DoD UNIFORM OUTPATIENTFORMULARY

Alphabetical Listing by Name

This document is current as of July 14, 2021 The availability of formulary items is subject to change.

Basic Core Formulary: MTF must have on formulary

Uniform Formulary: MTF may have on formulary Nonformulary: MTF must not have on formulary Extended Core Formulary: MTF must be on formulary if includes any drugs from that drug class

1 ABACAVIR Abacavir Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Mapap Extra Strength: 500 mg UNIFORM FORMULARY Elixir, Oral: Solution, Oral: Mapap Children's: 160 mg/5 mL (118 mL, 480 mL) [ethanol free; contains Ziagen: 20 mg/mL (240 mL) [contains methylparaben, propylene glycol, benzoic acid, propylene glycol, sodium benzoate; cherry flavor] propylparaben, saccharin sodium; strawberry-banana flavor] Injection, Solution [preservative free]: Tablet, Oral: Ofirmev: 10 mg/mL (100 mL) Generic: 300 mg Liquid, Oral: Generic: 160 mg/5 mL (120 mL, 473 mL); 500 mg/5 mL (240 mL) Abacavir and Lamivudine Solution, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 160 mg/5 mL (5 mL, 10 mL, 20 mL) UNIFORM FORMULARY Suppository, Rectal: Tablet, Oral: Generic: 120 mg (12s); 325 mg (12s) Generic: Abacavir 600 mg and lamivudine 300 mg Suspension, Oral: Generic: 160 mg/5 mL (5 mL, 10.15 mL, 20.3 mL) Abacavir, Dolutegravir, and Lamivudine Syrup, Oral: DoD Uniform Formulary Outpatient Dosage Forms Triaminic Children's Fever Reducer Pain Reliever: 160 mg/5 mL (118 mL) UNIFORM FORMULARY Tablet, Oral: Tablet, Oral: Generic: 325 mg, 500 mg Triumeq: Abacavir 600 mg, dolutegravir 50 mg, and lamivudine 300 mg Tablet, Chewable, Oral: Generic: 80 mg Abacavir, Lamivudine, and Zidovudine NOT COVERED DoD Uniform Formulary Outpatient Dosage Forms Caplet, Extended Release, Oral: UNIFORM FORMULARY Mapap Arthritis Pain: 650 mg Tablet, Oral: Tylenol 8 HR Arthritis Pain: 650 mg Generic: Abacavir sulfate 300 mg, lamivudine 150 mg, and zidovudine Suppository, Rectal: 300 mg Generic: 650 mg (12s) Abciximab Acetaminophen and Caffeine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Intravenous: Tablet, Oral: ReoPro: 2 mg/mL (5 mL) [contains polysorbate 80] Excedrin Tension Headache: Acetaminophen 500 mg and caffeine 65 mg [contains benzoic acid] Abemaciclib Excedrin Tension Headache: Acetaminophen 500 mg and caffeine 65 mg DoD Uniform Formulary Outpatient Dosage Forms [aspirin free; contains benzoic acid] UNIFORM FORMULARY Tablet, Oral: Acetaminophen and Codeine Verzenio: 50 mg, 100 mg, 150 mg, 200 mg DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY Abiraterone Acetate Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Acetaminophen 300 mg and codeine phosphate 30 mg UNIFORM FORMULARY Tablet, Oral: UNIFORM FORMULARY Yonsa: 125 mg Solution, Oral: Zytiga: 250 mg, 500 mg Generic: Acetaminophen 120 mg and codeine phosphate 12 mg per 5 mL (5 Generic: 250 mg mL, 12.5 mL, 118 mL, 473 mL) Tablet, Oral: AbobotulinumtoxinA Acetaminophen 300 mg and codeine phosphate 15 mg DoD Uniform Formulary Outpatient Dosage Forms Acetaminophen 300 mg and codeine phosphate 60 mg UNIFORM FORMULARY Acetaminophen and Diphenhydramine Solution Reconstituted, Intramuscular: Dysport: 300 units (1 ea); 500 units (1 ea) [contains milk protein] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Absorption Base Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Aceta-Gesic: Acetaminophen 325 mg and diphenhydramine hydrochloride UNIFORM FORMULARY 12.5 mg Cream: 480 g Excedrin PM: Acetaminophen 500 mg and diphenhydramine citrate 38 mg Ointment, topical: 480 g Legatrin PM: Acetaminophen 500 mg and diphenhydramine hydrochlor- ide 50 mg Acalabrutinib Percogesic Extra Strength: Acetaminophen 500 mg and diphenhydramine DoD Uniform Formulary Outpatient Dosage Forms hydrochloride 12.5 mg UNIFORM FORMULARY Generic: Acetaminophen 500 mg and diphenhydramine hydrochloride 25 mg Capsule, Oral: Calquence: 100 mg Acetaminophen and Pamabrom DoD Uniform Formulary Outpatient Dosage Forms Acamprosate UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Caplet, Oral: UNIFORM FORMULARY Midol Teen Formula: Acetaminophen 500 mg and pamabrom 25 mg Tablet Delayed Release, Oral, as calcium: Tylenol Women’s Menstrual Relief: Acetaminophen 500 mg and pamab- Generic: 333 mg rom 25 mg Tablet, Oral: Acarbose Cramp Tabs: Acetaminophen 325 mg and pamabrom 25 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Acetaminophen and Phenylephrine Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 25 mg, 50 mg, 100 mg UNIFORM FORMULARY Caplet, Oral: Acebutolol Contac Cold + Flu Maximum Strength Non Drowsy: Acetaminophen 500 mg DoD Uniform Formulary Outpatient Dosage Forms and phenylephrine hydrochloride 5 mg UNIFORM FORMULARY Mapap Sinus PE, Sudafed PE Pressure + Pain: Acetaminophen 325 mg and Capsule, Oral, as hydrochloride: phenylephrine hydrochloride 5 mg Generic: 200 mg, 400 mg Tylenol Sinus Congestion & Pain Daytime: Acetaminophen 325 mg and phenylephrine hydrochloride 5 mg [Cool Burst flavor] Acetaminophen Capsule, Liquid Filled, Oral: DoD Uniform Formulary Outpatient Dosage Forms Vicks DayQuil Sinex Daytime Sinus: Acetaminophen 325 mg and phenyl- UNIFORM FORMULARY ephrine hydrochloride 5 mg Caplet, Oral: Tablet, Oral: Generic: 500 mg Cetafen Cold: Acetaminophen 500 mg and phenylephrine hydrochloride 5 mg 2 ACETAMINOPHEN, DIPHENHYDRAMINE, AND PHENYLEPHRINE

Robitussin Peak Cold Nasal Relief: Acetaminophen 325 mg and phenyl- Tylenol Cold Max: Acetaminophen 325 mg, dextromethorphan hydrobromide ephrine hydrochloride 5 mg 10 mg, and phenylephrine hydrochloride 5 mg Sinus Pain & Pressure: Acetaminophen 500 mg and phenylephrine hydro- Capsule, Liquid filled, Oral: chloride 5 mg Alka-Seltzer Plus Day Cold: Acetaminophen 325 mg, dextromethorphan hydrobromide 10 mg, and phenylephrine hydrochloride 5 mg Acetaminophen and Phenyltoloxamine Mucinex Fast-Max Severe Cold & Sinus: Acetaminophen 325 mg, dextro- DoD Uniform Formulary Outpatient Dosage Forms methorphan hydrobromide 10 mg, and phenylephrine hydrochloride 5 mg UNIFORM FORMULARY [contains soybean lecithin] Tablet, Oral: Vicks DayQuil Cold & Flu Multi-Symptom: Acetaminophen 325 mg, dextro- Dolorex: Acetaminophen 325 mg and phenyltoloxamine citrate 25 mg methorphan hydrobromide 10 mg, and phenylephrine hydrochloride 5 mg Acetaminophen and Pseudoephedrine Liquid, Oral: Tylenol Cold Max: Acetaminophen 325 mg, dextromethorphan hydrobromide DoD Uniform Formulary Outpatient Dosage Forms 10 mg, and phenylephrine hydrochloride 5 mg per 15 mL (240 mL) [contains UNIFORM FORMULARY propylene glycol, sodium 5 mg/15 mL, sodium benzoate; citrus burst flavor] Caplet, Oral: Vicks DayQuil Cold & Flu Multi-Symptom: Acetaminophen 325 mg, dextro- Ornex Maximum Strength: Acetaminophen 500 mg and pseudoephedrine methorphan hydrobromide 10 mg, and phenylephrine hydrochloride 5 mg hydrochloride 30 mg per 15 mL (180 mL, 300 mL) [ethanol free, sugar free; contains propylene Acetaminophen and Tramadol glycol, sodium 50 mg/15 mL, sodium benzoate] DoD Uniform Formulary Outpatient Dosage Forms Powder for Solution, Oral: UNIFORM FORMULARY Theraflu Daytime Severe Cold & Cough: Acetaminophen 650 mg, dextro- Tablet, Oral: methorphan hydrobromide 20 mg, and phenylephrine hydrochloride 10 mg Generic: Acetaminophen 325 mg and tramadol hydrochloride 37.5 mg per packet (6s) [contains phenylalanine 14 mg/packet, potassium 10 mg/ packet, and sodium 20 mg/packet; berry-green tea-menthol flavor] Acetaminophen, Aspirin, and Caffeine Theraflu Multi-Symptom Severe Cold: Acetaminophen 500 mg, dextromethor- DoD Uniform Formulary Outpatient Dosage Forms phan hydrobromide 20 mg, and phenylephrine hydrochloride 10 mg per UNIFORM FORMULARY packet (6s) [contains phenylalanine 20 mg/packet, potassium 10 mg/packet, Caplet, Oral: and sodium 19 mg/packet; Lipton green tea and honey lemon flavors] Excedrin Extra Strength, Excedrin Migraine: Acetaminophen 250 mg, aspirin Syrup, Oral: 250 mg, and caffeine 65 mg Theraflu ExpressMax Daytime Severe Cold & Cough: Acetaminophen Vanquish Extra Strength Pain Reliever: Acetaminophen 194 mg, aspirin 325 mg, dextromethorphan hydrobromide 10 mg, and phenylephrine hydro- 227 mg, and caffeine 33 mg chloride 5 mg per 15 mL (245.5 mL) [contains ethanol, potassium 12 mg/15 Powder, Oral: mL, propylene glycol, sodium 8 mg/15 mL, sodium benzoate; berry flavor] Goody's Extra Strength Headache Powder: Acetaminophen 260 mg, aspirin 520 mg, and caffeine 32.5 mg [contains lactose] Acetaminophen, Diphenhydramine, and Phenylephrine Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Anacin Advanced Headache Formula: Acetaminophen 250 mg, aspirin UNIFORM FORMULARY 250 mg, and caffeine 65 mg Caplet, Oral: Excedrin Extra Strength, Excedrin Migraine, Pain-Off: Acetaminophen One Tab Allergy & Sinus: Acetaminophen 650 mg, diphenhydramine hydro- 250 mg, aspirin 250 mg, and caffeine 65 mg chloride 25 mg, and phenylephrine hydrochloride 10 mg [dye free] Fem-Prin: Acetaminophen 194.4 mg, aspirin 226.8 mg, and caffeine 32.4 mg One Tab Cold and Flu: Acetaminophen 650 mg, diphenhydramine hydro- chloride 25 mg, and phenylephrine hydrochloride 10 mg [dye free] Acetaminophen, Caffeine, and Dihydrocodeine Cold Control PE: Acetaminophen 650 mg, diphenhydramine hydrochloride DoD Uniform Formulary Outpatient Dosage Forms 25 mg, and phenylephrine hydrochloride 10 mg UNIFORM FORMULARY Theraflu ExpressMax Nighttime Severe Cold & Cough: Acetaminophen Capsule, Oral: 325 mg, diphenhydramine hydrochloride 12.5 mg, and phenylephrine hydro- Generic: Acetaminophen 320.5 mg, caffeine 30 mg, and dihydrocodeine chloride 5 mg bitartrate 16 mg Tylenol Allergy Multi-Symptom Nighttime: Acetaminophen 325 mg, diphen- hydramine hydrochloride 25 mg, and phenylephrine hydrochloride 5 mg Acetaminophen, Caffeine, and Isometheptene Mucate [Cool Burst flavor] DoD Uniform Formulary Outpatient Dosage Forms Liquid, Oral: UNIFORM FORMULARY Delsym Children's Cough+Cold Night Time: Acetaminophen 325 mg, diphen- Capsule, Oral: hydramine hydrochloride 12.5 mg, and phenylephrine hydrochloride 5 mg Generic: Acetaminophen 500 mg, caffeine 20 mg, isometheptene mucate per 10 mL (180 mL) [contains edetate disodium, propylene glycol, sodium 130 mg 6 mg/10 mL, sodium benzoate; berry flavor] Acetaminophen, Caffeine, and Pyrilamine Delsym Cough+Cold Night Time: Acetaminophen 650 mg, diphenhydramine hydrochloride 25 mg, and phenylephrine hydrochloride 10 mg per 20 mL DoD Uniform Formulary Outpatient Dosage Forms (180 mL) [contains edetate disodium, propylene glycol, sodium 12 mg/20 UNIFORM FORMULARY mL, sodium benzoate; mixed berry flavor] Tablet, Oral, as hydrochloride: Dimetapp Children's Multi-Symptom Cold & Flu: Acetaminophen 160 mg, Midol Complete: Acetaminophen 500 mg, caffeine 60 mg, and pyrilamine diphenhydramine hydrochloride 6.25 mg, and phenylephrine hydrochloride maleate 15 mg 2.5 mg per 5 mL (118 mL) [alcohol free; contains edetate disodium, menthol, Acetaminophen, Dextromethorphan, and Doxylamine polyethylene glycol, propylene glycol, sodium benzoate, sodium 3.5 mg/5 DoD Uniform Formulary Outpatient Dosage Forms mL; red grape flavor] UNIFORM FORMULARY Mucinex Sinus-Max Night Time Congestion & Cough: Acetaminophen Capsule, Liquid Filled, Oral: 650 mg, diphenhydramine hydrochloride 25 mg, and phenylephrine hydro- Generic: Acetaminophen 325 mg, dextromethorphan hydrobromide 15 mg, chloride 10 mg per 20 mL (180 mL) [contains edetate disodium, propylene and doxylamine succinate 6.25 mg glycol, sodium 12 mg/20 mL, sodium benzoate] Liquid, Oral: Theraflu ExpressMax Flu Cough & Sore Throat: Acetaminophen 325 mg, Vicks NyQuil Cold & Flu Nighttime Relief: Acetaminophen 650 mg, dextro- diphenhydramine hydrochloride 12.5 mg, and phenylephrine hydrochloride methorphan hydrobromide 30 mg, and doxylamine succinate 12.5 mg per 30 5 mg per 15 mL (245.5 mL) [contains edetate disodium, ethanol 10%, mL (240 mL, 360 mL) [contains ethanol 10%, propylene glycol, sodium potassium 12.5 mg/15 mL, propylene glycol, sodium 8 mg/15 mL, sodium benzoate, sodium 43 mg/30 mL] benzoate; berry flavor] Robitussin Peak Cold Nighttime Multi-Symptom Cold: Acetaminophen Acetaminophen, Dextromethorphan, and Phenylephrine 160 mg, diphenhydramine hydrochloride 6.25 mg, and phenylephrine hydro- DoD Uniform Formulary Outpatient Dosage Forms chloride 2.5 mg per 5 mL (118 mL, 237 mL) [contains menthol, propylene UNIFORM FORMULARY glycol, sodium 4 mg/5 mL, sodium benzoate] Caplet, Oal: Robitussin Severe Multi-Symptom Cough Cold + Flu Nighttime: Acetamino- Comtrex Maximum Strength, Non-Drowsy Cold & Cough: Acetaminophen phen 650 mg, diphenhydramine hydrochloride 25 mg, and phenylephrine 325 mg, dextromethorphan hydrobromide 10 mg, and phenylephrine hydro- hydrochloride 10 mg per 20 mL (118 mL, 237 mL) [contains edetate diso- chloride 5 mg dium, fd&c red #40, polyethylene glycol, propylene glycol, sodium 12 mg/20 Mapap Multi-Symptom Cold: Acetaminophen 325 mg, dextromethorphan mL, sodium benzoate, sorbitol] hydrobromide 10 mg, and phenylephrine hydrochloride 5 mg [cool blast Powder for Solution, Oral: flavor] Theraflu Nighttime Severe Cold: Acetaminophen 500 mg, diphenhydramine Sudafed PE Pressure+Pain+Cough: Acetaminophen 325 mg, dextromethor- hydrochloride 25 mg, and phenylephrine hydrochloride 10 mg per packet phan hydrobromide 10 mg, and phenylephrine hydrochloride 5 mg (6s) [contains phenylalanine 13 mg, potassium 10 mg, and sodium 23 mg Theraflu ExpressMax Daytime Severe Cold & Cough: Acetaminophen per packet; green tea and citrus flavor] 325 mg, dextromethorphan hydrobromide 10 mg, and phenylephrine hydro- Theraflu Nighttime Severe Cold & Cough: Acetaminophen 650 mg, diphen- chloride 5 mg hydramine hydrochloride 25 mg, and phenylephrine hydrochloride 10 mg per 3 ACETAMINOPHEN, DIPHENHYDRAMINE, AND PHENYLEPHRINE packet (6s) [contains phenylalanine 13 mg, potassium 10 mg, and sodium Acetylcholine 23 mg per packet; honey lemon flavor] DoD Uniform Formulary Outpatient Dosage Forms Theraflu Sugar-Free Nighttime Severe Cold & Cough: Acetaminophen UNIFORM FORMULARY 650 mg, diphenhydramine hydrochloride 25 mg, and phenylephrine hydro- Solution Reconstituted, Intraocular, as chloride: chloride 10 mg per packet (6s) [sugar free; contains phenylalanine 13 mg, Miochol-E: 20 mg (1 ea) [contains mannitol] potassium 10 mg, and sodium 23 mg per packet; honey lemon flavor] Syrup, Oral: Acetylcysteine Theraflu Warming Relief Flu & Sore Throat: Acetaminophen 325 mg, diphen- DoD Uniform Formulary Outpatient Dosage Forms hydramine hydrochloride 12.5 mg, and phenylephrine hydrochloride 5 mg UNIFORM FORMULARY per 15 mL (245.5 mL) [contains ethanol, potassium 5 mg/15 mL, propylene Solution, Injection [preservative free]: glycol, sodium 5 mg/15 mL, sodium benzoate; cherry flavor] Generic: 20% (30 mL) Theraflu ExpressMax Nighttime Severe Cold & Cough: Acetaminophen Solution, for Inhalation/Oral: 325 mg, diphenhydramine hydrochloride 12.5 mg, and phenylephrine hydro- Generic: 10% [100 mg/mL] (10 mL, 30 mL); 20% [200 mg/mL] (10 mL, 30 mL) chloride 5 mg per 15 mL (245.5 mL) [contains ethanol, potassium 12.5 mg/ Solution, for Inhalation/Oral [preservative free]: 15 mL, propylene glycol, sodium 8 mg/15 mL, sodium benzoate; cherry Generic: 10% [100 mg/mL] (4 mL, 10 mL, 30 mL); 20% [200 mg/mL] (4 mL, 10 flavor] mL, 30 mL) Tablet Effervescent, Oral: Acetaminophen, Guaifenesin, and Phenylephrine Cetylev: 500 mg, 2.5 g [contains edetate disodium; lemon mint flavor] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Acitretin Liquid, Oral: DoD Uniform Formulary Outpatient Dosage Forms Mucinex Fast-Max: Acetaminophen 650 mg, guaifenesin 400 mg, and phenyl- UNIFORM FORMULARY ephrine hydrochloride 10 mg per 20 mL (180 mL) [contains brilliant blue fcf Capsule, Oral: (fd&c blue #1), edetate disodium, fd&c red #40, propylene glycol, sodium Generic: 10 mg, 17.5 mg, 25 mg benzoate, sorbitol] Aclidinium Mucinex Fast-Max Cold & Sinus: Acetaminophen 650 mg, guaifenesin DoD Uniform Formulary Outpatient Dosage Forms 400 mg, and phenylephrine hydrochloride 10 mg per 20 mL (177 mL) UNIFORM FORMULARY [contains brilliant blue fcf (fd&c blue #1), edetate disodium, fd&c red #40, Aerosol Powder Breath Activated, Inhalation, as bromide: propylene glycol, sodium benzoate] Tudorza Pressair: 400 mcg/actuation (1 ea) [contains milk protein] Mucinex Sinus-Max: Acetaminophen 650 mg, guaifenesin 400 mg, and phe- nylephrine hydrochloride 10 mg per 20 mL (180 mL) [contains brilliant blue Aclidinium and Formoterol fcf (fd&c blue #1), edetate disodium, fd&c red #40, propylene glycol, sodium DoD Uniform Formulary Outpatient Dosage Forms benzoate] NOT COVERED Theraflu Warming Cold & Chest: Acetaminophen 325 mg, guaifenesin Aerosol Powder Breath Activated, Inhalation: 200 mg, and phenylephrine hydrochloride 5 mg per 15 mL (245.5 mL) Duaklir Pressair: Aclidinium bromide 400 mcg and formoterol fumarate 12 mcg [contains benzyl alcohol, edetate disodium, fd&c yellow #6 (sunset yellow), per actuation (1 ea) [contains lactose, milk protein] propylene glycol, sodium benzoate; orange flavor] Tablet, Oral: Acrivastine and Pseudoephedrine Mucinex Sinus-Max Congestion: Acetaminophen 325 mg, guaifenesin DoD Uniform Formulary Outpatient Dosage Forms 200 mg, and phenylephrine hydrochloride 5 mg [contains fd&c red #40 UNIFORM FORMULARY aluminum lake, fd&c yellow #6 aluminum lake] Capsule, Oral: Sudafed PE Pressure+Pain+Mucus: Acetaminophen 325 mg, guaifenesin Semprex-D: Acrivastine 8 mg and pseudoephedrine hydrochloride 60 mg 200 mg, and phenylephrine hydrochloride 5 mg Tylenol Sinus Severe: Acetaminophen 325 mg, guaifenesin 200 mg, and Acyclovir and Hydrocortisone phenylephrine hydrochloride 5 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Acetaminophen, Isometheptene, and Dichloralphenazone Cream, External: DoD Uniform Formulary Outpatient Dosage Forms Xerese: Acyclovir 5% and hydrocortisone 1% (5 g) UNIFORM FORMULARY Acyclovir (Systemic) Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: Acetaminophen 325 mg, isometheptene mucate 65 mg, and dichlor- BASIC CORE FORMULARY alphenazone 100 mg Capsule, Oral: AcetaZOLAMIDE Zovirax: 200 mg DoD Uniform Formulary Outpatient Dosage Forms Generic: 200 mg UNIFORM FORMULARY Suspension, Oral: Capsule Extended Release 12 Hour, Oral: Zovirax: 200 mg/5 mL (473 mL) Generic: 500 mg Generic: 200 mg/5 mL (473 mL) Solution Reconstituted, Injection [preservative free]: Tablet, Oral: Zovirax: 400 mg, 800 mg Generic: 500 mg (1 ea) Generic: 400 mg, 800 mg Tablet, Oral: Generic: 125 mg, 250 mg UNIFORM FORMULARY Solution, Intravenous, as sodium [strength expressed as base]: Acetic Acid (Otic) Generic: 50 mg/mL (10 mL, 20 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous, as sodium [strength expressed as base]: UNIFORM FORMULARY Generic: 500 mg (1 ea) Solution, Otic: Generic: 2% (15 mL, 60 mL) Acyclovir (Topical) DoD Uniform Formulary Outpatient Dosage Forms Acetic Acid, Propylene Glycol Diacetate, and Hydrocortisone UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Cream, External: UNIFORM FORMULARY Zovirax: 5% (5 g) [contains cetostearyl alcohol, propylene glycol] Solution, Otic [drops]: Ointment, External: Generic: Acetic acid 2%, propylene glycol diacetate 3%, and hydrocortisone Generic: 5% (5 g, 15 g, 30 g) 1% (10 mL) Tablet, Buccal: Sitavig: 50 mg [contains milk protein concentrate] Acetic Acid (Topical) DoD Uniform Formulary Outpatient Dosage Forms Adalimumab UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Irrigation: BASIC CORE FORMULARY Generic: 0.25% (250 mL, 500 mL, 1000 mL) Pen-injector Kit, Subcutaneous [preservative free]: Humira Pen: 40 mg/0.8 mL (1 ea); 40 mg/0.4 mL (1 ea)[contains polysor- Acetohydroxamic Acid bate 80] DoD Uniform Formulary Outpatient Dosage Forms Humira Pen-CD/UC/HS Starter: 40 mg/0.8 mL (1 ea); 80 mg/0.8 mL (1 ea) UNIFORM FORMULARY [contains polysorbate 80] Tablet, Oral: Humira Pen-Pediatric UC Start: 80 mg/0.8 mL (1 ea) [latex free; contains Lithostat: 250 mg polysorbate 80] 4 ALCOHOL (ISOPROPYL)

Humira Pen-Ps/UV/Adol HS Start: 40 mg/0.8 mL (1 ea); 80 mg/0.8 mL & Albuminar-5: 5% (250 mL, 500 mL) 40 mg/0.4 mL (1 ea) [contains polysorbate 80] AlbuRx: 5% (250 mL, 500 mL) Humira Pen-Psor/Uveit Starter: 80 MG/0.8ML & 40MG/0.4ML (1 ea) [contains Buminate: 5% (250 mL, 500 mL); 25% (20 mL) polysorbate 80] Plasbumin-5: 5% (50 mL, 250 mL) Prefilled Syringe Kit, Subcutaneous [preservative free]: Generic: 25% (50 mL, 100 mL) Humira: 10 mg/0.2 mL (1 ea); 20 mg/0.4 mL (1 ea); 40 mg/0.8 mL (1 ea); Solution, Intravenous [preservative free]: 10 mg/0.1 mL (1 ea); 20 mg/0.2 mL (1 ea); 40 mg/0.4 mL (1 ea) [contains Albutein: 5% (50 mL); 25% (20 mL) polysorbate 80] Plasbumin-5: 5% (50 mL) Humira Pediatric Crohns Start: 40 mg/0.8 mL (1 ea); 80 mg/0.8 mL (1 ea); Generic: 5% (100 mL, 250 mL, 500 mL); 25% (50 mL, 100 mL) 80 mg/0.8 mL & 40 mg0.4 mL (1 ea)[contains polysorbate 80] Albuterol Adapalene DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY UNIFORM FORMULARY Aerosol Solution, Inhalation: Cream, External: Generic: 0.1% (45 g) ProAir HFA: 90 mcg/actuation (8.5 g) Gel, External: Nebulization Solution, Inhalation: Generic: 0.1% (45 g); 0.3% (45 g) Generic: 0.083% [2.5 mg/3 mL] (3 mL) Lotion, External: Nebulization Solution, Inhalation [preservative free]: Generic: 0.1% (59 mL) Generic: 0.083% [2.5 mg/3 mL] (3 mL) NONFORMULARY UNIFORM FORMULARY Pad, Swab, External: Aerosol Powder Breath Activated, Inhalation: Generic: 0.1% (30 ea) [contains alcohol, usp] ProAir RespiClick: 90 mcg/actuation (1 ea) [contains milk protein] Solution, External: Nebulization Solution, Inhalation: Generic: 0.1% (60 mL) Generic: 0.63 mg/3 mL (3 mL); 0.5% [2.5 mg/0.5 mL] (20 mL) Nebulization Solution, Inhalation [preservative free]: Adefovir Generic: 0.63 mg/3 mL (3 mL); 1.25 mg/3 mL (3 mL); 0.5% [2.5 mg/0.5 mL] DoD Uniform Formulary Outpatient Dosage Forms (1 ea) UNIFORM FORMULARY Syrup, Oral: Tablet, Oral, as dipivoxil: Generic: 2 mg/5 mL (473 mL) Generic: 10 mg Tablet, Oral: Adenosine Generic: 2 mg, 4 mg DoD Uniform Formulary Outpatient Dosage Forms Tablet Extended Release 12 Hour, Oral: UNIFORM FORMULARY Generic: 4 mg, 8 mg Solution, Intravenous: NONFORMULARY Adenocard: 12 mg/4 mL (4 mL) Aerosol Solution, Inhalation: Generic: 3 mg/mL (20 mL, 30 mL); 6 mg/2 mL (2 mL) Proventil HFA: 90 mcg/actuation (6.7 g) Solution, Intravenous [preservative free]: Ventolin HFA: 90 mcg/actuation (8 g, 18 g) Generic: 3 mg/mL (20 mL, 30 mL); 6 mg/2 mL (2 mL); 12 mg/4 mL (4 mL) Alclometasone Adenovirus (Types 4, 7) Vaccine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Cream, External, as dipropionate: Tablet, Enteric Coated, Oral [combination package]: Generic: 0.05% (15 g, 45 g, 60 g) Adenovirus type 4 ≥4.5 log10 TCID50 [contains albumin (human); 100 white tablets] Ointment, External, as dipropionate: Generic: 0.05% (15 g, 45 g, 60 g) Adenovirus type 7 ≥4.5 log10 TCID50 [contains albumin (human); 100 white tablets] Alcohol (Ethyl) Ado-Trastuzumab Emtansine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Aerosol, Foam, External [instant hand sanitizer]: Solution Reconstituted, Intravenous [preservative free]: Epi-Clenz: 70% (240 mL) [contains aloe, vitamin E] Kadcyla: 100 mg (1 ea); 160 mg (1 ea) [contains mouse (murine) and/or Gel, External [foam/instant hand sanitizer]: hamster protein] Epi-Clenz: 70% (480 mL) [contains aloe, vitamin E] Gel, External [instant hand sanitizer]: Aducanumab GelRite: 67% (120 mL, 480 mL) Afatinib GelRite: 67% (800 mL) [contains vitamin E] Isagel: 60% (59 mL, 118 mL, 621 mL, 800 mL) DoD Uniform Formulary Outpatient Dosage Forms Prevacare: 60% (120 mL, 240 mL, 960 mL, 1200 mL, 1500 mL) UNIFORM FORMULARY Generic: 62% (1.5 mL, 118 mL, 354 mL, 473 mL) Tablet, Oral: Gilotrif: 20 mg, 30 mg, 40 mg Liquid, External [denatured]: Generic: 70% (480 mL, 3840 mL) Aflibercept (Ophthalmic) Liquid, External [denatured/rubbing alcohol]: DoD Uniform Formulary Outpatient Dosage Forms Lavacol: 70% (473 mL) UNIFORM FORMULARY Lotion, External [instant hand sanitizer]: Solution, Intraocular [preservative free]: Purell 2 in 1: 62% (60 mL, 360 mL, 1000 mL) Eylea: 2 mg/0.05 mL (0.05 mL) [contains mouse (murine) and/or hamster Pad, External [instant hand sanitizer/towelette]: protein] Isagel: 60% (50s, 300s) Purell: 62% (24s) [contains aloe, moisturizers, tartrazine, vitamin A, vitamin E] Agalsidase Beta Purell: 62% (35s, 175s) [contains moisturizers, vitamin E] DoD Uniform Formulary Outpatient Dosage Forms Solution, External [instant hand sanitizer]: UNIFORM FORMULARY Protection Plus: 62% (800 mL) Solution Reconstituted, Intravenous: Solution, Injection [dehydrated, preservative free]: Fabrazyme: 5 mg (1 ea); 35 mg (1 ea) [contains mouse (murine) and/or Generic: 98% (1 mL, 5 mL) hamster protein] Alcohol (Isopropyl) Albendazole DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Gel, External: Tablet, Oral: Albenza: 200 mg [contains saccharin sodium] Generic: 70% (118 mL) Miscellaneous, External: Albumin Essentra Wipes 9x9": 70% (30 ea, 270 ea) DoD Uniform Formulary Outpatient Dosage Forms Pad, External: UNIFORM FORMULARY Pharmacist Choice Alcohol: 70% (100 ea) Solution, Intravenous: Albumin-ZLB: 5% (250 mL, 500 mL) 5 ALDESLEUKIN Aldesleukin Prolastin-C: 1000 mg (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Alpha-Galactosidase UNIFORM FORMULARY Solution Reconstituted, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Proleukin: 22,000,000 units (1 ea) UNIFORM FORMULARY Tablet, Chewable, Oral: Alectinib beano: 150 Galactosidase units [scored] DoD Uniform Formulary Outpatient Dosage Forms Tablet, Orally Disintegrating, Oral: UNIFORM FORMULARY beano Meltaways: 300 Galactosidase units [strawberry flavor] Capsule, Oral: ALPRAZolam Alecensa: 150 mg DoD Uniform Formulary Outpatient Dosage Forms Alemtuzumab UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Concentrate, Oral: UNIFORM FORMULARY ALPRAZolam Intensol: 1 mg/mL (30 mL) [unflavored flavor] Solution, Intravenous [preservative free]: Tablet, Oral: Campath: 30 mg/mL (1 mL) [contains edetate disodium dihydrate, mouse Generic: 0.25 mg, 0.5 mg, 1 mg, 2 mg (murine) and/or hamster protein, polysorbate 80] Tablet Dispersible, Oral: Lemtrada: 12 mg/1.2 mL (1.2 mL) [contains edetate disodium dihydrate, Generic: 0.25 mg, 0.5 mg, 1 mg, 2 mg mouse (murine) and/or hamster protein, polysorbate 80] Tablet Extended Release 24 Hour, Oral: Generic: 0.5 mg, 1 mg, 2 mg, 3 mg Alendronate DoD Uniform Formulary Outpatient Dosage Forms Alprostadil BASIC CORE FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Oral: UNIFORM FORMULARY Generic: 70 mg/75 mL (75 mL) Kit, Intracavernosal: Tablet, Oral: Caverject Impulse: 10 mcg [contains benzyl alcohol] Generic: 5 mg, 10 mg, 35 mg, 40 mg, 70 mg Caverject Impulse: 20 mcg Edex: 10 mcg, 20 mcg, 40 mcg NONFORMULARY Pellet, Urethral: Tablet Effervescent, Oral: Muse: 125 mcg (1 ea, 6 ea); 250 mcg (1 ea, 6 ea); 500 mcg (1 ea, 6 ea); 1000 Binosto: 70 mg mcg (1 ea, 6 ea) Solution, Injection: Alfentanil Generic: 500 mcg/mL (1 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intracavernosal: UNIFORM FORMULARY Caverject: 20 mcg (1 ea) Injectable, Injection [preservative free]: Caverject: 20 mcg (1 ea); 40 mcg (1 ea) [contains benzyl alcohol] Generic: 500 mcg/mL (2 mL, 5 mL) Alteplase Alfuzosin DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Solution Reconstituted, Injection: Tablet Extended Release 24 Hour, Oral, as hydrochloride: Cathflo Activase: 2 mg (1 ea) Generic: 10 mg Solution Reconstituted, Intravenous: Alglucosidase Alfa Activase: 50 mg (1 ea); 100 mg (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Altretamine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous [preservative free]: UNIFORM FORMULARY Lumizyme: 50 mg (1 ea) [contains polysorbate 80] Capsule, Oral: Alirocumab Hexalen: 50 mg DoD Uniform Formulary Outpatient Dosage Forms Aluminum Acetate UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution Pen-injector, Subcutaneous [preservative free]: UNIFORM FORMULARY Praluent: 75 mg/mL (1 mL); 150 mg/mL (1 mL) [contains mouse (murine) and/ Packet, External: or hamster protein] Boro-Packs: Aluminum sulfate 49% and calcium acetate 51% per packet (14 Alitretinoin (Topical) ea, 100 ea) Domeboro: Aluminum sulfate tetradecahydrate 1347 mg and calcium acetate DoD Uniform Formulary Outpatient Dosage Forms monohydrate 952 mg per packet (12s, 100s) UNIFORM FORMULARY Pedi-Boro Soak: Aluminum sulfate tetradecahydrate 1191 mg and calcium Gel, External: acetate monohydrate 839 mg per packet (12 ea, 100 ea) Panretin: 0.1% (60 g) Generic: Aluminum sulfate tetradecahydrate 1347 mg and calcium acetate Allopurinol monohydrate 952 mg per packet (1 ea, 12 ea) DoD Uniform Formulary Outpatient Dosage Forms Solution, External: BASIC CORE FORMULARY Generic: (480 mL) Tablet, Oral, as sodium: Aluminum Acetate and Acetic Acid Generic: 100 mg, 300 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution Reconstituted, Intravenous, as sodium [strength expressed as base, Solution, Otic: preservative free]: Generic: Aluminum acetate 10% and acetic acid 2% (60 mL) Generic: 500 mg (1 ea) Aluminum Chloride Alosetron DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Gel, Oral [topical]: Tablet, Oral: ViscoStat Clear: 25% (1.2 mL, 30 mL) Generic: 0.5 mg, 1 mg Liquid, Oral [topical]: Hemoban: 25% (30 mL) Alpha1-Proteinase Inhibitor Hemodent: 21% (10 mL, 20 mL, 40 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Aluminum Chloride Hexahydrate Solution, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Glassia: 1000 mg/50 mL (1 ea) [latex free] UNIFORM FORMULARY Solution Reconstituted, Intravenous: Liquid, External: Zemaira: 1000 mg (1 ea) B+Drier: 15% (35 mL) Solution Reconstituted, Intravenous [preservative free]: Solution, External: Aralast NP: 500 mg (1 ea); 1000 mg (1 ea) [contains polyethylene glycol, Drysol: 20% (35 mL, 37.5 mL, 60 mL) polysorbate 80] Hypercare: 15% (35 mL, 60 mL) [contains sd alcohol 40] 6 AMINOLEVULINIC ACID (TOPICAL) Aluminum Hydroxide Amifostine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Ointment, External: Solution Reconstituted, Intravenous: DermaMed: (113 g) Generic: 500 mg (1 ea) Suspension, Oral: Amikacin (Systemic) Generic: 320 mg/5 mL (473 mL) DoD Uniform Formulary Outpatient Dosage Forms Aluminum Hydroxide and Magnesium Carbonate UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection, as sulfate: UNIFORM FORMULARY Generic: 500 mg/2 mL (2 mL); 1 g/4 mL (4 mL) Liquid: Solution, Injection, as sulfate [preservative free]: Generic: 500 mg/2 mL (2 mL); 1 g/4 mL (4 mL) Acid Gone: Aluminum hydroxide 31.7 mg and magnesium carbonate 119.3 mg per 5 mL (360 mL) AMILoride Gaviscon: Aluminum hydroxide 31.7 mg and magnesium carbonate 119.3 mg DoD Uniform Formulary Outpatient Dosage Forms per 5 mL (355 mL) [contains magnesium 38 mg/5 mL, sodium 17 mg/5 mL UNIFORM FORMULARY and benzyl alcohol; cool mint flavor] Tablet, Oral, as hydrochloride: Gaviscon Extra Strength: Aluminum hydroxide 254 mg and magnesium car- Generic: 5 mg bonate 237.5 mg per 5 mL (355 mL) [contains magnesium 80 mg/5 mL, sodium 14 mg/5 mL and benzyl alcohol; cool mint flavor] Amiloride and Hydrochlorothiazide Tablet, chewable: DoD Uniform Formulary Outpatient Dosage Forms Acid Gone Extra Strength: Aluminum hydroxide 160 mg and magnesium UNIFORM FORMULARY carbonate 105 mg Tablet,Oral: Gaviscon Extra Strength: Aluminum hydroxide 160 mg and magnesium car- Generic: 5/50: Amiloride hydrochloride 5 mg and hydrochlorothiazide 50 mg bonate 105 mg [contains sodium 19 mg/tablet (1.3 mEq/tablet); cherry and Amino Acid Injection original flavors] DoD Uniform Formulary Outpatient Dosage Forms Aluminum Hydroxide and Magnesium Hydroxide UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous: UNIFORM FORMULARY Aminosyn: 8.5% (500 mL); 10% (500 mL, 1000 mL) [latex free, sulfite free] Liquid, oral: Aminosyn II: 7% (500 mL); 8.5% (500 mL, 1000 mL); 10% (2000 mL) [latex free, sulfite free] Mag-Al: Aluminum hydroxide 200 mg and magnesium hydroxide 200 mg per 5 Aminosyn II: 10% (500 mL, 1000 mL); 15% (2000 mL) [sulfite free] mL (30 mL) [dye free, ethanol free, sugar free; contains propylene glycol, Aminosyn II/Electrolytes: 8.5% (500 mL) [latex free, sulfite free] sodium 4 mg/5 mL; peppermint flavor] Aminosyn M: 3.5% (1000 mL) [latex free, sulfite free] Aluminum Hydroxide, Magnesium Hydroxide, and Simethicone Aminosyn-HBC: 7% (500 mL) [latex free, sulfite free] DoD Uniform Formulary Outpatient Dosage Forms Aminosyn-PF: 7% (500 mL); 10% (1000 mL) [latex free, sulfite free] Aminosyn-RF: 5.2% (500 mL) [latex free, sulfite free] UNIFORM FORMULARY Aminosyn/Electrolytes: 8.5% (500 mL, 1000 mL) [latex free, sulfite free] Liquid, Oral: Clinimix E/Dextrose (2.75/10): 2.75% (1000 mL, 2000 mL) [sulfite free] Generic: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and Clinimix E/Dextrose (2.75/5): 2.75% (1000 mL, 2000 mL) [sulfite free] simethicone 20 mg per 5 mL (360 mL); aluminum hydroxide 400 mg, Clinimix E/Dextrose (4.25/10): 4.25% (1000 mL, 2000 mL) [sulfite free] magnesium hydroxide 400 mg, and simethicone 40 mg per 5 mL (360 mL) Clinimix E/Dextrose (4.25/25): 4.25% (1000 mL, 2000 mL) [sulfite free] Suspension, Oral: Clinimix E/Dextrose (4.25/5): 4.25% (1000 mL, 2000 mL) [sulfite free] Generic: Aluminum hydroxide 225 mg, magnesium hydroxide 200 mg, and Clinimix E/Dextrose (5/15): 5% (1000 mL, 2000 mL) [sulfite free] simethicone 25 mg per 5 mL (360 mL) Clinimix E/Dextrose (5/20): 5% (1000 mL, 2000 mL) [sulfite free] Tablet, Chewable, Oral: Clinimix E/Dextrose (5/25): 5% (1000 mL, 2000 mL) [sulfite free] Generic: Aluminum hydroxide 200 mg, magnesium hydroxide 200 mg, and Clinimix/Dextrose (2.75/5): 2.75% (1000 mL) [sulfite free] simethicone 25 mg Clinimix/Dextrose (4.25/10): 4.25% (1000 mL, 2000 mL) [sulfite free] Clinimix/Dextrose (4.25/20): 4.25% (1000 mL, 2000 mL) [sulfite free] Alvimopan Clinimix/Dextrose (4.25/25): 4.25% (1000 mL, 2000 mL) [sulfite free] DoD Uniform Formulary Outpatient Dosage Forms Clinimix/Dextrose (4.25/5): 4.25% (1000 mL, 2000 mL) [sulfite free] UNIFORM FORMULARY Clinimix/Dextrose (5/15): 5% (1000 mL, 2000 mL) [sulfite free] Capsule, Oral: Clinimix/Dextrose (5/20): 5% (1000 mL, 2000 mL) [sulfite free] Entereg: 12 mg Clinimix/Dextrose (5/25): 5% (1000 mL, 2000 mL) [sulfite free] Clinisol SF: 15% (500 mL, 2000 mL) [sulfite free] Amantadine FreAmine HBC: 6.9% (750 mL) DoD Uniform Formulary Outpatient Dosage Forms FreAmine III: 3% (1000 mL) BASIC CORE FORMULARY FreAmine III: 10% (1000 mL) [contains sodium bisulfite] Capsule, Oral, as hydrochloride: Hepatamine: 8% (500 mL) Generic: 100 mg NephrAmine: 5.4% (250 mL) Syrup, Oral, as hydrochloride: Plenamine: 15% (1000 mL) [contains sodium metabisulfite] Generic: 50 mg/5 mL (10 mL, 473 mL) Premasol: 6% (500 mL); 10% (500 mL, 1000 mL, 2000 mL) [sulfite free] Prosol: 20% (2000 mL) UNIFORM FORMULARY Travasol: 10% (500 mL, 1000 mL, 2000 mL) [sulfite free] Tablet, Oral, as hydrochloride: Trophamine: 6% (500 mL) Generic: 100 mg TrophAmine: 10% (500 mL) NONFORMULARY Aminocaproic Acid Capsule Extended Release 24 Hour, Oral, as hydrochloride [strength expressed DoD Uniform Formulary Outpatient Dosage Forms as base]: UNIFORM FORMULARY Gocovri: 68.5 mg, 137 mg Solution, Intravenous: Tablet Extended Release 24 Hour, Oral, as hydrochloride [strength expressed Generic: 250 mg/mL (20 mL) as base]: Solution, Oral: Osmolex ER: 129 mg, 193 mg, 258 mg Amicar: 25% (236.5 mL) [contains edetate disodium, methylparaben, propyl- Ambrisentan paraben, saccharin sodium; raspberry flavor] Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Amicar: 500 mg, 1000 mg [scored] UNIFORM FORMULARY Tablet, Oral: Aminolevulinic Acid (Topical) Letairis: 5 mg, 10 mg DoD Uniform Formulary Outpatient Dosage Forms NOT COVERED Amifampridine Gel, External: DoD Uniform Formulary Outpatient Dosage Forms Ameluz: 10% (2 g) [contains isopropyl alcohol, phosphatidylcholine, soy, UNIFORM FORMULARY polysorbate 80, propylene glycol, sodium benzoate] Tablet, Oral: Solution Reconstituted, External, as hydrochloride: Firdapse: 10 mg [scored] Levulan Kerastick: 20% (1 ea) [contains alcohol, usp, isopropyl alcohol, Ruzurgi: 10 mg laureth, polyethylene glycol] 7 AMINOPHYLLINE Aminophylline Generic: 10/40: Amlodipine 10 mg and benazepril hydrochloride 40 mg DoD Uniform Formulary Outpatient Dosage Forms Amlodipine and Celecoxib UNIFORM FORMULARY Solution, Intravenous, as dihydrate: DoD Uniform Formulary Outpatient Dosage Forms Generic: 25 mg/mL (10 mL, 20 mL) Tier 4 - NOT COVERED Tablet, Oral: Aminosalicylic Acid Consensi: Amlodipine besylate 2.5 mg and celecoxib 200 mg DoD Uniform Formulary Outpatient Dosage Forms Consensi: Amlodipine besylate 5 mg and celecoxib 200 mg UNIFORM FORMULARY Consensi: Amlodipine besylate 10 mg and celecoxib 200 mg [scored] Packet, Oral: Paser: 4 g (30 ea) Amlodipine and Olmesartan DoD Uniform Formulary Outpatient Dosage Forms Amiodarone UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: BASIC CORE FORMULARY 5/20: Amlodipine 5 mg and olmesartan medoxomil 20 mg Tablet, Oral, as hydrochloride: 5/40: Amlodipine 5 mg and olmesartan medoxomil 40 mg Generic: 200 mg 10/20: Amlodipine 10 mg and olmesartan medoxomil 20 mg UNIFORM FORMULARY 10/40: Amlodipine 10 mg and olmesartan medoxomil 40 mg Solution, Intravenous, as hydrochloride: Nexterone: 150 mg/100 mL in Dextrose (100 mL); 360 mg/200 mL in Dextrose Amlodipine and Valsartan (200 mL) DoD Uniform Formulary Outpatient Dosage Forms Generic: 150 mg/3 mL (3 mL); 450 mg/9 mL (9 mL); 900 mg/18 mL (18 mL) UNIFORM FORMULARY Tablet, Oral, as hydrochloride: Tablet, Oral: Generic: 100 mg, 400 mg Generic: 5/160: Amlodipine 5 mg and valsartan 160 mg Amitriptyline 5/320: Amlodipine 5 mg and valsartan 320 mg DoD Uniform Formulary Outpatient Dosage Forms 10/160: Amlodipine 10 mg and valsartan 160 mg BASIC CORE FORMULARY 10/320: Amlodipine 10 mg and valsartan 320 mg Tablet, Oral, as hydrochloride: Generic: 10 mg, 25 mg, 50 mg, 75 mg Amlodipine, Valsartan, and Hydrochlorothiazide DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral, as hydrochloride: Tablet, Oral: Generic: 100 mg, 150 mg Amlodipine 5 mg, valsartan 160 mg, and hydrochlorothiazide 12.5 mg Amlodipine 5 mg, valsartan 160 mg, and hydrochlorothiazide 25 mg Amitriptyline and Chlordiazepoxide Amlodipine 10 mg, valsartan 160 mg, and hydrochlorothiazide 12.5 mg DoD Uniform Formulary Outpatient Dosage Forms Amlodipine 10 mg, valsartan 160 mg, and hydrochlorothiazide 25 mg UNIFORM FORMULARY Amlodipine 10 mg, valsartan 320 mg, and hydrochlorothiazide 25 mg Tablet, Oral: 12.5/5: Amitriptyline hydrochloride 12.5 mg and chlordiazepoxide 5 mg Ammonia Spirit (Aromatic) 25/10: Amitriptyline hydrochloride 25 mg and chlordiazepoxide 10 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Amitriptyline and Perphenazine Solution, for Vapor Inhalation: DoD Uniform Formulary Outpatient Dosage Forms Generic; 2% (60 mL), 15% (0.33 mL) UNIFORM FORMULARY Tablet, Oral: Ammonium Alum Generic: DoD Uniform Formulary Outpatient Dosage Forms Amitriptyline hydrochloride 10 mg and perphenazine 2 mg UNIFORM FORMULARYPowder: 454 g Amitriptyline hydrochloride 10 mg and perphenazine 4 mg Amitriptyline hydrochloride 25 mg and perphenazine 2 mg Amobarbital Amitriptyline hydrochloride 25 mg and perphenazine 4 mg DoD Uniform Formulary Outpatient Dosage Forms Amitriptyline hydrochloride 50 mg and perphenazine 4 mg UNIFORM FORMULARY Solution Reconstituted, Injection, as sodium: Amivantamab Amytal Sodium: 500 mg (1 ea) AmLODIPine Amoxapine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY UNIFORM FORMULARY Tablet, Oral: Tablet, Oral: Generic: 2.5 mg, 5 mg, 10 mg Generic: 25 mg, 50 mg, 100 mg, 150 mg NONFORMULARY Suspension, Oral, as benzoate: Amoxicillin Katerzia: 1 mg/mL (150 mL) DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY Amlodipine and Atorvastatin Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 250 mg, 500 mg UNIFORM FORMULARY Suspension Reconstituted, Oral: Tablet, Oral: Generic: 250 mg/5 mL (80 mL, 100 mL, 150 mL); 400 mg/5 mL (50 mL, 75 mL, Generic: 100 mL) 2.5/10: Amlodipine 2.5 mg and atorvastatin 10 mg 2.5/20: Amlodipine 2.5 mg and atorvastatin 20 mg UNIFORM FORMULARY 2.5/40: Amlodipine 2.5 mg and atorvastatin 40 mg Suspension Reconstituted, Oral: 5/10: Amlodipine 5 mg and atorvastatin 10 mg Generic: 125 mg/5 mL (80 mL, 100 mL, 150 mL); 200 mg/5 mL (50 mL, 75 mL, 5/20: Amlodipine 5 mg and atorvastatin 20 mg 100 mL) 5/40: Amlodipine 5 mg and atorvastatin 40 mg Tablet, Oral: 5/80: Amlodipine 5 mg and atorvastatin 80 mg Generic: 500 mg, 875 mg 10/10: Amlodipine 10 mg and atorvastatin 10 mg Tablet Chewable, Oral: 10/20: Amlodipine 10 mg and atorvastatin 20 mg Generic: 125 mg, 250 mg 10/40: Amlodipine 10 mg and atorvastatin 40 mg Tablet Extended Release 24 Hour, Oral: 10/80: Amlodipine 10 mg and atorvastatin 80 mg Moxatag: 775 mg Amlodipine and Benazepril Amoxicillin and Clavulanate DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY BASIC CORE FORMULARY Capsule, Oral: Powder for Suspension, Oral: Generic: 2.5/10: Amlodipine 2.5 mg and benazepril hydrochloride 10 mg Augmentin: 125: Amoxicillin 125 mg and clavulanate potassium 31.25 mg per Generic: 5/10: Amlodipine 5 mg and benazepril hydrochloride 10 mg 5 mL (75 mL, 100 mL, 150 mL) [contains potassium 0.16 mEq/5 mL; banana Generic: 5/20: Amlodipine 5 mg and benazepril hydrochloride 20 mg flavor] Generic: 5/40: Amlodipine 5 mg and benazepril hydrochloride 40 mg Generic: 200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg per 5 Generic: 10/20: Amlodipine 10 mg and benazepril hydrochloride 20 mg mL (50 mL, 75 mL, 100 mL) 8 ANTIHEMOPHILIC FACTOR (RECOMBINANT

Generic: 250: Amoxicillin 250 mg and clavulanate potassium 62.5 mg per 5 Capsule, Oral: mL (75 mL, 100 mL, 150 mL) Generic: 0.5 mg, 1 mg Generic: 400: Amoxicillin 400 mg and clavulanate potassium 57 mg per 5 mL (50 mL, 75 mL, 100 mL) Anastrozole Generic: 600: Amoxicillin 600 mg and clavulanate potassium 42.9 mg per 5 DoD Uniform Formulary Outpatient Dosage Forms mL (75 mL, 125 mL, 200 mL) UNIFORM FORMULARY Tablet, Oral: Tablet, Oral: Generic: 250: Amoxicillin 250 mg and clavulanate potassium 125 mg Generic: 1 mg Generic: 500: Amoxicillin 500 mg and clavulanate potassium 125 mg Generic: 875: Amoxicillin 875 mg and clavulanate potassium 125 mg Anidulafungin DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Chewable, oral: Solution Reconstituted, Intravenous [preservative free]: Generic: 200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg [con- Eraxis: 50 mg (1 ea); 100 mg (1 ea) [contains polysorbate 80] tains phenylalanine] Generic: 400: Amoxicillin 400 mg and clavulanate potassium 57 mg [contains Ansuvimab phenylalanine] Tablet,Extended Release, Oral: Anthralin Generic: 1000: Amoxicillin 1000 mg and clavulanate acid 62.5 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Amphetamine Cream, External: DoD Uniform Formulary Outpatient Dosage Forms Dritho-Creme HP: 1% (50 g) [contains methylparaben] UNIFORM FORMULARY Zithranol-RR: 1.2% (45 g) [contains brilliant blue fcf (fd&c blue #1)] Tablet, Oral, as sulfate: Shampoo, External: Evekeo: 5 mg, 10 mg [scored] Zithranol: 1% (85 g) [contains brilliant blue fcf (fd&c blue #1)] Tablet Disintegrating, Oral, as sulfate: Evekeo ODT: 5 mg, 10 mg, 15 mg, 20 mg Anthrax Vaccine Adsorbed NONFORMULARY DoD Uniform Formulary Outpatient Dosage Forms Suspension Extended Release, Oral: UNIFORM FORMULARY Adzenys ER: 1.25 mg/mL (450 mL) Injection, suspension: Suspension Extended Release, Oral, as base: BioThrax: Bacillus anthracis proteins (5 mL) [contains aluminum, natural Dyanavel XR: 2.5 mg/mL (464 mL) [contains methylparaben, polysorbate 80, rubber/natural latex in packaging] propylparaben] Tablet Extended Release Dispersible, Oral, as base: Anticoagulant Citrate Dextrose Adzenys XR-ODT: 3.1 mg, 6.3 mg, 9.4 mg, 12.5 mg, 15.7 mg, 18.8 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Amphotericin B Deoxycholate Solution, In Vitro: DoD Uniform Formulary Outpatient Dosage Forms ACD Formula A: Citric acid anhydrous 0.73 g, dextrose monohydrate 2.45 g, UNIFORM FORMULARY and sodium citrate dihydrate 2.2 g per 100 mL (500 mL, 1000 mL) Solution Reconstituted, Injection, as desoxycholate: ACD-A noClot-50: Citric acid anhydrous 0.073 g, dextrose monohydrate Generic: 50 mg (1 ea) 0.245 g, and sodium citrate dihydrate 0.22 g per 10 mL (50 mL) Generic: Citric acid Monohydrate 0.8 g, dextrose monohydrate 2.45 g, and Amphotericin B (Lipid Complex) sodium citrate dihydrate 2.2 g per 100 mL (750 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Anticoagulant Citrate Phosphate Dextrose Suspension, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Abelcet: 5 mg/mL (20 mL) UNIFORM FORMULARY Amphotericin B (Liposomal) Injection: 63 mL DoD Uniform Formulary Outpatient Dosage Forms Anticoagulant Sodium Citrate UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Suspension Reconstituted, Intravenous: UNIFORM FORMULARY AmBisome: 50 mg (1 ea) [contains cholesterol, distearoyl phosphatidylgly- Concentrate, In Vitro: cerol, hydrogenated soy phosphatidylcholine, sodium succinate hexahy- TriCitrasol: 46.7% (30 mL) drate, sucrose, tocopherol, dl-alpha] Solution, In Vitro: Ampicillin Generic: 4% (250 mL, 500 mL) DoD Uniform Formulary Outpatient Dosage Forms Antihemophilic Factor (Human) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral: UNIFORM FORMULARY Generic: 250 mg, 500 mg Kit, Intravenous: Solution Reconstituted, Injection, as sodium [strength expressed as base]: Monoclate-P: ~1000 units, ~1500 units [contains mouse (murine) and/or Generic: 125 mg (1 ea); 250 mg (1 ea); 500 mg (1 ea); 1 g (1 ea); 2 g (1 ea); hamster protein] 10 g (1 ea) Solution Reconstituted, Intravenous: Solution Reconstituted, Injection, as sodium [strength expressed as base, Koate: ~250 units (1 ea); ~500 units (1 ea); ~1000 units (1 ea) [contains preservative free]: albumin human, polyethylene glycol, polysorbate 80] Generic: 250 mg (1 ea); 500 mg (1 ea) Koate-DVI: ~500 units (1 ea) [contains albumin human, polyethylene glycol, Solution Reconstituted, Intravenous, as sodium [strength expressed as base]: polysorbate 80] Generic: 1 g (1 ea); 2 g (1 ea); 10 g (1 ea) Solution Reconstituted, Intravenous [preservative free]: Suspension Reconstituted, Oral: Hemofil M: ~250 units (1 ea) [contains albumin human, mouse (murine) and/or Generic: 125 mg/5 mL (100 mL); 250 mg/5 mL (100 mL) hamster protein, polyethylene glycol] Ampicillin and Sulbactam Hemofil M: ~500 units (1 ea) [contains albumin human, mouse (murine) and/or DoD Uniform Formulary Outpatient Dosage Forms hamster protein, polyethylene glycol] UNIFORM FORMULARY Hemofil M: ~1000 units (1 ea); ~1700 units (1 ea) [contains albumin human, Injection, powder for reconstitution: mouse (murine) and/or hamster protein, polyethylene glycol] Generic: Koate-DVI: ~250 units (1 ea); ~1000 units (1 ea) [contains albumin human, 1.5 g: Ampicillin 1 g and sulbactam 0.5 g polyethylene glycol, polysorbate 80] 3 g: Ampicillin 2 g and sulbactam 1 g Antihemophilic Factor (Recombinant [Fc Fusion Protein]) 15 g: Ampicillin 10 g and sulbactam 5 g DoD Uniform Formulary Outpatient Dosage Forms Amyl Nitrite UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous [preservative free]: UNIFORM FORMULARY Eloctate: 250 units (1 ea); 500 units (1 ea); 750 units (1 ea); 1000 units (1 ea); Liquid, for inhalation: USP: 85% to 103% (0.3 mL) 1500 units (1 ea); 2000 units (1 ea); 3000 units (1 ea) Anagrelide DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY 9 ANTIHEMOPHILIC FACTOR (RECOMBINANT Antihemophilic Factor (Recombinant [Pegylated]) FVIII 1000 units and VWF:RCo 1000 units [contains polysorbate 80 (in DoD Uniform Formulary Outpatient Dosage Forms diluent); packaged with diluent] UNIFORM FORMULARY Anti-inhibitor Coagulant Complex (Human) Solution Reconstituted, Intravenous: Adynovate: 250 units (1 ea); 500 units (1 ea); 750 units (1 ea); 1000 units (1 DoD Uniform Formulary Outpatient Dosage Forms ea); 1500 units (1 ea); 2000 units (1 ea) [contains mouse (murine) and/or UNIFORM FORMULARY hamster protein, polysorbate 80] Solution Reconstituted, Intravenous [preservative free]: Esperoct: antihemophilic factor (recombinant) glycopegylated-exei ~500 units FEIBA: 500 units (1 ea); 1000 units (1 ea); 2500 units (1 ea) (1 ea); antihemophilic factor (recombinant) glycopegylated-exei ~2000 units Antithrombin (1 ea); antihemophilic factor (recombinant) glycopegylated-exei ~1500 units (1 ea); antihemophilic factor (recombinant) glycopegylated-exei ~1000 units DoD Uniform Formulary Outpatient Dosage Forms (1 ea) [contains polysorbate 80]; antihemophilic factor (recombinant) glyco- UNIFORM FORMULARY pegylated-exei ~3000 units (1 ea) Injection, powder for reconstitution [human, preservative free]: Jivi: ~500 units (1 ea); ~1000 units (1 ea); ~2000 units (1 ea); ~3000 units (1 Thrombate III: 500 units, 1000 units [contains heparin; exact potency labeled ea) [latex free; contains polysorbate 80] on each vial] Injection, powder for reconstitution [recombinant, preservative free]: Antihemophilic Factor (Recombinant [Porcine Sequence]) ATryn: 525 units, 1750 units [contains goat protein; exact potency labeled on DoD Uniform Formulary Outpatient Dosage Forms each vial] UNIFORM FORMULARY Solution Reconstituted, Intravenous: Antithymocyte Globulin (Equine) Obizur: 500 units (1 ea) [contains mouse (murine) and/or hamster protein, DoD Uniform Formulary Outpatient Dosage Forms polysorbate 80] UNIFORM FORMULARY Injectable, Intravenous: Antihemophilic Factor (Recombinant) Atgam: 50 mg/mL (5 mL) [thimerosal free] DoD Uniform Formulary Outpatient Dosage Forms Extended Core Formulary Antithymocyte Globulin (Rabbit) Kit, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Xyntha: 250 units, 500 units, 1000 units, 2000 units [albumin free; contains UNIFORM FORMULARY mouse protein (murine) (hamster), polysorbate 80] Solution Reconstituted, Intravenous: Thymoglobulin: 25 mg (1 ea) [contains glycine, mannitol, sodium chloride] UNIFORM FORMULARY Kit, Intravenous: Antivenin (Latrodectus mactans) Kogenate FS: 250 units, 500 units, 1000 units [contains mouse (murine) and/ DoD Uniform Formulary Outpatient Dosage Forms or hamster protein] UNIFORM FORMULARY Kit, Intravenous [preservative free]: Kit, Injection: Afstyla: 250 units, 500 units, 1000 units, 2000 units, 3000 units [contains Generic: 6000 Antivenin units polysorbate 80] Helixate FS: 250 units, 500 units, 1000 units, 2000 units, 3000 units [contains Antivenin (Micrurus fulvius) polysorbate 80] DoD Uniform Formulary Outpatient Dosage Forms Kogenate FS: 2000 units, 3000 units [contains mouse (murine) and/or hamster UNIFORM FORMULARY protein] Solution Reconstituted, Intravenous: Kogenate FS Bio-Set: 250 units, 500 units, 1000 units, 2000 units, 3000 units Generic: (1 ea) [contains mouse (murine) and/or hamster protein] Nuwiq: 250 units, 500 units, 1000 units, 2000 units Apalutamide Xyntha Solofuse: 250 units, 500 units, 1000 units, 2000 units, 3000 units DoD Uniform Formulary Outpatient Dosage Forms [albumin free; contains mouse (murine) and/or hamster protein, polysor- UNIFORM FORMULARY bate 80] Tablet, Oral: Solution Reconstituted, Intravenous: Erleada: 60 mg Kovaltry: 250 units (1 ea); 500 units (1 ea); 1000 units (1 ea); 2000 units (1 ea); 3000 units (1 ea) [contains mouse (murine) and/or hamster protein, poly- Apixaban sorbate 80] DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous [preservative free]: BASIC CORE FORMULARY Advate: 250 units (1 ea); 500 units (1 ea); 1000 units (1 ea); 1500 units (1 ea); Tablet, Oral: 2000 units (1 ea); 3000 units (1 ea); 4000 units (1 ea) [albumin free; contains Eliquis: 2.5 mg, 5 mg polysorbate 80] Eliquis DVT/PE Starter Pack: 5 mg Novoeight: 250 units (1 ea); 500 units (1 ea); 1000 units (1 ea); 1500 units (1 ea); 2000 units (1 ea); 3000 units (1 ea) [contains mouse (murine) and/or Apomorphine hamster protein, polysorbate 80] DoD Uniform Formulary Outpatient Dosage Forms Nuwiq: 250 units (1 ea); 500 units (1 ea); 1000 units (1 ea); 2000 units (1 ea) UNIFORM FORMULARY Recombinate: 220-400 units (1 ea); 401-800 units (1 ea); 801-1240 units (1 Solution, Subcutaneous, as hydrochloride: ea); 1241-1800 units (1 ea); 1801-2400 units (1 ea) [contains albumin Apokyn: 10 mg/mL (3 mL) [contains benzyl alcohol, sodium metabisulfite] human, polyethylene glycol, polysorbate 80] Apraclonidine Antihemophilic Factor/von Willebrand Factor Complex DoD Uniform Formulary Outpatient Dosage Forms (Human) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Ophthalmic: UNIFORM FORMULARY Generic: 0.5% (5 mL, 10 mL) Injection, powder for reconstitution [human derived]: Alphanate: Apremilast 250 units [Factor VIII and VWF:RCo ratio varies by lot; contains albumin and DoD Uniform Formulary Outpatient Dosage Forms polysorbate 80; packaged with diluent] UNIFORM FORMULARY 500 units [Factor VIII and VWF:RCo ratio varies by lot; contains albumin and Tablet, Oral: polysorbate 80; packaged with diluent] Otezla: 30 mg 1000 units [Factor VIII and VWF:RCo ratio varies by lot; contains albumin Tablet Therapy Pack, Oral: and polysorbate 80; packaged with diluent] Otezla: 10 & 20 & 30 mg (55 ea) 1500 units [Factor VIII and VWF:RCo ratio varies by lot; contains albumin and polysorbate 80; packaged with diluent] Aprepitant 2000 units [Factor VIII and VWF:RCo ratio varies by lot; contains albumin DoD Uniform Formulary Outpatient Dosage Forms and polysorbate 80; packaged with diluent] UNIFORM FORMULARY Humate-P: Capsule, Oral: FVIII 250 units and VWF:RCo 600 units [contains albumin; packaged with Generic: 40 mg, 80 mg, 125 mg, 80 mg & 125 mg diluent] Suspension Reconstituted, Oral: FVIII 500 units and VWF:RCo 1200 units [contains albumin; packaged with Emend: 125 mg (1 ea) diluent] FVIII 1000 units and VWF:RCo 2400 units [contains albumin; packaged with Arformoterol diluent] DoD Uniform Formulary Outpatient Dosage Forms Wilate: UNIFORM FORMULARY FVIII 500 units and VWF:RCo 500 units [contains polysorbate 80 (in diluent); Nebulization Solution, Inhalation: packaged with diluent] Brovana: 15 mcg/2 mL (2 mL) 10 ASCORBIC ACID Argatroban Gel, Ophthalmic: DoD Uniform Formulary Outpatient Dosage Forms Systane: Polyethylene glycol 400 0.4% and propylene glycol 0.3% (10 mL, UNIFORM FORMULARY 15 mL) Solution, Intravenous: Ointment, Ophthalmic: Generic: 125 mg/125 mL (125 mL); 250 mg/250 mL (250 mL); 250 mg/2.5 mL Altalube: Petrolatum 83% and mineral oil 15% (3.5 g) (2.5 mL) GenTeal Tears Night-Time: Petrolatum 94% and mineral oil 3% (3.5 g) Solution, Intravenous [preservative free]: Puralube: Petrolatum 85% and mineral oil 15% (3.5 g) Generic: 50 mg/50 mL (50 mL); 250 mg/2.5 mL (2.5 mL) Refresh Lacri-Lube: Petrolatum 83% and mineral oil 15% (3.5 g, 7 g) Tears Naturale PM: Petrolatum 94% and mineral oil 3% (3.5 g) [contains Arginine lanolin] DoD Uniform Formulary Outpatient Dosage Forms Ointment, Ophthalmic [preservative free]: UNIFORM FORMULARY LubriFresh P.M.: Petrolatum 83% and mineral oil 15% (3.5 g) Solution, Intravenous, as hydrochloride [preservative free]: Systane Nighttime: Petrolatum 94% and mineral oil 3% (3.5 g) R-Gene 10: 10% (300 mL) Solution, Ophthalmic: Advanced Eye Relief Dry Eye Environmental: Glycerin 1% (15 mL) [contains ARIPiprazole benzalkonium chloride] DoD Uniform Formulary Outpatient Dosage Forms Advanced Eye Relief Dry Eye Rejuvenation: Glycerin 0.3% and propylene BASIC CORE FORMULARY glycol 1% (30 mL) [contains benzalkonium chloride] Tablet, Oral: Genteal Tears Mild: Dextran 70 0.1%, and hydroxypropyl methylcellulose Generic: 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg 2910 0.3% (15 mL) UNIFORM FORMULARY Genteal Tears Moderate: Dextran 70 0.1%, glycerin 0.2%, and hydroxypropyl Prefilled Syringe, Intramuscular: methylcellulose 2910 0.3% (15 mL) Abilify Maintena: 300 mg (1 ea); 400 mg (1 ea) HypoTears: Polyvinyl alcohol 1% and polyethylene glycol 400 1% (30 mL) Solution, Oral: [contains benzalkonium chloride] Generic: 1 mg/mL (150 mL) LiquiTears: Polyvinyl alcohol 1.4% (15 mL) [contains benzalkonium chloride, Tablet, Oral: edetate disodium] Abilify: 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg Murine Tears: Polyvinyl alcohol 0.5% and povidone 0.6% (15 mL) [contains Tablet Dispersible, Oral: benzalkonium chloride] Generic: 10 mg, 15 mg Natural Balance Tears: Dextran 70 0.1% and hydroxypropyl methylcellulose 2910 0.3% (15 mL) [contains benzalkonium chloride, edetate disodium] NONFORMULARY Natures Tears: Dextran 70 0.1% and hydroxypropyl methylcellulose 2910 0.3 Tablet, Oral: % (15 mL) [contains benzalkonium chloride, edetate disodium] Abilify MyCite: 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg Soothe Hydration: Povidone 1.25% (15 mL) ARIPiprazole Lauroxil Systane Balance: Propylene glycol 0.6% (10 mL) DoD Uniform Formulary Outpatient Dosage Forms Systane Ultra: Polyethylene glycol 400 0.4% and propylene glycol 0.3% (5 UNIFORM FORMULARY mL, 10 mL) Prefilled Syringe, Intramuscular: Systane: Polyethylene glycol 400 0.4% and propylene glycol 0.3% (5 mL, 15 Aristada: 441 mg/1.6 mL (1.6 mL); 662 mg/2.4 mL (2.4 mL); 882 mg/3.2 mL mL, 30 mL) (3.2 mL) Tears Again: Polyvinyl alcohol 1.4% (15 mL, 30 mL) [contains benzalkonium chloride] Armodafinil Solution, Ophthalmic [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Bion Tears: Dextran 70 0.1% and hydroxypropyl methylcellulose 2910 0.3% UNIFORM FORMULARY per 0.4 mL (28s) Tablet, Oral: Genteal Tears Mild: Dextran 70 0.1%, and hydroxypropyl methylcellulose Nuvigil: 50 mg, 150 mg, 200 mg, 250 mg 2910 0.3% (36s) Generic: 50 mg, 150 mg, 200 mg, 250 mg Soothe: Glycerin 0.6% and propylene glycol 0.6% per 0.6 mL (28s) Systane Preservative Free: Polyethylene glycol 400 0.4% and propylene Arsenic Trioxide glycol 0.3% per 0.4 mL (28s, 30s) DoD Uniform Formulary Outpatient Dosage Forms Tears Naturale Free: Dextran 70 0.1% and hydroxypropyl methylcellulose UNIFORM FORMULARY 2910 0.3% per 0.5 mL (36s, 60s) Solution, Intravenous: Viva-Drops: Polysorbate 80 1% (0.5 mL, 10 mL) Trisenox: 10 mg/10 mL (10 mL) Ascorbic Acid Artemether and Lumefantrine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule Extended Release, Oral: Tablet, Oral: Generic: 500 mg Coartem: Artemether 20 mg and lumefantrine 120 mg Capsule Extended Release, Oral [preservative free]: Generic: 500 mg Artesunate Crystals, Oral: DoD Uniform Formulary Outpatient Dosage Forms Vita-C: (120 g, 480 g) [animal products free, gelatin free, gluten free, lactose NOT COVERED free, no artificial color(s), no artificial flavor(s), starch free, sugar free, Solution Reconstituted, Injection: yeast free] Generic: 110 mg [phosphate buffer solution provided as diluent] Liquid, Oral: Articaine and Epinephrine Generic: 500 mg/5 mL (473 mL) DoD Uniform Formulary Outpatient Dosage Forms Powder, Oral: Generic: (113 g, 120 g, 480 g) UNIFORM FORMULARY Powder Effervescent, Oral: Injection, solution [for dental use]: Ascocid-ISO-pH: (150 g) [corn free, rye free, wheat free] Articadent: Articaine hydrochloride 4% [40 mg/mL] and epinephrine 1:100,000 (1.7 mL) [contains sodium metabisulfite] Solution, Injection: Articadent: Articaine hydrochloride 4% [40 mg/mL] and epinephrine 1:200,000 Generic: 500 mg/mL (50 mL) (1.7 mL) [contains sodium metabisulfite] Solution, Injection [preservative free]: Orabloc: Articaine hydrochloride 4% [40 mg/mL] and epinephrine 1:100,000 Mega-C/A Plus: 500 mg/mL (50 mL) (1.8 mL) [contains sodium metabisulfite] Solution, Injection, as sodium ascorbate [preservative free]: Orabloc: Articaine hydrochloride 4% [40 mg/mL] and epinephrine 1:200,000 Generic: 250 mg/mL (30 mL) (1.8 mL) [contains sodium metabisulfite] Syrup, Oral: Septocaine with epinephrine 1:100,000: Articaine hydrochloride 4% Generic: 500 mg/5 mL (118 mL) [40 mg/mL] and epinephrine 1:100,000 (1.7 mL) [contains sodium metabi- Tablet, Oral: sulfite] Generic: 100 mg, 250 mg, 500 mg, 1000 mg Septocaine with epinephrine 1:200,000: Articaine hydrochloride 4% Tablet, Oral [preservative free]: [40 mg/mL] and epinephrine 1:200,000 (1.7 mL) [contains sodium metabi- Generic: 250 mg, 500 mg sulfite] Tablet Chewable, Oral: Zorcaine: Articaine hydrochloride 4% [40 mg/mL] and epinephrine 1:100,000 VitaChew Vit C Citrus Burst: 125 mg (1.7 mL) [contains sodium metabisulfite] Generic: 100 mg, 250 mg, 500 mg Tablet Chewable, Oral [preservative free]: Artificial Tears Generic: 500 mg DoD Uniform Formulary Outpatient Dosage Forms Tablet Extended Release, Oral: UNIFORM FORMULARY Generic: 500 mg, 1000 mg, 1500 mg 11 ASCORBIC ACID Wafer, Oral [preservative free]: Atenolol and Chlorthalidone Acerola C 500: 500 mg (50 ea) [corn free, no artificial color(s), no artificial DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMU- flavor(s), wheat free, yeast free; contains acerola (malpighia glabra)] LARY Asfotase Alfa Tablet, Oral: Generic: Atenolol 50 mg and chlorthalidone 25 mg DoD Uniform Formulary Outpatient Dosage Forms Generic: Atenolol 100 mg and chlorthalidone 25 mg UNIFORM FORMULARY Solution, Subcutaneous [preservative free]: Atezolizumab Strensiq: 18 mg/0.45 mL (0.45 mL); 28 mg/0.7 mL (0.7 mL); 40 mg/mL (1 mL); DoD Uniform Formulary Outpatient Dosage Forms 80 mg/0.8 mL (0.8 mL) [contains mouse (murine) and/or hamster protein] UNIFORM FORMULARY Solution, Intravenous [preservative free]: Asparaginase (Erwinia) Tecentriq: 1200 mg/20 mL (20 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY AtoMOXetine Solution Reconstituted, Intramuscular: DoD Uniform Formulary Outpatient Dosage Forms Erwinaze: 10,000 units (1 ea) UNIFORM FORMULARY Capsule, Oral: Aspirin Strattera: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY AtorvaSTATin Caplet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 81, 325 mg, 500 mg BASIC CORE FORMULARY Caplet, Oral [buffered]: Tablet, Oral: Generic: 500 mg Generic: 10 mg, 20 mg, 40 mg, 80 mg Caplet, Enteric Coated, Oral: Bayer Aspirin Regimen Regular Strength: 325 mg Atovaquone Suppository, Rectal: 300 mg (12s); 600 mg (12s) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMU- Tablet, Oral: LARY Generic: 325 mg Suspension, Oral: Tablet, Oral [buffered]: Generic: 750 mg/5 mL (210 mL) Generic: 325 mg Atovaquone and Proguanil Tablet, Chewable, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 81 mg UNIFORM FORMULARY Tablet, EntericCoated, Oral: Tablet, Oral: Generic: 81 mg, 325 mg, 650 mg Generic: Atovaquone 250 mg and proguanil hydrochloride 100 mg NONFORMULARY Tablet, Oral [pediatric]: Capsule Extended Release, oral: Malarone: Atovaquone 62.5 mg and proguanil hydrochloride 25 mg Durlaza: 162.5 mg Aspirin and Diphenhydramine Atracurium DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Intravenous, as besylate: Caplet, Oral: Generic: 50 mg/5 mL (5 mL); 100 mg/10 mL (10 mL) Bayer PM: Aspirin 500 mg and diphenhydramine citrate 38.3 mg Solution, Intravenous, as besylate [preservative free]: Aspirin and Dipyridamole Generic: 50 mg/5 mL (5 mL) DoD Uniform Formulary Outpatient Dosage Forms Atropine and Pralidoxime UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule Extended Release 12 Hour, Oral: NOT COVERED Generic: Aspirin 25 mg [immediate release] and dipyridamole 200 mg Injection, solution: [extended release] Duodote: Atropine 2.1 mg/0.7 mL and pralidoxime chloride 600 mg/2 mL Aspirin, Citric Acid, and Sodium Bicarbonate [contains benzyl alcohol; prefilled autoinjector] DoD Uniform Formulary Outpatient Dosage Forms Atropine (Ophthalmic) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet Effervescent, Oral: UNIFORM FORMULARY Alka-Seltzer: Aspirin 325 mg, citric acid 1000 mg, and sodium bicarbonate Ointment, Ophthalmic, as sulfate: 1916 mg [contains sodium 567 mg/tablet] Generic: 1% (3.5 g) Alka-Seltzer: Aspirin 325 mg, citric acid 1000 mg, and sodium bicarbonate Solution, Ophthalmic, as sulfate: 1700 mg [contains phenylalanine 9 mg/tablet, sodium 504 mg/tablet, sodium Generic: 1% (2 mL, 5 mL, 15 mL) benzoate; lemon lime flavor] Alka-Seltzer Extra Strength: Aspirin 500 mg, citric acid 1000 mg, and sodium Atropine (Systemic) bicarbonate 1985 mg [contains sodium 588 mg/tablet] DoD Uniform Formulary Outpatient Dosage Forms Medi-Seltzer: Aspirin 325 mg, citric acid 1000 mg, and sodium bicarbonate UNIFORM FORMULARY 1916 mg Device, Intramuscular, as sulfate: Neutralin: Aspirin 325 mg, citric acid 1000 mg, and sodium bicarbonate AtroPen: 0.25 mg/0.3 mL (0.3 mL) [pyrogen free] 1916 mg AtroPen: 0.5 mg/0.7 mL (0.7 mL); 1 mg/0.7 mL (0.7 mL); 2 mg/0.7 mL (0.7 mL) [pyrogen free; contains phenol] Atazanavir Solution, Injection, as sulfate: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.05 mg/mL (5 mL); 0.1 mg/mL (5 mL, 10 mL); 0.4 mg/mL (20 mL); UNIFORM FORMULARY 1 mg/mL (1 mL) Capsule, Oral, as sulfate: Solution, Injection, as sulfate [preservative free]: Reyataz: 150 mg, 200 mg, 300 mg [contains fd&c blue #2 (indigotine)] Generic: 0.4 mg/mL (1 mL); 0.8 mg/mL (0.5 mL); 1 mg/mL (1 mL) Packet, Oral, as sulfate: Reyataz: 50 mg (30 ea) [contains aspartame; orange-vanilla flavor] Auranofin DoD Uniform Formulary Outpatient Dosage Forms Atazanavir and Cobicistat UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral: UNIFORM FORMULARY Ridaura: 3 mg [contains benzyl alcohol] Tablet, Oral: Evotaz: Atazanavir 300 mg and cobicistat 150 mg Aurothioglucose DoD Uniform Formulary Outpatient Dosage Forms Atenolol UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Injection, suspension [gold 50%]: BASIC CORE FORMULARY Generic: 50 mg/mL (10 mL) Tablet, Oral: Generic: 25 mg, 50 mg, 100 mg 12 BACITRACIN (SYSTEMIC) Avapritinib Suspension Reconstituted, Oral, as monohydrate [strength expressed as base]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 100 mg/5 mL (15 mL) UNIFORM FORMULARY Tablet, Oral: Tablet, Oral: Generic: 250 mg, 500 mg Ayvakit: 100 mg, 200 mg, 300 mg UNIFORM FORMULARY Avatrombopag Solution Reconstituted, Intravenous: Generic: 500 mg (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous [preservative free]: UNIFORM FORMULARY Generic: 500 mg (1 ea) Tablet, Oral: Doptelet: 20 mg Aztreonam (Oral Inhalation) Avelumab DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution Reconstituted, Inhalation [preservative free]: Solution, Intravenous [preservative free]: Cayston: 75 mg (1 mL) [arginine free] Bavencio: 200 mg/10 mL (10 mL) Aztreonam (Systemic) Axicabtagene Ciloleucel DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Intravenous: Suspension, Intravenous [preservative free]: Azactam in Dextrose: 1 g (50 mL); 2 g (50 mL) [sodium free] Yescarta: (1 ea) [contains albumin human, dimethyl sulfoxide] Solution Reconstituted, Injection: Generic: 1 g (1 ea); 2 g (1 ea) Axitinib DoD Uniform Formulary Outpatient Dosage Forms Bacitracin and Polymyxin B (Ophthalmic) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Inlyta: 1 mg, 5 mg Ointment, Ophthalmic: Generic: Bacitracin 500 units and polymyxin B 10,000 units per g (3.5 g) AzaCITIDine DoD Uniform Formulary Outpatient Dosage Forms Bacitracin and Polymyxin B (Topical) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Onureg: 200 mg, 300 mg Ointment, External: Double Antibiotic: Bacitracin 500 units and polymyxin B 10,000 units per g (1 AzaTHIOprine ea, 14.17 g, 28.35 g) DoD Uniform Formulary Outpatient Dosage Forms Polysporin: Bacitracin 500 units and polymyxin B 10,000 units per g (1 ea, UNIFORM FORMULARY 14.2 g, 28.3 g) Solution Reconstituted, Injection: Generic: 100 mg (1 ea) Bacitracin, Neomycin, and Polymyxin B (Ophthalmic) Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Azasan: 75 mg, 100 mg [scored] BASIC CORE FORMULARY Generic: 50 mg Ointment, Ophthalmic: Generic: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 10,000 units Azelaic Acid per g (3.5 g) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Bacitracin, Neomycin, and Polymyxin B (Topical) Cream, External: DoD Uniform Formulary Outpatient Dosage Forms Azelex: 20% (30 g, 50 g) UNIFORM FORMULARY Foam, External: Ointment, External: Finacea: 15% (50 g) [contains benzoic acid, cetostearyl alcohol, polysorbate Generic: Bacitracin 400 units, neomycin 3.5 mg, and polymyxin B 5000 units 80, propylene glycol] per g (1 ea, 15 g, 28.35 g) Gel, External: Finacea: 15% (50 g) [contains benzoic acid, disodium edta, polysorbate 80, Bacitracin, Neomycin, Polymyxin B, and Hydrocortisone propylene glycol] (Ophthalmic) Azelastine (Ophthalmic) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Ointment, ophthalmic: UNIFORM FORMULARY Generic: Bacitracin 400 units, neomycin 3.5 mg, polymyxin B 10,000 units, Solution, Ophthalmic, as hydrochloride: and hydrocortisone 10 mg per g (3.5 g) Generic: 0.05% (6 mL) Bacitracin, Neomycin, Polymyxin B, and Hydrocortisone Azilsartan DoD Uniform Formulary Outpatient Dosage Forms (Topical) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral, as medoxomil: UNIFORM FORMULARY Edarbi: 40 mg, 80 mg Ointment, topical: Cortisporin: Bacitracin 400 units, neomycin 3.5 mg, polymyxin B 5000 units, Azilsartan and Chlorthalidone and hydrocortisone 10 mg per g (15 g) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Bacitracin, Neomycin, Polymyxin B, and Pramoxine Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Edarbyclor: 40/12.5: Azilsartan medoxomil 40 mg and chlorthalidone 12.5 mg UNIFORM FORMULARY Edarbyclor: 40/25: Azilsartan medoxomil 40 mg and chlorthalidone 25 mg Ointment, External Cortisporin: Bacitracin 400 units, neomycin 3.5 mg, polymyxin B 5000 units, Azithromycin (Ophthalmic) and hydrocortisone 10 mg per g (15 g) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Bacitracin (Ophthalmic) Solution, Ophthalmic: DoD Uniform Formulary Outpatient Dosage Forms AzaSite: 1% (2.5 mL) [contains benzalkonium chloride, disodium edta] UNIFORM FORMULARY Ointment, Ophthalmic: Azithromycin (Systemic) Generic: 500 units/g (3.5 g) DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY Bacitracin (Systemic) Packet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 1 g (3 ea, 10 ea) UNIFORM FORMULARY Suspension Reconstituted, Oral: Solution Reconstituted, Intramuscular: Generic: 100 mg/5 mL (15 mL) Generic: 50,000 units (1 ea) 13 BACITRACIN (TOPICAL) Bacitracin (Topical) Entero VU: 24% (600 mL) [contains polysorbate 80, saccharin sodium, sodium DoD Uniform Formulary Outpatient Dosage Forms benzoate] UNIFORM FORMULARY Liquid E-Z-Paque: 60% (355 mL) [contains saccharin sodium, sodium ben- Ointment, External, as zinc [strength expressed as base]: zoate] Generic: 500 units/g (1 ea, 1 g, 14 g, 14.17 g, 14.2 g, 15 g, 28 g, 28.35 g, Maxibar: 210% (120 mL) [contains saccharin sodium, sodium benzoate] 28.4 g, 30 g, 113.4 g, 453.6 g, 453.9 g) Readi-Cat 2: 2% (450 mL) [contains benzoic acid, saccharin sodium, sodium benzoate; banana smoothie flavor] Baclofen Readi-Cat 2: 2.1% (450 mL) [contains benzoic acid, saccharin sodium, sodium DoD Uniform Formulary Outpatient Dosage Forms benzoate] UNIFORM FORMULARY Readi-Cat 2: 2.1% (450 mL) [contains benzoic acid, saccharin sodium, sodium Cream, External: benzoate; berry smoothie flavor] EnovaRX-Baclofen: 1% (60 g, 120 g) [contains cetyl alcohol] Tagitol V: 40% (60 mL) [contains saccharin sodium, sodium benzoate; apple Generic: 2% (60 g) flavor] Solution, Intrathecal [preservative free]: Varibar Honey: 40% (250 mL) [contains polysorbate 80, saccharin sodium, Gablofen: 50 mcg/mL (1 mL); 10,000 mcg/20 mL (20 mL); 20,000 mcg/20 mL sodium benzoate; apple flavor] (20 mL); 40,000 mcg/20 mL (20 mL) [antioxidant free] Varibar Nectar: 40% (240 mL) [contains polysorbate 80, saccharin sodium, Lioresal: 0.05 mg/mL (1 mL); 10 mg/20 mL (20 mL); 10 mg/5 mL (5 mL); sodium benzoate; apple flavor] 40 mg/20 mL (20 mL) [antioxidant free] Varibar Thin Honey: 40% (250 mL) [contains polysorbate 80, saccharin Suspension, Oral: sodium, sodium benzoate; apple flavor] First-Baclofen 1: 1 mg/mL (120 mL) [contains saccharin sodium, sodium VoLumen: 0.1% (450 mL) [contains benzoic acid, saccharin sodium, sodium benzoate] benzoate; blueberry flavor] First-Baclofen 5: 5 mg/mL (60 mL, 120 mL) [contains saccharin sodium, Suspension Reconstituted, Oral, as sulfate: sodium benzoate] Digibar 190: 190% (120 mL) [grit free, odorless; contains saccharin sodium] Tablet, Oral: E-Z-HD: 98% (135 mL) [contains saccharin sodium] Generic: 10 mg, 20 mg E-Z-Paque: 96% (176 g) [contains propylene glycol, saccharin sodium] Varibar Thin Liquid: 40% (148 g) [contains polysorbate 80, saccharin sodium] NONFORMULARY Tablet, Oral, as sulfate: Solution, Oral: E-Z-Disk: 700 mg Ozobax: 5 mg/5 mL (473 mL) [contains methylparaben, propylparaben; grape flavor] Basiliximab Balanced Salt Solution DoD Uniform Formulary Outpatient Dosage Forms NOT COVERED DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous [preservative free]: UNIFORM FORMULARY Simulect: 10 mg (1 ea); 20 mg (1 ea) Solution, Ophthalmic [irrigation; preservative free]: BSS Plus: Sodium chloride 0.71%, potassium chloride 0.038%, calcium BCG (Intravesical) chloride 0.015%, magnesium chloride 0.02%, sodium phosphate 0.042%, DoD Uniform Formulary Outpatient Dosage Forms sodium bicarbonate 0.21%, dextrose 0.092%, glutathione 0.018% (250 mL, UNIFORM FORMULARY 500 mL) Suspension Reconstituted, Intravesical: Generic: Sodium chloride 0.64%, potassium chloride 0.075%, calcium chloride Tice BCG: 50 mg (1 ea) 0.048%, magnesium chloride 0.03%, sodium acetate 0.39%, sodium citrate Suspension Reconstituted, Intravesical [preservative free]: 0.17% (18 mL, 200 mL, 250 mL, 500 mL) TheraCys: 81 mg (1 ea) [contains monosodium glutamate (sodium glutamate)] Balsalazide BCG Vaccine (Immunization) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral, as disodium: Injectable, Injection: Generic: 750 mg Generic: 50 mg (1 ea) NONFORMULARY Tablet, Oral, as disodium: Becaplermin Giazo: 1.1 g DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Balsam Peru and Castor Oil Gel, External: DoD Uniform Formulary Outpatient Dosage Forms Regranex: 0.01% (15 g) [contains metacresol, methylparaben, propylparaben] UNIFORM FORMULARY Aerosol, External: Bedaquiline Amberderm: Balsam peru 72.5 mg and castor oil 650 mg per 0.82 mL DoD Uniform Formulary Outpatient Dosage Forms (113.4 g) UNIFORM FORMULARY Ointment, External: Tablet, Oral: Venelex: Balsam peru 87 mg and castor oil 788 mg per gram (30 g, 60 g) Sirturo: 100 mg [contains corn starch] Baricitinib Belatacept DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Solution Reconstituted, Intravenous: Olumiant: 2 mg Nulojix: 250 mg (1 ea) Barium Belimumab DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Cream, Oral, as sulfate: Solution Auto-injector, Subcutaneous [preservative free]: E-Z-Paste: 60% (454 g) [contains methylparaben, propylparaben, saccharin Benlysta: 200 mg/mL (1 mL) [contains polysorbate 80] sodium] Solution Prefilled Syringe, Subcutaneous [preservative free]: Esopho-Cat: 3% (30 g) [contains saccharin sodium, sodium benzoate] Benlysta: 200 mg/mL (1 mL) [contains polysorbate 80] Enema, Rectal, as sulfate: Solution Reconstituted, Intravenous [preservative free]: E-Z-Dose: 105% (650 mL) [contains saccharin sodium, sodium benzoate] Benlysta: 120 mg (1 ea); 400 mg (1 ea) [contains polysorbate 80] Packet, Oral, as sulfate: E-Z-Cat Dry: 2% (50 ea) [contains saccharin sodium] Belinostat Entero VU: 13% (12 ea) [contains saccharin sodium] DoD Uniform Formulary Outpatient Dosage Forms Paste, Oral, as sulfate: UNIFORM FORMULARY Varibar Pudding: 40% (230 mL) [contains polysorbate 80, saccharin sodium, Solution Reconstituted, Intravenous: sodium benzoate; vanilla flavor] Beleodaq: 500 mg (1 ea) Suspension, Combination, as sulfate: Liquid Polibar Plus: 105% (1900 mL) [contains saccharin sodium, sodium Belladonna and Opium benzoate] DoD Uniform Formulary Outpatient Dosage Forms Readi-Cat: 1.3% (900 mL) [contains saccharin sodium, sodium benzoate] UNIFORM FORMULARY Readi-Cat 2: 2.1% (450 mL) [contains saccharin sodium, sodium benzoate] Suppository: Suspension, Oral, as sulfate: Generic: Belladonna extract 16.2 mg and opium 30 mg; belladonna extract Entero VU: 13% (600 mL) [contains saccharin sodium, sodium benzoate] 16.2 mg and opium 60 mg 14 BENZOYL PEROXIDE Benazepril Strip, Mouth/Throat: DoD Uniform Formulary Outpatient Dosage Forms Ora-film: 6% (12 ea) [contains brilliant blue fcf (fd&c blue #1), menthol, UNIFORM FORMULARY methylparaben, propylparaben, tartrazine (fd&c yellow #5)] Tablet, Oral, as hydrochloride: Swab, Mouth/Throat: Generic: 5 mg, 10 mg, 20 mg, 40 mg Benz-O-Sthetic: 20% (2 ea) [contains benzyl alcohol, polyethylene glycol, saccharin sodium; cherry flavor] Benazepril and Hydrochlorothiazide Hurricaine: 20% (72 ea) [contains polyethylene glycol, saccharin sodium; wild DoD Uniform Formulary Outpatient Dosage Forms cherry flavor] UNIFORM FORMULARY Tablet, Oral: Benzocaine and Menthol Generic: DoD Uniform Formulary Outpatient Dosage Forms 5/6.25: Benazepril hydrochloride 5 mg and hydrochlorothiazide 6.25 mg UNIFORM FORMULARY 10/12.5: Benazepril hydrochloride 10 mg and hydrochlorothiazide 12.5 mg Lozenge, Mouth/Throat: 20/12.5: Benazepril hydrochloride 20 mg and hydrochlorothiazide 12.5 mg Cepacol Sore Throat: Benzocaine 10 mg and Menthol 2.1 mg (18 ea) 20/25: Benazepril hydrochloride 20 mg and hydrochlorothiazide 25 mg Cepacol Sore Throat: Benzocaine 15 mg and Menthol 2.6 mg (16 ea) Cepacol Sore Throat: Benzocaine 15 mg and Menthol 3.6 mg (8 ea, 16 ea) Bendamustine DoD Uniform Formulary Outpatient Dosage Forms Benzocaine, Butamben, and Tetracaine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous, as hydrochloride: UNIFORM FORMULARY Bendeka: 100 mg/4 mL (4 mL) [contains polyethylene glycol, propylene glycol] Aerosol, spray, topical [kit]: Solution Reconstituted, Intravenous, as hydrochloride: Cetacaine: Benzocaine 14%, butamben 2%, and tetracaine hydrochloride 2% Treanda: 25 mg (1 ea); 100 mg (1 ea) (56 g) [delivers benzocaine 28 mg, butamben 4 mg, and tetracaine hydro- chloride 4 mg per second; contains benzalkonium chloride, chlorofluorocar- Benralizumab bon; packaged with cannula assortment] DoD Uniform Formulary Outpatient Dosage Forms Aerosol, spray, topical: UNIFORM FORMULARY Cetacaine: Benzocaine 14%, butamben 2%, and tetracaine hydrochloride 2% Solution Auto-injector, Subcutaneous [preservative free]: (20 g) [delivers benzocaine 28 mg, butamben 4 mg, and tetracaine hydro- Fasenra Pen: 30 mg/mL (1 mL) chloride 4 mg per second; contains benzalkonium chloride, chlorofluorocar- bon; packaged with cannula] NOT COVERED Gel, External: Solution Prefilled Syringe, Subcutaneous [preservative free]: Cetacaine: Benzocaine 14%, butamben 2%, and tetracaine hydrochloride 2% Fasenra: 30 mg/mL (1 mL) (32 g) [delivers benzocaine 28 mg, butamben 4 mg and tetracaine hydro- Benzocaine chloride 4 mg per pump actuation ~ 0.25 inch (6.5 mm) x 0.5 inch (13 mm) long application; contains benzalkonium chloride] DoD Uniform Formulary Outpatient Dosage Forms Liquid, External [kit]: UNIFORM FORMULARY Cetacaine: Benzocaine 14%, butamben 2%, and tetracaine hydrochloride 2% Aerosol, External: (14 g, 30 g) [provides benzocaine 28 mg, butamben 4 mg, and tetracaine Dermoplast: Benzocaine 20% and menthol 0.5% (56 g) [contains methyl- hydrochloride 4 mg per 6-7 drops (0.2 mL); contains benzalkonium chloride; paraben] packaged with syringes and applicator tips] Ivy-Rid: 2% (82.5 mL) Liquid, External: Gel, Mouth/Throat: Cetacaine: Benzocaine 14%, butamben 2%, and tetracaine hydrochloride 2% Anbesol: 10% (9 g) [contains benzyl alcohol, brilliant blue fcf (fd&c blue #1), (14 g, 30 g) [provides benzocaine 28 mg, butamben 4 mg, and tetracaine fd&c yellow #10 (quinoline yellow), fd&c yellow #6 (sunset yellow), methyl- hydrochloride 4 mg per 6-7 drops (0.2 mL); contains benzalkonium chloride] paraben, propylene glycol, saccharin; cool mint flavor] Anbesol JR: 10% (9 g) [contains methylparaben] Benzoin Anbesol Maximum Strength: 20% (9 g) [contains brilliant blue fcf (fd&c blue DoD Uniform Formulary Outpatient Dosage Forms #1), fd&c red #40, fd&c yellow #10 (quinoline yellow), methylparaben, UNIFORM FORMULARY saccharin] Tincture, topical: Baby Anbesol: 7.5% (9 g) Benz-Protect Swabs: Benzoin Compound USP: Benzoin 10% (3 mL) Benz-O-Sthetic: 20% (15 g, 29 g) [contains benzyl alcohol, saccharin sodium] Generic: Benzoin Compound USP: Benzoin 10% (30 mL, 59 mL, 60 mL, 120 Dentapaine: 20% (11 g) mL, 473 mL); Benzoin NFXI (59 mL) Hurricaine: 20% (5.25 g, 28.4 g, 30 g) [contains polyethylene glycol, saccharin Tincture, topical [spray]: sodium] Sprayzoin: Benzoin Compound USP: Benzoin 10% (120 mL) Zilactin Baby: 10% (9.4 g) [alcohol free, dye free, saccharin free] Liquid, External: Benzonatate Chiggertox: 2.1% (30 mL) DoD Uniform Formulary Outpatient Dosage Forms Liquid, Mouth/Throat: UNIFORM FORMULARY Anbesol: 10% (12 mL) [contains brilliant blue fcf (fd&c blue #1), fd&c yellow Capsule, Oral: #10 (quinoline yellow), fd&c yellow #6 (sunset yellow), methylparaben, Generic: 100 mg, 150 mg, 200 mg saccharin; cool mint flavor] Anbesol Maximum Strength: 20% (12 mL) [contains benzyl alcohol, methyl- Benzoyl Peroxide paraben, polyethylene glycol, propylene glycol, saccharin] DoD Uniform Formulary Outpatient Dosage Forms Benz-O-Sthetic: 20% (56 g) [contains benzyl alcohol, polyethylene glycol, UNIFORM FORMULARY propylene glycol, saccharin] Cream, External: Dent-O-Kain/20: 20% (9 mL) [contains benzyl alcohol, propylene glycol, Clearskin: 10% (30 g) saccharin] Foam, External: Lozenge, Mouth/Throat: Generic: 5.3% (60 g, 100 g); 9.8% (100 g) Bi-Zets/Benzotroches: 15 mg (10 ea) [orange flavor] Gel, External: Sore Throat Relief: 10 mg (2 ea) [wild cherry flavor] Benziq: 5.25% (50 g) [contains benzyl alcohol, disodium edta, trolamine Trocaine Throat: 10 mg (1 ea) (triethanolamine)] Ointment, External: Benziq LS: 2.75% (50 g) [contains trolamine (triethanolamine)] Anacaine: 10% (30 g) OC8: 7% (45 g) [contains disodium edta, propylene glycol] Anbesol Cold Sore Therapy: 20 % (9 g) [contains aloe, vitamin e] Generic: 2.5% (60 g); 5% (60 g, 90 g); 10% (56 g, 60 g, 90 g) Blistex Medicated: (6.3 g) [contains cetyl alcohol, edetate calcium disodium, Kit, External: saccharin sodium, sd alcohol] AcneFree Acne Clearing System: Wash 2.5% and lotion 3.7% [contains Chiggerex: 2% (52.5 g) disodium edta, polysorbate 80, propylene glycol] Foille: 5% (28 g) AcneFree Severe Clearing Syst: Wash 2.5% and lotion 10% [contains Solution, Mouth/Throat: benzalkonium chloride, butylparaben, cetyl alcohol, disodium edta, edetate Benz-O-Sthetic: 20% (30 mL) [contains polyethylene glycol, saccharin] sodium (tetrasodium), ethylparaben, isobutylparaben, methylisothiazolinone, Hurricaine: 20% (57 g) [contains polyethylene glycol, saccharin] methylparaben, propylene glycol, propylparaben, soybeans (glycine max)] Hurricaine: 20% (30 mL) [contains polyethylene glycol, saccharin sodium; wild BPO Creamy Wash: Wash 4% (170.1 g) and bar soap 5% (2 x 21 g), Wash cherry flavor] 8% (170.1 g) and bar soap 5% (2 x 21 g) [contains disodium edta, methyl- HurriCaine One: 20% (2 ea, 25 ea) [contains polyethylene glycol, saccharin paraben] sodium] Inova: Pad 4% (30s) and tocopherol 5% (28s), Pad 8% (30s) and tocopherol Kank-A Mouth Pain: 20% (9.75 mL) [contains benzyl alcohol, propylene glycol, 5% (28s) [contains disodium edta, methylparaben] saccharin sodium] Lavoclen-4 Acne Wash: 4% [soap free; contains butylparaben, methylpara- Topex Topical Anesthetic: 20% (57 g) [cherry flavor] ben, propylparaben] 15 BENZOYL PEROXIDE

Lavoclen-8 Acne Wash: 8% [soap free; contains butylparaben, methylpara- Capsule, Oral: ben, propylparaben] Generic: 25,000 units Liquid, External: Capsule, Oral [preservative free]: Benzac AC Wash: 5% (226 g) B-Caro-T: 15 mg [dye free] BenzePrO Creamy Wash: 7% (180 g) [contains cetyl alcohol, edetate diso- Caroguard: 15 mg [dye free] dium, propylene glycol] Generic: 25,000 units Benziq Wash: 5.25% (175 g) [contains benzyl alcohol, cetyl alcohol, disodium edta, propylene glycol] Betaine Benzoyl Peroxide Wash: 5% (148 g, 237 g) [contains cetyl alcohol, edetate DoD Uniform Formulary Outpatient Dosage Forms disodium, propylene glycol] UNIFORM FORMULARY Benzoyl Peroxide Wash: 5% (142 g, 227 g) [contains edetate disodium] Powder, Oral, as anhydrous: Benzoyl Peroxide Wash: 10% (148 g, 237 g) [contains cetyl alcohol, edetate Cystadane: 1 g/scoop (180 g) disodium, propylene glycol] Benzoyl Peroxide Wash: 10% (142 g, 227 g) [contains edetate disodium] Betamethasone and Clotrimazole BP Foaming Wash: 10% (227 g) [contains cetearyl alcohol, methylparaben] DoD Uniform Formulary Outpatient Dosage Forms BP Wash: 2.5% (227 g); 5% (113 g, 142 g, 227 g) [contains cetearyl alcohol, UNIFORM FORMULARY methylparaben] Cream, External: BP Wash: 7% (473 mL) [contains benzyl alcohol, cetyl alcohol, propylene Generic: Betamethasone dipropionate 0.05% (base) and clotrimazole 1% glycol, trolamine (triethanolamine)] (15 g, 45 g) BP Wash: 10% (142 g, 227 g) [contains cetearyl alcohol, methylparaben] Lotion, External: BPO-10 Wash: 10% (227 g) [contains methylparaben, propylene glycol, Generic: Betamethasone dipropionate 0.05% (base) and clotrimazole 1% propylparaben] (30 mL) BPO-5 Wash: 5% (227 g) [contains methylparaben, propylene glycol, propyl- Betamethasone (Systemic) paraben] DoD Uniform Formulary Outpatient Dosage Forms Desquam-X Wash: 5% (140 g); 10% (140 g) [contains edetate disodium] UNIFORM FORMULARY Neutrogena Clear Pore: 3.5% (125 mL) [contains disodium edta, menthol] Kit, Injection: PanOxyl: 2.5% (156 g) [soap free; contains cetearyl alcohol] ReadySharp Betamethasone: Betamethasone sodium phosphate 3 mg and PanOxyl Wash: 10% (156 g) [contains alcohol, usp, methylparaben] betamethasone acetate 3 mg per 1 mL [contains benzalkonium chloride, PanOxyl-4 Creamy Wash: 4% (170.1 g) [contains cetearyl alcohol, methyl- disodium edta] paraben] Suspension, Injection: PR Benzoyl Peroxide Wash: 7% (180 g, 473 mL) [contains cetyl alcohol, Generic: Betamethasone sodium phosphate 3 mg and betamethasone ace- edetate disodium, propylene glycol] tate 3 mg per 1 mL (5 mL) Liquid Extended Release, External: Advanced Acne Wash: 4.4% (104 mL) Betamethasone (Topical) Lotion, External: DoD Uniform Formulary Outpatient Dosage Forms Acne Medication 5: 5% (29.5 mL) [odorless; contains disodium edta] UNIFORM FORMULARY Acne Medication 10: 10% (29.5 mL) [odorless; contains edetate disodium] Cream, External, as dipropionate [strength expressed as base]: Benzoyl Peroxide Cleanser: 3% (340.2 g); 6% (170.3 g, 340.2 g); 9% Generic: 0.05% (15 g, 45 g) (340.2 g) [contains cetyl alcohol, edetate disodium, propylene glycol] Cream, External, as dipropionate augmented [strength expressed as base]: Oscion Cleanser: 6% (170.3 g, 340.2 g) Generic: 0.05% (15 g, 50 g) Zaclir Cleansing: 8% (297 g) Cream, External, as valerate [strength expressed as base]: Miscellaneous, External: Generic: 0.1% (15 g, 45 g) BenzePrO Foaming Cloths: 6% (60 ea) [contains cetyl alcohol] Gel, External, as dipropionate augmented [strength expressed as base]: BPO Foaming Cloths: 6% (60 ea) [contains methylparaben] Generic: 0.05% (15 g, 50 g) Benzoyl Peroxide and Hydrocortisone Lotion, External, as dipropionate [strength expressed as base]: Generic: 0.05% (60 mL) DoD Uniform Formulary Outpatient Dosage Forms Lotion, External, as dipropionate augmented [strength expressed as base]: UNIFORM FORMULARY Generic: 0.05% (30 mL, 60 mL) Lotion, External: Lotion, External, as valerate [strength expressed as base]: Vanoxide-HC: Benzoyl peroxide 5% and hydrocortisone 0.5% (25 g) Generic: 0.1% (60 mL) Benzphetamine Ointment, External, as dipropionate [strength expressed as base]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.05% (15 g, 45 g) Ointment, External, as dipropionate augmented [strength expressed as base]: UNIFORM FORMULARY Generic: 0.05% (15 g, 45 g, 50 g) Tablet, Oral, as hydrochloride: Ointment, External, as valerate [strength expressed as base]: Generic: 25 mg, 50 mg Generic: 0.1% (15 g, 45 g) Benztropine NONFORMULARY DoD Uniform Formulary Outpatient Dosage Forms Emulsion, External, as dipropionate [strength expressed as base]: BASIC CORE FORMULARY Sernivo: 0.05% (120 mL) [contains cetostearyl alcohol, methylparaben, pro- Tablet, Oral, as mesylate: pylparaben] Generic: 0.5 mg, 1 mg, 2 mg Foam, External, as valerate: Luxiq: 0.12% (50 g, 100 g) UNIFORM FORMULARY Generic: 0.12% (50 g, 100 g) Solution, Injection, as mesylate: Generic: 1 mg/mL (2 mL) Betaxolol (Ophthalmic) DoD Uniform Formulary Outpatient Dosage Forms Benzyl Alcohol UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Ophthalmic: UNIFORM FORMULARY Generic: 0.5% (5 mL, 10 mL, 15 mL) Gel, Mouth/Throat: Suspension, Ophthalmic: Zilactin: 10% (7.1 g) [contains propylene glycol, sd alcohol] Betoptic-S: 0.25% (10 mL, 15 mL) Lotion, External: Ulesfia: 5% (227 g) [contains polysorbate 80, trolamine (triethanolamine)] Betaxolol (Systemic) DoD Uniform Formulary Outpatient Dosage Forms Benzylpenicilloyl Polylysine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral, as hydrochloride: UNIFORM FORMULARY Generic: 10 mg, 20 mg Injection, solution: Pre-Pen: 6 x 10-5 M (0.25 mL) Bethanechol DoD Uniform Formulary Outpatient Dosage Forms Beractant UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral, as chloride: UNIFORM FORMULARY Generic: 5 mg, 10 mg, 25 mg, 50 mg Suspension, Intratracheal: Survanta: Phospholipids 25 mg/mL (4 mL, 8 mL) Bevacizumab DoD Uniform Formulary Outpatient Dosage Forms Beta-Carotene UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous [preservative free]: UNIFORM FORMULARY Avastin: 100 mg/4 mL (4 mL); 400 mg/16 mL (16 mL) 16 BOTULISM IMMUNE GLOBULIN (INTRAVENOUS-HUMAN) Bexarotene (Systemic) Kaopectate Extra Strength: 750 mg/15 mL (250 mL, 350 mL) [peppermint DoD Uniform Formulary Outpatient Dosage Forms flavor] UNIFORM FORMULARY Kao-Tin: 262 mg/15 mL (236 mL, 473 mL) [contains saccharin sodium, sodium Capsule, Oral: benzoate] Generic: 75 mg Peptic Relief: 262 mg/15 mL (237 mL) [sugar free; contains benzoic acid, saccharin sodium; mint flavor] Bexarotene (Topical) Pepto-Bismol: 262 mg/15 mL (118 mL, 473 mL) [contains benzoic acid, DoD Uniform Formulary Outpatient Dosage Forms saccharin sodium] UNIFORM FORMULARY Pink Bismuth: 262 mg/15 mL (236 mL) Gel, External: Stomach Relief: 262 mg/15 mL (237 mL, 355 mL) [contains saccharin sodium] Targretin: 1% (60 g) [contains alcohol, usp] Stomach Relief: 527 mg/30 mL (240 mL, 480 mL) Stomach Relief Max St: 525 mg/15 mL (237 mL) [contains saccharin sodium] Bezlotoxumab Stomach Relief Plus: 525 mg/15 mL (240 mL, 480 mL) DoD Uniform Formulary Outpatient Dosage Forms Tablet Chewable, Oral: UNIFORM FORMULARY Stomach Relief: 262 mg [contains aspartame] Solution, Intravenous [preservative free]: Tablet Chewable, Oral, as subsalicylate: Zinplava: 1000 mg/40 mL (40 mL) [contains polysorbate 80] Generic: 262 mg Bicalutamide Bisoprolol DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY UNIFORM FORMULARY Tablet, Oral: Tablet, Oral, as fumarate: Generic: 50 mg Generic: 5 mg, 10 mg Bimatoprost Bisoprolol and Hydrochlorothiazide DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, External: Tablet, Oral: Generic: 0.03% (3 mL, 5 mL) Generic: Solution, Ophthalmic: 2.5/6.25: Bisoprolol fumarate 2.5 mg and hydrochlorothiazide 6.25 mg Lumigan: 0.01% (2.5 mL, 5 mL, 7.5 mL) [contains benzalkonium chloride] 5/6.25: Bisoprolol fumarate 5 mg and hydrochlorothiazide 6.25 mg Generic: 0.03% (2.5 mL, 5 mL, 7.5 mL) 10/6.25: Bisoprolol fumarate 10 mg and hydrochlorothiazide 6.25 mg Binimetinib Bivalirudin DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Solution Reconstituted, Intravenous: Mektovi: 15 mg Generic: 250 mg (1 ea) Biotin Bleomycin DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral: Solution Reconstituted, Injection: Meribin: 5 mg Generic: 15 units (1 ea); 30 units (1 ea) Capsule, Oral [preservative free]: Solution Reconstituted, Injection [preservative free]: Generic: 5000 mcg Generic: 15 units (1 ea); 30 units (1 ea) Tablet, Oral: Biotin Forte: 3 mg, 5 mg Blinatumomab Generic: 1000 mcg, 5 mg, 10 mg DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral [preservative free]: UNIFORM FORMULARY Generic: 300 mcg Solution Reconstituted, Intravenous [preservative free]: Bisacodyl Blincyto: 35 mcg (1 ea) [contains polysorbate 80] DoD Uniform Formulary Outpatient Dosage Forms Bortezomib UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Enema, Rectal: UNIFORM FORMULARY Fleet Bisacodyl: 10 mg/30 mL (37 mL) Solution Reconstituted, Injection: Suppository, Rectal: Velcade: 3.5 mg (1 ea) Generic: 10 mg (12 ea, 50 ea, 100 ea) Tablet Delayed Release, Oral: Bosentan Bisacodyl EC: 5 mg DoD Uniform Formulary Outpatient Dosage Forms Correct: 5 mg UNIFORM FORMULARY Ducodyl: 5 mg Tablet, Oral: Dulcolax: 5 mg [contains methylparaben, propylparaben, sodium benzoate] Tracleer: 62.5 mg, 125 mg Ex-Lax Ultra: 5 mg [contains methylparaben] Fleet Laxative: 5 mg NONFORMULARY Gentle Laxative: 5 mg Tablet Soluble, Oral: Stimulant Laxative: 5 mg Tracleer: 32 mg [scored; contains aspartame] Womens Laxative: 5 mg Bosutinib Bismuth Subcitrate, Metronidazole, and Tetracycline DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Capsule, Oral: Bosulif: 100 mg, 500 mg Pylera: Bismuth subcitrate potassium 140 mg, metronidazole 125 mg, and tetracycline hydrochloride 125 mg Botulism Antitoxin, Heptavalent DoD Uniform Formulary Outpatient Dosage Forms Bismuth Subsalicylate UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection [preservative free]: UNIFORM FORMULARY Each vial contains no less than serotype A antitoxin 4500 units, serotype B Capsule, Softgel, Oral: antitoxin 3300 units, serotype C antitoxin 3000 units, serotype D antitoxin Kaopectate: 240 mg 600 units, serotype E antitoxin 5100 units, serotype F antitoxin 3000 units, Suspension, Oral, as subsalicylate: and serotype G antitoxin 600 units (20 mL, 50 mL) Bismatrol: 262 mg/15 mL (236 mL) [contains benzoic acid, saccharin sodium; wintergreen flavor] Botulism Immune Globulin (Intravenous-Human) Bismatrol Maximum Strength: 525 mg/15 mL (236 mL) [contains benzoic acid, DoD Uniform Formulary Outpatient Dosage Forms saccharin sodium; wintergreen flavor] UNIFORM FORMULARY Geri-Pectate: 262 mg/15 mL (355 mL) Injection, powder for reconstitution [preservative free]: Kaopectate: 600 mg/15 mL (250 mL, 350 mL) [vanilla flavor] BabyBIG: ~ 100 mg [contains albumin (human), sucrose; supplied with Kaopectate Children’s: 600 mg/15 mL (180 mL) [cherry flavor] diluent] 17 BRENTUXIMAB VEDOTIN Brentuximab Vedotin Suspension, Oral: DoD Uniform Formulary Outpatient Dosage Forms Entre-B: Brompheniramine maleate 6 mg and phenylephrine hydrochloride UNIFORM FORMULARY 10 mg per 5 mL (118 mL) [contains benzoic acid, propylene glycol; bubble Solution Reconstituted, Intravenous [preservative free]: gum flavor] Adcetris: 50 mg (1 ea) [contains polysorbate 80] Vazobid-PD: Brompheniramine maleate 1.2 mg and phenylephrine hydro- chloride 2 mg per 1 mL (118 mL) [contains aspartame, sodium benzoate; Brexanolone bubblegum flavor] DoD Uniform Formulary Outpatient Dosage Forms Syrup, Oral: NOT COVERED Triaminic Cold & Allergy: Brompheniramine maleate 1 mg and phenylephrine Solution, Intravenous [preservative free]: hydrochloride 2.5 mg per 5 mL (118 mL) [contains propylene glycol, sodium Zulresso: 100 mg/20 mL (20 mL) benzoate; grape flavor] Tablet, Oral: Brigatinib Brohist D: Brompheniramine maleate 4 mg and phenylephrine hydrochlor- DoD Uniform Formulary Outpatient Dosage Forms ide 10 mg Uniorm Formulary Relhist BP: Brompheniramine maleate 4 mg and phenylephrine hydrochlor- Tablet, Oral: ide 10 mg Alunbrig: 30 mg, 90 mg, 180 mg Ru-Hist D: Brompheniramine maleate 4 mg and phenylephrine hydrochlor- Tablet Therapy Pack, Oral: ide 10 mg Alunbrig: 90 mg (7s) & 180 mg (23s) (30 ea) Brompheniramine and Pseudoephedrine Brimonidine (Ophthalmic) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Capsule, Oral: Solution, Ophthalmic, as tartrate: Lodrane D: Brompheniramine maleate 4 mg and pseudoephedrine hydro- Generic: 0.15% (5 mL, 10 mL, 15 mL); 0.2% (5 mL, 10 mL, 15 mL) chloride 60 mg Liquid, Oral: UNIFORM FORMULARY Brotapp: Brompheniramine maleate 1 mg and pseudoephedrine hydrochloride Solution, Ophthalmic, as tartrate: 15 mg per 5 mL (120 mL, 240 mL, 480 mL) [ethanol free, sugar free; contains Alphagan P: 0.1% (5 mL, 10 mL, 15 mL); 0.15% (5 mL, 10 mL, 15 mL) propylene glycol, sodium benzoate; grape flavor] Lumify: 0.025% (2.5 mL, 7.5 mL) Rynex PSE: Brompheniramine maleate 1 mg and pseudoephedrine hydro- Brincidofovir chloride 15 mg per 5 mL (473 mL) (ethanol free, sugar free; contains propylene glycol; orange flavor) Brinzolamide and Brimonidine DoD Uniform Formulary Outpatient Dosage Forms Brompheniramine, Dextromethorphan, and Phenylephrine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Suspension, Ophthalmic: UNIFORM FORMULARY Simbrinza: Brinzolamide 1% and brimonidine tartrate 0.2% (8 mL) [contains Capsule, Oral: benzalkonium chloride] Lodrane D: Brompheniramine maleate 4 mg and pseudoephedrine hydro- chloride 60 mg Brolucizumab Liquid, Oral: DoD Uniform Formulary Outpatient Dosage Forms Brotapp: Brompheniramine maleate 1 mg and pseudoephedrine hydrochloride 15 mg per 5 mL (120 mL, 240 mL, 480 mL) [ethanol free, sugar free; contains NOT COVERED propylene glycol, sodium benzoate; grape flavor] Solution, Intravitreal [preservative free]: Rynex PSE: Brompheniramine maleate 1 mg and pseudoephedrine hydro- Beovu: brolucizumab-dbll 6 mg/0.05 mL (0.05 mL) [contains polysorbate 80] chloride 15 mg per 5 mL (473 mL) (ethanol free, sugar free; contains Bromfenac propylene glycol; orange flavor) DoD Uniform Formulary Outpatient Dosage Forms Brompheniramine, Pseudoephedrine, and Dextromethorphan UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Ophthalmic: UNIFORM FORMULARY Generic: 0.09% (1.7 mL) Liquid, Oral: NONFORMULARY Brotapp-DM: Brompheniramine maleate 1 mg, pseudoephedrine hydrochlor- Solution, Ophthalmic: ide 15 mg, and dextromethorphan hydrobromide 5 mg per 5 mL (120 mL, BromSite: 0.075% (5 mL) 240 mL) [grape flavor] Prolensa: 0.07% (3 mL) Syrup, Oral: Bromfed DM: Brompheniramine maleate 2 mg, pseudoephedrine hydrochlor- Bromocriptine ide 30 mg, and dextromethorphan hydrobromide 10 mg per 5 mL (118 mL, DoD Uniform Formulary Outpatient Dosage Forms 473 mL) [contains ethanol 0.95%, propylene glycol, sodium benzoate; UNIFORM FORMULARY butterscotch flavor] Capsule, Oral: TGQ 30PSE/3BRM/15DM: Brompheniramine maleate 3 mg, pseudoephe- Generic: 5 mg drine hydrochloride 30 mg, and dextromethorphan hydrobromide 15 mg Tablet, Oral: per 5 mL (473 mL) [contains propylene glycol; berry-vanilla flavor] Generic: 2.5 mg Generic: Brompheniramine maleate 2 mg, pseudoephedrine hydrochloride NONFORMULARY 30 mg, and dextromethorphan hydrobromide 10 mg per 5 mL (118 mL, Tablet, Oral: 473 mL) Cycloset: 0.8 mg Budesonide (Nasal) Brompheniramine and Phenylephrine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Suspension, Nasal: Elixir, Oral: Rhinocort Allergy: 32 mcg/actuation (5 mL, 8.43 mL) Dimaphen Children's: Brompheniramine maleate 1 mg and phenylephrine hydrochloride 2.5 mg per 5 mL (118 mL, 237 mL) [ethanol free, gluten free; NONFORMULARY contains propylene glycol, sodium 2 mg/5 mL, sodium benzoate; grape Suspension, Nasal: flavor] Generic: 32 mcg/actuation (8.43 mL) Liquid, Oral: Budesonide (Oral Inhalation) Dimetapp Children’s Cold & Allergy: Brompheniramine maleate 1 mg and DoD Uniform Formulary Outpatient Dosage Forms phenylephrine hydrochloride 2.5 mg per 5 mL (118 mL, 237 mL) [ethanol UNIFORM FORMULARY free; contains sodium 3 mg/5 mL, propylene glycol, sodium benzoate; grape Suspension, Inhalation: flavor] Generic: 0.25 mg/2 mL (2 mL); 0.5 mg/2 mL (2 mL); 1 mg/2 mL (2 mL) Glenmax PEB: Brompheniramine maleate 4 mg and phenylephrine hydro- chloride 10 mg per 5 mL (473 mL) [alcohol free, dye free, sugar free; NONFORMULARY contains propylene glycol, saccharin sodium, sodium benzoate, sorbitol; fruit Aerosol Powder Breath Activated, Inhalation: gum flavor] Pulmicort Flexhaler: 90 mcg/actuation (1 ea); 180 mcg/actuation (1 ea) Rynex PE: Brompheniramine maleate 1 mg and phenylephrine hydrochloride [contains milk protein] 2.5 mg per 5 mL (473 mL) [ethanol free, gluten free, sugar free; contains propylene glycol; bubblegum flavor] 18 BUTALBITAL, ACETAMINOPHEN, CAFFEINE, AND CODEINE Budesonide (Systemic) methylparaben, propylparaben, saccharin sodium, sodium benzoate; pep- DoD Uniform Formulary Outpatient Dosage Forms permint flavor] UNIFORM FORMULARY Buprenorphine and Naloxone Capsule Delayed Release Particles, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 3 mg UNIFORM FORMULARY NONFORMULARY Film,Buccal: Tablet Extended Release 24 Hour, Oral: Bunavail: Buprenorphine 2.1 mg and naloxone 0.3 mg (30s); buprenorphine Uceris: 9 mg 4.2 mg and naloxone 0.7 mg (30s); buprenorphine 6.3 mg and naloxone 1 mg (30s) [citrus flavor] NOT COVERED Film, Sublingual: Capsule Extended Release 24 Hour, Oral: Suboxone: Buprenorphine 2 mg and naloxone 0.5 mg (30s); buprenorphine Ortikos: 6 mg, 9 mg 4 mg and naloxone 1 mg (30s); buprenorphine 8 mg and naloxone 2 mg Budesonide (Topical) (30s); buprenorphine 12 mg and naloxone 3 mg (30s) [lime flavor] DoD Uniform Formulary Outpatient Dosage Forms Tablet, Sublingual: UNIFORM FORMULARY Zubsolv: Buprenorphine 0.7 mg and naloxone 0.18 mg; buprenorphine 1.4 mg and naloxone 0.36 mg; buprenorphine 2.9 mg and naloxone 0.71 mg; bupre- Foam, Rectal: norphine 5.7 mg and naloxone 1.4 mg; buprenorphine 8.6 mg and naloxone Uceris: 2 mg/actuation (33.4 g) [contains cetyl alcohol, edetate disodium, 2.1 mg; buprenorphine 11.4 mg and naloxone 2.9 mg [menthol flavor] propylene glycol] Generic: Buprenorphine 2 mg and naloxone 0.5 mg; buprenorphine 8 mg and Bumetanide naloxone 2 mg DoD Uniform Formulary Outpatient Dosage Forms BuPROPion UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection: BASIC CORE FORMULARY Generic: 0.25 mg/mL (2 mL, 4 mL, 10 mL) Tablet, Oral, as hydrochloride: Tablet, Oral: Generic: 75 mg, 100 mg Generic: 0.5 mg, 1 mg, 2 mg Tablet Extended Release 12 Hour, Oral, as hydrochloride: Bupivacaine Generic: 100 mg, 150 mg DoD Uniform Formulary Outpatient Dosage Forms Tablet Extended Release 24 Hour, Oral, as hydrochloride: UNIFORM FORMULARY Generic: 150 mg, 300 mg Kit, Injection, as hydrochloride [preservative free]: NONFORMULARY ReadySharp Bupivacaine: 0.5% Tablet Extended Release 24 Hour, Oral, as hydrobromide: Solution, Injection, as hydrochloride: Aplenzin: 174 mg, 348 mg, 522 mg Generic: 0.25% (50 mL); 0.5% (50 mL) Tablet Extended Release 24 Hour, Oral, as hydrochloride: Solution, Injection, as hydrochloride [preservative free]: Forfivo XL: 450 mg Generic: 0.25% (10 mL, 30 mL); 0.5% (10 mL, 30 mL); 0.75% (10 mL, 30 mL) Solution, Intrathecal, as hydrochloride: Burosumab Generic: 0.75% [7.5 mg/mL] (2 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution, Intrathecal, as hydrochloride [preservative free]: UNIFORM FORMULARY Bupivacaine Spinal: 0.75% [7.5 mg/mL] (2 mL) Solution, Subcutaneous [preservative free]: Marcaine Spinal: 0.75% [7.5 mg/mL] (2 mL) Crysvita: 10 mg/mL (1 mL); 20 mg/mL (1 mL); 30 mg/mL (1 mL) [contains Sensorcaine-MPF Spinal: 0.75% [7.5 mg/mL] (2 mL) polysorbate 80] Bupivacaine and Epinephrine BusPIRone DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Injection, solution [preservative free]: Tablet, Oral, as hydrochloride: Sensorcaine MPF with Epinephrine: Bupivacaine hydrochloride 0.75% and Generic: 5 mg, 10 mg, 15 mg epinephrine 1:200,000 (30 mL) [contains sodium metabisulfite] UNIFORM FORMULARY Generic: Bupivacaine hydrochloride 0.25% and epinephrine 1:200,000 (10 Tablet, Oral, as hydrochloride: mL, 30 mL) Generic: 7.5 mg, 30 mg Generic: Bupivacaine hydrochloride 0.5% and epinephrine 1:200,000 (10 mL, 30 mL) Busulfan Injection, solution: DoD Uniform Formulary Outpatient Dosage Forms Generic: Bupivacaine hydrochloride 0.25% and epinephrine 1:200,000 UNIFORM FORMULARY (50 mL) Solution, Intravenous: Generic: Bupivacaine hydrochloride 0.5% and epinephrine 1:200,000 (50 mL) Busulfex: 6 mg/mL (10 mL) Injection, solution [for dental use]: Tablet, Oral: Marcaine with Epinephrine: Bupivacaine hydrochloride 0.5% and epinephrine Myleran: 2 mg 1:200,000 (1.8 mL) [contains edetate calcium disodium, sodium metabi- Butabarbital sulfate] Vivacaine: Bupivacaine hydrochloride 0.5% and epinephrine 1:200,000 (1.8 DoD Uniform Formulary Outpatient Dosage Forms mL) [contains edetate calcium disodium, sodium metabisulfate] UNIFORM FORMULARY Tablet, Oral, as sodium: Bupivacaine (Liposomal) Butisol Sodium: 30 mg [scored] DoD Uniform Formulary Outpatient Dosage Forms Butalbital, Acetaminophen, and Caffeine UNIFORM FORMULARY Suspension, Injection: DoD Uniform Formulary Outpatient Dosage Forms Exparel: 1.3% (10 mL, 20 mL) BASIC CORE FORMULARY Tablet, Oral: Buprenorphine Esgic: Butalbital 50 mg, acetaminophen 325 mg, and caffeine 40 mg DoD Uniform Formulary Outpatient Dosage Forms Generic: Butalbital 50 mg, acetaminophen 325 mg, and caffeine 40 mg UNIFORM FORMULARY UNIFORM FORMULARY Implant, Subcutaneous: Capsule, Oral: Probuphine Implant Kit: 74.2 mg (4 ea) Generic: Butalbital 50 mg, acetaminophen 300 mg, and caffeine 40 mg Patch Weekly, Transdermal: Generic: Butalbital 50 mg, acetaminophen 325 mg, and caffeine 40 mg Butrans: 5 mcg/hr (4 ea); 7.5 mcg/hr (4 ea); 10 mcg/hr (4 ea); 15 mcg/hr (4 ea); Solution, Oral: 20 mcg/hr (4 ea) Vanatol LQ: Butalbital 50 mg, acetaminophen 325 mg, and caffeine 40 mg per Solution, Injection: 15 mL (480 mL) Generic: 0.3 mg/mL (1 mL) Vtol LQ: Butalbital 50 mg, acetaminophen 325 mg, and caffeine 40 mg per 15 Solution Prefilled Syringe, Subcutaneous: mL (473 mL) Sublocade: 100 mg/0.5 mL (0.5 mL); 300 mg/1.5 mL (1.5 mL) Tablet Sublingual, Sublingual: Butalbital, Acetaminophen, Caffeine, and Codeine Generic: 2 mg, 8 mg DoD Uniform Formulary Outpatient Dosage Forms NONFORMULARY UNIFORM FORMULARY Film, Buccal: Capsule, Oral: Belbuca: 75 mcg (60 ea); 150 mcg (60 ea); 300 mcg (60 ea); 450 mcg (60 ea); Butalbital 50 mg, acetaminophen 300 mg, caffeine 40 mg, and codeine phos- 600 mcg (60 ea); 750 mcg (60 ea); 900 mcg (60 ea) [contains phate 30 mg 19 BUTALBITAL, ACETAMINOPHEN, CAFFEINE, AND CODEINE

