QUALIFIED HEALTH PLAN FORMULARY · 2021. 6. 3. · please contact EnvisionRxOptions at...

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QUALIFIED HEALTH PLAN FORMULARY

Effective November 2014

Provided by EnvisionRxOptions

Introduction

The Total Health Care (THC) Qualified Health Plan Formulary was developed to serve as a guide for

physicians, pharmacists, health care professionals and members in the selection of cost-effective drug

therapy. Total Health Care recognizes that drug therapy is an integral part of effective health

management.

Total Health Care continually reviews new and existing medications to ensure the Formulary remains

responsive to the needs of our members and health professionals. Criteria used to evaluate drug

selection for the formulary includes, but is not limited to: safety, efficacy and cost-effectiveness data,

as well as comparison of relevant benefits of similar prescription or over-the counter (OTC) agents

while minimizing potential duplications.

Notice

The information contained in this formulary is provided by THC & EnvisionRxOptions, solely for the

convenience of medical providers and members. THC does not warrant or assure accuracy of this

information, nor is it intended to be comprehensive in nature.

This formulary is not intended to be a substitute for the knowledge, expertise, skill or judgment of the

medical provider in their choice of prescription drugs. Total Health Care assumes no responsibility for

the actions or omissions of any medical provider based upon reliance, in whole or in part, on the

information contained herein. The medical provider should consult the drug manufacturer’s product

literature or standard references for more detailed information.

How to Read the Formulary

All formulary drugs are listed either by their generic names (in lowercase) or by their brand names (in

uppercase). Drugs are grouped together by their therapeutic drug category. Specific drug listings may

be accessed by using the index, using the covered generic name or the covered brand name of the drug.

Any drug not found in this Formulary listing shall be considered a non-formulary drug.

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Tier Guidelines

The Certificate of Coverage provided upon enrollment has specific information regarding co-payments,

co-insurance, annual deductible requirements and maximum out of pocket limits associated with the

corresponding pharmacy benefit.

Prescribing Guidelines

Prescribing guidelines may apply to select drugs on the THC formulary. Prescribing guidelines may

vary by benefit design but may include:

Age Limit (AL) Drug coverage may depend on patient age.

Prior Authorization

Required (PA)

Drug requires prior authorization through a specific physician request

process.

Step Therapy Required

(ST)

Drug coverage requires that an alternative or trial of another drug be used

before the medication is covered.

Quantity Limit (QL) Drug coverage may be limited to specific quantities per prescription

and/or time period.

Specialty Drugs (SP)

Drug requires processing through THC’s contracted specialty pharmacy,

Diplomat Specialty Pharmacy.

Gender Restriction (GE) Drug coverage may depend on patient gender.

Over the Counter Drugs

(OTC)

Drug coverage is available for drugs that are available OTC with an

authorized prescription from your provider.

Generic Tier 1

Preferred Brand Tier 2

Non-Preferred Brand

Non- Preferred Generic

Tier 3

Specialty Tier 4

Preventive Tier 5

$0 co-pay at in-network pharmacies

Medical Benefit Tier 6

Benefit may be available under medical coverage.

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Saving on Out-Of-Pocket Costs

Total Health Care has designed its prescription drug plan to encourage the use of generic and preferred

brand name drugs. Choosing non-preferred drugs may mean paying higher out-of-pocket expenses

(such as coinsurance and co-payments) or not receiving coverage at all. Members may also pay less for

generic drugs or they may be asked to pay the cost difference between brand name drugs and their

generic alternatives, which are preferred by the plan.

Benefit Coverage and Limitations

This formulary does not define benefit coverage and limitations. Many members have specific benefit

inclusions, exclusions, copayments, coinsurance or a lack of coverage, which are not reflected in the

THC Qualified Health Plan Formulary. Members should contact Total Health Care at 1-800-826-2862

if they have questions regarding their coverage. Please note that the formulary process is evolutionary

and changes can occur throughout the year.

Preventive Medications

Total Health Care covers certain preventive services for $0 co-pay when delivered by in-network

pharmacies. These drugs are indicated on the THC Qualified Health Plan Formulary under Drug

Tier 5. Examples of preventive medications include aspirin, contraceptives, iron supplementations,

smoking cessation products and Vitamin D drugs. These drugs are available with standard drug

coverage recommendations and are only available for certain populations.

Medical Benefit

Drugs indicated on the THC Qualified Health Plan Formulary under Drug Tier 6 are not available for

coverage as a pharmacy benefit. Please refer to the Certificate of Coverage to determine if drugs listed

as a Medical Benefit on the formulary are covered through the Medical Benefit.

Prior Authorization (PA)

Drugs indicated with a “PA” require Prior Authorization for coverage. A prescriber may complete a

Prior Authorization form that can be found on the Total Health Care website at www.THCmi.com. You

may also request a form by calling Total Health Care at 1-844-222-5584. Completed prior

authorization forms should be faxed to 1-877-503-7231. Prior Authorization review of prescribing

guidelines will be evaluated utilizing the established drug review criteria approved by Total Health

Care. If the request does not meet the approved criteria, the request will not be approved and

alternative therapy may be recommended along with the proper course of alternative action. The

requesting provider will be provided written notification of Total Health Care review decisions. THC’s

website has a contact link where members can contact THC’s Pharmacy Department to ask for an

exception request.

Non-Formulary Agents

Drugs not located on the Total Health Care Qualified Health Plan Formulary, or any updates published

by Total Health Care, shall be considered a non-formulary drug. Requests for coverage of non-

formulary agents may be requested by the health professional depending on specific coverage

parameters. Review for non-formulary drug requests will require a Prior Authorization request with

documentation of medical necessity. Generally, the following basic medical necessity guidelines are

used in conducting a review:

The patient has failed an appropriate trial of formulary or preferred agents.

The use of preferred or formulary agent is contraindicated in the patient.

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The formulary drug or preferred agents are not suited for the present patient care need, and the

drug selected is required for patient safety.

If the request does not meet the established guidelines request, it will not be approved and alternative

therapy may be recommended along with the proper course of alternative action.

Common Drug Exclusions

The member’s plan design may exclude certain drug classes. Prior authorization is generally not

available for drugs that are specifically excluded by benefit design. Common excluded coverages may

include, but are not limited to:

OTC medications or their equivalents unless otherwise specified in the Formulary listing.

Drug products used for cosmetic purposes

Experimental drug products, or any drug product used in an experimental manner

Foreign drugs or drugs not approved by the United States Food & Drug Administration (FDA)

Mandated Generic Substitution

Total Health Care advocates the use of cost-effective generic drugs where FDA-approved generic

equivalent drugs are available. Generic products are listed in the Formulary and noted in lowercase

lettering wherever an FDA-approved generic drug product is available. If a member or physician

requests a brand name product in lieu of an approved generic, the member, based upon their coverage,

will be required to pay the difference in cost between the brand and the generic drug, plus the

brand/non-preferred brand copay.

Total Health Care Pharmacy and Therapeutics (P&T) Committee

Total Health Care’s Pharmacy & Therapeutic Committee meets quarterly to review and recommend

medications for formulary consideration. The Committee considers clinical information on drugs that

are new to the market and drugs that are typically included in an outpatient pharmacy benefit. This

assures that the formulary remains responsive to patient and physician needs. The Committee is

composed of physicians, pharmacists, and health care professionals. The Committee also uses reference

materials from our Pharmacy Benefits Manager's Pharmacy and Therapeutics Advisory Panel.

Product Selection Criteria

The primary goal of the THC Pharmacy & Therapeutic Committee is to maintain and update the

formulary based upon an objective analysis of the safety, efficacy, approved indications, adverse

effects, contraindications, patient administration/compliance considerations and cost effectiveness of

available drugs. When a drug is considered for formulary inclusion, it will be reviewed relative to

similar drugs including those currently in the THC Formulary. Physicians may request a copy of THC’s

drug criteria by calling the Pharmacy Department at 1-800-826-2862.

Diabetic Testing Supplies

Total Health Care works with J&B Medical Supply to provide diabetic testing supplies to our members.

Covered diabetic testing supplies include Glucocard Vital glucometer, Glucocard Expression

glucometer, and SD Biosensor GlucoNavii glucometer, Glucocard Vital test strips, Glucocard

Expression test strips, SD Biosensor GlucoNavii test strips, lancets, insulin syringes, alcohol swabs and

ketone strips. These supplies are to be filled through J&B Medical Supply. If you have any questions

about our diabetic supply program, please contact J&B Medical Supply at 1-844-236-7933.

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Specialty Bio-Pharmaceutical Pharmacy Program

Total Health Care works with Diplomat Specialty Pharmacy to provide Specialty Bio-Pharmaceutical

Pharmacy products to our members. These medications are to be filled exclusively through Diplomat

Specialty Pharmacy.

A Specialty Drug Prior Authorization Request form must be completed and faxed to

EnvisionRxOptions at 1-877-503-7231 with supporting documentation and the prescription. A

prescriber may obtain a Specialty Drug Prior Authorization Request form found on the Total Health

Care website at www.THCmi.com.

Once the order is received, EnvisionRxOptions obtains authorization from Total Health Care. If the

specialty prior authorization is approved, Total Health Care notifies Diplomat Specialty Pharmacy.

Then the Diplomat Specialty Pharmacy staff ships the medication directly to the physician's office or

the patient’s home. All packages are individually marked for each patient and refrigerated items are

shipped in insulated containers. Where appropriate, each shipment includes needles, syringes and

alcohol swabs. If you have any questions about our Specialty Bio-Pharmaceutical Pharmacy program,

please contact EnvisionRxOptions at 1-844-222-5584 or Diplomat Specialty Pharmacy at 1-877-977-

9118.

Contact Information

The Total Health Care Qualified Health Plan Formulary is designed to assist physicians, members and

other health care professionals in the selection of cost-effective agents. Total Health Care encourages

your input and feedback on how we can assist in improving this document and the formulary

management process. You may contact THC at 1- 800-826-2862.

Medication Limitations

Age Limitations

Age Limitations are on medications throughout the formulary and are indicated with an "AL" notation.

Coverage for a medication is indicated by the age limitation. This could be a minimum age, maximum

age, and/or the combination of a minimum and maximum age edit.

Quantity Limitations Quantity Limitations are on medications throughout the formulary and are indicated with a "QL"

notation. These are medications that have a daily dose restriction, quantity/days’ supply limitation,

and/or a limitation on the duration of therapy.

Step Therapy Criteria

Step Therapy medications are indicated with a “ST” on the formulary and require that an alternative,

first line medication be tried and failed before the requested medication can be covered. The online

claims adjudication system will automatically allow for the requested medication to be filled based on

electronic claims history indicating that the first line medication was filled.

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Step Therapy Criteria

Therapy Class First Line Second Line Step Therapy Criteria

Anti-migraine sumatriptan,

rizatriptan

Axert, Relpax, Frova,

naratriptan, Zomig,

Treximet

Prior use of sumatriptan or

rizatriptan in the last 90 days

Angiotensin

Receptor

Blocker

losartan, losartan

HCTZ

Micardis/Micardis

HCTZ

Prior use of losartan or losartan

HCTZ in the last 90 days

Nasal

Corticosteroids

flunisolide,

fluticasone, Nasonex

Beconase AQ, QNASL,

Rhinocort, Veramyst,

Zetonna

Prior use of flunisolide, fluticasone

or Nasonex in last 180 days

Osteoporosis alendronate Actonel, Altelvia Prior use of alendronate within the

last 90 days.

Proton Pump

Inhibitors

Prilosec OTC,

Prevacid OTC,

Protonix and Zegerid

OTC

Dexilant Prior use of Prilosec OTC, Prevacid

OTC, Protonix and Zegerid OTC in

the last 30 days.

Urinary Anti-

spasmodics

oxybutynin,

oxybutynin-ER,

Oxytrol OTC

Detrol/Detrol LA,

Toviaz, Enablex,

Sanctura, Trospium,

Vesicare

Prior use of Oxytrol OTC,

oxybutynin, or oxybutynin-ER

within past 90 days.

Anti-depressants citalopram

escitalopram

Prior use of citalopram within past

120 days.

Gender Edits Gender edits are indicated with a “GE” on the formulary and require the member to be a specific

gender for coverage.

*Formulary Disclaimer: Coverage for some drugs may be limited to specific dosage forms and/or

strengths. The benefit design determines what is covered and the applicable co-payment. The

medications listed on this formulary are subject to change pursuant to the formulary management

activities of EnvisionRxOptions. The presence of a medication on this formulary list does not guarantee

coverage.

Drug Name Drug Tier Requirements/ Limits

AL-Age Limit, PA-Prior Authorization Required, ST-Step Therapy Required, QL-Quantity Limit per 30 days. For additional information call Member Services at 844-222-5584

Formulary last updated date (11/01/2014)

