Plan FIDA VillageCareMAX Full Advantage (Plan Medicare-Medicaid)

Transcription

1 H9345_MBR17_03h Approved Plan FIDA VillageCareMAX Full Advantage (Plan Medicare-Medicaid) Lis Medikaman Ki Kouvri 2017 (Fòmilè) Yo te mete fòmilè sa a ajou nan 04/2017. Pou enfòmasyon ki pi resan oswa lòt kesyon, tanpri kontakte Plan FIDA VillageCareMAX Full Advantage nan , oswa 711 pou itilizatè ATS yo, a 8:00am jiska 8:00pm, 7 jou pà semèn, oswa vizite Formulary ID: , Version 11

2 Plan FIDA VillageCareMAX Full Advantage Lismedikamanki kouvri (Fòmilè) 2017 Lis sa a se yon lis medikaman ke pàtisipan yo ka jwenn nan Plan FIDA VillageCareMAX Full Advantage. Plan FIDA VillageCareMAX Full Advantage se yon plan jesyon swen ki te pase kontra avèk konpayi Medicare ak New York State Department of Health (Medicaid)pou l bay patisipan yo benefistoude pwogram sa yoatravè demonstrasyonfully Integrated Duals Advantage (FIDA).Pwogram sa a se pou moun ki gen toude Medicare ak Medicaid e ki ranpli lòt kondisyon kalifikasyon pou demonstrasyon FIDA Lis Medikaman ki Kouvri yo ak/oswa famasi ak rezo founisè yo ka chanje tanzantan pandan ane a. Nap voye yon avi avan nou fè yon chanjman ka p afekte w. Benefis yo kapab chanje nandat 1e Janviye chak ane. Ou ka toujou verifye lis medikamanki ajou ki kouvri yo nan planvillagecaremax Full Advantage FIDA sou entènèt nanwww.villagecaremax.org osinon rele sèvis pàtisipan pou plan FIDA VillageCareMAX Full Advantage nan Yo gen dwa aplike limitasyon ak restrikyon.pou plis enfòmasyon, rele sèvis pàtisipan pou plan FIDA VillageCareMAX Full Advantage oswa limanyèl pàtisipan pou plan FIDA VillageCareMAX Full Advantage la. Pa gen okenn ko-peman pou tout medikaman ki kouvri yo. Ou ka jwenn enfòmasyon sa a gratis nan lòt fòma, tankou gwo karaktè, Bray oswa odyo. Rele nan pandan lè 8:00am jiska 8:00pm. Itilizatè TTY yo dwe rele nimweo 711.Apèl sa a gratis. Diskriminasyon se kont lalwa. ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call (TTY: 711). ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY: 711). 注意 : 如果您使用繁體中文, 您可以免費獲得語言援助服務 請致電 (TTY: 711) 주의 : 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다 (TTY: 711) 번으로전화해주십시오. Si ou gen kesyon, tanpri rele Plan FIDAVillageCareMAXFullAdvantagenan ,8:00nan20:00,7jou pà semèn.apèl sa a se gratis.itilizatè ATS ta dwe rele 711. Pou plis ii? enfòmasyon,vizite

3 ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (телетайп: 711). ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero (TTY: 711) ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele (TTY: 711). Lè ou enskri, nou pral mande ou nan k ilang ou pito resevwa kominikasyon ak enfòmasyon yo voye pa lapòs. Nou pral kenbe preferans ou nan yon dosye epi ou mèt chanje lang ou prefere a lè ou kontakte Sèvis Patisipan nou nan nimewo pandan èdtan 8è di maten ak 8è di swa, 7 jou pa semèn. Itilizatè TTY yo dwe rele 711. Koutfil la gratis. Eta Nouyòk kreye yon pwogramenvestigasyon poupatisipan ki rele (Rezo Pwomosyon Konsomatè Endepandan)Independent Consumer Advocacy Network(ICAN) pou bay pàtisipan yo asistans konfidansyèl gratis sou nenpòt sèvis Plan FIDAVillageCareMAX Full Advantage ofri.ou kapab kontakte ICAN nan nimewo sa a gratis oubyen sou entènèt nan (Itilizatè TTY yo dwe rele 711, epi lè sa a swiv èd memwa yo pou pase )? Si ou gen kesyon, tanpri rele Plan FIDAVillageCareMAXFullAdvantagenan ,8:00nan20:00,7jou pà semèn.apèl sa a se gratis.itilizatè ATS ta dwe rele 711. Pou plis enfòmasyon,vizite iii

4 Kesyon yo poze souvan (FAQ) Wa p Jwenn isit la repons pou kesyon ou genyen yo konsènan lismedikaman ki kouvri yo. Ou kapab li tout FAQ (kesyon yo poze souvan yo) pou w jwenn plis enfòmasyon oswa gade yon kesyon ak repons li. 1. Ki medikaman sou preskripsyon ki sou lis medikaman yo kouvri yo? (Nou rele Lis Medikaman ki Kouvri a Lis Medikaman pou pi kout.) Medikaman ki sou Lis Medikaman ki kouvri ki nan 1e paj la se mekikaman Plan FIDAVillageCareMAX Full Advantage kouvri. Medikaman sa yo disponib nan famasi ki nan rezo nou an. Yon famasi ap nan rezo nou si nou gen akò avèk li poultravay avèk nou ak pou ba w sèvis.nou rele famasi sa yo famasi rezo. Plan FIDA VillageCareMAX Full Advantage ap kouvri tout medikaman ki sou lis medikaman an si: Doktè w oswa lòt moun ki preskri w di ke ou bezwen yo pou w geri oswa pou w rete an sante Medikaman an nesesè pou kondisyon w, epi Ou rampli preskripsyon wnan yon fàmasi rezo ki fè pati Plan FIDA VillageCareMAX Full Advantage. Plan FIDAVillageCareMAX Full Advantage ka gen etap siplemantè pou w jwenn aksè nan sèten medikaman(gade nan #5 anba a).nan sèten ka, ou ka bezwen fè yon bagay avan pou w jwenn yon medikaman, tankou eseye lòt medikaman avan. Ou kapab wè tou yon lis medikaman ki ajou nou kouvri sou sit entènet nou nanwww.villagecaremax.org ou rele sèvis patisipan nan (TTY: 711). 2. Eske lismedikaman an ka chanje pafwa? Wi. Plan FIDA VillageCareMAX Full Advantage ka ajoute oubyen retire medikaman nan lis medikaman an pandan ane a. Jeneralman, lis medikaman an pral chanje sèlman si: Si gen yon nouvo medikaman ki travay menm jan avèk youn ki nan lis medikaman an,oswa Nou aprann ke yon medikaman danjere. Nouka chanje règ nou yo sou medikaman. Pa egzanp, nou ka:? Si ou gen kesyon, tanpri rele Plan FIDAVillageCareMAXFullAdvantagenan ,8:00nan20:00,7jou pà semèn.apèl sa a se gratis.itilizatè ATS ta dwe rele 711. Pou plis enfòmasyon,vizite iv

5 Deside pou n mande oswa pa mande apwobasyon davans pou yon medikaman. (Apwobasyon davans se yon pèmisyon nan men Plan FIDA VillageCareMAX Full Advantage oswa (Ekip Entèdisiplinè w) Interdisiplinary Team (IDT) avan ou ka jwenn yon medikaman.) Ajoute oswa chanje kantite medikaman ou ka genyen (ki rele limit kantite ). Ajoute ou chanje restriksyon etap terapi nan yon medikaman. (Etap terapi vle di ou dwe eseye yon medikaman avan pou nou kouvri yon lòt medikaman.) (Pou plis enfòmasyon sou règ medikaman sa yo, gade nan pajvi.) Nou pra di w lè yon medikaman wa p pran soti nan lis medikaman an. Nou pral di w tou lè nou chanje règ kouvèti sou yonmedikaman. Kesyon 3, 4 ak 7 anba a gen plis enfòmasyon sou sak pase lè lis medikaman la chanje. Ou ka toujou tcheke lis medikaman ki ajou Plan FIDA VillageCareMAX Full Advantage lasou entènet nan Ou ka rele sèvis patisipan tou pou w verifye lis medikaman aktyèl la nan Itilizatè ATS yo dwe rele Sak pase lè yon medikaman ki pi bon mache travaymenm jan ak yon medikaman ki deja sou lismedikaman an? Si yon medikaman ki pi bon mache vin disponib e ki travay menm jan ak yon medikaman kideja sou lis medikaman an: Famasyen w kapab ba w medikaman sa apwochen fwa wa p rampli preskripsyon w. Si ou menm ak fournisè w deside ke medikaman ki pi bon mache a pa pi bon pou ou, founisè w ka di famasyen w pou l kontinye ba w medikaman wa p pran kounye a. Plan FIDA VillageCareMAX Full Advantage ka deside pou l retire medikaman ki pi chèa sou lis medikaman an. Si wa p pran yon medikaman nou retire sou lis medikaman an paske yon medikaman ki pi bon mache parèt e ki travay menm jan, na p fè w konnen omwen 60 jou avan nou retire l sou lis medikaman anoubyen lèwa p renouvle preskripsyon w.lè sa a ou ka jwenn yon rezèv 60 jou pou medikaman sa a avannou fè chanjman an nan lis medikaman.plan FIDA VillageCareMAX Full Advantage ap voye yon lèt ba ou lè wa p pran yon medikaman ki soti nan lis medikaman an. Sit entènet nou an gen enfòmasyon pi ajou apwopo lismedikaman nou an.ou ka toujou tchekewww.villagecaremax.org oubyen rele sèvis patisipan an si ou gen kesyon.nimewo telefon nou se Itilizatè ATS dwe rele 711. Nou ouvri 7 jou pà semenn sòti nan 8:00am pou rive 8:00pm. Si ou gen kesyon, tanpri rele Plan FIDAVillageCareMAXFullAdvantagenan ,8:00nan20:00,7jou pà semèn.apèl sa a se gratis.itilizatè ATS ta dwe rele 711. Pou plis v? enfòmasyon,vizite

6 4. Sak pase lè nou dekouvri ke yon medikaman danjere? Si (Administrasyon Medikaman ak Manje) Food and Drug Administration (FDA)a di ke yon medikaman wa p pran danjere, nou pral retire l nan lis medikaman an touswit. Nou pral voye yon lèt ba ou epi rele w nan telefòn pou di w ke medikaman danjere a soti nan lis la. Tanpri pale ak doktè w si wa p pran yon medikaman FDAdetèmine ki danjere.dokte w ka preskri yon medikaman lòt pou ranplace medikaman ki pa disponib la. 5. Eske gen restriksyon oubyen limit nan kouvèti medikaman? Osinon èske gen aksyon obligatwa ki dwè fèt pou w jwenn sèten medikaman? Wi, sèten medikaman gen règ sou kouvèti oswa gen limit sou kantite ou ka jwenn. Nan sèten ka, ou menm oswa doktè w oswa lòt moun ki preskri w dwe fè yon bagay avan pou w jwenn medikaman sa a.pà egzanp: Apwobasyon davans(oubyen otorizasyon davans):pou sèten medikaman, ou menm, doktè w oswa lòt moun ki preskri w dwe gen apwobasyon Plan FIDA VillageCareMAX Full Advantage oubyen (Ekip Entèdisiplinè) Interdisciplinary Team (IDT)w avan ou ka rampli preskripsyon w. Si ou pa jwenn apwobasyon, Plan FIDA VillageCareMAX Full Advantage gen dwa pa kouvrimedikamansa a. Limit kantite:pafwa Plan FIDA VillageCareMAX Full Advantage limite kantite medikaman ou ka jwenn. Etap terapi:pafwaplan FIDA VillageCareMAX Full Advantage mande pou w fè terapi etap. Sa vle di ou pral gen pou w esaye medikaman nan sètenlòd pou kondisyon medikal ou.ou ka gen pou w esaye yon medikaman avan pou nou kouvri yon lòt. Si doktè w panse ke premye medikaman pa mache pou ou, alò nou pral kouvri dezyèm lan. Ou ka dekouvi si medikaman w gen egzijans siplemantè oswa limit si ou gade nan endèks nan paj1. Ou ka jwenn plis enfòmasyon tou si ou vizite sit entènet nou nannou afiche sou entènet la dokiman ki eksplike otorizasyon davans nou ak restriksyon etap terapi.ou ka mande tou pou nou voye yon kopi ba ou. Ou ka mande yon egzanpsyon pou limit sa yo.tanpri gade kesyon 11 pou plis enfòmasyon sou egzanpsyon. Si ou nan yon mezon retret oubyen nan yon etablisman swen alontèm epi ou bezwen yon medikaman ki pa sou lis medikamanan, oswa si ou pa ka jwennmedikaman ou bezwen fasil, nou ka ede w.nou pral kouvwi yon stok medikaman ijans ou bezwen an pou 31 jou (eksepte si ou gen preskripsyon pou mwens jou), menm si ou se yon nouvo patisipan ou non nan plan FIDA VillageCareMAX Full Advantage.Sa pral ba w tan pou w pale ak doktè w oswa lòt Si ou gen kesyon, tanpri rele Plan FIDAVillageCareMAXFullAdvantagenan ,8:00nan20:00,7jou pà semèn.apèl sa a se gratis.itilizatè ATS ta dwe rele 711. Pou plis vi? enfòmasyon,vizite

7 moun ki preskri w. Li ka ede w deside si gen yon medikaman similè sou lis medikamanan ou ka pran pito oubyen si li nesesè pou w mande yon ekzanpsyon. Tanpri gade nan kesyon 11 la pou plis enfòmasyon sou ekzanpsyon. 6. Kijan wa p konnen si medikaman ou bezwwn an gen limitasyon oubyen si gen aksyon obligatwa pou w pran pou w jwenn medikaman an? Lis Medikamanki Kouvri nan paj 1 an gen yon ribrik ki make Aksyon obligatwa, restriksyon oswa limit sou itilizasyon. 7. Saka p rive si nou chanje règ nou yo sou fason nou kouvri medikaman yo? Pà egzanp, si nou ajoute apwobasyon davans(apwouve), limit kantite ak/oswarestriksyon etap terapi sou yon medikaman. Nou pral di w si nou ajoute apwobasyon davans, limit kantite ak/oswa restriksyon etap terapi sou yon medikaman. Na p fè w konnen omwen 60 jou avan nou ajoute restriksyon sa yo oswa lè ou pra l renouvle preskripsyon w.kidonk, ou ka jwenn yon rezèv medikamanpou 60 jou avan nou fè chanjman an nan lismedikaman an.saap ba w tan pou w pale avèk doktè w oswa lot moun ki preskri w konsènan kisa pou w fè nan lavni. 8. Kouman ou ka jwenn yon medikamannan lis medikamanan? Gen de fason pou w jwenn yon medikaman: Ou ka chèche pà lòd alfabetik (si ou kon òtografmedikaman sa a), osinon Ou ka chèche pa kondisyon medikal. Pou w chèche alfabetikman, ale nan pati lis alfabetik nan paj I-1.Epi chèche non medikamanan nan lis sa a. Pou w chèche pakondisyon medikal, chache seksyon ki make lis medikaman pa kondisyon medikal nan paj 1.Medikaman yo nan seksyon sa a gwoupe pa kategori depann de kondisyon medikal yo trete a. Pà egzanp, si ou gen yon kondisyon kadyak, oudwe chèche nan kategori, ajan kadyovaskilè a. Se kote sa a ou pral jwenn medikaman ki trete kondisyon kadyak. 9. Sa ka p pase si medikaman ou vle pran an pa sou lis medikamanan? Si ou pa wè medikaman w sou lis medikamanan, rele sèvis patisitan nan epi mande pou li. Itilizatè ATS dwe rele 711.Si ou aprann ke Plan FIDA VillageCareMAX Full Advantage pa kouvri medikaman sa a, ou ka fè youn nan bagay sa yo: Si ou gen kesyon, tanpri rele Plan FIDAVillageCareMAXFullAdvantagenan ,8:00nan20:00,7jou pà semèn.apèl sa a se gratis.itilizatè ATS ta dwe rele 711. Pou plis vii? enfòmasyon,vizite

8 Mande sèvis patisipan pou yon lismedikamantankou sa ou vle pran an. Epi montre doktè w ak lòt moun ki preskri w lis la. Li ka preskri w yon medikamannan lis medikamanan ki menm jan avèkmedikaman ou vle pran an. Oswa Ou ka mande plan (Ekip Entèdisiplinè)Interdisiplinary Team (IDT) pou fè yon egzanpsyon pou kouvri medikaman w. Tanpri gade nan kesyon 11 pou plis enfomasyon sou egzanpsyon. 10. E si ou se yon nouvo patisipan nan plan FIDA VillageCareMAX Full Advantage epi ou pa ka jwenn medikaman w sou lis medikaman an oubyen ou gen pwoblèm pou w jwennmedikaman w? Nou kapab ede. Nou dwè kouvri yon apwovizyònman medikaman tamporè pou jiska 90 jou, si li nesesè, pandan 90 jou ou patisipan nan Plan FIDAVillageCareMAX Full Advantage la.sa pral ba w tan pou wpale ak doktè w oswa lòt moun ki preskri w. Li ka ede w deside si gen yon medikamanki menm jan nan lis medikaman an ou ka pran olye pou w mande yon egzanpsyon. Na p kouvri yon apwovizyònman medikaman tamporè w jiska 90 jou pou si: Wa p pran yon medikaman ki pa sou lis medikaman nou an, oswa Règ plan sante w pa kite jwenn kantite medikaman yo preskri w, oswa Medikaman an bezwen yon apwobasyon davansnan plan FIDA VillageCareMAX Full Advantage oswa (Ekip Entèdisiplinè) Interdisiplinary Team (IDT)w, oswa Wa p pran yon medikaman ki fè pati de yon restriksyon etap terapi. Si ou rete nan yon mezon retrèt oswa nan yon lòt etablisman alontèm, ou ka rampli preskripsyon w pou jiska 98 jou. Ou ka renouvlemedikamananplizyè fwa pandan premye 90 jou ou nan plan an. Sa baymoun ki preskri w yo tan pou chanje medikaman w pou medikamanki sou lis medikaman an oswa pou w mande yon egzanpsyon. Plan FIDA VillageCareMAX Full Advantage gen yon pwosesis tranzisyon epili asire kouvètimedikamanpou nouvo manm ak manm ki nan seksyon D aktyèl yo.pafwa ou ka gen yon chanjman nan nivo swen w, tankouyon konje oswa admisyon nan yon mezon swen alontèm oswa nan yon lopital. Nan ka sa yo, Plan FIDAVillageCareMAX Full Advantage pral ba w yon sèl apwovizyònman medikaman ijans ki pa nan fòmilè a. Medikamanki panan fòmilè a gen ladann toude medikaman seksyon D ki pa nan plan fòmilè aak Medikaman nan Seksyon D ki nan fòmilè a men ki bezwen apwobasyon davans oubyen etap terapi daprè règ jesyon plan itilizasyon.tanpri rele sèvis patisipan si ou gen kesyon. Ou ka rele a 8:00am jiska 8:00pm, 7 jou pà semèn. Itilizatè ATS yo dwe rele 711. Si ou gen kesyon, tanpri rele Plan FIDAVillageCareMAXFullAdvantagenan ,8:00nan20:00,7jou pà semèn.apèl sa a se gratis.itilizatè ATS ta dwe rele 711. Pou plis viii? enfòmasyon,vizite

9 11. Eske ou ka mande yon egzanpsyon pou w kouvri medikaman w? Wi. Ou ka mande Plan FIDA VillageCareMAX Full Advantage oswa (Ekip Entèdisiplinè) Interdisiplinary Team (IDT) w pou l fè yon egzanpsyon pou kouvri yon medikaman ki pa sou lis medikamanan. Ou ka tou mande Plan FIDA VillageCareMAX Full Advantage oswa IDT w pou chanje règ medikaman w. Pa egzanp, Plan FIDA VillageCareMAX Full Advantage ka limite kantite yon medikaman nou ka kouvri. Si medikaman w gen yon limit, ou ka mande nou oswaidt w pou chanje limit la epi kouvri plis. Lòt egzanp: Ou ka mande nou oswa IDT w pou retire restriksyon etap terapi oswa bezwen apwobasyon davans yo. 12. Konbyen tan sa pran pou w jwenn yon apwobasyon? Premyèman, Plan FIDA VillageCareMAX Full Advantage oubyen (Ekip Entèdisiplinè) Interdisiplinary Team (IDT) w dwe resevwa yon deklarasyon ki soti nan men moun ki preskri w ki sipòte demann pou w gen yon egzanpsyon.apre nou fin resevwa deklarasyon sa a, wa p resevwa yon desizyon sou demann egzanpsyon an nan espas 72 èdtan. Si ou menm oswa preskriptè w panse ke sante w ka petèt nan danje si ou rete tann pou 72 èdtan pou yon desizyon, ou ka mande pou yon egzanpsyon akselere. Sa se yon desizyon ki pi rapid. Si moun ki preskri w la sipòte demann ou, ou pral resevwa yon desizyon nan 24 èdtan apre nou resevwa deklarasyon sipòki soti nan men moun ki preskri w la. 13. Kouman ou ka mande yon egzanpsyon? Pou w mande pou yon egzanpsyon, rele Manadjè Swen w. Manadjè Swen w pra l travay avèk ou ansanm avèk founisè w pou l ede w mande yon egzanpsyon. 14. Kisa medikaman jenerik ye? Medikaman Jjenerik fèt ak menm engredyan ak medikaman mak yo. Yo dabitid koute mwen chè pasemedikaman mak yo epi yo pa gen non ki rekoni. Medikaman jenerik aprouve pa Food and Drug Administration (FDA). Plan FIDA VillageCareMAX Full Advantage kouvri medikaman makakmedikaman jenerik. Si ou gen kesyon, tanpri rele Plan FIDAVillageCareMAXFullAdvantagenan ,8:00nan20:00,7jou pà semèn.apèl sa a se gratis.itilizatè ATS ta dwe rele 711. Pou plis ix? enfòmasyon,vizite

10 15. Kisa Medikaman OTC ye? OTCvle di Over the Counter - Medikaman ki Vann San Preskripsyon. Plan FIDA VillageCareMAX Full Advantage kouvri kèk medikamanotc lè founisè w preskri yo. Ou ka li nan Lis medikaman nan plan FIDA VillageCareMAX Full Advantage pou wè w ki medikaman OTC ki kouvri. MedikamanOTCyo nan ranje Eske Plan FIDA VillageCareMAX Full Advantage kouvri pwodwi OTC ki pamedikaman? Plan FIDA VillageCareMAX Full Advantage kouvri kèk pwodwi OTC ki pa medikaman lè yo ekri tankou yon preskripsyon pa founisè w. Egzanp yo enkli: Ekipman OTC pou dyabèt tankou twal gaz, twal abaz alkol, sereng pou ensilin epi zegwi. Ou ka gade nan lis medikamannan Plan FIDAVillageCareMAX Full Advantage pou w wè ki medikaman ki kouvri. Ou ka li lis medikaman nan Plan FIDAVillageCareMAX Full Advantage pou w wè ki pwodwi OTC ki pa medikaman ki kouvri. 17. Kisa kopeman an ye? Nou pa pmande w yon kopeman pou medikamanki sou lis medikamanan. 18. Kisa nivo medikaman an ye? Nan fòmilè pou Plan FIDA VillageCareMAX Full Advantage,wa p wè 4 nivo medikamanki enkli nan lis fòmilè a. Medikaman nan nivo 1 se medikaman jenerik Medicare kouvri Medikaman nan nivo 2 se medikaman mak epi medikamanespesyal Medicare kouvri Medikaman nan nivo 3 se medikamanjenerik ki pa nan seskyon D epi medikaman mak Medicaid kouvri Medikaman nivo 4 se medikaman nan vant lib (OCT) Medicaid kouvri Kòm yon manm nan plan nou, w ap paye $0 kopeman pou medikaman nan nenpòt nan 4 nivo sa yo. Si ou gen kesyon, tanpri rele Plan FIDAVillageCareMAXFullAdvantagenan ,8:00nan20:00,7jou pà semèn.apèl sa a se gratis.itilizatè ATS ta dwe rele 711. Pou plis x? enfòmasyon,vizite

11 Lis medikaman ki kouvri yo Lis medikaman ki kouvri anba a ki kòmanse nan paj 1 bay w enfòmasyon sou medikaman ki kouvri nan Plan FIDA VillageCareMAX Full Advantage.Si ou gen pwoblèm pou w jwenn medikaman w nan lis la, tounen nan endeks ki komanseanba a nan paji-1. Premye ribrik tablo a afiche non medikaman an.medikaman mak yo ekri an majiskil (pa egzanp, LIPITOR epi medikaman jenerik yo ekri an italik ak lèt miniskil (egzanp, ibuprofen). Enfòmasyon nan ribrik aksyon nesesè, restriksyon oswa limit izajyo di w si Plan FIDAVillageCareMAX Full Advantage gen règ pou kouvri medikaman w. PA Si ou gen kesyon, tanpri rele Plan FIDAVillageCareMAXFullAdvantagenan ,8:00nan20:00,7jou pà semèn.apèl sa a se gratis.itilizatè ATS ta dwe rele 711. Pou plis xi? enfòmasyon,vizite PA- HRM ABREVYASYON DESKRIPSYON EKSPLIKASYON Restriksyon OtorizasyonDavans Restriksyon Apwobasyon Davans pou detèminasyon Seksyon B kont Seksyon D Restriksyon OtorizasyonDavans pou medikaman ki gen Gwo Risk Restriksyon Jesyon Itilizasyon Ou menm (oubyen doktè w) oblije gen otorizasyon davansnan Plan FIDA VillageCareMAX Full Advantage avan ou rampli preskripsyon pou medikaman sa a. San apwobasyon davans, Plan FIDAVillageCareMAX Full Advantage gen dwa pa kouvri medikaman sa a. Medikaman sa a petèt ka kalifye pou peman anba Medicare Seksyon B ou D. Ou menm (oswa doktè w) dwe gen otorizasyon davansnan Plan FIDA VillageCareMAX Full Advantage pou detèmine si medikaman sa a kouvri anba Medicare Seksyon D ou B avan ou esaye rampli preskipsyon w pou medikaman sa a. San otorizasyon davans, Plan FIDA VillageCareMAX Full Advantage gen dwapa kouvri medikaman sa a. CMS jije ke medikaman sa a ka danjere e poutèt sa li se yon medikaman ki gen Gwo Risk pou benefisyè Medicaire ki gen 65 ane oswa pi gran yo. Patisipan ki gen 65 ane oswa ki pi gran yo dwe jwenn otorizasyon davans nan Plan FIDA VillageCareMAX Full Advantage avan pou yo rampli preskipsyon pou medikamansa a. San otorizasyon sa a, Plan FIDA VillageCareMAX Full Advantage gen dwa pa kouvri medikaman sa a. PA NSO Restriksyon Otorizasyon Davans pou Nouvo Patisipan Sèlman Si ou se yon nouvo patisipan oswa si ou poko pran medikaman sa a, ou menm (oswa doktè w) oblije gen otorizasyon davans nan VillageCareMAX Full Advantage FIDA Plan Avan ou ranpli preskripsyon pou medikaman sa a. San apwobasyon davans, Plan VillageCareMAX Full Advantage FIDA gen dwa pa kouvri medikaman sa a.

12 QL ST Restriksyon Limit Kantite Restriksyon Etap Terapi Plan FIDA VillageCareMAX Full Advantage limite kantite nan medikaman sa a ki kouvri pa preskripsyon, oswa nan yon peryòd tan espesifik. Avan Plan FIDA VillageCareMAX Full Advantage ka founi kouvèti pou medikaman sa a, ou dwè esaye lòt medikamanpou trrete kondisyon medikal ou avan. Medikamansa a ka kouvri sèlman si lot medikaman an pa mache pou ou. Lòt Kondisyon Espesyal pou Kouvèti LA NM Medikaman ki gen Aksè Limite Medikaman sa a ka petèt disponib sèlman nan sèten famasi. Pou plis enfòmasyon, konsilte anèks famasi w oswa rele Sèvis Patisipan nan , 8:00 am to 8:00 pm, 7 jou pa semèm. Itilizatè ATS yo dwe rele 711. Medikaman ki pa nan Lòd Lapòs Sa a se pa yon medikaman ki nan seksyon D Ou kaanmezi pou w resevwa plis pase 1 mwa rezèv nan pi fò nan medikaman ki nan fòmilè w la pa lapòs pou yon pri redwi pataje. Medikaman ki pa disponib pa lapòs yonote nan NM nan kolòn Limit/Kondisyon nan fòmilè w la Sa a se pa yon medikaman kinan seksyon D, oswayon medikaman oswa yon pwodwi OTC. Remak: bò kote yon medikaman vle di ke medikaman an pa yon medikaman ki nan "Seksyon D" e li enkli nan ranje 3 ak 4. Medikaman sa yo gen diferan règ pou fè apèl. Yon apèl se yon fason fòmèl pou mande yon revizyon oswa yon chanjman konsènan desizyon kouvèti si ou panse ke te gen yon erè. Pa egzanp, Plan FIDA VillageCareMAX Full Advantage ak (Ekip Entèdisiplinè)Interdisiplinary Team (IDT) w ka deside ke yon medikaman ou bezwen pa kouvri epi Medicare ak Medicaid pa kouvri medikaman sa a ankò. Si ou menm oswa doktè oswa lòt moun ki preskri w pa dakò avèk desizyon sa a, ou gen dwa fè apèl. Pou w mande enstriksyon sou kijan pou w fè apèl, rele sèvis patisipan an nan oswa (Rezo Defans Dwa Konsomatè Endepandan) Independent Consumer Advocacy Network (ICAN) nan (Itilizatè TTY yo Si ou gen kesyon, tanpri rele Plan FIDAVillageCareMAXFullAdvantagenan ,8:00nan20:00,7jou pà semèn.apèl sa a se gratis.itilizatè ATS ta dwe rele 711. Pou plis xii? enfòmasyon,vizite

13 dwe rele 711, epi lè sa a swic èd memwa yo pou pase ) Ou kapab li manyèl patisipan an tou pou w konnen kijan pou w fè apèl kont yon desizyon. Lis Medikaman pa Kondisyon Medikal Medikaman ki nan seksyon sa a gwoupe pa kategori depann de kalite kondisyon medikal yo trete. Pa egzanp, si ou gen yon maladi kè, ou dwe gade nan kategori ajan kadyovaskilè. Se la wa p jwenn medikaman ka p trete maladi kè. Si ou gen kesyon, tanpri rele Plan FIDAVillageCareMAXFullAdvantagenan ,8:00nan20:00,7jou pà semèn.apèl sa a se gratis.itilizatè ATS ta dwe rele 711. Pou plis xiii? enfòmasyon,vizite

14

15 Table of Contents Analgesics... 3 Anesthetics Anti-Addiction/Substance Abuse Treatment Agents Antianxiety Agents Antibacterials Anticancer Agents Anticholinergic Agents Anticonvulsants Antidementia Agents Antidepressants Antidiabetic Agents Antifungals Antigout Agents Antihistamines Anti-Infectives (Skin And Mucous Membrane) Antimigraine Agents Antimycobacterials Antinausea Agents Antiparasite Agents Antiparkinsonian Agents Antipsychotic Agents Antivirals (Systemic) Blood Products/Modifiers/Volume Expanders

16 Caloric Agents Cardiovascular Agents Central Nervous System Agents Contraceptives Cough And Cold Products Dental And Oral Agents Dermatological Agents Devices Disinfectants (For Non-Dermatologic Use) Enzyme Replacement/Modifiers Eye, Ear, Nose, Throat Agents Gastrointestinal Agents Genitourinary Agents Heavy Metal Antagonists Hormonal Agents, Stimulant/Replacement/Modifying Immunological Agents Inflammatory Bowel Disease Agents Irrigating Solutions Metabolic Bone Disease Agents Miscellaneous Therapeutic Agents Ophthalmic Agents Replacement Preparations Respiratory Tract Agents Skeletal Muscle Relaxants Sleep Disorder Agents Vasodilating Agents Vitamins And Minerals

17 Analgesics Analgesics, Miscellaneous acephen 120 mg suppository outer 120 mg acephen 325 mg suppository outer 325 mg acephen 650 mg suppository outer 650 mg acetaminophen 120 mg suppos outer 120 mg acetaminophen 160 mg/5 ml elx 160 mg/5 ml acetaminophen 325 mg liqui-gel 325 mg acetaminophen 650 mg suppos 650 mg acetaminophen 80 mg rapid tab children's 80 mg acetaminophen-codeine oral solution mg/5 ml acetaminophen-codeine oral tablet mg acetaminophen-codeine oral tablet mg acetaminophen-codeine oral tablet mg ALLZITAL ORAL TABLET MG ascomp with codeine oral capsule mg BELBUCA BUCCAL FILM 150 MCG, 300 MCG, 450 MCG, 600 MCG, 75 MCG, 750 MCG, 900 MCG buprenorphine hcl injection solution 0.3 mg/ml (Non-Aspirin Child) (Non-Aspirin) (Pain Relief) (Acephen) (Children's Acetaminophen) (Tylenol-Codeine #3) (Tylenol-Codeine #4) (Buprenex) ; QL (30 per 30 ; QL (30 per 30 ; QL (30 per 30 ; QL (30 per 30 ; QL (240 per 30 ; QL (360 per 30 ; QL (30 per 30 ; QL (30 per 30 QL (2700 per 30 QL (360 per 30 QL (360 per 30 QL (180 per 30 PA-HRM; QL (360 per 30 ; AGE (Max 64 Years) PA-HRM; QL (180 per 30 ; AGE (Max 64 Years) QL (60 per 30 3

18 buprenorphine hcl injection syringe 0.3 mg/ml butalbital compound w/codeine oral capsule mg butalbital-acetaminop-caf-cod oral capsule mg butalbital-acetaminop-caf-cod oral capsule mg butalbital-acetaminophen oral tablet mg butalbital-acetaminophen-caff oral capsule mg butalbital-acetaminophen-caff oral tablet mg butalbital-aspirin-caffeine oral capsule mg BUTRANS TRANSDERMAL PATCH WEEKLY 10 MCG/HOUR, 15 MCG/HOUR, 20 MCG/HOUR, 5 MCG/HOUR, 7.5 MCG/HOUR (Fioricet with Codeine) (Tencon) (Zebutal) (Esgic) (Fiorinal) capacet oral capsule mg child non-aspirin 160 mg/5 ml children's 160 mg/5 ml child pain-fever 160 mg/5 ml a/f, asa/f, ibu/f 160 mg/5 ml child tactinal 80 mg tab chw 80 mg children's mapap 80 mg rapid 80 mg 4 PA-HRM; QL (180 per 30 ; AGE (Max 64 Years) PA-HRM; QL (180 per 30 ; AGE (Max 64 Years) PA-HRM; QL (180 per 30 ; AGE (Max 64 Years) PA-HRM; QL (180 per 30 ; AGE (Max 64 Years) PA-HRM; QL (180 per 30 ; AGE (Max 64 Years) PA-HRM; QL (180 per 30 ; AGE (Max 64 Years) PA-HRM; QL (180 per 30 ; AGE (Max 64 Years) QL (4 per 28 PA-HRM; QL (180 per 30 ; AGE (Max 64 Years) ; QL (240 per 30 ; QL (240 per 30 ; QL (30 per 30 ; QL (30 per 30

19 codeine sulfate oral tablet 15 mg, 30 QL (180 per 30 mg, 60 mg cvs acetaminophen 8-hr 650 mg ; QL (180 per 30 (Pain Relief) caplet 650 mg cvs child non-asa 80 mg tb chw 80 ; QL (30 per 30 mg cvs non-aspirin jr tab chew 160 mg ; QL (30 per 30 cvs pain relief 325 mg liq gel 325 ; QL (360 per 30 mg cvs pain relief adult liquid 500 ; QL (120 per 30 mg/15 ml endocet oral tablet mg QL (240 per 30 endocet oral tablet mg, 5- QL (360 per mg endocet oral tablet mg QL (300 per 30 endodan oral tablet mg QL (360 per 30 fentanyl citrate buccal lozenge on a handle 1,200 mcg, 1,600 mcg, 200 (Actiq) PA; QL (120 per 30 mcg, 400 mcg, 600 mcg, 800 mcg fentanyl transdermal patch 72 hour QL (10 per mcg/hr, 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr (Duragesic) fentanyl transdermal patch 72 hour 37.5 mcg/hour, 62.5 mcg/hour, 87.5 mcg/hour QL (10 per 30 feverall 120 mg suppository ; QL (30 per 30 children's, outer 120 mg feverall 325 mg suppository junior ; QL (30 per 30 str, outer 325 mg feverall 650 mg suppository adult, ; QL (30 per 30 inner 650 mg hydrocodone-acetaminophen oral QL (2700 per 30 solution mg/15 ml(15 ml), mg/5 ml hydrocodone-acetaminophen oral QL (2700 per 30 (Hycet) solution mg/15 ml 5

20 hydrocodone-acetaminophen oral QL (390 per 30 (Vicodin HP) tablet mg hydrocodone-acetaminophen oral QL (360 per 30 (Norco) tablet mg, mg hydrocodone-acetaminophen oral QL (360 per 30 (Verdrocet) tablet mg hydrocodone-acetaminophen oral QL (390 per 30 (Xodol 5/300) tablet mg hydrocodone-acetaminophen oral QL (360 per 30 (Lortab 5-325) tablet mg hydrocodone-acetaminophen oral QL (390 per 30 (Xodol 7.5/300) tablet mg hydrocodone-ibuprofen oral tablet QL (150 per 30 (Ibudone) mg, mg hydrocodone-ibuprofen oral tablet QL (150 per mg hydromorphone (pf) injection solution 10 (mg/ml) (5 ml) hydromorphone (pf) injection solution 10 mg/ml hydromorphone 10 mg/ml vial p/f,sdv,latex-f 10 mg/ml hydromorphone injection solution 2 mg/ml, 4 mg/ml hydromorphone injection syringe 2 mg/ml, 4 mg/ml hydromorphone oral liquid 1 mg/ml (Dilaudid) QL (1200 per 30 hydromorphone oral tablet 2 mg, 4 QL (180 per 30 (Dilaudid) mg, 8 mg HYSINGLA ER ORAL QL (30 per 30 TABLET,ORAL ONLY,EXT.REL.24 HR 100 MG, 120 MG, 20 MG, 30 MG, 40 MG, 60 MG, 80 MG infant pain relv 80 mg/0.8 ml a/f, ; QL (30 per 30 gluten-free 80 mg/0.8 ml jr pain-fever 160 mg rapid tab ; QL (30 per 30 junior,bubblegum 160 mg 6

21 junior mapap 160 mg rapid tab 160 ; QL (30 per 30 mg LAZANDA NASAL SPRAY,NON- AEROSOL 100 MCG/SPRAY, 300 MCG/SPRAY, 400 MCG/SPRAY PA; QL (30 per 30 lorcet (hydrocodone) oral tablet 5- QL (360 per mg lorcet hd oral tablet mg QL (360 per 30 lorcet plus oral tablet mg QL (360 per 30 mapap 160 mg/5 ml liquid 160 mg/5 ; QL (240 per 30 ml mapap 160 mg/5 ml suspension 160 ; QL (240 per 30 mg/5 ml mapap 325 mg tablet 325 mg ; QL (360 per 30 mapap 500 mg capsule 500 mg ; QL (240 per 30 mapap 500 mg tablet 500 mg ; QL (240 per 30 mapap 500 mg/15 ml liquid 500 ; QL (120 per 30 mg/15 ml mapap 80 mg tablet chew 80 mg ; QL (30 per 30 mapap arthritis er 650 mg cplt 650 ; QL (180 per 30 mg PA-HRM; QL (180 per margesic oral capsule ; AGE (Max mg 64 Years) methadone injection solution 10 mg/ml methadone oral solution 10 mg/5 QL (1800 per 30 ml, 5 mg/5 ml methadone oral tablet 10 mg (Dolophine) QL (360 per 30 methadone oral tablet 5 mg (Dolophine) QL (180 per 30 methadose oral tablet,soluble 40 mg QL (90 per 30 morphine 10 mg/ml carpuject outer, p/f, l/f, suv 10 mg/ml morphine 2 mg/ml carpuject outer, latex-f, p/f 2 mg/ml 7

22 morphine 4 mg/ml syringe p/f, latexfree 4 mg/ml morphine 8 mg/ml syringe 8 mg/ml morphine concentrate oral solution QL (180 per mg/5 ml (20 mg/ml) morphine intramuscular pen injector 10 mg/0.7 ml morphine intravenous cartridge 15 mg/ml morphine intravenous syringe 10 mg/ml, 2 mg/ml, 4 mg/ml, 8 mg/ml morphine oral solution 10 mg/5 ml QL (700 per 30 morphine oral solution 20 mg/5 ml QL (300 per 30 (4 mg/ml) MORPHINE ORAL TABLET 15 QL (180 per 30 MG MORPHINE ORAL TABLET 30 QL (120 per 30 MG morphine oral tablet extended QL (60 per 30 (MS Contin) release 100 mg, 200 mg, 60 mg morphine oral tablet extended QL (180 per 30 (MS Contin) release 15 mg morphine oral tablet extended QL (120 per 30 (MS Contin) release 30 mg non-aspirin x-str 167 mg/5 ml 500 ; QL (120 per 30 mg/15 ml nortemp 80 mg/0.8 ml drop 80 ; QL (30 per 30 mg/0.8 ml NUCYNTA ER ORAL TABLET QL (60 per 30 EXTENDED RELEASE 12 HR 100 MG, 150 MG, 200 MG, 250 MG, 50 MG NUCYNTA ORAL TABLET 100 QL (181 per 30 MG, 50 MG, 75 MG oxycodone oral concentrate 20 QL (120 per 30 mg/ml oxycodone oral solution 5 mg/5 ml QL (1300 per 30 oxycodone oral tablet 10 mg QL (180 per 30 8

23 oxycodone oral tablet 15 mg, 30 mg (Roxicodone) QL (120 per 30 oxycodone oral tablet 20 mg QL (120 per 30 oxycodone oral tablet 5 mg (Roxicodone) QL (180 per 30 oxycodone oral tablet,oral only,ext.rel.12 hr 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 60 mg (OxyContin) QL (60 per 30 oxycodone oral tablet,oral QL (120 per 30 (OxyContin) only,ext.rel.12 hr 80 mg oxycodone-acetaminophen oral QL (1800 per 30 solution mg/5 ml oxycodone-acetaminophen oral QL (240 per 30 (Percocet) tablet mg oxycodone-acetaminophen oral QL (360 per 30 (Percocet) tablet mg, mg oxycodone-acetaminophen oral QL (300 per 30 (Endocet) tablet mg oxycodone-aspirin oral tablet QL (360 per mg OXYCONTIN ORAL QL (60 per 30 TABLET,ORAL ONLY,EXT.REL.12 HR 10 MG, 15 MG, 20 MG, 30 MG, 40 MG, 60 MG OXYCONTIN ORAL QL (120 per 30 TABLET,ORAL ONLY,EXT.REL.12 HR 80 MG oxymorphone oral tablet 10 mg (Opana) QL (120 per 30 oxymorphone oral tablet 5 mg (Opana) QL (180 per 30 oxymorphone oral tablet extended QL (60 per 30 release 12 hr 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 5 mg, 7.5 mg pain relief 500 mg capsule 500 mg ; QL (240 per 30 pharbetol 325 mg tablet regular ; QL (360 per 30 strength 325 mg pharbetol 500 mg caplet extra-str, caplet 500 mg ; QL (240 per 30 9

24 pv non-aspirin 500 mg softgel exstr,liq filled 500 mg ; QL (240 per 30 q-pap 160 mg/5 ml solution a/f, ; QL (240 per 30 cherry 160 mg/5 ml q-pap 325 mg tablet 325 mg ; QL (360 per 30 q-pap 80 mg/0.8 ml drops 80 mg/0.8 ; QL (30 per 30 ml q-pap ex-str 500 mg tablet aspirin ; QL (240 per 30 free 500 mg reprexain oral tablet mg, QL (150 per mg, mg sm pain rel jr str tab chew 160 mg ; QL (30 per 30 sm pain reliever 80 mg tab ; QL (30 per 30 children's 80 mg tactinal 325 mg tablet 325 mg ; QL (360 per 30 tactinal 500 mg tablet extra-strength ; QL (240 per mg PA-HRM; QL (180 per tencon oral tablet mg 30 ; AGE (Max 64 Years) tramadol oral tablet 50 mg (Ultram) QL (240 per 30 tramadol-acetaminophen oral tablet QL (240 per 30 (Ultracet) mg vicodin es oral tablet mg QL (390 per 30 vicodin hp oral tablet mg QL (390 per 30 vicodin oral tablet mg QL (390 per 30 XTAMPZA ER ORAL QL (60 per 30 CAPSULE,SPRINKLE,ER 12HR TMPRR 13.5 MG, 18 MG, 9 MG XTAMPZA ER ORAL QL (120 per 30 CAPSULE,SPRINKLE,ER 12HR TMPRR 27 MG XTAMPZA ER ORAL QL (240 per 30 CAPSULE,SPRINKLE,ER 12HR TMPRR 36 MG xylon 10 oral tablet mg QL (150 per 30 10

25 zebutal oral capsule mg Nonsteroidal Anti-Inflammatory Agents ADVIL 100 MG TABLET JR STRENGTH,COATED 100 MG ADVIL 200 MG TABLET 200 MG ADVIL JR STR 100 MG TAB CHEW TB CHEW,8 HOUR,GRAPE 100 MG aspirin 300 mg suppository 300 mg aspirin 325 mg tablet 325 mg (Lite Coat Aspirin) aspirin 600 mg suppository 600 mg aspirin 81 mg chewable tablet 81 (St Joseph Aspirin) mg aspirin buffered 325 mg tab 325 mg (Tri-Buffered Aspirin) aspirin ec 325 mg tablet 325 mg (Ecotrin) aspirin ec 500 mg tablet 500 mg aspirin ec 81 mg tablet low dose 81 (Adult Low Dose mg Aspirin) aspir-low ec 81 mg tablet 81 mg bufferin 325 mg tablet coated 325 mg CALDOLOR INTRAVENOUS RECON SOLN 400 MG/4 ML (100 MG/ML) celecoxib oral capsule 100 mg, 200 mg, 400 mg, 50 mg CHILDREN'S ADVIL 100 MG/5 ML (OTC) 100 MG/5 ML cvs ibuprofen 200 mg softgel liquid filled,softge 200 mg (Celebrex) (Advil Liqui-Gel) PA-HRM; QL (180 per 30 ; AGE (Max 64 Years) QL (60 per 30 11

