Trustmark/Starmark Formulary Drug List April 2008 - Resource ...

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Brand Name Generic Name Tier Form VAZOTAN CAR-B-PEN TA/PHENYLEPHRINE/BPM 3 Suspension, Oral (Final Dose Form) CARBAPHEN 12 CAR-B-PEN TA/PHENYLEPHRINE/CP 3 Suspension, Oral (Final Dose Form) CARBAPHEN 12 PED CAR-B-PEN TA/PHENYLEPHRINE/CP 3 Suspension, Oral (Final Dose Form) PENTUSS CAR-B-PEN TA/PHENYLEPHRINE/CP 1 Suspension, Oral (Final Dose Form) RICOTUSS CAR-B-PEN TA/PHENYLEPHRINE/CP 1 Tablet XIRATUSS CAR-B-PEN TA/PHENYLEPHRINE/CP 1 Tablet TUSSI-12D S CAR-B-PEN TA/PHENYLEPHRINE/PYR 3 Suspension, Oral (Final Dose Form) TUSSI-12D CAR-B-PEN TA/PHENYLEPHRINE/PYR 3 Tablet ALACOL DM DEXTROMETHORPHAN/PE/BROMPHENIR 3 Drops BROMTUSS DM DEXTROMETHORPHAN/PE/BROMPHENIR 1 Liquid (ml) LORTUSS DM DEXTROMETHORPHAN/PE/BROMPHENIR 3 Liquid (ml) TUSDEC-DM DEXTROMETHORPHAN/PE/BROMPHENIR 1 Liquid (ml) ALACOL DM DEXTROMETHORPHAN/PE/BROMPHENIR 3 Syrup BALACALL DM DEXTROMETHORPHAN/PE/BROMPHENIR 1 Syrup BROM-PE-DM DEXTROMETHORPHAN/PE/BROMPHENIR 1 Syrup DURAVENT-DPB DEXTROMETHORPHAN/PE/BROMPHENIR 1 Syrup DONATUSSIN DM DM TAN/PE TAN/DEXCHLORPHEN TAN 3 Suspension, Oral (Final Dose Form) POLY TAN DM DM TAN/PE TAN/PYRIL/D-BROM TAN 3 Suspension, Oral (Final Dose Form) VIRAVAN-PDM DM,P-EPHED,PYRILAMINE TANNATES 3 Suspension, Oral (Final Dose Form) D-TANN DM DM/PHENYLEPH/DIPHENHYDRAM TANN 1 Suspension, Oral (Final Dose Form) DURATUSS AC 12 DM/PHENYLEPH/DIPHENHYDRAM TANN 3 Suspension, Oral (Final Dose Form) DYTAN-DM DM/PHENYLEPH/DIPHENHYDRAM TANN 3 Suspension, Oral (Final Dose Form) CORYZA-DM DM/PHENYLEPH/PYRIL/DEXCHLROPHE 1 Solution, Oral P-HIST DM/PHENYLEPH/PYRIL/DEXCHLROPHE 1 Solution, Oral PROHIST DM/PHENYLEPH/PYRIL/DEXCHLROPHE 3 Solution, Oral RESPERAL DM/PHENYLEPH/PYRIL/DEXCHLROPHE 1 Solution, Oral BP NEW ALLERGY DM D-METHORP TAN/PE/BR-PHENIR 1 Suspension, Oral (Final Dose Form) BROMATAN-DM D-METHORP TAN/PE/BR-PHENIR 1 Suspension, Oral (Final Dose Form) DM TANN-PE TANN-BROM TANN D-METHORP TAN/PE/BR-PHENIR 1 Suspension, Oral (Final Dose Form) DURATAN DM D-METHORP TAN/PE/BR-PHENIR 3 Suspension, Oral (Final Dose Form) DUR-TANN DM D-METHORP TAN/PE/BR-PHENIR 1 Suspension, Oral (Final Dose Form) NEO DM D-METHORP TAN/PE/BR-PHENIR 3 Suspension, Oral (Final Dose Form) ANAPLEX DMX D-METHORP TAN/P-EPD TAN/BPM 1 Suspension, Oral (Final Dose Form) BROM TANN-DM TANN-PSE TANN D-METHORP TAN/P-EPD TAN/BPM 1 Suspension, Oral (Final Dose Form) ATUSS DS D-METHORP TAN/P-EPD TAN/CP 3 Suspension, Oral (Final Dose Form) DICEL DM D-METHORP TAN/P-EPD TAN/CP 3 Suspension, Oral (Final Dose Form) T-TANNA DM D-METHORP TAN/P-EPD TAN/CP 1 Suspension, Oral (Final Dose Form) BROMATAN PLUS D-METHORP TAN/P-EPD TAN/D-CP 1 Suspension, Oral (Final Dose Form) C-PHED DPD TANNATE D-METHORP TAN/P-EPD TAN/D-CP 1 Suspension, Oral (Final Dose Form) DURATAN FORTE D-METHORP TAN/P-EPD TAN/D-CP 3 Suspension, Oral (Final Dose Form) DUR-TANN FORTE D-METHORP TAN/P-EPD TAN/D-CP 