L.A. Care Covered Drug Formulary (pdf)

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Index- # -0.5 NORMAL SALINE.............................................. 300.9 % SODIUM CHLORIDE......................................301 + 1-F...................................................................... 172TEK(OTC)...............................................................248-MOP...................................................................... 23- A -AA/ANTIPYRN/BCAINE/POLICO#1/AL................... 29AA/ANTPY/BCAINE/POLICO/AL ACET...................29AABP........................................................................ 29ABACAVIR SULFATE............................................... 41ABACAVIR SULFATE/LAMIVUDINE........................ 41ABACAVIR/LAMIVUDINE/ZIDOVUDINE..................41ABATACEPT.............................................................42ABILIFY DISCMELT(TAB RDP DIS)(10 MG)......8, 59,6 4ABILIFY DISCMELT(TAB RDP DIS)(15 MG)......8, 59,6 4ABILIFY(SOLUTION)..................................... 9, 59, 64ABILIFY(TAB)................................................. 9, 59, 64ABIRATERONE ACETATE....................................... 45ABSORICA............................................................... 16ABSTRAL........................................................... 47, 73ACAMPROSATE CALCIUM....................................... 8ACANYA................................................................... 16ACARBOSE..............................................................23ACCOLATE.................................................................7ACCU-CHEK FASTCLIX(OTC)................................ 28ACCU-CHEK SMARTVIEW(OTC)............................26ACCU-CHEK SOFTCLIX(OTC)................................28ACCU-CHEK(OTC)...................................... 24, 25, 28ACCUNEB.................................................................. 6ACCUPRIL................................................................11ACCUTREND GLUCOSE(OTC)...............................24ACEBUTOLOL HCL..................................................11ACEON..................................................................... 11ACETAMINOPH-CAFF-DIHYDROCODEIN............. 47ACETAMINOPHEN W/CODEINE.............................49ACETAMINOPHEN WITH CODEINE....................... 49ACETAMINOPHEN/CAFFEINE/BUTALB................. 47ACETAMINOPHEN/PHENYLTOLOX/CAFF.............47ACETAMINOPHEN-CODEINE................................. 49ACETAZOLAMIDE....................................................33ACETIC AC/RICINOLEIC/OXYQUINOL...................54ACETIC ACID.....................................................20, 29ACETIC ACID/ALUMINUM ACETATE......................29ACETIC ACID/HYDROCORTISONE........................29ACETIC ACID-ALUMINUM.......................................29ACETOHYDROXAMIC ACID................................... 44ACETYLCYSTEINE..................................................46ACID JELLY..............................................................54ACIPHEX......................................................53, 59, 64ACITRETIN...............................................................23ACLARO...................................................................23ACLARO PD.............................................................23ACLIDINIUM BROMIDE............................................. 6ACLOVATE............................................................... 18ACTIGALL................................................................ 44ACTIMMUNE............................................................37ACTIQ.................................................................47, 73ACTIVELLA.............................................................. 36ACTONEL WITH CALCIUM......................... 31, 59, 64ACTONEL(TAB)(150 MG)............................ 31, 59, 64ACTONEL(TAB)(30 MG).............................. 31, 59, 64ACTONEL(TAB)(35 MG).............................. 31, 59, 64ACTONEL(TAB)(5 MG)................................ 31, 59, 64ACTONEL(TAB)(75 MG).................................... 31, 64ACTOPLUS MET................................................24, 64ACTOPLUS MET XR..........................................24, 64ACTOS..................................................................... 24ACULAR................................................................... 32ACULAR LS..............................................................32ACURA CONTROL SOLUTION LOW(OTC)............25ACURA CONTROL SOLUTION NORMAL(OTC)......2 6ACURA CONTROL SOLUTION(OTC)..................... 25ACUVAIL...................................................................32ACYCLOVIR.......................................................18, 40ACYCLOVIR/HYDROCORTISONE..........................18ACYCLOVIR/LIDOCAINE HCL................................ 18ACZONE...................................................................16ADALAT CC..............................................................12ADALIMUMAB..........................................................42ADAPALENE............................................................ 