTERNAL SHAMPOO 2 % Formulary OTC NOBLE FORMULA HC EXTERNAL SOLUTION 1 % Formulary OTC nohist-dm oral liquid 10-4-15 mg/5ml Formulary nohist-lq oral liquid 4-10 mg/5ml Formulary OTC NOKOR ADMIX NEEDLE 18G X 1-1/2" Formulary OTC non-stick pad 2"x3" Formulary OTC NORDITROPIN FLEXPRO SOLUTION PEN-INJECTOR Formulary PA 10 MG/1.5ML SUBCUTANEOUS 10 MG/1.5ML NORDITROPIN FLEXPRO SOLUTION PEN-INJECTOR Formulary PA 15 MG/1.5ML SUBCUTANEOUS 15 MG/1.5ML

101 Drug Name Formulary Status Requirements/Limits NORDITROPIN FLEXPRO SOLUTION PEN-INJECTOR Formulary PA 30 MG/3ML SUBCUTANEOUS 30 MG/3ML NORDITROPIN FLEXPRO SOLUTION PEN-INJECTOR Formulary PA 5 MG/1.5ML SUBCUTANEOUS 5 MG/1.5ML NOREL AD ORAL TABLET 4-10-325 MG Formulary OTC NOREL CS ORAL LIQUID 10-4-12.5 MG/5ML Formulary OTC norethin ace-eth estrad-fe oral tablet 1.5-30 mg-mcg Formulary norethindrone acetate oral tablet 5 mg Formulary norethindrone acet-ethinyl est oral tablet 1-20 mg-mcg Formulary norgestim-eth estrad triphasic oral tablet 0.18/0.215/0.25 Formulary QL (28 EA per 28 days) mg-35 mcg NORMLSHIELD EXTERNAL CREAM 4.5 % Formulary OTC nortemp infants oral suspension 80 mg/0.8ml Formulary OTC nortriptyline hcl oral capsule 10 mg, 25 mg, 50 mg, 75 mg Formulary NORVIR ORAL CAPSULE 100 MG Formulary NORVIR ORAL SOLUTION 80 MG/ML Formulary nosebleed plugs/towelettes kit Formulary OTC NO-STING SKIN-PREP EXTERNAL Formulary OTC NOVA SUREFLEX LANCETS Formulary OTC; QL (150 EA per 30 days) NOVAFERRUM 125 ORAL LIQUID 125-100 MG- Formulary OTC UNT/5ML NOVAFERRUM 50 ORAL CAPSULE 50 MG Formulary OTC NOVAFERRUM ORAL LIQUID 125 MG/5ML Formulary OTC NOVAFERRUM PEDIATRIC DROPS ORAL LIQUID 15 Formulary OTC MG/ML NOVOLIN 70/30 FLEXPEN RELION SUBCUTANEOUS Formulary OTC SUSPENSION PEN-INJECTOR (70-30) 100 UNIT/ML NOVOLIN 70/30 FLEXPEN SUBCUTANEOUS Formulary OTC SUSPENSION PEN-INJECTOR (70-30) 100 UNIT/ML NOVOLIN N FLEXPEN RELION SUBCUTANEOUS Formulary OTC SUSPENSION PEN-INJECTOR 100 UNIT/ML NOVOLIN N FLEXPEN SUBCUTANEOUS Formulary OTC SUSPENSION PEN-INJECTOR 100 UNIT/ML NOVOLOG 70/30 FLEXPEN RELION SUSPENSION PEN-INJECTOR (70-30) 100 UNIT/ML Formulary SUBCUTANEOUS (70-30) 100 UNIT/ML NOVOLOG FLEXPEN RELION SOLUTION PEN- INJECTOR 100 UNIT/ML SUBCUTANEOUS 100 Formulary UNIT/ML NOVOLOG MIX 70/30 RELION SUSPENSION (70-30) Formulary 100 UNIT/ML SUBCUTANEOUS (70-30) 100 UNIT/ML NOVOLOG RELION SOLUTION 100 UNIT/ML Formulary SUBCUTANEOUS 100 UNIT/ML NOVOPEN ECHO DEVICE Formulary NOXICARE EXTERNAL CREAM Formulary OTC np thyroid oral tablet 15 mg, 30 mg, 60 mg, 90 mg Formulary NPLATE SUBCUTANEOUS SOLUTION Formulary PA RECONSTITUTED 250 MCG, 500 MCG

102 Drug Name Formulary Status Requirements/Limits NUEDEXTA ORAL CAPSULE 20-10 MG Formulary PA NUFERA ORAL TABLET Formulary NU-GEL EXTERNAL GEL Formulary OTC NULIDO EXTERNAL GEL 4-1 % Formulary OTC NU-MAG ORAL TABLET DELAYED RELEASE 71.5- Formulary OTC 119 MG NUPERCAINAL RECTAL OINTMENT 1 % Formulary OTC NUTRATEAR OPHTHALMIC SOLUTION 0.6 % Formulary OTC NUTR-E-SOL ORAL LIQUID 400 UNIT/15ML Formulary OTC NUVESSA VAGINAL GEL 1.3 % Formulary NYAMYC EXTERNAL POWDER 100000 UNIT/GM Formulary NYMALIZE ORAL SOLUTION 30 MG/10ML, 60 Formulary MG/20ML nystatin external cream 100000 unit/gm Formulary nystatin external ointment 100000 unit/gm Formulary nystatin external powder 100000 unit/gm Formulary nystatin mouth/throat suspension 100000 unit/ml Formulary nystatin oral tablet 500000 unit Formulary nystatin-triamcinolone external cream 100000-0.1 unit/gm- Formulary % nystatin-triamcinolone external ointment 100000-0.1 Formulary unit/gm-% NYSTOP EXTERNAL POWDER 100000 UNIT/GM Formulary NYTOL MAXIMUM STRENGTH ORAL TABLET 50 Formulary OTC MG OASIS MOISTURIZING MOUTHWASH Formulary OTC MOUTH/THROAT LIQUID OBSTETRIX DHA ORAL 29-1 & 387 MG Formulary OBSTETRIX EC ORAL TABLET 29-1 MG Formulary OC8 EXTERNAL GEL 7 % Formulary OTC OCEAN BLUE MINICAPS D/OMEGA3 ORAL Formulary OTC CAPSULE 350-1000 MG-UNIT OCEAN BLUE MINICAPS OMEGA-3 ORAL CAPSULE Formulary OTC 350 MG OCEAN BLUE OPTIMAL HEALTH ORAL CAPSULE Formulary OTC 250 MG OCEAN COMPLETE SINUS RINSE NASAL AEROSOL Formulary OTC SOLUTION OCEAN NASAL SOLUTION 0.65 % Formulary OTC oceanic selenium oral tablet 50 mcg Formulary OTC OCUSOFT LID SCRUB COMPLIANCE KIT Formulary OTC ODEFSEY ORAL TABLET 200-25-25 MG Formulary ODOR EATERS ANTIFUNGAL EXTERNAL POWDER Formulary OTC 1 % odor spray liquid Formulary OTC OFF ACTIVE EXTERNAL AEROSOL 15 % Formulary OTC

103 Drug Name Formulary Status Requirements/Limits OFF FAMILYCARE CLEAN FEEL EXTERNAL LIQUID Formulary OTC 5 % ofloxacin ophthalmic solution 0.3 % Formulary ofloxacin oral tablet 400 mg Formulary QL (68 EA per 34 days) ofloxacin otic solution 0.3 % Formulary OGESTREL ORAL TABLET 0.5-50 MG-MCG Formulary olanzapine intramuscular solution reconstituted 10 mg Formulary AGE (Min 18 Years) olanzapine oral tablet 10 mg, 15 mg, 2.5 mg, 20 mg, 5 mg, Formulary AGE (Min 18 Years) 7.5 mg olanzapine oral tablet dispersible 10 mg, 15 mg, 20 mg, 5 Formulary AGE (Min 18 Years) mg olmesartan medoxomil oral tablet 20 mg, 40 mg, 5 mg Formulary olmesartan medoxomil-hctz oral tablet 20-12.5 mg, 40-12.5 Formulary mg, 40-25 mg olopatadine hcl nasal solution 0.6 % Formulary olopatadine hcl ophthalmic solution 0.1 %, 0.2 % Formulary omega dha oral tablet chewable Formulary OTC OMEGA POWER ORAL CAPSULE 1050 MG Formulary OTC omega-3 fish oil ex st oral capsule 880 mg Formulary OTC omega-3 fish oil oral capsule 300 mg Formulary OTC omega-3 fish oil-vitamin d3 oral capsule 1200-1000 mg- Formulary OTC unit OMEGA-3 IQ ORAL TABLET CHEWABLE 240 MG Formulary OTC omega-3 oral capsule 1400 mg Formulary OTC omega-3-acid ethyl esters oral capsule 1 gm Formulary PA omeprazole magnesium oral capsule delayed release 20.6 Formulary OTC (20 base) mg omeprazole magnesium oral tablet delayed release 20 mg Formulary OTC omeprazole oral capsule delayed release 10 mg, 20 mg, 40 Formulary mg omeprazole oral tablet delayed release 20 mg Formulary OTC omeprazole-sodium bicarbonate capsule 20-1100 mg oral Formulary QL (34 EA per 34 days) (otc) 20-1100 mg OMNIFLEX DIAPHRAGM VAGINAL DIAPHRAGM Formulary ONCASPAR INJECTION SOLUTION 750 UNIT/ML Formulary hcl oral solution 4 mg/5ml Formulary QL (150 ML per 30 days) ondansetron hcl oral tablet 24 mg Formulary QL (1 EA per 30 days) ondansetron hcl oral tablet 4 mg, 8 mg Formulary QL (15 EA per 34 days) ondansetron oral tablet dispersible 4 mg, 8 mg Formulary QL (15 EA per 34 days) one step pregnancy in vitro diagnostic test Formulary OTC ONE-A-DAY ADULT VITACRAVES+DHA ORAL Formulary OTC TABLET CHEWABLE ONE-A-DAY WOMENS 50+ ADVANTAGE ORAL Formulary OTC TABLET ONETOUCH DELICA LANCETS 30G Formulary OTC; QL (150 EA per 30 days) ONETOUCH DELICA LANCETS 33G Formulary OTC; QL (150 EA per 30 days)

104 Drug Name Formulary Status Requirements/Limits ONETOUCH FINEPOINT LANCETS Formulary OTC; QL (150 EA per 30 days) ONETOUCH PING METER REMOTE SUPPLIES Formulary OTC ONETOUCH ULTRASOFT LANCETS Formulary OTC; QL (150 EA per 30 days) ONEXTON EXTERNAL GEL 1.2-3.75 % Formulary AGE (Max 19 Years) opium oral tincture 10 mg/ml (1%) Formulary OPSUMIT ORAL TABLET 10 MG Formulary PA OPTIONS CONCEPTROL VAGINAL GEL 4 % Formulary OTC OPTIONS GYNOL II CONTRACEPTIVE VAGINAL Formulary OTC GEL 3 % OPTIUM BLOOD GLUCOSE MONITOR KIT Formulary OTC; QL (1 EA per 365 days) W/DEVICE W/DEVICE OPTIUM GLUCOSE MONITOR SYSTEM DEVICE Formulary OTC; QL (150 EA per 30 days) OPTIUM TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) OPTIUMEZ TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) ORA-FILM MOUTH/THROAT STRIP 6 % Formulary OTC oral max st mouth/throat gel 20 % Formulary OTC oral anesthetic mouth/throat paste 20 % Formulary OTC oral electrolytes oral solution Formulary OTC ORAL SWAB PETITE MOUTH/THROAT SWAB Formulary OTC oral syringe bottle adapter Formulary OTC ORALONE MOUTH/THROAT PASTE 0.1 % Formulary ORAMAGIC PLUS MOUTH/THROAT SUSPENSION Formulary OTC RECONSTITUTED 10 % ORAZINC ORAL CAPSULE 220 (50 ZN) MG Formulary OTC ORAZINC ORAL TABLET 110 MG Formulary OTC ORFADIN ORAL CAPSULE 10 MG, 2 MG, 5 MG Formulary ORILISSA ORAL TABLET 150 MG, 200 MG Formulary PA ornithine oral capsule 500 mg Formulary OTC orphenadrine citrate er oral tablet extended release 12 hour Formulary 100 mg orphenadrine citrate injection solution 30 mg/ml Formulary ORTHOVISC INTRA-ARTICULAR SOLUTION Formulary PA PREFILLED SYRINGE 30 MG/2ML OS-CAL EXTRA D3 ORAL TABLET 500-600 MG-UNIT Formulary OTC OS-CAL ORAL TABLET CHEWABLE 500-600 MG- Formulary OTC UNIT OS-CAL ULTRA ORAL TABLET 600 MG Formulary OTC oseltamivir phosphate oral capsule 30 mg, 45 mg, 75 mg Formulary oseltamivir phosphate oral suspension reconstituted 6 Formulary mg/ml OSTEO-PORETICAL ORAL TABLET 600-1000 MG- Formulary OTC UNIT ostomy protective powder Formulary OTC OUTGRO PAIN RELIEF EXTERNAL LIQUID 20 % Formulary OTC ovulation predictor in vitro kit Formulary OTC oxaliplatin intravenous solution 100 mg/20ml, 50 mg/10ml Formulary 105 Drug Name Formulary Status Requirements/Limits oxaliplatin intravenous solution reconstituted 100 mg Formulary oxandrolone oral tablet 10 mg, 2.5 mg Formulary oxaprozin oral tablet 600 mg Formulary oxazepam oral capsule 10 mg, 15 mg, 30 mg Formulary QL (136 EA per 34 days) oxcarbazepine oral suspension 300 mg/5ml Formulary oxcarbazepine oral tablet 150 mg, 300 mg, 600 mg Formulary oxybutynin chloride er oral tablet extended release 24 hour Formulary 10 mg, 15 mg oxybutynin chloride er oral tablet extended release 24 hour Formulary QL (34 EA per 34 days) 5 mg oxybutynin chloride oral syrup 5 mg/5ml Formulary oxybutynin chloride oral tablet 5 mg Formulary oxycodone hcl er oral tablet er 12 hour abuse-deterrent 10 Formulary PA; QL (68 EA per 34 days) mg, 20 mg, 40 mg oxycodone hcl er oral tablet er 12 hour abuse-deterrent 15 Formulary PA; QL (102 EA per 34 days) mg, 30 mg, 60 mg, 80 mg oxycodone hcl oral capsule 5 mg Formulary PA; QL (84 EA per 7 days) oxycodone hcl oral concentrate 10 mg/0.5ml, 100 mg/5ml Formulary PA oxycodone hcl oral solution 5 mg/5ml Formulary PA; QL (420 ML per 7 days) oxycodone hcl oral tablet 10 mg Formulary PA; QL (42 EA per 7 days) oxycodone hcl oral tablet 15 mg Formulary PA; QL (28 EA per 7 days) oxycodone hcl oral tablet 20 mg Formulary PA; QL (21 EA per 7 days) oxycodone hcl oral tablet 30 mg Formulary PA; QL (14 EA per 7 days) oxycodone hcl oral tablet 5 mg Formulary PA; QL (84 EA per 7 days) oxycodone-acetaminophen oral tablet 10-325 mg Formulary PA; QL (42 EA per 7 days) oxycodone-acetaminophen oral tablet 2.5-325 mg Formulary PA; QL (168 EA per 7 days) oxycodone-acetaminophen oral tablet 5-325 mg Formulary PA; QL (84 EA per 7 days) oxycodone-acetaminophen oral tablet 7.5-325 mg Formulary PA; QL (56 EA per 7 days) oxycodone-ibuprofen oral tablet 5-400 mg Formulary PA OXYCONTIN ORAL TABLET ER 12 HOUR ABUSE- Formulary PA; QL (68 EA per 34 days) DETERRENT 10 MG, 20 MG, 40 MG OXYCONTIN ORAL TABLET ER 12 HOUR ABUSE- Formulary PA; QL (102 EA per 34 days) DETERRENT 15 MG, 30 MG, 60 MG, 80 MG oxymorphone hcl er oral tablet extended release 12 hour 10 Formulary PA; QL (68 EA per 34 days) mg, 15 mg, 20 mg, 5 mg, 7.5 mg oxymorphone hcl er oral tablet extended release 12 hour 30 Formulary PA; QL (102 EA per 34 days) mg oxymorphone hcl er oral tablet extended release 12 hour 40 Formulary PA; QL (34 EA per 34 days) mg oxymorphone hcl oral tablet 10 mg Formulary PA; QL (90 EA per 30 days) oxymorphone hcl oral tablet 5 mg Formulary PA; QL (180 EA per 30 days) OXYTROL FOR WOMEN TRANSDERMAL PATCH Formulary OTC TWICE WEEKLY 3.9 MG/24HR OXYZAL WET DRESSING EXTERNAL SOLUTION Formulary OTC 1:2000 oyster calcium + d oral tablet 250-125 mg-unit Formulary OTC oyster calcium/d3 oral tablet 500-200 mg-unit Formulary OTC 106 Drug Name Formulary Status Requirements/Limits oyster shell calcium 250+d oral tablet 250-125 mg-unit Formulary OTC oyster shell calcium 500+d oral tablet chewable 500-400 Formulary OTC mg-unit oyster shell calcium oral tablet 500-400 mg-unit Formulary OTC oyster shell calcium plus d oral tablet 500-125 mg-unit Formulary OTC oyster shell calcium/d oral tablet 250-250 mg-unit, 500-200 Formulary OTC mg-unit oyster shell calcium/d3 oral tablet 500-400 mg-unit Formulary OTC P & S EXTERNAL LIQUID Formulary OTC P & S EXTERNAL SHAMPOO 2 % Formulary OTC p-1000 oral capsule 500 mg Formulary OTC PA CLA ORAL CAPSULE 1000 MG Formulary OTC pa fish oil/vit d3 triple st oral capsule delayed release 900- Formulary OTC 1000 mg-unit pa glucosamine-chondroitin oral capsule 166.7-133.3 mg Formulary OTC pa prenatal formula oral tablet 9-0.5 mg Formulary OTC pa probiotic complex oral tablet Formulary OTC paclitaxel intravenous concentrate 100 mg/16.7ml, 150 Formulary mg/25ml, 30 mg/5ml, 300 mg/50ml pain & fever childrens oral tablet chewable 160 mg Formulary OTC pain relief day & night ex st oral 25-500 & 500 mg Formulary OTC pain relief oral tablet Formulary OTC pain relief roll-on external liquid 4 % Formulary OTC pain reliever extra strength oral tablet 500 mg Formulary OTC pain reliever pm ex st oral tablet 25-500 mg Formulary OTC pain reliever pm oral tablet 25-500 mg Formulary OTC pain reliever/fever reducer rectal suppository 120 mg Formulary OTC pain relieving + lidocaine cream 4 % external 4 % Formulary OTC pain relieving external gel 3.5 % Formulary OTC PALADIN EXTERNAL OINTMENT Formulary OTC pamidronate disodium intravenous solution 30 mg/10ml, 6 Formulary PA mg/ml, 90 mg/10ml pamidronate disodium intravenous solution reconstituted 30 Formulary PA mg, 90 mg pancreatin oral tablet 325 mg Formulary OTC PANCREAZE ORAL CAPSULE DELAYED RELEASE Formulary PARTICLES 4200-14200 UNIT PANOXYL EXTERNAL LIQUID 2.5 % Formulary OTC PANOXYL WASH EXTERNAL LIQUID 10 % Formulary OTC; AGE (Max 18 Years) PANOXYL-4 CREAMY WASH EXTERNAL LIQUID 4 Formulary OTC; AGE (Max 18 Years) % panto-250 oral capsule 250 mg Formulary OTC pantoprazole sodium oral tablet delayed release 20 mg, 40 Formulary mg pantothenic acid oral tablet 500 mg Formulary OTC papaya enzyme oral tablet chewable Formulary OTC

107 Drug Name Formulary Status Requirements/Limits PARAGARD INTRAUTERINE COPPER Formulary INTRAUTERINE INTRAUTERINE DEVICE paricalcitol intravenous solution 2 mcg/ml, 5 mcg/ml Formulary PA paricalcitol oral capsule 1 mcg, 2 mcg, 4 mcg Formulary PA MOUTH/THROAT PASTE 0.454 % Formulary OTC paromomycin sulfate oral capsule 250 mg Formulary hcl er oral tablet extended release 24 hour 12.5 Formulary QL (68 EA per 34 days) mg, 25 mg, 37.5 mg paroxetine hcl oral tablet 10 mg, 20 mg, 30 mg, 40 mg Formulary parvenzyme digestive enzyme oral tablet Formulary OTC PATADAY SOLUTION 0.1 % OPHTHALMIC 0.1 % Formulary OTC PAZEO OPHTHALMIC SOLUTION 0.7 % Formulary pc lancets super thin 30g Formulary OTC; QL (150 EA per 30 days) PECGEN DMX ORAL LIQUID 10-187 MG/5ML, 15-125 Formulary OTC MG/5ML pedia relief cough/cold oral liquid 15-1-5 mg/5ml Formulary OTC PEDIACARE CHILDRENS LONG-ACT ORAL LIQUID Formulary OTC 7.5 MG/5ML PEDIACARE CHILDRENS MULTI-SYMP ORAL Formulary OTC LIQUID 2.5-5 MG/5ML PEDIACARE MULTI-SYMPTOM ORAL LIQUID 2.5-1- Formulary OTC 5-160 MG/5ML PEDIA-LAX FIBER GUMMIES ORAL TABLET Formulary OTC CHEWABLE PEDIA-LAX ORAL LIQUID 50 MG/15ML Formulary OTC PEDIA-LAX ORAL TABLET CHEWABLE 400 MG Formulary OTC PEDIA-LAX RECTAL SUPPOSITORY 1 GM, 2.8 GM Formulary OTC PEDIALYTE ADVANCED CARE ORAL SOLUTION Formulary OTC PEDIARIX INTRAMUSCULAR SUSPENSION Formulary PEDIAVENT ORAL SYRUP 2 MG/5ML Formulary OTC PEDIAVENT ORAL TABLET CHEWABLE 1 MG Formulary OTC PEDIAVIT ORAL LIQUID Formulary OTC PEDVAX HIB INTRAMUSCULAR SUSPENSION 7.5 Formulary AGE (Min 19 Years) MCG/0.5ML PEGANONE ORAL TABLET 250 MG Formulary PEGASYS PROCLICK SUBCUTANEOUS SOLUTION Formulary PA 135 MCG/0.5ML, 180 MCG/0.5ML PEGASYS SUBCUTANEOUS SOLUTION 180 MCG/ML Formulary PA; QL (1 ML per 34 days) PEGINTRON SUBCUTANEOUS KIT 50 MCG/0.5ML Formulary penicillamine oral tablet 250 mg Formulary PA penicillin g potassium injection solution reconstituted Formulary 20000000 unit, 5000000 unit penicillin v potassium oral solution reconstituted 125 Formulary mg/5ml, 250 mg/5ml penicillin v potassium oral tablet 250 mg, 500 mg Formulary PENTACEL INTRAMUSCULAR SUSPENSION Formulary RECONSTITUTED

108 Drug Name Formulary Status Requirements/Limits pentamidine isethionate inhalation solution reconstituted Formulary 300 mg PENTASA ORAL CAPSULE EXTENDED RELEASE 250 Formulary MG, 500 MG pentoxifylline er oral tablet extended release 400 mg Formulary PENTRAX GOLD EXTERNAL SHAMPOO 4 % Formulary OTC PEPCID AC MAXIMUM STRENGTH ORAL TABLET Formulary OTC 20 MG PEPCID AC ORAL TABLET 10 MG Formulary OTC PEPTO-BISMOL MAX STRENGTH ORAL Formulary OTC SUSPENSION 525 MG/15ML PEPTO-BISMOL ORAL SUSPENSION 262 MG/15ML Formulary OTC PEPTO-BISMOL ORAL TABLET 262 MG Formulary OTC PEPTO-BISMOL TO-GO ORAL TABLET CHEWABLE Formulary OTC 262 MG PERFORM ATOMIC HEAT EXTERNAL CREAM 0.034- Formulary OTC 10 % PERFORM ATOMIC HEAT EXTERNAL LIQUID 0.034- Formulary OTC 10 % PERFORM PAIN RELIEVING EXTERNAL LIQUID 10.4 Formulary OTC % PERFORM PAIN RELIEVING ROLL-ON EXTERNAL Formulary OTC LIQUID 3.1 % PERIDIN-C ORAL TABLET 200-50-150 MG Formulary OTC perindopril erbumine oral tablet 2 mg, 4 mg, 8 mg Formulary PERIOMED MOUTH/THROAT CONCENTRATE 0.63 % Formulary OTC permethrin external cream 5 % Formulary PERNOX EXTERNAL LOTION 1.5-2 % Formulary OTC PEROXYL EXTERNAL SOLUTION 1.5-6 % Formulary OTC PEROXYL MOUTH/THROAT SOLUTION 1.5 % Formulary OTC PEROXYL SPOT TREATMENT MOUTH/THROAT GEL Formulary OTC 1.5 % perphenazine oral tablet 16 mg, 2 mg, 4 mg, 8 mg Formulary AGE (Min 18 Years) perphenazine-amitriptyline oral tablet 2-10 mg, 2-25 mg, 4- Formulary AGE (Min 18 Years) 10 mg, 4-25 mg, 4-50 mg PERRY PRENATAL ORAL CAPSULE 13.5-0.4 MG Formulary OTC external aerosol Formulary OTC petroleum jelly external ointment Formulary OTC PHARMABASE BARRIER EXTERNAL OINTMENT Formulary OTC 9.38 % PHARMACY COUNTER LANCETS Formulary OTC; QL (150 EA per 30 days) PHAZYME MAXIMUM STRENGTH ORAL CAPSULE Formulary OTC 250 MG PHAZYME ULTRA STRENGTH ORAL CAPSULE 180 Formulary OTC MG PHENADOZ RECTAL SUPPOSITORY 12.5 MG, 25 MG Formulary AGE (Min 2 Years) PHENAZO ORAL TABLET 200 MG Formulary phenazopyridine hcl oral tablet 100 mg Formulary 109 Drug Name Formulary Status Requirements/Limits phenazopyridine hcl oral tablet 95 mg Formulary OTC phenelzine sulfate oral tablet 15 mg Formulary phenobarbital oral elixir 20 mg/5ml Formulary phenobarbital oral solution 20 mg/5ml Formulary phenobarbital oral tablet 100 mg, 15 mg, 16.2 mg, 30 mg, Formulary 32.4 mg, 60 mg, 64.8 mg, 97.2 mg phenol external liquid Formulary OTC PHENOL EZ SWABS EXTERNAL SWAB 89 % Formulary OTC phenoxybenzamine hcl oral capsule 10 mg Formulary phentermine hcl oral capsule 15 mg, 30 mg, 37.5 mg Formulary PA phentermine hcl oral tablet 37.5 mg Formulary PA phenylalanine oral packet 50 mg Formulary OTC phenylephrine hcl oral tablet 10 mg Formulary OTC phenylephrine-dm-gg oral liquid 10-18-200 mg/15ml Formulary OTC PHENYTOIN INFATABS ORAL TABLET CHEWABLE Formulary 50 MG phenytoin oral suspension 125 mg/5ml Formulary phenytoin oral tablet chewable 50 mg Formulary phenytoin sodium extended oral capsule 100 mg, 200 mg, Formulary 300 mg phenytoin sodium injection solution 50 mg/ml Formulary PHLEXY-10 ORAL TABLET Formulary OTC PHOS-FLUR ORTHO DEFENSE MOUTH/THROAT Formulary OTC SOLUTION 0.044 % phos-nak oral packet 280-160-250 mg Formulary OTC phosphatidyl choline oral tablet 65 mg Formulary OTC PHOSPHOLINE IODIDE OPHTHALMIC SOLUTION Formulary RECONSTITUTED 0.125 % PHOTOFRIN INTRAVENOUS SOLUTION Formulary RECONSTITUTED 75 MG phytonadione oral tablet 5 mg Formulary PHYTOPLEX Z-GUARD EXTERNAL PASTE 57-17 % Formulary OTC PIFELTRO ORAL TABLET 100 MG Formulary QL (30 EA per 30 days) pilocarpine hcl oral tablet 5 mg, 7.5 mg Formulary pimecrolimus external cream 1 % Formulary PA; AGE (Min 2 Years) pindolol oral tablet 10 mg, 5 mg Formulary pinworm medicine oral suspension 144 (50 base) mg/ml Formulary OTC pioglitazone hcl oral tablet 15 mg, 30 mg, 45 mg Formulary pioglitazone hcl-glimepiride oral tablet 30-2 mg, 30-4 mg Formulary ST; QL (34 EA per 34 days) pioglitazone hcl-metformin hcl oral tablet 15-500 mg, 15- Formulary 850 mg piroxicam oral capsule 10 mg, 20 mg Formulary PLAN B ONE-STEP ORAL TABLET 1.5 MG Formulary OTC; QL (2 EA per 34 days) PLASBUMIN-25 INTRAVENOUS SOLUTION 25 % Formulary PLASBUMIN-5 INTRAVENOUS SOLUTION 5 % Formulary PLIAGEL GEL 0.5-0.5-0.25 % Formulary OTC 110 Drug Name Formulary Status Requirements/Limits PLO ULTRAMAX EXTERNAL GEL Formulary OTC PNEUMOVAX 23 INJECTION INJECTABLE 25 Formulary AGE (Min 19 Years) MCG/0.5ML pnv-dha oral capsule 27-0.6-0.4-300 mg Formulary pnv-dha+docusate oral capsule 27-1.25-300 mg Formulary pnv-omega oral capsule 28-0.6-0.4-340 mg Formulary pnv-select oral tablet 27-0.6-0.4 mg Formulary podofilox external solution 0.5 % Formulary poison ivy wash fast acting external Formulary OTC POLAR FREEZE EXTERNAL GEL 3.5-0.8 % Formulary OTC POLAR FROST EXTERNAL GEL 4 % Formulary OTC poly bacitracin external ointment 500-10000 unit/gm Formulary OTC POLY HIST FORTE ORAL TABLET 7.5-10 MG Formulary OTC polyethylene glycol 3350 oral packet 17 gm Formulary poly-hist dm oral liquid 5-25-10 mg/5ml Formulary OTC poly-hist pd oral liquid 6.25-6.25 mg/ml Formulary OTC poly-iron 150 forte oral capsule 150-25-1 mg-mcg-mg Formulary polymyxin b-trimethoprim ophthalmic solution 10000-0.1 Formulary unit/ml-% POLYSPORIN EXTERNAL OINTMENT 500-10000 Formulary OTC UNIT/GM poly-tussin ac oral liquid 10-4-10 mg/5ml Formulary OTC POLY-VENT DM ORAL TABLET 60-20-380 MG Formulary OTC POLY-VENT IR ORAL TABLET 60-380 MG Formulary OTC POLY-VI-SOL ORAL SOLUTION Formulary OTC POLY-VI-SOL/IRON ORAL SOLUTION Formulary OTC potassimin oral tablet 75 mg Formulary OTC potassium chloride crys er oral tablet extended release 10 Formulary meq, 15 meq, 20 meq potassium chloride oral solution 20 meq/15ml (10%), 40 Formulary meq/15ml (20%) potassium citrate er oral tablet extended release 10 meq Formulary (1080 mg), 5 meq (540 mg) potassium citrate-citric acid oral solution 1100-334 mg/5ml Formulary potassium gluconate oral tablet 2 meq, 2.5 meq, 595 (99 k) Formulary OTC mg potassium iodide (antidote) oral solution 65 mg/ml Formulary OTC povidone-iodine external ointment 10 % Formulary OTC povidone-iodine external solution 10 % Formulary OTC povidone-iodine external swab 7.5 % Formulary OTC povidone-iodine paint sponge external swab 10 % Formulary OTC povidone-iodine prep external pad 10 % Formulary OTC povidone-iodine scrub sponge external 10 % Formulary OTC power oral care system mouth/throat kit Formulary OTC PR NATAL 400 EC ORAL 29-1-200 & 400 MG (DR) Formulary PR NATAL 400 ORAL 29-1-200 & 400 MG Formulary 111 Drug Name Formulary Status Requirements/Limits PR NATAL 430 EC ORAL 29-1-200 & 430 MG (DR) Formulary PR NATAL 430 ORAL 29-1-200 & 430 MG Formulary PRADAXA ORAL CAPSULE 110 MG, 150 MG, 75 MG Formulary PRALUENT SOLUTION AUTO-INJECTOR 150 MG/ML Formulary PA SUBCUTANEOUS 150 MG/ML PRALUENT SOLUTION AUTO-INJECTOR 75 MG/ML Formulary PA SUBCUTANEOUS 75 MG/ML PRALUENT SUBCUTANEOUS SOLUTION PEN- Formulary PA INJECTOR 150 MG/ML, 75 MG/ML PRAMEGEL EXTERNAL GEL 1 % Formulary OTC pramipexole dihydrochloride oral tablet 0.125 mg, 0.25 mg, Formulary 0.5 mg, 0.75 mg, 1 mg, 1.5 mg PRAMOX EXTERNAL GEL 1 % Formulary pramoxine hcl rectal foam 1 % Formulary OTC prasugrel hcl oral tablet 10 mg, 5 mg Formulary pravastatin sodium oral tablet 10 mg, 20 mg, 40 mg, 80 mg Formulary prazosin hcl oral capsule 1 mg, 2 mg, 5 mg Formulary PRECISION GLUCOSE CONTROL LIQUID IN VITRO Formulary OTC; QL (100 EA per 30 days) PRECISION GLUCOSE CONTROL SOLN SOLUTION Formulary OTC; QL (150 EA per 30 days) IN VITRO PRECISION GLUCOSE KETONE CONTR LIQUID IN Formulary OTC; QL (100 EA per 30 days) VITRO PRECISION GLUCOSE/KETONE CONTR LIQUID IN Formulary OTC; QL (100 EA per 30 days) VITRO PRECISION LINK KIT Formulary OTC; QL (1 EA per 365 days) PRECISION PCX PLUS TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) PRECISION PCX STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) PRECISION POINT OF CARE TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) PRECISION QID MONITOR DEVICE Formulary OTC; QL (1 EA per 365 days) PRECISION QID MONITOR DEVICE Formulary OTC; QL (150 EA per 30 days) PRECISION QID TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) PRECISION SOF-TACT MONITOR DEVICE Formulary OTC; QL (1 EA per 365 days) PRECISION SOF-TACT TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) PRECISION SUREDOSE PLUS SYR 29G X 1/2" 0.3 ML Formulary OTC 29G X 1/2" 0.3 ML PRECISION SUREDOSE PLUS SYR 29G X 1/2" 1 ML Formulary OTC 29G X 1/2" 1 ML PRECISION SURE-DOSE SYRINGE 28G X 1/2" 0.5 ML Formulary OTC 28G X 1/2" 0.5 ML PRECISION SURE-DOSE SYRINGE 28G X 1/2" 1 ML Formulary OTC 28G X 1/2" 1 ML PRECISION SURE-DOSE SYRINGE 29G X 1/2" 0.5 ML Formulary OTC 29G X 1/2" 0.5 ML PRECISION SURE-DOSE SYRINGE 30G X 3/8" 0.5 ML Formulary OTC 30G X 3/8" 0.5 ML PRECISION THINS GP LANCETS Formulary OTC; QL (150 EA per 30 days) PRECISION XTRA BLOOD GLUCOSE STRIP IN Formulary OTC; QL (150 EA per 30 days) VITRO 112 Drug Name Formulary Status Requirements/Limits PRECISION XTRA DEVICE Formulary OTC; QL (1 EA per 365 days) PRECISION XTRA DEVICE Formulary OTC; QL (150 EA per 30 days) PRECISION XTRA KETONE STRIP IN VITRO Formulary OTC; QL (100 EA per 30 days) PRECISION XTRA KIT Formulary OTC; QL (1 EA per 365 days) PRECISION XTRA MONITOR DEVICE Formulary OTC; QL (1 EA per 365 days) PRED MILD OPHTHALMIC SUSPENSION 0.12 % Formulary prednicarbate external cream 0.1 % Formulary prednicarbate external ointment 0.1 % Formulary prednisolone acetate ophthalmic suspension 1 % Formulary prednisolone oral solution 15 mg/5ml Formulary prednisolone sodium phosphate oral solution 15 mg/5ml, 20 Formulary mg/5ml, 25 mg/5ml, 6.7 (5 base) mg/5ml PREDNISONE INTENSOL ORAL CONCENTRATE 5 Formulary MG/ML prednisone oral solution 5 mg/5ml Formulary prednisone oral tablet 1 mg, 10 mg, 2.5 mg, 20 mg, 5 mg, Formulary 50 mg prednisone oral tablet therapy pack 10 mg (21), 10 mg (48), Formulary 5 mg (21), 5 mg (48) preferred plus insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" Formulary OTC 0.5 ml preferred plus insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 Formulary OTC ml preferred plus insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" Formulary OTC 0.3 ml preferred plus insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" Formulary OTC 0.5 ml preferred plus insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 Formulary OTC ml preferred plus insulin syringe 30g x 5/16" 0.3 ml 30g x Formulary OTC 5/16" 0.3 ml preferred plus insulin syringe 30g x 5/16" 0.5 ml 30g x Formulary OTC 5/16" 0.5 ml preferred plus insulin syringe 30g x 5/16" 1 ml 30g x 5/16" Formulary OTC 1 ml preferred plus lancets colored Formulary OTC; QL (150 EA per 30 days) preferred plus lancets thin Formulary OTC; QL (150 EA per 30 days) pregabalin oral capsule 100 mg, 150 mg, 200 mg, 225 mg, Formulary 25 mg, 300 mg, 50 mg, 75 mg PREGNITUDE ORAL PACKET 2000-200 MG-MCG Formulary OTC PREMARIN VAGINAL CREAM 0.625 MG/GM Formulary PREMIER UROSTOMY POUCH Formulary OTC PREMPHASE ORAL TABLET 0.625-5 MG Formulary PREMPRO ORAL TABLET 0.3-1.5 MG, 0.45-1.5 MG, Formulary 0.625-2.5 MG, 0.625-5 MG prenatal 19 oral tablet Formulary OTC prenatal 19 oral tablet 29-1 mg Formulary prenatal dha oral capsule 200 mg Formulary OTC 113 Drug Name Formulary Status Requirements/Limits prenatal formula a-free oral tablet 9-0.267 mg Formulary OTC prenatal formula oral capsule 28-0.8-235 mg Formulary OTC prenatal low iron oral tablet 27-0.8 mg Formulary OTC prenatal multi +dha oral capsule 27-0.8-200 mg Formulary OTC prenatal multivitamin plus dha oral capsule 27-0.8-250 mg Formulary OTC prenatal oral tablet 27-0.8 mg Formulary prenatal oral tablet 28-0.8 mg, 6.75-0.2 mg Formulary OTC PRENATAL-U ORAL CAPSULE 106.5-1 MG Formulary PRENATE ORAL TABLET CHEWABLE 0.6-0.4 MG Formulary prep protective skin barrier external pad 0.5 % Formulary OTC PREPARATION H RECTAL CREAM 1-0.25-14.4-15 %, Formulary OTC 5-14.4 % PREPARATION H RECTAL GEL 0.25-50 % Formulary OTC PREPARATION H RECTAL OINTMENT 0.25-14-74.9 % Formulary OTC PREPARATION H TOTABLES RECTAL CREAM 1- Formulary OTC 0.25-14.4-15 % pres gen pediatric oral liquid 2.5-5-75 mg/5ml Formulary OTC PRESGEN B ORAL LIQUID 10-4-20 MG/5ML Formulary OTC PRETZ NASAL SOLUTION Formulary OTC PREVACARE ANTIMICROBIAL EXTERNAL GEL 60 Formulary OTC % PREVACARE EXTRA PROTECTIVE EXTERNAL Formulary OTC OINTMENT PREVACARE PERSONAL PROTECT EXTERNAL Formulary OTC CREAM PREVACARE TOTAL SKIN CARE EXTERNAL Formulary OTC SOLUTION PREVACID 24HR ORAL CAPSULE DELAYED Formulary OTC RELEASE 15 MG PREVIDENT MOUTH/THROAT SOLUTION 0.2 % Formulary PREVNAR 13 INTRAMUSCULAR SUSPENSION Formulary AGE (Min 19 Years) PREZISTA ORAL TABLET 150 MG, 600 MG, 75 MG, Formulary 800 MG PRIFTIN ORAL TABLET 150 MG Formulary PRILOSEC OTC ORAL TABLET DELAYED RELEASE Formulary OTC 20 MG PRIMATENE ASTHMA ORAL TABLET 12.5-200 MG Formulary OTC primidone oral tablet 250 mg, 50 mg Formulary PRO NUTRIENTS OMEGA 3 ORAL CAPSULE Formulary OTC DELAYED RELEASE 332.5 MG PROAIR HFA INHALATION AEROSOL SOLUTION Formulary 108 (90 BASE) MCG/ACT probenecid oral tablet 500 mg Formulary PROBIOMAX PLUS DF ORAL PACKET Formulary OTC probiotic digestive support oral capsule Formulary OTC probiotic oral capsule 250 mg Formulary OTC probiotic oral tablet delayed release Formulary OTC 114 Drug Name Formulary Status Requirements/Limits probiotic-prebiotic oral capsule 1-250 billion-mg Formulary OTC PROCARE PLUS UNDERWEAR MEDIUM Formulary OTC PRO-CEPTION VAGINAL KIT Formulary OTC prochlorperazine maleate oral tablet 10 mg, 5 mg Formulary prochlorperazine rectal suppository 25 mg Formulary PROCOMYCIN EXTERNAL CREAM 4 % Formulary OTC PROCTOFOAM RECTAL FOAM 1 % Formulary OTC PROCTOSOL HC RECTAL CREAM 2.5 % Formulary PRODIGY INSULIN SYRINGE 28G X 1/2" 1 ML 28G X Formulary OTC 1/2" 1 ML PRODIGY INSULIN SYRINGE 31G X 5/16" 0.3 ML 31G Formulary OTC X 5/16" 0.3 ML PRODIGY INSULIN SYRINGE 31G X 5/16" 0.5 ML 31G Formulary OTC X 5/16" 0.5 ML PRODIGY NO CODING BLOOD GLUC STRIP IN Formulary PA; OTC; QL (150 EA per 30 days) VITRO PRODIGY TWIST TOP LANCETS 28G Formulary OTC; QL (150 EA per 30 days) PROFE ORAL CAPSULE 391.3 (180 FE) MG Formulary OTC PROFERRIN ES ORAL TABLET 12 MG Formulary OTC PROFERRIN-FORTE ORAL TABLET 12-1 MG Formulary OTC PROFILNINE SD INTRAVENOUS SOLUTION Formulary RECONSTITUTED 500 UNIT progesterone intramuscular oil 50 mg/ml Formulary progesterone micronized oral capsule 100 mg, 200 mg Formulary progesterone oral capsule 100 mg, 200 mg Formulary PROLENSA OPHTHALMIC SOLUTION 0.07 % Formulary PROLIDA EXTERNAL PATCH 4-1 % Formulary OTC PROMACTA ORAL TABLET 12.5 MG Formulary PA; QL (240 EA per 30 days) PROMACTA ORAL TABLET 25 MG Formulary PA; QL (120 EA per 30 days) PROMACTA ORAL TABLET 50 MG Formulary PA; QL (60 EA per 30 days) PROMACTA ORAL TABLET 75 MG Formulary PA; QL (30 EA per 30 days) promethazine hcl oral syrup 6.25 mg/5ml Formulary AGE (Min 2 Years) promethazine hcl oral tablet 12.5 mg, 25 mg, 50 mg Formulary AGE (Min 2 Years) promethazine hcl rectal suppository 12.5 mg, 50 mg Formulary AGE (Min 2 Years) promethazine hcl rectal suppository 25 mg Formulary promethazine vc/codeine oral syrup 6.25-5-10 mg/5ml Formulary AGE (Min 6 Years) promethazine-codeine oral syrup 6.25-10 mg/5ml Formulary AGE (Min 6 Years) promethazine-dm oral syrup 6.25-15 mg/5ml Formulary AGE (Min 6 Years) promethazine-phenylephrine oral syrup 6.25-5 mg/5ml Formulary PROMETHEGAN RECTAL SUPPOSITORY 25 MG Formulary PROMETHEGAN RECTAL SUPPOSITORY 50 MG Formulary AGE (Min 2 Years) PROMOLAXIN ORAL TABLET 100 MG Formulary OTC PRONUTRIENTS CALCIUM+D3 ORAL TABLET 600- Formulary OTC 800 MG-UNIT PRONUTRIENTS SUPER B COMPLEX ORAL TABLET Formulary OTC

