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Beta-Adrenergic Blocking Agents - Alameda Alliance for Health

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AAH01<br />

ALAMEDA ALLIANCE FOR HEALTH<br />

DRUG FORMULARY<br />

July 2012<br />

INTRODUCTION<br />

Foreword<br />

This document provides physicians and pharmacists with a method to begin to evaluate the<br />

various drug products available. The medical treatment of patients is frequently relative to the<br />

practical application of drug therapy. Due to the vast availability of medication therapy and<br />

treatment modalities, a reasonable program of drug product selection and drug usage must be<br />

developed. The goal of the Drug Formulary is to enhance the physician and pharmacist’s<br />

abilities to provide optimal cost effective drug therapy <strong>for</strong> patients.<br />

The development, maintenance, and improvement of this process are evolutionary and require<br />

constant attention. The Formulary is a continually reviewed and revised list of drugs, which<br />

mirror the prevailing clinical opinion of the P & T and Formulary Committees. Un<strong>for</strong>tunately, this<br />

dynamic process does not allow this document to be completely accurate at all times. To<br />

accommodate the necessary changes of this document, updates are sent regularly.<br />

How to Use the Drug Formulary<br />

The Drug Formulary is a list of covered and preferred drug agents <strong>for</strong> members. All drugs are<br />

listed by their generic names and most common proprietary (branded) name. The Drug<br />

Formulary may be accessed by using either the generic or proprietary name (in small capital<br />

letters) and by therapeutic drug category. The brand names listed are <strong>for</strong> reference use only,<br />

and do not denote coverage, unless specifically noted. Any drug not found in this Formulary<br />

listing shall be considered a Non-Formulary drug.<br />

All drugs are listed in each category in alphabetical order by generic name. Where an FDA<br />

approved generic is available <strong>for</strong> the listed generic name, the generic name is bolded.<br />

For certain agents within the Drug Formulary, a recommended prescribing guideline may apply.<br />

These are denoted throughout the document using the following symbols:<br />

Age Edit<br />

Coverage may depend on patient age<br />

AGE<br />

G Gender Edit Coverage may depend on patient gender<br />

MD Physician Specialty Edit Coverage may depend on prescribing physician’s specialty or board certification<br />

PA Prior Authorization Requires specific physician request process<br />

QL Quantity Limit Coverage may be limited to specific quantities per prescription and/or time period<br />

ST Step Therapy Coverage may depend on previous use of another drug<br />

F Formulary


Benefit Coverage and Limitations<br />

This printed Formulary does not provide in<strong>for</strong>mation regarding the specific coverage and<br />

limitations an individual member may have. Many members have specific benefit inclusions,<br />

exclusions, copays, or a lack of coverage, which are not reflected in the Drug Formulary.<br />

The Drug Formulary applies only to outpatient drugs provided to members, and does not apply<br />

to medications used in inpatient settings. If a member has any specific questions regarding<br />

their coverage, they should contact their Plan Sponsor or MedImpact at (800) 788-2949.<br />

ALLERGY<br />

2nd Gen Antihistamine & Decongestant Combinations<br />

QL loratadine/pseudoephedrine CLARITIN-D 12 HOUR TAB ER 12H 5<br />

MG-120MG<br />

QL loratadine/pseudoephedrine CLARITIN-D 12 HOUR TAB ER 24H<br />

10MG-240MG<br />

Antihistamines<br />

tripelennamine hcl TRIPELENNAMINE HCL TABLET<br />

50MG<br />

Antihistamines - 1st Generation<br />

carbinoxamine maleate PALGIC LIQUID 4<br />

MG/5 ML<br />

chlorpheniramine maleate CHLOR-TRIMETON CAPSULE SA<br />

12MG<br />

chlorpheniramine maleate CHLOR-TRIMETON SYRUP 2<br />

MG/5 ML<br />

chlorpheniramine maleate CHLOR-TRIMETON TABLET 4<br />

MG<br />

clemastine fumarate TAVIST-1 TABLET 1.34<br />

MG<br />

clemastine fumarate TAVIST-1 SYRUP<br />

0.67MG/5ML<br />

cyproheptadine hcl CYPROHEPTADINE HCL SYRUP 2<br />

MG/5 ML<br />

cyproheptadine hcl CYPROHEPTADINE HCL TABLET 4<br />

MG<br />

diphenhydramine hcl BENADRYL TABLET 25<br />

MG<br />

diphenhydramine hcl BENADRYL CAPSULE 25<br />

MG<br />

diphenhydramine hcl BENADRYL CAPSULE 50<br />

MG


diphenhydramine hcl BENADRYL LIQUID<br />

12.5MG/5ML<br />

diphenhydramine hcl BENADRYL TAB CHEW<br />

12.5 MG<br />

diphenhydramine hcl BENADRYL SYRUP<br />

12.5MG/5ML<br />

diphenhydramine hcl BENADRYL TABLET 25<br />

MG<br />

diphenhydramine hcl BENADRYL TABLET 50<br />

MG<br />

diphenhydramine hcl BENADRYL LIQUID<br />

12.5MG/5ML<br />

hydroxyzine hcl HYZINE SYRUP 10<br />

MG/5 ML<br />

hydroxyzine hcl HYZINE TABLET 10<br />

MG<br />

hydroxyzine hcl HYZINE TABLET 25<br />

MG<br />

hydroxyzine hcl HYZINE TABLET 50<br />

MG<br />

hydroxyzine pamoate VISTARIL CAPSULE 100<br />

MG<br />

hydroxyzine pamoate VISTARIL CAPSULE 25<br />

MG<br />

hydroxyzine pamoate VISTARIL CAPSULE 50<br />

MG<br />

promethazine hcl PHENERGAN SYRUP<br />

6.25MG/5ML<br />

promethazine hcl PHENERGAN TABLET 12.5<br />

MG<br />

promethazine hcl PHENERGAN TABLET 25<br />

MG<br />

promethazine hcl PHENERGAN TABLET 50<br />

MG<br />

Antihistamines - 2nd Generation<br />

QL cetirizine hcl CHILDREN'S ZYRTEC SOLUTION 1<br />

MG/ML<br />

QL cetirizine hcl CHILDREN'S ZYRTEC TABLET 10<br />

MG<br />

QL cetirizine hcl CHILDREN'S ZYRTEC TABLET 5<br />

MG<br />

PA fexofenadine hcl ALLEGRA TABLET 30<br />

MG<br />

PA fexofenadine hcl ALLEGRA TABLET 60<br />

MG<br />

PA fexofenadine hcl ALLEGRA TABLET 180


MG<br />

QL loratadine CLARITIN TAB RAPDIS<br />

10 MG<br />

QL loratadine CLARITIN SOLUTION 5<br />

MG/5 ML<br />

QL loratadine CLARITIN TABLET 10<br />

MG<br />

Nasal Anti-Inflammatory Steroids<br />

flunisolide NASAREL SPRAY<br />

29MCG<br />

flunisolide NASAREL SPRAY 25<br />

MCG<br />

fluticasone propionate FLONASE SPRAY SUSP<br />

AGE+<br />

QL<br />

50 MCG<br />

mometasone furoate NASONEX SPRAY/PUMP<br />

50 MCG<br />

Nasal Mast Cell Stabilizers <strong>Agents</strong><br />

cromolyn sodium NASALCROM SPRAY/PUMP<br />

5.2 MG<br />

ANTIEMESIS/ANTIVERTIGO<br />

Antiemetic/Antivertigo <strong>Agents</strong><br />

dimenhydrinate DRAMAMINE TABLET<br />

50MG<br />

meclizine hcl ANTIVERT TABLET 12.5<br />

MG<br />

meclizine hcl ANTIVERT TABLET 25<br />

MG<br />

PA meclizine hcl ANTIVERT TABLET 50<br />

MG<br />

meclizine hcl ANTIVERT TAB CHEW<br />

25 MG<br />

QL ondansetron ZOFRAN ODT TAB RAPDIS<br />

4 MG<br />

QL ondansetron ZOFRAN ODT TAB RAPDIS<br />

8 MG<br />

QL ondansetron hcl ZOFRAN TABLET 4<br />

MG<br />

QL ondansetron hcl ZOFRAN TABLET 8<br />

QL+<br />

ST<br />

MG<br />

ondansetron hcl ZOFRAN TABLET 24<br />

MG<br />

prochlorperazine edisylate COMPAZINE SYRUP 5<br />

MG/5 ML<br />

prochlorperazine maleate COMPAZINE SUPP.RECT


25 MG<br />

prochlorperazine maleate COMPAZINE TABLET 10<br />

MG<br />

prochlorperazine maleate COMPAZINE TABLET 5<br />

MG<br />

promethazine hcl PHENERGAN SUPP.RECT<br />

25 MG<br />

promethazine hcl PHENERGAN SUPP.RECT<br />

50 MG<br />

promethazine hcl PHENERGAN SUPP.RECT<br />

12.5 MG<br />

trimethobenzamide hcl/b-caine TEBAMIDE SUPP.RECT<br />

100MG-2%<br />

trimethobenzamide hcl/b-caine TEBAMIDE SUPP.RECT<br />

200 MG-2 %<br />

ASTHMA<br />

<strong>Adrenergic</strong> <strong>Agents</strong>,Catecholamines<br />

isoetharine hcl ISOETHARINE HCL SOLUTION<br />

10MG/ML<br />

isoproterenol hcl ISUPREL AMPUL 0.2<br />

MG/ML<br />

<strong>Beta</strong>-<strong>Adrenergic</strong> <strong>Agents</strong><br />

albuterol sulfate VOSPIRE ER VIAL-NEB<br />

0.63MG/3ML<br />

albuterol sulfate VOSPIRE ER VIAL-NEB<br />

1.25MG/3ML<br />

albuterol sulfate VOSPIRE ER TABLET 2<br />

MG<br />

albuterol sulfate VOSPIRE ER TABLET 4<br />

MG<br />

albuterol sulfate VOSPIRE ER SYRUP 2<br />

QL+<br />

ST<br />

MG/5 ML<br />

HFA AER AD<br />

90 MCG<br />

albuterol sulfate<br />

PROAIR HFA<br />

VENTOLIN HFA<br />

albuterol sulfate VOSPIRE ER VIAL-NEB 2.5<br />

MG/0.5<br />

albuterol sulfate VOSPIRE ER VIAL-NEB 2.5<br />

MG/3ML<br />

<strong>for</strong>moterol fumarate FORADIL CAP W/DEV<br />

12 MCG<br />

metaproterenol sulfate ALUPENT SYRUP 10<br />

MG/5 ML<br />

metaproterenol sulfate ALUPENT TABLET 10<br />

MG


metaproterenol sulfate ALUPENT TABLET<br />

20MG<br />

ST salmeterol xinafoate SEREVENT DISKUS DISK W/DEV<br />

50 MCG<br />

terbutaline sulfate BRETHINE TABLET 5<br />

MG<br />

terbutaline sulfate BRETHINE TABLET 2.5<br />

MG<br />

<strong>Beta</strong>-<strong>Adrenergic</strong> And Anticholinergic Combinations<br />

ipratropium/albuterol sulfate DUONEB AMPUL-NEB<br />

0.5-3MG/3<br />

ipratropium/albuterol sulfate COMBIVENT AER W/ADAP<br />

18-103MCG<br />

<strong>Beta</strong>-<strong>Adrenergic</strong> And Glucocorticoid Combinations<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

