VIRGINIA PREMIER HEALTH PLAN MEDICAID FORMULARY

Transcription

1 VIRGINIA PREMIER HEALTH PLAN MEDICAID FORMULARY PLEASE NOTE: Check your benefit materials for the specific drugs covered and the copayments for your prescription drug program. For specific questions about your coverage, please call the phone number printed on your ID card. The list may not be allinclusive. THIS LIST IS SUBJECT TO CHANGE. For the member: Generic medications contain the same active ingredients as their corresponding brand-name medications, although they may look different in color or shape. They have been FDA-approved under strict standards. For the physician: Please prescribe preferred products and allow generic substitutions when medically appropriate. Thank you.

2 CURRENT AS OF 3/1/2019 lowercase italics = Generic drugs UPPERCASE = Brand name drugs Status = Covered Requirements/Limits AGE = Age limit requirement Custom = Drug has unique restrictions = Over the Counter PA = Prior Authorization required QL = Quantity Level Limit SP = Specialty Drug. Preferred Specialty Pharmacy will be listed if applicable ST = Step Therapy may apply to some or all strengths of the drug 1st relief spray external liquid 4-1 % 1st tier unifine pentips 29g x 12mm, 31g x 5 mm, 31g x 6 mm, 31g x 8 mm, 32g x 4 mm ; QL (200 EA per 30 days) 1st tier unilet comfortouch ; QL (150 EA per 30 days) 2-deoxy-d-glucose powder 50+ adult eye health oral capsule 7-keto dhea powder A & D ZINC OXIDE EXTERNAL CREAM a thru z advanced oral tablet a thru z advantage oral tablet a thru z select oral tablet chewable A+D CRACKED SKIN RELIEF EXTERNAL CREAM % a1c test at-home in vitro kit a-25 oral capsule unit abacavir sulfate oral solution 20 mg/ml abacavir sulfate oral tablet 300 mg abacavir sulfate-lamivudine oral tablet mg abacavir-lamivudine-zidovudine oral tablet mg ABANATUSS PED ORAL LIQUID MG/ML, MG/5ML ABATRACE ORAL CAPSULE ABATREX ORAL TABLET MG ABATRON AF ORAL TABLET MG ABATRON ORAL LIQUID ABATUSS DMX ORAL LIQUID MG/5ML ABILIFY MAINTENA INTRAMUSCULAR PREFILLED SYRINGE 300 MG, 400 MG ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION RECONSTITUTED ER 300 MG, 400 MG abiraterone acetate oral tablet 250 mg ABRAXANE INTRAVENOUS SUSPENSION RECONSTITUTED 100 MG ABREVA EXTERNAL CREAM 10 % acacia powder AGE (Min 18 Years) AGE (Min 18 Years) 1

3 acamprosate calcium oral tablet delayed release 333 mg acarbose oral tablet 100 mg, 25 mg, 50 mg ACCU-CHEK FASTCLIX LANCET KIT ACCU-CHEK SOFT TOUCH LANCETS ; QL (150 EA per 30 days) ACCU-CHEK SOFTCLIX LANCETS ; QL (150 EA per 30 days) ACCUTREND CHOLESTEROL CONTROL IN VITRO SOLUTION ACCUTREND CHOLESTEROL IN VITRO STRIP ACCUTREND PLUS DEVICE ACE AEROSOL CLOUD ENHANCER QL (2 EA per 365 days) ACE KNEE BRACE W/STABILIZERS acebutolol hcl oral capsule 200 mg, 400 mg ACEROLA C 500 ORAL WAFER 500 MG acesulfame potassium powder ACETA-GESIC ORAL TABLET MG acetaminophen oral liquid 160 mg/5ml acetaminophen oral solution 160 mg/5ml acetaminophen oral tablet 325 mg acetaminophen powder acetaminophen-codeine #2 oral tablet mg PA; QL (280 EA per 7 days) acetaminophen-codeine #3 oral tablet mg PA; QL (140 EA per 7 days) acetaminophen-codeine #4 oral tablet mg PA; QL (70 EA per 7 days) acetaminophen-codeine oral solution mg/5ml PA; QL (1750 ML per 7 days) ACETASOL HC OTIC SOLUTION 2-1 % acetazolamide crystals acetazolamide er oral capsule extended release 12 hour 500 mg acetazolamide oral tablet 250 mg acetic acid glacial solution 99 % acetic acid irrigation solution 0.25 % acetic acid otic solution 2 % acetic acid solution 3 % acetone solution acetylcysteine inhalation solution 10 %, 20 % acetyl-l-carnitine hcl powder ACID GONE ORAL SUSPENSION MG/15ML acid reducer maximum strength oral tablet 20 mg acidophilus oral capsule acidophilus probiotic oral tablet 10 mg acidophilus/bifidus oral tablet chewable acidophilus/citrus pectin oral tablet acidophilus/pectin oral capsule acitretin oral capsule 10 mg, 17.5 mg, 25 mg PA; QL (68 EA per 34 days) acne medication 10 external gel 10 % ; AGE (Max 18 Years) 2

4 acne medication 10 external lotion 10 % ; AGE (Max 18 Years) acne medication 5 external gel 5 % AGE (Max 18 Years) acne medication 5 external lotion 5 % ; AGE (Max 18 Years) ACNEFREE ACNE CLEARING SYSTEM EXTERNAL KIT 2.5 & 3.7 % ACNEFREE SEVERE CLEARING SYST EXTERNAL KIT 2.5 & 10 % ACT TOTAL CARE MOUTH/THROAT SOLUTION 0.05 % ACTHIB INTRAMUSCULAR SOLUTION RECONSTITUTED ACTICARNITINE SF ORAL SOLUTION 1 GM/10ML ACTICON ORAL SOLUTION 1-30 MG/5ML ACTICON ORAL TABLET 2-60 MG actidom dmx oral liquid mg/5ml actidose/sorbitol oral liquid 50 gm/240ml actidose-aqua oral liquid 15 gm/72ml ACTIFLOVIT EAR HEALTH ORAL TABLET ACTIFOAM COLLAGEN SPONGE EXTERNAL AGE (Min 19 Years) acti-lance lite lancets 28g ; QL (150 EA per 30 days) acti-lance special lancets 17g ; QL (150 EA per 30 days) acti-lance universal 23g ; QL (150 EA per 30 days) ACTIMMUNE SUBCUTANEOUS SOLUTION UNIT/0.5ML ACTINEL ORAL LIQUID MG/5ML ACTISEP MOUTH/THROAT SOLUTION % ACTITROM ORAL CAPSULE ACTIVE Q MAXIMUM STRENGTH ORAL CAPSULE 300 MG ACTIVE Q ORAL SYRUP 100 MG/5ML ACTIVE-Q EXTRA STRENGTH ORAL CAPSULE 200 MG ACTIVE-Q ORAL CAPSULE MG ACTIVITE EC ORAL TABLET 1 MG ACTIVON ARTHRITIS ULTRA ST EXTERNAL STICK % acyclovir external ointment 5 % acyclovir oral capsule 200 mg acyclovir oral suspension 200 mg/5ml acyclovir oral tablet 400 mg, 800 mg ADACEL INTRAMUSCULAR SUSPENSION LF-MCG/0.5 ADAGEN INTRAMUSCULAR SOLUTION 250 UNIT/ML adapalene external cream 0.1 % AGE (Max 18 Years) adapalene external gel 0.1 %, 0.3 % AGE (Max 18 Years) PA 3

5 ADCIRCA ORAL TABLET 20 MG PA ADDERALL XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG, 15 MG, 5 MG ADDERALL XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 20 MG, 25 MG, 30 MG adefovir dipivoxil oral tablet 10 mg adenosylcobalamin powder adhesive bandages sheer ST; QL (30 EA per 30 days); AGE (Min 4 Years and Max 17 Years) ST; QL (60 EA per 30 days); AGE (Min 4 Years and Max 17 Years) adjustable lancing device ; QL (1 EA per 365 days) ADRENAL C FORMULA ORAL TABLET ADRENALIN INJECTION SOLUTION 1 MG/ML, 30 MG/30ML ADRUCIL INTRAVENOUS SOLUTION 2.5 GM/50ML, 5 GM/100ML, 500 MG/10ML adult gummy oral tablet chewable adult mask device QL (2 EA per 365 days) adult wash cloths with aloe external 3 % adult-lock weekly pill remind ADVAIR DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED MCG/DOSE ADVAIR DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED MCG/DOSE, MCG/DOSE advanced acne wash external liquid extended release 4.4 % ADVANCED CALCIUM/D/MAGNESIUM ORAL TABLET AGE (Min 4 Years) AGE (Min 12 Years) advanced hand sanitizer external liquid 70 % ADVIL ALLERGY & CONGESTION ORAL TABLET MG ADVIL ALLERGY SINUS ORAL TABLET MG ADVIL COLD & SINUS LIQUI-GELS ORAL CAPSULE MG ADVIL COLD/SINUS ORAL TABLET MG ADVIL ORAL CAPSULE 200 MG ADVIL ORAL TABLET 200 MG ADVIL PM ORAL CAPSULE MG ADVIL PM ORAL TABLET MG ADVIL SINUS CONGESTION & PAIN ORAL TABLET MG ADVOCATE INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML ADVOCATE INSULIN SYRINGE 30G X 5/16" 0.3 ML 30G X 5/16" 0.3 ML ADVOCATE INSULIN SYRINGE 30G X 5/16" 1 ML 30G X 5/16" 1 ML ADVOCATE INSULIN SYRINGE 31G X 5/16" 1 ML 31G X 5/16" 1 ML AEROCHAMBER PLUS FLO-VU QL (2 EA per 365 days) 4

