2012 Formulary Print document - Alameda Alliance for Health
2012 Formulary Print document - Alameda Alliance for Health
2012 Formulary Print document - Alameda Alliance for Health
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Drug Name<br />
Drug<br />
Tier<br />
Requirements/Limits<br />
cefprozil (Cefzil) 1<br />
ceftazidime pentahydrate (Fortaz) 1 vial port: 1g<br />
ceftazidime pentahydrate (Fortaz) 1 vial, vial port: 2g<br />
CEFTAZIDIME 1<br />
ceftriaxone na/<br />
(Ceftriaxone Na/dextrose, Iso) 1<br />
dextrose,iso<br />
ceftriaxone sodium (Rocephin) 1<br />
CEFTRIAXONE 1<br />
cefuroxime axetil (Ceftin) 1<br />
cefuroxime sodium (Zinacef) 1<br />
cefuroxime sodium/ (Cefuroxime Sodium/dextrose, 1<br />
dextrose,iso<br />
Iso)<br />
cephalexin (Keflex) 1<br />
FORTAZ IN ISO-<br />
2<br />
OSMOTIC DEXTROSE<br />
SUPRAX 2 tablet<br />
TAZICEF IN<br />
2<br />
DEXTROSE<br />
Macrolides<br />
azithromycin hydrogen (Azithromycin Hydrogen<br />
1<br />
citrate<br />
Citrate)<br />
azithromycin (Zithromax) 1 packet<br />
azithromycin (Zithromax) 1 susp recon, tablet,<br />
vial<br />
clarithromycin (Biaxin) 1<br />
DIFICID 2 QL: 20 in<br />
10 days<br />
ery e-succ/sulfisoxazole (Pediazole) 1<br />
ERY-TAB 1<br />
ERYTHROCIN<br />
2 vial<br />
LACTOBIONATE<br />
ERYTHROCIN<br />
2 vial port<br />
LACTOBIONATE<br />
erythromycin base (Eryc) 1 capsule dr<br />
erythromycin base (Erythromycin Base) 1 tablet, tablet dr<br />
erythromycin<br />
ethylsuccinate<br />
(Erythromycin Ethylsuccinate) 1 oral susp: 200mg/<br />
5ml<br />
erythromycin<br />
(Erythromycin Ethylsuccinate) 1 tablet<br />
ethylsuccinate<br />
erythromycin stearate (Erythromycin Stearate) 1 tablet: 250mg<br />
erythromycin stearate (Erythromycin Stearate) 1 tablet: 500mg<br />
41<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
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