17ADAPALENE/BENZOYL PEROXIDE....................... 16ADCIRCA..................................................... 12, 64, 73ADDERALL...........................................................8, 59ADEFOVIR DIPIVOXIL.............................................41ADIPEX-P.................................................................57ADJUSTABLE LANCING DEVICE(OTC)................. 27ADOXA..................................................................... 39ADOXA CK............................................................... 39ADOXA PAK................................................. 39, 59, 64ADOXA TT................................................................39ADRENACLICK(AUTO INJECT)(0.15/0.15).............44ADRENACLICK(AUTO INJECT)(0.3MG/0.3)........... 44ADVAIR DISKUS............................................ 6, 59, 64ADVAIR HFA...................................................6, 59, 64ADVANCE INTUITION(OTC)....................................26ADVANCE(OTC).......................................................26ADVANCED LANCING DEVICE(OTC).....................28ADVATE....................................................................34ADVATE H................................................................ 34ADVATE L.................................................................34ADVATE M................................................................34ADVATE SH..............................................................34ADVATE UH..............................................................34ADVICOR(TBMP 24HR)(1000-20MG)......... 13, 59, 64ADVICOR(TBMP 24HR)(1000-40 MG)........ 13, 59, 64ADVICOR(TBMP 24HR)(500MG-20MG)......13, 59,6 4ADVICOR(TBMP 24HR)(750MG-20MG)......13, 59,6 4ADVOCATE CONTROL SOLUTION(OTC).............. 25ADVOCATE LANCING DEVICE(OTC).....................27ADVOCATE REDI-CODE+ CTRL SOLN(OTC)........25AEROBID-M............................................................... 7AFINITOR........................................................... 45, 73AGAMATRIX CONTROL(OTC).......................... 24, 25AGGRENOX.............................................................35AGRYLIN.................................................................. 35AHIST......................................................................... 5AKNE-MYCIN........................................................... 17AKTEN......................................................................32AKURZA................................................................... 21ALA-HIST....................................................................5ALAMAST.................................................................33ALA-QUIN.................................................................16ALA-TET...................................................................39ALBALON................................................................. 33ALBENDAZOLE....................................................... 40ALBENZA................................................................. 40ALBUTEROL SULFATE..............................................6ALC/ISOPROPANOL/PROP GLY/WATER............... 20ALCAFTADINE......................................................... 32ALCLOMETASONE DIPROPIONATE...................... 18ALCORTIN A............................................................ 17ALDACTAZIDE(TAB)(25 MG-25MG)........................12ALDACTAZIDE(TAB)(50 MG-50MG)........................12ALDACTONE............................................................12ALDARA............................................................. 37, 73ALDEX AN..................................................................5ALDOMET.................................................................11ALDORIL-D50...........................................................11ALENDRONATE SODIUM........................................31ALENDRONATE SODIUM/VITAMIN D3...................31ALFERON N............................................................. 37ALFUZOSIN HCL..................................................... 53ALINIA...................................................................... 17ALISKIREN HEMIFUMARATE................................. 13ALISKIREN/AMLODIPIN/HCTHIAZIDE....................12ALISKIREN/AMLODIPINE BESYLATE.................... 13ALISKIREN/HYDROCHLOROTHIAZIDE................. 13ALISKIREN/VALSARTAN......................................... 13ALITRETINOIN.........................................................22ALKERAN.................................................................45ALL ABBOTT PRODUCTS (FREESTYLE ANDPRECISION TEST STRIPS).....................................24ALL BAYER PRODUCTS (CONTOUR AND BREEZETEST STRIPS)......................................................... 24ALLEGRA................................................................... 5ALLEGRA-D 12 HOUR...............................................5ALLEGRA-D 24 HOUR...............................................5ALLERX....................................................................15ALLFEN CD..............................................................16ALLFEN CDX........................................................... 16ALLOPURINOL........................................................ 