6 AEROCHAMBER PLUS FLO-VU LARGE QL (2 EA per 365 days) AEROCHAMBER PLUS FLO-VU SMALL QL (2 EA per 365 days) AEROCHAMBER PLUS FLO-VU W/MASK QL (2 EA per 365 days) AFEDITAB CR ORAL TABLET EXTENDED RELEASE 24 HOUR 30 MG, 60 MG AFLURIA INTRAMUSCULAR SUSPENSION AGE (Min 19 Years) AFLURIA PRESERVATIVE FREE INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML AFREZZA INHALATION POWDER 12 UNIT, 8 UNIT AFRIN CHILDRENS NASAL SOLUTION 0.25 % AFRIN MENTHOL SPRAY NASAL SOLUTION 0.05 % AGE (Min 19 Years) AFTERA ORAL TABLET 1.5 MG ; QL (2 EA per 34 days) AGAMATRIX ULTRA-THIN LANCETS ; QL (150 EA per 30 days) AHIST ORAL TABLET 25 MG aimsco lubricated AIRAVITE ORAL TABLET MG AIRBORNE ORAL LOZENGE AIRS DISPOSABLE NEBULIZER ; QL (2 EA per 365 days) AIRS DISPOSABLE NEBULIZER KIT QL (2 EA per 365 days) AIRZONE PEAK FLOW METER DEVICE ; QL (2 EA per 365 days) ak-poly-bac ophthalmic ointment unit/gm AL12 EXTERNAL LOTION 12 % ALA SEB EXTERNAL SHAMPOO 2-2 % ALA SEB T EXTERNAL SHAMPOO % ALAHIST DM ORAL LIQUID MG/5ML ALA-HIST IR ORAL TABLET 2 MG ALA-HIST PE ORAL TABLET 2-10 MG alanine 1000 oral packet 1000 mg alba-lybe nr oral liquid mg/5ml albendazole oral tablet 200 mg ALBOLENE EXTERNAL CREAM ; QL (454 GM per 34 days) ALBUKED 25 INTRAVENOUS SOLUTION 25 % ALBUKED 5 INTRAVENOUS SOLUTION 5 % albuterol sulfate er oral tablet extended release 12 hour 4 mg, 8 mg albuterol sulfate inhalation nebulization solution (2.5 mg/3ml) 0.083%, (5 mg/ml) 0.5%, 0.63 mg/3ml, 1.25 mg/3ml albuterol sulfate oral syrup 2 mg/5ml albuterol sulfate oral tablet 2 mg, 4 mg alclometasone dipropionate external cream 0.05 % alclometasone dipropionate external ointment 0.05 % alcohol (rubbing) solution 70 % alcohol anhydrous liquid alcohol prep pad 70 % 5

7 alcohol prep pad 70 % 70 % alcohol swabs pad alcohol swabs pad 70 % 70 % alcohol wipes pad 70 % 70 % alcohol, usp solution 95 % alendronate sodium oral tablet 10 mg, 35 mg, 40 mg, 5 mg, 70 mg aler-cap oral capsule 25 mg aler-dryl oral tablet 50 mg alertness aid oral tablet 200 mg alevazol external ointment 1 % ALEVE ORAL CAPSULE 220 MG ALEVE ORAL TABLET 220 MG ALFERON N INJECTION SOLUTION UNIT/ML alfuzosin hcl er oral tablet extended release 24 hour 10 mg alga oral capsule mg-unit ALGAL-900 DHA ORAL CAPSULE 300 MG ALIMTA INTRAVENOUS SOLUTION RECONSTITUTED 100 MG, 500 MG ALIVE MULTI-VITAMIN CHILDRENS ORAL TABLET CHEWABLE 60 MG PA ALIVIO EXTERNAL PATCH % alka-aid oral tablet mg ALKA-SELTZER HEARTBURN + GAS ORAL TABLET CHEWABLE MG ALKA-SELTZER ORAL TABLET EFFERVESCENT MG all day allergy childrens oral solution 5 mg/5ml all day pain relief oral tablet 220 mg allantoin powder ALL-DRY SIZE 3 ALLEGRA ALLERGY CHILDRENS ORAL SUSPENSION 30 MG/5ML ALLEGRA ALLERGY CHILDRENS ORAL TABLET DISPERSIBLE 30 MG ALLEGRA ALLERGY ORAL TABLET 180 MG, 60 MG ALLEGRA-D ALLERGY & CONGESTION ORAL TABLET EXTENDED RELEASE 12 HOUR MG ALLEGRA-D ALLERGY & CONGESTION ORAL TABLET EXTENDED RELEASE 24 HOUR MG aller-ease oral tablet 60 mg ; QL (68 EA per 34 days) allergy childrens oral liquid 12.5 mg/5ml allergy eye ophthalmic solution % allergy multi-symptom day/nght oral allergy spray 24 hour aerosol 55 mcg/act nasal 55 mcg/act 6

8 ALLEVYN PLUS CAVITY PAD 6"X8" ALLI ORAL CAPSULE 60 MG allopurinol oral tablet 100 mg, 300 mg ALMACONE ORAL TABLET CHEWABLE MG almond oil bitter flavor liquid ALOCANE PLUS EXTERNAL GEL % ALOE GRANDE EXTERNAL CREAM UNIT/GM ALOE GRANDE EXTERNAL LOTION UNIT/30ML aloe vera external cream 72 % aloe vera external gel 99.5 % aloe vera freeze dried powder aloe vera moisturizing external gel 99.5 % ALOE VESTA 2-N-1 PROTECTIVE EXTERNAL OINTMENT ALOE VESTA CLEAR ANTIFUNGAL EXTERNAL OINTMENT 2 % ALOE VESTA MULTI PURPOSE EXTERNAL FOAM ALOE VESTA PROTECTIVE EXTERNAL OINTMENT ALOE VESTA SKIN PROTECTANT EXTERNAL AEROSOL 36 % aloe/lidocaine pain reliever external gel 0.5 % alosetron hcl oral tablet 0.5 mg, 1 mg PA alp high3 oral capsule delayed release 600 mg ALPAWASH EXTERNAL OINTMENT ALPHAGAN P OPHTHALMIC SOLUTION 0.1 %, 0.15 % alpha-lipoic acid oral capsule 100 mg alpha-lipoic acid oral tablet 200 mg alpha-lipoic acid powder ALPHANATE/VWF COMPLEX/HUMAN INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT, 1500 UNIT, 250 UNIT, 500 UNIT ALPHANINE SD INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT, 500 UNIT alph-e oral capsule 400 unit alph-e-mixed 1000 oral capsule 1000 unit alph-e-mixed oral capsule 200 unit alprazolam er oral tablet extended release 24 hour 0.5 mg, 1 mg, 2 mg QL (170 EA per 30 days) alprazolam er oral tablet extended release 24 hour 3 mg QL (170 EA per 34 days) ALPRAZOLAM INTENSOL ORAL CONCENTRATE 1 MG/ML QL (170 ML per 34 days) alprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg QL (170 EA per 34 days) 7