26 diclofenac potassium oral tablet 50 mg diclofenac sodium oral tablet extended release 24 hr 100 mg (Voltaren-XR) diclofenac sodium oral tablet,delayed release (dr/ec) 25 mg, 50 mg, 75 mg diclofenac-misoprostol oral tablet,ir,delayed rel,biphasic (Arthrotec 50) mg-mcg diclofenac-misoprostol oral tablet,ir,delayed rel,biphasic (Arthrotec 75) mg-mcg diflunisal oral tablet 500 mg ecotrin ec 325 mg tablet saftey coated 325 mg ecpirin ec 325 mg tablet 325 mg etodolac oral capsule 200 mg, 300 mg etodolac oral tablet 400 mg (Lodine) etodolac oral tablet 500 mg etodolac oral tablet extended release 24 hr 400 mg, 500 mg, 600 mg fenoprofen oral tablet 600 mg FLECTOR TRANSDERMAL PA PATCH 12 HOUR 1.3 % flurbiprofen oral tablet 100 mg, 50 mg gnp ibuprofen jr str 100 mg tb 100 mg ibuprofen 100 mg/5 ml susp (Child Ibuprofen) children's (otc) 100 mg/5 ml ibuprofen 200 mg tablet 200 mg (I-Prin) ibuprofen oral suspension 100 mg/5 ml (Child Ibuprofen) ibuprofen oral tablet 400 mg, 600 mg, 800 mg 12

27 indomethacin oral capsule 25 mg QL (240 per 30 indomethacin oral capsule 50 mg QL (120 per 30 indomethacin oral capsule, extended QL (60 per 30 release 75 mg indomethacin sodium intravenous recon soln 1 mg infant ibuprofen 50 mg/1.25 ml d/f,a/f,non-staining 50 mg/1.25 ml infants' advil 50 mg/1.25 ml 50 mg/1.25 ml ketoprofen oral capsule 50 mg, 75 mg ketoprofen oral capsule,ext rel. pellets 24 hr 200 mg ketorolac oral tablet 10 mg QL (20 per 30 mefenamic acid oral capsule 250 mg (Ponstel) meloxicam oral suspension 7.5 mg/5 ml meloxicam oral tablet 15 mg, 7.5 mg (Mobic) nabumetone oral tablet 500 mg, 750 mg naproxen oral suspension 125 mg/5 ml (Naprosyn) naproxen oral tablet 250 mg, 375 mg naproxen oral tablet 500 mg (Naprosyn) naproxen oral tablet,delayed release (EC-Naprosyn) (dr/ec) 375 mg, 500 mg naproxen sodium oral tablet 275 mg naproxen sodium oral tablet 550 mg (Anaprox DS) piroxicam oral capsule 10 mg, 20 mg (Feldene) ra aspirin tri-buffered tb 325 mg sm ibuprofen ib 100 mg tablet junior (Advil) strength 100 mg st. joseph aspirin 81 mg chew orange 81 mg 13

28 st. joseph aspirin ec 81 mg tb enteric coated 81 mg sulindac oral tablet 150 mg, 200 mg tolmetin oral capsule 400 mg tolmetin oral tablet 200 mg, 600 mg VOLTAREN TOPICAL GEL 1 % wal-profen 200 mg softgel softgel 200 mg Anesthetics Local Anesthetics glydo mucous membrane jelly in applicator 2 % lidocaine (pf) injection solution 15 mg/ml (1.5 %), 20 mg/ml (2 %), 5 (Xylocaine-MPF) mg/ml (0.5 %) lidocaine (pf) injection solution 40 mg/ml (4 %) lidocaine hcl injection solution 10 mg/ml (1 %), 20 mg/ml (2 %), 5 (Xylocaine) mg/ml (0.5 %) lidocaine hcl mucous membrane jelly 2 % lidocaine hcl mucous membrane solution 4 % (40 mg/ml) lidocaine topical adhesive patch,medicated 5 % (Lidoderm) lidocaine topical ointment 5 % lidocaine viscous mucous membrane solution 2 % lidocaine-prilocaine topical cream % Anti-Addiction/Substance Abuse Treatment Agents Anti-Addiction/Substance Abuse Treatment Agents acamprosate oral tablet,delayed release (dr/ec) 333 mg PA 14

29 BUNAVAIL BUCCAL FILM 2.1- QL (30 per MG BUNAVAIL BUCCAL FILM 4.2- QL (60 per MG, MG buprenorphine hcl sublingual tablet QL (90 per 30 2 mg, 8 mg buprenorphine-naloxone sublingual QL (90 per 30 tablet mg, 8-2 mg buproban oral tablet extended release 150 mg bupropion hcl (smoking deter) oral tablet extended release 150 mg (Zyban) CHANTIX CONTINUING QL (168 per 84 MONTH BOX ORAL TABLET 1 MG CHANTIX ORAL TABLET 0.5 QL (168 per 84 MG, 1 MG CHANTIX STARTING MONTH QL (53 per 28 BOX ORAL TABLETS,DOSE PACK 0.5 MG (11)- 1 MG (42) disulfiram oral tablet 250 mg, 500 mg (Antabuse) naloxone injection solution 0.4 mg/ml naloxone injection syringe 0.4 mg/ml, 1 mg/ml naltrexone oral tablet 50 mg (Revia) NARCAN NASAL SPRAY,NON- QL (4 per 30 AEROSOL 4 MG/ACTUATION nicorelief 2 mg gum 2 mg nicorelief 4 mg gum 4 mg NICORETTE 2 MG CHEWING GUM WHITE ICE MINT 2 MG nicotine 14 mg/24hr patch step 2 ; QL (180 per 365 (Nicoderm CQ) (otc) 14 mg/24 hr nicotine 2 mg chewing gum sugar (Nicorelief) free 2 mg 15

30 nicotine 2 mg lozenge mint, 3 (Stop Smoking quittube 2 mg Aid) nicotine 21 mg/24hr patch outer, ; QL (168 per 365 (NTS Step 1) clear, step 1 (otc) 21 mg/24 hr nicotine 22 mg/24hr patch 1 week ; QL (168 per 365 starter kit 22 mg/24 hr nicotine 4 mg chewing gum 4 mg (Nicorelief) nicotine 4 mg lozenge mint, 3 (Stop Smoking quittube 4 mg Aid) nicotine 7 mg/24hr patch step 3 ; QL (180 per 365 (Nicoderm CQ) (otc) 7 mg/24 hr NICOTROL INHALATION QL (1008 per 90 CARTRIDGE 10 MG SUBOXONE SUBLINGUAL FILM QL (60 per MG, 8-2 MG SUBOXONE SUBLINGUAL FILM QL (30 per MG, 4-1 MG ZUBSOLV SUBLINGUAL QL (30 per 30 TABLET MG, MG, MG, MG, MG ZUBSOLV SUBLINGUAL QL (60 per 30 TABLET MG Antianxiety Agents Benzodiazepines alprazolam oral tablet 0.25 mg, 0.5 QL (120 per 30 (Xanax) mg, 1 mg alprazolam oral tablet 2 mg (Xanax) QL (150 per 30 chlordiazepoxide hcl oral capsule QL (120 per mg, 25 mg, 5 mg clonazepam oral tablet 0.5 mg, 1 mg (Klonopin) QL (90 per 30 clonazepam oral tablet 2 mg (Klonopin) QL (300 per 30 clonazepam oral tablet,disintegrating mg, 0.25 mg, 0.5 mg, 1 mg QL (90 per 30 clonazepam oral QL (300 per 30 tablet,disintegrating 2 mg 16

31 clorazepate dipotassium oral tablet QL (180 per mg, 3.75 mg clorazepate dipotassium oral tablet QL (180 per 30 (Tranxene T-Tab) 7.5 mg diazepam injection solution 5 mg/ml QL (10 per 28 diazepam intensol oral concentrate QL (1200 per 30 5 mg/ml diazepam oral solution 5 mg/5 ml (1 QL (1200 per 30 mg/ml) diazepam oral tablet 10 mg, 2 mg, 5 QL (120 per 30 (Valium) mg diazepam rectal kit mg, mg (Diastat AcuDial) diazepam rectal kit 2.5 mg (Diastat) lorazepam injection solution 2 QL (2 per 30 (Ativan) mg/ml lorazepam oral tablet 0.5 mg, 1 mg (Ativan) QL (90 per 30 lorazepam oral tablet 2 mg (Ativan) QL (150 per 30 ONFI ORAL SUSPENSION 2.5 PA NSO; QL (480 per MG/ML 30 ONFI ORAL TABLET 10 MG, 20 PA NSO; QL (60 per MG 30 Antibacterials Aminoglycosides BETHKIS INHALATION SOLUTION FOR NEBULIZATION 300 MG/4 ML gentamicin in nacl (iso-osm) intravenous piggyback 100 mg/100 ml, 100 mg/50 ml, 60 mg/50 ml, 70 mg/50 ml, 80 mg/100 ml, 80 mg/50 ml, 90 mg/100 ml gentamicin injection solution 40 mg/ml gentamicin ped 20 mg/2 ml vial latex-free, sdv 20 mg/2 ml gentamicin sulfate (pf) intravenous solution 100 mg/10 ml 17

32 neomycin oral tablet 500 mg streptomycin intramuscular recon soln 1 gram TOBI PODHALER INHALATION CAPSULE, W/INHALATION DEVICE 28 MG tobramycin in % nacl inhalation solution for nebulization (Tobi) 300 mg/5 ml tobramycin in 0.9 % nacl intravenous piggyback 60 mg/50 ml tobramycin sulfate injection solution 10 mg/ml, 40 mg/ml Antibacterials, Miscellaneous bacitracin intramuscular recon soln 50,000 unit (BACiiM) chloramphenicol sod succinate intravenous recon soln 1 gram clindamycin 75 mg/5 ml soln 75 (Clindamycin mg/5 ml Pediatric) clindamycin hcl oral capsule 150 mg, 300 mg, 75 mg (Cleocin HCl) clindamycin in 5 % dextrose (Cleocin in 5 % intravenous piggyback 300 mg/50 dextrose) ml, 600 mg/50 ml, 900 mg/50 ml clindamycin pediatric oral recon soln 75 mg/5 ml clindamycin phosphate injection solution 150 (mg/ml) (6 ml) clindamycin phosphate injection solution 150 mg/ml (Cleocin) clindamycin phosphate intravenous (Cleocin) solution 600 mg/4 ml colistin (colistimethate na) injection recon soln 150 mg CUBICIN INTRAVENOUS RECON SOLN 500 MG (Coly-Mycin M Parenteral) QL (224 per 28 18

33 daptomycin intravenous recon soln 500 mg (Cubicin) linezolid intravenous parenteral solution 600 mg/300 ml (Zyvox) linezolid oral suspension for reconstitution 100 mg/5 ml (Zyvox) linezolid oral tablet 600 mg (Zyvox) methenamine hippurate oral tablet 1 gram (Hiprex) metronidazole in nacl (iso-os) intravenous piggyback 500 mg/100 (Metro I.V.) ml metronidazole oral capsule 375 mg (Flagyl) metronidazole oral tablet 250 mg, 500 mg (Flagyl) nitrofurantoin macrocrystal oral capsule 100 mg, 25 mg, 50 mg nitrofurantoin monohyd/m-cryst oral capsule 100 mg (Macrodantin) (Macrobid) polymyxin b sulfate injection recon soln 500,000 unit SYNERCID INTRAVENOUS RECON SOLN 500 MG trimethoprim oral tablet 100 mg PA-HRM; (High Risk Med. QL applies to all members; PA required for 65 years and older with over 90 days cumulative use of nitrofurantoin drugs); QL (120 per 30 ; AGE (Max 64 Years) PA-HRM; (High Risk Med. QL applies to all members; PA required for 65 years and older with over 90 days cumulative use of nitrofurantoin drugs); QL (60 per 30 ; AGE (Max 64 Years) 19

34 vancomycin hcl 1g/200 ml bag 1 gram/200 ml vancomycin intravenous recon soln 1,000 mg, 10 gram, 750 mg vancomycin intravenous recon soln 500 mg vancomycin oral capsule 125 mg, 250 mg (Vancocin) XIFAXAN ORAL TABLET 200 MG XIFAXAN ORAL TABLET 550 MG Cephalosporins cefaclor oral capsule 250 mg, 500 mg cefaclor oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml, 375 mg/5 ml cefadroxil oral capsule 500 mg cefadroxil oral suspension for reconstitution 250 mg/5 ml, 500 mg/5 ml cefadroxil oral tablet 1 gram cefazolin in dextrose (iso-os) intravenous piggyback 1 gram/50 ml, 2 gram/50 ml cefazolin injection recon soln 1 gram, 10 gram, 500 mg cefdinir oral capsule 300 mg cefdinir oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml cefditoren pivoxil oral tablet 200 mg cefditoren pivoxil oral tablet 400 mg (Spectracef) CEFEPIME 1 GM INJECTION 1 GRAM/50 ML cefepime hcl 1 gm vial 10's, sdv 1 gram (Maxipime) PA; QL (9 per 30 PA 20

35 cefepime hcl 2 gram vial latex/f, sdv, (Maxipime) outer 2 gram CEFEPIME INJECTION RECON SOLN 1 GRAM, 2 GRAM (Maxipime) CEFEPIME-DEXTROSE 2 GM/50 ML 2 GRAM/50 ML cefotaxime injection recon soln 1 gram, 10 gram, 2 gram (Claforan) cefotaxime injection recon soln 500 mg cefoxitin 2 gm piggyback bag 2 gram/50 ml cefoxitin 2 gm vial latex/f, outer 2 gram cefoxitin intravenous recon soln 1 gram, 10 gram cefoxitin intravenous recon soln 2 gram cefpodoxime oral suspension for reconstitution 100 mg/5 ml, 50 mg/5 ml cefpodoxime oral tablet 100 mg, 200 mg cefprozil oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml cefprozil oral tablet 250 mg, 500 mg ceftazidime injection recon soln 2 gram (Fortaz) ceftazidime injection recon soln 6 gram (TAZICEF) ceftibuten oral capsule 400 mg (Cedax) ceftibuten oral suspension for reconstitution 180 mg/5 ml (Cedax) ceftriaxone 1 gm piggyback latexfree 1 gram/50 ml ceftriaxone 2 gm piggyback latexfree 2 gram/50 ml 21

36 ceftriaxone injection recon soln 1 gram, 10 gram, 250 mg, 500 mg ceftriaxone intravenous recon soln 1 gram, 2 gram cefuroxime axetil oral tablet 250 mg, 500 mg cefuroxime sodium injection recon soln 750 mg (Zinacef) cefuroxime sodium intravenous recon soln 1.5 gram, 7.5 gram (Zinacef) cephalexin oral capsule 250 mg, 500 mg, 750 mg (Keflex) cephalexin oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml cephalexin oral tablet 250 mg, 500 mg MEFOXIN IN DEXTROSE (ISO- OSM) INTRAVENOUS PIGGYBACK 1 GRAM/50 ML, 2 GRAM/50 ML SUPRAX ORAL CAPSULE 400 MG SUPRAX ORAL TABLET,CHEWABLE 100 MG, 200 MG tazicef injection recon soln 2 gram, 6 gram TEFLARO INTRAVENOUS RECON SOLN 400 MG, 600 MG Macrolides azithromycin intravenous recon soln 500 mg (Zithromax) azithromycin oral packet 1 gram (Zithromax) azithromycin oral suspension for reconstitution 100 mg/5 ml, 200 (Zithromax) mg/5 ml azithromycin oral tablet 250 mg (Zithromax Z-Pak) 22

37 azithromycin oral tablet 250 mg (6 pack), 500 mg (3 pack) azithromycin oral tablet 500 mg (Zithromax TRI- PAK) azithromycin oral tablet 600 mg (Zithromax) clarithromycin oral suspension for reconstitution 125 mg/5 ml clarithromycin oral suspension for reconstitution 250 mg/5 ml (Biaxin) clarithromycin oral tablet 250 mg, 500 mg (Biaxin) clarithromycin oral tablet extended release 24 hr 500 mg DIFICID ORAL TABLET 200 MG QL (20 per 10 e.e.s. 400 oral tablet 400 mg e.e.s. granules oral suspension for reconstitution 200 mg/5 ml ery-tab oral tablet,delayed release (dr/ec) 250 mg, 500 mg ERY-TAB ORAL TABLET,DELAYED RELEASE (DR/EC) 333 MG erythrocin (as stearate) oral tablet 250 mg ERYTHROCIN INTRAVENOUS RECON SOLN 1,000 MG, 500 MG erythromycin ethylsuccinate oral suspension for reconstitution 200 (EryPed 200) mg/5 ml erythromycin ethylsuccinate oral tablet 400 mg (E.E.S. 400) erythromycin oral capsule,delayed release(dr/ec) 250 mg erythromycin oral tablet 250 mg, 500 mg Miscellaneous B-Lactam Antibiotics 23

38 aztreonam injection recon soln 1 gram, 2 gram (Azactam) CAYSTON INHALATION SOLUTION FOR NEBULIZATION 75 MG/ML imipenem-cilastatin intravenous recon soln 250 mg, 500 mg (Primaxin IV) INVANZ INJECTION RECON SOLN 1 GRAM meropenem intravenous recon soln 1 gram, 500 mg (Merrem) Penicillins amoxicillin oral capsule 250 mg, 500 mg amoxicillin oral suspension for reconstitution 125 mg/5 ml, 200 mg/5 ml, 250 mg/5 ml, 400 mg/5 ml amoxicillin oral tablet 500 mg, 875 mg amoxicillin oral tablet,chewable 125 mg, 250 mg amoxicillin-pot clavulanate oral suspension for reconstitution mg/5 ml, mg/5 ml amoxicillin-pot clavulanate oral suspension for reconstitution 250- (Augmentin) 62.5 mg/5 ml amoxicillin-pot clavulanate oral (Augmentin ESsuspension for reconstitution ) 42.9 mg/5 ml amoxicillin-pot clavulanate oral tablet mg amoxicillin-pot clavulanate oral tablet mg, mg (Augmentin) amoxicillin-pot clavulanate oral tablet extended release 12 hr 1,000- (Augmentin XR) 62.5 mg LA 24

39 amoxicillin-pot clavulanate oral tablet,chewable mg, mg ampicillin oral capsule 250 mg, 500 mg ampicillin oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml ampicillin sodium injection recon soln 1 gram, 10 gram, 125 mg, 2 gram, 250 mg, 500 mg ampicillin sodium intravenous recon soln 2 gram ampicillin-sulbactam injection recon soln 1.5 gram, 15 gram, 3 gram BICILLIN C-R INTRAMUSCULAR SYRINGE 1,200,000 UNIT/ 2 ML(600K/600K), 1,200,000 UNIT/ 2 ML(900K/300K) BICILLIN L-A INTRAMUSCULAR SYRINGE 1,200,000 UNIT/2 ML, 2,400,000 UNIT/4 ML, 600,000 UNIT/ML dicloxacillin oral capsule 250 mg, 500 mg nafcillin 2 gm vial 10's, latex-free 2 gram nafcillin injection recon soln 1 gram, 10 gram nafcillin intravenous recon soln 2 gram oxacillin 2 gm vial 10's,outer 2 gram oxacillin in dextrose(iso-osm) intravenous piggyback 1 gram/50 ml, 2 gram/50 ml (Unasyn) 25

40 oxacillin injection recon soln 10 gram oxacillin intravenous recon soln 2 gram penicillin g pot in dextrose intravenous piggyback 1 million unit/50 ml, 2 million unit/50 ml, 3 million unit/50 ml penicillin g potassium injection recon soln 5 million unit (Pfizerpen-G) penicillin g procaine intramuscular syringe 1.2 million unit/2 ml, 600,000 unit/ml penicillin gk 20 million unit 20 million unit (Pfizerpen-G) penicillin v potassium oral recon soln 125 mg/5 ml, 250 mg/5 ml penicillin v potassium oral tablet 250 mg, 500 mg pfizerpen-g injection recon soln 20 million unit piperacillin-tazobactam intravenous recon soln 2.25 gram, gram, (Zosyn) 4.5 gram, 40.5 gram Quinolones ciprofloxacin hcl oral tablet 100 mg, 750 mg ciprofloxacin hcl oral tablet 250 mg, (Cipro) 500 mg ciprofloxacin in 5 % dextrose intravenous piggyback 200 mg/100 ml ciprofloxacin in 5 % dextrose intravenous piggyback 400 mg/200 (Cipro in D5W) ml ciprofloxacin lactate intravenous solution 200 mg/20 ml, 400 mg/40 ml 26

41 ciprofloxacin oral suspension,microcapsule recon 250 (Cipro) mg/5 ml, 500 mg/5 ml levofloxacin in d5w intravenous piggyback 250 mg/50 ml, 500 mg/100 ml, 750 mg/150 ml levofloxacin intravenous solution 25 mg/ml levofloxacin oral solution 250 mg/10 ml levofloxacin oral tablet 250 mg, 500 mg, 750 mg (Levaquin) moxifloxacin oral tablet 400 mg (Avelox) ofloxacin oral tablet 300 mg, 400 mg Sulfonamides sulfadiazine oral tablet 500 mg sulfamethoxazole-trimethoprim intravenous solution mg/5 ml sulfamethoxazole-trimethoprim oral suspension mg/5 ml (Sulfatrim) sulfamethoxazole-trimethoprim oral tablet mg (Bactrim) sulfamethoxazole-trimethoprim oral tablet mg (Bactrim DS) sulfasalazine oral tablet 500 mg (Sulfazine) sulfasalazine oral tablet,delayed (Azulfidine ENtabs) release (dr/ec) 500 mg sulfatrim oral suspension mg/5 ml Tetracyclines doxy-100 intravenous recon soln 100 mg doxycycline hyclate intravenous recon soln 100 mg (Doxy-100) doxycycline hyclate oral capsule 100 mg (Vibramycin) 27

42 doxycycline hyclate oral capsule 50 mg doxycycline hyclate oral tablet 100 mg, 20 mg doxycycline monohydrate oral capsule 100 mg, 75 mg doxycycline monohydrate oral capsule 150 mg doxycycline monohydrate oral capsule 50 mg doxycycline monohydrate oral suspension for reconstitution 25 mg/5 ml doxycycline monohydrate oral tablet 100 mg doxycycline monohydrate oral tablet 150 mg, 50 mg, 75 mg minocycline oral capsule 100 mg, 50 mg, 75 mg minocycline oral tablet 100 mg, 50 mg, 75 mg tetracycline oral capsule 250 mg, 500 mg tigecycline intravenous recon soln 50 mg TYGACIL INTRAVENOUS RECON SOLN 50 MG Anticancer Agents Anticancer Agents ABRAXANE INTRAVENOUS SUSPENSION FOR RECONSTITUTION 100 MG ADCETRIS INTRAVENOUS RECON SOLN 50 MG adriamycin intravenous solution 2 mg/ml, 20 mg/10 ml adrucil 2,500 mg/50 ml vial outer, latex-free 2.5 gram/50 ml (Morgidox) (Monodox) (Mondoxyne NL) (Vibramycin) (Avidoxy) (Minocin) (Tygacil) PA NSO; QL (4 per 21 28

43 adrucil intravenous solution 500 mg/10 ml AFINITOR DISPERZ ORAL TABLET FOR SUSPENSION 2 MG, 3 MG, 5 MG AFINITOR ORAL TABLET 10 MG AFINITOR ORAL TABLET 2.5 MG, 5 MG, 7.5 MG ALECENSA ORAL CAPSULE 150 MG ALIMTA INTRAVENOUS RECON SOLN 100 MG, 500 MG anastrozole oral tablet 1 mg (Arimidex) AVASTIN INTRAVENOUS SOLUTION 25 MG/ML, 25 MG/ML (16 ML) azacitidine injection recon soln 100 mg (Vidaza) BELEODAQ INTRAVENOUS RECON SOLN 500 MG BENDEKA INTRAVENOUS SOLUTION 25 MG/ML bexarotene oral capsule 75 mg (Targretin) bicalutamide oral tablet 50 mg (Casodex) bleomycin injection recon soln 15 unit (Bleo 15K) bleomycin injection recon soln 30 unit BLINCYTO INTRAVENOUS KIT 35 MCG BOSULIF ORAL TABLET 100 MG BOSULIF ORAL TABLET 500 MG CABOMETYX ORAL TABLET 20 MG, 60 MG PA NSO; QL (112 per 28 PA NSO; QL (56 per 28 PA NSO; QL (28 per 28 PA NSO; QL (240 per 30 PA NSO PA NSO PA NSO PA NSO; QL (420 per 30 PA NSO; QL (140 per 365 PA NSO; QL (120 per 30 PA NSO; QL (30 per 30 PA NSO; QL (30 per 30 29

44 CABOMETYX ORAL TABLET 40 MG CAPRELSA ORAL TABLET 100 MG CAPRELSA ORAL TABLET 300 MG COMETRIQ ORAL CAPSULE 100 MG/DAY(80 MG X1-20 MG X1), 140 MG/DAY(80 MG X1-20 MG X3), 60 MG/DAY (20 MG X 3/DAY) COTELLIC ORAL TABLET 20 MG cyclophosphamide intravenous recon soln 1 gram, 2 gram, 500 mg CYCLOPHOSPHAMIDE ORAL CAPSULE 25 MG, 50 MG CYRAMZA INTRAVENOUS SOLUTION 10 MG/ML, 10 MG/ML (50 ML) DARZALEX INTRAVENOUS SOLUTION 20 MG/ML decitabine intravenous recon soln 50 mg doxorubicin 200 mg/100 ml vial latex-free 2 mg/ml doxorubicin intravenous solution 50 mg/25 ml doxorubicin, peg-liposomal intravenous suspension 2 mg/ml DROXIA ORAL CAPSULE 200 MG, 300 MG, 400 MG ELIGARD (3 MONTH) SUBCUTANEOUS SYRINGE 22.5 MG ELIGARD (4 MONTH) SUBCUTANEOUS SYRINGE 30 MG (Dacogen) (Adriamycin) (Adriamycin) (Doxil) PA NSO; QL (60 per 30 PA NSO; QL (60 per 30 PA NSO; QL (30 per 30 PA NSO; QL (112 per 28 PA NSO; LA; QL (63 per 28 ; ST PA NSO PA NSO; LA QL (1 per 84 QL (1 per

45 ELIGARD (6 MONTH) SUBCUTANEOUS SYRINGE 45 MG ELIGARD SUBCUTANEOUS SYRINGE 7.5 MG (1 MONTH) EMCYT ORAL CAPSULE 140 MG EMPLICITI INTRAVENOUS RECON SOLN 300 MG, 400 MG ERIVEDGE ORAL CAPSULE 150 MG ETOPOPHOS INTRAVENOUS RECON SOLN 100 MG etoposide intravenous solution 20 mg/ml (Toposar) exemestane oral tablet 25 mg (Aromasin) FARESTON ORAL TABLET 60 MG FARYDAK ORAL CAPSULE 10 MG, 15 MG, 20 MG FASLODEX INTRAMUSCULAR SYRINGE 250 MG/5 ML floxuridine injection recon soln 0.5 gram fluorouracil 5,000 mg/100 ml latexfree 5 gram/100 ml (Adrucil) fluorouracil intravenous solution 1 gram/20 ml fluorouracil intravenous solution 2.5 gram/50 ml, 500 mg/10 ml (Adrucil) flutamide oral capsule 125 mg GAZYVA INTRAVENOUS SOLUTION 1,000 MG/40 ML GILOTRIF ORAL TABLET 20 MG, 30 MG, 40 MG GLEOSTINE ORAL CAPSULE 10 MG, 100 MG, 40 MG, 5 MG QL (1 per 168 PA NSO PA NSO; QL (30 per 30 PA NSO PA NSO PA NSO; QL (30 per 30 31

46 HERCEPTIN INTRAVENOUS RECON SOLN 440 MG HEXALEN ORAL CAPSULE 50 MG hydroxyurea oral capsule 500 mg (Hydrea) IBRANCE ORAL CAPSULE 100 MG, 125 MG, 75 MG ICLUSIG ORAL TABLET 15 MG ICLUSIG ORAL TABLET 45 MG ifosfamide 1 gm/20 ml vial sdv,p/f,latex-free 1 gram/20 ml ifosfamide intravenous recon soln 1 gram ifosfamide-mesna intravenous kit 1-1 gram, 3,000-1,000 mg (Ifex) imatinib oral tablet 100 mg (Gleevec) imatinib oral tablet 400 mg (Gleevec) IMBRUVICA ORAL CAPSULE 140 MG IMLYGIC INJECTION SUSPENSION 10EXP6 (1 MILLION) PFU/ML IMLYGIC INJECTION SUSPENSION 10EXP8 (100 MILLION) PFU/ML INLYTA ORAL TABLET 1 MG INLYTA ORAL TABLET 5 MG IRESSA ORAL TABLET 250 MG IXEMPRA INTRAVENOUS RECON SOLN 15 MG, 45 MG PA NSO PA NSO; QL (21 per 28 PA NSO; QL (60 per 30 PA NSO; QL (30 per 30 PA NSO; QL (90 per 30 PA NSO; QL (60 per 30 PA NSO PA NSO; QL (4 per 365 PA NSO; QL (8 per 28 PA NSO; QL (180 per 30 PA NSO; QL (60 per 30 PA NSO; QL (60 per 30 32

47 JAKAFI ORAL TABLET 10 MG, 15 MG, 20 MG, 25 MG, 5 MG KEYTRUDA INTRAVENOUS RECON SOLN 50 MG KEYTRUDA INTRAVENOUS SOLUTION 100 MG/4 ML (25 MG/ML) KISQALI ORAL TABLET 200 MG/DAY (200 MG X 1), 400 MG/DAY (200 MG X 2), 600 MG/DAY (200 MG X 3) KYPROLIS INTRAVENOUS RECON SOLN 30 MG KYPROLIS INTRAVENOUS RECON SOLN 60 MG LARTRUVO INTRAVENOUS SOLUTION 10 MG/ML LENVIMA ORAL CAPSULE 10 MG/DAY (10 MG X 1/DAY), 14 MG/DAY(10 MG X 1-4 MG X 1), 18 MG/DAY (10 MG X 1-4 MG X2), 20 MG/DAY (10 MG X 2), 24 MG/DAY(10 MG X 2-4 MG X 1), 8 MG/DAY (4 MG X 2) letrozole oral tablet 2.5 mg (Femara) LEUKERAN ORAL TABLET 2 MG leuprolide subcutaneous kit 1 mg/0.2 ml LONSURF ORAL TABLET MG LONSURF ORAL TABLET MG LUPRON DEPOT (3 MONTH) INTRAMUSCULAR SYRINGE KIT MG, 22.5 MG LUPRON DEPOT (4 MONTH) INTRAMUSCULAR SYRINGE KIT 30 MG 33 PA NSO; QL (60 per 30 PA NSO PA NSO PA NSO; QL (63 per 28 PA NSO; QL (12 per 28 PA NSO; QL (6 per 28 PA NSO; LA PA NSO PA NSO; QL (100 per 28 PA NSO; QL (80 per 28 QL (1 per 84 QL (1 per 84

48 LUPRON DEPOT (6 MONTH) INTRAMUSCULAR SYRINGE KIT 45 MG LUPRON DEPOT INTRAMUSCULAR SYRINGE KIT 3.75 MG, 7.5 MG LYNPARZA ORAL CAPSULE 50 MG LYSODREN ORAL TABLET 500 MG MATULANE ORAL CAPSULE 50 MG megestrol oral tablet 20 mg, 40 mg MEKINIST ORAL TABLET 0.5 MG MEKINIST ORAL TABLET 2 MG mercaptopurine oral tablet 50 mg methotrexate sodium (pf) injection recon soln 1 gram methotrexate sodium (pf) injection solution 25 mg/ml methotrexate sodium injection solution 25 mg/ml methotrexate sodium oral tablet 2.5 mg mitoxantrone intravenous concentrate 2 mg/ml NEXAVAR ORAL TABLET 200 MG NILANDRON ORAL TABLET 150 MG nilutamide oral tablet 150 mg (Nilandron) NINLARO ORAL CAPSULE 2.3 MG, 3 MG, 4 MG ODOMZO ORAL CAPSULE 200 MG QL (1 per 168 PA NSO; QL (480 per 30 PA NSO; QL (90 per 30 PA NSO; QL (30 per 30 ; ST PA NSO; QL (120 per 30 PA NSO; QL (3 per 28 PA NSO; LA 34

49 ONCASPAR INJECTION SOLUTION 750 UNIT/ML ONIVYDE INTRAVENOUS DISPERSION 4.3 MG/ML OPDIVO INTRAVENOUS SOLUTION 100 MG/10 ML, 40 MG/4 ML POMALYST ORAL CAPSULE 1 MG, 2 MG, 3 MG, 4 MG PORTRAZZA INTRAVENOUS SOLUTION 800 MG/50 ML (16 MG/ML) PROLEUKIN INTRAVENOUS RECON SOLN 22 MILLION UNIT PURIXAN ORAL SUSPENSION 20 MG/ML REVLIMID ORAL CAPSULE 10 MG, 15 MG, 2.5 MG, 20 MG, 25 MG, 5 MG RITUXAN INTRAVENOUS CONCENTRATE 10 MG/ML RUBRACA ORAL TABLET 200 MG, 300 MG SOLTAMOX ORAL SOLUTION 10 MG/5 ML SPRYCEL ORAL TABLET 100 MG, 140 MG, 50 MG, 70 MG, 80 MG PA NSO PA NSO PA NSO; QL (60 per SPRYCEL ORAL TABLET 20 MG 30 STIVARGA ORAL TABLET 40 PA NSO; QL (84 per MG 28 SUTENT ORAL CAPSULE 12.5 PA NSO; QL (30 per MG, 25 MG, 37.5 MG, 50 MG 30 SYLVANT INTRAVENOUS PA NSO RECON SOLN 100 MG, 400 MG SYNRIBO SUBCUTANEOUS PA NSO; QL (28 per RECON SOLN 3.5 MG 28 TABLOID ORAL TABLET 40 MG 35 PA NSO; QL (21 per 28 PA NSO; QL (100 per 21 PA NSO; LA PA NSO PA NSO; QL (120 per 30 PA NSO; QL (30 per 30

50 TAFINLAR ORAL CAPSULE 50 MG, 75 MG TAGRISSO ORAL TABLET 40 MG, 80 MG tamoxifen oral tablet 10 mg, 20 mg TARCEVA ORAL TABLET 100 MG, 25 MG TARCEVA ORAL TABLET 150 MG TARGRETIN ORAL CAPSULE 75 MG TARGRETIN TOPICAL GEL 1 % TASIGNA ORAL CAPSULE 150 MG, 200 MG TECENTRIQ INTRAVENOUS SOLUTION 1,200 MG/20 ML (60 MG/ML) TEMODAR INTRAVENOUS RECON SOLN 100 MG thiotepa injection recon soln 15 mg toposar intravenous solution 20 mg/ml TREANDA INTRAVENOUS RECON SOLN 100 MG TRELSTAR MG VIAL INNER, SDV MG TRELSTAR 22.5 MG SYRINGE OUTER, L/F, SDV 22.5 MG/2 ML TRELSTAR 3.75 MG VIAL INNER, SDV 3.75 MG TRELSTAR INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 22.5 MG TRELSTAR INTRAMUSCULAR SYRINGE MG/2 ML TRELSTAR INTRAMUSCULAR SYRINGE 3.75 MG/2 ML PA NSO; QL (120 per 30 PA NSO; LA; QL (30 per 30 PA NSO; QL (60 per 30 PA NSO; QL (90 per 30 PA NSO; QL (420 per 30 PA NSO; QL (60 per 28 PA NSO; QL (112 per 28 PA NSO; QL (20 per 21 PA NSO QL (1 per 84 QL (1 per 168 QL (1 per 168 QL (1 per 84 36

51 tretinoin (chemotherapy) oral capsule 10 mg TREXALL ORAL TABLET 10 MG, 15 MG, 5 MG, 7.5 MG TYKERB ORAL TABLET 250 MG UNITUXIN INTRAVENOUS SOLUTION 3.5 MG/ML VALSTAR INTRAVESICAL SOLUTION 40 MG/ML VELCADE INJECTION RECON SOLN 3.5 MG VENCLEXTA ORAL TABLET 10 MG VENCLEXTA ORAL TABLET 100 MG VENCLEXTA ORAL TABLET 50 MG VENCLEXTA STARTING PACK ORAL TABLETS,DOSE PACK 10 MG-50 MG- 100 MG vinorelbine intravenous solution 10 mg/ml, 50 mg/5 ml (Navelbine) VOTRIENT ORAL TABLET 200 MG XALKORI ORAL CAPSULE 200 MG, 250 MG XTANDI ORAL CAPSULE 40 MG YERVOY INTRAVENOUS SOLUTION 200 MG/40 ML (5 MG/ML), 50 MG/10 ML (5 MG/ML) YONDELIS INTRAVENOUS RECON SOLN 1 MG ZELBORAF ORAL TABLET 240 MG ZOLADEX SUBCUTANEOUS IMPLANT 10.8 MG ; ST PA NSO PA NSO PA NSO; LA; QL (60 per 30 PA NSO; LA; QL (120 per 30 PA NSO; LA; QL (30 per 30 PA NSO; LA; QL (42 per 28 PA NSO; QL (120 per 30 PA NSO; QL (60 per 30 PA NSO; QL (120 per 30 PA NSO PA NSO PA NSO; QL (240 per 30 QL (1 per 84 37

52 ZOLADEX SUBCUTANEOUS IMPLANT 3.6 MG ZOLINZA ORAL CAPSULE 100 MG ZYDELIG ORAL TABLET 100 MG, 150 MG ZYKADIA ORAL CAPSULE 150 MG ZYTIGA ORAL TABLET 250 MG Anticholinergic Agents Antimuscarinics/Antispasmodics atropine injection syringe 0.05 mg/ml, 0.1 mg/ml propantheline oral tablet 15 mg Anticonvulsants Anticonvulsants APTIOM ORAL TABLET 200 MG, 400 MG, 600 MG, 800 MG BANZEL ORAL SUSPENSION 40 MG/ML BANZEL ORAL TABLET 200 MG, 400 MG BRIVIACT INTRAVENOUS SOLUTION 50 MG/5 ML BRIVIACT ORAL SOLUTION 10 MG/ML BRIVIACT ORAL TABLET 10 MG, 100 MG, 25 MG, 50 MG, 75 MG carbamazepine oral capsule, er multiphase 12 hr 100 mg, 200 mg, 300 mg (Carbatrol) carbamazepine oral suspension 100 mg/5 ml (Tegretol) carbamazepine oral tablet 200 mg (Tegretol) QL (1 per 28 PA NSO; QL (60 per 30 PA NSO; QL (140 per 28 PA NSO; QL (120 per 30 ST ST ST QL (80 per 30 QL (600 per 30 QL (60 per 30 38

53 carbamazepine oral tablet extended release 12 hr 100 mg, 200 mg, 400 mg carbamazepine oral tablet,chewable 100 mg CELONTIN ORAL CAPSULE 300 MG DILANTIN ORAL CAPSULE 30 MG divalproex oral capsule, sprinkle 125 mg divalproex oral tablet extended release 24 hr 250 mg, 500 mg divalproex oral tablet,delayed release (dr/ec) 125 mg, 250 mg, 500 (Tegretol XR) (Depakote Sprinkles) (Depakote ER) (Depakote) mg epitol oral tablet 200 mg ethosuximide oral capsule 250 mg (Zarontin) ethosuximide oral solution 250 mg/5 ml felbamate oral suspension 600 mg/5 ml felbamate oral tablet 400 mg, 600 mg fosphenytoin injection solution 100 mg pe/2 ml, 500 mg pe/10 ml FYCOMPA ORAL SUSPENSION 0.5 MG/ML FYCOMPA ORAL TABLET 10 MG, 12 MG, 2 MG, 4 MG, 6 MG, 8 MG gabapentin oral capsule 100 mg, 300 mg, 400 mg gabapentin oral solution 250 mg/5 ml gabapentin oral tablet 600 mg, 800 mg (Zarontin) (Felbatol) (Felbatol) (Cerebyx) (Neurontin) (Neurontin) (Neurontin) ST ST 39

54 GABITRIL ORAL TABLET 12 MG, 16 MG lamotrigine oral tablet 100 mg, 150 mg, 200 mg, 25 mg lamotrigine oral tablet extended release 24hr 100 mg, 200 mg, 25 mg, 250 mg, 300 mg, 50 mg lamotrigine oral tablet, chewable dispersible 25 mg, 5 mg lamotrigine oral tablets,dose pack 25 mg (35) levetiracetam intravenous solution 500 mg/5 ml levetiracetam oral solution 100 mg/ml levetiracetam oral tablet 1,000 mg, 250 mg, 500 mg, 750 mg levetiracetam oral tablet extended release 24 hr 500 mg, 750 mg LYRICA ORAL CAPSULE 100 MG, 150 MG, 200 MG, 225 MG, 25 MG, 300 MG, 50 MG, 75 MG LYRICA ORAL SOLUTION 20 MG/ML oxcarbazepine oral suspension 300 mg/5 ml (60 mg/ml) oxcarbazepine oral tablet 150 mg, 300 mg, 600 mg OXTELLAR XR ORAL TABLET EXTENDED RELEASE 24 HR 150 MG, 300 MG, 600 MG PEGANONE ORAL TABLET 250 MG phenobarbital oral elixir 20 mg/5 ml (4 mg/ml) phenobarbital oral tablet 100 mg, 15 mg, 16.2 mg, 32.4 mg, 60 mg, 64.8 mg, 97.2 mg (Lamictal) (Lamictal XR) (Lamictal) (Lamictal Starter (Blue) Kit) (Keppra) (Keppra) (Keppra) (Keppra XR) (Trileptal) (Trileptal) phenobarbital oral tablet 30 mg QL (200 per ST QL (90 per 30 QL (900 per 30 ST QL (1500 per 30 QL (90 per 30

55 phenytoin oral suspension 125 mg/5 ml phenytoin oral tablet,chewable 50 mg phenytoin sodium extended oral capsule 100 mg phenytoin sodium extended oral capsule 200 mg, 300 mg phenytoin sodium intravenous solution 50 mg/ml phenytoin sodium intravenous syringe 50 mg/ml POTIGA ORAL TABLET 200 MG, 300 MG, 400 MG (Dilantin-125) (Dilantin Infatabs) (Dilantin Kapseal) (Phenytek) POTIGA ORAL TABLET 50 MG primidone oral tablet 250 mg, 50 mg (Mysoline) ROWEEPRA ORAL TABLET 500 MG SABRIL ORAL POWDER IN PACKET 500 MG SABRIL ORAL TABLET 500 MG SPRITAM ORAL TABLET FOR SUSPENSION 1,000 MG SPRITAM ORAL TABLET FOR SUSPENSION 250 MG, 500 MG, 750 MG tiagabine oral tablet 2 mg, 4 mg (Gabitril) topiramate oral capsule, sprinkle 15 mg, 25 mg (Topamax) topiramate oral capsule,sprinkle,er 24hr 100 mg, 150 mg, 200 mg, 25 (Qudexy XR) mg, 50 mg topiramate oral tablet 100 mg, 200 mg, 25 mg, 50 mg (Topamax) ST; QL (90 per 30 ST; QL (270 per 30 ST; QL (60 per 30 ST; QL (120 per 30 41

56 TROKENDI XR ORAL CAPSULE,EXTENDED RELEASE 24HR 100 MG, 200 MG, 25 MG, 50 MG valproate sodium intravenous solution 500 mg/5 ml (100 mg/ml) (Depacon) valproic acid (as sodium salt) oral solution 250 mg/5 ml (Depakene) valproic acid oral capsule 250 mg (Depakene) VIMPAT INTRAVENOUS SOLUTION 200 MG/20 ML VIMPAT ORAL SOLUTION 10 MG/ML VIMPAT ORAL TABLET 100 MG, 150 MG, 200 MG, 50 MG zonisamide oral capsule 100 mg, 25 mg (Zonegran) zonisamide oral capsule 50 mg Antidementia Agents Antidementia Agents ST ST; QL (200 per 5 ST; QL (1200 per 30 ST; QL (60 per 30 donepezil oral tablet 10 mg, 23 mg, QL (30 per 30 (Aricept) 5 mg donepezil oral tablet,disintegrating QL (30 per mg, 5 mg galantamine oral capsule,ext rel. QL (30 per 30 (Razadyne ER) pellets 24 hr 16 mg, 24 mg, 8 mg galantamine oral solution 4 mg/ml QL (200 per 30 galantamine oral tablet 12 mg, 4 QL (60 per 30 (Razadyne) mg, 8 mg memantine oral solution 2 mg/ml (Namenda) QL (360 per 30 memantine oral tablet 10 mg, 5 mg (Namenda) QL (60 per 30 memantine oral tablets,dose pack 5- (Namenda Titration QL (49 per mg Pak) NAMENDA XR ORAL QL (28 per 28 CAP,SPRINKLE,ER 24HR DOSE PACK MG 42

57 NAMENDA XR ORAL QL (30 per 30 CAPSULE,SPRINKLE,ER 24HR 14 MG, 21 MG, 28 MG, 7 MG NAMZARIC ORAL QL (56 per 365 CAP,SPRINKLE,ER 24HR DOSE PACK 7/14/21/28 MG-10 MG NAMZARIC ORAL QL (30 per 30 CAPSULE,SPRINKLE,ER 24HR MG, MG, MG, 7-10 MG rivastigmine tartrate oral capsule QL (60 per mg, 3 mg, 4.5 mg, 6 mg rivastigmine transdermal patch 24 QL (30 per 30 hour 13.3 mg/24 hour, 4.6 mg/24 hr, 9.5 mg/24 hr (Exelon) Antidepressants Antidepressants amitriptyline oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg amoxapine oral tablet 100 mg, 150 mg, 25 mg, 50 mg BRINTELLIX ORAL TABLET 10 ST MG, 20 MG, 5 MG bupropion hcl oral tablet 100 mg, 75 mg bupropion hcl oral tablet extended release 100 mg, 150 mg, 200 mg (Wellbutrin SR) bupropion hcl oral tablet extended release 24 hr 150 mg, 300 mg (Wellbutrin XL) citalopram oral solution 10 mg/5 ml QL (600 per 30 citalopram oral tablet 10 mg, 20 QL (30 per 30 (Celexa) mg, 40 mg clomipramine oral capsule 25 mg, 50 mg, 75 mg (Anafranil) desipramine oral tablet 10 mg, 25 mg (Norpramin) desipramine oral tablet 100 mg, 150 mg, 50 mg, 75 mg 43