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FLAVOR PLUS LIQ 1

flavor plus liq 1

ANALGESICS Analgesics

ali-flex tab 50-500mg 1

ALPAIN TAB 1

APAP/CAFF/DI TAB HYDROCOD 1

ascomp/cod cap 30mg 1

biogesic tab 30-500mg 1

BIOREGESIC TAB 50-650MG 1

BUPAP TAB 50-650MG 1

but/apap/caf cap 1

but/apap/caf cap codeine 1

but/apap/caf tab 1

but/asa/caf/ cap cod 30mg 1

but/asa/caff cap 1

BUT/ASA/CAFF TAB 1

butal/apap tab 50-325mg 1

butalbital tab cpd 1

capacet cap 1

dologesic tab 30-500mg 1

dolorex tab 50-500mg 1

duraxin cap 1

ed-flex cap 1

esgic cap 1

margesic cap 1

marten-tab tab 50-325mg 1

orph/asa/caf tab 1

PRIALT INJ 100MCG 6

PRIALT INJ 25MCG/ML 6

promacet tab 50-650mg 1

RELAGESIC TAB 50-650MG 1

repan tab 1

RHINOFLEX TAB 50-650MG 1

tencon tab 50-325mg 1

TENCON TAB 50-650MG 1

TREZIX CAP 3

zebutal cap 1

zflex tab 1

ZGESIC TAB 66-600MG 1

Opioid Analgesics, Long-acting

astramorph inj 1mg/2ml 3 PA

astramorph inj 2mg/2ml 3 PA

duramorph inj 0.5mg/ml 3 PA

duramorph inj 1mg/ml 3 PA




2

fentanyl dis 100mcg/h 1 PA

fentanyl dis 12mcg/hr 1 PA




hydromorphon liq 1mg/ml 1

HYDROMORPHON SUP 3MG 1

hydromorphon tab 2mg 1



LAZANDA SPR 100MCG 3 PA

LEVORPHANOL TAB 2MG 1

meperidine inj 100mg/ml 3

MEPERIDINE INJ 10MG/ML 3



MEPERIDINE SOL 50MG/5ML 1

meperidine tab 100mg 1


meperitab tab 100mg 1


methadone con 10mg/ml 1

METHADONE INJ 10MG/ML 3

methadone sol 10mg/5ml 1


methadone tab 10mg 1


methadone tab 5mg 1

methadose tab 10mg 1


morphine sul inj 0.5mg/ml 3

MORPHINE SUL INJ 10/0.7ML 3

morphine sul inj 10mg/ml 3

MORPHINE SUL INJ 150/30ML 3



MORPHINE SUL INJ 25MG/ML 3





morphine sul sol 100/5ml 1

morphine sul sol 10mg/5ml 1


morphine sul sol 20mg/ml 1




3

MORPHINE SUL SUP 10MG 1




MORPHINE SUL TAB 15MG 1

MORPHINE SUL TAB 30MG 1

morphine sul tab 30mg 1

NUCYNTA ER TAB 100MG 3 PA





OXECTA TAB 5MG 3 PA

oxycodone cap 5mg 1

oxycodone con 100/5ml 1

oxycodone con 20mg/ml 1

oxycodone sol 5mg/5ml 1

oxycodone tab 10mg 1




oxycodone tab 5mg 1

SUBSYS SPR 100MCG 3 PA

Opioid Analgesics, Short-acting

apap/codeine sol 120-12/5 1

apap/codeine tab 300-15mg 1



co-gesic tab 5-500mg 1

CODEINE SULF SOL 30MG/5ML 1

CODEINE SULF TAB 15MG 1



CONZIP CAP 100MG 3 PA



endocet tab 10-325mg 1


endocet tab 2.5-325 1



endocet tab 7.5-500m 1

endodan tab 1

hydroco/apap sol 1

hydroco/apap sol 5-217/10 1




4

hydroco/apap sol 7.5-325 1


hydroco/apap tab 10-300mg 3






hydroco/apap tab 2.5-325 1










hydrocod/ibu tab 10-200mg 1

hydrocod/ibu tab 2.5-200 1



hydrogesic cap 5-500mg 1

ibudone tab 5-200mg 1

lorcet hd tab 10-325mg 1

lorcet plus tab 7.5-325 1

lorcet tab 5-325mg 1

lortab tab 10-325mg 1


lortab tab 7.5-325 1

OPANA ER TAB 10MG 3 PA






OPANA ER TAB 7.5MG 3 PA

oxycod/apap cap 5-500mg 1

oxycod/apap tab 10-325mg 1


oxycod/apap tab 2.5-325 1




oxycod/asa tab 1




5

oxycod/ibu tab 5-400mg 1

oxymorphone tab 10mg er 3 PA






oxymorphone tab 7.5mg er 3 PA

penta/apap tab 25-650mg 1

pentaz/nalox tab 50-0.5mg 1

reprexain tab 10-200mg 1

roxicet tab 5-325mg 1

RYBIX ODT TAB 50MG 3 PA

stagesic cap 5-500mg 1

TALWIN INJ 30MG/ML 3 PA

tramadl/apap tab 37.5-325 1

TRAMADOL HCL CAP 150MG ER 3

tramadol hcl tab 100mg er 3



tramadol hcl tab 50mg 1 QL 240/30

verdrocet tab 2.5-325 1

vicodin es tab 7.5-300 3

vicodin hp tab 10-300mg 3

vicodin tab 5-300mg 3

xylon tab 10-200mg 1

ZAMICET SOL 10-325MG 1

ANTI-ADDICTION/SUBSTANCE ABUSE TREATMENT AGENTS Alcohol Deterrents/Anti-craving

acampro cal tab 333mg 1

Opioid Antagonists

bupren/nalox sub 2-0.5mg 3 PA

bupren/nalox sub 8-2mg 3 PA

buprenorphin inj 0.3mg/ml 3 PA

buprenorphin sub 2mg 3 PA

buprenorphin sub 8mg 3 PA

butorphanol inj 1mg/ml 3


butorphanol sol 10mg/ml 1

BUTRANS DIS 10MCG/HR 3 PA



nalbuphine inj 10mg/ml 3


SUBOXONE MIS 12-3MG 3 PA




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SUBOXONE MIS 2-0.5MG 3 PA



Smoking Cessation Agents

buproban tab 150mg 5

bupropion tab 150mg 5

CHANTIX PAK 0.5& 1MG 5 QL 180/365

CHANTIX PAK 1MG 5 QL 180/365

CHANTIX TAB 0.5MG 5 QL 180/365

CHANTIX TAB 1MG 5 QL 180/365

cvs nicotine dis 14mg/24h 5 QL 90/365

cvs nicotine dis 7mg/24hr 5 QL 90/365

cvs nicotine gum 2mg cinn 5 QL 810/365

cvs nicotine gum 2mg mint 5 QL 810/365

cvs nicotine gum 2mg orig 5 QL 810/365

cvs nicotine gum 2mgfruit 5 QL 810/365

cvs nicotine gum 4mg cinn 5 QL 810/365

cvs nicotine gum 4mg mint 5 QL 810/365

cvs nicotine gum 4mg orig 5 QL 810/365

cvs nicotine gum 4mgfruit 5 QL 810/365

cvs nicotine loz 2mg 5 QL 810/365

cvs nicotine loz 2mg mint 5 QL 810/365

cvs nicotine loz 4mg mint 5 QL 810/365

cvs nts dis step 1 5 QL 90/365

eq nicotine dis 14mg/24h 5 QL 90/365

eq nicotine dis 21mg/24h 5 QL 90/365

eq nicotine dis 7mg/24hr 5 QL 90/365

eq nicotine gum 2mg cinn 5 QL 810/365

eq nicotine gum 2mg mint 5 QL 810/365

eq nicotine gum 2mg orig 5 QL 810/365

eq nicotine gum 2mgfruit 5 QL 810/365

eq nicotine gum 4mg cinn 5 QL 810/365

eq nicotine gum 4mg mint 5 QL 810/365

eq nicotine gum 4mg orig 5 QL 810/365

eq nicotine gum 4mg ref 5 QL 810/365

eq nicotine gum 4mg strt 5 QL 810/365

eq nicotine gum 4mgfruit 5 QL 810/365

eq nicotine loz 2mg cher 5 QL 810/365

eq nicotine loz 2mg mint 5 QL 810/365

eq nicotine loz 4mg chry 5 QL 810/365

eq nicotine loz 4mg mint 5 QL 810/365

eql nicotine dis 14mg/24h 5 QL 90/365

eql nicotine dis 21mg/24h 5 QL 90/365

eql nicotine dis 7mg/24hr 5 QL 90/365

eql nicotine gum 2mg 5 QL 810/365




7

eql nicotine gum 2mg ref 5 QL 810/365

eql nicotine gum 2mg strt 5 QL 810/365

eql nicotine gum 4mg 5 QL 810/365

eql nicotine gum 4mg ref 5 QL 810/365

eql nicotine gum 4mg strt 5 QL 810/365

eql nicotine loz 2mg mint 5 QL 810/365

eql nicotine loz 4mg mint 5 QL 810/365

gnp nicotine gum 2mg mint 5 QL 810/365

gnp nicotine gum 2mg orig 5 QL 810/365

gnp nicotine gum 4mg mint 5 QL 810/365

gnp nicotine gum 4mg orig 5 QL 810/365

gnp nicotine loz 2mg mint 5 QL 810/365

gnp nicotine loz 4mg mint 5 QL 810/365

hm nicotine dis 14mg/24h 5 QL 90/365

hm nicotine dis 21mg/24h 5 QL 90/365

hm nicotine gum 2mg mint 5 QL 810/365

hm nicotine gum 4mg mint 5 QL 810/365

hm nicotine loz 2mg mint 5 QL 810/365

hm nicotine loz 4mg mint 5 QL 810/365

kls quit2 gum 2mg 5 QL 810/365

kls quit4 gum 4mg 5 QL 810/365

nicorelief gum 2mg mint 5 QL 810/365

nicorelief gum 2mg orig 5 QL 810/365

nicorelief gum 4mg mint 5 QL 810/365

nicorelief gum 4mg orig 5 QL 810/365

nicorelief loz 2mg mint 5 QL 810/365

nicorelief loz 4mg mint 5 QL 810/365

nicotine dis 14mg/24h 5 QL 90/365

nicotine dis 21mg/24h 5 QL 90/365

nicotine dis 7mg/24hr 5 QL 90/365

nicotine dis step 1 5 QL 90/365



nicotine gum 2mgfruit 5 QL 810/365

nicotine gum 4mg 5 QL 810/365

nicotine loz 2mg chry 5 QL 810/365

nicotine loz 2mg mint 5 QL 810/365

nicotine loz 4mg chry 5 QL 810/365

nicotine loz 4mg cinn 5 QL 810/365

nicotine loz 4mg mint 5 QL 810/365

nicotine pol gum 2mg 5 QL 810/365

nicotine pol gum 2mg cinn 5 QL 810/365

nicotine pol gum 2mg mint 5 QL 810/365

nicotine pol gum 2mg orig 5 QL 810/365

nicotine pol gum 2mg ref 5 QL 810/365




8

nicotine pol gum 2mg strt 5 QL 810/365

nicotine pol gum 2mgfruit 5 QL 810/365

nicotine pol gum 4mg 5 QL 810/365

nicotine pol gum 4mg cinn 5 QL 810/365

nicotine pol gum 4mg mint 5 QL 810/365

nicotine pol gum 4mg orig 5 QL 810/365

nicotine pol gum 4mg ref 5 QL 810/365

nicotine pol gum 4mg strt 5 QL 810/365

nicotine pol gum 4mgfruit 5 QL 810/365

nicotine pol loz 2mg chry 5 QL 810/365

nicotine pol loz 2mg cinn 5 QL 810/365

nicotine pol loz 2mg mint 5 QL 810/365

nicotine pol loz 4mg chry 5 QL 810/365

nicotine pol loz 4mg cinn 5 QL 810/365

nicotine pol loz 4mg mint 5 QL 810/365

nicotine td dis 14mg/24h 5 QL 90/365

nicotine td dis 21mg/24h 5 QL 90/365

nicotine td dis 7mg/24hr 5 QL 90/365

NICOTROL INH 5

NICOTROL NS SPR 10MG/ML 5

ra nicotine dis 14mg/24h 5 QL 90/365

ra nicotine dis 21mg/24h 5 QL 90/365

ra nicotine dis 7mg/24hr 5 QL 90/365

ra nicotine gum 2mg 5 QL 810/365

ra nicotine gum 2mg cinn 5 QL 810/365

ra nicotine gum 2mg mint 5 QL 810/365

ra nicotine gum 2mgfruit 5 QL 810/365

ra nicotine gum 4mg 5 QL 810/365

ra nicotine gum 4mg frut 5 QL 810/365

ra nicotine gum 4mg mint 5 QL 810/365

ra nicotine loz 2mg mint 5 QL 810/365

ra nicotine loz 4mg mint 5 QL 810/365

sm nicotine dis 14mg/24h 5 QL 90/365

sm nicotine dis 21mg 5 QL 90/365

sm nicotine dis 7mg/24hr 5 QL 90/365

sm nicotine gum 2mg 5 QL 810/365

sm nicotine gum 2mg mint 5 QL 810/365

sm nicotine gum 4mg 5 QL 810/365

sm nicotine gum 4mg mint 5 QL 810/365

sm nicotine loz 2mg mint 5 QL 810/365

sm nicotine loz 4mg mint 5 QL 810/365

sr nicotine gum 2mg 5 QL 810/365

stop smoking gum 2mg mint 5 QL 810/365

stop smoking gum 2mg orig 5 QL 810/365

stop smoking gum 4mg 5 QL 810/365




9

stop smoking loz 2mg 5 QL 810/365

stop smoking loz 2mg mint 5 QL 810/365

stop smoking loz 4mg mint 5 QL 810/365

sw nicotine gum 2mg mint 5 QL 810/365

sw nicotine gum 4mg 5 QL 810/365

sw nicotine loz 2mg mint 5 QL 810/365

sw nicotine loz 4mg mint 5 QL 810/365

tgt nicotine dis 14mg/24h 5 QL 90/365

tgt nicotine dis 21mg/24h 5 QL 90/365

tgt nicotine dis 7mg/24hr 5 QL 90/365

tgt nicotine gum 2mg mint 5 QL 810/365

tgt nicotine gum 2mg orig 5 QL 810/365

tgt nicotine gum 2mgfruit 5 QL 810/365

tgt nicotine gum 4mg 5 QL 810/365

tgt nicotine gum 4mg mint 5 QL 810/365

tgt nicotine gum 4mg orig 5 QL 810/365

tgt nicotine loz 2mg chry 5 QL 810/365

tgt nicotine loz 2mg mint 5 QL 810/365

tgt nicotine loz 4mg chry 5 QL 810/365

tgt nicotine loz 4mg mint 5 QL 810/365

thrive gum 2mg mint 5 QL 810/365

thrive gum 4mg mint 5 QL 810/365

ANTI-INFLAMMATORY AGENTS Nonsteroidal Anti-inflammatory Drugs

asa low dose tab 81mg ec 5 QL 60/30 AL

aspir-81 tab 81mg ec 5 QL 60/30 AL

aspir-low tab 81mg ec 5 QL 60/30 AL

aspirin 81 tab 81mg ec 5 QL 60/30 AL

aspirin chil chw 81mg 5 QL 60/30 AL

aspirin chld chw 81mg 5 QL 60/30 AL

aspirin chw 81mg 5 QL 60/30 AL

aspirin low chw 81mg 5 QL 60/30 AL

aspirin low tab 81mg 5 QL 60/30 AL

aspirin low tab 81mg ec 5 QL 60/30 AL

aspirin tab 325mg 5 QL 30/30 AL

aspirin tab 325mg ec 5 QL 30/30 AL

aspirin tab 5gr ec 5 QL 30/30 AL

aspirin tab 81mg 5 QL 60/30 AL

aspirin tab 81mg ec 5 QL 60/30 AL

aspirtab tab 324mg ec 5 QL 30/30 AL

bayer adv tab 325mg 5 QL 30/30 AL

bayer asa tab 325mg 5 QL 30/30 AL

bayer low chw 81mg 5 QL 60/30 AL

bayer low tab 81mg ec 5 QL 60/30 AL

child asa chw 81mg 5 QL 60/30 AL




10

child asa ls chw 81mg 5 QL 60/30 AL

chld ibuprof sus 100/5ml 1

cho mag tris liq 500/5ml 1

cho mag tris tab 1000mg 1

cvs aspirin tab 325mg 5 QL 30/30 AL

cvs aspirin tab 325mg ec 5 QL 30/30 AL

cvs aspirin tab 81mg ec 5 QL 60/30 AL

cvs chld asa chw 81mg 5 QL 60/30 AL

diclo/misopr tab 50-0.2mg 1


diclofen pot tab 50mg 1

diclofenac tab 100mg er 1

diclofenac tab 25mg dr 1



diflunisal tab 500mg 1

ecotrin low tab 81mg ec 5 QL 60/30 AL

ecpirin tab 325mg ec 5 QL 30/30 AL

eq aspirin tab 325mg 5 QL 30/30 AL

eq aspirin tab 325mg ec 5 QL 30/30 AL

eq child asa chw 81mg 5 QL 60/30 AL

eql aspirin tab 325mg 5 QL 30/30 AL

eql aspirin tab 325mg ec 5 QL 30/30 AL

eql aspirin tab 81mg ec 5 QL 60/30 AL

eql chld asa chw 81mg 5 QL 60/30 AL

etodolac cap 200mg 1


etodolac er tab 400mg 1



etodolac tab 400mg 1


FENOPROFEN TAB 600MG 1

flurbiprofen tab 100mg 1


gnp aspirin chw 81mg 5 QL 60/30 AL

gnp aspirin tab 325mg 5 QL 30/30 AL

gnp aspirin tab 325mg ec 5 QL 30/30 AL

gnp aspirin tab 81mg ec 5 QL 60/30 AL

HALFPRIN TAB 162MG EC 5

halfprin tab 81mg ec 5 QL 60/30 AL

hm aspirin chw 81mg 5 QL 60/30 AL

hm aspirin tab 325mg 5 QL 30/30 AL

ibuprofen sus 100/5ml 1

ibuprofen tab 400mg 1




11



indomethacin cap 25mg 1 AL

indomethacin cap 50mg 1 AL

indomethacin cap 75mg er 1 AL

KETOPROFEN CAP 200MG ER 3 QL 30/30

ketoprofen cap 50mg 1 QL 180/30

ketoprofen cap 75mg 1 QL 120/30

ketorolac inj 15mg/ml 3


ketorolac inj 60mg/2ml 3

ketorolac tab 10mg 1 QL 20/23

kls aspirin tab 325mg ec 5 QL 30/30 AL

kls aspirin tab 81mg ec 5 QL 60/30 AL

kp aspirin tab 81mg ec 5 QL 60/30 AL

MECLOFEN SOD CAP 100MG 1

MECLOFEN SOD CAP 50MG 1

medi-profen sus 100/5ml 1

MELOXICAM SUS 7.5/5ML 3

meloxicam tab 15mg 1

meloxicam tab 7.5mg 1

miniprin low tab 81mg ec 5 QL 60/30 AL

mm aspirin tab 325mg 5 QL 30/30 AL

MOBIC SUS 7.5/5ML 3

MST 600 TAB 1

nabumetone tab 500mg 1 QL 120/30

nabumetone tab 750mg 1 QL 60/30

NAPRELAN TAB 500MG CR 3

NAPRELAN TAB 750MG CR 3 PA

naproxen dr tab 375mg 1


naproxen sod tab 275mg 1


naproxen sus 125/5ml 1

naproxen tab 250mg 1



norwich asa tab 325mg 5 QL 30/30 AL

oxaprozin tab 600mg 1

piroxicam cap 10mg 1


px aspirin chw 81mg 5 QL 60/30 AL

px aspirin tab 325mg 5 QL 30/30 AL

px aspirin tab 325mg ec 5 QL 30/30 AL

px aspirin tab 81mg ec 5 QL 60/30 AL




12

px profen ib sus 100/5ml 1

qc aspirin tab 325mg 5 QL 30/30 AL

qc aspirin tab 325mg ec 5 QL 30/30 AL

qc child asa chw 81mg 5 QL 60/30 AL

ra aspirin chw 81mg 5 QL 60/30 AL

ra aspirin tab 325mg 5 QL 30/30 AL

ra aspirin tab 325mg ec 5 QL 30/30 AL

ra aspirin tab 81mg ec 5 QL 60/30 AL

ra child asa chw 81mg 5 QL 60/30 AL

salsalate tab 500mg 1


sb aspirin tab 325mg 5 QL 30/30 AL

sb aspirin tab 325mg ec 5 QL 30/30 AL

sb child asa chw 81mg 5 QL 60/30 AL

sm aspirin chw 81mg 5 QL 60/30 AL

sm aspirin tab 325mg 5 QL 30/30 AL

sm aspirin tab 325mg ec 5 QL 30/30 AL

sm aspirin tab 81mg ec 5 QL 60/30 AL

sm child asa chw 81mg 5 QL 60/30 AL

SPRIX SPR 15.75MG 3

st joseph as chw 81mg 5 QL 60/30 AL

sulindac tab 150mg 1


tgt aspirin chw 81mg 5 QL 60/30 AL

tgt aspirin chw child 5 QL 60/30 AL

tgt aspirin tab 325mg 5 QL 30/30 AL

tgt aspirin tab 81mg ec 5 QL 60/30 AL

th aspirin tab 325mg 5 QL 30/30 AL

th aspirin tab 325mg ec 5 QL 30/30 AL

th aspirin tab 81mg ec 5 QL 60/30 AL

tolmetin sod cap 400mg 1

TOLMETIN SOD TAB 200MG 3

TOLMETIN SOD TAB 600MG 3

ANTIBACTERIALS Aminoglycosides

neomycin tab 500mg 1

Antibacterials, Other

clindamycin cap 150mg 1



clindamycin sol 75mg/5ml 1

CUBICIN SOL 500MG 3 PA

DAPSONE TAB 100MG 1

DAPSONE TAB 25MG 1

e.s.p. sus 200-600 1




13

ees/sulfisox sus 200-600 1

FLAGYL ER TAB 750MG 3

KETEK TAB 400MG 3

methenam hip tab 1gm 1

METHENAM MAN TAB 500MG 1

metronidazol cap 375mg 1

metronidazol tab 250mg 1


MONUROL PAK GRANULES 3

NEBUPENT INH 300MG 3

nitrofur mac cap 100mg 1


nitrofurantn sus 25mg/5ml 1

PENTAM 300 INJ 300MG 3

PRIMSOL SOL 50MG/5ML 3

SMZ-TMP INJ 400-80/5 6

smz-tmp sus 1

smz-tmp sus 200-40/5 1

smz-tmp tab 400-80mg 1

smz/tmp ds tab 800-160 1

sulfatrim pd sus 200-40/5 1

tinidazole tab 250mg 1


trimethoprim tab 100mg 1

TYGACIL INJ 50MG 6

vancomycin inj 1 gm 1

vancomycin inj 1000mg 1

vancomycin inj 10gm 1


VANCOMYCIN INJ 750MG 3

VIBATIV INJ 250MG 6

ZYVOX SOL 2MG/ML 3 PA

ZYVOX SUS 100MG/5M 3 PA

ZYVOX TAB 600MG 3 PA

Beta-lactam, Cephalosporins

cefaclor cap 250mg 1


CEFACLOR ER TAB 500MG 1

CEFACLOR SUS 125/5ML 1



cefadroxil cap 500mg 1

cefadroxil sus 250/5ml 1


cefadroxil tab 1gm 1




14

cefazolin inj 500mg 6

cefdinir cap 300mg 1

cefdinir sus 125/5ml 1 AL

cefdinir sus 250/5ml 1 AL

cefpodo prox sus 100/5ml 1

cefpodo prox sus 50mg/5ml 1

cefpodoxime tab 100mg 1


cefprozil sus 125/5ml 1


cefprozil tab 250mg 1


CEFTRIAX/DEX INJ 1GM 6

CEFTRIAX/DEX INJ 2GM 6

ceftriaxone inj 10gm 1

ceftriaxone inj 250mg 1


cefuroxime tab 250mg 1


cephalexin cap 250mg 1


cephalexin cap 750mg 1 PA

cephalexin sus 125/5ml 1


CEPHALEXIN TAB 250MG 1

CEPHALEXIN TAB 500MG 1

MEFOXIN INJ 1GM/50ML 6

SUPRAX SUS 500/5ML 3 AL

Beta-lactam, Other

AZACTAM/DEX INJ 1GM 6

Beta-lactam, Penicillins

amox-pot cla tab er 1

amox/k clav chw 200mg 1


amox/k clav sus 200/5ml 1




amox/k clav tab 250mg 1 QL 28/14



amoxicillin cap 250mg 1


AMOXICILLIN CHW 125MG 1

AMOXICILLIN CHW 250MG 1




15

amoxicillin sus 125/5ml 1




amoxicillin tab 500mg 1


ampicillin cap 250mg 1


AMPICILLIN INJ 10GM 6

AMPICILLIN INJ 125MG 6

ampicillin inj 1gm 6

AMPICILLIN INJ 2GM 6

AMPICILLIN SUS 125/5ML 1

AMPICILLIN SUS 250/5ML 1

AUGMENTIN SUS 125/5ML 2

BICILLIN L-A INJ 600000 4 PA

dicloxacill cap 250mg 1


penicilln vk sol 125/5ml 1


penicilln vk tab 250mg 1


Macrolides

azithromycin inj 500mg 1

AZITHROMYCIN POW 1GM PAK 3 QL 30/30

azithromycin sus 100/5ml 1


azithromycin tab 250mg 1 QL 120/30

azithromycin tab 500 mg 1 QL 12/30

azithromycin tab 600mg 1 QL 60/30

clarithromyc sus 125/5ml 1


clarithromyc tab 250mg 1


clarithromyc tab 500mg er 1

DIFICID TAB 200MG 3 PA

E.E.S. 400 TAB 400MG 1

ERY-TAB TAB 333MG EC 3

ERYTHROCIN TAB 250MG 1

ERYTHROM ETH TAB 400MG 1

erythromycin cap 250mg ec 1

ERYTHROMYCIN TAB 250MG BS 1

ERYTHROMYCIN TAB 500MG BS 1

PCE TAB 500MG EC 3

ZITHROMAX POW 1GM PAK 3 QL 30/30




16

Quinolones

ciprofloxacn sus 250mg/5 3


ciprofloxacn tab 1000mg 1




ciprofloxacn tab 500mg er 1


FACTIVE TAB 320MG 3

levofloxacin tab 250mg 1 QL 14/30



moxifloxacin tab 400mg 3

NOROXIN TAB 400MG 3

ofloxacin tab 200mg 1



Sulfonamides

SULFADIAZINE TAB 500MG 1

Tetracyclines

ALODOX KIT 20MG 3

avidoxy tab 100mg 1

demeclocycl tab 150mg 1


doxycyc mono tab 100mg 1




doxycycl hyc cap 100mg 1


doxycycl hyc tab 100mg 1

doxycycl hyc tab 100mg dr 3



doxycycline cap 150mg 3


doxycycline sus 25mg/5ml 1

doxycycline tab 20mg 1

minocycline cap 100mg 1



minocycline tab 100mg 1

minocycline tab 135mg er 3 PA





17




morgidox cap 1x100mg 1


OCUDOX KIT 3

SOLODYN TAB 55MG 3 PA

TETRACYCLINE CAP 250MG 1

TETRACYCLINE CAP 500MG 1

ANTICONVULSANTS Anticonvulsants, Other

BANZEL SUS 40MG/ML 3

LEVETIRACETA INJ 10MG/ML 6



levetiraceta sol 100mg/ml 1

levetiraceta sol 500/5ml 1

levetiraceta tab 1000mg 1 QL 90/30



levetiraceta tab 500mg er 1



levetiracetm inj 500/5ml 1

phenobarb elx 20mg/5ml 1

PHENOBARB INJ 130MG/ML 6

PHENOBARB INJ 65MG/ML 6

phenobarb sol 20mg/5ml 1

phenobarb tab 16.2mg 1


PHENOBARB TAB 64.8MG 1

PHENOBARB TAB 97.2MG 1

POTIGA TAB 200MG 3

POTIGA TAB 300MG 3

POTIGA TAB 400MG 3

POTIGA TAB 50MG 3

Benzodiazepines

clonazep odt tab 0.125mg 1



clonazep odt tab 1mg 1


clonazepam tab 0.5mg 1

clonazepam tab 1mg 1





18

DIASTAT ACDL GEL 12.5-20 3

DIASTAT ACDL GEL 5-10MG 3

DIASTAT PED GEL 2.5M GEL 3

DIAZEPAM GEL 10MG 3

DIAZEPAM GEL 2.5MG 3

DIAZEPAM GEL 20MG 3

Calcium Channel Modifying Agents

CELONTIN CAP 300MG 2

ethosuximide cap 250mg 1

ethosuximide sol 250/5ml 1

LYRICA CAP 100MG 3

LYRICA CAP 150MG 3

LYRICA CAP 200MG 3

LYRICA CAP 225MG 3

LYRICA CAP 25MG 3

LYRICA CAP 300MG 3

LYRICA CAP 50MG 3

LYRICA CAP 75MG 3

LYRICA SOL 20MG/ML 3 PA

zonisamide cap 100mg 1 QL 180/30



Gamma-aminobutyric Acid (GABA) Augmenting Agents

divalproex cap 125mg 1

divalproex tab 125mg dr 1


divalproex tab 250mg er 1



gabapentin cap 100mg 1



gabapentin sol 250/5ml 1

gabapentin tab 600mg 1


GABITRIL TAB 12MG 3

GABITRIL TAB 16MG 3

primidone tab 250mg 1


SABRIL POW 500MG 4 PA

STAVZOR CAP 125MG 3

tiagabine tab 2mg 1

tiagabine tab 4mg 1

valproate inj 100mg/ml 6

valproate inj 500/5ml 6




19

valproic acd cap 250mg 1

valproic acd sol 250/5ml 1

valproic acd syp 250/5ml 1

Glutamate Reducing Agents

felbamate sus 600/5ml 3

felbamate tab 400mg 3


LAMICTAL CHW 2MG 3

LAMICTAL KIT START 35 3



LAMICTAL ODT KIT 3

LAMICTAL ODT TAB 100MG 3




lamotrigine chw 25mg 1


lamotrigine tab 100mg 1

lamotrigine tab 100mg er 1









topiragen tab 100mg 1




topiramate cap 15mg 1


topiramate tab 100mg 1




Sodium Channel Agents

carbamazepin cap 100mg er 1



carbamazepin chw 100mg 1

carbamazepin sus 100/5ml 1

carbamazepin tab 200mg 1




20

carbamazepin tab 200mg er 1


DILANTIN CAP 30MG 2

epitol tab 200mg 1

oxcarbazepin sus 300mg/5m 1

oxcarbazepin tab 150mg 1



PEGANONE TAB 250MG 3

phenytoin chw 50mg 1

phenytoin ex cap 100mg 1



phenytoin inj 50mg/ml 1

phenytoin sus 125/5ml 1

TEGRETOL-XR TAB 100MG 2

ANTIDEMENTIA AGENTS Cholinesterase Inhibitors

donepezil tab 10mg 1

donepezil tab 10mg odt 1

donepezil tab 5mg 1


donepezil tab hcl 23mg 1

EXELON DIS 13.3/24 3 PA

EXELON DIS 4.6MG/24 3 PA

EXELON DIS 9.5MG/24 3 PA

EXELON SOL 2MG/ML 4 PA

galantamine cap 16mg er 1



galantamine sol 4mg/ml 1

galantamine tab 12mg 1



NAMENDA SOL 10MG/5ML 3 PA

NAMENDA TAB 10MG 3 PA

NAMENDA TAB 5-10MG 3 PA

NAMENDA TAB 5MG 3 PA

rivastigmine cap 1.5mg 3

rivastigmine cap 3mg 3



ANTIDEPRESSANTS Antidepressants, Other

APLENZIN TAB 174MG 3 PA




21

budeprion tab 100mg sr 1 QL 180/365

budeprion tab 150mg sr 5 QL 180/365


bupropion tab 100mg er 1 QL 180/365

bupropion tab 100mg sr 1 QL 180/365






bupropn hcl tab 150mg xl 1


FORFIVO XL TAB 450MG 3 PA

mirtazapine tab 15mg 1 AL

mirtazapine tab 15mg odt 1 AL





mirtazapine tab 7.5mg 1 AL

NEFAZODONE TAB 100MG 1



nefazodone tab 250mg 1


trazodone tab 100mg 1




VIIBRYD KIT 3

VIIBRYD TAB 10MG 3

VIIBRYD TAB 20MG 3

VIIBRYD TAB 40MG 3

Monoamine Oxidase Inhibitors

EMSAM DIS 12MG/24H 3

EMSAM DIS 6MG/24HR 3

EMSAM DIS 9MG/24HR 3

MARPLAN TAB 10MG 3

phenelzine tab 15mg 1

tranylcyprom tab 10mg 1

Serotonin/Norepinephrine Reuptake Inhibitors

citalopram sol 10mg/5ml 1

citalopram tab 10mg 1 QL 51/30






22

DESVENLAFAX TAB 100MG ER 1

DESVENLAFAX TAB 50MG ER 1

duloxetine cap 20mg 3 PA



escitalopram sol 5mg/5ml 1

escitalopram tab 10mg 1



fluoxetine cap 10mg 1



fluoxetine cap 90mg dr 1 QL 4/28

fluoxetine sol 20mg/5ml 1

fluoxetine tab 10mg 1


FLUOXETINE TAB 60MG 1

fluvoxamine tab 100mg 1



KHEDEZLA TAB 100MG ER 1

KHEDEZLA TAB 50MG ER 1

paroxetin er tab 12.5mg 3


paroxetine tab 10mg 1


paroxetine tab 25mg er 3



PAXIL SUS 10MG/5ML 3

PRISTIQ TAB 100MG 3 PA

PRISTIQ TAB 50MG 3 PA

sertraline con 20mg/ml 1

sertraline tab 100mg 1



venlafaxine cap 150mg er 1

venlafaxine cap 37.5 er 1

venlafaxine cap 37.5mg 1


venlafaxine tab 100mg 1

venlafaxine tab 150mg er 1

VENLAFAXINE TAB 225MG ER 1


venlafaxine tab 37.5 er 1




23

venlafaxine tab 37.5mg 1




Tricyclics

amitriptylin tab 100mg 1 AL






AMOXAPINE TAB 100MG 1 AL




clomipramine cap 25mg 1 AL



desipramine tab 100mg 1 QL 60/30






doxepin hcl cap 100mg 1 AL





DOXEPIN HCL CAP 75MG 1 AL

doxepin hcl con 10mg/ml 1 AL

imipram hcl tab 10mg 1 AL



imipram pam cap 100mg 1 AL




MAPROTILINE TAB 25MG 1



nortriptylin cap 10mg 1







24

NORTRIPTYLIN SOL 10MG/5ML 1

SILENOR TAB 3MG 3 QL 30/30

SILENOR TAB 6MG 3 QL 30/30

trimipramine cap 100mg 1



ANTIEMETICS Emetogenic Therapy Adjuncts

ANZEMET TAB 100MG 3

ANZEMET TAB 50MG 3

CESAMET CAP 1MG 3

DIMENHYDRIN INJ 50MG/ML 1

dramamine tab 25mg 1

dronabinol cap 10mg 4 PA

dronabinol cap 2.5mg 3 PA

dronabinol cap 5mg 4 PA

granisetron inj 0.1mg/ml 6

granisetron inj 1mg/ml 6

granisetron tab 1mg 1 QL 10/23

GRANISOL SOL 2MG/10ML 3 PA QL 60/30 AL

meclizine tab 12.5mg 1

meclizine tab 25mg 1

medi-meclizi tab 25mg 1

motion relf tab 25mg 1

motion sick tab 25mg 1

ondansetron inj 40/20ml 6

ondansetron sol 4mg/5ml 1

ondansetron tab 24mg 1 QL 5/23


ondansetron tab 4mg odt 1 QL 10/23


ondansetron tab 8mg odt 1 QL 10/23

SANCUSO DIS 3.1MG 4 PA QL 1/30

TIGAN INJ 100MG/ML 6

trimethobenz cap 300mg 1

trimethobenz inj 100mg/ml 6

wal-dram ii tab 25mg 1

ZUPLENZ MIS 4MG 3 PA QL 10/23

ZUPLENZ MIS 8MG 3 PA QL 10/23

ANTIFUNGALS Antifungals

fluconazole sus 10mg/ml 1 QL 105/30

fluconazole sus 40mg/ml 1 QL 105/30

fluconazole tab 100mg 1 QL 30/30





25



griseofulvin sus 125/5ml 1

griseofulvin tab micr 500 1

griseofulvin tab ultr 125 1


ketoconazole tab 200mg 1

nystatin tab 500000 1

terbinafine tab 250mg 1

TERBINEX KIT 3 PA

ANTIGOUT AGENTS Antigout Agents

allopurinol tab 100mg 1


COLCRYS TAB 0.6MG 2 QL 20/23

proben/colch tab 500-0.5 1

probenecid tab 500mg 1

ANTIMIGRAINE AGENTS Serotonin (5-HT) 1b/1d Receptor Agonists

ALSUMA INJ 6MG/0.5 4 PA QL 5/23

AXERT TAB 12.5MG 3 QL 9/23

AXERT TAB 6.25MG 3 QL 9/23

CAFERGOT TAB 1-100MG 2

FROVA TAB 2.5MG 3 QL 9/23

IMITREX SPR 20MG/ACT 3 QL 18/23

IMITREX SPR 5MG/ACT 3 QL 18/23

isometh/apap cap dichlor 1

migragesic cap ida 1

naratriptan tab 1mg 1 QL 9/23

naratriptan tab 2.5mg 1 QL 9/23

nodolor cap 1

RELPAX TAB 20MG 3 QL 9/23

RELPAX TAB 40MG 3 QL 9/23

rizatriptan tab 10mg 1

rizatriptan tab 10mg odt 1



sumatriptan inj 4mg/0.5 3 PA QL 5/23

sumatriptan inj 6mg/0.5 3 PA QL 5/23

SUMATRIPTAN SPR 20MG/ACT 3 QL 18/23

SUMATRIPTAN SPR 5MG/ACT 3 QL 18/23

sumatriptan tab 100mg 1 QL 9/23



SUMAVEL DOSE INJ 6MG/0.5 3 QL 5/23




26

TREXIMET TAB 85-500MG 3

zolmitriptan tab 2.5 mg 3 QL 9/23

zolmitriptan tab 2.5mg 3 QL 9/23

zolmitriptan tab 5mg 3 QL 9/23

ZOMIG NASAL SPR 5MG 3 QL 18/30

ANTIMYASTHENIC AGENTS Parasympathomimetics

MESTINON SYP 60MG/5ML 2

MESTINON TAB TIMESPAN 2

pyridostigm tab 60mg 1

REGONOL INJ 5MG/ML 6

ANTIMYCOBACTERIALS Antituberculars

ethambutol tab 100mg 1


ISONIAZID INJ 100MG/ML 6

ISONIAZID SYP 50MG/5ML 1

isoniazid tab 100mg 1


pyrazinamide tab 500mg 1

rifabutin cap 150mg 4

RIFAMATE CAP 3

rifampin cap 150mg 1


rifampin inj 600 mg 6

RIFATER TAB 3

ANTINEOPLASTICS Antiangiogenic Agents

REVLIMID CAP 10MG 4 PA


REVLIMID CAP 2.5MG 4 PA



THALOMID CAP 100MG 4 PA




Antineoplastics

ABRAXANE INJ 100MG 6

ACTIMMUNE INJ 2MU/0.5 4 PA

ADCETRIS INJ 50MG 6

adriamycin inj 10mg 6

adrucil inj 500/10ml 6

adrucil inj 5gm/100m 6

AFINITOR TAB 10MG 4 PA




27

AFINITOR TAB 2.5MG 4 PA

AFINITOR TAB 5MG 4 PA

AFINITOR TAB 7.5MG 4 PA

ALFERON N INJ 5MU/ML 6

amifostine inj 500mg 6

anastrozole tab 1mg 1 AL BD

ARZERRA CON 1000/50 6

AVASTIN INJ 6

azacitidine inj 100mg 6

bicalutamide tab 50mg 1

bleomycin inj 15unit 6

BOSULIF TAB 100MG 4 PA

BOSULIF TAB 500MG 4 PA

CALC FOLINAT INJ 300/30ML 6

capecitabine tab 150mg 4 PA

capecitabine tab 500mg 4 PA

CAPRELSA TAB 100MG 4 PA

CAPRELSA TAB 300MG 4 PA

carboplatin inj 50mg/5ml 6

cisplatin inj 100mg 6

cladribine inj 1mg/ml 6

CLOLAR INJ 1MG/ML 6

COMETRIQ KIT 100MG 4 PA



COSMEGEN INJ 0.5MG 6

CYCLOPHOSPH INJ 500MG 6

CYCLOPHOSPH TAB 25MG 1

CYCLOPHOSPH TAB 50MG 1

cytarabine inj 100mg/ml 6


cytarabine inj 500mg 6

daunorubicin inj 5mg/ml 6

DAUNOXOME INJ 2MG/ML 6

decitabine inj 50mg 6

DEPO-PROVERA INJ 400/ML 3 BD

DEPOCYT INJ 50MG/5ML 6