9 alprazolam oral tablet dispersible 0.25 mg, 0.5 mg, 1 mg, 2 mg ALTACAINE OPHTHALMIC SOLUTION 0.5 % ALTAFLUOR OPHTHALMIC SOLUTION % QL (170 EA per 34 days) ALTAVERA ORAL TABLET MG-MCG QL (28 EA per 28 days) alum ammonium powder aluminum acetate external solution aluminum bottle seal aluminum chloride hexahydrate crystals aluminum chloride hexahydrate powder aluminum chlorohydrate powder aluminum hydroxide dried gel powder aluminum hydroxide gel oral suspension 320 mg/5ml ALVESCO INHALATION AEROSOL SOLUTION 160 MCG/ACT, 80 MCG/ACT ALWAYS MAXI MAXIMUM PROTECTION PAD alyacen 1/35 oral tablet 1-35 mg-mcg QL (28 EA per 28 days) alyacen 7/7/7 oral tablet 0.5/0.75/1-35 mg-mcg QL (28 EA per 28 days) amantadine hcl oral capsule 100 mg amantadine hcl oral syrup 50 mg/5ml amantadine hcl oral tablet 100 mg ambi 12.5cpd/100gfn/30pse oral liquid mg/5ml ambi 12.5cpd/1dcpm/30pse oral liquid mg/5ml ambi 40pse/400gfn oral tablet mg ambi 60pse/400gfn oral tablet mg ambi 60pse/4cpm oral tablet 60-4 mg AMBI FADE EXTERNAL CREAM 2 % amcinonide external cream 0.1 % AMERICERIN EXTERNAL CREAM AMERIWASH EXTERNAL LOTION AMETHIA LO ORAL TABLET & 0.01 MG QL (91 EA per 91 days) AMETHIA ORAL TABLET &0.01 MG QL (91 EA per 91 days) AMETHYST ORAL TABLET MCG QL (28 EA per 28 days) AMICAR ORAL SOLUTION 0.25 GM/ML amiloride hcl oral tablet 5 mg amiloride-hydrochlorothiazide oral tablet 5-50 mg aminoacetic acid irrigation solution 1.5 % AMINOPMRMS ORAL CAPSULE AMINORELIEF RMS ORAL CAPSULE aminosalicylic acid-5 powder amiodarone hcl oral tablet 100 mg, 200 mg, 400 mg AMITIZA ORAL CAPSULE 24 MCG, 8 MCG PA; AGE (Min 18 Years) amitriptyline hcl oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg 8

10 amlodipine besy-benazepril hcl oral capsule mg, mg, mg, 5-10 mg, 5-20 mg, 5-40 mg amlodipine besylate oral tablet 10 mg, 2.5 mg, 5 mg amlodipine besylate-valsartan oral tablet mg, mg, mg, mg amlodipine-atorvastatin oral tablet mg, mg, mg, 5-10 mg, 5-20 mg, 5-40 mg amlodipine-valsartan-hctz oral tablet mg, mg, mg, mg, mg ammonia aromatic inhalation inhaler ammonia aromatic inhalation spirit ammonium carbonate powder ammonium chloride granules ammonium hydroxide solution ammonium lactate external cream 12 % amoxicillin oral capsule 250 mg, 500 mg amoxicillin oral suspension reconstituted 125 mg/5ml, 200 mg/5ml, 250 mg/5ml, 400 mg/5ml amoxicillin oral tablet 500 mg, 875 mg amoxicillin oral tablet chewable 125 mg, 250 mg amoxicillin-pot clavulanate oral suspension reconstituted mg/5ml, mg/5ml, mg/5ml, mg/5ml amoxicillin-pot clavulanate oral tablet mg, mg, mg amoxicillin-pot clavulanate oral tablet chewable mg, mg amphetamine-dextroamphetamine oral tablet 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg, 5 mg, 7.5 mg ampicillin oral capsule 500 mg ANA-LEX RECTAL KIT 2-2 % ANASEPT ANTIMICROBIAL EXTERNAL GEL % ANASEPT EXTERNAL LIQUID % anastrozole oral tablet 1 mg ANBESOL MAXIMUM STRENGTH MOUTH/THROAT LIQUID 20 % ST AGE (Min 4 Years and Max 17 Years) ANBESOL MOUTH/THROAT GEL 10 % ANBESOL MOUTH/THROAT LIQUID 10 % ANDROGEL PUMP TRANSDERMAL GEL MG/ACT (1.62%) ANDROGEL TRANSDERMAL GEL MG/1.25GM (1.62%), 25 MG/2.5GM (1%), 40.5 MG/2.5GM (1.62%), 50 MG/5GM (1%) ANECREAM EXTERNAL CREAM 4 % animal chews oral tablet chewable anise oil ANORO ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED MCG/INH PA PA AGE (Min 18 Years) 9

11 antacid anti-gas max strength oral suspension mg/5ml antacid anti-gas oral suspension mg/5ml antacid extra strength oral tablet chewable mg antacid multi-symptom oral tablet chewable mg antacid oral tablet chewable 500 mg antacid soft chews oral tablet chewable 1177 mg ANTARA ORAL CAPSULE 30 MG, 90 MG anthelios 50 mineral external liquid anti-allergy oral tablet mg antibacterial liquid soap external liquid 0.15 % anti-diarrheal oral liquid 1 mg/5ml anti-diarrheal oral tablet 2 mg antifungal external aerosol 1 % antifungal external cream 2 % anti-itch external cream % anti-itch external lotion % ANTI-ITCH INTENSIVE HEALING EXTERNAL LOTION 1 % antioxidant formula sg oral capsule extended release anti-oxidant oral tablet antiseptic external aerosol % ANTISEPTIC HAND RINSE EXTERNAL GEL 62 % antiseptic skin cleanser external solution 4 % ANUSOL-HC RECTAL CREAM 2.5 % AO-SEPT CONTACT LENS HOLDER APETIGEN ORAL ELIXIR APETIGEN-PLUS ORAL SOLUTION APETIGEN-PLUS ORAL TABLET ap-hist dm oral liquid mg/5ml APLIGRAF EXTERNAL DISK apothesar external cream apraclonidine hcl ophthalmic solution 0.5 % aprepitant oral capsule 125 mg, 40 mg, 80 & 125 mg QL (1 EA per 34 days) aprepitant oral capsule 80 mg QL (2 EA per 34 days) APRI ORAL TABLET MG-MCG QL (28 EA per 28 days) APRISO ORAL CAPSULE EXTENDED RELEASE 24 HOUR GM APTIVUS ORAL CAPSULE 250 MG APTIVUS ORAL SOLUTION 100 MG/ML AQUA CARE EXTERNAL LOTION 10 % aquabase external ointment AQUADEKS ORAL LIQUID AQUAFRESH DR SEUSS EXTRA SOFT 10

12 aquanaz oral tablet mg AQUAPHILIC EXTERNAL OINTMENT AQUAPHILIC/CARBAMIDE EXTERNAL OINTMENT 10 %, 20 % AQUASONIC 100 EXTERNAL GEL AQUEOUS SELENIUM ORAL LIQUID 95 MCG/DROP aqueous vitamin e oral solution 15 unit/0.3ml AQUORAL MOUTH/THROAT SOLUTION ARANELLE ORAL TABLET 0.5/1/ MG-MCG QL (28 EA per 28 days) ARANESP (ALBUMIN FREE) SOLUTION 100 MCG/ML INJECTION 100 MCG/ML ARANESP (ALBUMIN FREE) SOLUTION 200 MCG/ML INJECTION 200 MCG/ML ARANESP (ALBUMIN FREE) SOLUTION 25 MCG/ML INJECTION 25 MCG/ML ARANESP (ALBUMIN FREE) SOLUTION 300 MCG/ML INJECTION 300 MCG/ML ARANESP (ALBUMIN FREE) SOLUTION 40 MCG/ML INJECTION 40 MCG/ML ARANESP (ALBUMIN FREE) SOLUTION 60 MCG/ML INJECTION 60 MCG/ML ARANESP (ALBUMIN FREE) SOLUTION PREFILLED SYRINGE 10 MCG/0.4ML INJECTION 10 MCG/0.4ML ARANESP (ALBUMIN FREE) SOLUTION PREFILLED SYRINGE 100 MCG/0.5ML INJECTION 100 MCG/0.5ML ARANESP (ALBUMIN FREE) SOLUTION PREFILLED SYRINGE 150 MCG/0.3ML INJECTION 150 MCG/0.3ML ARANESP (ALBUMIN FREE) SOLUTION PREFILLED SYRINGE 200 MCG/0.4ML INJECTION 200 MCG/0.4ML ARANESP (ALBUMIN FREE) SOLUTION PREFILLED SYRINGE 25 MCG/0.42ML INJECTION 25 MCG/0.42ML ARANESP (ALBUMIN FREE) SOLUTION PREFILLED SYRINGE 300 MCG/0.6ML INJECTION 300 MCG/0.6ML ARANESP (ALBUMIN FREE) SOLUTION PREFILLED SYRINGE 40 MCG/0.4ML INJECTION 40 MCG/0.4ML ARANESP (ALBUMIN FREE) SOLUTION PREFILLED SYRINGE 500 MCG/ML INJECTION 500 MCG/ML ARANESP (ALBUMIN FREE) SOLUTION PREFILLED SYRINGE 60 MCG/0.3ML INJECTION 60 MCG/0.3ML ARCALYST SUBCUTANEOUS SOLUTION RECONSTITUTED 220 MG ARCAPTA NEOHALER INHALATION CAPSULE 75 MCG arctic relief pain relieving external gel % ARGIMENT AT ORAL PACKET PA 11

