Bureau of Prisons Health Services Winter 2020 National Formulary Part 2 IV Refrigeration:N/A Part. GPI Cd: N/A Item Type: N/A MRC Init. Only:No Include NF Use Criteria: Yes DEA Schedule:N/A Project Group: N/A Pill Line Only: No Include Advisory:Yes Include Restrictions:Yes Medi-Span Rt: N/A IV Type: N/A Requires Crushing: No Include. Default Sig: No Unit Dose:No Active Loc.:No Dosage Forms:N/A MLP Requires Cosign:No Form./Non: Formulary Include Look/Sound:No Active: No Changes Since: N/A Include Diagnosis: No MRC Use Only: No Non Substitutable: No Medguide:No Cosign Crush. Pill Ln Active Schd. Fmlry Dose Req. Sub. DEA MLP Only Bulk Loc. Non Unit Doctor Name Item Name Dosage Form GPI Code Abacavir Sulfate (ABC) Oral Soln 20mg/ml Abacavir Sulfate(ABC) Oral Soln 20 MG/ML 240ml (Ziagen) Sol 12105005102020 No 0 Yes Yes No No N/A No Yes **MLP Requires Cosign** Abacavir Sulfate (ABC) Tablet Abacavir (ABC) 300 MG TAB UD (Ziagen) Tab 12105005100320 No 0 Yes No No No N/A Yes Yes Abacavir (ABC) 300 MG TAB (Ziagen) Tab 12105005100320 No 0 Yes No No No N/A No Yes **MLP Requires Cosign** Abacavir Sulfate/Lamivudine 600mg/300 mgTablet Abacavir Sulfate/Lamivudine 600MG/300MG TAB (Epzicom) Tab 12109902200340 No 0 Yes No No No N/A No Yes Abacavir Sulfate/Lamivudine 600MG/300MG Tab UD (Epzicom) Tab 12109902200340 No 0 Yes No No No N/A Yes Yes **MLP Requires Cosign** Abacavir-Lamivudine-Zidovudine Tablet Abacavir-Lamivudine-Zidovud 300-150-300MG TAB UD (Trizivir) Tab 12109903200320 No 0 Yes No No No N/A Yes Yes Abacavir-Lamivudine-Zidovudine 300-150-300MG tab (Trizivir) Tab 12109903200320 No 0 Yes No No No N/A No Yes **MLP Requires Cosign** Ace Aerosol Spacer Ace Spacer Miscellaneous 97100000006300 No 0 No Yes No No N/A No Yes Acetaminophen 325 MG Tablet Acetaminophen 325 MG Tab (Tylenol) Tab 64200010000310 No 0 No No No No N/A No Yes Acetaminophen 325 MG Tab (OTC) 24 count (Tylenol) Tab 64200010000310 No 0 No No No No N/A No Yes Acetaminophen 325 MG Tab (OTC) 50 count (Tylenol) Tab 64200010000310 No 0 No No No No N/A No Yes Acetaminophen 325 MG Tab (OTC) 100 count Tab 64200010000310 No 0 No No No No N/A No Yes Acetaminophen 325 MG Tab UD (Tylenol) Tab 64200010000310 No 0 No No No No N/A Yes Yes Advisories: **Formulary OTC medications may only be prescribed as a maintenance medication associated with ongoing follow up in a chronic care clinic and is supported by an appropriate and commensurate indication. Refer to the Formulary OTC Prescribing Criteria Matrix contained within the BOP National Formulary, Part I.** Generated 11/30/2020 11:54 by Davis, James T. RPh Bureau of Prisons - VIP Page 1 of 189 Cosign Crush. Pill Ln Active Schd. Fmlry Dose Req. Sub. DEA MLP Only Bulk Loc. Non Unit Doctor Name Item Name Dosage Form GPI Code Acetaminophen Oral Solution Acetaminophen elixir 160mg/5ml - 473 ml (Tylenol) Elixir 64200010001015 No 0 No Yes No No N/A No Yes Acetaminophen elixir 650mg/20.3ml UD Cup (Tylenol) Elixir 64200010001015 No 0 No No No No N/A Yes Yes Advisories: **Formulary OTC medications may only be prescribed as a maintenance medication associated with ongoing follow up in a chronic care clinic and is supported by an appropriate and commensurate indication. Refer to the Formulary OTC Prescribing Criteria Matrix contained within the BOP National Formulary, Part I.