Kaiser Permanente Bernard J. Tyson School of Medicine, Inc ......Kaiser Permanente Bernard J. Tyson...

Kaiser Permanente Bernard J Tyson School of Medicine Inc Exclusive Provider Organization (EPO) Student Blanket Health Plan Drug Formulary

Effective June 1 2021

For the most current list of covered medications or for help understanding your KPIC insurance plan benefits including cost sharing for drugs under the prescription drug benefit and under the medical benefit

Call 1-800-533-1833 TTY 711 Monday through Friday 7 am to 9 pm ET

Visit kaiserpermanenteorg to

bull Find a participating retail pharmacy by ZIP codebull Look up possible lower-cost medication alternativesbull Compare medication pricing and optionsbull Find an electronic copy of the formulary herebull Get plan coverage information

For cost sharing information for the outpatient prescription drug benefits in your specific plan please visit kporgkpic-websiteTBD

Kaiser Permanente

Health Plan Products Kaiser Permanente Bernard J Tyson School of Medicine EPO Student Blanket Health Plan offered by Kaiser Permanente Insurance Company

The formulary is subject to change and all previous versions of the formulary are no longer in effectLast updated June 1 2021

Table of Contents

Informational Section3ANTIHISTAMINE DRUGS - Drugs for Allergy9ANTI-INFECTIVE AGENTS - Drugs for Infections 11ANTINEOPLASTIC AGENTS - Drugs for Cancer 30ANTITOXINSIMMUNE GLOBTOXOIDSVACCINES - DRUGS FOR THE IMMUNE SYSTEM 45AUTONOMIC DRUGS - Drugs for the Nervous System 52BLOOD FORMATION COAGULATION THROMBOSIS - Drugs for the Blood65CARDIOVASCULAR DRUGS - Drugs for the Heart 78CELLULAR AND GENE THERAPY - Drugs for Cancer 117CENTRAL NERVOUS SYSTEM AGENTS - Drugs for the Nervous System117DEVICES - Medical Supplies and Durable Medical Equipment 160DIAGNOSTIC AGENTS 167DISINFECTANTS (FOR NON-DERMATOLOGIC USE) - Disinfectants 173ELECTROLYTIC CALORIC AND WATER BALANCE173ENZYMES 183EYE EAR NOSE AND THROAT (EENT) PREPS 184GASTROINTESTINAL DRUGS 197GASTROINTESTINAL DRUGS - Drugs for the Stomach 197GOLD COMPOUNDS 206HEAVY METAL ANTAGONISTS - Drugs to Reduce Iron 206HORMONES AND SYNTHETIC SUBSTITUTES - Hormones207LOCAL ANESTHETICS (PARENTERAL) - Drugs for Numbing247MISCELLANEOUS THERAPEUTIC AGENTS248NONHORMONAL CONTRACEPTIVES - Drugs for Women 273OXYTOCICS - Drugs for Women274PHARMACEUTICAL AIDS274RADIOACTIVE AGENTS 275RESPIRATORY TRACT AGENTS - Drugs for the Lungs 275SKIN AND MUCOUS MEMBRANE AGENTS - Drugs for the Skin288SMOOTH MUSCLE RELAXANTS - Drugs to Relax Muscles 327VITAMINS 328

TOC-2

3

About this formulary Where differences between this formulary and your benefit plan exist the benefit plan documents rule This may not be a complete list of medications that are covered by your plan and it doesnrsquot mean that you are guaranteed to receive a medication on this list Please review your benefit plan for full details

Understanding your formulary

What is a formularyThis formulary provides a list of the approved prescription medications covered under your Health Insurance Plan including both generic and brand-name drugs This list applies only to prescribed outpatient prescription drugs obtained through a Kaiser Permanente pharmacy or a retail pharmacy within the OptumRx network

This list does not apply to medications administered in the doctorrsquos office or in the hospital which are covered under your medical benefit For information on drugs covered under your medical benefit please see the General Benefits section of your Certificate of Insurance

Review the formulary using either the categorical list of drugs or the alphabetical index The categorical list of drugs groups medications into drug categories and classes that are organized by the American Hospital Formulary Service (AHFS) Pharmacologic-Therapeutic Classification system

A prescription drug may be located by looking up the therapeutic category and class to which the drug belongs or the brand or generic name of the drug in the alphabetical index A drug is listed alphabetically by the brand and generic name in the therapeutic category and class to which it belongs The generic name for a brand-name drug is included after the brand-name in parentheses in all lowercase italicized letters

If a generic equivalent for a brand-name drug is both available and covered the generic drug will be listed separately from the brand medication in all lowercase italicized letters If a generic drug is marketed under a proprietary trademark protected brand name the brand name will be listed after the generic name in parentheses and regular typeface with the first letter of each word capitalized

If a generic equivalent for a brand-name drug is not available on the market or is not covered the drug will not be separately listed by its generic name

How do I use my formularyYou and your doctor can use the formulary to help you choose the most cost-effective prescription medications This guide tells you if a medication is generic or brand and if special rules apply Bring this list with you when you see your doctor A non-formulary drug must be covered when your doctor says it is medically necessary If your medication is not listed here please visit your planrsquos member website or call the number on your member ID card to submit a non-formulary exception request

Some medications on your formulary have extra requirements before they can be covered A few of the most common coverage programs are prior authorization (PA) step therapy (ST) Non-formulary (NF) quantity limits (QL) or max day supply limit per prescription (DSL) Please note this formulary is not subject to PA or ST programs

4

You may request exception to certain non-formulary programs when your doctor feels it is necessary If OptumRx doesnrsquot respond to your non-urgent NF exception request within 72 hours or your urgent NF exception request within 24 hours then your request will be automatically granted You may appeal the denial of an exception request Please review your coverage documents for more information on appeal rights and procedures We use programs like these to help make sure the medication you take is safe and effective

When you request coverage of a non-formulary drug we will notify you or your designee and your provider of the coverage determination within these time frames If the decision is to provide coverage for a non-urgent request coverage will be for the duration of the prescription including refills If the coverage decision is based on exigent circumstances coverage will be for the duration of the exigency Check your plan documents for more information Some Affordable Care Act (ACA) or Health Care Reform (HCR) preventive medications may have coverage restrictions

What are tiersTiers are the different cost levels you pay for a medication Each tier is assigned a cost set by your employer or plan sponsor This is how much you will pay when you fill a prescription

Mail orderHow can I receive medications by mail Most prescription refills can be mailed to you at no extra charge You can sign up for mail-order services at your Kaiser Permanente pharmacy by calling the number on the back of your ID card or by visiting kporg

When does the formulary changebull Medications may move to a lower tier at any time

bull Medications may move to a higher tier when a generic equal becomes available

bull Medications may move to a higher tier or be excluded from coverage on January 1 or July 1 of each year

When a medication changes tiers you may have to pay a different amount for that medication

Why are some medications excluded from coverageA medication may be excluded from coverage under your pharmacy benefit when it works the same as or similar to another prescription or over-the-counter (OTC) medication OptumRx and Kaiser Permanente Insurance Company may not limit or exclude coverage for a drug if the health insurer previously approved coverage of the drug for an insuredrsquos medical condition and the prescribing provider continues to prescribe the drug for the condition This is provided that the drug is appropriately prescribed and safe and effective for treating the insuredrsquos medical condition

What if I donrsquot agree with a decision about an excluded medicationYou or your authorized representative and your doctor can ask for a coverage request by calling the number on your member ID card


5

What is the maximum cost-share for oral anti-cancer drugs The cost-share for orally administered anti-cancer drugs shall not exceed $250 for a 30-day supply

What categories of medications are covered through my planYour prescription drug benefit will generally cover prescribed generic and brand-name medications listed on the formulary as long as the drug is medically necessary the prescription is filled by an OptumRx network pharmacy provider and other coverage rules are followed

Over-the-counter (OTC) medications are not generally covered however certain preventive OTC medications are covered when prescribed by a doctor such as aspirin and smoking cessation drugs Durable medical equipment prescribed by a doctor to treat diabetes or to assist with inhalation devices is also covered

The formulary lists the pharmacy benefits covered under your outpatient prescription drug benefit and obtained from a Kaiser Permanente pharmacy or an OptumRx network participating retail pharmacy This formulary does not apply to medications and devices that are obtained through the medical benefit portion of your coverage For example medications provided or administered in the doctorrsquos office or in the hospital or unless specifically stated otherwise devices covered under the durable medical equipment benefit that are obtained at the doctorrsquos office or through a durable medical equipment vendor

Diabetes medication and equipment Your outpatient prescription medication coverage includes the following prescription items for the management and treatment of diabetes

bull Insulin

bull Needles and syringes for injecting insulin

bull Prescriptive medications for the treatment of diabetes

bull Glucagon

Other medical benefit items Some durable medical equipment that is covered through your medical benefit is also available at the pharmacy such as disposable blood glucose test strips blood glucose monitors and lancets and lancet puncture devices

Contraceptives Your outpatient prescription drug coverage includes all prescribed FDA-approved contraceptive drugs including over the counter FDA-approved female contraceptive methods at no cost-share when prescribed by a licensed health care professional authorized to prescribe drugs All such medications require a prescription from your doctor

ACA Preventive drugs at no cost All medications even OTC drugs included under the federal Patient Affordable Care Act (ACA) as preventive medications are eligible for coverage with no cost-share if the insured has a prescription from his or her doctor Please note some medications are only covered at no cost for patients who meet the criteria listed in the formulary


6

Medication tips

What is the difference between brand-name and generic medicationsGeneric medications contain the same active ingredients (what makes the medication work) as brand-name medications but they often cost less Once the patent for a brand-name medication ends the FDA can approve a generic version with the same active ingredients

What if my doctor writes a brand-name prescriptionIf your doctor gives you a prescription for a brand-name medication ask if a generic or lower-cost option could be right for you Generic medications are usually your lowest-cost option

Over-the-counter medicationsAn over-the-counter (OTC) medication may be the right treatment for some conditions Talk to your doctor about available OTC options Even though OTC medications may not be covered by your pharmacy benefit they may cost less than a prescription medication

7

Brand name drug A drug that is marketed under a proprietary trademark-protected name A brand name drug is listed in this formulary in all CAPITAL letters

Coinsurance Percentage of the cost of a covered health care benefit that you pay after you have paid the deductible if a deductible applies to the health care benefit

Copayment Fixed dollar amount that you pay for a covered health care benefit after you have paid the deductible if a deductible applies to the health care benefit

Deductible Amount you pay for covered health care benefits that are subject to the deductible before your health insurer begins to pay If your health insurance policy has a deductible it may have either one deductible or separate deductibles for medical benefits and prescription drug benefits After you pay your deductible you usually pay only a copayment or coinsurance for covered health care benefits Your insurance company pays the rest

Drug Tier A group of prescription drugs that correspond to a specified cost sharing tier in your health insurance policy The drug tier in which a prescription drug is placed determines your portion of the cost for the drug

Exception request A request for coverage of a non-formulary drug If you your designee or your prescribing health care provider submits a request for coverage of a non-formulary drug your insurer must cover the nonformulary drug when it is medically necessary for you to take the drug

Exigent circumstances When you are suffering from a medical condition that may seriously jeopardize your life health or ability to regain maximum function or when you are undergoing a current course of treatment using a nonformulary drug

Formulary or prescription drug list The list of drugs that is covered by your health insurance policy under the prescription drug benefit of the policy

Generic drug A drug that is the same as its brand name drug equivalent in dosage strength effect how it is taken quality safety and intended use A generic drug is listed in this formulary in italicized lowercase letters

Medically Necessary Health care benefits needed to diagnose treat or prevent a medical condition or

its symptoms and that meet accepted standards of medicine Health insurance usually does not cover health care benefits that are not medically necessary The fact that a doctor may prescribe authorize or direct a service does not by itself make it medically necessary or confirm coverage by the policy

Nonformulary drug A prescription drug that is not listed on this formulary

Out-of-pocket cost Your expenses for health care benefits that arenrsquot reimbursed by your health insurance Out-of-pocket costs include deductibles copayments and coinsurance for covered health care benefits plus all costs for health care benefits that are not covered

Prescribing provider A health care provider who can write a prescription for a drug to diagnose treat or prevent a medical condition Prescription An oral written or electronic order from a prescribing provider authorizing a prescription drug to be provided to a specific individual

Prescription drug A drug that by law requires a prescription

Prior Authorization A decision by your health insurer that a health care benefit is medically necessary for you If a prescription drug is subject to prior authorization in this formulary your prescribing provider must request approval from your health insurer to cover the drug before you fill your prescription Your health insurer must grant a prior authorization request when it is medically necessary for you to take the drug

Step therapy A specific sequence in which prescription drugs for a particular medical condition must be tried If a drug is subject to step therapy in this formulary you may have to try one or more other drugs before your health insurance policy will cover that drug for your medical condition If your prescribing provider submits a request for an exception to the step therapy requirement your health insurer must grant the request when it is medically necessary for you to take the drug

Over-the-counter (OTC) drugs are medications sold directly to a consumer without requiring a prescription For this formulary OTC drugs that are covered under your outpatient prescription drug benefit require a prescription from your doctor

Definitions

8

Reading your formulary

The formulary gives you choices so you and your doctor can decide your best course of treatment In this formulary brand-name medications are shown in UPPERCASE (for example CLOBEX) Generic medications are shown in lowercase and italicized (for example clobetasol)

Tier informationUsing lower tier or preferred medications can help you pay your lowest out-of-pocket cost Your plan may have multiple or no tiers Please note If you have a high-deductible plan the tier cost levels will apply once you meet your deductible

The copayment or coinsurance for a covered outpatient prescription drug for an individual prescription should not exceed $250 for a 30-day supply after meeting the deductible if any

Please refer to the tier definition table below to see how to identify which medications are preferred or non-preferred drugs

Drug Tier Includes Helpful TipsPV $0 Preventative drugs Preventative drugs required under the Affordable Care

Act (ACA) at $0 cost shareTier 1 $ Lower-cost generics

and some brand nameUse Tier 1 drugs for the lowest out-of-pocket costs

Tier 2 $$ Mid-range cost preferred brand name

Use Tier 2 drugs if Tier 1 drugs are not available or you prefer a brand

Tier 3 $$ Exception-based non-preferred brand

Tier 3 drugs in this plan require an exception for coverage

Drug list informationIn this drug list some medications are noted with letters next to them to help you see which ones may have coverage requirements or limits Your benefit plan decides how these medications may be covered

OC Oral anti-cancer ndash Cost share not to exceed $250 per month for a 30-day supply

QL Quantity Limit ndash Medication may be limited to a certain quantity

DSL Day Supply Limit ndash Medication may be restricted to a maximum day supply limit per prescription

Please refer to your COI (Certificate of Insurance) for more information about

bull Your medical coverage bull Filing an appeal related to a denial of a coverage request Your COI will provide more information on appeal rights and procedures bull Existing conditions

bull Non-formulary drugs bull Outpatient prescription drug benefit

OptumRx updates the formulary on a monthly basis The notice includes a description of the types of changes made during the plan or policy year and the dates on which such changes are effective

Changes may include

bull Removal of a drug or dosage form of a medication from the formulary

bull Any change in tier placement of a medication that results in an increase in cost sharing

bull Adding or changing medication coverage requirements such as PA ST and QL programs

Prescription Drug Name Drug TierCoverage Requirements amp Limits

ANTIHISTAMINE DRUGS - Drugs for Allergy

ETHANOLAMINE DERIVATIVES - Drugs for Allergy

carbinoxamine maleate oral solution 4 mg5ml 1

carbinoxamine maleate oral tablet 4 mg 6 mg 1

clemastine fumarate oral tablet 268 mg 1

cvs motion sickness oral tablet 50 mg PV

DICOPANOL FUSEPAQ ORAL SUSPENSION RECONSTITUTED 5 MGML (diphenhydramine hcl)

3

diphen oral elixir 125 mg5ml 1

DI-PHEN ORAL LIQUID 125 MG5ML 3

diphenhydramine hcl injection solution 50 mgml 1

diphenhydramine hcl oral elixir 125 mg5ml 1

KARBINAL ER ORAL SUSPENSION EXTENDED RELEASE 4 MG5ML (carbinoxamine maleate)

3

motion sickness relief oral tablet 50 mg PV

ryvent oral tablet 6 mg 1

FIRST GEN ANTIHIST DERIVATIVES MISC - Drugs for Allergy

cyproheptadine hcl oral syrup 2 mg5ml 1

cyproheptadine hcl oral tablet 4 mg 1

FIRST GENERATION ANTIHISTAMINES - Drugs for Allergy







dexchlorpheniramine maleate oral solution 2 mg5ml 1


3






3



Drug Tier 1 Formulary Generic Drug Tier 2 Formulary Brand Drug Tier 3 Non-Formulary Non-Preferred Brand OC Oral anti-cancer PV Preventative QL Quantity Limit DSL Max day supply limit per prescription

9


PHENOTHIAZINE DERIVATIVES - Drugs for Allergy

PHENERGAN INJECTION SOLUTION 25 MGML 50 MGML (promethazine hcl)

PV

promethazine hcl injection solution 25 mgml 50 mgml PV

promethazine hcl oral solution 625 mg5ml PV

promethazine hcl oral syrup 625 mg5ml PV

promethazine hcl oral tablet 125 mg 25 mg 50 mg PV

promethazine hcl rectal suppository 125 mg 25 mg PV

promethazine vc oral syrup 625-5 mg5ml 1

promethazine vccodeine oral syrup 625-5-10 mg5ml 1

promethazine-dm oral syrup 625-15 mg5ml 1

promethazine-phenyleph-codeine oral syrup 625-5-10 mg5ml 1

promethazine-phenylephrine oral syrup 625-5 mg5ml 1

promethazine hcl (Promethegan Rectal Suppository 125 Mg 25 Mg)

PV

promethegan rectal suppository 50 mg PV

PIPERAZINE DERIVATIVES - Drugs for Allergy

hydroxyzine hcl oral syrup 10 mg5ml 1

hydroxyzine hcl oral tablet 10 mg 25 mg 50 mg 1

hydroxyzine pamoate oral capsule 100 mg 25 mg 50 mg 1

meclizine hcl oral tablet 125 mg 25 mg PV

meclizine hcl oral tablet chewable 25 mg PV

motion sickness relief oral tablet chewable 25 mg PV

PROPYLAMINE DERIVATIVES - Drugs for Allergy


hydrocodone polst-chlorphen polst er susp oral suspension extended release 10-8 mg5ml

1

NEOTUSS PLUS ORAL LIQUID 75-4-30 MG5ML (phenylephrine-chlorphen-dm)

3

TUSSICAPS ORAL CAPSULE EXTENDED RELEASE 12 HOUR 10-8 MG (hydrocod polst-chlorphen polst)

3

TUXARIN ER ORAL TABLET EXTENDED RELEASE 12 HOUR 543-8 MG (chlorpheniramine-codeine)

3

TUZISTRA XR ORAL SUSPENSION EXTENDED RELEASE 147-28 MG5ML (codeine polst-chlorphen polst)

3

SECOND GENERATION ANTIHISTAMINES - Drugs for Allergy

cetirizine hcl oral solution 1 mgml 5 mg5ml 1


10


CLARINEX-D 12 HOUR ORAL TABLET EXTENDED RELEASE 12 HOUR 25-120 MG (desloratadine-pseudoephedrine)

3

desloratadine oral tablet 5 mg 1

desloratadine oral tablet dispersible 5 mg 1

levocetirizine dihydrochloride oral solution 25 mg5ml 1

levocetirizine dihydrochloride oral tablet 5 mg 1

ANTI-INFECTIVE AGENTS - Drugs for Infections

1ST GENERATION CEPHALOSPORIN ANTIBIOTICS - Antibiotics

cefadroxil oral capsule 500 mg 1

cefadroxil oral suspension reconstituted 250 mg5ml 500 mg5ml

1

cefadroxil oral tablet 1 gm 1

cefazolin sodium injection solution reconstituted 1 gm 10 gm 1

cefazolin sodium-dextrose intravenous solution 2-4 gm100ml- 1

cephalexin oral capsule 250 mg 500 mg 750 mg 1

cephalexin oral suspension reconstituted 125 mg5ml 250 mg5ml

1

cephalexin oral tablet 250 mg 500 mg 1

2ND GENERATION CEPHALOSPORIN ANTIBIOTICS - Antibiotics

cefaclor er oral tablet extended release 12 hour 500 mg 1

cefaclor oral capsule 250 mg 500 mg 1

cefaclor oral suspension reconstituted 125 mg5ml 250 mg5ml 375 mg5ml

1

cefotetan disodium injection solution reconstituted 1 gm 2 gm 1

cefoxitin sodium injection solution reconstituted 10 gm 1

cefprozil oral suspension reconstituted 125 mg5ml 250 mg5ml 1

cefprozil oral tablet 250 mg 500 mg 1

cefuroxime axetil oral tablet 250 mg 500 mg 1

3RD GENERATION CEPHALOSPORIN ANTIBIOTICS - Antibiotics

cefdinir oral capsule 300 mg 1

cefdinir oral suspension reconstituted 125 mg5ml 250 mg5ml 1

cefixime oral capsule 400 mg 1

cefixime oral suspension reconstituted 100 mg5ml 200 mg5ml 1

cefotaxime sodium injection solution reconstituted 1 gm 2 gm 1

cefpodoxime proxetil oral suspension reconstituted 100 mg5ml 50 mg5ml

1


11


cefpodoxime proxetil oral tablet 100 mg 200 mg 1

ceftazidime injection solution reconstituted 1 gm 2 gm 6 gm 1

ceftriaxone sodium injection solution reconstituted 1 gm 2 gm 250 mg 500 mg

1

SUPRAX ORAL SUSPENSION RECONSTITUTED 100 MG5ML (cefixime)

2


3

SUPRAX ORAL TABLET CHEWABLE 100 MG 200 MG (cefixime)

3

ceftazidime (Tazicef Injection Solution Reconstituted 1 Gm 2 Gm 6 Gm)

1

tazicef intravenous solution reconstituted 1 gm 1

4TH GENERATION CEPHALOSPORIN ANTIBIOTICS - Antibiotics

cefepime hcl injection solution reconstituted 2 gm 1


TEFLARO INTRAVENOUS SOLUTION RECONSTITUTED 600 MG (ceftaroline fosamil)

3

ADAMANTANE ANTIVIRALS - Drugs for Viral Infections

amantadine hcl oral capsule 100 mg PV

amantadine hcl oral syrup 50 mg5ml PV

amantadine hcl oral tablet 100 mg PV

GOCOVRI ORAL CAPSULE EXTENDED RELEASE 24 HOUR 137 MG 685 MG (amantadine hcl)

PV DSL = 30 days

OSMOLEX ER ORAL TABLET ER 24 HOUR THERAPY PACK 129 amp 193 MG (amantadine hcl)

PV

OSMOLEX ER ORAL TABLET EXTENDED RELEASE 24 HOUR 129 MG 193 MG 258 MG (amantadine hcl)

PV

rimantadine hcl oral tablet 100 mg PV

ALLYLAMINE ANTIFUNGALS - Drugs for Fungus

terbinafine hcl oral tablet 250 mg 1

AMEBICIDES - Drugs for the Mouth and Throat

HELIDAC THERAPY ORAL (metronid-tetracyc-bis subsal) 3

metronidazole oral capsule 375 mg 1

metronidazole oral tablet 250 mg 500 mg 1

paromomycin sulfate oral capsule 250 mg 1

PYLERA ORAL CAPSULE 140-125-125 MG (bis subcit-metronid-tetracyc)

3


12


AMINOGLYCOSIDE ANTIBIOTICS - Antibiotics

amikacin sulfate injection solution 500 mg2ml 1

ARIKAYCE INHALATION SUSPENSION 590 MG84ML (amikacin sulfate liposome)

3 DSL = 30 days

KITABIS PAK INHALATION NEBULIZATION SOLUTION 300 MG5ML (tobramycin)

3

neomycin sulfate oral tablet 500 mg 1


streptomycin sulfate intramuscular solution reconstituted 1 gm 1

TOBI PODHALER INHALATION CAPSULE 28 MG (tobramycin)

2

tobramycin inhalation nebulization solution 300 mg4ml 1

tobramycin nebulization solution 300 mg5ml inhalation 300 mg5ml

1

TOBRAMYCIN NEBULIZATION SOLUTION 300 MG5ML INHALATION 300 MG5ML

3

ZEMDRI INTRAVENOUS SOLUTION 500 MG10ML (plazomicin sulfate)

3

AMINOMETHYLCYCLINES - Antibiotics

NUZYRA ORAL TABLET 150 MG (omadacycline tosylate) 3

SEYSARA ORAL TABLET 100 MG 150 MG 60 MG (sarecycline hcl)

3 DSL = 30 days

AMINOPENICILLIN ANTIBIOTICS - Antibiotics

amoxicill-clarithro-lansopraz oral 1

amoxicillin oral capsule 250 mg 500 mg 1

amoxicillin oral suspension reconstituted 125 mg5ml 200 mg5ml 250 mg5ml 400 mg5ml

1

amoxicillin oral tablet 500 mg 875 mg 1

amoxicillin oral tablet chewable 125 mg 250 mg 1

amoxicillin-potassium clavulanate er oral tablet extended release 12 hour 1000-625 mg

1

amoxicillin-potassium clavulanate oral suspension reconstituted200-285 mg5ml 250-625 mg5ml 400-57 mg5ml 600-429 mg5ml

1

amoxicillin-potassium clavulanate oral tablet 250-125 mg 500-125 mg 875-125 mg

1

amoxicillin-potassium clavulanate oral tablet chewable 200-285 mg 400-57 mg

1

ampicillin oral capsule 500 mg 1


13


ampicillin-sulbactam sodium injection solution reconstituted 3 (2-1) gm

1

AUGMENTIN ORAL SUSPENSION RECONSTITUTED 125-3125 MG5ML (amoxicillin-pot clavulanate)

2

OMECLAMOX-PAK ORAL 500-500-20 MG (amoxicill-clarithro-omeprazole)

3

TALICIA ORAL CAPSULE DELAYED RELEASE 250-125-10 MG (amoxicill-rifabutin-omeprazole)

3

ANTHELMINTICS - Drugs for Parasites

albendazole oral tablet 200 mg 1 DSL = 30 days

ALBENZA ORAL TABLET 200 MG (albendazole) 3 DSL = 30 days

BILTRICIDE ORAL TABLET 600 MG (praziquantel) 2

EGATEN ORAL TABLET 250 MG (triclabendazole) 3

EMVERM ORAL TABLET CHEWABLE 100 MG (mebendazole) 3

ivermectin oral tablet 3 mg 1

praziquantel oral tablet 600 mg 1

ANTIFUNGALS MISCELLANEOUS - Drugs for Fungus

griseofulvin microsize oral suspension 125 mg5ml 1

griseofulvin microsize oral tablet 500 mg 1

griseofulvin ultramicrosize oral tablet 125 mg 250 mg 1

IODINE STRONG ORAL SOLUTION 5 3

SSKI ORAL SOLUTION 1 GMML (potassium iodide (expectorant))

3

ANTIMALARIALS - Drugs for the Mouth and Throat

ARAKODA ORAL TABLET 100 MG (tafenoquine succinate) PV

atovaquone-proguanil hcl oral tablet 250-100 mg 625-25 mg PV

chloroquine phosphate oral tablet 250 mg 500 mg PV

COARTEM ORAL TABLET 20-120 MG (artemether-lumefantrine)

PV

DARAPRIM ORAL TABLET 25 MG (pyrimethamine) PV DSL = 30 days


hydroxychloroquine sulfate oral tablet 200 mg PV

KRINTAFEL ORAL TABLET 150 MG (tafenoquine succinate) PV

MALARONE ORAL TABLET 250-100 MG 625-25 MG (atovaquone-proguanil hcl)

PV

mefloquine hcl oral tablet 250 mg PV

PLAQUENIL ORAL TABLET 200 MG (hydroxychloroquine sulfate)

PV

primaquine phosphate oral tablet 263 mg PV


14



3

pyrimethamine oral tablet 25 mg PV DSL = 30 days

QUALAQUIN ORAL CAPSULE 324 MG (quinine sulfate) PV

quinidine gluconate er oral tablet extended release 324 mg 1

quinidine sulfate oral tablet 200 mg 300 mg 1

quinine sulfate oral capsule 324 mg PV

ANTIMYCOBACTERIALS MISCELLANEOUS - Antibiotics

dapsone oral tablet 100 mg 25 mg 1

ANTIPROTOZOALS MISCELLANEOUS - Drugs for the Mouth and Throat

ALINIA ORAL SUSPENSION RECONSTITUTED 100 MG5ML (nitazoxanide)

2

ALINIA ORAL TABLET 500 MG (nitazoxanide) 2

atovaquone oral suspension 750 mg5ml PV

BENZNIDAZOLE ORAL TABLET 100 MG 125 MG 3



IMPAVIDO ORAL CAPSULE 50 MG (miltefosine) 3 DSL = 30 days

LAMPIT ORAL TABLET 120 MG 30 MG (nifurtimox) 3

MEPRON ORAL SUSPENSION 750 MG5ML (atovaquone) PV



NEBUPENT INHALATION SOLUTION RECONSTITUTED 300 MG (pentamidine isethionate)

PV

nitazoxanide oral tablet 500 mg 1

PENTAM INJECTION SOLUTION RECONSTITUTED 300 MG (pentamidine isethionate)

PV

pentamidine isethionate inhalation solution reconstituted 300 mg

PV

pentamidine isethionate injection solution reconstituted 300 mg PV


3

SOLOSEC ORAL PACKET 2 GM (secnidazole) 3

tinidazole oral tablet 250 mg 500 mg 1

ANTITUBERCULOSIS AGENTS - Antibiotics


CAPASTAT SULFATE INJECTION SOLUTION RECONSTITUTED 1 GM (capreomycin sulfate)

2


15


CIPRO ORAL SUSPENSION RECONSTITUTED 250 MG5ML (5) 500 MG5ML (10) (ciprofloxacin)

2

ciprofloxacin hcl oral tablet 100 mg 250 mg 500 mg 750 mg 1

clarithromycin er oral tablet extended release 24 hour 500 mg 1

clarithromycin oral suspension reconstituted 125 mg5ml 250 mg5ml

1

clarithromycin oral tablet 250 mg 500 mg 1

cycloserine oral capsule 250 mg 1

ethambutol hcl oral tablet 100 mg 400 mg 1

isoniazid oral syrup 50 mg5ml 1

isoniazid oral tablet 100 mg 300 mg 1

levofloxacin oral solution 25 mgml 1

levofloxacin oral tablet 250 mg 500 mg 750 mg 1

moxifloxacin hcl in nacl intravenous solution 400 mg250ml 1

moxifloxacin hcl oral tablet 400 mg 1

PASER ORAL PACKET 4 GM (aminosalicylic acid) 3

PRETOMANID ORAL TABLET 200 MG 3

PRIFTIN ORAL TABLET 150 MG (rifapentine) 2

pyrazinamide oral tablet 500 mg 1

rifabutin oral capsule 150 mg 1

rifampin oral capsule 150 mg 300 mg 1

SIRTURO ORAL TABLET 100 MG 20 MG (bedaquiline fumarate)

3 DSL = 30 days


TRECATOR ORAL TABLET 250 MG (ethionamide) 2

ANTIVIRALS MISCELLANEOUS - Drugs for Viral Infections

foscarnet sodium intravenous solution 6000 mg250ml PV

FOSCAVIR INTRAVENOUS SOLUTION 6000 MG250ML (foscarnet sodium)

PV

PREVYMIS INTRAVENOUS SOLUTION 240 MG12ML 480 MG24ML (letermovir)

PV DSL = 30 days

PREVYMIS ORAL TABLET 240 MG 480 MG (letermovir) PV DSL = 30 days

XOFLUZA (40 MG DOSE) ORAL TABLET THERAPY PACK 2 X 20 MG (baloxavir marboxil)

3


3

AZOLE ANTIFUNGALS - Drugs for Fungus

CRESEMBA ORAL CAPSULE 186 MG (isavuconazonium sulfate)

3


16


fluconazole oral suspension reconstituted 10 mgml 40 mgml 1

fluconazole oral tablet 100 mg 150 mg 200 mg 50 mg 1

itraconazole oral capsule 100 mg 1

itraconazole oral solution 10 mgml 1

ketoconazole oral tablet 200 mg 1

NOXAFIL ORAL SUSPENSION 40 MGML (posaconazole) 3

posaconazole oral tablet delayed release 100 mg 1

SPORANOX ORAL SOLUTION 10 MGML (itraconazole) 2

TOLSURA ORAL CAPSULE 65 MG 3

VFEND ORAL SUSPENSION RECONSTITUTED 40 MGML (voriconazole)

PV

VFEND ORAL TABLET 200 MG 50 MG (voriconazole) PV

voriconazole oral suspension reconstituted 40 mgml PV

voriconazole oral tablet 200 mg 50 mg PV

CARBAPENEM ANTIBIOTICS - Antibiotics

ertapenem sodium injection solution reconstituted 1 gm 1

imipenem-cilastatin intravenous solution reconstituted 250 mg 1

INVANZ INJECTION SOLUTION RECONSTITUTED 1 GM (ertapenem sodium)

2

meropenem intravenous solution reconstituted 500 mg 1

MEROPENEM-SODIUM CHLORIDE INTRAVENOUS SOLUTION RECONSTITUTED 1 GM50ML 500 MG50ML

3

RECARBRIO INTRAVENOUS SOLUTION RECONSTITUTED 125 GM (imipenem-cilastatin-relebactam)

3 DSL = 30 days

CEPHAMYCIN ANTIBIOTICS - Antibiotics



CHLORAMPHENICOL ANTIBIOTICS - Antibiotics

chloramphenicol sod succinate intravenous solution reconstituted 1 gm

1

CYCLIC LIPOPEPTIDE ANTIBIOTICS - Antibiotics

CUBICIN INTRAVENOUS SOLUTION RECONSTITUTED 500 MG (daptomycin)

2

CUBICIN RF INTRAVENOUS SOLUTION RECONSTITUTED 500 MG (daptomycin)

2

daptomycin intravenous solution reconstituted 350 mg 500 mg 1

ECHINOCANDIN ANTIFUNGALS - Drugs for Fungus

CANCIDAS INTRAVENOUS SOLUTION RECONSTITUTED 70 MG (caspofungin acetate)

2


17


caspofungin acetate intravenous solution reconstituted 70 mg 1

ERAXIS INTRAVENOUS SOLUTION RECONSTITUTED 100 MG (anidulafungin)

3

micafungin sodium intravenous solution reconstituted 100 mg 1

ERYTHROMYCIN ANTIBIOTICS - Antibiotics

EES GRANULES ORAL SUSPENSION RECONSTITUTED 200 MG5ML (erythromycin ethylsuccinate)

3

ERYPED 200 ORAL SUSPENSION RECONSTITUTED 200 MG5ML (erythromycin ethylsuccinate)

3

ERYTHROCIN STEARATE ORAL TABLET 250 MG (erythromycin stearate)

3

erythromycin base oral capsule delayed release particles 250 mg

1

erythromycin base oral tablet 250 mg 500 mg 1

erythromycin base oral tablet delayed release 250 mg 333 mg 500 mg

1

erythromycin ethylsuccinate oral suspension reconstituted 200 mg5ml 400 mg5ml

1

erythromycin ethylsuccinate oral tablet 400 mg 1

erythromycin oral tablet delayed release 250 mg 333 mg 500 mg

1

EXTENDED-SPECTRUM PENICILLINS - Antibiotics

piperacillin sod-tazobactam so intravenous solution reconstituted 45 (4-05) gm

1

GLYCOPEPTIDE ANTIBIOTICS - Antibiotics

FIRVANQ ORAL SOLUTION RECONSTITUTED 25 MGML 50 MGML (vancomycin hcl)

2

vancomycin hcl in nacl intravenous solution 1-09 gm200ml- 1

vancomycin hcl intravenous solution 1000 mg200ml 1250 mg250ml 1500 mg300ml 1750 mg350ml 2000 mg400ml 500 mg100ml 750 mg150ml

1

vancomycin hcl oral capsule 125 mg 250 mg 1

vancomycin hcl oral solution reconstituted 250 mg5ml 1

GLYCYLCYCLINE ANTIBIOTICS - Antibiotics

tigecycline intravenous solution reconstituted 50 mg 1

HCV POLYMERASE INHIBITOR ANTIVIRALS - Drugs for Viral Infections

EPCLUSA ORAL TABLET 200-50 MG (sofosbuvir-velpatasvir) 3 DSL = 30 days



18


HARVONI ORAL PACKET 3375-150 MG 45-200 MG (ledipasvir-sofosbuvir)

3 DSL = 30 days

HARVONI ORAL TABLET 45-200 MG (ledipasvir-sofosbuvir) 3 DSL = 30 days


LEDIPASVIR-SOFOSBUVIR ORAL TABLET 90-400 MG 2 DSL = 30 days

SOFOSBUVIR-VELPATASVIR ORAL TABLET 400-100 MG 2 DSL = 30 days

SOVALDI ORAL PACKET 150 MG 200 MG (sofosbuvir) 3 DSL = 30 days

SOVALDI ORAL TABLET 200 MG (sofosbuvir) 3 DSL = 30 days


VIEKIRA PAK ORAL TABLET THERAPY PACK 125-75-50 amp250 MG (ombitas-paritapre-ritona-dasab)

3 DSL = 30 days

VOSEVI ORAL TABLET 400-100-100 MG (sofosbuv-velpatasv-voxilaprev)

2 DSL = 30 days

HCV PROTEASE INHIBITOR ANTIVIRALS - Drugs for Viral Infections

MAVYRET ORAL TABLET 100-40 MG (glecaprevir-pibrentasvir)

3 DSL = 30 days


3 DSL = 30 days

ZEPATIER ORAL TABLET 50-100 MG (elbasvir-grazoprevir) 3 DSL = 30 days

HCV REPLICATION COMPLEX INHIBITORS - Drugs for Viral Infections




3 DSL = 30 days





3 DSL = 30 days



3 DSL = 30 days


2 DSL = 30 days



19


HIV ENTRY AND FUSION INHIBITORS - Drugs for Viral Infections

FUZEON SUBCUTANEOUS SOLUTION RECONSTITUTED 90 MG (enfuvirtide)

2 DSL = 30 days

RUKOBIA ORAL TABLET EXTENDED RELEASE 12 HOUR 600 MG (fostemsavir tromethamine)

3

SELZENTRY ORAL SOLUTION 20 MGML (maraviroc) 3

SELZENTRY ORAL TABLET 150 MG 25 MG 300 MG 75 MG (maraviroc)

2

TROGARZO INTRAVENOUS SOLUTION 200 MG133ML (ibalizumab-uiyk)

3

HIV INTEGRASE INHIBITOR ANTIRETROVIRALS - Drugs for Viral Infections

BIKTARVY ORAL TABLET 50-200-25 MG (bictegravir-emtricitab-tenofov)

2

CABENUVA INTRAMUSCULAR SUSPENSION EXTENDED RELEASE 400 amp 600 MG2ML 600 amp 900 MG3ML

3

DOVATO ORAL TABLET 50-300 MG (dolutegravir-lamivudine) 2

GENVOYA ORAL TABLET 150-150-200-10 MG (elviteg-cobic-emtricit-tenofaf)

2

ISENTRESS HD ORAL TABLET 600 MG (raltegravir potassium)

2

ISENTRESS ORAL PACKET 100 MG (raltegravir potassium) 3

ISENTRESS ORAL TABLET 400 MG (raltegravir potassium) 2

ISENTRESS ORAL TABLET CHEWABLE 100 MG 25 MG (raltegravir potassium)

2

JULUCA ORAL TABLET 50-25 MG (dolutegravir-rilpivirine) 2

STRIBILD ORAL TABLET 150-150-200-300 MG (elviteg-cobic-emtricit-tenofdf)

2

TIVICAY ORAL TABLET 10 MG 25 MG 50 MG (dolutegravir sodium)

2

TIVICAY PD ORAL TABLET SOLUBLE 5 MG (dolutegravir sodium)

2

TRIUMEQ ORAL TABLET 600-50-300 MG (abacavir-dolutegravir-lamivud)

2

VOCABRIA ORAL TABLET 30 MG 3

HIV NONNUCLEOSIDE REVTRANSCRIP INHIB - Drugs for Viral Infections

ATRIPLA ORAL TABLET 600-200-300 MG (efavirenz-emtricitab-tenofovir)

3 DSL = 30 days


20


COMPLERA ORAL TABLET 200-25-300 MG (emtricitab-rilpivir-tenofovir)

2

DELSTRIGO ORAL TABLET 100-300-300 MG (doravirin-lamivudin-tenofov df)

3

EDURANT ORAL TABLET 25 MG (rilpivirine hcl) 2

efavirenz oral capsule 200 mg 50 mg 1

efavirenz oral tablet 600 mg 1

efavirenz-emtricitab-tenofovir oral tablet 600-200-300 mg 1

efavirenz-lamivudine-tenofovir oral tablet 400-300-300 mg 600-300-300 mg

1

INTELENCE ORAL TABLET 100 MG 200 MG 25 MG (etravirine)

2


nevirapine er oral tablet extended release 24 hour 100 mg 400 mg

1

nevirapine oral suspension 50 mg5ml 1

nevirapine oral tablet 200 mg 1

ODEFSEY ORAL TABLET 200-25-25 MG (emtricitab-rilpivir-tenofov af)

2

PIFELTRO ORAL TABLET 100 MG (doravirine) 3

VIRAMUNE ORAL SUSPENSION 50 MG5ML (nevirapine) 2

HIV NUCLEOSIDE NUCLEOTIDE RT INHIBITORS - Drugs for Viral Infections

abacavir sulfate oral solution 20 mgml 1

abacavir sulfate oral tablet 300 mg 1

abacavir sulfate-lamivudine oral tablet 600-300 mg 1

abacavir-lamivudine-zidovudine oral tablet 300-150-300 mg 1


3 DSL = 30 days


2

CIMDUO ORAL TABLET 300-300 MG (lamivudine-tenofovir) 2


2


3

DESCOVY ORAL TABLET 200-25 MG (emtricitabine-tenofovir af)

PV




21



1

emtricitabine oral capsule 200 mg 1

emtricitabine-tenofovir df oral tablet 100-150 mg 133-200 mg 167-250 mg 200-300 mg

1

EMTRIVA ORAL CAPSULE 200 MG (emtricitabine) 3

EMTRIVA ORAL SOLUTION 10 MGML (emtricitabine) 2

EPIVIR HBV ORAL SOLUTION 5 MGML (lamivudine) 2

EPIVIR HBV ORAL TABLET 100 MG (lamivudine) 2


2

lamivudine oral solution 10 mgml 1

lamivudine oral tablet 100 mg 150 mg 300 mg 1

lamivudine-zidovudine oral tablet 150-300 mg 1


2

RETROVIR INTRAVENOUS SOLUTION 10 MGML (zidovudine)

2

stavudine oral capsule 15 mg 20 mg 30 mg 40 mg 1


2

SYMTUZA ORAL TABLET 800-150-200-10 MG (darun-cobic-emtricit-tenofaf)

2

TEMIXYS ORAL TABLET 300-300 MG (lamivudine-tenofovir) 2

tenofovir disoproxil fumarate oral tablet 300 mg 1


2

TRUVADA ORAL TABLET 200-300 MG (emtricitabine-tenofovir df)

PV

VIREAD ORAL POWDER 40 MGGM (tenofovir disoproxil fumarate)

3

VIREAD ORAL TABLET 150 MG 200 MG 250 MG (tenofovir disoproxil fumarate)

3

ZIAGEN ORAL SOLUTION 20 MGML (abacavir sulfate) 2

zidovudine oral capsule 100 mg 1

zidovudine oral syrup 50 mg5ml 1

zidovudine oral tablet 300 mg 1

HIV PROTEASE INHIBITOR ANTIRETROVIRALS - Drugs for Viral Infections

APTIVUS ORAL CAPSULE 250 MG (tipranavir) 2


22


APTIVUS ORAL SOLUTION 100 MGML (tipranavir) 3

atazanavir sulfate oral capsule 150 mg 200 mg 300 mg 1

CRIXIVAN ORAL CAPSULE 400 MG (indinavir sulfate) 2

EVOTAZ ORAL TABLET 300-150 MG (atazanavir-cobicistat) 2

fosamprenavir calcium oral tablet 700 mg 1

INVIRASE ORAL TABLET 500 MG (saquinavir mesylate) 2

KALETRA ORAL SOLUTION 400-100 MG5ML (lopinavir-ritonavir)

2

KALETRA ORAL TABLET 100-25 MG 200-50 MG (lopinavir-ritonavir)

2

LEXIVA ORAL SUSPENSION 50 MGML (fosamprenavir calcium)

3

LEXIVA ORAL TABLET 700 MG (fosamprenavir calcium) 2

lopinavir-ritonavir oral solution 400-100 mg5ml 1

NORVIR ORAL PACKET 100 MG (ritonavir) 3

NORVIR ORAL SOLUTION 80 MGML (ritonavir) 2

PREZCOBIX ORAL TABLET 800-150 MG (darunavir-cobicistat) 2

PREZISTA ORAL SUSPENSION 100 MGML (darunavir ethanolate)

3

PREZISTA ORAL TABLET 150 MG 600 MG 75 MG 800 MG (darunavir ethanolate)

2

REYATAZ ORAL CAPSULE 150 MG 200 MG 300 MG (atazanavir sulfate)

3

REYATAZ ORAL PACKET 50 MG (atazanavir sulfate) 3

ritonavir oral tablet 100 mg 1


2


3 DSL = 30 days

VIRACEPT ORAL TABLET 250 MG 625 MG (nelfinavir mesylate)

2

INTERFERON ANTIVIRALS - Drugs for Viral Infections

ALFERON N INJECTION SOLUTION 5000000 UNITML (interferon alfa-n3)

3

INTRON A INJECTION SOLUTION 10000000 UNITML 6000000 UNITML (interferon alfa-2b)

2 DSL = 30 days

INTRON A INJECTION SOLUTION RECONSTITUTED 10000000 UNIT 18000000 UNIT 50000000 UNIT (interferon alfa-2b)

2 DSL = 30 days


23


PEGASYS SUBCUTANEOUS SOLUTION 180 MCG05ML 180 MCGML (peginterferon alfa-2a)

2 DSL = 30 days

PEGINTRON SUBCUTANEOUS KIT 50 MCG05ML (peginterferon alfa-2b)

2 DSL = 30 days

LINCOMYCIN ANTIBIOTICS - Antibiotics

CLEOCIN ORAL SOLUTION RECONSTITUTED 75 MG5ML (clindamycin palmitate hcl)

2

clindamycin hcl oral capsule 150 mg 300 mg 75 mg 1

clindamycin palmitate hcl oral solution reconstituted 75 mg5ml 1

lincomycin hcl injection solution 300 mgml 1

MACROLIDE ANTIBIOTICS - Antibiotics


3


3


3


1



1


1



1

MONOBACTAM ANTIBIOTICS - Antibiotics

CAYSTON INHALATION SOLUTION RECONSTITUTED 75 MG (aztreonam lysine)

3 DSL = 30 days

MONOCLONAL ANTIBODY ANTIVIRALS - Drugs for Viral Infections

BAMLANIVIMAB INTRAVENOUS SOLUTION 700 MG20ML 3

CASIRIVIMAB INTRAVENOUS SOLUTION 1332 MG111ML 300 MG25ML

3

ETESEVIMAB INTRAVENOUS SOLUTION 700 MG20ML 3

IMDEVIMAB INTRAVENOUS SOLUTION 1332 MG111ML 300 MG25ML

3

SYNAGIS INTRAMUSCULAR SOLUTION 100 MGML 50 MG05ML (palivizumab)

2


24


NATURAL PENICILLIN ANTIBIOTICS - Antibiotics

BICILLIN L-A INTRAMUSCULAR SUSPENSION 1200000 UNIT2ML 2400000 UNIT4ML 600000 UNITML (penicillin g benzathine)

2

penicillin g potassium injection solution reconstituted 5000000 unit

1

penicillin g procaine intramuscular suspension 600000 unitml 1

penicillin g sodium injection solution reconstituted 5000000 unit 1

penicillin v potassium oral solution reconstituted 125 mg5ml 250 mg5ml

1

penicillin v potassium oral tablet 250 mg 500 mg 1

NEURAMINIDASE INHIBITOR ANTIVIRALS - Drugs for Viral Infections

oseltamivir phosphate oral capsule 30 mg 45 mg 75 mg PV

oseltamivir phosphate oral suspension reconstituted 6 mgml PV

RAPIVAB INTRAVENOUS SOLUTION 200 MG20ML (peramivir)

PV

RELENZA DISKHALER INHALATION AEROSOL POWDER BREATH ACTIVATED 5 MGBLISTER (zanamivir)

PV

TAMIFLU ORAL CAPSULE 30 MG 45 MG 75 MG (oseltamivir phosphate)

PV

TAMIFLU ORAL SUSPENSION RECONSTITUTED 6 MGML (oseltamivir phosphate)

PV

NUCLEOSIDE AND NUCLEOTIDE ANTIVIRALS - Drugs for Viral Infections

acyclovir oral capsule 200 mg PV

acyclovir oral suspension 200 mg5ml PV

acyclovir oral tablet 400 mg 800 mg PV

ACYCLOVIX COMBINATION THERAPY PACK 200-10 MG- 3

adefovir dipivoxil oral tablet 10 mg 1

BARACLUDE ORAL SOLUTION 005 MGML (entecavir) 2

BARACLUDE ORAL TABLET 05 MG 1 MG (entecavir) 3

cidofovir intravenous solution 75 mgml PV

entecavir oral tablet 05 mg 1 mg 1

famciclovir oral tablet 125 mg 250 mg 500 mg PV


PV DSL = 30 days


ribavirin inhalation solution reconstituted 6 gm 1


25


ribavirin oral capsule 200 mg 1

ribavirin oral tablet 200 mg 1

SITAVIG BUCCAL TABLET 50 MG (acyclovir) PV


2

valacyclovir hcl oral tablet 1 gm 500 mg PV

VALCYTE ORAL SOLUTION RECONSTITUTED 50 MGML (valganciclovir hcl)

PV DSL = 30 days

VALCYTE ORAL TABLET 450 MG (valganciclovir hcl) PV DSL = 30 days

valganciclovir hcl oral solution reconstituted 50 mgml PV DSL = 30 days

valganciclovir hcl oral tablet 450 mg PV DSL = 30 days

VALTREX ORAL TABLET 1 GM 500 MG (valacyclovir hcl) PV

VEMLIDY ORAL TABLET 25 MG (tenofovir alafenamide fumarate)

3 DSL = 30 days

VIRAZOLE INHALATION SOLUTION RECONSTITUTED 6 GM (ribavirin)

2

ZOVIRAX ORAL SUSPENSION 200 MG5ML (acyclovir) PV

OTHER MACROLIDE ANTIBIOTICS - Antibiotics


azithromycin oral packet 1 gm 1

azithromycin oral suspension reconstituted 100 mg5ml 200 mg5ml

1

azithromycin oral tablet 250 mg 500 mg 600 mg 1



1


DIFICID ORAL SUSPENSION RECONSTITUTED 40 MGML (fidaxomicin)

3 DSL = 30 days

DIFICID ORAL TABLET 200 MG (fidaxomicin) 3 DSL = 30 days


3

ZITHROMAX ORAL PACKET 1 GM (azithromycin) 2

OTHER MISC ANTIBACTERIAL AGENTS - Antibiotics



3


26


OXAZOLIDINONE ANTIBIOTICS - Antibiotics

linezolid in sodium chloride intravenous solution 600-09 mg300ml-

1

linezolid intravenous solution 600 mg300ml 1

linezolid oral suspension reconstituted 100 mg5ml 1

linezolid oral tablet 600 mg 1

SIVEXTRO INTRAVENOUS SOLUTION RECONSTITUTED 200 MG (tedizolid phosphate)

3

SIVEXTRO ORAL TABLET 200 MG (tedizolid phosphate) 3

ZYVOX INTRAVENOUS SOLUTION 200 MG100ML 600 MG300ML (linezolid)

3

ZYVOX ORAL SUSPENSION RECONSTITUTED 100 MG5ML (linezolid)

2

ZYVOX ORAL TABLET 600 MG (linezolid) 2

PENICILLINASE-RESISTANT PENICILLINS - Antibiotics

dicloxacillin sodium oral capsule 250 mg 500 mg 1

nafcillin sodium injection solution reconstituted 1 gm 1

nafcillin sodium intravenous solution reconstituted 10 gm 1

oxacillin sodium injection solution reconstituted 1 gm 1

oxacillin sodium intravenous solution reconstituted 10 gm 1

PLEUROMUTILINS - Antibiotics

XENLETA INTRAVENOUS SOLUTION 150 MG15ML (lefamulin acetate)

3 DSL = 30 days

XENLETA ORAL TABLET 600 MG (lefamulin acetate) 3 DSL = 30 days

POLYENE ANTIFUNGALS - Drugs for Fungus

nystatin mouththroat suspension 100000 unitml 1

nystatin oral tablet 500000 unit 1

POLYMYXIN ANTIBIOTICS - Antibiotics

colistimethate sodium (cba) injection solution reconstituted 150 mg

1

polymyxin b sulfate injection solution reconstituted 500000 unit 1

PYRIMIDINE ANTIFUNGALS - Drugs for Fungus

flucytosine oral capsule 250 mg 500 mg 1

QUINOLONE ANTIBIOTICS - Antibiotics

BAXDELA INTRAVENOUS SOLUTION RECONSTITUTED 300 MG (delafloxacin meglumine)

3

BAXDELA ORAL TABLET 450 MG (delafloxacin meglumine) 3


2


27







ofloxacin oral tablet 300 mg 400 mg 1

RIFAMYCIN ANTIBIOTICS - Antibiotics

AEMCOLO ORAL TABLET DELAYED RELEASE 194 MG (rifamycin sodium)

3





3

XIFAXAN ORAL TABLET 200 MG (rifaximin) 3 DSL = 30 days


SIDEROPHORE CEPHALOSPORINS - Antibiotics

FETROJA INTRAVENOUS SOLUTION RECONSTITUTED 1 GM (cefiderocol sulfate tosylate)

3 DSL = 30 days

SULFONAMIDE ANTIBIOTICS (SYSTEMIC) - Antibiotics

sulfadiazine oral tablet 500 mg 1

sulfamethoxazole-trimethoprim oral suspension 200-40 mg5ml 1

sulfamethoxazole-trimethoprim oral tablet 400-80 mg 800-160 mg

1

sulfasalazine oral tablet 500 mg 1

sulfasalazine oral tablet delayed release 500 mg 1

sulfamethoxazole-trimethoprim (Sulfatrim Pediatric Oral Suspension 200-40 Mg5Ml)

1

TETRACYCLINE ANTIBIOTICS - Antibiotics

AVIDOXY DK COMBINATION KIT 100 MG (doxycycline-suncreen-sal acid)

3

avidoxy oral tablet 100 mg 1

BENZODOX COMBINATION THERAPY PACK 30 X 100 MG amp 44 60 X 100 MG amp 44 (doxycycline-benzoyl peroxide)

3

minocycline hcl (Coremino Oral Tablet Extended Release 24 Hour 135 Mg 45 Mg 90 Mg)

1

demeclocycline hcl oral tablet 150 mg 300 mg 1

DORYX MPC ORAL TABLET DELAYED RELEASE 120 MG (doxycycline hyclate)

3


28


DORYX ORAL TABLET DELAYED RELEASE 80 MG (doxycycline hyclate)

3

doxycycline hyclate (Doxy 100 Intravenous Solution Reconstituted 100 Mg)

1

doxycycline hyclate intravenous solution reconstituted 100 mg 1

doxycycline hyclate oral capsule 100 mg 50 mg 1

doxycycline hyclate oral tablet 100 mg 150 mg 50 mg 75 mg 1

doxycycline hyclate oral tablet delayed release 100 mg 150 mg 200 mg 50 mg 75 mg

1

DOXYCYCLINE HYCLATE ORAL TABLET DELAYED RELEASE 80 MG

3

doxycycline monohydrate oral capsule 100 mg 150 mg 50 mg 75 mg

1

doxycycline monohydrate oral suspension reconstituted 25 mg5ml

1

doxycycline monohydrate oral tablet 100 mg 150 mg 50 mg 75 mg

1

doxycycline oral capsule delayed release 40 mg 1


MINOCYCLINE HCL ER ORAL CAPSULE EXTENDED RELEASE 24 HOUR 135 MG 45 MG 90 MG

3

minocycline hcl er oral tablet extended release 24 hour 105 mg 115 mg 135 mg 45 mg 55 mg 65 mg 80 mg 90 mg

1

minocycline hcl oral capsule 100 mg 50 mg 75 mg 1

minocycline hcl oral tablet 100 mg 50 mg 75 mg 1

MINOLIRA ORAL TABLET EXTENDED RELEASE 24 HOUR 105 MG 135 MG (minocycline hcl)

3

doxycycline monohydrate (Mondoxyne Nl Oral Capsule 100 Mg 75 Mg)

1

MORGIDOX COMBINATION KIT 1 X 100 MG 2 X 100 MG (doxycycline hyclate-cleanser)

3

doxycycline hyclate (Morgidox Oral Capsule 100 Mg) 1

NUTRIDOX ORAL KIT 75 MG (doxycycline monohyd-omega 3-e)

3


3


3 DSL = 30 days

SOLODYN ORAL TABLET EXTENDED RELEASE 24 HOUR 105 MG 115 MG 55 MG 65 MG 80 MG (minocycline hcl)

3

tetracycline hcl oral capsule 250 mg 500 mg 1


29


VIBRAMYCIN ORAL SYRUP 50 MG5ML (doxycycline calcium) 3

XIMINO ORAL CAPSULE EXTENDED RELEASE 24 HOUR 135 MG 45 MG 90 MG (minocycline hcl)

3

URINARY ANTI-INFECTIVES - Drugs for the Urinary System

fosfomycin tromethamine oral packet 3 gm 1

HYOPHEN ORAL TABLET 816 MG (meth-hyo-m bl-benz acd-ph sal)

3

MACRODANTIN ORAL CAPSULE 25 MG (nitrofurantoin macrocrystal)

2

menaphosmbhyo1 oral tablet 816 mg 1

methenamine hippurate oral tablet 1 gm 1

methenamine mandelate oral tablet 05 gm 1 gm 1

nitrofurantoin macrocrystal oral capsule 100 mg 25 mg 50 mg 1

nitrofurantoin monohydrate macrocrystals oral capsule 100 mg 1

nitrofurantoin oral suspension 25 mg5ml 1

meth-hyo-m bl-na phos-ph sal (Phosphasal Oral Tablet 816 Mg)

3

PRIMSOL ORAL SOLUTION 50 MG5ML (trimethoprim hcl) 2

trimethoprim oral tablet 100 mg 1

meth-hyo-m bl-na phos-ph sal (Urelle Oral Tablet 81 Mg) 3

meth-hyo-m bl-na phos-ph sal (Uretron DS Oral Tablet 816 Mg)

1

meth-hyo-m bl-na phos-ph sal (Uribel Oral Capsule 118 Mg) 3

URIMAR-T ORAL TABLET 120 MG (meth-hyo-m bl-na phos-ph sal)

3

urin ds oral tablet 816 mg 1

URO-458 ORAL TABLET 81 MG 3

UROGESIC-BLUE ORAL TABLET 816 MG (methen-hyosc-meth blue-na phos)

3

uro-mp oral capsule 118 mg 1

meth-hyo-m bl-na phos-ph sal (Ustell Oral Capsule 120 Mg) 3

meth-hyo-m bl-na phos-ph sal (Utira-C Oral Tablet 816 Mg) 3

meth-hyo-m bl-na phos-ph sal (Vilamit Mb Oral Capsule 118 Mg)

3

meth-hyo-m bl-na phos-ph sal (Vilevev Mb Oral Tablet 81 Mg) 3

ANTINEOPLASTIC AGENTS - Drugs for Cancer


abiraterone acetate oral tablet 250 mg 500 mg 1 OC


30


ABRAXANE INTRAVENOUS SUSPENSION RECONSTITUTED 100 MG (paclitaxel protein-bound part)

2

ADCETRIS INTRAVENOUS SOLUTION RECONSTITUTED 50 MG (brentuximab vedotin)

2

doxorubicin hcl (Adriamycin Intravenous Solution 2 MgMl) 1

adriamycin intravenous solution reconstituted 10 mg 1


AFINITOR DISPERZ ORAL TABLET SOLUBLE 2 MG 3 MG 5 MG (everolimus)

3 DSL = 30 days OC

AFINITOR ORAL TABLET 10 MG (everolimus) 2 DSL = 30 days OC

AFINITOR ORAL TABLET 25 MG 5 MG 75 MG (everolimus) 3 DSL = 30 days OC

ALECENSA ORAL CAPSULE 150 MG (alectinib hcl) 2 DSL = 30 days OC


3

ALIMTA INTRAVENOUS SOLUTION RECONSTITUTED 100 MG (pemetrexed disodium)

3


2

ALIQOPA INTRAVENOUS SOLUTION RECONSTITUTED 60 MG (copanlisib hcl)

3 DSL = 30 days

ALKERAN ORAL TABLET 2 MG (melphalan) 2 OC

ALUNBRIG ORAL TABLET 180 MG 30 MG 90 MG (brigatinib) 2 DSL = 30 days OC

ALUNBRIG ORAL TABLET THERAPY PACK 90 amp 180 MG (brigatinib)

2 DSL = 30 days OC

anastrozole oral tablet 1 mg PV OC

ARIMIDEX ORAL TABLET 1 MG (anastrozole) PV OC

AROMASIN ORAL TABLET 25 MG (exemestane) PV OC

ARRANON INTRAVENOUS SOLUTION 5 MGML (nelarabine) 2

arsenic trioxide intravenous solution 10 mg10ml 1

arsenic trioxide intravenous solution 12 mg6ml 1 DSL = 30 days

ARZERRA INTRAVENOUS CONCENTRATE 100 MG5ML 1000 MG50ML (ofatumumab)

3 DSL = 30 days

ASPARLAS INTRAVENOUS SOLUTION 3750 UNIT5ML (calaspargase pegol-mknl)

3 DSL = 30 days

AVASTIN INTRAVENOUS SOLUTION 100 MG4ML 400 MG16ML (bevacizumab)

2

AYVAKIT ORAL TABLET 100 MG 200 MG 300 MG (avapritinib)

3 DSL = 30 days

azacitidine injection suspension reconstituted 100 mg 1

BALVERSA ORAL TABLET 3 MG 4 MG 5 MG (erdafitinib) 3 DSL = 30 days


31


BAVENCIO INTRAVENOUS SOLUTION 200 MG10ML (avelumab)

3 DSL = 30 days

BELEODAQ INTRAVENOUS SOLUTION RECONSTITUTED 500 MG (belinostat)

3 DSL = 30 days

BELRAPZO INTRAVENOUS SOLUTION 100 MG4ML (bendamustine hcl)

2 DSL = 30 days

BENDEKA INTRAVENOUS SOLUTION 100 MG4ML (bendamustine hcl)

2 DSL = 30 days

BESPONSA INTRAVENOUS SOLUTION RECONSTITUTED 09 MG (inotuzumab ozogamicin)

3 DSL = 30 days

bexarotene oral capsule 75 mg 1 OC

bicalutamide oral tablet 50 mg 1 OC

BICNU INTRAVENOUS SOLUTION RECONSTITUTED 100 MG (carmustine)

2

BLENREP INTRAVENOUS SOLUTION RECONSTITUTED 100 MG (belantamab mafodotin-blmf)

3 DSL = 30 days

bleomycin sulfate injection solution reconstituted 15 unit 30 unit 1

BLINCYTO INTRAVENOUS SOLUTION RECONSTITUTED 35 MCG (blinatumomab)

2 DSL = 30 days

BORTEZOMIB INTRAVENOUS SOLUTION RECONSTITUTED 35 MG

3

BOSULIF ORAL TABLET 100 MG 400 MG 500 MG (bosutinib) 3 DSL = 30 days OC

BRAFTOVI ORAL CAPSULE 75 MG (encorafenib) 3 DSL = 30 days

BREYANZI INTRAVENOUS SUSPENSION (lisocabtagene maraleucel)

3

BRUKINSA ORAL CAPSULE 80 MG (zanubrutinib) 3 DSL = 30 days

busulfan intravenous solution 6 mgml 1

CABOMETYX ORAL TABLET 20 MG 40 MG 60 MG (cabozantinib s-malate)

2 DSL = 30 days OC

CALQUENCE ORAL CAPSULE 100 MG (acalabrutinib) 3 DSL = 30 days OC

CAMPATH INTRAVENOUS SOLUTION 30 MGML (alemtuzumab)

3

capecitabine oral tablet 150 mg 500 mg 1 DSL = 30 days OC

CAPRELSA ORAL TABLET 100 MG 300 MG (vandetanib) 3 OC

CARAC EXTERNAL CREAM 05 (fluorouracil) 3

carboplatin intravenous solution 150 mg15ml 450 mg45ml 50 mg5ml 600 mg60ml

1

carmustine intravenous solution reconstituted 100 mg 1

CASODEX ORAL TABLET 50 MG (bicalutamide) 3 OC


32


cisplatin intravenous solution 100 mg100ml 200 mg200ml 50 mg50ml

1

CISPLATIN INTRAVENOUS SOLUTION RECONSTITUTED 50 MG

3

cladribine intravenous solution 10 mg10ml 1

clofarabine intravenous solution 1 mgml 1

COMETRIQ ORAL KIT 20 MG 3 X 20 MG amp 80 MG 80 amp 20 MG (cabozantinib s-malate)

2 DSL = 30 days OC

COPIKTRA ORAL CAPSULE 15 MG 25 MG (duvelisib) 2 DSL = 30 days

COSMEGEN INTRAVENOUS SOLUTION RECONSTITUTED 05 MG (dactinomycin)

2

COTELLIC ORAL TABLET 20 MG (cobimetinib fumarate) 2 DSL = 30 days OC

cyclophosphamide injection solution reconstituted 1 gm 2 gm 500 mg

1

CYCLOPHOSPHAMIDE INTRAVENOUS SOLUTION 1 GM5ML 500 MG25ML

3

cyclophosphamide oral capsule 25 mg 50 mg 1 OC

CYCLOPHOSPHAMIDE ORAL TABLET 25 MG 50 MG 3 OC

CYRAMZA INTRAVENOUS SOLUTION 100 MG10ML 500 MG50ML (ramucirumab)

2 DSL = 30 days

cytarabine (pf) injection solution 100 mgml 20 mgml 1

cytarabine injection solution 20 mgml 1

dacarbazine intravenous solution reconstituted 100 mg 200 mg 1

DACOGEN INTRAVENOUS SOLUTION RECONSTITUTED 50 MG (decitabine)

2

dactinomycin intravenous solution reconstituted 05 mg 1

DANYELZA INTRAVENOUS SOLUTION 40 MG10ML (naxitamab-gqgk)

3 DSL = 30 days

DARZALEX FASPRO SUBCUTANEOUS SOLUTION 1800-30000 MG-UT15ML (daratumumab-hyaluronidase-fihj)

3 DSL = 30 days

DARZALEX INTRAVENOUS SOLUTION 100 MG5ML 400 MG20ML (daratumumab)

2 DSL = 30 days

daunorubicin hcl intravenous solution 20 mg4ml 50 mg10ml 1

DAURISMO ORAL TABLET 100 MG 25 MG (glasdegib maleate)

3

decitabine intravenous solution reconstituted 50 mg 1

diclofenac sodium external gel 3 1

docetaxel intravenous concentrate 160 mg8ml 20 mgml 80 mg4ml

1


33


docetaxel intravenous solution 160 mg16ml 20 mg2ml 80 mg8ml

1

DOXIL INTRAVENOUS INJECTABLE 2 MGML (doxorubicin hcl liposomal)

2

doxorubicin hcl intravenous solution 2 mgml 1

doxorubicin hcl liposomal intravenous injectable 2 mgml 1

DROXIA ORAL CAPSULE 200 MG 300 MG 400 MG (hydroxyurea)

3

ELIGARD SUBCUTANEOUS KIT 225 MG (leuprolide acetate (3 month))

3


3


3

ELIGARD SUBCUTANEOUS KIT 75 MG (leuprolide acetate) 3

ELZONRIS INTRAVENOUS SOLUTION 1000 MCGML (tagraxofusp-erzs)

3 DSL = 30 days

EMCYT ORAL CAPSULE 140 MG (estramustine phosphate sodium)

2 DSL = 30 days OC

EMPLICITI INTRAVENOUS SOLUTION RECONSTITUTED 300 MG 400 MG (elotuzumab)

3 DSL = 30 days

ENHERTU INTRAVENOUS SOLUTION RECONSTITUTED 100 MG (fam-trastuzumab deruxtec-nxki)

3 DSL = 30 days

epirubicin hcl intravenous solution 200 mg100ml 50 mg25ml 1

ERBITUX INTRAVENOUS SOLUTION 100 MG50ML 200 MG100ML (cetuximab)

2

ERIVEDGE ORAL CAPSULE 150 MG (vismodegib) 2 DSL = 30 days OC

ERLEADA ORAL TABLET 60 MG (apalutamide) 3 DSL = 30 days OC

erlotinib hcl oral tablet 100 mg 150 mg 25 mg 1 DSL = 30 days OC

ERWINAZE INJECTION SOLUTION RECONSTITUTED 10000 UNIT (asparaginase erwinia chrysanth)

2

ETOPOPHOS INTRAVENOUS SOLUTION RECONSTITUTED 100 MG (etoposide phosphate)

3 DSL = 30 days

etoposide intravenous solution 1 gm50ml 100 mg5ml 500 mg25ml

1

etoposide oral capsule 50 mg 1 OC

everolimus oral tablet 25 mg 5 mg 75 mg 1 DSL = 30 days OC

EVOMELA INTRAVENOUS SOLUTION RECONSTITUTED 50 MG (melphalan hcl)

3 DSL = 30 days

exemestane oral tablet 25 mg PV OC


34


FARESTON ORAL TABLET 60 MG (toremifene citrate) PV OC

FARYDAK ORAL CAPSULE 10 MG 15 MG 20 MG (panobinostat lactate)

3 DSL = 30 days OC

FASLODEX INTRAMUSCULAR SOLUTION 250 MG5ML (fulvestrant)

3 DSL = 30 days

FEMARA ORAL TABLET 25 MG (letrozole) PV OC

FENSOLVI (6 MONTH) SUBCUTANEOUS KIT 45 MG (PED) (leuprolide acetate (6 month))

3

floxuridine injection solution reconstituted 05 gm 1

fludarabine phosphate intravenous solution 50 mg2ml 1

fludarabine phosphate intravenous solution reconstituted 50 mg 1

FLUOROPLEX EXTERNAL CREAM 1 (fluorouracil) 2

FLUOROURACIL EXTERNAL CREAM 05 3

fluorouracil external cream 5 1

fluorouracil external solution 2 5 1

fluorouracil intravenous solution 1 gm20ml 25 gm50ml 5 gm100ml 500 mg10ml

1

flutamide oral capsule 125 mg 1 OC

FOLOTYN INTRAVENOUS SOLUTION 20 MGML 40 MG2ML (pralatrexate)

3

FOTIVDA ORAL CAPSULE 089 MG 134 MG (tivozanib hcl) 3

fulvestrant intramuscular solution 250 mg5ml 1 DSL = 30 days

GAVRETO ORAL CAPSULE 100 MG (pralsetinib) 3 DSL = 30 days

GAZYVA INTRAVENOUS SOLUTION 1000 MG40ML (obinutuzumab)

2 DSL = 30 days

gemcitabine hcl intravenous solution 1 gm10ml 1 gm263ml 15 gm15ml 2 gm20ml 2 gm526ml 200 mg2ml 200 mg526ml

1

gemcitabine hcl intravenous solution reconstituted 1 gm 2 gm 200 mg

1

GILOTRIF ORAL TABLET 20 MG 30 MG 40 MG (afatinib dimaleate)

3 DSL = 30 days OC

GLEEVEC ORAL TABLET 100 MG 400 MG (imatinib mesylate) 3 DSL = 30 days OC

GLEOSTINE ORAL CAPSULE 10 MG 100 MG 40 MG (lomustine)

2 OC

HALAVEN INTRAVENOUS SOLUTION 1 MG2ML (eribulin mesylate)

2

HERCEPTIN HYLECTA SUBCUTANEOUS SOLUTION 600-10000 MG-UNT5ML (trastuzumab-hyaluronidase-oysk)

3


35


HERCEPTIN INTRAVENOUS SOLUTION RECONSTITUTED 150 MG (trastuzumab)

2 DSL = 30 days

HERZUMA INTRAVENOUS SOLUTION RECONSTITUTED 150 MG 420 MG (trastuzumab-pkrb)

3 DSL = 30 days

HYCAMTIN ORAL CAPSULE 025 MG 1 MG (topotecan hcl) 2 DSL = 30 days OC

HYDREA ORAL CAPSULE 500 MG (hydroxyurea) 3 OC

hydroxyurea oral capsule 500 mg 1 OC

IBRANCE ORAL CAPSULE 100 MG 125 MG 75 MG (palbociclib)

2 DSL = 30 days OC

IBRANCE ORAL TABLET 100 MG 125 MG 75 MG (palbociclib)

3 DSL = 30 days

ICLUSIG ORAL TABLET 10 MG 30 MG (ponatinib hcl) 3

ICLUSIG ORAL TABLET 15 MG 45 MG (ponatinib hcl) 3 DSL = 30 days OC

IDAMYCIN PFS INTRAVENOUS SOLUTION 10 MG10ML 20 MG20ML 5 MG5ML (idarubicin hcl)

2

idarubicin hcl intravenous solution 10 mg10ml 20 mg20ml 5 mg5ml

1

IDHIFA ORAL TABLET 100 MG 50 MG (enasidenib mesylate) 3 DSL = 30 days OC

ifosfamide intravenous solution 1 gm20ml 3 gm60ml 1

ifosfamide intravenous solution reconstituted 1 gm 3 gm 1

imatinib mesylate oral tablet 100 mg 400 mg 1 OC

IMBRUVICA ORAL CAPSULE 140 MG 70 MG (ibrutinib) 2 DSL = 30 days OC

IMBRUVICA ORAL TABLET 140 MG 280 MG 420 MG 560 MG (ibrutinib)

2 DSL = 30 days OC

IMFINZI INTRAVENOUS SOLUTION 120 MG24ML 500 MG10ML (durvalumab)

3 DSL = 30 days

IMLYGIC INTRALESIONAL SUSPENSION 1000000 UNITML 100000000 UNITML (talimogene laherparepvec)

3

INFUGEM INTRAVENOUS SOLUTION 1200-09 MG120ML- 1300-09 MG130ML- 1400-09 MG140ML- 1500-09 MG150ML- 1600-09 MG160ML- 1700-09 MG170ML- 1800-09 MG180ML- 1900-09 MG190ML- 2000-09 MG200ML- 2200-09 MG220ML- (gemcitabine hcl-nacl)

3 DSL = 30 days

INLYTA ORAL TABLET 1 MG 5 MG (axitinib) 3 DSL = 30 days OC

INQOVI ORAL TABLET 35-100 MG (decitabine-cedazuridine) 3 DSL = 30 days

INREBIC ORAL CAPSULE 100 MG (fedratinib hcl) 3 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


36


IRESSA ORAL TABLET 250 MG (gefitinib) 2 DSL = 30 days OC

irinotecan hcl intravenous solution 100 mg5ml 300 mg15ml 40 mg2ml 500 mg25ml

1

ISTODAX (OVERFILL) INTRAVENOUS SOLUTION RECONSTITUTED 10 MG (romidepsin)

2

IXEMPRA KIT INTRAVENOUS SOLUTION RECONSTITUTED 15 MG 45 MG (ixabepilone)

2 DSL = 30 days

JAKAFI ORAL TABLET 10 MG 15 MG 20 MG 25 MG 5 MG (ruxolitinib phosphate)

2 DSL = 30 days OC

JELMYTO SOLUTION RECONSTITUTED 80 (2 X 40) MG (mitomycin)

3 DSL = 30 days

JEVTANA INTRAVENOUS SOLUTION 60 MG15ML (cabazitaxel)

2

KADCYLA INTRAVENOUS SOLUTION RECONSTITUTED 100 MG 160 MG (ado-trastuzumab emtansine)

2 DSL = 30 days

KANJINTI INTRAVENOUS SOLUTION RECONSTITUTED 150 MG 420 MG (trastuzumab-anns)

3 DSL = 30 days

KEYTRUDA INTRAVENOUS SOLUTION 100 MG4ML (pembrolizumab)

2 DSL = 30 days

KISQALI FEMARA ORAL TABLET THERAPY PACK 200 amp 25 MG (ribociclib-letrozole)

3 DSL = 30 days OC

KISQALI ORAL TABLET THERAPY PACK 200 MG (ribociclib succinate)

3 DSL = 30 days OC

KOSELUGO ORAL CAPSULE 10 MG 25 MG (selumetinib sulfate)

3 DSL = 30 days

KYMRIAH INTRAVENOUS SUSPENSION (tisagenlecleucel) 3

KYPROLIS INTRAVENOUS SOLUTION RECONSTITUTED 10 MG 30 MG 60 MG (carfilzomib)

2 DSL = 30 days

lapatinib ditosylate oral tablet 250 mg 1 DSL = 30 days OC

LENVIMA ORAL CAPSULE THERAPY PACK 10 amp 4 MG 10 MG 2 X 10 MG 2 X 10 MG amp 4 MG (lenvatinib mesylate)

2 DSL = 30 days OC

LENVIMA ORAL CAPSULE THERAPY PACK 10 MG amp 2 X 4 MG 2 X 4 MG (lenvatinib mesylate)

3 DSL = 30 days OC

LENVIMA ORAL CAPSULE THERAPY PACK 3 X 4 MG 4 MG (lenvatinib mesylate)

3 DSL = 30 days

letrozole oral tablet 25 mg PV OC

LEUKERAN ORAL TABLET 2 MG (chlorambucil) 2 OC

leuprolide acetate injection kit 1 mg02ml 2

LIBTAYO INTRAVENOUS SOLUTION 350 MG7ML (cemiplimab-rwlc)

3 DSL = 30 days


37


LONSURF ORAL TABLET 15-614 MG 20-819 MG (trifluridine-tipiracil)

2 DSL = 30 days OC

LORBRENA ORAL TABLET 100 MG 25 MG (lorlatinib) 2 DSL = 30 days

LUMOXITI INTRAVENOUS SOLUTION RECONSTITUTED 1 MG (moxetumomab pasudotox-tdfk)

3 DSL = 30 days

LUPANETA PACK COMBINATION KIT 1125 amp 5 MG 375 amp 5 MG (leuprolide amp norethindrone)

3

LUPRON DEPOT (1-MONTH) INTRAMUSCULAR KIT 375 MG 75 MG (leuprolide acetate)

2

LUPRON DEPOT (3-MONTH) INTRAMUSCULAR KIT 1125 MG 225 MG (leuprolide acetate (3 month))

2

LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG INTRAMUSCULAR KIT 30 MG (leuprolide acetate (4 month))

2


2

LUPRON DEPOT-PED (1-MONTH) INTRAMUSCULAR KIT 1125 MG 15 MG 75 MG (leuprolide acetate)

2

LUPRON DEPOT-PED (3-MONTH) INTRAMUSCULAR KIT 1125 MG (PED) 30 MG (PED) (leuprolide acetate (3 month))

2

LUTATHERA INTRAVENOUS SOLUTION 370 MBQML (lutetium lu 177 dotatate)

3

LYNPARZA ORAL TABLET 100 MG 150 MG (olaparib) 2 DSL = 30 days OC

LYSODREN ORAL TABLET 500 MG (mitotane) 2 DSL = 30 days OC

MARGENZA INTRAVENOUS SOLUTION 250 MG10ML (margetuximab-cmkb)

3

MARQIBO INTRAVENOUS SUSPENSION 5 MG31ML (vincristine sulfate liposome)

2 DSL = 30 days

MATULANE ORAL CAPSULE 50 MG (procarbazine hcl) 2 DSL = 30 days OC

megestrol acetate oral suspension 40 mgml 1

megestrol acetate oral suspension 625 mg5ml PV

megestrol acetate oral tablet 20 mg 40 mg 1 OC

MEKINIST ORAL TABLET 05 MG 2 MG (trametinib dimethyl sulfoxide)

2 DSL = 30 days OC

MEKTOVI ORAL TABLET 15 MG (binimetinib) 3 DSL = 30 days

melphalan hcl intravenous solution reconstituted 50 mg 1

melphalan oral tablet 2 mg 1 OC

mercaptopurine oral tablet 50 mg 1 OC

methotrexate oral tablet 25 mg 1 OC

methotrexate sodium (pf) injection solution 1 gm40ml 250 mg10ml 50 mg2ml

1


38


methotrexate sodium injection solution 250 mg10ml 50 mg2ml 1

methotrexate sodium injection solution reconstituted 1 gm 1

methotrexate sodium oral tablet 25 mg 1 OC

mitomycin intravenous solution reconstituted 20 mg 40 mg 5 mg

1

MITOMYCIN INTRAVESICAL SOLUTION PREFILLED SYRINGE 20 MG40ML

3

mitoxantrone hcl intravenous concentrate 20 mg10ml 25 mg125ml 30 mg15ml

1

MONJUVI INTRAVENOUS SOLUTION RECONSTITUTED 200 MG (tafasitamab-cxix)

3 DSL = 30 days

mitomycin (Mutamycin Intravenous Solution Reconstituted 20 Mg 40 Mg 5 Mg)

1

MVASI INTRAVENOUS SOLUTION 100 MG4ML 400 MG16ML (bevacizumab-awwb)

3 DSL = 30 days

MYLERAN ORAL TABLET 2 MG (busulfan) 2 OC

MYLOTARG INTRAVENOUS SOLUTION RECONSTITUTED 45 MG (gemtuzumab ozogamicin)

3 DSL = 30 days

NAVELBINE INTRAVENOUS SOLUTION 10 MGML 50 MG5ML (vinorelbine tartrate)

3

NERLYNX ORAL TABLET 40 MG (neratinib maleate) 3 DSL = 30 days OC

NEXAVAR ORAL TABLET 200 MG (sorafenib tosylate) 2 DSL = 30 days OC

NILANDRON ORAL TABLET 150 MG (nilutamide) 3 OC

nilutamide oral tablet 150 mg 1 OC

NINLARO ORAL CAPSULE 23 MG 3 MG 4 MG (ixazomib citrate)

2 DSL = 30 days OC

NIPENT INTRAVENOUS SOLUTION RECONSTITUTED 10 MG (pentostatin)

3

NUBEQA ORAL TABLET 300 MG (darolutamide) 3 DSL = 30 days

ODOMZO ORAL CAPSULE 200 MG (sonidegib phosphate) 2 DSL = 30 days OC

OGIVRI INTRAVENOUS SOLUTION RECONSTITUTED 150 MG 420 MG (trastuzumab-dkst)

3 DSL = 30 days

ONCASPAR INJECTION SOLUTION 750 UNITML (pegaspargase)

2

ONIVYDE INTRAVENOUS INJECTABLE 43 MG10ML (irinotecan hcl liposome)

3 DSL = 30 days

ONTRUZANT INTRAVENOUS SOLUTION RECONSTITUTED 150 MG 420 MG (trastuzumab-dttb)

3 DSL = 30 days

ONUREG ORAL TABLET 200 MG 300 MG (azacitidine) 3 DSL = 30 days


39


OPDIVO INTRAVENOUS SOLUTION 100 MG10ML 40 MG4ML (nivolumab)

2 DSL = 30 days

OPDIVO INTRAVENOUS SOLUTION 240 MG24ML (nivolumab)

3 DSL = 30 days

ORGOVYX ORAL TABLET 120 MG (relugolix) 3 DSL = 30 days

OTREXUP SUBCUTANEOUS SOLUTION AUTO-INJECTOR 10 MG04ML 125 MG04ML 15 MG04ML 175 MG04ML 225 MG04ML 25 MG04ML (methotrexate (anti-rheumatic))

3

OTREXUP SUBCUTANEOUS SOLUTION AUTO-INJECTOR 20 MG04ML (methotrexate (anti-rheumatic))

2

oxaliplatin intravenous solution 100 mg20ml 200 mg40ml 50 mg10ml

1

oxaliplatin intravenous solution reconstituted 100 mg 50 mg 1

paclitaxel intravenous concentrate 100 mg1667ml 100 mg167ml 150 mg25ml 30 mg5ml 300 mg50ml

1

PADCEV INTRAVENOUS SOLUTION RECONSTITUTED 20 MG 30 MG (enfortumab vedotin-ejfv)

3 DSL = 30 days

PANRETIN EXTERNAL GEL 01 (alitretinoin) 3 DSL = 30 days

paraplatin intravenous solution 1000 mg100ml 1

carboplatin (Paraplatin Intravenous Solution 150 Mg15Ml 450 Mg45Ml 50 Mg5Ml 600 Mg60Ml)

1

PEMAZYRE ORAL TABLET 135 MG 45 MG 9 MG (pemigatinib)

3 DSL = 30 days

PEPAXTO INTRAVENOUS SOLUTION RECONSTITUTED 20 MG (melphalan flufenamide hcl)

3

PERJETA INTRAVENOUS SOLUTION 420 MG14ML (pertuzumab)

2 DSL = 30 days

PHESGO SUBCUTANEOUS SOLUTION 60-60-2000 MG-MG-UML 80-40-2000 MG-MG-UML (pertuz-trastuz-hyaluron-zzxf)

3 DSL = 30 days

PHOTOFRIN INTRAVENOUS SOLUTION RECONSTITUTED 75 MG (porfimer sodium)

3

PIQRAY ORAL TABLET THERAPY PACK 2 X 150 MG 200 amp 50 MG 200 MG (alpelisib)

3

POLIVY INTRAVENOUS SOLUTION RECONSTITUTED 140 MG (polatuzumab vedotin-piiq)

3


3 DSL = 30 days

POMALYST ORAL CAPSULE 1 MG 2 MG 3 MG 4 MG (pomalidomide)

2 DSL = 30 days OC

PORTRAZZA INTRAVENOUS SOLUTION 800 MG50ML (necitumumab)

3 DSL = 30 days


40


POTELIGEO INTRAVENOUS SOLUTION 20 MG5ML (mogamulizumab-kpkc)

3 DSL = 30 days

PROLEUKIN INTRAVENOUS SOLUTION RECONSTITUTED 22000000 UNIT (aldesleukin)

2 DSL = 30 days

PURIXAN ORAL SUSPENSION 2000 MG100ML (mercaptopurine)

2 DSL = 30 days OC

QINLOCK ORAL TABLET 50 MG (ripretinib) 3 DSL = 30 days

RASUVO SUBCUTANEOUS SOLUTION AUTO-INJECTOR 10 MG02ML 125 MG025ML 15 MG03ML 175 MG035ML 20 MG04ML 225 MG045ML 25 MG05ML 30 MG06ML 75 MG015ML (methotrexate (anti-rheumatic))

2

RETEVMO ORAL CAPSULE 40 MG 80 MG (selpercatinib) 3 DSL = 30 days

REVLIMID ORAL CAPSULE 10 MG 15 MG 25 MG 20 MG 25 MG 5 MG (lenalidomide)

2 DSL = 30 days OC

RIABNI INTRAVENOUS SOLUTION 100 MG10ML 500 MG50ML (rituximab-arrx)

3 DSL = 30 days

RITUXAN HYCELA SUBCUTANEOUS SOLUTION 1400-23400 MG -UT117ML 1600-26800 MG -UT134ML (rituximab-hyaluronidase human)

3 DSL = 30 days

RITUXAN INTRAVENOUS SOLUTION 100 MG10ML 500 MG50ML (rituximab)

2

ROMIDEPSIN INTRAVENOUS SOLUTION 275 MG55ML 3

ROZLYTREK ORAL CAPSULE 100 MG 200 MG (entrectinib) 3 DSL = 30 days

RUBRACA ORAL TABLET 200 MG 250 MG 300 MG (rucaparib camsylate)

3 DSL = 30 days OC

RUXIENCE INTRAVENOUS SOLUTION 100 MG10ML (rituximab-pvvr)

3 DSL = 30 days


3

RYDAPT ORAL CAPSULE 25 MG (midostaurin) 2 DSL = 30 days OC

SARCLISA INTRAVENOUS SOLUTION 100 MG5ML 500 MG25ML (isatuximab-irfc)

3 DSL = 30 days

SIKLOS ORAL TABLET 100 MG (hydroxyurea) 3

SIKLOS ORAL TABLET 1000 MG (hydroxyurea) 3 DSL = 30 days

SOLARAVIX EXTERNAL THERAPY PACK 3 3

SOLTAMOX ORAL SOLUTION 10 MG5ML (tamoxifen citrate) PV OC

SPRYCEL ORAL TABLET 100 MG 20 MG 50 MG 70 MG 80 MG (dasatinib)

2 DSL = 30 days OC

SPRYCEL ORAL TABLET 140 MG (dasatinib) 3 DSL = 30 days OC

STIVARGA ORAL TABLET 40 MG (regorafenib) 2 DSL = 30 days OC


41


SUPPRELIN LA SUBCUTANEOUS KIT 50 MG (histrelin acetate (cpp))

3

SUTENT ORAL CAPSULE 125 MG 25 MG 375 MG 50 MG (sunitinib malate)

2 DSL = 30 days OC

SYLVANT INTRAVENOUS SOLUTION RECONSTITUTED 100 MG 400 MG (siltuximab)

2 DSL = 30 days

SYNRIBO SUBCUTANEOUS SOLUTION RECONSTITUTED 35 MG (omacetaxine mepesuccinate)

3 DSL = 30 days

TABLOID ORAL TABLET 40 MG (thioguanine) 2 OC

TABRECTA ORAL TABLET 150 MG 200 MG (capmatinib hcl) 3 DSL = 30 days

TAFINLAR ORAL CAPSULE 50 MG 75 MG (dabrafenib mesylate)

2 DSL = 30 days OC

TAGRISSO ORAL TABLET 40 MG 80 MG (osimertinib mesylate)

2 DSL = 30 days OC

TALZENNA ORAL CAPSULE 025 MG 1 MG (talazoparib tosylate)

3

tamoxifen citrate oral tablet 10 mg 20 mg PV OC

TARCEVA ORAL TABLET 100 MG 150 MG 25 MG (erlotinib hcl)

3 DSL = 30 days OC

TARGRETIN EXTERNAL GEL 1 (bexarotene) 2

TARGRETIN ORAL CAPSULE 75 MG (bexarotene) 2 OC

TASIGNA ORAL CAPSULE 150 MG 200 MG (nilotinib hcl) 2 DSL = 30 days OC

TASIGNA ORAL CAPSULE 50 MG (nilotinib hcl) 3 DSL = 30 days

TAZVERIK ORAL TABLET 200 MG (tazemetostat hbr) 3 DSL = 30 days

TECARTUS INTRAVENOUS SUSPENSION (brexucabtagene autoleucel)

3

TECENTRIQ INTRAVENOUS SOLUTION 1200 MG20ML (atezolizumab)

2 DSL = 30 days


3

TEMODAR INTRAVENOUS SOLUTION RECONSTITUTED 100 MG (temozolomide)

3

TEMODAR ORAL CAPSULE 100 MG 140 MG 180 MG 250 MG (temozolomide)

3 OC

temozolomide oral capsule 100 mg 140 mg 180 mg 20 mg 250 mg 5 mg

1 OC

temsirolimus intravenous solution 25 mgml 1

teniposide intravenous solution 10 mgml 1

TEPADINA INJECTION SOLUTION RECONSTITUTED 100 MG 15 MG (thiotepa)

3 DSL = 30 days


42


TEPMETKO ORAL TABLET 225 MG (tepotinib hcl) 3 DSL = 30 days

thiotepa injection solution reconstituted 100 mg 15 mg 1 DSL = 30 days

TIBSOVO ORAL TABLET 250 MG (ivosidenib) 3 DSL = 30 days

TICE BCG INTRAVESICAL SUSPENSION RECONSTITUTED 50 MG (bcg live)

2

etoposide (Toposar Intravenous Solution 1 Gm50Ml 100 Mg5Ml 500 Mg25Ml)

1

topotecan hcl intravenous solution 4 mg4ml 1

topotecan hcl intravenous solution reconstituted 4 mg 1

toremifene citrate oral tablet 60 mg PV OC

TORISEL INTRAVENOUS SOLUTION 25 MGML (temsirolimus)

2

TRAZIMERA INTRAVENOUS SOLUTION RECONSTITUTED 150 MG (trastuzumab-qyyp)

3


3 DSL = 30 days

TREANDA INTRAVENOUS SOLUTION RECONSTITUTED 100 MG (bendamustine hcl)

