Formulary. Medi-Cal. Healthy Kids. and

Transcription

1 ormulary Medi-Cal and Healthy Kids 2015

2 IEHP Medi-Cal 2015 ormulary Table of Contents ADHD/Anti-Narcolepsy/Anti-Obesity/Anorexiants... 3 Aminoglycosides... 4 Analgesics - Anti-Inflammatory... 4 Analgesics - Nonnarcotic... 5 Analgesics - Opioid... 5 Anorectal Agents... 6 Antacids... 7 Anthelmintics... 7 Antianginal Agents... 7 Antianxiety Agents... 7 Antiarrhythmics... 8 Antiasthmatic And Bronchodilator Agents... 8 Anticoagulants Anticonvulsants Antidepressants Antidiabetics Antidiarrheals Antiemetics Antifungals Antihistamines Antihyperlipidemics Antihypertensives Anti-Infective Agents - Misc Antimalarials Antimyasthenic/Cholinergic Agents Antimycobacterial Agents Antineoplastics And Adjunctive Therapies Antiparkinson Agents Antipsychotics/Antimanic Agents Antiseptics & Disinfectants Antivirals Assorted Classes Beta Blockers Calcium Channel Blockers Cardiotonics Cephalosporins Contraceptives Corticosteroids Cough/Cold/Allergy Dermatologicals Diagnostic Products Digestive Aids

3 Diuretics Endocrine And Metabolic Agents - Misc Estrogens luoroquinolones Gastrointestinal Agents - Misc Genitourinary Agents - Miscellaneous Gout Agents Hematological Agents - Misc Hematopoietic Agents Hypnotics Laxatives Macrolides Medical Devices Migraine Products Minerals & Electrolytes Mouth/Throat/Dental Agents Multivitamins Musculoskeletal Therapy Agents Nasal Agents - Systemic And Topical Ophthalmic Agents Otic Agents Oxytocics Passive Immunizing Agents Penicillins Progestins Psychotherapeutic And Neurological Agents - Misc Sulfonamides Tetracyclines Thyroid Agents Ulcer Drugs Urinary Anti-Infectives Urinary Antispasmodics Vaginal Products Vasopressors Vitamins Index

4 IEHP Medi-Cal 2015 ormulary List of Covered Drugs CURRENT AS O 1/8/2015 lowercase italics= Generic drugs UPPERCASE= Brand name drugs Tier C1= Code 1 = ormulary NC= Not Covered N= Non-ormulary Requirements / Limits PA= Prior Authorization = Quantity Limit ST= Step Therapy Drug Name Tier Requirements / Limits ADHD/Anti-Narcolepsy/Anti-Obesity/Anorexiants amphetamine-dextroamphet er oral capsule extended release 24 hour 10 mg, 15 mg, 20 mg, 25 mg, 5 mg amphetamine-dextroamphet er oral capsule extended release 24 hour 30 mg amphetamine-dextroamphetamine oral tablet 10 mg, 12.5 mg, 15 mg, 30 mg, 5 mg, 7.5 mg amphetamine-dextroamphetamine oral tablet 20 mg clonidine hcl er oral tablet extended release 12 hr CONCERTA ORAL TABLET EXTENDEDRELEASE 18 MG, 27 MG, 36 MG, 54 MG dexmethylphenidate hcl oral tablet PA dextroamphetamine sulfate oral tablet dextroamphetamine sulfate er oral capsule extended release 24 hour OCALIN XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG, 15 MG, 20 MG, 5 MG OCALIN XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 25 MG, 30 MG, 35 MG, 40 MG PA PA; PA PA; PA; 3

5 methylphenidate hcl oral tablet 10 mg, 20 mg, 5 mg methylphenidate hcl er oral tablet extendedrelease 10 mg methylphenidate hcl er oral tablet extendedrelease 20 mg STRATTERA ORAL CAPSULE Aminoglycosides neomycin sulfate oral tablet paromomycin sulfate oral capsule C1 PA Analgesics - Anti-Inflammatory CELEBREX ORAL CAPSULE 100 MG, 200 MG N PA; CELEBREX ORAL CAPSULE 400 MG N PA diclofenac potassium oral tablet diclofenac sodium oral tablet delayed release diclofenac sodium er oral tablet extended release 24 hr etodolac oral capsule etodolac oral tablet ibuprofen oral capsule ibuprofen oral suspension ibuprofen oral tablet indomethacin oral capsule ketorolac tromethamine oral tablet leflunomide oral tablet meloxicam oral tablet nabumetone oral tablet naproxen oral suspension naproxen oral tablet 250 mg, 375 mg, 500 mg naproxen sodium oral tablet piroxicam oral capsule RHEUMATREX ORAL TABLET RIDAURA ORAL CAPSULE sulindac oral tablet 4

6 Analgesics - Nonnarcotic acetaminophen oral solution 160 mg/5ml acetaminophen oral tablet chewable apra oral elixir aspirin oral tablet 325 mg aspirin ec oral tablet delayed release 81 mg aspirin low strength oral tablet chewable butalbital-apap-caffeine oral capsule mg butalbital-apap-caffeine oral tablet mg butalbital-asa-caffeine oral capsule childrens acetaminophen oral suspension 160 mg/5ml childrens non-aspirin oral tablet chewable childrens silapap oral liquid choline & mag trisalicylate oral tablet choline-mag trisalicylate oral liquid ECOTRIN ORAL TABLET DELAYED RELEASE EXCEDRIN EXTRA STRENGTH ORAL TABLET EVERALL SUPPOSITORY 120 MG, 325 MG EVERALL SUPPOSITORY 80 MG infantaire oral solution infants mapap oral suspension infants pain relief oral suspension 80 mg/0.8ml non-aspirin oral tablet pain & fever childrens oral solution pain relief childrens oral suspension pain relief extra strength oral tablet q-pap infants oral solution salsalate oral tablet Analgesics - Opioid acetaminophen-codeine oral solution 5

7 acetaminophen-codeine #2 oral tablet acetaminophen-codeine #3 oral tablet acetaminophen-codeine #4 oral tablet AVINZA ORAL CAPSULE EXTENDED RELEASE 24 HOUR CAPITAL/CODEINE ORAL SUSPENSION ENDODAN ORAL TABLET fentanyl transdermal patch 72 hr hydrocodone-acetaminophen oral solution mg/15ml hydrocodone-acetaminophen oral solution mg/15ml hydrocodone-acetaminophen oral tablet mg, mg, mg, mg, mg, mg, mg, mg, mg, mg, mg kadian oral capsule extended release 24 hour 10 mg KADIAN ORAL CAPSULE EXTENDED RELEASE 24 HOUR 200 MG morphine sulfate oral solution N PA morphine sulfate oral tablet morphine sulfate suppository N PA morphine sulfate (concentrate) oral solution 20 mg/ml morphine sulfate er oral capsule extended release 24 hour 10 mg, 100 mg, 20 mg, 30 mg, 50 mg, 60 mg, 80 mg morphine sulfate er oral tablet extendedrelease N PA; oxycodone-acetaminophen oral capsule oxycodone-acetaminophen oral tablet mg, mg, mg ROXICET ORAL SOLUTION ROXICET ORAL TABLET MG tramadol hcl oral tablet Anorectal Agents hydrocortisone enema 6

8 hydrocortisone acetate suppository PROCTO-PAK CREAM PROCTOOAM HC OAM PROCTOZONE-HC CREAM Antacids antacid oral suspension mg/5ml antacid anti-gas max strength oral suspension calcium carbonate antacid oral tablet eq antacid oral suspension liquid antacid extra strength oral suspension MAALOX TC ORAL CONCENTRATE magnesium oxide oral tablet 400 mg, 420 mg MINTOX PLUS ORAL TABLET CHEWABLE sodium bicarbonate oral tablet 325 mg, 650 mg Anthelmintics reeses pinworm medicine oral suspension Antianginal Agents DILATRATE-SR ORAL CAPSULE EXTENDED RELEASE ISORDIL TITRADOSE ORAL TABLET 40 MG isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg, 5 mg isosorbide dinitrate sublingual tablet sublingual 2.5 mg isosorbide dinitrate er oral tablet extendedrelease isosorbide mononitrate oral tablet isosorbide mononitrate er oral tablet extended release 24 hr NITRO-BID TRANSDERMAL OINTMENT NITROSTAT SUBLINGUAL TABLET SUBLINGUAL Antianxiety Agents alprazolam oral tablet alprazolam er oral tablet extended release 24 hr 7

