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VIRGINIA HEALTH PLAN

Non-Part D/OTC Wrap 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 12 hour decongestant extended release 12 hour 120 Formulary Custom (*); OTC mg oral 120 mg 12 hour 0.05 % nasal 0.05 % Formulary Custom (*); OTC 2-deoxy-d-glucose Formulary 3 day vaginal 2 % vaginal 2 % Formulary Custom (*); OTC 7-keto dhea powder Formulary 8 hour relief tablet extended release 650 mg oral 650 Formulary Custom (*); OTC mg 8 hour pain reliever tablet extended release 650 mg oral Formulary Custom (*); OTC 650 mg A & D OXIDE EXTERNAL CREAM 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 25000 unit Formulary OTC ABATRACE ORAL CAPSULE Formulary OTC ABATREX ORAL TABLET 8-200-4-100-600 MG Formulary OTC ABATRON ORAL Formulary OTC ABREVA CREAM 10 % EXTERNAL 10 % Formulary Custom (*); OTC acacia powder Formulary a-caro-25 capsule 25000 unit oral 25000 unit Formulary Custom (*); OTC ACCU-CHEK ULTRAFLEX INF SET Formulary ACCUTREND CHOLESTEROL CONTROL IN VITRO Formulary OTC SOLUTION ACCUTREND CHOLESTEROL IN VITRO STRIP Formulary OTC ACCUTREND PLUS DEVICE Formulary OTC ACE KNEE BRACE W/STABILIZERS Formulary OTC ACEPHEN RECTAL 325 MG Formulary OTC ACEPHEN SUPPOSITORY 120 MG RECTAL 120 MG Formulary Custom (*); OTC ACEPHEN SUPPOSITORY 325 MG RECTAL 325 MG Formulary Custom (*); OTC ACEPHEN SUPPOSITORY 650 MG RECTAL 650 MG Formulary Custom (*); OTC ACEROLA C 500 ORAL WAFER 500 MG Formulary OTC acesulfame potassium powder Formulary ACETA-GESIC ORAL TABLET 12.5-325 MG Formulary OTC ACETA-GESIC TABLET 12.5-325 MG ORAL 12.5-325 Formulary Custom (*); OTC MG

1 Drug Name Formulary Status Requirements/Limits acetaminophen er tablet extended release 650 mg oral 650 Formulary Custom (*); OTC mg acetaminophen junior strength oral tablet dispersible 160 Formulary OTC mg acetaminophen liquid 160 mg/5ml oral 160 mg/5ml Formulary Custom (*); OTC acetaminophen powder Formulary acetaminophen rectal suppository 650 mg Formulary OTC acetaminophen solution 160 mg/5ml oral 160 mg/5ml Formulary Custom (*); OTC acetaminophen suppository 120 mg rectal 120 mg Formulary Custom (*); OTC acetaminophen suppository 650 mg rectal 650 mg Formulary Custom (*); OTC acetaminophen tablet 325 mg oral 325 mg Formulary Custom (*); OTC acetaminophen tablet 500 mg oral 500 mg Formulary Custom (*); OTC acetazolamide crystals Formulary OTC acetic acid glacial solution 99 % Formulary solution Formulary acetyl-l-carnitine hcl powder Formulary acid control maximum strength tablet 150 mg oral 150 mg Formulary Custom (*); OTC ACID GONE 95-358 MG/15ML ORAL 95- Formulary Custom (*); OTC 358 MG/15ML ACID GONE TABLET CHEWABLE 160-105 MG ORAL Formulary Custom (*); OTC 160-105 MG acid reducer complete tablet chewable 10-800-165 mg oral Formulary Custom (*); OTC 10-800-165 mg acid reducer maximum strength tablet 20 mg oral 20 mg Formulary Custom (*); OTC acid reducer tablet 10 mg oral 10 mg Formulary Custom (*); OTC acid reducer tablet 75 mg oral 75 mg Formulary Custom (*); OTC acid relief oral tablet 200 mg Formulary OTC acidophilus oral tablet chewable Formulary OTC acidophilus/citrus pectin oral tablet Formulary OTC acidophilus/pectin oral capsule Formulary OTC medication 10 10 % external 10 % Formulary Custom (*); OTC acne medication 10 10 % external 10 % Formulary Custom (*); OTC acne medication 5 gel 5 % external (otc) 5 % Formulary Custom (*) acne medication 5 lotion 5 % external 5 % Formulary Custom (*); OTC ACNEFREE ACNE CLEARING SYSTEM EXTERNAL Formulary OTC KIT 2.5 & 3.7 % ACNEFREE SEVERE CLEARING SYST EXTERNAL Formulary OTC KIT 2.5 & 10 % ACNOTEX EXTERNAL LOTION 2-8 % Formulary OTC ACT TOTAL CARE MOUTH/THROAT SOLUTION 0.05 Formulary OTC % ACTICARNITINE SF ORAL SOLUTION 1 GM/10ML Formulary OTC ACTIDOGESIC ORAL TABLET 1-500 MG Formulary OTC ACTIDOSE WITH SORBITOL ORAL LIQUID 25 Formulary OTC GM/120ML actidose-aqua oral liquid 25 gm/120ml Formulary OTC

2 Drug Name Formulary Status Requirements/Limits ACTIFLOVIT EAR HEALTH ORAL TABLET Formulary OTC ACTIMARIS WOUND EXTERNAL GEL 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 % ADAPT CONVEX BARRIER RING Formulary OTC adenosylcobalamin powder Formulary OTC adhesive bandages sheer Formulary OTC PA; Custom (*); QL (90 EA per 365 ADIPEX-P CAPSULE 37.5 MG ORAL 37.5 MG Formulary days) PA; Custom (*); QL (90 EA per 365 ADIPEX-P TABLET 37.5 MG ORAL 37.5 MG Formulary days) adult wash cloths with aloe external 3 % Formulary OTC advanced acne wash external liquid extended release 4.4 % Formulary OTC advanced formula eye drops solution 0.05-0.1-1-1 % Formulary Custom (*); OTC ophthalmic 0.05-0.1-1-1 % advanced external liquid 70 % Formulary OTC ADVIL ALLERGY & CONGESTION ORAL TABLET 4- Formulary OTC 10-200 MG ADVIL ALLERGY & CONGESTION TABLET 4-10-200 Formulary Custom (*); OTC MG ORAL 4-10-200 MG ADVIL ALLERGY SINUS ORAL TABLET 2-30-200 MG Formulary OTC ADVIL ALLERGY SINUS TABLET 2-30-200 MG ORAL Formulary Custom (*); OTC 2-30-200 MG ADVIL CAPSULE 200 MG ORAL 200 MG Formulary Custom (*); OTC ADVIL COLD & SINUS LIQUI- CAPSULE 30-200 Formulary Custom (*); OTC MG ORAL 30-200 MG ADVIL COLD & SINUS LIQUI-GELS ORAL CAPSULE Formulary OTC 30-200 MG ADVIL COLD/SINUS ORAL TABLET 30-200 MG Formulary OTC ADVIL COLD/SINUS TABLET 30-200 MG ORAL 30- Formulary Custom (*); OTC 200 MG ADVIL CONGESTION RELIEF ORAL TABLET 10-200 Formulary OTC MG ADVIL CONGESTION RELIEF TABLET 10-200 MG Formulary Custom (*); OTC ORAL 10-200 MG ADVIL JUNIOR STRENGTH TABLET 100 MG ORAL Formulary Custom (*); OTC 100 MG ADVIL JUNIOR STRENGTH TABLET CHEWABLE 100 Formulary Custom (*); OTC MG ORAL 100 MG ADVIL MIGRAINE CAPSULE 200 MG ORAL 200 MG Formulary Custom (*); OTC

3 Drug Name Formulary Status Requirements/Limits ADVIL ORAL CAPSULE 200 MG Formulary OTC ADVIL ORAL TABLET 200 MG Formulary OTC ADVIL PM CAPSULE 200-25 MG ORAL 200-25 MG Formulary Custom (*); OTC ADVIL PM ORAL CAPSULE 200-25 MG Formulary OTC ADVIL PM ORAL TABLET 200-38 MG Formulary OTC ADVIL PM TABLET 200-38 MG ORAL 200-38 MG Formulary Custom (*); OTC ADVIL TABLET 200 MG ORAL 200 MG Formulary Custom (*); OTC AEROCHAMBER PLUS FLO-VU Formulary AEROCHAMBER PLUS FLO-VU LARGE Formulary AEROCHAMBER PLUS FLO-VU SMALL Formulary AEROCHAMBER PLUS FLO-VU W/MASK Formulary AFRIN CHILDRENS NASAL SOLUTION 0.25 % Formulary OTC AFRIN SPRAY NASAL SOLUTION 0.05 % Formulary OTC AFRIN MENTHOL SPRAY SOLUTION 0.05 % NASAL Formulary Custom (*); OTC 0.05 % AFTERA TABLET 1.5 MG ORAL 1.5 MG Formulary Custom (*); OTC; QL (2 EA per 30 days) AHIST ORAL TABLET 25 MG Formulary OTC AIRBORNE ORAL LOZENGE Formulary OTC AL12 LOTION 12 % EXTERNAL 12 % Formulary Custom (*); OTC ALA SEB T EXTERNAL 1-2-2 % Formulary OTC ALAHIST DM LIQUID 7.5-4-15 MG/5ML ORAL 7.5-4- Formulary Custom (*); OTC 15 MG/5ML ALAHIST DM ORAL LIQUID 7.5-2-15 MG/5ML Formulary OTC ALA-HIST IR ORAL TABLET 2 MG Formulary OTC ALA-HIST IR TABLET 2 MG ORAL 2 MG Formulary Custom (*); OTC ALA-HIST PE ORAL TABLET 2-10 MG Formulary OTC ALA-HIST PE TABLET 2-10 MG ORAL 2-10 MG Formulary Custom (*); OTC alamag plus oral tablet chewable 200-200-25 mg Formulary OTC alanine 1000 oral packet 1000 mg Formulary OTC ALAVERT ALLERGY/SINUS TABLET EXTENDED Formulary Custom (*); OTC RELEASE 12 HOUR 5-120 MG ORAL 5-120 MG ALAVERT TABLET DISPERSIBLE 10 MG ORAL 10 Formulary Custom (*); OTC MG ALAWAY CHILDRENS ALLERGY SOLUTION 0.025 % Formulary Custom (*); OTC OPHTHALMIC 0.025 % ALAWAY SOLUTION 0.025 % OPHTHALMIC 0.025 % Formulary Custom (*); OTC alba-lybe nr oral liquid 325-10-50 mg/5ml Formulary OTC ALBUSTIX IN VITRO STRIP Formulary OTC ALC-FREE EXTERNAL FOAM 0.1 % Formulary OTC ALCO-GEL EXTERNAL GEL 60 % Formulary OTC (rubbing) solution 70 % Formulary OTC alcohol anhydrous liquid Formulary OTC alcohol prep pad 70 % Formulary OTC aler-dryl oral tablet 50 mg Formulary OTC alertness aid oral tablet 200 mg Formulary OTC

4 Drug Name Formulary Status Requirements/Limits alertness aid tablet 200 mg oral 200 mg Formulary Custom (*); OTC alevazol external ointment 1 % Formulary OTC alevazol ointment 1 % external 1 % Formulary Custom (*); OTC ALEVE ORAL CAPSULE 220 MG Formulary OTC ALEVE ORAL TABLET 220 MG Formulary OTC ALEVE-D SINUS & COLD ORAL TABLET EXTENDED Formulary OTC RELEASE 12 HOUR 120-220 MG alga oral capsule 0.225-2000 mg-unit Formulary OTC ALGAL-900 DHA ORAL CAPSULE 300 MG Formulary OTC ALGISITE M 4"X4" EXTERNAL Formulary OTC alka-aid oral tablet 180-360 mg Formulary OTC ALKA-SELTZER GOLD TABLET EFFERVESCENT Formulary Custom (*); OTC 832-312-958 MG ORAL 832-312-958 MG ALKA-SELTZER HEARTBURN + GAS ORAL TABLET Formulary OTC CHEWABLE 750-80 MG ALKA-SELTZER ORAL TABLET EFFERVESCENT Formulary OTC 325-1000-1916 MG all day allergy childrens solution 1 mg/ml oral 1 mg/ml Formulary Custom (*); OTC all day allergy childrens solution 5 mg/5ml oral 5 mg/5ml Formulary Custom (*); OTC all day allergy childrens tablet chewable 10 mg oral 10 mg Formulary Custom (*); OTC all day allergy d tablet extended release 12 hour 5-120 mg Formulary Custom (*); OTC oral 5-120 mg all day allergy d-12 tablet extended release 12 hour 5-120 Formulary Custom (*); OTC mg oral 5-120 mg all day allergy tablet 10 mg oral 10 mg Formulary Custom (*); OTC all day allergy-d tablet extended release 12 hour 5-120 mg Formulary Custom (*); OTC oral 5-120 mg all day pain relief tablet 220 mg oral 220 mg Formulary Custom (*); OTC all day relief tablet 220 mg oral 220 mg Formulary Custom (*); OTC allantoin powder Formulary 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-chlor syrup 2 mg/5ml oral 2 mg/5ml Formulary Custom (*); OTC aller-chlor tablet 4 mg oral 4 mg Formulary Custom (*); OTC aller-ease tablet 180 mg oral 180 mg Formulary Custom (*); OTC aller-ease tablet 60 mg oral 60 mg Formulary Custom (*); OTC allergy childrens liquid 12.5 mg/5ml oral 12.5 mg/5ml Formulary Custom (*); OTC allergy childrens oral liquid 12.5 mg/5ml Formulary OTC allergy eye drops solution 0.025 % ophthalmic 0.025 % Formulary Custom (*); OTC allergy eye ophthalmic solution 0.025-0.3 % Formulary OTC 5 Drug Name Formulary Status Requirements/Limits allergy multi-symptom day/nght oral Formulary OTC allergy multi-symptom tablet 2-5-325 mg oral 2-5-325 mg Formulary Custom (*); OTC allergy rel child (cetirizine) solution 5 mg/5ml oral 5 Formulary Custom (*); OTC mg/5ml allergy relief capsule 25 mg oral 25 mg Formulary Custom (*); OTC allergy relief child syrup 5 mg/5ml oral 5 mg/5ml Formulary Custom (*); OTC allergy relief childrens liquid 12.5 mg/5ml oral 12.5 mg/5ml Formulary Custom (*); OTC allergy relief d-24 tablet extended release 24 hour 10-240 Formulary Custom (*); OTC mg oral 10-240 mg allergy relief gel 2 % external 2 % Formulary Custom (*); OTC allergy relief plus sinus oral tablet 25-5-325 mg Formulary OTC allergy relief tablet 10 mg oral 10 mg Formulary Custom (*); OTC allergy relief tablet 25 mg oral 25 mg Formulary Custom (*); OTC allergy relief tablet 5 mg oral 5 mg Formulary OTC allergy relief tablet dispersible 10 mg oral 10 mg Formulary Custom (*); OTC allergy relief/nasal decongest tablet extended release 24 Formulary Custom (*); OTC hour 10-240 mg oral 10-240 mg allergy tablet 10 mg oral 10 mg Formulary Custom (*); OTC allergy tablet 25 mg oral 25 mg Formulary Custom (*); OTC allergy tablet 4 mg oral 4 mg Formulary Custom (*); OTC allergy tablet dispersible 10 mg oral 10 mg Formulary Custom (*); OTC allergy/congestion relief oral tablet extended release 24 Formulary OTC hour 10-240 mg allergy/congestion relief tablet extended release 12 hour 5- Formulary Custom (*); OTC 120 mg oral 5-120 mg allergy-time tablet 4 mg oral 4 mg Formulary Custom (*); OTC allerhist-1 tablet 1.34 mg oral 1.34 mg Formulary Custom (*); OTC aller-time oral tablet 2.5-60 mg Formulary OTC allevess external patch 0.05-5 % Formulary OTC ALLEVYN PLUS CAVITY PAD 6"X8" Formulary OTC allfen dm tablet 400-20 mg oral 400-20 mg Formulary Custom (*); OTC ALLFEN TABLET 400 MG ORAL 400 MG Formulary Custom (*); OTC ALLI CAPSULE 60 MG ORAL 60 MG Formulary Custom (*); OTC ALLI ORAL CAPSULE 60 MG Formulary OTC all-nite multi-sympt cold/flu liquid 15-6.25-325 mg/15ml Formulary Custom (*); OTC oral 15-6.25-325 mg/15ml ALMACONE DOUBLE STRENGTH SUSPENSION 400- Formulary Custom (*); OTC 400-40 MG/5ML ORAL 400-400-40 MG/5ML ALMACONE SUSPENSION 200-200-20 MG/5ML ORAL Formulary Custom (*); OTC 200-200-20 MG/5ML ALMACONE TABLET CHEWABLE 200-200-25 MG Formulary Custom (*); OTC ORAL 200-200-25 MG ALOCANE PLUS EXTERNAL GEL 4-0.13 % Formulary OTC aloe burn relief external aerosol 0.5 % Formulary OTC ALOE GRANDE EXTERNAL CREAM 100000-1500 Formulary OTC UNIT/GM

6 Drug Name Formulary Status Requirements/Limits ALOE GRANDE EXTERNAL LOTION 10000-1500 Formulary OTC UNIT/30ML aloe vera external cream 72 % Formulary OTC aloe vera external gel 99.5 % Formulary OTC aloe vera freeze dried powder Formulary aloe vera moisturizing external gel 99.5 % Formulary OTC ALOE VESTA 2-N-1 PROTECTIVE EXTERNAL Formulary OTC OINTMENT ALOE VESTA CLEAR ANTIFUNGAL OINTMENT 2 % Formulary Custom (*); OTC EXTERNAL 2 % ALOE VESTA MULTI PURPOSE EXTERNAL FOAM Formulary OTC ALOE VESTA PROTECTIVE OINTMENT EXTERNAL Formulary Custom (*); OTC ALOE VESTA SKIN PROTECTANT EXTERNAL Formulary OTC AEROSOL 36 % alp high3 oral capsule delayed release 600 mg Formulary OTC ALPAWASH EXTERNAL OINTMENT Formulary alpha-lipoic acid oral capsule 100 mg Formulary OTC alpha-lipoic acid oral tablet 200 mg Formulary OTC alpha-lipoic acid powder Formulary alum ammonium powder Formulary OTC alum sulfate-ca acetate packet external Formulary Custom (*); OTC aluminum acetate external solution Formulary OTC aluminum bottle seal Formulary OTC aluminum chloride hexahydrate crystals Formulary aluminum chloride hexahydrate powder Formulary aluminum chlorohydrate powder Formulary aluminum hydroxide dried gel powder Formulary aluminum hydroxide gel oral suspension 320 mg/5ml Formulary OTC aluminum hydroxide gel suspension 320 mg/5ml oral 320 Formulary Custom (*); OTC mg/5ml A-MANTLE EXTERNAL CREAM Formulary OTC amberderm external aerosol 650-72.5 mg/0.82ml Formulary OTC ambi 10peh/4cpm tablet 10-4 mg oral 10-4 mg Formulary Custom (*); OTC ambi 12.5cpd/100gfn/30pse liquid 30-12.5-100 mg/5ml oral Formulary Custom (*); OTC 30-12.5-100 mg/5ml ambi 12.5cpd/100gfn/30pse oral liquid 30-12.5-100 mg/5ml Formulary OTC ambi 12.5cpd/1dcpm/30pse liquid 30-1-12.5 mg/5ml oral Formulary Custom (*); OTC 30-1-12.5 mg/5ml ambi 12.5cpd/1dcpm/30pse oral liquid 30-1-12.5 mg/5ml Formulary OTC ambi 60pse/400gfn tablet 60-400 mg oral 60-400 mg Formulary Custom (*); OTC ambi 60pse/4cpm tablet 60-4 mg oral 60-4 mg Formulary Custom (*); OTC AMERIGEL WOUND EXTERNAL GEL Formulary OTC AMERIWASH EXTERNAL LOTION Formulary OTC AMINORELIEFRMS ORAL CAPSULE Formulary aminosalicylic acid-5 powder Formulary AMLACTIN LOTION 12 % EXTERNAL 12 % Formulary Custom (*); OTC 7 Drug Name Formulary Status Requirements/Limits aromatic Formulary OTC ammonia aromatic inhalation spirit Formulary OTC ammonium carbonate powder Formulary OTC ammonium chloride granules Formulary ammonium hydroxide solution Formulary ammonium lactate cream 12 % external (otc) 12 % Formulary Custom (*) ammonium lactate lotion 12 % external (otc) 12 % Formulary Custom (*) ANASEPT EXTERNAL GEL 0.057 % Formulary OTC ANASEPT EXTERNAL LIQUID 0.057 % Formulary OTC ANBESOL MAXIMUM STRENGTH MOUTH/THROAT Formulary OTC LIQUID 20 % ANBESOL MOUTH/THROAT LIQUID 10 % Formulary OTC ANECREAM EXTERNAL CREAM 4 % Formulary OTC anise oil Formulary OTC antacid anti-gas max strength oral suspension 400-400-40 Formulary OTC mg/5ml antacid anti-gas max strength suspension 400-400-40 Formulary Custom (*); OTC mg/5ml oral 400-400-40 mg/5ml antacid anti-gas oral suspension 200-200-20 mg/5ml Formulary OTC antacid calcium extra strength tablet chewable 750 mg oral Formulary Custom (*); OTC 750 mg antacid calcium tablet chewable 500 mg oral 500 mg Formulary Custom (*); OTC antacid double strength oral tablet chewable 700-300 mg Formulary OTC antacid extra strength oral tablet chewable 675-135 mg Formulary OTC antacid extra strength tablet chewable 750 mg oral 750 mg Formulary Custom (*); OTC antacid fast acting suspension 200-200-20 mg/5ml oral Formulary Custom (*); OTC 200-200-20 mg/5ml antacid fast relief suspension 200-200-20 mg/5ml oral 200- Formulary Custom (*); OTC 200-20 mg/5ml antacid maximum strength suspension 400-400-40 mg/5ml Formulary Custom (*); OTC oral 400-400-40 mg/5ml antacid multi-symptom oral tablet chewable 675-135-60 mg Formulary OTC antacid oral tablet chewable 500 mg Formulary OTC antacid plus anti-gas relief suspension 200-200-20 mg/5ml Formulary Custom (*); OTC oral 200-200-20 mg/5ml antacid plus anti-gas relief suspension 400-400-40 mg/5ml Formulary Custom (*); OTC oral 400-400-40 mg/5ml antacid soft chews oral tablet chewable 1177 mg Formulary OTC antacid suspension 200-200-20 mg/5ml oral 200-200-20 Formulary Custom (*); OTC mg/5ml antacid tablet chewable 500 mg oral 500 mg Formulary Custom (*); OTC anthelios 50 mineral external liquid Formulary OTC antibacterial liquid external liquid 0.15 % Formulary OTC anti-dandruff shampoo 1 % external 1 % Formulary Custom (*); OTC anti-diarrheal oral liquid 1 mg/5ml Formulary OTC anti-diarrheal tablet 2 mg oral 2 mg Formulary Custom (*); OTC

8 Drug Name Formulary Status Requirements/Limits antifungal aerosol 1 % external 1 % Formulary Custom (*); OTC antifungal cream 1 % external 1 % Formulary Custom (*); OTC antifungal cream 2 % external 2 % Formulary Custom (*); OTC anti-fungal external liquid 12.5 % Formulary OTC anti-fungal powder 1 % external 1 % Formulary Custom (*); OTC anti-gas ultra strength oral capsule 180 mg Formulary OTC anti-itch cream 2-0.1 % external 2-0.1 % Formulary Custom (*); OTC anti-itch external cream 1-0.1 % Formulary OTC anti-itch external lotion 0.5-0.5 % Formulary OTC anti-itch maximum strength cream 2 % external 2 % Formulary Custom (*); OTC anti-itch maximum strength solution 2 % external 2 % Formulary Custom (*); OTC antioxidant formula sg oral capsule extended release Formulary OTC external aerosol 4.5-0.05-40.5 % Formulary OTC antiseptic oral rinse mouth/throat liquid 0.05 % Formulary OTC ANTISEPTIC PERINEAL WASH II EXTERNAL Formulary OTC SOLUTION 0.2 % antiseptic skin cleanser external solution 4 % Formulary OTC antiseptic wound/skin cleanser external liquid 0.1 % Formulary OTC anu-med suppository 88.7-0.25 % rectal 88.7-0.25 % Formulary Custom (*); OTC APATATE FORTE ORAL LIQUID Formulary OTC APETIGEN ORAL Formulary OTC APETIGEN-PLUS ORAL SOLUTION Formulary OTC APETIGEN-PLUS ORAL TABLET Formulary OTC ap-hist dm liquid 7.5-4-15 mg/5ml oral 7.5-4-15 mg/5ml Formulary Custom (*); OTC apothesar external cream Formulary APRODINE TABLET 2.5-60 MG ORAL 2.5-60 MG Formulary Custom (*); OTC AQUA CARE EXTERNAL CREAM 10 % Formulary OTC aquabase external ointment Formulary OTC AQUADEKS ORAL LIQUID Formulary OTC aquanaz oral tablet 10-15-400 mg Formulary OTC AQUAPHILIC/CARBAMIDE EXTERNAL OINTMENT Formulary OTC 10 %, 20 % AQUASOL A SOLUTION 15 MG/ML Formulary Custom (*) INTRAMUSCULAR 15 MG/ML AQUASONIC 100 EXTERNAL GEL Formulary OTC AQUEOUS SELENIUM ORAL LIQUID 95 MCG/DROP Formulary OTC aqueous vitamin e oral solution 15 mg/0.67ml, 15 Formulary OTC unit/0.3ml AQUORAL MOUTH/THROAT SOLUTION Formulary arctic relief pain relieving gel 0.2-3.5 % external 0.2-3.5 % Formulary Custom (*); OTC ARGIMENT AT ORAL PACKET Formulary OTC arginine oral packet 500 mg Formulary OTC arginine2000 oral packet 2000 mg Formulary OTC arkaliox oral capsule 200 mg Formulary OTC ARLASILK PHOSPHOLIPID PLN LIQUID Formulary OTC 9 Drug Name Formulary Status Requirements/Limits arnica external 20 % Formulary OTC arnicare arthritis oral tablet dispersible Formulary OTC ARTHRI-FLEX ADVANTAGE TABLET ORAL Formulary Custom (*); OTC arthritis pain relief tablet extended release 650 mg oral 650 Formulary Custom (*); OTC mg artificial tears ointment 83-15 % ophthalmic 83-15 % Formulary Custom (*); OTC artificial tears ophthalmic solution 0.1-0.3 %, 1-0.3 % Formulary OTC artificial tears solution 1.4 % ophthalmic 1.4 % Formulary Custom (*); OTC asafetida tincture Formulary OTC ascocid-iso-ph oral powder effervescent Formulary OTC ascorbic acid granules Formulary ascorbic acid oral granules Formulary OTC ascorbic acid powder Formulary ascorbyl palmitate powder Formulary ASCRIPTIN MS ORAL TABLET 500-33-33-237 MG Formulary OTC ASCRIPTIN ORAL TABLET 325 MG Formulary OTC aspartate mg & k oral capsule 90-90 mg Formulary OTC ASPERCREME HEAT EXTERNAL GEL 10 % Formulary OTC ASPERCREME W/ EXTERNAL CREAM 4 Formulary OTC % aspirin 81 tablet delayed release 81 mg oral 81 mg Formulary Custom (*); OTC aspirin adult low strength tablet chewable 81 mg oral 81 Formulary Custom (*); OTC mg aspirin ec low dose tablet delayed release 81 mg oral 81 mg Formulary Custom (*); OTC aspirin ec low strength tablet delayed release 81 mg oral 81 Formulary Custom (*); OTC mg aspirin ec tablet delayed release 325 mg oral 325 mg Formulary Custom (*); OTC aspirin low dose tablet chewable 81 mg oral 81 mg Formulary Custom (*); OTC aspirin powder Formulary aspirin rectal suppository 120 mg, 200 mg, 300 mg, 600 mg Formulary OTC aspirin tablet 325 mg oral 325 mg Formulary Custom (*); OTC aspirin tablet chewable 81 mg oral 81 mg Formulary Custom (*); OTC aspirin tablet delayed release 81 mg oral 81 mg Formulary Custom (*); OTC ASPIR-LOW TABLET DELAYED RELEASE 81 MG Formulary Custom (*); OTC ORAL 81 MG aspirtab maximum strength oral tablet 500 mg Formulary OTC ASTERO EXTERNAL GEL 4 % Formulary ASTHMANEFRIN REFILL NEBULIZATION Formulary Custom (*); OTC SOLUTION 2.25 % INHALATION 2.25 % athletes foot af cream 1 % external 1 % Formulary Custom (*); OTC athletes foot spray aerosol 1 % external 1 % Formulary Custom (*); OTC ATLAS COLOR CONDOM/ DEVICE Formulary Custom (*); OTC ATRAC-TAIN EXTERNAL CREAM 10 % Formulary OTC ATRAC-TAIN EXTERNAL LOTION 5 % Formulary OTC avaderm external ointment 4-1 % Formulary OTC

10 Drug Name Formulary Status Requirements/Limits avalin external patch 4-1 % Formulary OTC AVEENO BATH MOISTURIZING PACKET 43 % Formulary Custom (*); OTC EXTERNAL 43 % AVEENO INTENSE RELIEF EXTERNAL CREAM 1.3 % Formulary OTC AVEENO NOURISH+DANDRUFF CONT EXTERNAL Formulary OTC LIQUID 0.5 % AVEENO POSITIVELY AGELESS EXTERNAL CREAM Formulary OTC AVEENO POSITIVELY AGELESS EXTERNAL LIQUID Formulary OTC AVEENO STRESS RELIEF BODY WASH EXTERNAL Formulary OTC LIQUID AVENOVA/NEUTROX EXTERNAL SOLUTION 0.01 % Formulary AVERTEAX MOUTH/THROAT OINTMENT 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 RINSE NASAL PACKET 1.57 Formulary OTC GM azec oral capsule Formulary OTC azelaic acid flakes Formulary azelaic acid powder Formulary OTC b complex formula 1 oral tablet Formulary OTC b complex oral capsule Formulary OTC b complex-c-biotin-e-fa tablet 0.4 mg oral 0.4 mg Formulary Custom (*); OTC b complex-folic acid oral tablet 500-5-200 mcg-mg-mcg Formulary OTC b complex-folic acid tablet 500-5-200 mcg-mg-mcg oral Formulary Custom (*); OTC 500-5-200 mcg-mg-mcg B&L SENSITIVE EYES SOLUTION 1-1 % Formulary OTC b-1 oral tablet 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 tablet sublingual 1000-400 mcg sublingual 1000-400 Formulary Custom (*); OTC mcg b-12 tablet sublingual 100-5000 mcg sublingual 100-5000 Formulary Custom (*); OTC mcg b-12 tr oral tablet extended release 2000 mcg Formulary OTC b-2 oral tablet 100 mg Formulary OTC b2 tablet 100 mg oral 100 mg Formulary Custom (*); OTC b-2 tablet 100 mg oral 100 mg Formulary Custom (*); OTC b-2 tablet 50 mg oral 50 mg Formulary Custom (*); OTC B-2-400 ORAL CAPSULE 400 MG Formulary OTC b-6 oral tablet 500 mg Formulary OTC baby darlings soothing bath packet external Formulary Custom (*); OTC

11 Drug Name Formulary Status Requirements/Limits BABY ORAJEL MOUTH/THROAT GEL 7.5 % Formulary OTC BABY ORAJEL NIGHTTIME MOUTH/THROAT GEL Formulary OTC 10 % baby super daily d3 oral liquid 400 ut/0.028ml Formulary OTC baby teething pain medicine mouth/throat gel 7.5 % Formulary OTC BACID ORAL TABLET Formulary OTC ointment 500 unit/gm external 500 unit/gm Formulary Custom (*); OTC bacitracin zinc external ointment 500 unit/gm Formulary bacitracin zinc ointment 500 unit/gm external (otc) 500 Formulary Custom (*) unit/gm bacitracin--polymyxin ointment 400-5-5000 Formulary Custom (*); OTC external 400-5-5000 back pain-off oral tablet 250-50-290 mg Formulary OTC backache relief extra strength oral tablet 467 mg, 580 mg Formulary OTC balamine dm oral syrup 5-2-10 mg/5ml Formulary OTC balamine dm syrup 5-2-10 mg/5ml oral 5-2-10 mg/5ml Formulary Custom (*); OTC balanced b-50 oral tablet extended release Formulary OTC BALMEX BABY EXTERNAL POWDER Formulary OTC BALNEOL EXTERNAL LOTION Formulary OTC BAND-AID SURGIPAD SURGICAL PAD 5"X9" Formulary OTC BANOPHEN CAPSULE 25 MG ORAL 25 MG Formulary Custom (*); OTC BANOPHEN CAPSULE 50 MG ORAL 50 MG Formulary Custom (*); OTC BANOPHEN CREAM 2-0.1 % EXTERNAL 2-0.1 % Formulary Custom (*); OTC BANOPHEN LIQUID 12.5 MG/5ML ORAL 12.5 Formulary Custom (*); OTC MG/5ML BANOPHEN TABLET 25 MG ORAL 25 MG Formulary Custom (*); OTC BARIDIUM ORAL TABLET 97.2 MG Formulary OTC basic fuchsin hcl powder Formulary BAYER BACK & BODY PAIN EX ST ORAL TABLET Formulary OTC 500-32.5 MG BAYER WOMENS ORAL TABLET 81-777 MG Formulary OTC baza antifungal cream 2 % external 2 % Formulary Custom (*); 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 capsule 15 mg oral 15 mg Formulary Custom (*); OTC b-caro-t oral capsule 15 mg Formulary OTC b-complex balanced oral tablet Formulary OTC b-complex high potency oral tablet extended release Formulary OTC b-complex/vitamin c tablet oral Formulary Custom (*); OTC BEANO TABLET ORAL Formulary Custom (*); OTC BEANO TO GO TABLET ORAL Formulary Custom (*); OTC bee pollen oral capsule 580 mg Formulary OTC 12 Drug Name Formulary Status Requirements/Limits bee pollen oral tablet chewable 500 mg Formulary OTC beef flavor powder Formulary BEELITH ORAL TABLET 362-20 MG Formulary OTC BENADRYL ALLERGY CHILDRENS ORAL LIQUID Formulary OTC 12.5 MG/5ML BENADRYL ALLERGY CHILDRENS ORAL TABLET Formulary OTC CHEWABLE 12.5 MG BENADRYL ALLERGY ORAL CAPSULE 25 MG Formulary OTC 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 ITCH STOPPING GEL 2 % EXTERNAL 2 Formulary Custom (*); OTC % BENADRYL MAXIMUM STRENGTH SOLUTION 2 % Formulary Custom (*); OTC EXTERNAL 2 % BENADRYL-D ALLERGY/SINUS CHILD ORAL Formulary OTC SOLUTION 12.5-5 MG/5ML BENEFIBER FOR CHILDREN ORAL POWDER Formulary OTC BENEFIBER ON THE GO ORAL PACKET Formulary OTC BENEFIBER ORAL POWDER Formulary OTC BENEFIBER ORAL TABLET Formulary OTC BENEFIBER ORAL TABLET CHEWABLE 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 BENGAY ARTHRITIS FORMULA EXTERNAL CREAM Formulary OTC 8-30 % BENGAY COLD THERAPY EXTERNAL GEL 5 % Formulary OTC BENGAY VANISHING SCENT EXTERNAL GEL 2.5 % Formulary OTC BENSULFOID EXTERNAL CREAM 2-8 % Formulary OTC bentonite powder Formulary BENZAC AC WASH EXTERNAL LIQUID 5 % Formulary benzaldehyde oral elixir Formulary OTC external concentrate 50 % Formulary OTC benzalkonium chloride external solution 50 % Formulary BENZEDREX INHALER NASAL Formulary Custom (*); OTC BENZEDREX NASAL INHALER Formulary OTC BENZEPRO FOAM 5.3 % EXTERNAL 5.3 % Formulary Custom (*) BENZEPRO SHORT CONTACT FOAM 9.8 % Formulary Custom (*) EXTERNAL 9.8 %

13 Drug Name Formulary Status Requirements/Limits powder Formulary BENZODENT MOUTH/THROAT CREAM 20 % Formulary OTC crystals Formulary benzonatate capsule 100 mg oral 100 mg Formulary Custom (*) benzonatate oral capsule 100 mg Formulary Custom (*) BENZ-O-STHETIC MOUTH/THROAT SOLUTION 20 % Formulary OTC BENZ-O-STHETIC MOUTH/THROAT SWAB 20 % Formulary OTC benzoyl peroxide cleanser external lotion 9 % Formulary OTC benzoyl peroxide cleanser liquid 6 % external 6 % Formulary Custom (*); OTC benzoyl peroxide external gel 2.5 % Formulary OTC benzoyl peroxide foam 5.3 % external (otc) 5.3 % Formulary Custom (*); OTC benzoyl peroxide foam 9.8 % external 9.8 % Formulary Custom (*) benzoyl peroxide gel 10 % external (otc) 10 % Formulary Custom (*) benzoyl peroxide gel 2.5 % external (otc) 2.5 % Formulary Custom (*); OTC benzoyl peroxide gel 5 % external (otc) 5 % Formulary Custom (*); OTC benzoyl peroxide wash liquid 10 % external (otc) 10 % Formulary Custom (*) benzoyl peroxide wash liquid 5 % external (otc) 5 % Formulary Custom (*); OTC PA; Custom (*); QL (90 EA per 365 benzphetamine hcl tablet 50 mg oral 50 mg Formulary days) bergamot oil oil Formulary OTC BERRI-FREEZ PAIN RELIEVING EXTERNAL GEL 4.5 Formulary OTC % 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 % Formulary OTC BETADINE SKIN CLEANSER EXTERNAL SOLUTION Formulary OTC 7.5 % BETADINE SWAB AID EXTERNAL SWAB 10 % Formulary OTC betaine anhydrous powder Formulary betaine hcl oral tablet 300 mg Formulary OTC BETAQUIK ORAL Formulary OTC BETASEPT SURGICAL SCRUB EXTERNAL LIQUID 4 Formulary OTC % BETASEPT SURGICAL SCRUB LIQUID 4 % Formulary Custom (*); OTC EXTERNAL 4 % BIATAIN HEEL ADH FOAM DRESSING PAD Formulary OTC 19CMX20CM BIATAIN SACRAL FOAM DRESSING PAD 9"X9" Formulary OTC BICARSIM FORTE ORAL TABLET 125 MG Formulary OTC BICARSIM ORAL TABLET 80 MG Formulary OTC bio t pres pediatric oral liquid 2.5-5-75 mg/5ml Formulary OTC biobron sf oral syrup 10-15-350 mg/5ml Formulary OTC biodesp dm oral syrup 5-15-100 mg/5ml Formulary OTC

14 Drug Name Formulary Status Requirements/Limits BIO-D-MULSION FORTE ORAL LIQUID 2000 Formulary OTC UNT/0.03ML BIO-D-MULSION ORAL LIQUID 400 UNT/0.03ML Formulary OTC bioflavonoid citrus powder Formulary OTC BIO-FLAX ORAL CAPSULE 1000 MG Formulary OTC BIOFLEXOR EXTERNAL GEL 3 % Formulary OTC BIOFLONEX ORAL TABLET 250-650 MG Formulary OTC BIOFREEZE EXTERNAL AEROSOL 10.5 % Formulary OTC BIOFREEZE EXTERNAL GEL 4 % Formulary OTC BIOFREEZE EXTERNAL LIQUID 10 % Formulary OTC BIOGAIA GASTRUS ORAL TABLET CHEWABLE Formulary OTC biogesic oral tablet 30-500 mg Formulary BIOGUARD NON-ADHERENT DRESSING PAD 3"X8" Formulary BION TEARS PF SOLUTION 0.1-0.3 % OPHTHALMIC Formulary Custom (*); OTC 0.1-0.3 % bionatuss dxp oral liquid 10-2-20 mg/5ml Formulary OTC BIOPATCH PROTECTIVE DISK/CHG EXTERNAL Formulary OTC (DRESSING) BIORX SPONIX ANTI-FUNGAL EXTERNAL Formulary OTC SOLUTION 22 % BIORX SPONIX ARTHR & MUSC EXTERNAL Formulary OTC SOLUTION 4-10-0.035 % bio-rytuss oral liquid 5-2-10 mg/5ml Formulary OTC 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 10000 mcg, 300 mcg, 800 mcg Formulary OTC biotin-d powder Formulary OTC biotuss oral liquid 10-15-300 mg/5ml Formulary biovol oral syrup Formulary OTC bisacodyl ec tablet delayed release 5 mg oral 5 mg Formulary Custom (*); OTC biscolax suppository 10 mg rectal 10 mg Formulary Custom (*); OTC bismatrol maximum strength suspension 525 mg/15ml oral Formulary Custom (*); OTC 525 mg/15ml bismatrol suspension 262 mg/15ml oral 262 mg/15ml Formulary Custom (*); OTC bismatrol tablet chewable 262 mg oral 262 mg Formulary Custom (*); OTC bismuth citrate powder Formulary bismuth subcarbonate powder Formulary bismuth subgallate powder Formulary bismuth subnitrate powder Formulary bismuth subsalicylate powder Formulary bite/itch external lotion 1-2 % Formulary OTC

15 Drug Name Formulary Status Requirements/Limits BI-ZETS/BENZOTROCHES MOUTH/THROAT Formulary OTC LOZENGE 15 MG BLINK TEARS OPHTHALMIC GEL 0.25 % Formulary OTC BLINK TEARS OPHTHALMIC SOLUTION 0.25 % Formulary OTC blood pressure monitor/wrist kit Formulary OTC blue gel gel 2 % external 2 % Formulary Custom (*); OTC boil pain relief external ointment 20 % Formulary OTC borage oral capsule 1000-240-378 mg Formulary OTC borax granules Formulary OTC boric acid external granules Formulary boric acid powder Formulary boron oral capsule 3 mg Formulary OTC boron oral tablet 6 mg Formulary OTC BOUDREAUXS BABY KISSES EXTERNAL Formulary OTC OINTMENT BOUDREAUXS BUTT EXTERNAL OINTMENT Formulary OTC 16 % BOUDREAUXS RASH PREVENTOR EXTERNAL Formulary OTC LIQUID 10 % bp gel external gel 5.5 % Formulary OTC bpm-dm-phen oral syrup 5-2-10 mg/5ml Formulary OTC bpo creamy wash external kit 8 & 5 % Formulary OTC BPROTECTED PEDIA POLY-VITE ORAL SOLUTION , Formulary OTC 35 MG/ML BPROTECTED PEDIA TRI-VITE SOLUTION 750-400- Formulary Custom (*); OTC 35 UNIT-MG/ML ORAL 750-400-35 UNIT-MG/ML BRASIVOL EXTERNAL PASTE Formulary OTC BRAUN NO TOUCH + FOREHEAD Formulary OTC brewers yeast oral tablet Formulary OTC BRIJ 30 LIQUID Formulary OTC brilliant green powder Formulary brohist d oral tablet 4-10 mg Formulary OTC bromelain powder Formulary BROMFED DM SYRUP 30-2-10 MG/5ML ORAL 30-2-10 Formulary Custom (*) MG/5ML bromi-lotion external lotion Formulary OTC bronchial asthma relief oral tablet 12.5-200 mg Formulary OTC BRONCOTRON PED ORAL LIQUID 10-15-350 Formulary OTC MG/5ML BRONKAID ORAL TABLET 25-400 MG Formulary OTC bronkids oral liquid 1.5-0.6-2.75 mg/ml, 10-4-10 mg/5ml Formulary OTC brontuss dx oral liquid 10-20-200 mg/5ml Formulary OTC brotapp dm liquid 15-1-5 mg/5ml oral 15-1-5 mg/5ml Formulary Custom (*); OTC brotapp dm oral liquid 15-1-5 mg/5ml Formulary OTC BROTAPP LIQUID 1-15 MG/5ML ORAL 1-15 MG/5ML Formulary Custom (*); OTC btrex oral tablet extended release 8-200-4-100-600 mg Formulary OTC 16 Drug Name Formulary Status Requirements/Limits BUCKLEYS COUGH ORAL LIQUID 12.5 MG/5ML Formulary OTC suspension 32 mcg/act nasal (otc) 32 mcg/act Formulary Custom (*) 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 SUPERBLOCK SPF50 EXTERNAL Formulary OTC LOTION BUMM BALM EXTERNAL OINTMENT 9.38 % Formulary OTC burn relief aerosol 0.5 % external 0.5 % Formulary Custom (*); OTC burn relief/lidocaine/aloe external gel 0.5 % Formulary OTC butylated hydroxytoluene crystals Formulary OTC butylparaben powder 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 ca phosphate dibasic dihyd powder Formulary OTC cadeau dha oral capsule 29-0.4-0.8-375 mg Formulary OTC caffeine anhydrous powder Formulary cal mag zinc +d3 tablet oral Formulary Custom (*); OTC cal/mag oral tablet 200-100 mg 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 lotion 8-8 % external 8-8 % Formulary Custom (*); OTC calamine phenolated external lotion Formulary OTC calamine powder Formulary calamine-zinc oxide external lotion Formulary OTC calamine-zinc oxide external suspension 8-8 % Formulary OTC CAL-CARB FORTE ORAL TABLET 1250 (500 CA) MG Formulary OTC CALCET PETITES ORAL TABLET 200-250 MG-UNIT Formulary OTC CALCI-CHEW ORAL TABLET CHEWABLE 1250 (500 Formulary OTC CA) MG CALCIFEROL ORAL SOLUTION 8000 UNIT/ML Formulary OTC calci-max oral capsule Formulary OTC cal-citrate oral capsule 150 mg Formulary OTC CALCITRATE ORAL TABLET 950 MG Formulary OTC calcium + d3 oral tablet 600-800 mg-unit Formulary OTC calcium 1200 oral tablet chewable 1200-1000 mg-unit Formulary OTC calcium 500 + d3 oral tablet 500-600 mg-unit Formulary OTC calcium 600 oral tablet 1500 (600 ca) mg Formulary OTC calcium 600+d high potency oral tablet 600-400 mg-unit Formulary OTC calcium 600+d3 plus minerals oral tablet 600-800 mg-unit Formulary OTC

17 Drug Name Formulary Status Requirements/Limits calcium acetate oral tablet 668 (169 ca) mg Formulary OTC calcium antacid extra strength tablet chewable 750 mg oral Formulary Custom (*); OTC 750 mg calcium antacid tablet chewable 500 mg oral 500 mg Formulary Custom (*); OTC calcium antacid ultra max st tablet chewable 1000 mg oral Formulary Custom (*); OTC 1000 mg calcium antacid ultra strength tablet chewable 1000 mg Formulary Custom (*); OTC oral 1000 mg calcium antacid ultra tablet chewable 1000 mg oral 1000 Formulary Custom (*); OTC mg calcium ascorbate oral tablet 500 mg Formulary OTC calcium ascorbate powder Formulary calcium ascorbate tablet 500 mg oral 500 mg Formulary Custom (*); OTC calcium aspartate oral tablet 75 mg Formulary OTC calcium carbonate antacid oral tablet 648 mg Formulary OTC calcium carbonate antacid suspension 1250 mg/5ml oral Formulary Custom (*); OTC 1250 mg/5ml calcium carbonate antacid tablet 648 mg oral 648 mg Formulary Custom (*); OTC calcium carbonate oral powder 800 mg/2gm Formulary OTC calcium carbonate oral tablet 1500 (600 ca) mg, 600 mg Formulary OTC calcium carbonate powder Formulary calcium carbonate tablet 1250 (500 ca) mg oral 1250 (500 Formulary Custom (*); OTC ca) mg calcium carbonate tablet 1500 (600 ca) mg oral 1500 (600 Formulary Custom (*); OTC ca) mg 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 chloride solution 10 % intravenous 10 % Formulary Custom (*) calcium citrate + tablet oral Formulary Custom (*); 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 tablet oral Formulary Custom (*); OTC calcium citrate plus/magnesium tablet oral Formulary Custom (*); OTC calcium citrate tetrahydrate powder Formulary calcium citrate-vitamin d oral tablet 200-125 mg-unit Formulary OTC calcium citrate-vitamin d3 oral liquid 1000-400 Formulary OTC calcium citrate-vitamin d3 oral tablet 315-250 mg-unit Formulary OTC calcium gluconate oral tablet 500 mg Formulary OTC calcium gluconate powder Formulary calcium high potency tablet 1500 (600 ca) mg oral 1500 Formulary Custom (*); OTC (600 ca) mg calcium high potency/vitamin d tablet 600-200 mg-unit oral Formulary Custom (*); OTC 600-200 mg-unit calcium hydroxide powder Formulary calcium lactate oral tablet 100 mg, 648 mg Formulary OTC

18 Drug Name Formulary Status Requirements/Limits calcium oral tablet chewable 500-100 mg-unit, 600-400 Formulary OTC mg-unit calcium pantothenate oral tablet 100 mg, 200 mg, 500 mg Formulary OTC calcium pantothenate powder Formulary calcium phosphate tribasic powder Formulary calcium plus vitamin d3 oral capsule 600-500 mg-unit Formulary OTC calcium saccharate powder Formulary OTC calcium soft chews oral tablet chewable 500-100-40 mg- Formulary OTC unt-mcg, 500-1000-40 mg-unt-mcg calcium sulfate powder 90 % Formulary OTC calcium-magnesium oral tablet 750-465 mg Formulary OTC calcium-magnesium-zinc oral tablet 334-134-5 mg Formulary OTC calcium-magnesium-zinc-d3 tablet oral Formulary Custom (*); OTC calcium-vitamin d oral tablet 600-200 mg-unit Formulary OTC calcium-vitamin d tablet 600-200 mg-unit oral 600-200 mg- Formulary Custom (*); OTC unit calcium-vitamin d3 oral tablet 600-125 mg-unit Formulary OTC calcium-vitamin d-minerals oral tablet chewable 600-800 Formulary OTC mg-unit calcium-vitamin d-minerals tablet chewable 600-400 mg- Formulary Custom (*); OTC unit oral 600-400 mg-unit caldyphen clear lotion 1-0.1 % external 1-0.1 % Formulary Custom (*); OTC calendula external lotion Formulary OTC calendula external ointment Formulary OTC CAL-GEST ANTACID TABLET CHEWABLE 500 MG Formulary Custom (*); OTC ORAL 500 MG cal-glu oral capsule 500 mg Formulary OTC cal-lac oral capsule 500 mg Formulary OTC CALLERGY CLEAR LOTION 1-0.1 % EXTERNAL 1-0.1 Formulary Custom (*); OTC % cal-mag zinc ii oral suspension Formulary OTC cal-mag-zinc-d tablet oral Formulary Custom (*); OTC cal-mint oral tablet chewable 260 mg Formulary OTC CALMOSEPTINE EXTERNAL OINTMENT 0.44-20.6 % Formulary OTC calna oral tablet Formulary OTC CALPHRON TABLET 667 MG ORAL 667 MG Formulary Custom (*); 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

19 Drug Name Formulary Status Requirements/Limits calvite p&d oral tablet 105-81-120 mg-mg-unit Formulary OTC CAMPHO-PHENIQUE EXTERNAL GEL 10.8-4.7 % Formulary OTC CAMPHO-PHENIQUE EXTERNAL LIQUID 10.8-4.7 % Formulary OTC camphor blocks gum Formulary OTC camphor crystals Formulary camphor granules Formulary CAMPHOTREX EXTERNAL GEL 10-4 % Formulary OTC CANKAID MOUTH/THROAT SOLUTION 10 % Formulary OTC capcof oral syrup 5-2-10 mg/5ml Formulary OTC capcof syrup 5-2-10 mg/5ml oral 5-2-10 mg/5ml Formulary Custom (*); OTC capmist dm oral tablet 60-15-400 mg Formulary OTC capmist dm tablet 60-15-400 mg oral 60-15-400 mg Formulary Custom (*); OTC capron dm liquid 7.5-7.5 mg/5ml oral 7.5-7.5 mg/5ml Formulary Custom (*); OTC capron dm oral liquid 7.5-7.5 mg/5ml Formulary OTC capron dmt oral tablet 30-30 mg Formulary OTC CAPSAGEL EXTERNAL GEL 0.025 % Formulary OTC CAPSAGEL EXTRA STRENGTH EXTERNAL GEL 0.05 Formulary OTC % CAPSAGEL MAXIMUM STRENGTH EXTERNAL GEL Formulary OTC 0.075 % capsaicin cream 0.025 % external 0.025 % Formulary Custom (*); OTC capsaicin hot patch external pad 0.025 % Formulary OTC capsaicin powder Formulary CAPSIDERM EXTERNAL PATCH 0.0375-5 % Formulary OTC capsule 1 clear veggie capsule Formulary OTC caraway oil oil Formulary OTC CARBAPHEN CH ORAL SUSPENSION 10-4-24 Formulary OTC MG/5ML CARBAPHEN PED CH ORAL SUSPENSION 2.5-1.25-8 Formulary OTC MG/ML CARBOHOL 940 GEL Formulary carbopol 940 nf powder Formulary carboxymethylcellulose sodium granules Formulary carboxymethylcellulose sodium powder Formulary CARBZERO ORAL EMULSION Formulary OTC cardamom oil Formulary OTC CARDENZ ORAL TABLET Formulary OTC 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 CARMOL 10 EXTERNAL LOTION 10 % Formulary OTC CARNI Q-GEL FORTE ORAL CAPSULE 30-250 MG Formulary OTC CARRASMART EXTERNAL GEL Formulary OTC CARRASORB H EXTERNAL Formulary OTC CARRASYN V WOUND DRESSING EXTERNAL GEL Formulary OTC 20 Drug Name Formulary Status Requirements/Limits CARRINGTON ANTIFUNGAL CREAM 2 % Formulary Custom (*); OTC EXTERNAL 2 % CARRINGTON DERMAL WOUND EXTERNAL GEL Formulary OTC CARRINGTON MOIST BARRIER/ZINC CREAM Formulary Custom (*); OTC EXTERNAL CARRINGTON MOISTURE BARRIER CREAM Formulary Custom (*); OTC EXTERNAL castellani paint modified external liquid 1.5 % Formulary OTC CASTIVA COOLING EXTERNAL LOTION 5-14 % Formulary OTC CASTIVA WARMING EXTERNAL LOTION 0.035 % Formulary OTC castor oil oil Formulary castor oil sulfated oil Formulary OTC CAVILON EMOLLIENT EXTERNAL CREAM Formulary OTC CAVILON FOOT & DRY SKIN EXTERNAL CREAM Formulary OTC CAVILON NO STING BARRIER FILM EXTERNAL Formulary OTC CAVILON NO STING BARRIER FILM EXTERNAL Formulary OTC LIQUID CAVILON ONE-STEP SKIN CARE EXTERNAL Formulary OTC LOTION CAVILON SKIN CLEANSER EXTERNAL LIQUID Formulary OTC c-caps tr oral capsule extended release 500 mg Formulary OTC CELACYN EXTERNAL GEL Formulary celery seed oil Formulary OTC cellulase powder Formulary OTC cellulose crystals Formulary cellulose powder Formulary centravites adults oral tablet 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 & COUGH Formulary OTC MOUTH/ 5-7.5 MG CEPACOL SORE THROAT MOUTH/THROAT Formulary OTC LOZENGE 15-2.6 MG, 15-3.6 MG CEPASTAT MOUTH/THROAT LOZENGE 5-6-10 MG Formulary OTC CERASPORT EX1 ORAL PACKET Formulary OTC CERAVE ITCH RELIEF EXTERNAL CREAM 1 % Formulary OTC CESIUM 1000 ORAL CAPSULE 1000 MG Formulary OTC cesium 500 oral capsule 500 mg Formulary OTC cesium oral tablet 100 mg Formulary OTC CETAPHIL GENTLE CLEANSING EXTERNAL BAR Formulary OTC cetirizine hcl allergy child solution 5 mg/5ml oral (otc) 5 Formulary Custom (*) mg/5ml cetirizine hcl childrens alrgy solution 1 mg/ml oral 1 mg/ml Formulary Custom (*); OTC

21 Drug Name Formulary Status Requirements/Limits cetirizine hcl childrens solution 5 mg/5ml oral 5 mg/5ml Formulary Custom (*); OTC cetirizine hcl tablet 10 mg oral 10 mg Formulary Custom (*); OTC cetirizine hcl tablet 5 mg oral 5 mg Formulary Custom (*); OTC cetirizine hcl tablet chewable 10 mg oral 10 mg Formulary Custom (*); OTC cetirizine hcl tablet chewable 5 mg oral 5 mg Formulary Custom (*); OTC cetirizine-pseudoephedrine er tablet extended release 12 Formulary Custom (*); OTC hour 5-120 mg oral 5-120 mg cetyl alcohol flakes Formulary CHAMOSYN EXTERNAL OINTMENT 0.45-20 % Formulary OTC CHAP-EX TROPICALS EXTERNAL STICK Formulary OTC CHAPSTICK OVERNIGHT EXTERNAL OINTMENT Formulary OTC CHAPSTICK ULTRA RENEWAL EXTERNAL CREAM Formulary OTC 2 % charcoal activated powder Formulary CHAR-FLO WITH SORBITOL ORAL SUSPENSION 25- Formulary OTC 48 GM/120ML chelated calcium oral tablet 200 mg Formulary OTC chelated magnesium oral tablet 100 mg Formulary OTC CHEMSTRIP CALIBRATION IN VITRO STRIP Formulary OTC CHERACOL-D COUGH ORAL LIQUID 10-100 MG/5ML Formulary OTC cheratussin ac syrup 100-10 mg/5ml oral 100-10 mg/5ml Formulary Custom (*); OTC cheratussin dac solution 30-10-100 mg/5ml oral 30-10-100 Formulary Custom (*); OTC mg/5ml cherry concentrate oral concentrate Formulary OTC chest congestion daytime tablet 325-200 mg oral 325-200 Formulary Custom (*); OTC mg chest congestion relief dm tablet 20-400 mg oral 20-400 mg Formulary Custom (*); OTC chest congestion relief pe tablet 10-400 mg oral 10-400 mg Formulary Custom (*); OTC chest congestion relief tablet 400 mg oral 400 mg Formulary Custom (*); OTC CHEW Q ORAL TABLET CHEWABLE 100 MG, 30 MG, Formulary OTC 600 MG chewable calcium oral tablet chewable 500-200-40 mg-unt- Formulary OTC mcg chewable iron oral tablet chewable 30-10-25 mg Formulary OTC CHIGG AWAY EXTERNAL LOTION 5-10 % Formulary OTC CHIGGEREX EXTERNAL OINTMENT 2 % Formulary OTC CHIGGERTOX EXTERNAL LIQUID 2.1 % Formulary OTC childrens acetaminophen suspension 325 mg/10.15ml oral Formulary Custom (*); OTC 325 mg/10.15ml CHILDRENS ADVIL SUSPENSION 100 MG/5ML ORAL Formulary Custom (*); OTC 100 MG/5ML childrens aspirin free oral elixir 80 mg/2.5ml Formulary OTC childrens aspirin low strength tablet chewable 81 mg oral Formulary Custom (*); OTC 81 mg childrens aspirin tablet chewable 81 mg oral 81 mg Formulary Custom (*); OTC childrens cold & allergy elixir 1-2.5 mg/5ml oral 1-2.5 Formulary Custom (*); OTC mg/5ml 22 Drug Name Formulary Status Requirements/Limits childrens ibuprofen suspension 100 mg/5ml oral 100 Formulary Custom (*); OTC mg/5ml childrens loratadine solution 5 mg/5ml oral 5 mg/5ml Formulary Custom (*); OTC childrens loratadine syrup 5 mg/5ml oral 5 mg/5ml Formulary Custom (*); OTC childrens mapap rapid tabs tablet dispersible 80 mg oral 80 Formulary Custom (*); OTC mg CHILDRENS MOTRIN ORAL SUSPENSION 100 Formulary OTC MG/5ML childrens mucus relief cough liquid 5-100 mg/5ml oral 5- Formulary Custom (*); OTC 100 mg/5ml childrens mucus relief expect liquid 100 mg/5ml oral 100 Formulary Custom (*); OTC mg/5ml childrens non-aspirin oral tablet dispersible 80 mg Formulary OTC 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 liquid 15 mg/5ml oral 15 mg/5ml Formulary Custom (*); OTC CHILDRENS SOOTHE ORAL TABLET CHEWABLE Formulary OTC 400 MG childrens tactinal tablet chewable 80 mg oral 80 mg Formulary Custom (*); OTC childs ibuprofen suspension 100 mg/5ml oral 100 mg/5ml Formulary Custom (*); OTC chlo hist oral solution 12.5-1 mg/5ml Formulary OTC chlo tuss ex liquid 12.5-100 mg/5ml oral 12.5-100 mg/5ml Formulary Custom (*); OTC CHLO TUSS LIQUID 30-1-12.5 MG/5ML ORAL 30-1- Formulary Custom (*); OTC 12.5 MG/5ML CHLO TUSS ORAL LIQUID 30-1-12.5 MG/5ML Formulary OTC chlophed oral liquid 5-12.5-100 mg/5ml Formulary OTC CHLORAPREP ONE STEP EXTERNAL SOLUTION 2- Formulary OTC 70 % CHLORASEPTIC MOUTH/THROAT LOZENGE 6-10 Formulary OTC MG CHLORASEPTIC SORE THROAT ORAL LIQUID 1000 Formulary OTC MG/30ML chlorella oral capsule Formulary OTC gluconate cloth external pad 2 % Formulary OTC chlorhexidine gluconate external liquid 2 % Formulary OTC chloroform solution Formulary chlorophyll oral tablet 3-0.6 mg Formulary OTC chlorpheniramine maleate er tablet extended release 12 mg Formulary Custom (*); OTC oral 12 mg 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 chocolate concentrate concentrate Formulary Custom (*); OTC cholecalciferol powder Formulary cholesterol acetate powder Formulary OTC

23 Drug Name Formulary Status Requirements/Limits cholesterol powder Formulary choline citrate oral tablet 650 mg Formulary OTC choline oral capsule 648 mg Formulary OTC CHONDROITIN SULFATE COMPLEX ORAL Formulary OTC CAPSULE 400-60-2.5 MG CHROMACAPS ORAL CAPSULE 1 MG Formulary OTC chromic chloride solution 40 mcg/10ml intravenous 40 Formulary Custom (*) mcg/10ml 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 200 mcg Formulary OTC chromium picolinate powder Formulary chrysin powder Formulary cinnamon oil oil Formulary OTC cinnamon oral capsule 500 mg Formulary OTC CITRA PH ORAL SOLUTION 2.7 GM/30ML Formulary OTC CITRACAL PLUS BONE DENSITY TABLET ORAL Formulary Custom (*); OTC CITRACAL PLUS TABLET ORAL Formulary Custom (*); OTC citric acid anhydrous granules Formulary citric acid anhydrous powder Formulary citric acid monohydrate granules Formulary citronella oil oil Formulary CITRUCEL ORAL POWDER Formulary OTC CITRUCEL ORAL TABLET 500 MG Formulary OTC CITRULLINE 1000 ORAL PACKET 1 GM Formulary OTC citrulline powder Formulary CITRULLINE200 ORAL PACKET 200 MG Formulary OTC citrus bioflavonoids oral tablet 1000 mg Formulary OTC CLARITIN CAPSULE 10 MG ORAL 10 MG Formulary Custom (*); OTC 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 REDITABS TABLET DISPERSIBLE 10 MG Formulary Custom (*); OTC ORAL 10 MG CLARITIN REDITABS TABLET DISPERSIBLE 5 MG Formulary Custom (*); OTC ORAL 5 MG CLARITIN SYRUP 5 MG/5ML ORAL 5 MG/5ML Formulary Custom (*); OTC CLARITIN TABLET 10 MG ORAL 10 MG Formulary Custom (*); OTC CLARITIN TABLET CHEWABLE 5 MG ORAL 5 MG Formulary Custom (*); OTC