Butalbital 50 mg, acetaminophen 325 mg, caffeine 40 mg, and codeine phos- Capsule, Oral [each package contains four blister cards; each card contains the phate 30 mg following]: Cometriq: 60 mg daily-dose: 20 mg (21s) Butalbital and Acetaminophen Cometriq: 100 mg daily-dose: 80 mg (7s) and 20 mg (7s) DoD Uniform Formulary Outpatient Dosage Forms Cometriq: 140 mg daily-dose: 80 mg (7s) and 20 mg (21s) UNIFORM FORMULARY Tablet, Oral: Tablet, Oral: Cabometyx: 20 mg, 40 mg, 60 mg Allzital: Butalbital 25 mg and acetaminophen 325 mg Butalbital 50 mg and acetaminophen 325 mg Caffeine NONFORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Butalbital 50 mg and acetaminophen 300 mg Solution, Injection, as citrate [preservative free]: Butalbital, Aspirin, and Caffeine Generic: 60 mg/3 mL (3 mL) [equivalent to 10 mg/mL caffeine base] Solution, Injection [with sodium benzoate]: DoD Uniform Formulary Outpatient Dosage Forms Generic: Caffeine 125 mg/mL and sodium benzoate 125 mg/mL (2 mL) UNIFORM FORMULARY Solution, Oral, as citrate [preservative free]: Capsule, Oral: Generic: 60 mg/3 mL (3 mL) [equivalent to 10 mg/mL caffeine base] Generic: Butalbital 50 mg, aspirin 325 mg, and caffeine 40 mg Tablet, Oral: Butalbital, Aspirin, Caffeine, and Codeine Generic: 200 mg DoD Uniform Formulary Outpatient Dosage Forms Calamine UNIFORM FORMULARY Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: Butalbital 50 mg, aspirin 325 mg, caffeine 40 mg, and codeine UNIFORM FORMULARY phosphate 30 mg Lotion, External: Caladryl: Calamine 8% and pramoxine hydrochloride 1% (177 mL) [contains Butenafine methylparaben, polysorbate 80, propylene glycol, propylparaben] DoD Uniform Formulary Outpatient Dosage Forms Calagesic: Calamine 8% and pramoxine hydrochloride 1% (177 mL) [contains UNIFORM FORMULARY alcohol, usp, methylparaben, polysorbate 80, propylene glycol, propyl- Cream, External, as hydrochloride: paraben] Lotrimin Ultra: 1% (30 g) [contains benzyl alcohol, cetyl alcohol, propylene Generic: 8% (180 mL); Calamine 8% and zinc oxide 8% (118 mL, 180 mL) glycol, sodium benzoate] Suspension, External: Lotrimin Ultra: 1% (12 g, 30 g) [contains benzyl alcohol, cetyl alcohol, propy- GoodSense Calamine: Calamine 8% and zinc oxide 8% (177 mL) lene glycol, sodium benzoate, trolamine (triethanolamine)] Mentax: 1% (15 g, 30 g) [contains benzyl alcohol, sodium benzoate] Calaspargase Pegol DoD Uniform Formulary Outpatient Dosage Forms Butoconazole NOT COVERED DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous [preservative free]: UNIFORM FORMULARY Asparlas: 3750 units/5 mL (5 mL) Cream, Vaginal, as nitrate: Gynazole-1: 2% (5 g) [contains edetate disodium, methylparaben, propylene Calcipotriene glycol, propylparaben] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Butorphanol Cream, External: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.005% (60 g, 120 g) UNIFORM FORMULARY Foam, External: Solution, Injection, as tartrate: Sorilux: 0.005% (60 g, 120 g) [contains cetyl alcohol, edetate disodium, Generic: 1 mg/mL (1 mL); 2 mg/mL (1 mL, 2 mL) propylene glycol] Solution, Nasal, as tartrate: Ointment, External: Generic: 10 mg/mL (2.5 mL) Generic: 0.005% (60 g, 120 g) C1 Inhibitor (Human) Solution, External: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.005% (60 mL) UNIFORM FORMULARY Calcipotriene and Betamethasone Kit, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Berinert: 500 units UNIFORM FORMULARY Solution Reconstituted, Intravenous [preservative free]: Foam, External: Cinryze: 500 units (1 ea) Enstilar: Calcipotriene 0.005% and betamethasone dipropionate NONFORMULARY 0.064% (60 g) Solution Reconstituted, Subcutaneous: Ointment, External: Haegarda: 2000 units (1 ea); 3000 units (1 ea) Generic: Calcipotriene 0.005% and betamethasone dipropionate 0.064% (60 g, 100 g) C1 Inhibitor (Recombinant) Suspension, External: DoD Uniform Formulary Outpatient Dosage Forms Taclonex: Calcipotriene 0.005% and betamethasone dipropionate 0.064% UNIFORM FORMULARY (60 g, 120 g) [contains castor oil] Solution Reconstituted, Intravenous [preservative free]: Ruconest: 2100 units (1 ea) [contains rabbit protein] Calcitonin Cabazitaxel DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection: UNIFORM FORMULARY Miacalcin: 200 units/mL (2 mL) [contains phenol] Solution, Intravenous: Solution, Nasal: Jevtana: 60 mg/1.5 mL (1.5 mL) [contains alcohol, usp, polysorbate 80] Generic: 200 units/actuation (3.7 mL) Cabergoline Calcitriol (Systemic) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 0.5 mg Capsule, Oral: Generic: 0.25 mcg, 0.5 mcg Cabotegravir and Rilpivirine Solution, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Generic: 1 mcg/mL (1 mL) NOT COVERED Solution, Oral: Suspension Extended Release, Intramuscular [preservative free]: Generic: 1 mcg/mL (15 mL) Cabenuva: Cabotegravir 400 mg and rilpivirine 600 mg per 2 mL (4 mL) Cabotegravir 600 mg and rilpivirine 900 mg per 3 mL (6 mL) Calcitriol (Topical) DoD Uniform Formulary Outpatient Dosage Forms Cabozantinib UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Ointment, External: UNIFORM FORMULARY Generic: 3 mcg/g (100 g) 20 CAMPHOR AND MENTHOL Calcium Acetate Tablet, Chewable, Oral: DoD Uniform Formulary Outpatient Dosage Forms Alka-Seltzer Heartburn + Gas: Calcium carbonate 750 mg and simethicone UNIFORM FORMULARY 80 mg [tropical punch flavor] Capsule, Oral: Gas-X with Maalox Extra Strength: Calcium carbonate 500 mg and simethi- Generic: 667 mg cone 125 mg [wild berry flavor] Solution, Oral: Maalox Advanced Maximum Strength: Calcium carbonate 1000 mg and Phoslyra: 667 mg/5 mL (473 mL) [contains methylparaben, propylene glycol] simethicone 60 mg [assorted fruit flavor, lemon flavor, wild berry flavor] Tablet, Oral: Maalox Junior Plus Antigas: Calcium carbonate 400 mg and simethicone Generic: 667 mg, 668 mg 24 mg [wild berry flavor] Calcium and Vitamin D Calcium Chloride DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Caplet, Oral: Solution, Intravenous: Citracal Maximum: Calcium 315 mg and vitamin D 250 units [gluten free] Generic: 10% (10 mL) Os-Cal Calcium + D3: Calcium 500 mg and vitamin D 200 units Solution, Intravenous [preservative free]: Os-Cal Extra D3: Calcium 500 mg and vitamin D 600 units Generic: 10% (10 mL) Capsule, Oral: Generic: Calcium 600 mg and vitamin D 100 units, Calcium 600 mg and Calcium Citrate vitamin D 400 units, Calcium 600 mg and vitamin D 500 units, Calcium DoD Uniform Formulary Outpatient Dosage Forms 600 mg and vitamin D 1000 units UNIFORM FORMULARY Tablet, Oral: Capsule, Oral [preservative free]: Calcet Petites: Calcium 200 mg and vitamin D 250 units [gluten free; contains Cal-Citrate: 150 mg [dye free] tartrazine] Granules, Oral: Citracal Petites: Calcium 200 mg and vitamin D 250 units [gluten free] Generic: 760 mg/3.5 g (480 g) Citracal Regular: Calcium 250 mg and vitamin D 200 units [gluten free] Tablet, Oral: Generic: Calcium 250 mg and vitamin D 125 units; Calcium 315 mg and Generic: 250 mg, 950 mg, 1040 mg vitamin D 200 units; Calcium 315 mg and vitamin D 250 units; Calcium Tablet, Oral [preservative free]: 500 mg and vitamin D 125 units; Calcium 500 mg and vitamin D 200 units; Calcitrate: 950 mg [lactose free, milk derivatives/products, no artificial color(s), Calcium 500 mg and vitamin D 400 units; Calcium 500 mg and vitamin D 600 no artificial flavor(s), sodium free, soy free, sugar free, wheat free, yeast free] units; Calcium 600 mg and vitamin D 125 units; Calcium 600 mg and vitamin D 200 units; Calcium 600 mg and vitamin D 400 units; Calcium 600 mg and Calcium Citrate and Vitamin D vitamin D 800 units DoD Uniform Formulary Outpatient Dosage Forms Tablet, Chewable, Oral: UNIFORM FORMULARY Caltrate Gummy Bites: Calcium 250 mg and vitamin D 400 units Tablet, Oral: Caltrate 600+D3 Soft: Calcium 600 mg and vitamin D 800 units [contains Generic: Calcium citrate 315 mg and vitamin D 200 units soybean oil] Generic: Calcium 500 mg and vitamin D 100 units; Calcium 500 mg and Calcium Glubionate vitamin D 200 units; Calcium 500 mg and vitamin D 600 units; Calcium DoD Uniform Formulary Outpatient Dosage Forms 600 mg and vitamin D 400 units UNIFORM FORMULARY Syrup, Oral: Calcium Carbonate Calcionate: 1.8 g/5 mL (473 mL) [fruit flavor] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Calcium Gluconate Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Florical: 364 mg (elemental calcium 145 mg) and fluoride 3.75 mg UNIFORM FORMULARY Powder, Oral: Capsule, Oral [preservative free]: Generic: Elemental calcium 800 mg/2 g (480 g) Cal-Glu: 500 mg [dye free] Suspension, Oral: Solution, Intravenous: Generic: 1250 mg (elemental calcium 500 mg) per 5 mL (5 mL, 473 mL, Generic: 10% (10 mL, 50 mL, 100 mL) 500 mL) Solution, Intravenous [preservative free]: Tablet, Oral: Generic: 10% (100 mL) Florical: 364 mg (elemental calcium 145 mg) and fluoride 3.75 mg Tablet, Oral: Generic: 648 mg, 1250 mg (elemental calcium 500 mg), 1500 mg (elemental Generic: 50 mg, 500 mg calcium 600 mg) Tablet, Oral [preservative free]: Calcium Lactate Generic: 1250 mg (elemental calcium 500 mg), 1500 mg (elemental calcium DoD Uniform Formulary Outpatient Dosage Forms 600 mg) UNIFORM FORMULARY Tablet Chewable, Oral: Capsule, Oral [preservative free]: Cal-Mint: Elemental calcium 260 mg [animal products free, gelatin free, gluten Cal-Lac: 500 mg [dye free] free, lactose free, no artificial color(s), no artificial flavor(s), starch free, sugar Tablet, Oral: free, yeast free] Generic: 100 mg Calci-Chew: 1250 mg (elemental calcium 500 mg) [cherry flavor] Tablet, Oral [preservative free]: Calcium Antacid Ultra Max St: 1000 mg [contains brilliant blue fcf (fd&c blue Generic: 648 mg #1), fd&c red #40, fd&c yellow #6 (sunset yellow), soybeans (glycine max), tartrazine (fd&c yellow #5)] Calfactant Maalox: 600 mg [contains aspartame; wild berry flavor] DoD Uniform Formulary Outpatient Dosage Forms Maalox Childrens: 400 mg [contains aspartame; wild berry flavor] UNIFORM FORMULARY Titralac: 420 mg [low sodium, sugar free; contains saccharin] Suspension, Intratracheal: Tums Chewy Delights: 1177 mg [contains fd&c red #40 aluminum lake, Infasurf: 35 mg phospholipids and 0.7 mg protein per mL (3 mL, 6 mL) soybean lecithin; cherry flavor] Tums Ultra 1000: 1000 mg Camphor Generic: 500 mg, 750 mg, Elemental calcium 260 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Calcium Carbonate and Magnesium Hydroxide Cream, External: DoD Uniform Formulary Outpatient Dosage Forms JointFlex: 3.1% (114 g) [contains disodium EDTA] UNIFORM FORMULARY Gel, External: Liquid, Oral: Benadryl Anti-Itch Childrens: 0.45% (85 g) [contains benzyl alcohol, edetate Geri-Lanta Supreme: Calcium carbonate 400 mg and magnesium hydroxide disodium, menthol, SD alcohol 40B, trolamine (triethanolamine)] 135 mg per 5 mL (355 mL) [cherry flavor] Liquid, Inhalation: Mylanta Supreme: Calcium carbonate 400 mg and magnesium hydroxide Vicks Vapo Steam: 6.2% (236 mL) [contains alcohol, USP, menthol] 135 mg per 5 mL (360 mL, 720 mL) [cherry flavor] Tablet, Chewable, Oral: Camphor and Menthol Mi-Acid Double Strength: Calcium carbonate 700 mg and magnesium hydrox- DoD Uniform Formulary Outpatient Dosage Forms ide 300 mg UNIFORM FORMULARY Cream, External: Calcium Carbonate and Simethicone Soltice Quick-Rub: Camphor 5.1% and menthol 5.1% (40 g, 90 g) DoD Uniform Formulary Outpatient Dosage Forms Gel, External: UNIFORM FORMULARY Camphotrex: Camphor 4% and menthol 10% (85 g) 21 CAMPHOR AND MENTHOL

Sombra Natural Pain Relieving: Camphor 3% and menthol 3% (85 g) [alco- Qutenza: 8% (1s, 2s) [contains metal; supplied with cleansing gel] hol free] Releevia: 0.0375% (15s) [contains menthol 5%] Lotion, External: Releevia MC: 0.0375% (15s) [contains menthol 5%] DermaSarra Anti-Itch: Camphor 0.5% and menthol 0.5% (222 mL) Renovo: 0.0375% (15s) [contains menthol 5%] Men-Phor: Camphor 0.5% and menthol 0.5% (222 mL, 225 mL) Salonpas Gel-Patch Hot: 0.025% (3s, 6s) [contains menthol] Sarna: Camphor 0.5% and menthol 0.5% (222 mL) Ointment, External: Captopril Mentholatum: Camphor 9% and menthol 1.3% (30 g, 90 g) DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY Camphor and Phenol Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 12.5 mg, 25 mg, 50 mg, 100 mg UNIFORM FORMULARY Gel, External: Captopril and Hydrochlorothiazide Campho-Phenique: Camphor 10.8% and phenol 4.7% (7 g, 14 g) DoD Uniform Formulary Outpatient Dosage Forms Liquid, External: UNIFORM FORMULARY Generic: Camphor 10.8% and phenol 4.7% (45 mL) Tablet, Oral: Generic: Canakinumab 25/15: Captopril 25 mg and hydrochlorothiazide 15 mg DoD Uniform Formulary Outpatient Dosage Forms 25/25: Captopril 25 mg and hydrochlorothiazide 25 mg NOT COVERED 50/15: Captopril 50 mg and hydrochlorothiazide 15 mg Solution, Subcutaneous: 50/25: Captopril 50 mg and hydrochlorothiazide 25 mg Ilaris: 150 mg/mL (1 mL) [contains polysorbate 80] Solution Reconstituted, Subcutaneous [preservative free]: Carbachol Ilaris: 180 mg (1 ea) [contains polysorbate 80] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Candesartan Solution, Intraocular: DoD Uniform Formulary Outpatient Dosage Forms Miostat: 0.01% (1.5 mL) UNIFORM FORMULARY Tablet, Oral, as cilexetil: CarBAMazepine Generic: 4 mg, 8 mg, 16 mg, 32 mg DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY Candesartan and Hydrochlorothiazide Suspension, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 100 mg/5 mL (10 mL, 450 mL) UNIFORM FORMULARY Tablet, Oral: Tablet, Oral: Generic: 200 mg Generic: Tablet, Chewable, Oral: 16/12.5: Candesartan cilexetil 16 mg and hydrochlorothiazide 12.5 mg Generic: 100 mg 32/12.5: Candesartan cilexetil 32 mg and hydrochlorothiazide 12.5 mg Tablet Extended Release 12 Hour, Oral: 32/25: Candesartan cilexetil 32 mg and hydrochlorothiazide 25 mg Generic: 400 mg Candida albicans (Monilia) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule Extended Release 12 Hour, Oral: Generic: 100 mg, 200 mg, 300 mg UNIFORM FORMULARY Solution, Intradermal: Carbamide Peroxide Generic: (5 mL) DoD Uniform Formulary Outpatient Dosage Forms Cangrelor UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Mouth/Throat: Gly-Oxide: 10% (15 mL, 60 mL) [contains propylene glycol] UNIFORM FORMULARY Solution, Otic: Solution Reconstituted, Intravenous: Auraphene-B: 6.5% (15 mL) Kengreal: 50 mg (1 ea) E-R-O Ear Drops: 6.5% (15 mL) [contains glycerin] Cannabidiol E-R-O Ear Wax Removal System: 6.5% (15 mL) DoD Uniform Formulary Outpatient Dosage Forms Ear Drops: 6.5% (15 mL) [contains propylene glycol] UNIFORM FORMULARY Earwax Treatment Drops: 6.5% (15 mL) [contains glycerin, propylene glycol] Solution, Oral: Carbidopa Epidiolex: 100 mg/mL (100 mL) [contains alcohol, usp, sesame oil; strawberry DoD Uniform Formulary Outpatient Dosage Forms flavor] UNIFORM FORMULARY Capecitabine Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 25 mg UNIFORM FORMULARY Carbidopa and Levodopa Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 150 mg, 500 mg BASIC CORE FORMULARY Capreomycin Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 10/100: Carbidopa 10 mg and levodopa 100 mg [scored] Generic: 25/100: Carbidopa 25 mg and levodopa 100 mg [scored] UNIFORM FORMULARY Generic: 25/250: Carbidopa 25 mg and levodopa 250 mg [scored] Solution Reconstituted, Injection, as sulfate: Capastat Sulfate: 1 g (1 ea) UNIFORM FORMULARY Capsule Extended Release, Oral: Capsaicin Rytary: 23.75/95: Carbidopa 23.75 mg and levodopa 95 mg DoD Uniform Formulary Outpatient Dosage Forms Rytary: 36.25/145: Carbidopa 36.25 mg and levodopa 145 mg UNIFORM FORMULARY Rytary: 48.75/195: Carbidopa 48.75 mg and levodopa 195 mg Cream, External: Rytary: 61.25/245: Carbidopa 61.25 mg and levodopa 245 mg Capzasin-HP: 0.1% (42.5 g) [contains benzyl alcohol] Suspension, Enteral: Capzasin-P: 0.035% (42.5 g) [contains benzyl alcohol] Duopa: Carbidopa 4.63 mg and levodopa 20 mg per 1 mL (100 mL) Zostrix-HP: 0.1% (60 g) [contains benzyl alcohol] Tablet Disintegrating, Oral: Generic: 0.025% (60 g) Generic: 10/100: Carbidopa 10 mg and levodopa 100 mg Gel, External: Generic: 25/100: Carbidopa 25 mg and levodopa 100 mg Capzasin-P: 0.025% (42.5 g) [contains menthol] Generic: 25/250: Carbidopa 25 mg and levodopa 250 mg Liquid, External: Tablet Extended Release, Oral: Capzasin-P: 0.15% (29.5 mL) Generic: 25/100: Carbidopa 25 mg and levodopa 100 mg; Lotion, External: Generic: 50/200: Carbidopa 50 mg and levodopa 200 mg DiabetAid Pain and Tingling Relief: 0.025% (120 mL) Patch, External: Carbinoxamine Allevess: 0.05% (15s) [contains menthol 5%] DoD Uniform Formulary Outpatient Dosage Forms Flexin: 0.0375% (15s) [contains menthol 5%] UNIFORM FORMULARY Levatio: 0.03% (15s) [contains menthol 5%] Solution, Oral, as maleate: MenCaps: 0.0225% (15s) [contains menthol 4.5%] Generic: 4 mg/5 mL (118 mL, 473 mL) 22 CEFDINIR

Suspension Extended Release, Oral, as maleate: Tablet, Oral: Karbinal ER: 4 mg/5 mL (480 mL) [contains methylparaben, polysorbate 80, Generic: Carisoprodol 200 mg, aspirin 325 mg, and codeine phosphate 16 mg propylparaben, sodium metabisulfite; strawberry-banana flavor] Tablet, Oral, as maleate: Carmustine Generic: 4 mg, 6 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY CARBOplatin Solution Reconstituted, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms BiCNU: 100 mg (1 ea) [contains alcohol, usp] UNIFORM FORMULARY Wafer, Implant: Solution, Intravenous: Gliadel Wafer: 7.7 mg (8 ea) [contains polifeprosan 20] Generic: 50 mg/5 mL (5 mL); 150 mg/15 mL (15 mL); 450 mg/45 mL (45 mL); 600 mg/60 mL (60 mL) Carteolol (Ophthalmic) Solution, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 50 mg/5 mL (5 mL); 150 mg/15 mL (15 mL); 450 mg/45 mL (45 mL); UNIFORM FORMULARY 600 mg/60 mL (60 mL) Solution, Ophthalmic, as hydrochloride: Generic: 1% (5 mL, 10 mL, 15 mL) Carboprost Tromethamine DoD Uniform Formulary Outpatient Dosage Forms Carvedilol UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Intramuscular [strength expressed as base]: BASIC CORE FORMULARY Hemabate: 250 mcg/mL (1 mL) [contains benzyl alcohol] Tablet, Oral: Carboxymethylcellulose Generic: 3.125 mg, 6.25 mg, 12.5 mg, 25 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule Extended Release 24 Hour, Oral, as phosphate: Gel, Ophthalmic, as sodium: Generic: 10 mg, 20 mg, 40 mg, 80 mg GenTeal: 0.25% (15 mL, 25 mL) Refresh Optive: 1 % (10 mL) Casimersen Theratears: 1% (28 ea) [contains calcium chloride anhydrous, magnesium DoD Uniform Formulary Outpatient Dosage Forms chloride, potassium chloride, sodium bicarbonate, sodium chloride, sodium NOT COVERED phosphate] Solution, Intravenous [preservative free]: Gel, Ophthalmic, as sodium [preservative free]: Amondys 45: 100 mg/2 mL (2 mL) Biolle Gel Tears: 1% (1 ea) Liquid, Ophthalmic, as sodium: Caspofungin Sterile Lubricant: 0.7% (15 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution, Ophthalmic, as sodium: UNIFORM FORMULARY Lubricating Plus Eye Drops: 0.5% (30 ea, 50 ea) Solution Reconstituted, Intravenous, as acetate: Refresh Liquigel: 1% (15 mL, 30 mL) Cancidas: 50 mg (1 ea); 70 mg (1 ea) Refresh Optive: 0.5% (15 mL) Refresh Optive Advanced: 0.5% (10 mL) Castor Oil Refresh Plus: 0.5% (30 ea, 50 ea, 70 ea) DoD Uniform Formulary Outpatient Dosage Forms Refresh Tears: 0.5% (15 mL, 30 mL) UNIFORM FORMULARY Theratears: 0.25% (15 mL, 30 mL) [contains calcium chloride dihydrate, Oil, Oral: magnesium chloride, potassium chloride, sodium bicarbonate, sodium chlor- Generic: (59 mL, 118 mL, 177 mL, 473 mL) ide, sodium phosphate, monobasic monohydrate] Ultra Fresh: 0.5% (15 mL, 30 mL) Cefaclor Solution, Ophthalmic, as sodium [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Biolle Tears: 0.5% (0.6 mL) UNIFORM FORMULARY Refresh Celluvisc: 1% (30 ea) Capsule, Oral: Refresh Optive Advanced: 0.5% (1 ea) Generic: 250 mg, 500 mg Refresh Optive Sensitive: 0.5% (1 ea) Suspension Reconstituted, Oral: Refresh Plus: 0.5% (30 ea, 50 ea) Generic: 125 mg/5 mL (150 mL); 250 mg/5 mL (150 mL); 375 mg/5 mL Theratears: 0.25% (32 ea) [contains calcium chloride dihydrate, magnesium (100 mL) chloride, potassium chloride, sodium bicarbonate, sodium chloride, sodium Tablet Extended Release 12 Hour, Oral: phosphate, monobasic monohydrate] Generic: 500 mg Cardioplegic Solution Cefadroxil DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Perfusion: Capsule, Oral: Generic: (1000 mL) Generic: 500 mg Suspension Reconstituted, Oral: Carfilzomib Generic: 250 mg/5 mL (50 mL, 100 mL); 500 mg/5 mL (75 mL, 100 mL) DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 1 g Solution Reconstituted, Intravenous: Kyprolis: 30 mg (1 ea); 60 mg (1 ea) CeFAZolin DoD Uniform Formulary Outpatient Dosage Forms Carglumic Acid UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous: UNIFORM FORMULARY Generic: 1 g (50 mL); 2 g (100 mL) Tablet, Oral: Solution Reconstituted, Injection: Carbaglu: 200 mg [scored] Generic: 500 mg (1 ea); 1 g (1 ea); 10 g (1 ea); 20 g (1 ea); 100 g (1 ea); Carisoprodol 300 g (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Injection [preservative free]: UNIFORM FORMULARY Generic: 500 mg (1 ea); 1 g (1 ea); 10 g (1 ea) Tablet, Oral: Solution Reconstituted, Intravenous: Generic: 250 mg, 350 mg Generic: 1 g (1 ea); 2 g (1 ea) Carisoprodol and Aspirin Cefdinir DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Capsule, Oral: Generic: Carisoprodol 200 mg and aspirin 325 mg Generic: 300 mg Suspension Reconstituted, Oral: Carisoprodol, Aspirin, and Codeine Generic: 125 mg/5 mL (60 mL, 100 mL); 250 mg/5 mL (60 mL, 100 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY 23 CEFDITOREN Cefditoren Ceftazidime and Avibactam DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Solution Reconstituted, Intravenous: Generic: 200 mg, 400 mg Avycaz: 2.5 g: Ceftazidime 2 g and avibactam 0.5 g (1 ea) Cefepime Ceftibuten DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Intravenous, as hydrochloride: Capsule, Oral: Generic: 1 g/50 mL (50 mL); 2% (100 mL) Generic: 400 mg Solution Reconstituted, Injection, as hydrochloride: Suspension Reconstituted, Oral: Generic: 1 g (1 ea); 2 g (1 ea) Generic: 180 mg/5 mL (60 mL) Solution Reconstituted, Intravenous, as hydrochloride: Generic: 1 g/50 mL (1 ea); 2 g/50 mL (1 ea) Ceftolozane and Tazobactam Cefixime DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous [preservative free]: UNIFORM FORMULARY Zerbaxa: 1.5 g: Ceftolozane 1 g and tazobactam 0.5 g (1 ea) Capsule, Oral: Suprax: 400 mg CefTRIAXone Suspension Reconstituted, Oral: DoD Uniform Formulary Outpatient Dosage Forms Suprax: 500 mg/5 mL (10 mL, 20 mL) [contains sodium benzoate; strawberry UNIFORM FORMULARY flavor] Solution, Intravenous: Generic: 100 mg/5 mL (50 mL); 200 mg/5 mL (50 mL, 75 mL) Generic: 20 mg/mL (50 mL); 40 mg/mL (50 mL) Tablet Chewable, Oral: Suprax: 100 mg, 200 mg [contains aspartame] Solution Reconstituted, Injection: Generic: 250 mg (1 ea); 500 mg (1 ea); 1 g (1 ea); 2 g (1 ea); 100 g (1 ea) Cefotaxime Solution Reconstituted, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Generic: 1 g (1 ea); 2 g (1 ea); 10 g (1 ea) UNIFORM FORMULARY Solution Reconstituted, Injection: Cefuroxime Generic: 500 mg (1 ea); 1 g (1 ea); 2 g (1 ea); 10 g (1 ea) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY CefoTEtan Solution, Intravenous, as sodium [strength expressed as base]: DoD Uniform Formulary Outpatient Dosage Forms Zinacef in Sterile Water: 1.5 g (50 mL) UNIFORM FORMULARY Solution Reconstituted, Injection, as sodium [strength expressed as base]: Solution Reconstituted, Injection: Generic: 750 mg (1 ea); 1.5 g (1 ea); 7.5 g (1 ea); 75 g (1 ea); 225 g (1 ea) Generic: 1 g (1 ea); 2 g (1 ea); 10 g (1 ea) Solution Reconstituted, Intravenous, as sodium [strength expressed as base]: Solution Reconstituted, Intravenous: Zinacef: 750 mg (1 ea) Generic: 1 g (1 ea); 2 g (1 ea) Generic: 1.5 g (1 ea) Suspension Reconstituted, Oral, as axetil [strength expressed as base]: CefOXitin Ceftin: 125 mg/5 mL (100 mL); 250 mg/5 mL (50 mL, 100 mL) [contains DoD Uniform Formulary Outpatient Dosage Forms aspartame; tutti-frutti flavor] UNIFORM FORMULARY Tablet, Oral, as axetil [strength expressed as base]: Solution Reconstituted, Injection: Generic: 250 mg, 500 mg Generic: 10 g (1 ea) Solution Reconstituted, Injection [preservative free]: Celecoxib Generic: 10 g (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous: Generic: 1 g (1 ea); 2 g (1 ea) BASIC CORE FORMULARY Solution Reconstituted, Intravenous [preservative free]: Capsule, Oral: Generic: 1 g (1 ea); 2 g (1 ea) Generic: 50 mg, 100 mg, 200 mg, 400 mg UNIFORM FORMULARY Cefpodoxime Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Celebrex: 50 mg, 100 mg, 200 mg, 400 mg UNIFORM FORMULARY Suspension Reconstituted, Oral: Cellulose (Oxidized Regenerated) Generic: 50 mg/5 mL (50 mL, 100 mL); 100 mg/5 mL (50 mL, 100 mL) DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 100 mg, 200 mg Pad, External: Cefprozil Interceed: (10 ea) Surgicel SNoW 1"x2": (10 ea) DoD Uniform Formulary Outpatient Dosage Forms Surgicel SNoW 2"x4": (10 ea) UNIFORM FORMULARY Surgicel SNoW 4"x4": (10 ea) Suspension Reconstituted, Oral: Generic: 125 mg/5 mL (50 mL, 75 mL, 100 mL); 250 mg/5 mL (50 mL, 75 mL, Cemiplimab 100 mL) DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 250 mg, 500 mg Solution, Intravenous [preservative free]: Ceftaroline Fosamil Libtayo: 350 mg/7 mL (7 mL) [contains polysorbate 80] DoD Uniform Formulary Outpatient Dosage Forms Cenegermin UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous: UNIFORM FORMULARY Teflaro: 400 mg (1 ea); 600 mg (1 ea) Solution, Ophthalmic [preservative free]: CefTAZidime Oxervate: 0.002% (1 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Cenobamate Solution, Intravenous, as sodium [strength expressed as base]: DoD Uniform Formulary Outpatient Dosage Forms Fortaz in D5W: 1 g (50 mL); 2 g (50 mL) UNIFORM FORMULARY Tazicef: 1 g/50 mL (50 mL) Tablet, Oral: Solution Reconstituted, Injection: Xcopri: 50 mg, 100 mg, 150 mg, 200 mg Fortaz: 500 mg (1 ea) Tablet Therapy Pack, Oral: Generic: 1 g (1 ea); 2 g (1 ea); 6 g (1 ea); 100 g (1 ea) Xcopri: 14 x 12.5 MG & 14 x 25 MG (28 ea) Solution Reconstituted, Injection [preservative free]: Xcopri: 14 x 50 MG & 14 x100 MG (28 ea) Generic: 1 g (1 ea); 2 g (1 ea); 6 g (1 ea) Xcopri: 14 x 150 MG & 14 x200 MG (28 ea) Solution Reconstituted, Intravenous: Xcopri (250 MG Daily Dose): 50 & 200 MG (56 ea) Generic: 1 g/50 mL (1 ea); 2 g/50 mL (1 ea) Xcopri (350 MG Daily Dose): 150 & 200 MG (56 ea) 24 CHLORPHENIRAMINE

Centruroides Immune F(ab’)2 (Equine) Suspension Reconstituted, Oral: DoD Uniform Formulary Outpatient Dosage Forms EZ Char: 25 g (1 ea) [contains bentonite] UNIFORM FORMULARY Chenodiol Solution Reconstituted, Intravenous [preservative free]: Anascorp: (1 ea) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Cephalexin Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Chenodal: 250 mg BASIC CORE FORMULARY Chlophedianol and Dexbrompheniramine Capsule, Oral: Generic: 250 mg, 500 mg DoD Uniform Formulary Outpatient Dosage Forms Suspension Reconstituted, Oral: UNIFORM FORMULARY Generic: 250 mg/5 mL (100 mL, 200 mL) Solution, Oral: Chlo Hist: Chlophedianol hydrochloride 12.5 mg and dexbrompheniramine UNIFORM FORMULARY maleate 1 mg per 5 mL (473 mL) [alcohol free, dye free, gluten free, sugar Capsule, Oral: free; contains propylene glycol, saccharin sodium; grape flavor] Daxbia: 333 mg Generic: 750 mg Chlorambucil DoD Uniform Formulary Outpatient Dosage Forms Ceritinib UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Leukeran: 2 mg Tablet, Oral: Zykadia: 150 mg Chloramphenicol (Systemic) DoD Uniform Formulary Outpatient Dosage Forms Cerliponase Alfa NOT COVERED DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous: UNIFORM FORMULARY Generic: 1 g (1 ea) Solution, Intraventric [preservative free]: Brineura: 150 mg/5 mL (1 ea) ChlordiazePOXIDE DoD Uniform Formulary Outpatient Dosage Forms Cetirizine and Pseudoephedrine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral, as hydrochloride: UNIFORM FORMULARY Generic: 5 mg, 10 mg, 25 mg Tablet, Extended Release, Oral: Generic: Cetirizine hydrochloride 5 mg and pseudoephedrine hydrochloride Chlorhexidine Gluconate (Oral) 120 mg DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY Cetirizine (Systemic) Solution, Mouth/Throat: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.12% (15 mL, 473 mL, 480 mL) UNIFORM FORMULARY Capsule, Oral, as hydrochloride: Chlorhexidine Gluconate (Topical) ZyrTEC Allergy: 10 mg DoD Uniform Formulary Outpatient Dosage Forms Solution, Oral, as hydrochloride: UNIFORM FORMULARY Generic: 5 mg/5 mL (120 mL, 473 mL) Liquid, External: Syrup, Oral, as hydrochloride: Generic: 4% (118 mL, 237 mL, 473 mL, 946 mL, 3800 mL) Generic: 5 mg/5 mL (120 mL, 480 mL) Miscellaneous, External: Tablet, Oral, as hydrochloride: Tegaderm CHG Dressing: (Dressing) (1 ea) Generic: 5 mg, 10 mg Pad, External: Tablet Chewable, Oral, as hydrochloride: Generic: 2% (2 ea, 6 ea) Generic: 5 mg, 10 mg Solution, External: Tablet Dispersible, Oral, as hydrochloride: Antiseptic Skin Cleanser: 4% (118 mL, 237 mL) [dye free; contains isopropyl ZyrTEC Allergy: 10 mg alcohol] ZyrTEC Allergy Childrens: 10 mg [citrus flavor] Dyna-Hex 2: 2% (473 mL) [contains isopropyl alcohol] Cetrorelix Chloroprocaine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Kit, Subcutaneous: Solution, Injection, as hydrochloride: Cetrotide: 0.25 mg[contains mannitol] Nesacaine: 1% (30 mL); 2% (30 mL) [contains disodium edta, methylparaben] Solution, Injection, as hydrochloride [preservative free]: Cetuximab Nesacaine-MPF: 2% (20 mL); 3% (20 mL) [methylparaben free] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Chloroquine Solution, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Erbitux: 100 mg/50 mL (50 mL); 200 mg/100 mL (100 mL) [contains galac- UNIFORM FORMULARY tose-alpha-1,3-galactose] Tablet, Oral, as phosphate: Generic: 250 mg [equivalent to chloroquine base 150 mg], 500 mg [equivalent Cevimeline to chloroquine base 300 mg] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Chlorothiazide Capsule, Oral, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Generic: 30 mg UNIFORM FORMULARY Solution Reconstituted, Intravenous, as sodium [strength expressed as base]: Charcoal, Activated Generic: 500 mg (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous, as sodium [strength expressed as base, UNIFORM FORMULARY preservative free]: Liquid, Oral: Generic: 500 mg (1 ea) Actidose-Aqua: 15 g/72 mL (72 mL); 25 g/120 mL (120 mL); 50 g/240 mL (240 Suspension, Oral: mL) [sweet flavor] Diuril: 250 mg/5 mL (237 mL) [contains alcohol, usp, benzoic acid, methyl- Actidose/Sorbitol: 25 g/120 mL (120 mL); 50 g/240 mL (240 mL) [sweet flavor] paraben, propylparaben, saccharin sodium] Kerr Insta-Char: 25 g/120 mL (120 mL); 50 g/240 mL (240 mL) [contains fd&c Tablet, Oral: red #40, methylparaben sodium, propylene glycol, propylparaben sodium, Generic: 250 mg, 500 mg sodium benzoate; cherry flavor] Kerr Insta-Char: 50 g/240 mL (240 mL) [contains propylene glycol] Chlorpheniramine Kerr Insta-Char in Sorbitol: 25 g/120 mL (120 mL); 50 g/240 mL (240 mL) DoD Uniform Formulary Outpatient Dosage Forms [contains fd&c red #40, methylparaben sodium, propylene glycol, propylpar- UNIFORM FORMULARY aben sodium, sodium benzoate; cherry flavor] Liquid, Oral, as maleate: Suspension, Oral: Ed ChlorPed: 2 mg/mL (60 mL) [contains fd&c red #40, propylene glycol, Char-Flo with Sorbitol: 25 g (120 mL) saccharin sodium, sodium benzoate; cotton candy flavor] 25 CHLORPHENIRAMINE

Syrup, Oral, as maleate: Liquid, Oral: Aller-Chlor: 2 mg/5 mL (120 mL) [contains alcohol, usp, fd&c yellow #6 (sunset Kidkare Children's Cough/Cold: Chlorpheniramine maleate 1 mg, pseudoe- yellow), menthol, methylparaben, propylene glycol, propylparaben] phedrine hydrochloride 15 mg, and dextromethorphan hydrobromide 5 mg Chlor-Trimeton: 2 mg/5 mL (120 mL) [contains alcohol, usp] per 5 mL (118 mL) [ethanol free; contains propylene glycol and sodium Ed Chlorped Jr: 2 mg/5 mL (118 mL, 473 mL) [alcohol free, sugar free; benzoate; cherry flavor] contains fd&c red #40, methylparaben, propylene glycol, propylparaben; Maxichlor PSE DM: Chlorpheniramine maleate 4 mg, pseudoephedrine hydro- cherry flavor] chloride 20 mg, and dextromethorphan hydrobromide 20 mg per 5 mL (473 Tablet, Oral, as maleate: mL) [sugar free; contains propylene glycol; vanilla flavor] Generic: 4 mg Pedia Relief Cough-Cold: Chlorpheniramine maleate 1 mg, pseudoephedrine Tablet Extended Release, Oral, as maleate: hydrochloride 15 mg, and dextromethorphan hydrobromide 5 mg per 5 mL Generic: 12 mg (120 mL) [ethanol free; contains propylene glycol and sodium benzoate; cherry flavor] Chlorpheniramine and Acetaminophen Pediatric Cough & Cold: Chlorpheniramine maleate 1 mg, pseudoephedrine DoD Uniform Formulary Outpatient Dosage Forms hydrochloride 15 mg, and dextromethorphan hydrobromide 5 mg per 5 mL UNIFORM FORMULARY (120 mL) [ethanol free; contains propylene glycol, sodium benzoate; wild Tablet, Oral: cherry flavor] Generic: Chlorpheniramine maleate 2 mg and acetaminophen 325 mg Rescon DM: Chlorpheniramine maleate 2 mg, pseudoephedrine hydrochlor- ide 30 mg, and dextromethorphan hydrobromide 10 mg per 5 mL (120 mL, Chlorpheniramine and Phenylephrine 480 mL) [dye free, ethanol free, sugar free; cherry flavor] DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: Chlorpheniramine maleate 4 mg, pseudoephedrine hydrochloride Liquid, Oral: 60 mg, and dextromethorphan hydrobromide 20 mg Dallergy: Chlorpheniramine maleate 1 mg and phenylephrine hydrochloride 2.5 mg per 1 mL (30 mL) [alcohol free, sugar free; contains propylene glycol, ChlorproMAZINE saccharin sodium; peach flavor] DoD Uniform Formulary Outpatient Dosage Forms Ed A-Hist: Chlorpheniramine maleate 4 mg and phenylephrine hydrochloride UNIFORM FORMULARY 10 mg per 5 mL (473 mL) [gluten free, sugar free; contains alcohol, usp, Solution, Injection, as hydrochloride: propylene glycol, saccharin sodium, sodium benzoate; grape flavor] Generic: 25 mg/mL (1 mL); 50 mg/2 mL (2 mL) Ed ChlorPed D: Chlorpheniramine maleate 2 mg and phenylephrine hydro- Tablet, Oral, as hydrochloride: chloride 5 mg per 1 mL (60 mL) [alcohol free, gluten free, sugar free; Generic: 10 mg, 25 mg, 50 mg, 100 mg, 200 mg contains methylparaben, propylene glycol, propylparaben; apple sauce flavor] ChlorproPAMIDE NoHist-LQ: Chlorpheniramine maleate 4 mg and phenylephrine hydrochloride DoD Uniform Formulary Outpatient Dosage Forms 10 mg per 5 mL (473 mL) [alcohol free, sugar free; contains edetate UNIFORM FORMULARY disodium, methylparaben, propylene glycol, propylparaben, saccharin cal- Tablet, Oral: cium; bubble-gum flavor] Generic: 100 mg, 250 mg Tablet, Oral: Ed A-Hist: Chlorpheniramine maleate 4 mg and phenylephrine hydrochloride Chlorthalidone 10 mg [scored] DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY Chlorpheniramine and Pseudoephedrine Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 25 mg, 50 mg UNIFORM FORMULARY Liquid, Oral: Chlorzoxazone LoHist-D: Chlorpheniramine maleate 2 mg and pseudoephedrine hydrochlor- DoD Uniform Formulary Outpatient Dosage Forms ide 30 mg per 5 mL (473 mL) [dye free, ethanol free, sugar free; cherry flavor] UNIFORM FORMULARY Tablet, Oral: Tablet, Oral: Generic: Chlorpheniramine maleate 4 mg and pseudoephedrine hydrochlor- Lorzone: 375 mg, 750 mg [contains sodium benzoate] ide 60 mg Generic: 500 mg Chlorpheniramine, Phenylephrine, and Dextromethorphan Cholecalciferol DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Liquid, Oral: Capsule, Oral: De-Chlor DM: Chlorpheniramine maleate 2 mg, phenylephrine hydrochloride Decara: 25,000 units [contains soybean oil] 10 mg, and dextromethorphan hydrobromide 15 mg per 5 mL (473 mL) [dye Dialyvite Vitamin D 5000: 5000 units free, ethanol free, sugar free; contains propylene glycol; strawberry flavor] Pronutrients Vitamin D3: 1000 units [contains soybean oil] Ed A-Hist DM: Chlorpheniramine maleate 4 mg, phenylephrine hydrochloride Generic: 10,000 units, 50,000 units 10 mg, and dextromethorphan hydrobromide 15 mg per 5 mL (473 mL) Capsule, Oral [preservative free]: [gluten free, sugar free; contains propylene glycol; banana flavor] D3-50: 50,000 units [dairy free, egg free, fish derivatives, gluten free, kosher Father John's Plus: Chlorpheniramine maleate 2 mg, phenylephrine hydro- certified, no artificial color(s), nut free, soy free, sugar free, wheat free, chloride 5 mg, and dextromethorphan hydrobromide 5 mg per 15 mL (118 yeast free] mL) [ethanol free] Generic: 2000 units, 5000 units NoHist DM: Chlorpheniramine maleate 4 mg, phenylephrine hydrochloride Liquid, Oral: 10 mg, and dextromethorphan hydrobromide 15 mg per 5 mL (473 mL) Bio-D-Mulsion Forte: 2000 units/0.03 mL (30 mL) [contains sesame oil] [dye free, ethanol free, sugar free; contains propylene glycol; grape flavor] Generic: 400 units/mL (50 mL, 52.5 mL) Norel CS: Chlorpheniramine maleate 4 mg, phenylephrine hydrochloride Liquid, Oral [preservative free]: 10 mg, and dextromethorphan hydrobromide 12.5 mg per 5 mL (473 mL) Generic: 5000 units/mL (52.5 mL) [dye free, ethanol free, sugar free; contains propylene glycol; grape flavor] Tablet, Oral: Liquid, Oral [drops]: Dialyvite Vitamin D3 Max: 50,000 units [scored] Cardec DM: Chlorpheniramine maleate 1 mg, phenylephrine hydrochloride Generic: 400 units, 1000 units, 2000 units, 3000 units, 5000 units 3.5 mg, and dextromethorphan hydrobromide 3 mg per 1 mL (30 mL) Tablet, Oral [preservative free]: [ethanol free, gluten free, sugar free; contains propylene glycol, sodium Generic: 400 units, 1000 units, 2000 units, 5000 units benzoate; grape flavor] Tablet Chewable, Oral: Tablet, Oral: Generic: 400 units Ed A-Hist: Chlorpheniramine maleate 4 mg, phenylephrine hydrochloride 10 mg, and dextromethorphan hydrobromide 10 mg Cholera Vaccine DoD Uniform Formulary Outpatient Dosage Forms Chlorpheniramine, Pseudoephedrine, and Codeine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Suspension Reconstituted, Oral: UNIFORM FORMULARY Vaxchora: Vibrio cholerae 4x108 to 2x109 CFU (100 mL) Liquid, Oral: Phenylhistine DH: Chlorpheniramine maleate 2 mg, pseudoephedrine hydro- Cholestyramine Resin chloride 30 mg, and codeine phosphate 10 mg per 5 mL (120 mL, 480 mL) DoD Uniform Formulary Outpatient Dosage Forms [contains ethanol 5.3%, menthol, sodium benzoate] UNIFORM FORMULARY Packet, Oral: Chlorpheniramine, Pseudoephedrine, and Dextromethorphan Generic: 4 g (1 ea, 60 ea) DoD Uniform Formulary Outpatient Dosage Forms Powder, Oral: UNIFORM FORMULARY Generic: 4 g/dose (210 g, 239.4 g, 378 g) 26 CLADRIBINE Cholic Acid Ciprofloxacin and Hydrocortisone DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral: Suspension, otic: Cholbam: 50 mg, 250 mg Cipro HC: Ciprofloxacin hydrochloride 0.2% and hydrocortisone 1% (10 mL) [contains benzyl alcohol] Choline Magnesium Trisalicylate DoD Uniform Formulary Outpatient Dosage Forms Ciprofloxacin (Ophthalmic) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Liquid, Oral: UNIFORM FORMULARY Generic: 500 mg/5 mL (240 mL) Ointment, Ophthalmic, as hydrochloride: Chorionic Gonadotropin (Human) Ciloxan: 0.3% (3.5 g) Solution, Ophthalmic, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.3% (2.5 mL, 5 mL, 10 mL) UNIFORM FORMULARY Solution Reconstituted, Intramuscular: Ciprofloxacin (Otic) Generic: 10,000 units (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Chorionic Gonadotropin (Recombinant) UNIFORM FORMULARY Ointment, Ophthalmic, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Ciloxan: 0.3% (3.5 g) UNIFORM FORMULARY Solution, Ophthalmic, as hydrochloride: Injectable, Subcutaneous: Generic: 0.3% (2.5 mL, 5 mL, 10 mL) Ovidrel: 250 mcg/0.5 mL (0.5 mL) Ciclopirox Ciprofloxacin (Systemic) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY UNIFORM FORMULARY Kit, External: Suspension Reconstituted, Oral: Ciclodan Solution: 8% [contains edetate disodium, isopropyl alcohol, menthol] Generic: 250 mg/5 mL (100 mL) Ciclopirox Treatment: 8% [contains edetate disodium, isopropyl alcohol, Tablet, Oral, as hydrochloride [strength expressed as base]: menthol] Generic: 100 mg, 250 mg, 500 mg, 750 mg Solution, External: UNIFORM FORMULARY Generic: 8% (6.6 mL) Solution, Intravenous: NONFORMULARY Generic: 200 mg/100 mL (100 mL); 400 mg/200 mL (200 mL) Cream, External, as olamine [strength expressed as base]: Solution, Intravenous [preservative free]: Generic: 0.77% (15 g, 30 g, 90 g) Generic: 200 mg/20 mL (20 mL); 200 mg/100 mL (100 mL); 400 mg/40 mL (40 Gel, External: mL); 400 mg/200 mL (200 mL) Generic: 0.77% (30 g, 45 g, 100 g) Tablet Extended Release 24 Hour, Oral, as base and hydrochloride [strength Kit, External: expressed as base]: Ciclodan Cream: 0.77% [contains benzyl alcohol, cetyl alcohol, edetate Generic: 500 mg, 1000 mg disodium, propylene glycol] Loprox: 0.77% [contains benzyl alcohol, cetyl alcohol] Cisatracurium Shampoo, External: DoD Uniform Formulary Outpatient Dosage Forms Loprox: 1% (120 mL) UNIFORM FORMULARY Generic: 1% (120 mL) Ointment, Ophthalmic, as hydrochloride: Suspension, External, as olamine [strength expressed as base]: Ciloxan: 0.3% (3.5 g) Generic: 0.77% (30 mL, 60 mL) Solution, Ophthalmic, as hydrochloride: Cidofovir Generic: 0.3% (2.5 mL, 5 mL, 10 mL) DoD Uniform Formulary Outpatient Dosage Forms CISplatin UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous [preservative free]: UNIFORM FORMULARY Generic: 75 mg/mL (5 mL) Solution, Intravenous: Cilostazol Generic: 50 mg/50 mL (50 mL); 100 mg/100 mL (100 mL); 200 mg/200 mL DoD Uniform Formulary Outpatient Dosage Forms (200 mL) Solution, Intravenous [preservative free]: UNIFORM FORMULARY Tablet, Oral: Generic: 50 mg/50 mL (50 mL); 100 mg/100 mL (100 mL); 200 mg/200 mL Generic: 50 mg, 100 mg (200 mL) Cimetidine Citalopram DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Solution, Oral, as hydrochloride [strength expressed as base]: Solution, Oral: Generic: 300 mg/5 mL (237 mL, 240 mL) Generic: 10 mg/5 mL (240 mL) Tablet, Oral: Tablet, Oral: Generic: 200 mg, 300 mg, 400 mg, 800 mg Generic: 10 mg, 20 mg, 40 mg Cinacalcet Citric Acid, Magnesium Carbonate, and Glucono-Delta-Lactone DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Solution, irrigation: Sensipar: 30 mg, 60 mg, 90 mg Renacidin: Citric acid 1980.6 mg, magnesium carbonate 980.4 mg, glucono- delta-lactone 59.4 mg per 30 mL (30 mL) [contains benzoic acid] Ciprofloxacin and Dexamethasone DoD Uniform Formulary Outpatient Dosage Forms Citric Acid, Sodium Citrate, and Potassium Citrate UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Suspension, otic: UNIFORM FORMULARY Ciprodex: Ciprofloxacin 0.3% and dexamethasone 0.1% (7.5 mL) [contains Solution, Oral: benzalkonium chloride] Generic: Citric acid 334 mg, sodium citrate 500 mg, and potassium citrate 550 mg per 5 mL (473 mL) Ciprofloxacin and Fluocinolone DoD Uniform Formulary Outpatient Dosage Forms Cladribine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Otic [preservative free]: UNIFORM FORMULARY Otovel: Ciprofloxacin 0.3 % and fluocinolone acetonide 0.025 % (14 ea) Solution, Intravenous [preservative free]: [contains polysorbate 80] Generic: 10 mg/10 mL (10 mL) 27 CLADRIBINE

Tablet Therapy Pack, Oral: Gel, External, as phosphate [strength expressed as base]: Mavenclad (4 Tabs, 5 Tabs, 6 Tabs, 7 Tabs, 8 Tabs, 9 Tabs,10 Tabs): Generic: 1% (30 g, 60 g) Kit, External, as phosphate [strength expressed as base]: Clarithromycin Clindacin ETZ: 1% [contains cetyl alcohol, isopropyl alcohol, propylene glycol] DoD Uniform Formulary Outpatient Dosage Forms Clindacin ETZ: 1% [contains cetyl alcohol, isopropyl alcohol, propylene glycol] UNIFORM FORMULARY Lotion, External, as phosphate [strength expressed as base]: Suspension Reconstituted, Oral: Generic: 1% (60 mL) Generic: 125 mg/5 mL (50 mL, 100 mL); 250 mg/5 mL (50 mL, 100 mL) Suppository, Vaginal, as phosphate [strength expressed as base]: Tablet, Oral: Cleocin: 100 mg (3 ea) Generic: 250 mg, 500 mg Swab, External, as phosphate [strength expressed as base]: Tablet Extended Release 24 Hour, Oral: Generic: 1% (60 ea) Generic: 500 mg NONFORMULARY Cleansing Lotion Gel, External, as phosphate [strength expressed as base]: DoD Uniform Formulary Outpatient Dosage Forms Clindagel: 1% UNIFORM FORMULARY Cream: Clioquinol and Hydrocortisone Lotion: DoD Uniform Formulary Outpatient Dosage Forms Lipid free (Cētaphil): 240 mL UNIFORM FORMULARY Nonalkaline: 180 mL Cream, External: Ala-Quin: Clioquinol 3% and hydrocortisone 0.5% (28.4 g, 80 g) Clemastine Dermasorb AF: Clioquinol 3% and hydrocortisone 0.5% (30 g) [packaged in a DoD Uniform Formulary Outpatient Dosage Forms kit with Dermasorb hydrating serum] UNIFORM FORMULARY Tablet, Oral, as fumarate: CloBAZam Dayhist Allergy 12 Hour Relief: 1.34 mg [scored; sodium free] DoD Uniform Formulary Outpatient Dosage Forms Tavist Allergy: 1.34 mg [scored; sodium free] UNIFORM FORMULARY Generic: 2.68 mg Suspension, Oral: Onfi: 2.5 mg/mL (120 mL) [contains methylparaben, polysorbate 80, propylene Clevidipine glycol, propylparaben; berry flavor] DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Onfi: 10 mg [scored], 20 mg [scored] Emulsion, Intravenous: Cleviprex: 0.5 mg/mL (50 mL, 100 mL) [contains edetate disodium, egg yolk NONFORMULARY phospholipids, soybean oil] Film, Oral: Sympazan: 5 mg (1 ea, 60 ea); 10 mg (1 ea, 60 ea); 20 mg (1 ea, 60 ea) Clidinium and Chlordiazepoxide DoD Uniform Formulary Outpatient Dosage Forms Clobetasol UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral: BASIC CORE FORMULARY Generic: Clidinium bromide 2.5 mg and chlordiazepoxide hydrochloride 5 mg Cream, External, as propionate: Generic: 0.05% (15 g, 30 g, 45 g, 60 g) Clindamycin and Benzoyl Peroxide Ointment, External, as propionate: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.05% (15 g, 30 g, 45 g, 60 g) BASIC CORE FORMULARY UNIFORM FORMULARY Gel, External: Foam, External, as propionate: Clindamycin phosphate 1.2% and benzoyl peroxide 5% (45 g) Generic: 0.05% (50 g, 100 g) UNIFORM FORMULARY Gel, External, as propionate: Gel, External: Generic: 0.05% (15 g, 30 g, 60 g) Generic: Clindamycin 1% and benzoyl peroxide 5% (25 g, 50 g) Liquid, External, as propionate: Generic: 0.05% (59 mL, 125 mL) NONFORMULARY Lotion, External, as propionate: Gel, External: Generic: 0.05% (59 mL, 118 mL) Neuac Kit: Clindamycin phosphate 1.2% and benzoyl peroxide 5% (130 g) Shampoo, External, as propionate: [with moisturizer] Generic: 0.05% (118 mL) Onexton: Clindamycin phosphate 1.2% and benzoyl peroxide 3.75% (50 g) Solution, External, as propionate: [contains propylene glycol] Generic: 0.05% (25 mL, 50 mL) Clindamycin (Systemic) NOT COVERED DoD Uniform Formulary Outpatient Dosage Forms Cream, External, as propionate: BASIC CORE FORMULARY Impoyz: 0.025% (60 g) [contains cetostearyl alcohol, methylparaben, propyl- Capsule, Oral, as hydrochloride [strength expressed as base]: paraben] Generic: 150 mg Kit, External, as propionate: UNIFORM FORMULARY Clodan: 0.05% [contains alcohol, usp, cetyl alcohol, edetate disodium, propy- Capsule, Oral, as hydrochloride [strength expressed as base]: lene glycol] Generic: 75 mg, 300 mg Clocortolone Kit, Injection, as phosphate [strength expressed as base]: DoD Uniform Formulary Outpatient Dosage Forms CLIN Single Use: 300 mg/2 mL [contains benzyl alcohol, edetate disodium] UNIFORM FORMULARY Solution, Injection, as phosphate [strength expressed as base]: Cream, External, as pivalate: Generic: 300 mg/2 mL (2 mL); 600 mg/4 mL (4 mL); 900 mg/6 mL (6 mL); Generic: 0.1% (45 g, 75 g, 90 g) 9000 mg/60 mL (60 mL); 9 g/60 mL (60 mL) NONFORMULARY Solution, Intravenous, as phosphate [strength expressed as base]: Cream, External, as pivalate: Generic: 150 mg/mL (2 mL); 300 mg/50 mL (50 mL); 600 mg/50 mL (50 mL); Cloderm: 0.1% (45 g, 90 g) 900 mg/50 mL (50 mL); 900 mg/6 mL (6 mL) Cloderm Pump: 0.1% (75 g) Solution Reconstituted, Oral, as palmitate hydrochloride [strength expressed as base]: Clofarabine Generic: 75 mg/5 mL (100 mL) DoD Uniform Formulary Outpatient Dosage Forms Clindamycin (Topical) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous [preservative free]: BASIC CORE FORMULARY Clolar: 1 mg/mL (20 mL) Cream, Vaginal, as phosphate [strength expressed as base]: Clofazimine Generic: 2% (40 g) DoD Uniform Formulary Outpatient Dosage Forms Solution, External, as phosphate [strength expressed as base]: UNIFORM FORMULARY Generic: 1% (30 mL, 60 mL) Capsule, Oral: UNIFORM FORMULARY Generic: 50 mg Foam, External, as phosphate [strength expressed as base]: Generic: 1% (50 g, 100 g) 28 CODEINE AND CHLORPHENIRAMINE ClomiPHENE Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 25 mg, 50 mg, 100 mg, 200 mg UNIFORM FORMULARY Tablet Dispersible, Oral: Tablet, Oral, as citrate: Generic: 12.5 mg, 25 mg, 100 mg, 150 mg, 200 mg Generic: 50 mg Coal Tar ClomiPRAMINE DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Foam, External: Capsule, Oral, as hydrochloride: Scytera: 2% (100 g) [contains disodium edta] Generic: 25 mg, 50 mg, 75 mg Ointment, External: Psoriasin: 2% (113 g) [contains alcohol, usp, polysorbate 80] ClonazePAM Shampoo, External: DoD Uniform Formulary Outpatient Dosage Forms Beta Care Betatar Gel: 2.5% (480 mL) [contains trolamine (triethanolamine)] BASIC CORE FORMULARY DHS Tar: 0.5% (120 mL, 240 mL) Tablet, Oral: DHS Tar Gel: 0.5% (240 mL) Generic: 0.5 mg Ionil-T: 1% (473 mL) [contains alcohol, usp, benzalkonium chloride, edetate sodium (tetrasodium), isopropyl alcohol] UNIFORM FORMULARY PC-Tar: 1% (177 mL) Tablet, Oral: Pentrax Gold: 4% (168 mL) Generic: 1 mg, 2 mg Tera-Gel Tar: 0.5% (118 mL, 235 mL) [contains edetate sodium (tetrasodium), Tablet Dispersible, Oral: methylparaben, polysorbate 80, propylparaben] Generic: 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 2 mg Therapeutic: 0.5% (251 mL) CloNIDine Theraplex T: 1% (240 mL) DoD Uniform Formulary Outpatient Dosage Forms X-Seb T Pearl: 10% (236 mL) [contains brilliant blue fcf (fd&c blue #1), edetate disodium] BASIC CORE FORMULARY X-Seb T Plus: 10% (236 mL) [contains brilliant blue fcf (fd&c blue #1), edetate Tablet, Oral, as hydrochloride: disodium] Generic: 0.1 mg, 0.2 mg, 0.3 mg Solution, External: UNIFORM FORMULARY Generic: 20% (100 mL, 500 mL, 4000 mL) Patch Weekly, Transdermal: Generic: 0.1 mg/24 hr (1 ea, 4 ea); 0.2 mg/24 hr (1 ea, 4 ea); 0.3 mg/24 hr (1 Coal Tar and Salicylic Acid ea, 4 ea) DoD Uniform Formulary Outpatient Dosage Forms Solution, Epidural, as hydrochloride: UNIFORM FORMULARY Generic: 100 mcg/mL (10 mL); 500 mcg/mL (10 mL) Gel, External [shampoo]: Solution, Epidural, as hydrochloride [preservative free]: Tarsum: Coal tar solution 10% [equivalent to coal tar 2%] and salicylic acid Generic: 100 mcg/mL (10 mL); 500 mcg/mL (10 mL) (120 mL, 240 mL) Tablet Extended Release 12 Hour, Oral, as hydrochloride: Shampoo, External: Generic: 0.1 mg X-Seb T Pearl: Coal tar solution 10% [equivalent to coal tar 2%] and salicylic acid (120 mL, 240 mL) Clonidine and Chlorthalidone X-Seb T Plus: Coal tar solution 10% [equivalent to coal tar 2%] and salicylic DoD Uniform Formulary Outpatient Dosage Forms acid (120 mL, 240 mL) [conditioning shampoo] UNIFORM FORMULARY Tablet, Oral: Cobicistat 0.1: Clonidine hydrochloride 0.1 mg and chlorthalidone 15 mg DoD Uniform Formulary Outpatient Dosage Forms 0.2: Clonidine hydrochloride 0.2 mg and chlorthalidone 15 mg UNIFORM FORMULARY 0.3: Clonidine hydrochloride 0.3 mg and chlorthalidone 15 mg Tablet, Oral: Tybost: 150 mg Clopidogrel DoD Uniform Formulary Outpatient Dosage Forms Cobimetinib BASIC CORE FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 75 mg, 300 mg Tablet, Oral: Cotellic: 20 mg Clorazepate DoD Uniform Formulary Outpatient Dosage Forms Cocaine (Topical) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral, as dipotassium: UNIFORM FORMULARY Generic: 3.75 mg, 7.5 mg, 15 mg Solution, External, as hydrochloride: Generic: 4% (4 mL, 10 mL) Clotrimazole (Oral) NONFORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Nasal, as hydrochloride [strength expressed as base]: UNIFORM FORMULARY Goprelto: 4% [40 mg/mL] (4mL) (4 mL) Lozenge, Mouth/Throat: Generic: 4% [40 mg/mL] (4mL) (4 mL) Generic: 10 mg (70 ea, 140 ea) Troche, Mouth/Throat: Coccidioides immitis Skin Test Generic: 10 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Clotrimazole (Topical) Solution, Intradermal: DoD Uniform Formulary Outpatient Dosage Forms Spherusol: 127 mcg/0.1 mL (1 mL) [contains phenol, thimerosal] UNIFORM FORMULARY Cream, External: Codeine Generic: 1% (15 g, 30 g, 45 g) DoD Uniform Formulary Outpatient Dosage Forms Cream, Vaginal: UNIFORM FORMULARY 3 Day Vaginal: 2% (21 g) [contains benzyl alcohol, cetyl alcohol] Tablet, Oral, as sulfate: Clotrimazole 3 Day: 2% (22.2 g) Generic: 15 mg, 30 mg, 60 mg Gyne-Lotrimin 3: 2% (21 g) [contains benzyl alcohol, cetyl alcohol] Generic: 1% (45 g) Codeine and Chlorpheniramine Ointment, External: DoD Uniform Formulary Outpatient Dosage Forms Alevazol: 1% (56.7 g) UNIFORM FORMULARY Solution, External: Liquid, Oral: Generic: 1% (10 mL, 30 mL) Codar AR: Codeine phosphate 8 mg and chlorpheniramine maleate 2 mg per 5 mL (473 mL) [contains propylene glycol; apple flavor] CloZAPine Lexuss 210: Codeine phosphate 10 mg and chlorpheniramine maleate 2 mg DoD Uniform Formulary Outpatient Dosage Forms per 5 mL (473 mL) [sugar free; contains alcohol 0.1%, propylene glycol; UNIFORM FORMULARY vanilla cream flavor] Suspension, Oral: Z-Tuss AC: Codeine phosphate 9 mg and chlorpheniramine maleate 2 mg per Versacloz: 50 mg/mL (100 mL) [contains methylparaben sodium, propylpar- 5 mL (473 mL) [alcohol free, gluten free, sugar free; contains propylene aben sodium] glycol, sodium benzoate; cherry flavor] 29 CODEINE AND CHLORPHENIRAMINE Suspension Extended Release, Oral, as polistirex [strength expressed as base]: Collagen Hemostat Tuzistra XR: Codeine 14.7 mg and chlorpheniramine 2.8 mg per 5 mL (473 DoD Uniform Formulary Outpatient Dosage Forms mL) [contains polysorbate 80; cherry flavor] UNIFORM FORMULARY Codeine, Phenylephrine, and Triprolidine Miscellaneous, External: Actifoam Collagen Sponge: (10 ea) DoD Uniform Formulary Outpatient Dosage Forms Endo Avitene: (1 ea) UNIFORM FORMULARY Syringe Avitene: (1 g) Syrup, Oral: Ultrafoam Sponge 2x6.25x7CM: 2 cm x 6.25 cm x 7 cm (1 ea) Histex-AC: Codeine phosphate 10 mg, phenylephrine hydrochloride 10 mg, Ultrafoam Sponge 8x12.5x1CM: 8 cm x 12.5 cm x 1 cm (1 ea) and triprolidine hydrochloride 2.5 mg per 5 mL (473 mL) [alcohol free, dye Ultrafoam Sponge 8x12.5x3CM: 8 cm x 12.5 cm x 3 cm (1 ea) free, sugar free; contains methylparaben, propylene glycol, propylparaben; Ultrafoam Sponge 8x25x1CM: 8 cm x 25 cm x 1 cm (1 ea) bubble-gum flavor] Ultrafoam Sponge 8x6.25x1CM: 8 cm x 6.25 cm x 1 cm (1 ea) Coenzyme Q-10 Pad, External: DoD Uniform Formulary Outpatient Dosage Forms Avitene: (1 ea) UNIFORM FORMULARY Powder, External: Avitene Flour: (6 ea, 1 g, 5 g) Capsule, Oral: Generic: 10 mg, 30 mg, 50 mg, 60 mg, 100 mg Collodion, Flexible Capsule, Oral [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Active Q Maximum Strength: 300 mg [milk free, no artificial color(s), no UNIFORM FORMULARY artificial flavor(s), starch free, sugar free, wheat free, yeast free; contains Liquid, External: soybean lecithin] Generic: (100 mL, 500 mL, 4000 mL) Generic: 30 mg, 50 mg, 100 mg, 200 mg Liquid, Oral: Conivaptan Generic: 30 mg/5 mL (480 mL) DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 25 mg, 200 mg Solution, Intravenous, as hydrochloride: Tablet Dispersible, Oral: Vaprisol: 20 mg (100 mL) QuinZyme: 90 mg [orange-vanilla flavor] Continuous Renal Replacement Therapy Solutions Colchicine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Intravenous [concentrate; preservative free]: Capsule, Oral: Normocarb HF 25: Bicarbonate 25 mEq/L, chloride 116.5 mEq/L, magnesium Generic: 0.6 mg 1.5 mEq/L, sodium 140 mEq/L (240 mL) Tablet, Oral: Normocarb HF 35: Bicarbonate 35 mEq/L, chloride 106.5 mEq/L, magnesium Generic: 0.6 mg 1.5 mEq/L, sodium 140 mEq/L (240 mL) Solution, Intravenous [preservative free]: NONFORMULARY Phoxillum B22K4/0: Bicarbonate 22 mEq/L, chloride 122 mEq/L, magnesium Solution, Oral: 1.5 mEq/L, phosphate 1 mmol/L, potassium 4 mEq/L, sodium 140 mEq/L Gloperba: 0.6 mg/5 mL (150 mL) [contains benzyl alcohol, fd&c red #40, (5000 mL) propylene glycol; cherry flavor]Tablet, Oral: Phoxillum BK4/2.5: Bicarbonate 32 mEq/L, calcium 2.5 mEq/L, chloride 114.5 Colchicine and Probenecid mEq/L, magnesium 1.5 mEq/L, phosphate 1 mmol/L, potassium 4 mEq/L, DoD Uniform Formulary Outpatient Dosage Forms sodium 140 mEq/L (5000 mL) UNIFORM FORMULARY PrismaSol B22GK 4/0: Bicarbonate 22 mEq/L, chloride 120.5 mEq/L, dextrose Tablet, Oral: 100 mg/dL, lactate 3 mEq/L, magnesium 1.5 mEq/L, potassium 4 mEq/L, Generic: Colchicine 0.5 mg and probenecid 0.5 g sodium 140 mEq/L (5000 mL) PrismaSol BGK 0/2.5: Bicarbonate 32 mEq/L, calcium 2.5 mEq/L, chloride 109 Colestipol mEq/L, dextrose 100 mg/dL, lactate 3 mEq/L, magnesium 1.5 mEq/L, DoD Uniform Formulary Outpatient Dosage Forms sodium 140 mEq/L (5000 mL) UNIFORM FORMULARY PrismaSol BGK 2/0: Bicarbonate 32 mEq/L, chloride 108 mEq/L, dextrose Granules, Oral, as hydrochloride: 100 mg/dL, lactate 3 mEq/L, magnesium 1 mEq/L, potassium 2 mEq/L, Generic: 5 g/5 g scoop (500 g) sodium 140 mEq/L (5000 mL) Packet, Oral, as hydrochloride: PrismaSol BGK 2/3.5: Bicarbonate 32 mEq/L, calcium 3.5 mEq/L, chloride Generic: 5 g (30 ea, 90 ea) 111.5 mEq/L, dextrose 100 mg/dL, lactate 3 mEq/L, magnesium 1 mEq/L, Tablet, Oral, as hydrochloride: potassium 2 mEq/L, sodium 140 mEq/L (5000 mL) Generic: 1 g PrismaSol BGK 4/0/1.2: Bicarbonate 32 mEq/L, chloride 110.2 mEq/L, dex- trose 100 mg/dL, lactate 3 mEq/L, magnesium 1.2 mEq/L, potassium 4 Colistimethate mEq/L, sodium 140 mEq/L (5000 mL) DoD Uniform Formulary Outpatient Dosage Forms PrismaSol BGK 4/2.5: Bicarbonate 32 mEq/L, calcium 2.5 mEq/L, chloride 113 UNIFORM FORMULARY mEq/L, dextrose 100 mg/dL, lactate 3 mEq/L, magnesium 1.5 mEq/L, Solution Reconstituted, Injection [strength expressed as base]: potassium 4 mEq/L, sodium 140 mEq/L (5000 mL) Generic: 150 mg (1 ea) PrismaSol BK 0/0/1.2: Bicarbonate 32 mEq/L, chloride 106.2 mEq/L, lactate 3 Solution Reconstituted, Injection [strength expressed as base, preservative mEq/L, magnesium 1.2 mEq/L, sodium 140 mEq/L (5000 mL) free]: Generic: 150 mg (1 ea) Copanlisib DoD Uniform Formulary Outpatient Dosage Forms Collagen (Absorbable/Dental) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous: UNIFORM FORMULARY Aliqopa: 60 mg (1 ea) Wound dressing: Copper 3/8" x 3/4" 3/4" x 1 1/2" DoD Uniform Formulary Outpatient Dosage Forms 1" x 3" UNIFORM FORMULARY Capsule, Oral [preservative free]: Collagenase (Systemic) Cu-5: 5 mg [dye free] DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous: NOT COVERED Generic: 0.4 mg/mL (10 mL) Solution Reconstituted, Injection: Tablet, Oral: Xiaflex: 0.9 mg (1 ea) Coppermin: 5 mg [corn free, rye free, wheat free] Collagenase (Topical) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Ointment, External: Santyl: 250 units/g (30 g, 90 g) 30 CYCLOSPORINE (OPHTHALMIC) Copper IUD Solution Reconstituted, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms CroFab: (1 ea) [contains thimerosal] UNIFORM FORMULARY Crotamiton Intrauterine Device, Intrauterine: DoD Uniform Formulary Outpatient Dosage Forms Paragard Intrauterine Copper: UNIFORM FORMULARY Corticorelin Cream, External: DoD Uniform Formulary Outpatient Dosage Forms Eurax: 10% (60 g) UNIFORM FORMULARY Lotion, External: Solution Reconstituted, Intravenous, as trifluoroacetate: Crotan: 10% (60 g, 227 g, 454 g) [contains benzyl alcohol, cetyl alcohol, Acthrel: 100 mcg (1 ea) propylene glycol] Eurax: 10% (60 g, 454 g) Corticotropin DoD Uniform Formulary Outpatient Dosage Forms Cyanocobalamin UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Gel, Injection: UNIFORM FORMULARY Acthar: 80 units/mL (5 mL) [contains phenol] Kit, Injection: B-12 Compliance Injection: 1000 mcg/mL [contains benzyl alcohol] Cortisone Physicians EZ Use B-12: 1000 mcg/mL [contains benzyl alcohol] DoD Uniform Formulary Outpatient Dosage Forms Vitamin Deficiency System-B12: 1000 mcg/mL [contains benzyl alcohol] UNIFORM FORMULARY Liquid, Sublingual: Tablet, Oral, as acetate: Generic: 3000 mcg/mL (52 mL) Generic: 25 mg Lozenge, Oral: Generic: 50 mcg (100 ea); 100 mcg (100 ea); 250 mcg (100 ea, 250 ea); 500 Cosyntropin mcg (100 ea, 250 ea) DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection: UNIFORM FORMULARY Generic: 1000 mcg/mL (1 mL, 10 mL, 30 mL) Solution Reconstituted, Injection: Solution, Nasal: Generic: 0.25 mg (1 ea) Nascobal: 500 mcg/0.1 mL (1 ea) [contains benzalkonium chloride] Solution Reconstituted, Injection [preservative free]: Tablet, Oral: Generic: 0.25 mg (1 ea) Generic: 100 mcg, 250 mcg, 500 mcg, 1000 mcg COVID-19 Vaccine (Adenovirus Vector) Tablet, Oral [preservative free]: Generic: 100 mcg, 500 mcg, 1000 mcg DoD Uniform Formulary Outpatient Dosage Forms Tablet Extended Release, Oral: UNIFORM FORMULARY Generic: 1000 mcg Suspension, Intramuscular [preservative free]: Tablet, Sublingual: Janssen COVID-19 Vaccine: 50 billion viral particles per 0.5 mL (2.5 mL) Generic: 2500 mcg [contains alcohol, usp, polysorbate 80] Tablet, Sublingual [preservative free]: COVID-19 Vaccine (mRNA) Generic: 2500 mcg DoD Uniform Formulary Outpatient Dosage Forms Cyclobenzaprine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Suspension, Intramuscular: BASIC CORE FORMULARY Pfizer-BioNTech COVID-19 Vacc: 30 mcg/0.3 mL (1.5 mL) [contains 2-((peg)- Tablet, Oral, as hydrochloride: 2000)-n,n-ditetradecylacetamide] Generic: 10 mg Suspension, Intramuscular [preservative free]: Moderna COVID-19 Vaccine: 100 mcg/0.5 mL (5 mL) [contains dmg-peg 2000] UNIFORM FORMULARY Capsule Extended Release 24 Hour, Oral, as hydrochloride: Crizotinib Generic: 15 mg, 30 mg DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral, as hydrochloride: UNIFORM FORMULARY Generic: 5 mg, 7.5 mg Capsule, Oral: Xalkori: 200 mg, 250 mg Cyclopentolate DoD Uniform Formulary Outpatient Dosage Forms Crofelemer UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Ophthalmic, as hydrochloride: UNIFORM FORMULARY Generic: 0.5% (15 mL); 1% (2 mL, 15 mL); 2% (2 mL, 5 mL, 15 mL) Tablet Delayed Release, Oral: Mytesi: 125 mg [contains methylparaben, propylparaben] Cyclopentolate and Phenylephrine DoD Uniform Formulary Outpatient Dosage Forms Cromolyn (Nasal) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, ophthalmic: UNIFORM FORMULARY Cyclomydril: Cyclopentolate hydrochloride 0.2% and phenylephrine hydro- Aerosol Solution, Nasal, as sodium: chloride 1% (2 mL, 5 mL) [contains benzalkonium chloride] Generic: 5.2 mg/actuation (26 mL) Cyclophosphamide Cromolyn (Ophthalmic) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral: Solution, Ophthalmic, as sodium: Generic: 25 mg, 50 mg Generic: 4% (10 mL) Solution Reconstituted, Injection: Cromolyn (Oral Inhalation) Generic: 500 mg (1 ea); 1 g (1 ea); 2 g (1 ea) DoD Uniform Formulary Outpatient Dosage Forms CycloSERINE UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Nebulization Solution, Inhalation, as sodium: UNIFORM FORMULARY Generic: 20 mg/2 mL (2 mL) Capsule, Oral: Cromolyn (Systemic) Generic: 250 mg DoD Uniform Formulary Outpatient Dosage Forms CycloSPORINE (Ophthalmic) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Concentrate, Oral, as sodium: UNIFORM FORMULARY Generic: 100 mg/5 mL (5 mL) Emulsion, Ophthalmic [preservative free]: Concentrate, Oral, as sodium [preservative free]: Restasis: 0.05% (1 ea) [contains polysorbate 80] Generic: 100 mg/5 mL (5 mL) Restasis Multidose: 0.05% (5.5 mL) [contains polysorbate 80] Crotalidae Polyvalent Immune FAB (Ovine) NONFORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Ophthalmic [preservative free]: UNIFORM FORMULARY Cequa: 0.09% (1 ea) 31 CYCLOSPORINE (SYSTEMIC) CycloSPORINE (Systemic) Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Vizimpro: 15 mg, 30 mg, 45 mg UNIFORM FORMULARY DACTINomycin Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 25 mg, 50 mg, 100 mg Solution, Intravenous: UNIFORM FORMULARY Generic: 50 mg/mL (5 mL) Solution Reconstituted, Intravenous: Solution, Oral: Cosmegen: 0.5 mg (1 ea) Generic: 100 mg/mL (50 mL) Dalbavancin Cyproheptadine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Solution Reconstituted, Intravenous [preservative free]: Syrup, Oral, as hydrochloride: Dalvance: 500 mg (1 ea) Generic: 2 mg/5 mL (473 mL) Dalfampridine Tablet, Oral, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Generic: 4 mg UNIFORM FORMULARY Cysteamine (Ophthalmic) Tablet Extended Release 12 Hour, Oral: DoD Uniform Formulary Outpatient Dosage Forms Ampyra: 10 mg UNIFORM FORMULARY Dalteparin Solution, Ophthalmic: DoD Uniform Formulary Outpatient Dosage Forms Cystaran: 0.44% (15 mL) [contains benzalkonium chloride] UNIFORM FORMULARY Solution, Ophthalmic, as hydrochloride: Solution, Subcutaneous: Cystadrops: 0.37% (5 mL) [contains benzalkonium chloride, disodium edta] Fragmin: 95,000 units/3.8 mL (3.8 mL) [contains benzyl alcohol] Cysteamine (Systemic) Solution, Subcutaneous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Fragmin: 10,000 units/mL (1 mL); 2500 units/0.2 mL (0.2 mL); 5000 units/0.2 UNIFORM FORMULARY mL (0.2 mL); 7500 units/0.3 mL (0.3 mL); 12,500 units/0.5 mL (0.5 mL); Capsule, Oral: 15,000 units/0.6 mL (0.6 mL); 18,000 units/0.72 mL (0.72 mL) Cystagon: 50 mg, 150 mg Danazol Capsule Delayed Release, Oral: DoD Uniform Formulary Outpatient Dosage Forms Procysbi: 25 mg, 75 mg UNIFORM FORMULARY Cysteine Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 50 mg, 100 mg, 200 mg UNIFORM FORMULARY Dantrolene Capsule, Oral, as hydrochloride [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Cystech: 500 mg [dye free] UNIFORM FORMULARY Solution, Intravenous, as hydrochloride: Capsule, Oral, as sodium: Generic: 50 mg/mL (10 mL, 50 mL) Generic: 25 mg, 50 mg, 100 mg Cytarabine (Conventional) Solution Reconstituted, Intravenous, as sodium: DoD Uniform Formulary Outpatient Dosage Forms Dantrium: 20 mg (1 ea) UNIFORM FORMULARY Revonto: 20 mg (1 ea) Solution, Injection: Suspension Reconstituted, Intravenous, as sodium: Generic: 20 mg/mL (25 mL) Ryanodex: 250 mg (1 ea) [contains polysorbate 80] Solution, Injection [preservative free]: Dapsone (Systemic) Generic: 20 mg/mL (5 mL, 50 mL); 100 mg/mL (20 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Injection: Generic: 100 mg (1 ea); 500 mg (1 ea); 1 g (1 ea) UNIFORM FORMULARY Tablet, Oral: Cytarabine (Liposomal) Generic: 25 mg, 100 mg DoD Uniform Formulary Outpatient Dosage Forms DAPTOmycin UNIFORM FORMULARY Suspension, Intrathecal: DoD Uniform Formulary Outpatient Dosage Forms DepoCyt: 50 mg/5 mL (5 mL) [contains cholesterol, dioleoylphosphatidylcho- NOT COVERED line (dopc), dipalmitoylphosphatidylglycerol (dppg), triolein] Solution Reconstituted, Intravenous [preservative free]: Generic: 500 mg (1 ea) Cytomegalovirus Immune Globulin (Intravenous-Human) Daratumumab DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Injection, solution [preservative free]: UNIFORM FORMULARY CytoGam: 50 mg (± 10 mg)/mL (50 mL) [contains sodium 20-30 mEq/L, Solution, Intravenous [preservative free]: human albumin, and sucrose 50 mg/mL] Darzalex: 100 mg/5 mL (5 mL); 400 mg/20 mL (20 mL) [contains mouse (murine) and/or hamster protein] Dabigatran Etexilate DoD Uniform Formulary Outpatient Dosage Forms Darbepoetin Alfa UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral: UNIFORM FORMULARY Pradaxa: 75 mg, 110 mg, 150 mg Solution, Injection [preservative free]: Aranesp (Albumin Free): 25 mcg/mL (1 mL); 40 mcg/mL (1 mL); 60 mcg/mL (1 Dabrafenib mL); 100 mcg/mL (1 mL); 200 mcg/mL (1 mL); 300 mcg/mL (1 mL) [albumin DoD Uniform Formulary Outpatient Dosage Forms free; contains mouse (murine) and/or hamster protein, polysorbate 80] UNIFORM FORMULARY Solution Prefilled Syringe, Injection [preservative free]: Capsule, Oral: Aranesp (Albumin Free): 10 mcg/0.4 mL (0.4 mL); 25 mcg/0.42 mL (0.42 mL); Tafinlar: 50 mg, 75 mg 40 mcg/0.4 mL (0.4 mL); 60 mcg/0.3 mL (0.3 mL); 100 mcg/0.5 mL (0.5 mL); 150 mcg/0.3 mL (0.3 mL); 200 mcg/0.4 mL (0.4 mL); 300 mcg/0.6 mL (0.6 Dacarbazine mL); 500 mcg/mL (1 mL) [albumin free; contains mouse (murine) and/or DoD Uniform Formulary Outpatient Dosage Forms hamster protein, polysorbate 80] UNIFORM FORMULARY Solution Reconstituted, Intravenous: Darunavir Generic: 100 mg (1 ea); 200 mg (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous [preservative free]: UNIFORM FORMULARY Generic: 200 mg (1 ea) Suspension, Oral: Prezista: 100 mg/mL (200 mL) [contains methylparaben sodium; strawberry Dacomitinib cream flavor] DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Prezista: 75 mg, 150 mg, 600 mg, 800 mg 32 DESOXIMETASONE Darunavir and Cobicistat Solution Reconstituted, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Baxdela: 300 mg (1 ea) [contains edetate disodium] UNIFORM FORMULARY NONFORMULARY Tablet, Oral: Tablet, Oral: Prezcobix: Darunavir 800 mg and cobicistat 150 mg Baxdela: 450 mg Darunavir, Cobicistat, Emtricitabine, and Tenofovir Delavirdine Alafenamide DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral, as mesylate: Tablet, Oral: Rescriptor: 100 mg, 200 mg Symtuza: 800 mg - 150 mg - 200 mg -10 mg Demeclocycline Dasatinib DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral, as hydrochloride: Tablet, Oral: Generic: 150 mg, 300 mg Sprycel: 20 mg, 50 mg, 70 mg, 80 mg, 100 mg, 140 mg Denosumab DAUNOrubicin (Conventional) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Subcutaneous [preservative free]: Injectable, Intravenous: Prolia: 60 mg/mL (1 mL) [contains mouse (murine) and/or hamster protein] Generic: 5 mg/mL (4 mL) Xgeva: 120 mg/1.7 mL (1.7 mL) Injectable, Intravenous [preservative free]: Generic: 5 mg/mL (4 mL, 10 mL) Desflurane DoD Uniform Formulary Outpatient Dosage Forms Decitabine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Inhalation: UNIFORM FORMULARY Suprane: 100% (240 mL) Solution Reconstituted, Intravenous: Generic: 50 mg (1 ea) Desipramine DoD Uniform Formulary Outpatient Dosage Forms Decitabine and Cedazuridine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral, as hydrochloride: Generic: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg UNIFORM FORMULARY Tablet, Oral: Desirudin Inqovi: 35-100 MG DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Deferasirox Solution Reconstituted, Subcutaneous: DoD Uniform Formulary Outpatient Dosage Forms Iprivask: 15 mg (1 ea) UNIFORM FORMULARY Packet, Oral: Desmopressin Jadenu Sprinkle: 90 mg (30 ea); 180 mg (30 ea); 360 mg (30 ea) DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Jadenu: 90 mg, 180 mg, 360 mg Solution, Injection, as acetate: Tablet Soluble, Oral: Generic: 4 mcg/mL (1 mL, 10 mL) Exjade: 125 mg, 250 mg, 500 mg Solution, Injection, as acetate [preservative free]: Generic: 4 mcg/mL (1 mL) Deferiprone Solution, Nasal, as acetate: DoD Uniform Formulary Outpatient Dosage Forms Stimate: 1.5 mg/mL (2.5 mL) [contains benzalkonium chloride] UNIFORM FORMULARY Generic: 0.01% (2.5 mL, 5 mL) Tablet, Oral: Tablet, Oral, as acetate: Ferriprox: 500 mg [scored] Generic: 0.1 mg, 0.2 mg NONFORMULARY Solution, Oral: NONFORMULARY Ferriprox: 100 mg/mL (500 mL) [cherry-peppermint flavor] Emulsion, Nasal, as acetate: Noctiva: 0.83 mcg/0.1 mL (3.8 g); 1.66 mcg/0.1 mL (3.8 g) Deferoxamine Tablet, Sublingual: DoD Uniform Formulary Outpatient Dosage Forms Nocdurna: 27.7 mcg, 55.3 mcg UNIFORM FORMULARY Solution Reconstituted, Injection, as mesylate: Desonide Generic: 500 mg (1 ea); 2 g (1 ea) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Defibrotide Cream, External: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.05% (15 g, 60 g) UNIFORM FORMULARY Ointment, External: Solution, Intravenous, as sodium [preservative free]: Generic: 0.05% (15 g, 60 g) Defitelio: 200 mg/2.5 mL (2.5 mL) NONFORMULARY Foam, External: Deflazacort Verdeso: 0.05% (100 g) [contains cetyl alcohol, propylene glycol] DoD Uniform Formulary Outpatient Dosage Forms Gel, External: UNIFORM FORMULARY Desonate: 0.05% (60 g) [contains edetate disodium dihydrate, methylparaben, Suspension, Oral: propylene glycol, propylparaben] Emflaza: 22.75 mg/mL (13 mL) [contains polysorbate 80, sorbitol] Lotion, External: Tablet, Oral: Generic: 0.05% (59 mL, 118 mL) Emflaza: 6 mg, 18 mg, 30 mg, 36 mg [contains corn starch] Desoximetasone Degarelix DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Cream, External: Suspension, Oral: Generic: 0.05% (15 g, 60 g, 100 g); 0.25% (15 g, 60 g, 100 g) Emflaza: 22.75 mg/mL (13 mL) [contains polysorbate 80, sorbitol] Liquid, External: Tablet, Oral: Topicort Spray: 0.25% (100 mL) [contains isopropyl alcohol, levomenthol] Emflaza: 6 mg, 18 mg, 30 mg, 36 mg [contains corn starch] Ointment, External: Generic: 0.05% (60 g, 100 g); 0.25% (15 g, 60 g, 100 g) Delafloxacin NONFORMULARY DoD Uniform Formulary Outpatient Dosage Forms Gel, External: UNIFORM FORMULARY Generic: 0.05% (15 g, 60 g) 33 DESVENLAFAXINE Desvenlafaxine Precedex: 80 mcg/20 mL (20 mL) DoD Uniform Formulary Outpatient Dosage Forms Generic: 200 mcg/2 mL (2 mL) UNIFORM FORMULARY Dexmethylphenidate Tablet Extended Release 24 Hour, Oral: Generic: 50 mg, 100 mg DoD Uniform Formulary Outpatient Dosage Forms NONFORMULARY UNIFORM FORMULARY Tablet Extended Release 24 Hour, Oral: Tablet, Oral, as hydrochloride: Khedezla: 50 mg, 100 mg Generic: 2.5 mg, 5 mg, 10 mg Tablet Extended Release 24 Hour, Oral, as succinate [strength expressed as Capsule Extended Release 24 Hour, Oral, as hydrochloride: base]: Generic: 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg Pristiq: 25 mg, 50 mg, 100 mg Dexrazoxane Generic: 25 mg, 50 mg, 100 mg DoD Uniform Formulary Outpatient Dosage Forms Deutetrabenazine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous: UNIFORM FORMULARY Generic: 250 mg (1 ea); 500 mg (1 ea) Tablet, Oral: Dextran Austedo: 6 mg, 9 mg, 12 mg DoD Uniform Formulary Outpatient Dosage Forms DexAMETHasone (Ophthalmic) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous: UNIFORM FORMULARY LMD in D5W: 10% Dextran 40 (500 mL) [latex free] Implant, Intraocular [preservative free]: LMD in NaCl: 10% Dextran 40 (500 mL) [latex free] Ozurdex: 0.7 mg (1 ea) Dextranomer and Hyaluronate Derivatives Solution, Ophthalmic, as phosphate: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.1% (5 mL) UNIFORM FORMULARY Suspension, Ophthalmic: Injection, gel: Maxidex: 0.1% (5 mL) Solesta: Dextranomer 50 mg and sodium hyaluronate 15 mg per 1 mL (1 mL) DexAMETHasone (Systemic) Dextroamphetamine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Concentrate, Oral: Capsule Extended Release 24 Hour, Oral, as sulfate: Dexamethasone Intensol: 1 mg/mL (30 mL) [contains alcohol, usp; unflavored Generic: 5 mg, 10 mg, 15 mg flavor] Solution, Oral, as sulfate: Elixir, Oral: Generic: 5 mg/5 mL (473 mL) Generic: 0.5 mg/5 mL (237 mL) Tablet, Oral, as sulfate: Kit, Injection, as sodium phosphate: Zenzedi: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg, 30 mg ReadySharp Dexamethasone: 10 mg/mL [contains benzyl alcohol, sodium Generic: 5 mg, 10 mg sulfite] Kit, Injection, as sodium phosphate [preservative free]: Dextroamphetamine and Amphetamine Active Injection D: 10 mg/mL DoD Uniform Formulary Outpatient Dosage Forms DoubleDex: 10 mg/mL BASIC CORE FORMULARY Solution, Oral: Capsule, Extended release, Oral: Generic: 0.5 mg/5 mL (240 mL, 500 mL) Generic: 5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine Solution, Injection, as sodium phosphate: saccharate 1.25 mg, amphetamine aspartate monohydrate 1.25 mg, Generic: 4 mg/mL (1 mL); 20 mg/5 mL (5 mL); 120 mg/30 mL (30 mL); amphetamine sulfate 1.25 mg (equivalent to amphetamine base 3.1 mg)] 10 mg/mL (1 mL); 100 mg/10 mL (10 mL) Generic: 10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine Solution, Injection, as sodium phosphate [preservative free]: saccharate 2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphet- Generic: 4 mg/mL (1 mL); 10 mg/mL (1 mL) amine sulfate 2.5 mg (equivalent to amphetamine base 6.3 mg)] Tablet, Oral: Generic: 15 mg [dextroamphetamine sulfate 3.75 mg, dextroamphetamine Generic: 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg saccharate 3.75 mg, amphetamine aspartate monohydrate 3.75 mg, Tablet Therapy Pack, Oral: amphetamine sulfate 3.75 mg (equivalent to amphetamine base 9.4 mg)] LoCort 11-Day: 1.5 mg (41 ea) [scored; contains fd&c red #40] Generic: 20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine sac- LoCort 7-Day: 1.5 mg (27 ea) [scored; contains fd&c red #40] charate 5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine ZonaCort 11 Day: 1.5 mg (41 ea) [scored; contains fd&c red #40] sulfate 5 mg (equivalent to amphetamine base 12.5 mg)] ZonaCort 7 Day: 1.5 mg (27 ea) [scored; contains fd&c red #40] Generic: 25 mg [dextroamphetamine sulfate 6.25 mg, dextroamphetamine Dexbrompheniramine and Phenylephrine saccharate 6.25 mg, amphetamine aspartate monohydrate 6.25 mg, DoD Uniform Formulary Outpatient Dosage Forms amphetamine sulfate 6.25 mg (equivalent to amphetamine base 15.6 mg)] Generic: 30 mg [dextroamphetamine sulfate 7.5 mg, dextroamphetamine UNIFORM FORMULARY saccharate 7.5 mg, amphetamine aspartate monohydrate 7.5 mg, amphet- Syrup, Oral: amine sulfate 7.5 mg (equivalent to amphetamine base 18.8 mg)] Dallergy: Dexbrompheniramine maleate 1 mg and phenylephrine hydrochlor- ide 5 mg per 5 mL (473 mL) [contains propylene glycol, saccharin sodium; UNIFORM FORMULARY grape flavor] Tablet, oral: 5 mg [dextroamphetamine sulfate 1.25 mg, dextroamphetamine saccharate Dexchlorpheniramine and Pseudoephedrine 1.25 mg, amphetamine aspartate monohydrate 1.25 mg, amphetamine sul- DoD Uniform Formulary Outpatient Dosage Forms fate 1.25 mg (equivalent to amphetamine base 3.13 mg)] UNIFORM FORMULARY 7.5 mg [dextroamphetamine sulfate 1.875 mg, dextroamphetamine saccha- Tablet, Oral: rate 1.875 mg, amphetamine aspartate monohydrate 1.875 mg, amphet- Rescon: Dexchlorpheniramine maleate 2 mg and pseudoephedrine hydro- amine sulfate 1.875 mg (equivalent to amphetamine base 4.7 mg)] chloride 60 mg 10 mg [dextroamphetamine sulfate 2.5 mg, dextroamphetamine saccharate 2.5 mg, amphetamine aspartate monohydrate 2.5 mg, amphetamine sulfate Dexchlorpheniramine, Dextromethorphan, and Phenylephrine 2.5 mg (equivalent to amphetamine base 6.3 mg)] DoD Uniform Formulary Outpatient Dosage Forms 12.5 mg [dextroamphetamine sulfate 3.125 mg, dextroamphetamine saccha- UNIFORM FORMULARY rate 3.125 mg, amphetamine aspartate monohydrate 3.125 mg, amphet- Syrup, Oral: amine sulfate 3.125 mg (equivalent to amphetamine base 7.8 mg)] Polytussin DM: Dexchlorpheniramine 1 mg, dextromethorphan 10 mg, and 15 mg [dextroamphetamine sulfate 3.75 mg, dextroamphetamine saccharate phenylephrine 5 mg per 5 mL (480 mL) 3.75 mg, amphetamine aspartate monohydrate 3.75 mg, amphetamine sul- DexmedeTOMIDine fate 3.75 mg (equivalent to amphetamine base 9.4 mg)] 20 mg [dextroamphetamine sulfate 5 mg, dextroamphetamine saccharate DoD Uniform Formulary Outpatient Dosage Forms 5 mg, amphetamine aspartate monohydrate 5 mg, amphetamine sulfate UNIFORM FORMULARY 5 mg (equivalent to amphetamine base 12.6 mg)] Solution, Intravenous: 30 mg [dextroamphetamine sulfate 7.5 mg, dextroamphetamine saccharate Generic: 400 mcg/4 mL (4 mL); 1000 mcg/10 mL (10 mL) 7.5 mg, amphetamine aspartate monohydrate 7.5 mg, amphetamine sulfate Solution, Intravenous [preservative free]: 7.5 mg (equivalent to amphetamine base 18.8 mg)] Precedex: 400 mcg/100 mL (100 mL); 200 mcg/2 mL (2 mL) [additive free, latex free] NONFORMULARY Precedex: 200 mcg/50 mL (50 mL) [latex free] Mydayis: 25 mg, 37.5 mg, 50 mg 34 DIABETIC SUPPLIES Dextromethorphan Syrup, Oral: DoD Uniform Formulary Outpatient Dosage Forms PediaCare Children’s Multi-Symptom Cold: Dextromethorphan hydrobromide UNIFORM FORMULARY 5 mg and phenylephrine hydrochloride 2.5 mg per 5 mL (118 mL) [contains Capsule, Oral, as hydrobromide: sodium 15 mg/5 mL; sodium benzoate; grape flavor] Robafen Cough: 15 mg Safetussin CD: Dextromethorphan hydrobromide 15 mg and phenylephrine Robitussin Lingering CoughGels: 15 mg [contains polyethylene glycol, propy- hydrochloride 2.5 mg per 5 mL (120 mL), [alcohol free; sugar free; contains lene glycol] menthol, propylene glycol; orange flavor] Gel, Oral, as hydrobromide: Triaminic Day Time Cold & Cough: Dextromethorphan hydrobromide 5 mg ElixSure Cough: 7.5 mg/5 mL (120 mL) [alcohol free; contains carbomer 934p, and phenylephrine hydrochloride 2.5 mg per 5 mL (120 mL, 240 mL) propylene glycol, propylparaben; cherry bubblegum flavor] [contains benzoic acid; sodium 2 mg/5 mL; propylene glycol; cherry flavor] Liquid, Oral, as hydrobromide: Dextromethorphan and Quinidine Buckleys Cough: 12.5 mg/5 mL (118 mL) [alcohol free, sugar free; contains DoD Uniform Formulary Outpatient Dosage Forms butylparaben, menthol, propylparaben, saccharin sodium] UNIFORM FORMULARY Little Colds Cough Formula: 7.5 mg/mL (30 mL) [alcohol free, dye free, Capsule, Oral: saccharin free; contains sodium benzoate; grape flavor] Nuedexta: Dextromethorphan hydrobromide 20 mg and quinidine sul- PediaCare Childrens Long-Act: 7.5 mg/5 mL (118 mL) [contains brilliant blue fate 10 mg fcf (fd&c blue #1), saccharin sodium, sodium benzoate] Robitussin Lingering LA Cough: 15 mg/5 mL (118 mL) [contains alcohol, usp, Dextrose fd&c red #40, menthol, saccharin sodium, sodium benzoate] DoD Uniform Formulary Outpatient Dosage Forms Scot-Tussin Diabetes CF: 10 mg/5 mL (480 mL, 3780 mL) [alcohol free, dye UNIFORM FORMULARY free, fructose free, sodium free, sorbitol free, sugar free] Gel, Oral: Triaminic Long Acting Cough: 7.5 mg/5 mL (118 mL) [alcohol free, dye free, Glutose 15: 40% (37.5 g) pseudoephedrine free; contains benzoic acid, propylene glycol] Insta-Glucose: 77.4% (31 g) [contains fd&c red #40, methylparaben, propyl- Lozenge, Mouth/Throat, as hydrobromide: paraben, sodium benzoate] Hold: 5 mg (10 ea) Liquid, Oral: Trocal Cough Suppressant: 7.5 mg (1 ea) [cherry flavor] Glutol: 100 g/180 mL (180 mL) [lemon flavor] Strip, Oral, as hydrobromide: Solution, Intravenous: Triaminic Long Acting Cough: 7.5 mg (14 ea, 16 ea) [contains alcohol, usp] Generic: 250 mg/mL (10 mL); 5% (25 mL, 50 mL, 100 mL, 150 mL, 250 mL, Suspension Extended Release, Oral: 500 mL, 1000 mL); 10% (250 mL, 500 mL, 1000 mL); 20% (500 mL); 30% Generic: Dextromethorphan polistirex [equivalent to dextromethorphan hydro- (500 mL); 40% (500 mL); 50% (50 mL, 500 mL); 70% (500 mL, 1000 mL, bromide 30 mg/5 mL] (89 mL) 2000 mL) Syrup, Oral, as hydrobromide: Solution, Oral: Creomulsion Adult: 20 mg/15 mL (118 mL) Glucose Nursette: 5% (59 mL) Creomulsion for Children: 5 mg/5 mL (118 mL) [cherry flavor] Good Start 5% Glucose Water: 5% (88.7 mL) Robitussin Childrens Cough LA: 7.5 mg/5 mL (118 mL) [contains fd&c red #40, Tablet Chewable, Oral: propylene glycol, saccharin sodium, sodium benzoate] Generic: 4 g Silphen DM Cough: 10 mg/5 mL (118 mL) [contains alcohol, usp; strawberry flavor] Dextrose and Ringer's Injection (Lactated) Triaminic Long Acting Cough: 7.5 mg/5 mL (118 mL) [alcohol free, dye free; DoD Uniform Formulary Outpatient Dosage Forms contains benzoic acid, edetate disodium, propylene glycol] UNIFORM FORMULARY Dextromethorphan and Chlorpheniramine Solution, Intravenous: Generic: Dextrose 5% in Lactated Ringer's (500 mL, 1000 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Dextrose and Sodium Chloride Syrup, Oral: DoD Uniform Formulary Outpatient Dosage Forms Dimetapp Children’s Long Acting Cough Plus Cold: Dextromethorphan hydro- UNIFORM FORMULARY bromide 7.5 mg and chlorpheniramine maleate 1 mg per 5 mL (118 mL) Solution, Intravenous: [ethanol free, sugar free; contains sodium 3 mg/5 mL, sodium benzoate, Dextrose 10% and sodium chloride 0.2% (250 mL) propylene glycol; grape flavor] Dextrose 10% and sodium chloride 0.225% (250 mL) Robitussin Children’s Cough and Cold Long-Acting: Dextromethorphan hydro- Dextrose 10% and sodium chloride 0.45% (1000 mL) bromide 7.5 mg and chlorpheniramine maleate 1 mg per 5 mL (118 mL) Dextrose 2.5% and sodium chloride 0.45% (1000 mL) [ethanol free; contains sodium 3 mg/5 mL, sodium benzoate, propylene Dextrose 5% and sodium chloride 0.2% (250 mL, 500 mL, 1000 mL) glycol; fruit punch flavor] Dextrose 5% and sodium chloride 0.3% (500 mL, 1000 mL) Scot-Tussin DM Maximum Strength: Dextromethorphan hydrobromide 15 mg Dextrose 5% and sodium chloride 0.33% (500 mL, 1000 mL) and chlorpheniramine maleate 2 mg per 5 mL (118 mL) [ethanol free, dye Dextrose 5% and sodium chloride 0.45% (250 mL, 500 mL, 1000 mL) free, sugar free; cherry-strawberry flavor] Dextrose 5% and sodium chloride 0.9% (500 mL, 1000 mL) Tablet, Oral: Coricidin HBP Cough and Cold: Dextromethorphan hydrobromide 30 mg and Diabetic Supplies chlorpheniramine maleate 4 mg DoD Uniform Formulary Outpatient Dosage Forms Tablet, Softchew, Oral: BASIC CORE FORMULARY Triaminic Children's Softchews Cough & Runny Nose: Dextromethorphan Syringe and needle: 31 gauge x 5/16" hydrobromide 5 mg and chlorpheniramine maleate 1 mg [contains coconut Advocate Syringes; BD Syringe 1 mL (Ultra-Fine II); Comfort EZ; Easy oil, phenylalanine 17.6 mg/softchew, sodium 5 mg/softchew; cherry flavor] Comfort Insulin Syringe; Easy Touch; Easy-Touch Insulin Syringe; FreeStyle Precision; Lite Touch; Monoject Insulin Syringe; Pro Comfort Insulin Syringe; Dextromethorphan and Menthol Sure-Ject Insulin Syringe; Techlite; Topcare Ultra Comfort; TrueComfort; DoD Uniform Formulary Outpatient Dosage Forms TruePlus Insulin Syringe; UltiCare; Ultilet Insulin Syringe; Ultra Comfort; UNIFORM FORMULARY Ultra-Thin II Lozenge, Mouth/Throat: Test Strips/Kit: Delsym Cough Relief: Dextromethorphan hydrobromide 5 mg and menthol FreeStyle Test Strips 5 mg (16 ea) [honey-lemon flavor] FreeStyle Lite Test Strips: 50/box, 100/box Delsym Cough Relief: Dextromethorphan hydrobromide 5 mg and menthol 5 mg (16 ea) [sugar free; cherry flavor] NONFORMULARY Delsym Cough+ Soothing Action: Dextromethorphan hydrobromide 5 mg and Accu-Chek; Accutrend; Advanced; Advocate Redi-Code; Agamatrix; Assure; menthol 5 mg (16 ea) [honey-lemon flavor] Breeze 2; Caresens N; Caretouch; Clever Choice; Contour Next; Control AST; Delsym Cough+ Soothing Action: Dextromethorphan hydrobromide 5 mg and Cool; Diatrue Plus; Easy Plus II; East Step; Easy Talk; Easy Touch; Easy Trak; menthol 5 mg (16 ea) [sugar free; cherry flavor] Easygluco; Easymax; Element; Embrace; Evencare; Evolution; EZ Smart; Robitussin Medi-Soothers: Dextromethorphan hydrobromide 5 mg and men- Fifty50; Fora D15G; ForaCare; Fortiscare; Freestyle InsulinX; Freestyle Pre- thol 5 mg (4 ea, 16 ea) [honey-lemon flavor] cision Neo; Freestyle; GE100; Genstrip; Gluco Navii; Glucocard; Glucocom; Gmate; HealthPro; Iglucose; Infinity; Liberty; Microdot; MyglucoHealth; Neutek Dextromethorphan and Phenylephrine 2Tek; Novo Max; On Call; OneTouch Ultra Blue; Optium; Parmacist Choice; DoD Uniform Formulary Outpatient Dosage Forms Precision PCX; Precision Point of Care; Precision Q-I-D; Premier; Premium; UNIFORM FORMULARY Pro Voice; Prodigy No Coding; Quintet AC; Refuah Plus; Relion Confirm- Liquid, Oral: Micro; Relion Prime; Reveal; RightTest; Smart Sense; Smartest; Solus V2; Sudafed PE Children's Cold & Cough: Dextromethorphan hydrobromide 5 mg Sure-Test; TelCare; Test N'Go; True Metrix; TrueTest; TrueTrack; Ultima; and phenylephrine hydrochloride 2.5 mg per 5 mL (118 mL) [ethanol free, Ultratrak; Unistrip1; Verasens; WaveSense Jazz; VGO 20; VGO 30; VGO sugar free; contains sodium 15 mg/5 mL, sodium benzoate; grape flavor] 40; WaveSense Presto 35 DIAGNOSTIC TEST FOR GLUCOSE IN URINE Diagnostic Test for Glucose in Urine Diclofenac (Ophthalmic) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Strip: 50s Solution, Ophthalmic, as sodium: Tablet, reagent: 36s Generic: 0.1% (2.5 mL, 5 mL) Diatrizoate Meglumine Diclofenac (Systemic) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Solution, Urethral: BASIC CORE FORMULARY Cystografin: 30% (100 mL, 300 mL) Tablet Delayed Release, Oral, as sodium: Cystografin-Dilute: 18% (300 mL) Generic: 25 mg, 50 mg, 75 mg Tablet Extended Release 24 Hour, Oral, as sodium: Diatrizoate Meglumine and Diatrizoate Sodium Generic: 100 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Intravenous, as sodium: Solution, injection: Dyloject: 37.5 mg/mL (1 mL) MD-76 R: Diatrizoate meglumine 660 mg and diatrizoate sodium 100 mg per 1 Tablet, Oral, as potassium: mL (50 mL, 100 mL, 200 mL) [provides organically-bound iodine 370 mg/mL; Generic: 50 mg contains edetate calcium disodium, sodium 3.65 mg (0.16 mEq)/mL] Solution, oral/rectal: NONFORMULARY Gastrografin: Diatrizoate meglumine 660 mg and diatrizoate sodium 100 mg Packet, Oral, as potassium: per 1 mL (30 mL, 120 mL) [provides organically-bound iodine 367 mg/mL; Cambia: 50 mg (1 ea, 9 ea) [anise-mint flavor] contains edetate disodium, sodium 4.8 mg (0.21 mEq)/mL; lemon flavor] MD-Gastroview: Diatrizoate meglumine 660 mg and diatrizoate sodium Tier 4 - NOT COVERED 100 mg per 1 mL (30 mL, 120 mL, 240 mL) [provides organically-bound Capsule, Oral, as base: iodine 367 mg/mL; contains edetate disodium, sodium 4.8 mg (0.21 mEq)/ Zorvolex: 18 mg, 35 mg mL; lemon-vanilla flavor] Capsule, Oral, as potassium: Zipsor: 25 mg [contains gelatin (bovine)] Diatrizoate Meglumine and Iodipamide Meglumine DoD Uniform Formulary Outpatient Dosage Forms Diclofenac (Topical) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Injection, solution [for intrauterine instillation]: BASIC CORE FORMULARY Sinografin: Diatrizoate meglumine 527 mg and iodipamide meglumine 268 mg Gel, Transdermal, as sodium: per mL (10 mL) [provides organically-bound iodine 380 mg/mL; contains Generic: 1% (100 g) edetate disodium, sodium 0.91 mg (0.04 mEq)/mL] UNIFORM FORMULARY DiazePAM Cream, Transdermal, as sodium: DoD Uniform Formulary Outpatient Dosage Forms EnovaRX-Diclofenac Sodium: 2.5% (60 g) [contains cetyl alcohol] BASIC CORE FORMULARY Rexaphenac: 1% (120 g) [contains isopropyl alcohol, propylene glycol] Tablet, Oral: Gel, Transdermal, as sodium: Generic: 5 mg Generic: 3% (100 g) UNIFORM FORMULARY Solution, Transdermal, as sodium: Concentrate, Oral: Generic: 1.5% (150 mL) Generic: 5 mg/mL (30 mL) Therapy Pack, External, as sodium: Gel, Rectal: Diclo Gel with Xrylix Sheets: 1% (1 ea) [contains isopropyl alcohol, propylene Generic: 2.5 mg (1 ea); 10 mg (1 ea); 20 mg (1 ea) glycol] Solution, Injection: Therapy Pack, Transdermal, as sodium: Generic: 5 mg/mL (2 mL, 10 mL) Diclozor: 1% (1 ea) [contains isopropyl alcohol, propylene glycol] Solution, Oral: Lexixryl: 1.5% (1 ea) [contains propylene glycol] Generic: 1 mg/mL (500 mL) Xrylix: 1.5% (1 ea) [contains propylene glycol] Solution Auto-injector, Intramuscular: Tier 4 - NOT COVERED Generic: 10 mg/2 mL (2 mL) Patch, Transdermal, as epolamine: NONFORMULARY Flector: 1.3% (5 ea, 30 ea) [contains edetate disodium, methylparaben, Liquid, Nasal: polysorbate 80, propylparaben] Valtoco 10 MG Dose: 10 mg/0.1 mL (1 ea) [contains alcohol, usp] Solution, Transdermal, as sodium: Valtoco 5 MG Dose: 5 mg/0.1 mL (1 ea) [contains alcohol, usp] Pennsaid: 2% (112 g) [contains propylene glycol] Liquid Therapy Pack, Nasal: Valtoco 15 MG Dose: 7.5 mg/0.1 mL (1 ea) [contains alcohol, usp] Dicloxacillin Valtoco 20 MG Dose: 10 mg/0.1 mL (1 ea) [contains alcohol, usp] DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY Diazoxide Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 250 mg, 500 mg UNIFORM FORMULARY Suspension, Oral: Dicyclomine Proglycem: 50 mg/mL (30 mL) [chocolate mint flavor] DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY Dibucaine Capsule, Oral, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Generic: 10 mg UNIFORM FORMULARY Tablet, Oral, as hydrochloride: Ointment, External: Generic: 20 mg Generic: 1% (28 g, 28.35 g) Ointment, Rectal: UNIFORM FORMULARY Nupercainal: 1% (28.4 g, 60 g) Solution, Intramuscular, as hydrochloride: Generic: 10 mg/mL (2 mL) Dichlorphenamide Solution, Oral, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Generic: 10 mg/5 mL (473 mL) UNIFORM FORMULARY Tablet, Oral: Didanosine Keveyis: 50 mg [contains corn starch] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Diclofenac and Misoprostol Capsule Delayed Release, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 125 mg, 200 mg, 250 mg, 400 mg UNIFORM FORMULARY Solution Reconstituted, Oral: Tablet, Oral: Videx: 2 g (100 mL); 4 g (200 mL) Generic: Diclofenac sodium 50 mg and misoprostol 200 mcg Generic: Diclofenac sodium 75 mg and misoprostol 200 mcg 36 DIPHENHYDRAMINE (SYSTEMIC) Diethylpropion Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 50 mg UNIFORM FORMULARY Tablet Chewable, Oral: Tablet, Oral, as hydrochloride: Dramamine: 50 mg [contains aspartame, fd&c yellow #6 aluminum lake] Generic: 25 mg Dimercaprol Tablet Extended Release 24 Hour, Oral, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Generic: 75 mg UNIFORM FORMULARY Difenoxin and Atropine Solution, Intramuscular: DoD Uniform Formulary Outpatient Dosage Forms Bal in Oil: 100 mg/mL (3 mL) [contains benzyl benzoate, peanut oil] UNIFORM FORMULARY Dimethyl Fumarate Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Motofen: Difenoxin hydrochloride 1 mg and atropine sulfate 0.025 mg UNIFORM FORMULARY [dye free] Capsule Delayed Release, Oral: Diflunisal Tecfidera: 120 mg, 240 mg [contains brilliant blue fcf (fd&c blue #1)] DoD Uniform Formulary Outpatient Dosage Forms Miscellaneous, Oral: UNIFORM FORMULARY Tecfidera: Capsule, delayed release: 120 mg (14s) and Capsule, delayed Tablet, Oral: release: 240 mg (46s) (60 ea) [contains brilliant blue fcf (fd&c blue #1)] Generic: 500 mg Dimethyl Sulfoxide Difluprednate DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Intravesical: Emulsion, Ophthalmic: Rimso-50: 50% (50 mL) Durezol: 0.05% (5 mL) [contains edetate sodium (tetrasodium), polysor- Dinoprostone bate 80] DoD Uniform Formulary Outpatient Dosage Forms Digoxin UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Gel, Vaginal: BASIC CORE FORMULARY Prepidil: 0.5 mg/3 g (3 g) Tablet, Oral: Insert, Vaginal: Generic: 125 mcg, 250 mcg Cervidil: 10 mg (1 ea) Suppository, Vaginal: UNIFORM FORMULARY Prostin E2: 20 mg (5 ea) Solution, Injection: Lanoxin Pediatric: 0.1 mg/mL (1 mL) [contains alcohol, usp, propylene glycol] Dinutuximab Generic: 0.25 mg/mL (2 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution, Oral: UNIFORM FORMULARY Generic: 0.05 mg/mL (60 mL) Solution, Intravenous [preservative free]: Tablet, Oral: Unituxin: 17.5 mg/5 mL (5 mL) [contains mouse (murine) and/or hamster Lanoxin: 62.5 mcg, 187.5 mcg protein] Digoxin Immune Fab Diphenhydramine, Aluminum Hydroxide, and Magnesium DoD Uniform Formulary Outpatient Dosage Forms Hydroxide UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous [preservative free]: UNIFORM FORMULARY DigiFab: 40 mg (1 ea) Suspension, Oral: Generic: Diphenhydramine elixir 50% and Maalox suspension 50% Dihydrocodeine, Aspirin, and Caffeine DoD Uniform Formulary Outpatient Dosage Forms Diphenhydramine and Ibuprofen UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, oral: UNIFORM FORMULARY Generic: Dihydrocodeine bitartrate 16 mg, aspirin 356.4 mg, and caf- Capsule, Oral: feine 30 mg Advil PM: Diphenhydramine hydrochloride 25 mg and ibuprofen 200 mg Tablet, Oral: Dihydroergotamine Advil PM: Diphenhydramine citrate 38 mg and ibuprofen 200 mg DoD Uniform Formulary Outpatient Dosage Forms Motrin PM: Diphenhydramine citrate 38 mg and ibuprofen 200 mg UNIFORM FORMULARY Solution, Injection, as mesylate: Diphenhydramine and Phenylephrine Generic: 1 mg/mL (1 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution, Nasal, as mesylate: UNIFORM FORMULARY Generic: 4 mg/mL (1 mL) Liquid, Oral: Benadryl-D Children's Allergy & Sinus: Diphenhydramine hydrochloride DilTIAZem 12.5 mg and phenylephrine hydrochloride 5 mg per 5 mL (118 mL) [ethanol DoD Uniform Formulary Outpatient Dosage Forms free, sugar free; contains sodium 10 mg/5 mL, sodium benzoate; grape BASIC CORE FORMULARY flavor] Capsule Extended Release 24 Hour, Oral, as hydrochloride: Syrup, Oral: Generic: 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg Dimetapp Children's Nighttime Cold and Congestion: Diphenhydramine hydro- UNIFORM FORMULARY chloride 6.25 mg and phenylephrine hydrochloride 2.5 mg per 5 mL (120 mL) Capsule Extended Release 12 Hour, Oral, as hydrochloride: [ethanol free, sugar free; contains propylene glycol, sodium 4 mg/5 mL, Generic: 60 mg, 90 mg, 120 mg sodium benzoate; grape flavor] Solution, Intravenous, as hydrochloride: Triaminic Children's Night Time Cold & Cough: Diphenhydramine hydrochlor- Generic: 25 mg/5 mL (5 mL); 50 mg/10 mL (10 mL); 125 mg/25 mL (25 mL) ide 6.25 mg and phenylephrine hydrochloride 2.5 mg per 5 mL (118 mL) Solution Reconstituted, Intravenous, as hydrochloride: [contains edetate disodium, propylene glycol, sodium 3 mg/5 mL, sodium Generic: 100 mg (1 ea) benzoate; grape flavor] Tablet, Oral, as hydrochloride: Tablet, Oral: Generic: 30 mg, 60 mg, 90 mg, 120 mg Generic: Diphenhydramine hydrochloride 25 mg and phenylephrine hydro- chloride 10 mg NONFORMULARY Tablet Extended Release 24 Hour, Oral, as hydrochloride: DiphenhydrAMINE (Systemic) Cardizem LA: 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg DoD Uniform Formulary Outpatient Dosage Forms Matzim LA: 180 mg, 240 mg, 300 mg, 360 mg, 420 mg UNIFORM FORMULARY Generic: 180 mg, 240 mg, 300 mg, 360 mg, 420 mg Capsule, Oral, as hydrochloride: Generic: 25 mg, 50 mg DimenhyDRINATE Elixir, Oral, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Generic: 12.5 mg/5 mL (5 mL, 10 mL) UNIFORM FORMULARY Liquid, Oral, as hydrochloride: Solution, Injection: Allergy Relief Childrens: 12.5 mg/5 mL (118 mL, 480 mL) [alcohol free; Generic: 50 mg/mL (1 mL) contains sodium benzoate] 37 DIPHENHYDRAMINE (SYSTEMIC)