115 Drug Name Formulary Status Requirements/Limits propafenone hcl er oral capsule extended release 12 hour Formulary 225 mg, 325 mg, 425 mg propafenone hcl oral tablet 150 mg, 225 mg, 300 mg Formulary propranolol hcl er oral capsule extended release 24 hour Formulary 120 mg, 160 mg, 60 mg, 80 mg propranolol hcl intravenous solution 1 mg/ml Formulary propranolol hcl oral solution 20 mg/5ml, 40 mg/5ml Formulary propranolol hcl oral tablet 10 mg, 20 mg, 40 mg, 60 mg, 80 Formulary mg propranolol-hctz oral tablet 40-25 mg, 80-25 mg Formulary propylene glycol external solution Formulary propylthiouracil oral tablet 50 mg Formulary PRO-RED AC ORAL SYRUP 5-1-9 MG/5ML Formulary OTC PROSHIELD SKIN CARE EXTERNAL KIT Formulary OTC protein oral powder 80 % Formulary OTC protein oral tablet 975 mg Formulary OTC PROTEINEX ORAL LIQUID Formulary OTC PROTEINEX P100 ORAL LIQUID Formulary OTC protriptyline hcl oral tablet 10 mg, 5 mg Formulary PROVENT SLEEP APNEA THERAPY Formulary PROVIDA DHA ORAL CAPSULE 16-16-1.25-110 MG Formulary PROVIEW KIT Formulary OTC pseudoeph-bromphen-dm oral syrup 30-2-10 mg/5ml Formulary pseudoephedrine hcl er oral tablet extended release 12 hour Formulary OTC 120 mg pseudoephedrine hcl oral syrup 30 mg/5ml Formulary OTC pseudoephedrine hcl oral tablet 30 mg Formulary OTC pseudoephedrine hcl oral tablet 60 mg Formulary psorcon external cream 0.05 % Formulary PSS SELECT GP LANCETS Formulary OTC; QL (150 EA per 30 days) PSS SELECT SAFETY LANCETS Formulary OTC; QL (150 EA per 30 days) PULMICORT FLEXHALER INHALATION AEROSOL POWDER BREATH ACTIVATED 180 MCG/ACT, 90 Formulary MCG/ACT PULMOZYME INHALATION SOLUTION 1 MG/ML Formulary PURACYN PLUS DUO-CARE EXTERNAL LIQUID Formulary OTC pure l-citrulline oral capsule 600 mg Formulary OTC pure l-citrulline oral powder Formulary OTC purefe ob plus oral capsule 162-115.2-1 mg Formulary purified water oral liquid Formulary px allergy relief d oral tablet extended release 12 hour 5- Formulary OTC 120 mg px allergy sinus pe oral tablet 2-5-325 mg Formulary OTC px antacid extra strength oral tablet chewable 750 mg Formulary OTC px artificial tears ophthalmic solution 5-6 mg/ml Formulary OTC px daytime cold oral tablet 10-5-325 mg Formulary OTC 116 Drug Name Formulary Status Requirements/Limits px daytime multi-symptom oral capsule 30-325-15 mg Formulary OTC px gas relief extra strength oral capsule 125 mg Formulary OTC px ibuprofen cold & sinus oral tablet 30-200 mg Formulary OTC px insulin syringe 30g x 1/2" 0.5 ml 30g x 1/2" 0.5 ml Formulary OTC px lancets ultra thin Formulary OTC; QL (150 EA per 30 days) px minoxidil for men external solution 5 % Formulary OTC px nasal four nasal solution 1 % Formulary OTC px nitetime multi-symptom oral capsule 30-6.25-15-325 mg Formulary OTC px omeprazole oral tablet delayed release 20 mg Formulary OTC PYLERA ORAL CAPSULE 140-125-125 MG Formulary pyrazinamide oral tablet 500 mg Formulary pyridostigmine bromide er oral tablet extended release 180 Formulary mg pyridostigmine bromide oral tablet 60 mg Formulary pyridoxine hcl oral tablet 25 mg Formulary OTC PYRIDOXINE/MINERALS ORAL CAPSULE 100-99-200 Formulary OTC MG pyrilamine-phenylephrine oral tablet 25-10 mg Formulary OTC pyrimethamine oral tablet 25 mg Formulary PA qc alcohol swabs pad 70 % 70 % Formulary OTC qc arthritis external cream 10 % Formulary OTC qc calamine external lotion Formulary OTC qc iodides external tincture Formulary OTC qc iodine tincture external tincture Formulary OTC qc lancets super thin 30g Formulary OTC; QL (150 EA per 30 days) qc lancets ultra thin Formulary OTC; QL (150 EA per 30 days) QC MEDIFIN PE ORAL TABLET 10-400 MG Formulary OTC qc natural vegetable oral powder 95 % Formulary OTC qc non-adherent pad 3"x4" Formulary OTC qc unilet lancets 28g Formulary OTC; QL (150 EA per 30 days) qc unilet lancets micro thin Formulary OTC; QL (150 EA per 30 days) Q-GEL ORAL CAPSULE 15 MG Formulary OTC quercetin oral tablet 250 mg, 50 mg Formulary OTC quetiapine fumarate er oral tablet extended release 24 hour QL (30 EA per 30 days); AGE (Min 18 Formulary 150 mg, 200 mg Years) quetiapine fumarate er oral tablet extended release 24 hour Formulary AGE (Min 18 Years) 300 mg, 400 mg, 50 mg quetiapine fumarate oral tablet 100 mg, 200 mg, 25 mg, 300 Formulary AGE (Min 18 Years) mg, 400 mg, 50 mg quinapril hcl oral tablet 10 mg, 20 mg, 40 mg, 5 mg Formulary quinapril-hydrochlorothiazide oral tablet 10-12.5 mg, 20- Formulary 12.5 mg, 20-25 mg quinidine gluconate er oral tablet extended release 324 mg Formulary quinidine sulfate oral tablet 200 mg, 300 mg Formulary quinine sulfate oral capsule 324 mg Formulary

117 Drug Name Formulary Status Requirements/Limits ra 8 hour pain relief oral tablet extended release 650 mg Formulary OTC ra acetaminophen flu cold oral tablet 30-500-15 mg Formulary OTC ra acid reducer plus antacid oral tablet chewable 10-800- Formulary OTC 165 mg ra acne maximum external pad 2 % Formulary OTC ra advanced eye health oral capsule 250-2.5-0.5 mg, 500-5- Formulary OTC 1 mg ra alcohol swabs pad 70 % 70 % Formulary OTC ra anorectal external cream 5 % Formulary OTC ra antifungal pen external liquid 25 % Formulary OTC ra b-12 mouth/throat lozenge 1000-400 mcg Formulary OTC ra baby care vit a&d to go external ointment Formulary OTC ra back & body pain relief oral tablet 500-32.5 mg Formulary OTC ra backache relief oral tablet 580 mg Formulary OTC ra b-complex/vitamin c cr oral tablet extended release Formulary OTC ra ca/mg/zn/cu oral tablet Formulary OTC ra calamine external lotion 6.971-6.971 % Formulary OTC ra calamine external suspension 8-8 % Formulary OTC ra calcium hi-cal/vitamin d oral tablet 250-125 mg-unit, Formulary OTC 500-125 mg-unit, 500-200 mg-unit ra calcium high potency oral tablet 600 mg Formulary OTC ra calcium oral tablet 500 mg Formulary OTC ra calcium soft chews oral tablet chewable 500-200-40 mg- Formulary OTC unt-mcg ra calcium-boron oral tablet 500-1.5 mg Formulary OTC ra cold remedy multi-symptom oral tablet dispersible Formulary OTC ra cold sore treatment external liquid 0.13 % Formulary OTC ra cold therapy gel external gel 4 % Formulary OTC ra cold/sinus max oral tablet 5-325-200 mg Formulary OTC ra corn cushions small pad Formulary OTC ra corn removers ultra thin external pad 40 % Formulary OTC ra cranberry oral capsule 425 mg Formulary OTC ra dark tanning external oil Formulary OTC ra day/night/cold/flu relief oral Formulary OTC ra daytime cold/flu relief oral liquid 10-5-325 mg/15ml Formulary OTC ra ear wax cleansing system otic kit 6.5 % Formulary OTC ra ethyl alcohol solution 70 % Formulary OTC ra exfoliating moisturizer external ointment 5-10 % Formulary OTC RA E-ZJECT COLOR LANCETS 33G Formulary OTC; QL (150 EA per 30 days) RA E-ZJECT LANCETS 28G Formulary OTC; QL (150 EA per 30 days) RA E-ZJECT LANCETS THIN 26G Formulary OTC; QL (150 EA per 30 days) RA E-ZJECT LANCETS THIN 28G Formulary OTC; QL (150 EA per 30 days) RA E-ZJECT LANCETS ULTRA THIN Formulary OTC; QL (150 EA per 30 days) ra feminine care douche vaginal solution Formulary OTC ra fever reducer/pain reliever oral suspension 160 mg/5ml Formulary OTC 118 Drug Name Formulary Status Requirements/Limits ra fiber weight management oral tablet chewable Formulary OTC ra first aid iodine external tincture Formulary OTC ra first aid non-stick pad Formulary OTC ra first aid saline wound wash external liquid 0.13 % Formulary OTC RA FISH OIL EXTRA STRENGTH ORAL CAPSULE 870 Formulary OTC MG ra fish oil oral capsule 900 mg Formulary OTC ra fish oil oral capsule delayed release 1400 mg Formulary OTC ra foaming hand soap refill external liquid 0.6 % Formulary OTC ra gel toe separator Formulary OTC ra glucosamine-chondroitin oral capsule 166.7-133.3 mg Formulary OTC ra glucosamine-chondroitin-d3 oral tablet 750-600-500 mg- Formulary OTC mg-unit ra glucosamine-chondroit-msm oral tablet , 500-400-300 Formulary OTC mg ra glucos-chondroit-msm oral tablet Formulary OTC ra glycerin child rectal suppository 80.7 % Formulary OTC ra hemorrhoid relief rectal suppository 0.25-85.5 % Formulary OTC ra hot & cold lidocaine external patch 4-1 % Formulary OTC ra hot/cold gel sleeve Formulary OTC ra hydrogen peroxide external solution 3 % Formulary OTC ra hydrogen peroxide wipes external 3 % Formulary OTC ra insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC ra insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC ra insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC ra insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC ra intimacy gels/him/her external gel Formulary OTC ra isopropyl alcohol wipes external 70 % Formulary OTC ra lice solution combination kit , 0.5-0.33-4 % Formulary OTC RA LOTION EXTERNAL LOTION Formulary OTC ra lubricant eye drops ophthalmic solution 0.6 % Formulary OTC ra lutein oral capsule 20-1 mg Formulary OTC RA LYCOPENE ORAL CAPSULE 15 MG Formulary OTC ra melatonin sublingual tablet sublingual 1 mg Formulary OTC ra miconazole 3 combo pack vaginal kit 200 & 2 mg-% Formulary OTC (9gm) ra mouth pain anesthetic mouth/throat liquid 20 % Formulary OTC ra mucus relief d max strength oral tablet extended release Formulary OTC 12 hour 120-1200 mg ra multihealth fiber oral powder 58.6 % Formulary OTC ra nasal strip/drug free/large strip Formulary OTC ra nighttime cold/flu relief oral liquid 30-12.5-650 mg/30ml Formulary OTC ra oatmeal moisturizing external lotion 1.6 % Formulary OTC ra omega 3-6-9 oral capsule Formulary OTC ra omeprazole oral tablet delayed release 20 mg Formulary OTC

119 Drug Name Formulary Status Requirements/Limits ra omeprazole-sodium bicarb capsule 20-1100 mg oral 20- Formulary OTC; QL (34 EA per 34 days) 1100 mg ra oyster shell calcium/d oral tablet 250-125 mg-unit, 500- Formulary OTC 200 mg-unit ra pain relief external cream 4 % Formulary OTC ra personal lubricant external liquid Formulary OTC ra prenatal oral tablet 28-0.8 mg Formulary OTC ra probiotic complex oral tablet Formulary OTC ra probiotic digestive care oral tablet Formulary OTC ra probiotic gummies oral tablet chewable Formulary OTC RA RENEWAL ACNE TREATMENT EXTERNAL GEL Formulary OTC 10 % RA RENEWAL DARK SPOT CORRECTOR EXTERNAL Formulary OTC LIQUID RA RENEWAL SHOWER & BATH EXTERNAL OIL Formulary OTC ra renewal soothing bath external packet 100 % Formulary OTC ra saline nasal spray nasal solution 0.65 % Formulary OTC ra saline wound wash external solution 0.9 % Formulary OTC ra sensitive anti-itch external lotion 1 % Formulary OTC ra severe cold/night cold&flu oral Formulary OTC ra severe congestion/cold max oral tablet 5-10-200-325 mg Formulary OTC ra shower & bath body external powder Formulary OTC ra silky lubricant moisturizer vaginal gel Formulary OTC ra sinus wash nasal relief nasal packet 1685-515 mg Formulary OTC ra sinus wash neti pot nasal packet 1685-515 mg Formulary OTC ra skin treatment external oil Formulary OTC ra slow release iron oral tablet extended release 45 mg Formulary OTC ra stay awake oral tablet 100 mg Formulary OTC ra sterile saline nasal mist nasal solution 0.9 % Formulary OTC ra triple antibiotic external aerosol 3.5-400-5000 Formulary OTC RA TUGABOOS BABY EXTERNAL OIL Formulary OTC ra tussin cough dm sugar free oral syrup 100-10 mg/5ml Formulary OTC ra vagicaine external cream 5-2 % Formulary OTC ra vagicaine vaginal cream 5-2 % Formulary OTC ra vaginal infection screening in vitro kit Formulary OTC ra vitamin b-12 oral liquid 1000 mcg/ml Formulary OTC ra vitamin c oral tablet chewable 300 mg Formulary OTC ra yeast relief plus oral tablet Formulary OTC rabano yodado oral liquid Formulary OTC RABAVERT INTRAMUSCULAR SUSPENSION Formulary AGE (Min 19 Years) RECONSTITUTED rabeprazole sodium oral tablet delayed release 20 mg Formulary RADIACARE POST HEALING EXTERNAL CREAM Formulary OTC raloxifene hcl oral tablet 60 mg Formulary ramelteon oral tablet 8 mg Formulary ST; QL (30 EA per 30 days)

120 Drug Name Formulary Status Requirements/Limits ramipril oral capsule 1.25 mg, 10 mg, 2.5 mg, 5 mg Formulary hcl oral syrup 75 mg/5ml Formulary ranitidine hcl oral tablet 150 mg, 300 mg Formulary ranitidine hcl oral tablet 75 mg Formulary OTC RASH AWAY EXTERNAL AEROSOL 33 % Formulary OTC RASH RELIEF EXTERNAL LIQUID 20-25 % Formulary OTC raspberry syrup oral syrup Formulary reality insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC reality insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC reality insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC reality insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC reality lancets Formulary OTC; QL (150 EA per 30 days) reality swabs pad Formulary OTC reality trigger lancets Formulary OTC; QL (150 EA per 30 days) REA-LO EXTERNAL CREAM 30 % Formulary OTC REBETOL ORAL CAPSULE 200 MG Formulary PA REBETOL ORAL SOLUTION 40 MG/ML Formulary PA RECOMBIVAX HB INJECTION SUSPENSION 10 Formulary AGE (Min 19 Years) MCG/ML, 40 MCG/ML, 5 MCG/0.5ML RECTICARE EXTERNAL CREAM 5 % Formulary OTC red cross cotton sterile Formulary OTC REDNESS RELIEF OPHTHALMIC SOLUTION 0.012- Formulary OTC 0.25 % reeses pinworm medicine oral tablet 180 mg Formulary OTC REFENESEN CHEST CONG/PAIN RLF ORAL TABLET Formulary OTC 650-400 MG REFENESEN CHST CONG/PAIN PE ORAL TABLET Formulary OTC 10-650-400 MG REFRESH LACRI-LUBE OPHTHALMIC OINTMENT Formulary OTC REFRESH OPHTHALMIC SOLUTION 1.4-0.6 % Formulary OTC REFRESH OPTIVE MEGA-3 OPHTHALMIC Formulary OTC SOLUTION 0.5-1-0.5 % REFRESH OPTIVE OPHTHALMIC GEL 1-0.9 % Formulary OTC REFRESH OPTIVE OPHTHALMIC SOLUTION 0.5-0.9 Formulary OTC % REFRESH OPTIVE SENSITIVE OPHTHALMIC Formulary OTC SOLUTION 0.5-0.9 % REFRESH P.M. OPHTHALMIC OINTMENT Formulary OTC REFRESH TEARS OPHTHALMIC SOLUTION 0.5 % Formulary OTC REGENECARE HA EXTERNAL LIQUID 2 % Formulary OTC REGRANEX EXTERNAL GEL 0.01 % Formulary PA; QL (15 GM per 34 days) relagesic oral tablet 29-500 mg Formulary OTC relcof c oral solution 100-6.3 mg/5ml Formulary OTC; AGE (Min 6 Years) RELIADERM EXTERNAL CREAM 0.035-10-25 % Formulary OTC RELIEF PAIN RELIEVING EXTERNAL CREAM 3 % Formulary OTC reliever external patch 0.05-5 % Formulary OTC 121 Drug Name Formulary Status Requirements/Limits RELION ALCOHOL SWABS PAD Formulary OTC RELION ALCOHOL SWABS PAD 70 % 70 % Formulary OTC RELION ALL-IN-ONE DEVICE Formulary OTC RELION BLOOD GLUCOSE TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days) RELION GLUCOSE SHOT ORAL LIQUID Formulary OTC RELI-ON INSULIN SYRINGE 29G 0.3 ML 29G 0.3 ML Formulary OTC RELI-ON INSULIN SYRINGE 29G 0.5 ML 29G 0.5 ML Formulary OTC RELION INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G X Formulary OTC 1/2" 0.3 ML RELION INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G X Formulary OTC 1/2" 0.5 ML RELION INSULIN SYRINGE 29G X 1/2" 1 ML 29G X Formulary OTC 1/2" 1 ML RELI-ON INSULIN SYRINGE 29G X 1/2" 1 ML 29G X Formulary OTC 1/2" 1 ML RELI-ON INSULIN SYRINGE 30G 0.3 ML 30G 0.3 ML Formulary OTC RELI-ON INSULIN SYRINGE 30G 0.5 ML 30G 0.5 ML Formulary OTC RELI-ON INSULIN SYRINGE 30G 1 ML 30G 1 ML Formulary OTC RELION INSULIN SYRINGE 30G X 5/16" 0.3 ML 30G X Formulary OTC 5/16" 0.3 ML RELION INSULIN SYRINGE 30G X 5/16" 0.5 ML 30G X Formulary OTC 5/16" 0.5 ML RELION INSULIN SYRINGE 30G X 5/16" 1 ML 30G X Formulary OTC 5/16" 1 ML RELION INSULIN SYRINGE 31G X 15/64" 0.3 ML 31G Formulary OTC X 15/64" 0.3 ML RELION INSULIN SYRINGE 31G X 15/64" 0.5 ML 31G Formulary OTC X 15/64" 0.5 ML RELION INSULIN SYRINGE 31G X 15/64" 1 ML 31G X Formulary OTC 15/64" 1 ML RELION INSULIN SYRINGE 31G X 5/16" 0.3 ML 31G X Formulary OTC 5/16" 0.3 ML RELION INSULIN SYRINGE 31G X 5/16" 0.5 ML 31G X Formulary OTC 5/16" 0.5 ML RELION INSULIN SYRINGE 31G X 5/16" 1 ML 31G X Formulary OTC 5/16" 1 ML RELION LANCETS MICRO-THIN 33G Formulary OTC; QL (150 EA per 30 days) RELION LANCETS STANDARD 21G Formulary OTC; QL (150 EA per 30 days) RELION LANCETS THIN 26G Formulary OTC; QL (150 EA per 30 days) RELION LANCETS ULTRA-THIN 30G Formulary OTC; QL (150 EA per 30 days) RELION ULTRA THIN LANCETS 30G Formulary OTC; QL (150 EA per 30 days) RELION ULTRA THIN PLUS LANCETS Formulary OTC; QL (150 EA per 30 days) RELISTOR ORAL TABLET 150 MG Formulary PA; QL (90 EA per 30 days) RELISTOR SUBCUTANEOUS SOLUTION 12 Formulary PA MG/0.6ML REMEDY ANTIMICROBIAL CLEANSER EXTERNAL Formulary OTC LIQUID 0.12 % REMEDY CALAZIME EXTERNAL PASTE 0.4-20.5 % Formulary OTC 122 Drug Name Formulary Status Requirements/Limits REMEDY CLEANSING BODY EXTERNAL LOTION Formulary OTC 1.5 % REMEDY PHYTOPLEX ANTIFUNGAL EXTERNAL Formulary OTC POWDER 2 % REMEDY SKIN REPAIR EXTERNAL CREAM 1.5 % Formulary OTC REMOVE ADHESIVE REMOVER WIPES EXTERNAL Formulary OTC RENACIDIN IRRIGATION SOLUTION Formulary renal vitamin oral tablet 0.8 mg Formulary OTC RENFLEXIS INTRAVENOUS SOLUTION Formulary RECONSTITUTED 100 MG repaglinide oral tablet 0.5 mg, 1 mg, 2 mg Formulary REPATHA SOLUTION PREFILLED SYRINGE 140 Formulary PA MG/ML SUBCUTANEOUS 140 MG/ML REPATHA SURECLICK SOLUTION AUTO-INJECTOR Formulary PA 140 MG/ML SUBCUTANEOUS 140 MG/ML REPHRESH VAGINAL GEL Formulary OTC REPLACE SR ORAL TABLET EXTENDED RELEASE Formulary OTC RESCON ORAL TABLET 2-60 MG Formulary OTC RESCRIPTOR ORAL TABLET 100 MG, 200 MG Formulary resorcinol-sulfur external lotion 2-5 % Formulary RESOURCE THICKENUP WATER ORAL LIQUID Formulary OTC RESPAIRE-30 ORAL CAPSULE 30-150 MG Formulary OTC RESTASIS OPHTHALMIC EMULSION 0.05 % Formulary PA; QL (60 EA per 30 days) RESTORE CLEANSER & MOISTURIZER EXTERNAL Formulary OTC LIQUID 2 % RETAINE PM OPHTHALMIC OINTMENT Formulary OTC REVEAL COLON DISEASE IN VITRO DIAGNOSTIC Formulary OTC TEST REVEAL DNA PATERNITY TEST IN VITRO KIT Formulary OTC REVEAL GET PREGNANT QUICK IN VITRO KIT Formulary OTC REVEAL MULTI-DRUG TESTING CUP IN VITRO Formulary OTC REVEAL URINARY TRACT IN VITRO STRIP Formulary OTC REVITADERM WOUND CARE EXTERNAL GEL Formulary OTC REVLIMID ORAL CAPSULE 10 MG, 15 MG, 2.5 MG, 20 Formulary PA MG, 25 MG, 5 MG REVONTO INTRAVENOUS SOLUTION Formulary RECONSTITUTED 20 MG REXALL LANCETS ULTRA THIN 30G Formulary OTC; QL (150 EA per 30 days) REZAMID EXTERNAL LOTION 2-5 % Formulary OTC RHINARIS NASAL SOLUTION 0.2 % Formulary OTC RHINASE NASAL GEL Formulary OTC RHINASE NASAL SOLUTION Formulary OTC RHOPRESSA OPHTHALMIC SOLUTION 0.02 % Formulary RIASTAP INTRAVENOUS SOLUTION Formulary RECONSTITUTED RIAX EXTERNAL FOAM 5.5 %, 9.5 % Formulary OTC; AGE (Max 19 Years)

123 Drug Name Formulary Status Requirements/Limits RIBASPHERE ORAL TABLET 200 MG, 400 MG, 600 Formulary PA MG ribavirin oral tablet 200 mg Formulary PA riboflavin oral capsule 50 mg Formulary OTC RICOLA CHERRY HONEY HERB MOUTH/THROAT Formulary OTC LOZENGE 2 MG RICOLA HERB MOUTH/THROAT LOZENGE 1.1 MG, Formulary OTC 2.6 MG RICOLA LEMON MINT MOUTH/THROAT LOZENGE Formulary OTC 1.5 MG RICOLA W/ECHINACEA MOUTH/THROAT LOZENGE Formulary OTC 3.5 MG RIDAURA ORAL CAPSULE 3 MG Formulary rifabutin oral capsule 150 mg Formulary rifampin oral capsule 150 mg, 300 mg Formulary RIGHTEST GL300 LANCETS Formulary OTC; QL (150 EA per 30 days) riluzole oral tablet 50 mg Formulary ringers irrigation irrigation solution Formulary risacal-d oral tablet 105-81-120 mg-mg-unit Formulary OTC RISAMINE EXTERNAL OINTMENT 0.44-20.625 % Formulary OTC RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION RECONSTITUTED 12.5 MG, 25 MG, 37.5 Formulary AGE (Min 18 Years) MG, 50 MG RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION RECONSTITUTED ER 12.5 MG, 25 MG, Formulary AGE (Min 18 Years) 37.5 MG, 50 MG risperidone oral solution 1 mg/ml Formulary AGE (Min 18 Years) risperidone oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 Formulary AGE (Min 18 Years) mg risperidone oral tablet dispersible 0.25 mg, 0.5 mg, 1 mg, 2 Formulary AGE (Min 18 Years) mg, 3 mg, 4 mg ritonavir oral tablet 100 mg Formulary RITUXAN INTRAVENOUS SOLUTION 100 MG/10ML, Formulary PA 500 MG/50ML rivastigmine tartrate oral capsule 1.5 mg, 3 mg, 4.5 mg, 6 Formulary mg rivastigmine transdermal patch 24 hour 13.3 mg/24hr, 4.6 Formulary mg/24hr, 9.5 mg/24hr rixubis intravenous solution reconstituted 1000 unit, 2000 Formulary unit, 250 unit, 3000 unit, 500 unit rizatriptan benzoate oral tablet 10 mg, 5 mg Formulary ST; QL (12 EA per 34 days) rizatriptan benzoate oral tablet dispersible 10 mg, 5 mg Formulary QL (12 EA per 34 days) ROBAFEN DM COUGH CLEAR ORAL SYRUP 100-10 Formulary OTC MG/5ML robafen oral syrup 100 mg/5ml Formulary OTC ROBATHOL EXTERNAL OIL Formulary OTC ROBITUSSIN CHILD COUGH/COLD CF ORAL LIQUID Formulary OTC 2.5-5-50 MG/5ML

124 Drug Name Formulary Status Requirements/Limits ROBITUSSIN CHILDRENS COUGH LA ORAL SYRUP Formulary OTC 7.5 MG/5ML ROBITUSSIN COLD+FLU DAYTIME ORAL CAPSULE Formulary OTC 10-5-325 MG ROBITUSSIN COUGH+CHEST CONG DM ORAL Formulary OTC CAPSULE 10-200 MG ROBITUSSIN DAY/NIGHT VALUE PAK ORAL Formulary OTC ROBITUSSIN LINGERING COUGHGELS ORAL Formulary OTC CAPSULE 15 MG ROBITUSSIN MUCUS+CHEST CONGEST ORAL Formulary OTC LIQUID 100 MG/5ML ROBITUSSIN MULTI-SYMPTOM MAX ORAL LIQUID Formulary OTC 5-10-200 MG/5ML ROBITUSSIN NIGHTTIME COUGH DM ORAL LIQUID Formulary OTC 12.5-30 MG/10ML ROBITUSSIN NIGHTTIME COUGH ORAL LIQUID 1- Formulary OTC 7.5 MG/5ML ROBITUSSIN PEAK COLD MULTI-SYM ORAL Formulary OTC LIQUID 6.25-2.5-160 MG/5ML ROBITUSSIN PK COLD DAY/NGHT DM ORAL Formulary OTC ROBITUSSIN PK COLD DAY/NGHT MS ORAL Formulary OTC ROBITUSSIN SEVERE NIGHTTIME ORAL LIQUID Formulary OTC 12.5-5-325 MG/10ML ROBITUSSIN TO GO COUGH/COLD CF ORAL LIQUID Formulary OTC 5-10-100 MG/5ML ROCKLATAN OPHTHALMIC SOLUTION 0.02-0.005 % Formulary ROLAIDS ORAL TABLET CHEWABLE 550-110 MG Formulary OTC hcl oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 Formulary mg, 4 mg, 5 mg rose water external liquid Formulary OTC rosuvastatin calcium oral tablet 10 mg, 20 mg, 40 mg, 5 mg Formulary ROTARIX ORAL SUSPENSION RECONSTITUTED Formulary AGE (Min 19 Years) ROTATEQ ORAL SOLUTION Formulary AGE (Min 19 Years) rotex external cream 0.038-4-35 % Formulary OTC rufinamide oral suspension 40 mg/ml Formulary PA rufinamide oral tablet 200 mg, 400 mg Formulary PA ru-hist d oral tablet 4-10 mg Formulary OTC rutin oral tablet 50 mg Formulary OTC rydex g oral tablet 38.5-398 mg Formulary OTC RYDEX ORAL LIQUID 10-1.33-6.33 MG/5ML Formulary OTC rymed oral tablet 2-10 mg Formulary OTC rynex pe oral elixir 1-2.5 mg/5ml Formulary OTC rynex pse oral liquid 1-15 mg/5ml Formulary OTC S.S.S. TONIC ORAL LIQUID Formulary OTC SAFE TUSSIN PM ORAL LIQUID 3.125-7.5 MG/5ML Formulary OTC SAFELET IV CATHETER Formulary OTC safety insulin syringes 27g x 1/2" 1 ml 27g x 1/2" 1 ml Formulary OTC

125 Drug Name Formulary Status Requirements/Limits safety insulin syringes 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC safety insulin syringes 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC safety insulin syringes 30g x 1/2" 1 ml 30g x 1/2" 1 ml Formulary OTC safety insulin syringes 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC SAFETY SEAL LANCETS Formulary OTC; QL (150 EA per 30 days) SAFETY-GARD NEEDLE 18G Formulary OTC SAFETY-LOK SYRINGE 21G X 1-1/2" 10 ML, 21G X 1- Formulary OTC 1/2" 5 ML SALEM SUMP TUBE 12FR Formulary external cream 6 % Formulary salicylic acid external foam 6 % Formulary salicylic acid external gel 6 % Formulary salicylic acid external lotion 6 % Formulary salicylic acid wart remover external liquid 27.5 % Formulary salicylic acid-cleanser external kit 6 % (lotion) Formulary saline nasal gel Formulary OTC saline solution Formulary OTC SALMON ORAL CAPSULE 200 MG Formulary OTC SAM-E COMPLETE ORAL TABLET DELAYED Formulary OTC RELEASE 200 MG sam-e oral tablet delayed release 400 mg Formulary OTC sam-g.l.a. oral capsule 100-150-40 mg Formulary OTC SAMSCA ORAL TABLET 15 MG Formulary PA; QL (34 EA per 34 days) SAMSCA ORAL TABLET 30 MG Formulary PA; QL (68 EA per 34 days) SANTYL EXTERNAL OINTMENT 250 UNIT/GM Formulary QL (60 GM per 34 days) sapropterin dihydrochloride oral tablet 100 mg Formulary PA sapropterin dihydrochloride oral tablet soluble 100 mg Formulary PA SARNA EXTERNAL LOTION 0.5-0.5 % Formulary OTC SASTID SOAP EXTERNAL BAR 3-5 % Formulary OTC SAVELLA ORAL TABLET 100 MG, 12.5 MG, 25 MG, 50 Formulary PA; QL (68 EA per 34 days) MG SAVELLA TITRATION PACK ORAL 12.5 & 25 & 50 Formulary PA; QL (55 EA per 30 days) MG sb alcohol prep pad 70 % 70 % Formulary OTC sb bacitracin external ointment 500 unit/gm Formulary OTC sb childrens cough/runny nose oral suspension 5-160-1 Formulary OTC mg/5ml sb cold & flu hbp oral tablet 2-325 mg Formulary OTC sb daytime sinus oral capsule 5-325 mg Formulary OTC sb fib lax orange oral powder 30 % Formulary OTC sb insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC sb insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC sb insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC sb insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC sb insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC

126 Drug Name Formulary Status Requirements/Limits sb lancets thin Formulary OTC; QL (150 EA per 30 days) sb lancets ultra thin Formulary OTC; QL (150 EA per 30 days) sb lice treatment external liquid 0.3-3 %, 1 % Formulary OTC sb nighttime sinus multi-sympt oral capsule 6.25-5-325 mg Formulary OTC sb omeprazole oral tablet delayed release 20 mg Formulary OTC sb stool softener oral capsule 240 mg Formulary OTC scarcin external cream Formulary OTC scot-tussin expectorant oral liquid 100 mg/5ml Formulary OTC SCYTERA EXTERNAL FOAM 2 % Formulary OTC se-100 oral capsule 100 mcg Formulary OTC SEBUDERM EXTERNAL GEL Formulary SEBULEX EXTERNAL SHAMPOO 2-2 % Formulary OTC SECONAL ORAL CAPSULE 100 MG Formulary SECURA EXTRA PROTECTIVE EXTERNAL CREAM Formulary OTC 30.6 % SECURA MOISTURIZING CLEANSER EXTERNAL Formulary OTC LIQUID 0.13 % SECURA TWO-STEP EXTERNAL KIT 0.13 & 10 % Formulary OTC SELECT-OB ORAL TABLET CHEWABLE 29-1 MG Formulary selegiline hcl oral capsule 5 mg Formulary selegiline hcl oral tablet 5 mg Formulary selenicaps-200 oral capsule 200 mcg Formulary OTC selenimin oral tablet 125 mcg Formulary OTC selenium er oral tablet extended release 200 mcg Formulary OTC selenium sulfide external lotion 2.5 % Formulary SELSUN BLUE DEEP CLEANSING EXTERNAL Formulary OTC SHAMPOO 3 % SELZENTRY ORAL TABLET 150 MG, 300 MG Formulary se-natal 19 oral tablet 29-1 mg Formulary senna laxative oral tablet 25 mg Formulary OTC senna leaves oral leaves Formulary OTC senna oral capsule 8.6 mg Formulary OTC senna oral syrup 176 mg/5ml Formulary OTC senna oral syrup 8.8 mg/5ml Formulary senna oral tablet 8.6 mg Formulary OTC SENNA PROMPT ORAL CAPSULE 9-500 MG Formulary OTC senna s oral tablet 8.6-50 mg Formulary OTC SENNA SMOOTH ORAL TABLET 15 MG Formulary OTC SENOKOT EXTRA STRENGTH ORAL TABLET 17.2 Formulary OTC MG SENOKOT S ORAL TABLET 8.6-50 MG Formulary OTC SENSI-CARE BODY EXTERNAL CREAM 1-30 % Formulary OTC SENSI-CARE PERINEAL/SKIN EXTERNAL LIQUID Formulary OTC SENSI-CARE PROTECTIVE BARRIER EXTERNAL Formulary OTC OINTMENT 49-15 %

127 Drug Name Formulary Status Requirements/Limits SENSIPAR ORAL TABLET 30 MG, 60 MG, 90 MG Formulary PA SENSITIVE EYES ENZYME CLEANER TABLET Formulary OTC EFFERVESCENT SENSODYNE MAXIMUM STRENGTH DENTAL GEL Formulary OTC SE-PLUS PROTEIN ORAL TABLET 200 MCG Formulary OTC SEREVENT DISKUS INHALATION AEROSOL Formulary POWDER BREATH ACTIVATED 50 MCG/DOSE sertraline hcl oral concentrate 20 mg/ml Formulary sertraline hcl oral tablet 100 mg, 25 mg, 50 mg Formulary sevelamer carbonate oral packet 0.8 gm, 2.4 gm Formulary sevelamer carbonate oral tablet 800 mg Formulary sevelamer hcl oral tablet 800 mg Formulary severe allergy oral tablet 12.5-500 mg Formulary OTC severe cold & flu day/night oral liquid therapy pack Formulary OTC sf 5000 plus dental cream 1.1 % Formulary shampoo & body wash rinse-free external foam Formulary OTC SHINGRIX INTRAMUSCULAR SUSPENSION Formulary RECONSTITUTED 50 MCG SHOPKO ALCOHOL SWABS PAD 70 % 70 % Formulary OTC SHOPKO UNILET LANCETS 30G Formulary OTC; QL (150 EA per 30 days) SHUR-SEAL CONTRACEPTIVE VAGINAL GEL 2 % Formulary OTC silace oral syrup 60 mg/15ml Formulary OTC sildenafil citrate oral suspension reconstituted 10 mg/ml Formulary PA; AGE (Min 18 Years) sildenafil citrate oral tablet 20 mg Formulary PA; AGE (Min 18 Years) silodosin oral capsule 4 mg, 8 mg Formulary silver nitrate external ointment 10 % Formulary silver nitrate external solution 0.5 %, 10 %, 25 %, 50 % Formulary silver sulfadiazine external cream 1 % Formulary SILVERMED EXTERNAL GEL Formulary OTC SIMILAC STERILIZED WATER ORAL LIQUID Formulary OTC SIMILASAN DRY EYE RELIEF OPHTHALMIC Formulary OTC SOLUTION SIMILASAN PINK EYE RELIEF OPHTHALMIC Formulary OTC SOLUTION SIMILASAN STYE EYE RELIEF OPHTHALMIC Formulary OTC SOLUTION simple syrup oral syrup Formulary simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg, 80 mg Formulary SINADRIN PE COMPLETE SINUS REL ORAL TABLET Formulary OTC 2-10-650 MG sinus & cold-d oral tablet extended release 12 hour 120- Formulary OTC 220 mg sinus & congestion day/night oral Formulary OTC sinus congestion/pain daytime oral tablet 5-325 mg Formulary OTC sinus relief sublingual tablet sublingual Formulary OTC sirolimus oral solution 1 mg/ml Formulary 128 Drug Name Formulary Status Requirements/Limits sirolimus oral tablet 0.5 mg, 1 mg, 2 mg Formulary siterol external patch 3.99-1 % Formulary OTC skin protectant external cream 12 % Formulary OTC skin tag remover external liquid Formulary OTC SKINTEGRITY HYDROGEL EXTERNAL GEL Formulary OTC SKYLA INTRAUTERINE INTRAUTERINE DEVICE Formulary 13.5 MG sleep aid oral tablet 25 mg Formulary OTC SLEEP-N-HEEL EXTERNAL KIT 20 % Formulary OTC SLO-NIACIN ORAL TABLET EXTENDED RELEASE Formulary OTC 500 MG, 750 MG SLOW FE ORAL TABLET EXTENDED RELEASE 142 Formulary OTC (45 FE) MG slow iron oral tablet extended release 160 (50 fe) mg Formulary OTC slow magnesium/calcium oral tablet delayed release 70-117 Formulary OTC mg slow release iron oral tablet extended release 47.5 mg Formulary OTC sm alcohol prep pad Formulary OTC sm alcohol prep pad 70 % 70 % Formulary OTC sm allergy relief oral tablet 1.34 mg Formulary OTC sm b super vitamin complex oral tablet Formulary OTC sm biotin oral tablet 5000 mcg Formulary OTC sm calamine external lotion Formulary OTC sm calcium soft chews oral tablet chewable 500-100-40 Formulary OTC sm chest congestion relief dm oral tablet 20-400 mg Formulary OTC SM CORAL CALCIUM ORAL TABLET 1000 (390 CA) Formulary OTC MG sm cosmetic puffs jumbo Formulary OTC sm cough drops mouth/throat lozenge 7 mg Formulary OTC sm cough/sore throat daytime oral liquid 1000-30 mg/30ml Formulary OTC sm daytime cold & cough child oral solution 2.5-5 mg/5ml Formulary OTC sm dental rinse anti-plaque mouth/throat liquid Formulary OTC sm ethyl alcohol (rubbing) solution 70 % Formulary OTC sm foaming antacid oral tablet chewable 80-20 mg Formulary OTC sm fruit coolers mouth/throat lozenge 7 mg Formulary OTC sm glucosamine hcl-msm oral tablet 750-750 mg Formulary OTC SM GLUCOSAMINE/CALCIUM + D ORAL TABLET Formulary OTC 500-333-250 MG-MG-UNIT sm hemorrhoidal rectal ointment 0.25-14-74.9 % Formulary OTC sm ibuprofen jr oral tablet 100 mg Formulary OTC sm iodides external tincture Formulary OTC sm iodine tincture external tincture Formulary OTC sm iron oral tablet 134 mg Formulary OTC sm lancets 33g Formulary OTC; QL (150 EA per 30 days) sm medicated chest rub external ointment 4.73-1.2-2.6 % Formulary OTC