24 Drug Name Formulary Status Requirements/Limits CLARITIN-D 12 HOUR ORAL TABLET EXTENDED Formulary OTC RELEASE 12 HOUR 5-120 MG CLARITIN-D 12 HOUR TABLET EXTENDED Formulary Custom (*); OTC RELEASE 12 HOUR 5-120 MG ORAL 5-120 MG CLARITIN-D 24 HOUR ORAL TABLET EXTENDED Formulary OTC RELEASE 24 HOUR 10-240 MG CLARITIN-D 24 HOUR TABLET EXTENDED Formulary Custom (*); OTC RELEASE 24 HOUR 10-240 MG ORAL 10-240 MG CLEAN & CLEAR ACNE CLEANSER EXTERNAL Formulary OTC FOAM 2 % CLEAN & CLEAR ACNE CLEANSER EXTERNAL Formulary OTC LIQUID 2 % CLEAN & CLEAR BLEMISH TREATMNT EXTERNAL Formulary OTC GEL 2 % CLEAN ZING MOUTH/THROAT LIQUID 0.06 % Formulary OTC CLEAR EYES COOLING COMFORT SOLUTION 0.012- Formulary Custom (*); OTC 0.25-0.25 % OPHTHALMIC 0.012-0.25-0.25 % CLEAR EYES REDNESS RELIEF OPHTHALMIC Formulary OTC SOLUTION 0.012-0.2 % clear zinc spf 50 external lotion Formulary OTC CLEARASIL DAILY CLEAR ACNE EXTERNAL Formulary OTC CREAM 10 % CLEARLAX POWDER 17 GM/SCOOP ORAL 17 Formulary Custom (*); OTC GM/SCOOP CLEARPLEX V EXTERNAL GEL 5 % Formulary OTC clemastine fumarate tablet 1.34 mg oral 1.34 mg Formulary Custom (*); OTC CLERZ PLUS SOLUTION Formulary OTC CLEVER CHOICE BP MONITOR/WRIST DEVICE Formulary OTC powder Formulary CLORPACTIN POWDER 2 GM Formulary OTC clotrimazole 3 vaginal cream 2 % Formulary OTC clotrimazole cream 1 % external (otc) 1 % Formulary Custom (*) clotrimazole cream 1 % vaginal 1 % Formulary Custom (*); OTC clotrimazole solution 1 % external (otc) 1 % Formulary Custom (*) clotrimazole vaginal cream 1 % Formulary OTC clove oil oil Formulary co q-10 oral capsule 200 mg Formulary OTC COAGUCHEK XS PLUS SYSTEM KIT Formulary OTC COAGUCHEK XS PT TEST IN VITRO STRIP Formulary OTC coal tar liquid Formulary OTC COATS ALOE EXTERNAL CREAM 0.5 % Formulary OTC COATS ALOE EXTERNAL GEL 0.5 % Formulary OTC COATS ALOE EXTERNAL LOTION 0.5 % Formulary OTC COATS ALOE JUICE DRINK ORAL LIQUID Formulary OTC COATS ALOE EXTERNAL LOTION 10 % Formulary OTC COATS ALOE VERA EXTERNAL LIQUID Formulary OTC cocoa butter Formulary 25 Drug Name Formulary Status Requirements/Limits cocoa butter skin external cream Formulary OTC cod liver oil oral oil Formulary cod liver oil w/vit a, c & d tablet chewable oral Formulary Custom (*); OTC codituss dm syrup 5-8.33-10 mg/5ml oral 5-8.33-10 mg/5ml Formulary Custom (*); OTC 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 co- q10-vitamin e oral wafer 200-400 mg-unit Formulary OTC cola syrup oral syrup Formulary OTC COLACE ORAL CAPSULE 100 MG Formulary OTC cold & cough day/night child oral 2.5-5 &2.5-6.25 mg/5ml Formulary OTC cold & hot balm extra strength external ointment 7.6-29 % Formulary OTC cold control pe cold/flu med oral tablet 25-10-650 mg Formulary OTC cold head congestion daytime tablet 10-5-325 mg oral 10-5- Formulary Custom (*); OTC 325 mg cold head congestion nighttime oral tablet 5-2-10-325 mg Formulary OTC cold head congestion nighttime tablet 5-2-10-325 mg oral Formulary Custom (*); OTC 5-2-10-325 mg cold head congestion severe tablet 5-10-200-325 mg oral 5- Formulary Custom (*); OTC 10-200-325 mg cold multi-symptom daytime tablet 10-5-325 mg oral 10-5- Formulary Custom (*); OTC 325 mg cold multi-symptom nighttime tablet 5-2-10-325 mg oral 5- Formulary Custom (*); OTC 2-10-325 mg cold multi-symptom severe day tablet 5-10-200-325 mg oral Formulary Custom (*); OTC 5-10-200-325 mg cold relief plus oral tablet effervescent 2-5-250 mg Formulary OTC cold relief plus tablet effervescent 2-7.8-325 mg oral 2-7.8- Formulary Custom (*); OTC 325 mg 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/allergy childrens elixir 1-2.5 mg/5ml oral 1-2.5 Formulary Custom (*); OTC mg/5ml cold/cough childrens liquid 2.5-1-5 mg/5ml oral 2.5-1-5 Formulary Custom (*); OTC mg/5ml cold/cough dm childrens elixir 2.5-1-5 mg/5ml oral 2.5-1-5 Formulary Custom (*); OTC mg/5ml COLD-EEZE MOUTH/THROAT LOZENGE 13.3 MG Formulary OTC COLD-EEZE ORAL GUM 13.3 MG Formulary OTC COLLASIL OSA POWDER Formulary

26 Drug Name Formulary Status Requirements/Limits collodion flexible external liquid Formulary collodion liquid Formulary colloidal oatmeal bath packet external Formulary Custom (*); OTC COMFORT CLEAN/COMFORT SHIELD EXTERNAL 3 Formulary OTC % comfort-heal heating pad pad Formulary OTC complete allergy capsule 25 mg oral 25 mg Formulary Custom (*); OTC complete allergy medicine capsule 25 mg oral 25 mg Formulary Custom (*); OTC complete allergy tablet 25 mg oral 25 mg Formulary Custom (*); OTC complete lice treatment kit 0.33-4-0.5 % combination 0.33- Formulary Custom (*); OTC 4-0.5 % compound benzoin tincture external swab Formulary OTC COMPOUND W MAXIMUM STRENGTH EXTERNAL Formulary OTC GEL 17 % 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 COMTREX DEEP CHEST COLD TABLET 325-200 MG Formulary Custom (*); OTC ORAL 325-200 MG CONEX COLD/ALLERGY ORAL SOLUTION 1-30 Formulary OTC MG/5ML CONEX COLD/ALLERGY ORAL TABLET 2-60 MG Formulary OTC CONEX COLD/ALLERGY SOLUTION 1-30 MG/5ML Formulary Custom (*); OTC ORAL 1-30 MG/5ML CONEX COLD/ALLERGY TABLET 2-60 MG ORAL 2- Formulary Custom (*); OTC 60 MG CONGESTAC ORAL TABLET 60-400 MG Formulary OTC CONGESTAC TABLET 60-400 MG ORAL 60-400 MG Formulary Custom (*); OTC congestion relief oral tablet 10-200 mg Formulary OTC congestion relief tablet 10-200 mg oral 10-200 mg Formulary Custom (*); OTC CONTRAVE TABLET EXTENDED RELEASE 12 HOUR PA; Custom (*); QL (90 EA per 365 Formulary 8-90 MG ORAL 8-90 MG days) cool mist humidifier Formulary OTC cool mist humidifier 0.8 gal Formulary OTC cool mist humidifier 1 gallon Formulary OTC cool mist humidifier 1.2 gal Formulary OTC cool mist humidifier 2 gallon Formulary OTC cool n heat ex st external patch 5 % Formulary OTC copper sulfate crystals Formulary OTC COPPERMIN ORAL TABLET 5 MG Formulary OTC co-q 10 omega-3 fish oil oral capsule Formulary OTC coq-10 oral capsule 10 mg, 150 mg, 50 mg Formulary OTC coq10 oral capsule 30 mg Formulary OTC coq10 oral powder 50 gm Formulary OTC 27 Drug Name Formulary Status Requirements/Limits coral calcium oral capsule 185-50-100 mg-mg-unit, 200- Formulary OTC 100-100 mg-unit CORICIDIN HBP COLD/FLU ORAL TABLET 2-325 MG Formulary OTC CORICIDIN HBP COLD/FLU TABLET 2-325 MG ORAL Formulary Custom (*); OTC 2-325 MG CORICIDIN HBP COUGH/COLD ORAL TABLET 4-30 Formulary OTC MG CORICIDIN HBP COUGH/COLD TABLET 4-30 MG Formulary Custom (*); OTC ORAL 4-30 MG CORICIDIN HBP DAY/NIGHT COLD ORAL 10-20 &15- Formulary OTC 200-2 MG CORICIDIN HBP NIGHTTIME COLD LIQUID 15-6.25- Formulary Custom (*); OTC 325 MG/15ML ORAL 15-6.25-325 MG/15ML CORICIDIN HBP NIGHTTIME COLD ORAL LIQUID Formulary OTC 15-6.25-500 MG/15ML corn oil oil Formulary corn oil oral oil Formulary OTC CORN REMOVER WATERPROOF EXTERNAL PAD 40 Formulary OTC % corn starch powder Formulary corn/callus remover external solution 12.6 % Formulary OTC CORTICOOL EXTERNAL GEL 1 % Formulary OTC CORTIZONE-10/ALOE EXTERNAL CREAM 1 % Formulary OTC COSAMIN ASU FOR JOINT HEALTH ORAL CAPSULE Formulary OTC COSAMIN VERDE FOR JOINT HEALTH ORAL Formulary OTC TABLET cottonseed oil oil Formulary COTTONTAILS DIAPER RASH CREAMY EXTERNAL Formulary OTC OINTMENT 10 % cough & chest congestion dm oral liquid 5-100 mg/5ml Formulary OTC cough & cold oral tablet 4-30 mg Formulary OTC cough & cold tablet 4-30 mg oral 4-30 mg Formulary Custom (*); OTC cough & sore throat day liquid 500-15 mg/15ml oral 500- Formulary Custom (*); OTC 15 mg/15ml cough dm suspension extended release 30 mg/5ml oral 30 Formulary Custom (*); OTC mg/5ml cough drops mouth/throat lozenge 10 mg, 3.1 mg, 5 mg, 5.4 Formulary OTC mg, 6.5 mg, 7 mg, 7.5 mg, 7.6 mg, 8 mg, 9.1 mg cough relief adult oral capsule 15 mg Formulary OTC cough syrup syrup 100 mg/5ml oral 100 mg/5ml Formulary Custom (*); OTC coughtab tablet 200 mg oral 200 mg Formulary Custom (*); OTC cramp tabs oral tablet 325-25 mg Formulary OTC cranberry concentrate oral capsule 500 mg Formulary OTC cranberry oral capsule 250 mg Formulary OTC cranberry/probiotic tablet oral Formulary Custom (*); OTC cream base with external cream Formulary creatine monohydrate powder Formulary

28 Drug Name Formulary Status Requirements/Limits creatine oral powder Formulary OTC creatine5000 oral packet 5000 mg Formulary OTC CREOMULSION ADULT ORAL SYRUP 20 MG/15ML Formulary OTC CREOMULSION FOR CHILDREN ORAL SYRUP 5 Formulary OTC MG/5ML CREST DENTAL PASTE 0.243 % Formulary OTC CR-GTF ORAL CAPSULE 200 MCG Formulary OTC CRITIC-AID CLEAR AF OINTMENT 2 % EXTERNAL 2 Formulary Custom (*); OTC % CRITIC-AID THICK MOIST BARRIER EXTERNAL Formulary OTC PASTE CRITIC-AID THICK MOIST BARRIER PASTE Formulary Custom (*); OTC EXTERNAL cromolyn sodium aerosol solution 5.2 mg/act nasal 5.2 Formulary Custom (*); OTC mg/act cromolyn sodium nasal aerosol solution 5.2 mg/act Formulary OTC croton oil oil Formulary CR-PLUS ORAL TABLET 500 MCG Formulary OTC cu-25 oral capsule 25 mg Formulary OTC cu-5 oral capsule 5 mg Formulary OTC cupric chloride solution 0.4 mg/ml intravenous 0.4 mg/ml Formulary Custom (*) cupric sulfate powder Formulary CURAD GERM SHIELD EXTERNAL GEL Formulary OTC CURAFIL WOUND DRESSING EXTERNAL GEL Formulary OTC CURASOL WOUND DRESSING EXTERNAL GEL Formulary OTC CURITY GAUZE PAD 2"X2" Formulary OTC CURITY MESH GAUZE BNDG 4"X30' Formulary OTC CURITY NURSING PAD Formulary OTC CURITY TELFA NON-STICK PAD 3"X4" Formulary OTC cvs absorbent cotton/rolled 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 allergy relief childrens oral tablet dispersible 12.5 mg Formulary OTC cvs allergy relief oral tablet extended release 12 mg Formulary OTC cvs allergy relief tablet 5 mg oral 5 mg Formulary OTC cvs antacid childrens oral liquid 400 mg/5ml Formulary OTC cvs anti-itch sensitive external lotion 1 % Formulary OTC cvs antiseptic mouth rinse mouth/throat liquid Formulary OTC cvs astringent solution external packet Formulary OTC cvs backache relief oral tablet 500 mg Formulary OTC cvs ca citrate+d/magnesium tablet oral Formulary Custom (*); OTC cvs calcium 600 plus oral tablet chewable Formulary OTC cvs calcium 600 plus tablet chewable oral Formulary Custom (*); OTC

29 Drug Name Formulary Status Requirements/Limits cvs calcium oral tablet chewable 250-400 mg-unit Formulary OTC cvs chest rub medicated external ointment 4.7-1.2-2.6 % Formulary OTC cvs childrens multivit/extra c tablet chewable oral Formulary Custom (*); OTC cvs cleansing eyelid wipes external pad Formulary OTC cvs cleansing skin external cream Formulary OTC cvs cold remedy oral tablet dispersible Formulary OTC cvs cool mist humidifer Formulary OTC cvs coq-10 oral capsule 400 mg Formulary OTC cvs corn/callus remover external kit 17 % Formulary OTC cvs cough dm oral suspension extended release 30 mg/5ml Formulary OTC cvs dairy relief ex st oral tablet 4500 unit Formulary OTC cvs daytime/nighttime cold/flu oral (liquid) Formulary OTC cvs daytime/nighttime cough oral liquid therapy pack 6.25- Formulary OTC 15 & 15 mg/15ml cvs diabetes health support oral Formulary OTC cvs digestive probiotic oral capsule Formulary OTC cvs diuretic maximum strength oral capsule 50 mg Formulary OTC cvs early result pregnancy in vitro diagnostic test Formulary OTC cvs easy fiber powder oral Formulary Custom (*); OTC cvs easy fiber/calcium oral tablet chewable Formulary OTC cvs epsom salt granules Formulary OTC cvs ethyl alcohol solution 70 % Formulary OTC cvs eye health formula oral capsule Formulary OTC cvs eye pad 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 capsule oral Formulary Custom (*); 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 hair regrowth for women external foam 5 % Formulary OTC cvs heartburn relief ex st oral suspension 254-237.5 mg/5ml Formulary OTC cvs heatwraps/back/hip Formulary OTC cvs hemorrhoidal & analgesic rectal ointment 1 % Formulary OTC cvs hemorrhoidal rectal ointment 0.25-14-74.9 % Formulary OTC cvs hemorrhoidal suppository rectal Formulary Custom (*); OTC cvs hot steam inhalation liquid 6.2 % Formulary OTC cvs hydrating skin treatment lotion 12 % external 12 % Formulary Custom (*); OTC cvs hydrocolloid pads pad Formulary OTC cvs hydrocortisone acetate external cream 0.5 % Formulary OTC cvs ibuprofen pm oral tablet 200-38 mg Formulary OTC

30 Drug Name Formulary Status Requirements/Limits cvs instant food thickener oral powder Formulary OTC cvs wipes external 70 % Formulary OTC cvs itch relief external gel 2 % Formulary OTC cvs itch relief gel 2 % external 2 % Formulary Custom (*); OTC cvs laxative dietary supplemnt oral tablet 500 mg Formulary OTC cvs loperamide hcl oral suspension 1 mg/7.5ml Formulary OTC cvs lubricant drops ophthalmic gel 0.25-0.3 %, 1 % Formulary OTC cvs magnesium citrate oral capsule 125 mg Formulary OTC cvs manuka wound external gel Formulary OTC cvs medicated wipes pad 50 % external 50 % Formulary Custom (*); OTC cvs melatonin oral capsule 10 mg Formulary OTC cvs melatonin oral tablet chewable 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 rectal enema 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 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 nerve pain relief external ointment Formulary OTC cvs non-aspirin headache pm oral tablet 500-38 mg Formulary OTC cvs non-drying sinus pe oral tablet 5-200 mg Formulary OTC cvs oral pain reliever mouth/throat cream 20 % Formulary OTC cvs pain pads external pad 154 mg 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 prenatal gummy oral tablet chewable 0.4-113.5 mg Formulary OTC cvs prenatal oral tablet 28-0.8 mg Formulary OTC cvs protective external powder 81-15 % Formulary OTC cvs saline wound wash external solution 0.9 % Formulary OTC cvs external gel Formulary OTC cvs sinus headache decongest oral tablet 30-500 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 cvs sore throat max strength mouth/throat lozenge 15-2.6 Formulary OTC mg, 15-3.6 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 super cranberry urinary oral capsule 140-100 mg Formulary OTC 31 Drug Name Formulary Status Requirements/Limits cvs tension headache oral capsule 500-65 mg Formulary OTC cvs therapeutic external shampoo 0.5 % Formulary OTC cvs therapeutic max st external shampoo 3 % 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 vaginal moisturizer vaginal gel Formulary OTC cvs vitamin a & d external ointment Formulary OTC cvs vitamin d infants oral liquid 400 unit/ml Formulary OTC cvs wart remover external liquid 17 % Formulary OTC cvs wart remover one step external strip 40 % 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 cvs zinc tablet 50 mg oral 50 mg Formulary Custom (*); OTC cyanocobalamin crystals Formulary cyanocobalamin solution 1000 mcg/ml 1000 Formulary Custom (*) mcg/ml CYSTECH ORAL CAPSULE 500 MG Formulary OTC cystine oral packet 500 mg Formulary OTC d 2000 oral tablet 50 mcg (2000 ut) Formulary OTC d 400 capsule oral Formulary Custom (*); OTC d 400 oral tablet chewable 10 mcg (400 unit) Formulary OTC d.o.s. capsule 250 mg oral 250 mg Formulary Custom (*); OTC DADS MENTHOL THROAT DROP MOUTH/THROAT Formulary OTC LOZENGE 3.5 MG daily care skin protectant external ointment 30 % Formulary OTC daily ovulation predictor in vitro strip 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 DALLERGY LIQUID 1-2.5 MG/ML ORAL 1-2.5 MG/ML Formulary Custom (*); OTC DALLERGY ORAL LIQUID 1-2.5 MG/ML Formulary OTC DALLERGY ORAL SYRUP 1-5 MG/5ML Formulary OTC DALLERGY ORAL TABLET 1-5 MG Formulary OTC DALLERGY SYRUP 1-5 MG/5ML ORAL 1-5 MG/5ML Formulary Custom (*); OTC DALLERGY TABLET 1-5 MG ORAL 1-5 MG Formulary Custom (*); OTC dandruff shampoo external lotion 1 % Formulary OTC DAY TIME COLD/FLU RELIEF CAPSULE 10-5-325 MG Formulary Custom (*); OTC ORAL 10-5-325 MG DAY TIME COLD/FLU RELIEF LIQUID 10-5-325 Formulary Custom (*); OTC MG/15ML ORAL 10-5-325 MG/15ML

32 Drug Name Formulary Status Requirements/Limits DAY TIME COLD/FLU RELIEF ORAL CAPSULE 10-5- Formulary OTC 325 MG day time cough liquid 15 mg/15ml oral 15 mg/15ml Formulary Custom (*); OTC day time cough oral liquid 15 mg/15ml Formulary OTC day time multi-sympt cold/flu liquid 10-5-325 mg/15ml oral Formulary Custom (*); OTC 10-5-325 mg/15ml day time pe cold/flu relief capsule 10-5-325 mg oral 10-5- Formulary Custom (*); OTC 325 mg day time/nite time cold/flu oral Formulary Custom (*); OTC DAYHIST ALLERGY 12 HOUR RELIEF TABLET 1.34 Formulary Custom (*); OTC MG ORAL 1.34 MG DAYTIME ORAL LIQUID 325-15 Formulary OTC MG/15ML day-time pe capsule 10-5-325 mg oral 10-5-325 mg Formulary Custom (*); OTC daytime sinus congestion oral capsule 5-325 mg Formulary OTC daytime/nighttime relief plus oral Formulary OTC DDROPS ORAL LIQUID 2000 UT/0.028ML Formulary OTC DECARA ORAL CAPSULE 625 MCG (25000 UT) Formulary OTC DECON-A ORAL LIQUID 2-5 MG/ML Formulary OTC DECONEX DMX ORAL TABLET 10-17.5-385 MG Formulary OTC DECONEX DMX TABLET 10-15-380 MG ORAL 10-15- Formulary Custom (*); OTC 380 MG DECONEX IR ORAL TABLET 10-385 MG Formulary OTC DECONEX IR TABLET 10-380 MG ORAL 10-380 MG Formulary Custom (*); OTC deep sea nasal spray solution 0.65 % nasal 0.65 % Formulary Custom (*); OTC dehydroepiandrosterone powder Formulary del clens external gel Formulary OTC DELBASE COMPOUNDING EXTERNAL OINTMENT Formulary OTC DELSYM CGH/CHEST CONG DM CHILD LIQUID 5- Formulary Custom (*); OTC 100 MG/5ML ORAL 5-100 MG/5ML DELSYM CGH/CLD NIGHTTIME CHILD LIQUID 12.5- Formulary Custom (*); OTC 5-325 MG/10ML ORAL 12.5-5-325 MG/10ML DELSYM CGH/CLD NIGHTTIME CHILD ORAL Formulary OTC LIQUID 12.5-5-325 MG/10ML DELSYM COUGH CHILDRENS SUSPENSION Formulary Custom (*); OTC EXTENDED RELEASE 30 MG/5ML ORAL 30 MG/5ML DELSYM COUGH RELIEF LOZENGE 5-5 MG Formulary Custom (*); OTC MOUTH/THROAT 5-5 MG DELSYM COUGH/CHEST CONGEST DM LIQUID 5- Formulary Custom (*); OTC 100 MG/5ML ORAL 5-100 MG/5ML DELSYM COUGH/COLD DAYTIME LIQUID 5-10-200- Formulary Custom (*); OTC 325 MG/10ML ORAL 5-10-200-325 MG/10ML DELSYM COUGH/COLD NIGHT TIME LIQUID 12.5-5- Formulary Custom (*); OTC 325 MG/10ML ORAL 12.5-5-325 MG/10ML DELSYM NIGHT TIME MULTI-SYMPT ORAL LIQUID Formulary OTC 5-6.25-10-325 MG/15ML DELSYM ORAL SUSPENSION EXTENDED RELEASE Formulary OTC 30 MG/5ML

33 Drug Name Formulary Status Requirements/Limits DELSYM SUSPENSION EXTENDED RELEASE 30 Formulary Custom (*); OTC MG/5ML ORAL 30 MG/5ML DELTUSS DMX ORAL LIQUID 30-1-15 MG/5ML Formulary OTC DELTUSS DP ORAL LIQUID 1-30 MG/5ML Formulary OTC DENDRACIN NEURODENDRAXCIN EXTERNAL Formulary LOTION 0.025-10-30 % DENDRACIN NEURODENDRAXCIN EXTERNAL Formulary OTC LOTION 0.0375-10-30 % DENTAPAINE MOUTH/THROAT GEL 20 % Formulary OTC DEQUASINE ORAL TABLET Formulary OTC DERMA CIDOL 2000 EXTERNAL LIQUID 0.5 % Formulary OTC dermacloud external cream Formulary OTC DERMAFUNGAL OINTMENT 2 % EXTERNAL 2 % Formulary Custom (*); 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 EXTERNAL OINTMENT Formulary OTC DERMAGRAN HYDROGEL WOUND EXTERNAL GEL Formulary OTC DERMAGRAN HYDROPHILIC-B EXTERNAL Formulary OTC OINTMENT DERMAGRAN-B HYDROPHILIC EXTERNAL GEL Formulary OTC DERMAL THERAPY FINGER CARE EXTERNAL Formulary OTC LOTION 20 % DERMAL WOUND CLEANSER EXTERNAL LIQUID Formulary OTC 0.13 % DERMAL WOUND CLEANSER LIQUID 0.13 % Formulary Custom (*); OTC EXTERNAL 0.13 % DERMAMED EXTERNAL OINTMENT Formulary OTC DERMAPLEX EXTERNAL GEL Formulary OTC DERMASARRA ANTI-ITCH LOTION 0.5-0.5 % Formulary Custom (*); OTC EXTERNAL 0.5-0.5 % DERMASTAT EXTERNAL FOAM 65 % Formulary OTC DERMASYN EXTERNAL GEL Formulary OTC DERMOPLAST EXTERNAL AEROSOL 20-0.5 % Formulary OTC dermovix external patch 2-30 % Formulary OTC DESENEX FOOT/SNEAKER SPRAY EXTERNAL Formulary OTC AEROSOL DESENEX POWDER 2 % EXTERNAL 2 % Formulary Custom (*); OTC DESITIN EXTERNAL PASTE 40 % Formulary OTC despec-dm oral tablet 30-10-200 mg Formulary OTC DESQUAM-X WASH EXTERNAL LIQUID 10 % Formulary OTC DEVON ANDREWS FRAME KIT Formulary OTC DEVROM ORAL TABLET CHEWABLE 200 MG Formulary OTC DEWEES CARMINATIVE ORAL LIQUID 6-250 Formulary OTC polistirex er suspension extended release Formulary Custom (*); OTC 30 mg/5ml oral 30 mg/5ml

34 Drug Name Formulary Status Requirements/Limits dextromethorphan-guaifenesin solution 10-100 mg/5ml oral Formulary Custom (*); OTC 10-100 mg/5ml dextromethorphan-guaifenesin solution 20-200 mg/10ml Formulary Custom (*); OTC oral 20-200 mg/10ml dextrose anhydrous granules Formulary OTC dextrose powder Formulary dha complete oral capsule 200 mg Formulary OTC dhea oral capsule 50 mg Formulary OTC dhea oral tablet 25 mg Formulary OTC DHS SAL SHAMPOO 3 % EXTERNAL 3 % Formulary Custom (*); OTC DHS TAR GEL SHAMPOO 0.5 % EXTERNAL 0.5 % Formulary Custom (*); OTC DHS TAR SHAMPOO 0.5 % EXTERNAL 0.5 % Formulary Custom (*); OTC DHS ZINC EXTERNAL SHAMPOO 2 % Formulary OTC DHS ZINC SHAMPOO 2 % EXTERNAL 2 % Formulary Custom (*); OTC DIAB DAILY CARE EXTERNAL GEL Formulary OTC DIABETIC BASICS HEALTHY FOOT EXTERNAL Formulary OTC LOTION 0.13 % diabetic siltussin das-na liquid 100 mg/5ml oral 100 Formulary Custom (*); OTC mg/5ml diabetic siltussin-dm liquid 100-10 mg/5ml oral 100-10 Formulary Custom (*); OTC mg/5ml diabetic siltussin-dm max st liquid 10-200 mg/5ml oral 10- Formulary Custom (*); OTC 200 mg/5ml DIABETIC TUSSIN ALLERGY ORAL SYRUP 2 Formulary OTC MG/5ML DIABETIC TUSSIN COLD & FLU ORAL LIQUID 10- Formulary OTC 12.5-325 MG/5ML DIABETIC TUSSIN COLD/FLU ORAL CAPSULE 325-4- Formulary OTC 15 MG DIABETIC TUSSIN DM LIQUID 100-10 MG/5ML ORAL Formulary Custom (*); OTC 100-10 MG/5ML DIABETIC TUSSIN LIQUID 100 MG/5ML ORAL 100 Formulary Custom (*); OTC MG/5ML DIABETIC TUSSIN MAX ST LIQUID 10-200 MG/5ML Formulary Custom (*); OTC ORAL 10-200 MG/5ML DIABETIC TUSSIN MUCUS RELIEF ORAL LIQUID Formulary OTC 200 MG/5ML 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 800/ZINC TABLET 0.8 MG ORAL 0.8 MG Formulary Custom (*); OTC DIALYVITE 800-ZINC 15 TABLET 0.8 MG ORAL 0.8 Formulary Custom (*); OTC MG diaper rash external cream 10 % Formulary OTC diaper rash external paste 40 % Formulary OTC 35 Drug Name Formulary Status Requirements/Limits DIASTIX IN VITRO STRIP Formulary OTC dibucaine (perianal) ointment 1 % external 1 % Formulary Custom (*); OTC dibucaine external ointment 1 % Formulary OTC dibucaine ointment 1 % external 1 % Formulary Custom (*); OTC dibutyl squarate liquid Formulary DICEL CD ORAL LIQUID 30-2-12.5 MG/5ML Formulary OTC DI-DAK-SOL EXTERNAL SOLUTION 0.0125 % Formulary OTC diethylpropion hcl er tablet extended release 24 hour 75 mg PA; Custom (*); QL (270 EA per 365 Formulary oral 75 mg days) diethylpropion hcl er tablet extended release 24 hour 75 mg PA; Custom (*); QL (90 EA per 365 Formulary oral 75 mg days) PA; Custom (*); QL (270 EA per 365 diethylpropion hcl tablet 25 mg oral 25 mg Formulary days) dimaphen childrens elixir 1-2.5 mg/5ml oral 1-2.5 mg/5ml Formulary Custom (*); OTC DIMAPHEN DM COLD/COUGH LIQUID 2.5-1-5 Formulary Custom (*); OTC MG/5ML ORAL 2.5-1-5 MG/5ML dimenhydrinate tablet 50 mg oral (otc) 50 mg Formulary Custom (*); OTC DIMETAPP COLD/ALLERGY ELIXIR 1-2.5 MG/5ML Formulary Custom (*); OTC ORAL 1-2.5 MG/5ML DIMETAPP COLD/ALLERGY ORAL ELIXIR 1-2.5 Formulary OTC MG/5ML DIMETAPP DM COLD/COUGH LIQUID 2.5-1-5 Formulary Custom (*); OTC MG/5ML ORAL 2.5-1-5 MG/5ML DIMETAPP DM COLD/COUGH ORAL LIQUID 2.5-1-5 Formulary OTC MG/5ML DIMETAPP LONG ACT COUGH/COLD ORAL SYRUP Formulary OTC 1-7.5 MG/5ML DIMETAPP LONG ACT COUGH/COLD SYRUP 1-7.5 Formulary Custom (*); OTC MG/5ML ORAL 1-7.5 MG/5ML DIMETAPP NIGHT COLD/CONGESTION LIQUID 6.25- Formulary Custom (*); OTC 2.5 MG/5ML ORAL 6.25-2.5 MG/5ML diocto liquid 50 mg/5ml oral 50 mg/5ml Formulary Custom (*); OTC diocto syrup 60 mg/15ml oral 60 mg/15ml Formulary Custom (*); OTC diphenhist capsule 25 mg oral 25 mg Formulary Custom (*); OTC diphenhist liquid 12.5 mg/5ml oral 12.5 mg/5ml Formulary Custom (*); OTC diphenhist tablet 25 mg oral 25 mg Formulary Custom (*); OTC diphenhydramine hcl (sleep) oral tablet 50 mg Formulary OTC diphenhydramine hcl capsule 25 mg oral (otc) 25 mg Formulary Custom (*) diphenhydramine hcl capsule 50 mg oral (otc) 50 mg Formulary Custom (*) diphenhydramine hcl tablet 25 mg oral 25 mg Formulary Custom (*); OTC diphenhydramine-apap (sleep) tablet 25-500 mg oral 25- Formulary Custom (*); OTC 500 mg dl-leucine powder Formulary dl-pa-500 oral capsule 500 mg Formulary OTC DML EXTERNAL LOTION Formulary OTC DOANS PILLS ORAL TABLET 325 MG Formulary OTC

36 Drug Name Formulary Status Requirements/Limits DOANS PM EXTRA STRENGTH ORAL TABLET 580- Formulary OTC 25 MG DOC OMEGA ORAL PACKET 200 MG Formulary OTC docosanol external cream 10 % Formulary OTC docqlace capsule 100 mg oral 100 mg Formulary Custom (*); OTC DOC-Q-LAX TABLET 8.6-50 MG ORAL 8.6-50 MG Formulary Custom (*); OTC docusate sodium oral tablet 100 mg Formulary OTC DOCUSOL KIDS RECTAL ENEMA 100 MG/5ML Formulary OTC DOCUSOL MINI RECTAL ENEMA 283 MG/5ML Formulary OTC DOK PLUS TABLET 50-8.6 MG ORAL 50-8.6 MG Formulary Custom (*); OTC DOK TABLET 100 MG ORAL 100 MG Formulary Custom (*); OTC DOLOGEN ORAL TABLET 1-325 MG, 2-650 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 dometuss-dmx oral liquid 10-30-200 mg/5ml Formulary OTC DONATUSSIN ORAL SYRUP 10-4-20 MG/5ML Formulary OTC DONATUSSIN SYRUP 10-4-20 MG/5ML ORAL 10-4-20 Formulary Custom (*); OTC MG/5ML double ointment 500-10000 unit/gm external 500- Formulary Custom (*); OTC 10000 unit/gm DOUBLE-TUSSIN DM ORAL LIQUID 20-300 MG/5ML Formulary OTC DOVER HYDROGEL FOLEY CATH 24FR Formulary doxylamine succinate powder Formulary DR BOLDTS HINEY HEALER EXTERNAL CREAM Formulary OTC DR SMITHS DIAPER EXTERNAL OINTMENT 10 % Formulary OTC DR SMITHS DIAPER OINTMENT 10 % EXTERNAL 10 Formulary Custom (*); OTC % DR SMITHS DIAPER RASH AEROSOL 10 % Formulary Custom (*); OTC EXTERNAL 10 % DR SMITHS DIAPER RASH EXTERNAL AEROSOL 10 Formulary OTC % DR SMITHS RASH + SKIN AEROSOL 10 % Formulary Custom (*); OTC EXTERNAL 10 % 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 dri-ear otic solution 2.75 % Formulary OTC DRIMINATE TABLET 50 MG ORAL 50 MG Formulary Custom (*); OTC DRISDOL CAPSULE 1.25 MG (50000 UT) ORAL 1.25 Formulary Custom (*) MG (50000 UT) DRISTAN COLD TABLET 2-5-325 MG ORAL 2-5-325 Formulary Custom (*); OTC MG DRISTAN SPRAY SOLUTION 0.05 % NASAL 0.05 % Formulary Custom (*); OTC DRIXORAL COLD/ALLERGY ORAL TABLET Formulary OTC EXTENDED RELEASE 12 HOUR 6-120 MG 37 Drug Name Formulary Status Requirements/Limits DRIXORAL COLD/FLU ORAL TABLET EXTENDED Formulary OTC RELEASE 3-60-500 MG DRIXORAL COUGH/SORE THROAT ORAL CAPSULE Formulary OTC 325-15 MG dry skin treatment adv therapy external ointment Formulary OTC drymax extra pad 8"x8" Formulary OTC dual action complete tablet chewable 10-800-165 mg oral Formulary Custom (*); OTC 10-800-165 mg DULCOLAX ORAL TABLET DELAYED RELEASE 5 Formulary OTC MG DULCOLAX RECTAL SUPPOSITORY 10 MG Formulary OTC DURAFLEX COMFORT EXTERNAL GEL Formulary OTC DURAFLU ORAL TABLET 60-20-200-325 MG Formulary OTC DURAFLU TABLET 60-20-200-500 MG ORAL (OTC) Formulary Custom (*); OTC 60-20-200-500 MG DURAPROXIN ES PATCH 3-1.25-10 Formulary OTC % DURAPROXIN 1.25-3 % Formulary OTC DURATION SPRAY NASAL SOLUTION 0.05 % Formulary OTC DURAVENT DM ORAL TABLET 10-15-395 MG Formulary OTC DURAVENT DM TABLET 10-15-395 MG ORAL 10-15- Formulary Custom (*); OTC 395 MG DURAVENT PE ORAL TABLET 10-395 MG Formulary OTC D-VI-SOL ORAL LIQUID 400 UNIT/ML Formulary OTC d-xylose powder Formulary DYNA-HEX 2 EXTERNAL SOLUTION 2 % Formulary OTC DY-O-DERM VITILIGO STAIN EXTERNAL Formulary OTC SOLUTION 6.55 % ear wax cleansing otic kit 6.5 % Formulary OTC ear wax removal drops solution 6.5 % otic 6.5 % Formulary Custom (*); OTC ear wax removal kit solution 6.5 % otic 6.5 % Formulary Custom (*); OTC earwax treatment drops solution 6.5 % otic 6.5 % Formulary Custom (*); OTC EASIVENT Formulary EASIVENT MASK LARGE Formulary EASIVENT MASK MEDIUM Formulary EASIVENT MASK SMALL Formulary ecee plus oral tablet Formulary OTC ECONTRA EZ TABLET 1.5 MG ORAL 1.5 MG Formulary Custom (*); OTC; QL (2 EA per 30 days) ECOTRIN MAXIMUM STRENGTH ORAL TABLET Formulary OTC DELAYED RELEASE 500 MG ECOTRIN ORAL TABLET DELAYED RELEASE 325 Formulary OTC MG ECPIRIN TABLET DELAYED RELEASE 325 MG ORAL Formulary Custom (*); OTC 325 MG e-cream complex external cream Formulary OTC ed a-hist dm oral tablet 10-4-10 mg Formulary OTC ed a-hist dm tablet 10-4-10 mg oral 10-4-10 mg Formulary Custom (*); OTC 38 Drug Name Formulary Status Requirements/Limits ED A-HIST LIQUID 4-10 MG/5ML ORAL (OTC) 4-10 Formulary Custom (*); OTC MG/5ML ED A-HIST ORAL LIQUID 4-10 MG/5ML Formulary OTC ed a-hist pse tablet 2.5-60 mg oral 2.5-60 mg Formulary Custom (*); OTC ED A-HIST TABLET 4-10 MG ORAL 4-10 MG Formulary Custom (*); OTC ed bron gp liquid 5-100 mg/5ml oral 5-100 mg/5ml Formulary Custom (*); OTC ed bron gp oral liquid 5-100 mg/5ml Formulary OTC ED CHLORPED D LIQUID 2-5 MG/ML ORAL 2-5 Formulary Custom (*); OTC MG/ML ED CHLORPED D ORAL LIQUID 2-5 MG/ML Formulary OTC ed chlorped jr syrup 2 mg/5ml oral 2 mg/5ml Formulary Custom (*); OTC ED CHLORPED LIQUID 2 MG/ML ORAL 2 MG/ML Formulary Custom (*); OTC ED CHLORPED ORAL LIQUID 2 MG/ML Formulary OTC ed-a-hist dm liquid 10-4-15 mg/5ml oral (otc) 10-4-15 Formulary Custom (*); OTC mg/5ml ed-apap liquid 160 mg/5ml oral 160 mg/5ml Formulary Custom (*); OTC ed-chlortan tablet 4 mg oral 4 mg Formulary Custom (*); OTC edetate disodium powder Formulary effervescent antacid/pain rel oral tablet effervescent 325- Formulary OTC 1000-1916 mg effervescent pain relief tablet effervescent 325-1000-1916 Formulary Custom (*); OTC mg oral 325-1000-1916 mg elite ca/mg oral tablet 100-50 mg Formulary OTC elite calcium oral tablet 150 mg Formulary OTC ELITE IRON ORAL TABLET 15 MG Formulary OTC ELITE ZINC ORAL CAPSULE 15 MG Formulary OTC ELIXSURE COUGH ORAL GEL 7.5 MG/5ML Formulary OTC ELIXSURE FEVER/PAIN ORAL GEL 160 MG/5ML Formulary OTC ellis tonic oral elixir Formulary OTC ELLURA ORAL CAPSULE 200 MG Formulary OTC ELTA DERMAL EXTERNAL GEL Formulary OTC ELTA DERMAL WOUND EXTERNAL GEL Formulary OTC ELTA SEAL MOISTURE BARRIER EXTERNAL Formulary OTC CREAM 6 % EMETROL ORAL SOLUTION 1.87-1.87-21.5 Formulary OTC empty capsule size 1 clear capsule Formulary ENDACOF-DM LIQUID 2.5-1-5 MG/5ML ORAL 2.5-1-5 Formulary Custom (*); OTC MG/5ML ENDACOF-DM ORAL LIQUID 2.5-1-5 MG/5ML Formulary OTC ENDOXCIN EXTERNAL PATCH 4-1 % Formulary OTC ENDUR-ACIN ORAL TABLET EXTENDED RELEASE Formulary OTC 500 MG enema enema 7-19 gm/118ml rectal 7-19 gm/118ml Formulary Custom (*); OTC ENEMEEZ PLUS RECTAL ENEMA 20-283 MG Formulary OTC ENFAMIL ENFALYTE ORAL SOLUTION Formulary OTC ENFAMIL EXPECTA ORAL 28-0.8 & 200 MG Formulary OTC 39 Drug Name Formulary Status Requirements/Limits ENTEX T ORAL TABLET 60-375 MG Formulary OTC ENTEX T TABLET 60-375 MG ORAL 60-375 MG Formulary Custom (*); OTC entre-cough liquid 30-15-175 mg/5ml oral 30-15-175 Formulary Custom (*); OTC mg/5ml ENTSOL NASAL GEL NASAL Formulary Custom (*); OTC ENTSOL NASAL SOLUTION Formulary OTC ENTSOL NASAL SOLUTION 3 % NASAL 3 % Formulary Custom (*); OTC ENTSOL NASAL WASH SOLUTION NASAL Formulary Custom (*); OTC ENTSOL SOLUTION NASAL Formulary Custom (*); OTC e-oil external oil 30000 unit Formulary OTC epa/gla oral capsule Formulary OTC ephedrine hcl oral tablet 25 mg Formulary OTC EPISORB TRANSDERMAL Formulary OTC epsom salt oral granules Formulary OTC epsom salt powder Formulary OTC eq allergy/sinus headache oral tablet 12.5-30-500 mg Formulary OTC eq antacid & anti-gas tablet chewable 1000-60 mg oral Formulary Custom (*); OTC 1000-60 mg 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 cold/allergy childrens oral elixir 1-15 mg/5ml 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 glucosamine chondr/msm/d tablet oral Formulary Custom (*); OTC eq glucosamine-chondroitin-msm tablet oral Formulary Custom (*); OTC eq hemorrhoidal suppository 0.25-85.39 % rectal 0.25- Formulary Custom (*); OTC 85.39 % 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 sinus relief max st oral tablet 30-500 mg Formulary OTC eq sleep-aid nighttime oral capsule 25 mg Formulary OTC eq tioconazole 1 vaginal ointment 6.5 % Formulary OTC 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

40 Drug Name Formulary Status Requirements/Limits eql chest congestion daytime tablet 325-200 mg oral 325- Formulary Custom (*); OTC 200 mg eql denture cleanser tablet effervescent Formulary OTC eql digestive oral tablet Formulary OTC eql ear drops otic solution Formulary OTC eql effervescent cold relief oral tablet effervescent 2-7.8- Formulary OTC 325 mg eql ethyl alcohol (rubbing) solution 70 % Formulary OTC eql everyday clean external shampoo 1 % Formulary OTC eql eye drops ac ophthalmic solution 0.05-0.25 % Formulary OTC eql fiber therapy oral powder 48.57 % Formulary OTC eql flax seed oil oral capsule 1000 mg Formulary OTC eql flu/severe cold daytime oral packet 20-10-500 mg Formulary OTC eql gas prevention oral capsule Formulary OTC eql gentle skin cleanser external liquid Formulary OTC eql glucosamine chondroitin tablet oral Formulary Custom (*); OTC eql glucosamine-chondroit-msm tablet oral Formulary Custom (*); OTC eql gummies childrens oral tablet chewable 30 mg Formulary OTC eql ibuprofen cold childrens suspension 15-100 mg/5ml oral Formulary Custom (*); OTC 15-100 mg/5ml eql lutein oral capsule 20 mg Formulary OTC eql omega 3 fish oil oral capsule delayed release 1200 mg Formulary OTC eql redness relief ophthalmic solution 0.012-0.2 % Formulary OTC eql scalp relief max strength external liquid 3 % Formulary OTC eql ultra protection spf50 external aerosol Formulary OTC eql vitamin d gummies child oral tablet chewable 10 mcg Formulary OTC (400 unit) eql vitamin d3 oral capsule 10 mcg (400 unit) Formulary OTC eql wet cleansing towelettes external Formulary OTC EQUALACTIN ORAL TABLET CHEWABLE 625 MG Formulary OTC ESOTERICA FACIAL EXTERNAL CREAM 2 % Formulary OTC ESOTERICA FADE NIGHTTIME EXTERNAL CREAM Formulary OTC 2 % ESOTERICA SENSITIVE SKIN EXTERNAL CREAM Formulary OTC 1.5 % ESTER-C ORAL TABLET 500-200-60 MG, 500-60 MG Formulary OTC ethoxy diglycol liquid Formulary ethyl alcohol (rubbing) solution 70 % Formulary OTC ethyl alcohol external solution 95 % Formulary OTC ethyl oleate liquid Formulary eucalyptol liquid Formulary eucalyptus oil external oil Formulary OTC eucalyptus oil oil Formulary EUCERIN ECZEMA RELIEF EXTERNAL CREAM 1 % Formulary OTC EUCERIN EXTERNAL CREAM Formulary OTC

41 Drug Name Formulary Status Requirements/Limits EUCERIN ORIGINAL HEALING EXTERNAL LOTION Formulary OTC eugenol solution Formulary EVAC ORAL POWDER Formulary OTC evening primrose oil oral capsule 1000 mg, 500 mg Formulary OTC EXACTA-MED ENTERAL DISPENSER Formulary OTC EXACTUSS TR ORAL TABLET 10-28-388 MG Formulary OTC EXCEDRIN EXTRA STRENGTH TABLET 250-250-65 Formulary Custom (*); OTC MG ORAL 250-250-65 MG EXCEDRIN MENSTRUAL COMPLETE ORAL TABLET Formulary OTC 250-250-65 MG EXCEDRIN MIGRAINE TABLET 250-250-65 MG ORAL Formulary Custom (*); OTC 250-250-65 MG EXCEDRIN PM ORAL TABLET 500-38 MG Formulary OTC EXCEDRIN TENSION HEADACHE ORAL TABLET Formulary OTC 500-65 MG EXCEDRIN TENSION HEADACHE TABLET 500-65 Formulary Custom (*); OTC MG ORAL 500-65 MG EXCEL AP EXTERNAL SWAB 7.5-72 % Formulary OTC EXCEL-GEL EXTERNAL GEL Formulary OTC EXFOLIX EXFOLIATING FOOT SOAP EXTERNAL Formulary OTC BAR EX-LAX MAXIMUM STRENGTH ORAL TABLET 25 Formulary OTC MG EX-LAX MAXIMUM STRENGTH TABLET 25 MG Formulary Custom (*); OTC ORAL 25 MG EX-LAX ORAL TABLET 15 MG Formulary OTC EX-LAX ORAL TABLET CHEWABLE 15 MG Formulary OTC EX-LAX TABLET 15 MG ORAL 15 MG Formulary Custom (*); OTC EX-LAX TABLET CHEWABLE 15 MG ORAL 15 MG Formulary Custom (*); OTC exoten-c pain relief external lotion 0.001-10-20 %, 0.025- Formulary OTC 10-20 % extended term oral care system mouth/throat kit Formulary OTC extra action cough syrup 100-10 mg/5ml oral 100-10 Formulary Custom (*); OTC mg/5ml EXTRESS-30 ORAL CAPSULE EXTENDED RELEASE Formulary OTC eye allergy relief ophthalmic solution 0.027-0.315 % Formulary OTC eye drops advanced relief solution 0.05-0.1-1-1 % Formulary Custom (*); OTC ophthalmic 0.05-0.1-1-1 % eye drops extra ophthalmic solution 0.05-1 % Formulary OTC eye drops maximum relief ophthalmic solution 0.05-0.1-1-1 Formulary OTC % eye drops maximum relief solution 0.05-0.1-1-1 % Formulary Custom (*); OTC ophthalmic 0.05-0.1-1-1 % eye drops ophthalmic solution 0.012-0.2 % Formulary OTC eye drops solution 0.05 % ophthalmic 0.05 % Formulary Custom (*); OTC EYE STREAM OPHTHALMIC SOLUTION Formulary OTC EYE STREAM SOLUTION OPHTHALMIC Formulary Custom (*); OTC

42 Drug Name Formulary Status Requirements/Limits EYE-SED OPHTHALMIC SOLUTION 0.217 % Formulary OTC EZFE 200 CAPSULE 434.8 (200 FE) MG ORAL 434.8 Formulary Custom (*); OTC (200 FE) MG EZFE 200 ORAL CAPSULE 434.8 (200 FE) MG Formulary OTC E-Z-GAS II ORAL PACKET 2.21-1.53-0.04 GM Formulary OTC FAGRON VERSIFIX TRANSDERMAL LIQUID Formulary OTC FALLBACK SOLO TABLET 1.5 MG ORAL 1.5 MG Formulary Custom (*); OTC; QL (2 EA per 30 days) famotidine tablet 10 mg oral 10 mg Formulary Custom (*); OTC FAST FREEZE PRO STYLE THERAPY EXTERNAL Formulary OTC GEL 3.5 % FAST FREEZE PRO STYLE THERAPY EXTERNAL Formulary OTC LIQUID 3.5 % father johns medicine oral syrup 10 mg/5ml Formulary OTC FATTYBLEND Formulary OTC fd&c blue #2 powder Formulary OTC fd&c red #40 aluminum lake powder Formulary OTC fd&c yellow #5 powder Formulary fdc blue 1 powder Formulary fdc green #3 powder Formulary fdc red #3 powder Formulary fdc yellow 6 powder Formulary FE C TABLET 100-250 MG ORAL 100-250 MG Formulary Custom (*); OTC FEBROL ORAL SOLUTION 325 MG/5ML Formulary OTC fem-cal citrate tablet oral Formulary Custom (*); OTC FEMINEASE VAGINAL CREAM Formulary OTC FERAHEME SOLUTION 510 MG/17ML Formulary Custom (*) INTRAVENOUS 510 MG/17ML FER-IN-SOL ORAL SOLUTION 75 (15 FE) MG/ML Formulary OTC fer-iron oral solution 75 (15 fe) mg/ml Formulary OTC 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 CAPSULE 150 MG ORAL 150 MG Formulary Custom (*); OTC ferric subsulfate powder Formulary OTC ferric subsulfate solution Formulary FERRIMIN 150 ORAL TABLET 150 MG Formulary OTC FERRLECIT SOLUTION 12.5 MG/ML INTRAVENOUS Formulary Custom (*) 12.5 MG/ML ferrous aspartate oral tablet 112 (18 fe) mg Formulary OTC ferrous fumarate oral tablet 324 (106 fe) mg Formulary OTC ferrous gluconate oral tablet 324 (37.5 fe) mg, 324 (38 fe) Formulary OTC mg ferrous sulfate er oral tablet extended release 140 (45 fe) Formulary OTC mg ferrous sulfate granules Formulary ferrous sulfate oral elixir 220 (44 fe) mg/5ml Formulary OTC 43 Drug Name Formulary Status Requirements/Limits 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 325 (65 fe) mg Formulary OTC ferrous sulfate oral tablet delayed release 324 (65 fe) mg, Formulary OTC 325 (65 fe) mg ferrous sulfate powder Formulary fever reducer childrens suppository 120 mg rectal 120 mg Formulary Custom (*); OTC FEVERALL ADULTS SUPPOSITORY 650 MG RECTAL Formulary Custom (*); OTC 650 MG FEVERALL CHILDRENS SUPPOSITORY 120 MG Formulary Custom (*); OTC RECTAL 120 MG FEVERALL INFANTS SUPPOSITORY 80 MG RECTAL Formulary Custom (*); OTC 80 MG FEVERALL JUNIOR STRENGTH SUPPOSITORY 325 Formulary Custom (*); OTC MG RECTAL 325 MG FEVERALL RECTAL SUPPOSITORY 80 MG Formulary OTC fexofenadine hcl childrens oral suspension 30 mg/5ml Formulary OTC fexofenadine hcl childrens suspension 30 mg/5ml oral 30 Formulary Custom (*); OTC mg/5ml fexofenadine hcl tablet 180 mg oral (otc) 180 mg Formulary Custom (*); OTC fexofenadine hcl tablet 60 mg oral (otc) 60 mg Formulary Custom (*); OTC fexofenadine-pseudoephed er tablet extended release 12 Formulary Custom (*); OTC hour 60-120 mg oral (otc) 60-120 mg fiber (corn dextrin) powder oral Formulary Custom (*); OTC fiber laxative capsule 0.52 gm oral 0.52 gm Formulary Custom (*); OTC fiber laxative oral tablet 625 mg Formulary OTC fiber oral capsule 0.52 gm Formulary OTC fiber plus calcium oral capsule Formulary OTC fiber tablet 625 mg oral 625 mg Formulary Custom (*); OTC fiber therapy oral powder 2 gm/19gm Formulary OTC fiber therapy powder 58.6 % oral 58.6 % Formulary Custom (*); OTC FIBERCON ORAL TABLET 625 MG Formulary OTC FIBEREX F15 ORAL LIQUID 15 GM/30ML Formulary OTC fiber-lax tablet 625 mg oral 625 mg Formulary Custom (*); OTC fibromyalgia symptom relief sublingual tablet sublingual Formulary OTC first aid antibiotic external ointment 4 % Formulary OTC first aid antiseptic spray external aerosol 20-0.13 % Formulary OTC fish oil + d3 oral capsule 1000-1000 mg-unit Formulary OTC fish oil adult gummies oral tablet chewable 113.5 mg Formulary OTC fish oil oral capsule 1000 mg, 1200 mg, 500 mg, 600 mg Formulary OTC flax oil-fish oil-borage oil oral capsule Formulary OTC FLEET BISACODYL RECTAL ENEMA 10 MG/30ML Formulary OTC FLEET ENEMA RECTAL ENEMA 7-19 GM/118ML Formulary OTC FLEET LIQUID GLYCERIN SUPP RECTAL ENEMA 5.4 Formulary OTC GM/DOSE

44 Drug Name Formulary Status Requirements/Limits FLEET NATURALS CLEANSING ENEMA RECTAL Formulary OTC ENEMA FLEET OIL RECTAL ENEMA Formulary OTC FLEXICHAMBER CHILD MASK/LARGE Formulary FLEXICHAMBER DEVICE Formulary FLEXIFLO EASY-FEED ENTERAL BAG Formulary OTC FLINTSTONES TODDLER ORAL TABLET Formulary OTC CHEWABLE 40 MG FLINTSTONES/EXTRA C TABLET CHEWABLE ORAL Formulary Custom (*); OTC FLOGEN ORAL TABLET 250-650 MG Formulary OTC FLONASE ALLERGY RELIEF SUSPENSION 50 Custom (*); OTC; QL (16 ML per 30 Formulary MCG/ACT NASAL 50 MCG/ACT days) 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 CAPSULE 8.3-364 MG ORAL 8.3-364 MG Formulary Custom (*); OTC FLORICAL ORAL CAPSULE 8.3-364 MG Formulary OTC FLORICAL ORAL TABLET 8.3-364 MG Formulary OTC FLORICAL TABLET 8.3-364 MG ORAL 8.3-364 MG Formulary Custom (*); OTC flow-eze vented needle Formulary OTC flu & sore throat packet 20-10-650 mg oral 20-10-650 mg Formulary Custom (*); OTC flu & sore throat relief oral liquid 12.5-5-325 mg/15ml Formulary OTC FLU RELIEF ORAL PELLET Formulary OTC flu/severe cold & cough day packet 20-10-650 mg oral 20- Formulary Custom (*); OTC 10-650 mg flu/severe cold/cough night packet 25-10-650 mg oral 25- Formulary Custom (*); OTC 10-650 mg FOILLE EXTERNAL OINTMENT 5-0.1 % Formulary OTC FOLGARD ORAL TABLET Formulary OTC folic acid oral capsule 0.8 mg, 20 mg, 5 mg Formulary OTC folic acid oral tablet 400 mcg, 800 mcg Formulary OTC folic acid powder Formulary folic acid solution 5 mg/ml injection 5 mg/ml Formulary Custom (*) folic acid tablet 1 mg oral (rx) 1 mg Formulary Custom (*) folinic-plus oral tablet 4-50-2 mg Formulary OTC FOLITAB 500 ORAL TABLET EXTENDED RELEASE Formulary OTC 105-500-0.8 MG FOLTABS 800 TABLET 800-10-115 MCG-MG-MCG Formulary Custom (*); OTC ORAL 800-10-115 MCG-MG-MCG food color black powder Formulary food color blue powder Formulary food color blue royal powder Formulary OTC food color brown powder Formulary 45 Drug Name Formulary Status Requirements/Limits food color flesh powder Formulary OTC food color green powder Formulary food color lime green powder Formulary food color orange powder Formulary food color red powder Formulary food color yellow powder Formulary OTC FORA D40 GLUCOSE/PRESSURE DEVICE Formulary OTC formaldehyde external solution 37 % Formulary FORMULA 405 LE PONT NAIL EXTERNAL OIL Formulary OTC formula em solution 1.87-1.87-21.5 oral 1.87-1.87-21.5 Formulary Custom (*); OTC FREE & CLEAR EXTERNAL LIQUID Formulary OTC freedom cepapro gel Formulary FREEDOM ODT BASE POWDER Formulary FREEDOM PAK SEVEN MALE CATH KIT Formulary OTC FRESHKOTE SOLUTION 2.7-2 % OPHTHALMIC 2.7-2 Formulary Custom (*); OTC % fructose granules Formulary fruit c oral tablet chewable 100 mg Formulary OTC fullers earth powder Formulary FUNGI-NAIL EXTERNAL SOLUTION 25 % Formulary OTC FUNGOID TINCTURE EXTERNAL KIT 2 % Formulary OTC FUNGOID TINCTURE KIT 2 % EXTERNAL 2 % Formulary Custom (*); OTC FUNGOID TINCTURE SOLUTION 2 % EXTERNAL 2 % Formulary Custom (*); OTC FUNGOID-D CREAM 1 % EXTERNAL 1 % Formulary Custom (*); OTC FUSION ORAL CAPSULE 65-65-25-30 MG Formulary OTC gamma aminobutyric acid oral powder Formulary OTC 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 capsule 180 mg oral 180 mg Formulary Custom (*); OTC gas relief extra strength capsule 125 mg oral 125 mg Formulary Custom (*); OTC gas relief maximum strength tablet chewable 125 mg oral Formulary Custom (*); OTC 125 mg gas relief oral liquid 40 mg/0.6ml Formulary OTC gas relief suspension 20 mg/0.3ml oral 20 mg/0.3ml Formulary Custom (*); OTC gas relief tablet chewable 80 mg oral 80 mg Formulary Custom (*); OTC gas relief ultra strength capsule 180 mg oral 180 mg Formulary Custom (*); OTC GAS-X CHILDRENS ORAL STRIP 40 MG Formulary OTC GAS-X EXTRA STRENGTH CAPSULE 125 MG ORAL Formulary Custom (*); OTC 125 MG GAS-X EXTRA STRENGTH ORAL STRIP 62.5 MG Formulary OTC GAS-X EXTRA STRENGTH ORAL TABLET Formulary OTC CHEWABLE 125 MG GAS-X EXTRA STRENGTH TABLET CHEWABLE 125 Formulary Custom (*); OTC MG ORAL 125 MG

46 Drug Name Formulary Status Requirements/Limits GAS-X ORAL TABLET CHEWABLE 80 MG Formulary OTC GAS-X PREVENTION ORAL CAPSULE Formulary OTC GAS-X TABLET CHEWABLE 80 MG ORAL 80 MG Formulary Custom (*); OTC GAS-X ULTRA STRENGTH CAPSULE 180 MG ORAL Formulary Custom (*); OTC 180 MG GAS-X WITH MAALOX EX ST ORAL TABLET Formulary OTC CHEWABLE 500-125 MG gavilax powder 17 gm/scoop oral 17 gm/scoop Formulary Custom (*); OTC GAVISCON EXTRA RELIEF FORMULA ORAL Formulary OTC SUSPENSION 508-475 MG/10ML GAVISCON EXTRA RELIEF FORMULA SUSPENSION Formulary Custom (*); OTC 508-475 MG/10ML ORAL 508-475 MG/10ML GAVISCON EXTRA STRENGTH SUSPENSION 254- Formulary Custom (*); OTC 237.5 MG/5ML ORAL 254-237.5 MG/5ML GAVISCON EXTRA STRENGTH TABLET CHEWABLE Formulary Custom (*); OTC 160-105 MG ORAL 160-105 MG GAVISCON ORAL SUSPENSION 95-358 MG/15ML Formulary OTC GAVISCON ORAL TABLET CHEWABLE 80-14.2 MG Formulary OTC GAVISCON SUSPENSION 95-358 MG/15ML ORAL 95- Formulary Custom (*); OTC 358 MG/15ML GAVISCON TABLET CHEWABLE 80-14.2 MG ORAL Formulary Custom (*); OTC 80-14.2 MG G-BUCAL-C MOUTH/THROAT SOLUTION 0.15-0.1 % Formulary OTC ge-150 oral capsule 150 mg Formulary OTC GEBAUERS INSTANT ICE EXTERNAL AEROSOL Formulary OTC gelatin oral capsule 650 mg Formulary OTC GELONASAL NASAL SOLUTION Formulary OTC GEL-STAT EXTERNAL GEL 62 % Formulary OTC GELUSIL ORAL TABLET CHEWABLE 200-200-25 MG Formulary OTC GENTEAL GEL 0.25-0.3 % OPHTHALMIC 0.25-0.3 % Formulary Custom (*); OTC GENTEAL MILD OPHTHALMIC SOLUTION 0.2 % Formulary OTC GENTEAL MILD TO MODERATE OPHTHALMIC Formulary OTC SOLUTION 0.3 % GENTEAL MILD TO MODERATE SOLUTION 0.3 % Formulary Custom (*); OTC OPHTHALMIC 0.3 % GENTEAL OPHTHALMIC GEL 0.25-0.3 % Formulary OTC GENTEAL SEVERE GEL 0.3 % OPHTHALMIC 0.3 % Formulary Custom (*); OTC GENTEAL SEVERE OPHTHALMIC GEL 0.3 % Formulary OTC GENTEAL TEARS NIGHT-TIME OINTMENT Formulary Custom (*); OTC OPHTHALMIC 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 RAIN EXTERNAL SHAMPOO Formulary OTC gentle skin cleanser external lotion Formulary OTC

47 Drug Name Formulary Status Requirements/Limits geravine oral elixir Formulary OTC geriatric vitamin liquid 100-1-10 oral 100-1-10 Formulary Custom (*); OTC geriatric vitamin oral liquid 100-1-10 Formulary OTC GERI-HYDROLAC 12 CREAM 12 % EXTERNAL 12 % Formulary Custom (*); OTC GERI-HYDROLAC 12 LOTION 12 % EXTERNAL 12 % Formulary Custom (*); OTC geri-lanta suspension 200-200-20 mg/5ml oral 200-200-20 Formulary Custom (*); OTC mg/5ml gerisilk bath oil external oil Formulary OTC GILPHEX TR ORAL TABLET 10-388 MG Formulary GILPHEX TR TABLET 10-388 MG ORAL 10-388 MG Formulary Custom (*) GILTUSS COUGH & COLD ORAL LIQUID 10-29-390 Formulary OTC MG/5ML GINKGO BILOBA XTRA ORAL CAPSULE Formulary OTC ginseng oral capsule 50 mg Formulary OTC gla-45 oral capsule 45 mg Formulary OTC glen pe oral liquid 16-5 mg/5ml Formulary OTC 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 GLUCOCOM AUTOLINK TELEMONITOR Formulary OTC glucoless capsule oral Formulary Custom (*); OTC glucosamine chond complex/msm tablet oral Formulary Custom (*); OTC glucosamine chondroitin adv tablet oral Formulary Custom (*); OTC glucosamine chondroitin complx oral capsule 500-250 mg Formulary OTC glucosamine chondroitin vit d3 capsule oral Formulary Custom (*); OTC glucosamine complex/vitamin d3 oral tablet Formulary OTC glucosamine hcl oral tablet 1500 mg Formulary OTC glucosamine hcl powder Formulary glucosamine sulfate oral capsule 1000 mg, 500 mg Formulary OTC glucosamine sulfate oral tablet 1000 mg Formulary OTC glucosamine sulfate powder Formulary glucosamine-chondroitin ds oral tablet 500-400 mg Formulary OTC glucosamine-chondroitin ds tablet oral Formulary Custom (*); 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 750-600 mg Formulary OTC glucosamine-chondroitin sulf tablet oral Formulary Custom (*); OTC glucosamine-chondroitin-msm oral tablet 400-333.3-200 Formulary OTC mg, 500-400-167 mg glucosamine-chondroitin-msm tablet oral Formulary Custom (*); OTC glucosamine-chondroitin-vit d3 oral packet 1500-1200-800 Formulary OTC mg-mg-unit glucosamine-msm oral liquid 1500-500 mg/30ml Formulary OTC glucos-chondroit-msm complex tablet oral Formulary Custom (*); OTC

48 Drug Name Formulary Status Requirements/Limits GLUCOSE NURSETTE ORAL SOLUTION 5 % Formulary OTC glucose oral liquid 15 gm/59ml Formulary OTC glucose oral tablet chewable 4-6 gm-mg Formulary OTC glutamine capsule 500 mg oral 500 mg Formulary Custom (*); OTC glutamine oral capsule 500 mg Formulary OTC glutamine powder Formulary glutathione oral tablet 50 mg Formulary OTC glutol oral liquid Formulary OTC glycerin (adult) rectal suppository 2 gm Formulary OTC glycerin (adult) suppository 3 gm Formulary OTC glycerin (infant) rectal suppository 80.7 % Formulary OTC glycerin (infants & children) rectal suppository 1 gm Formulary OTC glycerin external liquid Formulary OTC glycerin-rose water external solution Formulary OTC glyceryl monostearate flakes Formulary glycine powder Formulary glycine500 oral packet 500 mg Formulary OTC GLYCOLAX POWDER 17 GM/SCOOP ORAL 17 Formulary Custom (*); OTC GM/SCOOP glycolic acid crystals Formulary glycolic acid solution 70 % Formulary g-myco nail external solution Formulary OTC gnp 4x probiotic oral tablet Formulary OTC gnp 8 hour pain reliever tablet extended release 650 mg Formulary Custom (*); OTC oral 650 mg gnp acid control 150 max st tablet 150 mg oral 150 mg Formulary Custom (*); OTC gnp acid control 75 tablet 75 mg oral 75 mg Formulary Custom (*); OTC gnp acid reducer max st tablet 20 mg oral 20 mg Formulary Custom (*); OTC gnp acid reducer tablet 10 mg oral 10 mg Formulary Custom (*); OTC gnp acid reducer tablet 75 mg oral 75 mg Formulary Custom (*); OTC gnp acne treatment cream 10 % external 10 % Formulary Custom (*); OTC gnp advanced eye health oral capsule 250-2.5-0.5 mg Formulary OTC gnp alcohol denatured solution Formulary OTC gnp all day allergy childrens solution 1 mg/ml oral 1 mg/ml Formulary Custom (*); OTC gnp all day allergy childrens solution 5 mg/5ml oral 5 Formulary Custom (*); OTC mg/5ml gnp all day allergy tablet 10 mg oral 10 mg Formulary Custom (*); OTC gnp all day allergy-d tablet extended release 12 hour 5-120 Formulary Custom (*); OTC mg oral 5-120 mg gnp all day pain relief tablet 220 mg oral 220 mg Formulary Custom (*); OTC gnp allergy & congestion tablet extended release 24 hour Formulary Custom (*); OTC 10-240 mg oral 10-240 mg gnp allergy capsule 25 mg oral 25 mg Formulary Custom (*); OTC gnp allergy multi-symptom tablet 2-5-325 mg oral 2-5-325 Formulary Custom (*); OTC mg