Banophen: 12.5 mg/5 mL (118 mL) [alcohol free; cherry flavor] mcg, pertactin 8 mcg], type 1 poliovirus 40 D-antigen units, type 2 poliovirus Banophen: 12.5 mg/5 mL (473 mL) [alcohol free, sugar free; cherry flavor] 8 D-antigen units, and type 3 poliovirus 32 D-antigen units per 0.5 mL (0.5 Benadryl Allergy Childrens: 12.5 mg/5 mL (118 mL, 236 mL) [alcohol free; mL) [contains aluminum, neomycin sulfate, polymyxin B, polysorbate 80; contains sodium benzoate] may contain natural rubber/natural latex in prefilled syringe] Benadryl Allergy Childrens: 12.5 mg/5 mL (118 mL) [alcohol free, dye free, Quadracel: Diphtheria toxoid 15 Lf, tetanus toxoid 5 Lf, acellular pertussis sugar free; contains saccharin sodium, sodium benzoate] antigens [detoxified pertussis toxin 20 mcg, filamentous hemagglutinin 20 Diphenhist: 12.5 mg/5 mL (118 mL, 473 mL) [alcohol free; contains saccharin mcg, pertactin 3 mcg, fimbriae (types 2 and 3) 5 mcg], type 1 poliovirus 40 D- sodium, sodium benzoate; fruit flavor] antigen units, type 2 poliovirus 8 D-antigen units, and type 3 poliovirus 32 D- Naramin: 12.5 mg/5 mL (5 mL) [alcohol free; contains sodium benzoate; antigen units per 0.5 mL (0.5 mL) [contains aluminum, neomycin sulfate, cherry flavor] polymyxin B, polysorbate 80] PediaCare Childrens Allergy: 12.5 mg/5 mL (118 mL) [alcohol free; contains sodium benzoate] Diphtheria and Tetanus Toxoids, Acellular Pertussis, Poliovirus Q-Dryl: 12.5 mg/5 mL (118 mL, 237 mL, 473 mL) [alcohol free; contains and Haemophilus b Conjugate Vaccine saccharin sodium, sodium benzoate; cherry flavor] DoD Uniform Formulary Outpatient Dosage Forms Scot-Tussin Allergy Relief: 12.5 mg/5 mL (118.3 mL, 240 mL, 480 mL, 3780 UNIFORM FORMULARY mL) [alcohol free, dye free, saccharin free, sodium free, sorbitol free, Injection, suspension: sugar free] Siladryl Allergy: 12.5 mg/5 mL (118 mL, 237 mL, 473 mL) [alcohol free, sugar Pentacel: Diphtheria toxoid 15 Lf, tetanus toxoid 5 Lf, acellular pertussis free; contains methylparaben, propylene glycol, propylparaben, saccharin antigens [pertussis toxin detoxified 20 mcg, filamentous hemagglutinin 20 sodium; cherry flavor] mcg, pertactin 3 mcg, fimbriae (types 2 and 3) 5 mcg], type 1 poliovirus 40 D- Total Allergy Medicine: 12.5 mg/5 mL (118 mL) [alcohol free] antigen units; type 2 poliovirus 8 D-antigen units; type 3 poliovirus 32 D- ZzzQuil: 50 mg/30 mL (177 mL, 354 mL) [contains alcohol, usp, propylene antigen units, and Haemophilus b capsular polysaccharide 10 mcg [bound to glycol, saccharin sodium, sodium benzoate] tetanus toxoid 24 mcg] per 0.5 mL (0.5 mL) [contains albumin, aluminum, ZzzQuil: 50 mg/30 mL (177 mL, 354 mL) [alcohol free; contains propylene neomycin, polymyxin B sulfate, and polysorbate 80; supplied in two vials, one glycol, saccharin sodium, sodium benzoate] containing DTaP-IPV liquid and one containing Hib powder] Solution, Injection, as hydrochloride: Generic: 50 mg/mL (1 mL, 10 mL) Diphtheria and Tetanus Toxoids, and Acellular Pertussis Solution, Injection, as hydrochloride [preservative free]: Vaccine Generic: 50 mg/mL (1 mL) DoD Uniform Formulary Outpatient Dosage Forms Strip, Oral, as hydrochloride: UNIFORM FORMULARY Triaminic Cough/Runny Nose: 12.5 mg (14 ea) [contains alcohol, usp] Injection, suspension [Tdap, booster formulation]: Triaminic Cough/Runny Nose: 12.5 mg (16 ea) [contains alcohol, usp; grape Adacel: Diphtheria 2 Lf units, tetanus 5 Lf units, and acellular pertussis flavor] antigens [detoxified pertussis toxin 2.5 mcg, filamentous hemagglutinin 5 Suspension Reconstituted, Oral, as hydrochloride: mcg, pertactin 3 mcg, fimbriae (types 2 and 3) 5 mcg] per 0.5 mL (0.5 mL) Dicopanol FusePaq: 5 mg/mL (150 mL) [contains sodium benzoate] [contains aluminum; may contain natural rubber/natural latex in prefilled Dicopanol RapidPaq: 5 mg/mL (150 mL) [dye free, paraben free, sugar free; syringe] contains sodium benzoate] Boostrix: Diphtheria 2.5 Lf units, tetanus 5 Lf units, and acellular pertussis Syrup, Oral, as hydrochloride: antigens [inactivated pertussis toxin 8 mcg, filamentous hemagglutinin 8 Altaryl: 12.5 mg/5 mL (120 mL, 480 mL, 3785 mL) [alcohol free; cherry flavor] mcg, pertactin 2.5 mcg] per 0.5 mL (0.5 mL) [contains aluminum and Silphen Cough: 12.5 mg/5 mL (118 mL, 237 mL, 473 mL) [contains alcohol, polysorbate 80; may contain natural rubber/natural latex in prefilled syringe] usp, menthol, methylparaben, propylene glycol, propylparaben; strawberry Injection, suspension [DTaP, active immunization formulation]: flavor] Daptacel: Diphtheria 15 Lf units, tetanus 5 Lf units, and acellular pertussis Tablet, Oral, as hydrochloride: antigens [detoxified pertussis toxin 10 mcg, filamentous hemagglutinin 5 Aler-Dryl: 50 mg Nytol Maximum Strength: 50 mg mcg, pertactin 3 mcg, fimbriae (types 2 and 3) 5 mcg] per 0.5 mL (0.5 mL) Tetra-Formula Nighttime Sleep: 50 mg [preservative free; contains aluminum] Generic: 25 mg Infanrix: Diphtheria 25 Lf units, tetanus 10 Lf units, and acellular pertussis Tablet Chewable, Oral, as hydrochloride: antigens [inactivated pertussis toxin 25 mcg, filamentous hemagglutinin 25 Benadryl Allergy Childrens: 12.5 mg mcg, pertactin 8 mcg] per 0.5 mL (0.5 mL) [preservative free; contains aluminum and polysorbate 80; prefilled syringes contain natural rubber/ DiphenhydrAMINE (Topical) natural latex] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Diphtheria, Tetanus Toxoids, Acellular Pertussis, Hepatitis B Cream, External, as hydrochloride: (Recombinant), and Poliovirus (Inactivated) Vaccine Anti-Itch: 2% (28.4 g) [contains methylparaben, propylparaben] DoD Uniform Formulary Outpatient Dosage Forms Anti-Itch Maximum Strength: 2% (30 g) UNIFORM FORMULARY Banophen: 2% (28 g) [contains cetyl alcohol, methylparaben, propylene Injection, suspension [preservative free]: glycol, propylparaben] Pediarix: Diphtheria toxoid 25 Lf, tetanus toxoid 10 Lf, acellular pertussis Benadryl Itch Stopping: 1% (28.3 g) [contains cetyl alcohol] antigens [inactivated pertussis toxin 25 mcg, filamentous hemagglutin 25 Benadryl Itch Stopping: 1% (28.3 g) [contains cetyl alcohol, methylparaben, mcg, pertactin 8 mcg, HBsAg 10 mcg, type 1 poliovirus 40 D antigen units, propylene glycol, propylparaben] type 2 poliovirus 8 D antigen units and type 3 poliovirus 32 D antigen units] Itch Relief: 2% (15 g, 30 g, 56.8 g) per 0.5 mL (0.5 mL) [contains aluminum, neomycin sulfate (trace amounts), Stick, External, as hydrochloride: polymyxin B (trace amounts), polysorbate 80, and yeast protein ≤5%; may Benadryl Itch Relief: 2% (14 mL) [contains alcohol, usp] contain natural rubber/natural latex in prefilled syringe] Diphenoxylate and Atropine Dipyridamole DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Oral: Solution, Intravenous: Generic: Diphenoxylate hydrochloride 2.5 mg and atropine sulfate 0.025 mg per 5 mL (5 mL, 10 mL, 60 mL) Generic: 5 mg/mL (10 mL) Tablet, Oral: Tablet, Oral: Generic: Diphenoxylate hydrochloride 2.5 mg and atropine sulfate 0.025 mg Generic: 25 mg, 50 mg, 75 mg Diphtheria and Tetanus Toxoids Disopyramide DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Injection, Suspension [Td, adult; preservative free]: Capsule, Oral: Generic: Diphtheria 2 Lf units and tetanus 2 Lf units per 0.5 mL (0.5 mL) Generic: 100 mg, 150 mg Injection, suspension [DT, pediatric; preservative free]: Capsule Extended Release 12 Hour, Oral: Generic: Diphtheria 25 Lf units and tetanus 5 Lf units per 0.5 mL (0.5 mL) Norpace CR: 100 mg, 150 mg Diphtheria and Tetanus Toxoids, Acellular Pertussis, and Disulfiram Poliovirus Vaccine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Injection, suspension [preservative free]: Generic: 250 mg, 500 mg Kinrix: Diphtheria toxoid 25 Lf, tetanus toxoid 10 Lf, acellular pertussis antigens [inactivated pertussis toxin 25 mcg, filamentous hemagglutinin 25 38 DOXORUBICIN (CONVENTIONAL) DOBUTamine Doravirine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Intravenous, as hydrochloride: Tablet, Oral: Generic: 1 mg/mL (250 mL); 2 mg/mL (250 mL); 4 mg/mL (250 mL); 250 mg/ Pifeltro: 100 mg 20 mL (20 mL); 500 mg/40 mL (40 mL) Doravirine, Lamivudine, and Tenofovir Disoproxil Fumarate DOCEtaxel DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Concentrate, Intravenous: Delstrigo: Doravirine 100 mg, lamivudine 300 mg, and tenofovir disoproxil Generic: 20 mg/mL (1 mL); 80 mg/4 mL (4 mL); 160 mg/8 mL (8 mL); 20 mg/ fumarate 300 mg 0.5 mL (0.5 mL); 80 mg/2 mL (2 mL) Doripenem Concentrate, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 20 mg/mL (1 mL); 80 mg/4 mL (4 mL); 160 mg/8 mL (8 mL) UNIFORM FORMULARY Solution, Intravenous: Solution Reconstituted, Intravenous: Generic: 20 mg/2 mL (2 mL); 80 mg/8 mL (8 mL); 160 mg/16 mL (16 mL); Generic: 250 mg (1 ea); 500 mg (1 ea) 20 mg/mL (1 mL); 80 mg/4 mL (4 mL); 160 mg/8 mL (8 mL) Dornase Alfa Docosanol DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Inhalation: Cream, External: Pulmozyme: 1 mg/mL (2.5 mL) Abreva: 10% (2 g) [contains benzyl alcohol] Dorzolamide Docusate DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Ophthalmic: Capsule, Oral, as calcium: Generic: 2% (10 mL) Generic: 240 mg Capsule, Oral, as sodium: Dorzolamide and Timolol Colace Clear: 50 mg [dye free] DoD Uniform Formulary Outpatient Dosage Forms Generic: 100 mg, 250 mg UNIFORM FORMULARY Enema, Rectal, as sodium: Solution, Ophthalmic [drops]: DocuSol Kids: 100 mg/5 mL (5 ea) [contains polyethylene glycol] Generic: Dorzolamide 2% [20 mg/mL] and timolol 0.5% [5 mg/mL] (10 mL) DocuSol Mini: 283 mg (5 ea) Solution, Ophthalmic [drops, preservative free]: Enemeez Mini: 283 mg (5 mL) Cosopt PF: Dorzolamide 2% [20 mg/mL] and timolol 0.5% [5 mg/mL] (0.2 mL) Liquid, Oral, as sodium: Dostarlimab Pedia-Lax: 50 mg/15 mL (118 mL) [contains edetate disodium, methylpara- DoD Uniform Formulary Outpatient Dosage Forms ben, polyethylene glycol, propylene glycol, propylparaben; fruit punch flavor] NOT COVERED Silace: 150 mg/15 mL (473 mL) [lemon-vanilla flavor] Solution, Intravenous: Generic: 50 mg/5 mL (10 mL) Jemperli: Dostarlimab-gxly 500 mg/10 mL (10 mL) [contains polysorbate 80] Syrup, Oral, as sodium: Generic: 60 mg/15 mL (25 mL) Doxazosin Tablet, Oral, as sodium: DoD Uniform Formulary Outpatient Dosage Forms Generic: 100 mg UNIFORM FORMULARY Tablet, Oral: Docusate and Senna Generic: 1 mg, 2 mg, 4 mg, 8 mg DoD Uniform Formulary Outpatient Dosage Forms NONFORMULARY UNIFORM FORMULARY Tablet Extended Release 24 Hour, Oral: Tablet, Oral: Cardura XL: 4 mg, 8 mg Generic: Docusate sodium 50 mg and sennosides 8.6 mg Doxepin (Systemic) Dofetilide DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY UNIFORM FORMULARY Capsule, Oral: Capsule, Oral: Generic: 10 mg, 25 mg, 50 mg, 75 mg Generic: 125 mcg, 250 mcg, 500 mcg Concentrate, Oral: Generic: 10 mg/mL (118 mL, 120 mL) Dolutegravir UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral: UNIFORM FORMULARY Generic: 100 mg, 150 mg Tablet, Oral: Tablet, Oral: Tivicay: 10 mg, 25 mg, 50 mg Generic: 3 mg, 6 mg Donepezil Doxepin (Topical) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms Extended Core Formulary UNIFORM FORMULARY Tablet, Oral, as hydrochloride: Cream, External, as hydrochloride: Generic: 5 mg, 10 mg Generic: 5% (45 g) Tablet Disintegrating, Oral, as hydrochloride: Generic: 5 mg, 10 mg Doxercalciferol DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral, as hydrochloride: Capsule, Oral: Aricept: 5 mg, 10 mg Generic: 0.5 mcg, 1 mcg, 2.5 mcg NONFORMULARY Solution, Intravenous: Tablet, Oral, as hydrochloride: Hectorol: 2 mcg/mL (1 mL) [contains alcohol, usp, disodium edta] Generic: 23 mg Generic: 4 mcg/2 mL (2 mL) DOPamine DOXOrubicin (Conventional) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Intravenous, as hydrochloride: Solution, Intravenous, as hydrochloride: Generic: 0.8 mg/mL (250 mL, 500 mL); 1.6 mg/mL (250 mL, 500 mL); Generic: 2 mg/mL (5 mL, 10 mL, 25 mL, 100 mL) 3.2 mg/mL (250 mL); 40 mg/mL (5 mL, 10 mL); 80 mg/mL (5 mL); Solution, Intravenous, as hydrochloride [preservative free]: 160 mg/mL (5 mL) Generic: 2 mg/mL (5 mL, 10 mL, 25 mL, 75 mL, 100 mL) 39 DOXORUBICIN (CONVENTIONAL)

Solution Reconstituted, Intravenous, as hydrochloride: Solution, Injection: Adriamycin: 10 mg (1 ea); 20 mg (1 ea) Generic: 2.5 mg/mL (2 mL) Generic: 50 mg (1 ea) Solution Reconstituted, Intravenous, as hydrochloride [preservative free]: Drospirenone and Estradiol Generic: 10 mg (1 ea) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY DOXOrubicin (Liposomal) Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Angeliq: Drospirenone 0.25 mg and estradiol 0.5 mg; drospirenone 0.5 mg UNIFORM FORMULARY and estradiol 1 mg Injectable, Intravenous, as hydrochloride: Generic: 2 mg/mL (10 mL, 25 mL) Droxidopa DoD Uniform Formulary Outpatient Dosage Forms Doxycycline UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral: BASIC CORE FORMULARY Northera: 100 mg, 200 mg, 300 mg Capsule, Oral, as hyclate [strength expressed as base]: Generic: 100 mg DULoxetine Tablet, Oral, as hyclate [strength expressed as base]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 100 mg UNIFORM FORMULARY UNIFORM FORMULARY Capsule Delayed Release Particles, Oral: Capsule, Oral, as hyclate [strength expressed as base]: Generic: 20 mg, 30 mg, 40 mg, 60 mg Generic: 50 mg Dupilumab Capsule, Oral, as monohydrate [strength expressed as base]: Generic: 50 mg, 75 mg, 100 mg, 150 mg DoD Uniform Formulary Outpatient Dosage Forms Kit, Combination, as hyclate [strength expressed as base]: UNIFORM FORMULARY Morgidox: 1 x 50 mg, 2 x 100 mg, 1 x 100 mg [contains cetyl alcohol, edetate Solution Prefilled Syringe, Subcutaneous [preservative free]: disodium] Dupixent: 300 mg/2 mL (2 mL) [contains polysorbate 80] Solution Reconstituted, Intravenous, as hyclate [strength expressed as base, Durvalumab preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 100 mg (1 ea) UNIFORM FORMULARY Suspension Reconstituted, Oral, as monohydrate: Generic: 25 mg/5 mL (60 mL) Solution, Intravenous [preservative free]: Suspension Reconstituted, Oral, as monohydrate [strength expressed as base]: Imfinzi: 120 mg/2.4 mL (2.4 mL); 500 mg/10 mL (10 mL) [contains polysor- Suspension Reconstituted, Oral, as monohydrate [strength expressed as bate 80] base]: Duvelisib Syrup, Oral, as calcium [strength expressed as base]: DoD Uniform Formulary Outpatient Dosage Forms Vibramycin: 50 mg/5 mL (473 mL) [contains butylparaben, propylene glycol, UNIFORM FORMULARY propylparaben, sodium metabisulfite; raspberry-apple flavor] Capsule, Oral: Tablet, Oral, as hyclate [strength expressed as base]: Generic: 20 mg, 50 mg, 75 mg, 150 mg Copiktra: 15 mg, 25 mg Tablet, Oral, as monohydrate [strength expressed as base]: Dyclonine Generic: 50 mg, 75 mg, 100 mg, 150 mg DoD Uniform Formulary Outpatient Dosage Forms Tablet Delayed Release, Oral, as hyclate [strength expressed as base]: UNIFORM FORMULARY Soloxide: 150 mg [scored] Lozenge, Oral, as hydrochloride: NONFORMULARY Sucrets Children's: 1.2 mg (18s) [cherry flavor] Capsule, Oral, as hyclate [strength expressed as base]: Sucrets Maximum Strength: 3 mg (18s) [black-cherry flavor; wintergreen Morgidox: 50 mg, 100 mg flavor] Vibramycin: 100 mg Sucrets Regular Strength: 2 mg (18s) Capsule, Oral, as monohydrate [strength expressed as base]: Mondoxyne NL: 50 mg, 75 mg, 100 mg Ecallantide Monodox, Okebo: 75 mg, 100 mg DoD Uniform Formulary Outpatient Dosage Forms Capsule Delayed Release, Oral, as monohydrate [strength expressed as base]: UNIFORM FORMULARY Oracea, Generic: 40 mg Solution, Subcutaneous [preservative free]: Tablet, Oral, as hyclate [strength expressed as base]: Kalbitor: 10 mg/mL (1 mL) Acticlate: 75 mg, 150 mg TargaDOX: 50 mg Echothiophate Iodide Tablet, Oral, as monohydrate [strength expressed as base]: DoD Uniform Formulary Outpatient Dosage Forms Avidoxy: 100 mg UNIFORM FORMULARY Tablet Delayed Release, Oral, as hyclate [strength expressed as base]: Solution Reconstituted, Ophthalmic: Doryx: 200 mg [scored] Phospholine Iodide: 0.125% (5 mL) Doryx MPC: 120 mg [contains corn starch] Generic: 50 mg, 75 mg, 100 mg, 150 mg, 200 mg Econazole DoD Uniform Formulary Outpatient Dosage Forms Doxylamine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Foam, External, as nitrate: BASIC CORE FORMULARY Ecoza: 1% (70 g) [contains propylene glycol, trolamine (triethanolamine)] Tablet, Oral, as succinate: NONFORMULARY Sleep Aid: 25 mg [scored] Cream, External, as nitrate: Dronabinol Generic: 1% (15 g, 30 g, 85 g) DoD Uniform Formulary Outpatient Dosage Forms Eculizumab UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral: NOT COVERED Generic: 2.5 mg, 5 mg, 10 mg Solution, Intravenous [preservative free]: NONFORMULARY Soliris: 10 mg/mL (30 mL) Solution, Oral: Syndros: 5 mg/mL (30 mL) Edaravone DoD Uniform Formulary Outpatient Dosage Forms Dronedarone UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous: UNIFORM FORMULARY Radicava: 30 mg/100 mL (100 mL) [contains sodium bisulfite] Tablet, Oral: Multaq: 400 mg Edrophonium DoD Uniform Formulary Outpatient Dosage Forms Droperidol UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection, as chloride: UNIFORM FORMULARY Enlon: 10 mg/mL (15 mL) [contains phenol] 40 EMPAGLIFLOZIN AND LINAGLIPTIN Edrophonium and Atropine Eluxadoline DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Intravenous: Tablet, Oral: Enlon-Plus: Edrophonium chloride 10 mg/mL and atropine sulfate 0.14 mg/mL Viberzi: 75 mg, 100 mg (5 mL [DSC]) [contains sodium sulfite] Elvitegravir Efavirenz DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Capsule, Oral: Vitekta: 85 mg [DSC], 150 mg [DSC] Sustiva: 50 mg, 200 mg Tablet, Oral: Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Sustiva: 600 mg Alafenamide DoD Uniform Formulary Outpatient Dosage Forms Efavirenz, Emtricitabine, and Tenofovir Disoproxil Fumarate UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Genvoya: Elvitegravir 150 mg, cobicistat 150 mg, emtricitabine 200 mg, and Tablet, Oral: tenofovir alafenamide 10 mg Atripla: Efavirenz 600 mg, emtricitabine 200 mg, and tenofovir disoproxil fumarate 300 mg Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Disoproxil Efavirenz, Lamivudine, and Tenofovir Disoproxil Fumarate Fumarate DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Tablet, oral: Symfi: Efavirenz 600 mg, lamivudine 300 mg, and tenofovir disoproxil fuma- Stribild: Elvitegravir 150 mg, cobicistat 150 mg, emtricitabine 200 mg, and rate 300 mg tenofovir disoproxil fumarate 300 mg Symfi Lo: Efavirenz 400 mg, lamivudine 300 mg, and tenofovir disoproxil Emapalumab fumarate 300 mg DoD Uniform Formulary Outpatient Dosage Forms Eflornithine NOT COVERED DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous [preservative free]: UNIFORM FORMULARY Gamifant: 10 mg/2 mL (2 mL); 50 mg/10 mL (10 mL) [contains polysorbate 80] Cream, External, as hydrochloride: Emollients Vaniqa: 13.9% (45 g) [contains cetearyl alcohol, methylparaben, propyl- paraben] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Elapegademase Aerosol, Foam, External: DoD Uniform Formulary Outpatient Dosage Forms HylatopicPlus: (100 g, 150 g) UNIFORM FORMULARY Neosalus: (70 g, 200 g) Solution, Intramuscular [preservative free]: Cream, External: Revcovi: 2.4 mg/1.5 mL (1.5 mL) Atopiclair: (100 g) [dye free; contains shea nut derivatives] CeraVe: (340 g, 453 g) Electrolyte Replacement Solution Droxy: (56.7 g) DoD Uniform Formulary Outpatient Dosage Forms Eletone: (100 g) UNIFORM FORMULARY HylatopicPlus: (100 g, 450 g) Solution, Intravenous: Loutrex: (30 g) Hyperlyte-CR: (250 mL) Niseko: (85 g) Isolyte-S: (1000 mL) Nivatopic Plus: (100 g, 450 g) Isolyte-S pH 7.4: (500 mL, 1000 mL) Normlshield: (120 g) Normosol-R: (500 mL, 1000 mL) [latex free] Pen-Kera: (118 mL, 236 mL) [dye free] Normosol-R in D5W: (1000 mL) [latex free] Pentravan Plus: (500 g, 2500 g, 10000 g) Normosol-R pH 7.4: (500 mL, 1000 mL) [latex free] Promiseb: (30 g) [contains shea nut derivatives] Plasma-Lyte 148: (500 mL, 1000 mL) PruClair: (100 g) [contains shea nut derivatives] Plasma-Lyte A: (500 mL, 1000 mL) PR Cream: (56.7 g) [packaged with moisturizing cream] Vanicream: (57 g, 113 g, 453 g) [dye free, fragrance free] Eletriptan Cream, External [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms PruMyx: (140 g) UNIFORM FORMULARY Emulsion, External: Tablet, Oral: AVO Cream: (45 g, 90 g) Relpax: 20 mg, 40 mg Ceracade: (90 g, 270 g) Eliglustat Emulsion SB: (90 g) DoD Uniform Formulary Outpatient Dosage Forms EpiCeram Skin Barrier: (90 g, 225 g) KamDoy: (60 mL) [contains lidocaine <1%] UNIFORM FORMULARY Capsule, Oral: PruTect: (45 g, 90 g) Cerdelga: 84 mg Gel, topical: Atrapro Antipruritic: (113 g) Elosulfase Alfa Lotion, External: DoD Uniform Formulary Outpatient Dosage Forms CeraVe: (237 mL, 355 mL) UNIFORM FORMULARY HylatopicPlus: (420 mL) Solution, Intravenous [preservative free]: Moisturel: (226 g, 397 g) [contains benzyl alcohol] Vimizim: 5 mg/5 mL (5 mL) [contains mouse (murine) and/or hamster protein] Neosalus: (236 mL) Ointment, External: Elotuzumab DermaPhor: (106 g) [contains benzyl alcohol] DoD Uniform Formulary Outpatient Dosage Forms CeraVe: (144 g, 340 g) UNIFORM FORMULARY Solution Reconstituted, Intravenous: Empagliflozin Empliciti: 300 mg (1 ea); 400 mg (1 ea) [contains mouse (murine) and/or DoD Uniform Formulary Outpatient Dosage Forms hamster protein, polysorbate 80] UNIFORM FORMULARY Tablet, Oral: Eltrombopag Jardiance: 10 mg, 25 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Empagliflozin and Linagliptin Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Promacta: 12.5 mg, 25 mg, 50 mg, 75 mg UNIFORM FORMULARY NONFORMULARY Tablet, Oral: Packet, Oral: Glyxambi: Empagliflozin 10 mg and linagliptin 5 mg, Empagliflozin 25 mg and Promacta: 12.5 mg (1 ea, 30 ea) linagliptin 5 mg [contains corn starch] 41 EMPAGLIFLOZIN AND METFORMIN Empagliflozin and Metformin Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms IDHIFA: 50 mg, 100 mg UNIFORM FORMULARY Encorafenib Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Synjardy: Empagliflozin 5 mg and metformin hydrochloride 500 mg [contains corn starch] UNIFORM FORMULARY Synjardy: Empagliflozin 5 mg and metformin hydrochloride 1000 mg [contains Capsule, Oral: corn starch] Braftovi: 50 mg, 75 mg Synjardy: Empagliflozin 12.5 mg and metformin hydrochloride 500 mg [con- Enfortumab Vedotin tains corn starch] DoD Uniform Formulary Outpatient Dosage Forms Synjardy: Empagliflozin 12.5 mg and metformin hydrochloride 1000 mg [con- tains corn starch] NOT COVERED Solution Reconstituted, Intravenous [preservative free]: Empagliflozin, Linagliptin, and Metformin Padcev: enfortumab vedotin-ejfv 20 mg (1 ea); enfortumab vedotin-ejfv 30 mg DoD Uniform Formulary Outpatient Dosage Forms (1 ea) UNIFORM FORMULARY Enfuvirtide Tablet Extended Release 24 Hour, Oral: DoD Uniform Formulary Outpatient Dosage Forms Trijardy XR: Empagliflozin 10 mg, linagliptin 5 mg, and metformin 1,000 mg UNIFORM FORMULARY Trijardy XR: Empagliflozin 25 mg, linagliptin 5 mg, and metformin 1,000 mg Solution Reconstituted, Subcutaneous: Trijardy XR: Empagliflozin 5 mg, linagliptin 2.5 mg, and metformin 1,000 mg Fuzeon: 90 mg (1 ea) Trijardy XR: Empagliflozin 12.5 mg, linagliptin 2.5 mg, and metformin 1,000 mg Enoxaparin Emtricitabine DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection, as sodium: UNIFORM FORMULARY Generic: 300 mg/3 mL (3 mL) Capsule, Oral: Solution, Subcutaneous, as sodium [preservative free]: Emtriva: 200 mg Generic: 30 mg/0.3 mL (0.3 mL); 40 mg/0.4 mL (0.4 mL); 60 mg/0.6 mL (0.6 Solution, Oral: mL); 80 mg/0.8 mL (0.8 mL); 100 mg/mL (1 mL); 120 mg/0.8 mL (0.8 mL); Emtriva: 10 mg/mL (170 mL) [contains edetate disodium, methylparaben, 150 mg/mL (1 mL) propylene glycol, propylparaben; cotton candy flavor] Emtricitabine and Tenofovir Alafenamide Entacapone DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Tablet, Oral: Descovy: Emtricitabine 200 mg and tenofovir alafenamide 25 mg Generic: 200 mg Emtricitabine and Tenofovir Disoproxil Fumarate Entecavir DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Solution, Oral: Truvada: Emtricitabine 100 mg and tenofovir disoproxil fumarate 150 mg Baraclude: 0.05 mg/mL (210 mL) [contains methylparaben, propylparaben; Truvada: Emtricitabine 133 mg and tenofovir disoproxil fumarate 200 mg orange flavor] Truvada: Emtricitabine 167 mg and tenofovir disoproxil fumarate 250 mg Tablet, Oral: Truvada: Emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg Generic: 0.5 mg, 1 mg Emtricitabine, Rilpivirine, and Tenofovir Alafenamide Enzalutamide DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Capsule, Oral: Odefsey: Emtricitabine 200 mg, rilpivirine 25 mg, and tenofovir alafena- Xtandi: 40 mg mide 25 mg Ephedrine and Guaifenesin Emtricitabine, Rilpivirine, and Tenofovir Disoproxil Fumarate DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Tablet, Oral: Bronkaid: Ephedrine sulfate 25 mg and guaifenesin 400 mg Complera: Emtricitabine 200 mg, rilpivirine 25 mg, and tenofovir disoproxil Primatene Asthma: Ephedrine sulfate 12.5 mg and guaifenesin 200 mg fumarate 300 mg [scored] Enalapril EPHEDrine (Systemic) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Oral, as maleate: Solution, Injection, as sulfate: Epaned: 1 mg/mL (150 mL) [contains sodium benzoate] Generic: 50 mg/mL (1 mL) Solution Reconstituted, Oral, as maleate: Solution, Injection, as sulfate [preservative free]: Epaned: 1 mg/mL (150 mL) [contains methylparaben, propylparaben, saccha- Generic: 50 mg/mL (1 mL) rin sodium; berry-citrus flavor] Solution, Intravenous, as sulfate: Tablet, Oral, as maleate: Generic: 50 mg/mL (1 mL) Generic: 2.5 mg, 5 mg, 10 mg, 20 mg Solution, Intravenous, as sulfate [preservative free]: Generic: 50 mg/mL (1 mL) Enalapril and Hydrochlorothiazide Solution Prefilled Syringe, Intravenous, as sulfate: DoD Uniform Formulary Outpatient Dosage Forms Generic: 250 mg/5 mL (5 mL); 10 mg/5 mL in NaCl 0.9% (5 mL); 10 mg/mL in UNIFORM FORMULARY NaCl 0.9% (1 mL); 100 mg/10 mL in NaCl 0.9% (10 mL); 25 mg/5 mL (5 mL); Tablet, Oral: 50 mg/10 mL in NaCl 0.9% (10 mL); 50 mg/5 mL in NaCl 0.9% (5 mL) 5/12.5: Enalapril maleate 5 mg and hydrochlorothiazide 12.5 mg 10/25: Enalapril maleate 10 mg and hydrochlorothiazide 25 mg Epinastine DoD Uniform Formulary Outpatient Dosage Forms Enalaprilat UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Ophthalmic, as hydrochloride: UNIFORM FORMULARY Generic: 0.05% (5 mL) Injectable, Intravenous: Generic: 1.25 mg/mL (1 mL, 2 mL) EPINEPHrine (Nasal) DoD Uniform Formulary Outpatient Dosage Forms Enasidenib UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Nasal, as hydrochloride: UNIFORM FORMULARY Adrenalin: 0.1% (30 mL) 42 ERYTHROMYCIN (OPHTHALMIC) EPINEPHrine (Oral Inhalation) Eptifibatide DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Nebulization Solution, Inhalation: Solution, Intravenous: Asthmanefrin Refill: 2.25% (1 ea) [contains edetate disodium] Integrilin: 75 mg/100 mL (100 mL); 20 mg/10 mL (10 mL); 200 mg/100 mL Nebulization Solution, Inhalation [preservative free]: (100 mL) S2: 2.25% (1 ea) [sulfite free; contains edetate disodium] Generic: 75 mg/100 mL (100 mL); 20 mg/10 mL (10 mL) Epinephrine (Racemic) and Aluminum Potassium Sulfate Solution, Intravenous [preservative free]: Generic: 75 mg/100 mL (100 mL); 20 mg/10 mL (10 mL); 200 mg/100 mL DoD Uniform Formulary Outpatient Dosage Forms (100 mL) UNIFORM FORMULARY Retraction cord, for gingival sulcus placement: Eravacycline + GingiBRAID : DoD Uniform Formulary Outpatient Dosage Forms 0e fine: Epinephrine 0.10 – 0.30 mg and aluminum potassium sulfate 0.05 – UNIFORM FORMULARY 0.25 mg per inch Solution Reconstituted, Intravenous [preservative free]: 1e small: Epinephrine 0.20 – 0.60 mg and aluminum potassium sulfate 0.15 Xerava: 50 mg (1 ea) – 0.35 mg per inch 2e medium: Epinephrine 0.40 – 0.80 mg and aluminum potassium sulfate Erenumab 0.20 – 0.50 mg per inch DoD Uniform Formulary Outpatient Dosage Forms 3e large: Epinephrine 0.60 – 1.20 mg and aluminum potassium sulfate 0.30 – UNIFORM FORMULARY 0.80 mg per inch Solution Auto-injector, Subcutaneous [preservative free]: EPINEPHrine (Systemic) Aimovig: 70 mg/mL (1 mL) [contains polysorbate 80] DoD Uniform Formulary Outpatient Dosage Forms Aimovig 140 Dose: 70 mg/mL (1 mL) [contains polysorbate 80] UNIFORM FORMULARY Ergocalciferol Kit, Injection: Adyphren; Adyphren II; Adyphren Amp; Adyphren Amp II: 1 mg/mL [contains DoD Uniform Formulary Outpatient Dosage Forms sodium metabisulfite] UNIFORM FORMULARY EpinephrineSnap-EMS; Epinephrinesnap-v: 1 mg/mL [contains sodium meta- Capsule, Oral: bisulfite] Generic: 50,000 units EPIsnap: 1 mg/mL [contains sodium metabisulfite] Solution, Oral: Kit, Injection [preservative free]: Generic: 8000 units/mL (60 mL) Epinephrinesnap-v: 1 mg/mL Tablet, Oral: Solution, Injection: Generic: 400 units, 2000 units Generic: 30 mg/30 mL (30 mL) Solution, Injection [preservative free]: Ergoloid Mesylates Generic: 30 mg/30 mL (30 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution Auto-injector, Injection: UNIFORM FORMULARY Auvi-Q: 0.1 mg/0.1 mL (2 ea); 0.15 mg/0.15 mL (2 ea); 0.3 mg/0.3 mL (2 ea) Tablet, Oral: [contains sodium bisulfite] Generic: 1 mg EpiPen 2-Pak: 0.3 mg/0.3 mL (2 ea) [latex free; contains sodium metabisulfite] EpiPen Jr 2-Pak: 0.15 mg/0.3 mL (2 ea) [contains sodium metabisulfite] Ergotamine Generic: 0.15 mg/0.3 mL (2 ea); 0.15 mg/0.15 mL (1 ea, 2 ea); 0.3 mg/0.3 mL DoD Uniform Formulary Outpatient Dosage Forms (1 ea, 2 ea) UNIFORM FORMULARY Solution Prefilled Syringe, Injection [preservative free]: Tablet, Sublingual, as tartrate: Generic: 1 mg/10 mL (10 mL) Ergomar: 2 mg [contains saccharin sodium] NONFORMULARY Solution Prefilled Syringe, Injection [preservative free]: Ergotamine and Caffeine Symjepi: 0.3 mg/0.3 mL (2 ea) [contains sodium metabisulfite] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY EpiRUBicin Suppository, Rectal: DoD Uniform Formulary Outpatient Dosage Forms Migergot: Ergotamine tartrate 2 mg and caffeine 100 mg (12s) UNIFORM FORMULARY Tablet, Oral: Solution, Intravenous, as hydrochloride [preservative free]: Generic: Ergotamine tartrate 1 mg and caffeine 100 mg Generic: 50 mg/25 mL (25 mL); 200 mg/100 mL (100 mL) Eribulin Eplerenone DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Intravenous, as mesylate: Tablet, Oral: Halaven: 1 mg/2 mL (2 mL) [contains alcohol, usp] Generic: 25 mg, 50 mg Erlotinib Epoetin Alfa DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Solution, Injection: Tarceva: 25 mg, 100 mg, 150 mg Epogen: 10,000 units/mL (2 mL); 20,000 units/mL (1 mL) [contains benzyl alcohol] Ertapenem Procrit: 10,000 units/mL (2 mL); 20,000 units/mL (1 mL) [contains benzyl DoD Uniform Formulary Outpatient Dosage Forms alcohol] UNIFORM FORMULARY Solution, Injection [preservative free]: Solution Reconstituted, Injection: Epogen: 2000 units/mL (1 mL); 3000 units/mL (1 mL); 4000 units/mL (1 mL); INVanz: 1 g (1 ea) 10,000 units/mL (1 mL) Procrit: 2000 units/mL (1 mL); 3000 units/mL (1 mL); 4000 units/mL (1 mL); Solution Reconstituted, Intravenous: 10,000 units/mL (1 mL); 40,000 units/mL (1 mL) INVanz: 1 g (1 ea) Retacrit: 2000 units/mL (1 mL); 3000 units/mL (1 mL); 4000 units/mL (1 mL); Erythromycin and Benzoyl Peroxide 10,000 units/mL (1 mL); 40,000 units/mL (1 mL) DoD Uniform Formulary Outpatient Dosage Forms Epoprostenol UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Gel, External: UNIFORM FORMULARY Generic: Erythromycin 30 mg and benzoyl peroxide 50 mg per g (23 g, 47 g) Solution Reconstituted, Intravenous: Erythromycin (Ophthalmic) Generic: 0.5 mg (1 ea); 1.5 mg (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Eprosartan BASIC CORE FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Ointment, Ophthalmic: UNIFORM FORMULARY Generic: 5 mg/g (1 g, 3.5 g) Tablet, Oral: Generic: 600 mg 43 ERYTHROMYCIN (SYSTEMIC) Erythromycin (Systemic) Estradiol and Norgestimate DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY UNIFORM FORMULARY Suspension Reconstituted, Oral, as ethylsuccinate: Tablet, Oral: E.E.S. Granules: 200 mg/5 mL (100 mL, 200 mL) [cherry flavor] Prefest: Estradiol 1 mg [15 peach tablets] and estradiol 1 mg and norgesti- EryPed: 200 mg/5 mL (100 mL) [fruit flavor] mate 0.09 mg [15 white tablets] Generic: 200 mg/5 mL (100 mL, 200 mL) Tablet, Oral, as stearate: Estradiol (Systemic) Erythrocin Stearate: 250 mg DoD Uniform Formulary Outpatient Dosage Forms Tablet Delayed Release, Oral, as base: BASIC CORE FORMULARY Ery-Tab: 250 mg Patch Weekly, Transdermal: Generic: 0.025 mg/24 hours (4 ea); 0.0375 mg/24 hours (4 ea); 0.05 mg/24 UNIFORM FORMULARY hours (4 ea); 0.06 mg/24 hours (4 ea); 0.075 mg/24 hours (4 ea); 0.1 mg/24 Capsule Delayed Release Particles, Oral, as base: hours (4 ea) Generic: 250 mg Solution Reconstituted, Intravenous, as lactobionate: UNIFORM FORMULARY Erythrocin Lactobionate: 500 mg (1 ea) Cream, Transdermal: Tablet, Oral, as base: EC-RX Estradiol: 0.4% (30 g, 60 g); 0.6% (30 g, 60 g) [contains cetearyl Generic: 250 mg, 500 mg alcohol] Tablet, Oral, as ethylsuccinate: Emulsion, Transdermal, as hemihydrate: Generic: 400 mg Estrasorb: 4.35 mg/1.74 g (1.74 g [DSC]) [contains polysorbate 80, soy- bean oil] Erythromycin (Topical) Gel, Transdermal: DoD Uniform Formulary Outpatient Dosage Forms Divigel: 0.25 mg/0.25 g (1 ea); 0.5 mg/0.5 g (1 ea); 1 mg/g (1 g) [contains BASIC CORE FORMULARY propylene glycol, trolamine (triethanolamine)] Gel, External: Elestrin: 0.06% (26 g) [contains edetate disodium, propylene glycol, trolamine Generic: 2% (30 g, 60 g) (triethanolamine)] Solution, External: Estrogel: 0.06% (50 g) [contains alcohol, usp, trolamine (triethanolamine)] Generic: 2% (60 mL) Oil, Intramuscular, as cypionate: Depo-Estradiol: 5 mg/mL (5 mL) UNIFORM FORMULARY Oil, Intramuscular, as valerate: Pad, External: Delestrogen: 10 mg/mL (5 mL) [contains chlorobutanol (chlorobutol), ses- Generic: 2% (60 ea) ame oil] Generic: 20 mg/mL (5 mL); 40 mg/mL (5 mL) Escitalopram Patch Twice Weekly, Transdermal: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.025 mg/24 hr (8 ea); 0.0375 mg/24 hr (8 ea); 0.05 mg/24 hr (1 ea, UNIFORM FORMULARY 8 ea); 0.075 mg/24 hr (8 ea); 0.1 mg/24 hr (8 ea) Solution, Oral: Patch Weekly, Transdermal: Generic: 5 mg/5 mL (240 mL) Menostar: 14 mcg/24 hr (4 ea) Tablet, Oral: Ring, Vaginal, as acetate: Generic: 5 mg, 10 mg, 20 mg Femring: 0.05 mg/24 hr (1 ea); 0.1 mg/24 hr (1 ea) Solution, Transdermal: Esketamine Evamist: 1.53 mg/spray (8.1 mL) DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 0.5 mg, 1 mg, 2 mg Solution Therapy Pack, Nasal, as hydrochloride: Spravato (56 MG Dose): 28 mg/device (dose pack of 2) (1 ea) [contains Estradiol (Topical) edetate disodium] DoD Uniform Formulary Outpatient Dosage Forms Spravato (84 MG Dose): 28 mg/device (dose pack of 3) (1 ea) [contains UNIFORM FORMULARY edetate disodium] Cream, Vaginal: Estrace; Generic: 0.1 mg/g (42.5 g) Eslicarbazepine Ring, Vaginal, as base: DoD Uniform Formulary Outpatient Dosage Forms Estring: 2 mg (1 ea) UNIFORM FORMULARY Tablet, Vaginal, as base: Tablet, Oral: Generic, Vagifem, Yuvafen: 10 mcg Aptiom: 200 mg, 400 mg, 600 mg, 800 mg NONFORMULARY Esmolol Insert, Vaginal: DoD Uniform Formulary Outpatient Dosage Forms Imvexxy Maintenance Pack: 4 mcg (8 ea); 10 mcg (8 ea) UNIFORM FORMULARY Imvexxy Starter Pack: 4 mcg (18 ea); 10 mcg (18 ea) Solution, Intravenous, as hydrochloride: Estramustine Brevibloc: 100 mg/10 mL (10 mL) Brevibloc in NaCl: 2000 mg (100 mL); 2500 mg (250 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous, as hydrochloride [preservative free]: UNIFORM FORMULARY Generic: 100 mg/10 mL (10 mL) Capsule, Oral, as phosphate sodium: Emcyt: 140 mg Estazolam Estrogens (Conjugated/Equine) and Bazedoxifene DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Tablet, Oral: Tablet, Oral: Generic: 1 mg, 2 mg Duavee: Conjugated estrogens 0.45 mg and bazedoxifene 20 mg Estradiol and Levonorgestrel Estrogens (Conjugated/Equine) and Medroxyprogesterone DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Patch, transdermal: Tablet, Oral: ClimaraPro: Estradiol 0.045 mg and levonorgestrel 0.015 mg per 24 hours Prempro: 0.3/1.5: Conjugated estrogens 0.3 mg and medroxyprogesterone (4s) [22 cm2; contains estradiol 4.4 mg and levonorgestrel 1.39 mg] acetate 1.5 mg Estradiol and Norethindrone Prempro: 0.45/1.5: Conjugated estrogens 0.45 mg and medroxyprogesterone DoD Uniform Formulary Outpatient Dosage Forms acetate 1.5 mg Prempro: 0.625/2.5: Conjugated estrogens 0.625 mg and medroxyprogester- UNIFORM FORMULARY one acetate 2.5 mg Patch, transdermal: Prempro: 0.625/5: Conjugated estrogens 0.625 mg and medroxyprogesterone CombiPatch: 0.05/0.14: Estradiol 0.05 mg and norethindrone acetate 0.14 mg acetate 5 mg per day (8s) [9 sq cm] CombiPatch: 0.05/0.25: Estradiol 0.05 mg and norethindrone acetate 0.25 mg UNIFORM FORMULARY per day (8s) [16 sq cm] Tablet, Oral: Tablet, Oral: Premphase [therapy pack contains 2 separate tablet formulations]: Conju- Generic: 0.5/0.1: Estradiol 0.5 mg and norethindrone acetate 0.1 mg (28s) gated estrogens 0.625 mg [14 maroon tablets] and conjugated estrogen Generic: 1/0.5: Estradiol 1 mg and norethindrone acetate 0.5 mg (28s) 0.625 mg/medroxyprogesterone acetate 5 mg [14 light blue tablets] (28s) 44 ETHINYL ESTRADIOL AND ETONOGESTREL Estrogens (Conjugated/Equine, Systemic) Kimidess: DoD Uniform Formulary Outpatient Dosage Forms Day 1-21: Ethinyl estradiol 0.02 mg and desogestrel 0.15 mg [21 white BASIC CORE FORMULARY tablets] Tablet, Oral: Day 22-23: 2 inactive green tablets Premarin: 0.3 mg, 0.45 mg, 0.625 mg, 1.25 mg Day 24-28: Ethinyl estradiol 0.01 mg [5 yellow tablets] (28s) Mircette: UNIFORM FORMULARY Day 1-21: Ethinyl estradiol 0.02 mg and desogestrel 0.15 mg [21 white Solution Reconstituted, Injection: tablets] Premarin: 25 mg (1 ea) [contains benzyl alcohol] Day 22-23: 2 inactive green tablets Tablet, Oral: Day 24-28: Ethinyl estradiol 0.01 mg [5 yellow tablets] (28s) Premarin: 0.9 mg Pimtrea: Estrogens (Conjugated/Equine, Topical) Day 1-21: Ethinyl estradiol 0.02 mg and desogestrel 0.15 mg [21 dark blue DoD Uniform Formulary Outpatient Dosage Forms tablets] BASIC CORE FORMULARY Day 22-23: 2 inactive white tablets Cream, Vaginal: Day 24-28: Ethinyl estradiol 0.01 mg [5 green tablets] (28s) Premarin: 0.625 mg/g (30 g) Viorele: Day 1-21: Ethinyl estradiol 0.02 mg and desogestrel 0.15 mg [21 white Estrogens (Esterified) tablets] DoD Uniform Formulary Outpatient Dosage Forms Day 22-23: 2 inactive green tablets UNIFORM FORMULARY Day 24-28: Ethinyl estradiol 0.01 mg [5 yellow tablets] (28s) Tablet, Oral: Tablet, Oral [monophasic formulation]: Menest: 0.3 mg, 0.625 mg, 1.25 mg Apri 28: Ethinyl estradiol 0.03 mg and desogestrel 0.15 mg [21 rose tablets Estrogens (Esterified) and Methyltestosterone and 7 white inactive tablets] (28s) DoD Uniform Formulary Outpatient Dosage Forms Cyred: Ethinyl estradiol 0.03 mg and desogestrel 0.15 mg [21 active and 7 UNIFORM FORMULARY inactive tablets] (28s) Tablet, Oral: Desogen: Ethinyl estradiol 0.03 mg and desogestrel 0.15 mg [21 white tablets Generic: and 7 green inactive tablets] (28s) Esterified estrogen 0.625 mg and methyltestosterone 1.25 mg Emoquette: Ethinyl estradiol 0.03 mg and desogestrel 0.15 mg [21 white Esterified estrogens 1.25 mg and methyltestosterone 2.5 mg tablets and 7 light green inactive tablets] (28s) Enskyce: Ethinyl estradiol 0.03 mg and desogestrel 0.15 mg [21 light orange Eszopiclone tablets and 7 green inactive tablets] (28s) DoD Uniform Formulary Outpatient Dosage Forms Juleber: Ethinyl estradiol 0.03 mg and desogestrel 0.15 mg [21 yellow tablets UNIFORM FORMULARY and 7 white inactive tablets] (28s) Tablet, Oral: Reclipsen: Ethinyl estradiol 0.03 mg and desogestrel 0.15 mg [21 rose tablets Generic: 1 mg, 2 mg, 3 mg and 7 white inactive tablets] (28s) Solia: Ethinyl estradiol 0.03 mg and desogestrel 0.15 mg (28s) Etelcalcetide DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral [triphasic formulation]: UNIFORM FORMULARY Caziant: Solution, Intravenous [preservative free]: Day 1-7: Ethinyl estradiol 0.025 mg and desogestrel 0.1 mg [7 beige tablets] Parsabiv: 5 mg/mL (1 mL); 10 mg/2 mL (2 mL); 2.5 mg/0.5 mL (0.5 mL) Day 8-14: Ethinyl estradiol 0.025 mg and desogestrel 0.125 mg [7 orange tablets] Eteplirsen Day 15-21: Ethinyl estradiol 0.025 mg and desogestrel 0.15 mg [7 pink DoD Uniform Formulary Outpatient Dosage Forms tablets] UNIFORM FORMULARY Day 22-28: 7 white inactive tablets (28s) Solution, Intravenous [preservative free]: Cyclessa: Exondys 51: 50 mg/mL (2 mL, 10 mL) Day 1-7: Ethinyl estradiol 0.025 mg and desogestrel 0.1 mg [7 light yellow tablets] Ethacrynic Acid Day 8-14: Ethinyl estradiol 0.025 mg and desogestrel 0.125 mg [7 orange DoD Uniform Formulary Outpatient Dosage Forms tablets] UNIFORM FORMULARY Day 15-21: Ethinyl estradiol 0.025 mg and desogestrel 0.15 mg [7 red Solution Reconstituted, Intravenous, as ethacrynate sodium: tablets] Generic: 50 mg (1 ea) Day 22-28: 7 green inactive tablets (28s) Tablet, Oral: Velivet: Generic: 25 mg Day 1-7: Ethinyl estradiol 0.025 mg and desogestrel 0.1 mg [7 beige tablets] Ethambutol Day 8-14: Ethinyl estradiol 0.025 mg and desogestrel 0.125 mg [7 orange DoD Uniform Formulary Outpatient Dosage Forms tablets] BASIC CORE FORMULARY Day 15-21: Ethinyl estradiol 0.025 mg and desogestrel 0.15 mg [7 pink Tablet, Oral, as hydrochloride: tablets] Generic: 100 mg, 400 mg Day 22-28: 7 white inactive tablets (28s) Ethanolamine Oleate Ethinyl Estradiol and Drospirenone DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms NOT COVERED BASIC CORE FORMULARY Solution, Intravenous: Tablet, Oral: Ethamolin: 5% (2 mL) [contains benzyl alcohol] Generic: Ethinyl estradiol 0.02 mg and drospirenone 3 mg [21 active tablets and 7 inactive tablets] (28s) Ethinyl Estradiol and Desogestrel Generic: Ethinyl estradiol 0.03 mg and drospirenone 3 mg [21 active tablets DoD Uniform Formulary Outpatient Dosage Forms and 7 inactive tablets] (28s) UNIFORM FORMULARY Tablet, Oral [low dose formulation]: Ethinyl Estradiol and Ethynodiol Diacetate Azurette: DoD Uniform Formulary Outpatient Dosage Forms Day 1-21: Ethinyl estradiol 0.02 mg and desogestrel 0.15 mg [21 white UNIFORM FORMULARY tablets] Tablet, Oral [monophasic formulation]: Day 22-23: 2 inactive green tablets Generic: Ethinyl estradiol 0.05 mg and ethynodiol diacetate 1 mg [21 active Day 24-28: Ethinyl estradiol 0.01 mg [5 blue tablets] (28s) tablets and 7 inactive tablets] (28s) Bekyree: Day 1-21: Ethinyl estradiol 0.02 mg and desogestrel 0.15 mg [21 white Ethinyl Estradiol and Etonogestrel tablets] DoD Uniform Formulary Outpatient Dosage Forms Day 22-23: 2 inactive green tablets UNIFORM FORMULARY Day 24-28: Ethinyl estradiol 0.01 mg [5 yellow tablets] (28s) Ring, vaginal: Kariva: NuvaRing: Ethinyl estradiol 0.015 mg/day and etonogestrel 0.12 mg/day (3s) Day 1-21: Ethinyl estradiol 0.02 mg and desogestrel 0.15 mg [21 white [3-week duration] tablets] Day 22-23: 2 inactive light green tablets Day 24-28: Ethinyl estradiol 0.01 mg [5 light blue tablets] (28s) 45 ETHINYL ESTRADIOL AND LEVONORGESTREL Ethinyl Estradiol and Levonorgestrel Day 11-21: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [11 dark DoD Uniform Formulary Outpatient Dosage Forms yellow tablets] BASIC CORE FORMULARY Day 22-28: 7 white inactive tablets (28s) Tablet, Oral [extended cycle regimen]: Tablet, Oral [triphasic formulation]: Generic: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg [84 tablets and Alyacen 7/7/7; Cyclafem 7/7/7; Dasetta 7/7/7; Necon 7/7/7; Ortho-Novum 7/7/ 7 inactive tablets] (91s) 7; Nortrel 7/7/7; Pirmella 7/7/7: Tablet, Oral [low dose formulation]: Day 1-7: Ethinyl estradiol 0.035 mg and norethindrone 0.5 mg [7 tablets] Generic: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg [21 tablets and 7 Day 8-14: Ethinyl estradiol 0.035 mg and norethindrone 0.75 mg [7 tablets] inactive tablets] (28s) Day 15-21: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [7 tablets] Tablet, Oral [monophasic formulation]: Day 22-28: 7 inactive tablets (28s) Generic: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg [21 tablets and Aranelle; Leena; Tri-Norinyl: 7 inactive tablets] (28s) Day 1-7: Ethinyl estradiol 0.035 mg and norethindrone 0.5 mg [7 tablets] Day 8-16: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [9 tablets] UNIFORM FORMULARY Day 17-21: Ethinyl estradiol 0.035 mg and norethindrone 0.5 mg [5 tablets] Tablet, Oral [triphasic formulation]: Day 22-28: 7 inactive tablets (28s) Day 1-6: Ethinyl estradiol 0.03 mg and levonorgestrel 0.05 mg [6 tablets] Day 7-11: Ethinyl estradiol 0.04 mg and levonorgestrel 0.075 mg [5 tablets] NONFORMULARY Day 12-21: Ethinyl estradiol 0.03 mg and levonorgestrel 0.125 mg [10 tablets] Capsule, Oral: Day 22-28: 7 inactive tablets (28s) Taytulla: Ethinyl estradiol 0.02 mg and norethindrone acetate 1 mg [21 pale pink capsules] and ferrous fumarate 75 mg [7 maroon capsules] (28s) NONFORMULARY Tablet, Oral: Tablet, Oral: Aurovela 1/20; Balziva; Blisovi 24 Fe; Briellyn; Estrostep Fe; Gildagia; Gildess Amethia: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg [84 white 24 Fe; Junel Fe 24; Larin 24 Fe; Lo Loestrin Fe; Loestrin 24 Fe; Lomedia 24 tablets] and ethinyl estradiol 0.01 mg [7 light blue tablets] (91s) Fe; Microgestin 24 Fe; Minastrin 24 Fe; Ovcon 35; Philith; Tilia Fe; Tri-Legest Amethia Lo: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg [84 orange Fe; Vyfemla; Zenchent tablets] and ethinyl estradiol 0.01 mg [7 yellow tablets] (91s) Generess Fe; Kaitlib Fe; Layolis Fe; Melodetta 24 Fe; Mibelas 24 Fe; Minastrin Amethyst: Ethinyl estradiol 0.02 mg and levonorgestrel 0.09 mg [28 white 24 Fe; Wymzya Fe; Zenchent Fe, Zeosa tablets] (28s) Generic: Ethinyl estradiol 0.025 mg and norethindrone 0.8 mg [24 tablets] and Ashlyna: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg [84 blue ferrous fumarate 75 mg [4 tablets] (28s); tablets] and ethinyl estradiol 0.01 mg [7 yellow tablets] (91s) Generic: Ethinyl estradiol 0.035 mg and norethindrone 0.4 mg [21 tablets] and Balcoltra: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg [21 tablets] and ferrous fumarate 75 mg [7 tablets] (28s) ferrous bisglycinate 36.5 mg [7 tablets] camrese: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg [84 light blue- Ethinyl Estradiol and Norgestimate green tablets] and ethinyl estradiol 0.01 mg [7 yellow tablets] (91s) DoD Uniform Formulary Outpatient Dosage Forms camrese lo: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg [84 orange BASIC CORE FORMULARY tablets] and ethinyl estradiol 0.01 mg [7 yellow tablets] (91s) Tablet, Oral [monophasic formulation]: Daysee: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg [84 light blue Estarylla: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [21 blue tablets] and ethinyl estradiol 0.01 mg [7 mustard tablets] (91s) tablets and 7 green inactive tablets] (28s) LoSeasonique: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg [84 Mili: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [21 dark blue orange tablets] and ethinyl estradiol 0.01 mg [7 yellow tablets] (91s) tablets and 7 green inactive tablets] (28s) Seasonique: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg [84 light Mono-Linya: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [21 blue blue-green tablets] and ethinyl estradiol 0.01 mg [7 yellow tablets] (91s) tablets and 7 white inactive tablets] (28s) Generic: Ethinyl estradiol 0.02 mg and levonorgestrel 0.1 mg [84 tablets] and MonoNessa: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [21 blue ethinyl estradiol 0.01 mg [7 tablets] (91s) tablets and 7 green inactive tablets] Generic: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg [84 tablets] and Ortho-Cyclen: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [21 blue ethinyl estradiol 0.01 mg [7 tablets] (91s) tablets and 7 dark green inactive tablets] (28s) Generic: Ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg [84 tablets and Previfem: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [21 blue 7 inactive tablets] (91s) tablets and 7 light green inactive tablets] (28s) Sprintec: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [21 blue Ethinyl Estradiol and Norelgestromin tablets and 7 white inactive tablets] DoD Uniform Formulary Outpatient Dosage Forms VyLibra: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [21 dark blue UNIFORM FORMULARY tablets and 7 green inactive tablets] (28s) Patch, Transdermal: Tablet, Oral [triphasic formulation]: Xulane: Ethinyl estradiol 0.53 mg and norelgestromin 4.86 mg [releases Ortho Tri-Cyclen: ethinyl estradiol 35 mcg and norelgestromin 150 mcg per day] (3s) Day 1-7: Ethinyl estradiol 0.035 mg and norgestimate 0.18 mg [7 white Ethinyl Estradiol and Norethindrone tablets] Day 8-14: Ethinyl estradiol 0.035 mg and norgestimate 0.215 mg [7 light blue DoD Uniform Formulary Outpatient Dosage Forms tablets] BASIC CORE FORMULARY Day 15-21: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [7 blue Tablet, Oral [monophasic formulation]: tablets] Alyacen 1/35: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [21 peach Day 22-28: 7 dark green inactive tablets (28s) tablets and 7 light green inactive tablets] (28s) Tri-Estarylla: Cyclafem 1/35: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [21 pink Day 1-7: Ethinyl estradiol 0.035 mg and norgestimate 0.18 mg [7 white tablets and 7 light green inactive tablets] (28s) tablets] Dasetta 1/35: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [21 orange Day 8-14: Ethinyl estradiol 0.035 mg and norgestimate 0.215 mg [7 light blue tablets and 7 white inactive tablets] (28s) [contains soya lecithin, tartrazine] tablets] Nortrel 1/35: Day 15-21: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [7 blue Ethinyl estradiol 0.035 mg and norethindrone 1 mg [yellow tablets] (21s) tablets] Ethinyl estradiol 0.035 mg and norethindrone 1 mg [21 yellow tablets and 7 Day 22-28: 7 green inactive tablets (28s) white inactive tablets] (28s) Tri-Linyah: Ortho-Novum 1/35: Ethinyl estradiol 0.035 mg and norethindrone 1 mg (28s) Day 1 to 7: Ethinyl estradiol 0.035 mg and norgestimate 0.18 mg [7 green [21 peach tablets and 7 green inactive tablets] tablets] Pirmella 1/35: Ethinyl estradiol 0.035 mg and norethindrone 1 mg [21 peach Day 8 to 14: Ethinyl estradiol 0.035 mg and norgestimate 0.215 mg [7 light tablets and 7 green inactive tablets] (28s) blue tablets] UNIFORM FORMULARY Day 15 to 21: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [7 blue Tablet, Oral: tablets] Generic: Ethinyl estradiol 0.0025 mg and norethindrone acetate 0.5 mg (28s) Day 22 to 28: 7 white inactive tablets (28s) Generic: Ethinyl estradiol 0.005 mg and norethindrone acetate 1 mg Tri-Previfem: (28s, 90s) Day 1-7: Ethinyl estradiol 0.035 mg and norgestimate 0.18 mg [7 white Tablet, Chewable, Oral [monophasic formulation]: tablets] Generic: Ethinyl estradiol 0.025 mg and norethindrone 0.8 mg [24 tablets] and Day 8-14: Ethinyl estradiol 0.035 mg and norgestimate 0.215 mg [7 light blue ferrous fumarate 75 mg [4 tablets] (28s) tablets] Generic: Ethinyl estradiol 0.035 mg and norethindrone 0.4 mg [21 tablets] and Day 15-21: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [7 blue ferrous fumarate 75 mg [7 tablets] (28s) tablets] Tablet, Oral [biphasic formulation]: Day 22-28: 7 light green inactive tablets (28s) Necon 10/11: Tri-Sprintec 28: Day 1-10: Ethinyl estradiol 0.035 mg and norethindrone 0.5 mg [10 light Day 1-7: Ethinyl estradiol 0.035 mg and norgestimate 0.18 mg [7 gray yellow tablets] tablets] 46 EXENATIDE

Day 8-14: Ethinyl estradiol 0.035 mg and norgestimate 0.215 mg [7 light blue Capsule, Oral: tablets] Generic: 200 mg, 300 mg Day 15-21: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [7 blue Tablet, Oral: tablets] Generic: 400 mg, 500 mg Day 22-28: 7 white inactive tablets Tablet Extended Release 24 Hour, Oral: TriNessa: Generic: 400 mg, 500 mg, 600 mg Day 1-7: Ethinyl estradiol 0.035 mg and norgestimate 0.18 mg [7 white tablets] Etomidate Day 8-14: Ethinyl estradiol 0.035 mg and norgestimate 0.215 mg [7 light blue DoD Uniform Formulary Outpatient Dosage Forms tablets] UNIFORM FORMULARY Day 15-21: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [7 blue Solution, Intravenous: tablets] Generic: 2 mg/mL (10 mL, 20 mL) Day 22-28: 7 green inactive tablets Solution, Intravenous [preservative free]: Tri-Mili; Tri-VyLibra: Generic: 2 mg/mL (10 mL, 20 mL) Day 1 to 7: Ethinyl estradiol 0.035 mg and norgestimate 0.18 mg [7 white Etonogestrel tablets] DoD Uniform Formulary Outpatient Dosage Forms Day 8 to 14: Ethinyl estradiol 0.035 mg and norgestimate 0.215 mg [7 light UNIFORM FORMULARY blue tablets] Implant, Subcutaneous: Day 15 to 21: Ethinyl estradiol 0.035 mg and norgestimate 0.25 mg [7 dark Nexplanon: 68 mg (1 ea) blue tablets] Day 22 to 28: 7 green inactive tablets Etoposide UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral [triphasic formulation]: UNIFORM FORMULARY Ortho Tri-Cyclen Lo: Capsule, Oral: Day 1 to 7: Ethinyl estradiol 0.025 mg and norgestimate 0.18 mg [7 white Generic: 50 mg tablets] Solution, Intravenous: Day 8 to 14: Ethinyl estradiol 0.025 mg and norgestimate 0.215 mg [7 light Generic: 100 mg/5 mL (5 mL); 500 mg/25 mL (25 mL); 1 g/50 mL (50 mL) blue tablets] Day 15 to 21: Ethinyl estradiol 0.025 mg and norgestimate 0.25 mg [7 dark Etoposide Phosphate blue tablets] DoD Uniform Formulary Outpatient Dosage Forms Day 22 to 28: 7 dark green inactive tablets (28s) UNIFORM FORMULARY Tri-Lo-Estarylla; Tri-Lo-Marzia; Tri-Lo-Sprintec; TriNessa Lo: Solution Reconstituted, Intravenous [strength expressed as base]: Day 1 to 7: Ethinyl estradiol 0.025 mg and norgestimate 0.18 mg [7 tablets] Etopophos: 100 mg (1 ea) Day 8 to 14: Ethinyl estradiol 0.025 mg and norgestimate 0.215 mg [7 Etravirine tablets] DoD Uniform Formulary Outpatient Dosage Forms Day 15 to 21: Ethinyl estradiol 0.025 mg and norgestimate 0.25 mg [7 UNIFORM FORMULARY tablets] Tablet, Oral: Day 22 to 28: 7 inactive tablets (28s) Intelence: 25 mg [scored] Ethinyl Estradiol and Norgestrel Intelence: 100 mg, 200 mg DoD Uniform Formulary Outpatient Dosage Forms Everolimus UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral [monophasic formulation]: UNIFORM FORMULARY Ogestrel: Ethinyl estradiol 0.05 mg and norgestrel 0.5 mg [21 white tablets Tablet, Oral: and 7 peach inactive tablets] (28s) Afinitor: 2.5 mg, 5 mg, 7.5 mg, 10 mg Generic: Ethinyl estradiol 0.03 mg and norgestrel 0.3 mg [21 tablets and 7 Zortress: 0.25 mg, 0.5 mg, 0.75 mg inactive tablets] (28s) Tablet Soluble, Oral: Ethiodized Oil Afinitor Disperz: 2 mg, 3 mg, 5 mg DoD Uniform Formulary Outpatient Dosage Forms Evinacumab UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Injection: Iodine 37% (10 mL) NOT COVERED Ethionamide Solution, Intravenous [preservative free]:Evkeeza: Evinacumab-dgnb 1200 mg/8 mL (150 mg/mL) (8 mL) DoD Uniform Formulary Outpatient Dosage Forms Evinacumab-dgnb 345 mg/2.3 mL (150 mg/mL) (2.3 mL) UNIFORM FORMULARY Tablet, Oral: Evolocumab Trecator: 250 mg DoD Uniform Formulary Outpatient Dosage Forms Ethosuximide UNIFORM FORMULARY Solution Auto-injector, Subcutaneous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Repatha SureClick: 140 mg/mL (1 mL) [contains mouse (murine) and/or UNIFORM FORMULARY hamster protein, polysorbate 80] Capsule, Oral: Solution Cartridge, Subcutaneous [preservative free]: Generic: 250 mg Repatha Pushtronex System: 420 mg/3.5 mL (3.5 mL) [contains polysor- Solution, Oral: bate 80] Generic: 250 mg/5 mL (473 mL, 474 mL) Solution Prefilled Syringe, Subcutaneous [preservative free]: Ethotoin Repatha: 140 mg/mL (1 mL) [contains mouse (murine) and/or hamster protein, polysorbate 80] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Exemestane Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Peganone: 250 mg [scored] UNIFORM FORMULARY Ethyl Chloride Tablet, Oral: Generic: 25 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Exenatide Aerosol, External: DoD Uniform Formulary Outpatient Dosage Forms Generic: 100% (103.5 mL, 105 mL) BASIC CORE FORMULARY Etidronate Auto-injector, Subcutaneous: Bydureon BCise: 2 mg/0.85 mL (0.85 mL) DoD Uniform Formulary Outpatient Dosage Forms Pen-injector, Subcutaneous: UNIFORM FORMULARY Bydureon: 2 mg (1 ea) Tablet, Oral, as disodium: Suspension Reconstituted, Subcutaneous: Generic: 200 mg, 400 mg Bydureon: 2 mg (1 ea) Etodolac NONFORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution Pen-injector, Subcutaneous: UNIFORM FORMULARY Byetta 10 MCG Pen: 10 mcg/0.04 mL (2.4 mL) 47 EXENATIDE

Byetta 5 MCG Pen: 5 mcg/0.02 mL (1.2 mL) Tablet, Oral: Generic: 125 mg, 250 mg, 500 mg Ezetimibe DoD Uniform Formulary Outpatient Dosage Forms Famotidine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 10 mg Solution, Intravenous: Generic: 20 mg (50 mL); 20 mg/2 mL (2 mL); 40 mg/4 mL (4 mL); 200 mg/20 Ezogabine mL (20 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous [preservative free]: UNIFORM FORMULARY Generic: 20 mg/2 mL (2 mL) Tablet, Oral: Suspension Reconstituted, Oral: Potiga: 50 mg, 200 mg, 300 mg, 400 mg Generic: 40 mg/5 mL (50 mL) Tablet, Oral: Factor IX Complex (Human) [(Factors II, IX, X)] Generic: 10 mg, 20 mg, 40 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Famotidine, Calcium Carbonate, and Magnesium Hydroxide Solution Reconstituted, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Bebulin: 200-1200 units (1 ea) UNIFORM FORMULARY Profilnine: 500 units (1 ea); 1000 units (1 ea); 1500 units (1 ea) [contains Tablet, Chewable, Oral: polysorbate 80] Famotidine 10 mg, calcium carbonate 800 mg, and magnesium hydroxide 165 Profilnine SD: 500 units (1 ea); 1000 units (1 ea); 1500 units (1 ea) [contains Dual Action Complete: Famotidine 10 mg, calcium carbonate 800 mg, and polysorbate 80] magnesium hydroxide 165 mg [contains calcium 320 mg/tablet, magnesium 70 mg/tablet, phenylalanine 2.2 mg/tablet; berry flavor] Factor IX (Human) Pepcid Complete: Famotidine 10 mg, calcium carbonate 800 mg, and magne- DoD Uniform Formulary Outpatient Dosage Forms sium hydroxide 165 mg [contains calcium 320 mg/tablet, magnesium 70 mg/ UNIFORM FORMULARY tablet; berry flavor] Solution Reconstituted, Intravenous [preservative free]: Pepcid Complete: Famotidine 10 mg, calcium carbonate 800 mg, and magne- AlphaNine SD: 500 units (1 ea); 1000 units (1 ea); 1500 units (1 ea) [contains sium hydroxide 165 mg [contains calcium 320 mg/tablet, magnesium 70 mg/ polysorbate 80] tablet; mint flavor] Pepcid Complete: Famotidine 10 mg, calcium carbonate 800 mg, and magne- Factor IX (Recombinant [Albumin Fusion Protein]) sium hydroxide 165 mg [contains calcium 320 mg/tablet, magnesium 70 mg/ DoD Uniform Formulary Outpatient Dosage Forms tablet, tartrazine; tropical fruit flavor] UNIFORM FORMULARY Solution Reconstituted, Intravenous: Fam-Trastuzumab Deruxtecan Idelvion: 250 units (1 ea); 500 units (1 ea); 1000 units (1 ea); 2000 units (1 ea) DoD Uniform Formulary Outpatient Dosage Forms [contains hamster protein, polysorbate 80] NOT COVERED Solution Reconstituted, Intravenous [preservative free]: Factor IX (Recombinant [Fc Fusion Protein]) Enhertu: fam-trastuzumab deruxtecan-nxki 100 mg (1 ea) [contains polysor- DoD Uniform Formulary Outpatient Dosage Forms bate 80] UNIFORM FORMULARY Solution Reconstituted, Intravenous [preservative free]: Fat Emulsion (Fish Oil and Plant Based) Alprolix: 250 units (1 ea); 500 units (1 ea); 1000 units (1 ea); 2000 units (1 ea); DoD Uniform Formulary Outpatient Dosage Forms 3000 units (1 ea); 4000 units (1 ea) UNIFORM FORMULARY Emulsion, Intravenous: Factor IX (Recombinant) Smoflipid: 20% (100 mL, 250 mL, 500 mL) [contains egg phospholipids (egg DoD Uniform Formulary Outpatient Dosage Forms lecithin)] UNIFORM FORMULARY Kit, Intravenous [preservative free]: Fat Emulsion (Fish Oil Based) BeneFIX: 250 units (1 ea); 500 units (1 ea); 1000 units (1 ea); 2000 units (1 ea) DoD Uniform Formulary Outpatient Dosage Forms [contains polysorbate 80] NOT COVERED Solution Reconstituted, Intravenous [preservative free]: Emulsion, Intravenous: Ixinity: 250 units (1 ea); 500 units (1 ea); 1000 units (1 ea); 1500 units (1 ea); Omegaven: 5 g/50 mL (50 mL); 10% (100 mL) [contains egg phospholipids 2000 units (1 ea); 3000 units (1 ea) [contains mouse (murine) and/or hamster (egg lecithin)] protein, polysorbate 80] Rixubis: 250 units (1 ea); 500 units (1 ea); 1000 units (1 ea); 2000 units (1 ea); Fat Emulsion (Plant Based) 3000 units (1 ea) [contains polysorbate 80] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Factor X (Human) Emulsion, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Intralipid: 20% (100 mL, 250 mL, 500 mL, 1000 mL); 30% (500 mL) [contains UNIFORM FORMULARY egg yolk phospholipids, glycerin] Solution Reconstituted, Intravenous [preservative free]: Nutrilipid: 20% (250 mL, 500 mL, 1000 mL) [contains egg yolk phospholipids, Coagadex: 250 units (1 ea); 500 units (1 ea) [latex free] glycerin] Factor XIII A-Subunit (Recombinant) Fedratinib DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution Reconstituted, Intravenous: Capsule, Oral, as hydrochloride: Tretten: 2000 - 3125 units (1 ea) Inrebic: 100 mg Factor XIII Concentrate (Human) Felbamate DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Kit, Intravenous [preservative free]: Suspension, Oral: Corifact: 1000 - 1600 units Generic: 600 mg/5 mL (237 mL, 240 mL, 473 mL, 946 mL) Tablet, Oral: Factor VIIa (Recombinant) Generic: 400 mg, 600 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Felodipine Solution Reconstituted, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Sevenfact: Factor VIIa, recombinant-jncw 1 mg (1 ea); Factor VIIa, recombi- UNIFORM FORMULARY nant-jncw 5 mg (1 ea) [contains polysorbate 80] Tablet Extended Release 24 Hour, Oral: Solution Reconstituted, Intravenous [preservative free]: Generic: 2.5 mg, 5 mg, 10 mg NovoSeven RT: 1 mg (1 ea); 2 mg (1 ea); 5 mg (1 ea); 8 mg (1 ea) [contains polysorbate 80] Fenfluramine DoD Uniform Formulary Outpatient Dosage Forms Famciclovir UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Oral, as hydrochloride: UNIFORM FORMULARY Fintepla: 2.2 mg/mL (30 mL, 360 mL) 48 FEXOFENADINE AND PSEUDOEPHEDRINE Fenofibrate and Derivatives Ferric Pyrophosphate Citrate DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY UNIFORM FORMULARY Tablet, Oral, as fenofibrate: Packet, Hemodialysis: Generic: 48 mg, 145 mg Triferic: 272 mg (1 ea, 100 ea) UNIFORM FORMULARY Solution, Hemodialysis: Capsule, Oral, as fenofibrate: Triferic: 27.2 mg/5 mL (50 mL) Generic: 50 mg, 67 mg, 134 mg, 150 mg, 200 mg Ferric Subsulfate Capsule Delayed Release, Oral, as choline fenofibrate: DoD Uniform Formulary Outpatient Dosage Forms Generic: 45 mg, 135 mg UNIFORM FORMULARY Capsule, Oral, Micronized, as fenofibrate: Solution, External: Generic: 43 mg, 130 mg Astringyn: 259 mg/g (8 g) [contains benzalkonium chloride, glycerin, povidone Tablet, Oral, as fenofibrate: (polyvinylpyrrolidone)] Generic: 40 mg, 54 mg, 120 mg, 160 mg Monsels Ferric Subsulfate: (8 mL, 60 mL) Tablet, Oral, as fenofibric acid: Generic: 35 mg, 105 mg Ferrous Fumarate Fenoldopam DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Solution, Intravenous: Ferretts: 325 mg (106 mg elemental iron) [scored] Corlopam: 10 mg/mL (1 mL); 20 mg/2 mL (2 mL) [contains propylene glycol, Ferrimin 150: Elemental iron 150 mg sodium metabisulfite] Generic: 324 mg (106 mg elemental iron), Elemental iron 29 mg Fenoprofen Ferrous Gluconate DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Tablet, Oral: Generic: 600 mg Generic: 240 mg [elemental iron 27 mg], 324 mg [elemental iron 38 mg] Tier 4 - NOT COVERED Tablet, Oral [preservative free]: Capsule, Oral: Ferate: 240 mg [elemental iron 27 mg] [corn free, dairy free, egg free, Generic: 200 mg, 400 mg fragrance free, gluten free, no artificial flavor(s), sodium free, soy free, starch free, sugar free, wheat free, yeast free] FentaNYL Generic: 324 mg [elemental iron 37.5 mg] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Ferrous Sulfate Film, for buccal application, as citrate [strength expressed as base]: DoD Uniform Formulary Outpatient Dosage Forms Onsolis: 200 mcg (30s); 400 mcg (30s); 600 mcg (30s); 800 mcg (30s) UNIFORM FORMULARY Injection, solution, as citrate [strength expressed as base, preservative free]: Elixir, Oral: Generic: 100 mcg/2 mL (2 mL); 250 mcg/5 mL (5 mL); 500 mcg/10 mL (10 Generic: 220 (44 Fe) MG/5ML (5 mL [DSC], 473 mL) mL); 1000 mcg/ 20 mL (20 mL); 2500 mcg/50 mL (50 mL) Liquid, Oral: Lozenge, oral, as citrate [strength expressed as base, transmucosal]: Generic: 220 (44 Fe) MG/5ML (473 mL) Actiq: 1600 mcg (30s) [contains sugar 2 g/lozenge; berry flavor] Solution, Oral: Generic: 200 mcg (30s); 400 mcg (30s); 600 mcg (30s); 800 mcg (30s); 1200 Generic: 75 (15 Fe) mg/mL (50 mL) mcg (30s); 1600 mcg (30s) Syrup, Oral: Patch, transdermal, as base: Generic: 300 (60 Fe) MG/5ML (5 mL) Generic: 12 [delivers 12.5 mcg/hr] (5s); 25 [delivers 25 mcg/hr] (5s); 50 Tablet, Oral: [delivers 50 mcg/hr] (5s); 75 [delivers 75 mcg/hr] (5s); 87.5 [delivers 87.5 Generic: 325 (65 Fe) MG mcg/hr] (5s); 100 [delivers 100 mcg/hr] (5s) Tablet, Oral [preservative free]: Powder, for prescription compounding, as citrate: USP: 100% (1 g) Generic: 325 (65 Fe) MG NONFORMULARY Tablet Delayed Release, Oral: Liquid, sublingual, as base [spray]: Generic: 324 (65 Fe) MG, 325 (65 Fe) MG Subsys: 100 mcg (30s); 200 mcg (30s); 400 mcg (30s); 600 mcg (30s); 800 Tablet Extended Release, Oral: mcg (30s) [contains dehydrated ethanol 63.6%, propylene glycol] Slow Fe: 142 (45 Fe) MG Solution, intranasal, as citrate [strength expressed as base, spray]: Tablet Extended Release, Oral [preservative free]: Lazanda: 100 mcg/spray (5 mL); 300 mcg/spray (5 mL); 400 mcg/spray (5 mL) Slow Iron: 160 (50 Fe) MG [gluten free] [delivers 8 metered sprays] Generic: 140 (45 Fe) MG Tablet, for buccal application, as citrate [strength expressed as base]: Fentora: 100 mcg (28s); 200 mcg (28s); 400 mcg (28s); 600 mcg (28s); 800 Ferumoxytol mcg (28s) DoD Uniform Formulary Outpatient Dosage Forms Tablet, sublingual, as citrate [strength expressed as base]: UNIFORM FORMULARY Abstral: 100 mcg (12s, 32s); 200 mcg (12s, 32s); 300 mcg (12s, 32s); 400 mcg Solution, Intravenous [preservative free]: (12s, 32s); 600 mcg (32s); 800 mcg (32s) Feraheme: 510 mg/17 mL (17 mL) Ferric Carboxymaltose Fexofenadine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Intravenous: Suspension, Oral, as hydrochloride: Injectafer: 750 mg/15 mL (15 mL) Allegra Allergy Childrens: 30 mg/5 mL (240 mL) [alcohol free, dye free; Ferric Citrate contains butylparaben, edetate disodium, propylene glycol, propylparaben] DoD Uniform Formulary Outpatient Dosage Forms Fexofenadine HCl Childrens: 30 mg/5 mL (118 mL) [alcohol free, dye free; contains butylparaben, edetate disodium, propylene glycol, propylparaben; UNIFORM FORMULARY Tablet, Oral: berry flavor] Auryxia: Ferric iron 210 mg (ferric citrate 1 g) Tablet, Oral, as hydrochloride: Generic: 60 mg, 180 mg Ferric Gluconate Tablet Dispersible, Oral, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Allegra Allergy Childrens: 30 mg [contains aspartame; orange cream flavor] UNIFORM FORMULARY Solution, Intravenous: Fexofenadine and Pseudoephedrine Generic: 12.5 mg/mL (5 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Ferric Hexacyanoferrate Tablet, extended release: DoD Uniform Formulary Outpatient Dosage Forms Fexofenadine hydrochloride 60 mg [immediate release] and pseudoephedrine UNIFORM FORMULARY hydrochloride 120 mg [extended release] Capsule, Oral: Fexofenadine hydrochloride 180 mg [immediate release] and pseudoephe- Radiogardase: 0.5 g drine hydrochloride 240 mg [extended release] 49 FIBRINOGEN CONCENTRATE (HUMAN) Fibrinogen Concentrate (Human) Flecainide DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Injection, powder for reconstitution: Tablet, Oral, as acetate: RiaSTAP: 900-1300 mg [contains albumin (human); exact potency labeled Generic: 50 mg, 100 mg, 150 mg on vial] NONFORMULARY Flibanserin Injection, powder for reconstitution: DoD Uniform Formulary Outpatient Dosage Forms Fibryga: ~1 g [exact potency labeled on vial] UNIFORM FORMULARY Tablet, Oral: Fibrin Sealant Addyi: 100 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Florbetapir F18 Kit: DoD Uniform Formulary Outpatient Dosage Forms Artiss: Solution, topical: Fibrinogen 67-106 mg/mL and thrombin 2.5-6.5 units/ UNIFORM FORMULARY mL (2 mL, 4 mL, 10 mL) [contains albumin (human), aprotinin, polysorbate Solution, Intravenous: 80; prefilled syringe] Amyvid: 500-1900 MBQ/ML (1 ea) [contains alcohol, usp] Tisseel: Powder for solution, topical: Fibrinogen 67-106 mg/mL and thrombin 400-625 units/mL (2 mL, 4 mL, 10 mL) [contains albumin (human), aprotinin, Floxuridine polysorbate 80; packaged with reconstituting solutions] DoD Uniform Formulary Outpatient Dosage Forms Tisseel: Solution, topical: Fibrinogen 67-106 mg/mL and thrombin 400-625 UNIFORM FORMULARY units/mL (2 mL, 4 mL, 10 mL) [contains albumin (human), aprotinin, poly- Solution Reconstituted, Injection: sorbate 80; prefilled syringe] Generic: 0.5 g (1 ea) Kit [preservative free]: Evicel: Solution, topical: Fibrinogen 55-85 mg/mL and thrombin 800-1200 Fluciclovine F 18 units/mL (2 mL, 4 mL, 10 mL) [contains albumin (human)] DoD Uniform Formulary Outpatient Dosage Forms Patch, topical: UNIFORM FORMULARY Evarrest: Fibrinogen 8.6 mg/cm2 and thrombin 37.5 units/cm2 (1s) [contains Solution, Intravenous: albumin (human); 10.2 cm x 10.2 cm] Axumin: 335-8200 MBq/mL (9-221 mCi/mL) 2 2 Evarrest: Fibrinogen 8.6 mg/cm and thrombin 37.5 units/cm (2s) [contains Fluconazole albumin (human); 5.1 cm x 10.2 cm] DoD Uniform Formulary Outpatient Dosage Forms TachoSil: Fibrinogen 3.6-7.4 mg/cm2 and thrombin 1.3-2.7 units/cm2 (1s) BASIC CORE FORMULARY [contains albumin (human), collagen (equine); 9.5 cm x 4.8 cm] TachoSil: Fibrinogen 3.6-7.4 mg/cm2 and thrombin 1.3-2.7 units/cm2 (2s) Tablet, Oral: [contains albumin (human), collagen (equine); 4.8 cm x 4.8 cm] Generic: 150 mg UNIFORM FORMULARY Fidaxomicin Solution, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Generic: 100 mg (50 mL); 200 mg (100 mL); 400 mg (200 mL) UNIFORM FORMULARY Solution, Intravenous [preservative free]: Tablet, Oral: Generic: 200 mg (100 mL); 400 mg (200 mL) Dificid: 200 mg [contains soybean lecithin] Suspension Reconstituted, Oral: Filgrastim Generic: 10 mg/mL (35 mL); 40 mg/mL (35 mL) DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: BASIC CORE FORMULARY Generic: 50 mg, 100 mg, 200 mg Solution, Subcutaneous [preservative free]: Flucytosine Granix: tbo-filgrastim 300 mcg/mL (1 mL); tbo-filgrastim 480 mcg/1.6 mL (1.6 DoD Uniform Formulary Outpatient Dosage Forms mL) [contains polysorbate 80] UNIFORM FORMULARY Solution Prefilled Syringe, Subcutaneous [preservative free]: Capsule, Oral: Granix: tbo-filgrastim 300 mcg/0.5 mL (0.5 mL); tbo-filgrastim 480 mcg/0.8 mL Generic: 250 mg, 500 mg (0.8 mL) [contains polysorbate 80] UNIFORM FORMULARY Fludarabine Solution, Injection: DoD Uniform Formulary Outpatient Dosage Forms Neupogen: filgrastim 300 mcg/mL (1 mL); filgrastim 480 mcg/1.6 mL (1.6 mL) UNIFORM FORMULARY [contains polysorbate 80] Solution, Intravenous, as phosphate: Solution, Injection [preservative free]: Generic: 50 mg/2 mL (2 mL) Nivestym: filgrastim-aafi 300 mcg/mL (1 mL); filgrastim-aafi 480 mcg/1.6 mL Solution, Intravenous, as phosphate [preservative free]: (1.6 mL) [contains polysorbate 80] Generic: 50 mg/2 mL (2 mL) Solution Prefilled Syringe, Injection [preservative free]: Solution Reconstituted, Intravenous, as phosphate: Neupogen: filgrastim 300 mcg/0.5 mL (0.5 mL); filgrastim 480 mcg/0.8 mL (0.8 Generic: 50 mg (1 ea) mL) [contains polysorbate 80] Solution Reconstituted, Intravenous, as phosphate [preservative free]: Nivestym: filgrastim-aafi 300 mcg/0.5 mL (0.5 mL); filgrastim-aafi 480 mcg/0.8 Generic: 50 mg (1 ea) mL (0.8 mL) [contains polysorbate 80] Zarxio: filgrastim-sndz 300 mcg/0.5 mL (0.5 mL); filgrastim-sndz 480 mcg/0.8 Fludeoxyglucose F 18 mL (0.8 mL) [contains polysorbate 80] DoD Uniform Formulary Outpatient Dosage Forms Finasteride UNIFORM FORMULARY Solution, for Injection [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 20-300 mCi/mL (20 mL) BASIC CORE FORMULARY Tablet, Oral: Fludrocortisone Generic: 5 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Tablet, Oral, as acetate: Generic 1 mg Generic: 0.1 mg Fingolimod Flumazenil DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY NOT COVERED Capsule, Oral: Solution, Intravenous: Gilenya: 0.5 mg Generic: 0.5 mg/5 mL (5 mL); 1 mg/10 mL (10 mL) FlavoxATE Flunisolide (Nasal) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral, as hydrochloride: Solution, Nasal: Generic: 100 mg Generic: 25 mcg/actuation (0.025%) (25 mL) 50 FLUOROURACIL (SYSTEMIC) Fluocinolone, Hydroquinone, and Tretinoin PreviDent 5000 Dry Mouth: 1.1% (100 mL) [mint flavor; equivalent to fluoride DoD Uniform Formulary Outpatient Dosage Forms 2.5 mg/dose] UNIFORM FORMULARY Gel, Topical, as sodium: Cream, External: DentaGel: 1.1% (56 g) [fresh mint flavor; neutral pH; equivalent to fluoride Tri-Luma: Fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 2 mg/dose] 0.05% (30 g) [contains sodium metabisulfite] NeutraCare: 1.1% (60 g) [neutral pH] NeutraGard Advanced: 1.1% (60 g) [ neutral pH] Fluocinolone (Ophthalmic) Phos-Flur: 1.1% (51 g) [contains propylene glycol, sodium benzoate; mint DoD Uniform Formulary Outpatient Dosage Forms flavor; equivalent to fluoride 0.5%] UNIFORM FORMULARY PreviDent: 1.1% (56 g) [neutral pH; equivalent to fluoride 2 mg/dose] Implant, Intraocular, as acetonide: Gel, topical, as stannous fluoride: Iluvien: 0.19 mg (1 ea) Gel-Kam: 0.4% (129 g) Retisert: 0.59 mg (1 ea) Just For Kids: 0.4% (122 g) Omni Gel: 0.4% (122 g) Fluocinolone (Otic) Liquid, Oral, as base: DoD Uniform Formulary Outpatient Dosage Forms Fluoritab: 0.125 mg/drop [dye free] UNIFORM FORMULARY Lozenge, oral, as sodium: Oil, Otic, as acetonide: Lozi-Flur: 2.21 mg (90s) [sugar free; cherry flavor; equivalent to fluoride 1 mg] Generic: 0.01% (20 mL) Paste, oral, as sodium [toothpaste]: Clinpro 5000: 1.1% (113 g) [vanilla-mint flavor] Fluocinolone (Topical) Fluoridex: 1.1% (112 g) DoD Uniform Formulary Outpatient Dosage Forms Fluoridex Enhanced Whitening: 1.1% (112 g) [mint flavor] UNIFORM FORMULARY Paste, Oral, as stannous fluoride [toothpaste]: Cream, External, as acetonide: parodontax: 0.454% (96.4 g) [mint flavor] Generic: 0.01% (15 g, 60 g); 0.025% (15 g, 60 g) Sensodyne Repair & Protect: 0.454% (96.4 g) [mint flavor] Kit, External, as acetonide: Solution, Oral, as sodium [drops]: Synalar (Cream): 0.025% [contains cetyl alcohol, edetate disodium, methyl- Fluor-A-Day: 0.278 mg/drop (30 mL) [equivalent to fluoride 0.125 mg/drop] paraben, propylene glycol, propylparaben] Fluorabon: 0.55 mg/0.6 mL (60 mL) [dye free, sugar free; equivalent to fluoride Synalar (Ointment): 0.025% 0.25 mg/0.6 mL] Synalar TS: 0.01% [contains propylene glycol] Flura-Drops: 0.55 mg/drop (24 mL) [dye free, sugar free; contains natural Xilapak: 0.01% [contains butylparaben, cetyl alcohol, methylparaben, propy- rubber/natural latex in packaging; equivalent to fluoride 0.25 mg/drop] lene glycol, propylparaben] Solution, Oral, as sodium [rinse]: Ointment, External, as acetonide: Act: 0.05% (532 mL) [contains benzyl alcohol, propylene glycol, sodium Generic: 0.025% (15 g, 60 g) benzoate, tartrazine; cinnamon flavor; equivalent to fluoride 0.02%] Solution, External, as acetonide: Act: 0.05% (532 mL) [contains propylene glycol, sodium benzoate, tartrazine; Generic: 0.01% (60 mL) mint flavor; equivalent to fluoride 0.02%] NONFORMULARY Act Kids: 0.05% (532 mL) [ethanol free; contains benzyl alcohol, propylene Oil, External, as acetonide: glycol, sodium benzoate; bubblegum flavor; equivalent to fluoride 0.02%] Derma-Smoothe/FS Body: 0.01% (118.28 mL) [contains isopropyl alcohol, Act Kids: 0.05% (500 mL) [ethanol free; contains benzyl alcohol, propylene peanut oil] glycol, sodium benzoate; ocean berry flavor; equivalent to fluoride 0.02%] Generic: 0.01% (118.28 mL) Act Restoring: 0.02% (1000 mL) [contains ethanol 11%, propylene glycol, Shampoo, External, as acetonide: sodium benzoate; equivalent to fluoride 0.009%] Capex: 0.01% (120 mL) Act Restoring: 0.05% (532 mL) [contains ethanol 11%, propylene glycol, sodium benzoate; equivalent to fluoride 0.02%] Fluocinonide Act Total Care: 0.05% (88 mL, 532 mL, 1000 mL) [contains ethanol 11%, DoD Uniform Formulary Outpatient Dosage Forms propylene glycol, sodium benzoate; equivalent to fluoride 0.02%] BASIC CORE FORMULARY Act Total Care Dry Mouth: 0.02% (532 mL, 1000 mL) [ethanol free; contains Cream, External: propylene glycol, sodium benzoate; soothing mint flavor; equivalent to Generic: 0.05% (15 g, 30 g, 60 g, 120 g) fluoride 0.009%] Ointment, External: Act Total Care Sensitive: 0.02% (532 mL, 1000 mL) [ethanol free; contains Generic: 0.05% (15 g, 30 g, 60 g) propylene glycol, sodium benzoate; mint flavor; equivalent to fluo- Solution, External: ride 0.009%] Generic: 0.05% (20 mL, 60 mL) Fluorinse: 0.2% (480 mL) [ethanol free] OrthoWash: 0.044% (480 mL) [contains sodium benzoate] UNIFORM FORMULARY Phos-Flur Rinse: 0.044% (473 mL) [ethanol free, sugar free] Cream, External: Phos-Flur Rinse: 0.044% (500 mL) [sugar free; cool mint flavor] Generic: 0.1% (30 g, 60 g, 120 g) PreviDent: 0.2% (473 mL) [ethanol free; contains benzoic acid, propylene Gel, External: glycol, sodium benzoate; cool mint flavor] Generic: 0.05% (15 g, 30 g, 60 g) Solution, Oral, as stannous fluoride [concentrated rinse]: NONFORMULARY Fluoridex Daily Renewal: 0.63% (248 mL) [mint flavor; equivalent to fluoride Cream, External: 7 mg/30 mL dose] Vanos: 0.1% (30 g, 60 g, 120 g) Gel-Kam Rinse: 0.63% (300 mL) [mint flavor; equivalent to fluoride 7 mg/30 mL dose] Fluorescein PerioMed: 0.63% (284 mL) [ethanol free; cinnamon flavor; equivalent to DoD Uniform Formulary Outpatient Dosage Forms fluoride 7 mg/30 mL dose] UNIFORM FORMULARY PerioMed: 0.63% (284 mL) [ethanol free; equivalent to fluoride 7 mg/30 Solution, Intravenous, as sodium: mL dose] AK-Fluor: 10% (5 mL); 25% (2 mL) StanGard Perio: 0.63% (284 mL) [mint flavor] Fluorescite: 10% (5 mL) Tablet, Chewable, oral, as sodium: Strip, Ophthalmic, as sodium: Generic: 0.55 mg [equivalent to fluoride 0.25 mg], 1.1 mg [equivalent to Bio Glo: 1 mg (100 ea, 300 ea) fluoride 0.5 mg], 2.2 mg [equivalent to fluoride 1 mg] Fluor-I-Strips A.T.: 1 mg (300 ea) Ful-Glo: 0.6 mg (300 ea); 1 mg (100 ea) Fluorometholone DoD Uniform Formulary Outpatient Dosage Forms Fluorescein and Benoxinate UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Ointment, Ophthalmic, as base: UNIFORM FORMULARY FML: 0.1% (3.5 g) [contains phenylmercuric acetate] Solution, ophthalmic: Suspension, Ophthalmic, as acetate: Generic: Fluorescein sodium 0.25% and benoxinate hydrochloride 0.4% Flarex: 0.1% (5 mL) (5 mL) Suspension, Ophthalmic, as base: FML Forte: 0.25% (5 mL, 10 mL) Fluoride Generic: 0.1% (5 mL, 10 mL, 15 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Fluorouracil (Systemic) Cream, Oral, as sodium [toothpaste]: DoD Uniform Formulary Outpatient Dosage Forms Denta 5000 Plus: 1.1% (51 g) [equivalent to fluoride 2.5 mg/dose] UNIFORM FORMULARY Gel, Oral, as sodium [toothpaste]: Solution, Intravenous: PreviDent 5000 Booster: 1.1% (100 mL, 106 mL) [contains sodium benzoate; Generic: 500 mg/10 mL (10 mL); 1 g/20 mL (20 mL); 2.5 g/50 mL (50 mL); 5 g/ equivalent to fluoride 2.5 mg/dose] 100 mL (100 mL) 51 FLUOROURACIL (SYSTEMIC) Solution, Intravenous [preservative free]: Flutemetamol F18 Generic: 2.5 g/50 mL (50 mL); 5 g/100 mL (100 mL) DoD Uniform Formulary Outpatient Dosage Forms Fluorouracil (Topical) UNIFORM FORMULARY Solution, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Vizamyl: 4.05 mCi/mL (1 ea) [contains alcohol, usp, polysorbate 80] UNIFORM FORMULARY Cream, External: Fluticasone and Salmeterol Fluoroplex: 1% (30 g) [contains benzyl alcohol] DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.5% (30 g); 5% (40 g) BASIC CORE FORMULARY Solution, External: Aerosol, for Oral Inhalation: Generic: 2% (10 mL); 5% (10 mL) Advair HFA: 45/21: Fluticasone propionate 45 mcg and salmeterol 21 mcg per NONFORMULARY inhalation (8 g) [chlorofluorocarbon free; 60 metered actuations] Cream, External: Advair HFA: 45/21: Fluticasone propionate 45 mcg and salmeterol 21 mcg per Tolak: 4% (40 g) inhalation (12 g) [chlorofluorocarbon free; 120 metered actuations] Advair HFA: 115/21: Fluticasone propionate 115 mcg and salmeterol 21 mcg FLUoxetine per inhalation (8 g) [chlorofluorocarbon free; 60 metered actuations] DoD Uniform Formulary Outpatient Dosage Forms Advair HFA: 115/21: Fluticasone propionate 115 mcg and salmeterol 21 mcg BASIC CORE FORMULARY per inhalation (12 g) [chlorofluorocarbon free; 120 metered actuations] Capsule, Oral: Advair HFA: 230/21: Fluticasone propionate 230 mcg and salmeterol 21 mcg Generic: 10 mg, 20 mg, 40 mg per inhalation (8 g) [chlorofluorocarbon free; 60 metered actuations] Solution, Oral: Advair HFA: 230/21: Fluticasone propionate 230 mcg and salmeterol 21 mcg Generic: 20 mg/5 mL (5 mL, 120 mL) per inhalation (12 g) [chlorofluorocarbon free; 120 metered actuations] Powder, for Oral Inhalation: UNIFORM FORMULARY Advair Diskus: 100/50: Fluticasone propionate 100 mcg and salmeterol 50 Tablet, Oral: mcg (14s, 60s) [contains lactose] Generic: 60 mg Advair Diskus: 250/50: Fluticasone propionate 250 mcg and salmeterol 50 mcg (14s, 60s) [contains lactose] NONFORMULARY Advair Diskus: 500/50: Fluticasone propionate 500 mcg and salmeterol 50 Capsule Delayed Release, Oral: mcg (14s, 60s) [contains lactose] Generic: 90 mg UNIFORM FORMULARY Tablet, Oral: Powder, for Oral Inhalation: Generic: 10 mg, 20 mg Wixela Inhub: Fluticasone propionate 100 mcg and salmeterol 50 mcg (60 Fluoxymesterone units) Wixela Inhub: Fluticasone propionate 250 mcg and salmeterol 50 mcg (60 DoD Uniform Formulary Outpatient Dosage Forms units) UNIFORM FORMULARY Wixela Inhub: Fluticasone propionate 500 mcg and salmeterol 50 mcg (60 Tablet, Oral: units) Androxy: 10 mg [scored] NONFORMULARY FluPHENAZine Powder, for Oral Inhalation: DoD Uniform Formulary Outpatient Dosage Forms AirDuo RespiClick: 55/14: Fluticasone propionate 55 mcg and salmeterol 14 UNIFORM FORMULARY mcg (0.45 g) [contains lactose] Concentrate, Oral, as hydrochloride: AirDuo RespiClick:113/14: Fluticasone propionate 113 mcg and salmeterol 14 Generic: 5 mg/mL (120 mL) mcg (0.45 g) [contains lactose] Elixir, Oral, as hydrochloride: AirDuo RespiClick: 232/14: Fluticasone propionate 232 mcg and salmeterol 14 Generic: 2.5 mg/5 mL (60 mL, 473 mL) mcg (0.45 g) [contains lactose] Solution, Injection, as decanoate: Generic: 55/14; 113/14; 232/14 Generic: 25 mg/mL (5 mL) Fluticasone (Nasal) Solution, Injection, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Generic: 2.5 mg/mL (10 mL) BASIC CORE FORMULARY Tablet, Oral, as hydrochloride: Suspension, Nasal, as propionate: Generic: 1 mg, 2.5 mg, 5 mg, 10 mg Generic: 50 mcg/actuation (16 g) Flurandrenolide UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Suspension, Nasal, as furoate: UNIFORM FORMULARY Flonase Allergy Relief: 50 mcg/actuation (9.9 mL, 11.1 mL, 15.8 mL, 18.2 mL) Cream, External: Flonase Sensimist: 27.5 mcg/spray (9.9 mL, 15.8 mL) Generic: 0.05% (60 g, 120 g) Therapy Pack, Nasal, as propionate: Lotion, External: Ticaspray: 50 mcg/actuation (1 ea) [contains benzalkonium chloride, poly- Generic: 0.05% (120 mL) sorbate 80] Ointment, External: NONFORMULARY Generic: 0.05% (60 g) Exhaler Suspension, Nasal, as propionate: Tape, External: Xhance: 93 mcg/actuation (16 mL) [contains benzalkonium chloride, edetate Cordran: 4 mcg/cm2 (1 ea) disodium dihydrate, polysorbate 80] Flurazepam Fluticasone (Oral Inhalation) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Capsule, Oral, as hydrochloride: Aerosol, Inhalation, as propionate: Generic: 15 mg, 30 mg Flovent HFA: 44 mcg/inhalation (10.6 g) [chlorofluorocarbon free; 120 metered actuations] Flurbiprofen (Ophthalmic) Flovent HFA: 110 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 metered DoD Uniform Formulary Outpatient Dosage Forms actuations] UNIFORM FORMULARY Flovent HFA: 220 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 metered Solution, Ophthalmic, as sodium: actuations] Generic: 0.03% (2.5 mL) Aerosol Powder Breath Activated, Inhalation, as propionate: Flovent Diskus: 50 mcg (60s) [contains lactose] Flurbiprofen (Systemic) Flovent Diskus: 100 mcg (60s) [contains lactose] DoD Uniform Formulary Outpatient Dosage Forms Flovent Diskus: 250 mcg (60s) [contains lactose] UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Aerosol Powder Breath Activated, Inhalation, as furoate: Generic: 50 mg, 100 mg Arnuity Ellipta: 100 mcg/actuation (14 ea, 30 ea); 200 mcg/actuation (14 ea, 30 Flutamide ea) [contains lactose monohydrate] DoD Uniform Formulary Outpatient Dosage Forms NONFORMULARY UNIFORM FORMULARY Aerosol Powder Breath Activated, Inhalation, as propionate: Capsule, Oral: ArmonAir RespiClick: 55 mcg/actuation (1 ea); 232 mcg/actuation (1 ea); 113 Generic: 125 mg mcg/actuation (1 ea) [contains lactose monohydrate] 52 FOSINOPRIL AND HYDROCHLOROTHIAZIDE Fluticasone (Topical) Generic: Folic acid 2.5 mg, cyanocobalamin 200 mcg, and pyridoxine hydro- DoD Uniform Formulary Outpatient Dosage Forms chloride 25 mg UNIFORM FORMULARY Follitropin Alfa Cream, External, as propionate: Generic: 0.05% (15 g, 30 g, 60 g) DoD Uniform Formulary Outpatient Dosage Forms Lotion, External, as propionate: UNIFORM FORMULARY Generic: 0.05% (60 mL, 120 mL) Solution, Subcutaneous: Ointment, External, as propionate: Gonal-f RFF Rediject: 300 units/0.5 mL (0.5 mL); 450 units/0.75 mL (0.75 mL); Generic: 0.005% (15 g, 30 g, 60 g) 900 units/1.5 mL (1.5 mL) [contains metacresol] Solution Reconstituted, Injection: Fluvastatin Gonal-f: 450 units (1 ea); 1050 units (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Subcutaneous: UNIFORM FORMULARY Gonal-f RFF: 75 units (1 ea) Capsule, Oral: Generic: 20 mg, 40 mg Follitropin Beta NONFORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet Extended Release 24 Hour, Oral: UNIFORM FORMULARY Generic: 80 mg Solution, Injection: Follistim AQ: 75 units/0.5 mL (0.5 mL) FluvoxaMINE Solution, Subcutaneous: DoD Uniform Formulary Outpatient Dosage Forms Follistim AQ: 300 units/0.36 mL (0.42 mL); 600 units/0.72 mL (0.78 mL); 900 UNIFORM FORMULARY units/1.08 mL (1.17 mL) [contains benzyl alcohol] Capsule Extended Release 24 Hour, Oral, as maleate: Generic: 100 mg, 150 mg Fomepizole Tablet, Oral, as maleate: DoD Uniform Formulary Outpatient Dosage Forms Generic: 25 mg, 50 mg, 100 mg UNIFORM FORMULARY Solution, Intravenous [preservative free]: Folic Acid Generic: 1 g/mL (1.5 mL); 1.5 g/1.5 mL (1.5 mL) DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY Fondaparinux Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 1 mg UNIFORM FORMULARY Solution, Subcutaneous, as sodium: UNIFORM FORMULARY Generic: 2.5 mg/0.5 mL (0.5 mL); 5 mg/0.4 mL (0.4 mL); 7.5 mg/0.6 mL (0.6 Capsule, Oral [preservative free]: mL); 10 mg/0.8 mL (0.8 mL) FA-8: 0.8 mg [dye free, sugar free, yeast free] Solution, Subcutaneous, as sodium [preservative free]: Generic: 5 mg, 20 mg Generic: 2.5 mg/0.5 mL (0.5 mL); 5 mg/0.4 mL (0.4 mL); 7.5 mg/0.6 mL (0.6 Solution, Injection, as sodium folate: mL); 10 mg/0.8 mL (0.8 mL) Generic: 5 mg/mL (10 mL) Tablet, Oral: Formaldehyde Generic: 400 mcg, 800 mcg DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral [preservative free]: UNIFORM FORMULARY Generic: 400 mcg, 800 mcg Solution, External: 10% Folic Acid, Cyanocobalamin, and Pyridoxine Fosamprenavir DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral: Suspension, Oral, as calcium: Generic: Folic acid 1 mg, cyanocobalamin 400 mcg, and pyridoxine hydro- Lexiva: 50 mg/mL (225 mL) [contains methylparaben, polysorbate 80, propy- chloride 50 mg lene glycol, propylparaben; grape bubblegum peppermint flavor] Tablet, Oral: Tablet, Oral, as calcium: Airavite: Folic acid 2.5 mg, cyanocobalamin 1000 mcg, and pyridoxine hydro- Lexiva: 700 mg chloride 25 mg Av-VITE FB: Folic acid 2.5 mg, cyanocobalamin 1000 mcg, and pyridoxine Fosaprepitant hydrochloride 25 mg DoD Uniform Formulary Outpatient Dosage Forms CenFol: Folic acid 2.3 mg, cyanocobalamin 2000 mcg, and pyridoxine hydro- UNIFORM FORMULARY chloride 24.5 mg Solution Reconstituted, Intravenous: FaBB: Folic acid 2.2 mg, cyanocobalamin 1000 mcg, and pyridoxine hydro- Emend: 150 mg (1 ea) [contains disodium edta, polysorbate 80] chloride 25 mg Folastin: Folic acid 2.5 mg, cyanocobalamin 2000 mcg, and pyridoxine hydro- Foscarnet chloride 25 mg [DSC] DoD Uniform Formulary Outpatient Dosage Forms Folbee: Folic acid 2.5 mg, cyanocobalamin 1000 mcg, and pyridoxine hydro- UNIFORM FORMULARY chloride 25 mg [dye free, lactose free, and sugar free] Solution, Intravenous, as sodium [preservative free]: Folbic: Folic acid 2.5 mg, cyanocobalamin 2000 mcg, and pyridoxine hydro- Foscavir: 24 mg/mL (250 mL) chloride 25 mg Folgard RX: Folic acid 2.2 mg, cyanocobalamin 1000 mcg, and pyridoxine Fosdenopterin hydrochloride 25 mg DoD Uniform Formulary Outpatient Dosage Forms Folplex 2.2: Folic acid 2.2 mg, cyanocobalamin 500 mcg, and pyridoxine NOT COVERED hydrochloride 25 mg Solution Reconstituted, Intravenous, as hydrobromide [preservative free]: Foltabs 800: Folic acid 0.8 mg, cyanocobalamin 115 mcg, and pyridoxine Nulibry: 9.5 mg (1 ea) [latex free] hydrochloride 10 mg [gluten free] Homocysteine Formula: Folic acid 0.8 mg, cyanocobalamin 100 mcg, and Fosfomycin pyridoxine hydrochloride 50 mg DoD Uniform Formulary Outpatient Dosage Forms Niva-Fol: Folic acid 2.5 mg, cyanocobalamin 2000 mcg, and pyridoxine hydro- UNIFORM FORMULARY chloride 25 mg Packet, Oral: NuFol: Folic acid 2.5 mg, cyanocobalamin 1000 mcg, and pyridoxine hydro- Monurol: 3 g (1 ea) [orange flavor] chloride 25 mg Virt-Gard: Folic acid 2.2 mg, cyanocobalamin 1000 mcg, and pyridoxine Fosinopril hydrochloride 25 mg DoD Uniform Formulary Outpatient Dosage Forms Virt-Vite: Folic acid 2.5 mg, cyanocobalamin 1000 mcg, and pyridoxine hydro- UNIFORM FORMULARY chloride 25 mg Tablet, Oral, as sodium: Virt-Vite Forte: Folic acid 2.5 mg, cyanocobalamin 2000 mcg, and pyridoxine Generic: 10 mg, 20 mg, 40 mg hydrochloride 25 mg Generic: Folic acid 0.5 mg, cyanocobalamin 200 mcg, pyridoxine hydrochlor- Fosinopril and Hydrochlorothiazide ide 5 mg DoD Uniform Formulary Outpatient Dosage Forms Generic: Folic acid 0.8 mg, cyanocobalamin 100 mcg, and pyridoxine hydro- UNIFORM FORMULARY chloride 50 mg Tablet, Oral: Generic: Folic acid 2.2 mg, cyanocobalamin 500 mcg, and pyridoxine hydro- 10/12.5: Fosinopril sodium 10 mg and hydrochlorothiazide 12.5 mg chloride 25 mg 20/12.5: Fosinopril sodium 20 mg and hydrochlorothiazide 12.5 mg 53 FOSNETUPITANT AND PALONOSETRON Fosnetupitant and Palonosetron Solution, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Gadavist: 1 mmol/mL (2 mL, 7.5 mL, 10 mL, 15 mL, 30 mL, 65 mL) UNIFORM FORMULARY Solution Reconstituted, Intravenous: Gadodiamide Akynzeo: 235-0.25 MG (1 ea) [contains edetate disodium] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Fosphenytoin Solution, Injection [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Omniscan: 287 mg/mL (5 mL, 10 mL, 15 mL, 20 mL, 50 mL, 100 mL) UNIFORM FORMULARY Solution, Injection, as sodium: Gadofosveset Generic: 100 mg PE/2 mL (2 mL); 500 mg PE/10 mL (10 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Fostamatinib Solution, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Ablavar: 244 mg/mL (10 mL, 15 mL) UNIFORM FORMULARY Tablet, Oral: Gadopentetate Dimeglumine Tavalisse: 100 mg, 150 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Fostemsavir Solution, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Magnevist: 469.01 mg/mL (5 mL, 10 mL, 15 mL, 20 mL, 50 mL, 100 mL) UNIFORM FORMULARY [contains diethylenetriamine pentaacetic acid, meglumine] Tablet Extended Release 12 Hour, Oral, as tromethamine: Rukobia: 600 mg Gadoterate Meglumine Fremanezumab DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Intravenous: Solution Prefilled Syringe, Subcutaneous [preservative free]: Dotarem: 5 mmol/10 mL (10 mL); 7.5 mmol/15 mL (15 mL); 10 mmol/20 mL Ajovy: 225 mg/1.5 mL (1.5 mL) [contains disodium edta, polysorbate 80] (20 mL); 50 mmol/100 mL (100 mL) Solution Prefilled Syringe, Intravenous: Fructose, Dextrose, and Phosphoric Acid Dotarem: 5 mmol/10 mL (10 mL); 7.5 mmol/15 mL (15 mL); 10 mmol/20 mL DoD Uniform Formulary Outpatient Dosage Forms (20 mL) UNIFORM FORMULARY Liquid, Oral: Gadoteridol Generic: Fructose 1.87 g, dextrose 1.87 g, and phosphoric acid 21.5 mg per 5 DoD Uniform Formulary Outpatient Dosage Forms mL (120 mL) UNIFORM FORMULARY Solution, Intravenous: Fulvestrant Prohance: 279.3 mg/mL (5 mL, 10 mL, 15 mL, 17 mL, 20 mL, 50 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Gadoversetamide Solution, Intramuscular: DoD Uniform Formulary Outpatient Dosage Forms Faslodex: 250 mg/5 mL (5 mL) [contains alcohol, usp, benzyl alcohol, benzyl UNIFORM FORMULARY benzoate] Solution, Intravenous [preservative free]: Furosemide OptiMARK: 330.9 mg/mL (5 mL, 10 mL, 15 mL, 20 mL, 30 mL, 50 mL) DoD Uniform Formulary Outpatient Dosage Forms [contains calcium chloride dihydrate, calcium versetamide sodium] BASIC CORE FORMULARY Gadoxetate Solution, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 10 mg/mL (60 mL, 120 mL) UNIFORM FORMULARY Tablet, Oral: Generic: 20 mg, 40 mg Solution, Intravenous, as disodium: Eovist: 0.25 mmol/mL (10 mL, 15 mL) UNIFORM FORMULARY Solution, Injection: Galantamine Generic: 10 mg/mL (2 mL, 4 mL, 10 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection [preservative free]: UNIFORM FORMULARY Generic: 10 mg/mL (2 mL, 4 mL, 10 mL) Capsule Extended Release 24 Hour, Oral, as hydrobromide [strength NONFORMULARY expressed as base]: Solution, Intravenous: Generic: 8 mg, 16 mg, 24 mg Generic: 100 mg/100 mL in NaCl 0.9% (100 mL) Solution, Oral, as hydrobromide: Generic: 4 mg/mL (100 mL) Gabapentin Tablet, Oral, as hydrobromide [strength expressed as base]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 4 mg, 8 mg, 12 mg BASIC CORE FORMULARY Capsule, Oral: Galcanezumab Generic: 100 mg, 300 mg, 400 mg DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 600 mg, 800 mg Solution Auto-injector, Subcutaneous [preservative free]: UNIFORM FORMULARY Emgality: 120 mg/mL (1 mL) [contains polysorbate 80] Cream, External: Solution Prefilled Syringe, Subcutaneous [preservative free]: Neuraptine: 10% (30 mL) [contains cetyl alcohol] Emgality: galcanezumab-gnlm 120 mg/mL (1 mL) [latex free; contains poly- Solution, Oral: sorbate 80] Generic: 250 mg/5 mL (5 mL, 470 mL, 473 mL); 300 mg/6 mL (6 mL) NONFORMULARY Suspension, Oral: Solution Prefilled Syringe, Subcutaneous [preservative free]: Fanatrex FusePaq: 25 mg/mL (420 mL) [contains saccharin sodium, sodium Emgality 300 Dose: Galcanezumab-gnlm 100 mg/mL (1 mL) [latex free; benzoat contains polysorbate 80] NONFORMULARY Galsulfase Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Gralise: 300 mg, 600 mg UNIFORM FORMULARY Gadobenate Dimeglumine Solution, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Naglazyme: 1 mg/mL (5 mL) [contains mouse (murine) and/or hamster UNIFORM FORMULARY protein, polysorbate 80] Solution, Intravenous [preservative free]: MultiHance: 529 mg/mL (5 mL, 10 mL, 15 mL, 20 mL, 50 mL, 100 mL) Ganciclovir (Ophthalmic) DoD Uniform Formulary Outpatient Dosage Forms Gadobutrol UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Gel, Ophthalmic: UNIFORM FORMULARY Zirgan: 0.15% (5 g) [contains benzalkonium chloride] 54 GLUCAGON Ganciclovir (Systemic) Solution, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Generic: 60 mg (50 mL); 70 mg (50 mL); 80 mg (50 mL, 100 mL); 90 mg (100 UNIFORM FORMULARY mL); 100 mg (50 mL, 100 mL); 120 mg (100 mL); 10 mg/mL (6 mL, 10 mL) Solution Reconstituted, Intravenous: Generic: 500 mg (1 ea) Gentamicin (Topical) Solution Reconstituted, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 500 mg (1 ea) UNIFORM FORMULARY Cream, External: Ganirelix Generic: 0.1% (15 g, 30 g) DoD Uniform Formulary Outpatient Dosage Forms Ointment, External: UNIFORM FORMULARY Generic: 0.1% (15 g, 30 g) Solution, Subcutaneous, as acetate: Generic: 250 mcg/0.5 mL (0.5 mL) Gentian Violet DoD Uniform Formulary Outpatient Dosage Forms Gatifloxacin UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, External: UNIFORM FORMULARY Generic: 1% (59 mL); 2% (59 mL, 59.14 mL) Solution, Ophthalmic: Generic: 0.5% (2.5 mL) Gilteritinib Gefitinib DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral, as fumarate: UNIFORM FORMULARY Xospata: 40 mg Tablet, Oral: Iressa: 250 mg Givosiran Gelatin (Absorbable) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms NOT COVERED UNIFORM FORMULARY Solution, Subcutaneous [preservative free]: Film, External: Givlaari: 189 mg/mL (1 mL) Gelfilm: (1 ea) Film, Ophthalmic: Glasdegib Gelfilm: (6 ea) DoD Uniform Formulary Outpatient Dosage Forms Miscellaneous, External: UNIFORM FORMULARY Gelfoam Compressed Size 100: (6 ea) Tablet, Oral, as maleate: Gelfoam Dental Pack Size 4: (2 ea) Daurismo: 25 mg, 100 mg Gelfoam Sponge: 12-7 MM (12 ea) Gelfoam Sponge Size 50: (4 ea) Glatiramer Acetate Gelfoam Sponge Size 100: (6 ea) DoD Uniform Formulary Outpatient Dosage Forms Gelfoam Sponge Size 200: (6 ea) UNIFORM FORMULARY Powder, Mouth/Throat: Solution Prefilled Syringe, Subcutaneous: Gelfoam: (1 g) Copaxone: 20 mg/mL (1 mL) [contains mannitol] Gemcitabine Copaxone: 40 mg/mL (1 mL) DoD Uniform Formulary Outpatient Dosage Forms Glatopa: 20 mg/mL (1 mL) [contains mannitol] UNIFORM FORMULARY Glecaprevir and Pibrentasvir Solution, Intravenous: Generic: 200 mg/5.26 mL (5.26 mL); 1 g/26.3 mL (26.3 mL); 2 g/52.6 mL DoD Uniform Formulary Outpatient Dosage Forms (52.6 mL) UNIFORM FORMULARY Solution, Intravenous [preservative free]: Tablet, Oral: Generic: 200 mg/5.26 mL (5.26 mL); 1 g/26.3 mL (26.3 mL); 2 g/52.6 mL Mavyret: Glecaprevir 100 mg and pibrentasvir 40 mg (52.6 mL) Solution Reconstituted, Intravenous: Glimepiride Generic: 200 mg (1 ea); 1 g (1 ea); 2 g (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous [preservative free]: UNIFORM FORMULARY Generic: 200 mg (1 ea); 1 g (1 ea); 2 g (1 ea) Tablet, Oral: Generic: 1 mg, 2 mg, 4 mg Gemfibrozil DoD Uniform Formulary Outpatient Dosage Forms GlipiZIDE BASIC CORE FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: BASIC CORE FORMULARY Generic: 600 mg Tablet, Oral: Generic: 5 mg, 10 mg Gemifloxacin DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet Extended Release 24 Hour, Oral: Tablet, Oral: Generic: 2.5 mg, 5 mg, 10 mg Factive: 320 mg [scored] Glipizide and Metformin Gemtuzumab Ozogamicin DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Solution Reconstituted, Intravenous [preservative free]: 2.5/250: Glipizide 2.5 mg and metformin hydrochloride 250 mg Mylotarg: 4.5 mg (1 ea) [contains dextran 40] 2.5/500: Glipizide 2.5 mg and metformin hydrochloride 500 mg Gentamicin (Ophthalmic) 5/500: Glipizide 5 mg and metformin hydrochloride 500 mg DoD Uniform Formulary Outpatient Dosage Forms Glucagon BASIC CORE FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Ointment, Ophthalmic: UNIFORM FORMULARY Generic: 0.3% (3.5 g) Kit, Injection: Solution, Ophthalmic [drops]: Glucagon Emergency: 1 mg Generic: 0.3% (5 mL, 15 mL) Solution Reconstituted, Injection: Gentamicin (Systemic) Generic: 1 mg (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Solution Prefilled Syringe, Subcutaneous [preservative free]: UNIFORM FORMULARY Gvoke PFS: 0.5 mg/0.1 mL (0.1 mL); 1 mg/0.2 mL (0.2 mL) Solution, Injection: NONFORMULARY Generic: 10 mg/mL (2 mL); 40 mg/mL (2 mL, 20 mL) Powder, Nasal [preservative free]: Solution, Injection [preservative free]: Baqsimi One Pack: 3 mg/dose (1 ea) Generic: 10 mg/mL (2 mL) Baqsimi Two Pack: 3 mg/dose (1 ea) 55 GLUCARPIDASE Glucarpidase NONFORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection: UNIFORM FORMULARY Glyrx-PF: 0.2 mg/mL (1 mL); 0.4 mg/2 mL (2 mL) Solution Reconstituted, Intravenous [preservative free]: Generic: 0.2 mg/mL (1 mL); 0.4 mg/2 mL (2 mL); 1 mg/5 mL (5 mL); 4 mg/20 Voraxaze: 1000 units (1 ea) mL (20 mL) Glucosamine Glycopyrronium (Topical) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral: Pad, External, as tosylate: Generic: 500 mg, 750 mg Qbrexza: 2.4% (30 ea) Capsule, Oral [preservative free]: Generic: 500 mg Golimumab Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 500 mg UNIFORM FORMULARY Solution, Intravenous [preservative free]: Glucosamine and Chondroitin Simponi Aria: 50 mg/4 mL (4 mL) [latex free; contains polysorbate 80] DoD Uniform Formulary Outpatient Dosage Forms Solution Auto-injector, Subcutaneous [preservative free]: UNIFORM FORMULARY Simponi: 50 mg/0.5 mL (0.5 mL); 100 mg/mL (1 mL) [contains polysorbate 80] Capsule, Oral: Solution Prefilled Syringe, Subcutaneous [preservative free]: Generic: Glucosamine 250 mg and Chondroitin sulfate 200 mg Simponi: 50 mg/0.5 mL (0.5 mL); 100 mg/mL (1 mL) [contains polysorbate 80] Generic: Glucosamine 375 mg and Chondroitin sulfate 300 mg Generic: Glucosamine 500 mg and Chondroitin sulfate 400 mg Golodirsen Liquid, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: Glucosamine 1500 mg and Chondroitin sulfate 1200 mg NOT COVERED Tablet, Oral: Solution, Intravenous [preservative free]: Generic: Glucosamine 500 mg and Chondroitin sulfate 400 mg Vyondys 53: 100 mg/2 mL (2 mL) Generic: Glucosamine 750 mg and Chondroitin sulfate 600 mg Generic: Glucosamine 750 mg and Chondroitin sulfate 625 mg Goserelin DoD Uniform Formulary Outpatient Dosage Forms Glutamine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Implant, Subcutaneous: UNIFORM FORMULARY Zoladex: 3.6 mg (1 ea); 10.8 mg (1 ea) Capsule, Oral: Generic: 500 mg Granisetron Packet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Endari: 5 g (60 ea) UNIFORM FORMULARY Tablet, Oral: Prefilled Syringe, Subcutaneous: Generic: 500 mg Sustol: 10 mg/0.4 mL (0.4 mL) [contains polyethylene glycol] GlyBURIDE Solution, Intravenous: Generic: 1 mg/mL (1 mL); 4 mg/4 mL (4 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous [preservative free]: BASIC CORE FORMULARY Generic: 1 mg/mL (1 mL) Tablet, Oral: Tablet, Oral: Generic: 1.25 mg, 2.5 mg, 5 mg Generic: 1 mg Tablet, Micronized, Oral: NONFORMULARY Glynase: 1.5 mg 3 mg, 6 mg [scored] Patch, Transdermal: Glyburide and Metformin Sancuso: 3.1 mg/24 hr (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Grass Pollen Allergen Extract (5 Grass Extract) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: Tablet, Sublingual [preservative free]: 1.25 mg/250 mg: Glyburide 1.25 mg and metformin hydrochloride 250 mg 2.5 mg/500 mg: Glyburide 2.5 mg and metformin hydrochloride 500 mg Oralair: 300 IR (30s) 5 mg/500 mg: Glyburide 5 mg and metformin hydrochloride 500 mg Oralair Adult Sample Kit: 300 IR (9s) Oralair Childrens and Adolescents Sample Kit: 100 IR (3s) & 300 IR (6s) Glycerin Grass Pollen Allergen Extract (Timothy Grass) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Enema, Rectal: UNIFORM FORMULARY Fleet Liquid Glycerin Supp: 5.4 g/dose (7.5 mL) Tablet, Sublingual: Suppository, Rectal: Grastek: 2800 bau [contains gelatin (fish)] Glycerin (Adult): 2 g (12 ea, 24 ea, 25 ea, 50 ea); 2.1 g (25 ea) Griseofulvin Glycerin (Infants & Children): 1 g (12 ea, 25 ea) DoD Uniform Formulary Outpatient Dosage Forms Pedia-Lax: 1 g (12 ea); 2.8 g (4 mL) [contains edetate disodium] BASIC CORE FORMULARY Sani-Supp Adult: 2 g (10 ea, 25 ea) Suspension, Oral: Sani-Supp Pediatric: 1.2 g (10 ea, 25 ea) Generic: 125 mg/5 mL (120 mL) Glycerin and Lidocaine Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 125 mg, 250 mg UNIFORM FORMULARY GuaiFENesin Cream, Rectal: Preparation H: Glycerin 14.4% and lidocaine 5% (30 g) [contains cetyl alcohol, DoD Uniform Formulary Outpatient Dosage Forms disodium edta, methylparaben, propylene glycol, propylparaben] UNIFORM FORMULARY Liquid, Oral: Glycerol Phenylbutyrate Generic: 100 mg/5 mL (473 mL) DoD Uniform Formulary Outpatient Dosage Forms Packet, Oral: UNIFORM FORMULARY Mucinex For Kids: 100 mg (12 ea) [contains aspartame; bubble-gum flavor] Liquid, Oral: Solution, Oral: Ravicti: 1.1 g/mL (25 mL) Generic: 100 mg/5 mL (5 mL, 10 mL, 15 mL); 200 mg/10 mL (10 mL); 300 mg/ 15 mL (15 mL) Glycopyrrolate (Systemic) Syrup, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 100 mg/5 mL (480 mL) UNIFORM FORMULARY Tablet, Oral: Solution, Oral: Generic: 200 mg, 400 mg Cuvposa: 1 mg/5 mL (473 mL) [contains methylparaben, propylene glycol, Tablet Extended Release 12 Hour, Oral: propylparaben, saccharin sodium; cherry flavor] Mucinex: 600 mg Tablet, Oral: Mucinex Maximum Strength: 1200 mg Generic: 1 mg, 2 mg Generic: 1200 mg 56 GUAIFENESIN, DEXTROMETHORPHAN, AND PHENYLEPHRINE Guaifenesin and Codeine Zyncof: Guaifenesin 400 mg and dextromethorphan hydrobromide 20 mg per DoD Uniform Formulary Outpatient Dosage Forms 5 mL (120 mL, 480 mL) [dye free, ethanol free, sugar free; contains UNIFORM FORMULARY propylene glycol; grape flavor] Capsule, Oral: Generic: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per M-Clear: Guaifenesin 200 mg and codeine phosphate 9 mg [contains tar- 5 mL (5 mL, 10 mL, 120 mL, 480 mL) trazine] Tablet, Oral: Liquid, Oral: Silexin: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg Coditussin AC: Guaifenesin 200 mg and codeine phosphate 10 mg per 5 mL Generic: Guaifenesin 1000 mg and dextromethorphan hydrobromide 60 mg (473 mL) [alcohol free, dye free, sugar free; contains propylene glycol, Generic: Guaifenesin 1200 mg and dextromethorphan hydrobromide 60 mg saccharin sodium, sorbitol; cotton candy flavor] Tablet, extended release, oral: Dex-Tuss: Guaifenesin 300 mg and codeine phosphate 10 mg per 5 mL (473 Mucinex DM: Guaifenesin 600 mg and dextromethorphan hydrobro- mL) [ethanol free, gluten free, sugar free; contains propylene glycol; grape mide 30 mg flavor] Generic: Guaifenesin 1200 mg and dextromethorphan hydrobromide 60 mg M-Clear WC: Guaifenesin 100 mg and codeine phosphate 6.33 mg per 5 mL (473 mL) [contains propylene glycol; cotton candy flavor] Guaifenesin and Phenylephrine Ninjacof-XG: Guaifenesin 200 mg and codeine phosphate 8 mg per 5 mL (473 DoD Uniform Formulary Outpatient Dosage Forms mL) [dye free, ethanol free, sugar free; contains propylene glycol; cotton UNIFORM FORMULARY candy flavor] Liquid, Oral: Solution, Oral: Ed Bron GP: Guaifenesin 100 mg and phenylephrine hydrochloride 5 mg per Mar-Cof CG: Guaifenesin 225 mg and codeine phosphate 7.5 mg per 5 mL 5 mL (480 mL) [dye free, ethanol free, sugar free; contains propylene glycol; (473 mL) [ethanol free, sugar free; contains propylene glycol, sodium orange flavor] benzoate, sodium 6 mg/5 mL] Syrup, oral: Generic: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL (5 mL, Triaminic Children's Chest & Nasal Congestion: Guaifenesin 50 mg and 10 mL, 118 mL, 473 mL) phenylephrine hydrochloride 2.5 mg per 5 mL (118 mL) [contains benzoic Syrup, Oral: acid, propylene glycol, sodium 3 mg/5 mL; tropical flavor] Generic: Guaifenesin 100 mg and codeine phosphate 10 mg per 5 mL Tablet, Oral: (473 mL) Ambi 10PEH/400GFN: Guaifenesin 400 mg and phenylephrine hydrochlor- Tablet, Oral: ide 10 mg Allfen CD: Guaifenesin 400 mg and codeine phosphate 10 mg Deconex IR: Guaifenesin 385 mg and phenylephrine hydrochloride 10 mg Allfen CDX: Guaifenesin 400 mg and codeine phosphate 20 mg [contains tartrazine] Fenesin PE IR: Guaifenesin 400 mg and phenylephrine hydrochloride 10 mg Guaifenesin and Dextromethorphan Medent-PEI: Guaifenesin 400 mg and phenylephrine hydrochloride 10 mg DoD Uniform Formulary Outpatient Dosage Forms MucaphEd: Guaifenesin 400 mg and phenylephrine hydrochloride 10 mg UNIFORM FORMULARY Mucus Relief Sinus: Guaifenesin 400 mg and phenylephrine hydrochlor- Caplet, Oral: ide 10 mg Fenesin DM IR: Guaifenesin 400 mg and dextromethorphan hydrobro- Nu-COPD: Guaifenesin 400 mg and phenylephrine hydrochloride 10 mg mide 20 mg OneTab Congestion & Cold: Guaifenesin 400 mg and phenylephrine hydro- Refenesen DM: Guaifenesin 400 mg and dextromethorphan hydrobro- chloride 10 mg mide 20 mg Refenesen PE: Guaifenesin 400 mg and phenylephrine hydrochloride 10 mg Capsule, Oral: Relcof IR: Guaifenesin 380 mg and phenylephrine hydrochloride 10 mg Coricidin HBP Chest Congestion and Cough: Guaifenesin 200 mg and dextro- methorphan hydrobromide 10 mg Guaifenesin and Pseudoephedrine Robitussin Maximum Strength Cough + Congestion DM: Guaifenesin 200 mg DoD Uniform Formulary Outpatient Dosage Forms and dextromethorphan hydrobromide 10 mg UNIFORM FORMULARY Granules, Oral: Caplet, Oral: Mucinex Kid’s Cough Mini-Melts: Guaifenesin 100 mg and dextromethorphan Congestac: Guaifenesin 400 mg and pseudoephedrine hydrochloride 60 mg hydrobromide 5 mg per packet (12s) [contains magnesium 6 mg/pack, Tablet, Oral: phenylalanine 2 mg/packet, sodium 3 mg/packet; orange crème flavor] Ambifed-G: Guaifenesin 400 mg and pseudoephedrine hydrochloride 20 mg Liquid, Oral: Maxifed: Guaifenesin 400 mg and pseudoephedrine hydrochloride 60 mg Diabetic Tussin DM Maximum Strength: Guaifenesin 200 mg and dextro- Tablet, Extended Release, Oral: methorphan hydrobromide 10 mg per 5 mL (120 mL) [dye free, ethanol free, Mucinex D: Guaifenesin 600 mg and pseudoephedrine hydrochloride 60 mg sugar free; contains phenylalanine 8.4 mg/5 mL] Mucinex D Maximum Strength: Guaifenesin 1200 mg and pseudoephedrine Double Tussin DM: Guaifenesin 300 mg and dextromethorphan hydrobromide hydrochloride 120 mg 20 mg per 5 mL (120 mL, 480 mL) [dye free, ethanol free, sugar free] Generic: Guaifenesin 600 mg and pseudoephedrine hydrochloride 60 mg Kolephrin GG/DM: Guaifenesin 150 mg and dextromethorphan hydrobromide 10 mg per 5 mL (120 mL) [ethanol free; cherry flavor] Guaifenesin, Dextromethorphan, and Phenylephrine Mucinex Fast-Max DM Max: Guaifenesin 400 mg and dextromethorphan DoD Uniform Formulary Outpatient Dosage Forms hydrobromide 20 mg per 20 mL (180 mL) [contains propylene glycol, UNIFORM FORMULARY potassium 6 mg/20 mL, sodium 13 mg/20 mL] Liquid, Oral: Mucinex Kid’s Cough: Guaifenesin 100 mg and dextromethorphan hydro- Mucinex Children’s Multi-Symptom Cold: Guaifenesin 100 mg, dextromethor- bromide 5 mg per 5 mL (120 mL) [contains propylene glycol, sodium 3 mg/ phan hydrobromide 5 mg, and phenylephrine hydrochloride 2.5 mg per 5 mL 5 mL; cherry flavor] (118 mL, 201 mL) [ethanol free; contains propylene glycol, sodium benzoate, Robitussin Peak Cold Maximum Strength Cough + Chest Congestion DM: and sodium 3 mg/5 mL; very berry flavor] Guaifenesin 200 mg and dextromethorphan hydrobromide 10 mg per 5 mL Mucinex Children's Congestion & Cough: Guaifenesin 100 mg, dextromethor- (120 mL, 240 mL) [contains menthol, propylene glycol, sodium 5 mg/5 mL, phan hydrobromide 5 mg, and phenylephrine hydrochloride 2.5 mg per 5 mL sodium benzoate] (201 mL) [contains propylene glycol, sodium benzoate; berrylicious flavor] Safe Tussin DM: Guaifenesin 100 mg and dextromethorphan hydrobromide Mucinex Fast-Max Severe Congestion & Cough: Guaifenesin 100 mg, dextro- 15 mg per 5 mL (120 mL) [contains benzoic acid, phenylalanine 4.2 mg/5 methorphan hydrobromide 5 mg, and phenylephrine hydrochloride 2.5 mg mL, and propylene glycol; orange and mint flavors] per 5 mL (266 mL) [contains propylene glycol, sodium benzoate] Scot-Tussin Senior: Guaifenesin 200 mg and dextromethorphan hydrobro- NeoTuss-D: Guaifenesin 200 mg, dextromethorphan hydrobromide 30 mg, mide 15 mg per 5 mL (120 mL) [ethanol free, sodium free, sugar free] and phenylephrine hydrochloride 7.5 mg per 5 mL (474 mL) [dye free, Vicks 44E: Guaifenesin 200 mg and dextromethorphan hydrobromide 20 mg ethanol free, sugar free; contains propylene glycol] per 15 mL (120 mL, 235 mL) [contains ethanol, sodium 31 mg/15 mL, sodium Robitussin Children's Cough & Cold CF: Guaifenesin 50 mg, dextromethor- benzoate] phan hydrobromide 5 mg, and phenylephrine hydrochloride 2.5 mg per 5 mL Vicks DayQuil Mucus Control DM: Guaifenesin 200 mg and dextromethorphan (118 mL) [ethanol free; contains propylene glycol, sodium 3 mg/5 mL, and hydrobromide 10 mg per 15 mL (295 mL) [contains propylene glycol, sodium sodium benzoate; grape flavor] 25 mg/15 mL, sodium benzoate; citrus blend flavor] Robitussin Peak Cold Maximum Strength Multi-Symptom Cold: Guaifenesin Generic: Guaifenesin 100 mg and dextromethorphan hydrobromide 10 mg per 200 mg, dextromethorphan hydrobromide 10 mg, and phenylephrine hydro- 5 mL (480 mL) chloride 5 mg per 5 mL (118 mL, 237 mL) [contains menthol, propylene Syrup, Oral: glycol, sodium 3 mg/5 mL, sodium benzoate] Diabetic Siltussin-DM DAS-Na Maximum Strength: Guaifenesin 200 mg and Robitussin Peak Cold Multi-Symptom Cold: Guaifenesin 100 mg, dextrome- dextromethorphan hydrobromide 10 mg per 5 mL (118 mL) [ethanol free, thorphan hydrobromide 10 mg, and phenylephrine hydrochloride 5 mg per 5 sugar free; contains benzoic acid, phenylalanine 3 mg/5 mL, propylene mL (118 mL, 237 mL) [contains menthol, propylene glycol, sodium 3 mg/5 glycol; strawberry flavor] mL, sodium benzoate] Triaminic Cough & Cold: Guaifenesin 100 mg and dextromethorphan hydro- Tusicof: Guaifenesin 400 mg, dextromethorphan hydrobromide 20 mg, and bromide 5 mg per 5 mL (118 mL) [contains propylene glycol, sodium phenylephrine hydrochloride 10 mg per 5 mL (120 mL, 474 mL) [alcohol free, benzoate; cherry flavor] sugar free, dye free; contains menthol, propylene glycol] 57 GUAIFENESIN, DEXTROMETHORPHAN, AND PHENYLEPHRINE