2


3

TRELSTAR MIXJECT INTRAMUSCULAR SUSPENSION RECONSTITUTED 1125 MG 225 MG 375 MG (triptorelin pamoate)

3

tretinoin oral capsule 10 mg 1 DSL = 30 days OC

TREXALL ORAL TABLET 10 MG 15 MG 5 MG 75 MG (methotrexate sodium)

3 OC

TRIPTODUR INTRAMUSCULAR SUSPENSION RECONSTITUTED ER 225 MG (triptorelin pamoate)

3

TRISENOX INTRAVENOUS SOLUTION 12 MG6ML (arsenic trioxide)

2 DSL = 30 days

TRODELVY INTRAVENOUS SOLUTION RECONSTITUTED 180 MG (sacituzumab govitecan-hziy)

3 DSL = 30 days

TRUXIMA INTRAVENOUS SOLUTION 100 MG10ML 500 MG50ML (rituximab-abbs)

3 DSL = 30 days

TUKYSA ORAL TABLET 150 MG 50 MG (tucatinib) 3 DSL = 30 days

TURALIO ORAL CAPSULE 200 MG (pexidartinib hcl) 3 DSL = 30 days

TYKERB ORAL TABLET 250 MG (lapatinib ditosylate) 2 DSL = 30 days OC

UKONIQ ORAL TABLET 200 MG (umbralisib tosylate) 3 DSL = 30 days

UNITUXIN INTRAVENOUS SOLUTION 175 MG5ML (dinutuximab)

2 DSL = 30 days


43


VALCHLOR EXTERNAL GEL 0016 (mechlorethamine hcl (topical))

3 DSL = 30 days

valrubicin intravesical solution 40 mgml 1

VANTAS SUBCUTANEOUS KIT 50 MG (histrelin acetate) 3

VECTIBIX INTRAVENOUS SOLUTION 100 MG5ML 400 MG20ML (panitumumab)

3

VELCADE INJECTION SOLUTION RECONSTITUTED 35 MG (bortezomib)

2

VENCLEXTA ORAL TABLET 10 MG 100 MG 50 MG (venetoclax)

2 DSL = 30 days OC

VENCLEXTA STARTING PACK ORAL TABLET THERAPY PACK 10 amp 50 amp 100 MG (venetoclax)

2 DSL = 30 days OC

VERZENIO ORAL TABLET 100 MG 150 MG 200 MG 50 MG (abemaciclib)

3 DSL = 30 days OC

vinblastine sulfate intravenous solution 1 mgml 1

vincristine sulfate intravenous solution 1 mgml 1

vinorelbine tartrate intravenous solution 10 mgml 50 mg5ml 1

VITRAKVI ORAL CAPSULE 100 MG 25 MG (larotrectinib sulfate)

3 DSL = 30 days

VITRAKVI ORAL SOLUTION 20 MGML (larotrectinib sulfate) 3 DSL = 30 days

VIZIMPRO ORAL TABLET 15 MG 30 MG 45 MG (dacomitinib) 3 DSL = 30 days

VOTRIENT ORAL TABLET 200 MG (pazopanib hcl) 2 DSL = 30 days OC

VYXEOS INTRAVENOUS SUSPENSION RECONSTITUTED 44-100 MG (daunorubicin-cytarabine lipo)

2 DSL = 30 days

XALKORI ORAL CAPSULE 200 MG 250 MG (crizotinib) 2 DSL = 30 days OC

XATMEP ORAL SOLUTION 25 MGML (methotrexate) 3 DSL = 30 days OC

XELODA ORAL TABLET 150 MG 500 MG (capecitabine) 3 DSL = 30 days OC

XOSPATA ORAL TABLET 40 MG (gilteritinib fumarate) 3

XPOVIO (100 MG ONCE WEEKLY) ORAL TABLET THERAPY PACK 20 MG (selinexor)

3 DSL = 30 days


3 DSL = 30 days

XPOVIO (40 MG TWICE WEEKLY) ORAL TABLET THERAPY PACK 20 MG (selinexor)

3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


44



3 DSL = 30 days

XTANDI ORAL CAPSULE 40 MG (enzalutamide) 2 DSL = 30 days OC

XTANDI ORAL TABLET 40 MG 80 MG (enzalutamide) 2

YERVOY INTRAVENOUS SOLUTION 200 MG40ML 50 MG10ML (ipilimumab)

2

YESCARTA INTRAVENOUS SUSPENSION (axicabtagene ciloleucel)

3

YONDELIS INTRAVENOUS SOLUTION RECONSTITUTED 1 MG (trabectedin)

2 DSL = 30 days

YONSA ORAL TABLET 125 MG (abiraterone acetate) 3 DSL = 30 days

ZALTRAP INTRAVENOUS SOLUTION 100 MG4ML 200 MG8ML (ziv-aflibercept)

3 DSL = 30 days

ZANOSAR INTRAVENOUS SOLUTION RECONSTITUTED 1 GM (streptozocin)

2

ZEJULA ORAL CAPSULE 100 MG (niraparib tosylate) 2 DSL = 30 days OC

ZELBORAF ORAL TABLET 240 MG (vemurafenib) 2 DSL = 30 days OC

ZEPZELCA INTRAVENOUS SOLUTION RECONSTITUTED 4 MG (lurbinectedin)

3 DSL = 30 days

ZEVALIN Y-90 INTRAVENOUS KIT 32 MG2ML (ibritumomab tiuxetan for y-90)

3

ZIRABEV INTRAVENOUS SOLUTION 100 MG4ML (bevacizumab-bvzr)

3 DSL = 30 days


3

ZOLINZA ORAL CAPSULE 100 MG (vorinostat) 3 OC

ZYDELIG ORAL TABLET 100 MG 150 MG (idelalisib) 2 DSL = 30 days OC

ZYKADIA ORAL TABLET 150 MG (ceritinib) 2 DSL = 30 days

ZYTIGA ORAL TABLET 250 MG (abiraterone acetate) 3 DSL = 30 days OC


ANTITOXINSIMMUNE GLOBTOXOIDSVACCINES - DRUGS FOR THE IMMUNE SYSTEM

ALLERGENIC EXTRACTS (THERAPEUTIC) - DRUGS FOR THE IMMUNE SYSTEM

ACACIA SUBCUTANEOUS SOLUTION 120 3

ACREMONIUM SUBCUTANEOUS SOLUTION 20000 PNUML 3

ALDER SUBCUTANEOUS SOLUTION 120 3

ALTERNARIA SUBCUTANEOUS SOLUTION 20000 PNUML 3

AMERICAN BEECH SUBCUTANEOUS SOLUTION 120 3

AMERICAN COCKROACH SUBCUTANEOUS SOLUTION 120 3


45


AMERICAN ELM SUBCUTANEOUS SOLUTION 120 3

ARIZONA CYPRESS SUBCUTANEOUS SOLUTION 120 3

AUREOBASIDIUM SUBCUTANEOUS SOLUTION 10000 PNUML 20000 PNUML

3

AUSTRALIAN PINE SUBCUTANEOUS SOLUTION 120 3

BAHIA SUBCUTANEOUS SOLUTION 120 3

BALD CYPRESS SUBCUTANEOUS SOLUTION 120 3

BAYBERRY (WAX MYRTLE) SUBCUTANEOUS SOLUTION 120

3

BERMUDA GRASS SUBCUTANEOUS SOLUTION 10000 BAUML

3

BLACK WILLOW SUBCUTANEOUS SOLUTION 120 3

BOTRYTIS SUBCUTANEOUS SOLUTION 20000 PNUML 3

BROME SUBCUTANEOUS SOLUTION 120 3

CALIFORNIA PEPPER TREE SUBCUTANEOUS SOLUTION 120

3

CANDIDA ALBICANS EXTRACT SUBCUTANEOUS SOLUTION 10000 PNUML

3

CAT HAIR EXTRACT SUBCUTANEOUS SOLUTION 10000 BAUML

3

CATTLE EPITHELIUM SUBCUTANEOUS SOLUTION 120 3

CEDAR ELM SUBCUTANEOUS SOLUTION 120 3

CLADOSPORIUM CLADOSPORIOIDES SUBCUTANEOUS SOLUTION 10000 PNUML 20000 PNUML

3

CLADOSPORIUM SPHAEROSPERMUM SUBCUTANEOUS SOLUTION 20000 PNUML

3

COCKLEBUR SUBCUTANEOUS SOLUTION 120 3

CORN POLLEN SUBCUTANEOUS SOLUTION 120 3

CURVULARIA SUBCUTANEOUS SOLUTION 20000 PNUML 3

DOG EPITHELIUM SUBCUTANEOUS SOLUTION 110 120 3

DOG FENNEL SUBCUTANEOUS SOLUTION 120 3

DRECHSLERA SUBCUTANEOUS SOLUTION 10000 PNUML 20000 PNUML

3

DUST MITE MIXED ALLERGEN EXT SUBCUTANEOUS SOLUTION 10000 AUML

3

EASTERN COTTONWOOD SUBCUTANEOUS SOLUTION 120

3

EPICOCCUM SUBCUTANEOUS SOLUTION 10000 PNUML 20000 PNUML

3

FIRE ANT SUBCUTANEOUS SOLUTION 110 120 3


46


FUSARIUM SUBCUTANEOUS SOLUTION 10000 PNUML 20000 PNUML

3

GERMAN COCKROACH SUBCUTANEOUS SOLUTION 120 3

GOLDENROD SUBCUTANEOUS SOLUTION 120 3

GRASTEK SUBLINGUAL TABLET SUBLINGUAL 2800 BAU (timothy grass pollen allergen)

2

HACKBERRY SUBCUTANEOUS SOLUTION 120 3

HONEY BEE VENOM SUBCUTANEOUS SOLUTION RECONSTITUTED 1100 MCG

3

HORSE EPITHELIUM SUBCUTANEOUS SOLUTION 110 120

3

JOHNSON GRASS SUBCUTANEOUS SOLUTION 120 3

JUNE GRASS POLLEN STANDARDIZED SUBCUTANEOUS SOLUTION 100000 BAUML

3

KAPOK SUBCUTANEOUS SOLUTION 120 3

KOCHIA SUBCUTANEOUS SOLUTION 120 3

MEADOW FESCUE GRASS POLLEN SUBCUTANEOUS SOLUTION 100000 BAUML

3

MELALEUCA SUBCUTANEOUS SOLUTION 120 3

MESQUITE SUBCUTANEOUS SOLUTION 120 3

MITE (D FARINAE) SUBCUTANEOUS SOLUTION 10000 AUML

3

MITE (D PTERONYSSINUS) SUBCUTANEOUS SOLUTION 10000 AUML

3

MIXED ASPERGILLUS SUBCUTANEOUS SOLUTION 20000 PNUML

3

MIXED FEATHERS SUBCUTANEOUS SOLUTION 120 3

MIXED RAGWEED SUBCUTANEOUS SOLUTION 120 3

MIXED VESPID VENOM PROTEIN SUBCUTANEOUS SOLUTION RECONSTITUTED 1100-1100-1100 MCG

3

MOUNTAIN CEDAR SUBCUTANEOUS SOLUTION 120 3

MOUSE EPITHELIUM SUBCUTANEOUS SOLUTION 120 3

MUCOR SUBCUTANEOUS SOLUTION 10000 PNUML 20000 PNUML

3

MUGWORT SUBCUTANEOUS SOLUTION 120 3

ODACTRA SUBLINGUAL TABLET SUBLINGUAL 12 SQ-HDM (dust mite mixed allergen ext)

2

OLIVE TREE SUBCUTANEOUS SOLUTION 120 3

ORALAIR ADULT STARTER PACK SUBLINGUAL TABLET SUBLINGUAL 300 IR (grass mix pollens allergen ext)

3


47


ORALAIR CHILDRENS STARTER PACK SUBLINGUAL TABLET SUBLINGUAL 100 IR (grass mix pollens allergen ext)

3

ORALAIR SUBLINGUAL TABLET SUBLINGUAL 300 IR (grass mix pollens allergen ext)

3

ORCHARD GRASS POLLEN SUBCUTANEOUS SOLUTION 100000 BAUML

3

PALFORZIA ORAL 05 amp 1 amp 15 amp 3 amp 6 MG 2 X 1 MG amp 10 MG 2 X 100 MG 2 X 20 MG 2 X 20 MG amp 2 X 100 MG 20 MG 20 MG amp 100 MG 3 X 1 MG 3 X 20 MG amp 100 MG 4 X 20 MG 6 X 1 MG (peanut powder-dnfp)

3 DSL = 30 days

PALFORZIA ORAL PACKET 300 MG (peanut powder-dnfp) 3

PALFORZIA ORAL PACKET 300 MG (peanut powder-dnfp) 3 DSL = 30 days

PENICILLIUM NOTATUM SUBCUTANEOUS SOLUTION 10000 PNUML 20000 PNUML

3

PHOMA EXIGUA SUBCUTANEOUS SOLUTION 20000 PNUML

3

PRIVET SUBCUTANEOUS SOLUTION 120 3

QUEEN PALM SUBCUTANEOUS SOLUTION 120 3

RABBIT EPITHELIUM SUBCUTANEOUS SOLUTION 110 120

3

RAGWITEK SUBLINGUAL TABLET SUBLINGUAL 12 AMB A 1-U (short ragweed pollen ext)

3

RED MAPLE SUBCUTANEOUS SOLUTION 120 3

RED MULBERRY SUBCUTANEOUS SOLUTION 120 3

RED TOP GRASS POLLEN SUBCUTANEOUS SOLUTION 100000 BAUML

3

RHIZOPUS SUBCUTANEOUS SOLUTION 20000 PNUML 3

ROUGH MARSH ELDER SUBCUTANEOUS SOLUTION 120 3

RUSSIAN THISTLE SUBCUTANEOUS SOLUTION 120 3

SACCHAROMYCES CEREVISIAE SUBCUTANEOUS SOLUTION 20000 PNUML

3

SHAGBARK HICKORY SUBCUTANEOUS SOLUTION 120 3

SHEEP SORREL SUBCUTANEOUS SOLUTION 120 3

SHORT RAGWEED POLLEN EXT SUBCUTANEOUS SOLUTION 120

3

SORRELDOCK MIX SUBCUTANEOUS SOLUTION 120 3

SPINY PIGWEED SUBCUTANEOUS SOLUTION 120 3

SWEET GUM SUBCUTANEOUS SOLUTION 120 3

SWEET VERNAL GRASS POLLEN SUBCUTANEOUS SOLUTION 100000 BAUML

3


48


TALL RAGWEED SUBCUTANEOUS SOLUTION 120 3

TIMOTHY GRASS POLLEN ALLERGEN SUBCUTANEOUS SOLUTION 10000 BAUML 100000 BAUML

3

TRICHOPHYTON MENTAGROPHYTES SUBCUTANEOUS SOLUTION 120

3

TRICHOPHYTON SUBCUTANEOUS SOLUTION 20000 PNUML

3

WASP VENOM PROTEIN SUBCUTANEOUS SOLUTION RECONSTITUTED 1100 MCG

3

WESTERN JUNIPER SUBCUTANEOUS SOLUTION 120 3

WHITE BIRCH SUBCUTANEOUS SOLUTION 120 3

WHITE FACED HORNET VENOM SUBCUTANEOUS SOLUTION RECONSTITUTED 1100 MCG

3

WHITE MULBERRY SUBCUTANEOUS SOLUTION 120 3

WHITE OAK SUBCUTANEOUS SOLUTION 120 3

WHITE PINE SUBCUTANEOUS SOLUTION 120 3

YELLOW DOCK SUBCUTANEOUS SOLUTION 120 3

YELLOW HORNET VENOM PROTEIN SUBCUTANEOUS SOLUTION RECONSTITUTED 1100 MCG

3

YELLOW JACKET VENOM PROTEIN SUBCUTANEOUS SOLUTION RECONSTITUTED 120 MCG

3

ANTITOXINS AND IMMUNE GLOBULINS - Organ Transplant

ANTIVENIN LATRODECTUS MACTANS INJECTION KIT 2

ANTIVENIN MICRURUS FULVIUS INTRAVENOUS SOLUTION RECONSTITUTED

3

ASCENIV INTRAVENOUS SOLUTION 5 GM50ML (immune globulin (human)-slra)

3 DSL = 30 days

BIVIGAM INTRAVENOUS SOLUTION 5 GM50ML (immune globulin (human))

2

CARIMUNE NF INTRAVENOUS SOLUTION RECONSTITUTED 12 GM 6 GM (immune globulin (human))

2

CROFAB INTRAVENOUS SOLUTION RECONSTITUTED (crotalidae polyval immune fab)

2

CUTAQUIG SUBCUTANEOUS SOLUTION 1 GM6ML 165 GM10ML 2 GM12ML 33 GM20ML 4 GM24ML 8 GM48ML (immune globulin (human)-hipp)

3

CUVITRU SUBCUTANEOUS SOLUTION 1 GM5ML 10 GM50ML 2 GM10ML 4 GM20ML (immune globulin (human))

2 DSL = 30 days

CUVITRU SUBCUTANEOUS SOLUTION 8 GM40ML (immune globulin (human))

3 DSL = 30 days


49


CYTOGAM INTRAVENOUS INJECTABLE 50 MGML (cytomegalovirus immune glob)

2

DIGIFAB INTRAVENOUS SOLUTION RECONSTITUTED 40 MG (digoxin immune fab)

2

FLEBOGAMMA DIF INTRAVENOUS SOLUTION 05 GM10ML 10 GM100ML 10 GM200ML 25 GM50ML 20 GM200ML 20 GM400ML 5 GM100ML 5 GM50ML (immune globulin (human))

2

GAMASTAN INTRAMUSCULAR INJECTABLE (immune globulin (human))

2

GAMMAGARD INJECTION SOLUTION 1 GM10ML 10 GM100ML 25 GM25ML 20 GM200ML 30 GM300ML 5 GM50ML (immune globulin (human))

2

GAMMAGARD SD LESS IGA INTRAVENOUS SOLUTION RECONSTITUTED 10 GM 5 GM (immune globulin (human))

2

GAMMAKED INJECTION SOLUTION 1 GM10ML 10 GM100ML 20 GM200ML 5 GM50ML (immune globulin (human))

2

GAMMAPLEX INTRAVENOUS SOLUTION 10 GM100ML 10 GM200ML 20 GM200ML 20 GM400ML 5 GM100ML 5 GM50ML (immune globulin (human))

2

GAMUNEX-C INJECTION SOLUTION 1 GM10ML 10 GM100ML 25 GM25ML 20 GM200ML 5 GM50ML (immune globulin (human))

2

GAMUNEX-C INJECTION SOLUTION 40 GM400ML (immune globulin (human))

3

HEPAGAM B INJECTION SOLUTION (hepatitis b immune globulin)

3

HIZENTRA SUBCUTANEOUS SOLUTION 1 GM5ML 10 GM50ML 2 GM10ML 4 GM20ML (immune globulin (human))

2 DSL = 30 days

HIZENTRA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 1 GM5ML 2 GM10ML 4 GM20ML (immune globulin (human))

3

HYPERHEP B INTRAMUSCULAR SOLUTION (hepatitis b immune globulin)

2

HYPERRAB INJECTION SOLUTION 1500 UNIT5ML 900 UNIT3ML (rabies immune globulin)

3

HYPERRAB INJECTION SOLUTION 300 UNITML (rabies immune globulin)

2

HYPERRAB SD INJECTION SOLUTION 1500 UNIT10ML 300 UNIT2ML (rabies immune globulin)

3

HYPERRHO SD INTRAMUSCULAR SOLUTION PREFILLED SYRINGE 1500 UNIT 250 UNIT (rho d immune globulin)

2


50


HYPERTET SD INTRAMUSCULAR INJECTABLE 250 UNITML (tetanus immune globulin)

2

HYQVIA SUBCUTANEOUS KIT 10 GM100ML 25 GM25ML 20 GM200ML 30 GM300ML 5 GM50ML (immune globulin-hyaluronidase)

2 DSL = 30 days

IMOGAM RABIES-HT INJECTION SOLUTION 300 UNIT2ML (rabies immune globulin)

3

KEDRAB INJECTION SOLUTION 1500 UNIT10ML 300 UNIT2ML

3

MICRHOGAM ULTRA-FILTERED PLUS INTRAMUSCULAR SOLUTION PREFILLED SYRINGE 250 UNIT (rho d immune globulin)

2

NABI-HB INTRAMUSCULAR SOLUTION (hepatitis b immune globulin)

2

OCTAGAM INTRAVENOUS SOLUTION 1 GM20ML 10 GM100ML 10 GM200ML 25 GM50ML 20 GM200ML 25 GM500ML 5 GM100ML 5 GM50ML (immune globulin (human))

2

OCTAGAM INTRAVENOUS SOLUTION 2 GM20ML 30 GM300ML (immune globulin (human))

3

PANZYGA INTRAVENOUS SOLUTION 1 GM10ML 10 GM100ML 25 GM25ML 20 GM200ML 30 GM300ML 5 GM50ML (immune globulin (human)-ifas)

3

PRIVIGEN INTRAVENOUS SOLUTION 10 GM100ML 20 GM200ML 5 GM50ML (immune globulin (human))

2

PRIVIGEN INTRAVENOUS SOLUTION 40 GM400ML (immune globulin (human))

3

RHOGAM ULTRA-FILTERED PLUS INTRAMUSCULAR SOLUTION PREFILLED SYRINGE 1500 UNIT (rho d immune globulin)

2

RHOPHYLAC INJECTION SOLUTION PREFILLED SYRINGE 1500 UNIT2ML (rho d immune globulin)

2

VARIZIG INTRAMUSCULAR SOLUTION 125 UNIT12ML (varicella-zoster immune glob)

3

WINRHO SDF INJECTION SOLUTION 1500 UNIT13ML 15000 UNIT13ML 2500 UNIT22ML 5000 UNIT44ML (rho d immune globulin)

3

XEMBIFY SUBCUTANEOUS SOLUTION 1 GM5ML 10 GM50ML 2 GM10ML 4 GM20ML (immune globulin (human)-klhw)

3 DSL = 30 days

ZINPLAVA INTRAVENOUS SOLUTION 1000 MG40ML (bezlotoxumab)

3


51


VACCINES - Vaccines

AFLURIA QUADRIVALENT INTRAMUSCULAR SUSPENSION (influenza vac split quad)

PV

AFLURIA QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 025 ML 05 ML (influenza vac split quad)

PV

FLUAD INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 05 ML (influenza vac aampb surf ant adj)

PV

FLUAD QUADRIVALENT INTRAMUSCULAR PREFILLED SYRINGE 05 ML (influenza vac aampb sa adj quad)

PV

FLUARIX QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 05 ML (influenza vac split quad)

PV

FLUCELVAX QUADRIVALENT INTRAMUSCULAR SUSPENSION (influenza vac subunit quad)

PV

FLUCELVAX QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 05 ML (influenza vac subunit quad)

PV

FLULAVAL QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 05 ML (influenza vac split quad)

PV

FLUMIST QUADRIVALENT NASAL SUSPENSION (influenza virus vac live quad)

PV

FLUZONE HIGH-DOSE QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 07 ML (influenza vac high-dose quad)

PV

FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION 05 ML (influenza vac split quad)

PV

FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 05 ML (influenza vac split quad)

PV


2

AUTONOMIC DRUGS - Drugs for the Nervous System

ALPHA- AND BETA-ADRENERGIC AGONISTS - Drugs for Heart and Lungs

ADRENALIN INJECTION SOLUTION 1 MGML (epinephrine) 3

ADYPHREN AMP II INJECTION KIT 1 MGML (epinephrine) 3

ADYPHREN AMP INJECTION KIT 1 MGML (epinephrine) 3

ADYPHREN II INJECTION KIT 1 MGML (epinephrine) 3

ADYPHREN INJECTION KIT 1 MGML (epinephrine) 3

AUVI-Q INJECTION SOLUTION AUTO-INJECTOR 01 MG01ML 015 MG015ML 03 MG03ML (epinephrine)

3 DSL = 30 days


52



3

droxidopa oral capsule 100 mg 200 mg 300 mg 1 DSL = 30 days

ephedrine sulfate intravenous solution 50 mgml 1

EPHEDRINE SULFATE-NACL INTRAVENOUS SOLUTION PREFILLED SYRINGE 50-09 MG10ML- 50-09 MG5ML-

3

epinephrine injection solution auto-injector 015 mg015ml 03 mg03ml

1 DSL = 30 days

epinephrine injection solution auto-injector 015 mg03ml 1

EPINEPHRINE PROFESSIONAL INJECTION KIT 1 MGML 3

EPINEPHRINESNAP-EMS INJECTION KIT 1 MGML (epinephrine)

3

EPINEPHRINESNAP-V INJECTION KIT 1 MGML (epinephrine)

3

EPISNAP INJECTION KIT 1 MGML (epinephrine) 3

NORTHERA ORAL CAPSULE 100 MG 200 MG 300 MG (droxidopa)

3 DSL = 30 days

pseudoephedrine-bromphen-dm oral syrup 30-2-10 mg5ml 1

SYMJEPI INJECTION SOLUTION PREFILLED SYRINGE 015 MG03ML 03 MG03ML (epinephrine)

3

ALPHA-ADRENERGIC AGONISTS - Drugs for Heart and Lungs

CATAPRES-TTS-1 TRANSDERMAL PATCH WEEKLY 01 MG24HR (clonidine)

3


3


3

clonidine hcl er oral tablet extended release 12 hour 01 mg 1

clonidine hcl oral tablet 01 mg 02 mg 03 mg 1

clonidine transdermal patch weekly 01 mg24hr 02 mg24hr 03 mg24hr

1

GILPHEX TR ORAL TABLET 10-388 MG (phenylephrine-guaifenesin)

3

LUCEMYRA ORAL TABLET 018 MG (lofexidine hcl) 3 DSL = 30 days

methyldopa oral tablet 250 mg 500 mg 1

methyldopa-hydrochlorothiazide oral tablet 250-15 mg 250-25 mg

1

midodrine hcl oral tablet 10 mg 25 mg 5 mg 1


53



3

PHENYLEPHRINE HCL-NACL INTRAVENOUS SOLUTION PREFILLED SYRINGE 1-09 MG10ML- 20-09 MG50ML-

3





ANTIMUSCARINICSANTISPASMODICS - Drugs for Parkinson

ANASPAZ ORAL TABLET DISPERSIBLE 0125 MG (hyoscyamine sulfate)

3

ANORO ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 625-25 MCGINH (umeclidinium-vilanterol)

3

ATROPEN INTRAMUSCULAR SOLUTION AUTO-INJECTOR 05 MG07ML 1 MG07ML 2 MG07ML (atropine sulfate)

3

atropine sulfate injection solution 04 mgml 1 mgml 8 mg20ml

1

atropine sulfate injection solution prefilled syringe 025 mg5ml 05 mg5ml 1 mg10ml

1

atropine sulfate intravenous solution 04 mgml 1 mgml 1

ATROPINE SULFATE INTRAVENOUS SOLUTION PREFILLED SYRINGE 08 MG2ML 1 MG25ML 12 MG3ML

3

ATROVENT HFA INHALATION AEROSOL SOLUTION 17 MCGACT (ipratropium bromide hfa)

PV

BEVESPI AEROSPHERE INHALATION AEROSOL 9-48 MCGACT (glycopyrrolate-formoterol)

3

BREZTRI AEROSPHERE INHALATION AEROSOL 160-9-48 MCGACT (budeson-glycopyrrol-formoterol)

3

chlordiazepoxide-clidinium oral capsule 5-25 mg 1

COMBIVENT RESPIMAT INHALATION AEROSOL SOLUTION 20-100 MCGACT (ipratropium-albuterol)

PV

CUVPOSA ORAL SOLUTION 1 MG5ML (glycopyrrolate) 2

dicyclomine hcl oral capsule 10 mg 1

dicyclomine hcl oral solution 10 mg5ml 1

dicyclomine hcl oral tablet 20 mg 1

diphenoxylate-atropine oral liquid 25-0025 mg5ml 1

diphenoxylate-atropine oral tablet 25-0025 mg 1


54


DONNATAL ORAL ELIXIR 162 MG5ML (pb-hyoscy-atropine-scopolamine)

2

DONNATAL ORAL TABLET 162 MG (pb-hyoscy-atropine-scopolamine)

3

DUAKLIR PRESSAIR INHALATION AEROSOL POWDER BREATH ACTIVATED 400-12 MCGACT (aclidinium br-formoterol fum)

3 DSL = 30 days

ED-SPAZ ORAL TABLET DISPERSIBLE 0125 MG 3

GLYCATE ORAL TABLET 15 MG (glycopyrrolate) 3

GLYCOPYRROLATE INJECTION SOLUTION PREFILLED SYRINGE 06 MG3ML 1 MG5ML

3

GLYCOPYRROLATE INTRAVENOUS SOLUTION PREFILLED SYRINGE 06 MG3ML 1 MG5ML

3

glycopyrrolate oral tablet 1 mg 2 mg 1

GLYCOPYRROLATE ORAL TABLET 15 MG 3

glycopyrrolate pf injection solution prefilled syringe 02 mgml 04 mg2ml

1

GLYRX-PF INJECTION SOLUTION PREFILLED SYRINGE 06 MG3ML 1 MG5ML (glycopyrrolate)

3

hydrocodone-homatropine oral syrup 5-15 mg5ml 1

hydrocodone-homatropine oral tablet 5-15 mg 1

hydromet oral syrup 5-15 mg5ml 1

hyoscyamine sulfate er oral tablet extended release 12 hour0375 mg

1

hyoscyamine sulfate oral elixir 0125 mg5ml 1

hyoscyamine sulfate oral solution 0125 mgml 1

hyoscyamine sulfate oral tablet 0125 mg 1

hyoscyamine sulfate oral tablet dispersible 0125 mg 1

hyoscyamine sulfate sl sublingual tablet sublingual 0125 mg 1

hyoscyamine sulfate sublingual tablet sublingual 0125 mg 1

hyosyne oral elixir 0125 mg5ml 1

hyosyne oral solution 0125 mgml 1

INCRUSE ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 625 MCGINH (umeclidinium bromide)

3

ipratropium bromide inhalation solution 002 PV

ipratropium-albuterol inhalation solution 05-25 (3) mg3ml 1

LEVBID ORAL TABLET EXTENDED RELEASE 12 HOUR 0375 MG (hyoscyamine sulfate)

3

LEVSIN ORAL TABLET 0125 MG (hyoscyamine sulfate) 3


55


LEVSINSL SUBLINGUAL TABLET SUBLINGUAL 0125 MG (hyoscyamine sulfate)

3

LONHALA MAGNAIR REFILL KIT INHALATION SOLUTION 25 MCGML (glycopyrrolate)

3 DSL = 30 days

LONHALA MAGNAIR STARTER KIT INHALATION SOLUTION 25 MCGML (glycopyrrolate)

3 DSL = 30 days

methscopolamine bromide oral tablet 25 mg 5 mg 1

hyoscyamine sulfate (Nulev Oral Tablet Dispersible 0125 Mg) 3

oscimin oral tablet 0125 mg 1

oscimin sr oral tablet extended release 12 hour 0375 mg 1

oscimin sublingual tablet sublingual 0125 mg 1

pb-hyoscy-atropine-scopolamine oral elixir 162 mg5ml 1

pb-hyoscy-atropine-scopolamine oral tablet 162 mg 1

phenobarbital-belladonna alk oral elixir 162 mg5ml 1

phenobarbital-belladonna alk oral tablet 162 mg 1

pb-hyoscy-atropine-scopolamine (Phenohytro Oral Elixir 162 Mg5Ml)

2

pb-hyoscy-atropine-scopolamine (Phenohytro Oral Tablet 162 Mg)

3

QBREXZA EXTERNAL PAD 24 (glycopyrronium tosylate) 3

SEEBRI NEOHALER INHALATION CAPSULE 156 MCG (glycopyrrolate)

3

SPIRIVA HANDIHALER INHALATION CAPSULE 18 MCG (tiotropium bromide monohydrate)

3

SPIRIVA RESPIMAT INHALATION AEROSOL SOLUTION 125 MCGACT (tiotropium bromide monohydrate)

3


2

STIOLTO RESPIMAT INHALATION AEROSOL SOLUTION 25-25 MCGACT (tiotropium bromide-olodaterol)

2

SYMAX DUOTAB ORAL TABLET EXTENDED RELEASE 0375 MG (hyoscyamine sulfate)

3

hyoscyamine sulfate (Symax-Sl Sublingual Tablet Sublingual 0125 Mg)

3

hyoscyamine sulfate (Symax-Sr Oral Tablet Extended Release 12 Hour 0375 Mg)

3

TRELEGY ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 100-625-25 MCGINH (fluticasone-umeclidin-vilant)

3

TUDORZA PRESSAIR INHALATION AEROSOL POWDER BREATH ACTIVATED 400 MCGACT (aclidinium bromide)

3


56


UTIBRON NEOHALER INHALATION CAPSULE 275-156 MCG (indacaterol-glycopyrrolate)

3

YUPELRI INHALATION SOLUTION 175 MCG3ML (revefenacin)

3

ANTIPARKINSONIAN AGENTS - Drugs for Parkinson

benztropine mesylate oral tablet 05 mg 1 mg 2 mg 1

trihexyphenidyl hcl oral solution 04 mgml 1

trihexyphenidyl hcl oral tablet 2 mg 5 mg 1

AUTONOMIC DRUGS MISCELLANEOUS - Drugs for the Nervous System

CHANTIX CONTINUING MONTH PAK ORAL TABLET 1 MG (varenicline tartrate)

PV

CHANTIX ORAL TABLET 05 MG 1 MG (varenicline tartrate) PV

CHANTIX STARTING MONTH PAK ORAL TABLET 05 MG X 11 amp 1 MG X 42 (varenicline tartrate)

PV

goodsense nicotine mouththroat lozenge 4 mg PV

NICORETTE MOUTHTHROAT GUM 2 MG (nicotine polacrilex) PV

nicotine polacrilex mouththroat gum 2 mg 4 mg PV

nicotine polacrilex mouththroat lozenge 2 mg 4 mg PV

nicotine step 1 transdermal patch 24 hour 21 mg24hr PV



NICOTROL INHALATION INHALER 10 MG (nicotine) PV

NICOTROL NS NASAL SOLUTION 10 MGML (nicotine) PV

CENTRALLY ACTING SKELETAL MUSCLE RELAXNT - Drugs for Relaxing Muscles

carisoprodol oral tablet 250 mg 350 mg 1

carisoprodol-aspirin-codeine oral tablet 200-325-16 mg 1

chlorzoxazone oral tablet 250 mg 1 DSL = 30 days

chlorzoxazone oral tablet 375 mg 500 mg 750 mg 1

cyclobenzaprine hcl er oral capsule extended release 24 hour15 mg 30 mg

1

cyclobenzaprine hcl oral tablet 10 mg 5 mg 75 mg 1

CYCLOPAK COMBINATION THERAPY PACK 5 amp 25-25 MG amp (cyclobenz-lido-prilo-swall spr)

3

chlorzoxazone (Lorzone Oral Tablet 375 Mg 750 Mg) 3

metaxalone oral tablet 400 mg 800 mg 1

methocarbamol oral tablet 500 mg 750 mg 1


57


NOPIOID-LMC KIT COMBINATION THERAPY PACK 75 amp 4-4 MG amp (cyclobenzaprine-lidocaine-ment)

3

tizanidine hcl oral capsule 2 mg 4 mg 6 mg 1

tizanidine hcl oral tablet 2 mg 4 mg 1

DIRECT-ACTING SKELETAL MUSCLE RELAXANTS - Drugs for Relaxing Muscles

dantrolene sodium oral capsule 100 mg 25 mg 50 mg 1

GABA-DERIVATIVE SKELETAL MUSCLE RELAXANT - Drugs for Relaxing Muscles

baclofen intrathecal solution 10 mg20ml 20000 mcg20ml 40 mg20ml

1

baclofen oral tablet 10 mg 20 mg 5 mg 1

GABLOFEN INTRATHECAL SOLUTION PREFILLED SYRINGE 10000 MCG20ML 20000 MCG20ML 40000 MCG20ML 50 MCGML (baclofen)

2

LIORESAL INTRATHECAL SOLUTION 005 MGML 10 MG5ML (baclofen)

3

OZOBAX ORAL SOLUTION 5 MG5ML (baclofen) 3

NEUROMUSCULAR BLOCKING AGENTS - Drugs for Relaxing Muscles

SUCCINYLCHOLINE CHLORIDE INTRAVENOUS SOLUTION PREFILLED SYRINGE 140 MG7ML

3

VECURONIUM BROMIDE INTRAVENOUS SOLUTION PREFILLED SYRINGE 10 MG10ML

3

NON-SEL BETA-ADRENERGIC BLOCKING AGENTS - Drugs for the Heart

BETAPACE AF ORAL TABLET 120 MG 160 MG 80 MG (sotalol hcl af)

3

BETAPACE ORAL TABLET 120 MG 160 MG 80 MG (sotalol hcl)

3

BYSTOLIC ORAL TABLET 10 MG 25 MG 20 MG 5 MG (nebivolol hcl)

3

carvedilol oral tablet 125 mg 25 mg 3125 mg 625 mg 1

carvedilol phosphate er oral capsule extended release 24 hour10 mg 20 mg 40 mg 80 mg

1

COREG CR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG 20 MG 40 MG 80 MG (carvedilol phosphate)

3

COREG ORAL TABLET 125 MG 25 MG 3125 MG 625 MG (carvedilol)

3

CORGARD ORAL TABLET 20 MG 40 MG 80 MG (nadolol) 3

HEMANGEOL ORAL SOLUTION 428 MGML (propranolol hcl) 3


58


INDERAL LA ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG 160 MG 60 MG 80 MG (propranolol hcl)

3

INDERAL XL ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG 80 MG (propranolol hcl sr beads)

3

INNOPRAN XL ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG 80 MG (propranolol hcl sr beads)

3

labetalol hcl oral tablet 100 mg 200 mg 300 mg 1

nadolol oral tablet 20 mg 40 mg 80 mg 1

pindolol oral tablet 10 mg 5 mg 1

propranolol hcl er oral capsule extended release 24 hour 120 mg 160 mg 60 mg 80 mg

1

propranolol hcl oral solution 20 mg5ml 40 mg5ml 1

propranolol hcl oral tablet 10 mg 20 mg 40 mg 60 mg 80 mg 1

propranolol-hctz oral tablet 40-25 mg 80-25 mg 1

sotalol hcl (af) oral tablet 120 mg 160 mg 80 mg 1

sotalol hcl oral tablet 120 mg 160 mg 240 mg 80 mg 1

SOTYLIZE ORAL SOLUTION 5 MGML (sotalol hcl) 3

timolol maleate oral tablet 10 mg 20 mg 5 mg 1

NON-SELALPHA-1-ADRENERGIC BLOCKING AGTS - Drugs for the Heart

CARDURA ORAL TABLET 1 MG 2 MG 4 MG 8 MG (doxazosin mesylate)

3

CARDURA XL ORAL TABLET EXTENDED RELEASE 24 HOUR 4 MG 8 MG (doxazosin mesylate)

3

doxazosin mesylate oral tablet 1 mg 2 mg 4 mg 8 mg 1

MINIPRESS ORAL CAPSULE 1 MG 2 MG 5 MG (prazosin hcl)

3

prazosin hcl oral capsule 1 mg 2 mg 5 mg 1

terazosin hcl oral capsule 1 mg 10 mg 2 mg 5 mg 1

NON-SELALPHA-ADRENERGIC BLOCKING AGENTS - Drugs for the Heart

CAFERGOT ORAL TABLET 1-100 MG (ergotamine-caffeine) 2

DIBENZYLINE ORAL CAPSULE 10 MG (phenoxybenzamine hcl)

3

dihydroergotamine mesylate injection solution 1 mgml 1 DSL = 30 days

dihydroergotamine mesylate nasal solution 4 mgml 1 DSL = 30 days

ergoloid mesylates oral tablet 1 mg 1

ERGOMAR SUBLINGUAL TABLET SUBLINGUAL 2 MG (ergotamine tartrate)

2


59


ergotamine-caffeine oral tablet 1-100 mg 1

MIGERGOT RECTAL SUPPOSITORY 2-100 MG (ergotamine-caffeine)

2

MIGRANAL NASAL SOLUTION 4 MGML (dihydroergotamine mesylate)

2 DSL = 30 days

phenoxybenzamine hcl oral capsule 10 mg 1

phentolamine mesylate injection solution reconstituted 5 mg 1

TRI-MIX INTRACAVERNOSAL SOLUTION RECONSTITUTED 150-5-50 MG-MG-MCG

2

PARASYMPATHOMIMETIC (CHOLINERGIC AGENTS) - Drugs for Bladder Incontinence

bethanechol chloride oral tablet 10 mg 25 mg 5 mg 50 mg 1

cevimeline hcl oral capsule 30 mg 1

donepezil hcl oral tablet 10 mg 23 mg 5 mg 1

donepezil hcl oral tablet dispersible 10 mg 5 mg 1

galantamine hydrobromide er oral capsule extended release 24 hour 16 mg 24 mg 8 mg

1

galantamine hydrobromide oral solution 4 mgml 1

galantamine hydrobromide oral tablet 12 mg 4 mg 8 mg 1

GUANIDINE HCL ORAL TABLET 125 MG 2

MESTINON ORAL SOLUTION 60 MG5ML (pyridostigmine bromide)

2

MESTINON ORAL TABLET EXTENDED RELEASE 180 MG (pyridostigmine bromide)

2

NAMZARIC ORAL CAPSULE ER 24 HOUR THERAPY PACK 7 amp 14 amp 21 amp28 -10 MG (memantine hcl-donepezil hcl)

3

NAMZARIC ORAL CAPSULE EXTENDED RELEASE 24 HOUR 14-10 MG 28-10 MG (memantine hcl-donepezil hcl)

3 DSL = 30 days


3

NEOSTIGMINE METHYLSULFATE INTRAVENOUS SOLUTION PREFILLED SYRINGE 5 MG5ML

3

pilocarpine hcl oral tablet 5 mg 75 mg 1

pyridostigmine bromide er oral tablet extended release 180 mg 1

pyridostigmine bromide oral solution 60 mg5ml 1

pyridostigmine bromide oral tablet 30 mg 60 mg 1

rivastigmine tartrate oral capsule 15 mg 3 mg 45 mg 6 mg 1

rivastigmine transdermal patch 24 hour 133 mg24hr 46 mg24hr 95 mg24hr

1


60


SELECTIVE ALPHA-1-ADRENERGIC BLOCKAGENT - Drugs for the Heart

alfuzosin hcl er oral tablet extended release 24 hour 10 mg 1



1


3


3

dutasteride-tamsulosin hcl oral capsule 05-04 mg 1


silodosin oral capsule 4 mg 8 mg 1

tamsulosin hcl oral capsule 04 mg 1

SELECTIVE BETA-2-ADRENERGIC AGONISTS - Drugs for Heart and Lungs

ADVAIR DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 100-50 MCGDOSE 250-50 MCGDOSE 500-50 MCGDOSE (fluticasone-salmeterol)

2

ADVAIR HFA INHALATION AEROSOL 115-21 MCGACT 230-21 MCGACT 45-21 MCGACT (fluticasone-salmeterol)

2

AIRDUO DIGIHALER INHALATION AEROSOL POWDER BREATH ACTIVATED 113-14 MCGACT 232-14 MCGACT 55-14 MCGACT (fluticasone-salmeterol)

3

AIRDUO RESPICLICK 11314 INHALATION AEROSOL POWDER BREATH ACTIVATED 113-14 MCGACT (fluticasone-salmeterol)

3


3


3

albuterol sulfate er oral tablet extended release 12 hour 4 mg 8 mg

PV

albuterol sulfate hfa aerosol solution 108 (90 base) mcgact inhalation 108 (90 base) mcgact

PV

ALBUTEROL SULFATE HFA AEROSOL SOLUTION 108 (90 BASE) MCGACT INHALATION 108 (90 BASE) MCGACT

PV

albuterol sulfate inhalation nebulization solution (25 mg3ml) 0083 063 mg3ml 125 mg3ml 25 mg05ml

PV


61


ALBUTEROL SULFATE NEBULIZATION SOLUTION (5 MGML) 05 INHALATION (5 MGML) 05

PV

albuterol sulfate nebulization solution (5 mgml) 05 inhalation(5 mgml) 05

PV

albuterol sulfate oral syrup 2 mg5ml PV

albuterol sulfate oral tablet 2 mg 4 mg PV


3


3

BREO ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 100-25 MCGINH 200-25 MCGINH (fluticasone furoate-vilanterol)

3


3

BROVANA INHALATION NEBULIZATION SOLUTION 15 MCG2ML (arformoterol tartrate)

3

BUDESONIDE-FORMOTEROL FUMARATE INHALATION AEROSOL 160-45 MCGACT 80-45 MCGACT

3


PV


3 DSL = 30 days

DULERA INHALATION AEROSOL 100-5 MCGACT 200-5 MCGACT 50-5 MCGACT (mometasone furo-formoterol fum)

3

fluticasone-salmeterol inhalation aerosol powder breath activated 100-50 mcgdose 250-50 mcgdose 500-50 mcgdose

1

FLUTICASONE-SALMETEROL INHALATION AEROSOL POWDER BREATH ACTIVATED 113-14 MCGACT 232-14 MCGACT 55-14 MCGACT

3


levalbuterol hcl inhalation nebulization solution 031 mg3ml 063 mg3ml 125 mg05ml 125 mg3ml

1

LEVALBUTEROL HFA INHALATION AEROSOL 45 MCGACT 3

PERFOROMIST INHALATION NEBULIZATION SOLUTION 20 MCG2ML (formoterol fumarate)

3

PROAIR DIGIHALER INHALATION AEROSOL POWDER BREATH ACTIVATED 108 MCGACT (albuterol sulfate)

PV


62


PROAIR HFA INHALATION AEROSOL SOLUTION 108 (90 BASE) MCGACT (albuterol sulfate)

PV

PROAIR RESPICLICK INHALATION AEROSOL POWDER BREATH ACTIVATED 108 (90 BASE) MCGACT (albuterol sulfate)

PV

PROVENTIL HFA INHALATION AEROSOL SOLUTION 108 (90 BASE) MCGACT (albuterol sulfate)

PV

SEREVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 50 MCGDOSE (salmeterol xinafoate)

2


2

STRIVERDI RESPIMAT INHALATION AEROSOL SOLUTION 25 MCGACT (olodaterol hcl)

2

SYMBICORT INHALATION AEROSOL 160-45 MCGACT 80-45 MCGACT (budesonide-formoterol fumarate)

3

terbutaline sulfate injection solution 1 mgml PV

terbutaline sulfate oral tablet 25 mg 5 mg PV


3


3

VENTOLIN HFA INHALATION AEROSOL SOLUTION 108 (90 BASE) MCGACT (albuterol sulfate)

PV

fluticasone-salmeterol (Wixela Inhub Inhalation Aerosol Powder Breath Activated 100-50 McgDose 250-50 McgDose 500-50 McgDose)

1

XOPENEX HFA INHALATION AEROSOL 45 MCGACT (levalbuterol tartrate)

3

SELECTIVE BETA-ADRENERGIC BLOCKING AGENT - Drugs for the Heart

acebutolol hcl oral capsule 200 mg 400 mg 1

atenolol oral tablet 100 mg 25 mg 50 mg 1

atenolol-chlorthalidone oral tablet 100-25 mg 50-25 mg 1

betaxolol hcl oral tablet 10 mg 20 mg 1

bisoprolol fumarate oral tablet 10 mg 5 mg 1

bisoprolol-hydrochlorothiazide oral tablet 10-625 mg 25-625 mg 5-625 mg

1

DUTOPROL ORAL TABLET EXTENDED RELEASE 24 HOUR 100-125 MG 25-125 MG 50-125 MG (metoprolol-hydrochlorothiazide)

3


63


ESMOLOL HCL INTRAVENOUS SOLUTION PREFILLED SYRINGE 100 MG10ML

3

KAPSPARGO SPRINKLE ORAL CAPSULE ER 24 HOUR SPRINKLE 100 MG 200 MG 25 MG 50 MG (metoprolol succinate)

3

LOPRESSOR ORAL TABLET 100 MG 50 MG (metoprolol tartrate)

3

metoprolol succinate er oral tablet extended release 24 hour100 mg 200 mg 25 mg 50 mg

1

metoprolol tartrate oral tablet 100 mg 25 mg 375 mg 50 mg 75 mg

1

metoprolol-hydrochlorothiazide oral tablet 100-25 mg 100-50 mg 50-25 mg

1

TENORETIC 100 ORAL TABLET 100-25 MG (atenolol-chlorthalidone)

3


3

TENORMIN ORAL TABLET 100 MG 25 MG 50 MG (atenolol) 3

TOPROL XL ORAL TABLET EXTENDED RELEASE 24 HOUR 100 MG 200 MG 25 MG 50 MG (metoprolol succinate)

3

ZIAC ORAL TABLET 10-625 MG 25-625 MG 5-625 MG (bisoprolol-hydrochlorothiazide)

3

SKELETAL MUSCLE RELAXANTS MISCELLANEOUS - Drugs for Relaxing Muscles

BOTOX INJECTION SOLUTION RECONSTITUTED 100 UNIT 200 UNIT (onabotulinumtoxina)

2

DYSPORT INTRAMUSCULAR SOLUTION RECONSTITUTED 300 UNIT 500 UNIT (abobotulinumtoxina)

3

MYOBLOC INTRAMUSCULAR SOLUTION 10000 UNIT2ML 2500 UNIT05ML 5000 UNITML (rimabotulinumtoxinb)

2

NORGESIC FORTE ORAL TABLET 50-770-60 MG 3

orphenadrine citrate er oral tablet extended release 12 hour 100 mg

1

orphenadrine-asa-caffeine oral tablet 50-770-60 mg 1

orphenadrine-aspirin-caffeine (Orphengesic Forte Oral Tablet 50-770-60 Mg)

3

XEOMIN INTRAMUSCULAR SOLUTION RECONSTITUTED 100 UNIT 200 UNIT 50 UNIT (incobotulinumtoxina)

3


64


BLOOD FORMATION COAGULATION THROMBOSIS - Drugs for the Blood

ANTIANEMIA DRUGS - Vitamins and Minerals

REBLOZYL SUBCUTANEOUS SOLUTION RECONSTITUTED 25 MG 75 MG (luspatercept-aamt)

3 DSL = 30 days

ANTICOAGULANTS - Drugs to Prevent Blood Clots

TRICITRASOL IN VITRO CONCENTRATE 467 (anticoagulant sodium citrate)

3

ANTICOAGULANTS MISCELLANEOUS - Drugs to Prevent Blood Clots

ACD-A NOCLOT-50 IN VITRO SOLUTION 073-245-22 GM100ML (anticoagulant cit dext soln a)

2

ANTICOAGULANT SODIUM CITRATE IN VITRO SOLUTION 4 GM100ML

3

ARIXTRA SUBCUTANEOUS SOLUTION 10 MG08ML 25 MG05ML 5 MG04ML 75 MG06ML (fondaparinux sodium)

3 DSL = 30 days

fondaparinux sodium subcutaneous solution 10 mg08ml 25 mg05ml 5 mg04ml 75 mg06ml

1 DSL = 30 days

REGIOCIT IN VITRO SOLUTION 0529 (anticoagulant na cit (crrt))

3

THROMBATE III INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT (antithrombin iii (human))

3


2

ANTIHEMORRHAGIC AGENTS MISCELLANEOUS - Drugs to Prevent Bleeding

ANDEXXA INTRAVENOUS SOLUTION RECONSTITUTED 200 MG (coag fact xa inactivated-zhzo)

3

PRAXBIND INTRAVENOUS SOLUTION 25 GM50ML (idarucizumab)

2

ANTITHROMBOTIC AGENTS MISCELLANEOUS - Drugs to Prevent Blood Clots

CABLIVI INJECTION KIT 11 MG (caplacizumab-yhdp) 3 DSL = 30 days

BLOOD FORMCOAGTHROMBOSIS AGENTS MISC - Drugs to Prevent Bleeding

ADAKVEO INTRAVENOUS SOLUTION 100 MG10ML (crizanlizumab-tmca)

3 DSL = 30 days

OXBRYTA ORAL TABLET 500 MG (voxelotor) 3 DSL = 30 days

TAVALISSE ORAL TABLET 100 MG 150 MG (fostamatinib disodium)

3 DSL = 30 days


65


COUMARIN DERIVATIVES - Drugs to Prevent Blood Clots

warfarin sodium (Jantoven Oral Tablet 1 Mg 10 Mg 2 Mg 25 Mg 3 Mg 4 Mg 5 Mg 6 Mg 75 Mg)

1

warfarin sodium oral tablet 1 mg 10 mg 2 mg 25 mg 3 mg 4 mg 5 mg 6 mg 75 mg

1

DIRECT FACTOR XA INHIBITORS - Drugs to Prevent Blood Clots


3 DSL = 30 days

ELIQUIS DVTPE STARTER PACK ORAL TABLET THERAPY PACK 5 MG (apixaban)

3

ELIQUIS ORAL TABLET 25 MG 5 MG (apixaban) 3


1 DSL = 30 days

SAVAYSA ORAL TABLET 15 MG 30 MG 60 MG (edoxaban tosylate)

3

XARELTO ORAL TABLET 10 MG 15 MG 25 MG 20 MG (rivaroxaban)

3

XARELTO STARTER PACK ORAL TABLET THERAPY PACK 15 amp 20 MG (rivaroxaban)

3

DIRECT THROMBIN INHIBITORS - Drugs to Prevent Blood Clots

PRADAXA ORAL CAPSULE 110 MG 150 MG 75 MG (dabigatran etexilate mesylate)

2

HEMATOPOIETIC AGENTS - Drugs for Anemia

ARANESP (ALBUMIN FREE) INJECTION SOLUTION 100 MCGML 200 MCGML 25 MCGML 300 MCGML 40 MCGML 60 MCGML (darbepoetin alfa)

PV DSL = 30 days

ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED SYRINGE 10 MCG04ML 100 MCG05ML 150 MCG03ML 200 MCG04ML 25 MCG042ML 300 MCG06ML 40 MCG04ML 500 MCGML 60 MCG03ML (darbepoetin alfa)

PV DSL = 30 days

DOPTELET ORAL TABLET 20 MG (avatrombopag maleate) 3 DSL = 30 days

EPOGEN INJECTION SOLUTION 10000 UNITML 2000 UNITML 20000 UNITML 3000 UNITML 4000 UNITML (epoetin alfa)

PV DSL = 30 days

FULPHILA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 6 MG06ML (pegfilgrastim-jmdb)

PV DSL = 30 days

GRANIX SUBCUTANEOUS SOLUTION 300 MCGML 480 MCG16ML (tbo-filgrastim)

PV DSL = 30 days


66


GRANIX SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 300 MCG05ML 480 MCG08ML (tbo-filgrastim)

PV DSL = 30 days

LEUKINE INJECTION SOLUTION RECONSTITUTED 250 MCG (sargramostim)

PV DSL = 30 days

MIRCERA INJECTION SOLUTION PREFILLED SYRINGE 100 MCG03ML 150 MCG03ML 200 MCG03ML 30 MCG03ML 50 MCG03ML 75 MCG03ML (methoxy peg-epoetin beta)

PV

MOZOBIL SUBCUTANEOUS SOLUTION 24 MG12ML (plerixafor)

3

MULPLETA ORAL TABLET 3 MG (lusutrombopag) 3 DSL = 30 days

NEULASTA ONPRO SUBCUTANEOUS PREFILLED SYRINGE KIT 6 MG06ML (pegfilgrastim)

PV

NEULASTA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 6 MG06ML (pegfilgrastim)

PV

NEUPOGEN INJECTION SOLUTION 300 MCGML 480 MCG16ML (filgrastim)

PV DSL = 30 days

NEUPOGEN INJECTION SOLUTION PREFILLED SYRINGE 300 MCG05ML 480 MCG08ML (filgrastim)

PV DSL = 30 days

NIVESTYM INJECTION SOLUTION 300 MCGML 480 MCG16ML (filgrastim-aafi)

PV DSL = 30 days

NIVESTYM INJECTION SOLUTION PREFILLED SYRINGE 300 MCG05ML 480 MCG08ML (filgrastim-aafi)

PV DSL = 30 days

NPLATE SUBCUTANEOUS SOLUTION RECONSTITUTED 125 MCG 250 MCG 500 MCG (romiplostim)

3 DSL = 30 days

NYVEPRIA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 6 MG06ML (pegfilgrastim-apgf)

PV DSL = 30 days

PROCRIT INJECTION SOLUTION 10000 UNITML 2000 UNITML 20000 UNITML 3000 UNITML 4000 UNITML 40000 UNITML (epoetin alfa)

PV DSL = 30 days

PROMACTA ORAL PACKET 125 MG 25 MG (eltrombopag olamine)

3 DSL = 30 days

PROMACTA ORAL TABLET 125 MG 25 MG 50 MG 75 MG (eltrombopag olamine)

2 DSL = 30 days


3 DSL = 30 days

RETACRIT INJECTION SOLUTION 10000 UNITML 2000 UNITML 20000 UNITML 3000 UNITML 4000 UNITML 40000 UNITML (epoetin alfa-epbx)

PV DSL = 30 days

UDENYCA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 6 MG06ML (pegfilgrastim-cbqv)

PV DSL = 30 days


67


ZARXIO INJECTION SOLUTION PREFILLED SYRINGE 300 MCG05ML 480 MCG08ML (filgrastim-sndz)

PV DSL = 30 days

ZIEXTENZO SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 6 MG06ML (pegfilgrastim-bmez)

PV DSL = 30 days

HEMORRHEOLOGIC AGENTS - Drugs for Blood Flow

pentoxifylline er oral tablet extended release 400 mg 1

HEMOSTATICS - Drugs to Prevent Bleeding

ADVATE INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 1500 UNIT 2000 UNIT 250 UNIT 3000 UNIT 500 UNIT (antihemophil factor (rahf-pfm))

2

ADVATE INTRAVENOUS SOLUTION RECONSTITUTED 4000 UNIT (antihemophil factor (rahf-pfm))

2 DSL = 30 days

ADYNOVATE INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 1500 UNIT 2000 UNIT 250 UNIT 3000 UNIT 500 UNIT 750 UNIT

2

AFSTYLA INTRAVENOUS KIT 1000 UNIT 1500 UNIT 2000 UNIT 250 UNIT 2500 UNIT 3000 UNIT 500 UNIT (antihemophil fact single chain)

2 DSL = 30 days

ALPHANATE INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 1500 UNIT 2000 UNIT 250 UNIT 500 UNIT (antihemophilic factor-vwf)

2

ALPHANINE SD INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 1500 UNIT 500 UNIT (coagulation factor ix)

2

ALPROLIX INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 2000 UNIT 250 UNIT 3000 UNIT 4000 UNIT 500 UNIT (coagulation factor ix (rfixfc))

2

aminocaproic acid oral solution 025 gmml 1

aminocaproic acid oral tablet 1000 mg 500 mg 1

ASTRINGYN EXTERNAL SOLUTION 259 MGGM (ferric subsulfate)

3

AVITENE EXTERNAL PAD (microfibrillar coll hemostat) 3

AVITENE FLOUR EXTERNAL POWDER (microfibrillar coll hemostat)

3

BENEFIX INTRAVENOUS KIT 1000 UNIT 2000 UNIT 250 UNIT 3000 UNIT 500 UNIT (coagulation factor ix (recomb))

2

COAGADEX INTRAVENOUS SOLUTION RECONSTITUTED 250 UNIT 500 UNIT (coagulation factor x (human))

2

CORIFACT INTRAVENOUS KIT 1000-1600 UNIT (factor xiii concentrate human)

2

DDAVP RHINAL TUBE NASAL SOLUTION 001 (desmopressin ace refrigerated)

2


68


desmopressin ace spray refrig nasal solution 001 1

desmopressin acetate injection solution 4 mcgml 1

desmopressin acetate oral tablet 01 mg 02 mg 1

desmopressin acetate pf injection solution 4 mcgml 1

ELOCTATE INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 1500 UNIT 2000 UNIT 250 UNIT 3000 UNIT 4000 UNIT 500 UNIT 5000 UNIT 6000 UNIT 750 UNIT (antihem fact (bdd-rfviiifc))

2

ENDO AVITENE EXTERNAL (absorbable collagen hemostat) 3

ESPEROCT INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 1500 UNIT 2000 UNIT 3000 UNIT 500 UNIT (antihemoph fact rcmb gpeg-exei)

3

FEIBA INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 2500 UNIT 500 UNIT (antiinhibitor coagulant cmplx)

2

FIBRYGA INTRAVENOUS SOLUTION RECONSTITUTED (fibrinogen concentrate (human))

2

GELFOAM MOUTHTHROAT POWDER (gelatin absorbable) 3

HEMLIBRA SUBCUTANEOUS SOLUTION 105 MG07ML 150 MGML 30 MGML 60 MG04ML (emicizumab-kxwh)

2 DSL = 30 days

HEMOFIL M INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 1700 UNIT 250 UNIT 500 UNIT (antihemophilic factor)

2

HUMATE-P INTRAVENOUS SOLUTION RECONSTITUTED 1000-2400 UNIT 250-600 UNIT 500-1200 UNIT (antihemophilic factor-vwf)

2

IDELVION INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 2000 UNIT 250 UNIT 500 UNIT (coagulation factor ix (rix-fp))

2

IDELVION INTRAVENOUS SOLUTION RECONSTITUTED 3500 UNIT (coagulation factor ix (rix-fp))

3

IXINITY INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 1500 UNIT 2000 UNIT 250 UNIT 3000 UNIT 500 UNIT (coagulation factor ix (recomb))

2

JIVI INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 2000 UNIT 3000 UNIT 500 UNIT (ahf (bdd-rfviii peg-aucl))

3 DSL = 30 days

KOATE INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 250 UNIT 500 UNIT (antihemophilic factor)

2

KOATE-DVI INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 250 UNIT 500 UNIT (antihemophilic factor)

2

KOGENATE FS INTRAVENOUS KIT 1000 UNIT 250 UNIT 500 UNIT (antihem factor recomb (rfviii))

2 DSL = 30 days


69


KOGENATE FS INTRAVENOUS KIT 2000 UNIT 3000 UNIT (antihem factor recomb (rfviii))

2

KOVALTRY INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 2000 UNIT 250 UNIT 3000 UNIT 500 UNIT (antihemophil factor (rahf-pfm))

2

MONONINE INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT (coagulation factor ix)

2

monsels ferric subsulfate external solution 1

NOCDURNA SUBLINGUAL TABLET SUBLINGUAL 277 MCG 553 MCG (desmopressin acetate)

3

NOVOEIGHT INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 1500 UNIT 2000 UNIT 250 UNIT 3000 UNIT 500 UNIT (antihemophil fact bd truncated)

2

NOVOSEVEN RT INTRAVENOUS SOLUTION RECONSTITUTED 1 MG 2 MG 5 MG 8 MG (coagulation factor viia recomb)

2 DSL = 30 days

NUWIQ INTRAVENOUS KIT 1000 UNIT 250 UNIT 500 UNIT (antihem fact (bdd-rfviiisim))

3 DSL = 30 days

NUWIQ INTRAVENOUS KIT 2000 UNIT 2500 UNIT 3000 UNIT 4000 UNIT (antihem fact (bdd-rfviiisim))

3

NUWIQ INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 2000 UNIT 250 UNIT 500 UNIT (antihem fact (bdd-rfviiisim))

2

NUWIQ INTRAVENOUS SOLUTION RECONSTITUTED 2500 UNIT 3000 UNIT 4000 UNIT (antihem fact (bdd-rfviiisim))

3

OBIZUR INTRAVENOUS SOLUTION RECONSTITUTED 500 UNIT

2

PROFILNINE INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 1500 UNIT 500 UNIT (factor ix complex)

2 DSL = 30 days

REBINYN INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 2000 UNIT 500 UNIT (coagulation factor ix glycopeg)

3

RECOMBINATE INTRAVENOUS SOLUTION RECONSTITUTED 1241-1800 UNIT 1801-2400 UNIT 801-1240 UNIT (antihem factor recomb (rfviii))

2 DSL = 30 days

RECOMBINATE INTRAVENOUS SOLUTION RECONSTITUTED 220-400 UNIT 401-800 UNIT (antihem factor recomb (rfviii))

2

RECOTHROM EXTERNAL SOLUTION RECONSTITUTED 20000 UNIT 5000 UNIT (thrombin (recombinant))

2

RECOTHROM SPRAY KIT EXTERNAL SOLUTION RECONSTITUTED 20000 UNIT (thrombin (recombinant))

2


70


RIASTAP INTRAVENOUS SOLUTION RECONSTITUTED (fibrinogen concentrate (human))

2

RIXUBIS INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 2000 UNIT 250 UNIT 3000 UNIT 500 UNIT

2

SEVENFACT INTRAVENOUS SOLUTION RECONSTITUTED 1 MG 5 MG (coagulation factor viia-jncw)

3

STIMATE NASAL SOLUTION 15 MGML (desmopressin acetate)

2

SYRINGE AVITENE EXTERNAL (absorbable collagen hemostat)

3

TACHOSIL EXTERNAL PATCH 48 X 48 CM 95 X 48 CM (absorbable fibrin sealant)

3

THROMBIN-JMI EPISTAXIS EXTERNAL KIT 5000 UNIT (thrombin)

3

THROMBIN-JMI EXTERNAL KIT 20000 UNIT (thrombin) 2


tranexamic acid intravenous solution 1000 mg10ml 1

tranexamic acid oral tablet 650 mg 1

TRANEXAMIC ACID-NACL INTRAVENOUS SOLUTION 1000-07 MG100ML-

3

TRETTEN INTRAVENOUS SOLUTION RECONSTITUTED 2000-3125 UNIT (coagulation factor xiii a-sub)

2

VONVENDI INTRAVENOUS SOLUTION RECONSTITUTED 1300 UNIT 650 UNIT (von willebrand factor (recomb))

2 DSL = 30 days

WILATE INTRAVENOUS KIT 1000-1000 UNIT 500-500 UNIT (antihemophilic factor-vwf)

2

XYNTHA INTRAVENOUS KIT 1000 UNIT 250 UNIT 500 UNIT (antihem fact (bdd-rfviiimor))

2 DSL = 30 days

XYNTHA INTRAVENOUS KIT 2000 UNIT (antihem fact (bdd-rfviiimor))

2

XYNTHA SOLOFUSE INTRAVENOUS KIT 1000 UNIT 250 UNIT 500 UNIT (antihem fact (bdd-rfviiimor))

2 DSL = 30 days

XYNTHA SOLOFUSE INTRAVENOUS KIT 2000 UNIT 3000 UNIT (antihem fact (bdd-rfviiimor))

2

HEPARINS - Drugs to Prevent Blood Clots

enoxaparin sodium injection solution 300 mg3ml 1 DSL = 30 days

enoxaparin sodium subcutaneous solution 100 mgml 120 mg08ml 150 mgml 30 mg03ml 40 mg04ml 60 mg06ml 80 mg08ml

1 DSL = 30 days


71


FRAGMIN SUBCUTANEOUS SOLUTION 10000 UNITML 12500 UNIT05ML 15000 UNIT06ML 18000 UNT072ML 2500 UNIT02ML 5000 UNIT02ML 7500 UNIT03ML 95000 UNIT38ML (dalteparin sodium)

3 DSL = 30 days

heparin (porcine) in nacl intravenous solution 1000-09 ut500ml- 2000-09 unitl-

1

heparin lock flush intravenous solution 10 unitml 1

heparin sodium (porcine) injection solution 1000 unitml 10000 unitml 20000 unitml 5000 unitml

1

heparin sodium (porcine) injection solution prefilled syringe5000 unit05ml

1

heparin sodium (porcine) pf injection solution 5000 unit05ml 5000 unitml

1

heparin sodium lock flush intravenous solution 100 unitml 1

LOVENOX INJECTION SOLUTION 300 MG3ML (enoxaparin sodium)

2 DSL = 30 days

LOVENOX SUBCUTANEOUS SOLUTION 100 MGML 120 MG08ML 150 MGML 30 MG03ML 40 MG04ML 60 MG06ML 80 MG08ML (enoxaparin sodium)

2 DSL = 30 days

IRON PREPARATIONS - Vitamins and Minerals

ACTIVE FE ORAL TABLET 75-125 MG 3

AZESCHEW PRENATALPOSTNATAL ORAL TABLET CHEWABLE 13-1 MG

3

AZESCO ORAL TABLET 13-1 MG 3

BACMIN ORAL TABLET (multiple vitamins-minerals) 3

b-plex plus oral tablet 1

CENTRATEX ORAL CAPSULE 106-1 MG (fe fum-fa-b cmp-c-zn-mg-mn-cu)

3

iron combinations (Chromagen Oral Capsule) 3

CITRANATAL BLOOM ORAL TABLET 90-1 MG (prenatal-dss-fecb-fegl-fa)

3

CORVITE 150 ORAL TABLET (iron combinations) 3

CORVITE 150 ORAL TABLET 150-125 MG (iron-folic acid-c-b6-b12-zinc)

3

corvite fe oral tablet 1

ENBRACE HR ORAL CAPSULE (prenat vit-fe gly cys-fa-omega)

3

ENLYTE ORAL CAPSULE (dietary management product) 3

FERAHEME INTRAVENOUS SOLUTION 510 MG17ML (ferumoxytol)

PV


72


FERIVA 217 ORAL TABLET 75-1 MG (feasp-b12-fa-c-dss-succac-zn)

3

FERIVAFA ORAL CAPSULE 110-1 MG (iron-vit c-fa-b12-biot-cu-dss)

3

ferocon oral capsule PV

ferotrinsic oral capsule PV

FERRALET 90 ORAL TABLET 90-1 MG (fe cbn-fe gluc-fa-b12-c-dss)

3

ferraplus 90 oral tablet 90-1 mg 1

fe fum-fa-b cmp-c-zn-mg-mn-cu (Ferrocite Plus Oral Tablet 106-1 Mg)

1

ferrous sulfate oral solution 75 (15 fe) mgml PV

FOLITIN-Z ORAL TABLET (multiple vitamins-minerals) 3

foltrin oral capsule PV

FUSION PLUS ORAL CAPSULE (iron-fa-b cmp-c-biot-probiotic) 3

hematinic plus vitminerals oral tablet 106-1 mg 1

hematinicfolic acid oral tablet 324-1 mg 1

HEMATOGEN FA ORAL CAPSULE 200-250-001-1 MG (fe fum-vit c-vit b12-fa)

3

HEMATRON-AF ORAL TABLET 150-1 MG (iron-dss-b12-fa-c-e-cu-biotin)

3

HEMETAB ORAL TABLET 22-6-1-0025 MG 3

HEMOCYTE PLUS ORAL CAPSULE 106-1 MG (fe fum-fa-b cmp-c-zn-mg-mn-cu)

3

ferrous fumarate-folic acid (Hemocyte-F Oral Tablet 324-1 Mg) 1

ICAR-C PLUS ORAL TABLET 100-250-0025-1 MG (iron-vit c-vit b12-folic acid)

3

iron polysacch cmplx-b12-fa (Iferex 150 Forte Oral Capsule 150-25-1 Mg-Mcg-Mg)

1

INFED INJECTION SOLUTION 50 MGML (iron dextran) 2

INTEGRA F ORAL CAPSULE 125-1 MG (fe fum-fepoly-fa-vit c-vit b3)

3

INTEGRA PLUS ORAL CAPSULE (fefum-fepoly-fa-b cmp-c-biot)

3

IROSPAN 246 ORAL (fe-succ ac-b cmplx-c-ca-fa) 3

M-NATAL PLUS ORAL TABLET 27-1 MG 3

MONOFERRIC INTRAVENOUS SOLUTION 1000 MG10ML (ferric derisomaltose)

3

MULTIGEN FOLIC ORAL TABLET 70-150-2-1 MG (fe asp gly-succ-c-thre-b12-fa)

PV


73


MULTIGEN ORAL TABLET 70 MG (fe-succ-c-thre-b12-des stomach)

PV

MULTIGEN PLUS ORAL TABLET 50-101-1 MG (feasp-fefum -suc-c-thre-b12-fa)

3

MULTIPRO ORAL CAPSULE 3

multi-vitironfluoride oral solution 025-10 mgml 1

multi-vitaminfluorideiron oral solution 025-10 mgml 1

myferon 150 forte oral capsule 150-25-1 mg-mcg-mg 1

na ferric gluc cplx in sucrose intravenous solution 125 mgml 1

NESTABS ONE ORAL CAPSULE 38-1-225 MG (prenat-fe-methylfol-dha wo a)

3

NESTABS ORAL TABLET 32-1 MG (prenat-fe bisgly-fa-wo vit a)

3

NIFEREX ORAL TABLET (iron combinations) 3

NUFERA ORAL TABLET (iron combinations) 3

NUTRICAP ORAL TABLET (multiple vitamins-minerals) 3

NUTRIVIT ORAL LIQUID (b complex-lysine-min-fe-fa) 3

PNV TABS 20-1 ORAL TABLET 20-1 MG 3

poly-iron 150 forte oral capsule 150-25-1 mg-mcg-mg 1

polysaccharide iron forte oral capsule 150-25-1 mg-mcg-mg 1

POLY-VI-FLORIRON ORAL SUSPENSION 025-7 MGML (ped multivitamins-fl-iron)

3

POLY-VI-FLORIRON ORAL TABLET CHEWABLE 05-10 MG (ped multivitamins-fl-iron)

3

PREGEN DHA ORAL CAPSULE 28-1-35 MG 3

PREGENNA ORAL TABLET 20-1 MG 3

PRENAISSANCE ORAL CAPSULE 29-125-325 MG 3

prenatal oral tablet 27-1 mg 1

prenatal plus iron oral tablet 29-1 mg 1

prenatal vitamin plus low iron oral tablet 27-1 mg 1

PRENATE DHA ORAL CAPSULE 18-06-04-300 MG (prenat-feasp-meth-fa-dha wo a)

3

PRENATE ELITE ORAL TABLET 20-06-04 MG (prenatal-feaspgly-methylfol-fa)

3

PRENATE ENHANCE ORAL CAPSULE 28-06-04-400 MG (prenat wo a-fe-methfol-fa-dha)

3

PRENATE ESSENTIAL ORAL CAPSULE 18-06-04-300 MG (prenat-feasp-meth-fa-dha wo a)

3


74


PRENATE MINI ORAL CAPSULE 18-06-04-350 MG (prenat-fecbn-feasp-meth-fa-dha)

3

PRENATE PIXIE ORAL CAPSULE 10-06-04-200 MG (prenat-feasp-meth-fa-dha wo a)

3

PRENATE RESTORE ORAL CAPSULE 27-06-04-400 MG (prenat wo a-fe-methfol-fa-dha)

3

PRENATRIX ORAL TABLET 27-1 MG (prenatal vit-fe fumarate-fa)

3

PRENATRYL ORAL TABLET 27-1 MG (prenatal vit-fe fumarate-fa)

3

preplus oral tablet 27-1 mg 1

PRETAB ORAL TABLET 29-1 MG 3

PRIMACARE ORAL CAPSULE 30-1-470 MG (pren-fe-meth-fa-omeg wo a)

3

purevit dualfe plus oral capsule 162-1152-1 mg 1

QUFLORA FE ORAL TABLET CHEWABLE 025 MG (multi vit-min-fluoride-fe-fa)

3

QUFLORA FE PEDIATRIC ORAL LIQUID 025-95 MGML (ped multivitamins-fl-iron)

3

RELNATE DHA ORAL CAPSULE 28-1-200 MG 3

REMEDIENT ORAL CAPSULE 1 MG (multiple vitamins-minerals-fa)

3

SELECT-OB ORAL TABLET CHEWABLE 29-1 MG (prenatal vit-fe psac cmplx-fa)

3

se-tan plus oral capsule 162-1152-1 mg 1

SIDEROL ORAL TABLET (multiple vitamins-minerals) 3

STROVITE FORTE ORAL SYRUP (multiple vitamins-minerals-fa)

3

STROVITE FORTE ORAL TABLET (multiple vitamins-minerals) 3

tl-hem 150 oral tablet 150-1 mg 1

TRICARE PRENATAL DHA ONE ORAL CAPSULE 27-1-500 MG (prenatal-fefum-fa-dss-fish oil)

3

fe fumarate-b12-vit c-fa-ifc (Tricon Oral Capsule) PV

TRIFERIC HEMODIALYSIS PACKET 272 MG (ferric pyrophosphate citrate)

3

TRINATE ORAL TABLET (prenatal vit-fe fumarate-fa) 3

TRINAZ ORAL TABLET 12-1 MG 3

TRISTART DHA ORAL CAPSULE 31-06-04-200 MG 3

VENOFER INTRAVENOUS SOLUTION 20 MGML (iron sucrose)

2


75


VINATE ONE ORAL TABLET 60-1 MG (prenatal vit-fe fumarate-fa)

3

VIRT-FEFA PLUS ORAL CAPSULE 3

multiple vitamins-minerals (Vita S Forte Oral Tablet) 1

VITAFOL FE+ ORAL CAPSULE 90-06-04-200 MG (prenat-fe poly-methfol-fa-dha)

3

VITAFOL-NANO ORAL TABLET 18-06-04 MG (prenatal-fe fum-methf-fa wo a)

3

VITAFOL-OB+DHA ORAL 65-1 amp 250 MG (prenatal mv-min-fe fum-fa-dha)

3

VITRANOL FE ORAL TABLET (multiple vitamins-minerals) 3

VITREXATE FE ORAL TABLET (multiple vitamins-minerals) 3

VITREXYL + IRON ORAL TABLET (multiple vitamins-minerals) 3

vp-pnv-dha oral capsule 28-1-2158 mg 1

WESTAB PLUS ORAL TABLET 27-1 MG 3

WESTGEL DHA ORAL CAPSULE 31-06-04-200 MG 3

ZALVIT ORAL TABLET 13-1 MG 3

PLATELET-AGGREGATION INHIBITORS - Drugs to Prevent Blood Clots

adult aspirin regimen oral tablet delayed release 81 mg PV

aspirin adult low strength oral tablet delayed release 81 mg PV

aspirin childrens oral tablet chewable 81 mg PV

aspirin ec low dose oral tablet delayed release 81 mg PV

aspirin ec low strength oral tablet delayed release 81 mg PV

aspirin ec oral tablet delayed release 325 mg PV

aspirin low dose oral tablet chewable 81 mg PV

aspirin low dose oral tablet delayed release 81 mg PV

aspirin oral tablet 325 mg PV

aspirin oral tablet delayed release 325 mg 81 mg PV

aspirin-dipyridamole er oral capsule extended release 12 hour25-200 mg

1

ASPIRIN-OMEPRAZOLE ORAL TABLET DELAYED RELEASE 325-40 MG 81-40 MG

3

BAYER ASPIRIN EC LOW DOSE ORAL TABLET DELAYED RELEASE 81 MG (aspirin)

PV

BAYER ASPIRIN ORAL TABLET 325 MG (aspirin) PV

BAYER ASPIRIN ORAL TABLET DELAYED RELEASE 325 MG (aspirin)

PV

BRILINTA ORAL TABLET 60 MG (ticagrelor) 3


76



butalbital-aspirin-caffeine oral capsule 50-325-40 mg 1

butalbital-aspirin-caffeine oral tablet 50-325-40 mg 1

cilostazol oral tablet 100 mg 50 mg 1

clopidogrel bisulfate oral tablet 300 mg 75 mg 1

dipyridamole oral tablet 25 mg 50 mg 75 mg 1

DURLAZA ORAL CAPSULE EXTENDED RELEASE 24 HOUR 1625 MG (aspirin)

3

EFFIENT ORAL TABLET 10 MG 5 MG (prasugrel hcl) 2

goodsense aspirin low dose oral tablet delayed release 81 mg PV

PLAVIX ORAL TABLET 75 MG (clopidogrel bisulfate) 3

prasugrel hcl oral tablet 10 mg 5 mg 1

ST JOSEPH LOW DOSE ORAL TABLET DELAYED RELEASE 81 MG (aspirin)

PV

tri-buffered aspirin oral tablet 325 mg PV

YOSPRALA ORAL TABLET DELAYED RELEASE 325-40 MG 81-40 MG (aspirin-omeprazole)

3

ZONTIVITY ORAL TABLET 208 MG (vorapaxar sulfate) 3

PLATELET-REDUCING AGENTS - Drugs to Prevent Blood Clots

anagrelide hcl oral capsule 05 mg 1 mg 1

THROMBOLYTIC AGENTS - Drugs to Prevent Blood Clots

ACTIVASE INTRAVENOUS SOLUTION RECONSTITUTED 100 MG 50 MG (alteplase)

2












3


PV


77




PV



CATHFLO ACTIVASE INJECTION SOLUTION RECONSTITUTED 2 MG (alteplase)

2


3



PV



3

CARDIOVASCULAR DRUGS - Drugs for the Heart

ALPHA-ADRENERGIC BLOCKING AGENTS - Drugs for High Blood Pressure


3


3



1


3


3




3



ALPHA-ADRENERGIC BLOCKING AGT(HYPOTEN) - Drugs for High Blood Pressure amp Angina


3


78



3




3



ANGIOTENSIN II RECEPTOR ANTAGON(HYPOTN) - Drugs for High Blood Pressure amp Angina

amlodipine besylate-valsartan oral tablet 10-160 mg 10-320 mg 5-160 mg 5-320 mg

1

amlodipine-olmesartan oral tablet 10-20 mg 10-40 mg 5-20 mg 5-40 mg

1

amlodipine-valsartan-hctz oral tablet 10-160-125 mg 10-160-25 mg 10-320-25 mg 5-160-125 mg 5-160-25 mg

1

ATACAND HCT ORAL TABLET 16-125 MG 32-125 MG 32-25 MG (candesartan cilexetil-hctz)

3

ATACAND ORAL TABLET 16 MG 32 MG 4 MG 8 MG (candesartan cilexetil)

3

AVALIDE ORAL TABLET 150-125 MG 300-125 MG (irbesartan-hydrochlorothiazide)

3

AVAPRO ORAL TABLET 150 MG 300 MG 75 MG (irbesartan) 3

AZOR ORAL TABLET 10-20 MG 10-40 MG 5-20 MG 5-40 MG (amlodipine-olmesartan)

3

BENICAR HCT ORAL TABLET 20-125 MG 40-125 MG 40-25 MG (olmesartan medoxomil-hctz)

3

BENICAR ORAL TABLET 20 MG 40 MG 5 MG (olmesartan medoxomil)

3

candesartan cilexetil oral tablet 16 mg 32 mg 4 mg 8 mg 1

candesartan cilexetil-hctz oral tablet 16-125 mg 32-125 mg 32-25 mg

1

COZAAR ORAL TABLET 100 MG 25 MG 50 MG (losartan potassium)

3

DIOVAN HCT ORAL TABLET 160-125 MG 160-25 MG 320-125 MG 320-25 MG 80-125 MG (valsartan-hydrochlorothiazide)

3

DIOVAN ORAL TABLET 160 MG 320 MG 40 MG 80 MG (valsartan)

3

EDARBI ORAL TABLET 40 MG 80 MG (azilsartan medoxomil) 3


79


EDARBYCLOR ORAL TABLET 40-125 MG 40-25 MG (azilsartan-chlorthalidone)

3

EXFORGE HCT ORAL TABLET 10-160-125 MG 10-160-25 MG 10-320-25 MG 5-160-125 MG 5-160-25 MG (amlodipine-valsartan-hctz)

3

EXFORGE ORAL TABLET 10-160 MG 10-320 MG 5-160 MG 5-320 MG (amlodipine besylate-valsartan)

3

HYZAAR ORAL TABLET 100-125 MG 100-25 MG 50-125 MG (losartan potassium-hctz)

3

irbesartan oral tablet 150 mg 300 mg 75 mg 1

irbesartan-hydrochlorothiazide oral tablet 150-125 mg 300-125 mg

1

losartan potassium oral tablet 100 mg 25 mg 50 mg 1

losartan potassium-hctz oral tablet 100-125 mg 100-25 mg 50-125 mg

1

MICARDIS HCT ORAL TABLET 40-125 MG 80-125 MG 80-25 MG (telmisartan-hctz)

3

MICARDIS ORAL TABLET 20 MG 40 MG 80 MG (telmisartan) 3

olmesartan medoxomil oral tablet 20 mg 40 mg 5 mg 1

olmesartan medoxomil-hctz oral tablet 20-125 mg 40-125 mg 40-25 mg

1

olmesartan-amlodipine-hctz oral tablet 20-5-125 mg 40-10-125 mg 40-10-25 mg 40-5-125 mg 40-5-25 mg

1

telmisartan oral tablet 20 mg 40 mg 80 mg 1

telmisartan-amlodipine oral tablet 40-10 mg 40-5 mg 80-10 mg 80-5 mg

1

telmisartan-hctz oral tablet 40-125 mg 80-125 mg 80-25 mg 1

TRIBENZOR ORAL TABLET 20-5-125 MG 40-10-125 MG 40-10-25 MG 40-5-125 MG 40-5-25 MG (olmesartan-amlodipine-hctz)

3

TWYNSTA ORAL TABLET 40-10 MG 40-5 MG 80-10 MG 80-5 MG (telmisartan-amlodipine)

3

valsartan oral tablet 160 mg 320 mg 40 mg 80 mg 1

valsartan-hydrochlorothiazide oral tablet 160-125 mg 160-25 mg 320-125 mg 320-25 mg 80-125 mg

1

ANGIOTENSIN II RECEPTOR ANTAGONISTS - Drugs for the Heart


1


1


80



1


3


3


3



3


3


3



1


3


3


3



3

ENTRESTO ORAL TABLET 24-26 MG 49-51 MG 97-103 MG (sacubitril-valsartan)

2


3


3


3



1



81



1


3




1


1



1



3


3



1

ANGIOTENSIN-CONVERTENZYME INHIB(HYPOTN) - Drugs for High Blood Pressure amp Angina

ACCUPRIL ORAL TABLET 10 MG 20 MG 40 MG 5 MG (quinapril hcl)

3

ACCURETIC ORAL TABLET 10-125 MG 20-125 MG 20-25 MG (quinapril-hydrochlorothiazide)

3

ALTACE ORAL CAPSULE 125 MG 10 MG 25 MG 5 MG (ramipril)

3

amlodipine besylate-benazepril hcl oral capsule 10-20 mg 10-40 mg 25-10 mg 5-10 mg 5-20 mg 5-40 mg

1

benazepril hcl oral tablet 10 mg 20 mg 40 mg 5 mg 1

benazepril-hydrochlorothiazide oral tablet 10-125 mg 20-125 mg 20-25 mg 5-625 mg

1

captopril oral tablet 100 mg 125 mg 25 mg 50 mg 1

captopril-hydrochlorothiazide oral tablet 25-15 mg 25-25 mg 50-15 mg 50-25 mg

1

enalapril maleate oral tablet 10 mg 25 mg 20 mg 5 mg 1

enalapril-hydrochlorothiazide oral tablet 10-25 mg 5-125 mg 1

EPANED ORAL SOLUTION 1 MGML (enalapril maleate) 3


82


fosinopril sodium oral tablet 10 mg 20 mg 40 mg 1

fosinopril sodium-hctz oral tablet 10-125 mg 20-125 mg 1

lisinopril oral tablet 10 mg 25 mg 20 mg 30 mg 40 mg 5 mg 1

lisinopril-hydrochlorothiazide oral tablet 10-125 mg 20-125 mg 20-25 mg

1

LOTENSIN HCT ORAL TABLET 10-125 MG 20-125 MG 20-25 MG (benazepril-hydrochlorothiazide)

3

LOTENSIN ORAL TABLET 10 MG 20 MG 40 MG (benazepril hcl)

3

LOTREL ORAL CAPSULE 10-20 MG 10-40 MG 5-10 MG 5-20 MG (amlodipine besy-benazepril hcl)

3

moexipril hcl oral tablet 15 mg 75 mg 1

perindopril erbumine oral tablet 2 mg 4 mg 8 mg 1

PRESTALIA ORAL TABLET 14-10 MG 35-25 MG 7-5 MG (perindopril arg-amlodipine)

3

PRINIVIL ORAL TABLET 20 MG (lisinopril) 3

QBRELIS ORAL SOLUTION 1 MGML (lisinopril) 3

quinapril hcl oral tablet 10 mg 20 mg 40 mg 5 mg 1

quinapril-hydrochlorothiazide oral tablet 10-125 mg 20-125 mg 20-25 mg

1

ramipril oral capsule 125 mg 10 mg 25 mg 5 mg 1

TARKA ORAL TABLET EXTENDED RELEASE 2-180 MG 2-240 MG 4-240 MG (trandolapril-verapamil hcl)

3

trandolapril oral tablet 1 mg 2 mg 4 mg 1

trandolapril-verapamil hcl er oral tablet extended release 1-240 mg 2-180 mg 2-240 mg 4-240 mg

1

VASERETIC ORAL TABLET 10-25 MG (enalapril-hydrochlorothiazide)

3

VASOTEC ORAL TABLET 10 MG 25 MG 20 MG 5 MG (enalapril maleate)

3

ZESTORETIC ORAL TABLET 10-125 MG 20-125 MG 20-25 MG (lisinopril-hydrochlorothiazide)

3

ZESTRIL ORAL TABLET 10 MG 25 MG 20 MG 30 MG 40 MG 5 MG (lisinopril)

3

ANGIOTENSIN-CONVERTING ENZYME INHIBITORS - Drugs for the Heart


3


3


83



3


1



1



1








1


3


3


3




3





1



3



1


84



3


3


3


3

ANTIARRHYTHMICS MISCELLANEOUS - Drugs for Angina

digoxin (Digitek Oral Tablet 125 Mcg 250 Mcg) PV

digoxin (Digox Oral Tablet 125 Mcg 250 Mcg) PV

digoxin oral solution 005 mgml PV

digoxin oral tablet 125 mcg 250 mcg PV

LANOXIN ORAL TABLET 125 MCG 250 MCG 625 MCG (digoxin)

PV

magnesium sulfate intravenous solution 2 gm50ml 20 gm500ml 4 gm100ml 4 gm50ml 40 gm1000ml

PV

MAGNESIUM SULFATE SOLUTION 50 INJECTION 50 PV

magnesium sulfate solution 50 injection 50 PV

ANTILIPEMIC AGENTS MISCELLANEOUS - Drugs for Cholesterol

ANIMI-3 ORAL CAPSULE 1 MG (fa-b6-b12-d-omega 3-phytoster)

3

ANIMI-3VITAMIN D ORAL CAPSULE 1 MG (fa-b6-b12-d-omega 3-phytoster)

3

bp vit 3 oral capsule 1 mg 1

EVKEEZA INTRAVENOUS SOLUTION 1200 MG8ML 345 MG23ML (evinacumab-dgnb)

3

icosapent ethyl oral capsule 1 gm 1

JUXTAPID ORAL CAPSULE 10 MG 20 MG 30 MG 5 MG (lomitapide mesylate)

3 DSL = 30 days

NEXLETOL ORAL TABLET 180 MG (bempedoic acid) 3

NEXLIZET ORAL TABLET 180-10 MG (bempedoic acid-ezetimibe)

3

niacin (antihyperlipidemic) oral tablet 500 mg 1

niacin er (antihyperlipidemic) oral tablet extended release 1000 mg 500 mg 750 mg

1

niacor oral tablet 500 mg 1

NIASPAN ORAL TABLET EXTENDED RELEASE 1000 MG 500 MG 750 MG (niacin (antihyperlipidemic))

3


85


omega-3-acid ethyl esters oral capsule 1 gm 1

VASCEPA ORAL CAPSULE 05 GM 1 GM (icosapent ethyl) 3

BETA-ADRENERGIC BLOCKING AGENTS - Drugs for Abnormal Heart Rhythms





3


3




1


3



1


3


3



3


3



3


3


3


3



86



3


1


1


1




1








3


3




3


3

BETA-ADRENERGIC BLOCKING AGT(HYPOTEN) - Drugs for High Blood Pressure amp Angina





3


3




87



1



3


3



3


3


3


3



3


1


1


1




1








3


3


88





3


3

BILE ACID SEQUESTRANTS - Drugs for Cholesterol

cholestyramine light oral packet 4 gm 1

cholestyramine light oral powder 4 gmdose 1

cholestyramine oral packet 4 gm 1

cholestyramine oral powder 4 gmdose 1

colesevelam hcl oral packet 375 gm 1

colesevelam hcl oral tablet 625 mg 1

COLESTID FLAVORED ORAL GRANULES 5 GM (colestipol hcl)