13 arginine oral packet 500 mg arginine2000 oral packet 2000 mg ARGYLE STERILE SALINE IRRIGATION SOLUTION 0.9 % ARGYLE STERILE WATER IRRIGATION SOLUTION aripiprazole oral tablet 10 mg, 15 mg, 2 mg, 20 mg, 30 mg, 5 mg ARISTADA INITIO INTRAMUSCULAR PREFILLED SYRINGE 675 MG/2.4ML ARISTADA INTRAMUSCULAR PREFILLED SYRINGE 1064 MG/3.9ML, 441 MG/1.6ML, 662 MG/2.4ML, 882 MG/3.2ML arkaliox oral capsule 200 mg ARLASILK PHOSPHOLIPID PLN LIQUID ARMOUR THYROID ORAL TABLET 120 MG, 15 MG, 180 MG, 240 MG, 30 MG, 300 MG, 60 MG, 90 MG arnica external tincture 20 % arnicare arthritis oral tablet dispersible ARRANON INTRAVENOUS SOLUTION 5 MG/ML arthritis pain relieving external cream % artificial tears ophthalmic solution %, 1.4 % ARZERRA INTRAVENOUS CONCENTRATE 100 MG/5ML, 1000 MG/50ML ARZOL SILVER NIT APPLICATORS EXTERNAL % asafetida tincture ascocid-iso-ph oral powder effervescent ASCOMP-CODEINE ORAL CAPSULE MG PA ascorbic acid granules ascorbic acid oral granules ascorbic acid oral tablet 1000 mg, 500 mg ascorbic acid oral tablet chewable 250 mg ascorbic acid powder ascorbyl palmitate powder ASCRIPTIN ORAL TABLET 325 MG asepto oral thermometer kit ASILNASAL RMS ORAL CAPSULE ASMANEX 120 METERED DOSES INHALATION AEROSOL POWDER BREATH ACTIVATED 220 MCG/INH ASMANEX 30 METERED DOSES INHALATION AEROSOL POWDER BREATH ACTIVATED 110 MCG/INH aspartame powder aspartate mg & k oral capsule mg ASPERCREME W/LIDOCAINE EXTERNAL CREAM 4 % 12 AGE (Min 18 Years) AGE (Min 18 Years) AGE (Min 18 Years)

14 aspir-81 oral tablet delayed release 81 mg aspirin oral tablet 325 mg aspirin oral tablet chewable 81 mg aspirin oral tablet delayed release 325 mg aspirin powder aspirin rectal suppository 300 mg, 600 mg aspirin-dipyridamole er oral capsule extended release 12 hour mg aspirtab maximum strength oral tablet 500 mg ASSURE ID INSULIN SAFETY SYR 29G X 1/2" 0.5 ML () 29G X 1/2" 0.5 ML ASSURE ID INSULIN SAFETY SYR 29G X 1/2" 1 ML 29G X 1/2" 1 ML ASSURE LANCETS ; QL (150 EA per 30 days) ASTHMAPACK FOR CHILDREN KIT ; QL (2 EA per 365 days) atazanavir sulfate oral capsule 150 mg, 200 mg, 300 mg atenolol oral tablet 100 mg, 25 mg, 50 mg atenolol-chlorthalidone oral tablet mg, mg athletes foot maximum strength external ointment atomoxetine hcl oral capsule 10 mg AGE (Min 4 Years and Max 17 Years) atomoxetine hcl oral capsule 100 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg ATOPICLAIR EXTERNAL CREAM atorvastatin calcium oral tablet 10 mg, 20 mg, 40 mg, 80 mg atovaquone oral suspension 750 mg/5ml atovaquone-proguanil hcl oral tablet mg, mg ATRAC-TAIN EXTERNAL CREAM 10 % ATRAC-TAIN EXTERNAL LOTION 5 % ATRIPLA ORAL TABLET MG ATROVENT HFA INHALATION AEROSOL SOLUTION 17 MCG/ACT atuss da oral liquid mg/5ml QL (30 EA per 30 days); AGE (Min 4 Years and Max 17 Years) AUBRA ORAL TABLET MG-MCG QL (28 EA per 28 days) auraphene-b otic solution 6.5 % aurora lancet super thin 30g ; QL (150 EA per 30 days) aurora lancet thin 23g ; QL (150 EA per 30 days) AUTOJECT 2 ; QL (1 EA per 365 days) AUTOLET PLATFORMS autopen device ; QL (1 EA per 365 days) avalin external patch 4-1 % AVAR CLEANSER EXTERNAL EMULSION 10-5 % AVAR-E EMOLLIENT EXTERNAL CREAM 10-5 % AVASTIN INTRAVENOUS SOLUTION 100 MG/4ML, 400 MG/16ML PA 13

15 AVEENO BABY GENTLE CONDITION EXTERNAL SHAMPOO AVEENO BABY SOOTHING WASH EXTERNAL LIQUID AVEENO INTENSE RELIEF EXTERNAL CREAM 1.3 % AVEENO POSITIVELY RADIANT WASH EXTERNAL LIQUID AVENOVA/NEUTROX EXTERNAL SOLUTION 0.01 % AVERTEAX MOUTH/THROAT OINTMENT 1 % AVITENE EXTERNAL PAD AVITENE FLOUR EXTERNAL POWDER AVO CREAM EXTERNAL EMULSION AVONEX INTRAMUSCULAR KIT 30 MCG AVONEX PEN INTRAMUSCULAR AUTO-INJECTOR KIT 30 MCG/0.5ML AVONEX PREFILLED INTRAMUSCULAR PREFILLED SYRINGE KIT 30 MCG/0.5ML av-phos 250 neutral oral tablet mg axillary block needle 22g x 1", 25g x 1" AXSAIN EXTERNAL CREAM 0.25 % AYR SALINE NASAL DROPS NASAL SOLUTION 0.65 % AYR SALINE NASAL GEL NASAL SWAB AYR SALINE NASAL NASAL GEL AYR SALINE NASAL NO-DRIP NASAL GEL AYR SALINE NASAL RINSE NASAL PACKET 1.57 GM azacitidine injection suspension reconstituted 100 mg AZASAN ORAL TABLET 100 MG, 75 MG azathioprine oral tablet 50 mg azec oral capsule azelaic acid flakes azelaic acid powder azelastine hcl nasal solution 0.1 %, 0.15 % azithromycin oral packet 1 gm azithromycin oral suspension reconstituted 100 mg/5ml, 200 mg/5ml azithromycin oral tablet 250 mg, 500 mg, 600 mg AZOPT OPHTHALMIC SUSPENSION 1 % AZURETTE ORAL TABLET /0.01 MG (21/5) QL (28 EA per 28 days) b complete oral tablet b complex formula 1 oral tablet b complex oral capsule b complex oral tablet b complex-folic acid oral tablet mcg-mg-mcg b-1 oral tablet 100 mg, 250 mg 14

16 b-100 cr oral tablet extended release b-12 oral tablet 2000 mcg, 250 mcg b-12 sublingual tablet sublingual 1000 mcg, 2500 mcg, 5000 mcg b-12 tr oral tablet extended release 2000 mcg b-2 oral tablet 100 mg B ORAL CAPSULE 400 MG b-6 oral tablet 250 mg, 50 mg, 500 mg BABY ANBESOL MOUTH/THROAT GEL 7.5 % baby lotion external lotion baby super daily d3 oral liquid 400 ut/0.028ml baby teething pain medicine mouth/throat gel 7.5 % baby thermometer baciim intramuscular solution reconstituted unit bacitracin ophthalmic ointment 500 unit/gm bacitracin zinc external ointment 500 unit/gm bacitra-neomycin-polymyxin-hc ophthalmic ointment 1 % back pain-off oral tablet mg baclofen oral tablet 10 mg, 20 mg BACTROBAN NASAL NASAL OINTMENT 2 % balamine dm oral syrup mg/5ml balanced b-50 complex oral capsule balanced b-50 oral tablet extended release BAL-CARE DHA ORAL 27-1 & 430 MG BALNEOL EXTERNAL LOTION balsalazide disodium oral capsule 750 mg BALZIVA ORAL TABLET MG-MCG QL (28 EA per 28 days) BAND-AID SURGIPAD SURGICAL PAD 5"X9" BANOPHEN ORAL CAPSULE 50 MG BANZEL ORAL SUSPENSION 40 MG/ML PA BANZEL ORAL TABLET 200 MG, 400 MG PA BARACLUDE ORAL SOLUTION 0.05 MG/ML BASAGLAR KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML base g almond oil (sweet) oil basic fuchsin hcl powder BAYER BACK & BODY ORAL TABLET MG BAYER BREEZE 2 CONTROL LIQUID HIGH IN VITRO HIGH BAYER BREEZE 2 CONTROL LIQUID LOW IN VITRO LOW BAYER BREEZE 2 CONTROL LIQUID NORMAL IN VITRO NORMAL BAYER BREEZE 2 SYSTEM KIT W/DEVICE W/DEVICE QL (30 ML per 30 days) ; QL (100 EA per 30 days) ; QL (100 EA per 30 days) ; QL (100 EA per 30 days) ; QL (1 EA per 365 days) 15