fluticasone/salmeterol ADVAIR DISKUS DISK W/DEV<br />

100-50 MCG<br />

fluticasone/salmeterol ADVAIR DISKUS DISK W/DEV<br />

250-50 MCG<br />

fluticasone/salmeterol ADVAIR DISKUS DISK W/DEV<br />

500-50 MCG<br />

fluticasone/salmeterol ADVAIR HFA HFA AER AD<br />

45-21MCG<br />

fluticasone/salmeterol ADVAIR HFA HFA AER AD<br />

115-21MCG<br />

fluticasone/salmeterol ADVAIR HFA HFA AER AD<br />

230-21MCG<br />

General Bronchodilator <strong>Agents</strong><br />

QL epinephrine PRIMATENE MIST AER W/ADAP<br />

0.22MG<br />

ipratropium bromide ATROVENT HFA HFA AER AD<br />

17MCG<br />

ipratropium bromide IPRATROPIUM BROMIDE SOLUTION<br />

0.2 MG/ML<br />

ST tiotropium bromide SPIRIVA CAP W/DEV<br />

18 MCG<br />

Glucocorticoids, Orally Inhaled<br />

beclomethasone dipropionate QVAR AER W/ADAP<br />

40 MCG<br />

beclomethasone dipropionate QVAR AER W/ADAP<br />

80 MCG<br />

AGE budesonide PULMICORT AMPUL-NEB<br />

0.25MG/2ML<br />

AGE budesonide PULMICORT AMPUL-NEB<br />

0.5 MG/2ML


AGE+ fluticasone propionate FLOVENT DISKUS DISK W/DEV<br />

ST<br />

100 MCG<br />

AGE+ fluticasone propionate FLOVENT DISKUS DISK W/DEV<br />

ST<br />

50 MCG<br />

AGE+ fluticasone propionate FLOVENT HFA AER W/ADAP<br />

ST<br />

110MCG<br />

AGE+ fluticasone propionate FLOVENT HFA AER W/ADAP<br />

ST<br />

44MCG<br />

AGE+ fluticasone propionate FLOVENT HFA AER W/ADAP<br />

ST<br />

220 MCG<br />

PA mometasone furoate ASMANEX AER POW BA<br />

220MCG(14)<br />

PA mometasone furoate ASMANEX AER POW BA<br />

220MCG(30)<br />

PA mometasone furoate ASMANEX AER POW BA<br />

220MCG(60)<br />

Leukotriene Receptor Antagonists<br />

AGE+ montelukast sodium SINGULAIR GRAN PACK<br />

QL+<br />

4 MG<br />

ST<br />

AGE+ montelukast sodium SINGULAIR TAB CHEW 4<br />

QL+<br />

MG<br />

ST<br />

AGE+ montelukast sodium SINGULAIR TAB CHEW 5<br />

QL+<br />

MG<br />

ST<br />

AGE+ montelukast sodium SINGULAIR TABLET 10<br />

QL+<br />

ST<br />

MG<br />

Mast Cell Stabilizers<br />

cromolyn sodium GASTROCROM AMPUL-NEB<br />

20 MG/2 ML<br />

Monoclonal Antibodies To Immunoglobulin E(ige)<br />

AGE omalizumab XOLAIR VIAL 150 MG<br />

Respiratory Aids,Devices,Equipment<br />

QL compressor, <strong>for</strong> nebulizer DEVILBISS COMPACT<br />

DEVILBISS PULMO-AIDE<br />

MISTERNEB COMPRESSOR<br />

PULMO-AIDE<br />

SUNRISE COMPRESSOR-NEBULIZER<br />

QL compressor, <strong>for</strong> nebulizer DEVILBISS COMPACT<br />

DEVILBISS PULMO-AIDE<br />

MISTERNEB COMPRESSOR<br />

PULMO-AIDE<br />

EACH<br />

EACH


SUNRISE COMPRESSOR-NEBULIZER<br />

QL inhaler, assist devices EASIVENT<br />

MICROCHAMBER<br />

QL peak flow meter ASSESS<br />

PEAK-AIR<br />

PERSONAL BEST<br />

POCKET PEAK<br />

TRUZONE PEAK FLOW METER<br />

SPACER<br />

EACH<br />

Xanthines<br />

theophylline anhydrous THEO-24 CAP ER 24H<br />

400 MG<br />

theophylline anhydrous THEO-24 CAP ER 24H<br />

100 MG<br />

theophylline anhydrous THEO-24 CAP ER 24H<br />

200 MG<br />

theophylline anhydrous THEO-24 CAP ER 24H<br />

300 MG<br />

theophylline anhydrous UNIPHYL ELIXIR 80<br />

MG/15ML<br />

theophylline anhydrous UNIPHYL TAB ER 12H<br />

100 MG<br />

theophylline anhydrous UNIPHYL TAB ER 12H<br />

200 MG<br />

theophylline anhydrous UNIPHYL TAB ER 12H<br />

300 MG<br />

theophylline anhydrous UNIPHYL TABLET ER<br />

400 MG<br />

theophylline anhydrous UNIPHYL TAB ER 12H<br />

450 MG<br />

theophylline anhydrous UNIPHYL TABLET ER<br />

400 MG<br />

theophylline anhydrous UNIPHYL TABLET ER<br />

600 MG<br />

theophylline anhydrous UNIPHYL SOLUTION 80<br />

MG/15ML<br />

AUTONOMIC NERVOUS SYSTEM<br />

DISORDERS<br />

Cholinesterase Inhibitors<br />

pyridostigmine bromide MESTINON SYRUP 60<br />

MG/5 ML<br />

pyridostigmine bromide MESTINON TABLET 60<br />

MG


BEHAVIORAL HEALTH - ANTIDEPRESSANTS<br />

Alpha-2 Receptor Antagonist Antidepressants<br />

mirtazapine REMERON TAB RAPDIS<br />

15 MG<br />

mirtazapine REMERON TAB RAPDIS<br />

30 MG<br />

mirtazapine REMERON TAB RAPDIS<br />

45 MG<br />

mirtazapine REMERON TABLET 15<br />

MG<br />

mirtazapine REMERON TABLET<br />

30MG<br />

mirtazapine REMERON TABLET 45<br />

MG<br />

Norepinephrine And Dopamine Reuptake Inhib (ndris)<br />

bupropion hcl WELLBUTRIN SR TABLET 75<br />

MG<br />

bupropion hcl WELLBUTRIN SR TABLET 100<br />

MG<br />

bupropion hcl WELLBUTRIN SR TABLET ER<br />

150 MG<br />

bupropion hcl WELLBUTRIN SR TABLET ER<br />

100 MG<br />

bupropion hcl WELLBUTRIN SR TABLET ER<br />

200 MG<br />

ST bupropion hcl WELLBUTRIN SR TAB ER 24H<br />

150 MG<br />

ST bupropion hcl WELLBUTRIN SR TAB ER 24H<br />

300 MG<br />

Selective Serotonin Reuptake Inhibitor (ssris)<br />

QL citalopram hydrobromide CELEXA TABLET 20<br />

MG<br />

citalopram hydrobromide CELEXA TABLET 40<br />

MG<br />

citalopram hydrobromide CELEXA SOLUTION 10<br />

MG/5 ML<br />

QL citalopram hydrobromide CELEXA TABLET 10<br />

MG<br />

PA escitalopram oxalate LEXAPRO TABLET 10<br />

MG<br />

PA escitalopram oxalate LEXAPRO TABLET 20<br />

MG<br />

PA escitalopram oxalate LEXAPRO TABLET 5<br />

MG


fluoxetine hcl RAPIFLUX CAPSULE 10<br />

MG<br />

fluoxetine hcl RAPIFLUX CAPSULE 20<br />

MG<br />

QL fluoxetine hcl RAPIFLUX SOLUTION 20<br />

MG/5 ML<br />

fluvoxamine maleate FLUVOXAMINE MALEATE TABLET 25<br />

MG<br />

fluvoxamine maleate FLUVOXAMINE MALEATE TABLET 50<br />

MG<br />

fluvoxamine maleate FLUVOXAMINE MALEATE TABLET 100<br />

MG<br />

paroxetine hcl PAXIL TABLET 10<br />

MG<br />

paroxetine hcl PAXIL TABLET 20<br />

MG<br />

paroxetine hcl PAXIL TABLET 30<br />

MG<br />

paroxetine hcl PAXIL TABLET 40<br />

MG<br />

AGE paroxetine hcl PAXIL ORAL SUSP<br />

10 MG/5 ML<br />

PA paroxetine hcl PAXIL TAB ER 24H<br />

25 MG<br />

PA paroxetine hcl PAXIL TAB ER 24H<br />

37.5 MG<br />

PA paroxetine mesylate PEXEVA TABLET 10<br />

MG<br />

PA paroxetine mesylate PEXEVA TABLET 20<br />

MG<br />

PA paroxetine mesylate PEXEVA TABLET 30<br />

MG<br />

PA paroxetine mesylate PEXEVA TABLET 40<br />

MG<br />

QL sertraline hcl ZOLOFT CONC TABLET 25<br />

MG<br />

QL sertraline hcl ZOLOFT CONC TABLET 50<br />

MG<br />

QL sertraline hcl ZOLOFT CONC TABLET 100<br />

MG<br />

sertraline hcl ZOLOFT CONC ORAL CONC<br />

20 MG/ML<br />

Serotonin-2 Antagonist/Reuptake Inhibitors (saris)<br />

trazodone hcl DESYREL 300MG TABLET 50<br />

MG<br />

trazodone hcl DESYREL 300MG TABLET 100


MG<br />

trazodone hcl DESYREL 300MG TABLET 150<br />

MG<br />

Serotonin-Norepinephrine Reuptake-Inhib (snris)<br />

PA desvenlafaxine succinate PRISTIQ ER TAB ER 24H<br />

50 MG<br />

PA desvenlafaxine succinate PRISTIQ ER TAB ER 24H<br />

100 MG<br />

PA duloxetine hcl CYMBALTA CAPSULE DR<br />

20 MG<br />

PA duloxetine hcl CYMBALTA CAPSULE DR<br />

30 MG<br />

PA duloxetine hcl CYMBALTA CAPSULE DR<br />

60 MG<br />

PA venlafaxine hcl EFFEXOR 25MG TAB ER 24<br />

37.5 MG<br />

PA venlafaxine hcl EFFEXOR 25MG TAB ER 24 75<br />

MG<br />

PA venlafaxine hcl EFFEXOR 25MG TAB ER 24<br />

150 MG<br />

PA venlafaxine hcl VENLAFAXINE HCL ER TAB ER 24<br />

225 MG<br />

venlafaxine hcl EFFEXOR 25MG TABLET 25<br />

MG<br />

venlafaxine hcl EFFEXOR 25MG TABLET 37.5<br />

MG<br />

venlafaxine hcl EFFEXOR 25MG TABLET 50<br />

MG<br />

venlafaxine hcl EFFEXOR 25MG TABLET 75<br />

MG<br />

venlafaxine hcl EFFEXOR 25MG TABLET 100<br />

MG<br />

venlafaxine hcl EFFEXOR 25MG CAP ER 24H<br />

37.5 MG<br />

venlafaxine hcl EFFEXOR 25MG CAP ER 24H<br />

75 MG<br />

venlafaxine hcl EFFEXOR 25MG CAP ER 24H<br />

150 MG<br />

Tricyclic Antidepressant/Phenothiazine Combinatns<br />

perphenazine/amitriptyline hcl PERPHENAZINE/AMITRIPTYLINE HCL TABLET 2<br />

MG-10 MG<br />

perphenazine/amitriptyline hcl PERPHENAZINE/AMITRIPTYLINE HCL TABLET<br />

4MG-10MG<br />

perphenazine/amitriptyline hcl PERPHENAZINE/AMITRIPTYLINE HCL TABLET 2<br />

MG-25 MG


perphenazine/amitriptyline hcl PERPHENAZINE/AMITRIPTYLINE HCL TABLET 4<br />

MG-25 MG<br />

perphenazine/amitriptyline hcl PERPHENAZINE/AMITRIPTYLINE HCL TABLET<br />

4MG-50MG<br />

Tricyclic Antidepressants & Rel. Non-Sel. Ru-Inhib<br />

amitriptyline hcl AMITRIPTYLINE HCL TABLET 10<br />

MG<br />

amitriptyline hcl AMITRIPTYLINE HCL TABLET 100<br />

MG<br />

amitriptyline hcl AMITRIPTYLINE HCL TABLET 150<br />

MG<br />

amitriptyline hcl AMITRIPTYLINE HCL TABLET 25<br />

MG<br />

amitriptyline hcl AMITRIPTYLINE HCL TABLET 50<br />

MG<br />

amitriptyline hcl AMITRIPTYLINE HCL TABLET 75<br />

MG<br />

clomipramine hcl ANAFRANIL CAPSULE 25<br />

MG<br />

clomipramine hcl ANAFRANIL CAPSULE 50<br />

MG<br />

clomipramine hcl ANAFRANIL CAPSULE 75<br />

MG<br />

desipramine hcl NORPRAMIN TABLET 10<br />

MG<br />

desipramine hcl NORPRAMIN TABLET 100<br />

MG<br />

desipramine hcl NORPRAMIN TABLET 150<br />

MG<br />

desipramine hcl NORPRAMIN TABLET 25<br />

MG<br />

desipramine hcl NORPRAMIN TABLET 50<br />

MG<br />

desipramine hcl NORPRAMIN TABLET 75<br />

MG<br />

doxepin hcl DOXEPIN HCL CAPSULE 10<br />

MG<br />

doxepin hcl DOXEPIN HCL CAPSULE 100<br />

MG<br />

doxepin hcl DOXEPIN HCL CAPSULE 150<br />

MG<br />

doxepin hcl DOXEPIN HCL CAPSULE 25<br />

MG<br />

doxepin hcl DOXEPIN HCL CAPSULE 50<br />

MG<br />

doxepin hcl DOXEPIN HCL CAPSULE 75


MG<br />

doxepin hcl DOXEPIN HCL ORAL CONC<br />

10 MG/ML<br />

imipramine hcl TOFRANIL TABLET 10<br />

MG<br />

imipramine hcl TOFRANIL TABLET 25<br />

MG<br />

imipramine hcl TOFRANIL TABLET 50<br />

MG<br />

nortriptyline hcl AVENTYL SOL CAPSULE 10<br />

MG<br />

nortriptyline hcl AVENTYL SOL CAPSULE 25<br />

MG<br />

nortriptyline hcl AVENTYL SOL CAPSULE 50<br />

MG<br />

nortriptyline hcl AVENTYL SOL CAPSULE 75<br />

MG<br />

nortriptyline hcl AVENTYL SOL SOLUTION 10<br />

MG/5 ML<br />

BEHAVIORAL HEALTH - OTHER<br />

<strong>Adrenergic</strong>s, Aromatic, Non-Catecholamine<br />

AGE+ amphet asp/amphet/d-amphet ADDERALL CAP ER 24H<br />

QL<br />

10 MG<br />

AGE+ amphet asp/amphet/d-amphet ADDERALL CAP ER 24H<br />

QL<br />

20 MG<br />

AGE+ amphet asp/amphet/d-amphet ADDERALL CAP ER 24H<br />

QL<br />

30 MG<br />

AGE+ amphet asp/amphet/d-amphet ADDERALL CAP ER 24H 5<br />

QL<br />

MG<br />

AGE+ amphet asp/amphet/d-amphet ADDERALL CAP ER 24H<br />

QL<br />

15 MG<br />

AGE+ amphet asp/amphet/d-amphet ADDERALL CAP ER 24H<br />

QL<br />

25 MG<br />

QL amphet asp/amphet/d-amphet ADDERALL TABLET 7.5<br />

MG<br />

QL amphet asp/amphet/d-amphet ADDERALL TABLET 12.5<br />

MG<br />

QL amphet asp/amphet/d-amphet ADDERALL TABLET 15<br />

MG<br />

QL amphet asp/amphet/d-amphet ADDERALL TABLET 5<br />

MG<br />

QL amphet asp/amphet/d-amphet ADDERALL TABLET 10<br />

MG<br />

QL amphet asp/amphet/d-amphet ADDERALL TABLET 30<br />

MG


QL amphet asp/amphet/d-amphet ADDERALL TABLET 20<br />

MG<br />

dextroamphetamine sulfate DEXEDRINE CAPSULE ER<br />

10 MG<br />

dextroamphetamine sulfate DEXEDRINE CAPSULE ER<br />

15 MG<br />

dextroamphetamine sulfate DEXEDRINE CAPSULE ER<br />

5 MG<br />

dextroamphetamine sulfate DEXEDRINE TABLET 10<br />

MG<br />

dextroamphetamine sulfate DEXEDRINE TABLET 5<br />

MG<br />

ST lisdexamfetamine dimesylate VYVANSE CAPSULE 30<br />

MG<br />

ST lisdexamfetamine dimesylate VYVANSE CAPSULE 50<br />

MG<br />

ST lisdexamfetamine dimesylate VYVANSE CAPSULE 70<br />

MG<br />

ST lisdexamfetamine dimesylate VYVANSE CAPSULE 20<br />

MG<br />

ST lisdexamfetamine dimesylate VYVANSE CAPSULE 40<br />

MG<br />

ST lisdexamfetamine dimesylate VYVANSE CAPSULE 60<br />

MG<br />

Anti-Alcoholic Preparations<br />

disulfiram ANTABUSE TABLET 250<br />

MG<br />

disulfiram ANTABUSE TABLET 500<br />

MG<br />

Anti-Anxiety Drugs<br />

alprazolam NIRAVAM TABLET 0.25<br />

MG<br />

alprazolam NIRAVAM TABLET 0.5<br />

MG<br />

alprazolam NIRAVAM TABLET 1<br />

MG<br />

alprazolam NIRAVAM TABLET 2<br />

MG<br />

alprazolam ALPRAZOLAM INTENSOL ORAL CONC<br />

1 MG/ML<br />

buspirone hcl VANSPAR TABLET 5<br />

MG<br />

buspirone hcl VANSPAR TABLET 10<br />

MG<br />

buspirone hcl VANSPAR TABLET 15


MG<br />

PA buspirone hcl VANSPAR TABLET 30<br />

MG<br />

chlordiazepoxide LIBRITABS TABLET<br />

25MG<br />

chlordiazepoxide hcl LIBRIUM CAPSULE 10<br />

MG<br />

chlordiazepoxide hcl LIBRIUM CAPSULE 25<br />

MG<br />

chlordiazepoxide hcl LIBRIUM CAPSULE 5<br />

MG<br />

QL diazepam VALIUM TABLET 10<br />

MG<br />

QL diazepam VALIUM TABLET 2<br />

MG<br />

QL diazepam VALIUM TABLET 5<br />

MG<br />

lorazepam ATIVAN TABLET 0.5<br />

MG<br />

lorazepam ATIVAN TABLET 1<br />

MG<br />

lorazepam ATIVAN TABLET 2<br />

MG<br />

lorazepam ATIVAN ORAL CONC<br />

2 MG/ML<br />

PA oxazepam SERAX CAPSULE 10<br />

MG<br />

PA oxazepam SERAX CAPSULE 15<br />

MG<br />

PA oxazepam SERAX CAPSULE 30<br />

MG<br />

Barbiturates<br />

phenobarbital PHENOBARBITAL ELIXIR<br />

20MG/5ML<br />

phenobarbital PHENOBARBITAL TABLET 15<br />

MG<br />

phenobarbital PHENOBARBITAL TABLET 60<br />

MG<br />

phenobarbital PHENOBARBITAL TABLET 30<br />

MG<br />

phenobarbital PHENOBARBITAL TABLET 100<br />

MG<br />

phenobarbital PHENOBARBITAL TABLET 16.2<br />

MG<br />

Sedative-Hypnotics,Non-Barbiturate


diphenhydramine hcl DIPHENHYDRAMINE HCL TABLET 50<br />

MG<br />

diphenhydramine hcl DIPHENHYDRAMINE HCL TABLET 25<br />

MG<br />

diphenhydramine hcl DIPHENHYDRAMINE HCL CAPSULE 50<br />

MG<br />

diphenhydramine hcl ZZZQUIL CAPSULE 25<br />

MG<br />

AGE flurazepam hcl DALMANE CAPSULE 15<br />

MG<br />

AGE flurazepam hcl DALMANE CAPSULE 30<br />

MG<br />

lorazepam ATIVAN VIAL 2<br />

MG/ML<br />

temazepam RESTORIL CAPSULE 15<br />

MG<br />

temazepam RESTORIL CAPSULE 30<br />

MG<br />

PA temazepam RESTORIL CAPSULE 7.5<br />

MG<br />

PA temazepam RESTORIL CAPSULE<br />

22.5 MG<br />

triazolam HALCION TABLET 0.25<br />

MG<br />

triazolam HALCION TABLET 0.125<br />

MG<br />

ST zaleplon SONATA CAPSULE 5<br />

MG<br />

ST zaleplon SONATA CAPSULE 10<br />

MG<br />

QL zolpidem tartrate AMBIEN CR TABLET 5<br />

MG<br />

QL zolpidem tartrate AMBIEN CR TABLET 10<br />

MG<br />

ST zolpidem tartrate AMBIEN CR TAB MPHASE<br />

6.25 MG<br />

ST zolpidem tartrate AMBIEN CR TAB MPHASE<br />

12.5 MG<br />

Tx For Attention Deficit-Hyperact(adhd)/Narcolepsy<br />

QL dexmethylphenidate hcl FOCALIN TABLET 5<br />

MG<br />

QL dexmethylphenidate hcl FOCALIN TABLET 10<br />

MG<br />

ST methylphenidate DAYTRANA PATCH TD24<br />

10MG/9HR<br />

ST methylphenidate DAYTRANA PATCH TD24


15MG/9HR<br />

ST methylphenidate DAYTRANA PATCH TD24<br />

20 MG/9 HR<br />

ST methylphenidate DAYTRANA PATCH TD24<br />

30MG/9HR<br />

AGE+ methylphenidate hcl RITALIN TAB ER 24 54<br />

ST<br />

MG<br />

AGE+ methylphenidate hcl RITALIN TAB ER 24 18<br />

ST<br />

MG<br />

AGE+ methylphenidate hcl<br />

QL+<br />

RITALIN TAB ER 24 36<br />

MG<br />

ST<br />

ST+<br />

AGE<br />

methylphenidate hcl METADATE CD CPMP 30-70<br />

20 MG<br />

methylphenidate hcl RITALIN TABLET 10<br />

MG<br />

methylphenidate hcl RITALIN TABLET 5<br />

MG<br />

methylphenidate hcl RITALIN TABLET 20<br />

MG<br />

QL methylphenidate hcl RITALIN TABLET ER<br />

20 MG<br />

AGE+ methylphenidate hcl RITALIN TAB ER 24 27<br />

ST<br />

MG<br />

ST+<br />

AGE<br />

methylphenidate hcl METADATE CD CPMP 30-70<br />

30 MG<br />

ST+<br />

AGE<br />

methylphenidate hcl METADATE CD CPMP 30-70<br />

10 MG<br />

ST methylphenidate hcl RITALIN CPMP 50-50<br />

20 MG<br />

ST methylphenidate hcl RITALIN LA CPMP 50-50<br />

10 MG<br />

ST+<br />

AGE<br />

ST+<br />

AGE<br />

ST+<br />

AGE<br />

methylphenidate hcl METADATE CD CPMP 30-70<br />

40 MG<br />

methylphenidate hcl METADATE CD CPMP 30-70<br />

50 MG<br />

methylphenidate hcl METADATE CD CPMP 30-70<br />

60 MG<br />

QL methylphenidate hcl RITALIN TABLET ER<br />

10 MG<br />

CARDIOVASCULAR DISEASE -<br />

ARRHYTHMIA<br />

Antiarrhythmics<br />

amiodarone hcl CORDARONE TABLET 200


MG<br />

mexiletine hcl MEXITIL CAPSULE 150<br />

MG<br />

mexiletine hcl MEXITIL CAPSULE 200<br />

MG<br />

mexiletine hcl MEXITIL CAPSULE 250<br />

MG<br />

procainamide hcl PRONESTYL CAPSULE 375<br />

MG<br />

procainamide hcl PROCAINAMIDE HCL CAPSULE<br />

500MG<br />

procainamide hcl PROCAINAMIDE HCL TABLET SA<br />

250MG<br />

procainamide hcl PROCAINAMIDE HCL TABLET SA<br />

500MG<br />

propafenone hcl RYTHMOL SR TABLET 150<br />

MG<br />

propafenone hcl RYTHMOL SR TABLET 300<br />

MG<br />

propafenone hcl RYTHMOL SR TABLET 225<br />

MG<br />

quinidine gluconate QUINIDINE GLUCONATE TABLET ER<br />

324 MG<br />

quinidine sulfate QUINIDEX TABLET 200<br />

MG<br />

quinidine sulfate QUINIDEX TABLET 300<br />

MG<br />

quinidine sulfate QUINIDEX TABLET ER<br />

300 MG<br />

CARDIOVASCULAR DISEASE - CARDIAC<br />

STIMULANT<br />

Digitalis Glycosides<br />

digoxin DIGOXIN SOLUTION 50<br />

MCG/ML<br />

digoxin LANOXIN TABLET 125<br />

MCG<br />

digoxin LANOXIN TABLET 250<br />

MCG<br />

CARDIOVASCULAR DISEASE -<br />

HYPERTENSION<br />

Ace Inhibitor/Calcium Channel Blocker Combination


PA amlodipine besylate/benazepril LOTREL CAPSULE<br />

10MG-20MG<br />

PA amlodipine besylate/benazepril LOTREL CAPSULE<br />

5MG-40MG<br />

PA amlodipine besylate/benazepril LOTREL CAPSULE<br />

10MG-40MG<br />

PA amlodipine besylate/benazepril LOTREL CAPSULE<br />

5MG-20MG<br />

PA amlodipine besylate/benazepril LOTREL CAPSULE 5<br />

MG-10 MG<br />

PA amlodipine besylate/benazepril LOTREL CAPSULE<br />

2.5MG-10MG<br />

Ace Inhibitor/Thiazide & Thiazide-Like Diuretic<br />

benazepril/hydrochlorothiazide LOTENSIN HCT TABLET 5-<br />

6.25MG<br />

benazepril/hydrochlorothiazide LOTENSIN HCT TABLET 10-<br />

12.5MG<br />

benazepril/hydrochlorothiazide LOTENSIN HCT TABLET 20-<br />

12.5 MG<br />

benazepril/hydrochlorothiazide LOTENSIN HCT TABLET 20-<br />

25MG<br />

enalapril/hydrochlorothiazide VASERETIC TABLET<br />

10MG-25MG<br />

enalapril/hydrochlorothiazide VASERETIC TABLET<br />

5MG-12.5MG<br />

lisinopril/hydrochlorothiazide ZESTORETIC TABLET 20-<br />

12.5 MG<br />

lisinopril/hydrochlorothiazide ZESTORETIC TABLET 20-<br />

25MG<br />

lisinopril/hydrochlorothiazide ZESTORETIC TABLET 10-<br />

12.5MG<br />

Alpha-<strong>Adrenergic</strong> <strong>Blocking</strong> <strong>Agents</strong><br />

doxazosin mesylate CARDURA TABLET 1<br />

MG<br />

doxazosin mesylate CARDURA TABLET 2<br />

MG<br />

doxazosin mesylate CARDURA TABLET 4<br />

MG<br />

doxazosin mesylate CARDURA TABLET 8<br />

MG<br />

prazosin hcl MINIPRESS CAPSULE 1<br />

MG<br />

terazosin hcl HYTRIN CAPSULE 1<br />

MG<br />

terazosin hcl HYTRIN CAPSULE 2


MG<br />

terazosin hcl HYTRIN CAPSULE 5<br />

MG<br />

terazosin hcl HYTRIN CAPSULE 10<br />

MG<br />

Alpha/<strong>Beta</strong>-<strong>Adrenergic</strong> <strong>Blocking</strong> <strong>Agents</strong><br />

carvedilol COREG TABLET 25<br />

MG<br />

carvedilol COREG TABLET 12.5<br />

MG<br />

carvedilol COREG TABLET 3.125<br />

MG<br />

carvedilol COREG TABLET 6.25<br />

MG<br />

PA carvedilol phosphate COREG CR CPMP 24HR<br />

10 MG<br />

PA carvedilol phosphate COREG CR CPMP 24HR<br />

20 MG<br />

PA carvedilol phosphate COREG CR CPMP 24HR<br />

40 MG<br />

PA carvedilol phosphate COREG CR CPMP 24HR<br />

80 MG<br />

labetalol hcl TRANDATE TABLET 300<br />

MG<br />

labetalol hcl TRANDATE TABLET 200<br />

MG<br />

labetalol hcl TRANDATE TABLET 100<br />

MG<br />

Angiotensin Receptor Antag./Thiazide Diuretic Comb<br />

QL losartan/hydrochlorothiazide HYZAAR TABLET 50-<br />

12.5 MG<br />

QL losartan/hydrochlorothiazide HYZAAR TABLET<br />

100MG-25MG<br />

QL losartan/hydrochlorothiazide HYZAAR TABLET 100-<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

12.5MG<br />

valsartan/hydrochlorothiazide DIOVAN HCT TABLET 80-<br />

12.5MG<br />

valsartan/hydrochlorothiazide DIOVAN HCT TABLET 160-<br />

12.5MG<br />

valsartan/hydrochlorothiazide DIOVAN HCT TABLET 160-<br />

25MG<br />

valsartan/hydrochlorothiazide DIOVAN HCT TABLET<br />

320MG-25MG<br />

valsartan/hydrochlorothiazide DIOVAN HCT TABLET 320-<br />

12.5MG


Antihypertensives, Ace Inhibitors<br />

benazepril hcl LOTENSIN TABLET 5<br />

MG<br />

benazepril hcl LOTENSIN TABLET 10<br />

MG<br />

benazepril hcl LOTENSIN TABLET 20<br />

MG<br />

benazepril hcl LOTENSIN TABLET 40<br />

MG<br />

captopril CAPOTEN TABLET 100<br />

MG<br />

captopril CAPOTEN TABLET 25<br />

MG<br />

captopril CAPOTEN TABLET 50<br />

MG<br />

captopril CAPOTEN TABLET 12.5<br />

MG<br />

enalapril maleate VASOTEC TABLET 5<br />

MG<br />

enalapril maleate VASOTEC TABLET 10<br />

MG<br />

enalapril maleate VASOTEC TABLET 20<br />

MG<br />

enalapril maleate VASOTEC TABLET 2.5<br />

MG<br />

lisinopril PRINIVIL TABLET 5<br />

MG<br />

lisinopril PRINIVIL TABLET 10<br />

MG<br />

lisinopril PRINIVIL TABLET 20<br />

MG<br />

lisinopril PRINIVIL TABLET 40<br />

MG<br />

lisinopril PRINIVIL TABLET 2.5<br />

MG<br />

lisinopril PRINIVIL TABLET 30<br />

MG<br />

QL ramipril ALTACE CAPSULE<br />

1.25 MG<br />

QL ramipril ALTACE CAPSULE 2.5<br />

MG<br />

QL ramipril ALTACE CAPSULE 5<br />

MG<br />

ramipril ALTACE CAPSULE 10<br />

MG


Antihypertensives, Angiotensin Receptor Antagonist<br />

QL losartan potassium COZAAR TABLET 25<br />

MG<br />

QL losartan potassium COZAAR TABLET 50<br />

MG<br />

QL losartan potassium COZAAR TABLET 100<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

MG<br />

valsartan DIOVAN TABLET 320<br />

MG<br />

valsartan DIOVAN TABLET 160<br />

MG<br />

valsartan DIOVAN TABLET 80<br />

MG<br />

valsartan DIOVAN TABLET 40<br />

MG<br />

Antihypertensives, Sympatholytic<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

clonidine CATAPRES PATCH<br />

TDWK<br />

0.1MG/24HR<br />

clonidine CATAPRES PATCH<br />

TDWK<br />

0.2MG/24HR<br />

clonidine CATAPRES PATCH<br />

TDWK<br />

0.3MG/24HR<br />

clonidine hcl CATAPRES TABLET 0.1<br />

MG<br />

clonidine hcl CATAPRES TABLET 0.2<br />

MG<br />

clonidine hcl CATAPRES TABLET 0.3<br />

MG<br />

guanfacine hcl TENEX TABLET 1<br />

MG<br />

guanfacine hcl TENEX TABLET 2<br />

MG<br />

methyldopa ALDOMET TABLET 125<br />

MG<br />

methyldopa ALDOMET TABLET 250<br />

MG<br />

methyldopa ALDOMET TABLET 500<br />

MG<br />

methyldopa/hydrochlorothiazide METHYLDOPA/HYDROCHLOROTHIAZIDE TABLET<br />

250MG-15MG<br />

methyldopa/hydrochlorothiazide METHYLDOPA/HYDROCHLOROTHIAZIDE TABLET<br />

250MG-25MG


methyldopa/hydrochlorothiazide ALDORIL-D50 TABLET<br />

500MG-50MG<br />

reserpine RESERPINE TABLET 0.25<br />

MG<br />

reserpine/hydrochlorothiazide RESERPINE/HYDROCHLOROTHIAZIDE TABLET<br />

0.125-25MG<br />

reserpine/hydrochlorothiazide RESERPINE/HYDROCHLOROTHIAZIDE TABLET<br />

0.125-50MG<br />

Antihypertensives, Vasodilators<br />

hydralazine hcl APRESOLINE TABLET 10<br />

MG<br />

hydralazine hcl APRESOLINE TABLET 100<br />

MG<br />

hydralazine hcl APRESOLINE TABLET 25<br />

MG<br />

hydralazine hcl APRESOLINE TABLET 50<br />

MG<br />

minoxidil MINOXIDIL TABLET 10<br />

MG<br />

minoxidil MINOXIDIL TABLET 2.5<br />

MG<br />

<strong>Beta</strong>-<strong>Adrenergic</strong> <strong>Blocking</strong> <strong>Agents</strong><br />

atenolol TENORMIN TABLET 100<br />

MG<br />

atenolol TENORMIN TABLET 50<br />

MG<br />

atenolol TENORMIN TABLET 25<br />

MG<br />

ST metoprolol succinate TOPROL XL TAB ER 24H<br />

25 MG<br />

ST metoprolol succinate TOPROL XL TAB ER 24H<br />

50 MG<br />

ST metoprolol succinate TOPROL XL TAB ER 24H<br />

100 MG<br />

ST metoprolol succinate TOPROL XL TAB ER 24H<br />

200 MG<br />

metoprolol tartrate LOPRESSOR TABLET 25<br />

MG<br />

metoprolol tartrate LOPRESSOR TABLET 100<br />

MG<br />

metoprolol tartrate LOPRESSOR TABLET 50<br />

MG<br />

nadolol CORGARD TABLET 40<br />

MG<br />

nadolol CORGARD TABLET 80


MG<br />

nadolol CORGARD TABLET 20<br />

MG<br />

PA nebivolol hcl BYSTOLIC TABLET 5<br />

MG<br />

PA nebivolol hcl BYSTOLIC TABLET 20<br />

MG<br />

PA nebivolol hcl BYSTOLIC TABLET 2.5<br />

MG<br />

PA nebivolol hcl BYSTOLIC TABLET 10<br />

MG<br />

pindolol PINDOLOL TABLET 10<br />

MG<br />

pindolol PINDOLOL TABLET 5<br />

MG<br />

QL+ propranolol hcl INDERAL LA CAP SA 24H<br />

ST<br />

80 MG<br />

QL+ propranolol hcl INDERAL LA CAP SA 24H<br />

ST<br />

120 MG<br />

QL+ propranolol hcl INDERAL LA CAP SA 24H<br />

ST<br />

QL+<br />

ST<br />

160 MG<br />

propranolol hcl INDERAL LA CAP SA 24H<br />

60 MG<br />

propranolol hcl INDERAL LA TABLET 10<br />

MG<br />

propranolol hcl INDERAL LA TABLET 20<br />

MG<br />

propranolol hcl INDERAL LA TABLET 40<br />

MG<br />

propranolol hcl INDERAL LA TABLET 60<br />

MG<br />

propranolol hcl INDERAL LA TABLET 80<br />

MG<br />

propranolol hcl INDERAL LA SOLUTION 20<br />

MG/5 ML<br />

propranolol hcl INDERAL LA SOLUTION<br />

40MG/5ML<br />

QL sotalol hcl BETAPACE TABLET 160<br />

MG<br />

QL sotalol hcl BETAPACE TABLET 80<br />

MG<br />

QL sotalol hcl BETAPACE TABLET 240<br />

MG<br />

QL sotalol hcl BETAPACE TABLET 120<br />

MG<br />

<strong>Beta</strong>-<strong>Adrenergic</strong> <strong>Blocking</strong> <strong>Agents</strong>/Thiazide & Related


atenolol/chlorthalidone TENORETIC 50 TABLET 50<br />

MG-25MG<br />

atenolol/chlorthalidone TENORETIC 50 TABLET<br />

100MG-25MG<br />

bisoprolol fumarate/hctz ZIAC TABLET 2.5-<br />

6.25MG<br />

bisoprolol fumarate/hctz ZIAC TABLET 5-<br />

6.25MG<br />

bisoprolol fumarate/hctz ZIAC TABLET 10-<br />

6.25MG<br />

propranolol/hydrochlorothiazid INDERIDE-40/25 TABLET 40<br />

MG-25MG<br />

propranolol/hydrochlorothiazid INDERIDE-40/25 TABLET 80<br />

MG-25MG<br />

Calcium Channel <strong>Blocking</strong> <strong>Agents</strong><br />

QL amlodipine besylate NORVASC TABLET 2.5<br />

MG<br />

amlodipine besylate NORVASC TABLET 10<br />

MG<br />

QL amlodipine besylate NORVASC TABLET 5<br />

MG<br />

QL diltiazem hcl CARDIZEM CD CAP ER 12H<br />

90 MG<br />

QL diltiazem hcl CARDIZEM CD CAP ER 12H<br />

120 MG<br />

QL diltiazem hcl CARDIZEM CD CAP ER 12H<br />

60 MG<br />

QL diltiazem hcl CARDIZEM CD CAP ER 24H<br />

180 MG<br />

QL diltiazem hcl CARDIZEM CD CAP ER 24H<br />

240 MG<br />

QL diltiazem hcl CARDIZEM CD CAP ER 24H<br />

300 MG<br />

QL diltiazem hcl CARDIZEM CD CAP ER 24H<br />

120 MG<br />

QL diltiazem hcl CARDIZEM CD CAPSULE ER<br />

360 MG<br />

diltiazem hcl CARDIZEM CD CAPSULE ER<br />

300 MG<br />

diltiazem hcl CARDIZEM CD TABLET 30<br />

MG<br />

diltiazem hcl CARDIZEM CD TABLET 60<br />

MG<br />

diltiazem hcl CARDIZEM CD TABLET 90<br />

MG<br />

diltiazem hcl CARDIZEM CD TABLET 120


MG<br />

QL diltiazem hcl CARDIZEM CD CAP ER DEG<br />

180 MG<br />

QL diltiazem hcl CARDIZEM CD CAP ER DEG<br />

240 MG<br />

QL diltiazem hcl CARDIZEM CD CAP ER DEG<br />

120 MG<br />

PA felodipine PLENDIL TAB ER 24H<br />

2.5 MG<br />

PA felodipine PLENDIL TAB ER 24H 5<br />

MG<br />

PA felodipine PLENDIL TAB ER 24H<br />

10 MG<br />

nicardipine hcl CARDENE I.V. CAPSULE 20<br />

MG<br />

nicardipine hcl CARDENE I.V. CAPSULE 30<br />

MG<br />

QL nifedipine ADALAT CC TAB ER 24 30<br />

MG<br />

QL nifedipine ADALAT CC TAB ER 24 60<br />

MG<br />

QL nifedipine ADALAT CC TAB ER 24 90<br />

MG<br />

QL nifedipine ADALAT CC TABLET ER<br />

90 MG<br />

QL nifedipine ADALAT CC TABLET ER<br />

60 MG<br />

QL nifedipine ADALAT CC TABLET ER<br />

30 MG<br />

QL nifedipine ADALAT CC CAPSULE 10<br />

MG<br />

QL nifedipine ADALAT CC CAPSULE 20<br />

MG<br />

verapamil hcl VERELAN TABLET 120<br />

MG<br />

verapamil hcl VERELAN TABLET 80<br />

MG<br />

QL verapamil hcl VERELAN CAP24H PEL<br />

180 MG<br />

verapamil hcl VERELAN CAP24H PEL<br />

240 MG<br />

QL verapamil hcl VERELAN CAP24H PEL<br />

120 MG<br />

QL verapamil hcl VERELAN CAP24H PEL<br />

360 MG<br />

verapamil hcl VERELAN TABLET ER


240 MG<br />

QL verapamil hcl VERELAN TABLET ER<br />

180 MG<br />

QL verapamil hcl VERELAN TABLET ER<br />

120 MG<br />

verapamil hcl VERELAN TABLET 40<br />

MG<br />

Loop Diuretics<br />

bumetanide BUMEX TABLET 0.5<br />

MG<br />

bumetanide BUMEX TABLET 1<br />

MG<br />

bumetanide BUMEX TABLET 2<br />

MG<br />

furosemide LASIX SOLUTION 10<br />

MG/ML<br />

furosemide LASIX TABLET 20<br />

MG<br />

furosemide LASIX TABLET 40<br />

MG<br />

furosemide LASIX TABLET 80<br />

MG<br />

Potassium Sparing Diuretics<br />

spironolactone ALDACTONE TABLET 100<br />

MG<br />

spironolactone ALDACTONE TABLET 25<br />

MG<br />

spironolactone ALDACTONE TABLET 50<br />

MG<br />

Potassium Sparing Diuretics In Combination<br />

spironolact/hydrochlorothiazid ALDACTAZIDE TABLET 25-<br />

25MG<br />

spironolact/hydrochlorothiazid ALDACTAZIDE TABLET 50<br />

MG-50MG<br />

triamterene/hydrochlorothiazid MAXZIDE CAPSULE<br />

37.5-25MG<br />

triamterene/hydrochlorothiazid MAXZIDE TABLET 75<br />

MG-50MG<br />

triamterene/hydrochlorothiazid MAXZIDE TABLET 37.5-<br />

25MG<br />

Pulm.anti-Htn,Sel.c-Gmp Phosphodiesterase T5 Inhib<br />

AGE tadalafil ADCIRCA TABLET 20<br />

MG<br />

Pulmonary Anti-Htn, Endothelin Receptor Antagonist


AGE bosentan TRACLEER TABLET 125<br />

MG<br />

AGE bosentan TRACLEER TABLET 62.5<br />

MG<br />

Renin Inhibitor, Direct<br />

PA aliskiren hemifumarate TEKTURNA TABLET 300<br />

MG<br />

PA aliskiren hemifumarate TEKTURNA TABLET 150<br />

MG<br />

Renin Inhibitor,Direct & Angiotensin Recept Antag.<br />

PA aliskiren/valsartan VALTURNA TABLET 150-<br />

160MG<br />

PA aliskiren/valsartan VALTURNA TABLET 300-<br />

320MG<br />

Thiazide And Related Diuretics<br />

chlorthalidone CHLORTHALIDONE TABLET 25<br />

MG<br />

chlorthalidone CHLORTHALIDONE TABLET 50<br />

MG<br />

hydrochlorothiazide MICROZIDE CAPSULE<br />

12.5 MG<br />

hydrochlorothiazide MICROZIDE TABLET 25<br />

MG<br />

hydrochlorothiazide MICROZIDE TABLET 50<br />

MG<br />

indapamide LOZOL TABLET 2.5<br />

MG<br />

indapamide LOZOL TABLET 1.25<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