49 Drug Name Formulary Status Requirements/Limits gnp allergy relief tablet 180 mg oral 180 mg Formulary Custom (*); OTC gnp allergy relief tablet dispersible 10 mg oral 10 mg Formulary Custom (*); OTC gnp allergy tablet 25 mg oral 25 mg Formulary Custom (*); OTC gnp allergy tablet 4 mg oral 4 mg Formulary Custom (*); OTC gnp animal shapes plus extra c tablet chewable oral Formulary Custom (*); OTC gnp antacid & anti-gas oral tablet chewable 1000-60 mg Formulary OTC gnp antacid & anti-gas tablet chewable 1000-60 mg oral Formulary Custom (*); OTC 1000-60 mg gnp antacid anti-gas suspension 200-200-20 mg/5ml oral Formulary Custom (*); OTC 200-200-20 mg/5ml gnp antacid maximum strength suspension 400-400-40 Formulary Custom (*); OTC mg/5ml oral 400-400-40 mg/5ml gnp anti-diarrheal liquid 1 mg/5ml oral 1 mg/5ml Formulary Custom (*); OTC gnp anti-diarrheal tablet 2 mg oral 2 mg Formulary Custom (*); OTC gnp anti-fungal liquid 25 % external 25 % Formulary Custom (*); OTC gnp anti-gas capsule 180 mg oral 180 mg Formulary Custom (*); OTC gnp arthritis pain relief tablet extended release 650 mg oral Formulary Custom (*); OTC 650 mg gnp aspirin tablet delayed release 325 mg oral 325 mg Formulary Custom (*); OTC gnp aspirin tablet delayed release 81 mg oral 81 mg Formulary Custom (*); OTC gnp athletes foot cream 1 % external 1 % Formulary Custom (*); OTC gnp b-50 complex oral tablet extended release Formulary OTC gnp bacitracin zinc ointment 500 unit/gm external 500 Formulary Custom (*); OTC unit/gm gnp b-complex plus vitamin c tablet oral Formulary Custom (*); OTC gnp cal mag zinc +d3 tablet oral Formulary Custom (*); OTC gnp calamine external lotion 8-8 % Formulary OTC gnp calamine lotion 8-8 % external 8-8 % Formulary Custom (*); OTC gnp calamine phenolated lotion external Formulary Custom (*); 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 caldyphen lotion 1-8 % external 1-8 % Formulary Custom (*); OTC gnp chest rub ointment 4.8-1.2-2.6 % external 4.8-1.2-2.6 Formulary Custom (*); OTC % gnp childrens allergy liquid 12.5 mg/5ml oral 12.5 mg/5ml Formulary Custom (*); OTC gnp childrens chewables/ex c tablet chewable oral Formulary Custom (*); OTC gnp childrens ibuprofen suspension 100 mg/5ml oral 100 Formulary Custom (*); OTC mg/5ml gnp childrens pain relief/cold suspension 2.5-1-5-160 Formulary Custom (*); OTC mg/5ml oral 2.5-1-5-160 mg/5ml gnp childrens plus cough/sore liquid 160-5 mg/5ml oral Formulary Custom (*); OTC 160-5 mg/5ml gnp childrens plus multi-sympt suspension 2.5-1-5-160 Formulary Custom (*); OTC mg/5ml oral 2.5-1-5-160 mg/5ml GNP CLEARLAX POWDER 17 GM/SCOOP ORAL 17 Formulary Custom (*); OTC GM/SCOOP gnp clotrimazole 3 cream 2 % vaginal 2 % Formulary Custom (*); OTC 50 Drug Name Formulary Status Requirements/Limits gnp cold head congest day/nght 5-2-10-325 mg oral 5-2-10- Formulary Custom (*); OTC 325 mg gnp cold head congestion tablet 10-5-325 mg oral 10-5-325 Formulary Custom (*); OTC mg gnp cold head congestion tablet 5-10-200-325 mg oral 5- Formulary Custom (*); OTC 10-200-325 mg gnp cold head congestion tablet 5-2-10-325 mg oral 5-2-10- Formulary Custom (*); OTC 325 mg gnp cold multi-sympt day/night 5-2-10-325 mg oral 5-2-10- Formulary Custom (*); OTC 325 mg gnp cold multi-symptom daytime tablet 10-5-325 mg oral Formulary Custom (*); OTC 10-5-325 mg gnp cold multi-symptom night tablet 5-2-10-325 mg oral 5- Formulary Custom (*); OTC 2-10-325 mg gnp cold remedy oral tablet dispersible Formulary OTC gnp cold severe congestion day tablet 5-10-200-325 mg Formulary Custom (*); OTC oral 5-10-200-325 mg gnp cold/allergy childrens elixir 1-2.5 mg/5ml oral 1-2.5 Formulary Custom (*); OTC mg/5ml gnp cold/cough childrens liquid 2.5-1-5 mg/5ml oral 2.5-1- Formulary Custom (*); OTC 5 mg/5ml gnp coq-10 & fish oil oral capsule 120-180-50-30 Formulary OTC gnp cough dm er suspension extended release 30 mg/5ml Formulary Custom (*); OTC oral 30 mg/5ml gnp day time cold/flu capsule 10-5-325 mg oral 10-5-325 Formulary Custom (*); OTC mg gnp day time cold/flu relief liquid 10-5-325 mg/15ml oral Formulary Custom (*); OTC 10-5-325 mg/15ml gnp day time mucus relief dm liquid 10-200 mg/15ml oral Formulary Custom (*); OTC 10-200 mg/15ml gnp day time sinus capsule 5-325 mg oral 5-325 mg Formulary Custom (*); OTC gnp dayhist allergy tablet 1.34 mg oral 1.34 mg Formulary Custom (*); OTC gnp diaper rash creamy ointment 10 % external 10 % Formulary Custom (*); OTC gnp dual action complete tablet chewable 10-800-165 mg Formulary Custom (*); OTC oral 10-800-165 mg gnp ear drops solution 6.5 % otic 6.5 % Formulary Custom (*); OTC gnp ethyl alcohol solution 70 % Formulary OTC gnp eye drops solution 0.05-0.1-1-1 % ophthalmic 0.05-0.1- Formulary Custom (*); OTC 1-1 % gnp eye itch relief solution 0.025 % ophthalmic 0.025 % Formulary Custom (*); OTC gnp fish oil oral capsule 435 mg Formulary OTC gnp flu/severe cold daytime packet 10-650 mg oral 10-650 Formulary Custom (*); OTC mg gnp foaming antacid oral suspension 95-358 mg/15ml Formulary OTC gnp foaming antacid oral tablet chewable 80-20 mg Formulary OTC gnp gas relief extra strength capsule 125 mg oral 125 mg Formulary Custom (*); OTC gnp gas relief extra strength tablet chewable 125 mg oral Formulary Custom (*); OTC 125 mg gnp gentian violet external solution 1 % Formulary OTC 51 Drug Name Formulary Status Requirements/Limits gnp glucosame chondroitin ds tablet oral Formulary Custom (*); OTC gnp glucosamine chondroit ts tablet oral Formulary Custom (*); OTC gnp glucosamine chondroitin tablet oral Formulary Custom (*); OTC gnp headache relief extra str oral tablet 250-250-65 mg Formulary OTC gnp heartburn relief tablet 200 mg oral 200 mg Formulary Custom (*); OTC gnp hemorrhoidal ointment 0.25-14-74.9 % rectal 0.25-14- Formulary Custom (*); OTC 74.9 % gnp ibuprofen capsule 200 mg oral 200 mg Formulary Custom (*); OTC gnp ibuprofen cold/sinus tablet 30-200 mg oral 30-200 mg Formulary Custom (*); OTC gnp ibuprofen infants suspension 50 mg/1.25ml oral 50 Formulary Custom (*); OTC mg/1.25ml gnp ibuprofen junior strength tablet chewable 100 mg oral Formulary Custom (*); OTC 100 mg gnp ibuprofen pm tablet 200-38 mg oral 200-38 mg Formulary Custom (*); OTC gnp ibuprofen tablet 200 mg oral 200 mg Formulary Custom (*); OTC gnp iodides external tincture Formulary OTC gnp iodides tincture external Formulary Custom (*); OTC gnp external tincture Formulary OTC gnp itchy eye solution 0.025 % ophthalmic 0.025 % Formulary Custom (*); OTC gnp lansoprazole capsule delayed release 15 mg oral 15 mg Formulary Custom (*); OTC gnp lice solution kit 0.33-4-0.5 % combination 0.33-4-0.5 % Formulary Custom (*); OTC gnp lice treatment liquid 1 % external 1 % Formulary Custom (*); OTC gnp lice treatment shampoo 0.33-4 % external 0.33-4 % Formulary Custom (*); OTC gnp liquid bandage external liquid 0.75-0.2 % Formulary OTC gnp l-lysine oral tablet 600 mg Formulary OTC gnp loperamide hcl suspension 1 mg/7.5ml oral 1 mg/7.5ml Formulary Custom (*); OTC gnp loratadine childrens syrup 5 mg/5ml oral 5 mg/5ml Formulary Custom (*); OTC gnp loratadine syrup 5 mg/5ml oral 5 mg/5ml Formulary Custom (*); OTC gnp loratadine tablet 10 mg oral 10 mg Formulary Custom (*); OTC gnp loratadine-d 12hr tablet extended release 12 hour 5- Formulary Custom (*); OTC 120 mg oral 5-120 mg gnp loratadine-d 24 hour tablet extended release 24 hour Formulary Custom (*); OTC 10-240 mg oral 10-240 mg gnp lubricant eye drops solution 0.4-0.3 % ophthalmic 0.4- Formulary Custom (*); OTC 0.3 % gnp lubricant eye drops solution 0.5 % ophthalmic 0.5 % Formulary Custom (*); OTC gnp lubricant pm ointment ophthalmic Formulary Custom (*); OTC gnp lubricating plus eye drops solution 0.5 % ophthalmic Formulary Custom (*); OTC 0.5 % GNP MASANTI MAXIMUM STRENGTH SUSPENSION Formulary Custom (*); OTC 400-400-40 MG/5ML ORAL 400-400-40 MG/5ML GNP MASANTI REGULAR STRENGTH SUSPENSION Formulary Custom (*); OTC 200-200-20 MG/5ML ORAL 200-200-20 MG/5ML gnp miconazole 3 applicator kit 200 & 2 mg-% (9gm) Formulary Custom (*); OTC vaginal 200 & 2 mg-% (9gm) gnp miconazole 3 kit 200 & 2 mg-% (9gm) vaginal 200 & 2 Formulary Custom (*); OTC mg-% (9gm) 52 Drug Name Formulary Status Requirements/Limits gnp miconazole 7 cream 2 % vaginal 2 % Formulary Custom (*); OTC gnp migraine relief tablet 250-250-65 mg oral 250-250-65 Formulary Custom (*); OTC mg gnp motion sickness relief tablet 25 mg oral 25 mg Formulary Custom (*); OTC gnp motion sickness relief tablet 50 mg oral 50 mg Formulary Custom (*); OTC gnp mucus er tablet extended release 12 hour 600 mg oral Formulary Custom (*); OTC 600 mg gnp mucus relief cold & sinus tablet 5-325-200 mg oral 5- Formulary Custom (*); OTC 325-200 mg gnp mucus relief cold flu tablet 5-10-200-325 mg oral 5-10- Formulary Custom (*); OTC 200-325 mg gnp mucus relief congest/cold tablet 5-10-200-325 mg oral Formulary Custom (*); OTC 5-10-200-325 mg gnp mucus relief dm tablet 20-400 mg oral 20-400 mg Formulary Custom (*); OTC gnp mucus relief pe tablet 10-400 mg oral 10-400 mg Formulary Custom (*); OTC gnp mucus relief tablet 400 mg oral 400 mg Formulary Custom (*); OTC gnp multi-symptom cold daytime oral liquid 5-10-200-325 Formulary OTC mg/15ml gnp naproxen sodium capsule 220 mg oral 220 mg Formulary Custom (*); OTC gnp nasal decongestant pe tablet 10 mg oral 10 mg Formulary Custom (*); OTC gnp nasal decongestant tablet 30 mg oral 30 mg Formulary Custom (*); OTC gnp nasal spray extra moist solution 0.05 % nasal 0.05 % Formulary Custom (*); OTC gnp nasal spray solution 0.05 % nasal 0.05 % Formulary Custom (*); OTC gnp niacin oral tablet 250 mg Formulary OTC gnp polacrilex gum 2 mg mouth/throat 2 mg Formulary Custom (*); OTC gnp nicotine polacrilex gum 4 mg mouth/throat 4 mg Formulary Custom (*); OTC gnp nicotine polacrilex lozenge 2 mg mouth/throat 2 mg Formulary Custom (*); OTC gnp nicotine polacrilex lozenge 4 mg mouth/throat 4 mg Formulary Custom (*); OTC gnp night time cold & flu liquid 15-6.25-325 mg/15ml oral Formulary Custom (*); OTC 15-6.25-325 mg/15ml gnp night time cold/flu relief liquid 15-6.25-500 mg/15ml Formulary Custom (*); OTC oral 15-6.25-500 mg/15ml gnp night time cold-flu capsule 15-6.25-325 mg oral 15- Formulary Custom (*); OTC 6.25-325 mg gnp night time cough liquid 6.25-15 mg/15ml oral 6.25-15 Formulary Custom (*); OTC mg/15ml gnp night time sinus capsule 6.25-5-325 mg oral 6.25-5-325 Formulary Custom (*); OTC mg gnp nighttime sleep aid tablet 25 mg oral 25 mg Formulary Custom (*); OTC gnp no drip nasal spray solution 0.05 % nasal 0.05 % Formulary Custom (*); OTC gnp nose drops extra strength solution 1 % nasal 1 % Formulary Custom (*); OTC gnp omeprazole tablet delayed release 20 mg oral 20 mg Formulary Custom (*); OTC gnp one daily plus iron tablet oral Formulary Custom (*); OTC gnp pain relief ex st am/pm 25-500 & 500 mg oral 25-500 Formulary Custom (*); OTC & 500 mg gnp pain relief pm ex st tablet 25-500 mg oral 25-500 mg Formulary Custom (*); OTC gnp pain relief pm ex st tablet 500-25 mg oral 500-25 mg Formulary Custom (*); OTC

53 Drug Name Formulary Status Requirements/Limits gnp pain relief/benzocaine external pad 6-70 % Formulary OTC gnp peppermint spirit spirit Formulary OTC gnp pre-menstrual relf max st tablet 500-25-15 mg oral Formulary Custom (*); OTC 500-25-15 mg gnp pseudoephedrine hcl 12 hr tablet extended release 12 Formulary Custom (*); OTC hour 120 mg oral 120 mg gnp senna-lax tablet 8.6 mg oral 8.6 mg Formulary Custom (*); OTC gnp sinus & cold-d tablet extended release 12 hour 120-220 Formulary Custom (*); OTC mg oral 120-220 mg gnp sinus cong/pain day/night 2-5-325 & 5-325 mg oral 2- Formulary Custom (*); OTC 5-325 & 5-325 mg gnp sinus congest/pain night tablet 2-5-325 mg oral 2-5- Formulary Custom (*); OTC 325 mg gnp sinus congestion/pain day tablet 5-325 mg oral 5-325 Formulary Custom (*); OTC mg gnp sinus wash refill nasal packet 2300-700 mg Formulary OTC gnp sinus/allergy pe tablet 4-10 mg oral 4-10 mg Formulary Custom (*); OTC gnp sleep aid tablet 25 mg oral 25 mg Formulary Custom (*); OTC gnp sleep time liquid 50 mg/30ml oral 50 mg/30ml Formulary Custom (*); OTC gnp sodium silicate solution Formulary OTC gnp soothing bath treatment packet external Formulary Custom (*); OTC gnp stay awake tablet 200 mg oral 200 mg Formulary Custom (*); OTC gnp stomach relief max st suspension 525 mg/15ml oral 525 Formulary Custom (*); OTC mg/15ml gnp tab tussin dm tablet 20-400 mg oral 20-400 mg Formulary Custom (*); OTC gnp tab tussin tablet 400 mg oral 400 mg Formulary Custom (*); OTC gnp terbinafine hydrochloride cream 1 % external 1 % Formulary Custom (*); OTC gnp tioconazole 1 ointment 6.5 % vaginal 6.5 % Formulary Custom (*); OTC gnp tolnaftate cream 1 % external 1 % Formulary Custom (*); OTC gnp triple antibiotic ointment 3.5-400-5000 external 3.5- Formulary Custom (*); OTC 400-5000 gnp triple antibiotic plus ointment 1 % external 1 % Formulary Custom (*); OTC gnp tussin cf cough & cold syrup 5-10-100 mg/5ml oral 5- Formulary Custom (*); OTC 10-100 mg/5ml gnp tussin cf max liquid 5-10-200 mg/5ml oral 5-10-200 Formulary Custom (*); OTC mg/5ml gnp tussin cough long acting syrup 15 mg/5ml oral 15 Formulary Custom (*); OTC mg/5ml gnp tussin dm cough liquid 100-10 mg/5ml oral 100-10 Formulary Custom (*); OTC mg/5ml gnp tussin dm liquid 20-200 mg/10ml oral 20-200 mg/10ml Formulary Custom (*); OTC gnp tussin dm max liquid 10-200 mg/5ml oral 10-200 Formulary Custom (*); OTC mg/5ml gnp tussin syrup 100 mg/5ml oral 100 mg/5ml Formulary Custom (*); OTC gnp ultra lubricant eye drops solution 0.4-0.3 % ophthalmic Formulary Custom (*); OTC 0.4-0.3 % gnp urinary pain relief oral tablet 97.5 mg Formulary OTC gnp vitamin d-400 oral tablet 90-400 mg-unit Formulary OTC 54 Drug Name Formulary Status Requirements/Limits gnp zinc oxide ointment 20 % external 20 % Formulary Custom (*); OTC GOLD BOND MULTI-SYMPTOM EXTERNAL CREAM Formulary OTC 4 % GOLD BOND RAPID RELIEF EXTERNAL CREAM 1-1 Formulary OTC % goniosoft ophthalmic solution 2.5 % Formulary OTC GONIOSOL 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 tablet 10 mg oral 10 mg Formulary Custom (*); OTC goodsense arthritis pain tablet extended release 650 mg Formulary Custom (*); OTC oral 650 mg goodsense day time cold & flu liquid 5-10-200-325 Formulary Custom (*); OTC mg/15ml oral 5-10-200-325 mg/15ml goodsense day time cold & flu tablet 5-10-200-325 mg oral Formulary Custom (*); OTC 5-10-200-325 mg goodsense eye drops ophthalmic solution 0.05 % Formulary OTC goodsense headache pm tablet 25-500 mg oral 25-500 mg Formulary Custom (*); OTC goodsense hemorrhoidal ointment 0.25-14-74.9 % rectal Formulary Custom (*); OTC 0.25-14-74.9 % goodsense ibuprofen childrens suspension 100 mg/5ml oral Formulary Custom (*); OTC 100 mg/5ml goodsense ibuprofen infants suspension 50 mg/1.25ml oral Formulary Custom (*); OTC 50 mg/1.25ml goodsense ibuprofen junior st tablet chewable 100 mg oral Formulary Custom (*); OTC 100 mg goodsense ibuprofen pm tablet 200-38 mg oral 200-38 mg Formulary Custom (*); OTC goodsense ibuprofen tablet 200 mg oral 200 mg Formulary Custom (*); OTC goodsense lubricating solution 0.5 % ophthalmic Formulary Custom (*); OTC 0.5 % goodsense migraine formula tablet 250-250-65 mg oral Formulary Custom (*); OTC 250-250-65 mg goodsense naproxen sodium tablet 220 mg oral 220 mg Formulary Custom (*); OTC goodsense nicotine lozenge 4 mg mouth/throat 4 mg Formulary Custom (*); OTC goodsense pain relief tablet extended release 650 mg oral Formulary Custom (*); OTC 650 mg goodsense gel Formulary OTC goodsense redness relief plus ophthalmic solution 0.5-0.03 Formulary OTC % goodsense sinus congest/pain oral 2-5-325 & 5-325 mg Formulary OTC goodsense 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 55 Drug Name Formulary Status Requirements/Limits GORDO-POOL CONCENTRATE Formulary OTC gormel 10 external lotion 10 % Formulary OTC gormel external cream 20 % Formulary OTC GRANDPAS THYLOX SOAP EXTERNAL BAR 3 % Formulary OTC grape seed oil Formulary green soap external tincture Formulary OTC green tea extract liquid 90 % Formulary OTC grx hemorrhoidal rectal ointment 0.25-14-71.9 % Formulary OTC grx wound external gel Formulary OTC guaiatussin ac syrup 100-10 mg/5ml oral 100-10 mg/5ml Formulary Custom (*); OTC guaifenesin ac syrup 100-10 mg/5ml oral 100-10 mg/5ml Formulary Custom (*); OTC guaifenesin er tablet extended release 12 hour 600 mg oral Formulary Custom (*) (otc) 600 mg guaifenesin solution 100 mg/5ml oral 100 mg/5ml Formulary Custom (*); OTC guaifenesin solution 200 mg/10ml oral 200 mg/10ml Formulary Custom (*); OTC guaifenesin solution 300 mg/15ml oral 300 mg/15ml Formulary Custom (*); OTC guaifenesin tablet 200 mg oral (otc) 200 mg Formulary Custom (*); OTC guaifenesin-codeine solution 100-10 mg/5ml oral (otc) 100- Formulary Custom (*); OTC 10 mg/5ml guaifenesin-dm syrup 100-10 mg/5ml oral 100-10 mg/5ml Formulary Custom (*); OTC gumsol mouth/throat liquid 5-0.1 % Formulary OTC GYNE-LOTRIMIN 3 VAGINAL CREAM 2 % Formulary OTC GYNE-LOTRIMIN VAGINAL CREAM 1 % Formulary OTC G-ZYNCOF ORAL SYRUP 20-400 MG/5ML Formulary OTC H2Q ORAL POWDER 200 MG/GM Formulary OTC hair regrowth treatment men solution 5 % external 5 % Formulary Custom (*); OTC hand wipes external 0.13 % Formulary OTC hankscraft humidifier Formulary OTC HARD NAILS ORAL CAPSULE 2.5 MG Formulary OTC 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 formula added st tablet 250-250-65 mg oral 250- Formulary Custom (*); OTC 250-65 mg headache pm tablet 25-500 mg oral 25-500 mg Formulary Custom (*); OTC healthy kids cod liver/vit d tablet chewable oral Formulary Custom (*); OTC HEALTHYLAX PACKET 17 GM ORAL 17 GM Formulary Custom (*); OTC heartburn antacid ex st oral tablet chewable 160-105 mg Formulary OTC heartburn relief 150 max st tablet 150 mg oral 150 mg Formulary Custom (*); OTC heartburn relief max st tablet 20 mg oral 20 mg Formulary Custom (*); OTC heartburn relief tablet 10 mg oral 10 mg Formulary Custom (*); OTC heartburn relief tablet 200 mg oral 200 mg Formulary Custom (*); OTC heartburn treatment 24 hour capsule delayed release 15 mg Formulary Custom (*); OTC oral 15 mg HEET TRIPLE ACTION EXTERNAL LIQUID Formulary OTC 56 Drug Name Formulary Status Requirements/Limits HEMA-COMBISTIX IN VITRO STRIP Formulary OTC HEMOCYTE ORAL TABLET 324 (106 FE) MG Formulary OTC hemorrhoidal cooling gel 0.25-50 % external 0.25-50 % Formulary Custom (*); OTC hemorrhoidal cooling rectal gel 0.25-50 % Formulary OTC hemorrhoidal cream 1-0.25-14.4-15 % external 1-0.25- Formulary Custom (*); OTC 14.4-15 % hemorrhoidal hygiene pad 50 % external 50 % Formulary Custom (*); OTC hemorrhoidal max st/aloe rectal cream 1-0.25-14.4-15 % Formulary OTC hemorrhoidal ointment 0.25-14-74.9 % rectal 0.25-14-74.9 Formulary Custom (*); OTC % hemorrhoidal ointment rectal Formulary Custom (*); OTC hemorrhoidal pad 50 % external 50 % Formulary Custom (*); OTC hemorrhoidal rectal suppository 0.25-3-85.5 %, 0.25-85.39 Formulary OTC % hemorrhoidal suppository 0.25 % rectal 0.25 % Formulary Custom (*); OTC HIBICLENS EXTERNAL LIQUID 4 % Formulary OTC high potency iron oral tablet 134 mg, 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 LIQUID 0.938 MG/ML ORAL 0.938 MG/ML Formulary Custom (*); OTC HISTEX PD ORAL LIQUID 0.938 MG/ML Formulary OTC HISTEX PDX ORAL LIQUID 1.25 MG/ML Formulary OTC HISTEX SYRUP 2.5 MG/5ML ORAL 2.5 MG/5ML Formulary Custom (*); 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-DM SYRUP 10-2.5-20 MG/5ML ORAL 10-2.5- Formulary Custom (*); OTC 20 MG/5ML HISTEX-PE ORAL SYRUP 2.5-10 MG/5ML Formulary OTC HISTEX-PE SYRUP 2.5-10 MG/5ML ORAL 2.5-10 Formulary Custom (*); OTC MG/5ML hist-pse oral liquid 0.938-10 mg/ml Formulary OTC hm acid reducer tablet 150 mg oral 150 mg Formulary Custom (*); OTC hm acid reducer tablet 75 mg oral 75 mg Formulary Custom (*); OTC hm advanced antacid max st suspension 400-400-40 mg/5ml Formulary Custom (*); OTC oral 400-400-40 mg/5ml hm all day allergy tablet 10 mg oral 10 mg Formulary Custom (*); OTC hm allergy & congestion tablet extended release 12 hour 5- Formulary Custom (*); OTC 120 mg oral 5-120 mg hm allergy childrens liquid 12.5 mg/5ml oral 12.5 mg/5ml Formulary Custom (*); OTC hm allergy complete childrens solution 5 mg/5ml oral 5 Formulary Custom (*); OTC mg/5ml hm allergy complete-d tablet extended release 12 hour 5- Formulary Custom (*); OTC 120 mg oral 5-120 mg hm allergy multi symptom capsule 25 mg oral 25 mg Formulary Custom (*); OTC hm allergy relief (loratadine) tablet 10 mg oral 10 mg Formulary Custom (*); OTC

57 Drug Name Formulary Status Requirements/Limits hm allergy relief childrens liquid 12.5 mg/5ml oral 12.5 Formulary Custom (*); OTC mg/5ml hm allergy relief tablet 4 mg oral 4 mg Formulary Custom (*); OTC hm allergy relief tablet dispersible 10 mg oral 10 mg Formulary Custom (*); OTC hm allergy relief/nasal decong tablet extended release 24 Formulary Custom (*); OTC hour 10-240 mg oral 10-240 mg hm antacid anti-gas ex st suspension 400-400-40 mg/5ml Formulary Custom (*); OTC oral 400-400-40 mg/5ml hm antacid/antigas suspension 200-200-20 mg/5ml oral Formulary Custom (*); OTC 200-200-20 mg/5ml hm anti-diarrheal tablet 2 mg oral 2 mg Formulary Custom (*); OTC hm arthritis pain relief tablet extended release 650 mg oral Formulary Custom (*); OTC 650 mg hm artificial tears solution 5-6 mg/ml ophthalmic 5-6 mg/ml Formulary Custom (*); OTC hm aspirin tablet 325 mg oral 325 mg Formulary Custom (*); OTC hm bacitracin zinc ointment 500 unit/gm external 500 Formulary Custom (*); OTC unit/gm hm calamine external lotion 8-8 % Formulary OTC hm calamine lotion 8-8 % external 8-8 % Formulary Custom (*); OTC hm calcium antacid ex st tablet chewable 750 mg oral 750 Formulary Custom (*); OTC mg hm calcium antacid tablet chewable 500 mg oral 500 mg Formulary Custom (*); OTC hm castor oil oil Formulary OTC hm cetirizine hcl childrens solution 5 mg/5ml oral 5 mg/5ml Formulary Custom (*); OTC hm chest congestion relief dm tablet 20-400 mg oral 20-400 Formulary Custom (*); OTC mg hm chest congestion relief tablet 400 mg oral 400 mg Formulary Custom (*); OTC hm chest rub ointment 4.8-1.2-2.6 % external 4.8-1.2-2.6 % Formulary Custom (*); OTC hm clear fiber oral powder Formulary OTC HM CLEARLAX POWDER 17 GM/SCOOP ORAL 17 Formulary Custom (*); OTC GM/SCOOP hm cold & allergy childrens elixir 1-2.5 mg/5ml oral 1-2.5 Formulary Custom (*); OTC mg/5ml hm cold & cough childrens liquid 2.5-1-5 mg/5ml oral 2.5- Formulary Custom (*); OTC 1-5 mg/5ml hm cold & sinus relief tablet 30-200 mg oral 30-200 mg Formulary Custom (*); OTC hm complete dual action tablet chewable 10-800-165 mg Formulary Custom (*); OTC oral 10-800-165 mg hm cough dm suspension extended release 30 mg/5ml oral Formulary Custom (*); OTC 30 mg/5ml hm cough relief liquid 15 mg/5ml oral 15 mg/5ml Formulary Custom (*); OTC hm day time capsule 10-5-325 mg oral 10-5-325 mg Formulary Custom (*); OTC hm double antibiotic ointment 500-10000 unit/gm external Formulary Custom (*); OTC 500-10000 unit/gm hm earwax removal aid solution 6.5 % otic 6.5 % Formulary Custom (*); OTC hm earwax removal kit solution 6.5 % otic 6.5 % Formulary Custom (*); OTC hm enema enema 7-19 gm/118ml rectal 7-19 gm/118ml Formulary Custom (*); OTC hm enema mineral oil enema rectal Formulary Custom (*); OTC 58 Drug Name Formulary Status Requirements/Limits hm ethyl rubbing alcohol solution 70 % Formulary OTC hm eye drops advanced relief solution 0.05-0.1-1-1 % Formulary Custom (*); OTC ophthalmic 0.05-0.1-1-1 % hm eye drops solution 0.012-0.2 % ophthalmic 0.012-0.2 % Formulary Custom (*); OTC hm eye drops solution 0.05 % ophthalmic 0.05 % Formulary Custom (*); OTC hm eye itch relief solution 0.025 % ophthalmic 0.025 % Formulary Custom (*); OTC hm famotidine tablet 10 mg oral 10 mg Formulary Custom (*); OTC hm famotidine tablet 20 mg oral 20 mg Formulary Custom (*); OTC hm fexofenadine hcl tablet 180 mg oral 180 mg Formulary Custom (*); OTC hm fexofenadine hcl tablet 60 mg oral 60 mg Formulary Custom (*); OTC hm fiber capsule 0.52 gm oral 0.52 gm Formulary Custom (*); OTC hm fiber tablet 500 mg oral 500 mg Formulary Custom (*); OTC hm gas relief extra strength capsule 125 mg oral 125 mg Formulary Custom (*); OTC hm gas relief infants drops suspension 20 mg/0.3ml oral 20 Formulary Custom (*); OTC mg/0.3ml hm gas relief tablet chewable 80 mg oral 80 mg Formulary Custom (*); OTC hm ibuprofen capsule 200 mg oral 200 mg Formulary Custom (*); OTC hm ibuprofen childrens suspension 100 mg/5ml oral 100 Formulary Custom (*); OTC mg/5ml hm ibuprofen ib tablet 200 mg oral 200 mg Formulary Custom (*); OTC hm ibuprofen infants suspension 50 mg/1.25ml oral 50 Formulary Custom (*); OTC mg/1.25ml hm ibuprofen tablet 200 mg oral 200 mg Formulary Custom (*); OTC hm iodides external tincture Formulary OTC hm iodine external tincture Formulary OTC hm iron oral tablet 200 (65 fe) mg Formulary OTC hm lansoprazole capsule delayed release 15 mg oral 15 mg Formulary Custom (*); OTC hm lice killing max st shampoo 0.33-4 % external 0.33-4 % Formulary Custom (*); OTC hm lice treatment liquid 1 % external 1 % Formulary Custom (*); OTC hm lice treatment lotion 1 % external 1 % Formulary Custom (*); OTC hm loperamide hcl capsule 2 mg oral 2 mg Formulary Custom (*); OTC hm loperamide hcl liquid 1 mg/7.5ml oral 1 mg/7.5ml Formulary Custom (*); OTC hm loperamide hcl suspension 1 mg/7.5ml oral 1 mg/7.5ml Formulary Custom (*); OTC hm loratadine childrens syrup 5 mg/5ml oral 5 mg/5ml Formulary Custom (*); OTC hm loratadine tablet 10 mg oral 10 mg Formulary Custom (*); OTC hm lubricating plus solution 0.5 % ophthalmic 0.5 % Formulary Custom (*); OTC hm melatonin quick dissolve oral tablet dispersible 10 mg Formulary OTC hm migraine formula tablet 250-250-65 mg oral 250-250- Formulary Custom (*); OTC 65 mg hm milk of magnesia suspension 1200 mg/15ml oral 1200 Formulary Custom (*); OTC mg/15ml hm motion relief tablet 25 mg oral 25 mg Formulary Custom (*); OTC hm motion sickness relief tablet 50 mg oral 50 mg Formulary Custom (*); OTC hm mucus er tablet extended release 12 hour 600 mg oral Formulary Custom (*); OTC 600 mg hm multi-purpose no rub solution Formulary Custom (*); OTC 59 Drug Name Formulary Status Requirements/Limits hm naproxen sodium capsule 220 mg oral 220 mg Formulary Custom (*); OTC hm naproxen sodium tablet 220 mg oral 220 mg Formulary Custom (*); OTC hm nasal decongestant 12 hour tablet extended release 12 Formulary Custom (*); OTC hour 120 mg oral 120 mg hm nasal decongestant pe tablet 10 mg oral 10 mg Formulary Custom (*); OTC hm nasal decongestant tablet 30 mg oral 30 mg Formulary Custom (*); OTC hm nasal spray solution 0.05 % nasal 0.05 % Formulary Custom (*); OTC hm 24 hour 14 mg/24hr transdermal 14 Formulary Custom (*); OTC mg/24hr hm nicotine patch 24 hour 21 mg/24hr transdermal 21 Formulary Custom (*); OTC mg/24hr hm nicotine polacrilex gum 2 mg mouth/throat 2 mg Formulary Custom (*); OTC hm nicotine polacrilex gum 4 mg mouth/throat 4 mg Formulary Custom (*); OTC hm nicotine polacrilex lozenge 2 mg mouth/throat 2 mg Formulary Custom (*); OTC hm nicotine polacrilex lozenge 4 mg mouth/throat 4 mg Formulary Custom (*); OTC hm night time cold & flu capsule 15-6.25-325 mg oral 15- Formulary Custom (*); OTC 6.25-325 mg hm night time cold & flu liquid 15-6.25-325 mg/15ml oral Formulary Custom (*); OTC 15-6.25-325 mg/15ml hm nighttime sleep aid capsule 50 mg oral 50 mg Formulary Custom (*); OTC hm nose drops solution 1 % nasal 1 % Formulary Custom (*); OTC hm omeprazole tablet delayed release 20 mg oral 20 mg Formulary Custom (*); OTC hm pain & fever childrens suspension 160 mg/5ml oral 160 Formulary Custom (*); OTC mg/5ml hm pain relief extra strength tablet 500 mg oral 500 mg Formulary Custom (*); OTC hm pain reliever pm ex st tablet 25-500 mg oral 25-500 mg Formulary Custom (*); OTC hm probiotic digestive health oral capsule Formulary OTC hm rolled gauze bandage Formulary OTC hm saline nasal spray solution 0.65 % nasal 0.65 % Formulary Custom (*); OTC hm senna tablet 8.6 mg oral 8.6 mg Formulary Custom (*); OTC hm severe cold/cough/flu packet 20-10-650 mg oral 20-10- Formulary Custom (*); OTC 650 mg hm severe cold/flu tablet 5-10-200-325 mg oral 5-10-200- Formulary Custom (*); OTC 325 mg hm sinus nasal spray solution 0.05 % nasal 0.05 % Formulary Custom (*); OTC hm sleep aid tablet 25 mg oral 25 mg Formulary Custom (*); OTC hm stay awake tablet 200 mg oral 200 mg Formulary Custom (*); OTC hm stomach relief max strength suspension 525 mg/15ml Formulary Custom (*); OTC oral 525 mg/15ml hm stomach relief suspension 262 mg/15ml oral 262 Formulary Custom (*); OTC mg/15ml hm stomach relief tablet chewable 262 mg oral 262 mg Formulary Custom (*); OTC hm stool softener capsule 250 mg oral 250 mg Formulary Custom (*); OTC hm super vitamin b12 oral tablet chewable 2500 mcg Formulary OTC hm triple antibiotic max st ointment 1 % external 1 % Formulary Custom (*); OTC hm triple antibiotic ointment 3.5-400-5000 external 3.5- Formulary Custom (*); OTC 400-5000 60 Drug Name Formulary Status Requirements/Limits hm tussin adult dm liquid 100-10 mg/5ml oral 100-10 Formulary Custom (*); OTC mg/5ml hm tussin adult liquid 100 mg/5ml oral 100 mg/5ml Formulary Custom (*); OTC hm tussin adult multi-symptom liquid 5-10-100 mg/5ml oral Formulary Custom (*); OTC 5-10-100 mg/5ml hm vitamin b12 oral tablet extended release 1000 mcg Formulary OTC hm witch hazel solution 86 % external 86 % Formulary Custom (*); OTC hm z-sleep capsule 25 mg oral 25 mg Formulary Custom (*); OTC HOLD MOUTH/THROAT LOZENGE 5 MG Formulary OTC HONEY BEARS W/IRON-ZINC ORAL TABLET Formulary OTC CHEWABLE 30-200-3 HONGO CURA ANTI-FUNGAL EXTERNAL Formulary OTC OINTMENT 5-20 % hot steam inhalation liquid 6.2 % Formulary OTC HPR PLUS HYDROGEL EXTERNAL KIT Formulary hrt essential cream Formulary humidifier Formulary OTC HUMULIN 70/30 PEN SUBCUTANEOUS SUSPENSION Formulary OTC PEN-INJECTOR (70-30) 100 UNIT/ML HUMULIN N PEN SUBCUTANEOUS SUSPENSION Formulary OTC PEN-INJECTOR 100 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 hydrocerin external cream Formulary OTC hydrochloric acid liquid 37 % Formulary hydrocod polst-cpm polst er suspension extended release Formulary Custom (*) 10-8 mg/5ml oral 10-8 mg/5ml hydrocodone-homatropine syrup 5-1.5 mg/5ml oral 5-1.5 Formulary Custom (*) mg/5ml hydrocodone-homatropine tablet 5-1.5 mg oral 5-1.5 mg Formulary Custom (*) hydrocortisone acetate external cream 1 % Formulary OTC hydrocortisone cream 0.5 % external 0.5 % Formulary Custom (*); OTC hydrocortisone cream 1 % external (otc) 1 % Formulary Custom (*) hydrocortisone external ointment 0.5 % Formulary OTC hydrocortisone max st cream 1 % external 1 % Formulary Custom (*); OTC hydrocortisone ointment 0.5 % external 0.5 % Formulary Custom (*); OTC hydrocortisone ointment 1 % external (otc) 1 % Formulary Custom (*) hydrocortisone-aloe cream 0.5 % external 0.5 % Formulary Custom (*); OTC hydrocortisone-aloe cream 1 % external 1 % Formulary Custom (*); OTC hydrocortisone-aloe external cream 0.5 % Formulary OTC HYDROGEL AG EXTERNAL GEL Formulary OTC

61 Drug Name Formulary Status Requirements/Limits HYDROGEL EXTERNAL GEL Formulary OTC wipes external 3 % Formulary OTC hydromet syrup 5-1.5 mg/5ml oral 5-1.5 mg/5ml Formulary Custom (*) HYDROPEL EXTERNAL OINTMENT 30 % Formulary OTC hydrophilic external ointment Formulary OTC hydrophilic petrolatum external ointment Formulary OTC hydro-tabs oral tablet Formulary OTC hydroxocobalamin acetate solution 1000 mcg/ml Formulary Custom (*) intramuscular 1000 mcg/ml hydroxypropyl cellulose powder Formulary HYLATOPIC PLUS EXTERNAL LOTION Formulary HYPERCARE EXTERNAL SOLUTION 15 % Formulary OTC HYPOTEARS OPHTHALMIC SOLUTION 1-1 % Formulary OTC hypromellose powder Formulary HYSEPT EXTERNAL SOLUTION 0.25 %, 0.5 % Formulary OTC HYVEE ADVANCED ANTACID ORAL SUSPENSION Formulary OTC 400-400-40 MG/5ML ibu-200 tablet 200 mg oral 200 mg Formulary Custom (*); OTC ibu-drops suspension 40 mg/ml oral 40 mg/ml Formulary Custom (*); OTC ibu-drops suspension 50 mg/1.25ml oral 50 mg/1.25ml Formulary Custom (*); OTC ibuprofen 100 junior strength oral tablet chewable 100 mg Formulary OTC ibuprofen capsule 200 mg oral 200 mg Formulary Custom (*); OTC ibuprofen childrens suspension 100 mg/5ml oral 100 Formulary Custom (*); OTC mg/5ml ibu-profen cold/sinus tablet 30-200 mg oral 30-200 mg Formulary Custom (*); OTC ibuprofen infants suspension 50 mg/1.25ml oral 50 Formulary Custom (*); OTC mg/1.25ml ibuprofen junior strength tablet chewable 100 mg oral 100 Formulary Custom (*); OTC mg ibuprofen pm oral capsule 200-25 mg Formulary OTC ibuprofen pm tablet 200-38 mg oral 200-38 mg Formulary Custom (*); OTC ibuprofen suspension 100 mg/5ml oral (otc) 100 mg/5ml Formulary Custom (*) ibuprofen tablet 200 mg oral 200 mg Formulary Custom (*); OTC ICAR ORAL SUSPENSION 15 MG/1.25ML Formulary OTC ICAR-C ORAL TABLET 100-250 MG Formulary OTC ice bag Formulary OTC 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 % IFEREX 150 CAPSULE 150 MG ORAL 150 MG Formulary Custom (*); OTC 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 62 Drug Name Formulary Status Requirements/Limits IMODIUM A-D ORAL TABLET 2 MG Formulary OTC IMODIUM MULTI-SYMPTOM RELIEF ORAL TABLET Formulary OTC 2-125 MG IMPROVUE OPHTHALMIC SOLUTION PREFILLED Formulary OTC 1.7 % indole-3-carbinol powder Formulary infants gas relief suspension 20 mg/0.3ml oral 20 mg/0.3ml Formulary Custom (*); OTC infants ibuprofen suspension 50 mg/1.25ml oral 50 Formulary Custom (*); OTC mg/1.25ml infants pain relief suspension 80 mg/0.8ml oral 80 mg/0.8ml Formulary Custom (*); OTC infants pain reliever oral suspension 80 mg/0.8ml Formulary OTC infants simethicone suspension 20 mg/0.3ml oral 20 Formulary Custom (*); OTC mg/0.3ml INFED SOLUTION 50 MG/ML INJECTION 50 MG/ML Formulary Custom (*) INFUVITE ADULT INJECTABLE INTRAVENOUS Formulary Custom (*) INFUVITE PEDIATRIC SOLUTION INTRAVENOUS Formulary Custom (*) inositol hexanicotinate powder Formulary inositol oral tablet 500 mg, 650 mg Formulary OTC INOSITOL-5 ORAL TABLET 324 MG Formulary OTC INSPIRACHAMBER/LARGE DEVICE Formulary INSPIRACHAMBER/MEDIUM DEVICE Formulary INSPIRACHAMBER/MOUTHPIECE DEVICE Formulary INSPIRACHAMBER/SMALL DEVICE Formulary INSPIREASE Formulary 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 instant pain relief external liquid 10.8-4.7 % Formulary OTC INTEGRA ORAL CAPSULE 62.5-62.5-40-3 MG Formulary OTC intense cough reliever ex st liquid 20-300 mg/5ml oral 20- Formulary Custom (*); OTC 300 mg/5ml intense cough reliever oral liquid 20-300 mg/5ml Formulary OTC INTERDRY AG TEXTILE 10"X144" EXTERNAL Formulary OTC SHEET INTRASITE GEL APPLIPAK EXTERNAL GEL Formulary OTC invisible acne max st cream 10 % external 10 % Formulary Custom (*); OTC iodides tincture external tincture Formulary OTC iodine crystals Formulary OTC iodine external tincture , 2 % Formulary OTC iodine strong external tincture 6.9-5 % Formulary OTC iodine tincture external tincture Formulary OTC iodine tincture external tincture 2 % Formulary powder Formulary IONIL EXTERNAL SHAMPOO 2-0.2 % Formulary OTC

63 Drug Name Formulary Status Requirements/Limits iophen c-nr liquid 100-10 mg/5ml oral 100-10 mg/5ml Formulary Custom (*); OTC iophen dm-nr liquid 100-10 mg/5ml oral 100-10 mg/5ml Formulary Custom (*); OTC iophen-nr liquid 100 mg/5ml oral 100 mg/5ml Formulary Custom (*); OTC IOSAT ORAL TABLET 130 MG Formulary OTC ipecac oral syrup Formulary OTC IROFOL ORAL LIQUID 100-1000-15 MG-MCG/5ML Formulary OTC IROFOL ORAL TABLET 150-0.025-1 MG Formulary OTC iron (ferrous sulfate) oral tablet extended release 142 (45 Formulary OTC fe) mg iron 100 plus oral tablet 100-250-0.025-1 mg Formulary OTC iron 100/c oral tablet 100-250 mg Formulary OTC iron 21/7 oral Formulary OTC iron 27 oral tablet 240 (27 fe) mg Formulary OTC iron chews pediatric oral tablet chewable 15 mg Formulary OTC iron slow release oral tablet extended release 143 (45 fe) Formulary OTC mg ISOLEUCINE 1000 ORAL PACKET 1 GM Formulary OTC isoleucine oral packet 50 mg Formulary OTC isomalt base powder Formulary isopropyl alcohol (rubbing) solution 70 % Formulary OTC isopropyl alcohol (rubbing) solution 70 % 70 % Formulary Custom (*); OTC isopropyl alcohol solution , 70 %, 99 % Formulary isopropyl alcohol solution 50 %, 91 % Formulary OTC isopropyl alcohol solution 70 % (otc) 70 % Formulary Custom (*) isopropyl myristate solution Formulary isopropyl palmitate liquid Formulary ISOPTO TEARS OPHTHALMIC SOLUTION 0.5 % Formulary OTC ISOPTO TEARS SOLUTION 0.5 % OPHTHALMIC 0.5 % Formulary Custom (*); OTC itch relief cream 2 % external 2 % Formulary Custom (*); OTC itch relief external cream 2 % Formulary OTC ITCH-X EXTERNAL GEL 1-10 % Formulary OTC ITCH-X EXTERNAL SOLUTION 1-10 % Formulary OTC IV3000 1-HAND Formulary OTC IVAREST MEDICATED POISON IVY EXTERNAL Formulary OTC LIQUID 1 % IVAREST POISON IVY ITCH EXTERNAL CREAM 2- Formulary OTC 14-10.5 % IVY DRY EXTERNAL LOTION 2 % Formulary OTC ivy wash poison ivy cleanser external lotion 1 % Formulary OTC IVY-DRY EXTERNAL CREAM 10-0.6-0.4 % Formulary OTC IVY-RID EXTERNAL AEROSOL 0.15-5-9 % Formulary OTC J & J ALL-PURPOSE FIRST AID COMBINATION KIT Formulary OTC jessners external solution Formulary OTC J-MAX SYRUP 5-200 MG/5ML ORAL 5-200 MG/5ML Formulary Custom (*); OTC jock itch spray aerosol powder 1 % external 1 % Formulary Custom (*); OTC 64 Drug Name Formulary Status Requirements/Limits JOHNSONS BABY CORNSTARCH EXTERNAL Formulary OTC POWDER JOHNSONS BABY POWDER EXTERNAL POWDER Formulary OTC JOHNSONS NO MORE RASH EXTERNAL CREAM 13 Formulary OTC % J-TAN D PD LIQUID 1-7.5 MG/ML ORAL 1-7.5 MG/ML Formulary Custom (*); OTC J-TAN PD LIQUID 1 MG/ML ORAL 1 MG/ML Formulary Custom (*); OTC JUNIOR MAPAP TABLET DISPERSIBLE 160 MG Formulary Custom (*); OTC ORAL 160 MG k-99 oral capsule 595 mg Formulary OTC KANGAROO BALLOON 18FR/2.3CM KIT Formulary 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 % kaolin powder Formulary KAOPECTATE ORAL TABLET 262 MG Formulary OTC KAO-TIN SUSPENSION 262 MG/15ML ORAL 262 Formulary Custom (*); OTC MG/15ML karaya gum gum Formulary KARBOZYME ORAL TABLET DELAYED RELEASE Formulary OTC 167-173-346 MG kaz healthmist humidifier Formulary OTC kaz humidifier evaporativ 3000 Formulary OTC kaz humidifier evaporativ 3300 Formulary OTC kaz humidifier evaporativ 3400 Formulary OTC kaz ultrasonic humidifier Formulary OTC K-BICARB ORAL CAPSULE 99 MG Formulary OTC kelp oral tablet 150 mcg Formulary OTC kelp-b6-lecithin-vinegar oral capsule 5-0.75-200-50 mg Formulary OTC KENDALL ALGINATE DRESS 8"X8" EXTERNAL PAD Formulary OTC KENDALL HYDROGEL GAUZE 4"X8" EXTERNAL Formulary PAD KENDALL HYDROPHILIC FOAM DRESS PAD 4"X8" , Formulary OTC 5"X5" KERALYT EXTERNAL GEL 3 % Formulary OTC KERAMATRIX REPLICINE 10CMX10CM EXTERNAL Formulary SHEET KETOSTIX IN VITRO STRIP Formulary OTC ketotifen fumarate solution 0.025 % ophthalmic (otc) 0.025 Formulary Custom (*) % KEY OMEGA ORAL PACKET 200-100 MG Formulary OTC kidkare cough/cold liquid 15-1-5 mg/5ml oral 15-1-5 Formulary Custom (*); OTC mg/5ml kids vitamins plus extra c tablet chewable oral Formulary Custom (*); OTC

65 Drug Name Formulary Status Requirements/Limits k-iii oral solution reconstituted 33.3-33.3-33.3 % Formulary OTC kimono Formulary Custom (*); OTC kimono micro thin Formulary Custom (*); OTC kimono micro thin plus Formulary Custom (*); OTC kimono sensation Formulary Custom (*); OTC kimono sensation plus Formulary Custom (*); OTC KINERASE EXTERNAL CREAM 0.1 %, 0.125 % Formulary OTC KINERASE EXTERNAL LOTION 0.1 % Formulary OTC kls cold & flu ms day/night oral tablet therapy pack Formulary OTC kls esomeprazole magnesium oral capsule delayed release Formulary OTC 20 mg 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 kojic acid powder Formulary konsyl daily fiber oral packet 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 mag-oxide magnesium oral tablet 200 mg Formulary OTC kp silicone scar therapy gel strip Formulary OTC kpn prenatal oral tablet 0.1 mg Formulary OTC KT PRO EXTREME TAPE Formulary OTC KWAN LOONG PAIN RELIEVING EXTERNAL OIL Formulary OTC K-Y LUBRICATING EXTERNAL GEL Formulary OTC KYLEENA INTRAUTERINE Formulary 19.5 MG LAC-HYDRIN EXTERNAL LOTION 12 % Formulary LAC-HYDRIN FIVE EXTERNAL LOTION 5 % Formulary OTC LAC-HYDRIN FIVE LOTION 5 % EXTERNAL 5 % Formulary Custom (*); OTC LAC-HYDRIN TWELVE LOTION 12 % EXTERNAL 12 Formulary Custom (*); OTC % LACTAID ULTRA ORAL TABLET 9000 UNIT Formulary OTC lactic acid solution 85 % Formulary OTC lacto-bifidus-600 oral capsule Formulary OTC lactose monohydrate powder Formulary lactose powder Formulary l-alanine powder Formulary LAMISIL ADVANCED EXTERNAL GEL 1 % Formulary OTC LAMISIL ADVANCED GEL 1 % EXTERNAL 1 % Formulary Custom (*); OTC LAMISIL AF DEFENSE AEROSOL POWDER 1 % Formulary Custom (*); OTC EXTERNAL 1 % LAMISIL AT CREAM 1 % EXTERNAL 1 % Formulary Custom (*); OTC LAMISIL AT EXTERNAL CREAM 1 % Formulary OTC 66 Drug Name Formulary Status Requirements/Limits LAMISIL AT EXTERNAL POWDER Formulary OTC LAMISIL AT SPRAY SOLUTION 1 % EXTERNAL 1 % Formulary Custom (*); OTC LAMISIL SPRAY EXTERNAL SOLUTION 1 % Formulary LAMISILK PROTECT EXTERNAL LIQUID Formulary OTC LANACANE ANTI-BACTERIAL EXTERNAL Formulary OTC AEROSOL 20-0.2 % LANACANE MAXIMUM STRENGTH EXTERNAL Formulary OTC CREAM 20-0.2 % LAND BEFORE TIME MULTIVITAMIN TABLET CHEWABLE W/EXTRA C & FA ORAL W/EXTRA C & Formulary Custom (*); OTC FA lanolin anhydrous external ointment Formulary lanolin external ointment Formulary OTC lanolin hydrous-grx external ointment 72 % Formulary OTC lansoprazole capsule delayed release 15 mg oral (otc) 15 Formulary Custom (*) mg LANTISEPTIC ALL BODY WASH EXTERNAL LIQUID Formulary OTC l-arginine hcl powder Formulary l-arginine oral capsule 500 mg Formulary OTC l-arginine oral tablet 1000 mg, 500 mg Formulary OTC l-arginine powder Formulary l-aspartic acid powder Formulary lavender oil oil Formulary laxative oral tablet 25 mg Formulary OTC laxative pills oral tablet 15 mg Formulary OTC laxative suppository 10 mg rectal 10 mg Formulary Custom (*); OTC laxative tablet delayed release 5 mg oral 5 mg Formulary Custom (*); OTC l-carnitine hcl powder Formulary OTC l-carnitine oral capsule 250 mg, 500 mg Formulary OTC l-carnitine oral tablet 250 mg, 500 mg Formulary OTC l-carnitine powder Formulary l-citrulline oral capsule 600 mg Formulary OTC l-citrulline powder Formulary l-cysteine hcl powder Formulary l-cysteine powder Formulary l-cystine powder Formulary lecithin granules Formulary lecithin-kelp-b6-cider vinegar oral capsule 200-0.075-5-50 Formulary OTC mg lemon bioflavanoid powder Formulary OTC lemon oil oil Formulary OTC lemon-glycerin mouth/throat swab Formulary OTC LENZAGEL EXTERNAL GEL 4-1 % Formulary OTC LENZAPATCH EXTERNAL PATCH 4-1 % Formulary leucine oral packet 100 mg Formulary OTC

67 Drug Name Formulary Status Requirements/Limits levatio external patch 0.03-5 % Formulary levocarnitine (dietary) oral tablet 330 mg Formulary OTC levocarnitine-b5-taurine oral liquid 1000-10-150 mg/15ml Formulary OTC levocetirizine dihydrochloride tablet 5 mg oral (otc) 5 mg Formulary levonorgestrel tablet 1.5 mg oral (otc) 1.5 mg Formulary Custom (*); OTC; QL (2 EA per 30 days) l-glutamic acid powder Formulary l-glutamine oral capsule 500 mg Formulary OTC l-glutamine oral tablet 500 mg Formulary OTC l-glutathione crystals Formulary OTC l-histidine powder Formulary 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 killing maximum strength shampoo 0.33-4 % external Formulary Custom (*); OTC 0.33-4 % lice solution kit 0.33-4-0.5 % combination 0.33-4-0.5 % Formulary Custom (*); OTC lice treatment liquid 0.33-4 % external 0.33-4 % Formulary Custom (*); OTC LICEFREEE EXTERNAL SOLUTION Formulary OTC LICEMD COMPLETE EXTERNAL KIT 0.33-4 % Formulary OTC LICIDE TREATMENT COMBINATION KIT Formulary OTC lidocaine (anorectal) cream 5 % external 5 % Formulary Custom (*); OTC lidocaine external cream 5 % Formulary OTC; QL (60 GM per 30 days) LIDOCREAM EXTERNAL KIT 4 % Formulary OTC lidomd external ointment 4-0.0375-10-20 % Formulary OTC LIDOPATCH PAIN RELIEF EXTERNAL PATCH 3.99- Formulary OTC 1.25 % LIDOPRO TRANSDERMAL PATCH 4-4-5 % Formulary OTC LILETTA (52 MG) INTRAUTERINE INTRAUTERINE Formulary DEVICE 19.5 MCG/DAY lime oil oil Formulary limencin external patch 4-4 % Formulary OTC LINI MIST ANALGESIC EXTERNAL AEROSOL Formulary OTC SOLUTION base natural ointment Formulary OTC lip balm external stick Formulary OTC lip balm medicated external ointment Formulary OTC LIP MEDEX EXTERNAL OINTMENT Formulary OTC lipochol nr oral capsule Formulary OTC lipochol plus oral tablet Formulary OTC LIPO-GEL ORAL CAPSULE 100-30 MG-UNIT Formulary OTC lipoic acid oral capsule 150 mg Formulary OTC LIPOIL OIL Formulary OTC LIPOTRIAD ORAL TABLET Formulary OTC LIPOTRIAD VISIONARY ORAL CAPSULE Formulary OTC 68 Drug Name Formulary Status Requirements/Limits lipovan base external cream Formulary OTC LIQ-10 ORAL SYRUP 100-1 MG-UNT/5ML, 50-15 Formulary OTC LIQSORB ORAL LIQUID 500 MG/5ML Formulary OTC LIQUACEL ORAL LIQUID Formulary OTC LIQUIMAT EXTERNAL LOTION 5 % Formulary OTC liquitears solution 1.4 % ophthalmic 1.4 % Formulary Custom (*); OTC l-isoleucine powder Formulary LISTERINE NATURALS ANTISEPTIC Formulary OTC MOUTH/THROAT LIQUID LITTLE COLDS COUGH FORMULA ORAL LIQUID 7.5 Formulary OTC MG/ML LITTLE COLDS DECONGESTANT ORAL LIQUID 2.5 Formulary OTC MG/ML LITTLE NOSES MOISTURIZING GEL NASAL Formulary Custom (*); OTC LITTLE REMEDIES POISON TREAT ORAL Formulary OTC SUSPENSION RECONSTITUTED 15 GM/120ML LITTLE TUMMYS LAXATIVE ORAL LIQUID 8.8 Formulary OTC MG/ML liver extract oral tablet 455 mg Formulary OTC liver oral capsule 500 mg Formulary OTC l-lysine hcl oral capsule 500 mg Formulary OTC l-lysine hcl oral tablet 1000 mg Formulary OTC l-lysine hcl powder Formulary l-lysine oral capsule 500 mg Formulary OTC l-lysine oral tablet 1000 mg, 500 mg Formulary OTC l-methionine powder Formulary LMX 4 EXTERNAL CREAM 4 % Formulary OTC LMX 4 PLUS EXTERNAL KIT 4 % Formulary OTC LMX 5 EXTERNAL CREAM 5 % Formulary OTC LODRANE D CAPSULE 4-60 MG ORAL 4-60 MG Formulary Custom (*); OTC LODRANE D ORAL CAPSULE 4-60 MG Formulary OTC LOHIST-D LIQUID 2-30 MG/5ML ORAL 2-30 MG/5ML Formulary Custom (*); OTC LOHIST-D ORAL LIQUID 2-30 MG/5ML Formulary OTC lohist-dm syrup 5-2-10 mg/5ml oral 5-2-10 mg/5ml Formulary Custom (*); OTC loperamide hcl liquid 1 mg/5ml oral 1 mg/5ml Formulary Custom (*); OTC loperamide hcl suspension 1 mg/7.5ml oral 1 mg/7.5ml Formulary Custom (*); OTC loratadine childrens solution 5 mg/5ml oral 5 mg/5ml Formulary Custom (*); OTC loratadine childrens syrup 5 mg/5ml oral 5 mg/5ml Formulary Custom (*); OTC loratadine hives relief solution 5 mg/5ml oral 5 mg/5ml Formulary Custom (*); OTC loratadine oral capsule 10 mg Formulary OTC loratadine tablet 10 mg oral 10 mg Formulary Custom (*); OTC loratadine-d 12hr tablet extended release 12 hour 5-120 mg Formulary Custom (*); OTC oral 5-120 mg loratadine-d 24hr tablet extended release 24 hour 10-240 Formulary Custom (*); OTC mg oral 10-240 mg l-ornithine hydrochloride powder Formulary 69 Drug Name Formulary Status Requirements/Limits l-ornithine powder Formulary OTC LORTUSS DM LIQUID 30-6.25-15 MG/5ML ORAL 30- Formulary Custom (*); OTC 6.25-15 MG/5ML LORTUSS DM ORAL LIQUID 30-6.25-15 MG/5ML Formulary OTC LORTUSS EX LIQUID 30-10-100 MG/5ML ORAL 30-10- Formulary Custom (*); OTC 100 MG/5ML LORTUSS EX ORAL LIQUID 30-10-100 MG/5ML Formulary OTC LORTUSS LQ LIQUID 6.25-30 MG/5ML ORAL 6.25-30 Formulary Custom (*); OTC MG/5ML LORTUSS LQ ORAL LIQUID 6.25-30 MG/5ML Formulary OTC LOTRIMIN AF AEROSOL 2 % EXTERNAL 2 % Formulary Custom (*); OTC LOTRIMIN AF EXTERNAL CREAM 1 % Formulary OTC LOTRIMIN AF POWDER 2 % EXTERNAL 2 % Formulary Custom (*); OTC LOTRIMIN ULTRA CREAM 1 % EXTERNAL 1 % Formulary Custom (*); OTC LOZIBASE S Formulary l-phenylalanine oral tablet 500 mg Formulary OTC l-phenylalanine powder Formulary l-proline powder Formulary l-serine powder Formulary l-tyrosine oral capsule 500 mg Formulary OTC l-tyrosine oral tablet 500 mg Formulary OTC l-tyrosine powder Formulary lubricant drops/dual-action ophthalmic solution 0.5-0.9 % Formulary OTC lubricant eye drops (pf) ophthalmic solution 0.4-0.3 % Formulary OTC lubricant eye drops ophthalmic solution 0.4-0.3 % Formulary OTC lubricant eye drops solution 0.4-0.3 % ophthalmic 0.4-0.3 Formulary Custom (*); OTC % lubricating plus eye drops solution 0.5 % ophthalmic 0.5 % Formulary Custom (*); OTC LUBRISKIN EXTERNAL LOTION Formulary OTC 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 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 lysine acetate oral tablet 500 mg Formulary OTC lysine4000 oral packet 4000 mg Formulary OTC LYSINYL POWDER Formulary OTC M.V.I. ADULT INJECTABLE INTRAVENOUS Formulary Custom (*) M.V.I. PEDIATRIC SOLUTION RECONSTITUTED Formulary Custom (*) INTRAVENOUS M.V.I.-12 (WITHOUT VITAMIN K) INJECTABLE Formulary Custom (*) INTRAVENOUS