129 Drug Name Formulary Status Requirements/Limits sm melatonin oral tablet dispersible 5 mg Formulary OTC sm natural herb cough drops mouth/throat lozenge 4.8 mg Formulary OTC sm oatmeal bath external packet 100 % Formulary OTC sm omega-3-6-9 fatty acids oral capsule Formulary OTC sm omeprazole oral tablet delayed release 20 mg Formulary OTC sm one daily prenatal oral 28-0.8 & 440 mg Formulary OTC sm pain relief/menthol external gel Formulary OTC sm prenatal vitamins oral tablet 28-0.8 mg Formulary OTC sm slow release iron oral tablet extended release 143 (45 Formulary OTC fe) mg sm tussin cf oral liquid 30-10-100 mg/5ml Formulary OTC sm vitamin b1 oral tablet 100 mg Formulary OTC SMART SENSE COLOR LANCETS 33G Formulary OTC; QL (150 EA per 30 days) SMART SENSE STANDARD LANCETS Formulary OTC; QL (150 EA per 30 days) SMART SENSE SUPER THIN LANCETS Formulary OTC; QL (150 EA per 30 days) SMART SENSE THIN LANCETS 26G Formulary OTC; QL (150 EA per 30 days) smoothfit cuff Formulary OTC sod citrate-citric acid oral solution 500-334 mg/5ml Formulary sodium bicarbonate oral powder Formulary sodium bicarbonate oral tablet 325 mg, 650 mg Formulary OTC sodium chloride (hypertonic) ophthalmic ointment 5 % Formulary OTC sodium chloride (hypertonic) ophthalmic solution 5 % Formulary OTC sodium chloride inhalation nebulization solution 0.9 %, 3 Formulary %, 7 % sodium chloride oral solution 4 meq/ml Formulary OTC sodium chloride oral tablet 1 gm Formulary OTC sodium fluoride mouth/throat solution 0.2 % Formulary sodium fluoride oral solution 1.1 (0.5 f) mg/ml Formulary sodium fluoride oral tablet chewable 0.55 (0.25 f) mg, 1.1 Formulary (0.5 f) mg, 2.2 (1 f) mg sodium phenylbutyrate oral tablet 500 mg Formulary sodium polystyrene sulfonate oral suspension 15 gm/60ml Formulary sodium polystyrene sulfonate rectal suspension 30 Formulary gm/120ml sofosbuvir-velpatasvir oral tablet 400-100 mg Formulary PA; AGE (Min 18 Years) solifenacin succinate oral tablet 10 mg, 5 mg Formulary SOLIRIS INTRAVENOUS SOLUTION 300 MG/30ML Formulary PA SOLUBLE FIBER THERAPY ORAL POWDER Formulary OTC solvatech plus oral suspension Formulary SOMBRA COOL THERAPY EXTERNAL GEL 6 % Formulary OTC SOMBRA WARM THERAPY EXTERNAL GEL 3-3 % Formulary OTC SOOTHE & COOL INZO BARRIER EXTERNAL Formulary OTC CREAM 5-5 % SOOTHE XP XTRA PROTECTION OPHTHALMIC Formulary OTC SOLUTION

130 Drug Name Formulary Status Requirements/Limits sorbitol oral solution 70 % Formulary OTC sorbitol rectal solution 70 % Formulary OTC sorbutuss nr oral liquid 15-150-127.5 mg/7.5ml Formulary OTC sore throat lozenges mouth/throat lozenge 6-10 mg Formulary OTC sore throat mouth/throat lozenge 15-3.6 mg Formulary OTC sotalol hcl (af) oral tablet 120 mg, 160 mg, 80 mg Formulary sotalol hcl oral tablet 120 mg, 160 mg, 240 mg, 80 mg Formulary soya lecithin oral capsule 1200 mg Formulary OTC spinosad external suspension 0.9 % Formulary SPIRIVA HANDIHALER INHALATION CAPSULE 18 Formulary MCG spironolactone oral tablet 100 mg, 25 mg, 50 mg Formulary spironolactone-hctz oral tablet 25-25 mg Formulary sportbalm external lotion Formulary OTC SPORTSCREME EXTERNAL CREAM 10 % Formulary OTC spot acne treatment external cream 2.5 % Formulary OTC SPRAYZOIN EXTERNAL LIQUID Formulary OTC SPS ORAL SUSPENSION 15 GM/60ML Formulary stahist ad oral liquid 25-60 mg/5ml Formulary OTC stahist ad oral tablet 25-60 mg Formulary OTC STALEVO 100 ORAL TABLET 25-100-200 MG Formulary STALEVO 125 ORAL TABLET 31.25-125-200 MG Formulary STALEVO 150 ORAL TABLET 37.5-150-200 MG Formulary STALEVO 200 ORAL TABLET 50-200-200 MG Formulary STALEVO 75 ORAL TABLET 18.75-75-200 MG Formulary STANBACK HEADACHE ORAL PACKET Formulary OTC 650-200-32 MG stavudine oral capsule 15 mg, 20 mg, 30 mg, 40 mg Formulary STERILANCE TL Formulary OTC; QL (150 EA per 30 days) STERILE LUBRICANT OPHTHALMIC LIQUID 0.7 % Formulary OTC STERI-STRIP COMPOUND BENZOIN EXTERNAL Formulary OTC TINCTURE STERI-TAMP SEALS BOTTLES/VIALS Formulary OTC STERI-TAMP SEALS/BAGS Formulary OTC STERI-TAMP SEALS/SYRINGES Formulary OTC STIMATE NASAL SOLUTION 1.5 MG/ML Formulary STIMEX INSULATED NEEDLE 22G X 2-1/8" , 22G X 4- Formulary OTC 1/4" STIMULEN EXTERNAL GEL Formulary OTC STIOLTO RESPIMAT INHALATION AEROSOL Formulary SOLUTION 2.5-2.5 MCG/ACT STOMAHESIVE MOLDABLE ADHESIVE STRIP Formulary OTC STOMAHESIVE PASTE PASTE Formulary OTC stop lice maximum strength external liquid 0.33-4 % Formulary OTC STRIANT BUCCAL 30 MG Formulary

131 Drug Name Formulary Status Requirements/Limits STRIBILD ORAL TABLET 150-150-200-300 MG Formulary STRIDEX ESSENTIAL EXTERNAL PAD 1 % Formulary OTC STRI-DEX SENSITIVE SKIN EXTERNAL PAD 0.5 % Formulary OTC STUART ONE ORAL CAPSULE 27-0.8-200 MG Formulary OTC SUBLOCADE SUBCUTANEOUS SOLUTION Formulary PREFILLED SYRINGE 100 MG/0.5ML, 300 MG/1.5ML QL (60 EA per 30 days); AGE (Min 16 SUBOXONE SUBLINGUAL FILM 12-3 MG Formulary Years) QL (360 EA per 30 days); AGE (Min 16 SUBOXONE SUBLINGUAL FILM 2-0.5 MG Formulary Years) QL (180 EA per 30 days); AGE (Min 16 SUBOXONE SUBLINGUAL FILM 4-1 MG Formulary Years) QL (90 EA per 30 days); AGE (Min 16 SUBOXONE SUBLINGUAL FILM 8-2 MG Formulary Years) SUBSYS SUBLINGUAL LIQUID 100 MCG, 1200 (600 X 2) MCG, 1600 (800 X 2) MCG, 200 MCG, 400 MCG, 600 Formulary PA; QL (120 EA per 30 days) MCG, 800 MCG sucralfate oral suspension 1 gm/10ml Formulary sucralfate oral tablet 1 gm Formulary SUDAFED 24 HOUR ORAL TABLET EXTENDED Formulary OTC RELEASE 24 HOUR 240 MG SUDAFED CHILDRENS ORAL LIQUID 15 MG/5ML Formulary OTC SUDAFED ORAL TABLET 30 MG Formulary OTC SUDAFED PE CHILDRENS ORAL SOLUTION 2.5 Formulary OTC MG/5ML SUDAFED PE COLD & COUGH CHILD ORAL Formulary OTC SOLUTION 2.5-5 MG/5ML SUDAFED PE DAY & NIGHT ORAL 25-10 & 10 MG Formulary OTC SUDAFED PE MAXIMUM STRENGTH ORAL TABLET Formulary OTC 10 MG SUDAFED PRESSURE+PAIN 12 HR ORAL TABLET Formulary OTC EXTENDED RELEASE 12 HOUR 120-220 MG sulfacetamide sodium (acne) external lotion 10 % Formulary sulfacetamide sodium ophthalmic ointment 10 % Formulary sulfacetamide sodium ophthalmic solution 10 % Formulary sulfacetamide sodium-sulfur external liquid 9-4 % Formulary sulfacetamide sodium-sulfur external lotion 10-5 % Formulary sulfacetamide sodium-sulfur external pad 10-4 % Formulary sulfacetamide sodium-sulfur external suspension 8-4 % Formulary sulfacetamide-prednisolone ophthalmic solution 10-0.23 % Formulary sulfadiazine oral tablet 500 mg Formulary sulfamethoxazole-trimethoprim oral tablet 400-80 mg, 800- Formulary 160 mg SULFAMYLON EXTERNAL CREAM 85 MG/GM Formulary sulfasalazine oral tablet 500 mg Formulary sulfasalazine oral tablet delayed release 500 mg Formulary sulfo-lo external bar 5 % Formulary OTC

132 Drug Name Formulary Status Requirements/Limits sulfur external bar 10 % Formulary OTC sulindac oral tablet 150 mg, 200 mg Formulary nasal solution 20 mg/act, 5 mg/act Formulary sumatriptan succinate oral tablet 100 mg Formulary ST; QL (9 EA per 34 days) sumatriptan succinate oral tablet 25 mg, 50 mg Formulary ST; QL (18 EA per 34 days) sumatriptan succinate refill subcutaneous solution cartridge Formulary 4 mg/0.5ml, 6 mg/0.5ml sumatriptan succinate subcutaneous solution 6 mg/0.5ml Formulary sumatriptan succinate subcutaneous solution auto-injector Formulary 4 mg/0.5ml, 6 mg/0.5ml sumatriptan succinate subcutaneous solution prefilled Formulary syringe 6 mg/0.5ml SUMMERS EVE DEODORANT ULTRA EXTERNAL Formulary OTC AEROSOL super b-50 complex oral capsule Formulary OTC super c-500 complex oral tablet extended release Formulary OTC super cal/mag oral tablet 333.333-166.667 mg Formulary OTC super moleskin pad Formulary OTC SUPER OMEGA-3 ORAL CAPSULE Formulary OTC super thin lancets Formulary OTC; QL (150 EA per 30 days) supposibase f powder Formulary OTC SUPPRELIN LA SUBCUTANEOUS KIT 50 MG Formulary PA SUPREP BOWEL PREP KIT ORAL SOLUTION 17.5- Formulary 3.13-1.6 GM/177ML supress a pediatric oral liquid 5-1-10 mg/ml Formulary OTC supress dm pediatric oral liquid 5-50 mg/ml Formulary OTC SUPRESS-PE PEDIATRIC ORAL LIQUID 2.5-50 Formulary OTC MG/ML sure comfort alcohol prep pad 70 % 70 % Formulary OTC sure comfort insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" Formulary OTC 0.5 ml sure comfort insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC sure comfort insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" Formulary OTC 0.3 ml sure comfort insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" Formulary OTC 0.5 ml sure comfort insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC sure comfort insulin syringe 30g x 1/2" 0.3 ml 30g x 1/2" Formulary OTC 0.3 ml sure comfort insulin syringe 30g x 1/2" 0.5 ml 30g x 1/2" Formulary OTC 0.5 ml sure comfort insulin syringe 30g x 1/2" 1 ml 30g x 1/2" 1 ml Formulary OTC sure comfort insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" Formulary OTC 0.3 ml sure comfort insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" Formulary OTC 0.5 ml sure comfort insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 Formulary OTC ml 133 Drug Name Formulary Status Requirements/Limits sure comfort insulin syringe 31g x 1/4" 0.3 ml 31g x 1/4" Formulary OTC 0.3 ml sure comfort insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" Formulary OTC 0.3 ml sure comfort insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" Formulary OTC 0.5 ml sure comfort insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 Formulary OTC ml sure comfort lancets 28g Formulary OTC; QL (150 EA per 30 days) sure comfort lancets 30g Formulary OTC; QL (150 EA per 30 days) SURE-JECT INSULIN SYRINGE 28G X 1/2" 0.5 ML 28G Formulary OTC X 1/2" 0.5 ML SURE-JECT INSULIN SYRINGE 28G X 1/2" 1 ML 28G Formulary OTC X 1/2" 1 ML SURE-JECT INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G Formulary OTC X 1/2" 0.3 ML SURE-JECT INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G Formulary OTC X 1/2" 0.5 ML SURE-JECT INSULIN SYRINGE 29G X 1/2" 1 ML 29G Formulary OTC X 1/2" 1 ML SURE-JECT INSULIN SYRINGE 30G X 5/16" 0.3 ML Formulary OTC 30G X 5/16" 0.3 ML SURE-JECT INSULIN SYRINGE 30G X 5/16" 0.5 ML Formulary OTC 30G X 5/16" 0.5 ML SURE-JECT INSULIN SYRINGE 30G X 5/16" 1 ML 30G Formulary OTC X 5/16" 1 ML SURE-JECT INSULIN SYRINGE 31G X 5/16" 0.3 ML Formulary OTC 31G X 5/16" 0.3 ML SURE-JECT INSULIN SYRINGE 31G X 5/16" 0.5 ML Formulary OTC 31G X 5/16" 0.5 ML SURE-JECT INSULIN SYRINGE 31G X 5/16" 1 ML 31G Formulary OTC X 5/16" 1 ML SURE-LANCE ULTRA THIN LANCETS Formulary OTC; QL (150 EA per 30 days) SURELITE LANCETS Formulary OTC; QL (150 EA per 30 days) SUSPENDOL-S LIQUID Formulary OTC SUTENT ORAL CAPSULE 12.5 MG, 50 MG Formulary PA SWEEN EXTERNAL CREAM Formulary OTC SWEEN PREP EXTERNAL SOLUTION Formulary OTC SWIM EAR OTIC LIQUID 95 % Formulary OTC swimmers instant ear dry otic liquid 95 % Formulary OTC SYLATRON SUBCUTANEOUS KIT 200 MCG, 300 Formulary MCG, 600 MCG SYMBICORT INHALATION AEROSOL 160-4.5 Formulary MCG/ACT, 80-4.5 MCG/ACT sympathetic nerve needle 19g x 5" , 20g x 5" Formulary OTC SYNAGIS INTRAMUSCULAR SOLUTION 100 MG/ML, Formulary PA 50 MG/0.5ML Synera External Patch 70-70 MG Benefit Exclusion

134 Drug Name Formulary Status Requirements/Limits SYNJARDY ORAL TABLET 12.5-1000 MG, 12.5-500 Formulary ST; AGE (Min 18 Years) MG, 5-1000 MG, 5-500 MG SYNVISC INTRA-ARTICULAR SOLUTION Formulary PA PREFILLED SYRINGE 16 MG/2ML SYNVISC ONE INTRA-ARTICULAR SOLUTION Formulary PA PREFILLED SYRINGE 48 MG/6ML syringe 10-12 ml 12 ml Formulary OTC syringe 20-25 ml 25 ml Formulary OTC syringe 20g x 1" 12 ml, 20g x 1" 6 ml, 21g x 1" 6 ml, 21g x 1-1/4" 3 ml, 21g x 1-1/4" 6 ml, 22g x 1" 12 ml, 22g x 1" 6 Formulary OTC ml, 22g x 1-1/2" 12 ml, 22g x 1-1/2" 6 ml, 22g x 1-1/4" 6 ml, 22g x 3/4" 3 ml, 27g x 1-1/4" 3 ml, 2g x 1-1/4" 3 ml syringe 2-3 ml 3 ml Formulary OTC syringe 30-35 ml 35 ml Formulary OTC syringe 50-60 ml 60 ml Formulary OTC syringe 5-6 ml 6 ml Formulary OTC syringe luer slip 1 ml Formulary syringe luer slip 26g x 3/8" 1 ml, 27g x 1/2" 1 ml Formulary OTC syringe precisedose dispenser Formulary SYRSPEND SF ORAL LIQUID Formulary SYRSPEND SF PH4 ORAL SUSPENSION Formulary RECONSTITUTED syrup nf oral syrup 85 % Formulary OTC SYSTANE BALANCE OPHTHALMIC SOLUTION 0.6 % Formulary OTC SYSTANE LID WIPES EXTERNAL PAD Formulary OTC SYSTANE OPHTHALMIC GEL 0.4-0.3 % Formulary OTC SYSTANE OPHTHALMIC SOLUTION 0.4-0.3 % Formulary OTC SYSTANE OVERNIGHT THERAPY OPHTHALMIC Formulary OTC GEL 0.3 % SYSTANE PRESERVATIVE FREE OPHTHALMIC Formulary OTC SOLUTION 0.4-0.3 % SYSTANE ULTRA OPHTHALMIC SOLUTION 0.4-0.3 Formulary OTC % SYSTANE ULTRA PF OPHTHALMIC SOLUTION 0.4- Formulary OTC 0.3 % TABLOID ORAL TABLET 40 MG Formulary tacrolimus external ointment 0.03 %, 0.1 % Formulary PA tacrolimus oral capsule 0.5 mg, 1 mg, 5 mg Formulary tadalafil (pah) oral tablet 20 mg Formulary PA; AGE (Min 18 Years) tamoxifen citrate oral tablet 10 mg, 20 mg Formulary tamsulosin hcl oral capsule 0.4 mg Formulary TANDEM ORAL CAPSULE 162-115.2 MG Formulary OTC tangerine oil Formulary OTC TARGRETIN EXTERNAL GEL 1 % Formulary taron forte oral capsule Formulary TARON-PREX ORAL CAPSULE 30-1.2-265 MG Formulary TARSUM EXTERNAL SHAMPOO 10-5 % Formulary OTC 135 Drug Name Formulary Status Requirements/Limits taurine oral capsule 500 mg Formulary OTC tazarotene external cream 0.1 % Formulary PA TAZORAC EXTERNAL CREAM 0.05 % Formulary PA TAZORAC EXTERNAL GEL 0.05 %, 0.1 % Formulary PA TAZTIA XT ORAL CAPSULE EXTENDED RELEASE Formulary 24 HOUR 120 MG, 180 MG, 240 MG, 300 MG, 360 MG tb syringe 1 ml Formulary tdm solution external solution Formulary TEAR FLO OPHTHALMIC STRIP Formulary OTC TEARS NATURALE PM OPHTHALMIC OINTMENT 3- Formulary OTC 94 % TECHLITE AST LANCETS Formulary OTC; QL (150 EA per 30 days) TECHLITE LANCETS Formulary OTC; QL (150 EA per 30 days) TECHLITE LANCETS 30G Formulary OTC; QL (150 EA per 30 days) TECNU FIRST AID EXTERNAL GEL 0.2-2.5 % Formulary OTC TEGADERM CONTACT LAYER PAD 8"X10" Formulary OTC TEGADERM FOAM ADHESIVE PAD 2-3/4"X2-3/4" , 2- 3/4"X3" , 4"X4-1/2" , 5-5/8"X5-5/8" , 5-5/8"X6-1/8" , 7- Formulary OTC 1/2"X8-3/4" TEGADERM FOAM PAD 3-1/2"X3-1/2" Formulary OTC TEGADERM HYDROGEL WOUND FILLER Formulary OTC EXTERNAL GEL telmisartan oral tablet 20 mg, 40 mg, 80 mg Formulary telmisartan-hctz oral tablet 40-12.5 mg, 80-12.5 mg, 80-25 Formulary mg temazepam oral capsule 15 mg, 22.5 mg, 30 mg, 7.5 mg Formulary temozolomide oral capsule 100 mg, 140 mg, 180 mg, 20 mg, Formulary 250 mg, 5 mg temsirolimus intravenous solution 25 mg/ml Formulary tenofovir disoproxil fumarate oral tablet 300 mg Formulary tension headache oral tablet 500-65 mg Formulary OTC terazosin hcl oral capsule 1 mg, 2 mg, 5 mg Formulary QL (34 EA per 34 days) terazosin hcl oral capsule 10 mg Formulary QL (68 EA per 34 days) terbinafine hcl oral tablet 250 mg Formulary terbutaline sulfate oral tablet 2.5 mg, 5 mg Formulary terconazole vaginal cream 0.4 % Formulary QL (45 GM per 30 days) terconazole vaginal cream 0.8 % Formulary QL (20 GM per 30 days) terconazole vaginal suppository 80 mg Formulary QL (3 EA per 30 days) teriparatide (recombinant) subcutaneous solution pen- Formulary QL (2.48 ML per 30 days) injector 620 mcg/2.48ml terocin external lotion 2.5-0.025-10-25 % Formulary OTC terocin external patch 4-4 % Formulary OTC teroderm-plus external cream Formulary TESTOPEL IMPLANT PELLET 75 MG Formulary testosterone cypionate intramuscular solution 100 mg/ml, Formulary 200 mg/ml

136 Drug Name Formulary Status Requirements/Limits testosterone enanthate intramuscular solution 200 mg/ml Formulary testosterone transdermal gel 12.5 mg/act (1%), 20.25 mg/1.25gm (1.62%), 20.25 mg/act (1.62%), 25 mg/2.5gm Formulary AGE (Min 18 Years) (1%), 40.5 mg/2.5gm (1.62%), 50 mg/5gm (1%) tetanus-diphtheria toxoids td intramuscular suspension 2-2 Formulary AGE (Min 19 Years) lf/0.5ml tetrabenazine oral tablet 12.5 mg, 25 mg Formulary PA tetracycline hcl oral capsule 250 mg, 500 mg Formulary TETRA-FORMULA CGH/SORE THROAT Formulary OTC MOUTH/THROAT LOZENGE 10-15 MG tgt alcohol swabs pad 70 % 70 % Formulary OTC tgt first aid cleansing external liquid 2.5-0.13 % Formulary OTC tgt lancet micro thin 33g Formulary OTC; QL (150 EA per 30 days) tgt lancet thin 26g Formulary OTC; QL (150 EA per 30 days) tgt lancet ultra thin 30g Formulary OTC; QL (150 EA per 30 days) tgt lubricant eye drops ophthalmic solution 0.95 % Formulary OTC tgt lubricant redness reliever ophthalmic solution 0.03-0.5 Formulary OTC % tgt omeprazole oral tablet delayed release 20 mg Formulary OTC THALOMID ORAL CAPSULE 100 MG, 150 MG, 200 Formulary PA MG, 50 MG THE ITCH ERASER EXTERNAL SOLUTION 2 % Formulary OTC THEOCHRON ORAL TABLET EXTENDED RELEASE Formulary 12 HOUR 100 MG, 200 MG, 300 MG theophylline er oral tablet extended release 12 hour 450 mg Formulary theophylline er oral tablet extended release 24 hour 400 Formulary mg, 600 mg THERACOF PLUS COUGH/COLD REL ORAL LIQUID Formulary OTC 5-10-100-325 MG/5ML THERACYS INTRAVESICAL SUSPENSION Formulary RECONSTITUTED 81 MG/VIAL THERA-D 4000 ORAL TABLET 100 MCG (4000 UT) Formulary OTC THERAFLU COLD & COUGH ORAL PACKET 10-20-20 Formulary OTC MG THERAFLU EXPRESSMAX ORAL LIQUID 12.5-5-325 Formulary OTC MG/15ML THERAFLU FLU & SORE THROAT ORAL PACKET 20- Formulary OTC 10-650 MG THERAFLU SEVERE COLD & COUGH ORAL PACKET Formulary OTC THERAFLU SEVERE COLD DAYTIME ORAL TABLET Formulary OTC 15-5-325 MG THERAFLU SEVERE COLD NIGHTTIME ORAL Formulary OTC PACKET 25-10-500 MG THERAFLU SEVERE COLD NIGHTTIME ORAL Formulary OTC TABLET 5-2-10-325 MG THERAFLU SEVERE COLD ORAL PACKET 20-10-500 Formulary OTC MG THERAFLU SEVERE COLD/CGH NIGHT ORAL Formulary OTC PACKET 25-10-650 MG 137 Drug Name Formulary Status Requirements/Limits THERAFLU WARMING RELIEF SINUS ORAL LIQUID Formulary OTC 12.5-5-325 MG/15ML THERA-GESIC EXTERNAL CREAM 0.5-15 % Formulary OTC THERANATAL COMPLETE ORAL 27-1 & 300 MG Formulary OTC THERANATAL OVAVITE ORAL THERAPY PACK 18- Formulary OTC 1 & 125 MG THERAPLEX T EXTERNAL SHAMPOO 1 % Formulary OTC THERASEAL HAND PROTECTION EXTERNAL Formulary OTC LOTION 1 % THERATEARS NUTRITION ORAL CAPSULE Formulary OTC THERATEARS OPHTHALMIC GEL 1 % Formulary OTC THERATEARS OPHTHALMIC SOLUTION 0.25 % Formulary OTC thermometer covers Formulary OTC thiamine oral capsule 50 mg Formulary OTC THINLETS GP LANCETS Formulary OTC; QL (150 EA per 30 days) thioridazine hcl oral tablet 10 mg, 100 mg, 25 mg, 50 mg Formulary AGE (Min 18 Years) thiotepa injection solution reconstituted 15 mg Formulary thiothixene oral capsule 1 mg, 10 mg, 2 mg, 5 mg Formulary AGE (Min 18 Years) thrivite 19 oral tablet 29-1 mg Formulary THYROLAR-1 ORAL TABLET 60 MG Formulary THYROLAR-1/2 ORAL TABLET 30 MG Formulary THYROLAR-1/4 ORAL TABLET 15 MG Formulary THYROLAR-2 ORAL TABLET 120 MG Formulary THYROLAR-3 ORAL TABLET 180 MG Formulary tiagabine hcl oral tablet 12 mg, 16 mg, 2 mg, 4 mg Formulary TIELLE PAD 7"X7" Formulary OTC TIGER BALM EXTRA STRENGTH EXTERNAL Formulary OTC OINTMENT 11-10 % TIGER BALM LINIMENT EXTERNAL LIQUID 16-28 % Formulary OTC TIGER BALM MUSCLE RUB EXTERNAL CREAM 3-5- Formulary OTC 15 % TIGER BALM NECK & SHOULDER RUB EXTERNAL Formulary OTC CREAM 10-11 % TIGER BALM PAIN RELIEVING EXTERNAL PATCH Formulary OTC 80-24-16 MG TIGER BALM PAIN RELIEVING LG EXTERNAL Formulary OTC PATCH 70-230 MG TIGER BALM RED EXTRA STRENGTH EXTERNAL Formulary OTC OINTMENT TIGER BALM REGULAR STRENGTH EXTERNAL Formulary OTC OINTMENT 11-8 % TIGER BALM ULTRA STRENGTH EXTERNAL Formulary OTC OINTMENT TILIA FE ORAL TABLET 1-20/1-30/1-35 MG-MCG Formulary QL (28 EA per 28 days) timolol maleate ophthalmic gel forming solution 0.25 %, 0.5 Formulary % timolol maleate ophthalmic solution 0.25 %, 0.5 % Formulary

138 Drug Name Formulary Status Requirements/Limits timolol maleate oral tablet 10 mg, 20 mg, 5 mg Formulary TINACTIN EXTERNAL AEROSOL 1 % Formulary OTC TINACTIN EXTERNAL AEROSOL POWDER 1 % Formulary OTC TINACTIN JOCK ITCH EXTERNAL CREAM 1 % Formulary OTC TITRALAC ORAL TABLET CHEWABLE 420 MG Formulary OTC TIVICAY ORAL TABLET 10 MG, 25 MG, 50 MG Formulary tizanidine hcl oral capsule 2 mg, 4 mg, 6 mg Formulary tizanidine hcl oral tablet 2 mg, 4 mg Formulary TN DICKINSONS WITCH HAZEL EXTERNAL PAD Formulary OTC ST; QL (224 EA per 28 days); AGE (Min TOBI PODHALER INHALATION CAPSULE 28 MG Formulary 6 Years) TOBRADEX OPHTHALMIC OINTMENT 0.3-0.1 % Formulary tobramycin ophthalmic solution 0.3 % Formulary tobramycin-dexamethasone ophthalmic suspension 0.3-0.1 Formulary % TODAY SPONGE VAGINAL 1000 MG Formulary OTC todays health thin lancets 28g Formulary OTC; QL (150 EA per 30 days) todays health thin lancets 30g Formulary OTC; QL (150 EA per 30 days) tolazamide oral tablet 250 mg, 500 mg Formulary tolbutamide oral tablet 500 mg Formulary tolmetin sodium oral capsule 400 mg Formulary tolnaftate external powder 1 % Formulary OTC tolnaftate external solution 1 % Formulary OTC tolterodine tartrate er oral capsule extended release 24 Formulary QL (30 EA per 30 days) hour 2 mg, 4 mg tolterodine tartrate oral tablet 1 mg, 2 mg Formulary QL (60 EA per 30 days) toomey syringe 70 ml Formulary topcare lancets micro-thin 33g Formulary OTC; QL (150 EA per 30 days) topcare ultra comfort ins syr 29g x 1/2" 0.3 ml 29g x 1/2" Formulary OTC 0.3 ml topcare ultra comfort ins syr 29g x 1/2" 0.5 ml 29g x 1/2" Formulary OTC 0.5 ml topcare ultra comfort ins syr 29g x 1/2" 1 ml 29g x 1/2" 1 Formulary OTC ml topcare ultra comfort ins syr 30g x 5/16" 0.3 ml 30g x 5/16" Formulary OTC 0.3 ml topcare ultra comfort ins syr 30g x 5/16" 0.5 ml 30g x 5/16" Formulary OTC 0.5 ml topcare ultra comfort ins syr 30g x 5/16" 1 ml 30g x 5/16" 1 Formulary OTC ml topcare ultra comfort ins syr 31g x 5/16" 0.3 ml 31g x 5/16" Formulary OTC 0.3 ml topcare ultra comfort ins syr 31g x 5/16" 0.5 ml 31g x 5/16" Formulary OTC 0.5 ml topcare ultra comfort ins syr 31g x 5/16" 1 ml 31g x 5/16" 1 Formulary OTC ml TOPICAINE 5 EXTERNAL GEL 5 % Formulary OTC

139 Drug Name Formulary Status Requirements/Limits topiramate oral capsule sprinkle 15 mg, 25 mg Formulary topiramate oral tablet 100 mg, 200 mg, 25 mg, 50 mg Formulary topotecan hcl intravenous solution 4 mg/4ml Formulary topotecan hcl intravenous solution reconstituted 4 mg Formulary torsemide oral tablet 10 mg, 100 mg, 20 mg, 5 mg Formulary TOVIAZ ORAL TABLET EXTENDED RELEASE 24 Formulary HOUR 4 MG, 8 MG TRACLEER ORAL TABLET 125 MG, 62.5 MG Formulary PA TRACLEER ORAL TABLET SOLUBLE 32 MG Formulary PA TRADJENTA ORAL TABLET 5 MG Formulary ST; AGE (Min 18 Years) tramadol hcl er (biphasic) oral tablet extended release 24 Formulary PA; QL (34 EA per 34 days) hour 100 mg, 200 mg tramadol hcl er oral tablet extended release 24 hour 100 Formulary PA; QL (34 EA per 34 days) mg, 200 mg, 300 mg tramadol hcl oral tablet 50 mg Formulary PA; QL (126 EA per 7 days) tramadol-acetaminophen oral tablet 37.5-325 mg Formulary PA trandolapril oral tablet 1 mg, 2 mg, 4 mg Formulary tranexamic acid oral tablet 650 mg Formulary QL (30 EA per 30 days) TRANQUILITY BRIEFS KIT Formulary OTC TRANSANOSIL EXTERNAL LOTION 0.025-10-30 % Formulary OTC transderm-iq external ointment 4-0.0375-10-20 % Formulary OTC sulfate oral tablet 10 mg Formulary TRANZAREL EXTERNAL GEL 4 % Formulary travel sickness oral tablet chewable 25 mg Formulary OTC travoprost (bak free) ophthalmic solution 0.004 % Formulary trazodone hcl oral tablet 100 mg, 150 mg, 300 mg, 50 mg Formulary TREANDA INTRAVENOUS SOLUTION Formulary RECONSTITUTED 100 MG, 25 MG T-RELIEF PAIN ARNICA + 12 EXTERNAL OINTMENT Formulary OTC T-RELIEF PAIN ARNICA + 12 ORAL LIQUID Formulary OTC T-RELIEF PAIN RELIEF COMBINATION THERAPY Formulary OTC PACK TAB & CREA T-RELIEF PAIN RELIEF EXTERNAL CREAM Formulary OTC TRELSTAR MIXJECT INTRAMUSCULAR SUSPENSION RECONSTITUTED 11.25 MG, 22.5 MG, Formulary PA 3.75 MG treprostinil sodium injection solution 1 mg/ml, 10 mg/ml, Formulary PA 2.5 mg/ml, 5 mg/ml tretinoin external cream 0.025 %, 0.05 %, 0.1 % Formulary AGE (Max 18 Years) tretinoin external gel 0.01 %, 0.025 % Formulary AGE (Max 18 Years) tretinoin oral capsule 10 mg Formulary TREXALL ORAL TABLET 10 MG, 15 MG, 5 MG, 7.5 Formulary MG triacting nightime cold&cough oral liquid 6.25-2.5 mg/5ml Formulary OTC triamcinolone acetonide aerosol 55 mcg/act nasal (otc) 55 Formulary mcg/act

140 Drug Name Formulary Status Requirements/Limits triamcinolone acetonide external cream 0.025 %, 0.1 %, 0.5 Formulary % triamcinolone acetonide external lotion 0.025 %, 0.1 % Formulary triamcinolone acetonide external ointment 0.025 %, 0.05 %, Formulary 0.1 %, 0.5 % triamcinolone acetonide injection suspension 40 mg/ml Formulary TRIAMINIC CHEST/NASAL CONGEST ORAL LIQUID Formulary OTC 2.5-50 MG/5ML TRIAMINIC COLD & ALLERGY ORAL SYRUP 1-2.5 Formulary OTC MG/5ML TRIAMINIC COLD/COUGH DAY TIME ORAL SYRUP Formulary OTC 2.5-5 MG/5ML TRIAMINIC COLD/COUGH ORAL 2.5-5 &2.5-6.25 Formulary OTC MG/5ML TRIAMINIC COUGH/RUNNY NOSE ORAL TABLET Formulary OTC CHEWABLE 1-5 MG TRIAMINIC COUGH/SORE THROAT ORAL TABLET Formulary OTC CHEWABLE 160-5 MG TRIAMINIC FEVER REDUCER ORAL SYRUP 160 Formulary OTC MG/5ML TRIAMINIC FLU COUGH & FEVER ORAL SYRUP 7.5- Formulary OTC 160-1 MG/5ML TRIAMINIC FLU/COUGH/FEVER ORAL LIQUID 7.5- Formulary OTC 160-1 MG/5ML TRIAMINIC LONG ACTING COUGH ORAL LIQUID Formulary OTC 7.5 MG/5ML TRIAMINIC LONG ACTING COUGH ORAL STRIP 7.5 Formulary OTC MG TRIAMINIC NIGHT TIME COLD/CGH ORAL SYRUP Formulary OTC 6.25-2.5 MG/5ML TRIAMINIC SORE THROAT MOUTH/THROAT Formulary OTC SOLUTION 0.5 % triamino oral tablet Formulary OTC triamterene-hctz oral capsule 37.5-25 mg Formulary triamterene-hctz oral tablet 37.5-25 mg, 75-50 mg Formulary triazolam oral tablet 0.125 mg, 0.25 mg Formulary QL (34 EA per 34 days) tri-buffered aspirin oral tablet 325 mg Formulary OTC tricitrates oral solution 550-500-334 mg/5ml Formulary trifluoperazine hcl oral tablet 1 mg, 10 mg, 2 mg, 5 mg Formulary AGE (Min 18 Years) trifluridine ophthalmic solution 1 % Formulary trigels-f forte oral capsule 460-60-0.01-1 mg Formulary trihexyphenidyl hcl oral elixir 0.4 mg/ml Formulary trihexyphenidyl hcl oral tablet 2 mg, 5 mg Formulary TRI-LO-SPRINTEC ORAL TABLET 0.18/0.215/0.25 MG- Formulary 25 MCG trimethobenzamide hcl oral capsule 300 mg Formulary trimethoprim oral tablet 100 mg Formulary trimipramine maleate oral capsule 100 mg, 25 mg, 50 mg Formulary

141 Drug Name Formulary Status Requirements/Limits TRINATE ORAL TABLET Formulary triple antibiotic external ointment 3.5-400-5000 Formulary OTC TRIPLE FLEX ORAL TABLET 750-400-375 MG Formulary OTC triple helix collagen external powder Formulary OTC TRIPLE PASTE EXTERNAL OINTMENT 12.8 % Formulary OTC triprolidine hcl oral liquid 0.313 mg/ml, 0.625 mg/ml Formulary OTC TRISENOX INTRAVENOUS SOLUTION 12 MG/6ML Formulary TRISPEC PSE PEDIATRIC ORAL LIQUID 30-10-187 Formulary OTC MG/5ML TRIUMEQ ORAL TABLET 600-50-300 MG Formulary TRI-VI-SOL ORAL SOLUTION 750-400-35 UNIT- Formulary OTC MG/ML tri-vitamin/fluoride oral solution 0.5 mg/ml Formulary TROCAINE THROAT MOUTH/THROAT LOZENGE 10 Formulary OTC MG TROCAL COUGH SUPPRESSANT MOUTH/THROAT Formulary OTC LOZENGE 7.5 MG trochibase s flakes Formulary OTC TROGARZO INTRAVENOUS SOLUTION 200 Formulary PA MG/1.33ML TROMBONEX-D ORAL CAPSULE Formulary OTC trospium chloride oral tablet 20 mg Formulary TRUEPLUS GLUCOSE ORAL GEL Formulary OTC TRUEPLUS GLUCOSE ORAL TABLET CHEWABLE Formulary OTC TRUEPLUS INSULIN SYRINGE 28G X 1/2" 0.5 ML 28G Formulary OTC X 1/2" 0.5 ML TRUEPLUS INSULIN SYRINGE 28G X 1/2" 1 ML 28G Formulary OTC X 1/2" 1 ML TRUEPLUS INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G Formulary OTC X 1/2" 0.3 ML TRUEPLUS INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G Formulary OTC X 1/2" 0.5 ML TRUEPLUS INSULIN SYRINGE 29G X 1/2" 1 ML 29G Formulary OTC X 1/2" 1 ML TRUEPLUS INSULIN SYRINGE 30G X 5/16" 0.3 ML Formulary OTC 30G X 5/16" 0.3 ML TRUEPLUS INSULIN SYRINGE 30G X 5/16" 0.5 ML Formulary OTC 30G X 5/16" 0.5 ML TRUEPLUS INSULIN SYRINGE 30G X 5/16" 1 ML 30G Formulary OTC X 5/16" 1 ML TRUEPLUS INSULIN SYRINGE 31G X 5/16" 0.3 ML Formulary OTC 31G X 5/16" 0.3 ML TRUEPLUS INSULIN SYRINGE 31G X 5/16" 0.5 ML Formulary OTC 31G X 5/16" 0.5 ML TRUEPLUS INSULIN SYRINGE 31G X 5/16" 1 ML 31G Formulary OTC X 5/16" 1 ML TRUEPLUS LANCETS 26G Formulary OTC; QL (150 EA per 30 days) TRUEPLUS LANCETS 28G Formulary OTC; QL (150 EA per 30 days)