17 BAYER BREEZE 2 TEST DISK IN VITRO ; QL (150 EA per 30 days) BAYER CONTOUR LINK MONITOR KIT W/DEVICE W/DEVICE ; QL (1 EA per 365 days) BAYER CONTOUR LIQUID HIGH IN VITRO HIGH ; QL (100 EA per 30 days) BAYER CONTOUR LIQUID LOW IN VITRO LOW ; QL (100 EA per 30 days) BAYER CONTOUR LIQUID NORMAL IN VITRO NORMAL ; QL (100 EA per 30 days) BAYER CONTOUR MONITOR DEVICE ; QL (1 EA per 365 days) BAYER CONTOUR MONITOR KIT W/DEVICE W/DEVICE BAYER CONTOUR MONITOR KIT W/DEVICE W/DEVICE ; QL (1 EA per 365 days) ; QL (150 EA per 30 days) BAYER CONTOUR TEST STRIP IN VITRO ; QL (150 EA per 30 days) BAYER MICROLET LANCETS ; QL (150 EA per 30 days) BAYER WOMENS ORAL TABLET MG BAZA CLEANSE & PROTECT EXTERNAL LOTION 2 % BC FAST PAIN RELIEF ARTHRITIS ORAL PACKET MG BC FAST PAIN RELIEF ORAL PACKET MG b-caro-t oral capsule 15 mg b-complex high potency oral tablet extended release BD ALLERGY SYRINGE 28G X 1/2" 1 ML BD AUTOSHIELD 29G X 5MM, 29G X 8MM BD AUTOSHIELD DUO 30G X 5 MM BD BLUNT FILTER NEEDLE 18G X 1-1/2" BD DISP NEEDLE 22G X 3/4", 23G X 1-1/4", 27G X 1-1/4", 30G X 1" BD DISP NEEDLE TW 18G X 1" BD DISP NEEDLES 16G X 1-1/2", 19G X 1", 20G X 1", 21G X 1-1/2", 25G X 7/8", 27G X 1/2", 30G X 1/2" BD ECLIPSE NEEDLE 22G X 1-1/2", 23G X 1", 25G X 1-1/2", 25G X 5/8" BD ECLIPSE SYRINGE 25G X 5/8" 1 ML, 30G X 1/2" 1 ML BD HYPODERMIC NEEDLE 23G X 1-1/2", 26G X 5/8" BD INSULIN SYR ULTRAFINE II 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML BD INSULIN SYR ULTRAFINE II 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML BD INSULIN SYR ULTRAFINE II 31G X 5/16" 1 ML 31G X 5/16" 1 ML BD INSULIN SYRINGE 25G X 1" 1 ML 25G X 1" 1 ML BD INSULIN SYRINGE 25G X 5/8" 1 ML 25G X 5/8" 1 ML BD INSULIN SYRINGE 26G X 1/2" 1 ML 26G X 1/2" 1 ML 16

18 BD INSULIN SYRINGE 27.5G X 5/8" 2 ML 27.5G X 5/8" 2 ML BD INSULIN SYRINGE 27G X 1/2" 1 ML 27G X 1/2" 1 ML BD INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML BD INSULIN SYRINGE HALF-UNIT 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML BD INSULIN SYRINGE MICROFINE 27G X 5/8" 1 ML 27G X 5/8" 1 ML BD INSULIN SYRINGE MICROFINE 28G X 1/2" 0.5 ML 28G X 1/2" 0.5 ML BD INSULIN SYRINGE MICROFINE 28G X 1/2" 1 ML 28G X 1/2" 1 ML BD INSULIN SYRINGE U/F 1/2UNIT 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML BD INSULIN SYRINGE U/F 30G X 1/2" 0.3 ML 30G X 1/2" 0.3 ML BD INSULIN SYRINGE U/F 30G X 1/2" 0.5 ML 30G X 1/2" 0.5 ML BD INSULIN SYRINGE U/F 30G X 1/2" 1 ML 30G X 1/2" 1 ML BD INSULIN SYRINGE U/F 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML BD INSULIN SYRINGE U/F 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML BD INSULIN SYRINGE U/F 31G X 5/16" 1 ML 31G X 5/16" 1 ML BD INSULIN SYRINGE U ML U ML BD INSULIN SYRINGE U G X 6MM 0.5 ML 31G X 6MM 0.5 ML BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 1 ML 29G X 1/2" 1 ML BD INSULIN SYRINGE ULTRAFINE 30G X 1/2" 0.3 ML 30G X 1/2" 0.3 ML BD INSULIN SYRINGE ULTRAFINE 30G X 1/2" 0.5 ML 30G X 1/2" 0.5 ML BD INSULIN SYRINGE ULTRAFINE 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML BD LANCET ULTRAFINE 30G ; QL (150 EA per 30 days) BD LANCET ULTRAFINE 33G ; QL (150 EA per 30 days) 17

19 BD LUER-LOK SYRINGE 18G X 1-1/2" 3 ML, 20G X 1" 1 ML, 20G X 1" 10 ML, 20G X 1" 3 ML, 20G X 1" 5 ML, 20G X 1-1/2" 10 ML, 20G X 1-1/2" 3 ML, 20G X 1-1/2" 5 ML, 21G X 1" 10 ML, 21G X 1" 3 ML, 21G X 1" 5 ML, 21G X 1-1/2" 3 ML, 22G X 1" 10 ML, 22G X 1" 3 ML, 22G X 1" 5 ML, 22G X 1-1/2" 5 ML, 23G X 1" 3 ML, 23G X 1-1/2" 3 ML, 23G X 1-1/4" 10 ML, 25G X 1" 3 ML, 25G X 1-1/2" 3 ML, 25G X 5/8" 3 ML BD PEN NEEDLE ORIGINAL U/F 29G X 12.7MM BD SAFETYGLIDE INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML BD SAFETYGLIDE INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML BD SAFETYGLIDE INSULIN SYRINGE 30G X 5/16" 0.5 ML 30G X 5/16" 0.5 ML BD SAFETYGLIDE INSULIN SYRINGE 31G X 15/64" 0.3 ML 31G X 15/64" 0.3 ML BD SAFETYGLIDE INSULIN SYRINGE 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML BD SAFETYGLIDE NEEDLE 27G X 5/8" BD SAFETYGLIDE SYRINGE/NEEDLE 27G X 5/8" 1 ML BD SAFETY-LOK INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML BD SHARPS COLLECTOR BD SWAB SINGLE USE REGULAR PAD BD SWABS SINGLE USE BUTTERFLY PAD BD SYRINGE/NEEDLE SLIP TIP 26G X 5/8" 1 ML BD TB SYRINGE 21G X 1" 1 ML, 27G X 1/2" 0.5 ML BD VEO INSULIN SYRINGE U/F 31G X 15/64" 0.3 ML 31G X 15/64" 0.3 ML BD VEO INSULIN SYRINGE U/F 31G X 15/64" 0.5 ML 31G X 15/64" 0.5 ML BD VEO INSULIN SYRINGE U/F 31G X 15/64" 1 ML 31G X 15/64" 1 ML BEBULIN INTRAVENOUS SOLUTION RECONSTITUTED UNIT bec/zinc oral tablet bee pollen oral capsule 580 mg bee pollen oral tablet chewable 500 mg BEELITH ORAL TABLET MG BELBUCA BUCCAL FILM 150 MCG, 300 MCG, 450 MCG, 600 MCG, 75 MCG, 750 MCG, 900 MCG belladonna alkaloids-opium rectal suppository mg belladonna-opium rectal suppository mg BENADRYL ALLERGY CHILDRENS ORAL LIQUID 12.5 MG/5ML BENADRYL ALLERGY CHILDRENS ORAL TABLET CHEWABLE 12.5 MG PA; QL (68 EA per 34 days) BENADRYL ALLERGY ORAL TABLET 25 MG 18

20 BENADRYL ITCH RELIEF EXTERNAL STICK % BENADRYL ITCH STOPPING EXTERNAL CREAM % BENADRYL-D ALLERGY/SINUS CHILD ORAL SOLUTION MG/5ML benazepril hcl oral tablet 10 mg, 20 mg, 40 mg, 5 mg benazepril-hydrochlorothiazide oral tablet mg, mg, mg, mg BENEFIBER FOR CHILDREN ORAL POWDER BENEFIBER ON THE GO ORAL PACKET BENEFIBER ORAL POWDER BENEFIBER PLUS B VITS & FA ORAL TABLET BENEFIBER PLUS CALCIUM ORAL POWDER BENEFIBER PLUS CALCIUM ORAL TABLET CHEWABLE BENEFIBER PLUS HEART HEALTH ORAL POWDER benfotiamine multi-b oral capsule bentonite powder benzaldehyde oral elixir benzalkonium chloride external concentrate 50 % benzalkonium chloride external solution 50 % BENZEDREX NASAL INHALER BENZEPRO CREAMY WASH EXTERNAL LIQUID 7 % BENZEPRO EXTERNAL FOAM 5.3 % BENZEPRO SHORT CONTACT EXTERNAL FOAM 9.8 % benzocaine powder BENZODENT MOUTH/THROAT CREAM 20 % benzoic acid crystals benzoin external tincture benzonatate oral capsule 100 mg, 150 mg, 200 mg AGE (Min 6 Years) BENZ-O-STHETIC MOUTH/THROAT SWAB 20 % benzoyl peroxide cleanser external lotion 6 % benzoyl peroxide external gel 2.5 % ; AGE (Max 18 Years) benzoyl peroxide wash external liquid 10 % AGE (Max 18 Years) benzoyl peroxide wash external liquid 5 % ; AGE (Max 18 Years) benzoyl peroxide-erythromycin external gel 5-3 % benzphetamine hcl oral tablet 50 mg PA benztropine mesylate oral tablet 0.5 mg, 1 mg, 2 mg benzyl alcohol liquid benzyl benzoate liquid bergamot oil oil BERINERT INTRAVENOUS KIT 500 UNIT PA; QL (8 EA per 30 days) BERRI-FREEZ PAIN RELIEVING EXTERNAL GEL 4.5 % 19

