2012 Formulary Print document - Alameda Alliance for Health
2012 Formulary Print document - Alameda Alliance for Health
2012 Formulary Print document - Alameda Alliance for Health
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
Drug Name<br />
Acidifying and Alkalinizing Agents<br />
Acidifying and Alkalinizing Agents<br />
Drug<br />
Tier<br />
Requirements/Limits<br />
ammonium chloride (Ammonium Chloride) 1<br />
citric acid/sodium citrate (Bicitra) 1<br />
K-PHOS M.F. 2<br />
K-PHOS NO.2 2<br />
phosphorus #1 (K-phos Neutral) 1<br />
potassium citrate (Urocit-K) 1<br />
potassium citrate/citric (Polycitra-k) 1<br />
acid<br />
sod/pot/k cit/sod cit/cit (Polycitra-lc) 1<br />
acid<br />
sodium bicarbonate (Sodium Bicarbonate) 1 disp syrin: 0.5meq/<br />
ml; iv soln., vial<br />
sodium bicarbonate (Sodium Bicarbonate) 1 disp syrin: 0.9meq/<br />
ml, 1meq/ml<br />
sodium lactate (Sodium Lactate) 1 vial<br />
Adrenals<br />
Adrenals<br />
ADVAIR DISKUS 2 QL: 62 in<br />
31 days<br />
ADVAIR HFA 2 QL: 12 in<br />
28 days<br />
betamet acet/betamet na (Celestone) 1 PA<br />
ph<br />
budesonide (Entocort EC) 1 capdr & er<br />
cortisone acetate (Cortisone Acetate) 1 PA<br />
DEPO-MEDROL 2 PA vial: 20mg/ml<br />
dexamethasone sod (Dexamethasone Sod Phosphate) 1 PA vial: 10mg/ml<br />
phosphate<br />
dexamethasone sod (Dexamethasone Sod Phosphate) 1 PA vial: 4mg/ml<br />
phosphate<br />
dexamethasone (Dexamethasone) 1 PA elixir, tablet<br />
dexamethasone (Dexpak) 1 PA tab ds pk<br />
DULERA 2 QL: 13 in<br />
28 days<br />
FLOVENT DISKUS 2 QL: 120<br />
in 30<br />
days<br />
disk w/dev: 250mcg<br />
31<br />
<strong>Alliance</strong> CompleteCare <strong>2012</strong> Part D <strong>Formulary</strong> Effective: May 01, <strong>2012</strong><br />
<strong>Formulary</strong> ID: 12140.000, Version: 10
Change language