34ALMOTRIPTAN MALATE......................................... 49ALOCRIL.................................................................. 33ALODOX...................................................................33ALOGLIPTIN BENZ/METFORMIN HCL...................23ALOGLIPTIN BENZ/PIOGLITZONE.........................23ALOGLIPTIN BENZOATE........................................ 24ALOMIDE..................................................................33ALOQUIN..................................................................17ALORA............................................................... 36, 59ALOSETRON HCL................................................... 44ALPHAGAN P(DROPS)(0.1 %)................................33ALPHAGAN P(DROPS)(0.15 %)..............................33ALPHANATE.......................................................34, 35ALPHANINE SD....................................................... 35ALPHAQUIN HP.......................................................23ALPRAZOLAM............................................................8ALPRAZOLAM INTENSOL.........................................8ALPROSTADIL......................................................... 30ALREX......................................................................32ALSUMA.............................................................49, 59ALTABAX.................................................................. 18ALTACE(CAP)...........................................................11ALTACE(TAB)........................................................... 11ALTERNATE SITE LANCING DEVICE(OTC)...........27ALTOPREV...................................................13, 59, 64ALTRETAMINE......................................................... 45ALUMINUM ACETATE............................................. 16ALUMINUM CHLORIDE...........................................20ALUVEA................................................................... 21ALVESCO............................................................. 7, 59ALVIMOPAN............................................................. 44AMANTADINE.......................................................... 50AMANTADINE HCL.................................................. 50AMARYL................................................................... 24AMBENONIUM CHLORIDE....................................... 7AMBIEN................................................................9, 59AMBIFED..................................................................15AMBIFED DM........................................................... 16AMBIFED-G..............................................................15AMBIFED-G DM....................................................... 16AMBRISENTAN........................................................ 12AMCINONIDE...........................................................18AMERGE............................................................ 49, 59AMERICAINE........................................................... 22AMERICET............................................................... 47AMETHYST........................................................ 14, 64AMICAR(SOLUTION)...............................................34AMICAR(TAB)(1000 MG)......................................... 34AMICAR(TAB)(500 MG)........................................... 34AMILORIDE HCL......................................................12AMILORIDE/HYDROCHLOROTHIAZIDE................ 12AMILORIDE-HYDROCHLOROTHIAZIDE................12AMINO AC/FA/MV-MN/DIETARY 2.......................... 55AMINO ACID CERVICAL......................................... 54AMINO ACIDS/MV,FE,OTHER MIN......................... 56AMINOBENZOATE POTASSIUM.............................57AMINOCAPROIC ACID............................................34AMINOLEVULINIC ACID HCL..................................46AMINOPHYLLINE.......................................................7AMINOSALICYLIC ACID..........................................40AMIODARONE HCL.................................................10AMITIZA..............................................................44, 59AMITRIP HCL/CHLORDIAZEPOXIDE....................... 8AMITRIPTYLINE HCL................................................ 8AMLODIPINE BES/OLMESARTAN MED................. 11AMLODIPINE BESYLATE........................................ 12AMLODIPINE BESYLATE/BENAZEPRIL.................10AMLODIPINE/ATORVASTATIN................................ 14AMLODIPINE/VALSARTAN...................................... 11AMLODIPINE/VALSARTAN/HCTHIAZID..................11AMMONIUM LACTATE.............................................20AMOX TR-POTASSIUM CLAVULANATE.................38AMOXAPINE.............................................................. 8AMOXICILLIN...........................................................38AMOXICILLIN TRIHYDRATE................................... 