MG<br />

metolazone ZAROXOLYN TABLET 10<br />

MG<br />

metolazone ZAROXOLYN TABLET 2.5<br />

MG<br />

metolazone ZAROXOLYN TABLET 5<br />

MG<br />

CARDIOVASCULAR DISEASE - LIPID<br />

IRREGULARITY<br />

Antihyperlipidemic - Hmg Coa Reductase Inhibitors<br />

AGE+ atorvastatin calcium LIPITOR TABLET 10<br />

QL<br />

MG<br />

AGE+ atorvastatin calcium LIPITOR TABLET 20<br />

QL<br />

MG


AGE+ atorvastatin calcium LIPITOR TABLET 40<br />

QL<br />

MG<br />

AGE+ atorvastatin calcium LIPITOR TABLET 80<br />

QL<br />

MG<br />

pravastatin sodium PRAVACHOL TABLET 80<br />

MG<br />

pravastatin sodium PRAVACHOL TABLET 10<br />

MG<br />

pravastatin sodium PRAVACHOL TABLET 20<br />

MG<br />

pravastatin sodium PRAVACHOL TABLET 40<br />

MG<br />

simvastatin ZOCOR TABLET 5<br />

MG<br />

simvastatin ZOCOR TABLET 10<br />

MG<br />

simvastatin ZOCOR TABLET 20<br />

MG<br />

simvastatin ZOCOR TABLET 40<br />

MG<br />

Bile Salt Sequestrants<br />

cholestyramine (with sugar) QUESTRAN POWDER 4 G<br />

QL cholestyramine/aspartame QUESTRAN LIGHT POWDER 4 G<br />

QL cholestyramine/aspartame QUESTRAN LIGHT PACKET 4 G<br />

colestipol hcl COLESTID PACKET 5 G<br />

colestipol hcl COLESTID PACKET 7.5G<br />

colestipol hcl COLESTID TABLET 1 G<br />

colestipol hcl COLESTID GRANULES 5<br />

G<br />

Lipotropics<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

fenofibrate nanocrystallized TRICOR TABLET 48<br />

MG<br />

fenofibrate nanocrystallized TRICOR TABLET<br />

145MG<br />

gemfibrozil LOPID TABLET 600<br />

MG<br />

PA omega-3 acid ethyl esters LOVAZA CAPSULE 1 G<br />

QL omega-3 fatty acids/fish oil FISH OIL OMEGA-3 CAPSULE<br />

300-1000MG<br />

QL omega-3 fatty acids/fish oil OMEGA-3 FATTY ACIDS/FISH OIL CAPSULE<br />

340-1000MG<br />

QL omega-3 fatty acids/fish oil FISH OIL OMEGA-3 CAPSULE<br />

340-1000MG<br />

QL omega-3 fatty acids/fish oil FISH OIL OMEGA-3 CAPSULE<br />

396-1200MG


QL omega-3 fatty acids/vitamin e OMEGA-3 FATTY ACIDS/VITAMIN E CAPSULE<br />

1000 MG<br />

Niacin Preparations<br />

niacin SLO-NIACIN CAPSULE ER<br />

400 MG<br />

niacin SLO-NIACIN CAPSULE ER<br />

500 MG<br />

niacin SLO-NIACIN CAPSULE ER<br />

250 MG<br />

niacin SLO-NIACIN CAPSULE ER<br />

125 MG<br />

niacin SLO-NIACIN TABLET 500<br />

MG<br />

niacin SLO-NIACIN TABLET<br />

100MG<br />

niacin SLO-NIACIN TABLET 250<br />

MG<br />

niacin SLO-NIACIN TABLET<br />

50MG<br />

niacin SLO-NIACIN TABLET ER<br />

250 MG<br />

niacin SLO-NIACIN TABLET ER<br />

500 MG<br />

niacin SLO-NIACIN TABLET ER<br />

750 MG<br />

niacin SLO-NIACIN TABLET ER<br />

1000 MG<br />

CARDIOVASCULAR DISEASE -<br />

VASODILATION<br />

Vasodilators,Coronary<br />

isosorbide dinitrate ISORDIL TITRADOSE TABLET 10<br />

MG<br />

isosorbide dinitrate ISORDIL TITRADOSE TABLET 20<br />

MG<br />

isosorbide dinitrate ISORDIL TITRADOSE TABLET 5<br />

MG<br />

isosorbide dinitrate ISORDIL TITRADOSE TAB SUBL 5<br />

MG<br />

isosorbide dinitrate ISORDIL TITRADOSE TAB SUBL 2.5<br />

MG<br />

isosorbide mononitrate MONOKET TABLET 20<br />

MG<br />

isosorbide mononitrate MONOKET TABLET 10


MG<br />

isosorbide mononitrate MONOKET TAB ER 24H<br />

60 MG<br />

isosorbide mononitrate MONOKET TAB ER 24H<br />

120 MG<br />

isosorbide mononitrate MONOKET TAB ER 24H<br />

30 MG<br />

nitroglycerin NITRO-DUR CAPSULE ER<br />

2.5 MG<br />

nitroglycerin NITRO-DUR CAPSULE ER<br />

6.5 MG<br />

nitroglycerin NITRO-DUR CAPSULE ER<br />

9 MG<br />

nitroglycerin NITRO-BID OINT. (G) 2 %<br />

nitroglycerin NITRO-DUR PATCH TD24<br />

0.4MG/HR<br />

nitroglycerin NITRO-DUR PATCH TD24<br />

0.2MG/HR<br />

nitroglycerin NITRO-DUR PATCH TD24<br />

0.3 MG/HR<br />

nitroglycerin NITRO-DUR PATCH TD24<br />

0.8MG/HR<br />

nitroglycerin NITROSTAT TAB SUBL 0.3<br />

MG<br />

nitroglycerin NITROSTAT TAB SUBL 0.4<br />

MG<br />

nitroglycerin NITROSTAT TAB SUBL 0.6<br />

MG<br />

Vasodilators,Peripheral<br />

ergoloid mesylates ERGOLOID MESYLATES TAB SUBL<br />

1MG<br />

CONTRACEPTION/OXYTOCICS<br />

Contraceptives, Intravaginal, Systemic<br />

etonogestrel/ethinyl estradiol NUVARING VAG RING<br />

0.12-0.015<br />

Contraceptives,Injectable<br />

QL medroxyprogesterone acetate DEPO-PROVERA VIAL 150<br />

MG/ML<br />

QL medroxyprogesterone acetate DEPO-PROVERA DISP SYRIN<br />

150 MG/ML<br />

Contraceptives,Intravaginal<br />

nonoxynol 9 DELFEN FOAM/APPL<br />

12.5%


nonoxynol 9 GYNOL II JELLY/APPL<br />

2 %<br />

nonoxynol 9 GYNOL II JELLY/APPL<br />

3 %<br />

nonoxynol 9 SHUR-SEAL PACKET 2 %<br />

Contraceptives,Oral<br />

GEN desogestrel-ethinyl estradiol DESOGEN TABLET 0.15-<br />

0.03<br />

PA+<br />

GEN<br />

ethinyl estradiol/drospirenone ETHINYL ESTRADIOL/DROSPIRENONE<br />

YASMIN 28<br />

TABLET 0.03-<br />

3MG<br />

PA+<br />

GEN<br />

ethinyl estradiol/drospirenone ETHINYL ESTRADIOL/DROSPIRENONE<br />

YAZ<br />

TABLET 0.02-<br />

3(24)<br />

GEN ethynodiol d-ethinyl estradiol DEMULEN 1-50-21 TABLET 1<br />

MG-35MCG<br />

GEN ethynodiol d-ethinyl estradiol DEMULEN 1-50-21 TABLET 1<br />

MG-50MCG<br />

GEN levonorgestrel PLAN B ONE-STEP TABLET 1.5<br />

MG<br />

GEN levonorgestrel PLAN B TABLET 0.75<br />

MG<br />

GEN levonorgestrel-eth estradiol SEASONALE TABLET 0.15-<br />

0.03<br />

GEN levonorgestrel-eth estradiol SEASONALE TABLET 6-5-<br />

10<br />

GEN levonorgestrel-eth estradiol SEASONALE TABLET 0.1-<br />

0.02<br />

GEN noreth a-et estra/fe fumarate LOESTRIN FE TABLET 1.5-<br />

0.03MG<br />

GEN noreth a-et estra/fe fumarate LOESTRIN FE TABLET<br />

1MG-20MCG<br />

GEN noreth a-et estra/fe fumarate LOESTRIN FE TABLET 5-7-<br />

9-7<br />

GEN norethindrone MICRONOR TABLET 0.35<br />

MG<br />

GEN norethindrone a-e estradiol LOESTRIN TABLET 1.5-<br />

0.03MG<br />

GEN norethindrone a-e estradiol LOESTRIN TABLET<br />

1MG-20MCG<br />

GEN norethindrone-ethinyl estrad ORTHO-NOVUM TABLET 0.4-<br />

0.035<br />

GEN norethindrone-ethinyl estrad ORTHO-NOVUM TABLET 0.5-<br />

0.035<br />

GEN norethindrone-ethinyl estrad ORTHO-NOVUM TABLET 1<br />

MG-35MCG<br />

GEN norethindrone-ethinyl estrad OVCON-50 TABLET 1<br />

MG-50MCG


GEN norethindrone-ethinyl estrad ORTHO-NOVUM TABLET 10-<br />

11<br />

GEN norethindrone-ethinyl estrad ORTHO-NOVUM TABLET 7<br />

DAYS X 3<br />

GEN norethindrone-ethinyl estrad ORTHO-NOVUM TABLET 7-9-5<br />

GEN norethindrone-mestranol NORINYL 1+50 TABLET 1<br />

MG-50MCG<br />

GEN norgestimate-ethinyl estradiol ORTHO-CYCLEN TABLET 0.25-<br />

0.035<br />

GEN norgestimate-ethinyl estradiol ORTHO-CYCLEN TABLET<br />

7DAYSX3 28<br />

GEN norgestimate-ethinyl estradiol ORTHO TRI-CYCLEN LO TABLET<br />

7DAYSX3 LO<br />

GEN norgestrel-ethinyl estradiol LO-OVRAL-28 TABLET 0.3-<br />

0.03MG<br />

GEN norgestrel-ethinyl estradiol LO-OVRAL-28 TABLET 0.5-<br />

0.05MG<br />

Contraceptives,Transdermal<br />

PA norelgestromin/ethin.estradiol ORTHO EVRA PATCH<br />

TDWK 150-<br />

20/24H<br />

Diaphragms/Cervical Cap<br />

diaphragm fitting set,arcsprng<br />

ORTHO ALL-FLEX<br />

WIDE SEAL DIAPHRAGM<br />

EACH<br />

Oxytocics<br />

methylergonovine maleate METHERGINE TABLET 0.2<br />

MG<br />

COUGH AND COLD<br />

1st Gen Antihistamine & Decongestant Combinations<br />

p-ephed hcl/triprolidine hcl ZYMINE-D SYRUP 30-<br />

1.25/5<br />

p-ephed hcl/triprolidine hcl ZYMINE-D TABLET 60-<br />

2.5MG<br />

phenylephrine hcl/prometh hcl PROMETHAZINE-PHENYLEPHRINE SYRUP 5-<br />

6.25MG/5<br />

phenylephrine/chlorpheniramine DALLERGY LIQUID 10-<br />

4MG/5ML<br />

pseudoephed/chlorpheniramine TRIAMINIC COLD & ALLERGY SYRUP 15-<br />

1MG/5ML<br />

pseudoephed/chlorpheniramine TRIAMINIC COLD & ALLERGY LIQUID 30-<br />

2MG/5ML<br />

pseudoephed/chlorpheniramine TRIAMINIC COLD & ALLERGY TABLET 60<br />

MG-4 MG


pseudoephed/chlorpheniramine TRIAMINIC COLD & ALLERGY TABLET 60<br />

MG-4 MG<br />

pseudoephed/diphenhydramine BENADRYL-D TABLET 60-<br />

25MG<br />

pseudoephedrine/brompheniramin BROVEX PSB LIQUID 15-<br />

1MG/5ML<br />

1st Gen Antihistamine-Decongestant-Analgesic Comb<br />

p-ephed hcl/acetaminophn/cp ACTIFED COLD & SINUS TABLET 30-<br />

500-2MG<br />

Antitussives,Non-Narcotic<br />

dextromethorphan hbr SCOT-TUSSIN LIQUID 10<br />

MG/5 ML<br />

dextromethorphan hbr SCOT-TUSSIN LIQUID 15<br />

MG/5 ML<br />

dextromethorphan hbr SCOT-TUSSIN SYRUP 10<br />

MG/5 ML<br />

dextromethorphan hbr SCOT-TUSSIN SYRUP 5<br />

MG/5 ML<br />

dextromethorphan hbr SCOT-TUSSIN SYRUP 15<br />

MG/5 ML<br />

dextromethorphan hbr SCOT-TUSSIN SYRUP 7.5<br />

MG/5ML<br />

Cough And/Or Cold Preparations<br />

dm hb/p-ephed hcl/apap/doxylam DM HB/P-EPHED HCL/APAP/DOXYLAM LIQUID<br />

Decongestant-Expectorant Combinations<br />

guaifenesin/p-ephed hcl POLY-VENT IR SYRUP 50-<br />

15MG/5<br />

guaifenesin/p-ephed hcl TUSNEL PEDIATRIC DROPS 50-<br />

7.5MG/1<br />

guaifenesin/p-ephed hcl POLY-VENT IR SYRUP 100-<br />

30MG/5<br />

guaifenesin/phenylephrine hcl LIQUIBID PD-R LIQUID 100-5<br />

MG/5<br />

guaifenesin/phenylephrine hcl NUMONYL LIQUID 225-<br />

10MG/5<br />

guaifenesin/phenylephrine hcl NUMONYL PEDIATRIC DROPS 45-<br />

2MG/ML<br />

Expectorants<br />

guaifenesin MUCINEX SYRUP 100<br />

MG/5ML<br />

guaifenesin MUCINEX LIQUID 100<br />

MG/5ML<br />

guaifenesin MUCINEX LIQUID 100<br />

MG/5ML


guaifenesin MUCINEX TABLET 400<br />

MG<br />

Narcotic Antituss-1st Gen. Antihistamine-Decongest<br />

phenylephrine hcl/cod/prometh PHENYLEPHRINE HCL/COD/PROMETH SYRUP 5-10-<br />

6.25<br />

Narcotic Antitussive-1st Generation Antihistamine<br />

codeine/promethazine hcl CODEINE/PROMETHAZINE HCL SYRUP 10-<br />

6.25/5<br />

Narcotic Antitussive-Anticholinergic Comb.<br />

AGE hydrocodone bit/homatropine HYCODAN SYRUP 5-<br />

1.5MG/5<br />

Narcotic Antitussive-Expectorant Combination<br />

guaifenesin/codeine phosphate PRO-CLEAR CAPS LIQUID 100-<br />

10MG/5<br />

guaifenesin/codeine phosphate PRO-CLEAR CAPS LIQUID 100-<br />

10MG/5<br />

Non-Narc Antitus-1st Gen Antihist-Decon-Analges Cb<br />

dm/p-ephed/acetaminoph/doxylam VICKS NYQUIL LIQUID 15-<br />

500/15<br />

Non-Narc Antituss-1st Gen. Antihistamine-Decongest<br />

d-methorphan hb/p-epd hcl/bpm DIMETANE-DX ELIXIR 5-15-<br />

1MG/5<br />

d-methorphan hb/p-ephed hcl/cp VICKS CHILDREN'S NYQUIL SYRUP 15-15-<br />

2/5<br />

d-methorphan hb/p-ephed hcl/cp VICKS CHILDREN'S NYQUIL LIQUID 5-10-<br />

0.7/5<br />

d-methorphan hb/p-ephed hcl/cp RESCON-DM LIQUID 10-30-<br />

2/5<br />

d-methorphan hb/p-ephed hcl/cp VICKS CHILDREN'S NYQUIL SYRUP 15-30-<br />

2/15<br />

d-methorphan hb/p-ephed hcl/cp VICKS CHILDREN'S NYQUIL LIQUID 5-15-<br />

1MG/5<br />

dm hb/p-ephed hcl/carbinox DM HB/P-EPHED HCL/CARBINOX SYRUP 15-60-<br />

4/5<br />

dm/phenyleph/chlorpheniramine ACCUHIST PDX SYRUP 15-10-<br />

2/5<br />

dm/phenyleph/chlorpheniramine ACCUHIST PDX LIQUID 15-10-<br />

4/5<br />

dm/phenyleph/chlorpheniramine ACCUHIST PDX LIQUID 15-5-<br />

2MG/5<br />

Non-Narc Antitussive-1st Gen Antihistamine Comb.<br />

d-methorphan hb/prometh hcl PROMETHAZINE-DM SYRUP 15-<br />

6.25/5


dextromethorphan hbr/chlor-mal CORICIDIN HBP LIQUID 15-<br />

2MG/5ML<br />

Non-Narcotic Antituss-Decongestant-Expectorant Cmb<br />

guaifen/d-methorphan hb/pe BRONTUSS SF SYRUP 100-<br />

10-5<br />

guaifen/dm hb/p-ephedrine POLY-VENT DM LIQUID 67-10<br />

guaifenesin/dm/pseudoephedrine POLY-VENT DM SYRUP 100-<br />

10-30<br />

guaifenesin/dm/pseudoephedrine RU-TUSS DM LIQUID 100-<br />

15-45<br />

Non-Narcotic Antitussive And Expectorant Comb.<br />

guaifenesin/d-methorphan hb MUCINEX COUGH SYRUP 100-<br />

10MG/5<br />

guaifenesin/dextromethorphan MUCINEX COUGH SYRUP 200-<br />

10MG/5<br />

guaifenesin/dextromethorphan MUCINEX COUGH LIQUID 200-<br />

10MG/5<br />

guaifenesin/dextromethorphan MUCINEX COUGH SYRUP 100-<br />

15MG/5<br />

guaifenesin/dextromethorphan MUCINEX COUGH LIQUID 100-<br />

10MG/5<br />

guaifenesin/dextromethorphan MUCINEX COUGH LIQUID 200-<br />

30MG/5<br />

guaifenesin/dextromethorphan VICKS 44E COUGH & CHEST ELIXIR 66.7-<br />

6.7/5<br />

guaifenesin/dextromethorphan MUCINEX COUGH LIQUID 100-5<br />

MG/5<br />

guaifenesin/dextromethorphan MUCINEX COUGH LIQUID 100-<br />

15MG/5<br />

guaifenesin/dextromethorphan SCOT-TUSSIN SENIOR LIQUID 200-<br />

15MG/5<br />

Non-Narcotic Antitussive-Decongestant Combinations<br />

d-methorphan hb/p-ephed hcl PEDIACARE LIQUID 15-<br />

30MG/5<br />

dextromethorphan/pseudoephed VICKS 44D COUGH & HEAD ELIXIR 10-<br />

20MG/5<br />

dextromethorphan/pseudoephed PEDIACARE DROPS 2.5-<br />

7.5/.8<br />

dextromethorphan/pseudoephed PEDIACARE SYRUP 7.5-<br />

15MG/5<br />

Non-Narcotic Antitussive-Decongestant-Analgesic Cb<br />

dm/pseudoephed/acetaminophen TYLENOL INFANTS PLUS COLD-COUG DROPS 5-15-<br />

160MG<br />

Nose Preparations, Vasoconstrictors (rx)


QL epinephrine hcl ADRENALIN CHLORIDE SOLUTION<br />

1:1000<br />

Sympathomimetic <strong>Agents</strong><br />

ephedrine sulfate EPHEDRINE SULFATE CAPSULE 25<br />

MG<br />

phenylpropanolamine hcl PHENYLPROPANOLAMINE HCL TABLET<br />

50MG<br />

pseudoephedrine hcl SUDAFED DROPS<br />

9.4MG/ML<br />

pseudoephedrine hcl SUDAFED LIQUID 15<br />

MG/5 ML<br />

pseudoephedrine hcl SUDAFED LIQUID 30<br />

MG/5 ML<br />

pseudoephedrine hcl PSEUDOEPHEDRINE HCL TABLET 30<br />

MG<br />

pseudoephedrine hcl SUDAFED TABLET<br />

60MG<br />

pseudoephedrine hcl SUDAFED TABLET ER<br />

120 MG<br />

DERMATOLOGY - ACNE<br />

Acne <strong>Agents</strong>,Topical<br />

ST clindamycin phos/benzoyl perox BENZACLIN GEL (GRAM)<br />

1 %-5 %<br />

Astringents<br />

aluminum acetate ALUMINUM ACETATE SOLUTION<br />

Rosacea <strong>Agents</strong>, Topical<br />

metronidazole METROLOTION GEL (GRAM)<br />

0.75 %<br />

metronidazole METROLOTION CREAM (G)<br />

0.75 %<br />

Topical Preparations,Antibacterials<br />

chlorhexidine gluconate HIBICLENS LIQUID 4 %<br />

chlorhexidine gluconate HIBICLENS LIQUID 4 %<br />

chloroxylenol PERIGIENE LIQUID 0.5 %<br />

chloroxylenol PERIGIENE CLEANSER<br />

0.43%<br />

Vitamin A Derivatives<br />

AGE+ tretinoin RETIN-A GEL (GRAM)<br />

QL<br />

0.01 %<br />

AGE+ tretinoin RETIN-A GEL (GRAM)<br />

QL<br />

0.025 %<br />

AGE tretinoin RETIN-A CREAM (G)


0.05 %<br />

AGE+ tretinoin RETIN-A CREAM (G)<br />

QL<br />

0.1 %<br />

AGE+ tretinoin RETIN-A CREAM (G)<br />

QL<br />

0.025 %<br />

AGE+ tretinoin microspheres<br />

RETIN-A MICRO<br />

GEL (GRAM)<br />

QL<br />

RETIN-A MICRO PUMP<br />

0.04%<br />

AGE+ tretinoin microspheres<br />

RETIN-A MICRO<br />

GEL (GRAM)<br />

QL<br />

RETIN-A MICRO PUMP<br />

0.1 %<br />

DERMATOLOGY - ANTIINFECTIVE<br />

Topical Antibiotics<br />

bacitracin BACITRACIN PACKET 500<br />

UNIT/G<br />

bacitracin BACITRACIN OINT. (G) 500<br />

UNIT/G<br />

bacitracin zinc BACITRACIN ZINC OINT. (G) 500<br />

UNIT/G<br />

bacitracin zinc BACITRACIN ZINC PACKET 500<br />

UNIT/G<br />

bacitracin zinc/polymyx b sulf BACITRACIN ZINC/POLYMYX B SULF OINT. (G) 500-<br />

10K/G<br />

bacitracin/polymyxin b sulfate POLYSPORIN OINT. (G) 500-<br />

10K/G<br />

bacitracin/polymyxin b sulfate POLYSPORIN PACKET<br />

bacitracin/polymyxin b sulfate POLYSPORIN OINT. (G) 500-<br />

10K/G<br />

clindamycin phosphate EVOCLIN SOLUTION 1<br />

%<br />

clindamycin phosphate EVOCLIN LOTION 1 %<br />

clindamycin phosphate EVOCLIN MED. SWAB 1<br />

%<br />

erythromycin base AKNE-MYCIN OINT. (G) 2 %<br />

erythromycin base/ethanol ERYGEL GEL (GRAM)<br />

2 %<br />

erythromycin base/ethanol ERYGEL MED. SWAB 2<br />

%<br />

erythromycin base/ethanol ERYGEL SOLUTION 2<br />

%<br />

ST erythromycin/benzoyl peroxide BENZAMYCINPAK GEL (EA) 3 %-<br />

5 %<br />

ST erythromycin/benzoyl peroxide BENZAMYCIN GEL (GRAM)<br />

3 %-5 %<br />

gentamicin sulfate GENTAMICIN SULFATE CREAM (G)<br />

0.1 %<br />

gentamicin sulfate GENTAMICIN SULFATE OINT. (G) 0.1


Topical Antifungals<br />

chloroxylenol SWEEN PREP MED. PAD 0.5<br />

%<br />

ciclopirox olamine LOPROX SUSPENSION<br />

0.77%<br />

clotrimazole MYCELEX CREAM (G) 1<br />

%<br />

clotrimazole MYCELEX SOLUTION 1<br />

%<br />

ketoconazole NIZORAL A-D SHAMPOO 1<br />

%<br />

ketoconazole NIZORAL SHAMPOO 2<br />

%<br />

ketoconazole NIZORAL CREAM (G) 2<br />

%<br />

miconazole nitrate FUNGOID TINCTURE CREAM (G) 2<br />

%<br />

miconazole nitrate FUNGOID TINCTURE POWDER 2 %<br />

nystatin MYCOSTATIN CREAM (G)<br />

100000/G<br />

nystatin MYCOSTATIN OINT. (G)<br />

100000/G<br />

nystatin/triamcin MYCOGEN II CREAM (G)<br />

100000-0.1<br />

nystatin/triamcin MYCOGEN II OINT. (G)<br />

100000-0.1<br />

tolnaftate TINACTIN CREAM (G) 1<br />

%<br />

tolnaftate TINACTIN PACKET 1 %<br />

tolnaftate TINACTIN SOLUTION 1<br />

%<br />

Topical Antiparasitics<br />

crotamiton EURAX CREAM (G)<br />

10 %<br />

permethrin NIX CREAM (G) 5<br />

%<br />

permethrin NIX LIQUID 1 %<br />

permethrin RID LIQUID 1 %<br />

piperonyl butoxide/pyrethrins RID LIQUID 4%-<br />

0.33%<br />

piperonyl butoxide/pyrethrins RID SHAMPOO<br />

4%-0.33%<br />

piperonyl butoxide/pyrethrins RID SHAMPOO<br />

4%-0.33%<br />

%


piperonyl butoxide/pyrethrins RID LIQUID<br />

Topical Sulfonamides<br />

silver sulfadiazine SILVADENE CREAM (G) 1<br />

%<br />

sulfacetamide sodium/sulfur SUMADAN LOTION 10-<br />

5%(W/W)<br />

DERMATOLOGY - ANTIINFLAMMATORY<br />

Topical Anti-Inflammatory Steroidal<br />

betamethasone dipropionate DIPROSONE CREAM (G)<br />

0.05 %<br />

betamethasone dipropionate DIPROSONE OINT. (G) 0.05<br />

%<br />

betamethasone dipropionate DIPROSONE LOTION 0.05<br />

%<br />

betamethasone valerate VALISONE CREAM (G)<br />

0.1 %<br />

betamethasone valerate VALISONE OINT. (G) 0.1<br />

%<br />

betamethasone valerate VALISONE LOTION 0.1 %<br />

clobetasol propionate OLUX SOLUTION<br />

0.05 %<br />

clobetasol propionate OLUX OINT. (G) 0.05<br />

%<br />

clobetasol propionate OLUX CREAM (G)<br />

0.05 %<br />

desonide TRIDESILON CREAM (G)<br />

0.05 %<br />

desonide TRIDESILON OINT. (G) 0.05<br />

%<br />

fluocinolone acetonide DERMA-SMOOTHE-FS CREAM (G)<br />

0.01 %<br />

fluocinolone acetonide DERMA-SMOOTHE-FS CREAM (G)<br />

0.025 %<br />

fluocinolone acetonide DERMA-SMOOTHE-FS OINT. (G)<br />

0.025 %<br />

fluocinolone acetonide DERMA-SMOOTHE-FS SOLUTION<br />

0.01 %<br />

fluocinonide LIDEX GEL (GRAM)<br />

0.05 %<br />

fluocinonide LIDEX CREAM (G)<br />

0.05 %<br />

fluocinonide LIDEX OINT. (G) 0.05<br />

%<br />

fluocinonide LIDEX SOLUTION


0.05 %<br />

fluocinonide/emollient LIDEX-E CREAM (G)<br />

0.05 %<br />

fluticasone propionate CUTIVATE CREAM (G)<br />

0.05 %<br />

fluticasone propionate CUTIVATE OINT. (G)<br />

0.005 %<br />

hc/mineral oil/petrolat,wht HC/MINERAL OIL/PETROLAT,WHT OINT. (G) 1 %<br />

hydrocortisone CORTIZONE-10 SOLUTION 1<br />

%<br />

hydrocortisone CORTIZONE-10 LOTION 2 %<br />

hydrocortisone CORTIZONE-10 SPRAY 1 %<br />

hydrocortisone CORTIZONE-10 CREAM (G)<br />

0.5 %<br />

hydrocortisone CORTIZONE-10 CREAM (G) 1<br />

%<br />

QL hydrocortisone CORTIZONE-10 CREAM (G)<br />

2.5 %<br />

hydrocortisone CORTIZONE-10 OINT. (G) 0.5<br />

%<br />

hydrocortisone CORTIZONE-10 OINT. (G) 1 %<br />

hydrocortisone CORTIZONE-10 OINT. (G) 2.5<br />

%<br />

hydrocortisone CORTIZONE-10 LOTION 1 %<br />

hydrocortisone CORTIZONE-10 LOTION 2.5 %<br />

QL hydrocortisone acetate CORTAID CREAM (G) 1<br />

%<br />

QL hydrocortisone acetate CORTAID CREAM (G)<br />

0.5 %<br />

QL hydrocortisone acetate CORTAID OINT. (G) 1 %<br />

hydrocortisone acetate/alo ver NUZON OINT.(GM)<br />

0.5%<br />

hydrocortisone acetate/aloe v NUZON CREAM (G)<br />

0.5 %<br />

triamcinolone acetonide KENALOG CREAM (G)<br />

0.025 %<br />

triamcinolone acetonide KENALOG CREAM (G)<br />

0.1 %<br />

triamcinolone acetonide KENALOG CREAM (G)<br />

0.5 %<br />

triamcinolone acetonide KENALOG OINT. (G)<br />

0.025 %<br />

triamcinolone acetonide KENALOG OINT. (G) 0.1<br />

%<br />

triamcinolone acetonide KENALOG OINT. (G) 0.05<br />

%


triamcinolone acetonide KENALOG CREAM 1%<br />

triamcinolone acetonide KENALOG LOTION 0.025<br />

%<br />

triamcinolone acetonide KENALOG LOTION 0.1 %<br />

DERMATOLOGY - ANTIPRURITIC DRUGS<br />

Antipruritics,Topical<br />

diphenhydramine hcl BENADRYL CREAM (G) 2<br />

%<br />

diphenhydramine hcl BENADRYL SPRAY 2%<br />

diphenhydramine hcl BENADRYL SPRAY 1%<br />

diphenhydramine hcl DERMA-PAX LOTION 0.5 %<br />

diphenhydramine hcl BENADRYL GEL (ML) 2 %<br />

diphenhydramine hcl/zinc acet BENADRYL CREAM (G) 2<br />

%-0.1 %<br />

DERMATOLOGY - MISCELLANEOUS<br />

Antiseborrheic <strong>Agents</strong><br />

selenium sulfide SELSUN RX SUSPENSION<br />

2.5 %<br />

Antiseptics,General<br />

alcohol antiseptic pads<br />

ALCOHOL PREP PADS<br />

ALCOHOL SWABS<br />

SINGLE USE SWAB<br />

SURE COMFORT ALCOHOL<br />

SURE-PREP ALCOHOL PREP PADS<br />

MED. PAD<br />

Emollients<br />

ammonium lactate LAC-HYDRIN LOTION 12%<br />

Irrigants<br />

sod chloride/b-6/zinc acet/ca WOUND CLEANSER SPRAY<br />

QL sodium chloride irrig solution SODIUM CHLORIDE IRRIG SOLUTION IRRIG SOLN<br />