3

COLESTID FLAVORED ORAL PACKET 5 GM (colestipol hcl) 3

COLESTID ORAL GRANULES 5 GM (colestipol hcl) 3

COLESTID ORAL PACKET 5 GM (colestipol hcl) 3

COLESTID ORAL TABLET 1 GM (colestipol hcl) 3

colestipol hcl oral granules 5 gm 1

colestipol hcl oral packet 5 gm 1

colestipol hcl oral tablet 1 gm 1

cholestyramine light (Prevalite Oral Packet 4 Gm) 1

cholestyramine light (Prevalite Oral Powder 4 GmDose) 1

QUESTRAN LIGHT ORAL POWDER 4 GMDOSE (cholestyramine light)

3

QUESTRAN ORAL PACKET 4 GM (cholestyramine) 3

QUESTRAN ORAL POWDER 4 GMDOSE (cholestyramine) 3

WELCHOL ORAL PACKET 375 GM (colesevelam hcl) 3

WELCHOL ORAL TABLET 625 MG (colesevelam hcl) 3

CALCIUM-CHANNEL BLOCKAGTMISC(HYPOTEN) - Drugs for High Blood Pressure amp Angina

CALAN SR ORAL TABLET EXTENDED RELEASE 120 MG 180 MG 240 MG (verapamil hcl)

3

CARDIZEM CD ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG 180 MG 240 MG 300 MG 360 MG (diltiazem hcl coated beads)

3


89


CARDIZEM LA ORAL TABLET EXTENDED RELEASE 24 HOUR 120 MG 180 MG 240 MG 300 MG 360 MG 420 MG (diltiazem hcl coated beads)

3

CARDIZEM ORAL TABLET 120 MG 30 MG 60 MG (diltiazem hcl)

3

diltiazem hcl coated beads (Cartia Xt Oral Capsule Extended Release 24 Hour 120 Mg 180 Mg 240 Mg 300 Mg)

1

diltiazem hcl er beads oral capsule extended release 24 hour120 mg 180 mg 240 mg 300 mg 360 mg 420 mg

1

diltiazem hcl er coated beads oral capsule extended release 24 hour 120 mg 180 mg 240 mg 300 mg 360 mg

1

diltiazem hcl er coated beads oral tablet extended release 24 hour 180 mg 240 mg 300 mg 360 mg 420 mg

1

diltiazem hcl er oral capsule extended release 12 hour 120 mg 60 mg 90 mg

1


1

diltiazem hcl oral tablet 120 mg 30 mg 60 mg 90 mg 1

DILTIAZEM HCL-DEXTROSE INTRAVENOUS SOLUTION 125-5 MG125ML-

3

dilt-xr oral capsule extended release 24 hour 120 mg 180 mg 240 mg

1

diltiazem hcl coated beads (Matzim La Oral Tablet Extended Release 24 Hour 180 Mg 240 Mg 300 Mg 360 Mg 420 Mg)

1


3

diltiazem hcl er beads (Taztia Xt Oral Capsule Extended Release 24 Hour 120 Mg 180 Mg 240 Mg 300 Mg 360 Mg)

1

diltiazem hcl er beads (Tiadylt Er Oral Capsule Extended Release 24 Hour 120 Mg 180 Mg 240 Mg 300 Mg 360 Mg 420 Mg)

1

TIAZAC ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG 180 MG 240 MG 300 MG 360 MG 420 MG (diltiazem hcl er beads)

3


1

verapamil hcl er oral capsule extended release 24 hour 100 mg 120 mg 180 mg 200 mg 240 mg 300 mg 360 mg

1

verapamil hcl er oral tablet extended release 120 mg 180 mg 240 mg

1

verapamil hcl oral tablet 120 mg 40 mg 80 mg 1


90


VERELAN ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG 180 MG 240 MG 360 MG (verapamil hcl)

3

VERELAN PM ORAL CAPSULE EXTENDED RELEASE 24 HOUR 100 MG 200 MG 300 MG (verapamil hcl)

3

CALCIUM-CHANNEL BLOCKING AGENTS - Drugs for High Blood Pressure amp Angina

amlodipine besylate oral tablet 10 mg 25 mg 5 mg 1


1


1

amlodipine-atorvastatin oral tablet 10-10 mg 10-20 mg 10-40 mg 10-80 mg 25-10 mg 25-20 mg 25-40 mg 5-10 mg 5-20 mg 5-40 mg 5-80 mg

1


1


1


3

CADUET ORAL TABLET 10-10 MG 10-20 MG 10-40 MG 10-80 MG 5-10 MG 5-20 MG 5-40 MG 5-80 MG (amlodipine-atorvastatin)

3


3


3


3


3


1

CONJUPRI ORAL TABLET 25 MG 5 MG (levamlodipine maleate)

3


1


1


91



1


1


1



3


1


3


3

felodipine er oral tablet extended release 24 hour 10 mg 25 mg 5 mg

1

isradipine oral capsule 25 mg 5 mg 1

KATERZIA ORAL SUSPENSION 1 MGML (amlodipine benzoate)

3


3


1

nicardipine hcl oral capsule 20 mg 30 mg 1

nifedipine er oral tablet extended release 24 hour 30 mg 60 mg 90 mg

1

nifedipine er osmotic release oral tablet extended release 24 hour 30 mg 60 mg 90 mg

1

nifedipine oral capsule 10 mg 20 mg 1

nimodipine oral capsule 30 mg 1

nisoldipine er oral tablet extended release 24 hour 17 mg 20 mg 255 mg 30 mg 34 mg 40 mg 85 mg

1

NORVASC ORAL TABLET 10 MG 25 MG 5 MG (amlodipine besylate)

3

NYMALIZE ORAL SOLUTION 6 MGML (nimodipine) 3 DSL = 30 days


1


3


92


PROCARDIA ORAL CAPSULE 10 MG (nifedipine) 3

PROCARDIA XL ORAL TABLET EXTENDED RELEASE 24 HOUR 30 MG 60 MG 90 MG (nifedipine)

3

SULAR ORAL TABLET EXTENDED RELEASE 24 HOUR 17 MG 34 MG 85 MG (nisoldipine)

3


3


1


1


1


3


1


3


3


1


1



3


3

CALCIUM-CHANNEL BLOCKING AGENTS(HYPOTEN) - Drugs for High Blood Pressure amp Angina


3


3


93



3


3


1


1


1


1


1


1



3


1


1


3


1


1


3


1


1



3


94



3

CALCIUM-CHANNEL BLOCKING AGENTS MISC - Drugs for High Blood Pressure amp Angina


3


3


3


3


1


1


1


1


1


1



3


1


1


3


1


1


95



3


1


1


1



3


3

CARBONIC ANHYDRASE INHIBITORS(HYPOTEN) - Drugs for High Blood Pressure amp Angina

acetazolamide er oral capsule extended release 12 hour 500 mg

1

acetazolamide oral tablet 125 mg 250 mg 1

CARDIAC DRUGS MISCELLANEOUS - Drugs for Angina

CORLANOR ORAL SOLUTION 5 MG5ML (ivabradine hcl) 3

CORLANOR ORAL TABLET 5 MG 75 MG (ivabradine hcl) 3 DSL = 30 days

ranolazine er oral tablet extended release 12 hour 1000 mg 500 mg

1

VYNDAMAX ORAL CAPSULE 61 MG (tafamidis) 3 DSL = 30 days

VYNDAQEL ORAL CAPSULE 20 MG (tafamidis meglumine (cardiac))

3

CARDIOTONIC AGENTS - Drugs for Angina






PV

milrinone lactate in dextrose intravenous solution 20-5 mg100ml- 40-5 mg200ml-

1

milrinone lactate intravenous solution 10 mg10ml 20 mg20ml 50 mg50ml

1


96


CENTRAL ALPHA-AGONISTS - Drugs for High Blood Pressure amp Angina


3


3


3




1

guanfacine hcl er oral tablet extended release 24 hour 1 mg 2 mg 3 mg 4 mg

1

guanfacine hcl oral tablet 1 mg 2 mg 1



1

CHOLESTEROL ABSORPTION INHIBITORS - Drugs for Cholesterol

ezetimibe oral tablet 10 mg 1

ezetimibe-simvastatin oral tablet 10-10 mg 10-20 mg 10-40 mg 10-80 mg

1


3

ROSZET ORAL TABLET 10-10 MG 10-20 MG 10-40 MG 10-5 MG (ezetimibe-rosuvastatin)

3

VYTORIN ORAL TABLET 10-10 MG 10-20 MG 10-40 MG 10-80 MG (ezetimibe-simvastatin)

3

ZETIA ORAL TABLET 10 MG (ezetimibe) 3

CLASS IA ANTIARRHYTHMICS - Drugs for Angina

disopyramide phosphate oral capsule 100 mg 150 mg 1

NORPACE CR ORAL CAPSULE EXTENDED RELEASE 12 HOUR 100 MG 150 MG (disopyramide phosphate)

2

procainamide hcl injection solution 100 mgml 500 mgml 1



CLASS IB ANTIARRHYTHMICS - Drugs for Angina

DILANTIN ORAL CAPSULE 30 MG (phenytoin sodium extended)

2


97


LIDOCAINE HCL INJECTION SOLUTION PREFILLED SYRINGE 10 MGML

3

mexiletine hcl oral capsule 150 mg 200 mg 250 mg 1

phenytoin (Phenytoin Infatabs Oral Tablet Chewable 50 Mg) 1

phenytoin oral suspension 125 mg5ml 1

phenytoin oral tablet chewable 50 mg 1

phenytoin sodium extended oral capsule 100 mg 200 mg 300 mg

1

CLASS IC ANTIARRHYTHMICS - Drugs for Angina

flecainide acetate oral tablet 100 mg 150 mg 50 mg 1

propafenone hcl er oral capsule extended release 12 hour 225 mg 325 mg 425 mg

1

propafenone hcl oral tablet 150 mg 225 mg 300 mg 1

CLASS II ANTIARRHYTHMICS - Drugs for Angina





3


3




1



1


3


3



3


3



98



3


3


3


3



3


1


1


1




1








3


3




3


3

CLASS III ANTIARRHYTHMICS - Drugs for Angina

amiodarone hcl oral tablet 100 mg 200 mg 400 mg 1


99



3


3

dofetilide oral capsule 125 mcg 250 mcg 500 mcg 1

MULTAQ ORAL TABLET 400 MG (dronedarone hcl) 3




CLASS IV ANTIARRHYTHMICS - Drugs for Angina


3


3


3


3


1


1


1


1


1


1



3


1


1


1


100



1


3


1


1



3


3

DIHYDROPYRIDINES - Drugs for High Blood Pressure amp Angina



1


1


1


1


1


3


3


3

CONSENSI ORAL TABLET 10-200 MG 25-200 MG 5-200 MG (amlodipine besylate-celecoxib)

3


3


101



3


1



3


3



1


1




1


3



1


3



3


3


1


3


3

DIHYDROPYRIDINES (ANTIHYPERTENSIVE) - Drugs for High Blood Pressure amp Angina



102



1


1


1


1


1


3


3


3


3


3


1



3


3



1


1




1


3



103



1


3



3


3


1


3


3

DIRECT VASODILATORS - Drugs for High Blood Pressure amp Angina

BIDIL ORAL TABLET 20-375 MG (isosorb dinitrate-hydralazine)

3

hydralazine hcl oral tablet 10 mg 100 mg 25 mg 50 mg 1

minoxidil oral tablet 10 mg 25 mg 1

DIURETICS MISCELLANEOUS (HYPOTENSIVE) - Drugs for High Blood Pressure amp Angina

ELIXOPHYLLIN ORAL ELIXIR 80 MG15ML (theophylline) 3

THEO-24 ORAL CAPSULE EXTENDED RELEASE 24 HOUR 100 MG 200 MG 300 MG 400 MG (theophylline)

3

theophylline er oral tablet extended release 12 hour 300 mg 450 mg

PV


PV

theophylline oral solution 80 mg15ml 1

FIBRIC ACID DERIVATIVES - Drugs for Cholesterol

ANTARA ORAL CAPSULE 30 MG 90 MG (fenofibrate micronized)

3

fenofibrate micronized oral capsule 130 mg 134 mg 200 mg 43 mg 67 mg

1

fenofibrate oral capsule 134 mg 150 mg 200 mg 50 mg 67 mg

1

fenofibrate oral tablet 120 mg 145 mg 160 mg 40 mg 48 mg 54 mg

1


104


fenofibric acid oral capsule delayed release 135 mg 45 mg 1

fenofibric acid oral tablet 105 mg 35 mg 1

FENOGLIDE ORAL TABLET 120 MG 40 MG (fenofibrate) 3

FIBRICOR ORAL TABLET 105 MG 35 MG (fenofibric acid) 3

gemfibrozil oral tablet 600 mg 1

LIPOFEN ORAL CAPSULE 150 MG 50 MG (fenofibrate) 3

LOPID ORAL TABLET 600 MG (gemfibrozil) 3

TRICOR ORAL TABLET 145 MG 48 MG (fenofibrate) 3

TRILIPIX ORAL CAPSULE DELAYED RELEASE 135 MG 45 MG (choline fenofibrate)

3

HMG-COA REDUCTASE INHIBITORS - Drugs for Cholesterol

ALTOPREV ORAL TABLET EXTENDED RELEASE 24 HOUR 20 MG 40 MG 60 MG (lovastatin)

PV


1

atorvastatin calcium oral tablet 10 mg 20 mg 40 mg 80 mg PV


3

CRESTOR ORAL TABLET 10 MG 20 MG 40 MG 5 MG (rosuvastatin calcium)

PV

EZALLOR SPRINKLE ORAL CAPSULE SPRINKLE 10 MG 20 MG 40 MG 5 MG (rosuvastatin calcium)

3


1

FLOLIPID ORAL SUSPENSION 20 MG5ML 40 MG5ML 3

fluvastatin sodium er oral tablet extended release 24 hour 80 mg

PV

fluvastatin sodium oral capsule 20 mg 40 mg PV

LESCOL XL ORAL TABLET EXTENDED RELEASE 24 HOUR 80 MG (fluvastatin sodium)

PV

LIPITOR ORAL TABLET 10 MG 20 MG 40 MG 80 MG (atorvastatin calcium)

PV

LIVALO ORAL TABLET 1 MG 2 MG 4 MG (pitavastatin calcium)

PV

lovastatin oral tablet 10 mg 20 mg 40 mg PV

pravastatin sodium oral tablet 10 mg 20 mg 40 mg 80 mg PV

rosuvastatin calcium oral tablet 10 mg 20 mg 40 mg 5 mg PV


105



3

simvastatin oral tablet 10 mg 20 mg 40 mg 5 mg 80 mg PV


3

ZOCOR ORAL TABLET 10 MG 20 MG 40 MG 80 MG (simvastatin)

PV

ZYPITAMAG ORAL TABLET 2 MG 4 MG (pitavastatin magnesium)

3

HYPOTENSIVE AGENTS MISCELLANEOUS - Drugs for High Blood Pressure amp Angina




1


1


1


3


3


3



3


3



1


3


3


3


3


106




3


1



3


3


3



3


3



1


1




1


3







3


1





107





3



VECAMYL ORAL TABLET 25 MG (mecamylamine hcl) 3 DSL = 30 days

LOOP DIURETICS (HYPOTENSIVE AGENTS) - Drugs for High Blood Pressure amp Angina

bumetanide oral tablet 05 mg 1 mg 2 mg 1

EDECRIN ORAL TABLET 25 MG (ethacrynic acid) 2

ethacrynic acid oral tablet 25 mg 1

furosemide oral solution 10 mgml 8 mgml 1

furosemide oral tablet 20 mg 40 mg 80 mg 1

LASIX ORAL TABLET 20 MG 40 MG 80 MG (furosemide) 3

torsemide oral tablet 10 mg 100 mg 20 mg 5 mg 1

MINERALOCORTICOID (ALDOSTERONE) ANTAGNTS - Drugs for the Heart

ALDACTAZIDE ORAL TABLET 25-25 MG 50-50 MG (spironolactone-hctz)

3

ALDACTONE ORAL TABLET 100 MG 25 MG 50 MG (spironolactone)

3

CAROSPIR ORAL SUSPENSION 25 MG5ML (spironolactone) 3

eplerenone oral tablet 25 mg 50 mg 1

INSPRA ORAL TABLET 25 MG 50 MG (eplerenone) 3

spironolactone oral tablet 100 mg 25 mg 50 mg 1

spironolactone-hctz oral tablet 25-25 mg 1

MINERALOCORTICOID(ALDOSTER)ANTAG(HYPOT) - Drugs for High Blood Pressure amp Angina


3


3







108


NITRATES AND NITRITES - Drugs for the Heart


3

DILATRATE-SR ORAL CAPSULE EXTENDED RELEASE 40 MG (isosorbide dinitrate)

3

GONITRO SUBLINGUAL PACKET 400 MCG (nitroglycerin) 3

isosorbide dinitrate oral tablet 10 mg 20 mg 30 mg 40 mg 5 mg

1

isosorbide mononitrate er oral tablet extended release 24 hour120 mg 30 mg 60 mg

1

isosorbide mononitrate oral tablet 10 mg 20 mg 1

nitroglycerin (Minitran Transdermal Patch 24 Hour 01 MgHr 02 MgHr 04 MgHr 06 MgHr)

1

NITRO-BID TRANSDERMAL OINTMENT 2 (nitroglycerin) 2

NITRO-DUR TRANSDERMAL PATCH 24 HOUR 01 MGHR 02 MGHR 04 MGHR 06 MGHR (nitroglycerin)

3

NITRO-DUR TRANSDERMAL PATCH 24 HOUR 03 MGHR 08 MGHR (nitroglycerin)

2

nitroglycerin sublingual tablet sublingual 03 mg 04 mg 06 mg 1

nitroglycerin transdermal patch 24 hour 01 mghr 02 mghr 04 mghr 06 mghr

1

nitroglycerin translingual solution 04 mgspray 1

NITROMIST TRANSLINGUAL AEROSOL SOLUTION 400 MCGSPRAY (nitroglycerin)

3

NITROSTAT SUBLINGUAL TABLET SUBLINGUAL 03 MG 04 MG 06 MG (nitroglycerin)

2

NITRO-TIME ORAL CAPSULE EXTENDED RELEASE 25 MG 65 MG 9 MG (nitroglycerin)

3

PCSK9 INHIBITORS - Drugs for Cholesterol

PRALUENT SUBCUTANEOUS SOLUTION AUTO-INJECTOR 150 MGML 75 MGML (alirocumab)

3 DSL = 30 days

REPATHA PUSHTRONEX SYSTEM SUBCUTANEOUS SOLUTION CARTRIDGE 420 MG35ML (evolocumab)

3 DSL = 30 days

REPATHA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 140 MGML (evolocumab)

3 DSL = 30 days

REPATHA SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR 140 MGML (evolocumab)

3 DSL = 30 days

PHOSPHODIESTERASE TYPE 5 INHIBITORS - Drugs for the Heart

tadalafil (pah) (Alyq Oral Tablet 20 Mg) 1 DSL = 30 days



109


LEVITRA ORAL TABLET 20 MG (vardenafil hcl) 2

REVATIO ORAL TABLET 20 MG (sildenafil citrate) 3

sildenafil citrate intravenous solution 10 mg125ml 1

sildenafil citrate oral suspension reconstituted 10 mgml 1 DSL = 30 days

sildenafil citrate oral tablet 100 mg 25 mg 50 mg 2

sildenafil citrate oral tablet 20 mg 1

STENDRA ORAL TABLET 100 MG 200 MG 50 MG (avanafil) 2

tadalafil (pah) oral tablet 20 mg 1 DSL = 30 days

tadalafil oral tablet 10 mg 25 mg 20 mg 5 mg 2

vardenafil hcl oral tablet 10 mg 25 mg 20 mg 5 mg 2

vardenafil hcl oral tablet dispersible 10 mg 2

POTASSIUM-SPARING DIURETICS (HYPOTEN) - Drugs for High Blood Pressure amp Angina


3


3

amiloride hcl oral tablet 5 mg 1

amiloride-hydrochlorothiazide oral tablet 5-50 mg 1


DYRENIUM ORAL CAPSULE 100 MG 50 MG (triamterene) 2



MAXZIDE ORAL TABLET 75-50 MG (triamterene-hctz) 3

MAXZIDE-25 ORAL TABLET 375-25 MG (triamterene-hctz) 3



triamterene oral capsule 100 mg 50 mg 1

triamterene-hctz oral capsule 375-25 mg 1

triamterene-hctz oral tablet 375-25 mg 75-50 mg 1

RENIN INHIBITORS - Drugs for the Heart

aliskiren fumarate oral tablet 150 mg 300 mg 1

TEKTURNA HCT ORAL TABLET 150-125 MG 150-25 MG 300-125 MG 300-25 MG (aliskiren-hydrochlorothiazide)

3

TEKTURNA ORAL TABLET 150 MG 300 MG (aliskiren fumarate)

3


110


RENIN-ANGIOTEN-ALDOST SYS INHIB MISC - Drugs for the Heart


2

SCLEROSING AGENTS - Drugs for Varicose Veins

STERITALC INTRAPLEURAL POWDER 2 GM 3 GM 4 GM (talc)

3

THIAZIDE DIURETICS(HYPOTENSIVE AGENTS) - Drugs for High Blood Pressure amp Angina


3


3



1


3


3


1


3


1


1


1


3

DIURIL ORAL SUSPENSION 250 MG5ML (chlorothiazide) 3


3



3



111


hydrochlorothiazide oral capsule 125 mg 1

hydrochlorothiazide oral tablet 125 mg 25 mg 50 mg 1


3


1


1


1


3




1


1


3


1


1



1



3





3


1


3


112



3


3

THIAZIDE-LIKE DIURETICS(HYPOTENSIVE AGT) - Drugs for High Blood Pressure amp Angina


chlorthalidone oral tablet 25 mg 50 mg 1


3

indapamide oral tablet 125 mg 25 mg 1

metolazone oral tablet 10 mg 25 mg 5 mg 1


3


3

VASODILATING AGENTS MISCELLANEOUS - Drugs for the Heart

ADEMPAS ORAL TABLET 05 MG 1 MG 15 MG 2 MG 25 MG (riociguat)

3 DSL = 30 days

ambrisentan oral tablet 10 mg 5 mg 1 DSL = 30 days



1


1


1


1


1


3

bosentan oral tablet 125 mg 625 mg 1 DSL = 30 days


3


3


113



3


3


3


1

CAVERJECT IMPULSE INTRACAVERNOSAL KIT 10 MCG 20 MCG (alprostadil (vasodilator))

2

CAVERJECT INTRACAVERNOSAL SOLUTION RECONSTITUTED 40 MCG (alprostadil (vasodilator))

2


3


3


1


1


1


1


1



3


1


EDEX INTRACAVERNOSAL KIT 10 MCG 20 MCG 40 MCG (alprostadil (vasodilator))

2

epoprostenol sodium intravenous solution reconstituted 05 mg 15 mg

1


3


1


114


isoxsuprine hcl oral tablet 10 mg 20 mg 1



3

LETAIRIS ORAL TABLET 10 MG 5 MG (ambrisentan) 2 DSL = 30 days


3


1

MUSE URETHRAL PELLET 1000 MCG 125 MCG 250 MCG 500 MCG (alprostadil (vasodilator))

2



1


1




1


3



1

OPSUMIT ORAL TABLET 10 MG (macitentan) 3 DSL = 30 days

ORENITRAM ORAL TABLET EXTENDED RELEASE 0125 MG 025 MG 1 MG 25 MG 5 MG (treprostinil diolamine)

3 DSL = 30 days

papaverine hcl injection solution 30 mgml 2


3



3

REMODULIN INJECTION SOLUTION 100 MG20ML 20 MG20ML 200 MG20ML 50 MG20ML (treprostinil)

2


3


3


115



1


1


1


3

TRACLEER ORAL TABLET 125 MG 625 MG (bosentan) 2 DSL = 30 days

TRACLEER ORAL TABLET SOLUBLE 32 MG (bosentan) 2 DSL = 30 days


1

treprostinil injection solution 100 mg20ml 20 mg20ml 200 mg20ml 50 mg20ml

1


3


2


3

TYVASO INHALATION SOLUTION 06 MGML (treprostinil) 2 DSL = 30 days

TYVASO REFILL INHALATION SOLUTION 06 MGML (treprostinil)

2 DSL = 30 days

TYVASO STARTER INHALATION SOLUTION 06 MGML (treprostinil)

2 DSL = 30 days

UPTRAVI ORAL TABLET 1000 MCG 1200 MCG 1400 MCG 1600 MCG 200 MCG 400 MCG 600 MCG 800 MCG (selexipag)

3 DSL = 30 days

UPTRAVI ORAL TABLET THERAPY PACK 200 amp 800 MCG (selexipag)

3 DSL = 30 days

VENTAVIS INHALATION SOLUTION 10 MCGML 20 MCGML (iloprost)

2 DSL = 30 days


1


1



3


116



3

VERQUVO ORAL TABLET 10 MG 25 MG 5 MG (vericiguat) 3

CELLULAR AND GENE THERAPY - Drugs for Cancer


PROVENGE INTRAVENOUS SUSPENSION (sipuleucel-t) 3

CELLULAR THERAPY - Drugs for Cancer


GENE THERAPY - Drugs for Cancer


3


LUXTURNA INTRAOCULAR SUSPENSION 5000000000000 VGML (voretigene neparvovec-rzyl)

3


3


3

ZOLGENSMA INTRAVENOUS KIT 1X55ML amp 2X83ML 1X55ML amp 3X83ML 1X55ML amp 4X83ML 1X55ML amp 5X83ML 1X55ML amp 6X83ML 1X55ML amp 7X83ML 1X55ML amp 8X83ML 2X55ML amp 1X83ML 2X55ML amp 2X83ML 2X55ML amp 3X83ML 2X55ML amp 4X83ML 2X55ML amp 5X83ML 2X55ML amp 6X83ML 2X55ML amp 7X83ML 2X83 ML 3X83 ML 4X83 ML 5X83 ML 6X83 ML 7X83 ML 8X83 ML 9X83 ML (onasemnogene abeparvovec-xioi)

3

CENTRAL NERVOUS SYSTEM AGENTS - Drugs for the Nervous System

ADAMANTANES (CNS) - Drugs for Parkinson





PV DSL = 30 days


PV


PV

AMPHETAMINE DERIVATIVES - Drugs for the Nervous System

diethylpropion hcl er oral tablet extended release 24 hour 75 mg 2


117


diethylpropion hcl oral tablet 25 mg 2

LOMAIRA ORAL TABLET 8 MG (phentermine hcl) 2

phendimetrazine tartrate er oral capsule extended release 24 hour 105 mg

2

phendimetrazine tartrate oral tablet 35 mg 2

phentermine hcl oral capsule 15 mg 30 mg 375 mg 2

phentermine hcl oral tablet 375 mg 2

QSYMIA ORAL CAPSULE EXTENDED RELEASE 24 HOUR 1125-69 MG 15-92 MG 375-23 MG 75-46 MG (phentermine-topiramate)

2

AMPHETAMINES - Drugs for the Nervous System

ADDERALL XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG 15 MG 20 MG 25 MG 30 MG 5 MG (amphetamine-dextroamphetamine)

3

ADZENYS ER ORAL SUSPENSION EXTENDED RELEASE 125 MGML (amphetamine)

3 DSL = 30 days

ADZENYS XR-ODT ORAL TABLET EXTENDED RELEASE DISPERSIBLE 125 MG 157 MG 188 MG 31 MG 63 MG 94 MG (amphetamine)

3

AMPHETAMINE ER ORAL SUSPENSION EXTENDED RELEASE 125 MGML

3 DSL = 30 days

amphetamine sulfate oral tablet 10 mg 5 mg 1

amphetamine-dextroamphetamine er oral capsule extended release 24 hour 10 mg 15 mg 20 mg 25 mg 30 mg 5 mg

1

amphetamine-dextroamphetamine oral tablet 10 mg 125 mg 15 mg 20 mg 30 mg 5 mg 75 mg

1

benzphetamine hcl oral tablet 25 mg 50 mg 2

dextroamphetamine sulfate er oral capsule extended release 24 hour 10 mg 15 mg 5 mg

1

dextroamphetamine sulfate oral solution 5 mg5ml 1

dextroamphetamine sulfate oral tablet 10 mg 5 mg 1

DYANAVEL XR ORAL SUSPENSION EXTENDED RELEASE 25 MGML (amphetamine)

3

EVEKEO ODT ORAL TABLET DISPERSIBLE 10 MG 15 MG 20 MG 5 MG (amphetamine sulfate)

3

methamphetamine hcl oral tablet 5 mg 1

MYDAYIS ORAL CAPSULE EXTENDED RELEASE 24 HOUR 125 MG 25 MG 375 MG 50 MG (amphetamine-dextroamphetamine)

3 DSL = 30 days

VYVANSE ORAL CAPSULE 10 MG 20 MG 30 MG 40 MG 50 MG 60 MG 70 MG (lisdexamfetamine dimesylate)

2


118


VYVANSE ORAL TABLET CHEWABLE 10 MG 20 MG 30 MG 40 MG 50 MG 60 MG (lisdexamfetamine dimesylate)

3

ZENZEDI ORAL TABLET 15 MG 25 MG 20 MG 30 MG 75 MG (dextroamphetamine sulfate)

3

ANALGESICS AND ANTIPYRETICS MISC - Drugs for Pain

acetaminophen-codeine 2 oral tablet 300-15 mg 1



acetaminophen-codeine oral solution 120-12 mg5ml 1

acetaminophen-codeine oral tablet 300-15 mg 300-30 mg 300-60 mg

1

ALLZITAL ORAL TABLET 25-325 MG (butalbital-acetaminophen)

3

APADAZ ORAL TABLET 408-325 MG 612-325 MG 816-325 MG (benzhydrocodone-acetaminophen)

3 DSL = 30 days

apap-caff-dihydrocodeine oral capsule 3205-30-16 mg 1

apap-caff-dihydrocodeine oral tablet 325-30-16 mg 1

butalbital-apap-caffeine (Bac Oral Tablet 50-325-40 Mg) 1

BENZHYDROCODONE-ACETAMINOPHEN ORAL TABLET 408-325 MG 612-325 MG 816-325 MG

3 DSL = 30 days

butalbital-acetaminophen capsule 50-300 mg oral 50-300 mg 1

BUTALBITAL-ACETAMINOPHEN CAPSULE 50-300 MG ORAL 50-300 MG

3

butalbital-acetaminophen oral tablet 25-325 mg 50-300 mg 50-325 mg

1

butalbital-apap-caff-cod oral capsule 50-300-40-30 mg 50-325-40-30 mg

1

butalbital-apap-caffeine oral capsule 50-300-40 mg 50-325-40 mg

1

butalbital-apap-caffeine oral tablet 50-325-40 mg 1

oxycodone-acetaminophen (Endocet Oral Tablet 10-325 Mg 25-325 Mg 5-325 Mg 75-325 Mg)

1 DSL = 30 days

gabapentin oral capsule 100 mg 300 mg 400 mg 1

gabapentin oral solution 250 mg5ml 1

gabapentin oral tablet 600 mg 800 mg 1

GRALISE ORAL TABLET 300 MG 600 MG (gabapentin (once-daily))

3

HORIZANT ORAL TABLET EXTENDED RELEASE 300 MG 600 MG (gabapentin enacarbil)

3


119


hydrocodone-acetaminophen oral solution 10-325 mg15ml 75-325 mg15ml

1

hydrocodone-acetaminophen oral tablet 10-300 mg 10-325 mg 5-300 mg 5-325 mg 75-300 mg 75-325 mg

1

LORTAB ORAL ELIXIR 10-300 MG15ML (hydrocodone-acetaminophen)

2

LYRICA CR ORAL TABLET EXTENDED RELEASE 24 HOUR 165 MG 330 MG 825 MG (pregabalin)

3

NALOCET ORAL TABLET 25-300 MG 3 DSL = 30 days

oxycodone-acetaminophen oral tablet 10-325 mg 25-325 mg 5-325 mg 75-325 mg

1 DSL = 30 days

OXYCODONE-ACETAMINOPHEN ORAL TABLET 25-300 MG 3 DSL = 30 days

pregabalin er oral tablet extended release 24 hour 165 mg 330 mg 825 mg

1

pregabalin oral capsule 100 mg 150 mg 200 mg 225 mg 25 mg 300 mg 50 mg 75 mg

1

pregabalin oral solution 20 mgml 1

PRIALT INTRATHECAL SOLUTION 100 MCGML 500 MCG20ML 500 MCG5ML (ziconotide acetate)

3

PROLATE ORAL SOLUTION 10-300 MG5ML (oxycodone-acetaminophen)

3 DSL = 30 days

PROLATE ORAL TABLET 10-300 MG 5-300 MG 75-300 MG (oxycodone-acetaminophen)

3 DSL = 30 days

TENCON ORAL TABLET 50-325 MG (butalbital-acetaminophen)

3

tramadol-acetaminophen oral tablet 375-325 mg 1

VTOL LQ ORAL SOLUTION 50-325-40 MG15ML (butalbital-apap-caffeine)

3

ANOREXIGENIC AGENTS MISCELLANEOUS - Drugs for the Nervous System

CONTRAVE ORAL TABLET EXTENDED RELEASE 12 HOUR 8-90 MG (naltrexone-bupropion hcl)

2

IMCIVREE SUBCUTANEOUS SOLUTION 10 MGML (setmelanotide acetate)

2 DSL = 30 days


2

ANTICHOLINERGIC AGENTS (CNS) - Drugs for Parkinson





120


ANTICONVULSANTS MISCELLANEOUS - Drugs for Seizures

APTIOM ORAL TABLET 200 MG 400 MG 600 MG 800 MG (eslicarbazepine acetate)

3

BANZEL ORAL SUSPENSION 40 MGML (rufinamide) 2

BANZEL ORAL TABLET 200 MG 400 MG (rufinamide) 2

BRIVIACT INTRAVENOUS SOLUTION 50 MG5ML (brivaracetam)

3 DSL = 30 days

BRIVIACT ORAL SOLUTION 10 MGML (brivaracetam) 2 DSL = 30 days

BRIVIACT ORAL TABLET 10 MG 100 MG 25 MG 50 MG 75 MG (brivaracetam)

2 DSL = 30 days

carbamazepine er oral capsule extended release 12 hour 100 mg 200 mg 300 mg

1

carbamazepine er oral tablet extended release 12 hour 100 mg 200 mg 400 mg

1

carbamazepine oral suspension 100 mg5ml 1

carbamazepine oral tablet 200 mg 1

carbamazepine oral tablet chewable 100 mg 1

DEPAKOTE ER ORAL TABLET EXTENDED RELEASE 24 HOUR 250 MG 500 MG (divalproex sodium)

PV

DEPAKOTE ORAL TABLET DELAYED RELEASE 125 MG 250 MG 500 MG (divalproex sodium)

PV

DEPAKOTE SPRINKLES ORAL CAPSULE DELAYED RELEASE SPRINKLE 125 MG (divalproex sodium)

PV

DIACOMIT ORAL CAPSULE 250 MG 500 MG (stiripentol) 3 DSL = 30 days

DIACOMIT ORAL PACKET 250 MG 500 MG (stiripentol) 3 DSL = 30 days

divalproex sodium er oral tablet extended release 24 hour 250 mg 500 mg

PV

divalproex sodium oral capsule delayed release sprinkle 125 mg PV

divalproex sodium oral tablet delayed release 125 mg 250 mg 500 mg

PV

ELEPSIA XR ORAL TABLET EXTENDED RELEASE 24 HOUR 1000 MG 1500 MG (levetiracetam)

3

EPIDIOLEX ORAL SOLUTION 100 MGML (cannabidiol) 3 DSL = 30 days

carbamazepine (Epitol Oral Tablet 200 Mg) 1

EQUETRO ORAL CAPSULE EXTENDED RELEASE 12 HOUR 100 MG 300 MG (carbamazepine (antipsychotic))

3

EQUETRO ORAL CAPSULE EXTENDED RELEASE 12 HOUR 200 MG (carbamazepine (antipsychotic))

2

felbamate oral suspension 600 mg5ml 1


121


felbamate oral tablet 400 mg 600 mg 1

FELBATOL ORAL SUSPENSION 600 MG5ML (felbamate) 3

FINTEPLA ORAL SOLUTION 22 MGML (fenfluramine hcl) 3 DSL = 30 days

FYCOMPA ORAL SUSPENSION 05 MGML (perampanel) 3

FYCOMPA ORAL TABLET 10 MG 12 MG 2 MG 4 MG 6 MG 8 MG (perampanel)

3 DSL = 30 days




GABITRIL ORAL TABLET 12 MG 16 MG 2 MG 4 MG (tiagabine hcl)

3


3


3

LAMICTAL ODT ORAL KIT 21 X 25 MG amp 7 X 50 MG 25 amp 50 amp 100 MG 42 X 50 MG amp 14X100 MG (lamotrigine)

PV

LAMICTAL ODT ORAL TABLET DISPERSIBLE 100 MG 200 MG 25 MG 50 MG (lamotrigine)

PV

LAMICTAL ORAL TABLET 100 MG 150 MG 200 MG 25 MG (lamotrigine)

PV

LAMICTAL ORAL TABLET CHEWABLE 25 MG 5 MG (lamotrigine)

PV

LAMICTAL STARTER ORAL KIT 35 X 25 MG 42 X 25 MG amp 7 X 100 MG 84 X 25 MG amp 14X100 MG (lamotrigine)

PV

LAMICTAL XR ORAL KIT 21 X 25 MG amp 7 X 50 MG 25 amp 50 amp 100 MG 50 amp 100 amp 200 MG (lamotrigine)

PV

LAMICTAL XR ORAL TABLET EXTENDED RELEASE 24 HOUR 100 MG 200 MG 25 MG 250 MG 300 MG 50 MG (lamotrigine)

PV

lamotrigine er oral tablet extended release 24 hour 100 mg 200 mg 25 mg 250 mg 300 mg 50 mg

PV

lamotrigine oral kit 25 amp 50 amp 100 mg PV

lamotrigine oral tablet 100 mg 150 mg 200 mg 25 mg PV

lamotrigine oral tablet chewable 25 mg 5 mg PV

lamotrigine oral tablet dispersible 100 mg 200 mg 25 mg 50 mg

PV

lamotrigine starter kit-blue oral kit 35 x 25 mg PV

lamotrigine starter kit-green oral kit 84 x 25 mg amp 14x100 mg PV

lamotrigine starter kit-orange oral kit 42 x 25 mg amp 7 x 100 mg PV


122


levetiracetam er oral tablet extended release 24 hour 500 mg 750 mg

1

levetiracetam intravenous solution 500 mg5ml 1

levetiracetam oral solution 100 mgml 1

levetiracetam oral tablet 1000 mg 250 mg 500 mg 750 mg 1


3


PV



oxcarbazepine oral suspension 300 mg5ml 1

oxcarbazepine oral tablet 150 mg 300 mg 600 mg 1

OXTELLAR XR ORAL TABLET EXTENDED RELEASE 24 HOUR 150 MG 300 MG 600 MG (oxcarbazepine)

3


1


1



2

levetiracetam (Roweepra Oral Tablet 500 Mg) 1

rufinamide oral suspension 40 mgml 1

SABRIL ORAL PACKET 500 MG (vigabatrin) 2

SABRIL ORAL TABLET 500 MG (vigabatrin) 3 DSL = 30 days

SPRITAM ORAL TABLET DISINTEGRATING SOLUBLE 1000 MG 250 MG 500 MG 750 MG (levetiracetam)

3

lamotrigine (Subvenite Oral Tablet 100 Mg 150 Mg 200 Mg 25 Mg)

PV

lamotrigine (Subvenite Starter Kit-Blue Oral Kit 35 X 25 Mg) PV

lamotrigine (Subvenite Starter Kit-Green Oral Kit 84 X 25 Mg amp 14X100 Mg)

PV

lamotrigine (Subvenite Starter Kit-Orange Oral Kit 42 X 25 Mg amp 7 X 100 Mg)

PV

TEGRETOL-XR ORAL TABLET EXTENDED RELEASE 12 HOUR 100 MG 200 MG 400 MG (carbamazepine)

3

tiagabine hcl oral tablet 12 mg 16 mg 2 mg 4 mg 1


123


topiramate er oral capsule er 24 hour sprinkle 100 mg 150 mg 200 mg 25 mg 50 mg

1

topiramate oral capsule sprinkle 15 mg 25 mg 1

topiramate oral tablet 100 mg 200 mg 25 mg 50 mg 1

TROKENDI XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 100 MG 200 MG 25 MG 50 MG (topiramate)

3

valproic acid oral capsule 250 mg 1

valproic acid oral solution 250 mg5ml 1

vigabatrin oral packet 500 mg 1

vigabatrin oral tablet 500 mg 1 DSL = 30 days

vigabatrin (Vigadrone Oral Packet 500 Mg) 1

VIMPAT INTRAVENOUS SOLUTION 200 MG20ML (lacosamide)

3

VIMPAT ORAL SOLUTION 10 MGML (lacosamide) 3

VIMPAT ORAL TABLET 100 MG 150 MG 200 MG 50 MG (lacosamide)

3

XCOPRI ORAL TABLET 100 MG 150 MG 200 MG 50 MG (cenobamate)

3 DSL = 30 days

XCOPRI ORAL TABLET THERAPY PACK 14 X 125 MG amp 14 X 25 MG 14 X 150 MG amp 14 X200 MG 14 X 50 MG amp 14 X100 MG 150 amp 200 MG 50 amp 200 MG (cenobamate)

3 DSL = 30 days

zonisamide oral capsule 100 mg 25 mg 50 mg 1

ANTIDEPRESSANTS MISCELLANEOUS - Drugs for Depression amp Psychosis

APLENZIN ORAL TABLET EXTENDED RELEASE 24 HOUR 174 MG 348 MG 522 MG (bupropion hbr)

PV

bupropion hcl er (smoking det) oral tablet extended release 12 hour 150 mg

PV

bupropion hcl er (sr) oral tablet extended release 12 hour 100 mg 150 mg 200 mg

PV

bupropion hcl er (xl) oral tablet extended release 24 hour 150 mg 300 mg

PV

BUPROPION HCL ER (XL) ORAL TABLET EXTENDED RELEASE 24 HOUR 450 MG

PV

bupropion hcl oral tablet 100 mg 75 mg PV

FORFIVO XL ORAL TABLET EXTENDED RELEASE 24 HOUR 450 MG (bupropion hcl)

PV

mirtazapine oral tablet 15 mg 30 mg 45 mg 75 mg PV

mirtazapine oral tablet dispersible 15 mg 30 mg 45 mg PV

REMERON ORAL TABLET 15 MG 30 MG (mirtazapine) PV


124


REMERON SOLTAB ORAL TABLET DISPERSIBLE 15 MG 30 MG 45 MG (mirtazapine)

PV

SPRAVATO (56 MG DOSE) NASAL SOLUTION THERAPY PACK 28 MGDEVICE (esketamine hcl)

3


3

WELLBUTRIN SR ORAL TABLET EXTENDED RELEASE 12 HOUR 100 MG 150 MG 200 MG (bupropion hcl)

PV

WELLBUTRIN XL ORAL TABLET EXTENDED RELEASE 24 HOUR 150 MG 300 MG (bupropion hcl)

PV

ZULRESSO INTRAVENOUS SOLUTION 100 MG20ML (brexanolone)

3

ANTIMANIC AGENTS - Drugs for Personality Disorder

ABILIFY MAINTENA INTRAMUSCULAR PREFILLED SYRINGE 300 MG 400 MG (aripiprazole)

PV

ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION RECONSTITUTED ER 300 MG 400 MG (aripiprazole)

PV

ABILIFY MYCITE MAINTENANCE KIT ORAL TABLET 10 MG 15 MG 2 MG 20 MG 30 MG 5 MG (aripiprazole)

PV

ABILIFY MYCITE ORAL TABLET 10 MG 15 MG 2 MG 20 MG 30 MG 5 MG (aripiprazole)

PV

ABILIFY MYCITE STARTER KIT ORAL TABLET 10 MG 15 MG 2 MG 20 MG 30 MG 5 MG (aripiprazole)

PV

ABILIFY ORAL TABLET 10 MG 15 MG 2 MG 20 MG 30 MG 5 MG (aripiprazole)

PV

aripiprazole oral solution 1 mgml PV

aripiprazole oral tablet 10 mg 15 mg 2 mg 20 mg 30 mg 5 mg

PV

aripiprazole oral tablet dispersible 10 mg 15 mg PV

ARISTADA INITIO INTRAMUSCULAR PREFILLED SYRINGE 675 MG24ML (aripiprazole lauroxil)

PV

ARISTADA INTRAMUSCULAR PREFILLED SYRINGE 1064 MG39ML 441 MG16ML 662 MG24ML 882 MG32ML (aripiprazole lauroxil)

PV

asenapine maleate sublingual tablet sublingual 10 mg 25 mg 5 mg

PV


1


1



125





PV


PV


PV


PV



PV



3


2

GEODON INTRAMUSCULAR SOLUTION RECONSTITUTED 20 MG (ziprasidone mesylate)

PV

GEODON ORAL CAPSULE 20 MG 40 MG 60 MG 80 MG (ziprasidone hcl)

PV


PV


PV


PV


PV


PV





PV





126


lithium carbonate er oral tablet extended release 300 mg 450 mg

PV

lithium carbonate oral capsule 150 mg 300 mg 600 mg PV

lithium carbonate oral tablet 300 mg PV

lithium oral solution 8 meq5ml PV

LITHOBID ORAL TABLET EXTENDED RELEASE 300 MG (lithium carbonate)

PV

olanzapine intramuscular solution reconstituted 10 mg PV

olanzapine oral tablet 10 mg 15 mg 25 mg 20 mg 5 mg 75 mg

PV

olanzapine oral tablet dispersible 10 mg 15 mg 20 mg 5 mg PV

PERSERIS SUBCUTANEOUS PREFILLED SYRINGE 120 MG 90 MG (risperidone)

3

quetiapine fumarate er oral tablet extended release 24 hour 150 mg 200 mg 300 mg 400 mg 50 mg

PV

quetiapine fumarate oral tablet 100 mg 200 mg 25 mg 300 mg 400 mg 50 mg

PV

RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION RECONSTITUTED ER 125 MG 25 MG 375 MG 50 MG (risperidone microspheres)

PV

RISPERDAL ORAL SOLUTION 1 MGML (risperidone) PV

RISPERDAL ORAL TABLET 05 MG 1 MG 2 MG 3 MG 4 MG (risperidone)

PV

risperidone oral solution 1 mgml PV

risperidone oral tablet 025 mg 05 mg 1 mg 2 mg 3 mg 4 mg PV

risperidone oral tablet dispersible 025 mg 05 mg 1 mg 2 mg 3 mg 4 mg

PV

SAPHRIS SUBLINGUAL TABLET SUBLINGUAL 10 MG 25 MG 5 MG (asenapine maleate)

PV

SECUADO TRANSDERMAL PATCH 24 HOUR 38 MG24HR 57 MG24HR 76 MG24HR (asenapine)

3

SEROQUEL ORAL TABLET 100 MG 200 MG 25 MG 300 MG 400 MG 50 MG (quetiapine fumarate)

PV

SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HOUR 150 MG 200 MG 300 MG 400 MG 50 MG (quetiapine fumarate)

PV


PV



PV


127



PV


3



ziprasidone hcl oral capsule 20 mg 40 mg 60 mg 80 mg PV

ziprasidone mesylate intramuscular solution reconstituted 20 mg

PV

ZYPREXA INTRAMUSCULAR SOLUTION RECONSTITUTED 10 MG (olanzapine)

PV

ZYPREXA ORAL TABLET 10 MG 15 MG 25 MG 20 MG 5 MG 75 MG (olanzapine)

PV

ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION RECONSTITUTED 210 MG 300 MG 405 MG (olanzapine pamoate)

PV

ZYPREXA ZYDIS ORAL TABLET DISPERSIBLE 10 MG 15 MG 20 MG 5 MG (olanzapine)

PV

ANTIMIGRAINE AGENTS MISCELLANEOUS - Migraine Treatment


AIMOVIG SUBCUTANEOUS SOLUTION AUTO-INJECTOR 140 MGML (erenumab-aooe)

3


3 DSL = 30 days

AJOVY SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 225 MG15ML (fremanezumab-vfrm)

3 DSL = 30 days

butalbital-asa-caff-codeine (Ascomp-Codeine Oral Capsule 50-325-40-30 Mg)

1












128



PV



PV


1


1


butalbital-asa-caff-codeine oral capsule 50-325-40-30 mg 1




CAMBIA ORAL PACKET 50 MG (diclofenac potassium(migraine))

3


PV


PV


PV




PV



PV


3

EMGALITY SUBCUTANEOUS SOLUTION AUTO-INJECTOR 120 MGML (galcanezumab-gnlm)

3 DSL = 30 days

EMGALITY SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 120 MGML (galcanezumab-gnlm)

3 DSL = 30 days


2





129



3


3


3


2


2 DSL = 30 days


1




PV







3

ANTIPSYCHOTICS MISCELLANEOUS - Drugs for Depression amp Psychosis

ADASUVE INHALATION AEROSOL POWDER BREATH ACTIVATED 10 MG (loxapine)

PV

loxapine succinate oral capsule 10 mg 25 mg 5 mg 50 mg PV

molindone hcl oral tablet 10 mg 25 mg 5 mg PV

pimozide oral tablet 1 mg 2 mg PV

ANXIOLYTICSSEDATIVESAND HYPNOTICSMISC - Drugs for Anxiety amp Sleep Disorder

BELSOMRA ORAL TABLET 10 MG 15 MG 20 MG 5 MG (suvorexant)

3

buspirone hcl oral tablet 10 mg 15 mg 30 mg 5 mg 75 mg PV

DAYVIGO ORAL TABLET 10 MG 5 MG (lemborexant) 3

dexmedetomidine hcl in nacl intravenous solution 200 mcg50ml 200-09 mcg50ml- 400 mcg100ml 80 mcg20ml

1

dexmedetomidine hcl intravenous solution 200 mcg2ml 1


130


EDLUAR SUBLINGUAL TABLET SUBLINGUAL 10 MG 5 MG (zolpidem tartrate)

3 DSL = 30 days

eszopiclone oral tablet 1 mg 2 mg 3 mg 1 DSL = 30 days

HETLIOZ LQ ORAL SUSPENSION 4 MGML (tasimelteon) 3

HETLIOZ ORAL CAPSULE 20 MG (tasimelteon) 3 DSL = 30 days




meprobamate oral tablet 200 mg 400 mg PV


PV

PRECEDEX INTRAVENOUS SOLUTION 1000 MCG250ML (dexmedetomidine hcl in nacl)

3

PRECEDEX INTRAVENOUS SOLUTION 200 MCG2ML (dexmedetomidine hcl)

2







PV


ramelteon oral tablet 8 mg 1

zaleplon oral capsule 10 mg 5 mg 1 DSL = 30 days

zolpidem tartrate er oral tablet extended release 125 mg 625 mg

1 DSL = 30 days

zolpidem tartrate oral tablet 10 mg 5 mg 1 DSL = 30 days

zolpidem tartrate sublingual tablet sublingual 175 mg 35 mg 1 DSL = 30 days

ZOLPIMIST ORAL SOLUTION 5 MGACT (zolpidem tartrate) 3 DSL = 30 days

ATYPICAL ANTIPSYCHOTICS - Drugs for Depression amp Psychosis


PV


PV


PV


131



PV


PV


PV



PV



PV


PV


PV

CAPLYTA ORAL CAPSULE 42 MG (lumateperone tosylate) 3 DSL = 30 days

clozapine oral tablet 100 mg 200 mg 25 mg 50 mg PV

clozapine oral tablet dispersible 100 mg 125 mg 150 mg 200 mg 25 mg

PV

CLOZARIL ORAL TABLET 100 MG 200 MG 25 MG 50 MG (clozapine)

PV

FANAPT ORAL TABLET 1 MG 10 MG 12 MG 2 MG 4 MG 6 MG 8 MG (iloperidone)

PV

FANAPT TITRATION PACK ORAL TABLET 1 amp 2 amp 4 amp 6 MG (iloperidone)

PV


PV


PV

INVEGA ORAL TABLET EXTENDED RELEASE 24 HOUR 15 MG 3 MG 6 MG 9 MG (paliperidone)

PV

INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 117 MG075ML 156 MGML 234 MG15ML 39 MG025ML 78 MG05ML (paliperidone palmitate)

PV

INVEGA TRINZA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 273 MG0875ML 410 MG1315ML 546 MG175ML 819 MG2625ML (paliperidone palmitate)

PV

LATUDA ORAL TABLET 120 MG 20 MG 40 MG 60 MG 80 MG (lurasidone hcl)

PV


132


NUPLAZID ORAL CAPSULE 34 MG (pimavanserin tartrate) 3 DSL = 30 days

NUPLAZID ORAL TABLET 10 MG (pimavanserin tartrate) 3 DSL = 30 days



PV


olanzapine-fluoxetine hcl oral capsule 12-25 mg 12-50 mg 3-25 mg 6-25 mg 6-50 mg

PV

paliperidone er oral tablet extended release 24 hour 15 mg 3 mg 6 mg 9 mg

PV


3


PV


PV

REXULTI ORAL TABLET 025 MG 05 MG 1 MG 2 MG 3 MG 4 MG (brexpiprazole)

PV


PV



PV




PV


PV


3


PV


PV

SYMBYAX ORAL CAPSULE 12-50 MG 3-25 MG 6-25 MG 6-50 MG (olanzapine-fluoxetine hcl)

PV

VERSACLOZ ORAL SUSPENSION 50 MGML (clozapine) PV


133


VRAYLAR ORAL CAPSULE 15 MG 3 MG 45 MG 6 MG (cariprazine hcl)

PV DSL = 30 days

VRAYLAR ORAL CAPSULE THERAPY PACK 15 amp 3 MG (cariprazine hcl)

PV DSL = 30 days



PV


PV


PV


PV


PV

BARBITURATES (ANTICONVULSANTS) - Drugs for Seizures


2


3

METHOHEXITAL SODIUM INTRAVENOUS SOLUTION PREFILLED SYRINGE 100 MG10ML

3



phenobarbital oral elixir 20 mg5ml 1

phenobarbital oral tablet 100 mg 15 mg 162 mg 30 mg 324 mg 60 mg 648 mg 972 mg

1




2


3

primidone oral tablet 250 mg 50 mg 1

BARBITURATES (ANXIOLYTIC SEDATIVEHYP) - Drugs for Anxiety amp Sleep Disorder


3


134



1




3


1


1


1






2


3





1




2


3


3


3

BARBITURATES (GENERAL ANESTHETICS) - Anesthetics


3


135


BENZODIAZEPINES (ANTICONVULSANTS) - Drugs for Seizures

ATIVAN ORAL TABLET 05 MG 1 MG 2 MG (lorazepam) PV DSL = 30 days

clobazam oral suspension 25 mgml 1

clobazam oral tablet 10 mg 20 mg 1

clonazepam oral tablet 05 mg 1 mg 2 mg 1

clonazepam oral tablet dispersible 0125 mg 025 mg 05 mg 1 mg 2 mg

1

clorazepate dipotassium oral tablet 15 mg 375 mg 75 mg PV

DIASTAT ACUDIAL RECTAL GEL 10 MG 20 MG (diazepam) 2

DIASTAT PEDIATRIC RECTAL GEL 25 MG (diazepam) 2

diazepam (Diazepam Intensol Oral Concentrate 5 MgMl) PV

diazepam oral concentrate 5 mgml PV

diazepam oral solution 5 mg5ml PV

diazepam oral tablet 10 mg 2 mg 5 mg PV

diazepam rectal gel 10 mg 25 mg 20 mg 1

lorazepam injection solution 2 mgml 4 mgml 1

lorazepam (Lorazepam Intensol Oral Concentrate 2 MgMl) PV DSL = 30 days

lorazepam oral concentrate 2 mgml PV DSL = 30 days

lorazepam oral tablet 05 mg 1 mg 2 mg PV DSL = 30 days

NAYZILAM NASAL SOLUTION 5 MG01ML (midazolam (anticonvulsant))

3 DSL = 30 days

SYMPAZAN ORAL FILM 10 MG 20 MG 5 MG (clobazam) 3

TRANXENE-T ORAL TABLET 75 MG (clorazepate dipotassium)

PV

VALIUM ORAL TABLET 10 MG 2 MG 5 MG (diazepam) PV

VALTOCO NASAL LIQUID 10 MG01ML 5 MG01ML (diazepam)

3

VALTOCO NASAL LIQUID THERAPY PACK 10 MG01ML 75 MG01ML (diazepam)

3

BENZODIAZEPINES (ANXIOLYTICSEDATIVHYP) - Drugs for Anxiety amp Sleep Disorder

alprazolam er oral tablet extended release 24 hour 05 mg 1 mg 2 mg 3 mg

PV DSL = 30 days

alprazolam intensol oral concentrate 1 mgml PV DSL = 30 days

alprazolam oral tablet 025 mg 05 mg 1 mg 2 mg PV DSL = 30 days

alprazolam oral tablet dispersible 025 mg 05 mg 1 mg 2 mg PV DSL = 30 days

alprazolam xr oral tablet extended release 24 hour 05 mg 1 mg 2 mg 3 mg

PV DSL = 30 days


136



chlordiazepoxide hcl oral capsule 10 mg 25 mg 5 mg PV

chlordiazepoxide-amitriptyline oral tablet 10-25 mg 5-125 mg PV






1









estazolam oral tablet 1 mg 2 mg 1

flurazepam hcl oral capsule 15 mg 30 mg 1 DSL = 30 days





midazolam hcl oral syrup 2 mgml 1

MIDAZOLAM HCL-SODIUM CHLORIDE INTRAVENOUS SOLUTION 100-08 MG100ML- 100-09 MG100ML- 50-09 MG50ML-

3

MKO MELT DOSE PACK MOUTHTHROAT TROCHE 3-25-2 MG

3


3 DSL = 30 days

oxazepam oral capsule 10 mg 15 mg 30 mg PV DSL = 30 days

quazepam oral tablet 15 mg 1


temazepam oral capsule 15 mg 225 mg 30 mg 75 mg 1 DSL = 30 days


PV

triazolam oral tablet 0125 mg 025 mg 1 DSL = 30 days


137




3


3

XANAX ORAL TABLET 025 MG 05 MG 1 MG 2 MG (alprazolam)

PV DSL = 30 days

XANAX XR ORAL TABLET EXTENDED RELEASE 24 HOUR 05 MG 1 MG 2 MG 3 MG (alprazolam)

PV DSL = 30 days

BUTYROPHENONES - Drugs for Depression amp Psychosis

HALDOL DECANOATE INTRAMUSCULAR SOLUTION 100 MGML 50 MGML (haloperidol decanoate)

PV

haloperidol decanoate intramuscular solution 100 mgml 50 mgml

PV

haloperidol lactate oral concentrate 2 mgml PV

haloperidol oral tablet 05 mg 1 mg 10 mg 2 mg 20 mg 5 mg PV

CALCITONIN GENE-RELATED PEPTIDE ANTAG - Migraine Treatment


3


3 DSL = 30 days

AJOVY SUBCUTANEOUS SOLUTION AUTO-INJECTOR 225 MG15ML (fremanezumab-vfrm)

3


3 DSL = 30 days

EMGALITY (300 MG DOSE) SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MGML (galcanezumab-gnlm)

3


3 DSL = 30 days


3 DSL = 30 days

NURTEC ORAL TABLET DISPERSIBLE 75 MG (rimegepant sulfate)

3 DSL = 30 days

UBRELVY ORAL TABLET 100 MG 50 MG (ubrogepant) 3 DSL = 30 days

VYEPTI INTRAVENOUS SOLUTION 100 MGML (eptinezumab-jjmr)

3


138


CATECHOL-O-METHYLTRANSFERASE(COMT)INHIB - Drugs for Parkinson

carbidopa-levodopa-entacapone oral tablet 125-50-200 mg 1875-75-200 mg 25-100-200 mg 3125-125-200 mg 375-150-200 mg 50-200-200 mg

1

entacapone oral tablet 200 mg 1

ONGENTYS ORAL CAPSULE 25 MG 50 MG (opicapone) 3

TASMAR ORAL TABLET 100 MG (tolcapone) 3

tolcapone oral tablet 100 mg 1

CENTRAL NERVOUS SYSTEM AGENTS MISC - Drugs for Attention Deficit Disorder

acamprosate calcium oral tablet delayed release 333 mg 1

ADDYI ORAL TABLET 100 MG (flibanserin) 3 DSL = 30 days

atomoxetine hcl oral capsule 10 mg 100 mg 18 mg 25 mg 40 mg 60 mg 80 mg

1

AUSTEDO ORAL TABLET 12 MG 6 MG 9 MG (deutetrabenazine)

3 DSL = 30 days

carbidopa oral tablet 25 mg 1


1


INGREZZA ORAL CAPSULE 40 MG 80 MG (valbenazine tosylate)

3 DSL = 30 days

LODOSYN ORAL TABLET 25 MG (carbidopa) 2

memantine hcl er oral capsule extended release 24 hour 14 mg 21 mg 28 mg 7 mg

1

memantine hcl oral solution 2 mgml 1

memantine hcl oral tablet 10 mg 28 x 5 mg amp 21 x 10 mg 5 mg 1

NAMENDA TITRATION PAK ORAL TABLET 28 X 5 MG amp 21 X 10 MG (memantine hcl)

2

NAMENDA XR TITRATION PACK ORAL CAPSULE EXTENDED RELEASE 24 HOUR 7 amp 14 amp 21 amp28 MG (memantine hcl)

3


3


3 DSL = 30 days


3

NOURIANZ ORAL TABLET 20 MG 40 MG (istradefylline) 3 DSL = 30 days


139


NUEDEXTA ORAL CAPSULE 20-10 MG (dextromethorphan-quinidine)

3 DSL = 30 days

QELBREE ORAL CAPSULE EXTENDED RELEASE 24 HOUR 100 MG 150 MG 200 MG (viloxazine hcl)

3

RADICAVA INTRAVENOUS SOLUTION 30 MG100ML (edaravone)

3 DSL = 30 days

riluzole oral tablet 50 mg 1

STRATTERA ORAL CAPSULE 10 MG 100 MG 18 MG 25 MG 40 MG 60 MG 80 MG (atomoxetine hcl)

3

tetrabenazine oral tablet 125 mg 25 mg 1

TIGLUTIK ORAL SUSPENSION 50 MG10ML (riluzole) 3

VYLEESI SUBCUTANEOUS SOLUTION AUTO-INJECTOR 175 MG03ML (bremelanotide acetate)

3 DSL = 30 days

XYREM ORAL SOLUTION 500 MGML (sodium oxybate) 3 DSL = 30 days

XYWAV ORAL SOLUTION 500 MGML (ca mg k and na oxybates)

3 DSL = 30 days

CYCLOOXYGENASE-2 (COX-2) INHIBITORS - Drugs for Pain

celecoxib oral capsule 100 mg 200 mg 400 mg 50 mg 1


3

NUDROXIPAK COMBINATION THERAPY PACK 200 MG (celecoxib-capsaic-men-methsal)

3

DOPAMINE PRECURSORS - Drugs for Parkinson

carbidopa-levodopa er oral tablet extended release 25-100 mg 50-200 mg

1

carbidopa-levodopa oral tablet 10-100 mg 25-100 mg 25-250 mg

1

carbidopa-levodopa oral tablet dispersible 10-100 mg 25-100 mg 25-250 mg

1


1

DUOPA ENTERAL SUSPENSION 463-20 MGML (carbidopa-levodopa)

2

INBRIJA INHALATION CAPSULE 42 MG (levodopa) 3 DSL = 30 days

RYTARY ORAL CAPSULE EXTENDED RELEASE 2375-95 MG 3625-145 MG 4875-195 MG 6125-245 MG (carbidopa-levodopa)

3


140


ERGOT-DERIV DOPAMINE RECEPTOR AGONISTS - Drugs for Parkinson

bromocriptine mesylate oral capsule 5 mg 1

bromocriptine mesylate oral tablet 25 mg 1

cabergoline oral tablet 05 mg 1

CYCLOSET ORAL TABLET 08 MG (bromocriptine mesylate) 2

FIBROMYALGIA AGENTS - Drugs for Nerve Pain

CYMBALTA ORAL CAPSULE DELAYED RELEASE PARTICLES 20 MG 30 MG 60 MG (duloxetine hcl)

PV

DRIZALMA SPRINKLE ORAL CAPSULE DELAYED RELEASE SPRINKLE 20 MG 30 MG 40 MG 60 MG (duloxetine hcl)

3

duloxetine hcl oral capsule delayed release particles 20 mg 30 mg 40 mg 60 mg

PV


3


1


1


SAVELLA ORAL TABLET 100 MG 125 MG 25 MG 50 MG (milnacipran hcl)

3

SAVELLA TITRATION PACK ORAL 125 amp 25 amp 50 MG (milnacipran hcl)

3

GENERAL ANESTHETICS MISCELLANEOUS - Anesthetics

KETAMINE HCL SUBLINGUAL TROCHE 100 MG 3

KETAMINE HCL-SODIUM CHLORIDE INTRAVENOUS SOLUTION PREFILLED SYRINGE 50-09 MG5ML-

3


3

HYDANTOINS - Drugs for Seizures


2

fosphenytoin sodium injection solution 500 mg pe10ml 1





1


141


INHALATION ANESTHETICS - Anesthetics

desflurane inhalation solution 1

FORANE INHALATION SOLUTION (isoflurane) 2

isoflurane inhalation solution 1

sevoflurane inhalation solution 1

isoflurane (Terrell Inhalation Solution) 1

MONOAMINE OXIDASE B INHIBITORS - Drugs for Parkinson

EMSAM TRANSDERMAL PATCH 24 HOUR 12 MG24HR 6 MG24HR 9 MG24HR (selegiline)

3

rasagiline mesylate oral tablet 05 mg 1 mg 1

selegiline hcl oral capsule 5 mg 1

selegiline hcl oral tablet 5 mg 1

XADAGO ORAL TABLET 100 MG 50 MG (safinamide mesylate)

3

ZELAPAR ORAL TABLET DISPERSIBLE 125 MG (selegiline hcl)

3

MONOAMINE OXIDASE INHIBITORS - Drugs for Depression amp Psychosis


3

MARPLAN ORAL TABLET 10 MG (isocarboxazid) PV

NARDIL ORAL TABLET 15 MG (phenelzine sulfate) PV

PARNATE ORAL TABLET 10 MG (tranylcypromine sulfate) PV

phenelzine sulfate oral tablet 15 mg PV




tranylcypromine sulfate oral tablet 10 mg PV


3

NONERGOT-DERIVDOPAMINE RECEPTOR AGONIST - Drugs for Parkinson

APOKYN SUBCUTANEOUS SOLUTION CARTRIDGE 30 MG3ML (apomorphine hcl)

2 DSL = 30 days

KYNMOBI SUBLINGUAL FILM 10 MG 15 MG 20 MG 25 MG 30 MG (apomorphine hcl)

3 DSL = 30 days

KYNMOBI TITRATION KIT SUBLINGUAL KIT 1015202530 MG (apomorphine hcl)

3 DSL = 30 days


142


NEUPRO TRANSDERMAL PATCH 24 HOUR 1 MG24HR 2 MG24HR 3 MG24HR 4 MG24HR 6 MG24HR 8 MG24HR (rotigotine)

3

pramipexole dihydrochloride er oral tablet extended release 24 hour 0375 mg 075 mg 15 mg 225 mg 3 mg 375 mg 45 mg

1

pramipexole dihydrochloride oral tablet 0125 mg 025 mg 05 mg 075 mg 1 mg 15 mg

1

ropinirole hcl er oral tablet extended release 24 hour 12 mg 2 mg 4 mg 6 mg 8 mg

1

ropinirole hcl oral tablet 025 mg 05 mg 1 mg 2 mg 3 mg 4 mg 5 mg

1

OPIATE AGONISTS - Drugs for Pain






1


3 DSL = 30 days




1

belladonna alkaloids-opium rectal suppository 162-30 mg 162-60 mg

1


3 DSL = 30 days


1



codeine sulfate oral tablet 15 mg 30 mg 60 mg 1 DSL = 30 days

CONZIP ORAL CAPSULE EXTENDED RELEASE 24 HOUR 100 MG 200 MG 300 MG (tramadol hcl)

3

DSUVIA SUBLINGUAL TABLET SUBLINGUAL 30 MCG (sufentanil citrate)

3

duramorph injection solution 05 mgml 1 mgml 1


1 DSL = 30 days


143


fentanyl citrate (pf) injection solution 100 mcg2ml 1000 mcg20ml 250 mcg5ml 2500 mcg50ml 50 mcgml 500 mcg10ml

1 DSL = 30 days

fentanyl citrate (pf) injection solution cartridge 100 mcg2ml 1 DSL = 30 days

fentanyl citrate buccal lozenge on a handle 1200 mcg 1600 mcg 200 mcg 400 mcg 600 mcg 800 mcg

1 DSL = 30 days

FENTANYL CITRATE BUCCAL TABLET 100 MCG 200 MCG 400 MCG 600 MCG 800 MCG

3 DSL = 30 days

FENTANYL CITRATE INTRAVENOUS SOLUTION PREFILLED SYRINGE 100 MCG2ML

3

FENTANYL CITRATE-NACL INJECTION SOLUTION 10-09 MCGML-

3 DSL = 30 days

FENTANYL CITRATE-NACL INTRAVENOUS SOLUTION 1-09 MG100ML- 125-09 MG250ML- 2-09 MG100ML- 25-09 MG250ML-

3

FENTANYL CITRATE-NACL INTRAVENOUS SOLUTION PREFILLED SYRINGE 500-09 MCG50ML-

3

fentanyl transdermal patch 72 hour 100 mcghr 12 mcghr 25 mcghr 50 mcghr 75 mcghr

1 DSL = 30 days

fentanyl transdermal patch 72 hour 375 mcghr 625 mcghr 875 mcghr

1

FENTANYL-BUPIVACAINE-NACL EPIDURAL SOLUTION 02-01-09 MG100ML- 02-0125-09 MG100ML- 05-00625-09 MG250ML- 05-01-09 MG250ML- 05-0125-09 MG250ML-

3

FENTANYL-BUPIVACAINE-NACL INJECTION SOLUTION 2-0125-09 MCGML--

3 DSL = 30 days

FENTORA BUCCAL TABLET 100 MCG 200 MCG 400 MCG 600 MCG 800 MCG (fentanyl citrate)

3 DSL = 30 days

guaiatussin ac oral syrup 100-10 mg5ml 1

guaifenesin ac oral syrup 100-10 mg5ml 1

hydrocodone bitartrate er oral capsule extended release 12 hour 10 mg 15 mg 20 mg 30 mg 40 mg 50 mg

1 DSL = 30 days

hydrocodone bitartrate er oral tablet er 24 hour abuse-deterrent100 mg 120 mg 20 mg 30 mg 40 mg 60 mg 80 mg

1 DSL = 30 days


1


1


1



144



hydrocodone-ibuprofen oral tablet 10-200 mg 5-200 mg 75-200 mg

1


hydromorphone hcl er oral tablet extended release 24 hour 12 mg 16 mg 32 mg 8 mg

1 DSL = 30 days

hydromorphone hcl injection solution 2 mgml 1 DSL = 30 days

hydromorphone hcl oral liquid 1 mgml 1 DSL = 30 days

hydromorphone hcl oral tablet 2 mg 4 mg 8 mg 1 DSL = 30 days

hydromorphone hcl rectal suppository 3 mg 1 DSL = 30 days

HYDROMORPHONE HCL-NACL INTRAVENOUS SOLUTION 25-09 MG50ML- 50-09 MG50ML-

3

HYDROMORPHONE HCL-NACL INTRAVENOUS SOLUTION PREFILLED SYRINGE 10-09 MG50ML- 15-09 MG30ML-

3

HYSINGLA ER ORAL TABLET ER 24 HOUR ABUSE-DETERRENT 100 MG 120 MG 20 MG 30 MG 40 MG 60 MG 80 MG (hydrocodone bitartrate)

3 DSL = 30 days

INFUMORPH 200 INJECTION SOLUTION 200 MG20ML (10 MGML) (morphine sulfate microinfusion)

2 DSL = 30 days


2 DSL = 30 days

LAZANDA NASAL SOLUTION 100 MCGACT 400 MCGACT (fentanyl citrate)

3 DSL = 30 days

levorphanol tartrate oral tablet 2 mg 1 DSL = 30 days

levorphanol tartrate oral tablet 3 mg 1


2

maxi-tuss ac oral solution 100-10 mg5ml 1

meperidine hcl injection solution 50 mgml 1 DSL = 30 days

meperidine hcl oral solution 50 mg5ml 1 DSL = 30 days

meperidine hcl oral tablet 50 mg 1 DSL = 30 days

methadone hcl injection solution 10 mgml 1 DSL = 30 days

methadone hcl (Methadone Hcl Intensol Oral Concentrate 10 MgMl)

1 DSL = 30 days

methadone hcl oral concentrate 10 mgml 1 DSL = 30 days

methadone hcl oral solution 10 mg5ml 5 mg5ml 1 DSL = 30 days

methadone hcl oral tablet 10 mg 5 mg 1 DSL = 30 days

methadone hcl oral tablet soluble 40 mg 1 DSL = 30 days

methadose oral concentrate 10 mgml 1 DSL = 30 days


145


methadone hcl (Methadose Oral Tablet Soluble 40 Mg) 1 DSL = 30 days

methadose sugar-free oral concentrate 10 mgml 1 DSL = 30 days

morphine sulfate microinfusion (Mitigo Injection Solution 200 Mg20Ml (10 MgMl) 500 Mg20Ml (25 MgMl))

1 DSL = 30 days

morphine sulfate (concentrate) oral solution 100 mg5ml 20 mgml

1

morphine sulfate (pf) injection solution 05 mgml 1 mgml 10 mgml 2 mgml 4 mgml 5 mgml 8 mgml

1

morphine sulfate (pf) intravenous solution 10 mgml 2 mgml 4 mgml 8 mgml

1

morphine sulfate er beads oral capsule extended release 24 hour 120 mg 30 mg 45 mg 60 mg 75 mg 90 mg

1

morphine sulfate er oral capsule extended release 24 hour 10 mg 100 mg 20 mg 30 mg 40 mg 50 mg 60 mg 80 mg

1

morphine sulfate er oral tablet extended release 100 mg 15 mg 200 mg 30 mg 60 mg

1

MORPHINE SULFATE INJECTION SOLUTION 1 MGML 3 DSL = 30 days

morphine sulfate injection solution 2 mgml 4 mgml 1

MORPHINE SULFATE INTRAVENOUS SOLUTION 05 MGML 3

morphine sulfate intravenous solution 50 mgml 1

morphine sulfate oral solution 10 mg5ml 20 mg5ml 1

morphine sulfate oral tablet 15 mg 30 mg 1

morphine sulfate rectal suppository 10 mg 20 mg 30 mg 5 mg 1

MORPHINE SULFATE SOLUTION 1 MGML INTRAVENOUS 1 MGML

3

morphine sulfate solution 1 mgml intravenous 1 mgml 1

MORPHINE SULFATE-NACL INTRAVENOUS SOLUTION PREFILLED SYRINGE 50-09 MG50ML-

3


NUCYNTA ER ORAL TABLET EXTENDED RELEASE 12 HOUR 100 MG 150 MG 200 MG 250 MG 50 MG (tapentadol hcl)

3 DSL = 30 days

NUCYNTA ORAL TABLET 100 MG 50 MG 75 MG (tapentadol hcl)

3 DSL = 30 days

opium oral tincture 10 mgml (1) 1

OXAYDO ORAL TABLET 5 MG 75 MG (oxycodone hcl) 3 DSL = 30 days

OXYCODONE HCL ER ORAL TABLET ER 12 HOUR ABUSE-DETERRENT 10 MG 15 MG 20 MG 30 MG 40 MG 60 MG 80 MG

3 DSL = 30 days

oxycodone hcl oral capsule 5 mg 1 DSL = 30 days


146


oxycodone hcl oral concentrate 100 mg5ml 1 DSL = 30 days

oxycodone hcl oral solution 5 mg5ml 1 DSL = 30 days

oxycodone hcl oral tablet 10 mg 15 mg 20 mg 30 mg 5 mg 1 DSL = 30 days


1 DSL = 30 days


oxycodone-aspirin oral tablet 48355-325 mg 1 DSL = 30 days

OXYCONTIN ORAL TABLET ER 12 HOUR ABUSE-DETERRENT 10 MG 15 MG 20 MG 30 MG 40 MG 60 MG 80 MG (oxycodone hcl)

3 DSL = 30 days

oxymorphone hcl er oral tablet extended release 12 hour 10 mg 15 mg 20 mg 30 mg 40 mg 5 mg 75 mg

1 DSL = 30 days

oxymorphone hcl oral tablet 10 mg 5 mg 1 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


promethazine-codeine oral solution 625-10 mg5ml 1

promethazine-codeine oral syrup 625-10 mg5ml 1


QDOLO ORAL SOLUTION 5 MGML (tramadol hcl) 3

SUBSYS SUBLINGUAL LIQUID 100 MCG 1200 (600 X 2) MCG 1600 (800 X 2) MCG 200 MCG 400 MCG 600 MCG 800 MCG (fentanyl)

3 DSL = 30 days

SYNAPRYN FUSEPAQ ORAL SUSPENSION RECONSTITUTED 10 MGML (tramadol hcl)

3

tramadol hcl er (biphasic) oral tablet extended release 24 hour100 mg 200 mg 300 mg

1

TRAMADOL HCL ER ORAL CAPSULE EXTENDED RELEASE 24 HOUR 100 MG 200 MG 300 MG

3

tramadol hcl er oral tablet extended release 24 hour 100 mg 200 mg 300 mg

1

tramadol hcl oral tablet 100 mg 50 mg 1



3


3


147



3

virtussin ac walc oral liquid 100-10 mg5ml 1

XTAMPZA ER ORAL CAPSULE ER 12 HOUR ABUSE-DETERRENT 135 MG 18 MG 27 MG 36 MG 9 MG (oxycodone)

3

OPIATE ANTAGONISTS - Drugs for Overdose or Poisoning

LIFEMS NALOXONE INJECTION PREFILLED SYRINGE KIT 2 MG2ML

3

naloxone hcl injection solution 04 mgml 4 mg10ml 1

naloxone hcl injection solution cartridge 04 mgml 1

naloxone hcl injection solution prefilled syringe 2 mg2ml 1

naltrexone hcl oral tablet 50 mg 1

NARCAN NASAL LIQUID 4 MG01ML (naloxone hcl) 3

VIVITROL INTRAMUSCULAR SUSPENSION RECONSTITUTED 380 MG (naltrexone)

3

OPIATE PARTIAL AGONISTS - Drugs for Pain

BELBUCA BUCCAL FILM 150 MCG 300 MCG 450 MCG 600 MCG 75 MCG 750 MCG 900 MCG (buprenorphine hcl)

3

BUNAVAIL BUCCAL FILM 42-07 MG 63-1 MG (buprenorphine hcl-naloxone hcl)

3

buprenorphine hcl injection solution 03 mgml 1

buprenorphine hcl sublingual tablet sublingual 2 mg 8 mg 1

buprenorphine hcl-naloxone hcl sublingual film 12-3 mg 4-1 mg 1

buprenorphine hcl-naloxone hcl sublingual film 2-05 mg 8-2 mg

1 DSL = 30 days

buprenorphine hcl-naloxone hcl sublingual tablet sublingual 2-05 mg 8-2 mg

1

buprenorphine transdermal patch weekly 10 mcghr 20 mcghr 5 mcghr

1 DSL = 30 days

buprenorphine transdermal patch weekly 15 mcghr 75 mcghr 1

butorphanol tartrate injection solution 1 mgml 2 mgml 1

butorphanol tartrate nasal solution 10 mgml 1

nalbuphine hcl injection solution 20 mgml 1

pentazocine-naloxone hcl oral tablet 50-05 mg 1

PROBUPHINE IMPLANT KIT SUBCUTANEOUS IMPLANT 742 MG (buprenorphine hcl)

3

SUBLOCADE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MG05ML 300 MG15ML (buprenorphine)

3 DSL = 30 days


148


ZUBSOLV SUBLINGUAL TABLET SUBLINGUAL 07-018 MG 14-036 MG 114-29 MG 29-071 MG 57-14 MG 86-21 MG (buprenorphine hcl-naloxone hcl)

3 DSL = 30 days

OTHER NONSTEROIDAL ANTI-INFLAM AGENTS - Drugs for Pain

ADVIL JUNIOR STRENGTH ORAL TABLET 100 MG (ibuprofen)

PV

ADVIL JUNIOR STRENGTH ORAL TABLET CHEWABLE 100 MG (ibuprofen)

PV

ADVIL MIGRAINE ORAL CAPSULE 200 MG (ibuprofen) PV

ADVIL ORAL CAPSULE 200 MG (ibuprofen) PV

ADVIL ORAL TABLET 200 MG (ibuprofen) PV

ALEVE ORAL TABLET 220 MG (naproxen sodium) PV

CALDOLOR INTRAVENOUS SOLUTION 800 MG200ML 800 MG8ML (ibuprofen)

PV


3

CAPSFENAC PAK COMBINATION THERAPY PACK 15 amp 0025

3

CAPSINAC COMBINATION THERAPY PACK 0025-15 3

diclofenac potassium (Cataflam Oral Tablet 50 Mg) PV

DAYPRO ORAL TABLET 600 MG (oxaprozin) PV

DERMACINRX LEXITRAL PHARMAPAK COMBINATION THERAPY PACK 15 amp 0025 (diclofenac sodium-capsaicin)

3

DICLOFENAC CAP ORAL CAPSULE 35 MG PV

DICLOFENAC PATCH EXTERNAL PATCH 13 PV

diclofenac potassium oral tablet 50 mg PV

diclofenac sodium er oral tablet extended release 24 hour 100 mg

PV

diclofenac sodium external gel 1 PV

diclofenac sodium external solution 15 PV

diclofenac sodium oral tablet delayed release 25 mg 50 mg 75 mg

PV

diclofenac-misoprostol oral tablet delayed release 50-02 mg 75-02 mg

1

DICLOFENAC-NA HYALURON-NIACIN EXTERNAL GEL 3-2-4

3

DICLOFONO EXTERNAL GEL 16 (diclofenac sodium) PV

DICLOPR EXTERNAL KIT 1 amp 10-30 3


149


DICLOTREX EXTERNAL THERAPY PACK 15 amp 4-10 (diclofenac sod-camphor-menthol)

3

DICLOVIX COMBINATION KIT 15 amp 2-25-4 3

DICLOVIX M EXTERNAL THERAPY PACK 15-8 3

DICLOZOR EXTERNAL THERAPY PACK 1 3

diflunisal oral tablet 500 mg 1

DIMENTHO EXTERNAL THERAPY PACK 15 amp 10 3

DUEXIS ORAL TABLET 800-266 MG (ibuprofen-famotidine) 3

EC-NAPROSYN ORAL TABLET DELAYED RELEASE 375 MG 500 MG (naproxen)

PV

ec-naproxen oral tablet delayed release 375 mg 500 mg PV

etodolac er oral tablet extended release 24 hour 400 mg 500 mg 600 mg

PV

etodolac oral capsule 200 mg 300 mg PV

etodolac oral tablet 400 mg 500 mg PV

FELDENE ORAL CAPSULE 10 MG 20 MG (piroxicam) PV

fenoprofen calcium oral capsule 200 mg 400 mg PV

fenoprofen calcium oral tablet 600 mg PV

fenortho oral capsule 200 mg PV

FLECTOR EXTERNAL PATCH 13 (diclofenac epolamine) PV

FLEXIPAK COMBINATION THERAPY PACK 75 amp 0025 MG- 3

flurbiprofen oral tablet 100 mg 50 mg PV

goodsense ibuprofen oral capsule 200 mg PV


1

IBUPAK ORAL KIT 600 MG (ibuprofen) PV

ibuprofen infants oral suspension 50 mg125ml PV

ibuprofen oral capsule 200 mg PV

ibuprofen oral suspension 100 mg5ml PV

ibuprofen oral tablet 200 mg PV

ibuprofen (Ibuprofen Oral Tablet 400 Mg 600 Mg 800 Mg) PV

inavix combination therapy pack 75 amp 0025 mg- 1

INDOCIN ORAL SUSPENSION 25 MG5ML (indomethacin) PV

INDOCIN RECTAL SUPPOSITORY 50 MG (indomethacin) PV

indomethacin er oral capsule extended release 75 mg PV

INDOMETHACIN ORAL CAPSULE 20 MG PV

indomethacin oral capsule 25 mg 50 mg PV


150


diclofenac sodium-capsaicin (Inflammacin Combination Therapy Pack 75 amp 0025 Mg-)

3

INFLATHERM COMBINATION THERAPY PACK 75 amp 3-3 MG amp (diclofenac-menthol-camphor)

3

kapzin dc combination therapy pack 0025-15 1

ketoprofen er oral capsule extended release 24 hour 200 mg PV

ketoprofen oral capsule 25 mg 50 mg 75 mg PV

ketorolac tromethamine injection solution 15 mgml PV

ketorolac tromethamine intramuscular solution 60 mg2ml PV

KETOROLAC TROMETHAMINE NASAL SOLUTION 1575 MGSPRAY

PV

ketorolac tromethamine oral tablet 10 mg PV

ketorolac tromethamine solution 30 mgml injection 30 mgml PV

KETOROLAC TROMETHAMINE SOLUTION 30 MGML INJECTION 30 MGML

PV

LICART EXTERNAL PATCH 24 HOUR 13 (diclofenac epolamine)

PV

LODINE ORAL TABLET 400 MG (etodolac) PV

meclofenamate sodium oral capsule 100 mg 50 mg PV

mefenamic acid oral capsule 250 mg PV

meloxicam oral capsule 10 mg 5 mg PV

meloxicam oral tablet 15 mg 75 mg PV

MOBIC ORAL TABLET 15 MG 75 MG (meloxicam) PV

MOTRIN IB ORAL CAPSULE 200 MG (ibuprofen) PV

MOTRIN INFANTS DROPS ORAL SUSPENSION 50 MG125ML (ibuprofen)

PV

nabumetone oral tablet 500 mg 750 mg PV

NALFON ORAL CAPSULE 400 MG (fenoprofen calcium) PV

NALFON ORAL TABLET 600 MG (fenoprofen calcium) PV

NAPRELAN ORAL TABLET EXTENDED RELEASE 24 HOUR 375 MG 500 MG 750 MG (naproxen sodium)

PV

NAPROSYN ORAL SUSPENSION 125 MG5ML (naproxen) PV

NAPROSYN ORAL TABLET 500 MG (naproxen) PV

naproxen oral suspension 125 mg5ml PV

naproxen oral tablet 250 mg 375 mg 500 mg PV

naproxen oral tablet delayed release 375 mg 500 mg PV

naproxen sodium er oral tablet extended release 24 hour 375 mg 500 mg

PV


151


NAPROXEN SODIUM ER ORAL TABLET EXTENDED RELEASE 24 HOUR 750 MG

PV

naproxen sodium oral tablet 220 mg 275 mg 550 mg PV

naproxen-esomeprazole oral tablet delayed release 375-20 mg 500-20 mg

1

diclofenac sodium-capsaicin (Nudiclo Solupak Combination Therapy Pack 15 amp 0025 )

3

diclofenac sodium-capsaicin (Nudiclo Tabpak Combination Therapy Pack 75 amp 0025 Mg-)

3

NUDROXIPAK DSDR-50 COMBINATION KIT 50 MG (diclofenac sodium-liniment)

PV


PV

NUDROXIPAK E-400 COMBINATION KIT 400 MG (etodolac-liniment)

PV

NUDROXIPAK I-800 COMBINATION KIT 800 MG (ibuprofen-liniment)

PV

NUDROXIPAK N-500 COMBINATION KIT 500 MG (nabumetone-liniment)

PV

oxaprozin oral tablet 600 mg PV

PENNSAID EXTERNAL SOLUTION 2 (diclofenac sodium) PV

piroxicam oral capsule 10 mg 20 mg PV

previdolrx plus analgesic combination therapy pack 75 amp 0025 mg-

1

QMIIZ ODT ORAL TABLET DISPERSIBLE 15 MG 75 MG (meloxicam)

PV

RELAFEN DS ORAL TABLET 1000 MG (nabumetone) PV DSL = 30 days

nabumetone (Relafen Oral Tablet 500 Mg 750 Mg) PV

ROAOXIA EXTERNAL GEL 3-4 3

SPRIX NASAL SOLUTION 1575 MGSPRAY (ketorolac tromethamine)

PV

sulindac oral tablet 150 mg 200 mg PV

sumatriptan-naproxen sodium oral tablet 85-500 mg 1

sure result dss premium pack combination therapy pack 15 amp 0025

1

TIVORBEX ORAL CAPSULE 20 MG (indomethacin) PV

tolmetin sodium oral capsule 400 mg PV

tolmetin sodium oral tablet 600 mg PV

TORONOVA II SUIK COMBINATION KIT 30 MGML (ketorolac trometh amp anesthetic)

3


152


TORONOVA SUIK COMBINATION KIT 30 MGML (ketorolac trometh amp anesthetic)

3

VAROPHEN EXTERNAL KIT 15-10-15 (diclofenacamp menthol-methyl sal)

3

VENNGEL ONE EXTERNAL KIT 1 (diclofenac sodium) PV

VIVLODEX ORAL CAPSULE 10 MG 5 MG (meloxicam) PV

VOLTAREN EXTERNAL GEL 1 (diclofenac sodium) PV

XRYLIX EXTERNAL THERAPY PACK 15 (diclofenac sod-adhesive sheet)

3

ZIPSOR ORAL CAPSULE 25 MG (diclofenac potassium) PV

ZORVOLEX ORAL CAPSULE 18 MG 35 MG (diclofenac) PV

PHENOTHIAZINES - Drugs for Depression amp Psychosis

chlorpromazine hcl injection solution 25 mgml 50 mg2ml PV

chlorpromazine hcl oral tablet 10 mg 100 mg 200 mg 25 mg 50 mg

PV

prochlorperazine (Compro Rectal Suppository 25 Mg) PV

fluphenazine decanoate injection solution 25 mgml PV

fluphenazine hcl injection solution 25 mgml PV

fluphenazine hcl oral concentrate 5 mgml PV

fluphenazine hcl oral elixir 25 mg5ml PV

fluphenazine hcl oral tablet 1 mg 10 mg 25 mg 5 mg PV

perphenazine oral tablet 16 mg 2 mg 4 mg 8 mg PV

perphenazine-amitriptyline oral tablet 2-10 mg 2-25 mg 4-10 mg 4-25 mg 4-50 mg

PV

prochlorperazine maleate oral tablet 10 mg 5 mg PV

prochlorperazine rectal suppository 25 mg PV

thioridazine hcl oral tablet 10 mg 100 mg 25 mg 50 mg PV

trifluoperazine hcl oral tablet 1 mg 10 mg 2 mg 5 mg PV

RESPIRATORY AND CNS STIMULANTS - Drugs for the Nervous System

ADHANSIA XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 25 MG 35 MG 45 MG 55 MG 70 MG 85 MG (methylphenidate hcl)

3




1



153



1


1





caffeine citrate oral solution 20 mgml 60 mg3ml 1

CONCERTA ORAL TABLET EXTENDED RELEASE 18 MG 27 MG 36 MG 54 MG (methylphenidate hcl)

3

COTEMPLA XR-ODT ORAL TABLET EXTENDED RELEASE DISPERSIBLE 173 MG 259 MG 86 MG (methylphenidate)

3 DSL = 30 days

DAYTRANA TRANSDERMAL PATCH 10 MG9HR 15 MG9HR 20 MG9HR 30 MG9HR (methylphenidate)

3

dexmethylphenidate hcl er oral capsule extended release 24 hour 10 mg 15 mg 20 mg 25 mg 30 mg 35 mg 40 mg 5 mg

1

dexmethylphenidate hcl oral tablet 10 mg 25 mg 5 mg 1

JORNAY PM ORAL CAPSULE EXTENDED RELEASE 24 HOUR 100 MG 20 MG 40 MG 60 MG 80 MG (methylphenidate hcl)

3

methylphenidate hcl er (cd) oral capsule extended release 10 mg 20 mg 30 mg 40 mg 50 mg 60 mg

1

methylphenidate hcl er (la) oral capsule extended release 24 hour 10 mg 20 mg 30 mg 40 mg 60 mg

1

methylphenidate hcl er (xr) oral capsule extended release 24 hour 10 mg 15 mg 20 mg 30 mg 40 mg 50 mg 60 mg

1

methylphenidate hcl er oral tablet extended release 10 mg 18 mg 20 mg 27 mg 36 mg 54 mg 72 mg

1

methylphenidate hcl er oral tablet extended release 24 hour 18 mg 27 mg 36 mg 54 mg