70 Drug Name Formulary Status Requirements/Limits M2 C ORAL CAPSULE EXTENDED RELEASE 500 MG Formulary OTC MAALOX ADVANCED MAX ST SUSPENSION 400- Formulary Custom (*); OTC 400-40 MG/5ML ORAL 400-400-40 MG/5ML MAALOX ADVANCED MAX ST TABLET CHEWABLE Formulary Custom (*); OTC 1000-60 MG ORAL 1000-60 MG MAALOX ADVANCED SUSPENSION 200-200-20 Formulary Custom (*); OTC MG/5ML ORAL 200-200-20 MG/5ML MAALOX JUNIOR PLUS ANTIGAS ORAL TABLET Formulary OTC CHEWABLE 400-24 MG MAALOX MAX ORAL TABLET CHEWABLE 1000-60 Formulary OTC MG MAALOX ORAL TABLET CHEWABLE 600 MG Formulary OTC mafenide hcl powder Formulary OTC MAG-200 ORAL TABLET 200 MG Formulary OTC mag-al liquid 200-200 mg/5ml oral 200-200 mg/5ml Formulary Custom (*); OTC mag-al oral liquid 200-200 mg/5ml Formulary OTC mag-al plus liquid 200-200-20 mg/5ml oral 200-200-20 Formulary Custom (*); OTC mg/5ml mag-al plus xs liquid 400-400-40 mg/5ml oral 400-400-40 Formulary Custom (*); OTC mg/5ml magdelay oral tablet delayed release 70 mg Formulary OTC mag-g tablet 500 (27 mg) mg oral 500 (27 mg) mg Formulary Custom (*); OTC MAGIMIN ORAL TABLET 80 MG Formulary OTC magnacaps oral capsule 100 mg Formulary OTC MAGNEBIND 200 ORAL TABLET 450-200 MG Formulary OTC MAGNEBIND 300 ORAL TABLET 250-300 MG Formulary OTC magnesium aspartate oral tablet 65 mg Formulary OTC magnesium carbonate granules Formulary OTC magnesium carbonate heavy powder Formulary magnesium carbonate oral powder 250 mg/gm Formulary OTC magnesium chloride powder Formulary magnesium chloride-calcium oral tablet 64-112 mg Formulary OTC magnesium citrate powder Formulary magnesium citrate solution 1.745 gm/30ml oral 1.745 Formulary Custom (*); OTC gm/30ml 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, 500 mg Formulary OTC magnesium oral tablet 250 mg, 30 mg Formulary OTC magnesium oxide -mg supplement oral capsule 400 mg Formulary OTC magnesium oxide oral powder Formulary OTC magnesium oxide oral tablet 400 (240 mg) mg, 500 mg Formulary OTC magnesium oxide powder Formulary magnesium oxide tablet 400 (241.3 mg) mg oral 400 (241.3 Formulary Custom (*); OTC mg) mg

71 Drug Name Formulary Status Requirements/Limits magnesium oxide tablet 400 mg oral 400 mg Formulary Custom (*); OTC magnesium oxide tablet 420 mg oral 420 mg Formulary Custom (*); OTC magnesium stearate powder Formulary magnesium sulfate oral capsule 70 mg Formulary OTC magnesium sulfate powder Formulary MAGONATE ORAL LIQUID 1000 (54 MG) MG/5ML 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-sr plus calcium tablet delayed release 64-106 mg oral Formulary Custom (*); OTC 64-106 mg MAG-TAB SR ORAL TABLET EXTENDED RELEASE Formulary OTC 84 MG (7MEQ) MAJOR-PREP HEMORRHOIDAL OINTMENT 0.25-14- Formulary Custom (*); OTC 74.9 % RECTAL 0.25-14-74.9 % malic acid powder Formulary manganese aspartate oral tablet 93 mg Formulary OTC manganese chloride solution 0.1 mg/ml intravenous 0.1 Formulary Custom (*) mg/ml manganese gluconate oral tablet 50 mg Formulary OTC manganese oral tablet 15 mg Formulary OTC MANGIMIN ORAL TABLET 10 MG Formulary OTC mannitol powder Formulary MAOX ORAL TABLET 420 MG Formulary OTC MAPAP ACETAMINOPHEN EXTRA STR LIQUID 500 Formulary Custom (*); OTC MG/15ML ORAL 500 MG/15ML mapap arthritis pain tablet extended release 650 mg oral Formulary Custom (*); OTC 650 mg mapap capsule 500 mg oral 500 mg Formulary Custom (*); OTC MAPAP CHILDRENS SUSPENSION 160 MG/5ML Formulary Custom (*); OTC ORAL 160 MG/5ML MAPAP CHILDRENS TABLET CHEWABLE 80 MG Formulary Custom (*); OTC ORAL 80 MG MAPAP COLD FORMULA MULTI-SYMPT TABLET Formulary Custom (*); OTC 10-5-325 MG ORAL 10-5-325 MG MAPAP EXTRA STRENGTH TABLET 500 MG ORAL Formulary Custom (*); OTC 500 MG MAPAP HEADACHE PLUS ORAL TABLET 500-250 Formulary OTC MG mapap liquid 160 mg/5ml oral 160 mg/5ml Formulary Custom (*); OTC mapap pm tablet 500-25 mg oral 500-25 mg Formulary Custom (*); OTC MAPAP SINUS MAXIMUM STRENGTH TABLET 5-325 Formulary Custom (*); OTC MG ORAL 5-325 MG mapap tablet 325 mg oral 325 mg Formulary Custom (*); OTC mapap tablet 500 mg oral 500 mg Formulary Custom (*); OTC mapap tablet chewable 80 mg oral 80 mg Formulary Custom (*); OTC MAR-COF BP LIQUID 30-2-7.5 MG/5ML ORAL 30-2-7.5 Formulary Custom (*); OTC MG/5ML

72 Drug Name Formulary Status Requirements/Limits MAR-COF BP ORAL LIQUID 30-2-7.5 MG/5ML Formulary OTC MAR-COF CG EXPECTORANT LIQUID 225-7.5 Formulary Custom (*); OTC MG/5ML ORAL 225-7.5 MG/5ML MAR-COF CG EXPECTORANT ORAL LIQUID 225-7.5 Formulary OTC MG/5ML MASTISOL ADHESIVE EXTERNAL LIQUID Formulary OTC MAXIMUM D3 CAPSULE 325 MCG (13000 UT) ORAL Formulary Custom (*); OTC 325 MCG (13000 UT) MAXIMUM D3 ORAL CAPSULE 10000 UNIT Formulary OTC MAXIPHEN DM TABLET 10-20-400 MG ORAL 10-20- Formulary Custom (*); OTC 400 MG MAXIPHEN TABLET 10-400 MG ORAL 10-400 MG Formulary Custom (*); OTC m-clear wc solution 100-6.3 mg/5ml oral 100-6.3 mg/5ml Formulary Custom (*); OTC ME-500 ORAL CAPSULE 500 MG Formulary OTC meclizine hcl tablet 12.5 mg oral (otc) 12.5 mg Formulary Custom (*) meclizine hcl tablet chewable 25 mg oral (otc) 25 mg Formulary Custom (*) MEDADYNE ORAL PAIN RELIEF MOUTH/THROAT Formulary OTC LIQUID 10-0.13-70 % MEDERMA AG FACIAL CLEANSER EXTERNAL Formulary OTC LIQUID MEDERMA AG HAND & BODY EXTERNAL LOTION Formulary OTC MEDERMA EXTERNAL GEL Formulary OTC medi pads pad 50-10 % external 50-10 % Formulary Custom (*); OTC medicated body external powder Formulary OTC medicated body powder external Formulary Custom (*); OTC medicated cleansing pad 50 % external 50 % Formulary Custom (*); OTC medicated vaginal solution 0.3 % Formulary OTC medicated pain relieving external patch 1.2-5.7-6.3 % Formulary OTC medicated wipes external pad 50 % Formulary OTC medicated wipes pad 50 % external 50 % Formulary Custom (*); OTC MEDICONE RECTAL SUPPOSITORY 0.25 % Formulary OTC MEDI-DERM EXTERNAL CREAM 0.035-5-20 % Formulary OTC MEDI-DERM/L EXTERNAL CREAM 2-0.035-5-20 % Formulary OTC MEDI-FIRST ANTISEPTIC CLEANER EXTERNAL GEL Formulary OTC 66.5 % MEDI-FIRST/LIDOCAINE EXTERNAL CREAM 0.5- Formulary OTC 0.13 % MEDI-GRAINE TABLET 500-75-5 MG ORAL 500-75-5 Formulary Custom (*); OTC MG 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 73 Drug Name Formulary Status Requirements/Limits MEDIPLAST PAD 40 % EXTERNAL 40 % Formulary Custom (*); OTC MEDIPORE + PAD ADHESIVE DRESS PAD 2"X2-3/4" , Formulary OTC 3-1/2"X10" , 3-1/2"X13-3/4" medi-soothe external lotion 5-0.15 % Formulary OTC medi-tussin dm double strength oral liquid 30-200 mg/5ml Formulary OTC medi-tussin max strength oral syrup 30-15 mg/5ml Formulary OTC MEDROX EXTERNAL OINTMENT 0.0375-5-20 % Formulary OTC MEDROX EXTERNAL PATCH 0.0375-5-20 % Formulary OTC MEGA MULTIVITAMIN ORAL POWDER Formulary OTC mega stress 600/60 oral tablet Formulary OTC melatonin er oral tablet extended release 3 mg Formulary OTC melatonin oral capsule 1 mg, 10 mg, 2.5 mg, 3 mg, 5 mg Formulary OTC melatonin oral tablet 1 mg, 10 mg, 3 mg, 5 mg Formulary OTC melatonin powder Formulary melatonin sublingual tablet sublingual 10 mg, 5 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 mencaps external patch 0.0225-4.5 % Formulary OTC m-end dmx liquid 20-0.667-10 mg/5ml oral 20-0.667-10 Formulary Custom (*); OTC mg/5ml m-end dmx oral liquid 20-0.667-10 mg/5ml Formulary OTC m-end max d liquid 20-0.667-6 mg/5ml oral 20-0.667-6 Formulary Custom (*); OTC mg/5ml M-END PE LIQUID 3.33-1.33-6.33 MG/5ML ORAL 3.33- Formulary Custom (*); OTC 1.33-6.33 MG/5ML M-END PE ORAL LIQUID 3.33-1.33-6.33 MG/5ML Formulary OTC m-end wc liquid 10-1.33-6.33 mg/5ml oral 10-1.33-6.33 Formulary Custom (*); OTC mg/5ml m-end wc oral liquid 10-1.33-6.33 mg/5ml Formulary OTC menstrual pain relief oral tablet 500-25-15 mg Formulary OTC menstrual pms tablet 500-25-15 mg oral 500-25-15 mg Formulary Custom (*); OTC menstrual relief max strength oral tablet 500-60-15 mg Formulary OTC MENTAX EXTERNAL CREAM 1 % Formulary menthol crystals Formulary mentholix external liquid 4-1 % Formulary MEPHYTON TABLET 5 MG ORAL 5 MG Formulary Custom (*) METAMUCIL MULTIHEALTH FIBER ORAL POWDER Formulary OTC 63 % METAMUCIL MULTIHEALTH FIBER PACKET 58.12 Formulary Custom (*); OTC % ORAL 58.12 % METAMUCIL ORAL CAPSULE 0.52 GM Formulary OTC METAMUCIL ORAL POWDER 30.9 %, 48.57 % Formulary OTC METAMUCIL SMOOTH TEXTURE ORAL PACKET 28 Formulary OTC % methagual external ointment 2-8 % Formulary OTC 74 Drug Name Formulary Status Requirements/Limits methionine oral packet 100 mg Formulary OTC methionine oral tablet 500 mg Formulary OTC methyl alcohol solution Formulary OTC methyl salicylate external liquid Formulary methyl salicylate external oil Formulary OTC methyl sulfone crystals Formulary methylcellulose gel 1 % Formulary methylcellulose gel 2 %, 3 % Formulary OTC methylcellulose powder Formulary methylcobalamin powder Formulary methylparaben powder Formulary MEXSANA EXTERNAL POWDER 10.8 % Formulary OTC MG/TAURINE FORTE ORAL CAPSULE Formulary OTC m-hist pd oral liquid 0.625 mg/ml Formulary OTC mi-acid gas relief tablet chewable 80 mg oral 80 mg Formulary Custom (*); OTC mi-acid maximum strength suspension 400-400-40 mg/5ml Formulary Custom (*); OTC oral 400-400-40 mg/5ml MI-ACID SUSPENSION 200-200-20 MG/5ML ORAL Formulary Custom (*); OTC 200-200-20 MG/5ML MI-ACID TABLET CHEWABLE 700-300 MG ORAL Formulary Custom (*); OTC 700-300 MG MICATIN EXTERNAL CREAM 2 % Formulary OTC miconazole 3 combo-supp kit 200 & 2 mg-% (9gm) vaginal Formulary Custom (*); OTC 200 & 2 mg-% (9gm) miconazole 3 vaginal cream 4 % Formulary OTC miconazole 7 cream 2 % vaginal 2 % Formulary Custom (*); OTC miconazole nitrate aerosol powder 2 % external 2 % Formulary Custom (*); OTC miconazole nitrate cream 2 % external (otc) 2 % Formulary Custom (*) miconazole nitrate cream 2 % vaginal 2 % Formulary Custom (*); OTC miconazole nitrate suppository 100 mg vaginal 100 mg Formulary Custom (*); OTC miconazorb af powder 2 % external 2 % Formulary Custom (*); OTC MICRO GUARD POWDER 2 % EXTERNAL 2 % Formulary Custom (*); OTC microfiber cleaning cloths Formulary OTC MICRONEFRIN INHALATION NEBULIZATION Formulary OTC SOLUTION 2.25 % MIDOL CAFFEINE FREE ORAL TABLET 500-25 MG Formulary OTC MIDOL COMPLETE ORAL TABLET 500-60-15 MG Formulary OTC migraine formula tablet 250-250-65 mg oral 250-250-65 Formulary Custom (*); OTC mg MIL-A-MULSION ORAL EMULSION 10-15000 Formulary OTC UNIT/DROP milantex extra strength suspension 400-400-40 mg/5ml oral Formulary Custom (*); OTC 400-400-40 mg/5ml milantex suspension 200-200-20 mg/5ml oral 200-200-20 Formulary Custom (*); OTC mg/5ml MILCO-ZYME ORAL TABLET Formulary OTC

75 Drug Name Formulary Status Requirements/Limits milk of magnesia concentrate oral suspension 2400 Formulary OTC mg/10ml milk of magnesia concentrate suspension 2400 mg/10ml Formulary Custom (*); OTC oral 2400 mg/10ml milk of magnesia suspension 1200 mg/15ml oral 1200 Formulary Custom (*); OTC mg/15ml milk of magnesia suspension 400 mg/5ml oral 400 mg/5ml Formulary Custom (*); OTC milk of magnesia suspension 7.75 % oral 7.75 % Formulary Custom (*); OTC MILLGUARD ORAL TABLET 800-10-115 MCG-MG- Formulary OTC MCG MILTAB #1 ORAL TABLET Formulary OTC MINERAL ICE GEL 2 % EXTERNAL 2 % Formulary Custom (*); OTC mineral oil light external oil 100 % Formulary OTC mineral oil-hydrophil petrolat external ointment Formulary OTC MINIMED GUARDIAN LINK 3 Formulary MINIPRIN LOW DOSE TABLET DELAYED RELEASE Formulary Custom (*); OTC 81 MG ORAL 81 MG minoxidil for men external solution 5 % Formulary OTC minoxidil for men solution 2 % external 2 % Formulary Custom (*); OTC minoxidil for men solution 5 % external 5 % Formulary Custom (*); OTC minoxidil for women external solution 2 % Formulary OTC mintox maximum strength suspension 400-400-40 mg/5ml Formulary Custom (*); OTC oral 400-400-40 mg/5ml MINTOX PLUS TABLET CHEWABLE 200-200-25 MG Formulary Custom (*); OTC ORAL 200-200-25 MG MINTOX SUSPENSION 200-200-20 MG/5ML ORAL Formulary Custom (*); OTC 200-200-20 MG/5ML MIRAFIBER ORAL TABLET 500 MG Formulary OTC MIRALAX ORAL PACKET 17 GM Formulary OTC MIRALAX ORAL POWDER 17 GM/SCOOP Formulary OTC MIRALAX PACKET 17 GM ORAL 17 GM Formulary Custom (*); OTC MIRALAX POWDER 17 GM/SCOOP ORAL (OTC) 17 Formulary Custom (*); OTC GM/SCOOP MIRENA (52 MG) INTRAUTERINE INTRAUTERINE Formulary DEVICE 20 MCG/24HR mn-50 oral capsule 16.67 mg Formulary OTC moisture barrier external ointment 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 MONOCAL ORAL TABLET 625-22.75 MG Formulary OTC MONOCAL TABLET 625-22.75 MG ORAL 625-22.75 Formulary Custom (*); OTC MG MONOJECT MONODOSE ORAL MED SYR Formulary MONOJECT SYRINGE 18G X 1" 12 ML Formulary MOTRIN IB TABLET 200 MG ORAL 200 MG Formulary Custom (*); OTC 76 Drug Name Formulary Status Requirements/Limits MOTRIN INFANTS DROPS ORAL SUSPENSION 50 Formulary OTC MG/1.25ML mouth rinse mouth/throat liquid 0.07 % Formulary OTC mucaphed tablet 10-400 mg oral 10-400 mg Formulary Custom (*); OTC MUCINEX ALLERGY TABLET 180 MG ORAL 180 MG Formulary Custom (*); OTC MUCINEX CHEST CONGESTION CHILD LIQUID 100 Formulary Custom (*); OTC MG/5ML ORAL 100 MG/5ML MUCINEX CHILD MS DAY-NIGHT CLD ORAL Formulary Custom (*); OTC MUCINEX CHILD MULTI-SYMPTOM LIQUID 5-10- Formulary Custom (*); OTC 200-325 MG/10ML ORAL 5-10-200-325 MG/10ML MUCINEX COLD CGH THROAT CHILD LIQUID 5-10- Formulary Custom (*); OTC 200-325 MG/10ML ORAL 5-10-200-325 MG/10ML MUCINEX COLD CHILDRENS LIQUID 2.5-5-100 Formulary Custom (*); OTC MG/5ML ORAL 2.5-5-100 MG/5ML MUCINEX CONGEST & COUGH CHILD LIQUID 2.5-5- Formulary Custom (*); OTC 100 MG/5ML ORAL 2.5-5-100 MG/5ML MUCINEX COUGH CHILDRENS LIQUID 5-100 Formulary Custom (*); OTC MG/5ML ORAL 5-100 MG/5ML MUCINEX COUGH CHILDRENS ORAL LIQUID 5-100 Formulary OTC MG/5ML MUCINEX COUGH FOR KIDS ORAL PACKET 5-100 Formulary OTC MG MUCINEX COUGH FOR KIDS PACKET 5-100 MG Formulary Custom (*); OTC ORAL 5-100 MG MUCINEX D MAX STRENGTH ORAL TABLET Formulary OTC EXTENDED RELEASE 12 HOUR 120-1200 MG MUCINEX D MAX STRENGTH TABLET EXTENDED Formulary Custom (*); OTC RELEASE 12 HOUR 120-1200 MG ORAL 120-1200 MG MUCINEX D ORAL TABLET EXTENDED RELEASE 12 Formulary OTC HOUR 60-600 MG MUCINEX D TABLET EXTENDED RELEASE 12 Formulary Custom (*); OTC HOUR 60-600 MG ORAL (OTC) 60-600 MG MUCINEX DM MAXIMUM STRENGTH ORAL Formulary OTC TABLET EXTENDED RELEASE 12 HOUR 60-1200 MG MUCINEX DM MAXIMUM STRENGTH TABLET EXTENDED RELEASE 12 HOUR 60-1200 MG ORAL Formulary Custom (*); OTC 60-1200 MG MUCINEX DM ORAL TABLET EXTENDED RELEASE Formulary OTC 12 HOUR 30-600 MG MUCINEX DM TABLET EXTENDED RELEASE 12 Formulary Custom (*); OTC HOUR 30-600 MG ORAL (OTC) 30-600 MG MUCINEX FAST-MAX CAPSULE 5-10-200-325 MG Formulary Custom (*); OTC ORAL 5-10-200-325 MG MUCINEX FAST-MAX COLD & SINUS CAPSULE 10- Formulary Custom (*); OTC 5-325 MG ORAL 10-5-325 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

77 Drug Name Formulary Status Requirements/Limits MUCINEX FAST-MAX COLD & SINUS TABLET 5-325- Formulary Custom (*); OTC 200 MG ORAL 5-325-200 MG MUCINEX FAST-MAX COLD FLU LIQUID 5-10-200- Formulary Custom (*); OTC 325 MG/10ML ORAL 5-10-200-325 MG/10ML MUCINEX FAST-MAX COLD FLU NGHT CAPSULE 5- Formulary Custom (*); OTC 6.25-10-325 MG ORAL 5-6.25-10-325 MG MUCINEX FAST-MAX COLD FLU NGHT LIQUID 12.5- Formulary Custom (*); OTC 5-325 MG/10ML ORAL 12.5-5-325 MG/10ML MUCINEX FAST-MAX COLD FLU NGHT TABLET 25- Formulary Custom (*); OTC 5-325 MG ORAL 25-5-325 MG MUCINEX FAST-MAX COLD FLU ORAL LIQUID 5- Formulary OTC 10-200-325 MG/10ML MUCINEX FAST-MAX COLD FLU TABLET 5-10-200- Formulary Custom (*); OTC 325 MG ORAL 5-10-200-325 MG MUCINEX FAST-MAX CONGEST COUGH LIQUID 10- Formulary Custom (*); OTC 20-400 MG/20ML ORAL 10-20-400 MG/20ML MUCINEX FAST-MAX CONGEST COUGH ORAL Formulary OTC LIQUID 10-20-400 MG/20ML MUCINEX FAST-MAX CONGEST COUGH ORAL Formulary OTC TABLET 5-10-200 MG MUCINEX FAST-MAX CONGEST COUGH TABLET 5- Formulary Custom (*); OTC 10-200 MG ORAL 5-10-200 MG MUCINEX FAST-MAX DAY/NIGHT (TABLET) ORAL Formulary Custom (*); OTC (TABLET) MUCINEX FAST-MAX DAY/NIGHT CAPSULE Formulary Custom (*); OTC THERAPY PACK ORAL MUCINEX FAST-MAX DAY/NIGHT ORAL Formulary Custom (*); OTC MUCINEX FAST-MAX DAY/NIGHT ORAL , Formulary OTC (TABLET) MUCINEX FAST-MAX DAY/NIGHT ORAL CAPSULE Formulary OTC THERAPY PACK MUCINEX FAST-MAX DAY/NIGHT TAB ORAL Formulary OTC MUCINEX FAST-MAX DAY/NIGHT TAB TABLET Formulary Custom (*); OTC THERAPY PACK ORAL MUCINEX FAST-MAX DAY/NIGHTTIME ORAL Formulary Custom (*); OTC MUCINEX FAST-MAX DM MAX LIQUID 20-400 Formulary Custom (*); OTC MG/20ML ORAL 20-400 MG/20ML MUCINEX FAST-MAX ORAL CAPSULE 5-10-200-325 Formulary OTC MG MUCINEX FAST-MAX SEVERE COLD LIQUID 5-10- Formulary Custom (*); OTC 200-325 MG/10ML ORAL 5-10-200-325 MG/10ML MUCINEX FAST-MAX SEVERE COLD TABLET 5-10- Formulary Custom (*); OTC 200-325 MG ORAL 5-10-200-325 MG MUCINEX FOR KIDS ORAL PACKET 100 MG Formulary OTC MUCINEX FOR KIDS PACKET 100 MG ORAL 100 MG Formulary Custom (*); OTC MUCINEX MAXIMUM STRENGTH ORAL TABLET Formulary OTC EXTENDED RELEASE 12 HOUR 1200 MG MUCINEX MAXIMUM STRENGTH TABLET EXTENDED RELEASE 12 HOUR 1200 MG ORAL 1200 Formulary Custom (*); OTC MG

78 Drug Name Formulary Status Requirements/Limits MUCINEX MS COLD NIGHT CHILDREN LIQUID 12.5- Formulary Custom (*); OTC 5-325 MG/10ML ORAL 12.5-5-325 MG/10ML MUCINEX SINUS-MAX CAPSULE 5-10-200-325 MG Formulary Custom (*); OTC ORAL 5-10-200-325 MG MUCINEX SINUS-MAX CONGESTION ORAL TABLET Formulary OTC 5-325-200 MG MUCINEX SINUS-MAX CONGESTION TABLET 5-325- Formulary Custom (*); OTC 200 MG ORAL 5-325-200 MG MUCINEX SINUS-MAX DAY/NIGHT CAPSULE Formulary Custom (*); OTC THERAPY PACK ORAL 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 TABLET THERAPY PACK 5-200-325 & 5-25-325MG ORAL 5- Formulary Custom (*); OTC 200-325 & 5-25-325MG MUCINEX SINUS-MAX FULL FORCE SOLUTION 0.05 Formulary Custom (*); OTC % NASAL 0.05 % MUCINEX SINUS-MAX LIQUID 10-650-400 MG/20ML Formulary Custom (*); OTC ORAL 10-650-400 MG/20ML MUCINEX SINUS-MAX NIGHT TIME LIQUID 12.5-5- Formulary Custom (*); OTC 325 MG/10ML ORAL 12.5-5-325 MG/10ML MUCINEX SINUS-MAX PRESS & PAIN ORAL Formulary OTC TABLET 5-325-200 MG MUCINEX SINUS-MAX PRESS & PAIN TABLET 5- Formulary Custom (*); OTC 325-200 MG ORAL 5-325-200 MG MUCINEX STUFFY NOSE/COLD CHILD LIQUID 2.5- Formulary Custom (*); OTC 100 MG/5ML ORAL 2.5-100 MG/5ML MUCINEX STUFFY NOSE/COLD CHILD ORAL Formulary OTC LIQUID 2.5-100 MG/5ML MUCINEX TABLET EXTENDED RELEASE 12 HOUR Formulary Custom (*); OTC 600 MG ORAL 600 MG mucosa dm tablet 20-400 mg oral 20-400 mg Formulary Custom (*); OTC mucosa tablet 400 mg oral 400 mg Formulary Custom (*); OTC mucus d oral tablet extended release 12 hour 120-1200 mg Formulary OTC mucus relief childrens liquid 100 mg/5ml oral 100 mg/5ml Formulary Custom (*); OTC mucus relief cold/sinus max st oral liquid 10-650-400 Formulary OTC mg/20ml mucus relief cough childrens liquid 5-100 mg/5ml oral 5- Formulary Custom (*); OTC 100 mg/5ml mucus relief d oral tablet extended release 12 hour 60-600 Formulary OTC mg mucus relief dm tablet 20-400 mg oral 20-400 mg Formulary Custom (*); OTC 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 tablet 400 mg oral 400 mg Formulary Custom (*); OTC mucus-dm oral tablet extended release 12 hour 30-600 mg Formulary OTC mucus-er tablet extended release 12 hour 600 mg oral 600 Formulary Custom (*); OTC mg 79 Drug Name Formulary Status Requirements/Limits mucusrelief sinus tablet 10-400 mg oral 10-400 mg Formulary Custom (*); OTC multi-delyn/iron oral liquid Formulary OTC multi-minerals oral tablet Formulary OTC multisource calcium mag/d tablet oral Formulary Custom (*); OTC multi-symptom allergy capsule 25 mg oral 25 mg Formulary Custom (*); OTC multi-symptom cold childrens suspension 2.5-1-5-160 Formulary Custom (*); OTC mg/5ml oral 2.5-1-5-160 mg/5ml multi-symptom cold plus child oral liquid 2.5-5-100 mg/5ml Formulary OTC multivitamin gummies childrens oral tablet chewable Formulary OTC multivitamins plus zinc oral capsule Formulary OTC multivitamins plus zinc oral solution Formulary OTC MURI-LUBE OIL Formulary MURO 128 OINTMENT 5 % OPHTHALMIC 5 % Formulary Custom (*); OTC MURO 128 OPHTHALMIC OINTMENT 5 % Formulary OTC MURO 128 OPHTHALMIC SOLUTION 2 %, 5 % Formulary OTC MURO 128 SOLUTION 2 % OPHTHALMIC 2 % Formulary Custom (*); OTC MURO 128 SOLUTION 5 % OPHTHALMIC 5 % Formulary Custom (*); OTC muscle rub ultra strength external cream 4-10-30 % Formulary OTC mustard oil oil Formulary OTC MY WAY TABLET 1.5 MG ORAL (OTC) 1.5 MG Formulary Custom (*); OTC; QL (2 EA per 30 days) MYCOCIDE CX CALLUS EXFOLIATOR EXTERNAL Formulary OTC CREAM 12-0.1 % MYKIDZ IRON ORAL SUSPENSION 10 MG/2ML Formulary OTC MYLANTA GAS RELIEF MAXIMUM STR ORAL Formulary OTC CAPSULE 125 MG MYLANTA ORAL SUSPENSION 200-200-20 MG/5ML Formulary OTC mytab gas maximum strength tablet chewable 125 mg oral Formulary Custom (*); OTC 125 mg mytab gas tablet chewable 80 mg oral 80 mg Formulary Custom (*); OTC mytussin dac oral solution 30-10-100 mg/5ml Formulary OTC nac oral capsule 600 mg Formulary OTC NAIL SCRUB EXTERNAL LIQUID Formulary OTC NAIL-EX ORAL TABLET 2.5 MG Formulary OTC NANOVM 1-3 YEARS POWDER ORAL Formulary Custom (*); OTC NANOVM 4-8 YEARS POWDER ORAL Formulary Custom (*); OTC NANOVM 9-18 YEARS POWDER ORAL Formulary Custom (*); OTC NANOVM T/F POWDER ORAL Formulary Custom (*); OTC NAPHCON-A OPHTHALMIC SOLUTION 0.025-0.3 % Formulary OTC NAPHCON-A SOLUTION 0.025-0.3 % OPHTHALMIC Formulary Custom (*); OTC 0.025-0.3 % naproxen sodium capsule 220 mg oral 220 mg Formulary Custom (*); OTC naproxen sodium tablet 220 mg oral 220 mg Formulary Custom (*); OTC NASAFLO NETI POT NASAL WASH PACKET NASAL Formulary Custom (*); OTC NASAFLO PORCELAIN NASAL RINSE PACKET Formulary Custom (*); OTC NASAL

80 Drug Name Formulary Status Requirements/Limits nasal allergy aerosol solution 5.2 mg/act nasal 5.2 mg/act Formulary Custom (*); OTC nasal decongestant liquid 30 mg/5ml oral 30 mg/5ml Formulary Custom (*); OTC nasal decongestant oral liquid 30 mg/5ml Formulary OTC nasal decongestant oral syrup 30 mg/5ml Formulary OTC nasal decongestant pe max st tablet 10 mg oral 10 mg Formulary Custom (*); OTC nasal decongestant pe tablet 10 mg oral 10 mg Formulary Custom (*); OTC nasal decongestant solution 1 % nasal 1 % Formulary Custom (*); OTC nasal decongestant spray solution 0.05 % nasal 0.05 % Formulary Custom (*); OTC nasal decongestant syrup 30 mg/5ml oral 30 mg/5ml Formulary Custom (*); OTC nasal decongestant tablet 30 mg oral 30 mg Formulary Custom (*); OTC NASAL EASE ALLERGY RELIEVER NASAL POWDER Formulary OTC nasal four solution 1 % nasal 1 % Formulary Custom (*); OTC nasal relief solution 0.05 % nasal 0.05 % Formulary Custom (*); OTC nasal spray 12 hour solution 0.05 % nasal 0.05 % Formulary Custom (*); OTC nasal spray extra moisturizing solution 0.05 % nasal 0.05 Formulary Custom (*); OTC % NASALCARE FOR KIDS PACKET NASAL Formulary Custom (*); OTC NASALCARE FOR KIDS STARTER KIT PACKET Formulary Custom (*); OTC NASAL NASALCARE NASALCLEANSE KIT PACKET NASAL Formulary Custom (*); OTC NASALCARE PACKET NASAL Formulary Custom (*); OTC NASALCROM AEROSOL SOLUTION 5.2 MG/ACT Formulary Custom (*); OTC NASAL 5.2 MG/ACT NASALCROM NASAL AEROSOL SOLUTION 5.2 Formulary OTC MG/ACT NASCOBAL SOLUTION 500 MCG/0.1ML NASAL 500 Formulary Custom (*) MCG/0.1ML NASOPEN PE LIQUID 50-10 MG/15ML ORAL 50-10 Formulary Custom (*); OTC MG/15ML NASOPEN PE ORAL LIQUID 50-10 MG/15ML Formulary OTC natapres liquid Formulary nat-rul antioxidants c+e oral capsule 500-400 mg-unit Formulary OTC natrul colon care oral powder 100 % Formulary OTC nat-rul daily-vite+iron oral tablet Formulary OTC nat-rul oyster calcium+vit d oral tablet 500-125 mg-unit Formulary OTC natrul-cal tablet oral Formulary Custom (*); OTC natural balance tears ophthalmic solution 0.4 % Formulary OTC natural balance tears solution 0.4 % ophthalmic 0.4 % Formulary Custom (*); OTC natural bitterness powder Formulary OTC natural fiber laxative oral powder 28.3 %, 68 % Formulary OTC natural fiber therapy powder 28.3 % oral 28.3 % Formulary Custom (*); OTC natural fiber therapy powder 48.57 % oral 48.57 % Formulary Custom (*); OTC natural oatmeal bath treatment external packet 100 % Formulary OTC natural vitamin e moisturizing external gel Formulary OTC natures tears solution 0.4 % ophthalmic 0.4 % Formulary Custom (*); OTC

81 Drug Name Formulary Status Requirements/Limits na-zone nasal solution 0.65 % Formulary OTC NEOSPORIN + PAIN RELIEF MAX ST EXTERNAL Formulary OTC OINTMENT 1 % NEOSPORIN LIP HEALTH DAILY EXTERNAL Formulary OTC OINTMENT 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 HQ SKIN LIGHTENING EXTERNAL Formulary OTC GEL 2 % NEO-SYNEPHRINE NASAL SOLUTION 0.25 %, 0.5 %, Formulary OTC 1 % 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 NESTLE GOOD START DUAL FEEDER Formulary OTC neuro vite tablet oral Formulary Custom (*); OTC NEURO-K-250 T.D. ORAL CAPSULE 250 MG Formulary OTC neuromax external gel 20 % Formulary OTC NEUROPEN KIT Formulary OTC NEUROTIPS Formulary OTC NEUTROGENA BODY EXTERNAL OIL Formulary OTC NEUTROGENA CLEAR PORE EXTERNAL LIQUID 3.5 Formulary OTC % NEUTROGENA T/GEL STUBBORN ITCH EXTERNAL Formulary OTC SHAMPOO 0.5 % NEW DIGNITY ODOR ELIMINATOR EXTERNAL Formulary OTC SOLUTION 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 NEXCARE EARLOOP MASK Formulary OTC NEXCARE PREMIUM ADHESIVE GAUZE PAD 3- Formulary OTC 1/2"X6" , 3-1/2"X8" NEXT CHOICE ONE DOSE TABLET 1.5 MG ORAL Formulary Custom (*); OTC; QL (2 EA per 30 days) (OTC) 1.5 MG niacin er capsule extended release 250 mg oral 250 mg Formulary Custom (*); OTC niacin er capsule extended release 500 mg oral 500 mg Formulary Custom (*); OTC 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 Formulary OTC 82 Drug Name Formulary Status Requirements/Limits niacin powder Formulary niacinamide oral tablet 100 mg, 500 mg Formulary OTC niacinamide powder Formulary niacinamide tablet 100 mg oral 100 mg Formulary Custom (*); OTC niacinamide tablet 500 mg oral 500 mg Formulary Custom (*); OTC niacinamide tablet extended release 500 mg oral 500 mg Formulary Custom (*); OTC NICODERM CQ PATCH 24 HOUR 14 MG/24HR Formulary Custom (*); OTC TRANSDERMAL 14 MG/24HR NICODERM CQ PATCH 24 HOUR 21 MG/24HR Formulary Custom (*); OTC TRANSDERMAL 21 MG/24HR NICODERM CQ PATCH 24 HOUR 7 MG/24HR Formulary Custom (*); OTC TRANSDERMAL 7 MG/24HR NICODERM CQ TRANSDERMAL PATCH 24 HOUR 14 Formulary OTC MG/24HR, 21 MG/24HR, 7 MG/24HR NICORELIEF GUM 2 MG MOUTH/THROAT 2 MG Formulary Custom (*); OTC NICORELIEF GUM 4 MG MOUTH/THROAT 4 MG Formulary Custom (*); OTC GUM 2 MG MOUTH/THROAT 2 MG Formulary Custom (*); OTC NICORETTE GUM 4 MG MOUTH/THROAT 4 MG Formulary Custom (*); OTC NICORETTE LOZENGE 2 MG MOUTH/THROAT 2 MG Formulary Custom (*); OTC NICORETTE LOZENGE 4 MG MOUTH/THROAT 4 MG Formulary Custom (*); OTC NICORETTE MINI LOZENGE 2 MG MOUTH/THROAT Formulary Custom (*); OTC 2 MG NICORETTE MINI LOZENGE 4 MG MOUTH/THROAT Formulary Custom (*); OTC 4 MG NICORETTE MINI MOUTH/THROAT LOZENGE 2 MG Formulary OTC NICORETTE MOUTH/THROAT GUM 2 MG, 4 MG Formulary OTC NICORETTE MOUTH/THROAT LOZENGE 4 MG Formulary OTC NICORETTE STARTER KIT GUM 2 MG Formulary Custom (*); OTC MOUTH/THROAT 2 MG NICORETTE STARTER KIT GUM 4 MG Formulary Custom (*); OTC MOUTH/THROAT 4 MG nicotinamide adenine dinucleo powder Formulary nicotine patch 24 hour 14 mg/24hr transdermal (otc) 14 Formulary Custom (*); OTC mg/24hr nicotine patch 24 hour 21 mg/24hr transdermal (otc) 21 Formulary Custom (*); OTC mg/24hr nicotine patch 24 hour 7 mg/24hr transdermal (otc) 7 Formulary Custom (*); OTC mg/24hr nicotine polacrilex gum 2 mg mouth/throat 2 mg Formulary Custom (*); OTC nicotine polacrilex gum 4 mg mouth/throat 4 mg Formulary Custom (*); OTC nicotine polacrilex lozenge 2 mg mouth/throat 2 mg Formulary Custom (*); OTC night time cold/flu relief capsule 15-6.25-325 mg oral 15- Formulary Custom (*); OTC 6.25-325 mg night time cough/cold child oral liquid 6.25-2.5 mg/5ml Formulary OTC night time sleep aid tablet 25 mg oral 25 mg Formulary Custom (*); OTC night-time cold/flu relief oral capsule 15-6.25-325 mg Formulary OTC nighttime cold/flu relief plus oral capsule 5-6.25-10-325 mg Formulary OTC

83 Drug Name Formulary Status Requirements/Limits nighttime sinus & congestion oral capsule 6.25-5-325 mg Formulary OTC nighttime sleep aid tablet 25 mg oral 25 mg Formulary Custom (*); OTC NINJACOF LIQUID 12.5-12.5 MG/5ML ORAL 12.5-12.5 Formulary Custom (*); OTC MG/5ML NINJACOF ORAL LIQUID 12.5-12.5 MG/5ML Formulary OTC NINJACOF-A LIQUID 12.5-12.5-160 MG/5ML ORAL Formulary Custom (*); OTC 12.5-12.5-160 MG/5ML NINJACOF-A ORAL LIQUID 12.5-12.5-160 MG/5ML Formulary OTC NINJACOF-XG LIQUID 200-8 MG/5ML ORAL 200-8 Formulary Custom (*); OTC MG/5ML NINJACOF-XG ORAL LIQUID 200-8 MG/5ML Formulary OTC NISEKO SUNSCREEN SPF 25 EXTERNAL CREAM Formulary OTC nite time cold/flu relief liquid 15-6.25-500 mg/15ml oral 15- Formulary Custom (*); OTC 6.25-500 mg/15ml nite time cough liquid 6.25-15 mg/15ml oral 6.25-15 Formulary Custom (*); OTC mg/15ml nite time multi-symptom relief capsule 15-6.25-325 mg oral Formulary Custom (*); OTC 15-6.25-325 mg NITEBITE ORAL BAR Formulary OTC nite-time cold/flu capsule 15-6.25-325 mg oral 15-6.25-325 Formulary Custom (*); OTC mg nite-time cold/flu relief liquid 15-6.25-325 mg/15ml oral Formulary Custom (*); OTC 15-6.25-325 mg/15ml nite-time cold/flu relief liquid 15-6.25-500 mg/15ml oral Formulary Custom (*); OTC 15-6.25-500 mg/15ml nite-time cold/flu relief oral liquid 5-6.25-15-500 mg/15ml Formulary OTC NIVA-HIST DM LIQUID 7.5-4-15 MG/5ML ORAL 7.5-4- Formulary Custom (*); OTC 15 MG/5ML NIVANEX DMX TABLET 10-15-380 MG ORAL 10-15- Formulary Custom (*); OTC 380 MG NIX CREME RINSE EXTERNAL LIQUID 1 % Formulary OTC NIZORAL A-D EXTERNAL SHAMPOO 1 % Formulary OTC NO DOZ MAXIMUM STRENGTH TABLET 200 MG Formulary Custom (*); OTC ORAL 200 MG no drip nasal spray solution 0.05 % nasal 0.05 % Formulary Custom (*); OTC NOBLE FORMULA EXTERNAL SHAMPOO 2 % Formulary OTC NOBLE FORMULA HC EXTERNAL SOLUTION 1 % Formulary OTC nohist-dm liquid 10-4-15 mg/5ml oral (otc) 10-4-15 mg/5ml Formulary Custom (*) nohist-lq liquid 4-10 mg/5ml oral 4-10 mg/5ml Formulary Custom (*); OTC nohist-lq oral liquid 4-10 mg/5ml Formulary OTC non-aspirin extra strength oral capsule 500 mg Formulary OTC non-aspirin pain reliever tablet 325 mg oral 325 mg Formulary Custom (*); OTC non-aspirin tablet 325 mg oral 325 mg Formulary Custom (*); OTC non-pseudo sinus pain/pressure oral tablet 5-500 mg Formulary OTC non-stick pad 2"x3" Formulary OTC NOREL AD ORAL TABLET 4-10-325 MG Formulary OTC NOREL AD TABLET 4-10-325 MG ORAL 4-10-325 MG Formulary Custom (*); OTC

84 Drug Name Formulary Status Requirements/Limits NOREL CS LIQUID 10-4-12.5 MG/5ML ORAL 10-4-12.5 Formulary Custom (*); OTC MG/5ML NOREL CS ORAL LIQUID 10-4-12.5 MG/5ML Formulary OTC NORMLSHIELD EXTERNAL CREAM 4.5 % Formulary OTC NORTUSS-DE ORAL LIQUID 2.5-5-50 MG/ML Formulary 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 PED MULTI VIT-IRON ORAL LIQUID Formulary OTC 10 MG/ML NOVAFERRUM PEDIATRIC DROPS ORAL LIQUID 15 Formulary OTC MG/ML NOXICARE EXTERNAL CREAM Formulary OTC NRS NASAL RELIEF SOLUTION 0.05 % NASAL 0.05 % Formulary Custom (*); OTC NUFERA ORAL TABLET Formulary NU-GEL EXTERNAL GEL Formulary OTC NUPERCAINAL RECTAL OINTMENT 1 % Formulary OTC NUPREP 5% POVIDONE-IODINE EXTERNAL Formulary OTC SOLUTION 5 % NUTRATEAR OPHTHALMIC SOLUTION 0.6 % Formulary OTC NUTR-E-SOL ORAL LIQUID 400 UNIT/15ML Formulary OTC NYQUIL SEVERE COLD/FLU LIQUID 5-6.25-10-325 Formulary Custom (*); OTC MG/15ML ORAL 5-6.25-10-325 MG/15ML NYTOL MAXIMUM STRENGTH ORAL TABLET 50 Formulary OTC MG O.A.D. LIQUID Formulary OTC OASIS MOISTURIZING 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 MOISTURIZER GEL NASAL Formulary Custom (*); OTC OCEAN NASAL SPRAY NASAL SOLUTION 0.65 % Formulary OTC ODOR EATERS ANTIFUNGAL EXTERNAL POWDER Formulary OTC 1 % OILATUM EXTERNAL BAR 7.5 % Formulary OTC olive oil oil Formulary omega dha oral tablet chewable Formulary OTC

85 Drug Name Formulary Status Requirements/Limits 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 omeprazole tablet delayed release 20 mg oral 20 mg Formulary Custom (*); OTC OMNI GEL DENTAL GEL 0.4 % Formulary OTC OMNICIDE ANTIMICROBIAL EXTERNAL GEL 0.13 % Formulary OTC ONE-A-DAY ADULT VITACRAVES+DHA ORAL Formulary OTC TABLET CHEWABLE ONE-A-DAY WOMENS 50+ ADVANTAGE ORAL Formulary OTC TABLET ONE-A-DAY WOMENS FORMULA ORAL TABLET Formulary OTC one-step pregnancy in vitro diagnostic test Formulary OTC ONETOUCH PING METER REMOTE SUPPLIES Formulary OTC OPCICON ONE-STEP TABLET 1.5 MG ORAL 1.5 MG Formulary Custom (*); OTC; QL (2 EA per 30 days) OPERAND POVIDONE-IODINE EXTERNAL GEL 10 % Formulary OTC OPERAND SCRUB EXTERNAL SOLUTION 7.5 % Formulary OTC opti-clear solution 0.05 % ophthalmic 0.05 % Formulary Custom (*); OTC OPTICS MINI DROPS OPHTHALMIC SOLUTION 1.4- Formulary OTC 0.6 % OPTIONS CONCEPTROL VAGINAL GEL 4 % Formulary OTC ORA-FILM MOUTH/THROAT STRIP 6 % Formulary OTC ORA-HESIVE BASE PASTE Formulary OTC ORAJEL MAXIMUM STRENGTH MOUTH/THROAT Formulary OTC GEL 20 % oral analgesic max st mouth/throat gel 20 % Formulary OTC oral anesthetic mouth/throat paste 20 % Formulary OTC oral electrolytes oral solution Formulary OTC ORAMAGIC PLUS MOUTH/THROAT SUSPENSION Formulary OTC RECONSTITUTED 10 % orange oil oil Formulary OTC ORASEP MOUTH/THROAT SOLUTION 2-0.5-0.1 % Formulary OTC ORASEP SOLUTION 2-0.5-0.1 % MOUTH/THROAT 2- Formulary Custom (*); OTC 0.5-0.1 % ORA-SWEET SF SYRUP ORAL (OTC) Formulary Custom (*) ORA-SWEET SYRUP ORAL (OTC) Formulary Custom (*) ORAZINC ORAL TABLET 110 MG Formulary OTC organ-i nr tablet 200 mg oral 200 mg Formulary Custom (*); OTC organic coconut oil oil Formulary OTC ornithine oral capsule 500 mg Formulary OTC ORTHO-NESIC EXTERNAL GEL 0.2-3.5 % Formulary OTC OS-CAL EXTRA D3 ORAL TABLET 500-600 MG-UNIT Formulary OTC

86 Drug Name Formulary Status Requirements/Limits OS-CAL ORAL TABLET CHEWABLE 500-600 MG- Formulary OTC UNIT OS-CAL ULTRA ORAL TABLET 600 MG Formulary OTC OSCION CLEANSER EXTERNAL LOTION 6 % Formulary OSTEO BI-FLEX ADV TRIPLE ST ORAL TABLET Formulary OTC OSTEO-PORETICAL ORAL TABLET 600-1000 MG- Formulary OTC UNIT OSTIGEN ORAL 350 MG Formulary OTC ostomy protective powder Formulary OTC oval tape Formulary OTC oxalic acid crystals Formulary OTC OXYTROL TRANSDERMAL PATCH TWICE WEEKLY Formulary 3.9 MG/24HR OXYZAL WET DRESSING EXTERNAL SOLUTION Formulary OTC 1:2000 oyst-cal d tablet 250-125 mg-unit oral 250-125 mg-unit Formulary Custom (*); OTC oyster calcium + d oral tablet 250-125 mg-unit Formulary OTC oyster calcium/d3 oral tablet 500-200 mg-unit Formulary OTC oyster shell calcium 250+d oral tablet 250-125 mg-unit Formulary OTC oyster shell calcium 500+d oral tablet chewable 500-400 Formulary OTC mg-unit oyster shell calcium oral tablet 500 mg, 500-400 mg-unit Formulary OTC oyster shell calcium/d oral tablet 250-250 mg-unit Formulary OTC 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 PACQUIN PLUS HAND/BODY EXTERNAL CREAM 1 Formulary OTC % pain & fever childrens oral tablet chewable 160 mg Formulary OTC pain & fever childrens solution 160 mg/5ml oral 160 Formulary Custom (*); OTC mg/5ml pain & fever childrens suspension 160 mg/5ml oral 160 Formulary Custom (*); OTC mg/5ml pain & fever childrens tablet chewable 80 mg oral 80 mg Formulary Custom (*); OTC pain & fever extra strength tablet 500 mg oral 500 mg Formulary Custom (*); OTC pain & fever tablet 325 mg oral 325 mg Formulary Custom (*); OTC pain relief cold congestion tablet 5-10-200-325 mg oral 5- Formulary Custom (*); OTC 10-200-325 mg pain relief day & night ex st oral 25-500 & 500 mg Formulary OTC

87 Drug Name Formulary Status Requirements/Limits pain relief extra strength tablet 500 mg oral 500 mg Formulary Custom (*); OTC pain relief oral tablet Formulary OTC pain relief pm extra strength tablet 500-25 mg oral 500-25 Formulary Custom (*); OTC mg pain relief roll-on external liquid 4 % Formulary OTC pain relief sinus pe daytime tablet 5-325 mg oral 5-325 mg Formulary Custom (*); OTC pain relief tablet 325 mg oral 325 mg Formulary Custom (*); OTC pain relief tablet 500 mg oral 500 mg Formulary Custom (*); OTC pain reliever extra strength oral tablet 500 mg Formulary OTC pain reliever extra strength tablet 500 mg oral 500 mg Formulary Custom (*); OTC pain reliever plus tablet 250-250-65 mg oral 250-250-65 Formulary Custom (*); OTC mg pain reliever pm ex st tablet 500-25 mg oral 500-25 mg Formulary Custom (*); OTC pain reliever pm oral tablet 25-500 mg Formulary OTC pain reliever/fever reducer rectal suppository 120 mg Formulary OTC pain relieving external gel 3.5 % Formulary OTC PALADIN EXTERNAL OINTMENT Formulary OTC pamix oral suspension 50 mg/ml Formulary OTC PAMPERS SENSITIVE WIPES Formulary OTC PAMPRIN MAX PAIN FORMULA TABLET 500-25-15 Formulary Custom (*); OTC MG ORAL 500-25-15 MG PAMPRIN MULTI-SYMPTOM TABLET 500-25-15 MG Formulary Custom (*); OTC ORAL 500-25-15 MG PANATUSS PED DROPS ORAL LIQUID 15-0.5-6.25 Formulary OTC MG/ML PANATUSS PED ORAL LIQUID 60-2-25 MG/5ML Formulary OTC panax ginseng oral capsule 100 mg Formulary OTC pancreatin oral tablet 325 mg Formulary OTC PANOXYL BAR 10 % EXTERNAL 10 % Formulary Custom (*); OTC PANOXYL EXTERNAL LIQUID 2.5 % Formulary OTC PANOXYL GEL 3 % EXTERNAL 3 % Formulary Custom (*); OTC PANOXYL WASH LIQUID 10 % EXTERNAL 10 % Formulary Custom (*); OTC PANOXYL-4 CREAMY WASH EXTERNAL LIQUID 4 Formulary OTC % PANOXYL-4 CREAMY WASH LIQUID 4 % Formulary Custom (*); OTC EXTERNAL 4 % panto-250 oral capsule 250 mg Formulary OTC pantothenic acid oral tablet 500 mg Formulary OTC papaya enzyme oral tablet chewable Formulary OTC beads wax Formulary OTC parvenzyme digestive enzyme oral tablet Formulary OTC PAZOL XS EXTERNAL SHAMPOO 1-2-2 % Formulary OTC PCCA MBK (FATTY ACID) BASE Formulary OTC pc-tar external shampoo 1 % Formulary OTC peanut oil oil Formulary pearberry fragrance liquid Formulary OTC 88 Drug Name Formulary Status Requirements/Limits PECGEN PSE ORAL LIQUID 30-10-187 MG/5ML Formulary OTC pectin powder Formulary pedia relief cough/cold liquid 15-1-5 mg/5ml oral 15-1-5 Formulary Custom (*); OTC mg/5ml 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 pediatric cough/cold liquid 15-1-5 mg/5ml oral 15-1-5 Formulary Custom (*); OTC mg/5ml pediatric cough/cold oral liquid 15-1-5 mg/5ml Formulary OTC PEDIAVENT ORAL SYRUP 2 MG/5ML Formulary OTC PEDIAVENT ORAL TABLET CHEWABLE 1 MG Formulary OTC PEDIAVIT ORAL LIQUID Formulary OTC PEDI-BORO SOAK PACKET EXTERNAL Formulary Custom (*); OTC peg 300 liquid Formulary peg 3350 packet 17 gm oral 17 gm Formulary Custom (*); OTC peg 3350 powder 17 gm/scoop oral 17 gm/scoop Formulary Custom (*); OTC PENTRAX GOLD EXTERNAL SHAMPOO 4 % Formulary OTC peppermint oil oil Formulary peppermint spirit spirit Formulary OTC peptic relief suspension 262 mg/15ml oral 262 mg/15ml Formulary Custom (*); OTC peptic relief tablet chewable 262 mg oral 262 mg Formulary Custom (*); 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 SUSPENSION 524 MG/30ML ORAL Formulary Custom (*); OTC 524 MG/30ML PEPTO-BISMOL TO-GO ORAL TABLET CHEWABLE Formulary OTC 262 MG PERCOGESIC EXTRA STRENGTH ORAL TABLET Formulary OTC 12.5-500 MG PERDIEM OVERNIGHT RELIEF TABLET 15 MG Formulary Custom (*); OTC ORAL 15 MG PERFORM ATOMIC HEAT EXTERNAL CREAM 0.034- Formulary OTC 10 % PERFORM ATOMIC HEAT EXTERNAL LIQUID 0.034- Formulary OTC 10 %

89 Drug Name Formulary Status Requirements/Limits 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 PERIGUARD OINTMENT EXTERNAL Formulary Custom (*); OTC PERISHIELD EXTERNAL OINTMENT Formulary OTC 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 % PERRY PRENATAL ORAL CAPSULE 13.5-0.4 MG Formulary OTC personal ultrasonic humidifier Formulary OTC personal washcloths external Formulary OTC peruvian balsam liquid Formulary OTC petroleum jelly external aerosol Formulary OTC petroleum jelly external ointment Formulary OTC pharbedryl capsule 25 mg oral 25 mg Formulary Custom (*); OTC pharbedryl capsule 50 mg oral 50 mg Formulary Custom (*); OTC PHARMABASE ANTIOXIDANT CREAM EXTERNAL Formulary Custom (*); OTC PHAZYME MAXIMUM STRENGTH ORAL CAPSULE Formulary OTC 250 MG PHAZYME ULTRA STRENGTH CAPSULE 180 MG Formulary Custom (*); OTC ORAL 180 MG PHAZYME ULTRA STRENGTH ORAL CAPSULE 180 Formulary OTC MG PHENABID ORAL TABLET 3.5-10 MG Formulary OTC PHENAGIL CH ORAL TABLET 10-3.5-24 MG Formulary OTC phenaseptic liquid 1.4 % mouth/throat 1.4 % Formulary Custom (*); OTC phendimetrazine tartrate er capsule extended release 24 PA; Custom (*); QL (90 EA per 365 Formulary hour 105 mg oral 105 mg days) PA; Custom (*); QL (90 EA per 365 phendimetrazine tartrate tablet 35 mg oral 35 mg Formulary days) external liquid Formulary OTC PHENOL EZ SWABS EXTERNAL SWAB 89 % Formulary OTC PA; Custom (*); QL (90 EA per 365 phentermine hcl capsule 15 mg oral 15 mg Formulary days) PA; Custom (*); QL (90 EA per 365 phentermine hcl capsule 30 mg oral 30 mg Formulary days) PA; Custom (*); QL (90 EA per 365 phentermine hcl capsule 37.5 mg oral 37.5 mg Formulary days) PA; Custom (*); QL (90 EA per 365 phentermine hcl tablet 37.5 mg oral 37.5 mg Formulary days) phenylalanine oral packet 50 mg Formulary OTC phenylhistine dh liquid 30-2-10 mg/5ml oral 30-2-10 Formulary Custom (*); OTC mg/5ml

90 Drug Name Formulary Status Requirements/Limits 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 phosphatidylcholine powder Formulary phosphatidylserine powder Formulary OTC physicians antibacterial external liquid 0.3 % Formulary OTC PHYTOPLEX Z-GUARD EXTERNAL PASTE 57-17 % Formulary OTC PIC 200 ORAL CAPSULE 434.8 (200 FE) MG Formulary OTC pink bismuth tablet chewable 262 mg oral 262 mg Formulary Custom (*); OTC PIN-X SUSPENSION 50 MG/ML ORAL 50 MG/ML Formulary Custom (*); OTC PIN-X TABLET CHEWABLE 720.5 MG ORAL 720.5 Formulary Custom (*); OTC MG PINXAV EXTERNAL OINTMENT Formulary OTC PLAN B ONE-STEP TABLET 1.5 MG ORAL (OTC) 1.5 Formulary Custom (*); OTC; QL (2 EA per 30 days) MG plasticized base ointment Formulary PLIAGEL GEL 0.5-0.5-0.25 % Formulary OTC PLO ULTRAMAX EXTERNAL GEL Formulary OTC PLURONIC GEL 20 %, 30 % Formulary pmx-1184 silicone liquid Formulary PNEUMODORON #2 ORAL LIQUID Formulary podophyllum resin powder Formulary poison ivy wash external Formulary OTC POLAR FREEZE EXTERNAL GEL 3.5-0.8 % Formulary OTC poloxamer 188 powder Formulary poly bacitracin external ointment 500-10000 unit/gm Formulary OTC POLY HIST FORTE ORAL TABLET 7.5-10 MG Formulary OTC POLY HIST FORTE TABLET 7.5-10 MG ORAL 7.5-10 Formulary Custom (*); OTC MG 1000 liquid Formulary OTC polyethylene glycol 1450 liquid Formulary polyethylene glycol 3350 packet 17 gm oral (otc) 17 gm Formulary Custom (*) polyethylene glycol 3350 powder Formulary polyethylene glycol 3350 powder 17 gm/scoop oral (otc) 17 Formulary Custom (*) gm/scoop polyethylene glycol 400 liquid Formulary polyethylene glycol 8000 powder Formulary poly-hist dm liquid 5-25-10 mg/5ml oral 5-25-10 mg/5ml Formulary Custom (*); OTC poly-hist dm oral liquid 5-25-10 mg/5ml Formulary OTC poly-hist pd liquid 6.25-6.25 mg/ml oral 6.25-6.25 mg/ml Formulary Custom (*); OTC poly-hist pd oral liquid 6.25-6.25 mg/ml Formulary OTC POLY-IRON 150 CAPSULE 150 MG ORAL 150 MG Formulary Custom (*); OTC POLYMEM TRACH DRESSING PAD 3-1/2"X3-1/2" Formulary OTC polyoxyl 40 stearate powder Formulary

91 Drug Name Formulary Status Requirements/Limits polysorbate 80 oral liquid Formulary POLYSPORIN EXTERNAL OINTMENT 500-10000 Formulary OTC UNIT/GM POLYTAR EXTERNAL SHAMPOO Formulary OTC poly-tussin ac liquid 10-4-10 mg/5ml oral 10-4-10 mg/5ml Formulary Custom (*); OTC 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 DM TABLET 60-20-380 MG ORAL 60-20- Formulary Custom (*); OTC 380 MG POLY-VENT IR ORAL TABLET 60-380 MG Formulary OTC POLY-VENT IR TABLET 60-380 MG ORAL 60-380 MG Formulary Custom (*); OTC POLY-VI-SOL/IRON ORAL SOLUTION Formulary OTC potassimin oral tablet 75 mg Formulary OTC potassium bitartrate powder Formulary potassium bromide crystals Formulary potassium chloride crystals Formulary OTC potassium chloride granules Formulary potassium citrate granules Formulary OTC potassium gluconate anhydrous powder Formulary potassium gluconate oral tablet 2 meq, 2.5 meq, 595 (99 k) Formulary OTC mg potassium hydroxide pellet Formulary potassium hydroxide solution 10 % Formulary OTC potassium hydroxide solution 20 % Formulary OTC potassium iodide crystals Formulary potassium nitrate granules Formulary OTC granules Formulary potassium sodium tartrate powder Formulary OTC potassium sorbate crystals Formulary OTC povidone-iodine external ointment 10 % Formulary OTC povidone-iodine external pad 10 % Formulary OTC povidone-iodine external solution 10 % Formulary OTC povidone-iodine external swab 10 %, 7.5 % Formulary OTC povidone-iodine ointment 10 % external 10 % Formulary Custom (*); OTC povidone-iodine scrub sponge external 10 % Formulary OTC povidone-iodine solution 10 % external 10 % Formulary Custom (*); OTC PRAMEGEL EXTERNAL GEL 1 % Formulary OTC pramoxine hcl (perianal) foam 1 % external 1 % Formulary Custom (*); OTC pramoxine hcl rectal foam 1 % Formulary OTC PRAX EXTERNAL 1 % Formulary OTC PRAX EXTERNAL LOTION 1 % Formulary OTC PRECISION FOLEY CATH TRAY KIT Formulary PREGNITUDE ORAL PACKET 2000-200 MG-MCG Formulary OTC PREMIER UROSTOMY POUCH Formulary OTC

92 Drug Name Formulary Status Requirements/Limits premium hearing aid batteries Formulary OTC PREMSYN PMS TABLET 500-25-15 MG ORAL 500-25- Formulary Custom (*); OTC 15 MG prenatal formula a-free oral tablet 9-0.267 mg Formulary OTC prenatal formula oral capsule 28-0.8-235 mg Formulary OTC prenatal low iron oral tablet 27-0.8 mg Formulary OTC PRENATAL MULTIVITAMIN + DHA 28-0.8 & 200 MG Formulary Custom (*); OTC ORAL 28-0.8 & 200 MG 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 prep protective skin barrier external pad 0.5 % Formulary OTC PREPARATION H CREAM 1 % EXTERNAL 1 % Formulary Custom (*); OTC PREPARATION H CREAM 1-0.25-14.4-15 % Formulary Custom (*); OTC EXTERNAL 1-0.25-14.4-15 % PREPARATION H GEL 0.25-50 % EXTERNAL 0.25-50 Formulary Custom (*); OTC % PREPARATION H OINTMENT 0.25-14-74.9 % RECTAL Formulary Custom (*); OTC 0.25-14-74.9 % PREPARATION H PAD 50 % EXTERNAL 50 % Formulary Custom (*); 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 RECTAL SUPPOSITORY 0.25-88.44 Formulary OTC % PREPARATION H SUPPOSITORY 0.25-88.44 % Formulary Custom (*); OTC RECTAL 0.25-88.44 % PREPARATION H TOTABLES GEL 0.25-50 % Formulary Custom (*); OTC EXTERNAL 0.25-50 % PREPARATION H TOTABLES RECTAL CREAM 1- Formulary OTC 0.25-14.4-15 % PREPARATION H TOTABLES WIPES PAD 50 % Formulary Custom (*); OTC EXTERNAL 50 % PRESGEN B ORAL LIQUID 10-4-20 MG/5ML Formulary OTC pressure & pain & cold oral tablet 5-10-100-325 mg Formulary OTC PRETZ IRRIGATION NASAL SOLUTION Formulary OTC PRETZ SOLUTION 10 % Formulary OTC PREVACARE ANTIMICROBIAL EXTERNAL GEL 60 Formulary OTC % PREVACARE EXTRA PROTECTIVE EXTERNAL Formulary OTC OINTMENT PREVACARE PERSONAL PROTECT EXTERNAL Formulary OTC CREAM PREVACARE TOTAL SKIN CARE EXTERNAL Formulary OTC SOLUTION PREVACID 24HR CAPSULE DELAYED RELEASE 15 Formulary Custom (*); OTC MG ORAL 15 MG

93 Drug Name Formulary Status Requirements/Limits PREVACID ORAL CAPSULE DELAYED RELEASE 15 Formulary MG PRILOSEC OTC ORAL TABLET DELAYED RELEASE Formulary OTC 20 MG PRILOSEC OTC TABLET DELAYED RELEASE 20 MG Formulary Custom (*); OTC ORAL 20 MG PRIMATENE ASTHMA ORAL TABLET 12.5-200 MG Formulary OTC PRIMATENE ASTHMA TABLET 12.5-200 MG ORAL Formulary Custom (*); OTC 12.5-200 MG PRO NUTRIENTS OMEGA 3 ORAL CAPSULE Formulary OTC DELAYED RELEASE 332.5 MG PROBIOMAX PLUS DF ORAL PACKET Formulary OTC probiotic digestive support oral capsule Formulary OTC probiotic oral capsule 250 mg Formulary OTC probiotic-prebiotic oral capsule 1-250 billion-mg Formulary OTC PROCARE PLUS UNDERWEAR MEDIUM Formulary OTC PRO-CEPTION VAGINAL KIT Formulary OTC pro-chlo liquid 5-12.5-12.5 mg/5ml oral 5-12.5-12.5 Formulary Custom (*); OTC mg/5ml pro-chlo oral liquid 5-12.5-12.5 mg/5ml Formulary OTC PRO-CLEAR AC ORAL SYRUP 9-8.33 MG/5ML Formulary OTC PRO-CLEAR AC SYRUP 9-8.33 MG/5ML ORAL 9-8.33 Formulary Custom (*); OTC MG/5ML PROCOMYCIN EXTERNAL CREAM 4 % Formulary OTC PROCTOFOAM FOAM 1 % EXTERNAL 1 % Formulary Custom (*); OTC PROCTOFOAM RECTAL FOAM 1 % Formulary OTC profe forte oral capsule 155-1 mg Formulary OTC PROFE ORAL CAPSULE 391.3 (180 FE) MG Formulary OTC PROFERRIN ES ORAL TABLET 12 MG Formulary OTC PROLIDA EXTERNAL PATCH 4-1 % Formulary OTC promethazine vc/codeine syrup 6.25-5-10 mg/5ml oral 6.25- Formulary Custom (*) 5-10 mg/5ml promethazine-codeine solution 6.25-10 mg/5ml oral 6.25-10 Formulary Custom (*) mg/5ml promethazine-dm solution 6.25-15 mg/5ml oral 6.25-15 Formulary Custom (*) mg/5ml 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 PROPA PH ACNE MED MAX ST EXTERNAL PAD 2 % Formulary OTC propylene glycol external solution Formulary propylparaben powder Formulary PRO-RED AC ORAL SYRUP 5-1-9 MG/5ML Formulary OTC PRO-RED AC SYRUP 5-1-9 MG/5ML ORAL 5-1-9 Formulary Custom (*); OTC MG/5ML