142 Drug Name Formulary Status Requirements/Limits TRUEPLUS LANCETS 30G Formulary OTC; QL (150 EA per 30 days) TRUEPLUS LANCETS 33G Formulary OTC; QL (150 EA per 30 days) TRULICITY SUBCUTANEOUS SOLUTION PEN- INJECTOR 0.75 MG/0.5ML, 1.5 MG/0.5ML, 3 Formulary MG/0.5ML, 4.5 MG/0.5ML TRUSTEX NON-LUBRICATED Formulary OTC TRUSTEX RIA NON-LUBRICATED Formulary OTC trymine cg oral liquid 225-7.5 mg/5ml Formulary OTC E-X 750 ORAL TABLET CHEWABLE 750 MG Formulary OTC TUMS LASTING EFFECTS ORAL TABLET Formulary OTC CHEWABLE 500 MG TUMS ULTRA 1000 ORAL TABLET CHEWABLE 1000 Formulary OTC MG tuohy epidural needle tw 14g x 3" , 17g x 3-1/2" , 20g x 3- Formulary OTC 1/2" TUSICOF ORAL TABLET 10-20-400 MG Formulary OTC TUSNEL C ORAL SYRUP 30-10-100 MG/5ML Formulary OTC TUSNEL PEDIATRIC ORAL LIQUID 15-5-50 MG/5ML, Formulary OTC; AGE (Min 6 Years) 7.5-50 MG/ML TUSNEL-DM PEDIATRIC ORAL LIQUID 7.5-2.5-25 Formulary OTC MG/ML tussin cf cough & cold oral liquid 5-10-100 mg/5ml Formulary OTC tussin cf max multi-symptom oral liquid 5-10-200 mg/5ml Formulary OTC tussin cough dm oral syrup 100-10 mg/5ml Formulary OTC tussin cough long-acting oral syrup 15 mg/5ml Formulary OTC tussin cough oral capsule 15 mg Formulary OTC tussin cough oral syrup 15 mg/5ml Formulary OTC tussin dm max oral liquid 10-200 mg/5ml Formulary OTC tussin oral syrup 100 mg/5ml Formulary OTC TUSSI-PRES ORAL LIQUID 5-10-200 MG/5ML Formulary OTC TUSSI-PRES PE PEDIATRIC ORAL LIQUID 2.5-100 Formulary OTC MG/5ML TUSSI-PRES PEDIATRIC ORAL LIQUID 2.5-5-75 Formulary OTC MG/5ML TUSSLIN PEDIATRIC ORAL LIQUID 2.5-7.5-88 Formulary OTC MG/ML TWINRIX INTRAMUSCULAR SUSPENSION 720-20 Formulary AGE (Min 19 Years) TYLENOL 8 HOUR ORAL TABLET EXTENDED Formulary OTC RELEASE 650 MG TYLENOL CHILDRENS CLD+CGH ORAL Formulary OTC SUSPENSION 5-160-1 MG/5ML TYLENOL CHILDRENS PLUS MS COLD ORAL Formulary OTC SUSPENSION 2.5-1-5-160 MG/5ML TYLENOL COLD & HEAD ORAL TABLET 5-325-200 Formulary OTC MG TYLENOL COLD MAX ORAL LIQUID 10-5-325 Formulary OTC MG/15ML

143 Drug Name Formulary Status Requirements/Limits TYLENOL COLD MULTI-SYMPTOM ORAL LIQUID 5- Formulary OTC 6.25-10-325 MG/15ML TYLENOL COLD/FLU SEVERE ORAL TABLET 5-10- Formulary OTC 200-325 MG TYLENOL COLD/FLU SEVERE ORAL TABLET Formulary OTC THERAPY PACK TYLENOL EXTRA STRENGTH ORAL TABLET 500 Formulary OTC MG TYLENOL INFANTS ORAL SUSPENSION 160 Formulary OTC MG/5ML TYLENOL ORAL CAPSULE 325 MG Formulary OTC TYLENOL ORAL TABLET 325 MG Formulary OTC TYLENOL PM EXTRA STRENGTH ORAL TABLET Formulary OTC 500-25 MG TYLENOL SINUS SEVERE ORAL TABLET 5-325-200 Formulary OTC MG TYLENOL WARMING COUGH/CONGEST ORAL Formulary OTC LIQUID 5-10-200-325 MG/15ML TYPHIM VI INTRAMUSCULAR SOLUTION 25 Formulary AGE (Min 19 Years) MCG/0.5ML tyrosine oral packet 1000 mg Formulary OTC TYVASO REFILL INHALATION SOLUTION 0.6 Formulary PA MG/ML UBRELVY ORAL TABLET 100 MG, 50 MG Formulary ST ULCEREASE MOUTH/THROAT LIQUID 0.6 % Formulary OTC ULCEREASE MOUTH/THROAT SOLUTION 0.6-1.5 % Formulary OTC ULTICARE ALCOHOL SWABS PAD Formulary OTC ULTICARE ALCOHOL SWABS PAD 70 % 70 % Formulary OTC ULTICARE INSULIN SAFETY SYR 29G X 1/2" 0.5 ML Formulary 29G X 1/2" 0.5 ML ULTICARE INSULIN SAFETY SYR 29G X 1/2" 1 ML Formulary 29G X 1/2" 1 ML ULTICARE INSULIN SYRINGE 28G X 1/2" 0.5 ML 28G Formulary OTC X 1/2" 0.5 ML ULTICARE INSULIN SYRINGE 28G X 1/2" 1 ML 28G X Formulary OTC 1/2" 1 ML ULTICARE INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G Formulary OTC X 1/2" 0.3 ML ULTICARE INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G Formulary OTC X 1/2" 0.5 ML ULTICARE INSULIN SYRINGE 29G X 1/2" 1 ML 29G X Formulary OTC 1/2" 1 ML ULTICARE INSULIN SYRINGE 30G X 1/2" 0.3 ML 30G Formulary OTC X 1/2" 0.3 ML ULTICARE INSULIN SYRINGE 30G X 1/2" 0.5 ML 30G Formulary OTC X 1/2" 0.5 ML ULTICARE INSULIN SYRINGE 30G X 1/2" 1 ML 30G X Formulary OTC 1/2" 1 ML ULTICARE INSULIN SYRINGE 30G X 5/16" 0.3 ML Formulary OTC 30G X 5/16" 0.3 ML 144 Drug Name Formulary Status Requirements/Limits ULTICARE INSULIN SYRINGE 30G X 5/16" 0.5 ML Formulary OTC 30G X 5/16" 0.5 ML ULTICARE INSULIN SYRINGE 30G X 5/16" 1 ML 30G Formulary OTC X 5/16" 1 ML ULTICARE INSULIN SYRINGE 31G X 1/4" 0.3 ML 31G Formulary OTC X 1/4" 0.3 ML ULTICARE INSULIN SYRINGE 31G X 1/4" 0.5 ML 31G Formulary OTC X 1/4" 0.5 ML ULTICARE INSULIN SYRINGE 31G X 1/4" 1 ML 31G X Formulary OTC 1/4" 1 ML ULTICARE INSULIN SYRINGE 31G X 5/16" 0.3 ML Formulary OTC 31G X 5/16" 0.3 ML ULTICARE INSULIN SYRINGE 31G X 5/16" 0.5 ML Formulary OTC 31G X 5/16" 0.5 ML ULTICARE INSULIN SYRINGE 31G X 5/16" 1 ML 31G Formulary OTC X 5/16" 1 ML ULTICARE SYRINGE 22G X 1-1/2" 3 ML Formulary OTC ULTICARE TUBERCULIN SAFETY SYR 25G X 1" 1 Formulary OTC ML, 25G X 5/8" 1 ML ultilet alcohol swabs pad Formulary OTC ULTILET CLASSIC LANCETS Formulary OTC; QL (150 EA per 30 days) ULTILET INSULIN SYRINGE 30G X 1/2" 0.5 ML 30G X Formulary OTC 1/2" 0.5 ML ULTILET INSULIN SYRINGE 30G X 1/2" 1 ML 30G X Formulary OTC 1/2" 1 ML ULTILET INSULIN SYRINGE 30G X 5/16" 0.3 ML 30G Formulary OTC X 5/16" 0.3 ML ULTILET INSULIN SYRINGE 30G X 5/16" 0.5 ML 30G Formulary OTC X 5/16" 0.5 ML ULTILET INSULIN SYRINGE 30G X 5/16" 1 ML 30G X Formulary OTC 5/16" 1 ML ULTILET INSULIN SYRINGE 31G X 1/4" 0.3 ML 31G X Formulary OTC 1/4" 0.3 ML ULTILET INSULIN SYRINGE 31G X 1/4" 1 ML 31G X Formulary OTC 1/4" 1 ML ULTILET INSULIN SYRINGE 31G X 15/64" 0.3 ML Formulary (OTC) 31G X 15/64" 0.3 ML ULTILET INSULIN SYRINGE 31G X 15/64" 0.3 ML Formulary (RX) 31G X 15/64" 0.3 ML ULTILET INSULIN SYRINGE 31G X 15/64" 0.5 ML 31G Formulary OTC X 15/64" 0.5 ML ULTILET INSULIN SYRINGE 31G X 5/16" 0.3 ML 31G Formulary OTC X 5/16" 0.3 ML ULTILET INSULIN SYRINGE 31G X 5/16" 1 ML 31G X Formulary OTC 5/16" 1 ML ULTILET INSULIN SYRINGE SHORT 30G X 1/2" 0.3 Formulary OTC ML 30G X 1/2" 0.3 ML ULTILET INSULIN SYRINGE SHORT 30G X 5/16" 0.3 Formulary OTC ML 30G X 5/16" 0.3 ML

145 Drug Name Formulary Status Requirements/Limits ULTILET INSULIN SYRINGE SHORT 30G X 5/16" 0.5 Formulary OTC ML 30G X 5/16" 0.5 ML ULTILET INSULIN SYRINGE SHORT 30G X 5/16" 1 Formulary OTC ML 30G X 5/16" 1 ML ULTILET INSULIN SYRINGE SHORT 31G X 5/16" 0.3 Formulary OTC ML 31G X 5/16" 0.3 ML ULTILET INSULIN SYRINGE SHORT 31G X 5/16" 0.5 Formulary OTC ML 31G X 5/16" 0.5 ML ULTILET INSULIN SYRINGE SHORT 31G X 5/16" 1 Formulary OTC ML 31G X 5/16" 1 ML ULTILET LANCETS Formulary OTC; QL (150 EA per 30 days) ultra comfort insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" Formulary OTC 0.3 ml ULTRA FRESH OPHTHALMIC SOLUTION 0.5 % Formulary OTC ULTRA FRESH PM OPHTHALMIC OINTMENT Formulary OTC ULTRA MEGA GOLD ORAL TABLET EXTENDED Formulary OTC RELEASE ULTRA MIDE 25 EXTERNAL LOTION 25 % Formulary OTC ULTRABAG/DIANEAL PD-2/4.25%DEX Formulary INTRAPERITONEAL SOLUTION 485 MOSM/L ultracin external lotion 0.025-10-28 % Formulary OTC ULTRACIN M EXTERNAL GEL 5 % Formulary OTC ULTRACIN T EXTERNAL LOTION 10 % Formulary OTC ULTRACIN-M EXTERNAL GEL 10 % Formulary OTC ultra-comfort insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" Formulary OTC 0.5 ml ultra-comfort insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 Formulary OTC ml ultra-comfort insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" Formulary OTC 0.3 ml ultra-comfort insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" Formulary OTC 0.5 ml ultra-comfort insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 Formulary OTC ml ultra-comfort insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" Formulary OTC 0.3 ml ultra-comfort insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" Formulary OTC 0.5 ml ultra-comfort insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 Formulary OTC ml ultra-comfort insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" Formulary OTC 0.3 ml ultra-comfort insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" Formulary OTC 0.5 ml ultra-comfort insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 Formulary OTC ml ultrasone external cream Formulary OTC ULTRA-THIN II INS SYR SHORT 30G X 5/16" 0.3 ML Formulary OTC 30G X 5/16" 0.3 ML

146 Drug Name Formulary Status Requirements/Limits ULTRA-THIN II INS SYR SHORT 30G X 5/16" 0.5 ML Formulary OTC 30G X 5/16" 0.5 ML ULTRA-THIN II INS SYR SHORT 30G X 5/16" 1 ML Formulary OTC 30G X 5/16" 1 ML ULTRA-THIN II INS SYR SHORT 31G X 5/16" 0.3 ML Formulary OTC 31G X 5/16" 0.3 ML ULTRA-THIN II INS SYR SHORT 31G X 5/16" 0.5 ML Formulary OTC 31G X 5/16" 0.5 ML ULTRA-THIN II INS SYR SHORT 31G X 5/16" 1 ML Formulary OTC 31G X 5/16" 1 ML ULTRA-THIN II INSULIN SYRINGE 29G X 1/2" 0.3 ML Formulary OTC 29G X 1/2" 0.3 ML ULTRA-THIN II INSULIN SYRINGE 29G X 1/2" 0.5 ML Formulary OTC 29G X 1/2" 0.5 ML ULTRA-THIN II INSULIN SYRINGE 29G X 1/2" 1 ML Formulary OTC 29G X 1/2" 1 ML ULTRA-THIN II LANCETS Formulary OTC; QL (150 EA per 30 days) UMCKA ELDERBERRY COLD+FLU ORAL SYRUP Formulary OTC UMCKA FASTACTIVES COLD+FLU ORAL PACKET Formulary OTC UMECTA MOUSSE EXTERNAL FOAM 40 % Formulary UNDELENIC EXTERNAL TINCTURE Formulary OTC unibase external cream Formulary OTC UNILET COMFORTOUCH LANCET Formulary OTC; QL (150 EA per 30 days) UNILET EXCELITE Formulary OTC; QL (150 EA per 30 days) UNILET EXCELITE II Formulary OTC; QL (150 EA per 30 days) UNILET G.P. LANCET Formulary OTC; QL (150 EA per 30 days) UNILET G.P. SUPERLITE LANCET Formulary OTC; QL (150 EA per 30 days) UNILET GP 28 ULTRA THIN Formulary OTC; QL (150 EA per 30 days) UNILET LANCET Formulary OTC; QL (150 EA per 30 days) UNILET MICRO-THIN 33G Formulary OTC; QL (150 EA per 30 days) UNILET SUPERLITE LANCET Formulary OTC; QL (150 EA per 30 days) UNILET SUPER-THIN 30G Formulary OTC; QL (150 EA per 30 days) UNILET ULTRA-THIN 28G Formulary OTC; QL (150 EA per 30 days) UNI-SOLVE EXTERNAL PAD Formulary OTC UNIVERSAL 1 LANCETS THIN 26G Formulary OTC; QL (150 EA per 30 days) UNIVERSAL 1 LANCETS THIN 33G Formulary OTC; QL (150 EA per 30 days) UNIVERSAL 1 LANCETS ULTRA THIN Formulary OTC; QL (150 EA per 30 days) universal ph in vitro strip Formulary OTC urea 20 intensive hydrating external cream 20 % Formulary OTC urea external cream 40 %, 45 %, 50 % Formulary urea external lotion 40 % Formulary urea hydrating external foam 35 % Formulary urea nail external gel 45 % Formulary urinary pain relief oral tablet 95 mg Formulary OTC URO-MAG ORAL CAPSULE 140 MG Formulary OTC ursodiol oral capsule 300 mg Formulary 147 Drug Name Formulary Status Requirements/Limits ursodiol oral tablet 250 mg, 500 mg Formulary vagicaine external cream 20-3 % Formulary OTC vagicaine vaginal cream 20-3 % Formulary OTC VAGISIL EXTERNAL CREAM 5-2 % Formulary OTC valacyclovir hcl oral tablet 1 gm, 500 mg Formulary valerian oral capsule 500 mg Formulary OTC valerian root oral capsule 450 mg Formulary OTC valganciclovir hcl oral solution reconstituted 50 mg/ml Formulary valganciclovir hcl oral tablet 450 mg Formulary VALINE 1000 ORAL PACKET 1 GM Formulary OTC valine oral packet 50 mg Formulary OTC valproate sodium intravenous solution 100 mg/ml, 500 Formulary mg/5ml valproate sodium oral solution 250 mg/5ml Formulary valproic acid oral capsule 250 mg Formulary valproic acid oral solution 250 mg/5ml Formulary valsartan oral tablet 160 mg, 320 mg, 40 mg, 80 mg Formulary QL (34 EA per 34 days) valsartan-hydrochlorothiazide oral tablet 160-12.5 mg, Formulary 160-25 mg, 320-12.5 mg, 320-25 mg, 80-12.5 mg VALSTAR INTRAVESICAL SOLUTION 40 MG/ML Formulary VALTOCO 10 MG DOSE NASAL LIQUID 10 MG/0.1ML Formulary PA VALTOCO 15 MG DOSE NASAL LIQUID THERAPY Formulary PA PACK 7.5 MG/0.1ML VALTOCO 20 MG DOSE NASAL LIQUID THERAPY Formulary PA PACK 10 MG/0.1ML VALTOCO 5 MG DOSE NASAL LIQUID 5 MG/0.1ML Formulary PA value health insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 Formulary OTC ml value health insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC value plus lancet standard 21g Formulary OTC; QL (150 EA per 30 days) value plus lancets super thin Formulary OTC; QL (150 EA per 30 days) value plus lancets thin 26g Formulary OTC; QL (150 EA per 30 days) valumark lancet super thin 30g Formulary OTC; QL (150 EA per 30 days) valumark lancet ultra thin 28g Formulary OTC; QL (150 EA per 30 days) VAMOUSSE LICE TREATMENT EXTERNAL FOAM Formulary OTC VANACHOL ORAL CAPSULE Formulary OTC VANACOF AC ORAL LIQUID 12.5-25 MG/30ML Formulary OTC VANACOF DM ORAL LIQUID 10-18-200 MG/15ML Formulary OTC VANACOF ORAL LIQUID 30-1-12.5 MG/5ML Formulary OTC VANACOF-8 ORAL LIQUID 25-50 MG/15ML Formulary OTC vanadium oral capsule 7.5 mg Formulary OTC VANATAB AC ORAL TABLET 12.5-25 MG Formulary OTC VANATAB DM ORAL TABLET 5-9-198 MG Formulary OTC vancomycin hcl in dextrose intravenous solution 1-5 Formulary gm/200ml-%, 500-5 mg/100ml-%, 750-5 mg/150ml-%

148 Drug Name Formulary Status Requirements/Limits vancomycin hcl in dextrose intravenous solution 1-5 Formulary gm/250ml-% vancomycin hcl in nacl intravenous solution 1-0.9 Formulary gm/200ml-%, 500-0.9 mg/100ml-%, 750-0.9 mg/150ml-% vancomycin hcl intravenous solution reconstituted 10 gm, Formulary 1000 mg, 500 mg, 5000 mg, 750 mg vancomycin hcl oral capsule 125 mg, 250 mg Formulary VANDAZOLE VAGINAL GEL 0.75 % Formulary VANICREAM DIAPER RASH EXTERNAL OINTMENT Formulary OTC 1.1-40 % VANIPLY EXTERNAL OINTMENT 1 % Formulary OTC VANISHPOINT SAFETY SYRINGE 25G X 1-1/2" 10 ML, 25G X 1-1/2" 5 ML, 27G X 1-1/2" 10 ML, 27G X 1- Formulary OTC 1/2" 5 ML VANTAS SUBCUTANEOUS KIT 50 MG Formulary PA VAPOR PATCH EXTERNAL PATCH Formulary OTC vaporizing steam inhalation liquid 6.2 % Formulary OTC VAQTA INTRAMUSCULAR SUSPENSION 25 Formulary AGE (Min 19 Years) UNIT/0.5ML, 50 UNIT/ML VARIVAX SUBCUTANEOUS INJECTABLE 1350 Formulary AGE (Min 19 Years) PFU/0.5ML VASHE WOUND THERAPY EXTERNAL SOLUTION Formulary OTC VASOCLEAR-A OPHTHALMIC SOLUTION 0.02-0.25 Formulary OTC % VASOFLEX D1 ORAL TABLET 900-100 MG Formulary OTC VCF VAGINAL CONTRACEPTIVE VAGINAL FILM 28 Formulary OTC % VCF VAGINAL CONTRACEPTIVE VAGINAL FOAM Formulary OTC 12.5 % VCF VAGINAL CONTRACEPTIVE VAGINAL GEL 4 % Formulary OTC VECTIBIX INTRAVENOUS SOLUTION 100 MG/5ML, Formulary 400 MG/20ML VELCADE INJECTION SOLUTION RECONSTITUTED Formulary 3.5 MG venaliv oral tablet 900-100-100 mg Formulary OTC VENIA EXTERNAL PATCH 4-4 % Formulary OTC venlafaxine hcl er oral capsule extended release 24 hour Formulary 150 mg, 37.5 mg, 75 mg venlafaxine hcl er oral tablet extended release 24 hour 150 Formulary ST mg, 37.5 mg, 75 mg venlafaxine hcl oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg, Formulary 75 mg VENTAVIS INHALATION SOLUTION 10 MCG/ML, 20 Formulary MCG/ML VENTOLIN HFA INHALATION AEROSOL SOLUTION Formulary 108 (90 BASE) MCG/ACT verapamil hcl er oral capsule extended release 24 hour 120 Formulary mg, 180 mg, 200 mg, 240 mg, 300 mg, 360 mg

149 Drug Name Formulary Status Requirements/Limits verapamil hcl er oral tablet extended release 120 mg, 180 Formulary mg, 240 mg verapamil hcl intravenous solution 2.5 mg/ml Formulary verapamil hcl oral tablet 120 mg, 40 mg, 80 mg Formulary VERELAN PM ORAL CAPSULE EXTENDED Formulary RELEASE 24 HOUR 200 MG VERQUVO ORAL TABLET 10 MG, 2.5 MG, 5 MG Formulary PA VERSAPLUS ORAL SYRUP Formulary VERSIVA XC PAD 5-1/2"X5-1/2" Formulary OTC VH ESSENTIALS UTI RELIEF ORAL TABLET 97.2 MG Formulary OTC VIBERZI ORAL TABLET 100 MG, 75 MG Formulary PA VIBRAMYCIN ORAL SYRUP 50 MG/5ML Formulary VICKS DAYQUIL MUCUS CONTROL DM ORAL Formulary OTC LIQUID 10-200 MG/15ML VICKS NYQUIL CHILDRENS CLD/CGH ORAL Formulary OTC LIQUID 2-15 MG/15ML VICKS NYQUIL COLD & FLU NIGHT ORAL LIQUID Formulary OTC 15-6.25-325 MG/15ML, 30-650-4 MG/30ML VICKS NYQUIL COUGH ORAL LIQUID 12.5-30 Formulary OTC MG/30ML VICKS NYQUIL SEVERE COLD & FLU ORAL Formulary OTC TABLET 5-6.25-10-325 MG VICKS SINEX DAYQUIL/NYQUIL ORAL Formulary OTC VICKS SINEX DAYTIME ORAL CAPSULE 5-325 MG Formulary OTC VICKS SINEX NIGHTTIME ORAL CAPSULE 6.25-5- Formulary OTC 325 MG VICKS VAPO STEAM INHALATION LIQUID 6.2 % Formulary OTC VICKS VAPODROPS MOUTH/THROAT LOZENGE 1.7 Formulary OTC MG, 3.3 MG VICKS VAPOINHALER INHALATION INHALER Formulary OTC VICKS VAPOPADS PEDIATRIC PAD Formulary OTC VICKS VAPORIZER SCENT PAD Formulary OTC VICKS VAPORUB EXTERNAL OINTMENT 4.73-1.2-2.6 Formulary OTC % VICODIN ES ORAL TABLET 7.5-300 MG Formulary PA; QL (84 EA per 7 days) VICODIN HP ORAL TABLET 10-300 MG Formulary PA; QL (63 EA per 7 days) VICODIN ORAL TABLET 5-300 MG Formulary PA; QL (126 EA per 7 days) VICTOZA SUBCUTANEOUS SOLUTION PEN- Formulary INJECTOR 18 MG/3ML VIDA MIA UNILET LANCETS 28G Formulary OTC; QL (150 EA per 30 days) VIDEX ORAL SOLUTION RECONSTITUTED 2 GM, 4 Formulary GM vigabatrin oral packet 500 mg Formulary PA vigabatrin oral tablet 500 mg Formulary PA VIIBRYD ORAL TABLET 10 MG Formulary PA; QL (68 EA per 34 days) VIIBRYD ORAL TABLET 20 MG, 40 MG Formulary PA; QL (34 EA per 34 days) VIMPAT INTRAVENOUS SOLUTION 200 MG/20ML Formulary

150 Drug Name Formulary Status Requirements/Limits VIMPAT ORAL SOLUTION 10 MG/ML Formulary VIMPAT ORAL TABLET 100 MG, 150 MG, 200 MG, 50 Formulary MG VINATE II ORAL TABLET 29-1 MG Formulary VINATE M ORAL TABLET 27-1 MG Formulary vinblastine sulfate intravenous solution 1 mg/ml Formulary VINCASAR PFS INTRAVENOUS SOLUTION 1 MG/ML Formulary VINCE DENTAL POWDER Formulary OTC vinorelbine tartrate intravenous solution 10 mg/ml, 50 Formulary mg/5ml VIRACEPT ORAL TABLET 250 MG, 625 MG Formulary virtussin dac oral solution 30-10-100 mg/5ml Formulary OTC VISI-FLOW IRRIGATION STARTER KIT Formulary OTC vita-c oral crystals Formulary OTC VITA-CALCIUM ORAL WAFER 333-133 MG-UNIT Formulary OTC VITADYE EXTERNAL LOTION 5 % Formulary OTC VITAFOL ULTRA ORAL CAPSULE 29-0.6-0.4-200 MG Formulary VITALINE BIOTIN FORTE/ZINC ORAL TABLET 0.8 Formulary OTC MG VITALINE COQ10 ORAL TABLET 200 MG, 60 MG Formulary OTC VITA-MAG ORAL TABLET 133-5-10 MG Formulary OTC VITAMAX ORAL TABLET CHEWABLE 60 MG Formulary OTC VITAMELTS ENERGY VITAMIN B-12 ORAL TABLET Formulary OTC DISPERSIBLE 1500 MCG vitamin a & d oral capsule 5000-400 unit Formulary OTC vitamin a & d oral tablet 10000-400 unit Formulary OTC VITAMIN A FISH ORAL CAPSULE 7500 UNIT Formulary OTC vitamin a oral capsule 10000 unit, 8000 unit Formulary OTC vitamin a palmitate oral tablet 10000 unit, 15000 unit Formulary OTC vitamin a wrinkle treatment external gel Formulary OTC vitamin a-beta carotene oral tablet 10000-1000 unit, Formulary OTC 15000-10000 unit vitamin b complex-c oral capsule Formulary OTC vitamin b-1 oral tablet 50 mg Formulary OTC vitamin b-12 oral liquid 1000 mcg/15ml Formulary OTC vitamin b-12 oral lozenge 50 mcg, 500 mcg Formulary OTC vitamin b-12 oral tablet 100 mcg, 1000 mcg, 500 mcg Formulary OTC vitamin b12 sublingual liquid 3000 mcg/ml Formulary OTC vitamin b-12 sublingual tablet sublingual 500 mcg Formulary OTC vitamin b-2 oral tablet 25 mg, 50 mg Formulary OTC vitamin b-6 er oral tablet extended release 200 mg Formulary OTC vitamin b-6 oral tablet 100 mg Formulary OTC vitamin c (calcium ascorbate) oral solution reconstituted Formulary OTC vitamin c drops mouth/throat lozenge 60 mg Formulary OTC vitamin c er oral capsule extended release 500 mg Formulary OTC

151 Drug Name Formulary Status Requirements/Limits vitamin c gummies oral tablet chewable 125 mg Formulary OTC vitamin c oral liquid , 500 mg/5ml Formulary OTC vitamin c oral powder Formulary OTC vitamin c oral tablet 100 mg, 250 mg Formulary OTC vitamin c oral tablet chewable Formulary OTC vitamin c plus wild rose hips oral tablet chewable 500 mg Formulary OTC vitamin c-rose hips er oral tablet extended release 1000 mg, Formulary OTC 500 mg vitamin d2 oral tablet 50 mcg (2000 ut) Formulary OTC vitamin d3 oral capsule 1.25 mg (50000 ut), 125 mcg (5000 Formulary OTC ut), 250 mcg (10000 ut), 50 mcg (2000 ut) vitamin d3 oral liquid 5000 unit/ml Formulary OTC vitamin d3 oral tablet 1.25 mg (50000 ut) Formulary OTC vitamin d3 oral tablet chewable 10 mcg (400 unit), 25 mcg Formulary OTC (1000 ut), 50 mcg (2000 ut) vitamin d-400 oral tablet 10 mcg (400 unit) Formulary OTC VITAMIN E & C BEAUTY LOTION EXTERNAL Formulary OTC LOTION VITAMIN E & K BEAUTIFUL SKIN EXTERNAL OIL Formulary OTC vitamin e beauty external oil 24000 unit/52ml Formulary OTC vitamin e external cream Formulary OTC vitamin e external liquid 24000 unit Formulary OTC vitamin e oral capsule 100 unit Formulary OTC vitamin e oral tablet 400 unit Formulary OTC vitamin e/selenium oral capsule 400-50 unit-mcg Formulary OTC vitamins acd-fluoride oral solution 0.25 mg/ml Formulary VITAMINS E & A BEAUTY OIL EXTERNAL OIL 1000- Formulary OTC 14000 UNIT/52ML VITAMINS E & D BEAUTY OIL EXTERNAL OIL 400- Formulary OTC 14000 UNIT/52ML VITA-RAY EXTERNAL CREAM 10-200000-3000 Formulary OTC VITONIC ORAL LIQUID Formulary OTC VIVA DROPS OPHTHALMIC SOLUTION 1 % Formulary OTC viva external patch 2.5-4-2 % Formulary OTC VIVABEN ORAL CAPSULE Formulary OTC VIVITROL INTRAMUSCULAR SUSPENSION Formulary RECONSTITUTED 380 MG VIVOTIF ORAL CAPSULE DELAYED RELEASE Formulary AGE (Min 19 Years) vocabria oral tablet 30 mg Formulary voriconazole oral suspension reconstituted 40 mg/ml Formulary PA voriconazole oral tablet 200 mg, 50 mg Formulary PA vp insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC VYVANSE ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 QL (30 EA per 30 days); AGE (Min 4 Formulary MG, 50 MG, 60 MG, 70 MG Years and Max 17 Years) VYVANSE ORAL TABLET CHEWABLE 10 MG, 20 Formulary AGE (Min 4 Years and Max 17 Years) MG, 30 MG, 40 MG, 50 MG, 60 MG

152 Drug Name Formulary Status Requirements/Limits WAL-DRYL ANTI-ITCH EXTERNAL LIQUID 2-0.1 % Formulary OTC WAL-DRYL EXTERNAL CREAM 2-0.1 % Formulary OTC WAL-DRYL PE ALLERGY & SINUS ORAL TABLET Formulary OTC 25-10 MG WAL-FEX D ALLERGY & CONGESTION ORAL Formulary OTC TABLET EXTENDED RELEASE 24 HOUR 180-240 MG WAL-FLU COLD & SORE THROAT ORAL PACKET Formulary OTC 20-10-325 MG WAL-FLU SEV COLD/CGH DAY/NIGHT ORAL Formulary OTC PACKET WALGREENS LANCETS Formulary OTC; QL (150 EA per 30 days) walgreens lancets micro thin Formulary OTC; QL (150 EA per 30 days) walgreens lancets super thin Formulary OTC; QL (150 EA per 30 days) WALGREENS THIN LANCETS Formulary OTC; QL (150 EA per 30 days) WALGREENS ULTRA THIN LANCETS Formulary OTC; QL (150 EA per 30 days) WAL-ITIN D ORAL TABLET EXTENDED RELEASE 12 Formulary OTC HOUR 5-120 MG WAL-MUCIL PLUS CALCIUM ORAL CAPSULE Formulary OTC WAL-PHED PE DAYTIME/NIGHTTIME ORAL Formulary OTC WAL-SLEEP Z LIQUID SHOTS ORAL LIQUID 50 Formulary OTC MG/50ML WAL-SLEEP Z ORAL TABLET DISPERSIBLE 25 MG Formulary OTC wal-tap cold/allergy oral liquid 2-5 mg/10ml Formulary OTC WAL-TUSSIN CF MAX ORAL LIQUID 5-10-200-325 Formulary OTC MG/10ML wal-tussin cf oral liquid 30-10-100 mg/5ml Formulary OTC wal-tussin cough relief oral tablet chewable 7.5 mg Formulary OTC WAL-ZYR CHILDRENS ORAL TABLET CHEWABLE Formulary OTC 10 MG, 5 MG WAL-ZYR ORAL CAPSULE 10 MG Formulary OTC warfarin sodium oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 Formulary mg, 4 mg, 5 mg, 6 mg, 7.5 mg wart remover maximum strength external gel 17 % Formulary OTC wart remover maximum strength external liquid 17 % Formulary OTC water tabs oral tablet Formulary OTC wax for braces wax Formulary OTC WEBCOL ALCOHOL PREP LARGE PAD 70 % 70 % Formulary OTC WEBCOL ALCOHOL PREP MEDIUM PAD 70 % 70 % Formulary OTC wee care oral suspension 15 mg/1.25ml Formulary OTC wegmans complete prenatal+dha oral 28-0.975 & 200 mg Formulary OTC WEISS EPIDURAL NEEDLE 20G X 2" Formulary OTC WEISS EPIDURAL NEEDLE TW 17G X 5" , 18G X 3- Formulary OTC 1/2" , 18G X 5" WELLMIND MENTAL FOCUS ORAL TABLET Formulary OTC CHEWABLE WHITE PED ARTERIAL NEEDLE 19G X 1-1/2" , 20G X Formulary OTC 1-1/2"

153 Drug Name Formulary Status Requirements/Limits white petrolatum external ointment Formulary white petroleum jelly external gel Formulary OTC WIDE-SEAL DIAPHRAGM 60 VAGINAL DIAPHRAGM Formulary 2 % WIDE-SEAL DIAPHRAGM 65 VAGINAL DIAPHRAGM Formulary 2 % WIDE-SEAL DIAPHRAGM 70 VAGINAL DIAPHRAGM Formulary 2 % WIDE-SEAL DIAPHRAGM 75 VAGINAL DIAPHRAGM Formulary 2 % WIDE-SEAL DIAPHRAGM 80 VAGINAL DIAPHRAGM Formulary 2 % WIDE-SEAL DIAPHRAGM 85 VAGINAL DIAPHRAGM Formulary 2 % WIDE-SEAL DIAPHRAGM 90 VAGINAL DIAPHRAGM Formulary 2 % WIDE-SEAL DIAPHRAGM 95 VAGINAL DIAPHRAGM Formulary 2 % WINGS MATERNITY PANTS 2X-3X Formulary OTC WINRHO SDF INJECTION SOLUTION 1500 UNIT/1.3ML, 15000 UNIT/13ML, 2500 UNIT/2.2ML, Formulary 5000 UNIT/4.4ML witch hazel external liquid Formulary OTC witch hazel external solution 86 % Formulary OTC WIXELA INHUB INHALATION AEROSOL POWDER BREATH ACTIVATED 100-50 MCG/DOSE, 250-50 Formulary MCG/DOSE, 500-50 MCG/DOSE wound gel external gel Formulary OTC wound gel spray external gel Formulary OTC WYMZYA FE ORAL TABLET CHEWABLE 0.4-35 MG- Formulary QL (28 EA per 28 days) MCG XARELTO ORAL TABLET 10 MG, 15 MG, 2.5 MG, 20 Formulary MG XARELTO STARTER PACK ORAL TABLET THERAPY Formulary PACK 15 & 20 MG XEOMIN INTRAMUSCULAR SOLUTION Formulary PA RECONSTITUTED 100 UNIT, 200 UNIT, 50 UNIT XERAC AC EXTERNAL SOLUTION 6.25 % Formulary XEROFORM PETROLAT GAUZE 1"X8" EXTERNAL Formulary XGEVA SUBCUTANEOUS SOLUTION 120 MG/1.7ML Formulary XIAFLEX INJECTION SOLUTION RECONSTITUTED Formulary PA 0.9 MG XIFAXAN ORAL TABLET 200 MG, 550 MG Formulary PA XIGDUO XR ORAL TABLET EXTENDED RELEASE 24 HOUR 10-1000 MG, 10-500 MG, 2.5-1000 MG, 5-1000 Formulary ST; AGE (Min 18 Years) MG, 5-500 MG XOFLUZA (40 MG DOSE) ORAL TABLET THERAPY Formulary QL (2 EA per 180 days) PACK 2 X 20 MG XOFLUZA (80 MG DOSE) ORAL TABLET THERAPY Formulary QL (2 EA per 180 days) PACK 2 X 40 MG 154 Drug Name Formulary Status Requirements/Limits XOLAIR SUBCUTANEOUS SOLUTION PREFILLED Formulary PA; QL (2 EA per 28 days) SYRINGE 150 MG/ML, 75 MG/0.5ML XOLAIR SUBCUTANEOUS SOLUTION Formulary PA; QL (2 EA per 30 days) RECONSTITUTED 150 MG xolido external cream 2 % Formulary OTC X-SEB T PEARL EXTERNAL SHAMPOO 10 % Formulary OTC XTRA-CARE EXTERNAL LOTION Formulary OTC XULANE TRANSDERMAL PATCH WEEKLY 150-35 Formulary MCG/24HR XYREM ORAL SOLUTION 500 MG/ML Formulary PA; QL (540 ML per 30 days) YES FOR WOMEN EXTERNAL GEL Formulary OTC YF-VAX SUBCUTANEOUS INJECTABLE Formulary AGE (Min 19 Years) YUVAFEM VAGINAL TABLET 10 MCG Formulary ZADITOR OPHTHALMIC SOLUTION 0.025 % Formulary OTC ZAFEMY TRANSDERMAL PATCH WEEKLY 150-35 Formulary MCG/24HR zafirlukast oral tablet 10 mg, 20 mg Formulary zaleplon oral capsule 10 mg Formulary QL (68 EA per 34 days) zaleplon oral capsule 5 mg Formulary QL (34 EA per 34 days) ZANOSAR INTRAVENOUS SOLUTION Formulary RECONSTITUTED 1 GM ZANTAC 150 MAXIMUM STRENGTH ORAL TABLET Formulary OTC 150 MG ZANTAC 75 ORAL TABLET 75 MG Formulary OTC Z-BUM EXTERNAL CREAM 22.5 % Formulary OTC ZEASORB EXTERNAL POWDER Formulary OTC ZEGERID OTC CAPSULE 20-1100 MG ORAL 20-1100 Formulary OTC; QL (34 EA per 34 days) MG ZELBORAF ORAL TABLET 240 MG Formulary ZENATANE ORAL CAPSULE 10 MG, 20 MG, 30 MG, Formulary 40 MG ZENPEP ORAL CAPSULE DELAYED RELEASE PARTICLES 10000-32000 UNIT, 15000-47000 UNIT, Formulary PA 20000-63000 UNIT, 25000-79000 UNIT, 3000-10000 UNIT, 40000-126000 UNIT, 5000-24000 UNIT ZEPHREX-D ORAL TABLET ABUSE-DETERRENT 30 Formulary OTC MG ZE-PLUS ORAL CAPSULE Formulary OTC ZERIT ORAL SOLUTION RECONSTITUTED 1 MG/ML Formulary ZEVALIN Y-90 INTRAVENOUS KIT 3.2 MG/2ML Formulary ZICAM ALLERGY RELIEF NASAL GEL Formulary OTC ZICAM COLD REMEDY ORAL TABLET DISPERSIBLE Formulary OTC zidovudine oral capsule 100 mg Formulary zidovudine oral syrup 50 mg/5ml Formulary zidovudine oral tablet 300 mg Formulary ZIKS ARTHRITIS PAIN RELIEF EXTERNAL CREAM Formulary OTC 0.025-1-12 %

155 Drug Name Formulary Status Requirements/Limits ZILACTIN MOUTH/THROAT GEL 10 % Formulary OTC ZILACTIN-B MOUTH/THROAT GEL 10 % Formulary OTC ZIMS CRACK CREME DIABETIC EXTERNAL LIQUID Formulary OTC ZIMS MAX-FREEZE EXTERNAL GEL 3.7 % Formulary OTC zinc + vitamin c mouth/throat lozenge 20-120 mg Formulary OTC ZINC 15 ORAL TABLET 66 MG Formulary OTC zinc aspartate oral tablet 40 mg Formulary OTC zinc gluconate oral tablet 15 mg, 50 mg Formulary OTC zinc methionate oral capsule 50 mg Formulary OTC zinc mouth/throat lozenge 10 mg Formulary OTC zinc oral tablet 100 mg, 30 mg Formulary OTC zinc oxide external ointment 20 % Formulary OTC zinc oxide external paste 25 % Formulary OTC zinc sulfate oral tablet 220 (50 zn) mg Formulary OTC zinc-c-b6 mouth/throat lozenge 12-60-0.5 mg, 15-60-5 mg Formulary OTC zincolate oral capsule 10-20 mg Formulary OTC ZINC-OXYDE PLUS EXTERNAL OINTMENT 0.44-20 Formulary OTC % zinc-vitamin c oral tablet dispersible 15-60 mg Formulary OTC ziprasidone hcl oral capsule 20 mg, 40 mg, 60 mg, 80 mg Formulary AGE (Min 18 Years) ZITHROMAX ORAL PACKET 1 GM Formulary QL (8 EA per 34 days) zn-50 oral capsule 50 mg Formulary OTC ZOLADEX SUBCUTANEOUS IMPLANT 10.8 MG Formulary PA; QL (1 EA per 90 days) ZOLADEX SUBCUTANEOUS IMPLANT 3.6 MG Formulary PA zoledronic acid intravenous concentrate 4 mg/5ml Formulary PA zoledronic acid intravenous solution 4 mg/100ml, 5 Formulary PA mg/100ml ZOLINZA ORAL CAPSULE 100 MG Formulary PA zolmitriptan nasal solution 2.5 mg Formulary ST zolmitriptan nasal solution 5 mg Formulary ST; QL (36 EA per 3 days) zolmitriptan oral tablet 2.5 mg, 5 mg Formulary ST; QL (6 EA per 34 days) zolmitriptan oral tablet dispersible 2.5 mg, 5 mg Formulary ST; QL (6 EA per 34 days) zolpidem tartrate er oral tablet extended release 12.5 mg, Formulary QL (30 EA per 30 days) 6.25 mg zolpidem tartrate oral tablet 10 mg, 5 mg Formulary ZOMIG NASAL SOLUTION 2.5 MG Formulary ST ZOMIG NASAL SOLUTION 5 MG Formulary ST; QL (36 EA per 34 days) zonisamide oral capsule 100 mg, 25 mg, 50 mg Formulary ZOSTAVAX SUBCUTANEOUS SUSPENSION Formulary AGE (Min 19 Years) RECONSTITUTED 19400 UNT/0.65ML ZOSTRIX HOT & COLD THERAPY EXTERNAL KIT Formulary OTC 0.025 & 4 % ZOSTRIX HP EXTERNAL CREAM 0.1 % Formulary OTC ZOSTRIX NATURAL PAIN RELIEF EXTERNAL Formulary OTC CREAM 0.033 %