58 desvenlafaxine succinate oral tablet extended release 24 hr 100 mg, 25 mg, 50 mg (Pristiq) doxepin oral capsule 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg doxepin oral concentrate 10 mg/ml duloxetine oral capsule,delayed release(dr/ec) 20 mg, 60 mg (Cymbalta) duloxetine oral capsule,delayed release(dr/ec) 30 mg (Cymbalta) duloxetine oral capsule,delayed release(dr/ec) 40 mg (Irenka) EMSAM TRANSDERMAL PATCH 24 HOUR 12 MG/24 HR, 6 MG/24 HR, 9 MG/24 HR escitalopram oxalate oral solution 5 mg/5 ml (Lexapro) escitalopram oxalate oral tablet 10 mg, 20 mg, 5 mg (Lexapro) FETZIMA ORAL CAPSULE,EXT REL 24HR DOSE PACK 20 MG (2)- 40 MG (26) FETZIMA ORAL CAPSULE,EXTENDED RELEASE 24 HR 120 MG, 20 MG, 40 MG, 80 MG fluoxetine oral capsule 10 mg, 20 mg, 40 mg (Prozac) fluoxetine oral capsule,delayed release(dr/ec) 90 mg (Prozac Weekly) fluoxetine oral solution 20 mg/5 ml (4 mg/ml) fluoxetine oral tablet 10 mg, 20 mg (Sarafem) fluvoxamine oral capsule,extended release 24hr 100 mg, 150 mg fluvoxamine oral tablet 100 mg, 25 mg, 50 mg imipramine hcl oral tablet 10 mg, 25 (Tofranil) mg, 50 mg 44 ST; QL (30 per 30 (Cymbalta); QL (60 per 30 (Cymbalta); QL (30 per 30 (Irenka); QL (30 per 30 QL (30 per 30 ST ST

59 imipramine pamoate oral capsule 100 mg, 125 mg, 150 mg, 75 mg maprotiline oral tablet 25 mg, 50 mg, 75 mg MARPLAN ORAL TABLET 10 MG mirtazapine oral tablet 15 mg, 30 mg, 45 mg (Remeron) mirtazapine oral tablet 7.5 mg mirtazapine oral tablet,disintegrating 15 mg, 30 mg, (Remeron SolTab) 45 mg nefazodone oral tablet 100 mg, 150 mg, 200 mg, 250 mg, 50 mg nortriptyline oral capsule 10 mg, 25 mg, 50 mg, 75 mg (Pamelor) nortriptyline oral solution 10 mg/5 ml olanzapine-fluoxetine oral capsule mg, mg, 3-25 mg, 6-25 (Symbyax) mg, 6-50 mg paroxetine hcl oral tablet 10 mg, 20 mg, 30 mg, 40 mg (Paxil) paroxetine hcl oral tablet extended release 24 hr 12.5 mg, 25 mg, 37.5 (Paxil CR) mg PAXIL ORAL SUSPENSION 10 MG/5 ML perphenazine-amitriptyline oral tablet 2-10 mg, 2-25 mg, 4-10 mg, 4-25 mg, 4-50 mg phenelzine oral tablet 15 mg (Nardil) PRISTIQ ORAL TABLET EXTENDED RELEASE 24 HR 100 MG, 25 MG, 50 MG protriptyline oral tablet 10 mg, 5 mg sertraline oral concentrate 20 mg/ml (Zoloft) ST; QL (30 per 30 45

60 sertraline oral tablet 100 mg, 25 mg, 50 mg (Zoloft) SURMONTIL ORAL CAPSULE 100 MG, 25 MG, 50 MG tranylcypromine oral tablet 10 mg (Parnate) trazodone oral tablet 100 mg, 150 mg, 300 mg, 50 mg trimipramine oral capsule 100 mg, 25 mg, 50 mg (Surmontil) TRINTELLIX ORAL TABLET 10 MG, 20 MG, 5 MG venlafaxine oral capsule,extended release 24hr 150 mg, 37.5 mg, 75 (Effexor XR) mg venlafaxine oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg, 75 mg venlafaxine oral tablet extended release 24hr 150 mg, 37.5 mg, 75 mg VIIBRYD ORAL TABLET 10 MG, 20 MG, 40 MG VIIBRYD ORAL TABLETS,DOSE PACK 10 MG (7)- 20 MG (23) Antidiabetic Agents Antidiabetic Agents, Miscellaneous acarbose oral tablet 100 mg, 25 mg, 50 mg CYCLOSET ORAL TABLET 0.8 MG GLYXAMBI ORAL TABLET 10-5 MG, 25-5 MG INVOKAMET ORAL TABLET 150-1,000 MG, MG, 50-1,000 MG INVOKAMET ORAL TABLET MG (Precose) ST QL (90 per 30 QL (180 per 30 ST; QL (30 per 30 ST; QL (60 per 30 ST; QL (120 per 30 46

61 INVOKAMET XR ORAL TABLET, IR - ER, BIPHASIC 24HR 150-1,000 MG, MG, 50-1,000 MG, MG INVOKANA ORAL TABLET 100 MG INVOKANA ORAL TABLET 300 MG JANUMET ORAL TABLET 50-1,000 MG, MG JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 100-1,000 MG, 50-1,000 MG, MG JANUVIA ORAL TABLET 100 MG, 25 MG, 50 MG JARDIANCE ORAL TABLET 10 MG, 25 MG JENTADUETO ORAL TABLET 2.5-1,000 MG, MG, MG JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 2.5-1,000 MG, 5-1,000 MG KORLYM ORAL TABLET 300 MG 47 ST; QL (60 per 30 ST; QL (60 per 30 ST; QL (30 per 30 ST; QL (30 per 30 PA; QL (112 per 28 metformin oral tablet 1,000 mg (Glucophage) QL (75 per 30 metformin oral tablet 500 mg (Glucophage) QL (150 per 30 metformin oral tablet 850 mg (Glucophage) QL (90 per 30 metformin oral tablet extended QL (120 per 30 (Glucophage XR) release 24 hr 500 mg metformin oral tablet extended QL (90 per 30 (Glucophage XR) release 24 hr 750 mg metformin oral tablet extended ST; QL (60 per 30 (Fortamet) release 24hr 1,000 mg metformin oral tablet extended ST; QL (120 per 30 (Fortamet) release 24hr 500 mg miglitol oral tablet 100 mg, 25 mg, 50 mg (Glyset) QL (90 per 30

62 nateglinide oral tablet 120 mg, 60 QL (90 per 30 (Starlix) mg pioglitazone oral tablet 15 mg, 30 QL (30 per 30 (Actos) mg, 45 mg pioglitazone-glimepiride oral tablet QL (30 per 30 (DUETACT) 30-2 mg, 30-4 mg pioglitazone-metformin oral tablet QL (90 per 30 (Actoplus MET) mg, mg repaglinide oral tablet 0.5 mg QL (240 per 30 repaglinide oral tablet 1 mg, 2 mg (Prandin) QL (240 per 30 repaglinide-metformin oral tablet 1- QL (150 per mg, mg SYMLINPEN 120 SUBCUTANEOUS PEN PA; QL (10.8 per 28 INJECTOR 2,700 MCG/2.7 ML SYMLINPEN 60 SUBCUTANEOUS PEN PA; QL (6 per 28 INJECTOR 1,500 MCG/1.5 ML SYNJARDY ORAL TABLET ,000 MG, MG, 5-1,000 MG, MG TRADJENTA ORAL TABLET 5 MG TRULICITY SUBCUTANEOUS PEN INJECTOR 0.75 MG/0.5 ML, 1.5 MG/0.5 ML VICTOZA Insulins HUMULIN R U-500 (CONC) KWIKPEN SUBCUTANEOUS INSULIN PEN 500 UNIT/ML (3 ML) HUMULIN R U-500 (CONCENTRATED) SUBCUTANEOUS SOLUTION 500 UNIT/ML LANTUS SOLOSTAR SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (3 ML) 48 ST; QL (60 per 30 QL (24 per 28 QL (40 per 28 QL (30 per 28

63 LANTUS SUBCUTANEOUS QL (40 per 28 SOLUTION 100 UNIT/ML NOVOLIN 70/30 QL (40 per 28 SUBCUTANEOUS SUSPENSION 100 UNIT/ML (70-30) NOVOLIN N SUBCUTANEOUS QL (40 per 28 SUSPENSION 100 UNIT/ML NOVOLIN R INJECTION QL (40 per 28 SOLUTION 100 UNIT/ML NOVOLOG FLEXPEN QL (30 per 28 SUBCUTANEOUS INSULIN PEN 100 UNIT/ML NOVOLOG MIX FLEXPEN QL (30 per 28 SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (70-30) NOVOLOG MIX QL (40 per 28 SUBCUTANEOUS SOLUTION 100 UNIT/ML (70-30) NOVOLOG PENFILL QL (30 per 28 SUBCUTANEOUS CARTRIDGE 100 UNIT/ML NOVOLOG SUBCUTANEOUS QL (40 per 28 SOLUTION 100 UNIT/ML TOUJEO SOLOSTAR SUBCUTANEOUS INSULIN PEN 300 UNIT/ML (1.5 ML) Sulfonylureas glimepiride oral tablet 1 mg, 2 mg (Amaryl) QL (30 per 30 glimepiride oral tablet 4 mg (Amaryl) QL (60 per 30 glipizide oral tablet 10 mg (Glucotrol) QL (120 per 30 glipizide oral tablet 5 mg (Glucotrol) QL (60 per 30 glipizide oral tablet extended QL (60 per 30 (Glucotrol XL) release 24hr 10 mg glipizide oral tablet extended QL (30 per 30 (Glucotrol XL) release 24hr 2.5 mg, 5 mg glipizide-metformin oral tablet 2.5- QL (240 per mg 49

64 glipizide-metformin oral tablet 2.5- QL (120 per mg, mg glyburide micronized oral tablet 1.5 PA-HRM; AGE (Max (Glynase) mg, 3 mg, 6 mg 64 Years) glyburide oral tablet 1.25 mg, 2.5 PA-HRM; AGE (Max mg, 5 mg 64 Years) glyburide-metformin oral tablet PA-HRM; AGE (Max mg 64 Years) glyburide-metformin oral tablet 2.5- PA-HRM; AGE (Max (Glucovance) 500 mg, mg 64 Years) tolazamide oral tablet 250 mg QL (120 per 30 tolazamide oral tablet 500 mg QL (60 per 30 tolbutamide oral tablet 500 mg QL (180 per 30 Antifungals Antifungals 3-day vaginal cream 2 % ABELCET INTRAVENOUS SUSPENSION 5 MG/ML aloe vesta 2% antifungal oint 12's 2 % AMBISOME INTRAVENOUS SUSPENSION FOR RECONSTITUTION 50 MG amphotericin b injection recon soln 50 mg anti-fungal 1% powder 1 % antifungal 2% cream 2 % baza antifungal 2% cream 12's 2 % blis-to-sol 1% liquid 1 % CANCIDAS INTRAVENOUS RECON SOLN 50 MG, 70 MG ciclopirox topical cream 0.77 % (Ciclodan) ciclopirox topical gel 0.77 % ciclopirox topical shampoo 1 % (Loprox) ciclopirox topical solution 8 % (Penlac) ciclopirox topical suspension 0.77 % (Loprox (as olamine)) 50

65 clotrim 1% vaginal cream 1 % (Clotrimazole-7) clotrimazole 1% cream (otc) 1 % (Clotrimazole AF) clotrimazole 1% solution (otc) 1 % clotrimazole insert 100 mg clotrimazole mucous membrane troche 10 mg clotrimazole topical cream 1 % (Clotrimazole AF) clotrimazole topical solution 1 % clotrimazole-7 cream 1 % clotrimazole-betamethasone topical cream % (Lotrisone) clotrimazole-betamethasone topical lotion % critic-aid clear af 2% oint 12's, w/ antifungal 2 % cvs miconazole 3 combo pack 3pref applic w/cream 4 % (200 mg)- 2 % (9 gram) (Monistat 3) dermafungal 2% ointment 2 % econazole topical cream 1 % fluconazole in nacl (iso-osm) intravenous piggyback 100 mg/50 ml, 200 mg/100 ml, 400 mg/200 ml fluconazole oral suspension for reconstitution 10 mg/ml, 40 mg/ml (Diflucan) fluconazole oral tablet 100 mg, 150 mg, 200 mg, 50 mg (Diflucan) flucytosine oral capsule 250 mg, 500 mg (Ancobon) fungi cure intensive 1% spray 1 % fungoid-d 1% cream 1 % griseofulvin microsize oral tablet 500 mg inzo antifungal 2% cream 2 % itraconazole oral capsule 100 mg (Sporanox) ketoconazole oral tablet 200 mg ketoconazole topical cream 2 % 51

66 ketoconazole topical shampoo 2 % (Nizoral) lamisil af defens 1% spray pwd 1 % lamisil af defense 1% powder 1 % LAMISIL ANTIFUNGAL 1% SPRAY FOR ATHLETES FOOT 1 % LAMISIL AT 1% GEL 1 % micatin 2% antifungal cream 2 % miconazole 3 combo pack 3 sup,9gm crm w/app 200 mg- 2 % (9 gram) miconazole mg vag supp 100 mg miconazole nitrate 2% cream 2 % (Monistat 7) miconazole-3 vaginal suppository 200 mg MONISTAT 3 COMBO PACK 4 % (200 MG)- 2 % (9 GRAM) monistat 7 cream 7 applicators 2 % NOXAFIL ORAL SUSPENSION 200 MG/5 ML (40 MG/ML) NOXAFIL ORAL TABLET,DELAYED RELEASE (DR/EC) 100 MG nyamyc topical powder 100,000 unit/gram nyata topical powder 100,000 unit/gram nystatin oral suspension 100,000 unit/ml nystatin oral tablet 500,000 unit nystatin topical cream 100,000 unit/gram nystatin topical ointment 100,000 unit/gram nystatin topical powder 100,000 unit/gram (Nystop) 52

67 nystatin-triamcinolone topical cream 100, unit/g-% nystatin-triamcinolone topical ointment 100, unit/gram-% nystop topical powder 100,000 unit/gram pv foot odor control 1% powder 1 % qc 3 day vaginal 4% cream 200 mg/5 gram (4 %) ra antifungal 1% liquid spray liquid spray 1 % remedy phytplx antifungal oint 2 % terbinafine 1% cream 1 % (Lamisil AT) terbinafine hcl oral tablet 250 mg (Lamisil) tolnaftate 1% cream 1 % (Fungoid-D) tolnaftate 1% solution 1 % (Blis-To-Sol (tolnaftate)) tolnaftate 1% spray powder 1 % (Antifungal Spray) triple paste af 2% ointment 2 % vagistat-3 combo pack 200 mg- 2 % (9 gram) voriconazole intravenous solution 200 mg (Vfend IV) voriconazole oral suspension for reconstitution 200 mg/5 ml (40 (Vfend) mg/ml) voriconazole oral tablet 200 mg, 50 mg (Vfend) Antigout Agents Antigout Agents, Other allopurinol oral tablet 100 mg, 300 mg (Zyloprim) COLCRYS ORAL TABLET 0.6 MG probenecid oral tablet 500 mg 53

68 probenecid-colchicine oral tablet mg ULORIC ORAL TABLET 40 MG, QL (30 per MG ZURAMPIC ORAL TABLET 200 ST; QL (30 per 30 MG Antihistamines Antihistamines alavert 10 mg odt non-drowsy, mint 10 mg alavert d-12 allergy-sinus tab mg aller-chlor 2 mg/5 ml syrup 2 mg/5 ml aller-chlor 4 mg tablet 4 mg allerclear d-12hr tablet mg allerclear d-24hr er tablet nondrowsy mg allergy 4 mg tablet 4 mg aller-tec d mg tablet mg ambi 60pse-4cpm tablet 4-60 mg aprodine tablet mg banophen 25 mg capsule 25 mg banophen 25 mg tablet 25 mg banophen allergy 12.5 mg/5 ml a/f 12.5 mg/5 ml benadryl allergy 25 mg ultratb ultratab 25 mg cetirizine hcl 1 mg/1 ml soln (All Day Allergy children, s/f, grape (otc) 1 mg/ml (cetirizine)) cetirizine hcl 10 mg chew tab (Children's children's,outer,u-d 10 mg Cetirizine) cetirizine hcl 10 mg tablet 10 mg (24Hour Allergy) cetirizine hcl 5 mg chew tab (Children's children's,outer,u-d 5 mg Cetirizine) cetirizine-pse er mg tab (Allergy-Congest mg Relief-D (cet)) 54

69 child allegra allergy 30 mg/5 ml suspension 30 mg/5 ml child loratadine 5 mg/5 ml syr (Wal-itin) grape, s/f 5 mg/5 ml child triaminic cold & allergy mg/5 ml child wal-tap cold-allergy elx mg/5 ml child wal-zyr 1 mg/ml solution cherry 1 mg/ml children's wal-fex 30 mg/5 ml 30 mg/5 ml CHILDREN'S ZYRTEC 10 MG ODT 10 MG child's aller-tec 1 mg/ml soln 1 mg/ml CHILD'S CLARITIN 5 MG TAB CHEW 5 MG child's wal-zyr 10 mg chew tab 10 mg CLARITIN 10 MG LIQUI-GEL CAP 10 MG CLARITIN 5 MG REDITABS 5 MG cold-allergy-sinus oral tablet mg compoz 25 mg gelcap 25 mg cvs allergy relief 10 mg sftgl 10 mg cvs cold & cough nighttime liq mg/5 ml cvs loratadine-d 24hr tablet nondrowsy mg cyproheptadine oral syrup 2 mg/5 ml cyproheptadine oral tablet 4 mg dailyhist mg tablet 1.34 mg 55

70 dayhist allergy 1.34 mg tablet 12 hr relief 1.34 mg dimaphen elixir a/f, grape, gluten-f mg/5 ml dimetapp cold & congest liquid mg/5 ml diphenhist 12.5 mg/5 ml soln 12.5 mg/5 ml diphenhist 25 mg capsule 25 mg diphenhist 25 mg captab captab 25 mg diphenhydramine 25 mg capsule (Q-Dryl) (otc) 25 mg diphenhydramine 50 mg capsule (Sleep Aid Max Str (otc) 50 mg (diphenhydr)) diphenhydramine hcl injection solution 50 mg/ml ed chlorped jr syrup 2 mg/5 ml ed-a-hist 4 mg-10 mg tablet 4-10 mg eq allergy relief 25 mg tablet 25 mg fexofenadine hcl 180 mg tablet 24 (Aller-Fex) hour, non-drowsy (otc) 180 mg fexofenadine hcl 30 mg/5 ml 30 (Aller-ease) mg/5 ml fexofenadine hcl 60 mg tablet (Wal-Fex Allergy) indoor/outdoor (otc) 60 mg hm z-sleep 25 mg softgel 25 mg hydroxyzine hcl intramuscular solution 25 mg/ml, 50 mg/ml hydroxyzine hcl oral solution 10 mg/5 ml hydroxyzine hcl oral tablet 10 mg, 25 mg, 50 mg levocetirizine oral solution 2.5 mg/5 ml (Xyzal) levocetirizine oral tablet 5 mg (Xyzal) 56

71 loratadine 10 mg tablet 10 mg (Loradamed) loratadine-d 12 hour tablet nondrowsy mg promethazine oral syrup 6.25 mg/5 PA-HRM; AGE (Max ml 64 Years) pv nyt-time sleep 25 mg caplet 25 mg q-dryl 12.5 mg/5 ml liquid a/f,unboxed 12.5 mg/5 ml ra sleep aid 50 mg/30 ml liq 50 mg/30 ml siladryl 12.5 mg/5 ml liquid 12.5 mg/5 ml simply sleep 25 mg caplet caplet 25 mg sleep aid 25 mg tablet 25 mg sm allergy relief 1.34 mg tab 1.34 mg sm sinus and allergy tablet maximum strength 4-60 mg sm z-sleep 50 mg/30 ml liquid berry,gluten-free 50 mg/30 ml sudogest sinus & allergy tab 4-60 mg unisom 50 mg sleepgels softgel 50 mg unisom 50 mg/30 ml liquid 50 mg/30 ml unisom sleep aid 25 mg tablet 25 mg vicks qlearquil night 25 mg 25 mg wal-act d cold & allergy tab mg wal-dryl allergy 12.5 mg/5 ml children,a/f,s/f,d/f 12.5 mg/5 ml wal-dryl allergy 25 mg capsule 25 mg 57

72 wal-dryl allergy 25 mg minitab minitab, coated 25 mg wal-fex allergy 180 mg tablet 180 mg wal-fex allergy 60 mg tablet 60 mg wal-finate 4 mg tablet 4 mg wal-finate-d tablet 4-60 mg wal-itin 10 mg odt non-drowsy 10 mg wal-itin 10 mg tablet non-drowsy,24 hr rlf 10 mg wal-itin 5 mg/5 ml syrup children's, grape 5 mg/5 ml wal-itin d 12 hour tablet mg wal-itin d 24 hour tablet mg wal-phed pe sinus-allergy tab 4-10 mg wal-phed sinus and allergy tab 4-60 mg wal-sleep z 25 mg odt 25 mg wal-sleep z 25 mg softgel 25 mg wal-sleep z 50 mg/30 ml liquid berry, a/f, d/f, s/f 50 mg/30 ml wal-som 25 mg odt 25 mg wal-som 25 mg tablet 25 mg wal-som 50 mg softgel softgel 50 mg wal-tap elixir mg/5 ml wal-zyr 10 mg tablet 10 mg wal-zyr d tablet 12 hr relief mg ZYRTEC 10 MG ODT 10 MG Anti-Infectives (Skin And Mucous Membrane) Anti-Infectives (Skin And Mucous Membrane) 58

73 ABREVA 10% CREAM 10 % AVC VAGINAL VAGINAL CREAM 15 % clindamycin phosphate vaginal cream 2 % (Cleocin) metronidazole vaginal gel 0.75 % (Metrogel Vaginal) terconazole vaginal cream 0.4 % (Terazol 7) terconazole vaginal cream 0.8 % terconazole vaginal suppository 80 mg Antimigraine Agents Antimigraine Agents dihydroergotamine injection QL (30 per 28 (D.H.E.45) solution 1 mg/ml dihydroergotamine nasal spray,nonaerosol 0.5 mg/pump act. (4 mg/ml) QL (8 per 28 (Migranal) ERGOMAR SUBLINGUAL QL (40 per 28 TABLET 2 MG naratriptan oral tablet 1 mg, 2.5 mg (Amerge) QL (18 per 28 rizatriptan oral tablet 10 mg, 5 mg (Maxalt) QL (18 per 28 rizatriptan oral tablet,disintegrating QL (18 per 28 (Maxalt-MLT) 10 mg, 5 mg sumatriptan nasal spray,nonaerosol QL (12 per mg/actuation, 5 mg/actuation (Imitrex) sumatriptan succinate oral tablet QL (18 per 28 (Imitrex) 100 mg, 25 mg, 50 mg sumatriptan succinate subcutaneous (Imitrex STATdose QL (4 per 28 cartridge 4 mg/0.5 ml, 6 mg/0.5 ml Kit Refill) sumatriptan succinate subcutaneous QL (4 per 28 (Imitrex STATdose pen injector 4 mg/0.5 ml, 6 mg/0.5 Pen) ml sumatriptan succinate subcutaneous QL (4 per 28 (Imitrex) solution 6 mg/0.5 ml sumatriptan succinate subcutaneous QL (4 per 28 syringe 6 mg/0.5 ml zolmitriptan oral tablet 2.5 mg, 5 QL (12 per 28 (Zomig) mg 59

74 zolmitriptan oral tablet,disintegrating 2.5 mg, 5 mg (Zomig ZMT) Antimycobacterials Antimycobacterials CAPASTAT INJECTION RECON SOLN 1 GRAM dapsone oral tablet 100 mg, 25 mg ethambutol oral tablet 100 mg ethambutol oral tablet 400 mg (Myambutol) isoniazid oral solution 50 mg/5 ml isoniazid oral tablet 100 mg, 300 mg PASER ORAL GRANULES DR FOR SUSP IN PACKET 4 GRAM PRIFTIN ORAL TABLET 150 MG pyrazinamide oral tablet 500 mg rifabutin oral capsule 150 mg (Mycobutin) rifampin intravenous recon soln 600 mg (Rifadin) rifampin oral capsule 150 mg, 300 mg (Rifadin) RIFATER ORAL TABLET MG SIRTURO ORAL TABLET 100 MG TRECATOR ORAL TABLET 250 MG Antinausea Agents Antinausea Agents AKYNZEO ORAL CAPSULE MG aprepitant oral capsule 125 mg, 40 mg, 80 mg (Emend) aprepitant oral capsule,dose pack 125 mg (1)- 80 mg (2) (Emend) compro rectal suppository 25 mg QL (12 per 28 PA; QL (188 per

75 cvs motion sickness 50 mg tab 50 mg cvs motion sickness relief tab chewable tablet 25 mg dimenhydrinate injection solution 50 mg/ml dramamine 50 mg tablet 50 mg dramamine less drowsy 25 mg tb 25 mg driminate 50 mg tablet 50 mg dronabinol oral capsule 10 mg, 2.5 PA (Marinol) mg, 5 mg EMEND INTRAVENOUS RECON QL (2 per 28 SOLN 150 MG EMEND ORAL CAPSULE 125 MG, 40 MG, 80 MG EMEND ORAL CAPSULE,DOSE PACK 125 MG (1)- 80 MG (2) EMEND ORAL SUSPENSION FOR RECONSTITUTION 125 MG (25 MG/ ML FINAL CONC.) granisetron (pf) intravenous solution 100 mcg/ml granisetron hcl intravenous solution 1 mg/ml, 1 mg/ml (1 ml) granisetron hcl oral tablet 1 mg meclizine 12.5 mg caplet caplet (otc) 12.5 mg meclizine 25 mg tablet (otc) 25 mg (Medi-Meclizine) meclizine oral tablet 12.5 mg meclizine oral tablet 25 mg (Medi-Meclizine) medi-meclizine 25 mg tablet outer, f/c 25 mg ondansetron hcl (pf) injection solution 4 mg/2 ml ondansetron hcl (pf) injection syringe 4 mg/2 ml 61

76 ondansetron hcl oral solution 4 (Zofran (as mg/5 ml hydrochloride)) ondansetron hcl oral tablet 24 mg ondansetron hcl oral tablet 4 mg, 8 (Zofran (as mg hydrochloride)) ondansetron oral (Zofran ODT) tablet,disintegrating 4 mg, 8 mg phenadoz rectal suppository 12.5 PA-HRM; AGE (Max mg, 25 mg 64 Years) prochlorperazine edisylate injection solution 10 mg/2 ml (5 mg/ml) prochlorperazine maleate oral tablet 10 mg, 5 mg (Compazine) prochlorperazine rectal suppository 25 mg (Compazine) promethazine oral tablet 12.5 mg, PA-HRM; AGE (Max 25 mg, 50 mg 64 Years) promethazine rectal suppository PA-HRM; AGE (Max (Promethegan) 12.5 mg 64 Years) promethazine rectal suppository 25 PA-HRM; AGE (Max (Phenadoz) mg 64 Years) promethazine rectal suppository 50 PA-HRM; AGE (Max (Phenergan) mg 64 Years) promethegan rectal suppository PA-HRM; AGE (Max 12.5 mg, 25 mg, 50 mg 64 Years) ra motion sickness rlf tb chew raspberry flavor 25 mg TRANSDERM-SCOP QL (10 per 30 TRANSDERMAL PATCH 3 DAY 1.5 MG (1 MG OVER 3 DAYS) travel sickness 25 mg tab chew 25 mg wal-dram 50 mg tablet 50 mg Antiparasite Agents Antiparasite Agents ALBENZA ORAL TABLET 200 MG 62

77 ALINIA ORAL SUSPENSION FOR RECONSTITUTION 100 MG/5 ML ALINIA ORAL TABLET 500 MG atovaquone oral suspension 750 mg/5 ml (Mepron) atovaquone-proguanil oral tablet mg (Malarone) atovaquone-proguanil oral tablet (Malarone mg Pediatric) chloroquine phosphate oral tablet 250 mg, 500 mg COARTEM ORAL TABLET MG DARAPRIM ORAL TABLET 25 MG hydroxychloroquine oral tablet 200 mg (Plaquenil) ivermectin oral tablet 3 mg (Stromectol) mefloquine oral tablet 250 mg NEBUPENT INHALATION RECON SOLN 300 MG paromomycin oral capsule 250 mg PENTAM INJECTION RECON SOLN 300 MG PRIMAQUINE ORAL TABLET 26.3 MG 63 PA QL (90 per 30 quinine sulfate oral capsule 324 mg (Qualaquin) PA; QL (42 per 7 Antiparkinsonian Agents Antiparkinsonian Agents amantadine hcl oral capsule 100 mg amantadine hcl oral solution 50 mg/5 ml amantadine hcl oral tablet 100 mg APOKYN SUBCUTANEOUS CARTRIDGE 10 MG/ML AZILECT ORAL TABLET 0.5 MG, 1 MG QL (60 per 30

78 benztropine oral tablet 0.5 mg, 1 mg, 2 mg bromocriptine oral capsule 5 mg (Parlodel) bromocriptine oral tablet 2.5 mg (Parlodel) cabergoline oral tablet 0.5 mg carbidopa oral tablet 25 mg (Lodosyn) carbidopa-levodopa oral tablet mg, mg, mg (Sinemet) carbidopa-levodopa oral tablet extended release mg, (Sinemet CR) mg carbidopa-levodopa-entacapone oral tablet mg (Stalevo 50) carbidopa-levodopa-entacapone oral tablet mg (Stalevo 75) carbidopa-levodopa-entacapone oral tablet mg (Stalevo 100) carbidopa-levodopa-entacapone oral tablet mg (Stalevo 125) carbidopa-levodopa-entacapone oral tablet mg (Stalevo 150) carbidopa-levodopa-entacapone oral tablet mg (Stalevo 200) entacapone oral tablet 200 mg (Comtan) NEUPRO TRANSDERMAL PATCH 24 HOUR 1 MG/24 HOUR, 2 MG/24 HOUR, 3 MG/24 HOUR, 4 MG/24 HOUR, 6 MG/24 HOUR, 8 MG/24 HOUR pramipexole oral tablet mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 (Mirapex) mg rasagiline oral tablet 0.5 mg, 1 mg (Azilect) ropinirole oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg (Requip) ropinirole oral tablet extended release 24 hr 12 mg, 2 mg, 4 mg, 6 (Requip XL) mg, 8 mg PA-HRM; AGE (Max 64 Years) QL (30 per 30 64

79 selegiline hcl oral capsule 5 mg (Eldepryl) selegiline hcl oral tablet 5 mg trihexyphenidyl oral elixir 0.4 mg/ml trihexyphenidyl oral tablet 2 mg, 5 mg Antipsychotic Agents Antipsychotic Agents ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON 300 MG, 400 MG ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING 300 MG, 400 MG 65 PA-HRM; AGE (Max 64 Years) PA-HRM; AGE (Max 64 Years) QL (1 per 28 QL (1 per 28 aripiprazole oral solution 1 mg/ml QL (900 per 30 aripiprazole oral tablet 10 mg, 15 QL (30 per 30 (Abilify) mg, 20 mg, 30 mg, 5 mg aripiprazole oral tablet 2 mg (Abilify) QL (60 per 30 aripiprazole oral QL (90 per 30 tablet,disintegrating 10 mg aripiprazole oral QL (60 per 30 tablet,disintegrating 15 mg ARISTADA INTRAMUSCULAR QL (1.6 per 28 SUSPENSION,EXTENDED REL SYRING 441 MG/1.6 ML ARISTADA INTRAMUSCULAR QL (2.4 per 28 SUSPENSION,EXTENDED REL SYRING 662 MG/2.4 ML ARISTADA INTRAMUSCULAR QL (3.2 per 28 SUSPENSION,EXTENDED REL SYRING 882 MG/3.2 ML chlorpromazine injection solution 25 mg/ml chlorpromazine oral tablet 10 mg, 100 mg, 200 mg, 25 mg, 50 mg clozapine oral tablet 100 mg (Clozaril) QL (270 per 30

80 clozapine oral tablet 200 mg QL (135 per 30 clozapine oral tablet 25 mg (Clozaril) QL (90 per 30 clozapine oral tablet 50 mg QL (90 per 30 clozapine oral tablet,disintegrating 100 mg, 12.5 mg, 150 mg, 200 mg, 25 mg (FazaClo) ST FANAPT ORAL TABLET 1 MG, 10 MG, 12 MG, 2 MG, 4 MG, 6 MG, 8 MG FANAPT ORAL TABLETS,DOSE PACK 1MG(2)-2MG(2)- 4MG(2)- 6MG(2) fluphenazine decanoate injection solution 25 mg/ml fluphenazine hcl injection solution 2.5 mg/ml fluphenazine hcl oral concentrate 5 mg/ml fluphenazine hcl oral elixir 2.5 mg/5 ml fluphenazine hcl oral tablet 1 mg, 10 mg, 2.5 mg, 5 mg GEODON INTRAMUSCULAR RECON SOLN 20 MG/ML (FINAL CONC.) haloperidol dec 50 mg/ml vial 50 mg/ml haloperidol decanoate intramuscular solution 100 mg/ml haloperidol decanoate intramuscular solution 50 mg/ml haloperidol lactate injection solution 5 mg/ml haloperidol lactate oral concentrate 2 mg/ml haloperidol oral tablet 0.5 mg, 1 mg, 10 mg, 2 mg, 20 mg, 5 mg (Haldol Decanoate) (Haldol Decanoate) (Haldol Decanoate) (Haldol) ST; QL (60 per 30 ST; QL (8 per 28 QL (6 per 28 66

81 INVEGA SUSTENNA QL (0.75 per 28 INTRAMUSCULAR SYRINGE 117 MG/0.75 ML INVEGA SUSTENNA QL (1 per 28 INTRAMUSCULAR SYRINGE 156 MG/ML INVEGA SUSTENNA QL (1.5 per 28 INTRAMUSCULAR SYRINGE 234 MG/1.5 ML INVEGA SUSTENNA QL (0.25 per 28 INTRAMUSCULAR SYRINGE 39 MG/0.25 ML INVEGA SUSTENNA QL (0.5 per 28 INTRAMUSCULAR SYRINGE 78 MG/0.5 ML INVEGA TRINZA QL (0.875 per 84 INTRAMUSCULAR SYRINGE 273 MG/0.875 ML INVEGA TRINZA QL (1.315 per 84 INTRAMUSCULAR SYRINGE 410 MG/1.315 ML INVEGA TRINZA QL (1.75 per 84 INTRAMUSCULAR SYRINGE 546 MG/1.75 ML INVEGA TRINZA QL (2.625 per 84 INTRAMUSCULAR SYRINGE 819 MG/2.625 ML LATUDA ORAL TABLET 120 QL (30 per 30 MG, 20 MG, 40 MG, 60 MG, 80 MG loxapine succinate oral capsule 10 mg, 25 mg, 5 mg, 50 mg molindone oral tablet 10 mg QL (240 per 30 molindone oral tablet 25 mg QL (270 per 30 molindone oral tablet 5 mg QL (120 per 30 NUPLAZID ORAL TABLET 17 PA NSO; QL (60 per MG 30 olanzapine intramuscular recon soln QL (30 per 30 (Zyprexa) 10 mg 67

82 olanzapine oral tablet 10 mg, 15 QL (30 per 30 (Zyprexa) mg, 2.5 mg, 20 mg, 5 mg, 7.5 mg olanzapine oral tablet,disintegrating QL (30 per 30 (Zyprexa Zydis) 10 mg, 15 mg, 20 mg, 5 mg paliperidone oral tablet extended QL (30 per 30 (Invega) release 24hr 1.5 mg, 3 mg, 9 mg paliperidone oral tablet extended QL (60 per 30 (Invega) release 24hr 6 mg perphenazine oral tablet 16 mg, 2 mg, 4 mg, 8 mg pimozide oral tablet 1 mg, 2 mg (Orap) quetiapine oral tablet 100 mg, 200 QL (90 per 30 (Seroquel) mg, 25 mg, 300 mg, 400 mg, 50 mg quetiapine oral tablet extended release 24 hr 150 mg, 300 mg, 400 mg, 50 mg (Seroquel XR) ST; QL (60 per 30 quetiapine oral tablet extended ST; QL (30 per 30 (Seroquel XR) release 24 hr 200 mg REXULTI ORAL TABLET 0.25 ST; QL (120 per 30 MG REXULTI ORAL TABLET 0.5 MG ST; QL (60 per 30 REXULTI ORAL TABLET 1 MG, ST; QL (30 per 30 2 MG, 3 MG, 4 MG RISPERDAL CONSTA QL (4 per 28 INTRAMUSCULAR SYRINGE 12.5 MG/2 ML, 25 MG/2 ML, 37.5 MG/2 ML, 50 MG/2 ML risperidone oral solution 1 mg/ml (Risperdal) QL (480 per 30 risperidone oral tablet 0.25 mg, 0.5 QL (60 per 30 (Risperdal) mg, 1 mg, 2 mg, 3 mg, 4 mg risperidone oral QL (60 per 30 tablet,disintegrating 0.25 mg risperidone oral QL (60 per 30 (Risperdal M- tablet,disintegrating 0.5 mg, 1 mg, 2 TAB) mg risperidone oral (Risperdal M- QL (120 per 30 tablet,disintegrating 3 mg, 4 mg TAB) 68

83 SAPHRIS (BLACK CHERRY) SUBLINGUAL TABLET 10 MG, 2.5 MG, 5 MG SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HR 300 MG, 400 MG thioridazine oral tablet 10 mg, 100 mg, 25 mg, 50 mg thiothixene oral capsule 1 mg, 10 mg, 2 mg, 5 mg trifluoperazine oral tablet 1 mg, 10 mg, 2 mg, 5 mg VERSACLOZ ORAL SUSPENSION 50 MG/ML VRAYLAR ORAL CAPSULE 1.5 MG, 3 MG, 4.5 MG, 6 MG VRAYLAR ORAL CAPSULE,DOSE PACK 1.5 MG (1)- 3 MG (6) ziprasidone hcl oral capsule 20 mg, 40 mg, 60 mg, 80 mg ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 210 MG, 300 MG ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 405 MG (Geodon) Antivirals (Systemic) Antiretrovirals abacavir oral tablet 300 mg (Ziagen) abacavir-lamivudine oral tablet mg abacavir-lamivudine-zidovudine oral tablet mg (Epzicom) (Trizivir) ST; QL (60 per 30 ST; QL (60 per 30 PA NSO-HRM; AGE (Max 64 Years) ST; QL (540 per 30 ST; QL (30 per 30 ST; QL (7 per 30 QL (60 per 30 QL (2 per 28 QL (1 per 28 69

84 APTIVUS ORAL CAPSULE 250 MG APTIVUS ORAL SOLUTION 100 MG/ML ATRIPLA ORAL TABLET MG COMPLERA ORAL TABLET MG CRIXIVAN ORAL CAPSULE 200 MG, 400 MG DESCOVY ORAL TABLET MG didanosine oral capsule,delayed release(dr/ec) 125 mg, 200 mg, 250 mg, 400 mg EDURANT ORAL TABLET 25 MG EMTRIVA ORAL CAPSULE 200 MG EMTRIVA ORAL SOLUTION 10 MG/ML EPIVIR HBV ORAL SOLUTION 25 MG/5 ML (5 MG/ML) EPZICOM ORAL TABLET MG EVOTAZ ORAL TABLET MG FUZEON SUBCUTANEOUS RECON SOLN 90 MG GENVOYA ORAL TABLET MG INTELENCE ORAL TABLET 100 MG, 200 MG, 25 MG INVIRASE ORAL CAPSULE 200 MG INVIRASE ORAL TABLET 500 MG (Videx EC) 70

85 ISENTRESS ORAL POWDER IN PACKET 100 MG ISENTRESS ORAL TABLET 400 MG ISENTRESS ORAL TABLET,CHEWABLE 100 MG, 25 MG KALETRA ORAL SOLUTION MG/5 ML KALETRA ORAL TABLET MG, MG lamivudine oral solution 10 mg/ml (Epivir) lamivudine oral tablet 100 mg (Epivir HBV) lamivudine oral tablet 150 mg, 300 mg (Epivir) lamivudine-zidovudine oral tablet mg (Combivir) LEXIVA ORAL SUSPENSION 50 MG/ML LEXIVA ORAL TABLET 700 MG lopinavir-ritonavir oral solution mg/5 ml (Kaletra) nevirapine oral suspension 50 mg/5 ml (Viramune) nevirapine oral tablet 200 mg (Viramune) nevirapine oral tablet extended release 24 hr 100 mg, 400 mg (Viramune XR) NORVIR ORAL CAPSULE 100 MG NORVIR ORAL SOLUTION 80 MG/ML NORVIR ORAL TABLET 100 MG ODEFSEY ORAL TABLET MG PREZCOBIX ORAL TABLET MG-MG PREZISTA ORAL SUSPENSION 100 MG/ML 71

86 PREZISTA ORAL TABLET 150 MG, 400 MG, 600 MG, 75 MG, 800 MG RESCRIPTOR ORAL TABLET 200 MG RESCRIPTOR ORAL TABLET, DISPERSIBLE 100 MG RETROVIR INTRAVENOUS SOLUTION 10 MG/ML REYATAZ ORAL CAPSULE 150 MG, 200 MG, 300 MG REYATAZ ORAL POWDER IN PACKET 50 MG SELZENTRY ORAL TABLET 150 MG, 25 MG, 300 MG, 75 MG stavudine oral capsule 15 mg, 20 mg, 30 mg, 40 mg (Zerit) stavudine oral recon soln 1 mg/ml (Zerit) STRIBILD ORAL TABLET MG SUSTIVA ORAL CAPSULE 200 MG, 50 MG SUSTIVA ORAL TABLET 600 MG TIVICAY ORAL TABLET 10 MG, 25 MG, 50 MG TRIUMEQ ORAL TABLET MG TRUVADA ORAL TABLET MG, MG, MG, MG VIDEX 2 GRAM PEDIATRIC ORAL RECON SOLN 10 MG/ML (FINAL) VIRACEPT ORAL TABLET 250 MG, 625 MG VIREAD ORAL POWDER 40 MG/SCOOP (40 MG/GRAM) 72

87 VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG, 300 MG VITEKTA ORAL TABLET 150 MG, 85 MG ZERIT ORAL RECON SOLN 1 MG/ML ZIAGEN ORAL SOLUTION 20 MG/ML zidovudine oral capsule 100 mg (Retrovir) zidovudine oral syrup 10 mg/ml (Retrovir) zidovudine oral tablet 300 mg Antivirals, Miscellaneous foscarnet intravenous solution 24 (Foscavir) mg/ml oseltamivir oral capsule 30 mg (Tamiflu) QL (84 per 180 oseltamivir oral capsule 45 mg (Tamiflu) QL (48 per 180 oseltamivir oral capsule 75 mg (Tamiflu) QL (42 per 180 RELENZA DISKHALER INHALATION BLISTER WITH DEVICE 5 MG/ACTUATION rimantadine oral tablet 100 mg (Flumadine) SYNAGIS INTRAMUSCULAR SOLUTION 100 MG/ML, 50 MG/0.5 ML PA TAMIFLU ORAL CAPSULE 30 QL (84 per 180 MG TAMIFLU ORAL CAPSULE 45 QL (48 per 180 MG TAMIFLU ORAL CAPSULE 75 QL (42 per 180 MG TAMIFLU ORAL SUSPENSION QL (540 per 180 FOR RECONSTITUTION 6 MG/ML Hcv Antivirals DAKLINZA ORAL TABLET 30 PA; QL (28 per 28 MG, 60 MG, 90 MG EPCLUSA ORAL TABLET 400- PA; QL (28 per MG 73

88 HARVONI ORAL TABLET MG OLYSIO ORAL CAPSULE 150 MG SOVALDI ORAL TABLET 400 MG TECHNIVIE ORAL TABLET MG VIEKIRA PAK ORAL TABLETS,DOSE PACK 12.5 MG- 75 MG -50 MG/250 MG VIEKIRA XR ORAL TABLET, IR - ER, BIPHASIC 24HR 8.33 MG- 50 MG MG-200 MG ZEPATIER ORAL TABLET MG Interferons INTRON A INJECTION RECON SOLN 10 MILLION UNIT (1 ML), 18 MILLION UNIT (1 ML), 50 MILLION UNIT (1 ML) INTRON A INJECTION SOLUTION 10 MILLION UNIT/ML, 6 MILLION UNIT/ML PEGASYS PROCLICK SUBCUTANEOUS PEN INJECTOR 135 MCG/0.5 ML, 180 MCG/0.5 ML PEGASYS SUBCUTANEOUS SOLUTION 180 MCG/ML PEGASYS SUBCUTANEOUS SYRINGE 180 MCG/0.5 ML PEGINTRON SUBCUTANEOUS KIT 120 MCG/0.5 ML, 150 MCG/0.5 ML, 50 MCG/0.5 ML, 80 MCG/0.5 ML SYLATRON SUBCUTANEOUS KIT 200 MCG, 300 MCG, 600 MCG 74 PA; QL (30 per 30 PA; QL (28 per 28 PA; QL (28 per 28 PA; QL (56 per 28 PA; QL (112 per 28 PA; QL (84 per 28 PA; QL (30 per 30 PA NSO PA NSO PA NSO; QL (4 per 28