94 Drug Name Formulary Status Requirements/Limits PROSHIELD PLUS SKIN PROTECTANT CREAM 1 % Formulary Custom (*); OTC EXTERNAL 1 % 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 ORAL TABLET Formulary OTC PROTEINEX P100 ORAL LIQUID Formulary OTC PROVIEW KIT Formulary OTC PROVIL TABLET 200 MG ORAL 200 MG Formulary Custom (*); OTC pseudoeph-bromphen-dm syrup 30-2-10 mg/5ml oral (rx) Formulary Custom (*) 30-2-10 mg/5ml pseudoephedrine hcl er tablet extended release 12 hour 120 Formulary Custom (*); OTC mg oral 120 mg pseudoephedrine hcl oral syrup 30 mg/5ml Formulary OTC pseudoephedrine hcl tablet 30 mg oral (otc) 30 mg Formulary Custom (*); OTC PSORIASIS MEDICATED EXTERNAL LIQUID 3 % Formulary OTC psyllium husk powder Formulary PURACYN PLUS DUO-CARE EXTERNAL LIQUID Formulary OTC PURALUBE OINTMENT 85-15 % OPHTHALMIC 85-15 Formulary Custom (*); OTC % PURE & GENTLE LUBRICANT OPHTHALMIC Formulary OTC SOLUTION 0.3 % pure l-citrulline oral capsule 600 mg Formulary OTC pure l-citrulline oral powder Formulary OTC purified water oral liquid Formulary PURILON EXTERNAL GEL Formulary OTC px allergy relief d oral tablet extended release 12 hour 5- Formulary OTC 120 mg px allergy sinus pe oral tablet 2-5-325 mg Formulary OTC px artificial tears ophthalmic solution 5-6 mg/ml Formulary OTC px daytime cold oral tablet 10-5-325 mg Formulary OTC px daytime multi-symptom oral capsule 30-325-15 mg Formulary OTC px gas relief extra strength oral capsule 125 mg Formulary OTC px glucosamine-chondroitin tablet oral Formulary Custom (*); OTC px ibuprofen cold & sinus oral tablet 30-200 mg 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 vegetable laxative oral tablet 8.6 mg Formulary OTC pyridoxal-5 phosphate powder Formulary pyridoxine hcl powder Formulary pyridoxine hcl solution 100 mg/ml injection 100 mg/ml Formulary Custom (*) pyridoxine hcl tablet 25 mg oral 25 mg Formulary Custom (*); OTC pyridoxine hcl tablet 50 mg oral 50 mg Formulary Custom (*); OTC PYRIDOXINE/MINERALS ORAL CAPSULE 100-99-200 Formulary OTC MG 95 Drug Name Formulary Status Requirements/Limits pyrilamine-phenylephrine tablet 25-10 mg oral 25-10 mg Formulary Custom (*); OTC pyruvic acid liquid Formulary qc 3 day cream 4 % vaginal 4 % Formulary Custom (*); OTC qc acid controller max st tablet 20 mg oral 20 mg Formulary Custom (*); OTC qc acid controller tablet 10 mg oral 10 mg Formulary Custom (*); OTC qc all day allergy tablet 10 mg oral 10 mg Formulary Custom (*); OTC qc allergy relief multi-sympt tablet 2-5-325 mg oral 2-5-325 Formulary Custom (*); OTC mg qc allergy relief tablet dispersible 10 mg oral 10 mg Formulary Custom (*); OTC qc allergy/sinus headache tablet 12.5-5-325 mg oral 12.5-5- Formulary Custom (*); OTC 325 mg qc antacid suspension 200-200-20 mg/5ml oral 200-200-20 Formulary Custom (*); OTC mg/5ml qc antacid/anti-gas suspension 200-200-20 mg/5ml oral Formulary Custom (*); OTC 200-200-20 mg/5ml qc antacid/anti-gas suspension 400-400-40 mg/5ml oral Formulary Custom (*); OTC 400-400-40 mg/5ml qc anti-diarrheal tablet 2 mg oral 2 mg Formulary Custom (*); OTC qc arthritis external cream 10 % Formulary OTC qc arthritis pain relief tablet extended release 650 mg oral Formulary Custom (*); OTC 650 mg qc aspirin tablet delayed release 325 mg oral 325 mg Formulary Custom (*); OTC qc athletes foot cream 1 % external 1 % Formulary Custom (*); OTC qc bacitracin ointment 500 unit/gm external 500 unit/gm Formulary Custom (*); OTC qc calamine external lotion Formulary OTC qc calamine lotion external Formulary Custom (*); OTC qc castor oil oil Formulary OTC qc childrens ibuprofen suspension 100 mg/5ml oral 100 Formulary Custom (*); OTC mg/5ml qc childrens vitamins/extra c tablet chewable oral Formulary Custom (*); OTC qc chlor-pheniramine tablet 4 mg oral 4 mg Formulary Custom (*); OTC qc clotrimazole cream 1 % external 1 % Formulary Custom (*); OTC qc cold relief plus multi-symp suspension 2.5-1-5-160 Formulary Custom (*); OTC mg/5ml oral 2.5-1-5-160 mg/5ml qc complete allergy medicine tablet 25 mg oral 25 mg Formulary Custom (*); OTC qc cough relief liquid 15 mg/5ml oral 15 mg/5ml Formulary Custom (*); OTC qc cough/sore throat nighttime liquid 30-12.5-1000 Formulary Custom (*); OTC mg/30ml oral 30-12.5-1000 mg/30ml qc daytime cold/flu capsule 10-5-325 mg oral 10-5-325 mg Formulary Custom (*); OTC qc diarrhea relief suspension 262 mg/15ml oral 262 Formulary Custom (*); OTC mg/15ml qc effervescent antacid/pain tablet effervescent 325-1000- Formulary Custom (*); OTC 1916 mg oral 325-1000-1916 mg qc gentle laxative suppository 10 mg rectal 10 mg Formulary Custom (*); OTC qc hemorrhoidal suppository 0.25-88.44 % rectal 0.25- Formulary Custom (*); OTC 88.44 % qc ibuprofen cold/sinus tablet 30-200 mg oral 30-200 mg Formulary Custom (*); OTC

96 Drug Name Formulary Status Requirements/Limits qc ibuprofen ib tablet 200 mg oral 200 mg Formulary Custom (*); OTC qc iodides external tincture Formulary OTC qc iodine tincture external tincture Formulary OTC qc loratadine allergy relief tablet 10 mg oral 10 mg Formulary Custom (*); OTC qc loratadine-d tablet extended release 24 hour 10-240 mg Formulary Custom (*); OTC oral 10-240 mg QC MEDIFIN PE ORAL TABLET 10-400 MG Formulary OTC qc naproxen sodium tablet 220 mg oral 220 mg Formulary Custom (*); OTC qc natural vegetable oral powder 95 % Formulary OTC qc nighttime cold/flu relief liquid 15-6.25-500 mg/15ml oral Formulary Custom (*); OTC 15-6.25-500 mg/15ml qc nighttime cough liquid 6.25-15 mg/15ml oral 6.25-15 Formulary Custom (*); OTC mg/15ml qc nighttime multi-symptom capsule 15-6.25-325 mg oral Formulary Custom (*); OTC 15-6.25-325 mg qc non-aspirin 8 hour tablet extended release 650 mg oral Formulary Custom (*); OTC 650 mg qc non-aspirin pm tablet 500-25 mg oral 500-25 mg Formulary Custom (*); OTC qc omeprazole magnesium capsule delayed release 20.6 (20 Formulary Custom (*); OTC base) mg oral 20.6 (20 base) mg qc pink bismuth tablet chewable 262 mg oral 262 mg Formulary Custom (*); OTC qc rest simply tablet 25 mg oral 25 mg Formulary Custom (*); OTC qc severe cold/cough nighttime oral packet 25-10-650 mg Formulary OTC qc sinus pain relief tablet 5-325 mg oral 5-325 mg Formulary Custom (*); OTC qc sleep aid max st capsule 50 mg oral 50 mg Formulary Custom (*); OTC qc suphedrine maximum strength tablet extended release 12 Formulary Custom (*); OTC hour 120 mg oral 120 mg qc suphedrine pe tablet 10 mg oral 10 mg Formulary Custom (*); OTC qc suphedrine tablet 30 mg oral 30 mg Formulary Custom (*); OTC qc tolnaftate cream 1 % external 1 % Formulary Custom (*); OTC qc tussin cf liquid 5-10-100 mg/5ml oral 5-10-100 mg/5ml Formulary Custom (*); OTC qc witch hazel liquid 86 % external 86 % Formulary Custom (*); OTC q-dryl capsule 25 mg oral 25 mg Formulary Custom (*); OTC q-dryl liquid 12.5 mg/5ml oral 12.5 mg/5ml Formulary Custom (*); OTC Q-GEL ORAL CAPSULE 15 MG Formulary OTC q-pap childrens suspension 160 mg/5ml oral 160 mg/5ml Formulary Custom (*); OTC q-pap extra strength tablet 500 mg oral 500 mg Formulary Custom (*); OTC q-pap infants solution 80 mg/0.8ml oral 80 mg/0.8ml Formulary Custom (*); OTC q-pap liquid 160 mg/5ml oral 160 mg/5ml Formulary Custom (*); OTC q-pap tablet 325 mg oral 325 mg Formulary Custom (*); OTC QSYMIA CAPSULE EXTENDED RELEASE 24 HOUR Formulary PA; Custom (*); QL (14 EA per 14 days) 11.25-69 MG ORAL 11.25-69 MG QSYMIA CAPSULE EXTENDED RELEASE 24 HOUR PA; Custom (*); QL (90 EA per 365 Formulary 15-92 MG ORAL 15-92 MG days) QSYMIA CAPSULE EXTENDED RELEASE 24 HOUR Formulary PA; Custom (*); QL (14 EA per 14 days) 3.75-23 MG ORAL 3.75-23 MG

97 Drug Name Formulary Status Requirements/Limits QSYMIA CAPSULE EXTENDED RELEASE 24 HOUR PA; Custom (*); QL (90 EA per 365 Formulary 7.5-46 MG ORAL 7.5-46 MG days) Q-TAPP DM ELIXIR 15-1-5 MG/5ML ORAL 15-1-5 Formulary Custom (*); OTC MG/5ML Q-TAPP ELIXIR 1-15 MG/5ML ORAL 1-15 MG/5ML Formulary Custom (*); OTC q-tussin dm syrup 100-10 mg/5ml oral 100-10 mg/5ml Formulary Custom (*); OTC q-tussin solution 100 mg/5ml oral 100 mg/5ml Formulary Custom (*); OTC quenalin syrup 12.5 mg/5ml oral 12.5 mg/5ml Formulary Custom (*); OTC quercetin oral tablet 250 mg, 50 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 advanced healing external lotion 1 % Formulary OTC ra aloe vera/lidocaine external gel 0.5 % Formulary OTC ra anorectal external cream 5 % Formulary OTC ra antifungal pen external liquid 25 % Formulary OTC ra anti-itch extra strength gel 2 % external 2 % Formulary Custom (*); OTC ra arthritis pain relief external cream 0.075 % Formulary OTC ra b-12 mouth/throat lozenge 1000-400 mcg Formulary OTC ra back & body pain relief oral tablet 500-32.5 mg Formulary OTC ra bandages hypo-allergenic 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-boron oral tablet 500-1.5 mg Formulary OTC ra cold remedy multi-symptom oral tablet dispersible Formulary OTC ra cold/sinus max oral tablet 5-325-200 mg Formulary OTC ra corn cushions small pad Formulary OTC ra corn removers ultra thin external pad 40 % Formulary OTC ra dark tanning external oil Formulary OTC ra day/night/cold/flu relief oral Formulary OTC ra daytime cold/flu oral liquid 30-325-15 mg/15ml 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 feminine care douche vaginal solution Formulary OTC

98 Drug Name Formulary Status Requirements/Limits ra fever reducer/pain reliever oral suspension 160 mg/5ml 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 1000 mg, 1400 mg Formulary OTC ra flu maximum strength oral tablet 15-500-2 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 glucosamine-chondroit-msm-d tablet oral Formulary Custom (*); OTC ra glucos-chondroit-msm oral tablet Formulary OTC ra glucos-chondroit-msm tablet oral Formulary Custom (*); OTC ra hemorrhoid relief suppository 0.25-85.5 % rectal 0.25- Formulary Custom (*); OTC 85.5 % ra hemorrhoidal cooling gel 0.25-50 % external 0.25-50 % Formulary Custom (*); OTC ra hemorrhoidal medicated pad 50 % external 50 % Formulary Custom (*); OTC ra hot/cold gel sleeve Formulary OTC ra hydrogen peroxide external solution 3 % Formulary OTC ra ibuprofen cold childrens oral suspension 15-100 mg/5ml Formulary OTC ra isopropyl alcohol wipes external 70 % Formulary OTC ra laxative extra strength oral tablet 17.2 mg 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 medicated wipes pad 50 % external 50 % Formulary Custom (*); OTC ra melatonin sublingual tablet sublingual 1 mg Formulary OTC ra menstrual pain relief tablet 500-25-15 mg oral 500-25- Formulary Custom (*); OTC 15 mg ra miconazole 3 combo pack vaginal kit 200 & 2 mg-% Formulary OTC (9gm) ra mouth pain anesthetic mouth/throat liquid 20 % Formulary OTC 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

99 Drug Name Formulary Status Requirements/Limits ra omeprazole oral tablet delayed release 20 mg Formulary OTC 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 petroleum jelly gel Formulary Custom (*); OTC ra petroleum jelly ointment external Formulary Custom (*); 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 DAILY MOISTURIZING EXTERNAL Formulary OTC LOTION 1.3 % RA RENEWAL SHOWER & BATH EXTERNAL OIL Formulary OTC ra renewal soothing bath packet 100 % external 100 % Formulary Custom (*); 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 neti pot nasal packet 1685-515 mg Formulary OTC ra sleep aid oral liquid 50 mg/30ml 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 eye drops ophthalmic solution 0.03-0.5 % Formulary OTC ra sterile saline nasal mist nasal solution 0.9 % Formulary OTC ra suphedrine day/night combo tablet therapy pack oral Formulary Custom (*); OTC ra triple antibiotic external aerosol 3.5-400-5000 Formulary OTC RA TUGABOOS BABY EXTERNAL OIL Formulary OTC RA TUGABOOS PETROLEUM JELLY GEL Formulary Custom (*); OTC EXTERNAL ra vaginal screening in vitro kit Formulary OTC ra vitamin a & d capsule 5000-400 unit oral 5000-400 unit Formulary Custom (*); 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 racepinephrine hcl powder Formulary RADIACARE POST HEALING EXTERNAL CREAM Formulary OTC ranitidine hcl tablet 150 mg oral (otc) 150 mg Formulary Custom (*) ranitidine hcl tablet 75 mg oral 75 mg Formulary Custom (*); OTC RASH AWAY EXTERNAL AEROSOL 33 % Formulary OTC 100 Drug Name Formulary Status Requirements/Limits RASH RELIEF EXTERNAL LIQUID 20-25 % Formulary OTC raspberry flavor artificial concentrate Formulary OTC raspberry syrup oral syrup Formulary REA-LO EXTERNAL CREAM 30 % Formulary OTC REA-LO EXTERNAL LOTION 15 % Formulary OTC rectacaine rectal ointment 0.25-3-14-71.9 % Formulary OTC RECTICARE EXTERNAL PAD 5-20 % Formulary OTC red yeast rice extract powder Formulary OTC REDNESS RELIEF OPHTHALMIC SOLUTION 0.012- Formulary OTC 0.25 % reeses pinworm medicine oral tablet 180 mg Formulary OTC reeses pinworm medicine suspension 144 (50 base) mg/ml Formulary Custom (*); OTC oral 144 (50 base) mg/ml reeses pinworm medicine tablet 180 mg oral 180 mg Formulary Custom (*); OTC refenesen 400 tablet 400 mg oral 400 mg Formulary Custom (*); OTC REFENESEN CHEST CONG/PAIN RLF ORAL TABLET Formulary OTC 650-400 MG REFENESEN CHEST CONG/PAIN RLF TABLET 650- Formulary Custom (*); OTC 400 MG ORAL 650-400 MG REFENESEN CHST CONG/PAIN PE ORAL TABLET Formulary OTC 10-650-400 MG refenesen dm tablet 400-20 mg oral 400-20 mg Formulary Custom (*); OTC refenesen pe tablet 10-400 mg oral 10-400 mg Formulary Custom (*); OTC REFRESH CELLUVISC GEL 1 % OPHTHALMIC 1 % Formulary Custom (*); OTC REFRESH CELLUVISC OPHTHALMIC SOLUTION 1 % Formulary OTC REFRESH LIQUIGEL GEL 1 % OPHTHALMIC 1 % Formulary Custom (*); OTC REFRESH OPHTHALMIC SOLUTION 1.4-0.6 % Formulary OTC REFRESH OPTIVE ADVANCED OPHTHALMIC Formulary OTC SOLUTION 0.5-1-0.5 % REFRESH OPTIVE ADVANCED PF SOLUTION 0.5-1- Formulary Custom (*); OTC 0.5 % OPHTHALMIC 0.5-1-0.5 % REFRESH OPTIVE ADVANCED SOLUTION 0.5-1-0.5 Formulary Custom (*); OTC % OPHTHALMIC 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 PF SOLUTION 0.5-0.9 % Formulary Custom (*); OTC OPHTHALMIC 0.5-0.9 % REFRESH OPTIVE SENSITIVE OPHTHALMIC Formulary OTC SOLUTION 0.5-0.9 % REFRESH OPTIVE SOLUTION 0.5-0.9 % Formulary Custom (*); OTC OPHTHALMIC 0.5-0.9 % REFRESH PLUS OPHTHALMIC SOLUTION 0.5 % Formulary OTC REFRESH PLUS SOLUTION 0.5 % OPHTHALMIC 0.5 Formulary Custom (*); OTC % REFRESH SOLUTION 1.4-0.6 % OPHTHALMIC 1.4-0.6 Formulary Custom (*); OTC %

101 Drug Name Formulary Status Requirements/Limits REFRESH TEARS SOLUTION 0.5 % OPHTHALMIC 0.5 Formulary Custom (*); OTC % REGENECARE HA EXTERNAL LIQUID 2 % Formulary OTC REGULOID CAPSULE 0.52 GM ORAL 0.52 GM Formulary Custom (*); OTC REGULOID POWDER 28.3 % ORAL 28.3 % Formulary Custom (*); OTC REGULOID POWDER 48.57 % ORAL 48.57 % Formulary Custom (*); OTC REGULOID POWDER 58.6 % ORAL 58.6 % Formulary Custom (*); OTC relagesic oral tablet 29-500 mg Formulary OTC relcof c solution 100-6.3 mg/5ml oral 100-6.3 mg/5ml Formulary Custom (*); OTC RELIADERM EXTERNAL CREAM 0.035-10-25 % Formulary OTC RELIEF PAIN RELIEVING EXTERNAL CREAM 3 % Formulary OTC RELION GLUCOSE SHOT ORAL LIQUID Formulary OTC REMEDY ANTIFUNGAL CREAM 2 % EXTERNAL 2 % Formulary Custom (*); OTC REMEDY ANTIMICROBIAL CLEANSER EXTERNAL Formulary OTC LIQUID 0.12 % REMEDY ANTIMICROBIAL CLEANSER LIQUID 0.12 Formulary Custom (*); OTC % EXTERNAL 0.12 % REMEDY CALAZIME EXTERNAL PASTE 0.4-20.5 % Formulary OTC REMEDY CALAZIME PASTE 0.4-20.5 % EXTERNAL Formulary Custom (*); OTC 0.4-20.5 % REMEDY CLEANSING BODY EXTERNAL LOTION Formulary OTC 1.5 % REMEDY CLEANSING BODY LOTION 1.5 % Formulary Custom (*); OTC EXTERNAL 1.5 % REMEDY MOISTURE BARRIER CREAM 5 % Formulary Custom (*); OTC EXTERNAL 5 % REMEDY NUTRASHIELD CREAM 1 % EXTERNAL 1 Formulary Custom (*); OTC % REMEDY SKIN REPAIR CREAM 1.5 % EXTERNAL 1.5 Formulary Custom (*); OTC % REMEDY SKIN REPAIR EXTERNAL CREAM 1.5 % Formulary OTC REMOVE ADHESIVE REMOVER WIPES EXTERNAL Formulary OTC renal vitamin oral tablet 0.8 mg Formulary OTC RENAMENT ORAL PACKET Formulary OTC rena-vite tablet oral (otc) Formulary Custom (*); OTC RESCON DM SYRUP 30-2-10 MG/5ML ORAL 30-2-10 Formulary Custom (*); OTC MG/5ML RESCON ORAL TABLET 2-60 MG Formulary OTC RESCON TABLET 2-60 MG ORAL 2-60 MG Formulary Custom (*); OTC RESCON-GG LIQUID 5-100 MG/5ML ORAL 5-100 Formulary Custom (*); OTC MG/5ML resorcinol crystals Formulary resorcinol powder Formulary RESOURCE THICKENUP WATER ORAL LIQUID Formulary OTC RESPAIRE-30 CAPSULE 30-150 MG ORAL 30-150 MG Formulary Custom (*); OTC RESPAIRE-30 ORAL CAPSULE 30-150 MG Formulary OTC RESTFULLY SLEEP TABLET 25 MG ORAL 25 MG Formulary Custom (*); OTC 102 Drug Name Formulary Status Requirements/Limits RESTORE CLEANSER & MOISTURIZER EXTERNAL Formulary OTC LIQUID 2 % RESTORE FOAM DRESSING PAD 6"X6" Formulary OTC RESTORE HYDROGEL DRESSING EXTERNAL GEL Formulary OTC 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 rewetting drops solution Formulary OTC REZAMID EXTERNAL LOTION 2-5 % Formulary OTC RHINARIS NASAL SOLUTION 0.2 % Formulary OTC RHINASE NASAL GEL Formulary OTC RHINASE NASAL SOLUTION Formulary OTC riboflavin oral capsule 50 mg Formulary OTC riboflavin powder Formulary riboflavin-5-phosphate sodium powder Formulary RICOLA HERB MOUTH/THROAT LOZENGE 1.1 MG, Formulary OTC 2.6 MG RICOLA HONEY HERB MOUTH/THROAT LOZENGE Formulary OTC 2 MG RICOLA LEMON MINT MOUTH/THROAT LOZENGE Formulary OTC 1.5 MG RISAMINE EXTERNAL OINTMENT 0.44-20.625 % Formulary OTC robafen cf cough/cold oral syrup 5-10-100 mg/5ml Formulary OTC robafen cough capsule 15 mg oral 15 mg Formulary Custom (*); OTC ROBAFEN DM COUGH CLEAR SYRUP 100-10 Formulary Custom (*); OTC MG/5ML ORAL 100-10 MG/5ML robafen dm syrup 100-10 mg/5ml oral 100-10 mg/5ml Formulary Custom (*); OTC robafen syrup 100 mg/5ml oral 100 mg/5ml Formulary Custom (*); OTC ROBATHOL EXTERNAL OIL Formulary OTC ROBITUSSIN CHILD COUGH/COLD CF LIQUID 2.5-5- Formulary Custom (*); OTC 50 MG/5ML ORAL 2.5-5-50 MG/5ML ROBITUSSIN CHILD COUGH/COLD CF ORAL LIQUID Formulary OTC 2.5-5-50 MG/5ML ROBITUSSIN CHILD COUGH/COLD LA LIQUID 1-7.5 Formulary Custom (*); OTC MG/5ML ORAL 1-7.5 MG/5ML ROBITUSSIN CHILD COUGH/COLD LA ORAL Formulary OTC LIQUID 1-7.5 MG/5ML ROBITUSSIN CHILDRENS COUGH LA SYRUP 7.5 Formulary Custom (*); OTC MG/5ML ORAL 7.5 MG/5ML ROBITUSSIN COLD COUGH+ CHEST LIQUID 10-100 Formulary Custom (*); OTC MG/5ML ORAL 10-100 MG/5ML

103 Drug Name Formulary Status Requirements/Limits ROBITUSSIN COLD+FLU DAYTIME CAPSULE 10-5- Formulary Custom (*); OTC 325 MG ORAL 10-5-325 MG ROBITUSSIN COUGH+ CHEST MAX ST LIQUID 10- Formulary Custom (*); OTC 200 MG/5ML ORAL 10-200 MG/5ML ROBITUSSIN COUGH+ CHEST MAX ST ORAL Formulary OTC LIQUID 10-200 MG/5ML ROBITUSSIN COUGH+CHEST CONG DM CAPSULE Formulary Custom (*); OTC 10-200 MG ORAL 10-200 MG ROBITUSSIN COUGH+CHEST CONG DM ORAL Formulary OTC CAPSULE 10-200 MG ROBITUSSIN COUGHGELS ORAL CAPSULE 15 MG Formulary OTC ROBITUSSIN DAY/NIGHT VALUE PAK ORAL Formulary OTC ROBITUSSIN DM ORAL SYRUP 100-10 MG/5ML Formulary OTC ROBITUSSIN LINGERING LA COUGH LIQUID 15 Formulary Custom (*); OTC MG/5ML ORAL 15 MG/5ML ROBITUSSIN MUCUS+CHEST CONGEST LIQUID 100 Formulary Custom (*); OTC MG/5ML ORAL 100 MG/5ML ROBITUSSIN MULTI-SYMPTOM MAX LIQUID 5-10- Formulary Custom (*); OTC 200 MG/5ML ORAL 5-10-200 MG/5ML ROBITUSSIN MULTI-SYMPTOM MAX ORAL LIQUID Formulary OTC 5-10-200 MG/5ML ROBITUSSIN NIGHTTIME COUGH DM LIQUID 12.5- Formulary Custom (*); OTC 30 MG/10ML ORAL 12.5-30 MG/10ML ROBITUSSIN NIGHTTIME COUGH DM ORAL LIQUID Formulary OTC 12.5-30 MG/10ML ROBITUSSIN NT COUGH/COLD/FLU ORAL LIQUID Formulary OTC 6.25-2.5-160 MG/5ML ROBITUSSIN PEAK COLD DM SYRUP 100-10 Formulary Custom (*); OTC MG/5ML ORAL 100-10 MG/5ML ROBITUSSIN PEAK COLD MULTI-SYM LIQUID 5-10- Formulary Custom (*); OTC 100 MG/5ML ORAL 5-10-100 MG/5ML ROBITUSSIN PEAK COLD MULTI-SYM LIQUID 6.25- Formulary Custom (*); OTC 2.5-160 MG/5ML ORAL 6.25-2.5-160 MG/5ML ROBITUSSIN PEAK COLD MULTI-SYM ORAL Formulary OTC LIQUID 5-10-100 MG/5ML ROBITUSSIN PK COLD DAY/NGHT DM ORAL Formulary OTC ROBITUSSIN PK COLD DAY/NGHT MS ORAL Formulary OTC ROLAIDS ORAL TABLET CHEWABLE 550-110 MG Formulary OTC rose oil oil Formulary rose water external liquid Formulary OTC rosin powder Formulary OTC rotex external cream 0.038-4-35 % Formulary OTC ru-hist d oral tablet 4-10 mg Formulary OTC ru-hist d tablet 4-10 mg oral 4-10 mg Formulary Custom (*); OTC rulox suspension 200-200-20 mg/5ml oral 200-200-20 Formulary Custom (*); OTC mg/5ml rutin oral tablet 50 mg Formulary OTC rydex g oral tablet 38.5-398 mg Formulary OTC

104 Drug Name Formulary Status Requirements/Limits RYDEX LIQUID 10-1.33-6.33 MG/5ML ORAL 10-1.33- Formulary Custom (*); OTC 6.33 MG/5ML rymed oral tablet 2-10 mg Formulary OTC rymed tablet 2-10 mg oral 2-10 mg Formulary Custom (*); OTC rynex dm liquid 2.5-1-5 mg/5ml oral 2.5-1-5 mg/5ml Formulary Custom (*); OTC rynex pe elixir 1-2.5 mg/5ml oral 1-2.5 mg/5ml Formulary Custom (*); OTC rynex pse liquid 1-15 mg/5ml oral 1-15 mg/5ml Formulary Custom (*); OTC S2 (RACEPINEPHRINE) NEBULIZATION SOLUTION Formulary Custom (*); OTC 2.25 % INHALATION 2.25 % SAFE TUSSIN PM ORAL LIQUID 3.125-7.5 MG/5ML Formulary OTC SAFELET IV CATHETER Formulary OTC safflower oil oil Formulary SALACTIC FILM EXTERNAL SOLUTION 17 % Formulary OTC SALACTIC FILM SOLUTION 17 % EXTERNAL 17 % Formulary Custom (*); OTC SALEM SUMP TUBE 12FR Formulary salicylic acid powder Formulary saline mist spray solution 0.65 % nasal 0.65 % Formulary Custom (*); OTC SALMON ORAL CAPSULE 200 MG Formulary OTC SAL-PLANT GEL 17 % EXTERNAL 17 % Formulary Custom (*); OTC SALTAIRE SOLUTION NASAL Formulary Custom (*); 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 SANI-SUPP ADULT SUPPOSITORY 2 GM RECTAL 2 Formulary Custom (*); OTC GM SANI-SUPP PEDIATRIC SUPPOSITORY 1.2 GM Formulary Custom (*); OTC RECTAL 1.2 GM SARNA EXTERNAL LOTION 0.5-0.5 % Formulary OTC SASTID SOAP EXTERNAL BAR 3-5 % Formulary OTC SAXENDA SOLUTION PEN-INJECTOR 18 MG/3ML PA; Custom (*); QL (90 ML per 365 Formulary SUBCUTANEOUS 18 MG/3ML days) sb 12hr nasal spray solution 0.05 % nasal 0.05 % Formulary Custom (*); OTC sb allergy & cold pe tablet 12.5-5-325 mg oral 12.5-5-325 Formulary Custom (*); OTC mg sb allergy capsule 25 mg oral 25 mg Formulary Custom (*); OTC sb allergy medicine liquid 12.5 mg/5ml oral 12.5 mg/5ml Formulary Custom (*); OTC sb allergy medicine tablet 25 mg oral 25 mg Formulary Custom (*); OTC sb allergy relief oral tablet dispersible 10 mg Formulary OTC sb allergy relief/nasal decong tablet extended release 24 Formulary Custom (*); OTC hour 10-240 mg oral 10-240 mg sb allergy tablet 10 mg oral 10 mg Formulary Custom (*); OTC sb antacid anti-gas double st suspension 400-400-40 Formulary Custom (*); OTC mg/5ml oral 400-400-40 mg/5ml sb antacid extra strength tablet chewable 750 mg oral 750 Formulary Custom (*); OTC mg

105 Drug Name Formulary Status Requirements/Limits sb antacid tablet chewable 500 mg oral 500 mg Formulary Custom (*); OTC sb antacid/antigas suspension 200-200-20 mg/5ml oral 200- Formulary Custom (*); OTC 200-20 mg/5ml sb anti-diarrhea tablet 2 mg oral 2 mg Formulary Custom (*); OTC sb aspirin tablet 325 mg oral 325 mg Formulary Custom (*); OTC sb aspirin tablet delayed release 81 mg oral 81 mg Formulary Custom (*); OTC sb bismuth maximum strength suspension 525 mg/15ml oral Formulary Custom (*); OTC 525 mg/15ml sb bismuth suspension 262 mg/15ml oral 262 mg/15ml Formulary Custom (*); OTC sb bismuth tablet 262 mg oral 262 mg Formulary Custom (*); OTC sb childrens ibuprofen suspension 100 mg/5ml oral 100 Formulary Custom (*); OTC mg/5ml sb chlorpheniramine tablet 4 mg oral 4 mg Formulary Custom (*); OTC sb cold & cough hbp tablet 4-30 mg oral 4-30 mg Formulary Custom (*); OTC sb cold & flu hbp oral tablet 2-325 mg Formulary OTC sb cold head congestion severe tablet 5-10-200-325 mg oral Formulary Custom (*); OTC 5-10-200-325 mg sb cold multi-symptom severe tablet 5-10-200-325 mg oral Formulary Custom (*); OTC 5-10-200-325 mg sb cough control capsule 15 mg oral 15 mg Formulary Custom (*); OTC sb cough control cf liquid 5-10-100 mg/5ml oral 5-10-100 Formulary Custom (*); OTC mg/5ml sb cough control pe oral syrup 30-100 mg/5ml Formulary OTC sb cough control syrup 100 mg/5ml oral 100 mg/5ml Formulary Custom (*); OTC sb cough relief liquid 15 mg/5ml oral 15 mg/5ml Formulary Custom (*); OTC sb coughtab tablet 200 mg oral 200 mg Formulary Custom (*); OTC sb ear wax remover solution 6.5 % otic 6.5 % Formulary Custom (*); OTC sb fib lax orange oral powder 30 % Formulary OTC sb flu maximum strength hbp tablet 15-500-2 mg oral 15- Formulary Custom (*); OTC 500-2 mg sb gas relief suspension 40 mg/0.6ml oral 40 mg/0.6ml Formulary Custom (*); OTC sb ibuprofen tablet 200 mg oral 200 mg Formulary Custom (*); OTC sb itch relief max st solution 2 % external 2 % Formulary Custom (*); OTC sb lice treatment external liquid 0.3-3 % Formulary OTC sb loratadine tablet 10 mg oral 10 mg Formulary Custom (*); OTC sb low dose asa ec tablet delayed release 81 mg oral 81 mg Formulary Custom (*); OTC sb milk of magnesia suspension 400 mg/5ml oral 400 Formulary Custom (*); OTC mg/5ml sb motion sickness tablet 50 mg oral 50 mg Formulary Custom (*); OTC sb naproxen sodium tablet 220 mg oral 220 mg Formulary Custom (*); OTC sb non-aspirin tablet chewable 80 mg oral 80 mg Formulary Custom (*); OTC sb pain reliever childrens suspension 160 mg/5ml oral 160 Formulary Custom (*); OTC mg/5ml sb severe cold pe tablet 12.5-5-325 mg oral 12.5-5-325 mg Formulary Custom (*); OTC sb sinus & allergy max st tablet 4-10 mg oral 4-10 mg Formulary Custom (*); OTC

106 Drug Name Formulary Status Requirements/Limits sb sinus congest/pain day/nght 2-5-325 & 5-325 mg oral 2- Formulary Custom (*); OTC 5-325 & 5-325 mg sb sinus congestion/pain day tablet 5-325 mg oral 5-325 mg Formulary Custom (*); OTC sb sleep tablet 25 mg oral 25 mg Formulary Custom (*); OTC sb stool softener oral capsule 240 mg Formulary OTC sb triple antibiotic ointment 3.5-400-5000 external 3.5-400- Formulary Custom (*); OTC 5000 scarcin external cream Formulary OTC SCHOLLS ODOR DESTROYERS EXTERNAL Formulary OTC POWDER SCOT-TUSSIN DIABETES CF LIQUID 10 MG/5ML Formulary Custom (*); OTC ORAL 10 MG/5ML SCOT-TUSSIN DIABETES CF ORAL LIQUID 10 Formulary OTC MG/5ML SCOT-TUSSIN DM LIQUID 2-15 MG/5ML ORAL 2-15 Formulary Custom (*); OTC MG/5ML scot-tussin expectorant liquid 100 mg/5ml oral 100 mg/5ml Formulary Custom (*); OTC SCOT-TUSSIN ORAL LIQUID Formulary OTC SCOT-TUSSIN SENIOR LIQUID 15-200 MG/5ML ORAL Formulary Custom (*); OTC 15-200 MG/5ML SCYTERA EXTERNAL FOAM 2 % Formulary OTC se-100 oral capsule 100 mcg Formulary OTC SEA BOND DENTURE BRUSH Formulary OTC sea soft nasal mist solution 0.65 % nasal 0.65 % Formulary Custom (*); OTC sebex external shampoo 2-2 % Formulary OTC sebex shampoo 2-2 % external 2-2 % Formulary Custom (*); OTC SEBUDERM EXTERNAL GEL Formulary SEBULEX EXTERNAL SHAMPOO 2-2 % Formulary OTC SECURA ANTIFUNGAL CREAM 2 % EXTERNAL 2 % Formulary Custom (*); OTC SECURA ANTIFUNGAL EXTRA THICK CREAM 2 % Formulary Custom (*); OTC EXTERNAL 2 % SECURA DIMETHICONE PROTECTANT CREAM 5 % Formulary Custom (*); OTC EXTERNAL 5 % SECURA EPC SKIN CARE STARTER EXTERNAL KIT Formulary OTC 0.13 & 30.6 % SECURA EXTRA PROTECTIVE EXTERNAL CREAM Formulary OTC 30.6 % SECURA MOISTURIZING CLEANSER EXTERNAL Formulary OTC LIQUID 0.13 % SECURA MOISTURIZING CLEANSER LIQUID 0.13 % Formulary Custom (*); OTC EXTERNAL 0.13 % SECURA PERSONAL CLEANSER EXTERNAL LIQUID Formulary OTC 0.13 % SECURA PERSONAL CLEANSER LIQUID 0.13 % Formulary Custom (*); OTC EXTERNAL 0.13 % SECURA PERSONAL SKIN CARE EXTERNAL KIT Formulary OTC 0.13 & 98.789 %

107 Drug Name Formulary Status Requirements/Limits SECURA PROTECTIVE CREAM 10 % EXTERNAL 10 Formulary Custom (*); OTC % SECURA PROTECTIVE OINTMENT 98.789 % Formulary Custom (*); OTC EXTERNAL 98.789 % SECURA TOTAL BODY CLEANSER EXTERNAL Formulary OTC FOAM 0.13 % SECURA TOTAL BODY CLEANSER FOAM 0.13 % Formulary Custom (*); OTC EXTERNAL 0.13 % SECURA TWO-STEP EXTERNAL KIT 0.13 & 10 % Formulary OTC SECURI-T FLEXIBLE WAFER/FLANGE WAFER Formulary OTC 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 oral tablet 50 mcg Formulary OTC SELSUN BLUE DEEP CLEANSING EXTERNAL Formulary OTC SHAMPOO 3 % senexon liquid 8.8 mg/5ml oral 8.8 mg/5ml Formulary Custom (*); OTC senexon tablet 8.6 mg oral 8.6 mg Formulary Custom (*); OTC SENEXON-S TABLET 8.6-50 MG ORAL 8.6-50 MG Formulary Custom (*); OTC senna lax tablet 8.6 mg oral 8.6 mg Formulary Custom (*); OTC senna leaves oral leaves Formulary OTC senna oral capsule 8.6 mg Formulary OTC senna oral syrup 176 mg/5ml Formulary OTC senna plus tablet 8.6-50 mg oral 8.6-50 mg Formulary Custom (*); OTC SENNA PROMPT ORAL CAPSULE 9-500 MG Formulary OTC senna s oral tablet 8.6-50 mg Formulary OTC senna syrup 8.8 mg/5ml oral (otc) 8.8 mg/5ml Formulary Custom (*) senna tablet 8.6 mg oral 8.6 mg Formulary Custom (*); OTC senna-docusate sodium tablet 8.6-50 mg oral 8.6-50 mg Formulary Custom (*); OTC SENNALAX-S TABLET 8.6-50 MG ORAL 8.6-50 MG Formulary Custom (*); OTC senna-s tablet 8.6-50 mg oral 8.6-50 mg Formulary Custom (*); OTC SENOKOT ORAL TABLET 8.6 MG Formulary OTC 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 % SENSI-CARE PROTECTIVE BARRIER OINTMENT 49- Formulary Custom (*); OTC 15 % EXTERNAL 49-15 % SENSITIVE EYES ENZYME CLEANER TABLET Formulary OTC EFFERVESCENT SENSODYNE MAXIMUM STRENGTH DENTAL GEL Formulary OTC SENSODYNE REPAIR & PROTECT MOUTH/THROAT Formulary OTC PASTE 0.454 % SE-PLUS PROTEIN ORAL TABLET 200 MCG Formulary OTC severe cold & flu day/night oral liquid therapy pack Formulary OTC

108 Drug Name Formulary Status Requirements/Limits severe cold oral tablet 12.5-5-325 mg Formulary OTC shampoo & body wash rinse-free external foam Formulary OTC SHAMROCK LATEX EXAM GLOVES Formulary OTC SHARPSAFETY SAFETY IN ROOM Formulary OTC shea butter Formulary SHUR-SEAL CONTRACEPTIVE VAGINAL GEL 2 % Formulary OTC siberian ginseng oral capsule 250 mg Formulary OTC signacal oral tablet Formulary OTC silace oral liquid 150 mg/15ml Formulary OTC siladryl allergy liquid 12.5 mg/5ml oral 12.5 mg/5ml Formulary Custom (*); OTC SIL-K PAD SMALL EXTERNAL Formulary silphen cough syrup 12.5 mg/5ml oral 12.5 mg/5ml Formulary Custom (*); OTC siltussin dm das liquid 100-10 mg/5ml oral 100-10 mg/5ml Formulary Custom (*); OTC siltussin sa syrup 100 mg/5ml oral 100 mg/5ml Formulary Custom (*); OTC siltussin-dm alcohol free syrup 100-10 mg/5ml oral 100-10 Formulary Custom (*); OTC mg/5ml crystals Formulary simethicone capsule 180 mg oral 180 mg Formulary Custom (*); OTC simethicone liquid Formulary simethicone suspension 40 mg/0.6ml oral 40 mg/0.6ml Formulary Custom (*); OTC simethicone tablet chewable 80 mg oral 80 mg Formulary Custom (*); OTC SIMILAC STERILIZED WATER ORAL LIQUID Formulary OTC SIMILASAN DRY EYE RELIEF OPHTHALMIC Formulary OTC SOLUTION SIMILASAN NASAL ALLERGY RELIEF NASAL Formulary OTC LIQUID simple syrup oral syrup Formulary SINADRIN PE COMPLETE SINUS REL ORAL TABLET Formulary OTC 2-10-650 MG sinus & allergy oral tablet 4-10 mg Formulary OTC sinus & congestion day/night oral Formulary OTC sinus congestion/pain daytime oral tablet 5-325 mg Formulary OTC sinus congestion/pain daytime tablet 5-325 mg oral 5-325 Formulary Custom (*); OTC mg sinus congestion/pain night tablet 2-5-325 mg oral 2-5-325 Formulary Custom (*); OTC mg sinus nasal spray solution 0.05 % nasal 0.05 % Formulary Custom (*); OTC sinus relief nasal spray solution 0.05 % nasal 0.05 % Formulary Custom (*); OTC SINUS RINSE BOTTLE KIT PACKET NASAL Formulary Custom (*); OTC SINUS RINSE KIT PACKET NASAL Formulary Custom (*); OTC SINUS RINSE KIT PEDIATRIC PACKET NASAL Formulary Custom (*); OTC SINUS RINSE PEDIATRIC STARTER PACKET NASAL Formulary Custom (*); OTC siterol external patch 3.99-1 % Formulary OTC skin protectant external cream 12 % Formulary OTC skin tag remover external liquid Formulary OTC

109 Drug Name Formulary Status Requirements/Limits SKYLA INTRAUTERINE INTRAUTERINE DEVICE Formulary 13.5 MG sleep aid tablet 25 mg oral 25 mg Formulary Custom (*); OTC sleep tabs tablet 25 mg oral 25 mg Formulary Custom (*); 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 magnesium/calcium oral tablet delayed release 70-117 Formulary OTC mg slow magnesium/calcium tablet delayed release 70-117 mg Formulary Custom (*); OTC oral 70-117 mg slow release iron oral tablet extended release 47.5 mg Formulary OTC SLOW-MAG ORAL TABLET DELAYED RELEASE Formulary OTC 71.5-119 MG sm 12 hour sinus decongestant tablet extended release 12 Formulary Custom (*); OTC hour 120 mg oral 120 mg sm 12-hour no drip solution 0.05 % nasal 0.05 % Formulary Custom (*); OTC sm 3-day vaginal cream 2 % vaginal 2 % Formulary Custom (*); OTC sm 8 hour pain relief tablet extended release 650 mg oral Formulary Custom (*); OTC 650 mg sm acid reducer max st tablet 150 mg oral 150 mg Formulary Custom (*); OTC sm acid reducer max st tablet 20 mg oral 20 mg Formulary Custom (*); OTC sm acid reducer tablet 10 mg oral 10 mg Formulary Custom (*); OTC sm acid reducer tablet 200 mg oral 200 mg Formulary Custom (*); OTC sm acid reducer tablet 75 mg oral 75 mg Formulary Custom (*); OTC sm all day allergy childrens solution 5 mg/5ml oral 5 Formulary Custom (*); OTC mg/5ml sm all day allergy tablet 10 mg oral 10 mg Formulary Custom (*); OTC sm all day allergy-d tablet extended release 12 hour 5-120 Formulary Custom (*); OTC mg oral 5-120 mg sm all day pain relief tablet 220 mg oral 220 mg Formulary Custom (*); OTC sm allergy 4 hour tablet 4 mg oral 4 mg Formulary Custom (*); OTC sm allergy maximum strength cream 2 % external 2 % Formulary Custom (*); OTC sm allergy multi-symptom tablet 2-5-325 mg oral 2-5-325 Formulary Custom (*); OTC mg sm allergy relief capsule 25 mg oral 25 mg Formulary Custom (*); OTC sm allergy relief childrens liquid 12.5 mg/5ml oral 12.5 Formulary Custom (*); OTC mg/5ml sm allergy relief liquid 12.5 mg/5ml oral 12.5 mg/5ml Formulary Custom (*); OTC sm allergy relief tablet 1.34 mg oral 1.34 mg Formulary Custom (*); OTC sm allergy relief tablet 25 mg oral 25 mg Formulary Custom (*); OTC sm antacid advanced max st suspension 400-400-40 mg/5ml Formulary Custom (*); OTC oral 400-400-40 mg/5ml sm antacid anti-gas ex st suspension 400-400-40 mg/5ml Formulary Custom (*); OTC oral 400-400-40 mg/5ml

110 Drug Name Formulary Status Requirements/Limits sm antacid anti-gas suspension 200-200-20 mg/5ml oral Formulary Custom (*); OTC 200-200-20 mg/5ml sm antacid extra strength tablet chewable 160-105 mg oral Formulary Custom (*); OTC 160-105 mg sm antacid maximum strength suspension 400-400-40 Formulary Custom (*); OTC mg/5ml oral 400-400-40 mg/5ml sm antacid/antigas suspension 200-200-20 mg/5ml oral Formulary Custom (*); OTC 200-200-20 mg/5ml sm antibiotic ointment 500 unit/gm external 500 unit/gm Formulary Custom (*); OTC sm antibiotic plus pain relief cream 3.5-10000-10 external Formulary Custom (*); OTC 3.5-10000-10 sm anti-dandruff coal tar shampoo 0.5 % external 0.5 % Formulary Custom (*); OTC sm anti-diarrheal capsule 2 mg oral 2 mg Formulary Custom (*); OTC sm anti-diarrheal tablet 2 mg oral 2 mg Formulary Custom (*); OTC sm antifungal clotrimazole cream 1 % external 1 % Formulary Custom (*); OTC sm antifungal miconazole cream 2 % external 2 % Formulary Custom (*); OTC sm antifungal tolnaftate cream 1 % external 1 % Formulary Custom (*); OTC sm anti-itch extra strength cream 2-0.1 % external 2-0.1 % Formulary Custom (*); OTC sm arthritis pain relief tablet extended release 650 mg oral Formulary Custom (*); OTC 650 mg sm artificial tears solution ophthalmic Formulary Custom (*); OTC sm aspirin ec tablet delayed release 325 mg oral 325 mg Formulary Custom (*); OTC sm athletes foot cream 1 % external 1 % Formulary Custom (*); OTC sm biotin oral tablet 5000 mcg Formulary OTC sm calamine external lotion Formulary OTC sm calamine lotion external Formulary Custom (*); OTC sm calamine phenolated lotion external Formulary Custom (*); OTC sm calcium antacid ex st tablet chewable 750 mg oral 750 Formulary Custom (*); OTC mg sm calcium antacid tablet chewable 500 mg oral 500 mg Formulary Custom (*); OTC sm calcium antacid ultra st tablet chewable 1000 mg oral Formulary Custom (*); OTC 1000 mg sm caldyphen clear external lotion 1-0.1 % Formulary OTC sm caldyphen lotion 1-8 % external 1-8 % Formulary Custom (*); OTC sm camphor spirit spirit Formulary OTC sm chest congestion relief dm oral tablet 20-400 mg Formulary OTC sm chest congestion relief dm tablet 20-400 mg oral 20-400 Formulary Custom (*); OTC mg sm chest congestion relief pe tablet 10-400 mg oral 10-400 Formulary Custom (*); OTC mg sm chest congestion relief tablet 400 mg oral 400 mg Formulary Custom (*); OTC sm childrens ibuprofen suspension 100 mg/5ml oral 100 Formulary Custom (*); OTC mg/5ml sm childrens loratadine syrup 5 mg/5ml oral 5 mg/5ml Formulary Custom (*); OTC sm childrens plus ms cold suspension 2.5-1-5-160 mg/5ml Formulary Custom (*); OTC oral 2.5-1-5-160 mg/5ml

111 Drug Name Formulary Status Requirements/Limits SM CLEARLAX POWDER 17 GM/SCOOP ORAL 17 Formulary Custom (*); OTC GM/SCOOP sm clotrimazole vaginal cream 1 % vaginal 1 % Formulary Custom (*); OTC sm cold & allergy childrens elixir 1-2.5 mg/5ml oral 1-2.5 Formulary Custom (*); OTC mg/5ml sm cold & cough dm childrens liquid 2.5-1-5 mg/5ml oral Formulary Custom (*); OTC 2.5-1-5 mg/5ml sm cold & flu severe tablet 5-10-200-325 mg oral 5-10-200- Formulary Custom (*); OTC 325 mg sm cold head congestion tablet 5-10-200-325 mg oral 5-10- Formulary Custom (*); OTC 200-325 mg SM CORAL CALCIUM ORAL TABLET 1000 (390 CA) Formulary OTC MG sm cough relief syrup 15 mg/5ml oral 15 mg/5ml Formulary Custom (*); OTC sm day time cold & flu relief liquid 10-5-325 mg/15ml oral Formulary Custom (*); OTC 10-5-325 mg/15ml sm day time oral capsule 10-5-325 mg Formulary OTC sm day time pe cold/flu relief capsule 10-5-325 mg oral 10- Formulary Custom (*); OTC 5-325 mg sm daytime cold & cough child oral solution 2.5-5 mg/5ml Formulary OTC sm double antibiotic ointment 500-10000 unit/gm external Formulary Custom (*); OTC 500-10000 unit/gm sm ear drops solution 6.5 % otic 6.5 % Formulary Custom (*); OTC sm epsom salt granules oral Formulary Custom (*); OTC sm ethyl alcohol (rubbing) solution 70 % Formulary OTC sm ethyl alcohol solution 70 % 70 % Formulary Custom (*); OTC sm eye drops solution 0.05 % ophthalmic 0.05 % Formulary Custom (*); OTC sm eye drops solution 0.05-0.1-1-1 % ophthalmic 0.05-0.1- Formulary Custom (*); OTC 1-1 % sm eye itch relief solution 0.025 % ophthalmic 0.025 % Formulary Custom (*); OTC sm fexofenadine hcl tablet 180 mg oral 180 mg Formulary Custom (*); OTC sm fexofenadine hcl tablet 60 mg oral 60 mg Formulary Custom (*); OTC sm fiber laxative tablet 500 mg oral 500 mg Formulary Custom (*); OTC sm flu relief therapy night liquid 12.5-5-325 mg/15ml oral Formulary Custom (*); OTC 12.5-5-325 mg/15ml sm fruit coolers mouth/throat lozenge 7 mg Formulary OTC sm gas relief antiflatuent capsule 180 mg oral 180 mg Formulary Custom (*); OTC sm gas relief extra strength capsule 125 mg oral 125 mg Formulary Custom (*); OTC sm gas relief infants suspension 20 mg/0.3ml oral 20 Formulary Custom (*); OTC mg/0.3ml sm gas relief tablet chewable 80 mg oral 80 mg Formulary Custom (*); OTC sm glucosamine chondroitin tablet oral Formulary Custom (*); 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 glycerin pediatric suppository 1.2 gm rectal 1.2 gm Formulary Custom (*); OTC sm glycerin pediatric suppository 80.7 % rectal 80.7 % Formulary Custom (*); OTC

112 Drug Name Formulary Status Requirements/Limits sm hemorrhoidal suppository 0.25 % rectal 0.25 % Formulary Custom (*); OTC sm humidifier/cool mist Formulary OTC sm hydrocortisone-aloe max st cream 1 % external 1 % Formulary Custom (*); OTC sm ibuprofen capsule 200 mg oral 200 mg Formulary Custom (*); OTC sm ibuprofen cold & sinus tablet 30-200 mg oral 30-200 mg Formulary Custom (*); OTC sm ibuprofen ib tablet 200 mg oral 200 mg Formulary Custom (*); OTC sm ibuprofen ib tablet chewable 100 mg oral 100 mg Formulary Custom (*); OTC sm ibuprofen pm tablet 200-38 mg oral 200-38 mg Formulary Custom (*); OTC sm ibuprofen tablet 200 mg oral 200 mg Formulary Custom (*); OTC sm infants ibuprofen suspension 50 mg/1.25ml oral 50 Formulary Custom (*); OTC mg/1.25ml sm iodides external tincture Formulary OTC sm iodine tincture external tincture Formulary OTC sm isopropyl alcohol solution 50 % 50 % Formulary Custom (*); OTC sm isopropyl alcohol solution 70 % 70 % Formulary Custom (*); OTC sm isopropyl alcohol solution 91 % 91 % Formulary Custom (*); OTC sm isopropyl alcohol solution 99 % 99 % Formulary Custom (*); OTC sm lansoprazole capsule delayed release 15 mg oral 15 mg Formulary Custom (*); OTC sm laxative suppository 10 mg rectal 10 mg Formulary Custom (*); OTC sm lice killing max strength shampoo 0.33-4 % external Formulary Custom (*); OTC 0.33-4 % sm lice solution kit 0.33-4-0.5 % combination 0.33-4-0.5 % Formulary Custom (*); OTC sm lice treatment lotion 1 % external 1 % Formulary Custom (*); OTC sm loperamide hcl suspension 1 mg/7.5ml oral 1 mg/7.5ml Formulary Custom (*); OTC sm loratadine allergy relief tablet dispersible 10 mg oral 10 Formulary Custom (*); OTC mg sm loratadine d tablet extended release 12 hour 5-120 mg Formulary Custom (*); OTC oral 5-120 mg sm lorata-dine d tablet extended release 24 hour 10-240 mg Formulary Custom (*); OTC oral 10-240 mg sm loratadine syrup 5 mg/5ml oral 5 mg/5ml Formulary Custom (*); OTC sm loratadine tablet 10 mg oral 10 mg Formulary Custom (*); OTC sm lubricant eye drops solution 0.4-0.3 % ophthalmic 0.4- Formulary Custom (*); OTC 0.3 % sm medicated chest rub ointment 4.73-1.2-2.6 % external Formulary Custom (*); OTC 4.73-1.2-2.6 % sm melatonin oral tablet dispersible 5 mg Formulary OTC sm miconazole 3 kit 200 & 2 mg-% (9gm) vaginal 200 & 2 Formulary Custom (*); OTC mg-% (9gm) sm miconazole 7 cream 2 % vaginal 2 % Formulary Custom (*); OTC sm miconazole 7 suppository 100 mg vaginal 100 mg Formulary Custom (*); OTC sm migraine relief tablet 250-250-65 mg oral 250-250-65 Formulary Custom (*); OTC mg sm milk of magnesia suspension 1200 mg/15ml oral 1200 Formulary Custom (*); OTC mg/15ml sm motion sickness relief tablet 50 mg oral 50 mg Formulary Custom (*); OTC

113 Drug Name Formulary Status Requirements/Limits sm motion sickness tablet 25 mg oral 25 mg Formulary Custom (*); OTC sm mucus er tablet extended release 12 hour 600 mg oral Formulary Custom (*); OTC 600 mg sm mucus relief cough children liquid 5-100 mg/5ml oral 5- Formulary Custom (*); OTC 100 mg/5ml sm naproxen sodium capsule 220 mg oral 220 mg Formulary Custom (*); OTC sm naproxen sodium tablet 220 mg oral 220 mg Formulary Custom (*); OTC sm nasal decongestant max st tablet 30 mg oral 30 mg Formulary Custom (*); OTC sm nasal decongestant pe tablet 10 mg oral 10 mg Formulary Custom (*); OTC sm nasal pump spray mist solution 0.05 % nasal 0.05 % Formulary Custom (*); OTC sm nasal spray 12 hour solution 0.05 % nasal 0.05 % Formulary Custom (*); OTC sm nasal spray moisturizing solution 0.05 % nasal 0.05 % Formulary Custom (*); OTC sm nasal spray saline solution 0.65 % nasal 0.65 % Formulary Custom (*); OTC sm nasal spray sinus solution 0.05 % nasal 0.05 % Formulary Custom (*); OTC sm nasal spray solution 0.05 % nasal 0.05 % Formulary Custom (*); OTC sm natural herb cough drops mouth/throat lozenge 4.8 mg Formulary OTC sm 4 mg mouth/throat 4 mg Formulary Custom (*); OTC sm nicotine lozenge 2 mg mouth/throat 2 mg Formulary Custom (*); OTC sm nicotine patch 24 hour 14 mg/24hr transdermal 14 Formulary Custom (*); OTC mg/24hr sm nicotine patch 24 hour 21 mg/24hr transdermal 21 Formulary Custom (*); OTC mg/24hr sm nicotine patch 24 hour 7 mg/24hr transdermal 7 Formulary Custom (*); OTC mg/24hr sm nicotine polacrilex gum 2 mg mouth/throat 2 mg Formulary Custom (*); OTC sm nicotine polacrilex gum 4 mg mouth/throat 4 mg Formulary Custom (*); OTC sm nicotine polacrilex lozenge 4 mg mouth/throat 4 mg Formulary Custom (*); OTC sm nite time cold & flu liquid 15-6.25-325 mg/15ml oral 15- Formulary Custom (*); OTC 6.25-325 mg/15ml sm nite time cold & flu relief capsule 15-6.25-325 mg oral Formulary Custom (*); OTC 15-6.25-325 mg sm nite time cold & flu relief liquid 15-6.25-500 mg/15ml Formulary Custom (*); OTC oral 15-6.25-500 mg/15ml sm nite time cough liquid 6.25-15 mg/15ml oral 6.25-15 Formulary Custom (*); OTC mg/15ml sm nose drops nasal decongest solution 1 % nasal 1 % Formulary Custom (*); OTC sm omega-3-6-9 fatty acids oral capsule Formulary OTC sm omeprazole tablet delayed release 20 mg oral 20 mg Formulary Custom (*); OTC sm one daily prenatal oral 28-0.8 & 440 mg Formulary OTC sm ovulation predictor in vitro kit Formulary OTC sm pain & fever childrens suspension 160 mg/5ml oral 160 Formulary Custom (*); OTC mg/5ml sm pain & fever infants suspension 160 mg/5ml oral 160 Formulary Custom (*); OTC mg/5ml sm pain relief tablet 500 mg oral 500 mg Formulary Custom (*); OTC sm pain relief/menthol external gel Formulary OTC sm pain reliever pm ex st tablet 25-500 mg oral 25-500 mg Formulary Custom (*); OTC 114 Drug Name Formulary Status Requirements/Limits sm povidone-iodine solution 10 % external 10 % Formulary Custom (*); OTC sm prenatal vitamins oral tablet 28-0.8 mg Formulary OTC sm redness relief solution 0.012-0.2 % ophthalmic 0.012- Formulary Custom (*); OTC 0.2 % sm sleep aid maximum strength capsule 50 mg oral 50 mg Formulary Custom (*); OTC sm sleep aid night time tablet 25 mg oral 25 mg Formulary Custom (*); OTC sm sleep aid tablet 25 mg oral 25 mg Formulary Custom (*); OTC sm slow release iron oral tablet extended release 143 (45 Formulary OTC fe) mg sm sore throat spray liquid 1.4 % mouth/throat 1.4 % Formulary Custom (*); OTC sm stay awake maximum strength tablet 200 mg oral 200 Formulary Custom (*); OTC mg sm stomach relief max st suspension 525 mg/15ml oral 525 Formulary Custom (*); OTC mg/15ml sm stomach relief suspension 262 mg/15ml oral 262 Formulary Custom (*); OTC mg/15ml sm stomach relief suspension 527 mg/30ml oral 527 Formulary Custom (*); OTC mg/30ml sm stomach relief tablet 262 mg oral 262 mg Formulary Custom (*); OTC sm stomach relief tablet chewable 262 mg oral 262 mg Formulary Custom (*); OTC sm stool softener capsule 100 mg oral 100 mg Formulary Custom (*); OTC sm stool softener capsule 250 mg oral 250 mg Formulary Custom (*); OTC sm tioconazole-1 ointment 6.5 % vaginal 6.5 % Formulary Custom (*); OTC sm triple antibiotic max st ointment 1 % external 1 % Formulary Custom (*); OTC sm triple antibiotic ointment 3.5-400-5000 external 3.5- Formulary Custom (*); OTC 400-5000 sm tussin cf liquid 5-10-100 mg/5ml oral 5-10-100 mg/5ml Formulary Custom (*); OTC sm tussin cough/chest congest syrup 100-10 mg/5ml oral Formulary Custom (*); OTC 100-10 mg/5ml sm tussin dm syrup 100-10 mg/5ml oral 100-10 mg/5ml Formulary Custom (*); OTC sm tussin syrup 100 mg/5ml oral 100 mg/5ml Formulary Custom (*); OTC sm vitamin b1 oral tablet 100 mg Formulary OTC sm vitamin c tablet 250 mg oral 250 mg Formulary Custom (*); OTC sm vitamin e capsule 1000 unit oral 1000 unit Formulary Custom (*); OTC sm witch hazel liquid external Formulary Custom (*); OTC sm witch hazel solution 86 % external 86 % Formulary Custom (*); OTC smoothfit cuff Formulary OTC sochlor ophthalmic solution 5 % Formulary OTC sodium acetate powder Formulary sodium ascorbate powder Formulary sodium benzoate powder Formulary sodium bicarbonate oral powder Formulary sodium bicarbonate oral tablet 325 mg Formulary OTC sodium bicarbonate powder Formulary sodium bicarbonate tablet 325 mg oral 325 mg Formulary Custom (*); OTC sodium bicarbonate tablet 650 mg oral 650 mg Formulary Custom (*); OTC 115 Drug Name Formulary Status Requirements/Limits sodium bisulfite granules Formulary sodium borate decahydrate powder Formulary sodium bromide granules Formulary sodium butyrate powder Formulary sodium chloride (hypertonic) ointment 5 % ophthalmic 5 % Formulary Custom (*); OTC sodium chloride (hypertonic) ophthalmic ointment 5 % Formulary OTC sodium chloride (hypertonic) solution 5 % ophthalmic 5 % Formulary Custom (*); OTC sodium chloride granules Formulary sodium chloride oral solution 4 meq/ml Formulary OTC sodium chloride oral tablet 1 gm Formulary OTC sodium chloride tablet 1 gm oral 1 gm Formulary Custom (*); OTC sodium citrate dihydrate granules Formulary OTC sodium citrate granules Formulary sodium hydroxide pellet Formulary sodium metabisulfite granules Formulary sodium nitrate granules Formulary OTC sodium nitrite granules Formulary sodium perborate crystals Formulary OTC sodium perborate granules Formulary OTC sodium perborate powder Formulary sodium phosphate dibasic granules Formulary sodium phosphate monobasic powder Formulary sodium propionate powder Formulary sodium silicate solution 40 % Formulary OTC sodium starch glycolate powder Formulary OTC sodium sulfite powder Formulary SOLBAR SPF30 EXTERNAL GEL Formulary OTC SOLUBLE FIBER THERAPY POWDER ORAL Formulary Custom (*); 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 FREE MEDSEPTIC OINTMENT Formulary Custom (*); OTC EXTERNAL SOOTHE & COOL FREE MOISTURE OINTMENT Formulary Custom (*); OTC EXTERNAL SOOTHE & COOL FREE SKIN PASTE OINTMENT Formulary Custom (*); OTC EXTERNAL SOOTHE & COOL INZO ANTIFUNGAL CREAM 2 % Formulary Custom (*); OTC EXTERNAL 2 % SOOTHE & COOL INZO BARRIER CREAM 5-5 % Formulary Custom (*); OTC EXTERNAL 5-5 % SOOTHE & COOL INZO BARRIER EXTERNAL Formulary OTC CREAM 5-5 % SOOTHE & COOL PROTECT MOISTURE OINTMENT Formulary Custom (*); OTC EXTERNAL sorbic acid powder Formulary 116 Drug Name Formulary Status Requirements/Limits sorbitol oral solution 70 % Formulary OTC sorbitol rectal solution 70 % Formulary OTC sorbitol solution Formulary sorbitol solution 70 % (otc) 70 % Formulary Custom (*) sorbutuss nr oral liquid 15-150-127.5 mg/7.5ml Formulary OTC sorbutuss oral liquid 10-100-85-35 mg/5ml Formulary OTC sore throat & cough lozenges lozenge 5-7.5 mg Formulary Custom (*); OTC mouth/throat 5-7.5 mg sore throat lozenge 15-3.6 mg mouth/throat 15-3.6 mg Formulary Custom (*); OTC sore throat lozenges mouth/throat lozenge 6-10 mg Formulary OTC sore throat spray liquid 1.4 % mouth/throat 1.4 % Formulary Custom (*); OTC sore throat spray mouth/throat liquid† Formulary OTC soya lecithin oral capsule 1200 mg Formulary OTC soybean oil oil Formulary spearmint oil oil Formulary sportbalm external lotion Formulary OTC SPORTSCREME EXTERNAL CREAM 10 % Formulary OTC spot acne treatment external cream 2.5 % Formulary OTC SPRAYZOIN EXTERNAL LIQUID Formulary OTC squaric acid di-n-butyl ester powder Formulary OTC ST JOSEPH COUGH ORAL SYRUP 7.5 MG/5ML Formulary OTC STAFLEX ORAL TABLET 2-250 MG Formulary OTC STAFLEX TABLET 2-250 MG ORAL 2-250 MG Formulary Custom (*); OTC stahist ad liquid 25-60 mg/5ml oral 25-60 mg/5ml Formulary Custom (*); OTC stahist ad oral liquid 25-60 mg/5ml Formulary OTC stahist ad oral tablet 25-60 mg Formulary OTC stahist ad tablet 25-60 mg oral 25-60 mg Formulary Custom (*); OTC STANBACK HEADACHE ORAL PACKET Formulary OTC 650-200-32 MG STATUSS GREEN LIQUID 9-30-12.5 MG/5ML ORAL 9- Formulary Custom (*); OTC 30-12.5 MG/5ML stay awake maximum strength tablet 200 mg oral 200 mg Formulary Custom (*); OTC stay awake tablet 200 mg oral 200 mg Formulary Custom (*); OTC stearic acid powder Formulary stearyl alcohol powder Formulary STERILE LUBRICANT OPHTHALMIC LIQUID 0.7 % Formulary OTC sterile pad 3"x3" Formulary OTC STERI-STRIP COMPOUND BENZOIN EXTERNAL Formulary OTC TINCTURE STERI-TAMP SEALS BOTTLES/VIALS Formulary OTC STERI-TAMP SEALS/BAGS Formulary OTC STERI-TAMP SEALS/ Formulary OTC STERYMINE EXTERNAL GEL Formulary stevia extract powder 90 % Formulary laxative tablet delayed release 5 mg oral 5 mg Formulary Custom (*); OTC 117 Drug Name Formulary Status Requirements/Limits STIMULEN EXTERNAL GEL Formulary OTC stomach relief max st suspension 525 mg/15ml oral 525 Formulary Custom (*); OTC mg/15ml stomach relief suspension 262 mg/15ml oral 262 mg/15ml Formulary Custom (*); OTC stomach settle oral liquid Formulary OTC STOMAHESIVE MOLDABLE ADHESIVE STRIP Formulary OTC STOMAHESIVE PASTE PASTE Formulary OTC stool softener capsule 100 mg oral 100 mg Formulary Custom (*); OTC stool softener capsule 240 mg oral 240 mg Formulary Custom (*); OTC stress b-complex/vit c/zinc tablet oral Formulary Custom (*); OTC STRIDEX ESSENTIAL EXTERNAL PAD 1 % Formulary OTC STRI-DEX SENSITIVE SKIN EXTERNAL PAD 0.5 % Formulary OTC STROVITE ORAL TABLET Formulary STUART ONE ORAL CAPSULE 27-0.8-200 MG Formulary OTC sucrose crystals Formulary OTC SUDACARE ADVANCED REFILL PAD Formulary OTC 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 COLD ORAL Formulary Custom (*); OTC 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 sudogest 12 hour tablet extended release 12 hour 120 mg Formulary Custom (*); OTC oral 120 mg SUDOGEST PE TABLET 10 MG ORAL 10 MG Formulary Custom (*); OTC SUDOGEST SINUS/ALLERGY TABLET 4-60 MG Formulary Custom (*); OTC ORAL 4-60 MG SUDOGEST TABLET 30 MG ORAL 30 MG Formulary Custom (*); OTC SUDOGEST TABLET 60 MG ORAL 60 MG Formulary Custom (*); OTC sulfo-lo external bar 5 % Formulary OTC sulfur external bar 10 % Formulary OTC sulfur precipitated powder Formulary SUMMERS DEODORANT ULTRA EXTERNAL Formulary OTC AEROSOL sunbeam cool spray humidifier Formulary OTC sunbeam evap humidifier Formulary OTC sunbeam humidifier Formulary OTC SUNBEAM INSTANT WARM PACK Formulary OTC super b-50 complex oral capsule Formulary OTC super c-500 complex oral tablet extended release Formulary OTC 118 Drug Name Formulary Status Requirements/Limits super cal/mag oral tablet 333.333-166.667 mg Formulary OTC super natrul-100 oral tablet extended release Formulary OTC SUPER OMEGA-3 ORAL CAPSULE Formulary OTC super strength sinadrin oral tablet 4-10-650 mg Formulary OTC suphedrine 12hour tablet extended release 12 hour 120 mg Formulary Custom (*); OTC oral 120 mg suplevit liquid oral Formulary Custom (*); OTC supposibase f powder Formulary OTC SUPPOSIBLEND PELLET Formulary OTC SUPRENZA TABLET DISPERSIBLE 15 MG ORAL 15 PA; Custom (*); QL (90 EA per 365 Formulary MG days) SUPRENZA TABLET DISPERSIBLE 30 MG ORAL 30 PA; Custom (*); QL (90 EA per 365 Formulary MG days) SUPRENZA TABLET DISPERSIBLE 37.5 MG ORAL PA; Custom (*); QL (90 EA per 365 Formulary 37.5 MG days) 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 SUSPENDOL-S LIQUID Formulary OTC SWEEN EXTERNAL CREAM Formulary OTC SWEEN PREP EXTERNAL SOLUTION Formulary OTC SWIM EAR LIQUID 95 % OTIC 95 % Formulary Custom (*); OTC SWIM EAR OTIC LIQUID 95 % Formulary OTC swimmers instant ear dry otic liquid 95 % Formulary OTC SYRSPEND SF ORAL LIQUID Formulary SYRSPEND SF PH4 ORAL SUSPENSION Formulary RECONSTITUTED syrup nf oral syrup 85 % Formulary OTC SYSTANE GEL 0.4-0.3 % OPHTHALMIC 0.4-0.3 % Formulary Custom (*); OTC SYSTANE LID WIPES EXTERNAL PAD Formulary OTC SYSTANE NIGHTTIME OINTMENT OPHTHALMIC Formulary Custom (*); OTC SYSTANE OPHTHALMIC GEL 0.4-0.3 % Formulary OTC SYSTANE OPHTHALMIC SOLUTION 0.4-0.3 % Formulary OTC SYSTANE OVERNIGHT THERAPY GEL 0.3 % Formulary Custom (*); OTC OPHTHALMIC 0.3 % SYSTANE PRESERVATIVE FREE OPHTHALMIC Formulary OTC SOLUTION 0.4-0.3 % SYSTANE PRESERVATIVE FREE SOLUTION 0.4-0.3 Formulary Custom (*); OTC % OPHTHALMIC 0.4-0.3 % SYSTANE SOLUTION 0.4-0.3 % OPHTHALMIC 0.4-0.3 Formulary Custom (*); OTC % SYSTANE ULTRA HOME-AWAY PACK SOLUTION Formulary Custom (*); OTC 0.4-0.3 % OPHTHALMIC 0.4-0.3 % SYSTANE ULTRA OPHTHALMIC SOLUTION 0.4-0.3 Formulary OTC %