0.9 %<br />

Irritants/Counter-Irritants<br />

coal tar CUTAR L.C.D. EMULSION<br />

7.5 %<br />

coal tar DHS TAR CREAM (G) 2<br />

%<br />

Keratolytics<br />

benzoyl peroxide BENZAC AC GEL (GRAM)<br />

10 %<br />

benzoyl peroxide BENZAC AC GEL (GRAM)<br />

5 %<br />

benzoyl peroxide BENZAC AC GEL (GRAM)


2.5 %<br />

benzoyl peroxide BENZAC AC CLEANSER 5<br />

%<br />

benzoyl peroxide BP WASH CLEANSER<br />

2.5 %<br />

benzoyl peroxide BENZAC AC LOTION 10 %<br />

benzoyl peroxide BENZAC AC LOTION 5 %<br />

benzoyl peroxide BENZAC AC CREAM (G)<br />

2.5 %<br />

podofilox CONDYLOX GEL (GRAM)<br />

0.5 %<br />

podofilox CONDYLOX SOLUTION<br />

0.5 %<br />

salicylic acid VIRASAL LIQUID 3 %<br />

Protectives<br />

calamine CALAMINE LOTION<br />

zinc oxide BOUDREAUXS OINT. (G) 20<br />

%<br />

Topical Antineoplastic & Premalignant Lesion Agnts<br />

fluorouracil CARAC CREAM (G)<br />

0.5 %<br />

fluorouracil FLUOROPLEX CREAM (G) 1<br />

%<br />

fluorouracil EFUDEX CREAM (G) 5<br />

%<br />

fluorouracil EFUDEX SOLUTION 2<br />

%<br />

fluorouracil EFUDEX SOLUTION 5<br />

%<br />

Topical Local Anesthetics<br />

lidocaine LIDAMANTLE OINT. (G) 5 %<br />

Topical Preparations,Miscellaneous<br />

calcium acetate/aluminum sulf DOMEBORO PACKET<br />

DERMATOLOGY - PSORIASIS/ECZEMA<br />

Antipsoriatics <strong>Agents</strong><br />

calcipotriene DOVONEX OINT. (G)<br />

0.005 %<br />

calcipotriene DOVONEX CREAM<br />

0.005%<br />

calcipotriene DOVONEX SOLUTION<br />

0.005 %<br />

Topical Immunosuppressive <strong>Agents</strong>


AGE+ pimecrolimus ELIDEL CREAM (G) 1<br />

ST<br />

%<br />

AGE+ tacrolimus PROTOPIC OINT. (G) 0.03<br />

QL+<br />

%<br />

ST<br />

AGE+ tacrolimus PROTOPIC OINT. (G) 0.1<br />

QL+<br />

ST<br />

%<br />

DIABETES<br />

Antihypergly, (dpp-4) Inhibitor & Biguanide Comb.<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

sitagliptin phos/met<strong>for</strong>min hcl JANUMET TABLET<br />

50MG-500MG<br />

sitagliptin phos/met<strong>for</strong>min hcl JANUMET TABLET 50-<br />

1000 MG<br />

Antihyperglycemic, Alpha-Glucosidase Inhib (n-S)<br />

ST acarbose PRECOSE TABLET 100<br />

MG<br />

ST acarbose PRECOSE TABLET 50<br />

MG<br />

ST acarbose PRECOSE TABLET 25<br />

MG<br />

Antihyperglycemic, Dpp-4 Inhibitors<br />

PA linagliptin TRADJENTA TABLET 5<br />

MG<br />

PA saxagliptin hcl ONGLYZA TABLET 2.5<br />

MG<br />

PA saxagliptin hcl ONGLYZA TABLET 5<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

MG<br />

sitagliptin phosphate JANUVIA TABLET 25<br />

MG<br />

sitagliptin phosphate JANUVIA TABLET 50<br />

MG<br />

sitagliptin phosphate JANUVIA TABLET 100<br />

MG<br />

Antihyperglycemic, Insulin-Release Stimulant Type<br />

chlorpropamide DIABINESE TABLET 100<br />

MG<br />

chlorpropamide DIABINESE TABLET 250<br />

MG<br />

glimepiride AMARYL TABLET 1<br />

MG<br />

glimepiride AMARYL TABLET 2<br />

MG


glimepiride AMARYL TABLET 4<br />

MG<br />

glipizide GLUCOTROL XL TABLET 5<br />

MG<br />

glipizide GLUCOTROL XL TABLET 10<br />

MG<br />

glipizide GLUCOTROL XL TAB ER 24 10<br />

MG<br />

glipizide GLUCOTROL XL TAB ER 24 5<br />

MG<br />

glipizide GLUCOTROL XL TAB ER 24 2.5<br />

MG<br />

glyburide MICRONASE TABLET 1.25<br />

MG<br />

glyburide MICRONASE TABLET 2.5<br />

MG<br />

glyburide MICRONASE TABLET 5<br />

MG<br />

glyburide,micronized GLYNASE TABLET 1.5<br />

MG<br />

glyburide,micronized GLYNASE TABLET 3<br />

MG<br />

glyburide,micronized GLYNASE TABLET 6<br />

MG<br />

tolazamide TOLAZAMIDE TABLET 250<br />

MG<br />

tolazamide TOLAZAMIDE TABLET 500<br />

MG<br />

tolbutamide TOLBUTAMIDE TABLET 500<br />

MG<br />

Antihyperglycemic, Insulin-Response Enhancer (n-S)<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

pioglitazone hcl ACTOS TABLET 15<br />

MG<br />

pioglitazone hcl ACTOS TABLET 30<br />

MG<br />

pioglitazone hcl ACTOS TABLET 45<br />

MG<br />

rosiglitazone maleate AVANDIA TABLET 2<br />

MG<br />

rosiglitazone maleate AVANDIA TABLET 4<br />

MG<br />

rosiglitazone maleate AVANDIA TABLET 8<br />

MG<br />

Antihyperglycemic,Biguanide Type(non-Sulfonylurea)<br />

met<strong>for</strong>min hcl GLUCOPHAGE TABLET 500


MG<br />

met<strong>for</strong>min hcl GLUCOPHAGE TABLET 850<br />

MG<br />

met<strong>for</strong>min hcl GLUCOPHAGE TABLET 1000<br />

MG<br />

QL met<strong>for</strong>min hcl GLUCOPHAGE TAB ER 24H<br />

750 MG<br />

QL met<strong>for</strong>min hcl GLUCOPHAGE TAB ER 24H<br />

500 MG<br />

Antihyperglycemic,Insulin-Rel Stim.& Biguanide Cmb<br />

QL glyburide/met<strong>for</strong>min hcl GLUCOVANCE TABLET 1.25-<br />

250MG<br />

glyburide/met<strong>for</strong>min hcl GLUCOVANCE TABLET 5<br />

MG-500MG<br />

QL glyburide/met<strong>for</strong>min hcl GLUCOVANCE TABLET 2.5-<br />

500 MG<br />

Antihyperglycm,Insul-Resp.enhancer & Biguanide Cmb<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