Tussin CF Cough & Cold: Guaifenesin 100 mg, dextromethorphan hydro- NONFORMULARY bromide 10 mg, and phenylephrine hydrochloride 5 mg per 5 mL (118 mL, Foam, External: 237 mL) [ethanol free; contains propylene glycol, sodium benzoate] Lexette: 0.05% (50 g) Tablet, Oral: Halobetasol Propionate: 0.05% (50 g) Aquanaz: Guaifenesin 400 mg, dextromethorphan hydrobromide 15 mg, and Lotion, External: phenylephrine hydrochloride 10 mg Bryhali: 0.01% (60 g, 100 g) Deconex DMX: Guaifenesin 385 mg, dextromethorphan hydrobromide Lotion, External, as propionate: 17.5 mg, and phenylephrine hydrochloride 10 mg Ultravate: 0.05% (60 mL) Duravent DM: Guaifenesin 395 mg, dextromethorphan hydrobromide 15 mg, and phenylephrine hydrochloride 10 mg Halobetasol and Tazarotene Mucinex Fast-Max Severe Congestion & Cough: Guaifenesin 200 mg, dextro- DoD Uniform Formulary Outpatient Dosage Forms methorphan hydrobromide 10 mg, and phenylephrine hydrochloride 5 mg UNIFORM FORMULARY Nivanex DMX: Guaifenesin 380 mg, dextromethorphan hydrobromide 15 mg, Lotion, External: and phenylephrine hydrochloride 10 mg Duobrii: Halobetasol propionate 0.01% and tazarotene 0.045% (100 g) Relhist DMX: Guaifenesin 380 mg, dextromethorphan hydrobromide 15 mg, and phenylephrine hydrochloride 10 mg Haloperidol Tusicof: Guaifenesin 400 mg, dextromethorphan hydrobromide 20 mg, and DoD Uniform Formulary Outpatient Dosage Forms phenylephrine hydrochloride 10 mg UNIFORM FORMULARY Concentrate, Oral, as lactate [strength expressed as base]: Guaifenesin, Pseudoephedrine, and Codeine Generic: 2 mg/mL (5 mL, 15 mL, 120 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution, Intramuscular, as decanoate [strength expressed as base]: UNIFORM FORMULARY Generic: 50 mg/mL (1 mL, 5 mL); 100 mg/mL (1 mL, 5 mL) Liquid, Oral: Solution, Injection, as lactate [strength expressed as base]: Coditussin DAC: Guaifenesin 200 mg, pseudoephedrine hydrochloride 30 mg Generic: 5 mg/mL (1 mL, 10 mL) and codeine phosphate 10 mg per 5 mL (473 mL) [alcohol free, dye free, Solution, Injection, as lactate [strength expressed as base, preservative free]: gluten free, sugar free; contains propylene glycol, saccharin sodium, sorbitol; Generic: 5 mg/mL (1 mL) grape flavor] Tablet, Oral: Lortuss EX: Guaifenesin 100 mg, pseudoephedrine hydrochloride 30 mg and Generic: 0.5 mg, 1 mg, 2 mg, 5 mg, 10 mg, 20 mg codeine phosphate 10 mg per 5 mL (473 mL) [dye free, ethanol free, sugar free; contains propylene glycol; apple cinnamon flavor] Hemin Virtussin DAC: Guaifenesin 100 mg, pseudoephedrine hydrochloride 30 mg, DoD Uniform Formulary Outpatient Dosage Forms and codeine phosphate 10 mg per 5 mL (473 mL) [sugar free; contains NOT COVERED ethanol 2.1% v/v, propylene glycol, sodium benzoate] Solution Reconstituted, Intravenous: Syrup, Oral: Panhematin: 313 mg (1 ea) Generic: Guaifenesin 100 mg, pseudoephedrine hydrochloride 30 mg, and codeine phosphate 10 mg per 5 mL (473 mL) Heparin Guaifenesin, Pseudoephedrine, and Dextromethorphan DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Injection, as sodium: Liquid, Oral: Generic: 1000 units ((1 mL, 10 mL, 30 mL, 500 mL); 2000 units (1000 mL); Entre-Cough: Guaifenesin 175 mg, pseudoephedrine hydrochloride 30 mg, 5000 units/mL (1 mL, 10 mL); 10,000 units/mL (1 mL, 4 mL, 5 mL); 12,500 and dextromethorphan hydrobromide 15 mg per 5 mL (473 mL) [contains units (250 mL); 20,000 units/mL (1 mL); 25,000 units (250 mL, 500 mL) aspartame, methylparaben, sodium benzoate; cherry flavor] Solution, Injection, as sodium [preservative free]: Tablet, Oral: Generic: 1000 units/mL (2 mL); 5000 units/0.5 mL (0.5 mL) Capmist DM: Guaifenesin 400 mg, pseudoephedrine hydrochloride 60 mg, Solution, Intravenous, as sodium: and dextromethorphan hydrobromide 15 mg [scored] Generic: 1 units/mL (1 mL, 2 mL, 2.5 mL, 3 mL, 5 mL, 10 mL); 10 units/mL (1 Poly-Vent DM: Guaifenesin 380 mg, pseudoephedrine hydrochloride 60 mg, mL, 2 mL, 2.5 mL, 3 mL, 5 mL, 10 mL); 100 units/mL (1 mL, 2 mL, 2.5 mL, 3 and dextromethorphan hydrobromide 20 mg [scored; contains tartrazine] mL, 5 mL, 10 mL, 250 mL); 10,000 units (250 mL); 12,500 units (250 mL); 20,000 units (500 mL); 25,000 units (250 mL, 500 mL) GuanFACINE Solution, Intravenous, as sodium [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 10 units/mL (1 mL, 3 mL, 5 mL); 100 units/mL (1 mL, 3 mL, 5 mL) UNIFORM FORMULARY Tablet, Oral: Hepatitis A and Hepatitis B Recombinant Vaccine Generic: 1 mg, 2 mg DoD Uniform Formulary Outpatient Dosage Forms Tablet Extended Release 24 Hour, Oral: UNIFORM FORMULARY Generic: 1 mg, 2 mg, 3 mg, 4 mg Injection, suspension [preservative free]: Twinrix: Hepatitis A virus antigen 720 ELISA units and hepatitis B surface Guanidine antigen 20 mcg per mL (1 mL) [contains aluminum, yeast protein, and trace DoD Uniform Formulary Outpatient Dosage Forms amounts of neomycin; may contain natural rubber/natural latex in prefilled UNIFORM FORMULARY syringe] Tablet, Oral, as hydrochloride: Generic: 125 mg Hepatitis A Vaccine DoD Uniform Formulary Outpatient Dosage Forms Haemophilus b Conjugate Vaccine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Injection, suspension [adult, preservative free]: UNIFORM FORMULARY Havrix: Hepatitis A virus antigen 1440 ELISA units/mL (1 mL) [contains Injection, powder for reconstitution [preservative free]: aluminum, neomycin (may have trace amounts); may contain natural rub- Hiberix: Haemophilus b capsular polysaccharide 10 mcg [bound to tetanus ber/natural latex in prefilled syringe] toxoid 25 mcg] per 0.5 mL [contains lactose 12.6 mg] VAQTA: Hepatitis A virus antigen 50 units/mL (1 mL) [contains aluminum, Injection, suspension: natural rubber/natural latex in packaging] PedvaxHIB: Haemophilus b capsular polysaccharide 7.5 mcg [bound to Injection, suspension [pediatric, preservative free]: Neisseria meningitidis OMPC 125 mcg] per 0.5 mL (0.5 mL) [contains Havrix: Hepatitis A virus antigen 720 ELISA units/0.5 mL (0.5 mL) [contains aluminum; natural rubber/natural latex in packaging] aluminum, neomycin (may have trace amounts); may contain natural rubber/ Halcinonide natural latex in prefilled syringe] DoD Uniform Formulary Outpatient Dosage Forms Injection, suspension [pediatric/adolescent, preservative free]: NOT COVERED VAQTA: Hepatitis A virus antigen 25 units/0.5 mL (0.5 mL) [contains alumi- Cream, External: num, natural rubber/natural latex in packaging] Halog: 0.1% (30 g, 60 g, 216 g) [contains cetyl alcohol, propylene glycol] Ointment, External: Hepatitis B Immune Globulin (Human) Halog: 0.1% (30 g, 60 g) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Halobetasol Solution, Injection [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms HepaGam B: (1 mL, 5 mL) [contains polysorbate 80] UNIFORM FORMULARY Solution, Intramuscular: Cream, External, as propionate: HyperHEP B S/D: (0.5 mL, 1 mL, 5 mL) Generic: 0.05% (15 g, 50 g) Nabi-HB: (1 mL, 5 mL) [thimerosal free] Ointment, External, as propionate: Generic: 0.05% (15 g, 50 g) 58 HYDROCHLOROTHIAZIDE AND TRIAMTERENE Hepatitis B Vaccine (Recombinant [Adjuvanted]) Injection, Gel, Intradermal [sodium hyaluronate]: DoD Uniform Formulary Outpatient Dosage Forms Perlane: 20 mg/mL (1 mL) [derived from or manufactured from bacterial UNIFORM FORMULARY source] Solution, Intramuscular [preservative free]: Restylane: 20 mg/mL (0.4 mL, 1 mL, 2 mL) [derived from or manufactured Heplisav-B: Hepatitis B surface antigen 20 mcg/0.5 mL (0.5 mL) [contains from bacterial source] polysorbate 80] Injection, Gel, Subcutaneous/supraperiosteal [cross-linked hyaluronic acid]: Juvederm Voluma XC: Hyaluronic acid 20 mg/mL and lidocaine 0.3% [derived Hepatitis B Vaccine (Recombinant) from or manufactured from bacterial source] DoD Uniform Formulary Outpatient Dosage Forms Injection, Solution, Intra-articular [hyaluronan]: UNIFORM FORMULARY Monovisc: 88 mg/4 mL (4 mL) [derived from or manufactured from bacterial Injection, suspension [adult, preservative free]: source] Engerix-B: Hepatitis B surface antigen 20 mcg/mL (1 mL) [contains aluminum, Hymovis: 24 mg/3 mL (3 mL) [derived from or manufactured from bacterial yeast protein, may contain natural rubber/natural latex in prefilled syringe] source] Engerix-B: Hepatitis B surface antigen 20 mcg/mL (1 mL) [contains aluminum, Orthovisc: 30 mg/2 mL (2 mL) [derived from or manufactured from bacterial yeast protein; vial] source] Recombivax HB: Hepatitis B surface antigen 10 mcg/mL (1 mL) [contains Injection, Solution, Intra-articular [hylan polymers A and B]: aluminum, natural rubber/natural latex in packaging, yeast protein] Synvisc-One: 8 mg/mL (6 mL) [derived from or manufactured using an avian Injection, suspension [dialysis formulation, preservative free]: source] Recombivax HB: Hepatitis B surface antigen 40 mcg/mL (1 mL) [contains Synvisc: 8 mg/mL (2 mL) [derived from or manufactured using an avian aluminum, natural rubber/natural latex in packaging, yeast protein] source] Injection, suspension [pediatric/adolescent, preservative free]: Injection, Solution, Intra-articular [sodium hyaluronate]: Engerix-B: Hepatitis B surface antigen 10 mcg/0.5 mL (0.5 mL) [contains Euflexxa: 10 mg/mL (2 mL) aluminum, yeast protein, may contain natural rubber/natural latex in prefilled Gelsyn-3: 8.4 mg/mL (2 mL) [derived from or manufactured from bacterial syringe] source] Recombivax HB: Hepatitis B surface antigen 5 mcg/0.5 mL (0.5 mL) [contains aluminum, natural rubber/natural latex in packaging, yeast protein] GenVisc 850: 25 mg/2.5 mL (2.5 mL) [derived from or manufactured from bacterial source] Hetastarch Hyalgan: 10 mg/mL (2 mL) [derived from or manufactured using an avian DoD Uniform Formulary Outpatient Dosage Forms source] UNIFORM FORMULARY Supartz FX: 25 mg/2.5 mL (2.5 mL) [derived from or manufactured using an Solution, Intravenous: avian source] Generic: 6% (500 mL) Injection, Solution, Intraocular [sodium hyaluronate]: Amvisc: 12 mg/mL (0.5 mL, 0.8 mL) Hexaminolevulinate Amvisc Plus: 16 mg/mL (0.5 mL, 0.8 mL) DoD Uniform Formulary Outpatient Dosage Forms Provisc: 10 mg/mL (0.4 mL, 0.55 mL, 0.85 mL) [contains natural rubber/ UNIFORM FORMULARY natural latex in packaging] Solution Reconstituted, Intravesical, as hydrochloride: Cysview: 100 mg (1 ea) Hyaluronidase DoD Uniform Formulary Outpatient Dosage Forms Hexylresorcinol UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection: UNIFORM FORMULARY Amphadase: 150 units/mL (1 mL) [contains edetate disodium, thimerosal] Lozenge, oral: Solution, Injection [preservative free]: Sucrets Original: 2.4 mg (18s) [mint flavor] Vitrase: 200 units/mL (1.2 mL) Histoplasmin Generic: 150 units/mL (1 mL) DoD Uniform Formulary Outpatient Dosage Forms HydrALAZINE UNIFORM FORMULARYInjection: 1:100 (0.1 mL, 1.3 mL) DoD Uniform Formulary Outpatient Dosage Forms Histrelin BASIC CORE FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral, as hydrochloride: UNIFORM FORMULARY Generic: 10 mg, 25 mg, 50 mg, Kit, Subcutaneous: UNIFORM FORMULARY Supprelin LA: 50 mg Solution, Injection, as hydrochloride: Vantas: 50 mg Generic: 20 mg/mL (1 mL) Homatropine Tablet, Oral, as hydrochloride: Generic: 100 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY HydroCHLOROthiazide Solution, Ophthalmic, as hydrobromide: DoD Uniform Formulary Outpatient Dosage Forms Generic: 5% (5 mL) BASIC CORE FORMULARY Hyaluronate and Derivatives Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 12.5 mg UNIFORM FORMULARY Tablet, Oral: Cream, External [sodium hyaluronate]: Generic: 25 mg, 50 mg Bionect: 0.2% (25 g) UNIFORM FORMULARY Foam, External [sodium hyaluronate]: Tablet, Oral: Bionect: 0.2% (113.4 g) Generic: 12.5 mg Gel, External [sodium hyaluronate]: Bionect: 0.2% (30 g, 60 g) Hydrochlorothiazide and Spironolactone Injection, Gel, Intra-articular [cross-linked hyaluronate]: DoD Uniform Formulary Outpatient Dosage Forms Gel-One: 10 mg/mL (3 mL) [derived from or manufactured using an avian UNIFORM FORMULARY source] Tablet, Oral: Injection, Gel, Intradermal [hyaluronic acid]: Aldactazide: 25/25: Hydrochlorothiazide 25 mg and spironolactone 25 mg Juvederm Ultra: 24 mg/mL (0.4 mL, 0.8 mL) [derived from or manufactured Aldactazide: 50/50: Hydrochlorothiazide 50 mg and spironolactone 50 mg from bacterial source] Generic: Hydrochlorothiazide 25 mg and spironolactone 25 mg Juvederm Ultra Plus: 24 mg/mL (0.4 mL, 0.8 mL) [derived from or manufac- tured from bacterial source] Hydrochlorothiazide and Triamterene Juvederm Ultra Plus XC: Hyaluronic acid 24 mg/mL and lidocaine 0.3% (0.4 DoD Uniform Formulary Outpatient Dosage Forms mL, 0.8 mL) [derived from or manufactured from bacterial source] BASIC CORE FORMULARY Juvederm Ultra XC: Hyaluronic acid 24 mg/mL and lidocaine 0.3% (0.4 mL, Tablet, Oral: 0.8 mL) [derived from or manufactured from bacterial source] Generic: Hydrochlorothiazide 25 mg and triamterene 37.5 mg Restylane-L: Hyaluronic acid 20 mg/mL and lidocaine 0.3% (0.5 mL, 1 mL, 2 Generic: Hydrochlorothiazide 50 mg and triamterene 75 mg mL) [derived from or manufactured from bacterial source] Restylane Lyft: Hyaluronic acid 20 mg/mL and lidocaine 0.3% [derived from or UNIFORM FORMULARY manufactured from bacterial source] Capsule, Oral: Restylane Silk: Hyaluronic acid 20 mg/mL and lidocaine 0.3% [derived from or Hydrochlorothiazide 25 mg and triamterene 37.5 mg manufactured from bacterial source] Hydrochlorothiazide 25 mg and triamterene 50 mg 59 HYDROCODONE HYDROcodone Hydrocodone, Chlorpheniramine, and Pseudoephedrine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule ER 12 Hour Abuse-Deterrent, Oral, as bitartrate: Solution, Oral: Zohydro ER: 10 mg (60 ea); 15 mg (60 ea); 20 mg (60 ea); 30 mg (60 ea); Generic: Hydrocodone bitartrate 5 mg, chlorpheniramine maleate 4 mg, and 40 mg (60 ea); 50 mg (60 ea) pseudoephedrine hydrochloride 60 mg per 5 mL (480 mL)] Capsule Extended Release 12 Hour, Oral, as bitartrate: Hydrocodone, Pseudoephedrine, and Guaifenesin Tablet ER 24 Hour Abuse-Deterrent, Oral, as bitartrate: DoD Uniform Formulary Outpatient Dosage Forms Hysingla ER: 20 mg, 30 mg, 40 mg, 60 mg, 80 mg, 100 mg, 120 mg UNIFORM FORMULARY Hydrocodone and Acetaminophen Solution, Oral: DoD Uniform Formulary Outpatient Dosage Forms Hycofenix: Hydrocodone bitartrate 2.5 mg, pseudoephedrine hydrochloride 30 mg, and guaifenesin 200 mg per 5 mL (473 mL) [contains methylparaben, UNIFORM FORMULARY polyethylene glycol, propylparaben, saccharin sodium, sorbitol; black rasp- Solution, Oral: berry flavor] Zamicet: Hydrocodone bitartrate 10 mg and acetaminophen 325 mg per 15 mL (7.5 mL, 15 mL, 473 mL) [contains ethanol 6.7%, propylene glycol; fruit Hydrocortisone (Systemic) flavor] DoD Uniform Formulary Outpatient Dosage Forms Generic: Hydrocodone bitartrate 7.5 mg and acetaminophen 325 mg per UNIFORM FORMULARY 15 mL Solution Reconstituted, Injection, as sodium succinate [strength expressed as Tablet, Oral: base, preservative free]: Generic: Solu-CORTEF: 100 mg (1 ea); 250 mg (1 ea); 500 mg (1 ea); 1000 mg (1 ea) Hydrocodone bitartrate 2.5 mg and acetaminophen 325 mg Tablet, Oral, as base: Hydrocodone bitartrate 5 mg and acetaminophen 300 mg Generic: 5 mg, 10 mg, 20 mg Hydrocodone bitartrate 5 mg and acetaminophen 325 mg Hydrocodone bitartrate 7.5 mg and acetaminophen 300 mg Hydrocortisone (Topical) Hydrocodone bitartrate 7.5 mg and acetaminophen 325 mg DoD Uniform Formulary Outpatient Dosage Forms Hydrocodone bitartrate 10 mg and acetaminophen 300 mg BASIC CORE FORMULARY Hydrocodone bitartrate 10 mg and acetaminophen 325 mg Suppository, Rectal, as acetate: Anusol-HC: 25 mg (12s, 24s) Hydrocodone and Chlorpheniramine Hemmorex-HC: 25 mg (12 ea, 24 ea) DoD Uniform Formulary Outpatient Dosage Forms Generic: 25 mg (12s) UNIFORM FORMULARY UNIFORM FORMULARY Capsule Extended Release 12 Hour, Oral: Cream, External, as acetate: TussiCaps: Hydrocodone polistirex [equivalent to hydrocodone bitartrate MiCort-HC: 2.5% (4 g, 28.4 g) 5 mg] and chlorpheniramine polistirex [equivalent to chlorpheniramine mal- Cream, External, as base: eate 4 mg] Generic: 0.5% (15 g, 28.35 g, 28.4 g); 1% (1 g, 1.5 g, 14.2 g, 20 g, 28 g, TussiCaps: Hydrocodone polistirex [equivalent to hydrocodone bitartrate 28.35 g, 28.4 g, 30 g, 120 g, 453.6 g); 2.5% (20 g, 28 g, 28.35 g, 30 g, 10 mg] and chlorpheniramine polistirex [equivalent to chlorpheniramine 453.6 g) maleate 8 mg] Cream, Rectal, as base: Liquid Extended Release, Oral: Generic: 1% (28.4 g); 2.5% (30 g) Generic: Hydrocodone polistirex [equivalent to hydrocodone bitartrate 10 mg] Cream, External, as valerate: and chlorpheniramine polistirex [equivalent to chlorpheniramine maleate Generic: 0.2% (15 g, 45 g, 60 g) 8 mg] per 5 mL (115 mL, 473 mL) Enema, Rectal, as base: Solution, Oral: Generic: 100 mg/60 mL (60 mL) Foam, Rectal, as acetate: Vituz: Hydrocodone bitartrate 5 mg and chlorpheniramine maleate 4 mg per 5 Cortifoam: 10% [90 mg/applicatorful] (15 g) [contains cetyl alcohol, methyl- mL (480 mL) [contains methylparaben, propylene glycol, propylparaben, paraben, propylene glycol, propylparaben, trolamine (triethanolamine)] saccharin sodium; grape flavor] Gel, External, as base: Suspension Extended Release, Oral: Corticool: 1% (42.53 g) [contains cremophor el, propylene glycol] Generic: Hydrocodone polistirex [equivalent to hydrocodone bitartrate 10 mg] First-Hydrocortisone: 10% (60 g) [contains propylene glycol, simethicone] and chlorpheniramine polistirex [equivalent to chlorpheniramine maleate Kit, External, as base: 8 mg] per 5 mL (115 mL, 118 mL, 473 mL) Advanced Allergy Collection: 2.5% [contains cetyl alcohol, methylparaben, Hydrocodone and Guaifenesin propylene glycol, propylparaben] Dermasorb HC: 2% [contains menthol, methylparaben, propylene glycol, DoD Uniform Formulary Outpatient Dosage Forms propylparaben] UNIFORM FORMULARY Scalacort DK: Hydrocortisone lotion 2% and Sal Acid 2% and sulfur 2% Solution, Oral: [contains benzalkonium chloride, isopropyl alcohol, methylparaben, propy- Flowtuss: Hydrocodone bitartrate 2.5 mg and guaifenesin 200 mg per 5 mL lene glycol, propylparaben, soybean lecithin] (473 mL) [contains polyethylene glycol, saccharin; black raspberry flavor] Lotion, External, as acetate: Obredon: Hydrocodone bitartrate 2.5 mg and guaifenesin 200 mg per 5 mL NuCort: 2% (60 g) [contains benzyl alcohol, cetyl alcohol, menthol, trolamine (118 mL, 473 mL) [contains propylene glycol, saccharin; cherry punch flavor, (triethanolamine)] raspberry flavor] Lotion, External, as base: Generic: 1% (114 g); 2.5% (59 mL, 118 mL) Hydrocodone and Homatropine Ointment, External, as base: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.5% (28.35 g, 30 g); 2.5% (20 g, 28.35 g, 453.6 g, 454 g); 1% UNIFORM FORMULARY (25 g, 28 g, 28.35 g, 28.4 g, 30 g, 110 g, 430 g, 453.6 g) Syrup, Oral: Ointment, External, as valerate: Generic: Hydrocodone bitartrate 5 mg and homatropine methylbromide Generic: 0.2% (15 g, 45 g, 60 g) 1.5 mg per 5 mL (473 mL) Solution, External, as base: Tablet, Oral: Scalpicin Maximum Strength: 1% (44 mL) [contains disodium edta, menthol, Generic: Hydrocodone bitartrate 5 mg and homatropine methylbro- propylene glycol] mide 1.5 mg Texacort: 2.5% (30 mL) [lipid free, paraben free; contains alcohol, usp] Suppository, Rectal, as acetate: Hydrocodone and Ibuprofen Anu-med HC: 25 mg (12s) DoD Uniform Formulary Outpatient Dosage Forms Proctocort: 30 mg (12 ea) UNIFORM FORMULARY GenericL 30 mg (12s) Tablet, Oral: NONFORMULARY Hydrocodone bitartrate 5 mg and ibuprofen 200 mg Cream, External, as butyrate: Hydrocodone bitartrate 7.5 mg and ibuprofen 200 mg Generic: 0.1% (15 g, 45 g, 60 g) Hydrocodone bitartrate 10 mg and ibuprofen 200 mg Cream, External, as probutate: Pandel: 0.1% (45 g, 80 g) [contains butylparaben, methylparaben, propylene Hydrocodone and Pseudoephedrine glycol] DoD Uniform Formulary Outpatient Dosage Forms Lotion, External, as butyrate: UNIFORM FORMULARY Locoid: 0.1% (59 mL, 118 mL) [contains butylparaben, cetostearyl alcohol, Solution, Oral: propylparaben] Rezira: Hydrocodone bitartrate 5 mg and pseudoephedrine hydrochloride Ointment, External, as butyrate: 60 mg per 5 mL (480 mL) [contains propylene glycol; grape flavor] Generic: 0.1% (15 g, 45 g) 60 HYOSCYAMINE, METHENAMINE, METHYLENE BLUE, AND SODIUM PHOSPHATE MONOBASIC

Solution, External, as butyrate Insert, Ophthalmic [preservative free]: Generic: 0.1% (20 mL, 60 mL) Lacrisert: 5 mg (60 ea) Hydrogen Peroxide Hydroxypropyl Methylcellulose DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, External: Gel, Ophthalmic: Generic: 3% (30 mL, 237 mL, 473 mL, 3840 mL) GenTeal Severe: 0.3% (10 g) NONFORMULARY Systane Overnight Therapy: 0.3% (10 g) Solution, External: Solution, Intraocular: Eskata: 40% (1 ea) [contains isopropyl alcohol] OcuCoat Viscoadherent: 2% (1 mL) Solution, Ophthalmic: HYDROmorphone Gonak: 2.5% (15 mL) DoD Uniform Formulary Outpatient Dosage Forms Goniosoft: 2.5% (15 mL) UNIFORM FORMULARY Goniosol: 2.5% (15 mL) Liquid, Oral, as hydrochloride: Goniotaire: 2.5% (15 mL) Generic: 1 mg/mL (473 mL) Goniovisc: 2% (15 mL); 2.5% (15 mL) [contains benzalkonium chloride, Solution, Injection, as hydrochloride: edetate disodium] Generic: 1 mg/mL (0.5 mL, 1 mL); 2 mg/mL (1 mL, 20 mL); 4 mg/mL (1 mL) Isopto Tears: 0.5% (15 mL) [contains benzalkonium chloride] Solution, Injection, as hydrochloride [preservative free]: Pure & Gentle Lubricant: 3 mg/mL (15 mL, 30 mL) Generic: 10 mg/mL (1 mL); 50 mg/5 mL (5 mL); 500 mg/50 mL (50 mL) Solution, Ophthalmic [preservative free]: Solution, Intravenous, as hydrochloride: GenTeal Mild: 0.2% (15 mL) Generic: 6 mg/30 mL (30 mL) GenTeal Mild to Moderate: 0.3% (15 mL, 25 mL) Solution Prefilled Syringe, Intravenous, as hydrochloride: Solution Prefilled Syringe, Ophthalmic [preservative free]: Generic: 10 mg/50 mL (50 mL); 15 mg/30 mL (30 mL) ImproVue: 1.7% (2 mL) Solution Prefilled Syringe, Intravenous, as hydrochloride [preservative free]: Generic: 12 mg/60 mL (60 mL) Hydroxyurea Suppository, Rectal, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Generic: 3 mg (6 ea) UNIFORM FORMULARY Tablet, Oral, as hydrochloride: Capsule, Oral: Generic: 2 mg, 4 mg, 8 mg Droxia: 200 mg, 300 mg, 400 mg Tablet ER 24 Hour Abuse-Deterrent, Oral, as hydrochloride: Generic: 500 mg Generic: 8 mg, 12 mg, 16 mg, 32 mg Tablet, Oral: Hydroquinone Siklos: 100 mg, 1000 mg DoD Uniform Formulary Outpatient Dosage Forms HydrOXYzine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Cream, External: BASIC CORE FORMULARY AMBI Fade: 2% (56 g) [contains cetyl alcohol, disodium edta, ethylparaben, Solution, Oral, as hydrochloride: methylparaben, propylparaben, sodium metabisulfite, soy protein, soya Generic: 10 mg/5 mL (473 mL) sterol] Syrup, Oral, as hydrochloride: Esoterica Daytime: 2% (70 g) [contains disodium edta, methylparaben, pro- Generic: 10 mg/5 mL (118 mL, 473 mL) pylene glycol, propylparaben] Tablet, Oral, as hydrochloride: Esoterica Facial: 2% (85 g) Generic: 10 mg, 25 mg, 50 mg Esoterica Fade Nighttime: 2% (70 g) [contains disodium edta, methylparaben, propylene glycol, propylparaben, sodium metabisulfite] UNIFORM FORMULARY Esoterica Sensitive Skin: 1.5% (85 g) Capsule, Oral, as pamoate: Generic: 4% (28.35 g) Generic: 25 mg, 50 mg, 100 mg Gel, External: Exuviance Lightening Complex: 2% (30 g) [contains denatured alcohol, pro- Hyoscyamine pylene glycol, sodium bisulfite, sodium sulfite, tartrazine (fd&c yellow #5)] DoD Uniform Formulary Outpatient Dosage Forms NeoStrata HQ Skin Lightening: 2% (30 g) [fragrance free, oil free; contains UNIFORM FORMULARY propylene glycol, sodium bisulfite, sodium sulfite] Elixir, Oral, as sulfate: Solution, External: Generic: 0.125 mg/5 mL (473 mL) Melquin 3: 3% (29.57 mL) Solution, Injection, as sulfate: Levsin: 0.5 mg/mL (1 mL) [contains benzyl alcohol] Hydroxocobalamin Solution, Oral, as sulfate: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.125 mg/mL (15 mL) UNIFORM FORMULARY Tablet, Oral, as sulfate: Solution, Intramuscular: Generic: 0.125 mg Generic: 1000 mcg/mL (30 mL) Tablet Dispersible, Oral, as sulfate: Solution Reconstituted, Intravenous: Generic: 0.125 mg Cyanokit: 5 g (1 ea) Tablet Extended Release, Oral, as sulfate: Hydroxyamphetamine and Tropicamide Symax Duotab: 0.375 mg [contains brilliant blue fcf (fd&c blue #1)] Tablet Extended Release 12 Hour, Oral, as sulfate: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.375 mg UNIFORM FORMULARY Tablet Sublingual, as sulfate: Solution, Ophthalmic: Generic: 0.125 mg Paremyd: Hydroxyamphetamine hydrobromide 1% and tropicamide 0.25% (15 mL) [contains benzalkonium chloride] Hyoscyamine, Atropine, Scopolamine, and Phenobarbital Hydroxychloroquine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Elixir, Oral: UNIFORM FORMULARY Donnatal: Hyoscyamine sulfate 0.1037 mg, atropine sulfate 0.0194 mg, sco- Tablet, Oral, as sulfate: polamine hydrobromide 0.0065 mg, and phenobarbital 16.2 mg per 5 mL Generic: 200 mg (120 mL, 480 mL) [contains ethanol <23.8%] HYDROXYprogesterone Caproate Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Donnatal: Hyoscyamine sulfate 0.1037 mg, atropine sulfate 0.0194 mg, sco- UNIFORM FORMULARY polamine hydrobromide 0.0065 mg, and phenobarbital 16.2 mg Oil, Intramuscular: Phenohytro: Hyoscyamine sulfate 0.1037 mg, atropine sulfate 0.0194 mg, Makena: 250 mg/mL (5 mL) [contains benzyl alcohol, benzyl benzoate, castor scopolamine hydrobromide 0.0065 mg, and phenobarbital 16.2 mg oil (ricine oil)] Makena: 250 mg/mL (1 mL) [contains benzyl benzoate, castor oil (ricine oil)] Hyoscyamine, Methenamine, Methylene Blue, and Sodium Solution, Intramuscular: Phosphate Monobasic Generic: 1.25 g/5 mL (5 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Hydroxypropyl Cellulose Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Indiomin MB: Hyoscyamine sulfate 0.12 mg, methenamine 120 mg, methyl- UNIFORM FORMULARY ene blue 10 mg, and sodium phosphate monobasic 40.8 mg 61 HYOSCYAMINE, METHENAMINE, METHYLENE BLUE, AND SODIUM PHOSPHATE MONOBASIC

UTA: Hyoscyamine sulfate 0.12 mg, methenamine 120 mg, methylene blue Solution, Intravenous, as fumarate: 10 mg, and sodium phosphate monobasic 40.8 mg Generic: 1 mg/10 mL (10 mL) Tablet, Oral: ME/NaPhos/MB/Hyo1: Hyoscyamine sulfate 0.12 mg, methenamine 81.6 mg, Icatibant methylene blue 10.8 mg, and sodium phosphate monobasic 40.8 mg DoD Uniform Formulary Outpatient Dosage Forms [scored; contains brilliant blue fcf (fd&c blue #1)] UNIFORM FORMULARY Urogesic-Blue: Hyoscyamine sulfate 0.12 mg, methenamine 81.6 mg, meth- Solution, Subcutaneous [preservative free]: ylene blue 10.8 mg, and sodium phosphate monobasic 40.8 mg [scored] Firazyr: 30 mg/3 mL (3 mL) Urolet MB: Hyoscyamine sulfate 0.12 mg, methenamine 81.6 mg, methylene blue 10.8 mg, and sodium phosphate monobasic 40.8 mg [DSC] [scored; Icodextrin contains brilliant blue fcf (fd&c blue #1)] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Ibandronate Solution, Intraperitoneal: DoD Uniform Formulary Outpatient Dosage Forms Adept: 4% (1000 mL, 1500 mL) UNIFORM FORMULARY Extraneal: 7.5% (2000 mL, 2500 mL) Tablet, Oral: Generic: 150 mg Icosapent Ethyl DoD Uniform Formulary Outpatient Dosage Forms Ibrexafungerp UNIFORM FORMULARY Capsule, Oral: Ibritumomab Tiuxetan Vascepa: 0.5 g, 1 g DoD Uniform Formulary Outpatient Dosage Forms Generic: 1 g UNIFORM FORMULARY Kit, Intravenous [preservative free]: IDArubicin Zevalin Y-90: 3.2 mg/2 mL [pyrogen free; contains albumin human] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Ibrutinib Solution, Intravenous, as hydrochloride [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 5 mg/5 mL (5 mL); 10 mg/10 mL (10 mL); 20 mg/20 mL (20 mL) UNIFORM FORMULARY Capsule, Oral: IdaruCIZUmab Imbruvica: 140 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Ibuprofen Solution, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Praxbind: 2.5 g/50 mL (50 mL) BASIC CORE FORMULARY Tablet, Oral: Idelalisib Generic: 400 mg, 600 mg, 800 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Capsule, Oral: Zydelig: 100 mg, 150 mg Generic: 200 mg Cream, External: Idursulfase EnovaRX-Ibuprofen: 10% (60 g, 120 g) [contains cetearyl alcohol] DoD Uniform Formulary Outpatient Dosage Forms Kit, Combination: UNIFORM FORMULARY Ibuprofen Comfort Pac: 800 mg [contains methylparaben, trolamine (trietha- Solution, Intravenous [preservative free]: nolamine)] Elaprase: 6 mg/3 mL (3 mL) Solution, Intravenous: Caldolor: 400 mg/4 mL (4 mL [DSC]); 800 mg/8 mL (8 mL) Ifosfamide Solution, Intravenous, as lysine [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 10 mg/mL (2 mL) UNIFORM FORMULARY Suspension, Oral: Solution, Intravenous: Childrens Advil: 100 mg/5 mL (120 mL) Generic: 1 g/20 mL (20 mL); 3 g/60 mL (60 mL) Childrens Motrin: 100 mg/5 mL (120 mL) Solution, Intravenous [preservative free]: GoodSense Ibuprofen Childrens: 100 mg/5 mL (120 mL) Generic: 1 g/20 mL (20 mL); 3 g/60 mL (60 mL) Infants Advil: 50 mg/1.25 mL (15 mL, 30 mL) Solution Reconstituted, Intravenous: Motrin Infants Drops: 50 mg/1.25 mL (15 mL) Generic: 1 g (1 ea); 3 g (1 ea) Generic: 100 mg/5 mL (5 mL, 118 mL, 120 mL, 473 mL) Solution Reconstituted, Intravenous [preservative free]: Tablet, Oral: Generic: 1 g (1 ea); 3 g (1 ea) Generic: 200 mg Tablet Chewable, Oral: Iloprost Advil Junior Strength: 100 mg [scored] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Ibuprofen and Phenylephrine Solution, Inhalation [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Ventavis: 10 mcg/mL (1 mL); 20 mcg/mL (1 mL) [contains alcohol, usp, UNIFORM FORMULARY tromethamine] Tablet, Oral: Advil Congestion Relief: Ibuprofen 200 mg and phenylephrine hydrochlor- Imatinib ide 10 mg DoD Uniform Formulary Outpatient Dosage Forms Advil Sinus Congestion & Pain: 10-200 MG, Ibuprofen 200 mg and phenyl- UNIFORM FORMULARY ephrine hydrochloride 10 mg [contains corn starch] Tablet, Oral: Generic: 100 mg, 400 mg Ibuprofen, Phenylephrine, and Chlorpheniramine DoD Uniform Formulary Outpatient Dosage Forms Imiglucerase UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Advil Allergy & Congestion: Ibuprofen 200 mg, phenylephrine hydrochloride Solution Reconstituted, Intravenous: 10 mg, and chlorpheniramine maleate 4 mg Cerezyme: 400 units (1 ea) Ibuprofen, Pseudoephedrine, and Chlorpheniramine Imipenem and Cilastatin DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Caplet, Oral: Injection, Powder for Reconstitution: Advil Allergy Sinus: Ibuprofen 200 mg, pseudoephedrine hydrochloride Imipenem 250 mg and cilastatin 250 mg 30 mg, and chlorpheniramine maleate 2 mg Imipenem 500 mg and cilastatin 500 mg Advil Multi-Symptom Cold: Ibuprofen 200 mg, pseudoephedrine hydrochloride 30 mg, and chlorpheniramine maleate 2 mg Imipramine DoD Uniform Formulary Outpatient Dosage Forms Ibutilide BASIC CORE FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral, as pamoate: UNIFORM FORMULARY Generic: 75 mg 62 INFLUENZA VIRUS VACCINE (INACTIVATED) Tablet, Oral, as hydrochloride: Indium 111 Capromab Pendetide Generic: 10 mg, 25 mg, 50 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral, as pamoate: Kit, Intravenous [preservative free]: Generic: 100 mg, 125 mg, 150 mg ProstaScint: Capromab pendetide 0.5 mg per vial [to be combined with Indium In 111 (not included)] [pyrogen free; contains mouse (murine) and/or hamster Imiquimod protein] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Indium 111 Oxyquinoline Cream, External: DoD Uniform Formulary Outpatient Dosage Forms Zyclara: 3.75% (28 ea) [contains benzyl alcohol, cetyl alcohol, methylparaben, UNIFORM FORMULARY propylparaben] Solution, Intravenous: Zyclara Pump: 2.5% (7.5 g); 3.75% (7.5 g) [contains benzyl alcohol, cetyl Generic: 1 mCi/mL (1 mL) alcohol, methylparaben, propylparaben] Generic: 5% (1 ea, 12 ea, 24 ea) Indium In-111 Pentetreotide DoD Uniform Formulary Outpatient Dosage Forms Immune Globulin UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Kit, [preservative free]: UNIFORM FORMULARY OctreoScan: Injectable, Intramuscular [preservative free]: Injection, powder for reconstitution: Pentetreotide 10 mcg GamaSTAN S/D: 15% to 18% [150 to 180 mg/mL] (2 mL, 10 mL) Injection, solution: Indium In-111 chloride 111 MBq (3.0 mCi) per 1 mL Kit, Subcutaneous: (1.1 mL) Hyqvia: 2.5 g/25 mL, 5 g/50 mL, 10 g/100 mL, 20 g/200 mL, 30 g/300 mL [contains albumin human, edetate disodium dihydrate, mouse (murine) and/ Indocyanine Green or hamster protein] DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection [preservative free]: UNIFORM FORMULARY Gammagard: 1 g/10 mL (10 mL); 2.5 g/25 mL (25 mL); 5 g/50 mL (50 mL); Solution Reconstituted, Intravenous: 10 g/100 mL (100 mL); 20 g/200 mL (200 mL); 30 g/300 mL (300 mL) Generic: 25 mg (1 ea, 6 ea) [latex free] Indomethacin Gamunex-C: 1 g/10 mL (10 mL); 2.5 g/25 mL (25 mL); 5 g/50 mL (50 mL); 10 g/100 mL (100 mL); 20 g/200 mL (200 mL); 40 g/400 mL (400 mL) DoD Uniform Formulary Outpatient Dosage Forms [latex free] BASIC CORE FORMULARY Solution, Intravenous [preservative free]: Capsule, Oral: Bivigam: 5 g/50 mL (50 mL); 10 g/100 mL (100 mL) [sugar free; contains Generic: 25 mg, 50 mg polysorbate 80] Flebogamma DIF: 0.5 g/10 mL (10 mL); 5 g/50 mL (50 mL); 5 g/100 mL (100 UNIFORM FORMULARY mL); 10 g/100 mL (100 mL); 20 g/200 mL (200 mL); 20 g/400 mL (400 mL); Capsule Extended Release, Oral: 10 g/200 mL (200 mL); 2.5 g/50 mL (50 mL) [contains polyethylene glycol] Generic: 75 mg Gammaplex: 5 g/100 mL (100 mL); 20 g/400 mL (400 mL); 10 g/200 mL (200 Solution Reconstituted, Intravenous: mL); 2.5 g/50 mL (50 mL [DSC]) [contains polysorbate 80] Generic: 1 mg (1 ea) Octagam: 1 g/20 mL (20 mL); 2 g/20 mL (20 mL); 5 g/50 mL (50 mL); 5 g/100 Suppository, Rectal: mL (100 mL); 10 g/100 mL (100 mL); 20 g/200 mL (200 mL); 25 g/500 mL Indocin: 50 mg (30 ea) (500 mL); 10 g/200 mL (200 mL); 2.5 g/50 mL (50 mL) [sucrose free] Suspension, Oral: Privigen: 5 g/50 mL (50 mL); 10 g/100 mL (100 mL); 20 g/200 mL (200 mL); Indocin: 25 mg/5 mL (237 mL) [contains alcohol, usp; pineapple-coconut-mint 40 g/400 mL (400 mL) flavor] Solution, Subcutaneous [preservative free]: Tier 4 - NOT COVERED Cuvitru: 1 g/5 mL (5 mL); 2 g/10 mL (10 mL); 4 g/20 mL (20 mL); 8 g/40 mL Capsule, Oral: (40 mL) Tivorbex: 20 mg, 40 mg Hizentra: 1 g/5 mL (5 mL); 2 g/10 mL (10 mL); 4 g/20 mL (20 mL); 10 g/50 mL (50 mL) [contains polysorbate 80] Inebilizumab Solution Reconstituted, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Carimune NF: 6 g (1 ea); 12 g (1 ea) NOT COVERED Gammagard S/D Less IgA: 5 g (1 ea); 10 g (1 ea) Solution, Intravenous: NONFORMULARY Uplizna: Inebilizumab-cdon 100 mg/10 mL (10 mL) [contains polysorbate 80] Solution, Subcutaneous [preservative free]: Cutaquig: 1 g/6 mL (6 mL); 1.65 g/10 mL (10 mL); 2 g/12 mL (12 mL); 3.3 g/20 Infant Nutritional Formulas mL (20 mL); 4 g/24 mL (24 mL); 8 g/48 mL (48 mL) DoD Uniform Formulary Outpatient Dosage Forms Xembify: Immune globulin (human)-klhw 1 g/5 mL (5 mL); Immune globulin UNIFORM FORMULARY (human)-klhw 2 g/10 mL (10 mL); Immune globulin (human)-klhw 4 g/20 mL Liquid, Oral: (20 mL); Immune globulin (human)-klhw 10 g/50 mL (50 mL) [latex free; PediaSure Pediatric contains polysorbate 80] Powder, Oral: Solution, Injection [preservative free]: Similac PM Gammaked: 1 g/10 mL (10 mL); 2.5 g/25 mL (25 mL); 5 g/50 mL (50 mL); 10 g/100 mL (100 mL); 20 g/200 mL (200 mL) [latex free] Infigratinib IncobotulinumtoxinA InFLIXimab DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution Reconstituted, Intramuscular [preservative free]: Solution Reconstituted, Intravenous: Xeomin: 50 units (1 ea); 100 units (1 ea); 200 units (1 ea) [latex free; contains Inflectra: 100 mg (1 ea) [contains polysorbate 80] albumin human] Solution Reconstituted, Intravenous [preservative free]: Remicade: 100 mg (1 ea) [contains polysorbate 80] Indapamide DoD Uniform Formulary Outpatient Dosage Forms Influenza A Virus Vaccine (H5N1) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 1.25 mg, 2.5 mg Injection, emulsion [monovalent]: GlaxoSmithKline product: Adjuvanted Hemagglutinin [A/Indonesia/05/2005 (H5N1)] 3.75 mcg/0.5 mL (5 mL) [con- Indigotindisulfonate Sodium tains egg protein, polysorbate 80, and thimerosal] DoD Uniform Formulary Outpatient Dosage Forms Injection, suspension [monovalent]: Sanofi Pasteur product: Hemagglutinin [A/ UNIFORM FORMULARY Vietnam/1203/2004 (H5N1)] 90 mcg/mL (5 mL) [contains chicken and egg Solution, Injection: protein, porcine gelatin, and thimerosal] Indigo Carmine: 8 mg/mL (5 mL) Influenza Virus Vaccine (Inactivated) Indinavir DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Suspension, Intramuscular: Capsule, Oral: Afluria: (5 mL) [DSC] [contains neomycin sulfate, thimerosal] Crixivan: 200 mg, 400 mg Afluria Quadrivalent: (5 mL) [contains neomycin sulfate, thimerosal] 63 INFLUENZA VIRUS VACCINE (INACTIVATED) Flucelvax Quadrivalent: (5 mL) [contains polysorbate 80, thimerosal] Inotuzumab Ozogamicin FluLaval Quadrivalent: (5 mL) [contains egg white (egg protein), formaldehyde DoD Uniform Formulary Outpatient Dosage Forms solution, polysorbate 80, thimerosal] UNIFORM FORMULARY Fluzone Quadrivalent: (5 mL) [contains egg white (egg protein), formaldehyde Solution Reconstituted, Intravenous [preservative free]: solution, thimerosal] Besponsa: 0.9 mg (1 ea) [contains polysorbate 80] Suspension, Intramuscular [preservative free]: Fluzone Quadrivalent: (0.5 mL) [contains egg white (egg protein), formalde- Insulin Aspart hyde solution] DoD Uniform Formulary Outpatient Dosage Forms Suspension Pen-injector, Intradermal [preservative free]: BASIC CORE FORMULARY Fluzone Intradermal Quadrivalent: 9 mcg/strain (0.1 mL) [contains egg white Solution, Subcutaneous: (egg protein), formaldehyde solution] NovoLOG: 100 units/mL (10 mL) [contains metacresol, phenol] Suspension Prefilled Syringe, Intramuscular [preservative free]: Generic: 100 units/mL (10 mL) Afluria: (0.5 mL) [contains neomycin sulfate] Solution Cartridge, Subcutaneous: Afluria Quadrivalent: (0.25 mL, 0.5 mL) [contains neomycin sulfate] NovoLOG Penfill: 100 units/mL (3 mL) [contains metacresol, phenol] Fluad: (0.5 mL) [contains formaldehyde solution, neomycin, polysorbate 80] Generic: 100 units/mL (3 mL) Fluarix Quadrivalent: (0.5 mL) [contains egg white (egg protein), formaldehyde Solution Pen-injector, Subcutaneous: solution, gentamicin, polysorbate 80] NovoLOG FlexPen: 100 units/mL (3 mL) [contains metacresol, phenol] Flucelvax Quadrivalent: (0.5 mL) [contains polysorbate 80] Generic: 100 units/mL (3 mL) FluLaval Quadrivalent: (0.5 mL) [contains egg white (egg protein), polysorbate NONFORMULARY 80, formaldehyde solution] Solution, Subcutaneous: Fluzone High-Dose: (0.5 mL) [contains egg white (egg protein), formaldehyde Fiasp: 100 units/mL (10 mL) [contains metacresol, phenol] solution] Solution Pen-injector, Subcutaneous: Fluzone Quadrivalent: (0.25 mL, 0.5 mL) [contains egg white (egg protein), Fiasp FlexTouch: 100 units/mL (3 mL) [contains metacresol, phenol] formaldehyde solution] Influenza Virus Vaccine (Live/Attenuated) Insulin Aspart Protamine and Insulin Aspart DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY UNIFORM FORMULARY Suspension, Subcutaneous: Suspension, Nasal [preservative free]: NovoLOG Mix 70/30 FlexPen: Insulin aspart protamine suspension 70% FluMist Quadrivalent: (1 ea) [latex free; contains egg white (egg protein), [intermediate acting] and insulin aspart solution 30% [rapid acting]: 100 gelatin (pork)] units/mL (3 mL) Influenza Virus Vaccine (Recombinant) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Suspension, Subcutaneous: UNIFORM FORMULARY NovoLOG Mix 70/30: Insulin aspart protamine suspension 70% [intermediate Solution, Intramuscular [preservative free]: acting] and insulin aspart solution 30% [rapid acting]: 100 units/mL (10 mL) Flublok: (0.5 mL) [no egg protein] Insulin Detemir Ingenol Mebutate DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Subcutaneous: Gel, External: Levemir: 100 units/mL (10 mL) [contains metacresol, phenol] Picato: 0.015% (3 ea); 0.05% (2 ea) [contains benzyl alcohol, isopropyl NONFORMULARY alcohol] Solution Pen-injector, Subcutaneous: Inhalation Devices Levemir FlexTouch: 100 units/mL (3 mL) [contains metacresol, phenol] DoD Uniform Formulary Outpatient Dosage Forms Insulin Glargine BASIC CORE FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Holding Chamber/Spacer: BASIC CORE FORMULARY Ace Aerosol Cloud Enhance Solution, Subcutaneous: Aerochamber MV; Aerochamber Plus Flow-Vu; Aerochamber Plus W-flowsig- Lantus: 100 units/mL (10 mL) [contains metacresol] nal; Aerochamber Z-stat Plus Solution Pen-injector, Subcutaneous: Aerotrach Plus Lantus Solostar: 100 units/mL (3 mL) Aerovent Plus Breatherite UNIFORM FORMULARY Breatherite Valved MDI Chamber Solution Pen-injector, Subcutaneous: Clever Choice Holding Chamber Toujeo SoloStar: 300 units/mL (1.5 mL) [contains metacresol] Compact Space Chamber Toujeo Max SoloStar: 300 units/mL (3 mL) [contains metacresol] Easivent NONFORMULARY E-Z Spacer Solution Pen-injector, Subcutaneous: Flexichamber Basaglar KwikPen: 100 units/mL (3 mL) [contains metacresol] Inspirachamber Semglee: 100 units/mL (3 mL) [contains metacresol] Liteaire Optichamber Diamond Insulin Glulisine Pocket Chamber DoD Uniform Formulary Outpatient Dosage Forms Primeaire UNIFORM FORMULARY Prochamber Solution, Injection: Riteflow Spacer Apidra: 100 units/mL (10 mL) [contains metacresol] Vortex Holding Chamber Solution Pen-injector, Subcutaneous: Vortex VHC Frog Child Mask Apidra SoloStar: 100 units/mL (3 mL) [contains metacresol] Vortex VHC Landybug Toddler Mask Respiratory Therapy: Insulin Lispro Ace Aerosol Cloud Enhancer DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Subcutaneous: Drug delivery system: Admelog: 100 units/mL (10 mL) [contains metacresol] OptiHaler HumaLOG: 100 units/mL (3 mL, 10 mL) [contains metacresol, phenol] Inhalation kit (InspirEase) Solution Pen-injector, Subcutaneous: OptiChamber Admelog SoloStar: 100 units/mL (3 mL) [contains metacresol] Peak flow meter HumaLOG KwikPen: 100 units/mL (3 mL); 200 units/mL (3 mL) [contains Replacement bags (InspirEase) metacresol, phenol] Inotersen NONFORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution Pen-injector, Subcutaneous: UNIFORM FORMULARY HumaLOG Junior KwikPen: 100 units/mL (3 mL) [contains metacresol, phenol] Solution Prefilled Syringe, Subcutaneous [preservative free]: Tegsedi: 284 mg/1.5 mL (1.5 mL) 64 IODOQUINOL Insulin Lispro Protamine and Insulin Lispro Injection, Powder for Reconstitution [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Avonex: 30 mcg [contains albumin (human), mouse (murine) and/or hamster UNIFORM FORMULARY protein; supplied with diluent] Suspension, Subcutaneous: Solution, Injection: HumaLOG Mix 50/50: Insulin lispro protamine suspension 50% [intermediate Avonex: 30 mcg/0.5 mL (0.5 mL) [albumin free; contains mouse (murine) and/ acting] and insulin lispro solution 50% [rapid acting]: 100 units/mL (10 mL) or hamster protein; prefilled syringe] HumaLOG Mix 75/25: Insulin lispro protamine suspension 75% [intermediate Avonex Pen: 30 mcg/0.5 mL (0.5 mL) [albumin free; contains mouse (murine) acting] and insulin lispro solution 25% [rapid acting]: 100 units/mL (10 mL) and/or hamster protein] Suspension Pen-injector, Subcutaneous: Solution, Injection [preservative free]: HumaLOG Mix 50/50 KwikPen: Insulin lispro protamine suspension 50% Rebif: 22 mcg/0.5 mL (0.5 mL), 44 mcg/0.5 mL (0.5 mL) [contains albumin [intermediate acting] and insulin lispro solution 50% [rapid acting]: 100 (human), mouse (murine) and/or hamster protein; prefilled syringe] units/mL (3 mL) Rebif Rebidose: 22 mcg/0.5 mL (0.5 mL), 44 mcg/0.5 mL (0.5 mL) [contains HumaLOG Mix 75/25 KwikPen: Insulin lispro protamine suspension 75% albumin (human), mouse (murine) and/or hamster protein; autoinjector] [intermediate acting] and insulin lispro solution 25% [rapid acting]: 100 Solution, Injection [preservative free, combination package]: units/mL (3 mL) Rebif Titration Pack: 8.8 mcg/0.2 mL (6s) and 22 mcg/0.5 mL (6s) [contains albumin (human), mouse (murine) and/or hamster protein; prefilled syringe] Insulin NPH Rebif Rebidose Titration Pack: 8.8 mcg/0.2 mL (6s) and 22 mcg/0.5 mL (6s) DoD Uniform Formulary Outpatient Dosage Forms [contains albumin (human), mouse (murine) and/or hamster protein; auto- BASIC CORE FORMULARY injector] Suspension, Subcutaneous: Interferon Beta-1b NovoLIN N: 100 units/mL (10 mL) [contains metacresol, phenol] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Suspension, Subcutaneous: Kit, Subcutaneous: HumuLIN N: 100 units/mL (3 mL, 10 mL) [contains metacresol, phenol] Betaseron: 0.3 mg [contains albumin human] NovoLIN N ReliOn: 100 units/mL (10 mL) [contains metacresol, phenol] Kit, Subcutaneous [preservative free]: Suspension Pen-injector, Subcutaneous: Extavia: 0.3 mg [contains albumin human] HumuLIN N KwikPen: 100 units/mL (3 mL) [contains metacresol, phenol] NovoLIN N FlexPen: 100 units/mL (3 mL) [contains metacresol, phenol] Interferon Gamma-1b NovoLIN N FlexPen ReliOn: 100 units/mL (3 mL) [contains metacresol, DoD Uniform Formulary Outpatient Dosage Forms phenol] UNIFORM FORMULARY Solution, Subcutaneous: Insulin NPH and Insulin Regular Actimmune: 2,000,000 units/0.5 mL (0.5 mL) DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY Iobenguane I 123 Suspension, Subcutaneous: DoD Uniform Formulary Outpatient Dosage Forms NovoLIN 70/30: Insulin NPH suspension 70% [intermediate acting] and insulin UNIFORM FORMULARY regular solution 30% [short acting]: 100 units/mL (10 mL) [contains meta- Solution, Injection: cresol, phenol] AdreView: Iobenguane sulfate 0.08 mg and I 123 74 MBq (2 mCi) per mL (5 mL) [contains benzyl alcohol] UNIFORM FORMULARY Suspension, Subcutaneous: Iobenguane I 131 HumuLIN 70/30: Insulin NPH suspension 70% [intermediate acting] and DoD Uniform Formulary Outpatient Dosage Forms insulin regular solution 30% [short acting]: 100 units/mL (3 mL, 10 mL) [vial] UNIFORM FORMULARY HumuLIN 70/30 KwikPen: Insulin NPH suspension 70% [intermediate acting] Solution, Intravenous: and insulin regular solution 30% [short acting]: 100 units/mL (3 mL) Azedra Dosimetric: 555 MBq/mL (15 mCi/mL) (1 ea) NovoLIN 70/30 FlexPen: Insulin NPH suspension 70% [intermediate acting] Azedra Therapeutic: 555 MBq/mL (15 mCi/mL) (1 ea) and insulin regular solution 30% [short acting]: 100 units/mL (3 mL) [vial] NovoLIN 70/30 FlexPen Relion: Insulin NPH suspension 70% [intermediate Iodinated I 131 Albumin acting] and insulin regular solution 30% [short acting]: 100 units/mL (3 DoD Uniform Formulary Outpatient Dosage Forms mL) [vial] UNIFORM FORMULARY Solution, Intravenous: Insulin Regular Megatope: 1 mCi/mL (8 mL) [contains benzyl alcohol] DoD Uniform Formulary Outpatient Dosage Forms Solution Prefilled Syringe, Intravenous: BASIC CORE FORMULARY Volumex: 25 mcCi/mL (1 ea) [contains benzyl alcohol] Solution, Injection: NovoLIN R: 100 units/mL (10 mL) [contains metacresol] Iodine DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Injection: Gel, External [Cadexomer Iodine]: HumuLIN R: 100 units/mL (3 mL, 10 mL) [contains metacresol, phenol] Generic: 9% (10 g, 40 g) NovoLIN R ReliOn: 100 units/mL (10 mL) [contains metacresol] Tincture, External: Solution, Intravenous [preservative free]: Generic: 2% (30 mL, 473 mL, 500 mL, 4000 mL, 20000 mL); 7% (59 mL, 480 Myxredlin: 100 units/100 mL in NaCl 0.9% (100 mL) mL); (30 mL) Solution, Subcutaneous: HumuLIN R U-500 (CONCENTRATED): 500 units/mL (20 mL) [contains Iodine I-125 Human Serum Albumin metacresol] DoD Uniform Formulary Outpatient Dosage Forms Solution Pen-injector, Subcutaneous: UNIFORM FORMULARY HumuLIN R U-500 KwikPen: 500 units/mL (3 mL) [contains metacresol] Solution, for injection: Jeanatope: 18.5 megabecquerels (500 µCi)/0.5 mL [contains albumin Interferon Alfa-2b (human), benzyl alcohol] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Iodixanol Solution, Injection: DoD Uniform Formulary Outpatient Dosage Forms Intron A: 6,000,000 units/mL (3.8 mL); 10,000,000 units/mL (3.2 mL) [contains UNIFORM FORMULARY edetate disodium, metacresol, polysorbate 80] Solution, Intravenous: Solution Reconstituted, Injection [preservative free]: Visipaque: 320 mg/mL (50 mL, 100 mL, 150 mL, 200 mL, 500 mL) [contains Intron A: 10,000,000 units (1 ea); 18,000,000 units (1 ea); 50,000,000 units (1 edetate calcium disodium] ea) [contains albumin human] Visipaque: 270 mg/mL (50 mL, 100 mL, 150 mL, 200 mL) [pyrogen free; contains edetate calcium disodium, trolamine (triethanolamine)] Interferon Alfa-n3 Solution, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Visipaque: 320 mg/mL (50 mL) [pyrogen free; contains edetate calcium UNIFORM FORMULARY disodium] Solution, Injection: Alferon N: 5,000,000 units/mL (1 mL) Iodoquinol DoD Uniform Formulary Outpatient Dosage Forms Interferon Beta-1a UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Gel, External: UNIFORM FORMULARY Quinja: 1.25% (60 g) 65 IODOQUINOL AND HYDROCORTISONE Iodoquinol and Hydrocortisone Oxilan 350: 73% (50 mL, 100 mL, 150 mL, 200 mL, 500 mL) [contains edetate DoD Uniform Formulary Outpatient Dosage Forms calcium disodium, sodium 0.2 mg (0.01 mEq)/mL; provides organically- UNIFORM FORMULARY bound iodine 350 mg/mL] Cream, External: Generic: Iodoquinol 1% and hydrocortisone acetate 1% (30 g) Ipilimumab Generic: Iodoquinol 1% and hydrocortisone 1.9% per 2 g packet (30s) DoD Uniform Formulary Outpatient Dosage Forms Gel, External: UNIFORM FORMULARY Alcortin A: Iodoquinol 1% and hydrocortisone 2% (2 g, 48 g) [contains aloe, Solution, Intravenous [preservative free]: benzyl alcohol] Yervoy: 50 mg/10 mL (10 mL); 200 mg/40 mL (40 mL) [contains polysor- bate 80] Nonormulary Cream, External: Ipratropium and Albuterol Dermazene: Iodoquinol 1% and hydrocortisone acetate 1% (2 g, 30 g) [con- DoD Uniform Formulary Outpatient Dosage Forms tains cetyl alcohol] BASIC CORE FORMULARY Ioflupane I 123 Solution, for Nebulization: Generic: Ipratropium bromide 0.5 mg and albuterol (base) 2.5 mg per 3 mL DoD Uniform Formulary Outpatient Dosage Forms (30s, 60s) UNIFORM FORMULARY Solution, for Oral Inhalation [spray]: Solution, Intravenous: Combivent Respimat: Ipratropium bromide 20 mcg and albuterol (base) 100 DaTscan: 185 MBq/2.5 mL (2.5 mL) [pyrogen free; contains alcohol, usp] mcg per inhalation (4 g) [contains benzalkonium chloride] Iohexol Ipratropium (Nasal) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection: UNIFORM FORMULARY Omnipaque: 180 mg/mL (10 mL, 20 mL); 240 mg/mL (50 mL); 300 mg/mL (10 Solution, Nasal, as bromide: mL, 30 mL, 50 mL, 75 mL, 100 mL, 125 mL, 150 mL, 200 mL, 500 mL) Generic: 0.03% (30 mL); 0.06% (15 mL) [contains edetate calcium disodium] Ipratropium (Oral Inhalation) Solution, Injection [preservative free]: Omnipaque: 240 mg/mL (10 mL, 20 mL, 50 mL, 100 mL, 150 mL, 200 mL) DoD Uniform Formulary Outpatient Dosage Forms [pyrogen free; contains edetate calcium disodium] BASIC CORE FORMULARY Solution, Intravenous: Aerosol Solution, Inhalation, as bromide: Omnipaque: 140 mg/mL (50 mL) Atrovent HFA: 17 mcg/actuation (12.9 g) [contains alcohol, usp] Omnipaque: 350 mg/mL (50 mL, 75 mL, 100 mL, 125 mL, 150 mL, 200 mL, Solution, Inhalation, as bromide: 500 mL) [contains edetate calcium disodium] Generic: 0.02% (2.5 mL) Solution, Inhalation, as bromide [preservative free]: Iopamidol Generic: 0.02% (2.5 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Irbesartan Solution, Injection: DoD Uniform Formulary Outpatient Dosage Forms Isovue-M 200: 41% (10 mL, 20 mL) [contains edetate calcium disodium] UNIFORM FORMULARY Isovue-M 300: 61% (15 mL) Tablet, Oral: Solution, Intravenous: Generic: 75 mg, 150 mg, 300 mg Isovue-200: 41% (50 mL, 200 mL) [contains edetate calcium disodium] Isovue-250: 51% (50 mL, 100 mL, 150 mL, 200 mL) [contains edetate calcium Irbesartan and Hydrochlorothiazide disodium] DoD Uniform Formulary Outpatient Dosage Forms Isovue-300: 61% (30 mL, 50 mL, 75 mL, 100 mL, 125 mL, 150 mL, 200 mL, UNIFORM FORMULARY 500 mL) [contains edetate calcium disodium] Tablet, Oral: Isovue-370: 76% (50 mL, 75 mL, 100 mL, 125 mL, 150 mL, 200 mL, 500 mL) Generic: 150/12.5: Irbesartan 150 mg and hydrochlorothiazide 12.5 mg [contains edetate calcium disodium] Generic: 300/12.5: Irbesartan 300 mg and hydrochlorothiazide 12.5 mg Iopromide Irinotecan (Conventional) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Injection: Solution, Intravenous, as hydrochloride: Ultravist: 50% (100 mL, 200 mL); 62% (50 mL, 100 mL, 125 mL, 150 mL, 200 Camptosar: 300 mg/15 mL (15 mL) mL, 500 mL); 77% (50 mL, 100 mL, 150 mL, 200 mL, 500 mL) Generic: 40 mg/2 mL (2 mL); 100 mg/5 mL (5 mL); 500 mg/25 mL (25 mL) Iothalamate Meglumine Solution, Intravenous, as hydrochloride [preservative free]: Generic: 40 mg/2 mL (2 mL); 100 mg/5 mL (5 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Irinotecan (Liposomal) Solution, Injection: DoD Uniform Formulary Outpatient Dosage Forms Conray: 60% (30 mL, 50 mL, 100 mL, 150 mL) UNIFORM FORMULARY Solution, Intravenous: Injectable, Intravenous: Conray 30: 30% (150 mL) Onivyde: 43 mg/10 mL (10 mL) [contains mpeg-2000-dspe (methoxy-termi- Conray 43: 43% (50 mL, 250 mL) nated peg)] Solution, Urethral: Cysto-Conray II: 17.2% (250 mL) Iron Dextran Complex Ioversol DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Injection: Solution, Intravenous: Infed: 50 mg/mL (2 mL) Optiray 240: 51% (50 mL, 100 mL, 125 mL, 200 mL) [contains edetate calcium Iron Sucrose disodium] Optiray 300: 64% (50 mL, 100 mL, 150 mL, 200 mL, 500 mL) [contains edetate DoD Uniform Formulary Outpatient Dosage Forms calcium disodium] UNIFORM FORMULARY Optiray 320: 68% (20 mL, 30 mL, 50 mL, 75 mL, 100 mL, 125 mL, 150 mL, 200 Solution, Intravenous [preservative free]: mL) [contains edetate calcium disodium] Venofer: 20 mg/mL (2.5 mL, 5 mL, 10 mL) Optiray 350: 74% (50 mL, 75 mL, 100 mL, 125 mL, 150 mL, 200 mL, 250 mL, Isavuconazonium Sulfate 500 mL) [contains edetate calcium disodium] DoD Uniform Formulary Outpatient Dosage Forms Ioxilan UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral: UNIFORM FORMULARY Cresemba: 186 mg [contains disodium edta] Injection, solution [preservative free]: Solution Reconstituted, Intravenous: Oxilan 300: 62% (50 mL, 100 mL, 150 mL, 200 mL, 500 mL) [contains edetate Cresemba: 372 mg (1 ea) calcium disodium, sodium 0.2 mg (0.01 mEq)/mL; provides organically- bound iodine 300 mg/mL] 66 KETOCONAZOLE (TOPICAL) Isocarboxazid Solution, Oral: DoD Uniform Formulary Outpatient Dosage Forms Sporanox: 10 mg/mL (150 mL) [contains propylene glycol, saccharin sodium, UNIFORM FORMULARY sorbitol] Tablet, Oral: Tablet, Oral: Marplan: 10 mg [scored] Onmel: 200 mg NONFORMULARY Isoflurane Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Tolsura: 65 mg UNIFORM FORMULARY Solution, Inhalation: Ivabradine Forane: USP: ≥99.9 mL/100 mL (100 mL, 250 mL) DoD Uniform Formulary Outpatient Dosage Forms Terrell: USP: ≥99.9 mL/100 mL (100 mL, 250 mL) UNIFORM FORMULARY Generic: USP: ≥99.9 mL/100 mL (100 mL, 250 mL) Solution, Oral [preservative free]: Corlanor: 5 mg/5 mL (5 mL) Isoniazid Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Corlanor: 5 mg [scored], 7.5 mg BASIC CORE FORMULARY Tablet, Oral: Ivacaftor Generic: 100 mg, 300 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Packet, Oral: Solution, Injection: Kalydeco: 50 mg (56 ea); 75 mg (56 ea) Generic: 100 mg/mL (10 mL) Tablet, Oral: Syrup, Oral: Kalydeco: 150 mg Generic: 50 mg/5 mL (473 mL) Ivermectin (Systemic) Isoproterenol DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Solution, Injection, as hydrochloride: Generic: 3 mg Isuprel: 0.2 mg/mL (1 mL, 5 mL) [contains disodium edta] Ivermectin (Topical) Isosorbide Dinitrate DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Lotion, External: Tablet, Oral: Sklice: 0.5% (117 g) [contains methylparaben, propylparaben] Generic: 5 mg, 10 mg, 20 mg, 30 mg NONFORMULARY Tablet Extended Release, Oral: Cream, External: Generic: 40 mg Soolantra: 1% (30 g, 45 g) [contains cetyl alcohol, edetate disodium, methyl- paraben, propylene glycol, propylparaben] UNIFORM FORMULARY Capsule Extended Release, Oral: Ivosidenib Dilatrate-SR: 40 mg DoD Uniform Formulary Outpatient Dosage Forms Isosorbide Dinitrate and Hydralazine UNIFORM FORMULARY Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Tibsovo: 250 mg UNIFORM FORMULARY Tablet, Oral: Ixabepilone BiDil: Isosorbide dinitrate 20 mg and hydralazine hydrochloride 37.5 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Isosorbide Mononitrate Solution Reconstituted, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Ixempra Kit: 15 mg (1 ea); 45 mg (1 ea) [contains alcohol, usp, cremophor el] BASIC CORE FORMULARY Tablet Extended Release 24 Hour, Oral: Ixazomib Generic: 30 mg, 60 mg, 120 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral: Tablet, Oral: Ninlaro: 2.3 mg, 3 mg, 4 mg Generic: 10 mg, 20 mg Isosulfan Blue Japanese Encephalitis Virus Vaccine (Inactivated) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Suspension, Intramuscular: Solution, Subcutaneous: Ixiaro: (0.5 mL) [latex free; contains albumin bovine, protamine sulfate, sodium Generic: 1% (5 mL) metabisulfite] Solution, Subcutaneous [preservative free]: Generic: 1% (5 mL) Ketamine ISOtretinoin (Systemic) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection: UNIFORM FORMULARY Ketalar: 10 mg/mL (20 mL); 50 mg/mL (10 mL); 100 mg/mL (5 mL) Capsule, Oral: Generic: 10 mg/mL (20 mL); 50 mg/mL (10 mL); 100 mg/mL (5 mL, 10 mL) Generic: 10 mg, 20 mg, 30 mg, 40 mg NONFORMULARY Ketoconazole (Systemic) Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 25 mg, 35 mg UNIFORM FORMULARY Absorica LD: 8 mg, 16 mg, 24 mg, 32 mg Tablet, Oral: Generic: 200 mg Isoxsuprine DoD Uniform Formulary Outpatient Dosage Forms Ketoconazole (Topical) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral, as hydrochloride: BASIC CORE FORMULARY Generic: 10 mg, 20 mg Cream, External: Generic: 2% (15 g, 30 g, 60 g) Itraconazole UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Foam, External: UNIFORM FORMULARY Generic: 2% (50 g) Capsule, Oral: Gel, External: Generic: 100 mg Xolegel: 2% (45 g) [contains alcohol, usp] 67 KETOCONAZOLE (TOPICAL)

