Drug ID Drug Description Type of Charge
12NS1000 1/2 NORMAL SALINE 1,000 ML BAG Medication
12NS20K 1/2 NS W 20 MEQ KCL 1,000 ML BAG Medication
246ENEMA 246 ENEMA 120 ML BOT Medication
ABACAV3 ABACAVIR SULFATE 300 MG TAB Medication
ABAT250V ABATACEPT 250 MG/10 ML VIAL Medication
ABAT250V ABATACEPT 250 MG/10 ML VIAL Medication as an Additive
ACAMP333 ACAMPROSATE CALCIUM DELAYED RELEASE 333MG TAB Medication
ACAR50 ACARBOSE 50 MG TAB Medication
ACD5 ANTICOAGULANT CITRATE DEXTROSE 2 ML SYRINGE Medication
ACD5 ANTICOAGULANT CITRATE DEXTROSE 2 ML SYRINGE Medication as an Additive
ACDA ANTICOAGULANT CITRATE DEXTROSE 1,000 ML BAG Medication
ACDA ANTICOAGULANT CITRATE DEXTROSE 1,000 ML BAG Medication as an Additive
ACEBU200 ACEBUTOLOL 200 MG CAP Medication
ACEBU400 ACEBUTOLOL 400 MG CAP Medication
ACET600C ACETYLCYSTEINE 600 MG CAPSULE Medication
ACETA100V ACETAMINOPHEN 10 MG/ML 100 ML PREMIX Medication
ACETA120R ACETAMINOPHEN 120 MG SUPP Medication
ACETA160L ACETAMINOPHEN 160 MG/5 ML CUP (BUBBLE GUM) Medication
ACETA325L ACETAMINOPHEN 325 MG/10.15 ML CUP Medication
ACETA325R ACETAMINOPHEN 325 MG SUPP Medication
ACETA325T ACETAMINOPHEN 325 MG TAB Medication
ACETA500T ACETAMINOPHEN 500 MG TAB Medication
ACETA650L ACETAMINOPHEN 650 MG/20.3 ML CUP Medication
ACETA650R ACETAMINOPHEN 650 MG SUPP Medication
ACETA650X ACETAMINOPHEN-XR 650 MG Medication
ACETA80T ACETAMINOPHEN 80 MG CHEW Medication
ACETAZ250T acetaZOLAMIDE 250 MG TAB Medication
ACETAZ500V acetaZOLAMIDE 500 MG VIAL Medication
ACETAZ500V acetaZOLAMIDE 500 MG VIAL Medication as an Additive
ACETIC250 ACETIC ACID 0.25 % IRRIGATION 250 ML BOTTLE Medication
ACETICQIRR ACETIC ACID 0.25 % IRRIGATION 1000 ML BOTTLE Medication
ACETONE ACETONE 480 ML BOT Medication
ACETYLC10 ACETYLCYSTEINE 20% 10 ML ORAL/INHALATION Medication
ACETYLC30 ACETYLCYSTEINE 20% 30 ML INJECTION Medication
ACETYLC30 ACETYLCYSTEINE 20% 30 ML INJECTION Medication as an Additive
ACETYLC4 ACETYLCYSTEINE 20% 4 ML ORAL/INHALATION Medication
ACTIVELLA ACTIVELLA 0.1/0.5 MG 28 TAB PACK Medication
ACYC5OIN15 ACYCLOVIR 5% OINT 15 GM TUBE Medication
ACYCLO1V ACYCLOVIR 1,000 MG/20 ML VIAL Medication
ACYCLO1V ACYCLOVIR 1,000 MG/20 ML VIAL Medication as an Additive
ACYCLO200C ACYCLOVIR 200 MG CAP Medication
Page 1 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
ACYCLO200S ACYCLOVIR 200 MG/5 ML CUP Medication
ACYCLO500V ACYCLOVIR 500 MG/10 ML VIAL Medication
ACYCLO500V ACYCLOVIR 500 MG/10 ML VIAL Medication as an Additive
ACYCLO800C ACYCLOVIR 800 MG TAB Medication
ADALI40 ADALIMUMAB 40 MG SYRINGE Medication
ADAP45CR ADAPALENE 0.1% CREAM 45 GM TUBE Medication
ADDER10XR DEXTROAMPHETAMINE/AMPHETAMINE 10 MG XR CAP Medication
ADDER15XR DEXTROAMPHETAMINE/AMPHETAMINE 15 MG XR CAP Medication
ADDERAL10 DEXTROAMPHETAMINE/AMPHETAMINE 10 MG TAB Medication
ADEN3VIA ADENOSINE 60 MG/20 ML VIAL Medication
ADEN3VIA ADENOSINE 60 MG/20 ML VIAL Medication as an Additive
ADENO12SYR ADENOSINE 12 MG/4 ML VIAL Medication
ADENO630V ADENOSINE 90 MG/30 ML INJ Medication
ADENO6SYR ADENOSINE 6 MG/2 ML SYRINGE Medication
ADOINT A D OINTMENT 60 GM TUBE Medication
ADUD A D OINTMENT 5 GM PACKET Medication
AEROZOINSP AEROZOIN SPRAY 120 ML BOT Medication
AGGRENOX DIPYRIDAMOLE/ASPIRIN 1 CAPSULE Medication
AICC1000U ANTI-INHIBITOR COAGULANT COMPLEX (ANTI-FVIII INHIB) 1,000U/20 ML (FEIBA)/U Medication
AICC1000U ANTI-INHIBITOR COAGULANT COMPLEX (ANTI-FVIII INHIB) 1,000U/20 ML (FEIBA)/U Medication as an Additive
ALBU0.633 ALBUTEROL SULFATE 0.63 MG/3 ML NEB SOL Medication
ALBUM25100 ALBUMIN 25% 25GM/100ML BOT Medication
ALBUM2550 ALBUMIN 25% 12.5GM/50ML BOT Medication
ALBUM25500 ALBUMIN 5% 25 GM/500 ML BOTTLE Medication
ALBUM5250 ALBUMIN 5% 12.5 GM/250 ML BOT Medication
ALBUM550 ALBUMIN 5% 2.5 GM/50 ML BOTTLE Medication
ALBUT125 ALBUTEROL 1.25 MG/3 ML NEB SOLUTION Medication
ALBUT2.5 ALBUTEROL 2.5 MG/0.5 ML NEB SOL Medication
ALBUT4SR ALBUTEROL SR TAB 4 MG SRTABLET Medication
ALBUTE2L ALBUTEROL 2 MG/5 ML CUP Medication
ALBUTFIN18 ALBUTEROL ORAL INHALER 200 PUFF Medication
ALBUTHFA60 ALBUTEROL ORAL INHALER 60 PUFF Medication
ALCOHOL5ML ALCOHOL DEHYRATED FOR INJECTION 5 ML VIAL Medication
ALDES22 ALDESLEUKIN 1800000 IU VIAL Medication
ALDES22 ALDESLEUKIN 1800000 IU VIAL Medication as an Additive
ALEN35T ALENDRONATE 35 MG TAB Medication
ALEN70T ALENDRONATE 70 MG TAB Medication
ALFENT5ML ALFENTANIL 2500 MCG/5 ML AMP Medication
ALFENT5ML ALFENTANIL 2500 MCG/5 ML AMP Medication as an Additive
ALISK150T ALISKIREN 150 MG TAB Medication
ALKASEL ALKA SELTZER 1 PKT (2 TABS) Medication
ALLOP100T ALLOPURINOL 100 MG TAB Medication
Page 2 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
ALLOP300T ALLOPURINOL 300 MG TAB Medication
ALOSET1 ALOSETRON 1 MG TAB Medication
ALPHA1P ALPHA-1-PROTEINASE INHIBITOR (ZEMAIRA) ~1,000 MG VIAL (CHARGE PER MG) Medication
ALPHA1P ALPHA-1-PROTEINASE INHIBITOR (ZEMAIRA) ~1,000 MG VIAL (CHARGE PER MG) Medication as an Additive
ALPHAP1000 ALPHA-1-PROTEINASE INHIBITOR (PROLASTIN C) ~1,000 MG VIAL (CHARGE PER MG) Medication
ALPHAP1000 ALPHA-1-PROTEINASE INHIBITOR (PROLASTIN C) ~1,000 MG VIAL (CHARGE PER MG) Medication as an Additive
ALPRAZ1 ALPRAZolam 1 MG TAB Medication
ALPRAZ25 ALPRAZolam 0.25 MG TAB Medication
ALPRAZ5 ALPRAZolam 0.5 MG TAB Medication
ALPROS ALPROSTADIL 500 MCG/ML VIAL Medication
ALTCATHFLO ALTEPLASE CATHFLO 2 MG VIAL Medication
ALTCATHFLO ALTEPLASE CATHFLO 2 MG VIAL Medication as an Additive
ALUMIRRIG ALUM 1% IRRIGATION 3000 ML BAG Medication
ALUMIRRIG ALUM 1% IRRIGATION 3000 ML BAG Medication as a Carrier
ALVI12CA ALVIMOPAN 12 MG CAPSULE Medication
AMANTA100C AMANTADINE 100 MG CAP Medication
AMANTA100L AMANTADINE 100 MG/10 ML BOTTLE Medication
AMBR10TAB AMBRISENTAN 10 MG TABLET Medication
AMBR5TAB AMBRISENTAN 5 MG TAB Medication
AMCIN1OINT AMCINONIDE 0.1 % OINTMENT 60 GM TUBE Medication
AMERISPRY BENZOCAINE 20% SPRAY 57 GM CAN Medication
AMIKACIN AMIKACIN 500 MG/2 ML VIAL Medication
AMILOR5T aMILoride 5 MG TAB Medication
AMINACID15 AMINO ACIDS 15% 1,000 ML BOTTLE Medication
AMINACID15 AMINO ACIDS 15% 1,000 ML BOTTLE Medication as a Carrier
AMINACID15 AMINO ACIDS 15% 1,000 ML BOTTLE Medication as an Additive
AMINO10500 AMINO ACIDS 10% 500 ML BOT Medication
AMINO10500 AMINO ACIDS 10% 500 ML BOT Medication as a Carrier
AMINO10500 AMINO ACIDS 10% 500 ML BOT Medication as an Additive
AMINO8500 HEPATAMINE 8% 500 ML BOT Medication
AMINOC500T AMINOCAPROIC ACID 500 MG TAB Medication
AMINOC5I AMINOCAPROIC ACID 5 GM/20 ML VIAL Medication
AMINOC5I AMINOCAPROIC ACID 5 GM/20 ML VIAL Medication as an Additive
AMINOCL AMINOCAPROIC ACID 1250 MG/5 ML ORAL SOL Medication
AMINOP250I AMINOPHYLLINE 250 MG/10 ML VIAL Medication
AMINOP250I AMINOPHYLLINE 250 MG/10 ML VIAL Medication as an Additive
AMIO100S AMIODARONE 150 MG/100 ML PREMIX INJ Medication
AMIO200S AMIODARONE 360 MG/200ML PREMIX BAG Medication
AMIO50VI4 AMIODARONE 900 MG/18 ML VIAL Medication
AMIO50VI4 AMIODARONE 900 MG/18 ML VIAL Medication as an Additive
AMIOD200T AMIODARONE 200 MG TAB Medication
Page 3 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
AMIOIV AMIODARONE 150 MG/3 ML VIAL Medication
AMIOIV AMIODARONE 150 MG/3 ML VIAL Medication as an Additive
AMITRIP100 AMITRIPTYLINE 100 MG TAB Medication
AMITRIP10T AMITRIPTYLINE 10 MG TAB Medication
AMITRIP150 AMITRIPTYLINE 150 MG TAB Medication
AMITRIP25T AMITRIPTYLINE 25 MG TAB Medication
AMITRIP50T AMITRIPTYLINE 50 MG TAB Medication
AMITRIP75T AMITRIPTYLINE 75 MG TAB Medication
AMLODI10 amLODIPine 10 MG TAB Medication
AMLODI2.5 amLODIPine 2.5 MG TAB Medication
AMLODI5 amLODIPine 5 MG TAB Medication
AMMONIAVAP AMMONIA AROMATIC VAPOROLES Medication
AMOBAR500 AMOBARBITAL SODIUM 500 MG POWDER VIAL FOR INJ Medication
AMOBAR500 AMOBARBITAL SODIUM 500 MG POWDER VIAL FOR INJ Medication as an Additive
AMOXAP25T AMOXAPINE 25 MG TAB Medication
AMOXCHEW25 AMOXICILLIN 250 MG CHEW Medication
AMOXEP100T AMOXAPINE 100 MG TAB Medication
AMOXEP150T AMOXAPINE 150 MG TAB Medication
AMOXEP50T AMOXAPINE 50 MG TAB Medication
AMOXI125BU AMOXICILLIN 125 MG/5 ML 150ML BULK BOTTLE Medication
AMOXI250BU AMOXICILLIN 250 MG/5 ML 150 ML BULK BOTTLE Medication
AMOXIC250C AMOXICILLIN 250 MG CAP Medication
AMOXIC500C AMOXICILLIN 500 MG CAP/TAB Medication
AMPHO50V AMPHOTERICIN B 50 MG VIAL Medication
AMPHOLIPOS AMPHOTERICIN B LIPOSOME 50 MG VIAL Medication
AMPHOLIPOS AMPHOTERICIN B LIPOSOME 50 MG VIAL Medication as an Additive
AMPICI1V AMPICILLIN 1,000 MG VIAL Medication
AMPICI1V AMPICILLIN 1,000 MG VIAL Medication as an Additive
AMPICI250V AMPICILLIN 250 MG VIAL Medication
AMPICI250V AMPICILLIN 250 MG VIAL Medication as an Additive
AMPICI2PB AMPICILLIN 2,000 MG VIAL Medication
AMPICI2PB AMPICILLIN 2,000 MG VIAL Medication as an Additive
AMPICI500V AMPICILLIN 500 MG VIAL Medication
AMPICI500V AMPICILLIN 500 MG VIAL Medication as an Additive
ANAG05 ANAGRELIDE 0.5 MG CAP Medication
ANAKINRA ANAKINRA 100MG/0.67ML INJ Medication
ANAST1 ANASTROZOLE 1 MG TAB Medication
ANBESOLGEL BENZOCAINE 10% GEL 9.9 GM GEL Medication
ANGIOT2.5V ANGIOTENSIN II 2.5 MG/ML VIAL Medication
ANGIOT2.5V ANGIOTENSIN II 2.5 MG/ML VIAL Medication as an Additive
ANTITHROM ANTITHROMBIN III HUMAN ~500 UNIT VIAL (CHARGE PER UNIT) Medication
ANUSOLHCCR ANUSOL HC (HYDROCORTISONE 2.5%) 30 GM CREAM Medication
Page 4 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
ANUSOLRHC ANUSOL HC 25 MG SUPPOSITORY Medication
APIX2.5T1 APIXABAN 2.5 MG TAB Medication
APIX5T APIXABAN 5 MG TAB Medication
APRACL1OPS APRACLONIDINE 1% OPTH SOL (2 X 0.1 ML POUCH) Medication
APRE125C APREPITANT 125 MG CAP Medication
APRE40C APREPITANT 40 MG CAP Medication
APRE80C APREPITANT 80 MG CAP Medication
AQUA2OZ AQUAPHOR HEALING OINTMENT 50 GM TUBE Medication
AQUA2OZ AQUAPHOR HEALING OINTMENT 50 GM TUBE Medication as a Compound
ARGA1SOL ARGATROBAN 125 MG/125 ML PREMIX Medication
ARGAT100 ARGATROBAN 100 MG/ML 2.5 ML INJ Medication
ARGAT100 ARGATROBAN 100 MG/ML 2.5 ML INJ Medication as an Additive
ARGAT50 ARGATROBAN 50 MG/50 ML PREMIX Medication
ARGIN300IV ARGININE 300 ML BOT Medication
ARIP15 ARIPiprazole 15 MG TAB Medication
ARIPIP ARIPiprazole 10 MG TAB Medication
ARIPIP1064 ARIPIPRAZOLE LAUROXIL 1,064 MG/3.9 ML SUSP ER SYRINGE Medication
ARIPIP2 ARIPiprazole 2 MG TAB Medication
ARIPIP400 ARIPiprazole 400 MG SYRINGE KIT (ABILIFY MAINTENA) Medication
ARIPIP5 ARIPiprazole 5 MG TAB Medication
ARIPIP675 ARIPIPRAZOLE LAUROXIL SUBMICRONIZED 675 MG/2.4 ML SUSP ER SYRINGE Medication
ARIPIP882 ARIPIPRAZOLE LAUROXIL 882 MG/3.2 ML SUSP ER SYRINGE Medication
ARMO150T ARMODAFINIL 150 MG TABLET Medication
ARMO250T ARMODAFINIL 250 MG TABLET Medication
ARMO50T ARMODAFINIL 50 MG TAB Medication
ARTIFTEARS ARTIFICIAL TEARS SOLUTION (LIQUIFILM) 15 ML Medication
ARTTEAR35O ARTIFICIAL TEARS OINTMENT (AKWA TEARS) 3.5 GM Medication
ASA325EC ASPIRIN - ENTERIC COATED 325 MG TAB Medication
ASA325S ASPIRIN 300 MG SUPP Medication
ASA325T ASPIRIN 325 MG TAB Medication
ASA650S ASPIRIN 600 MG SUPP Medication
ASA81E ASPIRIN - ENTERIC COATED 81 MG TAB Medication
ASA81T ASPIRIN 81 MG CHEWABLE Medication
ASEN5SLT ASENAPINE 5 MG SL TAB Medication
ASPERCREME ASPERCREME (TROLAMINE SAL 10%) 2 OZ Medication
ATENOL100T ATENOLOL 100 MG TAB Medication
ATENOL25T ATENOLOL 25 MG TAB Medication
ATENOL50T ATENOLOL 50 MG TAB Medication
ATOMOX10 ATOMOXETINE 10 MG CAP Medication
ATOMOX18 ATOMOXETINE 18 MG CAP Medication
ATOMOX25 ATOMOXETINE 25 MG CAP Medication
ATOMOX40 ATOMOXETINE 40 MG CAP Medication
Page 5 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
ATOMOX60 ATOMOXETINE 60 MG CAP Medication
ATOR10T ATORVASTATIN 10 MG TAB Medication
ATOR20T ATORVASTATIN 20 MG TAB Medication
ATOR40T ATORVASTATIN 40 MG TAB Medication
ATOR80T ATORVASTATIN 80 MG TAB Medication
ATOV750L ATOVAQUONE 750 MG/5 ML CUP Medication
ATRO1OPH2M ATROPINE 1% OPHTH SOLN 2 ML BOT Medication
ATRO1OPH5M ATROPINE 1% OPHTH SOLN 5 ML BOT Medication
ATROP1MG10 ATROPINE 1 MG/10 ML SYRINGE Medication
ATROP1MGML ATROPINE 1 MG/ML 1 ML VIAL Medication
ATROP4MG20 ATROPINE 0.4 MG/ML 20 ML VIAL Medication
ATROP4MG20 ATROPINE 0.4 MG/ML 20 ML VIAL Medication as an Additive
ATROP4V ATROPINE 0.4 MG/ML 1 ML VIAL Medication
ATROPOPHOT ATROPINE 1% OPHTH OINT 3.5 GM TUBE Medication
ATROPPEDIN ATROPINE 0.25 MG/5 ML SYRINGE Medication
AUG250S75M AMOXICILLIN/CLAVULANATE 250 MG/5 ML SUSP 75ML BOTTLE Medication
AUGMEN250T AMOXICILLIN/CLAVULANATE 250 MG TAB Medication
AUGMEN400 AMOXICILLIN/CLAVULANATE 400 MG/5 ML SUSP 100ML *BULK* Medication
AUGMEN500T AMOXICILLIN/CLAVULANATE 500 MG TAB Medication
AUGMEN875T AMOXICILLIN/CLAVULANATE 875 MG TAB Medication
AUGXR1000 AMOXICILLIN/CLAVULANATE XR 1,000 MG TAB Medication
AURANOF3C AURANOFIN 3 MG CAP Medication
AVCC SULFANILAMIDE CREAM VAGINAL CREAM 4 OZ TUBE Medication
AVITENE MICROFIBRILLAR COLLAGEN HEMOST 1 PKT POWDER Medication
AYR AYR SALINE NASAL GEL 14GM Medication
AZAC100V AZACITIDINE 100 MG VIAL Medication
AZAC100V AZACITIDINE 100 MG VIAL Medication as an Additive
AZAC100VSQ AZACITIDINE 100 MG/4 ML VIAL *SUBCUTANEOUS* Medication
AZAC100VSQ AZACITIDINE 100 MG/4 ML VIAL *SUBCUTANEOUS* Medication as an Additive
AZATHIO50T azaTHIOprine 50 MG TAB Medication
AZELASNAS AZELASTINE 137 MCG/DOSE NASAL SPRAY 30 ML (0.1%) Medication
AZIT2.5D AZITHROMYCIN 1% OPH SOLN 2.5 ML BOTTLE Medication
AZITH100S AZITHROMYCIN 100 MG/5 ML SUSP 15 ML BOTTLE Medication
AZITH1GMS AZITHROMYCIN SUSP 1 GM PKT Medication
AZITH200S AZITHROMYCIN 200 MG/5 ML SUSP 15 ML BOTTLE Medication
AZITH6T AZITHROMYCIN 600 MG TAB Medication
AZITHR250 AZITHROMYCIN 250 MG TAB Medication
AZITHR500V AZITHROMYCIN 500 MG VIAL Medication
AZITHR500V AZITHROMYCIN 500 MG VIAL Medication as an Additive
AZTREO1V AZTREONAM 1,000 MG VIAL Medication
AZTREO1V AZTREONAM 1,000 MG VIAL Medication as an Additive
AZTREO2V AZTREONAM 2,000 MG VIAL Medication
Page 6 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
AZTREO2V AZTREONAM 2,000 MG VIAL Medication as an Additive
BABYOIL JOHNSONS BABY OIL 89 ML BOT Medication
BACI120O BACITRACIN 0.9 GM OINT PACKET Medication
BACITRACV BACITRACIN 50000 UNIT VIAL Medication
BACITRACV BACITRACIN 50000 UNIT VIAL Medication as an Additive
BACITROINT BACITRACIN 30 GM OINT TUBE Medication
BACITROPOI BACITRACIN 3.5 GM OPHTH OINT TUBE Medication
BACLOF10T BACLOFEN 10 MG TAB Medication
BACLOF20T BACLOFEN 20 MG TAB Medication
BACLOINTRA BACLOFEN 0.5 MG/ML 20 ML INTRATHECAL KIT Medication
BACLOINTRB BACLOFEN 0.05 MG/ML INTRATHECAL KIT 1 ML TEST Medication
BACLOINTRC BACLOFEN 2 MG/ML 20 ML INTRATHECAL KIT Medication
BAGBALM EMOLLIENT 226.8 GM CAN Medication
BBAG BRIDGE BAG OF TPN/PPN Medication
BCGV50V BCG VACCINE USP 1 ML (RECONSTITUTED) VIAL Medication
BCGV50V BCG VACCINE USP 1 ML (RECONSTITUTED) VIAL Medication as an Additive
BDRGEL BDR GEL 10 ML TOPICAL SYRINGE Medication
BELA250P BELATACEPT 250 MG INJECTION Medication
BELA250P BELATACEPT 250 MG INJECTION Medication as an Additive