9 ALPRAZOLAM INTENSOL ORAL CONCENTRATE buspirone hcl oral tablet 10 mg, 15 mg, 5 mg, 7.5 mg buspirone hcl oral tablet 30 mg diazepam oral solution 1 mg/ml PA; diazepam oral tablet DIAZEPAM INTENSOL ORAL CONCENTRATE hydroxyzine hcl oral syrup hydroxyzine hcl oral tablet hydroxyzine pamoate oral capsule lorazepam oral tablet Antiarrhythmics amiodarone hcl oral tablet 200 mg mexiletine hcl oral capsule propafenone hcl oral tablet propafenone hcl er oral capsule extended release 12 hour 225 mg propafenone hcl er oral capsule extended release 12 hour 325 mg, 425 mg quinidine gluconate er oral tablet extendedrelease Antiasthmatic And Bronchodilator Agents albuterol sulfate inhalation nebulization solution (2.5 mg/3ml) 0.083%, 0.63 mg/3ml, 1.25 mg/3ml albuterol sulfate inhalation nebulization solution (5 mg/ml) 0.5% albuterol sulfate oral syrup albuterol sulfate er oral tablet extended release 12 hr ASMANEX 120 METERED DOSES INHALATION AEROSOL POWDER, BREATH ACTIVATED ASMANEX 30 METERED DOSES INHALATION AEROSOL POWDER, BREATH ACTIVATED PA; 8

10 ASMANEX 60 METERED DOSES INHALATION AEROSOL POWDER, BREATH ACTIVATED ATROVENT HA INHALATION AEROSOL, SOLUTION budesonide inhalation suspension COMBIVENT INHALATION AEROSOL COMBIVENT RESPIMAT INHALATION AEROSOL, SOLUTION cromolyn sodium inhalation nebulization solution epinephrine hcl injection solution 0.1 mg/ml LOVENT DISKUS INHALATION AEROSOL POWDER, BREATH ACTIVATED LOVENT HA INHALATION AEROSOL ipratropium bromide inhalation solution levalbuterol hcl inhalation nebulization solution metaproterenol sulfate oral syrup metaproterenol sulfate oral tablet montelukast sodium oral packet PA montelukast sodium oral tablet montelukast sodium oral tablet chewable PULMICORT INHALATION SUSPENSION 1 MG/2ML PULMICORT LEXHALER INHALATION AEROSOL POWDER, BREATH ACTIVATED QVAR INHALATION AEROSOL, SOLUTION SEREVENT DISKUS INHALATION AEROSOL POWDER, BREATH ACTIVATED terbutaline sulfate oral tablet THEO-24 ORAL CAPSULE EXTENDED RELEASE 24 HOUR theophylline oral solution theophylline er oral tablet extended release 12 hr 100 mg, 200 mg, 300 mg, 450 mg theophylline er oral tablet extended release 24 hr 400 mg 9

11 TUDORZA PRESSAIR INHALATION AEROSOL POWDER, BREATH ACTIVATED VENTOLIN HA INHALATION AEROSOL, SOLUTION XOPENEX HA INHALATION AEROSOL N PA Anticoagulants enoxaparin sodium subcutaneous solution PA warfarin sodium oral tablet Anticonvulsants carbamazepine oral suspension carbamazepine oral tablet carbamazepine oral tablet chewable carbamazepine er oral capsule extended release 12 hour 100 mg, 200 mg, 300 mg carbamazepine er oral tablet extended release 12 hr 200 mg, 400 mg clonazepam oral tablet DIASTAT ACUDIAL N PA DIASTAT PEDIATRIC N PA DILANTIN ORAL CAPSULE 30 MG DILANTIN INATABS ORAL TABLET CHEWABLE divalproex sodium oral capsule sprinkle divalproex sodium oral tablet delayed release 125 mg divalproex sodium oral tablet delayed release 250 mg, 500 mg divalproex sodium er oral tablet extended release 24 hr 250 mg, 500 mg ethosuximide oral capsule ethosuximide oral solution gabapentin oral capsule 100 mg gabapentin oral capsule 300 mg, 400 mg gabapentin oral tablet 600 mg, 800 mg lamotrigine oral tablet 10

12 lamotrigine oral tablet chewable levetiracetam oral solution levetiracetam oral tablet oxcarbazepine oral suspension oxcarbazepine oral tablet phenytoin oral suspension 125 mg/5ml phenytoin sodium extended oral capsule 100 mg primidone oral tablet TEGRETOL-XR ORAL TABLET EXTENDED RELEASE 12 HR 100 MG topiramate oral capsule sprinkle topiramate oral tablet valproic acid oral capsule valproic acid oral syrup zonisamide oral capsule Antidepressants amitriptyline hcl oral tablet bupropion hcl oral tablet 100 mg, 75 mg bupropion hcl er (sr) oral tablet extended release 12 hr 100 mg, 150 mg, 200 mg bupropion hcl er (xl) oral tablet extended release 24 hr citalopram hydrobromide oral solution citalopram hydrobromide oral tablet desipramine hcl oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg doxepin hcl oral capsule 10 mg, 25 mg, 50 mg doxepin hcl oral capsule 100 mg, 150 mg, 75 mg duloxetine hcl oral capsule delayed release particles escitalopram oxalate oral tablet fluoxetine hcl oral capsule 10 mg, 20 mg, 40 mg fluoxetine hcl oral solution fluoxetine hcl oral tablet 10 mg fluoxetine hcl oral tablet 20 mg 11

13 imipramine hcl oral tablet mirtazapine oral tablet 15 mg, 30 mg, 45 mg, 7.5 mg mirtazapine oral tablet dispersible 15 mg, 30 mg mirtazapine oral tablet dispersible 45 mg nefazodone hcl oral tablet 100 mg, 150 mg, 200 mg, 250 mg, 50 mg nortriptyline hcl oral capsule nortriptyline hcl oral solution paroxetine hcl oral tablet 10 mg, 20 mg, 30 mg, 40 mg sertraline hcl oral concentrate sertraline hcl oral tablet 100 mg, 25 mg, 50 mg trazodone hcl oral tablet venlafaxine hcl oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg, 75 mg venlafaxine hcl er oral capsule extended release 24 hour 150 mg, 37.5 mg, 75 mg venlafaxine hcl er oral tablet extended release 24 hr 150 mg, 225 mg, 37.5 mg, 75 mg Antidiabetics acarbose oral tablet APIDRA INJECTION SOLUTION APIDRA SOLOSTAR SUBCUTANEOUS glimepiride oral tablet 1 mg, 2 mg, 4 mg glipizide oral tablet 10 mg, 5 mg glipizide er oral tablet extended release 24 hr GLIPIZIDE XL ORAL TABLET EXTENDED RELEASE 24 HR 10 MG, 2.5 MG, 5 MG glipizide-metformin hcl oral tablet mg, mg, mg GLUCAGEN INJECTION SOLUTION RECONSTITUTED GLUCAGEN HYPOKIT INJECTION SOLUTION RECONSTITUTED glucose oral tablet chewable 4 gm 12