89 Nucleosides And Nucleotides acyclovir 1,000 mg/20 ml vial latexfree,sdv 50 mg/ml acyclovir oral capsule 200 mg (Zovirax) acyclovir oral suspension 200 mg/5 ml (Zovirax) acyclovir oral tablet 400 mg, 800 mg (Zovirax) acyclovir sodium intravenous recon soln 500 mg acyclovir sodium intravenous solution 50 mg/ml adefovir oral tablet 10 mg (Hepsera) entecavir oral tablet 0.5 mg, 1 mg (Baraclude) famciclovir oral tablet 125 mg, 250 mg, 500 mg ganciclovir sodium intravenous recon soln 500 mg (Cytovene) ribasphere oral capsule 200 mg ribasphere oral tablet 200 mg, 400 mg, 600 mg ribavirin inhalation recon soln 6 gram (Virazole) TYZEKA ORAL TABLET 600 MG valacyclovir oral tablet 1 gram, 500 mg (Valtrex) valganciclovir oral tablet 450 mg (Valcyte) VEMLIDY ORAL TABLET 25 MG VIRAZOLE INHALATION RECON SOLN 6 GRAM Blood Products/Modifiers/Volume Expanders Anticoagulants CEPROTIN (BLUE BAR) INTRAVENOUS RECON SOLN 500 UNIT 75 QL (30 per 30

90 ELIQUIS ORAL TABLET 2.5 MG, 5 MG enoxaparin subcutaneous solution 300 mg/3 ml enoxaparin subcutaneous syringe 100 mg/ml, 120 mg/0.8 ml, 150 mg/ml, 30 mg/0.3 ml, 40 mg/0.4 ml, 60 mg/0.6 ml, 80 mg/0.8 ml fondaparinux subcutaneous syringe 10 mg/0.8 ml fondaparinux subcutaneous syringe 2.5 mg/0.5 ml fondaparinux subcutaneous syringe 5 mg/0.4 ml fondaparinux subcutaneous syringe 7.5 mg/0.6 ml heparin (porcine) in 5 % dex intravenous parenteral solution 20,000 unit/500 ml (40 unit/ml) heparin (porcine) in 5 % dex intravenous parenteral solution 25,000 unit/250 ml(100 unit/ml) heparin (porcine) injection solution 1,000 unit/ml, 10,000 unit/ml, 20,000 unit/ml, 5,000 unit/ml heparin 25,000 unit/250 ml (100 unit/ml)-0.45% nacl bag latex-free, inner 25,000 unit/250 ml heparin, porcine (pf) injection solution 5,000 unit/0.5 ml heparin, porcine (pf) injection syringe 5,000 unit/0.5 ml IPRIVASK SUBCUTANEOUS RECON SOLN 15 MG jantoven oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg PRADAXA ORAL CAPSULE 110 MG, 150 MG, 75 MG (Lovenox) (Lovenox) (Arixtra) (Arixtra) (Arixtra) (Arixtra) 76 QL (24 per 30 QL (15 per 30 QL (12 per 30 QL (18 per 30 PA; QL (24 per 28 ST; QL (60 per 30

91 warfarin oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg XARELTO ORAL TABLET 10 MG, 15 MG, 20 MG XARELTO ORAL TABLETS,DOSE PACK 15 MG (42)- 20 MG (9) Blood Formation Modifiers CINRYZE INTRAVENOUS RECON SOLN 500 UNIT (5 ML) EPOGEN 10,000 UNITS/ML VIAL SDV, P/F, OUTER 10,000 UNIT/ML EPOGEN INJECTION SOLUTION 2,000 UNIT/ML, 20,000 UNIT/2 ML, 20,000 UNIT/ML, 3,000 UNIT/ML, 4,000 UNIT/ML GRANIX SUBCUTANEOUS SYRINGE 300 MCG/0.5 ML, 480 MCG/0.8 ML LEUKINE INJECTION RECON SOLN 250 MCG MIRCERA INJECTION SYRINGE 100 MCG/0.3 ML, 150 MCG/0.3 ML, 200 MCG/0.3 ML, 30 MCG/0.3 ML, 50 MCG/0.3 ML, 75 MCG/0.3 ML MOZOBIL SUBCUTANEOUS SOLUTION 24 MG/1.2 ML (20 MG/ML) NEULASTA SUBCUTANEOUS SYRINGE 6 MG/0.6ML NEULASTA SUBCUTANEOUS SYRINGE, W/ WEARABLE INJECTOR 6 MG/0.6 ML NEUPOGEN INJECTION SOLUTION 300 MCG/ML, 480 MCG/1.6 ML (Coumadin) 77 PA PA; QL (12 per 28 PA; QL (12 per 28 PA; QL (0.6 per 28

92 NEUPOGEN INJECTION SYRINGE 300 MCG/0.5 ML, 480 MCG/0.8 ML PROCRIT INJECTION SOLUTION 10,000 UNIT/ML, 2,000 UNIT/ML, 20,000 UNIT/2 ML, 20,000 UNIT/ML, 3,000 UNIT/ML, 4,000 UNIT/ML PROCRIT INJECTION SOLUTION 40,000 UNIT/ML PROMACTA ORAL TABLET 12.5 MG, 25 MG, 50 MG, 75 MG ZARXIO INJECTION SYRINGE 300 MCG/0.5 ML, 480 MCG/0.8 ML Hematologic Agents, Miscellaneous anagrelide oral capsule 0.5 mg (Agrylin) anagrelide oral capsule 1 mg protamine intravenous solution 10 mg/ml tranexamic acid intravenous solution 1,000 mg/10 ml (100 (Cyklokapron) 78 PA; QL (12 per 28 PA; QL (6 per 28 PA; QL (30 per 30 ST mg/ml) tranexamic acid oral tablet 650 mg (Lysteda) QL (30 per 30 Platelet-Aggregation Inhibitors aspirin-dipyridamole oral capsule, er multiphase 12 hr mg (Aggrenox) BRILINTA ORAL TABLET 60 MG, 90 MG cilostazol oral tablet 100 mg, 50 mg clopidogrel oral tablet 300 mg, 75 mg (Plavix) dipyridamole oral tablet 25 mg, 50 mg, 75 mg EFFIENT ORAL TABLET 10 MG, 5 MG pentoxifylline oral tablet extended release 400 mg QL (30 per 30

93 Caloric Agents Caloric Agents AMINO ACIDS 15 % INTRAVENOUS PARENTERAL SOLUTION 15 % AMINOSYN 10 % INTRAVENOUS PARENTERAL SOLUTION 10 % AMINOSYN 7 % WITH ELECTROLYTES INTRAVENOUS PARENTERAL SOLUTION 7 % AMINOSYN 8.5 % INTRAVENOUS PARENTERAL SOLUTION 8.5 % AMINOSYN 8.5 %- ELECTROLYTES INTRAVENOUS PARENTERAL SOLUTION 8.5 % AMINOSYN II 10 % INTRAVENOUS PARENTERAL SOLUTION 10 % AMINOSYN II 15 % INTRAVENOUS PARENTERAL SOLUTION 15 % AMINOSYN II 7 % INTRAVENOUS PARENTERAL SOLUTION 7 % AMINOSYN II 8.5 % INTRAVENOUS PARENTERAL SOLUTION 8.5 % AMINOSYN II 8.5 %- ELECTROLYTES INTRAVENOUS PARENTERAL SOLUTION 8.5 % AMINOSYN M 3.5 % INTRAVENOUS PARENTERAL SOLUTION 3.5 % 79

94 AMINOSYN-HBC 7% INTRAVENOUS PARENTERAL SOLUTION 7 % AMINOSYN-PF 10 % INTRAVENOUS PARENTERAL SOLUTION 10 % AMINOSYN-PF 7 % (SULFITE- FREE) INTRAVENOUS PARENTERAL SOLUTION 7 % AMINOSYN-RF 5.2 % INTRAVENOUS PARENTERAL SOLUTION 5.2 % CLINIMIX 5%/D15W SULFITE FREE INTRAVENOUS PARENTERAL SOLUTION 5 % CLINIMIX 5%/D25W SULFITE- FREE INTRAVENOUS PARENTERAL SOLUTION 5 % CLINIMIX 2.75%/D5W SULFIT FREE INTRAVENOUS PARENTERAL SOLUTION 2.75 % CLINIMIX 4.25%/D10W SULF FREE INTRAVENOUS PARENTERAL SOLUTION 4.25 % CLINIMIX 4.25%/D5W SULFIT FREE INTRAVENOUS PARENTERAL SOLUTION 4.25 % CLINIMIX 4.25%-D20W SULF- FREE INTRAVENOUS PARENTERAL SOLUTION 4.25 % CLINIMIX 4.25%-D25W SULF- FREE INTRAVENOUS PARENTERAL SOLUTION 4.25 % 80

95 CLINIMIX 5%-D20W(SULFITE- FREE) INTRAVENOUS PARENTERAL SOLUTION 5 % CLINIMIX E 2.75%/D10W SUL FREE INTRAVENOUS PARENTERAL SOLUTION 2.75 % CLINIMIX E 2.75%/D5W SULF FREE INTRAVENOUS PARENTERAL SOLUTION 2.75 % CLINIMIX E 4.25%/D10W SUL FREE INTRAVENOUS PARENTERAL SOLUTION 4.25 % CLINIMIX E 4.25%/D25W SUL FREE INTRAVENOUS PARENTERAL SOLUTION 4.25 % CLINIMIX E 4.25%/D5W SULF FREE INTRAVENOUS PARENTERAL SOLUTION 4.25 % CLINIMIX E 5%/D15W SULFIT FREE INTRAVENOUS PARENTERAL SOLUTION 5 % CLINIMIX E 5%/D20W SULFIT FREE INTRAVENOUS PARENTERAL SOLUTION 5 % CLINIMIX E 5%/D25W SULFIT FREE INTRAVENOUS PARENTERAL SOLUTION 5 % CLINISOL SF 15 % INTRAVENOUS PARENTERAL SOLUTION 15 % dex4 glucose 4 gm tablet chew watermelon flavor 4 gram dex4 glucose 40% gel 40 % 81

96 dextrose 10 % in water (d10w) intravenous parenteral solution 10 % dextrose 20 % in water (d20w) intravenous parenteral solution 20 % dextrose 25 % in water (d25w) intravenous syringe dextrose 40 % in water (d40w) intravenous parenteral solution 40 % dextrose 5 % in ringers intravenous parenteral solution 5 % dextrose 5 % in water (d5w) intravenous parenteral solution dextrose 50 % in water (d50w) intravenous parenteral solution dextrose 50 % in water (d50w) intravenous syringe dextrose 70 % in water (d70w) intravenous parenteral solution FREAMINE HBC 6.9 % INTRAVENOUS PARENTERAL SOLUTION 6.9 % FREAMINE III 10 % INTRAVENOUS PARENTERAL SOLUTION 10 % gluco burst 40% gel 40 % glucose 4 gram tablet chew na/f, (Dex4 Glucose caffeine free 4 gram Pouch Pack) glucose 40% gel tropical fruit 40 % glutose 15 gel 3 pak, outer, u-d 40 % HEPATAMINE 8% INTRAVENOUS PARENTERAL SOLUTION 8 % insta-glucose gel 24 gram/31 gram 82

97 INTRALIPID INTRAVENOUS EMULSION 20 %, 30 % KABIVEN INTRAVENOUS EMULSION % NEPHRAMINE 5.4 % INTRAVENOUS PARENTERAL SOLUTION 5.4 % NUTRILIPID INTRAVENOUS EMULSION 20 % PERIKABIVEN INTRAVENOUS EMULSION % PREMASOL 10 % INTRAVENOUS PARENTERAL SOLUTION 10 % PREMASOL 6 % INTRAVENOUS PARENTERAL SOLUTION 6 % PROCALAMINE 3% INTRAVENOUS PARENTERAL SOLUTION 3 % PROSOL 20 % INTRAVENOUS PARENTERAL SOLUTION smoflipid intravenous emulsion 20 % TRAVASOL 10 % INTRAVENOUS PARENTERAL SOLUTION 10 % TROPHAMINE 10 % INTRAVENOUS PARENTERAL SOLUTION 10 % TROPHAMINE 6% INTRAVENOUS PARENTERAL SOLUTION 6 % Cardiovascular Agents Alpha-Adrenergic Agents clonidine hcl oral tablet 0.1 mg, 0.2 mg, 0.3 mg clonidine transdermal patch weekly 0.1 mg/24 hr (Catapres) (Catapres-TTS-1) QL (4 per 28 83

98 clonidine transdermal patch weekly 0.2 mg/24 hr clonidine transdermal patch weekly 0.3 mg/24 hr clorpres oral tablet mg, mg, mg doxazosin oral tablet 1 mg, 2 mg, 4 mg, 8 mg (Catapres-TTS-2) (Catapres-TTS-3) (Cardura) guanfacine oral tablet 1 mg, 2 mg midodrine oral tablet 10 mg, 2.5 mg, 5 mg NORTHERA ORAL CAPSULE 100 MG, 200 MG, 300 MG phenylephrine hcl injection solution 10 mg/ml (Vazculep) prazosin oral capsule 1 mg, 2 mg, 5 mg (Minipress) Angiotensin Ii Receptor Antagonists BENICAR HCT ORAL TABLET MG, MG, MG BENICAR ORAL TABLET 20 MG, 40 MG, 5 MG candesartan oral tablet 16 mg, 32 mg, 4 mg, 8 mg (Atacand) candesartan-hydrochlorothiazid oral tablet mg, mg, (Atacand HCT) mg ENTRESTO ORAL TABLET MG, MG, MG irbesartan oral tablet 150 mg, 300 mg, 75 mg (Avapro) irbesartan-hydrochlorothiazide oral tablet mg, mg (Avalide) losartan oral tablet 100 mg, 25 mg, 50 mg (Cozaar) QL (4 per 28 QL (8 per 28 PA-HRM; AGE (Max 64 Years) PA; QL (180 per 30 QL (60 per 30 84

99 losartan-hydrochlorothiazide oral tablet mg, mg, mg olmesartan oral tablet 20 mg, 40 mg, 5 mg olmesartan-amlodipin-hcthiazid oral tablet mg, mg, mg, mg, mg olmesartan-hydrochlorothiazide oral tablet mg, mg, mg telmisartan oral tablet 20 mg, 40 mg, 80 mg telmisartan-hydrochlorothiazid oral tablet mg, mg, mg TRIBENZOR ORAL TABLET MG, MG, MG, MG, MG valsartan oral tablet 160 mg, 320 mg, 40 mg, 80 mg valsartan-hydrochlorothiazide oral tablet mg, mg, 320- (Hyzaar) (Benicar) (Tribenzor) (Benicar HCT) (Micardis) (Micardis HCT) (Diovan) (Diovan HCT) 12.5 mg, mg, mg Angiotensin-Converting Enzyme Inhibitors benazepril oral tablet 10 mg, 5 mg benazepril oral tablet 20 mg, 40 mg (Lotensin) benazepril-hydrochlorothiazide oral tablet mg, mg, mg benazepril-hydrochlorothiazide oral tablet mg captopril oral tablet 100 mg, 12.5 mg, 25 mg, 50 mg captopril-hydrochlorothiazide oral tablet mg, mg, mg, mg (Lotensin HCT) 85

100 enalapril maleate oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg (Vasotec) enalaprilat intravenous solution 1.25 mg/ml enalapril-hydrochlorothiazide oral tablet mg (Vaseretic) enalapril-hydrochlorothiazide oral tablet mg fosinopril oral tablet 10 mg, 20 mg, 40 mg fosinopril-hydrochlorothiazide oral tablet mg, mg lisinopril oral tablet 10 mg (Prinivil) lisinopril oral tablet 2.5 mg, 20 mg, 30 mg, 40 mg, 5 mg (Zestril) lisinopril-hydrochlorothiazide oral tablet mg, mg, 20- (Zestoretic) 25 mg moexipril oral tablet 15 mg, 7.5 mg moexipril-hydrochlorothiazide oral tablet mg, mg, mg perindopril erbumine oral tablet 2 mg, 4 mg, 8 mg QBRELIS ORAL SOLUTION 1 MG/ML quinapril oral tablet 10 mg, 20 mg, 40 mg, 5 mg (Accupril) quinapril-hydrochlorothiazide oral tablet mg, mg, 20- (Accuretic) 25 mg ramipril oral capsule 1.25 mg, 10 mg, 2.5 mg, 5 mg (Altace) trandolapril oral tablet 1 mg, 2 mg (Mavik) trandolapril oral tablet 4 mg Antiarrhythmic Agents amiodarone oral tablet 100 mg, 200 mg, 400 mg (Pacerone) ST 86

101 disopyramide phosphate oral capsule 100 mg, 150 mg (Norpace) dofetilide oral capsule 125 mcg, 250 mcg, 500 mcg (Tikosyn) flecainide oral tablet 100 mg, 150 mg, 50 mg lidocaine (pf) intravenous syringe 50 mg/5 ml (1 %) lidocaine in 5 % dextrose (pf) intravenous parenteral solution 8 mg/ml (0.8 %) mexiletine oral capsule 150 mg, 200 mg, 250 mg MULTAQ ORAL TABLET 400 MG pacerone oral tablet 100 mg, 200 mg, 400 mg procainamide injection solution 100 mg/ml, 500 mg/ml propafenone oral capsule,extended release 12 hr 225 mg, 325 mg, 425 (Rythmol SR) mg propafenone oral tablet 150 mg, 225 mg, 300 mg quinidine gluconate oral tablet extended release 324 mg quinidine sulfate oral tablet 200 mg, 300 mg quinidine sulfate oral tablet extended release 300 mg Beta-Adrenergic Blocking Agents acebutolol oral capsule 200 mg, 400 mg atenolol oral tablet 100 mg, 25 mg, 50 mg (Tenormin) atenolol-chlorthalidone oral tablet mg (Tenoretic 100) 87

102 atenolol-chlorthalidone oral tablet mg (Tenoretic 50) betaxolol oral tablet 10 mg, 20 mg bisoprolol fumarate oral tablet 10 mg (Zebeta) bisoprolol fumarate oral tablet 5 mg bisoprolol-hydrochlorothiazide oral tablet mg, mg, 5- (Ziac) 6.25 mg BYSTOLIC ORAL TABLET 10 MG, 2.5 MG, 20 MG, 5 MG BYVALSON ORAL TABLET 5-80 MG carvedilol oral tablet 12.5 mg, 25 mg, mg, 6.25 mg (Coreg) esmolol intravenous solution 100 mg/10 ml (10 mg/ml) (Brevibloc) labetalol intravenous solution 5 mg/ml labetalol oral tablet 100 mg, 200 mg, 300 mg metoprolol succinate oral tablet extended release 24 hr 100 mg, 200 (Toprol XL) mg, 25 mg, 50 mg metoprolol ta-hydrochlorothiaz oral tablet mg, mg metoprolol ta-hydrochlorothiaz oral tablet mg (Lopressor HCT) metoprolol tartrate intravenous solution 5 mg/5 ml (Lopressor) metoprolol tartrate intravenous syringe 5 mg/5 ml metoprolol tartrate oral tablet 100 mg, 50 mg (Lopressor) metoprolol tartrate oral tablet 25 mg, 37.5 mg, 75 mg nadolol oral tablet 20 mg, 40 mg, 80 (Corgard) mg 88

103 pindolol oral tablet 10 mg, 5 mg propranolol intravenous solution 1 mg/ml propranolol oral capsule,extended release 24 hr 120 mg, 160 mg, 60 (Inderal LA) mg, 80 mg propranolol oral solution 20 mg/5 ml (4 mg/ml), 40 mg/5 ml (8 mg/ml) propranolol oral tablet 10 mg, 20 mg, 40 mg, 60 mg, 80 mg propranolol-hydrochlorothiazid oral tablet mg, mg sorine oral tablet 120 mg, 160 mg, 240 mg, 80 mg sotalol 120 mg tablet 120 mg (Sorine) sotalol af oral tablet 120 mg sotalol oral tablet 160 mg (Sotalol AF) sotalol oral tablet 240 mg, 80 mg (Betapace) timolol maleate oral tablet 10 mg, 20 mg, 5 mg Calcium-Channel Blocking Agents cartia xt oral capsule,extended release 24hr 120 mg, 180 mg, 240 mg, 300 mg diltiazem 24hr er 180 mg cap 180 mg (Cardizem CD) diltiazem 24hr er 360 mg cap 360 mg (Cardizem CD) diltiazem hcl intravenous recon soln 100 mg diltiazem hcl intravenous solution 5 mg/ml diltiazem hcl oral capsule, extended release 180 mg (Taztia XT) diltiazem hcl oral capsule, extended release 360 mg (Tiazac) diltiazem hcl oral capsule, extended release 420 mg (Tiazac) 89

104 diltiazem hcl oral capsule,extended release 12 hr 120 mg, 60 mg, 90 mg diltiazem hcl oral capsule,extended release 24hr 120 mg, 240 mg, 300 (Cardizem CD) mg diltiazem hcl oral tablet 120 mg, 30 mg, 60 mg (Cardizem) diltiazem hcl oral tablet 90 mg diltiazem hcl oral tablet extended release 24 hr 180 mg, 240 mg, 300 (Cardizem LA) mg, 360 mg, 420 mg dilt-xr oral capsule,ext release degradable 120 mg, 180 mg, 240 mg matzim la oral tablet extended release 24 hr 180 mg, 240 mg, 300 mg, 360 mg, 420 mg taztia xt oral capsule, extended release 120 mg, 180 mg, 240 mg, 300 mg, 360 mg verapamil intravenous syringe 2.5 mg/ml verapamil oral capsule, 24 hr er pellet ct 100 mg, 200 mg, 300 mg (Verelan PM) verapamil oral capsule,ext rel. pellets 24 hr 120 mg, 180 mg, 240 mg, 360 mg (Verelan) verapamil oral tablet 120 mg, 80 mg (Calan) verapamil oral tablet 40 mg verapamil oral tablet extended release 120 mg, 180 mg, 240 mg (Calan SR) Cardiovascular Agents, Miscellaneous CORLANOR ORAL TABLET 5 MG, 7.5 MG DEMSER ORAL CAPSULE 250 MG 90

105 digitek oral tablet 125 mcg digitek oral tablet 250 mcg digoxin 0.25 mg/ml syringe 250 mcg/ml digoxin injection solution 250 mcg/ml DIGOXIN ORAL SOLUTION 50 MCG/ML (Lanoxin) digoxin oral tablet 125 mcg (Digitek) PA-HRM; PA REQUIRED: High Risk Med for Ages 65 and Older and Dose is Greater than 125mcg per Day; QL (30 per 30 ; AGE (Max 64 Years) PA-HRM; PA REQUIRED: High Risk Med for Ages 65 and Older; QL (30 per 30 ; AGE (Max 64 Years) PA-HRM; PA REQUIRED: High Risk Med for Ages 65 and Older; AGE (Max 64 Years) PA-HRM; PA REQUIRED: High Risk Med for Ages 65 and Older; AGE (Max 64 Years) PA-HRM; PA REQUIRED: High Risk Med for Ages 65 and Older and Dose is Greater than 125mcg per Day; AGE (Max 64 Years) PA-HRM; PA REQUIRED: High Risk Med for Ages 65 and Older and Dose is Greater than 125mcg per Day; QL (30 per 30 ; AGE (Max 64 Years) 91

106 digoxin oral tablet 250 mcg (Digox) dobutamine in d5w intravenous parenteral solution 1,000 mg/250 ml (4,000 mcg/ml), 250 mg/250 ml (1 mg/ml), 500 mg/250 ml (2,000 mcg/ml) dobutamine intravenous solution 250 mg/20 ml (12.5 mg/ml), 500 mg/40 ml (12.5 mg/ml) dopamine in 5 % dextrose intravenous solution 200 mg/250 ml (800 mcg/ml), 400 mg/250 ml (1,600 mcg/ml), 800 mg/250 ml (3,200 mcg/ml) dopamine intravenous solution 200 mg/5 ml (40 mg/ml), 400 mg/5 ml (80 mg/ml), 800 mg/10 ml (80 mg/ml), 800 mg/5 ml (160 mg/ml) epinephrine hcl (pf) injection solution 1 mg/ml (1 ml) epinephrine injection auto-injector 0.15 mg/0.15 ml epinephrine injection auto-injector 0.15 mg/0.3 ml epinephrine injection auto-injector 0.3 % epinephrine injection auto-injector 0.3 mg/0.3 ml epinephrine injection syringe 0.1 mg/ml EPIPEN 2-PAK INJECTION AUTO-INJECTOR 0.3 MG/0.3 ML EPIPEN INJECTION AUTO- INJECTOR 0.3 MG/0.3 ML (Adrenaclick) (EpiPen Jr) (Adrenaclick) 92 PA-HRM; PA REQUIRED: High Risk Med for Ages 65 and Older; QL (30 per 30 ; AGE (Max 64 Years) GENERIC FOR ADRENACLICK GENERIC FOR EPIPEN QL (4 per 30 QL (4 per 30

107 EPIPEN JR 2-PAK INJECTION AUTO-INJECTOR 0.15 MG/0.3 ML FIRAZYR SUBCUTANEOUS SYRINGE 30 MG/3 ML hydralazine injection solution 20 mg/ml hydralazine oral tablet 10 mg, 100 mg, 25 mg, 50 mg LANOXIN ORAL TABLET MCG LANOXIN ORAL TABLET 62.5 MCG milrinone in 5 % dextrose intravenous piggyback 20 mg/100 ml (200 mcg/ml), 40 mg/200 ml (200 mcg/ml) milrinone intravenous solution 1 mg/ml norepinephrine bitartrate intravenous solution 1 mg/ml RANEXA ORAL TABLET EXTENDED RELEASE 12 HR 1,000 MG, 500 MG Dihydropyridines afeditab cr oral tablet extended release 30 mg, 60 mg amlodipine oral tablet 10 mg, 2.5 mg, 5 mg (Levophed (bitartrate)) (Norvasc) QL (4 per 30 PA-HRM; PA REQUIRED: High Risk Med for Ages 65 and Older; QL (30 per 30 ; AGE (Max 64 Years) PA-HRM; PA REQUIRED: High Risk Med for Ages 65 and Older and Dose is Greater than 125mcg per Day; QL (60 per 30 ; AGE (Max 64 Years) 93

108 amlodipine-benazepril oral capsule mg, mg, 5-10 mg, 5-20 (Lotrel) mg, 5-40 mg amlodipine-benazepril oral capsule mg amlodipine-olmesartan oral tablet mg, mg, 5-20 mg, 5-40 (Azor) mg amlodipine-valsartan oral tablet mg, mg, mg, 5- (Exforge) 320 mg amlodipine-valsartan-hcthiazid oral tablet mg, mg, mg, mg, (Exforge HCT) mg AZOR ORAL TABLET MG, MG, 5-20 MG, 5-40 MG CLEVIPREX INTRAVENOUS EMULSION 50 MG/100 ML felodipine oral tablet extended release 24 hr 10 mg, 2.5 mg, 5 mg isradipine oral capsule 2.5 mg, 5 mg nicardipine oral capsule 20 mg, 30 mg nifedical xl oral tablet extended release 24hr 30 mg, 60 mg nifedipine oral tablet extended release 24hr 30 mg, 60 mg, 90 mg (Procardia XL) nifedipine oral tablet extended release 30 mg, 60 mg (Afeditab CR) nifedipine oral tablet extended release 90 mg (Adalat CC) Diuretics amiloride oral tablet 5 mg amiloride-hydrochlorothiazide oral tablet 5-50 mg bumetanide injection solution 0.25 mg/ml 94

109 bumetanide oral tablet 0.5 mg, 1 mg, 2 mg chlorothiazide oral tablet 250 mg, 500 mg chlorothiazide sodium intravenous recon soln 500 mg (Diuril IV) chlorthalidone oral tablet 25 mg, 50 mg DYRENIUM ORAL CAPSULE 100 MG, 50 MG furosemide injection solution 10 mg/ml furosemide injection syringe 10 mg/ml furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml) furosemide oral tablet 20 mg, 40 mg, 80 mg (Lasix) hydrochlorothiazide oral capsule 12.5 mg (Microzide) hydrochlorothiazide oral tablet 12.5 mg, 25 mg, 50 mg indapamide oral tablet 1.25 mg, 2.5 mg methyclothiazide oral tablet 5 mg metolazone oral tablet 10 mg, 2.5 mg, 5 mg spironolactone oral tablet 100 mg, 25 mg, 50 mg (Aldactone) spironolacton-hydrochlorothiaz oral (Aldactazide) tablet mg torsemide oral tablet 10 mg, 20 mg (Demadex) torsemide oral tablet 100 mg, 5 mg triamterene-hydrochlorothiazid oral capsule mg (Dyazide) triamterene-hydrochlorothiazid oral capsule mg 95

110 triamterene-hydrochlorothiazid oral tablet mg (Maxzide-25mg) triamterene-hydrochlorothiazid oral tablet mg (Maxzide) Dyslipidemics amlodipine-atorvastatin oral tablet mg, mg, mg, mg, 5-10 mg, 5-20 mg, 5-40 mg, (Caduet) 5-80 mg amlodipine-atorvastatin oral tablet mg, mg, mg atorvastatin oral tablet 10 mg, 20 mg, 40 mg, 80 mg (Lipitor) cholestyramine light oral powder 4 gram cholestyramine light oral powder in packet 4 gram cholestyramine packet outer 4 gram (Questran) colestipol hcl granules packet 5 gram (Colestid) colestipol oral granules 5 gram (Colestid) colestipol oral tablet 1 gram (Colestid) endur-acin sr 500 mg tablet 500 mg fenofibrate micronized oral capsule 130 mg, 134 mg, 200 mg, 43 mg, 67 mg fenofibrate nanocrystallized oral tablet 145 mg, 48 mg (Tricor) fenofibrate oral tablet 120 mg, 40 mg (Fenoglide) fenofibrate oral tablet 160 mg, 54 mg fenofibric acid (choline) oral capsule,delayed release(dr/ec) 135 (Trilipix) mg, 45 mg fenofibric acid oral tablet 105 mg, 35 mg (Fibricor) 96

111 gemfibrozil oral tablet 600 mg (Lopid) JUXTAPID ORAL CAPSULE 10 PA; QL (30 per 30 MG, 30 MG, 40 MG, 60 MG JUXTAPID ORAL CAPSULE 20 PA; QL (90 per 30 MG JUXTAPID ORAL CAPSULE 5 PA; QL (45 per 30 MG KYNAMRO SUBCUTANEOUS PA; QL (4 per 28 SYRINGE 200 MG/ML LIVALO ORAL TABLET 1 MG, 2 QL (30 per 30 MG, 4 MG lovastatin oral tablet 10 mg, 20 mg, 40 mg niacin 50 mg tablet 50 mg niacin 500 mg capsule sa 500 mg niacin 500 mg tablet 500 mg (Niacor) niacin oral tablet extended release (Niaspan 24 hr 1,000 mg, 500 mg, 750 mg Extended-Release) niacin tr 500 mg caplet caplet 500 (Endur-Acin) mg niacinamide 500 mg tablet 500 mg (Niacin (niacinamide)) niacor oral tablet 500 mg PRALUENT PEN PA; QL (2 per 28 SUBCUTANEOUS PEN INJECTOR 150 MG/ML, 75 MG/ML PRALUENT SYRINGE PA; QL (2 per 28 SUBCUTANEOUS SYRINGE 150 MG/ML, 75 MG/ML pravastatin oral tablet 10 mg pravastatin oral tablet 20 mg, 40 mg, 80 mg (Pravachol) prevalite oral powder 4 gram prevalite packet outer 4 gram REPATHA PUSHTRONEX SUBCUTANEOUS WEARABLE INJECTOR 420 MG/3.5 ML 97 PA; QL (3.5 per 28

112 REPATHA SURECLICK PA; QL (3 per 28 SUBCUTANEOUS PEN INJECTOR 140 MG/ML REPATHA SYRINGE PA; QL (3 per 28 SUBCUTANEOUS SYRINGE 140 MG/ML rosuvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg (Crestor) simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg (Zocor) simvastatin oral tablet 80 mg (Zocor) QL (30 per 30 VASCEPA ORAL CAPSULE 0.5 QL (240 per 30 GRAM VASCEPA ORAL CAPSULE 1 QL (120 per 30 GRAM WELCHOL ORAL POWDER IN PACKET 3.75 GRAM WELCHOL ORAL TABLET 625 MG ZETIA ORAL TABLET 10 MG Renin-Angiotensin-Aldosterone System Inhibitors eplerenone oral tablet 25 mg, 50 mg (Inspra) TEKAMLO ORAL TABLET MG, MG, MG, MG TEKTURNA HCT ORAL TABLET MG, MG, MG, MG TEKTURNA ORAL TABLET 150 MG, 300 MG Vasodilators BIDIL ORAL TABLET MG isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg isosorbide dinitrate oral tablet 5 mg (Isordil Titradose) ST ST ST 98

113 isosorbide dinitrate oral tablet extended release 40 mg (ISOCHRON) isosorbide mononitrate oral tablet 10 mg, 20 mg isosorbide mononitrate oral tablet extended release 24 hr 120 mg, 30 mg, 60 mg minitran transdermal patch 24 hour 0.1 mg/hr, 0.2 mg/hr, 0.6 mg/hr minitran transdermal patch 24 hour 0.4 mg/hr minoxidil oral tablet 10 mg, 2.5 mg NITRO-BID TRANSDERMAL OINTMENT 2 % nitroglycerin in 5 % dextrose intravenous solution 100 mg/250 ml (400 mcg/ml), 25 mg/250 ml (100 mcg/ml), 50 mg/250 ml (200 mcg/ml) nitroglycerin intravenous solution 50 mg/10 ml (5 mg/ml) nitroglycerin sublingual tablet 0.3 mg, 0.4 mg, 0.6 mg (Nitrostat) nitroglycerin transdermal patch 24 hour 0.1 mg/hr (Minitran) nitroglycerin transdermal patch 24 hour 0.2 mg/hr, 0.6 mg/hr (Nitro-Dur) nitroglycerin transdermal patch 24 hour 0.4 mg/hr (Nitro-Dur) NITROSTAT SUBLINGUAL TABLET 0.3 MG, 0.4 MG, 0.6 MG PROGLYCEM ORAL SUSPENSION 50 MG/ML Central Nervous System Agents Central Nervous System Agents QL (30 per 30 QL (60 per 30 QL (30 per 30 QL (30 per 30 QL (60 per 30 99

114 AMPYRA ORAL TABLET EXTENDED RELEASE 12 HR 10 MG AUBAGIO ORAL TABLET 14 MG, 7 MG AVONEX (WITH ALBUMIN) INTRAMUSCULAR KIT 30 MCG AVONEX INTRAMUSCULAR PEN INJECTOR KIT 30 MCG/0.5 ML AVONEX INTRAMUSCULAR SYRINGE KIT 30 MCG/0.5 ML BETASERON SUBCUTANEOUS KIT 0.3 MG caffeine citrate intravenous solution 60 mg/3 ml (20 mg/ml) caffeine citrate oral solution 60 mg/3 ml (20 mg/ml) clonidine hcl oral tablet extended release 12 hr 0.1 mg COPAXONE SUBCUTANEOUS SYRINGE 20 MG/ML, 40 MG/ML dexmethylphenidate oral tablet 10 mg, 2.5 mg, 5 mg dextroamphetamine oral capsule, extended release 10 mg, 15 mg, 5 mg dextroamphetamine oral tablet 10 mg, 5 mg dextroamphetamine-amphetamine oral capsule,extended release 24hr 10 mg, 15 mg, 5 mg dextroamphetamine-amphetamine oral capsule,extended release 24hr 20 mg, 25 mg, 30 mg dextroamphetamine-amphetamine oral tablet 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg, 5 mg, 7.5 mg (Cafcit) (Kapvay) (Focalin) (Dexedrine Spansule) (Zenzedi) (Adderall XR) (Adderall XR) (Adderall) PA; QL (60 per 30 PA; QL (28 per 28 PA PA PA PA PA QL (60 per 30 QL (120 per 30 QL (180 per 30 QL (30 per 30 QL (60 per 30 QL (60 per

115 EXTAVIA SUBCUTANEOUS KIT 0.3 MG flumazenil intravenous solution 0.1 mg/ml GILENYA ORAL CAPSULE 0.5 MG guanfacine oral tablet extended release 24 hr 1 mg, 2 mg, 3 mg, 4 mg LEMTRADA INTRAVENOUS SOLUTION 12 MG/1.2 ML lithium carbonate oral capsule 150 mg, 300 mg, 600 mg lithium carbonate oral tablet 300 mg lithium carbonate oral tablet extended release 300 mg lithium carbonate oral tablet extended release 450 mg lithium citrate oral solution 8 meq/5 ml methylphenidate oral capsule, er biphasic mg, 20 mg, 40 mg, 50 mg, 60 mg methylphenidate oral capsule, er biphasic mg methylphenidate oral capsule,er biphasic mg, 40 mg methylphenidate oral capsule,er biphasic mg methylphenidate oral solution 10 mg/5 ml, 5 mg/5 ml methylphenidate oral tablet 10 mg, 20 mg, 5 mg methylphenidate oral tablet extended release 10 mg methylphenidate oral tablet extended release 20 mg (Intuniv ER) (Lithobid) (Metadate CD) (Metadate CD) (Ritalin LA) (Methylin) (Ritalin) (Metadate ER) PA PA; QL (28 per 28 PA QL (30 per 30 QL (60 per 30 QL (30 per 30 QL (30 per 30 QL (900 per 30 QL (90 per 30 QL (90 per 30 QL (90 per

116 methylphenidate oral tablet extended release 24hr 18 mg, 27 mg, 54 mg (Concerta) methylphenidate oral tablet extended release 24hr 36 mg (Concerta) NUEDEXTA ORAL CAPSULE MG PLEGRIDY SUBCUTANEOUS PEN INJECTOR 125 MCG/0.5 ML, 63 MCG/0.5 ML- 94 MCG/0.5 ML PLEGRIDY SUBCUTANEOUS SYRINGE 125 MCG/0.5 ML, 63 MCG/0.5 ML- 94 MCG/0.5 ML REBIF (WITH ALBUMIN) SUBCUTANEOUS SYRINGE 22 MCG/0.5 ML, 44 MCG/0.5 ML REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR 22 MCG/0.5 ML, 44 MCG/0.5 ML, 8.8MCG/0.2ML-22 MCG/0.5ML (6) REBIF TITRATION PACK SUBCUTANEOUS SYRINGE 8.8MCG/0.2ML-22 MCG/0.5ML (6) riluzole oral tablet 50 mg (Rilutek) SAVELLA ORAL TABLET 100 MG, 12.5 MG, 25 MG, 50 MG SAVELLA ORAL TABLETS,DOSE PACK 12.5 MG (5)-25 MG(8)-50 MG(42) STRATTERA ORAL CAPSULE 10 MG, 100 MG, 18 MG, 25 MG, 40 MG, 60 MG, 80 MG TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 120 MG QL (30 per 30 QL (60 per 30 QL (60 per 30 PA PA PA PA PA QL (60 per 30 QL (60 per 30 PA; QL (14 per

117 TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 120 MG (14)- 240 MG (46), 240 MG tetrabenazine oral tablet 12.5 mg, 25 mg (Xenazine) ZINBRYTA SUBCUTANEOUS SYRINGE 150 MG/ML Contraceptives Contraceptives altavera (28) oral tablet mg alyacen 1/35 (28) oral tablet 1-35 mg-mcg alyacen 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg amethia lo oral tablets,dose pack,3 month 0.10 mg-20 mcg (84)/10 mcg (7) amethia oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (7) apri oral tablet mg aranelle (28) oral tablet 0.5/1/ mg-mcg ashlyna oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (7) aubra oral tablet mg-mcg aviane oral tablet mg-mcg azurette (28) oral tablet mgx21 /0.01 mg x 5 balziva (28) oral tablet mgmcg bekyree (28) oral tablet mgx21 /0.01 mg x 5 blisovi 24 fe oral tablet 1 mg-20 mcg (24)/75 mg (4) PA; QL (60 per 30 PA; QL (112 per 28 PA; QL (1 per 28 QL (91 per 84 QL (91 per

118 blisovi fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) blisovi fe 1/20 (28) oral tablet 1 mg- 20 mcg (21)/75 mg (7) briellyn oral tablet mg-mcg camila oral tablet 0.35 mg camrese lo oral tablets,dose pack,3 month 0.10 mg-20 mcg (84)/10 mcg (7) camrese oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (7) caziant (28) oral tablet 0.1/.125/ mg-mcg cryselle (28) oral tablet mgmcg cyclafem 1/35 (28) oral tablet 1-35 mg-mcg cyclafem 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg cyred oral tablet mg dasetta 1/35 (28) oral tablet 1-35 mg-mcg dasetta 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg daysee oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (7) deblitane oral tablet 0.35 mg delyla (28) oral tablet mgmcg desog-e.estradiol/e.estradiol oral tablet mgx21 /0.01 mg x 5 (Azurette (28)) desogestrel-ethinyl estradiol oral tablet mg (Apri) drospirenone-ethinyl estradiol oral tablet mg (Loryna (28)) QL (91 per 84 QL (91 per 84 QL (91 per

119 drospirenone-ethinyl estradiol oral tablet mg (Zarah) econtra ez 1.5 mg tablet inner 1.5 ; QL (6 per 365 mg elinest oral tablet mg-mcg ELLA ORAL TABLET 30 MG QL (6 per 365 emoquette oral tablet mg enpresse oral tablet (6)/75-40 (5)/125-30(10) enskyce oral tablet mg errin oral tablet 0.35 mg estarylla oral tablet mg-mcg ethynodiol diac-eth estradiol oral tablet 1-50 mg-mcg (Zovia 1/50E (28)) fallback solo 1.5 mg tablet outer 1.5 ; QL (6 per 365 mg falmina (28) oral tablet mgmcg femynor oral tablet mg-mcg gianvi (28) oral tablet mg gildagia oral tablet mg-mcg gildess 1.5/30 (21) oral tablet mg-mcg gildess 1/20 (21) oral tablet 1-20 mg-mcg gildess 24 fe oral tablet 1 mg-20 mcg (24)/75 mg (4) gildess fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) gildess fe 1/20 (28) oral tablet 1 mg- 20 mcg (21)/75 mg (7) heather oral tablet 0.35 mg introvale oral tablets,dose pack,3 QL (91 per 84 month 0.15 mg-30 mcg jencycla oral tablet 0.35 mg jolessa oral tablets,dose pack,3 QL (91 per 84 month 0.15 mg-30 mcg jolivette oral tablet 0.35 mg 105

120 juleber oral tablet mg junel 1.5/30 (21) oral tablet mg-mcg junel 1/20 (21) oral tablet 1-20 mgmcg junel fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) junel fe 1/20 (28) oral tablet 1 mg- 20 mcg (21)/75 mg (7) junel fe 24 oral tablet 1 mg-20 mcg (24)/75 mg (4) kariva (28) oral tablet mgx21 /0.01 mg x 5 kelnor 1/35 (28) oral tablet 1-35 mg-mcg kimidess (28) oral tablet mgx21 /0.01 mg x 5 kurvelo oral tablet mg l norgest/e.estradiol-e.estrad oral tablets,dose pack,3 month 0.10 mg- 20 mcg (84)/10 mcg (7) (LoSeasonique) l norgest/e.estradiol-e.estrad oral tablets,dose pack,3 month 0.15 mg- (Amethia) 30 mcg (84)/10 mcg (7) larin 1.5/30 (21) oral tablet mg-mcg larin 1/20 (21) oral tablet 1-20 mgmcg larin 24 fe oral tablet 1 mg-20 mcg (24)/75 mg (4) larin fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) larin fe 1/20 (28) oral tablet 1 mg- 20 mcg (21)/75 mg (7) larissia oral tablet mg-mcg leena 28 oral tablet 0.5/1/ mg-mcg lessina oral tablet mg-mcg QL (91 per 84 QL (91 per

121 levonest (28) oral tablet (6)/75-40 (5)/125-30(10) levonor-eth estrad outer (Levora 0.15/30 QL (91 per mg (28)) levonorgestrel 1.5 mg tablet (otc) ; QL (6 per 365 (Plan B One-Step) 1.5 mg levonorgestrel-ethinyl estrad oral tablet mg-mcg (Vienva) levonorgestrel-ethinyl estrad oral QL (91 per 84 tablets,dose pack,3 month 0.15 mg- 30 mcg (Jolessa) levonorg-eth estrad triphasic oral QL (91 per 84 tablet (6)/75-40 (5)/125-30(10) (Trivora (28)) levora-28 oral tablet mg lomedia 24 fe oral tablet 1 mg-20 mcg (24)/75 mg (4) loryna (28) oral tablet mg low-ogestrel (28) oral tablet mg-mcg lutera (28) oral tablet mgmcg lyza oral tablet 0.35 mg marlissa oral tablet mg microgestin 1.5/30 (21) oral tablet mg-mcg microgestin 1/20 (21) oral tablet 1-20 mg-mcg microgestin fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) microgestin fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7) mono-linyah oral tablet mgmcg mononessa (28) oral tablet mg-mcg my way 1.5 mg tablet (otc) 1.5 mg ; QL (6 per

122 myzilra oral tablet (6)/75-40 (5)/125-30(10) necon 0.5/35 (28) oral tablet mg-mcg necon 1/35 (28) oral tablet 1-35 mgmcg necon 1/50 (28) oral tablet 1-50 mgmcg necon 10/11 (28) oral tablet /1-35 mg-mcg/mg-mcg necon 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg next choice one dose 1.5 mg tb (otc) 1.5 mg nikki (28) oral tablet mg nora-be oral tablet 0.35 mg norethindrone (contraceptive) oral tablet 0.35 mg (Jencycla) norethindrone ac-eth estradiol oral tablet 1-20 mg-mcg (Junel 1/20 (21)) norethindrone-e.estradiol-iron oral tablet 1 mg-20 mcg (24)/75 mg (4) (Lomedia 24 Fe) norgestimate-ethinyl estradiol oral tablet 0.18/0.215/0.25 mg-25 mcg (Tri-Lo-Sprintec) norgestimate-ethinyl estradiol oral (Ortho Tri-Cyclen tablet 0.18/0.215/0.25 mg-35 mcg (28)) (28) norgestimate-ethinyl estradiol oral tablet mg-mcg (Mononessa (28)) norlyroc oral tablet 0.35 mg nortrel 0.5/35 (28) oral tablet mg-mcg nortrel 1/35 (21) oral tablet 1-35 mg-mcg nortrel 1/35 (28) oral tablet 1-35 mg-mcg nortrel 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg ; QL (6 per