dexrazoxane inj 250mg 6

dexrazoxane inj 500mg 4 PA

DOCEFREZ INJ 20MG 6

DOCEFREZ INJ 80MG 6

DOCETAXEL INJ 20/0.5ML 6

DOCETAXEL INJ 20MG/2ML 6

DOCETAXEL INJ 20MG/ML 6

doxorubicin inj 10mg 6




28

doxorubicin inj 2mg/ml 6

DROXIA CAP 200MG 2

DROXIA CAP 300MG 2

DROXIA CAP 400MG 2

ELIGARD INJ 22.5MG 4

ELIGARD INJ 30MG 4 PA

ELIGARD INJ 45MG 4 PA

ELIGARD INJ 7.5MG 4 PA

ELITEK INJ 1.5MG 6

ELSPAR INJ 10000UNT 6

EMCYT CAP 140MG 3

epirubicin inj 50/25ml 6

ERBITUX INJ 100MG 6

ERWINAZE INJ 10000UNT 6

exemestane tab 25mg 1 AL BD

FARESTON TAB 60MG 4 PA

FASLODEX INJ 250MG 4 PA

FIRMAGON INJ 120MG 4 PA

FIRMAGON INJ 80MG 4 PA

floxuridine inj 0.5gm 6

fludarabine inj 50mg/2ml 6

fluorouracil inj 500/10ml 6

fluorouracil inj 5gm/100m 6

flutamide cap 125mg 3

FUSILEV INJ 50MG 6

gemcitabine inj 200mg 6

GLEEVEC TAB 100MG 4 PA

GLEEVEC TAB 400MG 4 PA

HALAVEN INJ 1MG/2ML 6

hydroxyurea cap 500mg 1

ICLUSIG TAB 15MG 4 PA

ICLUSIG TAB 45MG 4 PA

idarubicin inj 5mg/5ml 6

INLYTA TAB 1MG 4 PA

INLYTA TAB 5MG 4 PA

INTRON-A INJ 10MU 4 PA



irinotecan inj 100/5ml 6

ISTODAX INJ 10MG 6

JAKAFI TAB 10MG 4 PA




JAKAFI TAB 5MG 4 PA




29

KADCYLA INJ 160MG 6

KEPIVANCE INJ 6.25MG 6

KYPROLIS SOL 60MG 4 PA

letrozole tab 2.5mg 1 QL 30/30 AL BD

leucovor ca inj 350mg 6

LEUCOVOR CA TAB 10MG 4 PA

LEUCOVOR CA TAB 15MG 4 PA

leucovor ca tab 25mg 4 PA

leucovor ca tab 5mg 4 PA

LEUKERAN TAB 2MG 4 PA

leuprolide inj 1mg/0.2 4 PA

lipodox 50 inj 2mg/ml 6

lipodox inj 2mg/ml 6

LOMUSTINE CAP 100MG 4 PA



LUPRON DEPOT INJ 11.25MG 4 PA



LUPRON DEPOT INJ 30MG 4 PA

LUPRON DEPOT INJ 45MG 4 PA

LYSODREN TAB 500MG 2

MATULANE CAP 50MG 4 PA

megestrol ac sus 400mg/10 5

megestrol ac sus 40mg/ml 6

megestrol ac tab 20mg 1


mercaptopur tab 50mg 1

mesna inj 1gm 6

MESNEX TAB 400MG 4 PA

methotrexate inj 100/4ml 1

methotrexate inj 1gm 1

methotrexate inj 1gm/40ml 1



methotrexate inj 25mg/ml 1

methotrexate inj 50mg/2ml 1

methotrexate tab 2.5mg 1

mitomycin inj 20mg 6

mitoxantron inj 2mg/ml 6

MOZOBIL INJ 6

MUSTARGEN INJ 10MG 6

MYLERAN TAB 2MG 4 PA

NEXAVAR TAB 200MG 4 PA

NIPENT INJ 10MG 6




30

ONCASPAR INJ 750/ML 6

oxaliplatin inj 50mg 6

paclitaxel inj 100mg 6

POMALYST CAP 1MG 4 PA




PROLEUKIN INJ 22MU 6

RITUXAN INJ 100MG 6

RITUXAN INJ 500MG 6

SOLTAMOX SOL 10MG/5ML 3

SPRYCEL TAB 100MG 4 PA






STIVARGA TAB 40MG 4 PA

SUTENT CAP 12.5MG 4 PA

SUTENT CAP 25MG 4 PA

SUTENT CAP 50MG 4 PA

SYLATRON KIT 296MCG 4 PA



SYNRIBO INJ 3.5MG 6

TABLOID TAB 40MG 4 PA

tamoxifen tab 10mg 1


TARCEVA TAB 100MG 4 PA



TARGRETIN CAP 75MG 4 PA

TASIGNA CAP 150MG 4 PA

TASIGNA CAP 200MG 4 PA

TAXOTERE INJ 20MG/ML 6

TOTECT INJ 500MG 4 PA

TREANDA INJ 25MG 6

TRELSTAR DEP INJ 3.75MG 4 PA

TRELSTAR LA INJ 11.25MG 4 PA

TRELSTAR MIX INJ 22.5MG 4 PA

tretinoin cap 10mg 4 PA

TREXALL TAB 10MG 3 PA



TREXALL TAB 7.5MG 3 PA




31

TRISENOX SOL 10MG/10M 6

TYKERB TAB 250MG 4 PA

VALSTAR SOL 40MG/ML 4 PA

VANTAS KIT 50MG 4 PA

VELCADE INJ 3.5MG 6

VINBLASTINE INJ 10MG 6

vincasar pfs inj 1mg/ml 6

vincristine inj 1mg/ml 6

vinorelbine inj 10mg/ml 6

VORAXAZE INJ 1000UNIT 6

VOTRIENT TAB 200MG 4 PA

XALKORI CAP 200MG 4 PA

XALKORI CAP 250MG 4 PA

ZOLADEX IMP 10.8MG 3 PA

ZOLADEX IMP 3.6MG 3 PA

ZOLINZA CAP 100MG 4 PA

ZYTIGA TAB 250MG 4 PA

ANTIPARASITICS Anthelmintics

ALBENZA TAB 200MG 2

Antibacterials, Other

atovaquone sus 750/5ml 4 PA QL 210/18

Antiprotozoals

ALINIA SUS 100/5ML 2 PA

ALINIA TAB 500MG 2 PA

atovaq/progu tab 250-100 1 QL 30/30

atovaq/progu tab 62.5-25 1 QL 30/30

chloroquine tab 250mg 1


DARAPRIM TAB 25MG 2

hydroxychlor tab 200mg 1

mefloquine tab 250mg 1

PRIMAQUINE TAB 26.3MG 3

quinine sulf cap 324mg 1

ANTIPARKINSON AGENTS Antiparkinson Agents, Other

amantadine cap 100mg 1

amantadine syp 50mg/5ml 1

AMANTADINE TAB 100MG 1

benztropine inj 1mg/ml 3 AL

benztropine tab 0.5mg 1 AL

benztropine tab 1mg 1 AL

benztropine tab 2mg 1 AL

bromocriptin cap 5mg 1

bromocriptin tab 2.5mg 1




32

carbidopa tab 25mg 3

entacapone tab 200mg 1

selegiline cap 5mg 1

selegiline tab 5mg 1

TASMAR TAB 100MG 4 PA

Dopamine Agonists

AZILECT TAB 0.5MG 2

AZILECT TAB 1MG 2

carb/levo er tab 25-100mg 1


carb/levo tab 10-100mg 1



MIRAPEX ER TAB 0.375MG 3 PA





MIRAPEX ER TAB 3MG 3 PA


NEUPRO DIS 1MG/24HR 3






pramipexole tab 0.125mg 1





pramipexole tab 1mg 1

ropinirole tab 0.25mg 1


ropinirole tab 12mg er 1

ropinirole tab 1mg 1









ANTIPSYCHOTICS




33

1st Generation/Typical

CDP/AMITRIP TAB 10-25MG 1

CDP/AMITRIP TAB 5-12.5MG 1

CHLORPROMAZ INJ 25MG/ML 1

chlorpromaz tab 100mg 1





compazine sup 25mg 1

compro sup 25mg 1

fluphenaz de inj 25mg/ml 3

FLUPHENAZINE CON 5MG/ML 1

FLUPHENAZINE ELX 2.5/5ML 1

FLUPHENAZINE INJ 2.5MG/ML 1

fluphenazine tab 10mg 1


fluphenazine tab 2.5mg 1


haloper dec inj 100mg/ml 1


haloper lac inj 5mg/ml 1

haloperidol con 2mg/ml 1

haloperidol tab 0.5mg 1

haloperidol tab 10mg 1





ORAP TAB 1MG 3

ORAP TAB 2MG 3

PERPHEN/AMIT TAB 2-10MG 1





perphenazine tab 16mg 1




prochlorper inj 10mg/2ml 3

prochlorper inj 5mg/ml 3

prochlorper sup 25mg 1

prochlorper tab 10mg 1





34

thiothixene cap 10mg 1




trifluoperaz tab 10mg 1




2nd Generation/Atypical

ABILIFY DISC TAB 10MG 4 PA

ABILIFY DISC TAB 15MG 4 PA

ABILIFY INJ 9.75MG 4 PA

ABILIFY MAIN INJ 300MG 4 PA

ABILIFY SOL 1MG/ML 4 PA

ABILIFY TAB 10MG 4 PA






FANAPT TAB 10MG 4 PA

FANAPT TAB 12MG 4 PA

FANAPT TAB 1MG 4 PA

FANAPT TAB 2MG 4 PA

FANAPT TAB 4MG 4 PA

FANAPT TAB 6MG 4 PA

FANAPT TAB 8MG 4 PA

GEODON INJ 20MG 3 PA

INVEGA SUST INJ 117/0.75 4 PA

INVEGA SUST INJ 156MG/ML 4 PA



INVEGA SUST INJ 78/0.5ML 4 PA

INVEGA TAB 1.5MG 3 PA

INVEGA TAB 3MG 3 PA

INVEGA TAB 6MG 3 PA

INVEGA TAB 9MG 3 PA

LATUDA TAB 120MG 3 PA





loxapine cap 10mg 1

loxapine cap 25mg 1

loxapine cap 50mg 1




35

loxapine cap 5mg 1

olanza/fluox cap 12-25mg 3





olanzapine inj 10mg 3 PA

olanzapine tab 10mg 3 PA

olanzapine tab 10mg odt 3 PA



olanzapine tab 2.5mg 3 PA





olanzapine tab 7.5mg 3 PA

quetiapine tab 100mg 1 PA






risperidone sol 1mg/ml 1

risperidone tab 0.25 odt 1

risperidone tab 0.25mg 1


risperidone tab 0.5mg od 1

risperidone tab 1mg 1

risperidone tab 1mg odt 1







SAPHRIS SUB 10MG 3 PA

SAPHRIS SUB 5MG 3 PA

SEROQUEL XR TAB 150MG 3 PA





ziprasidone cap 20mg 1 PA





36



Treatment-Resistant

CLOZAPINE TAB 100/ODT 1

clozapine tab 100mg 1

CLOZAPINE TAB 12.5/ODT 1



CLOZAPINE TAB 25MG ODT 1


FAZACLO TAB 100/ODT 1

FAZACLO TAB 12.5/ODT 1

FAZACLO TAB 150MG 4 PA

FAZACLO TAB 25MG ODT 1

ANTIVIRALS Anti-cytomegalovirus (CMV) Agents

VALCYTE SOL 50MG/ML 4 PA

VALCYTE TAB 450MG 4 PA

Anti-HIV Agents, Other

abacavir tab 300mg 1 QL 60/30

APTIVUS CAP 250MG 2 QL 120/30

APTIVUS SOL 2 QL 300/30

CRIXIVAN CAP 200MG 2 QL 360/30

CRIXIVAN CAP 400MG 2 QL 180/30

didanosine cap 125mg 1 QL 60/30




EMTRIVA CAP 200MG 2 QL 30/30

EMTRIVA SOL 10MG/ML 2 QL 600/30

EPIVIR HBV SOL 5MG/ML 2 QL 1800/30

EPIVIR SOL 10MG/ML 2 QL 900/30

INVIRASE CAP 200MG 2 QL 300/30

INVIRASE TAB 500MG 2 QL 120/30

ISENTRESS CHW 100MG 3 QL 60/30

ISENTRESS CHW 25MG 3 QL 60/30

ISENTRESS TAB 400MG 2 QL 60/30

lamivudine tab 100mg 1 QL 90/30



LEXIVA SUS 50MG/ML 2 QL 1800/30

LEXIVA TAB 700MG 2 QL 120/30

NORVIR CAP 100MG 2 QL 360/30

NORVIR SOL 80MG/ML 2 QL 450/30

NORVIR TAB 100MG 2 QL 360/30




37

PREZISTA SUS 100MG/ML 3 QL 480/30

PREZISTA TAB 150MG 2 QL 240/30





REYATAZ CAP 100MG 2 QL 120/30




SELZENTRY TAB 150MG 2 QL 120/30

SELZENTRY TAB 300MG 2 QL 120/30

stavudine cap 15mg 1 QL 60/30




stavudine sol 1mg/ml 1 QL 1200/30

VIDEX SOL 2GM 2 QL 603/30

VIRACEPT TAB 250MG 2 QL 300/30

VIRACEPT TAB 625MG 2 QL 120/30

VIREAD TAB 150MG 2 QL 30/30




ZIAGEN SOL 20MG/ML 2 QL 900/30

zidovudine cap 100mg 1 QL 180/30

zidovudine syp 50mg/5ml 1 QL 1800/30

zidovudine tab 300mg 1 QL 60/30

Anti-influenza Agents

RELENZA MIS DISKHALE 2 QL 20/5

rimantadine tab 100mg 1

TAMIFLU CAP 30MG 2 QL 10/5



TAMIFLU SUS 6MG/ML 2 QL 120/10 AL

VIRAZOLE INH 6GM 4 PA

Antihepatitis Agents

adefov dipiv tab 10mg 4 PA

BARACLUDE SOL .05MG/ML 4 PA

BARACLUDE TAB 0.5MG 4 PA

BARACLUDE TAB 1MG 4 PA

INCIVEK TAB 375MG 4 PA

INFERGEN INJ 15MCG 4 PA

MODERIBA PAK 1000/DAY 4 PA





38



moderiba tab 200mg 4 PA

PEG-INTRON KIT 120 RP 4 PA

PEG-INTRON KIT 120MCG 4 PA

PEG-INTRON KIT 150 RP 4 PA



PEG-INTRON KIT 50MCG RP 4 PA


PEG-INTRON KIT 80MCG RP 4 PA

PEGASYS INJ 180MCG/M 4 PA

PEGASYS INJ PROCLICK 4 PA

PEGASYS KIT 4 PA

REBETOL SOL 40MG/ML 4 PA

RIBAPAK PAK 1000/DAY 4 PA




ribasphere cap 200mg 4 PA

ribasphere tab 200mg 4 PA

RIBASPHERE TAB 400MG 4 PA

RIBASPHERE TAB 600MG 4 PA

RIBATAB PAK 1000/DAY 4 PA

RIBATAB TAB 1200/DAY 4 PA

RIBATAB TAB 800/DAY 4 PA

ribavirin cap 200mg 4 PA

ribavirin tab 200mg 4 PA

TYZEKA TAB 600MG 4 PA

VICTRELIS CAP 200MG 4 PA

Antiherpetic Agents

acyclovir cap 200mg 1

acyclovir oin 5% 3

acyclovir sus 200/5ml 1 AL

acyclovir tab 400mg 1


DENAVIR CRE 1% 3

famciclovir tab 125mg 3 QL 90/30



valacyclovir tab 1gm 1 QL 60/30

valacyclovir tab 500mg 1 QL 60/30

ZOVIRAX CRE 5% 3

Antivirals, Other

abacav/lamiv tab /zidovud 1 QL 60/30




39

ATRIPLA TAB 2 QL 30/30

COMPLERA TAB 2 QL 30/30

EDURANT TAB 25MG 2 QL 30/30

EPZICOM TAB 600-300 2 QL 30/30

ganciclovir inj 500mg 6

INTELENCE TAB 100MG 2 QL 120/30



KALETRA SOL 2 QL 450/30

KALETRA TAB 100-25MG 2 QL 360/30

KALETRA TAB 200-50MG 2 QL 180/30

lamivud/zido tab 150-300 1 QL 60/30

NEVIRAPINE SUS 50MG/5ML 2 QL 1200/30

nevirapine tab 200mg 1 QL 60/30

nevirapine tab 400mg er 1 QL 30/30

RESCRIPTOR TAB 100 MG 2 QL 360/30

RESCRIPTOR TAB 200MG 2 QL 180/30

STRIBILD TAB 2 QL 30/30

SUSTIVA CAP 200MG 2 QL 90/30

SUSTIVA CAP 50MG 2 QL 360/30

SUSTIVA TAB 600MG 2 QL 30/30

TRUVADA TAB 200-300 2 QL 30/30

VIRAMUNE SUS 50MG/5ML 2 QL 1200/30

ANXIOLYTICS Anxiolytics, Other

buspirone tab 10mg 1



buspirone tab 5mg 1

buspirone tab 7.5mg 1

droperidol inj 2.5mg/ml 1

HYDROXYZ HCL INJ 25MG/ML 1 AL

hydroxyz hcl inj 50mg/ml 1 AL

hydroxyz hcl sol 10mg/5ml 1 AL

hydroxyz hcl syp 10mg/5ml 1 AL

hydroxyz hcl tab 10mg 1 AL



HYDROXYZ PAM CAP 100MG 1 AL

hydroxyz pam cap 25mg 1 AL

hydroxyz pam cap 50mg 1 AL

meprobamate tab 200mg 1 AL

meprobamate tab 400mg 1 AL

Benzodiazepines

alprazolam tab 0.25 odt 3 AL




40

alprazolam tab 0.25mg 1 AL

alprazolam tab 0.5mg 1 AL

alprazolam tab 0.5mg er 3 AL

alprazolam tab 0.5mg od 3 AL

alprazolam tab 0.5mg xr 3 AL

alprazolam tab 1mg 1 AL

alprazolam tab 1mg er 3 AL

alprazolam tab 1mg odt 3 AL

alprazolam tab 1mg xr 3 AL

alprazolam tab 2mg 1 AL


alprazolam tab 2mg odt 3 AL




chlordiazep cap 10mg 1 AL



cloraz dipot tab 15mg 1 AL

cloraz dipot tab 3.75mg 1 AL

cloraz dipot tab 7.5mg 1 AL

DIAZEPAM INJ 5MG/ML 1 AL

DIAZEPAM SOL 1MG/ML 1 AL

diazepam tab 10mg 1 AL



gene-xene tab 15mg 1 AL

gene-xene tab 3.75mg 1 AL

gene-xene tab 7.5mg 1 AL

lorazepam con 2mg/ml 1 AL

lorazepam inj 2mg/ml 1 AL

lorazepam inj 4mg/ml 1 AL

lorazepam tab 0.5mg 1 AL

lorazepam tab 1mg 1 AL

lorazepam tab 2mg 1 AL

oxazepam cap 10mg 1 AL



BIPOLAR AGENTS Mood Stabilizers

lithium carb cap 150mg 1



lithium carb tab 300mg 1

lithium carb tab 300mg er 1




41


LITHIUM CITR SOL 8MEQ/5ML 1

BLOOD GLUCOSE REGULATORS Antidiabetic Agents

acarbose tab 100mg 1

acarbose tab 25mg 1

acarbose tab 50mg 1

ACTOPLUS MET TAB XR 3

AVANDIA TAB 2MG 3

BYDUREON INJ 2 PA QL 4/30

BYETTA INJ 10MCG 3 PA QL 1.2/30

BYETTA INJ 5MCG 3 PA QL 1.2/30

CHLORPROPAM TAB 100MG 1

CHLORPROPAM TAB 250MG 1

CYCLOSET TAB 0.8MG 3

DIABETA TAB 2.5MG 3

DIABETA TAB 5MG 3

glimepiride tab 1mg 1



glip/metform tab 2.5-250m 1


glip/metform tab 5-500mg 1

glipizide er tab 10mg 1 QL 60/30

glipizide er tab 2.5mg 1 QL 60/30

glipizide er tab 5mg 1 QL 60/30

glipizide tab 10mg 1

glipizide tab 5mg 1

glipizide xl tab 10mg 1 QL 60/30

glipizide xl tab 2.5mg 1 QL 60/30

glipizide xl tab 5mg 1 QL 60/30

GLUMETZA TAB 500MG 3

glyb/metform tab 1.25-250 1


glyb/metform tab 5-500mg 1

glyburid mcr tab 1.5mg 1

glyburid mcr tab 3mg 1


glyburide tab 1.25mg 1


glyburide tab 5mg 1

GLYSET TAB 25MG 3

JANUMET TAB 50-1000 2 QL 60/30

JANUMET TAB 50-500MG 2 QL 60/30

JANUMET XR TAB 100-1000 3 QL 30/30




42

JANUMET XR TAB 50-1000 3 QL 30/30

JANUMET XR TAB 50-500MG 3 QL 30/30

JANUVIA TAB 100MG 2 QL 30/30



JENTADUETO TAB 2.5-1000 3 QL 60/30



JUVISYNC TAB 100-10MG 3






KOMBIGLYZE TAB 2.5-1000 3 QL 30/30

KOMBIGLYZE TAB 5-1000MG 3 QL 30/30

KOMBIGLYZE TAB 5-500MG 3 QL 30/30

metformin er tab 1000mg 1

metformin tab 1000mg 1


metformin tab 500mg er 1



nateglinide tab 120mg 1


ONGLYZA TAB 2.5MG 3 QL 30/30

ONGLYZA TAB 5MG 3 QL 30/30

pioglit/glim tab 30-2mg 1


pioglita/met tab 15-500mg 3


pioglitazone tab 15mg 3 QL 30/30



PRANDIMET TAB 1-500MG 3

PRANDIMET TAB 2-500MG 3

repaglinide tab 0.5mg 1

repaglinide tab 1mg 1


RIOMET SOL 3

SYMLINPEN 60 INJ 1000MCG 3

SYMLNPEN 120 INJ 1000MCG 3

tolazamide tab 250mg 1

TOLAZAMIDE TAB 500MG 1

TOLBUTAMIDE TAB 500MG 1




43

TRADJENTA TAB 5MG 3 QL 30/30

VICTOZA INJ 18MG/3ML 3 PA QL 6/30

Glycemic Agents

GLUCAGEN INJ 1MG 3 QL 2/30

GLUCAGEN INJ HYPOKIT 3 QL 2/30

GLUCAGON KIT 1MG 3 QL 2/30

PROGLYCEM SUS 50MG/ML 3

Insulins

APIDRA INJ SOLOSTAR 3

APIDRA INJ U-100 2

HUMALOG INJ 100/ML 3

HUMALOG KWIK INJ 100/ML 3

HUMALOG MIX INJ 50/50 3

HUMALOG MIX INJ 50/50KWP 3

HUMALOG MIX INJ 75/25KWP 3

HUMALOG MIX SUS 75/25 3

HUMULIN INJ 70/30 3

HUMULIN N INJ U-100 3

HUMULIN N INJ U-100KWP 3

HUMULIN N PN INJ U-100 3

HUMULIN PEN INJ 70/30 3

HUMULIN R INJ U-100 3

HUMULIN R INJ U-500 3 PA

LANTUS INJ 100/ML 2

LANTUS INJ SOLOSTAR 3

LEVEMIR INJ 2

LEVEMIR INJ FLEXPEN 3

LEVEMIR INJ FLEXTOUC 3

NOVOLIN INJ 70/30 2

NOVOLIN N INJ RELION 2

NOVOLIN N INJ U-100 2

NOVOLIN R INJ RELION 2

NOVOLIN R INJ U-100 2

NOVOLIN70/30 INJ RELION 2

NOVOLOG INJ 100/ML 3

NOVOLOG INJ FLEXPEN 3

NOVOLOG INJ PENFILL 3

NOVOLOG MIX INJ 70/30 3

NOVOLOG MIX INJ FLEXPEN 3

RELION R INJ 100/ML 3

RELION R INJ 100U/ML 3

BLOOD PRODUCTS/MODIFIERS/ VOLUME EXPANDERS Anticoagulants

argatroban inj 100mg/ml 6

ARGATROBAN INJ 125/125 6




44

ELIQUIS TAB 2.5MG 3 PA

ELIQUIS TAB 5MG 3 PA

enoxaparin inj 100mg/ml 3 QL 14/365 AL BD

enoxaparin inj 120/0.8 3 QL 14/365 AL BD

enoxaparin inj 150mg/ml 3 QL 14/365 AL BD

enoxaparin inj 30/0.3ml 3 QL 14/365 AL BD

enoxaparin inj 300/3ml 3 QL 14/365 AL BD




fondaparinux sol 10/0.8 4 PA

fondaparinux sol 2.5/0.5 4 PA



FRAGMIN INJ 10000/ML 4 PA

FRAGMIN INJ 12500UNT 4 PA



FRAGMIN INJ 2500/0.2 4 PA

FRAGMIN INJ 25000/ML 4 PA



hep flush-10 inj 10unt/ml 1

hep sod/d5w inj 20000unt 6


hep sod/nacl inj 1000unit 6

HEP SOD/NACL INJ 12500UNT 6

HEP SOD/NACL INJ 25000UNT 6

hep sod/nacl inj 2unit/ml 6

heparin lock inj 100/ml 1

heparin lock inj 10unt/ml 1

heparin lock inj 1unit/ml 1

HEPARIN LOCK INJ 2UNIT/ML 1

heparin sod inj 1000/ml 1


HEPARIN SOD INJ 2000/ML 1


HEPARIN SOD INJ 2500/ML 6

heparin sod inj 5000/0.5 1


jantoven tab 10mg 1

jantoven tab 1mg 1

jantoven tab 2.5mg 1

jantoven tab 2mg 1

jantoven tab 3mg 1




45

jantoven tab 4mg 1

jantoven tab 5mg 1

jantoven tab 6mg 1


PRADAXA CAP 150MG 3 PA

PRADAXA CAP 75MG 3 PA

warfarin tab 10mg 1

warfarin tab 1mg 1

warfarin tab 2.5mg 1

warfarin tab 2mg 1

warfarin tab 3mg 1

warfarin tab 4mg 1

warfarin tab 5mg 1

warfarin tab 6mg 1


XARELTO TAB 10MG 3 PA QL 30/30



Blood Formation Modifiers

ARANESP INJ 100MCG 4 PA








EPOGEN INJ 10000/ML 4 PA





LEUKINE INJ 250MCG 4 PA

LEUKINE INJ 500 MCG 4 PA

NEULASTA INJ 6MG/0.6M 4 PA

NEUMEGA INJ 5MG 4 PA

NEUPOGEN INJ 300/0.5 4 PA

NEUPOGEN INJ 300MCG 4 PA

NEUPOGEN INJ 480/0.8 4 PA

OMONTYS INJ 10MG/ML 4 PA

PROCRIT INJ 10000/ML 4 PA








46


Platelet Modifying Agents

AGGRENOX CAP 25-200MG 3

AMICAR TAB 1000MG 1

AMINOCAPR AC TAB 1000MG 1

aminocapr ac tab 500mg 3

anagrelide cap 0.5mg 1

anagrelide cap 1mg 1

BRILINTA TAB 90MG 3 PA

cilostazol tab 100mg 1


clopidogrel tab 300mg 1 QL 30/30

clopidogrel tab 75mg 1 QL 30/30

dipyridamole tab 25mg 1



INTEGRILIN INJ 0.75MG/1 6

INTEGRILIN INJ 2MG/ML 6

ticlopidine tab 250mg 1

tranex acid inj 100mg/ml 6

CARDIOVASCULAR AGENTS Alpha-adrenergic Agonists

ephedrine su inj 50mg/ml 6

midodrine tab 10mg 1

midodrine tab 2.5mg 1

midodrine tab 5mg 1

norepinephr inj 1mg/ml 6

Angiotensin II Receptor Antagonists

BENICAR TAB 20MG 3

BENICAR TAB 40MG 3

BENICAR TAB 5MG 3

candesartan tab 16mg 1 QL 30/30




EDARBI TAB 40MG 3

EDARBI TAB 80MG 3

eprosart mes tab 600mg 1

irbesartan tab 150mg 1 QL 30/30



losartan pot tab 100mg 1 QL 30/30



telmisartan tab 20mg 3




47



valsartan tab 160mg 1 PA QL 30/30



Angiotensin-converting Enzyme (ACE) Inhibitors

benazepril tab 10mg 1




captopril tab 100mg 1

captopril tab 12.5mg 1



enalapril tab 10mg 1

enalapril tab 2.5mg 1


enalapril tab 5mg 1

fosinopril tab 10mg 1



lisinopril tab 10mg 1

lisinopril tab 2.5mg 1





moexipril tab 15mg 1

moexipril tab 7.5mg 1

perindopril tab 2mg 1



quinapril tab 10mg 1



quinapril tab 5mg 1

ramipril cap 1.25mg 1

ramipril cap 10mg 1


ramipril cap 5mg 1

trandolapril tab 1mg 1 QL 30/30



Antiarrhythmics

amiodarone tab 100mg 1




48



disopyramide cap 100mg 1


flecainide tab 100mg 1



ibutilide inj 1mg/10ml 6

mexiletine cap 150mg 1



MULTAQ TAB 400MG 3 PA

NORPACE CAP 100MG CR 3

pacerone tab 100mg 1



PROCAINAMIDE INJ 100MG/ML 6

PROCAINAMIDE INJ 500MG/ML 6

propafenone cap 225mg er 1


propafenone cap 425mg sr 1

propafenone tab 150mg 1



QUINIDINE GL INJ 80MG/ML 6

quinidine gl tab 324mg cr 1

quinidine gl tab 324mg er 1

quinidine su tab 200mg 1


QUINIDINE SU TAB 300MG ER 1

Antihypertensive Combinations

amlod/benazp cap 10-20mg 1


amlod/benazp cap 2.5-10mg 1




AMTURNIDE150 TAB -5-12.5 2


AMTURNIDE300 TAB -10-25MG 2


AMTURNIDE300 TAB -5-25MG 2

atenol/chlor tab 100-25mg 1


AZOR TAB 10-20MG 3




49

AZOR TAB 10-40MG 3

AZOR TAB 5-20MG 3

AZOR TAB 5-40MG 3

benazep/hctz tab 10-12.5 1


benazep/hctz tab 20-25mg 1


BENICAR HCT TAB 20-12.5 3

BENICAR HCT TAB 40-12.5 3

BENICAR HCT TAB 40-25MG 3

bisoprl/hctz tab 10/6.25 1

bisoprl/hctz tab 2.5/6.25 1

bisoprl/hctz tab 5-6.25mg 1

candesa/hctz tab 16-12.5 1


candesa/hctz tab 32-25mg 1

CAPTOPR/HCTZ TAB 25-15MG 1




enalapr/hctz tab 10-25mg 1

enalapr/hctz tab 5-12.5mg 1

EXFORGE TAB 10-160MG 3




EXFORGEH/10- TAB 160-12.5 3

EXFORGEH/10- TAB 160-25 3


EXFORGEH/5- TAB 160-12.5 3


fosinop/hctz tab 10/12.5 1


irbesar/hctz tab 150-12.5 1


lisinop/hctz tab 10-12.5 1


lisinop/hctz tab 20-25mg 1

losartan/hct tab 100-12.5 1 QL 30/30

losartan/hct tab 100-25 1 QL 30/30

losartan/hct tab 50-12.5 1 QL 30/30

metoprl/hctz tab 100-25mg 1



moexipr/hctz tab 15-12.5 1




50

moexipr/hctz tab 15-25mg 1

moexipr/hctz tab 7.5-12.5 1

nadolol/bend tab 40-5mg 1


PROPRAN/HCTZ TAB 40/25 1

PROPRAN/HCTZ TAB 80/25 1

qnapril/hctz tab 10-12.5 1


qnapril/hctz tab 20-25mg 1

TARKA TAB 1-240 CR 3




TEKAMLO TAB 150-10MG 3




TEKTURNA HCT TAB 150-12.5 3

TEKTURNA HCT TAB 150-25MG 3

TEKTURNA HCT TAB 300-12.5 3

TEKTURNA HCT TAB 300-25MG 3

telmisa/hctz tab 40-12.5 3


telmisa/hctz tab 80-25mg 3

TRIBENZOR20- TAB 5-12.5MG 3

TRIBENZOR40- TAB 10-12.5 3

TRIBENZOR40- TAB 10-25MG 3

TRIBENZOR40- TAB 5-12.5MG 3

TRIBENZOR40- TAB 5-25MG 3

valsart/hctz tab 160-12.5 1 PA

valsart/hctz tab 160-25mg 1 PA


valsart/hctz tab 320-25mg 1 PA


Beta-adrenergic Blocking Agents

acebutolol cap 200mg 1


atenolol tab 100mg 1

atenolol tab 25mg 1

atenolol tab 50mg 1

betaxolol tab 10mg 4 PA

betaxolol tab 20mg 1

bisoprol fum tab 10mg 1


BYSTOLIC TAB 10MG 3




51

BYSTOLIC TAB 2.5MG 3

BYSTOLIC TAB 20MG 3

BYSTOLIC TAB 5MG 3

carvedilol tab 12.5mg 1

carvedilol tab 25mg 1



COREG CR CAP 10MG 3

COREG CR CAP 20MG 3

COREG CR CAP 40MG 3

COREG CR CAP 80MG 3

dilt-xr cap 120mg 1 QL 30/30

esmolol hcl inj 100mg/10 6

esmolol hcl inj 10mg/ml 6

INDERAL XL CAP 80MG 3

INNOPRAN XL CAP 80MG 3

labetalol inj 5mg/ml 6

labetalol tab 100mg 1



LEVATOL TAB 20MG 3

metoprol tar tab 100mg 1



metoprolol tab 100mg er 1 QL 30/30




nadolol tab 20mg 1

nadolol tab 40mg 1

nadolol tab 80mg 1

pindolol tab 10mg 1

pindolol tab 5mg 1

propranolol cap 120mg er 1




propranolol inj 1mg/ml 6

PROPRANOLOL SOL 20MG/5ML 1

PROPRANOLOL SOL 40MG/5ML 1

propranolol tab 10mg 1








52

sorine tab 120mg 1

sorine tab 160mg 1

sorine tab 240mg 1

sorine tab 80mg 1

SOTALOL HCL INJ 150/10ML 6

sotalol hcl tab 120mg 1




TIMOLOL MAL TAB 10MG 1



Calcium Channel Blocking Agents

afeditab tab 30mg cr 1 QL 30/30

afeditab tab 60mg cr 1 QL 30/30

amlodipine tab 10mg 1 QL 30/30

amlodipine tab 2.5mg 1 QL 30/30

amlodipine tab 5mg 1 QL 30/30

CARDENE IV SOL 20/200ML 6

CARDIZEM LA TAB 120MG 2 QL 30/30

cartia xt cap 120/24hr 1 QL 30/30

cartia xt cap 180/24hr 1



dilt-cd cap 120mg 1 QL 30/30

dilt-cd cap 180mg 1

dilt-cd cap 240mg 1

dilt-cd cap 300mg 1

diltiazem cap 120mg cd 1 QL 30/30

diltiazem cap 120mg er 1 QL 60/30

diltiazem cap 120mg/24 1 QL 30/30

diltiazem cap 180mg cd 1

diltiazem cap 180mg er 1












diltiazem er tab 180mg 1 QL 30/30




53





DILTIAZEM INJ 100MG 6

diltiazem inj 25mg/5ml 6

diltiazem tab 120mg 1




diltzac cap 120mg/24 1 QL 30/30





felodipine tab 10mg er 1 QL 30/30

felodipine tab 2.5mg er 1 QL 30/30

felodipine tab 5mg er 1 QL 30/30

ISRADIPINE CAP 2.5MG 1

ISRADIPINE CAP 5MG 1

matzim la tab 180mg/24 1 QL 30/30





nicardipine cap 20mg 1


nifediac cc tab 30mg er 1 QL 30/30



nifedical xl tab 30mg 1 QL 30/30

nifedical xl tab 60mg 1 QL 30/30

nifedipine cap 10mg 1


nifedipine tab 30mg er 1 QL 30/30



nimodipine cap 30mg 1

nisoldipine tab 17mg er 1

NISOLDIPINE TAB 20MG 1

NISOLDIPINE TAB 25.5MG 1




nisoldipine tab 8.5mg er 1




54

taztia xt cap 120mg/24 1 QL 30/30





verapamil cap 100mg er 1


verapamil cap 120mg sr 1








verapamil inj 2.5mg/ml 6

verapamil tab 120mg 1

verapamil tab 120mg er 1 QL 30/30



VERAPAMIL TAB 40MG 1


Cardiovascular Agents, Other

alprostadil inj 500mcg 1

amlod/atorva tab 10-10mg 3




amlod/atorva tab 2.5-10mg 3







BERINERT INJ 500UNIT 4 PA

BIDIL TAB 2

CEPROTIN INJ 500 UNIT 4 PA

CINRYZE SOL 500 UNIT 4 PA

clonidine dis 0.1/24hr 1



clonidine inj 6

clonidine inj 100/ml 6





55

clonidine tab 0.1mg 1

clonidine tab 0.1mg er 3 PA



DEMSER CAP 250MG 4 PA

DIBENZYLINE CAP 10MG 3

digox tab 0.125mg 1

digox tab 0.25mg 1

DIGOXIN SOL 50MCG/ML 1

digoxin tab 0.125mg 1


DILATRATE SR CAP 40MG 3

doxazosin tab 1mg 1 AL




eplerenone tab 25mg 1


fenoldopam inj 10mg/ml 6

FIRAZYR INJ 30MG/3ML 4 PA

guanfacine tab 1mg 1


hydralazine inj 20mg/ml 6

hydralazine tab 100mg 1




isoditrate tab 40mg er 1

ISOSORB DIN SUB 2.5MG 1

isosorb din tab 10mg 1



isosorb din tab 40mg er 1


isosorb mono tab 10mg 1

isosorb mono tab 120mg er 1




KALBITOR INJ 10MG/ML 4 PA

mannitol inj 10% 6

mannitol inj 15% 6

mannitol inj 20% 6

mannitol inj 25% 6

mannitol inj 5% 6




56

methyldopa tab 250mg 1


METHYLDOPATE INJ 250/5ML 6

minitran dis 0.1mg/hr 1




minoxidil tab 10mg 1

minoxidil tab 2.5mg 1

morrhuat sod inj 5% 1

NITRO-BID OIN 2% 2

NITRO-DUR DIS 0.3MG/HR 3

NITRO-DUR DIS 0.8MG/HR 3

nitro-time cap 2.5mg cr 1


nitro-time cap 9mg cr 1

NITROGLYCER AER 400MCG 3

nitroglycer cap 2.5mg er 1


nitroglycer cap 9mg er 1

nitroglycer dis 0.1mg/hr 1




NITROGLYCER INJ 5MG/ML 6

nitroglyceri dis 0.6mg/hr 1

nitroglycrn spr 0.4mg 3

nitroglycrn spr lingual 3

NITROMIST AER 400MCG 3

NITROSTAT SUB 0.3MG 2



osmitrol inj 10% 6

osmitrol inj 15% 6

osmitrol inj 5% 6

osmitrol vfx inj 20% 6

pentoxifylli tab 400mg er 1 QL 90/30

prazosin hcl cap 1mg 1



PROTAMINE SU SOL 10MG/ML 6

RANEXA TAB 1000MG 2 PA

RANEXA TAB 500MG 2 PA

RESERPINE TAB 0.1MG 1

RESERPINE TAB 0.25MG 1




57

RESPA-BR TAB 11MG 1

scleromate inj 5% 1

SOLIRIS INJ 10MG/ML 6

TEKTURNA TAB 150MG 3

TEKTURNA TAB 300MG 3

terazosin cap 10mg 1 AL




THROMBAT III INJ 500UNIT 6

Diuretics, Carbonic Anhydrase Inhibitors

acetazolamid cap 500mg er 1

acetazolamid inj 500mg 6

ACETAZOLAMID TAB 125MG 1

acetazolamid tab 250mg 1

Diuretics, Loop

bumetanide inj 0.25/ml 1

bumetanide tab 0.5mg 1

bumetanide tab 1mg 1


EDECRIN TAB 25MG 3

furosemide sol 10mg/ml 1

FUROSEMIDE SOL 8MG/ML 1

furosemide tab 20mg 1



SOD EDECRIN INJ 50MG 6

torsemide tab 100mg 1



torsemide tab 5mg 1

Diuretics, Potassium-sparing

amiloride tab 5mg 1

spironolact tab 100mg 1



Diuretics, Thiazide

amilor/hctz tab 5-50 1

chlorothiaz inj 500mg 6

chlorothiaz tab 250mg 1


CHLORTHALID TAB 100MG 1



chlorthalid tab 25mg 1




58


DYRENIUM CAP 100MG 3

hydrochlorot cap 12.5mg 1

hydrochlorot tab 12.5mg 1

hydrochlorot tab 25mg 1


indapamide tab 1.25mg 1


METHYCLOTHIA TAB 5MG 1

metolazone tab 10mg 1

metolazone tab 2.5mg 1


spirono/hctz tab 25/25 1

triamt/hctz cap 37.5-25 1

triamt/hctz tab 37.5-25 1

triamt/hctz tab 75-50mg 1

Dyslipidemics, Fibric Acid Derivatives

fenofibrate cap 130mg 1


FENOFIBRATE CAP 150MG 3



FENOFIBRATE CAP 50MG 3


fenofibrate tab 145mg 1




fenofibric cap 135mg dr 3 PA

fenofibric cap 45mg dr 3 PA

FENOFIBRIC TAB 105MG 1

FENOFIBRIC TAB 35MG 1

FENOGLIDE TAB 120MG 3

FENOGLIDE TAB 40MG 3

FIBRICOR TAB 105MG 3

FIBRICOR TAB 35MG 3

gemfibrozil tab 600mg 1

LIPOFEN CAP 150MG 3

LIPOFEN CAP 50MG 3

TRIGLIDE TAB 160MG 3

TRIGLIDE TAB 50MG 3

Dyslipidemics, HMG CoA Reductase Inhibitors

ALTOPREV TAB 20MG ER 3






59

atorvastatin tab 10mg 1 QL 30/30




CRESTOR TAB 10MG 3 QL 30/30




fluvastatin cap 20mg 1


LESCOL XL TAB 80MG 3

LIVALO TAB 1MG 3

LIVALO TAB 2MG 3

LIVALO TAB 4MG 3

lovastatin tab 10mg 1



pravastatin tab 10mg 1




SIMCOR TAB 1000-20 3

SIMCOR TAB 1000-40 3

SIMCOR TAB 500-20MG 3



simvastatin tab 10mg 1




simvastatin tab 80mg 1 PA

Dyslipidemics, Other

cholestyram pow 4gm lite 1

colestipol gra 5gm 1

colestipol tab 1gm 1

niacin er tab 1000mg 3



niacin tab 500mg er 3

NIACOR TAB 500MG 1

omega-3-acid cap 1gm 3 PA

prevalite pow 4gm 1

VASCEPA CAP 1GM 3

VYTORIN TAB 10-10MG 3





60



WELCHOL PAK 3.75GM 3

WELCHOL TAB 625MG 3

ZETIA TAB 10MG 3

CENTRAL NERVOUS SYSTEM AGENTS Attention Deficit Hyperactivity Disorder Agents, Amphetamines