14 glyburide oral tablet 1.25 mg, 5 mg glyburide oral tablet 2.5 mg glyburide-metformin oral tablet HUMALOG SUBCUTANEOUS 100 UNIT/ML HUMALOG SUBCUTANEOUS SOLUTION HUMALOG KWIKPEN SUBCUTANEOUS HUMALOG MIX 50/50 SUBCUTANEOUS SUSPENSION HUMALOG MIX 50/50 KWIKPEN SUBCUTANEOUS HUMALOG MIX 75/25 SUBCUTANEOUS SUSPENSION HUMALOG MIX 75/25 KWIKPEN SUBCUTANEOUS HUMULIN 70/30 SUBCUTANEOUS SUSPENSION HUMULIN 70/30 KWIKPEN SUBCUTANEOUS HUMULIN N SUBCUTANEOUS SUSPENSION HUMULIN N PEN SUBCUTANEOUS HUMULIN R INJECTION SOLUTION HUMULIN R U-500 (CONCENTRATED) SUBCUTANEOUS SOLUTION INVOKAMET ORAL TABLET ST; INVOKANA ORAL TABLET ST; JANUMET ORAL TABLET ST; JANUMET XR ORAL TABLET EXTENDED RELEASE 24 HR MG, MG, MG ST; JANUVIA ORAL TABLET ST; LANTUS SUBCUTANEOUS SOLUTION LANTUS SOLOSTAR SUBCUTANEOUS metformin hcl oral tablet 1000 mg, 500 mg, 850 mg metformin hcl er oral tablet extended release 24 hr 500 mg, 750 mg NOVOLOG SUBCUTANEOUS SOLUTION 13

15 NOVOLOG LEXPEN SUBCUTANEOUS NOVOLOG MIX 70/30 SUBCUTANEOUS SUSPENSION NOVOLOG MIX 70/30 LEXPEN SUBCUTANEOUS NOVOLOG PENILL SUBCUTANEOUS pioglitazone hcl oral tablet Antidiarrheals diphenoxylate-atropine oral liquid diphenoxylate-atropine oral tablet IMPERIM ORAL TABLET kao-tin oral suspension loperamide hcl oral capsule PEPTO-BISMOL ORAL TABLET pink bismuth oral suspension 524 mg/30ml pink bismuth oral tablet chewable stomach relief plus oral suspension tgt anti-diarrheal oral liquid Antiemetics meclizine hcl oral tablet ondansetron oral tablet dispersible ondansetron hcl oral tablet 4 mg, 8 mg TRANSDERM-SCOP TRANSDERMAL PATCH 72 HR trimethobenzamide hcl oral capsule vertin-32 oral tablet Antifungals ANCOBON ORAL CAPSULE bio-statin oral powder fluconazole oral suspension reconstituted fluconazole oral tablet GRIULVIN V ORAL TABLET GRIS-PEG ORAL TABLET griseofulvin microsize oral suspension 14

16 ketoconazole oral tablet nystatin oral powder nystatin oral tablet terbinafine hcl oral tablet Antihistamines all day allergy childrens oral tablet chewable aller-chlor oral syrup altaryl oral elixir BENADRYL ALLERGY CHILDRENS ORAL LIQUID cetirizine hcl oral syrup 1 mg/ml cetirizine hcl oral tablet cetirizine hcl childrens oral solution 5 mg/5ml cetirizine hcl childrens alrgy oral syrup 5 mg/5ml childrens loratadine oral syrup CHLOR-TRIMETON ORAL TABLET CHLOR-TRIMETON ALLERGY ORAL TABLET EXTENDEDRELEASE CLARITIN ORAL SYRUP CLARITIN ORAL TABLET CLARITIN ORAL TABLET CHEWABLE CLARITIN REDITABS ORAL TABLET DISPERSIBLE 10 MG complete allergy medication oral tablet cyproheptadine hcl oral syrup cyproheptadine hcl oral tablet diphenhydramine hcl oral capsule promethazine hcl oral syrup promethazine hcl oral tablet promethazine hcl suppository 12.5 mg, 25 mg PROMETHEGAN SUPPOSITORY 50 MG silphen cough oral syrup TOTAL ALLERGY MEDICINE ORAL LIQUID Antihyperlipidemics 15

17 atorvastatin calcium oral tablet cholestyramine oral packet cholestyramine light oral packet cholestyramine light oral powder fenofibrate oral tablet 145 mg, 48 mg fenofibrate oral tablet 160 mg, 54 mg fenofibrate micronized oral capsule 134 mg fenofibrate micronized oral capsule 200 mg, 67 mg fenofibric acid oral capsule delayed release gemfibrozil oral tablet lovastatin oral tablet 10 mg, 20 mg, 40 mg NIACOR ORAL TABLET NIASPAN ORAL TABLET EXTENDEDRELEASE pravastatin sodium oral tablet 10 mg, 20 mg, 40 mg, 80 mg simvastatin oral tablet 10 mg, 40 mg, 5 mg, 80 mg simvastatin oral tablet 20 mg Antihypertensives amlodipine besy-benazepril hcl oral capsule mg, mg, mg, 5-10 mg, 5-20 mg, 5-40 mg atenolol-chlorthalidone oral tablet benazepril hcl oral tablet 10 mg, 20 mg, 40 mg, 5 mg benazepril-hydrochlorothiazide oral tablet captopril oral tablet clonidine hcl oral tablet clonidine hcl transdermal patch weekly 0.1 mg/24hr, 0.2 mg/24hr, 0.3 mg/24hr doxazosin mesylate oral tablet 1 mg, 2 mg, 4 mg doxazosin mesylate oral tablet 8 mg enalapril maleate oral tablet 10 mg, 20 mg, 5 mg enalapril maleate oral tablet 2.5 mg guanfacine hcl oral tablet 16

18 hydralazine hcl oral tablet lisinopril oral tablet lisinopril-hydrochlorothiazide oral tablet mg, mg, mg losartan potassium oral tablet 100 mg, 25 mg, 50 mg losartan potassium-hctz oral tablet mg, mg, mg methyldopa oral tablet methyldopa-hydrochlorothiazide oral tablet minoxidil oral tablet prazosin hcl oral capsule terazosin hcl oral capsule 1 mg, 10 mg, 2 mg, 5 mg valsartan-hydrochlorothiazide oral tablet Anti-Infective Agents - Misc. CLEOCIN ORAL SOLUTION RECONSTITUTED clindamycin hcl oral capsule dapsone oral tablet E.S.P. ORAL SUSPENSION RECONSTITUTED MEPRON ORAL SUSPENSION metronidazole oral tablet NEBUPENT INHALATION SOLUTION RECONSTITUTED PRIMSOL ORAL SOLUTION sulfamethoxazole-tmp ds oral tablet sulfamethoxazole-trimethoprim oral suspension mg/5ml sulfamethoxazole-trimethoprim oral tablet trimethoprim oral tablet Antimalarials chloroquine phosphate oral tablet hydroxychloroquine sulfate oral tablet primaquine phosphate oral tablet Antimyasthenic/Cholinergic Agents 17

19 MESTINON ORAL SYRUP MESTINON ORAL TABLET EXTENDEDRELEASE PROSTIGMIN ORAL TABLET pyridostigmine bromide oral tablet Antimycobacterial Agents cycloserine oral capsule ethambutol hcl oral tablet ISONARI ORAL CAPSULE isoniazid oral syrup isoniazid oral tablet MYCOBUTIN ORAL CAPSULE C1 PA pyrazinamide oral tablet rifampin oral capsule Antineoplastics And Adjunctive Therapies ARIMIDEX ORAL TABLET CEENU ORAL CAPSULE 10 MG, 100 MG cyclophosphamide oral tablet DEPO-PROVERA INTRAMUSCULAR SUSPENSION 400 MG/ML etoposide oral capsule flutamide oral capsule hydroxyurea oral capsule ifosfamide intravenous solution 3 gm/60ml leucovorin calcium oral tablet LEUKERAN ORAL TABLET MATULANE ORAL CAPSULE megestrol acetate oral suspension 40 mg/ml, 400 mg/10ml megestrol acetate oral tablet 20 mg, 40 mg mercaptopurine oral tablet methotrexate oral tablet MYLERAN ORAL TABLET TABLOID ORAL TABLET 18