pioglitazone hcl/met<strong>for</strong>min hcl ACTOPLUS MET TABLET<br />

15MG-500MG<br />

pioglitazone hcl/met<strong>for</strong>min hcl ACTOPLUS MET TABLET<br />

15MG-850MG<br />

rosiglitazone/met<strong>for</strong>min hcl AVANDAMET TABLET 2-<br />

1000MG<br />

rosiglitazone/met<strong>for</strong>min hcl AVANDAMET TABLET 4-<br />

1000MG<br />

rosiglitazone/met<strong>for</strong>min hcl AVANDAMET TABLET 2<br />

MG-500MG<br />

rosiglitazone/met<strong>for</strong>min hcl AVANDAMET TABLET 4-<br />

500MG<br />

Blood Sugar Diagnostics<br />

PA+<br />

QL<br />

blood sugar diagnostic<br />

ACCU-CHEK AVIVA PLUS<br />

CONTOUR<br />

FREESTYLE LITE STRIPS<br />

ONE TOUCH ULTRA TEST STRIPS<br />

TRUETRACK TEST STRIP<br />

Diabetic Supplies<br />

QL blood-glucose meter TRUETRACK SMART SYSTEM KIT<br />

diabetic supplies,miscell NEEDLE FREE INSULIN SYR KIT KIT<br />

Hyperglycemics<br />

QL glucagon,human recombinant GLUCAGEN<br />

GLUCAGON EMERGENCY KIT<br />

STRIP<br />

KIT 1 MG<br />

Insulins<br />

QL hum insulin nph/reg insulin hm HUMULIN 70-30 VIAL 70-


NOVOLIN 70-30<br />

30/ML<br />

QL insulin aspart NOVOLOG VIAL 100/ML<br />

PA insulin detemir LEVEMIR INSULN PEN<br />

100/ML (3)<br />

QL+ insulin detemir LEVEMIR VIAL 100/ML<br />

ST<br />

QL insulin glargine,hum.rec.anlog LANTUS VIAL 100/ML<br />

QL insulin lispro HUMALOG VIAL 100/ML<br />

QL insulin npl/insulin lispro HUMALOG MIX 75-25 VIAL 75-<br />

25/ML<br />

QL insulin npl/insulin lispro HUMALOG MIX 50-50 VIAL 50-<br />

50/ML<br />

QL insulin regular, human HUMULIN R VIAL 500/ML<br />

QL insulin regular, human HUMULIN R<br />

VIAL 100/ML<br />

NOVOLIN R<br />

QL insuln asp prt/insulin aspart NOVOLOG MIX 70-30 VIAL 70-<br />

30/ML<br />

QL nph, human insulin isophane HUMULIN N<br />

NOVOLIN N<br />

VIAL 100/ML<br />

Urine Glucose Test Aids<br />

urine glucose test,strip<br />

DIASCREEN 1G REAGENT<br />

DIASTIX REAGENT<br />

STRIP<br />

EAR - GENERAL DISORDERS<br />

Ear Preparations, Misc. Anti-Infectives<br />

acetic acid ACETIC ACID SOLUTION 2<br />

%<br />

acetic acid/aluminum acetate DOMEBORO DROPS 2 %<br />

acetic acid/hydrocortisone VOSOL HC DROPS 2 %-1<br />

%<br />

Ear Preparations,Antibiotics<br />

neomycin/polymyxin b sulf/hc CORTISPORIN SOLUTION<br />

3.5-10K-1<br />

neomycin/polymyxin b sulf/hc CORTISPORIN DROPS SUSP<br />

3.5-10K-1<br />

ofloxacin FLOXIN DROPS 0.3 %<br />

Ear Preparations,Local Anesthetics<br />

antipyrine/benzocaine/glycerin OTRA NR DROPS 5.4 %-<br />

1.4%<br />

ELECTROLYTE REGULATION<br />

Electrolyte Depleters<br />

calcium acetate PHOSLO TABLET 667<br />

MG


calcium acetate PHOSLO CAPSULE 667<br />

MG<br />

calcium acetate PHOSLO TABLET 667<br />

MG<br />

Electrolyte Maintenance<br />

electrolyte,oral PEDIALYTE SOLUTION<br />

Potassium Replacement<br />

potassium bicarbonate QUIC-K TABLET EFF<br />

6.5MEQ<br />

potassium chloride MICRO-K CAPSULE ER<br />

8 MEQ<br />

potassium chloride MICRO-K CAPSULE ER<br />

10 MEQ<br />

potassium chloride MICRO-K PACKET 20<br />

MEQ<br />

potassium chloride MICRO-K PACKET 25<br />

MEQ<br />

potassium chloride MICRO-K LIQUID<br />

40MEQ/15ML<br />

potassium chloride MICRO-K LIQUID<br />

20MEQ/15ML<br />

potassium chloride MICRO-K TABLET SA<br />

10MEQ<br />

potassium chloride MICRO-K TAB ER PRT<br />

10 MEQ<br />

potassium chloride MICRO-K TAB ER PRT<br />

20 MEQ<br />

potassium chloride MICRO-K TABLET ER 8<br />

MEQ<br />

ENDOCRINE DISORDER - OTHER<br />

Antidiuretic And Vasopressor Hormones<br />

ST desmopressin (nonrefrigerated) DDAVP SPRAY/PUMP<br />

10/SPRAY<br />

ST desmopressin acetate DDAVP SOLUTION<br />

0.1 MG/ML<br />

ST desmopressin acetate DDAVP TABLET 0.1<br />

MG<br />

ST desmopressin acetate DDAVP TABLET 0.2<br />

MG<br />

Bone Resorption Inhibitors<br />

QL alendronate sodium FOSAMAX TABLET 35<br />

MG<br />

QL alendronate sodium FOSAMAX TABLET 10


MG<br />

QL alendronate sodium FOSAMAX TABLET 40<br />

MG<br />

QL alendronate sodium FOSAMAX TABLET 5<br />

MG<br />

QL alendronate sodium FOSAMAX TABLET 70<br />

MG<br />

PA calcitonin,salmon,synthetic CALCITONIN,SALMON,SYNTHETIC<br />

MIACALCIN<br />

FORTICAL<br />

SPRAY/PUMP<br />

200/DOSE<br />

PA raloxifene hcl EVISTA TABLET 60<br />

MG<br />

ENDOCRINE DISORDER - THYROID<br />

Antithyroid Preparations<br />

methimazole TAPAZOLE TABLET 20<br />

MG<br />

methimazole TAPAZOLE TABLET 10<br />

MG<br />

methimazole TAPAZOLE TABLET 5<br />

MG<br />

propylthiouracil PROPYLTHIOURACIL TABLET 50<br />

MG<br />

Iodine Containing <strong>Agents</strong><br />

potassium iodide POTASSIUM IODIDE SOLUTION<br />

1G/ML<br />

Thyroid Hormones<br />

levothyroxine sodium<br />

levothyroxine sodium<br />

levothyroxine sodium<br />

levothyroxine sodium<br />

levothyroxine sodium<br />

levothyroxine sodium<br />

LEVOTHROID<br />

LEVOXYL<br />

SYNTHROID<br />

LEVOTHROID<br />

LEVOXYL<br />

SYNTHROID<br />

LEVOTHROID<br />

LEVOXYL<br />

SYNTHROID<br />

LEVOTHROID<br />

LEVOXYL<br />

SYNTHROID<br />

LEVOTHROID<br />

LEVOXYL<br />

SYNTHROID<br />

LEVOTHROID<br />

LEVOXYL<br />

SYNTHROID<br />

TABLET 112<br />

MCG<br />

TABLET 25<br />

MCG<br />

TABLET 50<br />

MCG<br />

TABLET 100<br />

MCG<br />

TABLET 75<br />

MCG<br />

TABLET 200<br />

MCG


levothyroxine sodium LEVOTHROID<br />

LEVOXYL<br />

SYNTHROID<br />

levothyroxine sodium<br />

LEVOTHROID<br />

LEVOXYL<br />

SYNTHROID<br />

levothyroxine sodium<br />

LEVOTHROID<br />

LEVOXYL<br />

SYNTHROID<br />

levothyroxine sodium<br />

LEVOTHROID<br />

SYNTHROID<br />

UNITHROID<br />

levothyroxine sodium<br />

LEVOTHROID<br />

LEVOXYL<br />

SYNTHROID<br />

levothyroxine sodium<br />

LEVOTHROID<br />

LEVOXYL<br />

TABLET 125<br />

MCG<br />

TABLET 150<br />

MCG<br />

TABLET<br />

175MCG<br />

TABLET 300<br />

MCG<br />

TABLET 88<br />

MCG<br />

TABLET 137<br />

MCG<br />

SYNTHROID<br />

liothyronine sodium CYTOMEL TABLET 25<br />

MCG<br />

liothyronine sodium CYTOMEL TABLET 5<br />

MCG<br />

liothyronine sodium CYTOMEL TABLET 50<br />

MCG<br />

thyroid,pork ARMOUR THYROID TABLET 120<br />

MG<br />

thyroid,pork ARMOUR THYROID TABLET 30<br />

MG<br />

thyroid,pork ARMOUR THYROID TABLET 300<br />

MG<br />

thyroid,pork ARMOUR THYROID TABLET 60<br />

MG<br />

thyroid,pork ARMOUR THYROID TABLET 15<br />

MG<br />

thyroid,pork ARMOUR THYROID TABLET 90<br />

MG<br />

thyroid,pork ARMOUR THYROID TABLET 180<br />

MG<br />

thyroid,pork ARMOUR THYROID TABLET 240<br />

MG<br />

thyroid,pork ARMOUR THYROID TABLET 195<br />

MG<br />

thyroid,pork ARMOUR THYROID TABLET 16.25<br />

MG<br />

thyroid,pork ARMOUR THYROID TABLET 32.5<br />

MG


thyroid,pork ARMOUR THYROID TABLET 65<br />

MG<br />

thyroid,pork ARMOUR THYROID TABLET 130<br />

MG<br />

EYE - GENERAL DISORDERS<br />

Eye Antibiotic-Corticoid Combinations<br />

gentamicin/prednisol ac PRED-G DROPS SUSP<br />

0.3%-1%<br />

gentamicin/prednisol ac PRED-G OINT. (G) 0.3-<br />

0.6%<br />

neo/polymyx b sulf/dexameth MAXITROL OINT. (G) 3.5-<br />

10K-.1<br />

neo/polymyx b sulf/dexameth MAXITROL DROPS SUSP<br />

0.1 %<br />

neomy sulf/bacitrac zn/poly/hc TRIPLE ANTIBIOTIC HC OINT. (G) 3.5-<br />

10K-1<br />

neomycin sulfate/dex na ph NEOMYCIN SULFATE/DEX NA PH DROPS 0.35-<br />

0.1%<br />

tobramycin sulf/dexamethasone TOBRADEX OINT. (G) 0.3<br />

%-0.1%<br />

Eye Antihistamines<br />

QL ketotifen fumarate ZADITOR DROPS 0.025<br />

%<br />

Eye Antiinflammatory <strong>Agents</strong><br />

PA dexamethasone MAXIDEX DROPS SUSP<br />

0.1 %<br />

dexamethasone sod phosphate DECADRON OINT. (G) 0.05<br />

%<br />

dexamethasone sod phosphate DEXASOL DROPS 0.1 %<br />

ST diclofenac sodium VOLTAREN DROPS 0.1 %<br />

fluorometholone FLUOROMETHOLONE DROPS SUSP<br />

0.1 %<br />

flurbiprofen sodium OCUFEN DROPS 0.03 %<br />

ST ketorolac tromethamine ACULAR LS DROPS 0.4 %<br />

ST ketorolac tromethamine ACULAR LS DROPS 0.5 %<br />

prednisolone acetate PRED MILD DROPS SUSP<br />

0.12 %<br />

prednisolone acetate PRED FORTE DROPS SUSP<br />

1 %<br />

prednisolone sod phosphate PREDNISOL DROPS 1 %<br />

Eye Antivirals<br />

trifluridine VIROPTIC DROPS 1 %<br />

Eye Local Anesthetics


proparacaine hcl OPHTHETIC DROPS 0.5 %<br />

tetracaine hcl TETRAVISC DROPS 0.5 %<br />

Eye Sulfonamides<br />

na sulfacetm/prednis sp NA SULFACETM/PREDNIS SP DROPS 10-<br />

0.25%<br />

sulfacetamide sodium SULFAC OINT. (G) 10<br />

%<br />

sulfacetamide sodium SULFAC DROPS 10 %<br />

sulfacetm na/prednisol ac BLEPHAMIDE S.O.P. OINT. (G) 10<br />

%-0.2 %<br />

PA sulfacetm na/prednisol ac BLEPHAMIDE DROPS SUSP<br />

10 %-0.2 %<br />

Eye Vasoconstrictors (otc Only)<br />

naphazoline hcl NAPHCON DROPS 0.012<br />

%<br />

naphazoline hcl/pheniramine OPCON-A DROPS .0268-<br />

.315<br />

naphazoline hcl/pheniramine OPCON-A DROPS .0268-<br />

.315<br />

Eye Vasoconstrictors (rx Only)<br />

naphazoline hcl ALBALON DROPS 0.1 %<br />

phenylephrine hcl MYDFRIN DROPS 10 %<br />

phenylephrine hcl MYDFRIN DROPS 2.5 %<br />

Ophthalmic Antibiotics<br />

bacitracin BACITRACIN OINT. (G) 500<br />

UNIT/G<br />

bacitracin/polymyxin b sulfate POLYSPORIN OINT. (G) 500-<br />

10K/G<br />

bacitracin/polymyxin b sulfate POLYSPORIN OINT. (G) 500-<br />

10K/G<br />

ST ciprofloxacin hcl CILOXAN OINT. (G) 0.3<br />

%<br />

QL ciprofloxacin hcl CILOXAN DROPS 0.3 %<br />

erythromycin base ILOTYCIN OINT. (G)<br />

5MG/G<br />

gentamicin sulfate GARAMYCIN OINT. (G) 0.3<br />

%<br />

gentamicin sulfate GARAMYCIN DROPS 0.3 %<br />

neomy sulf/bacitra/polymyxin b NEOSPORIN OINT. (G)<br />

neomycin/polymyxn b/gramicidin<br />

3.5MG-400<br />

NEOMYCIN/POLYMYXN B/GRAMICIDIN DROPS<br />

1.75MG-10K<br />

QL ofloxacin OCUFLOX DROPS 0.3 %<br />

polymyxin b sulfate/tmp POLYTRIM DROPS


10K/ML-0.1<br />

tobramycin sulfate TOBREX DROPS 0.3 %<br />

Ophthalmic Mast Cell Stabilizers<br />

cromolyn sodium CROMOLYN SODIUM DROPS 4 %<br />

Ophthalmic Preparations, Miscellaneous<br />

sodium chloride SODIUM CHLORIDE OINT. (G) 5 %<br />

sodium chloride SODIUM CHLORIDE DROPS 5 %<br />

EYE - GLAUCOMA<br />

Carbonic Anhydrase Inhibitors<br />

acetazolamide DIAMOX SEQUELS CAPSULE ER<br />

500 MG<br />

acetazolamide DIAMOX SEQUELS TABLET 125<br />

MG<br />

acetazolamide DIAMOX SEQUELS TABLET 250<br />

MG<br />

methazolamide NEPTAZANE TABLET 50<br />

MG<br />

methazolamide NEPTAZANE TABLET 25<br />

MG<br />

Miotics/Other Intraoc. Pressure Reducers<br />

PA apraclonidine hcl IOPIDINE DROPERETTE<br />

1 %<br />

brimonidine tartrate ALPHAGAN P DROPS 0.2 %<br />

PA brinzolamide AZOPT DROPS SUSP<br />

1 %<br />

PA carbachol ISOPTO CARBACHOL DROPS 1.5 %<br />

carbachol ISOPTO CARBACHOL DROPS 3 %<br />

dorzolamide hcl TRUSOPT DROPS 2 %<br />

dorzolamide hcl/timolol maleat COSOPT DROPS 2%-<br />

0.5%<br />

echothiophate iodide PHOSPHOLINE IODIDE DROPS 0.125<br />

%<br />

latanoprost XALATAN DROPS 0.005<br />

%<br />

levobunolol hcl BETAGAN DROPS 0.5 %<br />

levobunolol hcl BETAGAN DROPS 0.25 %<br />

metipranolol OPTIPRANOLOL DROPS 0.3 %<br />

pilocarpine hcl ISOPTO CARPINE DROPS 1 %<br />

pilocarpine hcl ISOPTO CARPINE DROPS 2%<br />

pilocarpine hcl ISOPTO CARPINE DROPS 4%<br />

pilocarpine hcl ISOPTO CARPINE DROPS 8 %<br />

timolol maleate TIMOPTIC-XE DROPS 0.25 %<br />

timolol maleate TIMOPTIC-XE DROPS 0.5 %


PA timolol maleate/pf TIMOPTIC OCUDOSE DROPERETTE<br />

0.25 %<br />

PA timolol maleate/pf TIMOPTIC OCUDOSE DROPERETTE<br />

0.5 %<br />

Mydriatics<br />

atropine sulfate ISOPTO ATROPINE OINT. (G) 1 %<br />

atropine sulfate ISOPTO ATROPINE DROPS 1 %<br />

cyclopentolate hcl CYCLOGYL DROPS 0.5 %<br />

cyclopentolate hcl CYCLOGYL DROPS 1 %<br />

cyclopentolate hcl CYCLOGYL DROPS 2 %<br />

homatropine hbr ISOPTO HOMATROPINE DROPS 2 %<br />

homatropine hbr ISOPTO HOMATROPINE DROPS 5 %<br />

scopolamine hydrobromide ISOPTO HYOSCINE DROPS 0.25 %<br />

tropicamide MYDRIACYL DROPS 0.5 %<br />

tropicamide MYDRIACYL DROPS 1 %<br />

EYE - MISCELLANEOUS<br />

Artificial Tears<br />

glycerin/propylene glycol HYPOTEARS DROPS 0.3%-<br />

1%<br />

Contact Lens Preparations<br />

sodium chloride SODIUM CHLORIDE SPRAY 0.9 %<br />

Eye Preparations, Miscellaneous (otc)<br />

tyloxapol ENUCLENE DROPS 0.25 %<br />

GOUT AND RELATED DISEASES<br />

Colchicine<br />

colchicine COLCHICINE TABLET<br />

0.6MG<br />

colchicine/probenecid COLCHICINE/PROBENECID TABLET 0.5-<br />

500MG<br />

Hyperuricemia Tx - Purine Inhibitors<br />

allopurinol ZYLOPRIM TABLET 100<br />

MG<br />

allopurinol ZYLOPRIM TABLET 300<br />

MG<br />

Uricosuric <strong>Agents</strong><br />

probenecid PROBENECID TABLET 500<br />

MG<br />

HEMATOLOGICAL DISORDERS<br />

Anticoagulants,Coumarin Type


warfarin sodium COUMADIN TABLET 10<br />

MG<br />

warfarin sodium COUMADIN TABLET 2<br />

MG<br />

warfarin sodium COUMADIN TABLET 1<br />

MG<br />

warfarin sodium COUMADIN TABLET 5<br />

MG<br />

warfarin sodium COUMADIN TABLET 2.5<br />

MG<br />

warfarin sodium COUMADIN TABLET 7.5<br />

MG<br />

warfarin sodium COUMADIN TABLET 3<br />

MG<br />

warfarin sodium COUMADIN TABLET 4<br />

MG<br />

warfarin sodium COUMADIN TABLET 6<br />

MG<br />

Hemorrheologic <strong>Agents</strong><br />

pentoxifylline TRENTAL TABLET ER<br />

400 MG<br />

Heparin And Related Preparations<br />

QL enoxaparin sodium LOVENOX DISP SYRIN<br />

30MG/0.3ML<br />

QL enoxaparin sodium LOVENOX DISP SYRIN<br />

150 MG/ML<br />

QL enoxaparin sodium LOVENOX DISP SYRIN<br />

120MG/.8ML<br />

QL enoxaparin sodium LOVENOX DISP SYRIN<br />

60MG/0.6ML<br />

QL enoxaparin sodium LOVENOX DISP SYRIN<br />

80MG/0.8ML<br />

QL enoxaparin sodium LOVENOX DISP SYRIN<br />

100 MG/ML<br />

QL enoxaparin sodium LOVENOX DISP SYRIN<br />

40MG/0.4ML<br />

heparin sodium,porcine HEP-LOCK DISP SYRIN<br />

10 UNIT/ML<br />

heparin sodium,porcine HEP-LOCK VIAL<br />

5000/ML<br />

Platelet Aggregation Inhibitors<br />

clopidogrel bisulfate PLAVIX TABLET 75<br />

MG<br />

dipyridamole PERSANTINE TABLET 25<br />

MG


dipyridamole PERSANTINE TABLET 50<br />

MG<br />

dipyridamole PERSANTINE TABLET 75<br />

MG<br />

PA prasugrel hcl EFFIENT TABLET 10<br />

MG<br />

Sickle Cell Anemia <strong>Agents</strong><br />

hydroxyurea DROXIA CAPSULE 200<br />

MG<br />

hydroxyurea DROXIA CAPSULE 300<br />

MG<br />

hydroxyurea DROXIA CAPSULE 400<br />

MG<br />

Thrombin Inhibitors,Selective,Direct, & Reversible<br />

PA dabigatran etexilate mesylate PRADAXA CAPSULE 150<br />

MG<br />

PA dabigatran etexilate mesylate PRADAXA CAPSULE 75<br />

MG<br />

Vitamin K Preparations<br />

phytonadione MEPHYTON TABLET 5<br />

MG<br />

HORMONAL DEFICIENCY<br />

Androgenic <strong>Agents</strong><br />

fluoxymesterone FLUOXYMESTERONE TABLET 10<br />

MG<br />

methyltestosterone METHITEST TABLET 10<br />

MG<br />

PA testosterone TESTOPEL PELLET(EA)<br />

75 MG<br />

PA testosterone STRIANT MUC ER 12H<br />

30 MG<br />

PA testosterone ANDROGEL GEL MD PMP<br />

1.25G (1%)<br />

PA testosterone ANDRODERM PATCH TD24<br />

4 MG/24 HR<br />

PA testosterone ANDROGEL GEL MD PMP<br />

20.25/1.25<br />

PA testosterone ANDROGEL GEL PACKET<br />

25MG(1%)<br />

PA testosterone ANDROGEL<br />

TESTIM<br />

GEL PACKET<br />

50 MG (1%)<br />

AGE+ testosterone cypionate DEPO-TESTOSTERONE VIAL 200<br />

QL<br />

MG/ML


Estrogen/Androgen Combinations<br />

estrogen,ester/me-testosterone ESTRATEST TABLET<br />

0.625-1.25<br />

estrogen,ester/me-testosterone ESTRATEST TABLET 1.25-<br />

2.5MG<br />

Estrogenic <strong>Agents</strong><br />

estradiol CLIMARA TABLET 1<br />

MG<br />

estradiol CLIMARA TABLET 2<br />

MG<br />

estradiol CLIMARA TABLET 0.5<br />

MG<br />

PA estradiol DIVIGEL GEL PACKET<br />

0.5MG(0.1)<br />

PA estradiol ALORA<br />

VIVELLE-DOT<br />

PATCH TDSW<br />

0.05MG/24H<br />

PA estradiol ALORA<br />

VIVELLE-DOT<br />

PATCH TDSW<br />

0.1MG/24HR<br />

PA estradiol ALORA<br />

VIVELLE-DOT<br />

PATCH TDSW<br />

.025MG/24H<br />

PA estradiol CLIMARA PATCH<br />

TDWK<br />

0.1MG/24HR<br />

PA estradiol VIVELLE-DOT PATCH TDSW<br />

.0375MG/24<br />

estrogen,con/m-progest acet PREMPRO TABLET 0.45-<br />

1.5MG<br />

estrogen,con/m-progest acet PREMPRO TABLET 0.3-<br />

1.5MG<br />

estrogen,con/m-progest acet PREMPRO TABLET<br />

0.625-5MG<br />

estrogen,con/m-progest acet PREMPRO TABLET<br />

0.625-2.5<br />

estrogen,con/m-progest acet PREMPHASE TABLET 0.625<br />

(14)<br />

estrogens, conjugated PREMARIN TABLET 0.625<br />

MG<br />

estrogens, conjugated PREMARIN TABLET 0.3<br />

MG<br />

estrogens, conjugated PREMARIN TABLET 0.9<br />

MG<br />

estrogens, conjugated PREMARIN TABLET 1.25<br />

MG<br />

estrogens, conjugated PREMARIN TABLET<br />

0.45MG


estrogens,esterified MENEST TABLET 0.3<br />

MG<br />

estrogens,esterified MENEST TABLET 0.625<br />

MG<br />

estrogens,esterified MENEST TABLET 1.25<br />

MG<br />

estrogens,esterified MENEST TABLET 2.5<br />

MG<br />

norethind ac/ethinyl estradiol FEMHRT TABLET<br />

1MG-5MCG<br />

Progestational <strong>Agents</strong><br />

medroxyprogesterone acet PROVERA TABLET<br />

10MG<br />

medroxyprogesterone acetate PROVERA TABLET 2.5<br />

MG<br />

medroxyprogesterone acetate PROVERA TABLET 5<br />

MG<br />

norethindrone acetate AYGESTIN TABLET 5<br />

MG<br />

IMMUNIZATION<br />

Gram Positive Cocci Vaccines<br />

QL+ pneumococcal 23-val p-sac vac PNEUMOVAX 23 DISP SYRIN<br />

AGE<br />

25MCG/0.5<br />

QL+ pneumococcal 23-val p-sac vac PNEUMOVAX 23 VIAL<br />

AGE<br />

25MCG/0.5<br />

Influenza Virus Vaccines<br />

AGE+<br />

QL<br />

flu vaccine 2011 (36 mos+)/pf<br />

FLUZONE 2011-2012 (PF)<br />

FLUARIX 2011-2012 (PF)<br />

FLUVIRIN 2011-2012 (PF)<br />

AFLURIA 2011-2012 (PF)<br />

DISP SYRIN<br />

45MCG/.5ML<br />

AGE+ flu vaccine 2011 (36 mos+)/pf FLUZONE 2011-2012 (PF) VIAL<br />

QL<br />

45MCG/.5ML<br />

AGE+ flu vaccine 2011(6-35 mos)/pf FLUZONE 2011-2012 (PF) DISP SYRIN<br />

QL<br />

PED-0.25ML<br />

AGE+ flu vaccine ts 2011-12 (4 yr+) FLUVIRIN 2011-2012<br />

VIAL<br />

QL<br />

45MCG/.5ML<br />

FLULAVAL 2011-2012<br />

FLUZONE 2011-2012<br />

AFLURIA 2011-2012<br />

AGE+ influenza tvs 11-12 vaccine/pf FLUZONE INTRADERMAL DISP SYRIN<br />

QL<br />

27MCG/.1ML<br />

AGE+ influenza tvs 11-12 vaccine/pf FLUZONE HIGH-DOSE 2011-12 (PF) DISP SYRIN<br />