Kit, External: Capsule, Oral: Ketodan: 2% [contains cetyl alcohol, edetate disodium, propylene glycol] Advanced Probiotic: L. acidophilus, L. casei, L. delbrueckii, and L. rhamnosus Shampoo, External: GG 10 billion live cultures [also includes Bifidobacterium lactis, and B. Nizoral A-D: 1% (125 mL, 200 mL) longum] Generic: 2% (120 mL) Culturelle: L. rhamnosus GG 10 billion colony-forming units [contains casein and whey] Ketorolac (Ophthalmic) Dofus: L. acidophilus and L. bifidus 10:1 ratio [beet root powder base] DoD Uniform Formulary Outpatient Dosage Forms Flora-Q: L. acidophilus and L. paracasei ≥8 billion colony-forming units [also UNIFORM FORMULARY contains Bifidobacterium and S. thermophilus] Solution, Ophthalmic, as tromethamine: Lacto-Key: Generic: 0.4% (5 mL); 0.5% (3 mL, 5 mL, 10 mL) 100: L. acidophilus 1 billion colony-forming units [milk, soy, and yeast free; Solution, Ophthalmic, as tromethamine [preservative free]: rice derived] Acuvail: 0.45% (30 ea) 600: L. acidophilus 6 billion colony-forming units [milk, soy, and yeast free; Ketorolac (Systemic) rice derived] DoD Uniform Formulary Outpatient Dosage Forms Lacto-Bifidus: UNIFORM FORMULARY 100: L. bifidus 1 billion colony-forming units [milk, soy, and yeast free; rice Kit, Injection, as tromethamine: derived] ReadySharp Ketorolac: 15 mg/mL [contains alcohol, usp] 600: L. bifidus 6 billion colony-forming units [milk, soy, and yeast free; rice Solution, Injection, as tromethamine: derived] Generic: 15 mg/mL (1 mL); 30 mg/mL (1 mL); 60 mg/2 mL (2 mL) Lacto-Pectin: L. acidophilus, L. casei, L. plantarum, L. rhamnosus, Bifidobac- Solution, Injection, as tromethamine [preservative free]: terium breve, and B. longum 20 billion colony-forming units Generic: 15 mg/mL (1 mL); 30 mg/mL (1 mL) Lacto-TriBlend: Solution, Intramuscular, as tromethamine: 100: L. acidophilus, L. bifidus, and L. bulgaricus 1 billion colony-forming units Generic: 60 mg/2 mL (2 mL) [milk, soy and yeast free; rice derived] Solution, Intramuscular, as tromethamine [preservative free]: 600: L. acidophilus, L. bifidus, and L. bulgaricus 6 billion colony-forming units Generic: 60 mg/2 mL (2 mL) [milk, soy and yeast free; rice derived] Tablet, Oral, as tromethamine: Megadophilus, Superdophilus: L. acidophilus 2 billion units [available in dairy Generic: 10 mg based or dairy free formulations] RisaQuad: L. acidophilus and L. paracasei 8 billion colony-forming units [also Ketotifen (Ophthalmic) includes Bifidobacterium and Streptococcus thermophilus] DoD Uniform Formulary Outpatient Dosage Forms RisaQuad-2: L. acidophilus and L. paracasei 16 billion colony-forming units UNIFORM FORMULARY [gluten free; also includes Bifidobacterium and Streptococcus thermophilus] Solution, Ophthalmic: Visbiome: L. acidophilus, L. plantarum, L. paracasei, L. bulgaricus, Bifidobac- Generic: 0.025% (5 mL) terium breve, B. longum, B. infantis, and Streptococcus thermophilus112 billion live cells [gluten free; contains lactose, milk protein] Labetalol VSL #3: L. acidophilus, L. plantarum, L. paracasei, L. bulgaricus, Bifidobacte- DoD Uniform Formulary Outpatient Dosage Forms rium breve, B. longum, B. infantis, and Streptococcus thermophilus 112 UNIFORM FORMULARY billion live cells [gluten free] Solution, Intravenous, as hydrochloride: Caplet, Oral: Generic: 5 mg/mL (4 mL, 20 mL, 40 mL) Bacid: L. acidophilus and L. bulgaricus [also contains Bifidobacterium bifidum Tablet, Oral, as hydrochloride: and Streptococcus thermophilus] Generic: 100 mg, 200 mg, 300 mg Risa-Bid: L. acidophilus and L. bulgaricus [also contains Bifidobacterium Lacosamide bifidum and Streptococcus thermophilus] DoD Uniform Formulary Outpatient Dosage Forms Granules: UNIFORM FORMULARY Floranex: L. acidophilus and L. bulgaricus 100 million live cells per 1 g packet Solution, Intravenous: (12s) [contains milk, sodium 5 mg/packet, soy] Vimpat: 200 mg/20 mL (20 mL) Lactinex: L. acidophilus and L. bulgaricus 100 million live cells per 1 g packet Solution, Oral: (12s) [gluten free; contains calcium 5 mg/packet, lactose 380 mg/packet, Vimpat: 10 mg/mL (200 mL, 465 mL) [contains aspartame, methylparaben, potassium 20 mg/packet, sodium 5 mg/packet, sucrose 34 mg/packet, whey, polyethylene glycol, propylene glycol; strawberry flavor] evaporated milk, and soy peptone] Tablet, Oral: Powder: Vimpat: 50 mg, 100 mg, 150 mg, 200 mg Lacto-TriBlend: L. acidophilus, L. bifidus, and L. bulgaricus 10 billion colony- forming units per ¼ teaspoon (60 g) [milk, soy, and yeast free; rice derived] Lactase Megadophilus, Superdophilus: L. acidophilus 2 billion units per half-teaspoon DoD Uniform Formulary Outpatient Dosage Forms (49 g, 70 g, 84 g, 126 g) [available in dairy based or dairy free (garbanzo UNIFORM FORMULARY bean) formulations] Tablet, Oral: MoreDophilus: L. acidophilus 12.4 billion units per teaspoon (30 g, 120 g) Lac-Dose: 3000 units [dairy free, yeast free; soy and carrot derived] Lactaid: 3000 units Visbiome: L. acidophilus, L. plantarum, L. paracasei, L. bulgaricus 450 billion Lactaid Fast Act: 9000 units live cells per packet (30s) [gluten free; contains lactose, milk protein; also Lactase Enzyme: 3000 units contains Bifidobacterium breve, B. longum, B. infantis, and Streptococcus Lactase Fast Acting: 9000 units thermophilus; lemon flavor and unflavored] Surelac: 3000 units VSL #3: L. acidophilus, L. plantarum, L. paracasei, L. bulgaricus 450 billion live Tablet Chewable, Oral: cells per sachet (10s, 30s) [gluten free; also contains Bifidobacterium breve, Lactaid Fast Act: 9000 units [vanilla flavor] B. longum, B. infantis, and Streptococcus thermophilus; lemon cream flavor and unflavored] Lactic Acid VSL #3-DS: L. acidophilus, L. plantarum, L. paracasei, L. bulgaricus 900 billion DoD Uniform Formulary Outpatient Dosage Forms live cells per packet (20s,) [gluten free; also contains Bifidobacterium breve, UNIFORM FORMULARY B. longum, B. infantis, and Streptococcus thermophilus] Cream, External: Tablet, Oral: L. acidophilus 35 million and L. sporogenes 25 million Generic: 10% (113.4 g, 226.8 g) Floranex: L. acidophilus and L. bulgaricus 1 million colony-forming units Lotion, External: [contains lactose, nonfat dried milk, whey] Generic: 10% (354.84 mL, 473.12 mL) Kala: L. acidophilus 200 million units [dairy free, yeast free; soy based] Lactic Acid and Ammonium Hydroxide Tablet, Chewable, Oral: L. reuteri 100 million organisms DoD Uniform Formulary Outpatient Dosage Forms Dialyvite Probiotic: L. acidophilus and Bifidobacterium lactis 10 billion cells UNIFORM FORMULARY [orange cream flavor] Cream, External: Lactinex: L. acidophilus and L. bulgaricus 1 million live cells [gluten free; Generic: Lactic acid 12% with ammonium hydroxide (140 g, 280 g, 385 g) contains calcium 5.2 mg/4 tablets, lactose 960 mg/4 tablets, potassium Lotion, External: 20 mg/4 tablets, sodium 5.6 mg/4 tablets, and sucrose 500 sucrose/4 Generic: Lactic acid 12% with ammonium hydroxide (225 g, 400 g) tablets; contains whey, evaporated milk, and soy peptone] Geri-Hydrolac, Lac-Hydrin Five: Lactic acid 5% with ammonium hydroxide Pedia-Lax Probiotic Yums: L. reuteri 100 million organisms [dye free, gluten (120 mL, 240 mL) free, sugar free; contains milk protein; strawberry flavor] ReZyst IM: L. acidophilus and Bifidobacterium 150 mg [3 billion lives cells; Lactobacillus berry flavor] DoD Uniform Formulary Outpatient Dosage Forms Wafer: L. acidophilus 90 mg and L. bifidus 25 mg (100s) [provides 1 billion UNIFORM FORMULARY organisms/wafer at time of manufacture; milk free] 68 LESINURAD AND ALLOPURINOL Lactulose Lanthanum DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY UNIFORM FORMULARY Solution, Oral: Packet, Oral: Generic: 10 g/15 mL (15 mL, 30 mL, 236 mL, 237 mL, 473 mL, 500 mL, 946 Fosrenol: 750 mg (10 ea, 90 ea); 1000 mg (10 ea, 90 ea) mL, 1892 mL) Tablet Chewable, Oral: Fosrenol: 500 mg, 750 mg, 1000 mg UNIFORM FORMULARY Packet, Oral: Lapatinib Kristalose: 10 g (30 ea); 20 g (30 ea) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY LamiVUDine Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Tykerb: 250 mg UNIFORM FORMULARY Solution, Oral: Laronidase Epivir HBV: 5 mg/mL (240 mL) [contains methylparaben, propylene glycol, DoD Uniform Formulary Outpatient Dosage Forms propylparaben; strawberry-banana flavor] UNIFORM FORMULARY Generic: 10 mg/mL (240 mL) Solution, Intravenous: Tablet, Oral: Aldurazyme: 2.9 mg/5 mL (5 mL) [contains mouse (murine) and/or hamster Generic: 100 mg, 150 mg, 300 mg protein, polysorbate 80] Lamivudine and Zidovudine Larotrectinib DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Capsule, Oral, as sulfate: Generic: Lamivudine 150 mg and zidovudine 300 mg Vitrakvi: 25 mg Solution, Oral, as sulfate: LamoTRIgine Vitrakvi: 20 mg/mL (100 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Latanoprost Kit, Oral: DoD Uniform Formulary Outpatient Dosage Forms LaMICtal ODT: Blue Kit: 25 mg (21s) & 50 mg (7s), Orange Kit: 25 mg (14s) & BASIC CORE FORMULARY 50 mg (14s) & 100 mg (7s), Green Kit: 50 mg (42s) & 100 mg (14s) Solution, Ophthalmic: LaMICtal Starter: Blue Kit: 25 mg (35s) Generic: 0.005% (2.5 mL) LaMICtal Starter: Green Kit: 25 mg (84s) & 100 mg (14s), Orange Kit: 25 mg UNIFORM FORMULARY (42s) & 100 mg (7s) [contains fd&c yellow #6 aluminum lake] Solution, Ophthalmic: LaMICtal XR: Green Kit: 50 mg (14s) & 100 mg (14s) & 200 mg (7s) [contains Xalatan: 0.005% (2.5 mL) fd&c blue #2 aluminum lake, polysorbate 80] NONFORMULARY LaMICtal XR: Blue Kit: 25 mg (21s) & 50 mg (7s), Orange Kit: 25 mg (14s) & Emulsion, Ophthalmic: 50 mg (14s) & 100 mg (7s) [contains polysorbate 80] Xelpros: 0.005% (2.5 mL) Generic: Blue Kit: 25 mg (21s) & 50 mg (7s), Green Kit: 50 mg (42s) & 100 mg Ledipasvir and Sofosbuvir (14s), Orange Kit: 25 mg (14s) & 50 mg (14s) & 100 mg (7s) DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 25 mg, 100 mg, 150 mg, 200 mg Packet, Oral: Tablet Chewable, Oral: Harvoni: Ledipasvir 45 mg and sofosbuvir 200 mg (28 ea) Generic: 5 mg, 25 mg Harvoni: Ledipasvir 33.75 mg and sofosbuvir 150 mg (28 ea) Tablet Dispersible, Oral: Tablet, Oral: Generic: 25 mg, 50 mg, 100 mg, 200 mg Harvoni: Ledipasvir 45 mg and sofosbuvir 200 mg Tablet Extended Release 24 Hour, Oral: Harvoni: Ledipasvir 90 mg and sofosbuvir 400 mg Generic: 25 mg, 50 mg, 100 mg, 200 mg, 250 mg, 300 mg Leflunomide Lanadelumab DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Solution, Subcutaneous [preservative free]: Generic: 10 mg, 20 mg Takhzyro: 300 mg/2 mL (2 mL) [contains polysorbate 80] Lemborexant Lanolin DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Cream, External: DayVigo: 5 mg, 10 mg HPA Lanolin: (7 g, 40 g) Lan-O-Soothe: (7 g, 28 g, 56 g) Lenalidomide DoD Uniform Formulary Outpatient Dosage Forms Lanolin, Cetyl Alcohol, Glycerin, Petrolatum, and Mineral Oil UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral: UNIFORM FORMULARY Revlimid: 2.5 mg, 5 mg, 10 mg, 15 mg, 20 mg, 25 mg Lotion, External [bottle]: Generic: 180 mL, 300 mL, 480 mL Lenvatinib Lotion, External [tube]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 100 mL UNIFORM FORMULARY Capsule Therapy Pack, Oral: Lanreotide Lenvima 10 MG Daily Dose: 10 mg (30 ea) DoD Uniform Formulary Outpatient Dosage Forms Lenvima 14 MG Daily Dose: 10 mg & 4 mg (60 ea) UNIFORM FORMULARY Lenvima 18 MG Daily Dose: 10 mg & 2x4 mg (15 ea, 90 ea) Solution, Subcutaneous: Lenvima 20 MG Daily Dose: 2x10 mg (60 ea) Somatuline Depot: 120 mg/0.5 mL (0.5 mL); 60 mg/0.2 mL (0.2 mL); 90 mg/ Lenvima 24 MG Daily Dose: 2x10 mg & 4 mg (90 ea) 0.3 mL (0.3 mL) Lenvima 8 MG Daily Dose: 2x4 mg (10 ea, 60 ea) Lansoprazole, Amoxicillin, and Clarithromycin Lesinurad and Allopurinol DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY NONFORMULARY Combination package [each administration card contains]: Tablet, Oral: Generic: Duzallo: Lesinurad 200 mg and allopurinol 200 mg, Lesinurad 200 mg and Capsule: Amoxicillin 500 mg (4 capsules/day) allopurinol 300 mg Capsule, delayed release: Lansoprazole 30 mg (2 capsules/day) Tablet: Clarithromycin 500 mg (2 tablets/day) 69 LETERMOVIR Letermovir Levobunolol DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Intravenous [preservative free]: Solution, Ophthalmic, as hydrochloride: Prevymis: 240 mg/12 mL (12 mL); 480 mg/24 mL (24 mL) Generic: 0.5% (5 mL, 10 mL, 15 mL) NONFORMULARY LevOCARNitine Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Prevymis: 240 mg, 480 mg UNIFORM FORMULARY Letrozole Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 250 mg UNIFORM FORMULARY Capsule, Oral [preservative free]: Tablet, Oral: Generic: 250 mg Generic: 2.5 mg Solution, Intravenous: Carnitor: 200 mg/mL (5 mL) Leucovorin Calcium Solution, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 200 mg/mL (5 mL) UNIFORM FORMULARY Solution, Oral: Solution Reconstituted, Injection [strength expressed as base]: Generic: 1 g/10 mL (118 mL) Generic: 100 mg (1 ea); 200 mg (1 ea); 350 mg (1 ea); 500 mg (1 ea) Tablet, Oral: Solution Reconstituted, Injection [strength expressed as base, preservative Generic: 250 mg, 330 mg free]: Generic: 50 mg (1 ea); 100 mg (1 ea); 200 mg (1 ea); 350 mg (1 ea) Levodopa, Carbidopa, and Entacapone Tablet, Oral [strength expressed as base]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 5 mg, 10 mg, 15 mg, 25 mg UNIFORM FORMULARY Tablet, Oral: Leuprolide Generic: Levodopa 50 mg, carbidopa 12.5 mg, and entacapone 200 mg DoD Uniform Formulary Outpatient Dosage Forms Generic: Levodopa 75 mg, carbidopa 18.75 mg, and entacapone 200 mg UNIFORM FORMULARY Generic: Levodopa 100 mg, carbidopa 25 mg, and entacapone 200 mg Kit, Injection, as acetate: Generic: Levodopa 125 mg, carbidopa 31.25 mg, and entacapone 200 mg Generic: 1 mg/0.2 mL Generic: Levodopa 150 mg, carbidopa 37.5 mg, and entacapone 200 mg Kit, Intramuscular, as acetate: Generic: Levodopa 200 mg, carbidopa 50 mg, and entacapone 200 mg Lupron Depot (1-Month): 7.5 mg [latex free; contains polysorbate 80] Lupron Depot (6-Month): 45 mg [latex free; contains polysorbate 80] Levodopa (Oral Inhalation) Kit, Intramuscular, as acetate [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Lupron Depot (1-Month): 3.75 mg [latex free; contains polysorbate 80] UNIFORM FORMULARY Lupron Depot (3-Month): 11.25 mg, 22.5 mg [latex free; contains polysor- Capsule, Inhalation: bate 80] Inbrija: 42 mg per inhalation Lupron Depot (4-Month): 30 mg [latex free; contains polysorbate 80] Lupron Depot-Ped (1-Month): 7.5 mg, 11.25 mg, 15 mg [latex free; contains LevoFLOXacin (Ophthalmic) polysorbate 80] DoD Uniform Formulary Outpatient Dosage Forms Lupron Depot-Ped (3-Month): 30 mg (Ped), 11.25 mg (Ped) [latex free; UNIFORM FORMULARY contains polysorbate 80] Solution, Ophthalmic: Kit, Subcutaneous, as acetate: Generic: 0.5% (5 mL) Eligard: 7.5 mg, 22.5 mg, 30 mg, 45 mg LevoFLOXacin (Systemic) Leuprolide and Norethindrone DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY UNIFORM FORMULARY Solution, Oral: Kit, Combination: Generic: 25 mg/mL (100 mL, 200 mL, 480 mL) Lupaneta Pack: 1-month kit: leuprolide acetate 3.75 mg depot suspension for Tablet, Oral: injection (1) and norethindrone acetate 5 mg oral tablets (30), 3-month kit: Generic: 250 mg, 500 mg, 750 mg leuprolide acetate 11.25 mg depot suspension for injection (1) and norethin- drone acetate 5 mg oral tablets (90) [contains polysorbate 80] UNIFORM FORMULARY Solution, Intravenous: Levalbuterol Generic: 250 mg/50 mL (50 mL); 500 mg/100 mL (100 mL); 750 mg/150 mL DoD Uniform Formulary Outpatient Dosage Forms (150 mL) UNIFORM FORMULARY Solution, Intravenous [preservative free]: Aerosol, Inhalation, as tartrate [strength expressed as base]: Generic: 250 mg/50 mL (50 mL); 500 mg/100 mL (100 mL); 750 mg/150 mL Generic: 45 mcg/actuation (15 g) (150 mL); 25 mg/mL (20 mL, 30 mL) Nebulization Solution, Inhalation, as hydrochloride [strength expressed as base]: LEVOleucovorin Generic: 0.63 mg/3 mL (3 mL) DoD Uniform Formulary Outpatient Dosage Forms Nebulization Solution, Inhalation, as hydrochloride [strength expressed as base, UNIFORM FORMULARY preservative free]: Solution, Intravenous: Generic: 0.31 mg/3 mL (3 mL); 0.63 mg/3 mL (3 mL); 1.25 mg/3 mL (3 mL); Generic: 175 mg/17.5 mL (17.5 mL) 1.25 mg/0.5 mL (1 ea, 30 ea) Solution, Intravenous [preservative free]: NONFORMULARY Generic: 175 mg/17.5 mL (17.5 mL); 250 mg/25 mL (25 mL) Aerosol, Inhalation, as tartrate [strength expressed as base]: Solution Reconstituted, Intravenous: Xopenex HFA: 45 mcg/actuation (15 g) Generic: 50 mg (1 ea) Solution Reconstituted, Intravenous [preservative free]: LevETIRAcetam Generic: 175 mg (1 ea) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Levonorgestrel (IUD) Solution, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Generic: 500 mg/100 mL (100 mL); 1000 mg/100 mL (100 mL); 1500 mg/100 UNIFORM FORMULARY mL (100 mL); 500 mg/5 mL (5 mL) Intrauterine Device, Intrauterine: Solution, Intravenous [preservative free]: Kyleena: 19.5 mg Generic: 500 mg/5 mL (5 mL) Liletta (52 MG): 18.6 mcg/day Solution, Oral: Mirena (52 MG): 20 mcg/24 hr Generic: 100 mg/mL (5 mL, 473 mL, 500 mL) Skyla: 13.5 mg Tablet, Oral: Generic: 250 mg, 500 mg, 750 mg, 1000 mg Levonorgestrel (Systemic) Tablet Disintegrating Soluble, Oral: DoD Uniform Formulary Outpatient Dosage Forms Spritam: 250 mg, 500 mg, 750 mg, 1000 mg [spearmint flavor] BASIC CORE FORMULARY Tablet Extended Release 24 Hour, Oral: Tablet, Oral: Generic: 500 mg, 750 mg Generic: 1.5 mg 70 LIDOCAINE (OPHTHALMIC) UNIFORM FORMULARY Lidocaine and Menthol Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Aftera: 1.5 mg UNIFORM FORMULARY EContra EZ: 1.5 mg Cream, External: Fallback Solo: 1.5 mg LevigoLT: Lidocaine 4% and menthol 1% (76.5 g) [paraben free; contains My Way: 1.5 mg cetearyl alcohol, disodium edta] Next Choice One Dose: 1.5 mg Synvexia TC: Lidocaine 4% and menthol 1% (60 g) [contains cetyl alcohol, Opcicon One-Step: 1.5 mg naproxen, trolamine salicylate] React: 1.5 mg [contains corn starch] Gel, External: Take Action: 1.5 mg LenzaGel: Lidocaine 4% and menthol 1% (120 g) [ Levorphanol Kit, External: DoD Uniform Formulary Outpatient Dosage Forms Mentho-Caine: Lidocaine 5% and menthol 8% Liquid, External: UNIFORM FORMULARY Mentholix: Lidocaine 4% and menthol 1% (120 mL [DSC]) [contains propylene Tablet, Oral, as tartrate: glycol] Generic: 2 mg 1st Relief Spray: Lidocaine 4% and menthol 1% (118 mL) [contains sodium Levothyroxine benzoate] DoD Uniform Formulary Outpatient Dosage Forms Patch, External: BASIC CORE FORMULARY AvaLin: Lidocaine 4% and menthol 1% (15 ea) [contains polysorbate 80] Tablet, Oral, as sodium: Endoxcin: Lidocaine 4% and menthol 1% (15 ea, 30 ea) Generic (Euthyrox, Synthroid, Levothroid, Levoxyl): 25 mcg, 50 mcg, 75 mcg, LenzaPatch: Lidocaine 4% and menthol 1% (5 ea) 88 mcg, 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, Lidenza: Lidocaine 4% and menthol 1% (15 ea) [ 300 mcg LidoPatch Pain Relief: Lidocaine 3.99 % and menthol 1.25% (3 ea) Lidothol: Lidocaine 4.5% and menthol 5% (1 ea, 15 ea) [contains polysor- UNIFORM FORMULARY bate 80] Capsule, Oral, as sodium: LidozenPatch: Lidocaine 4% and menthol 1% (5 ea) Tirosint: 13 mcg, 25 mcg, 50 mcg, 75 mcg, 88 mcg, 100 mcg, 112 mcg, 125 Limencin: Lidocaine 4% and menthol 4% (10 ea) mcg, 137 mcg, 150 mcg Lorenza: Lidocaine 4% and menthol 1% (15 ea) [contains edetate disodium] Solution, Oral, as sodium: MaL Patch: Lidocaine 4% and menthol 5% (15 ea) Tirosint-SOL: 13 mcg/mL (1 mL); 25 mcg/mL (1 mL); 50 mcg/mL (1 mL); 75 Prolida: Lidocaine 4% and menthol 1% (15 ea) [contains polysorbate 80] mcg/mL (1 mL); 88 mcg/mL (1 mL); 100 mcg/mL (1 mL); 112 mcg/mL (1 mL); Releevia ML: Lidocaine 4% and menthol 1% (15 ea) 125 mcg/mL (1 mL); 137 mcg/mL (1 mL); 150 mcg/mL (1 mL); 175 mcg/mL (1 Siterol: Lidocaine 3.99% and menthol 1% (15 ea) mL); 200 mcg/mL (1 mL) Synvexia: Lidocaine 4% and menthol 1% (5 ea, 10 ea, 15 ea, 30 ea) [contains Solution Reconstituted, Intravenous, as sodium [preservative free]: disodium edta, polysorbate 80] Generic: 100 mcg (1 ea); 200 mcg (1 ea); 500 mcg (1 ea) Terocin: Lidocaine 4% and menthol 4% (10 ea) NONFORMULARY Venia: Lidocaine 4% and menthol 4% (10 ea) [contains polysorbate 80] Tablet, Oral, as sodium: Zeruvia: Lidocaine 4% and menthol 1% (15 ea, 30 ea) [contains disodium Unithroid: 25 mcg, 50 mcg, 75 mcg, 88 mcg, 100 mcg, 112 mcg, 125 mcg, 150 edta, polysorbate 80] mcg, 175 mcg, 200 mcg, 300 mcg Lidocaine and Prilocaine Lidocaine and Epinephrine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Cream, External: Solution, Injection: AgonEaze: Lidocaine 2.5% and prilocaine 2.5% (2 x 30 g) [packaged with Generic: occlusive dressing] 0.5% / 1:200,000: Lidocaine hydrochloride 0.5% [5 mg/mL] and epinephrine Anodyne LPT: Lidocaine 2.5% and prilocaine 2.5% (3 x 30 g) [packaged with 1:200,000 (50 mL) occlusive dressing] 1% / 1:100,000: Lidocaine hydrochloride 1% [10 mg/mL] and epinephrine DermacinRx Empricaine: Lidocaine 2.5% and prilocaine 2.5% (1 x 30 g) 1:100,000 (20 mL, 30 mL, 50 mL) [packaged with occlusive dressing] 2% / 1:100,000: Lidocaine hydrochloride 2% [20 mg/mL] and epinephrine DermacinRx Prizopak: Lidocaine 2.5% and prilocaine 2.5% (3 x 30 g) [pack- 1:100,000 (30 mL, 50 mL) aged with occlusive dressing] Solution, Injection [preservative free]: Leva Set: Lidocaine 2.5% and prilocaine 2.5% (3 x 30 g) [packaged with Xylocaine-MPF with Epinephrine: occlusive dressing] 1% / 1:200,000: Lidocaine hydrochloride 1% [10 mg/mL] and epinephrine Lidopril: Lidocaine 2.5% and prilocaine 2.5% (3 x 30 g) [packaged with 1:200,000 (5 mL, 10 mL, 30 mL) [contains sodium metabisulfite] occlusive dressing] Generic: Lidopril XR: Lidocaine 2.5% and prilocaine 2.5% (2 x 30 g) [packaged with 1.5% / 1:200,000: Lidocaine hydrochloride 1.5% [15 mg/mL] and epinephrine occlusive dressing] 1:200,000 (5 mL, 30 mL) LiProZonePak: Lidocaine 2.5% and prilocaine 2.5% (3 x 30 g) [packaged with 2% / 1:200,000: Lidocaine hydrochloride 2% [20 mg/mL] and epinephrine occlusive dressing] 1:200,000 (20 mL) Livixil Pak: Lidocaine 2.5% and prilocaine 2.5% (3 x 30 g) [packaged with Solution, Injection [for dental use]: occlusive dressing] Generic: LP Lite Pak: Lidocaine 2.5% and prilocaine 2.5% (2 x 30 g) [packaged with 2% / 1:50,000: Lidocaine hydrochloride 2% [20 mg/mL] and epinephrine occlusive dressing] 1:50,000 (1.7 mL, 1.8 mL) Medolor Pak: Lidocaine 2.5% and prilocaine 2.5% (3 x 30 g) [packaged with 2% / 1:100,000: Lidocaine hydrochloride 2% [20 mg/mL] and epinephrine occlusive dressing] 1:100,000 (1.7 mL, 1.8 mL) Prilolid: Lidocaine 2.5% and prilocaine 2.5% (1 x 30 g) [packaged with occlusive dressing] Lidocaine and Hydrocortisone Relador Pak: Lidocaine 2.5% and prilocaine 2.5% (3 x 30 g) [packaged with DoD Uniform Formulary Outpatient Dosage Forms occlusive dressing] UNIFORM FORMULARY Venipuncture CPI: Lidocaine 2.5% and prilocaine 2.5% (5 g) Cream, Rectal: Generic: Lidocaine 2.5% and prilocaine 2.5% (5 g, 30 g, 5800 g, 18,000 g) Lidocaine 2% and hydrocortisone 2% (7 g) Gel, periodontal: Lidocaine hydrochloride 3% and hydrocortisone acetate 0.5% (7 g) Oraqix: Lidocaine 2.5% and prilocaine 2.5% (1.7 g) Lidocaine hydrochloride 3% and hydrocortisone acetate 1% (7 g) Cream, External: Lidocaine and Tetracaine LidaMantle HC: Lidocaine hydrochloride 3% and hydrocortisone acetate DoD Uniform Formulary Outpatient Dosage Forms 0.5% (85 g) UNIFORM FORMULARY Gel, Rectal: Cream, external: Lidocaine hydrochloride 3% and hydrocortisone acetate 2.5% (7 g) Generic: Lidocaine 7% and tetracaine 7% (30 g) RectaGel HC: Lidocaine hydrochloride 2.8% and hydrocortisone acetate Patch, transdermal: 0.55% (20 g) [contains propylene glycol; kit contains 5 tubes (20 g each) Synera: Lidocaine 70 mg and tetracaine 70 mg (10s) [contains heating and 15 single-use applicators] component, metal; each patch is ~50 cm2] Lotion, External: LidaMantle HC: Lidocaine hydrochloride 3% and hydrocortisone acetate 0.5% Lidocaine (Ophthalmic) (177 mL) DoD Uniform Formulary Outpatient Dosage Forms Pad, External: UNIFORM FORMULARY LidaMantle HC Relief Pad: Lidocaine hydrochloride 2% and hydrocortisone Gel, Ophthalmic, as hydrochloride [preservative free]: acetate 2% (60s) [6 mL solution/pad] Akten: 3.5% (1 mL) 71 LIDOCAINE (SYSTEMIC) Lidocaine (Systemic) Solution, Ophthalmic: DoD Uniform Formulary Outpatient Dosage Forms Xiidra: 5% (5 ea) UNIFORM FORMULARY LinaCLOtide Kit, Injection, as hydrochloride: ReadySharp Lidocaine: 1% DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection, as hydrochloride: UNIFORM FORMULARY Generic: 0.5% (50 mL); 1% (2 mL, 10 mL, 20 mL, 50 mL); 2% (2 mL, 20 mL, Capsule, Oral: 50 mL) Linzess: 72 mcg, 145 mcg, 290 mcg Solution, Injection, as hydrochloride [preservative free]: LinaGLIPtin Generic: 0.5% (50 mL); 1% (2 mL, 5 mL, 30 mL); 1.5% (20 mL); 2% (2 mL, 5 mL, 10 mL); 4% (5 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous, as hydrochloride: UNIFORM FORMULARY Generic: 0.4% [4 mg/mL] (250 mL, 500 mL); 0.8% [8 mg/mL] (250 mL); 1% Tablet, Oral: [10 mg/mL] (5 mL); 2% [20 mg/mL] (5 mL); 5% [50 mg/mL] (2 mL) Tradjenta: 5 mg Solution, Intravenous, as hydrochloride [preservative free]: Linagliptin and Metformin Generic: 1% [10 mg/mL] (5 mL); 2% [20 mg/mL] (5 mL) DoD Uniform Formulary Outpatient Dosage Forms Lidocaine (Topical) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: Jentadueto 2.5/500: Linagliptin 2.5 mg and metformin hydrochloride 500 mg BASIC CORE FORMULARY Jentadueto 2.5/850: Linagliptin 2.5 mg and metformin hydrochloride 850 mg Patch, External: Jentadueto 2.5/1000: Linagliptin 2.5 mg and metformin hydrochloride Generic: 5% (1 ea, 15 ea, 30 ea) 1000 mg UNIFORM FORMULARY Tablet Extended Release, Oral: Cream, External: Jentadueto XR 2.5/1000: Linagliptin 2.5 mg and metformin hydrochloride Lidotral: 3.88% (85 g) [contains cetearyl alcohol, methylparaben, propylene 1000 mg glycol, propylparaben] Jentadueto XR 5/1000: Linagliptin 5 mg and metformin hydrochloride Lidovin: 3.95% (60 g) [contains peg-40 castor oil] 1000 mg Lidozol: 3.75% (60 g) [contains peg-40 castor oil] Generic: 5% (15 g, 30 g) Lincomycin Cream, External, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms CidalEaze: 3% (453.6 g) [contains aluminum sulfate, calcium acetate, cetyl UNIFORM FORMULARY alcohol, methylparaben, propylparaben] Solution, Injection, as hydrochloride: EnovaRX-Lidocaine HCl: 5% (60 g, 120 g); 10% (60 g, 120 g) [contains cetyl Lincocin: 300 mg/mL (2 mL, 10 mL) [contains benzyl alcohol] alcohol] Generic: 300 mg/mL (2 mL, 10 mL) Lidopin: 3% (28 g, 85 g); 3.25% (28 g, 85 g) [contains cetyl alcohol, methyl- paraben, propylparaben] Lindane Xolido: 2% (118 mL) [contains methylisothiazolinone] DoD Uniform Formulary Outpatient Dosage Forms Generic: 3% (28.3 g, 28.35 g, 85 g) UNIFORM FORMULARY Gel, External: Shampoo, External: Topicaine 5: 5% (10 g, 30 g, 113 g) [contains benzyl alcohol, disodium edta] Generic: 1% (60 mL) Generic: 2% (5 mL, 20 mL, 30 mL) Gel, External, as hydrochloride [preservative free]: Linezolid Glydo: 2% (6 mL, 11 mL) [pvc free] DoD Uniform Formulary Outpatient Dosage Forms Generic: 2% (5 mL, 10 mL) UNIFORM FORMULARY Jet-injector, Intradermal, as hydrochloride: Solution, Intravenous: Zingo: 0.5 mg (1 ea) Generic: 2 mg/mL (300 mL); 600 mg/300 mL (300 mL) Kit, External: Suspension Reconstituted, Oral: Lidopac: 5% [contains polyethylene glycol] Generic: 100 mg/5 mL (150 mL) Lidotrans 5 Pak: 5% [contains polyethylene glycol] Tablet, Oral: Xryliderm: 5% [contains edetate disodium, methylparaben, propylene glycol, Generic: 600 mg propylparaben] Zeyocaine: 5% Liothyronine Generic: 4% DoD Uniform Formulary Outpatient Dosage Forms Kit, External, as hydrochloride: UNIFORM FORMULARY Venipuncture Px1 Phlebotomy: 2% [latex free; contains methylparaben, Solution, Intravenous: propylparaben] Generic: 10 mcg/mL (1 mL) Lotion, External, as hydrochloride: Tablet, Oral: Anastia: 2.75% (15 g) [contains cetyl alcohol, methylparaben, propylparaben] Generic: 5 mcg, 25 mcg, 50 mcg Eha: 4% (88 mL) [contains methylisothiazolinone] Numbonex: 2.75% (30 g) [contains cetyl alcohol, methylparaben, propyl- Liotrix paraben] DoD Uniform Formulary Outpatient Dosage Forms Generic: 3% (118 mL, 177 mL) UNIFORM FORMULARY Ointment, External: Tablet, Oral: Generic: 5% (30 g, 35.44 g, 50 g, 2500 g) Thyrolar: 1/4 [levothyroxine sodium 12.5 mcg and liothyronine sodium 3.1 mcg] Solution, External, as hydrochloride: Thyrolar: 1/2 [levothyroxine sodium 25 mcg and liothyronine sodium 6.25 mcg] Generic: 4% (50 mL) Thyrolar: 1 [levothyroxine sodium 50 mcg and liothyronine sodium 12.5 mcg] Solution, Mouth/Throat, as hydrochloride: Thyrolar: 2 [levothyroxine sodium 100 mcg and liothyronine sodium 25 mcg] Generic: 2% (15 mL, 100 mL) Thyrolar: 3 [levothyroxine sodium 150 mcg and liothyronine sodium 37.5 mcg] Solution, Mouth/Throat, as hydrochloride [preservative free]: Generic: 4% (4 mL) Lisdexamfetamine NONFORMULARY DoD Uniform Formulary Outpatient Dosage Forms Patch, External: UNIFORM FORMULARY ZTlido: 1.8% (1 ea, 30 ea) Capsule, Oral, as dimesylate: Vyvanse: 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg NOT COVERED Tablet Chewable, Oral, as dimesylate: Cream, External: Vyvanse: 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg Lidovex: 3.75% (60 g) [contains cetyl alcohol, methylparaben, propylparaben] Xolido XP: 4% (118 mL) [contains methylisothiazolinone] Lisinopril Generic: 4% (5 g, 15 g, 30 g, 120 g) DoD Uniform Formulary Outpatient Dosage Forms Gel, External, as hydrochloride: BASIC CORE FORMULARY LidoRx: 3% (10 mL, 30 mL, 90 mL) [contains isopropyl alcohol, trolamine Tablet, Oral: (triethanolamine)] Generic: 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg Astero: 4% (30 mL) LDO Plus: 4% (30 mL) NONFORMULARY Solution, Oral: Lifitegrast Qbrelis: 1 mg/mL (150 mL) [contains sodium benzoate] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY 72 LOTEPREDNOL Lisinopril and Hydrochlorothiazide Loratadine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY UNIFORM FORMULARY Tablet, Oral: Capsule, Oral: Generic: 10/12.5: Lisinopril 10 mg and hydrochlorothiazide 12.5 mg Generic: 10 mg Generic: 20/12.5: Lisinopril 20 mg and hydrochlorothiazide 12.5 mg Solution, Oral: Generic: 20/25: Lisinopril 20 mg and hydrochlorothiazide 25 mg Childrens Loratadine: 5 mg/5 mL (120 mL) [alcohol free, dye free, sugar free; contains propylene glycol, sodium benzoate; grape flavor] Lisocabtagene Maraleucel Loratadine Childrens: 5 mg/5 mL (120 mL) [alcohol free, dye free, sugar free; DoD Uniform Formulary Outpatient Dosage Forms contains propylene glycol, sodium benzoate; fruit flavor] NOT COVERED Loratadine Hives Relief: 5 mg/5 mL (120 mL) [alcohol free, dye free, sugar Suspension, Intravenous: free; contains propylene glycol, sodium benzoate; grape flavor] Breyanzi: (1 ea) [contains albumin human] Syrup, Oral: Allergy Relief For Kids: 5 mg/5 mL (120 mL) [contains propylene glycol, Lithium sodium benzoate; fruit flavor] DoD Uniform Formulary Outpatient Dosage Forms Childrens Loratadine: 5 mg/5 mL (120 mL) [fruit flavor] BASIC CORE FORMULARY Childrens Loratadine: 5 mg/5 mL (120 mL) [alcohol free, dye free; contains Capsule, Oral, as carbonate: propylene glycol, sodium benzoate, sodium metabisulfite; grape flavor] Generic: 150 mg, 300 mg Claritin: 5 mg/5 mL (60 mL, 120 mL, 150 mL) [alcohol free, color free, dye free, Solution, Oral, as citrate: sugar free; contains edetate disodium, propylene glycol, sodium benzoate; Generic: 8 mEq/5 mL (500 mL) grape flavor] UNIFORM FORMULARY Loratadine Childrens: 5 mg/5 mL (120 mL) [sugar free; contains polyethylene Tablet, Oral, as carbonate: glycol, propylene glycol, sodium benzoate, sodium metabisulfite; grape Generic: 300 mg flavor] Tablet Extended Release, Oral, as carbonate: Tablet, Oral: Generic: 300 mg, 450 mg Generic: 10 mg Tablet Chewable, Oral: L-Lysine Claritin: 5 mg [contains aspartame; grape flavor] DoD Uniform Formulary Outpatient Dosage Forms Claritin Childrens: 5 mg [contains aspartame] UNIFORM FORMULARY Tablet Dispersible, Oral: Capsule, Oral: Alavert: 10 mg [contains aspartame] Generic: 500 mg Allergy Relief: 10 mg [contains aspartame; fruit flavor] Packet, Oral: Claritin Reditabs: 5 mg, 10 mg Lysine4000: 4000 mg (30 ea) Triaminic Allerchews: 10 mg Tablet, Oral: Loratadine and Pseudoephedrine Generic: 500 mg, 1000 mg DoD Uniform Formulary Outpatient Dosage Forms Lodoxamide UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Extended Release: UNIFORM FORMULARY Generic: Loratadine 5 mg and pseudoephedrine sulfate 120 mg Solution, Ophthalmic: Generic: Loratadine 10 mg and pseudoephedrine sulfate 240 mg Alomide: 0.1% (10 mL) LORazepam Lomitapide DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Concentrate, Oral: Capsule, Oral: Generic: 2 mg/mL (30 mL) Juxtapid: 5 mg, 10 mg, 20 mg, 30 mg, 40 mg, 60 mg Tablet, Oral: Generic: 0.5 mg, 1 mg, 2 mg Lomustine NONFORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection: UNIFORM FORMULARY Generic: 2 mg/mL (1 mL, 10 mL); 4 mg/mL (1 mL, 10 mL) Capsule, Oral: Gleostine: 5 mg, 10 mg, 40 mg, 100 mg Lorlatinib DoD Uniform Formulary Outpatient Dosage Forms Loperamide UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: BASIC CORE FORMULARY Lorbrena: 25 mg, 100 mg Capsule, Oral, as hydrochloride: Generic: 2 mg Losartan DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Liquid, Oral, as hydrochloride: Tablet, Oral, as potassium: Generic: 1 mg/5 mL (5 mL, 10 mL, 118 mL) Generic: 25 mg, 50 mg, 100 mg Suspension, Oral, as hydrochloride: Generic: 1 mg/7.5 mL (120 mL) Losartan and Hydrochlorothiazide Tablet, Oral, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Anti-Diarrheal: 2 mg BASIC CORE FORMULARY Diamode: 2 mg Tablet, Oral: Imodium A-D: 2 mg Generic: 50/12.5: Losartan potassium 50 mg and hydrochlorothiazide 12.5 mg Loperamide A-D: 2 mg Generic: 100/12.5: Losartan potassium 100 mg and hydrochlorothiazide 12.5 mg Loperamide and Simethicone Generic: 100/25: Losartan potassium 100 mg and hydrochlorothiazide 25 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Loteprednol Caplet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Imodium Multi-Symptom Relief: Loperamide hydrochloride 2 mg and simethi- UNIFORM FORMULARY cone 125 mg [contains calcium 65 mg/caplet, sodium 4 mg/caplet] Gel, Ophthalmic, as etabonate: Lotemax: 0.5% (5 g) [contains benzalkonium chloride, edetate disodium Lopinavir and Ritonavir dihydrate, propylene glycol] DoD Uniform Formulary Outpatient Dosage Forms Ointment, Ophthalmic, as etabonate: UNIFORM FORMULARY Lotemax: 0.5% (3.5 g) Solution, Oral: Suspension, Ophthalmic, as etabonate: Kaletra: Lopinavir 80 mg and ritonavir 20 mg per 1 mL (160 mL) [contains Alrex: 0.2% (5 mL, 10 mL) ethanol 42.4%, menthol, propylene glycol; cotton candy flavor]] Lotemax: 0.5% (5 mL, 10 mL, 15 mL) Tablet, Oral: NONFORMULARY Kaletra: Gel, Ophthalmic, as etabonate: Lopinavir 100 mg and ritonavir 25 mg Lotemax SM: 0.38% (5 g) [contains benzalkonium chloride, edetate disodium Lopinavir 200 mg and ritonavir 50 mg dihydrate, propylene glycol] 73 LOTEPREDNOL AND TOBRAMYCIN Loteprednol and Tobramycin Packet, External, as acetate: DoD Uniform Formulary Outpatient Dosage Forms Sulfamylon: 50 g (1 ea, 5 ea) UNIFORM FORMULARY Magnesium L-aspartate Hydrochloride Suspension, Ophthalmic [drops]: Zylet: Loteprednol etabonate 0.5% and tobramycin 0.3% (2.5 mL, 5 mL, 10 DoD Uniform Formulary Outpatient Dosage Forms mL) [contains benzalkonium chloride] UNIFORM FORMULARY Granules for solution, oral [preservative free]: Lovastatin Maginex DS: 1230 mg/packet (30s) [sugar free; lemon flavor; equivalent to DoD Uniform Formulary Outpatient Dosage Forms elemental magnesium 122 mg] UNIFORM FORMULARY Tablet, enteric coated, oral [preservative free]: Tablet, Oral: Maginex: 615 mg [sugar free; equivalent to elemental magnesium 61 mg] Generic: 10 mg, 20 mg, 40 mg NONFORMULARY Magnesium L-lactate Tablet Extended Release 24 Hour, Oral: DoD Uniform Formulary Outpatient Dosage Forms Altoprev: 20 mg, 40 mg, 60 mg [contains corn starch] UNIFORM FORMULARY Tablet Extended Release, Oral: Loxapine Mag-Tab SR: Elemental magnesium 84 mg [7 mEq] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Magnesium Carbonate Aerosol Powder Breath Activated, Inhalation [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Adasuve: 10 mg (1 ea) UNIFORM FORMULARY Capsule, Oral: Liquid, Oral: Generic: 5 mg, 10 mg, 25 mg, 50 mg Magonate: Elemental magnesium 54 mg/5 mL (355 mL) [contains sodium benzoate; mixed melon flavor] Lubiprostone Powder, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: Elemental magnesium 250 mg/g (480 g) UNIFORM FORMULARY Capsule, Oral: Magnesium Carbonate, Calcium Carbonate, and Folic Acid Amitiza: 8 mcg, 24 mcg DoD Uniform Formulary Outpatient Dosage Forms Lucinactant UNIFORM FORMULARY Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms MagneBind 400: Magnesium carbonate 400 mg, calcium carbonate 200 mg, UNIFORM FORMULARY and folic acid 1 mg Suspension, Intratracheal: Surfaxin: 30 mg/mL (8.5 mL [DSC]) Magnesium Chloride Luliconazole DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Injection, as hexahydrate: Cream, External: Generic: 200 mg/mL (50 mL) Luzu: 1% (60 g) [contains benzyl alcohol, methylparaben, propylene glycol] Tablet Delayed Release, Oral: Mag-SR Plus Calcium: 535 mg (elemental magnesium 64 mg, plus calcium Lumacaftor and Ivacaftor 106 mg) [starch free, sugar free] DoD Uniform Formulary Outpatient Dosage Forms Magdelay: Elemental magnesium 70 mg (plus calcium 118 mg) UNIFORM FORMULARY Nu-Mag: Elemental magnesium 71.5 mg (plus calcium 119 mg) Packet, Oral: Slow Magnesium/Calcium: 535 mg (elemental magnesium 64 mg, plus cal- Orkambi: Lumacaftor 100 mg and ivacaftor 125 mg (56 ea); Lumacaftor cium 106 mg) 150 mg and ivacaftor 188 mg (56 ea) Slow-Mag: Elemental magnesium 71.5 mg (plus calcium 119 mg) Tablet, Oral: Orkambi: Lumacaftor 200 mg and ivacaftor 125 mg Magnesium Citrate Orkambi: Lumacaftor 100 mg and ivacaftor 125 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Lumasiran Solution, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 1.745 g/30 mL (296 mL) NOT COVERED Tablet, Oral: Solution, Subcutaneous, as sodium [preservative free]: Generic: 100 mg Oxlumo: 94.5 mg/0.5 mL (0.5 mL) Magnesium Gluconate Lurasidone DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Liquid, Oral: Tablet, Oral, as hydrochloride: Magonate: Magnesium carbonate equivalent to magnesium gluconate Latuda: 20 mg, 40 mg, 60 mg, 80 mg, 120 mg 1000 mg (54 mg elemental magnesium) per 5 mL (355 mL) [contains sodium Luspatercept benzoate; mixed melon flavor] DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: Generic: Elemental magnesium 27.5 mg NOT COVERED Tablet, Oral [preservative free]: Solution Reconstituted, Subcutaneous [preservative free]: Generic: 500 mg (27 mg elemental magnesium) Reblozyl: luspatercept-aamt 25 mg (1 ea); luspatercept-aamt 75 mg (1 ea) [contains polysorbate 80] Magnesium Hydroxide DoD Uniform Formulary Outpatient Dosage Forms Lusutrombopag UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Suspension, Oral: UNIFORM FORMULARY Dulcolax Milk of Magnesia: 400 mg/5 mL (355 mL) [sugar free] Tablet, Oral: Milk of Magnesia: 400 mg/5 mL (355 mL, 473 mL, 480 mL, 769 mL); 1200 mg/ Mulpleta: 3 mg 15 mL (355 mL) Macitentan Milk of Magnesia: 7.75% (360 mL, 480 mL) DoD Uniform Formulary Outpatient Dosage Forms Milk of Magnesia Concentrate: 2400 mg/10 mL (100 mL, 400 mL) UNIFORM FORMULARY Tablet Chewable, Oral: Tablet, Oral: Pedia-Lax: 400 mg [scored; stimulant free; watermelon flavor] Opsumit: 10 mg [contains soybean lecithin] Magnesium Hydroxide and Mineral Oil Mafenide DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Suspension, oral: Cream, External, as acetate [strength expressed as base]: Phillips' M-O: Magnesium hydroxide 300 mg and mineral oil 1.25 mL per 5 mL Sulfamylon: 85 mg/g (56.7 g, 113.4 g, 453.6 g) [contains methylparaben, (360 mL, 780 mL) [contains magnesium 125 mg and sodium 1.5 mg per 5 propylparaben, sodium metabisulfite] mL mint flavors] 74 MEDROXYPROGESTERONE Magnesium Oxide Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Selzentry: 25 mg, 75 mg, 150 mg, 300 mg [contains soybean lecithin] UNIFORM FORMULARY Measles, Mumps, and Rubella Virus Vaccine Capsule, Oral: Uro-Mag: 140 mg DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 400 mg, 420 mg, 400 mg Injection, powder for reconstitution [preservative free]: Tablet, Oral [preservative free]: M-M-R II: Measles virus ≥1000 TCID50, mumps virus ≥20,000 TCID50, and Generic: 400 mg, 500 mg rubella virus ≥1000 TCID50 [contains albumin (human), bovine serum, chicken egg protein, gelatin, neomycin, sorbitol, and sucrose 1.9 mg/vial; NONFORMULARY supplied with diluent] Packet, Oral: Magnesium Oxide 400: 240 mg (80 ea) Measles, Mumps, Rubella, and Varicella Virus Vaccine DoD Uniform Formulary Outpatient Dosage Forms Magnesium Salicylate UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Injection, powder for reconstitution [preservative free]: UNIFORM FORMULARY ProQuad: Measles virus ≥3.00 log10 TCID50, mumps virus ≥4.3 log10 TCID50, Tablet, Oral: rubella virus ≥3.00 log10 TCID50, and varicella virus ≥3.99 log10 PFU Doans Pills: 325 mg [contains albumin (human), bovine serum, chicken egg protein, gelatin, Tablet, Oral, as tetrahydrate: neomycin, sorbitol, and sucrose (≤21 mg/vial)] Doans Extra Strength: 580 mg ProQuad: Measles virus ≥3.00 log10 TCID50, mumps virus ≥4.3 log10 TCID50, Magnesium Sulfate rubella virus ≥3.00 log10 TCID50, and varicella virus ≥3.99 log10 PFU DoD Uniform Formulary Outpatient Dosage Forms [contains recombinant albumin (human), bovine serum, chicken egg protein, UNIFORM FORMULARY gelatin, neomycin, sorbitol, and sucrose (≤21 mg/vial)] Capsule, Oral: Mebendazole Generic: 70 mg DoD Uniform Formulary Outpatient Dosage Forms Granules, Oral: UNIFORM FORMULARY Epsom Salt: (454 g, 1810 g) Tablet Chewable, Oral: GoodSense Epsom Salt: (1810 g) Solution, Injection: Emverm: 100 mg [contains saccharin sodium] Generic: 50% (2 mL, 10 mL, 20 mL) Mecamylamine Solution, Injection [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 50% (20 mL, 50 mL) UNIFORM FORMULARY Solution, Intravenous: Tablet, Oral, as hydrochloride: Generic: 1 g/100 mL (100 mL); 2 g/50 mL (50 mL); 4 g/100 mL (100 mL); 4 g/ Vecamyl: 2.5 mg 50 mL (50 mL); 20 g/500 mL (500 mL); 40 g/1000 mL (1000 mL) Malathion Mecasermin DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Lotion, External: Solution, Subcutaneous: Generic: 0.5% (59 mL) Increlex: 40 mg/4 mL (4 mL) [contains benzyl alcohol] Maltodextrin Mechlorethamine (Systemic) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Gel, topical: Solution Reconstituted, Injection, as hydrochloride: Multidex: (7.1 mL, 14.2 mL, 85.2 mL) Mustargen: 10 mg (1 ea) Powder, topical: Mechlorethamine (Topical) Multidex: (6 g, 12 g, 25 g, 45 g) DoD Uniform Formulary Outpatient Dosage Forms Manganese UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Gel, External: UNIFORM FORMULARY Valchlor: 0.016% (60 g) [contains edetate disodium, isopropyl alcohol, men- Capsule, Oral, as chelated: thol, propylene glycol] MN-50: Elemental manganese 16.67 mg Solution, Intravenous, as chloride: Meclizine Generic: Elemental manganese 0.1 mg/mL (10 mL) DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral, as aspartate: UNIFORM FORMULARY Generic: 93 mg [elemental manganese 25 mg] Tablet, Oral, as hydrochloride: Tablet, Oral, as chelated: Generic: 12.5 mg, 25 mg Mangimin: Elemental manganese 10 mg [corn free, rye free, wheat free] Tablet Chewable, Oral, as hydrochloride: Generic: Elemental manganese 15 mg, Elemental manganese 50 mg Generic: 25 mg Tablet, Oral, as gluconate: Generic: 50 mg [elemental manganese 5.7 mg] Medium Chain Triglycerides DoD Uniform Formulary Outpatient Dosage Forms Mannitol (Systemic) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Emulsion, Oral: UNIFORM FORMULARY Betaquik: (250 mL) Solution, Intravenous: Liquigen: (250 mL) Osmitrol: 5% (1000 mL); 10% (500 mL); 15% (500 mL); 20% (250 mL, 500 mL) Oil, Oral: Generic: 20% (250 mL, 500 mL); 25% (50 mL) MCT Oil: (946 mL) Solution, Intravenous [preservative free]: Generic: 25% (50 mL) MedroxyPROGESTERone Solution, Irrigation: DoD Uniform Formulary Outpatient Dosage Forms Resectisol: 5% (2000 mL) BASIC CORE FORMULARY Tablet, Oral, as acetate: Maprotiline Generic: 2.5 mg, 5 mg, 10 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral, as hydrochloride: Suspension, Intramuscular, as acetate: Generic: 25 mg, 50 mg, 75 mg Generic: 150 mg/mL (1 mL) Suspension Prefilled Syringe, Intramuscular, as acetate: Maraviroc Generic: 150 mg/mL (1 mL) DoD Uniform Formulary Outpatient Dosage Forms Suspension Prefilled Syringe, Subcutaneous, as acetate: UNIFORM FORMULARY Depo-SubQ Provera 104: 104 mg/0.65 mL (0.65 mL) [contains methylpara- Solution, Oral: ben, propylparaben] Selzentry: 20 mg/mL (230 mL) [contains sodium benzoate; strawberry flavor] 75 MEFLOQUINE Mefloquine supplied in two vials, one containing MenA powder and one containing DoD Uniform Formulary Outpatient Dosage Forms MenCYW-135 liquid] UNIFORM FORMULARY Meningococcal Polysaccharide (Groups C and Y) and Tablet, Oral, as hydrochloride: Generic: 250 mg Haemophilus b Tetanus Toxoid Conjugate Vaccine DoD Uniform Formulary Outpatient Dosage Forms Megestrol UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intramuscular [preservative free]: UNIFORM FORMULARY Menhibrix: 5 mcg each of polysaccharide antigen groups C and Y, and 2.5 mcg Suspension, Oral, as acetate: Haemophilus b capsular polysaccharide per 0.5 mL dose (1 ea) [contains Generic: 40 mg/mL (10 mL, 240 mL, 480 mL); 400 mg/10 mL (10 mL); tetanus toxoid] 625 mg/5 mL (150 mL) Tablet, Oral, as acetate: Menotropins Generic: 20 mg, 40 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Melatonin Injection, powder for reconstitution: DoD Uniform Formulary Outpatient Dosage Forms Menopur: 75 units [supplied with diluent] UNIFORM FORMULARY Capsule, Oral: Menthol Generic: 1 mg, 2.5 mg, 3 mg, 5 mg DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 3 mg Aerosol, External: Tablet, Oral [preservative free]: Biofreeze: 10.5% (89 mL) [aspirin free, ibuprofen free, paraben free, salicy- Generic: 1 mg, 3 mg, 5 mg late free] Tablet Extended Release, Oral [preservative free]: Cream, External: Melatonin TR: 1 mg [gluten free] Relief Pain Relieving: 3% (5 g) [contains benzyl alcohol, cetearyl alcohol, cetyl Generic: 3 mg alcohol] Tablet, Sublingual: Gel, External: Generic: 5 mg Bama Freeze: 3.7% (90 mL, 120 mL, 3785 mL) [contains isopropyl alcohol, Meloxicam trolamine (triethanolamine)] DoD Uniform Formulary Outpatient Dosage Forms Biofreeze: 4% (89 mL, 237 mL) [aspirin free, ibuprofen free, paraben free, BASIC CORE FORMULARY salicylate free; contains brilliant blue fcf (fd&c blue #1), isopropyl alcohol, Tablet, Oral: tartrazine (fd&c yellow #5), trolamine (triethanolamine)] Generic: 7.5 mg, 15 mg Biofreeze Colorless: 4% (89 mL) [aspirin free, ibuprofen free, paraben free, salicylate free; contains isopropyl alcohol, trolamine (triethanolamine)] NONFORMULARY Biofreeze Roll-On: 4% (74 mL) [aspirin free, ibuprofen free, paraben free, Tablet Disintegrating, Oral: salicylate free; contains brilliant blue fcf (fd&c blue #1), isopropyl alcohol, Qmiiz ODT: 7.5 mg, 15 mg [contains aspartame] tartrazine (fd&c yellow #5), trolamine (triethanolamine)] Tier 4 - NOT COVERED Mineral Freez: 2% (226.8 g) [contains brilliant blue fcf (fd&c blue #1), isopropyl Capsule, Oral: alcohol, trolamine (triethanolamine)] Vivlodex: 5 mg, 10 mg Mineral Ice: 2% (99.2 g, 226.8 g, 453.6 g) [contains brilliant blue fcf (fd&c blue #1), isopropyl alcohol] Melphalan Perform Pain Relieving: 3.1% (118 mL) [contains brilliant blue fcf (fd&c blue DoD Uniform Formulary Outpatient Dosage Forms #1), isopropyl alcohol, methylparaben, propylene glycol, trolamine (trietha- UNIFORM FORMULARY nolamine)] Solution Reconstituted, Intravenous: Perform Pain Relieving: 3.5% (118 mL) [aspirin free, ibuprofen free, paraben Generic: 50 mg (1 ea) free, salicylate free; contains isopropyl alcohol, trolamine (triethanolamine)] Solution Reconstituted, Intravenous [preservative free]: Polar Frost: 4% (150 mL) [contains alcohol, usp, brilliant blue fcf (fd&c blue Generic: 50 mg (1 ea) #1), methylparaben, propylene glycol, propylparaben, trolamine (triethanol- Tablet, Oral: amine)] Alkeran: 2 mg Ultracin M: 5% (120 mL) [paraben free; contains benzyl alcohol] Melphalan Flufenamide Ultracin-M: 10% (120 mL) [contains benzyl alcohol] DoD Uniform Formulary Outpatient Dosage Forms Liquid, External: NOT COVERED Berri-Freez Pain Relieving: 10% (118 mL) Solution Reconstituted, Intravenous, as hydrochloride [preservative free]: Perform Pain Relieving: 10.4% (118 mL) [aspirin free, ibuprofen free, paraben Pepaxto: 20 mg (1 ea) free, salicylate free] Perform Pain Relieving Roll-On: 3.1% (89 mL) [contains isopropyl alcohol, Memantine methylparaben, propylene glycol, trolamine (triethanolamine)] DoD Uniform Formulary Outpatient Dosage Forms Perform Pain Relieving Roll-On: 3.5% (89 mL) [aspirin free, ibuprofen free, UNIFORM FORMULARY paraben free, salicylate free; contains isopropyl alcohol, trolamine (triethanol- Solution, Oral, as hydrochloride: amine)] Generic: 2 mg/mL (360 mL) Lozenge, Mouth/Throat: Tablet, Oral, as hydrochloride: Cherry Cough Drops: 6.1 mg (1 ea) [cherry eucalyptus flavor] Generic: 5 mg, 10 mg, 5 mg (28s) and 10 mg (21s) Medikoff Drops: 7.6 mg (600 ea) NONFORMULARY Lozenge, Mouth/Throat, as hydrobromide: Capsule Extended Release 24 Hour, Oral, as hydrochloride: Nycoff: 15 mg (500 ea) Namenda XR: 7 mg, 14 mg, 21 mg, 28 mg Patch, External: Namenda XR Titration Pack: 7 mg (7s) and 14 mg (7s) and 21 mg (7s) and Cold/Hot Pain Relief Therapy: 5% (5 ea) [contains disodium edta, polysor- 28 mg (7s) bate 80] Generic: 7 mg, 14 mg, 21 mg, 28 mg Thritex: 5% (15 ea) [contains edetate disodium, methylparaben, polysorbate Meningococcal Group B Vaccine 80, propylparaben] DoD Uniform Formulary Outpatient Dosage Forms Menthol and Zinc Oxide (Topical) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Suspension Prefilled Syringe, Intramuscular: UNIFORM FORMULARY Bexsero: (0.5 mL) Ointment, External: Trumenba: (0.5 mL) [contains polysorbate 80] Caladrox: Menthol 0.44% and zinc oxide 20% (113 g) [contains phenol] Meningococcal (Groups A / C / Y and W-135) Conjugate Vaccine Calmoseptine: Menthol 0.44% and zinc oxide 20.6% (3.5 g, 71 g, 113 g) DoD Uniform Formulary Outpatient Dosage Forms [contains phenol] UNIFORM FORMULARY Lantiseptic Multi-Purpose: Menthol 0.45% and zinc oxide 20% (5 g, 113 g) Solution, Injection [preservative free]: [contains disodium edta, methylparaben, propylparaben] Menactra: 4 mcg each of polysaccharide antigen groups A, C, Y, and W-135 Risamine: Menthol 0.44% and zinc oxide 20.625% (113 g) [contains phenol] [bound to diphtheria toxoid 48 mcg] per 0.5 mL [MCV4 or MenACWY-D] Paste, External: Menveo: MenA oligosaccharide 10 mcg, MenC oligosaccharide 5 mcg, MenY Remedy Calazime: Menthol 0.4% and zinc oxide 20.5% (113 g) oligosaccharide 5 mcg, and MenW-135 oligosaccharide 5 mcg [bound to CRM197 protein 32.7-64.1 mcg] per 0.5 mL (0.5 mL) [MenACWY-CRM; 76 METHAZOLAMIDE Meperidine Capsule Delayed Release, Oral: DoD Uniform Formulary Outpatient Dosage Forms Delzicol: 400 mg UNIFORM FORMULARY Capsule Extended Release 24 Hour, Oral: Solution, Injection, as hydrochloride: Apriso: 0.375 g [contains aspartame] Demerol: 25 mg/mL (1 mL); 25 mg/0.5 mL (0.5 mL); 50 mg/mL (1 mL, 30 mL); Enema, Rectal: 75 mg/1.5 mL (1.5 mL); 100 mg/2 mL (2 mL); 75 mg/mL (1 mL); 100 mg/mL Generic: 4 g (60 mL) Kit, Rectal: (1 mL, 20 mL) Generic: 4 g Generic: 10 mg/mL (30 mL); 25 mg/mL (1 mL); 50 mg/mL (1 mL); 100 mg/mL Suppository, Rectal: (1 mL) Canasa: 1000 mg (30 ea, 42 ea) Solution, Oral, as hydrochloride: Generic: 50 mg/5 mL (500 mL) NONFORMULARY Tablet, Oral, as hydrochloride: Capsule Extended Release, Oral: Generic: 50 mg, 100 mg Pentasa: 250 mg, 500 mg Tablet Delayed Release, Oral: Mepivacaine Asacol HD: 800 mg DoD Uniform Formulary Outpatient Dosage Forms Generic: 800 mg UNIFORM FORMULARY Solution, Injection, as hydrochloride: Mesna Carbocaine: 1% (50 mL); 2% (50 mL) [contains methylparaben] DoD Uniform Formulary Outpatient Dosage Forms Polocaine: 1% (50 mL); 2% (50 mL) [contains methylparaben] UNIFORM FORMULARY Solution, Injection, as hydrochloride [preservative free]: Solution, Intravenous: Carbocaine Preservative-Free: 1% (30 mL); 1.5% (30 mL); 2% (20 mL) Generic: 100 mg/mL (10 mL) Polocaine-MPF: 1% (30 mL); 1.5% (30 mL); 2% (20 mL) [methylparaben free] Tablet, Oral: Solution, Injection, as hydrochloride [dental use]: Mesnex: 400 mg [scored] Carbocaine: 3% (1.7 mL) Metaproterenol Polocaine Dental: 3% (1.7 mL) DoD Uniform Formulary Outpatient Dosage Forms Scandonest 3% Plain: 3% (1.7 mL) UNIFORM FORMULARY Mepivacaine and Levonordefrin Syrup, Oral, as sulfate: DoD Uniform Formulary Outpatient Dosage Forms Generic: 10 mg/5 mL (473 mL) UNIFORM FORMULARY Tablet, Oral, as sulfate: Generic: 10 mg, 20 mg Injection, solution [for dental use]: Carbocaine 2% with Neo-Cobefrin: Mepivacaine hydrochloride 2% and levo- Metaxalone nordefrin 1:20,000 (1.7 mL) [contains edetate disodium, potassium meta- DoD Uniform Formulary Outpatient Dosage Forms bisulfite] UNIFORM FORMULARY Scandonest 2% L: Mepivacaine hydrochloride 2% and levonordefrin 1:20,000 Tablet, Oral: (1.7 mL) [contains edetate disodium, potassium metabisulfite] Generic: 400 mg, 800 mg Mepolizumab MetFORMIN DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Solution Auto-injector, Subcutaneous [preservative free]: Tablet, Oral, as hydrochloride: Nucala: 100 mg/mL (1 mL) [contains disodium edta, polysorbate 80] Generic: 500 mg, 850 mg, 1000 mg Solution Prefilled Syringe, Subcutaneous [preservative free]: Tablet Extended Release 24 Hour, Oral, as hydrochloride: Nucala: 100 mg/mL (1 mL) [contains edetate (edta) disodium dihydrate, Generic (Glucophage XR): 750 mg polysorbate 80] UNIFORM FORMULARY NOT COVERED Solution, Oral, as hydrochloride: Solution Reconstituted, Subcutaneous [preservative free]: Riomet: 500 mg/5 mL (118 mL, 473 mL) Nucala: 100 mg (1 ea) [contains polysorbate 80] NONFORMULARY Meprobamate Tablet Extended Release 24 Hour, Oral, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Fortamet: 500 mg, 1000 mg UNIFORM FORMULARY Generic: 500 mg, 1000 mg Tablet, Oral: NOT COVERED Generic: 200 mg, 400 mg Tablet Extended Release 24 Hour, Oral, as hydrochloride: Glumetza: 500 mg, 1000 mg Mercaptopurine DoD Uniform Formulary Outpatient Dosage Forms Methacholine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Suspension, Oral: UNIFORM FORMULARY Purixan: 2000 mg/100 mL (100 mL) [contains aspartame, methylparaben, Solution Reconstituted, Inhalation, as chloride: propylparaben] Provocholine: 100 mg (1 ea) NONFORMULARY Tablet, Oral: Methadone Generic: 50 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Meropenem Concentrate, Oral, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Generic: 10 mg/mL (30 mL, 1000 mL) UNIFORM FORMULARY Solution, Injection, as hydrochloride: Solution Reconstituted, Intravenous: Generic: 10 mg/mL (20 mL) Generic: 500 mg (1 ea); 1 g (1 ea) Solution, Oral, as hydrochloride: Solution Reconstituted, Intravenous [preservative free]: Generic: 5 mg/5 mL (500 mL); 10 mg/5 mL (500 mL) Generic: 500 mg (1 ea); 1 g (1 ea) Tablet, Oral, as hydrochloride: Generic: 5 mg, 10 mg Meropenem and Vaborbactam Tablet Soluble, Oral, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Generic: 40 mg UNIFORM FORMULARY Solution Reconstituted, Intravenous: Methamphetamine Vabomere: 2 g: Meropenem 1 g and vaborbactam 1 g (1 ea) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Mesalamine Tablet, Oral, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Generic: 5 mg BASIC CORE FORMULARY MethazolAMIDE Tablet Delayed Release, Oral: Lialda: 1.2 g DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Generic: 1.2 g Tablet, Oral: UNIFORM FORMULARY Generic: 25 mg, 50 mg 77 METHENAMINE Methenamine Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 5 mg, 10 mg UNIFORM FORMULARY Methionine Tablet, Oral, as hippurate: Generic: 1 g DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral, as mandelate: UNIFORM FORMULARY Generic: 0.5 g, 1 g Capsule, oral: ME-500: 500 mg Methenamine, Phenyl Salicylate, Atropine, Hyoscyamine, Tablet, Oral: Benzoic Acid, and Methylene Blue Generic: 500 mg DoD Uniform Formulary Outpatient Dosage Forms Methocarbamol UNIFORM FORMULARY Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Methenamine 40.8 mg, phenyl salicylate 18.1 mg, atropine sulfate 0.03 mg, BASIC CORE FORMULARY hyoscyamine sulfate 0.03 mg, benzoic acid 4.5 mg, and methylene Tablet, Oral: blue 5.4 mg Generic: 500 mg Methenamine, Phenyl Salicylate, Methylene Blue, Benzoic UNIFORM FORMULARY Solution, Injection:Robaxin: Acid, and Hyoscyamine Generic: 1000 mg/10 mL (10 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection [preservative free]: UNIFORM FORMULARY Generic: 1000 mg/10 mL (10 mL) Tablet, Oral: Hyophen: Methenamine 81.6 mg, phenyl salicylate 36.2 mg, methylene blue NONFORMULARY 10.8 mg, benzoic acid 9 mg, hyoscyamine sulfate 0.12 mg Solution, Injection: Urophen MB: Methenamine 81.6 mg, phenyl salicylate 36.2 mg, methylene Robaxin: 1000 mg/10 mL (10 mL) [contains polyethylene glycol 300] blue 10.8 mg, benzoic acid 9 mg, hyoscyamine sulfate 0.12 mg Methohexital Methenamine, Sodium Phosphate Monobasic, Phenyl DoD Uniform Formulary Outpatient Dosage Forms Salicylate, Methylene Blue, and Hyoscyamine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution Prefilled Syringe, Intravenous, as sodium: UNIFORM FORMULARY Generic: 100 mg/10 mL (10 mL) Capsule, oral: Solution Reconstituted, Injection, as sodium: Azuphen MB: Methenamine 120 mg, sodium phosphate monobasic 40.8 mg, Brevital Sodium: 500 mg (1 ea); 2.5 g (1 ea) phenyl salicylate 36 mg, methylene blue 10 mg, hyoscyamine sulfate 0.12 mg Methotrexate Uramit MB: Methenamine 118 mg, sodium phosphate monobasic 40.8 mg, DoD Uniform Formulary Outpatient Dosage Forms phenyl salicylate 36 mg, methylene blue 10 mg, hyoscyamine sulfate BASIC CORE FORMULARY 0.12 mg Tablet, Oral: Uribel: Methenamine 118 mg, sodium phosphate monobasic 40.8 mg, phenyl Generic: 2.5 mg salicylate 36 mg, methylene blue 10 mg, hyoscyamine sulfate 0.12 mg UNIFORM FORMULARY UroAv-B: Methenamine 118 mg, sodium phosphate monobasic 40.8 mg, Solution, Injection: phenyl salicylate 36 mg, methylene blue 10 mg, hyoscyamine sulfate 0.12 mg Generic: 250 mg/10 mL (10 mL); 50 mg/2 mL (2 mL) Uro-MP: Methenamine 118 mg, sodium phosphate monobasic 40.8 mg, phe- Solution, Injection [preservative free]: nyl salicylate 36 mg, methylene blue 10 mg, hyoscyamine sulfate 0.12 mg Generic: 1 g/40 mL (40 mL); 100 mg/4 mL (4 mL); 200 mg/8 mL (8 mL); Ustell: Methenamine 120 mg, sodium phosphate monobasic 40.8 mg, phenyl 250 mg/10 mL (10 mL); 50 mg/2 mL (2 mL) salicylate 36 mg, methylene blue 10 mg, hyoscyamine sulfate 0.12 mg Solution, Oral: Uticap: Methenamine 120 mg, sodium phosphate monobasic 40.8 mg, phenyl Xatmep: 2.5 mg/mL (120 mL) salicylate 36 mg, methylene blue 10 mg, hyoscyamine sulfate 0.12 mg Solution Reconstituted, Injection [preservative free]: Tablet, oral: Generic: 1 g (1 ea) Hyolev MB: Methenamine 81 mg, sodium phosphate monobasic 40.8 mg, Tablet, Oral: phenyl salicylate 32.4 mg, methylene blue 10.8 mg, hyoscyamine sulfate Trexall: 5 mg, 7.5 mg, 10 mg, 15 mg [scored] 0.12 mg NONFORMULARY Phosphasal: Methenamine 81.6 mg, sodium phosphate monobasic 40.8 mg, Solution Auto-injector, Subcutaneous [preservative free]: phenyl salicylate 36.2 mg, methylene blue 10.8 mg, hyoscyamine sulfate Otrexup: 7.5 mg/0.4 mL (0.4 mL); 10 mg/0.4 mL (0.4 mL); 12.5 mg/0.4 mL 0.12 mg (0.4 mL); 15 mg/0.4 mL (0.4 mL); 17.5 mg/0.4 mL (0.4 mL); 20 mg/0.4 mL Ur N-C: Methenamine 81.6 mg, sodium phosphate monobasic 40.8 mg, (0.4 mL); 22.5 mg/0.4 mL (0.4 mL); 25 mg/0.4mL (0.4 mL) phenyl salicylate 36.2 mg, methylene blue 10.8 mg, hyoscyamine sulfate 0.12 mg Rasuvo: 7.5 mg/0.15 mL (0.15 mL); 10 mg/0.2 mL (0.2 mL); 12.5 mg/0.25 mL Urelle: Methenamine 81 mg, sodium phosphate monobasic 40.8 mg, phenyl (0.25 mL); 15 mg/0.3 mL (0.3 mL); 17.5 mg/0.35 mL (0.35 mL); 20 mg/0.4 salicylate 32.4 mg, methylene blue 10.8 mg, hyoscyamine sulfate 0.12 mg mL (0.4 mL); 22.5 mg/0.45 mL (0.45 mL); 25 mg/0.5 mL (0.5 mL); 27.5 mg/ Uretron D/S: Methenamine 81.6 mg, sodium phosphate monobasic 40.8 mg, 0.55 mL (0.55 mL); 30 mg/0.6 mL (0.6 mL) phenyl salicylate 36.2 mg, methylene blue 10.8 mg, hyoscyamine sulfate Methoxsalen (Systemic) 0.12 mg DoD Uniform Formulary Outpatient Dosage Forms Urimar-T: Methenamine 120 mg, sodium phosphate monobasic 40.8 mg, phenyl salicylate 36.2 mg, methylene blue 10.8 mg, hyoscyamine sulfate UNIFORM FORMULARY 0.12 mg Capsule, Oral: Urin DS: Methenamine 81.6 mg, sodium phosphate monobasic 40.8 mg, Generic: 10 mg phenyl salicylate 36.2 mg, methylene blue 10.8 mg, hyoscyamine sulfate Methoxy Polyethylene Glycol-Epoetin Beta 0.12 mg DoD Uniform Formulary Outpatient Dosage Forms Uro-458: Methenamine 81 mg, sodium phosphate monobasic 40.8 mg, phenyl salicylate 32.4 mg, methylene blue 10.8 mg, hyoscyamine sulfate 0.12 mg UNIFORM FORMULARY UroAv-81: Methenamine 81 mg, sodium phosphate monobasic 40.8 mg, Solution, Injection [preservative free]: phenyl salicylate 32.4 mg, methylene blue 10.8 mg, hyoscyamine sulfate Mircera: 50 mcg/0.3 mL (0.3 mL); 75 mcg/0.3 mL (0.3 mL); 100 mcg/0.3 mL 0.12 mg (0.3 mL); 200 mcg/0.3 mL (0.3 mL) Uro-L: Methenamine 81 mg, sodium phosphate monobasic 40.8 mg, phenyl Solution Prefilled Syringe, Injection: salicylate 32.4 mg, methylene blue 10.8 mg, hyoscyamine sulfate Mircera: 30 mcg/0.3 mL (0.3 mL); 50 mcg/0.3 mL (0.3 mL); 75 mcg/0.3 mL (0.3 0.12 mg [DSC] mL); 100 mcg/0.3 mL (0.3 mL); 200 mcg/0.3 mL (0.3 mL) Utira-C: Methenamine 81.6 mg, sodium phosphate monobasic 40.8 mg, phe- Solution Prefilled Syringe, Injection [preservative free]: nyl salicylate 36.2 mg, methylene blue 10.8 mg, hyoscyamine sulfate Mircera: 150 mcg/0.3 mL (0.3 mL) 0.12 mg Utrona-C: Methenamine 81.6 mg, sodium phosphate monobasic 40.8 mg, Methscopolamine phenyl salicylate 36.2 mg, methylene blue 10.8 mg, hyoscyamine sulfate DoD Uniform Formulary Outpatient Dosage Forms 0.12 mg UNIFORM FORMULARY Tablet, Oral, as bromide: MethIMAzole Generic: 2.5 mg, 5 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY 78 METOCLOPRAMIDE Methsuximide Methylphenidate DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Capsule, Oral: Tablet Extended Release 24 Hour, Oral, as hydrochloride: Celontin: 300 mg Generic: 18 mg, 27 mg, 36 mg, 54 mg Methyclothiazide UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule Extended Release, Oral, as hydrochloride: UNIFORM FORMULARY Generic: 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg Tablet, Oral: Capsule Extended Release 24 Hour, Oral, as hydrochloride: Generic: 5 mg Generic: 20 mg, 30 mg, 40 mg, 60 mg Solution, Oral, as hydrochloride: Methylcellulose Generic: 5 mg/5 mL (500 mL); 10 mg/5 mL (500 mL) DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral, as hydrochloride: UNIFORM FORMULARY Generic: 5 mg, 10 mg, 20 mg Powder, Oral: Tablet Chewable, Oral, as hydrochloride: Citrucel: (454 g, 850 g) Generic: 2.5 mg, 5 mg, 10 mg Citrucel: (479 g, 907 g, 1191 g) [gluten free, sugar free; orange flavor] Tablet Extended Release, Oral, as hydrochloride: Soluble Fiber Therapy: (454 g) Generic: 10 mg, 20 mg Tablet, Oral: NONFORMULARY Citrucel: 500 mg Capsule Extended Release, Oral, as hydrochloride: Jornay PM: 20 mg, 40 mg, 60 mg, 80 mg, 100 mg Methyldopa Patch, Transdermal: DoD Uniform Formulary Outpatient Dosage Forms Daytrana: 10 mg/9 hr (30 ea); 15 mg/9 hr (30 ea); 20 mg/9 hr (30 ea); 30 mg/9 UNIFORM FORMULARY hr (30 ea) Solution, Intravenous, as hydrochloride: Tablet Chewable Extended Release, Oral, as hydrochloride: Generic: 250 mg/5 mL (5 mL) QuilliChew ER: 20 mg, 30 mg, 40 mg [contains aspartame] Tablet, Oral: Tablet Extended Release Disintegrating, Oral: Generic: 250 mg, 500 mg Cotempla XR-ODT: 8.6 mg, 17.3 mg, 25.9 mg Methyldopa and Hydrochlorothiazide NOT COVERED DoD Uniform Formulary Outpatient Dosage Forms Capsule Extended Release 24 Hour, Oral, as hydrochloride: UNIFORM FORMULARY Adhansia XR: 25 mg, 35 mg, 45 mg, 55 mg, 70 mg, 85 mg Tablet, Oral: Methyldopa 250 mg and hydrochlorothiazide 15 mg MethylPREDNISolone Methyldopa 250 mg and hydrochlorothiazide 25 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Methylene Blue Kit, Injection, as acetate: DoD Uniform Formulary Outpatient Dosage Forms ReadySharp Methylprednisolone: 80 mg/mL [contains polyethylene glycol] NOT COVERED Solution Reconstituted, Injection, as sodium succinate [strength expressed as Solution, Injection: base]: Generic: 1% (1 mL, 10 mL) SOLU-medrol: 500 mg (1 ea); 1000 mg (1 ea); 2 g (1 ea) Solution, Intravenous: Generic: 40 mg (1 ea); 125 mg (1 ea); 1000 mg (1 ea) ProvayBlue: 50 mg/10 mL (10 mL) Solution Reconstituted, Injection, as sodium succinate [strength expressed as base, preservative free]: Methylergonovine SOLU-medrol: 40 mg (1 ea); 125 mg (1 ea); 500 mg (1 ea); 1000 mg (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Suspension, Injection, as acetate: UNIFORM FORMULARY DEPO-Medrol: 20 mg/mL (5 mL); 40 mg/mL (5 mL, 10 mL) [contains benzyl Solution, Injection, as maleate: alcohol, polyethylene glycol, polysorbate 80] Generic: 0.2 mg/mL (1 mL) Generic: 40 mg/mL (1 mL, 10 mL); 80 mg/mL (1 mL, 5 mL) Solution, Injection, as maleate [preservative free]: Tablet, Oral: Generic: 0.2 mg/mL (1 mL) Medrol: 2 mg Tablet, Oral, as maleate: Generic: 4 mg, 8 mg, 16 mg, 32 mg Methergine: 0.2 mg [contains methylparaben, propylparaben] Tablet Therapy Pack, Oral: Generic: 4 mg (21 ea) Methylfolate DoD Uniform Formulary Outpatient Dosage Forms MethylTESTOSTERone UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral: UNIFORM FORMULARY Deplin 7.5: L-methylfolate 7.5 mg and Schizochytrium algae [contains fd&c red Capsule, Oral: #40, fd&c yellow #6 (sunset yellow), fd&c yellow #6 aluminum lake, sodium Generic: 10 mg caseinate, soy protein, soybean lecithin] Tablet, Oral: Deplin 15: L-methylfolate 15 mg and Schizochytrium algae [contains fd&c red Methitest: 10 mg [scored] #40, fd&c yellow #6 (sunset yellow), sodium caseinate, soy protein, soybean lecithin] Metipranolol L-Methylfolate Formula 15: L-methylfolate 15 mg and Schizochytrium algae DoD Uniform Formulary Outpatient Dosage Forms [contains sodium caseinate, soy protein, soybean lecithin] UNIFORM FORMULARY L-Methylfolate Formula 7.5: L-methylfolate 7.5 mg and Schizochytrium algae Solution, Ophthalmic: [contains sodium caseinate, soy protein, soybean lecithin] Generic: 0.3% (5 mL, 10 mL) L-Methylfolate Forte: L-methylfolate 7.5 mg and Schizochytrium algae [con- Metoclopramide tains sodium caseinate, soy protein, soybean lecithin] DoD Uniform Formulary Outpatient Dosage Forms L-Methylfolate Forte: L-methylfolate 15 mg and Schizochytrium algae [con- BASIC CORE FORMULARY tains sodium caseinate, soy protein, soybean lecithin] Solution, Oral: Tablet, Oral: Generic: 5 mg/5 mL (10 mL, 473 mL) Generic: 7.5 mg, 15 mg Tablet, Oral: Methylfolate, Methylcobalamin, and Acetylcysteine Generic: 10 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Injection: Tablet, Oral: Generic: 5 mg/mL (2 mL) Cerefolin NAC: L-methylfolate 6 mg, methylcobalamin 2 mg, N-acetylcysteine Solution, Injection [preservative free]: 600 mg, and Schizochytrium algae [contains soy; gluten free, lactose free, Generic: 5 mg/mL (2 mL) yeast free] Solution, Oral: Metafolbic Plus: L-methylfolate 6 mg, methylcobalamin 2 mg, and N-acetyl- Generic: 10 mg/10 mL (10 mL) cysteine 600 mg [gluten free, lactose free, sugar free, yeast free] Tablet, Oral: Metafolbic Plus RF: L-methylfolate 6 mg, methylcobalamin 2 mg, N-acetylcys- Generic: 5 mg teine 600 mg, and Schizochytrium algae [contains soy; gluten free, Tablet Dispersible, Oral: yeast free] Generic: 5 mg, 10 mg 79 METOLAZONE MetOLazone Mexiletine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Capsule, Oral, as hydrochloride: Generic: 2.5 mg, 5 mg, 10 mg Generic: 150 mg, 200 mg, 250 mg Metoprolol Micafungin DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY UNIFORM FORMULARY Tablet, Oral, as tartrate: Solution Reconstituted, Intravenous, as sodium: Generic: 25 mg, 50 mg, 100 mg Mycamine: 50 mg (1 ea); 100 mg (1 ea) Tablet Extended Release 24 Hour, Oral, as succinate: Solution Reconstituted, Intravenous, as sodium [preservative free]: Generic: 25 mg, 50 mg, 100 mg, 200 mg Mycamine: 50 mg (1 ea); 100 mg (1 ea) UNIFORM FORMULARY Miconazole (Oral) Capsule ER 24 Hour Sprinkle, Oral: DoD Uniform Formulary Outpatient Dosage Forms Kapspargo Sprinkle: 25 mg, 50 mg, 100 mg, 200 mg [contains corn starch] UNIFORM FORMULARY Solution, Intravenous, as tartrate: Tablet, Buccal: Generic: 1 mg/mL (5 mL); 5 mg/5 mL (5 mL) Oravig: 50 mg [contains corn starch, milk protein concentrate] Solution, Intravenous, as tartrate [preservative free]: Generic: 5 mg/5 mL (5 mL) Miconazole (Topical) Tablet, Oral, as tartrate: DoD Uniform Formulary Outpatient Dosage Forms Generic: 37.5 mg, 75 mg UNIFORM FORMULARY Aerosol, External, as nitrate: Metoprolol and Hydrochlorothiazide Lotrimin AF: 2% (150 g) DoD Uniform Formulary Outpatient Dosage Forms Aerosol Powder, External, as nitrate: UNIFORM FORMULARY Cruex Prescription Strength: 2% (85 g) Tablet, Oral: Desenex Jock Itch: 2% (113 g) 50/25: Metoprolol tartrate 50 mg and hydrochlorothiazide 25 mg Lotrimin AF Deodorant Powder: 2% (133 g) 100/25: Metoprolol tartrate 100 mg and hydrochlorothiazide 25 mg Lotrimin AF Jock Itch Powder: 2% (133 g) 100/50: Metoprolol tartrate 100 mg and hydrochlorothiazide 50 mg Lotrimin AF Powder: 2% (133 g) Tablet, Extended Release, Oral: Cream, External, as nitrate: 25/12.5: Metoprolol succinate 25 mg [extended release, expressed as mg Antifungal: 2% (14 g, 28 g, 42.5 g) [contains benzoic acid] equivalent to tartrate] and hydrochlorothiazide 12.5 mg Antifungal: 2% (113 g, 198 g) [contains cetyl alcohol, methylparaben, propy- 50/12.5: Metoprolol succinate 50 mg [extended release, expressed as mg lene glycol, propylparaben] equivalent to tartrate] and hydrochlorothiazide 12.5 mg Baza Antifungal: 2% (4 g, 57 g, 142 g) 100/12.5: Metoprolol succinate 100 mg [extended release, expressed as mg Carrington Antifungal: 2% (141 g) [contains disodium edta, methylparaben, equivalent to tartrate] and hydrochlorothiazide 12.5 mg propylene glycol, propylparaben] Micaderm: 2% (30 g) Metreleptin Micatin: 2% (14 g) [contains benzoic acid] DoD Uniform Formulary Outpatient Dosage Forms Podactin: 2% (28.35 g) [contains benzoic acid] UNIFORM FORMULARY Remedy Antifungal: 2% (118 mL) [contains methylparaben, propylparaben, Solution Reconstituted, Subcutaneous: trolamine (triethanolamine)] Myalept: 11.3 mg (1 ea) Secura Antifungal: 2% (57 g) [contains cetearyl alcohol, methylparaben, MetroNIDAZOLE (Systemic) propylparaben] Secura Antifungal Extra Thick: 2% (92 g) [contains cetearyl alcohol, methyl- DoD Uniform Formulary Outpatient Dosage Forms paraben, propylparaben] BASIC CORE FORMULARY Soothe & Cool INZO Antifungal: 2% (56.7 g, 141.7 g) Tablet, Oral: Generic: 2% (15 g, 30 g) Generic: 250 mg, 500 mg Cream, Vaginal, as nitrate: UNIFORM FORMULARY Miconazole 7: 2% (45 g) [contains benzoic acid] Capsule, Oral: Generic: 2% (45 g) Generic: 375 mg Kit, External, as nitrate: Solution, Intravenous: Fungoid Tincture: 2% [contains benzyl alcohol] Generic: 500 mg (100 mL) Kit, Vaginal, as nitrate: Miconazole 3 Combo Pack: Cream, topical: 2% (9 g) and Suppository, vaginal: MetroNIDAZOLE (Topical) 200 mg (3s) DoD Uniform Formulary Outpatient Dosage Forms Miconazole 3 Combo Pack: Cream, topical: 2% (9 g) and Suppository, vaginal: BASIC CORE FORMULARY 200 mg (3s) [contains benzoic acid] Gel, External: Vagistat-3: Cream, topical: 2% (9 g) and Suppository, vaginal: 200 mg (3s) Generic: 1% (60 g) [contains benzoic acid] Gel, Vaginal: Lotion, External, as nitrate: Generic: 0.75% (70 g) Zeasorb-AF: 2% (56 g) [contains alcohol, usp] Ointment, External, as nitrate: UNIFORM FORMULARY Aloe Vesta Antifungal: 2% (56 g, 141 g) Cream, External: Aloe Vesta Clear Antifungal: 2% (56 g, 141 g) [dye free, fragrance free] Generic: 0.75% (45 g) Critic-Aid Clear AF: 2% (4 g, 57 g, 142 g) Lotion, External: DermaFungal: 2% (113 g) Generic: 0.75% (59 mL) Remedy Antifungal Clear: 2% (71 g) [contains soybean oil] NONFORMULARY Triple Paste AF: 2% (56.7 g) [contains polysorbate 80] Cream, External: Powder, External, as nitrate: Noritate: 1% (60 g) [contains methylparaben, propylparaben, trolamine (trie- Desenex: 2% (43 g, 85 g) thanolamine)] Lotrimin AF: 2% (90 g) Kit, External: Micro Guard: 2% (85 g) Rosadan: 0.75% [contains benzyl alcohol] Remedy Antifungal: 2% (85 g) Rosadan: 0.75% [contains edetate disodium, methylparaben, propylene gly- Remedy Antifungal: 2% (85 g) [talc free; contains methylparaben] col, propylparaben] Remedy Phytoplex Antifungal: 2% (85 g) [paraben free; contains sodium benzoate, soy protein] MetyraPONE Zeasorb-AF: 2% (71 g) DoD Uniform Formulary Outpatient Dosage Forms Zeasorb-AF: 2% (71 g) [starch free] UNIFORM FORMULARY Solution, External, as nitrate: Capsule, Oral: Azolen Tincture: 2% (29.57 mL) [contains benzyl alcohol, isopropyl alcohol] Metopirone: 250 mg Fungoid Tincture: 2% (29.57 mL) [contains benzyl alcohol] Miranel AF: 2% (28 g) [contains disodium edta, menthol, propylene glycol, sd MetyroSINE alcohol 40b] DoD Uniform Formulary Outpatient Dosage Forms Suppository, Vaginal, as nitrate: UNIFORM FORMULARY Miconazole 7: 100 mg (7 ea) Capsule, Oral: Miconazole 3: 200 mg (3 ea) Demser: 250 mg Generic: 100 mg (7 ea) 80 MITOXANTRONE Midazolam Minocycline (Systemic) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Injection: Capsule, Oral: Generic: 2 mg/2 mL (2 mL); 5 mg/5 mL (5 mL); 10 mg/10 mL (10 mL); Generic: 50 mg, 75 mg, 100 mg 5 mg/mL (1 mL); 10 mg/2 mL (2 mL); 25 mg/5 mL (5 mL); 50 mg/10 mL Solution Reconstituted, Intravenous: (10 mL) Minocin: 100 mg (1 ea) Solution, Injection [preservative free]: Tablet, Oral: Generic: 2 mg/2 mL (2 mL); 5 mg/5 mL (5 mL); 5 mg/mL (1 mL); 10 mg/2 mL Generic: 50 mg, 75 mg, 100 mg (2 mL) NONFORMULARY Syrup, Oral: Capsule, Oral: Generic: 2 mg/mL (118 mL) Minocin: 50 mg, 75 mg, 100 mg NONFORMULARY Capsule Extended Release 24 Hour, Oral: Solution, Nasal: Ximino: 45 mg, 90 mg, 135 mg Nayzilam: 5 mg/0.1 mL (2 ea) Tablet Extended Release 24 Hour, Oral: Minolira: 105 mg, 135 mg [scored] Midodrine Solodyn: 55 mg, 65 mg, 80 mg, 105 mg, 115 mg DoD Uniform Formulary Outpatient Dosage Forms Generic: 45 mg, 90 mg, 135 mg UNIFORM FORMULARY Tablet, Oral, as hydrochloride: Minoxidil (Systemic) Generic: 2.5 mg, 5 mg, 10 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Midostaurin Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 2.5 mg, 10 mg UNIFORM FORMULARY Capsule, Oral: Minoxidil (Topical) Rydapt: 25 mg [contains cremophor rh40] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY MiFEPRIStone Foam, External: DoD Uniform Formulary Outpatient Dosage Forms Rogaine Mens: 5% (60 g) [contains cetyl alcohol, sd alcohol 40b] UNIFORM FORMULARY Rogaine Womens: 5% (60 g) [contains cetyl alcohol, sd alcohol 40b] Tablet, Oral: Solution, External: Korlym: 300 mg Generic: 2% (60 mL); 5% (60 mL) Mifeprex: 200 mg [contains corn starch] Mipomersen Migalastat DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution Prefilled Syringe, Subcutaneous, as sodium [preservative free]: Capsule, Oral: Kynamro: 200 mg/mL (1 mL) Galafold: 123 mg Mirabegron Miglitol DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet Extended Release 24 Hour, Oral: Tablet, Oral: Myrbetriq: 25 mg, 50 mg Generic: 25 mg, 50 mg, 100 mg Mirtazapine Miglustat DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Capsule, Oral: Generic: 7.5 mg, 15 mg, 30 mg, 45 mg Zavesca: 100 mg [contains soybean lecithin] Tablet Dispersible, Oral: Generic: 15 mg, 30 mg, 45 mg Milrinone DoD Uniform Formulary Outpatient Dosage Forms MiSOPROStol UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous: UNIFORM FORMULARY Generic: 200 mcg/mL (100 mL, 200 mL); 10 mg/10 mL (10 mL); 20 mg/20 mL Tablet, Oral: (20 mL); 50 mg/50 mL (50 mL) Generic: 100 mcg, 200 mcg Solution, Intravenous [preservative free]: Generic: 200 mcg/mL (100 mL, 200 mL) MitoMYcin (Ophthalmic) DoD Uniform Formulary Outpatient Dosage Forms Miltefosine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Kit, Ophthalmic: UNIFORM FORMULARY Mitosol: 0.2 mg Capsule, Oral: Impavido: 50 mg MitoMYcin (Systemic) DoD Uniform Formulary Outpatient Dosage Forms Mineral Oil UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous: UNIFORM FORMULARY Generic: 5 mg (1 ea); 20 mg (1 ea); 40 mg (1 ea) Enema, Rectal: Generic: (135 mL) Mitotane Oil, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: (30 mL, 472 mL, 473 mL, 500 mL, 1000 mL, 4000 mL) UNIFORM FORMULARY Tablet, Oral: Mineral Oil (Light) Lysodren: 500 mg [scored] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY MitoXANTRONE Liquid, sterile: 10 mL DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Minocycline Hydrochloride Periodontal Microspheres Concentrate, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Generic: 20 mg/10 mL (10 mL); 25 mg/12.5 mL (12.5 mL); 30 mg/15 mL (15 UNIFORM FORMULARY mL) Miscellaneous, Dental [strength expressed as base]: Arestin: 1 mg (1 ea) 81 MIVACURIUM Mivacurium Embeda 50/2: Morphine sulfate 50 mg and naltrexone hydrochloride 2 mg DoD Uniform Formulary Outpatient Dosage Forms Embeda 60/2.4: Morphine sulfate 60 mg and naltrexone hydrochloride 2.4 mg UNIFORM FORMULARY Embeda 80/3.2: Morphine sulfate 80 mg and naltrexone hydrochloride 3.2 mg Solution, Intravenous: Embeda 100/4: Morphine sulfate 100 mg and naltrexone hydrochloride 4 mg Mivacron: 10 mg/5 mL (5 mL); 20 mg/10 mL (10 mL) Morphine (Systemic) Modafinil DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY UNIFORM FORMULARY Tablet Extended Release, Oral, as sulfate: Tablet, Oral: Generic: 15 mg, 30 mg, 60 mg, 100 mg, 200 mg Generic: 100 mg, 200 mg UNIFORM FORMULARY Capsule Extended Release 24 Hour, Oral, as sulfate: Moexipril Generic: 10 mg, 20 mg, 30 mg, 45 mg, 50 mg, 60 mg, 75 mg, 80 mg, 90 mg, DoD Uniform Formulary Outpatient Dosage Forms 100 mg, 120 mg UNIFORM FORMULARY Device, Intramuscular, as sulfate: Tablet, Oral, as hydrochloride: Generic: 10 mg/0.7 mL (0.7 mL) Generic: 7.5 mg, 15 mg Solution, Injection, as sulfate: Moexipril and Hydrochlorothiazide Generic: 2 mg/mL (1 mL); 4 mg/mL (1 mL); 5 mg/mL (1 mL); 8 mg/mL (1 mL); 10 mg/mL (1 mL); 15 mg/mL (1 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection, as sulfate [preservative free]: UNIFORM FORMULARY Generic: 0.5 mg/mL (10 mL); 1 mg/mL (10 mL) Tablet, Oral: Solution, Intravenous, as sulfate: 7.5/12.5: Moexipril hydrochloride 7.5 mg and hydrochlorothiazide 12.5 mg Generic: 1 mg/mL (30 mL); 25 mg/mL (4 mL, 10 mL); 50 mg/mL (20 mL, 15/12.5: Moexipril hydrochloride 15 mg and hydrochlorothiazide 12.5 mg 50 mL) 15/25: Moexipril hydrochloride 15 mg and hydrochlorothiazide 25 mg Solution, Intravenous, as sulfate [preservative free]: Mogamulizumab Generic: 1 mg/mL (30 mL); 2 mg/mL (1 mL); 4 mg/mL (1 mL); 150 mg/30 mL DoD Uniform Formulary Outpatient Dosage Forms (30 mL); 8 mg/mL (1 mL); 10 mg/mL (1 mL); 15 mg/mL (1 mL); 25 mg/mL (10 mL) UNIFORM FORMULARY Solution, Oral, as sulfate: Solution, Intravenous [preservative free]: Generic: 10 mg/5 mL (5 mL, 15 mL, 100 mL, 500 mL); 20 mg/5 mL (5 mL, 100 Poteligeo: 20 mg/5 mL (5 mL) [contains polysorbate 80] mL, 500 mL); 100 mg/5 mL (15 mL, 30 mL, 120 mL, 240 mL) Molindone Suppository, Rectal, as sulfate: DoD Uniform Formulary Outpatient Dosage Forms Generic: 5 mg (12 ea); 10 mg (12 ea); 20 mg (12 ea); 30 mg (12 ea) UNIFORM FORMULARY Tablet, Oral, as sulfate: Tablet, Oral, as hydrochloride: Generic: 15 mg, 30 mg Generic: 5 mg, 10 mg, 25 mg NONFORMULARY Tablet ER 12 Hour Abuse-Deterrent, Oral, as sulfate: Mometasone (Nasal) MorphaBond ER: 15 mg, 30 mg, 60 mg, 100 mg DoD Uniform Formulary Outpatient Dosage Forms Tablet Extended Release Abuse-Deterrent, Oral, as sulfate: UNIFORM FORMULARY Arymo ER: 15 mg (100 ea); 30 mg (100 ea); 60 mg (100 ea) Implant, Nasal, as furoate: Sinuva: 1350 mcg (1 ea) Mouthwash NONFORMULARY DoD Uniform Formulary Outpatient Dosage Forms Suspension, Nasal, as furoate: UNIFORM FORMULARY Nasonex: 50 mcg/actuation (17 g) Solution, Mouth/Throat: Generic: 50 mcg/actuation (17 g) Crest Scope: Cetylpyridinium [contains alcohol 15%, tartrazine] Crest Scope Outlast: Cetylpyridinium [contains alcohol 13%, tartrazine] Mometasone (Oral Inhalation) Listerine Antiseptic: Eucalyptol 0.092%, menthol 0.042%, methyl salicylate DoD Uniform Formulary Outpatient Dosage Forms 0.06%, thymol 0.064% [contains alcohol 26.9%; original flavor, soft mint UNIFORM FORMULARY flavor, cool mint flavor, freshburst flavor] Aerosol, Inhalation, as furoate: Listerine Naturals Antiseptic: Eucalyptol 0.092%, menthol 0.042%, methyl Asmanex HFA: 100 mcg/actuation (13 g); 200 mcg/actuation (13 g) salicylate 0.06%, thymol 0.064% [contains alcohol 26.9%; herbal mint flavor] NONFORMULARY Listerine Ultraclean Antiseptic: Eucalyptol 0.092%, menthol 0.042%, methyl Aerosol Powder Breath Activated, Inhalation, as furoate: salicylate 0.06%, thymol 0.064% [contains alcohol 26.9%; arctic mint flavor, Asmanex 7 Metered Doses: 110 mcg/INH (1 ea) [contains milk protein] cool mint flavor, fresh citrus flavor] Asmanex 14 Metered Doses: 220 mcg/INH (1 ea) [contains milk protein] Asmanex 30 Metered Doses: 110 mcg/INH (1 ea); 220 mcg/INH (1 ea) Mouthwash, Magic [contains milk protein] DoD Uniform Formulary Outpatient Dosage Forms Asmanex 60 Metered Doses: 220 mcg/INH (1 ea) [contains milk protein] UNIFORM FORMULARY Asmanex 120 Metered Doses: 220 mcg/INH (1 ea) [contains milk protein] Extemporaneously prepared by Pharmacy Mometasone (Topical) Moxetumomab Pasudotox DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Cream, External, as furoate: Solution Reconstituted, Intravenous [preservative free]: Generic: 0.1% (15 g, 45 g) Lumoxiti: 1 mg (1 ea) [contains polysorbate 80] Lotion, External, as furoate: Elocon: 0.1% (30 mL, 60 mL) [contains isopropyl alcohol, propylene glycol] Moxifloxacin (Ophthalmic) Ointment, External, as furoate: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.1% (15 g, 45 g) UNIFORM FORMULARY Solution, External, as furoate: Solution, Ophthalmic: Generic: 0.1% (30 mL, 60 mL) Moxeza: 0.5% (3 mL) Vigamox: 0.5% (3 mL) Montelukast DoD Uniform Formulary Outpatient Dosage Forms Moxifloxacin (Systemic) BASIC CORE FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Packet, Oral: UNIFORM FORMULARY Generic: 4 mg/packet (1s, 30s) Solution, Intravenous: Tablet, Oral: Generic: 400 mg/250 mL (250 mL) Generic: 10 mg Tablet, Oral: Tablet Chewable, Oral: Generic: 400 mg Generic: 4 mg, 5 mg Mucosal Coating Agent Morphine and Naltrexone DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Gel, Mouth/Throat: Capsule, extended release, oral: Gelclair: 15 mL/packet (15 mL) Embeda 20/0.8: Morphine sulfate 20 mg and naltrexone hydrochloride 0.8 mg Liquid, Mouth/Throat: Embeda 30/1.2: Morphine sulfate 30 mg and naltrexone hydrochloride 1.2 mg Episil: (10 mL) 82 NAPROXEN

MuGard: (5 mL, 240 mL) [contains benzyl alcohol] Gel, External, as hydrochloride: Paste, Mouth/Throat: Naftin: 1% (40 g, 60 g, 90 g); 2% (45 g, 60 g) [contains alcohol, usp, edetate Orafate: 10% (30 mL) [contains methylparaben, propylparaben, saccharin disodium] sodium; strawberry flavor] Wafer, Mouth/Throat: Nalbuphine Mucotrol: (21 ea, 45 ea) [sugar free; mild licorice flavor] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY NONFORMULARY Solution, Injection, as hydrochloride: Paste, Mouth/Throat: Generic: 10 mg/mL (1 mL, 10 mL); 20 mg/mL (1 mL, 10 mL) ProThelial: 10% (125 mL, 250 mL, 500 mL) [contains methylparaben, propyl- paraben, saccharin sodium] Naldemedine DoD Uniform Formulary Outpatient Dosage Forms Mupirocin UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: BASIC CORE FORMULARY Symproic: 0.2 mg Ointment, External: Centany: 2% (30 g) Naloxegol Generic: 2% (22 g) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Cream, External, as calcium [strength expressed as base]: Movantik: 12.5 mg, 25 mg Generic: 2% (15 g, 30 g) Kit, External: Naloxone Centany AT: 2% [contains propylene glycol monostearate] DoD Uniform Formulary Outpatient Dosage Forms Ointment, Nasal, as calcium [strength expressed as base]: BASIC CORE FORMULARY Bactroban Nasal: 2% (1 g) Liquid, Nasal [spray]: Mycophenolate Narcan: 4 mg/0.1 mL (1 ea) [contains benzalkonium chloride, edetate disodium] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral, as mofetil: Solution, Injection, as hydrochloride: Generic: 250 mg Generic: 0.4 mg/mL (1 mL); 4 mg/10 mL (10 mL) Solution Reconstituted, Intravenous, as mofetil hydrochloride: Solution Cartridge, Injection, as hydrochloride: Generic: 500 mg (1 ea) Generic: 0.4 mg/mL (1 mL) Suspension Reconstituted, Oral, as mofetil: Solution Prefilled Syringe, Injection, as hydrochloride [preservative free]: Generic: 200 mg/mL (160 mL) Generic: 2 mg/2 mL (2 mL) Tablet, Oral, as mofetil: NONFORMULARY Generic: 500 mg Solution Auto-injector, Injection, as hydrochloride: Tablet Delayed Release, Oral, as mycophenolic acid: Evzio: 0.4 mg/0.4 mL (0.4 mL); 2 mg/0.4 mL (0.4 mL) Generic: 180 mg, 360 mg Naltrexone Nabilone DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Suspension Reconstituted, Intramuscular: Capsule, Oral: Vivitrol: 380 mg (1 ea) Cesamet: 1 mg Tablet, Oral, as hydrochloride: Nabumetone Generic: 50 mg DoD Uniform Formulary Outpatient Dosage Forms Naphazoline and Pheniramine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 500 mg, 750 mg Solution, Ophthalmic: Nadolol Naphcon-A: Naphazoline hydrochloride 0.025% and pheniramine maleate 0.3% (5 mL) [contains benzalkonium chloride; 2 bottles/box], (15 mL) DoD Uniform Formulary Outpatient Dosage Forms [contains benzalkonium chloride] UNIFORM FORMULARY Opcon-A: Naphazoline hydrochloride 0.027% and pheniramine maleate 0.3% Tablet, Oral: (15 mL) [contains benzalkonium chloride] Generic: 20 mg, 40 mg, 80 mg Visine-A: Naphazoline hydrochloride 0.025% and pheniramine maleate 0.3% Nadolol and Bendroflumethiazide (15 mL) [contains benzalkonium chloride] DoD Uniform Formulary Outpatient Dosage Forms Generic: Naphazoline hydrochloride 0.027% and pheniramine maleate 0.315% (15 mL) UNIFORM FORMULARY Tablet, Oral: Naphazoline (Ophthalmic) Generic: Nadolol 40 mg and bendroflumethiazide 5 mg DoD Uniform Formulary Outpatient Dosage Forms Generic: Nadolol 80 mg and bendroflumethiazide 5 mg UNIFORM FORMULARY Nafarelin Solution, Ophthalmic, as hydrochloride: Clear Eyes Redness Relief: Naphazoline 0.0125% and glycerin 0.2% (6 mL) DoD Uniform Formulary Outpatient Dosage Forms [contains benzalkonium chloride] UNIFORM FORMULARY Solution, Nasal: Naproxen Synarel: 2 mg/mL (8 mL) DoD Uniform Formulary Outpatient Dosage Forms Nafcillin BASIC CORE FORMULARY Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 250 mg, 500 mg UNIFORM FORMULARY Solution, Intravenous: UNIFORM FORMULARY Generic: 1 g/50 mL (50 mL); 2 g/100 mL (100 mL) Capsule, Oral, as sodium: Solution Reconstituted, Injection: Aleve: 220 mg Generic: 1 g (1 ea); 2 g (1 ea); 10 g (1 ea) Kit, Combination: Solution Reconstituted, Injection [preservative free]: Flanax Pain Relief: 500 mg [contains cetearyl alcohol, cremophor el, propyl- Generic: 1 g (1 ea); 2 g (1 ea); 10 g (1 ea) paraben] Solution Reconstituted, Intravenous: Naproxen Comfort Pac: 500 mg [contains methylparaben, trolamine (trietha- Generic: 1 g (1 ea); 2 g (1 ea) nolamine)] Suspension, Oral: Naftifine Generic: 125 mg/5 mL (500 mL) DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 375 mg Cream, External, as hydrochloride: Tablet, Oral, as sodium: Generic: 1% (60 g, 90 g); 2% (45 g, 60 g) Generic: 220 mg, 275 mg, 550 mg 83 NAPROXEN Tablet Delayed Release, Oral: Nelarabine EC-Naprosyn: 375 mg DoD Uniform Formulary Outpatient Dosage Forms EC-Naproxen: 375 mg, 500 mg UNIFORM FORMULARY Naproxen DR: 375 mg, 500 mg Solution, Intravenous: Arranon: 5 mg/mL (50 mL) NONFORMULARY Tablet Extended Release 24 Hour, Oral, as sodium [strength expressed as Nelfinavir base]: DoD Uniform Formulary Outpatient Dosage Forms Naprelan: 375 mg, 500 mg, 750 mg UNIFORM FORMULARY Generic: 375 mg, 500 mg Tablet, Oral: Naproxen and Diphenhydramine Viracept: 250 mg, 625 mg DoD Uniform Formulary Outpatient Dosage Forms Neomycin UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Caplet, Oral: UNIFORM FORMULARY Aleve PM: Naproxen sodium 220 mg and diphenhydramine hydrochlor- Tablet, Oral, as sulfate: ide 25 mg Generic: 500 mg Naproxen and Esomeprazole Neomycin and Polymyxin B DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Tier 4 - NOT COVERED Solution, Irrigation: Tablet Delayed Release, Oral: Generic: Neomycin 40 mg and polymyxin sulfate B 200,000 units per 1 mL (1 Naproxen [delayed release] 375 mg and esomeprazole [immediate release] mL, 20 mL) 20 mg [contains methylparaben, propylparaben] Naproxen [delayed release] 500 mg and esomeprazole [immediate release] Neomycin, Colistin, Hydrocortisone, and Thonzonium 20 mg [contains methylparaben, propylparaben] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Naproxen and Pseudoephedrine Suspension, otic [drops]: DoD Uniform Formulary Outpatient Dosage Forms Coly-Mycin S: Neomycin 0.33%, colistin 0.3%, hydrocortisone acetate 1%, UNIFORM FORMULARY and thonzonium bromide 0.05% (10 mL) [contains thimerosal] Caplet, extended release: Aleve-D Sinus & Cold: Naproxen sodium 220 mg [equivalent to naproxen Neomycin, Polymyxin B, and Dexamethasone 200 mg and sodium 20 mg] and pseudoephedrine hydrochloride 120 mg DoD Uniform Formulary Outpatient Dosage Forms Aleve-D Sinus & Headache: Naproxen sodium 220 mg [equivalent to nap- UNIFORM FORMULARY roxen 200 mg and sodium 20 mg] and pseudoephedrine hydrochloride Ointment, Ophthalmic: 120 mg Generic: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexame- thasone 0.1% per g (3.5 g) Sudafed 12 Hour Pressure + Pain: Naproxen sodium 220 mg [equivalent to Suspension, Ophthalmic [drops]: naproxen 200 mg and sodium 20 mg] and pseudoephedrine hydrochloride Generic: Neomycin 3.5 mg, polymyxin B sulfate 10,000 units, and dexame- 120 mg thasone 0.1% per 1 mL (5 mL) Naratriptan Neomycin, Polymyxin B, and Gramicidin DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Tablet, Oral: Solution, Ophthalmic [drops]: Generic: 1 mg, 2.5 mg Generic: Neomycin 1.75 mg, polymyxin B 10,000 units, and gramicidin Natalizumab 0.025 mg per 1 mL (10 mL) DoD Uniform Formulary Outpatient Dosage Forms Neomycin, Polymyxin B, and Hydrocortisone (Ophthalmic) NOT COVERED DoD Uniform Formulary Outpatient Dosage Forms Concentrate, Intravenous [preservative free]: UNIFORM FORMULARY Tysabri: 300 mg/15 mL (15 mL) [contains polysorbate 80] Suspension, Ophthalmic: Generic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone 1% Natamycin (7.5 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Neomycin, Polymyxin B, and Hydrocortisone (Otic) Suspension, Ophthalmic: DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FOR- Natacyn: 5% (15 mL) MULARY Solution, Otic: Nateglinide Generic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone DoD Uniform Formulary Outpatient Dosage Forms 10 mg per 1 mL (10 mL) UNIFORM FORMULARY Suspension, Otic: Tablet, Oral: Generic: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone Generic: 60 mg, 120 mg 10 mg per 1 mL (10 mL) Naxitamab Neomycin, Polymyxin B, and Hydrocortisone (Topical) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms NOT COVERED UNIFORM FORMULARY Cream, External: Solution, Intravenous [preservative free]: Cortisporin: Neomycin 3.5 mg, polymyxin B 10,000 units, and hydrocortisone Danyelza: Naxitamab-gqgk 4 mg/mL (10 mL) 0.5% per g (7.5 g) [contains methylparaben, propylene glycol] Necitumumab Neostigmine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Intravenous [preservative free]: Solution, Injection, as methylsulfate: Portrazza: 800 mg/50 mL (50 mL) [contains polysorbate 80] Generic: 0.5 mg/mL (10 mL); 1 mg/mL (10 mL) Nedocromil (Ophthalmic) Solution, Intravenous, as methylsulfate: Generic: 5 mg/10 mL (10 mL); 10 mg/10 mL (10 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution Prefilled Syringe, Intravenous, as methylsulfate: UNIFORM FORMULARY Generic: 4 mg/4 mL (4 mL); 5 mg/5 mL (5 mL) Solution, Ophthalmic, as sodium: Alocril: 2% (5 mL) [contains benzalkonium chloride] Nepafenac DoD Uniform Formulary Outpatient Dosage Forms Nefazodone UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Suspension, Ophthalmic: UNIFORM FORMULARY Ilevro: 0.3% (1.7 mL, 3 mL) [contains benzalkonium chloride, edetate diso- Tablet, Oral, as hydrochloride: dium, propylene glycol] Generic: 50 mg, 100 mg, 150 mg, 200 mg, 250 mg Nevanac: 0.1% (3 mL) [contains edentate disodium benzalkonium chloride] 84 NITROFURANTOIN Neratinib Lozenge, Mouth/Throat, as polacrilex: DoD Uniform Formulary Outpatient Dosage Forms Generic: 2 mg (24 ea, 27 ea); 4 mg (24 ea, 27 ea) UNIFORM FORMULARY Solution, Nasal: Tablet, Oral: Nicotrol NS: 10 mg/mL (10 mL) Nerlynx: 40 mg NIFEdipine Netarsudil DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY UNIFORM FORMULARY Tablet Extended Release 24 Hour, Oral: Solution, Ophthalmic: Generic: 30 mg, 60 mg, 90 mg Rhopressa: 0.02% (2.5 mL) [contains benzalkonium chloride] UNIFORM FORMULARY Netarsudil and Latanoprost Capsule, Oral: Generic: 10 mg, 20 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Nifurtimox Solution, Ophthalmic: DoD Uniform Formulary Outpatient Dosage Forms Rocklatan: Netarsudil dimesylate 0.02% and latanoprost 0.005% (2.5 mL) UNIFORM FORMULARY [contains benzalkonium chloride] Tablet, Oral: Netupitant and Palonosetron Lampit: 30 mg, 120 mg [contains corn starch] DoD Uniform Formulary Outpatient Dosage Forms Nilotinib UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral: UNIFORM FORMULARY Akynzeo: Netupitant 300 mg and palonosetron 0.5 mg Capsule, Oral: Nevirapine Tasigna: 150 mg, 200 mg DoD Uniform Formulary Outpatient Dosage Forms Nilutamide UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Suspension, Oral: UNIFORM FORMULARY Generic: 50 mg/5 mL (240 mL) Tablet, Oral: Tablet, Oral: Generic: 150 mg Generic: 200 mg Tablet Extended Release 24 Hour, Oral: NiMODipine Generic: 100 mg, 400 mg DoD Uniform Formulary Outpatient Dosage Forms Niacin UNIFORM FORMULARY Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 30 mg BASIC CORE FORMULARY Solution, Oral: Tablet Extended Release, Oral: Nymalize: 60 mg/20 mL (20 mL, 473 mL) [contains alcohol, usp, methylpar- Niaspan: 500 mg, 750 mg, 1000 mg aben, polyethylene glycol] UNIFORM FORMULARY Capsule Extended Release, Oral: Nintedanib Generic: 250 mg, 500 mg DoD Uniform Formulary Outpatient Dosage Forms Capsule Extended Release, Oral [preservative free]: UNIFORM FORMULARY Generic: 250 mg, 500 mg Capsule, Oral: Powder, Oral: Ofev: 100 mg, 150 mg Generic: (100 g, 1000 g) Tablet, Oral: Niraparib Generic: 50 mg, 100 mg, 250 mg, 500 mg DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral [preservative free]: UNIFORM FORMULARY Generic: 100 mg, 500 mg Capsule, Oral, as tosylate: Tablet Extended Release, Oral: Zejula: 100 mg Generic: 500 mg, 750 mg, 1000 mg Nitazoxanide Niacinamide DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Suspension Reconstituted, Oral: Tablet, Oral: Alinia: 100 mg/5 mL (60 mL) [contains sodium benzoate; strawberry flavor] Generic: 100 mg, 500 mg Tablet, Oral: Tablet, Oral [preservative free]: Alinia: 500 mg [contains corn starch, soybean lecithin] Generic: 100 mg, 500 mg Nitisinone NiCARdipine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral: Solution, Intravenous, as hydrochloride: Orfadin: 2 mg, 5 mg, 10 mg, 20 mg Cardene IV: 20 mg (200 mL); 40 mg (200 mL) Suspension, Oral: NONFORMULARY Orfadin: 4 mg/mL (90 mL) [contains polysorbate 80, sodium benzoate] Capsule, Oral, as hydrochloride: Tablet, Oral: Generic: 20 mg, 30 mg Nityr: 2 mg, 5 mg, 10 mg Solution, Intravenous, as hydrochloride: Generic: 2.5 mg/mL (10 mL); 25 mg/250 mL in Dextrose 5% (250 mL) Nitrofurantoin DoD Uniform Formulary Outpatient Dosage Forms Nicotine BASIC CORE FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral [macrocrystal]: BASIC CORE FORMULARY Generic: 50 mg Gum, Mouth/Throat, as polacrilex: Capsule, Oral [macrocrystal/monohydrate]: Generic: 2 mg (20 ea, 40 ea, 50 ea, 100 ea, 110 ea); 4 mg (20 ea, 40 ea, 50 Generic: 100 mg ea, 100 ea, 110 ea) UNIFORM FORMULARY Patch 24 Hour, Transdermal: Capsule, Oral [macrocrystal]: Generic: 7 mg/24 hr (7 ea, 14 ea); 14 mg/24 hr (7 ea, 14 ea); 21 mg/24 hr (7 Generic: 25 mg, 100 mg ea, 14 ea, 28 ea) Suspension, Oral: UNIFORM FORMULARY Generic: 25 mg/5 mL (230 mL, 240 mL) Inhaler, Inhalation: Nicotrol: 10 mg (168 ea) [contains menthol] Kit, Transdermal: Generic: 7 mg/24 hr (14s) & 14 mg/24 hr (14s) & 21 mg/24 hr (28s) 85 NITROGLYCERIN Nitroglycerin Norethindrone and Mestranol DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY UNIFORM FORMULARY Patch 24 Hour, Transdermal: Tablet, monophasic formulations: Generic: 0.1 mg/hour (30s); 0.2 mg/hour (30s); 0.4 mg/hour (30s); 0.6 mg/ Necon 1/50: Norethindrone 1 mg and mestranol 0.05 mg [21 light blue tablets hour (30s) and 7 white inactive tablets] (28s) Solution, Translingual: Generic: 0.4 mg/spray (4.9 g, 12 g) Nortriptyline Tablet, Sublingual: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.4 mg BASIC CORE FORMULARY Capsule, Oral: UNIFORM FORMULARY Generic: 10 mg, 25 mg, 50 mg Aerosol Solution, Translingual: Solution, Oral: Generic: 400 mcg/spray (4.1 g, 8.5 g) Generic: 10 mg/5 mL (473 mL) Capsule Extended Release, Oral: Generic: 2.5 mg, 6.5 mg, 9 mg Nusinersen Ointment, Rectal: DoD Uniform Formulary Outpatient Dosage Forms Rectiv: 0.4% (30 g) [contains propylene glycol] UNIFORM FORMULARY Ointment, Transdermal: Solution, Intrathecal [preservative free]: Nitro-Bid: 2% (1 g, 30 g, 60 g) Spinraza: 12 mg/5 mL (5 mL) Solution, Intravenous: Generic: 25 mg (250 mL); 50 mg (250 mL, 500 mL); 100 mg (250 mL); Nutritional Formula, Enteral/Oral 200 mg (500 mL); 5 mg/mL (10 mL) DoD Uniform Formulary Outpatient Dosage Forms Tablet, Sublingual: UNIFORM FORMULARY Generic: 0.3 mg, 0.6 mg Liquid: Calcium and sodium caseinate, maltodextrin, sucrose, partially hydro- NONFORMULARY genated soy oil, soy lecithin Packet, Sublingual: Powder: Amino acids, predigested carbohydrates, safflower oil GoNitro: 400 mcg (1 ea, 36 ea) Nystatin and Triamcinolone Nitroprusside DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Cream, External: Solution, Intravenous, as sodium: Generic: Nystatin 100,000 units and triamcinolone acetonide 0.1% (15 g, Nitropress: 25 mg/mL (2 mL) 30 g, 60 g) Solution, Intravenous, as sodium [preservative free]: Ointment, External: Nipride RTU: 50 mg/100 mL in NaCl 0.9% (100 mL) Generic: Nystatin 100,000 units and triamcinolone acetonide 0.1% (15 g, Generic: 25 mg/mL (2 mL) 30 g, 60 g) Nivolumab Nystatin (Oral) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Solution, Intravenous [preservative free]: Suspension, Mouth/Throat: Opdivo: 40 mg/4 mL (4 mL); 100 mg/10 mL (10 mL) [contains polysorbate 80] Generic: 100,000 units/mL (5 mL, 60 mL, 473 mL) Nizatidine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral [preservative free]: UNIFORM FORMULARY Bio-Statin: 500,000 units, 1,000,000 units [dye free] Capsule, Oral: Powder, Oral: Generic: 150 mg, 300 mg Bio-Statin: (1 ea) Solution, Oral: Tablet, Oral: Generic: 15 mg/mL (480 mL) Generic: 500,000 units Nonoxynol 9 Nystatin (Topical) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Film, Vaginal: Cream, External: VCF Vaginal Contraceptive: 28% (3 ea, 6 ea, 9 ea) [contains glycerin, polyvinyl Generic: 100,000 units/g (15 g, 30 g) alcohol] Ointment, External: Foam, Vaginal: Generic: 100,000 units/g (15 g, 30 g) VCF Vaginal Contraceptive: 12.5% (17 g) [hormone free; contains benzoic UNIFORM FORMULARY acid, cetyl alcohol, methylparaben, propylene glycol] Powder, External: Gel, Vaginal: Generic: 100,000 units/g (15 g, 30 g, 60 g) Options Conceptrol: 4% (2.55 g) [hormone free; contains methylparaben, propylene glycol] Oatmeal (Colloidal) Options Gynol II Contraceptive: 3% (81 g) [hormone free; contains methylpar- DoD Uniform Formulary Outpatient Dosage Forms aben, propylene glycol] UNIFORM FORMULARY Shur-Seal Contraceptive: 2% (24 ea) Cream, External: VCF Vaginal Contraceptive: 4% (2.55 g) [hormone free; contains edetate Gold Bond Ultra Eczema: 2% (226 g) trisodium, methylparaben, propylene glycol, sodium benzoate] Packet, External Miscellaneous, Vaginal: Aveeno Soothing Bath: 8 ea Today Sponge: 1000 mg (3 ea) [contains benzoic acid, sodium metabisulfite] Obeticholic Acid Norepinephrine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Solution, Intravenous [strength expressed as base]: Ocaliva: 5 mg, 10 mg Generic: 1 mg/mL (4 mL) Solution, Intravenous [strength expressed as base, preservative free]: Obinutuzumab Generic: 1 mg/mL (4 mL) DoD Uniform Formulary Outpatient Dosage Forms Norethindrone UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous [preservative free]: BASIC CORE FORMULARY Gazyva: 1000 mg/40 mL (40 mL) Tablet, Oral: Ocrelizumab Generic: 0.35 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral, as acetate: Solution, Intravenous [preservative free]: Generic: 5 mg Ocrevus: 300 mg/10 mL (10 mL) 86 OMEPRAZOLE Ocriplasmin Tablet, Oral, as medoxomil: DoD Uniform Formulary Outpatient Dosage Forms Generic: 5 mg, 20 mg, 40 mg UNIFORM FORMULARY Olmesartan and Hydrochlorothiazide Solution, Intraocular [preservative free]: Jetrea: 0.5 mg/0.2 mL (0.2 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Octreotide Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms 20/12.5: Olmesartan 20 mg and hydrochlorothiazide 12.5 mg UNIFORM FORMULARY 40/12.5: Olmesartan medoxomil 40 mg and hydrochlorothiazide 12.5 mg Kit, Intramuscular: 40/25: Olmesartan medoxomil 40 mg and hydrochlorothiazide 25 mg SandoSTATIN LAR Depot: 10 mg, 20 mg, 30 mg Solution, Injection: Olodaterol Generic: 50 mcg/mL (1 mL); 100 mcg/mL (1 mL); 200 mcg/mL (5 mL); 1000 DoD Uniform Formulary Outpatient Dosage Forms mcg/5 mL (5 mL); 500 mcg/mL (1 mL); 1000 mcg/mL (5 mL) UNIFORM FORMULARY Solution, Injection [preservative free]: Aerosol Solution, Inhalation: Generic: 100 mcg/mL (1 mL); 500 mcg/mL (1 mL) Striverdi Respimat: 2.5 mcg/actuation (4 g) [contains benzalkonium chloride, edetate disodium] NONFORMULARY Capsule Delayed Release, Oral, as acetate: Olopatadine (Ophthalmic) Mycapssa: 20 mg DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY Ofatumumab Solution, Ophthalmic: DoD Uniform Formulary Outpatient Dosage Forms Patanol: 0.1% (5 mL) [contains benzalkonium chloride] UNIFORM FORMULARY Generic: 0.1% (5 mL) Solution Auto-injector, Subcutaneous [preservative free]: Kesimpta: 20 mg/0.4 mL (0.4 mL) [contains disodium edta, polysorbate 80] UNIFORM FORMULARY Solution, Ophthalmic: NOT COVERED Pazeo: 0.7% (2.5 mL) [contains benzalkonium chloride] Concentrate, Intravenous [preservative free]: Arzerra: 100 mg/5 mL (5 mL); 1000 mg/50 mL (50 mL) [contains edetate NOT COVERED disodium, mouse (murine) and/or hamster protein, polysorbate 80] Solution, Ophthalmic: Pataday: 0.2% (2.5 mL) [contains benzalkonium chloride, edetate disodium] Ofloxacin (Ophthalmic) Generic: 0.2% (2.5 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Olsalazine Solution, Ophthalmic: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.3% (5 mL, 10 mL) UNIFORM FORMULARY Aerosol Solution, Inhalation: Ofloxacin (Otic) Striverdi Respimat: 2.5 mcg/actuation (4 g) [contains benzalkonium chloride, DoD Uniform Formulary Outpatient Dosage Forms edetate disodium] UNIFORM FORMULARY Solution, Otic: Omacetaxine Generic: 0.3% (5 mL, 10 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Ofloxacin (Systemic) Solution Reconstituted, Subcutaneous, as mepesuccinate [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Synribo: 3.5 mg (1 ea) UNIFORM FORMULARY Tablet, Oral: Omalizumab Generic: 300 mg, 400 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY OLANZapine Solution Reconstituted, Subcutaneous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Xolair: 150 mg (1 ea) UNIFORM FORMULARY Solution Reconstituted, Intramuscular: Ombitasvir, Paritaprevir, and Ritonavir Generic: 10 mg (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Suspension Reconstituted, Intramuscular: UNIFORM FORMULARY ZyPREXA Relprevv: 210 mg (1 ea); 300 mg (1 ea); 405 mg (1 ea) [contains Tablet, Oral: polysorbate 80] Technivie: Ombitasvir 12.5 mg, paritaprevir 75 mg, and ritonavir 50 mg Tablet, Oral: Generic: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir Tablet Dispersible, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 5 mg, 10 mg, 15 mg, 20 mg UNIFORM FORMULARY Combination package: Olanzapine and Fluoxetine Viekira Pak [28 day supply]: DoD Uniform Formulary Outpatient Dosage Forms Tablet, oral: Ombitasvir 12.5 mg, paritaprevir 75 mg, and ritonavir UNIFORM FORMULARY 50 mg (56s) Capsule, Oral: Tablet, oral: Dasabuvir 250 mg (56s) Generic 3/25: Olanzapine 3 mg and fluoxetine 25 mg Tablet Extended Release, Oral: Generic 6/25: Olanzapine 6 mg and fluoxetine 25 mg Viekira XR: Ombitasvir 8.33 mg, paritaprevir 50 mg, ritonavir 33.33 mg, and Generic 6/50: Olanzapine 6 mg and fluoxetine 50 mg dasabuvir 200 mg Generic 12/25: Olanzapine 12 mg and fluoxetine 25 mg Generic 12/50: Olanzapine 12 mg and fluoxetine 50 mg Omega-3 Fatty Acids Olanzapine and Samidorphan DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Olaparib Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 300 mg, 500 mg, 1000 mg, 1 g UNIFORM FORMULARY Capsule, Oral [preservative free]: Capsule, Oral: Generic: 200 mg, 1000 mg, 1200 mg Lynparza: 50 mg Capsule Delayed Release, Oral: Pro Nutrients Omega 3: 332.5 mg Olaratumab Generic: 1000 mg DoD Uniform Formulary Outpatient Dosage Forms Tablet Chewable, Oral: UNIFORM FORMULARY Omega-3 IQ: 240 mg [fruit flavor] Solution, Intravenous [preservative free]: Lartruvo: 190 mg/19 mL (19 mL); 500 mg/50 mL (50 mL) Omeprazole DoD Uniform Formulary Outpatient Dosage Forms Olmesartan BASIC CORE FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule Delayed Release, Oral: UNIFORM FORMULARY Generic: 10 mg, 20 mg, 40 mg 87 OMEPRAZOLE UNIFORM FORMULARY Orlistat Capsule Delayed Release, Oral, as magnesium [strength expressed as base]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 20 mg UNIFORM FORMULARY Packet, Oral, as magnesium [strength expressed as base]: Capsule, Oral: PriLOSEC: 2.5 mg (30 ea); 10 mg (30 ea) Alli: 60 mg Suspension, Oral: First-Omeprazole: 2 mg/mL (90 mL, 150 mL, 300 mL) [contains benzyl NONFORMULARY alcohol, fd&c red #40, saccharin sodium; strawberry flavor] Capsule, Oral: Omeprazole+Syrspend SF Alka: 2 mg/mL (120 mL, 240 mL) Xenical: 120 mg Omeprazole+Syrspend SF Alka: 2 mg/mL (100 mL) [cherry flavor] Tablet Delayed Release, Oral: Orphenadrine Generic: 20 mg DoD Uniform Formulary Outpatient Dosage Forms Tablet Delayed Release, Oral, as magnesium [strength expressed as base]: UNIFORM FORMULARY PriLOSEC OTC: 20 mg Solution, Injection, as citrate: Generic: 30 mg/mL (2 mL) Omeprazole, Clarithromycin, and Amoxicillin Solution, Injection, as citrate [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 30 mg/mL (2 mL) UNIFORM FORMULARY Tablet Extended Release 12 Hour, Oral, as citrate: Combination package, oral [each administration card contains]: Generic: 100 mg Omeclamox-Pak: Capsule, delayed release: Omeprazole: 20 mg (2s) Orphenadrine, Aspirin, and Caffeine Tablet: Clarithromycin: 500 mg (2s) DoD Uniform Formulary Outpatient Dosage Forms Capsule: Amoxicillin: 500 mg (4s) [contains sodium ≤0.0052 mEq UNIFORM FORMULARY (0.119 mg)/capsule] Tablet, Oral: Norgesic Forte: Orphenadrine citrate 50 mg, aspirin 770 mg, and caf- OnabotulinumtoxinA feine 60 mg DoD Uniform Formulary Outpatient Dosage Forms Orphengesic Forte: Orphenadrine citrate 50 mg, aspirin 770 mg, and caf- UNIFORM FORMULARY feine 60 mg Solution Reconstituted, Injection: Generic: Orphenadrine citrate 50 mg, aspirin 770 mg, and caffeine 60 mg Botox: 100 units (1 ea) Solution Reconstituted, Injection [preservative free]: Oseltamivir Botox: 200 units (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intramuscular: UNIFORM FORMULARY Botox Cosmetic: 100 units (1 ea) [contains albumin human] Capsule, Oral, as phosphate: Solution Reconstituted, Intramuscular [preservative free]: Generic: 30 mg, 45 mg, 75 mg Botox Cosmetic: 50 units (1 ea) [contains albumin human] Suspension Reconstituted, Oral, as base: Ondansetron Tamiflu: 6 mg/mL (60 mL) [contains saccharin sodium, sodium benzoate, sorbitol; tutti-frutti flavor] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Osilodrostat Solution, Injection, as hydrochloride [strength expressed as base]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 4 mg/2 mL (2 mL); 40 mg/20 mL (20 mL) UNIFORM FORMULARY Solution, Injection, as hydrochloride [strength expressed as base, preservative Tablet, Oral: free]: Isturisa: 1 mg, 5 mg, 10 mg Generic: 4 mg/2 mL (2 mL) Solution, Intravenous, as hydrochloride [strength expressed as base]: Osimertinib Generic: 12 mg/50 mL in NaCl 0.9% (50 mL); 16 mg/50 mL in NaCl 0.9% (50 DoD Uniform Formulary Outpatient Dosage Forms mL); 8 mg/50 mL in NaCl 0.9% (50 mL) UNIFORM FORMULARY Solution, Oral, as hydrochloride [strength expressed as base]: Tablet, Oral: Generic: 4 mg/5 mL (50 mL) Tagrisso: 40 mg, 80 mg Tablet, Oral: Generic: 24 mg Ospemifene Tablet, Oral, as hydrochloride [strength expressed as base]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 4 mg, 8 mg UNIFORM FORMULARY Tablet Dispersible, Oral: Tablet, Oral: Generic: 4 mg, 8 mg Osphena: 60 mg NONFORMULARY Film, Oral: Oxacillin Zuplenz: 4 mg (1 ea, 10 ea, 30 ea); 8 mg (1 ea, 10 ea, 30 ea) DoD Uniform Formulary Outpatient Dosage Forms Ophthalmic Irrigant Mixture UNIFORM FORMULARY Solution, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Bactocill in Dextrose: 1 g/50 mL (50 mL); 2 g/50 mL (50 mL) UNIFORM FORMULARY Solution Reconstituted, Injection: Solution, Ophthalmic: Generic: 1 g (1 ea); 2 g (1 ea); 10 g (1 ea) Generic: 15 mL, 30 mL, 120 mL Solution Reconstituted, Injection [preservative free]: Opicapone Generic: 1 g (1 ea); 2 g (1 ea); 10 g (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Oxaliplatin UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral: Ongentys: 50 mg UNIFORM FORMULARY Solution, Intravenous [preservative free]: Opium Tincture Generic: 50 mg/10 mL (10 mL); 100 mg/20 mL (20 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous [preservative free]: UNIFORM FORMULARY Generic: 50 mg (1 ea); 100 mg (1 ea) Tincture, Oral: Generic: 10 mg/mL (1%) (118 mL, 473 mL) Oxandrolone DoD Uniform Formulary Outpatient Dosage Forms Oral Rehydration Therapy UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 2.5 mg, 10 mg Packet, Oral [preservative free]: NONFORMULARY DripDrop: (4 ea) [no artificial color(s), no artificial flavor(s); berry flavor] Tablet, Oral: DripDrop: (4 ea) [no artificial color(s), no artificial flavor(s); lemon flavor] Oxandrin: 2.5 mg, 10 mg Oritavancin Oxaprozin DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution Reconstituted, Intravenous: Tablet, Oral: Orbactiv: 400 mg (1 ea, 3 ea) Generic: 600 mg 88 PALBOCICLIB Oxazepam Oxycodone and Ibuprofen DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral: Tablet, Oral: Generic: 10 mg, 15 mg, 30 mg Oxycodone hydrochloride 5 mg and ibuprofen 400 mg OXcarbazepine Oxymetazoline (Nasal) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Suspension, Oral: Solution, Nasal, as hydrochloride: Generic: 300 mg/5 mL (250 mL) 12 Hour Nasal Spray: 0.05% (15 mL, 30 mL) Tablet, Oral: Afrin Nasal Spray: 0.05% (15 mL, 20 mL, 30 mL) Generic: 150 mg, 300 mg, 600 mg Dristan Spray: 0.05% (15 mL) [contains benzalkonium chloride, disodium edta] Tablet Extended Release 24 Hour, Oral: Long Lasting Nasal Spray: 0.05% (30 mL) [contains benzalkonium chloride] Oxtellar XR: 150 mg, 300 mg, 600 mg Mucinex Nasal Spray: 0.05% (22 mL) Oxybate Salts (Calcium, Magnesium, Potassium, and Sodium) Nasal Decongestant Spray: 0.05% (15 mL, 30 mL) [contains benzalkonium chloride] DoD Uniform Formulary Outpatient Dosage Forms Nasal Spray 12 Hour: 0.05% (30 mL) UNIFORM FORMULARY Neo-Synephrine 12 Hour Spray: 0.05% (15 mL) Solution, Oral: Xywav: 500 mg/mL (180 mL) [barley free, gluten free, rye free, wheat free] QlearQuil: 0.05% (15 mL) [contains benzalkonium chloride, disodium edta] Sinus Nasal Spray: 0.05% (30 mL) Oxybutynin Vicks: 0.05% (15 mL) DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.05% (30 mL) BASIC CORE FORMULARY Tablet Extended Release 24 Hour, Oral, as chloride: Oxymetazoline (Ophthalmic) Generic: 5 mg, 10 mg, 15 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Ophthalmic, as hydrochloride [preservative free]: Syrup, Oral, as chloride: Upneeq: 0.1% (30 ea) Generic: 5 mg/5 mL (473 mL) Tablet, Oral, as chloride: Oxymetholone Generic: 5 mg DoD Uniform Formulary Outpatient Dosage Forms NONFORMULARY UNIFORM FORMULARY Gel, Transdermal, as chloride: Tablet, Oral: Gelnique: 10% (1 g) [contains alcohol, usp] Anadrol-50: 50 mg [scored] Patch Twice Weekly, Transdermal: OxyMORphone Oxytrol: 3.9 mg/24 hr (1 ea, 2 ea, 4 ea, 8 ea) Oxytrol For Women: 3.9 mg/24 hr (4 ea, 8 ea) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Oxychlorosene Solution, Injection, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Opana: 1 mg/mL (1 mL) NOT COVERED Tablet, Oral, as hydrochloride: Powder for solution, topical, as sodium: Generic: 5 mg, 10 mg Clorpactin WCS-90: 2 g/bottle Tablet ER 12 Hour Abuse-Deterrent, Oral, as hydrochloride: Opana ER: 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg, 30 mg, 40 mg OxyCODONE Tablet Extended Release 12 Hour, Oral, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Generic: 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg, 30 mg, 40 mg UNIFORM FORMULARY Capsule, Oral, as hydrochloride: Oxytocin Generic: 5 mg DoD Uniform Formulary Outpatient Dosage Forms Concentrate, Oral, as hydrochloride: UNIFORM FORMULARY Generic: 100 mg/5 mL (15 mL, 30 mL) Solution, Injection: Solution, Oral, as hydrochloride: Generic: 10 units/mL (1 mL, 10 mL, 30 mL) Generic: 5 mg/5 mL (5 mL, 15 mL, 473 mL, 500 mL) Tablet, Oral, as hydrochloride: Ozanimod Generic: 5 mg, 10 mg, 15 mg, 20 mg, 30 mg DoD Uniform Formulary Outpatient Dosage Forms Tablet Abuse-Deterrent, Oral, as hydrochloride: UNIFORM FORMULARY Oxaydo: 5 mg, 7.5 mg Capsule Therapy Pack, Oral: Tablet ER 12 Hour Abuse-Deterrent, Oral, as hydrochloride: Zeposia 7-Day Starter Pack: Ozanimod 0.23 mg (4 capsules) and ozanimod Generic: 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 60 mg, 80 mg 0.46 (3 capsules) (7 ea) NONFORMULARY Zeposia Starter Kit: Ozanimod 0.23 mg (4 capsules), ozanimod 0.46 mg (3 Capsule ER 12 Hour Abuse-Deterrent, Oral: capsules), and ozanimod 0.92 mg (30 capsules) (37 ea) Xtampza ER: 9 mg (100 ea); 13.5 mg (100 ea); 18 mg (100 ea); 27 mg (100 ea); 36 mg (100 ea) PACLitaxel (Conventional) Tablet Abuse-Deterrent, Oral: DoD Uniform Formulary Outpatient Dosage Forms RoxyBond: 15 mg, 30 mg UNIFORM FORMULARY Concentrate, Intravenous: Oxycodone and Acetaminophen Generic: 100 mg/16.7 mL (16.7 mL); 30 mg/5 mL (5 mL); 150 mg/25 mL (25 DoD Uniform Formulary Outpatient Dosage Forms mL); 300 mg/50 mL (50 mL) BASIC CORE FORMULARY Concentrate, Intravenous [preservative free]: Tablet, Oral: Generic: 100 mg/16.7 mL (16.7 mL); 30 mg/5 mL (5 mL); 300 mg/50 mL Generic: 5/325: Oxycodone hydrochloride 5 mg and acetaminophen 325 mg (50 mL) UNIFORM FORMULARY Solution, Oral: PACLitaxel (Protein Bound) Oxycodone hydrochloride 5 mg and acetaminophen 325 mg per 5 mL DoD Uniform Formulary Outpatient Dosage Forms (500 mL) UNIFORM FORMULARY Tablet, Oral: Suspension Reconstituted, Intravenous: 2.5/325: Oxycodone hydrochloride 2.5 mg and acetaminophen 325 mg; Abraxane: 100 mg (1 ea) 7.5/325: Oxycodone hydrochloride 7.5 mg and acetaminophen 325 mg 10/325: Oxycodone hydrochloride 10 mg and acetaminophen 325 mg Palbociclib Tablet, Extended Release, Oral: DoD Uniform Formulary Outpatient Dosage Forms Xartemis XR: Oxycodone hydrochloride 7.5 mg and acetaminophen 325 mg UNIFORM FORMULARY Capsule, Oral: Oxycodone and Aspirin Ibrance: 75 mg, 100 mg, 125 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Tablet, Oral: Generic: Oxycodone hydrochloride 4.8355 mg and aspirin 325 mg 89 PALIPERIDONE Paliperidone Tablet Delayed Release, Oral: DoD Uniform Formulary Outpatient Dosage Forms Protonix: 20 mg, 40 mg UNIFORM FORMULARY Papaverine Suspension, Intramuscular, as palmitate: DoD Uniform Formulary Outpatient Dosage Forms Invega Sustenna: 39 mg/0.25 mL (0.25 mL); 78 mg/0.5 mL (0.5 mL); 117 mg/ UNIFORM FORMULARY 0.75 mL (0.75 mL); 156 mg/mL (1 mL); 234 mg/1.5 mL (1.5 mL) [contains Solution, Injection, as hydrochloride: polyethylene glycol] Generic: 30 mg/mL (2 mL, 10 mL) Invega Trinza: 410 mg/1.315 mL (1.315 mL); 273 mg/0.875 mL (0.875 mL); 546 mg/1.75 mL (1.75 mL); 819 mg/2.625 mL (2.625 mL) [contains poly- Papillomavirus (9-Valent) Vaccine (Human, Recombinant) ethylene glycol] DoD Uniform Formulary Outpatient Dosage Forms Tablet Extended Release 24 Hour, Oral: UNIFORM FORMULARY Generic: 1.5 mg, 3 mg, 6 mg, 9 mg Suspension, Intramuscular [preservative free]: Palivizumab Gardasil 9: (0.5 mL) [contains polysorbate 80, yeast extract] Suspension Prefilled Syringe, Intramuscular [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Gardasil 9: (0.5 mL) [contains polysorbate 80, yeast extract] UNIFORM FORMULARY Solution, Intramuscular [preservative free]: Papillomavirus (Types 6, 11, 16, 18) Vaccine (Human, Synagis: 50 mg/0.5 mL (0.5 mL); 100 mg/mL (1 mL) [contains glycine, Recombinant) histidine] DoD Uniform Formulary Outpatient Dosage Forms Palonosetron UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Injection, suspension [preservative free]: UNIFORM FORMULARY Gardasil: HPV 6 L1 protein 20 mcg, HPV 11 L1 protein 40 mcg, HPV 16 L1 Solution, Intravenous: protein 40 mcg, and HPV 18 L1 protein 20 mcg per 0.5 mL (0.5 mL) [contains Aloxi: 0.25 mg/5 mL (5 mL) [contains edetate disodium] aluminum, polysorbate 80; manufactured using S. cerevisiae (baker's yeast)] Pamidronate Parathyroid Hormone DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Intravenous, as disodium: Cartridge, Subcutaneous: Generic: 30 mg/10 mL (10 mL); 90 mg/10 mL (10 mL) Natpara: 25 mcg (1 ea); 50 mcg (1 ea); 75 mcg (1 ea); 100 mcg (1 ea) Solution, Intravenous, as disodium [preservative free]: [contains metacresol] Generic: 6 mg/mL (10 mL) Paregoric Solution Reconstituted, Intravenous, as disodium: DoD Uniform Formulary Outpatient Dosage Forms Generic: 30 mg (1 ea); 90 mg (1 ea) UNIFORM FORMULARY Pancrelipase Tincture, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 2 mg/5 mL (473 mL) BASIC CORE FORMULARY Paricalcitol Capsule, Delayed Release, Enteric Coated Microspheres, Oral [porcine DoD Uniform Formulary Outpatient Dosage Forms derived]: UNIFORM FORMULARY Creon: Lipase 3000 USP units, protease 9500 USP units, and amylase 15,000 Capsule, Oral: USP units Generic: 1 mcg, 2 mcg, 4 mcg Creon: Lipase 6000 USP units, protease 19,000 USP units, and amylase Solution, Intravenous: 30,000 USP units Generic: 2 mcg/mL (1 mL); 5 mcg/mL (1 mL, 2 mL) Creon: Lipase 12,000 USP units, protease 38,000 USP units, and amylase 60,000 USP units Paromomycin Creon: Lipase 36,000 USP units, protease 114,000 USP units, and amylase DoD Uniform Formulary Outpatient Dosage Forms 180,000 USP units UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral: Tablet, Oral [porcine derived]: Generic: 250 mg Viokace: Lipase 10,440 USP units, protease 39,150 USP units, and amylase PARoxetine 39,150 USP units DoD Uniform Formulary Outpatient Dosage Forms Viokace: Lipase 20,880 USP units, protease 78,300 USP units, and amylase UNIFORM FORMULARY 78,300 USP units Capsule, Oral, as mesylate [strength expressed as base]: NONFORMULARY Brisdelle: 7.5 mg Capsule, delayed release: Suspension, Oral, as hydrochloride [strength expressed as base]: Pancreaze; Pertzye; Ultresa; Zenpep Paxil: 10 mg/5 mL (250 mL) [contains methylparaben, propylene glycol, propylparaben, saccharin sodium; orange flavor] Pancuronium Tablet, Oral, as hydrochloride [strength expressed as base]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 10 mg, 20 mg, 30 mg, 40 mg UNIFORM FORMULARY Tablet, Oral, as mesylate [strength expressed as base]: Solution, Intravenous, as bromide: Pexeva: 10 mg, 20 mg, 30 mg, 40 mg Generic: 1 mg/mL (10 mL); 2 mg/mL (2 mL, 5 mL) Tablet Extended Release 24 Hour, Oral, as hydrochloride [strength expressed as base]: Panitumumab Generic: 12.5 mg, 25 mg, 37.5 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Pasireotide Solution, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Vectibix: 100 mg/5 mL (5 mL); 400 mg/20 mL (20 mL) UNIFORM FORMULARY Solution, Subcutaneous: Panobinostat Signifor: 0.3 mg/mL (1 mL); 0.6 mg/mL (1 mL); 0.9 mg/mL (1 mL) DoD Uniform Formulary Outpatient Dosage Forms Suspension Reconstituted ER, Intramuscular, as pamoate [strength expressed UNIFORM FORMULARY as base]: Capsule, Oral: Signifor LAR: 20 mg (1 ea); 40 mg (1 ea); 60 mg (1 ea) Farydak: 10 mg, 15 mg, 20 mg Patiromer Pantoprazole DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Packet, Oral: Packet, Oral Veltassa: 8.4 g (1 ea, 4 ea, 30 ea); 16.8 g (1 ea, 30 ea); 25.2 g (1 ea, 30 ea) Generic: 40 mg (1 ea, 30 ea) Tablet Delayed Release, Oral: Patisiran Generic: 20 mg, 40 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Packet, Oral: Solution, Intravenous [preservative free]: Protonix: 40 mg (1 ea, 30 ea) [contains polysorbate 80] Onpattro: 10 mg/5 mL (5 mL) 90 PENTAMIDINE (ORAL INHALATION) PAZOPanib Solution Reconstituted, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Keytruda: 50 mg (1 ea) [contains polysorbate 80] UNIFORM FORMULARY PEMEtrexed Tablet, Oral: Votrient: 200 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Pegademase Bovine Solution Reconstituted, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Alimta: 100 mg (1 ea); 500 mg (1 ea) UNIFORM FORMULARY Solution, Intramuscular: Pemigatinib Adagen: 250 units/mL (1.5 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Pegaptanib Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Pemazyre: 4.5 mg, 9 mg, 13.5 mg UNIFORM FORMULARY Solution, Intraocular [preservative free]: Penciclovir Macugen: 0.3 mg (0.09 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Pegaspargase Cream, External: DoD Uniform Formulary Outpatient Dosage Forms Denavir: 1% (5 g) [contains cetostearyl alcohol, propylene glycol] UNIFORM FORMULARY Solution, Injection [preservative free]: PenicillAMINE Oncaspar: 750 units/mL (5 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Pegfilgrastim Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Cuprimine: 250 mg BASIC CORE FORMULARY Tablet, Oral: Solution Prefilled Syringe, Subcutaneous [preservative free]: Depen Titratabs: 250 mg [scored] Udenyca: pegfilgrastim-cbqv 6 mg/0.6 mL (0.6 mL) UNIFORM FORMULARY Penicillin V Potassium Prefilled Syringe Kit, Subcutaneous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Neulasta Onpro: 6 mg/0.6 mL (0.6 mL) BASIC CORE FORMULARY Solution Prefilled Syringe, Subcutaneous [preservative free]: Solution Reconstituted, Oral: Fulphila: 6 mg/0.6 mL (0.6 mL) Generic: 125 mg/5 mL (100 mL, 200 mL); 250 mg/5 mL (100 mL, 200 mL) Ziextenzo: pegfilgrastim-bmez 6 mg/0.6 mL (0.6 mL) Tablet, Oral: Solution, Subcutaneous [preservative free]: Generic: 250 mg, 500 mg Neulasta: 6 mg/0.6 mL (0.6 mL) NONFORMULARY Penicillin G Benzathine Solution Prefilled Syringe, Subcutaneous, as pegfilgrastim-jmdb [preservative DoD Uniform Formulary Outpatient Dosage Forms free]: UNIFORM FORMULARY Nyvepria: pegfilgrastim-apgf 6 mg/0.6 mL (0.6 mL) Suspension, Intramuscular: Bicillin L-A: 600,000 units/mL (1 mL); 1,200,000 units/2 mL (2 mL); 2,400,000 Peginterferon Alfa-2a units/4 mL (4 mL) [contains methylparaben, propylparaben] DoD Uniform Formulary Outpatient Dosage Forms Extended Core Formulary Penicillin G Benzathine and Penicillin G Procaine Solution, Subcutaneous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Pegasys: 180 mcg/0.5 mL [contains benzyl alcohol] UNIFORM FORMULARY Pegasys: 180 mcg/mL (0.5 mg, 1 mL) [contains benzyl alcohol, polysor- Injection, suspension [prefilled syringe]: bate 80] Bicillin C-R: 1,200,000 units: Penicillin G benzathine 600,000 units and penicillin G UNIFORM FORMULARY procaine 600,000 units per 2 mL (2 mL) Solution, Subcutaneous [preservative free]: Bicillin C-R 900/300: 1,200,000 units: Penicillin G benzathine 900,000 units Pegasys ProClick: 135 mcg/0.5 mL (0.5 mL); 180 mcg/0.5 mL (0.5 mL) and penicillin G procaine 300,000 units per 2 mL (2 mL) [contains benzyl alcohol, polysorbate 80] Penicillin G (Parenteral/Aqueous) Peginterferon Alfa-2b DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Intravenous, as potassium: Kit, Subcutaneous [preservative free]: Generic: 20,000 units/mL (50 mL); 40,000 units/mL (50 mL); 60,000 units/mL Peg-Intron Redipen: 50 mcg/0.5 mL, 80 mcg/0.5 mL, 120 mcg/0.5 mL, 150 (50 mL) mcg/0.5 mL Solution Reconstituted, Injection, as potassium: Peg-Intron Redipen Pak 4: 120 mcg/0.5 mL PegIntron: 50 mcg/0.5 mL, 80 mcg/0.5 mL, 120 mcg/0.5 mL, 150 mcg/0.5 mL Generic: 5,000,000 units (1 ea); 20,000,000 units (1 ea) [contains polysorbate 80] Solution Reconstituted, Injection, as potassium [preservative free]: Sylatron: 200 mcg, 300 mcg, 600 mcg [contains polysorbate 80] Generic: 20,000,000 units (1 ea) Solution Reconstituted, Injection, as sodium: Pegloticase Generic: 5,000,000 units (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Penicillin G Procaine UNIFORM FORMULARY Solution, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Krystexxa: 8 mg/mL (1 mL) UNIFORM FORMULARY Suspension, Intramuscular: Pegvaliase Generic: 600,000 units/mL (1 mL, 2 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Pentafluoropropane and Tetrafluoroethane Solution Prefilled Syringe, Subcutaneous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Palynziq: 2.5 mg/0.5 mL (0.5 mL); 10 mg/0.5 mL (0.5 mL); 20 mg/mL (1 mL) UNIFORM FORMULARY Aerosol, spray, topical: Pegvisomant Gebauer's Spray and Stretch: Pentafluoropropane 95% and tetrafluoroethane DoD Uniform Formulary Outpatient Dosage Forms 5% (103.5 mL) [available in fine stream spray] UNIFORM FORMULARY Gebauer's Pain Ease: Pentafluoropropane 95% and tetrafluoroethane 5% (30 Solution Reconstituted, Subcutaneous: mL, 103.5 mL) [available in mist spray or medium stream spray] Somavert: 10 mg (1 ea); 15 mg (1 ea); 20 mg (1 ea); 25 mg (1 ea); 30 mg Gebauer's Instant Ice [OTC]: Pentafluoropropane 95% and tetrafluoroethane (1 ea) 5% (103.5 mL) [available in mist spray or stream spray] Pembrolizumab Pentamidine (Oral Inhalation) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Intravenous [preservative free]: Solution Reconstituted, Inhalation, as isethionate: Keytruda: 100 mg/4 mL (4 mL) [contains polysorbate 80] Nebupent: 300 mg (1 ea) 91 PENTAMIDINE (SYSTEMIC) Pentamidine (Systemic) Prestalia: Perindopril arginine 14 mg and amlodipine 10 mg DoD Uniform Formulary Outpatient Dosage Forms Peritoneal Dialysis Solution UNIFORM FORMULARY Solution Reconstituted, Injection, as isethionate: DoD Uniform Formulary Outpatient Dosage Forms Pentam: 300 mg (1 ea) UNIFORM FORMULARY Solution, Intraperitoneal: Pentazocine Delflex-LC/1.5% Dextrose: 346 mOsm/L ( 2000 mL, 3000 mL, 5000 mL) DoD Uniform Formulary Outpatient Dosage Forms Delflex-LC/4.25% Dextrose: 483 mOsm/L (2000 mL, 3000 mL, 5000 mL) UNIFORM FORMULARY Dianeal Low Calcium/1.5% Dex: 344 mOsm/L (2000 mL, 3000 mL, 5000 mL, Solution, Injection: 6000 mL) Talwin: 30 mg/mL (1 mL) Dianeal Low Calcium/2.5% Dex: 395 mOsm/L (2000 mL, 3000 mL, 5000 mL, Talwin: 30 mg/mL (10 mL) [contains methylparaben, sodium bisulfite] 6000 mL) Dianeal Low Calcium/4.25% Dex: 483 mOsm/L (2000 mL, 3000 mL, 5000 mL, Pentazocine and Naloxone 6000 mL) DoD Uniform Formulary Outpatient Dosage Forms Dianeal PD-2/1.5% Dextrose: 346 mOsm/L (1000 mL, 2000 mL, 3000 mL, UNIFORM FORMULARY 5000 mL, 6000 mL) Tablet, Oral: Dianeal PD-2/2.5% Dextrose: 396 mOsm/L (1000 mL, 2000 mL, 3000 mL, Generic: Pentazocine 50 mg and naloxone 0.5 mg 5000 mL, 6000 mL) Dianeal PD-2/4.25% Dextrose: 485 mOsm/L (1000 mL, 2000 mL, 3000 mL, Pentetate Indium Disodium In 111 5000 mL, 6000 mL) DoD Uniform Formulary Outpatient Dosage Forms UltraBag/Dianeal PD-2/1.5% Dex: 346 mOsm/L (2000 mL, 2500 mL, 3000 mL) UNIFORM FORMULARY UltraBag/Dianeal PD-2/2.5% Dex: 396 mOsm/L (2000 mL, 2500 mL, 3000 mL) Solution, Intrathecal: UltraBag/Dianeal PD-2/4.25%Dex: 485 mOsm/L (2000 mL, 2500 mL, Generic: (1.5 mL) 3000 mL) PENTobarbital UltraBag/Dianeal/1.5% Dextrose: 344 mOsm/L (1500 mL, 2000 mL, 2500 mL, DoD Uniform Formulary Outpatient Dosage Forms 3000 mL) UNIFORM FORMULARY UltraBag/Dianeal/2.5% Dextrose: 395 mOsm/L (1500 mL, 2000 mL, 2500 mL, Solution, Injection, as sodium: 3000 mL) Nembutal: 50 mg/mL (20 mL, 50 mL) [latex free; contains alcohol, usp, UltraBag/Dianeal/4.25% Dex: 483 mOsm/L (1500 mL, 2000 mL, 2500 mL, propylene glycol] 3000 mL) Pentosan Polysulfate Sodium Permethrin DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Capsule, Oral: Cream, External: Elmiron: 100 mg Generic: 5% (60 g) Pentostatin Perphenazine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution Reconstituted, Intravenous: Tablet, Oral: Nipent: 10 mg (1 ea) Generic: 2 mg, 4 mg, 8 mg, 16 mg Pentoxifylline Pertuzumab DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet Extended Release, Oral: Solution, Intravenous [preservative free]: Generic: 400 mg Perjeta: 420 mg/14 mL (14 mL) [contains mouse (murine) and/or hamster protein] Peramivir DoD Uniform Formulary Outpatient Dosage Forms Phenazopyridine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous [preservative free]: BASIC CORE FORMULARY Rapivab: 200 mg/20 mL (20 mL) Tablet, Oral, as hydrochloride: Generic: 100 mg, 200 mg Perampanel DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral, as hydrochloride: Suspension, Oral: Baridium: 97.2 mg Fycompa: 0.5 mg/mL (340 mL) [contains sodium benzoate] Urinary Pain Relief: 95 mg Tablet, Oral: Generic: 95 mg Fycompa: 2 mg, 4 mg, 6 mg, 8 mg, 10 mg, 12 mg Phendimetrazine Perflutren Lipid Microspheres DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Solution, Injection [preservative free]: Capsule Extended Release 24 Hour, Oral, as tartrate: OFP 6.52 mg/mL and lipid blend 0.75 mg/mL (2 mL) [following activation, Generic: 105 mg forms a suspension containing perflutren lipid microspheres 1.2 x 1010/mL Tablet, Oral, as tartrate: and OFP 1.1 mg/mL] Generic: 35 mg Perflutren Protein Type A Phenelzine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Injection, suspension [preservative free]: Tablet, Oral: Optison: Perflutren 0.11-0.33 mg and protein-type A microspheres 5-8 x 108 Generic: 15 mg per mL (3 mL) [contains human albumin 10 mg/mL] PHENobarbital Perindopril DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY UNIFORM FORMULARY Elixir, Oral: Tablet, Oral, as erbumine: Generic: 20 mg/5 mL (473 mL) Generic: 2 mg, 4 mg, 8 mg Solution, Oral: Perindopril and Amlodipine Generic: 20 mg/5 mL (473 mL) Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 15 mg, 16.2 mg, 30 mg, 32.4 mg, 60 mg, 64.8 mg, 97.2 mg, 100 mg UNIFORM FORMULARY Tablet, Oral: UNIFORM FORMULARY Prestalia: Perindopril arginine 3.5 mg and amlodipine 2.5 mg Solution, Injection, as sodium: Prestalia: Perindopril arginine 7 mg and amlodipine 5 mg Generic: 65 mg/mL (1 mL); 130 mg/mL (1 mL) 92 PILOCARPINE (OPHTHALMIC) Phenol Phenylephrine (Ophthalmic) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Liquid, External: Solution, Ophthalmic, as hydrochloride: Generic: 1.5% (29.57 mL); Castellani Paint Modified 1.5% (29.57 mL) Generic: 2.5% (2 mL, 3 mL, 5 mL, 15 mL); 10% (5 mL) Liquid, Mouth/Throat: Solution, Ophthalmic, as hydrochloride [preservative free]: Chloraseptic: 1.4% (20 mL) [contains fd&c red #40, saccharin sodium; cherry Generic: 2.5% (1 ea) flavor] Oralseptic: 1.4% (177 mL) [alcohol free, aspirin free, sugar free] Phenylephrine (Systemic) Phenaseptic: 1.4% (177 mL) [sugar free; contains alcohol, usp, fd&c red #40, DoD Uniform Formulary Outpatient Dosage Forms saccharin sodium; cherry eucalyptus flavor] UNIFORM FORMULARY Sore Throat Spray: 1.4% (177 mL) Liquid, Oral, as hydrochloride: Ulcerease: 0.6% (178 mL) Little Colds Decongestant: 2.5 mg/mL (30 mL) [alcohol free, dye free, sac- Solution, Mouth/Throat: charin free; contains sodium benzoate; grape flavor] Triaminic Sore Throat: 0.5% (120 mL) [alcohol free, aspirin free, sugar free; Solution, Injection, as hydrochloride: contains saccharin sodium; grape flavor] Generic: 10 mg/mL (1 mL, 5 mL, 10 mL) Ulcerease: 0.6% (30 mL, 178 mL) Solution, Intravenous, as hydrochloride: Swab, External: Vazculep: 10 mg/mL (1 mL, 5 mL, 10 mL) [contains sodium metabisulfite] Phenol EZ Swabs: 89% (30 ea) Solution, Oral, as hydrochloride: Sudafed PE Childrens: 2.5 mg/5 mL (118 mL) [alcohol free, sugar free; Phenoxybenzamine contains edetate disodium, sodium benzoate; berry flavor] DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral, as hydrochloride: UNIFORM FORMULARY Nasal Decongestant: 10 mg Capsule, Oral, as hydrochloride: Nasal Decongestant PE Max St: 10 mg [pseudoephedrine free] Generic: 10 mg Non-Pseudo Sinus Decongestant: 10 mg Sudogest PE: 10 mg Phentermine DoD Uniform Formulary Outpatient Dosage Forms Phenylephrine (Topical) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral, as hydrochloride: UNIFORM FORMULARY Generic: 15 mg, 30 mg, 37.5 mg Ointment, Rectal, as hydrochloride: Tablet, Oral, as hydrochloride: GRX Hemorrhoidal: 0.25% (43 g) [contains benzoic acid, methylparaben, Generic: 37.5 mg propylparaben] NONFORMULARY Hemorrhoidal: 0.25% (57 g) [contains benzoic acid, methylparaben, propyl- Tablet, Oral, as hydrochloride: paraben] Lomaira: 8 mg Major-Prep Hemorrhoidal: 0.25% (57 g) [contains methylparaben, propyl- paraben] Phentolamine Preparation H: 0.25% (28 g, 57 g) [contains benzoic acid, methylparaben, DoD Uniform Formulary Outpatient Dosage Forms propylparaben] UNIFORM FORMULARY Suppository, Rectal, as hydrochloride: Solution, Injection, as mesylate [preservative free]: Anu-Med: 0.25% (12 ea) OraVerse: 0.4 mg/1.7 mL (1.7 mL) [contains edetate disodium; dental car- Hemorrhoidal: 0.25% (12 ea, 24 ea) [contains methylparaben, propylparaben] tridge] Preparation H: 0.25% (12 ea, 24 ea, 48 ea) [contains corn starch, methylpar- Solution Reconstituted, Injection, as mesylate: aben, propylparaben] Generic: 5 mg (1 ea) Rectacaine: 0.25% (12 ea) Phenylephrine and Ketorolac Phenytoin DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Solution, Intraocular: Capsule, Oral, as sodium: Omidria: Phenylephrine 1% and Ketorolac 0.3 % (4 mL) Generic: 100 mg Capsule Extended Release, Oral, as sodium: Phenylephrine and Pramoxine Generic: 100 mg DoD Uniform Formulary Outpatient Dosage Forms Suspension, Oral: UNIFORM FORMULARY Generic: 100 mg/4 mL (4 mL); 125 mg/5 mL (237 mL) Cream, Rectal: Tablet Chewable, Oral: Preparation H Totables: Phenylephrine hydrochloride 0.25%, pramoxine Generic: 50 mg hydrochloride 1%, glycerin 14.4%, and white petrolatum 15% (5.7 g) [con- UNIFORM FORMULARY tains cetyl alcohol, edetate disodium, methylparaben, propylene glycol, Solution, Injection, as sodium: propylparaben, sodium benzoate] Generic: 50 mg/mL (2 mL, 5 mL) Phenylephrine and Pyrilamine Phosphatidylserine, DHA, and EPA DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Liquid, Oral: Capsule, Oral: Glen PE: Phenylephrine hydrochloride 5 mg and pyrilamine maleate 16 mg Vayarin: Phosphatidylserine 75 mg, DHA 8.5 mg, and EPA 21.5 mg [contains per 5 mL (480 mL) [alcohol free, sugar free; contains propylene glycol, fd&c blue #2 (indigotine), fish oil, soybeans (glycine max)] saccharin sodium, sodium benzoate, sorbitol; cotton candy flavor] Tablet, Oral: Physostigmine Generic: Phenylephrine hydrochloride 10 mg and pyrilamine maleate 25mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Phenylephrine and Thonzylamine Solution, Injection, as salicylate: DoD Uniform Formulary Outpatient Dosage Forms Generic: 1 mg/mL (2 mL) UNIFORM FORMULARY Liquid: Phytonadione Nasopen PE: Phenylephrine 10 mg and thonzylamine 50 mg per 15 mL DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Phenylephrine (Nasal) Injection, aqueous colloidal: DoD Uniform Formulary Outpatient Dosage Forms Generic: 1 mg/0.5 mL (0.5 mL); 10 mg/mL (1 mL) UNIFORM FORMULARY Injection, aqueous colloidal [preservative free]: Solution, Nasal, as hydrochloride: Generic: 1 mg/0.5 mL (0.5 mL) 4-Way Fast Acting: 1% (14.8 mL, 29.6 mL) [contains benzalkonium chloride] Tablet, oral: 100 mcg 4-Way Menthol: 1% (14.8 mL, 29.6 mL) [contains benzalkonium chloride, Mephyton: 5 mg [scored] menthol, polysorbate 80] Afrin Childrens: 0.25% (15 mL) Pilocarpine (Ophthalmic) Nasal Four: 1% (29.6 mL) [contains benzalkonium chloride] DoD Uniform Formulary Outpatient Dosage Forms Neo-Synephrine Cold & Sinus: 0.25% (15 mL); 0.5% (15 mL); 1% (15 mL) UNIFORM FORMULARY [contains benzalkonium chloride] Solution, Ophthalmic, as hydrochloride: Rhinall: 0.25% (30 mL, 40 mL) Generic: 1% (15 mL); 2% (15 mL); 4% (15 mL) 93 PILOCARPINE (SYSTEMIC) Pilocarpine (Systemic) Plasminogen (Human) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Plazomicin Tablet, Oral, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Generic: 5 mg, 7.5 mg UNIFORM FORMULARY Solution, Intravenous, as sulfate [preservative free]: Pimecrolimus Zemdri: 500 mg/10 mL (10 mL) DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY Plecanatide Cream, External: DoD Uniform Formulary Outpatient Dosage Forms Generic: 1% (30 g, 60 g, 100 g) UNIFORM FORMULARY Tablet, Oral: Pimozide Trulance: 3 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Plerixafor Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 1 mg, 2 mg UNIFORM FORMULARY Solution, Subcutaneous [preservative free]: Pindolol Mozobil: 24 mg/1.2 mL (1.2 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Pneumococcal Conjugate Vaccine (13-Valent) Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 5 mg, 10 mg UNIFORM FORMULARY Injection, suspension: Pioglitazone Prevnar 13: 2 mcg of each capsular saccharide for serotypes 1, 3, 4, 5, 6A, 7F, DoD Uniform Formulary Outpatient Dosage Forms 9V, 14, 18C, 19A, 19F, and 23F, and 4 mcg of serotype 6B [bound to UNIFORM FORMULARY diphtheria CRM197 protein ~34 mcg] per 0.5 mL (0.5 mL) [contains aluminum, Tablet, Oral: polysorbate 80, and yeast] Generic: 15 mg, 30 mg, 45 mg Pneumococcal Conjugate Vaccine (20-Valent) Pioglitazone and Glimepiride DoD Uniform Formulary Outpatient Dosage Forms Pneumococcal Polysaccharide Vaccine (Polyvalent) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 30/2: Pioglitazone 30 mg and glimepiride 2 mg Injection, solution: Generic: 30/4: Pioglitazone 30 mg and glimepiride 4 mg Pneumovax 23: 25 mcg each of 23 capsular polysaccharide isolates/0.5 mL (0.5 mL, 2.5 mL) Pioglitazone and Metformin DoD Uniform Formulary Outpatient Dosage Forms Podofilox UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY 15/500: Pioglitazone 15 mg and metformin hydrochloride 500 mg Gel, External: 15/850: Pioglitazone 15 mg and metformin hydrochloride 850 mg Condylox: 0.5% (3.5 g) Tablet, variable release, oral: Solution, External: Actoplus Met XR: 15/1000: Pioglitazone 15 mg [immediate release] and Generic: 0.5% (3.5 mL) metformin hydrochloride 1000 mg [extended release] Actoplus Met XR: 30/1000: Pioglitazone 30 mg [immediate release] and Podophyllum Resin metformin hydrochloride 1000 mg [extended release] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Piperacillin and Tazobactam Solution, External: DoD Uniform Formulary Outpatient Dosage Forms Podocon: 25% (15 mL) Note: 8:1 ratio of piperacillin sodium/tazobactam sodium UNIFORM FORMULARY Polatuzumab Vedotin Infusion [premixed iso-osmotic solution]: DoD Uniform Formulary Outpatient Dosage Forms Zosyn: 2.25 g: Piperacillin 2 g and tazobactam 0.25 g (50 mL) [contains UNIFORM FORMULARY edetate disodium, sodium 128 mg (5.58 mEq)] Solution Reconstituted, Intravenous [preservative free]: Zosyn: 3.375 g: Piperacillin 3 g and tazobactam 0.375 g (50 mL) [contains Polivy: Polatuzumab vedotin-piiq 140 mg (1 ea) edetate disodium, sodium 192 mg (8.38 mEq)] Zosyn: 4.5 g: Piperacillin 4 g and tazobactam 0.5 g (100 mL) [contains Polidocanol edetate disodium, sodium 256 mg (11.17 mEq)] DoD Uniform Formulary Outpatient Dosage Forms Injection, Powder for Reconstitution: NOT COVERED 2.25 g: Piperacillin 2 g and tazobactam 0.25 g [contains edetate disodium, Foam, Intravenous: sodium 130 mg (5.68 mEq)] Varithena: 180 mg/18 mL (45 mL) [contains alcohol, usp] 3.375 g: Piperacillin 3 g and tazobactam 0.375 g [contains edetate disodium, Solution, Intravenous [preservative free]: sodium 195 mg (8.52 mEq)] Asclera: 0.5% (2 mL); 1% (2 mL) [contains alcohol, usp] 4.5 g: Piperacillin 4 g and tazobactam 0.5 g [contains edetate disodium, sodium 260 mg (11.36 mEq)] Poliovirus Vaccine (Inactivated) 40.5 g: Piperacillin 36 g and tazobactam 4.5 g [contains edetate disodium, DoD Uniform Formulary Outpatient Dosage Forms sodium 2304 mg (100.4 mEq) UNIFORM FORMULARY Injection, suspension: Pirfenidone IPOL: Type 1 poliovirus 40 D-antigen units, type 2 poliovirus 8 D-antigen units, DoD Uniform Formulary Outpatient Dosage Forms and type 3 poliovirus 32 D-antigen units per 0.5 mL (0.5 mL, 5 mL) [contains UNIFORM FORMULARY 2-phenoxyethanol, formaldehyde, calf serum protein, neomycin (may have Capsule, Oral: trace amounts), streptomycin (may have trace amounts), and polymyxin B Esbriet: 267 mg (may have trace amounts)] Tablet, Oral: Esbriet: 267 mg, 801 mg Poly-L-Lactic Acid DoD Uniform Formulary Outpatient Dosage Forms Piroxicam (Systemic) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Injection, powder for suspension: UNIFORM FORMULARY Sculptra, Sculptra Aesthetic: Poly-L-lactic acid USP Capsule, Oral: Generic: 10 mg, 20 mg Polycarbophil DoD Uniform Formulary Outpatient Dosage Forms Plasma Protein Fraction UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 625 mg Solution, Intravenous: Tablet, Oral [preservative free]: Plasmanate: 5% (50 mL, 250 mL) Fiber-Lax: 625 mg [scored; starch free] 94 POTASSIUM ACID PHOSPHATE Polyethylene Glycol 3350 Myferon 150: 150 mg DoD Uniform Formulary Outpatient Dosage Forms NovaFerrum 50: 50 mg UNIFORM FORMULARY Nu-Iron: 150 mg Packet, Oral: PIC 200: 200 mg Generic: (1 ea, 14 ea, 30 ea, 100 ea) Poly-Iron 150: 150 mg Powder, Oral: Liquid, Oral: Generic: 17 g/dose (119 g, 238 g, 255 g, 510 g, 527 g, 850 g) NovaFerrum 125: Polysaccharide-iron complex 125 mg and cholecalciferol 100 units per 5 mL (180 mL) [alcohol free, dye free, gluten free, lactose free, Polyethylene Glycol-Electrolyte Solution sodium free, sugar free; contains sodium benzoate; raspberry-grape flavor] DoD Uniform Formulary Outpatient Dosage Forms NovaFerrum Pediatric Drops: 15 mg/mL (120 mL) [alcohol free, dye free, UNIFORM FORMULARY gluten free, lactose free, sodium free, sugar free; contains sodium benzoate; Powder, for Solution, Oral: raspberry-grape flavor] PEG 3350 240 g, sodium sulfate 22.72 g, sodium bicarbonate 6.72 g, sodium chloride 5.84 g, and potassium chloride 2.98 g (4000 mL) Polysaccharide-Iron Complex, Vitamin B12, and Folic Acid PEG 3350 236 g, sodium sulfate 22.74 g, sodium bicarbonate 6.74 g, sodium DoD Uniform Formulary Outpatient Dosage Forms chloride 5.86 g, and potassium chloride 2.97 g (4000 mL) UNIFORM FORMULARY PEG 3350 240 g, sodium bicarbonate 5.72 g, sodium chloride 11.2 g, and Capsule, Oral: potassium chloride 1.48 g (4000 mL) iFerex 150 Forte: Elemental iron 150 mg, cyanocobalamin 25 mcg, and folic PEG 3350 420 g, sodium bicarbonate 5.72 g, sodium chloride 11.2 g, and acid 1 mg potassium chloride 1.48 g (4000 mL) Myferon 150 Forte: Elemental iron 150 mg, cyanocobalamin 25 mcg, and folic Colyte: PEG 3350 227.1 g, sodium sulfate 21.5 g, sodium bicarbonate 6.36 g, acid 1 mg sodium chloride 5.53 g, and potassium chloride 2.82 g (3785 mL) [supplied Poly-Iron 150 Forte: Elemental iron 150 mg, cyanocobalamin 25 mcg, and with cherry, lemon lime, and orange flavor packs] folic acid 1 mg Colyte: PEG 3350 240 g, sodium sulfate 22.72 g, sodium bicarbonate 6.72 g, Tablet, Oral: sodium chloride 5.84 g, and potassium chloride 2.98 g (4000 mL) [supplied BiferaRx: Iron as polysaccharide iron complex 22 mg, iron as heme iron with cherry, citrus berry, lemon lime, orange, and pineapple flavor packs] polypeptide 6 mg, cyanocobalamin 25 mcg, and folic acid 1 mg [scored] GaviLyte-C: PEG 3350 240 g, sodium sulfate 22.72 g, sodium bicarbonate Irofol: Elemental iron 150 mg, cyanocobalamin 25 mcg, and folic acid 1 mg 6.72 g, sodium chloride 5.84 g, and potassium chloride 2.98 g (4000 mL) [supplied with lemon flavor packet] Poly-Ureaurethane GaviLyte-G: PEG 3350 236 g, sodium sulfate 22.74 g, sodium bicarbonate DoD Uniform Formulary Outpatient Dosage Forms 6.74 g, sodium chloride 5.86 g, and potassium chloride 2.97 g (4000 mL) UNIFORM FORMULARY [supplied with lemon flavor packet] Solution, topical: GaviLyte-N: PEG 3350 420 g, sodium bicarbonate 5.72 g, sodium chloride Nuvail: 16% (15 mL) 11.2 g, and potassium chloride 1.48 g (4000 mL) [supplied with lemon flavor packet] Pomalidomide GoLYTELY: PEG 3350 227.1 g, sodium sulfate 21.5 g, sodium bicarbonate DoD Uniform Formulary Outpatient Dosage Forms 6.36 g, sodium chloride 5.53 g, and potassium chloride 2.82 g per packet UNIFORM FORMULARY (1s) [regular flavor; makes 1 gallon of solution after mixing] Capsule, Oral: GoLYTELY: PEG 3350 236 g, sodium sulfate 22.74 g, sodium bicarbonate Pomalyst: 1 mg, 2 mg, 3 mg, 4 mg 6.74 g, sodium chloride 5.86 g, and potassium chloride 2.97 g (4000 mL) [regular and pineapple flavor] PONATinib MoviPrep: Pouch A: PEG 3350 100g, sodium sulfate 7.5 g, sodium chloride DoD Uniform Formulary Outpatient Dosage Forms 2.69 g, potassium chloride 1.02 g; Pouch B: Ascorbic acid 4.7 g, sodium UNIFORM FORMULARY ascorbate 5.9 g (1000 mL) [contains phenylalanine 131 mg/treatment; lemon Tablet, Oral: flavor; packaged with 2 of Pouch A and 2 of Pouch B in carton and a Iclusig: 15 mg, 45 mg disposable reconstitution container] NuLYTELY: PEG 3350 420 g, sodium bicarbonate 5.72 g, sodium chloride Poractant Alfa 11.2 g, and potassium chloride 1.48 g (4000 mL) [supplied with cherry, DoD Uniform Formulary Outpatient Dosage Forms lemon-lime, orange, and pineapple flavor packs] UNIFORM FORMULARY Plenvu: Dose 1: PEG 3350 100 g, sodium sulfate 9 g, sodium chloride 2 g, Suspension, Intratracheal [preservative free]: potassium chloride 1 g [mango flavor; makes 473 mL of solution after Curosurf: 120 mg/1.5 mL (1.5 mL); 240 mg/3 mL (3 mL) [contains sodium mixing]; Dose 2, Pouch A: PEG 3350 40 g, sodium chloride 3.2 g, potassium chloride] chloride 1.2 g; Dose 2, Pouch B: sodium ascorbate 48.11 g, ascorbic acid 7.54 g [fruit punch flavor; makes 473 mL of solution after mixing] Porfimer TriLyte: PEG 3350 420 g, sodium bicarbonate 5.72 g, sodium chloride 11.2 g, DoD Uniform Formulary Outpatient Dosage Forms and potassium chloride 1.48 g (4000 mL) [supplied with cherry, citrus berry, NOT COVERED lemon lime, orange, and pineapple flavor packs] Solution Reconstituted, Intravenous, as sodium [preservative free]: Polyethylene Glycol-Electrolyte Solution and Bisacodyl Photofrin: 75 mg (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Posaconazole UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Kit [each kit contains]: UNIFORM FORMULARY GaviLyte-H and Bisacodyl: Solution, Intravenous: Powder for solution, oral (GaviLyte-H): PEG 3350 210 g, sodium bicarbonate Noxafil: 300 mg/16.7 mL (16.7 mL) [contains edetate disodium] 2.86 g, sodium chloride 5.6 g, potassium chloride 0.74 g (2000 mL) [con- Suspension, Oral: tains 3 flavor packs: cherry, lemon, orange] Noxafil: 40 mg/mL (105 mL) [contains polysorbate 80, sodium benzoate; Tablet, delayed release, oral (Bisacodyl): 5 mg (1s) cherry flavor] PEG-Prep and Bisacodyl: Tablet Delayed Release, Oral: Powder for solution, oral (PEG-Prep): PEG 3350 210 g, sodium bicarbonate 2.86 g, sodium chloride 5.6 g, potassium chloride 0.74 g (2000 mL) [con- Noxafil: 100 mg tains 3 flavor packs: cherry, lemon, orange] Potassium Acetate Tablet, delayed release, oral (Bisacodyl): 5 mg (1s) DoD Uniform Formulary Outpatient Dosage Forms Polymyxin B UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous: UNIFORM FORMULARY Generic: 2 mEq/mL (20 mL, 50 mL, 100 mL); 4 mEq/mL (50 mL) Solution Reconstituted, Injection: Potassium Acid Phosphate Generic: 500,000 units (1 ea) Solution Reconstituted, Injection [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 500,000 units (1 ea) UNIFORM FORMULARY Solution, Injection: Polysaccharide-Iron Complex Potassium 4.4 mEq and phosphorus 3 mmol per mL (5 mL, 15 mL, 50 mL) DoD Uniform Formulary Outpatient Dosage Forms [equivalent to potassium 170 mg and elemental phosphorus 93 mg per mL] UNIFORM FORMULARY Tablet, Oral: Capsule, Oral: K-Phos: 500 mg [scored] EZFE 200: 200 mg [non-toxic] Ferrex 150: 150 mg Ferric x-150: 150 mg iFerex 150: 150 mg 95 POTASSIUM BICARBONATE AND POTASSIUM CHLORIDE Potassium Bicarbonate and Potassium Chloride ThyroSafe: 65 mg [scored] DoD Uniform Formulary Outpatient Dosage Forms Potassium Iodide and Iodine UNIFORM FORMULARY Tablet for Solution, Oral [effervescent]: DoD Uniform Formulary Outpatient Dosage Forms Generic: Potassium chloride 25 mEq [potassium bicarbonate 0.5 g and UNIFORM FORMULARY potassium chloride 1.5 g] Solution, External: Generic: Potassium iodide 10% and iodine 5% (8 mL) Potassium Bicarbonate and Potassium Citrate Solution, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: Potassium iodide 10% and iodine 5% (14 mL, 473 mL) UNIFORM FORMULARY Tincture, External: Tablet Effervescent, Oral: Generic: Potassium iodide 5% and iodine 7% (30 mL, 480 mL) Effer-K: 10 mEq, 20 mEq, 25 mEq Potassium P-Aminobenzoate Generic: 25 mEq DoD Uniform Formulary Outpatient Dosage Forms Potassium Chloride UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral: BASIC CORE FORMULARY Potaba: 500 mg Capsule Extended Release, Oral: Packet, Oral: Generic: 10 mEq Generic: 2 g (50 ea) Liquid, Oral: Potassium Phosphate Generic: 20 mEq/15 mL (10%) (473 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution, Oral: UNIFORM FORMULARY Generic: 20 mEq/15 mL (15 mL, 30 mL, 473 mL) Solution, Injection: Tablet Extended Release, Oral: Potassium 4.4 mEq and phosphorus 3 mmol per mL (5 mL, 15 mL, 50 mL) Generic: 10 mEq, 20 mEq [equivalent to potassium 170 mg and elemental phosphorus 93 mg per mL] UNIFORM FORMULARY Tablet, Oral: Capsule Extended Release, Oral: K-Phos: 500 mg [scored] Generic: 8 mEq Packet, Oral: Potassium Phosphate and Sodium Phosphate Generic: 20 mEq (30 ea, 100 ea) DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous: UNIFORM FORMULARY Generic: 20 mEq (1000 mL); 40 mEq (1000 mL); 0.4 mEq/mL (50 mL); 10 Powder for solution, oral: mEq/100 mL (100 mL); 10 mEq/50 mL (50 mL); 20 mEq/100 mL (100 mL); 20 Phos-NaK: Dibasic potassium phosphate, monobasic potassium phosphate, mEq/50 mL (50 mL); 40 mEq/100 mL (100 mL); 2 mEq/mL (5 mL, 10 mL, 20 dibasic sodium phosphate, and monobasic sodium phosphate per packet mL, 30 mL, 250 mL); 20 mEq/L (1000 mL); 40 mEq/L (1000 mL) (100s) [sugar free; equivalent to elemental phosphorus 250 mg (8 mmol), Solution, Intravenous [with Dextrose]: sodium 160 mg (6.9 mEq), and potassium 280 mg (7.1 mEq) per packet; fruit Potassium 10 mEq/L, dextrose 5%, and sodium chloride 0.45% (1000 mL) flavor] Potassium 20 mEq/L, dextrose 5%, and sodium chloride 0.2% (250 mL, 500 Tablet, oral: mL, 1000 mL) Av-Phos 250 Neutral: Monobasic potassium phosphate 155 mg, dibasic Potassium 20 mEq/L, dextrose 5%, and sodium chloride 0.225% (500 mL, sodium phosphate 852 mg, and monobasic sodium phosphate 130 mg 1000 mL) [equivalent to elemental phosphorus 250 mg (8 mmol), sodium 298 mg (13 Potassium 20 mEq/L, dextrose 5%, and sodium chloride 0.33% (500 mL, mEq), and potassium 45 mg (1.1 mEq)] 1000 mL) K-Phos Neutral: Monobasic potassium phosphate 155 mg, dibasic sodium Potassium 20 mEq/L, dextrose 5%, and sodium chloride 0.45% (500mL, phosphate 852 mg, and monobasic sodium phosphate 130 mg [equivalent to 1000 mL) elemental phosphorus 250 mg (8 mmol), sodium 298 mg (13 mEq), and Potassium 20 mEq/L, dextrose 5%, and sodium chloride 0.9% (500 mL, potassium 45 mg (1.1 mEq)] 1000 mL) K-Phos No. 2: Potassium acid phosphate 305 mg and sodium acid phosphate Potassium 30 mEq/L, dextrose 5%, and sodium chloride 0.45% (1000 mL) 700 mg [equivalent to elemental phosphorus 250 mg (8 mmol), sodium Potassium 40 mEq/L, dextrose 5%, and sodium chloride 0.45% (1000 mL) 134 mg (5.8 mEq), and potassium 88 mg (2.3 mEq)] Potassium 40 mEq/L, dextrose 5%, and sodium chloride 0.9% (1000 mL) Phospha 250 Neutral: Monobasic potassium phosphate 155 mg, dibasic Solution, Oral: sodium phosphate 852 mg, and monobasic sodium phosphate 130 mg Generic: 40 mEq/15 mL (20%) (473 mL) [equivalent to elemental phosphorus 250 mg (8 mmol), sodium 298 mg (13 Tablet Extended Release, Oral: mEq), and potassium 45 mg (1.1 mEq)] Generic: 8 mEq Phospho-Trin 250 Neutral: Monobasic potassium phosphate 155 mg, dibasic sodium phosphate 852 mg, and monobasic sodium phosphate 130 mg Potassium Citrate [equivalent to elemental phosphorus 250 mg (8 mmol), sodium 298 mg (13 DoD Uniform Formulary Outpatient Dosage Forms mEq), and potassium 45 mg (1.1 mEq)] UNIFORM FORMULARY Virt-Phos 250 Neutral: Monobasic potassium phosphate 155 mg, dibasic Tablet Extended Release, Oral: sodium phosphate 852 mg, and monobasic sodium phosphate 130 mg Generic: 5 mEq (540 mg), 10 mEq (1080 mg), 15 mEq (1620 mg) [equivalent to elemental phosphorus 250 mg (8 mmol), sodium 298 mg (13 mEq), and potassium 45 mg (1.1 mEq)] Potassium Citrate and Citric Acid DoD Uniform Formulary Outpatient Dosage Forms Povidone-Iodine (Ophthalmic) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Powder for Solution, Oral: UNIFORM FORMULARY Cytra-K: Potassium citrate monohydrate 3300 mg and citric acid monohydrate Solution, Ophthalmic: 1002 mg per packet (100s) [sugar free; fruit-punch flavor; each packet Betadine Ophthalmic Prep: 5% (30 mL) contains potassium 30 mEq equivalent to bicarbonate 30 mEq] Solution, Oral: Povidone-Iodine (Topical) Generic: Potassium citrate monohydrate 1100 mg and citric acid monohydrate DoD Uniform Formulary Outpatient Dosage Forms 334 mg per 5 mL (473 mL) UNIFORM FORMULARY Gel, External: Potassium Gluconate Operand Povidone-Iodine: 10% (118 mL) DoD Uniform Formulary Outpatient Dosage Forms Ointment, External: UNIFORM FORMULARY Generic: 10% (1 g, 28.35 g) Capsule, Oral [preservative free]: Pad, External: K-99: 595 mg [dye free, sugar free, yeast free] Generic: 10% (1 ea, 200 ea) Tablet, Oral: Solution, External: Generic: 2 mEq, 2.5 mEq Betadine: 5% (88.7 mL); 10% (15 mL, 118 mL, 237 mL, 473 mL, 946 mL, Tablet, Oral [strength expressed as base]: 3780 mL) Generic: 80 mg Betadine Skin Cleanser: 7.5% (118 mL) Betadine Surgical Scrub: 7.5% (118 mL, 473 mL, 946 mL, 3780 mL) Potassium Iodide NuPrep 5% Povidone-Iodine: 5% (5 mL) DoD Uniform Formulary Outpatient Dosage Forms Operand Povidone-Iodine: 10% (59 mL, 118 mL, 237 mL, 473 mL, 946 mL, UNIFORM FORMULARY 3800 mL) [latex free] Solution, Oral: Operand Scrub: 7.5% (59 mL, 118 mL, 237 mL, 473 mL, 946 mL, 3800 mL) SSKI: 1 g/mL (30 mL, 237 mL) Generic: 10% (30 mL, 237 mL, 240 mL, 473 mL) Tablet, Oral: Solution, Vaginal: iOSAT: 130 mg [scored] Operand Povidone-Iodine: 10% (237 mL) 96 PREDNISOLONE (SYSTEMIC)