20 tamoxifen citrate oral tablet 10 mg tamoxifen citrate oral tablet 20 mg tretinoin oral capsule Antiparkinson Agents amantadine hcl oral capsule amantadine hcl oral syrup bromocriptine mesylate oral capsule C1 PA bromocriptine mesylate oral tablet C1 PA carbidopa-levodopa oral tablet carbidopa-levodopa er oral tablet extendedrelease mg pramipexole dihydrochloride oral tablet ropinirole hcl oral tablet Antipsychotics/Antimanic Agents prochlorperazine suppository prochlorperazine maleate oral tablet Antiseptics & Disinfectants BETADINE SWAB AID EXTERNAL SWAB BUCALSEP EXTERNAL SOLUTION HIBICLENS EXTERNAL LIQUID povidone-iodine external solution 10 % Antivirals acyclovir oral capsule acyclovir oral suspension acyclovir oral tablet didanosine oral capsule delayed release N PA famciclovir oral tablet TAMILU ORAL CAPSULE TAMILU ORAL SUSPENSION RECONSTITUTED 6 MG/ML valacyclovir hcl oral tablet 1 gm, 500 mg zidovudine oral capsule N PA zidovudine oral tablet N PA C1 C1 19

21 Assorted Classes azathioprine oral tablet Beta Blockers atenolol oral tablet 100 mg, 25 mg, 50 mg carvedilol oral tablet 12.5 mg, 25 mg, mg, 6.25 mg labetalol hcl intravenous solution labetalol hcl oral tablet metoprolol succinate er oral tablet extended release 24 hr 100 mg, 200 mg, 25 mg, 50 mg metoprolol tartrate oral tablet propranolol hcl oral solution 20 mg/5ml, 40 mg/5ml propranolol hcl oral tablet propranolol hcl er oral capsule extended release 24 hour 120 mg, 160 mg, 60 mg, 80 mg sotalol hcl oral tablet Calcium Channel Blockers amlodipine besylate oral tablet 10 mg, 2.5 mg, 5 mg dilt-xr oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg diltiazem hcl oral tablet 120 mg, 30 mg, 60 mg, 90 mg diltiazem hcl er oral capsule extended release 12 hour 120 mg diltiazem hcl er oral capsule extended release 12 hour 60 mg, 90 mg diltiazem hcl er beads oral capsule extended release 24 hour 360 mg, 420 mg diltiazem hcl er coated beads oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 300 mg, 360 mg felodipine er oral tablet extended release 24 hr 10 mg, 2.5 mg, 5 mg nifedipine oral capsule 10 mg, 20 mg nifedipine er oral tablet extended release 24 hr 20

22 nifedipine er osmotic oral tablet extended release 24 hr 30 mg, 60 mg, 90 mg TAZTIA XT ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG, 180 MG, 240 MG, 300 MG, 360 MG verapamil hcl oral tablet 120 mg, 40 mg, 80 mg verapamil hcl er oral capsule extended release 24 hour 100 mg, 120 mg, 180 mg, 200 mg, 240 mg, 300 mg verapamil hcl er oral tablet extendedrelease 120 mg, 180 mg, 240 mg Cardiotonics digoxin oral solution digoxin oral tablet mg, 250 mcg Cephalosporins CEDAX ORAL CAPSULE CEDAX ORAL SUSPENSION RECONSTITUTED cefaclor er oral tablet extended release 12 hr C1 PA cefdinir oral capsule C1 PA cefdinir oral suspension reconstituted 125 mg/5ml C1 PA cephalexin oral capsule 250 mg, 500 mg cephalexin oral suspension reconstituted SUPRAX ORAL SUSPENSION RECONSTITUTED 100 MG/5ML SUPRAX ORAL TABLET C1 PA Contraceptives AZURETTE ORAL TABLET BALZIVA ORAL TABLET CAMRESE ORAL TABLET CESIA ORAL TABLET ELLA ORAL TABLET EMCON E ORAL TABLET CHEWABLE GIANVI ORAL TABLET JOLIVETTE ORAL TABLET C1 C1 C1 PA 21

23 JUNEL E 1.5/30 ORAL TABLET JUNEL E 1/20 ORAL TABLET LEENA ORAL TABLET LEVORA 0.15/30 (28) ORAL TABLET LOSEASONIQUE ORAL TABLET LOW-OGESTREL ORAL TABLET medroxyprogesterone acetate intramuscular suspension MICROGESTIN 1.5/30 ORAL TABLET MICROGESTIN 1/20 ORAL TABLET MICROGESTIN E 1.5/30 ORAL TABLET MICROGESTIN E 1/20 ORAL TABLET MONONESSA ORAL TABLET NECON 0.5/35 (28) ORAL TABLET NECON 1/35 (28) ORAL TABLET NECON 1/50 (28) ORAL TABLET NECON 10/11 (28) ORAL TABLET NECON 7/7/7 ORAL TABLET NEXT CHOICE ORAL TABLET NEXT CHOICE ONE DOSE ORAL TABLET NUVARING VAGINAL RING OCELLA ORAL TABLET OGESTREL ORAL TABLET OVCON-50 ORAL TABLET QUASENSE ORAL TABLET SOLIA ORAL TABLET SRONYX ORAL TABLET TILIA E ORAL TABLET TRINESSA (28) ORAL TABLET TRIVORA (28) ORAL TABLET ZOVIA 1/35E (28) ORAL TABLET ZOVIA 1/50E (28) ORAL TABLET Corticosteroids 22

24 BAYCADRON ORAL ELIXIR dexamethasone oral solution dexamethasone oral tablet DEXAMETHASONE INTENSOL ORAL CONCENTRATE fludrocortisone acetate oral tablet hydrocortisone oral tablet methylprednisolone oral tablet 4 mg methylprednisolone (pak) oral tablet MILLIPRED ORAL TABLET MILLIPRED DP ORAL TABLET prednisolone oral solution prednisolone sodium phosphate oral solution 15 mg/5ml, 6.7 (5 base) mg/5ml prednisone oral solution prednisone oral tablet prednisone (pak) oral tablet PREDNISONE INTENSOL ORAL CONCENTRATE Cough/Cold/Allergy acetylcysteine inhalation solution ALAVERT ALLERGY/SINUS ORAL TABLET EXTENDED RELEASE 12 HR benzonatate oral capsule 100 mg, 200 mg BIOTUSS PEDIATRIC ORAL LIQUID BROMED DM ORAL SYRUP brotapp dm oral liquid cardec dm oral liquid cetirizine-pseudoephedrine er oral tablet extended release 12 hr corfen-dm oral liquid dextromethorphan-guaifenesin oral solution mg/5ml DIABETIC TUSSIN DM ORAL LIQUID DIABETIC TUSSIN MAX ST ORAL LIQUID 23

25 DIMETAPP COLD/ALLERGY ORAL ELIXIR DIMETAPP DM COLD/COUGH ORAL LIQUID guaifenesin ac oral syrup hydrocodone-homatropine oral syrup LOHIST-D ORAL LIQUID loratadine-d 24hr oral tablet extended release 24 hr MUCINEX ORAL TABLET EXTENDED RELEASE 12 HR MUCINEX COLD OR KIDS ORAL LIQUID MUCINEX COUGH OR KIDS ORAL LIQUID MUCINEX COUGH OR KIDS ORAL PACKET MUCINEX D ORAL TABLET EXTENDED RELEASE 12 HR MUCINEX DM ORAL TABLET EXTENDED RELEASE 12 HR MUCINEX DM MAXIMUM STRENGTH ORAL TABLET EXTENDED RELEASE 12 HR MUCINEX OR KIDS ORAL LIQUID MUCINEX MAXIMUM STRENGTH ORAL TABLET EXTENDED RELEASE 12 HR neotuss oral liquid NORTUSS-DE ORAL LIQUID pedia relief cough/cold oral liquid promethazine vc plain oral syrup promethazine vc/codeine oral syrup promethazine-codeine oral syrup promethazine-dm oral syrup Q-TAPP ORAL ELIXIR ra tussin oral syrup ritifed oral syrup ROBITUSSIN CHILDRENS COUGH LA ORAL SYRUP ROBITUSSIN PEAK COLD MULTI-SYM ORAL LIQUID MG/5ML 24