123 NUVARING VAGINAL RING ST; QL (1 per MG/24 HR ocella oral tablet mg ogestrel (28) oral tablet mgmcg opcicon one-step 1.5 mg tablet 1.5 ; QL (6 per 365 mg option mg tablet 1.5 mg ; QL (6 per 365 orsythia oral tablet mg-mcg philith oral tablet mg-mcg pimtrea (28) oral tablet mgx21 /0.01 mg x 5 pirmella oral tablet 0.5/0.75/1 mg- 35 mcg, 1-35 mg-mcg portia oral tablet mg previfem oral tablet mg-mcg quasense oral tablets,dose pack,3 QL (91 per 84 month 0.15 mg-30 mcg react 1.5 mg tablet 1.5 mg ; QL (6 per 365 reclipsen (28) oral tablet mg setlakin oral tablets,dose pack,3 QL (91 per 84 month 0.15 mg-30 mcg sharobel oral tablet 0.35 mg sprintec (28) oral tablet mgmcg sronyx oral tablet mg-mcg syeda oral tablet mg tarina fe 1/20 (28) oral tablet 1 mg- 20 mcg (21)/75 mg (7) tilia fe oral tablet 1-20(5)/1-30(7) /1mg-35mcg (9) tri-estarylla oral tablet 0.18/0.215/0.25 mg-35 mcg (28) tri-legest fe oral tablet 1-20(5)/1-30(7) /1mg-35mcg (9) tri-linyah oral tablet 0.18/0.215/0.25 mg-35 mcg (28) 109

124 tri-lo-estarylla oral tablet 0.18/0.215/0.25 mg-25 mcg tri-lo-marzia oral tablet 0.18/0.215/0.25 mg-25 mcg tri-lo-sprintec oral tablet 0.18/0.215/0.25 mg-25 mcg trinessa (28) oral tablet 0.18/0.215/0.25 mg-35 mcg (28) tri-previfem (28) oral tablet 0.18/0.215/0.25 mg-35 mcg (28) tri-sprintec (28) oral tablet 0.18/0.215/0.25 mg-35 mcg (28) trivora (28) oral tablet (6)/75-40 (5)/125-30(10) velivet triphasic regimen (28) oral tablet 0.1/.125/ mg-mcg vestura (28) oral tablet mg vienva oral tablet mg-mcg viorele (28) oral tablet mgx21 /0.01 mg x 5 vyfemla (28) oral tablet mgmcg wera (28) oral tablet mg-mcg xulane transdermal patch weekly mcg/24 hr zarah oral tablet mg zenchent (28) oral tablet mgmcg zovia 1/35e (28) oral tablet 1-35 mg-mcg zovia 1/50e (28) oral tablet 1-50 mg-mcg Cough And Cold Products Cough And Cold Products 15dm-5peh-2cpm liquid strawberry mg/5 ml 25cpd-200gfn liquid mg/5 ml 110 QL (3 per 28

125 30pse-150gfn-15dm liquid mg/5 ml 3brm-15dm-30pse liquid mg/5 ml actinel pediatric liquid mg/5 ml adt robitussin peak cld dm max mg/5 ml adult robitussin peak cold dm nondrowsy mg/5 ml adult wal-tussin dm max liq a/f,cherry menthol mg/5 ml adult wal-tussin dm syrup a/f,s/f,chry-menthol mg/5 ml adult wal-tussin liquid 100 mg/5 ml alka-seltzer plus mucus-conges mg ambi 10peh-4cpm-20dm tablet mg ambi 20dm-4cpm tablet 4-20 mg ambi 40pse-400gfn-20dm tablet mg ambi 60pse-4cpm-20dm tablet mg benzonatate 100 mg capsule 100 mg (Tessalon Perles) 3 $0 benzonatate 150 mg capsule 150 mg (Zonatuss) 3 $0 benzonatate 200 mg capsule 200 mg 3 $0 bio-dtuss dmx liquid mg/5 ml bionel pediatric liquid mg/5 ml biospec dmx liquid mg/5 ml 111

126 bp 8 cough oral suspension a/f, grape (otc) mg/5 ml bromfed dm cough syrup $0 mg/5 ml bromphenir-pseudoephed-dm syr (Bromfed DM) 3 $0 (rx) mg/5 ml brotapp dm liquid mg/5 ml centergy dm pediatric drops $0 mg/ml cheratussin ac syrup (otc) mg/5 ml cheratussin dac syrup mg/5 ml child plus cough-runny nose cherry flavor mg/5 ml child robitussin er 30 mg/5 ml 30 mg/5 ml child sudafed pe cough-cold lq mg/5 ml child triaminic cgh-congst syr mg/5 ml child wal-tussin 7.5 mg odt 7.5 mg children's mucinex cough liq a/f mg/5 ml children's silfedrine liq 15 mg/5 ml childs sudafed 15 mg/5 ml liq nondrowsy,a/f,s/f 15 mg/5 ml chl mucinex chest congest liq a/f 100 mg/5 ml codituss dm syrup mg/5 ml cold multi-symptom day-night pseudoephedrine-free mg cold multi-symptom night liq a/f, honey lemon mg/15 ml 112

127 cold relief multi-symp caplet cplt,12 day,12 night mg cold-flu relief d/n softgel mg(d)/ mg cold-flu relief liquid ,000 mg/30 ml congestac tablet mg congest-eze mg caplet mg coricidin hbp cold-multi sympt mg/15 ml coricidin hbp softgel mg cough & cold tablet 4-30 mg cough relief liquid 15 mg/5 ml cvs chest cong relief pe tab mg cvs chest congest + cough liq mg/5 ml cvs chest congest relief dm tb mg cvs child cold-cough day liq mg/5 ml cvs child cough & runny nose mg/5 ml cvs child cough dm er 30 mg/5 30 mg/5 ml cvs child's chest congest liq 100 mg/5 ml cvs cough & sore throat susp mg/5 ml cvs nighttime cough liquid cherry flavor mg/15 ml cvs tussin cf liquid a/f, non drowsy mg/5 ml cvs tussin cgh 15 mg liq gels nondrowsy, liq gels 15 mg cvs tussin dm cough-chest liq mg/5 ml 113

128 daytime cold & cough liquid 1, mg/30 ml daytime cough liquid a/f, gluten-free 5 mg/5 ml daytime-nighttime cold-flu liq multisymptom mg/15 ml daytime-nighttime cough liquid 15mg/15ml(d)/ mg/30ml delsym cough+chest cngst dm lq mg/5 ml despec-dm tablet mg dextromethorphan er 30 mg/5 ml 30 (Delsym 12 hour) mg/5 ml diabetic tussin dm liquid mg/5 ml diabetic tussin dm max-str liq mg/5 ml diabetic tussin ex liquid a/f,d/f,na/f,s/f 100 mg/5 ml DIMETAPP LONG-ACTING COUGH LIQ MG/5 ML ed bron gp liquid mg/5 ml entre-cough liquid mg/5 ml expectorant 100 mg/5 ml syrup 100 mg/5 ml expectorant dm cough liquid mg/5 ml expectorant max cough-cold mg/5 ml flu hbp tablet mg geri-tussin dm syrup mg/5 ml guaifenesin 200 mg tablet (otc) 200 (Organ-I NR) mg guaifenesin er 1,200 mg tablet 1,200 (Mucinex) mg 114

129 guaifenesin er 600 mg tablet 600 mg (Mucus Relief ER) head congestion day-night pack mg hydrocodone-chlorphen er susp 10- (Tussionex 3 $0 8 mg/5 ml Pennkinetic ER) hydrocodone-homatropine mg (Tussigon) 3 $0 tablet mg hydrocodone-homatropine syrup 5- (Hydrocodone 3 $0 1.5 mg/5 ml Compound) hydromet syrup mg/5 ml 3 $0 kidkare cough & cold liquid mg/5 ml liquibid d-r tablet mg lohist-dm syrup mg/5 ml lortuss ex liquid mg/5 ml mar-cof bp liquid mg/5 ml mar-cof cg liquid mg/5 ml MUCINEX FAST-MAX COLD- FLU-THRT MG mucinex fast-max dm max liquid maximum strength mg/5 ml mucus dm mg tablet mg mucus dm max 1, mg tab 60-1,200 mg mucus relief 400 mg tablet d/f 400 mg nasal-sinus decongest tab 30 mg NEO DM SYRUP MG/5 ML neo-tuss liquid mg/5 ml night time cold med liquid mg/15 ml night time cough & sore throat ,000 mg/30 ml 115

130 nohist-dm liquid mg/5 ml pecgen dmx mg/5 ml liq mg/5 ml pediacare multi-symt cold liq non drowsy, grape mg/5 ml phenylhistine dh liquid (otc) mg/5 ml promethazine vc-codeine syrup 3 $ mg/5 ml promethazine-codeine syrup $0 mg/5 ml promethazine-dm syrup $0 mg/5 ml pseudoephed 30 mg/5 ml soln 30 mg/5 ml (Nasal Decongestant (pseudoeph)) pseudoephedrine 30 mg tablet 30 (Suphedrin) mg pseudoephedrine 60 mg tablet exstr, non drowsy (otc) 60 mg (Sudogest) pv flu relief therapy liquid daytime mg/15 ml pv night-time softgel multisympt.,softgel mg pv tussin pe liquid mg/5 ml q-tussin 100 mg/5 ml solution a/f, non-drowsy 100 mg/5 ml q-tussin dm syrup mg/5 ml ra anti-tussive dm syrup mg/5 ml ra day cold-flu relief softgel a/f, multi-symptom mg ra daytime cold-flu liquid a/f,antihist free mg/15 ml ra daytime-nighttime softgel cold-flu relief mg(d)/ mg 116

131 ra flu formula gelcap mg ra mucus relief 400 mg tablet 400 mg ra multi-symptom cold caplet nighttime,cplt mg refenesen 400 mg tablet 400 mg refenesen pe caplet mg relcof c liquid mg/5 ml REZIRA SOLUTION 60-5 MG/5 3 $0 ML robafen 100 mg/5 ml syrup 100 mg/5 ml robafen cough 15 mg liquidgel nondrowsy,liquidgel 15 mg robafen-dm syrup mg/5 ml robitussin cough-chest dm liq mg/5 ml robitussin cough-chest-cong dm mg ROBITUSSIN LONG-ACTING LIQ MG/5 ML robitussin pediatric cough syp a/f,long-acting 7.5 mg/5 ml rydex liquid mg/5 ml rynex dm liquid a/f, prof use only mg/5 ml safetussin dm liquid mg/5 ml scot-tussin 100 mg/5 ml liq 100 mg/5 ml scot-tussin dm s-f liquid 2-15 mg/5 ml siltussin sa 100 mg/5 ml syr 100 mg/5 ml sm adult nasal decongestant lq 15 mg/5 ml 117

132 sm cold & cough liquid children's, day time mg/5 ml sm cough & runny nose liquid 1-5 mg/5 ml sm cough-head congestion lq mg/5 ml sm flu severe cold-congestion maximum strength ,000 mg sm nite time cold-flu liquid ,000 mg/30 ml sm nite time cold-flu rel sfgl softgel mg sm pain reliever cold caplet mg sm pedia relief liquid mg/5 ml sm severe cold m-s caplet mg sm tussin cf syrup mg/5 ml sudafed 30 mg tablet nondrowsy,max-str 30 mg sudogest 30 mg tablet boxed 30 mg sudogest 60 mg tablet 60 mg suphedrin liquid 15 mg/5 ml suphedrine pe combo pack cplt mg triaminic daytime cold-cough children's, cherry mg/5 ml tusnel diabetic liquid (otc) mg/5 ml TUSNEL LIQUID A/F,A/F,D/F MG/5 ML TUSSI PRES-B LIQUID MG/5 ML 118

133 tussin cold-congestion gelcap liquid gelcap mg tussin dm syrup mg/5 ml vicks dayquil cough liquid a/f,8 hr rlf 5 mg/5 ml vicks nature fusion cough liq 5 mg/5 ml vicks nyquil liquicaps cold & flu mg virtussin ac liquid mg/5 ml virtussin dac liquid mg/5 ml v-r infant non-asa cold drp mg/1.6 ml v-r non-aspirin flu gelcap gelatin caplet mg v-r pedia relief inf drops decongestant mg/0.8 ml vr triacting cold-cough liq mg/5 ml v-r tussin cf syrup mg/5 ml wal-flu severe cold-cough pckt mg wal-phed 30 mg tablet non-drowsy 30 mg wal-phed pe day-night combo pk caplet mg wal-tussin cough 15 mg softgel 15 mg wal-tussin max str cough syrup maximum strength 15 mg/5 ml zephrex-d 30 mg tablet 30 mg zyncof mg/5 ml liquid mg/5 ml Dental And Oral Agents Dental And Oral Agents cevimeline oral capsule 30 mg (Evoxac) 119

134 chlorhexidine gluconate mucous membrane mouthwash 0.12 % (Peridex) oralone dental paste 0.1 % periogard mucous membrane mouthwash 0.12 % pilocarpine hcl oral tablet 5 mg, 7.5 (Salagen mg (pilocarpine)) triamcinolone acetonide dental paste 0.1 % (Oralone) Dermatological Agents Dermatological Agents, Other 8-MOP ORAL CAPSULE 10 MG 120 acitretin oral capsule 10 mg, 17.5 mg, 25 mg (Soriatane) acne medication 10% gel 10 % acne medication 10% lotion 10 % acne medication 5% gel 5 % ACNE MEDICATION 5% LOTION 5 % acyclovir topical ointment 5 % (Zovirax) QL (5 per 4 ALCOHOL PADS TOPICAL PADS, MEDICATED ALCOHOL PREP PADS amlactin 12% lotion 12 % ammonium lactate 12% cream (Geri-Hydrolac) fragrance free (otc) 12 % ammonium lactate 12% lotion (Skin Treatment) fragrance free (otc) 12 % ammonium lactate topical cream 12 % (Geri-Hydrolac) ammonium lactate topical lotion 12 % (Skin Treatment) ANACAINE TOPICAL OINTMENT 10 % benzoyl peroxide 10% gel aqueous (Acne-Clear) (otc) 10 % benzoyl peroxide 5% gel aqueous (BP) (otc) 5 %

135 BETADINE 5% SPRAY 5 % calcipotriene scalp solution % calcipotriene topical cream % (Dovonex) calcipotriene topical ointment % (Calcitrene) calcitrene topical ointment % calcitriol topical ointment 3 mcg/gram (Vectical) CASTELLANI PAINT 1.5% COLORLESS 1.5 % CONDYLOX TOPICAL GEL 0.5 % COSENTYX (150 MG/ML) 300 PA MG DOSE-2 PENS 150 MG/ML COSENTYX (150 MG/ML) 300 PA MG DOSE-2 SYRINGES 150 MG/ML COSENTYX PEN PA SUBCUTANEOUS PEN INJECTOR 150 MG/ML COSENTYX SUBCUTANEOUS PA SYRINGE 150 MG/ML cutter backwoods 25% spray 25 % ; QL (340 per 180 cutter skinsations 7% spray 7 % ; QL (354 per 180 cvs skin treatment body lotion 12 % diclofenac sodium topical gel 3 % (Solaraze) fluorouracil topical cream 0.5 % (Carac) fluorouracil topical cream 5 % (Efudex) fluorouracil topical solution 2 %, 5 % geri-hydrolac 12% lotion 12 % geri-hydrolac 5% lotion 5 % imiquimod topical cream in packet 5 % (Aldara) PA NSO; QL (24 per

136 INSECT REPELLENT 20% SPRAY 20 % LACTINOL HX CREAM lobana bath oil methoxsalen oral capsule,liqdfilled,rapid rel 10 mg (Oxsoralen Ultra) ; QL (236 per 180 NATRAPEL 20% SPRAY 20 % ; QL (354 per 180 off active 15% spray 15 % ; QL (340 per 180 off deep woods 25% spray 25 % ; QL (340 per 180 off deep woods dry 25% spray 25 % ; QL (226 per 180 off familycare 15% rplnt i spr 15 % ; QL (142 per 180 PANRETIN TOPICAL GEL 0.1 % persa-gel 10% 12's,max-strength 10 % PICATO TOPICAL GEL % QL (3 per 56 PICATO TOPICAL GEL 0.05 % QL (2 per 56 podofilox topical solution 0.5 % (Condylox) potassium hydroxide topical solution 5 % pv acne pimple 10% gel 10 % repel sportsmen 25% spray 25 % ; QL (368 per 180 repel sportsmen max 40% spray 40 % SANTYL TOPICAL OINTMENT 250 UNIT/GRAM SILIQ SUBCUTANEOUS SYRINGE 210 MG/1.5 ML TALTZ 80 MG/ML AUTOINJECTOR P/F,LATEX- FREE,OUTER 80 MG/ML ; QL (368 per 180 PA PA 122

137 TALTZ AUTOINJECTOR (3 PA PACK) SUBCUTANEOUS AUTO- INJECTOR 80 MG/ML TALTZ SYRINGE PA SUBCUTANEOUS SYRINGE 80 MG/ML TOLAK TOPICAL CREAM 4 % VALCHLOR TOPICAL GEL % zenatane oral capsule 10 mg, 20 mg, 30 mg, 40 mg zinc oxide 20% ointment 20 % Dermatological Antibacterials bacitracin 500 unit/gm ointmnt 500 (Bacitraycin Plus) unit/gram bacitraycin plus 500 unit/gm 500 unit/gram clindamycin phosphate topical gel 1 % (Cleocin T) clindamycin phosphate topical lotion 1 % (Cleocin T) clindamycin phosphate topical solution 1 % (Cleocin T) clindamycin phosphate topical swab 1 % (Clindacin ETZ) cvs triple antibiotic ointment 3.5mg- 400 unit- 5,000 unit/gram ery pads topical swab 2 % erythromycin with ethanol topical gel 2 % (Erygel) erythromycin with ethanol topical solution 2 % erythromycin with ethanol topical swab 2 % (Ery Pads) gentamicin topical cream 0.1 % gentamicin topical ointment 0.1 % metronidazole topical cream 0.75 % (MetroCream) metronidazole topical gel 0.75 % (Rosadan) 123

138 metronidazole topical gel 1 % (Metrogel) metronidazole topical lotion 0.75 % (MetroLotion) mupirocin calcium topical cream 2 % (Bactroban) mupirocin topical ointment 2 % (Centany) neomycin-polymyxin b gu irrigation (Neosporin GU solution 40 mg-200,000 unit/ml Irrigant) neosporin ointment 3.5mg-400 unit- 5,000 unit/gram rosadan topical cream 0.75 % selenium sulfide topical lotion 2.5 % silver nitrate topical ointment 10 % silver nitrate topical solution 10 %, 25 %, 50 % silver sulfadiazine topical cream 1 % (Silvadene) ssd topical cream 1 % sulfacetamide sodium (acne) topical suspension 10 % (Klaron) triple antibiotic ointment 3.5mg-400 unit- 5,000 unit/gram Dermatological Anti-Inflammatory Agents ala-cort topical cream 1 %, 2.5 % ala-scalp topical lotion 2 % alclometasone topical cream 0.05 % alclometasone topical ointment 0.05 % anti-itch 1% lotion 1 % aquanil hc 1% lotion 1 % beta hc 1% lotion 1 % betamethasone dipropionate topical cream 0.05 % betamethasone dipropionate topical lotion 0.05 % betamethasone dipropionate topical ointment 0.05 % 124

139 betamethasone valerate topical cream 0.1 % betamethasone valerate topical foam 0.12 % (Luxiq) betamethasone valerate topical lotion 0.1 % betamethasone valerate topical ointment 0.1 % betamethasone, augmented topical cream 0.05 % (Diprolene AF) betamethasone, augmented topical gel 0.05 % betamethasone, augmented topical lotion 0.05 % betamethasone, augmented topical ointment 0.05 % (Diprolene) clobetasol 0.05% cream 0.05 % (Temovate) clobetasol scalp solution 0.05 % (Cormax) clobetasol topical foam 0.05 % (Olux) clobetasol topical gel 0.05 % clobetasol topical lotion 0.05 % (Clobex) clobetasol topical ointment 0.05 % (Temovate) clobetasol topical shampoo 0.05 % (Clobex) clobetasol-emollient topical cream 0.05 % clocortolone pivalate topical cream 0.1 % (Cloderm) cormax scalp solution 0.05 % cortaid 1% cream 12 hr, anti-itch 1 % cortizone-10 1% creme maximum strength 1 % cortizone-10 1% ointment 1 % dermarest eczema 1% lotion 1 % desonide topical cream 0.05 % (Tridesilon) desonide topical ointment 0.05 % desoximetasone topical cream 0.05 %, 0.25 % (Topicort) 125

140 desoximetasone topical gel 0.05 % (Topicort) desoximetasone topical ointment 0.05 %, 0.25 % (Topicort) ELIDEL TOPICAL CREAM 1 % EUCRISA TOPICAL OINTMENT 2 % fluocinonide topical cream 0.05 % fluocinonide topical gel 0.05 % fluocinonide topical ointment 0.05 % fluocinonide topical solution 0.05 % fluocinonide-e topical cream 0.05 % fluticasone topical cream 0.05 % (Cutivate) fluticasone topical ointment % halobetasol propionate topical cream 0.05 % (Ultravate) halobetasol propionate topical ointment 0.05 % (Ultravate) hydro skin 1% lotion 1 % hydrocortisone 0.5% cream (otc) 0.5 % hydrocortisone 0.5% ointment 0.5 % hydrocortisone 1% cream maximum (Eczema Anti-Itch) strength (otc) 1 % hydrocortisone 1% cream maximum strength 1 % hydrocortisone 1% lotion (otc) 1 % (Aquanil HC) hydrocortisone 1% ointment carton (Cortizone-10) (otc) 1 % hydrocortisone buty 0.1% cream 0.1 % (Locoid) hydrocortisone butyrate topical ointment 0.1 % (Locoid) hydrocortisone butyrate topical solution 0.1 % (Locoid) 126

141 hydrocortisone butyr-emollient (Locoid topical cream 0.1 % Lipocream) hydrocortisone topical cream 1 % (Eczema Anti-Itch) hydrocortisone topical cream 2.5 % (Ala-Cort) hydrocortisone topical lotion 2.5 % hydrocortisone topical ointment 1 % (Cortizone-10) hydrocortisone topical ointment 2.5 % hydrocortisone valerate topical cream 0.2 % hydrocortisone valerate topical ointment 0.2 % mometasone topical cream 0.1 % (Elocon) mometasone topical ointment 0.1 % (Elocon) mometasone topical solution 0.1 % neosporin 1% anti-itch cream 1 % prednicarbate topical cream 0.1 % (Dermatop) prednicarbate topical ointment 0.1 % (Dermatop) preparation h hc 1% cream 1 % procto-med hc topical cream with perineal applicator 2.5 % procto-pak topical cream with perineal applicator 1 % proctosol hc topical cream with perineal applicator 2.5 % proctozone-hc topical cream with perineal applicator 2.5 % recort plus 1% cream 1 % tacrolimus topical ointment 0.03 %, 0.1 % (Protopic) triamcinolone acetonide topical cream %, 0.5 % triamcinolone acetonide topical cream 0.1 % (Triderm) triamcinolone acetonide topical lotion %, 0.1 % 127

142 triamcinolone acetonide topical ointment %, 0.1 %, 0.5 % trianex topical ointment 0.05 % tridesilon topical cream 0.05 % u-cort topical cream 1-10 % Dermatological Retinoids adapalene topical cream 0.1 % (Differin) adapalene topical gel 0.1 % (Differin) TAZORAC TOPICAL CREAM 0.05 %, 0.1 % tretinoin gel micro 0.04% tube 0.04 PA (Retin-A Micro) % tretinoin gel micro 0.1% tube 0.1 % (Retin-A Micro) PA tretinoin microspheres topical gel (Retin-A Micro PA with pump 0.04 %, 0.1 % Pump) tretinoin topical cream %, PA (Retin-A) 0.05 %, 0.1 % tretinoin topical gel 0.01 % (Retin-A) PA tretinoin topical gel % (Avita) PA tretinoin topical gel 0.05 % (Atralin) PA Scabicides And Pediculicides cvs lice killing shampoo maximum strength % cvs permethrin 1% lotion 1 % (Lice Treatment (permethrin)) malathion topical lotion 0.5 % (Ovide) NIX 1% CREME RINSE LIQUID W/ NIT COMB 1 % permethrin topical cream 5 % (Elimite) ra lice treatment 1% crm rinse 2x59ml, 2 combs 1 % sm lice treatment 1% crm rinse 1 % v-r lice cream rinse 1 % Devices Devices ASSURE ID INSULIN SAFETY SYRINGE 1 ML 29 GAUGE X 1/2" 128

143 BD INSULIN SYR 0.3 ML 6MMX31G 0.3 ML 31 GAUGE X 15/64" BD INSULIN SYR 0.5 ML 6MMX31G 1/2 ML 31 GAUGE X 15/64" BD INSULIN SYR 1 ML 6MMX31G 1 ML 31 GAUGE X 15/64" BD ULTRA-FINE PEN NDL 8MMX31G SHORT 31 GAUGE X 5/16" BLADDER CONTROL PAD X- LONG 9'S,X-LONG GAUZE PAD TOPICAL BANDAGE 2 X 2 " GAUZE PADS, STERILE 2"X2" 2 X 2 " INSULIN SYRINGE-NEEDLE U- 100 SYRINGE 0.3 ML 29 GAUGE INSULIN SYRINGE-NEEDLE U- 100 SYRINGE 1 ML 29 GAUGE X 1/2" INSULIN SYRINGE-NEEDLE U- 100 SYRINGE 1/2 ML 28 GAUGE PEN NEEDLE, DIABETIC NEEDLE 29 GAUGE X 1/2" (Ultilet Insulin Syringe) (VanishPoint Syringe) (Monoject Ultra Comfort Insulin) (Insupen) VGO 40 DISPOSABLE DEVICE Disinfectants (For Non- Dermatologic Use) Disinfectants (For Non- Dermatologic Use) sm iodine tincture Enzyme Replacement/Modifiers Enzyme Replacement/Modifiers ADAGEN INTRAMUSCULAR SOLUTION 250 UNIT/ML 129

144 ALDURAZYME INTRAVENOUS SOLUTION 2.9 MG/5 ML CEREZYME INTRAVENOUS RECON SOLN 400 UNIT CREON ORAL CAPSULE,DELAYED RELEASE(DR/EC) 12,000-38,000-60,000 UNIT, 24,000-76, ,000 UNIT, 3,000-9,500-15,000 UNIT, 36, , ,000 UNIT, 6,000-19,000-30,000 UNIT ELAPRASE INTRAVENOUS SOLUTION 6 MG/3 ML ELITEK INTRAVENOUS RECON SOLN 1.5 MG, 7.5 MG FABRAZYME INTRAVENOUS RECON SOLN 35 MG KANUMA INTRAVENOUS SOLUTION 2 MG/ML KRYSTEXXA INTRAVENOUS SOLUTION 8 MG/ML KUVAN ORAL TABLET,SOLUBLE 100 MG MYOZYME INTRAVENOUS RECON SOLN 50 MG NAGLAZYME INTRAVENOUS SOLUTION 5 MG/5 ML ORFADIN ORAL CAPSULE 10 MG, 2 MG, 20 MG, 5 MG ORFADIN ORAL SUSPENSION 4 MG/ML PULMOZYME INHALATION SOLUTION 1 MG/ML STRENSIQ SUBCUTANEOUS SOLUTION 100 MG/ML, 40 MG/ML VIMIZIM INTRAVENOUS SOLUTION 5 MG/5 ML (1 MG/ML) 130 PA PA; LA PA

145 VPRIV INTRAVENOUS RECON SOLN 400 UNIT ZAVESCA ORAL CAPSULE 100 MG ZENPEP ORAL CAPSULE,DELAYED RELEASE(DR/EC) 10,000-34,000-55,000 UNIT, 15,000-51,000-82,000 UNIT, 20,000-68, ,000 UNIT, 25,000-85, ,000 UNIT, 3,000-10,000-16,000 UNIT, 40, , ,000 UNIT, 5,000-17,000-27,000 UNIT Eye, Ear, Nose, Throat Agents Eye, Ear, Nose, Throat Agents, Miscellaneous AKTEN (PF) OPHTHALMIC GEL 3.5 % alcaine ophthalmic drops 0.5 % altacaine ophthalmic drops 0.5 % altamist 0.65% nose spray 0.65 % apraclonidine ophthalmic drops 0.5 % (Iopidine) artificial tears artificial tears 1.4 % drops 1.4 % artificial tears drops p/f, sterile % artificial tears eye drops strl % ARTIFICIAL TEARS EYE OINTMENT % atropine ophthalmic drops 1 % (Isopto Atropine) ayr saline 0.65% nose drops 0.65 % ayr saline 0.65% nose spray 0.65 % QL (90 per

146 azelastine nasal aerosol,spray 137 QL (30 per 25 mcg (0.1 %) azelastine ophthalmic drops 0.05 % bion tears eye drops % carteolol ophthalmic drops 1 % cromolyn ophthalmic drops 4 % cvs artificial tears drops sterile % cvs lubricant 0.6% eye drops 0.6 % cvs lubricant dry eye rlf 1% 1 % cvs lubricant eye ointment p/f % cvs lubricant gel eye drops % cvs lubricating eye drops dry eye soln % cvs nasal spray 0.05% 0.05 % cvs saline 0.65% nose spray 0.65 % cyclopentolate ophthalmic drops 0.5 %, 1 %, 2 % (Cyclogyl) CYSTARAN OPHTHALMIC DROPS 0.44 % deep sea 0.65% nose spray 0.65 % dristan long lasting mist 0.05 % epinastine ophthalmic drops 0.05 % (Elestat) eq gentle 0.3% eye drops 0.3 % eq revive plus 0.5% eye drops 0.5 % flucaine ophthalmic drops % GENTEAL GEL DROPS % GENTEAL MILD 0.2% EYE DROPS 0.2 % GENTEAL SEVERE 0.3% EYE GEL P/F, STRL, INNER 0.3 % 132

147 GENTEAL TEARS 0.1%-0.2%- 0.3% % genteal tears 0.1%-0.3% drop % GENTEAL TEARS 0.1%-0.3% DROP % homatropaire ophthalmic drops 5 % homatropine hbr ophthalmic drops 5 % (Homatropaire) ipratropium bromide nasal QL (30 per 28 spray,non-aerosol 0.03 % ipratropium bromide nasal QL (15 per 10 spray,non-aerosol 0.06 % isopto tears 0.5% eye drops 0.5 % LACRISERT OPHTHALMIC INSERT 5 MG little remedies stuffy nose kt w/ nasal aspirator 0.65 % lubricant % eye drops % lubricant % eye drops % lubricating plus 0.5% eye drps p/f, 30x0.4ml 0.5 % lubrifresh pm eye ointment % mucinex sinus-max nasal spray full force 0.05 % muro-128 2% eye drops 2 % muro-128 5% eye drops 5 % muro-128 5% eye ointment 5 % naphazoline ophthalmic drops 0.1 % natural balance tears drops 0.4 % natural balance tears eye drop % nature's tears drops 0.4 % neo-synephrine 12 hour spray 0.05 % 133

148 ocean 0.65% nasal spray 0.65 % olopatadine ophthalmic drops 0.1 % (Patanol) OTOVEL OTIC SOLUTION % (0.25 ML) PATADAY OPHTHALMIC ST DROPS 0.2 % phenylephrine hcl ophthalmic drops 10 %, 2.5 % proparacaine ophthalmic drops 0.5 % pure & gentle eye drops lubricant 0.3 % pv artificial tears 0.4 % pv lubricant 1.4 % eye drops 1.4 % pv pure-gentle eye drops sterile 0.3 % REFRESH CELLUVISC 1% EYE DROPS 1 % REFRESH CLASSIC EYE DROPS U-D,P/F,30X.4ML % REFRESH LACRI-LUBE OINTMENT % retaine cmc 0.5% eye drops 0.5 % retaine hpmc 0.3% eye drops 0.3 % retaine pm eye ointment % sea soft 0.65% nasal mist 0.65 % sm lubricant eye drops strl % sochlor 5% eye drops 5 % sodium chloride 5% eye drop 5 % (Muro 128) sodium chloride 5% eye oint 5 % (Muro 128) soothe night time lub eye oint % SYSTANE 0.3% EYE GEL 0.3 % SYSTANE GEL EYE DROPS % 134

149 tears again 1.4 % drops 1.4 % tears again eye ointment % tears naturale free drops u- d,36x.9ml,p/f % ultra fresh pm ointment vicks qlearquil 0.05% mist 0.05 % vicks sinex 12 hour spray 0.05 % Eye, Ear, Nose, Throat Anti- Infectives Agents acetic acid otic solution 2 % bacitracin ophthalmic ointment 500 unit/gram bacitracin-polymyxin b ophthalmic ointment ,000 unit/gram (Polycin) bleph-10 ophthalmic drops 10 % CIPRODEX OTIC DROPS,SUSPENSION % ciprofloxacin hcl ophthalmic drops 0.3 % (Ciloxan) ciprofloxacin hcl otic dropperette 0.2 % (Cetraxal) COLY-MYCIN S OTIC DROPS,SUSPENSION MG/ML erythromycin ophthalmic ointment 5 mg/gram (0.5 %) gatifloxacin ophthalmic drops 0.5 % (Zymaxid) gentak ophthalmic ointment 0.3 % (3 mg/gram) gentamicin ophthalmic drops 0.3 % gentamicin ophthalmic ointment 0.3 % (3 mg/gram) (Gentak) levofloxacin ophthalmic drops 0.5 % MOXEZA OPHTHALMIC DROPS, VISCOUS 0.5 % NATACYN OPHTHALMIC DROPS,SUSPENSION 5 % 135

150 neomycin-bacitracin-poly-hc ophthalmic ointment ,000 mg-unit/g-1% neomycin-bacitracin-polymyxin ophthalmic ointment ,000 mg-unit-unit/g neomycin-polymyxin b-dexameth ophthalmic drops,suspension 3.5mg/ml-10,000 unit/ml-0.1 % neomycin-polymyxin b-dexameth ophthalmic ointment 3.5 mg/g- 10,000 unit/g-0.1 % neomycin-polymyxin-gramicidin ophthalmic drops 1.75 mg-10,000 unit-0.025mg/ml neomycin-polymyxin-hc ophthalmic drops,suspension , mgunit-mg/ml (Neo-Polycin HC) (Neo-Polycin) (Maxitrol) (Maxitrol) (Neosporin (neopolym-gramicid)) neomycin-polymyxin-hc otic drops,suspension ,000-1 mg/ml-unit/ml-% neomycin-polymyxin-hc otic solution ,000-1 mg/mlunit/ml-% neo-polycin hc ophthalmic ointment ,000 mg-unit/g-1% neo-polycin ophthalmic ointment ,000 mg-unit-unit/g ofloxacin ophthalmic drops 0.3 % (Ocuflox) ofloxacin otic drops 0.3 % (Floxin) polymyxin b sulf-trimethoprim ophthalmic drops 10,000 unit- 1 (Polytrim) mg/ml REFRESH OPTIVE ADVANCED DROPS % sulfacetamide sodium ophthalmic drops 10 % (Bleph-10) sulfacetamide sodium ophthalmic ointment 10 % 136

151 sulfacetamide-prednisolone ophthalmic drops 10 %-0.23 % (0.25 %) TOBRADEX OPHTHALMIC OINTMENT % TOBRADEX ST OPHTHALMIC DROPS,SUSPENSION % tobramycin ophthalmic drops 0.3 % (Tobrex) tobramycin-dexamethasone ophthalmic drops,suspension (TobraDex) % trifluridine ophthalmic drops 1 % (Viroptic) VIGAMOX OPHTHALMIC DROPS 0.5 % ZIRGAN OPHTHALMIC GEL 0.15 % ZYLET OPHTHALMIC DROPS,SUSPENSION % Eye, Ear, Nose, Throat Anti- Inflammatory Agents ALREX OPHTHALMIC DROPS,SUSPENSION 0.2 % bromfenac ophthalmic drops 0.09 % dexamethasone sodium phosphate ophthalmic drops 0.1 % diclofenac sodium ophthalmic drops 0.1 % DUREZOL OPHTHALMIC DROPS 0.05 % flunisolide nasal spray,non-aerosol 25 mcg (0.025 %) fluorometholone ophthalmic drops,suspension 0.1 % (FML Liquifilm) flurbiprofen sodium ophthalmic (Ocufen) drops 0.03 % fluticasone nasal spray,suspension 50 mcg/actuation (Flonase Allergy Relief) ST QL (50 per

152 ILEVRO OPHTHALMIC DROPS,SUSPENSION 0.3 % ketorolac ophthalmic drops 0.4 % (Acular LS) ketorolac ophthalmic drops 0.5 % (Acular) LOTEMAX OPHTHALMIC DROPS,GEL 0.5 % LOTEMAX OPHTHALMIC DROPS,SUSPENSION 0.5 % LOTEMAX OPHTHALMIC OINTMENT 0.5 % NEVANAC OPHTHALMIC DROPS,SUSPENSION 0.1 % prednisolone acetate ophthalmic drops,suspension 1 % (Omnipred) prednisolone sodium phosphate ophthalmic drops 1 % PROLENSA OPHTHALMIC DROPS 0.07 % RESTASIS MULTIDOSE OPHTHALMIC DROPS 0.05 % RESTASIS OPHTHALMIC DROPPERETTE 0.05 % Gastrointestinal Agents Antiflatulents bicarsim forte 125 mg tablet 125 mg cvs gas relief 125 mg chew tab extra strength 125 mg cvs gas relief 125 mg softgel softgel 125 mg cvs gas relief 80 mg tab chew 80 mg gas relief 125 mg chew tablet max str,lactose-free 125 mg gas relief 20 mg/0.3 ml drops dyefree 40 mg/0.6 ml gas relief 80 tablet chew 80 mg QL (5.5 per 30 QL (60 per

153 gas-x ultra strength softgel 180 mg mi-acid gas 80 mg tab chew 80 mg mytab gas 80 mg tablet chew 80 mg mytab gas max str 125 mg tab 125 mg simethicone 180 mg softgel 180 mg (Gas Relief Ultra Strength) v-r anti-gas 166 mg softgel 166 mg Antiulcer Agents And Acid Suppressants acid reducer 20 mg tablet maximum strength 20 mg amoxicil-clarithromy-lansopraz oral (Prevpac) combo pack mg CARAFATE ORAL SUSPENSION 100 MG/ML cimetidine hcl oral solution 300 mg/5 ml cimetidine oral tablet 200 mg (Acid Reducer (cimetidine)) cimetidine oral tablet 300 mg, 400 mg, 800 mg cvs acid reducer 150 mg tablet maximum strength 150 mg cvs cimetidine 200 mg tablet (otc) (Acid Reducer 200 mg (cimetidine)) esomeprazole sodium intravenous recon soln 20 mg esomeprazole sodium intravenous recon soln 40 mg (Nexium IV) famotidine (pf) intravenous solution 20 mg/2 ml famotidine (pf)-nacl (iso-os) intravenous piggyback 20 mg/50 ml 139

154 famotidine 20 mg/2 ml vial latexfree, p/f, sdv 20 mg/2 ml famotidine 40 mg/4 ml vial 25's,outer 10 mg/ml famotidine oral tablet 20 mg (Pepcid AC) famotidine oral tablet 40 mg (Pepcid) gnp acid reducer 10 mg tablet 10 mg lansoprazole dr 15 mg capsule na/f (Prevacid) (otc) 15 mg lansoprazole oral capsule,delayed release(dr/ec) 15 mg, 30 mg (Prevacid) misoprostol oral tablet 100 mcg, 200 mcg (Cytotec) omeprazole dr 20 mg tablet 20 mg omeprazole mag dr 20.6 mg cap two 14-days course 20 mg omeprazole oral capsule,delayed release(dr/ec) 10 mg, 20 mg, 40 mg pantoprazole intravenous recon soln (Protonix) 40 mg pantoprazole oral tablet,delayed release (dr/ec) 20 mg, 40 mg (Protonix) PRILOSEC OTC 20.6 MG TABLET OTC 20 MG pub famotidine 20 mg tablet max (Pepcid AC) strength (otc) 20 mg pv acid relief 200 mg tablet 200 mg ranitidine 75 mg tablet s/f, sodiumfree 75 mg (Wal-Zan 75) ranitidine hcl injection solution 25 mg/ml, 50 mg/2 ml (25 mg/ml) (Zantac) ranitidine hcl oral capsule 150 mg, 300 mg ranitidine hcl oral syrup 15 mg/ml ranitidine hcl oral tablet 150 mg (Zantac Maximum Strength) 140

155 ranitidine hcl oral tablet 300 mg (Zantac) sucralfate oral tablet 1 gram (Carafate) wal-zan 75 mg tablet 75 mg zantac 75 mg tablet 75 mg Gastrointestinal Agents, Other acid gone antacid liquid mg/15 ml almacone liquid mg/5 ml almacone-2 liquid mg/5 ml aluminum hydroxide gel sugar-free 320 mg/5 ml AMITIZA ORAL CAPSULE 24 QL (60 per 30 MCG, 8 MCG anti-diarrheal 2 mg caplet caplet 2 mg bismatrol suspension 262 mg/15 ml BUPHENYL ORAL TABLET 500 MG calci-chew tablet 500 mg calcium (1,250 mg) calcium 500 mg chewable tablet tab chew,p/f 500 mg calcium (1,250 mg) (Calcium 500) calcium antacid 500 mg chw tab assorted fruit 200 mg calcium (500 mg) calcium antacid 750 mg tb chew gluten-free 300 mg (750 mg) cal-gest 500 mg tablet chew 200 mg calcium (500 mg) CARBAGLU ORAL TABLET, DISPERSIBLE 200 MG child soothe 400 mg tab chew 400 mg 141

156 children pepto 400 mg tab chew bubble gum, na/f 400 mg comfort gel max str susp max-str mg/5 ml comfort gel suspension regular str, cherry mg/5 ml constulose oral solution 10 gram/15 ml cromolyn oral concentrate 100 mg/5 ml (Gastrocrom) cvs antacid ultra tab chew ultra strength 400 mg calcium (1,000 mg) cvs antacid-antigas tab chew 1, mg cvs anti-diarrheal 2 mg sftgel softgel 2 mg cvs anti-diarrheal suspension 262 mg/15 ml cvs flavor chew antacid 750 mg 300 mg (750 mg) cvs loperamide 1 mg/7.5 ml liq mint 1 mg/7.5 ml (Imodium A-D) diamode 2 mg tablet outer, f/c 2 mg dicyclomine oral capsule 10 mg (Bentyl) dicyclomine oral solution 10 mg/5 ml dicyclomine oral tablet 20 mg diphenoxylate-atropine oral liquid mg/5 ml diphenoxylate-atropine oral tablet mg (Lomotil) enulose oral solution 10 gram/15 ml foaming antacid liquid mg/15 ml GATTEX 5 MG 30-VIAL KIT 5 MG PA 142

157 GATTEX ONE-VIAL PA SUBCUTANEOUS KIT 5 MG gelusil antacid & antigas liq mg/5 ml gelusil tablet chewable cool mint mg generlac oral solution 10 gram/15 ml geri-lanta liquid mg/5 ml glycopyrrolate injection solution 0.2 mg/ml (Robinul) glycopyrrolate oral tablet 1 mg (Robinul) glycopyrrolate oral tablet 2 mg (Robinul Forte) imodium a-d 1 mg/7.5 ml liquid mint 1 mg/7.5 ml imodium a-d 2 mg softgel 2 mg kaopectate 262 mg/15 ml susp 262 mg/15 ml kionex 15 gm/60 ml suspension gram/60 ml kionex oral powder lactulose oral solution 10 gram/15 ml (Generlac) LINZESS ORAL CAPSULE 145 QL (30 per 30 MCG, 290 MCG, 72 MCG loperamide 1 mg/5 ml liquid 1 mg/5 (Anti-Diarrheal ml (loperamide)) loperamide 1 mg/7.5 ml susp mint 1 (Imodium A-D) mg/7.5 ml loperamide oral capsule 2 mg (Anti-Diarrheal (loperamide)) maalox advanced suspension regular strength mg/5 ml magnesium 250 mg tablet p/f 250 mg 143

158 magnesium 400 mg tablet glutenfree 400 mg (MagOx) magnesium oxide 500 mg capsule 500 mg magnesium oxide 500 mg tablet (Laxative Dietary p/f,s/f,lactose-free 500 mg Supplement) magnesium-oxide 400 mg tablet (MagOx) 241.3mg elemental 400 mg masanti liquid mg/5 ml medi-first pep-t-med tab chew 262 mg methscopolamine oral tablet 2.5 mg, 5 mg metoclopramide hcl injection solution 5 mg/ml metoclopramide hcl oral solution 5 mg/5 ml metoclopramide hcl oral tablet 10 mg, 5 mg (Reglan) mgo 400 mg tablet 400 mg mi acid suspension mg/5 ml, mg/5 ml mi-acid ds tablet mg mintox maximum strength susp max str, lemon creme mg/5 ml mintox plus tablet chewable mg mintox suspension mint creme mg/5 ml MOVANTIK ORAL TABLET 12.5 QL (30 per 30 MG, 25 MG NUTRESTORE ORAL POWDER IN PACKET 5 GRAM OCALIVA ORAL TABLET 10 PA; QL (30 per 30 MG, 5 MG phillips 500 mg caplet 500 mg 144

159 pink bismuth tablet chew 262 mg ra magnesium 500 mg capsule 500 mg RAVICTI ORAL LIQUID 1.1 PA GRAM/ML RELISTOR ORAL TABLET 150 PA; QL (90 per 30 MG RELISTOR SUBCUTANEOUS PA; QL (28 per 28 SOLUTION 12 MG/0.6 ML RELISTOR SUBCUTANEOUS SYRINGE 12 MG/0.6 ML, 8 MG/0.4 ML PA; QL (28 per 28 ri-gel ii suspension mg/5 ml riginic suspension mg/5 ml ri-mox suspension mg/5 ml sm antacid anti-gas liquid mg/5 ml sm foaming antacid tablet chew mg sm stomach relief caplet 262 mg sodium bicarb 650 mg tablet 10 gr 650 mg sodium polystyrene (sorb free) oral suspension 15 gram/60 ml sodium polystyrene sulfonate rectal enema 30 gram/120 ml soothe 262 mg caplet caplet 262 mg soothe 262 mg/15 ml suspension s/f,cherry 262 mg/15 ml sps (with sorbitol) oral suspension gram/60 ml ursodiol oral capsule 300 mg (Actigall) ursodiol oral tablet 250 mg (URSO 250) ursodiol oral tablet 500 mg (URSO Forte) 145