1

methylphenidate hcl oral solution 10 mg5ml 5 mg5ml 1

methylphenidate hcl oral tablet 10 mg 20 mg 5 mg 1

methylphenidate hcl oral tablet chewable 10 mg 25 mg 5 mg 1

QUILLICHEW ER ORAL TABLET CHEWABLE EXTENDED RELEASE 20 MG 30 MG 40 MG (methylphenidate hcl)

3

QUILLIVANT XR ORAL SUSPENSION RECONSTITUTED ER 25 MG5ML (methylphenidate hcl)

3

relexxii oral tablet extended release 72 mg 1


3


154


SALICYLATES - Drugs for Pain



1











1


3


PV



PV






3


methyl salicylate external liquid 1




3


salsalate oral tablet 500 mg 750 mg 1


PV



155


WPR PLUS WOUND HEALING SYSTEM EXTERNAL THERAPY PACK 4 amp 10-30

3


3

SELSEROTONINNOREPI REUPTAKE INHIBITOR - Drugs for Depression amp Psychosis


PV

DESVENLAFAXINE ER ORAL TABLET EXTENDED RELEASE 24 HOUR 100 MG 50 MG

PV

desvenlafaxine succinate er oral tablet extended release 24 hour 100 mg 25 mg 50 mg

PV


3


PV

EFFEXOR XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 150 MG 375 MG 75 MG (venlafaxine hcl)

PV

FETZIMA ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG 20 MG 40 MG 80 MG (levomilnacipran hcl)

PV

FETZIMA TITRATION ORAL CAPSULE ER 24 HOUR THERAPY PACK 20 amp 40 MG (levomilnacipran hcl)

PV

PRISTIQ ORAL TABLET EXTENDED RELEASE 24 HOUR 100 MG 25 MG 50 MG (desvenlafaxine succinate)

PV


3


3

venlafaxine hcl er oral capsule extended release 24 hour 150 mg 375 mg 75 mg

PV

venlafaxine hcl er oral tablet extended release 24 hour 150 mg 225 mg 375 mg 75 mg

PV

venlafaxine hcl oral tablet 100 mg 25 mg 375 mg 50 mg 75 mg

PV

SELECTIVE SEROTONIN AGONISTS - Migraine Treatment

almotriptan malate oral tablet 125 mg 625 mg 1

eletriptan hydrobromide oral tablet 20 mg 40 mg 1

frovatriptan succinate oral tablet 25 mg 1

IMITREX NASAL SOLUTION 20 MGACT 5 MGACT (sumatriptan)

3


156


IMITREX ORAL TABLET 100 MG 25 MG 50 MG (sumatriptan succinate)

3

MIGRANOW COMBINATION THERAPY PACK 50 amp 4-10 MG amp (sumatriptan amp camphor-menthol)

3

naratriptan hcl oral tablet 1 mg 25 mg 1

ONZETRA XSAIL NASAL EXHALER POWDER 11 MGNOSEPC (sumatriptan succinate)

3

REYVOW ORAL TABLET 100 MG 50 MG (lasmiditan succinate)

3 DSL = 30 days

rizatriptan benzoate oral tablet 10 mg 5 mg 1

rizatriptan benzoate oral tablet dispersible 10 mg 5 mg 1

sumatriptan nasal solution 20 mgact 5 mgact 1

sumatriptan succinate oral tablet 100 mg 25 mg 50 mg 1

sumatriptan succinate refill subcutaneous solution cartridge 4 mg05ml 6 mg05ml

1

sumatriptan succinate subcutaneous solution 6 mg05ml 1

sumatriptan succinate subcutaneous solution auto-injector 4 mg05ml 6 mg05ml

1

sumatriptan succinate subcutaneous solution prefilled syringe 6 mg05ml

1


TOSYMRA NASAL SOLUTION 10 MGACT (sumatriptan) 3 DSL = 30 days

ZEMBRACE SYMTOUCH SUBCUTANEOUS SOLUTION AUTO-INJECTOR 3 MG05ML (sumatriptan succinate)

3

ZOLMITRIPTAN NASAL SOLUTION 25 MG 5 MG 3

zolmitriptan oral tablet 25 mg 5 mg 1

zolmitriptan oral tablet dispersible 25 mg 5 mg 1

ZOMIG NASAL SOLUTION 25 MG 5 MG (zolmitriptan) 3

SELECTIVE-SEROTONIN REUPTAKE INHIBITORS - Drugs for Depression amp Psychosis

CELEXA ORAL TABLET 10 MG 20 MG 40 MG (citalopram hydrobromide)

PV

citalopram hydrobromide oral solution 10 mg5ml PV

citalopram hydrobromide oral tablet 10 mg 20 mg 40 mg PV

escitalopram oxalate oral solution 5 mg5ml PV

escitalopram oxalate oral tablet 10 mg 20 mg 5 mg PV

fluoxetine hcl (pmdd) oral tablet 10 mg 20 mg PV

fluoxetine hcl oral capsule 10 mg 20 mg 40 mg PV

fluoxetine hcl oral capsule delayed release 90 mg PV


157


fluoxetine hcl oral solution 20 mg5ml PV

fluoxetine hcl oral tablet 10 mg 20 mg 60 mg PV

fluvoxamine maleate er oral capsule extended release 24 hour100 mg 150 mg

PV

fluvoxamine maleate oral tablet 100 mg 25 mg 50 mg PV

LEXAPRO ORAL TABLET 10 MG 20 MG 5 MG (escitalopram oxalate)

PV


PV

paroxetine hcl er oral tablet extended release 24 hour 125 mg 25 mg 375 mg

PV

paroxetine hcl oral tablet 10 mg 20 mg 30 mg 40 mg PV

paroxetine mesylate oral capsule 75 mg 1

PAXIL CR ORAL TABLET EXTENDED RELEASE 24 HOUR 125 MG 25 MG 375 MG (paroxetine hcl)

PV

PAXIL ORAL SUSPENSION 10 MG5ML (paroxetine hcl) PV

PAXIL ORAL TABLET 10 MG 20 MG 30 MG 40 MG (paroxetine hcl)

PV

PEXEVA ORAL TABLET 10 MG 20 MG 30 MG 40 MG (paroxetine mesylate)

PV

PROZAC ORAL CAPSULE 10 MG 20 MG 40 MG (fluoxetine hcl)

PV

sertraline hcl oral concentrate 20 mgml PV

sertraline hcl oral tablet 100 mg 25 mg 50 mg PV


PV

ZOLOFT ORAL CONCENTRATE 20 MGML (sertraline hcl) PV

ZOLOFT ORAL TABLET 100 MG 25 MG 50 MG (sertraline hcl)

PV

SEROTONIN MODULATORS - Drugs for Depression amp Psychosis

nefazodone hcl oral tablet 100 mg 150 mg 200 mg 250 mg 50 mg

PV

trazodone hcl oral tablet 100 mg 150 mg 300 mg 50 mg PV

TRINTELLIX ORAL TABLET 10 MG 20 MG 5 MG (vortioxetine hbr)

PV

VIIBRYD ORAL TABLET 10 MG 20 MG 40 MG (vilazodone hcl)

PV

VIIBRYD STARTER PACK ORAL KIT 10 amp 20 MG (vilazodone hcl)

PV


158


SUCCINIMIDES - Drugs for Seizures

CELONTIN ORAL CAPSULE 300 MG (methsuximide) 2

ethosuximide oral capsule 250 mg 1

ethosuximide oral solution 250 mg5ml 1

THIOXANTHENES - Drugs for Depression amp Psychosis

thiothixene oral capsule 1 mg 10 mg 2 mg 5 mg PV

TRICYCLICS OTHER NOREPI-RU INHIBITORS - Drugs for Depression amp Psychosis

amitriptyline hcl oral tablet 10 mg 100 mg 150 mg 25 mg 50 mg 75 mg

PV

amoxapine oral tablet 100 mg 150 mg 25 mg 50 mg PV

ANAFRANIL ORAL CAPSULE 25 MG 50 MG 75 MG (clomipramine hcl)

PV


clomipramine hcl oral capsule 25 mg 50 mg 75 mg PV

desipramine hcl oral tablet 10 mg 100 mg 150 mg 25 mg 50 mg 75 mg

PV

doxepin hcl oral capsule 10 mg 100 mg 150 mg 25 mg 50 mg 75 mg

PV

doxepin hcl oral concentrate 10 mgml PV

doxepin hcl oral tablet 3 mg 6 mg 1

enovarx-amitriptyline external kit 2 PV

imipramine hcl oral tablet 10 mg 25 mg 50 mg PV

imipramine pamoate oral capsule 100 mg 125 mg 150 mg 75 mg

PV

maprotiline hcl oral tablet 25 mg 50 mg 75 mg PV

NORPRAMIN ORAL TABLET 10 MG 25 MG (desipramine hcl) PV

nortriptyline hcl oral capsule 10 mg 25 mg 50 mg 75 mg PV

nortriptyline hcl oral solution 10 mg5ml PV

PAMELOR ORAL CAPSULE 10 MG 25 MG 50 MG 75 MG (nortriptyline hcl)

PV


PV

protriptyline hcl oral tablet 10 mg 5 mg PV

trimipramine maleate oral capsule 100 mg 25 mg 50 mg PV

VESICULAR MONOAMINE TRANSPORT2 INHIBITOR - Drugs for the Nervous System


3 DSL = 30 days


159



3 DSL = 30 days

INGREZZA ORAL CAPSULE THERAPY PACK 40 amp 80 MG (valbenazine tosylate)

3 DSL = 30 days


WAKEFULNESS-PROMOTING AGENTS - Drugs for the Nervous System

armodafinil oral tablet 150 mg 200 mg 250 mg 50 mg 1

modafinil oral tablet 100 mg 200 mg 1

SUNOSI ORAL TABLET 150 MG 75 MG (solriamfetol hcl) 3

WAKIX ORAL TABLET 178 MG 445 MG (pitolisant hcl) 3 DSL = 30 days

DEVICES - Medical Supplies and Durable Medical Equipment


ACCUCAINE COMBINATION KIT 1 (lido-pentaf-tetrafl-ultrasound)

3

ACCU-CHEK AVIVA IN VITRO SOLUTION (blood glucose calibration)

2

ACCU-CHEK COMPACT PLUS CONTROL IN VITRO SOLUTION (blood glucose calibration)

2

ACCU-CHEK FASTCLIX LANCET KIT KIT (lancets misc) 2

ACCU-CHEK GUIDE CONTROL IN VITRO LIQUID (blood glucose calibration)

2

ACCU-CHEK GUIDE KIT WDEVICE (blood glucose monitoring suppl)

2

ACCU-CHEK SMARTVIEW CONTROL IN VITRO LIQUID (blood glucose calibration)

2

ACCU-CHEK SOFTCLIX LANCET DEVICE KIT KIT (lancets misc)

2

ACCU-CHEK TENDER 1 INFUSION KIT (iv sets-tubing) 3

ACCU-CHEK ULTRAFLEX INF SET (insulin infusion pump supplies)

3

ASTERO EXTERNAL GEL 4 (lidocaine hcl) 3

ATOPADERM EXTERNAL CREAM 3

ATOPICLAIR EXTERNAL CREAM (dermatological products misc)

3

AUTOLET LANCING DEVICE (lancet devices) PV

AUTOSOFT 30 INFUSION SET (insulin infusion pump supplies) 3



160


AUTOSOFT XC INFUSION SET (insulin infusion pump supplies)

3

BEAU RX EXTERNAL GEL 3

BETALOAN SUIK COMBINATION KIT 30 MG5ML (betameth sod phos-ace amp anesth)

3

CADIRAMD EXTERNAL KIT 25-25 (lido-prilocaine-blood collect)

3

CARETOUCH LANCINGEJECTOR (lancet devices) PV

CEQUR SIMPLICITY 2U DEVICE (injection device for insulin) PV

CONTOUR CONTROL IN VITRO LIQUID HIGH LOW NORMAL (blood glucose calibration)

2

CONTOUR MONITOR DEVICE DEVICE (blood glucose monitoring suppl)

2

CONTOUR MONITOR KIT WDEVICE KIT WDEVICE (blood glucose monitoring suppl)

2

CONTOUR NEXT CONTROL IN VITRO SOLUTION LOW NORMAL (blood glucose calibration)

2

CONTOUR NEXT EZ KIT WDEVICE (blood glucose monitoring suppl)

2

CONTOUR NEXT LINK KIT WDEVICE (blood glucose monitoring suppl)

2

CONTOUR NEXT MONITOR KIT WDEVICE (blood glucose monitoring suppl)

2

DEXCOM G4 G5 G6 RECEIVER TRANSMITTER SENSOR (INCLUDING PLATINUM PLATINUM PEDIATRIC) (continuous blood gluc transmit)

3

DEXCOM G4 G5 G6 RECEIVER TRANSMITTER SENSOR (INCLUDING PLATINUM PLATINUM PEDIATRIC) DEVICE (continuous blood gluc receiver)

3

DMT SUIK COMBINATION KIT 10 MGML (dexameth sod phos amp anesthetic)

3

DUROLANE INTRA-ARTICULAR PREFILLED SYRINGE 60 MG3ML (sodium hyaluronate (viscosup))

3

EASIVENT (spaceraero-holding chambers) 2

EASYMAX CONTROL IN VITRO SOLUTION NORMAL (blood glucose calibration)

2

ELETONE EXTERNAL CREAM (dermatological products misc)

3

EMULSION SB EXTERNAL EMULSION (dermatological products misc)

3

ENLITE GLUCOSE SENSOR (continuous blood gluc sensor) 3


161


ENTTY SPRAY EXTERNAL EMULSION (dermatological products misc)

3

EPICERAM EXTERNAL EMULSION (dermatological products misc)

3

EPISIL MOUTHTHROAT LIQUID (oral wound care products) 3

EUFLEXXA INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE 20 MG2ML (sodium hyaluronate (viscosup))

3

FLEXICHAMBER ADULT MASKSMALL (spaceraero-hold chamber mask)

3

FLEXICHAMBER CHILD MASKLARGE (spaceraero-hold chamber mask)

3

FLEXICHAMBER CHILD MASKSMALL (spaceraero-hold chamber mask)

3

FORTISCARE CONTROL IN VITRO SOLUTION HIGH LOW NORMAL (blood glucose calibration)

2

FREESTYLE LIBRE 14 DAY READER DEVICE (continuous blood gluc receiver)

3

FREESTYLE LIBRE 14 DAY SENSOR (continuous blood gluc sensor)

3

FREESTYLE LIBRE 2 READER DEVICE (continuous blood gluc receiver)

3

FREESTYLE LIBRE 2 SENSOR (continuous blood gluc sensor) 3

FREESTYLE LIBRE READER DEVICE (continuous blood gluc receiver)

3

FREESTYLE LIBRE SENSOR SYSTEM (continuous blood gluc sensor)

3

GEBAUERS PAIN EASE EXTERNAL AEROSOL (pentafluoroprop-tetrafluoroeth)

3

GEBAUERS SPRAY AND STRETCH EXTERNAL AEROSOL (pentafluoroprop-tetrafluoroeth)

3

GELCLAIR MOUTHTHROAT GEL (povidone-nahyaluron-glycyrrhet)

3

GEL-FLOW EXTERNAL KIT (gelatin absorb-thrombin) 3

GEL-FLOW NT EXTERNAL PREFILLED SYRINGE (gelatin absorbable)

3

GELFOAM COMPRESSED SIZE 100 EXTERNAL (gelatin absorbable)

3

GELFOAM DENTAL PACK SIZE 4 EXTERNAL (gelatin absorbable)

3


GELFOAM SPONGE EXTERNAL 12-7 MM (gelatin absorbable) 2


162


GELFOAM SPONGE SIZE 100 EXTERNAL (gelatin absorbable)

2


3

GELFOAM SPONGE SIZE 50 EXTERNAL (gelatin absorbable) 2

GELFOAM-JMI POWDER EXTERNAL KIT (gelatin absorb-thrombin)

3

GELFOAM-JMI SPONGE EXTERNAL KIT (gelatin absorb-thrombin)

3

GELSYN-3 INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE 168 MG2ML (sodium hyaluronate (viscosup))

3

GELX MOUTHTHROAT GEL (oral wound care products) 3

GENADUR COMBINATION KIT (dermatological products misc)

3

GENADUR EXTERNAL LIQUID (dermatological products misc)

3

GUARDIAN SENSOR (3) (continuous blood gluc sensor) 3


1



HPR PLUS EXTERNAL CREAM (dermatological products misc)

3

hpr plus external foam 1

HPR PLUS HYDROGEL EXTERNAL KIT (dermatological products misc)

3

HUMATROPEN FOR 12MG DEVICE (injection device) PV



HYALGAN INTRA-ARTICULAR SOLUTION 20 MG2ML (sodium hyaluronate (viscosup))

3

HYALGAN INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE 20 MG2ML (sodium hyaluronate (viscosup))

3

HYLATOPIC PLUS EXTERNAL CREAM (dermatological products misc)

3

HYLATOPIC PLUS EXTERNAL LOTION (dermatological products misc)

3

HYMOVIS INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE 24 MG3ML (hyaluronan)

3

HYPERSAL INHALATION NEBULIZATION SOLUTION 35 7 (sodium chloride)

3


163


HYPOCYN EXTERNAL SOLUTION (eyelid cleansers) 3

INSPIREASE RESERVOIR BAGS (spaceraero-hold chamber bags)

2

INSULIN PEN NEEDLES 29G X 127MM 29G X 5MM 29G X 8MM 31G X 5 MM 32G X 4 MM 33G X 4 MM (insulin pen needle)

PV

INSULIN PEN NEEDLES 29G X 12MM 31G X 6 MM 31G X 8 MM

PV

INSULIN SYRINGES 28G X 12 05 ML 28G X 12 1 ML 29G X 12 03 ML 29G X 12 05 ML 29G X 12 1 ML 30G X 12 03 ML 30G X 12 05 ML 30G X 12 1 ML 30G X 516 03 ML 30G X 516 05 ML 30G X 516 1 ML 31G X 1564 03 ML 31G X 1564 05 ML 31G X 516 03 ML 31G X 516 05 ML 31G X 516 1 ML (insulin syringe-needle u-100)

PV

KAMDOY EXTERNAL EMULSION (dermatological products misc)

3

KELARX EXTERNAL GEL (scar treatment products) 3

KIVIK EXTERNAL EMULSION (dermatological products misc) 3

LDO PLUS EXTERNAL GEL 4 (lidocaine hcl) 3

lidocaine-prilocaine (Lido Bdk External Kit 25-25 ) 3

MARVONA SUIK COMBINATION KIT 05 (bupivacaine hcl amp anesthetic)

3

MAXICOMFORT SYR 27G X 12 27G X 12 05 ML 27G X 12 1 ML (insulin syringe-needle u-100)

PV

MEDROLOAN II SUIK COMBINATION KIT 40 MGML (methylprednisolone amp anesth)

3

MEDROLOAN SUIK COMBINATION KIT 40 MGML (methylprednisolone amp anesth)

3

MICROLET NEXT LANCING DEVICE (lancet devices) PV

MIMYX EXTERNAL CREAM (dermatological products misc) 3

MINIMED PUMP RESERVOIR 3ML (insulin infusion pump supplies)

3

MONOVISC INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE 88 MG4ML (hyaluronan)

3

MUCOSITISRX MOUTHTHROAT PACKET (artificial saliva) 3

MUGARD MOUTHTHROAT LIQUID (oral wound care products)

3

NEOSALUS EXTERNAL CREAM (dermatological products misc)

3

NEOSALUS EXTERNAL FOAM (dermatological products misc)

3


164


NEOSALUS EXTERNAL LOTION (dermatological products misc)

3

NORDIPEN 5 INJECTION DEVICE (injection device) PV

NOVOFINE AUTOCOVER PEN NEEDLE 30G X 8 MM (insulin pen needle)

PV

NOVOFINE PEN NEEDLE 32G X 6 MM (insulin pen needle) PV

NOVOFINE PLUS PEN NEEDLE 32G X 4 MM (insulin pen needle)

PV

NOVOPEN ECHO DEVICE (injection device for insulin) PV

NOVOTWIST PEN NEEDLE 32G X 5 MM (insulin pen needle) PV

NUVAIL EXTERNAL SOLUTION (dermatological products misc)

3

ONETOUCH DELICA LANCING DEV (lancet devices) PV

ONETOUCH DELICA PLUS LANCING (lancet devices) PV

ONETOUCH ULTRA 2 KIT WDEVICE (blood glucose monitoring suppl)

2

ONETOUCH ULTRA MINI KIT WDEVICE (blood glucose monitoring suppl)

2

ONETOUCH VERIO FLEX SYSTEM KIT WDEVICE KIT WDEVICE (blood glucose monitoring suppl)

2

ONETOUCH VERIO IN VITRO SOLUTION HIGH (blood glucose calibration)

2

ONETOUCH VERIO IQ SYSTEM KIT WDEVICE (blood glucose monitoring suppl)

2

ONETOUCH VERIO KIT WDEVICE (blood glucose monitoring suppl)

2

ONETOUCH VERIO REFLECT KIT WDEVICE (blood glucose monitoring suppl)

2

ONETOUCH VERIO SYNC SYSTEM KIT WDEVICE KIT WDEVICE (blood glucose monitoring suppl)

2

ORAMAGICRX MOUTHTHROAT SUSPENSION RECONSTITUTED (oral wound care products)

3

ORTHOVISC INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE 30 MG2ML (hyaluronan)

3

PARI ALTERA NEBULIZER HANDSET (respiratory therapy supplies)

2

PARI TREK S COMBO PACK DEVICE (respiratory therapy supplies)

3

P-CARE K40G COMBINATION KIT 40 MGML 3



165


PENLEN EXTERNAL EMULSION (dermatological products misc)

3

PHLAG SPRAY EXTERNAL EMULSION (dermatological products misc)

3

PR CREAM EXTERNAL KIT (dermatological products misc) 3

PRECISION XTRA DEVICE (blood glucose monitoring suppl) 2

PRESERA EXTERNAL FOAM (dermatological products misc) 3

PROMISEB EXTERNAL CREAM (antiseborrheic products misc)

3

PROSILK EXTERNAL GEL (silicone) 3

PRUCLAIR EXTERNAL CREAM (dermatological products misc)

3

PRUMYX EXTERNAL CREAM (dermatological products misc) 3

RECEDO EXTERNAL GEL (scar treatment products) 3

SALICEPT MOUTHTHROAT SUSPENSION RECONSTITUTED (oral wound care products)

3

SALIVAMAX MOUTHTHROAT PACKET (artificial saliva) 3

SCARCIN EXTERNAL GEL 3

SCARCIN EXTERNAL LIQUID 3

SCARSILK EXTERNAL GEL 3

SHARPS CONTAINER 3

SILIPAC EXTERNAL KIT 3

sodium chloride inhalation nebulization solution 09 10 3 7

1

SUPARTZ FX INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE 25 MG25ML (sodium hyaluronate (viscosup))

2

SURESTEP PRO HIGH GLUCOSE IN VITRO LIQUID (blood glucose calibration)

2

SURESTEP PRO LOW GLUCOSE IN VITRO LIQUID (blood glucose calibration)

2

SURESTEP PRO NORMAL GLUCOSE IN VITRO LIQUID (blood glucose calibration)

2

SUVICORT EXTERNAL EMULSION 3

SYNERDERM EXTERNAL EMULSION (dermatological products misc)

3

SYNVISC INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE 16 MG2ML (hylan)

3

SYNVISC ONE INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE 48 MG6ML (hylan)

3


166


THROMBI-GEL 10 EXTERNAL PAD (thrombin-cmc-cacl-gelatin)

3


3


3

THROMBI-PAD EXTERNAL PAD 3X3 (thrombin-cmc-cacl) 3


3


3

TRILOAN II SUIK COMBINATION KIT 40 MGML (triamcinolone acet amp anesth)

3

TRILOAN SUIK COMBINATION KIT 40 MGML (triamcinolone acet amp anesth)

3

TRILURON INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE 20 MG2ML (sodium hyaluronate (viscosup))

3

TRUE METRIX LEVEL 1 IN VITRO SOLUTION LOW (blood glucose calibration)

2

TRUE METRIX LEVEL 2 IN VITRO SOLUTION NORMAL (blood glucose calibration)

2

TRUE METRIX LEVEL 3 IN VITRO SOLUTION HIGH (blood glucose calibration)

2

TRUSTEEL INFUSION SET (insulin infusion pump supplies) 3

UNISTRIP CONTROL IN VITRO SOLUTION LOW (blood glucose calibration)

2

VARISOFT INFUSION SET (insulin infusion pump supplies) 3

XEROSTOMIA RELIEF SPRAY MOUTHTHROAT SOLUTION (artificial saliva)

3

DIAGNOSTIC AGENTS

ADRENOCORTICAL INSUFFICIENCY

ACTHAR INJECTION GEL 80 UNITML (corticotropin) 2 DSL = 30 days

CORTROSYN INJECTION SOLUTION RECONSTITUTED 025 MG (cosyntropin)

2

cosyntropin injection solution reconstituted 025 mg 1

ALLERGENIC EXTRACTS (DIAGNOSTIC)






167







3





3


3





3


3


3




3


3







3


3


3


168



3



3





3


3



3




3




3


3


3




3




3




3


169



3


3




3




3





3




3





3



3


3


3


3




3



170






3


3

DIABETES MELLITUS

ACCU-CHEK AVIVA PLUS IN VITRO STRIP (glucose blood) PV

ACCU-CHEK COMPACT PLUS TEST STRIPS IN VITRO STRIP (glucose blood)

PV

ACCU-CHEK GUIDE IN VITRO STRIP (glucose blood) PV

ACCU-CHEK SMARTVIEW TEST STRIPS IN VITRO STRIP (glucose blood)

PV

CARETOUCH TEST IN VITRO STRIP (glucose blood) PV

CONTOUR NEXT TEST IN VITRO STRIP (glucose blood) PV

CONTOUR TEST IN VITRO STRIP (glucose blood) PV

FREESTYLE PRECISION NEO TEST IN VITRO STRIP (glucose blood)

PV

MICRODOT TEST IN VITRO STRIP (glucose blood) PV

ONETOUCH ULTRA IN VITRO STRIP (glucose blood) PV

ONETOUCH VERIO IN VITRO STRIP (glucose blood) PV

PRECISION PCX PLUS TEST IN VITRO STRIP (glucose blood)

PV

PRECISION QID TEST IN VITRO STRIP (glucose blood) PV

PRECISION SOF-TACT TEST IN VITRO STRIP (glucose blood)

PV

PRECISION XTRA BLOOD GLUCOSE IN VITRO STRIP (glucose blood)

PV

RELION BLOOD GLUCOSE TEST IN VITRO STRIP (glucose blood)

PV

TRUE METRIX BLOOD GLUCOSE TEST IN VITRO STRIP (glucose blood)

PV

TRUE METRIX PRO BLOOD GLUCOSE IN VITRO STRIP (glucose blood)

PV

TRUETRACK TEST IN VITRO STRIP (glucose blood) PV

DIAGNOSTIC AGENTS

GLEOLAN ORAL SOLUTION RECONSTITUTED 15 GM (aminolevulinic acid hcl)

3


171


KETONES

KETONE TEST IN VITRO STRIP 2

KETOSTIX IN VITRO STRIP (acetone (urine) test) 2

MYASTHENIA GRAVIS


3

OCULAR DISORDERS

ALTAFLUOR BENOX OPHTHALMIC SOLUTION 025-04 3

fluorescein sodium (Bio Glo Ophthalmic Strip 1 Mg) 3

fluorescein-proparacaine (Flucaine Ophthalmic Solution 025-05 )

3

FLUORESCEIN SODIUMBENOXINATE OPHTHALMIC SOLUTION 03-04

3

fluorescein-benoxinate ophthalmic solution 025-04 1

fluorescein sodium (Fluor-I-Strips AT Ophthalmic Strip 1 Mg) 1

FLURA-SAFE OPHTHALMIC SOLUTION 035-04 (fluorexon-benoxinate)

3

FUL-GLO OPHTHALMIC STRIP 06 MG (fluorescein sodium) 3

fluorescein sodium (Ful-Glo Ophthalmic Strip 1 Mg) 3

fluorescein sodium (Glostrips Ophthalmic Strip 1 Mg) 3

GREEN GLO LISSAMINE GREEN OPHTHALMIC STRIP 15 MG (lissamine green)

3

proparacaine-fluorescein ophthalmic solution 05-025 1

VISIONBLUE OPHTHALMIC SOLUTION 006 (trypan blue) 3

PITUITARY FUNCTION

MACRILEN ORAL PACKET 60 MG (macimorelin acetate) 3

METOPIRONE ORAL CAPSULE 250 MG (metyrapone) 2

RESPIRATORY FUNCTION

ARIDOL INHALATION KIT 0 amp 5 amp 10 amp 20 amp 40 MG (mannitol) 3

METHACHOLINE CHLORIDE INHALATION KIT 3

ROENTGENOGRAPHY AND OTHER IMAGING AGENTS


3

THYROID FUNCTION

THYROGEN INTRAMUSCULAR SOLUTION RECONSTITUTED 11 MG (thyrotropin alfa)

2


172


DISINFECTANTS (FOR NON-DERMATOLOGIC USE) - Disinfectants


GLUTARALDEHYDE EXTERNAL SOLUTION 25 3

ELECTROLYTIC CALORIC AND WATER BALANCE

ACIDIFYING AGENTS

K-PHOS NO 2 ORAL TABLET 305-700 MG (pot amp sod ac phosphates)

PV

K-PHOS ORAL TABLET 500 MG (potassium phosphate monobasic)

PV

K-PHOS-NEUTRAL ORAL TABLET 155-852-130 MG (k phos mono-sod phos di amp mono)

PV

k phos mono-sod phos di amp mono (Phospha 250 Neutral Oral Tablet 155-852-130 Mg)

PV

phosphorous oral tablet 155-852-130 mg PV

k phos mono-sod phos di amp mono (Phospho-Trin 250 Neutral Oral Tablet 155-852-130 Mg)

PV

virt-phos 250 neutral oral tablet 155-852-130 mg PV

ALKALINIZING AGENTS


3

cytra k crystals oral packet 3300-1002 mg 1

ORACIT ORAL SOLUTION 490-640 MG5ML (sod citrate-citric acid)

3

potassium citrate er oral tablet extended release 10 meq (1080 mg) 15 meq (1620 mg) 5 meq (540 mg)

1

potassium citrate-citric acid oral solution 1100-334 mg5ml 1


3

sod citrate-citric acid oral solution 500-334 mg5ml 1

sodium bicarbonate intravenous solution 42 75 1

SODIUM BICARBONATE ORAL POWDER 3

sodium bicarbonate solution 84 intravenous 84 1

SODIUM BICARBONATE SOLUTION 84 INTRAVENOUS 84

3


3

tricitrates oral solution 550-500-334 mg5ml 1


173


AMMONIA DETOXICANTS

BUPHENYL ORAL POWDER 3 GMTSP (sodium phenylbutyrate)

3 DSL = 30 days

BUPHENYL ORAL TABLET 500 MG (sodium phenylbutyrate) 2 DSL = 30 days

CARBAGLU ORAL TABLET 200 MG (carglumic acid) 3

constulose oral solution 10 gm15ml 1

enulose oral solution 10 gm15ml 1

generlac oral solution 10 gm15ml 1

KRISTALOSE ORAL PACKET 10 GM 20 GM (lactulose) 3

lactulose encephalopathy oral solution 10 gm15ml 1

lactulose oral packet 10 gm 1

lactulose oral solution 10 gm15ml 20 gm30ml 1

LITHOSTAT ORAL TABLET 250 MG (acetohydroxamic acid) 2

RAVICTI ORAL LIQUID 11 GMML (glycerol phenylbutyrate) 3 DSL = 30 days

sodium phenylbutyrate oral powder 3 gmtsp 1 DSL = 30 days

sodium phenylbutyrate oral tablet 500 mg 1 DSL = 30 days

CALORIC AGENTS - Drugs for Nutrition

3232a infant formula oral powder 2

AXONA ORAL PACKET (dietary management product) 3

CAMINO PRO COMPLETEGLYTACTIN ORAL BAR (nutritional supplements)

2

DOJOLVI ORAL LIQUID 100 (triheptanoin) 3 DSL = 30 days

EQUACARE JR ORAL POWDER 2

ESSENTIAL CARE JR ORAL POWDER (nutritional supplements)

2

GLYTACTIN BETTERMILK 15 ORAL PACKET (nutritional supplements)

2

GLYTACTIN BETTERMILK DE-LITE ORAL PACKET (nutritional supplements)

2

GLYTACTIN BUILD 10PE ORAL PACKET (nutritional supplements)

2

GLYTACTIN BUILD 2020 ORAL PACKET (nutritional supplements)

2

GLYTACTIN BUILD 2020 PKU ORAL PACKET (nutritional supplements)

2

GLYTACTIN BURST ORAL PACKET (nutritional supplements) 2

GLYTACTIN COMPLETE 10PE ORAL BAR (nutritional supplements)

2


174


GLYTACTIN RESTORE 10 ORAL LIQUID (nutritional supplements)

2

GLYTACTIN RESTORE 5 ORAL PACKET (nutritional supplements)

2

GLYTACTIN RESTORE LITE 10 ORAL LIQUID (nutritional supplements)

2

GLYTACTIN RESTORE LITE 10PE ORAL PACKET (nutritional supplements)

2

GLYTACTIN RTD 10 ORAL LIQUID (nutritional supplements) 2


GLYTACTIN RTD LITE 15 ORAL LIQUID (nutritional supplements)

2

GLYTACTIN SWIRL 15PE ORAL PACKET (nutritional supplements)

2

HCU EASY ORAL TABLET (nutritional supplements) 3

HOMACTIN AA PLUS ORAL LIQUID (nutritional supplements) 2

KETOVIE ORAL LIQUID (nutritional supplements) 2

KETOVIE PEPTIDE ORAL LIQUID (nutritional supplements) 2

L-CYSTINE POWDER 3

multiple vitamins-minerals (Lysiplex Plus Oral Tablet) 1

MSUD EASY ORAL TABLET (nutritional supplements) 3

PKU EASY MICROTABS ORAL TABLET DELAYED RELEASE (nutritional supplements)

3

PKU EASY ORAL TABLET (nutritional supplements) 3

PKU GO ORAL PACKET (nutritional supplements) 2

TYLACTIN BUILD 20PE TYR ORAL PACKET (nutritional supplements)

2

TYLACTIN COMPLETE 15 PE ORAL BAR (nutritional supplements)

2

TYLACTIN RESTORE 10 ORAL LIQUID (nutritional supplements)

2

TYLACTIN RESTORE 5PE ORAL PACKET (nutritional supplements)

2

TYLACTIN RTD 15 ORAL LIQUID (nutritional supplements) 2

TYR EASY ORAL TABLET (nutritional supplements) 3

TYROS 2 ORAL POWDER (nutritional supplements) 2

VILACTIN AA PLUS ORAL LIQUID (nutritional supplements) 2


175


CARBONIC ANHYDRASE INHIBITORS - Drugs for Water Balance


1


DIURETICS MISCELLANEOUS - Drugs for Water Balance



3


PV


PV


ELECTROLYTICCALORICWATER BALANCE MISC

CRYSVITA SUBCUTANEOUS SOLUTION 10 MGML 20 MGML 30 MGML (burosumab-twza)

3 DSL = 30 days

IRRIGATING SOLUTIONS

aminoacetic acid irrigation solution 15 1

glycine irrigation solution 15 1

glycine urologic irrigation solution 15 1

irrigation solns physiological (Physiolyte Irrigation Solution) 3

irrigation solns physiological (Physiosol Irrigation Irrigation Solution)

3

RENACIDIN IRRIGATION SOLUTION (citric ac-gluconolact-mg carb)

3

RESECTISOL IRRIGATION SOLUTION 5 (mannitol (gu irrigant))

3

RIMSO-50 INTRAVESICAL SOLUTION 50 (dimethyl sulfoxide)

2

ringers irrigation irrigation solution 1

SORBITOL IRRIGATION SOLUTION 3 33 3

sorbitol-mannitol irrigation solution 27-054 gm100ml 1

ringers irrigation (Tis-U-Sol Irrigation Solution) 1

LOOP DIURETICS - Drugs for Water Balance






176





OSMOTIC DIURETICS - Drugs for Water Balance


OTHER ION-REMOVING AGENTS

RADIOGARDASE ORAL CAPSULE 05 GM (prussian blue insoluble)

3

PHOSPHATE-REMOVING AGENTS

AURYXIA ORAL TABLET 1 GM 210 MG(FE) (ferric citrate) 3 DSL = 30 days

calcium acetate (phos binder) oral capsule 667 mg PV

calcium acetate (phos binder) oral tablet 667 mg PV

calcium acetate oral tablet 667 mg PV

FOSRENOL ORAL PACKET 1000 MG 750 MG (lanthanum carbonate)

PV

FOSRENOL ORAL TABLET CHEWABLE 1000 MG 500 MG 750 MG (lanthanum carbonate)

PV

lanthanum carbonate oral tablet chewable 1000 mg 500 mg 750 mg

PV

MAGNEBIND 400 ORAL TABLET 400-200-1 MG (magnesium-calcium-folic acid)

3

PHOSLYRA ORAL SOLUTION 667 MG5ML (calcium acetate (phos binder))

PV

RENAGEL ORAL TABLET 800 MG (sevelamer hcl) PV

RENVELA ORAL PACKET 08 GM 24 GM (sevelamer carbonate)

PV

RENVELA ORAL TABLET 800 MG (sevelamer carbonate) PV

sevelamer carbonate oral packet 08 gm 24 gm PV

sevelamer carbonate oral tablet 800 mg PV

sevelamer hcl oral tablet 400 mg 800 mg PV

VELPHORO ORAL TABLET CHEWABLE 500 MG (sucroferric oxyhydroxide)

3

POTASSIUM-REMOVING AGENTS

LOKELMA ORAL PACKET 10 GM 5 GM (sodium zirconium cyclosilicate)

3

sodium polystyrene sulfonate oral powder 1

sps oral suspension 15 gm60ml 1

VELTASSA ORAL PACKET 168 GM 252 GM 84 GM (patiromer sorbitex calcium)

3 DSL = 30 days


177


POTASSIUM-SPARING DIURETICS - Drugs for Water Balance


3


3












REPLACEMENT PREPARATIONS


calcium-folic acid plus d oral wafer 1342-1 mg 1

CARDIOPLEGIA DEL NIDO FORMULA PERFUSION SOLUTION

3

CARDIOPLEGIA IND PLASMA HIGH K PERFUSION SOLUTION

3

CARDIOPLEGIA IND PLASMA-TROMET PERFUSION SOLUTION

3

CARDIOPLEGIA INDUCTION HIGH K PERFUSION SOLUTION

3

CARDIOPLEGIA INDUCTION LOW DEX PERFUSION SOLUTION

3

CARDIOPLEGIA INDUCTION NON-ENR PERFUSION SOLUTION

3

CARDIOPLEGIA MAIN LOW DEXTROSE PERFUSION SOLUTION

3

CARDIOPLEGIA MAIN LOW TROMETHA PERFUSION SOLUTION

3

CARDIOPLEGIA MAIN PLASMA-TROME PERFUSION SOLUTION

3

CARDIOPLEGIA MAINTENANCE PERFUSION SOLUTION 3

CARDIOPLEGIA REPERFUSATE 41 PERFUSION SOLUTION 3


178


EFFER-K ORAL TABLET EFFERVESCENT 10 MEQ 20 MEQ (potassium bicarb-citric acid)

PV

potassium bicarbonate (Effer-K Oral Tablet Effervescent 25 Meq)

1

FOLGARD OS ORAL TABLET 500-11 MG (multiple vit-min-calcium-fa)

3

FOLITE ORAL TABLET 3

FOSTEUM PLUS ORAL CAPSULE (dietary management product)

3


3

ISOLYTE-S INTRAVENOUS SOLUTION (electrolyte-s) 3

KCL-LIDOCAINE-NACL INTRAVENOUS SOLUTION 10-10 MEQ-MG 100ML

3

potassium chloride (Klor-Con 10 Oral Tablet Extended Release 10 Meq)

PV

potassium chloride crys er (Klor-Con M10 Oral Tablet Extended Release 10 Meq)

PV

KLOR-CON M15 ORAL TABLET EXTENDED RELEASE 15 MEQ (potassium chloride crys er)

PV


PV

potassium chloride (Klor-Con Oral Packet 20 Meq) PV

potassium chloride (Klor-Con Oral Tablet Extended Release 8 Meq)

PV

potassium bicarbonate (Klor-ConEf Oral Tablet Effervescent 25 Meq)

1

potassium bicarbonate (K-Prime Oral Tablet Effervescent 25 Meq)

1

K-TAB ORAL TABLET EXTENDED RELEASE 10 MEQ 20 MEQ 8 MEQ (potassium chloride)

PV

MICROPLEGIA MSA-MSG PERFUSION SOLUTION 3



3

phosphorus supplement oral packet 280-160-250 mg PV

phosphorus wsod amp potassium oral packet 280-160-250 mg PV

PHOXILLUM B22K40 INTRAVENOUS SOLUTION 22-4-1 MEQ-MMOLL

3

PHOXILLUM BK425 INTRAVENOUS SOLUTION 32-4-25-1 MEQ-MMOLL

3


179


PLASMA-LYTE 148 INTRAVENOUS SOLUTION (electrolyte-148)

3

PLASMA-LYTE A INTRAVENOUS SOLUTION (electrolyte-a) 2

potassium chloride crys er oral tablet extended release 10 meq 20 meq

PV

potassium chloride er oral capsule extended release 10 meq 8 meq

PV

potassium chloride er oral tablet extended release 10 meq 20 meq 8 meq

PV

potassium chloride in nacl intravenous solution 20-045 meql- 20-09 meql- 40-09 meql-

1

potassium chloride oral packet 20 meq PV

potassium chloride oral solution 20 meq15ml (10) 40 meq15ml (20)

PV





PRENATE ORAL TABLET CHEWABLE 06-04 MG (prenat mv-min-methylfolate-fa)

3




3

sodium chloride (pf) injection solution 09 1


1

sodium chloride injection solution 25 meqml 1

sodium chloride intravenous solution 045 09 3 4 meqml 5

1



3


3


zinc sulfate oral tablet 220 (50 zn) mg PV

THIAZIDE DIURETICS - Drugs for Water Balance


3


180



3



1


3


3


1


3


1


1


1


3



3



3





3


1


1


1


181



3




1


1


3


1


1



1



3





3


1


3


3


3

THIAZIDE-LIKE DIURETICS - Drugs for Water Balance




3



182




3


3

URICOSURIC AGENTS

colchicine-probenecid oral tablet 05-500 mg 1

probenecid oral tablet 500 mg 1

VASOPRESSIN ANTAGONISTS - Drugs for Water Balance

JYNARQUE ORAL TABLET 15 MG 30 MG (tolvaptan) 3 DSL = 30 days

JYNARQUE ORAL TABLET THERAPY PACK 15 MG 45 amp 15 MG 60 amp 30 MG 90 amp 30 MG (tolvaptan)

3 DSL = 30 days

JYNARQUE ORAL TABLET THERAPY PACK 30 amp 15 MG (tolvaptan)

3

SAMSCA ORAL TABLET 15 MG 30 MG (tolvaptan) 3 DSL = 30 days

TOLVAPTAN ORAL TABLET 15 MG 3 DSL = 30 days

tolvaptan oral tablet 30 mg 1 DSL = 30 days

ENZYMES

ENZYMES


2

ALDURAZYME INTRAVENOUS SOLUTION 29 MG5ML (laronidase)

2

BRINEURA KIT 2 X 150 MG5ML (cerliponase alfa) 3


2

CEREZYME INTRAVENOUS SOLUTION RECONSTITUTED 400 UNIT (imiglucerase)

2

ELAPRASE INTRAVENOUS SOLUTION 6 MG3ML (idursulfase)

2 DSL = 30 days

ELELYSO INTRAVENOUS SOLUTION RECONSTITUTED 200 UNIT (taliglucerase alfa)

3 DSL = 30 days

ELITEK INTRAVENOUS SOLUTION RECONSTITUTED 15 MG 75 MG (rasburicase)

2

FABRAZYME INTRAVENOUS SOLUTION RECONSTITUTED 35 MG 5 MG (agalsidase beta)

2 DSL = 30 days

KANUMA INTRAVENOUS SOLUTION 20 MG10ML (sebelipase alfa)

3 DSL = 30 days

LUMIZYME INTRAVENOUS SOLUTION RECONSTITUTED 50 MG (alglucosidase alfa)

2 DSL = 30 days


183


MEPSEVII INTRAVENOUS SOLUTION 10 MG5ML (vestronidase alfa-vjbk)

3

NAGLAZYME INTRAVENOUS SOLUTION 1 MGML (galsulfase)

2 DSL = 30 days

PALYNZIQ SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 10 MG05ML 25 MG05ML 20 MGML (pegvaliase-pqpz)

3 DSL = 30 days

PULMOZYME INHALATION SOLUTION 1 MGML (dornase alfa)

2

REVCOVI INTRAMUSCULAR SOLUTION 24 MG15ML (elapegademase-lvlr)

3

STRENSIQ SUBCUTANEOUS SOLUTION 18 MG045ML 28 MG07ML 40 MGML 80 MG08ML (asfotase alfa)

2 DSL = 30 days

SUCRAID ORAL SOLUTION 8500 UNITML (sacrosidase) 3

VIMIZIM INTRAVENOUS SOLUTION 5 MG5ML (elosulfase alfa)

2 DSL = 30 days

VITRASE INJECTION SOLUTION 200 UNITML (hyaluronidase ovine)

3

VORAXAZE INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT (glucarpidase)

PV DSL = 30 days

VPRIV INTRAVENOUS SOLUTION RECONSTITUTED 400 UNIT (velaglucerase alfa)

2

XIAFLEX INJECTION SOLUTION RECONSTITUTED 09 MG (collagenase clostrid histolyt)

3

EYE EAR NOSE AND THROAT (EENT) PREPS

ALPHA-ADRENERGIC AGONISTS (EENT) - Drugs for the Eye

ALPHAGAN P OPHTHALMIC SOLUTION 01 (brimonidine tartrate)

3

brimonidine tartrate ophthalmic solution 015 02 1

BRIMONIDINE-DORZOLAMIDE OPHTHALMIC SOLUTION 015-2

3

COMBIGAN OPHTHALMIC SOLUTION 02-05 (brimonidine tartrate-timolol)

3

SIMBRINZA OPHTHALMIC SUSPENSION 1-02 (brinzolamide-brimonidine)

3

TIMOLOL-BRIMON-DORZOL-LATANOPR OPHTHALMIC SOLUTION 05-015-2 -0005

3

TIMOLOL-BRIMONIDINE-DORZOLAMID OPHTHALMIC SOLUTION 05-015-2

3


184


ANTIALLERGIC AGENTS - Drugs for Allergy

ALOCRIL OPHTHALMIC SOLUTION 2 (nedocromil sodium) 2

ALOMIDE OPHTHALMIC SOLUTION 01 (lodoxamide tromethamine)

3

azelastine hcl nasal solution 01 015 137 mcgspray 1

azelastine hcl ophthalmic solution 005 1

azelastine-fluticasone nasal suspension 137-50 mcgact 1

BEPREVE OPHTHALMIC SOLUTION 15 (bepotastine besilate)

3

cromolyn sodium ophthalmic solution 4 1

epinastine hcl ophthalmic solution 005 1

LASTACAFT OPHTHALMIC SOLUTION 025 (alcaftadine) 3

olopatadine hcl nasal solution 06 1

olopatadine hcl ophthalmic solution 01 02 1

ZERVIATE OPHTHALMIC SOLUTION 024 (cetirizine hcl) 3

ANTIBACTERIALS (EENT) - Drugs for Infections

ak-poly-bac ophthalmic ointment 500-10000 unitgm 1

ARESTIN DENTAL 1 MG (minocycline hcl) 3

AZASITE OPHTHALMIC SOLUTION 1 (azithromycin) 3

bacitracin ophthalmic ointment 500 unitgm 1

bacitracin-polymyxin b ophthalmic ointment 500-10000 unitgm 1

bacitra-neomycin-polymyxin-hc ophthalmic ointment 1 1

BESIVANCE OPHTHALMIC SUSPENSION 06 (besifloxacin hcl)

3

BLEPHAMIDE OPHTHALMIC SUSPENSION 10-02 (sulfacetamide-prednisolone)

2

BLEPHAMIDE SOP OPHTHALMIC OINTMENT 10-02 (sulfacetamide-prednisolone)

2

CILOXAN OPHTHALMIC OINTMENT 03 (ciprofloxacin hcl) 3

CIPRO HC OTIC SUSPENSION 02-1 (ciprofloxacin-hydrocortisone)

3

CIPRODEX OTIC SUSPENSION 03-01 (ciprofloxacin-dexamethasone)

3

ciprofloxacin hcl ophthalmic solution 03 1

ciprofloxacin hcl otic solution 02 1

ciprofloxacin-dexamethasone otic suspension 03-01 1

CIPROFLOXACIN-FLUOCINOLONE PF OTIC SOLUTION 03-0025

3


185


CORTISPORIN-TC OTIC SUSPENSION 33-3-10-05 MGML (neomycin-colist-hc-thonzonium)

2

doxycycline hyclate oral tablet 20 mg 1

erythromycin ophthalmic ointment 5 mggm 1

gatifloxacin ophthalmic solution 05 1

gentak ophthalmic ointment 03 1

gentamicin sulfate ophthalmic solution 03 1

KLARITY-A OPHTHALMIC SOLUTION 1 (azithromycin) 3

levofloxacin ophthalmic solution 05 1

moxifloxacin hcl (2x day) ophthalmic solution 05 1

moxifloxacin hcl ophthalmic solution 05 1

neomycin-bacitracin zn-polymyx ophthalmic ointment 35-400-10000 5-400-10000

1

neomycin-polymyxin-dexameth ophthalmic ointment 35-10000-01

1

neomycin-polymyxin-dexameth ophthalmic suspension 35-10000-01

1

neomycin-polymyxin-gramicidin ophthalmic solution 175-10000-025

1

neomycin-polymyxin-hc ophthalmic suspension 35-10000-1 1

neomycin-polymyxin-hc otic solution 1 35-10000-1 1

neomycin-polymyxin-hc otic suspension 35-10000-1 1

bacitracin-polymyx-neo-hc (Neo-Polycin Hc Ophthalmic Ointment 1 )

1

neomycin-bacitracin zn-polymyx (Neo-Polycin Ophthalmic Ointment 35-400-10000)

1

ofloxacin ophthalmic solution 03 1

ofloxacin otic solution 03 1

OTIPRIO INTRATYMPANIC SUSPENSION 6 (ciprofloxacin) 3

OTOVEL OTIC SOLUTION 03-0025 (ciprofloxacin-fluocinolone)

3

bacitracin-polymyxin b (Polycin Ophthalmic Ointment 500-10000 UnitGm)

1

polymyxin b-trimethoprim ophthalmic solution 10000-01 unitml-

1

PRED-G OPHTHALMIC SUSPENSION 03-1 (gentamicin-prednisolone acet)

3

PRED-G SOP OPHTHALMIC OINTMENT 03-06 (gentamicin-prednisolone acet)

3


186


PREDNISOL ACE-MOXIFLOX-BROMFEN OPHTHALMIC SUSPENSION 1-05-0075

3

PREDNISOLONE ACET-MOXIFLOXACIN OPHTHALMIC SUSPENSION 1-05

3

PREDNISOLONE-GATIFLOXACIN OPHTHALMIC SUSPENSION 1-05

3

PREDNISOLONE-MOXIFLOXACIN OPHTHALMIC SOLUTION 1-05

3

PREDNISOLON-GATIFLOX-BROMFENAC OPHTHALMIC SOLUTION 1-05-0075

3

PREDNISOLON-GATIFLOX-BROMFENAC OPHTHALMIC SUSPENSION 1-05-0075

3

PREDNISOLON-MOXIFLOX-BROMFENAC OPHTHALMIC SOLUTION 1-05-0075

3

PREDNISOLON-MOXIFLOX-NEPAFENAC OPHTHALMIC SUSPENSION 1-05-01

3

sulfacetamide sodium ophthalmic ointment 10 1

sulfacetamide sodium ophthalmic solution 10 1

sulfacetamide-prednisolone ophthalmic solution 10-023 1

TOBRADEX OPHTHALMIC OINTMENT 03-01 (tobramycin-dexamethasone)

2

TOBRADEX ST OPHTHALMIC SUSPENSION 03-005 (tobramycin-dexamethasone)

3

tobramycin ophthalmic solution 03 1

tobramycin-dexamethasone ophthalmic suspension 03-01 1

TOBREX OPHTHALMIC OINTMENT 03 (tobramycin) 2

ZYLET OPHTHALMIC SUSPENSION 05-03 (loteprednol-tobramycin)

3

ZYMAXID OPHTHALMIC SOLUTION 05 (gatifloxacin) 2

ANTIFUNGALS (EENT) - Drugs for Infections

NATACYN OPHTHALMIC SUSPENSION 5 (natamycin) 2

ANTIGLAUCOMA AGENTS MISCELLANEOUS - Drugs for the Eye

MITOSOL OPHTHALMIC KIT 02 MG (mitomycin) 2

RHOPRESSA OPHTHALMIC SOLUTION 002 (netarsudil dimesylate)

3

ROCKLATAN OPHTHALMIC SOLUTION 002-0005 (netarsudil-latanoprost)

3

ANTIVIRALS (EENT) - Drugs for Infections

trifluridine ophthalmic solution 1 1


187


ZIRGAN OPHTHALMIC GEL 015 (ganciclovir) 3

BETA-ADRENERGIC BLOCKING AGENTS (EENT) - Drugs for the Eye

betaxolol hcl ophthalmic solution 05 1

BETIMOL OPHTHALMIC SOLUTION 025 05 (timolol hemihydrate)

3

BETOPTIC-S OPHTHALMIC SUSPENSION 025 (betaxolol hcl)

3

carteolol hcl ophthalmic solution 1 1


3

dorzolamide hcl-timolol mal ophthalmic solution 223-68 mgml 1

dorzolamide hcl-timolol mal pf ophthalmic solution 2-05 1

LATANOPROST-TIMOLOL MALEATE OPHTHALMIC SOLUTION 0005-05

3

levobunolol hcl ophthalmic solution 05 1

timolol maleate ophthalmic gel forming solution 025 05 1

timolol maleate ophthalmic solution 025 05 05 (daily) 1

timolol maleate pf ophthalmic solution 05 1


3


3

TIMOLOL-DORZOLAMID-LATANOPROST OPHTHALMIC SOLUTION 05-015-0005

3

TIMOPTIC OCUDOSE OPHTHALMIC SOLUTION 025 (timolol maleate)

3

CARBONIC ANHYDRASE INHIBITORS (EENT) - Drugs for the Eye


1



3

brinzolamide ophthalmic suspension 1 1

DORZOLAMIDE HCL SOLUTION 2 OPHTHALMIC 2 3

dorzolamide hcl solution 2 ophthalmic 2 1



KEVEYIS ORAL TABLET 50 MG (dichlorphenamide) 3 DSL = 30 days


188


methazolamide oral tablet 25 mg 50 mg 1


3


3


3


3

CORTICOSTEROIDS (EENT) - Drugs for Inflammation

ALREX OPHTHALMIC SUSPENSION 02 (loteprednol etabonate)

3



BECONASE AQ NASAL SUSPENSION 42 MCGSPRAY (beclomethasone diprop monohyd)

3


3


3



3

CORTANE-B EXTERNAL LOTION 10-10-1 MGML (hc-pramoxine-chloroxylenol)

3

dexamethasone sodium phosphate ophthalmic solution 01 1

DEXTENZA OPHTHALMIC INSERT 04 MG (dexamethasone) 3

DEXYCU INTRAOCULAR SUSPENSION 9 (dexamethasone)

3

DUREZOL OPHTHALMIC EMULSION 005 (difluprednate) 3

exotic-hc otic solution 10-10-1 mgml 1

EYSUVIS OPHTHALMIC SUSPENSION 025 (loteprednol etabonate)

3

fluocinolone acetonide (Flac Otic Oil 001 ) 1

FLAREX OPHTHALMIC SUSPENSION 01 (fluorometholone acetate)

3

flunisolide nasal solution 25 mcgact (0025) 1

fluocinolone acetonide otic oil 001 1

fluorometholone ophthalmic suspension 01 1

fluticasone propionate nasal suspension 50 mcgact 1


189


FML FORTE OPHTHALMIC SUSPENSION 025 (fluorometholone)

2

FML OPHTHALMIC OINTMENT 01 (fluorometholone) 2

hydrocortisone-acetic acid otic solution 1-2 1

ILUVIEN INTRAVITREAL IMPLANT 019 MG (fluocinolone acetonide)

3

INVELTYS OPHTHALMIC SUSPENSION 1 (loteprednol etabonate)

3

KLARITY-L OPHTHALMIC EMULSION 02 05 (loteprednol etabonate)

3

LOTEMAX OPHTHALMIC OINTMENT 05 (loteprednol etabonate)

3

LOTEMAX SM OPHTHALMIC GEL 038 (loteprednol etabonate)

3

loteprednol etabonate ophthalmic gel 05 1

loteprednol etabonate ophthalmic suspension 05 1

MAXIDEX OPHTHALMIC SUSPENSION 01 (dexamethasone)

3

mometasone furoate nasal suspension 50 mcgact 1


1


1



1

OMNARIS NASAL SUSPENSION 50 MCGACT (ciclesonide) 3


3

OZURDEX INTRAVITREAL IMPLANT 07 MG (dexamethasone)

2

PRED FORTE OPHTHALMIC SUSPENSION 1 (prednisolone acetate)

PV

PRED MILD OPHTHALMIC SUSPENSION 012 (prednisolone acetate)

2


3


3


3


190


prednisolone acetate ophthalmic suspension 1 PV

prednisolone acetate p-f ophthalmic suspension 1 PV

PREDNISOLONE ACETATE-NEPAFENAC OPHTHALMIC SUSPENSION 1-01

3


3

prednisolone sodium phosphate ophthalmic solution 1 1

PREDNISOLONE-BROMFENAC OPHTHALMIC SOLUTION 1-0075

3

PREDNISOLONE-BROMFENAC OPHTHALMIC SUSPENSION 1-0075

3


3


3


3


3


3


3

QNASL CHILDRENS NASAL AEROSOL SOLUTION 40 MCGACT (beclomethasone diprop (nasal))

3

QNASL NASAL AEROSOL SOLUTION 80 MCGACT (beclomethasone diprop (nasal))

3

QUINIXIL EXTERNAL THERAPY PACK 01 amp 5 (mometasone furo-dimethicone)

3

RETISERT INTRAVITREAL IMPLANT 059 MG (fluocinolone acetonide)

2

SINUVA NASAL IMPLANT 1350 MCG (mometasone furoate) 3


2


3


XHANCE NASAL EXHALER SUSPENSION 93 MCGACT (fluticasone propionate)

3

YUTIQ INTRAVITREAL IMPLANT 018 MG (fluocinolone acetonide)

3


191


ZETONNA NASAL AEROSOL SOLUTION 37 MCGACT (ciclesonide)

3


3

EENT ANTI-INFECTIVES MISCELLANEOUS - Drugs for Infections

acetic acid otic solution 2 1

BETADINE OPHTHALMIC PREP OPHTHALMIC SOLUTION 5 (povidone-iodine)

3

chlorhexidine gluconate mouththroat solution 012 1


chlorhexidine gluconate (Periogard MouthThroat Solution 012 )

1

PRAMOTIC OTIC LIQUID 1-01 (pramoxine-chloroxylenol) 3

EENT ANTI-INFLAMMATORY AGENTS MISC - Drugs for Inflammation

CEQUA OPHTHALMIC SOLUTION 009 (cyclosporine) 2

CYCLOSPORINE IN KLARITY OPHTHALMIC EMULSION 01 (cyclosporine)

3

RESTASIS MULTIDOSE OPHTHALMIC EMULSION 005 (cyclosporine)

3

RESTASIS OPHTHALMIC EMULSION 005 (cyclosporine) 3

XIIDRA OPHTHALMIC SOLUTION 5 (lifitegrast) 3

EENT DRUGS MISCELLANEOUS

apraclonidine hcl ophthalmic solution 05 1

BEOVU INTRAVITREAL SOLUTION 6 MG005ML (brolucizumab-dbll)

3 DSL = 30 days

BEVACIZUMAB INTRAOCULAR SOLUTION PREFILLED SYRINGE 275 MG011ML 375 MG015ML

3

BEVACIZUMAB INTRAVITREAL SOLUTION PREFILLED SYRINGE 25 MG01ML 325 MG013ML 375 MG015ML

3

CHONDROITIN SULFATE OPHTHALMIC SOLUTION 025 3

CYSTADROPS OPHTHALMIC SOLUTION 037 (cysteamine hcl)

3 DSL = 30 days

CYSTARAN OPHTHALMIC SOLUTION 044 (cysteamine hcl)

3

DEBACTEROL MOUTHTHROAT SOLUTION 30-50 (sulfuric acid-sulf phenolics)

3


3


192


EYLEA INTRAVITREAL SOLUTION 2 MG005ML (aflibercept) 2

EYLEA INTRAVITREAL SOLUTION PREFILLED SYRINGE 2 MG005ML (aflibercept)

2

GELFILM OPHTHALMIC FILM (gelatin adsorbable) 2

IOPIDINE OPHTHALMIC SOLUTION 1 (apraclonidine hcl) 2

ipratropium bromide nasal solution 003 006 PV

LACRISERT OPHTHALMIC INSERT 5 MG (artificial tear insert) 2

LUCENTIS INTRAVITREAL SOLUTION 03 MG005ML 05 MG005ML (ranibizumab)

2 DSL = 30 days

LUCENTIS INTRAVITREAL SOLUTION PREFILLED SYRINGE 03 MG005ML 05 MG005ML (ranibizumab)

2 DSL = 30 days

OXERVATE OPHTHALMIC SOLUTION 0002 (cenegermin-bkbj)

3 DSL = 30 days

PHOTREXA-PHOTREXA VISCOUS KIT OPHTHALMIC SOLUTION PREFILLED SYRINGE 0146 amp0146-20 (riboflav5 amp riboflav5-dextran)

2


TEPEZZA INTRAVENOUS SOLUTION RECONSTITUTED 500 MG (teprotumumab-trbw)

3 DSL = 30 days

VISUDYNE INTRAVENOUS SOLUTION RECONSTITUTED 15 MG (verteporfin)

2

EENT NONSTEROIDAL ANTI-INFLAM AGENTS - Drugs for Inflammation

ACULAR LS OPHTHALMIC SOLUTION 04 (ketorolac tromethamine)

PV

ACULAR OPHTHALMIC SOLUTION 05 (ketorolac tromethamine)

PV

ACUVAIL OPHTHALMIC SOLUTION 045 (ketorolac tromethamine)

PV

bromfenac sodium (once-daily) ophthalmic solution 009 PV

BROMSITE OPHTHALMIC SOLUTION 0075 (bromfenac sodium)

PV

diclofenac sodium ophthalmic solution 01 PV

flurbiprofen sodium ophthalmic solution 003 PV

ILEVRO OPHTHALMIC SUSPENSION 03 (nepafenac) PV

ketorolac tromethamine ophthalmic solution 04 05 PV

NEVANAC OPHTHALMIC SUSPENSION 01 (nepafenac) PV


3


193



3


3


3


3


3


3


3

PROLENSA OPHTHALMIC SOLUTION 007 (bromfenac sodium)

PV

TROPIC-CYCLOPENT-PE-KETOROLAC OPHTHALMIC SOLUTION PREFILLED SYRINGE 1-1-10-05 1-1-25-05

3

TROPIC-CYCLOP-PE-KETO-PROPAR OPHTHALMIC SOLUTION PREFILLED SYRINGE

3

TROPIC-PROPARACA-PE-KETOROLAC OPHTHALMIC SOLUTION 1-05-25-05

3

LOCAL ANESTHETICS (EENT) - Drugs for Numbing

AKTEN OPHTHALMIC GEL 35 (lidocaine hcl) 2

ALCAINE OPHTHALMIC SOLUTION 05 (proparacaine hcl) 2

tetracaine hcl (Altacaine Ophthalmic Solution 05 ) 3


COCAINE HCL NASAL SOLUTION 40 MGML 3


3


3


lidocaine hcl (Glydo External Prefilled Syringe 2 ) 1

GOPRELTO NASAL SOLUTION 40 MGML 3

lidocaine hcl external solution 4 1

lidocaine hcl urethralmucosal external gel 2 1

lidocaine hcl urethralmucosal external prefilled syringe 2 1

lidocaine viscous hcl mouththroat solution 2 1


194


NUMBRINO NASAL SOLUTION 40 MGML (cocaine hcl (nasal anesthetic))

3


PROFESSIONAL DNA COLLECTION COMBINATION KIT 3

proparacaine hcl ophthalmic solution 05 1


tetracaine hcl ophthalmic solution 05 1


3


3

MIOTICS - Drugs for the Eye

PHOSPHOLINE IODIDE OPHTHALMIC SOLUTION RECONSTITUTED 0125 (echothiophate iodide)

2

pilocarpine hcl ophthalmic solution 1 2 4 1

MYDRIATICS - Drugs for the Eye

atropine sulfate ophthalmic ointment 1 1

ATROPINE SULFATE OPHTHALMIC SOLUTION 001 3

atropine sulfate ophthalmic solution 1 1

CYCLOGYL OPHTHALMIC SOLUTION 05 (cyclopentolate hcl)

2

CYCLOMYDRIL OPHTHALMIC SOLUTION 02-1 (cyclopentolate-phenylephrine)

2

cyclopentolate hcl ophthalmic solution 05 1 2 1

homatropaire ophthalmic solution 5 1

ISOPTO ATROPINE OPHTHALMIC SOLUTION 1 (atropine sulfate)

2

PAREMYD OPHTHALMIC SOLUTION 1-025 (hydroxyamphetamine-tropicamide)

3

tropicamide ophthalmic solution 05 1 1

TROPICAMIDE-CYCLOPENTOLATE-PE OPHTHALMIC SOLUTION 1-1-25

3

TROPICAMIDE-PHENYLEPHRINE OPHTHALMIC SOLUTION 1-25

3


3


3


3


195


PROSTAGLANDIN ANALOGS - Drugs for the Eye

bimatoprost ophthalmic solution 003 1

DURYSTA INTRAOCULAR IMPLANT 10 MCG (bimatoprost) 3 DSL = 30 days

latanoprost ophthalmic solution 0005 1


3

LUMIGAN OPHTHALMIC SOLUTION 001 (bimatoprost) 3


3


3


3

travoprost (bak free) ophthalmic solution 0004 1

VYZULTA OPHTHALMIC SOLUTION 0024 (latanoprostene bunod)

3

XELPROS OPHTHALMIC EMULSION 0005 (latanoprost) 3

ZIOPTAN OPHTHALMIC SOLUTION 00015 (tafluprost) 3

RHO KINASE INHIBITORS - Drugs for the Eye


3


3

VASOCONSTRICTORS

ADRENALIN NASAL SOLUTION 01 (epinephrine hcl (nasal))

3

phenylephrine hcl (Altafrin Ophthalmic Solution 10 25 ) 1

phenylephrine hcl ophthalmic solution 10 25 1


3


3


3


3

UPNEEQ OPHTHALMIC SOLUTION 01 (oxymetazoline hcl) 3


196


GASTROINTESTINAL DRUGS

ANTACIDS AND ADSORBENTS

magnesium oxide oral tablet 400 (2413 mg) mg 400 mg 420 mg

PV

magnesium-oxide oral tablet 400 (2413 mg) mg PV

mag-oxide oral tablet 200 mg PV


stomach relief oral tablet chewable 262 mg 1

GASTROINTESTINAL DRUGS - Drugs for the Stomach

5-HT3 RECEPTOR ANTAGONISTS - Drugs for Vomiting and Nausea

AKYNZEO INTRAVENOUS SOLUTION 235-025 MG20ML (fosnetupitant-palonosetron)

3

AKYNZEO INTRAVENOUS SOLUTION RECONSTITUTED 235-025 MG (fosnetupitant-palonosetron)

3

AKYNZEO ORAL CAPSULE 300-05 MG (netupitant-palonosetron)

2 DSL = 30 days

ALOXI INTRAVENOUS SOLUTION 025 MG5ML (palonosetron hcl)

PV

ANZEMET ORAL TABLET 100 MG 50 MG (dolasetron mesylate)

PV DSL = 30 days

granisetron hcl intravenous solution 1 mgml 4 mg4ml PV

granisetron hcl oral tablet 1 mg PV


3

ondansetron hcl injection solution 4 mg2ml 40 mg20ml PV

ondansetron hcl oral solution 4 mg5ml PV

ondansetron hcl oral tablet 24 mg 4 mg 8 mg PV

ondansetron odt oral tablet dispersible 4 mg 8 mg PV

palonosetron hcl intravenous solution 025 mg2ml 025 mg5ml PV

palonosetron hcl intravenous solution prefilled syringe 025 mg5ml

PV

SANCUSO TRANSDERMAL PATCH 31 MG24HR (granisetron)

PV

SUSTOL SUBCUTANEOUS PREFILLED SYRINGE 10 MG04ML (granisetron)

PV

ZOFRAN ORAL TABLET 4 MG (ondansetron hcl) PV

ZUPLENZ ORAL FILM 4 MG 8 MG (ondansetron) PV


197


ANTIDIARRHEA AGENTS - Drugs for Diarrhea



loperamide hcl oral capsule 2 mg 1

MOTOFEN ORAL TABLET 1-0025 MG (difenoxin-atropine) 3

MYTESI ORAL TABLET DELAYED RELEASE 125 MG (crofelemer)

3



XERMELO ORAL TABLET 250 MG (telotristat etiprate) 3 DSL = 30 days

ANTIEMETICS MISCELLANEOUS - Drugs for Vomiting and Nausea

BONJESTA ORAL TABLET EXTENDED RELEASE 20-20 MG (doxylamine-pyridoxine)

3

doxylamine-pyridoxine oral tablet delayed release 10-10 mg 1 DSL = 30 days

dronabinol oral capsule 10 mg 25 mg 5 mg 1

scopolamine transdermal patch 72 hour 1 mg3days PV

SYNDROS ORAL SOLUTION 5 MGML (dronabinol) 3 DSL = 30 days

TRANSDERM SCOP (15 MG) TRANSDERMAL PATCH 72 HOUR 1 MG3DAYS (scopolamine base)

PV

TRANSDERM-SCOP (15 MG) TRANSDERMAL PATCH 72 HOUR 1 MG3DAYS (scopolamine base)

PV

ANTIHISTAMINES (GI DRUGS) - Drugs for Vomiting and Nausea


3










TIGAN INTRAMUSCULAR SOLUTION 100 MGML (trimethobenzamide hcl)

PV

TIGAN ORAL CAPSULE 300 MG (trimethobenzamide hcl) PV

trimethobenzamide hcl oral capsule 300 mg PV


198


ANTI-INFLAMMATORY AGENTS (GI DRUGS) - Drugs for Inflammation

alosetron hcl oral tablet 05 mg 1 mg 1 DSL = 30 days

balsalazide disodium oral capsule 750 mg 1

CANASA RECTAL SUPPOSITORY 1000 MG (mesalamine) 3

DIPENTUM ORAL CAPSULE 250 MG (olsalazine sodium) 3 DSL = 30 days

LIALDA ORAL TABLET DELAYED RELEASE 12 GM (mesalamine)

2

LOTRONEX ORAL TABLET 05 MG 1 MG (alosetron hcl) 3 DSL = 30 days

mesalamine er oral capsule extended release 24 hour 0375 gm 1

mesalamine oral capsule delayed release 400 mg 1

mesalamine oral tablet delayed release 12 gm 800 mg 1

mesalamine rectal enema 4 gm 1

mesalamine rectal suppository 1000 mg 1

mesalamine-cleanser rectal kit 4 gm 1

PENTASA ORAL CAPSULE EXTENDED RELEASE 250 MG 500 MG (mesalamine)

2

SFROWASA RECTAL ENEMA 4 GM60ML (mesalamine) 3



ANTIULCER AGENTS AND ACID SUPPRESSMISC - Drugs for Ulcers and Stomach Acid



3


3

CATHARTICS AND LAXATIVES - Drugs for Constipation

AMITIZA ORAL CAPSULE 24 MCG 8 MCG (lubiprostone) 2

bisacodyl ec oral tablet delayed release 5 mg PV

bisacodyl rectal suppository 10 mg PV

cascara sagrada oral fluid extract 1 gmml 1

citroma oral solution 1745 gm30ml PV

clearlax oral powder 17 gmscoop PV

CLENPIQ ORAL SOLUTION 10-35-12 MG-GM -GM160ML (sod picosulfate-mag ox-cit acd)

PV

cvs gentle laxative rectal suppository 10 mg PV

docusate sodium oral capsule 100 mg PV


199


EX-LAX ULTRA ORAL TABLET DELAYED RELEASE 5 MG (bisacodyl)

PV

gavilax oral powder 17 gmscoop PV

gavilyte-c oral solution reconstituted 240 gm PV

peg 3350-kcl-nabcb-nacl-nasulf (Gavilyte-G Oral Solution Reconstituted 236 Gm)

PV

bisacodyl-peg-kcl-nabicar-nacl (Gavilyte-H Oral Kit 5-210 Mg-Gm)

PV

peg 3350-kcl-na bicarb-nacl (Gavilyte-N With Flavor Pack Oral Solution Reconstituted 420 Gm)

PV

gentle laxative oral tablet delayed release 5 mg PV

gentle laxative rectal suppository 10 mg PV

GIALAX ORAL KIT (polyethylene glycol 3350) 3

glycolax oral powder 17 gmscoop PV

GOLYTELY ORAL SOLUTION RECONSTITUTED 236 GM (peg 3350-kcl-nabcb-nacl-nasulf)

PV

hm stool softener oral capsule 100 mg PV

LUBIPROSTONE ORAL CAPSULE 24 MCG 8 MCG 2

magnesium citrate oral solution 1745 gm30ml PV

mineral oil heavy oral oil 1

MOVIPREP ORAL SOLUTION RECONSTITUTED 100 GM (peg-kcl-nacl-nasulf-na asc-c)

PV

NULYTELY LEMON-LIME ORAL SOLUTION RECONSTITUTED 420 GM (peg 3350-kcl-na bicarb-nacl)

PV

OSMOPREP ORAL TABLET 1102-0398 GM (sod phos mono-sod phos dibasic)

PV

peg 3350-kcl-na bicarb-nacl oral solution reconstituted 420 gm PV

peg-3350electrolytes oral solution reconstituted 236 gm PV

peg-3350electrolytesascorbat oral solution reconstituted 100 gm

PV

peg-kcl-nacl-nasulf-na asc-c oral solution reconstituted 100 gm PV

bisacodyl-peg-kcl-nabicar-nacl (Peg-Prep Oral Kit 5-210 Mg-Gm)

PV

PLENVU ORAL SOLUTION RECONSTITUTED 140 GM (peg-kcl-nacl-nasulf-na asc-c)

PV


qc magnesium citrate oral solution 1745 gm30ml PV

stool softener laxative oral capsule 100 mg PV

stool softener oral capsule 100 mg PV


200


SUPREP BOWEL PREP KIT ORAL SOLUTION 175-313-16 GM177ML (na sulfate-k sulfate-mg sulf)

PV

SUTAB ORAL TABLET 1479-225-188 MG (sodium sulfate-mag sulfate-kcl)

PV


3

CHOLELITHOLYTIC AGENTS - Drugs for the Stomach

CHENODAL ORAL TABLET 250 MG (chenodiol) 3 DSL = 30 days

RELTONE ORAL CAPSULE 200 MG 400 MG (ursodiol) 3 DSL = 30 days

URSO FORTE ORAL TABLET 500 MG (ursodiol) 2

ursodiol oral capsule 300 mg 1

ursodiol oral tablet 250 mg 500 mg 1

DIGESTANTS - Drugs for the Stomach

CREON ORAL CAPSULE DELAYED RELEASE PARTICLES 12000 UNIT 24000-76000 UNIT 3000-9500 UNIT 36000 UNIT 6000 UNIT (pancrelipase (lip-prot-amyl))

2

ENZADYNE ORAL CAPSULE 3

PANCREAZE ORAL CAPSULE DELAYED RELEASE PARTICLES 10500 UNIT 16800 UNIT 21000 UNIT 2600 UNIT 4200 UNIT (pancrelipase (lip-prot-amyl))

3

PERTZYE ORAL CAPSULE DELAYED RELEASE PARTICLES 16000 UNIT 24000-86250 UNIT 4000 UNIT 8000 UNIT (pancrelipase (lip-prot-amyl))

3

VIOKACE ORAL TABLET 10440 UNIT 20880 UNIT (pancrelipase (lip-prot-amyl))

3

ZENPEP ORAL CAPSULE DELAYED RELEASE PARTICLES 10000-32000 UNIT 15000-47000 UNIT 20000-63000 UNIT 25000-79000 UNIT 40000-126000 UNIT 5000-24000 UNIT (pancrelipase (lip-prot-amyl))

2

ZENPEP ORAL CAPSULE DELAYED RELEASE PARTICLES 3000-14000 UNIT (pancrelipase (lip-prot-amyl))

3

GI DRUGS MISCELLANEOUS - Drugs for the Stomach

alvimopan oral capsule 12 mg 1

AVSOLA INTRAVENOUS SOLUTION RECONSTITUTED 100 MG (infliximab-axxq)

3 DSL = 30 days

CHOLBAM ORAL CAPSULE 250 MG 50 MG (cholic acid) 3 DSL = 30 days

CIMZIA PREFILLED KIT SUBCUTANEOUS KIT 2 X 200 MGML (certolizumab pegol)

3 DSL = 30 days

CIMZIA STARTER KIT SUBCUTANEOUS KIT 6 X 200 MGML (certolizumab pegol)

3


201


CIMZIA SUBCUTANEOUS KIT 2 X 200 MG (certolizumab pegol)

3 DSL = 30 days

ENDARI ORAL PACKET 5 GM (glutamine (sickle cell)) 3 DSL = 30 days

ENTYVIO INTRAVENOUS SOLUTION RECONSTITUTED 300 MG (vedolizumab)

3

GATTEX SUBCUTANEOUS KIT 5 MG (teduglutide (rdna)) 3 DSL = 30 days

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 80 MG08ML 80 MG08ML amp 40MG04ML (adalimumab)

3 DSL = 30 days

HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT 40 MG04ML 80 MG08ML (adalimumab)

3 DSL = 30 days

HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT 40 MG08ML (adalimumab)

2 DSL = 30 days

HUMIRA PEN-CDUCHS STARTER SUBCUTANEOUS PEN-INJECTOR KIT 40 MG08ML (adalimumab)

2 DSL = 30 days


3 DSL = 30 days

HUMIRA PEN-PEDIATRIC UC START SUBCUTANEOUS PEN-INJECTOR KIT 80 MG08ML (adalimumab)

3 DSL = 30 days

HUMIRA PEN-PSUVADOL HS START SUBCUTANEOUS PEN-INJECTOR KIT 40 MG08ML (adalimumab)

2 DSL = 30 days

HUMIRA PEN-PSORUVEIT STARTER SUBCUTANEOUS PEN-INJECTOR KIT 80 MG08ML amp 40MG04ML (adalimumab)

3 DSL = 30 days

HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 10 MG01ML 20 MG02ML 40 MG04ML (adalimumab)

3 DSL = 30 days

HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 40 MG08ML (adalimumab)

2 DSL = 30 days

INFLECTRA INTRAVENOUS SOLUTION RECONSTITUTED 100 MG (infliximab-dyyb)

2

LACTEROL ORAL CAPSULE (probiotic product) 3

LINZESS ORAL CAPSULE 145 MCG 290 MCG 72 MCG (linaclotide)

3

MOVANTIK ORAL TABLET 125 MG 25 MG (naloxegol oxalate)

3

OCALIVA ORAL TABLET 10 MG 5 MG (obeticholic acid) 3 DSL = 30 days

PROBICHEW ORAL TABLET CHEWABLE 3

PRODIGEN ORAL CAPSULE 3

PROMELLA IN PREBIOTIC ORAL CAPSULE 3

RELISTOR ORAL TABLET 150 MG (methylnaltrexone bromide) 3 DSL = 30 days


202


RELISTOR SUBCUTANEOUS SOLUTION 12 MG06ML 8 MG04ML (methylnaltrexone bromide)

3 DSL = 30 days

REMICADE INTRAVENOUS SOLUTION RECONSTITUTED 100 MG (infliximab)

2

RENFLEXIS INTRAVENOUS SOLUTION RECONSTITUTED 100 MG (infliximab-abda)

3

RESTORA RX ORAL CAPSULE 60-125 MG (lactobacillus casei-folic acid)

3

SIMPONI ARIA INTRAVENOUS SOLUTION 50 MG4ML (golimumab)

3

SIMPONI SUBCUTANEOUS SOLUTION AUTO-INJECTOR 100 MGML 50 MG05ML (golimumab)

3 DSL = 30 days

SIMPONI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MGML 50 MG05ML (golimumab)

3 DSL = 30 days

SYMPROIC ORAL TABLET 02 MG (naldemedine tosylate) 3

TRULANCE ORAL TABLET 3 MG (plecanatide) 3

VIBERZI ORAL TABLET 100 MG 75 MG (eluxadoline) 3 DSL = 30 days

VISBIOME ORAL PACKET (probiotic product) 3

XENICAL ORAL CAPSULE 120 MG (orlistat) 2

ZELAC ORAL CAPSULE 3

ZELNORM ORAL TABLET 6 MG (tegaserod maleate) 3 DSL = 30 days

HISTAMINE H2-ANTAGONISTS - Drugs for Ulcers and Stomach Acid

acid reducer oral tablet 10 mg PV

cimetidine hcl oral solution 300 mg5ml PV

cimetidine oral tablet 200 mg 300 mg 400 mg 800 mg PV


famotidine oral suspension reconstituted 40 mg5ml PV

famotidine oral tablet 20 mg 40 mg PV

famotidine orig st oral tablet 10 mg PV

nizatidine oral capsule 150 mg 300 mg PV

nizatidine oral solution 15 mgml PV

PEPCID ORAL TABLET 20 MG 40 MG (famotidine) PV

NEUROKININ-1 RECEPTOR ANTAGONISTS - Drugs for Vomiting and Nausea


3


3


203



2 DSL = 30 days

aprepitant oral 80 amp 125 mg PV DSL = 30 days

aprepitant oral capsule 125 mg 40 mg 80 amp 125 mg 80 mg PV DSL = 30 days

EMEND INTRAVENOUS SOLUTION RECONSTITUTED 150 MG (fosaprepitant dimeglumine)

PV

EMEND ORAL CAPSULE 80 MG (aprepitant) PV DSL = 30 days

EMEND ORAL SUSPENSION RECONSTITUTED 125 MG5ML (aprepitant)

PV DSL = 30 days

EMEND TRI-PACK ORAL CAPSULE 80 amp 125 MG (aprepitant) PV DSL = 30 days

fosaprepitant dimeglumine intravenous solution reconstituted150 mg

PV

VARUBI (180 MG DOSE) ORAL TABLET THERAPY PACK 2 X 90 MG (rolapitant hcl)

PV

PROKINETIC AGENTS - Drugs for the Stomach

GIMOTI NASAL SOLUTION 15 MGACT (metoclopramide hcl) PV DSL = 30 days

metoclopramide hcl oral solution 10 mg10ml 5 mg5ml PV

metoclopramide hcl oral tablet 10 mg 5 mg PV

metoclopramide hcl oral tablet dispersible 10 mg 5 mg PV

MOTEGRITY ORAL TABLET 1 MG 2 MG (prucalopride succinate)

3

REGLAN ORAL TABLET 10 MG 5 MG (metoclopramide hcl) PV


PROSTAGLANDINS - Drugs for Ulcers and Stomach Acid

CYTOTEC ORAL TABLET 100 MCG 200 MCG (misoprostol) PV


1

misoprostol oral tablet 100 mcg 200 mcg PV

PROTECTANTS - Drugs for Ulcers and Stomach Acid

CARAFATE ORAL SUSPENSION 1 GM10ML (sucralfate) PV

CARAFATE ORAL TABLET 1 GM (sucralfate) PV

sucralfate oral suspension 1 gm10ml PV

sucralfate oral tablet 1 gm PV

PROTON-PUMP INHIBITORS - Drugs for Ulcers and Stomach Acid

ACIPHEX SPRINKLE ORAL CAPSULE SPRINKLE 10 MG 5 MG (rabeprazole sodium)

3



204



3

DEXILANT ORAL CAPSULE DELAYED RELEASE 30 MG 60 MG (dexlansoprazole)

3

ESOMEP-EZS ORAL KIT 20 MG (esomeprazole magnesium) PV

esomeprazole magnesium oral capsule delayed release 20 mg 40 mg

PV

esomeprazole magnesium oral packet 10 mg 20 mg 40 mg PV

ESOMEPRAZOLE STRONTIUM ORAL CAPSULE DELAYED RELEASE 493 MG

PV

FIRST-LANSOPRAZOLE ORAL SUSPENSION 3 MGML (lansoprazole)

PV

FIRST-OMEPRAZOLE ORAL SUSPENSION 2 MGML (omeprazole)

PV

lansoprazole oral capsule delayed release 15 mg 30 mg PV

lansoprazole oral tablet delayed release dispersible 15 mg 30 mg

PV


1

NEXIUM ORAL CAPSULE DELAYED RELEASE 20 MG 40 MG (esomeprazole magnesium)

PV

NEXIUM ORAL PACKET 10 MG 25 MG 20 MG 40 MG 5 MG (esomeprazole magnesium)

PV


3

omeprazole magnesium oral tablet delayed release 20 mg PV

omeprazole oral capsule delayed release 10 mg 20 mg 40 mg PV

omeprazole oral tablet delayed release 20 mg PV

OMEPRAZOLE+SYRSPEND SF ALKA ORAL SUSPENSION 2 MGML (omeprazole)

PV

omeprazole-sodium bicarbonate oral capsule 20-1100 mg 40-1100 mg

1

omeprazole-sodium bicarbonate oral packet 20-1680 mg 40-1680 mg

1

pantoprazole sodium oral packet 40 mg PV

pantoprazole sodium oral tablet delayed release 20 mg 40 mg PV

PREVACID 24HR ORAL CAPSULE DELAYED RELEASE 15 MG (lansoprazole)

PV

PREVACID ORAL CAPSULE DELAYED RELEASE 15 MG 30 MG (lansoprazole)

PV


205


PREVACID SOLUTAB ORAL TABLET DELAYED RELEASE DISPERSIBLE 15 MG 30 MG (lansoprazole)

PV

PRILOSEC ORAL PACKET 10 MG 25 MG (omeprazole magnesium)

PV

PROTONIX ORAL PACKET 40 MG (pantoprazole sodium) PV

PROTONIX ORAL TABLET DELAYED RELEASE 20 MG 40 MG (pantoprazole sodium)

PV

RABEPRAZOLE SODIUM ORAL CAPSULE SPRINKLE 10 MG 3

rabeprazole sodium oral tablet delayed release 20 mg 1


3


3

GOLD COMPOUNDS

GOLD COMPOUNDS

RIDAURA ORAL CAPSULE 3 MG (auranofin) 2

HEAVY METAL ANTAGONISTS - Drugs to Reduce Iron


CHEMET ORAL CAPSULE 100 MG (succimer) 2

trientine hcl (Clovique Oral Capsule 250 Mg) 1 DSL = 30 days

CUPRIMINE ORAL CAPSULE 250 MG (penicillamine) 3

deferasirox granules oral packet 180 mg 360 mg 90 mg 1

deferasirox oral packet 180 mg 360 mg 90 mg 1

deferasirox oral tablet 180 mg 360 mg 90 mg 1

deferasirox oral tablet soluble 125 mg 250 mg 500 mg 1

deferiprone oral tablet 500 mg 1 DSL = 30 days

deferoxamine mesylate injection solution reconstituted 2 gm 500 mg

1

DEPEN TITRATABS ORAL TABLET 250 MG (penicillamine) 2

EXJADE ORAL TABLET SOLUBLE 125 MG 250 MG 500 MG (deferasirox)

2 DSL = 30 days

FERRIPROX ORAL SOLUTION 100 MGML (deferiprone) 3 DSL = 30 days

FERRIPROX ORAL TABLET 1000 MG (deferiprone) 3

FERRIPROX ORAL TABLET 500 MG (deferiprone) 3 DSL = 30 days

FERRIPROX TWICE-A-DAY ORAL TABLET 1000 MG (deferiprone)

3 DSL = 30 days

GALZIN ORAL CAPSULE 25 MG 50 MG (zinc acetate (oral)) 3

JADENU ORAL TABLET 180 MG 360 MG 90 MG (deferasirox)

2 DSL = 30 days


206


JADENU SPRINKLE ORAL PACKET 180 MG 360 MG 90 MG (deferasirox)

2 DSL = 30 days

penicillamine oral capsule 250 mg 1

penicillamine oral tablet 250 mg 1

trientine hcl oral capsule 250 mg 1 DSL = 30 days

WILZIN ORAL CAPSULE 25 MG (zinc acetate (oral)) 3

HORMONES AND SYNTHETIC SUBSTITUTES - Hormones

ADRENALS - Hormones

ACTIVE INJECTION D INJECTION KIT 10 MGML 3


2


2


3


3


3


3

ALKINDI SPRINKLE ORAL CAPSULE SPRINKLE 05 MG 1 MG 2 MG 5 MG (hydrocortisone)

3 DSL = 30 days

ALVESCO INHALATION AEROSOL SOLUTION 160 MCGACT 80 MCGACT (ciclesonide)

2

ARMONAIR DIGIHALER INHALATION AEROSOL POWDER BREATH ACTIVATED 113 MCGACT 232 MCGACT 55 MCGACT (fluticasone propionate (inhal))

3

ARNUITY ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 100 MCGACT 200 MCGACT 50 MCGACT (fluticasone furoate)

3

ASMANEX (120 METERED DOSES) INHALATION AEROSOL POWDER BREATH ACTIVATED 220 MCGINH (mometasone furoate)

2


2


207


ASMANEX (30 METERED DOSES) INHALATION AEROSOL POWDER BREATH ACTIVATED 110 MCGINH 220 MCGINH (mometasone furoate)

2


2


2

ASMANEX HFA INHALATION AEROSOL 100 MCGACT 200 MCGACT (mometasone furoate)

2 DSL = 30 days

ASMANEX HFA INHALATION AEROSOL 50 MCGACT (mometasone furoate)

PV DSL = 30 days

BETA 1 KIT INJECTION KIT 30 MG5ML 3


3

BETAMETHASONE SOD PHOS amp ACET INJECTION SUSPENSION 7 (4-3) MGML

3

BETAMETHASONE SOD PHOS amp ACET SUSPENSION 6 (3-3) MGML INJECTION 6 (3-3) MGML

3

betamethasone sod phos amp acet suspension 6 (3-3) mgml injection 6 (3-3) mgml

1


3


3

BSP 0820 INJECTION KIT 30 MG5ML 3

budesonide er oral tablet extended release 24 hour 9 mg 1 DSL = 30 days

budesonide inhalation suspension 025 mg2ml 05 mg2ml 1 mg2ml

1

budesonide oral capsule delayed release particles 3 mg 1 DSL = 30 days


3

dexamethasone (Decadron Oral Tablet 05 Mg 075 Mg 4 Mg 6 Mg)

3

DEPO-MEDROL INJECTION SUSPENSION 20 MGML 40 MGML 80 MGML (methylprednisolone acetate)

PV

DEXABLISS ORAL TABLET THERAPY PACK 15 MG (39) 3

dexamethasone intensol oral concentrate 1 mgml 1

dexamethasone oral elixir 05 mg5ml 1


208


dexamethasone oral solution 05 mg5ml 1

dexamethasone oral tablet 05 mg 075 mg 1 mg 15 mg 2 mg 4 mg 6 mg

1

dexamethasone oral tablet therapy pack 15 mg (21) 15 mg (35) 15 mg (51)

1

dexamethasone sod phosphate pf injection solution 10 mgml 1

dexamethasone sod phosphate pf injection solution prefilled syringe 10 mgml

1

dexamethasone sodium phosphate injection solution 100 mg10ml 120 mg30ml 20 mg5ml

1

DEXAMETHASONE SODIUM PHOSPHATE SOLUTION 10 MGML INJECTION 10 MGML

3

dexamethasone sodium phosphate solution 10 mgml injection10 mgml

1


3

dexamethasone sodium phosphate solution 4 mgml injection 4 mgml

1

DEXONTO 04 IONTOPHORESIS SOLUTION 20 MG5ML (dexamethasone sodium phosphate)

3


3

DOUBLEDEX INJECTION KIT 10 MGML (dexamethasone sodium phosphate)