1 Suspension, Oral (Final Dose Form) SUTAN-DM D-METHORP TAN/P-EPD TAN/D-CP 1 Suspension, Oral (Final Dose Form) TANAFED DMX D-METHORP TAN/P-EPD TAN/D-CP 3 Suspension, Oral (Final Dose Form) TANDUR DM D-METHORP TAN/P-EPD TAN/D-CP 3 Suspension, Oral (Final Dose Form) TANNATE DMP-DEX D-METHORP TAN/P-EPD TAN/D-CP 1 Suspension, Oral (Final Dose Form) TANNATE PD-DM D-METHORP TAN/P-EPD TAN/D-CP 1 Suspension, Oral (Final Dose Form) MAXIPHEN ADT D-METHORP TAN/PHENYLEPHRINE/CP 3 Tablet BRONKIDS D-METHORPHAN HB/PE/CHLORPHENIR 3 Drops CARDEC DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Drops CERON-DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Drops CP DEC-DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Drops C-PHEN DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Drops DM-PE-CHLOR D-METHORPHAN HB/PE/CHLORPHENIR 1 Drops DONATUSSIN DM D-METHORPHAN HB/PE/CHLORPHENIR 3 Drops NASOHIST DM D-METHORPHAN HB/PE/CHLORPHENIR 3 Drops NEO DM D-METHORPHAN HB/PE/CHLORPHENIR 3 Drops QUARTUSS DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Drops RONDEC-DM D-METHORPHAN HB/PE/CHLORPHENIR 3 Drops RONDEX-DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Drops SILDEC PE-DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Drops CORFEN-DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Solution, Oral DEXTROMETHORPHAN-PE-CPM D-METHORPHAN HB/PE/CHLORPHENIR 1 Solution, Oral ED-A-HIST DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Solution, Oral NOREL DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Solution, Oral TRITAL DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Solution, Oral RICOTUSS D-METHORPHAN HB/PE/CHLORPHENIR 3 Suspension, Oral (Final Dose Form) BRONKIDS D-METHORPHAN HB/PE/CHLORPHENIR 1 Syrup CARDEC DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Syrup Page 34
Brand Name Generic Name Tier Form CERON-DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Syrup CP DEC-DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Syrup C-PHEN DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Syrup DE-CHLOR DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Syrup DE-CHLOR DR D-METHORPHAN HB/PE/CHLORPHENIR 1 Syrup DEX PC D-METHORPHAN HB/PE/CHLORPHENIR 1 Syrup DEXTROMETHORPHAN-PE-CPM D-METHORPHAN HB/PE/CHLORPHENIR 1 Syrup MINTUSS DR D-METHORPHAN HB/PE/CHLORPHENIR 1 Syrup PD-COF D-METHORPHAN HB/PE/CHLORPHENIR 1 Syrup PE-HIST DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Syrup POLY-TUSSIN DM D-METHORPHAN HB/PE/CHLORPHENIR 3 Syrup REME TUSSIN DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Syrup RONDEC-DM D-METHORPHAN HB/PE/CHLORPHENIR 3 Syrup RONDEX-DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Syrup SILDEC PE-DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Syrup STATUSS DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Syrup TRI-VENT DPC D-METHORPHAN HB/PE/CHLORPHENIR 1 Syrup TUSSPLEX DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Syrup ALBATUSSIN