156 Drug Name Formulary Status Requirements/Limits ZOSTRIX-HP EXTERNAL STICK 0.075 % Formulary OTC ZOVIRAX EXTERNAL CREAM 5 % Formulary QL (5 GM per 34 days) Z-TUSS AC ORAL LIQUID 2-9 MG/5ML Formulary OTC ZYCLARA EXTERNAL CREAM 3.75 % Formulary ZYCLARA PUMP EXTERNAL CREAM 3.75 % Formulary ZYLET OPHTHALMIC SUSPENSION 0.5-0.3 % Formulary ZYNCOF ORAL SYRUP 20-400 MG/5ML Formulary OTC ZYRTEC ALLERGY ORAL CAPSULE 10 MG Formulary OTC ZYRTEC ALLERGY ORAL TABLET 10 MG Formulary OTC ZYRTEC ALLERGY ORAL TABLET DISPERSIBLE 10 Formulary OTC MG ZYRTEC-D ALLERGY & CONGESTION ORAL Formulary OTC TABLET EXTENDED RELEASE 12 HOUR 5-120 MG ZZZQUIL ORAL LIQUID 50 MG/30ML Formulary OTC

157 158 Index 1st relief spray...... 1 acidophilus/bifidus...... 2 ADVIL COLD & SINUS LIQUI- 1st tier unifine pentips...... 1 acidophilus/citrus pectin...... 2 GELS...... 4 1st tier unilet comfortouch...... 1 acidophilus/pectin...... 2 ADVIL COLD/SINUS...... 4 4-N-1...... 1 acitretin...... 2 ADVIL PM...... 4 50+ adult eye health...... 1 acne maximum strength...... 2 ADVIL SINUS CONGESTION & A & D ZINC OXIDE...... 1 acne medication 10...... 3 PAIN...... 4 a thru z advanced...... 1 acne medication 5...... 3 ADVOCATE INSULIN SYRINGE...... 4 a thru z advantage...... 1 acne treatment...... 3 AEROCHAMBER MINI CHAMBER.... 4 a thru z select...... 1 ACNEFREE ACNE CLEARING AFLURIA...... 5 A+D CRACKED SKIN RELIEF...... 1 SYSTEM...... 3 AFLURIA PRESERVATIVE FREE...... 5 a1c test at-home...... 1 ACNEFREE SEVERE CLEARING AFLURIA QUADRIVALENT...... 5 a-25...... 1 SYST...... 3 AFREZZA...... 5 abacavir sulfate...... 1 ACT TOTAL CARE...... 3 AFRIN CHILDRENS...... 5 abacavir sulfate-lamivudine...... 1 ACTHIB...... 3 AFRIN MENTHOL SPRAY...... 5 abacavir-lamivudine-zidovudine...... 1 ACTICARNITINE SF...... 3 AFTERA...... 5 ABANATUSS PED...... 1 ACTICON...... 3 AGAMATRIX ULTRA-THIN ABATRACE...... 1 actidom dmx...... 3 LANCETS...... 5 ABATREX...... 1 ACTIDOSE WITH SORBITOL...... 3 AHIST...... 5 ABATRON...... 1 actidose-aqua...... 3 aimsco lubricated...... 5 ABATRON AF...... 1 ACTIFLOVIT EAR HEALTH...... 3 AIRAVITE...... 5 ABATUSS DMX...... 1 ACTIFOAM COLLAGEN SPONGE...... 3 AIRBORNE...... 5 ABILIFY MAINTENA...... 1 acti-lance lite lancets 28g...... 3 AIRS DISPOSABLE NEBULIZER...... 5 ABILIFY MYCITE...... 1 acti-lance special lancets 17g...... 3 AIRZONE PEAK FLOW METER...... 5 abiraterone acetate...... 1 acti-lance universal 23g...... 3 AJOVY...... 5 ABRAXANE...... 1 ACTIMARIS WOUND...... 3 ak-poly-bac...... 5 ABREVA...... 2 ACTIMMUNE...... 3 AL12...... 5 acamprosate calcium...... 2 ACTINEL...... 3 ALA SEB...... 5 acarbose...... 2 ACTISEP...... 3 ALA SEB T...... 5 ACCU-CHEK FASTCLIX LANCET...... 2 ACTITROM...... 3 ALAHIST DM...... 5 ACCU-CHEK SOFT TOUCH ACTIVE Q...... 3 ALA-HIST IR...... 5 LANCETS...... 2 ACTIVE Q MAXIMUM STRENGTH....3 ALA-HIST PE...... 5 ACCU-CHEK SOFTCLIX LANCETS....2 ACTIVE-Q...... 3 alanine 1000...... 5 ACCUTANE...... 2 ACTIVE-Q EXTRA STRENGTH...... 3 alba-lybe nr...... 5 ACCUTREND CHOLESTEROL...... 2 ACTIVITE EC...... 3 albendazole...... 5 ACCUTREND CHOLESTEROL ACTIVON ARTHRITIS ULTRA ST...... 3 ALBOLENE...... 5 CONTROL...... 2 acyclovir...... 3 ALBUKED 25...... 5 ACCUTREND PLUS...... 2 ADACEL...... 3 ALBUKED 5...... 5 ACE AEROSOL CLOUD ADAGEN...... 4 albumin human...... 5 ENHANCER...... 2 adapalene...... 4 albumin-zlb...... 5 ACE KNEE BRACE adefovir dipivoxil...... 4 alburx...... 5 W/STABILIZERS...... 2 adhesive bandages sheer...... 4 ALBUTEIN...... 5 acebutolol hcl...... 2 adjustable lancing device...... 4 albuterol sulfate...... 5, 6 ACEROLA C 500...... 2 ADMELOG...... 4 albuterol sulfate er...... 5 ACETA-GESIC...... 2 ADMELOG SOLOSTAR...... 4 albuterol sulfate hfa...... 5 acetaminophen...... 2 ADRENAL C FORMULA...... 4 alcohol (rubbing)...... 6 acetaminophen extra strength...... 2 ADRENALIN...... 4 alcohol prep...... 6 acetaminophen junior strength...... 2 ADRUCIL...... 4 alcohol swabs...... 6 acetaminophen rapid tabs child...... 2 ADULT ACNOMEL...... 4 alcohol wipes...... 6 acetaminophen-codeine...... 2 adult gummy...... 4 alendronate sodium...... 6 acetaminophen-codeine #2...... 2 adult mask...... 4 aler-cap...... 6 acetaminophen-codeine #3...... 2 adult wash cloths with aloe...... 4 aler-dryl...... 6 acetaminophen-codeine #4...... 2 adult-lock weekly pill remind...... 4 alertness aid...... 6 ACETASOL HC...... 2 advanced acne wash...... 4 alevazol...... 6 acetazolamide...... 2 ADVANCED ALEVE...... 6 acetazolamide er...... 2 CALCIUM/D/MAGNESIUM...... 4 ALFERON N...... 6 acetic acid...... 2 advanced hand sanitizer...... 4 alfuzosin hcl er...... 6 acetylcysteine...... 2 advanced lubricant...... 4 alga...... 6 ACID GONE...... 2 ADVIL...... 4 ALGAL-900 DHA...... 6 acid reducer maximum strength...... 2 ADVIL ALLERGY & CONGESTION... 4 ALIMTA...... 6 acidophilus...... 2 ADVIL ALLERGY SINUS...... 4 ALIVE MULTI-VITAMIN acidophilus probiotic...... 2 CHILDRENS...... 6