160 VELTASSA ORAL POWDER IN PACKET 16.8 GRAM, 25.2 GRAM, 8.4 GRAM VIBERZI ORAL TABLET 100 MG, 75 MG XERMELO ORAL TABLET 250 MG Laxatives alophen pills 5 mg bisac-evac 10 mg suppository 10 mg bisacodyl 10 mg suppository 10 mg (Dulcolax (bisacodyl)) bisacodyl ec 5 mg tablet 5 mg (Women's Gentle Laxative(bisac)) biscolax 10 mg suppository 10 mg clearlax powder 14 once-daily doses 17 gram/dose cvs enema disposable 19-7 gram/118 ml cvs fiber therapy 500 mg caplt soluble, caplet 500 mg cvs kids 100 mg mini enema 100 mg/5 ml cvs purelax powder 17 gram/dose cvs purelax powder packet s/f, 10 daily doses 17 gram doc-q-lace 100 mg softgel 100 mg docu liquid 50 mg/5 ml 50 mg/5 ml docusate sodium 100 mg tablet (DOK) crushable 100 mg docusate sodium-senna tablet mg docusol mini-enema outer 283 mg dok 100 mg softgel softgel 100 mg dok 100 mg tablet 100 mg dulcolax ss 100 mg softgel 100 mg 146 QL (30 per 30 ST; QL (60 per 30 PA; QL (90 per 30

161 enema disposable 19-7 gram/118 ml enema ready to use latex-free 19-7 gram/118 ml enemeez mini enema 5cc tubes, outer 283 mg/5 ml enemeez plus mini enema outer mg/5 ml eq fiber therapy powder equalactin 500 mg tab chew 500 mg evac-u-gen 8.6 mg tablet 8.6 mg fiber tablet unboxed 625 mg fiber therapy powder 2 gram/19 gram fiber-lax captabs 500mg polycarbophil 625 mg FLEET BISACODYL 10 MG ENEMA 10 MG/30 ML gavilyte-c oral recon soln gram gavilyte-g oral recon soln gram gavilyte-n oral recon soln 420 gram glycolax powder 31 doses (otc) 17 gram/dose healthylax powder packet 14x17gm, outer 17 gram hydrocil instant packet KONSYL 6 GM PACKET S/F, GLUTEN-F, OUTER 6 GRAM konsyl fiber 625 mg caplet caplet, s/f 625 mg konsyl psyllium fiber packet orange, gluten free 3.4 gram kro gentlelax 17 gram powder 17 gram/dose magic bullet 10 mg suppos 10 mg 147

162 milk of magnesia suspension 400 mg/5 ml mineral oil laxative MOVIPREP ORAL POWDER IN PACKET GRAM natural fiber lax powder oral saline laxative liquid s/f, ginger lemon gram/15 ml peg 3350-electrolytes oral recon soln gram (Golytely) peg 3350-electrolytes oral recon (Colyte with Flavor soln gram Packs) peg-electrolyte soln oral recon soln (TriLyte With 420 gram Flavor Packets) peri-colace tablet mg phillips' lax liqui-gels 100 mg phosphate oral saline laxative s/f, ginger lemon gram/15 ml polyethylene glycol 3350 oral powder 17 gram/dose (GentleLax) polyethylene glycol 3350 oral powder in packet 17 gram (Purelax) polyethylene glycol 3350 powd 14 once-daily doses (otc) 17 gram/dose (GentleLax) polyethylene glycol 3350 powd 17 (Purelax) grams pkts,outer (otc) 17 gram polyethylene glycol 3350 powd (Purelax) outer (otc) 17 gram promolaxin 100 mg tablet 100 mg pv fiber therapy powder pv senna 8.6 mg softgel 8.6 mg qc mineral oil heavy (Mineral Oil Laxative) qc natura-lax 17 gm powder 17 gram/dose ra enema twin pack 2 x 4.5oz, rtu 19-7 gram/118 ml 148

163 ra laxative peg 3350 powder 14 once-daily doses 17 gram/dose reguloid powder senexon 8.8 mg/5 ml liquid 8.8 mg/5 ml senexon tablet 8.6 mg senna 8.6 mg tablet 8.6 mg senna 8.8 mg/5 ml syrup a/f, chocolate 8.8 mg/5 ml senna-lax 8.6 mg tablet 8.6 mg senokot-s tablet mg silace 50 mg/5 ml liquid 50 mg/5 ml silace 60 mg/15 ml syrup 60 mg/15 ml sm fiber laxative 500 mg cplt 500 mg sm fiber smooth powder smoothlax powder packet s/f, 10 daily doses 17 gram stool softener 240 mg softgel softgel 240 mg SUPREP BOWEL PREP KIT ORAL RECON SOLN GRAM trilyte with flavor packets oral recon soln 420 gram Phosphate Binders calcium acetate oral capsule 667 mg calcium acetate oral tablet 667 mg (Eliphos) eliphos oral tablet 667 mg magnebind 400 oral tablet mg PHOSLYRA ORAL SOLUTION 667 MG (169 MG CALCIUM)/5 ML RENAGEL ORAL TABLET 400 MG, 800 MG 149

164 RENVELA ORAL POWDER IN PACKET 0.8 GRAM, 2.4 GRAM RENVELA ORAL TABLET 800 MG VELPHORO ORAL TABLET,CHEWABLE 500 MG Genitourinary Agents Antispasmodics, Urinary bethanechol chloride oral tablet 10 mg, 25 mg, 5 mg, 50 mg MYRBETRIQ ORAL TABLET EXTENDED RELEASE 24 HR 25 MG, 50 MG (Urecholine) oxybutynin chloride oral syrup 5 mg/5 ml oxybutynin chloride oral tablet 5 mg oxybutynin chloride oral tablet extended release 24hr 10 mg, 15 mg, 5 mg (Ditropan XL) tolterodine oral capsule,extended release 24hr 2 mg, 4 mg (Detrol LA) tolterodine oral tablet 1 mg, 2 mg (Detrol) TOVIAZ ORAL TABLET EXTENDED RELEASE 24 HR 4 MG, 8 MG trospium oral capsule,extended release 24hr 60 mg trospium oral tablet 20 mg VESICARE ORAL TABLET 10 MG, 5 MG Genitourinary Agents, Miscellaneous alfuzosin oral tablet extended release 24 hr 10 mg (Uroxatral) dutasteride oral capsule 0.5 mg (Avodart) dutasteride-tamsulosin oral capsule, er multiphase 24 hr mg (Jalyn) finasteride oral tablet 5 mg (Proscar) QL (30 per

165 tamsulosin oral capsule,extended release 24hr 0.4 mg terazosin oral capsule 1 mg, 10 mg, 2 mg, 5 mg Heavy Metal Antagonists Heavy Metal Antagonists CUPRIMINE ORAL CAPSULE 250 MG deferoxamine injection recon soln 2 gram, 500 mg DEPEN TITRATABS ORAL TABLET 250 MG EXJADE ORAL TABLET, DISPERSIBLE 125 MG, 250 MG, 500 MG FERRIPROX ORAL SOLUTION 100 MG/ML FERRIPROX ORAL TABLET 500 MG SYPRINE ORAL CAPSULE 250 MG Hormonal Agents, Stimulant/Replacement/Modif ying Androgens ANADROL-50 ORAL TABLET 50 MG ANDRODERM TRANSDERMAL PATCH 24 HOUR 2 MG/24 HOUR, 4 MG/24 HR (Flomax) (Desferal) ANDROGEL TRANSDERMAL GEL IN METERED-DOSE PUMP MG/1.25 GRAM (1.62 %) ANDROGEL TRANSDERMAL GEL IN PACKET 1.62 % (20.25 MG/1.25 GRAM), 1.62 % (40.5 MG/2.5 GRAM) androxy oral tablet 10 mg 151 PA PA; QL (30 per 30 PA; QL (150 per 30 PA; QL (150 per 30

166 danazol oral capsule 100 mg, 200 mg, 50 mg oxandrolone oral tablet 10 mg, 2.5 mg testosterone cypionate intramuscular oil 100 mg/ml, 200 mg/ml testosterone enanthate intramuscular oil 200 mg/ml testosterone transdermal gel 50 mg/5 gram (1 %) testosterone transdermal gel in metered-dose pump 12.5 mg/ 1.25 gram (1 %) testosterone transdermal gel in packet 1 % (25 mg/2.5gram), 1 % (50 mg/5 gram) Estrogens And Antiestrogens amabelz oral tablet mg, mg COMBIPATCH TRANSDERMAL PATCH SEMIWEEKLY MG/24 HR, MG/24 HR DUAVEE ORAL TABLET MG ESTRACE VAGINAL CREAM 0.01 % (0.1 MG/GRAM) estradiol oral tablet 0.5 mg, 1 mg, 2 mg estradiol transdermal patch semiweekly mg/24 hr, 0.1 mg/24 hr estradiol transdermal patch semiweekly mg/24 hr, 0.05 mg/24 hr estradiol transdermal patch semiweekly mg/24 hr (Oxandrin) (Depo- Testosterone) (Testim) (AndroGel) (AndroGel) (Estrace) (Alora) (Vivelle-Dot) (Vivelle) PA PA; QL (5 per 28 PA; QL (300 per 30 PA; QL (300 per 30 PA; QL (300 per 30 PA-HRM; QL (8 per 28 ; AGE (Max 64 Years) PA-HRM; AGE (Max 64 Years) PA-HRM; AGE (Max 64 Years) PA-HRM; QL (8 per 28 ; AGE (Max 64 Years) PA-HRM; QL (8 per 28 ; AGE (Max 64 Years) PA-HRM; QL (8 per 28 ; AGE (Max 64 Years) 152

167 estradiol transdermal patch weekly mg/24 hr, mg/24 hr, 0.06 mg/24 hr, mg/24 hr, 0.1 mg/24 hr estradiol transdermal patch weekly 0.05 mg/24 hr estradiol valerate intramuscular oil 20 mg/ml, 40 mg/ml estradiol-norethindrone acet oral tablet mg, mg estropipate oral tablet 0.75 mg, 1.5 mg, 3 mg FEMRING VAGINAL RING 0.05 MG/24 HR, 0.1 MG/24 HR MENEST ORAL TABLET 0.3 MG, MG, 1.25 MG, 2.5 MG (Climara) (Estradiol Transdermal Patch) (Delestrogen) (Lopreeza) mimvey lo oral tablet mg mimvey oral tablet mg 153 PA-HRM; QL (4 per 28 ; AGE (Max 64 Years) PA-HRM; QL (4 per 28 ; AGE (Max 64 Years) PA-HRM; AGE (Max 64 Years) PA-HRM; AGE (Max 64 Years) QL (1 per 84 PA-HRM; AGE (Max 64 Years) PA-HRM; AGE (Max 64 Years) PA-HRM; AGE (Max 64 Years) PREMARIN INJECTION RECON SOLN 25 MG PREMARIN ORAL TABLET 0.3 MG, 0.45 MG, MG, 0.9 MG, PA-HRM; AGE (Max 64 Years) 1.25 MG PREMARIN VAGINAL CREAM MG/GRAM PREMPHASE ORAL TABLET PA-HRM; AGE (Max MG (14)/ 0.625MG-5MG(14) 64 Years) PREMPRO ORAL TABLET MG, MG, MG, MG PA-HRM; AGE (Max 64 Years) raloxifene oral tablet 60 mg (Evista) VAGIFEM VAGINAL TABLET 10 QL (18 per 28 MCG yuvafem vaginal tablet 10 mcg QL (18 per 28 Glucocorticoids/Mineralocorticoids

168 a-hydrocort injection recon soln 100 mg betamethasone acet,sod phos (Celestone injection suspension 6 mg/ml Soluspan) cortisone oral tablet 25 mg dexamethasone oral elixir 0.5 mg/5 ml dexamethasone oral tablet 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg dexamethasone sodium phosphate injection solution 10 mg/ml, 4 mg/ml EMFLAZA ORAL SUSPENSION PA MG/ML EMFLAZA ORAL TABLET 18 PA; QL (30 per 30 MG EMFLAZA ORAL TABLET 30 PA; QL (60 per 30 MG, 6 MG EMFLAZA ORAL TABLET 36 PA MG fludrocortisone oral tablet 0.1 mg hydrocortisone oral tablet 10 mg, 20 (Cortef) mg, 5 mg methylprednisolone acetate injection suspension 40 mg/ml, 80 mg/ml (Depo-Medrol) methylprednisolone oral tablet 16 (Medrol) mg, 32 mg, 4 mg, 8 mg methylprednisolone oral tablets,dose pack 4 mg (Medrol (Pak)) methylprednisolone sodium succ injection recon soln 125 mg, 40 mg methylprednisolone sodium succ intravenous recon soln 1,000 mg (Solu-Medrol) prednisolone sodium phosphate oral solution 15 mg/5 ml (3 mg/ml), 25 mg/5 ml (5 mg/ml) 154

169 prednisolone sodium phosphate oral solution 5 mg base/5 ml (6.7 mg/5 ml) (Pediapred) prednisone oral solution 5 mg/5 ml prednisone oral tablet 1 mg, 2.5 mg, 5 mg, 50 mg prednisone oral tablet 10 mg prednisone oral tablet 20 mg (Deltasone) prednisone oral tablets,dose pack 10 mg, 10 mg (48 pack), 5 mg, 5 mg (48 pack) SOLU-CORTEF (PF) INJECTION RECON SOLN 100 MG/2 ML triamcinolone acetonide injection suspension 10 mg/ml, 40 mg/ml Pituitary desmopressin injection solution 4 mcg/ml desmopressin nasal solution 0.1 mg/ml (refrigerate) desmopressin nasal spray,nonaerosol 10 mcg/spray (0.1 ml) desmopressin oral tablet 0.1 mg, 0.2 mg GENOTROPIN MINIQUICK SUBCUTANEOUS SYRINGE 0.2 MG/0.25 ML, 0.4 MG/0.25 ML, 0.6 MG/0.25 ML, 0.8 MG/0.25 ML, 1 MG/0.25 ML, 1.2 MG/0.25 ML, 1.4 MG/0.25 ML, 1.6 MG/0.25 ML, 1.8 MG/0.25 ML, 2 MG/0.25 ML GENOTROPIN SUBCUTANEOUS CARTRIDGE 12 MG/ML (36 UNIT/ML), 5 MG/ML (15 UNIT/ML) HUMATROPE INJECTION CARTRIDGE 12 MG (36 UNIT), 24 MG (72 UNIT), 6 MG (18 UNIT) (Kenalog) (DDAVP) (DDAVP) (DDAVP) 155 QL (15 per 30 QL (15 per 30 PA PA PA

170 HUMATROPE INJECTION RECON SOLN 5 (15 UNIT) MG INCRELEX SUBCUTANEOUS SOLUTION 10 MG/ML LUPRON DEPOT-PED (3 MONTH) INTRAMUSCULAR SYRINGE KIT 30 MG LUPRON DEPOT-PED INTRAMUSCULAR KIT MG, 15 MG, 7.5 MG (PED) NORDITROPIN FLEXPRO SUBCUTANEOUS PEN INJECTOR 10 MG/1.5 ML (6.7 MG/ML), 15 MG/1.5 ML (10 MG/ML), 30 MG/3 ML (10 MG/ML), 5 MG/1.5 ML (3.3 MG/ML) NUTROPIN AQ NUSPIN SUBCUTANEOUS PEN INJECTOR 10 MG/2 ML (5 MG/ML), 20 MG/2 ML (10 MG/ML), 5 MG/2 ML (2.5 MG/ML) NUTROPIN AQ SUBCUTANEOUS CARTRIDGE 10 MG/2 ML (5 MG/ML), 20 MG/2 ML (10 MG/ML) octreotide acet 50 mcg/ml syr outer,single-dose,10 50 mcg/ml (1 ml) octreotide acetate injection solution 1,000 mcg/ml, 100 mcg/ml, 200 mcg/ml, 500 mcg/ml octreotide acetate injection solution 50 mcg/ml OMNITROPE SUBCUTANEOUS CARTRIDGE 10 MG/1.5 ML (6.7 MG/ML), 5 MG/1.5 ML (3.3 MG/ML) (Sandostatin) (Sandostatin) PA QL (1 per 84 PA PA PA PA 156

171 OMNITROPE SUBCUTANEOUS RECON SOLN 5.8 MG SAIZEN CLICK.EASY SUBCUTANEOUS CARTRIDGE 8.8 MG/1.5 ML (FNL) SAIZEN SUBCUTANEOUS RECON SOLN 5 MG, 8.8 MG SANDOSTATIN LAR DEPOT INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON 10 MG, 20 MG, 30 MG SEROSTIM SUBCUTANEOUS RECON SOLN 4 MG, 5 MG, 6 MG SOMATULINE DEPOT SUBCUTANEOUS SYRINGE 120 MG/0.5 ML, 60 MG/0.2 ML, 90 MG/0.3 ML SOMAVERT SUBCUTANEOUS RECON SOLN 10 MG, 15 MG, 20 MG, 25 MG, 30 MG SUPPRELIN LA IMPLANT KIT 50 MG (65 MCG/DAY) ZOMACTON SUBCUTANEOUS RECON SOLN 10 MG, 5 MG ZORBTIVE SUBCUTANEOUS RECON SOLN 8.8 MG Progestins DEPO-PROVERA INTRAMUSCULAR SOLUTION 400 MG/ML hydroxyprogesterone caproate intramuscular oil 250 mg/ml medroxyprogesterone intramuscular suspension 150 mg/ml medroxyprogesterone intramuscular syringe 150 mg/ml medroxyprogesterone oral tablet 10 mg, 2.5 mg, 5 mg (Depo-Provera) (Depo-Provera) (Provera) PA PA PA PA QL (1 per 28 QL (1 per 360 PA PA QL (10 per 28 PA NSO QL (1 per 84 QL (1 per

172 megestrol oral suspension 400 mg/10 ml (40 mg/ml) megestrol oral suspension 625 mg/5 ml norethindrone acetate oral tablet 5 mg progesterone in oil intramuscular oil 50 mg/ml progesterone micronized oral capsule 100 mg, 200 mg Thyroid And Antithyroid Agents levothyroxine intravenous recon soln 100 mcg, 200 mcg, 500 mcg levothyroxine oral tablet 100 mcg, 112 mcg, 137 mcg, 175 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg levothyroxine oral tablet 125 mcg, 150 mcg, 200 mcg, 88 mcg liothyronine oral tablet 25 mcg, 5 mcg, 50 mcg (Megace) (Megace ES) (Aygestin) (Prometrium) (Unithroid) (Levoxyl) (Cytomel) methimazole oral tablet 10 mg, 5 mg (Tapazole) propylthiouracil oral tablet 50 mg Immunological Agents Immunological Agents ACTEMRA INTRAVENOUS SOLUTION 200 MG/10 ML (20 MG/ML), 400 MG/20 ML (20 MG/ML), 80 MG/4 ML (20 MG/ML) ACTEMRA SUBCUTANEOUS PA SYRINGE 162 MG/0.9 ML ARCALYST SUBCUTANEOUS RECON SOLN 220 MG ASTAGRAF XL ORAL CAPSULE,EXTENDED RELEASE 24HR 0.5 MG, 1 MG, 5 MG azathioprine oral tablet 50 mg (Imuran) PA 158

173 azathioprine sodium injection recon soln 100 mg CARIMUNE NF NANOFILTERED INTRAVENOUS RECON SOLN 6 GRAM CELLCEPT INTRAVENOUS INTRAVENOUS RECON SOLN 500 MG CIMZIA POWDER FOR RECONST SUBCUTANEOUS KIT 400 MG (200 MG X 2 VIALS) CIMZIA SUBCUTANEOUS SYRINGE KIT 400 MG/2 ML (200 MG/ML X 2) cyclosporine intravenous solution 250 mg/5 ml (Sandimmune) cyclosporine modified oral capsule 100 mg, 25 mg, 50 mg (Gengraf) cyclosporine modified oral solution 100 mg/ml (Gengraf) cyclosporine oral capsule 100 mg, 25 mg (Sandimmune) ENBREL SUBCUTANEOUS RECON SOLN 25 MG (1 ML) ENBREL SUBCUTANEOUS SYRINGE 25 MG/0.5ML (0.51), 50 MG/ML (0.98 ML) ENBREL SURECLICK SUBCUTANEOUS PEN INJECTOR 50 MG/ML (0.98 ML) ENVARSUS XR ORAL TABLET EXTENDED RELEASE 24 HR 0.75 MG, 1 MG, 4 MG FLEBOGAMMA DIF INTRAVENOUS SOLUTION 10 %, 5 % PA PA PA PA PA 159

174 GAMASTAN S/D INTRAMUSCULAR SOLUTION % RANGE, % RANGE (10 ML), % RANGE (2 ML) GAMMAGARD LIQUID INJECTION SOLUTION 10 % GAMMAGARD S-D (IGA < 1 MCG/ML) INTRAVENOUS RECON SOLN 10 GRAM, 5 GRAM GAMMAPLEX (WITH SORBITOL) INTRAVENOUS SOLUTION 5 % gengraf oral capsule 100 mg, 25 mg, 50 mg gengraf oral solution 100 mg/ml HUMIRA PEDIATRIC CROHN'S PA START SUBCUTANEOUS SYRINGE KIT 40 MG/0.8 ML, 40 MG/0.8 ML (6 PACK) HUMIRA PEN CROHN'S-UC-HS PA START SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML HUMIRA PEN PSORIASIS- PA UVEITIS SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML HUMIRA PEN SUBCUTANEOUS PA PEN INJECTOR KIT 40 MG/0.8 ML HUMIRA SUBCUTANEOUS PA SYRINGE KIT 10 MG/0.2 ML, 20 MG/0.4 ML, 40 MG/0.8 ML HYPERRAB S/D (PF) INTRAMUSCULAR SOLUTION 150 UNIT/ML, 150 UNIT/ML (10 ML) 160

175 HYQVIA IG COMPONENT SUBCUTANEOUS SOLUTION 10 GRAM/100 ML (10 %), 2.5 GRAM/25 ML (10 %), 20 GRAM/200 ML (10 %), 30 GRAM/300 ML (10 %), 5 GRAM/50 ML (10 %) HYQVIA SUBCUTANEOUS SOLUTION 10 GRAM /100 ML (10 %), 2.5 GRAM /25 ML (10 %), 20 GRAM /200 ML (10 %), 30 GRAM /300 ML (10 %), 5 GRAM /50 ML (10 %) ILARIS (PF) SUBCUTANEOUS RECON SOLN 180 MG/1.2 ML (150 MG/ML) ILARIS (PF) SUBCUTANEOUS SOLUTION 150 MG/ML IMOGAM RABIES-HT (PF) INTRAMUSCULAR SOLUTION 150 UNIT/ML KINERET SUBCUTANEOUS SYRINGE 100 MG/0.67 ML leflunomide oral tablet 10 mg, 20 mg mycophenolate mofetil hcl intravenous recon soln 500 mg mycophenolate mofetil oral capsule 250 mg mycophenolate mofetil oral suspension for reconstitution 200 mg/ml mycophenolate mofetil oral tablet 500 mg mycophenolate sodium oral tablet,delayed release (dr/ec) 180 mg, 360 mg NULOJIX INTRAVENOUS RECON SOLN 250 MG (Arava) (CellCept Intravenous) (CellCept) (CellCept) (CellCept) (Myfortic) 161 PA PA PA; QL (18.76 per 28

176 OCTAGAM INTRAVENOUS SOLUTION 10 %, 5 % ORENCIA (WITH MALTOSE) INTRAVENOUS RECON SOLN 250 MG ORENCIA SUBCUTANEOUS SYRINGE 125 MG/ML OTEZLA ORAL TABLET 30 MG OTEZLA STARTER ORAL TABLETS,DOSE PACK 10 MG (4)-20 MG (4)-30 MG (47), 10 MG (4)-20 MG (4)-30 MG(19) OTREXUP (PF) SUBCUTANEOUS AUTO- INJECTOR 10 MG/0.4 ML, 12.5 MG/0.4 ML, 15 MG/0.4 ML, 17.5 MG/0.4 ML, 20 MG/0.4 ML, 22.5 MG/0.4 ML, 25 MG/0.4 ML, 7.5 MG/0.4 ML PRIVIGEN INTRAVENOUS SOLUTION 10 % PROGRAF INTRAVENOUS SOLUTION 5 MG/ML RAPAMUNE ORAL SOLUTION 1 MG/ML RASUVO (PF) SUBCUTANEOUS AUTO-INJECTOR 10 MG/0.2 ML, 12.5 MG/0.25 ML, 15 MG/0.3 ML, 17.5 MG/0.35 ML, 20 MG/0.4 ML, 22.5 MG/0.45 ML, 25 MG/0.5 ML, 27.5 MG/0.55 ML, 30 MG/0.6 ML, 7.5 MG/0.15 ML RIDAURA ORAL CAPSULE 3 MG SIMPONI ARIA INTRAVENOUS SOLUTION 12.5 MG/ML PA PA PA; QL (60 per 30 PA; QL (60 per 30 PA 162

177 SIMPONI SUBCUTANEOUS PEN INJECTOR 100 MG/ML, 50 MG/0.5 ML SIMPONI SUBCUTANEOUS SYRINGE 100 MG/ML, 50 MG/0.5 ML sirolimus oral tablet 0.5 mg, 1 mg, 2 mg STELARA INTRAVENOUS SOLUTION 130 MG/26 ML STELARA SUBCUTANEOUS SYRINGE 45 MG/0.5 ML, 90 MG/ML tacrolimus oral capsule 0.5 mg, 1 mg, 5 mg TYSABRI INTRAVENOUS SOLUTION 300 MG/15 ML (Rapamune) (Prograf) XELJANZ ORAL TABLET 5 MG XELJANZ XR ORAL TABLET EXTENDED RELEASE 24 HR 11 MG ZORTRESS ORAL TABLET 0.25 MG, 0.5 MG, 0.75 MG Vaccines ACTHIB (PF) INTRAMUSCULAR RECON SOLN 10 MCG/0.5 ML ADACEL(TDAP ADOLESN/ADULT)(PF) INTRAMUSCULAR SUSPENSION 2 LF-( MCG)-5LF/0.5 ML ADACEL(TDAP ADOLESN/ADULT)(PF) INTRAMUSCULAR SYRINGE 2 LF-( MCG)-5LF/0.5 ML BCG VACCINE, LIVE (PF) PERCUTANEOUS SUSPENSION FOR RECONSTITUTION 50 MG 163 PA PA PA PA PA; LA; QL (15 per 28 PA; QL (60 per 30 PA; QL (30 per 30

178 BEXSERO INTRAMUSCULAR SYRINGE MCG/0.5 ML BOOSTRIX TDAP INTRAMUSCULAR SUSPENSION LF-MCG- LF/0.5ML BOOSTRIX TDAP INTRAMUSCULAR SYRINGE LF-MCG-LF/0.5ML CERVARIX VACCINE (PF) INTRAMUSCULAR SYRINGE MCG/0.5 ML COMVAX (PF) INTRAMUSCULAR SUSPENSION MCG/0.5 ML DAPTACEL (DTAP PEDIATRIC) (PF) INTRAMUSCULAR SUSPENSION LF-MCG- LF/0.5ML ENGERIX-B (PF) INTRAMUSCULAR SUSPENSION 20 MCG/ML ENGERIX-B (PF) INTRAMUSCULAR SYRINGE 20 MCG/ML ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SUSPENSION 10 MCG/0.5 ML ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SYRINGE 10 MCG/0.5 ML GARDASIL (PF) INTRAMUSCULAR SUSPENSION MCG/0.5 ML QL (1.5 per

179 GARDASIL (PF) INTRAMUSCULAR SYRINGE MCG/0.5 ML GARDASIL 9 (PF) INTRAMUSCULAR SUSPENSION 0.5 ML GARDASIL 9 (PF) INTRAMUSCULAR SYRINGE 0.5 ML HAVRIX (PF) INTRAMUSCULAR SUSPENSION 1,440 ELISA UNIT/ML, 720 ELISA UNIT/0.5 ML HAVRIX (PF) INTRAMUSCULAR SYRINGE 1,440 ELISA UNIT/ML, 720 ELISA UNIT/0.5 ML HIBERIX (PF) INTRAMUSCULAR RECON SOLN 10 MCG/0.5 ML IMOVAX RABIES VACCINE (PF) INTRAMUSCULAR RECON SOLN 2.5 UNIT INFANRIX (DTAP) (PF) INTRAMUSCULAR SUSPENSION LF-MCG- LF/0.5ML IPOL INJECTION SUSPENSION UNIT/0.5 ML IPOL INJECTION SYRINGE UNIT/0.5 ML IXIARO (PF) INTRAMUSCULAR SYRINGE 6 MCG/0.5 ML KINRIX (PF) INTRAMUSCULAR SUSPENSION 25 LF-58 MCG-10 LF/0.5 ML QL (1.5 per 365 QL (1.5 per 365 QL (1.5 per

180 KINRIX (PF) INTRAMUSCULAR SYRINGE 25 LF-58 MCG-10 LF/0.5 ML MENACTRA (PF) INTRAMUSCULAR SOLUTION 4 MCG/0.5 ML MENHIBRIX (PF) INTRAMUSCULAR RECON SOLN MCG/0.5 ML MENOMUNE - A/C/Y/W-135 (PF) SUBCUTANEOUS RECON SOLN 50 MCG MENOMUNE - A/C/Y/W-135 SUBCUTANEOUS RECON SOLN 50 MCG MENVEO A-C-Y-W-135-DIP (PF) INTRAMUSCULAR KIT 10-5 MCG/0.5 ML M-M-R II (PF) SUBCUTANEOUS RECON SOLN 1,000-12,500 TCID50/0.5 ML PEDIARIX (PF) INTRAMUSCULAR SYRINGE 10 MCG-25LF-25 MCG-10LF/0.5 ML PEDVAX HIB (PF) INTRAMUSCULAR SOLUTION 7.5 MCG/0.5 ML PENTACEL (PF) INTRAMUSCULAR KIT 15 LF UNIT-20 MCG-5 LF/0.5 ML PROQUAD (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 10EXP TCID50/0.5 QUADRACEL (PF) INTRAMUSCULAR SUSPENSION 15 LF-48 MCG- 5 LF UNIT/0.5ML QL (2 per 365 QL (2 per

181 RABAVERT (PF) INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 2.5 UNIT RECOMBIVAX HB (PF) INTRAMUSCULAR SUSPENSION 10 MCG/ML, 40 MCG/ML RECOMBIVAX HB (PF) INTRAMUSCULAR SYRINGE 10 MCG/ML, 5 MCG/0.5 ML RECOMBIVAX HB 5 MCG/0.5 ML VL OUTER, P/F, SDV 5 MCG/0.5 ML ROTARIX ORAL SUSPENSION FOR RECONSTITUTION 10EXP6 CCID50/ML ROTATEQ VACCINE ORAL SUSPENSION 2 ML TENIVAC (PF) INTRAMUSCULAR SYRINGE 5-2 LF UNIT/0.5 ML TETANUS,DIPHTHERIA TOX PED(PF) INTRAMUSCULAR SUSPENSION 5-25 LF UNIT/0.5 ML TETANUS-DIPHTHERIA TOXOIDS-TD INTRAMUSCULAR SUSPENSION 2-2 LF UNIT/0.5 ML TICE BCG INTRAVESICAL SUSPENSION FOR RECONSTITUTION 50 MG TRUMENBA INTRAMUSCULAR SYRINGE 120 MCG/0.5 ML 167

182 TWINRIX (PF) INTRAMUSCULAR SUSPENSION 720 ELISA UNIT - 20 MCG/ML TWINRIX (PF) INTRAMUSCULAR SYRINGE 720 ELISA UNIT -20 MCG/ML TYPHIM VI INTRAMUSCULAR SOLUTION 25 MCG/0.5 ML TYPHIM VI INTRAMUSCULAR SYRINGE 25 MCG/0.5 ML VAQTA (PF) INTRAMUSCULAR SUSPENSION 50 UNIT/ML VAQTA (PF) INTRAMUSCULAR SYRINGE 25 UNIT/0.5 ML, 50 UNIT/ML VAQTA 25 UNITS/0.5 ML VIAL SDV, OUTER 25 UNIT/0.5 ML VARIVAX (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 1,350 UNIT/0.5 ML YF-VAX (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 10 EXP4.74 UNIT/0.5 ML ZOSTAVAX (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 19,400 UNIT/0.65 ML Inflammatory Bowel Disease Agents Inflammatory Bowel Disease Agents alosetron oral tablet 0.5 mg, 1 mg (Lotronex) APRISO ORAL CAPSULE,EXTENDED RELEASE 24HR GRAM QL (2 per 365 QL (1 per

183 ASACOL HD ORAL TABLET,DELAYED RELEASE (DR/EC) 800 MG balsalazide oral capsule 750 mg (Colazal) budesonide oral capsule,delayed,extend.release 3 mg (Entocort EC) colocort rectal enema 100 mg/60 ml DELZICOL ORAL CAPSULE (WITH DEL REL TABLETS) 400 MG DIPENTUM ORAL CAPSULE 250 MG hydrocortisone rectal enema 100 mg/60 ml (Cortenema) LIALDA ORAL TABLET,DELAYED RELEASE (DR/EC) 1.2 GRAM mesalamine oral tablet,delayed release (dr/ec) 800 mg (Asacol HD) UCERIS RECTAL FOAM 2 MG/ACTUATION Irrigating Solutions Irrigating Solutions acetic acid irrigation solution 0.25 % LACTATED RINGERS IRRIGATION SOLUTION ringers irrigation solution sodium chloride irrigation solution 0.9 % (Sterile Saline) sorbitol irrigation solution 3 %, 3.3 % sorbitol-mannitol urethral solution g/100 ml water for irrigation, sterile (Curity Sterile irrigation solution Water) Metabolic Bone Disease Agents 169 ST

184 Metabolic Bone Disease Agents alendronate oral solution 70 mg/75 QL (300 per 28 ml alendronate oral tablet 10 mg, 40 mg, 5 mg alendronate oral tablet 35 mg QL (4 per 28 alendronate oral tablet 70 mg (Fosamax) QL (4 per 28 calcitonin (salmon) nasal QL (3.7 per 28 spray,non-aerosol 200 unit/actuation (Miacalcin) calcitriol intravenous solution 1 mcg/ml calcitriol oral capsule 0.25 mcg, 0.5 mcg (Rocaltrol) calcitriol oral solution 1 mcg/ml (Rocaltrol) doxercalciferol intravenous solution 4 mcg/2 ml (Hectorol) doxercalciferol oral capsule 0.5 mcg, 1 mcg, 2.5 mcg (Hectorol) FORTEO SUBCUTANEOUS PEN INJECTOR 20 MCG/DOSE MCG/2.4 ML FORTICAL NASAL SPRAY,NON- AEROSOL 200 UNIT/ACTUATION ibandronate intravenous solution 3 mg/3 ml ibandronate intravenous syringe 3 mg/3 ml (Boniva) PA; QL (2.4 per 28 QL (3.7 per 28 QL (3 per 84 QL (3 per 84 ibandronate oral tablet 150 mg (Boniva) QL (1 per 28 MIACALCIN INJECTION SOLUTION 200 UNIT/ML NATPARA SUBCUTANEOUS PA; QL (2 per 28 CARTRIDGE 100 MCG/DOSE, 25 MCG/DOSE, 50 MCG/DOSE, 75 MCG/DOSE paricalcitol oral capsule 1 mcg, 2 mcg (Zemplar) 170

185 paricalcitol oral capsule 4 mcg PROLIA SUBCUTANEOUS QL (1 per 180 SYRINGE 60 MG/ML RAYALDEE ORAL QL (60 per 30 CAPSULE,EXTENDED RELEASE 24 HR 30 MCG risedronate oral tablet 150 mg (Actonel) QL (1 per 28 risedronate oral tablet 30 mg, 5 mg (Actonel) QL (30 per 30 ZEMPLAR INTRAVENOUS SOLUTION 2 MCG/ML, 5 MCG/ML zoledronic acid intravenous solution 4 mg/5 ml (Zometa) zoledronic acid-mannitol-water intravenous piggyback 4 mg/100 ml zoledronic acid-mannitol-water QL (100 per 300 (Reclast) intravenous solution 5 mg/100 ml ZOMETA INTRAVENOUS SOLUTION 4 MG/100 ML Miscellaneous Therapeutic Agents Miscellaneous Therapeutic Agents ACTIMMUNE SUBCUTANEOUS SOLUTION 100 MCG/0.5 ML amifostine crystalline intravenous recon soln 500 mg BENLYSTA INTRAVENOUS RECON SOLN 120 MG, 400 MG buspirone oral tablet 10 mg, 15 mg, 30 mg, 5 mg, 7.5 mg CERDELGA ORAL CAPSULE 84 MG CETYLEV ORAL TABLET, EFFERVESCENT 2.5 GRAM, 500 MG CYSTADANE ORAL POWDER 1 GRAM/1.7 ML (Ethyol) PA PA 171

186 droperidol injection solution 2.5 mg/ml ELMIRON ORAL CAPSULE 100 MG ergoloid oral tablet 1 mg EXONDYS 51 INTRAVENOUS SOLUTION 50 MG/ML, 50 MG/ML (10 ML) fomepizole intravenous solution 1 gram/ml FUSILEV INTRAVENOUS RECON SOLN 50 MG GLUCAGEN HYPOKIT INJECTION RECON SOLN 1 MG GLUCAGON EMERGENCY KIT (HUMAN) INJECTION KIT 1 MG guanidine oral tablet 125 mg hydroxyzine pamoate oral capsule 100 mg hydroxyzine pamoate oral capsule 25 mg, 50 mg (Vistaril) INFLECTRA INTRAVENOUS RECON SOLN 100 MG KEVEYIS ORAL TABLET 50 MG leucovorin calcium 200 mg vial sdv, p/f, latex-free 200 mg leucovorin calcium injection recon soln 100 mg, 350 mg, 50 mg leucovorin calcium oral tablet 10 mg, 15 mg, 25 mg, 5 mg levocarnitine (with sugar) oral solution 100 mg/ml (Carnitor) levocarnitine oral tablet 330 mg (Carnitor) LEVOLEUCOVORIN INTRAVENOUS RECON SOLN 175 MG PA; LA PA PA; QL (120 per

187 levoleucovorin intravenous recon soln 50 mg (Fusilev) mesna intravenous solution 100 mg/ml (Mesnex) MESNEX ORAL TABLET 400 MG MESTINON ORAL SYRUP 60 MG/5 ML MINERAL OIL HEAVY (Muri-Lube) ORENCIA CLICKJECT PA SUBCUTANEOUS AUTO- INJECTOR 125 MG/ML PROCYSBI ORAL CAPSULE, DELAYED REL SPRINKLE 25 MG, 75 MG pv extra cleansing douche pyridostigmine bromide oral tablet 60 mg (Mestinon) pyridostigmine bromide oral tablet (Mestinon extended release 180 mg Timespan) ra feminine care douche REMICADE INTRAVENOUS PA RECON SOLN 100 MG sb disp douche extra clns v&w SENSIPAR ORAL TABLET 30 MG, 60 MG, 90 MG SIGNIFOR SUBCUTANEOUS SOLUTION 0.3 MG/ML (1 ML), 0.6 MG/ML (1 ML), 0.9 MG/ML (1 ML) QL (60 per 30 summer's eve dche-xtra clns 12's,extra-cleansing summer's eve douche-ultra clns 12's,2pk,ultra clns SYNAREL NASAL SPRAY,NON- AEROSOL 2 MG/ML THALOMID ORAL CAPSULE 100 PA NSO; QL (60 per MG, 150 MG, 200 MG, 50 MG

188 THIOLA ORAL TABLET 100 MG TYBOST ORAL TABLET 150 MG QL (30 per 30 Ophthalmic Agents Antiglaucoma Agents acetazolamide oral capsule, extended release 500 mg (Diamox Sequels) acetazolamide oral tablet 125 mg, 250 mg acetazolamide sodium injection recon soln 500 mg ALPHAGAN P OPHTHALMIC DROPS 0.1 % AZOPT OPHTHALMIC DROPS,SUSPENSION 1 % betaxolol ophthalmic drops 0.5 % bimatoprost ophthalmic drops 0.03 % brimonidine ophthalmic drops 0.15 % (Alphagan P) brimonidine ophthalmic drops 0.2 % COMBIGAN OPHTHALMIC DROPS % dorzolamide ophthalmic drops 2 % (Trusopt) dorzolamide-timolol ophthalmic drops mg/ml (Cosopt) latanoprost ophthalmic drops % (Xalatan) levobunolol ophthalmic drops 0.5 % (Betagan) LUMIGAN OPHTHALMIC DROPS 0.01 % methazolamide oral tablet 25 mg, 50 (Neptazane) mg metipranolol ophthalmic drops 0.3 % PHOSPHOLINE IODIDE OPHTHALMIC DROPS % pilocarpine hcl ophthalmic drops 1 %, 2 %, 4 % (Isopto Carpine) 174 QL (2.5 per 25

189 SIMBRINZA OPHTHALMIC DROPS,SUSPENSION % timolol maleate ophthalmic drops 0.25 %, 0.5 % timolol maleate ophthalmic gel forming solution 0.25 %, 0.5 % TRAVATAN Z OPHTHALMIC DROPS % travoprost (benzalkonium) ophthalmic drops % ZIOPTAN (PF) OPHTHALMIC DROPPERETTE % Replacement Preparations Replacement Preparations calcitrate + vit d caplet mg-unit calcitrate 200 mg (950 mg) tab 200 mg (950 mg) calcium +d & min chew tab 600 mg (1,500 mg)-400 unit calcium 500+d tablet chew 500 mg(1,250mg) -400 unit calcium vit d 400 softgl 600 mg(1,500mg) -400 unit calcium vitamin d sftgl rapid release, sftgl 600 mg(1,500mg) -500 unit calcium 600 mg tablet 600 mg calcium (1,500 mg) calcium 600+d softgel 600 mg calcium- 200 unit calcium carb 1,250 mg/5 ml sus 500 mg/5 ml (1,250 mg/5 ml) calcium carbonate 648 mg tab 260 mg calcium (648 mg) calcium chloride intravenous syringe 100 mg/ml (10 %) (Timoptic) (Timoptic-XE) (Calcium D) (Calcium 600 with Vitamin D3) (Calcium 600 with Vitamin D3) QL (2.5 per 25 QL (2.5 per 25 QL (30 per

190 calcium citrate - vit d caplet caplet, (Calcium Citrate + coated mg-unit D) calcium gluconate 500 mg tab 45 mg (500 mg) calcium gluconate 648 mg tab 61 mg (648 mg) CALCIUM-500 MG TABLET CHEWABLE SOY FREE, YEAST FREE MG-UNIT CALTRATE D SOFT CHEW TAB CHOCOLATE TRUFFLE 600 MG (1,500 MG)-800 UNIT citracal + d maximum caplet mg-unit citrus calcium + d tablet mg-unit cvs calcium citrate-vit d tab (Citracal + D mg-unit Maximum) cvs magnesium 250 mg tablet 250 mg cvs pediatric electrolyte soln cvs pediatric electrolyte soln a/f, p/f d10 %-0.45 % sodium chloride intravenous parenteral solution d2.5 %-0.45 % sodium chloride intravenous parenteral solution d5 % and 0.9 % sodium chloride intravenous parenteral solution d5 %-0.45 % sodium chloride intravenous parenteral solution dextrose 10 % and 0.2 % nacl intravenous parenteral solution dextrose 5 %-lactated ringers intravenous parenteral solution dextrose 5%-0.2 % sod chloride intravenous parenteral solution 176

191 dextrose 5%-0.3 % sod.chloride intravenous parenteral solution dextrose with sodium chloride intravenous parenteral solution % dextrose-kcl-nacl intravenous solution % effer-k oral tablet, effervescent 25 meq electrolyte-48 in d5w intravenous parenteral solution eql cal 600-vit d3-min chew tb 600 mg (1,500 mg)-400 unit eql calcium 600 mg + d softgel 600 mg(1,500mg) -100 unit gnp calcium 600+d3+min chew tb p/f,gluten/f,yeast/f 600 mg calcium- 800 unit-40 mg hm calcium 600+d plus tab chew gluten-free 600 mg calcium- 800 unit-40 mg IONOSOL-B IN D5W INTRAVENOUS PARENTERAL SOLUTION 5 % IONOSOL-MB IN D5W INTRAVENOUS PARENTERAL SOLUTION 5 % ISOLYTE-P IN 5 % DEXTROSE INTRAVENOUS PARENTERAL SOLUTION 5 % ISOLYTE-S INTRAVENOUS PARENTERAL SOLUTION KLOR-CON 10 ORAL TABLET EXTENDED RELEASE 10 MEQ klor-con m10 oral tablet,er particles/crystals 10 meq klor-con m15 oral tablet,er particles/crystals 15 meq 177

192 klor-con m20 oral tablet,er particles/crystals 20 meq klor-con sprinkle oral capsule, extended release 10 meq, 8 meq liquid calcium 600-vit d3 sfgl 600 mg(1,500mg) -400 unit liquid calcium 600-vit d3 sfgl softgel,p/f,gluten-f 600 mg(1,500mg) -500 unit liquid calcium with vitamin d softgel, s/f, p/f 600 mg calcium- 200 unit mag delay dr 70 mg tablet 70 mg mag64 dr 64 mg tablet 64 mg mag-g 500 mg tablet 27 mg (500 mg) magnesium 250 mg tablet 250 mg magnesium 300 mg capsule 300 mg magnesium gluc 500 mg tablet 27 (Mag-G) mg (500 mg) magnesium sulfate in d5w intravenous piggyback 1 gram/100 ml magnesium sulfate in water intravenous parenteral solution 20 gram/500 ml (4 %), 40 gram/1,000 ml (4 %) magnesium sulfate in water intravenous piggyback 2 gram/50 ml (4 %), 4 gram/100 ml (4 %), 4 gram/50 ml (8 %) magnesium sulfate injection solution 4 meq/ml (50 %) magnesium sulfate injection syringe 4 meq/ml natural calcium 500 mg tablet 500 mg calcium (1,250 mg) 178