38AMOXICILLIN/POTASSIUM CLAV...........................38AMOXIL.................................................................... 38AMPICILLIN TRIHYDRATE...................................... 38AMPYRA............................................................ 46, 73AMRIX...................................................................... 51AMTURNIDE...................................................... 12, 73AMYL NITRITE.........................................................14ANACAINE............................................................... 22ANADROL-50........................................................... 36ANAFRANIL................................................................8ANAGRELIDE HCL.................................................. 35ANAKINRA............................................................... 41ANALPRAM E.......................................................... 43ANALPRAM HC........................................................43ANAMANTLE HC............................................... 43, 44ANAMANTLE HC FORTE........................................ 43ANAPROX................................................................ 43ANAPROX DS.......................................................... 43ANASTROZOLE.......................................................45ANCOBON................................................................39ANDRODERM(PATCH TD24)(2 MG/24 HR)............36ANDRODERM(PATCH TD24)(2.5MG/24HR)......36,7 3ANDRODERM(PATCH TD24)(4 MG/24 HR)......36, 73ANDRODERM(PATCH TD24)(5 MG/24 HR)......36, 73Page 75 of 91
IndexANDROGEL....................................................... 36, 73ANDROID................................................................. 36ANDROXY................................................................36ANGELIQ..................................................................36ANIMI-3.....................................................................56ANIMI-3 WITH VITAMIN D....................................... 56ANSAID.................................................................... 43ANTABUSE.................................................................8ANTARA................................................................... 14ANTHRALIN............................................................. 23ANTHRALIN MICRONIZED......................................23ANTIHEMOPH.FVIII PLAS/ALB FREE.................... 34ANTIHEMOPHILIC FACTOR, HUM REC.................34ANTIHEMOPHILIC FACTOR, HUMAN.............. 34, 35ANTIHEMOPHILIC FACTOR/VWF...........................35ANTI-INHIBITOR COAGULANT COMP................... 35ANTIPY/BENZOCAINE/POLICOS NO.1..................29ANTIPYRINE/BENZOCAIN/GLY/ZINC.....................29ANTIPYRINE/BENZOCAINE....................................29ANTIPYRINE/BENZOCAINE/GLYCERIN.................29ANTIPYRINE-BENZOCAINE....................................29ANTIVERT(TAB)(12.5 MG).........................................6ANTIVERT(TAB)(25 MG)............................................6ANTIVERT(TAB)(50 MG)............................................6ANZEMET(TAB)(100 MG).............................. 6, 59, 64ANZEMET(TAB)(50 MG)................................ 6, 59, 64APEXICON............................................................... 19APEXICON E............................................................19APIDRA.................................................................... 29APIDRA SOLOSTAR................................................ 29APIXABAN................................................................35APLENZIN...................................................... 7, 59, 64APOKYN.......................................................50, 59, 73APOMORPHINE HCL...............................................50APRACLONIDINE HCL............................................ 33APREPITANT......................................................... 5, 6APRI......................................................................... 14APRISO.................................................................... 43APTIVUS.................................................................. 40AQUA GLYCOLIC HC.............................................. 19AQUA LANCE LANCING DEVICE(OTC)................. 27AQUA-MEPHYTON.................................................. 36AQUAPHILIC W/TAC + CARBAMIDE...................... 19AQUAPHILIC W/TRIAMCINOLONE.........................19ARALEN PHOSPHATE............................................ 40ARANESP.......................................................... 35, 73ARAVA...................................................................... 42ARCALYST............................................................... 41ARCAPTA NEOHALER.................................. 6, 59, 64ARESTIN.................................................................. 46ARFORMOTEROL TARTRATE..................................6ARICEPT ODT............................................................7ARICEPT(TAB)(10 MG)..............................................7ARICEPT(TAB)(23 MG)..............................................7ARICEPT(TAB)(5 MG)................................................7ARIMIDEX................................................................ 