159 ALIVIO...... 6 ambi 12.5cpd/100gfn/30pse...... 8 ANTISEPTIC HAND RINSE...... 10 alka-aid...... 6 ambi 12.5cpd/1dcpm/30pse...... 8 antiseptic pain relief...... 10 ALKA-SELTZER...... 6 ambi 40pse/400gfn...... 8 antiseptic skin cleanser...... 10 ALKA-SELTZER HEARTBURN + ambi 60pse/400gfn...... 8 antiseptic wound/skin cleanser...... 10 GAS...... 6 ambi 60pse/4cpm...... 8 AO-SEPT CONTACT LENS ALKA-SELTZER PLUS DAY/NIGHT.. 6 AMBI FADE...... 8 HOLDER...... 10 all day allergy childrens...... 6 ambrisentan...... 8 APETIGEN...... 10 all day pain relief...... 6 amcinonide...... 8 APETIGEN-PLUS...... 10 ALLEGRA ALLERGY...... 6 AMERICERIN...... 8 ap-hist dm...... 10 ALLEGRA ALLERGY CHILDRENS.... 6 AMERIGEL WOUND DRESSING...... 8 APLICARE POVIDONE-IODINE...... 10 ALLEGRA-D ALLERGY & AMERIWASH...... 8 APLIGRAF...... 10 CONGESTION...... 6 AMETHIA...... 8 apothesar...... 10 aller-ease...... 6 AMETHIA LO...... 8 apraclonidine hcl...... 10 allergy childrens...... 6 AMETHYST...... 8 aprepitant...... 10 allergy eye...... 6 amiloride hcl...... 8 APRI...... 10 allergy multi-symptom day/nght...... 6 amiloride-hydrochlorothiazide...... 8 APTIVUS...... 10 allergy multi-symptom night...... 7 aminoacetic acid...... 8 AQUA CARE...... 10 allergy relief...... 7 aminocaproic acid...... 8 aquabase...... 10 allergy relief childrens...... 7 AMINORELIEFRMS...... 8 AQUADEKS...... 10 allergy spray 24 hour...... 7 amiodarone hcl...... 8 AQUAFRESH DR SEUSS EXTRA allevess...... 7 amitriptyline hcl...... 8 SOFT...... 10 ALLEVYN PLUS CAVITY...... 7 amlodipine besy-benazepril hcl...... 8 aquanaz...... 10 ALLI...... 7 amlodipine besylate...... 8 AQUAPHILIC...... 10 allopurinol...... 7 amlodipine besylate-valsartan...... 8 AQUAPHILIC/CARBAMIDE...... 10 ALMACONE...... 7 amlodipine-atorvastatin...... 8 AQUASONIC 100...... 10 ALOCANE PLUS...... 7 amlodipine-olmesartan...... 9 AQUEOUS SELENIUM...... 10 ALOE GRANDE...... 7 amlodipine-valsartan-hctz...... 9 aqueous vitamin e...... 11 aloe vera...... 7 ammonia aromatic...... 9 AQUORAL...... 11 aloe vera moisturizing...... 7 ammonium lactate...... 9 ARANELLE...... 11 ALOE VESTA 2-N-1 PROTECTIVE..... 7 AMNESTEEM...... 9 ARCALYST...... 11 ALOE VESTA CLEAR amoxicillin...... 9 ARCAPTA NEOHALER...... 11 ANTIFUNGAL...... 7 amoxicillin-pot clavulanate...... 9 arctic relief pain relieving...... 11 ALOE VESTA MULTI PURPOSE...... 7 amphetamine-dextroamphet er...... 9 arformoterol tartrate...... 11 ALOE VESTA PROTECTIVE...... 7 amphetamine-dextroamphetamine...... 9 ARGIMENT AT...... 11 ALOE VESTA SKIN PROTECTANT.... 7 ampicillin...... 9 arginine...... 11 aloe/lidocaine pain reliever...... 7 ANA-LEX...... 9 arginine2000...... 11 alosetron hcl...... 7 ANASEPT...... 9 ARGYLE STERILE SALINE...... 11 alp high3...... 7 ANASEPT ANTIMICROBIAL...... 9 ARGYLE STERILE WATER...... 11 ALPAWASH...... 7 anastrozole...... 9 aripiprazole...... 11 ALPHAGAN P...... 7 ANBESOL...... 9 ARISTADA...... 11 alpha-lipoic acid...... 7 ANBESOL COLD SORE THERAPY.....9 ARISTADA INITIO...... 11 ALPHANATE/VWF ANBESOL MAXIMUM STRENGTH....9 arkaliox...... 11 COMPLEX/HUMAN...... 7 ANECREAM...... 9 ARMOUR THYROID...... 11 ALPHANINE SD...... 7 animal chews...... 9 arnica...... 11 alph-e...... 7 ANORO ELLIPTA...... 9 arnicare...... 11 alph-e-mixed...... 7 antacid...... 9 arnicare arthritis...... 11 alph-e-mixed 1000...... 7 antacid anti-gas...... 9 ARRANON...... 11 alprazolam...... 7, 8 antacid anti-gas max strength...... 9 arthritis pain relieving...... 11 alprazolam er...... 7 antacid extra strength...... 9 artificial tears...... 11 ALPRAZOLAM INTENSOL...... 7 antacid multi-symptom...... 9 ARZERRA...... 11 ALTACAINE...... 8 antacid soft chews...... 9 ARZOL SILVER NIT ALTAFLUOR...... 8 ANTARA...... 10 APPLICATORS...... 11 altarussin-pe...... 8 anthelios 50 mineral...... 10 asafetida...... 11 ALTAVERA...... 8 anti-allergy...... 10 ascocid-iso-ph...... 11 aluminum acetate...... 8 antibacterial liquid soap...... 10 ASCOMP-CODEINE...... 11 aluminum bottle seal...... 8 anti-diarrheal...... 10 ascorbic acid...... 11 aluminum hydroxide gel...... 8 antifungal...... 10 ASCRIPTIN...... 11 ALWAYS MAXI MAXIMUM anti-fungal...... 10 asepto oral thermometer...... 11 PROTECTION...... 8 anti-itch...... 10 ASMANEX (120 METERED DOSES).12 alyacen 1/35...... 8 ANTI-ITCH INTENSIVE HEALING... 10 ASMANEX (30 METERED DOSES)...12 alyacen 7/7/7...... 8 anti-oxidant...... 10 aspartate mg & k...... 12 ALYQ...... 8 antioxidant formula sg...... 10 ASPERCREME W/LIDOCAINE...... 12 amantadine hcl...... 8 antiseptic...... 10 aspirin...... 12 160 aspirin 81...... 12 b complex...... 14 BD HYPODERMIC NEEDLE...... 15 aspirin-dipyridamole er...... 12 b complex formula 1...... 14 BD INSULIN SYR ULTRAFINE II...... 15 aspirtab maximum strength...... 12 b complex-folic acid...... 14 BD INSULIN SYRINGE...... 15, 16 ASSURE ID INSULIN SAFETY SYR..12 b-1...... 14 BD INSULIN SYRINGE HALF-UNIT.16 ASSURE LANCETS...... 12 b-100 cr...... 14 BD INSULIN SYRINGE ASTHMANEFRIN REFILL...... 12 b-12...... 14 MICROFINE...... 16 ASTHMAPACK FOR CHILDREN...... 12 b-12 tr...... 14 BD INSULIN SYRINGE U/F...... 16 ATABEX OB...... 12 b-2...... 14 BD INSULIN SYRINGE U/F 1/2UNIT 16 atazanavir sulfate...... 12 B-2-400...... 14 BD INSULIN SYRINGE U-500...... 16 atenolol...... 12 b-6...... 14 BD INSULIN SYRINGE atenolol-chlorthalidone...... 12 BABY ANBESOL...... 14 ULTRAFINE...... 16 athletes foot maximum strength...... 12 BABY DDROPS...... 14 BD LANCET ULTRAFINE 30G...... 16 atomoxetine hcl...... 12 baby diaper rash...... 14 BD LANCET ULTRAFINE 33G...... 16 ATOPICLAIR...... 12 baby lotion...... 14 BD LUER-LOK SYRINGE...... 17 atorvastatin calcium...... 12 baby super daily d3...... 14 BD PEN NEEDLE ORIGINAL U/F...... 17 atovaquone...... 12 baby teething pain medicine...... 14 BD SAFETYGLIDE INSULIN atovaquone-proguanil hcl...... 12 baby thermometer...... 14 SYRINGE...... 17 ATRAC-TAIN...... 12 baciim...... 14 BD SAFETYGLIDE NEEDLE...... 17 ATROVENT HFA...... 12 bacitracin...... 14 BD SAFETYGLIDE SHIELDED atuss da...... 12 bacitracin zinc...... 14 NEEDLE...... 17 AUBRA...... 12 bacitra-neomycin-polymyxin-hc...... 14 BD SAFETYGLIDE auraphene-b...... 12 back pain-off...... 14 SYRINGE/NEEDLE...... 17 aurora lancet super thin 30g...... 12 baclofen...... 14 BD SAFETY-LOK INSULIN aurora lancet thin 23g...... 13 BACTROBAN NASAL...... 14 SYRINGE...... 17 AUROVELA FE 1.5/30...... 13 balamine dm...... 14 BD SHARPS COLLECTOR...... 17 AUTOJECT 2...... 13 balanced b-50...... 14 BD SWAB SINGLE USE REGULAR.. 17 AUTOLET PLATFORMS...... 13 balanced b-50 complex...... 14 BD SWABS SINGLE USE autopen...... 13 BAL-CARE DHA...... 14 BUTTERFLY...... 17 avalin...... 13 BALNEOL...... 14 BD SYRINGE...... 17 AVAR CLEANSER...... 13 balsalazide disodium...... 14 BD SYRINGE LUER-LOK...... 17 AVAR-E EMOLLIENT...... 13 BALZIVA...... 14 BD SYRINGE SLIP TIP...... 17 AVASTIN...... 13 BAND-AID GAUZE SMALL...... 14 BD SYRINGE/NEEDLE SLIP TIP...... 17 AVEENO BABY GENTLE BAND-AID SURGIPAD SURGICAL.. 14 BD TB SYRINGE...... 17 CONDITION...... 13 BANOPHEN...... 14 BD VEO INSULIN SYR U/F 1/2UNIT.17 AVEENO BABY SOOTHING WASH. 13 BAQSIMI ONE PACK...... 14 BD VEO INSULIN SYRINGE U/F...... 17 AVEENO CREAMY BAQSIMI TWO PACK...... 14 BEBULIN...... 17 MOISTURIZING...... 13 BARACLUDE...... 14 bec/zinc...... 17 AVEENO INTENSE RELIEF...... 13 BASAGLAR KWIKPEN...... 15 bedding spray lice treatment...... 17 AVEENO POSITIVELY RADIANT BAYER BACK & BODY...... 15 bee pollen...... 17 WASH...... 13 BAYER BREEZE 2 CONTROL...... 15 BEELITH...... 18 AVENOVA/NEUTROX...... 13 BAYER BREEZE 2 SYSTEM...... 15 BELBUCA...... 18 AVERTEAX...... 13 BAYER BREEZE 2 TEST...... 15 belladonna alkaloids-opium...... 18 AVITENE...... 13 BAYER CONTOUR LINK belladonna-opium...... 18 AVITENE FLOUR...... 13 MONITOR...... 15 BENADRYL ALLERGY...... 18 AVO CREAM...... 13 BAYER CONTOUR MONITOR...... 15 BENADRYL ALLERGY AVONEX...... 13 BAYER MICROLET 2 LANCING CHILDRENS...... 18 AVONEX PEN...... 13 DEVIC...... 15 BENADRYL ALLERGY CON AVONEX PREFILLED...... 13 BAYER MICROLET LANCETS...... 15 ULTRATABS...... 18 av-phos 250 neutral...... 13 BAYER WOMENS...... 15 BENADRYL ALLERGY axillary block needle...... 13 BAZA CLEANSE & PROTECT...... 15 ULTRATABS...... 18 AXSAIN...... 13 BC FAST PAIN RELIEF...... 15 BENADRYL ITCH RELIEF...... 18 AYR SALINE NASAL...... 13 BC FAST PAIN RELIEF ARTHRITIS. 15 BENADRYL ITCH STOPPING...... 18 AYR SALINE NASAL DROPS...... 13 b-caro-t...... 15 BENADRYL-D ALLERGY/SINUS AYR SALINE NASAL GEL...... 13 b-complex high potency...... 15 CHILD...... 18 AYR SALINE NASAL NO-DRIP...... 13 BD ALLERGY SYRINGE...... 15 benazepril hcl...... 18 AYR SALINE NASAL RINSE...... 13 BD AUTOSHIELD...... 15 benazepril-hydrochlorothiazide...... 18 azacitidine...... 13 BD AUTOSHIELD DUO...... 15 BENEFIBER...... 18 azathioprine...... 13 BD BLUNT FILTER NEEDLE...... 15 BENEFIBER FOR CHILDREN...... 18 azec...... 13 BD DISP NEEDLE...... 15 BENEFIBER ON THE GO...... 18 azelastine hcl...... 13 BD DISP NEEDLE TW...... 15 BENEFIBER PLUS B VITS & FA...... 18 azithromycin...... 13, 14 BD DISP NEEDLES...... 15 BENEFIBER PLUS CALCIUM...... 18 AZURETTE...... 14 BD ECLIPSE NEEDLE...... 15 BENEFIBER PLUS HEART b complete...... 14 BD ECLIPSE SYRINGE...... 15 HEALTH...... 18 161 benfotiamine multi-b...... 18 BIORX SPONIX ANTI-FUNGAL...... 20 budesonide-formoterol fumarate...... 22 benzalkonium chloride...... 18 BIORX SPONIX ARTHR & MUSC..... 20 BUFFERIN...... 22 BENZEDREX...... 18 biospec dmx...... 20 BUFFERIN EXTRA STRENGTH...... 22 BENZEPRO...... 18 biotalan clear...... 20 BUFFERIN LOW DOSE...... 22 BENZEPRO CREAMY WASH...... 18 BIO-THERM PAIN RELIEVING...... 20 BULL FROG WATER ARMOR BENZEPRO SHORT CONTACT...... 18 biotin...... 20 SPORT...... 22 BENZODENT...... 18 biotin forte...... 20 bumetanide...... 22 benzoin...... 18 biotin plus keratin...... 20 buprenorphine...... 22 benzonatate...... 18 biotuss...... 20 buprenorphine hcl...... 22 BENZ-O-STHETIC...... 18 biovol...... 20 buprenorphine hcl-naloxone hcl...... 22 benzoyl peroxide...... 18 bisacodyl ec...... 20 bupropion hcl...... 22 benzoyl peroxide cleanser...... 18 bismatrol...... 20 bupropion hcl er (smoking det)...... 22 benzoyl peroxide wash...... 18 bismatrol maximum strength...... 20 bupropion hcl er (sr)...... 22 benzoyl peroxide-erythromycin...... 19 bisoprolol fumarate...... 20 bupropion hcl er (xl)...... 22 benzphetamine hcl...... 19 bisoprolol-hydrochlorothiazide...... 20 burn relief...... 22 BENZ-PROTECT...... 19 bite/itch...... 20 burn relief/lidocaine/aloe...... 22 benztropine mesylate...... 19 BI-ZETS/BENZOTROCHES...... 20 buspirone hcl...... 22 BERINERT...... 19 bleomycin sulfate...... 20 busulfan...... 22 BERRI-FREEZ PAIN RELIEVING...... 19 BLINK TEARS...... 20 butalbital-acetaminophen...... 22 BERRI-FREEZ PLUS...... 19 BLISOVI 24 FE...... 20 butalbital-apap-caff-cod...... 22 BETA CARE BETATAR GEL...... 19 BLISOVI FE 1.5/30...... 21 butalbital-apap-caffeine...... 23 beta carotene provitamin a...... 19 BLISOVI FE 1/20...... 21 butalbital-aspirin-caffeine...... 23 BETADINE...... 19 BLISTEX MEDICATED...... 21 butorphanol tartrate...... 23 BETADINE SURGICAL SCRUB...... 19 blood pressure monitor/wrist...... 21 BYDUREON...... 23 BETADINE SWABSTICKS...... 19 BOIL EASE MAXIMUM BYETTA 10 MCG PEN...... 23 betaine hcl...... 19 STRENGTH...... 21 BYETTA 5 MCG PEN...... 23 betamethasone dipropionate...... 19 BONE DENSITY...... 21 c & e...... 23 betamethasone dipropionate aug...... 19 BOOSTRIX...... 21 c-1500/rose hips sr...... 23 betamethasone valerate...... 19 borage...... 21 c1500/rose hips/bioflavonoid...... 23 BETAQUIK...... 19 boric acid...... 21 cabenuva...... 23 BETASERON...... 19 boron...... 21 cabergoline...... 23 betaxolol hcl...... 19 BOTOX...... 21 cadeau dha...... 23 bethanechol chloride...... 19 BOUDREAUXS BABY KISSES...... 21 caffeine citrate...... 23 BETHKIS...... 19 BOUDREAUXS BUTT PASTE...... 21 cal/mag...... 23 BEVESPI AEROSPHERE...... 19 BOUDREAUXS RASH PREVENTOR 21 CALADRYL...... 23 bexarotene...... 19 bp 10-1...... 21 CALADRYL CLEAR...... 23 BIATAIN HEEL ADH FOAM bp cleansing wash...... 21 CALAGEL MAXIMUM STRENGTH..23 DRESSING...... 19 bp wash...... 21 CALAGESIC...... 23 BIATAIN SACRAL FOAM BPROTECTED MULTI-VITE...... 21 calahist clear...... 23 DRESSING...... 19 BPROTECTED PEDIA IRON...... 21 calamine...... 23 bicalutamide...... 19 BPROTECTED PEDIA POLY-VITE....21 calamine phenolated...... 23 BICARSIM...... 19 BRAINSTRONG PRENATAL...... 21 calamine-zinc oxide...... 23 BICARSIM FORTE...... 19 BRASIVOL...... 21 CALAZIME SKIN PROTECTANT...... 23 BICNU...... 19 BRAUN NO TOUCH + FOREHEAD...21 CAL-CARB FORTE...... 23 BIKTARVY...... 20 BREEZE 2 TEST...... 21 CALCET PETITES...... 23 biobron sf...... 20 BREVIBLOC IN NACL...... 21 CALCI-CHEW...... 23 biocotron...... 20 brewers yeast...... 21 calci-max...... 23 biodesp dm...... 20 BRILINTA...... 21 calcipotriene...... 23 bioflavonoid-1000...... 20 brimonidine tartrate...... 21 calcitonin (salmon)...... 23 BIO-FLAX...... 20 brinzolamide...... 21 CALCITRATE...... 23 BIOFLONEX...... 20 BRIVIACT...... 21 cal-citrate...... 23 BIOFREEZE...... 20 brohist d...... 21 calcitriol...... 23 BIOFREEZE ROLL-ON bromi-lotion...... 21 calcium...... 24 COLORLESS...... 20 bromocriptine mesylate...... 21 calcium + d3...... 23 BIOGAIA GASTRUS...... 20 bronchial asthma relief...... 21 calcium 1200...... 23 biogtuss...... 20 BRONKAID...... 21 calcium 500 + d3...... 24 BIOGUARD NON-ADHERENT bronkids...... 22 calcium 600...... 24 DRESSING...... 20 brontuss dx...... 22 calcium 600 + d...... 24 BIOLLE GEL TEARS...... 20 brotapp dm...... 22 calcium 600+d3...... 24 bionatuss dxp...... 20 btrex...... 22 calcium 600+d3 plus minerals...... 24 BIOPATCH PROTECTIVE BUCKLEYS CHEST CONGESTION...22 calcium acetate...... 24 DISK/CHG...... 20 BUCKLEYS COUGH...... 22 calcium acetate (phos binder)...... 24 biopetit...... 20 budesonide...... 22 calcium ascorbate...... 24 162 calcium aspartate...... 24 CARBOHOL 940...... 26 CERALYTE 70...... 28 calcium carbonate...... 24 CARBZERO...... 26 CERAVE BABY...... 28 calcium carbonate antacid...... 24 CARDENZ...... 26 CERAVE ITCH RELIEF...... 28 calcium carbonate-vitamin d...... 24 CAREFINE PEN NEEDLES...... 26 CERAVE SUNSCREEN SPF50...... 28 calcium citrate...... 24 careone insulin syringe...... 26 CEROVEL...... 28 calcium citrate +...... 24 CAREONE LANCET SUPER THIN cesium...... 28 calcium citrate + d3...... 24 30G...... 26 CESIUM 1000...... 28 calcium citrate malate-vit d...... 24 careone lancet thin 23g...... 26 cesium 500...... 28 calcium citrate plus...... 24 CA-REZZ...... 26 CETACAINE...... 28 calcium citrate-vitamin d...... 24 ca-rezz gentle...... 26 CETAPHIL GENTLE CLEANSING.... 28 calcium citrate-vitamin d3...... 24 ca-rezz norisc...... 26 cetirizine hcl...... 28 calcium gluconate...... 24 CARRACOLLOID 4"X4"...... 26 CETRAXAL...... 28 calcium gummies...... 24 CARRASMART...... 26 CHANTIX...... 28 calcium high potency/vitamin d...... 24 CARRASORB H...... 26 CHANTIX CONTINUING MONTH calcium lactate...... 24 CARRASYN V WOUND DRESSING. 26 PAK...... 28 calcium oyster shell...... 24 CARRINGTON DERMAL WOUND....26 CHANTIX STARTING MONTH PAK.28 calcium pantothenate...... 24 carteolol hcl...... 26 CHAP-EX TROPICALS...... 28 calcium plus vitamin d3...... 24 CARTIA XT...... 26 CHAPSTICK MOISTURIZER...... 28 calcium soft chews...... 24 carvedilol...... 26 CHAPSTICK ULTRA RENEWAL...... 28 calcium-magnesium-zinc...... 24 cascara sagrada...... 26 CHAR-FLO WITH SORBITOL...... 28 calcium-vitamin d...... 24 castellani paint modified...... 26 chelated calcium...... 28 calcium-vitamin d3...... 24 CASTIVA COOLING...... 26 chelated magnesium...... 28 calcium-vitamin d-minerals...... 24 CASTIVA WARMING...... 26 chelated zinc...... 28 calendula...... 24 castor oil stimulant laxative...... 26 CHEMSTRIP 10 MD...... 28 cal-glu...... 24 CAVAREST...... 26 CHEMSTRIP 10/SG...... 28 cal-lac...... 25 CAVILON EMOLLIENT...... 26 CHEMSTRIP 2 GP...... 28 calmag thins...... 25 CAVILON FOOT & DRY SKIN...... 26 CHEMSTRIP 5 OB...... 28 cal-mint...... 25 CAVILON NO STING BARRIER CHEMSTRIP 7...... 28 CALMOL-4...... 25 FILM...... 27 CHEMSTRIP 9...... 28 calna...... 25 CAVILON ONE-STEP SKIN CARE.... 27 CHEMSTRIP CALIBRATION...... 28 CALTRATE 600+D...... 25 CAVILON SKIN CLEANSER...... 27 CHEMSTRIP MICRAL...... 28 CALTRATE 600+D PLUS CAYA...... 27 CHEMSTRIP UGK...... 28 MINERALS...... 25 CAZIANT...... 27 CHENODAL...... 28 CALTRATE 600+D3 SOFT...... 25 cefaclor...... 27 CHERACOL-D COUGH...... 28 CALTRATE GUMMY BITES...... 25 cefadroxil...... 27 cherry...... 29 CALTRATE MINIS PLUS cefdinir...... 27 cherry concentrate...... 29 MINERALS...... 25 cefpodoxime proxetil...... 27 chest rub...... 29 CAMILA...... 25 cefprozil...... 27 CHEW Q...... 29 CAMPHO-PHENIQUE...... 25 ceftriaxone sodium...... 27 chewable iron...... 29 CAMPHOTREX...... 25 ceftriaxone sodium in dextrose...... 27 CHIGG AWAY...... 29 candesartan cilexetil...... 25 ceftriaxone sodium-dextrose...... 27 childrens aspirin free...... 29 candesartan cilexetil-hctz...... 25 cefuroxime axetil...... 27 CHILDRENS MOTRIN...... 29 CANKAID...... 25 CELACYN...... 27 childrens pain reliever...... 29 capcof...... 25 celecoxib...... 27 childrens plus multi-sympt cld...... 29 capecitabine...... 25 celery seed...... 27 childrens silfedrine...... 29 capmist dm...... 25 CELONTIN...... 27 CHILDRENS SOOTHE...... 29 capron dm...... 25 CENTRATEX...... 27 chlo hist...... 29 capron dmt...... 25 centravites adults...... 27 CHLO TUSS...... 29 capsaicin...... 25 CENTRUM...... 27 chlophed...... 29 capsaicin hot patch...... 25 CENTRUM FLAVOR BURST CHLORASEPTIC...... 29 CAPSIDERM...... 25 DRINK...... 27 chlordiazepoxide hcl...... 29 capsule 1 clear veggie...... 25 CENTRUM SPECIALIST chlorella...... 29 captopril...... 25 PRENATAL...... 27 chlorhexidine gluconate...... 29 CAPZASIN-HP...... 25 CEO-TWO...... 27 chlorhexidine gluconate cloth...... 29 CARBAGLU...... 25 CEPACOL ANTIBACTERIAL...... 27 chlorophyll...... 29 carbamazepine...... 25 CEPACOL EXTRA STRENGTH...... 27 chloroquine phosphate...... 29 carbamazepine er...... 25 CEPACOL SORE THROAT...... 28 chlorothiazide...... 29 CARBAPHEN CH...... 25 CEPACOL SORE THROAT & CHLORPHEN SR...... 29 CARBAPHEN PED CH...... 26 COUGH...... 27 chlorpromazine hcl...... 29 carbidopa-levodopa...... 26 CEPACOL SORE THROAT EX ST..... 28 chlorthalidone...... 29 carbidopa-levodopa er...... 26 CEPASTAT...... 28 CHLOR-TRIMETON...... 29 carbidopa-levodopa-entacapone...... 26 cephalexin...... 28 CHLOR-TRIMETON ALLERGY...... 29 carbinoxamine maleate...... 26 CERACADE...... 28 chlorzoxazone...... 29 163 chocolated laxative...... 29 CLEARCANAL EAR WAX colesevelam hcl...... 33 cholesterol acetate...... 29 REMOVAL...... 31 colestipol hcl...... 34 cholestyramine...... 29, 30 CLEARLAX...... 31 collodion flexible...... 34 cholestyramine light...... 29 CLEARLIFE ALLERGY RELIEF...... 31 COLOCORT...... 34 choline...... 30 clemastine fumarate...... 31 COMBIGAN...... 34 choline citrate...... 30 CLEOCIN...... 31 COMBIVENT RESPIMAT...... 34 choline sr...... 30 CLERZ PLUS...... 32 COMFORT ASSIST INSULIN choline-mag trisalicylate...... 30 CLEVER CHOICE BP SYRINGE...... 34 CHONDROITIN SULFATE MONITOR/WRIST...... 32 comfort assured lancets 28g...... 34 COMPLEX...... 30 clindamycin hcl...... 32 comfort assured lancets 33g...... 34 CHROMACAPS...... 30 clindamycin palmitate hcl...... 32 COMFORT CLEAN/COMFORT chromium...... 30 clindamycin phos-benzoyl perox...... 32 SHIELD...... 34 chromium aspartate...... 30 clindamycin phosphate...... 32 COMFORT EZ PEN NEEDLES...... 34 chromium gtf...... 30 CLINDESSE...... 32 COMPAT STAY-PUT NJ DOUBLE chromium picolinate...... 30 clobazam...... 32 LUME...... 34 CICLODAN...... 30 clobetasol propionate...... 32 COMPLERA...... 34 ciclopirox...... 30 clobetasol propionate e...... 32 complete lice treatment...... 34 ciclopirox olamine...... 30 clobetasol propionate emulsion...... 32 complete natal dha...... 34 ciclopirox treatment...... 30 clofarabine...... 32 completenate...... 34 cilostazol...... 30 clomipramine hcl...... 32 COMPOUND W MAXIMUM cimetidine...... 30 clonazepam...... 32 STRENGTH...... 34 cinnamon...... 30 clonidine hcl...... 32 COMPOUND W ONE STEP CINRYZE...... 30 clonidine hcl (analgesia)...... 32 INVISIBLE...... 34 CIPRO...... 30 clonidine hcl er...... 32 compoz...... 34 CIPRODEX...... 30 clopidogrel bisulfate...... 32 COMPRO...... 34 ciprofloxacin...... 30 clorazepate dipotassium...... 32 COMTREX COLD & COUGH MAX ciprofloxacin hcl...... 30 clotrimazole...... 32 ST...... 34 ciprofloxacin-dexamethasone...... 30 clotrimazole 3...... 32 COMTREX COLD/COUGH cisplatin...... 30 clotrimazole anti-fungal...... 32 DAY/NITE MS...... 34 citalopram hydrobromide...... 30 clotrimazole-betamethasone...... 32 COMTREX DEEP CHEST COLD...... 34 CITRA PH...... 30 clozapine...... 32, 33 CO-NATAL FA...... 34 CITRANATAL 90 DHA...... 30 co q 10...... 33 CONCEPT DHA...... 35 CITRANATAL ASSURE...... 30 co q-10...... 33 CONCEPT OB...... 35 CITRANATAL B-CALM...... 30 COAGUCHEK XS PLUS SYSTEM..... 33 CONCEPTIONXR MOTILITY CITRANATAL DHA...... 30 COAGUCHEK XS PT TEST...... 33 SUPPORT...... 35 CITRANATAL HARMONY...... 30 COARTEM...... 33 condoms...... 35 CITRANATAL RX...... 31 COATS ALOE...... 33 constulose...... 35 CITRUCEL...... 31 COATS ALOE JUICE DRINK...... 33 CONTAC COLD+FLU MAX ST...... 35 CITRULLINE 1000...... 31 COATS ALOE LINIMENT...... 33 CONTOUR BLOOD GLUCOSE CITRULLINE200...... 31 cocoa butter skin...... 33 SYSTEM...... 35 cladribine...... 31 cod liver oil...... 33 CONTOUR CONTROL...... 35 CLARAVIS...... 31 codeine sulfate...... 33 CONTOUR MONITOR...... 35 clarithromycin...... 31 coditussin ac...... 33 CONTOUR NEXT CONTROL...... 35 clarithromycin er...... 31 coditussin dac...... 33 CONTOUR NEXT EZ...... 35 CLARITIN...... 31 coenzyme q10...... 33 CONTOUR NEXT LINK...... 35 CLARITIN CHILDRENS...... 31 coenzyme q-10...... 33 CONTOUR NEXT MONITOR...... 35 CLARITIN REDITABS...... 31 coenzyme q10-levocarnitine...... 33 CONTOUR NEXT ONE...... 35 CLARITIN-D 12 HOUR...... 31 co-enzyme q10-vitamin e...... 33 CONTOUR NEXT TEST...... 35 CLARITIN-D 24 HOUR...... 31 cola syrup...... 33 CONTOUR TEST...... 35 classic prenatal...... 31 COLACE...... 33 control denture adhesive...... 35 CLEAN & CLEAR ACNE colchicine...... 33 control syringe disposable...... 35 CLEANSER...... 31 colchicine-probenecid...... 33 convex eye protector...... 35 CLEAN & CLEAR ADVANTAGE cold & allergy...... 33 cool n heat ex st...... 35 MARK...... 31 cold & cough childrens...... 33 cool n heat maximum strength...... 35 CLEAN ZING...... 31 cold & cough day/night child...... 33 COPPERMIN...... 35 CLEANLET LANCETS 28G...... 31 cold & flu relief nighttime d...... 33 co-q 10 omega-3 fish oil...... 35 cleansing...... 31 cold multi-symptom nighttime...... 33 coq10...... 35 CLEAR EYES REDNESS RELIEF...... 31 cold remedy...... 33 coq-10...... 35 clear zinc spf 50...... 31 cold sore treatment...... 33 coral calcium...... 35 CLEARASIL DAILY CLEAN...... 31 cold therapy pain relief...... 33 CORICIDIN HBP COLD/FLU...... 35 CLEARASIL DAILY CLEAR...... 31 cold/cough childrens...... 33 CORICIDIN HBP COUGH/COLD...... 35 CLEARASIL DAILY CLEAR ACNE...31 cold/flu relief day/night...... 33 CORICIDIN HBP DAY/NIGHT COLD-EEZE...... 33 COLD...... 35 164 CORICIDIN HBP NIGHTTIME cvs antacid childrens...... 37 cvs laxative dietary supplemnt...... 39 COLD...... 35 cvs antacid supreme...... 37 CVS LICE SOLUTION 3-STEP...... 39 CORIFACT...... 35 cvs anti-diarrheal...... 37 cvs l-lysine...... 39 corn & callus remover...... 36 cvs anti-itch sensitive...... 37 cvs lubricant drops...... 39 corn oil...... 36 cvs astringent solution...... 37 cvs magnesium citrate...... 39 CORN REMOVER WATERPROOF.... 36 cvs b complex plus c...... 37 cvs manuka honey wound...... 39 corn/callus remover...... 36 cvs backache relief...... 37 cvs melatonin...... 39 CORRECTOL EXTRA GENTLE...... 36 cvs beta carotene...... 37 cvs melatonin extra strength...... 39 CORTIC-ND...... 36 cvs calcium...... 37 cvs miconazole 1 combo pack...... 39 CORTIFOAM...... 36 cvs calcium 600 plus...... 37 cvs miconazole 3 combo pack...... 39 cortisone acetate...... 36 cvs cherry menthol drops...... 37 cvs mineral oil...... 39 CORTIZONE-10...... 36 cvs chest rub medicated...... 37 cvs mineral oil enema...... 39 CORTIZONE-10/ALOE...... 36 cvs cleansing eyelid wipes...... 37 cvs mini enema kids...... 39 CORVITA 150...... 36 cvs cleansing skin...... 37 cvs multi-purpose...... 39 COSAMIN ASU FOR JOINT cvs cold & sinus relief...... 37 cvs nasal allergy spray...... 39 HEALTH...... 36 cvs cold remedy...... 37 cvs nasal decongestant...... 39 COSAMIN VERDE FOR JOINT cvs corn/callus remover...... 37 cvs nasal mist...... 39 HEALTH...... 36 cvs cortisone maximum strength...... 37 cvs natural fiber supplement...... 39 COTTONTAILS DIAPER RASH cvs creamy acne face wash...... 37 cvs natural fish oil...... 39 CREAMY...... 36 cvs d3...... 37 cvs nerve pain relief...... 39 cough & chest congestion dm...... 36 cvs dairy relief ex st...... 38 cvs non-drying sinus pe...... 39 cough & cold...... 36 cvs daytime/nighttime cold/flu...... 38 cvs omeprazole...... 39 cough & sore throat nighttime...... 36 cvs daytime/nighttime cough...... 38 cvs oral pain reliever...... 39 cough drops...... 36 cvs diabetes health support...... 38 cvs pain relief...... 39 cough relief...... 36 cvs digestive probiotic...... 38 cvs phosphate saline laxative...... 39 coughtab...... 36 cvs diuretic maximum strength...... 38 cvs pinworm treatment...... 39 cramp tabs...... 36 cvs e oil...... 38 cvs potassium gluconate...... 39 cranberry...... 36 cvs early result pregnancy...... 38 cvs prenatal...... 39 cream base with liposome...... 36 cvs easy fiber/calcium...... 38 cvs prenatal gummy...... 39 creatine...... 36 cvs enema disposable...... 38 cvs prep...... 39 creatine5000...... 36 cvs ethyl alcohol...... 38 cvs protective...... 39 CREON...... 36 cvs eye...... 38 cvs saline wound wash...... 39 CR-GTF...... 36 cvs feminine wipes max st...... 38 cvs selenium...... 39 CRITIC-AID CLEAR AF...... 36 cvs fiber gummies...... 38 cvs silver...... 39 CRIXIVAN...... 36 cvs flu relief...... 38 cvs sinus pe...... 39 cromolyn sodium...... 36 cvs gas relief...... 38 cvs sinus relief day/night...... 39 CROTAN...... 36 cvs gas relief extra strength...... 38 cvs skin relief...... 40 CR-PLUS...... 36 cvs gauze sterile...... 38 cvs sore muscle rub...... 40 CRYSELLE-28...... 36 cvs gluco-chondroit plus uc-ii...... 38 cvs sore throat max strength...... 40 cu-25...... 36 cvs glucosamine-chondroitin...... 38 cvs sore throat relief pops...... 40 cu-5...... 37 cvs glucosamine-chondroit-msm...... 38 cvs steam inhaler...... 40 CULTURELLE GENTLE-GO KIDS.... 37 cvs glucose bits...... 38 cvs stool softener...... 40 CULTURELLE KIDS...... 37 cvs glucose shot...... 38 cvs stuffy nose & cold child...... 40 CURAD GERM SHIELD...... 37 cvs glycerin adult...... 38 cvs super cranberry urinary...... 40 CURAFIL WOUND DRESSING...... 37 cvs hair regrowth for women...... 38 cvs tension headache...... 40 CURASOL WOUND DRESSING...... 37 cvs hand wash advanced antibac...... 38 cvs therapeutic...... 40 CURITY ALCOHOL PREPS...... 37 cvs heartburn relief ex st...... 38 cvs therapeutic dandruff...... 40 CURITY ALCOHOL SWABS...... 37 cvs heatwraps/back/hip...... 38 cvs triacting cough/runny nose...... 40 CURITY GAUZE SPONGE...... 37 cvs hemorrhoidal...... 38 cvs triple magnesium complex...... 40 CURITY GAUZE SPONGES...... 37 cvs hot steam...... 38 cvs ultra thin lancets...... 40 CURITY MESH GAUZE BNDG cvs hydrocolloid pads...... 38 cvs vaporizer warm steam...... 40 4"X30'...... 37 cvs inner ear plus...... 38 cvs wound wash advanced...... 40 CURX ANTIMICROBIAL...... 37 cvs instant food thickener...... 38 cvs yogurt+calcium gummies...... 40 CUTINOVA HYDRO 2"X2-3/8"...... 37 cvs iron...... 38 cvs zinc oxide diaper...... 40 cvs acetaminophen...... 37 cvs irritated eye...... 38 cyanocobalamin...... 40 cvs adhesive gauze...... 37 cvs isopropyl alcohol wipes...... 38 cyclobenzaprine hcl...... 40 cvs aftersun aloe/lidocaine...... 37 cvs itch relief...... 38 CYCLOMYDRIL...... 40 CVS AIRSHIELD...... 37 cvs lancets 21g...... 38 cyclopentolate hcl...... 40 cvs alcohol prep pads...... 37 cvs lancets micro thin 33g...... 38 cyclophosphamide...... 40 cvs allergy relief...... 37 cvs lancets original...... 38 cyclosporine...... 40 cvs allergy relief childrens...... 37 cvs lancets thin 26g...... 38 cyclosporine modified...... 40 cvs allergy relief d...... 37 cvs lancets ultra thin 30g...... 39 cyproheptadine hcl...... 40 cvs all-purpose skin protect...... 37 cvs lancets ultra-thin 30g...... 39 CYSTADANE...... 40 165 CYSTAGON...... 40 DERMOPLAST...... 42 DIGITEK...... 44 CYSTECH...... 40 dermovix...... 42 digoxin...... 44 cystine...... 40 DESCOVY...... 42 DILANTIN...... 44 cytarabine (pf)...... 40 DESENEX FOOT/SNEAKER SPRAY.42 diltiazem cd...... 44 CYTO-Q MAX...... 40 DESGEN DM...... 42 diltiazem hcl...... 44 cytra k crystals...... 40 desipramine hcl...... 42 diltiazem hcl er...... 44 d 1000...... 40 DESITIN MAXIMUM STRENGTH.....42 diltiazem hcl er beads...... 44 d 2000...... 40 desmopressin ace spray refrig...... 42 diltiazem hcl er coated beads...... 44 dacarbazine...... 40 desmopressin acetate...... 42 dilt-xr...... 44 daily care skin protectant...... 40 desmopressin acetate spray...... 42 dimenhydrinate...... 44 daily ovulation predictor...... 41 desonide...... 42 DIMETAPP COLD/ALLERGY...... 44 daily vite multivitamin/iron...... 41 despec dm-g...... 42 DIMETAPP DM COLD/COUGH...... 44 dairy relief...... 41 desvenlafaxine succinate er...... 42 DIMETAPP LONG ACT dakins...... 41 DEVROM...... 42 COUGH/COLD...... 45 dakins (1/2 strength)...... 41 DEWEES CARMINATIVE...... 42 DIMETAPP NIGHT dakins (1/4 strength)...... 41 DEWITTS PAIN RELIEVER...... 42 COLD/CONGESTION...... 45 DAKRINA...... 41 dexamethasone...... 42 dimethyl fumarate...... 45 danazol...... 41 DEXAMETHASONE INTENSOL...... 42 dimethyl fumarate starter pack...... 45 dandruff shampoo...... 41 dexamethasone sodium phosphate...... 43 diphenhydramine hcl...... 45 dantrolene sodium...... 41 dexmethylphenidate hcl...... 43 diphenhydramine hcl (sleep)...... 45 dapsone...... 41 dexmethylphenidate hcl er...... 43 diphenoxylate-atropine...... 45 daunorubicin hcl...... 41 dexrazoxane...... 43 diphtheria-tetanus toxoids dt...... 45 day time multi-sympt cold/flu...... 41 dextroamphetamine sulfate...... 43 dipyridamole...... 45 DAYTIME COLD MEDICINE...... 41 dhea...... 43 disulfiram...... 45 daytime cough...... 41 DHS BODY WASH...... 43 divalproex sodium...... 45 daytime severe cold & flu...... 41 DHS ZINC...... 43 divalproex sodium er...... 45 DAYTRANA...... 41 DIAB DAILY CARE...... 43 dl-pa-500...... 45 DDROPS...... 41 DIABETIC BASICS HEALTHY DML...... 45 DEBACTEROL...... 41 FOOT...... 43 DOANS EXTRA STRENGTH...... 45 DECARA...... 41 DIABETIC TUSSIN...... 43 DOANS PILLS...... 45 decitabine...... 41 DIABETIC TUSSIN ALLERGY...... 43 DOANS PM EXTRA STRENGTH...... 45 DECONEX DMX...... 41 DIABETIC TUSSIN COLD/FLU...... 43 DOC OMEGA...... 45 DECONEX IR...... 41 DIABETIC TUSSIN MAX ST...... 43 docetaxel...... 45 DEEP SLEEP...... 41 DIABETIC TUSSIN NIGHT docosanol...... 45 deferasirox...... 41 COLD/FLU...... 43 docusate sodium...... 45 del clens...... 41 diabet-x daily prevention...... 43 DOCUSOL KIDS...... 45 DELBASE COMPOUNDING...... 41 DIADERM FOOT REJUVENATING...43 DOCUSOL PLUS MINI-ENEMA...... 45 DELSYM COUGH CHILDRENS...... 41 DIALYVITE...... 43 dofetilide...... 45 DELTUSS DP...... 41 DIALYVITE 800...... 43 DOLOGEN...... 45 DELZICOL...... 41 DIALYVITE 800 PLUS D...... 43 dologesic-df...... 45 demeclocycline hcl...... 41 DIALYVITE 800/IRON...... 43 dolorex...... 45 DEMEROL...... 41 DIALYVITE/ZINC...... 43 DOMEBORO...... 45 DEMSER...... 41 diaper rash...... 43 dometuss-da/children...... 45 DENDRACIN DIASTIX...... 43 donepezil hcl...... 45, 46 NEURODENDRAXCIN...... 41 diazepam...... 43 dorzolamide hcl...... 46 DENTA 5000 PLUS...... 41 DIAZEPAM INTENSOL...... 43 dorzolamide hcl-timolol mal...... 46 DENTAPAINE...... 41 diazoxide...... 43 DOUBLE-TUSSIN DM...... 46 DEPACON...... 41 dibucaine...... 43 DOVER IRRIGATION TRAY...... 46 DEPO-PROVERA...... 42 diclofenac potassium...... 43 doxazosin mesylate...... 46 DEQUASINE...... 42 diclofenac sodium...... 44 doxepin hcl...... 46 DERMA CIDOL 2000...... 42 diclofenac sodium er...... 44 doxorubicin hcl...... 46 dermacloud...... 42 dicloxacillin sodium...... 44 doxycycline hyclate...... 46 DERMAGESIC...... 42 dicyclomine hcl...... 44 doxycycline monohydrate...... 46 DERMAGRAN...... 42 DI-DAK-SOL...... 44 DR BOLDTS HINEY HEALER...... 46 DERMAGRAN HYDROGEL didanosine...... 44 DR SMITHS DIAPER...... 46 WOUND...... 42 dieters super tea...... 44 DR SMITHS DIAPER RASH...... 46 DERMAL THERAPY FINGER CARE.42 dietex forte...... 44 DR SMITHS RASH + SKIN...... 46 DERMAMED...... 42 diethylpropion hcl...... 44 DRAMAMINE...... 46 DERMAPLEX...... 42 diethylpropion hcl er...... 44 DRITHO-CREME HP...... 46 DERMAREST PSORIASIS...... 42 DIFFERIN...... 44 DRIXORAL COLD/ALLERGY...... 46 DERMASTAT...... 42 diflorasone diacetate...... 44 DRIXORAL COUGH/SORE DERMASYN...... 42 diflunisal...... 44 THROAT...... 46 DERMAZENE...... 42 digestive enzyme ultra...... 44 dronabinol...... 46 166 DROPLET LANCETS ULTRA THIN EASYGEL...... 49 entecavir...... 51 30G...... 46 ecee plus...... 49 ENTEX T...... 51 drospirenone-ethinyl estradiol...... 46 econazole nitrate...... 49 entre-hist pse...... 51 DROXIA...... 46 ECOTRIN...... 49 ENTRESTO...... 51 drug mart lancets thin 26g...... 46 ECOTRIN MAXIMUM STRENGTH... 49 ENTSOL NASAL...... 51 DRUG MART UNILET LANCETS e-cream complex...... 49 enulose...... 51 28G...... 46 ED A-HIST...... 49 e-oil...... 51 DRUG MART UNILET LANCETS ed a-hist dm...... 49 epa/gla...... 51 30G...... 46 ed a-hist pse...... 49 EPANED...... 51 dry skin treatment adv therapy...... 46 ed bron gp...... 49 ephedrine hcl...... 51 drymax extra...... 46 ED CHLORPED...... 49 EPIDIOLEX...... 51 DRYSOL...... 46 ED CHLORPED D...... 49 epidural needle...... 51 DULCOLAX...... 47 ed-a-hist dm...... 49 epinastine hcl...... 51 DULCOLAX MILK OF MAGNESIA...47 ed-spaz...... 49 epinephrine...... 51 DULERA...... 47 EDURANT...... 49 epinephrine pf...... 51 duloxetine hcl...... 47 efavirenz...... 49 EPIPEN 2-PAK...... 51 DUNLAP MOIST HEAT PACK efavirenz-emtricitab-tenofovir...... 49 EPIPEN JR 2-PAK...... 51 COVER...... 47 EFFER-K...... 49 epirubicin hcl...... 51 DUOFILM...... 47 effervescent pain relief...... 49 EPISORB...... 51 DURAFLEX COMFORT...... 47 effervescent pot chloride...... 49 EPITOL...... 51 DURAFLU...... 47 EGRIFTA...... 49 EPIVIR HBV...... 51 DURAPROXIN...... 47 ELDERTONIC...... 49 eplerenone...... 51 DURAPROXIN ES...... 47 eletriptan hydrobromide...... 49 eprosartan mesylate...... 52 DURASAFE SPINAL/EPIDURAL...... 47 ELIDEL...... 49 epsom salt...... 52 DURATION SPRAY...... 47 ELIGARD...... 49 eq allergy relief...... 52 DURAVENT DM...... 47 ELIQUIS...... 49 eq allergy relief childrens...... 52 DURAVENT PE...... 47 elite ca/mg...... 49 eq allergy/sinus headache...... 52 DUREZOL...... 47 elite calcium...... 49 eq antibiotic + pain relief...... 52 dutasteride...... 47 ELITE ZINC...... 49 eq aspirin...... 52 dutasteride-tamsulosin hcl...... 47 ELITEK...... 49 EQ BABY CHEST RUB...... 52 D-VI-SOL...... 47 ELITE-OB...... 49 eq calcium citrate+d3 petites...... 52 d-xylose...... 47 elite-thin insulin syringe...... 49, 50 eq cough sugar free...... 52 DY-O-DERM VITILIGO STAIN...... 47 ELIXOPHYLLIN...... 50 eq cryogenic wart removal sys...... 52 ear wax cleansing...... 47 ELIXSURE COUGH...... 50 eq daily fiber...... 52 easy fiber...... 47 ELIXSURE FEVER/PAIN...... 50 eq dairy digestive fast acting...... 52 EASY TOUCH ALCOHOL PREP ELLA...... 50 eq feminine wash sensitive...... 52 MEDIUM...... 47 ELLURA...... 50 eq ibuprofen pm...... 52 EASY TOUCH ALLERGY SYRINGE.47 ELMIRON...... 50 EQ MUCUS ER...... 52 EASY TOUCH FLIPLOCK INSULIN ELTA DERMAL...... 50 eq multi-symptom cold children...... 52 SY...... 47 ELTA DERMAL WOUND...... 50 eq omeprazole...... 52 EASY TOUCH FLURINGE...... 47 ELURYNG...... 50 eq pain relief/rapid burst...... 52 EASY TOUCH HYPODERMIC EMCYT...... 50 eq sinus relief max st...... 52 NEEDLE...... 47 EMETROL...... 50 eq tioconazole 1...... 52 EASY TOUCH INSULIN SAFETY EMGALITY...... 50 eq vitamins a & d...... 52 SYR...... 47, 48 empty capsule size 1 clear...... 50 eql 2 in 1 probiotic...... 52 EASY TOUCH INSULIN SYRINGE... 48 emtricitabine...... 50 eql advanced relief...... 52 EASY TOUCH LANCETS 26G...... 48 emtricitabine-tenofovir df...... 50 eql alcohol swabs...... 52 EASY TOUCH LANCETS 28G...... 48 EMTRIVA...... 50 eql aller-ease...... 52 EASY TOUCH LANCETS EMULSION SB...... 50 eql allergy...... 52 28G/TWIST...... 48 enalapril maleate...... 50 eql aloe vera after sun...... 52 EASY TOUCH LANCETS 30G...... 48 enalapril-hydrochlorothiazide...... 50 eql antacid ultra strength...... 52 EASY TOUCH LANCETS ENBREL...... 50 eql antibacterial hand soap...... 52 30G/TWIST...... 48 ENBREL MINI...... 50 eql anti-nausea...... 52 EASY TOUCH LANCETS 32G...... 48 ENBREL SURECLICK...... 50 eql biotin...... 52 EASY TOUCH LANCETS ENDOXCIN...... 50 eql cold sore treatment...... 52 32G/TWIST...... 48 ENDUR-ACIN...... 50 eql color lancets 21g...... 52 EASY TOUCH LANCETS ENEMEEZ MINI...... 51 eql color lancets micro 33g...... 52 33G/TWIST...... 48 ENFAMIL ENFALYTE...... 51 eql congestion relief...... 52 EASY TOUCH SHEATHLOCK ENFAMIL EXPECTA...... 51 eql denture brush/pick...... 52 SYRINGE...... 48 ENGERIX-B...... 51 eql denture cleanser...... 52 EASY TOUCH TB FLIPLOCK ENLITE GLUCOSE SENSOR...... 51 eql digestive enzymes...... 52 SYRINGE...... 49 enoxaparin sodium...... 51 eql ear drops...... 52 EASY TWIST & CAP LANCETS...... 49 ENPRESSE-28...... 51 eql effervescent cold relief...... 53 167 eql ethyl alcohol (rubbing)...... 53 EXACTECH R-S-G TEST...... 55 fenoprofen calcium...... 57 eql everyday clean...... 53 EXACTECH TEST...... 55 fentanyl...... 57 eql eye drops ac...... 53 EXACTUSS TR...... 55 fentanyl citrate...... 57 eql fiber therapy...... 53 EXAPHEN...... 55 fentanyl citrate (pf)...... 57 eql gas prevention...... 53 EXAPHEN CH...... 55 FER-IN-SOL...... 57 eql gentle skin cleanser...... 53 EXAPHEX TR...... 55 ferocon...... 57 eql insulin syringe...... 53 EXCEDRIN EXTRA STRENGTH...... 55 ferraplus 90...... 57 eql lutein...... 53 EXCEDRIN PM...... 55 ferretts...... 57 eql mouthwash/gargle...... 53 EXCEDRIN TENSION HEADACHE...55 ferretts chewable iron...... 57 eql mucus-dm...... 53 EXCEL AP...... 55 ferretts ips...... 57 eql multi-purpose...... 53 EXEL COMFORT POINT INSULIN FERREX 150...... 57 eql omega 3 fish oil...... 53 SYR...... 55 FERREX 150 FORTE PLUS...... 57 eql omeprazole...... 53 exemestane...... 55 FERREX 28...... 57 eql one daily womens...... 53 EXFOLIX EXFOLIATING FOOT FERRIMIN 150...... 57 eql redness relief...... 53 SOAP...... 55 FERROCITE...... 57 eql scalp relief max strength...... 53 EX-LAX...... 55 FERROCITE PLUS...... 57 eql super thin lancets 30g...... 53 EX-LAX MAXIMUM STRENGTH...... 55 ferrous gluconate...... 57 eql thin lancets 26g...... 53 exoten-c pain relief...... 55 ferrous sulfate...... 57 eql ultra protection spf50...... 53 exotic-hc...... 55 ferrous sulfate er...... 57 eql vitamin d3...... 53 EXTRESS-30...... 55 FEVERALL INFANTS...... 57 eql wet cleansing towelettes...... 53 eye allergy relief...... 55 FEVERALL JUNIOR STRENGTH...... 57 eql zinc cold relief...... 