119 Drug Name Formulary Status Requirements/Limits SYSTANE ULTRA PF OPHTHALMIC SOLUTION 0.4- Formulary OTC 0.3 % SYSTANE ULTRA PF SOLUTION 0.4-0.3 % Formulary Custom (*); OTC OPHTHALMIC 0.4-0.3 % TABTUSSIN DM TABLET 20-400 MG ORAL 20-400 Formulary Custom (*); OTC MG TABTUSSIN TABLET 400 MG ORAL 400 MG Formulary Custom (*); OTC tactinal extra strength tablet 500 mg oral 500 mg Formulary Custom (*); OTC tactinal tablet 325 mg oral 325 mg Formulary Custom (*); OTC TAKE ACTION TABLET 1.5 MG ORAL 1.5 MG Formulary Custom (*); OTC; QL (2 EA per 30 days) talc powder Formulary TANDEM ORAL CAPSULE 162-115.2 MG Formulary OTC tangerine oil Formulary OTC tannic acid powder Formulary TARSUM EXTERNAL SHAMPOO 10-5 % Formulary OTC tartaric acid granules Formulary taurine oral capsule 500 mg Formulary OTC taurine powder Formulary TAVIST ALLERGY ORAL TABLET 1.34 MG Formulary OTC tdm solution external solution Formulary tea tree oil oil Formulary TEAR FLO OPHTHALMIC STRIP Formulary OTC TEARS AGAIN OINTMENT OPHTHALMIC Formulary Custom (*); OTC TEARS NATURALE FORTE SOLUTION 0.1-0.2-0.3 % Formulary Custom (*); OTC OPHTHALMIC 0.1-0.2-0.3 % TEARS NATURALE II SOLUTION OPHTHALMIC Formulary Custom (*); OTC TEARS NATURALE PM OPHTHALMIC OINTMENT 3- Formulary OTC 94 % tears pure solution 0.1-0.3 % ophthalmic 0.1-0.3 % Formulary Custom (*); OTC TECNU FIRST AID EXTERNAL GEL 0.2-2.5 % Formulary OTC TEGADERM AG MESH 2"X2" EXTERNAL PAD Formulary TEGADERM AG MESH 4"X5" EXTERNAL PAD Formulary TEGADERM AG MESH 4"X8" EXTERNAL PAD Formulary TEGADERM AG MESH 8"X8" EXTERNAL PAD Formulary TEGADERM ALGINATE AG DRESSING EXTERNAL Formulary OTC PAD 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 HIGH GELLING ALGINATE EXTERNAL Formulary OTC PAD TEGADERM HIGH INTEG ALGINATE EXTERNAL Formulary OTC PAD terbinafine hcl cream 1 % external 1 % Formulary Custom (*); OTC terocin external lotion 2.5-0.025-10-25 % Formulary OTC

120 Drug Name Formulary Status Requirements/Limits terocin external patch 4-4 % Formulary OTC teroderm-plus external cream Formulary TESSALON PERLES CAPSULE 100 MG ORAL 100 MG Formulary Custom (*) TETRA-FORMULA CGH/SORE THROAT Formulary OTC MOUTH/THROAT LOZENGE 10-15 MG tg 10peh/380gfn oral tablet 10-380 mg Formulary OTC tg 10peh/380gfn/15dm oral tablet 10-380-15 mg Formulary OTC tgt first aid cleansing external liquid 2.5-0.13 % Formulary OTC tgt flu/severe cold/cough rlf oral packet 20-10-650 mg Formulary OTC tgt lubricant eye drops ophthalmic solution 0.95 % Formulary OTC tgt medicated hemorrhoidal pad external Formulary Custom (*); OTC tgt pain reliever pm ex st oral tablet 25-500 mg Formulary OTC tgt zinc cold remedy oral tablet dispersible Formulary OTC th antacid supreme oral suspension 400-135 mg/5ml Formulary OTC th antibiotic + pain relief external cream 3.5-10000-10 Formulary OTC th calcium citrate-vitamin d oral tablet 315-200 mg-unit Formulary OTC th childrens plus oral suspension 5-160-1 mg/5ml Formulary OTC th cold & allergy oral elixir 1-2.5 mg/5ml Formulary OTC th eye drop advanced relief solution 0.05-0.1-1-1 % Formulary Custom (*); OTC ophthalmic 0.05-0.1-1-1 % th eye drop tears ophthalmic solution 0.2-0.2-1 % Formulary OTC th glucosamine sulfate oral tablet 500 mg Formulary OTC th magnesium oral tablet 200 mg Formulary OTC th mineral oil oral oil Formulary OTC th nasal decongestant pe oral tablet 10 mg Formulary OTC th nighttime cough oral liquid 6.25-15 mg/15ml Formulary OTC th stool softener oral capsule 250 mg Formulary OTC th tussin cf oral liquid 5-10-100 mg/5ml Formulary OTC THE ITCH ERASER EXTERNAL SOLUTION 2 % Formulary OTC theophylline anhydrous powder Formulary THERACAL D2000 TABLET ORAL Formulary Custom (*); OTC THERACAL D4000 TABLET ORAL Formulary Custom (*); OTC THERACAL RAPID REPLETION TABLET ORAL Formulary Custom (*); OTC THERACOF PLUS COUGH/COLD REL ORAL LIQUID Formulary OTC 5-10-100-325 MG/5ML THERAFLU COLD & COUGH ORAL PACKET 10-20-20 Formulary OTC MG THERAFLU COLD & SORE THROAT PACKET 20-10- Formulary Custom (*); OTC 325 MG ORAL 20-10-325 MG THERAFLU EXPRESSMAX ORAL LIQUID 12.5-5-325 Formulary OTC MG/15ML THERAFLU FLU & SORE THROAT PACKET 20-10-650 Formulary Custom (*); OTC MG ORAL 20-10-650 MG THERAFLU SEVERE COLD & COUGH ORAL PACKET Formulary OTC THERAFLU SEVERE COLD DAYTIME ORAL TABLET Formulary OTC 15-5-325 MG 121 Drug Name Formulary Status Requirements/Limits 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 DAY PACKET 20-10- Formulary Custom (*); OTC 650 MG ORAL 20-10-650 MG THERAFLU SEVERE COLD/CGH NIGHT ORAL Formulary OTC PACKET 25-10-650 MG THERAFLU SEVERE COLD/CGH NIGHT PACKET 25- Formulary Custom (*); OTC 10-650 MG ORAL 25-10-650 MG THERAFLU SINUS & COLD PACKET 20-10-325 MG Formulary Custom (*); OTC ORAL 20-10-325 MG THERAFLU WARMING RELIEF COLD TABLET 10-5- Formulary Custom (*); OTC 325 MG ORAL 10-5-325 MG THERAFLU WARMING RELIEF SINUS ORAL LIQUID Formulary OTC 12.5-5-325 MG/15ML THERA-GESIC CREAM 1-15 % EXTERNAL 1-15 % Formulary Custom (*); OTC THERA-GESIC PLUS CREAM EXTERNAL Formulary Custom (*); OTC THERANATAL COMPLETE 27-1 & 300 MG ORAL 27-1 Formulary Custom (*); OTC & 300 MG THERANATAL PLUS 27-1 & 300 MG ORAL 27-1 & 300 Formulary Custom (*); OTC MG therapeutic shampoo 0.5 % external 0.5 % Formulary Custom (*); OTC THERAPLEX T EXTERNAL SHAMPOO 1 % Formulary OTC THERASEAL HAND PROTECTION EXTERNAL Formulary OTC LOTION 1 % thera-tabs oral tablet Formulary OTC THERATEARS NUTRITION ORAL CAPSULE Formulary OTC THERATEARS OPHTHALMIC GEL 1 % Formulary OTC THERATEARS PF OPHTHALMIC SOLUTION 0.25 % Formulary OTC thiamine hcl powder Formulary thiamine hcl solution 100 mg/ml injection 100 mg/ml Formulary Custom (*) thiamine oral capsule 50 mg Formulary OTC threonine powder Formulary throat drops mouth/throat lozenge 2.8 mg Formulary OTC thymol crystals Formulary THYROSAFE ORAL TABLET 65 MG Formulary OTC THYROSHIELD ORAL SOLUTION 65 MG/ML Formulary OTC TIELLE PAD 7"X7" Formulary OTC 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 122 Drug Name Formulary Status Requirements/Limits TIGER BALM PAIN RELIEVING LG EXTERNAL Formulary OTC PATCH 70-230 MG TIGER BALM ULTRA STRENGTH OINTMENT Formulary Custom (*); OTC EXTERNAL TINACTIN AEROSOL 1 % EXTERNAL 1 % Formulary Custom (*); OTC TINACTIN EXTERNAL AEROSOL 1 % Formulary OTC TINACTIN EXTERNAL AEROSOL POWDER 1 % Formulary OTC TINACTIN JOCK ITCH EXTERNAL CREAM 1 % Formulary OTC tioconazole-1 ointment 6.5 % vaginal 6.5 % Formulary Custom (*); OTC TITRALAC ORAL TABLET CHEWABLE 420 MG Formulary OTC TN DICKINSONS WITCH HAZEL EXTERNAL PAD Formulary OTC tolnaftate cream 1 % external 1 % Formulary Custom (*); OTC tolnaftate powder 1 % external 1 % Formulary Custom (*); OTC tolnaftate solution 1 % external 1 % Formulary Custom (*); OTC TOPICAINE 5 EXTERNAL GEL 5 % Formulary OTC tragacanth powder Formulary travel sickness tablet 50 mg oral 50 mg Formulary Custom (*); OTC travel sickness tablet chewable 25 mg oral 25 mg Formulary Custom (*); OTC T-RELIEF PAIN ARNICA + 12 COMBINATION Formulary OTC THERAPY PACK TAB & OINT T-RELIEF PAIN RELIEF EXTERNAL CREAM Formulary OTC triacting cold/cough oral liquid† 15-1-7.5-160 mg/5ml Formulary OTC triacting nightime cold&cough liquid 6.25-2.5 mg/5ml oral Formulary Custom (*); OTC 6.25-2.5 mg/5ml TRIAMINIC CHEST/NASAL CONGEST ORAL LIQUID Formulary OTC 2.5-50 MG/5ML TRIAMINIC CHEST/NASAL CONGEST SYRUP 2.5-50 Formulary Custom (*); OTC MG/5ML ORAL 2.5-50 MG/5ML TRIAMINIC COLD & ALLERGY ORAL SYRUP 1-2.5 Formulary OTC MG/5ML TRIAMINIC COLD & ALLERGY SYRUP 1-2.5 MG/5ML Formulary Custom (*); OTC ORAL 1-2.5 MG/5ML TRIAMINIC COLD/COUGH DAY TIME ORAL Formulary OTC SOLUTION 2.5-5 MG/5ML TRIAMINIC COLD/COUGH DAY TIME SOLUTION Formulary Custom (*); OTC 2.5-5 MG/5ML ORAL 2.5-5 MG/5ML TRIAMINIC COLD/COUGH DAY TIME SYRUP 2.5-5 Formulary Custom (*); OTC MG/5ML ORAL 2.5-5 MG/5ML TRIAMINIC COLD/COUGH NIGHTTIME ORAL Formulary OTC LIQUID 6.25-2.5 MG/5ML TRIAMINIC COLD/COUGH ORAL 2.5-5 &2.5-6.25 Formulary OTC MG/5ML TRIAMINIC COUGH & CONGESTION ORAL SYRUP Formulary OTC 5-100 MG/5ML TRIAMINIC COUGH & CONGESTION SYRUP 5-100 Formulary Custom (*); OTC MG/5ML ORAL 5-100 MG/5ML TRIAMINIC COUGH & SORE THROAT SUSPENSION Formulary Custom (*); OTC 160-5 MG/5ML ORAL 160-5 MG/5ML

123 Drug Name Formulary Status Requirements/Limits TRIAMINIC COUGH & SORE THROAT SYRUP 160-5 Formulary Custom (*); OTC MG/5ML ORAL 160-5 MG/5ML TRIAMINIC COUGH/RUNNY NOSE ORAL STRIP 12.5 Formulary OTC MG TRIAMINIC COUGH/RUNNY NOSE ORAL TABLET Formulary OTC CHEWABLE 1-5 MG TRIAMINIC COUGH/SORE THROAT ORAL LIQUID Formulary OTC 160-5 MG/5ML TRIAMINIC COUGH/SORE THROAT ORAL TABLET Formulary OTC CHEWABLE 160-5 MG TRIAMINIC FEVER & COLD SUSPENSION 2.5-1-5-160 Formulary Custom (*); OTC MG/5ML ORAL 2.5-1-5-160 MG/5ML 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 NIGHT TIME COLD/CGH SYRUP 6.25-2.5 Formulary Custom (*); OTC MG/5ML ORAL 6.25-2.5 MG/5ML TRIAMINIC SORE THROAT MOUTH/THROAT Formulary OTC SOLUTION 0.5 % triamino oral tablet Formulary OTC tri-buffered aspirin oral tablet 325 mg Formulary OTC tri-buffered aspirin tablet 325 mg oral 325 mg Formulary Custom (*); OTC trichloroacetic acid crystals Formulary triple antibiotic external ointment 3.5-400-5000 Formulary OTC triple antibiotic ointment 3.5-400-5000 external 3.5-400- Formulary Custom (*); OTC 5000 triple antibiotic ointment 5-400-5000 external 5-400-5000 Formulary Custom (*); OTC triple antibiotic plus ointment 1 % external 1 % Formulary Custom (*); OTC triple antibiotic+pain relief external ointment 1 % 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 TRISPEC DMX ORAL LIQUID 10-187 MG/5ML, 15-125 Formulary OTC MG/5ML TRI-VI-SOL A/C/D SOLUTION 250-50-10 ORAL 250-50- Formulary Custom (*); OTC 10 TRI-VI-SOL ORAL SOLUTION 750-400-35 UNIT- Formulary OTC MG/ML TRI-VITA ORAL SOLUTION 1500-400-35 UNIT- Formulary OTC MG/ML

124 Drug Name Formulary Status Requirements/Limits TRI-VITA SOLUTION 1500-400-35 UNIT-MG/ML Formulary Custom (*); OTC ORAL 1500-400-35 UNIT-MG/ML tri-vitamin solution 1500-400-35 oral 1500-400-35 Formulary Custom (*); OTC trixaicin cream 0.025 % external 0.025 % Formulary Custom (*); OTC trixaicin hp cream 0.075 % external 0.075 % Formulary Custom (*); OTC TROCAINE THROAT MOUTH/THROAT LOZENGE 10 Formulary OTC MG TROCAL COUGH SUPPRESSANT MOUTH/THROAT Formulary OTC LOZENGE 7.5 MG TROCHIBASE CLASSIC FLAKES Formulary OTC trochibase s flakes Formulary OTC TROJAN Formulary Custom (*); OTC TROJAN ASSORTMENT PACK Formulary Custom (*); OTC TROJAN PLUS Formulary Custom (*); OTC TROJAN REGULAR Formulary Custom (*); OTC TROJAN RIBBED Formulary Custom (*); OTC trolamine liquid 99 % Formulary TROMBONEX-D ORAL CAPSULE Formulary OTC TRUEPLUS GLUCOSE ORAL GEL Formulary OTC TRUEPLUS GLUCOSE ORAL TABLET CHEWABLE Formulary OTC TRU-MICIN EXTERNAL LOTION 10 % Formulary OTC TRUSTEX LUB/RIBBED/STUDDED Formulary Custom (*); OTC TRUSTEX LUB/SPERMICIDE EX ST Formulary Custom (*); OTC TRUSTEX LUBRICATED Formulary Custom (*); OTC TRUSTEX LUBRICATED EX LARGE Formulary Custom (*); OTC TRUSTEX LUBRICATED EXTRA ST Formulary Custom (*); OTC TRUSTEX NON-LUBRICATED Formulary Custom (*); OTC TRUSTEX RIA LUB/SPERMICIDE Formulary Custom (*); OTC TRUSTEX RIA LUBRICATED Formulary Custom (*); OTC TRUSTEX RIA NON-LUBRICATED Formulary Custom (*); OTC TRUSTEX-NONOXYNOL-9/RIB/STUD Formulary Custom (*); OTC trymine cg oral liquid 225-7.5 mg/5ml Formulary OTC tryptophan powder Formulary TUCKS HEMORRHOIDAL OINTMENT 1-12.5 % Formulary Custom (*); OTC RECTAL 1-12.5 % TUCKS MEDICATED COOLING PAD 50 % Formulary Custom (*); OTC EXTERNAL 50 % TUCKS PAD 50 % EXTERNAL 50 % Formulary Custom (*); OTC TUMS CHEWY DELIGHTS TABLET CHEWABLE 1177 Formulary Custom (*); OTC MG ORAL 1177 MG TUMS E-X 750 ORAL TABLET CHEWABLE 750 MG Formulary OTC TUMS E-X 750 TABLET CHEWABLE 750 MG ORAL Formulary Custom (*); OTC 750 MG TUMS EXTRA STRENGTH 750 TABLET CHEWABLE Formulary Custom (*); OTC 750 MG ORAL 750 MG

125 Drug Name Formulary Status Requirements/Limits TUMS FRESHERS TABLET CHEWABLE 500 MG Formulary Custom (*); OTC ORAL 500 MG TUMS KIDS TABLET CHEWABLE 750 MG ORAL 750 Formulary Custom (*); OTC MG TUMS LASTING EFFECTS ORAL TABLET Formulary OTC CHEWABLE 500 MG TUMS SMOOTHIES TABLET CHEWABLE 750 MG Formulary Custom (*); OTC ORAL 750 MG TUMS TABLET CHEWABLE 500 MG ORAL 500 MG Formulary Custom (*); OTC TUMS ULTRA 1000 ORAL TABLET CHEWABLE 1000 Formulary OTC MG TUMS ULTRA 1000 TABLET CHEWABLE 1000 MG Formulary Custom (*); OTC ORAL 1000 MG turpentine liquid Formulary OTC turpentine oil oil Formulary OTC TUSICOF ORAL LIQUID 10-20-400 MG/5ML Formulary OTC TUSICOF ORAL TABLET 10-20-400 MG Formulary OTC TUSNEL C ORAL SYRUP 30-10-100 MG/5ML Formulary OTC TUSNEL C SYRUP 30-10-100 MG/5ML ORAL 30-10-100 Formulary Custom (*); OTC MG/5ML tusnel diabetic liquid 10-100 mg/5ml oral 10-100 mg/5ml Formulary Custom (*); OTC TUSNEL LIQUID 30-15-200 MG/5ML ORAL 30-15-200 Formulary Custom (*); OTC MG/5ML TUSNEL ORAL LIQUID 30-15-200 MG/5ML Formulary OTC TUSNEL PEDIATRIC LIQUID 15-5-50 MG/5ML ORAL Formulary Custom (*); OTC 15-5-50 MG/5ML TUSNEL PEDIATRIC LIQUID 7.5-50 MG/ML ORAL Formulary Custom (*); OTC 7.5-50 MG/ML TUSNEL TABLET 60-30-400 MG ORAL 60-30-400 MG Formulary Custom (*); OTC TUSNEL-DM PEDIATRIC LIQUID 7.5-2.5-25 MG/ML Formulary Custom (*); OTC ORAL 7.5-2.5-25 MG/ML TUSNEL-DM PEDIATRIC ORAL LIQUID 7.5-2.5-25 Formulary OTC MG/ML tussafex ex oral liquid 10-30-200 mg/5ml Formulary OTC TUSSICAPS CAPSULE EXTENDED RELEASE 12 Formulary Custom (*) HOUR 10-8 MG ORAL 10-8 MG TUSSICAPS CAPSULE EXTENDED RELEASE 12 Formulary Custom (*) HOUR 5-4 MG ORAL 5-4 MG tussin cf cough & cold liquid 5-10-100 mg/5ml oral 5-10- Formulary Custom (*); OTC 100 mg/5ml tussin cf liquid 5-10-100 mg/5ml oral 5-10-100 mg/5ml Formulary Custom (*); OTC tussin cf max multi-symptom liquid 5-10-200 mg/5ml oral 5- Formulary Custom (*); OTC 10-200 mg/5ml tussin cf oral liquid 30-10-100 mg/5ml Formulary OTC tussin chest congestion syrup 100 mg/5ml oral 100 mg/5ml Formulary Custom (*); OTC tussin cold/congestion oral capsule 30-10-200 mg Formulary OTC tussin cough dm oral syrup 100-10 mg/5ml Formulary OTC tussin cough long-acting oral syrup 15 mg/5ml Formulary OTC

126 Drug Name Formulary Status Requirements/Limits tussin cough syrup 15 mg/5ml oral 15 mg/5ml Formulary Custom (*); OTC tussin dm clear liquid 100-10 mg/5ml oral 100-10 mg/5ml Formulary Custom (*); OTC tussin dm liquid 100-10 mg/5ml oral 100-10 mg/5ml Formulary Custom (*); OTC tussin dm max liquid 10-200 mg/5ml oral 10-200 mg/5ml Formulary Custom (*); OTC tussin dm syrup 100-10 mg/5ml oral 100-10 mg/5ml Formulary Custom (*); OTC tussin expectorant oral syrup 100 mg/5ml Formulary OTC tussin mucus+chest congestion syrup 100 mg/5ml oral 100 Formulary Custom (*); OTC mg/5ml tussin syrup 100 mg/5ml oral 100 mg/5ml Formulary Custom (*); OTC tussi-pres b liquid 10-4-20 mg/5ml oral 10-4-20 mg/5ml Formulary Custom (*); OTC tussi-pres b oral liquid 10-4-20 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 ORAL LIQUID 10-28-388 MG/5ML Formulary OTC TUSSLIN PEDIATRIC ORAL LIQUID 2.5-7.5-88 Formulary OTC MG/ML TYLENOL ARTHRITIS PAIN ORAL TABLET Formulary OTC EXTENDED RELEASE 650 MG TYLENOL CHEST CONGESTION TABLET 325-200 MG Formulary Custom (*); OTC ORAL 325-200 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 MAX ORAL LIQUID 10-5-325 Formulary OTC MG/15ML TYLENOL COLD MULTI-SYMPTOM DAY ORAL Formulary OTC LIQUID 5-10-200-325 MG/15ML TYLENOL COLD MULTI-SYMPTOM ORAL 5-2-10-325 Formulary OTC MG TYLENOL COLD MULTI-SYMPTOM ORAL LIQUID 5- Formulary OTC 6.25-10-325 MG/15ML TYLENOL COLD MULTI-SYMPTOM ORAL TABLET Formulary OTC 5-10-200-325 MG TYLENOL COLD/FLU SEVERE ORAL TABLET Formulary OTC THERAPY PACK TYLENOL COUGH/SORE THROAT ORAL LIQUID 30- Formulary OTC 12.5-1000 MG/30ML, 500-15 MG/15ML 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 LIQUID 500 MG/15ML Formulary OTC TYLENOL ORAL TABLET 325 MG Formulary OTC

127 Drug Name Formulary Status Requirements/Limits TYLENOL PM EXTRA STRENGTH ORAL TABLET Formulary OTC 500-25 MG TYLENOL SINUS CONGESTION/PAIN ORAL 2-5-325 Formulary OTC & 5-325 MG TYLENOL SINUS CONGESTION/PAIN ORAL TABLET Formulary OTC 5-325-200 MG TYLENOL SINUS SEVERE ORAL TABLET 5-325-200 Formulary OTC MG TYLER SIMILASE SENSITIVE ORAL CAPSULE Formulary OTC tyrosine oral packet 1000 mg Formulary OTC ubidecarenone powder Formulary ULCEREASE MOUTH/THROAT LIQUID 0.6 % Formulary OTC ULCEREASE MOUTH/THROAT SOLUTION 0.6-1.5 % Formulary OTC ultilet alcohol swab pad Formulary OTC ULTILET OPERATING DEVICE Formulary OTC ULTRA FRESH PM OPHTHALMIC OINTMENT Formulary OTC ULTRA MEGA GOLD ORAL TABLET EXTENDED Formulary OTC RELEASE ULTRA MIDE 25 EXTERNAL LOTION 25 % Formulary OTC ultracin external lotion 0.025-10-28 % Formulary OTC ultrasone external cream Formulary OTC ultrasonic humidifier Formulary OTC UMCKA ELDERBERRY COLD+FLU ORAL SYRUP Formulary OTC UMCKA FASTACTIVES COLD+FLU ORAL PACKET Formulary OTC undecylenic acid liquid Formulary UNDELENIC EXTERNAL OINTMENT Formulary OTC UNDELENIC EXTERNAL TINCTURE Formulary OTC unibase external cream Formulary OTC UNI-SOLVE WIPES EXTERNAL PAD Formulary OTC universal ph in vitro strip Formulary OTC urea beads Formulary urea peroxide powder Formulary OTC urea powder Formulary urinary pain relief oral tablet 95 mg Formulary OTC URO-MAG ORAL CAPSULE 140 MG Formulary OTC vagicaine external cream 20-3 % Formulary OTC vagicaine vaginal cream 20-3 % Formulary OTC vagicream vaginal cream 5-2 % Formulary OTC VAGISTAT-1 OINTMENT 6.5 % VAGINAL 6.5 % Formulary Custom (*); OTC VAGISTAT-3 KIT 200 & 2 MG-% (9GM) VAGINAL 200 Formulary Custom (*); OTC & 2 MG-% (9GM) valerian oral capsule 500 mg Formulary OTC valerian root oral capsule 450 mg Formulary OTC VALINE 1000 ORAL PACKET 1 GM Formulary OTC valine oral packet 50 mg Formulary OTC

128 Drug Name Formulary Status Requirements/Limits valine powder Formulary VAMOUSSE LICE TREATMENT EXTERNAL FOAM Formulary OTC VANACHOL ORAL CAPSULE Formulary OTC VANACLEAR PD ORAL LIQUID 0.313 MG/ML Formulary OTC VANACOF AC ORAL LIQUID 12.5-25 MG/30ML Formulary OTC VANACOF DM LIQUID 10-18-200 MG/15ML ORAL 10- Formulary Custom (*); OTC 18-200 MG/15ML VANACOF DM ORAL LIQUID 10-18-200 MG/15ML Formulary OTC VANACOF LIQUID 30-1-12.5 MG/5ML ORAL 30-1-12.5 Formulary Custom (*); OTC MG/5ML VANACOF ORAL LIQUID 30-1-12.5 MG/5ML Formulary OTC VANACOF-8 LIQUID 25-50 MG/15ML ORAL 25-50 Formulary Custom (*); OTC MG/15ML VANACOF-8 ORAL LIQUID 25-50 MG/15ML Formulary OTC vanadium oral capsule 7.5 mg Formulary OTC VANAHIST PD LIQUID 0.625 MG/ML ORAL 0.625 Formulary Custom (*); OTC MG/ML VANAMINE PD ORAL LIQUID 6.25 MG/ML Formulary OTC VANATAB AC ORAL TABLET 12.5-25 MG Formulary OTC VANATAB DM ORAL TABLET 5-9-198 MG Formulary OTC VANICREAM DIAPER RASH EXTERNAL OINTMENT Formulary OTC 1.1-40 % VANIPLY EXTERNAL OINTMENT 1 % Formulary OTC vanishing cream botanical base cream external (otc) Formulary Custom (*) VAPOR PATCH EXTERNAL PATCH Formulary OTC 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 VAZOTAB ORAL TABLET 25-10 MG Formulary OTC VCF VAGINAL CONTRACEPTIVE VAGINAL FOAM Formulary OTC 12.5 % veegum Formulary OTC venaliv oral tablet 900-100-100 mg Formulary OTC VENIA EXTERNAL PATCH 4-4 % Formulary OTC VENOFER SOLUTION 20 MG/ML INTRAVENOUS 20 Formulary Custom (*) MG/ML VERSAPLUS ORAL SYRUP Formulary VERSIVA XC PAD 5-1/2"X5-1/2" Formulary OTC VIADENT ADVANCED CARE MOUTH/THROAT Formulary OTC LIQUID 0.05 % vicks cool mist humidifier Formulary OTC VICKS DAYQUIL MUCUS CONTROL DM ORAL Formulary OTC LIQUID 10-200 MG/15ML VICKS DAYQUIL SINEX ORAL CAPSULE 5-325 MG Formulary OTC vicks humidifier Formulary OTC

129 Drug Name Formulary Status Requirements/Limits vicks mini coolmist humidifier Formulary OTC 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 6.25-15 Formulary OTC MG/15ML VICKS NYQUIL D COLD & FLU ORAL LIQUID 60- Formulary OTC 12.5-30-1000 MG/30ML VICKS NYQUIL SEVERE COLD & FLU ORAL Formulary OTC TABLET 5-6.25-10-325 MG VICKS NYQUIL SEVERE COLD/FLU LIQUID 5-6.25- Formulary Custom (*); OTC 10-325 MG/15ML ORAL 5-6.25-10-325 MG/15ML VICKS NYQUIL SINEX ORAL CAPSULE 6.25-5-325 Formulary OTC MG VICKS SINEX DAYQUIL/NYQUIL ORAL Formulary OTC VICKS VAPO STEAM INHALATION LIQUID 6.2 % Formulary OTC VICKS VAPODROPS MOUTH/THROAT LOZENGE 1.7 Formulary OTC MG, 3.3 MG VICKS VAPOINHALER INHALATION INHALER Formulary OTC VICKS VAPORIZER Formulary OTC VICKS VAPORUB EXTERNAL OINTMENT 4.73-1.2-2.6 Formulary OTC % vicks warm mist humidifier Formulary OTC VINCE DENTAL POWDER Formulary OTC VIROXYN EXTERNAL LIQUID 0.13 % Formulary OTC virtussin a/c solution 100-10 mg/5ml oral 100-10 mg/5ml Formulary Custom (*); OTC virtussin dac solution 30-10-100 mg/5ml oral 30-10-100 Formulary Custom (*); OTC mg/5ml VISINE ADVANCED RELIEF SOLUTION 0.05-0.1-1-1 Formulary Custom (*); OTC % OPHTHALMIC 0.05-0.1-1-1 % VISINE MAXIMUM REDNESS RELIEF SOLUTION Formulary Custom (*); OTC 0.05-0.2-0.36-1 % OPHTHALMIC 0.05-0.2-0.36-1 % VISINE TOTALITY MULTI-SYMPTOM SOLUTION Formulary Custom (*); OTC 0.05 % OPHTHALMIC 0.05 % VISINE-LR SOLUTION 0.025 % OPHTHALMIC 0.025 % Formulary Custom (*); OTC VISTEC X-RAY DETECTABLE SPONGE PAD 3- Formulary OTC 1/2"X4" vita-c oral crystals Formulary OTC VITA-CALCIUM ORAL WAFER 333-133 MG-UNIT Formulary OTC VITADYE EXTERNAL LOTION 5 % Formulary OTC VITALINE BIOTIN FORTE/ZINC ORAL TABLET 0.8 Formulary OTC MG VITALINE BIOTIN FORTE/ZINC TABLET 0.8 MG Formulary Custom (*); OTC ORAL 0.8 MG VITALINE COQ10 ORAL TABLET 200 MG, 60 MG Formulary OTC vitalize oral liquid Formulary OTC VITAMAX ORAL TABLET CHEWABLE 60 MG Formulary OTC

130 Drug Name Formulary Status Requirements/Limits VITAMELTS ENERGY VITAMIN B-12 ORAL TABLET Formulary OTC DISPERSIBLE 1500 MCG vitamin a & d capsule 5000-400 unit oral 5000-400 unit Formulary Custom (*); OTC vitamin a & d oral capsule 5000-400 unit Formulary OTC vitamin a & d oral tablet 10000-400 unit Formulary OTC vitamin a & d tablet 10000-400 unit oral 10000-400 unit Formulary Custom (*); OTC vitamin a & d tablet 25000-1000 unit oral 25000-1000 unit Formulary Custom (*); OTC VITAMIN A FISH ORAL CAPSULE 7500 UNIT Formulary OTC vitamin a oral capsule 10000 unit, 8000 unit Formulary OTC vitamin a palmitate liquid Formulary vitamin a palmitate oral tablet 10000 unit, 15000 unit Formulary OTC vitamin a wrinkle treatment external gel Formulary OTC vitamin a-beta carotene capsule 25000 unit oral 25000 unit Formulary Custom (*); 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 100 mg, 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 b12-folic acid tablet 500-400 mcg oral 500-400 Formulary Custom (*); OTC mcg vitamin b-2 oral tablet 25 mg, 50 mg Formulary OTC vitamin b-2 tablet 100 mg oral 100 mg Formulary Custom (*); OTC vitamin b-2 tablet 25 mg oral 25 mg Formulary Custom (*); OTC vitamin b-2 tablet 50 mg oral 50 mg Formulary Custom (*); OTC vitamin b-6 er oral tablet extended release 200 mg Formulary OTC vitamin c (calcium ascorbate) oral solution reconstituted Formulary OTC vitamin c (calcium ascorbate) solution reconstituted oral Formulary Custom (*); OTC vitamin c drops mouth/throat lozenge 60 mg Formulary OTC vitamin c gummies oral tablet chewable 125 mg Formulary OTC vitamin c oral liquid 500 mg/5ml Formulary OTC vitamin c oral powder Formulary OTC vitamin c oral tablet 100 mg, 1000 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 oral tablet 250 mg Formulary OTC vitamin d (ergocalciferol) capsule 1.25 mg (50000 ut) oral Formulary Custom (*) 1.25 mg (50000 ut) vitamin d2 oral tablet 50 mcg (2000 ut) Formulary OTC vitamin d3 oral capsule 125 mcg (5000 ut), 250 mcg (10000 Formulary OTC ut), 50 mcg (2000 ut) vitamin d3 oral liquid 5000 unit/ml Formulary OTC

131 Drug Name Formulary Status Requirements/Limits vitamin d3 oral tablet 1.25 mg (50000 ut), 10 mcg (400 Formulary OTC unit), 25 mcg (1000 ut) vitamin d3 oral tablet chewable 25 mcg (1000 ut) Formulary OTC VITAMIN E & C BEAUTY LOTION EXTERNAL Formulary OTC LOTION VITAMIN E & K BEAUTIFUL SKIN EXTERNAL OIL Formulary OTC vitamin e acetate liquid Formulary vitamin e beauty external oil 24000 unit/52ml Formulary OTC vitamin e external cream Formulary OTC vitamin e external liquid 24000 unit Formulary OTC vitamin e oral capsule 100 unit Formulary OTC vitamin e oral tablet 400 unit Formulary OTC vitamin e succinate powder Formulary vitamin k (phytonadione) oral tablet 100 mcg Formulary OTC vitamin k1 powder Formulary OTC vitamin k1 solution 1 mg/0.5ml injection 1 mg/0.5ml Formulary Custom (*) vitamin k1 solution 10 mg/ml injection 10 mg/ml Formulary Custom (*) vitamins a & d capsule 5000-400 unit oral 5000-400 unit Formulary Custom (*); OTC vitamins a & d ointment external Formulary Custom (*); OTC 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-PLUS H ORAL CAPSULE Formulary OTC 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 VOPAC 5 EXTERNAL CREAM 5 % Formulary OTC WAL-DRYL ANTI-ITCH EXTERNAL LIQUID 2-0.1 % Formulary OTC WAL-DRYL EXTERNAL CREAM 2-0.1 % Formulary OTC WAL-DRYL-D ALLERGY/SINUS ORAL TABLET 25-10 Formulary OTC 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 WAL-FLU SEVERE COLD DAYTIME ORAL PACKET Formulary OTC 10-650 MG WAL-FLU SEVERE COLD NIGHT TIME ORAL Formulary OTC PACKET 20-10-650 MG WAL-ITIN D ORAL TABLET EXTENDED RELEASE 12 Formulary OTC HOUR 5-120 MG WAL-PHED PE DAYTIME/NIGHTTIME ORAL Formulary OTC

132 Drug Name Formulary Status Requirements/Limits WAL-SLEEP Z LIQUID SHOTS ORAL LIQUID 50 Formulary OTC MG/50ML wal-som oral tablet dispersible 25 mg Formulary OTC wal-tap cold/allergy oral liquid 2-5 mg/10ml Formulary OTC WAL-TUSSIN CF MAX ORAL LIQUID 5-10-200-325 Formulary OTC MG/10ML wal-tussin cough relief oral tablet chewable 7.5 mg Formulary OTC WAL-ZYR CHILDRENS ORAL TABLET CHEWABLE Formulary OTC 10 MG, 5 MG WAL-ZYR ORAL CAPSULE 10 MG Formulary OTC wart remover maximum strength external gel 17 % Formulary OTC washable pants kit Formulary OTC WATCHHALER DEVICE Formulary wax, white wax Formulary wee care oral suspension 15 mg/1.25ml Formulary OTC wee care suspension 15 mg/1.25ml oral 15 mg/1.25ml Formulary Custom (*); OTC wegmans complete prenatal+dha oral 28-0.975 & 200 mg Formulary OTC WELLMIND MENTAL FOCUS ORAL TABLET Formulary OTC CHEWABLE wellness protein shake oral powder 21 gm Formulary OTC white petrolatum external gel Formulary OTC white petrolatum external ointment Formulary white petrolatum ointment external (otc) Formulary Custom (*) white petroleum jelly gel external Formulary Custom (*); OTC WINGS MATERNITY PANTS 2X-3X Formulary OTC wintergreen oil oil Formulary OTC witch hazel external liquid , 14 % Formulary OTC witch hazel external solution 86 % Formulary OTC WITEPSOL PELLET Formulary xanthan gum powder Formulary XENICAL CAPSULE 120 MG ORAL 120 MG Formulary PA PA; Custom (*); QL (90 EA per 365 XENICAL CAPSULE 120 MG ORAL 120 MG Formulary days) xolido external cream 2 % Formulary OTC X-SEB T PLUS EXTERNAL SHAMPOO 10 % Formulary OTC XTRA-CARE EXTERNAL LOTION Formulary OTC xylitol powder Formulary YES FOR WOMEN EXTERNAL GEL Formulary OTC yl natural vitamin a & d capsule 1250-135 unit oral 1250- Formulary Custom (*); OTC 135 unit yl vitamin b-6 oral tablet 100 mg Formulary OTC yodefan-nf chest congestion liquid 200 mg/5ml oral 200 Formulary Custom (*); OTC mg/5ml ZADITOR SOLUTION 0.025 % OPHTHALMIC 0.025 % Formulary Custom (*); OTC ZANTAC 150 MAXIMUM STRENGTH ORAL TABLET Formulary OTC 150 MG 133 Drug Name Formulary Status Requirements/Limits ZANTAC 150 MAXIMUM STRENGTH TABLET 150 Formulary Custom (*); OTC MG ORAL 150 MG ZANTAC 75 ORAL TABLET 75 MG Formulary OTC ZANTAC 75 TABLET 75 MG ORAL 75 MG Formulary Custom (*); OTC Z-BUM EXTERNAL CREAM 22.5 % Formulary OTC Z-COF 12DM ORAL LIQUID 30-15-175 MG/5ML Formulary OTC ZEASORB EXTERNAL POWDER Formulary OTC ZEASORB-AF POWDER 2 % EXTERNAL 2 % Formulary Custom (*); OTC ZE-PLUS ORAL CAPSULE Formulary OTC ZICAM ALLERGY RELIEF NASAL GEL Formulary OTC ZICAM COLD REMEDY ORAL TABLET DISPERSIBLE Formulary OTC ZIKS ARTHRITIS PAIN RELIEF CREAM 0.025-1-12 % Formulary Custom (*); OTC EXTERNAL 0.025-1-12 % ZIKS ARTHRITIS PAIN RELIEF EXTERNAL CREAM Formulary OTC 0.025-1-12 % ZILACTIN BABY MOUTH/THROAT GEL 10 % Formulary OTC ZILACTIN MOUTH/THROAT GEL 10 % Formulary OTC ZIMS MAX-FREEZE EXTERNAL GEL 3.7 % Formulary OTC zinc + vitamin c lozenge 20-120 mg mouth/throat 20-120 Formulary Custom (*); OTC mg zinc + vitamin c mouth/throat lozenge 20-120 mg Formulary OTC ZINC 15 ORAL TABLET 66 MG Formulary OTC zinc acetate powder Formulary zinc aspartate oral tablet 40 mg Formulary OTC zinc chelated tablet 50 mg oral 50 mg Formulary Custom (*); OTC zinc chloride granules Formulary zinc chloride granules (otc) Formulary Custom (*) zinc chloride solution 1 mg/ml intravenous 1 mg/ml Formulary Custom (*) zinc gluconate oral tablet 15 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, 50 mg Formulary OTC zinc oxide external paste 25 % Formulary OTC zinc oxide ointment 20 % external 20 % Formulary Custom (*); OTC zinc oxide powder Formulary zinc stearate powder Formulary OTC zinc sulfate heptahydrate powder Formulary zinc sulfate oral tablet 220 (50 zn) mg Formulary OTC zinc tablet 50 mg oral 50 mg Formulary Custom (*); OTC zinc-c-b6 mouth/throat lozenge 15-60-5 mg Formulary OTC zincolate oral capsule 10-20 mg Formulary OTC ZINC-OXYDE PLUS EXTERNAL OINTMENT 0.44-20 Formulary OTC % zn-50 oral capsule 50 mg Formulary OTC ZNLIN EXTERNAL LOTION 16 % Formulary OTC

134 Drug Name Formulary Status Requirements/Limits ZN-PLUS ORAL TABLET 15 MG Formulary OTC ZODRYL AC 25 SUSPENSION 0.333-1 MG/ML ORAL Formulary Custom (*); OTC 0.333-1 MG/ML ZODRYL AC 30 SUSPENSION 0.286-1 MG/ML ORAL Formulary Custom (*); OTC 0.286-1 MG/ML ZODRYL AC 40 SUSPENSION 0.222-1 MG/ML ORAL Formulary Custom (*); OTC 0.222-1 MG/ML ZODRYL DEC 25 SUSPENSION 5-1-20 MG/ML ORAL Formulary Custom (*); OTC 5-1-20 MG/ML ZODRYL DEC 30 SUSPENSION 4.286-1-20 MG/ML Formulary Custom (*); OTC ORAL 4.286-1-20 MG/ML ZODRYL DEC 40 SUSPENSION 3.333-1-20 MG/ML Formulary Custom (*); OTC ORAL 3.333-1-20 MG/ML zoo friends plus extra c tablet chewable oral Formulary Custom (*); OTC ZOSTRIX ARTHRITIS PAIN RELIEF EXTERNAL Formulary OTC CREAM 0.025 % ZOSTRIX HOT & COLD THERAPY EXTERNAL KIT Formulary OTC 0.025 & 4 % ZOSTRIX-HP EXTERNAL STICK 0.075 % Formulary OTC Z-TUSS AC LIQUID 2-9 MG/5ML ORAL (OTC) 2-9 Formulary Custom (*); OTC MG/5ML Z-TUSS AC ORAL LIQUID 2-9 MG/5ML Formulary OTC ZYRTEC ALLERGY CHILDRENS ORAL TABLET Formulary OTC DISPERSIBLE 10 MG ZYRTEC ALLERGY ORAL CAPSULE 10 MG Formulary OTC ZYRTEC ALLERGY ORAL TABLET 10 MG Formulary OTC ZYRTEC ALLERGY TABLET 10 MG ORAL 10 MG Formulary Custom (*); OTC ZYRTEC CHILDRENS HIVES RELIEF ORAL SYRUP 1 Formulary OTC MG/ML ZYRTEC-D ALLERGY & CONGESTION ORAL Formulary OTC TABLET EXTENDED RELEASE 12 HOUR 5-120 MG ZZZQUIL LIQUID 50 MG/30ML ORAL 50 MG/30ML Formulary Custom (*); OTC ZZZQUIL ORAL LIQUID 50 MG/30ML Formulary OTC

135 136 Index 12 hour decongestant...... 1 ACTIVE-Q...... 3 ALKA-SELTZER...... 5 12 hour nasal spray...... 1 ACTIVE-Q EXTRA STRENGTH...... 3 ALKA-SELTZER GOLD...... 5 2-deoxy-d-glucose...... 1 ACTIVITE EC...... 3 ALKA-SELTZER HEARTBURN + 3 day vaginal...... 1 ACTIVON ARTHRITIS ULTRA ST...... 3 GAS...... 5 7-keto dhea...... 1 ADAPT CONVEX BARRIER RING...... 3 all day allergy...... 5 8 hour pain relief...... 1 adenosylcobalamin...... 3 all day allergy childrens...... 5 8 hour pain reliever...... 1 adhesive bandages sheer...... 3 all day allergy d...... 5 A & D ZINC OXIDE...... 1 ADIPEX-P...... 3 all day allergy d-12...... 5 A+D CRACKED SKIN RELIEF...... 1 adult wash cloths with aloe...... 3 all day allergy-d...... 5 a1c test at-home...... 1 advanced acne wash...... 3 all day pain relief...... 5 a-25...... 1 advanced formula eye drops...... 3 all day relief...... 5 ABATRACE...... 1 advanced hand sanitizer...... 3 allantoin...... 5 ABATREX...... 1 ADVIL...... 3, 4 ALLEGRA ALLERGY...... 5 ABATRON...... 1 ADVIL ALLERGY & CONGESTION... 3 ALLEGRA ALLERGY CHILDRENS.... 5 ABREVA...... 1 ADVIL ALLERGY SINUS...... 3 ALLEGRA-D ALLERGY & acacia...... 1 ADVIL COLD & SINUS LIQUI- CONGESTION...... 5 a-caro-25...... 1 GELS...... 3 aller-chlor...... 5 ACCU-CHEK ULTRAFLEX INF SET...1 ADVIL COLD/SINUS...... 3 aller-ease...... 5 ACCUTREND CHOLESTEROL...... 1 ADVIL CONGESTION RELIEF...... 3 allergy...... 6 ACCUTREND CHOLESTEROL ADVIL JUNIOR STRENGTH...... 3 allergy childrens...... 5 CONTROL...... 1 ADVIL MIGRAINE...... 3 allergy eye...... 5 ACCUTREND PLUS...... 1 ADVIL PM...... 4 allergy eye drops...... 5 ACE KNEE BRACE AEROCHAMBER PLUS FLO-VU...... 4 allergy multi-symptom...... 6 W/STABILIZERS...... 1 AEROCHAMBER PLUS FLO-VU allergy multi-symptom day/nght...... 6 ACEPHEN...... 1 LARGE...... 4 allergy rel child (cetirizine)...... 6 ACEROLA C 500...... 1 AEROCHAMBER PLUS FLO-VU allergy relief...... 6 acesulfame potassium...... 1 SMALL...... 4 allergy relief child...... 6 ACETA-GESIC...... 1 AEROCHAMBER PLUS FLO-VU allergy relief childrens...... 6 acetaminophen...... 2 W/MASK...... 4 allergy relief d-24...... 6 acetaminophen er...... 2 AFRIN CHILDRENS...... 4 allergy relief plus sinus...... 6 acetaminophen junior strength...... 2 AFRIN MENTHOL SPRAY...... 4 allergy relief/nasal decongest...... 6 acetazolamide...... 2 AFTERA...... 4 allergy/congestion relief...... 6 acetic acid glacial...... 2 AHIST...... 4 allergy-time...... 6 acetone...... 2 AIRBORNE...... 4 allerhist-1...... 6 acetyl-l-carnitine hcl...... 2 AL12...... 4 aller-time...... 6 acid control maximum strength...... 2 ALA SEB T...... 4 allevess...... 6 ACID GONE...... 2 ALAHIST DM...... 4 ALLEVYN PLUS CAVITY...... 6 acid reducer...... 2 ALA-HIST IR...... 4 ALLFEN...... 6 acid reducer complete...... 2 ALA-HIST PE...... 4 allfen dm...... 6 acid reducer maximum strength...... 2 alamag plus...... 4 ALLI...... 6 acid relief...... 2 alanine 1000...... 4 all-nite multi-sympt cold/flu...... 6 acidophilus...... 2 ALAVERT...... 4 ALMACONE...... 6 acidophilus/citrus pectin...... 2 ALAVERT ALLERGY/SINUS...... 4 ALMACONE DOUBLE STRENGTH.... 6 acidophilus/pectin...... 2 ALAWAY...... 4 ALOCANE PLUS...... 6 acne medication 10...... 2 ALAWAY CHILDRENS ALLERGY..... 4 aloe burn relief...... 6 acne medication 5...... 2 alba-lybe nr...... 4 ALOE GRANDE...... 6, 7 ACNEFREE ACNE CLEARING ALBUSTIX...... 4 aloe vera...... 7 SYSTEM...... 2 ALC-FREE...... 4 aloe vera freeze dried...... 7 ACNEFREE SEVERE CLEARING ALCO-GEL...... 4 aloe vera moisturizing...... 7 SYST...... 2 alcohol (rubbing)...... 4 ALOE VESTA 2-N-1 PROTECTIVE..... 7 ACNOTEX...... 2 alcohol anhydrous...... 4 ALOE VESTA CLEAR ACT TOTAL CARE...... 2 alcohol prep...... 4 ANTIFUNGAL...... 7 ACTICARNITINE SF...... 2 aler-dryl...... 4 ALOE VESTA MULTI PURPOSE...... 7 ACTIDOGESIC...... 2 alertness aid...... 4, 5 ALOE VESTA PROTECTIVE...... 7 ACTIDOSE WITH SORBITOL...... 2 alevazol...... 5 ALOE VESTA SKIN PROTECTANT.... 7 actidose-aqua...... 2 ALEVE...... 5 alp high3...... 7 ACTIFLOVIT EAR HEALTH...... 3 ALEVE-D SINUS & COLD...... 5 ALPAWASH...... 7 ACTIMARIS WOUND...... 3 alga...... 5 alpha-lipoic acid...... 7 ACTITROM...... 3 ALGAL-900 DHA...... 5 alum ammonium...... 7 ACTIVE Q...... 3 ALGISITE M 4"X4"...... 5 alum sulfate-ca acetate...... 7 ACTIVE Q MAXIMUM STRENGTH....3 alka-aid...... 5 aluminum acetate...... 7