45ARIPIPRAZOLE..................................................... 8, 9ARISTOCORT.......................................................... 42ARIXTRA.................................................................. 35ARMODAFINIL........................................................... 9ARMOUR THYROID.................................................32AROMASIN...............................................................45ARTEMETHER/LUMEFANTRINE............................ 40ARTHROTEC 50...................................................... 42ARTHROTEC 75...................................................... 42ASA/SALICYLAM/ACETAMINOPH/CAFF................47ASACOL................................................................... 43ASACOL HD.......................................................43, 64ASCENSIA AUTODISC(OTC).................................. 24ASCENSIA ELITE(OTC).................................... 24, 26ASCORBATE SODIUM............................................ 57ASCORBIC ACID..................................................... 57ASENAPINE MALEATE..............................................9ASMALPRED........................................................... 42ASMALPRED PLUS................................................. 42ASMANEX............................................................ 7, 59ASPIRIN................................................................... 47ASPIRIN/DIPYRIDAMOLE....................................... 35ASPIRIN/MEPROBAMATE.......................................47ASSURE 3(OTC)......................................................24ASSURE 4(OTC)......................................................25ASSURE DOSE(OTC)........................................24, 26ASSURE PRO(OTC)................................................ 24ASTELIN.........................................................5, 59, 65ASTEPRO...................................................... 5, 59, 65ASTRINGYN.............................................................36AT LAST(OTC)......................................................... 25ATACAND........................................................... 11, 65ATACAND HCT...................................................11, 65ATAZANAVIR SULFATE........................................... 41ATELVIA....................................................... 31, 59, 65ATENOLOL............................................................... 11ATENOLOL/CHLORTHALIDONE.............................12ATIVAN....................................................................... 8ATOMOXETINE HCL................................................10ATORVASTATIN CALCIUM...................................... 13ATOVAQUONE.........................................................40ATOVAQUONE/PROGUANIL HCL...........................40ATRALIN.............................................................17, 58ATRAPRO CP...........................................................20ATRAPRO DERMAL SPRAY....................................22ATRAPRO HYDROGEL........................................... 20ATRIDOX.................................................................. 46ATRIPLA................................................................... 41ATROPINE SULFATE.........................................34, 52ATROPINE SULFATE/PF......................................... 34ATROVENT.............................................................. 46ATROVENT HFA.................................................. 6, 59AUBAGIO........................................................... 46, 73AUGMENTIN ES-600............................................... 38AUGMENTIN(SUSP RECON)(125-31.25/).............. 38AUGMENTIN(SUSP RECON)(250-62.5/5).............. 38AUGMENTIN(SUSP RECON)(400-57MG/5)............38AUGMENTIN(TAB CHEW)....................................... 38AUGMENTIN(TAB)................................................... 38AURALGAN..............................................................29AURANOFIN.............................................................42AURAX..................................................................... 29AURSTAT................................................................. 20AUTO INJECTOR(OTC)...........................................27AUTODISC NORMAL(OTC).....................................26AUTO-LANCET MINI(OTC)......................................27AUTO-LANCET(OTC).............................................. 27AUTOLET IMPRESSION(OTC)................................28AUTOLET LANCING DEVICE(OTC)........................27AUTOLET LITE CLINISAFE(OTC)........................... 27AUTOLET LITE(OTC)...............................................27AUTOLET MINI(OTC)...............................................28AUTOLET MKII CLINISAFE(OTC)........................... 27AUVI-Q............................................................... 44, 65AVAGE......................................................................17AVALIDE(TAB)(150-12.5MG)....................................11AVALIDE(TAB)(300-12.5MG)....................................11AVALIDE(TAB)(300MG-25MG)................................. 