53 eye drops...... 55 fexofenadine hcl childrens...... 57 EQUALACTIN...... 53 eye itch relief...... 55 fiber...... 57 ERBITUX...... 53 EYE STREAM...... 56 fiber laxative...... 57 ergocalciferol...... 53 E-Z JECT LANCET MICRO-THIN fiber therapy...... 57 ergoloid mesylates...... 53 33G...... 56 FIBERCON...... 57 ery...... 53 E-Z JECT LANCET SUPER THIN FIBEREX F15...... 57 erythromycin...... 54 30G...... 56 FIFTY50 ALCOHOL PREP...... 57 erythromycin base...... 53 E-Z JECT LANCETS...... 56 FIFTY50 SUPERIOR COMFORT erythromycin ethylsuccinate...... 53 E-Z JECT LANCETS 21G...... 56 SYR...... 57 escavite lq...... 54 E-Z JECT LANCETS THIN 26G...... 56 filter needle...... 58 escitalopram oxalate...... 54 EZ SMART BLOOD GLUCOSE finasteride...... 58 esmolol hcl...... 54 LANCETS...... 56 FINE 30...... 58 esomeprazole magnesium...... 54 ezetimibe...... 56 first aid antibiotic...... 58 ESOTERICA FADE NIGHTTIME...... 54 ezetimibe-simvastatin...... 56 first aid antiseptic...... 58 ESOTERICA SENSITIVE SKIN...... 54 EZFE 200...... 56 first aid antiseptic spray...... 58 ESTARYLLA...... 54 ezfe forte...... 56 FIRVANQ...... 58 estazolam...... 54 E-Z-GAS II...... 56 fish oil...... 58 estradiol...... 54 EZ-LETS LANCETS 21G...... 56 fish oil + d3...... 58 estradiol valerate...... 54 EZ-LETS LANCETS 23G...... 56 fish oil adult gummies...... 58 estradiol-norethindrone acet...... 54 EZ-LETS LANCETS 28G...... 56 fish oil-flax oil-borage oil...... 58 estropipate...... 54 fabb...... 56 flavor packets...... 58 eszopiclone...... 54 famciclovir...... 56 flavoxate hcl...... 58 ethambutol hcl...... 54 famotidine...... 56 flecainide acetate...... 58 ethosuximide...... 54 FARESTON...... 56 FLEET BISACODYL...... 58 ethyl alcohol...... 54 FARXIGA...... 56 FLEET LIQUID GLYCERIN SUPP..... 58 ethyl alcohol (rubbing)...... 54 FAST FREEZE PRO STYLE FLEET NATURALS CLEANSING ethyl chloride...... 54 THERAPY...... 56 ENEMA...... 58 etidronate disodium...... 54 fast-heat heating pad...... 56 FLEET OIL...... 58 etodolac...... 54 father johns medicine...... 56 FLEET PEDIATRIC...... 58 etodolac er...... 54 fa-vitamin b-6-vitamin b-12...... 56 FLEXBUMIN...... 58 ETOPOPHOS...... 54 FAYOSIM...... 56 FLEXICHAMBER CHILD etoposide...... 54 FC FEMALE CONDOM...... 56 MASK/LARGE...... 58 etravirine...... 54 febuxostat...... 56 FLINTSTONES TODDLER...... 58 eucalyptus oil...... 54 feeding bottles/standard neck...... 56 FLOGEN...... 58 EUCERIN...... 54 FEIBA...... 56 FLONASE ALLERGY RELIEF...... 58 EUCERIN ECZEMA RELIEF...... 54 felbamate...... 56 FLONASE SENSIMIST...... 58 EUCERIN ORIGINAL HEALING...... 54 felodipine er...... 56 FLORA ASSIST...... 58 EUFLEXXA...... 55 FEM PH...... 56 FLORANEX...... 58 EURAX...... 55 FEMINEASE...... 56 FLORASTOR...... 58 EVAC-U-GEN...... 55 fenofibrate...... 56 FLORASTOR KIDS...... 58 evening primrose oil...... 55 fenofibrate micronized...... 56 FLORICAL...... 58 everolimus...... 55 fenofibric acid...... 56, 57 FLOVENT DISKUS...... 58 168 FLOVENT HFA...... 58 FREESTYLE CONTROL SOLUTION.61 GELONASAL...... 63 flow-eze vented needle...... 58 FREESTYLE FLASH SYSTEM...... 61 GELUSIL...... 63 FLOWING VAPORS...... 58 FREESTYLE FREEDOM...... 61 gemcitabine hcl...... 63 FLOWING VAPORS/VAPOR FAN..... 58 FREESTYLE FREEDOM LITE...... 61 gemfibrozil...... 63 floxuridine...... 59 FREESTYLE INSULINX SYSTEM..... 61 GENCONTUSS...... 63 flu hbp...... 59 FREESTYLE INSULINX TEST...... 61 GENOTROPIN...... 63 FLUAD QUADRIVALENT...... 59 FREESTYLE LANCETS...... 61 GENOTROPIN MINIQUICK...... 63 FLUCAINE...... 59 FREESTYLE LIBRE 14 DAY gentamicin sulfate...... 63 FLUCELVAX QUADRIVALENT...... 59 READER...... 61 GENTEAL...... 63 fluconazole...... 59 FREESTYLE LIBRE 14 DAY GENTEAL MILD...... 63 fludarabine phosphate...... 59 SENSOR...... 61 GENTEAL MILD TO MODERATE.....63 fludrocortisone acetate...... 59 FREESTYLE LIBRE 2 READER GENTEAL TEARS PF...... 63 flunisolide...... 59 SYSTM...... 61 gentian violet...... 63 fluocinolone acetonide...... 59 FREESTYLE LIBRE 2 SENSOR gentle laxative...... 63 fluocinolone acetonide body...... 59 SYSTM...... 61 GENTLE RAIN...... 63 fluocinolone acetonide scalp...... 59 FREESTYLE LIBRE READER...... 61 gentle skin cleanser...... 63 fluocinonide...... 59 FREESTYLE LIBRE SENSOR GENTLE-LET GP LANCETS...... 63 fluocinonide emulsified base...... 59 SYSTEM...... 61 GENTLE-LET LANCETS...... 63 fluoride mouth rinse...... 59 FREESTYLE LITE TEST...... 61 GENVOYA...... 64 fluoritab...... 59 FREESTYLE PRECISION INS SYR....61 geravine...... 64 fluorometholone...... 59 FREESTYLE PRECISION NEO geriatric vitamin...... 64 fluorouracil...... 59 SYSTEM...... 61 geri-lanta supreme...... 64 fluoxetine hcl...... 59 FREESTYLE PRECISION NEO TEST 61 gerisilk bath oil...... 64 fluphenazine decanoate...... 59 FREESTYLE SIDEKICK II...... 61 GERMBLOC HEALTH...... 64 fluphenazine hcl...... 59 FREESTYLE SYSTEM...... 61 GILTUSS COUGH & COLD...... 64 flurazepam hcl...... 59 FREESTYLE TEST...... 61 ginger root...... 64 flurbiprofen...... 59 fruit c...... 61 ginseng...... 64 flurbiprofen sodium...... 59 fulvestrant...... 61 gla-45...... 64 flutamide...... 60 FUNGI-NAIL...... 61 glass syringe 3 ml...... 64 fluticasone propionate...... 60 FUNGI-NAIL TOE & FOOT...... 61 glatiramer acetate...... 64 fluticasone-salmeterol...... 60 FUNGOID TINCTURE...... 61 glen pe...... 64 fluvoxamine maleate...... 60 FUNGOID-D...... 61 glenmax peb...... 64 FLUZONE HIGH-DOSE...... 60 furosemide...... 61, 62 glenmax peb dm...... 64 FLUZONE HIGH-DOSE FUSION...... 62 glenmax peb dm forte...... 64 QUADRIVALENT...... 60 FUZEON...... 62 glentuss...... 64 FLUZONE QUADRIVALENT...... 60 FYAVOLV...... 62 g-levocarnitine s/f...... 64 FOILLE...... 60 gabapentin...... 62 glimepiride...... 64 FOLET DHA...... 60 galantamine hydrobromide...... 62 glipizide...... 64 FOLGARD...... 60 galantamine hydrobromide er...... 62 glipizide er...... 64 FOLGARD OS...... 60 GARDASIL 9...... 62 glipizide xl...... 64 FOLIC + B12...... 60 garlic/epa...... 62 glipizide-metformin hcl...... 64 folic acid...... 60 garlic-lecithin...... 62 global inject ease insulin syr...... 64 folinic-plus...... 60 garlic-parsley...... 62 global insulin syringes...... 64 FOLITAB 500...... 60 gas relief...... 62 GLUCAGEN HYPOKIT...... 64 FOLIVANE-F...... 60 GAS-X...... 62 glucagon emergency...... 64 FOLIVANE-PLUS...... 60 GAS-X CHILDRENS...... 62 GLUCOCOM AUTOLINK FOLOTYN...... 60 GAS-X EXTRA STRENGTH...... 62 TELEMONITOR...... 64 foot powder...... 60 GAS-X PREVENTION...... 62 GLUCOCOM LANCETS 28G...... 64 FORA D40 GLUCOSE/PRESSURE..... 60 GAS-X WITH MAALOX EX ST...... 62 GLUCOCOM LANCETS 30G...... 64 FORA LANCETS...... 60 GAVILYTE-C...... 62 GLUCOCOM LANCETS 33G...... 64 FORADIL AEROLIZER...... 60 GAVILYTE-G...... 62 GLUCOPRO INSULIN SYRINGE. 64, 65 FORMADON...... 60 GAVILYTE-N WITH FLAVOR glucosamine chond complex/msm...... 65 formaldehyde...... 60 PACK...... 62 glucosamine chondroitin complx...... 65 FORMA-RAY...... 60 GAVISCON...... 62 glucosamine complex/vitamin d3...... 65 formoterol fumarate...... 60 GAVISCON EXTRA STRENGTH...... 62 glucosamine hcl...... 65 FORTEO...... 60 G-BUCAL-C...... 62 glucosamine sulfate...... 65 fosamprenavir calcium...... 60 G-DOLOGEN...... 62 glucosamine-chondroitin...... 65 fosfomycin tromethamine...... 60 ge-150...... 62 glucosamine-chondroitin-msm...... 65 fosinopril sodium...... 61 GEBAUERS INSTANT ICE...... 62 glucosamine-chondroitin-vit d3...... 65 fosinopril sodium-hctz...... 61 gelatin...... 62 glucosamine-msm...... 65 fosphenytoin sodium...... 61 GELFOAM SPONGE...... 62 glucose...... 65 freds pharmacy unilet lanc 28g...... 61 GELFOAM SPONGE SIZE 100...... 62 GLUCOSE NURSETTE...... 65 FREE & CLEAR...... 61 GEL-KAM...... 63 glutamine...... 65 169 glutathione...... 65 gnp terbinafine hydrochloride...... 67 haloperidol lactate...... 69 glutol...... 65 gnp ultra com insulin syringe...... 67 hand wipes...... 69 glyburide...... 65 gnp urinary pain relief...... 67 HARD NAILS...... 69 glyburide micronized...... 65 gnp vitamin a & d...... 67 HAVRIX...... 69 glyburide-metformin...... 65 gnp vitamin d super strength...... 67 HC DERMAPAX...... 69 glycerin...... 65 gnp vitamin d-400...... 67 H-CHLOR 12...... 69 glycerin (adult)...... 65 GOLD BOND FOOT POWDER MAX H-CHLOR 6...... 69 glycerin (infants & children)...... 65 ST...... 67 headache relief pm...... 69 glycine500...... 65 GOLD BOND MULTI-SYMPTOM...... 68 healthy accents unilet lancets...... 69 glycolic acid...... 65 GOLD BOND RAPID RELIEF...... 68 hearing aid batteries...... 69 glycopyrrolate...... 65 GOLD BOND ULTIMATE...... 68 heartburn antacid ex st...... 69 GLYDO...... 65 GONIOSOL...... 68 heartburn treatment 24 hour...... 69 GLYXAMBI...... 66 GONIOTAIRE...... 68 h-e-b incontrol alcohol...... 69 g-myco nail...... 66 GONIOVISC...... 68 h-e-b incontrol lancets 28g...... 69 gnp 24 hour nasal allergy...... 66 GOOD START 5% GLUCOSE h-e-b incontrol lancets 30g...... 69 gnp 4x probiotic...... 66 WATER...... 68 h-e-b incontrol lancets 33g...... 69 gnp advanced eye health...... 66 goodsense all day allergy...... 68 HEET TRIPLE ACTION...... 69 gnp alcohol denatured...... 66 goodsense cough dm...... 68 hematinic/folic acid...... 69 gnp alcohol swabs...... 66 goodsense eye drops...... 68 HEMATOGEN...... 70 gnp allergy & sinus headache...... 66 goodsense flu/cold/cough/night...... 68 HEMATOGEN FA...... 69 gnp allergy pls sinus headache...... 66 goodsense flu/cold/daytime...... 68 HEMOCYTE...... 70 gnp animal shapes plus iron...... 66 goodsense ibuprofen...... 68 hemorrhoidal...... 70 gnp antacid...... 66 goodsense ibuprofen childrens...... 68 hemorrhoidal cooling...... 70 gnp antacid & anti-gas...... 66 goodsense ibuprofen infants...... 68 hemorrhoidal max st/aloe...... 70 gnp b-50 complex...... 66 goodsense lancets 30g...... 68 heparin (porcine) in nacl...... 70 gnp b-complex plus vitamin c...... 66 goodsense lancets 33g...... 68 heparin sodium (porcine)...... 70 gnp calamine...... 66 goodsense lubricant eye drops...... 68 heparin sodium (porcine) pf...... 70 gnp calcium 600 plus d/mineral...... 66 goodsense miconazole 1...... 68 HERCEPTIN...... 70 gnp calcium plus 600 +d...... 66 goodsense nicotine...... 68 hetastarch-nacl...... 70 gnp capsaicin...... 66 goodsense nighttime cold & flu...... 68 HETLIOZ LQ...... 70 gnp childrens chewables/ex c...... 66 goodsense redness relief plus...... 68 HEXALEN...... 70 gnp cold & hot extra strength...... 66 goodsense severe sinus congest...... 68 HIBICLENS...... 70 gnp cold sore treatment...... 66 goodsense sinus congest/pain...... 68 high potency iron...... 70 gnp coq-10 & fish oil...... 66 goodsense sleeptime...... 68 histaflex...... 70 gnp ethyl alcohol...... 66 goodsense sore throat spray...... 68 HISTEX...... 70 gnp fish oil...... 66 gordomatic...... 68 HISTEX PD...... 70 gnp flu/severe cold daytime...... 66 GORDONS NO 5...... 68 HISTEX PDX...... 70 gnp gentian violet...... 66 gordons urea...... 68 HISTEX-AC...... 70 gnp glycerin/rose water...... 66 GORDONS-VITE A...... 68 HISTEX-DM...... 70 gnp headache relief extra str...... 66 GORDO-POOL...... 68 HISTEX-PE...... 70 gnp hydrogen peroxide wipes...... 66 GRANDPAS OATMEAL SOAP...... 68 hm 24 hour nasal allergy...... 70 gnp insulin syringe...... 66 GRANDPAS THYLOX SOAP...... 68 hm calamine...... 70 gnp iodides...... 66 GRANIX...... 68 hm clear fiber...... 70 gnp iodine...... 66 green soap...... 68 hm ethyl rubbing alcohol...... 70 gnp isopropyl alcohol wipes...... 66 griseofulvin microsize...... 69 hm iodides...... 70 gnp lancets...... 67 grx hemorrhoidal...... 69 hm iodine...... 70 gnp lancets 21g...... 67 grx wound...... 69 hm iron...... 70 gnp lancets micro thin 33g...... 67 g-supress dx pediatric...... 69 hm melatonin quick dissolve...... 70 gnp lancets super thin 30g...... 67 G-TRON PED...... 69 hm nighttime sleep aid...... 70 gnp lancets thin 26g...... 67 G-TUSICOF...... 69 hm omeprazole...... 70 gnp lice egg remover...... 67 guaifenesin...... 69 hm probiotic digestive health...... 70 gnp liquid bandage...... 67 guaifenesin-codeine...... 69 hm rolled gauze bandage...... 70 gnp l-lysine...... 67 guanfacine hcl...... 69 HM SALONPAS PAIN RELIEF...... 70 gnp micro thin lancets 33g...... 67 guanfacine hcl er...... 69 hm severe cold/cough/flu...... 70 gnp natural fiber...... 67 guanidine hcl...... 69 hm super vitamin b12...... 70 gnp niacin...... 67 gumsol...... 69 hm vitamin b12...... 70 gnp night time cold & flu...... 67 GYNE-LOTRIMIN...... 69 hm z-sleep...... 71 gnp omeprazole...... 67 GYNE-LOTRIMIN 3...... 69 HOLD...... 71 gnp pain relief/benzocaine...... 67 H2Q...... 69 HOMATROPAIRE...... 71 gnp potassium...... 67 HAILEY FE 1.5/30...... 69 HONEY BEARS W/IRON-ZINC...... 71 gnp shampoo & body wash...... 67 halobetasol propionate...... 69 HPR PLUS HYDROGEL...... 71 gnp sinus wash refill...... 67 haloperidol...... 69 huber needle...... 71 gnp super thin lancets 30g...... 67 haloperidol decanoate...... 69 HUGGIES NATURAL CARE WIPES..71 170 HUMALOG...... 71 HYPOTEARS...... 73 INTERDRY AG TEXTILE 10"X144".. 76 HUMALOG JUNIOR KWIKPEN...... 71 HYSEPT...... 73 INTRON A...... 76 HUMALOG KWIKPEN...... 71 HYVEE ADVANCED ANTACID...... 73 INTROVALE...... 76 HUMALOG MIX 50/50...... 71 HY-VEE LANCETS...... 73 INVEGA SUSTENNA...... 76 HUMALOG MIX 50/50 KWIKPEN..... 71 hy-vee thin lancets...... 73 INVEGA TRINZA...... 76 HUMALOG MIX 75/25...... 71 ibandronate sodium...... 73, 74 INVIRASE...... 76 HUMALOG MIX 75/25 KWIKPEN..... 71 ibuprofen...... 74 INVOKAMET...... 76 HUMAN ALBUMIN GRIFOLS...... 71 ibuprofen 100 junior strength...... 74 INVOKAMET XR...... 76 HUMATE-P...... 71 ibuprofen pm...... 74 INVOKANA...... 76 humidifier...... 71 ICAR...... 74 iodides tincture...... 76 HUMIRA...... 71 ICAR-C...... 74 iodine...... 76 HUMIRA PEDIATRIC CROHNS icatibant acetate...... 74 iodine strong...... 76 START...... 71 ice blue...... 74 iodine tincture...... 76 HUMIRA PEN...... 71 ICY HOT...... 74 IONIL...... 76 HUMIRA PEN-CD/UC/HS STARTER.71 ICY HOT LIDOCAINE PLUS IONIL-T...... 76 HUMIRA PEN-PS/UV/ADOL HS MENTHOL...... 74 IONSYS...... 76 START...... 71 idarubicin hcl...... 74 IPOL...... 76 HUMPHREYS #1 SIMPLE FEVER..... 71 IFEX...... 74 ipratropium bromide...... 76 HUMULIN 70/30...... 72 ifosfamide...... 74 ipratropium-albuterol...... 76 HUMULIN 70/30 KWIKPEN...... 71 imatinib mesylate...... 74 irbesartan...... 76 HUMULIN N...... 72 imipramine hcl...... 74 irbesartan-hydrochlorothiazide...... 76 HUMULIN N KWIKPEN...... 72 imipramine pamoate...... 74 irinotecan hcl...... 77 HUMULIN R...... 72 imiquimod...... 74 IROFOL...... 77 HUMULIN R U-500 imiquimod pump...... 74 iron...... 77 (CONCENTRATED)...... 72 immune support...... 74 iron (ferrous sulfate)...... 77 HUMULIN R U-500 KWIKPEN...... 72 IMODIUM A-D...... 74 iron 100 plus...... 77 HURRICAINE...... 72 IMODIUM MULTI-SYMPTOM iron 100/c...... 77 HURRICAINE ONE...... 72 RELIEF...... 74 iron 21/7...... 77 HURRIVIEW...... 72 IMOVAX RABIES...... 74 iron 27...... 77 HURRIVIEW II...... 72 IMPROVUE...... 74 iron chews pediatric...... 77 HYALGAN...... 72 indapamide...... 74 iron slow release...... 77 HYCAMTIN...... 72 indomethacin...... 74 irrigating eyewash...... 77 hydralazine hcl...... 72 indomethacin er...... 74 ISAGEL...... 77 HYDROCELL ADHESIVE INFANRIX...... 74 ISENTRESS...... 77 DRESSING...... 72 infants gas relief...... 74 ISENTRESS HD...... 77 hydrocerin...... 72 INFED...... 74 isoleucine...... 77 hydrochlorothiazide...... 72 INFUMORPH 200...... 74 ISOLEUCINE 1000...... 77 hydrocod polst-cpm polst er...... 72 INFUMORPH 500...... 75 isoniazid...... 77 hydrocodone-acetaminophen...... 72 inject-ease...... 75 isopropyl alcohol...... 77 hydrocodone-homatropine...... 72 INJECT-EASE AUTOMATIC isopropyl alcohol (rubbing)...... 77 hydrocodone-ibuprofen...... 72 INJECTOR...... 75 isopropyl alcohol wipes...... 77 hydrocortisone...... 73 inositol...... 75 ISOPTO TEARS...... 77 hydrocortisone ace-pramoxine...... 72 INOSITOL-5...... 75 isosorbide dinitrate...... 77 hydrocortisone butyrate...... 72 INSTACLEAN...... 75 isosorbide dinitrate er...... 77 hydrocortisone valerate...... 73 INSTA-GLUCOSE...... 75 isosorbide mononitrate...... 77 HYDROGEL...... 73 instant ear-dry...... 75 isosorbide mononitrate er...... 77 HYDROGEL AG...... 73 instant hand sanitizer...... 75 isotretinoin...... 77 hydromet...... 73 INSTAT...... 75 isradipine...... 77 hydromorphone hcl...... 73 INSUFLON...... 75 itch relief...... 77 hydromorphone hcl pf...... 73 insulin asp prot & asp flexpen...... 75 ITCH-X...... 77 hydrophilic...... 73 insulin aspart...... 75 itraconazole...... 77 hydrophilic petrolatum...... 73 insulin aspart flexpen...... 75 IVAREST MEDICATED POISON hydroxychloroquine sulfate...... 73 insulin aspart penfill...... 75 IVY...... 77 hydroxyurea...... 73 insulin aspart prot & aspart...... 75 IVAREST POISON IVY ITCH...... 77 hydroxyzine hcl...... 73 insulin lispro...... 75 ivermectin...... 77 hydroxyzine pamoate...... 73 insulin lispro (1 unit dial)...... 75 ivy wash poison ivy cleanser...... 77 HYLATOPIC PLUS...... 73 insulin lispro junior kwikpen...... 75 IVY-RID...... 78 hyoscyamine sulfate...... 73 insulin lispro prot & lispro...... 75 IXEMPRA KIT...... 78 hyoscyamine sulfate er...... 73 insulin syringe...... 75 IXIARO...... 78 hyoscyamine sulfate sl...... 73 insulin syringe/needle...... 75 J & J DENTAL FLOSS FOR KIDS...... 78 HYPERCARE...... 73 INSUPEN ULTRAFIN...... 75 JANTOVEN...... 78 HYPERRHO S/D...... 73 INTEGRA...... 76 JANUMET...... 78 hypodermic needle...... 73 intense cough reliever ex st...... 76 JANUMET XR...... 78 171 JANUVIA...... 78 kls natural psyllium fiber...... 80 LANTISEPTIC MULTI-PURPOSE...... 81 JARDIANCE...... 78 kls omeprazole...... 80 LANTUS...... 82 JENTADUETO...... 78 K-MAG...... 80 LANTUS SOLOSTAR...... 82 jessners...... 78 K-MAG ASPARTATE...... 80 l-arginine...... 82 jock itch spray...... 78 K-MAG-70...... 80 LARIN 1/20...... 82 JOHNSONS BABY CORNSTARCH....78 kmart valu insulin syringe 29g...... 80 LARIN FE 1.5/30...... 82 JOHNSONS BABY OIL GEL...... 78 kmart valu insulin syringe 30g...... 80 latanoprost...... 82 JOHNSONS BABY POWDER...... 78 KONSYL...... 80 LATUDA...... 82 JULUCA...... 78 konsyl daily fiber...... 80 laxative...... 82 JUNEL 1.5/30...... 78 KONSYL-D...... 80 laxative pills...... 82 JUNEL 1/20...... 78 korean ginseng...... 80 LAZANDA...... 82 JUNEL FE 1.5/30...... 78 kp hydrocortisone-aloe...... 80 l-carnitine...... 82 k 100...... 78 kp mag-oxide magnesium...... 80 leader insulin syringe...... 82 k-99...... 78 kp silicone scar therapy gel...... 80 lecithin-kelp-b6-cider vinegar...... 82 KAITLIB FE...... 78 K-PHOS...... 80 leflunomide...... 82 KALBITOR...... 78 K-PHOS NO 2...... 80 leg-gesic...... 82 KANGAROO ENTRIFLUSH PUMP kpn prenatal...... 80 lemon-glycerin...... 82 SET...... 78 krill oil...... 80 LENZAPATCH...... 82 KANGAROO JOEY PUMP SET...... 78 KROGER HEALTHPRO LANCET letrozole...... 82 KANK-A MOUTH PAIN...... 78 26G...... 80 leucine...... 82 KANK-A SOFTBRUSH...... 78 kroger insulin syringe...... 80 leucovorin calcium...... 82 KAOPECTATE...... 78 kroger lancets...... 80 LEUKERAN...... 82 KARBOZYME...... 78 kroger lancets 21g...... 80 leuprolide acetate...... 82 K-BICARB...... 78 kroger lancets micro thin 33g...... 80 levalbuterol hcl...... 82 kedbumin...... 78 kroger lancets super thin...... 80 levalbuterol tartrate...... 82 KELNOR 1/35...... 78 kroger lancets thin...... 80 LEVEMIR...... 82 kelp...... 78 kroger lancets thin 26g...... 80 LEVEMIR FLEXTOUCH...... 82 kelp-b6-lecithin-vinegar...... 78 kroger lancets ultrathin 30g...... 80 levetiracetam...... 83 KENALOG...... 78 KT TAPE PRO...... 80 levetiracetam er...... 83 KENDALL ALGINATE DRESS K-TAN PLUS...... 80 levetiracetam in nacl...... 83 8"X8"...... 78 KWAN LOONG PAIN RELIEVING....81 levobunolol hcl...... 83 KENDALL ANTIMICROBIAL KYLEENA...... 81 levocarnitine...... 83 BANDAGE...... 78 labetalol hcl...... 81 levocarnitine (dietary)...... 83 KENDALL CA ALGINATE 6"X10".... 79 LAC-HYDRIN FIVE...... 81 levocarnitine fumarate...... 83 KENDALL HYDROPHILIC FOAM LAC-HYDRIN TWELVE...... 81 levocarnitine-b5-taurine...... 83 DRESS...... 79 lactated ringers...... 81 levocetirizine dihydrochloride...... 83 KENDALL TRANSPARENT FILM lactic acid...... 81 levofloxacin...... 83 DRESS...... 79 lactic acid e...... 81 levoleucovorin calcium...... 83 KEPIVANCE...... 79 lacto-bifidus-600...... 81 LEVO-T...... 83 KERAMATRIX REPLICINE LAMISIL ADVANCED...... 81 LEXIVA...... 83 10CMX10CM...... 79 LAMISIL AT...... 81 l-glutamine...... 83 KERR TRIPLE DYE SWABS...... 79 LAMISIL AT SPRAY...... 81 LICE B GONE...... 83 KESIMPTA...... 79 LAMISILK PROTECT...... 81 LICE B GONE CAP SATURATED...... 83 ketoconazole...... 79 lamivudine...... 81 lice cure...... 83 ketorolac tromethamine...... 79 lamivudine-zidovudine...... 81 lice killing maximum strength...... 83 KETOSTIX...... 79 lamotrigine...... 81 lice treatment...... 83 kettle neti pot sinus wash...... 79 lamotrigine er...... 81 LICEFREEE...... 83 KEY OMEGA...... 79 LANACANE ANTI-BACTERIAL...... 81 LICEMD COMPLETE...... 83 k-iii...... 79 LANACANE MAXIMUM LICIDE TREATMENT...... 83 kimono micro thin...... 79 STRENGTH...... 81 lidocaine...... 83 KINERASE...... 79 LANACORT 10...... 81 lidocaine hcl...... 83 kinney lancets...... 79 lancets...... 81 lidocaine viscous...... 83 kinney thin lancets...... 79 lancets 28g...... 81 lidocaine-hydrocortisone ace...... 83 kinray insulin syringe...... 79 lancets 30g...... 81 lidocaine-menthol...... 83 KINRIX...... 79 lancets micro thin 33g...... 81 lidocaine-prilocaine...... 84 KIONEX...... 79 lancets super thin 28g...... 81 lidocaine-transparent dressing...... 84 KITABIS PAK...... 79 lancets thin...... 81 LIDOPATCH PAIN RELIEF...... 84 KLOR-CON...... 79 LANCETS ULTRA THIN...... 81 lidopin...... 84 KLOR-CON 10...... 79 lancets ultra thin 30g...... 81 LIDOPRO...... 84 KLOR-CON SPRINKLE...... 79 lanolin...... 81 LIDOZENGEL...... 84 KLS ALLER-CORT...... 79 lanolin anhydrous...... 81 LILETTA (52 MG)...... 84 kls cold & flu ms day/night...... 79 lanolin hydrous-grx...... 81 limencin...... 84 kls esomeprazole magnesium...... 80 lansoprazole...... 81 lindane...... 84 172 linezolid...... 84 loxapine succinate...... 86 MASTISOL ADHESIVE...... 88 LINZESS...... 84 LOZIBASE S...... 86 MATULANE...... 88 liothyronine sodium...... 84 l-phenylalanine...... 86 MAVYRET...... 88 lip balm...... 84 l-tyrosine...... 86 MAXI-COMFORT INSULIN LIP MEDEX...... 84 lubiprostone...... 86 SYRINGE...... 88 lip-guard...... 84 lubricant drops/dual-action...... 86 MAXIMUM D3...... 88 lipochol nr...... 84 lubricant eye drops...... 86 ME-500...... 88 lipochol plus...... 84 LUBRISKIN...... 86 mecholyl...... 88 LIPO-GEL...... 84 LUCENTIS...... 86 meclizine hcl...... 88 lipoic acid...... 84 LUDENS COUGH DROPS...... 86 MEDADYNE ORAL PAIN RELIEF.... 88 LIPOTRIAD...... 84 LUDENS THROAT DROPS...... 86 MEDERMA...... 88 LIPOTRIAD VISIONARY...... 84 LUPKYNIS...... 86 MEDERMA AG FACIAL LIQ-10...... 84 LUPRON DEPOT (1-MONTH)...... 86 CLEANSER...... 88 LIQSORB...... 84 LUPRON DEPOT (3-MONTH)...... 86 MEDERMA PM...... 88 LIQUACEL...... 84 LUPRON DEPOT (4-MONTH)...... 86 medic insulin syringe...... 88 LIQUIMAT...... 84 LUPRON DEPOT (6-MONTH)...... 86 medicated body...... 88 lisinopril...... 84 LUPRON DEPOT-PED (1-MONTH)....86 medicated douche...... 88 lisinopril-hydrochlorothiazide...... 84 LUPRON DEPOT-PED (3-MONTH)....87 medicated wipes...... 88 LISTERINE NATURALS lutein...... 87 MEDICONE...... 88 ANTISEPTIC...... 84 LUVENA FEMININE WIPES...... 87 MEDI-DERM/L-RX...... 89 lite touch lancets...... 84 LYCELLE...... 87 MEDI-DERM-RX...... 89 LITETOUCH INSULIN SYRINGE 84, 85 lysine4000...... 87 MEDI-FIRST ANTISEPTIC LITETOUCH LANCETS...... 85 LYSODREN...... 87 CLEANER...... 89 lithium...... 85 M2 C...... 87 medi-first hydrocortisone...... 89 lithium carbonate...... 85 MAALOX...... 87 MEDI-FIRST/LIDOCAINE...... 89 lithium carbonate er...... 85 MAALOX ADVANCED MAX ST...... 87 MEDIHONEY WOUND/BURN LITTLE COLDS COUGH FORMULA.85 MAALOX JUNIOR PLUS ANTIGAS..87 DRESSING...... 89 LITTLE COLDS DECONGESTANT... 85 MACUGEN...... 87 medi-laxx...... 89 LITTLE REMEDIES POISON mafenide acetate...... 87 MEDI-LYTE...... 89 TREAT...... 85 MAG-200...... 87 medi-patch-lidocaine...... 89 LITTLE TUMMYS LAXATIVE...... 85 mag-al...... 87 MEDIPLAST...... 89 LIVALO...... 85 magdelay...... 87 MEDIPORE + PAD ADHESIVE live better lancet super thin...... 85 MAGELLAN INSULIN SAFETY DRESS...... 89 live better lancet ultra thin...... 85 SYR...... 87 MEDISENSE GLUCOSE KETONE liver...... 85 MAGIMIN...... 87 CONTR...... 89 liver extract...... 85 magnacaps...... 87 MEDISENSE HI/MID/LOW l-lysine...... 85 MAGNEBIND 200...... 87 CONTROL...... 89 l-lysine hcl...... 85 MAGNEBIND 300...... 87 MEDISENSE HIGH/LOW CONTROL 89 LMX 4...... 85 magnesium...... 87 MEDISENSE MID CONTROL...... 89 LMX 4 PLUS...... 85 magnesium aspartate...... 87 MEDISENSE THIN LANCETS...... 89 LO LOESTRIN FE...... 85 magnesium carbonate...... 87 medi-tussin dm double strength...... 89 local anesthesia needle...... 85 magnesium chloride...... 87 MEDROX...... 89 LODRANE D...... 85 magnesium chloride-calcium...... 87 medroxyprogesterone acetate...... 89 LOESTRIN FE 1.5/30...... 85 magnesium citrate...... 87 mefenamic acid...... 89 LOHIST-D...... 85 magnesium fizz-plus...... 87 mefloquine hcl...... 89 lohist-dm...... 85 magnesium gluconate...... 87 mega coq10...... 89 longs insulin syringe...... 85 magnesium oxide...... 87, 88 MEGA MULTIVITAMIN...... 89 longs lancets thin...... 85 magnesium sulfate...... 88 megestrol acetate...... 89 loperamide hcl...... 86 magnum-75...... 88 meijer alcohol swabs...... 89 lopinavir-ritonavir...... 86 MAGONATE...... 88 MEIJER LANCETS...... 89 loratadine...... 86 mag-sr plus calcium...... 88 MEIJER LANCETS THIN...... 89 loratadine childrens...... 86 MAG-TAB SR...... 88 MEIJER LANCETS UNIVERSAL loratadine-d 24hr...... 86 MAKENA...... 88 21G...... 89 lorazepam...... 86 malathion...... 88 MEIJER LANCETS UNIVERSAL LORAZEPAM INTENSOL...... 86 manganese...... 88 33G...... 89 LORTUSS DM...... 86 manganese aspartate...... 88 MEIJER SUPER THIN LANCETS...... 89 LORTUSS EX...... 86 manganese gluconate...... 88 melatonin...... 90 LORTUSS LQ...... 86 MANGIMIN...... 88 melatonin er...... 89 losartan potassium...... 86 MAOX...... 88 melatonin tr...... 90 losartan potassium-hctz...... 86 mapap...... 88 melatonin-pyridoxine...... 90 LOTRIMIN AF...... 86 MAPAP HEADACHE PLUS...... 88 MELLOW-TONE...... 90 LOTRIMIN ULTRA...... 86 MAR-COF BP...... 88 meloxicam...... 90 lovastatin...... 86 MAR-COF CG EXPECTORANT...... 88 melphalan...... 90 173 melphalan hcl...... 90 miconazole 7...... 92 MONOVISC...... 95 memantine hcl...... 90 miconazole nitrate...... 92 montelukast sodium...... 95 memantine hcl er...... 90 MICORT-HC...... 92 MORPHABOND ER...... 95 MENACTRA...... 90 microfiber cleaning cloths...... 92 morphine sulfate...... 95, 96 mencaps...... 90 MICROGESTIN 1/20...... 92 morphine sulfate (concentrate)...... 95 m-end dmx...... 90 MICROGESTIN FE 1.5/30...... 92 morphine sulfate (pf)...... 95 M-END PE...... 90 MICROKLENZ...... 92 morphine sulfate er...... 95 MENEST...... 90 MICROLET LANCETS...... 92 morphine sulfate er beads...... 95 menstrual pain relief...... 90 MICROLET NEXT LANCING MOTRIN INFANTS DROPS...... 96 menstrual relief max strength...... 90 DEVICE...... 92 mouth rinse...... 96 MENVEO...... 90 midazolam hcl...... 92 MOVANTIK...... 96 meperidine hcl...... 90 midodrine hcl...... 92 moxifloxacin hcl...... 96 mercaptopurine...... 90 MIDOL CAFFEINE FREE...... 92 moxifloxacin hcl (2x day)...... 96 mesalamine...... 90 MIDOL COMPLETE...... 92 MOZOBIL...... 96 mesalamine er...... 90 MIGERGOT...... 92 ms insulin syringe...... 96 mesalamine-cleanser...... 90 miglitol...... 92 MUCINEX...... 96 mesna...... 90 miglustat...... 92 MUCINEX COUGH CHILDRENS...... 96 MESNEX...... 90 MIL-A-MULSION...... 92 MUCINEX COUGH FOR KIDS...... 96 MESTINON...... 90 MILCO-ZYME...... 92 MUCINEX D...... 96 METAMUCIL...... 90 milk of magnesia concentrate...... 92 MUCINEX D MAX STRENGTH...... 96 METAMUCIL MULTIHEALTH MILLGUARD...... 93 MUCINEX DM...... 96 FIBER...... 90 MILTAB #1...... 93 MUCINEX DM MAXIMUM METAMUCIL SMOOTH TEXTURE...90 mineral oil light...... 93 STRENGTH...... 96 metaproterenol sulfate...... 90 mineral oil-hydrophil petrolat...... 93 MUCINEX FAST-MAX...... 96 METAXALL...... 90 MINIMED GUARDIAN LINK 3...... 93 MUCINEX FAST-MAX COLD & metformin hcl...... 91 MINIMED PRO-SET INFUSION 42".. 93 SINUS...... 96 metformin hcl er...... 91 MINITRAN...... 93 MUCINEX FAST-MAX COLD FLU... 96 methadone hcl...... 91 minocycline hcl...... 93 MUCINEX FAST-MAX CONGEST METHADONE HCL INTENSOL...... 91 minoxidil...... 93 COUGH...... 96 methazolamide...... 91 minoxidil for women...... 93 MUCINEX FAST-MAX DAY/NIGHT.96 methenamine hippurate...... 91 MIRALAX...... 93 MUCINEX FAST-MAX DAY/NIGHT methenamine mandelate...... 91 MIRCERA...... 93 M/S...... 96 methimazole...... 91 MIRENA (52 MG)...... 93 MUCINEX FAST-MAX DAY/NIGHT methionine...... 91 mirtazapine...... 93 TAB...... 96 methitest...... 91 misoprostol...... 93 MUCINEX FOR KIDS...... 96 methocarbamol...... 91 mitomycin...... 93 MUCINEX MAXIMUM STRENGTH..96 methotrexate...... 91 mitoxantrone hcl...... 93 MUCINEX SINUS-MAX methotrexate sodium...... 91 M-M-R II...... 93 CONGESTION...... 96 methotrexate sodium (pf)...... 91 mn-50...... 93 MUCINEX SINUS-MAX methoxsalen...... 91 MODERIBA...... 93 DAY/NIGHT...... 97 methyl salicylate...... 91 moexipril hcl...... 93 MUCINEX SINUS-MAX PRESS & methyldopa...... 91 moisture barrier...... 93 PAIN...... 97 methylphenidate hcl...... 91 MOISTURE GUARD...... 93 MUCINEX STUFFY NOSE/COLD methylphenidate hcl er...... 91 MOISTUREL...... 93 CHILD...... 97 methylprednisolone...... 91 moisturizing skin protectant...... 93 mucus congest & cough child...... 97 methylprednisolone acetate...... 91 molybdenum...... 93 mucus relief cold/sinus max st...... 97 methylprednisolone sodium succ...... 91 mometasone furoate...... 93 mucus relief d...... 97 metipranolol...... 91 MONOCAL...... 93 mucus relief er...... 97 metoclopramide hcl...... 91 MONOJECT ALLERGIST TRAY...... 93 mucus relief pe...... 97 metolazone...... 91 MONOJECT BLUNTIP CANNULA.... 93 mucus relief severe cong/cold...... 97 metoprolol succinate er...... 91 MONOJECT HYPODERMIC mucus-dm max...... 97 metoprolol tartrate...... 92 NEEDLE...... 94 multi-delyn/iron...... 97 metoprolol-hydrochlorothiazide...... 92 MONOJECT INSULIN SYRINGE...... 94 multi-draw needle...... 97 metronidazole...... 92 MONOJECT LIFESHIELD SYRINGE.94 MULTIGEN...... 97 metronidazole in nacl...... 92 MONOJECT MAGELLAN SAFETY MULTIGEN FOLIC...... 97 mexiletine hcl...... 92 NDL...... 94 MULTIGEN PLUS...... 97 MEXSANA...... 92 MONOJECT MAGELLAN SYRINGE.94 multi-minerals...... 97 MG/TAURINE FORTE...... 92 MONOJECT SYRINGE...... 94 multi-purpose cold compress...... 97 MG217 PSORIASIS ANIT-ITCH...... 92 MONOJECT ULTRA COMFORT multi-symptom cold plus child...... 97 MI PASTE PLUS...... 92 SYRINGE...... 94, 95 multi-vit/fluoride...... 97 MIBELAS 24 FE...... 92 MONOLET LANCETS...... 95 multivitamin gummies childrens...... 97 MICATIN...... 92 MONOLET OPD LANCETS...... 95 multivitamin/fluoride...... 97 miconazole 3...... 92 MONONINE...... 95 multivitamin/fluoride/iron...... 97 174 multivitamins/fluoride...... 97 NEOSPORIN + PAIN RELIEF MAX nisoldipine er...... 101 mupirocin...... 97 ST...... 99 NITEBITE...... 101 MURO 128...... 97 NEOSPORIN ORIGINAL...... 99 nite-time cold/flu relief...... 101 muscle rub ultra strength...... 97 NEOSPORIN PLUS MAX ST...... 99 NITRO-BID...... 101 MUSTARGEN...... 97 NEOSPORIN PLUS PAIN RELIEF nitrofurantoin...... 101 M-VIT...... 97 MS...... 99 nitrofurantoin macrocrystal...... 101 MYCOCIDE CX CALLUS NEOSTRATA FACIAL CLEANSER... 99 nitrofurantoin monohyd macro...... 101 EXFOLIATOR...... 97 NEOTUSS-D...... 99 nitroglycerin...... 101 mycophenolate mofetil...... 97 NEPHRONEX...... 99 nitroglycerin er...... 101 mycophenolate sodium...... 98 NEPHRO-VITE...... 99 NIVANEX DMX...... 101 MYGLUCOHEALTH LANCETS 30G.98 NEULASTA...... 99 NIX CREME RINSE...... 101 MYLANTA...... 98 NEUPOGEN...... 99 nizatidine...... 101 MYLERAN...... 98 NEURO-K-250 T.D...... 99 NIZORAL A-D...... 101 MYNATAL...... 98 neuromax...... 99 NOBLE FORMULA...... 101 mynate 90 plus...... 98 NEUROPEN...... 99 NOBLE FORMULA HC...... 101 mynephrocaps...... 98 NEUROTIPS...... 99 nohist-dm...... 101 MYOBLOC...... 98 NEUTROGENA BODY...... 99 nohist-lq...... 101 MYORISAN...... 98 NEUTROGENA CLEAR PORE...... 100 NOKOR ADMIX NEEDLE...... 101 nabumetone...... 98 NEUTROGENA T/GEL...... 100 non-stick...... 101 nac...... 98 NEUTROGENA T/GEL STUBBORN NORDITROPIN FLEXPRO...... 101, 102 nadolol...... 98 ITCH...... 100 NOREL AD...... 102 NAIL SCRUB...... 98 nevirapine...... 100 NOREL CS...... 102 NAIL-EX...... 98 nevirapine er...... 100 norethin ace-eth estrad-fe...... 102 nalbuphine hcl...... 98 NEW DIGNITY ODOR norethindrone acetate...... 102 naloxone hcl...... 98 ELIMINATOR...... 100 norethindrone acet-ethinyl est...... 102 naltrexone hcl...... 98 NEW IMAGE SKIN/FLANGE/TAPE 100 norgestim-eth estrad triphasic...... 102 NAMENDA XR TITRATION PACK...98 new terocin...... 100 NORMLSHIELD...... 102 NAMZARIC...... 98 NEXAFED...... 100 nortemp infants...... 102 NAPHCON-A...... 98 NEXAFED SINUS PRESSURE + nortriptyline hcl...... 102 naproxen...... 98 PAIN...... 100 NORVIR...... 102 naproxen dr...... 98 NEXAVAR...... 100 nosebleed plugs/towelettes...... 102 naproxen sodium...... 98 NEXCARE PREMIUM ADHESIVE NO-STING SKIN-PREP...... 102 naratriptan hcl...... 98 GAUZE...... 100 NOVA SUREFLEX LANCETS...... 102 NARCAN...... 98 NEXIUM 24HR...... 100 NOVAFERRUM...... 102 NASACORT ALLERGY 24HR...... 98 NEXPLANON...... 100 NOVAFERRUM 125...... 102 NASACORT ALLERGY 24HR NEXT CHOICE ONE DOSE...... 100 NOVAFERRUM 50...... 102 CHILDREN...... 98 niacin...... 100 NOVAFERRUM PEDIATRIC DROPS nasal allergy 24 hour...... 98 niacin er...... 100 ...... 102 nasal aspirator...... 98 niacin er (antihyperlipidemic)...... 100 NOVOLIN 70/30 FLEXPEN...... 102 nasal decongestant...... 98 niacin flush free...... 100 NOVOLIN 70/30 FLEXPEN RELION102 nasal decongestant spray...... 98 niacinamide...... 100 NOVOLIN N FLEXPEN...... 102 NASAL EASE ALLERGY nicardipine hcl...... 100 NOVOLIN N FLEXPEN RELION...... 102 RELIEVER...... 98 nicardipine hcl in dextrose...... 100 NOVOLOG 70/30 FLEXPEN nasal mist...... 98 NICODERM CQ...... 100 RELION...... 102 NASALCROM...... 98 NICORETTE...... 100 NOVOLOG FLEXPEN RELION...... 102 NASOGEL...... 99 nicotine...... 101 NOVOLOG MIX 70/30 RELION...... 102 NASONEB NEBULIZER STARTER... 99 nicotine polacrilex...... 100 NOVOLOG RELION...... 102 NASOPEN PE...... 99 nicotine step 1...... 100 NOVOPEN ECHO...... 102 NATACYN...... 99 nicotine step 2...... 100 NOXICARE...... 102 nateglinide...... 99 nicotine step 3...... 100 np thyroid...... 102 NATELLE ONE...... 99 NICOTROL...... 101 NPLATE...... 102 NATROBA...... 99 NIFEDICAL XL...... 101 NUEDEXTA...... 103 natural fiber laxative...... 99 nifedipine...... 101 NUFERA...... 103 natural vitamin e moisturizing...... 99 nifedipine er...... 101 NU-GEL...... 103 NATURAL WHEY...... 99 nifedipine er osmotic release...... 101 NULIDO...... 103 NECON 0.5/35 (28)...... 99 nighttime cough...... 101 NU-MAG...... 103 neomycin sulfate...... 99 nilutamide...... 101 NUPERCAINAL...... 103 neomycin-bacitracin zn-polymyx...... 99 nimodipine...... 101 NUTRATEAR...... 103 neomycin-polymyxin b gu...... 99 NINJACOF...... 101 NUTR-E-SOL...... 103 neomycin-polymyxin-dexameth...... 99 NINJACOF-A...... 101 NUVESSA...... 103 neomycin-polymyxin-gramicidin...... 99 NINJACOF-XG...... 101 NYAMYC...... 103 neomycin-polymyxin-hc...... 99 NIPENT...... 101 NYMALIZE...... 103 NISEKO SUNSCREEN SPF 25...... 101 nystatin...... 103 175 nystatin-triamcinolone...... 103 OPTIONS GYNOL II pain & fever childrens...... 107 NYSTOP...... 103 CONTRACEPTIVE...... 105 pain relief...... 107 NYTOL MAXIMUM STRENGTH.....103 OPTIUM BLOOD GLUCOSE pain relief day & night ex st...... 107 OASIS MOISTURIZING MONITOR...... 105 pain relief roll-on...... 107 MOUTHWASH...... 103 OPTIUM GLUCOSE MONITOR pain reliever extra strength...... 107 OBSTETRIX DHA...... 103 SYSTEM...... 105 pain reliever pm...... 107 OBSTETRIX EC...... 103 OPTIUM TEST...... 105 pain reliever pm ex st...... 107 OC8...... 103 OPTIUMEZ TEST...... 105 pain reliever/fever reducer...... 107 OCEAN BLUE MINICAPS ORA-FILM...... 105 pain relieving...... 107 D/OMEGA3...... 103 oral analgesic max st...... 105 pain relieving + lidocaine...... 107 OCEAN BLUE MINICAPS OMEGA- oral anesthetic...... 105 PALADIN...... 107 3...... 103 oral electrolytes...... 105 pamidronate disodium...... 107 OCEAN BLUE OPTIMAL HEALTH.103 ORAL SWAB PETITE...... 105 pancreatin...... 107 OCEAN COMPLETE SINUS RINSE.103 oral syringe bottle adapter...... 105 PANCREAZE...... 107 OCEAN NASAL SPRAY...... 103 ORALONE...... 105 PANOXYL...... 107 oceanic selenium...... 103 ORAMAGIC PLUS...... 105 PANOXYL WASH...... 107 OCUSOFT LID SCRUB ORAZINC...... 105 PANOXYL-4 CREAMY WASH...... 107 COMPLIANCE...... 103 ORFADIN...... 105 panto-250...... 107 ODEFSEY...... 103 ORILISSA...... 105 pantoprazole sodium...... 107 ODOR EATERS ANTIFUNGAL...... 103 ornithine...... 105 pantothenic acid...... 107 odor spray...... 103 orphenadrine citrate...... 105 papaya enzyme...... 107 OFF ACTIVE...... 103 orphenadrine citrate er...... 105 PARAGARD INTRAUTERINE OFF FAMILYCARE CLEAN FEEL...104 ORTHOVISC...... 105 COPPER...... 108 ofloxacin...... 104 OS-CAL...... 105 paricalcitol...... 108 OGESTREL...... 104 OS-CAL EXTRA D3...... 105 PARODONTAX...... 108 olanzapine...... 104 OS-CAL ULTRA...... 105 paromomycin sulfate...... 108 olmesartan medoxomil...... 104 oseltamivir phosphate...... 105 paroxetine hcl...... 108 olmesartan medoxomil-hctz...... 104 OSTEO-PORETICAL...... 105 paroxetine hcl er...... 108 olopatadine hcl...... 104 ostomy protective...... 105 parvenzyme digestive enzyme...... 108 omega dha...... 104 OUTGRO PAIN RELIEF...... 105 PATADAY...... 108 OMEGA POWER...... 104 ovulation predictor...... 105 PAZEO...... 108 omega-3...... 104 oxaliplatin...... 105, 106 pc lancets super thin 30g...... 108 omega-3 fish oil...... 104 oxandrolone...... 106 PECGEN DMX...... 108 omega-3 fish oil ex st...... 104 oxaprozin...... 106 pedia relief cough/cold...... 108 omega-3 fish oil-vitamin d3...... 104 oxazepam...... 106 PEDIACARE CHILDRENS LONG- OMEGA-3 IQ...... 104 oxcarbazepine...... 106 ACT...... 108 omega-3-acid ethyl esters...... 104 oxybutynin chloride...... 106 PEDIACARE CHILDRENS MULTI- omeprazole...... 104 oxybutynin chloride er...... 106 SYMP...... 108 omeprazole magnesium...... 104 oxycodone hcl...... 106 PEDIACARE MULTI-SYMPTOM.....108 omeprazole-sodium bicarbonate...... 104 oxycodone hcl er...... 106 PEDIA-LAX...... 108 OMNIFLEX DIAPHRAGM...... 104 oxycodone-acetaminophen...... 106 PEDIA-LAX FIBER GUMMIES...... 108 ONCASPAR...... 104 oxycodone-ibuprofen...... 106 PEDIALYTE ADVANCED CARE.....108 ondansetron...... 104 OXYCONTIN...... 106 PEDIARIX...... 108 ondansetron hcl...... 104 oxymorphone hcl...... 106 PEDIAVENT...... 108 one step pregnancy...... 104 oxymorphone hcl er...... 106 PEDIAVIT...... 108 ONE-A-DAY ADULT OXYTROL FOR WOMEN...... 106 PEDVAX HIB...... 108 VITACRAVES+DHA...... 104 OXYZAL WET DRESSING...... 106 PEGANONE...... 108 ONE-A-DAY WOMENS 50+ oyster calcium + d...... 106 PEGASYS...... 108 ADVANTAGE...... 104 oyster calcium/d3...... 106 PEGASYS PROCLICK...... 108 ONETOUCH DELICA LANCETS oyster shell calcium...... 