BENAZEP20 BENAZEPRIL 20 MG TAB Medication
BENAZEP5 BENAZEPRIL 5 MG TAB Medication
BENDAM25V BENDAMUSTINE 100 MG/4 ML VIAL Medication
BENDAM25V BENDAMUSTINE 100 MG/4 ML VIAL Medication as an Additive
BENGAY BENGAY OINT 1 OZ TUBE Medication
BENGAY85 BENGAY CREAM 85 GM TUBE Medication
BENPER150 BENZOYL PEROXIDE 10% WASH 150 ML BOT Medication
BENZ0.252 BENZYLPENICILLOYL POLYLYSINE 0.25 ML AMP (PRE-PEN) Medication
BENZ0.5S2 BENZOCAINE 20% UNIT DOSE SPRAY 0.5 ML Medication
BENZ1GEL2 BENZOYL PEROXIDE/CLINDAMYCIN GEL 50 GM JAR Medication
BENZ60TI13 BENZOIN COMPOUND TINCTURE 60 ML BOTTLE Medication
BENZ9GEL BENZOCAINE 20% GEL 9 GM TUBE (ANBESOL MAX STRGTH) Medication
BENZOCOM48 BENZOIN COMPOUND TINCTURE 480 ML BOTTLE Medication
BENZON100C BENZONATATE 100 MG PERLES Medication
BENZOYL10G BENZOYL PEROXIDE 10% GEL 42.5 GM TUBE Medication
BENZOYL10L BENZOYL PEROXIDE 10% LOTION 30 ML BOT Medication
BENZOYLP5G BENZOYL PEROXIDE 5% GEL 42.5 GM TUBE Medication
BENZOYLP5L BENZOYL PEROXIDE 5% LOTION 30 ML BOT Medication
BENZTR1T BENZTROPINE MESYLATE 1 MG TAB Medication
BENZTR2AMP BENZTROPINE MESYLATE 2 MG/2 ML AMP Medication
BENZTR2T BENZTROPINE MESYLATE 2 MG TAB Medication
BENZTR5T BENZTROPINE MESYLATE 0.5 MG TAB Medication
BERACT BERACTANT SUSPENSION 25 MG/ML 8ML BOT Medication
Page 7 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
BERACT4 BERACTANT SUSPENSION 25 MG/ML 4ML BOT Medication
BETAMETH12 BETAMETHASONE 12 MG/2 ML SYRINGE Medication
BETAMETH6V BETAMETHASONE 6 MG/ML 5ML VIAL Medication
BETAXOL25 BETAXOLOL-S 0.25% OPHTH SUSP 10 ML Medication
BETHAN10T BETHANECHOL CHLORIDE 10 MG TAB Medication
BETHAN25T BETHANECHOL CHLORIDE 25 MG TAB Medication
BEVACIZ100 BEVACIZUMAB 100 MG/4 ML SDV Medication
BEVACIZ100 BEVACIZUMAB 100 MG/4 ML SDV Medication as an Additive
BEVACIZ400 BEVACIZUMAB 400 MG/16 ML SDV Medication
BEVACIZ400 BEVACIZUMAB 400 MG/16 ML SDV Medication as an Additive
BEZLO1000V BEZLOTOXUMAB 1,000 MG/40 ML VIAL Medication
BEZLO1000V BEZLOTOXUMAB 1,000 MG/40 ML VIAL Medication as an Additive
BIAFINE BIAFINE WOUND CARE EMULSION 45 GM TUBE Medication
BICAL50T BICALUTAMIDE 50 MG TAB Medication
BICIL90030 BICILLIN CR 900/300 SYRINGE Medication
BICILCR1.2 BICILLIN CR 1,200,000 UNIT SYR Medication
BICILLA12 PENICILLIN G BENZATHINE 1,200,000 UNIT TUBEX Medication
BICILLA24 PENICILLIN G BENZATHINE 2,400,000 UNIT TUBEX Medication
BICILLA600 PENICILLIN G BENZATHINE 600000 UNIT TUBEX Medication
BICITRA30 BICITRA 30 ML CUP Medication
BIFID4 ALIGN (BIFIDOBACTERIUM INFANTIS) 4 MG CAP Medication
BIMA2.5S BIMATOPROST 0.01% OPTH SOL 2.5 ML BOTTLE Medication
BISACO10R BISACODYL 10 MG SUPP Medication
BISACO5T BISACODYL 5 MG EC Medication
BISM1CAP BISMUTH/METRONID/TETRACYCLINE (PYLERA) CAPSULE Medication
BISM500P11 BISMUTH SUBGALLATE 30 GM POWDER Medication
BISMU262T BISMUTH SUBSALICYLATE 262 MG TAB Medication
BISMUTH30 BISMUTH SUBSALICYLATE 524 MG/30 ML CUP Medication
BISOP5 BISOPROLOL 5 MG TAB Medication
BIVALIR BIVALIRUDIN 250 MG INJ Medication
BIVALIR BIVALIRUDIN 250 MG INJ Medication as an Additive
BLACKWID WIDOW SPIDER ANTIVENIN 2.5 ML SDV Medication
BLEOM15V BLEOMYCIN 15 UNIT VIAL Medication
BLEOM15V BLEOMYCIN 15 UNIT VIAL Medication as an Additive
BLEPH3O BLEPHAMIDE OPHTH OINT 3.5 GM TUBE Medication
BLEPH5S BLEPHAMIDE OPTH SUSP 5 ML BOT Medication
BORTEZ3.5 BORTEZOMIB 3.5 MG VIAL Medication
BORTEZ3.5 BORTEZOMIB 3.5 MG VIAL Medication as an Additive
BOSUPP B AND O SUPP Medication
BOTOX BOTULINUM TOXIN TYPE A 100 UNIT VIAL Medication
BREX1TAB BREXPIPRAZOLE 1 MG TAB Medication
BREX4TAB BREXPIPRAZOLE 4 MG TAB Medication
Page 8 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
BRIM2OPH BRIMONIDINE TARTRATE 0.2% OPHTH SOL 5 ML Medication
BRIM5DRO2 BRIMONIDINE 0.2%/TIMOLOL 0.5% OPHTH SOL 5 ML (COMBIGAN) Medication
BRIMO1OPTH BRIMONIDINE TARTRATE 0.1% OPHTH SOL 5 ML Medication
BRIMOPTH BRIMONIDINE TARTRATE 0.15 % OPTH SOL 5 ML Medication
BRINZOPTH BRINZOLAMIDE 1% OPHTH SUSP 10 ML Medication
BROMOCR2T BROMOCRIPTINE MESYLATE 2.5 MG TAB Medication
BSS15ML BALANCED SALT SOLUTION 15 ML BOT Medication
BSS500 BALANCED SALT SOLUTION 500 ML BOT Medication
BSSPLUS500 BALANCED SALT SOLUTION PLUS 500 ML BOT Medication
BUDE0.25 BUDESONIDE 0.25 MG/2ML NEB SOLUTION Medication
BUDES0.5 BUDESONIDE 0.5 MG/2 ML NEB SOL Medication
BUDES3EC BUDESONIDE 3 MG EC CAP Medication
BUDES9ER BUDESONIDE 9 MG EXTENDED REL TAB Medication
BUDESAQUA BUDESONIDE AQUA 32 MCG NASAL SPRAY 8.43 ML Medication
BUFFERIN BUFFERED ASPIRIN 325 MG TAB Medication
BUMETA1T BUMETANIDE 1 MG TAB Medication
BUMETA5T BUMETANIDE 0.5 MG TAB Medication
BUMETAN1V BUMETANIDE 1 MG/4 ML VIAL Medication
BUMETAN1V BUMETANIDE 1 MG/4 ML VIAL Medication as an Additive
BUMETAN25V BUMETANIDE 2.5 MG/10 ML VIAL Medication
BUMETAN25V BUMETANIDE 2.5 MG/10 ML VIAL Medication as an Additive
BUP150XL buPROPion XL 150 MG 24-HR TAB Medication
BUP300XL buPROPion XL 300 MG 24-HR TAB Medication
BUPI10SU BUPIVACAINE LIPOSOME 1.3% 10 ML VIAL Medication
BUPI10SU BUPIVACAINE LIPOSOME 1.3% 10 ML VIAL Medication as an Additive
BUPI10VI5 BUPIVACAINE HCL 0.5%/1:200000 10 ML VIAL Medication
BUPI2.5V6 BUPIVACAINE 0.25% 10 ML SDV Medication
BUPI2.5V6 BUPIVACAINE 0.25% 10 ML SDV Medication as a Carrier
BUPI2.5V6 BUPIVACAINE 0.25% 10 ML SDV Medication as an Additive
BUPI25E BUPIVACAINE 0.25% EPI 1:200000 10 ML SDV Medication
BUPI25EMDV BUPIVACAINE 0.25% EPI 1:200000 50 ML MDV Medication
BUPI25ESDV BUPIVACAINE 0.25% EPI 1:200000 30 ML SDV Medication
BUPI75ESDV BUPIVACAINE 0.75% EPI 1:200000 30 ML SDV Medication
BUPIV10SDV BUPIVACAINE 0.5% 10 ML SDV Medication
BUPIV10SDV BUPIVACAINE 0.5% 10 ML SDV Medication as a Carrier
BUPIV10SDV BUPIVACAINE 0.5% 10 ML SDV Medication as an Additive
BUPIV25SDV BUPIVACAINE 0.25% 30 ML SDV Medication
BUPIV25SDV BUPIVACAINE 0.25% 30 ML SDV Medication as a Carrier
BUPIV25SDV BUPIVACAINE 0.25% 30 ML SDV Medication as an Additive
BUPIV5EMDV BUPIVACAINE HCL/EPI 1:200000 50 ML SOL Medication
BUPIV5ESDV BUPIVACAINE 0.5% W/EPI 1:200000 30 ML SDV Medication
BUPIV5MDV BUPIVACAINE HCL 0.5% 50 ML MDV Medication
Page 9 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
BUPIV5SDV BUPIVACAINE 0.5% 30 ML SDV Medication
BUPIV5SDV BUPIVACAINE 0.5% 30 ML SDV Medication as a Carrier
BUPIV5SDV BUPIVACAINE 0.5% 30 ML SDV Medication as an Additive
BUPIV75SDV BUPIVACAINE HCL 0.75% 30 ML SDV Medication
BUPIV75SDV BUPIVACAINE HCL 0.75% 30 ML SDV Medication as an Additive
BUPIVSPINA BUPIVACAINE 0.75% 2 ML AMP Medication
BUPR10TDM BUPRENORPHINE 10 MCG/HR-7 DAY 1 PATCH (BUTRANS) Medication
BUPR20TDM BUPRENORPHINE 20 MCG/HR-7 DAY PATCH (BUTRANS) Medication
BUPR5TDM BUPRENORPHINE 5 MCG/HR 7 DAY PATCH (BUTRANS) Medication
BUPREN2 BUPRENORPHINE 2 MG TAB Medication
BUPREN8 BUPRENORPHINE 8 MG TAB Medication
BUPRO100CR buPROPion SR 100 MG 12-HR TAB Medication
BUPRO150CR buPROPion SR 150 MG 12-HR TAB Medication
BUPROP100T buPROPion 100 MG TAB Medication
BUPROP75T buPROPion 75 MG TAB Medication
BUSPIR10T busPIRone 10 MG TAB Medication
BUSPIR5T busPIRone 5 MG TAB Medication
BUSPIR7.5T busPIRone 7.5 MG TAB Medication
BUSULFA2T BUSULFAN 2 MG TAB Medication
BUTORPH4V BUTORPHANOL TART 2 MG/ML 1 ML VIAL Medication
BUTORPHNS BUTORPHANOL NASAL SPRAY 10 MG/ML 2.5 ML Medication
C1EI500V C1 ESTERASE INHIBITOR HUMAN, 500 UNIT Medication
C1EI500V C1 ESTERASE INHIBITOR HUMAN, 500 UNIT Medication as an Additive
CABER0.5TB CABERGOLINE 0.5 MG TAB Medication
CAFERGOT ERGOTAMINE/CAFFEINE TAB Medication
CAFF200 CAFFEINE TAB 200 MG TAB Medication
CAFFCIT60 CAFFEINE (CITRATED) 20 MG/ML 3ML ORALSOL Medication
CAFFCITINJ CAFFEINE (CITRATED) 20 MG/ML 3ML INJECTION Medication
CAFFCITINJ CAFFEINE (CITRATED) 20 MG/ML 3ML INJECTION Medication as an Additive
CAFFEINEBV CAFFEINE NA BENZOATE 500MG/2ML AMP Medication
CAFFEINEBV CAFFEINE NA BENZOATE 500MG/2ML AMP Medication as an Additive
CALACE1TAB CALCIUM ACETATE 667 MG CAP Medication
CALACES CALCIUM ACETATE 1334 MG/10 ML SOLUTION Medication
CALADRYLOT CALADRYL LOTION (CALAMINE 8%/PRAMOXINE HCL 1%) 177 ML BOTT Medication
CALAMINE CALAMINE LOTION 177 ML BOTTLE Medication
CALCARB500 CALCIUM CARBONATE 500 MG CHEW TAB Medication
CALCARBCUP CALCIUM CARBONATE 1250 MG/5 ML CUP (500MG CA++) Medication
CALCHLJET CALCIUM CHLORIDE 1 GM/10 ML SYRINGE Medication
CALCHLJET CALCIUM CHLORIDE 1 GM/10 ML SYRINGE Medication as an Additive
CALCHLVIAL CALCIUM CHLORIDE 1 GM/10 ML VIAL Medication
CALCHLVIAL CALCIUM CHLORIDE 1 GM/10 ML VIAL Medication as an Additive
CALCIT950 CALCIUM CITRATE 950 MG (ELEMENTAL CA 200MG) Medication
Page 10 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
CALCITNS CALCITONIN RECOMBINANT NASAL SPRAY (200 UNIT/SPRAY) 3.7 ML Medication
CALCITO400 CALCITONIN-SALMON 400 UNIT/2 ML VIAL (CHARGE PER UNIT) Medication
CALCITRI1A CALCITRIOL 1 MCG/ML 1ML AMP Medication
CALCITROL CALCITRIOL 0.25 MCG CAP Medication
CALGLUC1V CALCIUM GLUCONATE 1 GM/10 ML VIAL Medication
CALGLUC1V CALCIUM GLUCONATE 1 GM/10 ML VIAL Medication as an Additive
CALITROLIQ CALCITRIOL 1 MCG/ML 15ML DROPPER BOTTLE Medication
CAMPHO CAMPHO-PHENIQUE 2 OZ BOT Medication
CAN100 CANAGLIFLOZIN 100 MG TAB Medication
CAN300 CANAGLIFLOZIN 300 MG TAB Medication
CANGREL50V CANGRELOR 50 MG VIAL Medication
CANGREL50V CANGRELOR 50 MG VIAL Medication as an Additive
CAPECIT500 CAPECITABINE 500 MG TAB Medication
CAPOZ2515 CAPTOPRIL/HCTZ 25/15 MG TAB Medication
CAPOZ5015 CAPTOPRIL/HCTZ 50/15 MG TAB Medication
CAPS8KIT CAPSAICIN 8% PATCH KIT Medication
CAPSA25CR CAPSAICIN 0.025% CREAM 60 GM Medication
CAPTOPR12T CAPTOPRIL 12.5 MG TAB Medication
CAPTOPR50T CAPTOPRIL 50 MG TAB Medication
CARBAM1ER carBAMazepine ER 100 MG 12-HR CAP Medication
CARBAM2ER carBAMazepine ER 200 MG 12-HR CAP Medication
CARBAM3ER carBAMazepine ER 300 MG 12-HR CAP Medication
CARBAMAZ1S carBAMazepine XR 100 MG 12-HR TAB Medication
CARBAMAZ1T carBAMazepine 100 MG CHEWABLE TABLET Medication
CARBAMAZ2S carBAMazepine XR 200 MG 12-HR TAB Medication
CARBAMAZ2T carBAMazepine 200 MG TAB Medication
CARBAMAZLQ carBAMazepine 200 MG/10 ML CUP Medication
CARBAMIDE CARBAMIDE PEROXIDE (GLY-OXIDE) SOL 15 ML Medication
CARBAMIDOT CARBAMIDE PEROXIDE (DEBROX) OTIC SOL 15 ML Medication
CARBFE50 CARBONYL IRON 45 MG TAB Medication
CARBID25T CARBIDOPA 25 MG TAB Medication
CARBLEV36 CARBIDOPA/LEVODOPA 36.25/145 MG (RYTARY) ER CAP Medication
CARBOPL450 CARBOplatin 450 MG/45 ML VIAL Medication
CARBOPL450 CARBOplatin 450 MG/45 ML VIAL Medication as an Additive
CARBOPROST CARBOPROST 250 MCG/1 ML AMP Medication
CARFIL30V CARFILZOMIB 30 MG VIAL Medication
CARFIL30V CARFILZOMIB 30 MG VIAL Medication as an Additive
CARI250T2 CARISOPRODOL 250 MG TABLET Medication
CARISOPROD CARISOPRODOL 350 MG TAB Medication
CARMEX CARMEX 7.5 GM JAR Medication
CARMUS100V CARMUSTINE 3.3 MG/ML 30ML VIAL Medication
CARMUS100V CARMUSTINE 3.3 MG/ML 30ML VIAL Medication as an Additive
Page 11 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
CARMUSWFR CARMUSTINE 8 WAFER/BOX Medication
CARV10CR CARVEDILOL CR 10 MG CAP Medication
CARV25 CARVEDILOL 25 MG TAB Medication
CARV3125 CARVEDILOL 3.125 MG TAB Medication
CARV625 CARVEDILOL 6.25 MG TAB Medication
CEFAC250C CEFACLOR 250 MG CAP Medication
CEFADR500C CEFADROXIL 500 MG CAP Medication
CEFADRBU25 CEFADROXIL 250 MG/5 ML 100 ML BOT Medication
CEFAZ1PIG ceFAZolin 1,000 MG VIAL Medication
CEFAZ1PIG ceFAZolin 1,000 MG VIAL Medication as an Additive
CEFAZ2PNS ceFAZolin 2 GM/100 ML PREMIX BAG IN *NS* Medication
CEFDINIR60 CEFDINIR 125 MG/5 ML SUSP 60ML *BULK* Medication
CEFE2VIA9 CEFEPIME 2,000 MG VIAL Medication
CEFE2VIA9 CEFEPIME 2,000 MG VIAL Medication as an Additive
CEFEP1000 CEFEPIME 1,000 MG VIAL Medication
CEFEP1000 CEFEPIME 1,000 MG VIAL Medication as an Additive
CEFIX100BK CEFIXIME 100 MG/5 ML SUSP 50 ML *BULK* Medication
CEFIXI400T CEFIXIME 400 MG TAB Medication
CEFOTA1000 CEFOTAXIME 1,000 MG VIAL Medication
CEFOTA1000 CEFOTAXIME 1,000 MG VIAL Medication as an Additive
CEFOTE1V cefoTEtan 1,000 MG VIAL Medication
CEFOTE1V cefoTEtan 1,000 MG VIAL Medication as an Additive
CEFOTE2V cefoTEtan 2,000 MG VIAL Medication
CEFOTE2V cefoTEtan 2,000 MG VIAL Medication as an Additive
CEFOXI1PIG cefOXitin 1,000 MG VIAL Medication
CEFOXI1PIG cefOXitin 1,000 MG VIAL Medication as an Additive
CEFOXI1PRE cefOXitin/DEXTROSE 1 GM/50 ML DUPLEX BAG Medication
CEFOXI2PIG cefOXitin 2,000 MG VIAL Medication
CEFOXI2PIG cefOXitin 2,000 MG VIAL Medication as an Additive
CEFOXI2PRE cefOXitin/DEXTROSE 2 GM/50 ML DUPLEX BAG Medication
CEFPOD200 CEFPODOXIME 200 MG TAB Medication
CEFPODSUSP CEFPODOXIME 100 MG/5 ML SUSP 100 ML BOTTLE Medication
CEFTAR400V CEFTAROLINE 400 MG VIAL Medication
CEFTAR400V CEFTAROLINE 400 MG VIAL Medication as an Additive
CEFTAR600V CEFTAROLINE 600 MG VIAL Medication
CEFTAR600V CEFTAROLINE 600 MG VIAL Medication as an Additive
CEFTAZ1PIG cefTAZidime 1,000 MG VIAL Medication
CEFTAZ1PIG cefTAZidime 1,000 MG VIAL Medication as an Additive
CEFTAZ2PIG cefTAZidime 2,000 MG VIAL Medication
CEFTAZ2PIG cefTAZidime 2,000 MG VIAL Medication as an Additive
CEFTAZAVI cefTAZidime/AVIBACTAM 2.5 GM VIAL Medication
CEFTAZAVI cefTAZidime/AVIBACTAM 2.5 GM VIAL Medication as an Additive
Page 12 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
CEFTAZLOCK cefTAZidime LOCK W/HEPARIN Medication
CEFTAZLOCK cefTAZidime LOCK W/HEPARIN Medication as an Additive
CEFTOL15V CEFTOLOZANE/TAZOBACTAM 1.5 GM VIAL Medication
CEFTOL15V CEFTOLOZANE/TAZOBACTAM 1.5 GM VIAL Medication as an Additive
CEFTRI1PIG cefTRIAXone 1,000 MG VIAL Medication
CEFTRI1PIG cefTRIAXone 1,000 MG VIAL Medication as an Additive
CEFTRI250V cefTRIAXone 250 MG VIAL Medication
CEFTRI250V cefTRIAXone 250 MG VIAL Medication as an Additive
CEFTRI2PIG cefTRIAXone 2,000 MG VIAL Medication
CEFTRI2PIG cefTRIAXone 2,000 MG VIAL Medication as an Additive
CEFURO15PI CEFUROXIME 1500 MG VIAL Medication
CEFURO15PI CEFUROXIME 1500 MG VIAL Medication as an Additive
CEFURO250T CEFUROXIME 250 MG TAB Medication
CEFURO750P CEFUROXIME 750 MG VIAL Medication
CEFURO750P CEFUROXIME 750 MG VIAL Medication as an Additive
CELEC100 CELECOXIB 100 MG CAP Medication
CELEC200 CELECOXIB 200 MG CAP Medication
CENTRUM CENTRUM TAB Medication
CEPACOLLOZ BENZOCAINE/MENTHOL 16 LOZ PER BOX Medication
CEPHAL125S CEPHALEXIN 125 MG/5 ML SUSP 100 ML BOTTLE Medication
CEPHAL250C CEPHALEXIN 250 MG CAP Medication
CEPHAL250S CEPHALEXIN 250 MG/5 ML SUSP 100 ML BOTTLE Medication
CEPHAL500C CEPHALEXIN 500 MG CAP Medication
CERT400S CERTOLIZUMAB PEGOL 200 MG/1ML KIT Medication
CETAPHIL CETAPHIL CREAM 16 OZ JAR Medication
CETAPHILCL CETAPHIL CLEANSER 236 ML (8 OZ) BOT Medication
CETAPHILM CETAPHIL MOISTURIZING LOTION 473 ML (16 OZ) BOT Medication
CETIR10 CETIRIZINE 10 MG TAB Medication
CETIR5LB CETIRIZINE 5 MG/5 ML CUP Medication
CEVIMEL30 CEVIMELINE 30 MG CAP Medication
CHARCOALSS ACTIVATED CHARCOAL W/SORBITOL 25 GM/120 ML BOT Medication
CHARCOSUSP ACTIVATED CHARCOAL 25 GM/120 ML BOT Medication
CHLORAM2T CHLORAMBUCIL 2 MG TAB Medication