26 ROBITUSSIN PEAK COLD NASAL RL ORAL TABLET MG rynex pse oral liquid SCOT-TUSSIN DM ORAL LIQUID SCOT-TUSSIN SENIOR ORAL LIQUID sodium chloride inhalation nebulization solution 0.45 %, 0.9 %, 10 %, 3 % tussin dm oral syrup WAL-ACT ORAL TABLET WAL-PHED SINUS/ALLERGY ORAL TABLET Dermatologicals ABREVA EXTERNAL CREAM acne medication external lotion acne medication 10 external acne medication 5 external 5 % acne medication 5 external lotion AMLACTIN EXTERNAL LOTION AMLACTIN OOT CREAM THERAPY EXTERNAL CREAM bacitracin external ointment bacitracin zinc external ointment BACTROBAN EXTERNAL CREAM BENZAC W WASH EXTERNAL LIQUID 5 % BENZAMYCINPAK EXTERNAL PACKET benzoyl peroxide external 2.5 % benzoyl peroxide wash external liquid 10 % benzoyl peroxide-erythromycin external beta hc external lotion betamethasone dipropionate external cream betamethasone dipropionate external lotion betamethasone dipropionate external ointment betamethasone dipropionate aug external cream betamethasone dipropionate aug external ointment betamethasone valerate external cream 25

27 betamethasone valerate external ointment calamine external lotion CALDECORT EXTERNAL CREAM CLEARSKIN EXTERNAL CREAM clindamycin phosphate external 1 % clindamycin phosphate external lotion clindamycin phosphate external solution clobetasol propionate external 0.05 % clobetasol propionate external foam clobetasol propionate external ointment clobetasol propionate external solution clobetasol propionate e external cream clotrimazole external cream clotrimazole external solution clotrimazole-betamethasone external cream clotrimazole-betamethasone external lotion COMPOUND W MAXIMUM STRENGTH EXTERNAL CONDYLOX EXTERNAL 0.5 % CORTISPORIN EXTERNAL OINTMENT cvs hc-1% hemorrhoid external ointment cvs liquid corn/callus remover external solution dandrex external shampoo DESITIN EXTERNAL CREAM DESITIN EXTERNAL OINTMENT 40 % desonide external cream desonide external lotion desonide external ointment double antibiotic external ointment DRITHO-CREME HP EXTERNAL CREAM econazole nitrate external cream erythromycin external 2 % erythromycin external solution 26

28 EURAX EXTERNAL CREAM EURAX EXTERNAL LOTION LANDERS BUTTOCKS EXTERNAL OINTMENT fluocinolone acetonide external cream fluocinolone acetonide external ointment fluocinolone acetonide external solution fluocinonide external 0.05 % fluocinonide external cream 0.05 % fluocinonide external ointment fluocinonide external solution fluocinonide-e external cream LUOROPLEX EXTERNAL CREAM fluorouracil external cream 5 % fluticasone propionate external cream fluticasone propionate external ointment gentamicin sulfate external cream gnp hydrocortisone external cream GYNECORT 10 EXTERNAL CREAM hydrocortisone external cream 2.5 % hydrocortisone external lotion 2.5 % hydrocortisone external ointment 0.5 %, 1 % hydrocortisone external ointment 2.5 % hydrocortisone-aloe external cream 1 % imiquimod external cream instacort 5 external cream ketoconazole external cream ketoconazole external shampoo lice killing maximum strength external shampoo lice treatment external liquid % lice treatment max st combination kit LIDODERM EXTERNAL PATCH malathion external lotion 27

29 MEDI-IRST ANTI-UNGAL EXTERNAL CREAM metronidazole external 0.75 % metronidazole external cream metronidazole external lotion micaderm external cream mometasone furoate external cream mometasone furoate external ointment mometasone furoate external solution mupirocin external ointment nystatin external cream nystatin external ointment nystatin external powder unit/gm nystatin-triamcinolone external cream nystatin-triamcinolone external ointment permethrin external cream permethrin external lotion podofilox external solution prednicarbate external cream prednicarbate external ointment ra wart remover external solution ra zinc oxide external ointment RID COMPLETE LICE ELIMINATION COMBINATION KIT SALACTIC ILM EXTERNAL SOLUTION SCALPICIN MAXIMUM STRENGTH EXTERNAL SOLUTION selenium sulf-pyrithione-urea external shampoo selenium sulfide external lotion SELSUN BLUE MEDICATED EXTERNAL LOTION silver sulfadiazine external cream TEGRIN-LT LICE TREATMENT EXTERNAL SHAMPOO tgt athletes foot external cream 28

30 tgt wart remover external liquid tinaspore external solution TING EXTERNAL CREAM tretinoin external 0.01 %, % C1 PA tretinoin external cream C1 PA tretinoin (emollient) external cream C1 PA triamcinolone acetonide external cream triamcinolone acetonide external lotion triamcinolone acetonide external ointment triamcinolone in absorbase external ointment triple antibiotic external ointment triple antibiotic plus external ointment ULESIA EXTERNAL LOTION urea external lotion 10 % VOLTAREN TRANSDERMAL wal-sporin external ointment zinc oxide external ointment zinc oxide external paste Diagnostic Products CHEMSTRIP K IN VITRO STRIP ORA V30A BLOOD GLUCOSE TEST IN VITRO STRIP KETO-DIASTIX IN VITRO STRIP MULTISTIX 10 SG IN VITRO STRIP Digestive Aids CREON ORAL CAPSULE DELAYED RELEASE PARTICLES UNIT, UNIT, UNIT, UNIT, 6000 UNIT pancrelipase (lip-prot-amyl) oral capsule delayed release particles Diuretics acetazolamide oral tablet acetazolamide er oral capsule extended release 12 hour 29

31 ALDACTAZIDE ORAL TABLET MG bumetanide oral tablet chlorothiazide oral tablet chlorthalidone oral tablet DIURIL ORAL SUSPENSION DYRENIUM ORAL CAPSULE 50 MG EDECRIN ORAL TABLET furosemide oral solution 10 mg/ml, 8 mg/ml furosemide oral tablet hydrochlorothiazide oral capsule hydrochlorothiazide oral tablet 12.5 mg, 25 mg, 50 mg indapamide oral tablet spironolactone oral tablet spironolactone-hctz oral tablet THALITONE ORAL TABLET triamterene-hctz oral capsule mg triamterene-hctz oral tablet Endocrine And Metabolic Agents - Misc. alendronate sodium oral tablet 10 mg, 40 mg alendronate sodium oral tablet 35 mg, 70 mg calcitonin (salmon) nasal solution calcitriol oral capsule CARNITOR S ORAL SOLUTION desmopressin acetate oral tablet C1 PA levocarnitine oral tablet Estrogens ALORA TRANSDERMAL PATCH BIWEEKLY est estrogens-methyltest ds oral tablet est estrogens-methyltest hs oral tablet ESTRADERM TRANSDERMAL PATCH BIWEEKLY estradiol oral tablet 30

32 estradiol transdermal patch weekly mg/24hr, mg/24hr, 0.05 mg/24hr, 0.06 mg/24hr, mg/24hr, 0.1 mg/24hr EMHRT 1/5 ORAL TABLET MENEST ORAL TABLET 0.3 MG, MG MENEST ORAL TABLET 1.25 MG, 2.5 MG PREMARIN ORAL TABLET 0.3 MG, MG, 0.9 MG, 1.25 MG PREMARIN ORAL TABLET 0.45 MG PREMPHASE ORAL TABLET PREMPRO ORAL TABLET MG, MG, MG, MG VIVELLE-DOT TRANSDERMAL PATCH BIWEEKLY luoroquinolones CIPRO ORAL SUSPENSION RECONSTITUTED ciprofloxacin hcl oral tablet 100 mg, 250 mg, 500 mg, 750 mg ciprofloxacin-ciproflox hcl er oral tablet extended release 24 hr LEVAQUIN ORAL TABLET Gastrointestinal Agents - Misc. balsalazide disodium oral capsule calcium acetate oral capsule calcium acetate (phos binder) oral tablet enulose oral solution GAS-X ORAL TABLET CHEWABLE LITTLE TUMMYS GAS RELIE ORAL SUSPENSION metoclopramide hcl oral solution 5 mg/5ml metoclopramide hcl oral tablet RENAGEL ORAL TABLET RENVELA ORAL TABLET sulfasalazine oral tablet sulfasalazine oral tablet delayed release 31