107 PEGINTRON...... 108 30G...... 104 oyster shell calcium 250+d...... 107 penicillamine...... 108 ONETOUCH DELICA LANCETS oyster shell calcium 500+d...... 107 penicillin g potassium...... 108 33G...... 104 oyster shell calcium plus d...... 107 penicillin v potassium...... 108 ONETOUCH FINEPOINT LANCETS105 oyster shell calcium/d...... 107 PENTACEL...... 108 ONETOUCH PING METER oyster shell calcium/d3...... 107 pentamidine isethionate...... 109 REMOTE...... 105 P & S...... 107 PENTASA...... 109 ONETOUCH ULTRASOFT p-1000...... 107 pentoxifylline er...... 109 LANCETS...... 105 PA CLA...... 107 PENTRAX GOLD...... 109 ONEXTON...... 105 pa fish oil/vit d3 triple st...... 107 PEPCID AC...... 109 opium...... 105 pa glucosamine-chondroitin...... 107 PEPCID AC MAXIMUM OPSUMIT...... 105 pa prenatal formula...... 107 STRENGTH...... 109 OPTIONS CONCEPTROL...... 105 pa probiotic complex...... 107 PEPTO-BISMOL...... 109 paclitaxel...... 107 PEPTO-BISMOL MAX STRENGTH. 109 176 PEPTO-BISMOL TO-GO...... 109 pnv-select...... 111 PRECISION XTRA BLOOD PERFORM ATOMIC HEAT...... 109 podofilox...... 111 GLUCOSE...... 112 PERFORM PAIN RELIEVING...... 109 poison ivy wash fast acting...... 111 PRECISION XTRA KETONE...... 113 PERFORM PAIN RELIEVING POLAR FREEZE...... 111 PRECISION XTRA MONITOR...... 113 ROLL-ON...... 109 POLAR FROST...... 111 PRED MILD...... 113 PERIDIN-C...... 109 poly bacitracin...... 111 prednicarbate...... 113 perindopril erbumine...... 109 POLY HIST FORTE...... 111 prednisolone...... 113 PERIOMED...... 109 polyethylene glycol 3350...... 111 prednisolone acetate...... 113 permethrin...... 109 poly-hist dm...... 111 prednisolone sodium phosphate...... 113 PERNOX...... 109 poly-hist pd...... 111 prednisone...... 113 PEROXYL...... 109 poly-iron 150 forte...... 111 PREDNISONE INTENSOL...... 113 PEROXYL SPOT TREATMENT...... 109 polymyxin b-trimethoprim...... 111 preferred plus insulin syringe...... 113 perphenazine...... 109 POLYSPORIN...... 111 preferred plus lancets colored...... 113 perphenazine-amitriptyline...... 109 poly-tussin ac...... 111 preferred plus lancets thin...... 113 PERRY PRENATAL...... 109 POLY-VENT DM...... 111 pregabalin...... 113 petroleum jelly...... 109 POLY-VENT IR...... 111 PREGNITUDE...... 113 PHARMABASE BARRIER...... 109 POLY-VI-SOL...... 111 PREMARIN...... 113 PHARMACY COUNTER LANCETS 109 POLY-VI-SOL/IRON...... 111 PREMIER UROSTOMY...... 113 PHAZYME MAXIMUM STRENGTH potassimin...... 111 PREMPHASE...... 113 ...... 109 potassium chloride...... 111 PREMPRO...... 113 PHAZYME ULTRA STRENGTH...... 109 potassium chloride crys er...... 111 prenatal...... 114 PHENADOZ...... 109 potassium citrate er...... 111 prenatal 19...... 113 PHENAZO...... 109 potassium citrate-citric acid...... 111 prenatal dha...... 113 phenazopyridine hcl...... 109, 110 potassium gluconate...... 111 prenatal formula...... 114 phenelzine sulfate...... 110 potassium iodide (antidote)...... 111 prenatal formula a-free...... 114 phenobarbital...... 110 povidone-iodine...... 111 prenatal low iron...... 114 phenol...... 110 povidone-iodine paint sponge...... 111 prenatal multi +dha...... 114 PHENOL EZ SWABS...... 110 povidone-iodine prep...... 111 prenatal multivitamin plus dha...... 114 phenoxybenzamine hcl...... 110 povidone-iodine scrub sponge...... 111 PRENATAL-U...... 114 phentermine hcl...... 110 power oral care system...... 111 PRENATE...... 114 phenylalanine...... 110 PR NATAL 400...... 111 prep protective skin barrier...... 114 phenylephrine hcl...... 110 PR NATAL 400 EC...... 111 PREPARATION H...... 114 phenylephrine-dm-gg...... 110 PR NATAL 430...... 112 PREPARATION H TOTABLES...... 114 phenytoin...... 110 PR NATAL 430 EC...... 112 pres gen pediatric...... 114 PHENYTOIN INFATABS...... 110 PRADAXA...... 112 PRESGEN B...... 114 phenytoin sodium...... 110 PRALUENT...... 112 PRETZ...... 114 phenytoin sodium extended...... 110 PRAMEGEL...... 112 PREVACARE ANTIMICROBIAL..... 114 PHLEXY-10...... 110 pramipexole dihydrochloride...... 112 PREVACARE EXTRA PROTECTIVE PHOS-FLUR ORTHO DEFENSE...... 110 PRAMOX...... 112 ...... 114 phos-nak...... 110 pramoxine hcl...... 112 PREVACARE PERSONAL phosphatidyl choline...... 110 prasugrel hcl...... 112 PROTECT...... 114 PHOSPHOLINE IODIDE...... 110 pravastatin sodium...... 112 PREVACARE TOTAL SKIN CARE.. 114 PHOTOFRIN...... 110 prazosin hcl...... 112 PREVACID 24HR...... 114 phytonadione...... 110 PRECISION GLUCOSE CONTROL..112 PREVIDENT...... 114 PHYTOPLEX Z-GUARD...... 110 PRECISION GLUCOSE CONTROL PREVNAR 13...... 114 PIFELTRO...... 110 SOLN...... 112 PREZISTA...... 114 pilocarpine hcl...... 110 PRECISION GLUCOSE KETONE PRIFTIN...... 114 pimecrolimus...... 110 CONTR...... 112 PRILOSEC OTC...... 114 pindolol...... 110 PRECISION GLUCOSE/KETONE PRIMATENE ASTHMA...... 114 pinworm medicine...... 110 CONTR...... 112 primidone...... 114 pioglitazone hcl...... 110 PRECISION LINK...... 112 PRO NUTRIENTS OMEGA 3...... 114 pioglitazone hcl-glimepiride...... 110 PRECISION PCX...... 112 PROAIR HFA...... 114 pioglitazone hcl-metformin hcl...... 110 PRECISION PCX PLUS TEST...... 112 probenecid...... 114 piroxicam...... 110 PRECISION POINT OF CARE TEST 112 PROBIOMAX PLUS DF...... 114 PLAN B ONE-STEP...... 110 PRECISION QID MONITOR...... 112 probiotic...... 114 PLASBUMIN-25...... 110 PRECISION QID TEST...... 112 probiotic digestive support...... 114 PLASBUMIN-5...... 110 PRECISION SOF-TACT MONITOR..112 probiotic-prebiotic...... 115 PLIAGEL...... 110 PRECISION SOF-TACT TEST...... 112 PROCARE PLUS UNDERWEAR PLO ULTRAMAX...... 111 PRECISION SUREDOSE PLUS SYR 112 MEDIUM...... 115 PNEUMOVAX 23...... 111 PRECISION SURE-DOSE SYRINGE 112 PRO-CEPTION...... 115 pnv-dha...... 111 PRECISION THINS GP LANCETS... 112 prochlorperazine...... 115 pnv-dha+docusate...... 111 PRECISION XTRA...... 113 prochlorperazine maleate...... 115 pnv-omega...... 111 PROCOMYCIN...... 115 177 PROCTOFOAM...... 115 px insulin syringe...... 117 ra day/night/cold/flu relief...... 118 PROCTOSOL HC...... 115 px lancets ultra thin...... 117 ra daytime cold/flu relief...... 118 PRODIGY INSULIN SYRINGE...... 115 px minoxidil for men...... 117 ra ear wax cleansing system...... 118 PRODIGY NO CODING BLOOD px nasal four...... 117 ra ethyl alcohol...... 118 GLUC...... 115 px nitetime multi-symptom...... 117 ra exfoliating moisturizer...... 118 PRODIGY TWIST TOP LANCETS px omeprazole...... 117 RA E-ZJECT COLOR LANCETS 33G 28G...... 115 PYLERA...... 117 ...... 118 PROFE...... 115 pyrazinamide...... 117 RA E-ZJECT LANCETS 28G...... 118 PROFERRIN ES...... 115 pyridostigmine bromide...... 117 RA E-ZJECT LANCETS THIN 26G...118 PROFERRIN-FORTE...... 115 pyridostigmine bromide er...... 117 RA E-ZJECT LANCETS THIN 28G...118 PROFILNINE SD...... 115 pyridoxine hcl...... 117 RA E-ZJECT LANCETS ULTRA progesterone...... 115 PYRIDOXINE/MINERALS...... 117 THIN...... 118 progesterone micronized...... 115 pyrilamine-phenylephrine...... 117 ra feminine care douche...... 118 PROLENSA...... 115 pyrimethamine...... 117 ra fever reducer/pain reliever...... 118 PROLIDA...... 115 qc alcohol swabs...... 117 ra fiber weight management...... 119 PROMACTA...... 115 qc arthritis...... 117 ra first aid iodine...... 119 promethazine hcl...... 115 qc calamine...... 117 ra first aid non-stick...... 119 promethazine vc/codeine...... 115 qc iodides...... 117 ra first aid saline wound wash...... 119 promethazine-codeine...... 115 qc iodine tincture...... 117 ra fish oil...... 119 promethazine-dm...... 115 qc lancets super thin 30g...... 117 RA FISH OIL EXTRA STRENGTH...119 promethazine-phenylephrine...... 115 qc lancets ultra thin...... 117 ra foaming hand soap refill...... 119 PROMETHEGAN...... 115 QC MEDIFIN PE...... 117 ra gel toe separator...... 119 PROMOLAXIN...... 115 qc natural vegetable...... 117 ra glucosamine-chondroitin...... 119 PRONUTRIENTS CALCIUM+D3..... 115 qc non-adherent...... 117 ra glucosamine-chondroitin-d3...... 119 PRONUTRIENTS SUPER B qc unilet lancets 28g...... 117 ra glucosamine-chondroit-msm...... 119 COMPLEX...... 115 qc unilet lancets micro thin...... 117 ra glucos-chondroit-msm...... 119 propafenone hcl...... 116 Q-GEL...... 117 ra glycerin child...... 119 propafenone hcl er...... 116 quercetin...... 117 ra hemorrhoid relief...... 119 propranolol hcl...... 116 quetiapine fumarate...... 117 ra hot & cold lidocaine...... 119 propranolol hcl er...... 116 quetiapine fumarate er...... 117 ra hot/cold gel sleeve...... 119 propranolol-hctz...... 116 quinapril hcl...... 117 ra hydrogen peroxide...... 119 propylene glycol...... 116 quinapril-hydrochlorothiazide...... 117 ra hydrogen peroxide wipes...... 119 propylthiouracil...... 116 quinidine gluconate er...... 117 ra insulin syringe...... 119 PRO-RED AC...... 116 quinidine sulfate...... 117 ra intimacy gels/him/her...... 119 PROSHIELD SKIN CARE...... 116 quinine sulfate...... 117 ra isopropyl alcohol wipes...... 119 protein...... 116 ra 8 hour pain relief...... 118 ra lice solution...... 119 PROTEINEX...... 116 ra acetaminophen flu cold...... 118 RA LOTION...... 119 PROTEINEX P100...... 116 ra acid reducer plus antacid...... 118 ra lubricant eye drops...... 119 protriptyline hcl...... 116 ra acne maximum...... 118 ra lutein...... 119 PROVENT SLEEP APNEA ra advanced eye health...... 118 RA LYCOPENE...... 119 THERAPY...... 116 ra alcohol swabs...... 118 ra melatonin...... 119 PROVIDA DHA...... 116 ra anorectal...... 118 ra miconazole 3 combo pack...... 119 PROVIEW...... 116 ra antifungal pen...... 118 ra mouth pain anesthetic...... 119 pseudoeph-bromphen-dm...... 116 ra b-12...... 118 ra mucus relief d max strength...... 119 pseudoephedrine hcl...... 116 ra baby care vit a&d to go...... 118 ra multihealth fiber...... 119 pseudoephedrine hcl er...... 116 ra back & body pain relief...... 118 ra nasal strip/drug free/large...... 119 psorcon...... 116 ra backache relief...... 118 ra nighttime cold/flu relief...... 119 PSS SELECT GP LANCETS...... 116 ra b-complex/vitamin c cr...... 118 ra oatmeal moisturizing...... 119 PSS SELECT SAFETY LANCETS.....116 ra ca/mg/zn/cu...... 118 ra omega 3-6-9...... 119 PULMICORT FLEXHALER...... 116 ra calamine...... 118 ra omeprazole...... 119 PULMOZYME...... 116 ra calcium...... 118 ra omeprazole-sodium bicarb...... 120 PURACYN PLUS DUO-CARE...... 116 ra calcium hi-cal/vitamin d...... 118 ra oyster shell calcium/d...... 120 pure l-citrulline...... 116 ra calcium high potency...... 118 ra pain relief...... 120 purefe ob plus...... 116 ra calcium soft chews...... 118 ra personal lubricant...... 120 purified water...... 116 ra calcium-boron...... 118 ra prenatal...... 120 px allergy relief d...... 116 ra cold remedy multi-symptom...... 118 ra probiotic complex...... 120 px allergy sinus pe...... 116 ra cold sore treatment...... 118 ra probiotic digestive care...... 120 px antacid extra strength...... 116 ra cold therapy gel...... 118 ra probiotic gummies...... 120 px artificial tears...... 116 ra cold/sinus max...... 118 RA RENEWAL ACNE TREATMENT px daytime cold...... 116 ra corn cushions small...... 118 ...... 120 px daytime multi-symptom...... 117 ra corn removers ultra thin...... 118 RA RENEWAL DARK SPOT px gas relief extra strength...... 117 ra cranberry...... 118 CORRECTOR...... 120 px ibuprofen cold & sinus...... 117 ra dark tanning...... 118 RA RENEWAL SHOWER & BATH..120 178 ra renewal soothing bath...... 120 RELION BLOOD GLUCOSE TEST...122 RICOLA HERB...... 124 ra saline nasal spray...... 120 RELION GLUCOSE SHOT...... 122 RICOLA LEMON MINT...... 124 ra saline wound wash...... 120 RELION INSULIN SYRINGE...... 122 RICOLA W/ECHINACEA...... 124 ra sensitive anti-itch...... 120 RELI-ON INSULIN SYRINGE...... 122 RIDAURA...... 124 ra severe cold/night cold&flu...... 120 RELION LANCETS MICRO-THIN rifabutin...... 124 ra severe congestion/cold max...... 120 33G...... 122 rifampin...... 124 ra shower & bath body...... 120 RELION LANCETS STANDARD RIGHTEST GL300 LANCETS...... 124 ra silky lubricant moisturizer...... 120 21G...... 122 riluzole...... 124 ra sinus wash nasal relief...... 120 RELION LANCETS THIN 26G...... 122 ringers irrigation...... 124 ra sinus wash neti pot...... 120 RELION LANCETS ULTRA-THIN risacal-d...... 124 ra skin treatment...... 120 30G...... 122 RISAMINE...... 124 ra slow release iron...... 120 RELION ULTRA THIN LANCETS RISPERDAL CONSTA...... 124 ra stay awake...... 120 30G...... 122 risperidone...... 124 ra sterile saline nasal mist...... 120 RELION ULTRA THIN PLUS ritonavir...... 124 ra triple antibiotic...... 120 LANCETS...... 122 RITUXAN...... 124 RA TUGABOOS BABY...... 120 RELISTOR...... 122 rivastigmine...... 124 ra tussin cough dm sugar free...... 120 REMEDY ANTIMICROBIAL rivastigmine tartrate...... 124 ra vagicaine...... 120 CLEANSER...... 122 rixubis...... 124 ra vaginal infection screening...... 120 REMEDY CALAZIME...... 122 rizatriptan benzoate...... 124 ra vitamin b-12...... 120 REMEDY CLEANSING BODY...... 123 robafen...... 124 ra vitamin c...... 120 REMEDY PHYTOPLEX ROBAFEN DM COUGH CLEAR...... 124 ra yeast relief plus...... 120 ANTIFUNGAL...... 123 ROBATHOL...... 124 rabano yodado...... 120 REMEDY SKIN REPAIR...... 123 ROBITUSSIN CHILD RABAVERT...... 120 REMOVE ADHESIVE REMOVER COUGH/COLD CF...... 124 rabeprazole sodium...... 120 WIPES...... 123 ROBITUSSIN CHILDRENS COUGH RADIACARE POST HEALING...... 120 RENACIDIN...... 123 LA...... 125 raloxifene hcl...... 120 renal vitamin...... 123 ROBITUSSIN COLD+FLU ramelteon...... 120 RENFLEXIS...... 123 DAYTIME...... 125 ramipril...... 121 repaglinide...... 123 ROBITUSSIN COUGH+CHEST ranitidine hcl...... 121 REPATHA...... 123 CONG DM...... 125 RASH AWAY...... 121 REPATHA SURECLICK...... 123 ROBITUSSIN DAY/NIGHT VALUE RASH RELIEF...... 121 REPHRESH...... 123 PAK...... 125 raspberry syrup...... 121 REPLACE SR...... 123 ROBITUSSIN LINGERING reality insulin syringe...... 121 RESCON...... 123 COUGHGELS...... 125 reality lancets...... 121 RESCRIPTOR...... 123 ROBITUSSIN MUCUS+CHEST reality swabs...... 121 resorcinol-sulfur...... 123 CONGEST...... 125 reality trigger lancets...... 121 RESOURCE THICKENUP WATER.. 123 ROBITUSSIN MULTI-SYMPTOM REA-LO...... 121 RESPAIRE-30...... 123 MAX...... 125 REBETOL...... 121 RESTASIS...... 123 ROBITUSSIN NIGHTTIME COUGH 125 RECOMBIVAX HB...... 121 RESTORE CLEANSER & ROBITUSSIN NIGHTTIME COUGH RECTICARE...... 121 MOISTURIZER...... 123 DM...... 125 red cross cotton sterile...... 121 RETAINE PM...... 123 ROBITUSSIN PEAK COLD MULTI- REDNESS RELIEF...... 121 REVEAL COLON DISEASE...... 123 SYM...... 125 reeses pinworm medicine...... 121 REVEAL DNA PATERNITY TEST...123 ROBITUSSIN PK COLD DAY/NGHT REFENESEN CHEST CONG/PAIN REVEAL GET PREGNANT QUICK. 123 DM...... 125 RLF...... 121 REVEAL MULTI-DRUG TESTING ROBITUSSIN PK COLD DAY/NGHT REFENESEN CHST CONG/PAIN PE 121 CUP...... 123 MS...... 125 REFRESH...... 121 REVEAL URINARY TRACT...... 123 ROBITUSSIN SEVERE NIGHTTIME REFRESH LACRI-LUBE...... 121 REVITADERM WOUND CARE...... 123 ...... 125 REFRESH OPTIVE...... 121 REVLIMID...... 123 ROBITUSSIN TO GO REFRESH OPTIVE MEGA-3...... 121 REVONTO...... 123 COUGH/COLD CF...... 125 REFRESH OPTIVE SENSITIVE...... 121 REXALL LANCETS ULTRA THIN ROCKLATAN...... 125 REFRESH P.M...... 121 30G...... 123 ROLAIDS...... 125 REFRESH TEARS...... 121 REZAMID...... 123 ropinirole hcl...... 125 REGENECARE HA...... 121 RHINARIS...... 123 rose water...... 125 REGRANEX...... 121 RHINASE...... 123 rosuvastatin calcium...... 125 relagesic...... 121 RHOPRESSA...... 123 ROTARIX...... 125 relcof c...... 121 RIASTAP...... 123 ROTATEQ...... 125 RELIADERM...... 121 RIAX...... 123 rotex...... 125 RELIEF PAIN RELIEVING...... 121 RIBASPHERE...... 124 rufinamide...... 125 reliever...... 121 ribavirin...... 124 ru-hist d...... 125 RELION ALCOHOL SWABS...... 122 riboflavin...... 124 rutin...... 125 RELION ALL-IN-ONE...... 122 RICOLA CHERRY HONEY HERB... 124 RYDEX...... 125 179 rydex g...... 125 SENNA PROMPT...... 127 sm calcium soft chews...... 129 rymed...... 125 senna s...... 127 sm chest congestion relief dm...... 129 rynex pe...... 125 SENNA SMOOTH...... 127 SM CORAL CALCIUM...... 129 rynex pse...... 125 SENOKOT EXTRA STRENGTH...... 127 sm cosmetic puffs jumbo...... 129 S.S.S. TONIC...... 125 SENOKOT S...... 127 sm cough drops...... 129 SAFE TUSSIN PM...... 125 SENSI-CARE BODY...... 127 sm cough/sore throat daytime...... 129 SAFELET IV CATHETER...... 125 SENSI-CARE PERINEAL/SKIN...... 127 sm daytime cold & cough child...... 129 safety insulin syringes...... 125, 126 SENSI-CARE PROTECTIVE sm dental rinse anti-plaque...... 129 SAFETY SEAL LANCETS...... 126 BARRIER...... 127 sm ethyl alcohol (rubbing)...... 129 SAFETY-GARD NEEDLE 18G...... 126 SENSIPAR...... 128 sm foaming antacid...... 129 SAFETY-LOK SYRINGE...... 126 SENSITIVE EYES ENZYME sm fruit coolers...... 129 SALEM SUMP TUBE 12FR...... 126 CLEANER...... 128 sm glucosamine hcl-msm...... 129 salicylic acid...... 126 SENSODYNE MAXIMUM SM GLUCOSAMINE/CALCIUM + D129 salicylic acid wart remover...... 126 STRENGTH...... 128 sm hemorrhoidal...... 129 salicylic acid-cleanser...... 126 SE-PLUS PROTEIN...... 128 sm ibuprofen jr...... 129 saline...... 126 SEREVENT DISKUS...... 128 sm iodides...... 129 SALMON...... 126 sertraline hcl...... 128 sm iodine tincture...... 129 sam-e...... 126 sevelamer carbonate...... 128 sm iron...... 129 SAM-E COMPLETE...... 126 sevelamer hcl...... 128 sm lancets 33g...... 129 sam-g.l.a...... 126 severe allergy...... 128 sm medicated chest rub...... 129 SAMSCA...... 126 severe cold & flu day/night...... 128 sm melatonin...... 130 SANTYL...... 126 sf 5000 plus...... 128 sm natural herb cough drops...... 130 sapropterin dihydrochloride...... 126 shampoo & body wash rinse-free...... 128 sm oatmeal bath...... 130 SARNA...... 126 SHINGRIX...... 128 sm omega-3-6-9 fatty acids...... 130 SASTID SOAP...... 126 SHOPKO ALCOHOL SWABS...... 128 sm omeprazole...... 130 SAVELLA...... 126 SHOPKO UNILET LANCETS 30G....128 sm one daily prenatal...... 130 SAVELLA TITRATION PACK...... 126 SHUR-SEAL CONTRACEPTIVE...... 128 sm pain relief/menthol...... 130 sb alcohol prep...... 126 silace...... 128 sm prenatal vitamins...... 130 sb bacitracin...... 126 sildenafil citrate...... 128 sm slow release iron...... 130 sb childrens cough/runny nose...... 126 silodosin...... 128 sm tussin cf...... 130 sb cold & flu hbp...... 126 silver nitrate...... 128 sm vitamin b1...... 130 sb daytime sinus...... 126 silver sulfadiazine...... 128 SMART SENSE COLOR LANCETS sb fib lax orange...... 126 SILVERMED...... 128 33G...... 130 sb insulin syringe...... 126 SIMILAC STERILIZED WATER...... 128 SMART SENSE STANDARD sb lancets thin...... 127 SIMILASAN DRY EYE RELIEF...... 128 LANCETS...... 130 sb lancets ultra thin...... 127 SIMILASAN PINK EYE RELIEF...... 128 SMART SENSE SUPER THIN sb lice treatment...... 127 SIMILASAN STYE EYE RELIEF...... 128 LANCETS...... 130 sb nighttime sinus multi-sympt...... 127 simple syrup...... 128 SMART SENSE THIN LANCETS sb omeprazole...... 127 simvastatin...... 128 26G...... 130 sb stool softener...... 127 SINADRIN PE COMPLETE SINUS smoothfit cuff...... 130 scarcin...... 127 REL...... 128 sod citrate-citric acid...... 130 scot-tussin expectorant...... 127 sinus & cold-d...... 128 sodium bicarbonate...... 130 SCYTERA...... 127 sinus & congestion day/night...... 128 sodium chloride...... 130 se-100...... 127 sinus congestion/pain daytime...... 128 sodium chloride (hypertonic)...... 130 SEBUDERM...... 127 sinus relief...... 128 sodium fluoride...... 130 SEBULEX...... 127 sirolimus...... 128, 129 sodium phenylbutyrate...... 130 SECONAL...... 127 siterol...... 129 sodium polystyrene sulfonate...... 130 SECURA EXTRA PROTECTIVE...... 127 skin protectant...... 129 sofosbuvir-velpatasvir...... 130 SECURA MOISTURIZING skin tag remover...... 129 solifenacin succinate...... 130 CLEANSER...... 127 SKINTEGRITY HYDROGEL...... 129 SOLIRIS...... 130 SECURA TWO-STEP...... 127 SKYLA...... 129 SOLUBLE FIBER THERAPY...... 130 SELECT-OB...... 127 sleep aid...... 129 solvatech plus...... 130 selegiline hcl...... 127 SLEEP-N-HEEL...... 129 SOMBRA COOL THERAPY...... 130 selenicaps-200...... 127 SLO-NIACIN...... 129 SOMBRA WARM THERAPY...... 130 selenimin...... 127 SLOW FE...... 129 SOOTHE & COOL INZO BARRIER. 130 selenium er...... 127 slow iron...... 129 SOOTHE XP XTRA PROTECTION.. 130 selenium sulfide...... 127 slow magnesium/calcium...... 129 sorbitol...... 131 SELSUN BLUE DEEP CLEANSING.127 slow release iron...... 129 sorbutuss nr...... 131 SELZENTRY...... 127 sm alcohol prep...... 129 sore throat...... 131 se-natal 19...... 127 sm allergy relief...... 129 sore throat lozenges...... 131 senna...... 127 sm b super vitamin complex...... 129 sotalol hcl...... 131 senna laxative...... 127 sm biotin...... 129 sotalol hcl (af)...... 131 senna leaves...... 127 sm calamine...... 129 soya lecithin...... 131 180 spinosad...... 131 sulindac...... 133 tamsulosin hcl...... 135 SPIRIVA HANDIHALER...... 131 sumatriptan...... 133 TANDEM...... 135 spironolactone...... 131 sumatriptan succinate...... 133 tangerine...... 135 spironolactone-hctz...... 131 sumatriptan succinate refill...... 133 TARGRETIN...... 135 sportbalm...... 131 SUMMERS EVE DEODORANT taron forte...... 135 SPORTSCREME...... 131 ULTRA...... 133 TARON-PREX...... 135 spot acne treatment...... 131 super b-50 complex...... 133 TARSUM...... 135 SPRAYZOIN...... 131 super c-500 complex...... 133 taurine...... 136 SPS...... 131 super cal/mag...... 133 tazarotene...... 136 stahist ad...... 131 super moleskin...... 133 TAZORAC...... 136 STALEVO 100...... 131 SUPER OMEGA-3...... 133 TAZTIA XT...... 136 STALEVO 125...... 131 super thin lancets...... 133 tb syringe 1 ml...... 136 STALEVO 150...... 131 supposibase f...... 133 tdm solution...... 136 STALEVO 200...... 131 SUPPRELIN LA...... 133 TEAR FLO...... 136 STALEVO 75...... 131 SUPREP BOWEL PREP KIT...... 133 TEARS NATURALE PM...... 136 STANBACK HEADACHE supress a pediatric...... 133 TECHLITE AST LANCETS...... 136 POWDERS...... 131 supress dm pediatric...... 133 TECHLITE LANCETS...... 136 stavudine...... 131 SUPRESS-PE PEDIATRIC...... 133 TECHLITE LANCETS 30G...... 136 STERILANCE TL...... 131 sure comfort alcohol prep...... 133 TECNU FIRST AID...... 136 STERILE LUBRICANT...... 131 sure comfort insulin syringe...... 133, 134 TEGADERM CONTACT LAYER...... 136 STERI-STRIP COMPOUND sure comfort lancets 28g...... 134 TEGADERM FOAM...... 136 BENZOIN...... 131 sure comfort lancets 30g...... 134 TEGADERM FOAM ADHESIVE...... 136 STERI-TAMP SEALS SURE-JECT INSULIN SYRINGE...... 134 TEGADERM HYDROGEL WOUND BOTTLES/VIALS...... 131 SURE-LANCE ULTRA THIN FILLER...... 136 STERI-TAMP SEALS/BAGS...... 131 LANCETS...... 134 telmisartan...... 136 STERI-TAMP SEALS/SYRINGES.....131 SURELITE LANCETS...... 134 telmisartan-hctz...... 136 STIMATE...... 131 SUSPENDOL-S...... 134 temazepam...... 136 STIMEX INSULATED NEEDLE...... 131 SUTENT...... 134 temozolomide...... 136 STIMULEN...... 131 SWEEN...... 134 temsirolimus...... 136 STIOLTO RESPIMAT...... 131 SWEEN PREP...... 134 tenofovir disoproxil fumarate...... 136 STOMAHESIVE MOLDABLE SWIM EAR...... 134 tension headache...... 136 ADHESIVE...... 131 swimmers instant ear dry...... 134 terazosin hcl...... 136 STOMAHESIVE PASTE...... 131 SYLATRON...... 134 terbinafine hcl...... 136 stop lice maximum strength...... 131 SYMBICORT...... 134 terbutaline sulfate...... 136 STRIANT...... 131 sympathetic nerve needle...... 134 terconazole...... 136 STRIBILD...... 132 SYNAGIS...... 134 teriparatide (recombinant)...... 136 STRIDEX ESSENTIAL...... 132 Synera...... 134 terocin...... 136 STRI-DEX SENSITIVE SKIN...... 132 SYNJARDY...... 135 teroderm-plus...... 136 STUART ONE...... 132 SYNVISC...... 135 TESTOPEL...... 136 SUBLOCADE...... 132 SYNVISC ONE...... 135 testosterone...... 137 SUBOXONE...... 132 syringe...... 135 testosterone cypionate...... 136 SUBSYS...... 132 syringe 10-12 ml...... 135 testosterone enanthate...... 137 sucralfate...... 132 syringe 20-25 ml...... 135 tetanus-diphtheria toxoids td...... 137 SUDAFED...... 132 syringe 2-3 ml...... 135 tetrabenazine...... 137 SUDAFED 24 HOUR...... 132 syringe 30-35 ml...... 135 tetracycline hcl...... 137 SUDAFED CHILDRENS...... 132 syringe 50-60 ml...... 135 TETRA-FORMULA CGH/SORE SUDAFED PE CHILDRENS...... 132 syringe 5-6 ml...... 135 THROAT...... 137 SUDAFED PE COLD & COUGH syringe luer slip...... 135 tgt alcohol swabs...... 137 CHILD...... 132 syringe precisedose dispenser...... 135 tgt first aid cleansing...... 137 SUDAFED PE DAY & NIGHT...... 132 SYRSPEND SF...... 135 tgt lancet micro thin 33g...... 137 SUDAFED PE MAXIMUM SYRSPEND SF PH4...... 135 tgt lancet thin 26g...... 137 STRENGTH...... 132 syrup nf...... 135 tgt lancet ultra thin 30g...... 137 SUDAFED PRESSURE+PAIN 12 HR132 SYSTANE...... 135 tgt lubricant eye drops...... 137 sulfacetamide sodium...... 132 SYSTANE BALANCE...... 135 tgt lubricant redness reliever...... 137 sulfacetamide sodium (acne)...... 132 SYSTANE LID WIPES...... 135 tgt omeprazole...... 137 sulfacetamide sodium-sulfur...... 132 SYSTANE OVERNIGHT THERAPY 135 THALOMID...... 137 sulfacetamide-prednisolone...... 132 SYSTANE PRESERVATIVE FREE...135 THE ITCH ERASER...... 137 sulfadiazine...... 132 SYSTANE ULTRA...... 135 THEOCHRON...... 137 sulfamethoxazole-trimethoprim...... 132 SYSTANE ULTRA PF...... 135 theophylline er...... 137 SULFAMYLON...... 132 TABLOID...... 135 THERACOF PLUS COUGH/COLD sulfasalazine...... 132 tacrolimus...... 135 REL...... 137 sulfo-lo...... 132 tadalafil (pah)...... 135 THERACYS...... 137 sulfur...... 133 tamoxifen citrate...... 135 THERA-D 4000...... 137 181 THERAFLU COLD & COUGH...... 137 tolazamide...... 139 trifluridine...... 141 THERAFLU EXPRESSMAX...... 137 tolbutamide...... 139 trigels-f forte...... 141 THERAFLU FLU & SORE THROAT 137 tolmetin sodium...... 139 trihexyphenidyl hcl...... 141 THERAFLU SEVERE COLD...... 137 tolnaftate...... 139 TRI-LO-SPRINTEC...... 141 THERAFLU SEVERE COLD & tolterodine tartrate...... 139 trimethobenzamide hcl...... 141 COUGH...... 137 tolterodine tartrate er...... 139 trimethoprim...... 141 THERAFLU SEVERE COLD toomey syringe...... 139 trimipramine maleate...... 141 DAYTIME...... 137 topcare lancets micro-thin 33g...... 139 TRINATE...... 142 THERAFLU SEVERE COLD topcare ultra comfort ins syr...... 139 triple antibiotic...... 142 NIGHTTIME...... 137 TOPICAINE 5...... 139 TRIPLE FLEX...... 142 THERAFLU SEVERE COLD/CGH topiramate...... 140 triple helix collagen...... 142 NIGHT...... 137 topotecan hcl...... 140 TRIPLE PASTE...... 142 THERAFLU WARMING RELIEF torsemide...... 140 triprolidine hcl...... 142 SINUS...... 138 TOVIAZ...... 140 TRISENOX...... 142 THERA-GESIC...... 138 TRACLEER...... 140 TRISPEC PSE PEDIATRIC...... 142 THERANATAL COMPLETE...... 138 TRADJENTA...... 140 TRIUMEQ...... 142 THERANATAL OVAVITE...... 138 tramadol hcl...... 140 TRI-VI-SOL...... 142 THERAPLEX T...... 138 tramadol hcl er...... 140 tri-vitamin/fluoride...... 142 THERASEAL HAND PROTECTION 138 tramadol hcl er (biphasic)...... 140 TROCAINE THROAT...... 142 THERATEARS...... 138 tramadol-acetaminophen...... 140 TROCAL COUGH SUPPRESSANT.. 142 THERATEARS NUTRITION...... 138 trandolapril...... 140 trochibase s...... 142 thermometer covers...... 138 tranexamic acid...... 140 TROGARZO...... 142 thiamine...... 138 TRANQUILITY BRIEFS...... 140 TROMBONEX-D...... 142 THINLETS GP LANCETS...... 138 TRANSANOSIL...... 140 trospium chloride...... 142 thioridazine hcl...... 138 transderm-iq...... 140 TRUEPLUS GLUCOSE...... 142 thiotepa...... 138 tranylcypromine sulfate...... 140 TRUEPLUS INSULIN SYRINGE...... 142 thiothixene...... 138 TRANZAREL...... 140 TRUEPLUS LANCETS 26G...... 142 thrivite 19...... 138 travel sickness...... 140 TRUEPLUS LANCETS 28G...... 142 THYROLAR-1...... 138 travoprost (bak free)...... 140 TRUEPLUS LANCETS 30G...... 143 THYROLAR-1/2...... 138 trazodone hcl...... 140 TRUEPLUS LANCETS 33G...... 143 THYROLAR-1/4...... 138 TREANDA...... 140 TRULICITY...... 143 THYROLAR-2...... 138 T-RELIEF PAIN ARNICA + 12...... 140 TRUSTEX NON-LUBRICATED...... 143 THYROLAR-3...... 138 T-RELIEF PAIN RELIEF...... 140 TRUSTEX RIA NON-LUBRICATED 143 tiagabine hcl...... 138 TRELSTAR MIXJECT...... 140 trymine cg...... 143 TIELLE...... 138 treprostinil sodium...... 140 TUMS E-X 750...... 143 TIGER BALM EXTRA STRENGTH. 138 tretinoin...... 140 TUMS LASTING EFFECTS...... 143 TIGER BALM LINIMENT...... 138 TREXALL...... 140 TUMS ULTRA 1000...... 143 TIGER BALM MUSCLE RUB...... 138 triacting nightime cold&cough...... 140 tuohy epidural needle tw...... 143 TIGER BALM NECK & SHOULDER triamcinolone acetonide...... 140, 141 TUSICOF...... 143 RUB...... 138 TRIAMINIC CHEST/NASAL TUSNEL C...... 143 TIGER BALM PAIN RELIEVING.....138 CONGEST...... 141 TUSNEL PEDIATRIC...... 143 TIGER BALM PAIN RELIEVING LG TRIAMINIC COLD & ALLERGY..... 141 TUSNEL-DM PEDIATRIC...... 143 ...... 138 TRIAMINIC COLD/COUGH...... 141 tussin...... 143 TIGER BALM RED EXTRA TRIAMINIC COLD/COUGH DAY tussin cf cough & cold...... 143 STRENGTH...... 138 TIME...... 141 tussin cf max multi-symptom...... 143 TIGER BALM REGULAR TRIAMINIC COUGH/RUNNY NOSE tussin cough...... 143 STRENGTH...... 138 ...... 141 tussin cough dm...... 143 TIGER BALM ULTRA STRENGTH. 138 TRIAMINIC COUGH/SORE tussin cough long-acting...... 143 TILIA FE...... 138 THROAT...... 141 tussin dm max...... 143 timolol maleate...... 138, 139 TRIAMINIC FEVER REDUCER...... 141 TUSSI-PRES...... 143 TINACTIN...... 139 TRIAMINIC FLU COUGH & FEVER141 TUSSI-PRES PE PEDIATRIC...... 143 TINACTIN JOCK ITCH...... 139 TRIAMINIC FLU/COUGH/FEVER... 141 TUSSI-PRES PEDIATRIC...... 143 TITRALAC...... 139 TRIAMINIC LONG ACTING TUSSLIN PEDIATRIC...... 143 TIVICAY...... 139 COUGH...... 141 TWINRIX...... 143 tizanidine hcl...... 139 TRIAMINIC NIGHT TIME TYLENOL...... 144 TN DICKINSONS WITCH HAZEL... 139 COLD/CGH...... 141 TYLENOL 8 HOUR...... 143 TOBI PODHALER...... 139 TRIAMINIC SORE THROAT...... 141 TYLENOL CHILDRENS CLD+CGH 143 TOBRADEX...... 139 triamino...... 141 TYLENOL CHILDRENS PLUS MS tobramycin...... 139 triamterene-hctz...... 141 COLD...... 143 tobramycin-dexamethasone...... 139 triazolam...... 141 TYLENOL COLD & HEAD...... 143 TODAY SPONGE...... 139 tri-buffered aspirin...... 141 TYLENOL COLD MAX...... 143 todays health thin lancets 28g...... 139 tricitrates...... 141 TYLENOL COLD MULTI- todays health thin lancets 30g...... 139 trifluoperazine hcl...... 141 SYMPTOM...... 144 182 TYLENOL COLD/FLU SEVERE...... 144 UNIVERSAL 1 LANCETS THIN 26G VELCADE...... 149 TYLENOL EXTRA STRENGTH...... 144 ...... 147 venaliv...... 149 TYLENOL INFANTS...... 144 UNIVERSAL 1 LANCETS THIN 33G VENIA...... 149 TYLENOL PM EXTRA STRENGTH.144 ...... 147 venlafaxine hcl...... 149 TYLENOL SINUS SEVERE...... 144 UNIVERSAL 1 LANCETS ULTRA venlafaxine hcl er...... 149 TYLENOL WARMING THIN...... 147 VENTAVIS...... 149 COUGH/CONGEST...... 144 universal ph...... 147 VENTOLIN HFA...... 149 TYPHIM VI...... 144 urea...... 147 verapamil hcl...... 150 tyrosine...... 144 urea 20 intensive hydrating...... 147 verapamil hcl er...... 149, 150 TYVASO REFILL...... 144 urea hydrating...... 147 VERELAN PM...... 150 UBRELVY...... 144 urea nail...... 147 VERQUVO...... 150 ULCEREASE...... 144 urinary pain relief...... 147 VERSAPLUS...... 150 ULTICARE ALCOHOL SWABS...... 144 URO-MAG...... 147 VERSIVA XC...... 150 ULTICARE INSULIN SAFETY SYR 144 ursodiol...... 147, 148 VH ESSENTIALS UTI RELIEF...... 150 ULTICARE INSULIN SYRINGE vagicaine...... 148 VIBERZI...... 150 ...... 144, 145 VAGISIL...... 148 VIBRAMYCIN...... 150 ULTICARE SYRINGE...... 145 valacyclovir hcl...... 148 VICKS DAYQUIL MUCUS ULTICARE TUBERCULIN SAFETY valerian...... 148 CONTROL DM...... 150 SYR...... 145 valerian root...... 148 VICKS NYQUIL CHILDRENS ultilet alcohol swabs...... 145 valganciclovir hcl...... 148 CLD/CGH...... 150 ULTILET CLASSIC LANCETS...... 145 valine...... 148 VICKS NYQUIL COLD & FLU ULTILET INSULIN SYRINGE...... 145 VALINE 1000...... 148 NIGHT...... 150 ULTILET INSULIN SYRINGE valproate sodium...... 148 VICKS NYQUIL COUGH...... 150 SHORT...... 145, 146 valproic acid...... 148 VICKS NYQUIL SEVERE COLD & ULTILET LANCETS...... 146 valsartan...... 148 FLU...... 150 ultra comfort insulin syringe...... 146 valsartan-hydrochlorothiazide...... 148 VICKS SINEX DAYQUIL/NYQUIL..150 ULTRA FRESH...... 146 VALSTAR...... 148 VICKS SINEX DAYTIME...... 150 ULTRA FRESH PM...... 146 VALTOCO 10 MG DOSE...... 148 VICKS SINEX NIGHTTIME...... 150 ULTRA MEGA GOLD...... 146 VALTOCO 15 MG DOSE...... 148 VICKS VAPO STEAM...... 150 ULTRA MIDE 25...... 146 VALTOCO 20 MG DOSE...... 148 VICKS VAPODROPS...... 150 ULTRABAG/DIANEAL PD- VALTOCO 5 MG DOSE...... 148 VICKS VAPOINHALER...... 150 2/4.25%DEX...... 146 value health insulin syringe...... 148 VICKS VAPOPADS PEDIATRIC...... 150 ultracin...... 146 value plus lancet standard 21g...... 148 VICKS VAPORIZER SCENT...... 150 ULTRACIN M...... 146 value plus lancets super thin...... 148 VICKS VAPORUB...... 150 ULTRACIN T...... 146 value plus lancets thin 26g...... 148 VICODIN...... 150 ULTRACIN-M...... 146 valumark lancet super thin 30g...... 148 VICODIN ES...... 150 ultra-comfort insulin syringe...... 146 valumark lancet ultra thin 28g...... 148 VICODIN HP...... 150 ultrasone...... 146 VAMOUSSE LICE TREATMENT.....148 VICTOZA...... 150 ULTRA-THIN II INS SYR SHORT VANACHOL...... 148 VIDA MIA UNILET LANCETS 28G.150 ...... 146, 147 VANACOF...... 148 VIDEX...... 150 ULTRA-THIN II INSULIN SYRINGE VANACOF AC...... 148 vigabatrin...... 150 ...... 147 VANACOF DM...... 148 VIIBRYD...... 150 ULTRA-THIN II LANCETS...... 147 VANACOF-8...... 148 VIMPAT...... 150, 151 UMCKA ELDERBERRY COLD+FLU vanadium...... 148 VINATE II...... 151 ...... 147 VANATAB AC...... 148 VINATE M...... 151 UMCKA FASTACTIVES VANATAB DM...... 148 vinblastine sulfate...... 151 COLD+FLU...... 147 vancomycin hcl...... 149 VINCASAR PFS...... 151 UMECTA MOUSSE...... 147 vancomycin hcl in dextrose...... 148, 149 VINCE...... 151 UNDELENIC...... 147 vancomycin hcl in nacl...... 149 vinorelbine tartrate...... 151 unibase...... 147 VANDAZOLE...... 149 VIRACEPT...... 151 UNILET COMFORTOUCH LANCET VANICREAM DIAPER RASH...... 149 virtussin dac...... 151 ...... 147 VANIPLY...... 149 VISI-FLOW IRRIGATION STARTER UNILET EXCELITE...... 147 VANISHPOINT SAFETY SYRINGE.149 ...... 151 UNILET EXCELITE II...... 147 VANTAS...... 149 vita-c...... 151 UNILET G.P. LANCET...... 147 VAPOR PATCH...... 149 VITA-CALCIUM...... 151 UNILET G.P. SUPERLITE LANCET.147 vaporizing steam...... 149 VITADYE...... 151 UNILET GP 28 ULTRA THIN...... 147 VAQTA...... 149 VITAFOL ULTRA...... 151 UNILET LANCET...... 147 VARIVAX...... 149 VITALINE BIOTIN FORTE/ZINC.....151 UNILET MICRO-THIN 33G...... 147 VASHE WOUND THERAPY...... 149 VITALINE COQ10...... 151 UNILET SUPERLITE LANCET...... 147 VASOCLEAR-A...... 149 VITA-MAG...... 151 UNILET SUPER-THIN 30G...... 147 VASOFLEX D1...... 149 VITAMAX...... 151 UNILET ULTRA-THIN 28G...... 147 VCF VAGINAL CONTRACEPTIVE. 149 VITAMELTS ENERGY VITAMIN B- UNI-SOLVE...... 147 VECTIBIX...... 149 12...... 151 183 vitamin a...... 151 wal-tap cold/allergy...... 153 ZANTAC 150 MAXIMUM vitamin a & d...... 151 wal-tussin cf...... 153 STRENGTH...... 155 VITAMIN A FISH...... 151 WAL-TUSSIN CF MAX...... 153 ZANTAC 75...... 155 vitamin a palmitate...... 151 wal-tussin cough relief...... 153 Z-BUM...... 155 vitamin a wrinkle treatment...... 151 WAL-ZYR...... 153 ZEASORB...... 155 vitamin a-beta carotene...... 151 WAL-ZYR CHILDRENS...... 153 ZEGERID OTC...... 155 vitamin b complex-c...... 151 warfarin sodium...... 153 ZELBORAF...... 155 vitamin b-1...... 151 wart remover maximum strength...... 153 ZENATANE...... 155 vitamin b12...... 151 water tabs...... 153 ZENPEP...... 155 vitamin b-12...... 151 wax for braces...... 153 ZEPHREX-D...... 155 vitamin b-2...... 151 WEBCOL ALCOHOL PREP LARGE 153 ZE-PLUS...... 155 vitamin b-6...... 151 WEBCOL ALCOHOL PREP ZERIT...... 155 vitamin b-6 er...... 151 MEDIUM...... 153 ZEVALIN Y-90...... 155 vitamin c...... 152 wee care...... 153 ZICAM ALLERGY RELIEF...... 155 vitamin c (calcium ascorbate)...... 151 wegmans complete prenatal+dha...... 153 ZICAM COLD REMEDY...... 155 vitamin c drops...... 151 WEISS EPIDURAL NEEDLE...... 153 zidovudine...... 155 vitamin c er...... 151 WEISS EPIDURAL NEEDLE TW..... 153 ZIKS ARTHRITIS PAIN RELIEF...... 155 vitamin c gummies...... 152 WELLMIND MENTAL FOCUS...... 153 ZILACTIN...... 156 vitamin c plus wild rose hips...... 152 WHITE PED ARTERIAL NEEDLE... 153 ZILACTIN-B...... 156 vitamin c-rose hips er...... 152 white petrolatum...... 154 ZIMS CRACK CREME DIABETIC... 156 vitamin d2...... 152 white petroleum jelly...... 154 ZIMS MAX-FREEZE...... 156 vitamin d3...... 152 WIDE-SEAL DIAPHRAGM 60...... 154 zinc...... 156 vitamin d-400...... 152 WIDE-SEAL DIAPHRAGM 65...... 154 zinc + vitamin c...... 156 vitamin e...... 152 WIDE-SEAL DIAPHRAGM 70...... 154 ZINC 15...... 156 VITAMIN E & C BEAUTY LOTION 152 WIDE-SEAL DIAPHRAGM 75...... 154 zinc aspartate...... 156 VITAMIN E & K BEAUTIFUL SKIN 152 WIDE-SEAL DIAPHRAGM 80...... 154 zinc gluconate...... 156 vitamin e beauty...... 152 WIDE-SEAL DIAPHRAGM 85...... 154 zinc methionate...... 156 vitamin e/selenium...... 152 WIDE-SEAL DIAPHRAGM 90...... 154 zinc oxide...... 156 vitamins acd-fluoride...... 152 WIDE-SEAL DIAPHRAGM 95...... 154 zinc sulfate...... 156 VITAMINS E & A BEAUTY OIL...... 152 WINGS MATERNITY PANTS 2X-3X zinc-c-b6...... 156 VITAMINS E & D BEAUTY OIL...... 152 ...... 154 zincolate...... 156 VITA-RAY...... 152 WINRHO SDF...... 154 ZINC-OXYDE PLUS...... 156 VITONIC...... 152 witch hazel...... 154 zinc-vitamin c...... 156 viva...... 152 WIXELA INHUB...... 154 ziprasidone hcl...... 156 VIVA DROPS...... 152 wound gel...... 154 ZITHROMAX...... 156 VIVABEN...... 152 wound gel spray...... 154 zn-50...... 156 VIVITROL...... 152 WYMZYA FE...... 154 ZOLADEX...... 156 VIVOTIF...... 152 XARELTO...... 154 zoledronic acid...... 156 vocabria...... 152 XARELTO STARTER PACK...... 154 ZOLINZA...... 156 voriconazole...... 152 XEOMIN...... 154 zolmitriptan...... 156 vp insulin syringe...... 152 XERAC AC...... 154 zolpidem tartrate...... 156 VYVANSE...... 152 XEROFORM PETROLAT GAUZE zolpidem tartrate er...... 156 WAL-DRYL...... 153 1"X8"...... 154 ZOMIG...... 156 WAL-DRYL ANTI-ITCH...... 153 XGEVA...... 154 zonisamide...... 156 WAL-DRYL PE ALLERGY & SINUS XIAFLEX...... 154 ZOSTAVAX...... 156 ...... 153 XIFAXAN...... 154 ZOSTRIX HOT & COLD THERAPY 156 WAL-FEX D ALLERGY & XIGDUO XR...... 154 ZOSTRIX HP...... 156 CONGESTION...... 153 XOFLUZA (40 MG DOSE)...... 154 ZOSTRIX NATURAL PAIN RELIEF 156 WAL-FLU COLD & SORE THROAT153 XOFLUZA (80 MG DOSE)...... 154 ZOSTRIX-HP...... 157 WAL-FLU SEV COLD/CGH XOLAIR...... 155 ZOVIRAX...... 157 DAY/NIGHT...... 153 xolido...... 155 Z-TUSS AC...... 157 WALGREENS LANCETS...... 153 X-SEB T PEARL...... 155 ZYCLARA...... 157 walgreens lancets micro thin...... 153 XTRA-CARE...... 155 ZYCLARA PUMP...... 157 walgreens lancets super thin...... 153 XULANE...... 155 ZYLET...... 157 WALGREENS THIN LANCETS...... 153 XYREM...... 155 ZYNCOF...... 157 WALGREENS ULTRA THIN YES FOR WOMEN...... 155 ZYRTEC ALLERGY...... 157 LANCETS...... 153 YF-VAX...... 155 ZYRTEC-D ALLERGY & WAL-ITIN D...... 153 YUVAFEM...... 155 CONGESTION...... 157 WAL-MUCIL PLUS CALCIUM...... 153 ZADITOR...... 155 ZZZQUIL...... 157 WAL-PHED PE ZAFEMY...... 155 DAYTIME/NIGHTTIME...... 153 zafirlukast...... 155 WAL-SLEEP Z...... 153 zaleplon...... 155 WAL-SLEEP Z LIQUID SHOTS...... 153 ZANOSAR...... 155 184