137 aluminum bottle seal...... 7 AQUA CARE...... 9 azelaic acid...... 11 aluminum chloride hexahydrate...... 7 aquabase...... 9 b complex...... 11 aluminum chlorohydrate...... 7 AQUADEKS...... 9 b complex formula 1...... 11 aluminum hydroxide dried gel...... 7 aquanaz...... 9 b complex-c-biotin-e-fa...... 11 aluminum hydroxide gel...... 7 AQUAPHILIC/CARBAMIDE...... 9 b complex-folic acid...... 11 A-MANTLE...... 7 AQUASOL A...... 9 B&L SENSITIVE EYES...... 11 amberderm...... 7 AQUASONIC 100...... 9 b-1...... 11 ambi 10peh/4cpm...... 7 AQUEOUS SELENIUM...... 9 b-100 cr...... 11 ambi 12.5cpd/100gfn/30pse...... 7 aqueous vitamin e...... 9 b-12...... 11 ambi 12.5cpd/1dcpm/30pse...... 7 AQUORAL...... 9 b-12 tr...... 11 ambi 60pse/400gfn...... 7 arctic relief pain relieving...... 9 b2...... 11 ambi 60pse/4cpm...... 7 ARGIMENT AT...... 9 b-2...... 11 AMERIGEL WOUND DRESSING...... 7 arginine...... 9 B-2-400...... 11 AMERIWASH...... 7 arginine2000...... 9 b-6...... 11 AMINORELIEFRMS...... 7 arkaliox...... 9 baby darlings soothing bath...... 11 aminosalicylic acid-5...... 7 ARLASILK PHOSPHOLIPID PLN...... 9 BABY ORAJEL...... 12 AMLACTIN...... 7 arnica...... 10 BABY ORAJEL NIGHTTIME...... 12 ammonia aromatic...... 8 arnicare arthritis...... 10 baby super daily d3...... 12 ammonium carbonate...... 8 ARTHRI-FLEX ADVANTAGE...... 10 baby teething pain medicine...... 12 ammonium chloride...... 8 arthritis pain relief...... 10 BACID...... 12 ammonium hydroxide...... 8 artificial tears...... 10 bacitracin...... 12 ammonium lactate...... 8 asafetida...... 10 bacitracin zinc...... 12 ANASEPT...... 8 ascocid-iso-ph...... 10 bacitracin-neomycin-polymyxin...... 12 ANASEPT ANTIMICROBIAL...... 8 ascorbic acid...... 10 back pain-off...... 12 ANBESOL...... 8 ascorbyl palmitate...... 10 backache relief extra strength...... 12 ANBESOL MAXIMUM STRENGTH....8 ASCRIPTIN...... 10 balamine dm...... 12 ANECREAM...... 8 ASCRIPTIN MS...... 10 balanced b-50...... 12 anise...... 8 aspartate mg & k...... 10 BALMEX BABY...... 12 antacid...... 8 ASPERCREME HEAT...... 10 BALNEOL...... 12 antacid anti-gas...... 8 ASPERCREME W/LIDOCAINE...... 10 BAND-AID SURGIPAD SURGICAL.. 12 antacid anti-gas max strength...... 8 aspirin...... 10 BANOPHEN...... 12 antacid calcium...... 8 aspirin 81...... 10 BARIDIUM...... 12 antacid calcium extra strength...... 8 aspirin adult low strength...... 10 basic fuchsin hcl...... 12 antacid double strength...... 8 aspirin ec...... 10 BAYER BACK & BODY PAIN EX antacid extra strength...... 8 aspirin ec low dose...... 10 ST...... 12 antacid fast acting...... 8 aspirin ec low strength...... 10 BAYER WOMENS...... 12 antacid fast relief...... 8 aspirin low dose...... 10 baza antifungal...... 12 antacid maximum strength...... 8 ASPIR-LOW...... 10 BAZA CLEANSE & PROTECT...... 12 antacid multi-symptom...... 8 aspirtab maximum strength...... 10 BC FAST PAIN RELIEF...... 12 antacid plus anti-gas relief...... 8 ASTERO...... 10 BC FAST PAIN RELIEF ARTHRITIS. 12 antacid soft chews...... 8 ASTHMANEFRIN REFILL...... 10 b-caro-t...... 12 anthelios 50 mineral...... 8 athletes foot af...... 10 b-complex balanced...... 12 antibacterial liquid soap...... 8 athletes foot spray...... 10 b-complex high potency...... 12 anti-dandruff...... 8 ATLAS COLOR b-complex/vitamin c...... 12 anti-diarrheal...... 8 CONDOM/SPERMICIDE...... 10 BEANO...... 12 antifungal...... 9 ATRAC-TAIN...... 10 BEANO TO GO...... 12 anti-fungal...... 9 avaderm...... 10 bee pollen...... 12, 13 anti-gas ultra strength...... 9 avalin...... 11 beef flavor...... 13 anti-itch...... 9 AVEENO BATH MOISTURIZING...... 11 BEELITH...... 13 anti-itch maximum strength...... 9 AVEENO INTENSE RELIEF...... 11 BENADRYL ALLERGY...... 13 antioxidant formula sg...... 9 AVEENO NOURISH+DANDRUFF BENADRYL ALLERGY antiseptic...... 9 CONT...... 11 CHILDRENS...... 13 antiseptic oral rinse...... 9 AVEENO POSITIVELY AGELESS.....11 BENADRYL ALLERGY ANTISEPTIC PERINEAL WASH II...... 9 AVEENO STRESS RELIEF BODY ULTRATABS...... 13 antiseptic skin cleanser...... 9 WASH...... 11 BENADRYL ITCH RELIEF...... 13 antiseptic wound/skin cleanser...... 9 AVENOVA/NEUTROX...... 11 BENADRYL ITCH STOPPING...... 13 anu-med...... 9 AVERTEAX...... 11 BENADRYL MAXIMUM APATATE FORTE...... 9 AXSAIN...... 11 STRENGTH...... 13 APETIGEN...... 9 AYR SALINE NASAL...... 11 BENADRYL-D ALLERGY/SINUS APETIGEN-PLUS...... 9 AYR SALINE NASAL DROPS...... 11 CHILD...... 13 ap-hist dm...... 9 AYR SALINE NASAL GEL...... 11 BENEFIBER...... 13 apothesar...... 9 AYR SALINE NASAL RINSE...... 11 BENEFIBER FOR CHILDREN...... 13 APRODINE...... 9 azec...... 11 BENEFIBER ON THE GO...... 13 138 BENEFIBER PLUS B VITS & FA...... 13 bio-rytuss...... 15 butylparaben...... 17 BENEFIBER PLUS CALCIUM...... 13 biospec dmx...... 15 c-1500/rose hips sr...... 17 BENEFIBER PLUS HEART biotalan clear...... 15 c1500/rose hips/bioflavonoid...... 17 HEALTH...... 13 BIO-THERM PAIN RELIEVING...... 15 ca phosphate dibasic dihyd...... 17 benfotiamine multi-b...... 13 biotin...... 15 cadeau dha...... 17 BENGAY ARTHRITIS FORMULA.....13 biotin forte...... 15 caffeine anhydrous...... 17 BENGAY COLD THERAPY...... 13 biotin-d...... 15 cal mag zinc +d3...... 17 BENGAY VANISHING SCENT...... 13 biotuss...... 15 cal/mag...... 17 BENSULFOID...... 13 biovol...... 15 CALADRYL...... 17 bentonite...... 13 bisacodyl ec...... 15 CALAGEL MAXIMUM STRENGTH..17 BENZAC AC WASH...... 13 biscolax...... 15 CALAGESIC...... 17 benzaldehyde...... 13 bismatrol...... 15 calahist clear...... 17 benzalkonium chloride...... 13 bismatrol maximum strength...... 15 calamine...... 17 BENZEDREX...... 13 bismuth citrate...... 15 calamine phenolated...... 17 BENZEPRO...... 13 bismuth subcarbonate...... 15 calamine-zinc oxide...... 17 BENZEPRO SHORT CONTACT...... 13 bismuth subgallate...... 15 CAL-CARB FORTE...... 17 benzocaine...... 14 bismuth subnitrate...... 15 CALCET PETITES...... 17 BENZODENT...... 14 bismuth subsalicylate...... 15 CALCI-CHEW...... 17 benzoic acid...... 14 bite/itch...... 15 CALCIFEROL...... 17 benzonatate...... 14 BI-ZETS/BENZOTROCHES...... 16 calci-max...... 17 BENZ-O-STHETIC...... 14 BLINK TEARS...... 16 CALCITRATE...... 17 benzoyl peroxide...... 14 blood pressure monitor/wrist...... 16 cal-citrate...... 17 benzoyl peroxide cleanser...... 14 blue gel...... 16 calcium...... 19 benzoyl peroxide wash...... 14 boil pain relief...... 16 calcium + d3...... 17 benzphetamine hcl...... 14 borage...... 16 calcium 1200...... 17 bergamot oil...... 14 borax...... 16 calcium 500 + d3...... 17 BERRI-FREEZ PAIN RELIEVING...... 14 boric acid...... 16 calcium 600...... 17 BERRI-FREEZ PLUS...... 14 boron...... 16 calcium 600+d high potency...... 17 BETA CARE BETATAR GEL...... 14 BOUDREAUXS BABY KISSES...... 16 calcium 600+d3 plus minerals...... 17 beta carotene provitamin a...... 14 BOUDREAUXS BUTT PASTE...... 16 calcium acetate...... 18 BETADINE...... 14 BOUDREAUXS RASH PREVENTOR 16 calcium antacid...... 18 BETADINE SKIN CLEANSER...... 14 bp gel...... 16 calcium antacid extra strength...... 18 BETADINE SWAB AID...... 14 bpm-dm-phen...... 16 calcium antacid ultra...... 18 betaine anhydrous...... 14 bpo creamy wash...... 16 calcium antacid ultra max st...... 18 betaine hcl...... 14 BPROTECTED PEDIA POLY-VITE....16 calcium antacid ultra strength...... 18 BETAQUIK...... 14 BPROTECTED PEDIA TRI-VITE...... 16 calcium ascorbate...... 18 BETASEPT SURGICAL SCRUB...... 14 BRASIVOL...... 16 calcium aspartate...... 18 BIATAIN HEEL ADH FOAM BRAUN NO TOUCH + FOREHEAD...16 calcium carbonate...... 18 DRESSING...... 14 brewers yeast...... 16 calcium carbonate antacid...... 18 BIATAIN SACRAL FOAM BRIJ 30...... 16 calcium carbonate-vitamin d...... 18 DRESSING...... 14 brilliant green...... 16 calcium chloride...... 18 BICARSIM...... 14 brohist d...... 16 calcium citrate...... 18 BICARSIM FORTE...... 14 bromelain...... 16 calcium citrate +...... 18 bio t pres pediatric...... 14 BROMFED DM...... 16 calcium citrate malate-vit d...... 18 biobron sf...... 14 bromi-lotion...... 16 calcium citrate plus...... 18 biodesp dm...... 14 bronchial asthma relief...... 16 calcium citrate plus/magnesium...... 18 BIO-D-MULSION...... 15 BRONCOTRON PED...... 16 calcium citrate tetrahydrate...... 18 BIO-D-MULSION FORTE...... 15 BRONKAID...... 16 calcium citrate-vitamin d...... 18 bioflavonoid citrus...... 15 bronkids...... 16 calcium citrate-vitamin d3...... 18 BIO-FLAX...... 15 brontuss dx...... 16 calcium gluconate...... 18 BIOFLEXOR...... 15 BROTAPP...... 16 calcium high potency...... 18 BIOFLONEX...... 15 brotapp dm...... 16 calcium high potency/vitamin d...... 18 BIOFREEZE...... 15 btrex...... 16 calcium hydroxide...... 18 BIOGAIA GASTRUS...... 15 BUCKLEYS COUGH...... 17 calcium lactate...... 18 biogesic...... 15 budesonide...... 17 calcium pantothenate...... 19 BIOGUARD NON-ADHERENT BUFFERIN...... 17 calcium phosphate tribasic...... 19 DRESSING...... 15 BUFFERIN EXTRA STRENGTH...... 17 calcium plus vitamin d3...... 19 BION TEARS PF...... 15 BUFFERIN LOW DOSE...... 17 calcium saccharate...... 19 bionatuss dxp...... 15 BULL FROG SUPERBLOCK SPF50... 17 calcium soft chews...... 19 BIOPATCH PROTECTIVE BUMM BALM...... 17 calcium sulfate...... 19 DISK/CHG...... 15 burn relief...... 17 calcium-magnesium...... 19 BIORX SPONIX ANTI-FUNGAL...... 15 burn relief/lidocaine/aloe...... 17 calcium-magnesium-zinc...... 19 BIORX SPONIX ARTHR & MUSC..... 15 butylated hydroxytoluene...... 17 calcium-magnesium-zinc-d3...... 19 139 calcium-vitamin d...... 19 castellani paint modified...... 21 childrens aspirin free...... 22 calcium-vitamin d3...... 19 CASTIVA COOLING...... 21 childrens aspirin low strength...... 22 calcium-vitamin d-minerals...... 19 CASTIVA WARMING...... 21 childrens cold & allergy...... 22 caldyphen clear...... 19 castor oil...... 21 childrens ibuprofen...... 23 calendula...... 19 castor oil sulfated...... 21 childrens loratadine...... 23 CAL-GEST ANTACID...... 19 CAVILON EMOLLIENT...... 21 childrens mapap rapid tabs...... 23 cal-glu...... 19 CAVILON FOOT & DRY SKIN...... 21 CHILDRENS MOTRIN...... 23 cal-lac...... 19 CAVILON NO STING BARRIER childrens mucus relief cough...... 23 CALLERGY CLEAR...... 19 FILM...... 21 childrens mucus relief expect...... 23 cal-mag zinc ii...... 19 CAVILON ONE-STEP SKIN CARE.... 21 childrens non-aspirin...... 23 cal-mag-zinc-d...... 19 CAVILON SKIN CLEANSER...... 21 childrens pain reliever...... 23 cal-mint...... 19 c-caps tr...... 21 childrens plus multi-sympt cld...... 23 CALMOSEPTINE...... 19 CELACYN...... 21 childrens silfedrine...... 23 calna...... 19 celery seed...... 21 CHILDRENS SOOTHE...... 23 CALPHRON...... 19 cellulase...... 21 childrens tactinal...... 23 CALTRATE 600+D...... 19 cellulose...... 21 childs ibuprofen...... 23 CALTRATE 600+D PLUS centravites adults...... 21 chlo hist...... 23 MINERALS...... 19 CENTRUM SPECIALIST CHLO TUSS...... 23 CALTRATE 600+D3 SOFT...... 19 PRENATAL...... 21 chlo tuss ex...... 23 CALTRATE GUMMY BITES...... 19 CEO-TWO...... 21 chlophed...... 23 CALTRATE MINIS PLUS CEPACOL ANTIBACTERIAL...... 21 CHLORAPREP ONE STEP...... 23 MINERALS...... 19 CEPACOL SORE THROAT...... 21 CHLORASEPTIC...... 23 calvite p ...... 20 CEPACOL SORE THROAT & CHLORASEPTIC SORE THROAT...... 23 CAMPHO-PHENIQUE...... 20 COUGH...... 21 chlorella...... 23 camphor...... 20 CEPASTAT...... 21 chlorhexidine gluconate...... 23 camphor blocks...... 20 CERASPORT EX1...... 21 chlorhexidine gluconate cloth...... 23 CAMPHOTREX...... 20 CERAVE ITCH RELIEF...... 21 chloroform...... 23 CANKAID...... 20 cesium...... 21 chlorophyll...... 23 capcof...... 20 CESIUM 1000...... 21 chlorpheniramine maleate er...... 23 capmist dm...... 20 cesium 500...... 21 CHLOR-TRIMETON...... 23 capron dm...... 20 CETAPHIL GENTLE CLEANSING.... 21 CHLOR-TRIMETON ALLERGY...... 23 capron dmt...... 20 cetirizine hcl...... 22 chocolate concentrate...... 23 CAPSAGEL...... 20 cetirizine hcl allergy child...... 21 cholecalciferol...... 23 CAPSAGEL EXTRA STRENGTH...... 20 cetirizine hcl childrens...... 22 cholesterol...... 24 CAPSAGEL MAXIMUM cetirizine hcl childrens alrgy...... 21 cholesterol acetate...... 23 STRENGTH...... 20 cetirizine-pseudoephedrine er...... 22 choline...... 24 capsaicin...... 20 cetyl alcohol...... 22 choline citrate...... 24 capsaicin hot patch...... 20 CHAMOSYN...... 22 CHONDROITIN SULFATE CAPSIDERM...... 20 CHAP-EX TROPICALS...... 22 COMPLEX...... 24 capsule 1 clear veggie...... 20 CHAPSTICK OVERNIGHT...... 22 CHROMACAPS...... 24 caraway oil...... 20 CHAPSTICK ULTRA RENEWAL...... 22 chromic chloride...... 24 CARBAPHEN CH...... 20 charcoal activated...... 22 chromium...... 24 CARBAPHEN PED CH...... 20 CHAR-FLO WITH SORBITOL...... 22 chromium aspartate...... 24 CARBOHOL 940...... 20 chelated calcium...... 22 chromium gtf...... 24 carbopol 940 nf...... 20 chelated magnesium...... 22 chromium picolinate...... 24 carboxymethylcellulose sodium...... 20 CHEMSTRIP CALIBRATION...... 22 chrysin...... 24 CARBZERO...... 20 CHERACOL-D COUGH...... 22 cinnamon...... 24 cardamom...... 20 cheratussin ac...... 22 cinnamon oil...... 24 CARDENZ...... 20 cheratussin dac...... 22 CITRA PH...... 24 CA-REZZ...... 20 cherry concentrate...... 22 CITRACAL PLUS...... 24 ca-rezz gentle...... 20 chest congestion daytime...... 22 CITRACAL PLUS BONE DENSITY... 24 ca-rezz norisc...... 20 chest congestion relief...... 22 citric acid anhydrous...... 24 CARMOL 10...... 20 chest congestion relief dm...... 22 citric acid monohydrate...... 24 CARNI Q-GEL FORTE...... 20 chest congestion relief pe...... 22 citronella oil...... 24 CARRASMART...... 20 CHEW Q...... 22 CITRUCEL...... 24 CARRASORB H...... 20 chewable calcium...... 22 citrulline...... 24 CARRASYN V WOUND DRESSING. 20 chewable iron...... 22 CITRULLINE 1000...... 24 CARRINGTON ANTIFUNGAL...... 21 CHIGG AWAY...... 22 CITRULLINE200...... 24 CARRINGTON DERMAL WOUND....21 CHIGGEREX...... 22 citrus bioflavonoids...... 24 CARRINGTON MOIST CHIGGERTOX...... 22 CLARITIN...... 24 BARRIER/ZINC...... 21 childrens acetaminophen...... 22 CLARITIN CHILDRENS...... 24 CARRINGTON MOISTURE CHILDRENS ADVIL...... 22 CLARITIN REDITABS...... 24 BARRIER...... 21 childrens aspirin...... 22 CLARITIN-D 12 HOUR...... 25 140 CLARITIN-D 24 HOUR...... 25 COMFORT CLEAN/COMFORT creatine monohydrate...... 28 CLEAN & CLEAR ACNE SHIELD...... 27 creatine5000...... 29 CLEANSER...... 25 comfort-heal heating pad...... 27 CREOMULSION ADULT...... 29 CLEAN & CLEAR BLEMISH complete allergy...... 27 CREOMULSION FOR CHILDREN..... 29 TREATMNT...... 25 complete allergy medicine...... 27 CREST...... 29 CLEAN ZING...... 25 complete lice treatment...... 27 CR-GTF...... 29 CLEAR EYES COOLING COMFORT.25 compound benzoin tincture...... 27 CRITIC-AID CLEAR AF...... 29 CLEAR EYES REDNESS RELIEF...... 25 COMPOUND W MAXIMUM CRITIC-AID THICK MOIST clear zinc spf 50...... 25 STRENGTH...... 27 BARRIER...... 29 CLEARASIL DAILY CLEAR ACNE...25 COMTREX COLD & COUGH MAX cromolyn sodium...... 29 CLEARLAX...... 25 ST...... 27 croton oil...... 29 CLEARPLEX V...... 25 COMTREX COLD/COUGH CR-PLUS...... 29 clemastine fumarate...... 25 DAY/NITE MS...... 27 cu-25...... 29 CLERZ PLUS...... 25 COMTREX DEEP CHEST COLD...... 27 cu-5...... 29 CLEVER CHOICE BP CONEX COLD/ALLERGY...... 27 cupric chloride...... 29 MONITOR/WRIST...... 25 CONGESTAC...... 27 cupric sulfate...... 29 clioquinol...... 25 congestion relief...... 27 CURAD GERM SHIELD...... 29 CLORPACTIN...... 25 CONTRAVE...... 27 CURAFIL WOUND DRESSING...... 29 clotrimazole...... 25 cool mist humidifier...... 27 CURASOL WOUND DRESSING...... 29 clotrimazole 3...... 25 cool mist humidifier 0.8 gal...... 27 CURITY GAUZE...... 29 clove oil...... 25 cool mist humidifier 1 gallon...... 27 CURITY MESH GAUZE BNDG co q-10...... 25 cool mist humidifier 1.2 gal...... 27 4"X30'...... 29 COAGUCHEK XS PLUS SYSTEM..... 25 cool mist humidifier 2 gallon...... 27 CURITY NURSING...... 29 COAGUCHEK XS PT TEST...... 25 cool n heat ex st...... 27 CURITY TELFA NON-STICK...... 29 coal tar...... 25 copper sulfate...... 27 cvs absorbent cotton/rolled...... 29 COATS ALOE...... 25 COPPERMIN...... 27 cvs acetaminophen...... 29 COATS ALOE JUICE DRINK...... 25 co-q 10 omega-3 fish oil...... 27 cvs adhesive gauze...... 29 COATS ALOE LINIMENT...... 25 coq10...... 27 cvs aftersun aloe/lidocaine...... 29 COATS ALOE VERA...... 25 coq-10...... 27 CVS AIRSHIELD...... 29 cocoa butter...... 25 coral calcium...... 28 cvs allergy relief...... 29 cocoa butter skin...... 26 CORICIDIN HBP COLD/FLU...... 28 cvs allergy relief childrens...... 29 cod liver oil...... 26 CORICIDIN HBP COUGH/COLD...... 28 cvs antacid childrens...... 29 cod liver oil w/vit a, c & d...... 26 CORICIDIN HBP DAY/NIGHT cvs anti-itch sensitive...... 29 codituss dm...... 26 COLD...... 28 cvs antiseptic mouth rinse...... 29 coditussin ac...... 26 CORICIDIN HBP NIGHTTIME cvs astringent solution...... 29 coditussin dac...... 26 COLD...... 28 cvs backache relief...... 29 coenzyme q10...... 26 corn oil...... 28 cvs ca citrate+d/magnesium...... 29 coenzyme q-10...... 26 CORN REMOVER WATERPROOF.... 28 cvs calcium...... 30 co-enzyme q10-vitamin e...... 26 corn starch...... 28 cvs calcium 600 plus...... 29 cola syrup...... 26 corn/callus remover...... 28 cvs chest rub medicated...... 30 COLACE...... 26 CORTICOOL...... 28 cvs childrens multivit/extra c...... 30 cold & cough day/night child...... 26 CORTIZONE-10/ALOE...... 28 cvs cleansing eyelid wipes...... 30 cold & hot balm extra strength...... 26 COSAMIN ASU FOR JOINT cvs cleansing skin...... 30 cold control pe cold/flu med...... 26 HEALTH...... 28 cvs cold remedy...... 30 cold head congestion daytime...... 26 COSAMIN VERDE FOR JOINT cvs cool mist humidifer...... 30 cold head congestion nighttime...... 26 HEALTH...... 28 cvs coq-10...... 30 cold head congestion severe...... 26 cottonseed oil...... 28 cvs corn/callus remover...... 30 cold multi-symptom daytime...... 26 COTTONTAILS DIAPER RASH cvs cough dm...... 30 cold multi-symptom nighttime...... 26 CREAMY...... 28 cvs dairy relief ex st...... 30 cold multi-symptom severe day...... 26 cough & chest congestion dm...... 28 cvs daytime/nighttime cold/flu...... 30 cold relief plus...... 26 cough & cold...... 28 cvs daytime/nighttime cough...... 30 cold remedy...... 26 cough & sore throat day...... 28 cvs diabetes health support...... 30 cold sore treatment...... 26 cough dm...... 28 cvs digestive probiotic...... 30 cold therapy pain relief...... 26 cough drops...... 28 cvs diuretic maximum strength...... 30 cold/allergy childrens...... 26 cough relief adult...... 28 cvs early result pregnancy...... 30 cold/cough childrens...... 26 cough syrup...... 28 cvs easy fiber...... 30 cold/cough dm childrens...... 26 coughtab...... 28 cvs easy fiber/calcium...... 30 COLD-EEZE...... 26 cramp tabs...... 28 cvs epsom salt...... 30 COLLASIL OSA...... 26 cranberry...... 28 cvs ethyl alcohol...... 30 collodion...... 27 cranberry concentrate...... 28 cvs eye...... 30 collodion flexible...... 27 cranberry/probiotic...... 28 cvs eye health formula...... 30 colloidal oatmeal bath...... 27 cream base with liposome...... 28 cvs gauze sterile...... 30 creatine...... 29 cvs gluco-chondroit plus uc-ii...... 30 141 cvs glucosamine-chondroitin...... 30 cvs zinc...... 32 DERMAGRAN HYDROGEL cvs glucosamine-chondroit-msm...... 30 cvs zinc oxide diaper...... 32 WOUND...... 34 cvs glucose bits...... 30 cyanocobalamin...... 32 DERMAGRAN HYDROPHILIC-B...... 34 cvs glucose shot...... 30 CYSTECH...... 32 DERMAGRAN-B HYDROPHILIC...... 34 cvs hair regrowth for women...... 30 cystine...... 32 DERMAL THERAPY FINGER CARE.34 cvs heartburn relief ex st...... 30 d 2000...... 32 DERMAL WOUND CLEANSER...... 34 cvs heatwraps/back/hip...... 30 d 400...... 32 DERMAMED...... 34 cvs hemorrhoidal...... 30 d.o.s...... 32 DERMAPLEX...... 34 cvs hemorrhoidal & analgesic...... 30 DADS MENTHOL THROAT DROP....32 DERMASARRA ANTI-ITCH...... 34 cvs hot steam...... 30 daily care skin protectant...... 32 DERMASTAT...... 34 cvs hydrating skin treatment...... 30 daily ovulation predictor...... 32 DERMASYN...... 34 cvs hydrocolloid pads...... 30 dairy relief...... 32 DERMOPLAST...... 34 cvs hydrocortisone acetate...... 30 dakins...... 32 dermovix...... 34 cvs ibuprofen pm...... 30 dakins (1/2 strength)...... 32 DESENEX...... 34 cvs instant food thickener...... 31 dakins (1/4 strength)...... 32 DESENEX FOOT/SNEAKER SPRAY.34 cvs isopropyl alcohol wipes...... 31 DAKRINA...... 32 DESITIN...... 34 cvs itch relief...... 31 DALLERGY...... 32 despec-dm...... 34 cvs laxative dietary supplemnt...... 31 dandruff shampoo...... 32 DESQUAM-X WASH...... 34 cvs loperamide hcl...... 31 DAY TIME COLD/FLU RELIEF... 32, 33 DEVON ANDREWS FRAME...... 34 cvs lubricant drops...... 31 day time cough...... 33 DEVROM...... 34 cvs magnesium citrate...... 31 day time multi-sympt cold/flu...... 33 DEWEES CARMINATIVE...... 34 cvs manuka honey wound...... 31 day time pe cold/flu relief...... 33 dextromethorphan polistirex er...... 34 cvs medicated wipes...... 31 day time/nite time cold/flu...... 33 dextromethorphan-guaifenesin...... 35 cvs melatonin...... 31 DAYHIST ALLERGY 12 HOUR dextrose...... 35 cvs miconazole 1 combo pack...... 31 RELIEF...... 33 dextrose anhydrous...... 35 cvs miconazole 3 combo pack...... 31 DAYTIME COLD MEDICINE...... 33 dha complete...... 35 cvs mineral oil enema...... 31 day-time pe...... 33 dhea...... 35 cvs mini enema kids...... 31 daytime sinus congestion...... 33 DHS SAL...... 35 cvs multi-purpose...... 31 daytime/nighttime relief plus...... 33 DHS TAR...... 35 cvs nasal decongestant...... 31 DDROPS...... 33 DHS TAR GEL...... 35 cvs nasal mist...... 31 DECARA...... 33 DHS ZINC...... 35 cvs natural fiber supplement...... 31 DECON-A...... 33 DIAB DAILY CARE...... 35 cvs nerve pain relief...... 31 DECONEX DMX...... 33 DIABETIC BASICS HEALTHY cvs non-aspirin headache pm...... 31 DECONEX IR...... 33 FOOT...... 35 cvs non-drying sinus pe...... 31 deep sea nasal spray...... 33 diabetic siltussin das-na...... 35 cvs oral pain reliever...... 31 dehydroepiandrosterone...... 33 diabetic siltussin-dm...... 35 cvs pain pads...... 31 del clens...... 33 diabetic siltussin-dm max st...... 35 cvs pain relief...... 31 DELBASE COMPOUNDING...... 33 DIABETIC TUSSIN...... 35 cvs phosphate saline laxative...... 31 DELSYM...... 33, 34 DIABETIC TUSSIN ALLERGY...... 35 cvs prenatal...... 31 DELSYM CGH/CHEST CONG DM DIABETIC TUSSIN COLD & FLU...... 35 cvs prenatal gummy...... 31 CHILD...... 33 DIABETIC TUSSIN COLD/FLU...... 35 cvs protective...... 31 DELSYM CGH/CLD NIGHTTIME DIABETIC TUSSIN DM...... 35 cvs saline wound wash...... 31 CHILD...... 33 DIABETIC TUSSIN MAX ST...... 35 cvs silver...... 31 DELSYM COUGH CHILDRENS...... 33 DIABETIC TUSSIN MUCUS RELIEF.35 cvs sinus headache decongest...... 31 DELSYM COUGH RELIEF...... 33 diabet-x daily prevention...... 35 cvs sinus relief day/night...... 31 DELSYM COUGH/CHEST DIADERM FOOT REJUVENATING...35 cvs sore throat max strength...... 31 CONGEST DM...... 33 DIALYVITE 800...... 35 cvs sore throat relief pops...... 31 DELSYM COUGH/COLD DAYTIME.33 DIALYVITE 800 PLUS D...... 35 cvs steam inhaler...... 31 DELSYM COUGH/COLD NIGHT DIALYVITE 800/IRON...... 35 cvs stool softener...... 31 TIME...... 33 DIALYVITE 800/ZINC...... 35 cvs super cranberry urinary...... 31 DELSYM NIGHT TIME MULTI- DIALYVITE 800-ZINC 15...... 35 cvs tension headache...... 32 SYMPT...... 33 diaper rash...... 35 cvs therapeutic...... 32 DELTUSS DMX...... 34 DIASTIX...... 36 cvs therapeutic max st...... 32 DELTUSS DP...... 34 dibucaine...... 36 cvs triacting cough/runny nose...... 32 DENDRACIN dibucaine (perianal)...... 36 cvs triple magnesium complex...... 32 NEURODENDRAXCIN...... 34 dibutyl squarate...... 36 cvs vaginal moisturizer...... 32 DENTAPAINE...... 34 DICEL CD...... 36 cvs vitamin a & d...... 32 DEQUASINE...... 34 DI-DAK-SOL...... 36 cvs vitamin d infants...... 32 DERMA CIDOL 2000...... 34 diethylpropion hcl...... 36 cvs wart remover...... 32 dermacloud...... 34 diethylpropion hcl er...... 36 cvs wart remover one step...... 32 DERMAFUNGAL...... 34 dimaphen childrens...... 36 cvs wound wash advanced...... 32 DERMAGESIC...... 34 DIMAPHEN DM COLD/COUGH...... 36 cvs yogurt+calcium gummies...... 32 DERMAGRAN...... 34 dimenhydrinate...... 36 142 DIMETAPP COLD/ALLERGY...... 36 DYNA-HEX 2...... 38 eq calcium citrate+d3 petites...... 40 DIMETAPP DM COLD/COUGH...... 36 DY-O-DERM VITILIGO STAIN...... 38 eq cold/allergy childrens...... 40 DIMETAPP LONG ACT ear wax cleansing...... 38 eq cough sugar free...... 40 COUGH/COLD...... 36 ear wax removal drops...... 38 eq cryogenic wart removal sys...... 40 DIMETAPP NIGHT ear wax removal kit...... 38 eq daily fiber...... 40 COLD/CONGESTION...... 36 earwax treatment drops...... 38 eq dairy digestive fast acting...... 40 diocto...... 36 EASIVENT...... 38 eq feminine wash sensitive...... 40 diphenhist...... 36 EASIVENT MASK LARGE...... 38 eq glucosamine chondr/msm/d...... 40 diphenhydramine hcl...... 36 EASIVENT MASK MEDIUM...... 38 eq glucosamine-chondroitin-msm...... 40 diphenhydramine hcl (sleep)...... 36 EASIVENT MASK SMALL...... 38 eq hemorrhoidal...... 40 diphenhydramine-apap (sleep)...... 36 ecee plus...... 38 EQ MUCUS ER...... 40 dl-leucine...... 36 ECONTRA EZ...... 38 eq multi-symptom cold children...... 40 dl-pa-500...... 36 ECOTRIN...... 38 eq sinus relief max st...... 40 DML...... 36 ECOTRIN MAXIMUM STRENGTH... 38 eq sleep-aid nighttime...... 40 DOANS PILLS...... 36 ECPIRIN...... 38 eq tioconazole 1...... 40 DOANS PM EXTRA STRENGTH...... 37 e-cream complex...... 38 eql allergy...... 40 DOC OMEGA...... 37 ED A-HIST...... 39 eql aloe vera after sun...... 40 docosanol...... 37 ed a-hist dm...... 38 eql antacid ultra strength...... 40 docqlace...... 37 ed a-hist pse...... 39 eql antibacterial hand soap...... 40 DOC-Q-LAX...... 37 ed bron gp...... 39 eql anti-nausea...... 40 docusate sodium...... 37 ED CHLORPED...... 39 eql biotin...... 40 DOCUSOL KIDS...... 37 ED CHLORPED D...... 39 eql chest congestion daytime...... 41 DOCUSOL MINI...... 37 ed chlorped jr...... 39 eql denture cleanser...... 41 DOK...... 37 ed-a-hist dm...... 39 eql digestive enzymes...... 41 DOK PLUS...... 37 ed-apap...... 39 eql ear drops...... 41 DOLOGEN...... 37 ed-chlortan...... 39 eql effervescent cold relief...... 41 dolorex...... 37 edetate disodium...... 39 eql ethyl alcohol (rubbing)...... 41 DOMEBORO...... 37 effervescent antacid/pain rel...... 39 eql everyday clean...... 41 dometuss-da/children...... 37 effervescent pain relief...... 39 eql eye drops ac...... 41 dometuss-dmx...... 37 elite ca/mg...... 39 eql fiber therapy...... 41 DONATUSSIN...... 37 elite calcium...... 39 eql flax seed oil...... 41 double antibiotic...... 37 ELITE IRON...... 39 eql flu/severe cold daytime...... 41 DOUBLE-TUSSIN DM...... 37 ELITE ZINC...... 39 eql gas prevention...... 41 DOVER HYDROGEL FOLEY CATH ELIXSURE COUGH...... 39 eql gentle skin cleanser...... 41 24FR...... 37 ELIXSURE FEVER/PAIN...... 39 eql glucosamine chondroitin...... 41 doxylamine succinate...... 37 ellis tonic...... 39 eql glucosamine-chondroit-msm...... 41 DR BOLDTS HINEY HEALER...... 37 ELLURA...... 39 eql gummies childrens...... 41 DR SMITHS DIAPER...... 37 ELTA DERMAL...... 39 eql ibuprofen cold childrens...... 41 DR SMITHS DIAPER RASH...... 37 ELTA DERMAL WOUND...... 39 eql lutein...... 41 DR SMITHS RASH + SKIN...... 37 ELTA SEAL MOISTURE BARRIER...39 eql omega 3 fish oil...... 41 DRAMAMINE...... 37 EMETROL...... 39 eql redness relief...... 41 dri-ear...... 37 empty capsule size 1 clear...... 39 eql scalp relief max strength...... 41 DRIMINATE...... 37 ENDACOF-DM...... 39 eql ultra protection spf50...... 41 DRISDOL...... 37 ENDOXCIN...... 39 eql vitamin d gummies child...... 41 DRISTAN COLD...... 37 ENDUR-ACIN...... 39 eql vitamin d3...... 41 DRISTAN SPRAY...... 37 enema...... 39 eql wet cleansing towelettes...... 41 DRIXORAL COLD/ALLERGY...... 37 ENEMEEZ PLUS...... 39 EQUALACTIN...... 41 DRIXORAL COLD/FLU...... 38 ENFAMIL ENFALYTE...... 39 ESOTERICA FACIAL...... 41 DRIXORAL COUGH/SORE ENFAMIL EXPECTA...... 39 ESOTERICA FADE NIGHTTIME...... 41 THROAT...... 38 ENTEX T...... 40 ESOTERICA SENSITIVE SKIN...... 41 dry skin treatment adv therapy...... 38 entre-cough...... 40 ESTER-C...... 41 drymax extra...... 38 ENTSOL...... 40 ethoxy diglycol...... 41 dual action complete...... 38 ENTSOL NASAL...... 40 ethyl alcohol...... 41 DULCOLAX...... 38 ENTSOL NASAL WASH...... 40 ethyl alcohol (rubbing)...... 41 DURAFLEX COMFORT...... 38 e-oil...... 40 ethyl oleate...... 41 DURAFLU...... 38 epa/gla...... 40 eucalyptol...... 41 DURAPROXIN...... 38 ephedrine hcl...... 40 eucalyptus oil...... 41 DURAPROXIN ES...... 38 EPISORB...... 40 EUCERIN...... 41 DURATION SPRAY...... 38 epsom salt...... 40 EUCERIN ECZEMA RELIEF...... 41 DURAVENT DM...... 38 eq allergy/sinus headache...... 40 EUCERIN ORIGINAL HEALING...... 42 DURAVENT PE...... 38 eq antacid & anti-gas...... 40 eugenol...... 42 D-VI-SOL...... 38 eq aspirin...... 40 EVAC...... 42 d-xylose...... 38 EQ BABY CHEST RUB...... 40 evening primrose oil...... 42 143 EXACTA-MED ENTERAL FEVERALL ADULTS...... 44 food color red...... 46 DISPENSER...... 42 FEVERALL CHILDRENS...... 44 food color yellow...... 46 EXACTUSS TR...... 42 FEVERALL INFANTS...... 44 FORA D40 GLUCOSE/PRESSURE..... 46 EXCEDRIN EXTRA STRENGTH...... 42 FEVERALL JUNIOR STRENGTH...... 44 formaldehyde...... 46 EXCEDRIN MENSTRUAL fexofenadine hcl...... 44 FORMULA 405 LE PONT NAIL...... 46 COMPLETE...... 42 fexofenadine hcl childrens...... 44 formula em...... 46 EXCEDRIN MIGRAINE...... 42 fexofenadine-pseudoephed er...... 44 FREE & CLEAR...... 46 EXCEDRIN PM...... 42 fiber...... 44 freedom cepapro...... 46 EXCEDRIN TENSION HEADACHE...42 fiber (corn dextrin)...... 44 FREEDOM ODT BASE...... 46 EXCEL AP...... 42 fiber laxative...... 44 FREEDOM PAK SEVEN MALE EXCEL-GEL...... 42 fiber plus calcium...... 44 CATH...... 46 EXFOLIX EXFOLIATING FOOT fiber therapy...... 44 FRESHKOTE...... 46 SOAP...... 42 FIBERCON...... 44 fructose...... 46 EX-LAX...... 42 FIBEREX F15...... 44 fruit c...... 46 EX-LAX MAXIMUM STRENGTH...... 42 fiber-lax...... 44 fullers earth...... 46 exoten-c pain relief...... 42 fibromyalgia symptom relief...... 44 FUNGI-NAIL...... 46 extended term oral care system...... 42 first aid antibiotic...... 44 FUNGOID TINCTURE...... 46 extra action cough...... 42 first aid antiseptic spray...... 44 FUNGOID-D...... 46 EXTRESS-30...... 42 fish oil...... 44 FUSION...... 46 eye allergy relief...... 42 fish oil + d3...... 44 gamma aminobutyric acid...... 46 eye drops...... 42 fish oil adult gummies...... 44 garlic/epa...... 46 eye drops advanced relief...... 42 flax oil-fish oil-borage oil...... 44 garlic-lecithin...... 46 eye drops extra...... 42 FLEET BISACODYL...... 44 garlic-parsley...... 46 eye drops maximum relief...... 42 FLEET ENEMA...... 44 gas relief...... 46 EYE STREAM...... 42 FLEET LIQUID GLYCERIN SUPP..... 44 gas relief extra strength...... 46 EYE-SED...... 43 FLEET NATURALS CLEANSING gas relief maximum strength...... 46 EZFE 200...... 43 ENEMA...... 45 gas relief ultra strength...... 46 E-Z-GAS II...... 43 FLEET OIL...... 45 GAS-X...... 47 FAGRON VERSIFIX...... 43 FLEXICHAMBER...... 45 GAS-X CHILDRENS...... 46 FALLBACK SOLO...... 43 FLEXICHAMBER CHILD GAS-X EXTRA STRENGTH...... 46 famotidine...... 43 MASK/LARGE...... 45 GAS-X PREVENTION...... 47 FAST FREEZE PRO STYLE FLEXIFLO EASY-FEED ENTERAL GAS-X ULTRA STRENGTH...... 47 THERAPY...... 43 BAG...... 45 GAS-X WITH MAALOX EX ST...... 47 father johns medicine...... 43 FLINTSTONES TODDLER...... 45 gavilax...... 47 FATTYBLEND...... 43 FLINTSTONES/EXTRA C...... 45 GAVISCON...... 47 fd&c blue #2...... 43 FLOGEN...... 45 GAVISCON EXTRA RELIEF fd&c red #40 aluminum lake...... 43 FLONASE ALLERGY RELIEF...... 45 FORMULA...... 47 fd&c yellow #5...... 43 FLONASE SENSIMIST...... 45 GAVISCON EXTRA STRENGTH...... 47 fdc blue 1...... 43 FLORA ASSIST...... 45 G-BUCAL-C...... 47 fdc green #3...... 43 FLORANEX...... 45 ge-150...... 47 fdc red #3...... 43 FLORASTOR...... 45 GEBAUERS INSTANT ICE...... 47 fdc yellow 6...... 43 FLORASTOR KIDS...... 45 gelatin...... 47 FE C...... 43 FLORICAL...... 45 GELONASAL...... 47 FEBROL...... 43 flow-eze vented needle...... 45 GEL-STAT...... 47 fem-cal citrate...... 43 flu & sore throat...... 45 GELUSIL...... 47 FEMINEASE...... 43 flu & sore throat relief...... 45 GENTEAL...... 47 FERAHEME...... 43 FLU RELIEF...... 45 GENTEAL MILD...... 47 FER-IN-SOL...... 43 flu/severe cold & cough day...... 45 GENTEAL MILD TO MODERATE.....47 fer-iron...... 43 flu/severe cold/cough night...... 45 GENTEAL SEVERE...... 47 ferretts...... 43 FOILLE...... 45 GENTEAL TEARS NIGHT-TIME...... 47 ferretts chewable iron...... 43 FOLGARD...... 45 GENTEAL TEARS PF...... 47 ferretts ips...... 43 folic acid...... 45 gentian violet...... 47 FERREX 150...... 43 folinic-plus...... 45 gentle laxative...... 47 ferric subsulfate...... 43 FOLITAB 500...... 45 GENTLE RAIN...... 47 FERRIMIN 150...... 43 FOLTABS 800...... 45 gentle skin cleanser...... 47 FERRLECIT...... 43 food color black...... 45 geravine...... 48 ferrous aspartate...... 43 food color blue...... 45 geriatric vitamin...... 48 ferrous fumarate...... 43 food color blue royal...... 45 GERI-HYDROLAC 12...... 48 ferrous gluconate...... 43 food color brown...... 45 geri-lanta...... 48 ferrous sulfate...... 43, 44 food color flesh...... 46 gerisilk bath oil...... 48 ferrous sulfate er...... 43 food color green...... 46 GILPHEX TR...... 48 fever reducer childrens...... 44 food color lime green...... 46 GILTUSS COUGH & COLD...... 48 FEVERALL...... 44 food color orange...... 46 GINKGO BILOBA XTRA...... 48 144 ginseng...... 48 gnp arthritis pain relief...... 50 gnp lice solution...... 52 gla-45...... 48 gnp aspirin...... 50 gnp lice treatment...... 52 glen pe...... 48 gnp athletes foot...... 50 gnp liquid bandage...... 52 glenmax peb...... 48 gnp b-50 complex...... 50 gnp l-lysine...... 52 glentuss...... 48 gnp bacitracin zinc...... 50 gnp loperamide hcl...... 52 g-levocarnitine s/f...... 48 gnp b-complex plus vitamin c...... 50 gnp loratadine...... 52 GLUCOCOM AUTOLINK gnp cal mag zinc +d3...... 50 gnp loratadine childrens...... 52 TELEMONITOR...... 48 gnp calamine...... 50 gnp loratadine-d 12hr...... 52 glucoless...... 48 gnp calamine phenolated...... 50 gnp loratadine-d 24 hour...... 52 glucosamine chond complex/msm...... 48 gnp calcium 600 plus d/mineral...... 50 gnp lubricant eye drops...... 52 glucosamine chondroitin adv...... 48 gnp calcium plus 600 +d...... 50 gnp lubricant pm...... 52 glucosamine chondroitin complx...... 48 gnp caldyphen...... 50 gnp lubricating plus eye drops...... 52 glucosamine chondroitin vit d3...... 48 gnp chest rub...... 50 GNP MASANTI MAXIMUM glucosamine complex/vitamin d3...... 48 gnp childrens allergy...... 50 STRENGTH...... 52 glucosamine hcl...... 48 gnp childrens chewables/ex c...... 50 GNP MASANTI REGULAR glucosamine sulfate...... 48 gnp childrens ibuprofen...... 50 STRENGTH...... 52 glucosamine-chondroitin...... 48 gnp childrens pain relief/cold...... 50 gnp miconazole 3...... 52 glucosamine-chondroitin ds...... 48 gnp childrens plus cough/sore...... 50 gnp miconazole 3 applicator...... 52 glucosamine-chondroitin sulf...... 48 gnp childrens plus multi-sympt...... 50 gnp miconazole 7...... 53 glucosamine-chondroitin-msm...... 48 GNP CLEARLAX...... 50 gnp migraine relief...... 53 glucosamine-chondroitin-vit d3...... 48 gnp clotrimazole 3...... 50 gnp motion sickness relief...... 53 glucosamine-msm...... 48 gnp cold head congest day/nght...... 51 gnp mucus er...... 53 glucos-chondroit-msm complex...... 48 gnp cold head congestion...... 51 gnp mucus relief...... 53 glucose...... 49 gnp cold multi-sympt day/night...... 51 gnp mucus relief cold & sinus...... 53 GLUCOSE NURSETTE...... 49 gnp cold multi-symptom daytime...... 51 gnp mucus relief cold flu...... 53 glutamine...... 49 gnp cold multi-symptom night...... 51 gnp mucus relief congest/cold...... 53 glutathione...... 49 gnp cold remedy...... 51 gnp mucus relief dm...... 53 glutol...... 49 gnp cold severe congestion day...... 51 gnp mucus relief pe...... 53 glycerin...... 49 gnp cold/allergy childrens...... 51 gnp multi-symptom cold daytime...... 53 glycerin (adult)...... 49 gnp cold/cough childrens...... 51 gnp naproxen sodium...... 53 glycerin (infant)...... 49 gnp coq-10 & fish oil...... 51 gnp nasal decongestant...... 53 glycerin (infants & children)...... 49 gnp cough dm er...... 51 gnp nasal decongestant pe...... 53 glycerin-rose water...... 49 gnp day time cold/flu...... 51 gnp nasal spray...... 53 glyceryl monostearate...... 49 gnp day time cold/flu relief...... 51 gnp nasal spray extra moist...... 53 glycine...... 49 gnp day time mucus relief dm...... 51 gnp niacin...... 53 glycine500...... 49 gnp day time sinus...... 51 gnp nicotine polacrilex...... 53 GLYCOLAX...... 49 gnp dayhist allergy...... 51 gnp night time cold & flu...... 53 glycolic acid...... 49 gnp diaper rash creamy...... 51 gnp night time cold/flu relief...... 53 g-myco nail...... 49 gnp dual action complete...... 51 gnp night time cold-flu...... 53 gnp 4x probiotic...... 49 gnp ear drops...... 51 gnp night time cough...... 53 gnp 8 hour pain reliever...... 49 gnp ethyl alcohol...... 51 gnp night time sinus...... 53 gnp acid control 150 max st...... 49 gnp eye drops...... 51 gnp nighttime sleep aid...... 53 gnp acid control 75...... 49 gnp eye itch relief...... 51 gnp no drip nasal spray...... 53 gnp acid reducer...... 49 gnp fish oil...... 51 gnp nose drops extra strength...... 53 gnp acid reducer max st...... 49 gnp flu/severe cold daytime...... 51 gnp omeprazole...... 53 gnp acne treatment...... 49 gnp foaming antacid...... 51 gnp one daily plus iron...... 53 gnp advanced eye health...... 49 gnp gas relief extra strength...... 51 gnp pain relief ex st am/pm...... 53 gnp alcohol denatured...... 49 gnp gentian violet...... 51 gnp pain relief pm ex st...... 53 gnp all day allergy...... 49 gnp glucosame chondroitin ds...... 52 gnp pain relief/benzocaine...... 54 gnp all day allergy childrens...... 49 gnp glucosamine chondroit ts...... 52 gnp peppermint spirit...... 54 gnp all day allergy-d...... 49 gnp glucosamine chondroitin...... 52 gnp pre-menstrual relf max st...... 54 gnp all day pain relief...... 49 gnp headache relief extra str...... 52 gnp pseudoephedrine hcl 12 hr...... 54 gnp allergy...... 49, 50 gnp heartburn relief...... 52 gnp senna-lax...... 54 gnp allergy & congestion...... 49 gnp hemorrhoidal...... 52 gnp sinus & cold-d...... 54 gnp allergy multi-symptom...... 49 gnp ibuprofen...... 52 gnp sinus cong/pain day/night...... 54 gnp allergy relief...... 50 gnp ibuprofen cold/sinus...... 52 gnp sinus congest/pain night...... 54 gnp animal shapes plus extra c...... 50 gnp ibuprofen infants...... 52 gnp sinus congestion/pain day...... 54 gnp antacid & anti-gas...... 50 gnp ibuprofen junior strength...... 52 gnp sinus wash refill...... 54 gnp antacid anti-gas...... 50 gnp ibuprofen pm...... 52 gnp sinus/allergy pe...... 54 gnp antacid maximum strength...... 50 gnp iodides...... 52 gnp sleep aid...... 54 gnp anti-diarrheal...... 50 gnp iodine...... 52 gnp sleep time...... 54 gnp anti-fungal...... 50 gnp itchy eye...... 52 gnp sodium silicate...... 54 gnp anti-gas...... 50 gnp lansoprazole...... 52 gnp soothing bath treatment...... 54 145 gnp stay awake...... 54 guaifenesin er...... 56 hm castor oil...... 58 gnp stomach relief max st...... 54 guaifenesin-codeine...... 56 hm cetirizine hcl childrens...... 58 gnp tab tussin...... 54 guaifenesin-dm...... 56 hm chest congestion relief...... 58 gnp tab tussin dm...... 54 gumsol...... 56 hm chest congestion relief dm...... 58 gnp terbinafine hydrochloride...... 54 GYNE-LOTRIMIN...... 56 hm chest rub...... 58 gnp tioconazole 1...... 54 GYNE-LOTRIMIN 3...... 56 hm clear fiber...... 58 gnp tolnaftate...... 54 G-ZYNCOF...... 56 HM CLEARLAX...... 58 gnp triple antibiotic...... 54 H2Q...... 56 hm cold & allergy childrens...... 58 gnp triple antibiotic plus...... 54 hair regrowth treatment men...... 56 hm cold & cough childrens...... 58 gnp tussin...... 54 hand wipes...... 56 hm cold & sinus relief...... 58 gnp tussin cf cough & cold...... 54 hankscraft humidifier...... 56 hm complete dual action...... 58 gnp tussin cf max...... 54 HARD NAILS...... 56 hm cough dm...... 58 gnp tussin cough long acting...... 54 HC DERMAPAX...... 56 hm cough relief...... 58 gnp tussin dm...... 54 H-CHLOR 12...... 56 hm day time...... 58 gnp tussin dm cough...... 54 H-CHLOR 6...... 56 hm double antibiotic...... 58 gnp tussin dm max...... 54 headache formula added st...... 56 hm earwax removal aid...... 58 gnp ultra lubricant eye drops...... 54 headache pm...... 56 hm earwax removal kit...... 58 gnp urinary pain relief...... 54 healthy kids cod liver/vit d...... 56 hm enema...... 58 gnp vitamin d-400...... 54 HEALTHYLAX...... 56 hm enema mineral oil...... 58 gnp zinc oxide...... 55 heartburn antacid ex st...... 56 hm ethyl rubbing alcohol...... 59 GOLD BOND MULTI-SYMPTOM...... 55 heartburn relief...... 56 hm eye drops...... 59 GOLD BOND RAPID RELIEF...... 55 heartburn relief 150 max st...... 56 hm eye drops advanced relief...... 59 goniosoft...... 55 heartburn relief max st...... 56 hm eye itch relief...... 59 GONIOSOL...... 55 heartburn treatment 24 hour...... 56 hm famotidine...... 59 GONIOVISC...... 55 HEET TRIPLE ACTION...... 56 hm fexofenadine hcl...... 59 GOOD START 5% GLUCOSE HEMA-COMBISTIX...... 57 hm fiber...... 59 WATER...... 55 HEMOCYTE...... 57 hm gas relief...... 59 goodsense all day allergy...... 55 hemorrhoidal...... 57 hm gas relief extra strength...... 59 goodsense arthritis pain...... 55 hemorrhoidal cooling...... 57 hm gas relief infants drops...... 59 goodsense day time cold & flu...... 55 hemorrhoidal hygiene...... 57 hm ibuprofen...... 59 goodsense eye drops...... 55 hemorrhoidal max st/aloe...... 57 hm ibuprofen childrens...... 59 goodsense headache pm...... 55 HIBICLENS...... 57 hm ibuprofen ib...... 59 goodsense hemorrhoidal...... 55 high potency iron...... 57 hm ibuprofen infants...... 59 goodsense ibuprofen...... 55 histaflex...... 57 hm iodides...... 59 goodsense ibuprofen childrens...... 55 HISTEX...... 57 hm iodine...... 59 goodsense ibuprofen infants...... 55 HISTEX PD...... 57 hm iron...... 59 goodsense ibuprofen junior st...... 55 HISTEX PDX...... 57 hm lansoprazole...... 59 goodsense ibuprofen pm...... 55 HISTEX-AC...... 57 hm lice killing max st...... 59 goodsense lubricating eye drop...... 55 HISTEX-DM...... 57 hm lice treatment...... 59 goodsense migraine formula...... 55 HISTEX-PE...... 57 hm loperamide hcl...... 59 goodsense naproxen sodium...... 55 hist-pse...... 57 hm loratadine...... 59 goodsense nicotine...... 55 hm acid reducer...... 57 hm loratadine childrens...... 59 goodsense pain relief...... 55 hm advanced antacid max st...... 57 hm lubricating plus...... 59 goodsense petroleum jelly...... 55 hm all day allergy...... 57 hm melatonin quick dissolve...... 59 goodsense redness relief plus...... 55 hm allergy & congestion...... 57 hm migraine formula...... 59 goodsense sinus congest/pain...... 55 hm allergy childrens...... 57 hm milk of magnesia...... 59 goodsense sore throat spray...... 55 hm allergy complete childrens...... 57 hm motion relief...... 59 gordomatic...... 55 hm allergy complete-d...... 57 hm motion sickness relief...... 59 GORDONS NO 5...... 55 hm allergy multi symptom...... 57 hm mucus er...... 59 gordons urea...... 55 hm allergy relief...... 58 hm multi-purpose no rub...... 59 GORDONS-VITE A...... 55 hm allergy relief (loratadine)...... 57 hm naproxen sodium...... 60 GORDO-POOL...... 56 hm allergy relief childrens...... 58 hm nasal decongestant...... 60 gormel...... 56 hm allergy relief/nasal decong...... 58 hm nasal decongestant 12 hour...... 60 gormel 10...... 56 hm antacid anti-gas ex st...... 58 hm nasal decongestant pe...... 60 GRANDPAS THYLOX SOAP...... 56 hm antacid/antigas...... 58 hm nasal spray...... 60 grape seed...... 56 hm anti-diarrheal...... 58 hm nicotine...... 60 green soap...... 56 hm arthritis pain relief...... 58 hm nicotine polacrilex...... 60 green tea extract...... 56 hm artificial tears...... 58 hm night time cold & flu...... 60 grx hemorrhoidal...... 56 hm aspirin...... 58 hm nighttime sleep aid...... 60 grx wound...... 56 hm bacitracin zinc...... 58 hm nose drops...... 60 guaiatussin ac...... 56 hm calamine...... 58 hm omeprazole...... 60 guaifenesin...... 56 hm calcium antacid...... 58 hm pain & fever childrens...... 60 guaifenesin ac...... 56 hm calcium antacid ex st...... 58 hm pain relief extra strength...... 60 146 hm pain reliever pm ex st...... 60 ibuprofen childrens...... 62 iron chews pediatric...... 64 hm probiotic digestive health...... 60 ibu-profen cold/sinus...... 62 iron slow release...... 64 hm rolled gauze bandage...... 60 ibuprofen infants...... 62 isoleucine...... 64 hm saline nasal spray...... 60 ibuprofen junior strength...... 62 ISOLEUCINE 1000...... 64 hm senna...... 60 ibuprofen pm...... 62 isomalt lollipop base...... 64 hm severe cold/cough/flu...... 60 ICAR...... 62 isopropyl alcohol...... 64 hm severe cold/flu...... 60 ICAR-C...... 62 isopropyl alcohol (rubbing)...... 64 hm sinus nasal spray...... 60 ice bag...... 62 isopropyl myristate...... 64 hm sleep aid...... 60 ice blue...... 62 isopropyl palmitate...... 64 hm stay awake...... 60 ICY HOT...... 62 ISOPTO TEARS...... 64 hm stomach relief...... 60 ICY HOT LIDOCAINE PLUS itch relief...... 64 hm stomach relief max strength...... 60 MENTHOL...... 62 ITCH-X...... 64 hm stool softener...... 60 IFEREX 150...... 62 IV3000 1-HAND...... 64 hm super vitamin b12...... 60 immune support...... 62 IVAREST MEDICATED POISON hm triple antibiotic...... 60 IMODIUM A-D...... 62, 63 IVY...... 64 hm triple antibiotic max st...... 60 IMODIUM MULTI-SYMPTOM IVAREST POISON IVY ITCH...... 64 hm tussin adult...... 61 RELIEF...... 63 IVY DRY...... 64 hm tussin adult dm...... 61 IMPROVUE...... 63 ivy wash poison ivy cleanser...... 64 hm tussin adult multi-symptom...... 61 indole-3-carbinol...... 63 IVY-DRY...... 64 hm vitamin b12...... 61 infants gas relief...... 63 IVY-RID...... 64 hm witch hazel...... 61 infants ibuprofen...... 63 J & J ALL-PURPOSE FIRST AID...... 64 hm z-sleep...... 61 infants pain relief...... 63 jessners...... 64 HOLD...... 61 infants pain reliever...... 63 J-MAX...... 64 HONEY BEARS W/IRON-ZINC...... 61 infants simethicone...... 63 jock itch spray...... 64 HONGO CURA ANTI-FUNGAL...... 61 INFED...... 63 JOHNSONS BABY CORNSTARCH....65 hot steam...... 61 INFUVITE ADULT...... 63 JOHNSONS BABY POWDER...... 65 HPR PLUS HYDROGEL...... 61 INFUVITE PEDIATRIC...... 63 JOHNSONS NO MORE RASH...... 65 hrt essential...... 61 inositol...... 63 J-TAN D PD...... 65 humidifier...... 61 inositol hexanicotinate...... 63 J-TAN PD...... 65 HUMULIN 70/30 PEN...... 61 INOSITOL-5...... 63 JUNIOR MAPAP...... 65 HUMULIN N PEN...... 61 INSPIRACHAMBER/LARGE...... 63 k-99...... 65 HURRICAINE...... 61 INSPIRACHAMBER/MEDIUM...... 63 KANGAROO BALLOON HURRICAINE ONE...... 61 INSPIRACHAMBER/MOUTHPIECE..63 18FR/2.3CM...... 65 HURRIVIEW...... 61 INSPIRACHAMBER/SMALL...... 63 KANGAROO ENTRIFLUSH PUMP HURRIVIEW II...... 61 INSPIREASE...... 63 SET...... 65 hydrocerin...... 61 INSTACLEAN...... 63 KANGAROO JOEY PUMP SET...... 65 hydrochloric acid...... 61 INSTA-GLUCOSE...... 63 KANK-A MOUTH PAIN...... 65 hydrocod polst-cpm polst er...... 61 instant ear-dry...... 63 KANK-A SOFTBRUSH...... 65 hydrocodone-homatropine...... 61 instant hand sanitizer...... 63 kaolin...... 65 hydrocortisone...... 61 instant pain relief...... 63 KAOPECTATE...... 65 hydrocortisone acetate...... 61 INTEGRA...... 63 KAO-TIN...... 65 hydrocortisone max st...... 61 intense cough reliever...... 63 karaya gum...... 65 hydrocortisone-aloe...... 61 intense cough reliever ex st...... 63 KARBOZYME...... 65 HYDROGEL...... 62 INTERDRY AG TEXTILE 10"X144".. 63 kaz healthmist humidifier...... 65 HYDROGEL AG...... 61 INTRASITE GEL APPLIPAK...... 63 kaz humidifier evaporativ 3000...... 65 hydrogen peroxide wipes...... 62 invisible acne max st...... 63 kaz humidifier evaporativ 3300...... 65 hydromet...... 62 iodides tincture...... 63 kaz humidifier evaporativ 3400...... 65 HYDROPEL...... 62 iodine...... 63 kaz ultrasonic humidifier...... 65 hydrophilic...... 62 iodine strong...... 63 K-BICARB...... 65 hydrophilic petrolatum...... 62 iodine tincture...... 63 kelp...... 65 hydro-tabs...... 62 iodoform...... 63 kelp-b6-lecithin-vinegar...... 65 hydroxocobalamin acetate...... 62 IONIL...... 63 KENDALL ALGINATE DRESS hydroxypropyl cellulose...... 62 iophen c-nr...... 64 8"X8"...... 65 HYLATOPIC PLUS...... 62 iophen dm-nr...... 64 KENDALL HYDROGEL GAUZE HYPERCARE...... 62 iophen-nr...... 64 4"X8"...... 65 HYPOTEARS...... 62 IOSAT...... 64 KENDALL HYDROPHILIC FOAM hypromellose...... 62 ipecac...... 64 DRESS...... 65 HYSEPT...... 62 IROFOL...... 64 KERALYT...... 65 HYVEE ADVANCED ANTACID...... 62 iron (ferrous sulfate)...... 64 KERAMATRIX REPLICINE ibu-200...... 62 iron 100 plus...... 64 10CMX10CM...... 65 ibu-drops...... 62 iron 100/c...... 64 KETOSTIX...... 65 ibuprofen...... 62 iron 21/7...... 64 ketotifen fumarate...... 65 ibuprofen 100 junior strength...... 62 iron 27...... 64 KEY OMEGA...... 65 147 kidkare cough/cold...... 65 lecithin...... 67 liver extract...... 69 kids vitamins plus extra c...... 65 lecithin-kelp-b6-cider vinegar...... 67 l-lysine...... 69 k-iii...... 66 lemon bioflavanoid...... 67 l-lysine hcl...... 69 kimono...... 66 lemon oil...... 67 l-methionine...... 69 kimono micro thin...... 66 lemon-glycerin...... 67 LMX 4...... 69 kimono micro thin plus...... 66 LENZAGEL...... 67 LMX 4 PLUS...... 69 kimono sensation...... 66 LENZAPATCH...... 67 LMX 5...... 69 kimono sensation plus...... 66 leucine...... 67 LODRANE D...... 69 KINERASE...... 66 levatio...... 68 LOHIST-D...... 69 kls cold & flu ms day/night...... 66 levocarnitine (dietary)...... 68 lohist-dm...... 69 kls esomeprazole magnesium...... 66 levocarnitine-b5-taurine...... 68 loperamide hcl...... 69 K-MAG...... 66 levocetirizine dihydrochloride...... 68 loratadine...... 69 K-MAG ASPARTATE...... 66 levonorgestrel...... 68 loratadine childrens...... 69 K-MAG-70...... 66 l-glutamic acid...... 68 loratadine hives relief...... 69 kojic acid...... 66 l-glutamine...... 68 loratadine-d 12hr...... 69 KONSYL...... 66 l-glutathione...... 68 loratadine-d 24hr...... 69 konsyl daily fiber...... 66 l-histidine...... 68 l-ornithine...... 70 KONSYL-D...... 66 LICE B GONE...... 68 l-ornithine hydrochloride...... 69 korean ginseng...... 66 LICE B GONE CAP SATURATED...... 68 LORTUSS DM...... 70 kp mag-oxide magnesium...... 66 lice cure...... 68 LORTUSS EX...... 70 kp silicone scar therapy gel...... 66 lice killing maximum strength...... 68 LORTUSS LQ...... 70 kpn prenatal...... 66 lice solution...... 68 LOTRIMIN AF...... 70 KT PRO EXTREME...... 66 lice treatment...... 68 LOTRIMIN ULTRA...... 70 KWAN LOONG PAIN RELIEVING....66 LICEFREEE...... 68 LOZIBASE S...... 70 K-Y LUBRICATING...... 66 LICEMD COMPLETE...... 68 l-phenylalanine...... 70 KYLEENA...... 66 LICIDE TREATMENT...... 68 l-proline...... 70 LAC-HYDRIN...... 66 lidocaine...... 68 l-serine...... 70 LAC-HYDRIN FIVE...... 66 lidocaine (anorectal)...... 68 l-tyrosine...... 70 LAC-HYDRIN TWELVE...... 66 LIDOCREAM...... 68 lubricant drops/dual-action...... 70 LACTAID ULTRA...... 66 lidomd...... 68 lubricant eye drops...... 70 lactic acid...... 66 LIDOPATCH PAIN RELIEF...... 68 lubricant eye drops (pf)...... 70 lacto-bifidus-600...... 66 LIDOPRO...... 68 lubricating plus eye drops...... 70 lactose...... 66 LILETTA (52 MG)...... 68 LUBRISKIN...... 70 lactose monohydrate...... 66 lime oil...... 68 LUDENS COUGH DROPS...... 70 l-alanine...... 66 limencin...... 68 LUDENS THROAT DROPS...... 70 LAMISIL ADVANCED...... 66 LINI MIST ANALGESIC...... 68 lutein...... 70 LAMISIL AF DEFENSE...... 66 lip balm...... 68 LUVENA FEMININE WIPES...... 70 LAMISIL AT...... 66, 67 lip balm base natural...... 68 LYCELLE...... 70 LAMISIL AT SPRAY...... 67 lip balm medicated...... 68 lysine acetate...... 70 LAMISIL SPRAY...... 67 LIP MEDEX...... 68 lysine4000...... 70 LAMISILK PROTECT...... 67 lipochol nr...... 68 LYSINYL...... 70 LANACANE ANTI-BACTERIAL...... 67 lipochol plus...... 68 M.V.I. ADULT...... 70 LANACANE MAXIMUM LIPO-GEL...... 68 M.V.I. PEDIATRIC...... 70 STRENGTH...... 67 lipoic acid...... 68 M.V.I.-12 (WITHOUT VITAMIN K)... 70 LAND BEFORE TIME LIPOIL...... 68 M2 C...... 71 MULTIVITAMIN...... 67 LIPOTRIAD...... 68 MAALOX...... 71 lanolin...... 67 LIPOTRIAD VISIONARY...... 68 MAALOX ADVANCED...... 71 lanolin anhydrous...... 67 lipovan base...... 69 MAALOX ADVANCED MAX ST...... 71 lanolin hydrous-grx...... 67 LIQ-10...... 