** Acetaminophen Oral Solution 160 MG/5ML Acetaminophen 160MG/5ML Oral Solution 120 ML (Pain & Fever) Sol 64200010002010 No 0 No Yes No No N/A No Yes Acetaminophen Oral Liquid 160 MG/5ML - 120 ml Liq 64200010000912 No 0 No Yes No No N/A No Yes Acetaminophen Oral Liquid 160 MG/5ML - 237 ml Liq 64200010000912 No 0 No Yes No No N/A No Yes Acetaminophen Oral Liquid 160 MG/5ML - 473 ml Liq 64200010000912 No 0 No Yes No No N/A No Yes Acetaminophen Oral Solution 160 MG/5ML UD [5ml] Sol 64200010002010 No 0 No Yes No No N/A Yes Yes Acetaminophen Oral Suspension 160 MG/5ML 118 ML (Pain & Fever infants) Susp 64200010001840 No 0 No Yes No No N/A No Yes Acetaminophen Oral Suspension 160 MG/5ML 30ML (Pain & Fever infants) Susp 64200010001840 No 0 No Yes No No N/A No Yes Acetaminophen Oral Suspension 160 MG/5ML 5ML UD (Pain & Fever infants) Susp 64200010001840 No 0 No Yes No No N/A Yes Yes Acetaminophen Oral Suspension 160 MG/5ML 60ML (Pain & Fever infants) Susp 64200010001840 No 0 No Yes No No N/A No Yes Acetaminophen Sol 160 MG/5ML [480ml] (Tylenol) Sol 64200010002010 No 0 No Yes No No N/A No Yes Advisories: **Formulary OTC medications may only be prescribed as a maintenance medication associated with ongoing follow up in a chronic care clinic and is supported by an appropriate and commensurate indication. Refer to the Formulary OTC Prescribing Criteria Matrix contained within the BOP National Formulary, Part I.** Acetaminophen Oral Solution 650 MG/20.3ML Acetaminophen Oral Solution 325 MG/10.15ML Sol 64200010002010 No 0 No Yes No No N/A Yes Yes Acetaminophen Sol 650 MG/20.3ML UD (Tylenol) Sol 64200010002010 No 0 No No No No N/A Yes Yes Advisories: **Formulary OTC medications may only be prescribed as a maintenance medication associated with ongoing follow up in a chronic care clinic and is supported by an appropriate and commensurate indication. Refer to the Formulary OTC Prescribing Criteria Matrix contained within the BOP National Formulary, Part I.** Acetaminophen Rectal Suppository 325 MG Acetaminophen Rectal Suppository 325 MG (Acephen) Supp 64200010005215 No 0 No Yes No No N/A No Yes Advisories: **Formulary OTC medications may only be prescribed as a maintenance medication associated with ongoing follow up in a chronic care clinic and is supported by an appropriate and commensurate indication. Refer to the Formulary OTC Prescribing Criteria Matrix contained within the BOP National Formulary, Part I.** Acetaminophen Suppositories 120 mg Acetaminophen Rectal Suppository 120 MG (Tylenol) Supp 64200010005205 No 0 No Yes No No N/A No Yes Advisories: **Formulary OTC medications may only be prescribed as a maintenance medication associated with ongoing follow up in a chronic care clinic and is supported by an appropriate and commensurate indication. Refer to the Formulary OTC Prescribing Criteria Matrix contained within the BOP National Formulary, Part I.** Acetaminophen Suppositories 650 mg Acetaminophen Rectal Suppository 650 MG (Tylenol) Supp 64200010005220 No 0 No Yes No No N/A No Yes Generated 11/30/2020 11:54 by Davis, James T. RPh Bureau of Prisons - VIP Page 2 of 189 Cosign Crush. Pill Ln Active Schd. Fmlry Dose Req. Sub. DEA MLP Only Bulk Loc. Non Unit Doctor Name Item Name Dosage Form GPI Code Advisories: **Formulary OTC medications may only be prescribed as a maintenance medication associated with ongoing follow up in a chronic care clinic and is supported by an appropriate and commensurate indication. Refer to the Formulary OTC Prescribing Criteria Matrix contained within the BOP National Formulary, Part I.