CHLORASLZ CHLORASEPTIC LOZENGES BOX OF 18 Medication
CHLORASPY CHLORASEPTIC SPRAY (ORAL ANESTHETIC/ANALGESIC) 177 ML BOT Medication
CHLORDI10C chlordiazePOXIDE 10 MG CAP Medication
CHLORDI25C chlordiazePOXIDE 25 MG CAP Medication
CHLORDI5C chlordiazePOXIDE 5 MG CAP Medication
CHLORHE15 CHLORHEXIDINE (0.12%) ORAL RINSE 15 ML CUP Medication
CHLORHE4S HIBICLENS (CHLORHEXIDINE GLUCONATE 4%) 4 OZ BOTTLE Medication
CHLORHEPKT CHLORHEXIDINE SCRUB PACKET Medication
CHLOROP230 CHLOROPROCAINE-MPF 2% 20 ML VIAL Medication
Page 13 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
CHLOROP330 CHLOROPROCAINE-MPF 3% 20 ML SDV Medication
CHLOROTH25 CHLOROTHIAZIDE 250 MG TAB Medication
CHLOROTH50 CHLOROTHIAZIDE 500 MG TAB Medication
CHLORP100T chlorproMAZINE 100 MG TAB Medication
CHLORP10T chlorproMAZINE 10 MG TAB Medication
CHLORP25T chlorproMAZINE 25 MG TAB Medication
CHLORP50A chlorproMAZINE 50 MG/2 ML AMP Medication
CHLORP50A chlorproMAZINE 50 MG/2 ML AMP Medication as an Additive
CHLORPHE4T CHLORPHENIRAMINE MAL 4 MG TAB Medication
CHLORPHLIQ CHLORPHENIRAMINE MAL 2 MG/5 ML BOT Medication
CHLORTH25T CHLORTHALIDONE 25 MG TAB Medication
CHLORTH50T CHLORTHALIDONE 50 MG TAB Medication
CHOLESTY4 CHOLESTYRAMINE 4 GM (ACTIVE DRUG) PACKET Medication
CHOLESTY4 CHOLESTYRAMINE 4 GM (ACTIVE DRUG) PACKET Medication as a Compound
CICL6.6S CICLOPIROX NAIL LACQR SOLUTION 6.6 ML BOTTLE Medication
CIDOF375V CIDOFOVIR 375 MG/5 ML VIAL Medication
CIDOF375V CIDOFOVIR 375 MG/5 ML VIAL Medication as an Additive
CILOST50 CILOSTAZOL 50 MG TABLET Medication
CINACALCET CINACALCET 30 MG TABLET Medication
CIPR200P10 CIPROFLOXACIN 200MG/100ML D5W PREMIX BAG Medication
CIPR500S CIPROFLOXACIN 500 MG/5 ML SUSP 100 ML BOTTLE Medication
CIPRODOTIC CIPROFLOXACIN 0.3%/DEXAMETHASONE 0.1% OTIC 7.5ML BOTTLE Medication
CIPROFL250 CIPROFLOXACIN 250 MG TAB Medication
CIPROFL500 CIPROFLOXACIN 500 MG TAB Medication
CIPROIVBAG CIPROFLOXACIN 400MG/200ML D5W PREMIX BAG Medication
CIPROOPH25 CIPROFLOXACIN 0.3% OPTH SOL 2.5 ML Medication
CIPROOPHSO CIPROFLOXACIN 0.3% OPTH SOL 5 ML Medication
CISATR10MD CISATRACURIUM 2 MG/ML 10 ML VIAL Medication
CISATR10MD CISATRACURIUM 2 MG/ML 10 ML VIAL Medication as an Additive
CISATR20MH CISATRACURIUM 10 MG/ML CONCENTRATED 20 ML VIAL Medication
CISATR20MH CISATRACURIUM 10 MG/ML CONCENTRATED 20 ML VIAL Medication as an Additive
CISATR5MD CISATRACURIUM BESYLATE 2 MG/ML 5 ML VIAL Medication
CISATR5MD CISATRACURIUM BESYLATE 2 MG/ML 5 ML VIAL Medication as an Additive
CISPLAT100 CISplatin 100 MG/100 ML MDV Medication
CITAL10 CITALOPRAM 10 MG TAB Medication
CITAL20 CITALOPRAM 20 MG TAB Medication
CITAL20L CITALOPRAM ORAL SOLUTION 20 MG/10 ML CUP Medication
CITRACALD CITRACAL D (CITRACAL MAXIMUM) TABLET 315MG CA ELEMTAL+ 250IU VITAMIN D Medication
CLADRI10V CLADRIBINE 1 MG/ML 10ML VIAL Medication
CLADRI10V CLADRIBINE 1 MG/ML 10ML VIAL Medication as an Additive
CLARI500XL CLARITHROMYCIN XL 500 MG TAB Medication
Page 14 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
CLARIT250S CLARITHROMYCIN 250 MG/5 ML SUSP 50 ML *BULK* Medication
CLARIT250T CLARITHROMYCIN 250 MG TAB Medication
CLARITIND LORATADINE 5 MG/PSEUDOEPHEDRINE 120MG 12HR SR TAB Medication
CLEV100V CLEVIDIPINE 0.5 MG/ML 100 ML PREMIX Medication
CLEVID50 CLEVIDIPINE 0.5 MG/ML 50 ML PREMIX Medication
CLIN40CR2 CLINDAMYCIN 2% VAG CREAM 40 GM (7 DAY) Medication
CLINDA150C CLINDAMYCIN 150 MG CAP Medication
CLINDA300P CLINDAMYCIN 300 MG/50 ML D5W PREMIX BAG Medication
CLINDA300V CLINDAMYCIN 300 MG/2 ML VIAL Medication
CLINDA300V CLINDAMYCIN 300 MG/2 ML VIAL Medication as an Additive
CLINDA600P CLINDAMYCIN 600 MG/50 ML D5W PREMIX BAG Medication
CLINDA900P CLINDAMYCIN 900 MG/50 ML D5W PREMIX BAG Medication
CLINDABULK CLINDAMYCIN ORAL SOLN 75 MG/5 ML 100 ML *BULK* Medication
CLINDATGEL CLINDAMYCIN 1% TOPICAL GEL 30 GM Medication
CLINDATSOL CLINDAMYCIN 1% TOPICAL SOL 60 ML Medication
CLO10T cloBAZam 10 MG TAB Medication
CLO20 CLOFARABINE 20 MG/20 ML VIAL Medication
CLO20 CLOFARABINE 20 MG/20 ML VIAL Medication as an Additive
CLOBET5CR3 CLOBETASOL PROPIONATE 0.05% CREAM 30 GM TUBE Medication
CLOBET5OI3 CLOBETASOL PROPIONATE 0.05% OINT 30 GM TUBE Medication
CLOMIP25C clomiPRAMINE 25 MG CAP Medication
CLONAZ25W clonazePAM 0.25 MG WAFER TABLET Medication
CLONAZEP1T clonazePAM 1 MG TAB Medication
CLONAZEP5T clonazePAM 0.5 MG TAB Medication
CLONID100V cloNIDine HCL 100 MCG/ML 10ML VIAL Medication
CLONID100V cloNIDine HCL 100 MCG/ML 10ML VIAL Medication as a Carrier
CLONID100V cloNIDine HCL 100 MCG/ML 10ML VIAL Medication as an Additive
CLONIDI1P cloNIDine 0.1 MG/DAY WEEKLY PATCH Medication
CLONIDI1T cloNIDine HCL 0.1 MG TAB Medication
CLONIDI2P cloNIDine 0.2 MG/DAY WEEKLY PATCH Medication
CLONIDI2T cloNIDine HCL 0.2 MG TAB Medication
CLONIDI3P cloNIDine 0.3 MG/DAY WEEKLY PATCH Medication
CLONIDI3T cloNIDine HCL 0.3 MG TAB Medication
CLOP300 CLOPIDOGREL 300 MG TAB Medication
CLOP75 CLOPIDOGREL 75 MG TAB Medication
CLORAZ375T CLORAZEPATE DIPOTASSIUM 3.75 MG Medication
CLOTRI10T CLOTRIMAZOLE 10 MG TROCHE Medication
CLOTRI1C CLOTRIMAZOLE 1% CREAM 15 GM TUBE Medication
CLOTRI1C3 CLOTRIMAZOLE 1% CREAM 30 GM TUBE Medication
CLOTRIL30 CLOTRIMAZOLE 1% TOPICAL SOLUTION 30 ML BOT Medication
CLOTRIVC CLOTRIMAZOLE 45 GM VAGINAL CREAM TUBE Medication
CLOZA150OD CLOZAPINE 150 MG ORALLY DISINTEGRATING (FAZACLO) Medication
Page 15 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
CLOZAP1OD CLOZAPINE 100 MG ORALLY DISINTEGRATING (FAZACLO) Medication
CLOZAP25OD CLOZAPINE 25 MG ORALLY DISINTEGRATING TAB (FAZACLO) Medication
COCAINE44 COCAINE 4% 4ML BOT Medication
CODEINE30T CODEINE 30 MG TAB Medication
COENZQ1010 CO-ENZYME Q10 100 MG CAP Medication
COLACE100 DOCUSATE SODIUM 100 MG LCAP Medication
COLACE100L DOCUSATE SODIUM 100 MG/10 ML CUP Medication
COLACE50C DOCUSATE SODIUM 50 MG LCAP Medication
COLCHICI6T COLCHICINE 0.6 MG TAB Medication
COLE3.752 COLESEVELAM HCL 3.75 GM PKT Medication
COLESEV625 COLESEVELAM HCL 625 MG TAB Medication
COLEST1 COLESTIPOL 1 GM TAB Medication
COLLAGOINT COLLAGENASE (SANTYL) OINTMENT 30 GM TUBE Medication
CONIVPRE CONIVAPTAN 20MG/100ML D5W PREMIX Medication
CONJEST125 CONJUGATED ESTROGENS 1.25 MG TAB Medication
CONJEST25V CONJUGATED ESTROGENS 25 MG INJ Medication
CONJEST25V CONJUGATED ESTROGENS 25 MG INJ Medication as an Additive
CONJEST3T CONJUGATED ESTROGENS 0.3 MG TAB Medication
CONJEST45 CONJUGATED ESTROGENS 0.45 MG TAB Medication
CONJEST625 CONJUGATED ESTROGENS 0.625 MG TAB Medication
CONJEST9T CONJUGATED ESTROGENS 0.9 MG TAB Medication
CONJESTVAG ESTROGENS CONJUGATED VAG CR 30 GM TUBE Medication
CORTISPCRM CORTISPORIN CREAM 7.5 GM TUBE Medication
CORTISPOPO CORTISPORIN OPHTHALMIC OINT 3.5 GM Medication
CORTISPOPS CORTISPORIN OPHTHALMIC SUSPENSION 7.5 ML Medication
CORTISPOTL CORTISPORIN OTIC SOLUTION 10 ML Medication
CORTISPOTS CORTISPORIN OTIC SUSPENSION 10 ML Medication
CORZIDE805 NADOLOL/BENDROFLUMETHIAZIDE 80/5 MG TAB Medication
COSOPT DORZOLAMIDE/TIMOLOL (COSOPT) OPHTH SOL 10 ML Medication
COSOPTUD DORZOLAMIDE/TIMOLOL (COSOPT) OPHTH SOL 0.2 ML AMPULE Medication
COSYNTR25V COSYNTROPIN 250 MCG/1 ML VIAL Medication
COSYNTR25V COSYNTROPIN 250 MCG/1 ML VIAL Medication as an Additive
CREON12 PANCRELIPASE (CREON-12) DR CAP Medication
CREON24 PANCRELIPASE (CREON-24) DR CAP Medication
CREON3 PANCRELIPASE (CREON-3) DR CAP Medication
CREON6 PANCRELIPASE (CREON-6) DR CAP Medication
CROMOLOPHS CROMOLYN SODIUM 4% OPHTH SOL 10 ML Medication
CUSIV CUSTOM IV SOLUTION Medication
CYANIDANTI CYANIDE ANTIDOTE KIT (NITHIODOTE) (SOD NITRITE/SOD THIOSULFATE) Medication
CYANO1000T CYANOCOBALAMIN (VIT B-12) 1000 MCG TAB Medication
CYANOCOB1T CYANOCOBALAMIN (VIT B-12) 100 MCG TAB Medication
CYANOCOB1V CYANOCOBALAMIN (VIT B-12) 1000 MCG VIAL Medication
Page 16 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
CYANOCOB5T CYANOCOBALAMIN (VIT B-12) 500 MCG TAB Medication
CYCL100S4 cycloSPORINE MODIFIED 100 MG/ML 50 ML ORAL SOL Medication
CYCLO1GM CYCLOPHOSPHAMIDE 1000 MG/50 ML PWVL Medication
CYCLO1GM CYCLOPHOSPHAMIDE 1000 MG/50 ML PWVL Medication as an Additive
CYCLO2GM CYCLOPHOSPHAMIDE 2000 MG/100 ML PWVL Medication
CYCLO2GM CYCLOPHOSPHAMIDE 2000 MG/100 ML PWVL Medication as an Additive
CYCLOBEN10 CYCLOBENZAPRINE 10 MG TAB Medication
CYCLOPEN05 CYCLOPENTOLATE HCL 0.5% OPHTH SOL 15 ML Medication
CYCLOPEN1S CYCLOPENTOLATE HCL 1% OPHTH SOL 2 ML Medication
CYCLOPH25T CYCLOPHOSPHAMIDE 25 MG CAP Medication
CYCLOPH500 CYCLOPHOSPHAMIDE 500 MG/25 ML VIAL Medication
CYCLOPH500 CYCLOPHOSPHAMIDE 500 MG/25 ML VIAL Medication as an Additive
CYCLOS100M cycloSPORINE MODIFIED 100 MG CAP Medication
CYCLOS25MC cycloSPORINE MODIFIED 25 MG CAP Medication
CYCLOSP100 cycloSPORINE 100 MG CAP Medication
CYCLOSP25C cycloSPORINE 25 MG CAP Medication
CYCLOSPGTT cycloSPORINE 0.05% OPHTH EMULSION 0.4 ML UD Medication
CYCLOSPINJ cycloSPORINE 50 MG/ML 5ML VIAL Medication
CYCLOSPINJ cycloSPORINE 50 MG/ML 5ML VIAL Medication as an Additive
CYCLOSPLIQ cycloSPORINE 100 MG/ML 50ML BOT Medication
CYPROHEP4T CYPROHEPTADINE 4 MG TAB Medication
CYTA100V CYTARABINE 100 MG/5 ML VIAL Medication
CYTA100V CYTARABINE 100 MG/5 ML VIAL Medication as an Additive
CYTARAB2G CYTARABINE 2,000 MG/20 ML VIAL Medication
CYTARAB2G CYTARABINE 2,000 MG/20 ML VIAL Medication as an Additive
D101000 DEXTROSE 10% 1000 ML BAG Medication
D101000 DEXTROSE 10% 1000 ML BAG Medication as a Carrier
D101000 DEXTROSE 10% 1000 ML BAG Medication as an Additive
D10250 DEXTROSE 10% 250 ML BAG Medication
D10250 DEXTROSE 10% 250 ML BAG Medication as a Carrier
D10250 DEXTROSE 10% 250 ML BAG Medication as an Additive
D10500 DEXTROSE 10% 500 ML BAG Medication
D10500 DEXTROSE 10% 500 ML BAG Medication as a Carrier
D10500 DEXTROSE 10% 500 ML BAG Medication as an Additive
D2510 DEXTROSE 25% 2.5 GM/10 ML SYRINGE Medication
D2510 DEXTROSE 25% 2.5 GM/10 ML SYRINGE Medication as an Additive
D5050 DEXTROSE 50% 50 ML SYRINGE Medication
D5050 DEXTROSE 50% 50 ML SYRINGE Medication as an Additive
D5050V DEXTROSE 50% 50 ML VIAL Medication
D5050V DEXTROSE 50% 50 ML VIAL Medication as an Additive
D5100 D5W 100 ML BAG Medication
D51000 D5W 1000 ML BAG Medication
Page 17 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
D520K D5 W/KCL 20MEQ/L 1000 ML BAG Medication
D5250 D5W 250 ML BAG Medication
D550 D5W 50 ML BAG Medication
D5500 D5W 500 ML BAG Medication
D5500 D5W 500 ML BAG Medication as a Carrier
D5500 D5W 500 ML BAG Medication as an Additive
D5H1000 D5 1/2 NORMAL SALINE 1000 ML BAG Medication
D5H20K D51/2NS W/KCL 20MEQ/L 1000 ML BAG Medication
D5H40K D51/2NS W/KCL 40MEQ/L 1000 ML BAG Medication
D5H500 D5 1/2 NORMAL SALINE 500 ML BAG Medication
D5LR1000 D5LR 1000 ML BAG Medication
D5LR20K D5LR W/KCL 20MEQ/L 1000 ML BAG Medication
D5LR500 D5LR 500 ML BAG Medication
D5NS1000 DEXTROSE 5% SOD CHL 0.9% 1000 ML BAG Medication
D5NS20K D5NS W/KCL 20MEQ/L 1000 ML BAG Medication
D5NS40K D5NS W/KCL 40MEQ/L 1000 ML BAG Medication
D5Q1000 D5 1/4 NORMAL SALINE 1000 ML BAG Medication
D5Q20K D51/4NS W/KCL 20MEQ/L 1000 ML BAG Medication
D5Q500 D5 1/4 NORMAL SALINE 500 ML BAG Medication
DABI110C DABIGATRAN 110 MG CAP Medication
DABI150C DABIGATRAN 150 MG CAP Medication
DABI75C DABIGATRAN 75 MG CAP Medication
DACARBA200 DACARBAZINE 200 MG/20 ML VIAL Medication
DACARBA200 DACARBAZINE 200 MG/20 ML VIAL Medication as an Additive
DACTINOM5V DACTINOMYCIN 500 MCG VIAL Medication
DACTINOM5V DACTINOMYCIN 500 MCG VIAL Medication as an Additive
DAKINS DAKINS 0.5% FULL STRENGTH SOLN 473 ML BOT Medication
DAKINS1/4 DAKINS 0.125% 1/4 STRENGTH 473 ML BOT Medication
DAKINSHALF DAKINS 0.25% 1/2 STRENGTH 473 ML BOT Medication
DANTROL100 DANTROLENE SODIUM 100 MG CAP Medication
DANTROL20V DANTROLENE SODIUM 20 MG VIAL Medication
DANTROL25C DANTROLENE SODIUM 25 MG CAP Medication
DANTROL50C DANTROLENE SODIUM 50 MG CAP Medication
DAPSON100 DAPSONE 100 MG TAB Medication
DAPTOM500 DAPTOmycin 500 MG VIAL Medication
DAPTOM500 DAPTOmycin 500 MG VIAL Medication as an Additive
DARATU400V DARATUMUMAB 400 MG/20 ML VIAL Medication
DARATU400V DARATUMUMAB 400 MG/20 ML VIAL Medication as an Additive
DARBEP25 DARBEPOETIN ALFA 25 MCG VIAL Medication
DARBEP40 DARBEPOETIN ALFA 40 MCG VIAL Medication
DARBEP60 DARBEPOETIN ALFA 60 MCG VIAL Medication
DARBEPOET DARBEPOETIN ALFA 100 MCG VIAL Medication
Page 18 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
DAUNORU20V DAUNOrubicin 20 MG/4 ML VIAL Medication
DAUNORU20V DAUNOrubicin 20 MG/4 ML VIAL Medication as an Additive
DEFEROX2 DEFEROXAMINE 2 GM VIAL Medication
DEFEROX2 DEFEROXAMINE 2 GM VIAL Medication as an Additive
DEGA120P3 DEGARELIX 120 MG VIAL Medication
DEGA80 DEGARELIX 80 MG VIAL Medication
DEMECLOC15 DEMECLOCYCLINE 150 MG TAB Medication
DEMECLOC30 DEMECLOCYCLINE 300 MG TAB Medication
DEN060S DENOSUMAB 60 MG/ML 1 ML INJ Medication
DENO120S DENOSUMAB 120 MG/1.7 ML INJ Medication
DEOXYRIBON DORNASE ALFA 2.5 MG/2.5 ML AMP Medication
DERMABOND DERMABOND 1 APP BOT Medication
DERMOPLAST DERMOPLAST SPRAY 1 CAN Medication
DESENEX85G MICONAZOLE NITRATE 2% POW 85 GM BOT Medication
DESENEXPWD MICONAZOLE NITRATE 2% POW 45 GRAM Medication
DESIPR10T DESIPRAMINE 10 MG TAB Medication
DESIPR25T DESIPRAMINE 25 MG TAB Medication
DESITINPAS DESITIN PASTE 57 GM TUBE Medication
DESMOPR1 DESMOPRESSIN ACETATE 0.1 MG TAB Medication
DESMOPR2 DESMOPRESSIN ACETATE 0.2 MG TAB Medication
DESMOPRINJ DESMOPRESSIN ACETATE 4 MCG/ML 1ML AMP Medication
DESMOPRINJ DESMOPRESSIN ACETATE 4 MCG/ML 1ML AMP Medication as an Additive
DESMOPRNAS DESMOPRESSIN ACETATE 10 MCG/0.1ML 5 ML NASAL SPRAY Medication
DESONI120L DESONIDE 0.05% LOTION 120 ML BOT Medication
DESONI5C DESONIDE 0.05% CREAM 15GM TUBE Medication
DESONI5O DESONIDE 0.05% OINTMENT 15GM TUBE Medication
DESOX2560C DESOXIMETASONE 0.25% CREAM 60 GM Medication
DESOXI25CR DESOXIMETASONE 0.25% CREAM 15 GM TUBE Medication
DESOXI25OI DESOXIMETASONE 0.25% OINTMENT 15 GM TUBE Medication
DESV50TA DESVENLAFAXINE 50 MG ER TAB Medication
DEX70 DEXTROSE 70% 2000 ML Medication
DEX70 DEXTROSE 70% 2000 ML Medication as a Carrier
DEX70 DEXTROSE 70% 2000 ML Medication as an Additive
DEXAMET10V DEXAMETHASONE 10 MG/ML 1ML VIAL Medication
DEXAMET10V DEXAMETHASONE 10 MG/ML 1ML VIAL Medication as an Additive
DEXAMET1T dexAMETHasone 1 MG TAB Medication
DEXAMET2T dexAMETHasone 2 MG TAB Medication
DEXAMET4T dexAMETHasone 4 MG TAB Medication
DEXAMET4V DEXAMETHASONE 4 MG/ML 1 ML VIAL Medication
DEXAMET5T dexAMETHasone 0.5 MG TAB Medication
DEXAMET75T dexAMETHasone 0.75 MG TAB Medication
DEXAMETMDV dexAMETHasone 4 MG/ML 5ML MDV Medication
Page 19 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
DEXAMETOPS dexAMETHasone SOD PHOS OPHTH SOL 0.1% 5 ML Medication
DEXAMORAL dexAMETHasone 2 MG/2 ML ORAL SYRINGE Medication
DEXAMORAL5 dexAMETHasone 5 MG/5 ML ORAL SYRINGE Medication
DEXM100S DEXMEDETOMIDINE 400 MCG/100 ML PREMIX Medication
DEXMEDET DEXMEDETOMIDINE 0.2MG/2ML VIAL Medication