Summers Eve Disp Medicated: 0.3% (133 mL) Gel, topical: Swab, External: Novacort: Pramoxine hydrochloride 1% and hydrocortisone acetate 2% (29 g) Generic: 7.5% (50 ea); 10% (1 ea, 2 ea, 3 ea, 50 ea, 100 ea) [contains aloe, benzyl alcohol, propylene glycol] Lotion, topical: PRALAtrexate Analpram-HC: Pramoxine hydrochloride 1% and hydrocortisone acetate 2.5% DoD Uniform Formulary Outpatient Dosage Forms (60 mL) UNIFORM FORMULARY Pramosone: Pramoxine hydrochloride 1% and hydrocortisone acetate 1% (60 Solution, Intravenous [preservative free]: mL, 120 mL, 240 mL); pramoxine hydrochloride 1% and hydrocortisone Folotyn: 20 mg/mL (1 mL); 40 mg/2 mL (2 mL) acetate 2.5% (60 mL, 120 mL) Pralidoxime Ointment, topical: DoD Uniform Formulary Outpatient Dosage Forms Pramosone: Pramoxine hydrochloride 1% and hydrocortisone acetate 1% NOT COVERED (30 g); pramoxine hydrochloride 1% and hydrocortisone acetate 2.5% (30 g) Solution Auto-injector, Intramuscular, as chloride: Prasugrel Generic: 600 mg/2 mL (2 mL) Solution Reconstituted, Intravenous, as chloride: DoD Uniform Formulary Outpatient Dosage Forms Protopam Chloride: 1 g (1 ea) UNIFORM FORMULARY Tablet, Oral: Pralsetinib Effient: 5 mg, 10 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Pravastatin Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Gavreto: 100 mg BASIC CORE FORMULARY Tablet, Oral, as sodium: Pramipexole Generic: 10 mg, 20 mg, 40 mg, 80 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Praziquantel Tablet, Oral, as dihydrochloride monohydrate: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg UNIFORM FORMULARY Tablet Extended Release 24 Hour, Oral, as dihydrochloride monohydrate: Tablet, Oral: Generic: 0.375 mg, 0.75 mg, 1.5 mg, 2.25 mg, 3 mg, 3.75 mg, 4.5 mg Biltricide: 600 mg [scored] Pramlintide Prazosin DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution Pen-injector, Subcutaneous, as acetate: Capsule, Oral: SymlinPen 60: 1500 mcg/1.5 mL (1.5 mL) [contains metacresol] Generic: 1 mg, 2 mg, 5 mg SymlinPen 120: 2700 mcg/2.7 mL (2.7 mL) [contains metacresol] Prednicarbate Pramoxine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Cream, External: Cream, External, as hydrochloride: Generic: 0.1% (60 g) CeraVe Itch Relief: 1% (340 g) [contains cetyl alcohol, disodium edta] Ointment, External: Foam, Rectal, as hydrochloride: Generic: 1% (15 g) Generic: 0.1% (15 g, 60 g) Gel, External, as hydrochloride: Prednisolone and Gentamicin Itch-X: 1% (35.4 g) DoD Uniform Formulary Outpatient Dosage Forms PrameGel: 1% (118 mL) UNIFORM FORMULARY Pramox: 1% (113 g) [contains methylparaben, propylene glycol, propyl- paraben] Ointment, ophthalmic: Lotion, External, as hydrochloride: Pred-G: Prednisolone acetate 0.6% and gentamicin sulfate 0.3% (3.5 g) Calaclear: 1% (177 mL) [contains alcohol, usp, methylparaben, polysorbate Suspension, ophthalmic: 80, propylene glycol, propylparaben] Pred-G: Prednisolone acetate 1% and gentamicin sulfate 0.3% (5 mL) [con- Callergy Clear: 1% (177 mL) [contains alcohol, usp, methylparaben, propylene tains benzalkonium chloride] glycol, propylparaben] Ivy Wash Poison Ivy Cleanser: 1% (177 mL) [contains disodium edta, PrednisoLONE (Ophthalmic) methylparaben, propylene glycol, propylparaben] DoD Uniform Formulary Outpatient Dosage Forms Prax: 1% (118 mL, 237 mL) [contains cetyl alcohol, trolamine (triethanol- BASIC CORE FORMULARY amine)] Suspension, Ophthalmic, as acetate: Sarna Sensitive: 1% (222 mL) [fragrance free, steroid free] Pred Mild: 0.12% (5 mL, 10 mL) [contains benzalkonium chloride, sodium Miscellaneous, External, as hydrochloride: bisulfite] Prax: 1% (1 ea, 12 ea) Generic: 1% (5 mL, 10 mL, 15 mL) Pramoxine and Hydrocortisone UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Ophthalmic, as sodium phosphate: UNIFORM FORMULARY Generic: 1% (10 mL) Aerosol, foam, rectal: PrednisoLONE (Systemic) ProctoFoam HC: Pramoxine hydrochloride 1% and hydrocortisone acetate 1% (10 g) DoD Uniform Formulary Outpatient Dosage Forms Aerosol, foam, topical: BASIC CORE FORMULARY Epifoam: Pramoxine hydrochloride 1% and hydrocortisone acetate 1% (10 g) Solution, Oral, as sodium phosphate [strength expressed as base]: Cream, topical: Pramoxine hydrochloride 1% and hydrocortisone acetate 1% Generic: 15 mg/5 mL (237 mL) (30 g); pramoxine hydrochloride 1% and hydrocortisone acetate 2.5% UNIFORM FORMULARY (30 g, 60 g) Solution, Oral, as base: Analpram Advanced Kit: Pramoxine hydrochloride 1% and hydrocortisone Generic: 15 mg/5 mL (240 mL, 480 mL) acetate 2.5% [kit includes Analpram HC cream, diosmiplex (Vasculera) Solution, Oral, as sodium phosphate [strength expressed as base]: tablets, AloeClean wipes, and applicators] Generic: 10 mg/5 mL (237 mL); 15 mg/5 mL (237 mL); 20 mg/5 mL (237 mL); Analpram HC: Pramoxine hydrochloride 1% and hydrocortisone acetate 1% 25 mg/5 mL (237 mL); 5 mg/5 mL (120 mL) (4 g, 30 g); pramoxine hydrochloride 1% and hydrocortisone acetate 2.5% (4 g, 30 g) Syrup, Oral, as base: PramCort: Pramoxine hydrochloride 1% and hydrocortisone acetate 1% (30 g) Generic: 15 mg/5 mL (240 mL, 480 mL) [contains propylene glycol] Tablet, Oral, as base: Pramosone: Pramoxine hydrochloride 1% and hydrocortisone acetate 1% Millipred: 5 mg [scored; contains sodium benzoate] (30 g, 60 g); pramoxine hydrochloride 1% and hydrocortisone acetate Millipred DP: 5 mg [scored; contains sodium benzoate] 2.5% (30 g, 60 g) Millipred DP 12-Day: 5 mg [scored; contains sodium benzoate] Pramosone E: Pramoxine hydrochloride 1% and hydrocortisone acetate 2.5% Tablet Dispersible, Oral, as sodium phosphate [strength expressed as base]: (30 g, 60 g) Generic: 10 mg, 15 mg, 30 mg ProCort: Pramoxine hydrochloride 1.15% and hydrocortisone acetate 1.85% (60 g) 97 PREDNISONE PredniSONE Suppository, Rectal: DoD Uniform Formulary Outpatient Dosage Forms Generic: 25 mg (1 ea, 12 ea, 1000 ea) BASIC CORE FORMULARY Tablet, Oral, as maleate [strength expressed as base]: Tablet, Oral: Generic: 5 mg, 10 mg Generic: 1 mg, 5 mg, 10 mg, 20 mg Progesterone UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Concentrate, Oral: UNIFORM FORMULARY PredniSONE Intensol: 5 mg/mL (30 mL) [contains alcohol, usp; unflavored Capsule, Oral: flavor] Generic: 100 mg, 200 mg Solution, Oral: Cream, Transdermal: Generic: 5 mg/5 mL (120 mL, 500 mL) EC-RX Progesterone: 10% (30 g, 60 g); 20% (30 g, 60 g) [contains cetearyl Tablet, Oral: alcohol] Generic: 2.5 mg, 50 mg Generic: 10% (60 g) Tablet Delayed Release, Oral: Gel, Vaginal: Rayos: 1 mg, 2 mg, 5 mg Tablet Therapy Pack, Oral: Crinone: 4% (1.125 g); 8% (1.125 g) Generic: 10 mg (21 ea, 48 ea); 5 mg (21 ea, 48 ea) Insert, Vaginal: Endometrin: 100 mg (21 ea) Pregabalin Oil, Intramuscular: DoD Uniform Formulary Outpatient Dosage Forms Generic: 50 mg/mL (10 mL) UNIFORM FORMULARY Suppository, Vaginal: Capsule, Oral: First-Progesterone VGS 100: 100 mg (30 ea) Lyrica: 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, 300 mg First-Progesterone VGS 200: 200 mg (30 ea) Solution, Oral: Lyrica: 20 mg/mL (473 mL) Promethazine NONFORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet Extended Release 24 Hour, Oral: BASIC CORE FORMULARY Lyrica CR: 82.5 mg, 165 mg, 330 mg Suppository, Rectal, as hydrochloride: Generic: 12.5 mg (12s); 25 mg (12s) Pretomanid Solution, Oral, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Generic: 6.25 mg/5 mL (118 mL, 473 mL) UNIFORM FORMULARY Syrup, Oral, as hydrochloride: Tablet, Oral: Generic: 6.25 mg/5 mL (118 mL, 473 mL) Generic: 200 mg Tablet, Oral, as hydrochloride: Prilocaine Generic: 25 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Injection, as hydrochloride: Solution, Injection, as hydrochloride: Generic: 25 mg/mL (1 mL); 50 mg/mL (1 mL) Citanest Plain Dental: 4% (1.8 mL) Suppository, Rectal, as hydrochloride: Prilocaine and Epinephrine Generic: 50 mg (12 ea) Tablet, Oral, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Generic: 12.5 mg, 50 mg UNIFORM FORMULARY Injection, solution [for dental use]: Promethazine and Codeine Citanest Forte Dental: Prilocaine hydrochloride 4% and epinephrine 1:200,000 DoD Uniform Formulary Outpatient Dosage Forms (1.7 mL) [contains sodium metabisulfite] UNIFORM FORMULARY Primaquine Syrup, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: Promethazine hydrochloride 6.25 mg and codeine phosphate 10 mg UNIFORM FORMULARY per 5 mL (5 mL, 118 mL, 473 mL) Tablet, Oral, as phosphate: Promethazine and Dextromethorphan Generic: 26.3 mg DoD Uniform Formulary Outpatient Dosage Forms Primidone UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Syrup, Oral: UNIFORM FORMULARY Generic: Promethazine hydrochloride 6.25 mg and dextromethorphan hydro- Tablet, Oral: bromide 15 mg per 5 mL (120 mL, 480 mL) Generic: 50 mg, 250 mg Promethazine and Phenylephrine Probenecid DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Syrup, Oral: Tablet, Oral: Generic: Promethazine hydrochloride 6.25 mg and phenylephrine hydrochlor- Generic: 500 mg ide 5 mg per 5 mL (473 mL) Probiotic Product Promethazine, Phenylephrine, and Codeine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral: Syrup, Oral: Align Generic: Promethazine hydrochloride 6.25 mg, phenylephrine hydrochloride Procainamide 5 mg, and codeine phosphate 10 mg per 5 mL (120 mL, 480 mL) DoD Uniform Formulary Outpatient Dosage Forms Propafenone UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection, as hydrochloride: UNIFORM FORMULARY Generic: 100 mg/mL (10 mL); 500 mg/mL (2 mL) Capsule Extended Release 12 Hour, Oral, as hydrochloride: Procarbazine Generic: 225 mg, 325 mg, 425 mg DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral, as hydrochloride: UNIFORM FORMULARY Generic: 150 mg, 225 mg, 300 mg Capsule, Oral, as hydrochloride: Propantheline Matulane: 50 mg DoD Uniform Formulary Outpatient Dosage Forms Prochlorperazine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral, as bromide: UNIFORM FORMULARY Generic: 15 mg Solution, Injection, as edisylate [strength expressed as base]: Generic: 5 mg/mL (2 mL) 98 PYRANTEL PAMOATE Proparacaine Syrup, Oral, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Nasal Decongestant: 30 mg/5 mL (473 mL) [contains methylparaben, saccha- UNIFORM FORMULARY rin sodium, sodium benzoate; raspberry flavor] Solution, Ophthalmic, as hydrochloride: Tablet, Oral, as hydrochloride: Generic: 0.5% (15 mL) Generic: 30 mg, 60 mg Tablet Abuse-Deterrent, Oral, as hydrochloride: Proparacaine and Fluorescein Nexafed: 30 mg DoD Uniform Formulary Outpatient Dosage Forms Zephrex-D: 30 mg UNIFORM FORMULARY Tablet Extended Release 12 Hour, Oral, as hydrochloride: Solution, ophthalmic: SudoGest 12 Hour: 120 mg Generic: Proparacaine hydrochloride 0.5% and fluorescein sodium 0.25% Generic: 120 mg (5 mL) Tablet Extended Release 24 Hour, Oral, as hydrochloride: Propofol Sudafed 24 Hour: 240 mg DoD Uniform Formulary Outpatient Dosage Forms Pseudoephedrine and Dextromethorphan UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Emulsion, Intravenous: UNIFORM FORMULARY Generic: 1000 mg/100 mL (100 mL); 200 mg/20 mL (20 mL); 500 mg/50 mL Liquid, Oral: (50 mL) Sudafed Children's Cold & Cough: Pseudoephedrine hydrochloride 15 mg and Emulsion, Intravenous [preservative free]: dextromethorphan hydrobromide 5 mg per 5 mL (120 mL) [alcohol free, Generic: 200 mg/20 mL (20 mL); 500 mg/50 mL (50 mL); 1000 mg/100 mL sugar free; contains sodium benzoate; cherry berry flavor] (100 mL) Syrup, Oral: Propranolol Pedia Relief Cough and Cold: Pseudoephedrine hydrochloride 15 mg and DoD Uniform Formulary Outpatient Dosage Forms dextromethorphan hydrobromide 7.5 mg per 5 mL (120 mL) [cherry flavor] UNIFORM FORMULARY Pseudoephedrine and Ibuprofen Emulsion, Intravenous: Generic: 200 mg/20 mL (20 mL); 500 mg/50 mL (50 mL); 1000 mg/100 mL DoD Uniform Formulary Outpatient Dosage Forms (100 mL) UNIFORM FORMULARY Emulsion, Intravenous [preservative free]: Capsule, liquid filled, Oral: Generic: 200 mg/20 mL (20 mL); 500 mg/50 mL (50 mL); 1000 mg/100 mL Advil Cold & Sinus: Pseudoephedrine hydrochloride 30 mg and ibuprofen (100 mL) 200 mg [solubilized ibuprofen as free acid and potassium salt; contains potassium 20 mg/capsule and coconut oil] Propranolol and Hydrochlorothiazide Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: Pseudoephedrine hydrochloride 30 mg and ibuprofen 200 mg UNIFORM FORMULARY Tablet, Oral: Psyllium Generic: Propranolol hydrochloride 40 mg and hydrochlorothiazide 25 mg; DoD Uniform Formulary Outpatient Dosage Forms Generic: Propranolol hydrochloride 80 mg and hydrochlorothiazide 25 mg UNIFORM FORMULARY Capsule, Oral: Propylhexedrine Konsyl: 520 mg [gluten free, sugar free] DoD Uniform Formulary Outpatient Dosage Forms Reguloid: 0.52 g UNIFORM FORMULARY Generic: 400 mg Inhaler, Nasal: 0.4-0.5 mg/inhalation (1s) [total content 250 mg] Packet, Oral: Konsyl: 28.3% (1 ea) [gluten free, kosher certified] Propylthiouracil Konsyl: 28.3% (30 ea) [gluten free, kosher certified; orange flavor] DoD Uniform Formulary Outpatient Dosage Forms Konsyl: 60.3% (1 ea, 30 ea) [gluten free, kosher certified, sugar free; contains BASIC CORE FORMULARY aspartame; orange flavor] Tablet, Oral: Konsyl: 100% (1 ea, 30 ea, 100 ea) [gluten free, kosher certified, sugar free; Generic: 50 mg bland flavor] Protamine Metamucil MultiHealth Fiber: 58.12% (1 ea, 30 ea]) [gluten free, sugar free; DoD Uniform Formulary Outpatient Dosage Forms contains aspartame; orange flavor] NOT COVERED Powder, Oral: Solution, Intravenous, as sulfate: Geri-Mucil: 68% (368 g) Generic: 10 mg/mL (5 mL, 25 mL) Geri-Mucil: 68% (368 g) Solution, Intravenous, as sulfate [preservative free]: Geri-Mucil: 68% (284 g) [sugar free] Generic: 10 mg/mL (5 mL, 25 mL) Konsyl: 30.9% (397 g) [gluten free, kosher certified; orange flavor] Konsyl: 28.3% (538 g) [gluten free, kosher certified; orange flavor] Protein C Concentrate (Human) Konsyl: 60.3% (450 g) [gluten free, kosher certified, sugar free; contains DoD Uniform Formulary Outpatient Dosage Forms aspartame; orange flavor] UNIFORM FORMULARY Konsyl: 71.67% (300 g); 100% (300 g, 450 g) [gluten free, kosher certified, Solution Reconstituted, Intravenous [preservative free]: sugar free; bland flavor] Ceprotin: 500 units (1 ea); 1000 units (1 ea) [contains albumin human, Konsyl: 60.3% (283 g) [sugar free; contains aspartame; orange flavor] heparin, mouse (murine) and/or hamster protein] Konsyl-D: 52.3% (397 g) [flavor free; sweet flavor] Prothrombin Complex Concentrate (Human) [(Factors II, VII, IX, Metamucil MultiHealth Fiber: 63% (660 g) [gluten free, sugar free] Natural Fiber Therapy: 30.9% (368 g, 539 g); 48.57% (368 g, 538 g) X), Protein C, and Protein S] Natural Psyllium Seed: 100% (480 g) [animal products free, gelatin free, DoD Uniform Formulary Outpatient Dosage Forms gluten free, kosher certified, lactose free, no artificial color(s), no artificial UNIFORM FORMULARY flavor(s), starch free, sugar free, yeast free] Kit, Intravenous [preservative free]: Natural Vegetable Fiber: 48.57% (368 g) Kcentra: ~500 units, ~1000 units [pyrogen free; contains albumin human, Reguloid: 48.57% (369 g, 540 g) antithrombin iii (human), heparin] Reguloid: 28.3% (369 g, 540 g) [orange flavor] Protriptyline Reguloid: 58.6% (284 g, 426 g) [sugar free; natural flavor] DoD Uniform Formulary Outpatient Dosage Forms Reguloid: 58.6% (284 g, 426 g) [sugar free] UNIFORM FORMULARY Sorbulax: 100% (420 g) Tablet, Oral, as hydrochloride: Powder, Oral [preservative free]: Generic: 5 mg, 10 mg Evac: (480 g) [dye free] Pseudoephedrine Pyrantel Pamoate DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Liquid, Oral, as hydrochloride: Suspension, Oral [strength expressed as base]: Childrens Silfedrine: 15 mg/5 mL (118 mL, 237 mL) [grape flavor] Reeses Pinworm Medicine: 50 mg/mL (30 mL) [contains saccharin sodium, Nasal Decongestant: 30 mg/5 mL (118 mL) [contains methylparaben, saccha- sodium benzoate] rin sodium, sodium benzoate; raspberry flavor] Tablet, Oral [strength expressed as base]: Sudafed Childrens: 15 mg/5 mL (118 mL) [alcohol free, sugar free; contains Reeses Pinworm Medicine: 62.5 mg [scored] edetate disodium, menthol, polyethylene glycol, saccharin sodium, sodium benzoate; grape flavor] 99 PYRAZINAMIDE Pyrazinamide QUEtiapine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY BASIC CORE FORMULARY Tablet, Oral: Tablet, Oral: Generic: 500 mg Generic: 25 mg, 50 mg, 100 mg, 200 mg, 300 mg, 400 mg Tablet Extended Release 24 Hour, Oral: Pyrethrins and Piperonyl Butoxide Generic: 50 mg, 150 mg, 200 mg, 300 mg, 400 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Quinapril Kit: DoD Uniform Formulary Outpatient Dosage Forms A-200 Lice Treatment Kit: UNIFORM FORMULARY Shampoo: Pyrethrins 0.33% and piperonyl butoxide 4% (120 mL) Tablet, Oral: [packaged with nit removal comb and household permethrin spray] Generic: 5 mg, 10 mg, 20 mg, 40 mg LiceMD Complete: Gel: Pyrethrins 0.33% and piperonyl butoxide 4% (118 mL) Quinapril and Hydrochlorothiazide [packaged with non-medicated shampoo, nit removal comb, and gloves] DoD Uniform Formulary Outpatient Dosage Forms LiceMD Treatment: UNIFORM FORMULARY Gel: Pyrethrins 0.33% and piperonyl butoxide 4% (118 mL) Tablet, Oral: [packaged with nit removal comb and gloves] Generic: 10/12.5: Quinapril 10 mg and hydrochlorothiazide 12.5 mg Pronto Plus Complete Lice Removal System: Generic: 20/12.5: Quinapril 20 mg and hydrochlorothiazide 12.5 mg Shampoo: Pyrethrins 0.33% and piperonyl butoxide 4% (60 mL) Generic: 20/25: Quinapril 20 mg and hydrochlorothiazide 25 mg [packaged with lice egg removal gel, nit removal comb, and household permethrin spray] QuiNIDine RID Lice Elimination Essentials: DoD Uniform Formulary Outpatient Dosage Forms Shampoo: Pyrethrins 0.33% and piperonyl butoxide 4% (118 mL) UNIFORM FORMULARY [packaged with hair comb out spray (detangler) and nit removal comb] Solution, Injection, as gluconate: RID Lice Treatment Complete: Generic: 80 mg/mL (10 mL) Shampoo: Pyrethrins 0.33% and piperonyl butoxide 4% (118 mL) Tablet, Oral, as sulfate: [packaged with hair comb out spray (detangler), nit removal comb and Generic: 200 mg, 300 mg household permethrin spray] Tablet Extended Release, Oral, as gluconate: Shampoo: Generic: 324 mg A-200 Maximum Strength: Pyrethrins 0.33% and piperonyl butoxide 4% (60 QuiNINE mL, 120 mL) [contains benzyl alcohol; packaged with nit removal comb] DoD Uniform Formulary Outpatient Dosage Forms Licide: Pyrethrins 0.33% and piperonyl butoxide 4% (120 mL) [packaged with UNIFORM FORMULARY nit removal comb; also available in a kit containing shampoo, household Capsule, Oral, as sulfate: spray, and nit removal comb] Generic: 324 mg RID Lice Killing: Pyrethrins 0.33% and piperonyl butoxide 4% (59 mL, 118 mL, 236 mL) [packaged with nit removal combs] Quinupristin and Dalfopristin Pyridostigmine DoD Uniform Formulary Outpatient Dosage Forms NOT COVERED DoD Uniform Formulary Outpatient Dosage Forms Injection, powder for reconstitution: UNIFORM FORMULARY Synercid: 500 mg: Quinupristin 150 mg and dalfopristin 350 mg Solution, Intravenous, as bromide: Regonol: 10 mg/2 mL (2 mL) [contains benzyl alcohol] RABEprazole Syrup, Oral, as bromide: DoD Uniform Formulary Outpatient Dosage Forms Mestinon: 60 mg/5 mL (473 mL) [contains alcohol, usp, sodium benzoate; UNIFORM FORMULARY raspberry flavor] Capsule Sprinkle, Oral, as sodium: Tablet, Oral, as bromide: AcipHex Sprinkle: 5 mg, 10 mg Generic: 60 mg Tablet Delayed Release, Oral, as sodium: Tablet Extended Release, Oral, as bromide: Generic: 20 mg Generic: 180 mg Rabies Immune Globulin (Human) Pyridoxine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Injectable, Intramuscular: Capsule, Oral, as hydrochloride: Imogam Rabies-HT: 300 units/2 mL (2 mL); 1500 units/10 mL (10 mL) Neuro-K-250 T.D.: 250 mg [corn free, rye free, starch free, sugar free, Injectable, Intramuscular [preservative free]: wheat free] HyperRAB: 300 units/mL (1 mL); 1500 units/5 mL (5 mL) Solution, Injection, as hydrochloride: HyperRAB S/D: 300 units/2 mL (2 mL); 1500 units/10 mL (10 mL) Generic: 100 mg/mL (1 mL) Kedrab: 300 units/2 mL (2 mL); 1500 units/10 mL (10 mL) [latex free, Tablet, Oral, as hydrochloride: pyrogen free] Neuro-K-500: 500 mg Generic: 25 mg, 50 mg, 100 mg, 250 mg Rabies Vaccine Tablet, Oral, as hydrochloride [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 25 mg, 50 mg, 100 mg UNIFORM FORMULARY Tablet Extended Release, Oral, as hydrochloride: Injectable, Intramuscular [preservative free]: Generic: 200 mg Imovax Rabies: 2.5 units/mL (1 ea) [contains albumin human, neomycin sulfate] Pyrimethamine Suspension Reconstituted, Intramuscular: DoD Uniform Formulary Outpatient Dosage Forms RabAvert: 2.5 units (1 ea) [contains albumin human, chicken protein, edetate UNIFORM FORMULARY disodium, gelatin (bovine), neomycin] Tablet, Oral: Daraprim: 25 mg [scored] Radium Ra 223 Dichloride DoD Uniform Formulary Outpatient Dosage Forms Pyrithione Zinc NOT COVERED DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous: UNIFORM FORMULARY Xofigo: 1100 kBq/mL (30 microcurie/mL) (6 mL) Liquid, External: DHS Body Wash: 0.5% (480 mL) [color free, fragrance free] Ragweed Pollen Allergen Extract Shampoo, External: DoD Uniform Formulary Outpatient Dosage Forms Beta Med: 2% (480 mL) UNIFORM FORMULARY DHS Zinc: 2% (240 mL, 480 mL) [contains fd&c yellow #6 (sunset yellow)] Tablet, Sublingual: Theraplex Z: 2% (240 mL) Ragwitek: 12 AMB A 1-U [contains gelatin (fish)] Quazepam Raloxifene DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Tablet, Oral: Tablet, Oral, as hydrochloride: Generic: 15 mg Generic: 60 mg 100 RIBOCICLIB AND LETROZOLE Raltegravir Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 1/500: Repaglinide 1 mg and metformin hydrochloride 500 mg UNIFORM FORMULARY Generic: 2/500: Repaglinide 2 mg and metformin hydrochloride 500 mg Packet, Oral: Reserpine Isentress: 100 mg (1 ea, 60 ea) [contains polyethylene glycol; banana flavor] Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Isentress: 400 mg [contains polyethylene glycol] UNIFORM FORMULARY Tablet Chewable, Oral: Tablet, Oral: Isentress: 25 mg [contains aspartame, saccharin sodium; orange banana Generic: 0.1 mg [DSC], 0.25 mg [DSC] flavor] Reslizumab Isentress: 100 mg [scored; contains aspartame, saccharin sodium; orange DoD Uniform Formulary Outpatient Dosage Forms banana flavor] UNIFORM FORMULARY Ramipril Solution, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Cinqair: 100 mg/10 mL (10 mL) [contains mouse (murine) and/or hamster BASIC CORE FORMULARY protein] Capsule, Oral: Retapamulin Altace: 1.25 mg, 2.5 mg, 5 mg, 10 mg Generic: 1.25 mg, 2.5 mg, 5 mg, 10 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Ramucirumab Ointment, External: DoD Uniform Formulary Outpatient Dosage Forms Altabax: 1% (15 g, 30 g) UNIFORM FORMULARY Solution, Intravenous [preservative free]: Rho(D) Immune Globulin Cyramza: 100 mg/10 mL (10 mL); 500 mg/50 mL (50 mL) [contains poly- DoD Uniform Formulary Outpatient Dosage Forms sorbate 80] UNIFORM FORMULARY Solution, Injection: Ranibizumab WinRho SDF: 2500 units/2.2 mL (2.2 mL); 5000 units/4.4 mL (4.4 mL); 1500 DoD Uniform Formulary Outpatient Dosage Forms units/1.3 mL (1.3 mL); 15,000 units/13 mL (13 mL) UNIFORM FORMULARY Solution, Injection [preservative free]: Solution, Intravitreal [preservative free]: WinRho SDF: 2500 units/2.2 mL (2.2 mL); 5000 units/4.4 mL (4.4 mL); 1500 Lucentis: 0.3 mg/0.05 mL (0.05 mL); 0.5 mg/0.05 mL (0.05 mL) units/1.3 mL (1.3 mL); 15,000 units/13 mL (13 mL) [contains polysorbate 80] Solution Prefilled Syringe, Intravitreal [preservative free]: Solution Prefilled Syringe, Injection [preservative free]: Lucentis: 0.5 mg/0.05 mL (0.05 mL) Rhophylac: 1500 units/2 mL (2 mL) Solution Prefilled Syringe, Intramuscular [preservative free]: Ranolazine HyperRHO S/D: 250 units (1 ea); 1500 units (1 ea) [latex free] DoD Uniform Formulary Outpatient Dosage Forms MICRhoGAM Ultra-Filtered Plus: 250 units (1 ea) [latex free, thimerosal free; UNIFORM FORMULARY contains polysorbate 80] Tablet Extended Release 12 Hour, Oral: RhoGAM Ultra-Filtered Plus: 1500 units (1 ea) [latex free, thimerosal free; Ranexa: 500 mg, 1000 mg contains polysorbate 80] Rasagiline Ribavirin (Oral Inhalation) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Solution Reconstituted, Inhalation: Generic: 0.5 mg, 1 mg Generic: 6 g (1 ea) Rasburicase Solution Reconstituted, Inhalation [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Virazole: 6 g (1 ea) NOT COVERED Ribavirin (Systemic) Solution Reconstituted, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Elitek: 1.5 mg (1 ea); 7.5 mg (1 ea) Extended Core Formulary Ravulizumab Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Ribasphere: 200 mg NOT COVERED Generic: 200 mg Solution, Intravenous [preservative free]: UNIFORM FORMULARY Ultomiris: 300 mg/30 mL (30 mL) [contains polysorbate 80] Solution, Oral: Rebetol: 40 mg/mL (100 mL) [contains propylene glycol, sodium benzoate; Regadenoson bubble-gum flavor] DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Moderiba: 200 mg Solution, Intravenous: Moderiba 1200 Dose Pack: 600 mg Lexiscan: 0.4 mg/5 mL (5 mL) [contains edetate disodium dihydrate, propy- NONFORMULARY lene glycol] Tablet Therapy Pack, Oral: Ribasphere RibaPak: 600, 800, 1000, 1200 Regorafenib DoD Uniform Formulary Outpatient Dosage Forms Ribociclib UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Stivarga: 40 mg [contains soybean lecithin] Tablet, Oral: Kisqali 200 Dose: 200 mg (21s) [contains soybean lecithin] Relugolix, Estradiol, and Norethindrone Kisqali 400 Dose: 200 mg (42s) [contains soybean lecithin] Remifentanil Kisqali 600 Dose: 200 mg (63s) [contains soybean lecithin] DoD Uniform Formulary Outpatient Dosage Forms Ribociclib and Letrozole UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous [preservative free]: UNIFORM FORMULARY Ultiva: 1 mg (1 ea); 2 mg (1 ea); 5 mg (1 ea) Therapy Pack, Tablet, Oral: Repaglinide Kisqali Femara Co-Pack: DoD Uniform Formulary Outpatient Dosage Forms 200 mg daily dose: Kisqali (ribociclib) 200 mg (21s), and Femara (letrozole) UNIFORM FORMULARY 2.5 mg (28s) Tablet, Oral: 400 mg daily dose: Kisqali (ribociclib) 200 mg (42s), and Femara (letrozole) Generic: 0.5 mg, 1 mg, 2 mg 2.5 mg (28s) 600 mg daily dose: Kisqali (ribociclib) 200 mg (63s), and Femara (letrozole) Repaglinide and Metformin 2.5 mg (28s) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY 101 RIBOFLAVIN Riboflavin RiMANTAdine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral: Tablet, Oral, as hydrochloride: B-2-400: 400 mg Generic: 100 mg Generic: 50 mg Tablet, Oral: Rimegepant Generic: 25 mg, 50 mg, 100 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Riboflavin 5'-Phosphate Tablet Disintegrating, Oral, as sulfate: DoD Uniform Formulary Outpatient Dosage Forms Nurtec: 75 mg [contains menthol] UNIFORM FORMULARY Ringer's Injection Solution, Ophthalmic: DoD Uniform Formulary Outpatient Dosage Forms Photrexa: 0.146% (3 mL) UNIFORM FORMULARY Photrexa Viscous: 0.146% in Dextran 20% (3 mL) Solution, Intravenous: Rifabutin Generic: Sodium Chloride 0.86 g, Potassium Chloride 0.03 g, Calcium Chlor- DoD Uniform Formulary Outpatient Dosage Forms ide Dihydrate 0.033 g (500 mL; 1,000 mL) UNIFORM FORMULARY Ringer's Injection (Lactated) Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 150 mg UNIFORM FORMULARY RifAMPin Solution, Intravenous: Generic: (250 mL, 500 mL, 1000 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution, Irrigation: BASIC CORE FORMULARY Generic: (1000 mL, 2000 mL, 3000 mL, 4000 mL) Capsule, Oral: Generic: 300 mg Riociguat UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Solution Reconstituted, Intravenous: Tablet, Oral: Generic: 600 mg (1 ea) Adempas: 0.5 mg, 1 mg, 1.5 mg, 2 mg, 2.5 mg Rifampin and Isoniazid Ripretinib DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, oral: Tablet, Oral: Rifamate: Rifampin 300 mg and isoniazid 150 mg Qinlock: 50 mg Rifampin, Isoniazid, and Pyrazinamide Risdiplam DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, oral: Solution Reconstituted, Oral: Rifater: Rifampin 120 mg, isoniazid 50 mg, and pyrazinamide 300 mg Evrysdi: 0.75 mg/mL (80 mL) [contains edetate (edta) disodium dihydrate, Rifamycin polyethylene glycol, sodium benzoate] DoD Uniform Formulary Outpatient Dosage Forms RisperiDONE NONFORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet Delayed Release, Oral: BASIC CORE FORMULARY Aemcolo: 194 mg Tablet, Oral: Generic: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg Rifapentine Tablet Dispersible, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg UNIFORM FORMULARY Tablet, Oral: UNIFORM FORMULARY Priftin: 150 mg [contains disodium edta] Solution, Oral: Generic: 1 mg/mL (30 mL) RifAXIMin Suspension Reconstituted, Intramuscular: DoD Uniform Formulary Outpatient Dosage Forms RisperDAL Consta: 12.5 mg (1 ea); 25 mg (1 ea); 37.5 mg (1 ea); 50 mg UNIFORM FORMULARY (1 ea) Tablet, Oral: Ritonavir Xifaxan: 200 mg, 550 mg [contains edetate disodium] DoD Uniform Formulary Outpatient Dosage Forms Rilonacept UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral: Norvir: 100 mg [contains alcohol, usp] UNIFORM FORMULARY Solution, Oral: Solution Reconstituted, Subcutaneous [preservative free]: Norvir: 80 mg/mL (240 mL) [contains alcohol, usp, fd&c yellow #6 (sunset Arcalyst: 220 mg (1 ea) [contains polyethylene glycol] yellow), propylene glycol, saccharin sodium; peppermint-caramel flavor] Rilpivirine Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Norvir: 100 mg UNIFORM FORMULARY RiTUXimab Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Edurant: 25 mg NOT COVERED Riluzole Solution, Intravenous [preservative free]: Riabni: rituximab-arrx 100 mg/10 mL (10 mL); rituximab-arrx 500 mg/50 mL DoD Uniform Formulary Outpatient Dosage Forms (50 mL) [contains polysorbate 80] UNIFORM FORMULARY Rituxan: 100 mg/10 mL (10 mL); 10 mg/mL (10 mL, 50 mL) [contains poly- Suspension, Oral: sorbate 80] Tiglutik: 50 mg/10 mL (300 mL) Ruxience: rituximab-pvvr 100 mg/10 mL (10 mL); rituximab-pvvr 500 mg/50 Tablet, Oral: mL (50 mL) [contains edetate (edta) disodium dihydrate, polysorbate 80] Generic: 50 mg Truxima: rituximab-abbs 100 mg/10 mL (10 mL); rituximab-abbs 500 mg/50 mL (50 mL) [contains polysorbate 80] RimabotulinumtoxinB DoD Uniform Formulary Outpatient Dosage Forms Rivaroxaban UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Intramuscular [preservative free]: UNIFORM FORMULARY Myobloc: 2500 units/0.5 mL (0.5 mL); 5000 units/mL (1 mL); 10,000 units/2 mL Tablet, Oral: (2 mL) [contains albumin human] Xarelto: 10 mg, 15 mg, 20 mg 102 SALICYLIC ACID Tablet Therapy Pack, Oral: Rotigotine Xarelto Starter Pack: 15 mg (42s) and 20 mg (9s) (51 ea) DoD Uniform Formulary Outpatient Dosage Forms Rivastigmine UNIFORM FORMULARY Patch 24 Hour, Transdermal: DoD Uniform Formulary Outpatient Dosage Forms Neupro: 1 mg/24 hr (30 ea); 2 mg/24 hr (30 ea); 3 mg/24 hr (30 ea); 4 mg/24 UNIFORM FORMULARY hr (30 ea); 6 mg/24 hr (30 ea); 8 mg/24 hr (30 ea) [contains sodium Capsule, Oral: metabisulfite] Generic: 1.5 mg, 3 mg, 4.5 mg, 6 mg Patch 24 Hour, Transdermal: Rufinamide Generic: 4.6 mg/24 hr (30 ea); 9.5 mg/24 hr (1 ea, 30 ea); 13.3 mg/24 hr DoD Uniform Formulary Outpatient Dosage Forms (30 ea) UNIFORM FORMULARY Suspension, Oral: Rizatriptan Banzel: 40 mg/mL (460 mL) [contains methylparaben, propylene glycol, DoD Uniform Formulary Outpatient Dosage Forms propylparaben; orange flavor] BASIC CORE FORMULARY Tablet, Oral: Tablet, Oral: Banzel: 200 mg, 400 mg [scored] Generic: 5 mg, 10 mg Tablet Dispersible, Oral: Ruxolitinib Generic: 5 mg, 10 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Rocuronium Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Jakafi: 5 mg, 10 mg, 15 mg, 20 mg, 25 mg UNIFORM FORMULARY Solution, Intravenous, as bromide: Saccharomyces boulardii Generic: 50 mg/5 mL (5 mL); 100 mg/10 mL (10 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous, as bromide [preservative free]: UNIFORM FORMULARY Capsule, oral: Generic: 50 mg/5 mL (5 mL); 100 mg/10 mL (10 mL) Florastor: 250 mg [contains lactose 32.5 mg/capsule, magnesium 2.85 mg/ Roflumilast capsule; provides 5 billion live cells] DoD Uniform Formulary Outpatient Dosage Forms Powder, oral: UNIFORM FORMULARY Florastor Kids: 250 mg/packet (10s) [contains lactose 32.5 mg/packet, mag- nesium 2.85 mg/packet; tutti frutti flavor; provides 5 billion live cells] Tablet, Oral: Daliresp: 500 mcg Sacrosidase RomiDEPsin DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Oral: UNIFORM FORMULARY Sucraid: 8500 units/mL (118 mL) [contains papain] Solution Reconstituted, Intravenous: Istodax: 10 mg (1 ea) [contains alcohol, usp, propylene glycol] Sacubitril and Valsartan Istodax (Overfill): 10 mg (1 ea) [contains alcohol, usp, propylene glycol] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY RomiPLOStim Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Entresto: Sacubitril 24 mg and valsartan 26 mg UNIFORM FORMULARY Entresto: Sacubitril 49 mg and valsartan 51 mg Solution Reconstituted, Subcutaneous [preservative free]: Entresto: Sacubitril 97 mg and valsartan 103 mg Nplate: 250 mcg (1 ea); 500 mcg (1 ea) Salicylic Acid Romosozumab DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Cream, External: Solution Prefilled Syringe, Subcutaneous [preservative free]: Generic: 6% (400 g, 454 g) Evenity: Romosozumab-aqqg 105 mg per 1.17 mL (1.17 mL) Foam, External: SalAc: 2% (100 g) [contains alcohol, usp] ROPINIRole Generic: 6% (70 g, 200 g) DoD Uniform Formulary Outpatient Dosage Forms Gel, External: UNIFORM FORMULARY Exuviance Blemish Treatment: 2% (15 g) [contains denatured alcohol, peanut Tablet, Oral: oil, propylene glycol] Generic: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg Keralyt: 3% (28.4 g) [contains alcohol, usp] Tablet Extended Release 24 Hour, Oral: Keralyt: 6% (40 g, 100 g) [contains hydroxypropyl cellulose, propylene glycol, Generic: 2 mg, 4 mg, 6 mg, 8 mg, 12 mg sd alcohol 40] Sal-Plant: 17% (14 g) Ropivacaine Generic: 6% (40 g, 240 g) DoD Uniform Formulary Outpatient Dosage Forms Kit, External: UNIFORM FORMULARY Generic: 6% Solution, Injection, as hydrochloride [preservative free]: Liquid, External: Generic: 2 mg/mL (10 mL, 20 mL, 100 mL); 5 mg/mL (20 mL, 30 mL); Neutrogena Oil-Free Acne Wash: 2% (124 mL) [contains benzalkonium 7.5 mg/mL (20 mL); 10 mg/mL (10 mL, 20 mL) chloride, disodium edta, propylene glycol] Psoriasin: 3% (177 mL) [dye free, fragrance free] Rosuvastatin Salicylic Acid Wart Remover: 27.5% (10 mL) [contains isopropyl alcohol] DoD Uniform Formulary Outpatient Dosage Forms Scalpicin 2 in 1: 3% (44 mL) [fragrance free; contains menthol, propylene BASIC CORE FORMULARY glycol] Tablet, Oral: Virasal: 27.5% (10 mL) [contains isopropyl alcohol, isopropyl-metacresol Generic: 5 mg, 10 mg, 20 mg, 40 mg (isopropyl-m-cresol] Generic: 26% (10 mL); 27.5% (10 mL) UNIFORM FORMULARY Lotion, External: Tablet, Oral: Salitech: 5% (177 mL) [contains cetearyl alcohol, cetyl alcohol, methylpar- Crestor: 5 mg, 10 mg, 20 mg, 40 mg aben, propylparaben] Generic: 6% (400 g, 414 mL, 473 mL) Rotavirus Vaccine Ointment, External: DoD Uniform Formulary Outpatient Dosage Forms Bensal HP: 3% (30 g) UNIFORM FORMULARY Pad, External: Powder, for suspension, oral [preservative free; human derived]: Clear Away 1-Step Wart Remover: 40% (14 ea) 6 Rotarix: G1P[8] ≥10 CCID50 per 1 mL [contains sorbitol, sucrose; supplied Corn Remover One Step: 40% (6 ea) with diluent which may contain natural rubber/natural latex in packaging] Corn Remover Ultra Thin: 40% (9 ea) Solution, oral [preservative free; bovine and human derived]: Mediplast: 40% (1 ea, 25 ea) RotaTeq: G1 ≥2.2 x 106 infectious units, G2 ≥2.8 x 106 infectious units, G3 One Step Callus Remover: 40% (4 ea) ≥2.2 x 106 infectious units, G4 ≥2 x 106 infectious units, and P1A [8] ≥2.3 x Stri-Dex Maximum Strength: 2% (55 ea, 90 ea) [alcohol free] 106 infectious units per 2 mL (2 mL) [contains sucrose] Stri-Dex Sensitive Skin: 0.5% (55 ea, 90 ea) [alcohol free] 103 SALICYLIC ACID Stridex Essential: 1% (55 ea) [alcohol free; contains menthol, tetrasodium Sapropterin etidronate] DoD Uniform Formulary Outpatient Dosage Forms Shampoo, External: UNIFORM FORMULARY Betasal: 3% (480 mL) Packet, Oral, as dihydrochloride: Ionil: 2% (120 mL) Kuvan: 100 mg (1 ea, 30 ea); 500 mg (1 ea, 30 ea) P & S: 2% (236 mL) [contains edetate sodium (tetrasodium), methylparaben, Tablet Soluble, Oral, as dihydrochloride: propylparaben, trolamine (triethanolamine)] Kuvan: 100 mg Salex: 6% (177 mL) [contains methylparaben, propylparaben, trolamine (triethanolamine)] Saquinavir Generic: 6% (177 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution, External: UNIFORM FORMULARY Gordofilm: 16.7% (15 mL) Capsule, Oral: Salactic Film: 17% (15 mL) Invirase: 200 mg Salisol: 23% (10 mL) [contains isopropyl alcohol] Tablet, Oral: Salisol Forte: 26% (10 mL) [contains isopropyl alcohol] Invirase: 500 mg UltraSal-ER: 28.5% (10 mL) [contains isopropyl alcohol, phenol, polysor- bate 80] Sargramostim Generic: 28.5% (10 mL) DoD Uniform Formulary Outpatient Dosage Forms NONFORMULARY UNIFORM FORMULARY Solution, External: Solution Reconstituted, Intravenous [preservative free]: Xalix: 28% (10 g) [contains isopropyl alcohol] Leukine: 250 mcg (1 ea) [contains benzyl alcohol] Saliva Substitute Satralizumab DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Liquid, oral: Solution Prefilled Syringe, Subcutaneous [preservative free]: Biotene Oral Balance: Water, starch, sunflower oil, propylene glycol, xylitol, Enspryng: Satralizumab-mwge 120 mg/mL (1 mL) glycerine, purified milk extract (45 mL) [sugar-free] Scopolamine Numoisyn: Water, sorbitol, linseed extract, Chondrus crispus, methylparaben, DoD Uniform Formulary Outpatient Dosage Forms sodium benzoate, potassium sorbate, dipotassium phosphate, propylpara- UNIFORM FORMULARY ben (300 mL) Patch 72 Hour, Transdermal: Lozenge, oral: Transderm-Scop (1.5 mg): 1 mg/3 days(1 ea, 4 ea, 10 ea, 24 ea) Numoisyn: Sorbitol 0.3 g/lozenge, polyethylene glycol, malic acid, sodium citrate, calcium phosphate dibasic, hydrogenated cottonseed oil, citric acid, Solution, Injection, as hydrobromide: magnesium stearate, silicon dioxide (100s) Generic: 0.4 mg/mL (1 mL) SalivaSure: Xylitol, citric acid, apple acid, sodium citrate dihydrate, sodium Sebelipase Alfa carboxymethylcellulose, dibasic calcium phosphate, silica colloidal, magne- DoD Uniform Formulary Outpatient Dosage Forms sium stearate, stearic acid (90s) UNIFORM FORMULARY Powder, for reconstitution, oral: Solution, Intravenous [preservative free]: NeutraSal: Calcium chloride, sodium bicarbonate, sodium chloride, and Kanuma: 20 mg/10 mL (10 mL) [contains albumin human, egg white (egg sodium phosphates (30s, 120s) protein)] SalivaMAX: Calcium chloride, sodium bicarbonate, sodium chloride, and sodium phosphates (30s, 120s) Secnidazole Salivate Rx: Calcium chloride, sodium bicarbonate, sodium chloride, and DoD Uniform Formulary Outpatient Dosage Forms sodium phosphates (30s) NONFORMULARY Solution, oral: Packet, Oral: Caphosol: Dibasic sodium phosphate 0.032%, monobasic sodium phosphate Solosec: 2 g (1 ea) [contains polyethylene glycol] 0.009%, calcium chloride 0.052%, sodium chloride 0.569%, purified water (30 mL) [packaged in two 15 mL ampuls when mixed together provide one 30 Secretin mL dose] DoD Uniform Formulary Outpatient Dosage Forms Entertainer's Secret: Sodium carboxymethylcellulose, aloe vera gel, glycerin UNIFORM FORMULARY (60 mL) [ethanol free; honey-apple flavor] Solution Reconstituted, Intravenous: Solution, oral [mouthwash/gargle]: ChiRhoStim: 16 mcg (1 ea) Oasis: Water, glycerin, sorbitol, poloxamer 338, PEG-60, hydrogenated castor SecreFlo: 16 mcg (1 ea) oil, copovidone, sodium benzoate, carboxymethylcellulose (473 mL) [ethanol free, sugar free; mild mint flavor] Secukinumab Solution, oral [spray]: DoD Uniform Formulary Outpatient Dosage Forms Aquoral: Oxidized glycerol triesters and silicon dioxide (5.6 mL) [contains UNIFORM FORMULARY aspartame; citrus flavor] Solution Auto-injector, Subcutaneous [preservative free]: Biotene Moisturizing Mouth Spray: Water, polyglycitol, propylene glycol, sun- Cosentyx Sensoready 300 Dose: 150 mg/mL (1 mL) [contains mouse (murine) flower oil, xylitol, milk protein extract, potassium sorbate, acesulfame K, and/or hamster protein, polysorbate 80] potassium thiocyanate, lysozyme, lactoferrin, lactoperoxidase (45 mL) Cosentyx Sensoready Pen: 150 mg/mL (1 mL) [contains mouse (murine) and/ Moi-Stir: Water, sorbitol, sodium carboxymethylcellulose, methylparaben, pro- or hamster protein, polysorbate 80] pylparaben, potassium chloride, dibasic sodium phosphate, calcium chloride, Solution Prefilled Syringe, Subcutaneous [preservative free]: magnesium chloride, sodium chloride (120 mL) Cosentyx: 150 mg/mL (1 mL) [contains mouse (murine) and/or hamster Mouth Kote: Water, xylitol, sorbitol, yerba santa, citric acid, ascorbic acid, protein, polysorbate 80] sodium saccharin, sodium benzoate (5 mL, 60 mL, 240 mL) [ethanol free, Cosentyx 300 Dose: 150 mg/mL (1 mL) [contains mouse (murine) and/or sugar free; lemon-lime flavor] hamster protein, polysorbate 80] Oasis: Glycerin, cetylpyridinium, copovidone (30 mL) [ethanol free, sugar free; contains sodium benzoate; delivers ~150 sprays, mild mint flavor] Selegiline DoD Uniform Formulary Outpatient Dosage Forms Salmeterol UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral, as hydrochloride: BASIC CORE FORMULARY Generic: 5 mg Aerosol Powder Breath Activated, Inhalation: Tablet, Oral, as hydrochloride: Serevent Diskus: 50 mcg (28s, 60s) [contains lactose] Generic: 5 mg Salsalate Tablet Dispersible, Oral, as hydrochloride: Zelapar: 1.25 mg [contains aspartame; grapefruit flavor] DoD Uniform Formulary Outpatient Dosage Forms NONFORMULARY UNIFORM FORMULARY Patch 24 Hour, Transdermal: Tablet, Oral: Emsam: 6 mg/24 hr (30 ea); 9 mg/24 hr (30 ea); 12 mg/24 hr (30 ea) Generic: 500 mg, 750 mg Selenium Samarium Sm 153 Lexidronam DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY NOT COVERED Capsule, Oral: Solution, Intravenous: Selenicaps-200: 200 mcg [corn free, no artificial color(s), rye free, sugar free, Quadramet: 1850 MBq/mL (1 ea]) wheat free, yeast free] 104 SIMVASTATIN Capsule, Oral [preservative free]: Sildenafil Se-100: 100 mcg [dye free, yeast free] DoD Uniform Formulary Outpatient Dosage Forms Liquid, Oral: BASIC CORE FORMULARY Aqueous Selenium: 95 mcg/drop (15 mL) [contains sodium benzoate] Tablet, Oral: Solution, Intravenous: Generic: 25 mg, 50 mg, 100 mg Generic: 40 mcg/mL (10 mL) Tablet, Oral: Extended Core Formulary Selenimin: 125 mcg [corn free, rye free, starch free, sugar free, wheat free] Tablet, Oral Generic: 50 mcg, 200 mcg Generic: 20 mg Tablet, Oral [preservative free]: UNIFORM FORMULARY Generic: 50 mcg, 200 mcg Solution, Intravenous: Tablet Extended Release, Oral [preservative free]: Generic: 10 mg/12.5 mL (12.5 mL) Generic: 200 mcg Suspension Reconstituted, Oral: Selenium Sulfide Generic: 10 mg/mL (112 mL) [contains sodium benzoate] DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: BASIC CORE FORMULARY Generic: 20 mg Lotion, External: NOT COVERED Generic: 2.5% (120 mL) Tablet, Oral: UNIFORM FORMULARY Viagra: 25 mg, 50 mg, 100 mg Shampoo, External: Siltuximab Anti-Dandruff: 1% (207 mL) [contains menthol DoD Uniform Formulary Outpatient Dosage Forms ]Dandrex: 1% (240 mL) UNIFORM FORMULARY Selexipag Solution Reconstituted, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Sylvant: 100 mg (1 ea); 400 mg (1 ea) [contains mouse (murine) and/or UNIFORM FORMULARY hamster protein, polysorbate 80] Tablet, Oral: Silver Uptravi: 200 mcg, 400 mcg, 600 mcg, 800 mcg, 1000 mcg, 1200 mcg, 1400 DoD Uniform Formulary Outpatient Dosage Forms mcg, 1600 mcg Tablet Therapy Pack, Oral: UNIFORM FORMULARY Uptravi: 200 mcg (140s) and 800 mcg (60s) (200 ea) Gel, External: Arida: (25 g, 45 g, 100 g, 500 g, 1000 g, 5000 g, 25000 g) Selpercatinib Pad, External: DoD Uniform Formulary Outpatient Dosage Forms Silverseal Hydrogel Dressing: 2"X3" (1 ea, 10 ea); 4"X5" (1 ea, 10 ea) UNIFORM FORMULARY [contains methylparaben, propylparaben] Capsule, Oral: Retevmo: 40 mg, 80 mg Silver Nitrate DoD Uniform Formulary Outpatient Dosage Forms Selumetinib UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Applicator sticks, topical: Silver nitrate 75% and potassium nitrate 25% UNIFORM FORMULARY Solution, topical: 0.5% (960 mL); 10% (30 mL); 25% (30 mL); 50% (30 mL) Capsule, Oral, as sulfate: Koselugo: 10 mg, 25 mg Silver Sulfadiazine DoD Uniform Formulary Outpatient Dosage Forms Senna BASIC CORE FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Cream, External: UNIFORM FORMULARY Generic: 1% (20 g, 25 g, 50 g, 85 g, 400 g) Leaves, Oral: Generic: (454 g) Simethicone Liquid, Oral: DoD Uniform Formulary Outpatient Dosage Forms Senexon: 8.8 mg/5 mL (237 mL) [contains methylparaben, propylene glycol, UNIFORM FORMULARY propylparaben] Capsule, Oral: Syrup, Oral: Phazyme Maximum Strength: 250 mg Generic: 8.8 mg/5 mL (5 mL, 236 mL, 237 mL); 176 mg/5 mL (15 mL, 237 mL) Generic: 125 mg, 180 mg Tablet, Oral: Liquid, Oral: Ex-Lax Maximum Strength: 25 mg [sodium free] Gas-X Infant Drops: 20 mg/0.3 mL (30 mL) [alcohol free, no artificial color(s), Senna Maximum Strength: 25 mg no artificial flavor(s), saccharin free; contains polyethylene glycol, sodium Senokot Extra Strength: 17.2 mg benzoate] Generic: 8.6 mg, 15 mg Strip, Oral: Tablet Chewable, Oral: Gas-X Childrens: 40 mg (16 ea) [contains alcohol, usp; sweet cinnamon Ex-Lax: 15 mg flavor] Ex-Lax: 15 mg [chocolate flavor] Gas-X Extra Strength: 62.5 mg (18 ea, 30 ea) [contains alcohol, usp; peppermint flavor] Sertraline Gas-X Extra Strength: 62.5 mg (18 ea) [contains alcohol, usp] DoD Uniform Formulary Outpatient Dosage Forms Suspension, Oral: BASIC CORE FORMULARY Gas Relief: 20 mg/0.3 mL (30 mL) [dye free; contains sodium benzoate; fruit Concentrate, Oral: flavor] Generic: 20 mg/mL (60 mL) Infants Gas Relief: 20 mg/0.3 mL (30 mL) [contains sodium benzoate] Tablet, Oral: Infants Simethicone: 20 mg/0.3 mL (30 mL) [alcohol free, no artificial color(s), Generic: 25 mg, 50 mg, 100 mg no artificial flavor(s), saccharin free; contains polyethylene glycol, sodium Sevelamer benzoate] Generic: 40 mg/0.6 mL (30 mL) DoD Uniform Formulary Outpatient Dosage Forms Tablet Chewable, Oral: UNIFORM FORMULARY Generic: 80 mg, 125 mg Packet, Oral, as carbonate: Renvela: 0.8 g (1 ea, 90 ea); 2.4 g (1 ea, 90 ea) [citrus flavor] Simvastatin Tablet, Oral, as carbonate: DoD Uniform Formulary Outpatient Dosage Forms Renvela: 800 mg BASIC CORE FORMULARY Tablet, Oral, as hydrochloride: Tablet, Oral: Renagel: 400 mg, 800 mg Generic: 5 mg, 10 mg, 20 mg, 40 mg Sevoflurane NONFORMULARY DoD Uniform Formulary Outpatient Dosage Forms Suspension, Oral: UNIFORM FORMULARY FloLipid: 20 mg/5 mL (150 mL); 40 mg/5 mL (150 mL) Solution, Inhalation: Generic: (100 mL, 250 mL) 105 SINECATECHINS Sinecatechins Sea-Clens Wound Cleanser: (178 mL, 355 mL) DoD Uniform Formulary Outpatient Dosage Forms Ultra-Klenz: (240 mL, 360 mL) UNIFORM FORMULARY Nebulization Solution, Inhalation: Ointment, External: Generic: 0.9% (3 mL) Veregen: 15% (30 g) [contains propylene glycol] Nebulization Solution, Inhalation [preservative free]: HyperSal: 3.5% (4 mL) [latex free] Siponimod Generic: 0.9% (3 mL, 5 mL, 15 mL); 3% (4 mL, 15 mL); 7% (4 mL); 10% (4 mL, DoD Uniform Formulary Outpatient Dosage Forms 15 mL) UNIFORM FORMULARY Ointment, Ophthalmic: Tablet, Oral, as fumarate: Generic: 5% (3.5 g) Mayzent: 0.25 mg, 2 mg [contains soybean lecithin] Packet, Nasal [preservative free]: Tablet Therapy Pack, Oral, as fumarate: Ayr Saline Nasal Neti Rinse: 1.57 g (40 ea) [iodine free] Mayzent Starter Pack: 0.25 mg (12 ea) [contains soybean lecithin] AYR Saline Nasal Rinse: 1.57 g (50 ea, 51 ea, 100 ea) [iodine free] Solution, External: Sipuleucel-T Saljet: 0.9% (30 mL) DoD Uniform Formulary Outpatient Dosage Forms Wound Wash Saline: 0.9% (210 mL) UNIFORM FORMULARY Solution, External [preservative free]: Suspension, Intravenous [preservative free]: Safe Wash: 0.9% (210 mL) [drug free, latex free] Provenge: (250 mL) Saljet Rinse: 0.9% (30 mL) Solution, Injection: Sirolimus Generic: 0.9% (2 mL, 10 mL, 20 mL, 30 mL, 100 mL); 14.6% (20 mL, 40 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection [preservative free]: UNIFORM FORMULARY Generic: 0.9% (2 mL, 3 mL, 5 mL, 10 mL, 20 mL, 50 mL) Solution, Oral: Solution, Intravenous: Rapamune: 1 mg/mL (60 mL) [contains alcohol, usp] Generic: 0.45% (25 mL, 50 mL, 100 mL, 250 mL, 500 mL, 1000 mL); 0.9% (2.5 Tablet, Oral: mL, 3 mL, 10 mL, 25 mL, 50 mL, 100 mL, 150 mL, 250 mL, 500 mL, 1000 Rapamune: 0.5 mg, 1 mg, 2 mg mL); 3% (500 mL); 5% (500 mL); 23.4% (30 mL, 100 mL, 200 mL, 250 Generic: 0.5 mg, 1 mg, 2 mg mL [DSC]) SITagliptin Solution, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.9% (1 mL, 2 mL, 2.5 mL, 3 mL, 5 mL, 10 mL, 50 mL, 100 mL, 125 mL, 500 mL, 1000 mL) BASIC CORE FORMULARY Solution, Irrigation: Tablet, Oral: Januvia: 25 mg, 50 mg, 100 mg Generic: 0.9% (250 mL, 500 mL, 1000 mL, 1500 mL, 2000 mL, 3000 mL, 4000 mL, 5000 mL) Sitagliptin and Metformin Solution, Nasal: DoD Uniform Formulary Outpatient Dosage Forms 4-Way Saline: (29.6 mL) BASIC CORE FORMULARY Afrin Saline Nasal Mist: 0.65% (30 mL, 45 mL) Tablet, Oral: Altamist Spray: 0.65% (45 mL, 60 mL) Janumet 50/500: Sitagliptin 50 mg and metformin hydrochloride 500 mg Ayr: 0.65% (50 mL) Janumet 50/1000: Sitagliptin 50 mg and metformin hydrochloride 1000 mg Ayr Nasal Mist Allergy/Sinus: 2.65% (50 mL) [contains benzalkonium chloride] Tablet, Extended Release, Oral: Baby Ayr Saline: 0.65% (30 mL) Janumet XR: 50/500: Sitagliptin 50 mg and metformin hydrochloride 500 mg Nasal Moist: 0.65% (15 mL, 45 mL) Janumet XR: 50/1000: Sitagliptin 50 mg and metformin hydrochloride Ocean for Kids: 0.65% (37.5 mL) [alcohol free, drug free; contains benzalko- 1000 mg nium chloride] Janumet XR: 100/1000: Sitagliptin 100 mg and metformin hydrochloride Generic: 0.65% (44 mL, 45 mL) 1000 mg Solution, Nasal [preservative free]: Entsol Nasal: 3% (100 mL) [drug free] Sodium Acetate Entsol Nasal Wash: (237 mL) DoD Uniform Formulary Outpatient Dosage Forms Ocean Ultra Saline Mist: (90 mL) [drug free] UNIFORM FORMULARY Solution, Ophthalmic: Solution, Intravenous, as anhydrous: Muro 128: 2% (15 mL); 5% (15 mL, 30 mL) Generic: 2 mEq/mL (20 mL, 50 mL, 100 mL); 4 mEq/mL (50 mL, 100 mL) Generic: 5% (15 mL) Solution, Oral: Sodium Bicarbonate Generic: 4 mEq/mL (23.4%) (473 mL) DoD Uniform Formulary Outpatient Dosage Forms Swab, Nasal: UNIFORM FORMULARY Ayr Saline Nasal Gel: (20 ea) [contains methylparaben, propylparaben, Powder, Oral: soybean oil, trolamine (triethanolamine)] Generic: (1 g, 120 g, 454 g, 500 g, 1000 g, 2500 g, 10000 g, 12000 g, Tablet, Oral: 25000 g, 45000 g) Generic: 1 g Solution, Intravenous: Neut: 4% (5 mL) Sodium Chloride and Sodium Citrate Generic: 4.2% (5 mL, 10 mL); 7.5% (50 mL); 8.4% (10 mL, 50 mL) Tablet, Oral: Sodium Chondroitin Sulfate and Sodium Hyaluronate Generic: 325 mg, 650 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Sodium Chloride Injection, solution, intraocular: DoD Uniform Formulary Outpatient Dosage Forms DisCoVisc: Sodium chondroitin sulfate ≤4% and sodium hyaluronate ≤1.7% (1 UNIFORM FORMULARY mL) [provided in a kit which also contains 27-gauge cannula and cannula Aerosol Solution, Inhalation: locking ring] Broncho Saline: 0.9% (90 mL, 240 mL) Viscoat: Sodium chondroitin sulfate ≤4% and sodium hyaluronate ≤3% (0.5 Aerosol Solution, Nasal [preservative free]: mL, 0.75 mL) [packaged with 27-gauge cannula and cannula locking ring] Ocean Complete Sinus Rinse: (177 mL) [drug free] Gel, Nasal: Sodium Citrate Ayr Saline Nasal: (14.1 g) [contains aloe barbadensis, methylparaben, pro- DoD Uniform Formulary Outpatient Dosage Forms pylparaben, soybean oil] UNIFORM FORMULARY Ayr Saline Nasal No-Drip: (22 mL) [contains aloe barbadensis, benzalkonium Solution, oral: 450 mg (30 mL) chloride, benzyl alcohol, soybean oil] Entsol Nasal: (20 g) Sodium Citrate and Citric Acid Ocean Nasal Moisturizer: (14 g) [drug free; contains methylparaben, propyl- DoD Uniform Formulary Outpatient Dosage Forms paraben, trolamine (triethanolamine)] UNIFORM FORMULARY Rhinase: (30 g) [odor free; contains benzalkonium chloride] Solution, Oral: Liquid, External: Oracit: Sodium citrate 490 mg and citric acid 640 mg per 5 mL (15 mL, 30 mL, Atrapro Dermal Spray: (236 mL) 500 mL, 3840 mL) DiaB Klenz: (240 mL) Shohl's Solution (Modified): Sodium citrate 500 mg and citric acid 300 mg per Elta Dermal Wound Cleanser: (240 mL) 5 mL (480 mL) [contains alcohol] MicroKlenz Wound Cleanser: (240 mL) Generic: Sodium citrate 500 mg and citric acid 334 mg per 5 mL (480 mL) RadiaKlenz: (240 mL) Remedy 4-in-1 Body Cleanser: 0.5% (236 mL) 106 SOMATROPIN Sodium Glycerophosphate Pentahydrate Tablet, Oral [scored]: DoD Uniform Formulary Outpatient Dosage Forms OsmoPrep: Monobasic sodium phosphate monohydrate 1.102 g and dibasic UNIFORM FORMULARY sodium phosphate anhydrous 0.398 g [sodium phosphate 1.5 g per tablet; Solution, Intravenous: gluten free] Glycophos: 1 mmol/mL (20 mL) Sodium Picosulfate, Magnesium Oxide, and Citric Acid Sodium Hypochlorite DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Powder for solution, oral [kit]: Gel, External: Prepopik: Sodium picosulfate 10 mg, magnesium oxide 3.5 g, and citric acid Anasept Antimicrobial: 0.057% (86 g) [latex free] 12 g per packet (2s) [orange flavor] Liquid, External: NONFORMULARY Anasept: 0.057% (237 mL) Solution, Oral: Anasept: 0.057% (443 mL) [latex free] Clenpiq: Sodium picosulfate 10 mg, magnesium oxide 3.5 g, and citric acid Solution, External: 12 g per 160 mL (2 x 160 mL) H-Chlor 6: 0.062% (473 mL) Generic: 0.125% (473 mL); 0.25% (473 mL); 0.5% (473 mL) Sodium Polystyrene Sulfonate Sodium Iodide DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Powder, Oral: UNIFORM FORMULARY Generic: (15 g, 453.6 g, 454 g) Solution, Injection: Suspension, Oral: Iodopen: 100 mcg/mL (10 mL) Generic: 15 g/60 mL (60 mL, 480 mL, 500 mL) Sodium Lactate Suspension, Rectal: DoD Uniform Formulary Outpatient Dosage Forms Generic: 30 g/120 mL (120 mL); 50 g/200 mL (200 mL) UNIFORM FORMULARY Sodium Sulfate, Potassium Sulfate, and Magnesium Sulfate Solution, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Generic: 5 mEq/mL (10 mL) UNIFORM FORMULARY Sodium Nitrite Solution, Oral: DoD Uniform Formulary Outpatient Dosage Forms Suprep Bowel Prep Kit: Sodium sulfate 17.5 g, potassium sulfate 3.13 g, and UNIFORM FORMULARY magnesuim sulfate 1.6 g per 180 mL (2 x 180 mL) [contains sodium Solution, Intravenous: benzoate] Generic: 30 mg/mL (10 mL) Sodium Tetradecyl Sulfate Sodium Nitrite and Sodium Thiosulfate DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms NOT COVERED UNIFORM FORMULARY Solution, Intravenous, as sulfate: Solution, Injection [combination package]: Sotradecol: 1% (2 mL); 3% (2 mL) [contains benzyl alcohol] Nithiodote: Sodium nitrite 300 mg/10 mL (10 mL) and sodium thiosulfate Sodium Thiosulfate 12.5 g/50 mL (50 mL) DoD Uniform Formulary Outpatient Dosage Forms Sodium Oxybate UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous: UNIFORM FORMULARY Generic: 25% [250 mg/mL] (50 mL) Solution, Oral: Xyrem: 500 mg/mL (180 mL) Sodium Zirconium Cyclosilicate DoD Uniform Formulary Outpatient Dosage Forms Sodium Phenylacetate and Sodium Benzoate UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Packet, Oral: UNIFORM FORMULARY Lokelma: 5 g (1 ea, 30 ea); 10 g (1 ea, 30 ea) Solution, Injection [concentrate]: Generic: Sodium phenylacetate 100 mg and sodium benzoate 100 mg per 1 Sofosbuvir and Velpatasvir mL (50 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Sodium Phenylbutyrate Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: Sofosbuvir 400 mg and velpatasvir 100 mg UNIFORM FORMULARY Powder, Oral: Sofosbuvir, Velpatasvir, and Voxilaprevir Generic: (250 g) DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Buphenyl: 500 mg [contains sodium 62 mg/tablet] Tablet, Oral: Vosevi: Sofosbuvir 400 mg, velpatasvir 100 mg, and voxilaprevir 100 mg Sodium Phosphates DoD Uniform Formulary Outpatient Dosage Forms Solifenacin UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection [concentrate; preservative free]: UNIFORM FORMULARY Generic: Phosphorus 3 mmol and sodium 4 mEq per 1 mL (5 mL, 15 mL, 50 Tablet, Oral, as succinate: mL) [equivalent to phosphorus 93 mg and sodium 92 mg per 1 mL; source of VESIcare: 5 mg, 10 mg electrolytes: monobasic and dibasic sodium phosphate] Solution, Oral: Somatropin Generic: Monobasic sodium phosphate monohydrate 2.4 g and dibasic DoD Uniform Formulary Outpatient Dosage Forms sodium phosphate heptahydrate 0.9 g per 5 mL (45 mL) [sugar free; contains Extended Core Formulary sodium 556 mg/5 mL, sodium benzoate; ginger-lemon flavor] Solution, Subcutaneous: Solution, Rectal [enema]: Norditropin NordiFlex Pen; Norditropin FlexPro: 5 mg/1.5 mL (1.5 mL); 10 mg/ Fleet Enema: Monobasic sodium phosphate monohydrate 19 g and dibasic 1.5 mL (1.5 mL); 15 mg/1.5 mL (1.5 mL); 30 mg/3 mL (3 mL) [contains sodium phosphate heptahydrate 7 g per 118 mL delivered dose (133 mL) phenol] [contains sodium 4.4 g/118 mL] UNIFORM FORMULARY Fleet Enema Extra: Monobasic sodium phosphate monohydrate 19 g and Solution Reconstituted, Subcutaneous: dibasic sodium phosphate heptahydrate 7 g per 197 mL delivered dose Serostim: 4 mg (1 ea); 5 mg (1 ea); 6 mg (1 ea) (230 mL) [contains sodium 4.4 g/197 mL] Zomacton: 5 mg (1 ea) [contains benzyl alcohol] Fleet Pedia-Lax™ Enema: Monobasic sodium phosphate monohydrate 9.5 g Zomacton: 10 mg (1 ea) [contains metacresol] and dibasic sodium phosphate heptahydrate 3.5 g per 59 mL delivered dose Zorbtive: 8.8 mg (1 ea) [contains benzyl alcohol] (66 mL) [contains sodium 2.2 g/59 mL] LaCrosse Complete: Monobasic sodium phosphate monohydrate 19 g and NONFORMULARY dibasic sodium phosphate heptahydrate 7 g per 118 mL delivered dose (133 Solution, Subcutaneous: mL) [contains sodium 4.4 g/118 mL] Nutropin AQ NuSpin 5: 5 mg/2 mL (2 mL) [contains phenol] Generic: Monobasic sodium phosphate monohydrate 19 g and dibasic sodium Nutropin AQ NuSpin 10: 10 mg/2 mL (2 mL) [contains phenol] phosphate heptahydrate 7 g per 118 mL delivered dose (133 mL) Nutropin AQ NuSpin 20: 20 mg/2 mL (2 mL) [contains phenol] 107 SOMATROPIN

Solution Reconstituted, Injection: Solution Reconstituted, Intramuscular: Humatrope: 5 mg (1 ea); 6 mg (1 ea); 12 mg (1 ea); 24 mg (1 ea) Generic: 1 g (1 ea) Saizen: 5 mg (1 ea); 8.8 mg (1 ea) Saizen Click.Easy: 8.8 mg (1 ea) Streptozocin Solution Reconstituted, Subcutaneous: DoD Uniform Formulary Outpatient Dosage Forms Genotropin: 5 mg (1 ea); 12 mg (1 ea) [contains metacresol] UNIFORM FORMULARY Omnitrope: 5.8 mg (1 ea) Solution Reconstituted, Intravenous: Serostim: 4 mg (1 ea); 5 mg (1 ea); 6 mg (1 ea) Zanosar: 1 g (1 ea) Zorbtive: 8.8 mg (1 ea) [contains benzyl alcohol] Solution Reconstituted, Subcutaneous [preservative free]: Strontium-89 Genotropin MiniQuick: 0.2 mg (1 ea); 0.4 mg (1 ea); 0.6 mg (1 ea); 0.8 mg (1 DoD Uniform Formulary Outpatient Dosage Forms ea); 1 mg (1 ea); 1.2 mg (1 ea); 1.4 mg (1 ea); 1.6 mg (1 ea); 1.8 mg (1 ea); NOT COVERED 2 mg (1 ea) Solution, Intravenous, as chloride: Solution, Subcutaneous: Generic: 1 mCi/mL (4 mL) Omnitrope: 5 mg/1.5 mL (1.5 mL) [contains benzyl alcohol] Omnitrope: 10 mg/1.5 mL (1.5 mL) [contains phenol] Succimer DoD Uniform Formulary Outpatient Dosage Forms Sonidegib UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral: UNIFORM FORMULARY Chemet: 100 mg Capsule, Oral: Odomzo: 200 mg Succinylcholine DoD Uniform Formulary Outpatient Dosage Forms SORAfenib UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection, as chloride: UNIFORM FORMULARY Anectine: 20 mg/mL (10 mL) [contains methylparaben] Tablet, Oral: Quelicin: 20 mg/mL (10 mL) [contains methylparaben, propylparaben] NexAVAR: 200 mg Sucralfate Sorbitol DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Solution, Irrigation: Generic: 3% (3000 mL); 3.3% (2000 mL, 4000 mL) Generic: 1 g Solution, Oral: NONFORMULARY Generic: 70% (30 mL, 473 mL, 474 mL, 480 mL, 3840 mL) Suspension, Oral: Solution, Rectal: Carafate: 1 g/10 mL (420 mL) [contains methylparaben; cherry flavor] Generic: 70% (473 mL) Sucroferric Oxyhydroxide Sotalol DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet Chewable, Oral: Solution, Intravenous, as hydrochloride: Velphoro: 500 mg [berry flavor] Generic: 150 mg/10 mL (10 mL) Solution, Oral, as hydrochloride: Sucrose Sotylize: 5 mg/mL (250 mL, 480 mL) [contains sodium benzoate; grape flavor] DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral, as hydrochloride: UNIFORM FORMULARY Generic: 80 mg, 120 mg, 160 mg, 240 mg Solution, Oral: Sweet-Ease Preserved: 24% (15 mL) Sotorasib TootSweet: 24% (0.5 mL, 1 mL, 2 mL, 12 mL) Solution, oral [preservative free]: Sotrovimab Sweet-Ease Natural: 24% (15 mL) Spinosad SUFentanil DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Suspension, External: Solution, Intravenous [preservative free]: Generic: 0.9% (120 mL) Generic: 50 mcg/mL (1 mL); 100 mcg/2 mL (2 mL); 250 mcg/5 mL (5 mL) Spironolactone Sugammadex DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY Tablet, Oral: UNIFORM FORMULARY Generic: 25 mg Solution, Intravenous: Bridion: 200 mg/2 mL (2 mL); 500 mg/5 mL (5 mL) UNIFORM FORMULARY Tablet, Oral: Sulfacetamide and Prednisolone Generic: 50 mg, 100 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY NONFORMULARY Suspension, Oral: Ointment, Ophthalmic: CaroSpir: 25 mg/5 mL (118 mL, 473 mL) [contains saccharin sodium; banana Blephamide: Sulfacetamide sodium 10% and prednisolone acetate flavor] 0.2% (3.5 g) Solution, Ophthalmic [drops]: Stavudine Sulfacetamide sodium 10% and prednisolone sodium phosphate 0.25% (5 mL, DoD Uniform Formulary Outpatient Dosage Forms 10 mL) UNIFORM FORMULARY Suspension, Ophthalmic [drops]: Capsule, Oral: Blephamide: Sulfacetamide sodium 10% and prednisolone acetate 0.2% (5 Generic: 15 mg, 20 mg, 30 mg, 40 mg mL, 10 mL) [contains benzalkonium chloride] Solution Reconstituted, Oral: Zerit: 1 mg/mL (200 mL) [dye free; fruit flavor] Sulfacetamide (Ophthalmic) DoD Uniform Formulary Outpatient Dosage Forms St Johns Wort BASIC CORE FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Ophthalmic, as sodium: UNIFORM FORMULARY Generic: 10% (15 mL) Capsule, Oral: Generic: 300 mg UNIFORM FORMULARY Ointment, Ophthalmic, as sodium: Streptomycin Generic: 10% (3.5 g) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY 108 SUNITINIB Sulfacetamide (Topical) Cream, External: DoD Uniform Formulary Outpatient Dosage Forms Generic: Sulfur 2% and sulfacetamide sodium 10% (57 g) UNIFORM FORMULARY Generic: Sulfur 4.8% and sulfacetamide sodium 9.8% (57 g) Cream, External, as sodium: Generic: Sulfur 5% and sulfacetamide sodium 10% (28 g) Ovace Plus: 10% (57 g) [contains benzyl alcohol, butylparaben, cetyl alcohol, Foam, topical: disodium edta, ethylparaben, methylparaben, propylparaben] AVAR: Sulfur 5% and sulfacetamide sodium 9.5% (100 g) [contains benzyl Foam, External: alcohol] Ovace Plus: 9.8% (100 g) [contains benzyl alcohol, cetyl alcohol, propylene Generic: Sulfur 5% and sulfacetamide sodium 10% (60 g) glycol] Gel, topical: Sulfur 5% and sulfacetamide sodium 10% (45 g) Gel, External, as sodium: Lotion, topical: Generic: 10% (355 mL) Generic: Sulfur 4.8% and sulfacetamide sodium 9.8% (57 g) Liquid, External, as sodium: Generic: Sulfur 5% and sulfacetamide sodium 10% (25 g, 30 g, 60 g) Generic: 10% (177 mL, 180 mL, 354.8 mL, 355 mL, 480 mL) Pad, External [cleansing cloth]: Lotion, External, as sodium: Avar: Sulfur 5% and sulfacetamide sodium 9.5% (30s, 60s) Ovace Plus: 9.8% (57 g, 113 g) [contains benzyl alcohol, cetyl alcohol, Plexion: Sulfur 4.8% and sulfacetamide sodium 9.8% (60s) [contains benzyl disodium edta] alcohol] Generic: 10% (118 mL) Rosula: Sulfur 5% and sulfacetamide sodium 10% (30s, 60s) Shampoo, External, as sodium: Generic: Sulfur 4% and sulfacetamide sodium 10% (60s) Generic: 10% (237 mL) Suspension,External: Suspension, External, as sodium: Generic: Sulfur 4% and sulfacetamide sodium 8% (473 mL) Generic: 10% (118 mL) Generic: Sulfur 5% and sulfacetamide sodium10% (30 g) Wash, topical: SulfADIAZINE BP 10-1: Sulfur 1% and sulfacetamide sodium 10% (170 g) DoD Uniform Formulary Outpatient Dosage Forms BP Cleansing Wash: Sulfur 5% and sulfacetamide sodium 10% (480 mL) UNIFORM FORMULARY [contains urea] Tablet, Oral: Rosula Wash: Sulfur 4.5% and sulfacetamide sodium 10% (340.2 g) Generic: 500 mg Generic: Sulfur 4% and sulfacetamide sodium 9% (480 mL) Wash, topical [emulsion-based]: Sulfamethoxazole and Trimethoprim BP Cleansing Wash: Sulfur 4% and sulfacetamide sodium 10% (473 mL) DoD Uniform Formulary Outpatient Dosage Forms [contains urea] BASIC CORE FORMULARY Generic: Sulfur 4.5% and sulfacetamide sodium 9% (454 g) Suspension, Oral: Generic: Sulfamethoxazole 200 mg and trimethoprim 40 mg per 5 mL (20 mL, Sulfur Hexafluoride Lipid-Type A Microspheres 473 mL) DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: Sulfamethoxazole 400 mg and trimethoprim 80 mg Suspension Reconstituted, Intravenous: Generic: Sulamethoxazole 800 mg and trimethoprim 160 mg Lumason: Lipid-type A 25 mg and sulfur hexafluoride 60.7 mg (1 ea) [contains UNIFORM FORMULARY polyethylene glycol] Solution, Intravenous: Sulindac Generic: Sulfamethoxazole 80 mg and trimethoprim 16 mg per mL (5 mL, 10 DoD Uniform Formulary Outpatient Dosage Forms mL, 30 mL) UNIFORM FORMULARY Sulfanilamide Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 150 mg, 200 mg UNIFORM FORMULARY SUMAtriptan Cream, Vaginal: AVC Vaginal: 15% (120 g) [contains methylparaben, propylene glycol, propyl- DoD Uniform Formulary Outpatient Dosage Forms paraben, trolamine (triethanolamine)] BASIC CORE FORMULARY Solution Auto-injector, Subcutaneous, as succinate [strength expressed as SulfaSALAzine base]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 6 mg/0.5 mL (0.5 mL) BASIC CORE FORMULARY Solution Cartridge, Subcutaneous, as succinate [strength expressed as base]: Tablet, Oral: Imitrex STATdose Refill: 6 mg/0.5 mL (0.5 mL) Generic: 500 mg Tablet, Oral, as succinate [strength expressed as base]: Tablet Delayed Release, Oral: Generic: 25 mg, 50 mg, 100 mg Generic: 500 mg UNIFORM FORMULARY Sulfonated Phenolics and Sulfuric Acid Solution, Nasal: DoD Uniform Formulary Outpatient Dosage Forms Generic: 5 mg/actuation (1 ea); 20 mg/actuation (1 ea) Solution Prefilled Syringe, Subcutaneous, as succinate [strength expressed as UNIFORM FORMULARY base, preservative free]: Solution, External [for oral mucosa]: Generic: 6 mg/0.5 mL (0.5 mL) Debacterol: Sulfonated phenolics 50% and sulfuric acid 30% (1.5 mL) [for professional use only] Solution, Subcutaneous, as succinate [strength expressed as base]: Swab, External [for oral mucosa]: Generic: 6 mg/0.5 mL (0.5 mL) Debacterol: Sulfonated phenolics 50% and sulfuric acid 30% (12s) (0.2 mL) Solution, Subcutaneous, as succinate [strength expressed as base, preserva- [for professional use only] tive free]: Generic: 6 mg/0.5 mL (0.5 mL) Sulfur and Salicylic Acid NONFORMULARY DoD Uniform Formulary Outpatient Dosage Forms Exhaler Powder, Nasal, as succinate [strength expressed as base]: UNIFORM FORMULARY Onzetra Xsail: 11 mg per nosepiece (2 ea) Cleanser, External [scrub]: Solution Auto-injector, Subcutaneous, as succinate [strength expressed as Pernox Lemon: Sulfur 2% and salicylic acid 1.5% (56 g, 113 g) base]: Pernox Regular: Sulfur 2% and salicylic acid 1.5% (113 g) Zembrace SymTouch: 3 mg/0.5 mL (0.5 mL) Shampoo, topical: Generic: 4 mg/0.5 mL (0.5 mL) ala seb: Sulfur 2% and salicylic acid 2% (118 mL, 355 mL) [contains soya Solution Jet-injector, Subcutaneous, as succinate [strength expressed as base]: lecithin] Sumavel DosePro: 6 mg/0.5 mL (0.5 mL) Sebex: Sulfur 2% and salicylic acid 2% (118 mL) Solution, Nasal: Sebulex: Sulfur 2% and salicylic acid 2% (200 g) NOT COVERED Sulfur and Sulfacetamide Tosymra: 10 mg/actuation (1 ea) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY SUNItinib Cleanser, External: DoD Uniform Formulary Outpatient Dosage Forms AVAR LS: Sulfur 2% and sulfacetamide sodium 10% (100 g) [contains benzyl UNIFORM FORMULARY alcohol] Capsule, Oral: Generic: Sulfur 2% and sulfacetamide sodium 10% (227 g) Sutent: 12.5 mg, 25 mg, 37.5 mg, 50 mg Generic: Sulfur 4.8% and sulfacetamide sodium 9.8% (285 g) Generic: Sulfur 5% and sulfacetamide sodium 10% (170 g, 340 g) 109 SURGICAL LUBRICANT Surgical Lubricant Talimogene Laherparepvec DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Gel, External: Suspension, Intralesional [preservative free]: Surgilube: (3 g, 5 g, 56.7 g, 120.49 g) [contains propylene glycol] Imlygic: 106 (1 million) PFU/mL (1 mL); 108 (100 million) PFU/mL (1 mL) [contains bovine serum] Syrup, Simple DoD Uniform Formulary Outpatient Dosage Forms Tamoxifen NOT COVERED DoD Uniform Formulary Outpatient Dosage Forms Syrup, Oral: BASIC CORE FORMULARY Generic: (480 mL, 500 mL, 3800 mL) Tablet, Oral: Generic: 10 mg, 20 mg Tacrolimus (Systemic) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Oral: UNIFORM FORMULARY Soltamox: 10 mg/5 mL (150 mL) [sugar free; contains alcohol, usp, propylene Capsule, Oral: glycol; licorice-aniseed flavor] Generic: 0.5 mg, 1 mg, 5 mg Capsule Extended Release 24 Hour, Oral: Tamsulosin Astagraf XL: 0.5 mg, 1 mg, 5 mg DoD Uniform Formulary Outpatient Dosage Forms Packet, Oral: BASIC CORE FORMULARY Prograf: 0.2 mg (50 ea); 1 mg (50 ea) Capsule, Oral, as hydrochloride: Solution, Intravenous: Generic: 0.4 mg Prograf: 5 mg/mL (1 mL) [contains alcohol, usp, cremophor el] Tablet Extended Release 24 Hour, Oral: Tapentadol Envarsus XR: 0.75 mg, 1 mg, 4 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Tacrolimus (Topical) Tablet Extended Release 12 Hour, Oral: DoD Uniform Formulary Outpatient Dosage Forms Nucynta ER: 50 mg, 100 mg, 150 mg, 200 mg, 250 mg BASIC CORE FORMULARY NONFORMULARY Ointment, External: Tablet, Oral: Generic: 0.03% (30 g, 60 g, 100 g); 0.1% (30 g, 60 g, 100 g) Nucynta: 50 mg, 75 mg, 100 mg UNIFORM FORMULARY Ointment, External: Tazarotene Protopic: 0.03% (30 g, 60 g, 100 g); 0.1% (30 g, 60 g, 100 g) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Tadalafil Tazorac: 0.05% (30 g, 60 g); 0.1% (30 g, 60 g) [contains benzyl alcohol] DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.1% (30 g, 60 g) Gel, External: UNIFORM FORMULARY Tazorac: 0.05% (30 g, 100 g); 0.1% (30 g, 100 g) [contains benzyl alcohol] Tablet, Oral: NONFORMULARY Adcirca: 20 mg Foam, External: Alyq: 20 mg Fabior: 0.1% (50 g, 100 g) NONFORMULARY Tablet, Oral: Tazemetostat Generic: 2.5 mg, 5 mg, 10 mg, 20 mg DoD Uniform Formulary Outpatient Dosage Forms NOT COVERED UNIFORM FORMULARY Tablet, Oral: Tablet, Oral: Cialis: 2.5 mg, 5 mg, 10 mg, 20 mg Tazverik: 200 mg Tafamidis Technetium Tc 99m Albumin Aggregated DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral: Injection, powder for reconstitution [kit]: Vyndamax: 61 mg Draximage MAA: Aggregated albumin 2.5 mg per vial (30s) [contains human albumin; vial contents to be combined with sodium pertechnetate Tc 99m Tafenoquine injection solution (not included)] DoD Uniform Formulary Outpatient Dosage Forms Technetium Tc 99m Bicisate UNIFORM FORMULARY Tablet, Oral, as succinate: DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Krintafel: 150 mg Kit, for Injection: Tablet, Oral, as succinate [strength expressed as base]: Neurolite: Bicisate dihydrochloride 0.9 mg per vial (2s, 5s) [to be combined Arakoda: 100 mg with sodium pertechnetate Tc99m injection solution (not included)] Tagraxofusp Technetium Tc 99m Diethylene Triamine Penta-Acetic Acid DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms NOT COVERED UNIFORM FORMULARY Solution, Intravenous: Kit, Intravenous: Elzonris: 1000 mcg/mL (1 mL) Drax Image DTPA: Talazoparib Technetium Tc 99m Disofenin DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral, as tosylate: Injection, mixture for reconstitution: Talzenna: 0.25 mg, 1 mg Hepatolite: Disofenin 20 mcg (5s, 30s) [vial contents to be combined with Talc (Sterile) Technetium Tc 99m pertechnetate sodium (not included)] DoD Uniform Formulary Outpatient Dosage Forms Technetium Tc 99m Exametazime UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Aerosol Powder, Intrapleural: UNIFORM FORMULARY Sclerosol Intrapleural: 4 g (30 g) [contains dichlorodifluoromethane] Kit, Intravenous: Suspension Reconstituted, Intrapleural: Ceretec: [contains methylene blue] Sterile Talc Powder: 5 g (1 ea) Technetium Tc 99m-Labeled Red Blood Cells Taliglucerase Alfa DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Kit, Intravenous: Solution Reconstituted, Intravenous [preservative free]: Ultratag RBC: Contents to be combined with patient blood sample and sodium Elelyso: 200 units (1 ea) [contains polysorbate 80] pertechnetate Tc99m injection solution (not included) 110 TENOFOVIR DISOPROXIL FUMARATE Technetium Tc 99m Mebrofenin Teduglutide DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Kit, Intravenous: Kit, Subcutaneous [preservative free]: Choletec: [contains methylparaben, propylparaben] Gattex: 5 mg Technetium Tc 99m Medronate Tegaserod DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY NOT COVERED Kit, Intravenous: Tablet, oral: Generic: Medronic acid 20 mg (5s, 30s) [vial contents to be combined with Zelnorm: 2 mg, 6 mg Technetium Tc 99m pertechnetate sodium (not included)] Telavancin Technetium Tc 99m Mertiatide DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution Reconstituted, Intravenous [preservative free]: Injection, Powder for Reconstitution [kit]: Vibativ: 750 mg (1 ea) TechneScan MAG3: Betiatide 1 mg (5s) (to be combined with sodium per- technetate Tc99m injection solution [not included]) Telmisartan DoD Uniform Formulary Outpatient Dosage Forms Technetium Tc 99m Oxidronate UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 20 mg, 40 mg, 80 mg Kit, Intravenous: TechneScan HDP: Contents to be combined with sodium pertechnetate Telmisartan and Amlodipine Tc99m injection solution (not included) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Technetium Tc 99m Pentetate Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: Telmisartan 40 mg and amlodipine 5 mg UNIFORM FORMULARY Generic: Telmisartan 40 mg and amlodipine 10 mg Kit, Intravenous: Generic: Telmisartan 80 mg and amlodipine 5 mg Drax Image DTPA: Lyophilized pentetic acid mixture to be combined with Generic:: Telmisartan 80 mg and amlodipine 10 mg sodium pertechnetate Tc99m injection solution (5s, 30s) Telmisartan and Hydrochlorothiazide Technetium Tc 99m Pyrophosphate DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Kit, Intravenous: 40/12.5: Telmisartan 40 mg and hydrochlorothiazide 12.5 mg Technescan PYP: Sodium pyrophosphate 11.9 mg [pyrogen free; vial contents 80/12.5: Telmisartan 80 mg and hydrochlorothiazide 12.5 mg to be combined with Technetium Tc 99m pertechnetate sodium (not 80/25: Telmisartan 80 mg and hydrochlorothiazide 25 mg included)] Telotristat Ethyl Technetium Tc 99m Sestamibi DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Kit, Intravenous: Xermelo: 250 mg Cardiolite: 2-methoxyisobutyl isonitrile (MIBI) copper tetrafluoroborate 1 mg (5s, 20s) [pyrogen free; vial contents to be combined with Technetium Tc 99m Temazepam pertechnetate sodium (not included)] DoD Uniform Formulary Outpatient Dosage Forms Generic: 2-methoxyisobutyl isonitrile (MIBI) copper tetrafluoroborate 1 mg (5s, BASIC CORE FORMULARY 20s, 30s) [vial contents to be combined with Technetium Tc 99m pertechne- Capsule, Oral: tate sodium (not included)] Generic: 15 mg, 30 mg Technetium Tc 99m Sodium Pertechnetate UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral: UNIFORM FORMULARY Generic: 7.5 mg, 22.5 mg Generator Column, for elution in producing technetium 99m sodium pertechne- tate solution for injection: Temozolomide Technelite: Molybdenum Mo99 1-20 Ci per generator system [available in high DoD Uniform Formulary Outpatient Dosage Forms or low enriched uranium] UNIFORM FORMULARY Capsule, Oral: Technetium Tc 99m Sulfur Colloid Generic: 5 mg, 20 mg, 100 mg, 140 mg, 180 mg, 250 mg DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous: UNIFORM FORMULARY Temodar: 100 mg (1 ea) [pyrogen free; contains polysorbate 80] Kit, Injection: Generic: Contents to be combined with Technetium Tc 99m pertechnetate Temsirolimus sodium (not included)] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Technetium Tc 99m Tetrofosmin Solution, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Torisel: 25 mg/mL (1 mL) [contains alcohol, usp, polyethylene glycol, poly- UNIFORM FORMULARY sorbate 80, propylene glycol] Kit, Injection: Generic: Contents to be combined with Technetium Tc 99m pertechnetate Tenecteplase sodium (not included)] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Technetium Tc 99m Tilmanocept Kit, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms TNKase: 50 mg UNIFORM FORMULARY Injection, powder for reconstitution [kit]: Teniposide Lymphoseek: Tilmanocept 250 mcg (5s) [vial contents to be combined with DoD Uniform Formulary Outpatient Dosage Forms Technetium Tc 99m pertechnetate sodium (not included)] UNIFORM FORMULARY Solution, Intravenous: Tedizolid Generic: 10 mg/mL (5 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Tenofovir Disoproxil Fumarate Solution Reconstituted, Intravenous, as phosphate [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Sivextro: 200 mg (1 ea) UNIFORM FORMULARY Tablet, Oral, as phosphate: Powder, Oral, as disoproxil fumarate: Sivextro: 200 mg Viread: 40 mg/g (60 g) 111 TENOFOVIR DISOPROXIL FUMARATE