QL<br />

180MCG/0.5<br />

AGE+ influenza vacc,tri 2011 (live) FLUMIST SPRAY<br />

QL<br />

10E6.5-7.5


Viral/Tumorigenic Vaccines<br />

QL+<br />

AGE<br />

varicella vacc/pf ZOSTAVAX VIAL 19400 U<br />

IMMUNOSUPPRESSION/MODULATION<br />

Immunomodulators<br />

imiquimod ALDARA CREAM<br />

PACK 5 %<br />

Immunosuppressives<br />

AGE azathioprine AZASAN TABLET 75<br />

MG<br />

AGE azathioprine AZASAN TABLET 100<br />

MG<br />

AGE azathioprine IMURAN TABLET 50<br />

MG<br />

AGE cyclosporine SANDIMMUNE CAPSULE 100<br />

MG<br />

AGE cyclosporine SANDIMMUNE CAPSULE 25<br />

MG<br />

AGE cyclosporine, modified NEORAL CAPSULE 50<br />

MG<br />

AGE cyclosporine, modified NEORAL SOLUTION<br />

100 MG/ML<br />

AGE cyclosporine, modified NEORAL CAPSULE 25<br />

MG<br />

AGE cyclosporine, modified NEORAL CAPSULE 100<br />

MG<br />

AGE mycophenolate mofetil CELLCEPT CAPSULE 250<br />

MG<br />

AGE mycophenolate mofetil CELLCEPT TABLET 500<br />

MG<br />

AGE mycophenolate mofetil CELLCEPT SUSP RECON<br />

200 MG/ML<br />

AGE mycophenolate sodium MYFORTIC TABLET DR<br />

180 MG<br />

AGE mycophenolate sodium MYFORTIC TABLET DR<br />

360 MG<br />

AGE sirolimus RAPAMUNE TABLET 1<br />

MG<br />

AGE sirolimus RAPAMUNE TABLET 2<br />

MG<br />

AGE sirolimus RAPAMUNE TABLET 0.5<br />

MG<br />

AGE sirolimus RAPAMUNE SOLUTION 1<br />

MG/ML


AGE tacrolimus PROGRAF CAPSULE 1<br />

MG<br />

AGE tacrolimus PROGRAF CAPSULE 5<br />

MG<br />

AGE tacrolimus PROGRAF CAPSULE 0.5<br />

MG<br />

INFECTIOUS DISEASE - BACTERIAL<br />

Absorbable Sulfonamides<br />

sulfamethoxazole/trimethoprim BACTRIM ORAL SUSP<br />

200-40MG/5<br />

sulfamethoxazole/trimethoprim BACTRIM TABLET<br />

400MG-80MG<br />

sulfamethoxazole/trimethoprim BACTRIM TABLET 800-<br />

160 MG<br />

Cephalosporins - 1st Generation<br />

cefazolin sodium ANCEF VIAL 1 G<br />

cephalexin KEFLEX CAPSULE 250<br />

MG<br />

cephalexin KEFLEX CAPSULE 500<br />

MG<br />

cephalexin KEFLEX SUSP RECON<br />

125 MG/5ML<br />

cephalexin KEFLEX SUSP RECON<br />

250 MG/5ML<br />

cephalexin KEFLEX TABLET 500<br />

MG<br />

cephalexin KEFLEX TABLET 250<br />

MG<br />

Cephalosporins - 2nd Generation<br />

cefaclor CECLOR CAPSULE 250<br />

MG<br />

cefaclor CECLOR CAPSULE 500<br />

MG<br />

Cephalosporins - 3rd Generation<br />

cefdinir OMNICEF SUSP RECON<br />

250 MG/5ML<br />

cefdinir OMNICEF CAPSULE 300<br />

MG<br />

cefdinir OMNICEF SUSP RECON<br />

125 MG/5ML<br />

cefixime SUPRAX TABLET 400<br />

MG<br />

cefixime SUPRAX SUSP RECON


100 MG/5ML<br />

cefixime SUPRAX SUSP RECON<br />

200 MG/5ML<br />

Chemotherapeutics, Antibacterial, Misc.<br />

methenamine mandelate MANDELAMINE TABLET 1 G<br />

methenamine mandelate MANDELAMINE TABLET 500<br />

MG<br />

trimethoprim PROLOPRIM TABLET 100<br />

MG<br />

trimethoprim PRIMSOL SOLUTION 50<br />

MG/5 ML<br />

Macrolides<br />

QL azithromycin ZITHROMAX PACKET 1 G<br />

QL azithromycin ZITHROMAX SUSP RECON<br />

100 MG/5ML<br />

QL azithromycin ZITHROMAX TABLET 250<br />

MG<br />

AGE+ azithromycin ZITHROMAX TABLET 600<br />

QL<br />

MG<br />

QL azithromycin ZITHROMAX TABLET 500<br />

MG<br />

QL azithromycin ZITHROMAX SUSP RECON<br />

200 MG/5ML<br />

clarithromycin BIAXIN XL TABLET 500<br />

MG<br />

clarithromycin BIAXIN XL TABLET 250<br />

MG<br />

ery e-succ/sulfisoxazole PEDIAZOLE SUSP RECON<br />

200-600/5<br />

erythromycin base ERYC CAPSULE DR<br />

250 MG<br />

erythromycin base ERYC TABLET 250<br />

MG<br />

erythromycin base ERYC TABLET 500<br />

MG<br />

erythromycin base ERYC TABLET DR<br />

250 MG<br />

erythromycin base ERY-TAB TABLET DR<br />

333 MG<br />

erythromycin base ERYC TABLET DR<br />

500 MG<br />

erythromycin ethylsuccinate ERYPED SUSP RECON<br />

200 MG/5ML<br />

erythromycin ethylsuccinate ERYPED 400 SUSP RECON<br />

400 MG/5ML


erythromycin ethylsuccinate ERYPED TABLET 400<br />

MG<br />

erythromycin stearate ERYTHROMYCIN STEARATE TABLET 250<br />

MG<br />

Nitrofuran Derivatives<br />

nitrofurantoin FURADANTIN ORAL SUSP<br />

25 MG/5 ML<br />

nitrofurantoin macrocrystal MACRODANTIN CAPSULE 100<br />

MG<br />

nitrofurantoin macrocrystal MACRODANTIN CAPSULE 25<br />

MG<br />

nitrofurantoin macrocrystal MACRODANTIN CAPSULE 50<br />

MG<br />

nitrofurantoin monohyd/m-cryst MACROBID CAPSULE 100<br />

MG<br />

Penicillins<br />

amoxicillin AMOXIL TABLET<br />

875MG<br />

amoxicillin AMOXIL TAB CHEW<br />

125 MG<br />

amoxicillin AMOXIL TAB CHEW<br />

250 MG<br />

amoxicillin AMOXIL CAPSULE 250<br />

MG<br />

amoxicillin AMOXIL CAPSULE 500<br />

MG<br />

amoxicillin AMOXIL SUSP RECON<br />

125 MG/5ML<br />

amoxicillin AMOXIL SUSP RECON<br />

250 MG/5ML<br />

amoxicillin AMOXIL SUSP RECON<br />

400 MG/5ML<br />

amoxicillin AMOXIL SUSP RECON<br />

200 MG/5ML<br />

amoxicillin/potassium clav AUGMENTIN SUSP RECON<br />

600-42.9/5<br />

amoxicillin/potassium clav AUGMENTIN TABLET 250-<br />

125MG<br />

amoxicillin/potassium clav AUGMENTIN TABLET 500-<br />

125 MG<br />

amoxicillin/potassium clav AUGMENTIN TABLET 875-<br />

125 MG<br />

amoxicillin/potassium clav AUGMENTIN TAB CHEW<br />

400-57MG<br />

amoxicillin/potassium clav AUGMENTIN TAB CHEW


200-28.5MG<br />

amoxicillin/potassium clav AUGMENTIN SUSP RECON<br />

125-31.25/<br />

amoxicillin/potassium clav AUGMENTIN SUSP RECON<br />

250-62.5/5<br />

amoxicillin/potassium clav AUGMENTIN SUSP RECON<br />

400-57MG/5<br />

amoxicillin/potassium clav AUGMENTIN SUSP RECON<br />

200-28.5/5<br />

ampicillin trihydrate AMPICILLIN TRIHYDRATE CAPSULE 250<br />

MG<br />

ampicillin trihydrate AMPICILLIN TRIHYDRATE CAPSULE 500<br />

MG<br />

ampicillin trihydrate AMPICILLIN TRIHYDRATE SUSP RECON<br />

125MG/5ML<br />

ampicillin trihydrate AMPICILLIN TRIHYDRATE SUSP RECON<br />

250MG/5ML<br />

dicloxacillin sodium DICLOXACILLIN SODIUM CAPSULE 250<br />

MG<br />

dicloxacillin sodium DICLOXACILLIN SODIUM CAPSULE 500<br />

MG<br />

penicillin v potassium VEETIDS 250 SOLN RECON<br />

125 MG/5ML<br />

penicillin v potassium VEETIDS 250 SOLN RECON<br />

250 MG/5ML<br />

penicillin v potassium VEETIDS 250 TABLET 250<br />

MG<br />

penicillin v potassium VEETIDS 250 TABLET 500<br />

MG<br />

Quinolones<br />

QL ciprofloxacin hcl CIPRO TABLET 250<br />

MG<br />

QL ciprofloxacin hcl CIPRO TABLET 500<br />

MG<br />

QL ciprofloxacin hcl CIPRO TABLET 750<br />

MG<br />

ciprofloxacin hcl CIPRO TABLET 100<br />

MG<br />

levofloxacin LEVAQUIN TABLET 250<br />

MG<br />

levofloxacin LEVAQUIN TABLET 500<br />

MG<br />

levofloxacin LEVAQUIN TABLET<br />

750MG<br />

ofloxacin FLOXIN TABLET 200<br />

MG


ofloxacin FLOXIN TABLET 300<br />

MG<br />

ofloxacin FLOXIN TABLET 400<br />

MG<br />

Tetracyclines<br />

doxycycline hyclate VIBRAMYCIN CAPSULE 100<br />

MG<br />

doxycycline hyclate VIBRAMYCIN CAPSULE<br />

50MG<br />

doxycycline hyclate VIBRAMYCIN TABLET 100<br />

MG<br />

QL+<br />

ST<br />

minocycline hcl SOLODYN CAPSULE 100<br />

MG<br />

tetracycline hcl ALA-TET CAPSULE 250<br />

MG<br />

tetracycline hcl ALA-TET CAPSULE 500<br />

MG<br />

tetracycline hcl ALA-TET ORAL SUSP<br />

125 MG/5ML<br />

INFECTIOUS DISEASE - FUNGAL<br />

Antifungal <strong>Agents</strong><br />

clotrimazole MYCELEX TROCHE 10<br />

MG<br />

fluconazole DIFLUCAN TABLET 100<br />

MG<br />

fluconazole DIFLUCAN TABLET 200<br />

MG<br />

fluconazole DIFLUCAN TABLET 50<br />

MG<br />

fluconazole DIFLUCAN TABLET 150<br />

MG<br />

fluconazole DIFLUCAN SUSP RECON<br />

40 MG/ML<br />

fluconazole DIFLUCAN SUSP RECON<br />

10 MG/ML<br />

itraconazole SPORANOX SOLUTION 10<br />

MG/ML<br />

itraconazole SPORANOX CAPSULE 100<br />

MG<br />

ketoconazole NIZORAL TABLET 200<br />

MG<br />

Antifungal Antibiotics<br />

griseofulvin ultramicrosize GRIS-PEG TABLET 125<br />

MG


griseofulvin ultramicrosize GRIS-PEG TABLET 250<br />

MG<br />

griseofulvin,microsize GRIFULVIN V ORAL SUSP<br />

125 MG/5ML<br />

griseofulvin,microsize FULVICIN U/F TABLET 250<br />

MG<br />

griseofulvin,microsize GRIFULVIN V TABLET 500<br />

MG<br />

nystatin MYCOSTATIN ORAL SUSP<br />

100000/ML<br />

nystatin MYCOSTATIN TABLET 500K<br />

UNIT<br />

INFECTIOUS DISEASE - MISCELLANEOUS<br />

Anti-Mycobacterium <strong>Agents</strong><br />

ethambutol hcl MYAMBUTOL TABLET 100<br />

MG<br />

ethambutol hcl MYAMBUTOL TABLET 400<br />

MG<br />

isoniazid ISONIAZID SYRUP 50<br />

MG/5 ML<br />

isoniazid ISONIAZID TABLET 100<br />

MG<br />

isoniazid ISONIAZID TABLET 300<br />

MG<br />

pyrazinamide PYRAZINAMIDE TABLET 500<br />

MG<br />

rifabutin MYCOBUTIN CAPSULE 150<br />

MG<br />

Antileprotics<br />

dapsone DAPSONE TABLET 100<br />

MG<br />

dapsone DAPSONE TABLET 25<br />

MG<br />

Antitubercular Antibiotics<br />

rifampin RIFADIN CAPSULE 150<br />

MG<br />

rifampin RIFADIN CAPSULE 300<br />

MG<br />

rifampin/isoniazid RIFAMATE CAPSULE<br />

300-150 MG<br />

rifampin/isoniazid/pyrazinamid RIFATER TABLET 120-<br />

50-300<br />

Lincosamides


clindamycin hcl CLEOCIN HCL CAPSULE 150<br />

MG<br />

AGE clindamycin palmitate hcl CLEOCIN PALMITATE SOLN RECON<br />

75 MG/5 ML<br />

INFECTIOUS DISEASE - PARASITIC<br />

Amebacides<br />

iodoquinol YODOXIN TABLET 210<br />

MG<br />

iodoquinol YODOXIN TABLET 650<br />

MG<br />

Anaerobic Antiprotozoal-Antibacterial <strong>Agents</strong><br />

metronidazole FLAGYL TABLET 250<br />

MG<br />

metronidazole FLAGYL TABLET 500<br />

MG<br />

Antimalarial Drugs<br />

chloroquine phosphate ARALEN PHOSPHATE TABLET 250<br />

MG<br />

chloroquine phosphate ARALEN PHOSPHATE TABLET 500<br />

MG<br />

hydroxychloroquine sulfate PLAQUENIL TABLET 200<br />

MG<br />

primaquine phosphate PRIMAQUINE TABLET 26.3<br />

MG<br />

pyrimethamine DARAPRIM TABLET 25<br />

MG<br />

Antiprotozoal Drugs,Miscellaneous<br />

AGE+<br />

QL<br />

atovaquone MEPRON ORAL SUSP<br />

750 MG/5ML<br />

INFECTIOUS DISEASE - VIRAL<br />

Antivirals, General<br />

acyclovir ZOVIRAX TABLET 800<br />

MG<br />

acyclovir ZOVIRAX TABLET 400<br />

MG<br />

acyclovir ZOVIRAX ORAL SUSP<br />

200 MG/5ML<br />

acyclovir ZOVIRAX CAPSULE 200<br />

MG<br />

QL oseltamivir phosphate TAMIFLU CAPSULE 75<br />

MG<br />

QL oseltamivir phosphate TAMIFLU CAPSULE 30


MG<br />

QL oseltamivir phosphate TAMIFLU CAPSULE 45<br />

MG<br />

zanamivir RELENZA DISK W/DEV<br />

5 MG<br />

Antivirals, Hiv-Specific, Nucleoside Analog, Rti<br />

didanosine VIDEX SOLN RECON<br />

FNL10MG/ML<br />

didanosine VIDEX EC CAPSULE DR<br />

250 MG<br />

didanosine VIDEX EC CAPSULE DR<br />

400 MG<br />

didanosine VIDEX EC CAPSULE DR<br />

125 MG<br />

didanosine VIDEX EC CAPSULE DR<br />

200 MG<br />

zidovudine RETROVIR SYRUP 10<br />

MG/ML<br />

zidovudine RETROVIR CAPSULE 100<br />

MG<br />

zidovudine RETROVIR TABLET 300<br />

MG<br />

Antivirals, Hiv-Specific, Nucleotide Analog, Rti<br />

PA tenofovir disoproxil fumarate VIREAD TABLET 300<br />

MG<br />

Hepatitis B Treatment <strong>Agents</strong><br />

ST adefovir dipivoxil HEPSERA TABLET 10<br />

MG<br />

PA entecavir BARACLUDE SOLUTION<br />

0.05MG/ML<br />

PA entecavir BARACLUDE TABLET 0.5<br />

MG<br />

PA entecavir BARACLUDE TABLET 1<br />

MG<br />

INFLAMMATORY DISEASE<br />

Anti-Arthritic And Chelating <strong>Agents</strong><br />

penicillamine CUPRIMINE CAPSULE 250<br />

MG<br />

penicillamine DEPEN TABLET 250<br />

MG<br />

Anti-Arthritic, Folate Antagonist <strong>Agents</strong><br />

methotrexate sodium RHEUMATREX TAB DS PK<br />

2.5MG


Glucocorticoids<br />

dexamethasone DEXPAK TAB DS PK<br />

1.5MG (51)<br />

dexamethasone DEXAMETHASONE ELIXIR 0.5<br />

MG/5ML<br />

dexamethasone DEXAMETHASONE SOLUTION<br />

0.5 MG/5ML<br />

dexamethasone DEXAMETHASONE TABLET 0.5<br />

MG<br />

dexamethasone DEXAMETHASONE TABLET 1<br />

MG<br />

dexamethasone DEXAMETHASONE TABLET 0.75<br />

MG<br />

dexamethasone DEXAMETHASONE TABLET 2<br />

MG<br />

dexamethasone DEXAMETHASONE TABLET 1.5<br />

MG<br />

dexamethasone DEXAMETHASONE TABLET 4<br />

MG<br />

dexamethasone DEXAMETHASONE TABLET 6<br />

MG<br />

hydrocortisone CORTEF TABLET 10<br />

MG<br />

hydrocortisone CORTEF TABLET 20<br />

MG<br />

hydrocortisone CORTEF TABLET 5<br />

MG<br />

methylprednisolone MEDROL TABLET 16<br />

MG<br />

methylprednisolone MEDROL TABLET 2<br />

MG<br />

methylprednisolone MEDROL TABLET 32<br />

MG<br />

methylprednisolone MEDROL TABLET 4<br />

MG<br />

methylprednisolone MEDROL TABLET 8<br />

MG<br />

methylprednisolone MEDROL TAB DS PK 4<br />

MG<br />

prednisolone PRELONE SOLUTION 15<br />

MG/5 ML<br />

prednisolone MILLIPRED DP TABLET 5<br />

MG<br />

prednisolone sod phosphate ORAPRED SOLUTION 5<br />

MG/5 ML<br />

prednisolone sod phosphate ORAPRED SOLUTION 15


MG/5 ML<br />

prednisone STERAPRED DS SOLUTION 5<br />

MG/5 ML<br />

prednisone PREDNISONE INTENSOL ORAL CONC<br />

5 MG/ML<br />

prednisone STERAPRED DS TABLET 1<br />

MG<br />

prednisone STERAPRED DS TABLET 10<br />

MG<br />

prednisone STERAPRED DS TABLET 2.5<br />

MG<br />

prednisone STERAPRED DS TABLET 20<br />

MG<br />

prednisone STERAPRED DS TABLET 5<br />

MG<br />

prednisone STERAPRED DS TABLET 50<br />

MG<br />

prednisone STERAPRED DS TAB DS PK 5<br />

MG<br />

prednisone STERAPRED DS TAB DS PK 10<br />

MG<br />

Gold Salts<br />

auranofin RIDAURA CAPSULE 3<br />

MG<br />

Mineralocorticoids<br />

fludrocortisone acetate FLORINEF ACETATE TABLET 0.1<br />

MG<br />

Nsaids, Cyclooxygenase 2 Inhibitor - Type<br />

AGE celecoxib CELEBREX CAPSULE 100<br />

MG<br />

AGE celecoxib CELEBREX CAPSULE 200<br />

MG<br />

Nsaids, Cyclooxygenase Inhibitor-Type<br />

AGE celecoxib CELEBREX CAPSULE 400<br />

MG<br />

AGE celecoxib CELEBREX CAPSULE 50<br />

MG<br />

diclofenac sodium VOLTAREN-XR TABLET DR<br />

25MG<br />

diclofenac sodium VOLTAREN-XR TABLET DR<br />

50 MG<br />

diclofenac sodium VOLTAREN-XR TABLET DR<br />

75 MG<br />

etodolac ETODOLAC CAPSULE 200


MG<br />

etodolac ETODOLAC CAPSULE 300<br />

MG<br />

etodolac ETODOLAC TABLET 400<br />

MG<br />

etodolac ETODOLAC TABLET 500<br />

MG<br />

ibuprofen CHILDREN'S MOTRIN CAPSULE 200<br />

MG<br />

ibuprofen CHILDREN'S MOTRIN TABLET 400<br />

MG<br />

ibuprofen CHILDREN'S MOTRIN TABLET 600<br />

MG<br />

QL ibuprofen CHILDREN'S MOTRIN TABLET 200<br />

MG<br />

ibuprofen CHILDREN'S MOTRIN TABLET 800<br />

MG<br />

ibuprofen CHILDREN'S MOTRIN TABLET 100<br />

MG<br />

ibuprofen CHILDREN'S MOTRIN TAB CHEW<br />

100 MG<br />

ibuprofen CHILDREN'S MOTRIN ORAL SUSP<br />

100 MG/5ML<br />

ibuprofen CHILDREN'S MOTRIN DROPS SUSP<br />

50 MG/1.25<br />

indomethacin INDOCIN SR CAPSULE 25<br />

MG<br />

indomethacin INDOCIN SR CAPSULE 50<br />

MG<br />

ketoprofen ORUDIS KT CAPSULE 75<br />

MG<br />

QL ketorolac tromethamine TORADOL TABLET 10<br />

MG<br />

meloxicam MOBIC TABLET 7.5<br />

MG<br />

meloxicam MOBIC TABLET 15<br />

MG<br />

nabumetone RELAFEN TABLET 500<br />

MG<br />

nabumetone RELAFEN TABLET 750<br />

MG<br />

naproxen EC-NAPROSYN TABLET 250<br />

MG<br />

naproxen EC-NAPROSYN TABLET 375<br />

MG<br />

naproxen EC-NAPROSYN TABLET 500


MG<br />

piroxicam FELDENE CAPSULE 10<br />

MG<br />

piroxicam FELDENE CAPSULE 20<br />

MG<br />

sulindac CLINORIL TABLET 150<br />

MG<br />

sulindac CLINORIL TABLET 200<br />

MG<br />

LOCAL ANESTHESIA<br />

Local Anesthetics<br />

lidocaine hcl XYLOCAINE JEL (ML) 2 %<br />

lidocaine hcl XYLOCAINE SOLUTION 20<br />

MG/ML<br />

lidocaine hcl XYLOCAINE SOLUTION 40<br />

MG/ML<br />

QL phenol PHENOL SPRAY 1.4 %<br />

LOWER GASTROINTESTINAL DISORDERS -<br />

BOWEL INFLAMMAT<br />

Bowel Antiinflamatory <strong>Agents</strong><br />

sulfasalazine AZULFIDINE TABLET 500<br />

MG<br />

sulfasalazine AZULFIDINE TABLET DR<br />

500 MG<br />

Drug Tx-Chronic Inflam. Colon Dx,5-Aminosalicylat<br />

AGE mesalamine ASACOL TABLET DR<br />

400 MG<br />

Hemorrhoidal Prep, Anti-Infam Steroid/Local Anesth<br />

PA hydrocortisone/pramoxine PROCTOFOAM-HC FOAM 1 %-1<br />

%<br />

Rectal Preparations<br />

QL hydrocortisone ANUSOL-HC CREAM (G)<br />

2.5 %<br />

hydrocortisone ANUSOL-HC CREAM (G) 1<br />

%<br />

hydrocortisone acetate PROCTOCORT SUPP.RECT<br />

25 MG<br />

PA hydrocortisone acetate PROCTOCORT SUPP.RECT<br />

30 MG<br />

QL hydrocortisone acetate PROCTOCORT OINT. (G) 1 %


Rectal/Lower Bowel Prep.,Glucocort. (non-Hemorr)<br />

hydrocortisone CORTENEMA ENEMA<br />

100MG/60ML<br />

LOWER GASTROINTESTINAL DISORDERS -<br />

OTHER<br />

Ammonia Inhibitors<br />

lactulose LACTULOSE SOLUTION 10<br />

G/15 ML<br />

lactulose LACTULOSE SOLUTION<br />

10G/15ML<br />

Antidiarrheals<br />

bismuth subsalicylate PEPTO-BISMOL TAB CHEW<br />

262 MG<br />

bismuth subsalicylate PEPTO-BISMOL TABLET 262<br />

MG<br />

bismuth subsalicylate PEPTO-BISMOL ORAL SUSP<br />

262MG/15ML<br />

bismuth subsalicylate PEPTO-BISMOL ORAL SUSP<br />

525MG/15ML<br />

diphenoxylate hcl/atropine LOMOTIL LIQUID 2.5-<br />

.025/5<br />

diphenoxylate hcl/atropine LOMOTIL TABLET 2.5-<br />

.025MG<br />

Bile Salts<br />

ursodiol ACTIGALL CAPSULE 300<br />

MG<br />

Laxatives And Cathartics<br />

bisacodyl DULCOLAX TABLET DR 5<br />

MG<br />

calcium polycarbophil FIBERCON TABLET 625<br />

MG<br />

casanthranol/docusate sodium CASANTHRANOL/DOCUSATE SODIUM CAPSULE 30-<br />

100MG<br />

casanthranol/docusate sodium CASANTHRANOL/DOCUSATE SODIUM TABLET 30-<br />

100MG<br />

cascara sagrada CASCARA SAGRADA CAPSULE<br />

500MG<br />

cascara sagrada CASCARA SAGRADA FL EXTRACT<br />

325MG/5ML<br />

cascara sagrada CASCARA SAGRADA TABLET<br />

325MG<br />

docusate sodium COLACE CAPSULE 100


MG<br />

docusate sodium COLACE CAPSULE 250<br />

MG<br />

docusate sodium COLACE CAPSULE 50<br />

MG<br />

docusate sodium COLACE LIQUID 50<br />

MG/5 ML<br />

docusate sodium COLACE SYRUP 60<br />

MG/15ML<br />

docusate sodium COLACE SYRUP<br />

50MG/15ML<br />

docusate sodium COLACE TABLET 100<br />

MG<br />

lactulose LACTULOSE SOLUTION 10<br />

G/15 ML<br />

lactulose LACTULOSE SOLUTION 10<br />

G/15 ML<br />

magnesium citrate MAGNESIUM CITRATE SOLUTION<br />

magnesium hydroxide PHILLIPS' MILK OF MAGNESIA ORAL SUSP<br />

400 MG/5ML<br />

mineral oil MINERAL OIL OIL<br />

QL peg 3350/na sulf,bicarb,cl/kcl COLYTE WITH FLAVOR PACKETS SOLN RECON<br />

240-22.72G<br />

QL peg 3350/na sulf,bicarb,cl/kcl COLYTE WITH FLAVOR PACKETS SOLN RECON<br />

236-22.74G<br />

QL polyethylene glycol 3350 GAVILAX<br />

MIRALAX<br />

POWDER<br />

17G/DOSE<br />

psyllium husk METAMUCIL CAPSULE<br />

0.52G<br />

psyllium husk (with sugar) WAL-MUCIL POWDER 3.4<br />

G/7 G<br />

psyllium husk/ca carbonate FIBER PLUS CALCIUM CAPSULE 1G-<br />

60MG<br />

psyllium seed METAMUCIL PACKET<br />

psyllium seed (with dextrose) KONSYL-D PACKET<br />

psyllium seed (with sugar) METAMUCIL WAFER<br />

psyllium seed (with sugar) METAMUCIL PACKET<br />

psyllium seed (with sugar) METAMUCIL POWDER 3.4<br />

G/12 G<br />

psyllium seed/sod bicarb PSYLLIUM SEED/SOD BICARB PACKET<br />

sennosides EX-LAX TABLET 8.6<br />

MG<br />

sennosides EX-LAX SYRUP<br />

8.8MG/5ML<br />

sodium chloride/nahco3/kcl/peg NULYTELY WITH FLAVOR PACKS SOLN RECON<br />

420G


Laxatives, Local/Rectal<br />

bisacodyl DULCOLAX SUPP.RECT<br />

10 MG<br />

docusate sodium DOCUSATE SODIUM ENEMA 283<br />

MG<br />

docusate sodium COLACE ENEMA 200<br />

MG/5ML<br />

glycerin GLYCERIN SUPP.RECT<br />

ADULT<br />

glycerin GLYCERIN SUPP.RECT<br />

PEDIATRIC<br />

na phos,m-b/na phos,di-ba PEDIA-LAX ENEMA ENEMA 19G-<br />

7G/118<br />

MEDICAL SUPPLIES<br />

Durable Medical Equipment,Misc<br />

container,empty<br />

PILL DIVIDER WITH PILL BOX<br />

CUT N CRUSH<br />

PILL SPLITTER<br />

TABLET CUTTER<br />

QL nebulizer accessories AIRS ADULT AEROSOL MASK<br />

BUBBLES THE FISH II<br />

PARI LC PLUS NEBULIZER<br />

REUSABLE NEBULIZER KIT<br />

SIDESTREAM MASK<br />

QL nebulizer accessories AIRS ADULT AEROSOL MASK<br />

BUBBLES THE FISH II<br />

PARI LC PLUS NEBULIZER<br />

REUSABLE NEBULIZER KIT<br />

SIDESTREAM MASK<br />

Durable Medical Equipment,Misc(group 1)<br />

lancets<br />

LANCETS<br />

SURE-LANCE<br />

TECHLITE<br />

THIN LANCETS<br />

EACH<br />

KIT<br />

EACH<br />

EACH<br />

Incontinence Supplies<br />

QL incontinence alarms WET-STOP 3 KIT N/A<br />

incontinence pants, reusable SLEEP PANTS EACH<br />

Syringes And Accessories<br />

syr,ndl,ins,safe,disp un, 1 ml<br />

MAGELLAN INSULIN SAFETY SYRNG<br />

SAFESNAP INSULIN SYRINGE<br />

DISP SYRIN<br />

28GX1/2"<br />

syring w-ndl,disp,insul,0.5ml GLUCOPRO DISP SYRIN<br />

31GX5/16"


MISCELLANEOUS AGENTS<br />

Anaphylaxis Therapy <strong>Agents</strong><br />

QL epinephrine EPIPEN JR PEN INJCTR<br />

0.15MG/0.3<br />

QL epinephrine EPIPEN PEN INJCTR<br />

0.3MG/0.3<br />

Parasympathetic <strong>Agents</strong><br />

bethanechol chloride URECHOLINE TABLET 10<br />

MG<br />

bethanechol chloride URECHOLINE TABLET 25<br />

MG<br />

bethanechol chloride URECHOLINE TABLET 5<br />

MG<br />

bethanechol chloride URECHOLINE TABLET 50<br />

MG<br />

NEOPLASTIC DISEASE<br />

Alkylating <strong>Agents</strong><br />

bendamustine hcl TREANDA VIAL 25 MG<br />

bendamustine hcl TREANDA VIAL 100 MG<br />

busulfan MYLERAN TABLET 2<br />

MG<br />

busulfan BUSULFEX AMPUL 60<br />

MG/10ML<br />

busulfan BUSULFEX VIAL 60<br />

MG/10ML<br />

carmustine in polifeprosan 20 GLIADEL WAFER 7.7-<br />

192.3<br />

AGE chlorambucil LEUKERAN TABLET 2<br />

MG<br />

AGE cyclophosphamide CYTOXAN TABLET 25<br />

MG<br />

AGE cyclophosphamide CYTOXAN TABLET 50<br />

MG<br />

AGE hydroxyurea HYDREA CAPSULE 500<br />

MG<br />

ifosfamide IFEX VIAL 1 G/20<br />

ML<br />

ifosfamide IFEX VIAL<br />

3G/60ML<br />

lomustine CEENU CAPSULE 40<br />

MG<br />

melphalan hcl ALKERAN VIAL 50 MG<br />

oxaliplatin OXALIPLATIN VIAL 50 MG


oxaliplatin OXALIPLATIN VIAL 100 MG<br />

oxaliplatin ELOXATIN VIAL<br />

200MG/40ML<br />

AGE temozolomide TEMODAR VIAL 100 MG<br />

AGE temozolomide TEMODAR CAPSULE 5<br />

MG<br />

AGE temozolomide TEMODAR CAPSULE 180<br />

MG<br />

Anti-Cd20 (b Lymphocyte) Monoclonal Antibody<br />

ofatumumab ARZERRA VIAL 1000<br />

MG/50<br />

Antiandrogenic <strong>Agents</strong><br />

bicalutamide CASODEX TABLET 50<br />

MG<br />

flutamide FLUTAMIDE CAPSULE 125<br />

MG<br />

nilutamide NILANDRON TABLET 150<br />

MG<br />

Antibiotic Antineoplastics<br />

epirubicin hcl ELLENCE VIAL<br />

200MG/0.1L<br />

plicamycin MITHRACIN VIAL<br />

2500MCG<br />

streptozocin ZANOSAR VIAL 1 G<br />

valrubicin VALSTAR VIAL 40<br />

MG/ML<br />

Antimetabolites<br />

clofarabine CLOLAR VIAL 20<br />

MG/20ML<br />

fluorouracil FLUOROURACIL VIAL<br />

500MG/10ML<br />

fluorouracil FLUOROURACIL VIAL 1 G/20<br />

ML<br />

fluorouracil FLUOROURACIL VIAL 2.5<br />

G/50ML<br />

fluorouracil FLUOROURACIL VIAL 5 G/100<br />

ML<br />

gemcitabine hcl GEMZAR VIAL 2 G<br />

gemcitabine hcl GEMZAR VIAL 1<br />

G/26.3ML<br />

gemcitabine hcl GEMZAR VIAL 2<br />

G/52.6ML<br />

gemcitabine hcl GEMZAR VIAL<br />

200MG/5.26


mercaptopurine PURINETHOL TABLET 50<br />

MG<br />

methotrexate sodium TREXALL TABLET 10<br />

MG<br />

methotrexate sodium TREXALL TABLET 5<br />

MG<br />

methotrexate sodium TREXALL TABLET 15<br />

MG<br />

methotrexate sodium TREXALL TABLET 7.5<br />

MG<br />

methotrexate sodium METHOTREXATE SODIUM TABLET 2.5<br />

MG<br />

nelarabine ARRANON VIAL<br />

250MG/50ML<br />

pemetrexed disodium ALIMTA VIAL 100 MG<br />

pralatrexate FOLOTYN VIAL<br />

20MG/ML(1)<br />

pralatrexate FOLOTYN VIAL<br />

40MG/2ML<br />

thioguanine TABLOID TABLET 40<br />

MG<br />

Antineoplast Egf Receptor Blocker Rcmb Mc Antibody<br />

pertuzumab PERJETA VIAL<br />

420MG/14ML<br />

Antineoplastic Aromatase Inhibitors<br />

anastrozole ARIMIDEX TABLET 1<br />

MG<br />

exemestane AROMASIN TABLET 25<br />

MG<br />

letrozole FEMARA TABLET 2.5<br />

MG<br />

Antineoplastic - Epothilones And Analogs<br />

ixabepilone IXEMPRA VIAL 15 MG<br />

ixabepilone IXEMPRA VIAL 45 MG<br />

Antineoplastic - Halichondrin B Analogs<br />

eribulin mesylate HALAVEN VIAL 1 MG/2<br />

ML<br />

Antineoplastic - Hedgehog Pathway Inhibitor<br />

vismodegib ERIVEDGE CAPSULE 150<br />

MG<br />

Antineoplastic - Immunotherapy, Therapeutic Vac<br />

sipuleucel-t/lactated ringers PROVENGE PLAST. BAG<br />

50 MM/250


Antineoplastic - Janus Kinase (jak) Inhibitors<br />

ruxolitinib phosphate JAKAFI TABLET 5<br />

MG<br />

ruxolitinib phosphate JAKAFI TABLET 10<br />

MG<br />

ruxolitinib phosphate JAKAFI TABLET 15<br />

MG<br />

ruxolitinib phosphate JAKAFI TABLET 20<br />

MG<br />

ruxolitinib phosphate JAKAFI TABLET 25<br />

MG<br />

Antineoplastic - Mtor Kinase Inhibitors<br />

everolimus AFINITOR TABLET 5<br />

MG<br />

everolimus AFINITOR TABLET 10<br />

MG<br />

everolimus AFINITOR TABLET 2.5<br />

MG<br />

everolimus AFINITOR TABLET 7.5<br />

MG<br />

temsirolimus TORISEL VIAL FNL<br />

30MG/3<br />

Antineoplastic - Topoisomerase I Inhibitors<br />

irinotecan hcl CAMPTOSAR VIAL<br />

40MG/2ML<br />

irinotecan hcl CAMPTOSAR VIAL 100<br />

MG/5ML<br />

irinotecan hcl CAMPTOSAR VIAL<br />

500MG/25ML<br />

irinotecan hcl CAMPTOSAR VIAL<br />

300MG/15ML<br />

topotecan hcl HYCAMTIN CAPSULE<br />

0.25 MG<br />

topotecan hcl HYCAMTIN VIAL 4 MG/4<br />

ML<br />

Antineoplastic Antibody/Radioactive-Drug Complexes<br />

tositumomab iodine-131/maltose BEXXAR VIAL<br />

5.6MCI/ML<br />

Antineoplastic Immunomodulator <strong>Agents</strong><br />

lenalidomide REVLIMID CAPSULE 2.5<br />

MG<br />

peginterferon alfa-2b<br />

SYLATRON<br />

KIT 296 MCG<br />

SYLATRON 4-PACK<br />

peginterferon alfa-2b SYLATRON KIT 888 MCG


peginterferon alfa-2b<br />

SYLATRON 4-PACK<br />

SYLATRON<br />

SYLATRON 4-PACK<br />

KIT 444 MCG<br />

Antineoplastic Lhrh(gnrh) Antagonist,Pituit.supprs<br />

degarelix acetate FIRMAGON VIAL 80 MG<br />

degarelix acetate FIRMAGON VIAL 120 MG<br />

Antineoplastic Systemic Enzyme Inhibitors<br />

axitinib INLYTA TABLET 1<br />

MG<br />

axitinib INLYTA TABLET 5<br />

MG<br />

crizotinib XALKORI CAPSULE 250<br />

MG<br />

crizotinib XALKORI CAPSULE 200<br />

MG<br />

dasatinib SPRYCEL TABLET 20<br />

MG<br />

dasatinib SPRYCEL TABLET 50<br />

MG<br />

dasatinib SPRYCEL TABLET 70<br />

MG<br />

dasatinib SPRYCEL TABLET 80<br />

MG<br />

dasatinib SPRYCEL TABLET 140<br />

MG<br />

AGE dasatinib SPRYCEL TABLET 100<br />

MG<br />

AGE erlotinib hcl TARCEVA TABLET 100<br />

MG<br />

AGE erlotinib hcl TARCEVA TABLET 25<br />

MG<br />

AGE nilotinib hcl TASIGNA CAPSULE 150<br />

MG<br />

nilotinib hcl TASIGNA CAPSULE 200<br />

MG<br />

pazopanib hcl VOTRIENT TABLET 200<br />

MG<br />

AGE vandetanib CAPRELSA TABLET 100<br />

MG<br />

AGE vandetanib CAPRELSA TABLET 300<br />

MG<br />

vemurafenib ZELBORAF TABLET 240<br />

MG<br />

Antineoplastic,Histone Deacetylase Inhibitors,Hdis<br />

romidepsin ISTODAX VIAL 10 MG/2


ML<br />

vorinostat ZOLINZA CAPSULE 100<br />

MG<br />

Antineoplastics Antibody/Antibody-Drug Complexes<br />

brentuximab vedotin ADCETRIS VIAL 50 MG<br />

kit <strong>for</strong> y-90/ibritumomab/album ZEVALIN KIT<br />

3.2MG/2ML<br />

kit i-111/ibritumomab tiuxetan ZEVALIN KIT<br />

3.2MG/2ML<br />

Antineoplastics,Miscellaneous<br />

asparaginase (erwinia chrysan) ERWINAZE VIAL 10000<br />

UNIT<br />

cabazitaxel JEVTANA VIAL<br />

FNL10MG/ML<br />

docetaxel TAXOTERE VIAL<br />

20MG/ML(1)<br />

docetaxel TAXOTERE VIAL 80 MG/4<br />

ML<br />

docetaxel TAXOTERE VIAL 80 MG/8<br />

ML<br />

docetaxel TAXOTERE VIAL 20 MG/2<br />

ML<br />

docetaxel TAXOTERE VIAL<br />

160MG/16ML<br />

docetaxel DOCEFREZ VIAL 80 MG<br />

docetaxel DOCEFREZ VIAL 20 MG<br />

etoposide VEPESID CAPSULE 50<br />

MG<br />

mitotane LYSODREN TABLET 500<br />

MG<br />

Chemotherapy Rescue/Antidote <strong>Agents</strong><br />

glucarpidase VORAXAZE VIAL 1000<br />

UNIT<br />

AGE leucovorin calcium LEUCOVORIN CALCIUM TABLET 10<br />

MG<br />

leucovorin calcium LEUCOVORIN CALCIUM TABLET<br />

15MG<br />

leucovorin calcium LEUCOVORIN CALCIUM TABLET 25<br />

MG<br />

AGE leucovorin calcium LEUCOVORIN CALCIUM TABLET 5<br />

MG<br />

levoleucovorin calcium FUSILEV VIAL 50 MG<br />

AGE mesna MESNEX TABLET 400<br />

MG


Cytotoxic T-Lymphocyte Antigen(ctla-4)rmc Antibody<br />

ipilimumab YERVOY VIAL 50<br />

MG/10ML<br />

ipilimumab YERVOY VIAL<br />

200MG/40ML<br />

Intrapleural Sclerosing <strong>Agents</strong>, Antineoplast. Adj.<br />

talc SCLEROSOL AERO POWD<br />

4 G<br />

talc TALC VIAL 5 G<br />

Photoactivated, Antineoplastic <strong>Agents</strong> (systemic)<br />

methoxsalen UVADEX VIAL 20<br />

MCG/ML<br />

Photoactivated, Antineopls. & Premalignant Lesions<br />

aminolevulinic acid hcl LEVULAN SOL W/APPL<br />

20 %<br />

methyl aminolevulinate hcl METVIXIA CREAM (G)<br />

168 MG/G<br />

Selective Estrogen Receptor Modulators (serm)<br />

tamoxifen citrate NOLVADEX TABLET 10<br />

MG<br />

tamoxifen citrate NOLVADEX TABLET 20<br />

MG<br />

Selective Retinoid X Receptor Agonists (rxr)<br />

bexarotene TARGRETIN CAPSULE 75<br />

MG<br />

Steroid Antineoplastics<br />

estramustine phosphate sodium EMCYT CAPSULE 140<br />

MG<br />

megestrol acetate MEGESTROL ACETATE TABLET 20<br />

MG<br />

megestrol acetate MEGESTROL ACETATE TABLET 40<br />

MG<br />

Vinca Alkaloids<br />

vincristine sulfate VINCRISTINE SULFATE VIAL 2 MG/2<br />

ML<br />

OTHER DRUGS<br />

Appetite Stim. For Anorexia,Cachexia,Wasting Synd.<br />

megestrol acetate MEGACE ORAL SUSP<br />

400MG/10ML<br />

Blood Testing Preparations,In-Vitro


QL blood ketone test,strips PRECISION XTRA STRIP<br />

Bulk Chemicals<br />

aromatic cascara fluid extract CASCARA SAGRADA FL EXTRACT<br />

100 %<br />

Condoms<br />

condoms, female<br />

FC CONDOM, FEMALE<br />

REALITY<br />

EACH<br />

Dietary Supplement, Miscellaneous<br />

PA caloric supplement DUOCAL LIQUID<br />

7KCAL/ML<br />

PA fos/inulin/nutrit supp/fiber FOS/INULIN/NUTRIT SUPP/FIBER ORAL SUSP<br />

0.06G-1.5<br />

PA fos/inulin/nutrit supp/fiber FOS/INULIN/NUTRIT SUPP/FIBER ORAL SUSP<br />

0.03G-1/ML<br />

PA lipase/protease/amylase TRI-PASE 8 TABLET 8K-<br />

30K-30K<br />

PA lipase/protease/amylase TRI-PASE 16 TABLET 16-<br />

60-60K<br />

PA milk based <strong>for</strong>mula MILK BASED FORMULA LIQUID<br />

PA ns comb1/fos/inulin PEPTAMEN AF ORAL SUSP<br />

0.0756-1.2<br />

PA nutritional supplement ENFAGROW GENTLEASE LIPIL ORAL SUSP<br />

0.03G-1/ML<br />

General Inhalation <strong>Agents</strong><br />

sodium chloride <strong>for</strong> inhalation SODIUM CHLORIDE VIAL-NEB 0.9<br />