DEXMEDET DEXMEDETOMIDINE 0.2MG/2ML VIAL Medication as an Additive
DEXMETH5XR DEXMETHYLPHENIDATE XR 5MG CAP Medication
DEXR500V2 DEXRAZOXANE 500 MG VIAL Medication
DEXR500V2 DEXRAZOXANE 500 MG VIAL Medication as an Additive
DEXT1CAP5 DEXTROMETHORPHAN/QUINIDINE 20 MG/10 MG CAP Medication
DEXTRAND5 DEXTRAN 40 10% D5W 500 ML BAG Medication
DEXTRANNS DEXTRAN 40/SODIUM CHLORIDE 500 ML SOL Medication
DEXTROAM10 DEXTROAMPHETAMINE SR 10 MG SRCAPSULE Medication
DEXTROAM15 DEXTROAMPHETAMINE SR 15 MG SRCAPSULE Medication
DEXTROAMP5 DEXTROAMPHETAMINE SULFATE 5 MG TAB Medication
DEXTROPED DEXTROMETHORPHAN 7.5 MG/5 ML CUP (ROBITUSSIN PEDIATRIC) Medication
DHE45 DIHYDROERGOTAMINE MESYLATE 1 MG AMP Medication
DHE45 DIHYDROERGOTAMINE MESYLATE 1 MG AMP Medication as an Additive
DIA10RECTA DIAZEPAM 10 MG ACUDIAL RECTAL GEL Medication
DIA2.5RECT diazePAM 2.5 MG RECTAL GEL Medication
DIAZEP10T DIAZEPAM 10 MG TAB Medication
DIAZEP10VL DIAZEPAM 10 MG/2 ML VIAL Medication
DIAZEP10VL DIAZEPAM 10 MG/2 ML VIAL Medication as an Additive
DIAZEP2T DIAZEPAM 2 MG TAB Medication
DIAZEP5T DIAZEPAM 5 MG TAB Medication
DIBUCAOINT DIBUCAINE 1% OINTMENT 30 GM TUBE Medication
DICL30AD DICLOFENAC 1.3% EPOLAMINE PATCH 5 PATCH/BOX Medication
DICLO100G DICLOFENAC SOD 1% GEL 100 GM Medication
DICLOF1OPH DICLOFENAC 0.1% OPTH SOL 2.5 ML Medication
DICLOF25T DICLOFENAC SODIUM 25 MG DELAYED RELEASE TAB Medication
DICLOF50T DICLOFENAC SODIUM 50 MG DELAYED RELEASE TAB Medication
DICLOF75T DICLOFENAC SODIUM 75 MG DELAYED RELEASE TAB Medication
DICLOFX100 DICLOFENAC SOD 100 MG XR TAB Medication
DICLOPOT50 DICLOFENAC POTASSIUM 50 MG TAB Medication
DICLOX250C DICLOXACILLIN SODIUM 250 MG CAP Medication
DICYCLO10C DICYCLOMINE 10 MG CAP Medication
DICYCLO10L DICYCLOMINE 10 MG/5 ML CUP Medication
DICYCLO20T DICYCLOMINE 20 MG TAB Medication
DICYCLO20V DICYCLOMINE 10 MG/ML 2ML VIAL Medication
DIFLUNI500 DIFLUNISAL 500 MG TAB Medication
DIGIFAB DIGOXIN IMUNE FAB 40 MG VIAL Medication
DIGIFAB DIGOXIN IMUNE FAB 40 MG VIAL Medication as an Additive
Page 20 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
DIGOX.5INJ DIGOXIN 250 MCG/ML 2 ML AMP Medication
DIGOX125L DIGOXIN LIQUID 125 MCG/2.5 ML ORAL SYRINGE Medication
DIGOX125T DIGOXIN 125 MCG TAB Medication
DIGOX25T DIGOXIN 250 MCG TAB Medication
DILTIA100M dilTIAZem 100 MG/100 ML D5 KIT Medication
DILTIA100M dilTIAZem 100 MG/100 ML D5 KIT Medication as a Carrier
DILTIA10IN dilTIAZem 50 MG/10 ML VIAL Medication
DILTIA10IN dilTIAZem 50 MG/10 ML VIAL Medication as an Additive
DILTIA125P dilTIAZem 125 MG/125 ML PREMIX BAG Medication
DILTIA30T dilTIAZem 30 MG TAB Medication
DILTIA5INJ dilTIAZem 25 MG/5 ML VIAL Medication
DILTIA5INJ dilTIAZem 25 MG/5 ML VIAL Medication as an Additive
DILTIA60T dilTIAZem 60 MG TAB Medication
DILTIA90T dilTIAZem 90 MG TAB Medication
DILTIZ120E dilTIAZem 120 MG ER CAP *24HR* Medication
DILTIZ180E dilTIAZem 180 MG ER CAP *24HR* Medication
DILTIZ240E dilTIAZem 240 MG ER *24HR* Medication
DILTIZ300E dilTIAZem 300 MG ER CAP *24HR* Medication
DIME5050 DIMETHYL SULFOXIDE 50 ML IRRIGATION BOT Medication
DIMEN50T dimenhyDRINATE 50 MG TAB Medication
DIMERC100I DIMERCAPROL 100 MG/ML 3 ML AMP Medication
DINOP10SUP DINOPROSTONE 10 MG VAGINAL INSERT Medication
DIPHEN125L diphenhydrAMINE 12.5 MG/5 ML CUP Medication
DIPHEN25C diphenhydrAMINE 25 MG TAB Medication
DIPHEN50C diphenhydrAMINE 50 MG CAP Medication
DIPHEN50V diphenhydrAMINE 50MG/ML INJ Medication
DIPHENCRM diphenhydrAMINE 1% CREAM 30GM TUBE Medication
DIPHTETADU TETANUS & DIPHTHERIA TOXOIDS 0.5 ML TUBEX Medication
DIPHTETPED TETANUS & DIPHTHERIA TOXOIDS PEDIATRIC 0.5 ML Medication
DIPROLE05C BETAMETHASONE DIPROP *AUGMENTED* 0.05% CREAM 15 GM TUBE Medication
DIPROLE05O BETAMETHASONE DIPROP *AUGMENTED* 0.05% OINT 15 GM TUBE Medication
DIPROSO15 BETAMETHASONE DIPROPIONATE 0.05% CREAM 15 GM TUBE Medication
DIPROSO15O BETAMETHASONE DIPROPIONATE 0.05% OINT 15 GM TUBE Medication
DIPROSO45 BETAMETHASONE DIPROPIONATE 0.05% CREAM 45 GM TUBE Medication
DIPROSO45O BETAMETHASONE DIPROPIONATE 0.05% OINT 45 GM TUBE Medication
DIPYRID25T DIPYRIDAMOLE 25 MG TAB Medication
DISULF250T DISULFIRAM 250 MG TAB Medication
DIVALP125T DIVALPROEX SODIUM 125 MG DELAYED RELEASE TAB Medication
DIVALP12SP DIVALPROEX SODIUM 125 MG SPRINKLE CAP Medication
DIVALP250T DIVALPROEX SODIUM 250 MG DELAYED RELEASE TAB Medication
DIVALP2ER DIVALPROEX SODIUM 250 MG *24 HR* EXTENDED RELEASE TAB Medication
DIVALP500T DIVALPROEX SODIUM 500 MG DELAYED RELEASE TAB Medication
Page 21 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
DIVALP5ER DIVALPROEX SODIUM 500 MG *24 HR* EXTENDED RELEASE TAB Medication
DOBU250I3 DOBUTamine PREMIX 250 MG/250 ML BAG Medication
DOBUTAM250 DOBUTamine 250 MG/20 ML VIAL Medication
DOBUTAM250 DOBUTamine 250 MG/20 ML VIAL Medication as an Additive
DOBUTDRIP DOBUTamine PREMIX 500 MG/250 ML BAG Medication
DOBUTDRIP1 DOBUTamine PREMIX 1,000 MG/250 ML BAG Medication
DOBUTSYR DOBUTamine 100MG/50ML SYRINGE Medication
DOCE10SO1 DOCEtaxel 10 MG/ML 8 ML VIAL Medication
DOCE10SO1 DOCEtaxel 10 MG/ML 8 ML VIAL Medication as an Additive
DOCOS2GM DOCOSANOL 10% 2 GM TUBE Medication
DOCUCAL240 DOCUSATE CALCIUM 240 MG LCAP Medication
DODDNOSE PHENYLEPHRINE 0.5%/LIDOCAINE 2% 10 ML BOT Medication
DOFE125 DOFETILIDE 125 MCG CAP Medication
DOFE250 DOFETILIDE 250 MCG CAP Medication
DOFE500 DOFETILIDE 500 MCG CAP Medication
DOLU50 DOLUTEGRAVIR SODIUM 50 MG TAB Medication
DOMEBORPWD DOMEBORO 2.2 GM PACKET Medication
DONE10ODT DONEPEZIL 10 MG OD TAB Medication
DONE23T DONEPEZIL 23 MG TAB Medication
DONE5ODT DONEPEZIL 5 MG OD TAB Medication
DONNATTAB DONNATAL (HYOSCYAMINE/ATROPINE/SCOPALAMINE/PHENOBARBITAL) TAB Medication
DOPAMI400V DOPamine 400 MG/10 ML VIAL Medication
DOPAMI400V DOPamine 400 MG/10 ML VIAL Medication as an Additive
DOPAMIDRIP DOPamine 400MG/250ML PREMIX Medication
DORZ10 DORZOLAMIDE 2% OPHTH SOL 10 ML Medication
DOXAPRAMVL DOXAPRAM 20 MG/ML 20ML VIAL Medication
DOXAPRAMVL DOXAPRAM 20 MG/ML 20ML VIAL Medication as an Additive
DOXAZO2 DOXAZOSIN 2 MG TAB Medication
DOXEPICONC DOXEPIN 10 MG/ML LIQ 120ML BOT Medication
DOXEPIN100 DOXEPIN 100 MG CAP Medication
DOXEPIN10C DOXEPIN 10 MG CAP Medication
DOXEPIN150 DOXEPIN 150 MG CAP Medication
DOXEPIN25C DOXEPIN 25 MG CAP Medication
DOXEPIN50C DOXEPIN 50 MG CAP Medication
DOXEPIN75C DOXEPIN 75 MG CAP Medication
DOXER0.5 DOXERCALCIFEROL 0.5 MCG CAP Medication
DOXORUB10V DOXOrubicin 10 MG/5 ML VIAL Medication
DOXORUB50 DOXOrubicin LIPOSOMAL 50 MG/25 ML VIAL Medication
DOXORUB50 DOXOrubicin LIPOSOMAL 50 MG/25 ML VIAL Medication as an Additive
DOXORUB50V DOXOrubicin 50 MG/25 ML VIAL Medication
DOXORUB50V DOXOrubicin 50 MG/25 ML VIAL Medication as an Additive
DOXY100T DOXYCYCLINE 100 MG TAB Medication
Page 22 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
DOXY100V DOXYCYCLINE 100 MG/5 ML VIAL Medication
DOXY100V DOXYCYCLINE 100 MG/5 ML VIAL Medication as an Additive
DOXY50C DOXYCYCLINE 50 MG CAP Medication
DOXY50SYR DOXYCYCLINE CALCIUM 100 MG/10 ML SYRUP Medication
DRONAB2.5 DRONABINOL 2.5 MG LCAP Medication
DRONE400T DRONEDARONE 400 MG TAB Medication
DULOXET20 DULoxetine 20 MG DR CAP Medication
DULOXET30 DULoxetine 30 MG DR CAP Medication
ECHOTH12OP ECHOTHIOPHATE 0.125% OPTH SOL 5 ML Medication
ECONAZ1C15 ECONAZOLE NITRATE 1% CREAM 15 GM TUBE Medication
EES200L ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML SUSP 100ML *BULK* Medication
EES400L ERYTHROMYCIN ETHYLSUCCINATE 400 MG/5 ML SUSP 100ML *BULK* Medication
EFAV1TAB EFAVIRENZ/EMTRICITAB/TENOFOVIR TABLET (600-200-300) Medication
EFAV200 EFAVIRENZ 200 MG CAP Medication
ELETRIP20 ELETRIPTAN 20 MG TAB Medication
EMETROL15 EMETROL ORAL SOLN 120 ML BOT Medication
ENA125I ENALAPRILAT 1.25 MG/ML 1ML VIAL Medication
ENALAP10T ENALAPRIL 10 MG TAB Medication
ENALAP25T ENALAPRIL 2.5 MG TAB Medication
ENALAP25V ENALAPRILAT 1.25 MG/ML 2ML VIAL Medication
ENALAP5T ENALAPRIL 5 MG TAB Medication
ENEMEEZ ENEMEEZ MINI ENEMA Medication
ENO80S ENOXAPARIN 80 MG/0.8 ML SYRINGE Medication
ENOX120 ENOXAPARIN 120 MG/0.8 ML SYRINGE Medication
ENOX150 ENOXAPARIN 150 MG/1 ML SYRINGE Medication
ENOX60 ENOXAPARIN 60 MG/0.6 ML SYRINGE Medication
ENOXAP100 ENOXAPARIN 100 MG/1 ML SYRINGE Medication
ENOXAP30 ENOXAPARIN 30 MG/0.3 ML SYRINGE Medication
ENOXAP40 ENOXAPARIN 40 MG/0.4 ML SYRINGE Medication
ENTAC200T ENTACAPONE 200 MG TAB Medication
ENTE0.5T ENTECAVIR 0.5 MG TABLET Medication
EPHEDR10SY ePHEDrine 5 MG/ML 10ML SYRINGE Medication
EPHEDRI50A ePHEDrine SULFATE 50 MG/ML AMP Medication
EPHEDRI50A ePHEDrine SULFATE 50 MG/ML AMP Medication as an Additive
EPI30IVMDV EPINEPHrine 1 MG/ML 30 ML MDV Medication
EPI30IVMDV EPINEPHrine 1 MG/ML 30 ML MDV Medication as an Additive
EPIAMP EPINEPHrine 0.1% 1 MG/1 ML AMP Medication
EPIAMP EPINEPHrine 0.1% 1 MG/1 ML AMP Medication as an Additive
EPIFENT fentaNYL STANDARD EPIDURAL (fentaNYL 3MCG/ML+BUPIVACAINE 0.05%) 250ML Medication
EPIFENT fentaNYL STANDARD EPIDURAL (fentaNYL 3MCG/ML+BUPIVACAINE 0.05%) 250ML Medication as an Additive
EPILD L&D STANDARD EPIDURAL(FENTANYL 2 MCG/ML+0.1% BUPIVACAINE IN NS)-100 ML Medication
Page 23 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
EPILD L&D STANDARD EPIDURAL(FENTANYL 2 MCG/ML+0.1% BUPIVACAINE IN NS)-100 ML Medication as an Additive
EPINON fentaNYL *NON-STANDARD* EPIDURAL (fentaNYL+BUPIVACAINE) 250ML Medication
EPINON fentaNYL *NON-STANDARD* EPIDURAL (fentaNYL+BUPIVACAINE) 250ML Medication as an Additive
EPIPEN EPINEPHrine 0.3 MG/0.3 ML AUTO INJECTOR Medication
EPIROPI2 ROPIVACAINE 0.2% EPIDURAL 250 ML CARTRIDGE ***FROM PREMIX BAGS*** Medication
EPIROPI2 ROPIVACAINE 0.2% EPIDURAL 250 ML CARTRIDGE ***FROM PREMIX BAGS*** Medication as an Additive
EPISYR EPINEPHRINE HCL IN 0.9 % NACL 100 MCG/10 ML SYRINGE Medication
EPISYRINGE EPINEPHrine 0.01% 1 MG/10 ML SYRINGE Medication
EPITOP30ML EPINEPHrine 1 MG/ML TOPICAL SOLN 30ML BOTTLE Medication
EPLER25T EPLERENONE 25 MG TAB Medication
EPOP0.5P EPOPROSTENOL 0.5 MG VIAL Medication
EPOP0.5P EPOPROSTENOL 0.5 MG VIAL Medication as an Additive
EPOP1.5V EPOPROSTENOL 1.5 MG VIAL Medication
EPS4LB MAGNESIUM SULFATE 4 LB BOX Medication
EPT20V EPTIFIBATIDE 20,000 MCG/10 ML VIAL Medication
EPT75V EPTIFIBATIDE 75 MG/100 ML VIAL Medication
EPT75V EPTIFIBATIDE 75 MG/100 ML VIAL Medication as a Carrier
ERLO25T ERLOTINIB 25 MG TAB Medication
ERTAP1GM ERTAPENEM 1,000 MG VIAL Medication
ERTAP1GM ERTAPENEM 1,000 MG VIAL Medication as an Additive
ERYOPTH1GM ERYTHROMYCIN 0.5% OPHTH OINT 1 GM TUBE Medication
ERYOPTH35G ERYTHROMYCIN 0.5% OPHTH OINT 3.5 GM TUBE Medication
ERYT500V ERYTHROMYCIN LACT 500 MG VIAL Medication
ERYT500V ERYTHROMYCIN LACT 500 MG VIAL Medication as an Additive
ERYTH2TOP ERYTHROMYCIN BASE 2% GEL 60 GM TUBE Medication
ERYTHB250T ERYTHROMYCIN BASE 250 MG EC TAB Medication
ERYTHB333T ERYTHROMYCIN BASE 333 MG EC TAB Medication
ESCITAL10 ESCITALOPRAM 10 MG TAB Medication
ESCITLIQ10 ESCITALOPRAM 10 MG/10 ML CUP Medication
ESGICTAB FIORICET (BUTALBITAL 50MG/APAP 325MG/CAFFEINE 40MG) CAP/TAB Medication
ESLICA200T ESLICARBAZEPINE ACETATE 200 MG TAB Medication
ESLICA400T ESLICARBAZEPINE ACETATE 400 MG TAB Medication
ESMOLOL10V ESMOLOL 100 MG/10 ML VIAL Medication
ESMOLOL10V ESMOLOL 100 MG/10 ML VIAL Medication as an Additive
ESMOLOLPRE ESMOLOL 2,500 MG/250 ML PREMIX BAG Medication
ESOMEP40IV ESOMEPRAZOLE 40 MG VIAL Medication
ESOMEP40IV ESOMEPRAZOLE 40 MG VIAL Medication as an Additive
ESTRAD25 ESTRADIOL 0.025 MG/DAY 7 DAY PATCH (CLIMARA) Medication
ESTRADCR ESTRADIOL 0.01% VAG CREAM 42.5 GM TUBE Medication
ESTRADIO1T ESTRADIOL 1 MG TAB Medication
ESTRADIO2T ESTRADIOL 2 MG TAB Medication
ESTROPAT ESTRADIOL 0.1 MG/DAY 7 DAY PATCH (CLIMARA) Medication
Page 24 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
ESTROPAT5 ESTRADIOL 0.05 MG/DAY 7 DAY PATCH (CLIMARA) Medication
ESZOPIC1 ESZOPICLONE 1 MG TAB Medication
ETANER25V ETANERCEPT 25 MG VIAL Medication
ETANER50 ETANERCEPT 50 MG SYRINGE Medication
ETHA2AMP ETHANOLAMINE OLEATE 5% 2 ML AMP Medication
ETHACRY25T ETHACRYNIC ACID 25 MG TAB Medication
ETHAMB400T ETHAMBUTOL HCL 400 MG TAB Medication
ETHOSU250C ETHOSUXIMIDE 250 MG CAP Medication
ETHOSU250L ETHOSUXIMIDE 250 MG/5 ML BOT Medication
ETHYLCHSPY ETHYL CHLORIDE SPRAY 3.5 OZ BOT Medication
ETODOL200C ETODOLAC 200 MG CAP Medication
ETODOL300C ETODOLAC 300 MG CAP Medication
ETODOL400X ETODOLAC 400 MG ER TAB Medication
ETOM2SOL12 ETOMIDATE 40 MG/20 ML VIAL Medication
ETOM2SOL12 ETOMIDATE 40 MG/20 ML VIAL Medication as an Additive
ETOMID20A ETOMIDATE 20 MG/10 ML VIAL Medication
ETOMID20A ETOMIDATE 20 MG/10 ML VIAL Medication as an Additive
ETONOG68I ETONOGESTREL 68 MG IMPLANT Medication
ETOPOSID10 ETOPOSIDE 100 MG/5 ML VIAL Medication
ETOPOSID10 ETOPOSIDE 100 MG/5 ML VIAL Medication as an Additive
EUCERIN4OZ EUCERIN 120 GM JAR Medication
EXCEDRIN ACETAMINOPHEN/ASPIRIN/CAFFEINE 250/250/65 MG TAB Medication
EXEMEST EXEMESTANE 25 MG TAB Medication
EXEN10 EXENATIDE 250 MCG/ML 2.4 ML (10 MCG/DOSE) (BYETTA) Medication
EXEN2GER EXENATIDE 2 MG SYRINGE (BYDUREON) Medication
EXEN5 EXENATIDE 250 MCG/ML 1.2 ML (5 MCG/DOSE) (BYETTA) Medication
EYESTRE EYE STREAM 30 ML EYE WASH SOLUTION Medication
EZETIM10 EZETIMIBE 10 MG TAB Medication
FACT1000 Factor VIIa, Recombinant 1000 MCG VIAL (NOVOSEVEN) Medication
FACT1000 Factor VIIa, Recombinant 1000 MCG VIAL (NOVOSEVEN) Medication as an Additive
FACT2000 Factor VIIa, Recombinant 2000 MCG VIAL (NOVOSEVEN) Medication
FACT2000 Factor VIIa, Recombinant 2000 MCG VIAL (NOVOSEVEN) Medication as an Additive
FACT5000 FACTOR VIIa, Recombinant 5000 mcg VIAL (NOVOSEVEN) Medication
FACT5000 FACTOR VIIa, Recombinant 5000 mcg VIAL (NOVOSEVEN) Medication as an Additive
FAM10 FAMOTIDINE 10 MG TAB Medication
FAMCI500 FAMCICLOVIR 500 MG TAB Medication
FAMO20PI FAMOTIDINE 20 MG/50 ML PREMIX IV Medication
FAMO20PI FAMOTIDINE 20 MG/50 ML PREMIX IV Medication as a Carrier
FAMOTI20L FAMOTIDINE 20 MG/2.5 ML ORAL SYRINGE Medication
FAMOTI20T FAMOTIDINE 20 MG TAB Medication
FAMOTI20V FAMOTIDINE 20 MG/2 ML VIAL Medication
FAMOTI20V FAMOTIDINE 20 MG/2 ML VIAL Medication as an Additive
Page 25 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
FEBU40TA FEBUXOSTAT 40 MG TAB Medication
FELBAM400 FELBAMATE 400 MG TAB Medication
FELBAM600 FELBAMATE 600 MG TAB Medication
FELODI25 FELODIPINE 2.5 MG ER TAB Medication
FELODI5 FELODIPINE 5 MG ER TAB Medication
FENO45CA FENOFIBRIC ACID 45 MG DR CAP Medication
FENOF200 FENOFIBRATE 200 MG CAP Medication
FENOF67 FENOFIBRATE 67 MG CAP Medication
FENT2AMP fentaNYL CITRATE 50 MCG/ML 2ML AMP Medication
FENT2AMP fentaNYL CITRATE 50 MCG/ML 2ML AMP Medication as an Additive
FENT5AMP FENTANYL CITRATE 50 MCG/ML 5ML AMP Medication
FENT5AMP FENTANYL CITRATE 50 MCG/ML 5ML AMP Medication as an Additive
FENTA100PT fentaNYL TRANSDERMAL PATCH 100 MCG/HR X 72 HR PATCH Medication
FENTA12PT fentaNYL TRANSDERMAL PATCH 12 MCG/HR X 72 HR PATCH Medication