3


3

DXEVO 11-DAY ORAL TABLET THERAPY PACK 15 MG (dexamethasone)

3

EMFLAZA ORAL SUSPENSION 2275 MGML (deflazacort) 3 DSL = 30 days

EMFLAZA ORAL TABLET 18 MG 30 MG 36 MG 6 MG (deflazacort)

3 DSL = 30 days

ENTOCORT EC ORAL CAPSULE DELAYED RELEASE PARTICLES 3 MG (budesonide)

3 DSL = 30 days

FLOVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 100 MCGBLIST 250 MCGBLIST 50 MCGBLIST (fluticasone propionate (inhal))

3

FLOVENT HFA INHALATION AEROSOL 110 MCGACT 220 MCGACT (fluticasone propionate hfa)

3

FLOVENT HFA INHALATION AEROSOL 44 MCGACT (fluticasone propionate hfa)

2

fludrocortisone acetate oral tablet 01 mg 1


209



1


3

HEMADY ORAL TABLET 20 MG (dexamethasone) 3

dexamethasone (Hidex 6-Day Oral Tablet Therapy Pack 15 Mg (21))

3

hydrocortisone oral tablet 10 mg 20 mg 5 mg 1

INTRAROSA VAGINAL INSERT 65 MG (prasterone) 3

KENALOG INJECTION SUSPENSION 10 MGML 40 MGML (triamcinolone acetonide)

2

KENALOG-80 INJECTION SUSPENSION 80 MGML (triamcinolone acetonide)

3

MAS CARE-PAK INJECTION KIT 10 MGML (dexamethasone sodium phosphate)

3

MEDROL ORAL TABLET 16 MG 2 MG 32 MG 4 MG 8 MG (methylprednisolone)

PV

MEDROL ORAL TABLET THERAPY PACK 4 MG (methylprednisolone)

PV


3


3

METHYLPREDNISOLONE ACETATE INJECTION SUSPENSION 50 MGML

PV

METHYLPREDNISOLONE ACETATE SUSPENSION 40 MGML INJECTION 40 MGML

PV

methylprednisolone acetate suspension 40 mgml injection 40 mgml

PV


PV


PV

methylprednisolone oral tablet 16 mg 32 mg 4 mg 8 mg PV

methylprednisolone oral tablet therapy pack 4 mg PV

MILLIPRED ORAL TABLET 5 MG (prednisolone) 2

ORTIKOS ORAL CAPSULE EXTENDED RELEASE 24 HOUR 6 MG 9 MG (budesonide)

3 DSL = 30 days

P-CARE K40 INJECTION KIT 40 MGML 3


210



P-CARE K80 INJECTION KIT 2 X 40 MGML 3


physicians ez use jointtunnel combination kit 40-1 mgml- 1

PHYSICIANS EZ USE M-PRED INJECTION KIT 40-05 MGML-

3

POD-CARE 100K INJECTION KIT 40 MGML 3

prednisolone oral solution 15 mg5ml 1

prednisolone sodium phosphate oral solution 10 mg5ml 15 mg5ml 20 mg5ml 25 mg5ml 67 (5 base) mg5ml

1

prednisolone sodium phosphate oral tablet dispersible 10 mg 15 mg 30 mg

1

prednisone intensol oral concentrate 5 mgml PV

prednisone oral solution 5 mg5ml PV

prednisone oral tablet 1 mg 10 mg 25 mg 20 mg 5 mg 50 mg

PV

prednisone oral tablet therapy pack 10 mg (21) 10 mg (48) 5 mg (21) 5 mg (48)

PV

PRO-C-DURE 5 INJECTION KIT 2 X 40 MGML (triamcinolone acetonide)

3


3

PULMICORT FLEXHALER INHALATION AEROSOL POWDER BREATH ACTIVATED 180 MCGACT (budesonide)

2


3

PULMICORT SUSPENSION INHALATION SUSPENSION 025 MG2ML 05 MG2ML 1 MG2ML (budesonide)

3

QVAR REDIHALER INHALATION AEROSOL BREATH ACTIVATED 40 MCGACT 80 MCGACT (beclomethasone diprop hfa)

3

RAYOS ORAL TABLET DELAYED RELEASE 1 MG 2 MG 5 MG (prednisone)

PV

READYSHARP BETAMETHASONE INJECTION KIT 30 MG5ML (betamethasone sod phos amp acet)

3

READYSHARP DEXAMETHASONE INJECTION KIT 10 MGML (dexamethasone sodium phosphate)

3

SOLU-CORTEF INJECTION SOLUTION RECONSTITUTED 100 MG (hydrocortisone sod succinate)

2


3


211


TAPERDEX 12-DAY ORAL TABLET THERAPY PACK 15 MG (49) (dexamethasone)

3

dexamethasone (Taperdex 6-Day Oral Tablet Therapy Pack 15 Mg 15 Mg (21))

3


3


3

TRIAMCINOLONE ACETONIDE INJECTION SUSPENSION 50 MGML

3

triamcinolone acetonide suspension 40 mgml injection 40 mgml

1

TRIAMCINOLONE ACETONIDE SUSPENSION 40 MGML INJECTION 40 MGML

2


3


3

UCERIS ORAL TABLET EXTENDED RELEASE 24 HOUR 9 MG (budesonide)

3 DSL = 30 days

UCERIS RECTAL FOAM 2 MGACT (budesonide) 3


1

ZCORT 7-DAY ORAL TABLET THERAPY PACK 15 MG (25) 3

ZILRETTA INTRA-ARTICULAR SUSPENSION RECONSTITUTED ER 32 MG (triamcinolone acetonide)

3

ALPHA-GLUCOSIDASE INHIBITORS - Drugs for Diabetes

acarbose oral tablet 100 mg 25 mg 50 mg 2

miglitol oral tablet 100 mg 25 mg 50 mg 2

PRECOSE ORAL TABLET 100 MG 25 MG 50 MG (acarbose) 2

AMYLINOMIMETICS - Drugs for Diabetes

SYMLINPEN 120 SUBCUTANEOUS SOLUTION PEN-INJECTOR 2700 MCG27ML (pramlintide acetate)

2


2

ANDROGENS - Hormones

ANDRODERM TRANSDERMAL PATCH 24 HOUR 2 MG24HR 4 MG24HR (testosterone)

2


212


AVEED INTRAMUSCULAR SOLUTION 750 MG3ML (testosterone undecanoate)

3

est estrogens-methyltest (Covaryx Hs Oral Tablet 0625-125 Mg)

3

est estrogens-methyltest (Covaryx Oral Tablet 125-25 Mg) 3

danazol oral capsule 100 mg 200 mg 50 mg 1

DEPO-TESTOSTERONE INTRAMUSCULAR SOLUTION 100 MGML 200 MGML (testosterone cypionate)

2

est estrogens-methyltest (Eemt Hs Oral Tablet 0625-125 Mg) 3

est estrogens-methyltest (Eemt Oral Tablet 125-25 Mg) 3

est estrogens-methyltest ds oral tablet 125-25 mg 1

est estrogens-methyltest hs oral tablet 0625-125 mg 1

est estrogens-methyltest oral tablet 0625-125 mg 125-25 mg 1

JATENZO ORAL CAPSULE 158 MG 198 MG 237 MG (testosterone undecanoate)

3 DSL = 30 days

METHITEST ORAL TABLET 10 MG 2

methyltestosterone oral capsule 10 mg 1

NATESTO NASAL GEL 55 MGACT (testosterone) 3

oxandrolone oral tablet 10 mg 25 mg 1

TESTONE CIK INTRAMUSCULAR KIT 200 MGML (testosterone cypionate)

3

TESTOPEL IMPLANT PELLET 75 MG (testosterone) 3

TESTOSTERONE CYPIONATE INJECTION SOLUTION 200 MGML

2

testosterone cypionate intramuscular solution 100 mgml 200 mgml

1

testosterone enanthate intramuscular solution 200 mgml 1

TESTOSTERONE IMPLANT PELLET 100 MG 200 MG 50 MG 3

testosterone transdermal gel 162 10 mgact (2) 125 mgact (1) 2025 mg125gm (162) 2025 mgact (162) 25 mg25gm (1) 405 mg25gm (162) 50 mg5gm (1)

1

testosterone transdermal solution 30 mgact 1

VOGELXO PUMP TRANSDERMAL GEL 125 MGACT (1) (testosterone)

2

XYOSTED SUBCUTANEOUS SOLUTION AUTO-INJECTOR 100 MG05ML 50 MG05ML 75 MG05ML (testosterone enanthate)

3

ANTIDIABETIC AGENTS MISCELLANEOUS - Drugs for Diabetes



213



KORLYM ORAL TABLET 300 MG (mifepristone) 2 DSL = 30 days



ANTIESTROGENS - Drugs for Women







3 DSL = 30 days OC


ANTIGONADTROPINS - Hormones

CETROTIDE SUBCUTANEOUS KIT 025 MG (cetrorelix acetate)

2

ganirelix acetate subcutaneous solution prefilled syringe 250 mcg05ml

2


ORIAHNN ORAL CAPSULE THERAPY PACK 300-1-05 amp 300 MG (elagolix-estradiol-norethind)

3 DSL = 30 days

ORILISSA ORAL TABLET 150 MG 200 MG (elagolix sodium) 3 DSL = 30 days

ANTIHYPOGLYCEMIC AGENTS MISCELLANEOUS - Hormones

diazoxide oral suspension 50 mgml 2

PROGLYCEM ORAL SUSPENSION 50 MGML (diazoxide) 2

ANTIPARATHYROID AGENTS - Drugs for Bones

calcitonin (salmon) nasal solution 200 unitact 1

cinacalcet hcl oral tablet 30 mg 60 mg 90 mg 1

MIACALCIN INJECTION SOLUTION 200 UNITML (calcitonin (salmon))

3 DSL = 30 days

PARSABIV INTRAVENOUS SOLUTION 10 MG2ML 25 MG05ML 5 MGML (etelcalcetide hcl)

3

SENSIPAR ORAL TABLET 30 MG 60 MG 90 MG (cinacalcet hcl)

3

ANTITHYROID AGENTS - Drugs for the Thyroid


methimazole oral tablet 10 mg 5 mg 1

propylthiouracil oral tablet 50 mg 1


214



3

BIGUANIDES - Drugs for Diabetes

ACTOPLUS MET ORAL TABLET 15-500 MG 15-850 MG (pioglitazone hcl-metformin hcl)

2

ALOGLIPTIN-METFORMIN HCL ORAL TABLET 125-1000 MG 125-500 MG

2

FORTAMET ORAL TABLET EXTENDED RELEASE 24 HOUR 1000 MG 500 MG (metformin hcl)

2

glipizide-metformin hcl oral tablet 25-250 mg 25-500 mg 5-500 mg

2

GLUMETZA ORAL TABLET EXTENDED RELEASE 24 HOUR 1000 MG 500 MG (metformin hcl)

2

glyburide-metformin oral tablet 125-250 mg 25-500 mg 5-500 mg

2

INVOKAMET ORAL TABLET 150-1000 MG 150-500 MG 50-1000 MG 50-500 MG (canagliflozin-metformin hcl)

2

INVOKAMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 150-1000 MG 150-500 MG 50-1000 MG 50-500 MG (canagliflozin-metformin hcl)

2

JANUMET ORAL TABLET 50-1000 MG 50-500 MG (sitagliptin-metformin hcl)

2

JANUMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 100-1000 MG 50-1000 MG 50-500 MG (sitagliptin-metformin hcl)

2

JENTADUETO ORAL TABLET 25-1000 MG 25-500 MG 25-850 MG (linagliptin-metformin hcl)

2

JENTADUETO XR ORAL TABLET EXTENDED RELEASE 24 HOUR 25-1000 MG 5-1000 MG (linagliptin-metformin hcl)

2

KAZANO ORAL TABLET 125-1000 MG 125-500 MG (alogliptin-metformin hcl)

2

KOMBIGLYZE XR ORAL TABLET EXTENDED RELEASE 24 HOUR 25-1000 MG 5-1000 MG 5-500 MG (saxagliptin-metformin)

2

metformin hcl er (mod) oral tablet extended release 24 hour1000 mg 500 mg

2

metformin hcl er (osm) oral tablet extended release 24 hour1000 mg 500 mg

2

metformin hcl er oral tablet extended release 24 hour 500 mg 750 mg

2

metformin hcl oral solution 500 mg5ml 2

metformin hcl oral tablet 1000 mg 500 mg 850 mg 2


215


pioglitazone hcl-metformin hcl oral tablet 15-500 mg 15-850 mg 2

RIOMET ORAL SOLUTION 500 MG5ML (metformin hcl) 2

SEGLUROMET ORAL TABLET 25-1000 MG 25-500 MG 75-1000 MG 75-500 MG (ertugliflozin-metformin hcl)

2

SYNJARDY ORAL TABLET 125-1000 MG 125-500 MG 5-1000 MG 5-500 MG (empagliflozin-metformin hcl)

2

SYNJARDY XR ORAL TABLET EXTENDED RELEASE 24 HOUR 10-1000 MG 125-1000 MG 25-1000 MG 5-1000 MG (empagliflozin-metformin hcl)

2

TRIJARDY XR ORAL TABLET EXTENDED RELEASE 24 HOUR 10-5-1000 MG 125-25-1000 MG 25-5-1000 MG 5-25-1000 MG (empagliflozin-linaglip-metform)

2

XIGDUO XR ORAL TABLET EXTENDED RELEASE 24 HOUR 10-1000 MG 10-500 MG 25-1000 MG 5-1000 MG 5-500 MG (dapagliflozin-metformin hcl)

2

CONTRACEPTIVES - Drugs for Women

levonorgestrel-ethinyl estrad (Afirmelle Oral Tablet 01-20 Mg-Mcg)

PV

levonorgestrel-ethinyl estrad (Altavera Oral Tablet 015-30 Mg-Mcg)

PV

alyacen 135 oral tablet 1-35 mg-mcg PV


levonorgest-eth estrad 91-day (Amethia Oral Tablet 015-003 amp001 Mg)

PV

levonorgestrel-ethinyl estrad (Amethyst Oral Tablet 90-20 Mcg) PV

ANNOVERA VAGINAL RING 0013-015 MG24HR (segesterone-ethinyl estradiol)

PV

desogestrel-ethinyl estradiol (Apri Oral Tablet 015-30 Mg-Mcg) PV

norethin-eth estrad triphasic (Aranelle Oral Tablet 05105-35 Mg-Mcg)

PV

levonorgest-eth estrad 91-day (Ashlyna Oral Tablet 015-003 amp001 Mg)

PV

levonorgestrel-ethinyl estrad (Aubra Eq Oral Tablet 01-20 Mg-Mcg)

PV

levonorgestrel-ethinyl estrad (Aubra Oral Tablet 01-20 Mg-Mcg) PV

norethindrone acet-ethinyl est (Aurovela 1530 Oral Tablet 15-30 Mg-Mcg)

PV


PV

norethin ace-eth estrad-fe (Aurovela 24 Fe Oral Tablet 1-20 Mg-Mcg(24))

PV


216


norethin ace-eth estrad-fe (Aurovela Fe 1530 Oral Tablet 15-30 Mg-Mcg)

PV


PV

levonorgestrel-ethinyl estrad (Aviane Oral Tablet 01-20 Mg-Mcg)

PV

levonorgestrel-ethinyl estrad (Ayuna Oral Tablet 015-30 Mg-Mcg)

PV

desogestrel-ethinyl estradiol (Azurette Oral Tablet 015-002001 Mg (215))

PV

BALCOLTRA ORAL TABLET 01-20 MG-MCG(21) (levonorgest-eth estrad-fe bisg)

PV

norethindrone-eth estradiol (Balziva Oral Tablet 04-35 Mg-Mcg) PV

desogestrel-ethinyl estradiol (Bekyree Oral Tablet 015-002001 Mg (215))

PV

BEYAZ ORAL TABLET 3-002-0451 MG (drospiren-eth estrad-levomefol)

PV

norethin ace-eth estrad-fe (Blisovi 24 Fe Oral Tablet 1-20 Mg-Mcg(24))

PV

norethin ace-eth estrad-fe (Blisovi Fe 1530 Oral Tablet 15-30 Mg-Mcg)

PV


PV

briellyn oral tablet 04-35 mg-mcg PV

norethindrone (Camila Oral Tablet 035 Mg) PV

levonorgest-eth estrad 91-day (Camrese Lo Oral Tablet 01-002 amp 001 Mg)

PV

levonorgest-eth estrad 91-day (Camrese Oral Tablet 015-003 amp001 Mg)

PV

desogestrel-ethinyl estradiol (Caziant Oral Tablet 010125015 -0025 Mg)

PV

norethin ace-eth estrad-fe (Charlotte 24 Fe Oral Tablet Chewable 1-20 Mg-Mcg(24))

PV

levonorgestrel-ethinyl estrad (Chateal Eq Oral Tablet 015-30 Mg-Mcg)

PV

levonorgestrel-ethinyl estrad (Chateal Oral Tablet 015-30 Mg-Mcg)

PV

norgestrel-ethinyl estradiol (Cryselle-28 Oral Tablet 03-30 Mg-Mcg)

PV

norethindrone-eth estradiol (Cyclafem 135 Oral Tablet 1-35 Mg-Mcg)

PV


217


norethin-eth estrad triphasic (Cyclafem 777 Oral Tablet 050751-35 Mg-Mcg)

PV

desogestrel-ethinyl estradiol (Cyred Eq Oral Tablet 015-30 Mg-Mcg)

PV

desogestrel-ethinyl estradiol (Cyred Oral Tablet 015-30 Mg-Mcg)

PV

norethindrone-eth estradiol (Dasetta 135 Oral Tablet 1-35 Mg-Mcg)

PV

norethin-eth estrad triphasic (Dasetta 777 Oral Tablet 050751-35 Mg-Mcg)

PV

levonorgest-eth estrad 91-day (Daysee Oral Tablet 015-003 amp001 Mg)

PV

norethindrone (Deblitane Oral Tablet 035 Mg) PV

levonorgestrel-ethinyl estrad (Delyla Oral Tablet 01-20 Mg-Mcg)

PV

desogestrel-ethinyl estradiol oral tablet 015-002001 mg (215) 015-30 mg-mcg

PV

drospiren-eth estrad-levomefol oral tablet 3-002-0451 mg 3-003-0451 mg

PV

drospirenone-ethinyl estradiol oral tablet 3-002 mg 3-003 mg PV

norgestrel-ethinyl estradiol (Elinest Oral Tablet 03-30 Mg-Mcg) PV

ELLA ORAL TABLET 30 MG (ulipristal acetate) PV

etonogestrel-ethinyl estradiol (Eluryng Vaginal Ring 012-0015 Mg24Hr)

PV

desogestrel-ethinyl estradiol (Emoquette Oral Tablet 015-30 Mg-Mcg)

PV

levonorg-eth estrad triphasic (Enpresse-28 Oral Tablet 50-3075-40 125-30 Mcg)

PV

desogestrel-ethinyl estradiol (Enskyce Oral Tablet 015-30 Mg-Mcg)

PV

norethindrone (Errin Oral Tablet 035 Mg) PV

norgestimate-eth estradiol (Estarylla Oral Tablet 025-35 Mg-Mcg)

PV

ESTROSTEP FE ORAL TABLET 1-201-301-35 MG-MCG (norethindron-ethinyl estrad-fe)

PV

ethynodiol diac-eth estradiol oral tablet 1-35 mg-mcg 1-50 mg-mcg

PV

etonogestrel-ethinyl estradiol vaginal ring 012-0015 mg24hr PV

levonorgestrel-ethinyl estrad (Falmina Oral Tablet 01-20 Mg-Mcg)

PV


218


levonorgest-eth estrad 91-day (Fayosim Oral Tablet 42-21-21-7 Days)

PV

norgestimate-eth estradiol (Femynor Oral Tablet 025-35 Mg-Mcg)

PV

norethin ace-eth estrad-fe (Gemmily Oral Capsule 1-20 Mg-Mcg(24))

PV

GENERESS FE ORAL TABLET CHEWABLE 08-25 MG-MCG (norethin-eth estradiol-fe)

PV

norethindrone acet-ethinyl est (Hailey 1530 Oral Tablet 15-30 Mg-Mcg)

PV

norethin ace-eth estrad-fe (Hailey 24 Fe Oral Tablet 1-20 Mg-Mcg(24))

PV

norethin ace-eth estrad-fe (Hailey Fe 1530 Oral Tablet 15-30 Mg-Mcg)

PV


PV

norethindrone (Heather Oral Tablet 035 Mg) PV

levonorgest-eth estrad 91-day (Iclevia Oral Tablet 015-003 Mg)

PV

norethindrone (Incassia Oral Tablet 035 Mg) PV

levonorgest-eth estrad 91-day (Introvale Oral Tablet 015-003 Mg)

PV

desogestrel-ethinyl estradiol (Isibloom Oral Tablet 015-30 Mg-Mcg)

PV

levonorgest-eth estrad 91-day (Jaimiess Oral Tablet 015-003 amp001 Mg)

PV

drospirenone-ethinyl estradiol (Jasmiel Oral Tablet 3-002 Mg) PV

norethindrone (Jencycla Oral Tablet 035 Mg) PV

levonorgest-eth estrad 91-day (Jolessa Oral Tablet 015-003 Mg)

PV

desogestrel-ethinyl estradiol (Juleber Oral Tablet 015-30 Mg-Mcg)

PV

norethindrone acet-ethinyl est (Junel 1530 Oral Tablet 15-30 Mg-Mcg)

PV


PV

norethin ace-eth estrad-fe (Junel Fe 1530 Oral Tablet 15-30 Mg-Mcg)

PV


PV


219


norethin ace-eth estrad-fe (Junel Fe 24 Oral Tablet 1-20 Mg-Mcg(24))

PV

norethin-eth estradiol-fe (Kaitlib Fe Oral Tablet Chewable 08-25 Mg-Mcg)

PV

desogestrel-ethinyl estradiol (Kalliga Oral Tablet 015-30 Mg-Mcg)

PV

desogestrel-ethinyl estradiol (Kariva Oral Tablet 015-002001 Mg (215))

PV

ethynodiol diac-eth estradiol (Kelnor 135 Oral Tablet 1-35 Mg-Mcg)

PV


PV

levonorgestrel-ethinyl estrad (Kurvelo Oral Tablet 015-30 Mg-Mcg)

PV

KYLEENA INTRAUTERINE INTRAUTERINE DEVICE 195 MG (levonorgestrel)

PV

norethindrone acet-ethinyl est (Larin 1530 Oral Tablet 15-30 Mg-Mcg)

PV


PV

norethin ace-eth estrad-fe (Larin 24 Fe Oral Tablet 1-20 Mg-Mcg(24))

PV

norethin ace-eth estrad-fe (Larin Fe 1530 Oral Tablet 15-30 Mg-Mcg)

PV


PV

levonorgestrel-ethinyl estrad (Larissia Oral Tablet 01-20 Mg-Mcg)

PV

norethin-eth estradiol-fe (Layolis Fe Oral Tablet Chewable 08-25 Mg-Mcg)

PV

norethin-eth estrad triphasic (Leena Oral Tablet 05105-35 Mg-Mcg)

PV

levonorgestrel-ethinyl estrad (Lessina Oral Tablet 01-20 Mg-Mcg)

PV

levonorg-eth estrad triphasic (Levonest Oral Tablet 50-3075-40 125-30 Mcg)

PV

levonorgest-eth est amp eth est oral tablet 42-21-21-7 days PV

levonorgest-eth estrad 91-day oral tablet 01-002 amp 001 mg 015-003 amp001 mg 015-003 mg

PV

levonorgestrel oral tablet 15 mg PV

levonorgestrel-ethinyl estrad oral tablet 01-20 mg-mcg 015-30 mg-mcg 90-20 mcg

PV


220


levonorg-eth estrad triphasic oral tablet 50-3075-40 125-30 mcg

PV

levonorgestrel-ethinyl estrad (Levora 01530 (28) Oral Tablet 015-30 Mg-Mcg)

PV

LILETTA (52 MG) INTRAUTERINE INTRAUTERINE DEVICE 195 MCGDAY (levonorgestrel)

PV

levonorgestrel-ethinyl estrad (Lillow Oral Tablet 015-30 Mg-Mcg)

PV

LO LOESTRIN FE ORAL TABLET 1 MG-10 MCG 10 MCG (norethin-eth estrad-fe biphas)

PV

norethindrone acet-ethinyl est (Loestrin 1530 (21) Oral Tablet 15-30 Mg-Mcg)

PV


PV

norethin ace-eth estrad-fe (Loestrin Fe 1530 Oral Tablet 15-30 Mg-Mcg)

PV


PV

levonorgest-eth estrad 91-day (Lojaimiess Oral Tablet 01-002 amp 001 Mg)

PV

drospirenone-ethinyl estradiol (Loryna Oral Tablet 3-002 Mg) PV

LOSEASONIQUE ORAL TABLET 01-002 amp 001 MG (levonorgest-eth estrad 91-day)

PV

norgestrel-ethinyl estradiol (Low-Ogestrel Oral Tablet 03-30 Mg-Mcg)

PV

drospirenone-ethinyl estradiol (Lo-Zumandimine Oral Tablet 3-002 Mg)

PV

levonorgestrel-ethinyl estrad (Lutera Oral Tablet 01-20 Mg-Mcg)

PV

norethindrone (Lyleq Oral Tablet 035 Mg) PV

norethindrone (Lyza Oral Tablet 035 Mg) PV

marlissa oral tablet 015-30 mg-mcg PV

norethin ace-eth estrad-fe (Merzee Oral Capsule 1-20 Mg-Mcg(24))

PV

norethin ace-eth estrad-fe (Mibelas 24 Fe Oral Tablet Chewable 1-20 Mg-Mcg(24))

PV

norethindrone acet-ethinyl est (Microgestin 1530 Oral Tablet 15-30 Mg-Mcg)

PV


PV


221


norethin ace-eth estrad-fe (Microgestin 24 Fe Oral Tablet 1-20 Mg-Mcg)

PV

norethin ace-eth estrad-fe (Microgestin Fe 1530 Oral Tablet 15-30 Mg-Mcg)

PV


PV

norgestimate-eth estradiol (Mili Oral Tablet 025-35 Mg-Mcg) PV

MINASTRIN 24 FE ORAL TABLET CHEWABLE 1-20 MG-MCG(24) (norethin ace-eth estrad-fe)

PV

MIRCETTE ORAL TABLET 015-002001 MG (215) (desogestrel-ethinyl estradiol)

PV

MIRENA (52 MG) INTRAUTERINE INTRAUTERINE DEVICE 20 MCG24HR (levonorgestrel)

PV

norgestimate-eth estradiol (Mono-Linyah Oral Tablet 025-35 Mg-Mcg)

PV

NATAZIA ORAL TABLET 32-22-31 MG (estradiol valerate-dienogest)

PV

norethindrone-eth estradiol (Necon 0535 (28) Oral Tablet 05-35 Mg-Mcg)

PV

NEXPLANON SUBCUTANEOUS IMPLANT 68 MG (etonogestrel)

PV

drospirenone-ethinyl estradiol (Nikki Oral Tablet 3-002 Mg) PV

norethindrone (Nora-Be Oral Tablet 035 Mg) PV

norethin ace-eth estrad-fe oral capsule 1-20 mg-mcg(24) PV

norethin ace-eth estrad-fe oral tablet 1-20 mg-mcg 15-30 mg-mcg

PV

norethin ace-eth estrad-fe oral tablet chewable 1-20 mg-mcg(24)

PV

norethindrone acet-ethinyl est oral tablet 1-20 mg-mcg 15-30 mg-mcg

PV

norethindrone oral tablet 035 mg PV

norethin-eth estradiol-fe oral tablet chewable 04-35 mg-mcg 08-25 mg-mcg

PV

norgestimate-eth estradiol oral tablet 025-35 mg-mcg PV

norgestimate-ethinyl estradiol triphasic oral tablet0180215025 mg-25 mcg 0180215025 mg-35 mcg

PV

norethindrone (Norlyda Oral Tablet 035 Mg) PV

norethindrone (Norlyroc Oral Tablet 035 Mg) PV

norethindrone-eth estradiol (Nortrel 0535 (28) Oral Tablet 05-35 Mg-Mcg)

PV


222



PV


PV

norethin-eth estrad triphasic (Nortrel 777 Oral Tablet 050751-35 Mg-Mcg)

PV

NUVARING VAGINAL RING 012-0015 MG24HR (etonogestrel-ethinyl estradiol)

PV

norethin-eth estrad triphasic (Nylia 777 Oral Tablet 050751-35 Mg-Mcg)

PV

norgestimate-eth estradiol (Nymyo Oral Tablet 025-35 Mg-Mcg) PV

drospirenone-ethinyl estradiol (Ocella Oral Tablet 3-003 Mg) PV

levonorgestrel-ethinyl estrad (Orsythia Oral Tablet 01-20 Mg-Mcg)

PV

ORTHO MICRONOR ORAL TABLET 035 MG (norethindrone) PV

norethindrone-eth estradiol (Philith Oral Tablet 04-35 Mg-Mcg) PV

desogestrel-ethinyl estradiol (Pimtrea Oral Tablet 015-002001 Mg (215))

PV

norethindrone-eth estradiol (Pirmella 135 Oral Tablet 1-35 Mg-Mcg)

PV

norethin-eth estrad triphasic (Pirmella 777 Oral Tablet 050751-35 Mg-Mcg)

PV

PLAN B ONE-STEP ORAL TABLET 15 MG (levonorgestrel) PV

levonorgestrel-ethinyl estrad (Portia-28 Oral Tablet 015-30 Mg-Mcg)

PV

norgestimate-eth estradiol (Previfem Oral Tablet 025-35 Mg-Mcg)

PV

QUARTETTE ORAL TABLET 42-21-21-7 DAYS (levonorgest-eth estrad 91-day)

PV

desogestrel-ethinyl estradiol (Reclipsen Oral Tablet 015-30 Mg-Mcg)

PV

levonorgest-eth estrad 91-day (Rivelsa Oral Tablet 42-21-21-7 Days)

PV

SAFYRAL ORAL TABLET 3-003-0451 MG (drospiren-eth estrad-levomefol)

PV

SEASONIQUE ORAL TABLET 015-003 amp001 MG (levonorgest-eth estrad 91-day)

PV

levonorgest-eth estrad 91-day (Setlakin Oral Tablet 015-003 Mg)

PV

norethindrone (Sharobel Oral Tablet 035 Mg) PV


223


desogestrel-ethinyl estradiol (Simliya Oral Tablet 015-002001 Mg (215))

PV

levonorgest-eth estrad 91-day (Simpesse Oral Tablet 015-003 amp001 Mg)

PV

SKYLA INTRAUTERINE INTRAUTERINE DEVICE 135 MG (levonorgestrel)

PV

SLYND ORAL TABLET 4 MG (drospirenone) PV

norgestimate-eth estradiol (Sprintec 28 Oral Tablet 025-35 Mg-Mcg)

PV

levonorgestrel-ethinyl estrad (Sronyx Oral Tablet 01-20 Mg-Mcg)

PV

drospirenone-ethinyl estradiol (Syeda Oral Tablet 3-003 Mg) PV

norethin ace-eth estrad-fe (Tarina 24 Fe Oral Tablet 1-20 Mg-Mcg(24))

PV

norethin ace-eth estrad-fe (Tarina Fe 120 Eq Oral Tablet 1-20 Mg-Mcg)

PV

norethin ace-eth estrad-fe (Tarina Fe 120 Oral Tablet 1-20 Mg-Mcg)

PV

TAYTULLA ORAL CAPSULE 1-20 MG-MCG(24) (norethin ace-eth estrad-fe)

PV

norethindron-ethinyl estrad-fe (Tilia Fe Oral Tablet 1-201-301-35 Mg-Mcg)

PV

norgestim-eth estrad triphasic (Tri Femynor Oral Tablet 0180215025 Mg-35 Mcg)

PV

norgestim-eth estrad triphasic (Tri-Estarylla Oral Tablet 0180215025 Mg-35 Mcg)

PV

norethindron-ethinyl estrad-fe (Tri-Legest Fe Oral Tablet 1-201-301-35 Mg-Mcg)

PV

norgestim-eth estrad triphasic (Tri-Linyah Oral Tablet 0180215025 Mg-35 Mcg)

PV

norgestim-eth estrad triphasic (Tri-Lo-Estarylla Oral Tablet 0180215025 Mg-25 Mcg)

PV

norgestim-eth estrad triphasic (Tri-Lo-Marzia Oral Tablet 0180215025 Mg-25 Mcg)

PV

norgestim-eth estrad triphasic (Tri-Lo-Mili Oral Tablet 0180215025 Mg-25 Mcg)

PV

norgestim-eth estrad triphasic (Tri-Lo-Sprintec Oral Tablet 0180215025 Mg-25 Mcg)

PV

norgestim-eth estrad triphasic (Tri-Mili Oral Tablet 0180215025 Mg-35 Mcg)

PV

norgestim-eth estrad triphasic (Tri-Nymyo Oral Tablet 0180215025 Mg-35 Mcg)

PV


224


norgestim-eth estrad triphasic (Tri-Previfem Oral Tablet 0180215025 Mg-35 Mcg)

PV

norgestim-eth estrad triphasic (Tri-Sprintec Oral Tablet 0180215025 Mg-35 Mcg)

PV

levonorg-eth estrad triphasic (Trivora (28) Oral Tablet 50-3075-40 125-30 Mcg)

PV

norgestim-eth estrad triphasic (Tri-Vylibra Lo Oral Tablet 0180215025 Mg-25 Mcg)

PV

norgestim-eth estrad triphasic (Tri-Vylibra Oral Tablet 0180215025 Mg-35 Mcg)

PV

norethindrone (Tulana Oral Tablet 035 Mg) PV

TWIRLA TRANSDERMAL PATCH WEEKLY 120-30 MCG24HR (levonorgestrel-eth estradiol)

2

tyblume oral tablet chewable 01-20 mg-mcg PV

drospiren-eth estrad-levomefol (Tydemy Oral Tablet 3-003-0451 Mg)

PV

desogestrel-ethinyl estradiol (Velivet Oral Tablet 010125015 -0025 Mg)

PV

drospirenone-ethinyl estradiol (Vestura Oral Tablet 3-002 Mg) PV

levonorgestrel-ethinyl estrad (Vienva Oral Tablet 01-20 Mg-Mcg)

PV

viorele oral tablet 015-002001 mg (215) PV

desogestrel-ethinyl estradiol (Volnea Oral Tablet 015-002001 Mg (215))

PV

norethindrone-eth estradiol (Vyfemla Oral Tablet 04-35 Mg-Mcg)

PV

norgestimate-eth estradiol (Vylibra Oral Tablet 025-35 Mg-Mcg) PV

norethindrone-eth estradiol (Wera Oral Tablet 05-35 Mg-Mcg) PV

norethin-eth estradiol-fe (Wymzya Fe Oral Tablet Chewable 04-35 Mg-Mcg)

PV

norelgestromin-eth estradiol (Xulane Transdermal Patch Weekly 150-35 Mcg24Hr)

PV

YASMIN 28 ORAL TABLET 3-003 MG (drospirenone-ethinyl estradiol)

PV

YAZ ORAL TABLET 3-002 MG (drospirenone-ethinyl estradiol) PV

norelgestromin-eth estradiol (Zafemy Transdermal Patch Weekly 150-35 Mcg24Hr)

PV

drospirenone-ethinyl estradiol (Zarah Oral Tablet 3-003 Mg) PV

ethynodiol diac-eth estradiol (Zovia 135 (28) Oral Tablet 1-35 Mg-Mcg)

PV


225


ethynodiol diac-eth estradiol (Zovia 135E (28) Oral Tablet 1-35 Mg-Mcg)

PV

drospirenone-ethinyl estradiol (Zumandimine Oral Tablet 3-003 Mg)

PV

DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS - Drugs for Diabetes

ALOGLIPTIN BENZOATE ORAL TABLET 125 MG 25 MG 625 MG

2


2

ALOGLIPTIN-PIOGLITAZONE ORAL TABLET 125-15 MG 125-30 MG 125-45 MG 25-15 MG 25-30 MG 25-45 MG

2

GLYXAMBI ORAL TABLET 10-5 MG 25-5 MG (empagliflozin-linagliptin)

2


2


2

JANUVIA ORAL TABLET 100 MG 25 MG 50 MG (sitagliptin phosphate)

2


2


2


2


2

NESINA ORAL TABLET 125 MG 25 MG 625 MG (alogliptin benzoate)

2

ONGLYZA ORAL TABLET 25 MG 5 MG (saxagliptin hcl) 2

OSENI ORAL TABLET 125-15 MG 125-30 MG 125-45 MG 25-15 MG 25-30 MG 25-45 MG (alogliptin-pioglitazone)

2

QTERN ORAL TABLET 10-5 MG 5-5 MG (dapagliflozin-saxagliptin)

2

STEGLUJAN ORAL TABLET 15-100 MG 5-100 MG (ertugliflozin-sitagliptin)

2

TRADJENTA ORAL TABLET 5 MG (linagliptin) 2


226



2

ESTROGEN AGONIST-ANTAGONISTS - Drugs for Women

clomiphene citrate oral tablet 50 mg 2

DUAVEE ORAL TABLET 045-20 MG (conj estrogens-bazedoxifene)

3

EVISTA ORAL TABLET 60 MG (raloxifene hcl) 3


OSPHENA ORAL TABLET 60 MG (ospemifene) PV

raloxifene hcl oral tablet 60 mg 1




ESTROGENS - Drugs for Women

ACTIVELLA ORAL TABLET 1-05 MG (estradiol-norethindrone acet)

PV

ALORA TRANSDERMAL PATCH TWICE WEEKLY 0025 MG24HR 005 MG24HR 0075 MG24HR 01 MG24HR (estradiol)

PV

estradiol-norethindrone acet (Amabelz Oral Tablet 05-01 Mg 1-05 Mg)

PV

ANGELIQ ORAL TABLET 025-05 MG 05-1 MG (drospirenone-estradiol)

3

BIJUVA ORAL CAPSULE 1-100 MG (estradiol-progesterone) 3

CLIMARA PRO TRANSDERMAL PATCH WEEKLY 0045-0015 MGDAY (estradiol-levonorgestrel)

3

CLIMARA TRANSDERMAL PATCH WEEKLY 0025 MG24HR 00375 MG24HR 005 MG24HR 006 MG24HR 0075 MG24HR 01 MG24HR (estradiol)

PV

COMBIPATCH TRANSDERMAL PATCH TWICE WEEKLY 005-014 MGDAY 005-025 MGDAY (estradiol-norethindrone acet)

PV


3


DELESTROGEN INTRAMUSCULAR OIL 10 MGML (estradiol valerate)

3

DELESTROGEN INTRAMUSCULAR OIL 20 MGML 40 MGML (estradiol valerate)

2


227


DEPO-ESTRADIOL INTRAMUSCULAR OIL 5 MGML (estradiol cypionate)

2

DIVIGEL TRANSDERMAL GEL 025 MG025GM 05 MG05GM 075 MG075GM 1 MGGM 125 MG125GM (estradiol)

PV

estradiol (Dotti Transdermal Patch Twice Weekly 0025 Mg24Hr 00375 Mg24Hr 005 Mg24Hr 0075 Mg24Hr 01 Mg24Hr)

PV


3



ELESTRIN TRANSDERMAL GEL 052 MG087 GM (006) (estradiol)

PV




ESTRACE ORAL TABLET 05 MG 1 MG 2 MG (estradiol) PV

ESTRACE VAGINAL CREAM 01 MGGM (estradiol) 2

estradiol oral tablet 05 mg 1 mg 2 mg PV

estradiol transdermal patch twice weekly 0025 mg24hr 00375 mg24hr 005 mg24hr 0075 mg24hr 01 mg24hr

PV

estradiol transdermal patch weekly 0025 mg24hr 00375 mg24hr 005 mg24hr 006 mg24hr 0075 mg24hr 01 mg24hr

PV

estradiol vaginal cream 01 mggm 1

estradiol vaginal tablet 10 mcg 1

estradiol valerate intramuscular oil 20 mgml 40 mgml 1

estradiol-norethindrone acet oral tablet 05-01 mg 1-05 mg PV

ESTRING VAGINAL RING 2 MG (estradiol) 2

ESTROGEL TRANSDERMAL GEL 075 MG125 GM (006) (estradiol)

PV

EVAMIST TRANSDERMAL SOLUTION 153 MGSPRAY (estradiol)

PV

FEMHRT LOW DOSE ORAL TABLET 05-25 MG-MCG (norethindrone-eth estradiol)

PV

FEMRING VAGINAL RING 005 MG24HR 01 MG24HR (estradiol acetate)

3

norethindrone-eth estradiol (Fyavolv Oral Tablet 05-25 Mg-Mcg 1-5 Mg-Mcg)

PV


228


IMVEXXY MAINTENANCE PACK VAGINAL INSERT 10 MCG 4 MCG (estradiol)

3

IMVEXXY STARTER PACK VAGINAL INSERT 10 MCG 4 MCG (estradiol)

3

norethindrone-eth estradiol (Jinteli Oral Tablet 1-5 Mg-Mcg) PV

estradiol (Lyllana Transdermal Patch Twice Weekly 0025 Mg24Hr 00375 Mg24Hr 005 Mg24Hr 0075 Mg24Hr 01 Mg24Hr)

PV

MENEST ORAL TABLET 03 MG 0625 MG 125 MG (esterified estrogens)

PV

MENOSTAR TRANSDERMAL PATCH WEEKLY 14 MCG24HR (estradiol)

PV

estradiol-norethindrone acet (Mimvey Oral Tablet 1-05 Mg) PV

MINIVELLE TRANSDERMAL PATCH TWICE WEEKLY 0025 MG24HR 00375 MG24HR 005 MG24HR 0075 MG24HR 01 MG24HR (estradiol)

PV

norethindrone-eth estradiol oral tablet 05-25 mg-mcg 1-5 mg-mcg

PV


3 DSL = 30 days

PREFEST ORAL TABLET 11-009 MG (1515) (estradiol-norgestimate)

3

PREMARIN ORAL TABLET 03 MG 045 MG 0625 MG 09 MG 125 MG (estrogens conjugated)

PV

PREMARIN VAGINAL CREAM 0625 MGGM (estrogens conjugated)

3

PREMPHASE ORAL TABLET 0625-5 MG (conj estrog-medroxyprogest ace)

PV

PREMPRO ORAL TABLET 03-15 MG 045-15 MG 0625-25 MG 0625-5 MG (conj estrog-medroxyprogest ace)

PV

VAGIFEM VAGINAL TABLET 10 MCG (estradiol) 2

VIVELLE-DOT TRANSDERMAL PATCH TWICE WEEKLY 0025 MG24HR 00375 MG24HR 005 MG24HR 0075 MG24HR 01 MG24HR (estradiol)

PV

estradiol (Yuvafem Vaginal Tablet 10 Mcg) 1

GLYCOGENOLYTIC AGENTS - Hormones

BAQSIMI ONE PACK NASAL POWDER 3 MGDOSE (glucagon)

2

BAQSIMI TWO PACK NASAL POWDER 3 MGDOSE (glucagon)

2

GLUCAGEN HYPOKIT INJECTION SOLUTION RECONSTITUTED 1 MG (glucagon hcl (rdna))

2


229


glucagon emergency kit 1 mg injection 1 mg PV

GLUCAGON EMERGENCY KIT 1 MG INJECTION 1 MG PV

GLUCAGON EMERGENCY KIT INJECTION SOLUTION RECONSTITUTED 1 MGML

2

GVOKE HYPOPEN 1-PACK SUBCUTANEOUS SOLUTION AUTO-INJECTOR 05 MG01ML 1 MG02ML (glucagon)

2


2

GVOKE PFS SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 05 MG01ML 1 MG02ML (glucagon)

2

ZEGALOGUE SUBCUTANEOUS SOLUTION AUTO-INJECTOR 06 MG06ML (dasiglucagon hcl)

2

ZEGALOGUE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 06 MG06ML (dasiglucagon hcl)

2

GONADOTROPINS - Hormones

chorionic gonadotropin intramuscular solution reconstituted10000 unit

2


3


3


3



3

FOLLISTIM AQ SUBCUTANEOUS SOLUTION 300 UNT036ML 600 UNT072ML 900 UNT108ML (follitropin beta)

2

GONAL-F INJECTION SOLUTION RECONSTITUTED 1050 UNIT 450 UNIT (follitropin alfa)

2

GONAL-F RFF REDIJECT SUBCUTANEOUS SOLUTION 300 UNIT05ML 450 UNT075ML 900 UNIT15ML (follitropin alfa)

2

GONAL-F RFF SUBCUTANEOUS SOLUTION RECONSTITUTED 75 UNIT (follitropin alfa)

2



3


2


230



2


2


2


2


2

MENOPUR SUBCUTANEOUS SOLUTION RECONSTITUTED 75 UNIT (menotropins)

2

novarel intramuscular solution reconstituted 10000 unit 2

NOVAREL INTRAMUSCULAR SOLUTION RECONSTITUTED 5000 UNIT (chorionic gonadotropin)

2

OVIDREL SUBCUTANEOUS INJECTABLE 250 MCG05ML (choriogonadotropin alfa)

2

pregnyl intramuscular solution reconstituted 10000 unit 2


3

SYNAREL NASAL SOLUTION 2 MGML (nafarelin acetate) 2


3


3


GONADOTROPINS AND ANTIGONADOTROPINS - Hormones


2


3


3


3



2


231



2


2


2



3


2


2


2


2


2


2


2



2


2



3



3


INCRETIN MIMETICS - Drugs for Diabetes

ADLYXIN STARTER PACK SUBCUTANEOUS PEN-INJECTOR KIT 10 amp 20 MCG02ML (lixisenatide)

2

ADLYXIN SUBCUTANEOUS SOLUTION PEN-INJECTOR 20 MCG02ML (lixisenatide)

2


232


BYDUREON BCISE AUTOINJECTOR SUBCUTANEOUS AUTO-INJECTOR 2 MG085ML (exenatide)

2

BYETTA 10 MCG PEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 10 MCG004ML (exenatide)

2


2

OZEMPIC SUBCUTANEOUS SOLUTION PEN-INJECTOR 2 MG15ML 4 MG3ML (semaglutide)

2

RYBELSUS ORAL TABLET 14 MG 3 MG 7 MG (semaglutide) 2 DSL = 30 days

SAXENDA SUBCUTANEOUS SOLUTION PEN-INJECTOR 18 MG3ML (liraglutide -weight management)

2

SOLIQUA SUBCUTANEOUS SOLUTION PEN-INJECTOR 100-33 UNT-MCGML (insulin glargine-lixisenatide)

2 DSL = 30 days

TRULICITY SUBCUTANEOUS SOLUTION PEN-INJECTOR 075 MG05ML 15 MG05ML 3 MG05ML 45 MG05ML (dulaglutide)

2 DSL = 30 days

VICTOZA SUBCUTANEOUS SOLUTION PEN-INJECTOR 18 MG3ML (liraglutide)

2

XULTOPHY SUBCUTANEOUS SOLUTION PEN-INJECTOR 100-36 UNIT-MGML (insulin degludec-liraglutide)

2 DSL = 30 days

INSULINS - Drugs for Diabetes

ADMELOG SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNITML (insulin lispro)

2

ADMELOG SUBCUTANEOUS SOLUTION 100 UNITML (insulin lispro)

2

AFREZZA INHALATION POWDER 12 UNIT 4 amp 8 amp 12 UNIT 4 UNIT 8 UNIT 90 X 4 UNIT amp 90X8 UNIT (insulin regular human)

2

AFREZZA INHALATION POWDER 90 X 8 UNIT amp 90X12 UNIT (insulin regular human)

2 DSL = 30 days

APIDRA SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNITML (insulin glulisine)

2

APIDRA VIAL INJECTION SOLUTION 100 UNITML (insulin glulisine)

2

BASAGLAR KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNITML (insulin glargine)

2

FIASP FLEXTOUCH SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNITML (insulin aspart (wniacinamide))

2

FIASP PENFILL SUBCUTANEOUS SOLUTION CARTRIDGE 100 UNITML (insulin aspart (wniacinamide))

2

FIASP SUBCUTANEOUS SOLUTION 100 UNITML (insulin aspart (wniacinamide))

2


233


HUMALOG KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNITML 200 UNITML (insulin lispro)

2

HUMALOG MIX 5050 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR (50-50) 100 UNITML (insulin lispro prot amp lispro)

2

HUMALOG MIX 5050 VIAL SUBCUTANEOUS SUSPENSION (50-50) 100 UNITML (insulin lispro prot amp lispro)

2


2


2

HUMALOG U-100 JUNIOR KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNITML (insulin lispro)

2

HUMALOG VIAL SUBCUTANEOUS SOLUTION 100 UNITML (insulin lispro)

2

HUMALOG VIAL SUBCUTANEOUS SOLUTION CARTRIDGE 100 UNITML (insulin lispro)

2

HUMULIN 7030 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR (70-30) 100 UNITML (insulin nph isophane amp regular)

2

HUMULIN 7030 VIAL SUBCUTANEOUS SUSPENSION (70-30) 100 UNITML (insulin nph isophane amp regular)

2

HUMULIN N KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR 100 UNITML (insulin nph human (isophane))

2

HUMULIN N VIAL SUBCUTANEOUS SUSPENSION 100 UNITML (insulin nph human (isophane))

2

HUMULIN R U-500 KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 500 UNITML (insulin regular human)

PV

HUMULIN R U-500 VIAL SUBCUTANEOUS SOLUTION 500 UNITML (insulin regular human)

2

HUMULIN R VIAL INJECTION SOLUTION 100 UNITML (insulin regular human)

2

INSULIN ASP PROT amp ASP FLEXPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR (70-30) 100 UNITML

2

INSULIN ASPART FLEXPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNITML

2

INSULIN ASPART PENFILL SUBCUTANEOUS SOLUTION CARTRIDGE 100 UNITML

2

INSULIN ASPART PROT amp ASPART SUBCUTANEOUS SUSPENSION (70-30) 100 UNITML

2


234


INSULIN ASPART SUBCUTANEOUS SOLUTION 100 UNITML

2

INSULIN LISPRO (1 UNIT DIAL) SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNITML

2

INSULIN LISPRO JUNIOR KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNITML

2

INSULIN LISPRO PROT amp LISPRO SUBCUTANEOUS SUSPENSION PEN-INJECTOR (75-25) 100 UNITML

2

INSULIN LISPRO SUBCUTANEOUS SOLUTION 100 UNITML 2

LANTUS SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNITML (insulin glargine)

2

LANTUS U-100 VIAL SUBCUTANEOUS SOLUTION 100 UNITML (insulin glargine)

2

LEVEMIR U-100 FLEXTOUCH SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNITML (insulin detemir)

2

LEVEMIR U-100 VIAL SUBCUTANEOUS SOLUTION 100 UNITML (insulin detemir)

2

LYUMJEV KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNITML 200 UNITML (insulin lispro-aabc)

2

LYUMJEV VIAL INJECTION SOLUTION 100 UNITML (insulin lispro-aabc)

2

MYXREDLIN INTRAVENOUS SOLUTION 100-09 UT100ML- (insulin regular(human) in nacl)

2

NOVOLIN 7030 FLEXPEN RELION SUBCUTANEOUS SUSPENSION PEN-INJECTOR (70-30) 100 UNITML (insulin nph isophane amp regular)

2

NOVOLIN 7030 FLEXPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR (70-30) 100 UNITML (insulin nph isophane amp regular)

2

NOVOLIN 7030 RELION SUBCUTANEOUS SUSPENSION (70-30) 100 UNITML (insulin nph isophane amp regular)

2

NOVOLIN 7030 VIAL SUBCUTANEOUS SUSPENSION (70-30) 100 UNITML (insulin nph isophane amp regular)

2

NOVOLIN N FLEXPEN RELION SUBCUTANEOUS SUSPENSION PEN-INJECTOR 100 UNITML (insulin nph human (isophane))

2

NOVOLIN N FLEXPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR 100 UNITML (insulin nph human (isophane))

2

NOVOLIN N RELION SUBCUTANEOUS SUSPENSION 100 UNITML (insulin nph human (isophane))

2

NOVOLIN N VIAL SUBCUTANEOUS SUSPENSION 100 UNITML (insulin nph human (isophane))

2


235


NOVOLIN R FLEXPEN INJECTION SOLUTION PEN-INJECTOR 100 UNITML (insulin regular human)

2

NOVOLIN R FLEXPEN RELION INJECTION SOLUTION PEN-INJECTOR 100 UNITML (insulin regular human)

2

NOVOLIN R RELION INJECTION SOLUTION 100 UNITML (insulin regular human)

2

NOVOLIN R VIAL INJECTION SOLUTION 100 UNITML (insulin regular human)

2

NOVOLOG FLEXPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNITML (insulin aspart)

2

NOVOLOG MIX 7030 FLEXPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR (70-30) 100 UNITML (insulin aspart prot amp aspart)

2

NOVOLOG MIX 7030 VIAL SUBCUTANEOUS SUSPENSION (70-30) 100 UNITML (insulin aspart prot amp aspart)

2

NOVOLOG PENFILL SUBCUTANEOUS SOLUTION CARTRIDGE 100 UNITML (insulin aspart)

2

NOVOLOG U-100 VIAL SUBCUTANEOUS SOLUTION 100 UNITML (insulin aspart)

2

SEMGLEE SUBCUTANEOUS SOLUTION 100 UNITML (insulin glargine)

2 DSL = 30 days

SEMGLEE SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNITML (insulin glargine)

2 DSL = 30 days


2 DSL = 30 days

TOUJEO MAX SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR 300 UNITML (insulin glargine)

2 DSL = 30 days

TOUJEO SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR 300 UNITML (insulin glargine)

2 DSL = 30 days

TRESIBA FLEXTOUCH SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNITML 200 UNITML (insulin degludec)

2 DSL = 30 days

TRESIBA SUBCUTANEOUS SOLUTION 100 UNITML (insulin degludec)

2


2 DSL = 30 days

INTERMEDIATE-ACTING INSULINS - Drugs for Diabetes


2


2


236



2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


237



2

LEPTINS - Hormones

MYALEPT SUBCUTANEOUS SOLUTION RECONSTITUTED 113 MG (metreleptin)

3 DSL = 30 days

LONG-ACTING INSULINS - Drugs for Diabetes


2


2


2


2


2


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2


2 DSL = 30 days

MEGLITINIDES - Drugs for Diabetes

nateglinide oral tablet 120 mg 60 mg 2

repaglinide oral tablet 05 mg 1 mg 2 mg 2

STARLIX ORAL TABLET 120 MG (nateglinide) 2

PARATHYROID AGENTS - Drugs for Bones

FORTEO SUBCUTANEOUS SOLUTION PEN-INJECTOR 620 MCG248ML (teriparatide (recombinant))

2 DSL = 30 days

NATPARA SUBCUTANEOUS CARTRIDGE 100 MCG 25 MCG 50 MCG 75 MCG (parathyroid hormone (recomb))

3 DSL = 30 days


238


TERIPARATIDE (RECOMBINANT) SUBCUTANEOUS SOLUTION PEN-INJECTOR 620 MCG248ML

2 DSL = 30 days

TYMLOS SUBCUTANEOUS SOLUTION PEN-INJECTOR 3120 MCG156ML (abaloparatide)

3 DSL = 30 days

PARATHYROID AND ANTIPARATHYROID AGENTS - Drugs for Bones



2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days

PITUITARY - Hormones



2





desmopressin acetate spray nasal solution 001 1

GENOTROPIN MINIQUICK SUBCUTANEOUS SOLUTION RECONSTITUTED 02 MG 04 MG 06 MG 08 MG 1 MG 12 MG 14 MG 16 MG 18 MG 2 MG (somatropin)

2

GENOTROPIN SUBCUTANEOUS SOLUTION RECONSTITUTED 12 MG 5 MG (somatropin)

2

HUMATROPE INJECTION SOLUTION RECONSTITUTED 12 MG 24 MG 5 MG 6 MG (somatropin)

2


3

NORDITROPIN FLEXPRO SUBCUTANEOUS SOLUTION PEN-INJECTOR 10 MG15ML 15 MG15ML 30 MG3ML 5 MG15ML (somatropin)

2

NUTROPIN AQ NUSPIN 10 SUBCUTANEOUS SOLUTION PEN-INJECTOR 10 MG2ML (somatropin)

2


2


239



2

OMNITROPE SUBCUTANEOUS SOLUTION CARTRIDGE 10 MG15ML 5 MG15ML (somatropin)

2

OMNITROPE SUBCUTANEOUS SOLUTION RECONSTITUTED 58 MG (somatropin)

2

SAIZEN INJECTION SOLUTION RECONSTITUTED 5 MG 88 MG (somatropin (non-refrigerated))

2

SAIZENPREP INJECTION SOLUTION RECONSTITUTED 88 MG (somatropin (non-refrigerated))

2

SEROSTIM SUBCUTANEOUS SOLUTION RECONSTITUTED 4 MG 5 MG 6 MG (somatropin (non-refrigerated))

2


2

ZOMACTON (FOR ZOMA-JET 10) SUBCUTANEOUS SOLUTION RECONSTITUTED 10 MG (somatropin)

2

ZOMACTON SUBCUTANEOUS SOLUTION RECONSTITUTED 10 MG 5 MG (somatropin)

2

ZORBTIVE SUBCUTANEOUS SOLUTION RECONSTITUTED 88 MG (somatropin (non-refrigerated))

2

PROGESTINS - Drugs for Women


PV


PV


3

AYGESTIN ORAL TABLET 5 MG (norethindrone acetate) PV



PV

CRINONE VAGINAL GEL 4 8 (progesterone) PV

DEPO-PROVERA INTRAMUSCULAR SUSPENSION 150 MGML (medroxyprogesterone acetate)

PV

DEPO-PROVERA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 150 MGML (medroxyprogesterone acetate)

PV

DEPO-SUBQ PROVERA 104 SUBCUTANEOUS SUSPENSION PREFILLED SYRINGE 104 MG065ML (medroxyprogesterone acetate)

PV

ENDOMETRIN VAGINAL INSERT 100 MG (progesterone) PV


240




PV


PV

hydroxyprogesterone caproate intramuscular oil 250 mgml PV DSL = 30 days

hydroxyprogesterone caproate intramuscular solution 125 gm5ml

1 DSL = 30 days



3

MAKENA INTRAMUSCULAR OIL 250 MGML (hydroxyprogesterone caproate)

PV DSL = 30 days

MAKENA SUBCUTANEOUS SOLUTION AUTO-INJECTOR 275 MG11ML (hydroxyprogesterone caproate)

PV DSL = 30 days

medroxyprogesterone acetate intramuscular suspension 150 mgml

PV

medroxyprogesterone acetate intramuscular suspension prefilled syringe 150 mgml

PV

medroxyprogesterone acetate oral tablet 10 mg 25 mg 5 mg PV





norethindrone acetate oral tablet 5 mg PV


PV


3 DSL = 30 days

progesterone intramuscular oil 50 mgml PV

progesterone oral capsule 100 mg 200 mg PV

PROMETRIUM ORAL CAPSULE 100 MG 200 MG (progesterone)

PV

PROVERA ORAL TABLET 10 MG 25 MG 5 MG (medroxyprogesterone acetate)

PV


RAPID-ACTING INSULINS - Drugs for Diabetes


2


241



2


2


2 DSL = 30 days


2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


242



2


2


2


2


2



2


2


2


2


2


2


2

SHORT-ACTING INSULINS - Drugs for Diabetes


2


2


PV


2


2


2


243



2


2


2


2


2


2


2


2

SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB - Drugs for Diabetes

FARXIGA ORAL TABLET 10 MG 5 MG (dapagliflozin propanediol)

2


2


2


2

INVOKANA ORAL TABLET 100 MG 300 MG (canagliflozin) 2

JARDIANCE ORAL TABLET 10 MG 25 MG (empagliflozin) 2


2


2

STEGLATRO ORAL TABLET 15 MG 5 MG (ertugliflozin l-pyroglutamicac)

2


2


2


244



2


2


2

SOMATOSTATIN AGONISTS - Hormones

BYNFEZIA PEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 2500 MCGML (28 ML) (octreotide acetate)

3 DSL = 30 days

MYCAPSSA ORAL CAPSULE DELAYED RELEASE 20 MG (octreotide acetate)

3 DSL = 30 days

octreotide acetate injection solution 100 mcgml 1000 mcgml 200 mcgml 50 mcgml 500 mcgml

1

SANDOSTATIN LAR DEPOT INTRAMUSCULAR KIT 10 MG 20 MG 30 MG (octreotide acetate)

2 DSL = 30 days

SIGNIFOR LAR INTRAMUSCULAR SUSPENSION RECONSTITUTED ER 10 MG 20 MG 30 MG 40 MG 60 MG (pasireotide pamoate)

3 DSL = 30 days

SIGNIFOR SUBCUTANEOUS SOLUTION 03 MGML 06 MGML 09 MGML (pasireotide diaspartate)

3 DSL = 30 days

SOMATULINE DEPOT SUBCUTANEOUS SOLUTION 120 MG05ML 60 MG02ML 90 MG03ML (lanreotide acetate)

3 DSL = 30 days

SOMATOTROPIN AGONISTS - Hormones

EGRIFTA SV SUBCUTANEOUS SOLUTION RECONSTITUTED 2 MG (tesamorelin acetate)

2 DSL = 30 days

INCRELEX SUBCUTANEOUS SOLUTION 40 MG4ML (mecasermin)

3

SOMATOTROPIN ANTAGONISTS - Hormones

SOMAVERT SUBCUTANEOUS SOLUTION RECONSTITUTED 10 MG 15 MG 20 MG 25 MG 30 MG (pegvisomant)

3 DSL = 30 days

SULFONYLUREAS - Drugs for Diabetes

AMARYL ORAL TABLET 1 MG 2 MG 4 MG (glimepiride) 2

DUETACT ORAL TABLET 30-2 MG 30-4 MG (pioglitazone hcl-glimepiride)

2

glimepiride oral tablet 1 mg 2 mg 4 mg 2

glipizide er oral tablet extended release 24 hour 10 mg 25 mg 5 mg

2

glipizide oral tablet 10 mg 5 mg 2


245


glipizide xl oral tablet extended release 24 hour 10 mg 25 mg 5 mg

2


2

GLUCOTROL ORAL TABLET 10 MG (glipizide) 2

GLUCOTROL XL ORAL TABLET EXTENDED RELEASE 24 HOUR 10 MG 25 MG 5 MG (glipizide)

2

glyburide micronized oral tablet 15 mg 3 mg 6 mg 2

glyburide oral tablet 125 mg 25 mg 5 mg 2


2

GLYNASE ORAL TABLET 15 MG 3 MG 6 MG (glyburide micronized)

2

pioglitazone hcl-glimepiride oral tablet 30-2 mg 30-4 mg 2

tolbutamide oral tablet 500 mg 2

THIAZOLIDINEDIONES - Drugs for Diabetes


2

ACTOS ORAL TABLET 15 MG 30 MG 45 MG (pioglitazone hcl)

2


2


2


2

pioglitazone hcl oral tablet 15 mg 30 mg 45 mg 2



THYROID AGENTS - Drugs for the Thyroid

ARMOUR THYROID ORAL TABLET 120 MG 15 MG 180 MG 240 MG 30 MG 300 MG 60 MG 90 MG (thyroid)

3

CYTOMEL ORAL TABLET 25 MCG 5 MCG 50 MCG (liothyronine sodium)

3

levothyroxine sodium (Euthyrox Oral Tablet 100 Mcg 112 Mcg 125 Mcg 137 Mcg 150 Mcg 175 Mcg 200 Mcg 25 Mcg 50 Mcg 75 Mcg 88 Mcg)

1

levothyroxine sodium (Levo-T Oral Tablet 100 Mcg 112 Mcg 125 Mcg 137 Mcg 150 Mcg 175 Mcg 200 Mcg 25 Mcg 300 Mcg 50 Mcg 75 Mcg 88 Mcg)

1


246


LEVOTHYROXINE SODIUM ORAL CAPSULE 100 MCG 112 MCG 125 MCG 13 MCG 137 MCG 150 MCG 175 MCG 200 MCG 25 MCG 50 MCG 75 MCG 88 MCG

3

levothyroxine sodium oral tablet 100 mcg 112 mcg 125 mcg 137 mcg 150 mcg 175 mcg 200 mcg 25 mcg 300 mcg 50 mcg 75 mcg 88 mcg

1

levothyroxine sodium (Levoxyl Oral Tablet 100 Mcg 112 Mcg 125 Mcg 137 Mcg 150 Mcg 175 Mcg 200 Mcg 25 Mcg 50 Mcg 75 Mcg 88 Mcg)

1

liothyronine sodium oral tablet 25 mcg 5 mcg 50 mcg 1

NATURE-THROID ORAL TABLET 11375 MG 130 MG 14625 MG 1625 MG 1625 MG 195 MG 260 MG 325 MG 325 MG 4875 MG 65 MG 8125 MG 975 MG (thyroid)

3

np thyroid oral tablet 120 mg 15 mg 30 mg 60 mg 90 mg 1

THYQUIDITY ORAL SOLUTION 100 MCG5ML (levothyroxine sodium)

3

TIROSINT ORAL CAPSULE 100 MCG 112 MCG 125 MCG 13 MCG 137 MCG 150 MCG 175 MCG 200 MCG 25 MCG 50 MCG 75 MCG 88 MCG (levothyroxine sodium)

3

TIROSINT-SOL ORAL SOLUTION 100 MCGML 112 MCGML 125 MCGML 13 MCGML 137 MCGML 150 MCGML 175 MCGML 200 MCGML 25 MCGML 50 MCGML 75 MCGML 88 MCGML (levothyroxine sodium)

3

levothyroxine sodium (Unithroid Oral Tablet 100 Mcg 112 Mcg 125 Mcg 137 Mcg 150 Mcg 175 Mcg 200 Mcg 25 Mcg 300 Mcg 50 Mcg 75 Mcg 88 Mcg)

1

WESTHROID ORAL TABLET 130 MG 195 MG 325 MG 65 MG 975 MG (thyroid)

3

WP THYROID ORAL TABLET 11375 MG 130 MG 1625 MG 325 MG 4875 MG 65 MG 8125 MG 975 MG (thyroid)

3

LOCAL ANESTHETICS (PARENTERAL) - Drugs for Numbing



3

bupivacaine fisiopharma injection solution 25 mgml 5 mgml 1

bupivacaine hcl (pf) injection solution 025 05 075 1

bupivacaine hcl injection solution 025 05 1

EXPAREL INJECTION SUSPENSION 13 (bupivacaine liposome)

3


247



3


3 DSL = 30 days

lidocaine hcl (pf) injection solution 05 1 15 2 4 1

lidocaine hcl injection solution 05 1

LIDOCAINE HCL INJECTION SOLUTION PREFILLED SYRINGE 10 MGML 100 MG10ML 100 MG5ML 200 MG10ML 60 MG3ML

3

LIDOCAINE HCL INTRADERMAL JET-INJECTOR 05 MG 3

LIDOCAINE HCL SOLUTION 1 INJECTION 1 3

lidocaine hcl solution 1 injection 1 1



LIDOMARK 25 INJECTION KIT 2 3


3


bupivacaine hcl (Sensorcaine Injection Solution 025 05 ) 3

bupivacaine hcl (Sensorcaine-Mpf Injection Solution 075 ) 3

bupivacaine hcl (Sensorcaine-Mpf Solution 025 Injection 025 )

1


2


1


3

XARACOLL IMPLANT IMPLANT 3 X 100 MG (bupivacaine hcl) 3

ZINGO INTRADERMAL JET-INJECTOR 05 MG (lidocaine hcl) 3

MISCELLANEOUS THERAPEUTIC AGENTS

5-ALPHA-REDUCTASE INHIBITORS

dutasteride oral capsule 05 mg 1


finasteride oral tablet 5 mg 1

ALCOHOL DETERRENTS - Drugs for Alcohol Dependence

disulfiram oral tablet 250 mg 500 mg 1


248




3

ANTIDOTES - Drugs for Overdose or Poisoning



3


3


2


2

BRIDION INTRAVENOUS SOLUTION 200 MG2ML (sugammadex sodium)

2


3



2


1


2


PV


PV


2




2


2


2


2



249


KHAPZORY INTRAVENOUS SOLUTION RECONSTITUTED 175 MG 300 MG (levoleucovorin)

PV DSL = 30 days


PV

leucovorin calcium injection solution 100 mg10ml 500 mg50ml PV

leucovorin calcium injection solution reconstituted 100 mg 200 mg 350 mg 50 mg 500 mg

PV

leucovorin calcium oral tablet 10 mg 15 mg 25 mg 5 mg PV

levoleucovorin calcium intravenous solution reconstituted 50 mg PV

levoleucovorin calcium pf intravenous solution 175 mg175ml 250 mg25ml

PV


3


PV



MEPHYTON ORAL TABLET 5 MG (phytonadione) PV





phytonadione injection solution 1 mg05ml 10 mgml 1

phytonadione oral tablet 5 mg PV


3



PV








3

VISTOGARD ORAL PACKET 10 GM (uridine triacetate) 3 DSL = 30 days

vitamin k1 injection solution 1 mg05ml 10 mgml 1


250



PV DSL = 30 days

ANTIGOUT AGENTS - Drugs for Gout


allopurinol oral tablet 100 mg 300 mg PV

COLCHICINE ORAL CAPSULE 06 MG PV

colchicine oral tablet 06 mg PV


COLCRYS ORAL TABLET 06 MG (colchicine) PV


PV


febuxostat oral tablet 40 mg 80 mg PV

GLOPERBA ORAL SOLUTION 06 MG5ML (colchicine) PV DSL = 30 days






KRYSTEXXA INTRAVENOUS SOLUTION 8 MGML (pegloticase)

PV

MITIGARE ORAL CAPSULE 06 MG (colchicine) PV


PV







PV


PV




ULORIC ORAL TABLET 40 MG 80 MG (febuxostat) PV

ZYLOPRIM ORAL TABLET 100 MG 300 MG (allopurinol) PV


251


ANTISENSE OLIGONUCLEOTIDES

AMONDYS 45 INTRAVENOUS SOLUTION 100 MG2ML 3

EVRYSDI ORAL SOLUTION RECONSTITUTED 075 MGML (risdiplam)

3 DSL = 30 days

EXONDYS 51 INTRAVENOUS SOLUTION 100 MG2ML 500 MG10ML (eteplirsen)

3 DSL = 30 days

SPINRAZA INTRATHECAL SOLUTION 12 MG5ML (nusinersen)

3 DSL = 30 days

TEGSEDI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 284 MG15ML (inotersen sodium)

3 DSL = 30 days

VILTEPSO INTRAVENOUS SOLUTION 250 MG5ML (viltolarsen)

3 DSL = 30 days

VYONDYS 53 INTRAVENOUS SOLUTION 100 MG2ML (golodirsen)

3 DSL = 30 days

BONE ANABOLIC AGENTS

EVENITY SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 105 MG117ML (romosozumab-aqqg)

3 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days

BONE RESORPTION INHIBITORS - Drugs for Bone Loss

ACTONEL ORAL TABLET 150 MG 35 MG (risedronate sodium)

3

alendronate sodium oral solution 70 mg75ml 1

alendronate sodium oral tablet 10 mg 35 mg 5 mg 70 mg 1

ATELVIA ORAL TABLET DELAYED RELEASE 35 MG (risedronate sodium)

3

BINOSTO ORAL TABLET EFFERVESCENT 70 MG (alendronate sodium)

3

BONIVA ORAL TABLET 150 MG (ibandronate sodium) 3



FOSAMAX ORAL TABLET 70 MG (alendronate sodium) 3

FOSAMAX PLUS D ORAL TABLET 70-2800 MG-UNIT 70-5600 MG-UNIT (alendronate-cholecalciferol)

3


252


ibandronate sodium intravenous solution 3 mg3ml 1

ibandronate sodium oral tablet 150 mg 1


3 DSL = 30 days

pamidronate disodium intravenous solution 30 mg10ml 6 mgml 90 mg10ml

1

pamidronate disodium intravenous solution reconstituted 30 mg 90 mg

1

PROLIA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 60 MGML (denosumab)

3


risedronate sodium oral tablet 150 mg 30 mg 35 mg 5 mg 1

risedronate sodium oral tablet delayed release 35 mg 1

XGEVA SUBCUTANEOUS SOLUTION 120 MG17ML (denosumab)

2 DSL = 30 days

zoledronic acid intravenous concentrate 4 mg5ml 1

zoledronic acid intravenous solution 4 mg100ml 5 mg100ml 1

CARIOSTATIC AGENTS - Vitamins and Fluoride

adcf (05mgml) oral solution 05 mgml 1

sodium fluoride (Cavarest Dental Gel 11 ) PV

sodium fluoride (Clinpro 5000 Dental Paste 11 ) PV

sodium fluoride (Denta 5000 Plus Dental Cream 11 ) PV

sodium fluoride (Dentagel Dental Gel 11 ) PV

FLORIVA ORAL LIQUID 025-400 MG-UNITML (sodium fluoride-vitamin d)

3

FLORIVA ORAL TABLET CHEWABLE 025 MG 05 MG 1 MG (ped multiple vit-minerals-fl)

3

FLORIVA PLUS ORAL SOLUTION 025 MGML (pediatric multivitamins-fl)

3

sodium fluoride (Fluoridex Dental Paste 11 ) PV

sod fluoride-potassium nitrate (Fluoridex Sensitivity Relief Dental Paste 11-5 )

3

fluoritab oral solution 0275 (0125 f) mgdrop PV


multivitaminfluoride oral solution 025 mgml 05 mgml 1

multi-vitaminfluoride oral solution 025 mgml 05 mgml 1

multivitaminfluoride oral tablet chewable 025 mg 05 mg 1 mg 1

MULTIVITAMINFLUORIDE ORAL TABLET CHEWABLE 025-03 MG

3


253



NAFRINSE DAILYNEUTRAL MOUTHTHROAT SOLUTION RECONSTITUTED 005 (sodium fluoride)

PV

POLY-VI-FLOR ORAL SUSPENSION 025 MGML (pediatric multivitamins-fl)

3

POLY-VI-FLOR ORAL TABLET CHEWABLE 025 MG 05 MG 1 MG (pediatric multivitamins-fl)

3


3


3

PREVIDENT 5000 BOOSTER PLUS DENTAL PASTE 11 (sodium fluoride)

PV

PREVIDENT 5000 DRY MOUTH DENTAL GEL 11 (sodium fluoride)

PV

PREVIDENT 5000 ENAMEL PROTECT DENTAL PASTE 11-5 (sod fluoride-potassium nitrate)

3

PREVIDENT 5000 ORTHO DEFENSE DENTAL PASTE 11 (sodium fluoride)

PV

PREVIDENT 5000 PLUS DENTAL CREAM 11 (sodium fluoride)

PV

PREVIDENT 5000 SENSITIVE DENTAL PASTE 11-5 (sod fluoride-potassium nitrate)

3

PREVIDENT DENTAL GEL 11 (sodium fluoride) PV

PREVIDENT MOUTHTHROAT SOLUTION 02 (sodium fluoride)

PV


3


3

QUFLORA GUMMIES ORAL TABLET CHEWABLE 0125 MG (pediatric multivitamins-fl)

3

QUFLORA PEDIATRIC ORAL SOLUTION 025 MGML 05 MGML (pediatric multivitamins-fl)

3

QUFLORA PEDIATRIC ORAL TABLET CHEWABLE 025 MG 05 MG 1 MG (pediatric multivitamins-fl)

3

sf 5000 plus dental cream 11 PV

sf dental gel 11 PV

sodium fluoride 5000 enamel dental paste 11-5 1

sodium fluoride 5000 plus dental cream 11 PV

sodium fluoride 5000 ppm dental cream 11 PV


254


sodium fluoride 5000 ppm dental paste 11 PV

sodium fluoride 5000 sensitive dental paste 11-5 1

sodium fluoride dental cream 11 PV

sodium fluoride dental gel 11 PV

sodium fluoride oral solution 11 (05 f) mgml PV

sodium fluoride oral tablet 11 (05 f) mg 22 (1 f) mg PV

sodium fluoride oral tablet chewable 055 (025 f) mg 11 (05 f) mg 22 (1 f) mg

PV

TRI-VI-FLOR ORAL SUSPENSION 025 MGML 05 MGML (ped vit a-c-d-methylfolate-fl)

3

TRI-VI-FLORO ORAL SUSPENSION 025 MGML 05 MGML 3

tri-vitefluoride oral solution 025 mgml 05 mgml 1

vitamins acd-fluoride oral solution 025 mgml 1

COMPLEMENT INHIBITORS

BERINERT INTRAVENOUS KIT 500 UNIT (c1 esterase inhibitor (human))

3 DSL = 30 days

CINRYZE INTRAVENOUS SOLUTION RECONSTITUTED 500 UNIT (c1 esterase inhibitor (human))

2 DSL = 30 days

FIRAZYR SUBCUTANEOUS SOLUTION 30 MG3ML (icatibant acetate)

2 DSL = 30 days

HAEGARDA SUBCUTANEOUS SOLUTION RECONSTITUTED 2000 UNIT 3000 UNIT (c1 esterase inhibitor (human))

2 DSL = 30 days

icatibant acetate subcutaneous solution 30 mg3ml 1 DSL = 30 days

ORLADEYO ORAL CAPSULE 110 MG 150 MG (berotralstat hcl)

3 DSL = 30 days

RUCONEST INTRAVENOUS SOLUTION RECONSTITUTED 2100 UNIT (c1 esterase inhibitor (recomb))

3 DSL = 30 days

SOLIRIS INTRAVENOUS SOLUTION 300 MG30ML (eculizumab)

2

TAKHZYRO SUBCUTANEOUS SOLUTION 300 MG2ML (lanadelumab-flyo)

2 DSL = 30 days

ULTOMIRIS INTRAVENOUS SOLUTION 1100 MG11ML 300 MG3ML (ravulizumab-cwvz)

3

ULTOMIRIS INTRAVENOUS SOLUTION 300 MG30ML (ravulizumab-cwvz)

3 DSL = 30 days

DISEASE-MODIFYING ANTIRHEUMATIC AGENTS - Drugs for Arthritis

ACTEMRA ACTPEN SUBCUTANEOUS SOLUTION AUTO-INJECTOR 162 MG09ML (tocilizumab)

3


255


ACTEMRA INTRAVENOUS SOLUTION 200 MG10ML 400 MG20ML 80 MG4ML (tocilizumab)

3

ACTEMRA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 162 MG09ML (tocilizumab)

3 DSL = 30 days


3 DSL = 30 days

AZASAN ORAL TABLET 100 MG 75 MG (azathioprine) 3

azathioprine oral tablet 50 mg 1

azathioprine sodium injection solution reconstituted 100 mg 1


3 DSL = 30 days


3


3 DSL = 30 days


cyclosporine intravenous solution 50 mgml 1

cyclosporine modified oral capsule 100 mg 25 mg 50 mg 1

cyclosporine modified oral solution 100 mgml 1

cyclosporine oral capsule 100 mg 25 mg 1


ENBREL MINI SUBCUTANEOUS SOLUTION CARTRIDGE 50 MGML (etanercept)

3 DSL = 30 days

ENBREL SUBCUTANEOUS SOLUTION 25 MG05ML (etanercept)

3 DSL = 30 days

ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 25 MG05ML 50 MGML (etanercept)

2 DSL = 30 days

ENBREL SUBCUTANEOUS SOLUTION RECONSTITUTED 25 MG (etanercept)

2 DSL = 30 days

ENBREL SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR 50 MGML (etanercept)

2 DSL = 30 days

cyclosporine modified (Gengraf Oral Capsule 100 Mg 25 Mg) 1

cyclosporine modified (Gengraf Oral Solution 100 MgMl) 1

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 80 MG08ML (adalimumab)

3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


256



2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days



2

KEVZARA SUBCUTANEOUS SOLUTION AUTO-INJECTOR 150 MG114ML 200 MG114ML (sarilumab)

3 DSL = 30 days

KEVZARA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 150 MG114ML 200 MG114ML (sarilumab)

3 DSL = 30 days

KINERET SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MG067ML (anakinra)

2 DSL = 30 days

leflunomide oral tablet 10 mg 20 mg 1

LUPKYNIS ORAL CAPSULE 79 MG (voclosporin) 3 DSL = 30 days



1




NEORAL ORAL SOLUTION 100 MGML (cyclosporine modified)

2

OLUMIANT ORAL TABLET 1 MG 2 MG (baricitinib) 3 DSL = 30 days

ORENCIA CLICKJECT SUBCUTANEOUS SOLUTION AUTO-INJECTOR 125 MGML (abatacept)

2 DSL = 30 days

ORENCIA INTRAVENOUS SOLUTION RECONSTITUTED 250 MG (abatacept)

2 DSL = 30 days


257


ORENCIA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 125 MGML 50 MG04ML 875 MG07ML (abatacept)

2 DSL = 30 days

OTEZLA ORAL TABLET 30 MG (apremilast) 2 DSL = 30 days

OTEZLA ORAL TABLET THERAPY PACK 10 amp 20 amp 30 MG (apremilast)

2 DSL = 30 days


3


2




PV


2

REDITREX SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 10 MG04ML 125 MG05ML 15 MG06ML 175 MG07ML 20 MG08ML 225 MG09ML 25 MGML 75 MG03ML (methotrexate (anti-rheumatic))

3


2


3


RINVOQ ORAL TABLET EXTENDED RELEASE 24 HOUR 15 MG (upadacitinib)

3 DSL = 30 days

SANDIMMUNE INTRAVENOUS SOLUTION 50 MGML (cyclosporine)

2

SANDIMMUNE ORAL CAPSULE 100 MG 25 MG (cyclosporine)

2

SANDIMMUNE ORAL SOLUTION 100 MGML (cyclosporine) 2


3


3 DSL = 30 days


3 DSL = 30 days


258


STELARA INTRAVENOUS SOLUTION 130 MG26ML (ustekinumab)

3

STELARA SUBCUTANEOUS SOLUTION 45 MG05ML (ustekinumab)

2

STELARA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 45 MG05ML 90 MGML (ustekinumab)

2




3 OC


XELJANZ ORAL SOLUTION 1 MGML (tofacitinib citrate) 3 DSL = 30 days

XELJANZ ORAL TABLET 10 MG 5 MG (tofacitinib citrate) 2 DSL = 30 days

XELJANZ XR ORAL TABLET EXTENDED RELEASE 24 HOUR 11 MG (tofacitinib citrate)

2 DSL = 30 days


3

GONADOTROPIN-RELEASING HORMONE ANTAGNTS - Hormones


2


2

IMMUNOMODULATORY AGENTS - DRUGS FOR THE IMMUNE SYSTEM


3


3


3 DSL = 30 days

ACTIMMUNE SUBCUTANEOUS SOLUTION 2000000 UNIT05ML (interferon gamma-1b)

2 DSL = 30 days

AUBAGIO ORAL TABLET 14 MG 7 MG (teriflunomide) 3 DSL = 30 days

AVONEX PEN INTRAMUSCULAR AUTO-INJECTOR KIT 30 MCG05ML (interferon beta-1a)

2 DSL = 30 days

AVONEX PREFILLED INTRAMUSCULAR PREFILLED SYRINGE KIT 30 MCG05ML (interferon beta-1a)

2 DSL = 30 days


3 DSL = 30 days



259




BAFIERTAM ORAL CAPSULE DELAYED RELEASE 95 MG (monomethyl fumarate)

3 DSL = 30 days

BETASERON SUBCUTANEOUS KIT 03 MG (interferon beta-1b)

3 DSL = 30 days


3 DSL = 30 days


3


3 DSL = 30 days

COPAXONE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 20 MGML 40 MGML (glatiramer acetate)

3 DSL = 30 days





dimethyl fumarate oral capsule delayed release 120 mg 240 mg

1 DSL = 30 days

dimethyl fumarate starter pack oral 120 amp 240 mg 1 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days

ENSPRYNG SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 120 MGML (satralizumab-mwge)

3 DSL = 30 days


3

EXTAVIA SUBCUTANEOUS KIT 03 MG (interferon beta-1b) 3 DSL = 30 days



GILENYA ORAL CAPSULE 025 MG 05 MG (fingolimod hcl) 3 DSL = 30 days


260


glatiramer acetate subcutaneous solution prefilled syringe 20 mgml 40 mgml

1 DSL = 30 days

glatiramer acetate (Glatopa Subcutaneous Solution Prefilled Syringe 20 MgMl 40 MgMl)

1 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days



2


2 DSL = 30 days


2 DSL = 30 days

KESIMPTA SUBCUTANEOUS SOLUTION AUTO-INJECTOR 20 MG04ML (ofatumumab)

3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


261



LEMTRADA INTRAVENOUS SOLUTION 12 MG12ML (alemtuzumab)

3 DSL = 30 days

MAYZENT ORAL TABLET 025 MG 2 MG (siponimod fumarate)

3



1





2

OCREVUS INTRAVENOUS SOLUTION 300 MG10ML (ocrelizumab)

3 DSL = 30 days



2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days



2 DSL = 30 days


3


2


PV

PLEGRIDY INTRAMUSCULAR SOLUTION PREFILLED SYRINGE 125 MCG05ML (peginterferon beta-1a)

3 DSL = 30 days

PLEGRIDY STARTER PACK SUBCUTANEOUS SOLUTION PEN-INJECTOR 63 amp 94 MCG05ML (peginterferon beta-1a)

3 DSL = 30 days

PLEGRIDY STARTER PACK SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 63 amp 94 MCG05ML (peginterferon beta-1a)

3 DSL = 30 days


262


PLEGRIDY SUBCUTANEOUS SOLUTION PEN-INJECTOR 125 MCG05ML (peginterferon beta-1a)

3 DSL = 30 days

PLEGRIDY SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 125 MCG05ML (peginterferon beta-1a)

3 DSL = 30 days


2 DSL = 30 days OC

PONVORY ORAL TABLET 20 MG (ponesimod) 3

PONVORY STARTER PACK ORAL TABLET THERAPY PACK 2-3-4-5-6-7-8-9 amp 10 MG (ponesimod)

3


2 DSL = 30 days


2

REBIF REBIDOSE SUBCUTANEOUS SOLUTION AUTO-INJECTOR 22 MCG05ML 44 MCG05ML (interferon beta-1a)

3

REBIF REBIDOSE TITRATION PACK SUBCUTANEOUS SOLUTION AUTO-INJECTOR 6X88 amp 6X22 MCG (interferon beta-1a)

3

REBIF SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 22 MCG05ML 44 MCG05ML (interferon beta-1a)

3

REBIF TITRATION PACK SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 6X88 amp 6X22 MCG (interferon beta-1a)

3


3


2


3


2 DSL = 30 days OC



3 DSL = 30 days


2


2



263



3


3 DSL = 30 days


3 DSL = 30 days


3


2


2



TECFIDERA ORAL 120 amp 240 MG (dimethyl fumarate) 3 DSL = 30 days

TECFIDERA ORAL CAPSULE DELAYED RELEASE 120 MG 240 MG (dimethyl fumarate)

3 DSL = 30 days

THALOMID ORAL CAPSULE 100 MG 150 MG 200 MG 50 MG (thalidomide)

2 DSL = 30 days OC


3 OC

TYSABRI INTRAVENOUS CONCENTRATE 300 MG15ML (natalizumab)

2 DSL = 30 days

UPLIZNA INTRAVENOUS SOLUTION 100 MG10ML (inebilizumab-cdon)

3 DSL = 30 days

VUMERITY ORAL CAPSULE DELAYED RELEASE 231 MG (diroximel fumarate)

3 DSL = 30 days





2 DSL = 30 days


3

ZEPOSIA 7-DAY STARTER PACK ORAL CAPSULE THERAPY PACK 4 X 023MG amp 3 X 046MG (ozanimod hcl)

3 DSL = 30 days

ZEPOSIA ORAL CAPSULE 092 MG (ozanimod hcl) 3 DSL = 30 days

ZEPOSIA STARTER KIT ORAL CAPSULE THERAPY PACK 023MG amp 046MG amp 092MG (ozanimod hcl)

3 DSL = 30 days


264


IMMUNOSUPPRESSIVE AGENTS - Drugs for Transplant

ASTAGRAF XL ORAL CAPSULE EXTENDED RELEASE 24 HOUR 05 MG 1 MG 5 MG (tacrolimus)

3

ATGAM INTRAVENOUS INJECTABLE 50 MGML (lymphocyteanti-thymo imm glob)

2




BENLYSTA INTRAVENOUS SOLUTION RECONSTITUTED 120 MG 400 MG (belimumab)

3 DSL = 30 days

BENLYSTA SUBCUTANEOUS SOLUTION AUTO-INJECTOR 200 MGML (belimumab)

3 DSL = 30 days

BENLYSTA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 200 MGML (belimumab)

3 DSL = 30 days


1


3







ELIDEL EXTERNAL CREAM 1 (pimecrolimus) 3

ENVARSUS XR ORAL TABLET EXTENDED RELEASE 24 HOUR 075 MG 1 MG 4 MG (tacrolimus)

3

everolimus oral tablet 025 mg 05 mg 075 mg 1

GAMIFANT INTRAVENOUS SOLUTION 10 MG2ML 100 MG20ML 50 MG10ML (emapalumab-lzsg)

3 DSL = 30 days




MAVENCLAD ORAL TABLET THERAPY PACK 10 MG (cladribine)

3




1


265





mycophenolate mofetil hcl intravenous solution reconstituted500 mg

1

mycophenolate mofetil intravenous solution reconstituted 500 mg

1

mycophenolate mofetil oral capsule 250 mg 1

mycophenolate mofetil oral suspension reconstituted 200 mgml 1

mycophenolate mofetil oral tablet 500 mg 1

mycophenolate sodium oral tablet delayed release 180 mg 360 mg

1


2

NULOJIX INTRAVENOUS SOLUTION RECONSTITUTED 250 MG (belatacept)

3


3


2

pimecrolimus external cream 1 1

PROGRAF INTRAVENOUS SOLUTION 5 MGML (tacrolimus) 2

PROGRAF ORAL PACKET 02 MG 1 MG (tacrolimus) 3


2 DSL = 30 days OC

RAPAMUNE ORAL SOLUTION 1 MGML (sirolimus) 2


2


3


2


2



266


SIMULECT INTRAVENOUS SOLUTION RECONSTITUTED 10 MG 20 MG (basiliximab)

3

sirolimus oral solution 1 mgml 1

sirolimus oral tablet 05 mg 1 mg 2 mg 1

tacrolimus oral capsule 05 mg 1 mg 5 mg 1

THYMOGLOBULIN INTRAVENOUS SOLUTION RECONSTITUTED 25 MG (anti-thymocyte glob (rabbit))

3


3 OC


ZORTRESS ORAL TABLET 1 MG (everolimus) 3

OTHER MISCELLANEOUS THERAPEUTIC AGENTS


acetylcysteine inhalation solution 10 20 1







amino acids (Aminoreliefrms Oral Capsule) 2

AMPYRA ORAL TABLET EXTENDED RELEASE 12 HOUR 10 MG (dalfampridine)

3 DSL = 30 days

ARCALYST SUBCUTANEOUS SOLUTION RECONSTITUTED 220 MG (rilonacept)

3



3


AVAILNEX ORAL TABLET CHEWABLE 750 MG (carbocysteine)

3

AZALGIA ORAL CAPSULE 3


3 DSL = 30 days




3


267



3



2




3


3

CARDIOVID PLUS ORAL CAPSULE (dha-epa-vit b6-b12-folic acid)

3

CARNITOR INTRAVENOUS SOLUTION 200 MGML (levocarnitine)

2

CARTICEL INTRA-ARTICULAR IMPLANT (autologous culture chondrocyte)

3


3



CERDELGA ORAL CAPSULE 84 MG (eliglustat tartrate) 2 DSL = 30 days



3


3




CYSTADANE ORAL POWDER (betaine) 2 DSL = 30 days

CYSTAGON ORAL CAPSULE 150 MG 50 MG (cysteamine bitartrate)

2 DSL = 30 days

dalfampridine er oral tablet extended release 12 hour 10 mg 1 DSL = 30 days

DEMSER ORAL CAPSULE 250 MG (metyrosine) 3




3


268



3


3


3


ENTERAGAM ORAL PACKET 5 GM (sbiprotein isolate) 3


3



3 DSL = 30 days


3 DSL = 30 days

FIRDAPSE ORAL TABLET 10 MG (amifampridine phosphate) 3


FOSTEUM ORAL CAPSULE 27-20-200 MG-MG-UNIT (genistein-zn chelate-vit d)

3


3


3

GALAFOLD ORAL CAPSULE 123 MG (migalastat hcl) 3 DSL = 30 days


GIVLAARI SUBCUTANEOUS SOLUTION 189 MGML (givosiran sodium)

3 DSL = 30 days



2



3

ILARIS SUBCUTANEOUS SOLUTION 150 MGML (canakinumab)