amphetamine cap 10mg er 1 QL 30/30 AL






amphetamine tab 10mg 1 AL

amphetamine tab 12.5mg 1 AL





amphetamine tab 7.5mg 1 AL

dextroamphet cap 10mg er 1 AL



dextroamphet tab 10mg 1 AL

dextroamphet tab 5mg 1 AL

methamphetam tab 5mg 1 AL

VYVANSE CAP 20MG 3

VYVANSE CAP 30MG 3

VYVANSE CAP 40MG 3

VYVANSE CAP 50MG 3

VYVANSE CAP 60MG 3

VYVANSE CAP 70MG 3

zenzedi tab 10mg 1 AL

zenzedi tab 5mg 1 AL

Attention Deficit Hyperactivity Disorder Agents, Non-amphetamines

DAYTRANA DIS 10MG/9HR 3 PA QL 30/30 AL




dexmethylph cap 15mg er 3 PA QL 30/30 AL



dexmethylph tab 10mg 1 AL

dexmethylph tab 2.5mg 1 AL

dexmethylph tab 5mg 1 AL




61

FOCALIN XR CAP 10MG 3 PA QL 30/30 AL





INTUNIV TAB 1MG 3 PA AL




KAPVAY MIS 0.1&0.2 3 PA AL

metadate tab 20mg er 1 QL 30/30 AL

methylphenid cap 10mg 1 AL

methylphenid cap 20mg 1 QL 30/30 AL





methylphenid sol 10mg/5ml 1 AL

methylphenid sol 5mg/5ml 1 AL

methylphenid tab 10mg 1 AL

METHYLPHENID TAB 10MG ER 1 QL 30/30 AL

methylphenid tab 18mg er 1 QL 30/30 AL



methylphenid tab 20mg sr 1 QL 30/30 AL





QUILLIVANT SUS XR 3 PA AL

STRATTERA CAP 100MG 3 PA AL







Central Nervous System, Other

doxapram hcl inj 20mg/ml 1

DYSPORT INJ 500UNIT 4 PA

riluzole tab 50mg 4

XENAZINE TAB 12.5MG 4 PA

XENAZINE TAB 25MG 4 PA

Fibromyalgia Agents

GRALISE STAR MIS 300/600 3




62

GRALISE TAB 300MG 3

HORIZANT TAB 600MG 3

NUEDEXTA CAP 20-10MG 4 PA

SAVELLA TAB 100MG 3

SAVELLA TAB 12.5MG 3

SAVELLA TAB 25MG 3

SAVELLA TAB 50MG 3

Multiple Sclerosis Agents

AMPYRA TAB 10MG 4 PA

AVONEX KIT 30MCG 4 PA

AVONEX PEN KIT 30MCG 4 PA

AVONEX PREFL KIT 30MCG 4 PA

BETASERON INJ 0.3MG 4 PA

COPAXONE INJ 40MG/ML 4 PA

COPAXONE KIT 20MG/ML 4 PA

EXTAVIA INJ 0.3MG 4 PA

GILENYA CAP 0.5MG 4 PA

REBIF INJ 22/0.5 4 PA

REBIF INJ 44/0.5 4 PA

REBIF REBIDO INJ 22/0.5 4 PA

REBIF REBIDO INJ 44/0.5 4 PA

REBIF REBIDO SOL TITRATN 4 PA

REBIF TITRTN SOL PACK 4 PA

XYREM SOL 500MG/ML 4 PA

DENTAL AND ORAL AGENTS Dental and Oral Agents

cavarest gel 1.1% 1

cavirinse sol 0.2% 1

chlorhex glu sol 0.12% 1

clinpro 5000 pst 1.1% 1

clotrimazole loz 10mg 1

clotrimazole tro 10mg 1

controlrx cre 1.1% 1

controlrx pst 1.1% 1

denta 5000 cre plus 1

denta 5000 cre plus 2pk 1

dentagel gel 1.1% 1

fluoridex dd pst sensitiv 1

fluoridex gel 1.1% 1

fluoridex gel whitenin 1

karigel gel 0.5% 1

karigel-n gel 1.1% 1

lidocaine sol 2% visc 1 QL 100/23

lidocaine sol 4% 1 QL 100/23

neutragard gel 1.1% 1




63

nystatin sus 100000 1

oralone pst 0.1% 1

ORAVIG TAB 50MG 3

paroex sol 0.12% 1

perio med con 0.63% 1

periogard sol 0.12% 1

phos-flur gel 1.1% 1

pilocarpine tab 5mg 1

pilocarpine tab 7.5mg 1

sf 5000 plus cre 1.1% 1

sf gel 1.1% 1

sod fluoride sol 0.2% 1

sod fluoride sol 0.2%mint 1

stan fluorid con 0.63% 1

triamcin/ora pst 0.1% 1

triamcinolon pst 0.1% 1

DERMATOLOGICAL AGENTS Dermatological Agents

8-MOP CAP 10MG 3 PA

ACANYA GEL 1.2-2.5% 3 PA

acetylcyst inj 200mg/ml 1

acitretin cap 10mg 4 PA

acitretin cap 17.5mg 4 PA

acitretin cap 25mg 4 PA

acne medicat gel 10% 1


acne pimple gel 10% 1

acne treatmn gel 10% 1

acne-clear gel 10% 1

acticin cre 5% 1

al12 lot 12% 1

ala cort cre 1% 1 QL 120/23

alclometason cre 0.05% 1

alclometason oin 0.05% 1

alphaquin hp cre 4% 1

alphatrex gel 0.05% 1 QL 100/23

ALTABAX OIN 1% 3

amcinonide cre 0.1% 1

AMCINONIDE LOT 0.1% 1

AMCINONIDE OIN 0.1% 1

amlactin lot 12% 1

ammonium lac cre 12% 1

ammonium lac lot 12% 1

ana-lex kit 3

ANALPRAM-HC LOT 2.5% 3




64

anti-itch cre /aloe/e 1 QL 120/23

anti-itch cre /oatmeal 1 QL 120/23

anti-itch cre 1% 1 QL 120/23

anti-itch cre 1%pls 10 1 QL 120/23

anti-itch lot 1% 1 QL 240/23

anti-itch oin 1% 1 QL 90/23

anti-itch oin max st 1 QL 90/23

antifungal cre 1% 3

antifungal cre 2% 1

anucort-hc sup 25mg 1

APEXICON E CRE 0.05% 3 QL 120/23

apexicon oin 0.05% 3 QL 120/23

aquanil hc lot 1% 1 QL 240/23

athlete foot cre 1% 3

ATRALIN GEL 0.05% 3 QL 45/23 AL

aug betamet cre 0.05% 1 QL 100/23

aug betamet gel 0.05% 1 QL 100/23

aug betamet lot 0.05% 1 QL 120/23

aug betamet oin 0.05% 1 QL 100/23

AVAGE CRE 0.1% 4 PA

aveeno cre 1% 1 QL 120/23

avita cre 0.025% 1 QL 45/23 AL

avita gel 0.025% 1 QL 45/23 AL

baza antifun cre 2% 1

benzepro aer 5.3% 1

benzepro sc aer 9.8% 1

benziq wash liq 5.25% 1

BENZOIN CMPD TIN 1

benzoyl per aer 5.3% 1


benzoyl per gel 10% 1


benzoyl per lot 6% 1

benzoyl pero aer 9.8% 1

benzoyl pero kit acne pck 1

beta hc lot 1% 1 QL 240/23

betameth dip cre 0.05% 1 QL 90/23

betameth dip lot 0.05% 1 QL 120/23

betameth dip oin 0.05% 1 QL 90/23

betameth val aer 0.12% 1

betameth val cre 0.1% 1 QL 90/23

betameth val lot 0.1% 1 QL 120/23

betameth val oin 0.1% 1 QL 90/23

BP CLEANSING LOT 4% 1

bp foam aer 5.3% 1




65

bp foam aer 9.8% 1

bp gel gel 10% 1

bp gel gel 5% 1

bp wash liq 5.25% 1

bp wash liq 7% 1

CA-DTPA SOL 1000MG 1

calcipotrien cre 0.005% 1

calcipotrien oin 0.005% 1

calcipotrien sol 0.005% 3

calcitrene oin 0.005% 1

CALCITRIOL OIN 3MCG/GM 3 PA

CALCIUM DISO INJ 500/2.5M 1

CAPEX SHA 0.01% 3 QL 120/23

CARAC CRE 0.5% 3

CEM-UREA SOL 45% 1

CENTANY OIN 2% 1

cerovel gel 40% 1

cerovel lot 40% 1

CHLORHEX DIG SOL 20% 1

CHLORHEX GLU SOL 20% 1

clearplex v gel 5% 1

clearplex x gel 10% 1

clindacin mis etz 1% 1

clindacin-p pad 1% 1

clindamax gel 1% 3

clindamax lot 10mg/ml 1

clindamy/ben gel 1-5% 1

clindamycin aer 1% 1

clindamycin gel 1% 3

clindamycin lot 1% 1

clindamycin lot 10mg/ml 1

clindamycin pad 1% 1

clindamycin sol 1% 1

clobetasol aer 0.05% 1

clobetasol cre 0.05% 1 QL 120/23

clobetasol gel 0.05% 1 QL 120/23

clobetasol lot 0.05% 1

clobetasol oin 0.05% 1 QL 120/23

clobetasol sha 0.05% 1

clobetasol sol 0.05% 1 QL 100/23

CLOBEX SPR 0.05% 3

CLOCORTOLONE CRE PIV 0.1% 3

clodan sha 0.05% 1

CLODERM CRE 0.1% 3

CLODERM CRE 0.1% PMP 3




66

clotrim/beta cre 1-0.05% 1 QL 90/23

clotrim/beta cre diprop 1 QL 90/23

clotrim/beta lot diprop 1 QL 60/23

clotrimazole sol 1% 1

CNL8 NAIL KIT 3

COAL TAR SOL 20% 1

COCAINE HCL SOL 10% 1

COCAINE HCL SOL 4% 1

colocort ene 100mg 1

CONDYLOX GEL 0.5% 3

CORDRAN 24X3 TAP 4MCG/CM 3 QL 1/23

CORDRAN 80X3 TAP 4MCG/CM 3 QL 1/23

CORDRAN LOT 0.05% 3

CORDRAN SP CRE 0.05% 3

cormax scalp sol 0.05% 1 QL 100/23

cort intense cre heal 1% 1 QL 120/23

cortaid adv cre 1% 12 hr 1 QL 120/23

cortaid cre 1% 1 QL 120/23

cortalo gel 2% 1

CORTIFOAM AER 90MG 3

cortisone + cre 1% 1 QL 120/23

cortisone cre 1% 1 QL 120/23

cortisone lot 1% 1 QL 240/23

cortisone oin 1%max st 1 QL 90/23

CORTISPORIN CRE 0.5% 3

CORTISPORIN OIN 1% 3

cortizone-10 lot eczema 1 QL 240/23

cortizone-10 lot hydraten 1 QL 240/23

cortizone-10 oin 1% 1 QL 90/23

cvs cort int cre heal 1% 1 QL 120/23

deferoxamine inj 500mg 1

DELAZINC OIN 1

DERMASORB TA KIT 0.1% 3

desenex cre 1% 3

DESONATE GEL 0.05% 3 QL 120/23

desonide cre 0.05% 1 QL 120/23

desonide lot 0.05% 1 QL 120/23

desonide oin 0.05% 1 QL 120/23

DESOWEN CRM KIT 0.05% 3

DESOWEN LOT KIT 0.05% 3

DESOWEN OINT KIT 0.05% 3

DESOXIMETAS CRE 0.05% 3 QL 200/30

desoximetas cre 0.25% 1 QL 200/30

desoximetas gel 0.05% 1 QL 120/23

DESOXIMETAS OIN 0.05% 3 QL 120/23




67

desoximetas oin 0.25% 1 QL 200/23

DIFLORASONE CRE 0.05% 3 QL 120/23

diflorasone oin 0.05% 1 QL 120/23

DRITHO-CREME CRE HP 1% 1

econazole cre 1% 1 QL 85/23

ELIDEL CRE 1% 3 QL 100/30

EPIDUO GEL 0.1-2.5% 3

eq hydrocort cre 1% 1 QL 120/23

ERTACZO CRE 2% 3

ery pad 2% 1

erythromycin gel /benzoyl 1

erythromycin gel 2% 1

erythromycin pad 2% 1

erythromycin sol 2% 1

ETHYL CHLOR AER FINE PIN 1

ETHYL CHLOR AER FN STRM 1

ETHYL CHLOR AER MED JET 1

ETHYL CHLOR AER MED STRM 1

ETHYL CHLOR AER MIST 1

ETHYL CHLOR AER SPRAY 1

EURAX CRE 10% 2

EURAX LOT 10% 2

exoderm lot 25-1% 1

FERRIPROX TAB 500MG 4 PA

FINACEA GEL 15% 3

finasteride tab 1mg 1

FLECTOR DIS 1.3% 3

fluocin acet cre 0.01% 1 QL 120/23

fluocin acet cre 0.025% 1 QL 120/23

fluocin acet oil 0.01% 1

fluocin acet oil 0.01% sc 1 QL 120/23

fluocin acet oil body 1 QL 120/23

fluocin acet oil scalp 1 QL 120/23

fluocin acet oin 0.025% 1 QL 120/23

fluocin acet sol 0.01% 1 QL 120/23

fluocinonide cre 0.05% 1 QL 120/23

fluocinonide gel 0.05% 1 QL 120/23

fluocinonide oin 0.05% 1 QL 120/23

fluocinonide sol 0.05% 1 QL 120/23

FLUOROPLEX CRE 1% 3

fluorouracil cre 5% 1

fluorouracil dro 2% 1


fluorouracil sol 2% 1





68

fluticasone cre 0.05% 1 QL 120/23

fluticasone lot 0.05% 1

fluticasone oin 0.005% 1 QL 120/23

fomepizole inj 1.5gm 1

fomepizole inj 1gm/ml 1

FORMA-RAY SOL 20% 1

formadon sol 1

formaldehyde sol 10% 1

fungicure spr intens 1

GENTAMICIN CRE 0.1% 1

GENTAMICIN OIN 0.1% 1

geri-hydrola cre 12% 1

geri-hydrola lot 12% 1

gnp hydrocor cre 1% plus 1 QL 120/23

GNP IODIDES TIN 1

GNP IODINE TIN 2% MILD 1

grx hicort sup 25mg 1

halac kit 1

halobetasol cre 0.05% 1 QL 100/23

halobetasol oin 0.05% 1 QL 100/23

HALOG CRE 0.1% 3 QL 100/23

HALOG OIN 0.1% 3 QL 100/23

halonate pac kit 1

hc ac/aloe gel 2% 1

hc butyrate cre 0.1% 1

hc butyrate oin 0.1% 1

hc butyrate sol 0.1% 1

hc pramoxine cre 1-1% 1

hc pramoxine cre 1-2.5% 1 QL 60/23

hc pramoxine cre 2.5-1% 1

hc valerate cre 0.2% 1 QL 120/23

hc valerate oin 0.2% 1 QL 120/23

hc/lidocaine kit 2-2% 3

hemril-30 sup 30mg 1

HM IODIDES TIN 1

HM IODINE TIN 2% MILD 1

hyaluronate gel 0.2% 1

hydro skin lot 1% 1 QL 240/23

hydro-lotion lot 1% 1 QL 240/23

hydrocort ac sup 25mg 1


hydrocort cre 1% 1 QL 120/23

hydrocort cre 1% plus 1 QL 120/23

hydrocort cre 1%max st 1 QL 120/23

hydrocort cre 1%pls 10 1 QL 120/23




69

hydrocort cre 2.5% 1 QL 90/23

hydrocort ene 100mg 1

hydrocort lot 1% 1 QL 240/23

hydrocort lot 2.5% 1 QL 120/23

hydrocort oin 1% 1 QL 90/23

hydrocort oin 2.5% 1 QL 90/23

hydrocort/ kit pramoxin 1

hydrocort/ab oin 1% 1 QL 90/23

hydrocream cre 1% 1 QL 120/23

hydroquinone cre 4% 1

hydroquinone cre 4% tr 1

hydroskin cre 1% 1 QL 120/23

hygel gel 0.2% 1

hypercare sol 20% 1

imiquimod cre 5% 3 QL 60/30

IODIDES TIN 1

IODINE TIN 1

IODINE TIN 1% 1

IODINE TIN 2% 1

IODINE TIN 2% MILD 1

jock itch cre 1% 3

KENALOG AER SPRAY 3

kericort 10 cre 1% 1 QL 120/23

ketoconazole aer 2% 1

ketoconazole cre 2% 1

ketoconazole sha 2% 1

ketodan aer 2% 1

laclotion lot 12% 1

lactic acid cre /vit e 1

lactic acid cre e 1

lactic acid lot 10% 1

latrix sus 50% 1

LAVOCLEN-4 LIQ CREM WSH 1

LAVOCLEN-8 LIQ CREM WSH 1

lidazone cre 1

LIDO-HYDRO GEL 2.8-0.55 1

lido/prilocn cre 2.5-2.5% 1 AL

lidocaine cre 3% 1 QL 85/23

lidocaine gel 2% 1 QL 90/23

lidocaine gel 2% jelly 1 QL 90/23

LIDOCAINE LOT 3% 3 QL 100/23

lidocaine oin 5% 1 QL 70.8/23

lidocaine pad 5% 3 PA

lidocaine/hc cre 3%-0.5% 1

lidocaine/hc kit 2-2% 3




70

lidocaine/hc kit 3%-1% 3

lidocaine/hc kit 3-2.5% 3

lindane lot 1% 3

lindane sha 1% 3

LOCOID LOT 0.1% 3

lokara lot 0.05% 1 QL 120/23

LOTRIMIN ULT CRE 1% 3

LUGOLS SOL STRONG 1

mafenide ace pak 5% 1

malathion lot 0.5% 1

med-derm hc cre 1% 1 QL 120/23

melpaque hp cre 4% 1

MELQUIN 3 SOL 3% 1

melquin hp cre 4% 1

MENTAX CRE 1% 3

methoxsalen cap 10mg 3 PA

metronidazol cre 0.75% 1

metronidazol gel 0.75% 1

metronidazol gel 1% 1

metronidazol lot 0.75% 1

micaderm cre 2% 1

micro guard cre 2% 1

moist skin cre 12% 1

moist skin lot 12% 1

mometasone cre 0.1% 1

mometasone oin 0.1% 1

mometasone sol 0.1% 1

mupirocin ca cre 2% 1

mupirocin cre 2% 1

mupirocin oin 2% 3

NAFTIN CRE 2% 3

NATROBA SUS 0.9% 3

nava-sc cre 4% 1

neosporin af cre 2% jock 1

neosporin cre eczema 1 QL 120/23

noble formul cre hc 1% 1 QL 120/23

nuquin hp cre 4% 1

NUQUIN HP GEL 4% 3

nyamyc pow 100000 1

nystat/triam cre 1

nystat/triam oin 1

nystatin cre 100000 1

nystatin oin 100000 1

nystatin pow 100000 1

nystop pow 100000 1




71

ORACEA CAP 40MG 3 PA

oscion clnsr lot 6% 1

OVACE PLUS CRE 10% 3

OXISTAT CRE 1% 3

OXSORALEN LOT 1% 3

PANOXYL-4 LIQ CREM WSH 1

PANOXYL-8 LIQ CREM WSH 1

pedi-dri pow 100000 1

PEDIADERM HC KIT 3

PEDIADERM TA KIT 3

PEDIPIROX-4 KIT NAIL 3

permethrin cre 5% 1

persa-gel gel 10% 1

persa-gel xs gel 5% 1

PHISOHEX LIQ 3% 3

PHYSOS SALIC INJ 1MG/ML 1

podactin cre 2% 1

PODOCON SOL 25% 1

podofilox sol 0.5% 1

pr benzoyl liq 7% wash 1

PRALIDOXIME INJ 600/2ML 6

pramcort cre 1-1% 1

pramegel gel 1% 1

PRAMOSONE E CRE 1-2.5% 3

PRAMOSONE LOT 1% 3

PRAMOSONE LOT 2.5% 3

PRAMOSONE OIN 1% 3

PRAMOSONE OIN 2.5% 3

pramox gel 1% 1

prednicarbat cre 0.1% 1 QL 120/23

prednicarbat oin 0.1% 1 QL 120/23

prep h hc cre 1% 1 QL 120/23

proctocream cre hc 2.5% 1

PROCTOFOAM AER HC 1% 3

proctosol hc cre 2.5% 1

proctozone cre -hc 2.5% 1

PROTOPIC OIN 0.03% 3 QL 100/30

PROTOPIC OIN 0.1% 3 QL 100/30

PRUDOXIN CRE 5% 3

PYROGALL ACD OIN 1

qc hydrocort cre 1% 1 QL 120/23

QC IODIDES TIN 1

QC IODINE TIN 1

ra anti-itch cre 1% 1 QL 120/23

ra anti-itch oin 1% 1 QL 90/23




72

RA FIRST AID TIN IODINE 1

ra hydrocort cre 1% 1 QL 120/23

ra hydrocort cre 1%pls 12 1 QL 120/23

ra renewal gel 10% 1

recort plus cre 1% 1 QL 120/23

rectacort-hc sup 25mg 1

RECTIV OIN 0.4% 3

rederm lot 1% 1 QL 240/23

REFISSA CRE 0.05% 3

regenecare gel ha 2% 1 QL 90/23

REGRANEX GEL 0.01% 3

remedy cre antifung 1

remergent hq cre 4% 1

remeven cre 50% 1

RENOVA CRE 0.02% 3

RENOVA PUMP CRE 0.02% 3

revina oin 1

ringworm cre 1% 3

rosadan cre 0.75% 1

rosadan gel 0.75% 1

salacyn cre 6% 1

salacyn lot 6% 1

salicylic ac cre 6% 1

salicylic ac gel 6% 1

SALICYLIC AC LIQ 26% 1

salicylic ac liq 27.5% 1

salicylic ac lot 6% 1

salicylic ac sha 6% 1

salicylic aer 6% 1

SANTYL OIN 250U/GM 2

SANTYL OIN 250/GM 2

sarnol-hc lot 1% 1 QL 240/23

sb hydrocort cre 1% 1 QL 120/23

sb hydrocort oin 1% 1 QL 90/23

scalacort lot 2% 1 QL 120/23

SE BPO 7-5.5 KIT WASH KIT 1

se bpo wash liq 7% 1

seb-prev liq wash 1

selenium sul lot 2.5% 1

SELENIUM SUL SHA 2.25% 1

selenium sul sha 2.5% 1

SILVER NITRA OIN 10% 1

SILVER NITRA SOL 0.5% 1

SILVER NITRA SOL 10% 1





73


skin bleach cre 4% 1

skin bleach cre sunscree 1

skin trtment lot 12% 1

SKLICE LOT 0.5% 3

sm antifungl cre 1% 3


sm antifungl sol 1% 1

sm hydrocort cre 1% 1 QL 120/23

sm hydrocort oin 1% 1 QL 90/23

SM IODIDES TIN 1

SM IODINE TIN MILD 1

SOD NITRITE INJ 30MG/ML 6

sod sul/sulf lot 10-5% 1

SOD SULFACET PAD 10% 1

sod sulfacet sha 10% 1

SOD THIOSULF INJ 10% 6

sod thiosulf inj 25% 6

sodium sulfa liq 10% wash 1

soothe&cool cre inzo 2% 1

SPINOSAD SUS 0.9% 3

STELARA INJ 45MG/0.5 4 PA

STELARA INJ 90MG/ML 4 PA

sulfacetamid lot 10% 1

sulfacetamid sus 10% 1

SULFAMYLON CRE 85MG/GM 3

SYNERA DIS 70-70MG 3

TACLONEX SUS 3

TAZORAC CRE 0.05% 4 PA

TAZORAC CRE 0.1% 4 PA

TAZORAC GEL 0.05% 4 PA

TAZORAC GEL 0.1% 4 PA

TEXACORT SOL 2.5% 3

th hydrocort cre 1% 1 QL 120/23

theracort lot 1% 1 QL 240/23

tl hydroquin cre 4% 1

tl urea lot 45% 1

TOPICORT CRE 0.05% 3 QL 200/30

TOPICORT OIN 0.05% 3 QL 120/23

TRETIN-X CRE 0.0375% 3 QL 45/23

tretinoin cre 0.025% 1 QL 45/23 AL



TRETINOIN EM CRE 0.05% 3

tretinoin gel 0.01% 1 QL 45/23 AL




74

tretinoin gel 0.025% 1 QL 45/23 AL

tretinoin gel 0.04% 3

tretinoin gel 0.04%pmp 3

triamcinolon cre 0.025% 1 QL 160/23



triamcinolon lot 0.025% 1 QL 120/23

triamcinolon lot 0.1% 1 QL 120/23

triamcinolon oin 0.025% 1 QL 160/23

triamcinolon oin 0.1% 1 QL 160/23

TRIAMCINOLON OIN 0.5% 3 QL 60/23

TRIANEX OIN 0.05% 1 QL 60/23

triderm cre 0.1% 1 QL 160/23

u-kera e cre 40% 1

ULTRAVATE KIT PAC 3

umecta mouss aer 40% 1

URAMAXIN AER 20% 1

urea 40% sus nail 1

urea cre 39% 1

urea cre 40% 1

urea cre 45% 1

urea cre 50% 1

urea emu 50% 1

urea gel 40% 1

urea lot 40% 1

urea lot 45% 1

urea nail gel 45% 1

UREA NAIL KIT 1

urea sus 50% 1

urea topical sus 40% 1

urea-c40 lot 40% 1

vasolex oin 1

VECTICAL OIN 3MCG/GM 3 PA

VELTIN GEL 2

VERDESO AER 0.05% 3

VEREGEN OIN 15% 3

versiclear lot 1

VOLTAREN GEL 1% 3 QL 200/30

x-viate cre 40% 1

x-viate gel 40% 1

x-viate lot 40% 1

XOLEGEL GEL 2% 3

ZACLIR LOT 8% 1

ZIANA GEL 3

ZN-DTPA SOL 1000MG 1




75

ZONALON CRE 5% 3

ZYCLARA CRE 3.75% 3 PA

ZYCLARA PUMP CRE 3.75% 3 PA

GASTROINTESTINAL AGENTS Antispasmodics, Gastrointestinal

ATROPEN INJ 0.5MG 3

bella alk/pb tab 16.2mg 1 AL

BELLA/OPIUM SUP 16.2-30 1 AL

BELLA/OPIUM SUP 16.2-60 1 AL

BENTYL INJ 10MG/ML 3 AL

CANTIL TAB 25MG 3

chlord/clidi cap 5-2.5mg 1

CUVPOSA SOL 1MG/5ML 3

dicyclomine cap 10mg 1 AL

DICYCLOMINE SOL 10MG/5ML 1 AL

dicyclomine tab 20mg 1 AL

DONNATAL TAB EXTENTAB 3

ed-spaz tab 0.125mg 1 AL

glycopyrrol inj 0.2mg/ml 6

glycopyrrol tab 1mg 1


hyomax-sl sub 0.125mg 1 AL

hyoscyamine dro 0.125/ml 1 AL

hyoscyamine elx 0.125/5 1 AL

hyoscyamine sub 0.125mg 1 AL

hyoscyamine tab 0.125mg 1 AL

hyoscyamine tab 0.375 er 1 AL

hyoscyamine tab 0.375 sr 1 AL

hyosyne dro 0.125/ml 1 AL

hyosyne elx 0.125/5 1 AL

me-pb-hyos tab 16.2mg 1 AL

methscopolam tab 2.5mg 1 AL

methscopolam tab 5mg 1 AL

nulev tab 0.125mg 1 AL

oscimin sr tab 0.375mg 1 AL

oscimin sub 0.125mg 1 AL

oscimin tab 0.125mg 1 AL

PROPANTHELIN TAB 15MG 1

symax fastab tab 0.125mg 1 AL

symax-sl sub 0.125mg 1 AL

symax-sr tab 0.375mg 1 AL

Digestive Enzymes

CREON CAP 12000UNT 2

CREON CAP 24000UNT 2

CREON CAP 3000UNIT 2




76

CREON CAP 6000UNIT 2

ZENPEP CAP 25000UNT 2

Gastrointestinal Agents, Other

AMITIZA CAP 24MCG 3 PA

AMITIZA CAP 8MCG 3 PA

anti-diarrhe cap 2mg 1

anti-diarrhe liq 1mg/5ml 1

anti-diarrhe tab 2mg 1

CARAFATE SUS 1GM/10ML 3

clearlax pow 1

COLYTE/FLAVR SOL PACKS 3

constulose sol 10gm/15 1

cromolyn sod con 100/5ml 1

cvs purelax pow 1

DEXPANTHENOL INJ 250MG/ML 6

diamode tab 2mg 1

DIPHEN/ATROP LIQ 2.5/5 1

diphen/atrop tab 2.5mg 1

dulcolax pow balance 1

enulose sol 10gm/15 1

eq clearlax pow 1

eql clearlax pow 1

gavilax pow 1

gavilyte-c sol 1

gavilyte-g sol 1

gavilyte-n sol flav pk 1

generlac sol 10gm/15 1

gentlelax pow 1

glycolax pow 3350 nf 1

gnp clearlax pow 1

GOLYTELY SOL 3

HALFLYTELY KIT FLAV PKS 3

hm clearlax pow 1

imperim tab 2mg 1

kls anti-dia tab 2mg 1

KRISTALOSE PAK 10GM 3

KRISTALOSE PAK 20GM 3

lactulose sol 10gm/15 1


lansopr/amox mis /clarith 1

laxaclear pow 1

LINZESS CAP 145MCG 3 PA

LINZESS CAP 290MCG 3 PA

lofene tab 2.5mg 1

lonox tab 2.5mg 1




77

loperamide cap 2mg 1

loperamide liq 1mg/5ml 1

loperamide tab 2mg 1

LOTRONEX TAB 1MG 3

metoclopram inj 10mg/2ml 6

metoclopram inj 5mg/ml 6

metoclopram sol 10/10ml 1

metoclopram sol 5mg/5ml 1

metoclopram tab 10mg 1


MOTOFEN TAB 2

MOVIPREP SOL 3

natura-lax pow 3350 nf 1

omepra/bicar cap 40-1100 1 QL 30/30

OPIUM TINCT TIN 2MG/5ML 1

OSMOPREP TAB 1.5GM 3

peg 3350 pow 1

peg 3350 sol electrol 1

peg-3350 sol electrol 1

peg-3350/kcl sol /sodium 1

pegylax pow 1

polyeth glyc pow 3350 nf 1

polyeth glyc pow 3350-grx 1

powderlax pow 1

PREPOPIK PAK 3 PA

ra laxative pow 1

sm anti-diar tab 2mg 1

sm clearlax pow 1

smooth lax pow 1

SUCRAID SOL 8500/ML 4 PA

sucralfate tab 1gm 1

SUPREP BOWEL SOL PREP 3

sw clearlax pow 1

trilyte sol 1

ursodiol cap 300mg 1

ursodiol tab 250mg 3


Histamine2 (H2) Receptor Antagonists

acid control tab 150mg 1


acid reducer tab 150mg 1



acid reducer tab max st 1

acid relief tab 200mg 1




78

cimetidine sol 300/5ml 1

cimetidine tab 200mg 1




eq heartburn tab relief 1

famotidine inj 10mg/ml 6

famotidine inj 200/20ml 6

famotidine inj 20mg/2ml 6

FAMOTIDINE INJ 20MG/50M 6


famotidine sus 40mg/5ml 1

famotidine tab 20mg 1


heartbrn rel tab 200mg 1

heartburn tab 150mg 1



heartburn tab relief 1

misoprostol tab 100mcg 1


nizatidine cap 150mg 1


nizatidine sol 15mg/ml 1

ranitidine cap 150mg 3


ranitidine inj 150/6ml 6

ranitidine syp 150/10ml 1

ranitidine syp 15mg/ml 1

ranitidine syp 75mg/5ml 1

ranitidine tab 150mg 1


sm acid redu tab 200mg 1

wal-zan tab 150mg 1

Proton Pump Inhibitors

DEXILANT CAP 30MG DR 3 QL 30/30

DEXILANT CAP 60MG DR 3 QL 30/30

heartburn tr cap 15mg 1 QL 60/30

hrtbrn rel cap 15mg dr 1 QL 60/30

lansoprazole cap 15mg dr 1 QL 60/30

lansoprazole cap 30mg dr 3 PA QL 60/30

LANSOPRAZOLE SUS 3MG/ML 3 QL 150/30

NEXIUM 24HR CAP 20MG

NEXIUM 24HR CAP 20MG 1 QL 60/30

omepra/bicar cap 20-1100 1 QL 30/30




79

omeprazole cap 10mg 1 QL 60/30



pantoprazole inj 40mg 6

pantoprazole tab 20mg 1 QL 60/30

pantoprazole tab 40mg 1 QL 60/30

PREVACID TAB 15MG STB 3 QL 60/30

PREVACID TAB 30MG STB 3 PA QL 60/30

ZEGERID POW 20-1680 3 QL 30/30

ZEGERID POW 40-1680 3 QL 30/30

GENITOURINARY AGENTS Antispasmodics, Urinary

bethanechol tab 10mg 1




ENABLEX TAB 15MG 2

ENABLEX TAB 7.5MG 2

flavoxate tab 100mg 1

GELNIQUE GEL 10% 3

GELNIQUE GEL 3% 3

hyophen tab 1

MYRBETRIQ TAB 25MG 3 PA

oxybutynin syp 5mg/5ml 1

oxybutynin tab 10mg er 1


oxybutynin tab 5mg 1


OXYTROL DIS 3.9MG/24 3

OXYTROL/WOMN DIS 3.9MG/24 3

phosphasal tab 1

tolterodine cap 2mg er 1


tolterodine tab 1mg 1


TOVIAZ TAB 4MG 2

TOVIAZ TAB 8MG 2

trospium chl cap 60mg er 1

trospium cl tab 20mg 1

ur n-c tab 1

uretron d/s tab 1

urin d/s tab 1

ustell cap 1

uta cap 120mg 1

uticap cap 1




80

utira-c tab 1

utrona-c tab 1

VESICARE TAB 10MG 2

VESICARE TAB 5MG 2

Benign Prostatic Hypertrophy Agents

alfuzosin tab 10mg 1

AVODART CAP 0.5MG 3

CARDURA XL TAB 4MG 3


RAPAFLO CAP 4MG 3 PA

RAPAFLO CAP 8MG 3 PA

tamsulosin cap 0.4mg 1 QL 60/30

Genitourinary Agents, Other

CAVERJECT INJ 20MCG 3 PA

CAVERJECT INJ 40MCG 3 PA

CAVERJECT KIT 10MCG 3 PA

CAVERJECT KIT 20MCG 3 PA

CIALIS TAB 10MG 3 PA

CIALIS TAB 2.5MG 3 PA

CIALIS TAB 20MG 3 PA

CIALIS TAB 5MG 3 PA

EDEX KIT 10MCG 3 PA

EDEX KIT 20MCG 3 PA

methylergon inj 0.2mg/ml 6

methylergon tab 0.2mg 1

MUSE SUP 1000MCG 3 PA




oxytocin inj 10unt/ml 6

Phosphate Binders

calc acetate cap 667mg 1

calc acetate tab 667mg 1

FOSRENOL CHW 1000MG 3 PA



kionex sus 15gm/60 1

PHOSLYRA SOL 3

RENAGEL TAB 400MG 3 PA

RENAGEL TAB 800MG 3 PA

RENVELA PAK 0.8GM 3 PA

RENVELA PAK 2.4GM 3 PA

RENVELA TAB 800MG 3 PA

SEVELAMER TAB 800MG 3 PA

sod poly sul sus 15gm/60 1




81

Vaginal Products

AVC CRE 15% 3

CLEOCIN SUP 100MG 3

clindamycin cre 2% vag 1

clotrimazole cre 1% 1

clotrimazole cre 1% vag 1

CRINONE GEL 4% VAG 4 PA

CRINONE GEL 8% VAG 4 PA

ENDOMETRIN SUP 100MG 3

ESTRACE VAG CRE 0.1MG/GM 2

ESTRING MIS 2MG 3

GYNAZOLE-1 CRE 2% 2

metronidazol gel 0.75%vag 1

miconazole 3 kit combo pk 1

miconazole cre 2% 1

POT CITRATE TAB 540MG 3

terconazole cre 0.4% 1


terconazole sup 80mg 1

UROCIT-K 5 TAB 3

VAGIFEM TAB 10MCG 3

vagistat-3 kit combo pk 1

vandazole gel 0.75% 1

zazole cre 0.4% 1

zazole cre 0.8% 1

zazole sup 80mg 1

HORMONAL AGENTS, STIMULANT/ REPLACEMENT/ MODIFYING (ADRENAL) Glucocorticoids/Mineralocorticoids

baycadron elx 0.5/5ml 1

beta-phos/ac inj 3-3mg/ml 1

budesonide cap 3mg/24hr 1

CORTISONE AC TAB 25MG 1

DEPO-MEDROL INJ 20MG/ML 3

dexameth pho inj 10mg/ml 1

dexameth pho inj 120mg/30 1

dexameth pho inj 20mg/5ml 1


DEXAMETHASON CON 1MG/ML 3

dexamethason elx 0.5/5ml 1

DEXAMETHASON SOL 0.5/5ML 3

dexamethason tab 0.5mg 1



DEXAMETHASON TAB 1MG 1

DEXAMETHASON TAB 2MG 1




82

dexamethason tab 4mg 1


DEXPAK PAK 10 DAY 3

DEXPAK PAK 13 DAY 3

DEXPAK PAK 6 DAY 3

fludrocort tab 0.1mg 1

hydrocort tab 10mg 1


hydrocort tab 5mg 1

methylpred pak 4mg 1

methylpred tab 16mg 1




MILLIPRED DP PAK 5MG 3

MILLIPRED TAB 5MG 3

ORAPRED ODT TAB 10MG 3

pred sod pho sol 5mg/5ml 1

prednisolone sol 15mg/5ml 1

PREDNISOLONE SOL 25MG/5ML 1

prednisolone syp 15mg/5ml 1

PREDNISONE CON 5MG/ML 3

prednisone pak 10mg 1

PREDNISONE PAK 5MG 1

PREDNISONE SOL 5MG/5ML 1

prednisone tab 10mg 1


prednisone tab 2.5mg 1


PREDNISONE TAB 50MG 1


RAYOS TAB 1MG 3

SOLU-CORTEF INJ 1000MG 3

VERIPRED 20 SOL 20MG/5ML 3

HORMONAL AGENTS, STIMULANT/ REPLACEMENT/ MODIFYING (SEX

HORMONES/ MODIFIERS) Androgens

ANADROL-50 TAB 50MG 4 PA

ANDRODERM DIS 2MG/24HR 3 PA

ANDRODERM DIS 4MG/24HR 3 PA

ANDROGEL GEL 1%(25MG) 3 PA

ANDROGEL GEL 1.62% 3 PA

ANDROXY TAB 10MG 3 PA

AXIRON SOL 30MG/ACT 3 PA

FORTESTA GEL 10MG/ACT 3 PA




83

METHITEST TAB 10MG 3

testost cyp inj 100mg/ml 1 PA QL 20/30

testost cyp inj 200mg/ml 1 PA QL 20/30

Contraceptives

ALORA DIS 0.025MG 2 QL 8/28 BD




altavera tab 5 QL 37.5/30

alyacen tab 1/35 5 QL 37.5/30

alyacen tab 7/7/7 5 QL 37.5/30

apri tab 5 QL 37.5/30

aubra tab 0.1-0.02 1 QL 37.5/28 BD

aviane tab 5 QL 37.5/28 BD

BEYAZ TAB 3 QL 37.5/30

camila tab 0.35mg 5 QL 37.5/30

caziant pak 5 QL 37.5/30

cesia pak 5 QL 37.5/30

chateal tab 0.15/30 5 QL 37.5/30

cryselle-28 tab 28 tabs 1 QL 37.5/30

cyclafem tab 1/35 5 QL 37.5/30

cyclafem tab 7/7/7 5 QL 37.5/30

dasetta tab 1/35 5 QL 37.5/30

dasetta tab 7/7/7 5 QL 37.5/30

delyla tab 0.1-0.02 1 QL 37.5/28 BD

DEPO-SQ PROV INJ 104 3

deso/ethinyl tab estradio 1

elinest tab 1 QL 37.5/30

ELLA TAB 30MG 3

emoquette tab 5 QL 37.5/30

enpresse-28 1 QL 28/28

enpresse-28 tab 5 QL 37.5/30

enskyce tab 1

errin tab 0.35mg 5 QL 37.5/30

estarylla tab 0.25-35 5 QL 37.5/30

estrad val inj 10mg/ml 1 BD

estrad val inj 200mg/5 1 BD



falmina tab 1 QL 37.5/28 BD

gildess fe tab 1.5/30 5 QL 37.5/30

gildess fe tab 1/20 5 QL 37.5/30

gildess tab 1.5/30 1

gildess tab 1/20 1 QL 37.5/30

heather tab 0.35mg 5 QL 37.5/30




84

jencycla tab 0.35mg 1

jolivette tab 0.35mg 5 QL 37.5/30

junel 1.5/30 tab 5 QL 37.5/30

junel 1/20 tab 5 QL 37.5/30

junel fe tab 1.5/30 5 QL 37.5/30

junel fe tab 1/20 5 QL 37.5/30

kelnor tab 1/35 5 QL 37.5/28 BD

kurvelo tab 0.15/30 5 QL 37.5/30

larin fe tab 1.5/30 1

larin fe tab 1/20 1

larin tab 1.5/30 1

larin tab 1/20 1

lessina tab 5 QL 37.5/28 BD

levonest tab 5 QL 37.5/30

levonor/ethi tab 0.1-0.02 1 QL 37.5/28 BD

levonor/ethi tab estradio 5 QL 37.5/30

levonorgestr tab 0.75mg 5 QL 2/30 BD

levonorgestrel tab 1.5 mg 1 QL 2/30 BD

levora-28 tab 0.15/30 5 QL 37.5/30

LO LOESTRIN TAB 3 QL 37.5/30

LOESTRIN 24 TAB FE 3 QL 37.5/28 BD

LOMEDIA 24 TAB FE 3 QL 37.5/28 BD

low-ogestrel tab 5 QL 37.5/30

lutera tab 5 QL 37.5/28 BD

lyza tab 0.35mg 1

MAKENA INJ 250MG/ML 4 PA

marlissa tab 0.15/30 5 QL 37.5/30

medroxypr ac inj 150mg/ml 5 QL 1/90

microgestin tab 1/20

microgestin tab 1.5/30 5 QL 37.5/30

microgestin tab 1/20 5 QL 37.5/30

microgestin tab fe 1/20 5 QL 37.5/30

microgestin tab fe1.5/30 5 QL 37.5/30

MINIVELLE DIS 0.0375MG 2 QL 8/28 BD




mono-linyah tab 0.25-35 1 QL 37.5/30

mononessa tab 5 QL 37.5/30

myzilra tab 5 QL 37.5/30

necon tab 0.5/35 5 QL 37.5/30

necon tab 1/35 5 QL 37.5/30

necon tab 7/7/7 5 QL 37.5/30

next choice tab 0.75mg 5 QL 2/30 BD

nora-be tab 0.35mg 5 QL 37.5/30




85

noreth/ethin tab 1/20 1

noreth/ethin tab fe 1/20 1

norethindron tab 0.35mg 5 QL 37.5/30

norgest/ethi tab 0.25/35 5 QL 37.5/30

norgest/ethi tab estradio 5 QL 37.5/30

norlyroc tab 0.35mg 1

nortrel tab 0.5/35 5 QL 37.5/30

nortrel tab 1/35 5 QL 37.5/30

nortrel tab 7/7/7 5 QL 37.5/30

orsythia tab 1 QL 37.5/28 BD

pirmella tab 1/35 1

pirmella tab 7/7/7 1

portia-28 tab 5 QL 37.5/30

previfem tab 5 QL 37.5/30

reclipsen tab 5 QL 37.5/30

SAFYRAL TAB 3 QL 37.5/30

solia tab 5 QL 37.5/30

sprintec 28 tab 28 day 5 QL 37.5/30

sronyx tab 5 QL 37.5/28 BD

tri-estaryll tab 5 QL 37.5/30

tri-linyah tab 5 QL 37.5/30

tri-previfem tab 5 QL 37.5/30

tri-sprintec tab 5 QL 37.5/30

trinessa tab 5 QL 37.5/30

trivora-28 tab 5 QL 37.5/30

velivet pak 5 QL 37.5/30

VIVELLE-DOT DIS 0.025MG 2 QL 8/28 BD





wera tab 0.5/35 5 QL 37.5/30

zovia 1/35e tab 5 QL 37.5/28 BD

Estrogens

CENESTIN TAB 0.3MG 3 BD





COMBIPATCH DIS .05/.14 2

COMBIPATCH DIS .05/.25 2

covaryx hs tab 1

covaryx tab 1

DEPO-ESTRADI INJ 5MG/ML 3 BD

eemt hs tab 1




86

eemt tab 1

ENJUVIA TAB 0.3MG 2 BD





est estrogen tab mtest 1

est estrogen tab mtest ds 1

est estrogen tab mtest hs 1

estra/noreth tab 0.5-0.1 1

estra/noreth tab 1-0.5mg 1

estradiol dis 0.025mg 1 QL 4/28 BD






estradiol tab 0.5mg 1 BD

estradiol tab 1mg 1 BD

estradiol tab 2mg 1 BD

ESTROGEL GEL 3 BD

estropipate tab 0.75mg 1 BD

estropipate tab 1.5mg 1 BD

ESTROPIPATE TAB 3MG 1 BD

EVAMIST SPR 1.53MG 3 BD

JINTELI TAB 1MG-5MCG 1 QL 37.5/28 BD

jinteli tab 1mg-5mcg 1 QL 37.5/28 BD

MENEST TAB 0.3MG 3 BD




mimvey lo tab 0.5-0.1 1

mimvey tab 1-0.5mg 1

mtest hs/est tab estrogen 1

mtest/est tab estrogen 1

ortho-est tab 0.625 1 BD

ortho-est tab 1.25 1 BD

PREMARIN TAB 0.3MG 2 BD





PREMPHASE TAB 2

PREMPRO TAB .625-2.5 2

PREMPRO TAB 0.3-1.5 2




87

PREMPRO TAB 0.45-1.5 2

PREMPRO TAB 0.625-5 2

Progestins

medroxypr ac tab 10mg 1

medroxypr ac tab 2.5mg 1


norethin ace tab 5mg 1

HORMONAL AGENTS, STIMULANT/REPLACEMENT/ MODIFYING (PITUITARY) Hormonal Agents, Stimulant/Replacement/ Modifying (Pituitary)

ACTHAR HP INJ 80UNIT 4 PA

cabergoline tab 0.5mg 1

desmopressin inj 4mcg/ml 1

desmopressin sol 0.01% 1

desmopressin spr 0.01% 1

desmopressin tab 0.1mg 1


STIMATE SOL 1.5MG/ML 4 PA

vasopressin inj 10/0.5ml 1

vasopressin inj 20unt/ml 1

HORMONAL AGENTS, STIMULANT/REPLACEMENT/ MODIFYING (THYROID) Hormonal Agents, Stimulant/Replacement/ Modifying (Thyroid)

levothroid tab 100mcg 1












LEVOTHYROXIN INJ 100MCG 1

levothyroxin tab 100mcg 1














88


levoxyl tab 100mcg 1







levoxyl tab 25mcg 1

levoxyl tab 50mcg 1

levoxyl tab 75mcg 1

levoxyl tab 88mcg 1

liothyronine inj 10mcg/ml 3

liothyronine tab 25mcg 1



NATURE-THROI TAB 130MG 1

NATURE-THROI TAB 16.25MG 1


NATURE-THROI TAB 32.5MG 1


SYNTHROID TAB 100MCG 2



























89













THYROLAR-1 TAB 60MG 3

THYROLAR-1/2 TAB 30MG 3

THYROLAR-1/4 TAB 15MG 3



unith direct tab 100mcg 1











unithroid tab 100mcg 1












WESTHROID TAB 130MG 1

WESTHROID TAB 16.25MG 1


WESTHROID TAB 32.5MG 1





90

WESTHROID-P TAB 130MG 1

WESTHROID-P TAB 16.25MG 1

WESTHROID-P TAB 32.5MG 1

WESTHROID-P TAB 65MG 1

WP THYROID TAB 130MG 1

WP THYROID TAB 16.25MG 1

WP THYROID TAB 32.5MG 1

WP THYROID TAB 65MG 1

HORMONAL AGENTS, SUPPRESSANT (PITUITARY) Hormonal Agents, Suppressant (Pituitary)