FENTA25PT fentaNYL TRANSDERMAL PATCH 25 MCG/HR X 72 HR PATCH Medication
FENTA50PT fentaNYL TRANSDERMAL PATCH 50 MCG/HR X 72 HR PATCH Medication
FENTA75PT fentaNYL TRANSDERMAL PATCH 75 MCG/HR X 72 HR PATCH Medication
FENTGTT10 fentaNYL DRIP 10 MCG/ML 100 ML CASSETTE Medication
FENTPCA10 fentaNYL PCA 10 MCG/ML 100 ML CASSETTE Medication
FERAHEME FERUMOXYTOL 510 MG/17 ML VIAL Medication
FERAHEME FERUMOXYTOL 510 MG/17 ML VIAL Medication as an Additive
FERGLU300T FERROUS GLUCONATE 324 MG (36 MG IRON)TAB Medication
FEROFOLIC FERO-FOLIC-500 TAB (FERROUS SULFATE 105MG/ FOLIC ACID 0.8MG/VIT C 500MG) Medication
FERR8SOLU FERRIC SUBSULFATE 1 APP/8 ML BOT Medication
FERROSEQUL FERROUS FUMARATE/ASCORBIC ACID 65 MG FE/25 MG TAB Medication
FERSUL160T FERROUS SULFATE 140 MG ER TAB (45 MG ELEMENTAL IRON) Medication
FERSUL300L FERROUS SULFATE LIQUID 300 MG/5 ML (60 MG ELEMENTAL IRON/5 ML) CUP Medication
FERSUL325T FERROUS SULFATE 325 MG (ELEMENTAL IRON 65 MG) TAB Medication
FERSULDROP FERROUS SULFATE (15 MG FE/1 ML) 50 ML BOT Medication
FEXOF180 FEXOFENADINE 180 MG TAB Medication
FEXOF60 FEXOFENADINE 60 MG TAB Medication
FIBERCONT POLYCARBOPHIL TAB 625MG Medication
FIDA200T FIDAXOMICIN 200 MG TAB Medication
FILGRS300 FILGRASTIM-SNDZ 300 MCG/0.5 ML SYRINGE Medication
FILGRS480 FILGRASTIM-SNDZ 480 MCG/0.8 ML SYRINGE Medication
FINAST5 FINASTERIDE 5 MG TAB Medication
FIORINAL3 FIORINAL WITH CODEINE (BUTALBITAL 50/ASA 325/CAFFEINE 40/CODEINE 30MG) Medication
FIORINALT FIORINAL (BUTALBITAL 50MG/ ASPIRIN 325MG/ CAFFEINE40 MG)CAPSULE Medication
FLAVOXATE FLAVOXATE 100 MG TAB Medication
FLEC50 FLECAINIDE 50 MG TAB Medication
FLECAINIDE FLECAINIDE 100 MG TAB Medication
FLEETENEMA FLEETS ENEMA 1 BOTTLE Medication
Page 26 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
FLEETOIL MINERAL OIL 1 ENEMA BOT Medication
FLEETPED FLEETS PEDIATRIC ENEMA Medication
FLU10T FLUoxetine 10 MG CAP Medication
FLUC500C1 FLUCYTOSINE 500 MG CAP Medication
FLUCON100T FLUCONAZOLE 100 MG TAB Medication
FLUCON150T FLUCONAZOLE 150 MG TAB Medication
FLUCON200P FLUCONAZOLE 200MG/100ML NORMAL SALINE *PREMIX* Medication
FLUCON400P FLUCONAZOLE 400MG/200ML NORMAL SALINE *PREMIX* Medication
FLUCON40S FLUCONAZOLE 40 MG/ML SUSP 35ML BOT Medication
FLUDARA50V FLUDARABINE 50 MG VIAL Medication
FLUDROCO1T FLUDROCORTISONE ACETATE 0.1 MG TAB Medication
FLUMAZ10VL FLUMAZENIL 0.1 MG/ML VIAL Medication
FLUMAZ5VL FLUMAZENIL 0.1 MG/ML 5ML VIAL Medication
FLUOCIN30C FLUOCINONIDE 0.05% CREAM 30 GM TUBE Medication
FLUOCIN30O FLUOCINONIDE 0.05% OINT 30 GM TUBE Medication
FLUOCIN60S FLUOCINONIDE 0.05% SOLUTION 60 ML BOT Medication
FLUOCINO1C FLUOCINOLONE 0.01% CREAM 15 GM TUBE Medication
FLUOCINO1L FLUOCINOLONE 0.01% SOLUTION 60 ML Medication
FLUOCINO2C FLUOCINOLONE 0.025% CREAM 15 GM TUBE Medication
FLUOCINO2O FLUOCINOLONE 0.025% OINT 15 GM TUBE Medication
FLUORESBOT FLUORESCEIN 0.25%/PROPARACAINE 0.5% OPHTH SOLN 5 ML BOT Medication
FLUORESC10 FLUORESCEIN 10% INJECTION 5 ML Medication
FLUOROME1 FLUOROMETHOLONE 0.1% OPHTH SUSP 5 ML Medication
FLUOROME2 FLUOROMETHOLONE 0.25% OPHTH SUSP 5 ML Medication
FLUOROURAC FLUOROURACIL 500 MG/10 ML VIAL Medication
FLUOROURAC FLUOROURACIL 500 MG/10 ML VIAL Medication as an Additive
FLUORSTRIP FLUORESCEIN OPHTHALMIC 1 MG STRIP Medication
FLUOX1WK FLUoxetine ONCE WEEKLY 90 MG CAP Medication
FLUOXET20 FLUoxetine 20 MG CAP Medication
FLUOXET20L FLUoxetine 20 MG/5 ML CUP Medication
FLUPHEN1T fluPHENAZine 1 MG TAB Medication
FLUPHEN25D fluPHENAZine decanoate 25 MG/ML 5ML VIAL Medication
FLUPHEN2T fluPHENAZine 2.5 MG TAB Medication
FLUPHEN2V fluPHENAZine 25 MG/10 ML VIAL Medication
FLUPHEN5OC fluPHENAZine 5 MG/ML ORAL CONC Medication
FLUPHEN5T fluPHENAZine 5 MG TAB Medication
FLURAZE15 FLURAZEPAM 15 MG CAP Medication
FLURBIPROF FLURBIPROFEN 0.03% OPTH SOL 2.5 ML Medication
FLUTAM FLUTAMIDE 125 MG CAP Medication
FLUTNAS FLUTICASONE NASAL SPRAY**50/SPRAY** 120 SPRAY Medication
FLUV20T FLUVASTATIN 20 MG CAP Medication
FLUVOX50T FLUVOXAMINE 50 MG TAB Medication
Page 27 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
FOLIC4T FOLIC ACID 0.4 MG TAB Medication
FOLICT FOLIC ACID 1 MG TAB Medication
FOLICV FOLIC ACID 5 MG/ML 10ML VIAL Medication
FOLICV FOLIC ACID 5 MG/ML 10ML VIAL Medication as an Additive
FOMEPIZSDV FOMEPIZOLE 1000 MG/ML 1.5 ML VIAL Medication
FOMEPIZSDV FOMEPIZOLE 1000 MG/ML 1.5 ML VIAL Medication as a Carrier
FOMEPIZSDV FOMEPIZOLE 1000 MG/ML 1.5 ML VIAL Medication as an Additive
FONDA10 FONDAPARINUX SODIUM 10 MG/0.8 ML SYRINGE Medication
FONDA25 FONDAPARINUX SODIUM 2.5 MG/0.5 ML SYRINGE Medication
FONDA5 FONDAPARINUX SODIUM 5 MG/0.4 ML SYRINGE Medication
FONDA75 FONDAPARINUX SODIUM 7.5 MG/0.6 ML SYRINGE Medication
FORMO20/2 FORMOTEROL FUMARATE 20 MCG/2 ML NEB SOL Medication
FOSAPR150V FOSAPREPITANT DIMEGLUMINE 150 MG/5 ML VIAL Medication
FOSAPR150V FOSAPREPITANT DIMEGLUMINE 150 MG/5 ML VIAL Medication as an Additive
FOSF3PAC FOSFOMYCIN TROMETHAMINE 3 GM PACKET Medication
FOSINO10T FOSINOPRIL 10 MG TAB Medication
FOSPHE100V FOSPHENYTOIN SODIUM 100 PE/2 ML VIAL Medication
FOSPHE100V FOSPHENYTOIN SODIUM 100 PE/2 ML VIAL Medication as an Additive
FOSPHE500V FOSPHENYTOIN SODIUM 500 PE/10 ML VIAL Medication
FOSPHE500V FOSPHENYTOIN SODIUM 500 PE/10 ML VIAL Medication as an Additive
FSSHAM120 FLUOCINOLONE ACETONIDE 0.1%- 120 ML BOT Medication
FUROSEM100 FUROSEMIDE 100 MG/10 ML VIAL Medication
FUROSEM20T FUROSEMIDE 20 MG TAB Medication
FUROSEM20V FUROSEMIDE 20 MG/2 ML VIAL Medication
FUROSEM40L FUROSEMIDE SOLUTION 40 MG/5 ML CUP Medication
FUROSEM40T FUROSEMIDE 40 MG TAB Medication
FUROSEM40V FUROSEMIDE 40 MG/4 ML VIAL Medication
FUROSEM40V FUROSEMIDE 40 MG/4 ML VIAL Medication as an Additive
FUROSEM80T FUROSEMIDE 80 MG TAB Medication
FVIII1000 FACTOR VIII (ANTIHEMOPHILIC FACTOR) ~1,000 UNIT/15 ML KIT (HUMATE-P) Medication
FVIII1000 FACTOR VIII (ANTIHEMOPHILIC FACTOR) ~1,000 UNIT/15 ML KIT (HUMATE-P) Medication as an Additive
FVIII250 FACTOR VIII (ANTIHEMOPHILIC FACTOR) ~250 UNIT/5 ML KIT (HUMATE-P) Medication
FVIII250 FACTOR VIII (ANTIHEMOPHILIC FACTOR) ~250 UNIT/5 ML KIT (HUMATE-P) Medication as an Additive
FVIII500 FACTOR VIII (ANTIHEMOPHILIC FACTOR) ~500 UNIT/10 ML KIT (HUMATE-P) Medication
FVIII500 FACTOR VIII (ANTIHEMOPHILIC FACTOR) ~500 UNIT/10 ML KIT (HUMATE-P) Medication as an Additive
GABAPEN100 GABAPENTIN 100 MG CAP Medication
GABAPEN300 GABAPENTIN 300 MG CAP Medication
GABAPEN400 GABAPENTIN 400 MG CAP Medication
GABAPSUSP GABAPENTIN 250 MG/5 ML CUP Medication
GALANT GALANTAMINE 4 MG TAB Medication
GALANTER8 GALANTAMINE 8 MG ER CAP Medication
GALSULF GALSULFASE 5 MG/5 ML VIAL Medication
Page 28 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
GALSULF GALSULFASE 5 MG/5 ML VIAL Medication as an Additive
GANCIC500V GANCICLOVIR 500 MG VIAL Medication
GANCIC500V GANCICLOVIR 500 MG VIAL Medication as an Additive
GANCICOP GANCICLOVIR 0.15% OPHTH GEL 5 GM Medication
GATI2.5S GATIFLOXACIN 0.5% OPHTH SOL 2.5 ML Medication
GAVISCONT GAVISCON EX STRGTH 1 TAB CTB Medication
GELFILM GELFILM OPHTH FILM #1 (1X2 INCH) Medication
GELFLOW GEL-FLOW KIT Medication
GELFOAM+C GELFOAM PLUS COMPRESSED HEMOSTASIS KIT Medication
GELFOAM100 GELFOAM SIZE 100 SPONGE Medication
GELFOAM127 SURGIFOAM 12-7 1 SPONGE Medication
GELFOAMPLU GELFOAM PLUS HEMOSTASIS KIT Medication
GEMCIT1000 GEMCITABINE 1,000 MG/26.3 ML VIAL Medication
GEMCIT200I GEMCITABINE 200 MG/5.26 ML VIAL Medication
GEMFIB600 GEMFIBROZIL 600 MG TAB Medication
GENTA20A GENTAMICIN ** PEDIATRIC **20 MG/2 ML AMP Medication
GENTA20A GENTAMICIN ** PEDIATRIC **20 MG/2 ML AMP Medication as an Additive
GENTA3L GENTAMICIN 0.3% OPHTH SOL 5 ML Medication
GENTA3O GENTAMICIN 0.3% OPHTHALMIC OINT 3.5 GM Medication
GENTA80A GENTAMICIN SULFATE 80 MG/2 ML AMP Medication
GENTA80A GENTAMICIN SULFATE 80 MG/2 ML AMP Medication as an Additive
GENTIAVIO1 GENTIAN VIOLET 1% 59 ML BOT Medication
GENTLOCK GENT LOCK THERAPY W/HEPARIN Medication
GENTLOCK GENT LOCK THERAPY W/HEPARIN Medication as an Additive
GICOCKTAIL GI COCKTAIL 30 ML CUP Medication
GLATIR20 GLATIRAMER ACETATE 20 MG/1 ML SYRINGE Medication
GLATIR40 GLATIRAMER ACETATE 40MG/ML SYRINGE Medication
GLIM1T GLIMEPIRIDE 1 MG TAB Medication
GLIM2T GLIMEPIRIDE 2 MG TAB Medication
GLIPIZ10 glipiZIDE 10 MG TAB Medication
GLIPIZ25SR glipiZIDE XL 2.5 MG 24-HR TAB Medication
GLIPIZ5 glipiZIDE 5 MG TAB Medication
GLIPIZ5SR glipiZIDE XL 5 MG 24-HR TAB Medication
GLUCAGON1V GLUCAGON 1 MG VIAL Medication
GLUCOS2ML GLUCOSE (DEXTROSE) GEL 0.8 G/2 ML ORAL SYRINGE Medication
GLYBURI25T glyBURIDE 2.5 MG TAB Medication
GLYBURI5 glyBURIDE 5 MG TAB Medication
GLYC0.2V4 GLYCOPYRROLATE 0.4MG/2ML VIAL Medication
GLYC50SO FLOLAN STERILE DILUENT 50 ML Medication
GLYCERIAD GLYCERIN SUPPOSITORY ADULT Medication
GLYCERICH GLYCERINE SUPPOSITORY **CHILD** Medication
GLYCINE30 GLYCINE IRR 3,000 ML BAG Medication
Page 29 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
GLYCOPYR1T GLYCOPYRROLATE 1 MG TAB Medication
GLYCOPYR1V GLYCOPYRROLATE 0.2 MG/1 ML VIAL Medication
GOLYTELY4 GOLYTELY 4,000 ML BOT Medication
GRAN01 GRANISETRON 0.1 MG/ML VIAL Medication
GRAN1V GRANISETRON 1 MG/ML VIAL Medication
GUAI120L ROBITUSSIN CF (DM 20MG, guaiFENesin 200MG, PE 10MG)10 ML CUP Medication
GUAIFEN guaiFENesin 200 MG/10 ML CUP Medication
GUAIFEN5 guaiFENesin 100 MG/5 ML CUP Medication
GUAIFEN600 guaiFENesin 600 MG ERTABLET (MUCINEX) Medication
GUANF1ER guanFACINE 1 MG ER TAB (INTUNIV) Medication
GUANFA1T guanFACINE 1 MG TAB Medication
GUAR1PAC2 BENEFIBER 4 GM POWDER PACKET (WHEAT DEXTRIN-GLUTEN FREE) Medication
H201IRBOTA STERILE WATER FOR IRR *BOTTLE* 1,000 ML BOT Medication
H2O1000IV STERILE WATER FOR INJECTION 1000 ML BAG Medication
H2O10VL STERILE WATER FOR INJECTION 10 ML VIAL Medication
H2O10VL STERILE WATER FOR INJECTION 10 ML VIAL Medication as a Carrier
H2O10VL STERILE WATER FOR INJECTION 10 ML VIAL Medication as an Additive
H2O1500IRR STERILE WATER FOR IRR *BOTTLE* 1,500 ML BOT Medication
H2O20VL STERILE WATER FOR INJECTION 20 ML VIAL Medication
H2O20VL STERILE WATER FOR INJECTION 20 ML VIAL Medication as a Carrier
H2O20VL STERILE WATER FOR INJECTION 20 ML VIAL Medication as an Additive
H2O30VL STERILE WATER FOR INJECTION 30 ML VIAL Medication
H2O30VL STERILE WATER FOR INJECTION 30 ML VIAL Medication as an Additive
H2O500IRR STERILE WATER FOR IRRIGATION 500 ML *BOTTLE* Medication
HAEMBVAC HAEMOPHILUS B CONJUGATE VACCINE 10 MCG/0.5 ML VIAL Medication
HALOP100DE HALOPERIDOL DECANOATE 100 MG/ML 1ML AMP Medication
HALOP50DEC HALOPERIDOL DECANOATE 50 MG/ML 1ML AMP Medication
HALOPECONC HALOPERIDOL 2 MG/ML 5 ML ORAL CONC Medication
HALOPER.5 HALOPERIDOL 0.5 MG TAB Medication
HALOPER1 HALOPERIDOL 1 MG TAB Medication
HALOPER10T HALOPERIDOL 10 MG TAB Medication
HALOPER2 HALOPERIDOL 2 MG TAB Medication
HALOPER5 HALOPERIDOL 5 MG TAB Medication
HALOPER5A HALOPERIDOL 5 MG/ML AMP Medication
HBIG1ML HEPATITIS B IMMUNE GLOBULIN 1 ML VIAL Medication
HBIG5ML HEPATITIS B IMMUNE GLOBULIN 5 ML VIAL Medication
HCTZ12.5 hydroCHLOROthiazide 12.5 MG CAP Medication
HCTZ25 hydroCHLOROthiazide 25 MG TAB Medication
HCTZ50 hydroCHLOROthiazide 50 MG TAB Medication
HEMI313V HEMIN 313 MG/44.7 ML INJ Medication
HEMI313V HEMIN 313 MG/44.7 ML INJ Medication as an Additive
HEP100PF HEPARIN LOCK CENTRAL FLUSH 500 UNITS/5 ML(100 UNITS/ML) SYRINGE ***PF*** Medication
Page 30 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
HEP100PF HEPARIN LOCK CENTRAL FLUSH 500 UNITS/5 ML(100 UNITS/ML) SYRINGE ***PF*** Medication as an Additive
HEP2/2PF HEPARIN FLUSH 2 UNITS/2 ML(1 UNIT/ML) SYRINGE *PF* NEONATAL Medication
HEP5/5PF HEPARIN FLUSH 5 UNITS/5 ML(1 UNIT/ML) SYRINGE *PF* NEONATAL Medication
HEP5M10 HEPARIN DIALYSIS CATHETER 50,000UNITS/10ML (5,000UNIT/ML) VIAL Medication
HEPARIN10K HEPARIN SODIUM 10,000 UNIT/1 ML VIAL Medication
HEPARIN10K HEPARIN SODIUM 10,000 UNIT/1 ML VIAL Medication as an Additive
HEPARIN1K HEPARIN 10,000 UNITS/10 ML (1,000 UNITS/ML) VIAL Medication
HEPARINART HEPARIN 1000 UNITS/500 ML NS PREMIX (2 UNITS/ML) *CATH LAB ONLY* Medication
HEPARINDR HEPARIN 25,000 UNITS/250 ML (100 UNITS/ML) PREMIX BAG Medication
HEPB20SD HEPATITIS B VACCINE ADULT 20 MCG/1 ML VIAL Medication
HEPPROGMSD HEP B VACCINE PED (MERCK)PROGRAM 5 MCG/0.5 ML VIAL Medication
HEPPROGRAM HEPATITIS B VACCINE PED GSK PROGRAM 10 MCG/0.5 ML VIAL Medication
HEPPROGSYR HEP B VACCINE PED (MERCK) PROGRAM 5 MCG/0.5 ML SYRINGE Medication
HEPV5SD HEP B VACCINE PEDIATRIC (MERCK) 5 MCG/0.5 ML VIAL Medication
HEPVA HEPATITIS A VACCINE 1440 UNIT/ML 1 ML VIAL Medication
HEPVPED10 HEPATITIS B VACCINE PED GSK 10 MCG/0.5 ML VIAL Medication
HUM7030 INSULIN - HumuLIN 70/30 100 UNIT/ML 10ML VIAL Medication
HUM7030PEN INSULIN - HumuLIN 70/30 100 UNIT/ML KWIKPEN Medication
HUM7525 INSULIN - HumaLOG MIX 75/25 100 UNIT/ML 10ML VIAL Medication
HUM7525S INSULIN - HumaLOG MIX 75/25 100 UNIT/ML 3 ML KWIKPEN Medication
HUMNPH INSULIN - HUMAN NPH 100 UNIT/ML 10ML VIAL Medication
HUMNPH3 INSULIN - HUMAN NPH 100 UNIT/ML 3ML VIAL Medication
HUMR INSULIN - HUMAN REGULAR 100 UNIT/ML 10 ML VIAL Medication
HUMR INSULIN - HUMAN REGULAR 100 UNIT/ML 10 ML VIAL Medication as an Additive
HYAL150S3 HYALURONIDASE 150 UNIT/ML 1 ML VIAL Medication
HYAL2 HYLAN G-F 20 2 ML SYRINGE (8 MG/ML) Medication
HYAL200V HYALURONIDASE,OVINE 200 UNIT/1 ML 1.2 ML VIAL Medication
HYAL6 HYLAN G-F 20 6 ML SYRINGE (8 MG/ML) Medication
HYDRACET15 HYDROcodone/ACETAMINOPHEN 7.5-325 MG/15 ML CUP Medication
HYDRALA10 hydrALAZINE 10 MG TAB Medication
HYDRALA20V hydrALAZINE 20 MG/ML 1ML VIAL Medication
HYDRALA25 hydrALAZINE 25 MG TAB Medication
HYDRALA50 hydrALAZINE 50 MG TAB Medication
HYDRCOOINT HYDROCORTISONE VALERATE 0.2% OINTMENT 45 GM TUBE Medication
HYDROCO10F HYDROCORTISONE ACETATE 10% RECTAL FOAM 15 GM Medication
HYDROCO1C3 HYDROCORTISONE 1% CREAM 30 GM TUBE Medication
HYDROCO1C3 HYDROCORTISONE 1% CREAM 30 GM TUBE Medication as a Compound
HYDROCO1L4 HYDROCORTISONE 1% LOTION 120 ML BOT Medication
HYDROCO1O3 HYDROCORTISONE 1% OINT 30 GM TUBE Medication
HYDROCO2C1 HYDROCORTISONE 2.5% CREAM 20 GM TUBE Medication
HYDROCO2O2 HYDROCORTISONE 2.5% OINT 20 GM TUBE Medication
HYDROCO5C3 HYDROCORTISONE 0.5% CREAM 30 GM TUBE Medication
Page 31 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
HYDROCO5O3 HYDROCORTISONE 0.5% OINT 30 GM TUBE Medication
HYDROCOENE HYDROCORTISONE 100 MG/60 ML ENEMA Medication
HYDROCORT1 HYDROCORTISONE 10 MG TAB Medication
HYDROCOVAL HYDROCORTISONE VALERATE 0.2% CREAM 45 GM TUBE Medication
HYDROGEP16 HYDROGEN PEROXIDE 473 ML (16 OZ) BOT Medication
HYDROGNSIR HYDROGEN PEROXIDE/NS 1:1 IRR 1,000 ML BOT Medication
HYDROGWATE HYDROGEN PEROXIDE/H2O 1:1 IRR 1,000 ML BOT Medication
HYDROMGTT HYDROmorphone DRIP 200MCG/ML Medication
HYDROMOR1 HYDROmorphone HCL 1 MG INJECTION Medication
HYDROMOR1 HYDROmorphone HCL 1 MG INJECTION Medication as an Additive
HYDROMOR2A HYDROmorphone 2 MG/1 ML INJ Medication