193 NORMOSOL-M IN 5 % DEXTROSE INTRAVENOUS PARENTERAL SOLUTION NORMOSOL-R IV SOLUTION 12'S,LATEX-FREE NORMOSOL-R PH 7.4 INTRAVENOUS PARENTERAL SOLUTION nu-mag 71.5 mg tablet 71.5 mg oralyte electrolyte soln oralyte freezer pops oysco-500 tablet 500 mg calcium (1,250 mg) oyster shell calcium 500 mg tb 500mg elemental ca 500 mg calcium (1,250 mg) oyster shell calcium-vit d tab 500 mg(1,250mg) -200 unit pediatric electrolyte solution PLASMA-LYTE 148 INTRAVENOUS PARENTERAL SOLUTION PLASMA-LYTE A INTRAVENOUS PARENTERAL SOLUTION PLASMA-LYTE-56 IN 5 % DEXTROSE INTRAVENOUS PARENTERAL SOLUTION 5 % potassium acetate intravenous solution 2 meq/ml potassium chlorid-d5-0.45%nacl intravenous parenteral solution 10 meq/l, 20 meq/l, 30 meq/l, 40 meq/l potassium chloride in 0.9%nacl intravenous parenteral solution 20 meq/l, 40 meq/l potassium chloride in 5 % dex intravenous parenteral solution 20 meq/l, 30 meq/l, 40 meq/l 179

194 potassium chloride in lr-d5 intravenous parenteral solution 20 meq/l potassium chloride intravenous piggyback 10 meq/100 ml, 20 meq/100 ml, 30 meq/100 ml, 40 meq/100 ml potassium chloride intravenous solution 2 meq/ml potassium chloride oral capsule, extended release 10 meq, 8 meq potassium chloride oral liquid 20 meq/15 ml, 40 meq/15 ml potassium chloride oral packet 20 meq potassium chloride oral tablet extended release 10 meq, 8 meq potassium chloride oral tablet extended release 20 meq potassium chloride oral tablet,er particles/crystals 10 meq potassium chloride-0.45 % nacl intravenous parenteral solution 20 meq/l potassium chloride-d5-0.2%nacl intravenous parenteral solution 10 meq/l, 20 meq/l, 30 meq/l, 40 meq/l potassium chloride-d5-0.3%nacl intravenous parenteral solution 20 meq/l potassium chloride-d5-0.9%nacl intravenous parenteral solution 20 meq/l, 40 meq/l potassium citrate oral tablet extended release 10 meq (1,080 mg) potassium citrate oral tablet extended release 15 meq potassium citrate oral tablet extended release 5 meq (540 mg) (Klor-Con Sprinkle) (Klor-Con) (K-Tab) (K-Tab) (Klor-Con M10) (Urocit-K 10) (Urocit-K 15) (Urocit-K 5) 180

195 potassium citrate-citric acid oral packet 3,300-1,002 mg (Cytra K Crystals) potassium cl 10 meq/50 ml sol 10 meq/50 ml potassium cl 20 meq/50 ml sol 20 meq/50 ml potassium cl er 20 meq tablet microencapsulated 20 meq (Klor-Con M20) ra cal 600-vit d3-min chew tab 600 mg calcium- 400 unit-40 mg ra oyster shell-vitamin d tab s/f, p/f 250 (625)-125 mg-unit ra pediatric electrolyte soln a/f ra pediatric freezer pops ringers intravenous parenteral solution sm calcium citrate-vit d cplt caplet, (Citracal + D gluten-free mg-unit Maximum) sm magnesium 250 mg tablet 250 mg sm pediatric electrolyte soln sodium acetate intravenous solution 2 meq/ml sodium bicarbonate intravenous syringe 8.4 % (1 meq/ml) sodium chloride 0.45 % intravenous parenteral solution 0.45 % sodium chloride 0.9 % intravenous parenteral solution 0.9 % sodium chloride 3 % intravenous parenteral solution 3 % sodium chloride 5 % intravenous parenteral solution 5 % sodium chloride intravenous parenteral solution 2.5 meq/ml sodium lactate intravenous solution 5 meq/ml 181

196 sodium phosphate intravenous solution 3 mmol/ml TPN ELECTROLYTES II IV SOLN 25'S,20ML/50ML FTV MEQ/20 ML TPN ELECTROLYTES INTRAVENOUS SOLUTION MEQ/20 ML Respiratory Tract Agents Anti-Inflammatories, Inhaled Corticosteroids ADVAIR DISKUS INHALATION BLISTER WITH DEVICE MCG/DOSE, MCG/DOSE, MCG/DOSE ADVAIR HFA INHALATION HFA AEROSOL INHALER MCG/ACTUATION, MCG/ACTUATION, MCG/ACTUATION ARNUITY ELLIPTA INHALATION BLISTER WITH DEVICE 100 MCG/ACTUATION, 200 MCG/ACTUATION BREO ELLIPTA INHALATION BLISTER WITH DEVICE MCG/DOSE, MCG/DOSE budesonide inhalation suspension for nebulization 0.25 mg/2 ml, 0.5 mg/2 ml, 1 mg/2 ml DULERA INHALATION HFA AEROSOL INHALER MCG/ACTUATION, MCG/ACTUATION FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 100 MCG/ACTUATION, 50 MCG/ACTUATION (Pulmicort) QL (60 per 30 QL (12 per 28 QL (30 per 30 QL (60 per 30 QL (13 per 28 QL (60 per

197 FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 250 MCG/ACTUATION FLOVENT HFA INHALATION HFA AEROSOL INHALER 110 MCG/ACTUATION FLOVENT HFA INHALATION HFA AEROSOL INHALER 220 MCG/ACTUATION FLOVENT HFA INHALATION HFA AEROSOL INHALER 44 MCG/ACTUATION QVAR INHALATION AEROSOL 40 MCG/ACTUATION, 80 MCG/ACTUATION SYMBICORT MCG INHALER 60 INHALATIONS MCG/ACTUATION SYMBICORT INHALATION HFA AEROSOL INHALER MCG/ACTUATION, MCG/ACTUATION Antileukotrienes montelukast oral granules in packet 4 mg (Singulair) montelukast oral tablet 10 mg (Singulair) montelukast oral tablet,chewable 4 mg, 5 mg (Singulair) zafirlukast oral tablet 10 mg, 20 mg (Accolate) Bronchodilators albuterol sulfate inhalation solution for nebulization 0.63 mg/3 ml, 1.25 mg/3 ml, 2.5 mg /3 ml (0.083 %), 5 mg/ml albuterol sulfate oral syrup 2 mg/5 ml albuterol sulfate oral tablet 2 mg, 4 mg QL (120 per 30 QL (12 per 28 QL (24 per 28 QL (21.2 per 28 QL (17.4 per 25 QL (12 per 25 QL (11 per

198 albuterol sulfate oral tablet extended release 12 hr 4 mg, 8 mg ANORO ELLIPTA INHALATION BLISTER WITH DEVICE MCG/ACTUATION ATROVENT HFA INHALATION HFA AEROSOL INHALER 17 MCG/ACTUATION COMBIVENT RESPIMAT INHALATION MIST MCG/ACTUATION INCRUSE ELLIPTA INHALATION BLISTER WITH DEVICE 62.5 MCG/ACTUATION ipratropium bromide inhalation solution 0.02 % metaproterenol oral syrup 10 mg/5 ml metaproterenol oral tablet 10 mg, 20 mg PROAIR HFA INHALATION HFA AEROSOL INHALER 90 MCG/ACTUATION PROAIR RESPICLICK INHALATION AEROSOL POWDR BREATH ACTIVATED 90 MCG/ACTUATION SEREVENT DISKUS INHALATION BLISTER WITH DEVICE 50 MCG/DOSE SPIRIVA RESPIMAT INHALATION MIST 1.25 MCG/ACTUATION, 2.5 MCG/ACTUATION SPIRIVA WITH HANDIHALER INHALATION CAPSULE, W/INHALATION DEVICE 18 MCG QL (60 per 30 QL (25.8 per 28 QL (8 per 30 QL (30 per 30 QL (60 per

199 STIOLTO RESPIMAT INHALATION MIST MCG/ACTUATION STRIVERDI RESPIMAT INHALATION MIST 2.5 MCG/ACTUATION terbutaline oral tablet 2.5 mg, 5 mg terbutaline subcutaneous solution 1 mg/ml theophylline in dextrose 5 % intravenous parenteral solution 200 mg/100 ml, 200 mg/50 ml, 400 mg/250 ml, 400 mg/500 ml, 800 mg/250 ml theophylline oral solution 80 mg/15 ml theophylline oral tablet extended release 12 hr 100 mg, 200 mg, 300 (Theochron) mg theophylline oral tablet extended release 12 hr 450 mg theophylline oral tablet extended release 24 hr 400 mg, 600 mg VENTOLIN HFA INHALATION HFA AEROSOL INHALER 90 MCG/ACTUATION Respiratory Tract Agents, Other acetylcysteine intravenous solution 200 mg/ml (20 %) (Acetadote) acetylcysteine solution 100 mg/ml (10 %), 200 mg/ml (20 %) CINQAIR INTRAVENOUS SOLUTION 10 MG/ML cromolyn inhalation solution for nebulization 20 mg/2 ml cromolyn sodium nasal spray 5.2 mg/spray (4 %) (Nasalcrom) DALIRESP ORAL TABLET 500 MCG 185 QL (4 per 28 QL (4 per 28 PA QL (30 per 30

200 ESBRIET ORAL CAPSULE 267 MG KALYDECO ORAL GRANULES IN PACKET 50 MG, 75 MG KALYDECO ORAL TABLET 150 MG NUCALA SUBCUTANEOUS RECON SOLN 100 MG OFEV ORAL CAPSULE 100 MG, 150 MG ORKAMBI ORAL TABLET MG, MG PROLASTIN-C INTRAVENOUS RECON SOLN 1,000 MG sodium chloride 0.9% inhal vl u-d, suv, p/f (rx) 0.9 % XOLAIR SUBCUTANEOUS RECON SOLN 150 MG 3 $0 Skeletal Muscle Relaxants Skeletal Muscle Relaxants baclofen oral tablet 10 mg, 20 mg carisoprodol oral tablet 250 mg, 350 mg (Soma) chlorzoxazone oral tablet 500 mg (Parafon Forte DSC) cyclobenzaprine oral tablet 10 mg, 5 mg dantrolene oral capsule 100 mg dantrolene oral capsule 25 mg, 50 mg (Dantrium) metaxall oral tablet 800 mg metaxalone oral tablet 400 mg metaxalone oral tablet 800 mg (Metaxall) PA; QL (270 per 30 PA; QL (60 per 30 PA; QL (60 per 30 PA; LA; QL (1 per 28 PA; QL (60 per 30 PA; QL (120 per 30 PA PA-HRM; QL (120 per 30 ; AGE (Max 64 Years) PA-HRM; AGE (Max 64 Years) PA-HRM; AGE (Max 64 Years) PA-HRM; AGE (Max 64 Years) PA-HRM; AGE (Max 64 Years) PA-HRM; AGE (Max 64 Years) 186

201 methocarbamol oral tablet 500 mg (Robaxin) methocarbamol oral tablet 750 mg (Robaxin-750) revonto intravenous recon soln 20 mg tizanidine oral capsule 2 mg, 4 mg, 6 mg (Zanaflex) tizanidine oral tablet 2 mg tizanidine oral tablet 4 mg (Zanaflex) Sleep Disorder Agents Sleep Disorder Agents armodafinil oral tablet 150 mg, 200 mg, 250 mg, 50 mg BELSOMRA ORAL TABLET 10 MG, 15 MG, 20 MG, 5 MG eszopiclone oral tablet 1 mg, 2 mg, 3 mg (Nuvigil) (Lunesta) HETLIOZ ORAL CAPSULE 20 MG ROZEREM ORAL TABLET 8 MG SILENOR ORAL TABLET 3 MG, 6 MG XYREM ORAL SOLUTION 500 MG/ML PA-HRM; AGE (Max 64 Years) PA-HRM; AGE (Max 64 Years) PA QL (30 per 30 PA-HRM; (High Risk Med. QL applies to all members; PA required for 65 years and older with over 90 days cumulative use with any nonbenzodiazepine hypnotic drug); QL (30 per 30 ; AGE (Max 64 Years) PA; QL (30 per 30 QL (30 per 30 LA 187

202 zaleplon oral capsule 10 mg, 5 mg (Sonata) zolpidem oral tablet 10 mg, 5 mg (Ambien) zolpidem oral tablet,ext release multiphase 12.5 mg, 6.25 mg Vasodilating Agents Vasodilating Agents (Ambien CR) ADCIRCA ORAL TABLET 20 MG ADEMPAS ORAL TABLET 0.5 MG, 1 MG, 1.5 MG, 2 MG, 2.5 MG PA-HRM; (High Risk Med. QL applies to all members; PA required for 65 years and older with over 90 days cumulative use with any nonbenzodiazepine hypnotic drug); QL (60 per 30 ; AGE (Max 64 Years) PA-HRM; (High Risk Med. QL applies to all members; PA required for 65 years and older with over 90 days cumulative use with any nonbenzodiazepine hypnotic drug); QL (30 per 30 ; AGE (Max 64 Years) PA-HRM; (High Risk Med. QL applies to all members; PA required for 65 years and older with over 90 days cumulative use with any nonbenzodiazepine hypnotic drug); QL (30 per 30 ; AGE (Max 64 Years) PA; QL (60 per 30 PA; QL (90 per

203 epoprostenol (glycine) intravenous recon soln 0.5 mg, 1.5 mg LETAIRIS ORAL TABLET 10 MG, 5 MG (Flolan) OPSUMIT ORAL TABLET 10 MG ORENITRAM ORAL TABLET EXTENDED RELEASE MG, 0.25 MG, 1 MG, 2.5 MG REMODULIN INJECTION SOLUTION 1 MG/ML, 10 MG/ML, 2.5 MG/ML, 5 MG/ML sildenafil intravenous solution 10 mg/12.5 ml (Revatio) sildenafil oral tablet 20 mg (Revatio) TRACLEER ORAL TABLET 125 MG, 62.5 MG TYVASO INHALATION SOLUTION FOR NEBULIZATION 1.74 MG/2.9 ML (0.6 MG/ML) UPTRAVI ORAL TABLET 1,000 MCG, 1,200 MCG, 1,400 MCG, 1,600 MCG, 400 MCG, 600 MCG, 800 MCG UPTRAVI ORAL TABLET 200 MCG UPTRAVI ORAL TABLETS,DOSE PACK 200 MCG (140)- 800 MCG (60) Vitamins And Minerals Vitamins And Minerals a thru z advanced formula tab gluten-free mg-mcg a thru z advanced formula tab new formula PA; QL (30 per 30 PA; QL (30 per 30 PA PA PA; QL (37.5 per 1 day) PA; QL (90 per 30 PA; LA; QL (60 per 30 PA PA; QL (60 per 30 PA; QL (240 per 30 PA; QL (400 per

204 a thru z advanced formula tab w/ lutein & lycopene mg-mcg-mcg-mcg a thru z select 50+ formula tb advanced formula mgmcg-mcg a thru z select men 50+ tablet mcg a thru z select multivit tab mcg a thru z select multivit tab iron-free, 50+ form mg-mcg-mcg a thru z select tablet new formulation a thru z select women's tablet abc plus tablet mgmcg-mcg adult multi gummies 200 mcg adult multivitamin gummies assorted flavors 200 mcg adult one daily gummies 200 mcg adults 50+ multivitamin tablet mg-mcg-mcg animal chews tablet antioxidant softgel softgel apatate forte liquid b complete tablet b complex capsule (Super B-50 Complex) b complex formula #1 tablet b complex tablet b mcg tablet 500 mcg b-12 dots 500 mcg tablet 500 mcg baby vitamin d3 400 unit/drop 400 unit/drop balance b-100 tablet balance b-50 tablet 190

205 balance b-50 tablet inner,p/f,gluten/f balanced b-100 tablet balanced b-100 tablet 100 mg balanced b-50 tablet balanced b-complex caplet p/f,nolactose 400 mcg b-complex plus vitamin c cplt caplet (Total B/C) b-complex with b12 tablet b-complex with c tablet (Total B/C) b-complex with vit c caplet s/f,p/f,gluten-free 400 mcg bee-zee tablet biosupp liquid biotin 300 mcg tablet 300 mcg biovol syrup c complex 500 mg tablet sa 500 mg calcidol drops 8,000 unit/ml calcium 1,000 + d3 caplet 1,000 mg(2,500 mg)-800 unit calcium 250-vit d3 125 tablet 250- (Oyster Shell 125 mg-unit Calcium-Vit D3) calcium vit d 400 caplet s/f, p/f, caplet 600 mg(1,500mg) -400 unit calcium vit d tablet mg-unit calcium 600-vit d3 200 tablet 600 mg(1,500mg) -200 unit calcium 600-vit d3 400 tablet 600 (Calcium with mg(1,500mg) -400 unit Vitamin D) centamin liquid 9 mg iron/15 ml central-vite seniors tablet centram-care multivit-min liq 9 mg iron/15 ml centravites 50 plus tablet 191

206 centravites 50 plus tablet outer mg-mcg-mcg centrum complete multivit tab mg-mcg centrum multivit-mineral liq 9 mg iron/15 ml centrum silver tablet adults mg-mcg-mcg century ultimate men's tablet mcg century ultimate women's tab mg-mcg cerovite advanced form tab mg-mcg cerovite jr tablet chew cerovite liquid 9 mg iron/15 ml cerovite senior tablet certavite sr-antioxidant tab mg-mcg-mcg certavite-antioxidant liquid 9 mg iron/15 ml certavite-antioxidant tablet mg-mcg chewable-vite tablet chew-vites-iron tablet chew child chew + iron tab chew child chew vitamin tablet child ferrous sulfate 15 mg/ml 15 (Fer-In-Sol) mg iron (75 mg)/ml child multivitamin plus iron 18 mg iron childrens chew vitamin tab children's chewable vitamin childrens multivit tab chew childrens vit-iron tab chew compete tablet complete multi 50+ tablet mcg 192

207 complete multi tablet mg-mcg-mcg-mcg complete multivitamin tab complete senior tablet cvs bal b-100 tablet cvs bal b-50 tablet cvs balanced b-150 tablet cvs b-complex-vit c caplet caplet (Total B/C) cvs calcium vit d tablet oyster shell 500 mg(1,250mg) -125 unit cvs calcium 600-vit d3 800 tab 600 (Caltrate with mg(1,500mg) -800 unit Vitamin D3) cvs calcium 600-vit d3 800 tab p/f, (Caltrate with s/f,gluten-free 600 mg(1,500mg) - Vitamin D3) 800 unit cvs child vit-mineral tab cvs children's chewable vit cvs childs vit with c tab chew cvs child's vitamin-iron tb cvs daily gummies p/f, gluten-free 200 mcg cvs daily multiple tablet cvs daily multiple tablet for women cvs gummy swirls chewable cvs hair, skin and nails cplt cvs iron 27 mg tablet 240 mg (27 mg iron) cvs men's daily gummies p/f, glutenfree 200 mcg cvs men's multi-vit tablet cvs prenatal vitamin tablet cvs spectravite adult 50+ tabs mg-mcg-mcg cvs spectravite adult gummy 200 mcg cvs spectravite advanced tab mg-mcg 193

208 cvs spectravite senior cvs spectravite senior tab cvs spectravite ultra men's tb mcg cvs spectravite ultra women tb mg-mcg cvs super b complx & c cplt caplet, p/f cvs vitamin b-100 complx tb cvs vitamin c 1,000 mg tb chw 1,000 mg cvs vitamin d3 1,000 unit sfgl softgel (Vitamin D3) 1,000 unit cvs vitamin d3 400 unit/drop 400 (Baby Ddrops) unit/drop cvs women's daily gummies p/f,gummies 200 mcg cyanocobalamin 1,000 mcg/ml 25's (Vitamin B-12) 3 $0 1,000 mcg/ml d3 dots 2,000 unit tablet p/f 2,000 unit daily multi vitamin-iron tab daily multiple tablet mg-mcg daily multiple vitamin tab sugar coated daily multivitamin-iron tablet mg-mcg daily value multivitamin tab s/f daily vitamin + iron tablet daily vitamin formula tablet daily vitamin formula tablet daily vitamin formula-iron tab mg-mcg daily vite tablet s/f, p/f daily vite tablet s/f,p/f daily vite with iron tablet daily-vite tablet 194

209 daily-vites with iron tablet delta d3 400 unit tablet s/f,l/f,y/f,gluten/f 400 unit dino-life extra c tab chew dino-life iron-zinc tb chew dino-life tablet chewable d-vi-sol 400 units/ml drop 400 unit/ml eldertonic elixir mg ellis tonic eq child complete chew tablet 18 mg iron eq complete multivitamin tab mg-mcg-mcg eq complete multivitamin tab glutenfree mg-mcg eq one daily men's tablet gluten free mcg eql central-vite select tablet eql century mature tablet mcg eql century multi-vitamin tab mg eql chewable multi vitamin tab eql child's multivit tab chew with vitamin c eql childs multivit-mineral tb eql eye health plus lutein tab 1,000 unit-200 mg-60 unit-2 mg eql one daily 50 plus tablet eql one daily essential tablet eql one daily maximum tablet mg eql one daily men's tablet eql prenatal vitamin tablet 28 mg iron- 800 mcg ergocalciferol 8,000 units/ml 8,000 (Calciferol) unit/ml 195

210 essentia tablet mg-mcg essential balance tablet essential daily tablet w/iron & calcium mg feosol 65 mg tablet 325 mg (65 mg iron) ferocon capsule mg 3 $0 ferretts 325 mg tablet 325 mg (106 mg iron) ferrex 150 capsule outer, u-d 150 mg iron ferrex 150 plus capsule mg ferric x-150 capsule 150 mg iron ferrocite tablet 324 mg (106 mg iron) ferrous fumarate 324 mg tab 324 mg (Ferrocite) (106 mg iron) ferrous gluconate 240 mg tab (Iron High 240mg=27mg elemental 240 mg (27 Potency) mg iron) ferrous gluconate 324 mg tab 324 mg (36 mg iron), 324 mg (37.5 mg iron), 324 mg (38 mg iron) ferrous sulf 220 mg/5 ml elix 220 mg (44 mg iron)/5 ml ferrous sulf 300 mg/5 ml liq 300 mg (60 mg iron)/5 ml ferrous sulf ec 324 mg tablet 324 mg (65 mg iron) ferrous sulf ec 325 mg tablet 325 mg (65 mg iron) ferrous sulfate 325 mg tablet red (iron) 325 mg (65 mg iron) flintstones complete tablet flintstones extra c tab chew flintstones tablet chewable 196

211 flintstones with iron tab chew 18 mg iron folic acid 1 mg tablet (rx) 1 mg 3 $0 folic acid 1,000 mcg tablet p/f,s/f (otc) 1 mg folic acid 400 mcg tablet s/f,p/f,lactose-free 400 mcg fosfree tablet mg geravim liquid geriaton liquid gnp calcium 500-vit d3 600 tab (Os-Cal D3) 500mg (1,250mg) -600 unit gnp century mature tablet glutenfree mg-mcg-mcg gnp century tablet adults mg-mcg-mcg gnp century tablet gluten-free mg-mcg gnp one daily essential tablet gs prenatal vitamins tablet mg-mcg gummi bear multivit tab chew multivit & minerals hair vitamins hemocyte tablet u-u,blister pk 324 mg (106 mg iron) hi-b complex tablet hm animal shapes complete chew child's, w/ choline 18 mg iron hm complete 50+ tablet mg-mcg-mcg hm complete women tablet mg-mcg hm one daily with iron tablet glutenfree mg-mcg hm super vitamin b complex glutenfree 400 mcg honey bears chew tab 197

212 honey bears-iron-zinc tab chew icaps plus tablet lactose free iferex 150 capsule 150 mg iron iron 27 mg tablet 236 mg (27 mg iron) iron 28 mg tablet 256 mg (28 mg iron) kenwood therapeutic liquid kids multivitamin complete tab 18 mg iron kobee tablet 0.4 mg kpn tablet life-pack women's p/f,s/f 0.8 mg little animals child tb chw little animals-iron tab chew lysiplex plus liquid MACUVITE EYE CARE TABLET 7,160 UNIT-113 MG-100 UNIT mega multivitamin-mineral tab mega multivit-chelated min tab men's multivitamin gummies 200 mcg MEPHYTON 5 MG TABLET 5 3 $0 MG milltrium senior multivit tab multi complete-iron tablet mg-mcg multi for her tablet 18 mg iron-600 mcg-80 mcg multi-day plus iron tablet mg-mcg multi-delyn liquid s/f,a/f multi-delyn with iron liquid 10 mg iron/5 ml multilex tablet multilex-t-m-minerals tab multiple vitamin with iron tab (Daily Vitamin with Iron) 198

213 multiple vitamin w-minerals tb multiple vitamins tablet one daily multivitamin child tab chew (Flintstones/Extra C) multi-vitamin daily tablet multivitamin-mineral liquid 9 mg iron/15 ml multivitamins tablet (Super Multivitamin) multivit-fluor 0.25 mg/ml drop 0.25 mg/ml multivit-iron child tab chew children's multivit-mineral hp cap multivit-minerals tablet s/f,p/f (Hair,Skin and Nails) my favorite multiple liquid myvitalife soft-gel capsule NASCOBAL 500 MCG NASAL SPRAY OUTER 500 MCG/SPRAY 3 $0 nephplex rx tablet $0 mg-mg-mcg-mg nephron fa tablet mg 3 $0 nephro-vite rx tablet mgmg-mcg 3 $0 niacinamide er 500 mg tablet 500 mg nu-iron 150 capsule 150 mg iron ocutabs tablet s/f, w/lutein once daily tablet once daily with iron tablet oncovite tablet one daily complete tablet one daily complete tablet mg one daily essential tablet 199

214 one daily for women tablet mg one daily gummy vites gummie 200 mcg one daily maximum tablet mg one daily multivitamin tab one daily multivitamin tablet one daily multivitamin tablet 400 mcg one daily multivitamin-iron tb mg-mcg one daily plus iron tablet mg-mcg one daily tablet one daily tablet one daily tablet men's formula one daily with minerals tablet one-a-day essential tablet one-a-day max formula tab one-a-day men's tablet mcg one-a-day teen advantage tab mg-mcg one-a-day teen advantage tab 9 mg iron-400 mcg oysco 500-vit d3 200 tablet 500 mg(1,250mg) -200 unit oysco d tablet mg-unit oyster shell 500-vit d3 200 tb 500 mg(1,250mg) -200 unit oyster shell calcium tablet 500 mg(1,250mg) -400 unit oyster shell calcium-vit d tab p/f,s/f,gluten-free 500 mg(1,250mg) -400 unit oystercal-d 500 mg-400 unit tb 500 mg(1,250mg) -400 unit 200

215 perry prenatal capsule mg pharmacist multi-vite tab phytonadione 1 mg/0.5 ml syr latexfree, p/f 1 mg/0.5 ml 3 $0 pnv prenatal plus multivit tab s/f, (All Rx Prenatal gluten-free 27 mg iron- 1 mg Vitamins Covered) poly-iron 150 mg capsule 150 mg iron poly-vita drops 1, unitmg-unit/ml poly-vita with iron drops 1,500 unit- 400 unit-10 mg/ml poly-vitamin drops 1, unit-mg-unit/ml poly-vitamin tab chew polyvitamin w-iron drops 1,500 unit-400 unit-10 mg/ml polyvitamin with iron tab chew prenatal formula tablet 28 mg iron- 800 mcg prenatal tablet (otc) mg prenatal tablet (otc) mg prenatal tablet 27 mg iron- 800 mcg prenatal tablet 28 mg iron- 800 mcg prenatal tablet 28 mg iron- 800 mcg (Prenatal Formula) prenatal tablet 28 mg iron- 800 mcg (Prenatal Tablet) prenatal tablet outer (otc) mg prenatal vitamin plus low iron oral (All Rx Prenatal tablet 27 mg iron- 1 mg Vitamins Covered) prenatal vitamin tablet 27 mg iron- 800 mcg 201

216 prenatal vitamins tablet phosphorus free 28 mg iron- 800 mcg prosight tablet 5, unit-mgunit pub multivitamin 50 plus tab pv b-100 complex pv b-50 complex pv kid's gummy bear tab chew chewable pv kid's vit + extra c chew tb pv kid's vit + iron tab chew pv kid's vit complete tab chew pv kid's vitamins chew tab pv kids vitamins chew tab 300 mcg pv kids vitamins complete mg-mcg pv kids vitamins+iron tab chew 15 mg iron pv multivital platinum tablet pv multivital platinum tablet w/lutein & lycopene mcg pv multivital tablet mg pv multivital tablet mg-mcg-mcg-mcg pv prenatal formula tablet 28 mg iron- 800 mcg pv stress 500 plus zinc tab pv stress 500 tablet pyridoxine 100 mg/ml vial 25's $0 mg/ml pyridoxine 250 mg tablet 250 mg (Vitamin B-6) qc child complete vit chew tab 18 mg iron qc children's chewable tablet qc maximum daily multivit tab mg 202

217 qc multi-vite 50 & over tablet w/lycopene qc multi-vite tablet mg-mcg qc women's daily multivit tab mg ra balanced b-100 tablet 0.4 mg ra balanced b-50 tablet natural,p/f ra b-complex tablet p/f ra b-complex tablet p/f (Ultra B-100 Complex) ra central vite select tab p/f ra central-vite select tab p/f ra central-vite senior tablet mg-mcg-mcg ra central-vite tablet mg-mcg-mcg ra central-vite tablet mgmcg ra hi-cal plus vitamin d tab 500 mg(1,250mg) -200 unit ra one daily energy tablet ra one daily maximum tablet mg ra one daily multi-vitamin tab p/f ra one daily plus iron tablet ra prenatal tablet 28 mg iron- 800 mcg ra therapeutic m multivit tab mg ra vit b-12 1,000 mcg/ml liq 1,000 mcg/ml ra vitamin b-12 1,000 mcg tab (Vitamin B-12) timed-release 1,000 mcg ra vitamin c 1,000 mg tab sa w/bioflavonoids 1,000 mg 203

218 ra vitamin c 500 mg tab chew p/f 500 mg ra vitamin d3 1,000 unit tab s/f,gluten/f,yeast/f 1,000 unit rena-vite rx tablet mg-mgmcg 3 $0 right step prenatal vit tab mg scooby-doo one a day tablet senior tabs mg-mcgmcg sentry multivit & mineral cplt mg-mcg-mcg-mcg sentry senior multivitamin tab sodium/f,yeast/f mcg sentry senior tablet mgmcg-mcg sentry tablet mg-mcg sm animal shapes complete chew gluten-free 18 mg iron (Flintstones/Extra sm animal shapes tab chew C) sm animal shapes tab chew toddlers sm animal shapes w-iron tab children's sm b complex with vit c tablet (Total B/C) gluten-free sm complete advanced tablet mg-mcg-mcg-mcg sm complete multi-vit-mineral advanced formula mg-mcg sm complete senior formula tab sm complete senior formula tab mg-mcg-mcg sm complete tablet mg (Daily Vitamin sm multivitamin w-iron tab with Iron) 204

219 sm multivitamins tablet (Super Multivitamin) sm natural balanced b-100 tab 100 mg sm prenatal vitamins tablet 28 mg iron- 800 mcg sm super b complex-c caplet caplet sm therapeutic m tablet mg sm ultimate men's complete tab mcg sm vitamin b complex tablet glutenfree 0.4 mg (B Complex 100) sm vitamin b-100 complex tab gluten-free 0.4 mg sm vitamin d3 4,000 unit sftgl softgel, gluten-free 4,000 unit sodium fluoride oral tablet 1 mg fluoride (2.2 mg) stress b tablet stress b with zinc tablet stress formula tablet stress formula with iron tab stress formula with iron tab 500 mg- 400 mcg- 18 mg iron stress formula with iron tab 500 mg- 400 mcg- 27 mg iron stress formula with zinc tab stress-c tablet stress-c with iron tablet 500 mg-400 mcg- 18 mg iron sunvite tablet 18 mg iron-400 mcg- 25 mcg super b complex-c caplet caplet super b maxi complex caplet 0.4 mg super b with vit c capsule super b-50 complex capsule 205

220 super b-50 complex plus tab super b-complex folic-vit c tb p/f 400 mcg super multiple vit-mineral tab super multivitamin tablet super quints b-50 tablet 0.4 mg super quints b-50 tablets super thera vite m tablet superior 35 vit-mineral tab sa superplex-t tablet support liquid support-500 softgel sv hair, skin and nails caplet 1 mg iron-66.7 mcg-1,000 mcg tab-a-vite tablet tab-a-vite with iron tablet tab-a-vite-minerals tablet thera m plus tablet 9 mg iron-400 mcg thera tablet thera-d 2000 tablet 2,000 unit theradex m tablet mg thera-m caplet thera-m caplet caplet mg thera-m tablet w/beta carotene 9 mg iron-400 mcg therapeutic-m caplet caplet 9 mg iron-400 mcg therapeutic-m tablet mgmcg thera-tabs tablet theratrum complete 50 plus p/f,caplet theratrum complete tablet w/lutein, p/f therems tablet total b with vit c caplet 206

221 totalday multiple tablet sa tri-vi-sol drops 750 unit-35 mg -400 unit/ml tri-vita drops 1, unit-mgunit/ml tri-vitamin drops 1, unitmg-unit/ml ultra b-100 complex tablet unicomplex-m tablet v-c forte capsule 1 mg 3 $0 vic-forte capsule 1 mg 3 $0 vision plus lutein vitamin tab vision vitamins vit d mg (50,000 unit) capsule 3 $0 50,000 unit vitalets tablet chewable child, orange,s/f vitamin a 10,000 units capsule soluble 10,000 unit vitamin and minerals tablet vitamin b complex capsule vitamin b complex tablet 500 mg- 400 mcg- 18 mg iron vitamin b complex-vit c cap (Super B/C) vitamin b complex-vit c tablet (Total B/C) vitamin b mg tablet 100 mg vitamin b-1 50 mg tablet 50 mg vitamin b-12 1,000 mcg tablet 1,000 mcg vitamin b mcg tablet 100 mcg vitamin b mcg tablet 250 mcg vitamin b mcg tablet 500 mcg vitamin b12-folic acid tablet mcg 207

222 vitamin b-50 complex tablet (B Complex 100) s/f,p/f,dairy-free 0.4 mg vitamin b mg tablet p/f 250 mg vitamin b-6 50 mg tablet 50 mg vitamin b-complex & c caplet p/f,lactose free mcg-mg vitamin c 1,000 mg tablet 1,000 mg vitamin c 1,500 mg tablet sa na/f,s/f,starch/free 1,500 mg vitamin c 250 mg tablet 250 mg vitamin c 250 mg tablet chew 250 mg vitamin c 500 mg tablet chew 500 mg vitamin c 500 mg/5 ml liquid 500 mg/5 ml vitamin d 1,000 unit tablet 1,000 unit vitamin d3 1,000 unit tablet s/f,p/f 1,000 unit vitamin d3 10,000 unit softgel (Maximum D3) softgel 10,000 unit vitamin d3 10,000 unit softgel (Maximum D3) softgel,p/f,s/f 10,000 unit vitamin d3 2,000 unit tablet s/f,p/f (D3 DOTS) 2,000 unit vitamin d3 400 unit tab chew (Kids Vitamin D3) orange, p/f 400 unit vitamin d3 400 unit tablet s/f,p/f 400 unit vitamin d3 400 unit/5 ml liq 400 unit/5 ml vitamin d3 400 unit/ml drop a/f, s/f, (Just D) fruit 400 unit/ml vitamin d3 5,000 unit capsule s/f, p/f (Dialyvite Vitamin 5,000 unit D) 208

223 vitamin d3 5,000 unit/ml drops a/f, p/f,gluten-free 5,000 unit/ml vitamin k 100 mcg tablet p/f,na/f,wheat-free 100 mcg vitamin k-1 1 mg/0.5 ml ampul 3 $0 25's,latex-free 1 mg/0.5 ml vitamin k-1 10 mg/ml ampul 3 $0 25's,latex-free 10 mg/ml vitamins for hair tablet vitatrum tablet mgmcg-mcg-mcg vitrum 50+ senior tablet mcg vitrum senior tablet f/f,p/f vol-care rx tablet mg-mgmcg 3 $0 vp-vite rx tablet mg-mgmcg 3 $0 v-r calcium d 133 caplet mg-unit v-r natural b-100 tablet v-r vitamin c tr 500 mg caplet 500 mg women's multivitamin gummies gluten-f, lactose-f 200 mcg yelets tablet mg-mcg zoo chews gummie tablet 209

224 INDEX 3 3 day vaginal pse-150gfn-15dm day vaginal MOP A a thru z a thru z advanced formula a thru z high potency a thru z select a thru z select 50+ formula a thru z select women's abacavir abacavir-lamivudine abacavir-lamivudine-zidovudine abc plus ABELCET ABILIFY MAINTENA ABRAXANE ABREVA acamprosate acarbose acebutolol acephen... 3 acetaminophen... 3, 5 acetaminophen-codeine... 3 acetazolamide acetazolamide sodium acetic acid , 178 acetylcysteine acid gone antacid acid reducer (famotidine) , 147 acid reducer (ranitidine) acid relief (cimetidine) acitretin acne medication , 129 ACNE MEDICATION ACTEMRA ACTHIB (PF) ACTIMMUNE actinel pediatric acyclovir... 78, 79, 127 acyclovir sodium... 78, 79 ADACEL(TDAP ADOLESN/ADULT)(PF) 172 ADAGEN adapalene ADCETRIS ADCIRCA adefovir ADEMPAS adriamycin adrucil adt robitussin peak cld dm max adult multivitamin gummies 200 adult nasal decongestant adult one daily gummies adult robitussin peak cold dm adult wal-tussin adult wal-tussin dm max adults 50 plus ADVAIR DISKUS ADVAIR HFA ADVIL afeditab cr AFINITOR AFINITOR DISPERZ a-hydrocort AKTEN (PF) AKYNZEO ala-cort ala-scalp alavert alavert d-12 allergy-sinus ALBENZA albuterol sulfate alcaine alclometasone ALCOHOL PADS ALCOHOL PREP PADS ALDURAZYME ALECENSA alendronate alfuzosin ALIMTA ALINIA alka-seltzer plus mucus-conges aller-chlor allerclear d-12hr allerclear d-24hr allergy (chlorpheniramine) allergy relief (cetirizine) allergy relief (clemastine) allergy relief(diphenhydramin) aller-tec d allopurinol ALLZITAL... 3 almacone almacone aloe vesta antifungal (micon). 52 alophen alosetron ALPHAGAN P alprazolam ALREX altacaine altamist I-1

225 altavera (28) aluminum hydroxide gel alyacen 1/35 (28) alyacen 7/7/7 (28) amabelz amantadine hcl... 66, 67 ambi 10peh-4cpm-20dm ambi 20dm-4cpm ambi 40pse-400gfn-20dm ambi 60pse-4cpm ambi 60pse-4cpm-20dm AMBISOME amethia amethia lo amifostine crystalline amiloride amiloride-hydrochlorothiazide99 AMINO ACIDS 15 % AMINOSYN 10 % AMINOSYN 7 % WITH ELECTROLYTES AMINOSYN 8.5 % AMINOSYN 8.5 %- ELECTROLYTES AMINOSYN II 10 % AMINOSYN II 15 % AMINOSYN II 7 % AMINOSYN II 8.5 % AMINOSYN II 8.5 %- ELECTROLYTES AMINOSYN M 3.5 % AMINOSYN-HBC 7% AMINOSYN-PF 10 % AMINOSYN-PF 7 % (SULFITE-FREE) AMINOSYN-RF 5.2 % amiodarone AMITIZA amitriptyline amlactin amlodipine amlodipine-atorvastatin amlodipine-benazepril amlodipine-olmesartan amlodipine-valsartan amlodipine-valsartan-hcthiazid ammonium lactate amoxapine amoxicil-clarithromy-lansopraz amoxicillin amoxicillin-pot clavulanate... 25, 26 amphotericin b ampicillin ampicillin sodium ampicillin-sulbactam AMPYRA ANACAINE ANADROL anagrelide anastrozole ANDRODERM ANDROGEL androxy animal chews animal shape vitamins animal shapes complete 208, 215 animal shapes plus iron ANORO ELLIPTA antacid anti-gas (ca carb-sim) antacid ultra strength antacid-antigas ii anti-diarrheal anti-diarrheal (loperamide). 149, 150 antifungal (tolnaftate)... 53, 55 antifungal cream anti-gas maximum strength anti-itch (hc) antioxidant antitussive dm apatate forte APOKYN apraclonidine aprepitant... 63, 64 apri APRISO aprodine APTIOM APTIVUS aquanil hc aranelle (28) ARCALYST aripiprazole ARISTADA... 68, 69 armodafinil ARNUITY ELLIPTA ARTIFICIAL TEARS (PETRO/MIN) artificial tears (pf) artificial tears (polyvin alc) artificial tears(dext70-hypro) 138 artificial tears(glycerin-peg). 139 artificial tears(hypromellose) 141 ASACOL HD ascomp with codeine... 3 ascorbic acid (vitamin c) , 219 ashlyna aspirin... 11, 12 aspirin, buffered aspirin-dipyridamole aspir-low ASSURE ID INSULIN SAFETY ASTAGRAF XL atenolol atenolol-chlorthalidone atorvastatin atovaquone atovaquone-proguanil ATRIPLA atropine... 40, 139 I-2

226 ATROVENT HFA AUBAGIO aubra AVASTIN AVC VAGINAL aviane AVONEX AVONEX (WITH ALBUMIN) ayr saline azacitidine azathioprine azathioprine sodium azelastine AZILECT azithromycin... 23, 24 AZOPT AZOR aztreonam azurette (28) B b complete b complex b complex b complex-vitamin b b complex-vitamin c-folic acid , 208, 217 b-100 complex b-12 dots b-50 complex baby vitamin d bacitracin... 19, 130, 142 bacitracin-polymyxin b bacitraycin plus baclofen bal b bal b balance b balance b balanced b , 214 balanced b balanced b , 214 balsalazide balziva (28) banophen banophen allergy BANZEL baza antifungal BCG VACCINE, LIVE (PF) 172 b-complex b-complex with vitamin c , 203, 215, 218, 219 BD INSULIN PEN NEEDLE UF SHORT BD INSULIN SYRINGE ULTRA-FINE bee-zee bekyree (28) BELBUCA... 3 BELEODAQ BELSOMRA benadryl allergy benazepril benazepril-hydrochlorothiazide BENDEKA BENICAR BENICAR HCT BENLYSTA benzonatate benzoyl peroxide benztropine BETADINE beta-hc betamethasone acet,sod phos 162 betamethasone dipropionate. 131 betamethasone valerate betamethasone, augmented BETASERON betaxolol... 92, 183 bethanechol chloride BETHKIS bexarotene BEXSERO bicalutamide bicarsim forte BICILLIN C-R BICILLIN L-A BIDIL bimatoprost bio-dtuss dmx bion tears (pf) bionel pediatric biospec dmx biosupp biotin biovol bisac-evac bisacodyl biscolax bismatrol bisoprolol fumarate bisoprolol-hydrochlorothiazide bleomycin bleph BLINCYTO blisovi 24 fe blisovi fe 1.5/30 (28) blisovi fe 1/20 (28) blis-to-sol (tolnaftate) BOOSTRIX TDAP BOSULIF bp 8 cough BREO ELLIPTA briellyn BRILINTA brimonidine , 184 BRINTELLIX BRIVIACT bromfed dm bromfenac bromocriptine brompheniramine-pseudoephdm , 118 brotapp dm I-3

227 budesonide , 192 bufferin bumetanide BUNAVAIL BUPHENYL buprenorphine hcl... 4, 15 buprenorphine-naloxone buproban bupropion hcl bupropion hcl (smoking deter)16 buspirone butalbital compound w/codeine 4 butalbital-acetaminop-caf-cod. 4 butalbital-acetaminophen... 4 butalbital-acetaminophen-caff. 4 butalbital-aspirin-caffeine... 4 BUTRANS... 4 BYSTOLIC BYVALSON C c complex cabergoline CABOMETYX ca-d3-mag ox-zinc-cop-mangbor , 191 caffeine citrate calci-chew calcidol calcipotriene calcitonin (salmon) calcitrate calcitrate-vitamin d calcitrene calcitriol , 179 calcium d (d3) calcium calcium d(3) 185, 201, 202 calcium 600 with vitamin d3 187 calcium acetate , 158 calcium antacid calcium carbonate , 185 calcium carbonate-vit d3-min , 186 calcium carbonate-vitamin d , 186, 201, 202, 203, 207 CALCIUM CARBONATE- VITAMIN D calcium chloride calcium citrate-vitamin d , 186, 191 calcium gluconate calcium+d CALDOLOR cal-gest antacid CALTRATE D camila camrese camrese lo CANCIDAS candesartan candesartan-hydrochlorothiazid capacet... 4 CAPASTAT CAPRELSA captopril captopril-hydrochlorothiazide 90 CARAFATE CARBAGLU carbamazepine carbidopa carbidopa-levodopa carbidopa-levodopa-entacapone CARIMUNE NF NANOFILTERED carisoprodol carteolol cartia xt carvedilol CASTELLANI PAINT CAYSTON caziant (28) cefaclor cefadroxil cefazolin cefazolin in dextrose (iso-os). 21 cefdinir cefditoren pivoxil cefepime CEFEPIME CEFEPIME IN DEXTROSE 5 % CEFEPIME IN DEXTROSE,ISO-OSM cefotaxime cefoxitin cefoxitin in dextrose, iso-osm 22 cefpodoxime cefprozil ceftazidime ceftibuten ceftriaxone ceftriaxone in dextrose,iso-os. 23 cefuroxime axetil cefuroxime sodium celecoxib CELLCEPT INTRAVENOUS CELONTIN centamin centergy dm central vite with lutein central-vite central-vite for seniors central-vite select , 214 central-vite senior centram-care centravites 50 plus centrum centrum complete centrum silver century , 208 century adults century mature , 207 I-4