33 ursodiol oral capsule ursodiol oral tablet 250 mg Genitourinary Agents - Miscellaneous ARGYLE STERILE SALINE IRRIGATION SOLUTION finasteride oral tablet 5 mg neomycin-polymyxin b gu irrigation solution NEOSPORIN GU IRRIGANT IRRIGATION SOLUTION phenazopyridine hcl oral tablet 100 mg, 200 mg tamsulosin hcl oral capsule Gout Agents allopurinol oral tablet colchicine-probenecid oral tablet COLCRYS ORAL TABLET probenecid oral tablet Hematological Agents - Misc. AGGRENOX ORAL CAPSULE EXTENDED RELEASE 12 HOUR cilostazol oral tablet pentoxifylline er oral tablet extendedrelease PLAVIX ORAL TABLET 75 MG Hematopoietic Agents cyanocobalamin injection solution EPOGEN INJECTION SOLUTION 2000 UNIT/ML ferrous sulfate oral elixir ferrous sulfate oral solution ferrous sulfate oral syrup ferrous sulfate oral tablet delayed release 324 (65 fe) mg ferrous sulfate oral tablet delayed release 325 (65 fe) mg ferrousul oral tablet N PA 32

34 folic acid oral tablet 1 mg yl folic acid oral tablet Hypnotics chloral hydrate oral syrup compoz oral tablet nighttime sleep aid oral tablet 25 mg nighttime sleep aid oral tablet 50 mg NYTOL MAXIMUM STRENGTH ORAL TABLET phenobarbital oral elixir phenobarbital oral tablet SOMNOTE ORAL CAPSULE temazepam oral capsule triazolam oral tablet zolpidem tartrate oral tablet 10 mg, 5 mg Laxatives BENEIBER ORAL POWDER CITRUCEL ORAL TABLET COLACE ORAL CAPSULE 50 MG diocto oral liquid docusate sodium oral tablet dss oral capsule 250 mg DULCOLAX STOOL SOTENER ORAL CAPSULE IBERCON ORAL TABLET LEET ENEMA ENEMA LEET PEDIATRIC ENEMA GAVILYTE-G ORAL SOLUTION RECONSTITUTED gentle laxative oral tablet delayed release glycerin (adult) suppository 2.1 gm glycerin (pediatric) suppository lactulose oral solution 10 gm/15ml magnesium citrate oral solution 33

35 METAMUCIL ORAL CAPSULE METAMUCIL ORAL POWDER 28.3 % METAMUCIL SMOOTH TEXTURE ORAL PACKET METAMUCIL SMOOTH TEXTURE ORAL POWDER 58.6 % milk of magnesia oral suspension 1200 mg/15ml milk of magnesia concentrate oral suspension natural fiber therapy oral powder % NUTRISOURCE IBER ORAL POWDER PEDIA-LAX ORAL LIQUID PEDIA-LAX SUPPOSITORY 1 GM peg 3350/electrolytes oral solution reconstituted polyethylene glycol 3350 oral powder psyldex oral powder senna oral syrup 8.8 mg/5ml senna lax oral tablet senna plus oral tablet silace oral syrup stimulant laxative oral tablet delayed release TRILYTE ORAL SOLUTION RECONSTITUTED Macrolides azithromycin oral packet azithromycin oral suspension reconstituted azithromycin oral tablet 250 mg, 600 mg azithromycin oral tablet 500 mg clarithromycin oral suspension reconstituted clarithromycin oral tablet 250 mg, 500 mg clarithromycin er oral tablet extended release 24 hr E.E.S. 400 ORAL TABLET E.E.S. GRANULES ORAL SUSPENSION RECONSTITUTED 34

36 ERY-TAB ORAL TABLET DELAYED RELEASE 250 MG, 333 MG ERY-TAB ORAL TABLET DELAYED RELEASE 500 MG ERYPED 400 ORAL SUSPENSION RECONSTITUTED ERYTHROCIN STEARATE ORAL TABLET erythromycin base oral capsule delayed release particles erythromycin base oral tablet 250 mg PCE ORAL TABLET DELAYED RELEASE 333 MG PCE ORAL TABLET DELAYED RELEASE 500 MG Medical Devices LANCETS ULTRA THIN PA peak flow meter device pharmacist choice alcohol pad premium condoms lubricated Migraine Products EPIDRIN ORAL CAPSULE ergotamine-caffeine oral tablet MIGERGOT SUPPOSITORY naratriptan hcl oral tablet rizatriptan benzoate oral tablet sumatriptan nasal solution 20 mg/act PA; sumatriptan nasal solution 5 mg/act sumatriptan succinate oral tablet sumatriptan succinate subcutaneous solution PA; sumatriptan succinate refill subcutaneous Minerals & Electrolytes calcium 600 oral tablet 600 mg calcium carbonate oral tablet 1250 mg calcium gluconate oral tablet 500 mg, 648 (60 ca) mg 35

37 calcium lactate oral tablet 648 mg EER-K ORAL TABLET EERVESCENT LUOR-A-DAY ORAL SOLUTION fluoritab oral tablet chewable 1.1 (0.5 f) mg, 2.2 (1 f) mg KLOR-CON ORAL TABLET EXTENDEDRELEASE KLOR-CON 10 ORAL TABLET EXTENDEDRELEASE magnesium oral tablet 250 mg magnesium oxide oral tablet 500 mg NARINSE DROPS ORAL SOLUTION PEDIALYTE ORAL SOLUTION pediatric electrolyte oral solution N PA; potassium chloride oral liquid 40 meq/15ml (20%) potassium chloride oral solution potassium chloride crys er oral tablet extendedrelease potassium chloride er oral capsule extended release sodium chloride intravenous solution 0.9 % sodium fluoride oral solution sodium fluoride oral tablet chewable 0.55 (0.25 f) mg SSKI ORAL SOLUTION zinc gluconate oral tablet 50 mg Mouth/Throat/Dental Agents chlorhexidine gluconate mouth/throat solution clotrimazole mouth/throat lozenge lidocaine viscous mouth/throat solution nystatin mouth/throat suspension ORALONE MOUTH/THROAT PASTE PREVIDENT 5000 PLUS DENTAL CREAM Multivitamins multi-vit/fluoride oral solution 36

38 multi-vit/fluoride/iron oral solution NEPHRO-VITE ORAL TABLET NEPHRO-VITE RX ORAL TABLET niacin flush free oral capsule mg O-CAL A ORAL TABLET POLY-VI-SOL ORAL SOLUTION polyvitamin oral solution polyvitamin/iron oral solution prenatabs fa oral tablet PRENATABS RX ORAL TABLET prenatal low iron oral tablet prenatal plus oral tablet prenatal vitamins oral tablet mg prenatal/iron oral tablet TRI-VI-SOL/IRON ORAL SOLUTION tri-vit/fluoride oral solution tri-vit/fluoride/iron oral solution tri-vitamin oral solution Musculoskeletal Therapy Agents baclofen oral tablet carisoprodol oral tablet 350 mg carisoprodol-aspirin oral tablet cyclobenzaprine hcl oral tablet 10 mg, 5 mg methocarbamol oral tablet tizanidine hcl oral tablet Nasal Agents - Systemic And Topical AYR SALINE NASAL DROPS NASAL SOLUTION azelastine hcl nasal solution 137 mcg/spray BACTROBAN NASAL NASAL OINTMENT cromolyn sodium nasal aerosol, solution decongestant 12hour max st oral tablet extended release 12 hr 37