HYDROMOR2A HYDROmorphone 2 MG/1 ML INJ Medication as an Additive
HYDROMOR2T HYDROmorphone 2 MG TAB Medication
HYDROMOR4A HYDROmorphone HCL 4 MG INJECTION Medication
HYDROMOR4A HYDROmorphone HCL 4 MG INJECTION Medication as an Additive
HYDROMOR4T HYDROmorphone 4 MG TAB Medication
HYDROMPCA HYDROmorphone PCA 200 MCG/ML-100 ML CARTRIDGE Medication
HYDROSUC1 HYDROCORTISONE SUCC 100 MG/2 ML VIAL Medication
HYDROSUC1 HYDROCORTISONE SUCC 100 MG/2 ML VIAL Medication as an Additive
HYDROSUC2 HYDROCORTISONE SUCC 250 MG/2 ML VIAL Medication
HYDROSUC2 HYDROCORTISONE SUCC 250 MG/2 ML VIAL Medication as an Additive
HYDROSUC5 HYDROCORTISONE SUCC 500 MG/4 ML VIAL Medication
HYDROSUC5 HYDROCORTISONE SUCC 500 MG/4 ML VIAL Medication as an Additive
HYDROXY10T hydrOXYzine HCL 10 MG TAB Medication
HYDROXY10V hydrOXYzine HCL 50 MG/ML VIAL Medication
HYDROXY25T hydrOXYzine HCL 25 MG TAB Medication
HYDROXY25V hydrOXYzine HCL 25 MG/ML VIAL Medication
HYDROXY50T hydrOXYzine HCL 50 MG TAB Medication
HYDROXYCHL HYDROXYCHLOROQUINE SULFATE 200 MG TAB Medication
HYDROXYURE HYDROXYUREA 500 MG CAP Medication
HYOSCAM1S HYOSCYAMINE 0.125 MG TAB (SL, CHEWABLE OR ORAL) Medication
HYPERTET TETANUS IMMUNE GLOBULIN 250 UNIT SYRINGE Medication
IBUP20VI IBUPROFEN LYSINE/PF 20 MG/2 ML NEONATAL Medication
IBUP20VI IBUPROFEN LYSINE/PF 20 MG/2 ML NEONATAL Medication as an Additive
IBUPRO100C IBUPROFEN 100 MG CHEW Medication
IBUPRO200 IBUPROFEN 200 MG TAB Medication
IBUPRO400 IBUPROFEN 400 MG TAB Medication
IBUPRO600 IBUPROFEN 600 MG TAB Medication
IBUPRO800 IBUPROFEN 800 MG TAB Medication
IBUPROSUS IBUPROFEN 100 MG/5 ML CUP Medication
IBUPROSUSP IBUPROFEN 200 MG/10 ML CUP Medication
IDARUB10V IDArubicin 10 MG/10 ML VIAL Medication
Page 32 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
IDARUB5V IDArubidin 5 MG/5 ML VIAL Medication
IFOSFA1 IFOSFAMIDE 1 GM/20 ML VIAL Medication
IFOSFA3 IFOSFAMIDE 3 GM/60 ML VIAL Medication
IFOSFA3 IFOSFAMIDE 3 GM/60 ML VIAL Medication as an Additive
ILEX ILEX (ZINC/WHITE PETROLATUM) PASTE 57 GM TUBE Medication
ILOP4TAB ILOPERIDONE 4 MG TAB Medication
ILOP6TAB ILOPERIDONE 6 MG TAB Medication
IMIPRAM10T IMIPRAMINE 10 MG TAB Medication
IMIPRAM25T IMIPRAMINE 25 MG TAB Medication
IMIPRAM50 IMIPRAMINE 50 MG TAB Medication
IMMU10/100 IMMUNE GLOBULIN 10% 10 GM/100 ML VIAL (GAMUNEX-C) Medication
IMMU10/100 IMMUNE GLOBULIN 10% 10 GM/100 ML VIAL (GAMUNEX-C) Medication as an Additive
IMMU10OCT IMMUNE GLOBULIN 10% 10 GM/100 ML VIAL (OCTAGAM) Medication
IMMU10OCT IMMUNE GLOBULIN 10% 10 GM/100 ML VIAL (OCTAGAM) Medication as an Additive
IMMU20/200 IMMUNE GLOBULIN 10% 20 GM/200 ML VIAL (GAMUNEX-C) Medication
IMMU20/200 IMMUNE GLOBULIN 10% 20 GM/200 ML VIAL (GAMUNEX-C) Medication as an Additive
IMMU20OCT IMMUNE GLOBULIN 10% 20 GM/200 ML VIAL (OCTAGAM) Medication
IMMU20OCT IMMUNE GLOBULIN 10% 20 GM/200 ML VIAL (OCTAGAM) Medication as an Additive
IMMU50VI3 IMMUNE GLOBULIN,GAMMA (IGG) 5 GM/50 ML (PRIVIGEN) Medication
IMMU50VI3 IMMUNE GLOBULIN,GAMMA (IGG) 5 GM/50 ML (PRIVIGEN) Medication as a Carrier
IMMU50VI3 IMMUNE GLOBULIN,GAMMA (IGG) 5 GM/50 ML (PRIVIGEN) Medication as an Additive
IMMU5OCT IMMUNE GLOBULIN 10% 5 GM/50 ML VIAL (OCTAGAM) Medication
IMMU5OCT IMMUNE GLOBULIN 10% 5 GM/50 ML VIAL (OCTAGAM) Medication as an Additive
INDAPAM INDAPAMIDE 2.5 MG TAB Medication
INDIGOC INDIGOTINDISULFONATE SOD 5 ML AMP Medication
INDO1VIA INDOMETHACIN SODIUM TRIHYDRATE 1 MG VIAL Medication
INDOCGREEN INDOCYANINE GREEN 25MG PWVL/DILUENT Medication
INDOMETH25 INDOMETHACIN 25 MG CAP Medication
INDOMETH50 INDOMETHACIN 50 MG CAP Medication
INDOMETH75 INDOMETHACIN SR 75 MG SRCAPSULE Medication
INDOMETHSU INDOMETHACIN 50 MG SUPP Medication
INFLIXABDA inFLIXimab-ABDA 100 MG/10 ML VIAL Medication
INFLIXABDA inFLIXimab-ABDA 100 MG/10 ML VIAL Medication as an Additive
INFLUCEL INFLUENZA VACCINE 0.5 ML (FLUCELVAX) 4yr-ADULT 2019-2020 *EGG FREE* Medication
INFLULAVQ INFLUENZA VACCINE 0.5 ML (FLULAVAL QUAD) 6mo-ADULT 2019-2020 Medication
INSGLU INSULIN APIDRA 100 UNIT/ML 10ML VIAL Medication
INSU500PEN INSULIN - HUMAN REGULAR *500 UNIT/ML* PEN ***HIGH ALERT*** Medication
INTER1A INTERFERON BETA 1A 30 MCG/0.5 ML PREFILLED SYR Medication
INTER1A22 INTERFERON BETA 1A 22 MCG/0.5 ML INJ Medication
INTER1A44 INTERFERON BETA 1A 44 MCG/0.5 ML INJ Medication
INTERFER1B INTERFERON BETA 1B 0.3 MG INJ Medication
INTRONA3 INTERFERON ALFA-2B 18 MILLION UNIT VIAL Medication
Page 33 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
IODINESTR STRONG IODINE (LUGOL'S SOL) (5%) 14 ML BOTTLE Medication
IODINETINC IODINE TINCTURE 2% 30 ML BOTTLE Medication
IOH30010 IOHEXOL 300 MG/ML 10ML VIAL Medication
IPRA03NA IPRATROPIUM NASAL SPRAY 0.03% 30 ML Medication
IPRA06NA IPRATROPIUM NASAL SPRAY 0.06% 15 ML Medication
IPRA2.5S9 IPRATROPIUM BROMIDE 0.5 MG/2.5 ML NEBSOL Medication
IPRA3AMP16 ALBUTEROL/IPRATROPIUM 3 ML NEB SOL Medication
IRB150 IRBESARTAN 150 MG TAB Medication
IRB300 IRBESARTAN 300 MG TAB Medication
IRB75 IRBESARTAN 75 MG TAB Medication
IRINOT100V IRINOTECAN 20 MG/ML 5 ML VIAL Medication
IRINOT100V IRINOTECAN 20 MG/ML 5 ML VIAL Medication as an Additive
IRONSUC IRON SUCROSE INJ 20 MG/ML 5ML VIAL Medication
IRONSUC IRON SUCROSE INJ 20 MG/ML 5ML VIAL Medication as an Additive
ISAVUC372V ISAVUCONAZONIUM 372 MG VIAL Medication
ISAVUC372V ISAVUCONAZONIUM 372 MG VIAL Medication as an Additive
ISOFLUR100 ISOFLURANE 100 ML BOT Medication
ISONIAZ300 ISONIAZID 300 MG TAB Medication
ISONIAZ50S ISONIAZID 50 MG/5 ML SYRUP Medication
ISOPRO1ML ISOPROTERENOL 0.2 MG/1 ML AMP Medication
ISOPRO1ML ISOPROTERENOL 0.2 MG/1 ML AMP Medication as an Additive
ISOPROP480 ISOPROPYL ALCOHOL 480 ML BOT Medication
ISOSOR10T ISOSORBIDE DINITRATE 10 MG TAB Medication
ISOSOR20T ISOSORBIDE DINITRATE 20 MG TAB Medication
ISOSOR30T ISOSORBIDE DINITRATE 30 MG TAB Medication
ISOSOR5T ISOSORBIDE DINITRATE 5 MG TAB Medication
ISOSORM20T ISOSORBIDE MONONITRATE 20 MG TAB Medication
ISOSORM30S ISOSORBIDE MONONITRATE 30 MG ER TAB Medication
ISOSORM60S ISOSORBIDE MONONITRATE 60 MG ER TAB Medication
ISOSULF1IN ISOSULFAN BLUE 10 MG/ML 5 ML SDPF VIAL Medication
ISOTRET40 ISOTRETINOIN 40 MG CAP Medication
ISOXSU10T ISOXSUPRINE 10 MG TAB Medication
ITRACON100 ITRACONAZOLE 100 MG CAP Medication
IVAB5TAB IVABRADINE 5 MG TAB Medication
KCL10RD KCL 10 MEQ IN SWI 100 ML PREMIX Medication
KCL10T POTASSIUM CHLORIDE 10 MEQ ER CAPSULE/TAB Medication
KCL20EFF POTASSIUM BICARB/CITRIC ACID 20 MEQ EFFERVESCENT TAB Medication
KCL20IV POTASSIUM CHLORIDE IV 20 MEQ/10 ML VIAL Medication
KCL20IV POTASSIUM CHLORIDE IV 20 MEQ/10 ML VIAL Medication as an Additive
KCL20L POTASSIUM CHLORIDE LIQUID 20 MEQ/15 ML CUP Medication
KCL20RD KCL 20 MEQ IN SWI 100ML PREMIX Medication
KCL20T POTASSIUM CHLORIDE 20 MEQ ER TAB Medication
Page 34 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
KCL40IV POTASSIUM CHLORIDE IV 40 MEQ/20 ML VIAL Medication
KCL40IV POTASSIUM CHLORIDE IV 40 MEQ/20 ML VIAL Medication as an Additive
KCL40L POTASSIUM CHLORIDE LIQUID 40 MEQ/30 ML CUP Medication
KCL8C POTASSIUM CHLORIDE ER 8MEQ SRTABLET Medication
KETAMI2 KETAMINE 100 MG/2 ML SYRINGE Medication
KETAMI200 KETAMINE 200 MG/20 ML MDV Medication
KETAMI200 KETAMINE 200 MG/20 ML MDV Medication as an Additive
KETAMI5ML KETAMINE 100MG/ML 5 ML VIAL Medication
KETAMI5ML KETAMINE 100MG/ML 5 ML VIAL Medication as an Additive
KETAMIINJ KETAMINE 500 MG/10 ML VIAL Medication
KETAMIINJ KETAMINE 500 MG/10 ML VIAL Medication as an Additive
KETO200C KETOPROFEN 200MG CAP 200 MG CAP Medication
KETOCONSHA KETOCONAZOLE 2% SHAMPOO 120 ML Medication
KETOCONTOP KETOCONAZOLE 2% CREAM 15 GM TUBE Medication
KETOPRO75C KETOPROFEN 75 MG CAP Medication
KETOR10T KETOROLAC TROMETHAMINE 10 MG TAB Medication
KETOR15INJ KETOROLAC 15 MG VIAL Medication
KETOR30INJ KETOROLAC 30 MG VIAL Medication
KETOR60INJ KETOROLAC 60 MG VIAL Medication
KETOROPSOL KETOROLAC 0.5% OPHTH SOL 5 ML Medication
KOND30UD MINERAL OIL SUSPENSION 30 ML CUP Medication
LABETA100T LABETALOL 100 MG TAB Medication
LABETA100V LABETALOL HCL 100 MG/20 ML VIAL Medication
LABETA100V LABETALOL HCL 100 MG/20 ML VIAL Medication as an Additive
LABETA200T LABETALOL 200 MG TAB Medication
LABETA200V LABETALOL 200 MG/40 ML VIAL Medication
LABETA200V LABETALOL 200 MG/40 ML VIAL Medication as an Additive
LABETA20V LABETALOL HCL 20 MG/4 ML INJ Medication
LABETA20V LABETALOL HCL 20 MG/4 ML INJ Medication as an Additive
LABETA300T LABETALOL 300 MG TAB Medication
LACHYDRIN5 AMMONIUM LACTATE 12% LOTION 400 GM BOTTLE Medication
LACO100T2 LACOSAMIDE 100 MG TAB Medication
LACO200L LACOSAMIDE 200 MG/20 ML CUP Medication
LACO200T2 LACOSAMIDE 200 MG TAB Medication
LACO200V LACOSAMIDE 200 MG/20 ML INJ Medication
LACO200V LACOSAMIDE 200 MG/20 ML INJ Medication as an Additive
LACTAID LACTAID TAB Medication
LACTOBACAP LACTOBACILLUS RHAMNOSUS GG CAPSULE Medication
LACTULO30L LACTULOSE 30 ML CUP Medication
LAMI10SO LAMIVUDINE 10 MG/ML ORAL SUSPENSION 240 ML BOTTLE Medication
LAMIV150T lamiVUDine 150 MG TAB Medication
LAMO100T2 lamoTRIgine 100 MG XR TAB Medication
Page 35 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
LAMO100T3 lamoTRIgine 100 MG ORALLY DISINT TAB Medication
LAMO25TA6 lamoTRIgine 25 MG XR TAB Medication
LAMO25TA7 lamoTRIgine 25 MG ORALLY DISINT TAB Medication
LAN15SOLU LANSOPRAZOLE 15 MG SOLUTAB Medication
LAN30SOLU LANSOPRAZOLE 30 MG SOLUTAB Medication
LANOLINCRM LANOLIN OINTMENT 0.25 OZ TUBE Medication
LANSOP15C LANSOPRAZOLE 15 MG DR CAP Medication
LANSOP30T LANSOPRAZOLE 30 MG DR CAP Medication
LANTHAN LANTHANUM CARBONATE 500 MG TAB Medication
LATANOPH25 LATANOPROST 0.005% OPHTH SOL 2.5 ML Medication
LECITHICAP LECITHIN CAP Medication
LEFLUN10 LEFLUNOMIDE 10 MG TAB Medication
LET LET GEL 3 ML Medication
LETROZ25 LETROZOLE 2.5 MG TAB Medication
LEUCOVO100 LEUCOVORIN CALCIUM 100 MG VIAL Medication
LEUCOVO50V LEUCOVORIN CALCIUM 50 MG VIAL Medication
LEUCOVO5T LEUCOVORIN CALCIUM 5 MG TAB Medication
LEV500L levoFLOXacin 500 MG/20 ML ORAL SOLUTION Medication
LEVA1.255 LEVALBUTEROL 1.25 MG/0.5ML NEB Medication
LEVA31 LEVALBUTEROL 0.31 MG/3 ML NEB SOLUTION ***PEDIATRIC*** Medication
LEVAL1.253 LEVALBUTEROL 1.25 MG/3 ML NEB Medication
LEVAL63 LEVALBUTEROL 0.63 MG/3 ML NEB SOLUTION Medication
LEVE750T56 levETIRAcetam 750 MG XR TAB Medication
LEVET1000P levETIRAcetam 1,000 MG/100 ML PREMIX BAG Medication
LEVET250T levETIRAcetam 250 MG TAB Medication
LEVET500 levETIRAcetam 500 MG TAB Medication
LEVET500IV levETIRAcetam 500 MG/5 ML VIAL Medication
LEVET500IV levETIRAcetam 500 MG/5 ML VIAL Medication as an Additive
LEVET500P levETIRAcetam 500 MG/100 ML PREMIX BAG Medication
LEVET500XR levETIRAcetam 500 MG XR TAB Medication
LEVETSOLN levETIRAcetam 500 MG/5 ML ORAL SOLN CUP Medication
LEVOBUN55 LEVOBUNOLOL 0.5 % OPHTH SOL 5 ML Medication
LEVOC1GM LEVOCARNITINE 1000 MG/5 ML VIAL Medication
LEVOC1GM LEVOCARNITINE 1000 MG/5 ML VIAL Medication as an Additive
LEVOC330 LEVOCARNITINE 330 MG CAP Medication
LEVOF250T levoFLOXacin 250 MG TAB Medication
LEVOF500P levoFLOXacin 500 MG/100 ML PREMIX BAG Medication
LEVOF500T levoFLOXacin 500 MG TAB Medication
LEVOF500V levoFLOXacin 500 MG/20 ML VIAL Medication
LEVOF500V levoFLOXacin 500 MG/20 ML VIAL Medication as an Additive
LEVOF750P levoFLOXacin 750 MG/150 ML PREMIX BAG Medication
LEVOF750T levoFLOXacin 750 MG TAB Medication
Page 36 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
LEVOM20ERC LEVOMILNACIPRAN 20 MG ER CAP Medication
LEVONOR15T LEVONORGESTREL 1.5 MG TAB Medication
LEVOPRE250 levoFLOXacin 250 MG/50 ML PREMIX BAG Medication
LEVOTH100V LEVOTHYROXINE SOD 100 MCG INJECTION Medication
LEVOTH112T LEVOTHYROXINE SOD 112 MCG TAB Medication
LEVOTH125T LEVOTHYROXINE SOD 125 MCG TAB Medication
LEVOTH137T LEVOTHYROXINE SOD 137 MCG TAB Medication
LEVOTH15T LEVOTHYROXINE SOD 150 MCG TAB Medication
LEVOTH175T LEVOTHYROXINE SOD 175 MCG TAB Medication
LEVOTH1T LEVOTHYROXINE SOD 100 MCG TAB Medication
LEVOTH25T LEVOTHYROXINE SOD 25 MCG TAB Medication
LEVOTH2T LEVOTHYROXINE SOD 200 MCG TAB Medication
LEVOTH5T LEVOTHYROXINE SOD 50 MCG TAB Medication
LEVOTH75T LEVOTHYROXINE SOD 75 MCG TAB Medication
LEVOTH88T LEVOTHYROXINE SOD 88 MCG TAB Medication
LIBRAXCAP LIBRAX 1 CAPSULE Medication
LID1MDV50 LIDOCAINE 1% (10 MG/ML) 50ML MDV Medication
LIDO100JET LIDOCAINE 2% 100 MG/5 ML SYRINGE Medication
LIDO10VI21 LIDOCAINE 1% (10 MG/ML) 10ML MDV Medication
LIDO10VI4 LIDOCAINE 1% W/EPI 1:200,000 10ML SDV Medication
LIDO10VI9 LIDOCAINE 1% (10 MG/ML) 2ML PF VIAL Medication
LIDO15AMP LIDOCAINE 1.5% 20 ML AMP PF Medication
LIDO15E30V LIDOCAINE 1.5% W/EPI 1:200,000 30ML SDV Medication
LIDO15EAMP LIDOCAINE 1.5% W/EPI 1:200,000 5ML PF AMP Medication
LIDO15PF LIDOCAINE 1% (10 MG/ML) PF 5 ML SDV (50 MG/5 ML) Medication
LIDO15PF LIDOCAINE 1% (10 MG/ML) PF 5 ML SDV (50 MG/5 ML) Medication as an Additive
LIDO1AMP LIDOCAINE HCL 1% MPF 10 ML POLY AMP Medication
LIDO1E110 LIDOCAINE 1% W/EPI 1:100,000 10ML MDV Medication
LIDO1E110 LIDOCAINE 1% W/EPI 1:100,000 10ML MDV Medication as an Additive
LIDO1E1MDV LIDOCAINE 1% W/EPI 1:100,000 30ML MDV Medication
LIDO1E1MDV LIDOCAINE 1% W/EPI 1:100,000 30ML MDV Medication as an Additive
LIDO1E2SDV LIDOCAINE 1% W/EPI 1:200,000 30ML SDV Medication
LIDO1MDV LIDOCAINE 1% (10 MG/ML) 20ML MDV Medication
LIDO1TTOP LIDOCAINE HCL 1% 30ML TEAR TOP/VIAL Medication
LIDO1TTOP LIDOCAINE HCL 1% 30ML TEAR TOP/VIAL Medication as an Additive
LIDO20VI12 LIDOCAINE 1% W/EPI 1:100,000 20ML MDV Medication
LIDO20VI12 LIDOCAINE 1% W/EPI 1:100,000 20ML MDV Medication as an Additive
LIDO20VI7 LIDOCAINE 2% PF 5 ML VIAL (20 MG/ML) Medication
LIDO2AMP LIDOCAINE 2% PF 10 ML AMP (20 MG/ML) Medication
LIDO2AMP LIDOCAINE 2% PF 10 ML AMP (20 MG/ML) Medication as an Additive
LIDO2E150 LIDOCAINE 2% W/EPI 1:100,000 50ML MDV Medication
LIDO2E1MDV LIDOCAINE 2% W/EPI 1:100,000 20ML MDV Medication
Page 37 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
LIDO2E2SDV LIDOCAINE 2% W/EPI 1:200,000 20ML SDV Medication
LIDO2GMBAG LIDOCAINE 2GM/D5W 500ML PREMIX Medication
LIDO2JEL30 LIDOCAINE 2% JELLY 30 APP/30 ML TUBE Medication
LIDO2JEL5 LIDOCAINE 2% JELLY 5 APP/5 ML TUBE Medication
LIDO2JEL5 LIDOCAINE 2% JELLY 5 APP/5 ML TUBE Medication as a Compound
LIDO2JEL6 LIDOCAINE 2% JELLY PF 6 ML APPLICATOR Medication
LIDO2MDV LIDOCAINE HCL 2% 20ML MDV Medication
LIDO2MDV LIDOCAINE HCL 2% 20ML MDV Medication as an Additive
LIDO2MDV10 LIDOCAINE HCL 2% 10 ML MDV Medication
LIDO2MDV50 LIDOCAINE HCL 20 MG/ML VIAL 50 ML MDV Medication
LIDO2MDV50 LIDOCAINE HCL 20 MG/ML VIAL 50 ML MDV Medication as an Additive
LIDO2PO100 LIDOCAINE 2% VISCOUS SOLUTION 100 ML BOTTLE Medication
LIDO2PO20 LIDOCAINE VISCOUS 2% SOLN 15 ML CUP Medication
LIDO2SDV2 LIDOCAINE HCL 2% MPF 2 ML VIAL Medication
LIDO2URO LIDOCAINE 2% UROJET 5 ML SYRINGE Medication
LIDO4/5 LIDOCAINE PF 4% 5 ML SOLUTION Medication
LIDO4TOPS LIDOCAINE HCL 4% TOPICAL SOLUTION 50 ML BOTTLE Medication