SR D-METHORPHAN HB/PE/CHLORPHENIR 3 Tablet, Sustained Release 12 Hr PHENABID DM D-METHORPHAN HB/PE/CHLORPHENIR 1 Tablet, Sustained Release 12 Hr ZOTEX-12D D-METHORPHAN HB/PE/CHLORPHENIR 1 Tablet, Sustained Release 12 Hr TUSSALL D-METHORPHAN HB/PE/D-BP 3 Syrup TUSSALL-ER D-METHORPHAN HB/PE/D-BP 3 Tablet, Sustained Release 12 Hr Y-COF DM D-METHORPHAN HB/PE/D-BP 1 Tablet, Sustained Release 12 Hr MYHIST-DM D-METHORPHAN HB/PE/PYRIL 1 Liquid (ml) POLY HIST DM D-METHORPHAN HB/PE/PYRIL 3 Liquid (ml) REME HIST DM D-METHORPHAN HB/PE/PYRIL 1 Liquid (ml) TRIPLEX DM D-METHORPHAN HB/PE/PYRIL 1 Liquid (ml) CODAL-DM D-METHORPHAN HB/PE/PYRIL 1 Syrup ACCUHIST DM D-METHORPHAN HB/P-EPD HCL/BPM 3 Drops ALLANHIST PDX D-METHORPHAN HB/P-EPD HCL/BPM 1 Drops BROMHIST PDX D-METHORPHAN HB/P-EPD HCL/BPM 1 Drops BROMHIST-DM D-METHORPHAN HB/P-EPD HCL/BPM 1 Drops ENDACOF-PD D-METHORPHAN HB/P-EPD HCL/BPM 1 Drops PEDIAHIST DM D-METHORPHAN HB/P-EPD HCL/BPM 1 Drops P-HIST DM D-METHORPHAN HB/P-EPD HCL/BPM 1 Drops PROHIST DM D-METHORPHAN HB/P-EPD HCL/BPM 3 Drops RESPERAL-DM D-METHORPHAN HB/P-EPD HCL/BPM 1 Drops DALLERGY DM D-METHORPHAN HB/P-EPD HCL/BPM 3 Liquid (ml) DELTUSS DMX D-METHORPHAN HB/P-EPD HCL/BPM 3 Liquid (ml) NEO DM D-METHORPHAN HB/P-EPD HCL/BPM 3 Liquid (ml) ANAPLEX DM D-METHORPHAN HB/P-EPD HCL/BPM 1 Syrup ANDEHIST-DM D-METHORPHAN HB/P-EPD HCL/BPM 1 Syrup BROMETANE DX D-METHORPHAN HB/P-EPD HCL/BPM 1 Syrup BROMFED-DM D-METHORPHAN HB/P-EPD HCL/BPM 3 Syrup BROMPHENEX DM D-METHORPHAN HB/P-EPD HCL/BPM 1 Syrup BROMPLEX DM D-METHORPHAN HB/P-EPD HCL/BPM 1 Syrup CARBODEX DM D-METHORPHAN HB/P-EPD HCL/BPM 1 Syrup CARBOFED DM D-METHORPHAN HB/P-EPD HCL/BPM 1 Syrup ENDACOF-DM D-METHORPHAN HB/P-EPD HCL/BPM 1 Syrup MYPHETANE DX D-METHORPHAN HB/P-EPD HCL/BPM 1 Syrup PSE BROM D-METHORPHAN HB/P-EPD HCL/BPM 1 Syrup SILDEC-DM D-METHORPHAN HB/P-EPD HCL/BPM 1 Syrup ACCUHIST PDX D-METHORPHAN HB/P-EPHED HCL/CP 3 Drops NEUTRAHIST PDX D-METHORPHAN HB/P-EPHED HCL/CP 1 Drops HDC DM D-METHORPHAN HB/P-EPHED HCL/CP 3 Syrup M-END DM D-METHORPHAN HB/P-EPHED HCL/CP 1 Syrup ALDEX DM DM-PE-PYRILAMINE TANNATES 3 Suspension, Oral (Final Dose Form) ALLANVAN-DM DM-PE-PYRILAMINE TANNATES 1 Suspension, Oral (Final Dose Form) SINADEX 12 DM-PE-PYRILAMINE TANNATES 3 Suspension, Oral (Final Dose Form) TANNATE-V-DM DM-PE-PYRILAMINE TANNATES 1 Suspension, Oral (Final Dose Form) VIRATAN-DM DM-PE-PYRILAMINE TANNATES 1 Suspension, Oral (Final Dose Form) ZOTEX 12 DM-PE-PYRILAMINE TANNATES 1 Suspension, Oral (Final Dose Form) DECONSAL DM DM-PE-PYRILAMINE TANNATES 3 Tablet, Chewable VIRATAN-DM DM-PE-PYRILAMINE TANNATES 1 Tablet, Chewable NON-NARCOTIC ANTITUSSIVE AND EXPECTORANT COMBINATION SORBUTUSS GUAIFEN/D-METHORPHAN HB/K CIT 3 Liquid (ml) DYNEX VR GUAIFENESIN/CARBETAPENTANE CIT 3 Capsule, Multiphasic Release 12 Hr Page 35
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Trustmark/Starmark Formulary Drug List April 2008 - Resource ...

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