3 DSL = 30 days

ISTURISA ORAL TABLET 1 MG 10 MG 5 MG (osilodrostat phosphate)

3 DSL = 30 days



3


269




KUVAN ORAL PACKET 100 MG (sapropterin dihydrochloride) 3 DSL = 30 days

KUVAN ORAL TABLET 100 MG (sapropterin dihydrochloride) 3 DSL = 30 days

levocarnitine oral solution 1 gm10ml 2

levocarnitine oral tablet 330 mg 2

levocarnitine sf oral solution 1 gm10ml 2

LIMBREL ORAL CAPSULE 250 MG 500 MG (flavocoxid) 3

LIMBREL250 ORAL CAPSULE 250-50 MG (flavocoxid-cit zn bisglcinate)

3


3


3



metyrosine oral capsule 250 mg 1

miglustat oral capsule 100 mg 1 DSL = 30 days


3


3


3






3



2

n-acetyl-l-cysteine oral capsule 600 mg 1

NICADAN ORAL TABLET (multiple vitamins-minerals) 3

NICAPRIN ORAL TABLET (dietary management product) 3

NICAZEL FORTE ORAL TABLET (multiple vitamins-minerals) 3

NICAZEL ORAL TABLET (multiple vitamins-minerals) 3

NICAZYME ORAL TABLET 3


270


nitisinone oral capsule 10 mg 2 mg 5 mg 1 DSL = 30 days

NITYR ORAL TABLET 10 MG 2 MG 5 MG (nitisinone) 3 DSL = 30 days

NULIBRY INTRAVENOUS SOLUTION RECONSTITUTED 95 MG (fosdenopterin hydrobromide)

3


1


ONPATTRO INTRAVENOUS SOLUTION 10 MG5ML (patisiran sodium)

3 DSL = 30 days


3


3


3


3

ORFADIN ORAL CAPSULE 10 MG 2 MG 20 MG 5 MG (nitisinone)

3 DSL = 30 days

ORFADIN ORAL SUSPENSION 4 MGML (nitisinone) 3 DSL = 30 days

OVEEZA ORAL CAPSULE 05 MG (fa-b12-ala-co q10-omega 3)

3

OXLUMO SUBCUTANEOUS SOLUTION 945 MG05ML (lumasiran sodium)

3

PANHEMATIN INTRAVENOUS SOLUTION RECONSTITUTED 350 MG (hemin)

3


3


3


3

POTABA ORAL CAPSULE 500 MG (potassium aminobenzoate)

2



PROCYSBI ORAL CAPSULE DELAYED RELEASE 25 MG 75 MG (cysteamine bitartrate)

3 DSL = 30 days

PROCYSBI ORAL PACKET 300 MG 75 MG (cysteamine bitartrate)

3 DSL = 30 days



271



3


3




3


2

RHEUMATE ORAL CAPSULE (dietary management product) 3




RUZURGI ORAL TABLET 10 MG (amifampridine) 3


3


2 DSL = 30 days

sapropterin dihydrochloride oral packet 100 mg 1 DSL = 30 days

sapropterin dihydrochloride oral packet 500 mg 1

sapropterin dihydrochloride oral tablet 100 mg 1 DSL = 30 days


3




3



3 DSL = 30 days




3


2

TALIVA ORAL CAPSULE 1 MG (fa-b6-b12-omega 3-phytosterols)

3



272


THIOLA EC ORAL TABLET DELAYED RELEASE 100 MG 300 MG (tiopronin)

3

THIOLA ORAL TABLET 100 MG (tiopronin) 2


3


3

TYBOST ORAL TABLET 150 MG (cobicistat) 3

ULTRA HIS ORAL CAPSULE 3

VASCULERA ORAL TABLET (dietary management product) 3







3

XURIDEN ORAL PACKET 2 GM (uridine triacetate) 3 DSL = 30 days

XYZMUNE ORAL CAPSULE 3


ZOKINVY ORAL CAPSULE 50 MG 75 MG (lonafarnib) 3 DSL = 30 days

PROTECTIVE AGENTS

COSELA INTRAVENOUS SOLUTION RECONSTITUTED 300 MG (trilaciclib dihydrochloride)

PV DSL = 30 days

dexrazoxane hcl intravenous solution reconstituted 250 mg 500 mg

PV

ELMIRON ORAL CAPSULE 100 MG (pentosan polysulfate sodium)

2

ETHYOL INTRAVENOUS SOLUTION RECONSTITUTED 500 MG (amifostine)

PV

mesna intravenous solution 100 mgml PV

MESNEX INTRAVENOUS SOLUTION 100 MGML (mesna) PV

MESNEX ORAL TABLET 400 MG (mesna) PV DSL = 30 days OC

TOTECT INTRAVENOUS SOLUTION RECONSTITUTED 500 MG (dexrazoxane hcl)

PV

NONHORMONAL CONTRACEPTIVES - Drugs for Women


CAYA VAGINAL DIAPHRAGM (diaphragm arc-spring) PV


273


PARAGARD INTRAUTERINE COPPER INTRAUTERINE INTRAUTERINE DEVICE (copper)

PV

PHEXXI VAGINAL GEL 18-1-04 (lactic ac-citric ac-pot bitart)

3

VCF VAGINAL CONTRACEPTIVE VAGINAL FILM 28 (nonoxynol-9)

PV

vcf vaginal contraceptive vaginal gel 4 PV

WIDE-SEAL DIAPHRAGM 60 VAGINAL DIAPHRAGM 2 (diaphragm wide seal)

PV


PV


PV


PV


PV


PV


PV


PV

OXYTOCICS - Drugs for Women


CERVIDIL VAGINAL INSERT 10 MG (dinoprostone) 2

methylergonovine maleate (Methergine Oral Tablet 02 Mg) 1

methylergonovine maleate oral tablet 02 mg 1

MIFEPREX ORAL TABLET 200 MG (mifepristone) PV

mifepristone oral tablet 200 mg PV

OXYTOCIN-LACTATED RINGERS INTRAVENOUS SOLUTION 30 UNIT500ML

3

OXYTOCIN-SODIUM CHLORIDE INTRAVENOUS SOLUTION 20-09 UNITL- 20-09 UNTL-

3

PREPIDIL VAGINAL GEL 05 MG3GM (dinoprostone) 2

PROSTIN E2 VAGINAL SUPPOSITORY 20 MG (dinoprostone) 2

PHARMACEUTICAL AIDS

PHARMACEUTICAL AIDS

ASPARTAME (NUTRASWEET) POWDER (aspartame) 3

ASPARTAME POWDER 3


274


benzoin compound external tincture 1

BENZOIN EXTERNAL TINCTURE 2

COPASIL EXTERNAL GEL (scar treatment products) 3

formaldehyde external solution 10 1

FORMALDEHYDE EXTERNAL SOLUTION 37 3

GELFILM EXTERNAL FILM (gelatin absorbable) 3

L-ISOLEUCINE POWDER 2


RECURA EXTERNAL CREAM (misc antifungal combo products)

3

STRATA CTX EXTERNAL GEL (dermatological products misc)

3

STRATA XRT EXTERNAL GEL (dermatological products misc)

3

TURPENTINE EXTERNAL SPIRIT 3

RADIOACTIVE AGENTS

RADIOACTIVE AGENTS


3

XOFIGO INTRAVENOUS SOLUTION 30 MCCIML (radium ra 223 dichloride)

3

RESPIRATORY TRACT AGENTS - Drugs for the Lungs

ALPHA AND BETA ADRENERGIC AGONIST(RESPR) - Drugs for AsthmaCOPD







3 DSL = 30 days


3



3


1 DSL = 30 days



275




3


3




3

ANTICHOLINERGIC AGENTS (RESPIRTRACT) - Drugs for AsthmaCOPD


3


3


1


1

ATROPINE SULFATE INTRAVENOUS SOLUTION PREFILLED SYRINGE 08 MG2ML

3


PV


3


3


PV




3 DSL = 30 days


3




3


276



3


2


2

TRELEGY ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 100-625-25 MCGINH 200-625-25 MCGINH (fluticasone-umeclidin-vilant)

3


3


3

ANTIFIBROTIC AGENTS - Drugs for the Lungs

ESBRIET ORAL CAPSULE 267 MG (pirfenidone) 3 DSL = 30 days

ESBRIET ORAL TABLET 267 MG (pirfenidone) 3

ESBRIET ORAL TABLET 801 MG (pirfenidone) 3 DSL = 30 days

OFEV ORAL CAPSULE 100 MG 150 MG (nintedanib esylate) 3 DSL = 30 days

ANTI-INFLAMMATORY AGENTS (RESPIRATORY) - Drugs for Inflammation

NUCALA SUBCUTANEOUS SOLUTION RECONSTITUTED 100 MG (mepolizumab)

3 DSL = 30 days

ANTITUSSIVES - Drugs for Cough and Cold

benzonatate oral capsule 100 mg 150 mg 200 mg 1





1






3


3 DSL = 30 days





277






3


3


3


CYSTIC FIBROSIS (CFTR) CORRECTORS - Drugs for the Lungs

ORKAMBI ORAL PACKET 100-125 MG 150-188 MG (lumacaftor-ivacaftor)

2 DSL = 30 days

ORKAMBI ORAL TABLET 100-125 MG 200-125 MG (lumacaftor-ivacaftor)

2 DSL = 30 days

SYMDEKO ORAL TABLET THERAPY PACK 100-150 amp 150 MG (tezacaftor-ivacaftor)

2 DSL = 30 days


3 DSL = 30 days

CYSTIC FIBROSIS (CFTR) POTENTIATORS - Drugs for the Lungs

KALYDECO ORAL PACKET 25 MG (ivacaftor) 3 DSL = 30 days

KALYDECO ORAL PACKET 50 MG 75 MG (ivacaftor) 2 DSL = 30 days

KALYDECO ORAL TABLET 150 MG (ivacaftor) 2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days

EXPECTORANTS - Drugs for the Lungs


3






278



3


FIRST GENERATION ANTIHIST(RESPIR TRACT) - Drugs for Allergy


3









3







1


3



3


PV











279







3


3


3

INTERLEUKIN ANTAGONISTS - Drugs for Inflammation

CINQAIR INTRAVENOUS SOLUTION 100 MG10ML (reslizumab)

3 DSL = 30 days

DUPIXENT SUBCUTANEOUS SOLUTION PEN-INJECTOR 300 MG2ML (dupilumab)

3 DSL = 30 days

DUPIXENT SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 200 MG114ML 300 MG2ML (dupilumab)

3 DSL = 30 days

FASENRA PEN SUBCUTANEOUS SOLUTION AUTO-INJECTOR 30 MGML (benralizumab)

3 DSL = 30 days

FASENRA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 30 MGML (benralizumab)

3

NUCALA SUBCUTANEOUS SOLUTION AUTO-INJECTOR 100 MGML (mepolizumab)

3 DSL = 30 days

NUCALA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MGML (mepolizumab)

3


3 DSL = 30 days

LEUKOTRIENE MODIFIERS - Drugs for Inflammation

ACCOLATE ORAL TABLET 10 MG 20 MG (zafirlukast) PV

montelukast sodium oral packet 4 mg PV

montelukast sodium oral tablet 10 mg PV

montelukast sodium oral tablet chewable 4 mg 5 mg PV

SINGULAIR ORAL PACKET 4 MG (montelukast sodium) PV

SINGULAIR ORAL TABLET 10 MG (montelukast sodium) PV

SINGULAIR ORAL TABLET CHEWABLE 4 MG 5 MG (montelukast sodium)

PV

zafirlukast oral tablet 10 mg 20 mg PV

zileuton er oral tablet extended release 12 hour 600 mg 1 DSL = 30 days

ZYFLO ORAL TABLET 600 MG (zileuton) 3


280


MAST-CELL STABILIZERS - Drugs for Inflammation


cromolyn sodium inhalation nebulization solution 20 mg2ml PV


cromolyn sodium oral concentrate 100 mg5ml 1

MUCOLYTIC AGENTS - Drugs for the Lungs



2

NASAL PREPARATIONS (STEROIDS) - Drugs for Inflammation



3






3


3



3


3

ORALLY INHALED PREPARATIONS (STEROIDS) - Drugs for Inflammation


2


2


3


3


281



3


3


2


3


3


2


2


2


2


2


2 DSL = 30 days


PV DSL = 30 days


3


3


1


3


282



3


3


3


2


1


3


2


3


3


3


3


3


1

PHOSPHODIESTERASE TYPE 4 INHIBITORS - Drugs for the Lungs

DALIRESP ORAL TABLET 250 MCG (roflumilast) 3


PULMONARY SURFACTANTS - Drugs for the Lungs

CUROSURF INTRATRACHEAL SUSPENSION 120 MG15ML (poractant alfa)

2

INFASURF INTRATRACHEAL SUSPENSION 35-09 MGML- (calfactant in nacl)

3


283


SURVANTA INTRATRACHEAL SUSPENSION 25-09 MGML- (beractant in nacl)

2

RESPIRATORY TRACT AGENTS MISCELLANEOUS - Drugs for the Lungs

ARALAST NP INTRAVENOUS SOLUTION RECONSTITUTED 1000 MG 500 MG (alpha1-proteinase inhibitor)

2 DSL = 30 days

BRONCHITOL INHALATION CAPSULE 40 MG (mannitol (cystic fibrosis))

3 DSL = 30 days

BRONCHITOL TOLERANCE TEST INHALATION CAPSULE 40 MG (mannitol (cystic fibrosis))

3 DSL = 30 days

GLASSIA INTRAVENOUS SOLUTION 1000 MG50ML (alpha1-proteinase inhibitor)

3 DSL = 30 days

PROLASTIN-C INTRAVENOUS SOLUTION 1000 MG20ML (alpha1-proteinase inhibitor)

3

PROLASTIN-C INTRAVENOUS SOLUTION RECONSTITUTED 1000 MG (alpha1-proteinase inhibitor)

2 DSL = 30 days

XOLAIR SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 150 MGML 75 MG05ML (omalizumab)

2

XOLAIR SUBCUTANEOUS SOLUTION RECONSTITUTED 150 MG (omalizumab)

2 DSL = 30 days

ZEMAIRA INTRAVENOUS SOLUTION RECONSTITUTED 1000 MG (alpha1-proteinase inhibitor)

2 DSL = 30 days

SECOND GENERATION ANTIHIST(RESPIR TRACT) - Drugs for Allergy




3





SELECTBETA-2-ADRENERGIC AGONIST(RESPIR) - Drugs for AsthmaCOPD


2


2


284



3


3


3


3


PV


PV


PV


PV


PV


PV




3


3


3


3


3


3


PV


285



3 DSL = 30 days


3


1


3



1



3


PV


PV


PV


PV


2


2


2


3




3


3


286



PV


1


3

VASODILATING AGENTS (RESPIRATORY TRACT) - Drugs for the Lungs


3 DSL = 30 days





1




3 DSL = 30 days


2









1



2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


287



3 DSL = 30 days


2 DSL = 30 days

XANTHINE DERIVATIVES - Drugs for AsthmaCOPD



3


PV


PV


SKIN AND MUCOUS MEMBRANE AGENTS - Drugs for the Skin

ALLYLAMINES (SKIN AND MUCOUS MEMBRANE) - Drugs for the Skin

naftifine hcl external cream 1 2 1

naftifine hcl external gel 1 1

NAFTIN EXTERNAL GEL 2 (naftifine hcl) 3

ANTIBACTERIALS (SKIN MUCOUS MEMBRANE) - Drugs for the Skin

ACZONE EXTERNAL GEL 5 75 (dapsone) 3

ADAPALENE-BENZOYL PER-CLINDAMY EXTERNAL GEL 03-25-1

3

ALTABAX EXTERNAL OINTMENT 1 (retapamulin) 3

AMZEEQ EXTERNAL FOAM 4 (minocycline hcl micronized) 3

AVEIDAOXIA EXTERNAL GEL 1-1-4 3

BENZ PER-CLIND-NIACIN-TRETIN EXTERNAL GEL 25-1-2-0025 5-1-2-0025 5-1-2-005

3

benzoyl peroxide-erythromycin external gel 5-3 1

CENTANY AT EXTERNAL KIT 2 (mupirocin) 3

CLEOCIN VAGINAL SUPPOSITORY 100 MG (clindamycin phosphate)

3

CLINDACIN ETZ EXTERNAL KIT 1 (clindamycin phos amp cleanser)

3

clindamycin phosphate (Clindacin Etz External Swab 1 ) 1

CLINDACIN PAC EXTERNAL KIT 1 (clindamycin phos amp cleanser)

3

clindamycin phosphate (Clindacin-P External Swab 1 ) 1


288


CLINDAGEL EXTERNAL GEL 1 (clindamycin phosphate) 3

CLINDAMY-BENZOYL PER-NIACINAM EXTERNAL GEL 1-5-4 25-1-4

3

clindamycin phos-benzoyl perox external gel 1-5 12-25 12-5

1

CLINDAMYCIN PHOS-NIACINAMIDE EXTERNAL GEL 1-4 3

CLINDAMYCIN PHOS-NIACINAMIDE EXTERNAL LOTION 1-4

3

clindamycin phosphate external foam 1 1

clindamycin phosphate external lotion 1 1

clindamycin phosphate external solution 1 1

clindamycin phosphate external swab 1 1

CLINDAMYCIN PHOSPHATE GEL 1 EXTERNAL 1 3

clindamycin phosphate gel 1 external 1 1

clindamycin phosphate vaginal cream 2 1

CLINDAMYCIN-NIACIN-TRETINOIN EXTERNAL CREAM 1-4-0025

3

clindamycin-tretinoin external gel 12-0025 1

CLINDESSE VAGINAL CREAM 2 (clindamycin phosphate (1 dose))

3

CLIND-NIACIN-SPIRONOLAC-TRETIN EXTERNAL GEL 1-4-2-0025

3

dapsone external gel 5 1

dapsone gel 75 external 75 1

DAPSONE GEL 75 EXTERNAL 75 3

DAPSONE-NIACINAMIDE EXTERNAL GEL 6-4 85-4 3

DAPSONE-NIACINAMIDE-SPIRONOLAC EXTERNAL GEL 6-2-5 85-2-5

3

DEOXIA EXTERNAL GEL 1-4 3

DEOXIA EXTERNAL LOTION 1-4 3

DERMACINRX CLORHEXACIN EXTERNAL KIT 4 amp 2 amp 5 (OINT) (chlorhex-mupir-dimeth-silicone)

3

DIADIMAXIA EXTERNAL GEL 6-2-5 3

DIAOXIA EXTERNAL GEL 6-4 3

DIASDIMAXIA EXTERNAL GEL 85-2-5 3

DIASOXIA EXTERNAL GEL 85-4 3

ery external pad 2 1

erythromycin external gel 2 1

erythromycin external solution 2 1


289


gentamicin sulfate external cream 01 1

gentamicin sulfate external ointment 01 1

IVERMECTIN-METRONIDAZOL-NIACIN EXTERNAL GEL 1-1-4

3

metronidazole external cream 075 1

metronidazole external gel 075 1 1

metronidazole external lotion 075 1

metronidazole vaginal gel 075 1

mupirocin calcium external cream 2 1

mupirocin external ointment 2 1

neomycin-polymyxin b gu irrigation solution 40-200000 1

NEO-SYNALAR EXTERNAL CREAM 05-0025 (neomycin-fluocinolone)

3

NEO-SYNALAR EXTERNAL KIT 05-0025 (neo-fluocinolone amp emollient)

3

clindamycin-benzoyl per (refr) (Neuac External Gel 12-5 ) 1

NEUAC EXTERNAL KIT 12-5 (clindamycin-benzoyl per-moist)

3

NORITATE EXTERNAL CREAM 1 (metronidazole) 3

NUCARACLINPAK EXTERNAL KIT 1 (clindamycin phos- moisturizer)

3

NUCARARXPAK EXTERNAL KIT 1-25 (clindamycin-benzoyl per-moist)

3

NUSURGEPAK SURGICAL PREPCARE EXTERNAL KIT 4 amp 2 amp 5 (OINT) (chlorhex-mupir-dimeth-silicone)

3

NUVESSA VAGINAL GEL 13 (metronidazole) 3

ONEXTON EXTERNAL GEL 12-375 (clindamycin phos-benzoyl perox)

3

ONZDEOXIA EXTERNAL GEL 1-5-4 3

metronidazole (Rosadan External Cream 075 ) 1

metronidazole (Rosadan External Gel 075 ) 1

ROSADAN EXTERNAL KIT 075 (CREAM) 075 (GEL) (metronidazole-cleanser)

3

TARDEOXIA EXTERNAL CREAM 1-4-0025 3

metronidazole (Vandazole Vaginal Gel 075 ) 1

VELTIN EXTERNAL GEL 12-0025 (clindamycin-tretinoin) 3

XEPI EXTERNAL CREAM 1 (ozenoxacin) 3

ZILXI EXTERNAL FOAM 15 (minocycline hcl micronized) 3


290


ANTIFULGALS (SKIN MUCOUS MEMBRANE)MISC - Drugs for the Skin

ALA-QUIN EXTERNAL CREAM 3-05 (clioquinol-hc) 3

EXODERM EXTERNAL LOTION 25-1 (sod thiosulfate-salicylic acd)

3

ANTI-INFLAMMATORY AGENTS (SKIN MUCOUS) - Drugs for the Skin

ADVANCED ALLERGY COLLECTION EXTERNAL KIT 25 (hydrocortisone)

3

ALA SCALP EXTERNAL LOTION 2 (hydrocortisone) 3

ala-cort external cream 1 25 1


alclometasone dipropionate external cream 005 1

alclometasone dipropionate external ointment 005 1

ALCORTIN A EXTERNAL GEL 1-2-1 (iodoquinol-hc-aloe polysacch)

3

amcinonide external cream 01 1

amcinonide external lotion 01 1

amcinonide external ointment 01 1

lidocaine-hydrocortisone ace (Ana-Lex Rectal Kit 2-2 ) 1

ANALPRAM HC EXTERNAL CREAM 25-1 (hydrocortisone ace-pramoxine)

3

ANALPRAM HC SINGLES EXTERNAL CREAM 25-1 (hydrocortisone ace-pramoxine)

3

ANALPRAM-HC EXTERNAL CREAM 1-1 (hydrocortisone ace-pramoxine)

2

ANALPRAM-HC EXTERNAL LOTION 25-1 (hydrocortisone ace-pramoxine)

2

anucort-hc rectal suppository 25 mg 1

hydrocortisone acetate (Anusol-Hc Rectal Suppository 25 Mg) 3

APEXICON E EXTERNAL CREAM 005 (diflorasone diacet emoll base)

3

fluticasone propionate (Beser External Lotion 005 ) 1

betamethasone dipropionate aug external cream 005 1

betamethasone dipropionate aug external gel 005 1

betamethasone dipropionate aug external lotion 005 1

betamethasone dipropionate aug external ointment 005 1

betamethasone dipropionate external cream 005 1

betamethasone dipropionate external lotion 005 1


291


betamethasone dipropionate external ointment 005 1

betamethasone valerate external cream 01 1

betamethasone valerate external foam 012 1

betamethasone valerate external lotion 01 1

betamethasone valerate external ointment 01 1

calcipotriene-betameth diprop external ointment 0005-0064 1 DSL = 30 days

calcipotriene-betameth diprop external suspension 0005-0064

1

CAPEX EXTERNAL SHAMPOO 001 (fluocinolone acetonide)

3

clobetasol prop emollient base external cream 005 1

clobetasol propionate e external cream 005 1

clobetasol propionate emulsion external foam 005 1

clobetasol propionate external cream 005 1

clobetasol propionate external foam 005 1

clobetasol propionate external gel 005 1

clobetasol propionate external liquid 005 1

clobetasol propionate external lotion 005 1

clobetasol propionate external ointment 005 1

clobetasol propionate external shampoo 005 1

clobetasol propionate external solution 005 1

CLOBEX EXTERNAL LOTION 005 (clobetasol propionate) 2

CLOBEX SPRAY EXTERNAL LIQUID 005 (clobetasol propionate)

2

clocortolone pivalate external cream 01 1

CLODAN EXTERNAL KIT 005 (clobetasol prop amp cleanser) 3

clobetasol propionate (Clodan External Shampoo 005 ) 1

clotrimazole-betamethasone external cream 1-005 1

clotrimazole-betamethasone external lotion 1-005 1

CORDRAN EXTERNAL CREAM 0025 (flurandrenolide) 3

CORDRAN EXTERNAL TAPE 4 MCGSQCM (flurandrenolide) 2

CORTIFOAM EXTERNAL FOAM 10 (hydrocortisone acetate) 3

DERMACINRX THERAZOLE PAK EXTERNAL THERAPY PACK 1-005 amp 20 (clotrimazole-betameth amp zn ox)

3

desonide external cream 005 1

desonide external gel 005 1

desonide external lotion 005 1

desonide external ointment 005 1


292


desoximetasone external cream 005 025 1

desoximetasone external gel 005 1

desoximetasone external liquid 025 1

desoximetasone external ointment 005 025 1

diflorasone diacetate external cream 005 1

diflorasone diacetate external ointment 005 1

enovarx-ibuprofen external cream 10 PV

enovarx-naproxen external cream 10 PV

ENSTILAR EXTERNAL FOAM 0005-0064 (calcipotriene-betameth diprop)

3

EPIFOAM EXTERNAL FOAM 1-1 (pramoxine-hc) 3

EUCRISA EXTERNAL OINTMENT 2 (crisaborole) 3

FLUOCINOLONE ACET-NIACINAMIDE EXTERNAL CREAM 001-4 0025-4

3

fluocinolone acetonide body external oil 001 1

fluocinolone acetonide external cream 001 0025 1

fluocinolone acetonide external ointment 0025 1

fluocinolone acetonide external solution 001 1

fluocinolone acetonide scalp external oil 001 1

fluocinonide emulsified base external cream 005 1

fluocinonide external cream 005 01 1

fluocinonide external gel 005 1

fluocinonide external ointment 005 1

fluocinonide external solution 005 1

flurandrenolide external cream 005 1

flurandrenolide external lotion 005 1

flurandrenolide external ointment 005 1

fluticasone propionate external cream 005 1

fluticasone propionate external lotion 005 1

fluticasone propionate external ointment 0005 1

FROTEK EXTERNAL CREAM 10 (ketoprofen) PV

halcinonide external cream 01 1

halobetasol propionate external cream 005 1

halobetasol propionate external ointment 005 1

HALOG EXTERNAL OINTMENT 01 (halcinonide) 3

HALOG EXTERNAL SOLUTION 01 (halcinonide) 3 DSL = 30 days


293


hydrocortisone acetate (Hemmorex-Hc Rectal Suppository 25 Mg)

3

hydrocortisone (perianal) external cream 1 25 1

hydrocortisone ace-pramoxine external cream 1-1 25-1 1

hydrocortisone acetate rectal suppository 25 mg 30 mg 1

hydrocortisone butyr lipo base external cream 01 1

hydrocortisone butyrate external cream 01 1

hydrocortisone butyrate external lotion 01 1

hydrocortisone butyrate external ointment 01 1

hydrocortisone butyrate external solution 01 1

hydrocortisone external cream 1 25 1

hydrocortisone external lotion 25 1

hydrocortisone external ointment 1 25 1

hydrocortisone rectal enema 100 mg60ml 1

hydrocortisone valerate external cream 02 1

hydrocortisone valerate external ointment 02 1

hydrocort-pramoxine (perianal) external cream 25-1 1

IMPOYZ EXTERNAL CREAM 0025 (clobetasol propionate) 3

iodoquinol-hc-aloe polysacch external gel 1-2-1 1

iodoquinol-hydrocortisone-aloe external cream 1-19 1

lidocaine-hydrocort (perianal) external cream 3-05 1

LIDOCAINE-HYDROCORTISONE ACE RECTAL GEL 28-055

3

lidocaine-hydrocortisone ace rectal kit 2-2 3-05 3-1 3-25

1

lidocaine-hydrocortisone ace (Lidocort External Cream 3-05 ) 3

mometasone furoate external cream 01 1

mometasone furoate external ointment 01 1

mometasone furoate external solution 01 1


3


3

flurandrenolide (Nolix External Cream 005 ) 1

flurandrenolide (Nolix External Lotion 005 ) 1

NOVACORT EXTERNAL GEL 1-2 (pramoxine-hc) 3

NUCORT EXTERNAL LOTION 2 (hydrocortisone acetate) 3


294


triamcinolone-dimeth-silicone (Nutriarx Creampak External Kit 01 amp 5 )

3

triamcinolone acetonide (Oralone MouthThroat Paste 01 ) 1

PANDEL EXTERNAL CREAM 01 (hydrocortisone probutate) 3

pramosone external cream 1-1 1

PRAMOSONE EXTERNAL CREAM 1-25 (pramoxine-hc) 3

PRAMOSONE EXTERNAL LOTION 1-1 1-25 (pramoxine-hc)

2

PRAMOSONE EXTERNAL OINTMENT 1-1 1-25 (pramoxine-hc)

2

prednicarbate external cream 01 1

prednicarbate external ointment 01 1

PROCORT EXTERNAL CREAM 185-115 (hydrocortisone ace-pramoxine)

3

PROCTOCORT RECTAL SUPPOSITORY 30 MG (hydrocortisone acetate)

3

PROCTOFOAM HC EXTERNAL FOAM 1-1 (hydrocortisone ace-pramoxine)

3

hydrocortisone (Procto-Med Hc External Cream 25 ) 1

hydrocortisone (Procto-Pak External Cream 1 ) 1

hydrocortisone (Proctozone-Hc External Cream 25 ) 1

PSORCON EXTERNAL CREAM 005 3


2

SANADERMRX SKIN REPAIR EXTERNAL KIT 01 amp 5 3

SCALACORT DK EXTERNAL KIT 2 amp 2-2 (hc amp sal acid-sulfur amp shampoo)

3

SERNIVO EXTERNAL EMULSION 005 (betamethasone dipropionate)

3

SYNALAR (CREAM) EXTERNAL KIT 0025 (fluocinolone-emollient)

3

SYNALAR (OINTMENT) EXTERNAL KIT 0025 (fluocinolone-emollient)

3

SYNALAR TS EXTERNAL KIT 001 (fluocinolone amp cleanser) 3

TACLONEX EXTERNAL SUSPENSION 0005-0064 (calcipotriene-betameth diprop)

3

TEXACORT EXTERNAL SOLUTION 25 (hydrocortisone) 3

TOPICORT SPRAY EXTERNAL LIQUID 025 (desoximetasone)

3

clobetasol propionate emulsion (Tovet External Foam 005 ) 1


295


triamcinolone acetonide external aerosol solution 0147 mggm 1

triamcinolone acetonide external cream 0025 01 05 1

triamcinolone acetonide external lotion 0025 01 1

triamcinolone acetonide external ointment 0025 005 01 05

1

triamcinolone acetonide mouththroat paste 01 1

triamcinolone acetonide (Trianex External Ointment 005 ) 3

triamcinolone acetonide (Triderm External Cream 01 05 ) 1

triamcinolone-dimeth-silicone (Trivix External Kit 01 amp 5 ) 3

ULTRAVATE EXTERNAL LOTION 005 (halobetasol propionate)

3 DSL = 30 days

benzoyl perox-hydrocortisone (Vanoxide-Hc External Lotion 5-05 )

3

VERDESO EXTERNAL FOAM 005 (desonide) 3

VYTONE EXTERNAL CREAM 1-19 (iodoquinol-hydrocortisone-aloe)

3

XERESE EXTERNAL CREAM 5-1 (acyclovir-hydrocortisone) 3

ANTI-INFLAMMATORY AGENTS MISC (SKIN) - Drugs for the Skin


ANTIPRURITICS AND LOCAL ANESTHETICS - Drugs for the Skin


3

AGONEAZE EXTERNAL KIT 25-25 3

ANACAINE EXTERNAL OINTMENT 10 (benzocaine) 3



3


3


2


2

ANODYNE LPT EXTERNAL KIT 25-25 3

APRIZIO PAK EXTERNAL KIT 25-25 (lidocaine-prilocaine-dressing)

3

APRIZIO PAK II EXTERNAL KIT 25-25 (lidocaine-prilocaine-dressing)

3


296




3


3

CETACAINE EXTERNAL AEROSOL 2-2-14 (butamben-tetracaine-benzocaine)

3


3

lidocaine-prilocaine (Dermacinrx Empricaine External Kit 25-25 )

3

DERMACINRX PHN EXTERNAL THERAPY PACK 5 amp 5 (lidocaine-dimethicone)

3

lidocaine-prilocaine (Dermacinrx Prizopak External Kit 25-25 )

3

DERMACINRX ZRM EXTERNAL THERAPY PACK 5 (lidocaine-emollient)

3

DERMALID EXTERNAL THERAPY PACK 5 3


doxepin hcl external cream 5 1

EHA EXTERNAL LOTION 4 3

EMPRICAINE-II EXTERNAL KIT 25-25 (lidocaine-prilocaine-dressing)

3

enovarx-lidocaine hcl external cream 10 5 1


ethyl chloride external aerosol 1


3


3

GEN7T EXTERNAL LOTION 35 3

GEN7T EXTERNAL PATCH 35 3

GEN7T PLUS EXTERNAL LOTION 35-7 3

GEN7T PLUS EXTERNAL PATCH 35-7 3




lets kit 1



297


lidocaine external ointment 5 1

lidocaine external patch 5 1

lidocaine hcl external cream 3 1

lidocaine hcl external lotion 3 1


lidocaine hcl mouththroat solution 4 1



3


1

lidocaine-prilocaine external cream 25-25 1

lidocaine-prilocaine external kit 25-25 1

LIDOCAINE-TETRACAINE EXTERNAL CREAM 7-7 3


LIDO-EPINEPHRINE-TETRACAINE EXTERNAL SOLUTION 4-005-05

3

LIDOPAC EXTERNAL KIT 5 3

lidopin external cream 3 1

LIDOPIN EXTERNAL CREAM 325 3

LIDOPRIL EXTERNAL KIT 25-25 3

LIDOPRIL XR EXTERNAL KIT 25-25 3

lidocaine-prilocaine (Lido-Prilo Caine Pack External Kit 25-25 )

3

LIDOPURE PATCH EXTERNAL KIT 5 (lidocaine-adhesive sheets)

3

LIDORX EXTERNAL GEL 3 3

lidocaine hcl (Lido-Sorb External Lotion 3 ) 3

LIDOTRAL EXTERNAL CREAM 388 (lidocaine hcl) 3

LIDTOPIC MAX EXTERNAL CREAM 10 (lidocaine hcl) 3

lidocaine-prilocaine (Livixil Pak External Kit 25-25 ) 3

LMR PLUS EXTERNAL KIT 5 amp 05-05 (lidocaine-camphor-menthol)

3


3


3


3


298



3


lidocaine-prilocaine (Nuvakaan External Kit 25-25 ) 3

NUVAKAAN-II EXTERNAL KIT 25-25 (lido-prilo amp silicone dressing)

3

PAINGO KFT EXTERNAL KIT 25-25-10-30 3

phenazopyridine hcl (Phenazo Oral Tablet 200 Mg) 1

phenazopyridine hcl oral tablet 100 mg 200 mg 1

PLIAGLIS EXTERNAL CREAM 7-7 (lidocaine-tetracaine) 3




2


2

pramox external gel 1 1

PRILO PATCH EXTERNAL KIT 25 (lidocaine-prilocaine) 3

PRILO PATCH II EXTERNAL KIT 25-25 amp 5 (lidocaine-prilocaine)

3

PRILOLID EXTERNAL KIT 25-25 3

PRILOVIX EXTERNAL KIT 25-25 3

PRILOVIX LITE EXTERNAL KIT 25-25 3

PRILOVIX LITE PLUS EXTERNAL KIT 25-25 3

PRILOVIX PLUS EXTERNAL KIT 25-25 3

PRILOVIX ULTRALITE EXTERNAL KIT 25-25 3

PRILOVIX ULTRALITE PLUS EXTERNAL KIT 25-25 3

PRILOVIXIL EXTERNAL KIT 25-25 3

PRIZOPAK II EXTERNAL KIT 25-25 (lidocaine-prilocaine-dressing)

3

PRIZOTRAL-II EXTERNAL KIT 25-25 amp 388 (lidocaine-prilocaine)

3


3


3

PYRIDIUM ORAL TABLET 100 MG 200 MG (phenazopyridine hcl)

3

lidocaine-prilocaine (Relador Pak External Kit 25-25 ) 3


299


lidocaine-prilocaine (Relador Pak Plus External Kit 25-25 ) 3

SKYADERM-LP EXTERNAL KIT 25-25 (lidocaine-prilocaine-dressing)

3

STERILE TOPICAL LET GEL EXTERNAL GEL 018-4-05 (lido-epinephrine-tetracaine)

3

SYNERA EXTERNAL PATCH 70-70 MG (lidocaine-tetracaine) 3


3

ZERUVIA EXTERNAL PATCH 4-1 3

ZILACAINE PATCH EXTERNAL THERAPY PACK 5 (lidocaine-silicone)

3

ZIONODIL 100 EXTERNAL LOTION 3 3

ZIONODIL EXTERNAL LOTION 3 3

ZTLIDO EXTERNAL PATCH 18 (lidocaine) 3

ANTIVIRALS (SKIN AND MUCOUS MEMBRANE) - Drugs for the Skin

acyclovir external cream 5 1

acyclovir external ointment 5 1

DENAVIR EXTERNAL CREAM 1 (penciclovir) 3


ZOVIRAX EXTERNAL CREAM 5 (acyclovir) 3

ASTRINGENTS - Drugs for the Skin

DRYSOL EXTERNAL SOLUTION 20 (aluminum chloride) 2

XERAC AC EXTERNAL SOLUTION 625 (aluminum chloride in alcohol)

2

AZOLES (SKIN AND MUCOUS MEMBRANE) - Drugs for the Skin

clotrimazole external cream 1 1

clotrimazole external solution 1 1

clotrimazole mouththroat troche 10 mg 1




3

DIFMETIOXRIME EXTERNAL SOLUTION 4-2-1-4 3

ECONASIL EXTERNAL KIT 1 (econaz amp gauze amp silicone tape)

3

econazole nitrate external cream 1 1


300


ECONAZOLE NITRATE-NIACINAMIDE EXTERNAL CREAM 1-4

3

ECOZA EXTERNAL FOAM 1 (econazole nitrate) 3

ERTACZO EXTERNAL CREAM 2 (sertaconazole nitrate) 3

EXELDERM EXTERNAL CREAM 1 (sulconazole nitrate) 3

EXELDERM EXTERNAL SOLUTION 1 (sulconazole nitrate) 3

FLUCON-IBUPROF-ITRACON-TERBINA EXTERNAL SOLUTION 4-2-1-4

3

GYNAZOLE-1 VAGINAL CREAM 2 (butoconazole nitrate (1 dose))

3

IMIOXIA EXTERNAL CREAM 1-4 3

IODOQUINOL-HC-KETOCONAZOLE EXTERNAL CREAM 1-25-2

3

JUBLIA EXTERNAL SOLUTION 10 (efinaconazole) 3

ketoconazole external cream 2 1

ketoconazole external foam 2 1

ketoconazole external shampoo 2 1

KETOCONAZOLE-HYDROCORTISONE EXTERNAL CREAM 2-25

3

ketoconazole (Ketodan External Foam 2 ) 1

KETODAN EXTERNAL KIT 2 (ketoconazole-cleanser) 3

LULICONAZOLE EXTERNAL CREAM 1 3

LUZU EXTERNAL CREAM 1 (luliconazole) 3

miconazole 3 vaginal suppository 200 mg 1

MICONAZOLE-ZINC OXIDE-PETROLAT EXTERNAL OINTMENT 025-15-8135

3

ORAVIG BUCCAL TABLET 50 MG (miconazole) 3

oxiconazole nitrate external cream 1 1

OXISTAT EXTERNAL LOTION 1 (oxiconazole nitrate) 3

PEDIZOLPAK EXTERNAL THERAPY PACK 2 amp 2 3

PHEODOYO EXTERNAL CREAM 1-25-2 3

PHEYO EXTERNAL CREAM 25-2 3

SULCONAZOLE NITRATE EXTERNAL CREAM 1 3

SULCONAZOLE NITRATE EXTERNAL SOLUTION 1 3

terconazole vaginal cream 04 08 1

terconazole vaginal suppository 80 mg 1

VUSION EXTERNAL OINTMENT 025-15-8135 (miconazole-zinc oxide-petrolat)

3


301


XOLEGEL EXTERNAL GEL 2 (ketoconazole) 3

ZOLPAK EXTERNAL KIT 1 (econazole nitrate amp dressing) 3

BASIC LOTIONS AND LINIMENTS - Drugs for the Skin

ammonium lactate external lotion 12 1


3

lactic acid external lotion 10 1


3

BASIC OILS AND OTHER SOLVENTS - Drugs for the Skin

CERACADE EXTERNAL EMULSION (dermatological products misc)

3


3


3

BASIC OINTMENTS AND PROTECTANTS - Drugs for the Skin

ammonium lactate external cream 12 1



3


3


3

DERMELLE EXTERNAL GEL (scar treatment products) 3

DEXERYL EXTERNAL CREAM (dermatological products misc)

3


3

HALUCORT EXTERNAL GEL (dermatological products misc) 3

lactic acid e external cream 10-3500 -unt30gm 1

NUDERMRXPAK 120 EXTERNAL THERAPY PACK 0005-5 (calcipotriene-dimethicone)

3


3

NUTRASEB EXTERNAL CREAM (antiseborrheic products misc)

3


302


STRATA MARK EXTERNAL GEL (dermatological products misc)

3

scar treatment products (Strata Triz External Gel) 3

TETRIX EXTERNAL CREAM (dermatological products misc) 3

BENZYLAMINES (SKIN AND MUCOUS MEMBRANE) - Drugs for the Skin

MENTAX EXTERNAL CREAM 1 (butenafine hcl) 3

CELL STIMULANTS AND PROLIFERANTS - Drugs for the Skin

ALTRENO EXTERNAL LOTION 005 (tretinoin) 3

tretinoin (Avita External Cream 0025 ) 2

tretinoin (Avita External Gel 0025 ) 2


3


3



3

HYALURONATE-NIACINAM-TRETINOIN EXTERNAL CREAM 05-4-0025 05-4-005 05-4-01

3

IMIQUIMOD-LEVOCET-TRETINOIN EXTERNAL GEL 5-1-005

3

KEPIVANCE INTRAVENOUS SOLUTION RECONSTITUTED 625 MG (palifermin)

2 DSL = 30 days

NIACINAMIDE-TRETINOIN EXTERNAL CREAM 4-0025 4-005

3

NIACINAMIDE-TRETINOIN EXTERNAL GEL 4-0025 4-005

3

NIACIN-SPIRONOLACTON-TRETINOIN EXTERNAL GEL 2-5-0025 2-5-005

3

OXIATAR EXTERNAL CREAM 4-0025 3

OXIAVARRY EXTERNAL CREAM 4-005 3

RETIN-A EXTERNAL CREAM 0025 005 01 (tretinoin)

2

RETIN-A EXTERNAL GEL 001 0025 (tretinoin) 2

RETIN-A MICRO EXTERNAL GEL 004 01 (tretinoin microsphere)

2

RETIN-A MICRO PUMP EXTERNAL GEL 004 01 (tretinoin microsphere)

2


303


RETIN-A MICRO PUMP EXTERNAL GEL 006 (tretinoin microsphere)

3 DSL = 30 days


3


TARDIMAXIA EXTERNAL GEL 2-5-0025 3

TAROXIA EXTERNAL CREAM 4-0025 3

TAROXIA EXTERNAL GEL 4-0025 3

tretinoin external cream 0025 005 01 1

tretinoin external gel 001 0025 005 1

tretinoin microsphere external gel 004 01 1

tretinoin microsphere pump external gel 004 01 1

VARDIMAXIA EXTERNAL GEL 2-5-005 3

VAROXIA EXTERNAL CREAM 4-005 3

VAROXIA EXTERNAL GEL 4-005 3


CORTICOSTEROIDS (SKIN MUCOUS MEMBRANE) - Drugs for the Skin


3







3






3


3


2


2


304





3

BESER EXTERNAL KIT 005 (fluticasone-emollient) 3













BRYHALI EXTERNAL LOTION 001 (halobetasol propionate) 3



1

CALCIPOTRIENE-CLOBETASOL PROP EXTERNAL SOLUTION 0005-005

3


3

CHLOOXIA EXTERNAL CREAM 005-4 3

CHLOOXIA EXTERNAL OINTMENT 005-4 3

CHLOOXIA EXTERNAL SOLUTION 005-4 3

CICLOPIROX-CLOBETASOL EXTERNAL SHAMPOO 077-005

3

CICLOPIROX-CLOBETASOL-SAL ACID EXTERNAL SHAMPOO 077-005-3

3








305







CLOBETASOL PROP-LEVOCETIRIZINE EXTERNAL SHAMPOO 005-2

3

CLOBETASOL PROP-NIACINAMIDE EXTERNAL CREAM 005-4

3

CLOBETASOL PROP-NIACINAMIDE EXTERNAL OINTMENT 005-4

3

CLOBETASOL PROP-NIACINAMIDE EXTERNAL SOLUTION 005-4

3

CLOBETAVIX EXTERNAL KIT 005 3



2










3












306


DUOBRII EXTERNAL LOTION 001-0045 (halobetasol prop-tazarotene)

3


3












FLUOPAR EXTERNAL KIT 01 amp 5 (fluocinonide amp dimethicone)

3

FLUOVIX EXTERNAL THERAPY PACK 01 3

FLUOVIX PLUS EXTERNAL THERAPY PACK 01 3









HALOBETASOL PROPIONATE EXTERNAL FOAM 005 3 DSL = 30 days





3







307











hydrocortisone-iodoquinol external cream 1-1 1


IMPEKLO EXTERNAL LOTION 015 MGACT (005) (clobetasol propionate)

3




3



3

LEXETTE EXTERNAL FOAM 005 (halobetasol propionate) 3 DSL = 30 days



3


1






3


3

NIACINAMIDE-TRIAMCINOLONE ACET EXTERNAL CREAM 4-01

3





308




3








2


2




3


3


3






3



3


3

SILA III EXTERNAL THERAPY PACK 01 (triamcinolone acet-silicone)

3


3


3



309



3

TASOPROL EXTERNAL KIT 005 (clobetasol propionate) 3



3


TOVET EXTERNAL KIT 005 (clobetasol emul foam wmoistcr)

3





1




TRILOCICLO EXTERNAL KIT 01 amp 8 (triamcinolone acet-ciclopirox)

3



3 DSL = 30 days


3



3

WYNZORA EXTERNAL CREAM 0005-0064 (calcipotriene-betameth diprop)

3 DSL = 30 days


HYDROXYPYRIDONES (SKIN MUCOUS MEMBRANE) - Drugs for the Skin

ciclopirox (Ciclodan External Solution 8 ) 1

ciclopirox external gel 077 1

ciclopirox external shampoo 1 1

ciclopirox external solution 8 1

ciclopirox olamine external cream 077 1

ciclopirox olamine external suspension 077 1

ciclopirox treatment external kit 8 1


310



3


3

CICLOPIROX-SALICYLIC ACID EXTERNAL SHAMPOO 077-2

3

LOPROX EXTERNAL KIT 077 077 (SUSP) (ciclopirox olamine-cleanser)

3


3

KERATOLYTIC AGENTS - Drugs for the Skin

ARZOL SILVER NIT APPLICATORS EXTERNAL 75-25 (silver nitrate-pot nitrate)

3

sulfacetamide sodium-sulfur (Avar Cleanser External Emulsion 10-5 )

3

AVAR LS CLEANSER EXTERNAL LIQUID 10-2 (sulfacetamide sodium-sulfur)

3

sulfacetamide sodium-sulfur (Avar-E Emollient External Cream 10-5 )

3

sulfacetamide sodium-sulfur (Avar-E Green External Cream 10-5 )

3

AVAR-E LS EXTERNAL CREAM 10-2 (sulfacetamide sodium-sulfur)

3

BENSAL HP EXTERNAL OINTMENT 3 3

BENZAC AC WASH EXTERNAL LIQUID 5 (benzoyl peroxide)

3

benzoyl peroxide (Benzepro Creamy Wash External Liquid 7 ) 3

BENZEPRO EXTERNAL 58 (benzoyl peroxide) 3

BENZEPRO EXTERNAL FOAM 52 (benzoyl peroxide) 3

benzoyl peroxide (Benzepro External Foam 53 ) 1

benzoyl peroxide (Benzepro Foaming Cloths External 6 ) 3

benzoyl peroxide (Benzepro Short Contact External Foam 98 )

3


3

benzoyl peroxide external foam 98 1

BENZOYL PEROXIDE EXTERNAL GEL 8 3

bp 10-1 external emulsion 10-1 1

bp cleansing wash external emulsion 10-4 1

bp wash external liquid 25 7 1


311


CEM-UREA EXTERNAL SOLUTION 45 (urea) 3

urea (Cerovel External Lotion 40 ) 1



3


3

CIMETIDINE-LIDO-SALICYLIC ACID EXTERNAL CREAM 10-5-40

3


3


1

DRAXACE EXTERNAL SUSPENSION 2-8 3

DRAXACE LOTION CLEANSER EXTERNAL SUSPENSION 2-8

3

DRIXECE EXTERNAL SUSPENSION 5-10 3

benzoyl peroxide (Enzoclear External Foam 98 ) 3

ESKATA EXTERNAL SOLUTION 40 (hydrogen peroxide) 3

GEAMETDRAY EXTERNAL GEL 5-2-17 3

GORDOFILM EXTERNAL SOLUTION 167-167 (salicylic acid-lactic acid)

3

GUANENDRUX EXTERNAL CREAM 10-5-40 3

HYDRO 40 EXTERNAL FOAM 40 (urea) 3

INOVA 41 ACNE CONTROL THERAPY EXTERNAL KIT 4 amp 1 amp 5 (benzoyl perox-salicyl ac-vit e)

3


3

INOVA EXTERNAL KIT 4 amp 5 8 amp 5 (benzoyl peroxide-vitamin e)

3

KERALAC EXTERNAL CREAM 47 (urea) 3

KERALYT EXTERNAL GEL 6 (salicylic acid) 2

salicylic acid (Keralyt External Shampoo 6 ) 3

KERALYT SCALP EXTERNAL KIT 6 (salicylic acid) 3



3


3


312



3


PLEXION CLEANSER EXTERNAL LIQUID 98-48 (sulfacetamide sodium-sulfur)

3

PLEXION CLEANSING CLOTH EXTERNAL PAD 98-48 (sulfacetamide sodium-sulfur)

3

PLEXION EXTERNAL CREAM 98-48 (sulfacetamide sodium-sulfur)

3

PLEXION EXTERNAL LOTION 98-48 (sulfacetamide sodium-sulfur)

3

benzoyl peroxide (Pr Benzoyl Peroxide Wash External Liquid 7 )

3

RIAX EXTERNAL FOAM 55 95 (benzoyl peroxide) 3

SALEX EXTERNAL SHAMPOO 6 (salicylic acid) 3

salicylic acid er external solution 285 1

salicylic acid external foam 6 1

salicylic acid external gel 6 1

salicylic acid external shampoo 6 1

salicylic acid external solution 26 1

salicylic acid wart remover external liquid 275 1

salicylic acid-cleanser external kit 6 (cream) 1

SALICYLIC ACID-SULFACETAMIDE EXTERNAL SUSPENSION 2-8 5-10

3

salimez external cream 6 1

SALIMEZ FORTE EXTERNAL CREAM 10 3

SALVAX DUO PLUS EXTERNAL KIT 6 amp 35 (salicylic acid-urea in lactac)

3

SALVAX EXTERNAL FOAM 6 (salicylic acid) 3

silver nitrate external solution 10 1

sss 10-5 external cream 10-5 1

sss 10-5 external foam 10-5 1

sulfacetamide sodium-sulfur external cream 10-2 10-5 98-48

1

sulfacetamide sodium-sulfur external emulsion 10-5 1

sulfacetamide sodium-sulfur external liquid 10-2 9-4 9-45 98-48

1

sulfacetamide sodium-sulfur external lotion 10-5 98-48 1

sulfacetamide sodium-sulfur external pad 10-4 1


313


sulfacetamide sodium-sulfur external suspension 10-5 8-4 1

sulfacetamide sod-sulfur wash external kit 9-45 1

sulfacetamide sod-sulfur wash external liquid 9-4 9-45 1

sulfacetamide-sulfur in urea external emulsion 10-5 1

sulfacetamide sodium-sulfur (Sulfacleanse 84 External Suspension 8-4 )

3

SUMADAN EXTERNAL KIT 9-45 (sulfacetamide-sulfur-cleanser)

3

SUMADAN WASH EXTERNAL LIQUID 9-45 (sulfacetamide sodium-sulfur)

3

SUMADAN XLT EXTERNAL KIT 9-45 (sulfacetamide-sulfur-sunscreen)

3

SUMAXIN CP EXTERNAL KIT 10-4 (sulfacetamide-sulfur-cleanser)

3

SUMAXIN EXTERNAL PAD 10-4 (sulfacetamide sodium-sulfur)

3

SUMAXIN WASH EXTERNAL LIQUID 9-4 (sulfacetamide sodium-sulfur)

3

ULTRASAL-ER EXTERNAL SOLUTION 285 (salicylic acid) 3

urea (Umecta Mousse External Foam 40 ) 3

URAMAXIN EXTERNAL GEL 45 (urea) 3

urea external cream 39 40 41 45 47 1

urea external lotion 40 1

urea hydrating external foam 35 1

urea nail external gel 45 1

UTOPIC EXTERNAL CREAM 41 (urea) 3

VIRASAL EXTERNAL LIQUID 275 (salicylic acid) 3

XALIX EXTERNAL SOLUTION 28 (salicylic acid) 3

xurea external cream 39 1

ZACARE EXTERNAL KIT 4 amp 02 8 amp 02 (benzoyl peroxide-hyaluronate)

3

zaclir cleansing external lotion 8 1

KERATOPLASTIC AGENTS - Drugs for the Skin

COAL TAR EXTERNAL SOLUTION 20 3

DRITHO-CREME HP EXTERNAL CREAM 1 (anthralin) 2


3


3


314


ZITHRANOL EXTERNAL SHAMPOO 1 (anthralin) 3

LOCAL ANTI-INFECTIVES MISCELLANEOUS - Drugs for the Skin

ALCOHOL PREP PADS PAD 3

ALCOHOL PREP PADS PAD 70 3


3


3


3


3


3


3

BENZALKONIUM CHLORIDE EXTERNAL SOLUTION 3

benzalkonium chloride external solution 50 1




3



3


ECEOXIA EXTERNAL CREAM 4-10 3

FEM PH VAGINAL GEL 09-0025 (acetic acid-oxyquinoline) 3

HIBICLENS EXTERNAL LIQUID 4 (chlorhexidine gluconate) 3


iodine tincture external tincture 2 1



3


LUGOLS STRONG IODINE EXTERNAL SOLUTION 5-10 3

mafenide acetate external packet 5 1

NIACINAMIDE-SULFACETAMIDE EXTERNAL CREAM 4-10 3


315



3

OVACE PLUS EXTERNAL CREAM 10 (sulfacetamide sodium)

3

OVACE PLUS EXTERNAL FOAM 98 (sulfacetamide sodium)

3

OVACE PLUS EXTERNAL LOTION 98 (sulfacetamide sodium)

3

OVACE PLUS EXTERNAL SHAMPOO 10 (sulfacetamide sodium)

3

OVACE PLUS WASH EXTERNAL GEL 10 (sulfacetamide sodium)

3

OVACE PLUS WASH EXTERNAL LIQUID 10 (sulfacetamide sodium)

3

OVACE WASH EXTERNAL LIQUID 10 (sulfacetamide sodium)

3



3


3


3


3

QUINJA EXTERNAL GEL 125-1 (iodoquinol-aloe polysaccharide)

3


3

selenium sulfide external lotion 25 1

selenium sulfide external shampoo 225 23 1

SELRX EXTERNAL SHAMPOO 23 (selenium sulfide) 3

silver nitrate external solution 05 25 50 1

silver sulfadiazine external cream 1 1

sodium sulfacetamide external shampoo 10 1

sodium sulfacetamide wash external liquid 10 1

SODIUM SULFACETAMIDE-BAKUCHIOL EXTERNAL LIQUID 10

3

silver sulfadiazine (Ssd External Cream 1 ) 1



316



sulfacetamide sodium (acne) external lotion 10 1

sulfacetamide sodium external gel 10 (cleans) 1

sulfacetamide sodium external liquid 10 1


1



1








3

SULFAMYLON EXTERNAL CREAM 85 MGGM (mafenide acetate)

2


3


3


3


3


3


3


3

NONSTEROIDAL ANTI-INFLAMMATAGENTS(SKIN) - Drugs for the Skin


3



3


317







3




3












PV


3





1


3




3

OXABOROLES - Drugs for the Skin

tavaborole external solution 5 1


318


PIGMENTING AGENTS - Drugs for the Skin

methoxsalen rapid oral capsule 10 mg 1

POLYENES (SKIN AND MUCOUS MEMBRANE) - Drugs for the Skin

nystatin (Nyamyc External Powder 100000 UnitGm) 1

nystatin external cream 100000 unitgm 1

nystatin external ointment 100000 unitgm 1

nystatin external powder 100000 unitgm 1

nystatin-triamcinolone external cream 100000-01 unitgm- 1

nystatin-triamcinolone external ointment 100000-01 unitgm- 1

nystatin (Nystop External Powder 100000 UnitGm) 1

SCABICIDES AND PEDICULICIDES - Drugs for the Skin



crotan external lotion 10 1

ELIMITE EXTERNAL CREAM 5 (permethrin) 3

ivermectin external lotion 05 1


3

lindane external shampoo 1 1

malathion external lotion 05 1

permethrin external cream 5 1

spinosad external suspension 09 1

SKIN AND MUCOUS MEMBRANE AGENTS MISC - Drugs for the Skin

ABSORICA LD ORAL CAPSULE 16 MG 24 MG 32 MG 8 MG (isotretinoin micronized)

3 DSL = 30 days

ABSORICA ORAL CAPSULE 10 MG 20 MG 30 MG 40 MG (isotretinoin)

3

ABSORICA ORAL CAPSULE 25 MG 35 MG (isotretinoin) 3 DSL = 30 days

isotretinoin (Accutane Oral Capsule 20 Mg 30 Mg 40 Mg) 1

ACIOXIAY EXTERNAL CREAM 15-4 3

acitretin oral capsule 10 mg 175 mg 25 mg 1 DSL = 30 days


adapalene external cream 01 1

adapalene external gel 01 03 1

ADAPALENE EXTERNAL PAD 01 3

ADAPALENE EXTERNAL SOLUTION 01 3


319



3

ADAPALENE-BENZOYL PER-NIACINAM EXTERNAL GEL 03-25-4

3

adapalene-benzoyl peroxide external gel 01-25 1

AKLIEF EXTERNAL CREAM 0005 (trifarotene) 3

AMELUZ EXTERNAL GEL 10 (aminolevulinic acid hcl) 3

isotretinoin (Amnesteem Oral Capsule 10 Mg 20 Mg 40 Mg) 1

ARAZLO EXTERNAL LOTION 0045 (tazarotene) 3

ARTISS EXTERNAL SOLUTION (fibrin sealant component) 3


3 DSL = 30 days

azelaic acid external gel 15 1

AZELAIC ACID-NIACINAMIDE EXTERNAL CREAM 15-4 3

AZELEX EXTERNAL CREAM 20 (azelaic acid) 3


calcipotriene external cream 0005 1

CALCIPOTRIENE EXTERNAL FOAM 0005 3

calcipotriene external ointment 0005 1

calcipotriene external solution 0005 1



1


3

calcitriol external ointment 3 mcggm 1

CANTHARIDIN EXTERNAL SOLUTION 07 3

capsaicin external cream 0025 1


3



isotretinoin (Claravis Oral Capsule 10 Mg 20 Mg 30 Mg 40 Mg)

1

CONDYLOX EXTERNAL GEL 05 (podofilox) 2


1

COSENTYX (300 MG DOSE) SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 150 MGML (secukinumab)

2 DSL = 30 days


320


COSENTYX 150 MGML SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 150 MGML (secukinumab)

2 DSL = 30 days

COSENTYX SENSOREADY (300 MG) SUBCUTANEOUS SOLUTION AUTO-INJECTOR 150 MGML (secukinumab)

2 DSL = 30 days

COSENTYX SENSOREADY PEN SUBCUTANEOUS SOLUTION AUTO-INJECTOR 150 MGML (secukinumab)

2 DSL = 30 days






3


3


3


3

DERMACINRX PENETRAL EXTERNAL CREAM 0025 (capsaicin)

2










3



DIFFERIN EXTERNAL CREAM 01 (adapalene) 2

DIFFERIN EXTERNAL GEL 03 (adapalene) 3

DIFFERIN EXTERNAL LOTION 01 (adapalene) 3

DIMOXIA EXTERNAL GEL 4-5 3



3


321



3 DSL = 30 days


3 DSL = 30 days



3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days

enovarx-baclofen external cream 1 1

enovarx-cyclobenzaprine hcl transdermal cream 20 mggm 1


3

EPIDUO EXTERNAL GEL 01-25 (adapalene-benzoyl peroxide)

3

EPIDUO FORTE EXTERNAL GEL 03-25 (adapalene-benzoyl peroxide)

2


ETHOXIA EXTERNAL CREAM 4-005 3

FABIOR EXTERNAL FOAM 01 (tazarotene) 3

FINACEA EXTERNAL FOAM 15 (azelaic acid) 3

FIRST-MOUTHWASH BLM MOUTHTHROAT SUSPENSION (dph-lido-alhydr-mghydr-simeth)

3









3 DSL = 30 days


3 DSL = 30 days


322



2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days

HYALURONATE-NIACIN-TACROLIMUS EXTERNAL CREAM 1-4-01

3

ILUMYA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MGML (tildrakizumab-asmn)

3

imiquimod external cream 375 5 1

IMIQUIMOD PUMP EXTERNAL CREAM 375 3

IMIQUIMOD-LEVOCETIRIZIN-NIACIN EXTERNAL GEL 5-1-2

3


3



3


3


2

isotretinoin oral capsule 10 mg 20 mg 30 mg 40 mg 1

ITHOXIA EXTERNAL CREAM 4-01 3


KLISYRI EXTERNAL OINTMENT 1 (tirbanibulin) 3 DSL = 30 days

LEVULAN KERASTICK EXTERNAL SOLUTION RECONSTITUTED 20 (aminolevulinic acid hcl)

2


323



3


3


3


1


3

MIRVASO EXTERNAL GEL 033 (brimonidine tartrate) 3


3

MUCOTROL MOUTHTHROAT WAFER (oral wound care products)

3

isotretinoin (Myorisan Oral Capsule 10 Mg 20 Mg 30 Mg 40 Mg)

1

NEURAPTINE EXTERNAL CREAM 10 (gabapentin) 3

NIACINAMIDE-SPIRONOLACTONE EXTERNAL GEL 4-5 3

NIACINAMIDE-TACROLIMUS EXTERNAL OINTMENT 4-01 3

NIACINAMIDE-TAZAROTENE EXTERNAL CREAM 4-005 4-01

3


3


3


3


3


3


PV


PV


PV


PV


324



PV


3



2 DSL = 30 days

OXIANUJO EXTERNAL CREAM 4-01 3

OXIANUJO EXTERNAL OINTMENT 4-01 3




podocon external solution 25 1

podofilox external solution 05 1


1

PYROGALLIC ACID EXTERNAL OINTMENT 25-2 3


QUTENZA (2 PATCH) EXTERNAL KIT 8 (capsaicin-cleansing gel)

3


3

QUTENZA EXTERNAL KIT 8 (capsaicin-cleansing gel) 3

RECTIV RECTAL OINTMENT 04 (nitroglycerin) 3


2


3

RHOFADE EXTERNAL CREAM 1 (oxymetazoline hcl) 3


SANTYL EXTERNAL OINTMENT 250 UNITGM (collagenase) 2

SCENESSE SUBCUTANEOUS IMPLANT 16 MG (afamelanotide acetate)

3 DSL = 30 days

SILIQ SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 210 MG15ML (brodalumab)

3 DSL = 30 days

SKYRIZI (150 MG DOSE) SUBCUTANEOUS PREFILLED SYRINGE KIT 75 MG083ML (risankizumab-rzaa)

2 DSL = 30 days


3

SOOLANTRA EXTERNAL CREAM 1 (ivermectin) 3


325


SORILUX EXTERNAL FOAM 0005 (calcipotriene) 3


3


2


2


1


3

TACROLIMUS EXTERNAL CREAM 01 3

tacrolimus external ointment 003 01 1

TALTZ SUBCUTANEOUS SOLUTION AUTO-INJECTOR 80 MGML (ixekizumab)

3 DSL = 30 days

TALTZ SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 80 MGML (ixekizumab)

3 DSL = 30 days


tazarotene external cream 01 1

TAZAROTENE EXTERNAL FOAM 01 3

TAZORAC EXTERNAL CREAM 005 (tazarotene) 2

TAZORAC EXTERNAL GEL 005 01 (tazarotene) 2

TISSEEL EXTERNAL KIT 10 ML 2 ML 4 ML (fibrin sealant component)

3

TREMFYA SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 MGML (guselkumab)

2

TREMFYA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MGML (guselkumab)

2

TRI-CHLOR EXTERNAL LIQUID 80 (trichloroacetic acid) 2


3 DSL = 30 days

VECTICAL EXTERNAL OINTMENT 3 MCGGM (calcitriol) 2


VEREGEN EXTERNAL OINTMENT 15 (sinecatechins) 3


WINLEVI EXTERNAL CREAM 1 (clascoterone) 3


3 DSL = 30 days


3


326



3

isotretinoin (Zenatane Oral Capsule 10 Mg 20 Mg 30 Mg 40 Mg)

1

ZYCLARA PUMP EXTERNAL CREAM 25 375 (imiquimod)

3

SUNSCREEN AGENTS - Drugs for the Skin


3


3


3

SMOOTH MUSCLE RELAXANTS - Drugs to Relax Muscles

ANTIMUSCARINICS - Drugs for the Urinary System

darifenacin hydrobromide er oral tablet extended release 24 hour 15 mg 75 mg

1

flavoxate hcl oral tablet 100 mg 1

GELNIQUE TRANSDERMAL GEL 10 (oxybutynin chloride) 3

oxybutynin chloride er oral tablet extended release 24 hour 10 mg 15 mg 5 mg

1

oxybutynin chloride oral syrup 5 mg5ml 1

oxybutynin chloride oral tablet 5 mg 1

OXYTROL TRANSDERMAL PATCH TWICE WEEKLY 39 MG24HR (oxybutynin)

2

solifenacin succinate oral tablet 10 mg 5 mg 1

tolterodine tartrate er oral capsule extended release 24 hour 2 mg 4 mg

1

tolterodine tartrate oral tablet 1 mg 2 mg 1

TOVIAZ ORAL TABLET EXTENDED RELEASE 24 HOUR 4 MG 8 MG (fesoterodine fumarate)

3

trospium chloride er oral capsule extended release 24 hour 60 mg

1

trospium chloride oral tablet 20 mg 1

VESICARE LS ORAL SUSPENSION 5 MG5ML (solifenacin succinate)

3

RESPIRATORY SMOOTH MUSCLE RELAXANTS - Drugs for Lungs



327



3


PV


PV


SELECTIVE BETA-3-ADRENERGIC AGONISTS - Drugs for the Urinary System

GEMTESA ORAL TABLET 75 MG (vibegron) 3

MYRBETRIQ ORAL TABLET EXTENDED RELEASE 24 HOUR 25 MG 50 MG (mirabegron)

3

VITAMINS

MULTIVITAMIN PREPARATIONS




3


3



3



biocel oral tablet 1



3




3



3


3

FOLIC-K ORAL CAPSULE 1 MG 3



328



3

INFUVITE ADULT INTRAVENOUS INJECTABLE (multiple vitamin)

2

INFUVITE PEDIATRIC INTRAVENOUS SOLUTION (pediatric multiple vitamins)

2

MVI ADULT INTRAVENOUS INJECTABLE (multiple vitamin) 2

MVI PEDIATRIC INTRAVENOUS SOLUTION RECONSTITUTED (pediatric multiple vitamins)

3








3


NEOVITE ORAL TABLET 3


3


3



OCUVEL ORAL CAPSULE 05 MG (multiple vitamins-minerals-fa)

3

OMNIVEX ORAL TABLET 3

ONEVITE ORAL TABLET 1 MG 3



3


3


3


3




329







3


3


3


3


3


3


3


3


3


3




3


3


3


3


3


3



3


330


REQ 49+ ORAL TABLET (multiple vitamins-minerals) 3


3


3


STROVITE ONE ORAL TABLET (multiple vitamins-minerals) 3

support oral liquid 1

TOBAKIENT ORAL CAPSULE (dietary management product) 3


3





3



UDAMIN SP ORAL TABLET 1 MG (multiple vitamins-minerals-fa)

3

urosex oral tablet 1

v-c forte oral capsule 1

VENEXA ORAL TABLET (multiple vitamins-minerals) 3

multiple vitamins-minerals (Vic-Forte Oral Capsule) 1


3


multiple vitamins-minerals (Vitacel Oral Tablet) 1


3


3


3


VITA-RX DIABETIC VITAMIN ORAL CAPSULE 3



VITREXATE ORAL TABLET (multiple vitamins-minerals) 3


331



VITREXYL ORAL TABLET (multiple vitamins-minerals) 3




XYZBAC ORAL TABLET 3


ZYVANA ORAL CAPSULE 3

ZYVIT ORAL TABLET 3

VITAMIN A


AQUASOL A INTRAMUSCULAR SOLUTION 15 MGML 50000 UNITML (vitamin a)

2

COD LIVER OIL ORAL OIL 3



VITAMIN B COMPLEX

cyanocobalamin-methylcobalamin (Abaneu-Sl Sublingual Tablet Sublingual 600-600 Mcg)

3


ACTIVITE ORAL TABLET 1 MG 3

folic acid-vit b6-vit b12 (Airavite Oral Tablet 25-25-1 Mg) 1


3


3


3


B-12 COMPLIANCE INJECTION INJECTION KIT 1000 MCGML

3




3


b-plex oral tablet 1

CENFOL ORAL TABLET 23-245-2 MG (folic acid-vit b6-vit b12)

3


332


cerefolin nac oral tablet 6-90314-2-600 mg 1

CHOLECAL DF ORAL TABLET 1-3800 MG-UNIT 3


CIFEREX ORAL CAPSULE 1-3775 MG-UNIT (folic acid-cholecalciferol)

3


3



3


cyanocobalamin injection solution 1000 mcgml 1

DEPLIN 15 ORAL CAPSULE 15-90314 MG (l-methylfolate-algae)

3


3

DERMACINRX PUREFOLIX ORAL TABLET 1-5000 MG-UNIT (folic acid-cholecalciferol)

3

b complex-c-folic acid (Dexifol Oral Tablet 5 Mg) 3

DIALYVITE 3000 ORAL TABLET 3 MG (b complex-c-biotin-e-min-fa)

3


3

b complex-c-folic acid (Dialyvite Oral Tablet) 3

DIALYVITE SUPREME D ORAL TABLET 3 MG (multiple vitamins-minerals-fa)

3

DIALYVITEZINC ORAL TABLET (b complex-c-zn-folic acid) 3


ELFOLATE ORAL TABLET 15 MG 75 MG (l-methylfolate) 3

ELFOLATE PLUS ORAL TABLET 3-35-2 MG (l-methylfolate-b6-b12)

3


3


fabb oral tablet 22-25-1 mg 1

FALESSA ORAL KIT 20-1-01 MCG-MG (levonorgestrel-eth estrad amp fa)

PV

fa-vitamin b-6-vitamin b-12 oral tablet 22-25-05 mg 1


3


333



3


3



1

folbee oral tablet 25-25-1 mg 1

FOLBEE PLUS CZ ORAL TABLET 5 MG (b-complex-c-biotin-minerals-fa)

3

folbee plus oral tablet 1

FOLBIC RF ORAL TABLET 113-25-2 MG (l-methylfolate-b6-b12)

3

FOLGARD RX ORAL TABLET 22-25-1 MG (folic acid-vit b6-vit b12)

3

folic acid injection solution 5 mgml 1

folic acid oral tablet 1 mg 1

FOLIC D3 ORAL CAPSULE 1-3775 MG-UNIT 3




FOLIXAPURE ORAL TABLET 1-5000 MG-UNIT (folic acid-cholecalciferol)

3

folplex 22 oral tablet 22-25-05 mg 1

foltanx oral tablet 3-35-2 mg 1

FOLTANX RF ORAL CAPSULE 3-90314-2-35 MG (l-methylfolate-algae-b12-b6)

3

FOLTRATE ORAL TABLET 500-1 MCG-MG (cobalamin combinations)

3

FOLTREXYL ORAL TABLET 1-5000 MG-UNIT (folic acid-cholecalciferol)

3

FOLTX ORAL TABLET 113-25-2 MG (l-methylfolate-b6-b12) 3

folic acid-cholecalciferol (Folvite-D Oral Tablet 1-3775 Mg-Unit) 3



3

GENICIN VITA-D ORAL TABLET 1-3775 MG-UNIT (folic acid-cholecalciferol)

3

GENICIN VITA-Q ORAL TABLET 1 MG (multiple vitamins with fa)

3


334


b complex-c-folic acid (Genicin Vita-S Oral Tablet 1 Mg) 3




3



HYLAVITE ORAL TABLET 3

HYLAZINC ORAL TABLET 3


3


1


3


3


l-methylfolate ca me-cbl nac oral tablet 6-90314-2-600 mg 1

l-methylfolate calcium oral tablet 15 mg 75 mg 1

l-methylfolate forte oral capsule 15-90314 mg 75-90314 mg 1

l-methylfolate oral tablet 15 mg 75 mg 1

l-methylfolate-algae oral capsule 15-90314 mg 1

l-methylfolate-algae-b12-b6 oral capsule 3-90314-2-35 mg 1

l-methylfolate-b6-b12 oral tablet 3-35-2 mg 1

l-methyl-mc nac oral tablet 6-2-600 mg 1

l-methyl-mc oral tablet 6-1-50-5 mg 1

LORID ORAL TABLET 1 MG 3

LORMATE ORAL CAPSULE 3

metafolbic oral tablet 6-1-50-5 mg 1

metafolbic plus oral tablet 6-2-600 mg 1

METAFOLBIC PLUS RF ORAL TABLET 6-90314-2-600 MG (methylfol-algae-b12-acetylcyst)

3

METANX ORAL CAPSULE 3-90314-2-35 MG (l-methylfolate-algae-b12-b6)

3

METHAVER ORAL CAPSULE 3

methylfol-algae-b12-acetylcyst oral tablet 6-90314-2-600 mg 1



335



PV


3



mynephrocaps oral capsule 1 mg 1

b complex-c-folic acid (Mynephron Oral Capsule 1 Mg) 3

NASCOBAL NASAL SOLUTION 500 MCG01ML (cyanocobalamin)

3


NEPHPLEX RX ORAL TABLET (b complex-c-zn-folic acid) 3

b complex-c-folic acid (Nephronex Oral Tablet) 1

NEPHRO-VITE RX ORAL TABLET 1 MG (b complex-c-folic acid)

3


3


3

NEURIN-SL SUBLINGUAL TABLET SUBLINGUAL 600-600 MCG

3






NICOMIDE ORAL TABLET 750-27-2-05 MG (niacinamide-zn-cu-methfo-se-cr)

3






3



ORTHO DF ORAL CAPSULE 1-3775 MG-UNIT 3

PHYSICIANS EZ USE B-12 INJECTION KIT 1000 MCGML 3



336


PODIAPN ORAL CAPSULE (l-methylfolate-b6-b12) 3










3


3


3


3


3


3


3


3


3


3




3

pyridoxine hcl injection solution 100 mgml 1



3

b complex-c-folic acid (Renal Oral Capsule 1 Mg) 3

RENATABS WITH IRON ORAL 1 amp 100 MG (b complex-c-biotin-e-fa-fe cbn)

3


337



3

REVESTA ORAL CAPSULE 1-5750 MG-UNIT 3

RIBOZEL ORAL CAPSULE 3


3



3



SUPERVITE ORAL LIQUID (b complex-lysine-zn-fa) 3

SUPPORT-500 ORAL CAPSULE (specialty vitamins products) 3

thiamine hcl injection solution 100 mgml 1




3




TRONVITE ORAL TABLET 1 MG 3


3






3

virt-caps oral capsule 1 mg 1


folic acid-vit b6-vit b12 (Virt-Gard Oral Tablet 22-25-1 Mg) 1




3


3


338



3

VITAL-D RX ORAL TABLET 1 MG (b complex-c-biotin-d-zinc-fa)

3

vitamin b complex 100 injection injectable 1

vitamin b-complex 100 injection injectable 1


VITASURE ORAL TABLET 1 MG 3







vp-vite rx oral tablet 1 mg 1

westab max oral tablet 25-25-2 mg 1

westab mini oral tablet 22-25-1 mg 1

westab one oral tablet 25-25-1 mg 1



XAQUIL XR ORAL TABLET EXTENDED RELEASE 30 MG (levomefolate glucosamine)

3

XVITE ORAL TABLET 1 MG 3




ZYVIT ORAL TABLET 3

VITAMIN C



ASCOR INTRAVENOUS SOLUTION 25000 MG50ML (ascorbic acid)

3

ASCORBIC ACID SOLUTION 500 MGML INJECTION 500 MGML

3

ascorbic acid solution 500 mgml injection 500 mgml 1




339



3


3






3


3


3



1






3



3


3


3




PV


3






340



3




3



3











3






VITAMIN D



3


3

calcidol oral solution 200 mcgml PV

calcitriol intravenous solution 1 mcgml PV

calcitriol oral capsule 025 mcg 05 mcg PV

calcitriol oral solution 1 mcgml PV



3


341



d3 high potency oral capsule 25 mcg (1000 ut) 1

d3 super strength oral capsule 50 mcg (2000 ut) 1

DECARA ORAL CAPSULE 125 MG (50000 UT) 250 MCG (10000 UT) (cholecalciferol)

3


3


3

doxercalciferol oral capsule 05 mcg 1 mcg 25 mcg 1

DRISDOL ORAL CAPSULE 125 MG (50000 UT) (ergocalciferol)

PV

ERGOCAL ORAL CAPSULE 625 MCG (2500 UT) PV

ergocalciferol oral capsule 125 mg (50000 ut) PV

ergocalciferol oral solution 200 mcgml PV


3




3


3



3


3




paricalcitol intravenous solution 2 mcgml 5 mcgml 1

paricalcitol oral capsule 1 mcg 2 mcg 4 mcg 1

RAYALDEE ORAL CAPSULE EXTENDED RELEASE 30 MCG (calcifediol)

PV DSL = 30 days


ROCALTROL ORAL CAPSULE 025 MCG 05 MCG (calcitriol) PV

ROCALTROL ORAL SOLUTION 1 MCGML (calcitriol) PV



342





3

vitamin d (ergocalciferol) oral capsule 125 mg (50000 ut) PV


weekly-d oral capsule 125 mg (50000 ut) 1


VITAMIN E



3

WHEAT GERM OIL ORAL OIL 3

VITAMIN K ACTIVITY


2






343

Index of Drugs

3232a infant formula 174abacavir sulfate 21abacavir sulfate-lamivudine 21abacavir-lamivudine-zidovudine 21Abaneu-Sl 332ABILIFY125 132ABILIFY MAINTENA 125 131ABILIFY MYCITE 125 132ABILIFY MYCITE MAINTENANCE KIT 125 131ABILIFY MYCITE STARTER KIT 125 132abiraterone acetate 30ABRAXANE 31ABSORICA 319ABSORICA LD319ACACIA45 167 267acamprosate calcium 139acarbose 212ACCOLATE280ACCUCAINE160 247 296ACCU-CHEK AVIVA 160ACCU-CHEK AVIVA PLUS171ACCU-CHEK COMPACT PLUS CONTROL 160ACCU-CHEK COMPACT PLUS TEST STRIPS 171ACCU-CHEK FASTCLIX LANCET KIT 160ACCU-CHEK GUIDE 160 171ACCU-CHEK GUIDE CONTROL 160ACCU-CHEK SMARTVIEW CONTROL 160ACCU-CHEK SMARTVIEW TEST STRIPS171ACCU-CHEK SOFTCLIX LANCET DEVICE KIT160ACCU-CHEK TENDER 1 INFUSION160ACCU-CHEK ULTRAFLEX INF SET 160ACCUPRIL82 83ACCURETIC 82 83 111 180Accutane 319ACD-A NOCLOT-5065acebutolol hcl 63 86 87 98 106acetaminophen-codeine 119 143acetaminophen-codeine 2 119 143

acetaminophen-codeine 3 119 143acetaminophen-codeine 4 119 143acetazolamide 96 176 188acetazolamide er 96 176 188acetic acid 192acetylcysteine 267 281acid reducer 203ACIOXIAY 319ACIPHEX SPRINKLE 204acitretin 319ACREMONIUM 45 167 267ACTEMRA 256 259ACTEMRA ACTPEN255 259ACTHAR 167 239ACTIMMUNE 259ACTIVASE 77 183ACTIVE FE 72 328 332ACTIVE INJECTION D 207ACTIVELLA227 240ACTIVITE332 339ACTONEL 252ACTOPLUS MET 215 246ACTOS246ACULAR 193ACULAR LS 193ACUVAIL193acyclovir 25 300ACYCLOVIX 25 319ACZONE 288 319ADAKVEO65adapalene 319ADAPALENE 319ADAPALENE-BENZOYL PER-CLINDAMY 288 320ADAPALENE-BENZOYL PER-NIACINAM 320adapalene-benzoyl peroxide 320ADASUVE130adcf (05mgml) 253 328 332 339 341ADCETRIS31ADDERALL XR 118ADDYI 139adefovir dipivoxil 25ADEMPAS 113 287ADHANSIA XR153ADLYXIN232ADLYXIN STARTER PACK 232ADMELOG 233 242ADMELOG SOLOSTAR 233 241

ADRENALIN 52 196 275Adriamycin 31adriamycin 31adult aspirin regimen 76 77 128 155ADVAIR DISKUS 61 207 281 284ADVAIR HFA 61 207 281 284ADVANCED ALLERGY COLLECTION 291 304ADVATE68ADVIL149ADVIL JUNIOR STRENGTH 149ADVIL MIGRAINE149ADYNOVATE68ADYPHREN 52 275ADYPHREN AMP 52 275ADYPHREN AMP II 52 275ADYPHREN II 52 275ADZENYS ER 118ADZENYS XR-ODT 118AEMCOLO 28AFINITOR 31AFINITOR DISPERZ31Afirmelle 216AFLURIA QUADRIVALENT52AFREZZA233 242AFSTYLA 68AGONEAZE 296AIMOVIG128 138Airavite 332AIRDUO DIGIHALER 61 207 281 285AIRDUO RESPICLICK 11314 61 207 281 285AIRDUO RESPICLICK 23214 61 207 282 285AIRDUO RESPICLICK 5514 61 207 282 285AJOVY 128 138AKLIEF320ak-poly-bac 185AKTEN 194AKYNZEO197 203 204ALA SCALP 291 304ala-cort 291 304ALA-QUIN 291 304albendazole 14ALBENZA14albuterol sulfate 61 62 285ALBUTEROL SULFATE 62 285albuterol sulfate er 61 285

344

albuterol sulfate hfa 61 285ALBUTEROL SULFATE HFA 61 285ALCAINE194alclometasone dipropionate 291 304ALCOHOL PREP PADS 315ALCORTIN A 291 304 315ALDACTAZIDE 108 110 111 178 181ALDACTONE 108 110 178ALDER 45 167 267ALDURAZYME 183ALECENSA31alendronate sodium 252ALEVE 149 251ALFERON N 23 31alfuzosin hcl er 61ALIMTA 31ALINIA15ALIQOPA 31aliskiren fumarate 110ALKERAN 31ALKINDI SPRINKLE 207allopurinol 251ALLZITAL119 134almotriptan malate 156ALOCRIL185 281ALOGLIPTIN BENZOATE 226ALOGLIPTIN-METFORMIN HCL215 226ALOGLIPTIN-PIOGLITAZONE 226 246ALOMIDE185ALORA227alosetron hcl 199ALOXI 197ALPHAGAN P 184ALPHANATE68ALPHANINE SD68alprazolam 136alprazolam er 136alprazolam intensol 136alprazolam xr 136ALPROLIX 68ALREX 189ALTABAX288Altacaine 194ALTACE 82 84ALTAFLUOR BENOX 172 194Altafrin196Altavera216ALTERNARIA 45 167 267

ALTOPREV105ALTRENO 303ALUNBRIG31ALVESCO 207 282alvimopan 201alyacen 135 216alyacen 777 216Alyq 109 287Amabelz 227 240amantadine hcl 12 117AMARYL 245ambrisentan 113 287amcinonide 291 304AMELUZ 320AMERICAN BEECH45 168 267AMERICAN COCKROACH 45 168 267AMERICAN ELM46 168 267Amethia216Amethyst 216amikacin sulfate 13 15amiloride hcl 110 178amiloride-hydrochlorothiazide 110 111 178 181aminoacetic acid 176aminocaproic acid 68Aminoreliefrms 267amiodarone hcl 99AMITIZA199amitriptyline hcl 159amlodipine besylate 91 101 102 106 113amlodipine besylate-benazepril hcl 82 84 91 101 103 106 113amlodipine besylate-valsartan 79 80 91 101 103 106 113amlodipine-atorvastatin 91 101 103 105 113amlodipine-olmesartan 79 80 91 101 103 106 113amlodipine-valsartan-hctz 79 81 91 101 103 111 181ammonium lactate 302Amnesteem320AMONDYS 45252amoxapine 159amoxicill-clarithro-lansopraz 13 26 204amoxicillin 13amoxicillin-potassium clavulanate 13amoxicillin-potassium clavulanate er 13

AMPHETAMINE ER118amphetamine sulfate 118amphetamine-dextroamphetamine 118amphetamine-dextroamphetamine er 118ampicillin 13ampicillin-sulbactam sodium 14AMPYRA267AMZEEQ288ANACAINE296ANAFRANIL159anagrelide hcl 77Ana-Lex291 296 304ANALPRAM HC 291 296 304ANALPRAM HC SINGLES 291 296 304ANALPRAM-HC291 296 304ANASPAZ 54anastrozole 31 214ANDEXXA65ANDRODERM 212ANGELIQ 227 240ANIMI-385 328 332 341ANIMI-3VITAMIN D 85 328 332 341ANNOVERA216ANODYNE LPT296ANORO ELLIPTA54 62 276 285ANTARA 104ANTICOAGULANT SODIUM CITRATE65 173ANTIVENIN LATRODECTUS MACTANS 49 249ANTIVENIN MICRURUS FULVIUS49 249anucort-hc 291 305Anusol-Hc 291 305ANZEMET197APADAZ119 143apap-caff-dihydrocodeine 119 143 153APEXICON E 291 305APIDRA SOLOSTAR 233 242APIDRA VIAL233 242APLENZIN 124APOKYN 142apraclonidine hcl 192aprepitant 204Apri216APRIZIO PAK 296APRIZIO PAK II 296APTIOM 121

345

APTIVUS22 23AQUASOL A 332ARAKODA 14ARALAST NP284Aranelle216ARANESP (ALBUMIN FREE)66ARAZLO320ARCALYST 267ARESTIN 185ARIDOL172ARIKAYCE13ARIMIDEX31 214aripiprazole 125 132ARISTADA 125 132ARISTADA INITIO 125 132ARIXTRA 65 66ARIZONA CYPRESS 46 168 267armodafinil 160ARMONAIR DIGIHALER 207 282ARMOUR THYROID246ARNUITY ELLIPTA207 282AROMASIN31 214ARRANON 31arsenic trioxide 31ARTISS 320ARZERRA31ARZOL SILVER NIT APPLICATORS311ASCENIV 49Ascomp-Codeine 128 135 143 153 155ASCOR 339ASCORBIC ACID339ascorbic acid 339asenapine maleate 125 132Ashlyna 216ASMANEX (120 METERED DOSES) 207 282ASMANEX (14 METERED DOSES) 207 282ASMANEX (30 METERED DOSES) 208 282ASMANEX (60 METERED DOSES) 208 282ASMANEX (7 METERED DOSES) 208 282ASMANEX HFA 208 282ASPARLAS 31ASPARTAME274ASPARTAME (NUTRASWEET) 274aspirin 76 77 128 155

aspirin adult low strength 76 77 128 155aspirin childrens 76 77 128 155aspirin ec 76 77 128 155aspirin ec low dose 76 77 128 155aspirin ec low strength 76 77 128 155aspirin low dose 76 77 128 155aspirin-dipyridamole er 76 113 155ASPIRIN-OMEPRAZOLE 76 77 155 205ASTAGRAF XL 265ASTERO 160 297ASTRINGYN 68ATACAND79 81ATACAND HCT 79 81 111 181atazanavir sulfate 23ATELVIA 252atenolol 63 86 87 98atenolol-chlorthalidone 63 86 87 98 113 182ATGAM 265ATIVAN 136 137atomoxetine hcl 139ATOPADERM 160ATOPICLAIR160 302atorvastatin calcium 105atovaquone 15atovaquone-proguanil hcl 14ATRIPLA 20 21ATROPEN54 249 276atropine sulfate 54 195 276ATROPINE SULFATE 54 195 276ATROVENT HFA 54 276AUBAGIO259Aubra 216Aubra Eq 216AUGMENTIN 14AUREOBASIDIUM46 168 267Aurovela 1530216Aurovela 120216Aurovela 24 Fe216Aurovela Fe 1530217Aurovela Fe 120217AURYXIA 177AUSTEDO139 159AUSTRALIAN PINE 46 168 267AUTOLET LANCING DEVICE 160AUTOSOFT 30 INFUSION SET 160

AUTOSOFT 90 INFUSION SET 160AUTOSOFT XC INFUSION SET 161AUVI-Q52 275AVAILNEX 267AVALIDE79 81 111 181AVAPRO 79 81Avar Cleanser 311 315AVAR LS CLEANSER 311 315Avar-E Emollient 311 315Avar-E Green 311 315AVAR-E LS 311 315AVASTIN31AVEED213AVEIDAOXIA 288 319Aviane 217avidoxy 28AVIDOXY DK 28Avita 303AVITENE68AVITENE FLOUR 68AVONEX PEN259AVONEX PREFILLED 259AVSOLA201 256 259 320AXONA 174 328AYGESTIN240Ayuna217AYVAKIT31azacitidine 31AZALGIA267AZASAN256 259 265AZASITE 185azathioprine 256 260 265azathioprine sodium 256 260 265azelaic acid 320AZELAIC ACID-NIACINAMIDE 320azelastine hcl 185azelastine-fluticasone 185 189 281 284AZELEX 320AZESCHEW PRENATALPOSTNATAL 72 328 332AZESCO 72 328 332azithromycin 26AZOR 79 81 91 101 103 106 113Azurette217B-12 COMPLIANCE INJECTION 332Bac119 128 135 153

346

bacitracin 185bacitracin-polymyxin b 185bacitra-neomycin-polymyxin-hc 185 189baclofen 58BACMIN 72 328 332BAFIERTAM 260 267BAHIA 46 168 267BALCOLTRA217BALD CYPRESS 46 168 267balsalazide disodium 199BALVERSA 31Balziva 217BAMLANIVIMAB 24BANZEL 121BAQSIMI ONE PACK 229 249BAQSIMI TWO PACK229 249BARACLUDE 25BASAGLAR KWIKPEN 233 238BAVENCIO 32BAXDELA 27BAYBERRY (WAX MYRTLE) 46 168 267BAYER ASPIRIN 76 78 129 155BAYER ASPIRIN EC LOW DOSE76 77 129 155BEAU RX 161BECONASE AQ189 281Bekyree217BELBUCA 148BELEODAQ 32belladonna alkaloids-opium 143BELRAPZO32BELSOMRA 130benazepril hcl 82 84benazepril-hydrochlorothiazide 82 84 111 181BENDEKA32BENEFIX68BENICAR 79 81BENICAR HCT79 81 111 181BENLYSTA 265BENSAL HP311BENZ PER-CLIND-NIACIN-TRETIN 288 303BENZAC AC WASH311BENZALKONIUM CHLORIDE 315benzalkonium chloride 315BENZEPRO 311Benzepro311Benzepro Creamy Wash311Benzepro Foaming Cloths 311Benzepro Short Contact311