CETROTIDE KIT 0.25MG 4 PA

CETROTIDE KIT 3MG 4 PA

chor gonadot inj 10000unt 4 PA

GANIRELIX AC INJ 4 PA

GENOTROPIN INJ 0.2MG 4 PA








GENOTROPIN INJ 12MG 4 PA




HUMATROPE INJ 12MG 4 PA




INCRELEX INJ 40MG/4ML 4 PA

LUPR DEP-PED INJ 11.25MG 4 PA

LUPR DEP-PED INJ 15MG 4 PA

LUPR DEP-PED INJ 7.5MG 4 PA

NORDITROPIN INJ 10/1.5ML 4 PA


NORDITROPIN INJ 30/3ML 4 PA


novarel inj 10000unt 4 PA

NUTROPIN AQ INJ 10MG/2ML 4 PA

NUTROPIN AQ INJ 20MG/2ML 4 PA

NUTROPIN AQ INJ NUSPIN 5 4 PA

NUTROPIN INJ 10MG 4 PA

octreotide inj 1000mcg 4 PA





91



octreotide inj 50mcg/ml 4 PA

OMNITROPE INJ 10/1.5ML 4 PA

OMNITROPE INJ 5.8MG 4 PA

OMNITROPE INJ 5/1.5ML 4 PA

pregnyl inj 10000unt 4 PA

SAIZEN INJ 5MG 4 PA

SAIZEN INJ 8.8MG 4 PA

SANDOSTATIN KIT LAR 10MG 4 PA



SEROSTIM INJ 4MG 4 PA



SOMATULINE INJ 120/.5ML 4 PA

SOMATULINE INJ 60/0.2ML 4 PA

SOMATULINE INJ 90/0.3ML 4 PA

SOMAVERT INJ 10MG 4 PA



TEV-TROPIN INJ 5MG 4 PA

ZORBTIVE INJ 8.8MG 4 PA

HORMONAL AGENTS, SUPPRESSANT (THYROID) Antithyroid Agents

methimazole tab 10mg 1


propylthiour tab 50mg 1

IMMUNOLOGICAL AGENTS Immune Suppressants

ACTEMRA INJ 80MG/4ML 6

ARCALYST INJ 220MG 4 PA

ATGAM INJ 250MG 6

AZASAN TAB 100MG 3 PA

AZASAN TAB 75 MG 3 PA

azathioprine tab 50mg 1

CELLCEPT IV INJ 500MG 6

CELLCEPT SUS 200MG/ML 4 PA

cyclosporine cap 100mg 1

cyclosporine cap 100mg md 1


cyclosporine cap 25mg mod 1

CYCLOSPORINE CAP 50MG MOD 1

cyclosporine inj 50mg/ml 6

cyclosporine sol modified 1




92

ENBREL INJ 25/0.5ML 4 PA

ENBREL INJ 25MG 4 PA

ENBREL INJ 50MG/ML 4 PA

ENBREL SRCLK INJ 50MG/ML 4 PA

gengraf cap 100mg 1

gengraf cap 25mg 1

gengraf sol 100mg/ml 1

hecoria cap 0.5mg 1

hecoria cap 1mg 1

hecoria cap 5mg 1

HUMIRA KIT 20MG/0.4 4 PA

HUMIRA KIT 40MG/0.8 4 PA

HUMIRA PEN KIT 40MG/0.8 4 PA

HUMIRA PEN KIT CROHNS 4 PA

HUMIRA PEN KIT PSORIASI 4 PA

KINERET INJ 4 PA

leflunomide tab 10mg 1


mycophenolat cap 250mg 1

mycophenolat tab 500mg 1

mycophenolic tab 180mg dr 3 PA

mycophenolic tab 360mg dr 3 PA

PROGRAF INJ 5MG/ML 6

RAPAMUNE SOL 1MG/ML 4 PA

RAPAMUNE TAB 1MG 4 PA

RAPAMUNE TAB 2MG 4 PA

RHEUMATREX TAB 2.5MG 3 PA

RIDAURA CAP 3MG 3 PA

SANDIMMUNE SOL 100MG/ML 4 PA

SIMULECT INJ 20MG 6

sirolimus tab 0.5mg 4 PA

tacrolimus cap 0.5mg 1

tacrolimus cap 1mg 1


THYMOGLOBULN INJ 25MG 6

ZORTRESS TAB 0.25MG 4 PA



Immunizing Agents, Passive

SYNAGIS INJ 100MG/ML 4 PA

Vaccines

AFLURIA INJ 2012-13 5

AFLURIA INJ 2013-14 5

AFLURIA INJ PF 12-13 5

AFLURIA INJ PF 13-14 5




93

FLUARIX INJ PF 12-13 5

FLUARIX PF INJ 2013-14 5

FLUARIX QUAD INJ 2013-14 5

FLUARIX QUAD INJ 2014-15 5

FLULAVAL INJ 2012-13 5



FLULAVAL QUA INJ 2014-15 5

FLUVIRIN INJ 2012-13 5



FLUVIRIN INJ PF 12-13 5

FLUVIRIN INJ PF 13-14 5

FLUVIRIN PF INJ 2014-15 5

FLUZONE INJ INTRADRM 5

FLUZONE INJ PF 12-13 5

FLUZONE INJ PF 13-14 5

FLUZONE PED/ INJ PF 12-13 5



FLUZONE QUAD INJ 13-14 5

FLUZONE QUAD INJ 14-15 5

FLUZONE SPLT INJ 2012-13 5



ZOSTAVAX INJ 5

INFLAMMATORY BOWEL DISEASE AGENTS Aminosalicylates

APRISO CAP 0.375GM 2

ASACOL HD TAB 800MG 3

ASACOL TAB 400MG DR 2

balsalazide cap 750mg 1

CANASA SUP 1000MG 2

DELZICOL CAP 400MG 2

DIPENTUM CAP 250MG 3

GIAZO TAB 1.1GM 3

mesalamine ene 4gm 1 QL 1800/30

PENTASA CAP 250MG CR 3

PENTASA CAP 500MG CR 3

Sulfonamides

LOTRONEX TAB 0.5MG 3

sulfasalazin tab 500mg 1

sulfasalazin tab 500mg dr 1

sulfazine ec tab 500mg 1

sulfazine tab 500mg 1




94

METABOLIC BONE DISEASE AGENTS Metabolic Bone Disease Agents

ACTONEL TAB 30MG 2 QL 30/30



alendronate tab 10mg 1


ALENDRONATE TAB 40MG 1


alendronate tab 70mg 1 QL 4/28

ATELVIA TAB 3 QL 4/30

BINOSTO TAB 70MG 3

calcitonin spr 200/act 1

ETIDRON DISD TAB 200MG 1

ETIDRON DISD TAB 400MG 1

FORTEO SOL 600/2.4 4 PA

FORTICAL SPR 200/ACT 1

FOSAMAX + D TAB 70-2800 3

FOSAMAX + D TAB 70-5600 3

ibandronate tab 150mg 3

MIACALCIN INJ 200/ML 3

pamidronate inj 30/10ml 6

PAMIDRONATE INJ 6MG/ML 6


PROLIA SOL 60MG/ML 4 PA

raloxifene tab 60mg 3

risedronate tab 150mg 1 QL 1/30

MISCELLANEOUS Miscellaneous

ADRENACLICK INJ 0.15MG 3 QL 2/90

ADRENACLICK INJ 0.3MG 3 QL 2/90

AMINOHIPPURA INJ 20% 6

argyl saline sol 100ml 1

AUVI-Q INJ 0.15MG 3 QL 2/90

AUVI-Q INJ 0.3MG 3 QL 2/90

BD SWAB BFLY PAD SNGL USE 1 QL 100/23

BD SWAB REG PAD SNGL USE 1 QL 100/23

BD-INSUL SYR MIS LO DOSE 1 QL 100/26

caffeine cit inj 60mg/3ml 1

caffeine cit sol 20mg/ml 1

caffeine cit sol 60mg/3ml 1

CAFFEINE/SOD INJ BENZOATE 1

CHEMET CAP 100MG 2

compound 347 liq 1

COSYNTROPIN INJ 0.25MG 6




95

CURITY PREP PAD ALCOHOL 1 QL 100/23

CURITY SWABS PAD ALCOHOL 1 QL 100/23

DEPEN TITRA TAB 250MG 3

diethylprop tab 25mg 1

diethylprop tab 75mg er 1

dihydroergot inj 1mg/ml 3

DIHYDROERGOT SPR 4MG/ML 3

dipyridamole inj 5mg/ml 6

disulfiram tab 250mg 1


EASIVENT MIS 1 QL 2/365

EASIVENT MIS MASK LG 1 QL 2/365

EASIVENT MIS MASK MED 1 QL 2/365

EASIVENT MIS MASK SM 1 QL 2/365

EPINEPHRINE INJ 0.15MG 1 QL 2/90

epinephrine inj 0.1mg/ml 1

EPINEPHRINE INJ 0.3MG 1 QL 2/90

EPIPEN 2-PAK INJ 0.3MG 2 QL 2/90

EPIPEN-JR INJ 0.15MG 2

EPIPEN-JR INJ 2-PAK 2 QL 2/90

ERGOLOID MES TAB 1MG ORAL 1

FIFTY50 PREP PAD PADS 1 QL 100/23

flumazenil inj 1mg/10ml 6

GLOBAL PREP PAD PADS 1 QL 100/23

GNP ALCOHOL PAD SWABS 1 QL 100/23

INSULIN SYRG MIS 0.3/28G 1 QL 100/26









INSULIN SYRG MIS 1ML 1 QL 100/26

INSULIN SYRG MIS 1ML/25G 1 QL 100/26







INSULIN SYRG MIS 2/27.5G 1 QL 100/26

INSULIN SYRG MIS 28GX1/2" 1 QL 100/26

INSULIN SYRG MIS 29GX1/2" 1 QL 100/26




96


INSULIN SYRG MIS 30GX5/16 1 QL 100/26

INSULIN SYRG MIS 31GX5/16 1 QL 100/26

isosulfan inj blue 1% 6

KETOSTIX TES STRIP 1 QL 50/23

lactated rin sol irrigat 1

MIGRANAL SPR 4MG/ML 3

naltrexone tab 50mg 1

ORTHO FLAT DPR KIT 55 1 QL 1/273









ORTHO FLEX DPR 65MM 1 QL 1/273




PHENDIMETRAZ CAP 105MG ER 1

phendimetraz tab 35mg 1

phentermine cap 15mg 1


phentermine cap 37.5mg 1

phentermine tab 37.5mg 1

physiolyte sol 1

physiosol sol irrigat 1

PRECISN XTRA TES KETONE 1 QL 10/23

QC ALCOHOL PAD SWABS 1 QL 100/23

RA ALCOHOL PAD SWABS 1 QL 100/23

REALITY SWAB PAD 1 QL 100/23

ringers irr sol 1

SAPS CARE PAD ALCOHOL 1 QL 100/23

SB ALCOHOL PAD PREP 1 QL 100/23

SM ALCOHOL PAD PREP 1 QL 100/23

steril water sol irrig 1

SYPRINE CAP 250MG 3

TENDER 1 KIT 31" 3

TENDER 1 KIT 43" 3

TENDER 1 KIT INFUSION 3

TENDER 2 KIT 31" 3

THYROGEN INJ 1.1MG 4 PA

tis-u-sol sol 1




97

TRICHOPHYTON INJ 1:200 6

ulticare syg mis .3cc/29g 1 QL 100/26



ULTICARE SYG MIS 1CC/28G 1 QL 100/26

ulticare syg mis 1cc/29g 1 QL 100/26

ULTILET ALCH PAD SWAB 1 QL 100/23

VIVITROL INJ 380MG 4 PA

WEBCOL PREP PAD LARGE 1 QL 100/23

WEBCOL PREP PAD MEDIUM 1 QL 100/23

YODOXIN TAB 210MG 3

YODOXIN TAB 650MG 3

OPHTHALMIC AGENTS Ophthalmic Prostaglandin and Prostamide Analogs

latanoprost sol 0.005% 1 QL 5/23

LUMIGAN SOL 0.01% 3

TRAVATAN Z DRO 0.004% 3

ZIOPTAN DRO 0.0015% 3

Ophthalmic Agents, Other

akorn balanc sol salt op 1

ALOCRIL SOL 2% 3

ALOMIDE SOL 0.1% OP 3

ALPHAGAN P SOL 0.1% 2

altacaine sol 0.5% op 1

apraclonidin sol 0.5% op 1

azelastine dro 0.05% 1

bal salt sol op 1

balanced sal sol op 1

BEPREVE DRO 1.5% 3

brimonidine sol 0.15% 1

brimonidine sol 0.2% op 1

bss sol op 1

collyrium sol 1

collyrium sol eye wash 1

cromolyn sod sol 4% op 1

epinastine dro 0.05% 1

eye irrigati sol op 1

eye wash dro solution 1

eye wash sol 1

gnp eye wash sol op 1

IOPIDINE SOL 1% OP 3

ISO CARBACHO SOL 1.5% OP 2

ISO CARBACHO SOL 3% OP 2

LASTACAFT SOL 0.25% 3

mediwash irr sol op 1




98

NAPHAZOLINE SOL 0.1% OP 1

ocusoft eye sol wash 1

ocusoft ii sol irrigati 1

optics eye sol 1

parcaine sol 0.5% op 1

PATADAY SOL 0.2% 3

PATANOL SOL 0.1% OP 3

PHOSPHOLINE SOL 0.125%OP 2

pilocarpine sol 1% op 1



PILOPINE HS GEL 4% OP 3

proparacaine sol 0.5% op 1

ra eye wash sol op 1

RETISERT IMP 0.59MG 3

sm eye wash sol op 1

tetcaine sol 0.5% op 1

tetracaine sol 0.5% op 1

tetravisc sol 0.5% op 1

tetravisc sol forte 1

Ophthalmic Anti Infectives

ak-poly-bac oin op 1

AZASITE SOL 1% 3

bacit/polymy oin op 1

BACITRACIN OIN OP 1

BESIVANCE SUS 0.6% 2

CETRAXAL SOL 0.2% 1

CILOXAN OIN 0.3% OP 2

CIPROFLOXACN SOL 0.2% 1

ciprofloxacn sol 0.3% op 1

erythromycin oin 5mg/gm 1

erythromycin oin op 1

garamycin oin 0.3% op 1

gatifloxacin sol 0.5% 3

gentak oin 0.3% op 1

gentamicin oin 0.3% op 1

gentamicin sol 0.3% op 1

ilotycin oin op 1

levofloxacin sol 0.5% 1

MOXEZA SOL 0.5% 3

NATACYN SUS 5% OP 3

neo-polycin oin op 1

neo/bac/poly oin op 1

neo/poly/gra sol op 1

ofloxacin dro 0.3% op 1




99

polycin b oin op 1

polycin oin op 1

polymyxin b/ sol trimethp 1

romycin oin op 1

sod sulfacet sol 10% op 1

SULFACET SOD OIN 10% OP 1

sulfacet sod sol 10% op 1

tobramycin sol 0.3% op 1

TOBREX OIN 0.3% OP 2

trifluridine sol 1% op 1

trimethoprim sol polymyxn 1

VIGAMOX DRO 0.5% 3

ZIRGAN GEL 0.15% 3

Ophthalmic Anti-allergy Agents

dorzolamide sol 2% op 1

Ophthalmic Anti-inflammatories

ACUVAIL SOL 0.45% 3

atropin-care sol 1% op 1

ATROPINE SUL OIN 1% OP 1

atropine sul sol 1% op 1

BLEPHAMIDE OIN S.O.P. 2

BROMDAY SOL 0.09% 2

BROMFENAC SOL 0.09% 1

cyclopentol sol 1% op 1


CYSTARAN SOL 0.44% 3

dexameth pho sol 0.1% op 1

diclofenac sol 0.1% op 1

DUREZOL EMU 0.05% 2

FLAREX SUS 0.1% OP 3

flucaine sol 0.25-0.5 1

fluorescein/ sol proparac 1

fluoromethol sus 0.1% op 1

flurbiprofen sol 0.03% op 1

FML OIN 0.1% OP 2

homatropaire sol 5% op 1

homatropine sol 5% op 1

ketorolac sol 0.4% 1


LOTEMAX OIN 0.5% 3

LOTEMAX SUS 0.5% 3

mydral sol 0.5% op 1

mydral sol 1% op 1

neo-polycin oin hc 1%op 1

neo/poly/bac oin /hc 1%op 1




100

neo/poly/dex oin 0.1% op 1

neo/poly/dex sus 0.1% op 1

NEO/POLY/HC SUS OP 1

NEVANAC SUS 0.1% 3

OZURDEX IMP 0.7MG 3

poly-dex oin 0.1% op 1

PRED MILD SUS 0.12% OP 2

PRED SOD PHO SOL 1% OP 1

prednisolone sus 1% op 1

sulf/pred na sol op 1

tobra/dexame sus 0.3-0.1% 1 QL 2.5/10

TOBRADEX OIN 0.3-0.1% 2 QL 3.5/10

TOBRADEX ST SUS 0.3-0.05 2 QL 5/10

tropicamide sol 0.5% op 1

tropicamide sol 1% op 1

VEXOL SUS 1% OP 3

ZYLET SUS 0.5-0.3% 2

Ophthalmic Antiglaucoma Agents

betaxolol sol 0.5% op 1

BETIMOL SOL 0.5% 3

BETOPTIC-S SUS 0.25% OP 2

carteolol sol 1% op 1

COMBIGAN SOL 0.2/0.5% 2

COSOPT SOL 2-0.5%OP 2

dorzol/timol sol 2-0.5%op 1

ISTALOL SOL 0.5% OP 1

LACRISERT MIS 5MG OP 3 PA

LEVOBUNOLOL SOL 0.25% OP 1

levobunolol sol 0.5% op 1

timolol gel sol 0.25% op 1


timolol mal sol 0.25% op 1


OTIC AGENTS Otic Agents

acetasol hc sol otic 1

acetic acid sol 2% otic 1

antipy/benzo sol otic 1

aurodex sol otic 1

CIPRO HC SUS OTIC 3

CIPRODEX SUS 0.3-0.1% 2

COLY-MYCIN S SUS OTIC 3

CORTISPORIN SUS -TC OTIC 3

fluocin acet oil ear0.01% 1

hc/acet acid sol otic 1




101

neo/poly/hc sol 1% otic 1

neo/poly/hc sus 1% otic 1

ofloxacin dro 0.3%otic 1

RESPIRATORY TRACT AGENTS Anti-inflammatories, Inhaled Corticosteroids

ALVESCO AER 160MCG 3 QL 12.2/30

ALVESCO AER 80MCG 3 QL 12.2/30

ASMANEX 120 AER 220MCG 3 QL 2/30






budesonide sus 0.25mg/2 1 QL 120/30 AL

budesonide sus 0.5mg/2 1 QL 120/30 AL

FLOVENT DISK AER 100MCG 3 QL 28/30

PULMICORT INH 180MCG 3 QL 1/30

PULMICORT INH 90MCG 3 QL 1/30

PULMICORT SUS 1MG/2ML 3 QL 120/30

QVAR AER 40MCG 2 QL 8.7/30

QVAR AER 80MCG 2 QL 8.7/30

ZYFLO CR TAB 600MG 4 PA

ZYFLO TAB 600MG 4 PA

Antihistamines

alavert tab 10mg 1

all day allg sol 1mg/ml 1

all day allg sol 5mg/5ml 1

all day allg syp 1mg/ml 1

all day allg syp 5mg/5ml 1

all day allg tab 10mg 1

ALLEGRA ALRG TAB 30MG 1

aller-ease tab 180mg 1


aller-fex tab 180mg 1

aller-tec sol 1mg/ml 1

aller-tec tab 10mg 1

allerclear tab 10mg 1

allergy chld sol 1mg/ml 1

allergy comp sol 1mg/ml 1

allergy rel elx 12.5/5ml 1 AL

allergy rel sol 1mg/ml 1

allergy rel tab 10mg 1

allergy relf elx 12.5/5ml 1 AL

allergy relf sol 5mg/5ml 1

allergy relf syp 5mg/5ml 1




102

allergy relf tab 10mg 1



allergy tab 10mg 1

altaryl elx 12.5/5ml 1 AL

altaryl syp 12.5/5ml 1 AL

arbinoxa sol 4mg/5ml 1

arbinoxa tab 4mg 1 AL

banophen cap 50mg 1 AL

carbinoxamin sol 4mg/5ml 1

carbinoxamin tab 4mg 1 AL

cetirizine sol 1mg/ml 1

cetirizine sol 5mg/5ml 1

cetirizine syp 1mg/ml 1

cetirizine syp 5mg/5ml 1

cetirizine tab 10mg 1


CLARITIN CHW 5MG 1

CLEMASTINE SYP 0.5/5ML 1 AL

clemastine tab 2.68mg 1 AL

cvs allergy tab 10mg 1


cyproheptad syp 2mg/5ml 1 AL

cyproheptad tab 4mg 1 AL

DEXCHLORPHEN SYP 2MG/5ML 1 AL

diphenhydram cap 50mg 1 AL

diphenhydram elx 12.5/5ml 1 AL

diphenhydram inj 50mg/ml 1 AL

eq allergy elx 12.5/5ml 1 AL

eql all day tab allergy 1

fexofenadine tab 180mg 1


gnp all day tab allergy 1

gnp allergy tab 180mg 1

kp loratadin tab 10mg 1

loradamed tab 10mg 1

loratadine sol 5mg/5ml 1

loratadine syp 5mg/5ml 1

loratadine tab 10mg 1

medi-phedryl elx 12.5/5ml 1 AL

mucinex allr tab 180mg 1

ormir cap 50mg 1 AL

pharbedryl cap 50mg 1 AL

phenadoz sup 12.5mg 1 AL

phenadoz sup 25mg 1 AL




103

promethazine inj 25mg/ml 1 AL

promethazine inj 50mg/ml 1 AL

promethazine sol 6.25/5ml 1 AL

promethazine sup 12.5mg 1 AL

promethazine sup 25mg 1 AL

promethazine syp 6.25/5ml 1 AL

promethazine tab 12.5mg 1 AL

promethazine tab 25mg 1 AL

promethazine tab 50mg 1 AL

promethegan sup 12.5mg 1 AL

promethegan sup 25mg 1 AL

PROMETHEGAN SUP 50MG 1 AL

qc allergy tab 10mg 1

quenalin syp 12.5/5ml 1 AL

ra cetirizin tab 10mg 1

sb allergy tab 10mg 1

silphen coug syp 12.5/5ml 1 AL

sm all day tab allergy 1

triaminic tab 10mg 1

wal-fex allr tab 180mg 1

wal-fex alrg tab 60mg 1

wal-itin syp 5mg/5ml 1

wal-itin tab 10mg 1

wal-vert tab 10mg 1

wal-zyr sol 1mg/ml 1

wal-zyr sol 5mg/5ml 1

wal-zyr tab 10mg 1

Antileukotrienes

montelukast chw 4mg 1


montelukast gra 4mg 1

montelukast tab 10mg 1

zafirlukast tab 10mg 3


Bronchodilators, Anticholinergic

ATROVENT HFA AER 17MCG 2 QL 26/25

cromolyn sod neb 20mg/2ml 1

ipratropium sol 0.02%inh 1

TUDORZA PRES AER 400/ACT 2 QL 1/30

Bronchodilators, Sympathomimetic

ADVAIR DISKU AER 100/50 2 QL 14/30



ADVAIR HFA AER 115/21 3 QL 8/30





104


albuterol neb 0.083% 1


albuterol neb 0.63mg/3 1


albuterol syp 2mg/5ml 1

albuterol tab 2mg 1

albuterol tab 4mg 1

albuterol tab 4mg er 1


ANORO ELLIPT AER 62.5-25 2 QL 14/30

ARCAPTA CAP 75MCG 3 QL 30/30

BREO ELLIPTA INH 100-25 2 QL 28/30

BROVANA NEB 15MCG 3

DULERA AER 100-5MCG 2 QL 13/25

DULERA AER 200-5MCG 2 QL 13/25

epinephrine inj 1mg/ml 1

FORADIL CAP AEROLIZE 2 QL 60/30

ipratropium/ sol albuter 1

levalbuterol neb 0.31mg 1


levalbuterol neb 1.25/0.5 1

MAXAIR AUTOH AER 200MCG 3 QL 14/30

METAPROTEREN SYP 10MG/5ML 1

METAPROTEREN TAB 10MG 1

METAPROTEREN TAB 20MG 1

PERFOROMIST NEB 20MCG 3

PROAIR HFA AER 3 QL 8.5/30

PROVENTIL AER HFA 3 QL 6.7/30

SEREVENT DIS AER 50MCG 2 QL 28/30

SYMBICORT AER 160-4.5 2 QL 6.9/30

SYMBICORT AER 80-4.5 2 QL 6.9/30

terbutaline inj 1mg/ml 1

terbutaline tab 2.5mg 1

terbutaline tab 5mg 1

VENTOLIN HFA AER 2 QL 8/30

XOPENEX HFA AER 3 QL 30/30

Nasal Agents

azelastine spr 0.1% 1


BACTROBAN OIN NASAL 2% 3

BECONASE AQ SUS 0.042% 3

budesonide sus 32mcg 3

flunisolide spr 0.025% 1 QL 50/25

FLUNISOLIDE SPR 29MCG 1




105

fluticasone spr 50mcg 1 QL 16/25

ipratropium spr 0.03% 1 QL 30/25

ipratropium spr 0.06% 1 QL 15/25

NASONEX SPR 50MCG/AC 3

PATANASE SPR 0.6% 3

QNASL AER 80MCG 3

triamcinolon spr 55mcg/ac 1

TYZINE PED DRO 0.05% 3

TYZINE SOL 0.1% 3

VERAMYST SPR 27.5MCG 3

ZETONNA AER 37MCG 3

Pulmonary Antihypertensives

ADCIRCA TAB 20MG 4 PA

epoprostenol inj 0.5mg 6


isoxsuprine tab 10mg 1

LETAIRIS TAB 10MG 4 PA

LETAIRIS TAB 5MG 4 PA

papaverine inj 30mg/ml 1

papaverine sol 30mg/ml 1

REMODULIN INJ 10MG/ML 6


REMODULIN INJ 2.5MG/ML 6


REVATIO INJ 6

sildenafil tab 20mg 4 PA

TYVASO REFIL SOL 0.6MG/ML 4 PA

TYVASO SOL 0.6MG/ML 4 PA

TYVASO START SOL 0.6MG/ML 4 PA

VELETRI INJ 0.5MG 6

VELETRI INJ 1.5MG 6

VENTAVIS SOL 10MCG/ML 4 PA

VENTAVIS SOL 20MCG/ML 4 PA

Respiratory Tract Agents, Other

acetylcyst sol 10% 1


aminophyllin inj 25mg/ml 1

benzonatate cap 100mg 1


brom/pse/dm syp 1

bromfed dm syp 1

broncho sal aer 0.9% 1 QL 180/23

CLARINEX-D TAB 2.5-120 3

CLARINEX-D TAB 5-240MG 3

difil-g fort liq 100-100 1




106

dimetane dx syp 1

donatussin dro 1

ELIXOPHYLLIN ELX 80/15ML 2

entre-b sus 6-10mg/5 1

hyd pol/cpm liq 10-8/5ml 1

hydrocod/hom syp 5-1.5/5 1

hydrocodone/ tab homatrop 1

hydromet syp 5-1.5/5 1

J-MAX SYP 5-200MG 1

KALYDECO TAB 150MG 4 PA

LUFYLLIN TAB 200MG 3

nasal mist aer 0.9% 1

nebusal neb 3% 1

pe/guaifenes dro 1.5-20mg 1

prometh vc syp 6.25-5/5 1

prometh vc/ syp codeine 1

prometh/cod syp 6.25-10 1

promethazine syp dm 1

pulmosal neb 7% 1

PULMOZYME SOL 1MG/ML 4 PA QL 60/30

RESCON-JR TAB 1

REZIRA SOL 60-5/5ML 3

simply salin aer baby 1 QL 88/23

sod chloride neb 0.9% 1

sodium chlor neb 10% 1



TGQ 15DM/5PE SYP H/2CPM 1

TGQ 30/ SYP 150/15 1

THEO-24 CAP 100MG CR 3

theochron tab 100mg cr 1



theophylline sol 80/15ml 1

theophylline tab 100mg cr 1

theophylline tab 100mg er 1







tl-dmx syp 5-200mg 1

TUSSICAPS CAP 10-8MG 3

TUSSICAPS CAP 5-4MG 3




107

tussigon tab 5mg 1

vazobid-pd sus 6-10mg/5 1

XOLAIR SOL 150MG 4 PA

zoden dm dro 1

zoden dro 1

SKELETAL MUSCLE RELAXANTS Skeletal Muscle Relaxants

AMRIX CAP 15MG 3

AMRIX CAP 30MG 1

baclofen tab 10mg 1

baclofen tab 20mg 1

chlorzoxazon tab 500mg 1 AL

CYCLOBENZAPR CRE 20MG/GM 1 AL

cyclobenzapr tab 10mg 1 AL

cyclobenzapr tab 5mg 1 AL

cyclobenzapr tab 7.5mg 1 AL

GABLOFEN INJ 10000/20 6



GABLOFEN INJ 50MCG/ML 6

LORZONE TAB 375MG 3

metaxalone tab 800mg 3 PA

methocarbam tab 500mg 1 AL

methocarbam tab 750mg 1 AL

orphenadrine inj 30mg/ml 1 AL

orphenadrine tab 100mg er 1 AL

tizanidine cap 2mg 3 QL 90/30



tizanidine tab 2mg 1 QL 90/30

tizanidine tab 4mg 1 QL 90/30

SLEEP DISORDER AGENTS Benzodiazepines

estazolam tab 1mg 1

estazolam tab 2mg 1

flurazepam cap 15mg 1 AL

flurazepam cap 30mg 1 AL

midazolam inj 2mg/2ml 6

midazolam inj 5mg/ml 6

midazolam syp 2mg/ml 6

temazepam cap 15mg 1 AL

temazepam cap 22.5mg 1 AL

temazepam cap 30mg 1 AL

temazepam cap 7.5mg 1 AL

triazolam tab 0.125mg 1 AL




108

triazolam tab 0.25mg 1 AL

GABA Receptor Modulators

eszopiclone tab 1mg 3 PA QL 30/30 AL



INTERMEZZO SUB 3.5MG 3 PA QL 30/30 AL

ROZEREM TAB 8MG 3 QL 30/30

zaleplon cap 10mg 1 AL

zaleplon cap 5mg 1 AL

zolpidem er tab 12.5mg 3 QL 30/30 AL

zolpidem er tab 6.25mg 3 QL 30/30 AL

zolpidem tab 10mg 1 QL 30/30 AL

zolpidem tab 5mg 1 QL 30/30 AL

Sleep Disorders, Other

modafinil tab 100mg 4 PA

modafinil tab 200mg 4 PA

NUVIGIL TAB 150MG 3 PA

THERAPEUTIC NUTRIENTS/ MINERALS/ ELECTROLYTES Electrolyte/Mineral Modifiers

calcitriol cap 0.25mcg 1


calcitriol inj 1mcg/ml 3

calcitriol sol 1mcg/ml 3

CYSTADANE POW 4 PA

doxercalcif cap 0.5mcg 04 PA

doxercalcif cap 1mcg 04 PA

doxercalcif cap 2.5mcg 04 PA

levocarnitin inj 200mg/ml 6

levocarnitin sol 1gm/10ml 3

levocarnitin tab 330mg 3

ORFADIN CAP 10MG 4 PA



paricalcitol cap 1 mcg 3 PA



SAMSCA TAB 15MG 4 PA

SAMSCA TAB 30MG 4 PA

SENSIPAR TAB 30MG 4 PA



ZEMPLAR CAP 1MCG 3 PA



ZEMPLAR INJ 2MCG/ML 6




109

ZEMPLAR INJ 5MCG/ML 6

Electrolyte/Mineral Replacement

acetic acid sol 0.25%irr 1

aminoac acid sol 1.5% irr 1

argyl saline sol 0.9% 1

citric acid/ sol sod citr 1

curity salin sol 0.9% irr 1

CYSTAGON CAP 150MG 4 PA

CYSTAGON CAP 50MG 4 PA

cytra-2 sol 1

CYTRA-3 SYP 1

CYTRA-K SOL 1

ELMIRON CAP 100MG 4 PA

glycine sol 1.5% irr 1

neo/poly gu sol 40/ml ir 1

ORACIT SOL 3

phenazo tab 200mg 1

phenazopyrid tab 100mg 1




sodium chlor sol 0.9% irr 1

SORBITOL SOL 3% IRR 1

SORBITOL SOL 3.3% IRR 1

SORBITOL-MAN SOL 1

TRICITRATES SOL 1

UROCIT-K 10 TAB 3

UROCIT-K 15 TAB 3

Nutrients

FLUOR-A-DAY CHW 0.25MG F 3

FLUOR-A-DAY CHW 0.5MG F 3

FLUORABON DRO 3

fluoride chw 0.5mg f 5

fluoride chw 1mg f 5

fluoritab chw 0.5mg f 5

fluoritab chw 1mg f 5

fluoritab chw 2.2mg 5

IODINE SOL STRONG 1

LOZI-FLUR LOZ 1MG F 5

ludent chw 0.5mg f 5

ludent chw 1mg f 5

LUGOLS SOL 1

nafrinse chw 1mg f 5

sod fluoride chw 0.5mg f 5

sod fluoride chw 1.1mg 5




110

sod fluoride chw 1mg f 5


sod fluoride dro 0.5mg/ml 5

Vitamins

acd/fluoride dro 0.25mg 1

ADV DIABETIC TAB MULTIVIT 3

airavite tab 1

ALIVE 50+ TAB WOMENS 3

ALIVE ENERGY TAB MENS 3

ALIVE ENERGY TAB WOMENS 3

AMINOBEZ POT POW 1

ANTIOXIDANT TAB FORTE 3

AP-ZEL TAB 3

ascor l 500 inj 500mg/ml 1

ascor l nc inj 500mg/ml 1

ascorbic acd inj 500mg/ml 1

B6 FOLIC ACD CAP 1

BACMIN TAB 3

BASIC AM TAB 3

BASIC PM TAB 3

bd posiflush inj 0.9% 1

BP FOLINATAL TAB PLUS B 1

CAL-DAY 1000 TAB 3

CENTRAL-VITE TAB UNDER 50 3

CENTRUM SPEC TAB HEART 3

CENTRUM SPEC TAB IMMUNE 3

CENTRUM SPEC TAB VISION 3

CENTRUM TAB CARDIO 3

CENTRUM TAB SILVER 3

CENTRUM TAB ULTRA 3

CEREFOLIN TAB 3

CERTAVITE TAB SENIOR 3

child vit d chw 400unit 5

COMPLETE 50+ TAB MENS 3

COMPLETE 50+ TAB WOMENS 3

cvs iron tab 27mg 5

cvs iron tab 325mg 5

cvs vit d cap 2000unit 5

cyanocobalam inj 1000mcg 1

cysteine hcl inj 50mg/ml 1

d 1000 cap 1000unit 5

d 1000 chw 1000unit 5

d 400 chw 400unit 5

d 400 tab 400unit 5

d-3 gummy chw 400unit 5




111

d-400 tab 400unit 5

d-vita liq 400unit 5

d3 adult chw 1000unit 5

d3 cap 1000unit 5

d3 cap 2000unit 5

D3 CAP 400UNIT 5 QL 60/30

d3 kids chw 400unit 5

d3 max st dro 5000unit 5

d3 maximum cap 5000unit 5

d3 super str cap 2000unit 5

d3 tab 1000unit 5

d3 tab 2000unit 5

d3-1000 cap 1000unit 5

decara cap 50000unt 5

delta d3 tab 400unit 5

DERMAVITE TAB 3

dexferrum inj 50mg/ml 4 PA

dialyvite d cap 5000unit 5

EFFER-K TAB 10MEQ 3

EFFER-K TAB 20MEQ 3

effer-k tab 25meq ef 1

EQ COMPLETE TAB ADULT 3

EQ ONE DAILY TAB MENS 3

EQ ONE DAILY TAB WOMENS 3

ergocalcifer cap 50000unt 1

fa-8 tab 0.8mg 5 QL 30/30 BD

fa-b6-b12 tab 1

fabb tab 1

fe tabs tab 325mg ec 5

feosol tab 65mg 5

fer-iron dro 15mg/ml 5 QL 50/30 AL

ferate tab 27mg 5

ferocon cap 1

ferosul elx 220/5ml 5

ferotrinsic cap 1

FERRAPLUS 90 TAB 1

ferrex 150 cap forte 1

ferro-bob tab 325mg 5

ferrogels fo cap forte 1

ferrous dro 15mg/ml 5 QL 50/30 AL

ferrous gluc tab 240mg 5

ferrous sulf dro 15mg/ml 5 QL 50/30 AL

ferrous sulf elx 220/5ml 5

ferrous sulf tab 325mg 5

ferrous sulf tab 325mg ec 5




112

ferrous sulf tab 325mg fc 5

ferrous sulf tab 5gr 5

ferrousul tab 325mg 5

FITNESS TABS TAB MEN 3

FITNESS TABS TAB WOMEN 3

FOLBECAL TAB 1

folbee tab 1

folcaps tab 1

FOLIC ACID INJ 5MG/ML 1

folic acid tab 1000mcg 5 QL 30/30 BD

folic acid tab 1mg 5 QL 30/30 BD



folplex 2.2 tab 1

foltrin cap 1

FREEDAVITE TAB 3

GALZIN CAP 25MG 3

GALZIN CAP 50MG 3

GERI-FREEDA TAB SENIOR 3

gnp iron tab 325mg 5

gnp vit d tab 1000unit 5



gnp vit d3 tab 1000unit 5

HAIR-VITES TAB 3

HAIR/SKIN/ TAB NAILS 3

hematinic/fa tab 1

hematogen cap forte 1

HEMATOGEN FA CAP 1

hemocyte-f tab 1

HM COMPLETE TAB 3

HM HAIR/SKIN TAB /NAILS 3

HM ONE DAILY TAB MENS 3

hm vit d3 cap 2000unit 5

hm vitamin d tab 1000unit 5

HYALEX TAB 3

HYDROXOCOBAL INJ 1000MCG 1

ICAPS AREDS TAB FORMULA 3

ICAPS PLUS TAB 3

iferex 150 cap forte 1

infed inj 50mg/ml 4 PA

infuvite inj 1

infuvite inj adult 1

infuvite inj pediatri 1

iron supplem tab therapy 5




113

iron supplmt dro 15mg/ml 5 QL 50/30 AL

iron tab 27mg 5

iron tab 325mg 5

iron tab 65mg 5

just d liq 400unit 5

k-effervesce tab 25meq ef 1

K-PAX TAB PROF ST 3

k-prime tab 25meq ef 1

k-vescent pow 20meq 1

k-vescent tab 25meq ef 1

klor-con 10 tab 10meq er 1


klor-con m10 tab 10meq er 1

KLOR-CON M15 TAB 3


klor-con pow 20meq 1

klor-con/ef tab 25meq fr 1

l-cysteine inj 50mg/ml 1

L-METHYL-MC TAB 3

M.V.I PEDIAT INJ 3

M.V.I-12 W/O INJ VIT K 3

M.V.I. ADULT INJ 3

MACULAR VIT TAB BENEFIT 3

MAGNESIUM GLUCONATE TAB 500 M

magnesium gluconate tab 500 m

martinic cap 1

MEGA MULTIVI TAB MEN 3

MEGA MULTIVI TAB WOMEN 3

MEGA SELECT TAB MENS 3

MEGA SELECT TAB WOMENS 3

mega-c/a plu inj 500mg/ml 1

MEGAVITE TAB FRT/VEG 3

MEGAVITE TAB GOLD 55+ 3

MENS MULTI TAB VIT/MIN 3

MEPHYTON TAB 5MG 2

METAFOLBIC TAB 3

mi-omega nf cap 1

mult-vit/fl chw 0.5mg 1

MULTI PRENAT TAB 5

MULTI VITAMN TAB MINERALS 3

MULTI-BETIC TAB 3

MULTI-BETIC TAB DIABETES 3

multi-vit/fl chw 0.25mg 1


multi-vit/fl chw 1mg 1




114

multi-vit/fl dro 0.25mg 1

MULTI-VITAMI TAB MONOCAPS 3

multivit/fl chw 0.25mg 1


multivit/fl chw 1mg 1

MULTIVITAL TAB PLATINUM 3

mvc-fluoride chw 0.25mg 1


mvc-fluoride chw 1mg 1

myferon 150 cap forte 1

n-acetyl-l- cap cysteine 1

nac 600 cap 1

nac cap 600mg 1

NATRUL-MEGA TAB 3

NATRUL-VITES TAB 3

niacin tab 500mg 1

NIACIN TR TAB 1000MG 1

NICADAN TAB 3

NICAZEL TAB 3

NICAZEL TAB FORTE 3

normal salin inj 0.9% 1

norml saline inj flush 1

norml saline inj iv flush 1

nufol tab 1

NUTRICAP TAB 3

NUTRIENT 45+ TAB WOMEN 3

NUTRIENT 50+ TAB MEN 3

NUTRIENTS TAB MEN 3

NUTRIENTS TAB TEENS 3

NUTRIENTS TAB WOMEN 3

ONCOVITE TAB 3

ONE DAILY MN TAB W/O IRON 3

ONE DAILY TAB DIET SUP 3

ONE DAILY TAB MENS 3

ONE DAILY TAB MENS 50+ 3

ONE DAILY TAB WOMANS 3

ONE-A-DAY TAB 50+ ADV 3

ONE-A-DAY TAB ENERGY 3

ONE-A-DAY TAB MENOPAUS 3

ONE-A-DAY TAB MENS 3

ONE-A-DAY TAB PROEDGE 3

ONE-A-DAY TAB TEEN/HIM 3

OPTI-WOMAN TAB 3

optimal-d cap 50000unt 5

OPURITY TAB 3




115

orazinc cap 220mg 1

ortho-cs 250 inj 250mg/ml 1

pa vitamin cap 2000unit 5

PARVLEX TAB 3

pedia d-vite dro 400unit 5

pedia iron dro 15mg/ml 5 QL 50/30 AL

phospha 250 tab neutral 1

phytonadione inj 1mg/0.5 1

PNV FE FUM TAB DOC/FA 1

poly-iron cap 150 fort 1

polysacchari cap iron 1

pot bicarbon tab 25meq ef 1

pot chloride cap 10meq er 1


pot chloride liq 10% 1

pot chloride liq 10% sf 1


pot chloride pow 20meq 1

pot chloride sol 10% sf 1

pot chloride tab 10meq cr 1

pot chloride tab 10meq er 1

pot chloride tab 25meq ef 1


pot chloride tab 8meq sr 1

pot cl micro tab 10meq cr 1

pot cl micro tab 10meq er 1


pot/chloride tab 25meq ef 1

POTABA CAP 500MG 3

POTABA TAB 500MG 3

potassium tab 25meq ef 1

PRENATAL 19 TAB 1

PRENATAL 19 TAB 29-1MG 1

PRENATAL ONE TAB DAILY 5

PRENATAL TAB 27-0.8MG 5

PRENATAL TAB LOW IRON 5

PRO-CAL TAB 3

PROCERV HP TAB 3

PYRIDOXINE INJ 100MG/ML 1

QUENCH TAB 3

quflora ped dro 0.25mg 1

QUIN B TAB STRONG 3

QUINTABS-M TAB 3

ra iron tab 325mg 5

ra iron tab 65mg 5




116

ra niacin tab 500mg 1

ra vitamin cap 2000unit 5

RENAPLEX-D TAB 3

REPLESTA NX WAF 14000UNT 5

REPLESTA WAF 14000UNT 5

REPLESTA WAF 50000UNT 5

REQ 49+ TAB 3

RIGHT STEP TAB PRENATAL 5

saline flush inj 0.9% 1

saline flush inj zr 0.9% 1

SE-NATAL 19 TAB 1

SENTRY TAB 3

SIDEROL TAB 3

sm folic acd tab 400mcg 5 QL 30/30 BD

sm iron tab 325mg 5

SM ONE DAILY TAB MENS 3

SM ONE DAILY TAB WOMENS 3

sm vitamin d tab 400unit 5

sod chloride inj 0.9% 1

SOLO TAB 3

SPECTRAVITE TAB ADLT 50+ 3

SPECTRAVITE TAB CARDIO 3

SPECTRAVITE TAB ENERGY 3

SPECTRAVITE TAB MEN 50+ 3

SPECTRAVITE TAB SENIOR 3

SPECTRAVITE TAB ULT MEN 3

SPECTRAVITE TAB ULT WMN 3

STROVITE ONE TAB 3

SUPERB NAILS TAB 3

swabflush inj 0.9% 1

T-VITES TAB 3

TANDEM F CAP 1

TARON-PREX CAP 1

th iron tab 65mg 5

THERA M PLUS TAB 3

thera-d tab 2000unit 5

THERA-D TAB 4000UNIT 5

THERA-M TAB 3

THERA-TABS M TAB 3

THERABETIC TAB MULTIVIT 3

THERAGRAN-M TAB 3

THERAGRAN-M TAB 50 PLUS 3

THERAGRAN-M TAB ADVANCED 3

THERAGRAN-M TAB PREMIER 3

THEREMS-H TAB 3




117

THEREMS-M TAB 3

thiamine hcl inj 100mg/ml 1

tl gard rx tab 1

tl icon cap 1

tri-vit/fl dro 0.25mg 1


tri-vit/fluo dro 0.25mg 1


tri-vita/fl dro 0.25mg 1

TRI-ZEL TAB 3

tricon cap 1

trigels-f cap forte 1

UNICOMPLEX-M TAB 3

VAYACOG CAP 3

VAYARIN CAP 3

VAYAROL CAP 3

virt-phos tab 250 neut 1

virt-vite tab 1

vit d gummie chw 400unit 5

VITA-RESPA TAB 3

VITALINE TAB FORMULA2 3

VITALINE TAB FORMULA3 3

vitamin b-12 tab 1000mcg 1

vitamin c inj 222mg/ml 1

vitamin d cap 1000unit 5


VITAMIN D CAP 400UNIT 5 QL 60/30

vitamin d cap 50000unt 1

vitamin d chw 1000unit 5


vitamin d dro 400unit 5

vitamin d tab 1000unit 5



vitamin d-3 cap 1000unit 5


vitamin d-3 tab 1000unit 5



vitamin d3 cap 10000unt 5

vitamin d3 cap 1000unit 5


VITAMIN D3 CAP 400UNIT 5 QL 60/30






118

vitamin d3 chw 1000unit 5


vitamin d3 dro 400unit 5


vitamin d3 tab 1000unit 5


VITAMIN D3 TAB 3000UNIT 5


VITAMIN D3 TAB 50000UNT 5


VITAMIN D3 TAB COMPLETE 3

vitamin k1 inj 1mg/0.5 1

VITASANA TAB 3

VITATRUM TAB 3

VITRUM TAB SENIOR 3

VP-ZEL TAB 3

WHOLE FOOD TAB MULTIVIT 3

WOMENS BIO- TAB MULTIPLE 3

WOMENS MULTI TAB VIT/MIN 3

YELETS TEEN TAB FORMULA 3

yl folic aci tab 400mcg 5 QL 30/30 BD

zinc sulfate cap 220mg 1

zinc-220 cap 1

119

8 8-mop cap 10mg 62

A abacav/lamiv tab /zidovud 38

abacavir tab 300mg 35

abilify disc tab 10mg 33

abilify disc tab 15mg 33

abilify inj 9.75mg 33

abilify main inj 300mg 33

abilify sol 1mg/ml 33

abilify tab 10mg 33

abilify tab 15mg 33

abilify tab 20mg 33

abilify tab 2mg 33

abilify tab 30mg 33

abilify tab 5mg 33

abraxane inj 100mg 26

acampro cal tab 333mg 5

acanya gel 1.2-2.5% 62




acd/fluoride dro 0.25mg 107



acetasol hc sol otic 98

acetazolamid cap 500mg er 56

acetazolamid inj 500mg 56



acetic acid sol 0.25%irr 106

acetic acid sol 2% otic 98

acetylcyst inj 200mg/ml 62








acid reducer tab max st 76

acid relief tab 200mg 76

acitretin cap 10mg 62

acitretin cap 17.5mg 62

acitretin cap 25mg 62



acne pimple gel 10% 62

acne treatmn gel 10% 62

acne-clear gel 10% 62

actemra inj 80mg/4ml 89

acthar hp inj 80unit 85

acticin cre 5% 62

actimmune inj 2mu/0.5 26

actonel tab 30mg 92

actonel tab 35mg 92

actonel tab 5mg 92

actoplus met tab xr 40

acuvail sol 0.45% 97

acyclovir cap 200mg 37