%<br />

Needles/Needleless Devices<br />

needleless access. dev,insulin<br />

MEDI-JECTOR NEEDLE-FREE SYR B<br />

MEDI-JECTOR NEEDLE-FREE SYR C<br />

PEN NEEDLE<br />

PRODIGY PEN NEEDLE<br />

NOVOFINE AUTOCOVER<br />

EACH<br />

Nose Preparations, Miscellaneous (otc)<br />

sodium chloride LITTLE NOSES SPRAY 0.65 %<br />

sodium chloride LITTLE NOSES DROPS 0.65 %<br />

Nut.tx Phenylketonuria (pku) Formulations<br />

PA infant <strong>for</strong>m.<strong>for</strong> pku,iron no.4 PERIFLEX INFANT POWDER<br />

13G-421<br />

PA nut. tx <strong>for</strong> pku with iron #10 NUT. TX FOR PKU WITH IRON #10 POWDER<br />

16.2G-500<br />

PA nut. tx <strong>for</strong> pku with iron #13 EAA POWD PACK<br />

5G-36KCAL<br />

PA nut. tx <strong>for</strong> pku with iron #2 XPHE MAXAMUM LIQUID


0.06G-0.64<br />

PA nut. tx <strong>for</strong> pku with iron #20 PERIFLEX ADVANCE POWDER<br />

35G-385<br />

PA nut. tx <strong>for</strong> pku with iron #20 PERIFLEX ADVANCE POWDER 35<br />

G-369<br />

PA nut. tx <strong>for</strong> pku with iron #27 PHENYLADE60 POWD PACK<br />

10G-49<br />

PA nut. tx <strong>for</strong> pku with iron #27 PHENYLADE60 POWDER<br />

60G-295<br />

PA nut. tx <strong>for</strong> pku with iron #27 PHENYLADE60 POWDER<br />

60G-327<br />

PA nut. tx <strong>for</strong> pku with iron #3 PERIFLEX JUNIOR POWDER 25<br />

G-374<br />

PA nut. tx <strong>for</strong> pku with iron #3 PERIFLEX JUNIOR POWDER 25<br />

G-394<br />

PA nut. tx <strong>for</strong> pku with iron #3 PERIFLEX JUNIOR POWDER 25<br />

G-374<br />

PA nut. tx <strong>for</strong> pku with iron #33 PHENYLENE POWDER<br />

31.1G-422<br />

PA nut. tx <strong>for</strong> pku with iron #34 PHENYLENE 75 POWDER<br />

74.97G-301<br />

PA nut. tx <strong>for</strong> pku with iron #35 PHENYLADE ESSENTIAL POWDER<br />

25G-390<br />

PA nut. tx <strong>for</strong> pku with iron #35 PHENYLADE ESSENTIAL POWD PACK<br />

10G-156/40<br />

PA nut. tx <strong>for</strong> pku with iron #36 ADD-INS POWD PACK<br />

10G-86<br />

PA nut. tx <strong>for</strong> pku with iron #4 NUT. TX FOR PKU WITH IRON #4<br />

PKU COOLER 10<br />

PKU COOLER 15<br />

PKU COOLER 20<br />

ORAL SUSP<br />

0.12G-0.71<br />

PA nut. tx <strong>for</strong> pku with iron #40 PKU LOPHLEX LIQUID PKT<br />

20-116/125<br />

PA nut. tx <strong>for</strong> pku with iron #41 CAMINO PRO 15 PKU POWD PACK<br />