39 flunisolide nasal solution 25 mcg/act (0.025%) flunisolide nasal solution 29 mcg/act (0.025%) fluticasone propionate nasal suspension gnp suphedrin oral liquid kp pseudoephedrine hcl oral tablet 60 mg nasal decongestant oral tablet 30 mg nasal spray extra moisturizing nasal solution OCEAN NASAL SPRAY NASAL SOLUTION Ophthalmic Agents ACULAR LS OPHTHALMIC SOLUTION ALAWAY OPHTHALMIC SOLUTION ALOMIDE OPHTHALMIC SOLUTION ALTALUBE OPHTHALMIC OINTMENT apraclonidine hcl ophthalmic solution artificial tears ophthalmic solution % atropine sulfate ophthalmic ointment atropine sulfate ophthalmic solution AZOPT OPHTHALMIC SUSPENSION bacitracin-polymyxin b ophthalmic ointment betaxolol hcl ophthalmic solution BETIMOL OPHTHALMIC SOLUTION BETOPTIC-S OPHTHALMIC SUSPENSION BION TEARS OPHTHALMIC SOLUTION BLEPHAMIDE OPHTHALMIC SUSPENSION BLEPHAMIDE S.O.P. OPHTHALMIC OINTMENT brimonidine tartrate ophthalmic solution CILOXAN OPHTHALMIC OINTMENT ciprofloxacin hcl ophthalmic solution cromolyn sodium ophthalmic solution cvs eye lubricant ophthalmic ointment CYCLOGYL OPHTHALMIC SOLUTION 0.5 %, 2 % cyclopentolate hcl ophthalmic solution 1 % 38

40 dexamethasone sodium phosphate ophthalmic solution diclofenac sodium ophthalmic solution dorzolamide hcl ophthalmic solution dorzolamide hcl-timolol mal ophthalmic solution dry eyes ophthalmic ointment LAREX OPHTHALMIC SUSPENSION fluorometholone ophthalmic suspension ML ORTE OPHTHALMIC SUSPENSION GENTAK OPHTHALMIC OINTMENT gentamicin sulfate ophthalmic solution GENTEAL MILD OPHTHALMIC SOLUTION HOMATROPAIRE OPHTHALMIC SOLUTION ISOPTO CARBACHOL OPHTHALMIC SOLUTION ISOPTO HOMATROPINE OPHTHALMIC SOLUTION 2 % ISOPTO TEARS OPHTHALMIC SOLUTION ketorolac tromethamine ophthalmic solution 0.5 % levobunolol hcl ophthalmic solution 0.25 %, 0.5 % levofloxacin ophthalmic solution LOTEMAX OPHTHALMIC 0.5 % LOTEMAX OPHTHALMIC OINTMENT lubrifresh p.m. ophthalmic ointment MAXIDEX OPHTHALMIC SUSPENSION metipranolol ophthalmic solution MOISTURE EYES OPHTHALMIC SOLUTION MURINE TEARS OR DRY EYES OPHTHALMIC SOLUTION MURO 128 OPHTHALMIC SOLUTION 2 % MYDRIN OPHTHALMIC SOLUTION naphazoline hcl ophthalmic solution NAPHCON-A OPHTHALMIC SOLUTION NATACYN OPHTHALMIC SUSPENSION N N 39

41 natural balance tears ophthalmic solution neomycin-bacitracin zn-polymyx ophthalmic ointment neomycin-polymyxin-dexameth ophthalmic ointment neomycin-polymyxin-dexameth ophthalmic suspension neomycin-polymyxin-gramicidin ophthalmic solution neomycin-polymyxin-hc ophthalmic suspension ofloxacin ophthalmic solution PATADAY OPHTHALMIC SOLUTION N PA PATANOL OPHTHALMIC SOLUTION C1 PA PHOSPHOLINE IODIDE OPHTHALMIC SOLUTION RECONSTITUTED pilocarpine hcl ophthalmic solution polymyxin b-trimethoprim ophthalmic solution polyvinyl alcohol ophthalmic solution PRED MILD OPHTHALMIC SUSPENSION prednisolone acetate ophthalmic suspension prednisolone sodium phosphate ophthalmic solution proparacaine hcl ophthalmic solution PURE & GENTLE LUBRICANT OPHTHALMIC SOLUTION 3 MG/ML RERESH LACRI-LUBE OPHTHALMIC OINTMENT RERESH P.M. OPHTHALMIC OINTMENT RERESH TEARS OPHTHALMIC SOLUTION romycin ophthalmic ointment sodium chloride (hypertonic) ophthalmic ointment sodium chloride (hypertonic) ophthalmic solution sulfacetamide sodium ophthalmic ointment sulfacetamide sodium ophthalmic solution sulfacetamide-prednisolone ophthalmic solution 40

42 SYSTANE NIGHTTIME OPHTHALMIC OINTMENT tears again advanced eyelid ophthalmic solution TEARS NATURALE ORTE OPHTHALMIC SOLUTION tgt eye allergy relief ophthalmic solution timolol maleate ophthalmic gel forming solution timolol maleate ophthalmic solution TOBRADEX OPHTHALMIC OINTMENT tobramycin ophthalmic solution tobramycin-dexamethasone ophthalmic suspension TOBREX OPHTHALMIC OINTMENT TRAVATAN Z OPHTHALMIC SOLUTION trifluridine ophthalmic solution tropicamide ophthalmic solution VIGAMOX OPHTHALMIC SOLUTION XALATAN OPHTHALMIC SOLUTION ZADITOR OPHTHALMIC SOLUTION ZIRGAN OPHTHALMIC Otic Agents acetic acid otic solution acetic acid-aluminum acetate otic solution antipyrine-benzocaine otic solution mg/ml CIPRO HC OTIC SUSPENSION CIPRODEX OTIC SUSPENSION DEBROX OTIC SOLUTION neomycin-polymyxin-hc otic solution neomycin-polymyxin-hc otic suspension ofloxacin otic solution Oxytocics METHERGINE ORAL TABLET Passive Immunizing Agents GAMMAGARD INJECTION SOLUTION 1 GM/10ML N N PA 41

43 Penicillins amoxicillin oral capsule 250 mg, 500 mg amoxicillin oral suspension reconstituted amoxicillin oral tablet 500 mg, 875 mg amoxicillin oral tablet chewable 125 mg, 250 mg amoxicillin-pot clavulanate oral suspension reconstituted amoxicillin-pot clavulanate oral tablet mg amoxicillin-pot clavulanate oral tablet mg, mg amoxicillin-pot clavulanate oral tablet chewable mg, mg amoxicillin-pot clavulanate er oral tablet extended release 12 hr ampicillin oral capsule ampicillin oral suspension reconstituted dicloxacillin sodium oral capsule penicillin v potassium oral solution reconstituted penicillin v potassium oral tablet 250 mg, 500 mg Progestins medroxyprogesterone acetate oral tablet 10 mg, 2.5 mg, 5 mg Psychotherapeutic And Neurological Agents - Misc. ANTABUSE ORAL TABLET bupropion hcl er (smoking det) oral tablet extended release 12 hr chantix oral tablet 0.5 mg chantix continuing month pak oral tablet chantix starting month pak oral tablet disulfiram oral tablet 500 mg donepezil hcl oral tablet 10 mg, 5 mg donepezil hcl oral tablet dispersible 10 mg, 5 mg nicotine transdermal kit nicotine transdermal patch 24 hr 42