acyclovir oin 5% 37

acyclovir sus 200/5ml 37



adcetris inj 50mg 26

adcirca tab 20mg 103

adefov dipiv tab 10mg 37

adrenaclick inj 0.15mg 92

adrenaclick inj 0.3mg 92

adriamycin inj 10mg 26

adrucil inj 500/10ml 26

adrucil inj 5gm/100m 26

adv diabetic tab multivit 107

advair disku aer 100/50 101



advair hfa aer 115/21 101



afeditab tab 30mg cr 51

afeditab tab 60mg cr 51

afinitor tab 10mg 26

afinitor tab 2.5mg 26

afinitor tab 5mg 26

afinitor tab 7.5mg 26

afluria inj 2012-13 90

afluria inj 2013-14 90

afluria inj pf 12-13 90

afluria inj pf 13-14 91

aggrenox cap 25-200mg 45

airavite tab 107

akorn balanc sol salt op 95

ak-poly-bac oin op 96

al12 lot 12% 62

ala cort cre 1% 62

alavert tab 10mg 99

albenza tab 200mg 30





albuterol syp 2mg/5ml 101

albuterol tab 2mg 101

albuterol tab 4mg 101



alclometason cre 0.05% 62

alclometason oin 0.05% 62






alferon n inj 5mu/ml 26

alfuzosin tab 10mg 78

ali-flex tab 50-500mg 1

alinia sus 100/5ml 30

alinia tab 500mg 30

alive 50+ tab womens 107

alive energy tab mens 107

alive energy tab womens 107

all day allg sol 1mg/ml 99

all day allg sol 5mg/5ml 99

all day allg syp 1mg/ml 99

all day allg syp 5mg/5ml 99

all day allg tab 10mg 99

allegra alrg tab 30mg 99

allerclear tab 10mg 99



aller-fex tab 180mg 99

allergy chld sol 1mg/ml 99

allergy comp sol 1mg/ml 99

allergy rel elx 12.5/5ml 99

allergy rel sol 1mg/ml 99

allergy rel tab 10mg 99

allergy relf elx 12.5/5ml 99

allergy relf sol 5mg/5ml 99

allergy relf syp 5mg/5ml 99




allergy tab 10mg 99

aller-tec sol 1mg/ml 99

aller-tec tab 10mg 99



120

alocril sol 2% 95

alodox kit 20mg 16

alomide sol 0.1% op 95

alora dis 0.025mg 81

alora dis 0.05mg 81

alora dis 0.075mg 81

alora dis 0.1mg 81

alpain tab 1

alphagan p sol 0.1% 95

alphaquin hp cre 4% 62

alphatrex gel 0.05% 62

alprazolam tab 0.25 odt 39

alprazolam tab 0.25mg 39

alprazolam tab 0.5mg 39

alprazolam tab 0.5mg er 39

alprazolam tab 0.5mg od 39

alprazolam tab 0.5mg xr 39

alprazolam tab 1mg 39

alprazolam tab 1mg er 39

alprazolam tab 1mg odt 39

alprazolam tab 1mg xr 39

alprazolam tab 2mg 39


alprazolam tab 2mg odt 39




alprostadil inj 500mcg 53

alsuma inj 6mg/0.5 24

altabax oin 1% 62

altacaine sol 0.5% op 95

altaryl elx 12.5/5ml 99

altaryl syp 12.5/5ml 99

altavera tab 81

altoprev tab 20mg er 57



alvesco aer 160mcg 98

alvesco aer 80mcg 98

alyacen tab 1/35 81

alyacen tab 7/7/7 81

amantadine cap 100mg 31

amantadine syp 50mg/5ml 31

amantadine tab 100mg 31

amcinonide cre 0.1% 62

amcinonide lot 0.1% 62

amcinonide oin 0.1% 62

amicar tab 1000mg 45

amifostine inj 500mg 26

amilor/hctz tab 5-50 56

amiloride tab 5mg 56

aminoac acid sol 1.5% irr 106

aminobez pot pow 107



aminohippura inj 20% 92

aminophyllin inj 25mg/ml 103




amitiza cap 24mcg 74

amitiza cap 8mcg 74

amitriptylin tab 100mg 22






amlactin lot 12% 62














amlod/benazp cap 2.5-10mg 47




amlodipine tab 10mg 51

amlodipine tab 2.5mg 51

amlodipine tab 5mg 51

ammonium lac cre 12% 62

ammonium lac lot 12% 62







amox/k clav tab 250mg 14



amoxapine tab 100mg 22






amoxicillin chw 125mg 14

amoxicillin chw 250mg 14







amox-pot cla tab er 14

amphetamine cap 10mg er 58






amphetamine tab 10mg 59

amphetamine tab 12.5mg 59





amphetamine tab 7.5mg 59




ampicillin inj 125mg 14



ampicillin sus 125/5ml 14

ampicillin sus 250/5ml 14

ampyra tab 10mg 60

amrix cap 15mg 104

amrix cap 30mg 104

amturnide150 tab -5-12.5 47


amturnide300 tab -10-25mg 47


amturnide300 tab -5-25mg 47

anadrol-50 tab 50mg 81

anagrelide cap 0.5mg 45

anagrelide cap 1mg 45

ana-lex kit 62

analpram-hc lot 2.5% 62

anastrozole tab 1mg 26

121

androderm dis 2mg/24hr 81

androderm dis 4mg/24hr 81

androgel gel 1%(25mg) 81

androgel gel 1.62% 81

androxy tab 10mg 81

anoro ellipt aer 62.5-25 102

anti-diarrhe cap 2mg 74

anti-diarrhe liq 1mg/5ml 74

anti-diarrhe tab 2mg 74

antifungal cre 1% 62

antifungal cre 2% 62

anti-itch cre /aloe/e 62

anti-itch cre /oatmeal 62

anti-itch cre 1% 62

anti-itch cre 1%pls 10 62

anti-itch lot 1% 62

anti-itch oin 1% 62

anti-itch oin max st 62

antioxidant tab forte 107

antipy/benzo sol otic 98

anucort-hc sup 25mg 62

anzemet tab 100mg 23

anzemet tab 50mg 23

apap/caff/di tab hydrocod 1

apap/codeine sol 120-12/5 3




apexicon e cre 0.05% 62

apexicon oin 0.05% 62

apidra inj solostar 42

apidra inj u-100 42

aplenzin tab 174mg 20

apraclonidin sol 0.5% op 95

apri tab 81

apriso cap 0.375gm 91

aptivus cap 250mg 35

aptivus sol 35

ap-zel tab 107

aquanil hc lot 1% 62

aranesp inj 100mcg 44








arbinoxa sol 4mg/5ml 99

arbinoxa tab 4mg 99

arcalyst inj 220mg 89

arcapta cap 75mcg 102

argatroban inj 100mg/ml 43

argatroban inj 125/125 43

argyl saline sol 0.9% 106

argyl saline sol 100ml 92

arzerra con 1000/50 26

asa low dose tab 81mg ec 9

asacol hd tab 800mg 91

asacol tab 400mg dr 91

ascomp/cod cap 30mg 1

ascor l 500 inj 500mg/ml 107

ascor l nc inj 500mg/ml 107

ascorbic acd inj 500mg/ml 107

asmanex 120 aer 220mcg 99






aspir-81 tab 81mg ec 9

aspirin 81 tab 81mg ec 9

aspirin chil chw 81mg 9

aspirin chld chw 81mg 9

aspirin chw 81mg 9

aspirin low chw 81mg 9

aspirin low tab 81mg 9

aspirin low tab 81mg ec 9

aspirin tab 325mg 9

aspirin tab 325mg ec 9

aspirin tab 5gr ec 9

aspirin tab 81mg 9

aspirin tab 81mg ec 9

aspir-low tab 81mg ec 9

aspirtab tab 324mg ec 9

astramorph inj 1mg/2ml 1

astramorph inj 2mg/2ml 1

atelvia tab 92






atgam inj 250mg 89

athlete foot cre 1% 62

atorvastatin tab 10mg 57




atovaq/progu tab 250-100 30

atovaq/progu tab 62.5-25 30

atovaquone sus 750/5ml 30

atralin gel 0.05% 62

atripla tab 38

atropen inj 0.5mg 73

atropin-care sol 1% op 97

atropine sul oin 1% op 97

atropine sul sol 1% op 97

atrovent hfa aer 17mcg 101

aubra tab 0.1-0.02 81

aug betamet cre 0.05% 62

aug betamet gel 0.05% 62

aug betamet lot 0.05% 63

aug betamet oin 0.05% 63

augmentin sus 125/5ml 15

aurodex sol otic 98

auvi-q inj 0.15mg 92

auvi-q inj 0.3mg 92

avage cre 0.1% 63

avandia tab 2mg 40

avastin inj 26

avc cre 15% 79

aveeno cre 1% 63

aviane tab 81

avidoxy tab 100mg 16

avita cre 0.025% 63

avita gel 0.025% 63

avodart cap 0.5mg 78

avonex kit 30mcg 60

avonex pen kit 30mcg 60

avonex prefl kit 30mcg 60

axert tab 12.5mg 24

axert tab 6.25mg 24

axiron sol 30mg/act 81

azacitidine inj 100mg 26

azactam/dex inj 1gm 14

azasan tab 100mg 89

azasan tab 75 mg 89

azasite sol 1% 96

azathioprine tab 50mg 89

azelastine dro 0.05% 95



azilect tab 0.5mg 31

azilect tab 1mg 31

azithromycin inj 500mg 15

azithromycin pow 1gm pak 15



azithromycin tab 250mg 15

122

azithromycin tab 500 mg 15

azithromycin tab 600mg 15

azor tab 10-20mg 47

azor tab 10-40mg 47

azor tab 5-20mg 47

azor tab 5-40mg 48

B b6 folic acd cap 108

bacit/polymy oin op 96

bacitracin oin op 96

baclofen tab 10mg 104

baclofen tab 20mg 104

bacmin tab 108

bactroban oin nasal 2% 102

bal salt sol op 95

balanced sal sol op 95

balsalazide cap 750mg 91

banophen cap 50mg 100

banzel sus 40mg/ml 16

baraclude sol .05mg/ml 37

baraclude tab 0.5mg 37

baraclude tab 1mg 37

basic am tab 108

basic pm tab 108

baycadron elx 0.5/5ml 79

bayer adv tab 325mg 9

bayer asa tab 325mg 9

bayer low chw 81mg 9

bayer low tab 81mg ec 9

baza antifun cre 2% 63

bd posiflush inj 0.9% 108

bd swab bfly pad sngl use 92

bd swab reg pad sngl use 92

bd-insul syr mis lo dose 92

beconase aq sus 0.042% 102

bella alk/pb tab 16.2mg 73

bella/opium sup 16.2-30 73

bella/opium sup 16.2-60 73



benazep/hctz tab 20-25mg 48






benicar hct tab 20-12.5 48

benicar hct tab 40-12.5 48

benicar hct tab 40-25mg 48

benicar tab 20mg 45

benicar tab 40mg 45

benicar tab 5mg 45

bentyl inj 10mg/ml 73

benzepro aer 5.3% 63

benzepro sc aer 9.8% 63

benziq wash liq 5.25% 63

benzoin cmpd tin 63







benzoyl per lot 6% 63

benzoyl pero aer 9.8% 63

benzoyl pero kit acne pck 63

benztropine inj 1mg/ml 31

benztropine tab 0.5mg 31

benztropine tab 1mg 31

benztropine tab 2mg 31

bepreve dro 1.5% 95

berinert inj 500unit 53

besivance sus 0.6% 96

beta hc lot 1% 63

betameth dip cre 0.05% 63

betameth dip lot 0.05% 63

betameth dip oin 0.05% 63

betameth val aer 0.12% 63

betameth val cre 0.1% 63

betameth val lot 0.1% 63

betameth val oin 0.1% 63

beta-phos/ac inj 3-3mg/ml 79

betaseron inj 0.3mg 60

betaxolol sol 0.5% op 98







betimol sol 0.5% 98

betoptic-s sus 0.25% op 98

beyaz tab 81

bicalutamide tab 50mg 26

bicillin l-a inj 600000 15

bidil tab 53

binosto tab 70mg 92

biogesic tab 30-500mg 1

bioregesic tab 50-650mg 1

bisoprl/hctz tab 10/6.25 48

bisoprl/hctz tab 2.5/6.25 48

bisoprl/hctz tab 5-6.25mg 48



bleomycin inj 15unit 26

blephamide oin s.o.p. 97

bosulif tab 100mg 26

bosulif tab 500mg 26

bp cleansing lot 4% 63

bp foam aer 5.3% 63

bp foam aer 9.8% 63

bp folinatal tab plus b 108

bp gel gel 10% 63

bp gel gel 5% 63

bp wash liq 5.25% 63

bp wash liq 7% 63

breo ellipta inh 100-25 102

brilinta tab 90mg 45

brimonidine sol 0.15% 95

brimonidine sol 0.2% op 95

brom/pse/dm syp 103

bromday sol 0.09% 97

bromfed dm syp 103

bromfenac sol 0.09% 97

bromocriptin cap 5mg 31

bromocriptin tab 2.5mg 31

broncho sal aer 0.9% 103

brovana neb 15mcg 102

bss sol op 95

budeprion tab 100mg sr 20

budeprion tab 150mg sr 20

budesonide cap 3mg/24hr 79

budesonide sus 0.25mg/2 99

budesonide sus 0.5mg/2 99

budesonide sus 32mcg 102

bumetanide inj 0.25/ml 56

bumetanide tab 0.5mg 56



bupap tab 50-650mg 1

bupren/nalox sub 2-0.5mg 5

bupren/nalox sub 8-2mg 5

buprenorphin inj 0.3mg/ml 5

buprenorphin sub 2mg 5

buprenorphin sub 8mg 5

buproban tab 150mg 5


bupropion tab 100mg er 20

bupropion tab 100mg sr 20


123












buspirone tab 7.5mg 38

but/apap/caf cap 1

but/apap/caf cap codeine 1

but/apap/caf tab 1

but/asa/caf/ cap cod 30mg 1

but/asa/caff cap 1

but/asa/caff tab 1

butal/apap tab 50-325mg 1

butalbital tab cpd 1



butorphanol sol 10mg/ml 5

butrans dis 10mcg/hr 5



bydureon inj 40

byetta inj 10mcg 40

byetta inj 5mcg 40

bystolic tab 10mg 49

bystolic tab 2.5mg 49

bystolic tab 20mg 49

bystolic tab 5mg 49

C cabergoline tab 0.5mg 85

ca-dtpa sol 1000mg 63

cafergot tab 1-100mg 24

caffeine cit inj 60mg/3ml 92

caffeine cit sol 20mg/ml 92

caffeine cit sol 60mg/3ml 92

caffeine/sod inj benzoate 92

calc acetate cap 667mg 78

calc acetate tab 667mg 78

calc folinat inj 300/30ml 26

calcipotrien cre 0.005% 63

calcipotrien oin 0.005% 63

calcipotrien sol 0.005% 63

calcitonin spr 200/act 92

calcitrene oin 0.005% 63



calcitriol inj 1mcg/ml 106

calcitriol oin 3mcg/gm 63

calcitriol sol 1mcg/ml 106

calcium diso inj 500/2.5m 63

cal-day 1000 tab 108

camila tab 0.35mg 81

canasa sup 1000mg 91



candesa/hctz tab 32-25mg 48

candesartan tab 16mg 45




cantil tab 25mg 73

capacet cap 1

capecitabine tab 150mg 26

capecitabine tab 500mg 26

capex sha 0.01% 63

caprelsa tab 100mg 26

caprelsa tab 300mg 26

captopr/hctz tab 25-15mg 48





captopril tab 12.5mg 46



carac cre 0.5% 63

carafate sus 1gm/10ml 74









carbamazepin chw 100mg 19

carbamazepin sus 100/5ml 19

carbamazepin tab 200mg 19



carbidopa tab 25mg 31

carbinoxamin sol 4mg/5ml 100

carbinoxamin tab 4mg 100

carboplatin inj 50mg/5ml 26

cardene iv sol 20/200ml 51

cardizem la tab 120mg 51

cardura xl tab 4mg 78

carteolol sol 1% op 98






carvedilol tab 25mg 50



cavarest gel 1.1% 61

caverject inj 20mcg 78

caverject inj 40mcg 78

caverject kit 10mcg 78

caverject kit 20mcg 78

cavirinse sol 0.2% 61

caziant pak 81

cdp/amitrip tab 10-25mg 32

cdp/amitrip tab 5-12.5mg 32



cefaclor er tab 500mg 13

cefaclor sus 125/5ml 13



cefadroxil cap 500mg 13



cefadroxil tab 1gm 13

cefazolin inj 500mg 13

cefdinir cap 300mg 13

cefdinir sus 125/5ml 13

cefdinir sus 250/5ml 13

cefpodo prox sus 100/5ml 13

cefpodo prox sus 50mg/5ml 13







ceftriax/dex inj 1gm 13

ceftriax/dex inj 2gm 14


ceftriaxone inj 250mg 14




cellcept iv inj 500mg 89

124

cellcept sus 200mg/ml 89

celontin cap 300mg 17

cem-urea sol 45% 63

cenestin tab 0.3mg 83





centany oin 2% 63

central-vite tab under 50 108

centrum spec tab heart 108

centrum spec tab immune 108

centrum spec tab vision 108

centrum tab cardio 108

centrum tab silver 108

centrum tab ultra 108






cephalexin tab 250mg 14

cephalexin tab 500mg 14

ceprotin inj 500 unit 53

cerefolin tab 108

cerovel gel 40% 63

cerovel lot 40% 63

certavite tab senior 108

cesamet cap 1mg 23

cesia pak 81

cetirizine sol 1mg/ml 100

cetirizine sol 5mg/5ml 100

cetirizine syp 1mg/ml 100

cetirizine syp 5mg/5ml 100



cetraxal sol 0.2% 96

cetrotide kit 0.25mg 88

cetrotide kit 3mg 88

chantix pak 0.5& 1mg 6

chantix pak 1mg 6

chantix tab 0.5mg 6

chantix tab 1mg 6

chateal tab 0.15/30 81

chemet cap 100mg 92

child asa chw 81mg 9

child asa ls chw 81mg 9

child vit d chw 400unit 108

chld ibuprof sus 100/5ml 9

chlord/clidi cap 5-2.5mg 73

chlordiazep cap 10mg 39



chlorhex dig sol 20% 64

chlorhex glu sol 0.12% 61

chlorhex glu sol 20% 64



chlorothiaz inj 500mg 56



chlorpromaz inj 25mg/ml 32






chlorpropam tab 100mg 40

chlorpropam tab 250mg 40




chlorzoxazon tab 500mg 104

cho mag tris liq 500/5ml 9

cho mag tris tab 1000mg 9

cholestyram pow 4gm lite 58

chor gonadot inj 10000unt 88

cialis tab 10mg 78

cialis tab 2.5mg 78

cialis tab 20mg 78

cialis tab 5mg 78



ciloxan oin 0.3% op 96

cimetidine sol 300/5ml 76





cinryze sol 500 unit 53

cipro hc sus otic 98

ciprodex sus 0.3-0.1% 98

ciprofloxacn sol 0.2% 96

ciprofloxacn sol 0.3% op 96







ciprofloxacn tab 500mg er 15


cisplatin inj 100mg 26

citalopram sol 10mg/5ml 21

citalopram tab 10mg 21



citric acid/ sol sod citr 106

cladribine inj 1mg/ml 26

clarinex-d tab 2.5-120 103

clarinex-d tab 5-240mg 103





clarithromyc tab 500mg er 15

claritin chw 5mg 100

clearlax pow 74

clearplex v gel 5% 64

clearplex x gel 10% 64

clemastine syp 0.5/5ml 100

clemastine tab 2.68mg 100

cleocin sup 100mg 79

clindacin mis etz 1% 64

clindacin-p pad 1% 64

clindamax gel 1% 64

clindamax lot 10mg/ml 64

clindamy/ben gel 1-5% 64

clindamycin aer 1% 64




clindamycin cre 2% vag 79

clindamycin gel 1% 64

clindamycin lot 1% 64

clindamycin lot 10mg/ml 64

clindamycin pad 1% 64

clindamycin sol 1% 64

clindamycin sol 75mg/5ml 12

clinpro 5000 pst 1.1% 61

clobetasol aer 0.05% 64

clobetasol cre 0.05% 64

clobetasol gel 0.05% 64

clobetasol lot 0.05% 64

clobetasol oin 0.05% 64

clobetasol sha 0.05% 64

clobetasol sol 0.05% 64

clobex spr 0.05% 64

clocortolone cre piv 0.1% 64

clodan sha 0.05% 64

125

cloderm cre 0.1% 64

cloderm cre 0.1% pmp 64

clolar inj 1mg/ml 26

clomipramine cap 25mg 22








clonazepam tab 0.5mg 17






clonidine inj 53




clonidine tab 0.1mg er 53



clopidogrel tab 300mg 45

clopidogrel tab 75mg 45

cloraz dipot tab 15mg 39

cloraz dipot tab 3.75mg 39

cloraz dipot tab 7.5mg 39

clotrim/beta cre 1-0.05% 64

clotrim/beta cre diprop 64

clotrim/beta lot diprop 64

clotrimazole cre 1% 79

clotrimazole cre 1% vag 79

clotrimazole loz 10mg 61

clotrimazole sol 1% 64

clotrimazole tro 10mg 61

clozapine tab 100/odt 35


clozapine tab 12.5/odt 35



clozapine tab 25mg odt 35


cnl8 nail kit 64

coal tar sol 20% 64

cocaine hcl sol 10% 64

cocaine hcl sol 4% 64

codeine sulf sol 30mg/5ml 3

codeine sulf tab 15mg 3



co-gesic tab 5-500mg 3

colcrys tab 0.6mg 24

colestipol gra 5gm 58

colestipol tab 1gm 58

collyrium sol 95

collyrium sol eye wash 95

colocort ene 100mg 64

coly-mycin s sus otic 98

colyte/flavr sol packs 74

combigan sol 0.2/0.5% 98

combipatch dis .05/.14 84

combipatch dis .05/.25 84

cometriq kit 100mg 26



compazine sup 25mg 32

complera tab 38

complete 50+ tab mens 108

complete 50+ tab womens 108

compound 347 liq 92

compro sup 25mg 32

condylox gel 0.5% 64

constulose sol 10gm/15 74

controlrx cre 1.1% 61

controlrx pst 1.1% 61

conzip cap 100mg 3

conzip cap 200mg 3

conzip cap 300mg 3

copaxone inj 40mg/ml 60

copaxone kit 20mg/ml 60

cordran 24x3 tap 4mcg/cm 64

cordran 80x3 tap 4mcg/cm 64

cordran lot 0.05% 64

cordran sp cre 0.05% 64

coreg cr cap 10mg 50




cormax scalp sol 0.05% 64

cort intense cre heal 1% 64

cortaid adv cre 1% 12 hr 64

cortaid cre 1% 64

cortalo gel 2% 64

cortifoam aer 90mg 65

cortisone + cre 1% 65

cortisone ac tab 25mg 79

cortisone cre 1% 65

cortisone lot 1% 65

cortisone oin 1%max st 65

cortisporin cre 0.5% 65

cortisporin oin 1% 65

cortisporin sus -tc otic 98

cortizone-10 lot eczema 65

cortizone-10 lot hydraten 65

cortizone-10 oin 1% 65

cosmegen inj 0.5mg 26

cosopt sol 2-0.5%op 98

cosyntropin inj 0.25mg 92

covaryx hs tab 84

covaryx tab 84

creon cap 12000unt 74

creon cap 24000unt 74

creon cap 3000unit 74

creon cap 6000unit 74

crestor tab 10mg 57

crestor tab 20mg 57

crestor tab 40mg 57

crestor tab 5mg 57

crinone gel 4% vag 79

crinone gel 8% vag 79

crixivan cap 200mg 35

crixivan cap 400mg 35

cromolyn sod con 100/5ml 74

cromolyn sod neb 20mg/2ml

101

cromolyn sod sol 4% op 95

cryselle-28 tab 28 tabs 81

cubicin sol 500mg 12

curity prep pad alcohol 92

curity salin sol 0.9% irr 106

curity swabs pad alcohol 93

cuvposa sol 1mg/5ml 73



cvs aspirin tab 325mg 9

cvs aspirin tab 325mg ec 9

cvs aspirin tab 81mg ec 9

cvs chld asa chw 81mg 9

cvs cort int cre heal 1% 65



cvs nicotine dis 14mg/24h 6

cvs nicotine dis 7mg/24hr 6

cvs nicotine gum 2mg cinn 6

cvs nicotine gum 2mg mint 6

cvs nicotine gum 2mg orig 6

cvs nicotine gum 2mgfruit 6

cvs nicotine gum 4mg cinn 6

126

cvs nicotine gum 4mg mint 6

cvs nicotine gum 4mg orig 6

cvs nicotine gum 4mgfruit 6

cvs nicotine loz 2mg 6

cvs nicotine loz 2mg mint 6

cvs nicotine loz 4mg mint 6

cvs nts dis step 1 6

cvs purelax pow 74

cvs vit d cap 2000unit 108

cyanocobalam inj 1000mcg 108

cyclafem tab 1/35 81

cyclafem tab 7/7/7 81

cyclobenzapr cre 20mg/gm 104

cyclobenzapr tab 10mg 105

cyclobenzapr tab 5mg 105

cyclobenzapr tab 7.5mg 105



cyclophosph inj 500mg 27

cyclophosph tab 25mg 27

cyclophosph tab 50mg 27

cycloset tab 0.8mg 40


cyclosporine cap 100mg md 89




cyclosporine inj 50mg/ml 90

cyclosporine sol modified 90

cyproheptad syp 2mg/5ml 100

cyproheptad tab 4mg 100

cystadane pow 106

cystagon cap 150mg 106

cystagon cap 50mg 106

cystaran sol 0.44% 97

cysteine hcl inj 50mg/ml 108



cytarabine inj 500mg 27

cytra-2 sol 106

cytra-3 syp 106

cytra-k sol 106

D d 1000 cap 1000unit 108

d 1000 chw 1000unit 108

d 400 chw 400unit 108

d 400 tab 400unit 108

d3 adult chw 1000unit 108

d3 cap 1000unit 108

d3 cap 2000unit 108

d3 cap 400unit 108

d-3 gummy chw 400unit 108

d3 kids chw 400unit 108

d3 max st dro 5000unit 108

d3 maximum cap 5000unit 108

d3 super str cap 2000unit 108

d3 tab 1000unit 108

d3 tab 2000unit 108

d3-1000 cap 1000unit 108

d-400 tab 400unit 108

dapsone tab 100mg 12

dapsone tab 25mg 12

daraprim tab 25mg 30

dasetta tab 1/35 81

dasetta tab 7/7/7 81

daunorubicin inj 5mg/ml 27

daunoxome inj 2mg/ml 27

daytrana dis 10mg/9hr 59




decara cap 50000unt 108

decitabine inj 50mg 27

deferoxamine inj 500mg 65

delazinc oin 65

delta d3 tab 400unit 108

delyla tab 0.1-0.02 81

delzicol cap 400mg 91



demser cap 250mg 53

denavir cre 1% 37

denta 5000 cre plus 61

denta 5000 cre plus 2pk 61

dentagel gel 1.1% 61

depen titra tab 250mg 93

depocyt inj 50mg/5ml 27

depo-estradi inj 5mg/ml 84

depo-medrol inj 20mg/ml 79

depo-provera inj 400/ml 27

depo-sq prov inj 104 81

dermasorb ta kit 0.1% 65

dermavite tab 108

desenex cre 1% 65

desipramine tab 100mg 22






desmopressin inj 4mcg/ml 85

desmopressin sol 0.01% 85

desmopressin spr 0.01% 85



deso/ethinyl tab estradio 81

desonate gel 0.05% 65

desonide cre 0.05% 65

desonide lot 0.05% 65

desonide oin 0.05% 65

desowen crm kit 0.05% 65

desowen lot kit 0.05% 65

desowen oint kit 0.05% 65

desoximetas cre 0.05% 65

desoximetas cre 0.25% 65

desoximetas gel 0.05% 65

desoximetas oin 0.05% 65

desoximetas oin 0.25% 65

desvenlafax tab 100mg er 21

desvenlafax tab 50mg er 21


dexameth pho inj 120mg/30 80

dexameth pho inj 20mg/5ml 80


dexameth pho sol 0.1% op 97

dexamethason con 1mg/ml 80

dexamethason elx 0.5/5ml 80

dexamethason sol 0.5/5ml 80








dexchlorphen syp 2mg/5ml 100

dexferrum inj 50mg/ml 108

dexilant cap 30mg dr 77

dexilant cap 60mg dr 77

dexmethylph cap 15mg er 59



dexmethylph tab 10mg 59

dexmethylph tab 2.5mg 59

dexmethylph tab 5mg 59

dexpak pak 10 day 80

dexpak pak 13 day 80

dexpak pak 6 day 80

dexpanthenol inj 250mg/ml 74


127


dextroamphet cap 10mg er 59



dextroamphet tab 10mg 59

dextroamphet tab 5mg 59

diabeta tab 2.5mg 40

diabeta tab 5mg 40

dialyvite d cap 5000unit 109

diamode tab 2mg 74

diastat acdl gel 12.5-20 17

diastat acdl gel 5-10mg 17

diastat ped gel 2.5m gel 17

diazepam gel 10mg 17

diazepam gel 2.5mg 17

diazepam gel 20mg 17

diazepam inj 5mg/ml 39

diazepam sol 1mg/ml 39

diazepam tab 10mg 39

diazepam tab 2mg 39

diazepam tab 5mg 39

dibenzyline cap 10mg 53



diclofen pot tab 50mg 10

diclofenac sol 0.1% op 97

diclofenac tab 100mg er 10






dicyclomine cap 10mg 73

dicyclomine sol 10mg/5ml 73

dicyclomine tab 20mg 73

didanosine cap 125mg 35




diethylprop tab 25mg 93

diethylprop tab 75mg er 93

dificid tab 200mg 15

difil-g fort liq 100-100 103

diflorasone cre 0.05% 65

diflorasone oin 0.05% 65

diflunisal tab 500mg 10

digox tab 0.125mg 53

digox tab 0.25mg 53

digoxin sol 50mcg/ml 54



dihydroergot inj 1mg/ml 93

dihydroergot spr 4mg/ml 93

dilantin cap 30mg 19

dilatrate sr cap 40mg 54

dilt-cd cap 120mg 51






diltiazem cap 120mg/24 51














diltiazem er tab 180mg 51





diltiazem inj 100mg 51

diltiazem inj 25mg/5ml 51





dilt-xr cap 120mg 50

diltzac cap 120mg/24 52





dimenhydrin inj 50mg/ml 23

dimetane dx syp 103

dipentum cap 250mg 91

diphen/atrop liq 2.5/5 74

diphen/atrop tab 2.5mg 74

diphenhydram cap 50mg 100

diphenhydram elx 12.5/5ml 100

diphenhydram inj 50mg/ml 100

dipyridamole inj 5mg/ml 93








divalproex cap 125mg 18






docefrez inj 20mg 27

docefrez inj 80mg 27

docetaxel inj 20/0.5ml 27

docetaxel inj 20mg/2ml 27

docetaxel inj 20mg/ml 27

dologesic tab 30-500mg 1

dolorex tab 50-500mg 1

donatussin dro 103





donepezil tab hcl 23mg 20

donnatal tab extentab 73

dorzol/timol sol 2-0.5%op 98

dorzolamide sol 2% op 97

doxapram hcl inj 20mg/ml 60

doxazosin tab 1mg 54




doxepin hcl cap 100mg 23






doxepin hcl con 10mg/ml 23

doxercalcif cap 0.5mcg 106

doxercalcif cap 1mcg 106

doxercalcif cap 2.5mcg 106

doxorubicin inj 10mg 27

doxorubicin inj 2mg/ml 27




128




doxycycl hyc tab 100mg 16






doxycycline sus 25mg/5ml 16

doxycycline tab 20mg 16

dramamine tab 25mg 23

dritho-creme cre hp 1% 65

dronabinol cap 10mg 23

dronabinol cap 2.5mg 23

dronabinol cap 5mg 23

droperidol inj 2.5mg/ml 38

droxia cap 200mg 27

droxia cap 300mg 27

droxia cap 400mg 27

dulcolax pow balance 74

dulera aer 100-5mcg 102

dulera aer 200-5mcg 102

duloxetine cap 20mg 21



duramorph inj 0.5mg/ml 1

duramorph inj 1mg/ml 1

duraxin cap 1

durezol emu 0.05% 97

d-vita liq 400unit 108

dyrenium cap 100mg 56

dysport inj 500unit 60

E e.e.s. 400 tab 400mg 15

e.s.p. sus 200-600 12

easivent mis 93

easivent mis mask lg 93

easivent mis mask med 93

easivent mis mask sm 93

econazole cre 1% 65

ecotrin low tab 81mg ec 10

ecpirin tab 325mg ec 10

edarbi tab 40mg 45

edarbi tab 80mg 45

edecrin tab 25mg 56

edex kit 10mcg 78

edex kit 20mcg 78

ed-flex cap 1

ed-spaz tab 0.125mg 73

edurant tab 25mg 38

eemt hs tab 84

eemt tab 84

ees/sulfisox sus 200-600 12

effer-k tab 10meq 109

effer-k tab 20meq 109

effer-k tab 25meq ef 109

elidel cre 1% 65

eligard inj 22.5mg 27

eligard inj 30mg 27

eligard inj 45mg 27

eligard inj 7.5mg 27

elinest tab 81

eliquis tab 2.5mg 43

eliquis tab 5mg 43

elitek inj 1.5mg 27

elixophyllin elx 80/15ml 103

ella tab 30mg 81

elmiron cap 100mg 106

elspar inj 10000unt 27

emcyt cap 140mg 27

emoquette tab 81

emsam dis 12mg/24h 21

emsam dis 6mg/24hr 21

emsam dis 9mg/24hr 21

emtriva cap 200mg 35

emtriva sol 10mg/ml 35

enablex tab 15mg 77

enablex tab 7.5mg 77

enalapr/hctz tab 10-25mg 48

enalapr/hctz tab 5-12.5mg 48


enalapril tab 2.5mg 46



enbrel inj 25/0.5ml 90

enbrel inj 25mg 90

enbrel inj 50mg/ml 90

enbrel srclk inj 50mg/ml 90






endocet tab 7.5-500m 3

endodan tab 3

endometrin sup 100mg 79

enjuvia tab 0.3mg 84





enoxaparin inj 100mg/ml 43

enoxaparin inj 120/0.8 43

enoxaparin inj 150mg/ml 43

enoxaparin inj 30/0.3ml 43

enoxaparin inj 300/3ml 43




enpresse-28 81

enpresse-28 tab 81

enskyce tab 81

entacapone tab 200mg 31

entre-b sus 6-10mg/5 103

enulose sol 10gm/15 74

ephedrine su inj 50mg/ml 45

epiduo gel 0.1-2.5% 65

epinastine dro 0.05% 95

epinephrine inj 0.15mg 93

epinephrine inj 0.1mg/ml 93

epinephrine inj 0.3mg 93

epinephrine inj 1mg/ml 102

epipen 2-pak inj 0.3mg 93

epipen-jr inj 0.15mg 93

epipen-jr inj 2-pak 93

epirubicin inj 50/25ml 27

epitol tab 200mg 19

epivir hbv sol 5mg/ml 35

epivir sol 10mg/ml 35



epogen inj 10000/ml 44







eprosart mes tab 600mg 45

epzicom tab 600-300 38

eq allergy elx 12.5/5ml 100

eq aspirin tab 325mg 10

eq aspirin tab 325mg ec 10

eq child asa chw 81mg 10

eq clearlax pow 74

eq complete tab adult 109

eq heartburn tab relief 76

eq hydrocort cre 1% 65

eq nicotine dis 14mg/24h 6

129

eq nicotine dis 21mg/24h 6

eq nicotine dis 7mg/24hr 6

eq nicotine gum 2mg cinn 6

eq nicotine gum 2mg mint 6

eq nicotine gum 2mg orig 6

eq nicotine gum 2mgfruit 6

eq nicotine gum 4mg cinn 6

eq nicotine gum 4mg mint 6

eq nicotine gum 4mg orig 6

eq nicotine gum 4mg ref 6

eq nicotine gum 4mg strt 6

eq nicotine gum 4mgfruit 6

eq nicotine loz 2mg cher 6

eq nicotine loz 2mg mint 6

eq nicotine loz 4mg chry 6

eq nicotine loz 4mg mint 6

eq one daily tab mens 109

eq one daily tab womens 109

eql all day tab allergy 100

eql aspirin tab 325mg 10

eql aspirin tab 325mg ec 10

eql aspirin tab 81mg ec 10

eql chld asa chw 81mg 10

eql clearlax pow 74

eql nicotine dis 14mg/24h 6

eql nicotine dis 21mg/24h 6

eql nicotine dis 7mg/24hr 6

eql nicotine gum 2mg 6

eql nicotine gum 2mg ref 6

eql nicotine gum 2mg strt 6

eql nicotine gum 4mg 6

eql nicotine gum 4mg ref 6

eql nicotine gum 4mg strt 6

eql nicotine loz 2mg mint 6

eql nicotine loz 4mg mint 7

erbitux inj 100mg 27

ergocalcifer cap 50000unt 109

ergoloid mes tab 1mg oral 93

errin tab 0.35mg 81

ertaczo cre 2% 65

erwinaze inj 10000unt 27

ery pad 2% 65

ery-tab tab 333mg ec 15

erythrocin tab 250mg 15

erythrom eth tab 400mg 15

erythromycin cap 250mg ec 15

erythromycin gel /benzoyl 65

erythromycin gel 2% 65

erythromycin oin 5mg/gm 96

erythromycin oin op 96

erythromycin pad 2% 65

erythromycin sol 2% 65

erythromycin tab 250mg bs 15

erythromycin tab 500mg bs 15

escitalopram sol 5mg/5ml 21




esgic cap 1

esmolol hcl inj 100mg/10 50

esmolol hcl inj 10mg/ml 50

est estrogen tab mtest 84

est estrogen tab mtest ds 84

est estrogen tab mtest hs 84

estarylla tab 0.25-35 81

estazolam tab 1mg 105

estazolam tab 2mg 105

estra/noreth tab 0.5-0.1 84

estra/noreth tab 1-0.5mg 84

estrace vag cre 0.1mg/gm 79

estrad val inj 10mg/ml 82

estrad val inj 200mg/5 82



estradiol dis 0.025mg 84






estradiol tab 0.5mg 84

estradiol tab 1mg 84

estradiol tab 2mg 84

estring mis 2mg 79

estrogel gel 84

estropipate tab 0.75mg 84

estropipate tab 1.5mg 84

estropipate tab 3mg 84

eszopiclone tab 1mg 105





ethosuximide cap 250mg 17

ethosuximide sol 250/5ml 17

ethyl chlor aer fine pin 65

ethyl chlor aer fn strm 65

ethyl chlor aer med jet 65

ethyl chlor aer med strm 65

ethyl chlor aer mist 65

ethyl chlor aer spray 65

etidron disd tab 200mg 92

etidron disd tab 400mg 92








eurax cre 10% 66

eurax lot 10% 66

evamist spr 1.53mg 84

exelon dis 13.3/24 20

exelon dis 4.6mg/24 20

exelon dis 9.5mg/24 20

exelon sol 2mg/ml 20

exemestane tab 25mg 27

exforge tab 10-160mg 48




exforgeh/10- tab 160-12.5 48

exforgeh/10- tab 160-25 48


exforgeh/5- tab 160-12.5 48


exoderm lot 25-1% 66

extavia inj 0.3mg 61

eye irrigati sol op 95

eye wash dro solution 95

eye wash sol 95

F fa-8 tab 0.8mg 109

fa-b6-b12 tab 109

fabb tab 109

factive tab 320mg 15

falmina tab 82

famciclovir tab 125mg 38



famotidine inj 10mg/ml 76

famotidine inj 200/20ml 76


famotidine inj 20mg/50m 76


famotidine sus 40mg/5ml 76



fanapt tab 10mg 33

130

fanapt tab 12mg 33

fanapt tab 1mg 33

fanapt tab 2mg 33

fanapt tab 4mg 33

fanapt tab 6mg 33

fanapt tab 8mg 33

fareston tab 60mg 27

faslodex inj 250mg 27

fazaclo tab 100/odt 35

fazaclo tab 12.5/odt 35

fazaclo tab 150mg 35

fazaclo tab 25mg odt 35

fe tabs tab 325mg ec 109

felbamate sus 600/5ml 18



felodipine tab 10mg er 52

felodipine tab 2.5mg er 52

felodipine tab 5mg er 52












fenofibric cap 135mg dr 57

fenofibric cap 45mg dr 57

fenofibric tab 105mg 57

fenofibric tab 35mg 57

fenoglide tab 120mg 57

fenoglide tab 40mg 57

fenoldopam inj 10mg/ml 54

fenoprofen tab 600mg 10

fentanyl dis 100mcg/h 1

fentanyl dis 12mcg/hr 2




feosol tab 65mg 109

ferate tab 27mg 109

fer-iron dro 15mg/ml 109

ferocon cap 109

ferosul elx 220/5ml 109

ferotrinsic cap 109

ferraplus 90 tab 109

ferrex 150 cap forte 109

ferriprox tab 500mg 66

ferro-bob tab 325mg 109

ferrogels fo cap forte 109

ferrous dro 15mg/ml 109

ferrous gluc tab 240mg 109

ferrous sulf dro 15mg/ml 109

ferrous sulf elx 220/5ml 109