11AVANDAMET......................................................24, 65AVANDARYL...................................................... 24, 65AVANDIA............................................................ 24, 65AVAPRO....................................................................11AVAR LS................................................................... 18AVAR-E LS............................................................... 18AVAR-E LS CREAM................................................. 18AVC...........................................................................54AVELOX....................................................................38AVELOX ABC PACK.................................................38AVIDOXY.................................................................. 39AVIDOXY DK............................................................ 39AVINZA..................................................................... 48AVITENE...................................................................36AVODART...........................................................53, 65AVONEX............................................................. 46, 65AVONEX ADMINISTRATION PACK...................46, 65AXERT..........................................................49, 59, 65AXID......................................................................... 53AXIRON..............................................................36, 73AXITINIB...................................................................45AYGESTIN................................................................37AZASAN................................................................... 37AZASITE...................................................................33AZATHIOPRINE....................................................... 37AZELAIC ACID......................................................... 16AZELAIC ACID/CERAMIDE 1,3,6-11....................... 16AZELASTINE HCL............................................... 5, 32AZELASTINE/FLUTICASONE....................................5AZELEX....................................................................16AZILECT.............................................................50, 59AZILSARTAN MED/CHLORTHALIDONE................. 11AZILSARTAN MEDOXOMIL..................................... 11AZITHROMYCIN................................................ 33, 38AZMACORT..........................................................7, 59AZOPT......................................................................33AZOR.................................................................. 11, 65AZTREONAM LYSINE..............................................37- B -B CMPLX 4/VIT D3/C/FA/ZINC OX.......................... 56B COMPLEX WITH VITAMIN C................................56B1/B2/B3/B5/B6/B12/IRON...................................... 56B1/B2/B3/B5/B6/B12/VIT C/FA.................................56B12/LEVOMEFOLATE CALCIUM/B-6......................56BACITRACIN............................................................33BACITRACIN/POLYMYXIN B SULFATE.................. 33BACLOFEN.............................................................. 51BACMIN....................................................................56BACTOCILL..............................................................38BACTRIM..................................................................37BACTROBAN........................................................... 17BACTROBAN NASAL.............................................. 46BALACET 325.................................................... 49, 59BALSALAZIDE DISODIUM...................................... 43BANZEL(ORAL SUSP).................................51, 59, 65BANZEL(TAB)(200 MG)............................... 51, 59, 65BANZEL(TAB)(400 MG)............................... 51, 59, 65BARACLUDE............................................................41BARBIDONNA..........................................................52B-CAINE/ZINC CL/PINE/CPYRD............................. 43B-COMPLEX.............................................................57BEBULIN.................................................................. 35BEBULIN VH IMMUNO............................................ 35BECAPLERMIN........................................................28BECLOMETHASONE DIPROPIONATE.................5, 6BECONASE AQ............................................. 5, 59, 65BELLADONNA ALKALOIDS.................................... 52BELLADONNA ALKALOIDS/PHENOBARB.............52BELLADONNA-OPIUM.............................................48BELLADONNA-PHENOBARBITAL.......................... 52BENAZEPRIL HCL................................................... 11BENAZEPRIL/HYDROCHLOROTHIAZIDE..............10BENCORT.......................................................... 16, 21BENDROFLUMETHIAZIDE......................................13BENEFIX.................................................................. 