21 BERRI-FREEZ PAIN RELIEVING EXTERNAL LIQUID 10 % BERRI-FREEZ PLUS EXTERNAL GEL % beta carotene provitamin a oral capsule unit BETADINE EXTERNAL SOLUTION 10 %, 5 % BETADINE SURGICAL SCRUB EXTERNAL SOLUTION 7.5 % BETADINE SWABSTICKS EXTERNAL SWAB 10 % betaine anhydrous powder betaine hcl oral tablet 300 mg betamethasone dipropionate aug external cream 0.05 % betamethasone dipropionate aug external lotion 0.05 % betamethasone dipropionate aug external ointment 0.05 % betamethasone dipropionate external cream 0.05 % betamethasone dipropionate external lotion 0.05 % betamethasone dipropionate external ointment 0.05 % betamethasone valerate external cream 0.1 % betamethasone valerate external lotion 0.1 % betamethasone valerate external ointment 0.1 % BETAQUIK ORAL EMULSION BETASERON SUBCUTANEOUS KIT 0.3 MG betaxolol hcl ophthalmic solution 0.5 % betaxolol hcl oral tablet 10 mg, 20 mg bethanechol chloride oral tablet 10 mg, 25 mg, 5 mg, 50 mg BETHKIS INHALATION NEBULIZATION SOLUTION 300 MG/4ML BEVESPI AEROSPHERE INHALATION AEROSOL MCG/ACT bexarotene oral capsule 75 mg PA BIATAIN HEEL ADH FOAM DRESSING PAD 19CMX20CM QL (280 ML per 28 days); AGE (Min 6 Years) AGE (Min 17 Years) BIATAIN SACRAL FOAM DRESSING PAD 9"X9" bicalutamide oral tablet 50 mg BICARSIM FORTE ORAL TABLET 125 MG BICARSIM ORAL TABLET 80 MG BICNU INTRAVENOUS SOLUTION RECONSTITUTED 100 MG BIKTARVY ORAL TABLET MG QL (30 EA per 30 days) biobron sf oral syrup mg/5ml biocotron oral liquid mg/5ml biodesp dm oral syrup mg/5ml bioflavonoid citrus powder BIO-FLAX ORAL CAPSULE 1000 MG BIOFLONEX ORAL TABLET MG BIOFREEZE EXTERNAL AEROSOL 10.5 % 20

22 BIOFREEZE ROLL-ON COLORLESS EXTERNAL GEL 4 % BIOGAIA GASTRUS ORAL TABLET CHEWABLE biogtuss oral liquid mg/5ml BIOGUARD NON-ADHERENT DRESSING PAD 3"X8" BIOLLE GEL TEARS OPHTHALMIC GEL 1 % bionatuss dxp oral liquid mg/5ml BIOPATCH PROTECTIVE DISK/CHG EXTERNAL (DRESSING) BIORX SPONIX ANTI-FUNGAL EXTERNAL SOLUTION 22 % BIORX SPONIX ARTHR & MUSC EXTERNAL SOLUTION % biospec dmx oral liquid mg/5ml biotalan clear oral liquid BIO-THERM PAIN RELIEVING EXTERNAL LOTION % biotin forte oral tablet 3 mg biotin oral capsule 10 mg, 2500 mcg biotin oral tablet 1000 mcg, mcg, 300 mcg, 800 mcg biotin plus keratin oral tablet mcg-mg biotin-d powder biotuss oral liquid mg/5ml biovol oral syrup bisacodyl ec oral tablet delayed release 5 mg bismatrol maximum strength oral suspension 525 mg/15ml bismatrol oral tablet chewable 262 mg bismuth citrate powder bismuth subcarbonate powder bismuth subgallate powder bismuth subnitrate powder bismuth subsalicylate powder bisoprolol fumarate oral tablet 10 mg, 5 mg bisoprolol-hydrochlorothiazide oral tablet mg, mg, mg bite/itch external lotion 1-2 % BI-ZETS/BENZOTROCHES MOUTH/THROAT LOZENGE 15 MG bladder 2.2 oral tablet bleomycin sulfate injection solution reconstituted 15 unit, 30 unit BLINK TEARS OPHTHALMIC GEL 0.25 % BLINK TEARS OPHTHALMIC SOLUTION 0.25 % BLISOVI 24 FE ORAL TABLET 1-20 MG-MCG(24) BLISOVI FE 1.5/30 ORAL TABLET MG-MCG BLISOVI FE 1/20 ORAL TABLET 1-20 MG-MCG 21

23 blood pressure monitor/wrist kit BOIL EASE MAXIMUM STRENGTH EXTERNAL OINTMENT 20 % BONE DENSITY ORAL TABLET MG-UNIT BOOST PUDDING ORAL PUDDING BOOSTRIX INTRAMUSCULAR SUSPENSION borage oral capsule mg borax granules boric acid external granules boric acid powder boron oral capsule 3 mg boron oral tablet 6 mg BOTOX INJECTION SOLUTION RECONSTITUTED 100 UNIT, 200 UNIT BOUDREAUXS BABY KISSES EXTERNAL OINTMENT BOUDREAUXS BUTT PASTE EXTERNAL OINTMENT 16 %, 40 % BOUDREAUXS RASH PREVENTOR EXTERNAL LIQUID 10 % bp 10-1 external emulsion 10-1 % QL (170.1 GM per 30 days) bp cleansing wash external emulsion 10-4 % bp wash external liquid 2.5 % PA BPROTECTED MULTI-VITE ORAL LIQUID BPROTECTED PEDIA IRON ORAL SOLUTION 75 (15 FE) MG/ML BPROTECTED PEDIA POLY-VITE ORAL SOLUTION 35 MG/ML BRAINSTRONG PRENATAL ORAL & 350 MG BRASIVOL EXTERNAL PASTE BRAUN NO TOUCH + FOREHEAD BREVIBLOC IN NACL INTRAVENOUS SOLUTION 2000 MG/100ML, 2500 MG/250ML brewers yeast oral tablet BRIJ 30 LIQUID BRILINTA ORAL TABLET 60 MG, 90 MG brilliant green powder brimonidine tartrate ophthalmic solution 0.15 %, 0.2 % BRIVIACT INTRAVENOUS SOLUTION 50 MG/5ML brohist d oral tablet 4-10 mg bromelain powder bromi-lotion external lotion bromocriptine mesylate oral capsule 5 mg bromocriptine mesylate oral tablet 2.5 mg bronchial asthma relief oral tablet mg 22

24 BRONKAID ORAL TABLET MG bronkids oral liquid mg/ml, mg/5ml brontuss dx oral liquid mg/5ml brotapp dm oral liquid mg/5ml BROVANA INHALATION NEBULIZATION SOLUTION 15 MCG/2ML btrex oral tablet extended release mg BUCKLEYS CHEST CONGESTION ORAL LIQUID 100 MG/5ML AGE (Min 17 Years) BUCKLEYS COUGH ORAL LIQUID 12.5 MG/5ML budesonide oral capsule delayed release particles 3 mg budesonide suspension 32 mcg/act nasal (otc) 32 mcg/act BUFFERIN EXTRA STRENGTH ORAL TABLET 500 MG BUFFERIN LOW DOSE ORAL TABLET 81 MG BUFFERIN ORAL TABLET 325 MG BULL FROG WATER ARMOR SPORT EXTERNAL GEL bumetanide oral tablet 0.5 mg, 1 mg, 2 mg BUPHENYL ORAL TABLET 500 MG buprenorphine hcl injection solution 0.3 mg/ml PA buprenorphine hcl sublingual tablet sublingual 2 mg buprenorphine hcl sublingual tablet sublingual 8 mg buprenorphine transdermal patch weekly 10 mcg/hr, 15 mcg/hr, 20 mcg/hr, 5 mcg/hr, 7.5 mcg/hr bupropion hcl er (smoking det) oral tablet extended release 12 hour 150 mg bupropion hcl er (sr) oral tablet extended release 12 hour 100 mg, 150 mg, 200 mg bupropion hcl er (xl) oral tablet extended release 24 hour 150 mg, 300 mg bupropion hcl oral tablet 100 mg, 75 mg burn relief/lidocaine/aloe external gel 0.5 % buspirone hcl oral tablet 10 mg, 15 mg, 30 mg, 5 mg, 7.5 mg busulfan intravenous solution 6 mg/ml butalbital-acetaminophen oral tablet mg butalbital-apap-caff-cod oral capsule mg, mg butalbital-apap-caffeine oral tablet mg butalbital-aspirin-caffeine oral capsule mg butorphanol tartrate injection solution 1 mg/ml, 2 mg/ml PA; QL (360 EA per 30 days); AGE (Min 16 Years) PA; QL (90 EA per 30 days); AGE (Min 16 Years) PA; QL (5 EA per 34 days) PA; QL (140 EA per 7 days) butorphanol tartrate nasal solution 10 mg/ml PA; QL (5 ML per 34 days) BUTRANS TRANSDERMAL PATCH WEEKLY 10 MCG/HR, 15 MCG/HR, 20 MCG/HR, 5 MCG/HR, 7.5 MCG/HR PA; QL (5 EA per 34 days) 23