44 nicotine polacrilex mouth/throat gum nicotine polacrilex mouth/throat lozenge nicotrol inhalation inhaler nicotrol ns nasal solution rivastigmine tartrate oral capsule 1.5 mg, 3 mg, 4.5 mg, 6 mg Sulfonamides sulfadiazine oral tablet Tetracyclines doxycycline hyclate oral capsule doxycycline hyclate oral tablet 100 mg doxycycline monohydrate oral capsule 100 mg, 50 mg doxycycline monohydrate oral tablet 100 mg, 50 mg, 75 mg minocycline hcl oral capsule minocycline hcl oral tablet 100 mg tetracycline hcl oral capsule Thyroid Agents ARMOUR THYROID ORAL TABLET 120 MG, 30 MG, 60 MG ARMOUR THYROID ORAL TABLET 15 MG, 180 MG, 240 MG, 300 MG, 90 MG levothyroxine sodium oral tablet 100 mcg, 125 mcg, 150 mcg, 25 mcg, 50 mcg, 75 mcg levothyroxine sodium oral tablet 112 mcg, 300 mcg LEVOXYL ORAL TABLET 137 MCG, 88 MCG LEVOXYL ORAL TABLET 175 MCG, 200 MCG liothyronine sodium oral tablet methimazole oral tablet propylthiouracil oral tablet Ulcer Drugs acid reducer oral tablet 75 mg 43

45 CARAATE ORAL SUSPENSION cimetidine oral tablet cimetidine hcl oral solution DEXILANT ORAL CAPSULE DELAYED RELEASE dicyclomine hcl oral capsule dicyclomine hcl oral solution dicyclomine hcl oral tablet DONNATAL ORAL ELIXIR famotidine oral tablet 20 mg, 40 mg IRST-LANSOPRAZOLE ORAL SUSPENSION PA; IRST-OMEPRAZOLE ORAL SUSPENSION PA; heartburn relief oral tablet 10 mg lansoprazole oral capsule delayed release 15 mg misoprostol oral tablet C1 PA NEXIUM 24HR ORAL CAPSULE DELAYED RELEASE omeprazole oral capsule delayed release 10 mg, 20 mg omeprazole oral capsule delayed release 40 mg omeprazole oral tablet delayed release pantoprazole sodium oral tablet delayed release 20 mg, 40 mg PEPCID ORAL SUSPENSION RECONSTITUTED PREVACID 24HR ORAL CAPSULE DELAYED RELEASE PRILOSEC OTC ORAL TABLET DELAYED RELEASE rabeprazole sodium oral tablet delayed release ranitidine hcl oral syrup 15 mg/ml ranitidine hcl oral tablet 150 mg, 300 mg sucralfate oral tablet Urinary Anti-Infectives URADANTIN ORAL SUSPENSION 44 N PA

46 MACRODANTIN ORAL CAPSULE 25 MG methenamine mandelate oral tablet nitrofurantoin macrocrystal oral capsule 100 mg, 50 mg nitrofurantoin monohyd macro oral capsule Urinary Antispasmodics bethanechol chloride oral tablet DETROL LA ORAL CAPSULE EXTENDED RELEASE 24 HOUR 2 MG, 4 MG oxybutynin chloride oral tablet oxybutynin chloride er oral tablet extended release 24 hr tolterodine tartrate oral tablet tolterodine tartrate er oral capsule extended release 24 hour 2 mg tolterodine tartrate er oral capsule extended release 24 hour 4 mg Vaginal Products clindamycin phosphate vaginal cream clotrimazole vaginal cream 1 % CONCEPTROL VAGINAL CONCEPTROL INSERTS VAGINAL INSERT ENCARE VAGINAL SUPPOSITORY gnp miconazole 3 vaginal kit GYNOL II VAGINAL GYNOL II EXTRA STRENGTH VAGINAL metronidazole vaginal miconazole 3 vaginal suppository miconazole 3 combo pack vaginal kit mg-% (9gm) miconazole nitrate vaginal cream miconazole nitrate vaginal suppository MONISTAT 3 VAGINAL CREAM nystatin vaginal tablet PREMARIN VAGINAL CREAM N PA; 45

47 SHUR-SEAL CONTRACEPTIVE VAGINAL terconazole vaginal cream 0.4 %, 0.8 % terconazole vaginal suppository VC VAGINAL CONTRACEPTIVE VAGINAL ILM VC VAGINAL CONTRACEPTIVE VAGINAL OAM Vasopressors ADRENALIN INJECTION SOLUTION 1 MG/ML auvi-q injection epipen 2-pak injection epipen jr 2-pak injection Vitamins d oral capsule d 400 oral tablet chewable d-5000 oral tablet D-VI-SOL ORAL LIQUID d3 kids oral tablet chewable D3-50 ORAL CAPSULE ergocalciferol oral capsule gnp vitamin b1 oral tablet kp vitamin d oral capsule 1000 unit MEPHYTON ORAL TABLET niacin oral tablet niacin er oral capsule extended release niacin er oral tablet extendedrelease 500 mg SLO-NIACIN ORAL TABLET EXTENDEDRELEASE 500 MG sm vitamin d3 oral capsule 4000 unit vitamin b-1 oral tablet vitamin b-6 oral tablet 100 mg, 25 mg, 50 mg vitamin d oral tablet 1000 unit, 2000 unit vitamin d (ergocalciferol) oral capsule 46

48 vitamin d2 oral tablet 400 unit vitamin d3 oral capsule 2000 unit, 400 unit, 5000 unit vitamin d3 oral tablet 400 unit 47

49 Index A ABREVA acarbose acetaminophen... 4 acetaminophen-codeine... 4 acetaminophen-codeine # acetaminophen-codeine # acetaminophen-codeine # acetazolamide acetazolamide er acetic acid acetic acid-aluminum acetate 40 acetylcysteine acid reducer acne medication acne medication acne medication ACULAR LS acyclovir ADRENALIN AGGRENOX ALAVERT ALLERGY/SINUS ALAWAY albuterol sulfate... 7 albuterol sulfate er... 7 ALDACTAZIDE alendronate sodium all day allergy childrens aller-chlor allopurinol ALOMIDE ALORA alprazolam... 6 alprazolam er... 6 ALPRAZOLAM INTENSOL 7 ALTALUBE altaryl amantadine hcl amiodarone hcl... 7 amitriptyline hcl AMLACTIN AMLACTIN OOT CREAM THERAPY amlodipine besy-benazepril hcl amlodipine besylate amoxicillin amoxicillin-pot clavulanate.. 41 amoxicillin-pot clavulanate er amphetamine-dextroamphet er... 2 amphetaminedextroamphetamine... 2 ampicillin ANCOBON ANTABUSE antacid... 6 antacid anti-gas max strength. 6 antipyrine-benzocaine APIDRA APIDRA SOLOSTAR apra... 4 apraclonidine hcl ARGYLE STERILE SALINE ARIMIDEX ARMOUR THYROID artificial tears ASMANEX 120 METERED DOSES... 7 ASMANEX 30 METERED DOSES... 7 ASMANEX 60 METERED DOSES... 8 aspirin... 4 aspirin ec... 4 aspirin low strength... 4 atenolol atenolol-chlorthalidone atorvastatin calcium atropine sulfate ATROVENT HA... 8 auvi-q AVINZA... 5 AYR SALINE NASAL DROPS azathioprine azelastine hcl azithromycin AZOPT AZURETTE B bacitracin bacitracin zinc bacitracin-polymyxin b baclofen BACTROBAN BACTROBAN NASAL balsalazide disodium BALZIVA BAYCADRON BENADRYL ALLERGY CHILDRENS benazepril hcl benazepril-hydrochlorothiazide BENEIBER BENZAC W WASH BENZAMYCINPAK benzonatate benzoyl peroxide benzoyl peroxide wash benzoyl peroxide-erythromycin beta hc BETADINE SWAB AID betamethasone dipropionate. 24 betamethasone dipropionate aug betamethasone valerate... 24, 25 betaxolol hcl bethanechol chloride BETIMOL BETOPTIC-S BION TEARS bio-statin BIOTUSS PEDIATRIC BLEPHAMIDE BLEPHAMIDE S.O.P brimonidine tartrate BROMED DM bromocriptine mesylate brotapp dm BUCALSEP budesonide... 8 bumetanide bupropion hcl bupropion hcl er (smoking det) bupropion hcl er (sr) bupropion hcl er (xl) buspirone hcl... 7