Tablet, Oral, as disoproxil fumarate: Solution, Intramuscular, as cypionate: Viread: 150 mg, 200 mg, 250 mg, 300 mg Generic: 100 mg/mL (10 mL); 200 mg/mL (1 mL, 10 mL) Solution, Intramuscular, as enanthate: Terazosin Generic: 200 mg/mL (5 mL) DoD Uniform Formulary Outpatient Dosage Forms Solution, Intramuscular, as undecanoate: BASIC CORE FORMULARY Aveed: 750 mg/3 mL (3 mL) [contains benzyl benzoate, castor oil (ricine oil)] Capsule, Oral: Generic: 1 mg, 2 mg, 5 mg, 10 mg NONFORMULARY Capsule, Oral, as undecanoate: Terbinafine (Systemic) Jatenzo: 158 mg, 198 mg, 237 mg DoD Uniform Formulary Outpatient Dosage Forms Gel, Transdermal: UNIFORM FORMULARY AndroGel: 25 mg/2.5 g (1%) (2.5 g); 20.25 mg/1.25 g (1.62%) (1.25 g); Tablet, Oral: 40.5 mg/2.5 g (1.62%) (2.5 g); 50 mg/5 g (1%) (5 g) [contains alcohol, usp] Generic: 250 mg AndroGel Pump: 20.25 mg/actuation (1.62%) (75 g) [contains alcohol, usp] Terbinafine (Topical) Generic: 12.5 mg/actuation (1%) (75 g) Solution, Transdermal: DoD Uniform Formulary Outpatient Dosage Forms Axiron: 30 mg/actuation (90 mL) [contains isopropyl alcohol] UNIFORM FORMULARY Generic: 30 mg/actuation (90 mL) Cream, External, as hydrochloride: Solution Auto-injector, Subcutaneous [preservative free]: LamISIL AT: 1% (12 g, 24 g, 30 g, 36 g, 42 g) [contains benzyl alcohol, cetyl alcohol] Xyosted: 50 mg/0.5 mL (0.5 mL); 75 mg/0.5 mL (0.5 mL); 100 mg/0.5 mL (0.5 LamISIL AT Jock Itch: 1% (12 g) [contains benzyl alcohol, cetyl alcohol] mL) [contains sesame oil] Generic: 1% (15 g, 30 g) Tetanus Immune Globulin (Human) Gel, External: DoD Uniform Formulary Outpatient Dosage Forms LamISIL Advanced: 1% (12 g) [contains alcohol, usp] UNIFORM FORMULARY Solution, External, as hydrochloride: LamISIL AT Spray: 1% (125 mL) [contains alcohol, usp, propylene glycol] Injectable, Intramuscular: HyperTET S/D: 250 units/mL (1 ea) Terbutaline DoD Uniform Formulary Outpatient Dosage Forms Tetrabenazine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Injection, as sulfate: UNIFORM FORMULARY Generic: 1 mg/mL (1 mL) Tablet, Oral: Tablet, Oral, as sulfate: Generic: 12.5 mg, 25 mg Generic: 2.5 mg, 5 mg Tetracaine (Ophthalmic) Terconazole DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Ophthalmic, as hydrochloride: Cream, Vaginal: Generic: 0.5% (1 mL, 4 mL, 15 mL) Generic: 0.4% (45 g); 0.8% (20 g) Suppository, Vaginal: Tetracaine (Spinal) Generic: 80 mg (3 ea) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Teriflunomide Solution, Injection, as hydrochloride [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 1% (2 mL) UNIFORM FORMULARY Tablet, Oral: Tetracaine (Topical) Aubagio: 7 mg, 14 mg Tetracycline, Bismuth Subsalicylate, and Metronidazole Teriparatide DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral: Solution, Subcutaneous: Helidac: 240 mg Forteo: 600 mcg/2.4 mL (2.4 mL) [contains metacresol] Tetracycline (Systemic) Tesamorelin DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral, as hydrochloride: Solution Reconstituted, Subcutaneous [preservative free]: Generic: 250 mg, 500 mg Egrifta: 1 mg (1 ea); 2 mg (1 ea) Tetrahydrozoline (Nasal) Testosterone DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Solution, Nasal, as hydrochloride: Gel, Transdermal: Tyzine: 0.05% (15 mL) [contains benzalkonium chloride, edetate disodium] Fortesta: 10 mg/actuation (2%) (60 g) Generic: 10 mg/actuation (2%) (60 g) Tetrahydrozoline (Ophthalmic) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Cream, Transdermal: UNIFORM FORMULARY EC-RX Testosterone: 0.2% (30 g, 60 g); 0.4% (30 g, 60 g); 10% (30 g, 60 g); Solution, Ophthalmic, as hydrochloride: 20% (30 g, 60 g) [contains cetearyl alcohol] Eye Drops: 0.05% (15 mL) [contains benzalkonium chloride, edetate disodium] First-Testosterone MC: 2% (60 g) [contains benzyl alcohol, sesame oil] Opti-Clear: 0.05% (15 mL) [contains benzalkonium chloride, edetate disodium] Gel, Nasal: Generic: 0.05% (15 mL) Natesto: 5.5 mg/actuation (7.32 g) Gel, Transdermal: Tetrastarch Generic: 25 mg/2.5 g (1%) (2.5 g); 10 mg/actuation (2%) (60 g); 50 mg/5 g DoD Uniform Formulary Outpatient Dosage Forms (1%) (5 g) UNIFORM FORMULARY Miscellaneous, Buccal: Solution, Intravenous: Striant: 30 mg (60 ea) Voluven: 6% (500 mL) [dehp free, latex free, pvc free] Ointment, Transdermal: First-Testosterone: 2% (60 g) [contains benzyl alcohol, butylated hydroxyto- Tezacaftor and Ivacaftor luene (bht), petrolatum, sesame oil] DoD Uniform Formulary Outpatient Dosage Forms Patch 24 Hour, Transdermal: UNIFORM FORMULARY Androderm: 2 mg/24 hr (1 ea, 60 ea); 4 mg/24 hr (1 ea, 30 ea) Tablet Therapy Pack, Oral: Pellet, Implant: Symdeko: Tezacaftor 50 mg and ivacaftor 75 mg (28s); Ivacaftor 75 mg (28s) Testopel: 75 mg (10 ea, 100 ea) (56 ea) Pellet, Implant [preservative free]: Symdeko: Tezacaftor 100 mg and ivacaftor 150 mg (28s); Ivacaftor 150 mg Generic: 2.5 mg (1 ea); 25 mg (1 ea); 37.5 mg (1 ea); 50 mg (1 ea) (28s) (56 ea) 112 TIOCONAZOLE Thalidomide Sponge, topical [preservative free; bovine derived]: DoD Uniform Formulary Outpatient Dosage Forms Thrombi-Gel 10: ≥1000 units (10s) UNIFORM FORMULARY Thrombi-Gel 40: ≥1000 units (5s) Capsule, Oral: Thrombi-Gel 100: ≥2000 units (5s) Thalomid: 50 mg, 100 mg, 150 mg, 200 mg Thyroid, Desiccated Thallous Chloride TI 201 DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Solution, Intravenous: Armour Thyroid: 15 mg, 30 mg, 60 mg, 90 mg, 120 mg, 180 mg, 240 mg, Generic: 37 MBq (1 mCi)/mL (1 ea); 74 MBq (2 mCi)/mL (1 ea) 300 mg Nature-Throid: 16.25 mg, 32.5 mg, 48.75 mg, 65 mg, 81.25 mg, 97.5 mg, Theophylline 113.75 mg, 130 mg, 146.25 mg, 162.5 mg, 195 mg, 260 mg, 325 mg DoD Uniform Formulary Outpatient Dosage Forms [scored] BASIC CORE FORMULARY NP Thyroid: 15 mg, 30 mg, 60 mg, 90 mg Capsule Extended Release 24 Hour, Oral: Westhroid: 32.5 mg, 65 mg, 97.5 mg, 130 mg, 195 mg Theo-24: 300 mg, 400 mg WP Thyroid: 16.25 mg, 32.5 mg, 48.75 mg, 65 mg, 81.25 mg, 97.5 mg, Elixir, Oral: 113.75 mg, 130 mg Elixophyllin: 80 mg/15 mL (473 mL) [mixed fruit flavor] Solution, Oral: Thyrotropin Alfa Generic: 80 mg/15 mL (15 mL, 473 mL) DoD Uniform Formulary Outpatient Dosage Forms Tablet Extended Release 12 Hour, Oral: UNIFORM FORMULARY Generic: 200 mg, 300 mg Solution Reconstituted, Intramuscular: Tablet Extended Release 24 Hour, Oral: Thyrogen: 1.1 mg (1 ea) Generic: 400 mg TiaGABine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule Extended Release 24 Hour, Oral: UNIFORM FORMULARY Theo-24: 100 mg, 200 mg Tablet, Oral, as hydrochloride: Solution, Intravenous: Gabitril: 2 mg, 4 mg, 12 mg, 16 mg Generic: 400 mg (250 mL, 500 mL) Generic: 2 mg, 4 mg Tablet Extended Release 12 Hour, Oral: Generic: 100 mg, 450 mg Ticagrelor Tablet Extended Release 24 Hour, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 600 mg UNIFORM FORMULARY Tablet, Oral: Thiamine Brilinta: 60 mg, 90 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Ticarcillin and Clavulanate Potassium Capsule, Oral, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Generic: 50 mg UNIFORM FORMULARY Solution, Injection, as hydrochloride: Infusion [premixed, frozen]: Generic: 100 mg/mL (2 mL) Timentin: Ticarcillin 3 g and clavulanic acid 0.1 g (100 mL [DSC]) [contains Tablet, Oral, as hydrochloride: sodium 4.51 mEq and potassium 0.15 mEq per g] Generic: 50 mg, 100 mg, 250 mg Injection, powder for reconstitution: Tablet, Oral, as hydrochloride [preservative free]: Timentin: Ticarcillin 3 g and clavulanic acid 0.1 g (3.1 g [DSC], 31 g [DSC]) Generic: 100 mg [contains sodium 4.51 mEq and potassium 0.15 mEq per g] Thioguanine Tigecycline DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY NOT COVERED Tablet, Oral: Solution Reconstituted, Intravenous [preservative free]: Tabloid: 40 mg Generic: 50 mg (1 ea) Thioridazine Timolol (Ophthalmic) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY BASIC CORE FORMULARY Tablet, Oral, as hydrochloride: Solution, Ophthalmic, as maleate [strength expressed as base]: Generic: 10 mg, 25 mg, 50 mg, 100 mg Generic: 0.25% (5 mL, 10 mL, 15 mL); 0.5% (5 mL, 10 mL, 15 mL) Thiotepa UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Gel Forming Solution, Ophthalmic, as maleate [strength expressed as base]: UNIFORM FORMULARY Generic: 0.25% (5 mL); 0.5% (5 mL) Solution Reconstituted, Injection: Solution, Ophthalmic, as maleate [strength expressed as base, preservative Generic: 15 mg (1 ea) free]: Timoptic in OcuDose: 0.25% (0.2 mL); 0.5% (0.2 mL) Thiothixene NONFORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Ophthalmic, as hemihydrate [strength expressed as base]: UNIFORM FORMULARY Betimol: 0.25% (5 mL); 0.5% (5 mL, 10 mL, 15 mL) [contains benzalkonium Capsule, Oral: chloride] Generic: 1 mg, 2 mg, 5 mg, 10 mg Solution, Ophthalmic, as maleate [strength expressed as base]: Thrombin (Topical) Istalol: 0.5% (2.5 mL, 5 mL) [contains benzalkonium chloride] DoD Uniform Formulary Outpatient Dosage Forms Timolol (Systemic) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Pad, topical [preservative free; bovine derived]: UNIFORM FORMULARY Thrombi-Pad 3x3: ≥200 units (10s) Tablet, Oral, as maleate: Powder for reconstitution, topical [bovine derived]: Generic: 5 mg, 10 mg, 20 mg Thrombin-JMI: 5000 units, 20,000 units [supplied with diluent] Thrombin-JMI Epistaxis kit: 5000 units [supplied with diluent] Tinidazole Thrombin-JMI Pump Spray Kit: 20,000 units [supplied with diluents] DoD Uniform Formulary Outpatient Dosage Forms Thrombin-JMI Syringe Spray Kit: 5000 units; 20,000 units [supplied with UNIFORM FORMULARY diluent] Tablet, Oral: Powder for reconstitution, topical [preservative free; recombinant]: Generic: 250 mg, 500 mg Recothrom: 5000 units; 20,000 units [production involves products derived from hamster and snake sources; supplied with diluent] Tioconazole Recothrom Spray Kit: 20,000 units [production involves products derived from DoD Uniform Formulary Outpatient Dosage Forms hamster and snake sources; supplied with diluent] UNIFORM FORMULARY Solution, topical [human derived]: Ointment, Vaginal: Evithrom: 800-1200 units/mL (2 mL, 5 mL, 20 mL) Vagistat-1: 6.5% (4.6 g) 113 TIOPRONIN Tiopronin Solution, Injection: DoD Uniform Formulary Outpatient Dosage Forms Generic: 10 mg/mL (2 mL); 80 mg/2 mL (2 mL); 1.2 g/30 mL (30 mL); 2 g/50 UNIFORM FORMULARY mL (50 mL) Tablet, Oral: Solution, Intravenous: Thiola: 100 mg Generic: 80 mg (100 mL) Solution Reconstituted, Injection: Tiotropium Generic: 1.2 g (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Injection [preservative free]: BASIC CORE FORMULARY Generic: 1.2 g (1 ea) Aerosol Solution, Inhalation: Spiriva Respimat: 1.25 mcg/actuation (4 g); 2.5 mcg/actuation (4 g) [contains TOLAZamide benzalkonium chloride, disodium edta] DoD Uniform Formulary Outpatient Dosage Forms Capsule, Inhalation: UNIFORM FORMULARY Spiriva HandiHaler: 18 mcg [contains milk protein] Tablet, Oral: Generic: 250 mg, 500 mg Tiotropium and Olodaterol DoD Uniform Formulary Outpatient Dosage Forms TOLBUTamide UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Aerosol Solution, Inhalation: UNIFORM FORMULARY Stiolto Respimat: Tiotropium 2.5 mcg and olodaterol 2.5 mcg per actuation Tablet, Oral: (4 g) [contains benzalkonium chloride, edetate disodium] Generic: 500 mg Tipranavir Tolcapone DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral: Tablet, Oral: Generic: 100 mg Aptivus: 250 mg Solution, Oral: Tolnaftate Aptivus: 100 mg/mL (95 mL) [contains polyethylene glycol, propylene glycol, DoD Uniform Formulary Outpatient Dosage Forms tocophersolan; buttermint-butter toffee flavor] UNIFORM FORMULARY Tirofiban Aerosol, External: DoD Uniform Formulary Outpatient Dosage Forms Athletes Foot Spray: 1% (150 g) [contains sd alcohol 40] Tinactin: 1% (150 g) UNIFORM FORMULARY Aerosol Powder, External: Concentrate, Intravenous: Jock Itch Spray: 1% (130 g) [contains sd alcohol 40b] Aggrastat: 3.75 mg/15 mL (15 mL) LamISIL AF Defense: 1% (133 g) Solution, Intravenous: Tinactin: 1% (133 g) Aggrastat: 50 mcg/mL (100 mL, 250 mL) Tinactin Deodorant: 1% (133 g) Tisagenlecleucel Cream, External: DoD Uniform Formulary Outpatient Dosage Forms Generic: 1% (15 g, 20 g, 28.3 g, 30 g) UNIFORM FORMULARY Powder, External: Suspension, Intravenous: Generic: 1% (45 g) Kymriah: (1 ea) [contains albumin human, dextran 40, dimethyl sulfoxide] Solution, External: Generic: 1% (10 mL) TiZANidine Tolterodine DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral: BASIC CORE FORMULARY Generic: 2 mg, 4 mg, 6 mg Capsule Extended Release 24 Hour, Oral, as tartrate: Generic: 2 mg, 4 mg Tablet, Oral: Generic: 2 mg, 4 mg UNIFORM FORMULARY Tablet, Oral, as tartrate: Tobramycin and Dexamethasone Generic: 1 mg, 2 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Tolvaptan Ointment, ophthalmic: DoD Uniform Formulary Outpatient Dosage Forms TobraDex: Tobramycin 0.3% and dexamethasone 0.1% (3.5 g) [contains UNIFORM FORMULARY chlorobutanol] Tablet, Oral: Suspension, ophthalmic: Samsca: 15 mg, 30 mg TobraDex ST: Tobramycin 0.3% and dexamethasone 0.05% (5 mL) [contains Tablet Therapy Pack, Oral: benzalkonium chloride] Jynarque: 45 & 15 mg (14 ea); 60 & 30 mg (14 ea); 90 & 30 mg (14 ea) Generic: Tobramycin 0.3% and dexamethasone 0.1% (2.5 mL, 5 mL, 10 mL) Topiramate Tobramycin (Ophthalmic) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule ER 24 Hour Sprinkle, Oral: Ointment, Ophthalmic: Generic: 25 mg (30 ea); 50 mg (30 ea); 100 mg (30 ea); 150 mg (30 ea); Tobrex: 0.3% (3.5 g) 200 mg (30 ea) Solution, Ophthalmic: Capsule Extended Release 24 Hour, Oral: Generic: 0.3% (5 mL) Trokendi XR: 25 mg, 50 mg, 100 mg, 200 mg [contains sodium benzoate] Capsule Sprinkle, Oral: Tobramycin (Oral Inhalation) Generic: 15 mg, 25 mg DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 25 mg, 50 mg, 100 mg, 200 mg Capsule, Inhalation: Tobi Podhaler: 28 mg Topotecan Nebulization Solution, Inhalation: DoD Uniform Formulary Outpatient Dosage Forms Generic: 300 mg/5 mL (5 mL) UNIFORM FORMULARY Nebulization Solution, Inhalation [preservative free]: Capsule, Oral: Bethkis: 300 mg/4 mL (4 mL) Hycamtin: 0.25 mg, 1 mg Generic: 300 mg/5 mL (5 mL) Solution, Intravenous: NONFORMULARY Generic: 4 mg/4 mL (4 mL) Nebulization Solution, Inhalation [preservative free]: Solution, Intravenous [preservative free]: Kitabis Pak: 300 mg/5 mL (5 mL) Generic: 4 mg/4 mL (4 mL) Solution Reconstituted, Intravenous: Tobramycin (Systemic) Generic: 4 mg (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Solution Reconstituted, Intravenous [preservative free]: UNIFORM FORMULARY Generic: 4 mg (1 ea) 114 TRETINOIN (TOPICAL) Toremifene Trandolapril 2 mg [immediate release] and verapamil hydrochloride 180 mg DoD Uniform Formulary Outpatient Dosage Forms [sustained release] UNIFORM FORMULARY Trandolapril 2 mg [immediate release] and verapamil hydrochloride 240 mg Tablet, Oral: [sustained release] Fareston: 60 mg Trandolapril 4 mg [immediate release] and verapamil hydrochloride 240 mg [sustained release] Torsemide DoD Uniform Formulary Outpatient Dosage Forms Tranexamic Acid UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 5 mg, 10 mg, 20 mg, 100 mg Solution, Intravenous: Generic: 1000 mg/10 mL (10 mL) Total Parenteral Nutrition Solution, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 1000 mg/10 mL (10 mL) UNIFORM FORMULARY Tablet, Oral: Emulsion, Intravenous: Generic: 650 mg Kabiven: (1026 mL,1540 mL, 2053 mL, 2566 mL) [sulfite free; lipid chamber contains egg phospholipids (egg lecithin), soybean oil] Tranylcypromine Perikabiven: (1440 mL,1920 mL, 2400 mL) [sulfite free; lipid chamber contains DoD Uniform Formulary Outpatient Dosage Forms egg phospholipids (egg lecithin), soybean oil] UNIFORM FORMULARY Trabectedin Tablet, Oral: Generic: 10 mg DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Trastuzumab Solution Reconstituted, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Yondelis: 1 mg (1 ea) UNIFORM FORMULARY Trace Elements Solution Reconstituted, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Herceptin: 440 mg (1 ea) [contains benzyl alcohol, mouse (murine) and/or UNIFORM FORMULARY hamster protein] Solution, Injection: Trastuzumab and Hyaluronidase Multitrace-4: Chromium 4 mcg, copper 0.4 mg, manganese 0.1 mg, and zinc DoD Uniform Formulary Outpatient Dosage Forms 1 mg per 1 mL (10 mL) [contains aluminum, benzyl alcohol] NOT COVERED Multitrace-4 Concentrate: Chromium 10 mcg, copper 1 mg, manganese Solution, Subcutaneous [preservative free]: 0.5 mg, and zinc 5 mg per 1 mL (1 mL) [contains aluminum]; chromium 10 Herceptin Hylecta: Trastuzumab 600 mg and hyaluronidase-oysk 10,000 units mcg, copper 1 mg, manganese 0.5 mg, and zinc 5 mg per 1 mL (10 mL) [contains benzyl alcohol] per 5 mL (5 mL) Multitrace-4 Neonatal: Chromium 0.85 mcg, copper 0.1 mg, manganese TraZODone 0.025 mg, and zinc 1.5 mg per 1 mL (2 mL) [contains aluminum] DoD Uniform Formulary Outpatient Dosage Forms Multitrace-5: Chromium 4 mcg, copper 0.4 mg, manganese 0.1 mg, selenium BASIC CORE FORMULARY 20 mcg, and zinc 1 mg per 1 mL (10 mL) [contains aluminum, benzyl alcohol] Multitrace-5 Concentrate: Chromium 10 mcg, copper 1 mg, manganese Tablet, Oral, as hydrochloride: 0.5 mg, selenium 60 mcg, and zinc 5 mg per 1 mL (1 mL) [contains Generic: 50 mg, 100 mg, 150 mg, 300 mg aluminum]; chromium 10 mcg, copper 1 mg, manganese 0.5 mg, selenium Treprostinil 60 mcg, and zinc 5 mg per 1 mL (10 mL) [contains benzyl alcohol] DoD Uniform Formulary Outpatient Dosage Forms Trace Elements 4 Pediatric: Chromium 1 mcg, copper 0.1 mg, manganese UNIFORM FORMULARY 0.03 mg, and zinc 0.5 mg per 1 mL (10 mL) [contains aluminum, benzyl Solution, Inhalation: alcohol] Solution, Injection [preservative free]: Tyvaso: 0.6 mg/mL (2.9 mL) Multitrace-4 Pediatric: Chromium 1 mcg, copper 0.1 mg, manganese Tyvaso Refill: 0.6 mg/mL (2.9 mL) 0.025 mg, and zinc 1 mg per 1 mL (3 mL) [contains aluminum] Tyvaso Starter: 0.6 mg/mL (2.9 mL) Solution, Injection: TraMADol Remodulin: 1 mg/mL (20 mL); 2.5 mg/mL (20 mL); 5 mg/mL (20 mL); DoD Uniform Formulary Outpatient Dosage Forms 10 mg/mL (20 mL) [contains metacresol] BASIC CORE FORMULARY Tablet Extended Release, Oral: Tablet, Oral, as hydrochloride: Orenitram: 0.125 mg, 0.25 mg, 1 mg, 2.5 mg Generic: 50 mg Tretinoin (Systemic) UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule Extended Release 24 Hour, Oral, as hydrochloride: UNIFORM FORMULARY Generic: 100 mg, 150 mg, 200 mg, 300 mg Capsule, Oral: Cream, External, as hydrochloride: Generic: 10 mg Active-Tramadol: 8% (120 g) [contains chlorocresol (chloro-m-cresol)] EnovaRX-Tramadol: 5% (60 g, 120 g) [contains cetyl alcohol] Tretinoin (Topical) Suspension Reconstituted, Oral, as hydrochloride: DoD Uniform Formulary Outpatient Dosage Forms Synapryn FusePaq: 10 mg/mL (500 mL) [contains saccharin sodium, sodium BASIC CORE FORMULARY benzoate] Cream, External: NONFORMULARY Generic: 0.025% (20 g, 45 g); 0.05% (20 g, 45 g) Tablet Extended Release 24 Hour, Oral, as hydrochloride: UNIFORM FORMULARY Generic: 100 mg, 200 mg, 300 mg Cream, External: Trametinib Renova: 0.02% (40 g, 60 g) [contains benzyl alcohol, cetyl alcohol, edetate DoD Uniform Formulary Outpatient Dosage Forms disodium, methylparaben, propylparaben] UNIFORM FORMULARY Renova Pump: 0.02% (44 g) [contains benzyl alcohol, cetyl alcohol, edetate Tablet, Oral: disodium, methylparaben, propylparaben] Mekinist: 0.5 mg, 2 mg Retin-A: 0.1% (20 g, 45 g) Tretin-X: 0.0375% (0.075% (35 g) Trandolapril Gel, External: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.01% (15 g, 45 g) UNIFORM FORMULARY Tablet, Oral: NONFORMULARY Generic: 1 mg, 2 mg, 4 mg Gel, External [microsphere]: Retin-A Micro: 0.04% (20 g, 45 g); 0.1% (20 g, 45 g) [contains benzyl alcohol, Trandolapril and Verapamil disodium edta, propylene glycol, trolamine (triethanolamine)] DoD Uniform Formulary Outpatient Dosage Forms Retin-A Micro Pump: 0.04% (50 g); 0.08% (50 g); 0.1% (50 g) [contains UNIFORM FORMULARY benzyl alcohol, disodium edta, propylene glycol, trolamine (triethanolamine)] Tablet, variable release: Generic: 0.04% (20 g, 45 g, 50 g); 0.1% (20 g, 45 g, 50 g) Tarka: 1/240: Trandolapril 1 mg [immediate release] and verapamil hydro- Lotion, External: chloride 240 mg [sustained release] Altreno: 0.05% (45 g) 115 TRIAMCINOLONE (NASAL) Triamcinolone (Nasal) Trientine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Aerosol, Nasal, as acetonide: Capsule, Oral, as hydrochloride: Generic: 55 mcg/actuation (16.5 g, 16.9 mL) Syprine: 250 mg Triamcinolone (Ophthalmic) Trifluoperazine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Suspension, Intraocular, as acetonide: Tablet, Oral: Triesence: 40 mg/mL (1 mL) [contains polysorbate 80] Generic: 1 mg, 2 mg, 5 mg, 10 mg Triamcinolone (Systemic) Trifluridine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Solution, Ophthalmic: Kit, Injection, as acetonide: Generic: 1% (7.5 mL) Arze-Ject-A: 40 mg/mL (3 x 1 mL) [contains benzyl alcohol, polysorbate 80] Pro-C-Dure 5: 40 mg/mL (2 x 1 mL) [contains benzyl alcohol, polysorbate 80] Trifluridine and Tipiracil Pro-C-Dure 6: 40 mg/mL (3 x 1 mL) [contains benzyl alcohol, polysorbate 80] DoD Uniform Formulary Outpatient Dosage Forms ReadySharp Triamcinolone: 40 mg/mL (1 x 1 mL) [contains benzyl alcohol, UNIFORM FORMULARY polysorbate 80] Tablet, Oral: Suspension, Injection, as acetonide: Lonsurf: Trifluridine 15 mg and tipiracil 6.14 mg, Trifluridine 20 mg and tipiracil Kenalog: 10 mg/mL (5 mL); 40 mg/mL (1 mL, 5 mL, 10 mL) [contains benzyl 8.19 mg alcohol, polysorbate 80] Triheptanoin Triamcinolone (Topical) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Liquid, Oral: BASIC CORE FORMULARY Dojolvi: 100% (500 mL) Cream, External, as acetonide: Generic: 0.1% (15 g, 30 g, 80 g, 454 g) Trihexyphenidyl Ointment, External, as acetonide: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.1% (15 g, 80 g, 453.6 g, 454 g) BASIC CORE FORMULARY Uniform Formuary Elixir, Oral, as hydrochloride: Aerosol Solution, External, as acetonide: Generic: 0.4 mg/mL (473 mL) Generic: 0.147 mg/g (63 g, 100 g) Tablet, Oral, as hydrochloride: Cream, External, as acetonide: Generic: 2 mg Generic: 0.025% (15 g, 80 g, 453.6 g, 454 g); 0.5% (15 g) Trilaciclib Kit, External, as acetonide: Dermasorb TA: 0.1% [contains cetyl alcohol, milk protein, propylene glycol] DoD Uniform Formulary Outpatient Dosage Forms Lotion, External, as acetonide: NOT COVERED Solution Reconstituted, Intravenous: Generic: 0.025% (60 mL); 0.1% (60 mL) Cosela: 300 mg (1 ea) Ointment, External, as acetonide: Generic: 0.025% (15 g, 80 g, 454 g); 0.5% (15 g) Trimethobenzamide Paste, Mouth/Throat, as acetonide: DoD Uniform Formulary Outpatient Dosage Forms Generic: 0.1% (5 g) UNIFORM FORMULARY Therapy Pack, External, as acetonide: Capsule, Oral, as hydrochloride: Dermazone: 0.1% (1 ea) [contains propylene glycol] Generic: 300 mg NONFORMULARY Solution, Intramuscular, as hydrochloride: Kit, External, as acetonide: Tigan: 100 mg/mL (2 mL, 20 mL) [contains phenol] Pediaderm TA: 0.1% [DSC] [contains cetyl alcohol, methylparaben, polysor- Trimethoprim bate 80, propylene glycol, propylparaben] Therapy Pack, External, as acetonide: DoD Uniform Formulary Outpatient Dosage Forms SilaLite Pak: 0.1% (1 ea [DSC]) UNIFORM FORMULARY Solution, Oral [strength expressed as base]: Triamterene Primsol: 50 mg/5 mL (473 mL) [alcohol free, dye free; contains methylpar- DoD Uniform Formulary Outpatient Dosage Forms aben, propylene glycol, propylparaben, saccharin sodium, sodium benzoate] UNIFORM FORMULARY Tablet, Oral: Capsule, Oral: Generic: 100 mg Dyrenium: 50 mg, 100 mg Trimethoprim and Polymyxin B Triazolam DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY UNIFORM FORMULARY Solution, Ophthalmic: Tablet, Oral: Polytrim: Trimethoprim 1 mg and polymyxin B sulfate 10,000 units per 1 mL Generic: 0.125 mg, 0.25 mg (10 mL) [contains benzalkonium chloride] Generic: Trimethoprim 1 mg and polymyxin B sulfate 10,000 units per 1 mL Trichloroacetic Acid (10 mL) DoD Uniform Formulary Outpatient Dosage Forms Trimipramine UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Liquid, External: UNIFORM FORMULARY Tri-Chlor: 80% (15 mL) Capsule, Oral: Trichophyton Skin Test Surmontil: 25 mg, 50 mg, 100 mg DoD Uniform Formulary Outpatient Dosage Forms Triprolidine NOT COVERED DoD Uniform Formulary Outpatient Dosage Forms Injectable, Intradermal: UNIFORM FORMULARY Generic: 1000 pn unit/mL (2 mL) [DSC] Liquid, Oral, as hydrochloride: Solution, Subcutaneous: Histex PD: 0.938 mg/mL (30 mL) Generic: 1:20 (5 mL, 10 mL, 50 mL) M-Hist PD: 0.625 mg/mL (30 mL) Triclosan and Fluoride Generic: 0.625 mg/mL (30 mL) DoD Uniform Formulary Outpatient Dosage Forms Syrup, Oral, as hydrochloride: Histex: 2.5 mg/5 mL (237 mL) [alcohol free, dye free, sugar free; contains UNIFORM FORMULARY propylene glycol, saccharin sodium; bubble-gum flavor] Gel, oral [toothpaste]: Triclosan 0.30% and sodium fluoride 0.24% (119 g, 170 g, 221 g) NOT COVERED Paste, oral [toothpaste]: Triclosan 0.30% and sodium fluoride 0.24% (119 g, Tablet Chewable, Oral, as hydrochloride: 170 g, 221 g) Histex: 1.25 mg 116 UREA (TOPICAL) Triprolidine and Pseudoephedrine Umbralisib DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY NONFORMULARY Liquid, Oral: Tablet, Oral, as tosylate: Entre-Hist PSE: Triprolidine hydrochloride 0.938 mg and pseudoephedrine Ukoniq: 200 mg hydrochloride 10 mg per 1 mL (30 mL) [cotton candy flavor] Syrup, Oral: Umeclidinium Aprodine: Triprolidine hydrochloride 1.25 mg and pseudoephedrine hydro- DoD Uniform Formulary Outpatient Dosage Forms chloride 30 mg per 5 mL (120 mL) UNIFORM FORMULARY Tablet, oral: Aerosol Powder Breath Activated, Inhalation: Aprodine: Triprolidine hydrochloride 2.5 mg and pseudoephedrine hydrochlor- Incruse Ellipta: 62.5 mcg/inhalation (7 ea, 30 ea) [contains lactose monohy- ide 60 mg drate] Ed A-Hist PSE: Triprolidine hydrochloride 2.5 mg and pseudoephedrine hydrochloride 60 mg Umeclidinium and Vilanterol DoD Uniform Formulary Outpatient Dosage Forms Triptorelin UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Aerosol Powder Breath Activated, Inhalation: UNIFORM FORMULARY Anoro Ellipta: Umeclidinium 62.5 mcg and vilanterol 25 mcg per inhalation (7 Suspension Reconstituted, Intramuscular: dose, 30 dose) [contains milk protein] Trelstar: 3.75 mg (1 ea); 11.25 mg (1 ea) [contains polysorbate 80] Trelstar Mixject: 3.75 mg (1 ea); 11.25 mg (1 ea); 22.5 mg (1 ea) [contains Undecylenic Acid and Derivatives polysorbate 80] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Trolamine Solution, External: DoD Uniform Formulary Outpatient Dosage Forms Fungi-Nail: Undecylenic acid 25% (29.57 mL) NOT COVERED Cream, External, as salicylate: Unoprostone Generic: 10% (85 g) DoD Uniform Formulary Outpatient Dosage Forms Lotion, External, as salicylate: UNIFORM FORMULARY Tru-micin: 10% (100 mL) [odorless; contains cetyl alcohol] Solution, Ophthalmic, as isopropyl ester: Ultracin T: 10% (120 mL) [paraben free; contains benzoic acid, cetearyl Rescula: 0.15% (5 mL) [contains benzalkonium chloride, edetate disodium, alcohol, propylene glycol] polysorbate 80] Tromethamine Urea (Systemic) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms NOT COVERED UNIFORM FORMULARY Solution, Intravenous: Powder for Solution, Oral: Tham: 30 mEq/100 mL (500 mL) Ure-Na: 15 g (8s) [lemon-lime flavor] Tropicamide Urea (Topical) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Ophthalmic: Cream, External: Generic: 0.5% (15 mL); 1% (2 mL, 3 mL, 15 mL) Generic: 10% (85 g); 20% (85 g); 40% (28 g, 28.35 g, 85 g, 198 g, 198.4 g); Trospium 45% (255 g); 47% (142 g); 50% (142 g, 255 g); 39% (226.8 g, 227 g) DoD Uniform Formulary Outpatient Dosage Forms Emulsion, External: UNIFORM FORMULARY Latrix XM: 45% (240 mL) [contains cetyl alcohol, disodium edta, propylene Capsule Extended Release 24 Hour, Oral, as chloride: glycol, trolamine (triethanolamine)] Generic: 60 mg Umecta: 40% (120 g, 227 g) [contains trolamine (triethanolamine)] Tablet, Oral, as chloride: Generic: 50% (284 g, 300 g) Generic: 20 mg Foam, External: Hydro 35: 35% (150 g) [contains ethylparaben, methylparaben, propylene Trypan Blue glycol, propylparaben, trolamine (triethanolamine)] DoD Uniform Formulary Outpatient Dosage Forms Hydro 40: 40% (150 g) [contains ethylparaben, methylparaben, propylene NOT COVERED glycol, propylparaben, trolamine (triethanolamine)] Solution, Ophthalmic: Umecta Mousse: 40% (113.4 g) [contains soya sterol, trolamine (triethanol- MembraneBlue: 0.15% (0.5 mL) amine)] VisionBlue: 0.06% (0.5 mL) Uramaxin: 20% (100 g) [contains cetyl alcohol, propylene glycol] Urea Hydrating: 35% (150 g) [contains ethylparaben, methylparaben, propy- Tuberculin Tests lene glycol, propylparaben, trolamine (triethanolamine)] DoD Uniform Formulary Outpatient Dosage Forms Gel, External: UNIFORM FORMULARY Uramaxin: 45% (28 mL) [contains edetate disodium, menthol, propylene Solution, Intradermal: glycol] Aplisol: 5 units/0.1 mL (1 mL, 5 mL) [latex free; contains phenol, polysor- Uramaxin GT: 45% (20 mL) [contains edetate disodium, menthol, propylene bate 80] glycol] Tubersol: 5 units/0.1 mL (1 mL, 5 mL) [contains phenol] Urea Nail: 45% (28 mL) [contains edetate disodium, menthol, propylene glycol] Tucatinib Generic: 40% (15 mL) DoD Uniform Formulary Outpatient Dosage Forms Kit, External: UNIFORM FORMULARY Dermasorb XM: 39% [contains ceteareth-20, cetyl alcohol, chlorocresol Tablet, Oral: (chloro-m-cresol)] Tukysa: 50 mg, 150 mg Uramaxin GT: 45% [contains edetate disodium, menthol, propylene glycol] Typhoid Vaccine Urea Nail: 40 & 0.2 % [contains disodium edta, methylparaben, propylpar- DoD Uniform Formulary Outpatient Dosage Forms aben, trolamine (triethanolamine)] UNIFORM FORMULARY Lotion, External: Capsule, enteric coated [live]: Generic: 10% (180 mL, 236 mL, 480 mL); 40% (226.8 g, 236.6 mL); Vivotif: Viable S. typhi Ty21a 2-6.8 x 109 colony-forming units and nonviable S. 45% (480 g) typhi Ty21a 5-50 x 109 bacterial cells [contains lactose 100-180 mg/capsule Ointment, External: and sucrose 26-130 mg/capsule] Aquaphilic/Carbamide: 10% (180 g, 454 g); 20% (454 g) Injection, solution [inactivated]: Gordons Urea: 22% (30 g); 40% (30 g) Typhim Vi: Purified Vi capsular polysaccharide 25 mcg/0.5 mL (0.5 mL, 10 mL) Lanaphilic/Urea: 10% (454 g); 20% (454 g) [derived from S. typhi Ty2 strain] Shampoo, External: Carmol: 10% (240 mL) Ulipristal Solution, External: DoD Uniform Formulary Outpatient Dosage Forms CEM-Urea: 45% (20 mL) [contains edetate disodium, menthol, methylpara- BASIC CORE FORMULARY ben, propylene glycol] Tablet, Oral, as acetate: Stick, External: Ella: 30 mg Urea Nail: 50% (2.4 mL) [contains cetyl alcohol, disodium edta] 117 UREA (TOPICAL)

Suspension, External: Tablet, Oral: Generic: 40% (283.4 g, 18 mL); 50% (284 g) Generic: 40 mg, 80 mg, 160 mg, 320 mg NONFORMULARY Valsartan and Hydrochlorothiazide Cream, External: DoD Uniform Formulary Outpatient Dosage Forms Xurea: 39% (227 g) BASIC CORE FORMULARY Uridine Triacetate Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 80 mg/12.5 mg: Valsartan 80 mg and hydrochlorothiazide 12.5 mg Generic: 160 mg/12.5 mg: Valsartan 160 mg and hydrochlorothiazide 12.5 mg UNIFORM FORMULARY Packet, Oral: Generic: 160 mg/25 mg: Valsartan 160 mg and hydrochlorothiazide 25 mg Vistogard: 10 g (4 ea, 20 ea) [orange flavor] Generic: 320 mg/12.5 mg: Valsartan 320 mg and hydrochlorothiazide 12.5 mg Xuriden: 2 g (1 ea, 30 ea) [orange flavor] Generic: 320 mg/25 mg: Valsartan 320 mg and hydrochlorothiazide 25 mg Urofollitropin Vancomycin DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution Reconstituted, Injection: Capsule, Oral: Bravelle: 75 units (1 ea) Generic: 125 mg, 250 mg Solution, Intravenous: Ursodiol Generic: 1 g/200 mL (200 mL); 500-5 MG/100ML-% (100 mL); 750-5 MG/ DoD Uniform Formulary Outpatient Dosage Forms 150ML-% (150 mL) UNIFORM FORMULARY Solution Reconstituted, Intravenous: Capsule, Oral: Generic: 500 mg (1 ea); 750 mg (1 ea); 1000 mg (1 ea); 5000 mg (1 ea); 10 g Generic: 300 mg (1 ea) Tablet, Oral: Solution Reconstituted, Intravenous [preservative free]: Generic: 250 mg, 500 mg Generic: 500 mg (1 ea); 1000 mg (1 ea); 5000 mg (1 ea); 10 g (1 ea) Solution Reconstituted, Oral, as hydrochloride: Ustekinumab Firvanq: 25 mg/mL (150 mL, 300 mL); 50 mg/mL (150 mL, 300 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Vandetanib Solution, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Stelara: 130 mg/26 mL (26 mL) [contains edetate disodium dihydrate, poly- UNIFORM FORMULARY sorbate 80] Tablet, Oral: Solution, Subcutaneous [preservative free]: Caprelsa: 100 mg, 300 mg Stelara: 45 mg/0.5 mL (0.5 mL) [contains polysorbate 80] Solution Prefilled Syringe, Subcutaneous [preservative free]: Vardenafil Stelara: 45 mg/0.5 mL (0.5 mL); 90 mg/mL (1 mL) [contains polysorbate 80] DoD Uniform Formulary Outpatient Dosage Forms NOT COVERED ValACYclovir Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Levitra: 5 mg, 10 mg, 20 mg UNIFORM FORMULARY Generic: 2.5 mg, 5 mg, 10 mg, 20 mg Tablet, Oral: Tablet Dispersible, Oral: Generic: 500 mg, 1 g Staxyn: 10 mg Valbenazine Generic: 10 mg DoD Uniform Formulary Outpatient Dosage Forms Varenicline UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral: UNIFORM FORMULARY Ingrezza: 40 mg, 80 mg Tablet, Oral: ValGANciclovir Chantix: 0.5 mg, 1 mg Chantix Continuing Month Pak: 1 mg DoD Uniform Formulary Outpatient Dosage Forms Chantix Starting Month Pak: 0.5 mg x 11 & 1 mg x 42 UNIFORM FORMULARY Solution Reconstituted, Oral: Varicella Virus Vaccine Generic: 50 mg/mL (88 mL) DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 450 mg Injectable, Subcutaneous [preservative free]: Valproic Acid and Derivatives Varivax: 1350 PFU/0.5 mL (1 ea) DoD Uniform Formulary Outpatient Dosage Forms Varicella-Zoster Immune Globulin (Human) BASIC CORE FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule Sprinkle, Oral, as divalproex sodium: UNIFORM FORMULARY Generic: 125 mg Solution, Intramuscular [preservative free]: Tablet Extended Release 24 Hour, Oral, as divalproex sodium: VariZIG: 125 units/1.2 mL (1.2 mL) [contains polysorbate 80] Generic: 250 mg, 500 mg UNIFORM FORMULARY Vasopressin Capsule, Oral, as valproic acid: DoD Uniform Formulary Outpatient Dosage Forms Generic: 250 mg UNIFORM FORMULARY Solution, Intravenous, as valproate sodium: Solution, Intravenous: Depacon: 100 mg/mL (5 mL) Vasostrict: 20 units/mL (1 mL) Solution, Intravenous, as valproate sodium [preservative free]: Vasostrict: 20 units/mL (10 mL) [contains chlorobutanol (chlorobutol)] Generic: 100 mg/mL (5 mL) Solution, Oral, as valproate sodium: Vecuronium Generic: 250 mg/5 mL (473 mL) DoD Uniform Formulary Outpatient Dosage Forms Syrup, Oral, as valproate sodium: UNIFORM FORMULARY Generic: 250 mg/5 mL (5 mL, 10 mL, 473 mL) Solution Reconstituted, Intravenous, as bromide: Tablet Delayed Release, Oral, as divalproex sodium: Generic: 10 mg (1 ea); 20 mg (1 ea) Generic: 125 mg, 250 mg, 500 mg Solution Reconstituted, Intravenous, as bromide [preservative free]: Generic: 10 mg (1 ea); 20 mg (1 ea) Valrubicin DoD Uniform Formulary Outpatient Dosage Forms Vedolizumab UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravesical [preservative free]: UNIFORM FORMULARY Valstar: 40 mg/mL (5 mL) [contains alcohol, usp, cremophor el] Solution Reconstituted, Intravenous [preservative free]: Entyvio: 300 mg (1 ea) [contains mouse (murine) and/or hamster protein, Valsartan polysorbate 80] DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FORMULARY 118 VITAMIN B COMPLEX COMBINATIONS Velaglucerase Alfa VinCRIStine (Liposomal) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution Reconstituted, Intravenous [preservative free]: Suspension, Intravenous, as sulfate: Vpriv: 400 units (1 ea) Marqibo: 5 mg/31 mL (1 ea) Vemurafenib Vinorelbine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Tablet, Oral: Solution, Intravenous: Zelboraf: 240 mg Generic: 10 mg/mL (1 mL); 50 mg/5 mL (5 mL) Venetoclax Solution, Intravenous [preservative free]: Generic: 10 mg/mL (1 mL); 50 mg/5 mL (5 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Vismodegib Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Venclexta: 10 mg, 50 mg, 100 mg UNIFORM FORMULARY Tablet Therapy Pack, Oral: Capsule, Oral: Venclexta Starting Pack: Week 1: 10 mg (14); Week 2: 50 mg (7); Week 3: Erivedge: 150 mg 100 mg (7); Week 4: 100 mg (14) (42 ea) Vitamin A Venlafaxine DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms BASIC CORE FOR- UNIFORM FORMULARY MULARY Capsule, Oral: Capsule Extended Release 24 Hour, Oral: A-25: 25,000 units Generic: 37.5 mg, 75 mg, 150 mg Tablet, Oral: Vitamin A Fish: 7500 units Generic: 25 mg, 37.5 mg, 50 mg, 75 mg, 100 mg Generic: 10,000 units Tablet Extended Release 24 Hour, Oral: Capsule, Oral [preservative free]: Generic: 225 mg A-25: 25,000 units [dye free] Generic: 8000 units UNIFORM FORMULARY Cream, External: Tablet Extended Release 24 Hour, Oral: AFirm 1X: 0.15% (30 g) [fragrance free; contains benzyl alcohol, cetyl alcohol, Generic: 37.5 mg, 75 mg, 150 mg, 225 mg disodium edta, methylparaben, peg-10 soya sterol, trolamine (triethanol- Verapamil amine)] AFirm 2X: 0.3% (30 g) [fragrance free; contains benzyl alcohol, cetyl alcohol, DoD Uniform Formulary Outpatient Dosage Forms disodium edta, methylparaben, peg-10 soya sterol, trolamine (triethanol- BASIC CORE FORMULARY amine)] Tablet Extended Release, Oral, as hydrochloride: AFirm 3X: 0.6% (30 g) [fragrance free; contains benzyl alcohol, cetyl alcohol, Generic: 120 mg, 180 mg, 240 mg disodium edta, methylparaben, peg-10 soya sterol, trolamine (triethanol- UNIFORM FORMULARY amine)] Solution, Intravenous, as hydrochloride: Gordons-Vite A: 100,000 units/g (75 g, 120 g, 480 g, 2400 g) Generic: 2.5 mg/mL (2 mL, 4 mL) Lotion, External: Tablet, Oral, as hydrochloride: Gordons-Vite A: 100,000 units (120 mL, 4000 mL) Generic: 40 mg, 80 mg, 120 mg Solution, Intramuscular: NONFORMULARY Aquasol A: 50,000 units/mL (2 mL) [contains chlorobutanol (chlorobutol)] Capsule Extended Release 24 Hour, Oral, as hydrochloride: Tablet, Oral: Generic: 100 mg, 120 mg, 180 mg, 200 mg, 240 mg, 300 mg, 360 mg Generic: 10,000 units, 15,000 units, Vitamin A 10000 units and beta carotene 1000 units Vericiguat DoD Uniform Formulary Outpatient Dosage Forms Vitamin A and Vitamin D (Systemic) NONFORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Verquvo: 2.5 mg, 5 mg, 10 mg Capsule, Softgel, Oral: Generic: Vitamin A 1250 units and vitamin D 130 units, Vitamin A 1250 units Verteporfin and vitamin D 135 units, Vitamin A 5,000 units and vitamin D 400 units, DoD Uniform Formulary Outpatient Dosage Forms Vitamin A 10,000 units and vitamin D 400 units, Vitamin A 25,000 units and NOT COVERED vitamin D 1000 units Solution Reconstituted, Intravenous: Oil, Oral: Visudyne: 15 mg (1 ea) [contains egg phosphatidylglycerol] Generic: Vitamin A 5000 units and vitamin D 500 units per 5 mL (120 mL, Vestronidase Alfa 473 mL) Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: Vitamin A 10,000 units and vitamin D 400 units UNIFORM FORMULARY Solution, Intravenous [preservative free]: Vitamin A and Vitamin D (Topical) Mepsevii: 10 mg/5 mL (5 mL) DoD Uniform Formulary Outpatient Dosage Forms Vigabatrin UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Cream, topical: UNIFORM FORMULARY Sween Cream: (2 g, 85 g, 190 g, 340 g) Packet, Oral: Ointment, topical: Sabril: 500 mg (50 ea) A+D Original: (42.5 g); (120 g); (454 g) [in lanolin-petrolatum base] Tablet, Oral: Baza Clear: (50 g, 142 g, 227 g) [in petrolatum base] Sabril: 500 mg [scored] Generic: (5 g, 60 g, 120 g, 454 g) VinBLAStine Vitamin B Complex, Ascorbic Acid, and Folic Acid DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Intravenous, as sulfate: Content may vary slightly depending on product used. For more detailed Generic: 1 mg/mL (10 mL) information on ingredients in these and other multivitamins, please refer to Multivitamin Products. VinCRIStine DoD Uniform Formulary Outpatient Dosage Forms Vitamin B Complex Combinations UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Intravenous, as sulfate: UNIFORM FORMULARY Vincasar PFS: 1 mg/mL (1 mL, 2 mL) Content varies depending on product used. For more detailed information on Solution, Intravenous, as sulfate [preservative free]: ingredients in these and other multivitamins, please refer to specific product Generic: 1 mg/mL (1 mL, 2 mL) labeling. 119 VITAMIN E (SYSTEMIC) Vitamin E (Systemic) Tablet, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 50 mg, 200 mg UNIFORM FORMULARY Vorinostat Capsule, Oral: Generic: 100 units, 200 units, 400 units, 1000 units DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral [preservative free]: UNIFORM FORMULARY Generic: 100 units, 400 units Capsule, Oral: Liquid, Oral: Zolinza: 100 mg Nutr-E-Sol: 400 units/15 mL (473 mL) [color free, starch free, sugar free] Warfarin Solution, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 15 units/0.3 mL (12 mL) BASIC CORE FORMULARY Tablet, Oral: Tablet, Oral, as sodium: Generic: 100 units, 200 units, 400 units Generic: 1 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg, 10 mg Vitamin E (Topical) Water for Injection (Bacteriostatic) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral: Solution, Injection: Formula E 400: 400 units Generic: (30 mL) Cream, External: Gordons-Vite E: 1500 units/30 g (15 g, 75 g, 480 g, 2400 g) Water for Injection (Sterile) Liquid, External: DoD Uniform Formulary Outpatient Dosage Forms Generic: 920 units/mL (28.5 mL, 57 mL, 114 mL) UNIFORM FORMULARY Lotion, External: Solution, Injection: Vitec: (113 g) Generic: (5 mL, 10 mL, 20 mL, 50 mL, 100 mL, 1000 mL) Xtra-Care: (2 mL, 59 mL, 118 mL, 237 mL, 621 mL, 1000 mL, 3840 mL) Solution, Intravenous: Oil, External: Generic: (250 mL, 500 mL, 1000 mL, 2000 mL, 3000 mL, 5000 mL) Vitamin E Beauty: 24,000 units/52 mL (52 mL); 49,000 units/52 mL (52 mL) Water for Irrigation (Sterile) Vitamins (Multiple/Injectable) DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Solution, Irrigation: Content varies depending on product used. For more detailed information on Generic: (250 mL, 500 mL, 1000 mL, 1500 mL, 2000 mL, 3000 mL, 4000 mL) ingredients in these and other multivitamins, please refer to specific product labeling. Wheat Dextrin Vitamins (Multiple/Oral) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Packet, Oral: UNIFORM FORMULARY Benefiber Drink Mix: (28 ea) [flavor free, gluten free, grit free, sugar free] Content varies depending on product used. For more detailed information on Benefiber Drink Mix: (8 ea) [sugar free; contains aspartame; raspberry tea ingredients in these and other multivitamins, please refer to specific product flavor] labeling. Benefiber Drink Mix: (8 ea, 24 ea) [sugar free; contains aspartame, fd&c red NONFORMULARY: #40; cherry pomegranate flavor] Genicin Vita-Q; Folika-V; Taliva Benefiber Drink Mix: (16 ea, 24 ea) [sugar free; contains aspartame, fd&c red Vitamins (Multiple/Pediatric) #40; kiwi strawberry flavor] DoD Uniform Formulary Outpatient Dosage Forms Benefiber Drink Mix: (16 ea) [sugar free; contains aspartame, fd&c yellow #6 UNIFORM FORMULARY (sunset yellow), soybean oil, tartrazine (fd&c yellow #5); citrus punch flavor] Content varies depending on product used. For more detailed information on Powder, Oral: ingredients in these and other multivitamins, please refer to specific product Benefiber: (80 g, 155 g, 245 g, 350 g, 477 g, 730 g) [gluten free, grit free, labeling. sugar free] Benefiber: (267 g, 529 g) [grit free, sugar free; contains aspartame, fd&c red Vitamins (Multiple/Prenatal) #40, fd&c yellow #6 (sunset yellow), lactose; orange flavor] DoD Uniform Formulary Outpatient Dosage Forms Benefiber For Children: (155 g) [grit free, sugar free; unflavored flavor] Content varies depending on product used. For more detailed information on Benefiber Plus Calcium: (423.8 g) [gluten free, grit free, sugar free] ingredients in these and other multivitamins, please refer to specific product Benefiber Plus Calcium: (305 g) [gluten free, grit free, sugar free; contains labeling. aspartame, fd&c red #40, fd&c yellow #6 (sunset yellow); orange flavor] UNIFORM FORMULARY Benefiber Plus Heart Health: (182.4 g) [gluten free, grit free, sugar free; Tablet, Oral: contains sodium benzoate] Prenatal Vitamin: 27 mg - 0.8 mg Tablet, Oral: Prenatal Vitamins PlusLow I Benefiber: Prenatal Vitamin + Low Iron: 27 mg - 1 mg Benefiber Plus B Vits & FA: [contains sodium benzoate] Prenatal Plus: 29 mg - 1 mg Tablet Chewable, Oral: PrePlus: Ca-Fe 27 mg - Fa 1 mg Benefiber: [scored; gluten free, sugar free; contains aspartame, fd&c blue #1 NONFORMULARY aluminum lake, fd&c red #40 aluminum lake, fd&c yellow #6 aluminum lake; All products other than the products listed in the UNIFORM FORMULARY assorted fruit flavor] Benefiber: [scored; gluten free, sugar free; contains aspartame, fd&c yellow #6 von Willebrand Factor (Recombinant) aluminum lake; orange cream flavor] DoD Uniform Formulary Outpatient Dosage Forms Benefiber Plus Calcium: [scored; sugar free; contains aspartame, fd&c blue #1 UNIFORM FORMULARY aluminum lake, fd&c red #40 aluminum lake, soybeans (glycine max); wild Solution Reconstituted, Intravenous [preservative free]: berry flavor] Vonvendi: 650 units (1 ea); 1300 units (1 ea) [contains mouse (murine) and/or hamster protein, polysorbate 80] White Petrolatum DoD Uniform Formulary Outpatient Dosage Forms Voretigene Neparvovec UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Gel: 5 g UNIFORM FORMULARY Suspension, Intraocular: Witch Hazel Luxturna: (0.5 mL) DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Voriconazole Pad, External: DoD Uniform Formulary Outpatient Dosage Forms A.E.R. Traveler: 50% (50 ea) [contains benzalkonium chloride, methyl- UNIFORM FORMULARY paraben] Solution Reconstituted, Intravenous: A.E.R. Witch Hazel: 50% (40 ea) [contains benzalkonium chloride, methyl- Generic: 200 mg (1 ea) paraben] Solution Reconstituted, Intravenous [preservative free]: Hemorrhoidal Hygiene: 50% (100 ea) [latex free; contains alcohol, usp] Vfend IV: 200 mg (1 ea) Medi Pads: 50% (100 ea) Suspension Reconstituted, Oral: Pre-Moistened Witch Hazel: 50% (40 ea) [contains benzalkonium chloride, Generic: 40 mg/mL (75 mL) methylparaben] 120 ZOLMITRIPTAN

Preparation H: 50% (10 ea, 48 ea) [contains glycerin, methylparaben, propyl- Capsule, Oral [preservative free]: paraben] Zn-50: 50 mg [dye free, sugar free, yeast free] Preparation H for Women: 20% (10 ea, 48 ea) [contains edetate disodium, Gum, Oral: methylparaben, propylene glycol, propylparaben] Cold-Eeze: 13.3 mg (18 ea, 20 ea) Preparation H Totables Wipes: 50% (10 ea) [contains methylparaben, propy- Lozenge, Mouth/Throat: lene glycol, propylparaben] Cold-Eeze: 13.3 mg (6 ea) Sooze Pads: 50% (40 ea) Generic: 10 mg (100 ea) Solution, External: Solution, Intravenous: Generic: 86% (473 mL) Generic: 10 mg/10 mL (10 mL) Tablet, Oral: Wound Dressing, Biocomposite Generic: 15 mg, 30 mg, 50 mg, 100 mg DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral [preservative free]: UNIFORM FORMULARYDressing, External: Generic: 50 mg Band-Aid CarboFlex Zinc Oxide Carrasyn Hydrogel DoD Uniform Formulary Outpatient Dosage Forms Curasol UNIFORM FORMULARY SilvaSorb Cream, topical: Balmex: 11.3% (60 g, 120 g, 480 g) [contains aloe, benzoic acid, soybean oil, Xenon Xe 133 Gas and vitamin E] DoD Uniform Formulary Outpatient Dosage Forms Desitin Rapid Relief: 13% (57 g, 113 g) UNIFORM FORMULARY Elta Seal Moisture Barrier: 6% (114 g) Gas, for Inhalation: Cream, topical [stick]: Xenon Xe 133 gas: 370 MBq (3 mL); 740 MBq (3 mL) [Calidose system] Balmex: 11.3% (56 g) [contains aloe, benzoic acid, soybean oil, and vitamin E] Ointment, topical: Yellow Fever Vaccine AmeriDerm PeriShield: 3.8% (100 g) DoD Uniform Formulary Outpatient Dosage Forms Dr. Smith's Diaper Rash: 10% (57 g, 85 g, 227 g) UNIFORM FORMULARY PeriGuard: 3.8% (100 g) Injection, powder for reconstitution [17D-204 strain]: Pharmabase Barrier: 9.38% (500 g) Generic: 20% (30 g, 60 g, 454 g); 40% (120 g) YF-VAX: ≥4.74 log10 plaque-forming units (PFU) per 0.5 mL dose [single-dose or 5-dose vial; produced in chicken embryos; contains gelatin; packaged with Paste, topical: diluent] Boudreaux's Butt Paste: 16% (30 g, 60 g, 120 g, 480 g) [contains castor oil, boric acid, mineral oil, and Peruvian balsam] Zafirlukast Desitin Maximum Strength Original: 40% (28 g, 57 g, 85 g, 120 g, 113 g, DoD Uniform Formulary Outpatient Dosage Forms 454 g) [contains cod liver oil and lanolin] UNIFORM FORMULARY Critic-Aid Skin Care: 20% (71 g, 170 g) Tablet, Oral: Powder, topical: Generic: 10 mg, 20 mg Ammens Original Medicated: 9.1% (312 g) Ammens Shower Fresh: 9.1% (312 g) Zaleplon Zinc Sulfate DoD Uniform Formulary Outpatient Dosage Forms DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY UNIFORM FORMULARY Capsule, Oral: Capsule, Oral: Generic: 5 mg, 10 mg Generic: 220 mg Zanamivir Solution, Intravenous: DoD Uniform Formulary Outpatient Dosage Forms Generic: 5 mg/mL (5 mL) Solution, Ophthalmic: UNIFORM FORMULARY Eye-Sed: 0.217% (15 mL) [contains benzalkonium chloride, boric acid] Aerosol Powder Breath Activated, Inhalation: Tablet, Oral: Relenza Diskhaler: 5 mg/blister (20 ea) [contains lactose] Orazinc: 110 mg Ziconotide Zinc 15: 66 mg DoD Uniform Formulary Outpatient Dosage Forms Generic: 220 mg Tablet, Oral [preservative free]: NOT COVERED Generic: 220 mg Solution, Intrathecal, as acetate [preservative free]: Prialt: 500 mcg/20 mL (20 mL); 100 mcg/mL (1 mL); 500 mcg/5 mL (5 mL) Ziprasidone Zidovudine DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Capsule, Oral, as hydrochloride: UNIFORM FORMULARY Generic: 20 mg, 40 mg, 60 mg, 80 mg Capsule, Oral: Solution Reconstituted, Intramuscular, as mesylate [strength expressed as Retrovir: 100 mg [contains soybean lecithin] base]: Solution, Intravenous [preservative free]: Geodon: 20 mg (1 ea) Retrovir: 10 mg/mL (20 mL) Syrup, Oral: Ziv-Aflibercept (Systemic) Generic: 50 mg/5 mL (240 mL) DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 300 mg Solution, Intravenous [preservative free]: Zaltrap: 100 mg/4 mL (4 mL); 200 mg/8 mL (8 mL) [contains mouse (murine) Zinc Acetate and/or hamster protein] DoD Uniform Formulary Outpatient Dosage Forms UNIFORM FORMULARY Zoledronic Acid Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Galzin: 25 mg, 50 mg UNIFORM FORMULARY Concentrate, Intravenous: Zinc Chloride Generic: 4 mg/5 mL (5 mL) DoD Uniform Formulary Outpatient Dosage Forms Concentrate, Intravenous [preservative free]: UNIFORM FORMULARY Generic: 4 mg/5 mL (5 mL) Solution, Intravenous: Solution, Intravenous: Generic: 1 mg/mL (10 mL) Zometa: 4 mg/100 mL (100 mL) Generic: 5 mg/100 mL (100 mL) Zinc Gelatin Solution, Intravenous [preservative free]: DoD Uniform Formulary Outpatient Dosage Forms Generic: 4 mg/100 mL (100 mL); 5 mg/100 mL (100 mL) UNIFORM FORMULARY Bandage: 3" x 10 yards; 4" x 10 yards ZOLMitriptan DoD Uniform Formulary Outpatient Dosage Forms Zinc Gluconate BASIC CORE FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral: UNIFORM FORMULARY Generic: 2.5 mg, 5 mg 121 ZOLMITRIPTAN

Tablet Dispersible, Oral: Generic: 1.75 mg, 3.5 mg Generic: 2.5 mg, 5 mg Zonisamide UNIFORM FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Solution, Nasal: UNIFORM FORMULARY Zomig: 2.5 mg (6 ea); 5 mg (6 ea) Capsule, Oral: Zolpidem Generic: 25 mg, 50 mg, 100 mg DoD Uniform Formulary Outpatient Dosage Forms Zoster Vaccine (Live/Attenuated) BASIC CORE FORMULARY DoD Uniform Formulary Outpatient Dosage Forms Tablet, Oral, as tartrate: UNIFORM FORMULARY Generic: 5 mg, 10 mg Suspension Reconstituted, Subcutaneous [preservative free]: Tablet Extended Release, Oral, as tartrate: Zostavax: 19,400 units/0.65 mL (1 ea) Generic: 6.25 mg, 12.5 mg NONFORMULARY Zoster Vaccine (Recombinant) Solution, Oral, as tartrate: DoD Uniform Formulary Outpatient Dosage Forms Zolpimist: 5 mg/actuation (4.5 mL, 7.7 mL) UNIFORM FORMULARY Tablet Sublingual, as tartrate: Suspension Reconstituted, Intramuscular: Edluar: 5 mg, 10 mg [contains saccharin sodium] Shingrix: 50 mcg [contains polysorbate 80] Intermezzo: 1.75 mg, 3.5 mg

122 Therapeutic Category Index

123 ABORTIFACIENT

Abortifacient Dextromethorphan and Chlorpheniramine ...... 35 Carboprost Tromethamine ...... 23 Hydrocodone and Chlorpheniramine ...... 60 Dinoprostone ...... 37 Ibuprofen, Phenylephrine, and Chlorpheniramine ...... 62 MiFEPRIStone ...... 81 Ibuprofen, Pseudoephedrine, and Chlorpheniramine ...... 62 Naphazoline and Pheniramine ...... 83 Acetylcholinesterase Inhibitor Triprolidine ...... 116 Echothiophate Iodide ...... 40 Triprolidine and Pseudoephedrine ...... 117 Edrophonium ...... 40 Edrophonium and Atropine ...... 41 Allergen-Specific Immunotherapy Neostigmine ...... 84 Grass Pollen Allergen Extract (5 Grass Extract) ...... 56 Physostigmine ...... 93 Grass Pollen Allergen Extract (Timothy Grass) ...... 56 Pyridostigmine ...... 100 Ragweed Pollen Allergen Extract ...... 100

Acetylcholinesterase Inhibitor (Central) Alpha1 Agonist Donepezil ...... 39 Midodrine ...... 81 Galantamine ...... 54 Naphazoline and Pheniramine ...... 83 Rivastigmine ...... 103 Naphazoline (Ophthalmic) ...... 83

Acne Products Alpha1 Blocker Adapalene ...... 5 Alfuzosin ...... 6 Benzoyl Peroxide ...... 15 Doxazosin ...... 39 Benzoyl Peroxide and Hydrocortisone ...... 16 Phenoxybenzamine ...... 93 Clindamycin and Benzoyl Peroxide ...... 28 Phentolamine ...... 93 Erythromycin and Benzoyl Peroxide ...... 43 Prazosin ...... 97 Erythromycin (Topical) ...... 44 Tamsulosin ...... 110 ISOtretinoin (Systemic) ...... 67 Terazosin ...... 112 Salicylic Acid ...... 103 Sulfacetamide (Topical) ...... 109 Alpha2-Adrenergic Agonist Sulfur and Sulfacetamide ...... 109 CloNIDine ...... 29 Tazarotene ...... 110 Clonidine and Chlorthalidone ...... 29 Tretinoin (Topical) ...... 115 DexmedeTOMIDine ...... 34 GuanFACINE ...... 58 Activated Prothrombin Complex Concentrate (aPCC) Methyldopa ...... 79 Anti-inhibitor Coagulant Complex (Human) ...... 10 Methyldopa and Hydrochlorothiazide ...... 79 Activin Receptor Ligand Trap TiZANidine ...... 114

Luspatercept ...... 74 Alpha2 Agonist, Ophthalmic Adhesiolytic Apraclonidine ...... 10 Icodextrin ...... 62 Brimonidine (Ophthalmic) ...... 18 Brinzolamide and Brimonidine ...... 18 Adrenergic Agonist Agent DOBUTamine ...... 39 Alpha-Adrenergic Agonist DOPamine ...... 39 Acetaminophen, Diphenhydramine, and Phenylephrine ...... 3 Epinephrine (Racemic) and Aluminum Potassium Sulfate ...... 43 Acetaminophen, Guaifenesin, and Phenylephrine ...... 4 Oxymetazoline (Nasal) ...... 89 Brompheniramine and Phenylephrine ...... 18 Propylhexedrine ...... 99 Brompheniramine, Dextromethorphan, and Phenylephrine ...... 18 Tetrahydrozoline (Nasal) ...... 112 Chlorpheniramine and Phenylephrine ...... 26 Tetrahydrozoline (Ophthalmic) ...... 112 Chlorpheniramine, Phenylephrine, and Dextromethorphan ...... 26 Dexbrompheniramine and Phenylephrine ...... 34 Adrenergic Agonist Agent, Ophthalmic Diphenhydramine and Phenylephrine ...... 37 Hydroxyamphetamine and Tropicamide ...... 61 Ibuprofen, Phenylephrine, and Chlorpheniramine ...... 62 Phenylephrine and Ketorolac ...... 93 Phenylephrine and Pramoxine ...... 93 Adrenocorticotropin Stimulating Hormone Phenylephrine and Pyrilamine ...... 93 Phenylephrine and Thonzylamine ...... 93 Corticotropin ...... 31 Phenylephrine (Nasal) ...... 93 Cosyntropin ...... 31 Phenylephrine (Ophthalmic) ...... 93 Aldehyde Dehydrogenase Inhibitor Phenylephrine (Systemic) ...... 93 Disulfiram ...... 38 Phenylephrine (Topical) ...... 93 Promethazine and Phenylephrine ...... 98 Alkalinizing Agent Promethazine, Phenylephrine, and Codeine ...... 98 Citric Acid, Sodium Citrate, and Potassium Citrate ...... 27 Sodium Bicarbonate ...... 106 Alpha/Beta Agonist Acetaminophen and Pseudoephedrine ...... 3 Alkalinizing Agent, Oral Acrivastine and Pseudoephedrine ...... 4 Potassium Citrate ...... 96 Brompheniramine and Pseudoephedrine ...... 18 Potassium Citrate and Citric Acid ...... 96 Brompheniramine, Pseudoephedrine, and Dextromethorphan ...... 18 Sodium Citrate and Citric Acid ...... 106 Cetirizine and Pseudoephedrine ...... 25 Alkalinizing Agent, Parenteral Chlorpheniramine and Pseudoephedrine ...... 26 Sodium Lactate ...... 107 Chlorpheniramine, Pseudoephedrine, and Codeine ...... 26 Tromethamine ...... 117 Chlorpheniramine, Pseudoephedrine, and Dextromethorphan ...... 26 Codeine, Phenylephrine, and Triprolidine ...... 30 Alkylamine Derivative Dexchlorpheniramine and Pseudoephedrine ...... 34 Acrivastine and Pseudoephedrine ...... 4 Droxidopa ...... 40 Brompheniramine and Phenylephrine ...... 18 EPHEDrine (Systemic) ...... 42 Brompheniramine and Pseudoephedrine ...... 18 EPINEPHrine (Nasal) ...... 42 Brompheniramine, Dextromethorphan, and Phenylephrine ...... 18 EPINEPHrine (Oral Inhalation) ...... 43 Brompheniramine, Pseudoephedrine, and Dextromethorphan ...... 18 Epinephrine (Racemic) and Aluminum Potassium Sulfate ...... 43 Chlophedianol and Dexbrompheniramine ...... 25 EPINEPHrine (Systemic) ...... 43 Chlorpheniramine ...... 25 Fexofenadine and Pseudoephedrine ...... 49 Chlorpheniramine and Acetaminophen ...... 26 Guaifenesin and Pseudoephedrine ...... 57 Chlorpheniramine and Phenylephrine ...... 26 Hydrocodone, Chlorpheniramine, and Pseudoephedrine ...... 60 Chlorpheniramine and Pseudoephedrine ...... 26 Ibuprofen, Pseudoephedrine, and Chlorpheniramine ...... 62 Chlorpheniramine, Phenylephrine, and Dextromethorphan ...... 26 Loratadine and Pseudoephedrine ...... 73 Chlorpheniramine, Pseudoephedrine, and Codeine ...... 26 Norepinephrine ...... 86 Chlorpheniramine, Pseudoephedrine, and Dextromethorphan ...... 26 Pseudoephedrine ...... 99 Codeine, Phenylephrine, and Triprolidine ...... 30 Triprolidine and Pseudoephedrine ...... 117 Dexbrompheniramine and Phenylephrine ...... 34 Dexchlorpheniramine and Pseudoephedrine ...... 34 5 Alpha-Reductase Inhibitor Dexchlorpheniramine, Dextromethorphan, and Phenylephrine ...... 34 Finasteride ...... 50 124 ANDROGEN

Amebicide Nabumetone ...... 83 Iodoquinol ...... 65 Naproxen ...... 83 MetroNIDAZOLE (Systemic) ...... 80 Naproxen and Diphenhydramine ...... 84 Paromomycin ...... 90 Naproxen and Esomeprazole ...... 84 Tinidazole ...... 113 Naproxen and Pseudoephedrine ...... 84 Oxaprozin ...... 88 Amino Acid Piroxicam (Systemic) ...... 94 Glutamine ...... 56 Pseudoephedrine and Ibuprofen ...... 99 Aminolevulinate Synthase 1-Directed Small Interfering Ribonucleic Sucrose ...... 108 Acid (siRNA) Sulindac ...... 109 Givosiran ...... 55 Ziconotide ...... 121 Aminoquinoline (Antimalarial) Analgesic, Opioid Chloroquine ...... 25 Acetaminophen and Codeine ...... 2 Hydroxychloroquine ...... 61 Acetaminophen and Tramadol ...... 3 Primaquine ...... 98 Acetaminophen, Caffeine, and Dihydrocodeine ...... 3 Tafenoquine ...... 110 Alfentanil ...... 6 Belladonna and Opium ...... 14 5-Aminosalicylic Acid Derivative Buprenorphine ...... 19 Balsalazide ...... 14 Buprenorphine and Naloxone ...... 19 Mesalamine ...... 77 Butalbital, Acetaminophen, Caffeine, and Codeine ...... 19 Olsalazine ...... 87 Butalbital, Aspirin, Caffeine, and Codeine ...... 20 SulfaSALAzine ...... 109 Butorphanol ...... 20 Ammonium Detoxicant Chlorpheniramine, Pseudoephedrine, and Codeine ...... 26 Lactulose ...... 69 Codeine ...... 29 Neomycin ...... 84 Codeine and Chlorpheniramine ...... 29 Codeine, Phenylephrine, and Triprolidine ...... 30 AMPA Glutamate Receptor Antagonist Dihydrocodeine, Aspirin, and Caffeine ...... 37 Perampanel ...... 92 FentaNYL ...... 49 Amylinomimetic HYDROcodone ...... 60 Hydrocodone and Acetaminophen ...... 60 Pramlintide ...... 97 Hydrocodone and Chlorpheniramine ...... 60 Anabolic Steroid Hydrocodone and Homatropine ...... 60 Oxymetholone ...... 89 Hydrocodone, Chlorpheniramine, and Pseudoephedrine ...... 60 HYDROmorphone ...... 61 Analgesic Combination (Opioid) Levorphanol ...... 71 Acetaminophen and Codeine ...... 2 Meperidine ...... 77 Acetaminophen and Tramadol ...... 3 Methadone ...... 77 Acetaminophen, Caffeine, and Dihydrocodeine ...... 3 Morphine and Naltrexone ...... 82 Belladonna and Opium ...... 14 Morphine (Systemic) ...... 82 Butalbital, Acetaminophen, Caffeine, and Codeine ...... 19 Nalbuphine ...... 83 Butalbital, Aspirin, Caffeine, and Codeine ...... 20 Opium Tincture ...... 88 Hydrocodone and Acetaminophen ...... 60 OxyCODONE ...... 89 Hydrocodone and Ibuprofen ...... 60 Oxycodone and Acetaminophen ...... 89 Oxycodone and Acetaminophen ...... 89 Oxycodone and Aspirin ...... 89 Oxycodone and Aspirin ...... 89 Oxycodone and Ibuprofen ...... 89 Oxycodone and Ibuprofen ...... 89 OxyMORphone ...... 89 Analgesic, Miscellaneous Paregoric ...... 90 Acetaminophen and Pseudoephedrine ...... 3 Pentazocine ...... 92 Pentazocine and Naloxone ...... 92 Analgesic, Nonopioid Promethazine and Codeine ...... 98 Acetaminophen ...... 2 Promethazine, Phenylephrine, and Codeine ...... 98 Acetaminophen and Caffeine ...... 2 Remifentanil ...... 101 Acetaminophen and Diphenhydramine ...... 2 SUFentanil ...... 108 Acetaminophen and Pamabrom ...... 2 Tapentadol ...... 110 Acetaminophen and Phenylephrine ...... 2 TraMADol ...... 115 Acetaminophen and Phenyltoloxamine ...... 3 Acetaminophen, Aspirin, and Caffeine ...... 3 Analgesic, Opioid Partial Agonist Acetaminophen, Caffeine, and Pyrilamine ...... 3 Buprenorphine ...... 19 Acetaminophen, Dextromethorphan, and Doxylamine ...... 3 Buprenorphine and Naloxone ...... 19 Acetaminophen, Dextromethorphan, and Phenylephrine ...... 3 Butorphanol ...... 20 Acetaminophen, Diphenhydramine, and Phenylephrine ...... 3 Nalbuphine ...... 83 Acetaminophen, Guaifenesin, and Phenylephrine ...... 4 Pentazocine ...... 92 Acetaminophen, Isometheptene, and Dichloralphenazone ...... 4 Pentazocine and Naloxone ...... 92 Amlodipine and Celecoxib ...... 8 Aspirin ...... 12 Analgesic, Topical Aspirin and Diphenhydramine ...... 12 Benzocaine ...... 15 Aspirin, Citric Acid, and Sodium Bicarbonate ...... 12 Benzyl Alcohol ...... 16 Butalbital, Acetaminophen, and Caffeine ...... 19 Capsaicin ...... 22 Butalbital and Acetaminophen ...... 20 Lidocaine and Menthol ...... 71 Celecoxib ...... 24 Lidocaine and Tetracaine ...... 71 Chlorpheniramine and Acetaminophen ...... 26 Lidocaine (Topical) ...... 72 Diclofenac and Misoprostol ...... 36 Trolamine ...... 117 Diclofenac (Systemic) ...... 36 Diflunisal ...... 37 Analgesic, Urinary Diphenhydramine and Ibuprofen ...... 37 Pentosan Polysulfate Sodium ...... 92 Etodolac ...... 47 Phenazopyridine ...... 92 Fenoprofen ...... 49 Anaplerotic Agent Flurbiprofen (Systemic) ...... 52 Triheptanoin ...... 116 Ibuprofen ...... 62 Ibuprofen and Phenylephrine ...... 62 Androgen Ibuprofen, Phenylephrine, and Chlorpheniramine ...... 62 Danazol ...... 32 Ibuprofen, Pseudoephedrine, and Chlorpheniramine ...... 62 Fluoxymesterone ...... 52 Indomethacin ...... 63 MethylTESTOSTERone ...... 79 Ketorolac (Systemic) ...... 68 Oxandrolone ...... 88 Meloxicam ...... 76 Testosterone ...... 112 125 ANESTHETIC/CORTICOSTEROID

Anesthetic/Corticosteroid Ivermectin (Systemic) ...... 67 Lidocaine and Hydrocortisone ...... 71 Mebendazole ...... 75 Pramoxine and Hydrocortisone ...... 97 Praziquantel ...... 97 Pyrantel Pamoate ...... 99 Anesthetic, Topical Fluorescein and Benoxinate ...... 51 Anti-Amyloid Monoclonal Antibody Pentafluoropropane and Tetrafluoroethane ...... 91 Aducanumab ...... 5 Phenol ...... 93 Antiandrogen Angiogenesis Inhibitor Abiraterone Acetate ...... 2 Lenalidomide ...... 69 Antianginal Agent Pomalidomide ...... 95 AmLODIPine ...... 8 Ranibizumab ...... 101 Amlodipine and Atorvastatin ...... 8 Thalidomide ...... 113 Amlodipine and Benazepril ...... 8 Angiotensin II Receptor Blocker Amlodipine and Olmesartan ...... 8 Amlodipine and Olmesartan ...... 8 Amlodipine and Valsartan ...... 8 Amlodipine and Valsartan ...... 8 Amlodipine, Valsartan, and Hydrochlorothiazide ...... 8 Amlodipine, Valsartan, and Hydrochlorothiazide ...... 8 Atenolol ...... 12 Azilsartan ...... 13 DilTIAZem ...... 37 Azilsartan and Chlorthalidone ...... 13 Isosorbide Dinitrate ...... 67 Candesartan ...... 22 Isosorbide Mononitrate ...... 67 Candesartan and Hydrochlorothiazide ...... 22 Metoprolol ...... 80 Eprosartan ...... 43 Nadolol ...... 83 Irbesartan ...... 66 NiCARdipine ...... 85 Irbesartan and Hydrochlorothiazide ...... 66 NIFEdipine ...... 85 Losartan ...... 73 Nitroglycerin ...... 86 Losartan and Hydrochlorothiazide ...... 73 Perindopril and Amlodipine ...... 92 Olmesartan ...... 87 Propranolol ...... 99 Olmesartan and Hydrochlorothiazide ...... 87 Ranolazine ...... 101 Sacubitril and Valsartan ...... 103 Telmisartan and Amlodipine ...... 111 Telmisartan ...... 111 Verapamil ...... 119 Telmisartan and Amlodipine ...... 111 Antianxiety Agent, Miscellaneous Telmisartan and Hydrochlorothiazide ...... 111 BusPIRone ...... 19 Valsartan ...... 118 Meprobamate ...... 77 Valsartan and Hydrochlorothiazide ...... 118 Antiarrhythmic Agent, Class Ia Angiotensin-Converting Enzyme (ACE) Inhibitor Disopyramide ...... 38 Amlodipine and Benazepril ...... 8 Procainamide ...... 98 Benazepril ...... 15 QuiNIDine ...... 100 Benazepril and Hydrochlorothiazide ...... 15 Captopril ...... 22 Antiarrhythmic Agent, Class Ib Captopril and Hydrochlorothiazide ...... 22 Lidocaine (Systemic) ...... 72 Enalapril ...... 42 Mexiletine ...... 80 Enalapril and Hydrochlorothiazide ...... 42 Enalaprilat ...... 42 Antiarrhythmic Agent, Class Ic Fosinopril ...... 53 Flecainide ...... 50 Fosinopril and Hydrochlorothiazide ...... 53 Propafenone ...... 98 Lisinopril ...... 72 Antiarrhythmic Agent, Class II Lisinopril and Hydrochlorothiazide ...... 73 Acebutolol ...... 2 Moexipril ...... 82 Esmolol ...... 44 Moexipril and Hydrochlorothiazide ...... 82 Propranolol ...... 99 Perindopril ...... 92 Sotalol ...... 108 Perindopril and Amlodipine ...... 92 Quinapril ...... 100 Antiarrhythmic Agent, Class III Quinapril and Hydrochlorothiazide ...... 100 Amiodarone ...... 8 Ramipril ...... 101 Dofetilide ...... 39 Trandolapril ...... 115 Dronedarone ...... 40 Trandolapril and Verapamil ...... 115 Ibutilide ...... 62 Sotalol ...... 108 Anilidopiperidine Opioid Alfentanil ...... 6 Antiarrhythmic Agent, Class IV FentaNYL ...... 49 DilTIAZem ...... 37 Remifentanil ...... 101 Verapamil ...... 119 SUFentanil ...... 108 Antiarrhythmic Agent, Miscellaneous Anorexiant Adenosine ...... 5 Benzphetamine ...... 16 Digoxin ...... 37 Diethylpropion ...... 37 Antibacterial, Dental Methamphetamine ...... 77 Triclosan and Fluoride ...... 116 Phendimetrazine ...... 92 Phentermine ...... 93 Antibacterial, Topical Hydrogen Peroxide ...... 61 Antacid Aluminum Hydroxide ...... 7 Antibiotic, Aminoglycoside Aluminum Hydroxide and Magnesium Carbonate ...... 7 Amikacin (Systemic) ...... 7 Aluminum Hydroxide and Magnesium Hydroxide ...... 7 Gentamicin (Ophthalmic) ...... 55 Aluminum Hydroxide, Magnesium Hydroxide, and Simethicone ...... 7 Gentamicin (Systemic) ...... 55 Aspirin, Citric Acid, and Sodium Bicarbonate ...... 12 Gentamicin (Topical) ...... 55 Calcium Carbonate ...... 21 Neomycin ...... 84 Calcium Carbonate and Magnesium Hydroxide ...... 21 Plazomicin ...... 94 Calcium Carbonate and Simethicone ...... 21 Streptomycin ...... 108 Famotidine, Calcium Carbonate, and Magnesium Hydroxide ...... 48 Tobramycin (Ophthalmic) ...... 114 Magnesium Hydroxide ...... 74 Tobramycin (Oral Inhalation) ...... 114 Sodium Bicarbonate ...... 106 Tobramycin (Systemic) ...... 114 Sodium Citrate ...... 106 Antibiotic, Carbapenem Anthelmintic Doripenem ...... 39 Albendazole ...... 5 Ertapenem ...... 43 126 ANTIBIOTIC, PLEUROMUTILIN

Imipenem and Cilastatin ...... 62 Antibiotic, Miscellaneous Meropenem ...... 77 Bacitracin (Systemic) ...... 13 Meropenem and Vaborbactam ...... 77 Bismuth Subcitrate, Metronidazole, and Tetracycline ...... 17 Antibiotic, Cephalosporin (First Generation) Capreomycin ...... 22 Chloramphenicol (Systemic) ...... 25 Cefadroxil ...... 23 Clofazimine ...... 28 CeFAZolin ...... 23 Colistimethate ...... 30 Cephalexin ...... 25 CycloSERINE ...... 31 Antibiotic, Cephalosporin (Second Generation) Dapsone (Systemic) ...... 32 Cefaclor ...... 23 Fosfomycin ...... 53 CefoTEtan ...... 24 Hyoscyamine, Methenamine, Methylene Blue, and Sodium Phosphate CefOXitin ...... 24 Monobasic ...... 61 Cefprozil ...... 24 Methenamine ...... 78 Cefuroxime ...... 24 Methenamine, Phenyl Salicylate, Methylene Blue, Benzoic Acid, and Hyoscyamine ...... 78 Antibiotic, Cephalosporin (Third Generation) Methenamine, Sodium Phosphate Monobasic, Phenyl Salicylate, Cefdinir ...... 23 Methylene Blue, and Hyoscyamine ...... 78 Cefditoren ...... 24 MetroNIDAZOLE (Systemic) ...... 80 Cefixime ...... 24 Nitrofurantoin ...... 85 Cefotaxime ...... 24 Polymyxin B ...... 95 Cefpodoxime ...... 24 Rifampin and Isoniazid ...... 102 CefTAZidime ...... 24 Rifampin, Isoniazid, and Pyrazinamide ...... 102 Ceftibuten ...... 24 Secnidazole ...... 104 CefTRIAXone ...... 24 Sulfamethoxazole and Trimethoprim ...... 109 Antibiotic, Cephalosporin (Fourth Generation) Tetracycline, Bismuth Subsalicylate, and Metronidazole ...... 112 Cefepime ...... 24 Tinidazole ...... 113 Trimethoprim ...... 116 Antibiotic, Cephalosporin (Fifth Generation) Ceftaroline Fosamil ...... 24 Antibiotic, Monobactam Aztreonam (Oral Inhalation) ...... 13 Antibiotic/Corticosteroid, Ophthalmic Aztreonam (Systemic) ...... 13 Loteprednol and Tobramycin ...... 74 Neomycin, Polymyxin B, and Dexamethasone ...... 84 Antibiotic, Ophthalmic Neomycin, Polymyxin B, and Hydrocortisone (Ophthalmic) ...... 84 Azithromycin (Ophthalmic) ...... 13 Prednisolone and Gentamicin ...... 97 Bacitracin and Polymyxin B (Ophthalmic) ...... 13 Sulfacetamide and Prednisolone ...... 108 Bacitracin, Neomycin, and Polymyxin B (Ophthalmic) ...... 13 Tobramycin and Dexamethasone ...... 114 Bacitracin, Neomycin, Polymyxin B, and Hydrocortisone (Ophthalmic) ...... 13 Antibiotic/Corticosteroid, Otic Bacitracin (Ophthalmic) ...... 13 Ciprofloxacin and Dexamethasone ...... 27 Ciprofloxacin (Ophthalmic) ...... 27 Ciprofloxacin and Fluocinolone ...... 27 Erythromycin (Ophthalmic) ...... 43 Ciprofloxacin and Hydrocortisone ...... 27 Gatifloxacin ...... 55 Neomycin, Colistin, Hydrocortisone, and Thonzonium ...... 84 Gentamicin (Ophthalmic) ...... 55 Neomycin, Polymyxin B, and Hydrocortisone (Otic) ...... 84 LevoFLOXacin (Ophthalmic) ...... 70 Moxifloxacin (Ophthalmic) ...... 82 Antibiotic/Corticosteroid, Topical Neomycin, Polymyxin B, and Gramicidin ...... 84 Neomycin, Polymyxin B, and Hydrocortisone (Topical) ...... 84 Neomycin, Polymyxin B, and Hydrocortisone (Ophthalmic) ...... 84 Antibiotic, Cyclic Lipopeptide Ofloxacin (Ophthalmic) ...... 87 DAPTOmycin ...... 32 Sulfacetamide (Ophthalmic) ...... 108 Tobramycin (Ophthalmic) ...... 114 Antibiotic, Fluoroquinolone Trimethoprim and Polymyxin B ...... 116 Ciprofloxacin and Fluocinolone ...... 27 Ciprofloxacin (Ophthalmic) ...... 27 Antibiotic, Oral Rinse Ciprofloxacin (Otic) ...... 27 Chlorhexidine Gluconate (Oral) ...... 25 Ciprofloxacin (Systemic) ...... 27 Hydrogen Peroxide ...... 61 Delafloxacin ...... 33 Antibiotic, Otic Gatifloxacin ...... 55 Ciprofloxacin and Dexamethasone ...... 27 Gemifloxacin ...... 55 Ciprofloxacin and Fluocinolone ...... 27 LevoFLOXacin (Ophthalmic) ...... 70 Ciprofloxacin and Hydrocortisone ...... 27 LevoFLOXacin (Systemic) ...... 70 Ciprofloxacin (Otic) ...... 27 Moxifloxacin (Ophthalmic) ...... 82 Neomycin, Colistin, Hydrocortisone, and Thonzonium ...... 84 Moxifloxacin (Systemic) ...... 82 Neomycin, Polymyxin B, and Hydrocortisone (Otic) ...... 84 Ofloxacin (Ophthalmic) ...... 87 Ofloxacin (Otic) ...... 87 Ofloxacin (Otic) ...... 87 Ofloxacin (Systemic) ...... 87 Antibiotic, Oxazolidinone Linezolid ...... 72 Antibiotic, Glycylcycline Tedizolid ...... 111 Tigecycline ...... 113 Antibiotic, Penicillin Antibiotic, Irrigation Amoxicillin ...... 8 Polymyxin B ...... 95 Amoxicillin and Clavulanate ...... 8 Antibiotic, Lincosamide Ampicillin ...... 9 Clindamycin (Systemic) ...... 28 Ampicillin and Sulbactam ...... 9 Clindamycin (Topical) ...... 28 Dicloxacillin ...... 36 Lincomycin ...... 72 Lansoprazole, Amoxicillin, and Clarithromycin ...... 69 Nafcillin ...... 83 Antibiotic, Macrolide Omeprazole, Clarithromycin, and Amoxicillin ...... 88 Azithromycin (Ophthalmic) ...... 13 Oxacillin ...... 88 Azithromycin (Systemic) ...... 13 Penicillin V Potassium ...... 91 Clarithromycin ...... 28 Penicillin G Benzathine ...... 91 Erythromycin (Ophthalmic) ...... 43 Penicillin G Benzathine and Penicillin G Procaine ...... 91 Erythromycin (Systemic) ...... 44 Penicillin G (Parenteral/Aqueous) ...... 91 Erythromycin (Topical) ...... 44 Penicillin G Procaine ...... 91 Fidaxomicin ...... 50 Piperacillin and Tazobactam ...... 94 Ticarcillin and Clavulanate Potassium ...... 113 Antibiotic, Macrolide Combination Lansoprazole, Amoxicillin, and Clarithromycin ...... 69 Antibiotic, Pleuromutilin Omeprazole, Clarithromycin, and Amoxicillin ...... 88 Retapamulin ...... 101 127 ANTIBIOTIC, RESPIRATORY FLUOROQUINOLONE

Antibiotic, Respiratory Fluoroquinolone Umeclidinium ...... 117 Gemifloxacin ...... 55 Umeclidinium and Vilanterol ...... 117 LevoFLOXacin (Systemic) ...... 70 Anticholinergic Agent, Ophthalmic Moxifloxacin (Systemic) ...... 82 Atropine (Ophthalmic) ...... 12 Antibiotic, Streptogramin Cyclopentolate ...... 31 Quinupristin and Dalfopristin ...... 100 Homatropine ...... 59 Antibiotic, Sulfonamide Derivative Anticoagulant Sulfacetamide (Topical) ...... 109 Anticoagulant Citrate Dextrose ...... 9 SulfADIAZINE ...... 109 Anticoagulant Citrate Phosphate Dextrose ...... 9 Sulfamethoxazole and Trimethoprim ...... 109 Anticoagulant Sodium Citrate ...... 9 Sulfur and Sulfacetamide ...... 109 Antithrombin ...... 10 Antibiotic, Tetracycline Derivative Apixaban ...... 10 Bismuth Subcitrate, Metronidazole, and Tetracycline ...... 17 Argatroban ...... 11 Demeclocycline ...... 33 Bivalirudin ...... 17 Doxycycline ...... 40 Dabigatran Etexilate ...... 32 Eravacycline ...... 43 Dalteparin ...... 32 Minocycline Hydrochloride Periodontal Microspheres ...... 81 Desirudin ...... 33 Minocycline (Systemic) ...... 81 Enoxaparin ...... 42 Tetracycline, Bismuth Subsalicylate, and Metronidazole ...... 112 Fondaparinux ...... 53 Tetracycline (Systemic) ...... 112 Heparin ...... 58 Rivaroxaban ...... 102 Antibiotic, Topical Sodium Chloride and Sodium Citrate ...... 106 Bacitracin and Polymyxin B (Topical) ...... 13 Warfarin ...... 120 Bacitracin, Neomycin, and Polymyxin B (Topical) ...... 13 Bacitracin, Neomycin, Polymyxin B, and Hydrocortisone (Topical) ...... 13 Anticoagulant, Direct Thrombin Inhibitor Bacitracin, Neomycin, Polymyxin B, and Pramoxine ...... 13 Argatroban ...... 11 Bacitracin (Topical) ...... 14 Bivalirudin ...... 17 Chlorhexidine Gluconate (Topical) ...... 25 Dabigatran Etexilate ...... 32 Clioquinol and Hydrocortisone ...... 28 Desirudin ...... 33 Erythromycin (Topical) ...... 44 Gentamicin (Topical) ...... 55 Anticoagulant, Factor Xa Inhibitor Gentian Violet ...... 55 Apixaban ...... 10 Mafenide ...... 74 Fondaparinux ...... 53 MetroNIDAZOLE (Topical) ...... 80 Rivaroxaban ...... 102 Mupirocin ...... 83 Anticoagulant, Low Molecular Weight Heparin Neomycin and Polymyxin B ...... 84 Dalteparin ...... 32 Neomycin, Polymyxin B, and Hydrocortisone (Topical) ...... 84 Enoxaparin ...... 42 Oxychlorosene ...... 89 Retapamulin ...... 101 Anticoagulant, Vitamin K Antagonist Silver ...... 105 Warfarin ...... 120 Silver Nitrate ...... 105 Silver Sulfadiazine ...... 105 Anticonvulsant Cannabidiol ...... 22 Antibiotic, Urinary Anti-infective Methenamine, Phenyl Salicylate, Atropine, Hyoscyamine, Benzoic Acid, Anticonvulsant, Barbiturate and Methylene Blue ...... 78 PENTobarbital ...... 92 PHENobarbital ...... 92 Anti-CD19 Monoclonal Antibody Inebilizumab ...... 63 Anticonvulsant, Benzodiazepine CloBAZam ...... 28 Anti-CD20 Monoclonal Antibody ClonazePAM ...... 29 Ocrelizumab ...... 86 Clorazepate ...... 29 Ofatumumab ...... 87 DiazePAM ...... 36 Anticholinergic Agent LORazepam ...... 73 Aclidinium ...... 4 Midazolam ...... 81 Aclidinium and Formoterol ...... 4 Anticonvulsant, Hydantoin Atropine and Pralidoxime ...... 12 Ethotoin ...... 47 Atropine (Systemic) ...... 12 Benztropine ...... 16 Fosphenytoin ...... 54 Dicyclomine ...... 36 Phenytoin ...... 93 Edrophonium and Atropine ...... 41 Anticonvulsant, Miscellaneous Glycopyrrolate (Systemic) ...... 56 AcetaZOLAMIDE ...... 4 Glycopyrronium (Topical) ...... 56 CarBAMazepine ...... 22 Hyoscyamine ...... 61 Cenobamate ...... 24 Hyoscyamine, Atropine, Scopolamine, and Phenobarbital ...... 61 Eslicarbazepine ...... 44 Ipratropium and Albuterol ...... 66 Felbamate ...... 48 Ipratropium (Nasal) ...... 66 Fenfluramine ...... 48 Ipratropium (Oral Inhalation) ...... 66 Gabapentin ...... 54 Methscopolamine ...... 78 Lacosamide ...... 68 Propantheline ...... 98 Scopolamine ...... 104 LamoTRIgine ...... 69 Solifenacin ...... 107 LevETIRAcetam ...... 70 Tiotropium ...... 114 Magnesium Sulfate ...... 75 Tiotropium and Olodaterol ...... 114 OXcarbazepine ...... 89 Tolterodine ...... 114 Perampanel ...... 92 Trihexyphenidyl ...... 116 Pregabalin ...... 98 Trospium ...... 117 Primidone ...... 98 Umeclidinium ...... 117 TiaGABine ...... 113 Umeclidinium and Vilanterol ...... 117 Topiramate ...... 114 Valproic Acid and Derivatives ...... 118 Anticholinergic Agent, Long-Acting Vigabatrin ...... 119 Aclidinium ...... 4 Zonisamide ...... 122 Aclidinium and Formoterol ...... 4 Tiotropium ...... 114 Anticonvulsant, Neuronal Potassium Channel Opener Tiotropium and Olodaterol ...... 114 Ezogabine ...... 48 128 ANTIDOTE

Anticonvulsant, Succinimide Antidiabetic Agent, Meglitinide Analog Ethosuximide ...... 47 Nateglinide ...... 84 Methsuximide ...... 79 Repaglinide ...... 101 Repaglinide and Metformin ...... 101 Anticonvulsant, Triazole Derivative Rufinamide ...... 103 Antidiabetic Agent, Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor Anticystine Agent Empagliflozin ...... 41 Cysteamine (Ophthalmic) ...... 32 Empagliflozin and Linagliptin ...... 41 Cysteamine (Systemic) ...... 32 Empagliflozin and Metformin ...... 42 Antidepressant, Alpha-2 Antagonist Empagliflozin, Linagliptin, and Metformin ...... 42 Mirtazapine ...... 81 Antidiabetic Agent, Sulfonylurea Antidepressant, Dopamine/Norepinephrine-Reuptake Inhibitor ChlorproPAMIDE ...... 26 BuPROPion ...... 19 Glimepiride ...... 55 GlipiZIDE ...... 55 Antidepressant, Monoamine Oxidase Inhibitor Glipizide and Metformin ...... 55 Isocarboxazid ...... 67 GlyBURIDE ...... 56 Phenelzine ...... 92 Glyburide and Metformin ...... 56 Selegiline ...... 104 Pioglitazone and Glimepiride ...... 94 Tranylcypromine ...... 115 TOLAZamide ...... 114 TOLBUTamide ...... 114 Antidepressant, Selective Serotonin Reuptake Inhibitor Citalopram ...... 27 Antidiabetic Agent, Thiazolidinedione Escitalopram ...... 44 Pioglitazone ...... 94 FLUoxetine ...... 52 Pioglitazone and Glimepiride ...... 94 FluvoxaMINE ...... 53 Pioglitazone and Metformin ...... 94 Olanzapine and Fluoxetine ...... 87 Antidiarrheal PARoxetine ...... 90 Bismuth Subcitrate, Metronidazole, and Tetracycline ...... 17 Sertraline ...... 105 Bismuth Subsalicylate ...... 17 Antidepressant, Serotonin/Norepinephrine Reuptake Inhibitor Crofelemer ...... 31 Desvenlafaxine ...... 34 Difenoxin and Atropine ...... 37 DULoxetine ...... 40 Diphenoxylate and Atropine ...... 38 Venlafaxine ...... 119 Loperamide ...... 73 Loperamide and Simethicone ...... 73 Antidepressant, Serotonin Reuptake Inhibitor/Antagonist Octreotide ...... 87 Nefazodone ...... 84 Opium Tincture ...... 88 TraZODone ...... 115 Paregoric ...... 90 Polycarbophil ...... 94 Antidepressant, Tetracyclic Psyllium ...... 99 Maprotiline ...... 75 Tetracycline, Bismuth Subsalicylate, and Metronidazole ...... 112 Antidepressant, Tricyclic (Secondary Amine) Antidiarrheal, Miscellaneous Amoxapine ...... 8 Probiotic Product ...... 98 Desipramine ...... 33 Nortriptyline ...... 86 Antidiuretic Hormone Analog Protriptyline ...... 99 Vasopressin ...... 118 Antidepressant, Tricyclic (Tertiary Amine) Antidote Amitriptyline ...... 8 Acetylcysteine ...... 4 Amitriptyline and Chlordiazepoxide ...... 8 Alcohol (Ethyl) ...... 5 Amitriptyline and Perphenazine ...... 8 Aluminum Hydroxide ...... 7 ClomiPRAMINE ...... 29 Amifostine ...... 7 Doxepin (Systemic) ...... 39 Atropine and Pralidoxime ...... 12 Imipramine ...... 62 Atropine (Systemic) ...... 12 Calcitonin ...... 20 Trimipramine ...... 116 Calcium Acetate ...... 21 Antidiabetic Agent Calcium Carbonate ...... 21 Pramlintide ...... 97 Carglumic Acid ...... 23 Charcoal, Activated ...... 25 Antidiabetic Agent, Alpha-Glucosidase Inhibitor Deferoxamine ...... 33 Acarbose ...... 2 Dexrazoxane ...... 34 Miglitol ...... 81 Digoxin Immune Fab ...... 37 Antidiabetic Agent, Biguanide Dimercaprol ...... 37 Edrophonium ...... 40 Empagliflozin and Metformin ...... 42 Edrophonium and Atropine ...... 41 Empagliflozin, Linagliptin, and Metformin ...... 42 Ferric Hexacyanoferrate ...... 49 Glipizide and Metformin ...... 55 Flumazenil ...... 50 Glyburide and Metformin ...... 56 Fomepizole ...... 53 Linagliptin and Metformin ...... 72 Glucagon ...... 55 MetFORMIN ...... 77 Glucarpidase ...... 56 Pioglitazone and Metformin ...... 94 Hydroxocobalamin ...... 61 Repaglinide and Metformin ...... 101 IdaruCIZUmab ...... 62 Sitagliptin and Metformin ...... 106 Leucovorin Calcium ...... 70 Antidiabetic Agent, Dipeptidyl Peptidase 4 (DPP-4) Inhibitor LEVOleucovorin ...... 70 Empagliflozin and Linagliptin ...... 41 Mesna ...... 77 Empagliflozin, Linagliptin, and Metformin ...... 42 Methylene Blue ...... 79 Naloxone ...... 83 LinaGLIPtin ...... 72 Naltrexone ...... 83 Linagliptin and Metformin ...... 72 Octreotide ...... 87 SITagliptin ...... 106 Patiromer ...... 90 Sitagliptin and Metformin ...... 106 Phenoxybenzamine ...... 93 Antidiabetic Agent, Dopamine Agonist Physostigmine ...... 93 Bromocriptine ...... 18 Potassium Iodide ...... 96 Pralidoxime ...... 97 Antidiabetic Agent, Glucagon-Like Peptide-1 (GLP-1) Receptor Protamine ...... 99 Agonist Sodium Nitrite ...... 107 Exenatide ...... 47 Sodium Nitrite and Sodium Thiosulfate ...... 107 129 ANTIDOTE

Sodium Phenylacetate and Sodium Benzoate ...... 107 Ketoconazole (Systemic) ...... 67 Sodium Polystyrene Sulfonate ...... 107 Posaconazole ...... 95 Sodium Thiosulfate ...... 107 Terbinafine (Systemic) ...... 112 Sodium Zirconium Cyclosilicate ...... 107 Voriconazole ...... 120 Succimer ...... 108 Sugammadex ...... 108 Antifungal Agent, Oral Nonabsorbed Uridine Triacetate ...... 118 Clotrimazole (Oral) ...... 29 Miconazole (Oral) ...... 80 Antidote, Extravasation Dexrazoxane ...... 34 Antifungal Agent, Oral Nonabsorbed/Partially Absorbed Dimethyl Sulfoxide ...... 37 Clotrimazole (Topical) ...... 29 Hyaluronidase ...... 59 Miconazole (Topical) ...... 80 Nitroglycerin ...... 86 Nystatin (Oral) ...... 86 Phentolamine ...... 93 Antifungal Agent, Parenteral Sodium Thiosulfate ...... 107 Amphotericin B Deoxycholate ...... 9 Terbutaline ...... 112 Amphotericin B (Lipid Complex) ...... 9 Antidote, Hypoglycemia Amphotericin B (Liposomal) ...... 9 Dextrose ...... 35 Anidulafungin ...... 9 Diazoxide ...... 36 Caspofungin ...... 23 Glucagon ...... 55 Fluconazole ...... 50 Isavuconazonium Sulfate ...... 66 Antiemetic Micafungin ...... 80 Aprepitant ...... 10 Voriconazole ...... 120 DexAMETHasone (Systemic) ...... 34 Dronabinol ...... 40 Antifungal Agent, Topical Droperidol ...... 40 Betamethasone and Clotrimazole ...... 16 Fosaprepitant ...... 53 Butenafine ...... 20 Fosnetupitant and Palonosetron ...... 54 Ciclopirox ...... 27 Fructose, Dextrose, and Phosphoric Acid ...... 54 Clioquinol and Hydrocortisone ...... 28 Granisetron ...... 56 Clotrimazole (Topical) ...... 29 HydrOXYzine ...... 61 Econazole ...... 40 Meclizine ...... 75 Gentian Violet ...... 55 Metoclopramide ...... 79 Iodoquinol and Hydrocortisone ...... 66 Nabilone ...... 83 Ketoconazole (Topical) ...... 67 Netupitant and Palonosetron ...... 85 Luliconazole ...... 74 Ondansetron ...... 88 Miconazole (Topical) ...... 80 Palonosetron ...... 90 Naftifine ...... 83 Perphenazine ...... 92 Nystatin and Triamcinolone ...... 86 Prochlorperazine ...... 98 Nystatin (Topical) ...... 86 Promethazine ...... 98 Terbinafine (Topical) ...... 112 Trimethobenzamide ...... 116 Tolnaftate ...... 114 Anti-FGF23 Monoclonal Antibody Undecylenic Acid and Derivatives ...... 117 Burosumab ...... 19 Antifungal Agent, Triterpenoid Antifibrinolytic Agent Ibrexafungerp ...... 62 Aminocaproic Acid ...... 7 Tranexamic Acid ...... 115 Antifungal Agent, Vaginal Butoconazole ...... 20 Antifibrotic Agent Clotrimazole (Topical) ...... 29 Pirfenidone ...... 94 Miconazole (Topical) ...... 80 Sulfanilamide ...... 109 Antiflatulent Terconazole ...... 112 Aluminum Hydroxide, Magnesium Hydroxide, and Simethicone ...... 7 Tioconazole ...... 113 Calcium Carbonate and Simethicone ...... 21 Loperamide and Simethicone ...... 73 Antigout Agent Simethicone ...... 105 Allopurinol ...... 6 Antifungal Agent Colchicine ...... 30 Pentamidine (Oral Inhalation) ...... 91 Colchicine and Probenecid ...... 30 Pentamidine (Systemic) ...... 92 Lesinurad and Allopurinol ...... 69 Antifungal Agent, Azole Derivative Antihemophilic Agent Isavuconazonium Sulfate ...... 66 Aminocaproic Acid ...... 7 Itraconazole ...... 67 Antihemophilic Factor (Human) ...... 9 Posaconazole ...... 95 Antihemophilic Factor (Recombinant) ...... 10 Terconazole ...... 112 Antihemophilic Factor/von Willebrand Factor Complex (Human) ...... 10 Voriconazole ...... 120 Anti-inhibitor Coagulant Complex (Human) ...... 10 Desmopressin ...... 33 Antifungal Agent, Imidazole Derivative Factor IX Complex (Human) [(Factors II, IX, X)] ...... 48 Butoconazole ...... 20 Factor IX (Human) ...... 48 Clotrimazole (Oral) ...... 29 Factor IX (Recombinant [Fc Fusion Protein]) ...... 48 Clotrimazole (Topical) ...... 29 Factor X (Human) ...... 48 Econazole ...... 40 Factor XIII A-Subunit (Recombinant) ...... 48 Ketoconazole (Systemic) ...... 67 Factor XIII Concentrate (Human) ...... 48 Ketoconazole (Topical) ...... 67 Factor VIIa (Recombinant) ...... 48 Miconazole (Oral) ...... 80 Tranexamic Acid ...... 115 Miconazole (Topical) ...... 80 von Willebrand Factor (Recombinant) ...... 120 Tioconazole ...... 113 Antihemorrhoidal Agent Antifungal Agent, Ophthalmic Dibucaine ...... 36 Natamycin ...... 84 Glycerin and Lidocaine ...... 56 Antifungal Agent, Oral Hydrocortisone (Topical) ...... 60 Fluconazole ...... 50 Lidocaine and Hydrocortisone ...... 71 Flucytosine ...... 50 Phenylephrine and Pramoxine ...... 93 Griseofulvin ...... 56 Phenylephrine (Topical) ...... 93 Ibrexafungerp ...... 62 Pramoxine ...... 97 Isavuconazonium Sulfate ...... 66 Witch Hazel ...... 120 Itraconazole ...... 67 Zinc Oxide ...... 121 130 ANTILIPEMIC AGENT, MISCELLANEOUS

Antihepaciviral, NS3/4A Protease Inhibitor (Anti-HCV) Labetalol ...... 68 Glecaprevir and Pibrentasvir ...... 55 Lisinopril ...... 72 Ombitasvir, Paritaprevir, and Ritonavir ...... 87 Lisinopril and Hydrochlorothiazide ...... 73 Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir ...... 87 Losartan ...... 73 Losartan and Hydrochlorothiazide ...... 73 Antihepaciviral, NS5A Inhibitor Methyclothiazide ...... 79 Glecaprevir and Pibrentasvir ...... 55 Methyldopa ...... 79 Ledipasvir and Sofosbuvir ...... 69 Methyldopa and Hydrochlorothiazide ...... 79 Ombitasvir, Paritaprevir, and Ritonavir ...... 87 Metoprolol ...... 80 Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir ...... 87 Metoprolol and Hydrochlorothiazide ...... 80 Sofosbuvir and Velpatasvir ...... 107 Minoxidil (Systemic) ...... 81 Sofosbuvir, Velpatasvir, and Voxilaprevir ...... 107 Moexipril ...... 82 Antihepaciviral, Nucleoside (Anti-HCV) Moexipril and Hydrochlorothiazide ...... 82 Ribavirin (Systemic) ...... 101 Nadolol ...... 83 Nadolol and Bendroflumethiazide ...... 83 Antihepaciviral, Polymerase Inhibitor (Anti-HCV) NiCARdipine ...... 85 Ledipasvir and Sofosbuvir ...... 69 NIFEdipine ...... 85 Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir ...... 87 Nitroprusside ...... 86 Sofosbuvir and Velpatasvir ...... 107 Olmesartan ...... 87 Sofosbuvir, Velpatasvir, and Voxilaprevir ...... 107 Perindopril ...... 92 Antihepadnaviral, Reverse Transcriptase Inhibitor, Nucleoside Perindopril and Amlodipine ...... 92 (Anti-HBV) Phentolamine ...... 93 Entecavir ...... 42 Pindolol ...... 94 LamiVUDine ...... 69 Prazosin ...... 97 Propranolol ...... 99 Antihepadnaviral, Reverse Transcriptase Inhibitor, Nucleotide Propranolol and Hydrochlorothiazide ...... 99 (Anti-HBV) Quinapril ...... 100 Adefovir ...... 5 Quinapril and Hydrochlorothiazide ...... 100 Tenofovir Disoproxil Fumarate ...... 111 Ramipril ...... 101 Antihyperlipidemic Agent, Apolipoprotein B Antisense Spironolactone ...... 108 Oligonucleotide Telmisartan ...... 111 Telmisartan and Amlodipine ...... 111 Mipomersen ...... 81 Telmisartan and Hydrochlorothiazide ...... 111 Antihypertensive Terazosin ...... 112 Acebutolol ...... 2 Timolol (Systemic) ...... 113 AMILoride ...... 7 Torsemide ...... 115 Amiloride and Hydrochlorothiazide ...... 7 Trandolapril ...... 115 AmLODIPine ...... 8 Trandolapril and Verapamil ...... 115 Amlodipine and Atorvastatin ...... 8 Triamterene ...... 116 Amlodipine and Benazepril ...... 8 Valsartan ...... 118 Amlodipine and Celecoxib ...... 8 Valsartan and Hydrochlorothiazide ...... 118 Amlodipine and Olmesartan ...... 8 Verapamil ...... 119 Amlodipine and Valsartan ...... 8 Amlodipine, Valsartan, and Hydrochlorothiazide ...... 8 Anti-inflammatory Agent Atenolol ...... 12 Balsalazide ...... 14 Atenolol and Chlorthalidone ...... 12 Colchicine and Probenecid ...... 30 Azilsartan ...... 13 DexAMETHasone (Systemic) ...... 34 Azilsartan and Chlorthalidone ...... 13 Pirfenidone ...... 94 Benazepril ...... 15 Anti-inflammatory Agent, Ophthalmic Benazepril and Hydrochlorothiazide ...... 15 DexAMETHasone (Ophthalmic) ...... 34 Betaxolol (Systemic) ...... 16 Bisoprolol ...... 17 Anti-inflammatory, Locally Applied Bisoprolol and Hydrochlorothiazide ...... 17 Carbamide Peroxide ...... 22 Bumetanide ...... 19 Maltodextrin ...... 75 Candesartan ...... 22 Candesartan and Hydrochlorothiazide ...... 22 Anti-interleukin 17A Monoclonal Antibody Captopril ...... 22 Secukinumab ...... 104 Captopril and Hydrochlorothiazide ...... 22 Antilipemic Agent, 2-Azetidinone Carvedilol ...... 23 Chlorothiazide ...... 25 Ezetimibe ...... 48 Chlorthalidone ...... 26 Antilipemic Agent, Angiopoietin-Like Protein 3 (ANGPTL3) Clevidipine ...... 28 Inhibitor CloNIDine ...... 29 Evinacumab ...... 47 Clonidine and Chlorthalidone ...... 29 DilTIAZem ...... 37 Antilipemic Agent, Bile Acid Sequestrant Doxazosin ...... 39 Cholestyramine Resin ...... 26 Enalapril ...... 42 Colestipol ...... 30 Enalapril and Hydrochlorothiazide ...... 42 Enalaprilat ...... 42 Antilipemic Agent, Fibric Acid Eplerenone ...... 43 Fenofibrate and Derivatives ...... 49 Eprosartan ...... 43 Gemfibrozil ...... 55 Esmolol ...... 44 Antilipemic Agent, HMG-CoA Reductase Inhibitor Felodipine ...... 48 Amlodipine and Atorvastatin ...... 8 Fenoldopam ...... 49 AtorvaSTATin ...... 12 Fosinopril ...... 53 Fluvastatin ...... 53 Fosinopril and Hydrochlorothiazide ...... 53 Lovastatin ...... 74 Furosemide ...... 54 Pravastatin ...... 97 GuanFACINE ...... 58 Rosuvastatin ...... 103 HydrALAZINE ...... 59 HydroCHLOROthiazide ...... 59 Simvastatin ...... 105 Hydrochlorothiazide and Spironolactone ...... 59 Antilipemic Agent, Microsomal Triglyceride Transfer Protein (MTP) Hydrochlorothiazide and Triamterene ...... 59 Inhibitor Indapamide ...... 63 Lomitapide ...... 73 Irbesartan ...... 66 Irbesartan and Hydrochlorothiazide ...... 66 Antilipemic Agent, Miscellaneous Isosorbide Dinitrate and Hydralazine ...... 67 Niacin ...... 85 131 ANTILIPEMIC AGENT, OMEGA-3 FATTY ACIDS

Antilipemic Agent, Omega-3 Fatty Acids Antineoplastic Agent, Alkylating Agent (Nitrosourea) Icosapent Ethyl ...... 62 Carmustine ...... 23 Omega-3 Fatty Acids ...... 87 Lomustine ...... 73 Streptozocin ...... 108 Antilipemic Agent, PCSK9 Inhibitor Alirocumab ...... 6 Antineoplastic Agent, Alkylating Agent (Triazene) Evolocumab ...... 47 Dacarbazine ...... 32 Temozolomide ...... 111 Antimalarial Agent Artemether and Lumefantrine ...... 11 Antineoplastic Agent, Anaplastic Lymphoma Kinase Inhibitor Artesunate ...... 11 Alectinib ...... 6 Atovaquone and Proguanil ...... 12 Brigatinib ...... 18 Chloroquine ...... 25 Ceritinib ...... 25 Hydroxychloroquine ...... 61 Crizotinib ...... 31 Mefloquine ...... 76 Lorlatinib ...... 73 Primaquine ...... 98 Pyrimethamine ...... 100 Antineoplastic Agent, Anthracenedione QuiNIDine ...... 100 MitoXANTRONE ...... 81 QuiNINE ...... 100 Antineoplastic Agent, Anthracycline Tafenoquine ...... 110 DAUNOrubicin (Conventional) ...... 33 Antimanic Agent DOXOrubicin (Conventional) ...... 39 ChlorproMAZINE ...... 26 DOXOrubicin (Liposomal) ...... 40 Lithium ...... 73 EpiRUBicin ...... 43 OLANZapine ...... 87 IDArubicin ...... 62 Olanzapine and Samidorphan ...... 87 Valrubicin ...... 118 RisperiDONE ...... 102 Antineoplastic Agent, Anti-CC Chemokine Receptor 4 Antibody Valproic Acid and Derivatives ...... 118 Mogamulizumab ...... 82 Antimicrobial Mouth Rinse Antineoplastic Agent, Antiandrogen Mouthwash ...... 82 Abiraterone Acetate ...... 2 Antimigraine Agent Apalutamide ...... 10 Acetaminophen, Caffeine, and Isometheptene Mucate ...... 3 Bicalutamide ...... 17 Dihydroergotamine ...... 37 Enzalutamide ...... 42 Eletriptan ...... 41 Flutamide ...... 52 Erenumab ...... 43 Nilutamide ...... 85 Ergotamine ...... 43 Antineoplastic Agent, Antibiotic Ergotamine and Caffeine ...... 43 Bleomycin ...... 17 Fremanezumab ...... 54 DACTINomycin ...... 32 Galcanezumab ...... 54 MitoMYcin (Ophthalmic) ...... 81 Naratriptan ...... 84 MitoMYcin (Systemic) ...... 81 Rimegepant ...... 102 Rizatriptan ...... 103 Antineoplastic Agent, Antibody Drug Conjugate SUMAtriptan ...... 109 Ado-Trastuzumab Emtansine ...... 5 ZOLMitriptan ...... 121 Brentuximab Vedotin ...... 18 Enfortumab Vedotin ...... 42 Antimycobacterial, Nitroimidazole Fam-Trastuzumab Deruxtecan ...... 48 Pretomanid ...... 98 Gemtuzumab Ozogamicin ...... 55 Antineoplastic Agent Inotuzumab Ozogamicin ...... 64 Acalabrutinib ...... 2 Polatuzumab Vedotin ...... 94 Ibrutinib ...... 62 Antineoplastic Agent, Anti-CD19 Lenalidomide ...... 69 Axicabtagene Ciloleucel ...... 13 Pomalidomide ...... 95 Lisocabtagene Maraleucel ...... 73 Thalidomide ...... 113 Tisagenlecleucel ...... 114 Venetoclax ...... 119 Antineoplastic Agent, Anti-CD19/CD3 Antineoplastic Agent, Alkylating Agent Blinatumomab ...... 17 Altretamine ...... 6 Bendamustine ...... 15 Antineoplastic Agent, Anti-CD20 Busulfan ...... 19 Ibritumomab Tiuxetan ...... 62 CARBOplatin ...... 23 Obinutuzumab ...... 86 Carmustine ...... 23 Ofatumumab ...... 87 Chlorambucil ...... 25 RiTUXimab ...... 102 CISplatin ...... 27 Rituximab and Hyaluronidase ...... 102 Cyclophosphamide ...... 31 Antineoplastic Agent, Anti-CD22 Estramustine ...... 44 Inotuzumab Ozogamicin ...... 64 Ifosfamide ...... 62 Moxetumomab Pasudotox ...... 82 Lomustine ...... 73 Mechlorethamine (Systemic) ...... 75 Antineoplastic Agent, Anti-CD30 Mechlorethamine (Topical) ...... 75 Brentuximab Vedotin ...... 18 Melphalan ...... 76 Melphalan Flufenamide ...... 76 Antineoplastic Agent, Anti-CD33 Oxaliplatin ...... 88 Gemtuzumab Ozogamicin ...... 55 Procarbazine ...... 98 Antineoplastic Agent, Anti-CD38 Streptozocin ...... 108 Daratumumab ...... 32 Thiotepa ...... 113 Antineoplastic Agent, Anti-CD52 Antineoplastic Agent, Alkylating Agent (Nitrogen Mustard) Alemtuzumab ...... 6 Bendamustine ...... 15 Chlorambucil ...... 25 Antineoplastic Agent, Anti-CD79B Cyclophosphamide ...... 31 Polatuzumab Vedotin ...... 94 Ifosfamide ...... 62 Antineoplastic Agent, Anti-CD123 Mechlorethamine (Systemic) ...... 75 Tagraxofusp ...... 110 Mechlorethamine (Topical) ...... 75 Melphalan ...... 76 Antineoplastic Agent, Anti-CTLA4 Monoclonal Antibody Melphalan Flufenamide ...... 76 Ipilimumab ...... 66 132 ANTINEOPLASTIC AGENT, EZH2-INHIBITOR