228 century ultimate men's century ultimate women's cephalexin CEPROTIN (BLUE BAR) CERDELGA CEREZYME cerovite cerovite advanced formula cerovite jr cerovite senior certavite senior-antioxidant certavite-antioxid (iron gluc) 202 certavite-antioxidant CERVARIX VACCINE (PF) cetirizine cetirizine-pseudoephedrine CETYLEV cevimeline CHANTIX CHANTIX CONTINUING MONTH BOX CHANTIX STARTING MONTH BOX cheratussin ac cheratussin dac chest congestion relief + dm 119 chest congestion relief pe chewable multi vitamin chewable-vite chewable-vite with iron child chest congestion + cough child complete multivitamin 205 child cough and sore throat child mucinex chest congestion child multivitamin plus iron. 203 child plus cough and runnynose child triaminic cold-allergy child triaminic cough-congest child vitamin with minerals child wal-tap cold-allergy child wal-tussin cough relief 118 CHILDREN'S ADVIL children's allegra allergy children's aller-tec children's chest congestion children's chewable children's chewable complete children's chewable vitamin. 203 children's chewable w/minerals CHILDREN'S CLARITIN children's cold-cough daytime children's complete vitamin. 213 children's cough and runnynose children's cough dm er children's mapap... 5 children's mucinex cough children's multivit w/extra c. 206 children's non-aspirin... 4, 5 children's pain reliever children's pain-fever relief... 4, 7 children's pepto children's robitussin er children's silfedrine children's soothe children's sudafed children's sudafed pe cough. 118 children's tactinal... 5 children's wal-fex children's wal-zyr CHILDREN'S ZYRTEC ALLERGY childs chew vite child's chewable vitamins/iron child's vitamin with iron child's vitamin with vitamin c childs/iron chlophedianol-guaifenesin chloramphenicol sod succinate chlordiazepoxide hcl chlorhexidine gluconate chloroquine phosphate chlorothiazide chlorothiazide sodium chlorpheniramine-phenyleph-dm chlorpromazine chlorthalidone chlorzoxazone cholecalciferol (vitamin d3) 204, 219, 220 cholestyramine (with sugar). 101 cholestyramine light ciclopirox cilostazol cimetidine cimetidine hcl CIMZIA CIMZIA POWDER FOR RECONST CINQAIR CINRYZE CIPRODEX ciprofloxacin ciprofloxacin hcl... 27, 28, 142 ciprofloxacin in 5 % dextrose 28 ciprofloxacin lactate citalopram citracal + d maximum citrus calcium clarithromycin CLARITIN LIQUI-GEL CLARITIN REDITABS clearlax I-5

229 CLEVIPREX clindamycin hcl clindamycin in 5 % dextrose.. 19 clindamycin palmitate hcl clindamycin pediatric clindamycin phosphate... 19, 62, 130 CLINIMIX 5%/D15W SULFITE FREE CLINIMIX 5%/D25W SULFITE-FREE CLINIMIX 2.75%/D5W SULFIT FREE CLINIMIX 4.25%/D10W SULF FREE CLINIMIX 4.25%/D5W SULFIT FREE CLINIMIX 4.25%-D20W SULF-FREE CLINIMIX 4.25%-D25W SULF-FREE CLINIMIX 5%- D20W(SULFITE-FREE) CLINIMIX E 2.75%/D10W SUL FREE CLINIMIX E 2.75%/D5W SULF FREE CLINIMIX E 4.25%/D10W SUL FREE CLINIMIX E 4.25%/D25W SUL FREE CLINIMIX E 4.25%/D5W SULF FREE CLINIMIX E 5%/D15W SULFIT FREE CLINIMIX E 5%/D20W SULFIT FREE CLINIMIX E 5%/D25W SULFIT FREE CLINISOL SF 15 % clobetasol clobetasol-emollient clocortolone pivalate clomipramine clonazepam clonidine clonidine hcl... 88, 105 clopidogrel clorazepate dipotassium clorpres clotrimazole clotrimazole clotrimazole-betamethasone clozapine COARTEM codeine sulfate... 5 codituss dm COLCRYS cold and cough (diphenhydr-pe) cold and cough (pe-dm) cold multi-symptom day/night cold multi-symptom nighttime cold relief m/s day/night cold-allergy-sinus cold-flu relief cold-flu relief, day/night colestipol colistin (colistimethate na) colocort COLY-MYCIN S COMBIGAN COMBIPATCH COMBIVENT RESPIMAT. 194 COMETRIQ comfort gel comfort gel extra strength compete COMPLERA complete complete complete multi complete multi complete multivitamin. 203, 205 complete multivitamin-mineral , 215 complete senior , 215 complete women compoz compro COMVAX (PF) CONDYLOX congestac congest-eze constulose COPAXONE coricidin hbp coricidin hbp cold-multi sympt CORLANOR cormax cortaid cortisone cortizone COSENTYX COSENTYX (2 SYRINGES) COSENTYX PEN COSENTYX PEN (2 PENS) 127 COTELLIC cough and cold cough and runny nose cough relief CREON critic-aid clear af CRIXIVAN cromolyn , 149, 195 cryselle (28) CUBICIN CUPRIMINE cutter backwoods cutter skinsations cyanocobalamin (vitamin b-12) , 204, 214, 218, 219 I-6

230 cyclafem 1/35 (28) cyclafem 7/7/7 (28) cyclobenzaprine cyclopentolate cyclophosphamide CYCLOPHOSPHAMIDE CYCLOSET cyclosporine cyclosporine modified cyproheptadine CYRAMZA cyred CYSTADANE CYSTARAN D d10 %-0.45 % sodium chloride d2.5 %-0.45 % sodium chloride d3 dots d5 % and 0.9 % sodium chloride d5 %-0.45 % sodium chloride daily gummies daily multiple , 205 daily multi-vitamin daily multivitamin with iron 205 daily multi-vitamins/iron daily value daily vitamin formula daily vitamin formula-iron daily vitamin formula-minerals daily vitamin with iron daily vites/iron dailyhist daily-vite DAKLINZA DALIRESP danazol dantrolene dapsone DAPTACEL (DTAP PEDIATRIC) (PF) daptomycin DARAPRIM DARZALEX dasetta 1/35 (28) dasetta 7/7/7 (28) dayhist allergy daysee daytime cold and cough daytime cold-flu daytime cold-flu relief (pe) day-time cough daytime-nighttime daytime-nighttime cold-flu daytime-nighttime cough deblitane decitabine decongestant cough deep sea nasal deferoxamine delsym cough-chest congest dm delta d delyla (28) DELZICOL DEMSER DEPEN TITRATABS DEPO-PROVERA dermafungal dermarest eczema (hydrocort) DESCOVY desipramine... 45, 46 desmopressin desog-e.estradiol/e.estradiol. 110 desogestrel-ethinyl estradiol 110 desonide desoximetasone despec-dm (pseudoeph-dmguaif) desvenlafaxine succinate dex4 glucose dexamethasone dexamethasone sodium phosphate , 162 dexmethylphenidate dextroamphetamine dextroamphetamineamphetamine dextromethorphan polistirex 120 dextrose 10 % and 0.2 % nacl dextrose 10 % in water (d10w) dextrose 20 % in water (d20w) dextrose 25 % in water (d25w) dextrose 40 % in water (d40w) dextrose 5 % in ringers dextrose 5 % in water (d5w).. 86 dextrose 5 %-lactated ringers186 dextrose 5%-0.2 % sod chloride dextrose 5%-0.3 % sod.chloride dextrose 50 % in water (d50w) dextrose 70 % in water (d70w) dextrose with sodium chloride dextrose-kcl-nacl diabetic tussin dm diabetic tussin ex diamode diazepam... 17, 18 diazepam intensol diclofenac potassium diclofenac sodium.. 12, 128, 145 diclofenac-misoprostol I-7

231 dicloxacillin dicyclomine didanosine DIFICID diflunisal digitek... 95, 96 digoxin DIGOXIN dihydroergotamine DILANTIN diltiazem hcl... 94, 95 dilt-xr dimaphen (pe) dimenhydrinate dimetapp cold-congestion DIMETAPP LONG-ACTING (CPM-DM) dino-life dino-life with extra c dino-life with iron-zinc DIPENTUM diphenhist diphenhydramine hcl diphenoxylate-atropine dipyridamole disopyramide phosphate disulfiram divalproex dobutamine dobutamine in d5w doc-q-lace docu docusate sodium docusol dofetilide dok , 155 donepezil dopamine dopamine in 5 % dextrose dorzolamide dorzolamide-timolol douche vinegar and water extra doxazosin doxepin doxercalciferol doxorubicin doxorubicin, peg-liposomal doxy doxycycline hyclate doxycycline monohydrate dramamine dramamine less drowsy driminate dristan long lasting dronabinol droperidol drospirenone-ethinyl estradiol DROXIA DUAVEE dulcolax stool softener (dss) 155 DULERA duloxetine DUREZOL dutasteride dutasteride-tamsulosin d-vi-sol DYRENIUM E e.c. prin e.e.s e.e.s. granules econazole econtra ez ecotrin ed a-hist ed bron gp ed chlorped jr EDURANT effer-k EFFIENT ELAPRASE eldertonic electrolyte-48 in d5w ELIDEL ELIGARD ELIGARD (3 MONTH) ELIGARD (4 MONTH) ELIGARD (6 MONTH) elinest eliphos ELIQUIS ELITEK ELLA ellis tonic ELMIRON EMCYT EMEND EMFLAZA , 163 emoquette EMPLICITI EMSAM EMTRIVA enalapril maleate enalaprilat enalapril-hydrochlorothiazide 90 ENBREL ENBREL SURECLICK endocet... 5 endodan... 5 endur-acin enema , 157 enema disposable , 155 enemeez enemeez plus ENGERIX-B (PF) ENGERIX-B PEDIATRIC (PF) enoxaparin... 79, 80 enpresse enskyce entacapone entecavir entre-cough I-8

232 ENTRESTO enulose ENVARSUS XR EPCLUSA epinastine epinephrine epinephrine hcl (pf) EPIPEN EPIPEN 2-PAK EPIPEN JR 2-PAK epitol EPIVIR HBV eplerenone EPOGEN epoprostenol (glycine) EPZICOM eq gentle equalactin ergocalciferol (vitamin d2). 206, 218 ergoloid ERGOMAR ERIVEDGE errin ery pads ery-tab ERY-TAB ERYTHROCIN erythrocin (as stearate) erythromycin... 25, 143 erythromycin ethylsuccinate.. 24 erythromycin with ethanol ESBRIET escitalopram oxalate esmolol esomeprazole sodium essentia essential balance with lutein 206 essential daily estarylla ESTRACE estradiol estradiol valerate estradiol-norethindrone acet. 161 estropipate eszopiclone ethambutol ethosuximide ethynodiol diac-eth estradiol 111 etodolac ETOPOPHOS etoposide EUCRISA evac-u-gen (sennosides) EVOTAZ exemestane EXJADE EXONDYS expectorant expectorant dm expectorant max strength EXTAVIA extra cleansing douche eye health plus lutein F FABRAZYME fallback solo falmina (28) famciclovir famotidine , 148 famotidine (pf) famotidine (pf)-nacl (iso-os) 147 FANAPT FARESTON FARYDAK FASLODEX felbamate felodipine feminine care douche FEMRING femynor fenofibrate , 102 fenofibrate micronized fenofibrate nanocrystallized. 101 fenofibric acid fenofibric acid (choline) fenoprofen fentanyl... 5 fentanyl citrate... 5 feosol ferocon ferretts ferrex ferrex 150 plus ferric x FERRIPROX ferrocite ferrous fumarate ferrous gluconate , 208 ferrous sulfate , 207 FETZIMA feverall... 5 fexofenadine fiber (calcium polycarbophil) fiber laxative (methylcellulo)157 fiber smooth fiber therapy (m-cell/sugar) fiber therapy (m-cellulose) fiber therapy (psyllium/sugar) fiber therapy sugar free fiber-lax finasteride FIRAZYR flavor chews antacid FLEBOGAMMA DIF flecainide FLECTOR FLEET BISACODYL flintstones complete (iron) flintstones multivitamin flintstones with iron flintstones/extra c FLOVENT DISKUS FLOVENT HFA I-9

233 floxuridine flu formula daytime-nighttime flu hbp flu relief therapy daytime flu severe cold-congestion flucaine fluconazole fluconazole in nacl (iso-osm). 54 flucytosine fludrocortisone flumazenil flunisolide fluocinonide fluocinonide-e fluorometholone fluorouracil... 33, 128 fluoxetine fluphenazine decanoate fluphenazine hcl flurbiprofen flurbiprofen sodium flutamide fluticasone , 145 fluvoxamine... 46, 47 foaming antacid , 153 folic acid fomepizole fondaparinux foot odor control FORTEO FORTICAL foscarnet fosfree fosinopril fosinopril-hydrochlorothiazide fosphenytoin FREAMINE HBC 6.9 % FREAMINE III 10 % fungi cure fungoid-d furosemide FUSILEV FUZEON FYCOMPA G gabapentin GABITRIL galantamine GAMASTAN S/D GAMMAGARD LIQUID GAMMAGARD S-D (IGA < 1 MCG/ML) GAMMAPLEX (WITH SORBITOL) ganciclovir sodium GARDASIL (PF) , 174 GARDASIL 9 (PF) gas relief gas relief gas relief extra strength gas-x ultra-strength gatifloxacin GATTEX 30-VIAL GATTEX ONE-VIAL GAUZE PAD gavilyte-c gavilyte-g gavilyte-n GAZYVA gelusil antacid and anti-gas gemfibrozil generlac gengraf GENOTROPIN GENOTROPIN MINIQUICK gentak gentamicin... 18, 130, 143 gentamicin in nacl (iso-osm).. 18 gentamicin sulfate (ped) (pf).. 18 gentamicin sulfate (pf) GENTEAL GEL GENTEAL MILD GENTEAL SEVERE genteal tears GENTEAL TEARS (DXTRN- HPM-GLY) GENTEAL TEARS (PF) gentlelax GENVOYA GEODON geravim geriaton geri-hydrolac geri-lanta geri-tussin dm gianvi (28) gildagia gildess 1.5/30 (21) gildess 1/20 (21) gildess 24 fe gildess fe 1.5/30 (28) gildess fe 1/20 (28) GILENYA GILOTRIF GLEOSTINE glimepiride glipizide glipizide-metformin GLUCAGEN HYPOKIT GLUCAGON EMERGENCY KIT (HUMAN) gluco burst glucose glucose gel glutose glyburide glyburide micronized glyburide-metformin glycolax glycopyrrolate glydo GLYXAMBI granisetron (pf) I-10

234 granisetron hcl GRANIX griseofulvin microsize guaifenesin guanfacine... 88, 106 guanidine gummi bear multivitamin , 213 gummy swirls H hair vitamins hair,skin and nails , 217 halobetasol propionate haloperidol haloperidol decanoate haloperidol lactate HARVONI HAVRIX (PF) head congestion day-night healthylax heather hemocyte heparin (porcine) heparin (porcine) in 5 % dex.. 80 heparin(porcine) in 0.45% nacl heparin, porcine (pf) HEPATAMINE 8% HERCEPTIN HETLIOZ HEXALEN hi-b complex HIBERIX (PF) hi-cal plus vit d homatropaire homatropine hbr honey bears honey bears with iron-zinc HUMATROPE HUMIRA HUMIRA PEDIATRIC CROHN'S START HUMIRA PEN HUMIRA PEN CROHN'S-UC- HS START HUMIRA PEN PSORIASIS- UVEITIS HUMULIN R U-500 (CONC) KWIKPEN HUMULIN R U-500 (CONCENTRATED) hydralazine hydrochlorothiazide hydrocil instant hydrocodone-acetaminophen... 6 hydrocodone-chlorpheniramine hydrocodone-homatropine hydrocodone-ibuprofen... 6 hydrocortisone , 134, 163, 178 hydrocortisone acetate hydrocortisone butyrate hydrocortisone butyr-emollient hydrocortisone valerate hydromet hydromorphone... 6 hydromorphone (pf)... 6 hydroskin hydroxychloroquine hydroxyprogesterone caproate hydroxyurea hydroxyzine hcl hydroxyzine pamoate HYPERRAB S/D (PF) HYQVIA HYQVIA IG COMPONENT HYSINGLA ER... 7 I ibandronate , 180 IBRANCE ibuprofen... 12, 13, 14 ibuprofen jr strength icaps plus ICLUSIG iferex ifosfamide ifosfamide-mesna ILARIS (PF) ILEVRO imatinib IMBRUVICA imipenem-cilastatin imipramine hcl imipramine pamoate imiquimod IMLYGIC imodium a-d IMOGAM RABIES-HT (PF) IMOVAX RABIES VACCINE (PF) INCRELEX INCRUSE ELLIPTA indapamide indomethacin indomethacin sodium INFANRIX (DTAP) (PF) infant's advil infant's ibuprofen infants' non-aspirin cold infant's pain reliever... 7 INFLECTRA INLYTA INSECT REPELLENT (PICARIDIN) insta-glucose INSULIN SYRINGE-NEEDLE U INTELENCE INTRALIPID INTRON A introvale I-11

235 INVANZ INVEGA SUSTENNA INVEGA TRINZA... 70, 71 INVIRASE INVOKAMET INVOKAMET XR INVOKANA inzo antifungal iodine IONOSOL-B IN D5W IONOSOL-MB IN D5W IPOL ipratropium bromide , 194 IPRIVASK irbesartan irbesartan-hydrochlorothiazide IRESSA iron high potency ISENTRESS ISOLYTE-P IN 5 % DEXTROSE ISOLYTE-S isoniazid isopto tears isosorbide dinitrate isosorbide mononitrate isradipine itraconazole ivermectin IXEMPRA IXIARO (PF) J JAKAFI jantoven JANUMET JANUMET XR JANUVIA JARDIANCE jencycla JENTADUETO JENTADUETO XR jolessa jolivette juleber junel 1.5/30 (21) junel 1/20 (21) junel fe 1.5/30 (28) junel fe 1/20 (28) junel fe junior mapap... 7 JUXTAPID K KABIVEN KALETRA KALYDECO KANUMA kaopectate (bismuth subsalicy) kariva (28) kelnor 1/35 (28) ketoconazole ketoprofen... 13, 14 ketorolac... 14, 145 KEVEYIS KEYTRUDA kidkare cough/cold kids mini enema kids multivitamin complete kid's vitamins kid's vitamins + extra c kids vitamins + iron kid's vitamins + iron kids vitamins complete kimidess (28) KINERET KINRIX (PF) , 175 kionex kionex (with sorbitol) KISQALI KLOR-CON klor-con m klor-con m klor-con m klor-con sprinkle kobee konsyl (sugar) konsyl fiber KONSYL SUGAR-FREE KORLYM kpn KRYSTEXXA kurvelo KUVAN KYNAMRO KYPROLIS L l norgest/e.estradiol-e.estrad. 112 labetalol LACRISERT LACTATED RINGERS LACTINOL HX lactulose LAMISIL (AEROSOL) lamisil af LAMISIL AT lamivudine lamivudine-zidovudine lamotrigine... 41, 42 LANOXIN lansoprazole LANTUS LANTUS SOLOSTAR larin 1.5/30 (21) larin 1/20 (21) larin 24 fe larin fe 1.5/30 (28) larin fe 1/20 (28) larissia LARTRUVO latanoprost LATUDA laxative peg LAZANDA... 7 leena leflunomide I-12

236 LEMTRADA LENVIMA lessina LETAIRIS letrozole leucovorin calcium LEUKERAN LEUKINE leuprolide levetiracetam levobunolol levocarnitine levocarnitine (with sugar) levocetirizine levofloxacin... 28, 143 levofloxacin in d5w levoleucovorin LEVOLEUCOVORIN levonest (28) levonorgestrel levonorgestrel-ethinyl estrad112, 113 levonorg-eth estrad triphasic 113 levora levothyroxine LEXIVA LIALDA lice cream rinse lice killing lice treatment lice treatment (permethrin) lidocaine lidocaine (pf)... 15, 91 lidocaine hcl lidocaine in 5 % dextrose (pf) 91 lidocaine viscous lidocaine-prilocaine life-pack women's linezolid LINZESS liothyronine liquibid d-r liquid calcium with vitamin d lisinopril lisinopril-hydrochlorothiazide 90 lithium carbonate lithium citrate little animals little animals-iron little remedies LIVALO lobana bath lohist-dm lomedia 24 fe LONSURF loperamide , 151 lopinavir-ritonavir loratadine... 57, 59 loratadine-d... 58, 59 lorazepam lorcet (hydrocodone)... 7 lorcet hd... 7 lorcet plus... 7 lortuss ex loryna (28) losartan losartan-hydrochlorothiazide. 89 LOTEMAX lovastatin low-ogestrel (28) loxapine succinate lubricant dry eye relief lubricant eye lubricant eye (cmc-glycer)(pf) lubricant eye (cmc-glycerin) 140 lubricant eye (pg-peg 400) lubricant eye (polyv alcohol) 141 lubricant eye (propyl glycol) 139 lubricant gel lubricating drops lubricating plus lubrifresh pm LUMIGAN LUPRON DEPOT LUPRON DEPOT (3 MONTH) LUPRON DEPOT (4 MONTH) LUPRON DEPOT (6 MONTH) LUPRON DEPOT-PED LUPRON DEPOT-PED (3 MONTH) lutera (28) LYNPARZA LYRICA lysiplex plus LYSODREN lyza M maalox advanced MACUVITE EYE CARE mag mag-delay mag-g magnebind magnesium , 188, 191 magnesium (oxide/aa chelate) magnesium gluconate magnesium oxide , 152 magnesium sulfate magnesium sulfate in d5w magnesium sulfate in water malathion mapap (acetaminophen)... 7 mapap arthritis pain... 7 mapap extra strength... 7 maprotiline mar-cof bp mar-cof cg margesic... 7 marlissa MARPLAN I-13

237 masanti double strength MATULANE matzim la maximum daily multivitamin meclizine medi-meclizine medroxyprogesterone mefenamic acid mefloquine MEFOXIN IN DEXTROSE (ISO-OSM) mega multiple/chelated mineral mega multivitamin with mineral megestrol... 35, 166 MEKINIST... 35, 36 meloxicam memantine MENACTRA (PF) MENEST MENHIBRIX (PF) MENOMUNE - A/C/Y/W MENOMUNE - A/C/Y/W-135 (PF) men's daily gummies men's multi-vitamin men's multivitamin gummies 209 men's one daily , 206 MENVEO A-C-Y-W-135-DIP (PF) MEPHYTON mercaptopurine meropenem mesalamine mesna MESNEX MESTINON metaproterenol metaxall metaxalone metformin... 49, 50 methadone... 8 methadose... 8 methazolamide methenamine hippurate methimazole methocarbamol methotrexate sodium methotrexate sodium (pf) methoxsalen methscopolamine methyclothiazide methylphenidate methylprednisolone methylprednisolone acetate methylprednisolone sodium succ metipranolol metoclopramide hcl metolazone metoprolol succinate metoprolol ta-hydrochlorothiaz metoprolol tartrate metronidazole... 20, 62, 130 metronidazole in nacl (iso-os) 20 mexiletine mgo MIACALCIN mi-acid mi-acid gas relief micatin miconazole miconazole nitrate miconazole , 55 microgestin 1.5/30 (21) microgestin 1/20 (21) microgestin fe 1.5/30 (28) microgestin fe 1/20 (28) midodrine miglitol milk of magnesia milltrium senior milrinone milrinone in 5 % dextrose mimvey mimvey lo mineral oil MINERAL OIL mineral oil laxative minitran minocycline minoxidil mintox mintox maximum strength mintox plus MIRCERA mirtazapine misoprostol mitoxantrone M-M-R II (PF) moexipril moexipril-hydrochlorothiazide molindone mometasone MONISTAT monistat mono-linyah mononessa (28) montelukast morphine... 8 MORPHINE... 8 morphine concentrate... 8 motion sickness motion sickness relief(mecliz)... 64, 65 MOVANTIK MOVIPREP MOXEZA moxifloxacin MOZOBIL I-14

238 MUCINEX FAST-MAX COLD-FLU-THRT mucinex fast-max dm max mucinex sinus-max mucus dm mucus dm max mucus relief , 123 MULTAQ multi complete with iron multi for her multi-day with iron multi-delyn multi-delyn with iron multilex multilex-t and m multiple vitamin-minerals multiple vitamins multiple vitamins with iron multi-symptom cold night time multivital multivital platinum multivitamin , 216 multivitamin 50 plus multi-vitamin hp/minerals multi-vitamin with fluoride multivitamin with iron. 209, 216 multivitamin with minerals. 209, 210 multi-vite multi-vite 50 and over mupirocin mupirocin calcium muro my favorite multiple my way mycophenolate mofetil mycophenolate mofetil hcl mycophenolate sodium MYOZYME MYRBETRIQ mytab gas mytab gas maximum strength my-vitalife myzilra N nabumetone nadolol nafcillin... 26, 27 NAGLAZYME naloxone naltrexone NAMENDA XR... 44, 45 NAMZARIC naphazoline naproxen naproxen sodium naratriptan NARCAN nasal and sinus decongestant 122 nasal spray (oxymetazoline). 139 NASCOBAL NATACYN nateglinide NATPARA NATRAPEL natural b natural b-100 complex natural balance natural balance tears natural calcium natural fiber laxative therapy 156 natura-lax nature's tears (hypromellose) 141 NEBUPENT necon 0.5/35 (28) necon 1/35 (28) necon 1/50 (28) necon 10/11 (28) necon 7/7/7 (28) nefazodone NEO DM neomycin neomycin-bacitracin-poly-hc 143 neomycin-bacitracin-polymyxin neomycin-polymyxin b gu neomycin-polymyxin b- dexameth neomycin-polymyxingramicidin neomycin-polymyxin-hc , 144 neo-polycin neo-polycin hc neosporin (neo-bac-polym) neosporin anti-itch neo-synephrine 12 h spr (oxym) neo-tuss nephplex rx NEPHRAMINE 5.4 % nephron fa nephro-vite rx NEULASTA NEUPOGEN NEUPRO NEVANAC nevirapine NEXAVAR next choice one dose niacin niacinamide , 210 niacor nicardipine nicorelief NICORETTE nicotine... 16, 17 nicotine (polacrilex)... 16, 17 NICOTROL nifedical xl nifedipine night time night time cold medicine night time cold-flu I-15

239 night time cold-flu relief night time cough-sore throat 122 nighttime cough nikki (28) NILANDRON nilutamide NINLARO NITRO-BID nitrofurantoin macrocrystal nitrofurantoin monohyd/m-cryst nitroglycerin , 105 nitroglycerin in 5 % dextrose 104 NITROSTAT NIX CREME RINSE nohist-dm non-aspirin cold non-aspirin extra strength.. 9, 10 non-aspirin flu non-aspirin jr strength... 5 nora-be NORDITROPIN FLEXPRO 165 norepinephrine bitartrate norethindrone (contraceptive) norethindrone acetate norethindrone ac-eth estradiol norethindrone-e.estradiol-iron norgestimate-ethinyl estradiol norlyroc NORMOSOL-M IN 5 % DEXTROSE NORMOSOL-R NORMOSOL-R PH nortemp... 9 NORTHERA nortrel 0.5/35 (28) nortrel 1/35 (21) nortrel 1/35 (28) nortrel 7/7/7 (28) nortriptyline NORVIR NOVOLIN 70/ NOVOLIN N NOVOLIN R NOVOLOG NOVOLOG FLEXPEN NOVOLOG MIX NOVOLOG MIX FLEXPEN NOVOLOG PENFILL NOXAFIL NUCALA NUCYNTA... 9 NUCYNTA ER... 9 NUEDEXTA nu-iron NULOJIX nu-mag NUPLAZID NUTRESTORE NUTRILIPID NUTROPIN AQ NUTROPIN AQ NUSPIN NUVARING nyamyc nyata nystatin nystatin-triamcinolone nystop nyt-time sleep O OCALIVA ocean nasal ocella OCTAGAM octreotide acetate ocutabs ODEFSEY ODOMZO OFEV off active off deep woods off deep woods dry off familycare (with deet) ofloxacin... 28, 144 ogestrel (28) olanzapine olanzapine-fluoxetine olmesartan olmesartan-amlodipin-hcthiazid olmesartan-hydrochlorothiazide olopatadine OLYSIO omeprazole omeprazole magnesium OMNITROPE ONCASPAR once daily oncovite ondansetron ondansetron hcl ondansetron hcl (pf) one daily , 214 one daily 50 plus one daily complete one daily energy one daily essential 206, 208, 210 one daily for women one daily gummy vites one daily maximum , 214 one daily maximum (with ca) one daily multi-vit w-mineral one daily multivitamin. 210, 211 one daily multivit-iron(folic) 211 one daily plus iron 208, 211, 214 one daily plus minerals one daily with iron , 211 one-a-day essential I-16

240 one-a-day maximum formula211 one-a-day men's multivitamin one-a-day teen advantage ONFI ONIVYDE opcicon one-step OPDIVO OPSUMIT option oral saline laxative oralone oralyte ORENCIA ORENCIA (WITH MALTOSE) ORENCIA CLICKJECT ORENITRAM ORFADIN ORKAMBI orsythia oseltamivir OTEZLA OTEZLA STARTER OTOVEL OTREXUP (PF) oxacillin oxacillin in dextrose(iso-osm) 27 oxandrolone oxcarbazepine OXTELLAR XR oxybutynin chloride oxycodone... 9 oxycodone-acetaminophen... 9 oxycodone-aspirin... 9 OXYCONTIN oxymorphone oysco 500/d oysco d oysco oyster shell calcium oyster shell calcium-vit d , 191 oyster shell calcium-vit d oystercal-d P pacerone pain relief... 5, 10 pain relief adult... 5 pain reliever jr strength paliperidone PANRETIN pantoprazole paricalcitol paromomycin paroxetine hcl PASER PATADAY PAXIL pecgen dmx pedia relief pedia relief infant pediacare multi-symptom cold PEDIARIX (PF) pediatric electrolyte , 189, 191 pediatric freezer pops pediatric multivitamin.. 209, 215 PEDVAX HIB (PF) peg 3350-electrolytes PEGANONE PEGASYS PEGASYS PROCLICK peg-electrolyte soln PEGINTRON PEN NEEDLE, DIABETIC. 136 penicillin g pot in dextrose penicillin g potassium penicillin g procaine penicillin v potassium PENTACEL (PF) PENTAM pentoxifylline pep-t-med peri-colace PERIKABIVEN perindopril erbumine periogard permethrin perphenazine perphenazine-amitriptyline perry prenatal persa-gel pfizerpen-g pharbetol pharmacist favorite multi-vit 211 phenadoz phenelzine phenobarbital phenylephrine hcl... 88, 141 phenylhistine dh phenytoin... 42, 43 phenytoin sodium phenytoin sodium extended philith phillips phillips' liqui-gels PHOSLYRA phosphate laxative PHOSPHOLINE IODIDE phytonadione (vitamin k1).. 211, 220 PICATO pilocarpine hcl , 184 pimozide pimtrea (28) pindolol pink bismuth pioglitazone pioglitazone-glimepiride pioglitazone-metformin piperacillin-tazobactam pirmella piroxicam I-17

241 PLASMA-LYTE PLASMA-LYTE A PLASMA-LYTE-56 IN 5 % DEXTROSE PLEGRIDY pnv cmb#95-ferrous fumarate-fa podofilox polyethylene glycol poly-iron polymyxin b sulfate polymyxin b sulf-trimethoprim poly-vita poly-vita (iron) poly-vitamin poly-vitamin with iron polyvitamin/iron poly-vitamins POMALYST portia PORTRAZZA potassium acetate potassium chlorid-d5-0.45%nacl potassium chloride , 190 potassium chloride in 0.9%nacl potassium chloride in 5 % dex potassium chloride in lr-d potassium chloride-0.45 % nacl potassium chloride-d5-0.2%nacl potassium chloride-d5-0.3%nacl potassium chloride-d5-0.9%nacl potassium citrate potassium citrate-citric acid. 190 potassium hydroxide POTIGA PRADAXA PRALUENT PEN PRALUENT SYRINGE pramipexole pravastatin prazosin prednicarbate prednisolone acetate prednisolone sodium phosphate , 163 prednisone PREMARIN PREMASOL 10 % PREMASOL 6 % PREMPHASE PREMPRO prenatal , 212, 216 prenatal formula , 213 prenatal plus (calcium carb). 212 prenatal tablet prenatal vit#96-ferrous fum-fa prenatal vitamin , 206, 212 prenatal vitamin plus low iron prenatal vit-iron fumarate-fa 212 preparation h hydrocortisone 134 PREVAIL BLADDER CONTROL PAD prevalite previfem PREZCOBIX PREZISTA PRIFTIN PRILOSEC OTC PRIMAQUINE primidone PRISTIQ PRIVIGEN PROAIR HFA PROAIR RESPICLICK probenecid probenecid-colchicine procainamide PROCALAMINE 3% prochlorperazine prochlorperazine edisylate prochlorperazine maleate PROCRIT procto-med hc procto-pak proctosol hc proctozone-hc PROCYSBI progesterone in oil progesterone micronized PROGLYCEM PROGRAF PROLASTIN-C PROLENSA PROLEUKIN PROLIA PROMACTA promethazine... 60, 65 promethazine vc-codeine promethazine-codeine promethazine-dm promethegan promolaxin propafenone propantheline proparacaine propranolol propranolol-hydrochlorothiazid propylthiouracil PROQUAD (PF) prosight PROSOL 20 % protamine protriptyline pseudoephedrine hcl PULMOZYME I-18

242 pure and gentle eye purelax PURIXAN pyrazinamide pyridostigmine bromide pyridoxine (vitamin b6) Q QBRELIS q-dryl q-pap q-pap extra strength q-tussin q-tussin dm QUADRACEL (PF) quasense quetiapine quinapril quinapril-hydrochlorothiazide 91 quinidine gluconate quinidine sulfate quinine sulfate QVAR R RABAVERT (PF) raloxifene ramipril RANEXA ranitidine hcl RAPAMUNE rasagiline RASUVO (PF) RAVICTI RAYALDEE react REBIF (WITH ALBUMIN) 107 REBIF REBIDOSE REBIF TITRATION PACK 108 reclipsen (28) RECOMBIVAX HB (PF) recort plus refenesen refenesen pe REFRESH CELLUVISC REFRESH CLASSIC (PF) REFRESH LACRI-LUBE REFRESH OPTIVE ADVANCED reguloid relcof c RELENZA DISKHALER RELISTOR remedy phytoplex antifungal. 56 REMICADE REMODULIN RENAGEL rena-vite rx RENVELA repaglinide repaglinide-metformin REPATHA PUSHTRONEX 103 REPATHA SURECLICK REPATHA SYRINGE repel sportsmen repel sportsmen max reprexain RESCRIPTOR RESTASIS RESTASIS MULTIDOSE retaine cmc retaine hpmc retaine pm RETROVIR revive plus REVLIMID revonto REXULTI... 71, 72 REYATAZ REZIRA ribasphere ribavirin RIDAURA rifabutin rifampin RIFATER ri-gel ii right step prenatal vitamins riginic riluzole rimantadine ri-mox ringers , 191 risedronate RISPERDAL CONSTA risperidone RITUXAN rivastigmine rivastigmine tartrate rizatriptan robafen robafen cough robafen dm robitussin cough-chest cong dm ROBITUSSIN LONG-ACTING robitussin pediatric ropinirole rosadan rosuvastatin ROTARIX ROTATEQ VACCINE ROWEEPRA ROZEREM RUBRACA rydex rynex dm S SABRIL safe tussin dm SAIZEN SAIZEN CLICK.EASY saline nose SANDOSTATIN LAR DEPOT SANTYL I-19

243 SAPHRIS (BLACK CHERRY) SAVELLA scooby-doo one a day scot-tussin dm scot-tussin expectorant sea soft nasal mist selegiline hcl selenium sulfide SELZENTRY senexon senior tabs senna senna lax senna with docusate sodium. 154 senokot-s SENSIPAR sentry sentry (with lutein) sentry senior SEREVENT DISKUS SEROQUEL XR SEROSTIM sertraline setlakin sharobel SIGNIFOR silace siladryl sa sildenafil SILENOR SILIQ siltussin sa silver nitrate silver sulfadiazine SIMBRINZA simethicone simply sleep SIMPONI , 172 SIMPONI ARIA simvastatin sinus and allergy(pseudoephed) sirolimus SIRTURO skin treatment sleep aid (diphenhydramine).. 60 sleep aid (doxylamine) smoflipid smoothlax sochlor sodium acetate sodium bicarbonate , 191 sodium chloride , 178, 191, 196 sodium chloride 0.45 % sodium chloride 0.9 % sodium chloride 3 % sodium chloride 5 % sodium fluoride sodium lactate sodium phosphate sodium polystyrene (sorb free) sodium polystyrene sulfonate SOLTAMOX SOLU-CORTEF (PF) SOMATULINE DEPOT SOMAVERT soothe (bismuth subsalicylate) soothe night time lubricant soothe regular strength sorbitol sorbitol-mannitol sorine sotalol sotalol af SOVALDI spectravite adult spectravite adult spectravite advanced formula spectravite senior spectravite senior w-lycopene spectravite ultra men's sr spectravite ultra women SPIRIVA RESPIMAT SPIRIVA WITH HANDIHALER spironolactone spironolacton-hydrochlorothiaz sprintec (28) SPRITAM SPRYCEL sps (with sorbitol) sronyx ssd st joseph aspirin st. joseph aspirin stavudine STELARA STERILE GAUZE PAD STIOLTO RESPIMAT STIVARGA stomach relief stool softener STRATTERA STRENSIQ streptomycin stress stress 500 plus zinc stress b with zinc stress b-biotin stress formula stress formula 600 c stress formula plus iron stress formula with iron stress formula with iron(sulf)216 stress formula with zinc STRIBILD I-20

244 STRIVERDI RESPIMAT SUBOXONE sucralfate sudafed sudogest sudogest sinus and allergy sulfacetamide sodium sulfacetamide sodium (acne) 131 sulfacetamide-prednisolone. 144 sulfadiazine sulfamethoxazole-trimethoprim sulfasalazine sulfatrim sulindac sumatriptan sumatriptan succinate summer's eve disposable douche summers eve extra cleansing 183 sunvite super b complex-vitamin c.. 204, 216 super b maxi complex super b/c super b-50 complex super b-50 complex plus super multiple super multivitamin super quints super quints b super thera vite m superior superplex-t suphedrin suphedrine pe day-night suphedrine severe cold max str support support SUPPRELIN LA SUPRAX SUPREP BOWEL PREP KIT SURMONTIL SUSTIVA SUTENT syeda SYLATRON SYLVANT SYMBICORT SYMLINPEN SYMLINPEN SYNAGIS SYNAREL SYNERCID SYNJARDY SYNRIBO SYPRINE SYSTANE GEL T tab-a-vite tab-a-vite/iron tab-a-vite-minerals TABLOID tacrolimus , 172 tactinal tactinal extra strength TAFINLAR TAGRISSO TALTZ AUTOINJECTOR TALTZ AUTOINJECTOR (3 PACK) TALTZ SYRINGE TAMIFLU tamoxifen tamsulosin TARCEVA TARGRETIN... 37, 38 tarina fe 1/20 (28) TASIGNA tazicef TAZORAC taztia xt tears again tears again (pva) tears naturale free (pf) TECENTRIQ TECFIDERA TECHNIVIE TEFLARO TEKAMLO TEKTURNA TEKTURNA HCT telmisartan telmisartan-hydrochlorothiazid TEMODAR tencon TENIVAC (PF) terazosin terbinafine hcl terbutaline terconazole testosterone testosterone cypionate testosterone enanthate TETANUS,DIPHTHERIA TOX PED(PF) TETANUS-DIPHTHERIA TOXOIDS-TD tetrabenazine tetracycline THALOMID the magic bullet theophylline theophylline in dextrose 5 % 195 thera m plus (ferrous fumarat) thera vitamin thera-d theradex m thera-m therapeutic liquid therapeutic m + beta-carotene I-21

245 therapeutic-m therapeutic-m vitamin/minerals , 217 thera-tabs theratrum complete 50 plus theratrum complete with lutein therems THIOLA thioridazine thiotepa thiothixene tiagabine TICE BCG tigecycline tilia fe timolol maleate... 94, 184 TIVICAY tizanidine TOBI PODHALER TOBRADEX TOBRADEX ST tobramycin tobramycin in % nacl tobramycin in 0.9 % nacl tobramycin sulfate tobramycin-dexamethasone. 144 TOLAK tolazamide tolbutamide tolmetin tolnaftate tolterodine topiramate toposar torsemide total b/c totalday multiple TOUJEO SOLOSTAR TOVIAZ TPN ELECTROLYTES TPN ELECTROLYTES II TRACLEER TRADJENTA tramadol tramadol-acetaminophen trandolapril tranexamic acid TRANSDERM-SCOP tranylcypromine TRAVASOL 10 % TRAVATAN Z travel sickness (meclizine) travoprost (benzalkonium) trazodone TREANDA TRECATOR TRELSTAR tretinoin tretinoin (chemotherapy) tretinoin microspheres TREXALL triacting m-sym cold/cough. 125 triamcinolone acetonide , 134, 163 triaminic cold and cough (pe) triamterene-hydrochlorothiazid trianex TRIBENZOR tri-buffered aspirin tridesilon tri-estarylla trifluoperazine trifluridine trihexyphenidyl tri-legest fe tri-linyah tri-lo-estarylla tri-lo-marzia tri-lo-sprintec trilyte with flavor packets trimethoprim trimipramine trinessa (28) TRINTELLIX triple antibiotic , 131 triple paste af tri-previfem (28) tri-sprintec (28) TRIUMEQ tri-vi-sol tri-vita tri-vitamin trivora (28) TROKENDI XR TROPHAMINE 10 % TROPHAMINE 6% trospium , 159 TRULICITY TRUMENBA TRUVADA tusnel diabetic TUSNEL NEW FORMULA 125 TUSSI PRES-B tussin cf , 126 tussin cf (pe-dm-guaif) tussin cold-congestion tussin cough (dm only) tussin dm tussin dm cough and chest tussin pe TWINRIX (PF) TYBOST TYGACIL TYKERB TYPHIM VI TYSABRI TYVASO TYZEKA U UCERIS u-cort ULORIC ultimate men's complete I-22

246 ultra b-100 complex ultra fresh pm unicomplex-m unisom (diphenhydramine) unisom (doxylamine) unisom sleepgels UNITUXIN UPTRAVI ursodiol V VAGIFEM vagistat valacyclovir VALCHLOR valganciclovir valproate sodium valproic acid valproic acid (as sodium salt) 44 valsartan valsartan-hydrochlorothiazide 90 VALSTAR vancomycin vancomycin in dextrose 5 %.. 21 VAQTA (PF) VARIVAX (PF) VASCEPA v-c forte VELCADE velivet triphasic regimen (28) VELPHORO VELTASSA VEMLIDY VENCLEXTA VENCLEXTA STARTING PACK venlafaxine VENTOLIN HFA verapamil VERSACLOZ VESICARE vestura (28) VGO VIBERZI vic-forte vicks dayquil cough vicks nature fusion cough vicks nyquil cold/flu liquicap vicks qlearquil nighttime rlf vicks qlearquil(oxymetazoline) vicks sinex 12-hour vicodin vicodin es vicodin hp VICTOZA 3-PAK VIDEX 2 GRAM PEDIATRIC VIEKIRA PAK VIEKIRA XR vienva VIGAMOX VIIBRYD VIMIZIM VIMPAT vinorelbine viorele (28) VIRACEPT VIRAZOLE VIREAD virtussin ac virtussin dac vision vision plus lutein vit b complex-folic acid 216, 219 vitalets vitamin a vitamin b complex , 214 vitamin b vitamin b-100 complex vitamin b12-folic acid vitamin b vitamin c , 215, 219, 220 vitamin d , 216, 219, 220 vitamin k vitamin k vitamins and minerals vitamins b complex , 218 vitamins for hair vitatrum VITEKTA vitrum senior vol-care rx VOLTAREN voriconazole VOTRIENT VPRIV vp-vite rx VRAYLAR vyfemla (28) W wal-act d cold and allergy wal-dram wal-dryl allergy wal-fex allergy wal-finate wal-finate-d wal-flu severe cold-cough wal-itin wal-itin d wal-itin d 12 hour wal-phed... 61, 126 wal-phed pe day-night wal-phed pe sinus and allergy 61 wal-profen wal-sleep z wal-som (diphenhydramine).. 61 wal-som (doxylamine) wal-tap wal-tussin cough wal-tussin dm wal-tussin max strength cough wal-zan wal-zyr (cetirizine) I-23

247 wal-zyr d warfarin water for irrigation, sterile WELCHOL wera (28) womens daily gummies women's daily multivitamin. 214 women's multivitamin gummies X XALKORI XARELTO XELJANZ XELJANZ XR XERMELO XIFAXAN XOLAIR XTAMPZA ER XTANDI xulane xylon XYREM Y yelets YERVOY YF-VAX (PF) YONDELIS yuvafem Z zafirlukast zaleplon zantac zarah ZARXIO ZAVESCA zebutal ZELBORAF ZEMPLAR zenatane zenchent (28) ZENPEP ZEPATIER zephrex-d ZERIT ZETIA ZIAGEN zidovudine ZINBRYTA zinc oxide ZIOPTAN (PF) ziprasidone hcl ZIRGAN ZOLADEX zoledronic acid zoledronic acid-mannitol-water ZOLINZA zolmitriptan zolpidem ZOMACTON ZOMETA zonisamide zoo chews ZORBTIVE ZORTRESS ZOSTAVAX (PF) zovia 1/35e (28) zovia 1/50e (28) z-sleep... 59, 60 ZUBSOLV ZURAMPIC ZYDELIG ZYKADIA ZYLET zyncof ZYPREXA RELPREVV ZYRTEC ZYTIGA I-24

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