ferrous sulf tab 325mg 109

ferrous sulf tab 325mg ec 109

ferrous sulf tab 325mg fc 109

ferrous sulf tab 5gr 109

ferrousul tab 325mg 109



fibricor tab 105mg 57

fibricor tab 35mg 57

fifty50 prep pad pads 93

finacea gel 15% 66



firazyr inj 30mg/3ml 54

firmagon inj 120mg 27

firmagon inj 80mg 27

fitness tabs tab men 109

fitness tabs tab women 109

flagyl er tab 750mg 12

flarex sus 0.1% op 97

flavor plus liq 1

flavoxate tab 100mg 77




flector dis 1.3% 66

flovent disk aer 100mcg 99

floxuridine inj 0.5gm 27

fluarix inj pf 12-13 91

fluarix pf inj 2013-14 91

fluarix quad inj 2013-14 91

fluarix quad inj 2014-15 91

flucaine sol 0.25-0.5 97

fluconazole sus 10mg/ml 24

fluconazole sus 40mg/ml 24

fluconazole tab 100mg 24




fludarabine inj 50mg/2ml 27

fludrocort tab 0.1mg 80

flulaval inj 2012-13 91



flulaval qua inj 2014-15 91

flumazenil inj 1mg/10ml 93

flunisolide spr 0.025% 102

flunisolide spr 29mcg 102

fluocin acet cre 0.01% 66

fluocin acet cre 0.025% 66

fluocin acet oil 0.01% 66

fluocin acet oil 0.01% sc 66

fluocin acet oil body 66

fluocin acet oil ear0.01% 98

fluocin acet oil scalp 66

fluocin acet oin 0.025% 66

fluocin acet sol 0.01% 66

fluocinonide cre 0.05% 66

fluocinonide gel 0.05% 66

fluocinonide oin 0.05% 66

fluocinonide sol 0.05% 66

fluorabon dro 107

fluor-a-day chw 0.25mg f 107

fluor-a-day chw 0.5mg f 107

fluorescein/ sol proparac 97

fluoride chw 0.5mg f 107

fluoride chw 1mg f 107

fluoridex dd pst sensitiv 61

fluoridex gel 1.1% 61

fluoridex gel whitenin 61

fluoritab chw 0.5mg f 107

fluoritab chw 1mg f 107

fluoritab chw 2.2mg 107

fluoromethol sus 0.1% op 97

fluoroplex cre 1% 66

fluorouracil cre 5% 66



fluorouracil inj 500/10ml 27

fluorouracil inj 5gm/100m 27






fluoxetine cap 90mg dr 21

fluoxetine sol 20mg/5ml 21




fluphenaz de inj 25mg/ml 32

fluphenazine con 5mg/ml 32

131

fluphenazine elx 2.5/5ml 32

fluphenazine inj 2.5mg/ml 32



fluphenazine tab 2.5mg 32


flurazepam cap 15mg 105

flurazepam cap 30mg 105

flurbiprofen sol 0.03% op 97



flutamide cap 125mg 27

fluticasone cre 0.05% 66

fluticasone lot 0.05% 66

fluticasone oin 0.005% 66

fluticasone spr 50mcg 102



fluvirin inj 2012-13 91



fluvirin inj pf 12-13 91

fluvirin inj pf 13-14 91

fluvirin pf inj 2014-15 91




fluzone inj intradrm 91

fluzone inj pf 12-13 91

fluzone inj pf 13-14 91

fluzone ped/ inj pf 12-13 91



fluzone quad inj 13-14 91

fluzone quad inj 14-15 91

fluzone splt inj 2012-13 91



fml oin 0.1% op 97

focalin xr cap 10mg 59





folbecal tab 109

folbee tab 109

folcaps tab 109

folic acid inj 5mg/ml 109

folic acid tab 1000mcg 109

folic acid tab 1mg 109



folplex 2.2 tab 109

foltrin cap 109

fomepizole inj 1.5gm 66

fomepizole inj 1gm/ml 66

fondaparinux sol 10/0.8 43

fondaparinux sol 2.5/0.5 43



foradil cap aerolize 102

forfivo xl tab 450mg 20

formadon sol 66

formaldehyde sol 10% 66

forma-ray sol 20% 66

forteo sol 600/2.4 92

fortesta gel 10mg/act 81

fortical spr 200/act 92

fosamax + d tab 70-2800 92

fosamax + d tab 70-5600 92






fosrenol chw 1000mg 79



fragmin inj 10000/ml 43

fragmin inj 12500unt 43



fragmin inj 2500/0.2 43

fragmin inj 25000/ml 43



freedavite tab 109

frova tab 2.5mg 24

fungicure spr intens 66






fusilev inj 50mg 27

G gabapentin cap 100mg 18



gabapentin sol 250/5ml 18



gabitril tab 12mg 18

gabitril tab 16mg 18

gablofen inj 10000/20 105



gablofen inj 50mcg/ml 105




galantamine sol 4mg/ml 20




galzin cap 25mg 109

galzin cap 50mg 109

ganciclovir inj 500mg 38

ganirelix ac inj 88

garamycin oin 0.3% op 96

gatifloxacin sol 0.5% 96

gavilax pow 74

gavilyte-c sol 74

gavilyte-g sol 74

gavilyte-n sol flav pk 74

gelnique gel 10% 77

gelnique gel 3% 77

gemcitabine inj 200mg 27

gemfibrozil tab 600mg 57

generlac sol 10gm/15 74

gene-xene tab 15mg 39

gene-xene tab 3.75mg 39

gene-xene tab 7.5mg 39

gengraf cap 100mg 90

gengraf cap 25mg 90

gengraf sol 100mg/ml 90

genotropin inj 0.2mg 88








genotropin inj 12mg 88




gentak oin 0.3% op 96

gentamicin cre 0.1% 66

132

gentamicin oin 0.1% 66

gentamicin oin 0.3% op 96

gentamicin sol 0.3% op 96

gentlelax pow 74

geodon inj 20mg 33

geri-freeda tab senior 110

geri-hydrola cre 12% 66

geri-hydrola lot 12% 66

giazo tab 1.1gm 91

gildess fe tab 1.5/30 82

gildess fe tab 1/20 82

gildess tab 1.5/30 82

gildess tab 1/20 82

gilenya cap 0.5mg 61

gleevec tab 100mg 27

gleevec tab 400mg 28






glip/metform tab 5-500mg 40

glipizide er tab 10mg 40

glipizide er tab 2.5mg 40

glipizide er tab 5mg 40



glipizide xl tab 10mg 40

glipizide xl tab 2.5mg 40

glipizide xl tab 5mg 40

global prep pad pads 93

glucagen inj 1mg 42

glucagen inj hypokit 42

glucagon kit 1mg 42

glumetza tab 500mg 40



glyb/metform tab 5-500mg 40

glyburid mcr tab 1.5mg 40





glyburide tab 5mg 41

glycine sol 1.5% irr 106

glycolax pow 3350 nf 74

glycopyrrol inj 0.2mg/ml 73



glyset tab 25mg 41

gnp alcohol pad swabs 93

gnp all day tab allergy 100

gnp allergy tab 180mg 100

gnp aspirin chw 81mg 10

gnp aspirin tab 325mg 10

gnp aspirin tab 325mg ec 10

gnp aspirin tab 81mg ec 10

gnp clearlax pow 75

gnp eye wash sol op 95

gnp hydrocor cre 1% plus 66

gnp iodides tin 66

gnp iodine tin 2% mild 66

gnp iron tab 325mg 110

gnp nicotine gum 2mg mint 7

gnp nicotine gum 2mg orig 7

gnp nicotine gum 4mg mint 7

gnp nicotine gum 4mg orig 7

gnp nicotine loz 2mg mint 7

gnp nicotine loz 4mg mint 7




gnp vit d3 tab 1000unit 110

golytely sol 75

gralise star mis 300/600 60

gralise tab 300mg 60

granisetron inj 0.1mg/ml 23

granisetron inj 1mg/ml 23

granisetron tab 1mg 23

granisol sol 2mg/10ml 23

griseofulvin sus 125/5ml 24

griseofulvin tab micr 500 24



grx hicort sup 25mg 66



gynazole-1 cre 2% 79

H hair/skin/ tab nails 110

hair-vites tab 110

halac kit 66

halaven inj 1mg/2ml 28

halflytely kit flav pks 75

halfprin tab 162mg ec 10

halfprin tab 81mg ec 10

halobetasol cre 0.05% 66

halobetasol oin 0.05% 66

halog cre 0.1% 66

halog oin 0.1% 67

halonate pac kit 67



haloper lac inj 5mg/ml 32

haloperidol con 2mg/ml 32

haloperidol tab 0.5mg 32






hc ac/aloe gel 2% 67

hc butyrate cre 0.1% 67

hc butyrate oin 0.1% 67

hc butyrate sol 0.1% 67

hc pramoxine cre 1-1% 67

hc pramoxine cre 1-2.5% 67

hc pramoxine cre 2.5-1% 67

hc valerate cre 0.2% 67

hc valerate oin 0.2% 67

hc/acet acid sol otic 98

hc/lidocaine kit 2-2% 67

heartbrn rel tab 200mg 76




heartburn tab relief 76

heartburn tr cap 15mg 77

heather tab 0.35mg 82

hecoria cap 0.5mg 90

hecoria cap 1mg 90

hecoria cap 5mg 90

hematinic/fa tab 110

hematogen cap forte 110

hematogen fa cap 110

hemocyte-f tab 110

hemril-30 sup 30mg 67

hep flush-10 inj 10unt/ml 43



hep sod/nacl inj 1000unit 43

hep sod/nacl inj 12500unt 43

hep sod/nacl inj 25000unt 43

hep sod/nacl inj 2unit/ml 43

heparin lock inj 100/ml 43

heparin lock inj 10unt/ml 43





133




heparin sod inj 5000/0.5 43


hm aspirin chw 81mg 10

hm aspirin tab 325mg 10

hm clearlax pow 75

hm complete tab 110

hm hair/skin tab /nails 110

hm iodides tin 67

hm iodine tin 2% mild 67

hm nicotine dis 14mg/24h 7

hm nicotine dis 21mg/24h 7

hm nicotine gum 2mg mint 7

hm nicotine gum 4mg mint 7

hm nicotine loz 2mg mint 7

hm nicotine loz 4mg mint 7

hm one daily tab mens 110

hm vit d3 cap 2000unit 110

hm vitamin d tab 1000unit 110

homatropaire sol 5% op 97

homatropine sol 5% op 97

horizant tab 600mg 60

hrtbrn rel cap 15mg dr 77

humalog inj 100/ml 42

humalog kwik inj 100/ml 42

humalog mix inj 50/50 42

humalog mix inj 50/50kwp 42

humalog mix inj 75/25kwp 42

humalog mix sus 75/25 42

humatrope inj 12mg 88




humira kit 20mg/0.4 90

humira kit 40mg/0.8 90

humira pen kit 40mg/0.8 90

humira pen kit crohns 90

humira pen kit psoriasi 90

humulin inj 70/30 42

humulin n inj u-100 42

humulin n inj u-100kwp 42

humulin n pn inj u-100 42

humulin pen inj 70/30 42

humulin r inj u-100 42

humulin r inj u-500 42

hyalex tab 110

hyaluronate gel 0.2% 67

hyd pol/cpm liq 10-8/5ml 103

hydralazine inj 20mg/ml 54





hydro skin lot 1% 67

hydrochlorot cap 12.5mg 56

hydrochlorot tab 12.5mg 56



hydroco/apap sol 3

hydroco/apap sol 5-217/10 3



















hydrocod/hom syp 5-1.5/5 103





hydrocodone/ tab homatrop 103



hydrocort cre 1% 67

hydrocort cre 1% plus 67

hydrocort cre 1%max st 67

hydrocort cre 1%pls 10 67

hydrocort cre 2.5% 67

hydrocort ene 100mg 67

hydrocort lot 1% 67

hydrocort lot 2.5% 67

hydrocort oin 1% 67

hydrocort oin 2.5% 67




hydrocort/ kit pramoxin 67

hydrocort/ab oin 1% 67

hydrocream cre 1% 67

hydrogesic cap 5-500mg 4

hydro-lotion lot 1% 67

hydromet syp 5-1.5/5 103

hydromorphon liq 1mg/ml 2

hydromorphon sup 3mg 2




hydroquinone cre 4% 67

hydroquinone cre 4% tr 67

hydroskin cre 1% 67

hydroxocobal inj 1000mcg 110

hydroxychlor tab 200mg 31

hydroxyurea cap 500mg 28

hydroxyz hcl inj 25mg/ml 38

hydroxyz hcl inj 50mg/ml 38

hydroxyz hcl sol 10mg/5ml 38

hydroxyz hcl syp 10mg/5ml 38

hydroxyz hcl tab 10mg 38



hydroxyz pam cap 100mg 39



hygel gel 0.2% 67

hyomax-sl sub 0.125mg 73

hyophen tab 77

hyoscyamine dro 0.125/ml 73

hyoscyamine elx 0.125/5 73

hyoscyamine sub 0.125mg 73

hyoscyamine tab 0.125mg 73

hyoscyamine tab 0.375 er 73

hyoscyamine tab 0.375 sr 73

hyosyne dro 0.125/ml 74

hyosyne elx 0.125/5 74

hypercare sol 20% 67

I ibandronate tab 150mg 92

ibudone tab 5-200mg 4

ibuprofen sus 100/5ml 10




ibutilide inj 1mg/10ml 47

icaps areds tab formula 110

icaps plus tab 110

134

iclusig tab 15mg 28

iclusig tab 45mg 28

idarubicin inj 5mg/5ml 28

iferex 150 cap forte 110

ilotycin oin op 96

imipram hcl tab 10mg 23



imipram pam cap 100mg 23




imiquimod cre 5% 67

imitrex spr 20mg/act 25

imitrex spr 5mg/act 25

imperim tab 2mg 75

incivek tab 375mg 37

increlex inj 40mg/4ml 88



inderal xl cap 80mg 50

indomethacin cap 25mg 10

indomethacin cap 50mg 10

indomethacin cap 75mg er 10

infed inj 50mg/ml 110

infergen inj 15mcg 37

infuvite inj 110

infuvite inj adult 110

infuvite inj pediatri 110

inlyta tab 1mg 28

inlyta tab 5mg 28

innopran xl cap 80mg 50

insulin syrg mis 0.3/28g 93









insulin syrg mis 1ml 93

insulin syrg mis 1ml/25g 93







insulin syrg mis 2/27.5g 93

insulin syrg mis 28gx1/2" 93

insulin syrg mis 29gx1/2" 93


insulin syrg mis 30gx5/16 93

insulin syrg mis 31gx5/16 94

integrilin inj 0.75mg/1 45

integrilin inj 2mg/ml 45

intelence tab 100mg 38



intermezzo sub 3.5mg 105

intron-a inj 10mu 28



intuniv tab 1mg 59

intuniv tab 2mg 59

intuniv tab 3mg 59

intuniv tab 4mg 59

invega sust inj 117/0.75 33

invega sust inj 156mg/ml 33



invega sust inj 78/0.5ml 33

invega tab 1.5mg 34

invega tab 3mg 34

invega tab 6mg 34

invega tab 9mg 34

invirase cap 200mg 35

invirase tab 500mg 35

iodides tin 67

iodine sol strong 107

iodine tin 67

iodine tin 1% 67

iodine tin 2% 67

iodine tin 2% mild 67

iopidine sol 1% op 95

ipratropium sol 0.02%inh 101

ipratropium spr 0.03% 102

ipratropium spr 0.06% 102

ipratropium/ sol albuter 102



irbesartan tab 150mg 45



irinotecan inj 100/5ml 28

iron supplem tab therapy 110

iron supplmt dro 15mg/ml 110

iron tab 27mg 110

iron tab 325mg 110

iron tab 65mg 110

isentress chw 100mg 35

isentress chw 25mg 36

isentress tab 400mg 36

iso carbacho sol 1.5% op 95

iso carbacho sol 3% op 95

isoditrate tab 40mg er 54

isometh/apap cap dichlor 25

isoniazid inj 100mg/ml 25

isoniazid syp 50mg/5ml 25



isosorb din sub 2.5mg 54




isosorb din tab 40mg er 54







isosulfan inj blue 1% 94

isoxsuprine tab 10mg 103

isradipine cap 2.5mg 52

isradipine cap 5mg 52

istalol sol 0.5% op 98

istodax inj 10mg 28

J jakafi tab 10mg 28

jakafi tab 15mg 28

jakafi tab 20mg 28

jakafi tab 25mg 28

jakafi tab 5mg 28

jantoven tab 10mg 43

jantoven tab 1mg 43


jantoven tab 2mg 44

jantoven tab 3mg 44

jantoven tab 4mg 44

jantoven tab 5mg 44

jantoven tab 6mg 44


janumet tab 50-1000 41

janumet tab 50-500mg 41

janumet xr tab 100-1000 41

janumet xr tab 50-1000 41

janumet xr tab 50-500mg 41

januvia tab 100mg 41

135

januvia tab 25mg 41

januvia tab 50mg 41

jencycla tab 0.35mg 82

jentadueto tab 2.5-1000 41



jinteli tab 1mg-5mcg 84

j-max syp 5-200mg 103

jock itch cre 1% 67

jolivette tab 0.35mg 82

junel 1.5/30 tab 82

junel 1/20 tab 82

junel fe tab 1.5/30 82

junel fe tab 1/20 82

just d liq 400unit 110

juvisync tab 100-10mg 41






K kadcyla inj 160mg 28

kalbitor inj 10mg/ml 54

kaletra sol 38

kaletra tab 100-25mg 38

kaletra tab 200-50mg 38

kalydeco tab 150mg 103

kapvay mis 0.1&0.2 59

karigel gel 0.5% 61

karigel-n gel 1.1% 61

k-effervesce tab 25meq ef 110

kelnor tab 1/35 82

kenalog aer spray 67

kepivance inj 6.25mg 28

kericort 10 cre 1% 68

ketek tab 400mg 12

ketoconazole aer 2% 68

ketoconazole cre 2% 68

ketoconazole sha 2% 68

ketoconazole tab 200mg 24

ketodan aer 2% 68

ketoprofen cap 200mg er 10

ketoprofen cap 50mg 10

ketoprofen cap 75mg 10



ketorolac inj 60mg/2ml 11



ketorolac tab 10mg 11

ketostix tes strip 94

khedezla tab 100mg er 21

khedezla tab 50mg er 22

kineret inj 90

kionex sus 15gm/60 79




klor-con m15 tab 110


klor-con pow 20meq 110

klor-con/ef tab 25meq fr 110

kls anti-dia tab 2mg 75

kls aspirin tab 325mg ec 11

kls aspirin tab 81mg ec 11

kls quit2 gum 2mg 7

kls quit4 gum 4mg 7

kombiglyze tab 2.5-1000 41

kombiglyze tab 5-1000mg 41

kombiglyze tab 5-500mg 41

kp aspirin tab 81mg ec 11

kp loratadin tab 10mg 100

k-pax tab prof st 110

k-prime tab 25meq ef 110

kristalose pak 10gm 75

kristalose pak 20gm 75

kurvelo tab 0.15/30 82

k-vescent pow 20meq 110

k-vescent tab 25meq ef 110

kyprolis sol 60mg 28

L labetalol inj 5mg/ml 50




laclotion lot 12% 68

lacrisert mis 5mg op 98

lactated rin sol irrigat 94

lactic acid cre /vit e 68

lactic acid cre e 68

lactic acid lot 10% 68



lamictal chw 2mg 18

lamictal kit start 35 18



lamictal odt kit 18

lamictal odt tab 100mg 18




lamivud/zido tab 150-300 38

lamivudine tab 100mg 36















lansopr/amox mis /clarith 75

lansoprazole cap 15mg dr 77

lansoprazole cap 30mg dr 77

lansoprazole sus 3mg/ml 77

lantus inj 100/ml 42

lantus inj solostar 42

larin fe tab 1.5/30 82

larin fe tab 1/20 82

larin tab 1.5/30 82

larin tab 1/20 82

lastacaft sol 0.25% 95

latanoprost sol 0.005% 95

latrix sus 50% 68

latuda tab 120mg 34

latuda tab 20mg 34

latuda tab 40mg 34

latuda tab 60mg 34

latuda tab 80mg 34

lavoclen-4 liq crem wsh 68

lavoclen-8 liq crem wsh 68

laxaclear pow 75

lazanda spr 100mcg 2

l-cysteine inj 50mg/ml 110



lescol xl tab 80mg 57

lessina tab 82

letairis tab 10mg 103

letairis tab 5mg 103

letrozole tab 2.5mg 28

leucovor ca inj 350mg 28

136

leucovor ca tab 10mg 28




leukeran tab 2mg 28

leukine inj 250mcg 44

leukine inj 500 mcg 44

leuprolide inj 1mg/0.2 28



levalbuterol neb 1.25/0.5 102

levatol tab 20mg 50

levemir inj 42

levemir inj flexpen 42

levemir inj flextouc 42

levetiraceta inj 10mg/ml 16



levetiraceta sol 100mg/ml 16

levetiraceta sol 500/5ml 17

levetiraceta tab 1000mg 17






levetiracetm inj 500/5ml 17



levocarnitin inj 200mg/ml 106

levocarnitin sol 1gm/10ml 106

levocarnitin tab 330mg 106

levofloxacin sol 0.5% 96

levofloxacin tab 250mg 15



levonest tab 82

levonor/ethi tab 0.1-0.02 82

levonor/ethi tab estradio 82

levonorgestr tab 0.75mg 82

levonorgestrel tab 1.5 mg 82

levora-28 tab 0.15/30 82

levorphanol tab 2mg 2













levothyroxin inj 100mcg 85
























lexiva sus 50mg/ml 36

lexiva tab 700mg 36

lidazone cre 68

lido/prilocn cre 2.5-2.5% 68

lidocaine cre 3% 68

lidocaine gel 2% 68

lidocaine gel 2% jelly 68

lidocaine lot 3% 68

lidocaine oin 5% 68

lidocaine pad 5% 68

lidocaine sol 2% visc 61

lidocaine sol 4% 61

lidocaine/hc cre 3%-0.5% 68

lidocaine/hc kit 2-2% 68

lidocaine/hc kit 3%-1% 68

lidocaine/hc kit 3-2.5% 68

lido-hydro gel 2.8-0.55 68

lindane lot 1% 68

lindane sha 1% 68

linzess cap 145mcg 75

linzess cap 290mcg 75

liothyronine inj 10mcg/ml 86




lipodox 50 inj 2mg/ml 28

lipodox inj 2mg/ml 28

lipofen cap 150mg 57

lipofen cap 50mg 57



lisinop/hctz tab 20-25mg 48


lisinopril tab 2.5mg 46








lithium carb tab 300mg 40



lithium citr sol 8meq/5ml 40

livalo tab 1mg 57

livalo tab 2mg 58

livalo tab 4mg 58

l-methyl-mc tab 110

lo loestrin tab 82

locoid lot 0.1% 68

loestrin 24 tab fe 82

lofene tab 2.5mg 75

lokara lot 0.05% 68

lomedia 24 tab fe 82

lomustine cap 100mg 28



lonox tab 2.5mg 75

loperamide cap 2mg 75

loperamide liq 1mg/5ml 75

loperamide tab 2mg 75

loradamed tab 10mg 100

loratadine sol 5mg/5ml 100

loratadine syp 5mg/5ml 100

loratadine tab 10mg 100

lorazepam con 2mg/ml 39

lorazepam inj 2mg/ml 39

lorazepam inj 4mg/ml 39

lorazepam tab 0.5mg 39

lorazepam tab 1mg 39

137

lorazepam tab 2mg 39

lorcet hd tab 10-325mg 4

lorcet plus tab 7.5-325 4

lorcet tab 5-325mg 4



lortab tab 7.5-325 4

lorzone tab 375mg 105

losartan pot tab 100mg 45



losartan/hct tab 100-12.5 48

losartan/hct tab 100-25 48

losartan/hct tab 50-12.5 48

lotemax oin 0.5% 97

lotemax sus 0.5% 97

lotrimin ult cre 1% 68

lotronex tab 0.5mg 91

lotronex tab 1mg 75




low-ogestrel tab 82

loxapine cap 10mg 34



loxapine cap 5mg 34

lozi-flur loz 1mg f 107

ludent chw 0.5mg f 107

ludent chw 1mg f 107

lufyllin tab 200mg 103

lugols sol 107

lugols sol strong 68

lumigan sol 0.01% 95

lupr dep-ped inj 11.25mg 88

lupr dep-ped inj 15mg 88

lupr dep-ped inj 7.5mg 88

lupron depot inj 11.25mg 28



lupron depot inj 30mg 28

lupron depot inj 45mg 28

lutera tab 82

lyrica cap 100mg 17

lyrica cap 150mg 17

lyrica cap 200mg 17

lyrica cap 225mg 17

lyrica cap 25mg 17

lyrica cap 300mg 17

lyrica cap 50mg 17

lyrica cap 75mg 18

lyrica sol 20mg/ml 18

lysodren tab 500mg 28

lyza tab 0.35mg 82

M m.v.i pediat inj 111

m.v.i. adult inj 111

m.v.i-12 w/o inj vit k 111

macular vit tab benefit 111

mafenide ace pak 5% 68

magnesium gluconate tab 500 m

111

makena inj 250mg/ml 82

malathion lot 0.5% 68

mannitol inj 10% 54

mannitol inj 15% 54

mannitol inj 20% 54

mannitol inj 25% 54

mannitol inj 5% 54

maprotiline tab 25mg 23



margesic cap 1

marlissa tab 0.15/30 82

marplan tab 10mg 21

marten-tab tab 50-325mg 1

martinic cap 111

matulane cap 50mg 28

matzim la tab 180mg/24 52





maxair autoh aer 200mcg 102

meclizine tab 12.5mg 23

meclizine tab 25mg 23

meclofen sod cap 100mg 11

meclofen sod cap 50mg 11

med-derm hc cre 1% 68

medi-meclizi tab 25mg 23

medi-phedryl elx 12.5/5ml 100

medi-profen sus 100/5ml 11

mediwash irr sol op 95

medroxypr ac inj 150mg/ml 82


medroxypr ac tab 2.5mg 85


mefloquine tab 250mg 31

mefoxin inj 1gm/50ml 14

mega multivi tab men 111

mega multivi tab women 111

mega select tab mens 111

mega select tab womens 111

mega-c/a plu inj 500mg/ml 111

megavite tab frt/veg 111

megavite tab gold 55+ 111

megestrol ac sus 400mg/10 28

megestrol ac sus 40mg/ml 28



meloxicam sus 7.5/5ml 11

meloxicam tab 15mg 11

meloxicam tab 7.5mg 11

melpaque hp cre 4% 68

melquin 3 sol 3% 68

melquin hp cre 4% 68

menest tab 0.3mg 84

menest tab 0.625mg 84

menest tab 1.25mg 84

menest tab 2.5mg 84

mens multi tab vit/min 111

mentax cre 1% 68

me-pb-hyos tab 16.2mg 74





meperidine sol 50mg/5ml 2





mephyton tab 5mg 111

meprobamate tab 200mg 39

meprobamate tab 400mg 39

mercaptopur tab 50mg 28

mesalamine ene 4gm 91

mesna inj 1gm 29

mesnex tab 400mg 29

mestinon syp 60mg/5ml 25

mestinon tab timespan 25

metadate tab 20mg er 59

metafolbic tab 111

metaproteren syp 10mg/5ml 102

metaproteren tab 10mg 102

metaproteren tab 20mg 102

metaxalone tab 800mg 105

metformin er tab 1000mg 41



138




methadone con 10mg/ml 2

methadone inj 10mg/ml 2





methadone tab 5mg 2



methamphetam tab 5mg 59

methenam hip tab 1gm 12

methenam man tab 500mg 12



methitest tab 10mg 81

methocarbam tab 500mg 105

methocarbam tab 750mg 105


methotrexate inj 1gm 29

methotrexate inj 1gm/40ml 29



methotrexate inj 25mg/ml 29

methotrexate inj 50mg/2ml 29

methotrexate tab 2.5mg 29

methoxsalen cap 10mg 68

methscopolam tab 2.5mg 74

methscopolam tab 5mg 74

methyclothia tab 5mg 56



methyldopate inj 250/5ml 54

methylergon inj 0.2mg/ml 78

methylergon tab 0.2mg 78

methylphenid cap 10mg 59






methylphenid sol 10mg/5ml 60

methylphenid sol 5mg/5ml 60

methylphenid tab 10mg 60

methylphenid tab 10mg er 60




methylphenid tab 20mg sr 60





methylpred pak 4mg 80





metoclopram inj 10mg/2ml 75

metoclopram inj 5mg/ml 75

metoclopram sol 10/10ml 75

metoclopram sol 5mg/5ml 75




metolazone tab 2.5mg 56








metoprolol tab 100mg er 50




metronidazol cap 375mg 12

metronidazol cre 0.75% 68

metronidazol gel 0.75% 68

metronidazol gel 0.75%vag 79

metronidazol gel 1% 68

metronidazol lot 0.75% 68






miacalcin inj 200/ml 92

micaderm cre 2% 68

miconazole 3 kit combo pk 79

miconazole cre 2% 79

micro guard cre 2% 68

microgestin tab 1/20 82

microgestin tab 1.5/30 82

microgestin tab 1/20 82

microgestin tab fe 1/20 82

microgestin tab fe1.5/30 82

midazolam inj 2mg/2ml 105

midazolam inj 5mg/ml 105

midazolam syp 2mg/ml 105


midodrine tab 2.5mg 45


migragesic cap ida 25

migranal spr 4mg/ml 94

millipred dp pak 5mg 80

millipred tab 5mg 80

mimvey lo tab 0.5-0.1 84

mimvey tab 1-0.5mg 84

miniprin low tab 81mg ec 11





minivelle dis 0.0375mg 82








minocycline tab 135mg er 16





minoxidil tab 10mg 54

minoxidil tab 2.5mg 54

mi-omega nf cap 111

mirapex er tab 0.375mg 31





mirapex er tab 3mg 31


mirtazapine tab 15mg 20

mirtazapine tab 15mg odt 20





mirtazapine tab 7.5mg 20



mitomycin inj 20mg 29

139

mitoxantron inj 2mg/ml 29

mm aspirin tab 325mg 11

mobic sus 7.5/5ml 11

modafinil tab 100mg 106

modafinil tab 200mg 106

moderiba pak 1000/day 37




moderiba tab 200mg 37

moexipr/hctz tab 15-12.5 48

moexipr/hctz tab 15-25mg 48

moexipr/hctz tab 7.5-12.5 48

moexipril tab 15mg 46

moexipril tab 7.5mg 46

moist skin cre 12% 68

moist skin lot 12% 69

mometasone cre 0.1% 69

mometasone oin 0.1% 69

mometasone sol 0.1% 69

mono-linyah tab 0.25-35 83

mononessa tab 83



montelukast gra 4mg 101

montelukast tab 10mg 101

monurol pak granules 12



morphine sul inj 0.5mg/ml 2

morphine sul inj 10/0.7ml 2


morphine sul inj 150/30ml 2








morphine sul sol 100/5ml 2



morphine sul sol 20mg/ml 2

morphine sul sup 10mg 2






morrhuat sod inj 5% 55

motion relf tab 25mg 24

motion sick tab 25mg 24

motofen tab 75

moviprep sol 75

moxeza sol 0.5% 96

moxifloxacin tab 400mg 15

mozobil inj 29

mst 600 tab 11

mtest hs/est tab estrogen 84

mtest/est tab estrogen 84

mucinex allr tab 180mg 100

multaq tab 400mg 47

multi prenat tab 111

multi vitamn tab minerals 111

multi-betic tab 111

multi-betic tab diabetes 111





multivit/fl chw 1mg 111

multi-vit/fl chw 1mg 111

multi-vit/fl dro 0.25mg 111

multivital tab platinum 111

multi-vitami tab monocaps 111

mult-vit/fl chw 0.5mg 111

mupirocin ca cre 2% 69

mupirocin cre 2% 69

mupirocin oin 2% 69

muse sup 1000mcg 78

muse sup 125mcg 78

muse sup 250mcg 78

muse sup 500mcg 78

mustargen inj 10mg 29



mvc-fluoride chw 1mg 111

mycophenolat cap 250mg 90

mycophenolat tab 500mg 90

mycophenolic tab 180mg dr 90

mycophenolic tab 360mg dr 90

mydral sol 0.5% op 97

mydral sol 1% op 97

myferon 150 cap forte 111

myleran tab 2mg 29

myrbetriq tab 25mg 77

myzilra tab 83

N nabumetone tab 500mg 11

nabumetone tab 750mg 11

nac 600 cap 111

nac cap 600mg 111

n-acetyl-l- cap cysteine 111

nadolol tab 20mg 50

nadolol tab 40mg 50

nadolol tab 80mg 50



nafrinse chw 1mg f 107

naftin cre 2% 69



naltrexone tab 50mg 94

namenda sol 10mg/5ml 20

namenda tab 10mg 20

namenda tab 5-10mg 20

namenda tab 5mg 20

naphazoline sol 0.1% op 95

naprelan tab 500mg cr 11

naprelan tab 750mg cr 11





naproxen sus 125/5ml 11




naratriptan tab 1mg 25

naratriptan tab 2.5mg 25

nasal mist aer 0.9% 103

nasonex spr 50mcg/ac 102

natacyn sus 5% op 96



natroba sus 0.9% 69

natrul-mega tab 111

natrul-vites tab 111

natura-lax pow 3350 nf 75

nature-throi tab 130mg 86

nature-throi tab 16.25mg 86


nature-throi tab 32.5mg 86


nava-sc cre 4% 69

nebupent inh 300mg 12

nebusal neb 3% 104

necon tab 0.5/35 83

necon tab 1/35 83

140

necon tab 7/7/7 83






neo/bac/poly oin op 96

neo/poly gu sol 40/ml ir 106

neo/poly/bac oin /hc 1%op 97

neo/poly/dex oin 0.1% op 97

neo/poly/dex sus 0.1% op 97

neo/poly/gra sol op 96

neo/poly/hc sol 1% otic 98

neo/poly/hc sus 1% otic 98

neo/poly/hc sus op 97

neomycin tab 500mg 12

neo-polycin oin hc 1%op 97

neo-polycin oin op 96

neosporin af cre 2% jock 69

neosporin cre eczema 69

neulasta inj 6mg/0.6m 44

neumega inj 5mg 44

neupogen inj 300/0.5 44

neupogen inj 300mcg 44

neupogen inj 480/0.8 44

neupro dis 1mg/24hr 31






neutragard gel 1.1% 61

nevanac sus 0.1% 97

nevirapine sus 50mg/5ml 38

nevirapine tab 200mg 38

nevirapine tab 400mg er 38

nexavar tab 200mg 29

nexium 24hr cap 20mg 77

nexium 24hr cap 20mg 77

next choice tab 0.75mg 83




niacin tab 500mg 111

niacin tab 500mg er 58

niacin tr tab 1000mg 111

niacor tab 500mg 58

nicadan tab 111



nicazel tab 111

nicazel tab forte 111

nicorelief gum 2mg mint 7

nicorelief gum 2mg orig 7

nicorelief gum 4mg mint 7

nicorelief gum 4mg orig 7

nicorelief loz 2mg mint 7

nicorelief loz 4mg mint 7

nicotine dis 14mg/24h 7

nicotine dis 21mg/24h 7

nicotine dis 7mg/24hr 7

nicotine dis step 1 7



nicotine gum 2mgfruit 7

nicotine gum 4mg 7

nicotine loz 2mg chry 7

nicotine loz 2mg mint 7

nicotine loz 4mg chry 7

nicotine loz 4mg cinn 7

nicotine loz 4mg mint 7

nicotine pol gum 2mg 7

nicotine pol gum 2mg cinn 7

nicotine pol gum 2mg mint 7

nicotine pol gum 2mg orig 7

nicotine pol gum 2mg ref 7

nicotine pol gum 2mg strt 7

nicotine pol gum 2mgfruit 7

nicotine pol gum 4mg 7

nicotine pol gum 4mg cinn 7

nicotine pol gum 4mg mint 7

nicotine pol gum 4mg orig 7

nicotine pol gum 4mg ref 7

nicotine pol gum 4mg strt 8

nicotine pol gum 4mgfruit 8

nicotine pol loz 2mg chry 8

nicotine pol loz 2mg cinn 8

nicotine pol loz 2mg mint 8

nicotine pol loz 4mg chry 8

nicotine pol loz 4mg cinn 8

nicotine pol loz 4mg mint 8

nicotine td dis 14mg/24h 8

nicotine td dis 21mg/24h 8

nicotine td dis 7mg/24hr 8

nicotrol inh 8

nicotrol ns spr 10mg/ml 8

nifediac cc tab 30mg er 52



nifedical xl tab 30mg 52

nifedical xl tab 60mg 52



nifedipine tab 30mg er 52



nimodipine cap 30mg 52

nipent inj 10mg 29


nisoldipine tab 20mg 52

nisoldipine tab 25.5mg 52




nisoldipine tab 8.5mg er 52

nitro-bid oin 2% 55

nitro-dur dis 0.3mg/hr 55

nitro-dur dis 0.8mg/hr 55



nitrofurantn sus 25mg/5ml 13

nitroglycer aer 400mcg 55



nitroglycer cap 9mg er 55





nitroglycer inj 5mg/ml 55

nitroglyceri dis 0.6mg/hr 55

nitroglycrn spr 0.4mg 55

nitroglycrn spr lingual 55

nitromist aer 400mcg 55

nitrostat sub 0.3mg 55





nitro-time cap 9mg cr 55



nizatidine sol 15mg/ml 76

noble formul cre hc 1% 69

nodolor cap 25

nora-be tab 0.35mg 83

norditropin inj 10/1.5ml 88


norditropin inj 30/3ml 88


141

norepinephr inj 1mg/ml 45

noreth/ethin tab 1/20 83

noreth/ethin tab fe 1/20 83

norethin ace tab 5mg 85

norethindron tab 0.35mg 83

norgest/ethi tab 0.25/35 83

norgest/ethi tab estradio 83

norlyroc tab 0.35mg 83

normal salin inj 0.9% 112

norml saline inj flush 112

norml saline inj iv flush 112

noroxin tab 400mg 15

norpace cap 100mg cr 47

nortrel tab 0.5/35 83

nortrel tab 1/35 83

nortrel tab 7/7/7 83





nortriptylin sol 10mg/5ml 23

norvir cap 100mg 36

norvir sol 80mg/ml 36

norvir tab 100mg 36

norwich asa tab 325mg 11

novarel inj 10000unt 88

novolin inj 70/30 42

novolin n inj relion 42

novolin n inj u-100 42

novolin r inj relion 42

novolin r inj u-100 42

novolin70/30 inj relion 42

novolog inj 100/ml 42

novolog inj flexpen 42

novolog inj penfill 42

novolog mix inj 70/30 42

novolog mix inj flexpen 42

nucynta er tab 100mg 3





nuedexta cap 20-10mg 60

nufol tab 112

nulev tab 0.125mg 74

nuquin hp cre 4% 69

nuquin hp gel 4% 69

nutricap tab 112

nutrient 45+ tab women 112

nutrient 50+ tab men 112

nutrients tab men 112

nutrients tab teens 112

nutrients tab women 112

nutropin aq inj 10mg/2ml 88

nutropin aq inj 20mg/2ml 88

nutropin aq inj nuspin 5 88

nutropin inj 10mg 89

nuvigil tab 150mg 106

nyamyc pow 100000 69

nystat/triam cre 69

nystat/triam oin 69

nystatin cre 100000 69

nystatin oin 100000 69

nystatin pow 100000 69

nystatin sus 100000 61

nystatin tab 500000 24

nystop pow 100000 69

O octreotide inj 1000mcg 89

octreotide inj 100mcg 89



octreotide inj 50mcg/ml 89

ocudox kit 16

ocusoft eye sol wash 95

ocusoft ii sol irrigati 95

ofloxacin dro 0.3% op 96

ofloxacin dro 0.3%otic 98









olanzapine inj 10mg 34

olanzapine tab 10mg 34

olanzapine tab 10mg odt 34



olanzapine tab 2.5mg 34





olanzapine tab 7.5mg 34

omega-3-acid cap 1gm 58

omepra/bicar cap 20-1100 77

omepra/bicar cap 40-1100 75

omeprazole cap 10mg 77



omnitrope inj 10/1.5ml 89

omnitrope inj 5.8mg 89

omnitrope inj 5/1.5ml 89

omontys inj 10mg/ml 44

oncaspar inj 750/ml 29

oncovite tab 112

ondansetron inj 40/20ml 24

ondansetron sol 4mg/5ml 24

ondansetron tab 24mg 24


ondansetron tab 4mg odt 24


ondansetron tab 8mg odt 24

one daily mn tab w/o iron 112

one daily tab diet sup 112

one daily tab mens 112

one daily tab mens 50+ 112

one daily tab womans 112

one-a-day tab 50+ adv 112

one-a-day tab energy 112

one-a-day tab menopaus 112