25 butylated hydroxytoluene crystals butylparaben powder BYDUREON SUBCUTANEOUS PEN-INJECTOR 2 MG BYDUREON SUBCUTANEOUS SUSPENSION RECONSTITUTED ER 2 MG BYETTA 10 MCG PEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 10 MCG/0.04ML BYETTA 5 MCG PEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 5 MCG/0.02ML c-1500/rose hips sr oral tablet extended release 1500 mg c1500/rose hips/bioflavonoid oral tablet extended release ca phosphate dibasic dihyd powder cabergoline oral tablet 0.5 mg QL (10 EA per 34 days) cadeau dha oral capsule mg caffeine anhydrous powder caffeine citrate oral solution 20 mg/ml cal/mag oral tablet mg CALADRYL CLEAR EXTERNAL LOTION % CALADRYL EXTERNAL LOTION 1-8 % CALAGEL MAXIMUM STRENGTH EXTERNAL GEL CALAGESIC EXTERNAL LOTION 1-8 % calahist clear external lotion % calamine external lotion, 8-8 % calamine phenolated external lotion calamine powder calamine-zinc oxide external suspension 8-8 % CAL-CARB FORTE ORAL TABLET 1250 (500 CA) MG CALCET PETITES ORAL TABLET MG-UNIT CALCI-CHEW ORAL TABLET CHEWABLE 1250 (500 CA) MG calci-max oral capsule calcipotriene external cream % calcipotriene external ointment % calcipotriene external solution % calcitonin (salmon) nasal solution 200 unit/act cal-citrate oral capsule 150 mg CALCITRATE ORAL TABLET 950 MG calcitriol oral capsule 0.25 mcg, 0.5 mcg calcitriol oral solution 1 mcg/ml calcium + d3 oral tablet mg-unit calcium 1200 oral tablet chewable mg-unit calcium d3 oral tablet mg-unit calcium d oral tablet mg-unit calcium 600 oral tablet 1500 (600 ca) mg calcium 600+d3 oral tablet mg-unit 24

26 calcium 600+d3 plus minerals oral tablet mg-unit calcium acetate (phos binder) oral capsule 667 mg calcium acetate (phos binder) oral tablet 667 mg calcium acetate oral tablet 668 (169 ca) mg calcium ascorbate oral tablet 500 mg calcium ascorbate powder calcium aspartate oral tablet 75 mg calcium carbonate antacid oral tablet 648 mg calcium carbonate oral powder 800 mg/2gm calcium carbonate oral tablet 600 mg calcium carbonate powder calcium carbonate-vitamin d oral capsule mg-unit calcium carbonate-vitamin d oral tablet mg-unit calcium citrate + d3 oral tablet mg-unit calcium citrate malate-vit d oral tablet mg-unit calcium citrate oral tablet 1040 mg, 200 mg, 250 mg calcium citrate plus oral tablet calcium citrate tetrahydrate powder calcium citrate-vitamin d oral tablet mg-unit calcium citrate-vitamin d3 oral liquid calcium citrate-vitamin d3 oral tablet mg-unit calcium gluconate oral tablet 500 mg calcium gluconate powder calcium gummies oral tablet chewable mgunit calcium high potency/vitamin d oral tablet mg-unit calcium hydroxide powder calcium lactate oral tablet 100 mg, 648 mg calcium oral tablet mg-unit calcium oral tablet chewable mg-unit, mg-unit calcium oyster shell oral tablet 500 mg calcium pantothenate oral tablet 100 mg, 200 mg, 500 mg calcium pantothenate powder calcium phosphate tribasic powder calcium plus vitamin d3 oral capsule mg-unit calcium saccharate powder calcium soft chews oral tablet chewable mgunt-mcg, mg-unt-mcg calcium sulfate powder 90 % calcium-magnesium-zinc oral tablet mg calcium-vitamin d oral tablet mg-unit calcium-vitamin d3 oral tablet mg-unit calcium-vitamin d-minerals oral tablet chewable mg-unit, mg-unit 25

27 calendula external lotion calendula external ointment cal-glu oral capsule 500 mg cal-lac oral capsule 500 mg calmag thins oral tablet mg cal-mint oral tablet chewable 260 mg CALMOL-4 RECTAL SUPPOSITORY % calna oral tablet CALTRATE 600+D ORAL TABLET MG-UNIT CALTRATE 600+D PLUS MINERALS ORAL TABLET MG-UNIT CALTRATE 600+D PLUS MINERALS ORAL TABLET CHEWABLE MG-UNIT CALTRATE 600+D3 SOFT ORAL TABLET CHEWABLE MG-UNIT CALTRATE GUMMY BITES ORAL TABLET CHEWABLE MG-UNIT CALTRATE MINIS PLUS MINERALS ORAL TABLET MG-UNIT CAMILA ORAL TABLET 0.35 MG QL (28 EA per 28 days) CAMPHO-PHENIQUE EXTERNAL GEL % CAMPHO-PHENIQUE EXTERNAL LIQUID % camphor blocks gum camphor crystals camphor granules camphor spirit spirit CAMPHOTREX EXTERNAL GEL 10-4 % CAMPTOSAR INTRAVENOUS SOLUTION 300 MG/15ML CANASA RECTAL SUPPOSITORY 1000 MG candesartan cilexetil oral tablet 16 mg, 32 mg, 4 mg, 8 mg candesartan cilexetil-hctz oral tablet mg, mg CANKAID MOUTH/THROAT SOLUTION 10 % capcof oral syrup mg/5ml capecitabine oral tablet 150 mg, 500 mg PA capmist dm oral tablet mg capron dm oral liquid mg/5ml capron dmt oral tablet mg capsaicin external cream %, 0.1 % capsaicin hot patch external pad % capsaicin powder CAPSIDERM EXTERNAL PATCH % capsule 1 clear veggie capsule captopril oral tablet 100 mg, 12.5 mg, 25 mg, 50 mg CAPZASIN-HP EXTERNAL CREAM 0.1 % 26

28 CARAFATE ORAL SUSPENSION 1 GM/10ML caraway oil oil CARBAGLU ORAL TABLET 200 MG carbamazepine er oral capsule extended release 12 hour 100 mg, 200 mg, 300 mg carbamazepine er oral tablet extended release 12 hour 100 mg, 200 mg, 400 mg carbamazepine oral suspension 100 mg/5ml carbamazepine oral tablet 200 mg carbamazepine oral tablet chewable 100 mg CARBAPHEN CH ORAL SUSPENSION MG/5ML CARBAPHEN PED CH ORAL SUSPENSION MG/ML carbidopa-levodopa er oral tablet extended release mg, mg carbidopa-levodopa oral tablet mg, mg, mg carbidopa-levodopa oral tablet dispersible mg, mg, mg carbidopa-levodopa-entacapone oral tablet mg CARBOHOL 940 GEL carbopol 940 nf powder carboxymethylcellulose sodium granules carboxymethylcellulose sodium powder CARBZERO ORAL EMULSION cardamom oil CARDENZ ORAL TABLET CAREFINE PEN NEEDLES 32G X 5 MM, 32G X 6 MM careone insulin syringe 30g x 1/2" 0.3 ml 30g x 1/2" 0.3 ml careone insulin syringe 30g x 1/2" 0.5 ml 30g x 1/2" 0.5 ml careone insulin syringe 30g x 1/2" 1 ml 30g x 1/2" 1 ml careone insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml careone insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml careone insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml careone lancet thin 23g ; QL (150 EA per 30 days) careone lancet ultra thin 28g ; QL (150 EA per 30 days) CA-REZZ EXTERNAL LIQUID 0.25 % ca-rezz gentle external liquid 0.2 % ca-rezz norisc external cream 0.2 % CARNI Q-GEL FORTE ORAL CAPSULE MG CARRACOLLOID 4"X4" EXTERNAL PAD CARRASMART EXTERNAL GEL CARRASORB H EXTERNAL 27