35BENICAR............................................................ 11, 65BENICAR HCT....................................................11, 65BENOXINATE HCL/FLUORESCEIN NA.................. 32BENPROX................................................................ 21BENSAL HP............................................................. 17BENTYL....................................................................52BENZ PEROX/HC/SKIN CLNSR NO.14.................. 21BENZAC W 10..........................................................21BENZAC W 5............................................................21BENZAC W WASH................................................... 21BENZACLIN..............................................................16BENZALKONIUM CHLORIDE..................................22BENZAMYCIN.......................................................... 17BENZASHAVE..........................................................21BENZEFOAM........................................................... 21BENZEFOAM ULTRA...............................................21BENZIQ.................................................................... 21BENZIQ LS...............................................................21BENZOCAINE.................................................... 22, 29BENZOCAINE/TAN AC/MENTH/CPYRD................. 43BENZOIC ACID/SALICYLIC ACID........................... 17BENZONATATE........................................................15BENZOTIC................................................................29BENZOYL PEROXIDE............................................. 21BENZOYL PEROXIDE MICROSPHERES............... 21BENZOYL PEROXIDE&SKIN CLEANSR5.............. 21BENZOYL PEROXIDE/ALOE VERA........................21BENZOYL PEROXIDE/BLEMISH CNCLR............... 21BENZOYL PEROXIDE/HYALURONT SOD..............21BENZOYL PEROXIDE/HYDROCORTISON............ 16BENZOYL PEROXIDE/SULFUR..............................21BENZOYL PEROXIDE/UREA.................................. 21BENZOYL PEROXIDE/VIT E MIX............................21BENZPHETAMINE HCL........................................... 57BENZTROPINE MESYLATE.................................... 50BENZYL ALCOHOL................................................. 18BEPOTASTINE BESILATE.......................................32BEPREVE.................................................................32BERACTANT............................................................ 46BERINERT..........................................................42, 73BESIFLOXACIN HCL............................................... 33BESIVANCE............................................................. 33BETADINE................................................................ 32BETAGAN.................................................................33BETAMETHASONE..................................................42BETAMETHASONE DIPROPIONATE......................18BETAMETHASONE DIPROPIONATE(CREAM)...... 18BETAMETHASONE DIPROPIONATE(GEL)............ 18BETAMETHASONE DIPROPIONATE(LOTION)...... 18BETAMETHASONE DIPROPIONATE(OINT)...........18BETAMETHASONE VALERATE...............................18BETAMETHASONE/PROPYLENE GLYC................ 19BETAPACE............................................................... 12BETASERON......................................................46, 65BETAXOLOL HCL...............................................11, 33BETHANECHOL CHLORIDE................................... 45BETIMOL..................................................................34BETOPTIC S............................................................ 33Page 76 of 91
Page 6:
Commercial FormularyT1 budesonide P
Page 19 and 20:
Commercial FormularyT3 triamcinolon
Page 21:
Commercial FormularyOxidizing Agent
Page 24: Commercial FormularyT2 blood glucos
Page 28 and 29: Commercial FormularyT2 insulinLANTU
Page 30 and 31: Commercial FormularyENDOCRINE DISOR
Page 32 and 33: Commercial FormularyEye Sulfonamide
Page 34 and 35: Commercial FormularyT4 antihemophil
Page 36 and 37: Commercial FormularyT2 norethind ac
Page 38 and 39: Commercial FormularyTetracyclinesT1
Page 40 and 41: Commercial FormularyAntivirals, Hiv
Page 42 and 43: Commercial FormularyT1 etodolacT1 f
Page 44 and 45: Commercial FormularyT2 epinephrineE
Page 46 and 47: Commercial FormularyT2 butalbital/a
Page 48 and 49: Commercial FormularyT1 pentazocineh
Page 50 and 51: Commercial FormularyT1 levetiraceta
Page 52 and 53: Commercial FormularyUPPER GASTROINT
Page 54 and 55: Commercial FormularyGeriatric Vitam
Page 56 and 57: Commercial FormularyT1 fa/vitbcomp&
Page 58 and 59: Preferred Drug List Medication Pres
Page 64 and 65: • ASTELIN Prior prescription for
Page 76 and 77: IndexBEXAROTENE....................
Page 78 and 79: IndexDEPO-PROVERA..................
Page 80 and 81: IndexFIRST-PROGESTERONE VGS 200....
Page 82 and 83: IndexIRON FUM&POLYSAC#1/FA/MV NO.18
Page 84 and 85: IndexMONOCLATE-P...................
Page 86 and 87: IndexPHENDIMETRAZINE TARTRATE......
Page 88 and 89: IndexSIMCOR(TBMP 24HR)(500MG-40MG).
Page 90: IndexVAGIFEM.......................
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