BENZHYDROCODONE-ACETAMINOPHEN119 143BENZNIDAZOLE 15BENZODOX28 311BENZOIN 275 320benzoin compound 275 302benzonatate 277benzoyl peroxide 311BENZOYL PEROXIDE311benzoyl peroxide-erythromycin 288benzphetamine hcl 118benztropine mesylate 57 120BEOVU 192BEPREVE 185BERINERT255BERMUDA GRASS 46 168 268Beser291 305BESER305BESIVANCE 185BESPONSA 32BETA 1 KIT 208BETADINE OPHTHALMIC PREP 192BETALOAN SUIK 161 208 297betamethasone dipropionate 291 292 305betamethasone dipropionate aug 291 305BETAMETHASONE SOD PHOS amp ACET208betamethasone sod phos amp acet 208betamethasone valerate 292 305BETAPACE 58 86 87 98 100 106BETAPACE AF 58 86 87 98 100 106BETASERON260betaxolol hcl 63 86 87 98 106 188bethanechol chloride 60BETIMOL 188BETOPTIC-S 188BEVACIZUMAB 192BEVESPI AEROSPHERE 54 62 276 285bexarotene 32BEYAZ 217bicalutamide 32BICILLIN L-A25BICNU32BIDIL 104 109

BIJUVA 227 240BIKTARVY 20 21BILTRICIDE 14bimatoprost 196BINOSTO252Bio Glo 172biocel 328 332bisacodyl 199bisacodyl ec 199bisoprolol fumarate 63 86 87 98bisoprolol-hydrochlorothiazide 63 86 88 98 111 181BIVIGAM 49BLACK WILLOW46 168 268BLENREP 32bleomycin sulfate 32BLEPHAMIDE185BLEPHAMIDE SOP 185BLINCYTO 32Blisovi 24 Fe 217Blisovi Fe 1530 217Blisovi Fe 120 217BONIVA 252BONJESTA 198 279 332BORTEZOMIB 32bosentan 113 287BOSULIF32BOTOX 64 268BOTRYTIS 46 168 268bp 10-1 311 315bp cleansing wash 311 315bp vit 3 85 332bp wash 311b-plex 332 339b-plex plus 72 328BRAFTOVI 32BREO ELLIPTA 62 208 282 285BREYANZI 32 117BREZTRI AEROSPHERE 54 62 208 276 282 285BRIDION 249briellyn 217BRILINTA76 77brimonidine tartrate 184BRIMONIDINE-DORZOLAMIDE184 188BRINEURA 183brinzolamide 188BRIVIACT 121BROME46 168 268bromfenac sodium (once-daily) 193bromocriptine mesylate 141

347

BROMSITE 193BRONCHITOL 284BRONCHITOL TOLERANCE TEST284BROVANA 62 285BRUKINSA32BRYHALI305BSP 0820208budesonide 208 282budesonide er 208BUDESONIDE-FORMOTEROL FUMARATE 62 208 282 285bumetanide 108 176BUNAVAIL 148BUPHENYL174bupivacaine fisiopharma 247bupivacaine hcl 247bupivacaine hcl (pf) 247buprenorphine 148buprenorphine hcl 148buprenorphine hcl-naloxone hcl 148bupropion hcl 124bupropion hcl er (smoking det)124bupropion hcl er (sr) 124bupropion hcl er (xl) 124BUPROPION HCL ER (XL) 124buspirone hcl 130busulfan 32butalbital-acetaminophen 119 135BUTALBITAL-ACETAMINOPHEN119 135butalbital-apap-caff-cod 119 129 135 143 154butalbital-apap-caffeine 119 129 135 154butalbital-asa-caff-codeine 129 135 143 154 155butalbital-aspirin-caffeine 77 78 129 135 154 155butorphanol tartrate 148BYDUREON BCISE AUTOINJECTOR 233BYETTA 10 MCG PEN 233BYETTA 5 MCG PEN 233BYNFEZIA PEN 245BYSTOLIC 58 86CABENUVA 20cabergoline 141CABLIVI 65CABOMETYX 32CADIRAMD161 297

CADUET 91 101 103 105 113CAFERGOT 59 129caffeine citrate 154CALAN SR 89 91 93 95 100 113calcidol 341calcipotriene 320CALCIPOTRIENE 320calcipotriene-betameth diprop 292 305 320CALCIPOTRIENE-CLOBETASOL PROP305 320calcitonin (salmon) 214 239 252calcitriol 320 341calcium acetate 177calcium acetate (phos binder) 177 178calcium-folic acid plus d 178CALDOLOR 149CALIFORNIA PEPPER TREE 46 168 268CALQUENCE32CAMBIA 129 149Camila217CAMINO PRO COMPLETEGLYTACTIN 174CAMPATH 32Camrese 217Camrese Lo 217CANASA 199CANCIDAS 17candesartan cilexetil 79 81candesartan cilexetil-hctz 79 81 111 181CANDIDA ALBICANS EXTRACT 46 168 268CANTHARIDIN 320CAPASTAT SULFATE15capecitabine 32CAPEX292 305CAPLYTA132CAPRELSA32capsaicin 320CAPSFENAC PAK149 317 320CAPSINAC149 317 320captopril 82 84captopril-hydrochlorothiazide 82 84 111 181CARAC 32 320CARAFATE204CARBAGLU 174carbamazepine 121 125 126carbamazepine er 121 125

carbidopa 139carbidopa-levodopa 140carbidopa-levodopa er 140carbidopa-levodopa-entacapone 139 140carbinoxamine maleate 9 279carboplatin 32CARDIOPLEGIA DEL NIDO FORMULA 178CARDIOPLEGIA IND PLASMA HIGH K178CARDIOPLEGIA IND PLASMA-TROMET 178CARDIOPLEGIA INDUCTION HIGH K178CARDIOPLEGIA INDUCTION LOW DEX 178CARDIOPLEGIA INDUCTION NON-ENR 178CARDIOPLEGIA MAIN LOW DEXTROSE 178CARDIOPLEGIA MAIN LOW TROMETHA178CARDIOPLEGIA MAIN PLASMA-TROME 178CARDIOPLEGIA MAINTENANCE178CARDIOPLEGIA REPERFUSATE 41 178CARDIOVID PLUS268CARDIZEM 90 91 94 95 100 114CARDIZEM CD 89 91 93 95 100 114CARDIZEM LA 90 91 94 95 100 114CARDURA 59 78 106CARDURA XL59 78 79 106CARETOUCH LANCINGEJECTOR 161CARETOUCH TEST 171CARIMUNE NF 49carisoprodol 57carisoprodol-aspirin-codeine 57 143 155carmustine 32CARNITOR 268CAROSPIR 108 110 178carteolol hcl 188Cartia Xt 90 91 94 95 100 114CARTICEL 268carvedilol 58 61 78 86 98 106

348

carvedilol phosphate er 58 61 78 86 98 106cascara sagrada 199CASIRIVIMAB24CASODEX 32caspofungin acetate 18CAT HAIR EXTRACT46 168 268Cataflam149CATAPRES-TTS-1 53 97CATAPRES-TTS-2 53 97CATAPRES-TTS-3 53 97CATHFLO ACTIVASE 78 183CATTLE EPITHELIUM 46 168 268Cavarest253CAVERJECT114CAVERJECT IMPULSE114CAYA 273CAYSTON24Caziant217CEDAR ELM 46 168 268cefaclor 11cefaclor er 11cefadroxil 11cefazolin sodium 11cefazolin sodium-dextrose 11cefdinir 11cefepime hcl 12cefixime 11cefotaxime sodium 11cefotetan disodium 11 17cefoxitin sodium 11 17cefpodoxime proxetil 11 12cefprozil 11ceftazidime 12ceftriaxone sodium 12cefuroxime axetil 11celecoxib 140CELEXA157CELONTIN159CEM-UREA312CENFOL 332CENTANY AT 288CENTRATEX 72 328cephalexin 11CEQUA 192CEQUR SIMPLICITY 2U 161CERACADE 302CERDELGA 268cerefolin nac 333CEREZYME 183Cerovel312CERVIDIL 274

CETACAINE 297cetirizine hcl 10 284CETROTIDE 214 259cevimeline hcl 60CHANTIX 57CHANTIX CONTINUING MONTH PAK57CHANTIX STARTING MONTH PAK57Charlotte 24 Fe 217Chateal217Chateal Eq 217CHEMET206 249CHENODAL 201CHLOOXIA 305chloramphenicol sod succinate 17chlordiazepoxide hcl 137chlordiazepoxide-amitriptyline 137 159chlordiazepoxide-clidinium 54 137chlorhexidine gluconate 192chloroquine phosphate 14chlorpromazine hcl 153chlorthalidone 113 182chlorzoxazone 57CHOLBAM 201CHOLECAL DF333 341cholestyramine 89cholestyramine light 89CHONDROITIN SULFATE 192chorionic gonadotropin 230 231Chromagen 72 333 339Ciclodan 310ciclopirox 310ciclopirox olamine 310ciclopirox treatment 310 312CICLOPIROX-CLOBETASOL 305 311CICLOPIROX-CLOBETASOL-SAL ACID305 311 312CICLOPIROX-SALICYLIC ACID 311 312cidofovir 25CIFEREX 333 341cilostazol 77 109CILOXAN 185CIMDUO 21cimetidine 203cimetidine hcl 203CIMETIDINE-LIDO-SALICYLIC ACID 312CIMZIA202 256 260

CIMZIA PREFILLED KIT 201 256 260CIMZIA STARTER KIT 201 256 260cinacalcet hcl 214 268CINQAIR 280CINRYZE 255CIPRO16 27CIPRO HC 185 189CIPRODEX 185 189ciprofloxacin hcl 16 28 185ciprofloxacin-dexamethasone 185 189CIPROFLOXACIN-FLUOCINOLONE PF 185 189cisplatin 33CISPLATIN 33citalopram hydrobromide 157CITRANATAL BLOOM 72 333 340citroma 199CLADOSPORIUM CLADOSPORIOIDES46 168 268CLADOSPORIUM SPHAEROSPERMUM 46 168 268cladribine 33Claravis 320CLARINEX-D 12 HOUR 11 53 275 284clarithromycin 16 26clarithromycin er 16 26clearlax 199clemastine fumarate 9 279CLENPIQ 199CLEOCIN 24 288CLIMARA 227CLIMARA PRO 227CLINDACIN ETZ288Clindacin Etz 288CLINDACIN PAC 288Clindacin-P288CLINDAGEL289CLINDAMY-BENZOYL PER-NIACINAM 289 312clindamycin hcl 24clindamycin palmitate hcl 24clindamycin phos-benzoyl perox 289 312CLINDAMYCIN PHOS-NIACINAMIDE 289clindamycin phosphate 289CLINDAMYCIN PHOSPHATE 289

349

CLINDAMYCIN-NIACIN-TRETINOIN289 303clindamycin-tretinoin 289 303CLINDESSE289CLIND-NIACIN-SPIRONOLAC-TRETIN 289 303Clinpro 5000253clobazam 136 137clobetasol prop emollient base 292 305clobetasol propionate 292 305 306clobetasol propionate e 292 305clobetasol propionate emulsion 292 305CLOBETASOL PROP-LEVOCETIRIZINE 306CLOBETASOL PROP-NIACINAMIDE 306CLOBETAVIX 306CLOBEX 292 306CLOBEX SPRAY 292 306clocortolone pivalate 292 306CLODAN 292 306Clodan292 306clofarabine 33clomiphene citrate 227clomipramine hcl 159clonazepam 136 137clonidine 53 97clonidine hcl 53 97clonidine hcl er 53 97clopidogrel bisulfate 77clorazepate dipotassium 136 137clotrimazole 300clotrimazole-betamethasone 292 300 306Clovique 206clozapine 132CLOZARIL 132COAGADEX68COAL TAR 314COARTEM 14COCAINE HCL 194COCKLEBUR46 168 268COD LIVER OIL332 342codeine sulfate 143 277COLCHICINE251colchicine 251colchicine-probenecid 183 251COLCRYS251colesevelam hcl 89 213 214COLESTID 89

COLESTID FLAVORED89colestipol hcl 89colistimethate sodium (cba) 27COMBIGAN 184 188COMBIPATCH 227 240COMBIVENT RESPIMAT 54 62 276 285COMETRIQ33COMPLERA21Compro 153 198CONCERTA154CONDYLOX320CONJUPRI91 101 103 106 114CONSENSI 101 114 140constulose 174CONTOUR CONTROL 161CONTOUR MONITOR DEVICE161CONTOUR MONITOR KIT WDEVICE 161CONTOUR NEXT CONTROL161CONTOUR NEXT EZ161CONTOUR NEXT LINK 161CONTOUR NEXT MONITOR 161CONTOUR NEXT TEST 171CONTOUR TEST171CONTRAVE 120CONZIP 143COPASIL 275COPAXONE260COPIKTRA33CORDRAN292 306COREG58 61 78 86 98 106COREG CR 58 61 78 86 98 106Coremino 28 320CORGARD58 86 88 98CORIFACT68CORLANOR96CORN POLLEN 46 168 268CORTANE-B189CORTIFOAM 292 306CORTISPORIN-TC 186CORTROSYN 167CORVITE 150 72 328 333 340corvite fe 72 328 333COSELA 273COSENTYX (300 MG DOSE)320COSENTYX 150 MGML 321COSENTYX SENSOREADY (300 MG)321COSENTYX SENSOREADY PEN321

COSMEGEN 33cosyntropin 167COTELLIC 33COTEMPLA XR-ODT 154Covaryx213 227Covaryx Hs 213 227COZAAR 79 81CREON 201CRESEMBA16CRESTOR 105CRINONE 240CRIXIVAN 23CROFAB 49 249cromolyn sodium 185 281crotan 319Cryselle-28217CRYSVITA 176CUBICIN 17CUBICIN RF 17CUPRIMINE206 256CUROSURF283CURVULARIA46 168 268CUTAQUIG 49CUVITRU 49CUVPOSA 54cvs gentle laxative 199cvs motion sickness 9 198 279cyanocobalamin 333Cyclafem 135 217Cyclafem 777 218cyclobenzaprine hcl 57cyclobenzaprine hcl er 57CYCLOGYL 195CYCLOMYDRIL 195CYCLOPAK 57 297cyclopentolate hcl 195cyclophosphamide 33 265CYCLOPHOSPHAMIDE 33 265cycloserine 16CYCLOSET141cyclosporine 256 260 265CYCLOSPORINE IN KLARITY 192cyclosporine modified 256 260 265CYMBALTA141 156cyproheptadine hcl 9 279CYRAMZA 33Cyred 218Cyred Eq 218CYSTADANE 268CYSTADROPS 192CYSTAGON268

350

CYSTARAN 192cytarabine 33cytarabine (pf) 33CYTOGAM50CYTOMEL246CYTOTEC204cytra k crystals 173d3 high potency 342d3 super strength 342dacarbazine 33DACOGEN33dactinomycin 33dalfampridine er 268DALIRESP 283danazol 213dantrolene sodium 58DANYELZA 33dapsone 15 289 321DAPSONE 289 321DAPSONE-NIACINAMIDE 289 321DAPSONE-NIACINAMIDE-SPIRONOLAC 289 321daptomycin 17DARAPRIM 14darifenacin hydrobromide er 327DARZALEX 33DARZALEX FASPRO 33Dasetta 135218Dasetta 777218daunorubicin hcl 33DAURISMO33DAYPRO149Daysee218DAYTRANA 154DAYVIGO130DDAVP RHINAL TUBE68 239DEBACTEROL192 321Deblitane218Decadron 208DECARA 342decitabine 33deferasirox 206deferasirox granules 206deferiprone 206deferoxamine mesylate 206 249DELESTROGEN227DELSTRIGO 21Delyla 218demeclocycline hcl 28DEMSER268DENAVIR 300Denta 5000 Plus 253

Dentagel253DEOXIA 289DEPAKOTE 121 126 129DEPAKOTE ER 121 126 129DEPAKOTE SPRINKLES 121 126 129DEPEN TITRATABS206 256DEPLIN 15 333DEPLIN 75 333DEPO-ESTRADIOL 228DEPO-MEDROL 208DEPO-PROVERA 240DEPO-SUBQ PROVERA 104240DEPO-TESTOSTERONE 213DERMACINRX CLORHEXACIN 289 315 321Dermacinrx Empricaine297DERMACINRX LEXITRAL PHARMAPAK 149 317 321DERMACINRX PENETRAL321DERMACINRX PHN 297 302Dermacinrx Prizopak297DERMACINRX PUREFOLIX 333 342DERMACINRX THERAZOLE PAK292 300 302 306DERMACINRX ZRM 297 302DERMALID 297DERMELLE302DESCOVY 21desflurane 142desipramine hcl 159desloratadine 11 284desmopressin ace spray refrig 69 239desmopressin acetate 69 239desmopressin acetate pf 69 239desmopressin acetate spray 239desogestrel-ethinyl estradiol 218desonide 292 306desoximetasone 293 306DESVENLAFAXINE ER156desvenlafaxine succinate er 156DEXABLISS 208dexamethasone 208 209dexamethasone intensol 208dexamethasone sod phosphate pf 209dexamethasone sodium phosphate 189 209DEXAMETHASONE SODIUM PHOSPHATE209

dexchlorpheniramine maleate 9 10 279DEXCOM G4 G5 G6 RECEIVER TRANSMITTER SENSOR (INCLUDING PLATINUM PLATINUM PEDIATRIC)161DEXERYL 302Dexifol 333 340DEXILANT 205dexmedetomidine hcl 130dexmedetomidine hcl in nacl 130dexmethylphenidate hcl 154dexmethylphenidate hcl er 154DEXONTO 04 209dexrazoxane hcl 273DEXTENZA189dextroamphetamine sulfate 118dextroamphetamine sulfate er 118DEXYCU 189DIACOMIT 121DIADIMAXIA 289 321Dialyvite 333 340DIALYVITE 3000333DIALYVITE 5000333DIALYVITE SUPREME D333 342DIALYVITEZINC 333 340DIAOXIA 289 321DIASDIMAXIA289 321DIASOXIA 289 321DIASTAT ACUDIAL 136 137DIASTAT PEDIATRIC136 137diazepam 136 137Diazepam Intensol 136 137diazoxide 214DIBENZYLINE 59 106DICLOFENAC CAP 149DICLOFENAC PATCH 149 318 321diclofenac potassium 149diclofenac sodium 33 149 193 318 321diclofenac sodium er 149diclofenac-misoprostol 149 204DICLOFENAC-NA HYALURON-NIACIN 149 192 318 321DICLOFONO149 318DICLOPR 149 318 321DICLOTREX 150 318DICLOVIX 150 297 318DICLOVIX M 150 318dicloxacillin sodium 27

351

DICLOZOR 150 318 321DICOPANOL FUSEPAQ9 279dicyclomine hcl 54diethylpropion hcl 118diethylpropion hcl er 117DIFFERIN 321DIFICID 26diflorasone diacetate 293 306diflunisal 150DIFMETIOXRIME 300DIGIFAB50 249Digitek 85 96Digox85 96digoxin 85 96dihydroergotamine mesylate 59 129DILANTIN97 141DILATRATE-SR 109diltiazem hcl 90 92 94 95 100 114diltiazem hcl er 90 92 94 95 100 114diltiazem hcl er beads 90 91 94 95 100 114diltiazem hcl er coated beads 90 91 92 94 95 100 114DILTIAZEM HCL-DEXTROSE 90 92 94 95 100 114dilt-xr 90 92 94 95 100 114DIMENTHO150 318dimethyl fumarate 260dimethyl fumarate starter pack260DIMOXIA321DIOVAN 79 81DIOVAN HCT79 81 111 181DIPENTUM 199diphen 9 279DI-PHEN 9 279diphenhydramine hcl 9 279diphenoxylate-atropine 54 198 276dipyridamole 77 114disopyramide phosphate 97disulfiram 248DIURIL 111 181divalproex sodium 121 126 129divalproex sodium er 121 126 129DIVIGEL228DMT SUIK161 209docetaxel 33 34docusate sodium 199dofetilide 100

DOG EPITHELIUM 46 168 268DOG FENNEL46 168 268DOJOLVI174donepezil hcl 60DONNATAL 55 134 135DOPTELET 66DORYX 29DORYX MPC 28DORZOLAMIDE HCL 188dorzolamide hcl 188dorzolamide hcl-timolol mal 188dorzolamide hcl-timolol mal pf 188Dotti 228DOUBLEDEX209DOVATO20 21doxazosin mesylate 59 78 79 107doxepin hcl 159 297doxercalciferol 342DOXIL 34doxorubicin hcl 34doxorubicin hcl liposomal 34Doxy 10029doxycycline 29 321doxycycline hyclate 29 186DOXYCYCLINE HYCLATE29doxycycline monohydrate 29doxylamine-pyridoxine 198 279 333DRAXACE312 315DRAXACE LOTION CLEANSER312 315DRECHSLERA 46 168 268DRISDOL 342DRITHO-CREME HP 314DRIXECE 312 315DRIZALMA SPRINKLE 141 156dronabinol 198drospiren-eth estrad-levomefol218drospirenone-ethinyl estradiol 218DROXIA 34droxidopa 53DRYSOL 300DSUVIA143DUAKLIR PRESSAIR 55 62 276 286DUAVEE 227 228DUETACT 245 246DUEXIS150 203DULERA 62 209 283 286duloxetine hcl 141 156DUOBRII 307 321DUOPA 140

DUPIXENT280 322duramorph 143DUREZOL189DURLAZA 77 78 129 155DUROLANE 161DURYSTA196DUST MITE MIXED ALLERGEN EXT46 168 269dutasteride 248dutasteride-tamsulosin hcl 61 248DUTOPROL 63 86 88 98 111 181DXEVO 11-DAY209DYANAVEL XR118DYRENIUM110 178DYSPORT64 269EES GRANULES 18 24EASIVENT 161EASTERN COTTONWOOD 46 168 269EASYMAX CONTROL 161ECEOXIA 315EC-NAPROSYN150 251ec-naproxen 150 251ECONASIL300econazole nitrate 300ECONAZOLE NITRATE-NIACINAMIDE 301ECOZA301EDARBI79 81EDARBYCLOR 80 81 113 182EDECRIN108 176EDEX 114EDLUAR 131ED-SPAZ 55EDURANT21Eemt213 228Eemt Hs 213 228efavirenz 21efavirenz-emtricitab-tenofovir 21efavirenz-lamivudine-tenofovir 21 22EFFER-K179Effer-K179EFFEXOR XR 156EFFIENT 77EGATEN 14EGRIFTA SV245EHA297ELAPRASE 183ELELYSO183ELEPSIA XR 121ELESTRIN 228

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ELETONE 161 302eletriptan hydrobromide 156ELFOLATE333ELFOLATE PLUS 333ELIDEL265 322ELIGARD 34 230 231ELIMITE 319Elinest 218ELIQUIS66ELIQUIS DVTPE STARTER PACK 66ELITEK183ELIXOPHYLLIN 104 176 288 327ELLA 218ELMIRON273ELOCTATE 69Eluryng218ELZONRIS 34EMCYT 34EMEND 204EMEND TRI-PACK 204EMFLAZA 209EMGALITY129 138EMGALITY (300 MG DOSE) 138Emoquette218EMPLICITI 34EMPRICAINE-II 297EMSAM142emtricitabine 22emtricitabine-tenofovir df 22EMTRIVA 22EMULSION SB 161EMVERM 14enalapril maleate 82 84enalapril-hydrochlorothiazide 82 84 111 181ENBRACE HR 72 328 333ENBREL256 260 322ENBREL MINI 256 260 322ENBREL SURECLICK 256 260 322ENDARI 202 269ENDO AVITENE 69Endocet119 143ENDOMETRIN240ENHERTU34ENLITE GLUCOSE SENSOR161ENLYTE 72 328 333 340enovarx-amitriptyline 159enovarx-baclofen 322enovarx-cyclobenzaprine hcl 322enovarx-ibuprofen 293 318

enovarx-lidocaine hcl 297enovarx-naproxen 293 318enoxaparin sodium 71Enpresse-28218Enskyce 218ENSPRYNG260ENSTILAR 293 307 322entacapone 139entecavir 25ENTERAGAM 269ENTOCORT EC209ENTRESTO 81 111ENTTY SPRAY 162ENTYVIO 202 260enulose 174ENVARSUS XR 265ENZADYNE 201Enzoclear 312EPANED 82 84EPCLUSA 18 19ephedrine sulfate 53 275EPHEDRINE SULFATE-NACL 53 275EPICERAM 162EPICOCCUM 46 169 269EPIDIOLEX 121EPIDUO 322EPIDUO FORTE 322EPIFOAM293 297 307epinastine hcl 185epinephrine 53 275EPINEPHRINE PROFESSIONAL 53 276EPINEPHRINESNAP-EMS 53 276EPINEPHRINESNAP-V 53 276epirubicin hcl 34EPISIL162EPISNAP 53 276Epitol 121 126EPIVIR HBV22eplerenone 108 110EPOGEN66epoprostenol sodium 114 287EQUACARE JR 174EQUETRO 121 126ERAXIS18ERBITUX 34ERGOCAL 342ergocalciferol 342ergoloid mesylates 59ERGOMAR 59 129ergotamine-caffeine 60 129

ERIVEDGE 34ERLEADA 34erlotinib hcl 34Errin 218ERTACZO301ertapenem sodium 17ERWINAZE 34ery 289ERYPED 200 18 24ERYTHROCIN STEARATE 18 24erythromycin 18 24 186 289erythromycin base 18 24erythromycin ethylsuccinate18 24ESBRIET277escitalopram oxalate 157ESKATA312 322ESMOLOL HCL 64 86 88 98ESOMEP-EZS 205esomeprazole magnesium 205ESOMEPRAZOLE STRONTIUM205ESPEROCT 69ESSENTIAL CARE JR174est estrogens-methyltest 213 228est estrogens-methyltest ds 213 228est estrogens-methyltest hs 213 228Estarylla 218estazolam 137ESTRACE 228estradiol 228estradiol valerate 228estradiol-norethindrone acet 228 241ESTRING 228ESTROGEL 228ESTROSTEP FE218eszopiclone 131ETESEVIMAB 24ethacrynic acid 108 176ethambutol hcl 16ethosuximide 159ETHOXIA 322ethyl chloride 297ethynodiol diac-eth estradiol 218ETHYOL273etodolac 150etodolac er 150etonogestrel-ethinyl estradiol 218ETOPOPHOS 34etoposide 34EUCRISA 293 296

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EUFLEXXA 162Euthyrox246EVAMIST 228EVEKEO ODT118EVENITY252everolimus 34 265EVISTA 227 252EVKEEZA 85EVOMELA34EVOTAZ23 269EVRYSDI 252 269EXELDERM 301exemestane 34 214EXFORGE 80 81 92 102 103 107 114EXFORGE HCT 80 81 92 101 103 111 181EXJADE 206EX-LAX ULTRA 200EXODERM291EXONDYS 51 252 269exotic-hc 189EXPAREL 247EXTAVIA260EYLEA 193EYSUVIS 189EZALLOR SPRINKLE105ezetimibe 97ezetimibe-simvastatin 97 105fabb 333FABIOR322FABRAZYME 183FALESSA333Falmina 218famciclovir 25famotidine 203famotidine orig st 203FANAPT132FANAPT TITRATION PACK 132FARESTON 35 227FARXIGA 244FARYDAK 35FASENRA 280FASENRA PEN280FASLODEX35fa-vitamin b-6-vitamin b-12 333Fayosim 219febuxostat 251FEIBA69felbamate 121 122FELBATOL122FELDENE 150

felodipine er 92 102 103 107 114FEM PH 315FEMARA 35 214FEMHRT LOW DOSE228 241FEMRING 228Femynor219fenofibrate 104fenofibrate micronized 104fenofibric acid 105FENOGLIDE 105fenoprofen calcium 150fenortho 150FENSOLVI (6 MONTH)35 230fentanyl 144fentanyl citrate 144FENTANYL CITRATE144fentanyl citrate (pf) 144FENTANYL CITRATE-NACL 144FENTANYL-BUPIVACAINE-NACL 144 248FENTORA144FERAHEME 72FERIVA 217 73 333 340FERIVAFA 73 334 340ferocon 73ferotrinsic 73FERRALET 90 73 334 340ferraplus 90 73 334 340FERRIPROX 206FERRIPROX TWICE-A-DAY 206Ferrocite Plus73 334 340ferrous sulfate 73FETROJA28FETZIMA156FETZIMA TITRATION156FIASP233 242FIASP FLEXTOUCH233 242FIASP PENFILL 233 242FIBRICOR105FIBRYGA 69FINACEA 322finasteride 248FINTEPLA122FIRAZYR255FIRDAPSE 269FIRE ANT46 169 269FIRST-LANSOPRAZOLE 205FIRST-MOUTHWASH BLM 322FIRST-OMEPRAZOLE 205FIRVANQ 18Flac 189FLAREX 189

flavoxate hcl 327FLEBOGAMMA DIF50flecainide acetate 98FLECTOR 150 318 322FLEXICHAMBER ADULT MASKSMALL 162FLEXICHAMBER CHILD MASKLARGE162FLEXICHAMBER CHILD MASKSMALL 162FLEXIPAK150 322FLOLIPID 105FLORIVA253 328 342FLORIVA PLUS 253 328FLOVENT DISKUS 209 283FLOVENT HFA 209 283floxuridine 35FLUAD 52FLUAD QUADRIVALENT 52FLUARIX QUADRIVALENT52Flucaine 172 194FLUCELVAX QUADRIVALENT 52fluconazole 17FLUCON-IBUPROF-ITRACON-TERBINA 301flucytosine 27fludarabine phosphate 35fludrocortisone acetate 209FLULAVAL QUADRIVALENT 52FLUMIST QUADRIVALENT52flunisolide 189 281FLUOCINOLONE ACET-NIACINAMIDE 293fluocinolone acetonide 189 293 307fluocinolone acetonide body 293 307fluocinolone acetonide scalp 293 307fluocinonide 293 307fluocinonide emulsified base 293 307FLUOPAR 307FLUORESCEIN SODIUMBENOXINATE 172 194fluorescein-benoxinate 172 194Fluoridex 253Fluoridex Sensitivity Relief253Fluor-I-Strips AT172fluoritab 253fluorometholone 189FLUOROPLEX35 322

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FLUOROURACIL35 322fluorouracil 35 322FLUOVIX307FLUOVIX PLUS 307fluoxetine hcl 157 158fluoxetine hcl (pmdd) 157fluphenazine decanoate 153fluphenazine hcl 153flurandrenolide 293 307FLURA-SAFE172flurazepam hcl 137flurbiprofen 150flurbiprofen sodium 193flutamide 35fluticasone propionate 189 281 293 307fluticasone-salmeterol 62 210 283 286FLUTICASONE-SALMETEROL62 210 283 286fluvastatin sodium 105fluvastatin sodium er 105fluvoxamine maleate 158fluvoxamine maleate er 158FLUZONE HIGH-DOSE QUADRIVALENT 52FLUZONE QUADRIVALENT 52FML190FML FORTE190folbee 334folbee plus 334 340FOLBEE PLUS CZ334FOLBIC RF 334FOLGARD OS 179FOLGARD RX334folic acid 334FOLIC D3334 342FOLIC-K328 334 343FOLITE 179 334 342FOLITIN-Z73 328 334FOLIXAPURE 334 342FOLLISTIM AQ 230 231FOLOTYN 35folplex 22 334foltanx 334FOLTANX RF334FOLTRATE 334FOLTREXYL 334 342foltrin 73FOLTX 334Folvite-D334 342fondaparinux sodium 65 66FORANE 142

FORFIVO XL124formaldehyde 275 322FORMALDEHYDE 275FORTAMET 215FORTEO 238 239 252FORTISCARE CONTROL 162FOSAMAX 252FOSAMAX PLUS D 252 342fosamprenavir calcium 23fosaprepitant dimeglumine 204foscarnet sodium 16FOSCAVIR16fosfomycin tromethamine 30fosinopril sodium 83 84fosinopril sodium-hctz 83 84 111 181fosphenytoin sodium 141FOSRENOL 177 249FOSTEUM 269FOSTEUM PLUS 179 269FOTIVDA 35FRAGMIN 72FREESTYLE LIBRE 14 DAY READER 162FREESTYLE LIBRE 14 DAY SENSOR162FREESTYLE LIBRE 2 READER 162FREESTYLE LIBRE 2 SENSOR162FREESTYLE LIBRE READER162FREESTYLE LIBRE SENSOR SYSTEM 162FREESTYLE PRECISION NEO TEST 171FROTEK 293 318frovatriptan succinate 156FUL-GLO 172Ful-Glo 172FULPHILA66fulvestrant 35furosemide 108 176 177FUSARIUM 47 169 269FUSION PLUS 73 334 340FUZEON 20Fyavolv228 241FYCOMPA 122gabapentin 119 122GABITRIL122GABLOFEN 58GALAFOLD269galantamine hydrobromide 60galantamine hydrobromide er 60

GALZIN 206GAMASTAN50GAMIFANT 265GAMMAGARD 50GAMMAGARD SD LESS IGA50GAMMAKED 50GAMMAPLEX 50GAMUNEX-C 50ganirelix acetate 214 259gatifloxacin 186GATTEX202gavilax 200gavilyte-c 200Gavilyte-G 200Gavilyte-H 200Gavilyte-N With Flavor Pack 200GAVRETO 35GAZYVA 35GEAMETDRAY312 318GEBAUERS PAIN EASE 162 297GEBAUERS SPRAY AND STRETCH 162 297GELCLAIR 162GELFILM193 275GEL-FLOW 162GEL-FLOW NT 162GELFOAM 69 162GELFOAM COMPRESSED SIZE 100 162GELFOAM DENTAL PACK SIZE 4 162GELFOAM SPONGE 162GELFOAM SPONGE SIZE 100 163GELFOAM SPONGE SIZE 200 163GELFOAM SPONGE SIZE 50 163GELFOAM-JMI POWDER 163GELFOAM-JMI SPONGE 163GELNIQUE 327GELSYN-3 163GELX 163gemcitabine hcl 35gemfibrozil 105Gemmily219GEMTESA 328GEN7T 297GEN7T PLUS297GENADUR 163 334GENERESS FE 219generlac 174Gengraf 256 260 265GENICIN VITA-D 334 342

355

GENICIN VITA-Q 334Genicin Vita-S 335 340GENOTROPIN239GENOTROPIN MINIQUICK239gentak 186gentamicin sulfate 186 290gentle laxative 200GENVOYA 20 22GEODON 126 132GERMAN COCKROACH 47 169 269GIALAX 200GILENYA 260GILOTRIF 35GILPHEX TR53 278GIMOTI 204GIVLAARI 269GLASSIA284glatiramer acetate 261Glatopa 261GLEEVEC 35GLEOLAN 171 172GLEOSTINE 35glimepiride 245glipizide 245glipizide er 245glipizide xl 246glipizide-metformin hcl 215 246GLOPERBA 251Glostrips172GLUCAGEN HYPOKIT 229 249glucagon emergency kit 230 249GLUCAGON EMERGENCY KIT 230 249GLUCOTROL246GLUCOTROL XL 246GLUMETZA 215GLUTARALDEHYDE 173glyburide 246glyburide micronized 246glyburide-metformin 215 246GLYCATE 55glycine 176glycine urologic 176glycolax 200GLYCOPYRROLATE55glycopyrrolate 55glycopyrrolate pf 55Glydo194GLYNASE 246GLYRX-PF 55GLYTACTIN BETTERMILK 15174

GLYTACTIN BETTERMILK DE-LITE 174GLYTACTIN BUILD 10PE 174GLYTACTIN BUILD 2020 174GLYTACTIN BUILD 2020 PKU174GLYTACTIN BURST174GLYTACTIN COMPLETE 10PE 174GLYTACTIN RESTORE 10 175GLYTACTIN RESTORE 5 175GLYTACTIN RESTORE LITE 10 175GLYTACTIN RESTORE LITE 10PE 175GLYTACTIN RTD 10 175GLYTACTIN RTD 15 175GLYTACTIN RTD LITE 15175GLYTACTIN SWIRL 15PE175GLYXAMBI226 244GOCOVRI 12 117GOLDENROD47 169 269GOLYTELY 200GONAL-F 230 232GONAL-F RFF 230 232GONAL-F RFF REDIJECT 230 232GONITRO 109goodsense aspirin low dose 77 78 129 155goodsense ibuprofen 150goodsense nicotine 57GOPRELTO 194GORDOFILM 312GRALISE 119 122granisetron hcl 197GRANIX 66 67GRASTEK47 269GREEN GLO LISSAMINE GREEN 172griseofulvin microsize 14griseofulvin ultramicrosize 14guaiatussin ac 144 277 278guaifenesin ac 144 277 278GUANENDRUX 312guanfacine hcl 97 139guanfacine hcl er 97 139GUANIDINE HCL60GUARDIAN SENSOR (3) 163GVOKE HYPOPEN 1-PACK 230 249

GVOKE HYPOPEN 2-PACK 230 249GVOKE PFS 230 249GYNAZOLE-1 301HACKBERRY47 169 269HAEGARDA255Hailey 1530 219Hailey 24 Fe219Hailey Fe 1530219Hailey Fe 120219HALAVEN 35halcinonide 293 307HALDOL DECANOATE 138halobetasol propionate 293 307HALOBETASOL PROPIONATE 307HALOG 293 307haloperidol 138haloperidol decanoate 138haloperidol lactate 138HALUCORT 302HARVONI19HCU EASY175Heather 219HELIDAC THERAPY 12 14 15 26 29 199HEMADY210HEMANGEOL 58 86 88 98 107 129hematinic plus vitminerals 73 335 340hematinicfolic acid 73 335HEMATOGEN FA 73 335 340HEMATRON-AF73HEMETAB73 335HEMLIBRA69Hemmorex-Hc294 307HEMOCYTE PLUS 73 329Hemocyte-F 73 335HEMOFIL M 69HEPAGAM B50heparin (porcine) in nacl 72 163heparin lock flush 72 163heparin sodium (porcine) 72heparin sodium (porcine) pf 72heparin sodium lock flush 72 163HERCEPTIN 36HERCEPTIN HYLECTA35HERZUMA 36HETLIOZ131HETLIOZ LQ 131HIBICLENS 315Hidex 6-Day 210

356

HIZENTRA 50hm stool softener 200HOMACTIN AA PLUS175homatropaire 195HONEY BEE VENOM47 169HORIZANT119 122HORSE EPITHELIUM 47 169 269HPR PLUS 163hpr plus 163HPR PLUS HYDROGEL163HUMALOG KWIKPEN 234 242HUMALOG MIX 5050 KWIKPEN 234 236 242HUMALOG MIX 5050 VIAL 234 236 242HUMALOG MIX 7525 KWIKPEN 234 237 242HUMALOG MIX 7525 VIAL 234 237 242HUMALOG U-100 JUNIOR KWIKPEN 234 242HUMALOG VIAL 234 242HUMATE-P 69HUMATROPE 239HUMATROPEN FOR 12MG 163HUMATROPEN FOR 24MG 163HUMATROPEN FOR 6MG 163HUMIRA202 257 261 323HUMIRA PEDIATRIC CROHNS START 202 256 261 322HUMIRA PEN 202 256 261 322 323HUMIRA PEN-CDUCHS STARTER 202 257 261 323HUMIRA PEN-PEDIATRIC UC START 202 257 261 323HUMIRA PEN-PSUVADOL HS START 202 257 261 323HUMIRA PEN-PSORUVEIT STARTER 202 257 261 323HUMULIN 7030 KWIKPEN 234 237 243HUMULIN 7030 VIAL 234 237 243HUMULIN N KWIKPEN 234 237HUMULIN N VIAL 234 237HUMULIN R U-500 KWIKPEN 234 243HUMULIN R U-500 VIAL 234 243HUMULIN R VIAL 234 243HYALGAN163

HYALURONATE-NIACINAM-TRETINOIN303HYALURONATE-NIACIN-TACROLIMUS 323HYCAMTIN 36hydralazine hcl 104HYDREA 36HYDRO 40 312hydrochlorothiazide 112 181hydrocodone bitartrate er 144hydrocodone polst-chlorphen polst er susp 10 144 277 279hydrocodone-acetaminophen 120 144hydrocodone-homatropine 55 144 145 277hydrocodone-ibuprofen 145 150hydrocortisone 210 294 308hydrocortisone (perianal) 294 307hydrocortisone ace-pramoxine 294 297 307hydrocortisone acetate 294 307hydrocortisone butyr lipo base 294 307hydrocortisone butyrate 294 307 308hydrocortisone valerate 294 308hydrocortisone-acetic acid 190 192hydrocortisone-iodoquinol 308 315hydrocort-pramoxine (perianal) 294 297 308hydromet 55 145 277hydromorphone hcl 145hydromorphone hcl er 145HYDROMORPHONE HCL-NACL 145hydroxychloroquine sulfate 14 257 261hydroxyprogesterone caproate241hydroxyurea 36hydroxyzine hcl 10 131hydroxyzine pamoate 10 131HYLATOPIC PLUS 163HYLAVITE335 340HYLAZINC 335HYMOVIS 163HYOPHEN 30hyoscyamine sulfate 55hyoscyamine sulfate er 55hyoscyamine sulfate sl 55hyosyne 55

HYPERHEP B50HYPERRAB 50HYPERRAB SD 50HYPERRHO SD50HYPERSAL163 179HYPERTET SD51HYPOCYN 164HYQVIA 51HYSINGLA ER145HYZAAR 80 81 112 181ibandronate sodium 253IBRANCE 36IBUPAK150ibuprofen 150Ibuprofen150ibuprofen infants 150ICAR-C PLUS 73 335 340icatibant acetate 255Iclevia219ICLUSIG36icosapent ethyl 85IDAMYCIN PFS 36idarubicin hcl 36IDELVION 69IDHIFA 36Iferex 150 Forte73 335ifosfamide 36ILARIS269ILEVRO193ILUMYA323ILUVIEN 190imatinib mesylate 36IMBRUVICA 36IMCIVREE120IMDEVIMAB24IMFINZI 36IMIOXIA 301imipenem-cilastatin 17imipramine hcl 159imipramine pamoate 159imiquimod 323IMIQUIMOD PUMP323IMIQUIMOD-LEVOCETIRIZIN-NIACIN323IMIQUIMOD-LEVOCET-TRETINOIN303 323IMITREX 156 157IMLYGIC 36IMOGAM RABIES-HT51IMPAVIDO 15IMPEKLO 308IMPOYZ 294 308

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IMVEXXY MAINTENANCE PACK 229IMVEXXY STARTER PACK 229inavix 150 323INBRIJA 140Incassia219INCRELEX 245INCRUSE ELLIPTA 55 276indapamide 113 182INDERAL LA 59 86 88 99 107 130INDERAL XL 59 86 88 99 107 130INDOCIN150 251INDOMETHACIN 150 251indomethacin 150 251indomethacin er 150 251INFASURF 283INFED 73Inflammacin151 323INFLATHERM 151 323INFLECTRA 202 257 261 323INFUGEM 36INFUMORPH 200 145INFUMORPH 500 145INFUVITE ADULT329 343INFUVITE PEDIATRIC 329INGREZZA139 160INLYTA 36INNOPRAN XL 59 86 88 99 107 130INOVA312INOVA 41 ACNE CONTROL THERAPY 312INOVA 82 ACNE CONTROL THERAPY 312INQOVI 36INREBIC 36INSPIREASE RESERVOIR BAGS 164INSPRA108 110INSULIN ASP PROT amp ASP FLEXPEN234 237 242INSULIN ASPART 235 243INSULIN ASPART FLEXPEN 234 242INSULIN ASPART PENFILL 234 242INSULIN ASPART PROT amp ASPART234 237 243INSULIN LISPRO235 243INSULIN LISPRO (1 UNIT DIAL)235 243

INSULIN LISPRO JUNIOR KWIKPEN 235 243INSULIN LISPRO PROT amp LISPRO235 237 243INSULIN PEN NEEDLES164INSULIN SYRINGES 164INTEGRA F73 335 340INTEGRA PLUS73 335 340INTELENCE21INTRAROSA 210INTRON A23 36 261Introvale 219INVANZ17INVEGA 132INVEGA SUSTENNA132INVEGA TRINZA 132INVELTYS190INVIRASE 23INVOKAMET215 244INVOKAMET XR215 244INVOKANA 244IODINE STRONG 14 214 249 278iodine tincture 315iodoquinol-hc-aloe polysacch 294 308 315IODOQUINOL-HC-KETOCONAZOLE 301 308 315iodoquinol-hydrocortisone-aloe 294 308 315IOPIDINE 193ipratropium bromide 55 193 276ipratropium-albuterol 55 62 276 286irbesartan 80 81irbesartan-hydrochlorothiazide 80 81 112 181IRESSA37irinotecan hcl 37IROSPAN 24673 335 340ISENTRESS20ISENTRESS HD 20Isibloom219isoflurane 142ISOLYTE-S 179isoniazid 16ISOPTO ATROPINE 195isosorbide dinitrate 109isosorbide mononitrate 109isosorbide mononitrate er 109isotretinoin 323isoxsuprine hcl 115isradipine 92 102 103 107 115

ISTODAX (OVERFILL) 37ISTURISA 269ITHOXIA323itraconazole 17ivermectin 14 319IVERMECTIN-METRONIDAZOL-NIACIN 290 319IXEMPRA KIT 37IXINITY 69JADENU206JADENU SPRINKLE207Jaimiess 219JAKAFI37Jantoven 66JANUMET 215 226JANUMET XR 215 226JANUVIA226JARDIANCE244Jasmiel219JATENZO213JELMYTO 37Jencycla 219JENTADUETO 215 226JENTADUETO XR 215 226JEVTANA37Jinteli 229 241JIVI69JOHNSON GRASS47 169 269Jolessa219JORNAY PM 154JUBLIA301Juleber 219JULUCA 20 21JUNE GRASS POLLEN STANDARDIZED 47 169 269Junel 1530 219Junel 120 219Junel Fe 1530 219Junel Fe 120 219Junel Fe 24 220JUXTAPID85JYNARQUE 183KADCYLA 37Kaitlib Fe 220KALETRA23Kalliga 220KALYDECO 278KAMDOY 164KANJINTI 37KANUMA183KAPOK47 169 270

358

KAPSPARGO SPRINKLE 64 86 88 99kapzin dc 151 318 323KARBINAL ER 9 279Kariva220KATERZIA 92 102 103 107 115KAZANO 215 226KCL-LIDOCAINE-NACL179KEDRAB 51KELARX164Kelnor 135220Kelnor 150220KENALOG210KENALOG-80 210KEPIVANCE 303KERALAC 312KERALYT312Keralyt312KERALYT SCALP312KESIMPTA261KETAMINE HCL 141KETAMINE HCL-SODIUM CHLORIDE 141ketoconazole 17 301KETOCONAZOLE-HYDROCORTISONE301 308Ketodan301KETODAN301KETONE TEST 172ketoprofen 151ketoprofen er 151ketorolac tromethamine 151 193KETOROLAC TROMETHAMINE151KETOSTIX 172KETOVIE 175KETOVIE PEPTIDE 175KEVEYIS188KEVZARA 257 261KEYTRUDA 37KHAPZORY 250KINERET 257 261KISQALI 37KISQALI FEMARA 37 214KITABIS PAK 13KIVIK164KLARITY-A 186KLARITY-L190KLISYRI 323Klor-Con179Klor-Con 10179Klor-Con M10179KLOR-CON M15 179

Klor-Con M20179Klor-ConEf 179KOATE69KOATE-DVI69KOCHIA 47 169 270KOGENATE FS 69 70KOMBIGLYZE XR215 226KORLYM214KOSELUGO37KOVALTRY70K-PHOS 173K-PHOS NO 2173K-PHOS-NEUTRAL 173K-Prime 179KRINTAFEL 14KRISTALOSE 174KRYSTEXXA 251K-TAB 179Kurvelo220KUVAN270KYLEENA 220KYMRIAH37 117KYNMOBI 142KYNMOBI TITRATION KIT142KYPROLIS 37labetalol hcl 59 61 78 79 86 88 99LACRISERT193LACTEROL 202lactic acid 302lactic acid e 302lactulose 174lactulose encephalopathy 174LAMICTAL 122 126LAMICTAL ODT122 126LAMICTAL STARTER122 126LAMICTAL XR 122lamivudine 22lamivudine-zidovudine 22lamotrigine 122 126lamotrigine er 122lamotrigine starter kit-blue 122 126lamotrigine starter kit-green 122 126lamotrigine starter kit-orange 122 126LAMPIT 15LANOXIN 85 96lansoprazole 205lanthanum carbonate 177 250LANTUS SOLOSTAR 235 238LANTUS U-100 VIAL 235 238

lapatinib ditosylate 37Larin 1530 220Larin 120 220Larin 24 Fe220Larin Fe 1530220Larin Fe 120220Larissia220LASIX108 177LASTACAFT 185latanoprost 196LATANOPROST-TIMOLOL MALEATE 188 196LATUDA132Layolis Fe220LAZANDA 145L-CYSTINE 175LDO PLUS 164 297LEDIPASVIR-SOFOSBUVIR 19Leena 220leflunomide 257 262LEMTRADA 262LENVIMA 37LESCOL XL 105Lessina220LETAIRIS 115 287letrozole 37 214lets 297leucovorin calcium 250LEUKERAN37LEUKINE67leuprolide acetate 37 230 232levalbuterol hcl 62 286LEVALBUTEROL HFA62 286LEVBID 55LEVEMIR U-100 FLEXTOUCH 235 238LEVEMIR U-100 VIAL235 238levetiracetam 123levetiracetam er 123LEVITRA 110levobunolol hcl 188levocarnitine 270levocarnitine sf 270levocetirizine dihydrochloride 11 284levofloxacin 16 28 186levoleucovorin calcium 250levoleucovorin calcium pf 250Levonest 220levonorgest-eth est amp eth est 220levonorgest-eth estrad 91-day 220levonorgestrel 220levonorgestrel-ethinyl estrad 220

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levonorg-eth estrad triphasic 221Levora 01530 (28)221levorphanol tartrate 145Levo-T246LEVOTHYROXINE SODIUM 247levothyroxine sodium 247Levoxyl247LEVSIN 55LEVSINSL56LEVULAN KERASTICK 323LEXAPRO 158LEXETTE 308LEXIVA 23LIALDA199LIBTAYO37LICART 151 318Lido Bdk 164 297lidocaine 298LIDOCAINE HCL 98 248lidocaine hcl 194 248 298lidocaine hcl (pf) 248lidocaine hcl urethralmucosal 194lidocaine viscous hcl 194lidocaine-hydrocort (perianal) 294 298 308LIDOCAINE-HYDROCORTISONE ACE 294 298 308lidocaine-hydrocortisone ace 294 298 308lidocaine-prilocaine 298LIDOCAINE-TETRACAINE298Lidocort 294 298 308LIDO-EPINEPHRINE-TETRACAINE 298LIDOMARK 25 248LIDOPAC 298lidopin 298LIDOPIN298LIDOPRIL298LIDOPRIL XR298Lido-Prilo Caine Pack 298LIDOPURE PATCH 298LIDORX298Lido-Sorb 298LIDOTRAL 298LIDTOPIC MAX298LIFEMS NALOXONE 148 250LILETTA (52 MG)221Lillow 221LIMBREL270LIMBREL250270LIMBREL500270

lincomycin hcl 24lindane 319linezolid 27linezolid in sodium chloride 27LINZESS 202LIORESAL 58liothyronine sodium 247LIPITOR 105LIPOFEN105lisinopril 83 84lisinopril-hydrochlorothiazide 83 84 112 181L-ISOLEUCINE 275lithium 127lithium carbonate 127lithium carbonate er 127LITHOBID 127LITHOSTAT 174LIVALO 105Livixil Pak 298l-methylfolate 335l-methylfolate ca me-cbl nac 335l-methylfolate calcium 335l-methylfolate forte 335l-methylfolate-algae 335l-methylfolate-algae-b12-b6 335l-methylfolate-b6-b12 335l-methyl-mc 335l-methyl-mc nac 335LMR PLUS 298LO LOESTRIN FE221LODINE151LODOSYN 139Loestrin 1530 (21)221Loestrin 120 (21)221Loestrin Fe 1530 221Loestrin Fe 120 221Lojaimiess 221LOKELMA 177LOMAIRA118LONHALA MAGNAIR REFILL KIT 56LONHALA MAGNAIR STARTER KIT56LONSURF38loperamide hcl 198LOPID 105lopinavir-ritonavir 23LOPRESSOR64 87 88 99LOPROX 311 324lorazepam 136 137Lorazepam Intensol 136 137LORBRENA 38

LORID 335 340LORMATE335LORTAB120 145Loryna 221Lorzone 57losartan potassium 80 81losartan potassium-hctz 80 82 112 181LOSEASONIQUE 221LOTEMAX190LOTEMAX SM 190LOTENSIN 83 84LOTENSIN HCT83 84 112 182loteprednol etabonate 190LOTREL 83 84 92 102 103 107 115LOTRONEX 199lovastatin 105LOVENOX72Low-Ogestrel221loxapine succinate 130Lo-Zumandimine 221LUBIPROSTONE200LUCEMYRA 53LUCENTIS 193LUGOLS STRONG IODINE315LULICONAZOLE301LUMIGAN196LUMIZYME 183LUMOXITI 38LUPANETA PACK 38 230 232 241LUPKYNIS 257 265LUPRON DEPOT (1-MONTH) 38 230 232LUPRON DEPOT (3-MONTH) 38 231 232LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG 38 231 232LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG 38 231 232LUPRON DEPOT-PED (1-MONTH)38 231 232LUPRON DEPOT-PED (3-MONTH)38 231 232LUTATHERA38 275Lutera221LUXTURNA117LUZU301Lyleq 221Lyllana229

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LYNPARZA 38LYRICA CR120 123 141Lysiplex Plus 175LYSODREN 38LYUMJEV KWIKPEN235 243LYUMJEV VIAL235 243Lyza 221MVI ADULT329MVI PEDIATRIC 329MACRILEN 172MACRODANTIN 30mafenide acetate 315MAGNEBIND 400 177magnesium citrate 200magnesium oxide 197magnesium sulfate 85 123 250MAGNESIUM SULFATE 85 123 250magnesium-oxide 197mag-oxide 197MAKENA241MALARONE14malathion 319maprotiline hcl 159MARGENZA38marlissa 221MARPLAN142MARQIBO 38MARVONA SUIK 164 248 298MAS CARE-PAK210MATULANE 38Matzim La90 92 94 95 100 115MAVENCLAD265MAVYRET19MAXICOMFORT SYR 27G X 12164MAXIDEX190maxi-tuss ac 145 277 278MAXZIDE 110 112 178 182MAXZIDE-25110 112 178 182MAYZENT262menaphosmbhyo1 30MEADOW FESCUE GRASS POLLEN47 169 270meclizine hcl 10 198meclofenamate sodium 151MEDROL210MEDROLOAN II SUIK 164 210 298MEDROLOAN SUIK164 210 298medroxyprogesterone acetate 241mefenamic acid 151mefloquine hcl 14

megestrol acetate 38 241MEKINIST 38MEKTOVI38MELALEUCA 47 169 270meloxicam 151melphalan 38melphalan hcl 38memantine hcl 139memantine hcl er 139MENEST 229MENOPUR231 232MENOSTAR229MENTAX 303meperidine hcl 145MEPHYTON250 343meprobamate 131MEPRON 15MEPSEVII 184mercaptopurine 38 265meropenem 17MEROPENEM-SODIUM CHLORIDE 17Merzee 221mesalamine 199mesalamine er 199mesalamine-cleanser 199mesna 273MESNEX273MESQUITE 47 169 270MESTINON 60metafolbic 335metafolbic plus 335METAFOLBIC PLUS RF335METANX 335metaxalone 57metformin hcl 215metformin hcl er 215metformin hcl er (mod) 215metformin hcl er (osm) 215METHACHOLINE CHLORIDE 172methadone hcl 145Methadone Hcl Intensol 145methadose 145Methadose 146methadose sugar-free 146methamphetamine hcl 118METHAVER 335methazolamide 189methenamine hippurate 30methenamine mandelate 30Methergine 274methimazole 214METHITEST213

methocarbamol 57METHOHEXITAL SODIUM 134 135methotrexate 38 257 262 265methotrexate sodium 39 257 262 266methotrexate sodium (pf) 38 257 262 265methoxsalen rapid 319methscopolamine bromide 56methyl salicylate 155methyldopa 53 97methyldopa-hydrochlorothiazide 53 97 112 182methylergonovine maleate 274methylfol-algae-b12-acetylcyst335methylphenidate hcl 154methylphenidate hcl er 154methylphenidate hcl er (cd) 154methylphenidate hcl er (la) 154methylphenidate hcl er (xr) 154methylprednisolone 210METHYLPREDNISOLONE ACETATE 210methylprednisolone acetate 210methyltestosterone 213metoclopramide hcl 204metolazone 113 183METOPIRONE172metoprolol succinate er 64 87 88 99metoprolol tartrate 64 87 88 99metoprolol-hydrochlorothiazide 64 87 88 99 112 182metronidazole 12 15 290metyrosine 270mexiletine hcl 98MIACALCIN 214 239 253Mibelas 24 Fe 221micafungin sodium 18MICARDIS 80 82MICARDIS HCT 80 82 112 182miconazole 3 301MICONAZOLE-ZINC OXIDE-PETROLAT 301MICRHOGAM ULTRA-FILTERED PLUS 51MICRODOT TEST 171Microgestin 1530221Microgestin 120221Microgestin 24 Fe 222Microgestin Fe 1530 222

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Microgestin Fe 120 222MICROLET NEXT LANCING DEVICE164MICROPLEGIA MSA-MSG179midazolam hcl 137MIDAZOLAM HCL-SODIUM CHLORIDE 137midodrine hcl 53MIFEPREX274mifepristone 274MIGERGOT 60 130miglitol 212miglustat 270MIGRANAL 60 130MIGRANOW 157 324Mili 222MILLIPRED 210milrinone lactate 96milrinone lactate in dextrose 96Mimvey229 241MIMYX 164MINASTRIN 24 FE222mineral oil heavy 200MINIMED PUMP RESERVOIR 3ML 164MINIPRESS 59 78 79Minitran 109MINIVELLE 229minocycline hcl 29MINOCYCLINE HCL ER29 324minocycline hcl er 29 324MINOLIRA29 324minoxidil 104MIRCERA 67MIRCETTE222MIRENA (52 MG)222mirtazapine 124MIRVASO 324misoprostol 204MITE (D FARINAE)47 169 270MITE (D PTERONYSSINUS) 47 169 270MITIGARE251Mitigo 146mitomycin 39MITOMYCIN 39MITOSOL187mitoxantrone hcl 39MIXED ASPERGILLUS 47 169 270MIXED FEATHERS 47 169 270MIXED RAGWEED 47 169 270

MIXED VESPID VENOM PROTEIN 47 169MKO MELT DOSE PACK 137 141 197M-NATAL PLUS 73 179 329 335MOBIC 151modafinil 160moexipril hcl 83 84molindone hcl 130mometasone furoate 190 281 294 308Mondoxyne Nl 29MONJUVI39MONOFERRIC 73Mono-Linyah 222MONONINE 70MONOVISC 164monsels ferric subsulfate 70 275montelukast sodium 280MORGIDOX 29 324Morgidox 29MORPHINE SULFATE 146morphine sulfate 146morphine sulfate (concentrate)146morphine sulfate (pf) 146morphine sulfate er 146morphine sulfate er beads 146MORPHINE SULFATE-NACL146MOTEGRITY204motion sickness relief 9 10 198 279MOTOFEN 198MOTRIN IB 151MOTRIN INFANTS DROPS151MOUNTAIN CEDAR 47 169 270MOUSE EPITHELIUM 47 169 270MOVANTIK 202MOVIPREP 200moxifloxacin hcl 16 28 186moxifloxacin hcl (2x day) 186moxifloxacin hcl in nacl 16 28MOZOBIL67MSUD EASY175MUCOR 47 169 270MUCOSITISRX 164MUCOTROL 324MUGARD 164MUGWORT47 169 270MULPLETA 67MULTAQ 100MULTIGEN 74MULTIGEN FOLIC73 336 340

MULTIGEN PLUS 74 336 340MULTIPRO 74 329 336multi-vitironfluoride 74 253 329multivitaminfluoride 253 329MULTIVITAMINFLUORIDE 253 329multi-vitaminfluoride 253 329multi-vitaminfluorideiron 74 254 329mupirocin 290mupirocin calcium 290MUSE115Mutamycin39MVASI39MYALEPT 238MYCAPSSA 245mycophenolate mofetil 266mycophenolate mofetil hcl 266mycophenolate sodium 266MYDAYIS118myferon 150 forte 74 336MYLERAN39MYLOTARG39mynephrocaps 336 340Mynephron 336 340MYOBLOC 64 270Myorisan 324MYRBETRIQ328MYTESI198MYXREDLIN 235 243na ferric gluc cplx in sucrose 74NABI-HB 51nabumetone 151n-acetyl-l-cysteine 270nadolol 59 87 88 99nafcillin sodium 27NAFRINSE DAILYNEUTRAL254naftifine hcl 288NAFTIN 288NAGLAZYME184nalbuphine hcl 148NALFON 151NALOCET 120 146naloxone hcl 148 250naltrexone hcl 148 249NAMENDA TITRATION PAK139NAMENDA XR TITRATION PACK 139NAMZARIC 60 139NAPRELAN151 251NAPROSYN151 251naproxen 151 251naproxen sodium 152 251

362

naproxen sodium er 151 251NAPROXEN SODIUM ER 152 251naproxen-esomeprazole 152 205naratriptan hcl 157NARCAN148 250NARDIL142NASCOBAL 336NATACYN187NATAZIA222nateglinide 238NATESTO 213NATPARA 238 239 252NATURE-THROID 247NAVELBINE39NAYZILAM 136 137NEBUPENT 15Necon 0535 (28) 222nefazodone hcl 158neomycin sulfate 13neomycin-bacitracin zn-polymyx 186neomycin-polymyxin b gu 290neomycin-polymyxin-dexameth 186 190neomycin-polymyxin-gramicidin 186neomycin-polymyxin-hc 186 190Neo-Polycin186Neo-Polycin Hc 186 190NEORAL 257 262 266NEOSALUS 164 165NEOSTIGMINE METHYLSULFATE 60 172NEO-SYNALAR 290 294 308NEOTUSS PLUS 10 54 277 279NEOVITE 329 336NEPHPLEX RX336 340Nephronex 336 340 342NEPHRO-VITE RX 336 341NERLYNX 39NESINA226NESTABS 74 179 329 336NESTABS ONE 74 329 336Neuac290 312NEUAC 290 312NEULASTA 67NEULASTA ONPRO67NEUPOGEN 67NEUPRO143NEURAPTINE324NEURIN-SL336NEVANAC193

nevirapine 21nevirapine er 21NEXAVAR39NEXIUM 205NEXLETOL 85NEXLIZET85 97NEXPLANON222niacin (antihyperlipidemic) 85niacin er (antihyperlipidemic) 85NIACINAMIDE-SPIRONOLACTONE 324NIACINAMIDE-SULFACETAMIDE315NIACINAMIDE-TACROLIMUS324NIACINAMIDE-TAZAROTENE 324NIACINAMIDE-TRETINOIN303NIACINAMIDE-TRIAMCINOLONE ACET 308NIACIN-SPIRONOLACTON-TRETINOIN303niacor 85NIASPAN 85NICADAN270 336NICAPRIN270 336nicardipine hcl 92 102 103 107 115NICAZEL270 336NICAZEL FORTE270 336NICAZYME 270 336NICOMIDE 336NICORETTE 57nicotine polacrilex 57nicotine step 1 57nicotine step 2 57nicotine step 3 57NICOTROL 57NICOTROL NS 57nifedipine 92 102 103 107 115nifedipine er 92 102 103 107 115nifedipine er osmotic release 92 102 103 107 115NIFEREX 74 336 341Nikki 222NILANDRON39nilutamide 39nimodipine 92 102 103 107 115NINLARO 39NIPENT39nisoldipine er 92 102 103 107 115nitazoxanide 15

nitisinone 271NITRO-BID109NITRO-DUR109nitrofurantoin 30nitrofurantoin macrocrystal 30nitrofurantoin monohydrate macrocrystals 30nitroglycerin 109NITROMIST 109NITROSTAT109NITRO-TIME 109NITYR 271NIVESTYM67nizatidine 203NOCDURNA 70 239Nolix 294 308NOPIOID-LMC KIT 58 299Nora-Be222NORDIPEN 5 INJECTION DEVICE165NORDITROPIN FLEXPRO 239norethin ace-eth estrad-fe 222norethindrone 222norethindrone acetate 241norethindrone acet-ethinyl est 222norethindrone-eth estradiol 229 241norethin-eth estradiol-fe 222NORGESIC FORTE64 155norgestimate-eth estradiol 222norgestimate-ethinyl estradiol triphasic 222NORITATE290Norlyda222Norlyroc222NORPACE CR 97NORPRAMIN 159NORTHERA53Nortrel 0535 (28)222Nortrel 135 (21)223Nortrel 135 (28)223Nortrel 777 223nortriptyline hcl 159NORVASC 92 102 103 107 115NORVIR 23NOURIANZ 139NOVACORT294 299 308novarel 231 232NOVAREL231 232NOVOEIGHT 70NOVOFINE AUTOCOVER PEN NEEDLE 165NOVOFINE PEN NEEDLE 165

363

NOVOFINE PLUS PEN NEEDLE165NOVOLIN 7030 FLEXPEN 235 237 244NOVOLIN 7030 FLEXPEN RELION235 237 244NOVOLIN 7030 RELION 235 237 244NOVOLIN 7030 VIAL 235 237 244NOVOLIN N FLEXPEN235 237NOVOLIN N FLEXPEN RELION235 237NOVOLIN N RELION235 237NOVOLIN N VIAL 235 237NOVOLIN R FLEXPEN236 244NOVOLIN R FLEXPEN RELION236 244NOVOLIN R RELION236 244NOVOLIN R VIAL 236 244NOVOLOG FLEXPEN 236 243NOVOLOG MIX 7030 FLEXPEN236 237 243NOVOLOG MIX 7030 VIAL 236 238 243NOVOLOG PENFILL 236 243NOVOLOG U-100 VIAL 236 243NOVOPEN ECHO165NOVOSEVEN RT 70NOVOTWIST PEN NEEDLE 165NOXAFIL17np thyroid 247NPLATE 67NUBEQA39NUCALA 277 280NUCARACLINPAK 290 327NUCARARXPAK290 312 327NUCORT294 309NUCYNTA146NUCYNTA ER146NUDERMRXPAK 120 302 314 324NUDERMRXPAK 60 302 314 324Nudiclo Solupak 152 318 324Nudiclo Tabpak 152 324NUDROXIPAK 140 324NUDROXIPAK DSDR-50 152 324NUDROXIPAK DSDR-75 152 324NUDROXIPAK E-400152 324NUDROXIPAK I-800 152 324NUDROXIPAK N-500 152 325NUEDEXTA 140 277

NUFERA 74 336 341 342Nulev56NULIBRY 271NULOJIX266NULYTELY LEMON-LIME 200NUMBRINO 195NUPLAZID 133NURTEC 138NUSURGEPAK SURGICAL PREPCARE 290 316 325NUTRASEB 302Nutriarx Creampak295 309NUTRICAP74 329 336NUTRIDOX 29NUTRIVIT 74 329 336NUTROPIN AQ NUSPIN 10 239NUTROPIN AQ NUSPIN 20 239NUTROPIN AQ NUSPIN 5 240NUVAIL 165Nuvakaan299NUVAKAAN-II 299NUVARING 223NUVESSA290NUWIQ70NUZYRA 13Nyamyc 319Nylia 777 223NYMALIZE 92 102 103 107 115Nymyo223nystatin 27 319nystatin-triamcinolone 319Nystop319NYVEPRIA67OBIZUR 70OCALIVA 202Ocella223OCREVUS 262OCTAGAM51octreotide acetate 245 271OCUVEL 329 336 341 343ODACTRA 47ODEFSEY21 22ODOMZO39OFEV 277ofloxacin 28 186OGIVRI 39olanzapine 127 133olanzapine-fluoxetine hcl 133 158OLIVE TREE47 169 271olmesartan medoxomil 80 82olmesartan medoxomil-hctz 80 82 112 182

olmesartan-amlodipine-hctz80 82 92 102 104 112 115 182olopatadine hcl 185OLUMIANT 257 262OMECLAMOX-PAK 14 26 205omega-3-acid ethyl esters 86omeprazole 205omeprazole magnesium 205OMEPRAZOLE+SYRSPEND SF ALKA 205omeprazole-sodium bicarbonate 205OMNARIS 190 281OMNITROPE 240OMNIVEX 329 336ONCASPAR39ondansetron hcl 197ondansetron odt 197ONETOUCH DELICA LANCING DEV165ONETOUCH DELICA PLUS LANCING 165ONETOUCH ULTRA171ONETOUCH ULTRA 2165ONETOUCH ULTRA MINI 165ONETOUCH VERIO 165 171ONETOUCH VERIO FLEX SYSTEM KIT WDEVICE165ONETOUCH VERIO IQ SYSTEM 165ONETOUCH VERIO REFLECT165ONETOUCH VERIO SYNC SYSTEM KIT WDEVICE165ONEVITE 329 336ONEXTON 290 313ONGENTYS139ONGLYZA226ONIVYDE39ONPATTRO 271ONTRUZANT39ONUREG 39ONZDEOXIA290 313ONZETRA XSAIL157OPDIVO 40opium 146 198OPSUMIT115 287ORACIT 173ORALAIR 48 271ORALAIR ADULT STARTER PACK 47 271

364

ORALAIR CHILDRENS STARTER PACK 48 271Oralone 295 309ORAMAGICRX 165ORAVIG 301ORCHARD GRASS POLLEN 48 169 271ORENCIA257 258 262ORENCIA CLICKJECT 257 262ORENITRAM 115 287ORFADIN271ORGOVYX40 214ORIAHNN 214 229 241ORILISSA 214ORKAMBI 278ORLADEYO 255orphenadrine citrate er 64orphenadrine-asa-caffeine 64 155Orphengesic Forte 64 155Orsythia223ORTHO DF 336 342ORTHO MICRONOR 223ORTHOVISC165ORTIKOS210oscimin 56oscimin sr 56oseltamivir phosphate 25OSENI226 246OSMOLEX ER 12 117OSMOPREP 200OSPHENA 227OTEZLA 258 262 325OTIPRIO 186OTOVEL 186 190OTREXUP40 258 262 266OVACE PLUS 316OVACE PLUS WASH 316OVACE WASH316OVEEZA 271OVIDREL 231 232oxacillin sodium 27oxaliplatin 40oxandrolone 213oxaprozin 152OXAYDO146oxazepam 137OXBRYTA65oxcarbazepine 123OXERVATE 193OXIANUJO325OXIATAR 303OXIAVARRY 303oxiconazole nitrate 301

OXISTAT301OXLUMO 271OXTELLAR XR 123oxybutynin chloride 327oxybutynin chloride er 327oxycodone hcl 146 147OXYCODONE HCL ER 146oxycodone-acetaminophen 120 147OXYCODONE-ACETAMINOPHEN120 147oxycodone-aspirin 147 155OXYCONTIN147oxymorphone hcl 147oxymorphone hcl er 147OXYTOCIN-LACTATED RINGERS274OXYTOCIN-SODIUM CHLORIDE 274OXYTROL327OZEMPIC233OZOBAX 58OZURDEX 190paclitaxel 40PADCEV 40PAINGO KFT 299PALFORZIA 48paliperidone er 133palonosetron hcl 197PALYNZIQ 184PAMELOR 159pamidronate disodium 253PANCREAZE 201PANDEL295 309PANHEMATIN 271PANRETIN40 325pantoprazole sodium 205PANZYGA51papaverine hcl 115PARAGARD INTRAUTERINE COPPER274paraplatin 40Paraplatin40PAREMYD 195PARI ALTERA NEBULIZER HANDSET165PARI TREK S COMBO PACK 165paricalcitol 342PARNATE 142paromomycin sulfate 12 13paroxetine hcl 158paroxetine hcl er 158paroxetine mesylate 158

PARSABIV 214 271PASER16PAXIL158PAXIL CR158pb-hyoscy-atropine-scopolamine 56 134 135P-CARE K40 210P-CARE K40G 165 211P-CARE K80 211P-CARE K80G 165 211PEDIZOLPAK 301peg 3350-kcl-na bicarb-nacl 200peg-3350electrolytes 200peg-3350electrolytesascorbat 200PEGASYS24PEGINTRON24peg-kcl-nacl-nasulf-na asc-c 200Peg-Prep200PEMAZYRE 40penicillamine 207 258penicillin g potassium 25penicillin g procaine 25penicillin g sodium 25penicillin v potassium 25PENICILLIUM NOTATUM 48 170 271PENLEN166PENNSAID152 318 325PENTAM 15pentamidine isethionate 15PENTASA 199pentazocine-naloxone hcl 148pentoxifylline er 68PEPAXTO 40PEPCID203PERFOROMIST62 286perindopril erbumine 83 84Periogard 192PERJETA40permethrin 319perphenazine 153perphenazine-amitriptyline 153 159PERSERIS127 133PERTZYE 201PEXEVA158Phenazo299phenazopyridine hcl 299phendimetrazine tartrate 118phendimetrazine tartrate er 118phenelzine sulfate 142PHENERGAN 10 131 279

365

phenobarbital 134 135phenobarbital-belladonna alk 56 134 135Phenohytro56 134 135phenoxybenzamine hcl 60 107phentermine hcl 118phentolamine mesylate 60 107phenylephrine hcl 196PHENYLEPHRINE HCL-NACL54phenytoin 98 141Phenytoin Infatabs 98 141phenytoin sodium extended 98 141PHEODOYO 301 309 316PHESGO40PHEXXI274PHEYO 301 309Philith 223PHLAG SPRAY166 302PHOMA EXIGUA 48 170 271PHOSLYRA 177Phospha 250 Neutral 173Phosphasal 30PHOSPHOLINE IODIDE195phosphorous 173phosphorus supplement 179phosphorus wsod amp potassium 179Phospho-Trin 250 Neutral173PHOTOFRIN40PHOTREXA-PHOTREXA VISCOUS KIT 193PHOXILLUM B22K40 179PHOXILLUM BK425 179PHYSICIANS EZ USE B-12336physicians ez use jointtunnel 211 248PHYSICIANS EZ USE M-PRED 211Physiolyte176Physiosol Irrigation176phytonadione 250 343PIFELTRO 21pilocarpine hcl 60 195pimecrolimus 266 325pimozide 130Pimtrea223pindolol 59 87 88 99 107pioglitazone hcl 246pioglitazone hcl-glimepiride 246pioglitazone hcl-metformin hcl 216 246piperacillin sod-tazobactam so 18

PIQRAY 40Pirmella 135 223Pirmella 777 223piroxicam 152PKU EASY 175PKU EASY MICROTABS175PKU GO 175PLAN B ONE-STEP223PLAQUENIL14 258 262PLASMA-LYTE 148 180PLASMA-LYTE A180PLAVIX 77PLEGRIDY262 263PLEGRIDY STARTER PACK 262PLENVU200PLEXION 313 316PLEXION CLEANSER 313 316PLEXION CLEANSING CLOTH313 316PLIAGLIS 299PNV TABS 20-1 74 329 336POD-CARE 100K211PODIAPN337podocon 325podofilox 325POLIVY 40Polycin 186poly-iron 150 forte 74 337polymyxin b sulfate 27polymyxin b-trimethoprim 186polysaccharide iron forte 74 337POLY-VI-FLOR 254 329POLY-VI-FLORIRON 74 254 329POMALYST 40 263PONVORY 263PONVORY STARTER PACK 263Portia-28 223PORTRAZZA 40posaconazole 17POTABA 271potassium chloride 180potassium chloride crys er 180potassium chloride er 180potassium chloride in nacl 180potassium citrate er 173potassium citrate-citric acid 173POTELIGEO 41Pr Benzoyl Peroxide Wash 313PR CREAM 166PRADAXA66PRALUENT109pramipexole dihydrochloride 143

pramipexole dihydrochloride er 143pramosone 295 299 309PRAMOSONE295 299 309PRAMOTIC 192 195pramox 299prasugrel hcl 77pravastatin sodium 105PRAXBIND65praziquantel 14prazosin hcl 59 78 79PRECEDEX 131PRECISION PCX PLUS TEST171PRECISION QID TEST171PRECISION SOF-TACT TEST 171PRECISION XTRA166PRECISION XTRA BLOOD GLUCOSE 171PRECOSE 212PRED FORTE190PRED MILD 190PRED-G 186 190PRED-G SOP 186 190prednicarbate 295 309PREDNISOL ACE-MOXIFLOX-BROMFEN 187 190 193prednisolone 211prednisolone acetate 191prednisolone acetate p-f 191PREDNISOLONE ACETATE-NEPAFENAC 191 194PREDNISOLONE ACET-MOXIFLOXACIN187 191prednisolone sodium phosphate 191 211PREDNISOLONE-BROMFENAC 191 194PREDNISOLONE-GATIFLOXACIN187 191PREDNISOLONE-MOXIFLOXACIN187 191PREDNISOLON-GATIFLOX-BROMFENAC 187 191 194PREDNISOLON-MOXIFLOX-BROMFENAC 187 191 194PREDNISOLON-MOXIFLOX-NEPAFENAC 187 191 194prednisone 211prednisone intensol 211PREFEST 229pregabalin 120 123 141

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pregabalin er 120 123 141PREGEN DHA 74 329 337PREGENNA74 329 337pregnyl 231 232PREMARIN 229PREMPHASE 229PREMPRO229PRENAISSANCE 74 180 200 330 337prenatal 74 180 330 337prenatal plus iron 74 180 330 337prenatal vitamin plus low iron 74 180 330 337PRENATE 180 330 337PRENATE DHA 74 330 337PRENATE ELITE 74 330 337PRENATE ENHANCE 74 330 337PRENATE ESSENTIAL 74 330 337PRENATE MINI 75 330 337PRENATE PIXIE75 330 337PRENATE RESTORE 75 330 337PRENATRIX 75 330 337PRENATRYL 75 330 337PREPIDIL274preplus 75 180 330 337PRESERA166PRESTALIA 83 84 92 94 102 104 115PRETAB75 180 330 337PRETOMANID 16PREVACID205PREVACID 24HR 205PREVACID SOLUTAB206Prevalite 89PREVIDENT 254PREVIDENT 5000 BOOSTER PLUS254PREVIDENT 5000 DRY MOUTH254PREVIDENT 5000 ENAMEL PROTECT254PREVIDENT 5000 ORTHO DEFENSE 254PREVIDENT 5000 PLUS 254PREVIDENT 5000 SENSITIVE 254previdolrx plus analgesic 152 325Previfem223PREVYMIS 16 25

PREZCOBIX 23 271PREZISTA 23PRIALT 120PRIFTIN 16 28PRILO PATCH 299PRILO PATCH II 299PRILOLID299PRILOSEC206PRILOVIX 299PRILOVIX LITE299PRILOVIX LITE PLUS 299PRILOVIX PLUS 299PRILOVIX ULTRALITE 299PRILOVIX ULTRALITE PLUS299PRILOVIXIL 299PRIMACARE75 330 337primaquine phosphate 14primidone 134PRIMSOL30PRINIVIL 83 84PRISTIQ156PRIVET 48 170 271PRIVIGEN51PRIZOPAK II299PRIZOTRAL-II299PROAIR DIGIHALER62 286PROAIR HFA 63 286PROAIR RESPICLICK63 286probenecid 183 251PROBICHEW202PROBUPHINE IMPLANT KIT 148procainamide hcl 97PROCARDIA 93 102 104 107 115PROCARDIA XL 93 102 104 107 115PRO-C-DURE 5 211PRO-C-DURE 6 211prochlorperazine 153 198prochlorperazine maleate153 198PROCORT 295 299 309PROCRIT67PROCTOCORT 295 309PROCTOFOAM HC 295 299 309Procto-Med Hc 295 309Procto-Pak 295 309Proctozone-Hc 295 309PROCYSBI 271PRODIGEN202PROFESSIONAL DNA COLLECTION 195PROFILNINE 70progesterone 241

PROGLYCEM 214PROGRAF 266PROLASTIN-C284PROLATE 120 147PROLENSA 194PROLEUKIN 41 263PROLIA253PROMACTA67PROMELLA IN PREBIOTIC 202promethazine hcl 10 131 279promethazine vc 10 54 279promethazine vccodeine 10 54 147 277 279promethazine-codeine 147 277 279promethazine-dm 10 278 279promethazine-phenyleph-codeine 10 54 147 278 280promethazine-phenylephrine 10 54 280Promethegan 10 131promethegan 10 131PROMETRIUM 241PROMISEB 166propafenone hcl 98propafenone hcl er 98proparacaine hcl 195proparacaine-fluorescein 172 195propranolol hcl 59 87 88 99 107 130propranolol hcl er 59 87 88 99 107 130propranolol-hctz 59 87 88 99 112 182propylthiouracil 214PROSILK 166PROSTIN E2274PROTONIX 206protriptyline hcl 159PROVENGE117PROVENTIL HFA 63 286PROVERA 241PROZAC 158PRUCLAIR166 302PRUMYX166pseudoephedrine-bromphen-dm 53 276 278 280PSORCON295 309PULMICORT FLEXHALER 211 283PULMICORT SUSPENSION 211 283PULMOZYME 184 281

367

purevit dualfe plus 75PURIXAN 41 266PYLERA12 15 26 29 199pyrazinamide 16PYRIDIUM 299pyridostigmine bromide 60pyridostigmine bromide er 60pyridoxine hcl 337pyrimethamine 15PYROGALLIC ACID 325QBRELIS 83 84QBREXZA56 325qc magnesium citrate 200QDOLO 147QELBREE 140QINLOCK41QMIIZ ODT 152QNASL191 281QNASL CHILDRENS 191 281QSYMIA 118 120 123QTERN 226 244QUALAQUIN15QUARTETTE 223quazepam 137QUEEN PALM 48 170 271QUESTRAN 89QUESTRAN LIGHT 89quetiapine fumarate 127 133quetiapine fumarate er 127 133QUFLORA FE 75 254 330QUFLORA FE PEDIATRIC 75 254 330QUFLORA GUMMIES 254 330QUFLORA PEDIATRIC 254 330QUILLICHEW ER154QUILLIVANT XR 154quinapril hcl 83 84quinapril-hydrochlorothiazide 83 84 112 182quinidine gluconate er 15 97quinidine sulfate 15 97quinine sulfate 15QUINIXIL191 309QUINJA316QUTENZA325QUTENZA (2 PATCH) 325QUTENZA (4 PATCH) 325QVAR REDIHALER 211 283RABBIT EPITHELIUM 48 170 272RABEPRAZOLE SODIUM 206rabeprazole sodium 206RADICAVA140

RADIOGARDASE 177 250RAGWITEK48 272raloxifene hcl 227 253ramelteon 131ramipril 83 84ranolazine er 96RAPAMUNE266RAPIVAB 25rasagiline mesylate 142RASUVO41 258 263 266RAVICTI174RAYALDEE342RAYOS 211READYSHARP BETAMETHASONE211READYSHARP DEXAMETHASONE 211REBIF 263REBIF REBIDOSE263REBIF REBIDOSE TITRATION PACK 263REBIF TITRATION PACK263REBINYN 70REBLOZYL 65 67RECARBRIO17RECEDO166Reclipsen 223RECOMBINATE70RECOTHROM 70RECOTHROM SPRAY KIT70RECTIV325RECURA275RED MAPLE 48 170 272RED MULBERRY 48 170 272RED TOP GRASS POLLEN 48 170 272REDITREX258 263 266REGIOCIT65 173 180REGLAN 204Relador Pak 299Relador Pak Plus 300Relafen152RELAFEN DS 152RELENZA DISKHALER 25relexxii 154RELION BLOOD GLUCOSE TEST171RELISTOR 202 203RELNATE DHA75 330 337RELTONE 201REMEDIENT75 330 337REMERON124REMERON SOLTAB 125

REMICADE 203 258 263 272 325REMODULIN 115 287RENACIDIN 176RENAGEL177 250Renal337 341RENATABS WITH IRON 337 341RENFLEXIS 203 258 263 325RENVELA 177 250repaglinide 238REPATHA 109REPATHA PUSHTRONEX SYSTEM 109REPATHA SURECLICK 109REQ 49+ 331RESECTISOL 176RESTASIS 192RESTASIS MULTIDOSE 192RESTORA RX203 338RETACRIT 67RETEVMO 41RETIN-A303RETIN-A MICRO303RETIN-A MICRO PUMP 303 304RETISERT 191RETROVIR 22REVATIO 110 287REVCOVI184REVESTA 338 342REVLIMID 41 263REXULTI133REYATAZ 23REYVOW 157RHEUMATE272RHIZOPUS 48 170 272RHOFADE 325RHOGAM ULTRA-FILTERED PLUS51RHOPHYLAC51RHOPRESSA 187 196RIABNI 41RIASTAP71RIAX313ribavirin 25 26RIBOZEL338 341RIDAURA206 258 263rifabutin 16 28rifampin 16 28riluzole 140rimantadine hcl 12RIMSO-50 176 295ringers irrigation 176RINVOQ258 263

368

RIOMET 216risedronate sodium 253RISPERDAL127 133RISPERDAL CONSTA127 133risperidone 127 133ritonavir 23RITUXAN 41RITUXAN HYCELA41rivastigmine 60rivastigmine tartrate 60Rivelsa 223RIXUBIS71rizatriptan benzoate 157ROAOXIA152 193 318 325ROCALTROL 342ROCKLATAN 187 196ROMIDEPSIN 41ropinirole hcl 143ropinirole hcl er 143Rosadan290ROSADAN 290rosuvastatin calcium 105ROSZET 97 106ROUGH MARSH ELDER 48 170 272Roweepra123ROZLYTREK 41RUBRACA 41RUCONEST255rufinamide 123RUKOBIA20RUSSIAN THISTLE 48 170 272RUXIENCE 41RUZURGI272RYBELSUS233RYDAPT 41RYTARY 140ryvent 9 280SABRIL 123SACCHAROMYCES CEREVISIAE 48 170 272SAFYRAL223SAIZEN 240SAIZENPREP 240SALEX 313SALICEPT166salicylic acid 313salicylic acid er 313salicylic acid wart remover 313salicylic acid-cleanser 313SALICYLIC ACID-SULFACETAMIDE313 316salimez 313

SALIMEZ FORTE 313SALIVAMAX166salsalate 155SALVAX 313SALVAX DUO PLUS313SAMSCA183SANADERMRX SKIN REPAIR 295 309SANCUSO 197SANDIMMUNE 258 263 266SANDOSTATIN LAR DEPOT 245 272SANTYL 325SAPHRIS 127 133sapropterin dihydrochloride 272SARCLISA 41SAVAYSA 66SAVELLA 141 156SAVELLA TITRATION PACK 141 156SAXENDA233SCALACORT DK 295 309SCARCIN166SCARSILK 166SCENESSE 325scopolamine 198SEASONIQUE 223SECUADO 127 133SEEBRI NEOHALER 56SEGLUROMET216 244SELECT-OB75 331 338selegiline hcl 142selenium sulfide 316SELRX 316SELZENTRY20SEMGLEE236 238SENSIPAR214 272Sensorcaine 248Sensorcaine-Mpf248SEREVENT DISKUS 63 286SERNIVO295 309SEROQUEL 127 133SEROQUEL XR 127 133SEROSTIM 240sertraline hcl 158se-tan plus 75Setlakin 223sevelamer carbonate 177 250sevelamer hcl 177 250SEVENFACT 71sevoflurane 142SEYSARA 13 29sf 254

sf 5000 plus 254SFROWASA 199SHAGBARK HICKORY 48 170 272Sharobel223SHARPS CONTAINER 166SHEEP SORREL 48 170 272SHORT RAGWEED POLLEN EXT 48 170 272SIDEROL 75 338 341SIGNIFOR245SIGNIFOR LAR245SIKLOS 41SILA III 309sildenafil citrate 110 287SILIPAC 166SILIQ325silodosin 61silver nitrate 313 316silver sulfadiazine 316SIMBRINZA 184 189Simliya 224Simpesse 224SIMPONI203 258 264SIMPONI ARIA 203 258 264SIMULECT267simvastatin 106SINGULAIR280SINUVA191 281sirolimus 267SIRTURO16SITAVIG26SIVEXTRO27SKYADERM-LP 300SKYLA 224SKYRIZI (150 MG DOSE)325SLYND 224 241sod citrate-citric acid 173sodium bicarbonate 173SODIUM BICARBONATE 173 197sodium chloride 166 180sodium chloride (pf) 180sodium fluoride 255sodium fluoride 5000 enamel 254sodium fluoride 5000 plus 254sodium fluoride 5000 ppm 254 255sodium fluoride 5000 sensitive255sodium phenylbutyrate 174sodium polystyrene sulfonate 177 250sodium sulfacetamide 316

369

sodium sulfacetamide wash 316SODIUM SULFACETAMIDE-BAKUCHIOL 316SOFOSBUVIR-VELPATASVIR19SOLARAVIX41 318solifenacin succinate 327SOLIQUA 233 236 238SOLIRIS255SOLODYN 29 325SOLOSEC15SOLTAMOX 41 227SOLU-CORTEF 211SOMATULINE DEPOT 245SOMAVERT245SOOLANTRA325SORBITOL176sorbitol-mannitol 176 177SORILUX 326SORRELDOCK MIX 48 170 272sotalol hcl 59 87 88 99 100 108sotalol hcl (af) 59 87 88 99 100 107SOTYLIZE 59 87 88 99 100 108SOVALDI 19spinosad 319SPINRAZA 252 272SPINY PIGWEED 48 170 272SPIRIVA HANDIHALER56 276SPIRIVA RESPIMAT 56 277spironolactone 108 110 178spironolactone-hctz 108 110 112 178 182SPORANOX17SPRAVATO (56 MG DOSE) 125SPRAVATO (84 MG DOSE) 125Sprintec 28224SPRITAM 123SPRIX 152SPRYCEL 41sps 177 250Sronyx224Ssd316SSKI14 215 250 279sss 10-5 313 316 317ST JOSEPH LOW DOSE 77 78 130 155STARLIX 238stavudine 22STEGLATRO 244STEGLUJAN226 244STELARA259 264 326STENDRA110

STERILE TOPICAL LET GEL300STERITALC 111STIMATE 71 240STIOLTO RESPIMAT 56 63 277 286STIVARGA41stomach relief 197 198stool softener 200stool softener laxative 200STRATA CTX275STRATA MARK 303Strata Triz 303STRATA XRT275STRATTERA140STRENSIQ184streptomycin sulfate 13 16STRIBILD20 22STRIVERDI RESPIMAT 63 286STROVITE FORTE75 331 338STROVITE ONE 331 338 342SUBLOCADE148SUBSYS 147Subvenite 123 127Subvenite Starter Kit-Blue 123 127Subvenite Starter Kit-Green 123 127Subvenite Starter Kit-Orange 123 128SUCCINYLCHOLINE CHLORIDE 58SUCRAID184sucralfate 204SULAR 93 102 104 108 115SULCONAZOLE NITRATE301sulfacetamide sodium 187 317sulfacetamide sodium (acne) 317sulfacetamide sodium-sulfur 313 314 317sulfacetamide sod-sulfur wash 314 317sulfacetamide-prednisolone 187sulfacetamide-sulfur in urea 314 317Sulfacleanse 84 314 317sulfadiazine 28sulfamethoxazole-trimethoprim 28SULFAMYLON317sulfasalazine 28 199 259 264Sulfatrim Pediatric28sulindac 152SUMADAN 314 317

SUMADAN WASH 314 317SUMADAN XLT 314 317 327sumatriptan 157sumatriptan succinate 157sumatriptan succinate refill 157sumatriptan-naproxen sodium 152 157SUMAXIN314 317SUMAXIN CP314 317SUMAXIN WASH314 317SUNOSI 160SUPARTZ FX166SUPERVITE338support 331SUPPORT-500 338 341SUPPRELIN LA 42 231 232SUPRAX 12SUPREP BOWEL PREP KIT201sure result dss premium pack 152 318 326SURESTEP PRO HIGH GLUCOSE 166SURESTEP PRO LOW GLUCOSE 166SURESTEP PRO NORMAL GLUCOSE 166SURVANTA 284SUSTOL197SUTAB 201SUTENT42SUVICORT 166SWEET GUM48 170 272SWEET VERNAL GRASS POLLEN48 170 272Syeda224SYLVANT42SYMAX DUOTAB 56Symax-Sl56Symax-Sr 56SYMBICORT63 211 283 286SYMBYAX133 158SYMDEKO 278SYMJEPI53 276SYMLINPEN 120 212SYMLINPEN 60 212SYMPAZAN 136 137SYMPROIC203SYMTUZA22 23 26 272SYNAGIS 24SYNALAR (CREAM)295 309SYNALAR (OINTMENT) 295 309SYNALAR TS295 309SYNAPRYN FUSEPAQ 147