15G-140/49<br />

PA nut. tx <strong>for</strong> pku with iron #42 PKU LOPHLEX LIQUID PKT<br />

20-115/125<br />

PA nut. tx <strong>for</strong> pku with iron #45 PHENYL-FREE 2 POWDER<br />

22G-410<br />

PA nut. tx <strong>for</strong> pku with iron #45 PHENYL-FREE 2HP POWDER<br />

40G-390<br />

PA nut. tx <strong>for</strong> pku with iron #48 PKU TRIO POWDER 30<br />

G-404<br />

PA nut. tx <strong>for</strong> pku with iron, #26 CAMINO PRO 15 ORAL SUSP<br />

0.11G-1.06<br />

PA nut. tx <strong>for</strong> pku, #22 PREKUNIL TABLET 0.4G-


2.2<br />

PA nut. tx <strong>for</strong> pku, #23 NEOPHE TABLET 0.4G-<br />

2.1<br />

PA nut. tx <strong>for</strong> pku, #38 NEOPHE POWDER<br />

60G-315<br />

PA nut. tx <strong>for</strong> pku, #43 PHENYLADE PHEBLOC POWD PACK<br />

2.2G-10/3G<br />

PA nut. tx <strong>for</strong> pku, #46 CAMINO-PRO RESTORE LIQUID 2G-<br />

36/100<br />

Nutritional Therapy, Med Cond Special Formulation<br />

PA nut.tx. metabolic disorder,soy PERATIVE LIQUID<br />

0.067G-1.3<br />

PA nut.tx.comp. immune systm,soy CRUCIAL LIQUID<br />

PA nut.tx.gluc.intoler,lac-fr,reg DIABETISOURCE LIQUID<br />

PA nut.tx.gluc.intoler,lac-fr,soy GLUCERNA HUNGER SMART LIQUID<br />

PA nut.tx.glucose intol,soy/fiber DIABETISOURCE AC<br />

RESOURCE DIABETIC TF<br />

LIQUID<br />

0.06G-1.2<br />

PA nut.tx.imp.renal fxn,lac-free NUT.TX.IMP.RENAL FXN,LAC-FREE<br />

PRO-STAT RC<br />

LIQUID<br />

0.08G-2/ML<br />

PA nut.tx.imp.renal fxn,lac-free NUT.TX.IMP.RENAL FXN,LAC-FREE<br />

NUTREN PULMONARY<br />

LIQUID<br />

0.08G-2/ML<br />

PA nut.tx.impaired digest fxn,soy VIVONEX RTF LIQUID<br />

0.05G-1/ML<br />

PA nut.tx.impaired digest fxn,soy PEPDITE JUNIOR POWD PACK<br />

7.4G-240<br />

PA nut.tx.impaired hepatic fxn NUT.TX.IMPAIRED HEPATIC FXN LIQUID<br />

0.16G-1.5<br />

PA nut.tx.impaired renal fxn,soy NEPRO<br />

NEPRO CARB STEADY<br />

SUPLENA CARB STEADY<br />

LIQUID<br />

0.08G-1.80<br />

PA nut.tx.pulm.disord.soy,lac-fr NUT.TX.PULM.DISORD.SOY,LAC-FR LIQUID<br />

Solvents<br />

isopropyl alcohol INSTACLEAN SOLUTION<br />

mineral oil MINERAL OIL HEAVY OIL<br />

Urine Acetone Test Aids<br />

QL urine acetone test,strips DIASCREEN 1K REAGENT STRIP<br />

Vehicles<br />

sorbitol solution SORBITOL SOLUTION 70<br />

%<br />

PAIN MANAGEMENT - ANALGESICS<br />

Analgesic, Salicylate, Barbiturate,& Xanthine Cmb<br />

butalbital/aspirin/caffeine FIORINAL CAPSULE 50-<br />

325-40


utalbital/aspirin/caffeine FIORINAL TABLET 50-<br />

325-40<br />

Analgesic,Non-Salicylate,Barbiturate,&xanthine Cmb<br />

acetaminophen/caffeine/butalb ESGIC-PLUS TABLET 325-<br />

40-50<br />

Analgesic/Antipyretics, Salicylates<br />

asa/calcium carb/mag/al hydrox ASCRIPTIN TABLET 325<br />

MG<br />

QL aspirin BAYER ASPIRIN TABLET DR<br />

81 MG<br />

QL aspirin BAYER ASPIRIN TABLET<br />

325MG<br />

QL aspirin BAYER ASPIRIN TABLET 500<br />

MG<br />

QL aspirin BAYER ASPIRIN TAB CHEW<br />

81 MG<br />

QL aspirin BAYER ASPIRIN TABLET DR<br />

325 MG<br />

QL aspirin BAYER ASPIRIN TABLET DR<br />

500MG<br />

QL aspirin BAYER ASPIRIN TABLET DR<br />

650 MG<br />

QL aspirin BAYER ASPIRIN TABLET DR<br />

975 MG<br />

aspirin/acetaminophen/caffeine EXCEDRIN EXTRA STRENGTH TABLET<br />

aspirin/mag carb/al aminoacet ASPIRIN/MAG CARB/AL AMINOACET TABLET 325<br />

MG<br />

choline sal/mag salicylate CHOLINE SAL/MAG SALICYLATE LIQUID 500<br />

MG/5ML<br />

salsalate SALFLEX TABLET 500<br />

MG<br />

salsalate SALFLEX TABLET 750<br />

MG<br />

Analgesic/Antipyretics,Non-Salicylate<br />

acetaminophen ACETAMINOPHEN CAPSULE<br />

500MG<br />

acetaminophen ACETAMINOPHEN SUPP.RECT<br />

120 MG<br />

acetaminophen ACETAMINOPHEN SUPP.RECT<br />

325 MG<br />

acetaminophen ACETAMINOPHEN SUPP.RECT<br />

650 MG<br />

acetaminophen FEVERALL SUPP.RECT<br />

80 MG<br />

acetaminophen ACETAMINOPHEN TABLET ER


650 MG<br />

acetaminophen ACETAMINOPHEN ELIXIR<br />

160MG/5ML<br />

acetaminophen ACETAMINOPHEN LIQUID 500<br />

MG/5ML<br />

acetaminophen ACETAMINOPHEN SOLUTION<br />

160 MG/CUP<br />

acetaminophen ACETAMINOPHEN LIQUID<br />

160MG/5ML<br />

acetaminophen ACETAMINOPHEN LIQUID<br />

500MG/15ML<br />

acetaminophen ACETAMINOPHEN DROPS SUSP<br />

80MG/0.8ML<br />

acetaminophen ACETAMINOPHEN TABLET<br />

325MG<br />

acetaminophen ACETAMINOPHEN TABLET 500<br />

MG<br />

acetaminophen ACETAMINOPHEN TABLET 650<br />

MG<br />

acetaminophen ACETAMINOPHEN TAB CHEW<br />

160 MG<br />

acetaminophen ACETAMINOPHEN ORAL SUSP<br />

160 MG/5ML<br />

acetaminophen ACETAMINOPHEN DROPS SUSP<br />

80MG/0.8ML<br />

Analgesics,Narcotics<br />

QL+ fentanyl DURAGESIC PATCH TD72<br />

ST<br />

25MCG/HR<br />

QL+ fentanyl DURAGESIC PATCH TD72<br />

ST<br />

50MCG/HR<br />

QL+ fentanyl DURAGESIC PATCH TD72<br />

ST<br />

75MCG/HR<br />

QL+ fentanyl DURAGESIC PATCH TD72<br />

ST<br />

100 MCG/HR<br />

QL+ fentanyl DURAGESIC PATCH TD72<br />

ST<br />

12 MCG/HR<br />

QL hydrocodone bit/acetaminophen VICODIN TABLET<br />

5MG-325MG<br />

QL hydrocodone bit/acetaminophen VICODIN TABLET 7.5-<br />

325MG<br />

hydrocodone bit/acetaminophen VICODIN CAPSULE 5<br />

MG-500MG<br />

QL hydrocodone bit/acetaminophen VICODIN TABLET<br />

10MG-325MG<br />

QL hydrocodone bit/acetaminophen VICODIN TABLET 5<br />

MG-500MG


QL hydrocodone bit/acetaminophen VICODIN TABLET<br />

10MG-650MG<br />

QL hydrocodone bit/acetaminophen VICODIN TABLET 7.5-<br />

650 MG<br />

QL hydrocodone bit/acetaminophen VICODIN TABLET<br />

10MG-500MG<br />

QL hydrocodone bit/acetaminophen VICODIN TABLET 7.5-<br />

750MG<br />

QL hydrocodone bit/acetaminophen VICODIN TABLET 7.5-<br />

500MG<br />

QL hydrocodone bit/acetaminophen VICODIN SOLUTION<br />

7.5-500/15<br />

QL hydrocodone bit/acetaminophen VICODIN TABLET 10-<br />

660MG<br />

QL hydromorphone hcl DILAUDID-5 SUPP.RECT 3<br />

MG<br />

QL hydromorphone hcl DILAUDID-5 TABLET 2<br />

MG<br />

QL hydromorphone hcl DILAUDID-5 TABLET 4<br />

MG<br />

QL hydromorphone hcl DILAUDID-5 TABLET 8<br />

MG<br />

methadone hcl DOLOPHINE HCL SOLUTION 5<br />

MG/5 ML<br />

methadone hcl DOLOPHINE HCL SOLUTION 10<br />

MG/5 ML<br />

methadone hcl DOLOPHINE HCL TABLET 10<br />

MG<br />

methadone hcl DOLOPHINE HCL TABLET 5<br />

MG<br />

methadone hcl DOLOPHINE HCL TABLET SOL<br />

40 MG<br />

PA morphine sulfate KADIAN CAP ER PEL<br />

30 MG<br />

PA morphine sulfate KADIAN CAP ER PEL<br />

60 MG<br />

PA morphine sulfate KADIAN CAP ER PEL<br />

100 MG<br />

PA morphine sulfate KADIAN CAP ER PEL<br />

50 MG<br />

PA morphine sulfate KADIAN CAP ER PEL<br />

20 MG<br />

morphine sulfate KADIAN SOLUTION 10<br />

MG/5 ML<br />

morphine sulfate KADIAN SOLUTION 20<br />

MG/5 ML


morphine sulfate KADIAN SOLUTION<br />

100 MG/5ML<br />

morphine sulfate KADIAN TABLET 15<br />

MG<br />

morphine sulfate KADIAN TABLET 30<br />

MG<br />

QL morphine sulfate KADIAN TABLET ER<br />

200 MG<br />

PA morphine sulfate AVINZA CPMP 24HR<br />

45 MG<br />

PA morphine sulfate AVINZA CPMP 24HR<br />

75 MG<br />

QL morphine sulfate KADIAN TABLET ER<br />

30 MG<br />

QL morphine sulfate KADIAN TABLET ER<br />

60 MG<br />

QL morphine sulfate KADIAN TABLET ER<br />

100 MG<br />

QL morphine sulfate KADIAN TABLET ER<br />

15 MG<br />

PA morphine sulfate AVINZA CPMP 24HR<br />

120 MG<br />

PA morphine sulfate AVINZA CPMP 24HR<br />

90 MG<br />

PA morphine sulfate AVINZA CPMP 24HR<br />

60 MG<br />

PA morphine sulfate AVINZA CPMP 24HR<br />

30 MG<br />

PA morphine sulfate KADIAN CAP ER PEL<br />

10 MG<br />

PA morphine sulfate KADIAN CAP ER PEL<br />

80 MG<br />

PA morphine sulfate KADIAN CAP ER PEL<br />

200 MG<br />

QL oxycodone hcl/acetaminophen TYLOX TABLET 7.5-<br />

325MG<br />

QL oxycodone hcl/acetaminophen TYLOX TABLET<br />

10MG-325MG<br />

QL oxycodone hcl/acetaminophen TYLOX TABLET 7.5-<br />

500MG<br />

QL oxycodone hcl/acetaminophen TYLOX TABLET<br />

10MG-650MG<br />

oxycodone hcl/acetaminophen TYLOX SOLUTION 5-<br />

325/5ML<br />

QL oxycodone hcl/acetaminophen TYLOX TABLET 5<br />

MG-500MG


QL oxycodone hcl/acetaminophen TYLOX TABLET<br />

5MG-325MG<br />

QL oxycodone hcl/acetaminophen TYLOX CAPSULE 5<br />

MG-500MG<br />

QL oxycodone hcl/aspirin ENDODAN TABLET<br />

4.8355-325<br />

pentazocine hcl/naloxone hcl TALWIN NX TABLET<br />

50MG-0.5MG<br />

QL tramadol hcl ULTRAM TABLET 50<br />

MG<br />

Antimigraine Preparations<br />

QL+ almotriptan malate AXERT TABLET 12.5<br />

ST<br />

MG<br />

QL+ almotriptan malate AXERT TABLET 6.25<br />

ST<br />

MG<br />

QL eletriptan hydrobromide RELPAX TABLET 20<br />

MG<br />

QL eletriptan hydrobromide RELPAX TABLET 40<br />

MG<br />

ergotamine tartrate ERGOMAR TAB SUBL 2<br />

MG<br />

ergotamine tartrate/caffeine CAFERGOT SUPP.RECT 2-<br />

100MG<br />

ergotamine tartrate/caffeine CAFERGOT TABLET<br />

1MG-100MG<br />

QL+<br />

ST<br />

frovatriptan succinate FROVA TABLET 2.5<br />

MG<br />

isomethept/acetaminop/dichlphn MIDRIN CAPSULE 65-<br />

325-100<br />

isometheptene/acetaminoph/caff PRODRIN TABLET 130-<br />

500-20<br />

QL+ rizatriptan benzoate MAXALT TABLET 5<br />

ST<br />

MG<br />

QL+ rizatriptan benzoate MAXALT TABLET 10<br />

ST<br />

MG<br />

QL+ rizatriptan benzoate MAXALT MLT TAB RAPDIS<br />

ST<br />

5 MG<br />

QL+ rizatriptan benzoate MAXALT MLT TAB RAPDIS<br />

ST<br />

10 MG<br />

QL+ sumatriptan IMITREX SPRAY 5 MG<br />

ST<br />

QL+<br />

ST<br />

QL sumatriptan succinate IMITREX TABLET 50<br />

MG<br />

QL sumatriptan succinate IMITREX TABLET 100<br />

sumatriptan IMITREX SPRAY 20 MG


MG<br />

QL sumatriptan succinate IMITREX TABLET 25<br />

MG<br />

QL+<br />

ST<br />

sumatriptan succinate IMITREX PEN INJCTR 6<br />

MG/0.5ML<br />

Narc.& Non-Sal.analgesic,Barbiturate &xanthine Cmb<br />

codeine/butalbit/acetamin/caff FIORICET WITH CODEINE CAPSULE 30-<br />

50-325<br />

Narcotic & Salicylate Analgesics, Barb.& Xanthine<br />

codeine/butalbital/asa/caffein FIORINAL WITH CODEINE #3 CAPSULE 30-<br />

50-325<br />

Narcotic Analgesic & Non-Salicylate Analgesic Comb<br />

QL acetaminophen with codeine TYLENOL-CODEINE NO.4 ELIXIR 120-<br />

12MG/5<br />

acetaminophen with codeine CAPITAL W-CODEINE ORAL SUSP<br />

120-12MG/5<br />

QL acetaminophen with codeine TYLENOL-CODEINE NO.4 TABLET<br />

300MG-15MG<br />

QL acetaminophen with codeine TYLENOL-CODEINE NO.4 TABLET<br />

300MG-30MG<br />

acetaminophen with codeine TYLENOL-CODEINE NO.4 TABLET<br />

650MG-30MG<br />

QL acetaminophen with codeine TYLENOL-CODEINE NO.4 TABLET<br />

300MG-60MG<br />

PARKINSONS DISEASE<br />

Antiparkinsonism Drugs,Other<br />

PA bromocriptine mesylate PARLODEL CAPSULE 5<br />

MG<br />

bromocriptine mesylate PARLODEL TABLET 2.5<br />

MG<br />

carbidopa/levodopa PARCOPA TABLET ER<br />

50MG-200MG<br />

carbidopa/levodopa PARCOPA TABLET ER<br />

25MG-100MG<br />

carbidopa/levodopa PARCOPA TABLET<br />

10MG-100MG<br />

carbidopa/levodopa PARCOPA TABLET<br />

25MG-100MG<br />

carbidopa/levodopa PARCOPA TABLET<br />

25MG-250MG<br />

ST carbidopa/levodopa/entacapone STALEVO 100 TABLET<br />

18.75-75MG<br />

ST carbidopa/levodopa/entacapone STALEVO 100 TABLET


31.25-125<br />

ST carbidopa/levodopa/entacapone STALEVO 100 TABLET 37.5-<br />

150MG<br />

ST carbidopa/levodopa/entacapone STALEVO 100 TABLET 25-<br />

100-200<br />

ST carbidopa/levodopa/entacapone STALEVO 100 TABLET 12.5-<br />

50MG<br />

ST carbidopa/levodopa/entacapone STALEVO 100 TABLET 50-<br />

200-200<br />

ST entacapone COMTAN TABLET 200<br />

MG<br />

pramipexole di-hcl MIRAPEX TABLET 1<br />

MG<br />

pramipexole di-hcl MIRAPEX TABLET 1.5<br />

MG<br />

pramipexole di-hcl MIRAPEX TABLET 0.125<br />

MG<br />

pramipexole di-hcl MIRAPEX TABLET 0.25<br />

MG<br />

pramipexole di-hcl MIRAPEX TABLET 0.5<br />

MG<br />

pramipexole di-hcl MIRAPEX TABLET 0.75<br />

MG<br />

ropinirole hcl REQUIP TABLET 0.25<br />

MG<br />

ropinirole hcl REQUIP TABLET 1<br />

MG<br />

ropinirole hcl REQUIP TABLET 2<br />

MG<br />

ropinirole hcl REQUIP TABLET 5<br />

MG<br />

ropinirole hcl REQUIP TABLET 0.5<br />

MG<br />

ropinirole hcl REQUIP TABLET 4<br />

MG<br />

ropinirole hcl REQUIP TABLET 3<br />

MG<br />

selegiline hcl ELDEPRYL TABLET 5<br />

MG<br />

selegiline hcl ELDEPRYL CAPSULE 5<br />

MG<br />

SEIZURE DISORDER<br />

Anticonvulsants<br />

carbamazepine CARBATROL TABLET 200<br />

MG


carbamazepine CARBATROL TAB CHEW<br />

100 MG<br />

PA carbamazepine TEGRETOL XR TAB ER 12H<br />

100 MG<br />

PA carbamazepine CARBAMAZEPINE<br />

TEGRETOL XR<br />

TAB ER 12H<br />

200 MG<br />

PA carbamazepine CARBAMAZEPINE<br />

TEGRETOL XR<br />

TAB ER 12H<br />

400 MG<br />

carbamazepine CARBATROL ORAL SUSP<br />

100 MG/5ML<br />

clonazepam KLONOPIN TABLET 0.5<br />

MG<br />

clonazepam KLONOPIN TABLET 1<br />

MG<br />

clonazepam KLONOPIN TABLET 2<br />

MG<br />

QL diazepam DIASTAT ACUDIAL KIT 5-7.5-<br />

10MG<br />

QL diazepam DIASTAT ACUDIAL KIT 12.5-15-20<br />

QL diazepam DIASTAT KIT 2.5 MG<br />

QL diazepam DIASTAT KIT 5-7.5-<br />

10MG<br />

QL diazepam DIASTAT KIT 12.5-15-20<br />

divalproex sodium DEPAKOTE TABLET DR<br />

250 MG<br />

divalproex sodium DEPAKOTE TABLET DR<br />

500 MG<br />

divalproex sodium DEPAKOTE TABLET DR<br />

125 MG<br />

divalproex sodium DEPAKOTE CAP SPRINK<br />

125 MG<br />

divalproex sodium DEPAKOTE TAB ER 24H<br />

500 MG<br />

divalproex sodium DEPAKOTE TAB ER 24H<br />

250 MG<br />

ethosuximide ZARONTIN CAPSULE 250<br />

MG<br />

ethosuximide ZARONTIN SYRUP 250<br />

MG/5ML<br />

QL gabapentin NEURONTIN CAPSULE 100<br />

MG<br />

QL gabapentin NEURONTIN CAPSULE 300<br />

MG<br />

QL gabapentin NEURONTIN CAPSULE 400<br />

MG<br />

QL gabapentin NEURONTIN TABLET 800


MG<br />

QL gabapentin NEURONTIN TABLET 600<br />

MG<br />

PA lacosamide VIMPAT TABLET 50<br />

MG<br />

PA lacosamide VIMPAT TABLET 100<br />

MG<br />

PA lacosamide VIMPAT TABLET 150<br />

MG<br />

PA lacosamide VIMPAT TABLET 200<br />

MG<br />

PA lacosamide VIMPAT SOLUTION 10<br />

MG/ML<br />

PA lamotrigine LAMICTAL XR TAB ER 24 25<br />

MG<br />

PA lamotrigine LAMICTAL XR TAB ER 24 50<br />

MG<br />

PA lamotrigine LAMICTAL XR TAB ER 24<br />

100 MG<br />

PA lamotrigine LAMICTAL XR TAB ER 24<br />

200 MG<br />

PA lamotrigine LAMICTAL XR TAB ER 24<br />

300 MG<br />

PA lamotrigine LAMICTAL XR TAB ER 24<br />

250 MG<br />

AGE+ lamotrigine LAMICTAL TABLET 100<br />

QL<br />

MG<br />

AGE+ lamotrigine LAMICTAL TABLET 25<br />

QL<br />

MG<br />

AGE+ lamotrigine LAMICTAL TB CHW DSP<br />

QL<br />

5 MG<br />

AGE+ lamotrigine LAMICTAL TABLET 150<br />

QL<br />

MG<br />

AGE+ lamotrigine LAMICTAL TABLET 200<br />

QL<br />

MG<br />

AGE+ levetiracetam KEPPRA XR TAB ER 24H<br />

QL+<br />

500 MG<br />

ST<br />

AGE+ levetiracetam KEPPRA XR SOLUTION<br />

QL<br />

100 MG/ML<br />

AGE+ levetiracetam KEPPRA XR TAB ER 24H<br />

QL+<br />

750 MG<br />

ST<br />

AGE+ levetiracetam KEPPRA XR TABLET 750<br />

QL<br />

MG<br />

AGE+ levetiracetam KEPPRA XR TABLET 250


QL<br />

MG<br />

AGE+ levetiracetam KEPPRA XR TABLET<br />

QL<br />

500MG<br />

AGE+ levetiracetam KEPPRA XR TABLET 1000<br />

QL<br />

MG<br />

AGE+ oxcarbazepine TRILEPTAL TABLET 300<br />

QL<br />

MG<br />

AGE+ oxcarbazepine TRILEPTAL TABLET 600<br />

QL<br />

MG<br />

AGE+ oxcarbazepine TRILEPTAL TABLET 150<br />

QL<br />

MG<br />

phenytoin DILANTIN-125 ORAL SUSP<br />

125 MG/5ML<br />

phenytoin DILANTIN TAB CHEW<br />

50 MG<br />

phenytoin sodium extended DILANTIN CAPSULE 300<br />

MG<br />

phenytoin sodium extended DILANTIN CAPSULE 200<br />

MG<br />

phenytoin sodium extended DILANTIN CAPSULE 100<br />

MG<br />

phenytoin sodium extended DILANTIN CAPSULE 30<br />

MG<br />

primidone MYSOLINE TABLET 250<br />

MG<br />

primidone MYSOLINE TABLET 50<br />

MG<br />

PA rufinamide BANZEL TABLET 200<br />

MG<br />

PA rufinamide BANZEL TABLET 400<br />

MG<br />

PA tiagabine hcl GABITRIL TABLET 4<br />

MG<br />

PA tiagabine hcl GABITRIL TABLET 12<br />

MG<br />

PA tiagabine hcl GABITRIL TABLET 16<br />

MG<br />

PA tiagabine hcl GABITRIL TABLET 2<br />

MG<br />

QL+ topiramate TOPAMAX TABLET 50<br />

AGE<br />

MG<br />

QL+ topiramate TOPAMAX TABLET 100<br />

AGE<br />

MG<br />

QL+ topiramate TOPAMAX TABLET 200<br />

AGE<br />

MG<br />

QL+ topiramate TOPAMAX TABLET 25


AGE<br />

MG<br />

PA topiramate TOPAMAX CAP SPRINK<br />

15 MG<br />

PA topiramate TOPAMAX CAP SPRINK<br />

25 MG<br />

valproate sodium DEPACON SOLUTION<br />

250 MG/5ML<br />

valproic acid DEPAKENE CAPSULE 250<br />

MG<br />

AGE+ zonisamide ZONEGRAN CAPSULE 25<br />

QL<br />

MG<br />

AGE+ zonisamide ZONEGRAN CAPSULE 50<br />

QL<br />

MG<br />

AGE+ zonisamide ZONEGRAN CAPSULE 100<br />

QL<br />

MG<br />

SKELETAL MUSCLE DISORDER<br />

Skeletal Muscle Relaxants<br />

baclofen BACLOFEN TABLET 10<br />

MG<br />

baclofen BACLOFEN TABLET 20<br />

MG<br />

carisoprodol SOMA TABLET 350<br />

MG<br />

cyclobenzaprine hcl FLEXERIL TABLET 10<br />

MG<br />

methocarbamol ROBAXIN-750 TABLET 500<br />

MG<br />

methocarbamol ROBAXIN-750 TABLET 750<br />

MG<br />

SMOKING CESSATION<br />

Smoking Deterrent <strong>Agents</strong> (ganglionic Stim,Others)<br />

QL nicotine NICODERM CQ PATCH TD24<br />

7MG/24HR<br />

QL nicotine NICODERM CQ PATCH TD24<br />

14MG/24HR<br />

QL nicotine NICODERM CQ PATCH TD24<br />

21 MG/24HR<br />

QL nicotine polacrilex NICORETTE GUM 2MG<br />

QL nicotine polacrilex NICORETTE GUM 4 MG<br />

Smoking Deterrents, Other<br />

bupropion hcl ZYBAN TABLET ER<br />

150 MG


UPPER GASTROINTESTINAL DISORDERS -<br />

DIGESTIVE<br />

Antiflatulents<br />

simethicone INFANTS' MYLICON DROPS SUSP<br />

40MG/0.6ML<br />

simethicone INFANTS' MYLICON CAPSULE 125<br />

MG<br />

Pancreatic Enzymes<br />

AGE lipase/protease/amylase ULTRASE MT 20 CAPSULE DR<br />

371 MG<br />

AGE lipase/protease/amylase ULTRASE MT 12 CAPSULE DR<br />

223MG<br />

AGE lipase/protease/amylase VIOKASE TABLET<br />

468MG<br />

AGE lipase/protease/amylase ULTRASE MT 18 CAPSULE DR<br />

333 MG<br />

AGE lipase/protease/amylase VIOKASE TABLET 935<br />

MG<br />

AGE lipase/protease/amylase CREON CAPSULE DR<br />

6K-19K-30K<br />

AGE lipase/protease/amylase CREON CAPSULE DR<br />

12K-38K-60<br />

AGE lipase/protease/amylase CREON CAPSULE DR<br />

24-76-120K<br />

AGE lipase/protease/amylase ZENPEP CAPSULE DR<br />

5K-17K-27K<br />

AGE lipase/protease/amylase ZENPEP CAPSULE DR<br />

10-34-55K<br />

AGE lipase/protease/amylase ZENPEP CAPSULE DR<br />

15-51-82K<br />

AGE lipase/protease/amylase ZENPEP CAPSULE DR<br />

20-68-109K<br />

AGE lipase/protease/amylase PANCREAZE CAPSULE DR<br />

16.8-40-70<br />

AGE lipase/protease/amylase PANCREAZE CAPSULE DR<br />

21-37-61K<br />

AGE lipase/protease/amylase PANCREAZE CAPSULE DR<br />

10.5K-25K<br />

AGE lipase/protease/amylase PANCREAZE CAPSULE DR<br />

4.2K-10K<br />

AGE lipase/protease/amylase CREON CAPSULE DR<br />

3-9.5-15K<br />

AGE lipase/protease/amylase ZENPEP CAPSULE DR


3K-10K-16K<br />

AGE lipase/protease/amylase ZENPEP CAPSULE DR<br />

25-85-136K<br />

AGE lipase/protease/amylase PERTZYE CAPSULE DR<br />

8K-28.75K<br />

AGE lipase/protease/amylase PERTZYE CAPSULE DR<br />

16K-57.5K<br />

AGE lipase/protease/amylase ULTRASE CAPSULE DR<br />

250 MG<br />

AGE pancreatin/potass/sod bicarb KARBOZYME TABLET<br />

UPPER GASTROINTESTINAL DISORDERS -<br />

SPASTIC DISEASE<br />

Anticholinergics/Antispasmodics<br />

dicyclomine hcl BENTYL CAPSULE 10<br />

MG<br />

dicyclomine hcl BENTYL SYRUP 10<br />

MG/5 ML<br />

dicyclomine hcl BENTYL TABLET 20<br />

MG<br />

Belladonna Alkaloids<br />

belladonna alkaloids/phenobarb DONNATAL TABLET<br />

16.2MG<br />

hyoscyamine sulfate SYMAX DUOTAB ELIXIR<br />

125MCG/5ML<br />

hyoscyamine sulfate SYMAX DUOTAB DROPS<br />

0.125MG/ML<br />

hyoscyamine sulfate SYMAX DUOTAB TAB ER 12H<br />

0.375 MG<br />

hyoscyamine sulfate SYMAX DUOTAB TABLET 0.125<br />

MG<br />

hyoscyamine sulfate SYMAX DUOTAB TAB SUBL<br />

0.125 MG<br />

phenobarb/hyoscy/atropine/scop DONNATAL ELIXIR<br />

16.2MG/5ML<br />

UPPER GASTROINTESTINAL DISORDERS -<br />

ULCER DISEASE<br />

Antacids<br />

aluminum hydroxide ALTERNAGEL ORAL SUSP<br />

320MG/5ML<br />

aluminum hydroxide ALTERNAGEL ORAL SUSP<br />

600MG/5ML


calcium carbonate TUMS TAB CHEW<br />

168(420)MG<br />

calcium carbonate TUMS TAB CHEW<br />

200(500)MG<br />

calcium carbonate TUMS TAB CHEW<br />

300MG(750)<br />

calcium carbonate TUMS TAB CHEW<br />

400(1000)<br />

calcium carbonate TUMS TAB CHEW<br />

600 MG<br />

calcium carbonate/simethicone MAALOX ADVANCED TAB CHEW<br />

1000-60MG<br />

mag hydrox/al hydrox/simeth MYLANTA DOUBLE-STRENGTH ORAL SUSP<br />

200-200-20<br />

mag hydrox/al hydrox/simeth MYLANTA DOUBLE-STRENGTH ORAL SUSP<br />

400-400-30<br />

mag hydrox/al hydrox/simeth MYLANTA DOUBLE-STRENGTH ORAL SUSP<br />

400-400-40<br />

mag hydrox/al hydrox/simeth MYLANTA DOUBLE-STRENGTH ORAL SUSP<br />

200-225-25<br />

mag hydrox/al hydrox/simeth MYLANTA DOUBLE-STRENGTH ORAL SUSP<br />

450-500-40<br />

mag hydrox/al hydrox/simeth MYLANTA DOUBLE-STRENGTH TAB CHEW<br />

200-200-20<br />

mag hydrox/al hydrox/simeth MYLANTA DOUBLE-STRENGTH TAB CHEW<br />

200-200-25<br />

mag hydrox/al hydrox/simeth MYLANTA DOUBLE-STRENGTH TAB CHEW<br />

400-400-40<br />

mag hydrox/al hydrox/simeth MYLANTA DOUBLE-STRENGTH ORAL SUSP<br />

200-200-20<br />

magnesium carbonate/al hydrox GAVISCON TAB CHEW<br />

105-160MG<br />

mg trisilicate/alh/nahco3/aa GAVISCON TAB CHEW<br />

20-80MG<br />

sodium bicarbonate SODIUM BICARBONATE TABLET 650<br />

MG<br />

Anti-Ulcer Preparations<br />

misoprostol CYTOTEC TABLET 200<br />

MCG<br />

misoprostol CYTOTEC TABLET 100<br />

MCG<br />

sucralfate CARAFATE ORAL SUSP 1<br />

G/10 ML<br />

sucralfate CARAFATE TABLET 1 G<br />

Anti-Ulcer-H.pylori <strong>Agents</strong>


PA lansoprazole/amoxiciln/clarith PREVPAC COMBO. PKG<br />

30-500-500<br />

Anticholinergics,Quaternary Ammonium<br />

propantheline bromide PROPANTHELINE BROMIDE TABLET 15<br />

MG<br />

propantheline bromide PRO-BANTHINE TABLET 7.5<br />

MG<br />

Histamine H2-Receptor Inhibitors<br />

cimetidine TAGAMET TABLET 200<br />

MG<br />

cimetidine TAGAMET TABLET 300<br />

MG<br />

cimetidine TAGAMET TABLET 400<br />

MG<br />

cimetidine TAGAMET TABLET 800<br />

MG<br />

cimetidine hcl CIMETIDINE HCL SOLUTION<br />

300 MG/5ML<br />

famotidine PEPCID TABLET 20<br />

MG<br />

famotidine PEPCID TABLET 40<br />

MG<br />

famotidine PEPCID TABLET 10<br />

MG<br />

ranitidine ZANTAC TABLET 150<br />

ranitidine hcl ZANTAC TABLET 300<br />

MG<br />

ranitidine hcl ZANTAC SYRUP 15<br />

MG/ML<br />

ranitidine hcl ZANTAC CAPSULE 150<br />

MG<br />

ranitidine hcl ZANTAC CAPSULE 300<br />

MG<br />

Intestinal Motility Stimulants<br />

metoclopramide hcl REGLAN SOLUTION<br />

5MG/5ML<br />

metoclopramide hcl REGLAN TABLET 10<br />

MG<br />

metoclopramide hcl REGLAN TABLET 5<br />

MG<br />

Proton-Pump Inhibitors<br />

lansoprazole PREVACID 24HR CAPSULE DR<br />

15 MG<br />

omeprazole PRILOSEC OTC TABLET DR


20 MG<br />

QL pantoprazole sodium PROTONIX TABLET DR<br />

40 MG<br />

QL pantoprazole sodium PROTONIX TABLET DR<br />

20 MG<br />

URINARY TRACT - FUNCTIONAL<br />

DISORDERS<br />

Benign Prostatic Hypertrophy/Micturition <strong>Agents</strong><br />

ST+<br />

QL<br />

QL+<br />

ST<br />

finasteride PROSCAR TABLET 5<br />

MG<br />

tamsulosin hcl FLOMAX CAP ER 24H<br />

0.4 MG<br />

Urinary Ph Modifiers<br />

QL potassium citrate UROCIT-K TABLET ER 5<br />

MEQ<br />

QL potassium citrate UROCIT-K TABLET ER<br />

10 MEQ<br />

potassium phosphate,monobasic K-PHOS ORIGINAL TABLET SOL<br />

500 MG<br />

Urinary Tract Anesthetic/Analgesic Agnt (azo-Dye)<br />

phenazopyridine hcl AZO STANDARD TABLET 100<br />

MG<br />

phenazopyridine hcl AZO STANDARD TABLET 200<br />

MG<br />

Urinary Tract Antispasmodic/Antiincontinence Agent<br />

oxybutynin chloride DITROPAN XL SYRUP 5<br />

MG/5 ML<br />

oxybutynin chloride DITROPAN XL TABLET 5<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

QL+<br />

ST<br />

MG<br />

oxybutynin chloride DITROPAN XL TAB ER 24 5<br />

MG<br />

oxybutynin chloride DITROPAN XL TAB ER 24 10<br />

MG<br />

oxybutynin chloride DITROPAN XL TAB ER 24 15<br />

MG<br />

VAGINAL DISORDERS<br />

Vaginal Antibiotics<br />

clindamycin phosphate CLEOCIN CREAM/APPL<br />

2 %<br />

metronidazole METROGEL-VAGINAL GEL W/APPL<br />

0.75 %


Vaginal Antifungals<br />

butoconazole nitrate MYCELEX-3 CREAM/APPL<br />

2 %<br />

butoconazole nitrate FEMSTAT 3 CRM/PF APP<br />

2 %<br />

clotrimazole FEMCARE CREAM/APPL<br />

1 %<br />

clotrimazole FEMCARE CREAM/APPL<br />

2 %<br />

clotrimazole FEMCARE TABLET 100<br />

MG<br />

clotrimazole FEMCARE COMBO. PKG<br />

100MG-1%<br />

clotrimazole FEMCARE COMBO. PKG<br />

200 MG-1 %<br />

miconazole nitrate MONISTAT 3 CREAM/APPL<br />

2 %<br />

miconazole nitrate MONISTAT 3 CREAM/APPL<br />

4 %<br />

miconazole nitrate MONISTAT 3 SUPP.VAG<br />

100 MG<br />

miconazole nitrate MONISTAT 3 SUPP.VAG<br />

200 MG<br />

miconazole nitrate MONISTAT 3 COMBO. PKG<br />

200 MG-2 %<br />

miconazole nitrate MONISTAT 3 COMBO. PKG<br />

1200MG-2%<br />

nystatin NYSTATIN TABLET 100K<br />

UNIT<br />

terconazole TERAZOL 3 SUPP.VAG 80<br />

MG<br />

terconazole TERAZOL 3 CREAM/APPL<br />

0.4 %<br />

terconazole TERAZOL 3 CREAM/APPL<br />

0.8 %<br />

tioconazole VAGISTAT-1 OIN/PF APP<br />

6.5 %<br />

Vaginal Estrogen Preparations<br />

estradiol ESTRACE CREAM/APPL<br />

0.01 %<br />

estrogens, conjugated PREMARIN CREAM/APPL<br />

0.625 MG/G<br />

VITAMIN AND/OR MINERAL DEFICIENCY<br />

Bioflavonoids


PA bioflav,lemon/vit bcomp&c BIOFLAV,LEMON/VIT BCOMP&C TABLET 200-<br />

100 MG<br />

Calcium Replacement<br />

calcium CALCIUM TABLET 500<br />

MG<br />

calcium carb&gluc/vitamin d2 OS-CAL 500+D TABLET 500<br />

MG-200<br />

calcium carbonate CALTRATE 600 TABLET<br />

500(1250)<br />

calcium carbonate CALTRATE 600 TABLET 600<br />

MG<br />

calcium carbonate CALTRATE 600 TABLET 600<br />

MG<br />

calcium carbonate CALTRATE 600 TABLET 648<br />

MG<br />

calcium carbonate CALTRATE 600 TAB CHEW<br />

300MG(750)<br />

calcium carbonate CALTRATE 600 TAB CHEW<br />

500(1250)<br />

calcium carbonate CALCIUM CARBONATE ORAL SUSP<br />

500 MG/5ML<br />

calcium carbonate CALCIUM CARBONATE TAB CHEW<br />

500(1250)<br />

calcium carbonate/vitamin d2 OS-CAL 500+D TABLET 250<br />

MG-125<br />

calcium carbonate/vitamin d2 OS-CAL 500+D TABLET 500<br />

MG-125<br />

calcium carbonate/vitamin d3 OS-CAL 500+D TABLET 500<br />

MG-200<br />

calcium carbonate/vitamin d3 OS-CAL 500+D TABLET 250<br />

MG-125<br />

calcium carbonate/vitamin d3 OS-CAL 500+D TABLET 600<br />

MG-200<br />

calcium carbonate/vitamin d3 OS-CAL 500+D TABLET 600<br />

MG-400<br />

calcium carbonate/vitamin d3 CALCIUM WITH VITAMIN D TAB CHEW<br />

500 MG-100<br />

calcium citrate/vitamin d2 CALCIUM CITRATE/VITAMIN D2 TABLET<br />

1500MG-200<br />

calcium citrate/vitamin d3 CITRACAL + D TABLET<br />

250MG-200<br />

calcium citrate/vitamin d3 CITRACAL + D TABLET 315<br />

MG-200<br />

calcium gluconate CALCIUM GLUCONATE TABLET<br />

45(500) MG<br />

calcium gluconate CALCIUM GLUCONATE TABLET


60(648) MG<br />

calcium lactate CALCIUM LACTATE TABLET 84<br />

MG(648)<br />

calcium phosphate/vitamin d3 CALCIUM PHOSPHATE/VITAMIN D3 TABLET 105<br />

MG-120<br />

Fluoride Preparations<br />

sodium fluoride ACT ANTI-CAVITY MOUTH RINSE SOLUTION<br />

sodium fluoride<br />

NAFRINSE DAILY-NEUTRAL<br />

PHOS-FLUR<br />

0.2 %<br />

SOLUTION<br />

0.05 %<br />

sodium fluoride FLUORITAB DROPS<br />

0.125/DROP<br />

sodium fluoride FLURA-DROPS DROPS<br />

0.25MG/DRP<br />

sodium fluoride ACT ANTI-CAVITY MOUTH RINSE DROPS 0.5<br />

MG/ML<br />

sodium fluoride FLUOR-A-DAY DROPS 2.5<br />

MG/ML<br />

sodium fluoride ACT ANTI-CAVITY MOUTH RINSE TAB CHEW<br />

0.25(0.55)<br />

sodium fluoride ACT ANTI-CAVITY MOUTH RINSE TAB CHEW<br />

0.5(1.1)MG<br />

sodium fluoride ACT ANTI-CAVITY MOUTH RINSE TAB CHEW<br />

1MG(2.2MG)<br />

sodium fluoride ACT ANTI-CAVITY MOUTH RINSE TABLET<br />

1MG(2.2MG)<br />

sodium fluoride ACT ANTI-CAVITY MOUTH RINSE TAB CHEW<br />

0.5(1.1)MG<br />

Folic Acid Preparations<br />

folic acid FOLIC ACID TABLET 1<br />

MG<br />

Iron Replacement<br />

QL ferrous sulfate FER-IN-SOL SOLUTION<br />

220(44)/5<br />

QL ferrous sulfate FER-IN-SOL LIQUID 300<br />

MG/5ML<br />

QL ferrous sulfate FER-IN-SOL DROPS 15<br />

MG/ML<br />

QL ferrous sulfate FER-IN-SOL TABLET<br />

325(65) MG<br />

QL ferrous sulfate FER-IN-SOL TABLET DR<br />

325(65) MG<br />

Magnesium Salts Replacement<br />

PA magnesium oxide/mag aa chelate MG-PLUS-PROTEIN TABLET


133MG<br />

Multivitamin Preparations<br />

PA b complex with vitamin c BEROCCA TABLET<br />

beta-carotene(a) w-c & e/min OCUVITE TABLET ER<br />

folic acid/mv,fe,other min/lut FOLIC ACID/MV,FE,OTHER MIN/LUT TABLET 0.4-<br />

18-250<br />

QL multivitamins,ther w-minerals THERAPEUTIC-M TABLET<br />

QL multivitamins,therapeutic MULTIVITAMINS,THERAPEUTIC TABLET<br />

QL multivitamins,therapeutic MULTIVITAMINS,THERAPEUTIC LIQUID<br />

QL multivits w-iron,hematinic CENTRUM TABLET<br />

27MG-0.4MG<br />

QL multivits,th w-fe,other min MULTIVITS,TH W-FE,OTHER MIN TABLET<br />

Pediatric Vitamin Preparations<br />

QL+<br />

AGE<br />

QL+<br />

AGE<br />

QL+<br />

AGE<br />

QL+<br />

AGE<br />

QL+<br />

AGE<br />

QL+<br />

AGE<br />

QL+<br />

AGE<br />

QL+<br />

AGE<br />

QL+<br />

AGE<br />

QL+<br />

AGE<br />

fluoride ion/multivitamins POLY-VI-FLOR DROPS<br />

0.5MG/ML<br />

fluoride/iron/vit a,c&d FLUORIDE/IRON/VIT A,C&D DROPS 0.25<br />

MG/ML<br />

multivitamin POLY-VI-SOL DROPS<br />

multivitamins with fluoride POLY-VI-FLOR DROPS 0.25<br />

MG/ML<br />

multivitamins with fluoride MULTIVITAMINS WITH FLUORIDE DROPS 0.5<br />

MG/ML<br />

multivitamins with iron POLY-VI-SOL WITH IRON DROPS<br />

multivits with iron & fluoride MULTIVITS WITH IRON & FLUORIDE DROPS 0.25<br />

MG/ML<br />

ped mv a,c,d3 #21 w-fluoride FLUORABON BASIC DROPS 0.5<br />

MG/ML<br />

ped mv a,c,d3 #21 w-fluoride FLUORABON BASIC DROPS 0.25<br />

MG/ML<br />

pedi m.vit no.17 with fluoride POLY-VI-FLOR TAB CHEW<br />

0.5 MG<br />

pedi m.vit no.17 with fluoride POLY-VI-FLOR TAB CHEW 1<br />

MG<br />

pedi m.vit no.17 with fluoride POLY-VI-FLOR TAB CHEW<br />

0.25 MG<br />

pedi multivits a,c,&d3 no.21 PEDI MULTIVITS A,C,&D3 NO.21 DROPS 1500-<br />

35/ML<br />

pedi mv a,c,d3 #21 with iron TRI-VI-SOL WITH IRON DROPS 1500-<br />

10/ML<br />

Prenatal Vitamin Preparations<br />

QL+ pnv #14/ferrous fum/folic acid NATACHEW TAB CHEW<br />

GEN+<br />

29 MG-1 MG<br />

AGE


QL+ pnv cmb#95/ferrous fumarate/fa PRENATAL TABLET<br />

GEN+<br />

28MG-0.8MG<br />

AGE<br />

QL+ pnv cmb#95/ferrous fumarate/fa TRICARE TABLET<br />

GEN+<br />

28MG-0.8MG<br />

AGE<br />

QL+ pnv no.4/iron cbn&gluc/fa/doss CITRANATAL RX TABLET 27-1-<br />

GEN+<br />

50MG<br />

AGE<br />

QL+ pnv w-o ca no5/fe fumarate/fa PNV W-O CA NO5/FE FUMARATE/FA CAPSULE<br />

GEN+<br />

106.5-1MG<br />

AGE<br />

QL+ pnv with ca no.36/iron/fa P-D NATAL PLUS CAPSULE<br />

GEN+<br />

13.5-0.4MG<br />

AGE<br />

QL+ pnv with ca,no.71/iron/fa TRICARE TABLET 27<br />

GEN+<br />

MG-1 MG<br />

AGE<br />

QL+ pnv with ca,no.74/iron/fa PNV WITH CA,NO.74/IRON/FA TABLET 27<br />

GEN+<br />

MG-1 MG<br />

AGE<br />

QL+ pnv2/iron b-g suc-p/fa/omega-3 TRUST NATAL DHA COMBO. PKG<br />

GEN+<br />

29-1-250MG<br />

AGE<br />

GEN+ prenatal vit #76/iron,carb/fa NESTABS CBF TABLET 29<br />

AGE+<br />

MG-1 MG<br />

QL<br />

QL+ prenatal vit 15/iron cb/fa/dss PRENATAL VIT 15/IRON CB/FA/DSS TABLET 90-1-<br />

GEN+<br />

50 MG<br />

AGE<br />

QL+ prenatal vit no.73/iron/fa TRICARE TABLET 28<br />

GEN+<br />

MG-1 MG<br />

AGE<br />

QL+ prenatal vit no.78/iron/fa TRICARE TABLET 29<br />

GEN+<br />

MG-1 MG<br />

AGE<br />

QL+ prenatal vit/fe carb-feso4/fa PRENATAL VIT/FE CARB-FESO4/FA TABLET 60-<br />

GEN+<br />

1MG<br />

AGE<br />

QL+ prenatal vit/fe fum/doss/fa PRENATAL VIT/FE FUM/DOSS/FA TABLET ER<br />

GEN+<br />

90-50-1MG<br />

AGE<br />

QL+ prenatal vit/fe fumarate/fa/se MATERNA TABLET 27<br />

GEN+<br />

MG-1 MG<br />

AGE<br />

QL+ prenatal vit/fe gluconate/fa PRENATAL VIT/FE GLUCONATE/FA TABLET 30-


GEN+<br />

0.8MG<br />

AGE<br />

QL+ prenatal vit/iron bisglycin/fa NATELLE TABLET 29<br />

GEN+<br />

MG-1 MG<br />

AGE<br />

QL+ prenatal vit/iron bisglycin/fa NATELLE TABLET 27<br />

GEN+<br />

MG-1 MG<br />

AGE<br />

QL+ prenatal vit/iron fumarate/fa TRICARE TABLET<br />

GEN+<br />

60MG-0.8MG<br />

AGE<br />

QL+ prenatal vit/iron fumarate/fa TRICARE TABLET 65<br />

GEN+<br />

MG-1 MG<br />

AGE<br />

QL+ prenatal vit/iron fumarate/fa TRICARE TABLET 66-<br />

GEN+<br />

1MG<br />

AGE<br />

QL+ prenatal vit/iron fumarate/fa TRICARE TAB CHEW<br />

GEN+<br />

29 MG-1 MG<br />

AGE<br />

QL+ prenatal vit27&calcium/iron/fa TRICARE TABLET 60<br />

GEN+<br />

MG-1 MG<br />

AGE<br />

QL+ pv w-o cal/ferrous fumarate/fa M-VIT TABLET 27<br />

GEN+<br />

AGE<br />

MG-1 MG<br />

Prenatal Vitamins Without Iron<br />

QL+<br />

GEN+<br />

AGE<br />

pnv w-o iron/fa/calcium/b6/b12 PREMESIS RX TBMP 24HR<br />

1-200-75<br />

Vitamin B Preparations<br />

PA fa/vit b complex & c/rice bran ALLBEE C-800 TABLET<br />

400MCG-500<br />

PA vit b cmplx 3/fa/vit c/biotin NEPHROCAPS TABLET<br />

1MG-60MG<br />

Vitamin B1 Preparations<br />

thiamine hcl THIAMINE HCL TABLET 100<br />

MG<br />

Vitamin B6 Preparations<br />

pyridoxine hcl PYRIDOXINE HCL TABLET<br />

100MG<br />

pyridoxine hcl PYRIDOXINE HCL TABLET 500<br />

MG<br />

pyridoxine hcl PYRIDOXINE HCL TABLET 50


MG<br />

pyridoxine hcl PYRIDOXINE HCL TABLET<br />

25MG<br />

Vitamin D Preparations<br />

calcitriol ROCALTROL CAPSULE<br />

0.25 MCG<br />

calcitriol ROCALTROL CAPSULE 0.5<br />

MCG<br />

cholecalciferol VITAMIN D TABLET 1000<br />

UNIT<br />

dihydrotachysterol DHT TABLET<br />

0.2MG<br />

ergocalciferol (vitamin d2) DRISDOL DROPS<br />

8000/ML<br />

ergocalciferol (vitamin d2) DRISDOL CAPSULE<br />

50000 UNIT

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