one-a-day tab mens 112

one-a-day tab proedge 112

one-a-day tab teen/him 112

onglyza tab 2.5mg 41

onglyza tab 5mg 41

opana er tab 10mg 4

opana er tab 15mg 4

opana er tab 20mg 4

opana er tab 30mg 4

opana er tab 40mg 4

opana er tab 5mg 4

opana er tab 7.5mg 4

opium tinct tin 2mg/5ml 75

optics eye sol 95

optimal-d cap 50000unt 112

opti-woman tab 112

opurity tab 112

oracea cap 40mg 69

oracit sol 107

oralone pst 0.1% 61

orap tab 1mg 32

orap tab 2mg 32

orapred odt tab 10mg 80

oravig tab 50mg 61

orazinc cap 220mg 112

orfadin cap 10mg 106

142

orfadin cap 2mg 106

orfadin cap 5mg 106

ormir cap 50mg 100

orph/asa/caf tab 1

orphenadrine inj 30mg/ml 105

orphenadrine tab 100mg er 105

orsythia tab 83

ortho flat dpr kit 55 94









ortho flex dpr 65mm 94




ortho-cs 250 inj 250mg/ml 112

ortho-est tab 0.625 84

ortho-est tab 1.25 84

oscimin sr tab 0.375mg 74

oscimin sub 0.125mg 74

oscimin tab 0.125mg 74

oscion clnsr lot 6% 69

osmitrol inj 10% 55

osmitrol inj 15% 55

osmitrol inj 5% 55

osmitrol vfx inj 20% 55

osmoprep tab 1.5gm 75

ovace plus cre 10% 69

oxaliplatin inj 50mg 29

oxaprozin tab 600mg 11

oxazepam cap 10mg 39



oxcarbazepin sus 300mg/5m 19




oxecta tab 5mg 3

oxistat cre 1% 69

oxsoralen lot 1% 69

oxybutynin syp 5mg/5ml 77



oxybutynin tab 5mg 77


oxycod/apap cap 5-500mg 4







oxycod/asa tab 4

oxycod/ibu tab 5-400mg 4

oxycodone cap 5mg 3

oxycodone con 100/5ml 3

oxycodone con 20mg/ml 3

oxycodone sol 5mg/5ml 3





oxycodone tab 5mg 3

oxymorphone tab 10mg er 4






oxymorphone tab 7.5mg er 5

oxytocin inj 10unt/ml 78

oxytrol dis 3.9mg/24 77

oxytrol/womn dis 3.9mg/24 77

ozurdex imp 0.7mg 97

P pa vitamin cap 2000unit 112




paclitaxel inj 100mg 29


pamidronate inj 6mg/ml 92


panoxyl-4 liq crem wsh 69

panoxyl-8 liq crem wsh 69

pantoprazole inj 40mg 77

pantoprazole tab 20mg 77

pantoprazole tab 40mg 77

papaverine inj 30mg/ml 103

papaverine sol 30mg/ml 103

parcaine sol 0.5% op 96

paricalcitol cap 1 mcg 106



paroex sol 0.12% 61





paroxetine tab 25mg er 22



parvlex tab 112

pataday sol 0.2% 96

patanase spr 0.6% 102

patanol sol 0.1% op 96

paxil sus 10mg/5ml 22

pce tab 500mg ec 15

pe/guaifenes dro 1.5-20mg 104

pedia d-vite dro 400unit 112

pedia iron dro 15mg/ml 112

pediaderm hc kit 69

pediaderm ta kit 69

pedi-dri pow 100000 69

pedipirox-4 kit nail 69

peg 3350 pow 75

peg 3350 sol electrol 75

peg-3350 sol electrol 75

peg-3350/kcl sol /sodium 75

peganone tab 250mg 19

pegasys inj 180mcg/m 37

pegasys inj proclick 37

pegasys kit 37

peg-intron kit 120 rp 37

peg-intron kit 120mcg 37

peg-intron kit 150 rp 37



peg-intron kit 50mcg rp 37


peg-intron kit 80mcg rp 37

pegylax pow 75





penta/apap tab 25-650mg 5

pentam 300 inj 300mg 13

pentasa cap 250mg cr 91

pentasa cap 500mg cr 91

pentaz/nalox tab 50-0.5mg 5

pentoxifylli tab 400mg er 55

perforomist neb 20mcg 102



143


perio med con 0.63% 61

periogard sol 0.12% 61

permethrin cre 5% 69

perphen/amit tab 2-10mg 32









persa-gel gel 10% 69

persa-gel xs gel 5% 69

pharbedryl cap 50mg 100

phenadoz sup 12.5mg 100

phenadoz sup 25mg 100

phenazo tab 200mg 107



phendimetraz cap 105mg er 94

phendimetraz tab 35mg 94

phenelzine tab 15mg 21

phenobarb elx 20mg/5ml 17

phenobarb inj 130mg/ml 17

phenobarb inj 65mg/ml 17

phenobarb sol 20mg/5ml 17







phentermine cap 37.5mg 94

phentermine tab 37.5mg 94

phenytoin chw 50mg 19




phenytoin inj 50mg/ml 19

phenytoin sus 125/5ml 19

phisohex liq 3% 69

phos-flur gel 1.1% 61

phoslyra sol 79

phospha 250 tab neutral 112

phosphasal tab 77

phospholine sol 0.125%op 96

physiolyte sol 94

physiosol sol irrigat 94

physos salic inj 1mg/ml 69

phytonadione inj 1mg/0.5 112




pilocarpine tab 5mg 61

pilocarpine tab 7.5mg 61

pilopine hs gel 4% op 96

pindolol tab 10mg 50

pindolol tab 5mg 50





pioglitazone tab 15mg 41



pirmella tab 1/35 83

pirmella tab 7/7/7 83



pnv fe fum tab doc/fa 112

podactin cre 2% 69

podocon sol 25% 69

podofilox sol 0.5% 69

polycin b oin op 96

polycin oin op 96

poly-dex oin 0.1% op 97

polyeth glyc pow 3350 nf 75

polyeth glyc pow 3350-grx 75

poly-iron cap 150 fort 112

polymyxin b/ sol trimethp 96

polysacchari cap iron 112

pomalyst cap 1mg 29

pomalyst cap 2mg 29

pomalyst cap 3mg 29

pomalyst cap 4mg 29

portia-28 tab 83

pot bicarbon tab 25meq ef 112




pot chloride liq 10% sf 112


pot chloride pow 20meq 112

pot chloride sol 10% sf 112

pot chloride tab 10meq cr 112


pot chloride tab 25meq ef 113


pot chloride tab 8meq sr 113

pot citrate tab 1080mg 107



pot cl micro tab 10meq cr 113



pot/chloride tab 25meq ef 113

potaba cap 500mg 113

potaba tab 500mg 113

potassium tab 25meq ef 113

potiga tab 200mg 17

potiga tab 300mg 17

potiga tab 400mg 17

potiga tab 50mg 17

powderlax pow 75

pr benzoyl liq 7% wash 69

pradaxa cap 150mg 44

pradaxa cap 75mg 44

pralidoxime inj 600/2ml 69

pramcort cre 1-1% 69

pramegel gel 1% 69






pramipexole tab 1mg 32

pramosone e cre 1-2.5% 69

pramosone lot 1% 70

pramosone lot 2.5% 70

pramosone oin 1% 70

pramosone oin 2.5% 70

pramox gel 1% 70

prandimet tab 1-500mg 41

prandimet tab 2-500mg 41








precisn xtra tes ketone 94

pred mild sus 0.12% op 98

pred sod pho sol 1% op 98

pred sod pho sol 5mg/5ml 80

prednicarbat cre 0.1% 70

prednicarbat oin 0.1% 70


144


prednisolone sus 1% op 98

prednisolone syp 15mg/5ml 80

prednisone con 5mg/ml 80



prednisone sol 5mg/5ml 80



prednisone tab 2.5mg 80




pregnyl inj 10000unt 89

premarin tab 0.3mg 84





premphase tab 85

prempro tab .625-2.5 85

prempro tab 0.3-1.5 85

prempro tab 0.45-1.5 85

prempro tab 0.625-5 85

prenatal 19 tab 113

prenatal 19 tab 29-1mg 113

prenatal one tab daily 113

prenatal tab 27-0.8mg 113

prenatal tab low iron 113

prep h hc cre 1% 70

prepopik pak 75

prevacid tab 15mg stb 77

prevacid tab 30mg stb 77

prevalite pow 4gm 58

previfem tab 83

prezista sus 100mg/ml 36

prezista tab 150mg 36





prialt inj 100mcg 1

prialt inj 25mcg/ml 1

primaquine tab 26.3mg 31



primsol sol 50mg/5ml 13

pristiq tab 100mg 22

pristiq tab 50mg 22

proair hfa aer 102

proben/colch tab 500-0.5 24

probenecid tab 500mg 24

procainamide inj 100mg/ml 47

procainamide inj 500mg/ml 47

pro-cal tab 113

procerv hp tab 113

prochlorper inj 10mg/2ml 33

prochlorper inj 5mg/ml 33

prochlorper sup 25mg 33



procrit inj 10000/ml 44






proctocream cre hc 2.5% 70

proctofoam aer hc 1% 70

proctosol hc cre 2.5% 70

proctozone cre -hc 2.5% 70

proglycem sus 50mg/ml 42

prograf inj 5mg/ml 90

proleukin inj 22mu 29

prolia sol 60mg/ml 92

promacet tab 50-650mg 1

prometh vc syp 6.25-5/5 104

prometh vc/ syp codeine 104

prometh/cod syp 6.25-10 104

promethazine inj 25mg/ml 100

promethazine inj 50mg/ml 100

promethazine sol 6.25/5ml 100

promethazine sup 12.5mg 100

promethazine sup 25mg 100

promethazine syp 6.25/5ml 100

promethazine syp dm 104

promethazine tab 12.5mg 100

promethazine tab 25mg 100

promethazine tab 50mg 100

promethegan sup 12.5mg 101

promethegan sup 25mg 101

promethegan sup 50mg 101



propafenone cap 425mg sr 47




propanthelin tab 15mg 74

proparacaine sol 0.5% op 96

propran/hctz tab 40/25 49

propran/hctz tab 80/25 49





propranolol inj 1mg/ml 50

propranolol sol 20mg/5ml 50

propranolol sol 40mg/5ml 50






propylthiour tab 50mg 89

protamine su sol 10mg/ml 55

protopic oin 0.03% 70

protopic oin 0.1% 70

proventil aer hfa 102

prudoxin cre 5% 70

pulmicort inh 180mcg 99

pulmicort inh 90mcg 99

pulmicort sus 1mg/2ml 99

pulmosal neb 7% 104

pulmozyme sol 1mg/ml 104

px aspirin chw 81mg 11

px aspirin tab 325mg 11

px aspirin tab 325mg ec 11

px aspirin tab 81mg ec 11

px profen ib sus 100/5ml 11

pyrazinamide tab 500mg 25

pyridostigm tab 60mg 25

pyridoxine inj 100mg/ml 113

pyrogall acd oin 70

Q qc alcohol pad swabs 94

qc allergy tab 10mg 101

qc aspirin tab 325mg 11

qc aspirin tab 325mg ec 11

qc child asa chw 81mg 11

qc hydrocort cre 1% 70

qc iodides tin 70

qc iodine tin 70



qnapril/hctz tab 20-25mg 49

qnasl aer 80mcg 102

quenalin syp 12.5/5ml 101

quench tab 113

quetiapine tab 100mg 34

145






quflora ped dro 0.25mg 113

quillivant sus xr 60

quin b tab strong 113





quinidine gl inj 80mg/ml 47

quinidine gl tab 324mg cr 47

quinidine gl tab 324mg er 47



quinidine su tab 300mg er 47

quinine sulf cap 324mg 31

quintabs-m tab 113

qvar aer 40mcg 99

qvar aer 80mcg 99

R ra alcohol pad swabs 94

ra anti-itch cre 1% 70

ra anti-itch oin 1% 70

ra aspirin chw 81mg 11

ra aspirin tab 325mg 11

ra aspirin tab 325mg ec 11

ra aspirin tab 81mg ec 11

ra cetirizin tab 10mg 101

ra child asa chw 81mg 11

ra eye wash sol op 96

ra first aid tin iodine 70

ra hydrocort cre 1% 70

ra hydrocort cre 1%pls 12 70

ra iron tab 325mg 113

ra iron tab 65mg 113

ra laxative pow 75

ra niacin tab 500mg 113

ra nicotine dis 14mg/24h 8

ra nicotine dis 21mg/24h 8

ra nicotine dis 7mg/24hr 8

ra nicotine gum 2mg 8

ra nicotine gum 2mg cinn 8

ra nicotine gum 2mg mint 8

ra nicotine gum 2mgfruit 8

ra nicotine gum 4mg 8

ra nicotine gum 4mg frut 8

ra nicotine gum 4mg mint 8

ra nicotine loz 2mg mint 8

ra nicotine loz 4mg mint 8

ra renewal gel 10% 70

ra vitamin cap 2000unit 113

raloxifene tab 60mg 92


ramipril cap 10mg 46


ramipril cap 5mg 46

ranexa tab 1000mg 55

ranexa tab 500mg 55



ranitidine inj 150/6ml 76

ranitidine syp 150/10ml 76

ranitidine syp 15mg/ml 76

ranitidine syp 75mg/5ml 76



rapaflo cap 4mg 78

rapaflo cap 8mg 78

rapamune sol 1mg/ml 90

rapamune tab 1mg 90

rapamune tab 2mg 90

rayos tab 1mg 80

reality swab pad 94

rebetol sol 40mg/ml 37

rebif inj 22/0.5 61

rebif inj 44/0.5 61

rebif rebido inj 22/0.5 61

rebif rebido inj 44/0.5 61

rebif rebido sol titratn 61

rebif titrtn sol pack 61

reclipsen tab 83

recort plus cre 1% 70

rectacort-hc sup 25mg 70

rectiv oin 0.4% 70

rederm lot 1% 70

refissa cre 0.05% 70

regenecare gel ha 2% 70

regonol inj 5mg/ml 25

regranex gel 0.01% 70

relagesic tab 50-650mg 1

relenza mis diskhale 36

relion r inj 100/ml 42

relion r inj 100u/ml 42

relpax tab 20mg 25

relpax tab 40mg 25

remedy cre antifung 70

remergent hq cre 4% 70

remeven cre 50% 70

remodulin inj 10mg/ml 103


remodulin inj 2.5mg/ml 103


renagel tab 400mg 79

renagel tab 800mg 79

renaplex-d tab 113

renova cre 0.02% 70

renova pump cre 0.02% 70

renvela pak 0.8gm 79

renvela pak 2.4gm 79

renvela tab 800mg 79

repaglinide tab 0.5mg 41



repan tab 1

replesta nx waf 14000unt 113

replesta waf 14000unt 113

replesta waf 50000unt 113

reprexain tab 10-200mg 5

req 49+ tab 113

rescon-jr tab 104

rescriptor tab 100 mg 38

rescriptor tab 200mg 38

reserpine tab 0.1mg 55

reserpine tab 0.25mg 55

respa-br tab 11mg 55

retisert imp 0.59mg 96

revatio inj 103

revina oin 70

revlimid cap 10mg 26


revlimid cap 2.5mg 26


revlimid cap 5mg 26

reyataz cap 100mg 36




rezira sol 60-5/5ml 104

rheumatrex tab 2.5mg 90

rhinoflex tab 50-650mg 1

ribapak pak 1000/day 37




ribasphere cap 200mg 37

ribasphere tab 200mg 37


146


ribatab pak 1000/day 37

ribatab tab 1200/day 37

ribatab tab 800/day 37

ribavirin cap 200mg 37

ribavirin tab 200mg 37

ridaura cap 3mg 90

rifabutin cap 150mg 25

rifamate cap 25



rifampin inj 600 mg 25

rifater tab 26

right step tab prenatal 113

riluzole tab 50mg 60

rimantadine tab 100mg 36

ringers irr sol 94

ringworm cre 1% 70

riomet sol 41

risedronate tab 150mg 92

risperidone sol 1mg/ml 34

risperidone tab 0.25 odt 34



risperidone tab 0.5mg od 34









rituxan inj 100mg 29

rituxan inj 500mg 29









romycin oin op 96













rosadan cre 0.75% 70

rosadan gel 0.75% 70

roxicet tab 5-325mg 5

rozerem tab 8mg 105

rybix odt tab 50mg 5

S sabril pow 500mg 18

safyral tab 83

saizen inj 5mg 89

saizen inj 8.8mg 89

salacyn cre 6% 70

salacyn lot 6% 70

salicylic ac cre 6% 70

salicylic ac gel 6% 70

salicylic ac liq 26% 70

salicylic ac liq 27.5% 71

salicylic ac lot 6% 71

salicylic ac sha 6% 71

salicylic aer 6% 71

saline flush inj 0.9% 113

saline flush inj zr 0.9% 113



samsca tab 15mg 106

samsca tab 30mg 106

sancuso dis 3.1mg 24

sandimmune sol 100mg/ml 90

sandostatin kit lar 10mg 89



santyl oin 250u/gm 71

santyl oin 250/gm 71

saphris sub 10mg 35

saphris sub 5mg 35

saps care pad alcohol 94

sarnol-hc lot 1% 71

savella tab 100mg 60

savella tab 12.5mg 60

savella tab 25mg 60

savella tab 50mg 60

sb alcohol pad prep 94

sb allergy tab 10mg 101

sb aspirin tab 325mg 12

sb aspirin tab 325mg ec 12

sb child asa chw 81mg 12

sb hydrocort cre 1% 71

sb hydrocort oin 1% 71

scalacort lot 2% 71

scleromate inj 5% 55

se bpo 7-5.5 kit wash kit 71

se bpo wash liq 7% 71

seb-prev liq wash 71

selegiline cap 5mg 31

selegiline tab 5mg 31

selenium sul lot 2.5% 71



selzentry tab 150mg 36

selzentry tab 300mg 36

se-natal 19 tab 113

sensipar tab 30mg 106



sentry tab 113

serevent dis aer 50mcg 102

seroquel xr tab 150mg 35





serostim inj 4mg 89

serostim inj 5mg 89

serostim inj 6mg 89

sertraline con 20mg/ml 22




sevelamer tab 800mg 79

sf 5000 plus cre 1.1% 61

sf gel 1.1% 61

siderol tab 113

sildenafil tab 20mg 103

silenor tab 3mg 23

silenor tab 6mg 23

silphen coug syp 12.5/5ml 101

silver nitra oin 10% 71

silver nitra sol 0.5% 71

silver nitra sol 10% 71



simcor tab 1000-20 58

simcor tab 1000-40 58

simcor tab 500-20mg 58


147


simply salin aer baby 104

simulect inj 20mg 90






sirolimus tab 0.5mg 90

skin bleach cre 4% 71

skin bleach cre sunscree 71

skin trtment lot 12% 71

sklice lot 0.5% 71

sm acid redu tab 200mg 77

sm alcohol pad prep 94

sm all day tab allergy 101

sm anti-diar tab 2mg 75



sm antifungl sol 1% 71

sm aspirin chw 81mg 12

sm aspirin tab 325mg 12

sm aspirin tab 325mg ec 12

sm aspirin tab 81mg ec 12

sm child asa chw 81mg 12

sm clearlax pow 75

sm eye wash sol op 96

sm folic acd tab 400mcg 113

sm hydrocort cre 1% 71

sm hydrocort oin 1% 71

sm iodides tin 71

sm iodine tin mild 71

sm iron tab 325mg 113

sm nicotine dis 14mg/24h 8

sm nicotine dis 21mg 8

sm nicotine dis 7mg/24hr 8

sm nicotine gum 2mg 8

sm nicotine gum 2mg mint 8

sm nicotine gum 4mg 8

sm nicotine gum 4mg mint 8

sm nicotine loz 2mg mint 8

sm nicotine loz 4mg mint 8

sm one daily tab mens 113

sm one daily tab womens 113

sm vitamin d tab 400unit 113

smooth lax pow 75

smz/tmp ds tab 800-160 13

smz-tmp inj 400-80/5 13

smz-tmp sus 13

smz-tmp sus 200-40/5 13

smz-tmp tab 400-80mg 13

sod chloride inj 0.9% 113

sod chloride neb 0.9% 104

sod edecrin inj 50mg 56

sod fluoride chw 0.5mg f 107


sod fluoride chw 1mg f 107


sod fluoride dro 0.5mg/ml 107

sod fluoride sol 0.2% 61

sod fluoride sol 0.2%mint 61

sod nitrite inj 30mg/ml 71

sod poly sul sus 15gm/60 79

sod sul/sulf lot 10-5% 71

sod sulfacet pad 10% 71

sod sulfacet sha 10% 71

sod sulfacet sol 10% op 96






sodium chlor sol 0.9% irr 107

sodium sulfa liq 10% wash 71

solia tab 83

soliris inj 10mg/ml 55

solo tab 113

solodyn tab 55mg 16

soltamox sol 10mg/5ml 29

solu-cortef inj 1000mg 80

somatuline inj 120/.5ml 89

somatuline inj 60/0.2ml 89

somatuline inj 90/0.3ml 89

somavert inj 10mg 89



soothe&cool cre inzo 2% 71

sorbitol sol 3% irr 107

sorbitol sol 3.3% irr 107

sorbitol-man sol 107

sorine tab 120mg 50

sorine tab 160mg 50

sorine tab 240mg 50

sorine tab 80mg 50

sotalol hcl inj 150/10ml 50





spectravite tab adlt 50+ 113

spectravite tab cardio 113

spectravite tab energy 114

spectravite tab men 50+ 114

spectravite tab senior 114

spectravite tab ult men 114

spectravite tab ult wmn 114

spinosad sus 0.9% 71

spirono/hctz tab 25/25 57




sprintec 28 tab 28 day 83

sprix spr 15.75mg 12

sprycel tab 100mg 29

sprycel tab 140mg 29

sprycel tab 20mg 29

sprycel tab 50mg 29

sprycel tab 70mg 29

sprycel tab 80mg 29

sr nicotine gum 2mg 8

sronyx tab 83

st joseph as chw 81mg 12

stagesic cap 5-500mg 5

stan fluorid con 0.63% 61

stavudine cap 15mg 36




stavudine sol 1mg/ml 36

stavzor cap 125mg 18

stelara inj 45mg/0.5 71

stelara inj 90mg/ml 71

steril water sol irrig 94

stimate sol 1.5mg/ml 85

stivarga tab 40mg 29

stop smoking gum 2mg mint 8

stop smoking gum 2mg orig 8

stop smoking gum 4mg 8

stop smoking loz 2mg 8

stop smoking loz 2mg mint 8

stop smoking loz 4mg mint 8

strattera cap 100mg 60







stribild tab 38

strovite one tab 114

148

suboxone mis 12-3mg 5

suboxone mis 2-0.5mg 5



subsys spr 100mcg 3

sucraid sol 8500/ml 75

sucralfate tab 1gm 76

sulf/pred na sol op 98

sulfacet sod oin 10% op 97

sulfacet sod sol 10% op 97

sulfacetamid lot 10% 71

sulfacetamid sus 10% 71

sulfadiazine tab 500mg 16

sulfamylon cre 85mg/gm 71

sulfasalazin tab 500mg 91

sulfasalazin tab 500mg dr 91

sulfatrim pd sus 200-40/5 13

sulfazine ec tab 500mg 91

sulfazine tab 500mg 91



sumatriptan inj 4mg/0.5 25

sumatriptan inj 6mg/0.5 25

sumatriptan spr 20mg/act 25

sumatriptan spr 5mg/act 25

sumatriptan tab 100mg 25



sumavel dose inj 6mg/0.5 25

superb nails tab 114

suprax sus 500/5ml 14

suprep bowel sol prep 76

sustiva cap 200mg 38

sustiva cap 50mg 38

sustiva tab 600mg 38

sutent cap 12.5mg 29

sutent cap 25mg 29

sutent cap 50mg 29

sw clearlax pow 76

sw nicotine gum 2mg mint 8

sw nicotine gum 4mg 8

sw nicotine loz 2mg mint 8

sw nicotine loz 4mg mint 8

swabflush inj 0.9% 114

sylatron kit 296mcg 29



symax fastab tab 0.125mg 74

symax-sl sub 0.125mg 74

symax-sr tab 0.375mg 74

symbicort aer 160-4.5 102

symbicort aer 80-4.5 102

symlinpen 60 inj 1000mcg 41

symlnpen 120 inj 1000mcg 42

synagis inj 100mg/ml 90

synera dis 70-70mg 72

synribo inj 3.5mg 29

synthroid tab 100mcg 86






synthroid tab 200mcg 86, 87






syprine cap 250mg 94

T tabloid tab 40mg 29

taclonex sus 72

tacrolimus cap 0.5mg 90



talwin inj 30mg/ml 5

tamiflu cap 30mg 36

tamiflu cap 45mg 36

tamiflu cap 75mg 36

tamiflu sus 6mg/ml 36



tamsulosin cap 0.4mg 78

tandem f cap 114

tarceva tab 100mg 29

tarceva tab 150mg 30

tarceva tab 25mg 30

targretin cap 75mg 30

tarka tab 1-240 cr 49




taron-prex cap 114

tasigna cap 150mg 30

tasigna cap 200mg 30

tasmar tab 100mg 31

taxotere inj 20mg/ml 30

tazorac cre 0.05% 72

tazorac cre 0.1% 72

tazorac gel 0.05% 72

tazorac gel 0.1% 72

taztia xt cap 120mg/24 52





tegretol-xr tab 100mg 19

tekamlo tab 150-10mg 49




tekturna hct tab 150-12.5 49

tekturna hct tab 150-25mg 49

tekturna hct tab 300-12.5 49

tekturna hct tab 300-25mg 49

tekturna tab 150mg 55

tekturna tab 300mg 55



telmisa/hctz tab 80-25mg 49




temazepam cap 15mg 105

temazepam cap 22.5mg 105

temazepam cap 30mg 105

temazepam cap 7.5mg 105



tender 1 kit 31" 94

tender 1 kit 43" 94

tender 1 kit infusion 94

tender 2 kit 31" 94

terazosin cap 10mg 55




terbinafine tab 250mg 24

terbinex kit 24

terbutaline inj 1mg/ml 102

terbutaline tab 2.5mg 102

terbutaline tab 5mg 102



terconazole sup 80mg 79

testost cyp inj 100mg/ml 81

testost cyp inj 200mg/ml 81

tetcaine sol 0.5% op 96

tetracaine sol 0.5% op 96

149

tetracycline cap 250mg 16

tetracycline cap 500mg 16

tetravisc sol 0.5% op 96

tetravisc sol forte 96

tev-tropin inj 5mg 89

texacort sol 2.5% 72

tgq 15dm/5pe syp h/2cpm 104

tgq 30/ syp 150/15 104

tgt aspirin chw 81mg 12

tgt aspirin chw child 12

tgt aspirin tab 325mg 12

tgt aspirin tab 81mg ec 12

tgt nicotine dis 14mg/24h 8

tgt nicotine dis 21mg/24h 9

tgt nicotine dis 7mg/24hr 9

tgt nicotine gum 2mg mint 9

tgt nicotine gum 2mg orig 9

tgt nicotine gum 2mgfruit 9

tgt nicotine gum 4mg 9

tgt nicotine gum 4mg mint 9

tgt nicotine gum 4mg orig 9

tgt nicotine loz 2mg chry 9

tgt nicotine loz 2mg mint 9

tgt nicotine loz 4mg chry 9

tgt nicotine loz 4mg mint 9

th aspirin tab 325mg 12

th aspirin tab 325mg ec 12

th aspirin tab 81mg ec 12

th hydrocort cre 1% 72

th iron tab 65mg 114

thalomid cap 100mg 26




theo-24 cap 100mg cr 104




theophylline sol 80/15ml 104









thera m plus tab 114

therabetic tab multivit 114

theracort lot 1% 72



theragran-m tab 114

theragran-m tab 50 plus 114

theragran-m tab advanced 114

theragran-m tab premier 114

thera-m tab 114

thera-tabs m tab 114

therems-h tab 114

therems-m tab 114

thiamine hcl inj 100mg/ml 114





thrive gum 2mg mint 9

thrive gum 4mg mint 9

thrombat iii inj 500unit 55

thymoglobuln inj 25mg 90

thyrogen inj 1.1mg 94

thyrolar-1 tab 60mg 87

thyrolar-1/2 tab 30mg 87

thyrolar-1/4 tab 15mg 87



tiagabine tab 2mg 18

tiagabine tab 4mg 18

ticlopidine tab 250mg 45

tigan inj 100mg/ml 24





timolol mal tab 10mg 51





tis-u-sol sol 94

tizanidine cap 2mg 105



tizanidine tab 2mg 105

tizanidine tab 4mg 105

tl gard rx tab 114

tl hydroquin cre 4% 72

tl icon cap 114

tl urea lot 45% 72

tl-dmx syp 5-200mg 104

tobra/dexame sus 0.3-0.1% 98

tobradex oin 0.3-0.1% 98

tobradex st sus 0.3-0.05 98

tobramycin sol 0.3% op 97

tobrex oin 0.3% op 97



tolbutamide tab 500mg 42

tolmetin sod cap 400mg 12

tolmetin sod tab 200mg 12

tolmetin sod tab 600mg 12





topicort cre 0.05% 72

topicort oin 0.05% 72















totect inj 500mg 30

toviaz tab 4mg 78

toviaz tab 8mg 78

tradjenta tab 5mg 42

tramadl/apap tab 37.5-325 5

tramadol hcl cap 150mg er 5




tramadol hcl tab 50mg 5

trandolapril tab 1mg 46



tranex acid inj 100mg/ml 45

tranylcyprom tab 10mg 21

travatan z dro 0.004% 95





150

treanda inj 25mg 30

trelstar dep inj 3.75mg 30

trelstar la inj 11.25mg 30

trelstar mix inj 22.5mg 30

tretinoin cap 10mg 30

tretinoin cre 0.025% 72



tretinoin em cre 0.05% 72




tretinoin gel 0.04%pmp 72

tretin-x cre 0.0375% 72

trexall tab 10mg 30

trexall tab 15mg 30

trexall tab 5mg 30

trexall tab 7.5mg 30

treximet tab 85-500mg 25

trezix cap 1

triamcin/ora pst 0.1% 61

triamcinolon cre 0.025% 72



triamcinolon lot 0.025% 72

triamcinolon lot 0.1% 72

triamcinolon oin 0.025% 72



triamcinolon pst 0.1% 61

triamcinolon spr 55mcg/ac 102

triaminic tab 10mg 101

triamt/hctz cap 37.5-25 57

triamt/hctz tab 37.5-25 57

triamt/hctz tab 75-50mg 57

trianex oin 0.05% 72

triazolam tab 0.125mg 105

triazolam tab 0.25mg 105

tribenzor20- tab 5-12.5mg 49

tribenzor40- tab 10-12.5 49

tribenzor40- tab 10-25mg 49

tribenzor40- tab 5-12.5mg 49

tribenzor40- tab 5-25mg 49

trichophyton inj 1

200 94

tricitrates sol 107

tricon cap 114

triderm cre 0.1% 72

tri-estaryll tab 83





trifluridine sol 1% op 97

trigels-f cap forte 114

triglide tab 160mg 57

triglide tab 50mg 57

tri-linyah tab 83

trilyte sol 76

trimethobenz cap 300mg 24

trimethobenz inj 100mg/ml 24

trimethoprim sol polymyxn 97

trimethoprim tab 100mg 13




trinessa tab 83

tri-previfem tab 83

trisenox sol 10mg/10m 30

tri-sprintec tab 83





tri-vita/fl dro 0.25mg 114

trivora-28 tab 83

tri-zel tab 114

tropicamide sol 0.5% op 98

tropicamide sol 1% op 98

trospium chl cap 60mg er 78

trospium cl tab 20mg 78

truvada tab 200-300 38

tudorza pres aer 400/act 101

tussicaps cap 10-8mg 104

tussicaps cap 5-4mg 104

tussigon tab 5mg 104

t-vites tab 114

tygacil inj 50mg 13

tykerb tab 250mg 30

tyvaso refil sol 0.6mg/ml 103

tyvaso sol 0.6mg/ml 103

tyvaso start sol 0.6mg/ml 103

tyzeka tab 600mg 37

tyzine ped dro 0.05% 102

tyzine sol 0.1% 102

U u-kera e cre 40% 72

ulticare syg mis .3cc/29g 94



ulticare syg mis 1cc/28g 95

ulticare syg mis 1cc/29g 95

ultilet alch pad swab 95

ultravate kit pac 72

umecta mouss aer 40% 72

unicomplex-m tab 114
























ur n-c tab 78

uramaxin aer 20% 72

urea 40% sus nail 72

urea cre 39% 72

urea cre 40% 72

urea cre 45% 72

urea cre 50% 72

urea emu 50% 72

urea gel 40% 72

urea lot 40% 72

urea lot 45% 72

urea nail gel 45% 72

urea nail kit 73

urea sus 50% 73

urea topical sus 40% 73

urea-c40 lot 40% 73

uretron d/s tab 78

urin d/s tab 78

urocit-k 10 tab 107

urocit-k 15 tab 107

urocit-k 5 tab 79

151

ursodiol cap 300mg 76



ustell cap 78

uta cap 120mg 78

uticap cap 78

utira-c tab 78

utrona-c tab 78

V vagifem tab 10mcg 79

vagistat-3 kit combo pk 79

valacyclovir tab 1gm 38

valacyclovir tab 500mg 38

valcyte sol 50mg/ml 35

valcyte tab 450mg 35

valproate inj 100mg/ml 18

valproate inj 500/5ml 18

valproic acd cap 250mg 18

valproic acd sol 250/5ml 18

valproic acd syp 250/5ml 18

valsart/hctz tab 160-12.5 49

valsart/hctz tab 160-25mg 49


valsart/hctz tab 320-25mg 49


valsartan tab 160mg 46



valstar sol 40mg/ml 30

vancomycin inj 1 gm 13


vancomycin inj 10gm 13



vandazole gel 0.75% 79

vantas kit 50mg 30

vascepa cap 1gm 58

vasolex oin 73

vasopressin inj 10/0.5ml 85

vasopressin inj 20unt/ml 85

vayacog cap 114

vayarin cap 114

vayarol cap 114

vazobid-pd sus 6-10mg/5 104

vectical oin 3mcg/gm 73

velcade inj 3.5mg 30

veletri inj 0.5mg 103

veletri inj 1.5mg 103

velivet pak 83

veltin gel 73


venlafaxine cap 37.5 er 22

venlafaxine cap 37.5mg 22






venlafaxine tab 37.5 er 22

venlafaxine tab 37.5mg 22




ventavis sol 10mcg/ml 103

ventavis sol 20mcg/ml 103

ventolin hfa aer 102

veramyst spr 27.5mcg 102











verapamil inj 2.5mg/ml 53


verapamil tab 120mg er 53





verdeso aer 0.05% 73

verdrocet tab 2.5-325 5

veregen oin 15% 73

veripred 20 sol 20mg/5ml 80

versiclear lot 73

vesicare tab 10mg 78

vesicare tab 5mg 78

vexol sus 1% op 98

vibativ inj 250mg 13

vicodin es tab 7.5-300 5

vicodin hp tab 10-300mg 5

vicodin tab 5-300mg 5

victoza inj 18mg/3ml 42

victrelis cap 200mg 37

videx sol 2gm 36

vigamox dro 0.5% 97

viibryd kit 21

viibryd tab 10mg 21

viibryd tab 20mg 21

viibryd tab 40mg 21

vinblastine inj 10mg 30

vincasar pfs inj 1mg/ml 30

vincristine inj 1mg/ml 30

vinorelbine inj 10mg/ml 30

viracept tab 250mg 36

viracept tab 625mg 36

viramune sus 50mg/5ml 38

virazole inh 6gm 36

viread tab 150mg 36

viread tab 200mg 36

viread tab 250mg 36

viread tab 300mg 36

virt-phos tab 250 neut 114

virt-vite tab 114

vit d gummie chw 400unit 114

vitaline tab formula2 114

vitaline tab formula3 114

vitamin b-12 tab 1000mcg 114

vitamin c inj 222mg/ml 115




vitamin d cap 50000unt 115



vitamin d dro 400unit 115





















152


vitamin d3 tab 50000unt 115



vitamin d3 tab complete 115

vitamin k1 inj 1mg/0.5 115

vita-respa tab 114

vitasana tab 115

vitatrum tab 115

vitrum tab senior 115

vivelle-dot dis 0.025mg 83





vivitrol inj 380mg 95

voltaren gel 1% 73

voraxaze inj 1000unit 30

votrient tab 200mg 30

vp-zel tab 115

vytorin tab 10-10mg 58




vyvanse cap 20mg 59

vyvanse cap 30mg 59

vyvanse cap 40mg 59

vyvanse cap 50mg 59

vyvanse cap 60mg 59

vyvanse cap 70mg 59

W wal-dram ii tab 25mg 24

wal-fex allr tab 180mg 101

wal-fex alrg tab 60mg 101

wal-itin syp 5mg/5ml 101

wal-itin tab 10mg 101

wal-vert tab 10mg 101

wal-zan tab 150mg 77

wal-zyr sol 1mg/ml 101

wal-zyr sol 5mg/5ml 101

wal-zyr tab 10mg 101

warfarin tab 10mg 44

warfarin tab 1mg 44


warfarin tab 2mg 44

warfarin tab 3mg 44

warfarin tab 4mg 44

warfarin tab 5mg 44

warfarin tab 6mg 44


webcol prep pad large 95

webcol prep pad medium 95

welchol pak 3.75gm 58

welchol tab 625mg 58

wera tab 0.5/35 83

westhroid tab 130mg 87

westhroid tab 16.25mg 88


westhroid tab 32.5mg 88


westhroid-p tab 130mg 88

westhroid-p tab 16.25mg 88

westhroid-p tab 32.5mg 88

westhroid-p tab 65mg 88

whole food tab multivit 115

womens bio- tab multiple 115

womens multi tab vit/min 115

wp thyroid tab 130mg 88

wp thyroid tab 16.25mg 88

wp thyroid tab 32.5mg 88

wp thyroid tab 65mg 88

X xalkori cap 200mg 30

xalkori cap 250mg 30

xarelto tab 10mg 44

xarelto tab 15mg 44

xarelto tab 20mg 44

xenazine tab 12.5mg 60

xenazine tab 25mg 60

xolair sol 150mg 104

xolegel gel 2% 73

xopenex hfa aer 102

x-viate cre 40% 73

x-viate gel 40% 73

x-viate lot 40% 73

xylon tab 10-200mg 5

xyrem sol 500mg/ml 61

Y yelets teen tab formula 115

yl folic aci tab 400mcg 115

yodoxin tab 210mg 95

yodoxin tab 650mg 95

Z zaclir lot 8% 73



zaleplon cap 10mg 105

zaleplon cap 5mg 105

zamicet sol 10-325mg 5

zazole cre 0.4% 79

zazole cre 0.8% 79

zazole sup 80mg 79

zebutal cap 1

zegerid pow 20-1680 77

zegerid pow 40-1680 77

zemplar cap 1mcg 106



zemplar inj 2mcg/ml 106

zemplar inj 5mcg/ml 106

zenpep cap 25000unt 74

zenzedi tab 10mg 59

zenzedi tab 5mg 59

zetia tab 10mg 58

zetonna aer 37mcg 102

zflex tab 1

zgesic tab 66-600mg 1

ziagen sol 20mg/ml 36

ziana gel 73

zidovudine cap 100mg 36

zidovudine syp 50mg/5ml 36

zidovudine tab 300mg 36

zinc sulfate cap 220mg 115

zinc-220 cap 115

zioptan dro 0.0015% 95

ziprasidone cap 20mg 35




zirgan gel 0.15% 97

zithromax pow 1gm pak 15

zn-dtpa sol 1000mg 73

zoden dm dro 104

zoden dro 104

zoladex imp 10.8mg 30

zoladex imp 3.6mg 30

zolinza cap 100mg 30

zolmitriptan tab 2.5 mg 25

zolmitriptan tab 2.5mg 25

zolmitriptan tab 5mg 25

zolpidem er tab 12.5mg 105

zolpidem er tab 6.25mg 105

zolpidem tab 10mg 105

zolpidem tab 5mg 105

zomig nasal spr 5mg 25

zonalon cre 5% 73

zonisamide cap 100mg 18



zorbtive inj 8.8mg 89

153

zortress tab 0.25mg 90



zostavax inj 91

zovia 1/35e tab 83

zovirax cre 5% 38

zuplenz mis 4mg 24

zuplenz mis 8mg 24

zyclara cre 3.75% 73

zyclara pump cre 3.75% 73

zyflo cr tab 600mg 99

zyflo tab 600mg 99

zylet sus 0.5-0.3% 98

zytiga tab 250mg 30

zyvox sol 2mg/ml 13

zyvox sus 100mg/5m 13

zyvox tab 600mg 13

QUALIFIED HEALTH PLAN FORMULARY · 2021. 6. 3. · please contact EnvisionRxOptions at...

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Transcript of QUALIFIED HEALTH PLAN FORMULARY · 2021. 6. 3. · please contact EnvisionRxOptions at...