Antineoplastic Agent, Anti-GD2 Antineoplastic Agent, Anti-SLAMF7 Dinutuximab ...... 37 Elotuzumab ...... 41 Naxitamab ...... 84 Antineoplastic Agent, Aromatase Inhibitor Antineoplastic Agent, Anti-HER2 Anastrozole ...... 9 Ado-Trastuzumab Emtansine ...... 5 Exemestane ...... 47 Fam-Trastuzumab Deruxtecan ...... 48 Letrozole ...... 70 Lapatinib ...... 69 Ribociclib and Letrozole ...... 101 Neratinib ...... 85 Pertuzumab ...... 92 Antineoplastic Agent, BCL-2 Inhibitor Trastuzumab ...... 115 Venetoclax ...... 119 Trastuzumab and Hyaluronidase ...... 115 Antineoplastic Agent, BCR-ABL Tyrosine Kinase Inhibitor Tucatinib ...... 117 Bosutinib ...... 17 Antineoplastic Agent, Antimetabolite Dasatinib ...... 33 AzaCITIDine ...... 13 Imatinib ...... 62 Capecitabine ...... 22 Nilotinib ...... 85 Cladribine ...... 27 PONATinib ...... 95 Clofarabine ...... 28 Antineoplastic Agent, Biological Response Modulator Cytarabine (Conventional) ...... 32 Cytarabine (Liposomal) ...... 32 Aldesleukin ...... 6 Decitabine ...... 33 BCG (Intravesical) ...... 14 Decitabine and Cedazuridine ...... 33 Interferon Alfa-2b ...... 65 Floxuridine ...... 50 Peginterferon Alfa-2b ...... 91 Fludarabine ...... 50 Tagraxofusp ...... 110 Fluorouracil (Systemic) ...... 51 Antineoplastic Agent, BRAF Kinase Inhibitor Fluorouracil (Topical) ...... 52 Dabrafenib ...... 32 Gemcitabine ...... 55 Encorafenib ...... 42 Mercaptopurine ...... 77 Vemurafenib ...... 119 Nelarabine ...... 84 PEMEtrexed ...... 91 Antineoplastic Agent, Bruton Tyrosine Kinase Inhibitor Pentostatin ...... 92 Acalabrutinib ...... 2 PRALAtrexate ...... 97 Ibrutinib ...... 62 Thioguanine ...... 113 Trifluridine and Tipiracil ...... 116 Antineoplastic Agent, Camptothecin Irinotecan (Conventional) ...... 66 Antineoplastic Agent, Antimetabolite (Antifolate) Irinotecan (Liposomal) ...... 66 Methotrexate ...... 78 Topotecan ...... 114 PEMEtrexed ...... 91 PRALAtrexate ...... 97 Antineoplastic Agent, CAR-T Immunotherapy Axicabtagene Ciloleucel ...... 13 Antineoplastic Agent, Antimetabolite (Purine Analog) Lisocabtagene Maraleucel ...... 73 Cladribine ...... 27 Tisagenlecleucel ...... 114 Clofarabine ...... 28 Fludarabine ...... 50 Antineoplastic Agent, Cephalotaxine Mercaptopurine ...... 77 Omacetaxine ...... 87 Nelarabine ...... 84 Antineoplastic Agent, Cyclin-Dependent Kinase Inhibitor Pentostatin ...... 92 Abemaciclib ...... 2 Thioguanine ...... 113 Palbociclib ...... 89 Antineoplastic Agent, Antimetabolite (Pyrimidine Analog) Ribociclib ...... 101 Capecitabine ...... 22 Ribociclib and Letrozole ...... 101 Cytarabine (Conventional) ...... 32 Trilaciclib ...... 116 Cytarabine (Liposomal) ...... 32 Floxuridine ...... 50 Antineoplastic Agent, DNA Methylation Inhibitor Fluorouracil (Systemic) ...... 51 AzaCITIDine ...... 13 Fluorouracil (Topical) ...... 52 Decitabine ...... 33 Gemcitabine ...... 55 Decitabine and Cedazuridine ...... 33 Trifluridine and Tipiracil ...... 116 Antineoplastic Agent, Enzyme Antineoplastic Agent, Antimicrotubular Asparaginase (Erwinia) ...... 12 Ado-Trastuzumab Emtansine ...... 5 Calaspargase Pegol ...... 20 Brentuximab Vedotin ...... 18 Pegaspargase ...... 91 Cabazitaxel ...... 20 Antineoplastic Agent, Epidermal Growth Factor Receptor (EGFR) DOCEtaxel ...... 39 Inhibitor Enfortumab Vedotin ...... 42 Afatinib ...... 5 Eribulin ...... 43 Estramustine ...... 44 Amivantamab ...... 8 Ixabepilone ...... 67 Cetuximab ...... 25 PACLitaxel (Conventional) ...... 89 Dacomitinib ...... 32 PACLitaxel (Protein Bound) ...... 89 Erlotinib ...... 43 VinBLAStine ...... 119 Gefitinib ...... 55 VinCRIStine ...... 119 Lapatinib ...... 69 VinCRIStine (Liposomal) ...... 119 Necitumumab ...... 84 Vinorelbine ...... 119 Neratinib ...... 85 Osimertinib ...... 88 Antineoplastic Agent, Anti-Nectin-4 Panitumumab ...... 90 Enfortumab Vedotin ...... 42 Vandetanib ...... 118 Antineoplastic Agent, Anti-PD-1 Monoclonal Antibody Antineoplastic Agent, Epothilone B Analog Cemiplimab ...... 24 Ixabepilone ...... 67 Dostarlimab ...... 39 Nivolumab ...... 86 Antineoplastic Agent, Estrogen Receptor Antagonist Pembrolizumab ...... 91 Fulvestrant ...... 54 Tamoxifen ...... 110 Antineoplastic Agent, Anti-PD-L1 Monoclonal Antibody Toremifene ...... 115 Atezolizumab ...... 12 Avelumab ...... 13 Antineoplastic Agent, EZH2-Inhibitor Durvalumab ...... 40 Tazemetostat ...... 110 133 ANTINEOPLASTIC AGENT, FIBROBLAST GROWTH FACTOR RECEPTOR (FGFR) INHIBITOR

Antineoplastic Agent, Fibroblast Growth Factor Receptor (FGFR) Bevacizumab ...... 16 Inhibitor Blinatumomab ...... 17 Infigratinib ...... 63 Brentuximab Vedotin ...... 18 Pemigatinib ...... 91 Burosumab ...... 19 Cemiplimab ...... 24 Antineoplastic Agent, FLT3 Inhibitor Cetuximab ...... 25 Fedratinib ...... 48 Daratumumab ...... 32 Gilteritinib ...... 55 Dinutuximab ...... 37 Midostaurin ...... 81 Dostarlimab ...... 39 Antineoplastic Agent, Gonadotropin-Releasing Hormone Agonist Durvalumab ...... 40 Goserelin ...... 56 Elotuzumab ...... 41 Histrelin ...... 59 Enfortumab Vedotin ...... 42 Leuprolide ...... 70 Fam-Trastuzumab Deruxtecan ...... 48 Gemtuzumab Ozogamicin ...... 55 Antineoplastic Agent, Gonadotropin-Releasing Hormone Ibritumomab Tiuxetan ...... 62 Antagonist Inotuzumab Ozogamicin ...... 64 Degarelix ...... 33 Ipilimumab ...... 66 Mogamulizumab ...... 82 Antineoplastic Agent, Hedgehog Pathway Inhibitor Naxitamab ...... 84 Glasdegib ...... 55 Necitumumab ...... 84 Sonidegib ...... 108 Nivolumab ...... 86 Vismodegib ...... 119 Obinutuzumab ...... 86 Antineoplastic Agent, Histone Deacetylase (HDAC) Inhibitor Ofatumumab ...... 87 Belinostat ...... 14 Olaratumab ...... 87 Panobinostat ...... 90 Panitumumab ...... 90 RomiDEPsin ...... 103 Pembrolizumab ...... 91 Vorinostat ...... 120 Pertuzumab ...... 92 Polatuzumab Vedotin ...... 94 Antineoplastic Agent, Histone Methyltransferase (HMT) Inhibitor Ramucirumab ...... 101 Tazemetostat ...... 110 RiTUXimab ...... 102 Antineoplastic Agent, Hormone Rituximab and Hyaluronidase ...... 102 Megestrol ...... 76 Siltuximab ...... 105 Trastuzumab ...... 115 Antineoplastic Agent, Hormone (Estrogen/Nitrogen Mustard) Trastuzumab and Hyaluronidase ...... 115 Estramustine ...... 44 Antineoplastic Agent, mTOR Kinase Inhibitor Antineoplastic Agent, IDH1 Inhibitor Everolimus ...... 47 Ivosidenib ...... 67 Temsirolimus ...... 111 Antineoplastic Agent, IDH2 Inhibitor Antineoplastic Agent, Oncolytic Virus Enasidenib ...... 42 Talimogene Laherparepvec ...... 110 Antineoplastic Agent, Immune Checkpoint Inhibitor Antineoplastic Agent, PARP Inhibitor Atezolizumab ...... 12 Niraparib ...... 85 Avelumab ...... 13 Olaparib ...... 87 Cemiplimab ...... 24 Talazoparib ...... 110 Dostarlimab ...... 39 Durvalumab ...... 40 Antineoplastic Agent, PDGFR-alpha Blocker Ipilimumab ...... 66 Avapritinib ...... 13 Nivolumab ...... 86 Olaratumab ...... 87 Pembrolizumab ...... 91 Ripretinib ...... 102 Antineoplastic Agent, Janus Associated Kinase Inhibitor Antineoplastic Agent, Phosphatidylinositol 3-Kinase Inhibitor Fedratinib ...... 48 Copanlisib ...... 30 Ruxolitinib ...... 103 Duvelisib ...... 40 Idelalisib ...... 62 Antineoplastic Agent, KIT Inhibitor Umbralisib ...... 117 Avapritinib ...... 13 Ripretinib ...... 102 Antineoplastic Agent, Platinum Analog CARBOplatin ...... 23 Antineoplastic Agent, KRAS Inhibitor CISplatin ...... 27 Sotorasib ...... 108 Oxaliplatin ...... 88 Antineoplastic Agent, MEK Inhibitor Antineoplastic Agent, Podophyllotoxin Derivative Binimetinib ...... 17 Etoposide ...... 47 Cobimetinib ...... 29 Etoposide Phosphate ...... 47 Selumetinib ...... 105 Teniposide ...... 111 Trametinib ...... 115 Antineoplastic Agent, Proteasome Inhibitor Antineoplastic Agent, MET Inhibitor Bortezomib ...... 17 Amivantamab ...... 8 Carfilzomib ...... 23 Antineoplastic Agent, Miscellaneous Ixazomib ...... 67 Aldesleukin ...... 6 Antineoplastic Agent, Protein Synthesis Inhibitor Arsenic Trioxide ...... 11 Asparaginase (Erwinia) ...... 12 Omacetaxine ...... 87 Calaspargase Pegol ...... 20 Antineoplastic Agent, Retinoic Acid Derivative Hydroxyurea ...... 61 Alitretinoin (Topical) ...... 6 Mitotane ...... 81 Bexarotene (Systemic) ...... 17 Pegaspargase ...... 91 Bexarotene (Topical) ...... 17 Porfimer ...... 95 ISOtretinoin (Systemic) ...... 67 Tagraxofusp ...... 110 Tretinoin (Systemic) ...... 115 Trabectedin ...... 115 Antineoplastic Agent, RET Kinase Inhibitor Antineoplastic Agent, Monoclonal Antibody Pralsetinib ...... 97 Ado-Trastuzumab Emtansine ...... 5 Selpercatinib ...... 105 Alemtuzumab ...... 6 Amivantamab ...... 8 Antineoplastic Agent, Taxane Derivative Atezolizumab ...... 12 Cabazitaxel ...... 20 Avelumab ...... 13 DOCEtaxel ...... 39 134 ANTIPSORIATIC AGENT

PACLitaxel (Conventional) ...... 89 Antiparasitic Agent PACLitaxel (Protein Bound) ...... 89 Miltefosine ...... 81 Antineoplastic Agent, Topoisomerase I Inhibitor Antiparasitic Agent, Topical Fam-Trastuzumab Deruxtecan ...... 48 Benzyl Alcohol ...... 16 Irinotecan (Conventional) ...... 66 Ivermectin (Topical) ...... 67 Irinotecan (Liposomal) ...... 66 Lindane ...... 72 Topotecan ...... 114 Malathion ...... 75 Antineoplastic Agent, Topoisomerase II Inhibitor Permethrin ...... 92 Pyrethrins and Piperonyl Butoxide ...... 100 DAUNOrubicin (Conventional) ...... 33 Spinosad ...... 108 DOXOrubicin (Conventional) ...... 39 DOXOrubicin (Liposomal) ...... 40 Anti-Parkinson Agent, Anticholinergic EpiRUBicin ...... 43 Benztropine ...... 16 Etoposide ...... 47 Trihexyphenidyl ...... 116 Etoposide Phosphate ...... 47 IDArubicin ...... 62 Anti-Parkinson Agent, COMT Inhibitor MitoXANTRONE ...... 81 Entacapone ...... 42 Teniposide ...... 111 Levodopa, Carbidopa, and Entacapone ...... 70 Valrubicin ...... 118 Opicapone ...... 88 Tolcapone ...... 114 Antineoplastic Agent, Tropomyosin Receptor Kinase (TRK) Inhibitor Anti-Parkinson Agent, Decarboxylase Inhibitor Larotrectinib ...... 69 Carbidopa ...... 22 Carbidopa and Levodopa ...... 22 Antineoplastic Agent, Tyrosine Kinase Inhibitor Levodopa, Carbidopa, and Entacapone ...... 70 Acalabrutinib ...... 2 Afatinib ...... 5 Anti-Parkinson Agent, Dopamine Agonist Alectinib ...... 6 Amantadine ...... 7 Avapritinib ...... 13 Apomorphine ...... 10 Axitinib ...... 13 Bromocriptine ...... 18 Bosutinib ...... 17 Pramipexole ...... 97 Brigatinib ...... 18 ROPINIRole ...... 103 Cabozantinib ...... 20 Anti-Parkinson Agent, Dopamine Precursor Ceritinib ...... 25 Carbidopa and Levodopa ...... 22 Crizotinib ...... 31 Levodopa, Carbidopa, and Entacapone ...... 70 Dacomitinib ...... 32 Levodopa (Oral Inhalation) ...... 70 Dasatinib ...... 33 Erlotinib ...... 43 Anti-Parkinson Agent, MAO Type B Inhibitor Fedratinib ...... 48 Rasagiline ...... 101 Gefitinib ...... 55 Selegiline ...... 104 Gilteritinib ...... 55 Anti-Parkinson's Agent, Dopamine Agonist Ibrutinib ...... 62 Rotigotine ...... 103 Imatinib ...... 62 Infigratinib ...... 63 Antiplaque Agent Lapatinib ...... 69 Mouthwash ...... 82 Larotrectinib ...... 69 Lenvatinib ...... 69 Antiplatelet Agent Lorlatinib ...... 73 Anagrelide ...... 9 Midostaurin ...... 81 Aspirin ...... 12 Neratinib ...... 85 Aspirin and Dipyridamole ...... 12 Nilotinib ...... 85 Cangrelor ...... 22 Osimertinib ...... 88 Cilostazol ...... 27 PAZOPanib ...... 91 Clopidogrel ...... 29 Pemigatinib ...... 91 Defibrotide ...... 33 PONATinib ...... 95 Dipyridamole ...... 38 Pralsetinib ...... 97 Prasugrel ...... 97 Regorafenib ...... 101 Ticagrelor ...... 113 Ripretinib ...... 102 Antiplatelet Agent, Glycoprotein IIb/IIIa Inhibitor Ruxolitinib ...... 103 Abciximab ...... 2 Selpercatinib ...... 105 Eptifibatide ...... 43 SORAfenib ...... 108 Tirofiban ...... 114 SUNItinib ...... 109 Tucatinib ...... 117 Antiplatelet Agent, Non-thienopyridine Vandetanib ...... 118 Cangrelor ...... 22 Ticagrelor ...... 113 Antineoplastic Agent, Vascular Endothelial Growth Factor Receptor 2 (VEGFR2) Inhibitor Antiplatelet Agent, Thienopyridine Ramucirumab ...... 101 Clopidogrel ...... 29 Prasugrel ...... 97 Antineoplastic Agent, Vascular Endothelial Growth Factor (VEGF) Inhibitor Antiprogestin Axitinib ...... 13 MiFEPRIStone ...... 81 Bevacizumab ...... 16 Antiprotozoal Cabozantinib ...... 20 Atovaquone ...... 12 Lenvatinib ...... 69 Eflornithine ...... 41 PAZOPanib ...... 91 Nifurtimox ...... 85 Ramucirumab ...... 101 Nitazoxanide ...... 85 Regorafenib ...... 101 Pentamidine (Oral Inhalation) ...... 91 SORAfenib ...... 108 Pentamidine (Systemic) ...... 92 SUNItinib ...... 109 Vandetanib ...... 118 Antiprotozoal, Nitroimidazole Ziv-Aflibercept (Systemic) ...... 121 MetroNIDAZOLE (Systemic) ...... 80 Secnidazole ...... 104 Antineoplastic Agent, Vinca Alkaloid Tinidazole ...... 113 VinBLAStine ...... 119 VinCRIStine ...... 119 Antipsoriatic Agent VinCRIStine (Liposomal) ...... 119 Anthralin ...... 9 Vinorelbine ...... 119 Golimumab ...... 56 135 ANTIPSORIATIC AGENT

Secukinumab ...... 104 Antirheumatic, Disease Modifying Ustekinumab ...... 118 Adalimumab ...... 4 Antiretroviral Agent, gp120 Attachment Inhibitor Baricitinib ...... 14 Golimumab ...... 56 Fostemsavir ...... 54 InFLIXimab ...... 63 Antiretroviral, CCR5 Antagonist (Anti-HIV) Leflunomide ...... 69 Maraviroc ...... 75 Methotrexate ...... 78 Antiretroviral, Fusion Protein Inhibitor (Anti-HIV) Antirheumatic Miscellaneous Enfuvirtide ...... 42 Baricitinib ...... 14 Cyclophosphamide ...... 31 Antiretroviral, Integrase Inhibitor (Anti-HIV) Hyaluronate and Derivatives ...... 59 Abacavir, Dolutegravir, and Lamivudine ...... 2 RiTUXimab ...... 102 Cabotegravir and Rilpivirine ...... 20 Dolutegravir ...... 39 Antiseborrheic Agent, Topical Elvitegravir ...... 41 Selenium Sulfide ...... 105 Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Alafenamide ...... 41 Sulfur and Salicylic Acid ...... 109 Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Disoproxil Sulfur and Sulfacetamide ...... 109 Fumarate ...... 41 Raltegravir ...... 101 Antisense Oligonucleotide Casimersen ...... 23 Antiretroviral, Protease Inhibitor (Anti-HIV) Eteplirsen ...... 45 Atazanavir ...... 12 Golodirsen ...... 56 Atazanavir and Cobicistat ...... 12 Inotersen ...... 64 Darunavir ...... 32 Nusinersen ...... 86 Darunavir and Cobicistat ...... 33 Darunavir, Cobicistat, Emtricitabine, and Tenofovir Alafenamide ...... 33 Antiseptic, Ophthalmic Fosamprenavir ...... 53 Povidone-Iodine (Ophthalmic) ...... 96 Indinavir ...... 63 Antiseptic, Topical Lopinavir and Ritonavir ...... 73 Alcohol (Isopropyl) ...... 5 Nelfinavir ...... 84 Benzoin ...... 15 Ritonavir ...... 102 Hexylresorcinol ...... 59 Saquinavir ...... 104 Iodine ...... 65 Tipranavir ...... 114 Potassium Iodide and Iodine ...... 96 Antiretroviral, Reverse Transcriptase Inhibitor, Non-nucleoside Povidone-Iodine (Topical) ...... 96 (Anti-HIV) Antiseptic, Vaginal Cabotegravir and Rilpivirine ...... 20 Povidone-Iodine (Topical) ...... 96 Delavirdine ...... 33 Doravirine ...... 39 Antispasmodic Agent, Gastrointestinal Doravirine, Lamivudine, and Tenofovir Disoproxil Fumarate ...... 39 Atropine (Systemic) ...... 12 Efavirenz ...... 41 Clidinium and Chlordiazepoxide ...... 28 Efavirenz, Emtricitabine, and Tenofovir Disoproxil Fumarate ...... 41 Hyoscyamine, Atropine, Scopolamine, and Phenobarbital ...... 61 Efavirenz, Lamivudine, and Tenofovir Disoproxil Fumarate ...... 41 Antispasmodic Agent, Urinary Emtricitabine, Rilpivirine, and Tenofovir Alafenamide ...... 42 Belladonna and Opium ...... 14 Emtricitabine, Rilpivirine, and Tenofovir Disoproxil Fumarate ...... 42 FlavoxATE ...... 50 Etravirine ...... 47 Oxybutynin ...... 89 Nevirapine ...... 85 Rilpivirine ...... 102 Antithyroid Agent MethIMAzole ...... 78 Antiretroviral, Reverse Transcriptase Inhibitor, Nucleoside (Anti- Potassium Iodide ...... 96 HIV) Potassium Iodide and Iodine ...... 96 Abacavir ...... 2 Propylthiouracil ...... 99 Abacavir and Lamivudine ...... 2 Abacavir, Dolutegravir, and Lamivudine ...... 2 Antitoxin Abacavir, Lamivudine, and Zidovudine ...... 2 Botulism Antitoxin, Heptavalent ...... 17 Darunavir, Cobicistat, Emtricitabine, and Tenofovir Alafenamide ...... 33 Didanosine ...... 36 Anti-Transthyretin Small Interfering Ribonucleic Acid (siRNA) Doravirine, Lamivudine, and Tenofovir Disoproxil Fumarate ...... 39 Agent Efavirenz, Emtricitabine, and Tenofovir Disoproxil Fumarate ...... 41 Patisiran ...... 90 Efavirenz, Lamivudine, and Tenofovir Disoproxil Fumarate ...... 41 Antitrypsin Deficiency Agent Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Alafenamide ...... 41 Alpha -Proteinase Inhibitor ...... 6 Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Disoproxil 1 Fumarate ...... 41 Antitubercular Agent Emtricitabine ...... 42 Aminosalicylic Acid ...... 8 Emtricitabine and Tenofovir Alafenamide ...... 42 Bedaquiline ...... 14 Emtricitabine and Tenofovir Disoproxil Fumarate ...... 42 Capreomycin ...... 22 Emtricitabine, Rilpivirine, and Tenofovir Alafenamide ...... 42 CycloSERINE ...... 31 Emtricitabine, Rilpivirine, and Tenofovir Disoproxil Fumarate ...... 42 Ethambutol ...... 45 LamiVUDine ...... 69 Ethionamide ...... 47 Lamivudine and Zidovudine ...... 69 Isoniazid ...... 67 Stavudine ...... 108 Pretomanid ...... 98 Zidovudine ...... 121 Pyrazinamide ...... 100 Rifabutin ...... 102 Antiretroviral, Reverse Transcriptase Inhibitor, Nucleotide (Anti- RifAMPin ...... 102 HIV) Rifapentine ...... 102 Darunavir, Cobicistat, Emtricitabine, and Tenofovir Alafenamide ...... 33 Streptomycin ...... 108 Doravirine, Lamivudine, and Tenofovir Disoproxil Fumarate ...... 39 Efavirenz, Emtricitabine, and Tenofovir Disoproxil Fumarate ...... 41 Antitussive Efavirenz, Lamivudine, and Tenofovir Disoproxil Fumarate ...... 41 Acetaminophen, Dextromethorphan, and Doxylamine ...... 3 Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Alafenamide ...... 41 Acetaminophen, Dextromethorphan, and Phenylephrine ...... 3 Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Disoproxil Benzonatate ...... 15 Fumarate ...... 41 Brompheniramine, Dextromethorphan, and Phenylephrine ...... 18 Emtricitabine and Tenofovir Alafenamide ...... 42 Brompheniramine, Pseudoephedrine, and Dextromethorphan ...... 18 Emtricitabine and Tenofovir Disoproxil Fumarate ...... 42 Camphor ...... 21 Emtricitabine, Rilpivirine, and Tenofovir Alafenamide ...... 42 Chlophedianol and Dexbrompheniramine ...... 25 Emtricitabine, Rilpivirine, and Tenofovir Disoproxil Fumarate ...... 42 Chlorpheniramine, Phenylephrine, and Dextromethorphan ...... 26 Tenofovir Disoproxil Fumarate ...... 111 Chlorpheniramine, Pseudoephedrine, and Codeine ...... 26 136 BETA-BLOCKER WITH ALPHA-BLOCKING ACTIVITY

Chlorpheniramine, Pseudoephedrine, and Dextromethorphan ...... 26 Barbiturate Codeine ...... 29 Amobarbital ...... 8 Codeine and Chlorpheniramine ...... 29 Butabarbital ...... 19 Codeine, Phenylephrine, and Triprolidine ...... 30 Butalbital, Acetaminophen, and Caffeine ...... 19 Dexchlorpheniramine, Dextromethorphan, and Phenylephrine ...... 34 Butalbital, Acetaminophen, Caffeine, and Codeine ...... 19 Dextromethorphan ...... 35 Butalbital and Acetaminophen ...... 20 Dextromethorphan and Chlorpheniramine ...... 35 Butalbital, Aspirin, and Caffeine ...... 20 Dextromethorphan and Menthol ...... 35 Butalbital, Aspirin, Caffeine, and Codeine ...... 20 Dextromethorphan and Phenylephrine ...... 35 Methohexital ...... 78 Guaifenesin and Codeine ...... 57 PENTobarbital ...... 92 Guaifenesin and Dextromethorphan ...... 57 PHENobarbital ...... 92 Guaifenesin, Dextromethorphan, and Phenylephrine ...... 57 Primidone ...... 98 Hydrocodone and Chlorpheniramine ...... 60 Hydrocodone and Homatropine ...... 60 Benzodiazepine Hydrocodone, Chlorpheniramine, and Pseudoephedrine ...... 60 ALPRAZolam ...... 6 Promethazine and Codeine ...... 98 Amitriptyline and Chlordiazepoxide ...... 8 Promethazine and Dextromethorphan ...... 98 ChlordiazePOXIDE ...... 25 Promethazine, Phenylephrine, and Codeine ...... 98 Clidinium and Chlordiazepoxide ...... 28 CloBAZam ...... 28 Antitussive/Decongestant ClonazePAM ...... 29 Hydrocodone and Pseudoephedrine ...... 60 Clorazepate ...... 29 Pseudoephedrine and Dextromethorphan ...... 99 DiazePAM ...... 36 Estazolam ...... 44 Antitussive/Decongestant/Expectorant LORazepam ...... 73 Guaifenesin, Pseudoephedrine, and Codeine ...... 58 Midazolam ...... 81 Guaifenesin, Pseudoephedrine, and Dextromethorphan ...... 58 Oxazepam ...... 89 Hydrocodone, Pseudoephedrine, and Guaifenesin ...... 60 Quazepam ...... 100 Antitussive/Expectorant Temazepam ...... 111 Hydrocodone and Guaifenesin ...... 60 Triazolam ...... 116 Antivenin Beta1/Beta2 Agonist Antivenin (Latrodectus mactans) ...... 10 Isoproterenol ...... 67 Antivenin (Micrurus fulvius) ...... 10 Beta2-Adrenergic Agonist Centruroides Immune F(ab’)2 (Equine) ...... 25 Arformoterol ...... 10 Crotalidae Polyvalent Immune FAB (Ovine) ...... 31 Ipratropium and Albuterol ...... 66 Antiviral Agent Beta2-Adrenergic Agonist, Long-Acting Acyclovir (Systemic) ...... 4 Aclidinium and Formoterol ...... 4 Amantadine ...... 7 Arformoterol ...... 10 Ansuvimab ...... 9 Fluticasone and Salmeterol ...... 52 Brincidofovir ...... 18 Olodaterol ...... 87 Cidofovir ...... 27 Salmeterol ...... 104 Famciclovir ...... 48 Umeclidinium and Vilanterol ...... 117 Foscarnet ...... 53 Ganciclovir (Systemic) ...... 55 Beta2 Agonist Letermovir ...... 70 Aclidinium and Formoterol ...... 4 Oseltamivir ...... 88 Albuterol ...... 5 Penciclovir ...... 91 Fluticasone and Salmeterol ...... 52 Peramivir ...... 92 Levalbuterol ...... 70 Ribavirin (Oral Inhalation) ...... 101 Metaproterenol ...... 77 RiMANTAdine ...... 102 Olodaterol ...... 87 Sotrovimab ...... 108 Salmeterol ...... 104 ValACYclovir ...... 118 Terbutaline ...... 112 ValGANciclovir ...... 118 Tiotropium and Olodaterol ...... 114 Zanamivir ...... 121 Umeclidinium and Vilanterol ...... 117

Antiviral Agent, Adamantane Beta2 Agonist, Long-Acting Amantadine ...... 7 Tiotropium and Olodaterol ...... 114 RiMANTAdine ...... 102 Beta3 Agonist Antiviral Agent, Ophthalmic Mirabegron ...... 81 Ganciclovir (Ophthalmic) ...... 54 Beta-Adrenergic Blocker, Nonselective Trifluridine ...... 116 Dorzolamide and Timolol ...... 39 Antiviral Agent, Oral Levobunolol ...... 70 Brincidofovir ...... 18 Propranolol ...... 99 ValACYclovir ...... 118 Sotalol ...... 108 Antiviral Agent, Topical Beta-Blocker, Beta-1 Selective Acyclovir and Hydrocortisone ...... 4 Atenolol ...... 12 Acyclovir (Topical) ...... 4 Atenolol and Chlorthalidone ...... 12 Docosanol ...... 39 Betaxolol (Systemic) ...... 16 Bisoprolol ...... 17 Aphthous Ulcer Treatment Agent Bisoprolol and Hydrochlorothiazide ...... 17 Sulfonated Phenolics and Sulfuric Acid ...... 109 Esmolol ...... 44 Appetite Stimulant Metoprolol ...... 80 Dronabinol ...... 40 Metoprolol and Hydrochlorothiazide ...... 80 Megestrol ...... 76 Beta-Blocker, Nonselective Artemisinin Derivative Metipranolol ...... 79 Artesunate ...... 11 Nadolol ...... 83 Nadolol and Bendroflumethiazide ...... 83 Astringent Propranolol and Hydrochlorothiazide ...... 99 Aluminum Chloride ...... 6 Timolol (Ophthalmic) ...... 113 Epinephrine (Racemic) and Aluminum Potassium Sulfate ...... 43 Timolol (Systemic) ...... 113 Witch Hazel ...... 120 Beta-Blocker With Alpha-Blocking Activity Bandage/Dressing Carvedilol ...... 23 Wound Dressing, Biocomposite ...... 121 Labetalol ...... 68 137 BETA-BLOCKER WITH INTRINSIC SYMPATHOMIMETIC ACTIVITY

Beta-Blocker With Intrinsic Sympathomimetic Activity Amlodipine and Celecoxib ...... 8 Acebutolol ...... 2 Amlodipine and Olmesartan ...... 8 Pindolol ...... 94 Amlodipine and Valsartan ...... 8 Amlodipine, Valsartan, and Hydrochlorothiazide ...... 8 Beta-Lactamase Inhibitor Clevidipine ...... 28 Meropenem and Vaborbactam ...... 77 DilTIAZem ...... 37 Bile Acid Felodipine ...... 48 Chenodiol ...... 25 NiCARdipine ...... 85 Cholic Acid ...... 27 NIFEdipine ...... 85 NiMODipine ...... 85 Biological, Miscellaneous Perindopril and Amlodipine ...... 92 Glatiramer Acetate ...... 55 Telmisartan and Amlodipine ...... 111 Trandolapril and Verapamil ...... 115 Biological Response Modulator Verapamil ...... 119 Interferon Alfa-2b ...... 65 Peginterferon Alfa-2b ...... 91 Calcium Channel Blocker, Dihydropyridine AmLODIPine ...... 8 Biotinidase Deficiency, Treatment Agent Amlodipine and Atorvastatin ...... 8 Biotin ...... 17 Amlodipine and Benazepril ...... 8 Bisphosphonate Derivative Amlodipine and Celecoxib ...... 8 Alendronate ...... 6 Amlodipine and Olmesartan ...... 8 Etidronate ...... 47 Amlodipine and Valsartan ...... 8 Ibandronate ...... 62 Amlodipine, Valsartan, and Hydrochlorothiazide ...... 8 Pamidronate ...... 90 Clevidipine ...... 28 Zoledronic Acid ...... 121 Felodipine ...... 48 NiCARdipine ...... 85 Blood Modifiers NIFEdipine ...... 85 Hemin ...... 58 NiMODipine ...... 85 Perindopril and Amlodipine ...... 92 Blood Product Derivative Telmisartan and Amlodipine ...... 111 Albumin ...... 5 Alpha1-Proteinase Inhibitor ...... 6 Calcium Channel Blocker, Nondihydropyridine Antihemophilic Factor (Human) ...... 9 DilTIAZem ...... 37 Antihemophilic Factor/von Willebrand Factor Complex (Human) ...... 10 Verapamil ...... 119 Anti-inhibitor Coagulant Complex (Human) ...... 10 Antithrombin ...... 10 Calcium Channel Blocker, N-Type Botulism Immune Globulin (Intravenous-Human) ...... 17 Ziconotide ...... 121 C1 Inhibitor (Human) ...... 20 Calcium Salt Cytomegalovirus Immune Globulin (Intravenous-Human) ...... 32 Calcium Acetate ...... 21 Factor IX Complex (Human) [(Factors II, IX, X)] ...... 48 Calcium and Vitamin D ...... 21 Factor IX (Human) ...... 48 Calcium Carbonate ...... 21 Factor X (Human) ...... 48 Calcium Chloride ...... 21 Factor XIII Concentrate (Human) ...... 48 Calcium Citrate ...... 21 Fibrinogen Concentrate (Human) ...... 50 Calcium Citrate and Vitamin D ...... 21 Fibrin Sealant ...... 50 Calcium Glubionate ...... 21 Hemin ...... 58 Calcium Gluconate ...... 21 Hepatitis B Immune Globulin (Human) ...... 58 Calcium Lactate ...... 21 Immune Globulin ...... 63 Magnesium Carbonate, Calcium Carbonate, and Folic Acid ...... 74 Plasma Protein Fraction ...... 94 Plasminogen (Human) ...... 94 Caloric Agent Protein C Concentrate (Human) ...... 99 Fat Emulsion (Fish Oil and Plant Based) ...... 48 Prothrombin Complex Concentrate (Human) [(Factors II, VII, IX, X), Fat Emulsion (Fish Oil Based) ...... 48 Protein C, and Protein S] ...... 99 Fat Emulsion (Plant Based) ...... 48 Rabies Immune Globulin (Human) ...... 100 Total Parenteral Nutrition ...... 115 Rho(D) Immune Globulin ...... 101 Cannabinoid Tetanus Immune Globulin (Human) ...... 112 Cannabidiol ...... 22 Thrombin (Topical) ...... 113 Dronabinol ...... 40 Varicella-Zoster Immune Globulin (Human) ...... 118 Carbonic Anhydrase Inhibitor Blood Viscosity Reducer Agent AcetaZOLAMIDE ...... 4 Pentoxifylline ...... 92 Dichlorphenamide ...... 36 Bone-Modifying Agent MethazolAMIDE ...... 77 Denosumab ...... 33 Carbonic Anhydrase Inhibitor (Ophthalmic) C1 Esterase Inhibitor Brinzolamide and Brimonidine ...... 18 C1 Inhibitor (Human) ...... 20 Dorzolamide ...... 39 C1 Inhibitor (Recombinant) ...... 20 Dorzolamide and Timolol ...... 39 Calcimimetic Cardiac Glycoside Cinacalcet ...... 27 Digoxin ...... 37 Etelcalcetide ...... 45 Cardiovascular Agent, Miscellaneous Calcineurin Inhibitor Cardioplegic Solution ...... 23 CycloSPORINE (Ophthalmic) ...... 31 Ivabradine ...... 67 CycloSPORINE (Systemic) ...... 32 Ranolazine ...... 101 Pimecrolimus ...... 94 CAR-T Cell Immunotherapy Tacrolimus (Systemic) ...... 110 Axicabtagene Ciloleucel ...... 13 Tacrolimus (Topical) ...... 110 Lisocabtagene Maraleucel ...... 73 Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonist Tisagenlecleucel ...... 114 Erenumab ...... 43 Cathartic Fremanezumab ...... 54 Sodium Phosphates ...... 107 Galcanezumab ...... 54 Rimegepant ...... 102 Cauterizing Agent, Topical Silver Nitrate ...... 105 Calcium Channel Blocker AmLODIPine ...... 8 Cellular Immunotherapy, Autologous Amlodipine and Atorvastatin ...... 8 Axicabtagene Ciloleucel ...... 13 Amlodipine and Benazepril ...... 8 Lisocabtagene Maraleucel ...... 73 138 CORTICOSTEROID, TOPICAL

Sipuleucel-T ...... 106 Ethinyl Estradiol and Levonorgestrel ...... 46 Tisagenlecleucel ...... 114 Ethinyl Estradiol and Norelgestromin ...... 46 Ethinyl Estradiol and Norethindrone ...... 46 Central Monoamine-Depleting Agent Ethinyl Estradiol and Norgestimate ...... 46 Deutetrabenazine ...... 34 Ethinyl Estradiol and Norgestrel ...... 47 Reserpine ...... 101 Etonogestrel ...... 47 Tetrabenazine ...... 112 Levonorgestrel (IUD) ...... 70 Valbenazine ...... 118 Levonorgestrel (Systemic) ...... 70 Central Nervous System Depressant MedroxyPROGESTERone ...... 75 Oxybate Salts (Calcium, Magnesium, Potassium, and Sodium) ...... 89 Nonoxynol 9 ...... 86 Sodium Oxybate ...... 107 Norethindrone ...... 86 Norethindrone and Mestranol ...... 86 Central Nervous System Stimulant Ulipristal ...... 117 Amphetamine ...... 9 Armodafinil ...... 11 Contrast Agent Benzphetamine ...... 16 Diatrizoate Meglumine and Iodipamide Meglumine ...... 36 Caffeine ...... 20 Hexaminolevulinate ...... 59 Dexmethylphenidate ...... 34 Iohexol ...... 66 Dextroamphetamine ...... 34 Iopamidol ...... 66 Dextroamphetamine and Amphetamine ...... 34 Ioxilan ...... 66 Diethylpropion ...... 37 Isosulfan Blue ...... 67 Ergotamine and Caffeine ...... 43 Corneal Collagen Cross-Linking Agent, Ophthalmic Lisdexamfetamine ...... 72 Riboflavin 5'-Phosphate ...... 102 Methamphetamine ...... 77 Methylphenidate ...... 79 Corticosteroid, Inhalant (Oral) Modafinil ...... 82 Budesonide (Oral Inhalation) ...... 18 Phentermine ...... 93 Fluticasone and Salmeterol ...... 52 Fluticasone (Oral Inhalation) ...... 52 Cephalosporin Combination Mometasone (Oral Inhalation) ...... 82 Ceftazidime and Avibactam ...... 24 Ceftolozane and Tazobactam ...... 24 Corticosteroid, Nasal Budesonide (Nasal) ...... 18 Chelating Agent Flunisolide (Nasal) ...... 50 Deferasirox ...... 33 Fluticasone (Nasal) ...... 52 Deferiprone ...... 33 Mometasone (Nasal) ...... 82 Deferoxamine ...... 33 Triamcinolone (Nasal) ...... 116 PenicillAMINE ...... 91 Trientine ...... 116 Corticosteroid, Ophthalmic Bacitracin, Neomycin, Polymyxin B, and Hydrocortisone Chelating Agent, Oral (Ophthalmic) ...... 13 Zinc Acetate ...... 121 DexAMETHasone (Ophthalmic) ...... 34 Chemoprotective Agent Difluprednate ...... 37 Amifostine ...... 7 Fluocinolone (Ophthalmic) ...... 51 Dexrazoxane ...... 34 Fluorometholone ...... 51 Mesna ...... 77 Loteprednol ...... 73 Palifermin ...... 89 Neomycin, Polymyxin B, and Hydrocortisone (Ophthalmic) ...... 84 PrednisoLONE (Ophthalmic) ...... 97 Chemotherapy Modulating Agent Triamcinolone (Ophthalmic) ...... 116 Leucovorin Calcium ...... 70 LEVOleucovorin ...... 70 Corticosteroid, Otic Ciprofloxacin and Dexamethasone ...... 27 Chimeric Antigen Receptor T-Cell Immunotherapy Ciprofloxacin and Fluocinolone ...... 27 Axicabtagene Ciloleucel ...... 13 Ciprofloxacin and Hydrocortisone ...... 27 Lisocabtagene Maraleucel ...... 73 DexAMETHasone (Ophthalmic) ...... 34 Tisagenlecleucel ...... 114 Fluocinolone (Otic) ...... 51 Chloride Channel Activator Neomycin, Colistin, Hydrocortisone, and Thonzonium ...... 84 Lubiprostone ...... 74 Neomycin, Polymyxin B, and Hydrocortisone (Otic) ...... 84 Cholinergic Agonist Corticosteroid, Rectal Acetylcholine ...... 4 Budesonide (Topical) ...... 19 Amifampridine ...... 7 Hydrocortisone (Topical) ...... 60 Bethanechol ...... 16 Corticosteroid, Systemic Carbachol ...... 22 Betamethasone (Systemic) ...... 16 Cevimeline ...... 25 Budesonide (Systemic) ...... 19 Guanidine ...... 58 Cortisone ...... 31 Pilocarpine (Systemic) ...... 94 Cosyntropin ...... 31 Colony Stimulating Factor Deflazacort ...... 33 Avatrombopag ...... 13 DexAMETHasone (Systemic) ...... 34 Darbepoetin Alfa ...... 32 Fludrocortisone ...... 50 Eltrombopag ...... 41 Hydrocortisone (Systemic) ...... 60 Epoetin Alfa ...... 43 MethylPREDNISolone ...... 79 Filgrastim ...... 50 PrednisoLONE (Systemic) ...... 97 Lusutrombopag ...... 74 PredniSONE ...... 98 Methoxy Polyethylene Glycol-Epoetin Beta ...... 78 Triamcinolone (Systemic) ...... 116 Pegfilgrastim ...... 91 Corticosteroid, Topical RomiPLOStim ...... 103 Acyclovir and Hydrocortisone ...... 4 Sargramostim ...... 104 Alclometasone ...... 5 Complement Inhibitor Bacitracin, Neomycin, Polymyxin B, and Hydrocortisone (Topical) ...... 13 Eculizumab ...... 40 Betamethasone and Clotrimazole ...... 16 Ravulizumab ...... 101 Betamethasone (Topical) ...... 16 Calcipotriene and Betamethasone ...... 20 Contraceptive Clioquinol and Hydrocortisone ...... 28 Copper IUD ...... 31 Clobetasol ...... 28 Ethinyl Estradiol and Desogestrel ...... 45 Clocortolone ...... 28 Ethinyl Estradiol and Drospirenone ...... 45 Desonide ...... 33 Ethinyl Estradiol and Ethynodiol Diacetate ...... 45 Desoximetasone ...... 33 Ethinyl Estradiol and Etonogestrel ...... 45 Fluocinolone, Hydroquinone, and Tretinoin ...... 51 139 CORTICOSTEROID, TOPICAL

Fluocinolone (Topical) ...... 51 Depigmenting Agent Fluocinonide ...... 51 Fluocinolone, Hydroquinone, and Tretinoin ...... 51 Flurandrenolide ...... 52 Hydroquinone ...... 61 Fluticasone (Topical) ...... 53 Halcinonide ...... 58 Diagnostic Agent Halobetasol ...... 58 Adenosine ...... 5 Halobetasol and Tazarotene ...... 58 Arginine ...... 11 Hydrocortisone (Topical) ...... 60 Benzylpenicilloyl Polylysine ...... 16 Iodoquinol and Hydrocortisone ...... 66 Candida albicans (Monilia) ...... 22 Mometasone (Topical) ...... 82 Coccidioides immitis Skin Test ...... 29 Neomycin, Polymyxin B, and Hydrocortisone (Topical) ...... 84 Corticorelin ...... 31 Nystatin and Triamcinolone ...... 86 Cosyntropin ...... 31 Prednicarbate ...... 97 Edrophonium ...... 40 Triamcinolone (Topical) ...... 116 Fluorescein ...... 51 Fluorescein and Benoxinate ...... 51 Cortisol Receptor Blocker Gadobenate Dimeglumine ...... 54 MiFEPRIStone ...... 81 Gadobutrol ...... 54 Gadodiamide ...... 54 Cortisol Synthesis Inhibitor Gadofosveset ...... 54 Osilodrostat ...... 88 Gadopentetate Dimeglumine ...... 54 Cosmetic Agent, Implant Gadoterate Meglumine ...... 54 Hyaluronate and Derivatives ...... 59 Gadoteridol ...... 54 Poly-L-Lactic Acid ...... 94 Gadoversetamide ...... 54 Gadoxetate ...... 54 Cystic Fibrosis Transmembrane Conductance Regulator Corrector Glucagon ...... 55 Lumacaftor and Ivacaftor ...... 74 Histoplasmin ...... 59 Tezacaftor and Ivacaftor ...... 112 Indocyanine Green ...... 63 Cystic Fibrosis Transmembrane Conductance Regulator Methacholine ...... 77 MetyraPONE ...... 80 Potentiator Perflutren Lipid Microspheres ...... 92 Ivacaftor ...... 67 Perflutren Protein Type A ...... 92 Lumacaftor and Ivacaftor ...... 74 Proparacaine and Fluorescein ...... 99 Tezacaftor and Ivacaftor ...... 112 Regadenoson ...... 101 Cytidine Deaminase Inhibitor Secretin ...... 104 Decitabine and Cedazuridine ...... 33 Sincalide ...... 105 Sulfur Hexafluoride Lipid-Type A Microspheres ...... 109 Cytochrome P-450 Inhibitor Thyrotropin Alfa ...... 113 Atazanavir and Cobicistat ...... 12 Trichophyton Skin Test ...... 116 Cobicistat ...... 29 Tuberculin Tests ...... 117 Darunavir and Cobicistat ...... 33 Darunavir, Cobicistat, Emtricitabine, and Tenofovir Alafenamide ...... 33 Diagnostic Agent, Diabetes Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Alafenamide ...... 41 Diagnostic Test for Glucose in Urine ...... 36 Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Disoproxil Diagnostic Agent, Kidney Function Fumarate ...... 41 Indigotindisulfonate Sodium ...... 63 Ombitasvir, Paritaprevir, and Ritonavir ...... 87 Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir ...... 87 Diagnostic Agent, Ophthalmic Hydroxypropyl Methylcellulose ...... 61 Decongestant Acetaminophen and Phenylephrine ...... 2 Diagnostic Agent, Radiologic Examination of GI Tract Acetaminophen, Dextromethorphan, and Phenylephrine ...... 3 Ethiodized Oil ...... 47 Acetaminophen, Diphenhydramine, and Phenylephrine ...... 3 Acetaminophen, Guaifenesin, and Phenylephrine ...... 4 Dialysis Solution Acrivastine and Pseudoephedrine ...... 4 Continuous Renal Replacement Therapy Solutions ...... 30 Brompheniramine and Phenylephrine ...... 18 Icodextrin ...... 62 Brompheniramine and Pseudoephedrine ...... 18 Peritoneal Dialysis Solution ...... 92 Brompheniramine, Dextromethorphan, and Phenylephrine ...... 18 Dietary Supplement Brompheniramine, Pseudoephedrine, and Dextromethorphan ...... 18 Lactobacillus ...... 68 Cetirizine and Pseudoephedrine ...... 25 LevOCARNitine ...... 70 Chlorpheniramine and Phenylephrine ...... 26 Manganese ...... 75 Chlorpheniramine and Pseudoephedrine ...... 26 Methionine ...... 78 Chlorpheniramine, Phenylephrine, and Dextromethorphan ...... 26 Saccharomyces boulardii ...... 103 Chlorpheniramine, Pseudoephedrine, and Codeine ...... 26 Chlorpheniramine, Pseudoephedrine, and Dextromethorphan ...... 26 Direct Oral Anticoagulant (DOAC) Codeine, Phenylephrine, and Triprolidine ...... 30 Apixaban ...... 10 Dexchlorpheniramine and Pseudoephedrine ...... 34 Dabigatran Etexilate ...... 32 Dexchlorpheniramine, Dextromethorphan, and Phenylephrine ...... 34 Rivaroxaban ...... 102 Dextromethorphan and Phenylephrine ...... 35 Disinfectant, Antibacterial (Topical) Diphenhydramine and Phenylephrine ...... 37 Sodium Hypochlorite ...... 107 Fexofenadine and Pseudoephedrine ...... 49 Guaifenesin and Phenylephrine ...... 57 Diuretic, Carbonic Anhydrase Inhibitor Guaifenesin, Dextromethorphan, and Phenylephrine ...... 57 AcetaZOLAMIDE ...... 4 Hydrocodone, Chlorpheniramine, and Pseudoephedrine ...... 60 MethazolAMIDE ...... 77 Ibuprofen and Phenylephrine ...... 62 Ibuprofen, Pseudoephedrine, and Chlorpheniramine ...... 62 Diuretic, Combination Loratadine and Pseudoephedrine ...... 73 Acetaminophen and Pamabrom ...... 2 Oxymetazoline (Nasal) ...... 89 Amiloride and Hydrochlorothiazide ...... 7 Phenylephrine and Pyrilamine ...... 93 Diuretic, Loop Phenylephrine and Thonzylamine ...... 93 Bumetanide ...... 19 Phenylephrine (Nasal) ...... 93 Ethacrynic Acid ...... 45 Promethazine and Phenylephrine ...... 98 Furosemide ...... 54 Promethazine, Phenylephrine, and Codeine ...... 98 Torsemide ...... 115 Pseudoephedrine ...... 99 Tetrahydrozoline (Nasal) ...... 112 Diuretic, Osmotic Triprolidine and Pseudoephedrine ...... 117 Mannitol (Systemic) ...... 75 Decongestant/Analgesic Diuretic, Potassium-Sparing Naproxen and Pseudoephedrine ...... 84 AMILoride ...... 7 Pseudoephedrine and Ibuprofen ...... 99 Eplerenone ...... 43 140 ESTROGEN AND PROGESTIN COMBINATION

Hydrochlorothiazide and Triamterene ...... 59 Sodium Bicarbonate ...... 106 Spironolactone ...... 108 Sodium Chloride ...... 106 Triamterene ...... 116 Sodium Glycerophosphate Pentahydrate ...... 107 Sodium Phosphates ...... 107 Diuretic, Thiazide Amlodipine, Valsartan, and Hydrochlorothiazide ...... 8 Endocrine and Metabolic Agent, Miscellaneous Atenolol and Chlorthalidone ...... 12 Uridine Triacetate ...... 118 Benazepril and Hydrochlorothiazide ...... 15 Bisoprolol and Hydrochlorothiazide ...... 17 Endothelin Receptor Antagonist Candesartan and Hydrochlorothiazide ...... 22 Ambrisentan ...... 7 Captopril and Hydrochlorothiazide ...... 22 Bosentan ...... 17 Chlorothiazide ...... 25 Macitentan ...... 74 Enalapril and Hydrochlorothiazide ...... 42 Enzyme Fosinopril and Hydrochlorothiazide ...... 53 Agalsidase Beta ...... 5 HydroCHLOROthiazide ...... 59 Alglucosidase Alfa ...... 6 Hydrochlorothiazide and Spironolactone ...... 59 Alpha-Galactosidase ...... 6 Hydrochlorothiazide and Triamterene ...... 59 Asfotase Alfa ...... 12 Irbesartan and Hydrochlorothiazide ...... 66 Collagenase (Systemic) ...... 30 Lisinopril and Hydrochlorothiazide ...... 73 Dornase Alfa ...... 39 Losartan and Hydrochlorothiazide ...... 73 Elapegademase ...... 41 Methyclothiazide ...... 79 Elosulfase Alfa ...... 41 Methyldopa and Hydrochlorothiazide ...... 79 Galsulfase ...... 54 Metoprolol and Hydrochlorothiazide ...... 80 Glucarpidase ...... 56 Moexipril and Hydrochlorothiazide ...... 82 Hyaluronidase ...... 59 Nadolol and Bendroflumethiazide ...... 83 Idursulfase ...... 62 Olmesartan and Hydrochlorothiazide ...... 87 Imiglucerase ...... 62 Propranolol and Hydrochlorothiazide ...... 99 Lactase ...... 68 Quinapril and Hydrochlorothiazide ...... 100 Laronidase ...... 69 Telmisartan and Hydrochlorothiazide ...... 111 Pancrelipase ...... 90 Valsartan and Hydrochlorothiazide ...... 118 Pegademase Bovine ...... 91 Diuretic, Thiazide-Related Pegloticase ...... 91 Azilsartan and Chlorthalidone ...... 13 Protein C Concentrate (Human) ...... 99 Chlorthalidone ...... 26 Rasburicase ...... 101 Clonidine and Chlorthalidone ...... 29 Taliglucerase Alfa ...... 110 Indapamide ...... 63 Velaglucerase Alfa ...... 119 MetOLazone ...... 80 Vestronidase Alfa ...... 119 Docosanoid, Synthetic Enzyme Cofactor Unoprostone ...... 117 Sapropterin ...... 104 Dopamine Agonist Enzyme, Gastrointestinal Fenoldopam ...... 49 Sacrosidase ...... 103 Dopamine Antagonist Enzyme Inhibitor Metoclopramide ...... 79 Eliglustat ...... 41 Miglustat ...... 81 Echinocandin Anidulafungin ...... 9 Enzyme, Replacement Therapy Caspofungin ...... 23 Sebelipase Alfa ...... 104 Micafungin ...... 80 Enzyme, Topical Debridement Electrolyte Replacement, Oral Collagenase (Topical) ...... 30 Oral Rehydration Therapy ...... 88 Enzyme, Urate-Oxidase (Recombinant) Electrolyte Supplement Pegloticase ...... 91 Magnesium L-lactate ...... 74 Rasburicase ...... 101 Electrolyte Supplement, Oral Ergot Derivative Calcium and Vitamin D ...... 21 Bromocriptine ...... 18 Calcium Carbonate ...... 21 Cabergoline ...... 20 Calcium Gluconate ...... 21 Dihydroergotamine ...... 37 Electrolyte Replacement Solution ...... 41 Ergoloid Mesylates ...... 43 Magnesium L-aspartate Hydrochloride ...... 74 Ergotamine ...... 43 Magnesium Carbonate ...... 74 Ergotamine and Caffeine ...... 43 Magnesium Carbonate, Calcium Carbonate, and Folic Acid ...... 74 Methylergonovine ...... 79 Magnesium Chloride ...... 74 Erythropoiesis-Stimulating Agent (ESA) Magnesium Gluconate ...... 74 Darbepoetin Alfa ...... 32 Magnesium Oxide ...... 75 Epoetin Alfa ...... 43 Potassium Bicarbonate and Potassium Chloride ...... 96 Methoxy Polyethylene Glycol-Epoetin Beta ...... 78 Potassium Bicarbonate and Potassium Citrate ...... 96 Potassium Chloride ...... 96 Estrogen and Androgen Combination Potassium Gluconate ...... 96 Estrogens (Esterified) and Methyltestosterone ...... 45 Potassium Phosphate and Sodium Phosphate ...... 96 Sodium Bicarbonate ...... 106 Estrogen and Progestin Combination Drospirenone and Estradiol ...... 40 Electrolyte Supplement, Parenteral Estradiol and Levonorgestrel ...... 44 Calcium Chloride ...... 21 Estradiol and Norethindrone ...... 44 Calcium Gluconate ...... 21 Estradiol and Norgestimate ...... 44 Dextrose and Ringer's Injection (Lactated) ...... 35 Estrogens (Conjugated/Equine) and Medroxyprogesterone ...... 44 Electrolyte Replacement Solution ...... 41 Ethinyl Estradiol and Desogestrel ...... 45 Magnesium Chloride ...... 74 Ethinyl Estradiol and Drospirenone ...... 45 Magnesium Sulfate ...... 75 Ethinyl Estradiol and Ethynodiol Diacetate ...... 45 Potassium Acetate ...... 95 Ethinyl Estradiol and Etonogestrel ...... 45 Potassium Acid Phosphate ...... 95 Ethinyl Estradiol and Levonorgestrel ...... 46 Potassium Chloride ...... 96 Ethinyl Estradiol and Norelgestromin ...... 46 Potassium Phosphate ...... 96 Ethinyl Estradiol and Norethindrone ...... 46 Ringer's Injection ...... 102 Ethinyl Estradiol and Norgestimate ...... 46 Ringer's Injection (Lactated) ...... 102 Ethinyl Estradiol and Norgestrel ...... 47 Sodium Acetate ...... 106 Norethindrone and Mestranol ...... 86 141 ESTROGEN DERIVATIVE

Estrogen Derivative Ganglionic Blocking Agent Estradiol (Systemic) ...... 44 Mecamylamine ...... 75 Estradiol (Topical) ...... 44 Gastrointestinal Agent, Miscellaneous Estrogens (Conjugated/Equine) and Bazedoxifene ...... 44 Adalimumab ...... 4 Estrogens (Conjugated/Equine, Systemic) ...... 45 Alvimopan ...... 7 Estrogens (Conjugated/Equine, Topical) ...... 45 Eluxadoline ...... 41 Estrogens (Esterified) ...... 45 Glutamine ...... 56 Relugolix, Estradiol, and Norethindrone ...... 101 InFLIXimab ...... 63 Ethanolamine Derivative Lansoprazole, Amoxicillin, and Clarithromycin ...... 69 Acetaminophen, Dextromethorphan, and Doxylamine ...... 3 LinaCLOtide ...... 72 Acetaminophen, Diphenhydramine, and Phenylephrine ...... 3 Lubiprostone ...... 74 Carbinoxamine ...... 22 Mucosal Coating Agent ...... 82 Clemastine ...... 28 Naldemedine ...... 83 DimenhyDRINATE ...... 37 Naloxegol ...... 83 Diphenhydramine and Ibuprofen ...... 37 Natalizumab ...... 84 Omeprazole, Clarithromycin, and Amoxicillin ...... 88 Diphenhydramine and Phenylephrine ...... 37 Plecanatide ...... 94 DiphenhydrAMINE (Systemic) ...... 37 Saliva Substitute ...... 104 DiphenhydrAMINE (Topical) ...... 38 Sucralfate ...... 108 Doxylamine ...... 40 Tetracycline, Bismuth Subsalicylate, and Metronidazole ...... 112 Ethylenediamine Derivative Vedolizumab ...... 118 Phenylephrine and Pyrilamine ...... 93 Gastrointestinal Agent, Prokinetic Phenylephrine and Thonzylamine ...... 93 Metoclopramide ...... 79 Expectorant Tegaserod ...... 111 Acetaminophen, Guaifenesin, and Phenylephrine ...... 4 General Anesthetic GuaiFENesin ...... 56 Etomidate ...... 47 Guaifenesin and Codeine ...... 57 FentaNYL ...... 49 Guaifenesin and Dextromethorphan ...... 57 Ketamine ...... 67 Guaifenesin and Phenylephrine ...... 57 Methohexital ...... 78 Guaifenesin and Pseudoephedrine ...... 57 Propofol ...... 99 Potassium Iodide ...... 96 SUFentanil ...... 108 Expectorant/Decongestant General Anesthetic, Inhalation Ephedrine and Guaifenesin ...... 42 Desflurane ...... 33 Farnesoid X Receptor Agonist Isoflurane ...... 67 Sevoflurane ...... 105 Obeticholic Acid ...... 86 Gene Therapy, Adeno-Associated Virus Fiber Supplement Voretigene Neparvovec ...... 120 Methylcellulose ...... 79 Polycarbophil ...... 94 Genitourinary Irrigant Psyllium ...... 99 Acetic Acid (Topical) ...... 4 Wheat Dextrin ...... 120 Citric Acid, Magnesium Carbonate, and Glucono-Delta-Lactone ...... 27 Mannitol (Systemic) ...... 75 First Generation (Typical) Antipsychotic Neomycin and Polymyxin B ...... 84 Amitriptyline and Perphenazine ...... 8 Sodium Chloride ...... 106 ChlorproMAZINE ...... 26 Sorbitol ...... 108 Droperidol ...... 40 FluPHENAZine ...... 52 Glucagon-Like Peptide-2 (GLP-2) Analog Haloperidol ...... 58 Teduglutide ...... 111 Loxapine ...... 74 Glucosylceramide Synthase Inhibitor Molindone ...... 82 Eliglustat ...... 41 Perphenazine ...... 92 Miglustat ...... 81 Pimozide ...... 94 Prochlorperazine ...... 98 Glutamate Inhibitor Thioridazine ...... 113 Riluzole ...... 102 Thiothixene ...... 113 Glycopeptide Trifluoperazine ...... 116 Dalbavancin ...... 32 Free Radical Scavenger Oritavancin ...... 88 Edaravone ...... 40 Telavancin ...... 111 Vancomycin ...... 118 Fumaric Acid Derivative Dimethyl Fumarate ...... 37 Gold Compound Auranofin ...... 12 GABA Agonist/Glutamate Antagonist Aurothioglucose ...... 12 Acamprosate ...... 2 Gonadotropin GABA Analog Chorionic Gonadotropin (Human) ...... 27 Gabapentin ...... 54 Chorionic Gonadotropin (Recombinant) ...... 27 Pregabalin ...... 98 Follitropin Alfa ...... 53 Follitropin Beta ...... 53 Gadolinium-Containing Contrast Agent Menotropins ...... 76 Gadobenate Dimeglumine ...... 54 Urofollitropin ...... 118 Gadobutrol ...... 54 Gadodiamide ...... 54 Gonadotropin Releasing Hormone Agonist Gadofosveset ...... 54 Goserelin ...... 56 Gadopentetate Dimeglumine ...... 54 Histrelin ...... 59 Gadoterate Meglumine ...... 54 Leuprolide ...... 70 Gadoteridol ...... 54 Leuprolide and Norethindrone ...... 70 Gadoversetamide ...... 54 Nafarelin ...... 83 Gadoxetate ...... 54 Triptorelin ...... 117 Gallstone Dissolution Agent Gonadotropin Releasing Hormone Antagonist Ursodiol ...... 118 Cetrorelix ...... 25 Degarelix ...... 33 Gamma-Aminobutyric Acid (GABA) A Receptor Positive Modulator Ganirelix ...... 55 Brexanolone ...... 18 Relugolix, Estradiol, and Norethindrone ...... 101 142 HISTAMINE H ANTAGONIST 2 Growth Factor, Platelet-Derived Hydrocodone and Chlorpheniramine ...... 60 Becaplermin ...... 14 Hydrocodone, Chlorpheniramine, and Pseudoephedrine ...... 60 HydrOXYzine ...... 61 Growth Hormone Ibuprofen, Phenylephrine, and Chlorpheniramine ...... 62 Somatropin ...... 107 Ibuprofen, Pseudoephedrine, and Chlorpheniramine ...... 62 Growth Hormone Receptor Antagonist Ketotifen (Ophthalmic) ...... 68 Pegvisomant ...... 91 Loratadine ...... 73 Loratadine and Pseudoephedrine ...... 73 Growth Hormone Releasing Factor Meclizine ...... 75 Tesamorelin ...... 112 Naphazoline and Pheniramine ...... 83 Naproxen and Diphenhydramine ...... 84 Guanylate Cyclase-C (GC-C) Agonist Olopatadine (Ophthalmic) ...... 87 LinaCLOtide ...... 72 Phenylephrine and Pyrilamine ...... 93 Plecanatide ...... 94 Phenylephrine and Thonzylamine ...... 93 Hematopoietic Agent Promethazine ...... 98 Avatrombopag ...... 13 Promethazine and Codeine ...... 98 Darbepoetin Alfa ...... 32 Promethazine and Dextromethorphan ...... 98 Eltrombopag ...... 41 Promethazine and Phenylephrine ...... 98 Epoetin Alfa ...... 43 Promethazine, Phenylephrine, and Codeine ...... 98 Filgrastim ...... 50 Triprolidine ...... 116 Luspatercept ...... 74 Triprolidine and Pseudoephedrine ...... 117 Lusutrombopag ...... 74 Histamine H1 Antagonist, First Generation Methoxy Polyethylene Glycol-Epoetin Beta ...... 78 Acetaminophen, Caffeine, and Pyrilamine ...... 3 Pegfilgrastim ...... 91 Acetaminophen, Dextromethorphan, and Doxylamine ...... 3 Plerixafor ...... 94 Acetaminophen, Diphenhydramine, and Phenylephrine ...... 3 RomiPLOStim ...... 103 Brompheniramine and Phenylephrine ...... 18 Sargramostim ...... 104 Brompheniramine and Pseudoephedrine ...... 18 Hematopoietic Stem Cell Mobilizer Brompheniramine, Dextromethorphan, and Phenylephrine ...... 18 Plerixafor ...... 94 Brompheniramine, Pseudoephedrine, and Dextromethorphan ...... 18 Carbinoxamine ...... 22 Hemostatic Agent Chlophedianol and Dexbrompheniramine ...... 25 Aluminum Chloride ...... 6 Chlorpheniramine ...... 25 Aluminum Chloride Hexahydrate ...... 6 Chlorpheniramine and Acetaminophen ...... 26 Aminocaproic Acid ...... 7 Chlorpheniramine and Phenylephrine ...... 26 Cellulose (Oxidized Regenerated) ...... 24 Chlorpheniramine and Pseudoephedrine ...... 26 Collagen (Absorbable/Dental) ...... 30 Chlorpheniramine, Phenylephrine, and Dextromethorphan ...... 26 Collagen Hemostat ...... 30 Chlorpheniramine, Pseudoephedrine, and Codeine ...... 26 Desmopressin ...... 33 Chlorpheniramine, Pseudoephedrine, and Dextromethorphan ...... 26 Ferric Subsulfate ...... 49 Clemastine ...... 28 Fibrin Sealant ...... 50 Codeine and Chlorpheniramine ...... 29 Gelatin (Absorbable) ...... 55 Codeine, Phenylephrine, and Triprolidine ...... 30 Prothrombin Complex Concentrate (Human) [(Factors II, VII, IX, X), Cyproheptadine ...... 32 Protein C, and Protein S] ...... 99 Dexbrompheniramine and Phenylephrine ...... 34 Thrombin (Topical) ...... 113 Dexchlorpheniramine and Pseudoephedrine ...... 34 Tranexamic Acid ...... 115 Dexchlorpheniramine, Dextromethorphan, and Phenylephrine ...... 34 Dextromethorphan and Chlorpheniramine ...... 35 Herb DimenhyDRINATE ...... 37 St Johns Wort ...... 108 Diphenhydramine and Ibuprofen ...... 37 Diphenhydramine and Phenylephrine ...... 37 Histamine H1 Antagonist Acetaminophen, Caffeine, and Pyrilamine ...... 3 DiphenhydrAMINE (Systemic) ...... 37 Acetaminophen, Dextromethorphan, and Doxylamine ...... 3 DiphenhydrAMINE (Topical) ...... 38 Acetaminophen, Diphenhydramine, and Phenylephrine ...... 3 Doxylamine ...... 40 Acrivastine and Pseudoephedrine ...... 4 Hydrocodone and Chlorpheniramine ...... 60 Azelastine (Ophthalmic) ...... 13 Hydrocodone, Chlorpheniramine, and Pseudoephedrine ...... 60 Brompheniramine and Phenylephrine ...... 18 HydrOXYzine ...... 61 Brompheniramine and Pseudoephedrine ...... 18 Ibuprofen, Phenylephrine, and Chlorpheniramine ...... 62 Brompheniramine, Dextromethorphan, and Phenylephrine ...... 18 Ibuprofen, Pseudoephedrine, and Chlorpheniramine ...... 62 Brompheniramine, Pseudoephedrine, and Dextromethorphan ...... 18 Meclizine ...... 75 Carbinoxamine ...... 22 Naphazoline and Pheniramine ...... 83 Cetirizine and Pseudoephedrine ...... 25 Naproxen and Diphenhydramine ...... 84 Cetirizine (Systemic) ...... 25 Phenylephrine and Pyrilamine ...... 93 Chlophedianol and Dexbrompheniramine ...... 25 Promethazine ...... 98 Chlorpheniramine ...... 25 Promethazine and Codeine ...... 98 Chlorpheniramine and Acetaminophen ...... 26 Promethazine and Dextromethorphan ...... 98 Chlorpheniramine and Phenylephrine ...... 26 Promethazine and Phenylephrine ...... 98 Chlorpheniramine and Pseudoephedrine ...... 26 Promethazine, Phenylephrine, and Codeine ...... 98 Chlorpheniramine, Phenylephrine, and Dextromethorphan ...... 26 Triprolidine ...... 116 Chlorpheniramine, Pseudoephedrine, and Codeine ...... 26 Triprolidine and Pseudoephedrine ...... 117 Chlorpheniramine, Pseudoephedrine, and Dextromethorphan ...... 26 Histamine H1 Antagonist, Second Generation Clemastine ...... 28 Acrivastine and Pseudoephedrine ...... 4 Codeine and Chlorpheniramine ...... 29 Azelastine (Ophthalmic) ...... 13 Codeine, Phenylephrine, and Triprolidine ...... 30 Cetirizine and Pseudoephedrine ...... 25 Cyproheptadine ...... 32 Cetirizine (Systemic) ...... 25 Dexbrompheniramine and Phenylephrine ...... 34 Epinastine ...... 42 Dexchlorpheniramine and Pseudoephedrine ...... 34 Fexofenadine ...... 49 Dexchlorpheniramine, Dextromethorphan, and Phenylephrine ...... 34 Fexofenadine and Pseudoephedrine ...... 49 Dextromethorphan and Chlorpheniramine ...... 35 Ketotifen (Ophthalmic) ...... 68 DimenhyDRINATE ...... 37 Loratadine ...... 73 Diphenhydramine and Ibuprofen ...... 37 Loratadine and Pseudoephedrine ...... 73 Diphenhydramine and Phenylephrine ...... 37 Olopatadine (Ophthalmic) ...... 87 DiphenhydrAMINE (Systemic) ...... 37 DiphenhydrAMINE (Topical) ...... 38 Histamine H2 Antagonist Doxylamine ...... 40 Cimetidine ...... 27 Epinastine ...... 42 Famotidine ...... 48 Fexofenadine ...... 49 Famotidine, Calcium Carbonate, and Magnesium Hydroxide ...... 48 Fexofenadine and Pseudoephedrine ...... 49 Nizatidine ...... 86 143 HISTONE DEACETYLASE INHIBITOR

Histone Deacetylase Inhibitor Insulin, Intermediate-Acting Valproic Acid and Derivatives ...... 118 Insulin NPH ...... 65 Homocystinuria, Treatment Agent Insulin-Like Growth Factor-1, Recombinant Betaine ...... 16 Mecasermin ...... 75 Hormone Insulin, Long-Acting Calcitonin ...... 20 Insulin Detemir ...... 64 Melatonin ...... 76 Insulin Glargine ...... 64 Hormone, Posterior Pituitary Insulin, Rapid-Acting Desmopressin ...... 33 Insulin Aspart ...... 64 Vasopressin ...... 118 Insulin Glulisine ...... 64 Insulin Lispro ...... 64 5-HT1AReceptor Partial Agonist Gadoterate Meglumine ...... 54 Insulin, Short-Acting Insulin Regular ...... 65 Hydrolytic Lysosomal N-terminal Tripeptidyl Peptidase Cerliponase Alfa ...... 25 Interferon Interferon Alfa-2b ...... 65 Hydroxyacid Oxidase 1 (HAO1)-Directed Small Interfering Interferon Alfa-n3 ...... 65 Ribonucleic Acid (siRNA) Interferon Beta-1a ...... 65 Lumasiran ...... 74 Interferon Beta-1b ...... 65 4-Hydroxyphenylpyruvate Dioxygenase Inhibitor Interferon Gamma-1b ...... 65 Nitisinone ...... 85 Peginterferon Alfa-2a ...... 91 Peginterferon Alfa-2b ...... 91 Hypnotic, Benzodiazepine Flurazepam ...... 52 Interleukin-1 Beta Inhibitor Canakinumab ...... 22 Hypnotic, Miscellaneous Eszopiclone ...... 45 Interleukin-1 Inhibitor Lemborexant ...... 69 Canakinumab ...... 22 Melatonin ...... 76 Rilonacept ...... 102 Zaleplon ...... 121 Interleukin-2 Inhibitor Zolpidem ...... 122 Basiliximab ...... 14 Imidazoline Derivative Interleukin-4 Receptor Antagonist Naphazoline and Pheniramine ...... 83 Dupilumab ...... 40 Naphazoline (Ophthalmic) ...... 83 Oxymetazoline (Nasal) ...... 89 Interleukin-5 Antagonist Oxymetazoline (Ophthalmic) ...... 89 Mepolizumab ...... 77 Tetrahydrozoline (Nasal) ...... 112 Reslizumab ...... 101 Tetrahydrozoline (Ophthalmic) ...... 112 Interleukin-5 Receptor Antagonist Immune Globulin Benralizumab ...... 15 Aducanumab ...... 5 Antithymocyte Globulin (Equine) ...... 10 Interleukin-6 Inhibitor Antithymocyte Globulin (Rabbit) ...... 10 Siltuximab ...... 105 Botulism Immune Globulin (Intravenous-Human) ...... 17 Interleukin-12 Inhibitor Cytomegalovirus Immune Globulin (Intravenous-Human) ...... 32 Ustekinumab ...... 118 Hepatitis B Immune Globulin (Human) ...... 58 Immune Globulin ...... 63 Interleukin-23 Inhibitor Rabies Immune Globulin (Human) ...... 100 Ustekinumab ...... 118 Rho(D) Immune Globulin ...... 101 Intravenous Nutritional Therapy Tetanus Immune Globulin (Human) ...... 112 Amino Acid Injection ...... 7 Varicella-Zoster Immune Globulin (Human) ...... 118 Cysteine ...... 32 Immunosuppressant Agent Dextrose ...... 35 Antithymocyte Globulin (Equine) ...... 10 Dextrose and Sodium Chloride ...... 35 Antithymocyte Globulin (Rabbit) ...... 10 Total Parenteral Nutrition ...... 115 AzaTHIOprine ...... 13 Iodinated Contrast Media Basiliximab ...... 14 Diatrizoate Meglumine ...... 36 Cladribine ...... 27 Diatrizoate Meglumine and Diatrizoate Sodium ...... 36 Cyclophosphamide ...... 31 Diatrizoate Meglumine and Iodipamide Meglumine ...... 36 CycloSPORINE (Ophthalmic) ...... 31 Iodixanol ...... 65 CycloSPORINE (Systemic) ...... 32 Iohexol ...... 66 Everolimus ...... 47 Iopamidol ...... 66 InFLIXimab ...... 63 Iopromide ...... 66 Mercaptopurine ...... 77 Iothalamate Meglumine ...... 66 Methotrexate ...... 78 Ioversol ...... 66 Mycophenolate ...... 83 Ioxilan ...... 66 Pimecrolimus ...... 94 RiTUXimab ...... 102 Iron Preparations Sirolimus ...... 106 Ferric Carboxymaltose ...... 49 Tacrolimus (Systemic) ...... 110 Ferric Citrate ...... 49 Tacrolimus (Topical) ...... 110 Ferric Gluconate ...... 49 Inhalation, Miscellaneous Ferric Pyrophosphate Citrate ...... 49 Ferrous Fumarate ...... 49 Inhalation Devices ...... 64 Ferrous Gluconate ...... 49 Inotrope Ferrous Sulfate ...... 49 DOBUTamine ...... 39 Ferumoxytol ...... 49 DOPamine ...... 39 Iron Dextran Complex ...... 66 Milrinone ...... 81 Iron Sucrose ...... 66 Polysaccharide-Iron Complex ...... 95 Insulin, Combination Polysaccharide-Iron Complex, Vitamin B12, and Folic Acid ...... 95 Insulin Aspart Protamine and Insulin Aspart ...... 64 Insulin Lispro Protamine and Insulin Lispro ...... 65 Irrigant Insulin NPH and Insulin Regular ...... 65 Sodium Chloride ...... 106 144 METABOLIC ALKALOSIS AGENT

Irrigating Solution Chloroprocaine ...... 25 Balanced Salt Solution ...... 14 Cocaine (Topical) ...... 29 Dextromethorphan and Menthol ...... 35 Janus Associated Kinase Inhibitor Dibucaine ...... 36 Fedratinib ...... 48 Ethyl Chloride ...... 47 Ruxolitinib ...... 103 Glycerin and Lidocaine ...... 56 Janus Kinase Inhibitor Hexylresorcinol ...... 59 Baricitinib ...... 14 Lidocaine and Epinephrine ...... 71 Lidocaine and Menthol ...... 71 Kallikrein Inhibitor Lidocaine and Prilocaine ...... 71 Ecallantide ...... 40 Lidocaine and Tetracaine ...... 71 Lanadelumab ...... 69 Lidocaine (Ophthalmic) ...... 71 Keratinocyte Growth Factor Lidocaine (Systemic) ...... 72 Palifermin ...... 89 Lidocaine (Topical) ...... 72 Mepivacaine ...... 77 Keratolytic Agent Mepivacaine and Levonordefrin ...... 77 Anthralin ...... 9 Phenylephrine and Pramoxine ...... 93 Podofilox ...... 94 Pramoxine ...... 97 Podophyllum Resin ...... 94 Prilocaine ...... 98 Salicylic Acid ...... 103 Prilocaine and Epinephrine ...... 98 Sinecatechins ...... 106 Proparacaine and Fluorescein ...... 99 Tazarotene ...... 110 Ropivacaine ...... 103 Trichloroacetic Acid ...... 116 Tetracaine (Ophthalmic) ...... 112 Urea (Topical) ...... 117 Tetracaine (Spinal) ...... 112 Laxative Tetracaine (Topical) ...... 112 Magnesium Hydroxide ...... 74 Local Anesthetic, Ophthalmic Magnesium Hydroxide and Mineral Oil ...... 74 Lidocaine (Ophthalmic) ...... 71 Methylcellulose ...... 79 Proparacaine ...... 99 Laxative, Bowel Evacuant Proparacaine and Fluorescein ...... 99 Polyethylene Glycol-Electrolyte Solution and Bisacodyl ...... 95 Tetracaine (Ophthalmic) ...... 112 Sodium Phosphates ...... 107 Local Anesthetic, Oral Laxative, Bulk-Producing Dyclonine ...... 40 Methylcellulose ...... 79 Polycarbophil ...... 94 Lubricant, Ocular Psyllium ...... 99 Hydroxypropyl Methylcellulose ...... 61 Wheat Dextrin ...... 120 Sodium Chloride ...... 106 Laxative, Lubricant Lung Surfactant Mineral Oil ...... 81 Beractant ...... 16 Mineral Oil (Light) ...... 81 Calfactant ...... 21 Lucinactant ...... 74 Laxative, Miscellaneous Poractant Alfa ...... 95 Castor Oil ...... 23 Lymphocyte Function-Associated Antigen 1 (LFA-1) Antagonist Laxative, Osmotic Lifitegrast ...... 72 Glycerin ...... 56 Lactulose ...... 69 Lysine Analog Polyethylene Glycol 3350 ...... 95 Aminocaproic Acid ...... 7 Polyethylene Glycol-Electrolyte Solution ...... 95 Tranexamic Acid ...... 115 Sodium Picosulfate, Magnesium Oxide, and Citric Acid ...... 107 Macrocyclic Gadolinium-Based Contrast Agent Sodium Sulfate, Potassium Sulfate, and Magnesium Sulfate ...... 107 Gadobutrol ...... 54 Sorbitol ...... 108 Gadoterate Meglumine ...... 54 Laxative, Saline Gadoteridol ...... 54 Magnesium Citrate ...... 74 Magnesium Salt Laxative, Stimulant Magnesium L-aspartate Hydrochloride ...... 74 Bisacodyl ...... 17 Magnesium L-lactate ...... 74 Docusate and Senna ...... 39 Magnesium Carbonate ...... 74 Polyethylene Glycol-Electrolyte Solution and Bisacodyl ...... 95 Magnesium Carbonate, Calcium Carbonate, and Folic Acid ...... 74 Senna ...... 105 Magnesium Chloride ...... 74 Sodium Picosulfate, Magnesium Oxide, and Citric Acid ...... 107 Magnesium Citrate ...... 74 Leptin Analog Magnesium Gluconate ...... 74 Magnesium Hydroxide ...... 74 Metreleptin ...... 80 Magnesium Oxide ...... 75 Leukotriene-Receptor Antagonist Magnesium Sulfate ...... 75 Montelukast ...... 82 Zafirlukast ...... 121 Mast Cell Stabilizer Cromolyn (Nasal) ...... 31 Linear Gadolinium-Based Contrast Agent Cromolyn (Ophthalmic) ...... 31 Gadobenate Dimeglumine ...... 54 Cromolyn (Oral Inhalation) ...... 31 Gadodiamide ...... 54 Cromolyn (Systemic) ...... 31 Gadofosveset ...... 54 Ketotifen (Ophthalmic) ...... 68 Gadopentetate Dimeglumine ...... 54 Lodoxamide ...... 73 Gadoversetamide ...... 54 Nedocromil (Ophthalmic) ...... 84 Gadoxetate ...... 54 Medical Food Lipase Inhibitor Methylfolate ...... 79 Orlistat ...... 88 Methylfolate, Methylcobalamin, and Acetylcysteine ...... 79 Local Anesthetic Phosphatidylserine, DHA, and EPA ...... 93 Articaine and Epinephrine ...... 11 Urea (Systemic) ...... 117 Benzocaine ...... 15 Melatonin Receptor Agonist Benzocaine, Butamben, and Tetracaine ...... 15 Melatonin ...... 76 Bupivacaine ...... 19 Bupivacaine and Epinephrine ...... 19 Metabolic Alkalosis Agent Bupivacaine (Liposomal) ...... 19 Carglumic Acid ...... 23 145 MINERALOCORTICOID (ALDOSTERONE) RECEPTOR ANTAGONISTS

Mineralocorticoid (Aldosterone) Receptor Antagonists Neuraminidase Inhibitor Eplerenone ...... 43 Oseltamivir ...... 88 Hydrochlorothiazide and Spironolactone ...... 59 Peramivir ...... 92 Spironolactone ...... 108 Zanamivir ...... 121 Mineral, Oral (Topical) Neuromuscular Blocker Agent, Depolarizing Triclosan and Fluoride ...... 116 Succinylcholine ...... 108 Miscellaneous Product Neuromuscular Blocker Agent, Nondepolarizing Coenzyme Q-10 ...... 30 Atracurium ...... 12 Diabetic Supplies ...... 35 Cisatracurium ...... 27 Mivacurium ...... 82 Mixed 5-HT1A Agonist/5-HT2A Antagonist Pancuronium ...... 90 Flibanserin ...... 50 Rocuronium ...... 103 Molybdenum Cofactor Vecuronium ...... 118 Fosdenopterin ...... 53 Neuromuscular Blocker Agent, Toxin Monoclonal Antibody AbobotulinumtoxinA ...... 2 Adalimumab ...... 4 IncobotulinumtoxinA ...... 63 Aducanumab ...... 5 OnabotulinumtoxinA ...... 88 Alemtuzumab ...... 6 RimabotulinumtoxinB ...... 102 Alirocumab ...... 6 N-Methyl-D-Aspartate (NMDA) Receptor Antagonist Ansuvimab ...... 9 Dextromethorphan ...... 35 Basiliximab ...... 14 Dextromethorphan and Quinidine ...... 35 Belimumab ...... 14 Esketamine ...... 44 Bezlotoxumab ...... 17 Memantine ...... 76 Burosumab ...... 19 Canakinumab ...... 22 Nonsteroidal Anti-inflammatory Drug (NSAID) Denosumab ...... 33 Diclofenac (Ophthalmic) ...... 36 Dupilumab ...... 40 Diclofenac (Systemic) ...... 36 Eculizumab ...... 40 Diclofenac (Topical) ...... 36 Emapalumab ...... 41 Nonsteroidal Anti-inflammatory Drug (NSAID), COX-2 Selective Evinacumab ...... 47 Amlodipine and Celecoxib ...... 8 Evolocumab ...... 47 Celecoxib ...... 24 Golimumab ...... 56 Ibritumomab Tiuxetan ...... 62 Nonsteroidal Anti-inflammatory Drug (NSAID), Ophthalmic IdaruCIZUmab ...... 62 Bromfenac ...... 18 Inebilizumab ...... 63 Diclofenac (Ophthalmic) ...... 36 InFLIXimab ...... 63 Flurbiprofen (Ophthalmic) ...... 52 Lanadelumab ...... 69 Ketorolac (Ophthalmic) ...... 68 Ocrelizumab ...... 86 Nepafenac ...... 84 Ofatumumab ...... 87 Phenylephrine and Ketorolac ...... 93 Palivizumab ...... 90 Nonsteroidal Anti-inflammatory Drug (NSAID), Oral Ranibizumab ...... 101 Aspirin ...... 12 Ravulizumab ...... 101 Diclofenac and Misoprostol ...... 36 RiTUXimab ...... 102 Diclofenac (Systemic) ...... 36 Romosozumab ...... 103 Diflunisal ...... 37 Satralizumab ...... 104 Diphenhydramine and Ibuprofen ...... 37 Secukinumab ...... 104 Etodolac ...... 47 Sotrovimab ...... 108 Fenoprofen ...... 49 Ustekinumab ...... 118 Flurbiprofen (Systemic) ...... 52 Vedolizumab ...... 118 Hydrocodone and Ibuprofen ...... 60 Monoclonal Antibody, Anti-Asthmatic Ibuprofen ...... 62 Benralizumab ...... 15 Ibuprofen, Phenylephrine, and Chlorpheniramine ...... 62 Dupilumab ...... 40 Ibuprofen, Pseudoephedrine, and Chlorpheniramine ...... 62 Indomethacin ...... 63 Mepolizumab ...... 77 Ketorolac (Systemic) ...... 68 Omalizumab ...... 87 Meloxicam ...... 76 Reslizumab ...... 101 Nabumetone ...... 83 Monoclonal Antibody, CGRP Antagonist Naproxen ...... 83 Erenumab ...... 43 Naproxen and Diphenhydramine ...... 84 Fremanezumab ...... 54 Naproxen and Esomeprazole ...... 84 Galcanezumab ...... 54 Oxaprozin ...... 88 Oxycodone and Ibuprofen ...... 89 Monoclonal Antibody, Complement Inhibitor Piroxicam (Systemic) ...... 94 Eculizumab ...... 40 Sulindac ...... 109 Ravulizumab ...... 101 Nonsteroidal Anti-inflammatory Drug (NSAID), Parenteral Monoclonal Antibody, Selective Adhesion-Molecule Inhibitor Ibuprofen ...... 62 Natalizumab ...... 84 Indomethacin ...... 63 Vedolizumab ...... 118 Ketorolac (Systemic) ...... 68 Mouthwash Meloxicam ...... 76 Diphenhydramine, Aluminum Hydroxide, and Magnesium Nonsteroidal Anti-inflammatory Drug (NSAID), Topical Hydroxide ...... 37 Diclofenac (Topical) ...... 36 Mouthwash ...... 82 Mouthwash, Magic ...... 82 Norepinephrine Reuptake Inhibitor, Selective AtoMOXetine ...... 12 mTOR Kinase Inhibitor Everolimus ...... 47 NS3/4A Inhibitor Sirolimus ...... 106 Glecaprevir and Pibrentasvir ...... 55 Ombitasvir, Paritaprevir, and Ritonavir ...... 87 Mucolytic Agent Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir ...... 87 Acetylcysteine ...... 4 Sofosbuvir, Velpatasvir, and Voxilaprevir ...... 107 Dornase Alfa ...... 39 NS5A Inhibitor Neprilysin Inhibitor Glecaprevir and Pibrentasvir ...... 55 Sacubitril and Valsartan ...... 103 Ledipasvir and Sofosbuvir ...... 69 146 PHENOTHIAZINE DERIVATIVE

Ombitasvir, Paritaprevir, and Ritonavir ...... 87 Opioid Antagonist Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir ...... 87 Morphine and Naltrexone ...... 82 Sofosbuvir and Velpatasvir ...... 107 Naloxone ...... 83 Sofosbuvir, Velpatasvir, and Voxilaprevir ...... 107 Naltrexone ...... 83 NS5B RNA Polymerase Inhibitor Olanzapine and Samidorphan ...... 87 Ledipasvir and Sofosbuvir ...... 69 Opioid Antagonist, Peripherally-Acting Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir ...... 87 Alvimopan ...... 7 Sofosbuvir and Velpatasvir ...... 107 Naldemedine ...... 83 Sofosbuvir, Velpatasvir, and Voxilaprevir ...... 107 Naloxegol ...... 83 Nutraceutical Orexin Receptor Antagonist Glucosamine ...... 56 Lemborexant ...... 69 Glucosamine and Chondroitin ...... 56 Otic Agent, Anti-infective Nutritional Supplement Acetic Acid (Otic) ...... 4 Biotin ...... 17 Acetic Acid, Propylene Glycol Diacetate, and Hydrocortisone ...... 4 Fluoride ...... 51 Aluminum Acetate and Acetic Acid ...... 6 Infant Nutritional Formulas ...... 63 L-Lysine ...... 73 Otic Agent, Cerumenolytic Medium Chain Triglycerides ...... 75 Carbamide Peroxide ...... 22 Nutritional Formula, Enteral/Oral ...... 86 Ovulation Stimulator Triheptanoin ...... 116 Chorionic Gonadotropin (Human) ...... 27 Ophthalmic Agent Chorionic Gonadotropin (Recombinant) ...... 27 Aflibercept (Ophthalmic) ...... 5 ClomiPHENE ...... 29 Brolucizumab ...... 18 Follitropin Alfa ...... 53 Cysteamine (Ophthalmic) ...... 32 Follitropin Beta ...... 53 Fluorescein and Benoxinate ...... 51 Menotropins ...... 76 Ocriplasmin ...... 87 Urofollitropin ...... 118 Pegaptanib ...... 91 Oxytocic Agent Ranibizumab ...... 101 Oxytocin ...... 89 Riboflavin 5'-Phosphate ...... 102 Trypan Blue ...... 117 P2Y12 Antagonist Verteporfin ...... 119 Cangrelor ...... 22 Ophthalmic Agent, Antiglaucoma Clopidogrel ...... 29 Prasugrel ...... 97 AcetaZOLAMIDE ...... 4 Ticagrelor ...... 113 Betaxolol (Ophthalmic) ...... 16 Bimatoprost ...... 17 Parathyroid Hormone Analog Brimonidine (Ophthalmic) ...... 18 Parathyroid Hormone ...... 90 Brinzolamide and Brimonidine ...... 18 Teriparatide ...... 112 Carteolol (Ophthalmic) ...... 23 Dorzolamide ...... 39 Partial Nicotine Agonist Dorzolamide and Timolol ...... 39 Varenicline ...... 118 Echothiophate Iodide ...... 40 Pediculocide Latanoprost ...... 69 Benzyl Alcohol ...... 16 Levobunolol ...... 70 Ivermectin (Topical) ...... 67 MethazolAMIDE ...... 77 Lindane ...... 72 Metipranolol ...... 79 Malathion ...... 75 Netarsudil and Latanoprost ...... 85 Permethrin ...... 92 Pilocarpine (Ophthalmic) ...... 93 Pyrethrins and Piperonyl Butoxide ...... 100 Timolol (Ophthalmic) ...... 113 Spinosad ...... 108 Unoprostone ...... 117 Pentasaccharide, Synthetic Ophthalmic Agent, Miotic Fondaparinux ...... 53 Acetylcholine ...... 4 Carbachol ...... 22 Peritoneal Dialysate, Osmotic Echothiophate Iodide ...... 40 Icodextrin ...... 62 Pilocarpine (Ophthalmic) ...... 93 Pharmaceutical Aid Ophthalmic Agent, Miscellaneous Alcohol (Ethyl) ...... 5 Artificial Tears ...... 11 Ammonium Alum ...... 8 Balanced Salt Solution ...... 14 Collodion, Flexible ...... 30 Carboxymethylcellulose ...... 23 Menthol ...... 76 Hydroxypropyl Cellulose ...... 61 Syrup, Simple ...... 110 MitoMYcin (Ophthalmic) ...... 81 Water for Injection (Bacteriostatic) ...... 120 Ophthalmic Irrigant Mixture ...... 88 Water for Injection (Sterile) ...... 120 Water for Irrigation (Sterile) ...... 120 Ophthalmic Agent, Mydriatic White Petrolatum ...... 120 Atropine (Ophthalmic) ...... 12 Cyclopentolate and Phenylephrine ...... 31 Pharmacologic Chaperone Homatropine ...... 59 Migalastat ...... 81 Phenylephrine and Ketorolac ...... 93 Phenylephrine (Ophthalmic) ...... 93 Phenothiazine Derivative Tropicamide ...... 117 Amitriptyline and Perphenazine ...... 8 ChlorproMAZINE ...... 26 Ophthalmic Agent, Toxin FluPHENAZine ...... 52 IncobotulinumtoxinA ...... 63 Methylene Blue ...... 79 OnabotulinumtoxinA ...... 88 Perphenazine ...... 92 Ophthalmic Agent, Vasoconstrictor Prochlorperazine ...... 98 Promethazine ...... 98 Naphazoline and Pheniramine ...... 83 Promethazine and Codeine ...... 98 Naphazoline (Ophthalmic) ...... 83 Promethazine and Dextromethorphan ...... 98 Tetrahydrozoline (Ophthalmic) ...... 112 Promethazine and Phenylephrine ...... 98 Ophthalmic Agent, Viscoelastic Promethazine, Phenylephrine, and Codeine ...... 98 Hyaluronate and Derivatives ...... 59 Thioridazine ...... 113 Sodium Chondroitin Sulfate and Sodium Hyaluronate ...... 106 Trifluoperazine ...... 116 147 PHENYLALANINE AMMONIA LYASE ENZYME

Phenylalanine Ammonia Lyase Enzyme Selexipag ...... 105 Pegvaliase ...... 91 Treprostinil ...... 115 Phenylalanine Ammonia Lyase, Recombinant Prostacyclin IP Receptor Agonist Pegvaliase ...... 91 Selexipag ...... 105 Phosphate Binder Prostaglandin Calcium Acetate ...... 21 Alprostadil ...... 6 Calcium Carbonate ...... 21 Carboprost Tromethamine ...... 23 Ferric Citrate ...... 49 Diclofenac and Misoprostol ...... 36 Lanthanum ...... 69 Dinoprostone ...... 37 Sevelamer ...... 105 Epoprostenol ...... 43 Sucroferric Oxyhydroxide ...... 108 Iloprost ...... 62 Phosphodiesterase-3 Enzyme Inhibitor MiSOPROStol ...... 81 Treprostinil ...... 115 Anagrelide ...... 9 Cilostazol ...... 27 Prostaglandin, Ophthalmic Milrinone ...... 81 Bimatoprost ...... 17 Phosphodiesterase-4 Enzyme Inhibitor Latanoprost ...... 69 Apremilast ...... 10 Netarsudil and Latanoprost ...... 85 Roflumilast ...... 103 Protectant, Topical Phosphodiesterase-5 Enzyme Inhibitor Aluminum Hydroxide ...... 7 Avanafil ...... 12 Balsam Peru and Castor Oil ...... 14 Sildenafil ...... 105 Menthol and Zinc Oxide (Topical) ...... 76 Tadalafil ...... 110 Poly-Ureaurethane ...... 95 Vardenafil ...... 118 Protein C Phosphodiesterase Enzyme Inhibitor, Nonselective Protein C Concentrate (Human) ...... 99 Aminophylline ...... 8 Prothrombin Complex Concentrate (PCC) Caffeine ...... 20 Factor IX Complex (Human) [(Factors II, IX, X)] ...... 48 Theophylline ...... 113 Prothrombin Complex Concentrate (Human) [(Factors II, VII, IX, X), Photosensitizing Agent, Topical Protein C, and Protein S] ...... 99 Aminolevulinic Acid (Topical) ...... 7 Proton Pump Inhibitor Piperazine Derivative Lansoprazole, Amoxicillin, and Clarithromycin ...... 69 Cetirizine and Pseudoephedrine ...... 25 Naproxen and Esomeprazole ...... 84 Cetirizine (Systemic) ...... 25 Omeprazole ...... 87 HydrOXYzine ...... 61 Omeprazole, Clarithromycin, and Amoxicillin ...... 88 Meclizine ...... 75 Pantoprazole ...... 90 RABEprazole ...... 100 Piperidine Derivative Cyproheptadine ...... 32 Psoralen Fexofenadine ...... 49 Methoxsalen (Systemic) ...... 78 Fexofenadine and Pseudoephedrine ...... 49 Ketotifen (Ophthalmic) ...... 68 Pyrimidine Synthesis Inhibitor Loratadine ...... 73 Teriflunomide ...... 112 Loratadine and Pseudoephedrine ...... 73 Radiological/Contrast Media, Ionic Olopatadine (Ophthalmic) ...... 87 Gadoterate Meglumine ...... 54 Plasma Volume Expander, Colloid Radiological/Contrast Media, Ionic (High Osmolality) Albumin ...... 5 Diatrizoate Meglumine ...... 36 Dextran ...... 34 Diatrizoate Meglumine and Diatrizoate Sodium ...... 36 Hetastarch ...... 59 Gadopentetate Dimeglumine ...... 54 Tetrastarch ...... 112 Iothalamate Meglumine ...... 66 Polyclonal Antibody Radiological/Contrast Media, Ionic (Low Osmolality) Antithymocyte Globulin (Equine) ...... 10 Antithymocyte Globulin (Rabbit) ...... 10 Diatrizoate Meglumine and Iodipamide Meglumine ...... 36 Gadoxetate ...... 54 Potassium Binder Patiromer ...... 90 Radiological/Contrast Media, Nonionic (High Osmolality) Sodium Polystyrene Sulfonate ...... 107 Gadobenate Dimeglumine ...... 54 Sodium Zirconium Cyclosilicate ...... 107 Gadobutrol ...... 54 Gadoversetamide ...... 54 Potassium Channel Blocker Iohexol ...... 66 Amifampridine ...... 7 Dalfampridine ...... 32 Radiological/Contrast Media, Nonionic (Iso-Osmolality) Iodixanol ...... 65 Probiotic Lactobacillus ...... 68 Radiological/Contrast Media, Nonionic (Low Osmolality) Saccharomyces boulardii ...... 103 Gadodiamide ...... 54 Gadofosveset ...... 54 Progestin Gadoteridol ...... 54 Etonogestrel ...... 47 Iohexol ...... 66 HYDROXYprogesterone Caproate ...... 61 Iopamidol ...... 66 Leuprolide and Norethindrone ...... 70 Iopromide ...... 66 Levonorgestrel (IUD) ...... 70 Ioversol ...... 66 Levonorgestrel (Systemic) ...... 70 Ioxilan ...... 66 MedroxyPROGESTERone ...... 75 Megestrol ...... 76 Radiological/Contrast Media, Paramagnetic Agent Norethindrone ...... 86 Gadobenate Dimeglumine ...... 54 Progesterone ...... 98 Gadobutrol ...... 54 Relugolix, Estradiol, and Norethindrone ...... 101 Gadodiamide ...... 54 Progestin Receptor Modulator Gadofosveset ...... 54 Gadopentetate Dimeglumine ...... 54 Ulipristal ...... 117 Gadoterate Meglumine ...... 54 Prostacyclin Gadoteridol ...... 54 Epoprostenol ...... 43 Gadoversetamide ...... 54 Iloprost ...... 62 Gadoxetate ...... 54 148 SKIN AND MUCOUS MEMBRANE AGENT

Radiopaque Agents Salsalate ...... 104 Barium ...... 14 Trolamine ...... 117 Radiopharmaceutical Scabicidal Agent Florbetapir F18 ...... 50 Crotamiton ...... 31 Fluciclovine F 18 ...... 50 Malathion ...... 75 Fludeoxyglucose F 18 ...... 50 Permethrin ...... 92 Flutemetamol F18 ...... 52 Sclerosing Agent Gallium Ga 68 Dotatate ...... 54 Ethanolamine Oleate ...... 45 Gallium Ga 68 PSMA-11 ...... 54 Polidocanol ...... 94 Ibritumomab Tiuxetan ...... 62 Sodium Tetradecyl Sulfate ...... 107 Indium 111 Capromab Pendetide ...... 63 Indium 111 Oxyquinoline ...... 63 Talc (Sterile) ...... 110 Indium In-111 Pentetreotide ...... 63 Sclerostin Inhibitor Iobenguane I 123 ...... 65 Romosozumab ...... 103 Iobenguane I 131 ...... 65 Iodinated I 131 Albumin ...... 65 Second Generation (Atypical) Antipsychotic Iodine I-125 Human Serum Albumin ...... 65 ARIPiprazole ...... 11 Ioflupane I 123 ...... 66 ARIPiprazole Lauroxil ...... 11 Pentetate Indium Disodium In 111 ...... 92 CloZAPine ...... 29 Piflufolastat F18 ...... 94 Lurasidone ...... 74 Radium Ra 223 Dichloride ...... 100 OLANZapine ...... 87 Samarium Sm 153 Lexidronam ...... 104 Olanzapine and Fluoxetine ...... 87 Strontium-89 ...... 108 Olanzapine and Samidorphan ...... 87 Technetium Tc 99m Albumin Aggregated ...... 110 Paliperidone ...... 90 Technetium Tc 99m Bicisate ...... 110 QUEtiapine ...... 100 Technetium Tc 99m Diethylene Triamine Penta-Acetic Acid ...... 110 RisperiDONE ...... 102 Technetium Tc 99m Disofenin ...... 110 Ziprasidone ...... 121 Technetium Tc 99m Exametazime ...... 110 Sedative Technetium Tc 99m-Labeled Red Blood Cells ...... 110 Acetaminophen, Isometheptene, and Dichloralphenazone ...... 4 Technetium Tc 99m Mebrofenin ...... 111 DexmedeTOMIDine ...... 34 Technetium Tc 99m Medronate ...... 111 Technetium Tc 99m Mertiatide ...... 111 Selective 5-HT3 Receptor Antagonist Technetium Tc 99m Oxidronate ...... 111 Alosetron ...... 6 Technetium Tc 99m Pentetate ...... 111 Fosnetupitant and Palonosetron ...... 54 Technetium Tc 99m Pyrophosphate ...... 111 Granisetron ...... 56 Technetium Tc 99m Sestamibi ...... 111 Netupitant and Palonosetron ...... 85 Technetium Tc 99m Sodium Pertechnetate ...... 111 Ondansetron ...... 88 Technetium Tc 99m Sulfur Colloid ...... 111 Palonosetron ...... 90 Technetium Tc 99m Tetrofosmin ...... 111 Technetium Tc 99m Tilmanocept ...... 111 Selective Bradykinin B2 Receptor Antagonist Thallous Chloride TI 201 ...... 113 Icatibant ...... 62 Xenon Xe 133 Gas ...... 121 Selective Estrogen Receptor Modulator (SERM) Rauwolfia Alkaloid ClomiPHENE ...... 29 Reserpine ...... 101 Estrogens (Conjugated/Equine) and Bazedoxifene ...... 44 Ospemifene ...... 88 Recombinant Human Nerve Growth Factor Raloxifene ...... 100 Cenegermin ...... 24 Tamoxifen ...... 110 Rehydration, Oral Toremifene ...... 115 Oral Rehydration Therapy ...... 88 Selective Relaxant Binding Agent Renal Replacement Solution Sugammadex ...... 108 Continuous Renal Replacement Therapy Solutions ...... 30 Selective T-Cell Costimulation Blocker Rescue Agent (Chemotherapy) Belatacept ...... 14 Leucovorin Calcium ...... 70 Serotonin 5-HT1B, 1D Receptor Agonist LEVOleucovorin ...... 70 Eletriptan ...... 41 Respiratory Stimulant Naratriptan ...... 84 Ammonia Spirit (Aromatic) ...... 8 Rizatriptan ...... 103 SUMAtriptan ...... 109 Retinoic Acid Derivative ZOLMitriptan ...... 121 Adapalene ...... 5 Fluocinolone, Hydroquinone, and Tretinoin ...... 51 Serotonin 5HT-2 Receptor Agonist Halobetasol and Tazarotene ...... 58 Fenfluramine ...... 48 ISOtretinoin (Systemic) ...... 67 Serotonin 5-HT4 Receptor Agonist Tazarotene ...... 110 Metoclopramide ...... 79 Tretinoin (Systemic) ...... 115 Tegaserod ...... 111 Tretinoin (Topical) ...... 115 Shampoo, Pediculocide Retinoid-Like Compound Pyrethrins and Piperonyl Butoxide ...... 100 Acitretin ...... 4 Skeletal Muscle Relaxant Rho Kinase Inhibitor Baclofen ...... 14 Netarsudil ...... 85 Carisoprodol ...... 23 Netarsudil and Latanoprost ...... 85 Carisoprodol and Aspirin ...... 23 Rifamycin Carisoprodol, Aspirin, and Codeine ...... 23 Rifabutin ...... 102 Chlorzoxazone ...... 26 RifAMPin ...... 102 Cyclobenzaprine ...... 31 Rifamycin ...... 102 Dantrolene ...... 32 Rifapentine ...... 102 Metaxalone ...... 77 RifAXIMin ...... 102 Methocarbamol ...... 78 Orphenadrine ...... 88 Salicylate Orphenadrine, Aspirin, and Caffeine ...... 88 Aspirin ...... 12 Choline Magnesium Trisalicylate ...... 27 Skin and Mucous Membrane Agent Magnesium Salicylate ...... 75 Imiquimod ...... 63 149 SKIN AND MUCOUS MEMBRANE AGENT, MISCELLANEOUS

Skin and Mucous Membrane Agent, Miscellaneous Thyroid Product Dextranomer and Hyaluronate Derivatives ...... 34 Levothyroxine ...... 71 Emollients ...... 41 Liothyronine ...... 72 Hyaluronate and Derivatives ...... 59 Liotrix ...... 72 Thyroid, Desiccated ...... 113 Smoking Cessation Aid BuPROPion ...... 19 Tissue-Selective Estrogen Complex (TSEC) Nicotine ...... 85 Estrogens (Conjugated/Equine) and Bazedoxifene ...... 44 Varenicline ...... 118 Topical Skin Product Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor Absorption Base ...... 2 Empagliflozin ...... 41 Aluminum Acetate ...... 6 Empagliflozin and Linagliptin ...... 41 Aluminum Chloride Hexahydrate ...... 6 Empagliflozin and Metformin ...... 42 Aminolevulinic Acid (Topical) ...... 7 Empagliflozin, Linagliptin, and Metformin ...... 42 Becaplermin ...... 14 Benzoin ...... 15 Sodium Salt Benzoyl Peroxide ...... 15 Sodium Chloride ...... 106 Benzoyl Peroxide and Hydrocortisone ...... 16 Soluble Guanylate Cyclase (sGC) Stimulator Benzyl Alcohol ...... 16 Riociguat ...... 102 Calamine ...... 20 Vericiguat ...... 119 Calcipotriene ...... 20 Camphor ...... 21 Somatostatin Analog Camphor and Menthol ...... 21 Lanreotide ...... 69 Camphor and Phenol ...... 22 Octreotide ...... 87 Capsaicin ...... 22 Pasireotide ...... 90 Cleansing Lotion ...... 28 Clindamycin and Benzoyl Peroxide ...... 28 Spermicide Coal Tar ...... 29 Nonoxynol 9 ...... 86 Coal Tar and Salicylic Acid ...... 29 Sphingosine 1-Phosphate (S1P) Receptor Modulator Collodion, Flexible ...... 30 Fingolimod ...... 50 DiphenhydrAMINE (Topical) ...... 38 Ozanimod ...... 89 Doxepin (Topical) ...... 39 Siponimod ...... 106 Eflornithine ...... 41 Emollients ...... 41 Spleen Tyrosine Kinase (Syk) Inhibitor Erythromycin (Topical) ...... 44 Fostamatinib ...... 54 Fluorouracil (Topical) ...... 52 Imiquimod ...... 63 Stool Softener Ingenol Mebutate ...... 64 Docusate ...... 39 Lactic Acid ...... 68 Docusate and Senna ...... 39 Lactic Acid and Ammonium Hydroxide ...... 68 Substance P/Neurokinin 1 Receptor Antagonist Lanolin ...... 69 Aprepitant ...... 10 Lanolin, Cetyl Alcohol, Glycerin, Petrolatum, and Mineral Oil ...... 69 Fosaprepitant ...... 53 Menthol and Zinc Oxide (Topical) ...... 76 Fosnetupitant and Palonosetron ...... 54 Minoxidil (Topical) ...... 81 Oatmeal (Colloidal) ...... 86 Netupitant and Palonosetron ...... 85 Pimecrolimus ...... 94 Substituted Benzimidazole Podofilox ...... 94 Lansoprazole, Amoxicillin, and Clarithromycin ...... 69 Povidone-Iodine (Topical) ...... 96 Naproxen and Esomeprazole ...... 84 Pyrithione Zinc ...... 100 Omeprazole ...... 87 Selenium Sulfide ...... 105 Omeprazole, Clarithromycin, and Amoxicillin ...... 88 Sinecatechins ...... 106 Pantoprazole ...... 90 Surgical Lubricant ...... 110 RABEprazole ...... 100 Tacrolimus (Topical) ...... 110 Trolamine ...... 117 Substrate Replacement Therapy Urea (Topical) ...... 117 Fosdenopterin ...... 53 Vitamin A and Vitamin D (Topical) ...... 119 Survival of Motor Neuron 2 (SMN2)-Directed RNA Splicing Modifier White Petrolatum ...... 120 Zinc Gelatin ...... 121 Risdiplam ...... 102 Zinc Oxide ...... 121 Sympathomimetic Topical Skin Product, Acne Acetaminophen, Isometheptene, and Dichloralphenazone ...... 4 Adapalene ...... 5 Benzphetamine ...... 16 Azelaic Acid ...... 13 Diethylpropion ...... 37 Benzoyl Peroxide ...... 15 Methamphetamine ...... 77 Benzoyl Peroxide and Hydrocortisone ...... 16 Phendimetrazine ...... 92 Clindamycin and Benzoyl Peroxide ...... 28 Phentermine ...... 93 Clindamycin (Topical) ...... 28 Thioamide Erythromycin and Benzoyl Peroxide ...... 43 MethIMAzole ...... 78 Erythromycin (Topical) ...... 44 Propylthiouracil ...... 99 Salicylic Acid ...... 103 Sulfacetamide (Topical) ...... 109 Thrombolytic Agent Sulfur and Sulfacetamide ...... 109 Alteplase ...... 6 Tazarotene ...... 110 Defibrotide ...... 33 Tretinoin (Topical) ...... 115 Tenecteplase ...... 111 Topical Skin Product, Antibacterial Thrombopoietic Agent Silver Nitrate ...... 105 Avatrombopag ...... 13 Eltrombopag ...... 41 Trace Element Lusutrombopag ...... 74 Zinc Chloride ...... 121 RomiPLOStim ...... 103 Zinc Gluconate ...... 121 Zinc Sulfate ...... 121 Thrombopoietin Receptor Agonist Avatrombopag ...... 13 Trace Element, Parenteral Eltrombopag ...... 41 Copper ...... 30 Lusutrombopag ...... 74 Manganese ...... 75 Selenium ...... 104 Thymidine Phosphorylase Inhibitor Sodium Iodide ...... 107 Trifluridine and Tipiracil ...... 116 Trace Elements ...... 115 150 VASODILATOR

Transient Receptor Potential Vanilloid 1 (TRPV1) Agonist Vaccine, Adenovirus Vector Capsaicin ...... 22 COVID-19 Vaccine (Adenovirus Vector) ...... 31 Transthyretin Stabilizer Vaccine, Inactivated (Bacterial) Tafamidis ...... 110 Anthrax Vaccine Adsorbed ...... 9 Diphtheria and Tetanus Toxoids ...... 38 Tryptophan Hydroxylase Inhibitor Diphtheria and Tetanus Toxoids, Acellular Pertussis, and Poliovirus Telotristat Ethyl ...... 111 Vaccine ...... 38 Tumor Necrosis Factor (TNF) Blocking Agent Diphtheria and Tetanus Toxoids, Acellular Pertussis, Poliovirus and Adalimumab ...... 4 Haemophilus b Conjugate Vaccine ...... 38 Golimumab ...... 56 Diphtheria and Tetanus Toxoids, and Acellular Pertussis Vaccine ...... 38 InFLIXimab ...... 63 Diphtheria, Tetanus Toxoids, Acellular Pertussis, Hepatitis B (Recombinant), and Poliovirus (Inactivated) Vaccine ...... 38 Tyrosine Hydroxylase Inhibitor Haemophilus b Conjugate Vaccine ...... 58 MetyroSINE ...... 80 Meningococcal Group B Vaccine ...... 76 Tyrosine Kinase Inhibitor Meningococcal (Groups A / C / Y and W-135) Conjugate Vaccine ...... 76 Meningococcal Polysaccharide (Groups C and Y) and Haemophilus b Fostamatinib ...... 54 Tetanus Toxoid Conjugate Vaccine ...... 76 Nintedanib ...... 85 Pneumococcal Conjugate Vaccine (13-Valent) ...... 94 Urea Cycle Disorder (UCD) Treatment Agent Pneumococcal Conjugate Vaccine (20-Valent) ...... 94 Carglumic Acid ...... 23 Pneumococcal Polysaccharide Vaccine (Polyvalent) ...... 94 Glycerol Phenylbutyrate ...... 56 Typhoid Vaccine ...... 117 Sodium Phenylacetate and Sodium Benzoate ...... 107 Vaccine, Inactivated (Viral) Sodium Phenylbutyrate ...... 107 Diphtheria and Tetanus Toxoids, Acellular Pertussis, and Poliovirus Uric Acid Transporter 1 (URAT1) Inhibitor Vaccine ...... 38 Lesinurad and Allopurinol ...... 69 Diphtheria and Tetanus Toxoids, Acellular Pertussis, Poliovirus and Haemophilus b Conjugate Vaccine ...... 38 Uricosuric Agent Diphtheria, Tetanus Toxoids, Acellular Pertussis, Hepatitis B Colchicine and Probenecid ...... 30 (Recombinant), and Poliovirus (Inactivated) Vaccine ...... 38 Probenecid ...... 98 Hepatitis A and Hepatitis B Recombinant Vaccine ...... 58 Urinary Acidifying Agent Hepatitis A Vaccine ...... 58 Potassium Acid Phosphate ...... 95 Hepatitis B Vaccine (Recombinant [Adjuvanted]) ...... 59 Potassium Phosphate ...... 96 Influenza A Virus Vaccine (H5N1) ...... 63 Influenza Virus Vaccine (Inactivated) ...... 63 Urinary Tract Product Japanese Encephalitis Virus Vaccine (Inactivated) ...... 67 Acetohydroxamic Acid ...... 4 Papillomavirus (9-Valent) Vaccine (Human, Recombinant) ...... 90 Citric Acid, Magnesium Carbonate, and Glucono-Delta-Lactone ...... 27 Papillomavirus (Types 6, 11, 16, 18) Vaccine (Human, Cysteamine (Systemic) ...... 32 Recombinant) ...... 90 Dimethyl Sulfoxide ...... 37 Poliovirus Vaccine (Inactivated) ...... 94 Methenamine, Phenyl Salicylate, Atropine, Hyoscyamine, Benzoic Acid, Rabies Vaccine ...... 100 and Methylene Blue ...... 78 Tiopronin ...... 114 Vaccine, Live (Bacterial) BCG Vaccine (Immunization) ...... 14 Vaccine Cholera Vaccine ...... 26 Adenovirus (Types 4, 7) Vaccine ...... 5 Typhoid Vaccine ...... 117 Anthrax Vaccine Adsorbed ...... 9 BCG Vaccine (Immunization) ...... 14 Vaccine, Live (Viral) Cholera Vaccine ...... 26 Adenovirus (Types 4, 7) Vaccine ...... 5 COVID-19 Vaccine (Adenovirus Vector) ...... 31 Influenza Virus Vaccine (Live/Attenuated) ...... 64 COVID-19 Vaccine (mRNA) ...... 31 Measles, Mumps, and Rubella Virus Vaccine ...... 75 Diphtheria and Tetanus Toxoids ...... 38 Measles, Mumps, Rubella, and Varicella Virus Vaccine ...... 75 Diphtheria and Tetanus Toxoids, Acellular Pertussis, and Poliovirus Rotavirus Vaccine ...... 103 Vaccine ...... 38 Varicella Virus Vaccine ...... 118 Diphtheria and Tetanus Toxoids, Acellular Pertussis, Poliovirus and Yellow Fever Vaccine ...... 121 Haemophilus b Conjugate Vaccine ...... 38 Zoster Vaccine (Live/Attenuated) ...... 122 Diphtheria and Tetanus Toxoids, and Acellular Pertussis Vaccine ...... 38 Vaccine, mRNA Diphtheria, Tetanus Toxoids, Acellular Pertussis, Hepatitis B COVID-19 Vaccine (mRNA) ...... 31 (Recombinant), and Poliovirus (Inactivated) Vaccine ...... 38 Haemophilus b Conjugate Vaccine ...... 58 Vaccine, Recombinant Hepatitis A and Hepatitis B Recombinant Vaccine ...... 58 Hepatitis B Vaccine (Recombinant [Adjuvanted]) ...... 59 Hepatitis A Vaccine ...... 58 Influenza Virus Vaccine (Recombinant) ...... 64 Hepatitis B Vaccine (Recombinant [Adjuvanted]) ...... 59 Zoster Vaccine (Recombinant) ...... 122 Influenza A Virus Vaccine (H5N1) ...... 63 Influenza Virus Vaccine (Inactivated) ...... 63 Vascular Endothelial Growth Factor (VEGF) Inhibitor Influenza Virus Vaccine (Live/Attenuated) ...... 64 Aflibercept (Ophthalmic) ...... 5 Influenza Virus Vaccine (Recombinant) ...... 64 Bevacizumab ...... 16 Japanese Encephalitis Virus Vaccine (Inactivated) ...... 67 Brolucizumab ...... 18 Measles, Mumps, and Rubella Virus Vaccine ...... 75 Pegaptanib ...... 91 Measles, Mumps, Rubella, and Varicella Virus Vaccine ...... 75 Ranibizumab ...... 101 Meningococcal Group B Vaccine ...... 76 SUNItinib ...... 109 Meningococcal (Groups A / C / Y and W-135) Conjugate Vaccine ...... 76 Ziv-Aflibercept (Systemic) ...... 121 Meningococcal Polysaccharide (Groups C and Y) and Haemophilus b Vasoconstrictor Tetanus Toxoid Conjugate Vaccine ...... 76 Epinephrine (Racemic) and Aluminum Potassium Sulfate ...... 43 Papillomavirus (9-Valent) Vaccine (Human, Recombinant) ...... 90 Oxymetazoline (Ophthalmic) ...... 89 Papillomavirus (Types 6, 11, 16, 18) Vaccine (Human, Recombinant) ...... 90 Vasodilator Pneumococcal Conjugate Vaccine (13-Valent) ...... 94 Alprostadil ...... 6 Pneumococcal Conjugate Vaccine (20-Valent) ...... 94 Ambrisentan ...... 7 Pneumococcal Polysaccharide Vaccine (Polyvalent) ...... 94 Amyl Nitrite ...... 9 Poliovirus Vaccine (Inactivated) ...... 94 Bosentan ...... 17 Rabies Vaccine ...... 100 Cilostazol ...... 27 Rotavirus Vaccine ...... 103 Dipyridamole ...... 38 Typhoid Vaccine ...... 117 Epoprostenol ...... 43 Varicella Virus Vaccine ...... 118 HydrALAZINE ...... 59 Yellow Fever Vaccine ...... 121 Iloprost ...... 62 Zoster Vaccine (Live/Attenuated) ...... 122 Isosorbide Dinitrate ...... 67 Zoster Vaccine (Recombinant) ...... 122 Isosorbide Dinitrate and Hydralazine ...... 67 151 VASODILATOR

Isosorbide Mononitrate ...... 67 Isoxsuprine ...... 67 Macitentan ...... 74 Nitroglycerin ...... 86 Nitroprusside ...... 86 Papaverine ...... 90 Selexipag ...... 105 Treprostinil ...... 115 Vasodilator, Direct-Acting Diazoxide ...... 36 Minoxidil (Systemic) ...... 81 Vasopressin Analog, Synthetic Desmopressin ...... 33 Vasopressin Antagonist Conivaptan ...... 30 Tolvaptan ...... 114 Vesicular Monoamine Transporter 2 (VMAT2) Inhibitor Deutetrabenazine ...... 34 Tetrabenazine ...... 112 Valbenazine ...... 118 Vitamin Folic Acid, Cyanocobalamin, and Pyridoxine ...... 53 Magnesium Carbonate, Calcium Carbonate, and Folic Acid ...... 74 Vitamin B Complex Combinations ...... 119 Vitamins (Multiple/Injectable) ...... 120 Vitamins (Multiple/Oral) ...... 120 Vitamins (Multiple/Pediatric) ...... 120 Vitamins (Multiple/Prenatal) ...... 120 Vitamin D Analog Calcipotriene ...... 20 Calcipotriene and Betamethasone ...... 20 Calcitriol (Systemic) ...... 20 Calcitriol (Topical) ...... 20 Cholecalciferol ...... 26 Doxercalciferol ...... 39 Ergocalciferol ...... 43 Paricalcitol ...... 90 Vitamin, Fat Soluble Beta-Carotene ...... 16 Calcium and Vitamin D ...... 21 Phytonadione ...... 93 Vitamin A ...... 119 Vitamin A and Vitamin D (Systemic) ...... 119 Vitamin E (Systemic) ...... 120 Vitamin E (Topical) ...... 120 Vitamin, Water Soluble Ascorbic Acid ...... 11 Biotin ...... 17 Cyanocobalamin ...... 31 Folic Acid ...... 53 Hydroxocobalamin ...... 61 Leucovorin Calcium ...... 70 Magnesium Carbonate, Calcium Carbonate, and Folic Acid ...... 74 Niacin ...... 85 Niacinamide ...... 85 Potassium P-Aminobenzoate ...... 96 Pyridoxine ...... 100 Riboflavin ...... 102 Thiamine ...... 113 Vitamin B Complex, Ascorbic Acid, and Folic Acid ...... 119 Vitreolytic Ocriplasmin ...... 87 Xanthine Oxidase Inhibitor Allopurinol ...... 6 Lesinurad and Allopurinol ...... 69 152