29 CARRASYN V WOUND DRESSING EXTERNAL GEL CARRINGTON DERMAL WOUND EXTERNAL GEL carteolol hcl ophthalmic solution 1 % CARTIA XT ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG, 180 MG, 240 MG, 300 MG carvedilol oral tablet 12.5 mg, 25 mg, mg, 6.25 mg cascara sagrada oral capsule 450 mg castellani paint modified external liquid 1.5 % CASTIVA COOLING EXTERNAL LOTION 5-14 % CASTIVA WARMING EXTERNAL LOTION % castor oil oil castor oil stimulant laxative oral oil 100 % castor oil sulfated oil CATAPRES-TTS-1 TRANSDERMAL PATCH WEEKLY 0.1 MG/24HR CATAPRES-TTS-2 TRANSDERMAL PATCH WEEKLY 0.2 MG/24HR CATAPRES-TTS-3 TRANSDERMAL PATCH WEEKLY 0.3 MG/24HR CAVAREST DENTAL GEL 1.1 % CAVILON EMOLLIENT EXTERNAL CREAM CAVILON FOOT & DRY SKIN EXTERNAL CREAM CAVILON NO STING BARRIER FILM EXTERNAL LIQUID CAVILON ONE-STEP SKIN CARE EXTERNAL LOTION CAVILON SKIN CLEANSER EXTERNAL LIQUID CAZIANT ORAL TABLET 0.1/0.125/ MG QL (28 EA per 28 days) cefaclor oral capsule 250 mg, 500 mg cefaclor oral suspension reconstituted 125 mg/5ml cefadroxil oral capsule 500 mg cefadroxil oral suspension reconstituted 250 mg/5ml, 500 mg/5ml cefadroxil oral tablet 1 gm cefdinir oral capsule 300 mg cefdinir oral suspension reconstituted 125 mg/5ml, 250 mg/5ml cefixime oral suspension reconstituted 100 mg/5ml, 200 mg/5ml cefpodoxime proxetil oral suspension reconstituted 100 mg/5ml, 50 mg/5ml QL (200 ML per 34 days) cefpodoxime proxetil oral tablet 100 mg, 200 mg QL (28 EA per 34 days) cefprozil oral suspension reconstituted 125 mg/5ml, 250 mg/5ml cefprozil oral tablet 250 mg, 500 mg ceftriaxone sodium in dextrose intravenous solution 20 mg/ml, 40 mg/ml 28

30 ceftriaxone sodium injection solution reconstituted 1 gm, 2 gm, 250 mg, 500 mg ceftriaxone sodium intravenous solution reconstituted 10 gm, 2 gm ceftriaxone sodium-dextrose intravenous solution reconstituted gm-%, gm-% cefuroxime axetil oral tablet 250 mg, 500 mg CELACYN EXTERNAL GEL celecoxib oral capsule 100 mg, 200 mg, 400 mg, 50 mg ST celery seed oil cellulase powder cellulose crystals cellulose powder CELONTIN ORAL CAPSULE 300 MG CENTRATEX ORAL CAPSULE MG centravites adults oral tablet CENTRUM FLAVOR BURST DRINK ORAL PACKET CENTRUM ORAL LIQUID CENTRUM SPECIALIST PRENATAL ORAL & 200 MG CEO-TWO RECTAL SUPPOSITORY CEPACOL EXTRA STRENGTH MOUTH/THROAT LOZENGE MG CEPACOL SORE THROAT & COUGH MOUTH/THROAT LOZENGE MG CEPACOL SORE THROAT EX ST MOUTH/THROAT LOZENGE MG CEPACOL SORE THROAT MOUTH/THROAT LOZENGE MG CEPASTAT MOUTH/THROAT LOZENGE MG cephalexin oral capsule 250 mg, 500 mg cephalexin oral suspension reconstituted 125 mg/5ml, 250 mg/5ml CERACADE EMULSION EXTERNAL CERALYTE 70 ORAL PACKET CERAVE BABY EXTERNAL LOTION 1 % CERAVE ITCH RELIEF EXTERNAL CREAM 1 % CERAVE SUNSCREEN SPF50 EXTERNAL LOTION CEROVEL EXTERNAL LOTION 40 % CESIUM 1000 ORAL CAPSULE 1000 MG cesium 500 oral capsule 500 mg cesium oral tablet 100 mg CETAPHIL GENTLE CLEANSING EXTERNAL BAR cetirizine hcl oral tablet 5 mg CETRAXAL OTIC SOLUTION 0.2 % cetyl alcohol flakes 29

31 CHANTIX CONTINUING MONTH PAK ORAL TABLET 1 MG CHANTIX ORAL TABLET 0.5 MG CHANTIX STARTING MONTH PAK ORAL TABLET 0.5 MG X 11 & 1 MG X 42 CHAP-EX TROPICALS EXTERNAL STICK charcoal activated powder CHAR-FLO WITH SORBITOL ORAL SUSPENSION GM/120ML chelated calcium oral tablet 200 mg chelated magnesium oral tablet 100 mg chelated zinc oral tablet 50 mg CHEMSTRIP CALIBRATION IN VITRO STRIP CHEMSTRIP UGK IN VITRO STRIP CHENODAL ORAL TABLET 250 MG PA CHERACOL-D COUGH ORAL LIQUID MG/5ML cherry concentrate oral concentrate cherry oral syrup chest rub external ointment % CHEW Q ORAL TABLET CHEWABLE 100 MG, 30 MG, 600 MG chewable iron oral tablet chewable mg CHIGG AWAY EXTERNAL LOTION 5-10 % childrens aspirin free oral elixir 80 mg/2.5ml CHILDRENS MOTRIN ORAL SUSPENSION 100 MG/5ML childrens pain reliever oral tablet chewable 80 mg childrens plus multi-sympt cld oral suspension mg/5ml childrens silfedrine oral liquid 15 mg/5ml CHILDRENS SOOTHE ORAL TABLET CHEWABLE 400 MG chlo hist oral solution mg/5ml CHLO TUSS ORAL LIQUID MG/5ML chlophed oral liquid mg/5ml chloral hydrate crystals CHLORASEPTIC MOUTH/THROAT LOZENGE 6-10 MG chlordiazepoxide hcl oral capsule 10 mg, 5 mg QL (170 EA per 34 days) chlordiazepoxide hcl oral capsule 25 mg QL (170 EA per 30 days) chlorella oral capsule chlorhexidine gluconate cloth external pad 2 % chlorhexidine gluconate external liquid 2 %, 4 % chlorhexidine gluconate mouth/throat solution 0.12 % chloroform solution chlorophyll oral tablet mg 30

32 chloroquine phosphate oral tablet 250 mg, 500 mg chlorothiazide oral tablet 250 mg, 500 mg CHLORPHEN SR ORAL TABLET EXTENDED RELEASE 12 MG chlorpromazine hcl injection solution 25 mg/ml, 50 mg/2ml AGE (Min 18 Years) chlorpromazine hcl oral tablet 10 mg, 100 mg, 200 mg, 25 mg, 50 mg chlorpromazine hcl powder chlorthalidone oral tablet 25 mg, 50 mg CHLOR-TRIMETON ALLERGY ORAL TABLET EXTENDED RELEASE 12 MG AGE (Min 18 Years) CHLOR-TRIMETON ORAL SYRUP 2 MG/5ML CHLOR-TRIMETON ORAL TABLET 4 MG chlorzoxazone oral tablet 500 mg chocolated laxative oral tablet chewable 15 mg cholecalciferol powder cholesterol acetate powder cholesterol powder cholestyramine light oral packet 4 gm cholestyramine light oral powder 4 gm/dose cholestyramine oral packet 4 gm cholestyramine oral powder 4 gm/dose choline citrate oral tablet 650 mg choline oral capsule 648 mg choline sr oral tablet extended release 300 mg choline-mag trisalicylate oral liquid 500 mg/5ml CHONDROITIN SULFATE COMPLEX ORAL CAPSULE MG CHROMACAPS ORAL CAPSULE 1 MG chromium aspartate oral tablet 1000 mcg chromium gtf oral tablet 200 mcg chromium oral tablet 1000 mcg, 400 mcg chromium picolate oral tablet 1000 mcg chromium picolinate oral capsule 200 mcg chromium picolinate oral tablet 200 mcg, 400 mcg chromium picolinate powder chrysin powder CICLODAN EXTERNAL CREAM 0.77 % ciclopirox external gel 0.77 % ciclopirox external shampoo 1 % ciclopirox external solution 8 % ciclopirox olamine external suspension 0.77 % ciclopirox treatment external kit 8 % cilostazol oral tablet 100 mg, 50 mg cimetidine oral tablet 300 mg, 400 mg, 800 mg 31