69 MAALOX JUNIOR PLUS ANTIGAS..71 lansoprazole...... 67 LIQSORB...... 69 MAALOX MAX...... 71 LANTISEPTIC ALL BODY WASH.....67 LIQUACEL...... 69 mafenide hcl...... 71 l-arginine...... 67 LIQUIMAT...... 69 MAG-200...... 71 l-arginine hcl...... 67 liquitears...... 69 mag-al...... 71 l-aspartic acid...... 67 l-isoleucine...... 69 mag-al plus...... 71 lavender oil...... 67 LISTERINE NATURALS mag-al plus xs...... 71 laxative...... 67 ANTISEPTIC...... 69 magdelay...... 71 laxative pills...... 67 LITTLE COLDS COUGH FORMULA.69 mag-g...... 71 l-carnitine...... 67 LITTLE COLDS DECONGESTANT... 69 MAGIMIN...... 71 l-carnitine hcl...... 67 LITTLE NOSES MOISTURIZING...... 69 magnacaps...... 71 l-citrulline...... 67 LITTLE REMEDIES POISON MAGNEBIND 200...... 71 l-cysteine...... 67 TREAT...... 69 MAGNEBIND 300...... 71 l-cysteine hcl...... 67 LITTLE TUMMYS LAXATIVE...... 69 magnesium...... 71 l-cystine...... 67 liver...... 69 magnesium aspartate...... 71 148 magnesium carbonate...... 71 MEDIHONEY WOUND/BURN milantex extra strength...... 75 magnesium carbonate heavy...... 71 DRESSING...... 73 MILCO-ZYME...... 75 magnesium chloride...... 71 medi-laxx...... 73 milk of magnesia...... 76 magnesium chloride-calcium...... 71 MEDI-LYTE...... 73 milk of magnesia concentrate...... 76 magnesium citrate...... 71 medi-patch-lidocaine...... 73 MILLGUARD...... 76 magnesium fizz-plus...... 71 MEDIPLAST...... 73, 74 MILTAB #1...... 76 magnesium gluconate...... 71 MEDIPORE + PAD ADHESIVE MINERAL ICE...... 76 magnesium oxide...... 71, 72 DRESS...... 74 mineral oil light...... 76 magnesium oxide -mg supplement...... 71 medi-soothe...... 74 mineral oil-hydrophil petrolat...... 76 magnesium stearate...... 72 medi-tussin dm double strength...... 74 MINIMED GUARDIAN LINK 3...... 76 magnesium sulfate...... 72 medi-tussin max strength...... 74 MINIPRIN LOW DOSE...... 76 MAGONATE...... 72 MEDROX...... 74 minoxidil for men...... 76 mag-sr plus calcium...... 72 MEGA MULTIVITAMIN...... 74 minoxidil for women...... 76 MAG-TAB SR...... 72 mega stress 600/60...... 74 MINTOX...... 76 MAJOR-PREP HEMORRHOIDAL...... 72 melatonin...... 74 mintox maximum strength...... 76 malic acid...... 72 melatonin er...... 74 MINTOX PLUS...... 76 manganese...... 72 melatonin tr...... 74 MIRAFIBER...... 76 manganese aspartate...... 72 melatonin-pyridoxine...... 74 MIRALAX...... 76 manganese chloride...... 72 MELLOW-TONE...... 74 MIRENA (52 MG)...... 76 manganese gluconate...... 72 mencaps...... 74 mn-50...... 76 MANGIMIN...... 72 m-end dmx...... 74 moisture barrier...... 76 mannitol...... 72 m-end max d...... 74 MOISTURE GUARD...... 76 MAOX...... 72 M-END PE...... 74 MOISTUREL...... 76 mapap...... 72 m-end wc...... 74 moisturizing skin protectant...... 76 MAPAP ACETAMINOPHEN EXTRA menstrual pain relief...... 74 molybdenum...... 76 STR...... 72 menstrual pms...... 74 MONOCAL...... 76 mapap arthritis pain...... 72 menstrual relief max strength...... 74 MONOJECT MONODOSE ORAL MAPAP CHILDRENS...... 72 MENTAX...... 74 MED SYR...... 76 MAPAP COLD FORMULA MULTI- menthol...... 74 MONOJECT SYRINGE...... 76 SYMPT...... 72 mentholix...... 74 MOTRIN IB...... 76 MAPAP EXTRA STRENGTH...... 72 MEPHYTON...... 74 MOTRIN INFANTS DROPS...... 77 MAPAP HEADACHE PLUS...... 72 METAMUCIL...... 74 mouth rinse...... 77 mapap pm...... 72 METAMUCIL MULTIHEALTH mucaphed...... 77 MAPAP SINUS MAXIMUM FIBER...... 74 MUCINEX...... 79 STRENGTH...... 72 METAMUCIL SMOOTH TEXTURE...74 MUCINEX ALLERGY...... 77 MAR-COF BP...... 72, 73 methagual...... 74 MUCINEX CHEST CONGESTION MAR-COF CG EXPECTORANT...... 73 methionine...... 75 CHILD...... 77 MASTISOL ADHESIVE...... 73 methyl alcohol...... 75 MUCINEX CHILD MS DAY-NIGHT MAXIMUM D3...... 73 methyl salicylate...... 75 CLD...... 77 MAXIPHEN...... 73 methyl sulfone...... 75 MUCINEX CHILD MULTI- MAXIPHEN DM...... 73 methylcellulose...... 75 SYMPTOM...... 77 m-clear wc...... 73 methylcobalamin...... 75 MUCINEX COLD CGH THROAT ME-500...... 73 methylparaben...... 75 CHILD...... 77 meclizine hcl...... 73 MEXSANA...... 75 MUCINEX COLD CHILDRENS...... 77 MEDADYNE ORAL PAIN RELIEF.... 73 MG/TAURINE FORTE...... 75 MUCINEX CONGEST & COUGH MEDERMA...... 73 m-hist pd...... 75 CHILD...... 77 MEDERMA AG FACIAL MI-ACID...... 75 MUCINEX COUGH CHILDRENS...... 77 CLEANSER...... 73 mi-acid gas relief...... 75 MUCINEX COUGH FOR KIDS...... 77 MEDERMA AG HAND & BODY...... 73 mi-acid maximum strength...... 75 MUCINEX D...... 77 medi pads...... 73 MICATIN...... 75 MUCINEX D MAX STRENGTH...... 77 medicated body...... 73 miconazole 3...... 75 MUCINEX DM...... 77 medicated cleansing...... 73 miconazole 3 combo-supp...... 75 MUCINEX DM MAXIMUM medicated douche...... 73 miconazole 7...... 75 STRENGTH...... 77 medicated pain relieving...... 73 miconazole nitrate...... 75 MUCINEX FAST-MAX...... 77, 78 medicated wipes...... 73 miconazorb af...... 75 MUCINEX FAST-MAX COLD & MEDICONE...... 73 MICRO GUARD...... 75 SINUS...... 77, 78 MEDI-DERM...... 73 microfiber cleaning cloths...... 75 MUCINEX FAST-MAX COLD FLU... 78 MEDI-DERM/L...... 73 MICRONEFRIN...... 75 MUCINEX FAST-MAX COLD FLU MEDI-FIRST ANTISEPTIC MIDOL CAFFEINE FREE...... 75 NGHT...... 78 CLEANER...... 73 MIDOL COMPLETE...... 75 MUCINEX FAST-MAX CONGEST MEDI-FIRST/LIDOCAINE...... 73 migraine formula...... 75 COUGH...... 78 MEDI-GRAINE...... 73 MIL-A-MULSION...... 75 MUCINEX FAST-MAX DAY/NIGHT.78 milantex...... 75 149 MUCINEX FAST-MAX DAY/NIGHT NANOVM 1-3 YEARS...... 80 NEUROTIPS...... 82 TAB...... 78 NANOVM 4-8 YEARS...... 80 NEUTROGENA BODY...... 82 MUCINEX FAST-MAX NANOVM 9-18 YEARS...... 80 NEUTROGENA CLEAR PORE...... 82 DAY/NIGHTTIME...... 78 NANOVM T/F...... 80 NEUTROGENA T/GEL STUBBORN MUCINEX FAST-MAX DM MAX...... 78 NAPHCON-A...... 80 ITCH...... 82 MUCINEX FAST-MAX SEVERE naproxen sodium...... 80 NEW DIGNITY ODOR COLD...... 78 NASAFLO NETI POT NASAL ELIMINATOR...... 82 MUCINEX FOR KIDS...... 78 WASH...... 80 new terocin...... 82 MUCINEX MAXIMUM STRENGTH..78 NASAFLO PORCELAIN NASAL NEXAFED...... 82 MUCINEX MS COLD NIGHT RINSE...... 80 NEXAFED SINUS PRESSURE + CHILDREN...... 79 nasal allergy...... 81 PAIN...... 82 MUCINEX SINUS-MAX...... 79 nasal decongestant...... 81 NEXCARE EARLOOP MASK...... 82 MUCINEX SINUS-MAX nasal decongestant pe...... 81 NEXCARE PREMIUM ADHESIVE CONGESTION...... 79 nasal decongestant pe max st...... 81 GAUZE...... 82 MUCINEX SINUS-MAX nasal decongestant spray...... 81 NEXT CHOICE ONE DOSE...... 82 DAY/NIGHT...... 79 NASAL EASE ALLERGY niacin...... 82, 83 MUCINEX SINUS-MAX FULL RELIEVER...... 81 niacin er...... 82 FORCE...... 79 nasal four...... 81 niacin flush free...... 82 MUCINEX SINUS-MAX NIGHT nasal relief...... 81 niacinamide...... 83 TIME...... 79 nasal spray 12 hour...... 81 NICODERM CQ...... 83 MUCINEX SINUS-MAX PRESS & nasal spray extra moisturizing...... 81 NICORELIEF...... 83 PAIN...... 79 NASALCARE...... 81 NICORETTE...... 83 MUCINEX STUFFY NOSE/COLD NASALCARE FOR KIDS...... 81 NICORETTE MINI...... 83 CHILD...... 79 NASALCARE FOR KIDS STARTER NICORETTE STARTER KIT...... 83 mucosa...... 79 KIT...... 81 nicotinamide adenine dinucleo...... 83 mucosa dm...... 79 NASALCARE NASALCLEANSE nicotine...... 83 mucus d...... 79 KIT...... 81 nicotine polacrilex...... 83 mucus relief...... 79 NASALCROM...... 81 night time cold/flu relief...... 83 mucus relief childrens...... 79 NASCOBAL...... 81 night time cough/cold child...... 83 mucus relief cold/sinus max st...... 79 NASOPEN PE...... 81 night time sleep aid...... 83 mucus relief cough childrens...... 79 natapres...... 81 night-time cold/flu relief...... 83 mucus relief d...... 79 nat-rul antioxidants c+e...... 81 nighttime cold/flu relief plus...... 83 mucus relief dm...... 79 natrul colon care...... 81 nighttime sinus & congestion...... 84 mucus relief er...... 79 nat-rul daily-vite+iron...... 81 nighttime sleep aid...... 84 mucus relief pe...... 79 nat-rul oyster calcium+vit d...... 81 NINJACOF...... 84 mucus-dm...... 79 natrul-cal...... 81 NINJACOF-A...... 84 mucus-er...... 79 natural balance tears...... 81 NINJACOF-XG...... 84 mucusrelief sinus...... 80 natural bitterness...... 81 NISEKO SUNSCREEN SPF 25...... 84 multi-delyn/iron...... 80 natural fiber laxative...... 81 nite time cold/flu relief...... 84 multi-minerals...... 80 natural fiber therapy...... 81 nite time cough...... 84 multisource calcium mag/d...... 80 natural oatmeal bath treatment...... 81 nite time multi-symptom relief...... 84 multi-symptom allergy...... 80 natural vitamin e moisturizing...... 81 NITEBITE...... 84 multi-symptom cold childrens...... 80 natures tears...... 81 nite-time cold/flu...... 84 multi-symptom cold plus child...... 80 na-zone...... 82 nite-time cold/flu relief...... 84 multivitamin gummies childrens...... 80 NEOSPORIN + PAIN RELIEF MAX NIVA-HIST DM...... 84 multivitamins plus zinc...... 80 ST...... 82 NIVANEX DMX...... 84 MURI-LUBE...... 80 NEOSPORIN LIP HEALTH DAILY.... 82 NIX CREME RINSE...... 84 MURO 128...... 80 NEOSPORIN ORIGINAL...... 82 NIZORAL A-D...... 84 muscle rub ultra strength...... 80 NEOSPORIN PLUS MAX ST...... 82 NO DOZ MAXIMUM STRENGTH..... 84 mustard oil...... 80 NEOSPORIN PLUS PAIN RELIEF no drip nasal spray...... 84 MY WAY...... 80 MS...... 82 NOBLE FORMULA...... 84 MYCOCIDE CX CALLUS NEOSTRATA HQ SKIN NOBLE FORMULA HC...... 84 EXFOLIATOR...... 80 LIGHTENING...... 82 nohist-dm...... 84 MYKIDZ IRON...... 80 NEO-SYNEPHRINE...... 82 nohist-lq...... 84 MYLANTA...... 80 NEOTUSS-D...... 82 non-aspirin...... 84 MYLANTA GAS RELIEF NEPHRONEX...... 82 non-aspirin extra strength...... 84 MAXIMUM STR...... 80 NEPHRO-VITE...... 82 non-aspirin pain reliever...... 84 mytab gas...... 80 NESTLE GOOD START DUAL non-pseudo sinus pain/pressure...... 84 mytab gas maximum strength...... 80 FEEDER...... 82 non-stick...... 84 mytussin dac...... 80 neuro vite...... 82 NOREL AD...... 84 nac...... 80 NEURO-K-250 T.D...... 82 NOREL CS...... 85 NAIL SCRUB...... 80 neuromax...... 82 NORMLSHIELD...... 85 NAIL-EX...... 80 NEUROPEN...... 82 NORTUSS-DE...... 85 150 NOVAFERRUM...... 85 ORAMAGIC PLUS...... 86 PANOXYL...... 88 NOVAFERRUM 125...... 85 orange oil...... 86 PANOXYL WASH...... 88 NOVAFERRUM 50...... 85 ORASEP...... 86 PANOXYL-4 CREAMY WASH...... 88 NOVAFERRUM PED MULTI VIT- ORA-SWEET...... 86 panto-250...... 88 IRON...... 85 ORA-SWEET SF...... 86 pantothenic acid...... 88 NOVAFERRUM PEDIATRIC DROPS 85 ORAZINC...... 86 papaya enzyme...... 88 NOXICARE...... 85 organ-i nr...... 86 paraffin wax beads...... 88 NRS NASAL RELIEF...... 85 organic coconut oil...... 86 parvenzyme digestive enzyme...... 88 NUFERA...... 85 ornithine...... 86 PAZOL XS...... 88 NU-GEL...... 85 ORTHO-NESIC...... 86 PCCA MBK (FATTY ACID) BASE.....88 NUPERCAINAL...... 85 OS-CAL...... 87 pc-tar...... 88 NUPREP 5% POVIDONE-IODINE...... 85 OS-CAL EXTRA D3...... 86 peanut oil...... 88 NUTRATEAR...... 85 OS-CAL ULTRA...... 87 pearberry fragrance...... 88 NUTR-E-SOL...... 85 OSCION CLEANSER...... 87 PECGEN PSE...... 89 NYQUIL SEVERE COLD/FLU...... 85 OSTEO BI-FLEX ADV TRIPLE ST.....87 pectin...... 89 NYTOL MAXIMUM STRENGTH...... 85 OSTEO-PORETICAL...... 87 pedia relief cough/cold...... 89 O.A.D...... 85 OSTIGEN...... 87 PEDIACARE CHILDRENS LONG- OASIS MOISTURIZING ostomy protective...... 87 ACT...... 89 MOUTHWASH...... 85 oval tape...... 87 PEDIACARE CHILDRENS MULTI- OBSTETRIX DHA...... 85 oxalic acid...... 87 SYMP...... 89 OBSTETRIX EC...... 85 OXYTROL...... 87 PEDIACARE MULTI-SYMPTOM...... 89 OC8...... 85 OXYZAL WET DRESSING...... 87 PEDIA-LAX...... 89 OCEAN BLUE MINICAPS oyst-cal d...... 87 PEDIA-LAX FIBER GUMMIES...... 89 D/OMEGA3...... 85 oyster calcium + d...... 87 PEDIALYTE ADVANCED CARE...... 89 OCEAN BLUE MINICAPS OMEGA- oyster calcium/d3...... 87 pediatric cough/cold...... 89 3...... 85 oyster shell calcium...... 87 PEDIAVENT...... 89 OCEAN BLUE OPTIMAL HEALTH...85 oyster shell calcium 250+d...... 87 PEDIAVIT...... 89 OCEAN COMPLETE SINUS RINSE...85 oyster shell calcium 500+d...... 87 PEDI-BORO SOAK...... 89 OCEAN NASAL MOISTURIZER...... 85 oyster shell calcium/d...... 87 peg 300...... 89 OCEAN NASAL SPRAY...... 85 oyster shell calcium/d3...... 87 peg 3350...... 89 ODOR EATERS ANTIFUNGAL...... 85 P & S...... 87 PENTRAX GOLD...... 89 OILATUM...... 85 p-1000...... 87 peppermint oil...... 89 olive oil...... 85 PA CLA...... 87 peppermint spirit...... 89 omega dha...... 85 pa fish oil/vit d3 triple st...... 87 peptic relief...... 89 OMEGA POWER...... 86 pa glucosamine-chondroitin...... 87 PEPTO-BISMOL...... 89 omega-3...... 86 pa prenatal formula...... 87 PEPTO-BISMOL MAX STRENGTH... 89 omega-3 fish oil...... 86 pa probiotic complex...... 87 PEPTO-BISMOL TO-GO...... 89 omega-3 fish oil ex st...... 86 PACQUIN PLUS HAND/BODY...... 87 PERCOGESIC EXTRA STRENGTH... 89 omega-3 fish oil-vitamin d3...... 86 pain & fever...... 87 PERDIEM OVERNIGHT RELIEF...... 89 OMEGA-3 IQ...... 86 pain & fever childrens...... 87 PERFORM ATOMIC HEAT...... 89 omeprazole...... 86 pain & fever extra strength...... 87 PERFORM PAIN RELIEVING...... 90 OMNI GEL...... 86 pain relief...... 88 PERFORM PAIN RELIEVING OMNICIDE ANTIMICROBIAL...... 86 pain relief cold congestion...... 87 ROLL-ON...... 90 ONE-A-DAY ADULT pain relief day & night ex st...... 87 PERIDIN-C...... 90 VITACRAVES+DHA...... 86 pain relief extra strength...... 88 PERIGUARD...... 90 ONE-A-DAY WOMENS 50+ pain relief pm extra strength...... 88 PERISHIELD...... 90 ADVANTAGE...... 86 pain relief roll-on...... 88 PERNOX...... 90 ONE-A-DAY WOMENS FORMULA.. 86 pain relief sinus pe daytime...... 88 PEROXYL...... 90 one-step pregnancy...... 86 pain reliever extra strength...... 88 PEROXYL SPOT TREATMENT...... 90 ONETOUCH PING METER pain reliever plus...... 88 PERRY PRENATAL...... 90 REMOTE...... 86 pain reliever pm...... 88 personal ultrasonic humidifier...... 90 OPCICON ONE-STEP...... 86 pain reliever pm ex st...... 88 personal washcloths...... 90 OPERAND POVIDONE-IODINE...... 86 pain reliever/fever reducer...... 88 peruvian balsam...... 90 OPERAND SCRUB...... 86 pain relieving...... 88 petroleum jelly...... 90 opti-clear...... 86 PALADIN...... 88 pharbedryl...... 90 OPTICS MINI DROPS...... 86 pamix...... 88 PHARMABASE ANTIOXIDANT...... 90 OPTIONS CONCEPTROL...... 86 PAMPERS SENSITIVE WIPES...... 88 PHAZYME MAXIMUM STRENGTH. 90 ORA-FILM...... 86 PAMPRIN MAX PAIN FORMULA.....88 PHAZYME ULTRA STRENGTH...... 90 ORA-HESIVE BASE...... 86 PAMPRIN MULTI-SYMPTOM...... 88 PHENABID...... 90 ORAJEL MAXIMUM STRENGTH...... 86 PANATUSS PED...... 88 PHENAGIL CH...... 90 oral analgesic max st...... 86 PANATUSS PED DROPS...... 88 phenaseptic...... 90 oral anesthetic...... 86 panax ginseng...... 88 phendimetrazine tartrate...... 90 oral electrolytes...... 86 pancreatin...... 88 phendimetrazine tartrate er...... 90 151 phenol...... 90 pramoxine hcl (perianal)...... 92 PROTEINEX...... 95 PHENOL EZ SWABS...... 90 PRAX...... 92 PROTEINEX P100...... 95 phentermine hcl...... 90 PRECISION FOLEY CATH TRAY...... 92 PROVIEW...... 95 phenylalanine...... 90 PREGNITUDE...... 92 PROVIL...... 95 phenylhistine dh...... 90 PREMIER UROSTOMY...... 92 pseudoeph-bromphen-dm...... 95 PHOS-FLUR ORTHO DEFENSE...... 91 premium hearing aid batteries...... 93 pseudoephedrine hcl...... 95 phos-nak...... 91 PREMSYN PMS...... 93 pseudoephedrine hcl er...... 95 phosphatidyl choline...... 91 prenatal...... 93 PSORIASIS MEDICATED...... 95 phosphatidylcholine...... 91 prenatal formula...... 93 psyllium husk...... 95 phosphatidylserine...... 91 prenatal formula a-free...... 93 PURACYN PLUS DUO-CARE...... 95 physicians antibacterial...... 91 prenatal low iron...... 93 PURALUBE...... 95 PHYTOPLEX Z-GUARD...... 91 PRENATAL MULTIVITAMIN + PURE & GENTLE LUBRICANT...... 95 PIC 200...... 91 DHA...... 93 pure l-citrulline...... 95 pink bismuth...... 91 prenatal multivitamin plus dha...... 93 purified water...... 95 PIN-X...... 91 prep protective skin barrier...... 93 PURILON...... 95 PINXAV...... 91 PREPARATION H...... 93 px allergy relief d...... 95 PLAN B ONE-STEP...... 91 PREPARATION H TOTABLES...... 93 px allergy sinus pe...... 95 plasticized base...... 91 PREPARATION H TOTABLES px artificial tears...... 95 PLIAGEL...... 91 WIPES...... 93 px daytime cold...... 95 PLO ULTRAMAX...... 91 PRESGEN B...... 93 px daytime multi-symptom...... 95 PLURONIC...... 91 pressure & pain & cold...... 93 px gas relief extra strength...... 95 pmx-1184 silicone...... 91 PRETZ...... 93 px glucosamine-chondroitin...... 95 PNEUMODORON #2...... 91 PRETZ IRRIGATION...... 93 px ibuprofen cold & sinus...... 95 podophyllum resin...... 91 PREVACARE ANTIMICROBIAL...... 93 px nasal four...... 95 poison ivy wash...... 91 PREVACARE EXTRA PROTECTIVE 93 px nitetime multi-symptom...... 95 POLAR FREEZE...... 91 PREVACARE PERSONAL px vegetable laxative...... 95 poloxamer 188...... 91 PROTECT...... 93 pyridoxal-5 phosphate...... 95 poly bacitracin...... 91 PREVACARE TOTAL SKIN CARE.... 93 pyridoxine hcl...... 95 POLY HIST FORTE...... 91 PREVACID...... 94 PYRIDOXINE/MINERALS...... 95 polyethylene glycol 1000...... 91 PREVACID 24HR...... 93 pyrilamine-phenylephrine...... 96 polyethylene glycol 1450...... 91 PRILOSEC OTC...... 94 pyruvic acid...... 96 polyethylene glycol 3350...... 91 PRIMATENE ASTHMA...... 94 qc 3 day...... 96 polyethylene glycol 400...... 91 PRO NUTRIENTS OMEGA 3...... 94 qc acid controller...... 96 polyethylene glycol 8000...... 91 PROBIOMAX PLUS DF...... 94 qc acid controller max st...... 96 poly-hist dm...... 91 probiotic...... 94 qc all day allergy...... 96 poly-hist pd...... 91 probiotic digestive support...... 94 qc allergy relief...... 96 POLY-IRON 150...... 91 probiotic-prebiotic...... 94 qc allergy relief multi-sympt...... 96 POLYMEM TRACH DRESSING...... 91 PROCARE PLUS UNDERWEAR qc allergy/sinus headache...... 96 polyoxyl 40 stearate...... 91 MEDIUM...... 94 qc antacid...... 96 polysorbate 80...... 92 PRO-CEPTION...... 94 qc antacid/anti-gas...... 96 POLYSPORIN...... 92 pro-chlo...... 94 qc anti-diarrheal...... 96 POLYTAR...... 92 PRO-CLEAR AC...... 94 qc arthritis...... 96 poly-tussin ac...... 92 PROCOMYCIN...... 94 qc arthritis pain relief...... 96 POLY-VENT DM...... 92 PROCTOFOAM...... 94 qc aspirin...... 96 POLY-VENT IR...... 92 PROFE...... 94 qc athletes foot...... 96 POLY-VI-SOL/IRON...... 92 profe forte...... 94 qc bacitracin...... 96 potassimin...... 92 PROFERRIN ES...... 94 qc calamine...... 96 potassium bitartrate...... 92 PROLIDA...... 94 qc castor oil...... 96 potassium bromide...... 92 promethazine vc/codeine...... 94 qc childrens ibuprofen...... 96 potassium chloride...... 92 promethazine-codeine...... 94 qc childrens vitamins/extra c...... 96 potassium citrate...... 92 promethazine-dm...... 94 qc chlor-pheniramine...... 96 potassium gluconate...... 92 PROMOLAXIN...... 94 qc clotrimazole...... 96 potassium gluconate anhydrous...... 92 PRONUTRIENTS CALCIUM+D3...... 94 qc cold relief plus multi-symp...... 96 potassium hydroxide...... 92 PRONUTRIENTS SUPER B qc complete allergy medicine...... 96 potassium iodide...... 92 COMPLEX...... 94 qc cough relief...... 96 potassium nitrate...... 92 PROPA PH ACNE MED MAX ST...... 94 qc cough/sore throat nighttime...... 96 potassium permanganate...... 92 propylene glycol...... 94 qc daytime cold/flu...... 96 potassium sodium tartrate...... 92 propylparaben...... 94 qc diarrhea relief...... 96 potassium sorbate...... 92 PRO-RED AC...... 94 qc effervescent antacid/pain...... 96 povidone-iodine...... 92 PROSHIELD PLUS SKIN qc gentle laxative...... 96 povidone-iodine scrub sponge...... 92 PROTECTANT...... 95 qc hemorrhoidal...... 96 PRAMEGEL...... 92 PROSHIELD SKIN CARE...... 95 qc ibuprofen cold/sinus...... 96 pramoxine hcl...... 92 protein...... 95 qc ibuprofen ib...... 97 152 qc iodides...... 97 ra daytime cold/flu...... 98 ra silky lubricant moisturizer...... 100 qc iodine tincture...... 97 ra daytime cold/flu relief...... 98 ra sinus wash neti pot...... 100 qc loratadine allergy relief...... 97 ra ear wax cleansing system...... 98 ra sleep aid...... 100 qc loratadine-d...... 97 ra ethyl alcohol...... 98 ra slow release iron...... 100 QC MEDIFIN PE...... 97 ra exfoliating moisturizer...... 98 ra stay awake...... 100 qc naproxen sodium...... 97 ra feminine care douche...... 98 ra sterile eye drops...... 100 qc natural vegetable...... 97 ra fever reducer/pain reliever...... 99 ra sterile saline nasal mist...... 100 qc nighttime cold/flu relief...... 97 ra first aid iodine...... 99 ra suphedrine day/night combo...... 100 qc nighttime cough...... 97 ra first aid non-stick...... 99 ra triple antibiotic...... 100 qc nighttime multi-symptom...... 97 ra first aid saline wound wash...... 99 RA TUGABOOS BABY...... 100 qc non-aspirin 8 hour...... 97 ra fish oil...... 99 RA TUGABOOS PETROLEUM qc non-aspirin pm...... 97 RA FISH OIL EXTRA STRENGTH.....99 JELLY...... 100 qc omeprazole magnesium...... 97 ra flu maximum strength...... 99 ra vaginal infection screening...... 100 qc pink bismuth...... 97 ra foaming hand soap refill...... 99 ra vitamin a & d...... 100 qc rest simply...... 97 ra gel toe separator...... 99 ra vitamin b-12...... 100 qc severe cold/cough nighttime...... 97 ra glucosamine-chondroitin...... 99 ra vitamin c...... 100 qc sinus pain relief...... 97 ra glucosamine-chondroitin-d3...... 99 ra yeast relief plus...... 100 qc sleep aid max st...... 97 ra glucosamine-chondroit-msm...... 99 rabano yodado...... 100 qc suphedrine...... 97 ra glucosamine-chondroit-msm-d...... 99 racepinephrine hcl...... 100 qc suphedrine maximum strength...... 97 ra glucos-chondroit-msm...... 99 RADIACARE POST HEALING...... 100 qc suphedrine pe...... 97 ra hemorrhoid relief...... 99 ranitidine hcl...... 100 qc tolnaftate...... 97 ra hemorrhoidal cooling...... 99 RASH AWAY...... 100 qc tussin cf...... 97 ra hemorrhoidal medicated...... 99 RASH RELIEF...... 101 qc witch hazel...... 97 ra hot/cold gel sleeve...... 99 raspberry flavor artificial...... 101 q-dryl...... 97 ra hydrogen peroxide...... 99 raspberry syrup...... 101 Q-GEL...... 97 ra ibuprofen cold childrens...... 99 REA-LO...... 101 q-pap...... 97 ra isopropyl alcohol wipes...... 99 rectacaine...... 101 q-pap childrens...... 97 ra laxative extra strength...... 99 RECTICARE...... 101 q-pap extra strength...... 97 ra lice solution...... 99 red yeast rice extract...... 101 q-pap infants...... 97 RA LOTION...... 99 REDNESS RELIEF...... 101 QSYMIA...... 97, 98 ra lubricant eye drops...... 99 reeses pinworm medicine...... 101 Q-TAPP...... 98 ra lutein...... 99 refenesen 400...... 101 Q-TAPP DM...... 98 RA LYCOPENE...... 99 REFENESEN CHEST CONG/PAIN q-tussin...... 98 ra medicated wipes...... 99 RLF...... 101 q-tussin dm...... 98 ra melatonin...... 99 REFENESEN CHST CONG/PAIN PE 101 quenalin...... 98 ra menstrual pain relief...... 99 refenesen dm...... 101 quercetin...... 98 ra miconazole 3 combo pack...... 99 refenesen pe...... 101 ra acetaminophen flu cold...... 98 ra mouth pain anesthetic...... 99 REFRESH...... 101 ra acid reducer plus antacid...... 98 ra multihealth fiber...... 99 REFRESH CELLUVISC...... 101 ra acne maximum...... 98 ra nasal strip/drug free/large...... 99 REFRESH LIQUIGEL...... 101 ra advanced eye health...... 98 ra nighttime cold/flu relief...... 99 REFRESH OPTIVE...... 101 ra advanced healing...... 98 ra oatmeal moisturizing...... 99 REFRESH OPTIVE ADVANCED...... 101 ra aloe vera/lidocaine...... 98 ra omega 3-6-9...... 99 REFRESH OPTIVE ADVANCED PF 101 ra anorectal...... 98 ra omeprazole...... 100 REFRESH OPTIVE PF...... 101 ra antifungal pen...... 98 ra oyster shell calcium/d...... 100 REFRESH OPTIVE SENSITIVE...... 101 ra anti-itch extra strength...... 98 ra pain relief...... 100 REFRESH PLUS...... 101 ra arthritis pain relief...... 98 ra personal lubricant...... 100 REFRESH TEARS...... 102 ra b-12...... 98 ra petroleum jelly...... 100 REGENECARE HA...... 102 ra back & body pain relief...... 98 ra prenatal...... 100 REGULOID...... 102 ra bandages hypo-allergenic...... 98 ra probiotic complex...... 100 relagesic...... 102 ra b-complex/vitamin c cr...... 98 ra probiotic digestive care...... 100 relcof c...... 102 ra ca/mg/zn/cu...... 98 ra probiotic gummies...... 100 RELIADERM...... 102 ra calamine...... 98 RA RENEWAL ACNE TREATMENT RELIEF PAIN RELIEVING...... 102 ra calcium...... 98 ...... 100 RELION GLUCOSE SHOT...... 102 ra calcium hi-cal/vitamin d...... 98 RA RENEWAL DAILY REMEDY ANTIFUNGAL...... 102 ra calcium high potency...... 98 MOISTURIZING...... 100 REMEDY ANTIMICROBIAL ra calcium-boron...... 98 RA RENEWAL SHOWER & BATH..100 CLEANSER...... 102 ra cold remedy multi-symptom...... 98 ra renewal soothing bath...... 100 REMEDY CALAZIME...... 102 ra cold/sinus max...... 98 ra saline wound wash...... 100 REMEDY CLEANSING BODY...... 102 ra corn cushions small...... 98 ra sensitive anti-itch...... 100 REMEDY MOISTURE BARRIER..... 102 ra corn removers ultra thin...... 98 ra severe cold/night cold&flu...... 100 REMEDY NUTRASHIELD...... 102 ra dark tanning...... 98 ra severe congestion/cold max...... 100 REMEDY SKIN REPAIR...... 102 ra day/night/cold/flu relief...... 98 ra shower & bath body...... 100 153 REMOVE ADHESIVE REMOVER ROBITUSSIN MULTI-SYMPTOM sb cold & flu hbp...... 106 WIPES...... 102 MAX...... 104 sb cold head congestion severe...... 106 renal vitamin...... 102 ROBITUSSIN NIGHTTIME COUGH sb cold multi-symptom severe...... 106 RENAMENT...... 102 DM...... 104 sb cough control...... 106 rena-vite...... 102 ROBITUSSIN NT sb cough control cf...... 106 RESCON...... 102 COUGH/COLD/FLU...... 104 sb cough control pe...... 106 RESCON DM...... 102 ROBITUSSIN PEAK COLD DM...... 104 sb cough relief...... 106 RESCON-GG...... 102 ROBITUSSIN PEAK COLD MULTI- sb coughtab...... 106 resorcinol...... 102 SYM...... 104 sb ear wax remover...... 106 RESOURCE THICKENUP WATER.. 102 ROBITUSSIN PK COLD DAY/NGHT sb fib lax orange...... 106 RESPAIRE-30...... 102 DM...... 104 sb flu maximum strength hbp...... 106 RESTFULLY SLEEP...... 102 ROBITUSSIN PK COLD DAY/NGHT sb gas relief...... 106 RESTORE CLEANSER & MS...... 104 sb ibuprofen...... 106 MOISTURIZER...... 103 ROLAIDS...... 104 sb itch relief max st...... 106 RESTORE FOAM DRESSING...... 103 rose oil...... 104 sb lice treatment...... 106 RESTORE HYDROGEL DRESSING.103 rose water...... 104 sb loratadine...... 106 RETAINE PM...... 103 rosin...... 104 sb low dose asa ec...... 106 REVEAL COLON DISEASE...... 103 rotex...... 104 sb milk of magnesia...... 106 REVEAL DNA PATERNITY TEST...103 ru-hist d...... 104 sb motion sickness...... 106 REVEAL GET PREGNANT QUICK. 103 rulox...... 104 sb naproxen sodium...... 106 REVEAL MULTI-DRUG TESTING rutin...... 104 sb non-aspirin...... 106 CUP...... 103 RYDEX...... 105 sb pain reliever childrens...... 106 REVEAL URINARY TRACT...... 103 rydex g...... 104 sb severe cold pe...... 106 REVITADERM WOUND CARE...... 103 rymed...... 105 sb sinus & allergy max st...... 106 rewetting drops...... 103 rynex dm...... 105 sb sinus congest/pain day/nght...... 107 REZAMID...... 103 rynex pe...... 105 sb sinus congestion/pain day...... 107 RHINARIS...... 103 rynex pse...... 105 sb sleep...... 107 RHINASE...... 103 S2 (RACEPINEPHRINE)...... 105 sb stool softener...... 107 riboflavin...... 103 SAFE TUSSIN PM...... 105 sb triple antibiotic...... 107 riboflavin-5-phosphate sodium...... 103 SAFELET IV CATHETER...... 105 scarcin...... 107 RICOLA HERB...... 103 safflower oil...... 105 SCHOLLS ODOR DESTROYERS..... 107 RICOLA HONEY HERB...... 103 SALACTIC FILM...... 105 SCOT-TUSSIN...... 107 RICOLA LEMON MINT...... 103 SALEM SUMP TUBE 12FR...... 105 SCOT-TUSSIN DIABETES CF...... 107 RISAMINE...... 103 salicylic acid...... 105 SCOT-TUSSIN DM...... 107 robafen...... 103 saline mist spray...... 105 scot-tussin expectorant...... 107 robafen cf cough/cold...... 103 SALMON...... 105 SCOT-TUSSIN SENIOR...... 107 robafen cough...... 103 SAL-PLANT...... 105 SCYTERA...... 107 robafen dm...... 103 SALTAIRE...... 105 se-100...... 107 ROBAFEN DM COUGH CLEAR...... 103 sam-e...... 105 SEA BOND DENTURE BRUSH...... 107 ROBATHOL...... 103 SAM-E COMPLETE...... 105 sea soft nasal mist...... 107 ROBITUSSIN CHILD sam-g.l.a...... 105 sebex...... 107 COUGH/COLD CF...... 103 SANI-SUPP ADULT...... 105 SEBUDERM...... 107 ROBITUSSIN CHILD SANI-SUPP PEDIATRIC...... 105 SEBULEX...... 107 COUGH/COLD LA...... 103 SARNA...... 105 SECURA ANTIFUNGAL...... 107 ROBITUSSIN CHILDRENS COUGH SASTID SOAP...... 105 SECURA ANTIFUNGAL EXTRA LA...... 103 SAXENDA...... 105 THICK...... 107 ROBITUSSIN COLD COUGH+ sb 12hr nasal spray...... 105 SECURA DIMETHICONE CHEST...... 103 sb allergy...... 105 PROTECTANT...... 107 ROBITUSSIN COLD+FLU sb allergy & cold pe...... 105 SECURA EPC SKIN CARE DAYTIME...... 104 sb allergy medicine...... 105 STARTER...... 107 ROBITUSSIN COUGH+ CHEST sb allergy relief...... 105 SECURA EXTRA PROTECTIVE...... 107 MAX ST...... 104 sb allergy relief/nasal decong...... 105 SECURA MOISTURIZING ROBITUSSIN COUGH+CHEST sb antacid...... 106 CLEANSER...... 107 CONG DM...... 104 sb antacid anti-gas double st...... 105 SECURA PERSONAL CLEANSER...107 ROBITUSSIN COUGHGELS...... 104 sb antacid extra strength...... 105 SECURA PERSONAL SKIN CARE...107 ROBITUSSIN DAY/NIGHT VALUE sb antacid/antigas...... 106 SECURA PROTECTIVE...... 108 PAK...... 104 sb anti-diarrhea...... 106 SECURA TOTAL BODY ROBITUSSIN DM...... 104 sb aspirin...... 106 CLEANSER...... 108 ROBITUSSIN LINGERING LA sb bismuth...... 106 SECURA TWO-STEP...... 108 COUGH...... 104 sb bismuth maximum strength...... 106 SECURI-T FLEXIBLE ROBITUSSIN MUCUS+CHEST sb childrens ibuprofen...... 106 WAFER/FLANGE...... 108 CONGEST...... 104 sb chlorpheniramine...... 106 selenicaps-200...... 108 sb cold & cough hbp...... 106 selenimin...... 108 154 selenium...... 108 siterol...... 109 sm cold & cough dm childrens...... 112 selenium er...... 108 skin protectant...... 109 sm cold & flu severe...... 112 SELSUN BLUE DEEP CLEANSING.108 skin tag remover...... 109 sm cold head congestion...... 112 senexon...... 108 SKYLA...... 110 SM CORAL CALCIUM...... 112 SENEXON-S...... 108 sleep aid...... 110 sm cough relief...... 112 senna...... 108 sleep tabs...... 110 sm day time...... 112 senna lax...... 108 SLEEP-N-HEEL...... 110 sm day time cold & flu relief...... 112 senna leaves...... 108 SLO-NIACIN...... 110 sm day time pe cold/flu relief...... 112 senna plus...... 108 SLOW FE...... 110 sm daytime cold & cough child...... 112 SENNA PROMPT...... 108 slow magnesium/calcium...... 110 sm double antibiotic...... 112 senna s...... 108 slow release iron...... 110 sm ear drops...... 112 senna-docusate sodium...... 108 SLOW-MAG...... 110 sm epsom salt...... 112 SENNALAX-S...... 108 sm 12 hour sinus decongestant...... 110 sm ethyl alcohol...... 112 senna-s...... 108 sm 12-hour no drip...... 110 sm ethyl alcohol (rubbing)...... 112 SENOKOT...... 108 sm 3-day vaginal...... 110 sm eye drops...... 112 SENOKOT S...... 108 sm 8 hour pain relief...... 110 sm eye itch relief...... 112 SENSI-CARE BODY...... 108 sm acid reducer...... 110 sm fexofenadine hcl...... 112 SENSI-CARE PERINEAL/SKIN...... 108 sm acid reducer max st...... 110 sm fiber laxative...... 112 SENSI-CARE PROTECTIVE sm all day allergy...... 110 sm flu relief therapy night...... 112 BARRIER...... 108 sm all day allergy childrens...... 110 sm fruit coolers...... 112 SENSITIVE EYES ENZYME sm all day allergy-d...... 110 sm gas relief...... 112 CLEANER...... 108 sm all day pain relief...... 110 sm gas relief antiflatuent...... 112 SENSODYNE MAXIMUM sm allergy 4 hour...... 110 sm gas relief extra strength...... 112 STRENGTH...... 108 sm allergy maximum strength...... 110 sm gas relief infants...... 112 SENSODYNE REPAIR & PROTECT 108 sm allergy multi-symptom...... 110 sm glucosamine chondroitin...... 112 SE-PLUS PROTEIN...... 108 sm allergy relief...... 110 sm glucosamine hcl-msm...... 112 severe cold...... 109 sm allergy relief childrens...... 110 SM GLUCOSAMINE/CALCIUM + D112 severe cold & flu day/night...... 108 sm antacid advanced max st...... 110 sm glycerin pediatric...... 112 shampoo & body wash rinse-free...... 109 sm antacid anti-gas...... 111 sm hemorrhoidal...... 113 SHAMROCK LATEX EXAM sm antacid anti-gas ex st...... 110 sm humidifier/cool mist...... 113 GLOVES...... 109 sm antacid extra strength...... 111 sm hydrocortisone-aloe max st...... 113 SHARPSAFETY SAFETY IN ROOM 109 sm antacid maximum strength...... 111 sm ibuprofen...... 113 shea butter...... 109 sm antacid/antigas...... 111 sm ibuprofen cold & sinus...... 113 SHUR-SEAL CONTRACEPTIVE...... 109 sm antibiotic...... 111 sm ibuprofen ib...... 113 siberian ginseng...... 109 sm antibiotic plus pain relief...... 111 sm ibuprofen pm...... 113 signacal...... 109 sm anti-dandruff coal tar...... 111 sm infants ibuprofen...... 113 silace...... 109 sm anti-diarrheal...... 111 sm iodides...... 113 siladryl allergy...... 109 sm antifungal clotrimazole...... 111 sm iodine tincture...... 113 SIL-K PAD SMALL...... 109 sm antifungal miconazole...... 111 sm isopropyl alcohol...... 113 silphen cough...... 109 sm antifungal tolnaftate...... 111 sm lansoprazole...... 113 siltussin dm das...... 109 sm anti-itch extra strength...... 111 sm laxative...... 113 siltussin sa...... 109 sm arthritis pain relief...... 111 sm lice killing max strength...... 113 siltussin-dm alcohol free...... 109 sm artificial tears...... 111 sm lice solution...... 113 silver nitrate...... 109 sm aspirin ec...... 111 sm lice treatment...... 113 simethicone...... 109 sm athletes foot...... 111 sm loperamide hcl...... 113 SIMILAC STERILIZED WATER...... 109 sm biotin...... 111 sm loratadine...... 113 SIMILASAN DRY EYE RELIEF...... 109 sm calamine...... 111 sm loratadine allergy relief...... 113 SIMILASAN NASAL ALLERGY sm calamine phenolated...... 111 sm loratadine d...... 113 RELIEF...... 109 sm calcium antacid...... 111 sm lorata-dine d...... 113 simple syrup...... 109 sm calcium antacid ex st...... 111 sm lubricant eye drops...... 113 SINADRIN PE COMPLETE SINUS sm calcium antacid ultra st...... 111 sm medicated chest rub...... 113 REL...... 109 sm caldyphen...... 111 sm melatonin...... 113 sinus & allergy...... 109 sm caldyphen clear...... 111 sm miconazole 3...... 113 sinus & congestion day/night...... 109 sm camphor spirit...... 111 sm miconazole 7...... 113 sinus congestion/pain daytime...... 109 sm chest congestion relief...... 111 sm migraine relief...... 113 sinus congestion/pain night...... 109 sm chest congestion relief dm...... 111 sm milk of magnesia...... 113 sinus nasal spray...... 109 sm chest congestion relief pe...... 111 sm motion sickness...... 114 sinus relief nasal spray...... 109 sm childrens ibuprofen...... 111 sm motion sickness relief...... 113 SINUS RINSE BOTTLE KIT...... 109 sm childrens loratadine...... 111 sm mucus er...... 114 SINUS RINSE KIT...... 109 sm childrens plus ms cold...... 111 sm mucus relief cough children...... 114 SINUS RINSE KIT PEDIATRIC...... 109 SM CLEARLAX...... 112 sm naproxen sodium...... 114 SINUS RINSE PEDIATRIC sm clotrimazole vaginal...... 112 sm nasal decongestant max st...... 114 STARTER...... 109 sm cold & allergy childrens...... 112 sm nasal decongestant pe...... 114 155 sm nasal pump spray mist...... 114 sodium perborate...... 116 stomach settle...... 118 sm nasal spray...... 114 sodium phosphate dibasic...... 116 STOMAHESIVE MOLDABLE sm nasal spray 12 hour...... 114 sodium phosphate monobasic...... 116 ADHESIVE...... 118 sm nasal spray moisturizing...... 114 sodium propionate...... 116 STOMAHESIVE PASTE...... 118 sm nasal spray saline...... 114 sodium silicate...... 116 stool softener...... 118 sm nasal spray sinus...... 114 sodium starch glycolate...... 116 stress b-complex/vit c/zinc...... 118 sm natural herb cough drops...... 114 sodium sulfite...... 116 STRIDEX ESSENTIAL...... 118 sm nicotine...... 114 SOLBAR SPF30...... 116 STRI-DEX SENSITIVE SKIN...... 118 sm nicotine polacrilex...... 114 SOLUBLE FIBER THERAPY...... 116 STROVITE...... 118 sm nite time cold & flu...... 114 solvatech plus...... 116 STUART ONE...... 118 sm nite time cold & flu relief...... 114 SOMBRA COOL THERAPY...... 116 sucrose...... 118 sm nite time cough...... 114 SOMBRA WARM THERAPY...... 116 SUDACARE ADVANCED REFILL.. 118 sm nose drops nasal decongest...... 114 SOOTHE & COOL FREE SUDAFED...... 118 sm omega-3-6-9 fatty acids...... 114 MEDSEPTIC...... 116 SUDAFED CHILDRENS...... 118 sm omeprazole...... 114 SOOTHE & COOL FREE SUDAFED PE CHILDRENS...... 118 sm one daily prenatal...... 114 MOISTURE...... 116 SUDAFED PE COLD & COUGH sm ovulation predictor...... 114 SOOTHE & COOL FREE SKIN CHILD...... 118 sm pain & fever childrens...... 114 PASTE...... 116 SUDAFED PE DAY & NIGHT...... 118 sm pain & fever infants...... 114 SOOTHE & COOL INZO SUDAFED PE DAY & NIGHT COLD sm pain relief...... 114 ANTIFUNGAL...... 116 ...... 118 sm pain relief/menthol...... 114 SOOTHE & COOL INZO BARRIER. 116 SUDAFED PE MAXIMUM sm pain reliever pm ex st...... 114 SOOTHE & COOL PROTECT STRENGTH...... 118 sm povidone-iodine...... 115 MOISTURE...... 116 SUDAFED PRESSURE+PAIN 12 HR118 sm prenatal vitamins...... 115 sorbic acid...... 116 SUDOGEST...... 118 sm redness relief...... 115 sorbitol...... 117 sudogest 12 hour...... 118 sm sleep aid...... 115 sorbutuss...... 117 SUDOGEST PE...... 118 sm sleep aid maximum strength...... 115 sorbutuss nr...... 117 SUDOGEST SINUS/ALLERGY...... 118 sm sleep aid night time...... 115 sore throat...... 117 sulfo-lo...... 118 sm slow release iron...... 115 sore throat & cough lozenges...... 117 sulfur...... 118 sm sore throat spray...... 115 sore throat lozenges...... 117 sulfur precipitated...... 118 sm stay awake maximum strength...... 115 sore throat spray...... 117 SUMMERS EVE DEODORANT sm stomach relief...... 115 soya lecithin...... 117 ULTRA...... 118 sm stomach relief max st...... 115 soybean oil...... 117 sunbeam cool spray humidifier...... 118 sm stool softener...... 115 spearmint oil...... 117 sunbeam evap humidifier...... 118 sm tioconazole-1...... 115 sportbalm...... 117 sunbeam humidifier...... 118 sm triple antibiotic...... 115 SPORTSCREME...... 117 SUNBEAM INSTANT WARM PACK sm triple antibiotic max st...... 115 spot acne treatment...... 117 ...... 118 sm tussin...... 115 SPRAYZOIN...... 117 super b-50 complex...... 118 sm tussin cf...... 115 squaric acid di-n-butyl ester...... 117 super c-500 complex...... 118 sm tussin cough/chest congest...... 115 ST JOSEPH COUGH...... 117 super cal/mag...... 119 sm tussin dm...... 115 STAFLEX...... 117 super natrul-100...... 119 sm vitamin b1...... 115 stahist ad...... 117 SUPER OMEGA-3...... 119 sm vitamin c...... 115 STANBACK HEADACHE super strength sinadrin...... 119 sm vitamin e...... 115 POWDERS...... 117 suphedrine 12hour...... 119 sm witch hazel...... 115 STATUSS GREEN...... 117 suplevit...... 119 smoothfit cuff...... 115 stay awake...... 117 supposibase f...... 119 sochlor...... 115 stay awake maximum strength...... 117 SUPPOSIBLEND...... 119 sodium acetate...... 115 stearic acid...... 117 SUPRENZA...... 119 sodium ascorbate...... 115 stearyl alcohol...... 117 supress a pediatric...... 119 sodium benzoate...... 115 sterile...... 117 supress dm pediatric...... 119 sodium bicarbonate...... 115 STERILE LUBRICANT...... 117 SUPRESS-PE PEDIATRIC...... 119 sodium bisulfite...... 116 STERI-STRIP COMPOUND SUSPENDOL-S...... 119 sodium borate decahydrate...... 116 BENZOIN...... 117 SWEEN...... 119 sodium bromide...... 116 STERI-TAMP SEALS SWEEN PREP...... 119 sodium butyrate...... 116 BOTTLES/VIALS...... 117 SWIM EAR...... 119 sodium chloride...... 116 STERI-TAMP SEALS/BAGS...... 117 swimmers instant ear dry...... 119 sodium chloride (hypertonic)...... 116 STERI-TAMP SEALS/SYRINGES.....117 SYRSPEND SF...... 119 sodium citrate...... 116 STERYMINE...... 117 SYRSPEND SF PH4...... 119 sodium citrate dihydrate...... 116 stevia extract...... 117 syrup nf...... 119 sodium hydroxide...... 116 stimulant laxative...... 117 SYSTANE...... 119 sodium metabisulfite...... 116 STIMULEN...... 118 SYSTANE LID WIPES...... 119 sodium nitrate...... 116 stomach relief...... 118 SYSTANE NIGHTTIME...... 119 sodium nitrite...... 116 stomach relief max st...... 118 SYSTANE OVERNIGHT THERAPY 119 156 SYSTANE PRESERVATIVE FREE...119 th nasal decongestant pe...... 121 TN DICKINSONS WITCH HAZEL... 123 SYSTANE ULTRA...... 119 th nighttime cough...... 121 tolnaftate...... 123 SYSTANE ULTRA HOME-AWAY th stool softener...... 121 TOPICAINE 5...... 123 PACK...... 119 th tussin cf...... 121 tragacanth...... 123 SYSTANE ULTRA PF...... 120 THE ITCH ERASER...... 121 travel sickness...... 123 TABTUSSIN...... 120 theophylline anhydrous...... 121 T-RELIEF PAIN ARNICA + 12...... 123 TABTUSSIN DM...... 120 THERACAL D2000...... 121 T-RELIEF PAIN RELIEF...... 123 tactinal...... 120 THERACAL D4000...... 121 triacting cold/cough...... 123 tactinal extra strength...... 120 THERACAL RAPID REPLETION.....121 triacting nightime cold&cough...... 123 TAKE ACTION...... 120 THERACOF PLUS COUGH/COLD TRIAMINIC CHEST/NASAL talc...... 120 REL...... 121 CONGEST...... 123 TANDEM...... 120 THERAFLU COLD & COUGH...... 121 TRIAMINIC COLD & ALLERGY..... 123 tangerine...... 120 THERAFLU COLD & SORE TRIAMINIC COLD/COUGH...... 123 tannic acid...... 120 THROAT...... 121 TRIAMINIC COLD/COUGH DAY TARSUM...... 120 THERAFLU EXPRESSMAX...... 121 TIME...... 123 tartaric acid...... 120 THERAFLU FLU & SORE THROAT 121 TRIAMINIC COLD/COUGH taurine...... 120 THERAFLU SEVERE COLD...... 122 NIGHTTIME...... 123 TAVIST ALLERGY...... 120 THERAFLU SEVERE COLD & TRIAMINIC COUGH & tdm solution...... 120 COUGH...... 121 CONGESTION...... 123 tea tree oil...... 120 THERAFLU SEVERE COLD TRIAMINIC COUGH & SORE TEAR FLO...... 120 DAYTIME...... 121 THROAT...... 123, 124 TEARS AGAIN...... 120 THERAFLU SEVERE COLD TRIAMINIC COUGH/RUNNY NOSE TEARS NATURALE FORTE...... 120 NIGHTTIME...... 122 ...... 124 TEARS NATURALE II...... 120 THERAFLU SEVERE COLD/CGH TRIAMINIC COUGH/SORE TEARS NATURALE PM...... 120 DAY...... 122 THROAT...... 124 tears pure...... 120 THERAFLU SEVERE COLD/CGH TRIAMINIC FEVER & COLD...... 124 TECNU FIRST AID...... 120 NIGHT...... 122 TRIAMINIC FEVER REDUCER...... 124 TEGADERM AG MESH 2"X2"...... 120 THERAFLU SINUS & COLD...... 122 TRIAMINIC FLU COUGH & FEVER124 TEGADERM AG MESH 4"X5"...... 120 THERAFLU WARMING RELIEF TRIAMINIC FLU/COUGH/FEVER... 124 TEGADERM AG MESH 4"X8"...... 120 COLD...... 122 TRIAMINIC LONG ACTING TEGADERM AG MESH 8"X8"...... 120 THERAFLU WARMING RELIEF COUGH...... 124 TEGADERM ALGINATE AG SINUS...... 122 TRIAMINIC NIGHT TIME DRESSING...... 120 THERA-GESIC...... 122 COLD/CGH...... 124 TEGADERM CONTACT LAYER...... 120 THERA-GESIC PLUS...... 122 TRIAMINIC SORE THROAT...... 124 TEGADERM FOAM ADHESIVE...... 120 THERANATAL COMPLETE...... 122 triamino...... 124 TEGADERM HIGH GELLING THERANATAL PLUS...... 122 tri-buffered aspirin...... 124 ALGINATE...... 120 therapeutic...... 122 trichloroacetic acid...... 124 TEGADERM HIGH INTEG THERAPLEX T...... 122 triple antibiotic...... 124 ALGINATE...... 120 THERASEAL HAND PROTECTION 122 triple antibiotic plus...... 124 terbinafine hcl...... 120 thera-tabs...... 122 triple antibiotic+pain relief...... 124 terocin...... 120, 121 THERATEARS...... 122 TRIPLE FLEX...... 124 teroderm-plus...... 121 THERATEARS NUTRITION...... 122 triple helix collagen...... 124 TESSALON PERLES...... 121 THERATEARS PF...... 122 TRIPLE PASTE...... 124 TETRA-FORMULA CGH/SORE thiamine...... 122 TRISPEC DMX...... 124 THROAT...... 121 thiamine hcl...... 122 TRI-VI-SOL...... 124 tg 10peh/380gfn...... 121 threonine...... 122 TRI-VI-SOL A/C/D...... 124 tg 10peh/380gfn/15dm...... 121 throat drops...... 122 TRI-VITA...... 124, 125 tgt first aid cleansing...... 121 thymol...... 122 tri-vitamin...... 125 tgt flu/severe cold/cough rlf...... 121 THYROSAFE...... 122 trixaicin...... 125 tgt lubricant eye drops...... 121 THYROSHIELD...... 122 trixaicin hp...... 125 tgt medicated hemorrhoidal...... 121 TIELLE...... 122 TROCAINE THROAT...... 125 tgt pain reliever pm ex st...... 121 TIGER BALM LINIMENT...... 122 TROCAL COUGH SUPPRESSANT.. 125 tgt zinc cold remedy...... 121 TIGER BALM MUSCLE RUB...... 122 TROCHIBASE CLASSIC...... 125 th antacid supreme...... 121 TIGER BALM NECK & SHOULDER trochibase s...... 125 th antibiotic + pain relief...... 121 RUB...... 122 TROJAN...... 125 th calcium citrate-vitamin d...... 121 TIGER BALM PAIN RELIEVING.....122 TROJAN ASSORTMENT PACK...... 125 th childrens plus...... 121 TIGER BALM PAIN RELIEVING LG TROJAN PLUS...... 125 th cold & allergy...... 121 ...... 123 TROJAN REGULAR...... 125 th eye drop advanced relief...... 121 TIGER BALM ULTRA STRENGTH. 123 TROJAN RIBBED...... 125 th eye drop tears...... 121 TINACTIN...... 123 trolamine...... 125 th glucosamine sulfate...... 121 TINACTIN JOCK ITCH...... 123 TROMBONEX-D...... 125 th magnesium...... 121 tioconazole-1...... 123 TRUEPLUS GLUCOSE...... 125 th mineral oil...... 121 TITRALAC...... 123 TRU-MICIN...... 125 157 TRUSTEX LUB/RIBBED/STUDDED125 TYLENOL CHILDRENS PLUS MS VAPOR PATCH...... 129 TRUSTEX LUB/SPERMICIDE EX COLD...... 127 VASHE WOUND THERAPY...... 129 ST...... 125 TYLENOL COLD MAX...... 127 VASOCLEAR-A...... 129 TRUSTEX LUBRICATED...... 125 TYLENOL COLD MULTI- VASOFLEX D1...... 129 TRUSTEX LUBRICATED EX SYMPTOM...... 127 VAZOTAB...... 129 LARGE...... 125 TYLENOL COLD MULTI- VCF VAGINAL CONTRACEPTIVE. 129 TRUSTEX LUBRICATED EXTRA SYMPTOM DAY...... 127 veegum...... 129 ST...... 125 TYLENOL COLD/FLU SEVERE...... 127 venaliv...... 129 TRUSTEX NON-LUBRICATED...... 125 TYLENOL COUGH/SORE THROAT 127 VENIA...... 129 TRUSTEX RIA LUB/SPERMICIDE.. 125 TYLENOL EXTRA STRENGTH...... 127 VENOFER...... 129 TRUSTEX RIA LUBRICATED...... 125 TYLENOL INFANTS...... 127 VERSAPLUS...... 129 TRUSTEX RIA NON-LUBRICATED 125 TYLENOL PM EXTRA STRENGTH.128 VERSIVA XC...... 129 TRUSTEX-NONOXYNOL- TYLENOL SINUS VIADENT ADVANCED CARE...... 129 9/RIB/STUD...... 125 CONGESTION/PAIN...... 128 vicks cool mist humidifier...... 129 trymine cg...... 125 TYLENOL SINUS SEVERE...... 128 VICKS DAYQUIL MUCUS tryptophan...... 125 TYLER SIMILASE SENSITIVE...... 128 CONTROL DM...... 129 TUCKS...... 125 tyrosine...... 128 VICKS DAYQUIL SINEX...... 129 TUCKS HEMORRHOIDAL...... 125 ubidecarenone...... 128 vicks humidifier...... 129 TUCKS MEDICATED COOLING..... 125 ULCEREASE...... 128 vicks mini coolmist humidifier...... 130 TUMS...... 126 ultilet alcohol swab...... 128 VICKS NYQUIL CHILDRENS TUMS CHEWY DELIGHTS...... 125 ULTILET OPERATING DEVICE...... 128 CLD/CGH...... 130 TUMS E-X 750...... 125 ULTRA FRESH PM...... 128 VICKS NYQUIL COLD & FLU TUMS EXTRA STRENGTH 750...... 125 ULTRA MEGA GOLD...... 128 NIGHT...... 130 TUMS FRESHERS...... 126 ULTRA MIDE 25...... 128 VICKS NYQUIL COUGH...... 130 TUMS KIDS...... 126 ultracin...... 128 VICKS NYQUIL D COLD & FLU..... 130 TUMS LASTING EFFECTS...... 126 ultrasone...... 128 VICKS NYQUIL SEVERE COLD & TUMS SMOOTHIES...... 126 ultrasonic humidifier...... 128 FLU...... 130 TUMS ULTRA 1000...... 126 UMCKA ELDERBERRY COLD+FLU VICKS NYQUIL SEVERE turpentine...... 126 ...... 128 COLD/FLU...... 130 turpentine oil...... 126 UMCKA FASTACTIVES VICKS NYQUIL SINEX...... 130 TUSICOF...... 126 COLD+FLU...... 128 VICKS SINEX DAYQUIL/NYQUIL..130 TUSNEL...... 126 undecylenic acid...... 128 VICKS VAPO STEAM...... 130 TUSNEL C...... 126 UNDELENIC...... 128 VICKS VAPODROPS...... 130 tusnel diabetic...... 126 unibase...... 128 VICKS VAPOINHALER...... 130 TUSNEL PEDIATRIC...... 126 UNI-SOLVE WIPES...... 128 VICKS VAPORIZER...... 130 TUSNEL-DM PEDIATRIC...... 126 universal ph...... 128 VICKS VAPORUB...... 130 tussafex ex...... 126 urea...... 128 vicks warm mist humidifier...... 130 TUSSICAPS...... 126 urea peroxide...... 128 VINCE...... 130 tussin...... 127 urinary pain relief...... 128 VIROXYN...... 130 tussin cf...... 126 URO-MAG...... 128 virtussin a/c...... 130 tussin cf cough & cold...... 126 vagicaine...... 128 virtussin dac...... 130 tussin cf max multi-symptom...... 126 vagicream...... 128 VISINE ADVANCED RELIEF...... 130 tussin chest congestion...... 126 VAGISTAT-1...... 128 VISINE MAXIMUM REDNESS tussin cold/congestion...... 126 VAGISTAT-3...... 128 RELIEF...... 130 tussin cough...... 127 valerian...... 128 VISINE TOTALITY MULTI- tussin cough dm...... 126 valerian root...... 128 SYMPTOM...... 130 tussin cough long-acting...... 126 valine...... 128, 129 VISINE-LR...... 130 tussin dm...... 127 VALINE 1000...... 128 VISTEC X-RAY DETECTABLE tussin dm clear...... 127 VAMOUSSE LICE TREATMENT.....129 SPONGE...... 130 tussin dm max...... 127 VANACHOL...... 129 vita-c...... 130 tussin expectorant...... 127 VANACLEAR PD...... 129 VITA-CALCIUM...... 130 tussin mucus+chest congestion...... 127 VANACOF...... 129 VITADYE...... 130 TUSSI-PRES...... 127 VANACOF AC...... 129 VITALINE BIOTIN FORTE/ZINC.....130 tussi-pres b...... 127 VANACOF DM...... 129 VITALINE COQ10...... 130 TUSSI-PRES PE PEDIATRIC...... 127 VANACOF-8...... 129 vitalize...... 130 TUSSI-PRES PEDIATRIC...... 127 vanadium...... 129 VITAMAX...... 130 TUSSLIN...... 127 VANAHIST PD...... 129 VITAMELTS ENERGY VITAMIN B- TUSSLIN PEDIATRIC...... 127 VANAMINE PD...... 129 12...... 131 TYLENOL...... 127 VANATAB AC...... 129 vitamin a...... 131 TYLENOL ARTHRITIS PAIN...... 127 VANATAB DM...... 129 vitamin a & d...... 131 TYLENOL CHEST CONGESTION... 127 VANICREAM DIAPER RASH...... 129 VITAMIN A FISH...... 131 TYLENOL CHILDRENS CLD+CGH 127 VANIPLY...... 129 vitamin a palmitate...... 131 vanishing cream botanical base...... 129 vitamin a wrinkle treatment...... 131 158 vitamin a-beta carotene...... 131 wellness protein shake...... 133 Z-TUSS AC...... 135 vitamin b complex-c...... 131 white petrolatum...... 133 ZYRTEC ALLERGY...... 135 vitamin b-1...... 131 white petroleum jelly...... 133 ZYRTEC ALLERGY CHILDRENS... 135 vitamin b12...... 131 WINGS MATERNITY PANTS 2X-3X ZYRTEC CHILDRENS HIVES vitamin b-12...... 131 ...... 133 RELIEF...... 135 vitamin b12-folic acid...... 131 wintergreen oil...... 133 ZYRTEC-D ALLERGY & vitamin b-2...... 131 witch hazel...... 133 CONGESTION...... 135 vitamin b-6 er...... 131 WITEPSOL...... 133 ZZZQUIL...... 135 vitamin c...... 131 xanthan gum...... 133 vitamin c (calcium ascorbate)...... 131 XENICAL...... 133 vitamin c drops...... 131 xolido...... 133 vitamin c gummies...... 131 X-SEB T PLUS...... 133 vitamin c plus wild rose hips...... 131 XTRA-CARE...... 133 vitamin c-rose hips...... 131 xylitol...... 133 vitamin d (ergocalciferol)...... 131 YES FOR WOMEN...... 133 vitamin d2...... 131 yl natural vitamin a & d...... 133 vitamin d3...... 131, 132 yl vitamin b-6...... 133 vitamin e...... 132 yodefan-nf chest congestion...... 133 VITAMIN E & C BEAUTY LOTION 132 ZADITOR...... 133 VITAMIN E & K BEAUTIFUL SKIN 132 ZANTAC 150 MAXIMUM vitamin e acetate...... 132 STRENGTH...... 133, 134 vitamin e beauty...... 132 ZANTAC 75...... 134 vitamin e succinate...... 132 Z-BUM...... 134 vitamin k (phytonadione)...... 132 Z-COF 12DM...... 134 vitamin k1...... 132 ZEASORB...... 134 vitamins a & d...... 132 ZEASORB-AF...... 134 VITAMINS E & A BEAUTY OIL...... 132 ZE-PLUS...... 134 VITAMINS E & D BEAUTY OIL...... 132 ZICAM ALLERGY RELIEF...... 134 VITA-PLUS H...... 132 ZICAM COLD REMEDY...... 134 VITA-RAY...... 132 ZIKS ARTHRITIS PAIN RELIEF...... 134 VITONIC...... 132 ZILACTIN...... 134 viva...... 132 ZILACTIN BABY...... 134 VIVA DROPS...... 132 ZIMS MAX-FREEZE...... 134 VOPAC 5...... 132 zinc...... 134 WAL-DRYL...... 132 zinc + vitamin c...... 134 WAL-DRYL ANTI-ITCH...... 132 ZINC 15...... 134 WAL-DRYL-D ALLERGY/SINUS.... 132 zinc acetate...... 134 WAL-FEX D ALLERGY & zinc aspartate...... 134 CONGESTION...... 132 zinc chelated...... 134 WAL-FLU COLD & SORE THROAT132 zinc chloride...... 134 WAL-FLU SEV COLD/CGH zinc gluconate...... 134 DAY/NIGHT...... 132 zinc methionate...... 134 WAL-FLU SEVERE COLD zinc oxide...... 134 DAYTIME...... 132 zinc stearate...... 134 WAL-FLU SEVERE COLD NIGHT zinc sulfate...... 134 TIME...... 132 zinc sulfate heptahydrate...... 134 WAL-ITIN D...... 132 zinc-c-b6...... 134 WAL-PHED PE zincolate...... 134 DAYTIME/NIGHTTIME...... 132 ZINC-OXYDE PLUS...... 134 WAL-SLEEP Z LIQUID SHOTS...... 133 zn-50...... 134 wal-som...... 133 ZNLIN...... 134 wal-tap cold/allergy...... 133 ZN-PLUS...... 135 WAL-TUSSIN CF MAX...... 133 ZODRYL AC 25...... 135 wal-tussin cough relief...... 133 ZODRYL AC 30...... 135 WAL-ZYR...... 133 ZODRYL AC 40...... 135 WAL-ZYR CHILDRENS...... 133 ZODRYL DEC 25...... 135 wart remover maximum strength...... 133 ZODRYL DEC 30...... 135 washable pants...... 133 ZODRYL DEC 40...... 135 WATCHHALER...... 133 zoo friends plus extra c...... 135 wax, white...... 133 ZOSTRIX ARTHRITIS PAIN RELIEF wee care...... 133 ...... 135 wegmans complete prenatal+dha...... 133 ZOSTRIX HOT & COLD THERAPY 135 WELLMIND MENTAL FOCUS...... 133 ZOSTRIX-HP...... 135 159