LIDO50VI6 LIDOCAINE 1% W/EPI 1:100,000 50ML MDV Medication
LIDO50VI6 LIDOCAINE 1% W/EPI 1:100,000 50ML MDV Medication as an Additive
LIDO5D75 LIDOCAINE HCL 5% W/DEXTROSE 7.5% 2 ML AMP Medication
LIDO5E2MDV LIDOCAINE 0.5% W/EPI 1:200,000 50ML MDV Medication
LIDO5MDV LIDOCAINE 0.5% 50ML MDV Medication
LIDO5MLOR LIDOCAINE 2% 20 MG/ML 5ML SYRINGE Medication
LIDO5OINT LIDOCAINE HCL 5% OINTMENT 35 GM TUBE Medication
LIDO5SDV LIDOCAINE MPF 0.5% 50 ML SDV Medication
LIDODRESS LIDOCAINE 4% CREAM 5 GM TUBE (L-M-X-4) Medication
LIDOPEDCOR LIDOCAINE 2 GM/D5W 250 ML PREMIX (8000 MCG/ML) Medication
LIDOPTCH1 LIDOCAINE 5% "SINGLE" PATCH Medication
LINA145C LINACLOTIDE 145 MCG CAP Medication
LINA5TAB2 LINAGLIPTIN 5 MG TAB Medication
LINA72C LINACLOTIDE 72 MCG CAP Medication
LINEZ600 LINEZOLID 600 MG/300 ML PREMIX BAG Medication
LINEZSUSP LINEZOLID 100 MG/5 ML SUSP 150ML BOTTLE Medication
LINZLID LINEZOLID 600 MG TAB Medication
LIOTHYR25T LIOTHYRONINE SOD 25 MCG TAB Medication
LIOTHYR5T LIOTHYRONINE SOD 5 MCG TAB Medication
LIPID20 FAT EMULSION 20% 500ML BAG Medication
LIPID20 FAT EMULSION 20% 500ML BAG Medication as a Carrier
LIPID20 FAT EMULSION 20% 500ML BAG Medication as an Additive
LIPID20250 FAT EMULSION 20% 250 ML BAG Medication
LIPID20250 FAT EMULSION 20% 250 ML BAG Medication as a Carrier
LIPID20250 FAT EMULSION 20% 250 ML BAG Medication as an Additive
Page 38 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
LIPID20L FAT EMULSION 20% 1000 ML BOT Medication
LIPID20L FAT EMULSION 20% 1000 ML BOT Medication as a Carrier
LIPID20L FAT EMULSION 20% 1000 ML BOT Medication as an Additive
LIRA6SYR LIRAGLUTIDE 6 MG/ML SYRINGE 3 ML Medication
LISDEX20C LISDEXAMFETAMINE 20 MG CAP Medication
LISDEX30C LISDEXAMFETAMINE 30 MG CAP OR CHEW TAB Medication
LISDEX50C LISDEXAMFETAMINE 50 MG CAP Medication
LISDEX70C LISDEXAMFETAMINE 70 MG CAP Medication
LISINO10T LISINOPRIL 10 MG TAB Medication
LISINO20T LISINOPRIL 20 MG TAB Medication
LISINO25T LISINOPRIL 2.5 MG TAB Medication
LISINO40T LISINOPRIL 40 MG TAB Medication
LISINO5T LISINOPRIL 5 MG TAB Medication
LITH300SR LITHIUM CARBONATE SR 300 MG SRTABLET Medication
LITH300T LITHIUM CARBONATE 300 MG TAB Medication
LITH450SR LITHIUM CARBONATE SR 450 MG SRTABLET Medication
LITHCIT8L LITHIUM CITRATE 8 MEQ/5 ML CUP Medication
LMX30 LIDOCAINE 4% CREAM 30 GM (LMX4) Medication
LOMOTIL25T DIPHENOXYLATE-ATROPINE TAB Medication
LOMOTIL5ML DIPHENOXYLATE-ATROPINE 2.5 MG/5 ML CUP Medication
LOMUST10C LOMUSTINE 10 MG CAP Medication
LOMUST40C LOMUSTINE 40 MG CAP Medication
LOPERAM1L LOPERAMIDE 2 MG/10 ML CUP Medication
LOPERAM2C LOPERAMIDE 2 MG CAP Medication
LORA2ORA LORAZEPAM 2 MG/1 ML ORAL CONC 30 ML BOTTLE Medication
LORAT10OD LORATADINE 10 MG ORALLY DISINTEGRATING TAB Medication
LORAT1L LORATADINE 5 MG/5 ML ORAL SOLUTION Medication
LORATA10 LORATADINE 10 MG TAB Medication
LORAZEP1T LORazepam 1 MG TAB Medication
LORAZEP2I LORazepam 2 MG/1 ML VIAL Medication
LORAZEP2MD LORazepam 2 MG/ML 10ML VIAL Medication
LORAZEP2MD LORazepam 2 MG/ML 10ML VIAL Medication as a Carrier
LORAZEP2MD LORazepam 2 MG/ML 10ML VIAL Medication as an Additive
LORAZEP5T LORazepam 0.5 MG TAB Medication
LOSAR100T LOSARTAN 100 MG TAB Medication
LOSAR25T LOSARTAN 25 MG TAB Medication
LOT0.55 LOTEPREDNOL ETABONATE 0.5% OPHTH SUSP 5 ML Medication
LOTRISCR45 LOTRISONE CREAM 45 GM TUBE Medication
LOTRISONCR LOTRISONE CREAM 15 GM TUBE Medication
LOTRISONLO LOTRISONE LOTION 30 ML BOTTLE Medication
LOVASTA20T LOVASTATIN 20 MG TAB Medication
LOXAPIN10C LOXAPINE SUCCINATE 10 MG CAP Medication
Page 39 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
LOXAPIN25C LOXAPINE SUCCINATE 25 MG CAP Medication
LOXAPIN5C LOXAPINE SUCCINATE 5 MG CAP Medication
LR1000 LACTATED RINGERS 1000 ML BAG Medication
LR500 LACTATED RINGERS 500 ML BAG Medication
LTAKIT LTA KIT (LIDOCAINE 4%) Medication
LUBEYEGEL CARBOXYMETHYLCELLULOSE (REFRESH CELLUVISC) 0.4 ML GEL DROPPERETTE Medication
LUBI24CAP LUBIPROSTONE 24 MCG GELCAP Medication
LUBI8CAP LUBIPROSTONE 8 MCG GELCAP Medication
LUBRID16OZ LUBRIDERM LOTION 480 ML BOT (16 OZ) Medication
LUBRIJEL27 LUBRICATING JELLY 3 GM PACKET Medication
LUM20G LUMBAR 20G BULK Medication
LURA20T LURASIDONE 20 MG TAB Medication
LURA40TA1 LURASIDONE 40 MG TAB Medication
MAG20WPRE MAGNESIUM SO4 20 GM/500 ML H2O PREMIX BAG Medication
MAG237MO MAGIC MOUTHWASH 20 ML UD CUP Medication
MAG2GMCOM MAGNESIUM SULFATE 2 GM/50 ML D5W BAG Medication
MAG4GMCOM MAGNESIUM SULFA 4 GM/50 ML D5W Medication
MAGBOLUS2W MAGNESIUM SO4 2 GM/50ML H2O PREMIX BAG Medication
MAGBOLUS4W MAGNESIUM SO4 4 GM/50ML H2O PREMIX BAG Medication
MAGCIT MAGNESIUM CITRATE 300 ML BOT Medication
MAGGLU500T MAGNESIUM GLUCONATE 500 MG TAB Medication
MAGOX250T MAGNESIUM OXIDE 400MG TAB (MAGNESIUM 240 MG) Medication
MAGPREMIXW MAGNESIUM S04 40GM/H2O 1000 ML PREMIX BAG Medication
MAGSUL16OZ MAGNESIUM SULFATE 16 OZ BOX Medication
MAGSUL1GMV MAGNESIUM SULFATE 1 GM/2 ML VIAL Medication
MAGSUL1GMV MAGNESIUM SULFATE 1 GM/2 ML VIAL Medication as an Additive
MAGSUL25GV MAGNESIUM SULFATE 25 GM/50 ML VIAL Medication
MAGSUL25GV MAGNESIUM SULFATE 25 GM/50 ML VIAL Medication as an Additive
MAGSUL5GMV MAGNESIUM SULF 5 GM/10 ML VIAL Medication
MAGSUL5GMV MAGNESIUM SULF 5 GM/10 ML VIAL Medication as an Additive
MAGSUL8IV MAGNESIUM SULFATE 8 MEQ/2 ML VIAL Medication
MAGSUL8IV MAGNESIUM SULFATE 8 MEQ/2 ML VIAL Medication as an Additive
MANFILTER 0.22 MICRON FILTER 1 UNIT Medication
MANNIT50ML MANNITOL 25% 12.5 GM/50ML VIAL Medication
MANNIT50ML MANNITOL 25% 12.5 GM/50ML VIAL Medication as an Additive
MANNITOL20 MANNITOL 20% 100 GM/500 ML BAG Medication
MANNITOL20 MANNITOL 20% 100 GM/500 ML BAG Medication as a Carrier
MANNITOL20 MANNITOL 20% 100 GM/500 ML BAG Medication as an Additive
MAPROTIL25 MAPROTILINE 25 MG TAB Medication
MASTISOL MASTISOL LIQUID ADHESIVE 2/3 ML VIAL Medication
MAXITOPHML MAXITROL OPTH SUSP 5 ML Medication
MAXITOPHOT MAXITROL OPHTH OINT 3.5 GM Medication
Page 40 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
MAXZIDE25T TRIAMTERENE/HCTZ 37.5-25 MG TAB Medication
MAXZIDETAB TRIAMTERENE/HCTZ 75-50 MG TAB Medication
MCT30LIQ MEDIUM CHAIN TRIGLYCERIDES 946 ML BOT (1 QUART) Medication
MECLIZ125T MECLIZINE 12.5 MG TAB Medication
MECLIZ25TB MECLIZINE 25 MG TAB Medication
MECLOFE100 MECLOFENAMATE 100 MG CAP Medication
MEDROX100V medroxyPROGESTERone ACETA 150 MG/ML 1 ML VIAL Medication
MEDROXY10T medroxyPROGESTERone ACETA 10 MG TAB Medication
MEDROXY25T medroxyPROGESTERone ACETATE 2.5 MG TAB Medication
MEGES10ML MEGESTROL ACETATE 400 MG/10 ML CUP Medication
MEGESTR20T MEGESTROL ACETATE 20 MG TAB Medication
MEGESTR40T MEGESTROL ACETATE 40 MG TAB Medication
MELA3 MELATONIN 3 MG TAB Medication
MELOX7.5 MELOXICAM 7.5 MG TAB Medication
MEMANTINE5 MEMANTINE 5 MG TAB Medication
MEMANTXR14 MEMANTINE 14 MG ER CAP Medication
MEMANTXR21 MEMANTINE 21 MG ER CAP Medication
MEMANTXR28 MEMANTINE 28 MG ER CAP Medication
MEMANTXR7 MEMANTINE 7 MG ER CAP Medication
MENINGDIPMENINGOCOCCAL CONJ VACC (9MO TO 55 YRS OR BOOSTERS) A,C,Y,W-135 &
DIPHTHERMedication
MENTHOLAOT MENTHOLATUM OINT 30 GM (1 OZ) Medication
MEPERI100A MEPERIDINE 100 MG/ML AMP Medication
MEPERI100A MEPERIDINE 100 MG/ML AMP Medication as an Additive
MEPERID25A MEPERIDINE 25 MG/ML AMP Medication
MEPERID25A MEPERIDINE 25 MG/ML AMP Medication as an Additive
MEPERID50A MEPERIDINE 50 MG/ML AMP Medication
MEPERID50A MEPERIDINE 50 MG/ML AMP Medication as an Additive
MEPERID50T MEPERIDINE 50 MG TAB Medication
MEPERPCA MEPERIDINE PCA 10 MG/ML 100 ML NO BASAL Medication
MEPIVA15SD MEPIVACAINE 1.5% (15 MG/ML) 30 ML SDV Medication
MEPIVA2MDV MEPIVACAINE 2% (20 MG/ML) 50 ML MDV Medication
MEPOLI100V MEPOLIZUMAB 100 MG/1 ML VIAL Medication
MER1I MEROPENEM 1,000 MG VIAL Medication
MER1I MEROPENEM 1,000 MG VIAL Medication as an Additive
MERCAPTO50 MERCAPTOPURINE 50 MG TAB Medication
MERO500P2 MEROPENEM 500 MG VIAL Medication
MERO500P2 MEROPENEM 500 MG VIAL Medication as an Additive
MESA1.2T MESALAMINE 1.2 GM DR TAB Medication
MESAL375 MESALAMINE 0.375 GM ER CAPSULE Medication
MESALA250C MESALAMINE 250 MG CONTROLLED RELEASE CAP Medication
MESALA400C MESALAMINE 400 MG DELAYED RELEASE CAP Medication
MESALA4EN MESALAMINE 4 GM ENEMA Medication
Page 41 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
MESALSUPP1 MESALAMINE 1,000 MG SUPP Medication
MESNA1GM MESNA 1 GM/10 ML VIAL Medication
MESNA1GM MESNA 1 GM/10 ML VIAL Medication as an Additive
METAXAL800 METAXALONE 800 MG TAB Medication
METF500T metFORMIN 500 MG TAB Medication
METF500XR metFORMIN 500 MG ER TAB Medication
METF750XR metFORMIN 750 MG ER TAB Medication
METF850T metFORMIN 850 MG TAB Medication
METH25VI10 metHOTREXate 50 MG/2 ML VIAL Medication
METH25VI10 metHOTREXate 50 MG/2 ML VIAL Medication as an Additive
METH25VI11 metHOTREXate PF 1 GM/40ML VIAL Medication
METH25VI11 metHOTREXate PF 1 GM/40ML VIAL Medication as an Additive
METH25VI18 metHOTREXate 250 MG/10 ML VIAL Medication
METH25VI18 metHOTREXate 250 MG/10 ML VIAL Medication as an Additive
METH5SOL methaDONE 1 MG/1 ML ORAL SYRINGE Medication
METHACHLNG METHACHOLINE CHALLENGE TEST (5 COLOR CODED SYRINGES) Medication
METHAD10C methaDONE 10 MG/ML ORAL LIQ (PER ML FROM 30 ML BOT) Medication
METHADO10T methaDONE 10 MG TAB Medication
METHADO5L methaDONE 5 MG/5 ML CUP Medication
METHADO5T methaDONE 5 MG TAB Medication
METHENHIP1 METHENAMINE HIPPURATE 1 GM TAB Medication
METHIMA5 methIMAzole 5 MG TAB Medication
METHO2.5 METHOTREXATE 2.5 MG TAB Medication
METHO50 metHOTREXate PF 50 MG/2 ML VIAL Medication
METHO50 metHOTREXate PF 50 MG/2 ML VIAL Medication as an Additive
METHOC1GMV METHOCARBAMOL 1000 MG/10 ML VIAL Medication
METHOC1GMV METHOCARBAMOL 1000 MG/10 ML VIAL Medication as an Additive
METHOC500T METHOCARBAMOL 500 MG TAB Medication
METHOC750T METHOCARBAMOL 750 MG TAB Medication
METHYCLO5T METHYCLOTHIAZIDE 5 MG TAB Medication
METHYLD250 METHYLDOPA 250 MG TAB Medication
METHYLEN5M METHYLENE BLUE 0.5 % (50 MG/10 ML) 10ML Medication
METHYLER27 METHYLPHENIDATE 27 MG ER TAB Medication
METHYLERIM METHYLERGONOVINE MALEATE 200 MCG AMP Medication
METHYLERPO METHYLERGONOVINE MALEATE 0.2 MG TAB Medication
METHYLNA12 METHYLNALTREXONE 12 MG/0.6 ML INJ Medication
METHYLNA8 METHYLNALTREXONE 8 MG/0.4 ML SYRINGE Medication
METHYLP125 methylPREDNISolone SS 125 MG VIAL Medication
METHYLP125 methylPREDNISolone SS 125 MG VIAL Medication as an Additive
METHYLP16T methylPREDNISolone 16 MG TAB Medication
METHYLP1K methylPREDNISolone SS 1,000 MG/16 ML VIAL Medication
METHYLP1K methylPREDNISolone SS 1,000 MG/16 ML VIAL Medication as an Additive
Page 42 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
METHYLP2K methylPREDNISolone SS 2,000 MG VIAL Medication
METHYLP2K methylPREDNISolone SS 2,000 MG VIAL Medication as an Additive
METHYLP40S methylPREDNISolone SS 40 MG VIAL Medication
METHYLP4PK methylPREDNISolone 1 UNIT BULK Medication
METHYLP4T methylPREDNISolone 4 MG TAB Medication
METHYLP500 methylPREDNISolone SS 500 MG/8 ML VIAL Medication
METHYLP500 methylPREDNISolone SS 500 MG/8 ML VIAL Medication as an Additive
METHYLPA40 methylPREDNISolone ACETATE 40 MG/ML 1ML VIAL Medication
METHYLPA80 methylPREDNISolone ACETATE 80 MG/ML 1ML VIAL Medication
METHYLPHE1 METHYLPHENIDATE 10 MG TAB Medication
METHYLPHE2 METHYLPHENIDATE 20 MG ER TAB Medication
METHYLPHE5 METHYLPHENIDATE 5 MG TAB Medication
METHYLPHER METHYLPHENIDATE 18 MG ER TAB Medication
METOCLO10L METOCLOPRAMIDE 10 MG/10 ML ORAL SOLN Medication
METOCLO10T METOCLOPRAMIDE 10 MG TAB Medication
METOCLO10V METOCLOPRAMIDE 10 MG/2 ML VIAL Medication
METOCLO10V METOCLOPRAMIDE 10 MG/2 ML VIAL Medication as an Additive
METOCLO5T METOCLOPRAMIDE 5 MG TAB Medication
METOLAZ25T METOLAZONE 2.5 MG TAB Medication
METOLAZ5T METOLAZONE 5 MG TAB Medication
METOPR100 METOPROLOL TARTRATE 100 MG TAB Medication
METOPR12 METOPROLOL TARTRATE 12.5 MG TAB Medication
METOPR12SR METOPROLOL SUCCINATE 12.5 MG ER TAB Medication
METOPR25 METOPROLOL TARTRATE 25 MG TAB Medication
METOPR25SR METOPROLOL SUCCINATE 25 MG ER TAB Medication
METOPR50 METOPROLOL TARTRATE 50 MG TAB Medication
METOPR50SR METOPROLOL SUCCINATE 50 MG ER TAB Medication
METOPRO5A METOPROLOL TARTRATE 5 MG/5 ML AMP Medication
METRON500P metroNIDAZOLE 500 MG/100 ML *PREMIX BAG* Medication
METRON5INJ metroNIDAZOLE 5 MG/ML IV (USING PREMIX) Medication
METRON5INJ metroNIDAZOLE 5 MG/ML IV (USING PREMIX) Medication as an Additive
METRONI250 metroNIDAZOLE 250 MG TAB Medication
METRONI250 metroNIDAZOLE 250 MG TAB Medication as a Compound
METRONIGEL metroNIDAZOLE 1% TOPICAL GEL 60 GM Medication
METRVAGGEL metroNIDAZOLE 0.75% VAGINAL GEL 70 GM TUBE Medication
MEXILET150 MEXILETINE 150 MG CAP Medication
MEXILET200 MEXILETINE 200 MG CAP Medication
MEXILET250 MEXILETINE 250 MG CAP Medication
MEXSANAPWD MEXSANA 311 APP/311 GM CAN Medication
MICA100V MICAFUNGIN SODIUM SDV 100 MG VIAL Medication
MICA100V MICAFUNGIN SODIUM SDV 100 MG VIAL Medication as an Additive
MICON2C MICONAZOLE 2% CREAM 30 GM TUBE Medication
Page 43 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
MICONALOEO MICONAZOLE 2% OINTMENT 150 APP/150 GM TUBE (5 OZ) Medication
MICONAZ100 MICONAZOLE 100 MG VAGSUPP Medication
MICONAZ200 MICONAZOLE 200 MG VAGSUPP Medication
MICONAZ45V MICONAZOLE-7 VAGINAL CREAM 2% 45 GM Medication
MICONCRIT MICONAZOLE 2% OINTMENT 57 APP/57 GM TUBE (2 OZ) Medication
MIDAZ10MG MIDAZOLAM 10 MG/2 ML VIAL Medication
MIDAZ10MG MIDAZOLAM 10 MG/2 ML VIAL Medication as an Additive
MIDAZ2MG MIDAZOLAM 2 MG/2 ML VIAL Medication
MIDAZ2MG MIDAZOLAM 2 MG/2 ML VIAL Medication as an Additive
MIDAZ2SOL2 MIDAZOLAM 10 MG/5 ML ORAL SYRUP Medication
MIDAZ50MG MIDAZOLAM 50 MG/10 ML SDV Medication
MIDAZ50MG MIDAZOLAM 50 MG/10 ML SDV Medication as an Additive
MIDAZ55V MIDAZOLAM 5 MG/5 ML VIAL Medication
MIDAZ55V MIDAZOLAM 5 MG/5 ML VIAL Medication as an Additive
MIDAZOLAM MIDAZOLAM 5 MG/1 ML VIAL Medication
MIDAZOLAM MIDAZOLAM 5 MG/1 ML VIAL Medication as an Additive
MIDO5T MIDODRINE 5 MG TAB Medication
MIDODR2.5T MIDODRINE 2.5 MG TAB Medication
MILLIGS.2 MILLIPORE GS 0.2 MICRON FILTER SET BLUE Medication
MILN12.5 MILNACIPRAN 12.5 MG TAB Medication
MILN50TA MILNACIPRAN 50 MG TAB Medication
MILRIN10V MILRINONE 1 MG/ML 10 ML VIAL Medication
MILRIN10V MILRINONE 1 MG/ML 10 ML VIAL Medication as an Additive
MILRINPRE MILRINONE 20 MG/100 ML D5W PREMIX Medication
MINERAL30L MINERAL OIL 30 ML CUP Medication
MINERALSTE MINERAL OIL STERILE 10 ML VIAL Medication
MINOCYC100 MINOCYCLINE 100 MG CAP Medication
MINOCYC50C MINOCYCLINE 50 MG CAP Medication
MINOXIDIL2 MINOXIDIL 2.5 MG TAB Medication
MINOXIDILT MINOXIDIL 10 MG TAB Medication
MIRALAX17 POLYETHYLENE GLYCOL/LYTES 17 GM PKT Medication
MIRTSOL15 MIRTAZAPINE SOLTAB 15 MG TAB Medication
MIRTSOL30 MIRTAZAPINE SOLTAB 30 MG TAB Medication
MISOPR100T MISOPROSTOL 100 MCG TAB Medication
MISOPR200T miSOPROStol 200 MCG TAB Medication
MISOPR25T MISOPROSTOL 25 MCG TAB Medication