** Acetaminophen Suspension 1000 MG/30ML Acetaminophen Suspension 1000 MG/30ML [240 ml] (Tylenol Extra Strength Suspension) Liq 64200010000914 No 0 No Yes No No N/A No Yes Advisories: **Formulary OTC medications may only be prescribed as a maintenance medication associated with ongoing follow up in a chronic care clinic and is supported by an appropriate and commensurate indication. Refer to the Formulary OTC Prescribing Criteria Matrix contained within the BOP National Formulary, Part I.** Acetaminophen/Codeine 300/15 MG Tablet Acetaminophen-Codeine #2 300-15 MG tab (Tylenol #2) Tab 65991002050310 No 3 Yes No Yes Yes N/A No Yes Advisories: ****ORDER MAY NOT EXCEED 30 DAYS** **PILL LINE ONLY** **IMMEDIATE RELEASE, NON-ENTERIC COATED, ORAL CONTROLLED SUBSTANCES ARE TO BE CRUSHED PRIOR TO ADMINISTRATION** **IMMEDIATE RELEASE, CONTROLLED SUBSTANCE CAPSULES SHOULD BE PULLED APART AND ADMINISTERED IN POWDER FORM**** **MLP Requires Cosign** Acetaminophen/Codeine 300/30 MG Tablets Acetaminophen/Codeine 300/30MG Tab (Tylenol #3) Tab 65991002050315 No 3 Yes No Yes Yes N/A No Yes Acetaminophen/Codeine 300/30MG Tab UD (Tylenol #3) Tab 65991002050315 No 3 Yes No Yes Yes N/A Yes Yes Advisories: ****ORDER MAY NOT EXCEED 30 DAYS** **PILL LINE ONLY** **IMMEDIATE RELEASE, NON-ENTERIC COATED, ORAL CONTROLLED SUBSTANCES ARE TO BE CRUSHED PRIOR TO ADMINISTRATION** **IMMEDIATE RELEASE, CONTROLLED SUBSTANCE CAPSULES SHOULD BE PULLED APART AND ADMINISTERED IN POWDER FORM**** **MLP Requires Cosign** Acetaminophen/Codeine 300/60MG Tablet Acetaminophen/Codeine 300/60MG Tab (Tylenol #4) Tab 65991002050320 No 3 Yes No Yes Yes N/A No Yes Acetaminophen/Codeine 300/60MG Tab UD (Tylenol #4) Tab 65991002050320 No 3 Yes No Yes Yes N/A Yes Yes Advisories: ****ORDER MAY NOT EXCEED 30 DAYS** **PILL LINE ONLY** **IMMEDIATE RELEASE, NON-ENTERIC COATED, ORAL CONTROLLED SUBSTANCES ARE TO BE CRUSHED PRIOR TO ADMINISTRATION** **IMMEDIATE RELEASE, CONTROLLED SUBSTANCE CAPSULES SHOULD BE PULLED APART AND ADMINISTERED IN POWDER FORM**** **MLP Requires Cosign** Acetaminophen/Codeine Oral Soln 120-12 MG/5ML Acetaminophen-Codeine Soln 120-12 MG/5ML 480ML Sol 65991002052020 No 5 Yes Yes Yes No N/A No Yes Acetaminophen/Codeine 120MG/12 MG/5ML (5ML) Soln (Tylenol with Codeine Solution) Sol 65991002052020 No 5 Yes Yes Yes No N/A No Yes Acetaminophen/Codeine 120MG/12MG/5ML (5ML) Susp (Tylenol with Codeine Solution) Susp 65991002051805 No 5 Yes Yes Yes No N/A No Yes Acetaminophen/Codeine 120MG/12MG/5ML (5ML)Sol UD Sol 65991002052020 No 5 Yes Yes Yes No N/A Yes Yes Acetaminophen/Codeine 120MG/12MG/5ML, 10ML soln (Tylenol with Codeine Solution) Sol 65991002052020 No 5 Yes Yes Yes No N/A No Yes Acetaminophen/Codeine 120MG/12MG/5ML, 15ML soln (Tylenol with Codeine Solution) Sol 65991002052020 No 5 Yes Yes Yes No N/A Yes Yes Acetaminophen/Codeine 120MG/12MG/5ML,12.5ML Soln (Tylenol with Codeine Solution) Sol 65991002052020 No 5 Yes Yes Yes No N/A Yes Yes Generated 11/30/2020 11:54 by Davis, James T.