370

SYNAREL 231 232SYNDROS 198SYNERA 300SYNERDERM 166 302SYNJARDY216 244SYNJARDY XR216 245SYNRIBO42SYNVISC 166SYNVISC ONE 166SYRINGE AVITENE 71TABLOID42TABRECTA42TACHOSIL 71TACLONEX295 310 326tacrolimus 267 326TACROLIMUS 326tadalafil 110tadalafil (pah) 110 287TAFINLAR42TAGRISSO 42TAKHZYRO 255TALICIA 14 28 199 206TALIVA272TALL RAGWEED49 170 272TALTZ 326TALZENNA 42TAMIFLU25tamoxifen citrate 42 227tamsulosin hcl 61TAPERDEX 12-DAY 212Taperdex 6-Day 212TAPERDEX 7-DAY 212TARCEVA 42TARDEOXIA 290 304TARDIMAXIA 304TARGRETIN 42 326Tarina 24 Fe224Tarina Fe 120224Tarina Fe 120 Eq 224TARKA 83 84 90 93 95 115TAROXIA 304TASIGNA 42TASMAR 139TASOPROL 310tavaborole 318TAVALISSE 65TAYTULLA224tazarotene 326TAZAROTENE326Tazicef 12tazicef 12TAZORAC326Taztia Xt90 93 94 95 100 116

TAZVERIK 42TECARTUS42 117TECENTRIQ 42TECFIDERA264TEFLARO 12TEGRETOL-XR 123 128TEGSEDI 252TEKTURNA110TEKTURNA HCT 110 112 182telmisartan 80 82telmisartan-amlodipine 80 82 93 102 104 116telmisartan-hctz 80 82 112 182temazepam 137TEMIXYS 22TEMODAR 42temozolomide 42temsirolimus 42TENCON120 135teniposide 42tenofovir disoproxil fumarate 22TENORETIC 100 64 87 88 99 113 183TENORETIC 50 64 87 88 99 113 183TENORMIN64 87 89 99TEPADINA 42TEPEZZA193TEPMETKO 43terazosin hcl 59 78 79 108terbinafine hcl 12terbutaline sulfate 63 286terconazole 301TERIPARATIDE (RECOMBINANT) 239 252Terrell 142TESTONE CIK 213TESTOPEL 213TESTOSTERONE213testosterone 213TESTOSTERONE CYPIONATE 213testosterone cypionate 213testosterone enanthate 213tetrabenazine 140 160tetracaine hcl 195tetracycline hcl 29TETRIX 303TEXACORT 295 310THALOMID 264THEO-24104 176 288 328theophylline 104 176 288 328theophylline er 104 176 288 328

thiamine hcl 338THIOLA 273THIOLA EC 273thioridazine hcl 153thiotepa 43thiothixene 159THROMBATE III 65THROMBI-GEL 10 167THROMBI-GEL 100 167THROMBI-GEL 40 167THROMBIN-JMI71THROMBIN-JMI EPISTAXIS 71THROMBI-PAD167THYMOGLOBULIN267THYQUIDITY 247THYROGEN172Tiadylt Er90 93 94 95 101 116tiagabine hcl 123TIAZAC 90 93 94 96 101 116TIBSOVO 43TICE BCG 43 52TIGAN 198tigecycline 18TIGLUTIK140Tilia Fe 224timolol maleate 59 87 89 99 108 130 188timolol maleate pf 188TIMOLOL-BRIMON-DORZOL-LATANOPR184 188 189 196TIMOLOL-BRIMONIDINE-DORZOLAMID 184 188 189TIMOLOL-DORZOLAMID-LATANOPROST 188 189 196TIMOPTIC OCUDOSE188TIMOTHY GRASS POLLEN ALLERGEN49 170 273tinidazole 15TIROSINT 247TIROSINT-SOL247TISSEEL 326Tis-U-Sol 176TIVICAY 20TIVICAY PD 20TIVORBEX152 251tizanidine hcl 58tl-hem 150 75 338 341TOBAKIENT331 338 341 343TOBI PODHALER13TOBRADEX 187 191TOBRADEX ST187 191tobramycin 13 187TOBRAMYCIN 13

371

tobramycin-dexamethasone 187 191TOBREX 187tolbutamide 246tolcapone 139tolmetin sodium 152TOLSURA 17tolterodine tartrate 327tolterodine tartrate er 327TOLVAPTAN183tolvaptan 183TOPICORT SPRAY 295 310topiramate 124topiramate er 124Toposar43topotecan hcl 43TOPROL XL64 87 89 99toremifene citrate 43 227TORISEL43TORONOVA II SUIK 152 167TORONOVA SUIK 153 167torsemide 108 177TOSYMRA 157TOTECT273TOUJEO MAX SOLOSTAR 236 238TOUJEO SOLOSTAR236 238Tovet 295 310TOVET 310TOVIAZ 327TRACLEER116 287TRADJENTA226tramadol hcl 147TRAMADOL HCL ER147tramadol hcl er 147tramadol hcl er (biphasic) 147tramadol-acetaminophen 120 130 147trandolapril 83 84trandolapril-verapamil hcl er 83 84 90 93 96 116tranexamic acid 71TRANEXAMIC ACID-NACL 71TRANSDERM SCOP (15 MG) 198TRANSDERM-SCOP (15 MG) 198TRANXENE-T 136 137tranylcypromine sulfate 142travoprost (bak free) 196TRAZIMERA 43trazodone hcl 158TREANDA43

TRECATOR 16TRELEGY ELLIPTA 56 63 212 277 283 286TRELSTAR MIXJECT43 231TREMFYA326treprostinil 116 287TRESIBA236 238TRESIBA FLEXTOUCH236 238tretinoin 43 304tretinoin microsphere 304tretinoin microsphere pump 304TRETTEN 71TREXALL 43 259 264 267Tri Femynor224TRIAMCINOLONE ACETONIDE 212triamcinolone acetonide 212 296 310triamterene 110 178triamterene-hctz 110 112 178 182Trianex 296 310triazolam 137TRIBENZOR80 82 93 102 104 112 116 182tri-buffered aspirin 77 78 130 155TRICARE PRENATAL DHA ONE 75 201 331 338TRI-CHLOR 326TRICHOPHYTON 49 170 273TRICHOPHYTON MENTAGROPHYTES49 170TRICITRASOL 65 173tricitrates 173Tricon 75TRICOR 105Triderm296 310trientine hcl 207Tri-Estarylla224TRIFERIC 75trifluoperazine hcl 153trifluridine 187trihexyphenidyl hcl 57 120TRIJARDY XR 216 227 245Tri-Legest Fe224Tri-Linyah 224TRILIPIX 105TRILOAN II SUIK 167 212TRILOAN SUIK 167 212TRILOCICLO 310 311Tri-Lo-Estarylla224

Tri-Lo-Marzia224Tri-Lo-Mili 224Tri-Lo-Sprintec 224TRILURON167trimethobenzamide hcl 198trimethoprim 30Tri-Mili 224trimipramine maleate 159TRI-MIX60 116TRINATE75 180 331 338TRINAZ 75 331 338TRINTELLIX158Tri-Nymyo 224Tri-Previfem 225TRIPTODUR 43 231 232TRISENOX43Tri-Sprintec 225TRISTART DHA75 331 338TRIUMEQ 20 22TRI-VI-FLOR255 331TRI-VI-FLORO 255 331tri-vitefluoride 255 331 332 341 343Trivix 296 310Trivora (28) 225Tri-Vylibra225Tri-Vylibra Lo225TRODELVY43TROGARZO20TROKENDI XR 124TRONVITE338 341tropicamide 195TROPICAMIDE-CYCLOPENTOLATE-PE 195 196TROPICAMIDE-PHENYLEPHRINE195TROPIC-CYCLOPENT-PE-KETOROLAC194 195 196TROPIC-CYCLOP-PE-KETO-PROPAR194 195 196TROPIC-PROPARACA-PE-KETOROLAC194 195 196trospium chloride 327trospium chloride er 327TRUE METRIX BLOOD GLUCOSE TEST 171TRUE METRIX LEVEL 1 167TRUE METRIX LEVEL 2 167TRUE METRIX LEVEL 3 167TRUE METRIX PRO BLOOD GLUCOSE 171TRUETRACK TEST171TRULANCE203

372

TRULICITY 233TRUSTEEL INFUSION SET 167TRUVADA22TRUXIMA43TUDORZA PRESSAIR 56 277TUKYSA43Tulana 225TURALIO 43TURPENTINE 275TUSSICAPS10 147 278 280TUXARIN ER 10 147 278 280TUZISTRA XR 10 148 278 280TWIRLA 225TWYNSTA 80 82 93 102 104 116tyblume 225TYBOST273Tydemy 225TYKERB43TYLACTIN BUILD 20PE TYR 175TYLACTIN COMPLETE 15 PE 175TYLACTIN RESTORE 10 175TYLACTIN RESTORE 5PE 175TYLACTIN RTD 15 175TYMLOS 239 252TYR EASY 175TYROS 2175TYSABRI264TYVASO 116 287TYVASO REFILL 116 287TYVASO STARTER116 287UBRELVY 138UCERIS 212UDAMIN SP 331 338UDENYCA 67UKONIQ43ULORIC 251ULTOMIRIS 255ULTRA HIS 273ULTRASAL-ER 314ULTRAVATE296 310Umecta Mousse 314UNISTRIP CONTROL167Unithroid247UNITUXIN 43UPLIZNA264UPNEEQ196UPTRAVI 116 287 288URAMAXIN 314urea 314urea hydrating 314urea nail 314

Urelle30Uretron DS 30Uribel30URIMAR-T 30urin ds 30URO-45830UROGESIC-BLUE 30uro-mp 30urosex 331 338URSO FORTE 201ursodiol 201Ustell 30UTIBRON NEOHALER 57 63 277 286Utira-C30UTOPIC 314VAGIFEM229valacyclovir hcl 26VALCHLOR44 326VALCYTE26valganciclovir hcl 26VALIUM136 138valproic acid 124 128 130valrubicin 44valsartan 80 82valsartan-hydrochlorothiazide 80 82 112 182VALTOCO136 138VALTREX26vancomycin hcl 18vancomycin hcl in nacl 18Vandazole 290Vanoxide-Hc 296 310VANTAS44 231 232vardenafil hcl 110VARDIMAXIA304VARISOFT INFUSION SET167VARIZIG51VAROPHEN153 318VAROXIA 304VARUBI (180 MG DOSE) 204VASCEPA 86VASCULERA 273VASERETIC83 85 112 182VASOTEC83 85v-c forte 331 338VCF VAGINAL CONTRACEPTIVE 274vcf vaginal contraceptive 274VECAMYL108VECTIBIX44VECTICAL 326VECURONIUM BROMIDE58

VELCADE 44Velivet 225VELPHORO 177VELTASSA 177VELTIN 290 304VEMLIDY 26VENCLEXTA44VENCLEXTA STARTING PACK 44VENEXA 331 338venlafaxine hcl 156venlafaxine hcl er 156VENNGEL ONE 153 318 326VENOFER75VENTAVIS 116 288VENTOLIN HFA63 287verapamil hcl 90 93 94 96 101 116verapamil hcl er 90 93 94 96 101 116VERDESO 296 310VEREGEN 326VERELAN91 93 94 96 101 116VERELAN PM 91 93 95 96 101 117VERQUVO 117VERSACLOZ 133VERZENIO44VESICARE LS 327Vestura225VFEND17VIBERZI 203VIBRAMYCIN30Vic-Forte 331 338VICTOZA 233VIEKIRA PAK19 23Vienva 225vigabatrin 124Vigadrone124VIIBRYD158VIIBRYD STARTER PACK 158VILACTIN AA PLUS175Vilamit Mb 30Vilevev Mb 30VILTEPSO 252VIMIZIM 184VIMPAT124VINATE ONE 76 180 331 338vinblastine sulfate 44vincristine sulfate 44vinorelbine tartrate 44VIOKACE 201viorele 225

373

VIRACEPT 23VIRAMUNE 21VIRASAL314VIRAZOLE 26VIREAD22virt-caps 338 341VIRT-FEFA PLUS 76 338 341Virt-Gard 338virt-phos 250 neutral 173virtussin ac walc 148 278 279VISBIOME203VISIONBLUE 172VISTOGARD250VISUDYNE193Vita S Forte 76 331 338Vitacel 331 338VITAFOL FE+ 76 331 338VITAFOL-NANO 76 331 338VITAFOL-OB+DHA 76 180 331 339VITAL-D RX 339 341 343vitamin b complex 100 339vitamin b-complex 100 339vitamin d (ergocalciferol) 343vitamin k1 250 343vitamins acd-fluoride 255 331 332 341 343VITA-RX DIABETIC VITAMIN 331 339VITASURE 339 341VITRAKVI44VITRANOL FE 76 331 339VITRASE184VITREXATE 331 339VITREXATE FE 76 331 339VITREXYL332 339VITREXYL + IRON76 332 339VIVELLE-DOT229VIVITROL148 249VIVLODEX 153VIZIMPRO44VOCABRIA 20VOGELXO PUMP 213Volnea225VOLTAREN153 318 326VONVENDI 71VORAXAZE 184 251voriconazole 17VOSEVI19VOTRIENT44vp-pnv-dha 76 332 339VPRIV 184vp-vite rx 339 341

VRAYLAR 134VTOL LQ120 130 135 154VUMERITY 264VUSION 301VYEPTI 138Vyfemla 225VYLEESI 140Vylibra 225VYNDAMAX96VYNDAQEL 96VYONDYS 53 252VYTONE 296 310 317VYTORIN 97 106VYVANSE 118 119VYXEOS 44VYZULTA196WAKIX 160warfarin sodium 66WASP VENOM PROTEIN 49 170weekly-d 343WELCHOL 89 214WELLBUTRIN SR125WELLBUTRIN XL 125Wera 225westab max 339westab mini 339westab one 339WESTAB PLUS 76 180 332 339WESTERN JUNIPER49 170 273WESTGEL DHA76 332 339WESTHROID 247WHEAT GERM OIL 343WHITE BIRCH 49 170 273WHITE FACED HORNET VENOM49 170WHITE MULBERRY 49 170 273WHITE OAK49 171 273WHITE PINE 49 171 273WIDE-SEAL DIAPHRAGM 60 274WIDE-SEAL DIAPHRAGM 65 274WIDE-SEAL DIAPHRAGM 70 274WIDE-SEAL DIAPHRAGM 75 274WIDE-SEAL DIAPHRAGM 80 274WIDE-SEAL DIAPHRAGM 85 274WIDE-SEAL DIAPHRAGM 90 274WIDE-SEAL DIAPHRAGM 95 274WILATE71WILZIN207WINLEVI 326WINRHO SDF51Wixela Inhub 63 212 283 287WP THYROID 247

WPR PLUS WOUND HEALING SYSTEM 156 300Wymzya Fe 225WYNZORA310 326XADAGO142XALIX314XALKORI 44XANAX138XANAX XR138XAQUIL XR339XARACOLL248XARELTO 66XARELTO STARTER PACK66XATMEP 44 259 264 267XCOPRI 124XELJANZ 259 264XELJANZ XR 259 264XELODA 44XELPROS 196XEMBIFY 51XENICAL203XENLETA27XEOMIN64 273XEPI290XERAC AC300XERESE 296 300 310XERMELO 198XEROSTOMIA RELIEF SPRAY167XGEVA253XHANCE 191 281XIAFLEX 184XIFAXAN28XIGDUO XR216 245XIIDRA 192XIMINO 30 326XOFIGO 275XOFLUZA (40 MG DOSE) 16XOFLUZA (80 MG DOSE) 16XOLAIR284XOLEGEL 302XOPENEX HFA 63 287XOSPATA 44XPOVIO (100 MG ONCE WEEKLY)44XPOVIO (40 MG ONCE WEEKLY)44XPOVIO (40 MG TWICE WEEKLY)44XPOVIO (60 MG ONCE WEEKLY)44XPOVIO (60 MG TWICE WEEKLY)44

374

XPOVIO (80 MG ONCE WEEKLY)44XPOVIO (80 MG TWICE WEEKLY)45XRYLIX 153 318 327XTAMPZA ER 148XTANDI45Xulane225XULTOPHY233 236 238xurea 314XURIDEN273XVITE339 341XYNTHA 71XYNTHA SOLOFUSE71XYOSTED213XYREM 140XYWAV 140XYZBAC332 339XYZMUNE 273YASMIN 28 225YAZ 225YELLOW DOCK49 171 273YELLOW HORNET VENOM PROTEIN 49 171YELLOW JACKET VENOM PROTEIN 49 171YERVOY 45YESCARTA45 117YONDELIS45YONSA 45YOSPRALA77 78 156 206YUPELRI57YUTIQ 191Yuvafem229ZACARE 314zaclir cleansing 314Zafemy 225zafirlukast 280zaleplon 131ZALTRAP45ZALVIT76 332 339ZANOSAR45Zarah225ZARXIO68ZCORT 7-DAY 212ZEGALOGUE230ZEJULA45ZELAC 203ZELAPAR142ZELBORAF 45ZELNORM 203 204ZEMAIRA 284ZEMBRACE SYMTOUCH 157

ZEMDRI 13Zenatane327ZENPEP201ZENZEDI119ZEPATIER 19ZEPOSIA 264ZEPOSIA 7-DAY STARTER PACK 264ZEPOSIA STARTER KIT 264ZEPZELCA 45ZERUVIA 300ZERVIATE 185ZESTORETIC 83 85 113 182ZESTRIL 83 85ZETIA97ZETONNA192 281ZEVALIN Y-90 45ZIAC64 87 89 99 113 182ZIAGEN22zidovudine 22ZIEXTENZO68ZILACAINE PATCH 300zileuton er 280ZILRETTA 212ZILXI 290zinc sulfate 180ZINGO248ZINPLAVA51ZIONODIL 300ZIONODIL 100 300ZIOPTAN 196ziprasidone hcl 128 134ziprasidone mesylate 128 134ZIPSOR153ZIRABEV45ZIRGAN 188ZITHRANOL315ZITHROMAX26ZOCOR 106ZOFRAN 197ZOKINVY 273zoledronic acid 253ZOLGENSMA 117ZOLINZA45ZOLMITRIPTAN157zolmitriptan 157ZOLOFT158ZOLPAK302zolpidem tartrate 131zolpidem tartrate er 131ZOLPIMIST 131ZOMACTON 240

ZOMACTON (FOR ZOMA-JET 10)240ZOMIG 157zonisamide 124ZONTIVITY 77ZORBTIVE 240ZORTRESS 267ZORVOLEX 153Zovia 135 (28)225Zovia 135E (28) 226ZOVIRAX 26 300ZTLIDO 300ZUBSOLV 149ZULRESSO125Zumandimine 226ZUPLENZ197ZYCLARA PUMP 327ZYDELIG45ZYFLO 280ZYKADIA45ZYLET187 192ZYLOPRIM251ZYMAXID 187ZYPITAMAG 106ZYPREXA 128 134ZYPREXA RELPREVV 128 134ZYPREXA ZYDIS128 134ZYTIGA 45ZYVANA332 339 341 343ZYVIT332 339ZYVOX27

375

KPIC-TL18-001-CA

Kaiser Permanente Insurance Company Notice of Language Assistance

No Cost Language Services You can get an interpreter You can get documents read to you and some sent to you in your language For help call us at the number listed on your ID card or 1-866-213-3062 For more help call the CA Dept of Insurance at 1-800-927-4357 TTY users call 711 English

Servicios en otros idiomas sin ninguacuten costo Puede conseguir un inteacuterprete Puede conseguir que le lean los documentos y que algunos se le enviacuteen en su idioma Para obtener ayuda llaacutemenos al nuacutemero que aparece en su tarjeta de identificacioacuten o al 1-866-213-3062 Para obtener maacutes ayuda llame al Departamento de Seguro de CA al 1-800-927-4357 Los usuarios de la liacutenea TTY deben llamar al 711 Spanish

免費語言服務您可使用口譯員您可請人將文件唸給您聽且您可請我們將您語言版本的部分文件寄給您如需協助

請致電列於會員卡上的電話號碼或致電1-866-213-3062與我們聯絡如需進一步協助請致電1-800-927-4357與加州保險局聯絡聽障及語障電話專線使用者請致電711Chinese

No Cost Language Services You can get an interpreter and get documents read to you in your language For help call us at the number listed on your ID card or 1-866-213-3062 For more help call the CA Dept of Insurance at 1-800-927-4357 TTY users call 711 English

Doo b33h7l7n8g00 h1 atarsquo hane Atarsquo halnersquo7 h1 sh0n1otrsquoeeh d00 naaltsoos trsquo11 hazaad bee bikrsquoirsquo ashch98go hachrsquo8rsquo y7d0oltah biniiy4 hachrsquo8rsquo 1n1lrsquo88h [eh Sh7k1 irsquodoolwo[ n7n7zingo nihichrsquo8rsquo hod77lnih koj8rsquo 1-866-2143-3062 47 bee n44h0zin biniiy4 neiy7t1n7g77 bik11rsquo k1 ersquo4lyeed jin7zingo CA Dept of Insurance bichrsquo8rsquo hojilnih kwersquo4 1-800-927-4357 TTY chojoo[lsquo98go 47 711 bi[ azhdilchirsquo Navajo

Dịch vụ ngocircn ngữ miễn phiacute Quyacute vị coacute thể được cấp thocircng dịch viecircn vagrave được người đọc giấy tờ tagravei liệu cho quyacute vị bằng ngocircn ngữcủa quyacute vị Để được giuacutep đỡ xin gọi cho chuacuteng tocirci ở số điện thoại ghi trecircn thẻ ID hội viecircn hoặc số 1-866-213-3062 Để được giuacutep đỡthecircm xin gọi Bộ Bảo hiểm CA ở số 1-800-927-4357 Người sử dụng TTY gọi số 711 Vietnamese

무료언어서비스한국어통역서비스및한국어로서류를낭독해드리는서비스를제공하고있습니다도움이필요하신분은귀하의 ID 카드에나와있는전화번호또는1-866-213-3062번으로문의하십시오보다자세한사항은캘리포니아주보험국전화번호 1-800-927-4357번으로문의하십시오 TTY 사용자번호 711 Korean

Mga Libreng Serbisyo kaugnay sa Wika Maaari kayong kumuha ng tagasalin-wika at hingin na basahin sa inyo ang mga dokumento sa sarili ninyong wika Para humingi ng tulong tawagan kami sa numerong nakasulat sa inyong ID card o sa 1-866-213-3062 Para sa karagdagang tulong tawagan ang CA Dept of Insurance sa 1-800-927-4357 Dapat tumawag ang mga gumagamit ng TTY sa 711 Tagalog

Անվճար լեզվական ծառայություններ Դուք կարող եք օգտվել բանավոր թարգմանչի ծառայություններից և խնդրել որփաստաթղթերը Ձեր լեզվով կարդան Ձեզ համար Օգնության համար զանգահարեք մեզ` Ձեր ID քարտի վրա նշված կամ1-866-213-3062 հեռախոսահամարով Լրացուցիչ օգնության համար զանգահարեք Կալիֆոռնիայի ապահովագրությանդեպարտամենտ` 1-800-927-4357 հեռախոսահամարով TTY-ից օգտվողները պետք է զանգահարեն 711 Armenian

Бесплатные переводческие услуги Вы можете воспользоваться услугами переводчика который переведет вам документы на ваш язык Если вам нужна помощь позвоните нам по номеру телефону указанному в вашей идентификационной карточке или 1-866-213-3062 За дополнительной помощью обращайтесь в Департамент страхования штата Калифорния (CA Dept ofInsurance) по телефону 1-800-927-4357 Пользователи TTY звоните по номеру 711 Russian

KPIC-TL18-001-CA

無料の言語サービス通訳に日本語で書類を読んでもらうことができます通訳サービスが必要な際はID カードに記載の番号または1-866-213-3062にお電話くださいさらにヘルプが必要な場合はカリフォルニア州保険庁（1-800-927-4357）にお電話くださいTTY ユーザーの方は711 をご使用くださいJapanese

و برای دریافت کمک می توانید از خدمات مترجم شفاهی بهره مند شوید و ترتیب خواندن متن ها برای شما به زبان خودتان را بدهید خدمات زبان به صورت رایگانبرای دریافت کمک و راهنمایی بیشتر با اداره بیمه تماس حاصل نمایند 3062-213-866-1راهنمایی با ما به شماره ای که روی کارت شناسایی شما قید شده یا شماره

حاصل نمایندتماس 711با شماره TTYکاربران تماس بگیرید 1-800-927-4357 Persian کالیفرنیا به شماره

ਮਫ਼ਤ ਭਾਸ਼ਾ ਸਵਾਵਾਾ ਤਸੀ ਾ ਕਿਸ ਦਭਾਸ਼ੀਏ ਨ ਪਰਾਪਤ ਿਰ ਸਿਦ ਹ ਅਤ ਤਸੀ ਾ ਦਸਤਾਵਜ਼ਾਾ ਨ ਆਪਣੀ ਭਾਸ਼ਾ ਕਵਿਚ ਪੜਹਵਾ ਸਿਦ ਹ ਮਦਦ ਲਈ ਆਪਣ ਆਈਡੀ ਿਾਰਡ ਤ ਕਦਿਤ ਨ ਬਰ lsquoਤ ਜਾਾ 1-866-213-3062 lsquoਤ ਸਾਨ ਿਾਲ ਿਰ ਵਧਰੀ ਮਦਦ ਲਈ CA ਕਡਪਾਰਟਮਟ ਆਿਫ ਇਨਸ਼ਰਸ ਨ 1-800-927-4357 ਤ ਿਾਲ ਿਰ TTY ਦ ਉਪਯਗਿਰਤਾ 711 ਤ ਿਾਲ ਿਰ Punjabi

សេវាភាសាឥតគតថលៃ អនកអាចទទលបានអនកបកបរប នងឲយគេអានឯកសារជនអនក ជាភាសាបមែ រ សរាបជនយ សមទរសពទមកគយើង តាមគលមបែលមានគៅគលើបណណ ID របសអនក ឬ 1-866-213-3062 សរាបជនយបែមគទៀត ទរសពទគៅរកសងធានារាា បរង រែឋកាលហវ រនញា តាមគលម 1 800-927-4357 អនកគរបើ TTY គៅគលម 711 Khmer

ة عضویتك أو على یمكنك الحصول على مترجم وقراءة الوثائق لك باللغة العربیة للحصول على المساعدة اتصل بنا على الرقم المبین على بطاقخدمات ترجمة بدون تكلفة لمستخدمي خدمة الهاتف النصي یرجى 4357-927-800-1 للحصول على مزید من المعلومات اتصل بإدارة التأمین لولایة كالیفورنیا على الرقم 3062-213-866-1الرقم

Arabic 711الاتصال على

Cov Kev Pab Txhais Lus Tsis Raug Nqi Dab Tsi Koj muaj tau ib tug neeg txhais lus thiab hais tau kom nyeem cov ntaub ntawv ua koj hom lus rau koj Yog xav tau kev pab hu rau peb ntawm tus xov tooj teev muaj nyob rau ntawm koj daim yuaj ID los yog 1-866-213-3062 Yog xav tau kev pab ntxiv hu rau CA Tuam Tsev Tswj Kev Pov Hwm ntawm 1 800-927-4357 Cov neeg siv TTY hu rau 711 Hmong

मफत भाषा सवाए आप एक दभाषिया परापत कर सकत ह और आपको दसतावज़ आपकी भािा म पढ़ कर सनाए जा सकत ह सहायता क षिए अपन आईडी काडड पर षदए नमबर या 1-866-213-3062 पर हम फोन कर अषिक सहायता क षिए कषिफोषनडया षडपारडमर ऑफ इनशरनस को 1-800-927-4357 TTY परयोकता 711 पर फोन कर Hindi

บรการดานภาษาทไมคดคาบรการ คณสามารถขอรบบรการลามแปลภาษาและขอใหอานเอกสารใหคณฟงเปนภาษาของคณได หากตองการความชวยเหลอ โปรดโทรตดตอหาเราตามหมายเลขทระบอยบนบตร ID ของคณหรอหมายเลข 1-866-213-3062 หากตองการความชวยเหลอในเรองอนๆ เพมเตม โปรดโทรตดตอฝายประกนโรคมะเรงทหมายเลข 1 800-927-4357 ผใช TTY โปรดโทรไปทหมายเลข 711 Thai

សេវាភាសាឥតគតថលៃ អនកអាចទទលបានអនកបកបរែ នងឲយគេអានឯកសារជនអនក ជាភាសាខមែរ សរាបជនយ សមទរសពទមកយើង តាមលេខដែលមាននៅលើបណណ ID របសអនក ឬ 1-866-213-3062 សរាបជនយថែមទៀត ទរសពទទៅករសងធានារ ាបរង រដឋកាលហវ រនញា តាមលេខ 1 800-927-4357 អនកបរ ើ TTY ហៅលេខ 711 Khmer

optumrxcom

WF1822264_ORX_Kaiser_SF formulary booklet_12162019 Kaiser Permanente

OptumRx specializes in the delivery clinical management and affordability of prescription medications and consumer health products We are an Optumreg company mdash a leading provider of integrated health services Learn more at optumcomoptumrxAll Optum trademarks and logos are owned by Optum Inc in the US and other jurisdictions All other trademarks are the property of their respective ownerscopy 2020 Optum Inc All rights reserved











DIAGNOSTIC AGENTS



ENZYMES




GOLD COMPOUNDS







PHARMACEUTICAL AIDS

RADIOACTIVE AGENTS




VITAMINS











DIAGNOSTIC AGENTS



ENZYMES




GOLD COMPOUNDS







PHARMACEUTICAL AIDS

RADIOACTIVE AGENTS




VITAMINS

Table of Contents

Informational Section3ANTIHISTAMINE DRUGS - Drugs for Allergy9ANTI-INFECTIVE AGENTS - Drugs for Infections 11ANTINEOPLASTIC AGENTS - Drugs for Cancer 30ANTITOXINSIMMUNE GLOBTOXOIDSVACCINES - DRUGS FOR THE IMMUNE SYSTEM 45AUTONOMIC DRUGS - Drugs for the Nervous System 52BLOOD FORMATION COAGULATION THROMBOSIS - Drugs for the Blood65CARDIOVASCULAR DRUGS - Drugs for the Heart 78CELLULAR AND GENE THERAPY - Drugs for Cancer 117CENTRAL NERVOUS SYSTEM AGENTS - Drugs for the Nervous System117DEVICES - Medical Supplies and Durable Medical Equipment 160DIAGNOSTIC AGENTS 167DISINFECTANTS (FOR NON-DERMATOLOGIC USE) - Disinfectants 173ELECTROLYTIC CALORIC AND WATER BALANCE173ENZYMES 183EYE EAR NOSE AND THROAT (EENT) PREPS 184GASTROINTESTINAL DRUGS 197GASTROINTESTINAL DRUGS - Drugs for the Stomach 197GOLD COMPOUNDS 206HEAVY METAL ANTAGONISTS - Drugs to Reduce Iron 206HORMONES AND SYNTHETIC SUBSTITUTES - Hormones207LOCAL ANESTHETICS (PARENTERAL) - Drugs for Numbing247MISCELLANEOUS THERAPEUTIC AGENTS248NONHORMONAL CONTRACEPTIVES - Drugs for Women 273OXYTOCICS - Drugs for Women274PHARMACEUTICAL AIDS274RADIOACTIVE AGENTS 275RESPIRATORY TRACT AGENTS - Drugs for the Lungs 275SKIN AND MUCOUS MEMBRANE AGENTS - Drugs for the Skin288SMOOTH MUSCLE RELAXANTS - Drugs to Relax Muscles 327VITAMINS 328

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3


3 DSL = 30 days




3


3




3


3




3





3




3





3


48




3


3


3


3




3






3


3




3


3 DSL = 30 days


2


2


2


3


2 DSL = 30 days


3 DSL = 30 days


49



2


2


2


2


2


2


2


2


2


3


3


2 DSL = 30 days


3


2


3


2


3


2


50



2


2 DSL = 30 days


3


3


2


2


2


3


3


2


3


2


2


3


3


3 DSL = 30 days


3


51


VACCINES - Vaccines


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


2









3 DSL = 30 days


52



3




3


1 DSL = 30 days




3


3



3 DSL = 30 days



3



3


3


3




1


3




1



53



3


3







3


3


3


1


1



3


PV


3


3



PV








54



2


3


3 DSL = 30 days




3


3




1


3





1










3




3



55



3


3 DSL = 30 days


3 DSL = 30 days











2


3



3


3


3


2


2


3


3


3


3


3


56



3


3







PV



PV
















1



3





57



3







1



2


3




3


3



3


3


3



1


3


3




58



3


3


3





1










3


3



3






3





2


59




2


2 DSL = 30 days




2







1





2


2


3


3 DSL = 30 days


3


3







1


60






1


3


3







2


2


3


3


3


3


PV


PV


PV


PV


61



PV


PV




3


3


3


3


3


3


PV


3 DSL = 30 days


3


1


3



1



3


PV


62



PV


PV


PV


2


2


2


3




3


3


PV


1


3








1


3


63



3


3


3


1


1


1


3


3



3


3



2


3


2



1



3


3


64





3 DSL = 30 days



3



2


3


3 DSL = 30 days


1 DSL = 30 days


3


3


2



3


2





3 DSL = 30 days



3 DSL = 30 days


65




1


1



3 DSL = 30 days


3



1 DSL = 30 days


3


3


3



2



PV DSL = 30 days


PV DSL = 30 days



PV DSL = 30 days


PV DSL = 30 days


PV DSL = 30 days


66



PV DSL = 30 days


PV DSL = 30 days


PV


3



PV


PV


PV DSL = 30 days


PV DSL = 30 days


PV DSL = 30 days


PV DSL = 30 days


3 DSL = 30 days


PV DSL = 30 days


PV DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


PV DSL = 30 days


PV DSL = 30 days


67



PV DSL = 30 days


PV DSL = 30 days





2


2 DSL = 30 days


2


2 DSL = 30 days


2


2


2




3



3


2


2


2


2


68







2



3


2


2



2 DSL = 30 days


2


2


2


3


2


3 DSL = 30 days


2


2


2 DSL = 30 days


69



2


2


2



3


2


2 DSL = 30 days


3 DSL = 30 days


3


2


3


2


2 DSL = 30 days


3


2 DSL = 30 days


2


2


2


70



2


2


3


2


3


3


3






3


2


2 DSL = 30 days


2


2 DSL = 30 days


2


2 DSL = 30 days


2




1 DSL = 30 days


71



3 DSL = 30 days


1



1


1


1



2 DSL = 30 days


2 DSL = 30 days




3





3



3



3



3



PV


72



3


3




3



1








3


3



3



3


1



3


3




3


PV


73



PV


3







3


3









3


3








3


3


3


3


74



3


3


3


3


3




3



3


3



3


3




3




3



3





2


75



3




3


3


3




















1


3


PV



PV



76









3






PV



3






2












3


PV


77




PV




2


3



PV



3




3


3



1


3


3




3





3


78



3




3





1


1


1


3


3


3



3


3


3



1


3


3


3



79



3


3


3


3



1



1


3




1


1



1



3


3



1



1


1


80



1


3


3


3



3


3


3



1


3


3


3



3


2


3


3


3



1



81



1


3




1


1



1



3


3



1



3


3


3


1



1



1





82






1


3


3


3




3





1



3



1


3


3


3


3



3


3


83



3


1



1



1








1


3


3


3




3





1



3



1


84



3


3


3


3







PV


PV





3


3



3



3 DSL = 30 days



3



1



3


85









3


3




1


3



1


3


3



3


3



3


3


3


3



86



3


1


1


1




1








3


3




3


3






3


3




87



1



3


3



3


3


3


3



3


1


1


1




1








3


3


88





3


3









3











3







3


3


89



3


3


1


1


1


1


1


1



3


1


1


3


1


1


3


1


1


1



90



3


3




1


1


1


1


1


3


3


3


3


3


3


1


3


1


1


91



1


1


1



3


1


3


3


1



3


3


1



1


1




1


3



1


3


92




3


3


3


1


1


1


3


1


3


3


1


1



3


3



3


3


93



3


3


1


1


1


1


1


1



3


1


1


3


1


1


3


1


1



3


94



3



3


3


3


3


1


1


1


1


1


1



3


1


1


3


1


1


95



3


1


1


1



3


3



1






1



3







PV


1


1


96




3


3


3




1


1




1




1


3


3


3





2






2


97



3






1




1







3


3




1



1


3


3



3


3



98



3


3


3


3



3


1


1


1




1








3


3




3


3




99



3


3








3


3


3


3


1


1


1


1


1


1



3


1


1


1


100



1


3


1


1



3


3




1


1


1


1


1


3


3


3


3


3


101



3


1



3


3



1


1




1


3



1


3



3


3


1


3


3




102



1


1


1


1


1


3


3


3


3


3


1



3


3



1


1




1


3



103



1


3



3


3


1


3


3



3






3


PV


PV




3


1


1


1


104











3



PV


1



3


PV


3


1



PV



PV


PV


PV





105



3



3


PV


3





1


1


1


3


3


3



3


3



1


3


3


3


3


106




3


1



3


3


3



3


3



1


1




1


3







3


1





107





3














3


3








3


3







108




3


3



1


1



1



3


2



1



3


2


3



3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days





109















3


3

















3


3


110




2



3



3


3



1


3


3


1


3


1


1


1


3



3



3



111





3


1


1


1


3




1


1


3


1


1



1



3





3


1


3


112



3


3





3




3


3



3 DSL = 30 days




1


1


1


1


1


3



3


3


113



3


3


3


1


2


2


3


3


1


1


1


1


1



3


1



2


1


3


1


114





3



3


1


2



1


1




1


3



1



3 DSL = 30 days



3



3


2


3


3


115



1


1


1


3




1


1


3


2


3



2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


1


1



3


116



3









3



3


3


3


3







PV DSL = 30 days


PV


PV




117





2





2



3


3 DSL = 30 days


3


3 DSL = 30 days



1


1



1




3


3



3 DSL = 30 days


2


118



3


3







1


3


3 DSL = 30 days





3 DSL = 30 days



3


1


1


1



1 DSL = 30 days





3


3


119



1


1


2


3



1 DSL = 30 days



1


1



3


3 DSL = 30 days


3 DSL = 30 days


3



3



2


2 DSL = 30 days


2






120




3




3 DSL = 30 days



2 DSL = 30 days


1


1





PV


PV


PV




PV



PV


3




3


2



121







3 DSL = 30 days





3


3


3


PV


PV


PV


PV


PV


PV


PV


PV





PV





122



1





3


PV






3


1


1



2






3


PV



PV


PV


3



123



1




3







3



3


3 DSL = 30 days


3 DSL = 30 days




PV


PV


PV


PV


PV



PV





124



PV


3


3


PV


PV


3



PV


PV


PV


PV


PV


PV



PV



PV


PV


PV


1


1



125





PV


PV


PV


PV



PV



3


2


PV


PV


PV


PV


PV


PV


PV





PV





126



PV





PV



PV



3


PV


PV


PV



PV




PV


PV


3


PV


PV


PV



PV


127



PV


3





PV


PV


PV


PV


PV




3


3 DSL = 30 days


3 DSL = 30 days


1












128



PV



PV


1


1







3


PV


PV


PV




PV



PV


3


3 DSL = 30 days


3 DSL = 30 days


2





129



3


3


3


2


2 DSL = 30 days


1




PV







3



PV






3




1



130



3 DSL = 30 days









PV


3


2







PV





1 DSL = 30 days






PV


PV


PV


131



PV


PV


PV



PV



PV


PV


PV




PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


132






PV



PV


PV


3


PV


PV


PV


PV



PV




PV


PV


3


PV


PV


PV



133



PV DSL = 30 days


PV DSL = 30 days



PV


PV


PV


PV


PV



2


3


3





1




2


3




3


134



1




3


1


1


1






2


3





1




2


3


3


3



3


135








1














3 DSL = 30 days



PV



3


3



PV DSL = 30 days





PV DSL = 30 days


136










1

















3


3


3 DSL = 30 days






PV



137




3


3


PV DSL = 30 days


PV DSL = 30 days



PV


PV





3


3 DSL = 30 days


3


3 DSL = 30 days


3


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days



3


138




1









1


3 DSL = 30 days



1



3 DSL = 30 days



1




2


3


3


3 DSL = 30 days


3



139



3 DSL = 30 days


3


3 DSL = 30 days



3




3 DSL = 30 days



3 DSL = 30 days




3


3



1


1


1


1


2



3


140









PV


3


PV


3


1


1



3


3




3


3



2






1


141










3





3


3



3










3



2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


142



3


1


1


1


1







1


3 DSL = 30 days




1


1


3 DSL = 30 days


1





3


3



1 DSL = 30 days


143



1 DSL = 30 days



1 DSL = 30 days


3 DSL = 30 days


3


3 DSL = 30 days


3


3


1 DSL = 30 days


1


3


3 DSL = 30 days


3 DSL = 30 days




1 DSL = 30 days


1 DSL = 30 days


1


1


1



144




1



1 DSL = 30 days






3


3


3 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days




2







1 DSL = 30 days







145





1 DSL = 30 days


1


1


1


1


1


1









3



3



3 DSL = 30 days


3 DSL = 30 days




3 DSL = 30 days



146






1 DSL = 30 days




3 DSL = 30 days


1 DSL = 30 days



3 DSL = 30 days


3 DSL = 30 days







3 DSL = 30 days


3


1


3


1




3


3


147



3



3



3







3



3


3





1 DSL = 30 days


1


1 DSL = 30 days







3


3 DSL = 30 days


148



3 DSL = 30 days



PV


PV






PV


3


3





3





PV




PV


1


3




149



3








PV



PV












1














150



3


3







PV




PV


PV









PV





PV







PV


151



PV



1


3


3


PV


PV


PV


PV


PV





1


PV





PV




1





3


152



3


3





3






PV









PV







3




1



153



1


1







3


3 DSL = 30 days


3


1



3


1


1


1


1


1





3


3



3


154





1











1


3


PV



PV






3






3




PV



155



3


3



PV


PV


PV


3


PV


PV


PV


PV


PV


3


3


PV


PV


PV






3


156



3


3



3


3 DSL = 30 days






1



1


1




3







PV









157





PV



PV


PV


PV




PV



PV


PV


PV




PV



PV



PV



PV


PV


PV


158










PV



PV




PV


PV






PV






PV


PV





3 DSL = 30 days


159



3 DSL = 30 days


3 DSL = 30 days










3


2


2



2


2


2


2



3




3





160



3



3


3




2


2


2


2


2


2


2


3


3


3


3



2


3


3



161



3


3



3


3


3


3


2


3


3


3



3


3


3


3


3



3


3


3




162



2


3



3


3


3



3


3



1




3



3





3


3


3


3


3


3


163




2


PV


PV


PV


3






3


PV


3


3




3


3



3


3


3


164



3



PV



PV




3




2


2


2


2


2


2


2


2


3


3


2


3




165



3


3





3



3




3





SHARPS CONTAINER 3



1


2


2


2


2



3


3


3


166



3


3


3



3


3


3


3


3


2


2


2



2



3

DIAGNOSTIC AGENTS




2








167







3





3


3





3


3


3




3


3







3


3


3


168



3



3





3


3



3




3




3


3


3




3




3




3


169



3


3




3




3





3




3





3



3


3


3


3




3



170






3


3

DIABETES MELLITUS



PV



PV





PV





PV



PV


PV


PV


PV


PV


DIAGNOSTIC AGENTS


3


171


KETONES



MYASTHENIA GRAVIS


3

OCULAR DISORDERS




3


3




3





3



PITUITARY FUNCTION








3

THYROID FUNCTION


2


172






ACIDIFYING AGENTS


PV


PV


PV


PV



PV


ALKALINIZING AGENTS


3



3


1



3






3


3



173


AMMONIA DETOXICANTS


3 DSL = 30 days


















2




2


2


2


2


2


2



2


174



2


2


2


2




2


2





L-CYSTINE POWDER 3




3




2


2


2


2






175




1





3


PV


PV




3 DSL = 30 days







3


3


3


2











176









3







PV


PV


PV


3


PV



PV






3



3




3 DSL = 30 days


177




3


3
















3


3


3


3


3


3


3


3


3




178



PV


1


3



3


3



3


PV


PV


PV


PV



PV


1


1


PV




3




3


3


179



3



PV


PV


PV


1



PV






3




3



1



1



3


3





3


180



3



1


3


3


1


3


1


1


1


3



3



3





3


1


1


1


181



3




1


1


3


1


1



1



3





3


1


3


3


3





3



182




3


3

URICOSURIC AGENTS






3 DSL = 30 days


3




ENZYMES

ENZYMES


2


2



2


2


2 DSL = 30 days


3 DSL = 30 days


2


2 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


183



3


2 DSL = 30 days


3 DSL = 30 days


2


3


2 DSL = 30 days



2 DSL = 30 days


3


PV DSL = 30 days


2


3




3



3


3


3


3


3


184





3





3















3


2


2



3


3





3


185



2











1


1


1


1





1


1





3


1


1


3


3


186



3


3


3


3


3


3


3


3





2


3





3







3


3




187






3


3



3




3






3


3


3


3



1



3








188




3


3


3


3



3




3


3


3



3


3




3




3



3






189



2




3


3


3


3


3




3



1


1



1



3


2


PV


2


3


3


3


190





3


3



3


3


3


3


3


3


3


3


3


3


3


2



2


3



3


3


191



3


3




3




1





3


3






3 DSL = 30 days


3


3



3 DSL = 30 days


3


3


3


192




2






2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


2



3 DSL = 30 days


2



PV


PV


PV



PV







3


193



3


3


3


3


3


3


3


PV


3


3


3








3


3









194



3







3


3



2







2


2




2


3



3


3


3


3


3


195







3



3


3


3



3





3


3

VASOCONSTRICTORS


3




3


3


3


3



196





PV








3


3


2 DSL = 30 days


PV


PV DSL = 30 days




3







PV


PV


PV




197








3






3






PV


PV



3











PV




198








2









2







3


3









PV




199



PV




PV


PV


PV






PV






PV


PV


PV




PV



PV


PV






200



PV


PV


3









2



3


3


3


2


3




3 DSL = 30 days



3 DSL = 30 days


3


201



3 DSL = 30 days



3



3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


2



3


3







202



3 DSL = 30 days


2


3


3


3


3 DSL = 30 days


3 DSL = 30 days





















3


3


203



2 DSL = 30 days




PV



PV DSL = 30 days



PV


PV







3






1









3



204



3


3



PV



PV


PV


PV



PV


1


PV


PV


3





PV


1


1




PV


PV


205



PV


PV



PV




3


3

GOLD COMPOUNDS

GOLD COMPOUNDS













1



2 DSL = 30 days





3 DSL = 30 days



2 DSL = 30 days


206



2 DSL = 30 days






ADRENALS - Hormones



2


2


3


3


3


3


3 DSL = 30 days


2


3


3


2


2


207



2


2


2


2 DSL = 30 days


PV DSL = 30 days



3


3


3


1


3


3




1



3


3


PV





208




1


1



1


1


3


1


3


1


3


3


3


3


3



3 DSL = 30 days


3 DSL = 30 days


3


3


2



209



1


3



3




2


3


3


PV


PV


3


3


PV


PV


PV


PV


PV





3 DSL = 30 days



210







3




1


1




PV


PV


3


3


2


3


3


3


PV


3


3


2


3


211



3


3


3


3


3


1


2


3


3


3 DSL = 30 days



1



3







2


2



2


212



3


3




2







3 DSL = 30 days






3



2


1




1



2


3




213













3 DSL = 30 days OC




2


2



3 DSL = 30 days









3 DSL = 30 days


3


3






214



3



2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


2




215





2


2


2


2


2



PV


PV




PV



PV



PV


PV


PV



PV


PV


PV


216



PV


PV


PV


PV


PV


PV



PV


PV


PV


PV


PV




PV


PV


PV


PV


PV


PV


PV


PV


217



PV


PV


PV


PV


PV


PV



PV


PV


PV





PV


PV


PV


PV



PV


PV


PV



PV


218



PV


PV


PV


PV


PV


PV


PV


PV



PV



PV


PV


PV




PV


PV


PV


PV


PV


PV


219



PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV



PV



PV


220



PV


PV


PV


PV


PV


PV


PV


PV


PV


PV



PV


PV


PV


PV





PV


PV


PV


PV


221



PV


PV


PV



PV


PV


PV


PV


PV


PV


PV





PV


PV


PV



PV



PV




PV


222



PV


PV


PV


PV


PV




PV




PV


PV


PV



PV


PV


PV


PV


PV


PV


PV


PV



223



PV


PV


PV



PV


PV



PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


224



PV


PV


PV


PV


PV



2



PV


PV



PV



PV


PV




PV


PV


PV



PV



PV


225



PV


PV



2


2


2


2


2


2


2


2


2


2


2


2



2


2


2



226



2




3










PV


PV


PV


3



3


PV


PV


3



3


2


227



2


PV


PV


3




PV








PV


PV







PV


PV


PV


3


PV


228



3


3



PV


PV


PV



PV


PV


3 DSL = 30 days


3


PV


3


PV


PV



PV




2


2


2


229





2


2


2


2


2


2



2


3


3


3



3


2


2


2


2



3


2


230



2


2


2


2


2


2



2


2



3



3


3




2


3


3


3



2


231



2


2


2



3


2


2


2


2


2


2


2



2


2



3



3




2


2


232



2


2


2


2



2


2 DSL = 30 days


2 DSL = 30 days


2


2 DSL = 30 days



2


2


2


2 DSL = 30 days


2


2


2


2


2


2


233



2


2


2


2


2


2


2


2


2


2


2


2


PV


2


2


2


2


2


2


234



2


2


2


2



2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


235



2


2


2


2


2


2


2


2


2


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2


2 DSL = 30 days



2


2


236



2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


237



2

LEPTINS - Hormones


3 DSL = 30 days



2


2


2


2


2


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2


2 DSL = 30 days







2 DSL = 30 days


3 DSL = 30 days


238



2 DSL = 30 days


3 DSL = 30 days




2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days




2







2


2


2


3


2


2


2


239



2


2


2


2


2


2


2


2


2


2



PV


PV


3




PV



PV


PV


PV



240




PV


PV



1 DSL = 30 days



3


PV DSL = 30 days


PV DSL = 30 days


PV


PV








PV


3 DSL = 30 days




PV


PV




2


241



2


2


2 DSL = 30 days


2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


242



2


2


2


2


2



2


2


2


2


2


2


2



2


2


PV


2


2


2


243



2


2


2


2


2


2


2


2



2


2


2


2




2


2


2


2


2


244



2


2


2



3 DSL = 30 days


3 DSL = 30 days


1


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days



2 DSL = 30 days


3



3 DSL = 30 days




2



2



245



2


2



2




2


2





2


2


2


2


2






3


3


1


1


246



3


1


1



3



3


3


3


1


3


3




3





3


247



3


3 DSL = 30 days




3








3





1


2


1


3











248




3




3


3


2


2


2


3



2


1


2


PV


PV


2




2


2


2


2



249



PV DSL = 30 days


PV



PV




PV


3


PV











3



PV








3




250



PV DSL = 30 days









PV










PV



PV







PV


PV







251





3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days



3 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days



3




3


3






3


252





3 DSL = 30 days


1


1


3





2 DSL = 30 days










3


3


3



3







3


253




PV


3


3


3


3


PV


PV


3


PV


PV


3



PV


3


3


3


3


3


sf dental gel 11 PV





254









PV


3






3 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days



3 DSL = 30 days


3 DSL = 30 days


2


2 DSL = 30 days


3


3 DSL = 30 days



3


255



3


3 DSL = 30 days


3 DSL = 30 days





3 DSL = 30 days


3


3 DSL = 30 days








3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days




3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


256



2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days



2


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days





1





2



2 DSL = 30 days


2 DSL = 30 days


257



2 DSL = 30 days



2 DSL = 30 days


3


2




PV


2


3


2


3



3 DSL = 30 days


2


2



3


3 DSL = 30 days


3 DSL = 30 days


258



3


2


2




3 OC





2 DSL = 30 days


3



2


2



3


3


3 DSL = 30 days


2 DSL = 30 days



2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days



259





3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3


3 DSL = 30 days


3 DSL = 30 days






1 DSL = 30 days



3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3






260



1 DSL = 30 days


1 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days



2


2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


261




3 DSL = 30 days


3



1





2


3 DSL = 30 days



2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days



2 DSL = 30 days


3


2


PV


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


262



3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days OC



3


2 DSL = 30 days


2


3


3


3


3


3


2


3


2 DSL = 30 days OC



3 DSL = 30 days


2


2



263



3


3 DSL = 30 days


3 DSL = 30 days


3


2


2





3 DSL = 30 days


2 DSL = 30 days OC


3 OC


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days





2 DSL = 30 days


3


3 DSL = 30 days



3 DSL = 30 days


264




3


2





3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


1


3









3



3 DSL = 30 days





3




1


265






1


1





1


2


3


3


2





2 DSL = 30 days OC



2


3


2


2



266



3





3


3 OC














3 DSL = 30 days


3



3



3



3 DSL = 30 days




3


267



3



2




3


3


3


2


3


3






3


3






2 DSL = 30 days






3


268



3


3


3




3



3 DSL = 30 days


3 DSL = 30 days




3


3


3




3 DSL = 30 days



2



3


3 DSL = 30 days


3 DSL = 30 days



3


269











3


3


3






3


3


3






3



2








270





3


1



3 DSL = 30 days


3


3


3


3


3 DSL = 30 days



3


3


3


3


3


3


2




3 DSL = 30 days


3 DSL = 30 days



271



3


3




3


2







3


2 DSL = 30 days





3




3



3 DSL = 30 days




3


2


3



272



3



3


3










3





PROTECTIVE AGENTS


PV DSL = 30 days


PV


2


PV





PV





273



PV


3


PV



PV


PV


PV


PV


PV


PV


PV


PV









3


3



PHARMACEUTICAL AIDS

PHARMACEUTICAL AIDS


ASPARTAME POWDER 3


274











3


3


3


RADIOACTIVE AGENTS

RADIOACTIVE AGENTS


3


3









3 DSL = 30 days


3



3


1 DSL = 30 days



275




3


3




3



3


3


1


1


3


PV


3


3


PV




3 DSL = 30 days


3




3


276



3


2


2


3


3


3








3 DSL = 30 days







1






3


3 DSL = 30 days





277






3


3


3




2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days






2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days



3






278



3




3









3







1


3



3


PV











279







3


3


3



3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3


3 DSL = 30 days


3


3 DSL = 30 days









PV





280










2




3






3


3



3


3



2


2


3


3


281



3


3


2


3


3


2


2


2


2


2


2 DSL = 30 days


PV DSL = 30 days


3


3


1


3


282



3


3


3


2


1


3


2


3


3


3


3


3


1






2


3


283



2



2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3


2 DSL = 30 days


2


2 DSL = 30 days


2 DSL = 30 days





3







2


2


284



3


3


3


3


PV


PV


PV


PV


PV


PV




3


3


3


3


3


3


PV


285



3 DSL = 30 days


3


1


3



1



3


PV


PV


PV


PV


2


2


2


3




3


3


286



PV


1


3



3 DSL = 30 days





1




3 DSL = 30 days


2









1



2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


287



3 DSL = 30 days


2 DSL = 30 days




3


PV


PV










3





3




3


3



3



288




3


1



3









3



3


3






3




3









289





3









3


3



3



3


3


3



3





3







290





3



3







3






3


3


2


2




3









291









1


3














2










3






292











3




3
























293



3





















3


1






3


3






294



3






2


2




3


3


3






2



3


3


3


3



3



3



295






1






3 DSL = 30 days


3



3






3





3


3


2


2



3


3


296




3


3


3


3


3


3


3


3






3





3


3








lets kit 1



297










3


1






3







3


3







3


3


3


3


298



3




3








2


2




3










3


3


3


3


3



299




3


3



3



3













2








3



3



300



3






3


3



3






3







3












3


301







3



3



3


3


3





3


3


3



3


3




3


3


3


302



3










3


3



3


3


3


2 DSL = 30 days


3


3


3




2



2


2


303



3 DSL = 30 days


3















3







3






3


3


2


2


304





3

















1


3


3





3


3








305








3


3


3


3




2










3












306



3


3













3
















3







307














3




3



3




3


1






3


3


3





308




3








2


2




3


3


3






3



3


3


3


3


3



309



3




3



3





1





3



3 DSL = 30 days


3



3


3 DSL = 30 days











310



3


3


3


3


3



3


3


3


3


3


3



3







3


3







311






3


3


3


3


1



3






3




3


3


3







3


3


312



3



3


3


3


3


3











3




3






1



1




313







3


3


3


3


3


3


3













3






3


3


314







3


3


3


3


3


3






3



3









3






315



3


3


3


3


3


3


3


3



3


3


3


3


3


3









3




316







1



1








3


2


3


3


3


3


3


3


3



3



3


317







3




3












PV


3





1


3




3




318



















3







3 DSL = 30 days


3











319



3


3








3 DSL = 30 days











1


3





3




1



1


2 DSL = 30 days


320



2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days






3


3


3


3


2










3









3


321



3 DSL = 30 days


3 DSL = 30 days



3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days




3


3


2






3









3 DSL = 30 days


3 DSL = 30 days


322



2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3


3




3


3



3


3


2






2


323



3


3


3


1


3



3


3


1





3


3


3


3


3


3


PV


PV


PV


PV


324



PV


3



2 DSL = 30 days









1




3


3




2


3





3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3



325




3


2


2


1


3




3 DSL = 30 days


3 DSL = 30 days







3


2


2



3 DSL = 30 days







3 DSL = 30 days


3


326



3


1


3



3


3


3




1




1




2



1



3


1



3




327



3


PV


PV





3

VITAMINS





3


3



3






3




3



3


3




328



3


2


2



3








3




3


3




3





3


3


3


3




329







3


3


3


3


3


3


3


3


3


3




3


3


3


3


3


3



3


330




3


3






3





3




3






3




3


3


3







331










ZYVIT ORAL TABLET 3

VITAMIN A



2




VITAMIN B COMPLEX


3





3


3


3



3




3




3


332






3


3



3




3


3


3



3


3



3





3


3




PV



3


333



3


3



1



3



3


3








3




3


3


3





3


3


3


334






3






3


1


3


3
















3


3





335



PV


3






3





3


3


3


3







3






3







336












3


3


3


3


3


3


3


3


3


3




3




3



3


337



3




3



3









3






3






3







3


3


338



3


3


















3





ZYVIT ORAL TABLET 3

VITAMIN C




3


3





339



3


3






3


3


3



1






3



3


3


3




PV


3






340



3




3



3











3






VITAMIN D



3


3







3


341






3


3


3



PV





3




3


3



3


3







PV DSL = 30 days






342





3





VITAMIN E



3


VITAMIN K ACTIVITY


2






343

Index of Drugs




344




345




346




347




348




349




350




351




352




353




354




355




356




357




358




359




360




361




362




363




364




365




366




367




368




369




370




371




372




373




374




375

KPIC-TL18-001-CA













KPIC-TL18-001-CA












optumrxcom













DIAGNOSTIC AGENTS



ENZYMES




GOLD COMPOUNDS







PHARMACEUTICAL AIDS

RADIOACTIVE AGENTS




VITAMINS











DIAGNOSTIC AGENTS



ENZYMES




GOLD COMPOUNDS







PHARMACEUTICAL AIDS

RADIOACTIVE AGENTS




VITAMINS

3











4












5






bull Insulin



bull Glucagon





6

Medication tips




7



















Definitions

8





















Changes may include












3






3















3






3




9




PV












PV












1


3


3


3


3




10



3









1






1






1













1


11





1


2


3


3


1






3






PV DSL = 30 days


PV


PV










3


12





3 DSL = 30 days


3





2



1


3


3




3 DSL = 30 days





1




1


1


1


1



13



1


2


3


3















3






PV






PV



PV



14



3










2












PV



PV


PV



3






2


15



2




1

















3 DSL = 30 days






PV


PV DSL = 30 days



3


3



3


16












PV








2



3


3 DSL = 30 days






1



2


2




2


17




3




3


3


3


1



1


1



1



1



2



1









18



3 DSL = 30 days









3 DSL = 30 days


2 DSL = 30 days



3 DSL = 30 days


3 DSL = 30 days






3 DSL = 30 days





3 DSL = 30 days



3 DSL = 30 days


2 DSL = 30 days



19




2 DSL = 30 days


3



2


3



2


3



2


2




2



2


2


2


2




3 DSL = 30 days


20



2


3






1


2



1




2









3 DSL = 30 days


2



2


3


PV




21



1



1






2





2


2



2


2




2


PV


3


3








22









2


2


3







3


2


3




2


3 DSL = 30 days


2



3


2 DSL = 30 days


2 DSL = 30 days


23



2 DSL = 30 days


2 DSL = 30 days



2






3


3


3


1



1


1



1



3 DSL = 30 days




3



3


2


24




2


1




1






PV


PV


PV


PV













PV DSL = 30 days




25






2



PV DSL = 30 days






3 DSL = 30 days


2






1




1



3 DSL = 30 days



3





3


26




1





3



3


2










3 DSL = 30 days







1






3



2


27










3





3





3 DSL = 30 days





1




1



3



3


1



3


28



3


1





1


3


1


1


1




3


1




3


1


3



3


3


3 DSL = 30 days


3



29




3




3


2








3





1



3




3





3






30



2


2





3 DSL = 30 days OC





3


3


2


3 DSL = 30 days




2 DSL = 30 days OC








3 DSL = 30 days


3 DSL = 30 days


2


3 DSL = 30 days




31



3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days




2


3 DSL = 30 days



2 DSL = 30 days


3




3




2 DSL = 30 days OC



3





1




32



1


3




2 DSL = 30 days OC



2



1


3




2 DSL = 30 days





2



3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days



3




1


33



1


2




3


3


3


3



3 DSL = 30 days


2 DSL = 30 days OC


3 DSL = 30 days


3 DSL = 30 days



2





2


3 DSL = 30 days


1




3 DSL = 30 days



34




3 DSL = 30 days OC


3 DSL = 30 days



3









1



3





2 DSL = 30 days


1


1


3 DSL = 30 days OC



2 OC


2


3


35



2 DSL = 30 days


3 DSL = 30 days





2 DSL = 30 days OC


3 DSL = 30 days




2


1







2 DSL = 30 days OC


3 DSL = 30 days


3


3 DSL = 30 days





2 DSL = 30 days


2 DSL = 30 days


36




1


2


2 DSL = 30 days


2 DSL = 30 days OC


3 DSL = 30 days


2


2 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days OC


3 DSL = 30 days OC


3 DSL = 30 days



2 DSL = 30 days



2 DSL = 30 days OC


3 DSL = 30 days OC


3 DSL = 30 days





3 DSL = 30 days


37



2 DSL = 30 days OC



3 DSL = 30 days


3


2


2


2


2


2


2


3




3


2 DSL = 30 days






2 DSL = 30 days OC







1


38






1


3


1


3 DSL = 30 days


1


3 DSL = 30 days



3 DSL = 30 days


3






2 DSL = 30 days OC


3




3 DSL = 30 days


2


3 DSL = 30 days


3 DSL = 30 days



39



2 DSL = 30 days


3 DSL = 30 days



3


2


1



1


3 DSL = 30 days




1


3 DSL = 30 days


3


2 DSL = 30 days


3 DSL = 30 days


3


3


3


3 DSL = 30 days


2 DSL = 30 days OC


3 DSL = 30 days


40



3 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days OC



2



2 DSL = 30 days OC


3 DSL = 30 days


3 DSL = 30 days


2




3 DSL = 30 days OC


3 DSL = 30 days


3



3 DSL = 30 days






2 DSL = 30 days OC




41



3


2 DSL = 30 days OC


2 DSL = 30 days


3 DSL = 30 days




2 DSL = 30 days OC


2 DSL = 30 days OC


3



3 DSL = 30 days OC







3


2 DSL = 30 days


3


3


3 OC


1 OC




3 DSL = 30 days


42






2


1





2


3


3 DSL = 30 days


2


3


3



3 OC


3


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days






2 DSL = 30 days


43



3 DSL = 30 days




3


2


2 DSL = 30 days OC


2 DSL = 30 days OC


3 DSL = 30 days OC





3 DSL = 30 days





2 DSL = 30 days






3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


44



3 DSL = 30 days




2


3


2 DSL = 30 days



3 DSL = 30 days


2




3 DSL = 30 days


3


3 DSL = 30 days


3















45





3





3


3





3


3


3




3


3







3


3


3


3



46



3




2



3


3



3




3




3


3


3




3




3



2



3


47



3


3


3


3 DSL = 30 days




3


3




3


3




3





3




3





3


48




3


3


3


3




3






3


3




3


3 DSL = 30 days


2


2


2


3


2 DSL = 30 days


3 DSL = 30 days


49



2


2


2


2


2


2


2


2


2


3


3


2 DSL = 30 days


3


2


3


2


3


2


50



2


2 DSL = 30 days


3


3


2


2


2


3


3


2


3


2


2


3


3


3 DSL = 30 days


3


51


VACCINES - Vaccines


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


2









3 DSL = 30 days


52



3




3


1 DSL = 30 days




3


3



3 DSL = 30 days



3



3


3


3




1


3




1



53



3


3







3


3


3


1


1



3


PV


3


3



PV








54



2


3


3 DSL = 30 days




3


3




1


3





1










3




3



55



3


3 DSL = 30 days


3 DSL = 30 days











2


3



3


3


3


2


2


3


3


3


3


3


56



3


3







PV



PV
















1



3





57



3







1



2


3




3


3



3


3


3



1


3


3




58



3


3


3





1










3


3



3






3





2


59




2


2 DSL = 30 days




2







1





2


2


3


3 DSL = 30 days


3


3







1


60






1


3


3







2


2


3


3


3


3


PV


PV


PV


PV


61



PV


PV




3


3


3


3


3


3


PV


3 DSL = 30 days


3


1


3



1



3


PV


62



PV


PV


PV


2


2


2


3




3


3


PV


1


3








1


3


63



3


3


3


1


1


1


3


3



3


3



2


3


2



1



3


3


64





3 DSL = 30 days



3



2


3


3 DSL = 30 days


1 DSL = 30 days


3


3


2



3


2





3 DSL = 30 days



3 DSL = 30 days


65




1


1



3 DSL = 30 days


3



1 DSL = 30 days


3


3


3



2



PV DSL = 30 days


PV DSL = 30 days



PV DSL = 30 days


PV DSL = 30 days


PV DSL = 30 days


66



PV DSL = 30 days


PV DSL = 30 days


PV


3



PV


PV


PV DSL = 30 days


PV DSL = 30 days


PV DSL = 30 days


PV DSL = 30 days


3 DSL = 30 days


PV DSL = 30 days


PV DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


PV DSL = 30 days


PV DSL = 30 days


67



PV DSL = 30 days


PV DSL = 30 days





2


2 DSL = 30 days


2


2 DSL = 30 days


2


2


2




3



3


2


2


2


2


68







2



3


2


2



2 DSL = 30 days


2


2


2


3


2


3 DSL = 30 days


2


2


2 DSL = 30 days


69



2


2


2



3


2


2 DSL = 30 days


3 DSL = 30 days


3


2


3


2


2 DSL = 30 days


3


2 DSL = 30 days


2


2


2


70



2


2


3


2


3


3


3






3


2


2 DSL = 30 days


2


2 DSL = 30 days


2


2 DSL = 30 days


2




1 DSL = 30 days


71



3 DSL = 30 days


1



1


1


1



2 DSL = 30 days


2 DSL = 30 days




3





3



3



3



3



PV


72



3


3




3



1








3


3



3



3


1



3


3




3


PV


73



PV


3







3


3









3


3








3


3


3


3


74



3


3


3


3


3




3



3


3



3


3




3




3



3





2


75



3




3


3


3




















1


3


PV



PV



76









3






PV



3






2












3


PV


77




PV




2


3



PV



3




3


3



1


3


3




3





3


78



3




3





1


1


1


3


3


3



3


3


3



1


3


3


3



79



3


3


3


3



1



1


3




1


1



1



3


3



1



1


1


80



1


3


3


3



3


3


3



1


3


3


3



3


2


3


3


3



1



81



1


3




1


1



1



3


3



1



3


3


3


1



1



1





82






1


3


3


3




3





1



3



1


3


3


3


3



3


3


83



3


1



1



1








1


3


3


3




3





1



3



1


84



3


3


3


3







PV


PV





3


3



3



3 DSL = 30 days



3



1



3


85









3


3




1


3



1


3


3



3


3



3


3


3


3



86



3


1


1


1




1








3


3




3


3






3


3




87



1



3


3



3


3


3


3



3


1


1


1




1








3


3


88





3


3









3











3







3


3


89



3


3


1


1


1


1


1


1



3


1


1


3


1


1


3


1


1


1



90



3


3




1


1


1


1


1


3


3


3


3


3


3


1


3


1


1


91



1


1


1



3


1


3


3


1



3


3


1



1


1




1


3



1


3


92




3


3


3


1


1


1


3


1


3


3


1


1



3


3



3


3


93



3


3


1


1


1


1


1


1



3


1


1


3


1


1


3


1


1



3


94



3



3


3


3


3


1


1


1


1


1


1



3


1


1


3


1


1


95



3


1


1


1



3


3



1






1



3







PV


1


1


96




3


3


3




1


1




1




1


3


3


3





2






2


97



3






1




1







3


3




1



1


3


3



3


3



98



3


3


3


3



3


1


1


1




1








3


3




3


3




99



3


3








3


3


3


3


1


1


1


1


1


1



3


1


1


1


100



1


3


1


1



3


3




1


1


1


1


1


3


3


3


3


3


101



3


1



3


3



1


1




1


3



1


3



3


3


1


3


3




102



1


1


1


1


1


3


3


3


3


3


1



3


3



1


1




1


3



103



1


3



3


3


1


3


3



3






3


PV


PV




3


1


1


1


104











3



PV


1



3


PV


3


1



PV



PV


PV


PV





105



3



3


PV


3





1


1


1


3


3


3



3


3



1


3


3


3


3


106




3


1



3


3


3



3


3



1


1




1


3







3


1





107





3














3


3








3


3







108




3


3



1


1



1



3


2



1



3


2


3



3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days





109















3


3

















3


3


110




2



3



3


3



1


3


3


1


3


1


1


1


3



3



3



111





3


1


1


1


3




1


1


3


1


1



1



3





3


1


3


112



3


3





3




3


3



3 DSL = 30 days




1


1


1


1


1


3



3


3


113



3


3


3


1


2


2


3


3


1


1


1


1


1



3


1



2


1


3


1


114





3



3


1


2



1


1




1


3



1



3 DSL = 30 days



3



3


2


3


3


115



1


1


1


3




1


1


3


2


3



2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


1


1



3


116



3









3



3


3


3


3







PV DSL = 30 days


PV


PV




117





2





2



3


3 DSL = 30 days


3


3 DSL = 30 days



1


1



1




3


3



3 DSL = 30 days


2


118



3


3







1


3


3 DSL = 30 days





3 DSL = 30 days



3


1


1


1



1 DSL = 30 days





3


3


119



1


1


2


3



1 DSL = 30 days



1


1



3


3 DSL = 30 days


3 DSL = 30 days


3



3



2


2 DSL = 30 days


2






120




3




3 DSL = 30 days



2 DSL = 30 days


1


1





PV


PV


PV




PV



PV


3




3


2



121







3 DSL = 30 days





3


3


3


PV


PV


PV


PV


PV


PV


PV


PV





PV





122



1





3


PV






3


1


1



2






3


PV



PV


PV


3



123



1




3







3



3


3 DSL = 30 days


3 DSL = 30 days




PV


PV


PV


PV


PV



PV





124



PV


3


3


PV


PV


3



PV


PV


PV


PV


PV


PV



PV



PV


PV


PV


1


1



125





PV


PV


PV


PV



PV



3


2


PV


PV


PV


PV


PV


PV


PV





PV





126



PV





PV



PV



3


PV


PV


PV



PV




PV


PV


3


PV


PV


PV



PV


127



PV


3





PV


PV


PV


PV


PV




3


3 DSL = 30 days


3 DSL = 30 days


1












128



PV



PV


1


1







3


PV


PV


PV




PV



PV


3


3 DSL = 30 days


3 DSL = 30 days


2





129



3


3


3


2


2 DSL = 30 days


1




PV







3



PV






3




1



130



3 DSL = 30 days









PV


3


2







PV





1 DSL = 30 days






PV


PV


PV


131



PV


PV


PV



PV



PV


PV


PV




PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


132






PV



PV


PV


3


PV


PV


PV


PV



PV




PV


PV


3


PV


PV


PV



133



PV DSL = 30 days


PV DSL = 30 days



PV


PV


PV


PV


PV



2


3


3





1




2


3




3


134



1




3


1


1


1






2


3





1




2


3


3


3



3


135








1














3 DSL = 30 days



PV



3


3



PV DSL = 30 days





PV DSL = 30 days


136










1

















3


3


3 DSL = 30 days






PV



137




3


3


PV DSL = 30 days


PV DSL = 30 days



PV


PV





3


3 DSL = 30 days


3


3 DSL = 30 days


3


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days



3


138




1









1


3 DSL = 30 days



1



3 DSL = 30 days



1




2


3


3


3 DSL = 30 days


3



139



3 DSL = 30 days


3


3 DSL = 30 days



3




3 DSL = 30 days



3 DSL = 30 days




3


3



1


1


1


1


2



3


140









PV


3


PV


3


1


1



3


3




3


3



2






1


141










3





3


3



3










3



2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


142



3


1


1


1


1







1


3 DSL = 30 days




1


1


3 DSL = 30 days


1





3


3



1 DSL = 30 days


143



1 DSL = 30 days



1 DSL = 30 days


3 DSL = 30 days


3


3 DSL = 30 days


3


3


1 DSL = 30 days


1


3


3 DSL = 30 days


3 DSL = 30 days




1 DSL = 30 days


1 DSL = 30 days


1


1


1



144




1



1 DSL = 30 days






3


3


3 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days




2







1 DSL = 30 days







145





1 DSL = 30 days


1


1


1


1


1


1









3



3



3 DSL = 30 days


3 DSL = 30 days




3 DSL = 30 days



146






1 DSL = 30 days




3 DSL = 30 days


1 DSL = 30 days



3 DSL = 30 days


3 DSL = 30 days







3 DSL = 30 days


3


1


3


1




3


3


147



3



3



3







3



3


3





1 DSL = 30 days


1


1 DSL = 30 days







3


3 DSL = 30 days


148



3 DSL = 30 days



PV


PV






PV


3


3





3





PV




PV


1


3




149



3








PV



PV












1














150



3


3







PV




PV


PV









PV





PV







PV


151



PV



1


3


3


PV


PV


PV


PV


PV





1


PV





PV




1





3


152



3


3





3






PV









PV







3




1



153



1


1







3


3 DSL = 30 days


3


1



3


1


1


1


1


1





3


3



3


154





1











1


3


PV



PV






3






3




PV



155



3


3



PV


PV


PV


3


PV


PV


PV


PV


PV


3


3


PV


PV


PV






3


156



3


3



3


3 DSL = 30 days






1



1


1




3







PV









157





PV



PV


PV


PV




PV



PV


PV


PV




PV



PV



PV



PV


PV


PV


158










PV



PV




PV


PV






PV






PV


PV





3 DSL = 30 days


159



3 DSL = 30 days


3 DSL = 30 days










3


2


2



2


2


2


2



3




3





160



3



3


3




2


2


2


2


2


2


2


3


3


3


3



2


3


3



161



3


3



3


3


3


3


2


3


3


3



3


3


3


3


3



3


3


3




162



2


3



3


3


3



3


3



1




3



3





3


3


3


3


3


3


163




2


PV


PV


PV


3






3


PV


3


3




3


3



3


3


3


164



3



PV



PV




3




2


2


2


2


2


2


2


2


3


3


2


3




165



3


3





3



3




3





SHARPS CONTAINER 3



1


2


2


2


2



3


3


3


166



3


3


3



3


3


3


3


3


2


2


2



2



3

DIAGNOSTIC AGENTS




2








167







3





3


3





3


3


3




3


3







3


3


3


168



3



3





3


3



3




3




3


3


3




3




3




3


169



3


3




3




3





3




3





3



3


3


3


3




3



170






3


3

DIABETES MELLITUS



PV



PV





PV





PV



PV


PV


PV


PV


PV


DIAGNOSTIC AGENTS


3


171


KETONES



MYASTHENIA GRAVIS


3

OCULAR DISORDERS




3


3




3





3



PITUITARY FUNCTION








3

THYROID FUNCTION


2


172






ACIDIFYING AGENTS


PV


PV


PV


PV



PV


ALKALINIZING AGENTS


3



3


1



3






3


3



173


AMMONIA DETOXICANTS


3 DSL = 30 days


















2




2


2


2


2


2


2



2


174



2


2


2


2




2


2





L-CYSTINE POWDER 3




3




2


2


2


2






175




1





3


PV


PV




3 DSL = 30 days







3


3


3


2











176









3







PV


PV


PV


3


PV



PV






3



3




3 DSL = 30 days


177




3


3
















3


3


3


3


3


3


3


3


3




178



PV


1


3



3


3



3


PV


PV


PV


PV



PV


1


1


PV




3




3


3


179



3



PV


PV


PV


1



PV






3




3



1



1



3


3





3


180



3



1


3


3


1


3


1


1


1


3



3



3





3


1


1


1


181



3




1


1


3


1


1



1



3





3


1


3


3


3





3



182




3


3

URICOSURIC AGENTS






3 DSL = 30 days


3




ENZYMES

ENZYMES


2


2



2


2


2 DSL = 30 days


3 DSL = 30 days


2


2 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


183



3


2 DSL = 30 days


3 DSL = 30 days


2


3


2 DSL = 30 days



2 DSL = 30 days


3


PV DSL = 30 days


2


3




3



3


3


3


3


3


184





3





3















3


2


2



3


3





3


185



2











1


1


1


1





1


1





3


1


1


3


3


186



3


3


3


3


3


3


3


3





2


3





3







3


3




187






3


3



3




3






3


3


3


3



1



3








188




3


3


3


3



3




3


3


3



3


3




3




3



3






189



2




3


3


3


3


3




3



1


1



1



3


2


PV


2


3


3


3


190





3


3



3


3


3


3


3


3


3


3


3


3


3


2



2


3



3


3


191



3


3




3




1





3


3






3 DSL = 30 days


3


3



3 DSL = 30 days


3


3


3


192




2






2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


2



3 DSL = 30 days


2



PV


PV


PV



PV







3


193



3


3


3


3


3


3


3


PV


3


3


3








3


3









194



3







3


3



2







2


2




2


3



3


3


3


3


3


195







3



3


3


3



3





3


3

VASOCONSTRICTORS


3




3


3


3


3



196





PV








3


3


2 DSL = 30 days


PV


PV DSL = 30 days




3







PV


PV


PV




197








3






3






PV


PV



3











PV




198








2









2







3


3









PV




199



PV




PV


PV


PV






PV






PV


PV


PV




PV



PV


PV






200



PV


PV


3









2



3


3


3


2


3




3 DSL = 30 days



3 DSL = 30 days


3


201



3 DSL = 30 days



3



3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


2



3


3







202



3 DSL = 30 days


2


3


3


3


3 DSL = 30 days


3 DSL = 30 days





















3


3


203



2 DSL = 30 days




PV



PV DSL = 30 days



PV


PV







3






1









3



204



3


3



PV



PV


PV


PV



PV


1


PV


PV


3





PV


1


1




PV


PV


205



PV


PV



PV




3


3

GOLD COMPOUNDS

GOLD COMPOUNDS













1



2 DSL = 30 days





3 DSL = 30 days



2 DSL = 30 days


206



2 DSL = 30 days






ADRENALS - Hormones



2


2


3


3


3


3


3 DSL = 30 days


2


3


3


2


2


207



2


2


2


2 DSL = 30 days


PV DSL = 30 days



3


3


3


1


3


3




1



3


3


PV





208




1


1



1


1


3


1


3


1


3


3


3


3


3



3 DSL = 30 days


3 DSL = 30 days


3


3


2



209



1


3



3




2


3


3


PV


PV


3


3


PV


PV


PV


PV


PV





3 DSL = 30 days



210







3




1


1




PV


PV


3


3


2


3


3


3


PV


3


3


2


3


211



3


3


3


3


3


1


2


3


3


3 DSL = 30 days



1



3







2


2



2


212



3


3




2







3 DSL = 30 days






3



2


1




1



2


3




213













3 DSL = 30 days OC




2


2



3 DSL = 30 days









3 DSL = 30 days


3


3






214



3



2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


2




215





2


2


2


2


2



PV


PV




PV



PV



PV


PV


PV



PV


PV


PV


216



PV


PV


PV


PV


PV


PV



PV


PV


PV


PV


PV




PV


PV


PV


PV


PV


PV


PV


PV


217



PV


PV


PV


PV


PV


PV



PV


PV


PV





PV


PV


PV


PV



PV


PV


PV



PV


218



PV


PV


PV


PV


PV


PV


PV


PV



PV



PV


PV


PV




PV


PV


PV


PV


PV


PV


219



PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV



PV



PV


220



PV


PV


PV


PV


PV


PV


PV


PV


PV


PV



PV


PV


PV


PV





PV


PV


PV


PV


221



PV


PV


PV



PV


PV


PV


PV


PV


PV


PV





PV


PV


PV



PV



PV




PV


222



PV


PV


PV


PV


PV




PV




PV


PV


PV



PV


PV


PV


PV


PV


PV


PV


PV



223



PV


PV


PV



PV


PV



PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


PV


224



PV


PV


PV


PV


PV



2



PV


PV



PV



PV


PV




PV


PV


PV



PV



PV


225



PV


PV



2


2


2


2


2


2


2


2


2


2


2


2



2


2


2



226



2




3










PV


PV


PV


3



3


PV


PV


3



3


2


227



2


PV


PV


3




PV








PV


PV







PV


PV


PV


3


PV


228



3


3



PV


PV


PV



PV


PV


3 DSL = 30 days


3


PV


3


PV


PV



PV




2


2


2


229





2


2


2


2


2


2



2


3


3


3



3


2


2


2


2



3


2


230



2


2


2


2


2


2



2


2



3



3


3




2


3


3


3



2


231



2


2


2



3


2


2


2


2


2


2


2



2


2



3



3




2


2


232



2


2


2


2



2


2 DSL = 30 days


2 DSL = 30 days


2


2 DSL = 30 days



2


2


2


2 DSL = 30 days


2


2


2


2


2


2


233



2


2


2


2


2


2


2


2


2


2


2


2


PV


2


2


2


2


2


2


234



2


2


2


2



2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


235



2


2


2


2


2


2


2


2


2


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2


2 DSL = 30 days



2


2


236



2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


237



2

LEPTINS - Hormones


3 DSL = 30 days



2


2


2


2


2


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2


2 DSL = 30 days







2 DSL = 30 days


3 DSL = 30 days


238



2 DSL = 30 days


3 DSL = 30 days




2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days




2







2


2


2


3


2


2


2


239



2


2


2


2


2


2


2


2


2


2



PV


PV


3




PV



PV


PV


PV



240




PV


PV



1 DSL = 30 days



3


PV DSL = 30 days


PV DSL = 30 days


PV


PV








PV


3 DSL = 30 days




PV


PV




2


241



2


2


2 DSL = 30 days


2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


2


242



2


2


2


2


2



2


2


2


2


2


2


2



2


2


PV


2


2


2


243



2


2


2


2


2


2


2


2



2


2


2


2




2


2


2


2


2


244



2


2


2



3 DSL = 30 days


3 DSL = 30 days


1


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days



2 DSL = 30 days


3



3 DSL = 30 days




2



2



245



2


2



2




2


2





2


2


2


2


2






3


3


1


1


246



3


1


1



3



3


3


3


1


3


3




3





3


247



3


3 DSL = 30 days




3








3





1


2


1


3











248




3




3


3


2


2


2


3



2


1


2


PV


PV


2




2


2


2


2



249



PV DSL = 30 days


PV



PV




PV


3


PV











3



PV








3




250



PV DSL = 30 days









PV










PV



PV







PV


PV







251





3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days



3 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days



3




3


3






3


252





3 DSL = 30 days


1


1


3





2 DSL = 30 days










3


3


3



3







3


253




PV


3


3


3


3


PV


PV


3


PV


PV


3



PV


3


3


3


3


3


sf dental gel 11 PV





254









PV


3






3 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days



3 DSL = 30 days


3 DSL = 30 days


2


2 DSL = 30 days


3


3 DSL = 30 days



3


255



3


3 DSL = 30 days


3 DSL = 30 days





3 DSL = 30 days


3


3 DSL = 30 days








3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days




3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


256



2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days



2


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days





1





2



2 DSL = 30 days


2 DSL = 30 days


257



2 DSL = 30 days



2 DSL = 30 days


3


2




PV


2


3


2


3



3 DSL = 30 days


2


2



3


3 DSL = 30 days


3 DSL = 30 days


258



3


2


2




3 OC





2 DSL = 30 days


3



2


2



3


3


3 DSL = 30 days


2 DSL = 30 days



2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days



259





3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3


3 DSL = 30 days


3 DSL = 30 days






1 DSL = 30 days



3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3






260



1 DSL = 30 days


1 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days



2


2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


261




3 DSL = 30 days


3



1





2


3 DSL = 30 days



2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days



2 DSL = 30 days


3


2


PV


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


262



3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days OC



3


2 DSL = 30 days


2


3


3


3


3


3


2


3


2 DSL = 30 days OC



3 DSL = 30 days


2


2



263



3


3 DSL = 30 days


3 DSL = 30 days


3


2


2





3 DSL = 30 days


2 DSL = 30 days OC


3 OC


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days





2 DSL = 30 days


3


3 DSL = 30 days



3 DSL = 30 days


264




3


2





3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


1


3









3



3 DSL = 30 days





3




1


265






1


1





1


2


3


3


2





2 DSL = 30 days OC



2


3


2


2



266



3





3


3 OC














3 DSL = 30 days


3



3



3



3 DSL = 30 days




3


267



3



2




3


3


3


2


3


3






3


3






2 DSL = 30 days






3


268



3


3


3




3



3 DSL = 30 days


3 DSL = 30 days




3


3


3




3 DSL = 30 days



2



3


3 DSL = 30 days


3 DSL = 30 days



3


269











3


3


3






3


3


3






3



2








270





3


1



3 DSL = 30 days


3


3


3


3


3 DSL = 30 days



3


3


3


3


3


3


2




3 DSL = 30 days


3 DSL = 30 days



271



3


3




3


2







3


2 DSL = 30 days





3




3



3 DSL = 30 days




3


2


3



272



3



3


3










3





PROTECTIVE AGENTS


PV DSL = 30 days


PV


2


PV





PV





273



PV


3


PV



PV


PV


PV


PV


PV


PV


PV


PV









3


3



PHARMACEUTICAL AIDS

PHARMACEUTICAL AIDS


ASPARTAME POWDER 3


274











3


3


3


RADIOACTIVE AGENTS

RADIOACTIVE AGENTS


3


3









3 DSL = 30 days


3



3


1 DSL = 30 days



275




3


3




3



3


3


1


1


3


PV


3


3


PV




3 DSL = 30 days


3




3


276



3


2


2


3


3


3








3 DSL = 30 days







1






3


3 DSL = 30 days





277






3


3


3




2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days






2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days



3






278



3




3









3







1


3



3


PV











279







3


3


3



3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3


3 DSL = 30 days


3


3 DSL = 30 days









PV





280










2




3






3


3



3


3



2


2


3


3


281



3


3


2


3


3


2


2


2


2


2


2 DSL = 30 days


PV DSL = 30 days


3


3


1


3


282



3


3


3


2


1


3


2


3


3


3


3


3


1






2


3


283



2



2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


3


2 DSL = 30 days


2


2 DSL = 30 days


2 DSL = 30 days





3







2


2


284



3


3


3


3


PV


PV


PV


PV


PV


PV




3


3


3


3


3


3


PV


285



3 DSL = 30 days


3


1


3



1



3


PV


PV


PV


PV


2


2


2


3




3


3


286



PV


1


3



3 DSL = 30 days





1




3 DSL = 30 days


2









1



2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


287



3 DSL = 30 days


2 DSL = 30 days




3


PV


PV










3





3




3


3



3



288




3


1



3









3



3


3






3




3









289





3









3


3



3



3


3


3



3





3







290





3



3







3






3


3


2


2




3









291









1


3














2










3






292











3




3
























293



3





















3


1






3


3






294



3






2


2




3


3


3






2



3


3


3


3



3



3



295






1






3 DSL = 30 days


3



3






3





3


3


2


2



3


3


296




3


3


3


3


3


3


3


3






3





3


3








lets kit 1



297










3


1






3







3


3







3


3


3


3


298



3




3








2


2




3










3


3


3


3


3



299




3


3



3



3













2








3



3



300



3






3


3



3






3







3












3


301







3



3



3


3


3





3


3


3



3


3




3


3


3


302



3










3


3



3


3


3


2 DSL = 30 days


3


3


3




2



2


2


303



3 DSL = 30 days


3















3







3






3


3


2


2


304





3

















1


3


3





3


3








305








3


3


3


3




2










3












306



3


3













3
















3







307














3




3



3




3


1






3


3


3





308




3








2


2




3


3


3






3



3


3


3


3


3



309



3




3



3





1





3



3 DSL = 30 days


3



3


3 DSL = 30 days











310



3


3


3


3


3



3


3


3


3


3


3



3







3


3







311






3


3


3


3


1



3






3




3


3


3







3


3


312



3



3


3


3


3


3











3




3






1



1




313







3


3


3


3


3


3


3













3






3


3


314







3


3


3


3


3


3






3



3









3






315



3


3


3


3


3


3


3


3



3


3


3


3


3


3









3




316







1



1








3


2


3


3


3


3


3


3


3



3



3


317







3




3












PV


3





1


3




3




318



















3







3 DSL = 30 days


3











319



3


3








3 DSL = 30 days











1


3





3




1



1


2 DSL = 30 days


320



2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days






3


3


3


3


2










3









3


321



3 DSL = 30 days


3 DSL = 30 days



3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days


2 DSL = 30 days




3


3


2






3









3 DSL = 30 days


3 DSL = 30 days


322



2 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3


3




3


3



3


3


2






2


323



3


3


3


1


3



3


3


1





3


3


3


3


3


3


PV


PV


PV


PV


324



PV


3



2 DSL = 30 days









1




3


3




2


3





3 DSL = 30 days


3 DSL = 30 days


2 DSL = 30 days


3



325




3


2


2


1


3




3 DSL = 30 days


3 DSL = 30 days







3


2


2



3 DSL = 30 days







3 DSL = 30 days


3


326



3


1


3



3


3


3




1




1




2



1



3


1



3




327



3


PV


PV





3

VITAMINS





3


3



3






3




3



3


3




328



3


2


2



3








3




3


3




3





3


3


3


3




329







3


3


3


3


3


3


3


3


3


3




3


3


3


3


3


3



3


330




3


3






3





3




3






3




3


3


3







331










ZYVIT ORAL TABLET 3

VITAMIN A



2




VITAMIN B COMPLEX


3





3


3


3



3




3




3


332






3


3



3




3


3


3



3


3



3





3


3




PV



3


333



3


3



1



3



3


3








3




3


3


3





3


3


3


334






3






3


1


3


3
















3


3





335



PV


3






3





3


3


3


3







3






3







336












3


3


3


3


3


3


3


3


3


3




3




3



3


337



3




3



3









3






3






3







3


3


338



3


3


















3





ZYVIT ORAL TABLET 3

VITAMIN C




3


3





339



3


3






3


3


3



1






3



3


3


3




PV


3






340



3




3



3











3






VITAMIN D



3


3







3


341






3


3


3



PV





3




3


3



3


3







PV DSL = 30 days






342





3





VITAMIN E



3


VITAMIN K ACTIVITY


2






343

Index of Drugs




344




345




346




347




348




349




350




351




352




353




354




355




356




357




358




359




360




361




362




363




364




365




366




367




368




369




370




371




372




373




374




375

KPIC-TL18-001-CA













KPIC-TL18-001-CA












optumrxcom













DIAGNOSTIC AGENTS



ENZYMES




GOLD COMPOUNDS







PHARMACEUTICAL AIDS

RADIOACTIVE AGENTS




VITAMINS











DIAGNOSTIC AGENTS



ENZYMES




GOLD COMPOUNDS







PHARMACEUTICAL AIDS

RADIOACTIVE AGENTS




VITAMINS

Kaiser Permanente Bernard J. Tyson School of Medicine, Inc ......Kaiser Permanente Bernard J. Tyson...

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Transcript of Kaiser Permanente Bernard J. Tyson School of Medicine, Inc ......Kaiser Permanente Bernard J. Tyson...