MITO2VIA22 mitoXANTRONE 25 MG/12.5 ML VIAL Medication
MITO2VIA22 mitoXANTRONE 25 MG/12.5 ML VIAL Medication as an Additive
MITO40PD mitoMYcin 40 MG VIAL Medication
MITO40PD mitoMYcin 40 MG VIAL Medication as an Additive
MITO500T MITOTANE 500 MG TAB Medication
MITOM4TOP mitoMYcin 0.4 MG/ML TOPICAL SYRINGE Medication
Page 44 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
MITOMYCIN5 mitoMYcin 5 MG/10 ML VIAL Medication
MITOMYCIN5 mitoMYcin 5 MG/10 ML VIAL Medication as an Additive
MMRIIV MEASLES MUMPS RUBELLA VACCINE Medication
MODAF100 MODAFINIL 100 MG TAB Medication
MOEX75T MOEXIPRIL 7.5 MG TAB Medication
MOM30L MILK OF MAGNESIA 30 ML CUP Medication
MON10 MONTELUKAST 10 MG TAB Medication
MON4 MONTELUKAST 4 MG CHEW Medication
MON5 MONTELUKAST 5 MG CHEWTAB Medication
MORPHIN20L morphine SULFATE 20 MG/1 ML UD ORAL CONCENTRATE Medication
MOX400 MOXIFLOXACIN 400 MG TAB Medication
MOXIPREMIX MOXIFLOXACIN 400MG/250ML PREMIX BAG Medication
MOXOPTH.5 MOXIFLOXACIN 0.5% OPH DROP 3 ML BOT Medication
MS100SR morphine 100MG SR*12 HR* 100 MG TAB Medication
MS10A morphine SULFATE 10 MG/ML 1 ML AMP Medication
MS10A morphine SULFATE 10 MG/ML 1 ML AMP Medication as an Additive
MS10L morphine SULFATE 10 MG/5 ML CUP Medication
MS10PCA morphine PCA 1000 MCG/ML-100 ML CARTRIDGE Medication
MS10SR24 morphine 10 MG SR *24 HR* (KADIAN) SRCAPSULE Medication
MS15 morphine SULFATE 15 MG IR TAB Medication
MS15SR morphine 15 MG SR *12 HR* TAB (MS CONTIN) Medication
MS200 morphine PF 10 MG/ML 20ML AMP Medication
MS20L0.5 morphine SULFATE 10 MG/0.5ML CONCENTRATE ORAL SYRINGE Medication
MS20L30 morphine SULFATE 20 MG/ML 30ML BULK Medication
MS20SR24 morphine 20 MG SR *24 HR* (KADIAN) SRCAPSULE Medication
MS250 morphine PF 25 MG/ML 10ML AMP Medication
MS250 morphine PF 25 MG/ML 10ML AMP Medication as a Carrier
MS250 morphine PF 25 MG/ML 10ML AMP Medication as an Additive
MS2A morphine SULFATE 2 MG/ML 1ML AMP Medication
MS2A morphine SULFATE 2 MG/ML 1ML AMP Medication as an Additive
MS30 morphine SULFATE 30 MG IR TAB Medication
MS30SR morphine 30 MG SR*12 HR*TAB (MS CONTIN) Medication
MS30SR24 morphine 30 MG SR *24 HR* (KADIAN) SRCAPSULE Medication
MS4A morphine SULFATE 4 MG/ML 1 ML AMP Medication
MS4A morphine SULFATE 4 MG/ML 1 ML AMP Medication as an Additive
MS500 morphine PF 25 MG/ML 20ML AMP Medication
MS50SR24 morphine 50 MG SR *24 HR* (KADIAN) SRCAPSULE Medication
MS50V20ML morphine SULFATE 50 MG/ML 20ML VIAL Medication
MS50V20ML morphine SULFATE 50 MG/ML 20ML VIAL Medication as an Additive
MS5PF morphine PF 5 MG/10 ML AMP Medication
MS5PF morphine PF 5 MG/10 ML AMP Medication as an Additive
MUCINEXDM guaiFENesin 600 MG/DEXTROMETHORPHAN 30 MG ER TAB (MUCINEX DM) Medication
Page 45 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
MULTVITLIQ MULTIVITAMIN/MINERALS LIQUID 15 ML CUP Medication
MUPIRO15 MUPIROCIN 2% CREAM 15 GM TUBE Medication
MUPIRO22 MUPIROCIN 2% OINTMENT 22 GM TUBE Medication
MURO1282SO SODIUM CHLORIDE 2% OPH SOL 20 DROP/ML BOT Medication
MURO1285SO SODIUM CHLORIDE 5% OPTH SOL 15 ML Medication
MURO128OIN SODIUM CHLORIDE 5% OPTH OINT 3.5 GM Medication
MVI12 MVI 12 10 ML VIAL Medication
MVI12 MVI 12 10 ML VIAL Medication as an Additive
MVIPED MVI PEDIATRIC 5 ML VIAL Medication
MVIPED MVI PEDIATRIC 5 ML VIAL Medication as an Additive
MYCO180T MYCOPHENOLIC ACID 180 MG DELAYED REL TAB Medication
MYCO500V MYCOPHENOLATE MOFETIL 500 MG INJ Medication
MYCO500V MYCOPHENOLATE MOFETIL 500 MG INJ Medication as an Additive
MYCOLOGCRM MYCOLOG (NYSTATIN/TRIAMCINOLONE) CREAM 15 GM Medication
MYCOLOGOIN MYCOLOG OINTMENT 15 GM TUBE Medication
MYCOP250C MYCOPHENOLATE MOFETIL 250 MG CAP Medication
MYCOSUSP MYCOPHENOLATE MOFETIL 200MG/ML 160 ML BOTTLE Medication
MYLANTA30 MYLANTA MAXIMUM STRENGTH 30 ML CUP Medication
NABUME500T NABUMETONE 500 MG TABLET Medication
NABUME750T NABUMETONE 750 MG TAB Medication
NACETIV ACETAMINOPHEN NEO-PED IV 10 MG/ML SYRINGE Medication
NACYCLO5/1 ACYCLOVIR IV 5 MG/ML NEONATAL SYRINGE Medication
NACYCLO5/1 ACYCLOVIR IV 5 MG/ML NEONATAL SYRINGE Medication as an Additive
NADO20TA2 NADOLOL 20 MG TAB Medication
NADOLOL40T NADOLOL 40 MG TAB Medication
NALBUPH10M NALBUPHINE 10 MG/ML 10ML VIAL Medication
NALBUPH10M NALBUPHINE 10 MG/ML 10ML VIAL Medication as an Additive
NALBUPH10V NALBUPHINE HCL 10 MG/1 ML AMP Medication
NALBUPH10V NALBUPHINE HCL 10 MG/1 ML AMP Medication as an Additive
NALOX.410 NALOXONE 0.4MG/ML 10ML INJ Medication
NALOX.410 NALOXONE 0.4MG/ML 10ML INJ Medication as an Additive
NALOX.41V NALOXONE 0.4 MG/ML VIAL Medication
NALOX.41V NALOXONE 0.4 MG/ML VIAL Medication as an Additive
NALOX11IV NALOXONE 1 MG/ML 2 ML SYRINGE Medication
NALOX11IV NALOXONE 1 MG/ML 2 ML SYRINGE Medication as an Additive
NALOXE125T NALOXEGOL 12.5 MG TAB Medication
NALTREX380 NALTREXONE 380 MG EXTENDED RELEASE INJ Medication
NALTREX50 NALTREXONE 50 MG TAB Medication
NAMP50/1 AMPICILLIN IV 50 MG/ML NEONATAL Medication
NAMP50/1 AMPICILLIN IV 50 MG/ML NEONATAL Medication as an Additive
NAPHCOA5ML NAPHCON A OPHTHALMIC SOL 5ML BOTTLE Medication
NAPHCOAOPH NAPHCON A OPHTHALMIC SOL 15ML BOTTLE Medication
Page 46 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
NAPRO500 NAPROXEN 500 MG CR TAB Medication
NAPROS220 NAPROXEN 220 MG TAB Medication
NAPROX250T NAPROXEN 250 MG TAB Medication
NAPROX375T NAPROXEN 375 MG TAB Medication
NAPROX500T NAPROXEN 500 MG TAB Medication
NAPROX550T NAPROXEN 550 MG TAB Medication
NATALI300 NATALIZUMAB 300 MG/15 ML VIAL Medication
NATEG120 NATEGLINIDE 120 MG TAB Medication
NAZITH AZITHROMYCIN NEO IV 500 MG VIAL NEONATAL Medication
NAZITH AZITHROMYCIN NEO IV 500 MG VIAL NEONATAL Medication as an Additive
NCEFOT CEFOTAXIME 100 MG/ML NEONATAL SYRINGE Medication
NCEFOT CEFOTAXIME 100 MG/ML NEONATAL SYRINGE Medication as an Additive
NCEFTRI cefTRIAXone 25 MG/ML INFANT SYRINGE Medication
NCEFTRI cefTRIAXone 25 MG/ML INFANT SYRINGE Medication as an Additive
NCLIND6/ML CLINDAMYCIN NEO-PED IV 6 MG/ML SYRINGE Medication
NCLO cloNIDine 1 MCG/ML NEONATAL ORAL SYRINGE Medication
NEBI10TAB NEBIVOLOL HCL 10 MG TAB Medication
NEBI5TAB NEBIVOLOL HCL 5 MG TAB Medication
NEBMS04 MORPHINE PF NEBULIZED SOLUTION Medication
NEDOCRO2 NEDOCROMIL 2% OPTH SOL 5 ML Medication
NEF50 NEFAZODONE 50 MG TAB Medication
NEFAZ150Y NEFAZODONE 150 MG TAB Medication
NEILMED NeilMed SINUS RINSE (NAHCO3/NACL)POWDER PKT Medication
NEOFAM FAMOTIDINE 20MG/2ML VIAL-NEONATAL Medication
NEOFAM FAMOTIDINE 20MG/2ML VIAL-NEONATAL Medication as an Additive
NEOFOSP FOSPHENYTOIN NEO-PED IV 8 PE/ML SYRINGE Medication
NEOFOSP FOSPHENYTOIN NEO-PED IV 8 PE/ML SYRINGE Medication as an Additive
NEOIV NEONATAL IV SOLUTION (CUSTOM) Medication
NEOMETRO metroNIDAZOLE NEO-PED IV 5 MG/ML SYRINGE Medication
NEOMYC500T NEOMYCIN 500 MG TAB Medication
NEOPHENO PHENobarbital 10 MG/ML IV NEONATAL SYRINGE Medication
NEOPHENO PHENobarbital 10 MG/ML IV NEONATAL SYRINGE Medication as an Additive
NEOPOLYIRR NEOMYCIN & POLYMYXIN B SOL FOR IRR,U.S.P. 1 ML AMP Medication
NEOPOLYIRR NEOMYCIN & POLYMYXIN B SOL FOR IRR,U.S.P. 1 ML AMP Medication as an Additive
NEOSPOPS NEOSPORIN OPHTHALMIC SOLUTION 30 DROP/10 ML BOT Medication
NEOSPOROIN NEOSPORIN TOPICAL OINT 15 GM TUBE Medication
NEOSPOROPO NEOSPORIN OPTHALMIC OINTMENT 3.5 GM Medication
NEOSPORPKT NEOSPORIN PKT 1/32 OZ Medication
NEOSPPLUS NEOSPORIN PLUS OINTMENT 30 GM TUBE Medication
NEOST5SY NEOSTIGMINE METHYSULFATE 1 MG/ML 5ML SYRINGE Medication
NEOSTI1000 NEOSTIGMINE METHYSULFATE 1 MG/ML 10 ML VIAL Medication
NEOSTI1000 NEOSTIGMINE METHYSULFATE 1 MG/ML 10 ML VIAL Medication as an Additive
Page 47 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
NEPAFE1 NEPAFENAC 0.1% OPTH SUSP 3 ML Medication
NEPHROVITE NEPHROVITE TAB Medication
NEUT5ML SODIUM BICARBONATE 4% 5 ML VIAL (NEUT) Medication
NEUT5ML SODIUM BICARBONATE 4% 5 ML VIAL (NEUT) Medication as an Additive
NEUTRA125C PHOS-NAK PKT (PHOS 16 MEQ, K 7 MEQ, NA 7 MEQ) Medication
NFEN fentaNYL CITRATE 10 MCG/ML NEONATAL INJ Medication
NFEN fentaNYL CITRATE 10 MCG/ML NEONATAL INJ Medication as an Additive
NFLU FLUCONAZOLE 10 MG/ML ORAL SYRINGE Medication
NFUR FUROSEMIDE 10 MG/ML SOLUTION ORAL SYRINGE Medication
NGENT2/1 GENTAMICIN *NEONATAL* 2 MG/ML IV SYRINGE Medication
NGENT2/1 GENTAMICIN *NEONATAL* 2 MG/ML IV SYRINGE Medication as an Additive
NIACIN250C NIACIN SUSTAINED RELEASE 250 MG SRCAPSULE Medication
NIACIN500C NIACIN 500 MG SR CAP Medication
NIACIN500T NIACIN 500 MG TAB Medication
NICAR20PRE niCARdipine 20 MG/200 ML NS PREMIX BAG Medication
NICARD25IV niCARdipine HCL 2.5 MG/ML 10 ML INJ Medication
NICARD25IV niCARdipine HCL 2.5 MG/ML 10 ML INJ Medication as an Additive
NICO2LOZ13 NICOTINE POLACRILEX 2 MG LOZENGE Medication
NICO4LOZ15 NICOTINE POLACRILEX 4 MG LOZENGE Medication
NICOR2C NICOTINE POLACRILEX GUM 2 MG CHEWING PIECE Medication
NICOR4C NICOTINE POLACRILEX GUM 4 MG CHEWING PIECE Medication
NICOTIN14P NICOTINE TRANSDERMAL PATCH 14 MG PATCH Medication
NICOTIN21P NICOTINE TRANSDERMAL PATCH 21 MG PATCH Medication
NICOTIN7P NICOTINE TRANSDERMAL PATCH 7 MG PATCH Medication
NIF30CC NIFEdipine CC 30 MG 24-HR TAB Medication
NIF60CC NIFEdipine CC 60 MG 24-HR TAB Medication
NIF90CC NIFEdipine CC 90 MG 24-HR TAB Medication
NIFEDIP10C NIFEdipine 10 MG CAP Medication
NIFEREX150 NIFEREX-150 CAPSULE Medication
NIMODI30C niMODipine 30 MG CAP Medication
NITR4.9S NITROGLYCERIN SPRAY 400 MCG/SPRAY (60 SPRAY BOTTLE) Medication
NITROFU25C NITROFURANTOIN 25 MG CAP Medication
NITROFU25L NITROFURANTOIN 25 MG/5 ML CUP Medication
NITROFU50C NITROFURANTOIN 50 MG CAP Medication
NITROFUMAC NITROFURANTOIN 100 MG CAP (MACROBID) Medication
NITROPPRE NITROPRUSSIDE IN 0.9% NACL 50 MG/100 ML PREMIX Medication
NITROPR50V NITROPRUSSIDE SODIUM 50 MG/2 ML VIAL Medication
NITROPR50V NITROPRUSSIDE SODIUM 50 MG/2 ML VIAL Medication as an Additive
NITROSYR NITROGLYCERIN 6 MG/30 ML SYRINGE *CATHLAB 200 MCG/ML* Medication
NLORO LORAZEPAM 2 MG/1 ML CONCENTRATED ORAL SYRINGE Medication
NMCT MEDIUM CHAIN TRIGLYCERIDES 3 ML ORALSYR Medication
NMOR morphine 0.4 MG/ML NEONATAL ORAL SYRINGE Medication
Page 48 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
NORCO HYDROcodone 10 MG/APAP 325 MG TAB Medication
NORCO5 HYDROcodone 5 MG/APAP 325 MG TAB Medication
NORCO7.5 HYDROcodone 7.5 MG/APAP 325 MG TAB Medication
NOREPI4AMP NORepinephrine BITARTRATE 4 MG/4 ML AMP Medication
NOREPI4AMP NORepinephrine BITARTRATE 4 MG/4 ML AMP Medication as an Additive
NOREPIPRE NORepinephrine 8 MG/250 ML PREMIX Medication
NORETHIN5T NORETHINDRONE ACETATE 5 MG TAB Medication
NORTRIP10C NORTRIPTYLINE 10 MG CAP Medication
NORTRIP10L NORTRIPTYLINE 10 MG/5 ML CUP Medication
NORTRIP25C NORTRIPTYLINE 25 MG CAP Medication
NORTRIP50C NORTRIPTYLINE 50 MG CAP Medication
NORTRIP75C NORTRIPTYLINE 75 MG CAP Medication
NPENGK100M NEO-PED PENICILLIN G POTASSIUM IV 100,000 UNIT/ML SYRINGE Medication
NPENGK100M NEO-PED PENICILLIN G POTASSIUM IV 100,000 UNIT/ML SYRINGE Medication as an Additive
NS100 NORMAL SALINE 0.9% 100 ML BAG Medication
NS100 NORMAL SALINE 0.9% 100 ML BAG Medication as a Carrier
NS100 NORMAL SALINE 0.9% 100 ML BAG Medication as an Additive
NS1000 NORMAL SALINE 0.9% 1000 ML BAG Medication
NS1000IRRI NACL 0.9% IRRIGATION *BOTTLE* 1,000 ML BOT Medication
NS100ADDVA NORMAL SALINE 0.9% ADD-VANTAGE 100 ML BAG Medication
NS100AG NORMAL SALINE 0.9% 108 ML BAG Medication
NS100MINI NORMAL SALINE MINI BAG 100 ML BAG Medication
NS100MINI NORMAL SALINE MINI BAG 100 ML BAG Medication as a Carrier
NS100MINI NORMAL SALINE MINI BAG 100 ML BAG Medication as an Additive
NS1500IRRI NACL 0.9% IRRIGATION *BOTTLE* 1,500 ML BOT Medication
NS20K 0.9% NACL 1000ML W/ 20MEQ KCL 1,000 ML BAG Medication
NS20VL NORMAL SALINE 0.9% 20 ML VIAL Medication
NS20VL NORMAL SALINE 0.9% 20 ML VIAL Medication as a Carrier
NS25 NORMAL SALINE 0.9% 25 ML BAG Medication
NS250 NORMAL SALINE 0.9% 250 ML BAG Medication
NS250IRRI NACL 0.9% IRRIGATION *BOTTLE* 250 ML BOT Medication
NS3000IRRI NACL 0.9% IRRIGATION *BAG* 3000 ML BAG Medication
NS30BACTVL NORMAL SALINE 0.9% 30 ML VIAL Medication
NS40K 0.9% NACL 1000ML W/ 40MEQ KCL 1,000 ML BAG Medication
NS50 NORMAL SALINE 0.9% 50 ML BAG Medication
NS500 NORMAL SALINE 0.9% 500 ML BAG Medication
NS500IRRI NACL 0.9% IRRIGATION *BOTTLE* 500 ML BOT Medication
NS50ADDVAN NORMAL SALINE 0.9% ADD-VANTAGE 50 ML BAG Medication
NS50MINI NORMAL SALINE MINI BAG 50 ML BAG Medication
NTG1GMPKG NITROGLYCERIN OINTMENT 2% (1 GM FOIL PACK) Medication
NTG25C NITROGLYCERIN 2.5 MG SR CAP Medication
NTG2P NITROGLYCERIN 0.2 MG/HR PATCH Medication
Page 49 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
NTG4P NITROGLYCERIN 0.4 MG/HR PATCH Medication
NTG4SL NITROGLYCERIN SUBLINGUAL 0.4 MG TAB (25 TAB BOTTLE) Medication
NTG50INJ NITROGLYCERIN 50 MG/10 ML VIAL Medication
NTG50INJ NITROGLYCERIN 50 MG/10 ML VIAL Medication as an Additive
NTG60OINT NITROGLYCERIN OINTMENT 2% (60 GM TUBE) Medication
NTG6P NITROGLYCERIN 0.6 MG/HR PATCH Medication
NTGDR NITROGLYCERIN 50 MG/250 ML PREMIX BOTTLE Medication
NTPN TPN NEONATAL FORMULA 24 HR BAG Medication
NTPNSTART TPN-NEO STARTER BAG (AA 4%/D10W) 250 ML PREMIX Medication
NVAN NEO-PED-VANCOMYCIN IV 5 MG/ML Medication
NVAN NEO-PED-VANCOMYCIN IV 5 MG/ML Medication as an Additive
NVIT BABY VITAMIN DROPS 1 ML ORAL SYRINGE Medication
NVITFE BABY VITAMIN DROPS W/IRON 1 ML ORAL SYRINGE Medication
NYST5SUSP NYSTATIN 500,000 UNIT/5 ML CUP Medication
NYST60SUSP NYSTATIN 100,000 UNIT/ML ORAL SUSP 60 ML *BULK* Medication
NYSTCRM30 NYSTATIN CREAM 30 GM TUBE Medication
NYSTCRM30 NYSTATIN CREAM 30 GM TUBE Medication as a Compound
NYSTTOPCRM NYSTATIN CREAM 15 GM TUBE Medication
NYSTTOPOIN NYSTATIN OINTMENT 15 GM TUBE Medication
NYSTTOPPWD NYSTATIN POWDER 15 GM BOT Medication
OBINUT1000 OBINUTUZUMAB 1,000 MG/40 ML VIAL Medication
OBINUT1000 OBINUTUZUMAB 1,000 MG/40 ML VIAL Medication as an Additive
OCEAN OCEAN SALINE NASAL SPRAY 44 ML BOTTLE Medication
OCRELI300V OCRELIZUMAB 300 MG/10 ML VIAL Medication
OCRELI300V OCRELIZUMAB 300 MG/10 ML VIAL Medication as an Additive
OCTREO05V OCTREOTIDE 50 MCG/1 ML AMP Medication
OCTREO05V OCTREOTIDE 50 MCG/1 ML AMP Medication as an Additive
OCTREO1V OCTREOTIDE 100 MCG/1 ML AMP Medication
OCTREO1V OCTREOTIDE 100 MCG/1 ML AMP Medication as an Additive
OCTREO5V OCTREOTIDE 500 MCG/1 ML AMP Medication
OCTREO5V OCTREOTIDE 500 MCG/1 ML AMP Medication as an Additive
OCUVITETAB OCUVITE TAB Medication
OFLOXOPH5 OFLOXACIN 0.3% OPHTH SLN 5 ML Medication
OLANPWVL OLANZapine 10 MG POWDER VIAL Medication
OLANZ10T OLANZapine 10 MG TAB Medication
OLANZ5T OLANZapine 5 MG TAB Medication
OLOP2.5D OLOPATADINE HCL 0.2% OPTHALMIC SOLUTION 2.5 ML Medication
OLOPAT1 OLOPATADINE 0.1% OPTHALMIC SOLN 5 ML BOT Medication
OMALIZ150 OMALIZUMAB 150 MG VIAL Medication
OMALIZ150 OMALIZUMAB 150 MG VIAL Medication as an Additive
OMEGA3 OMEGA-3-ACID ETHYL ESTERS 1 GM CAPSULE Medication
OMEP10C OMEPRAZOLE 10 MG SRCAPSULE Medication
Page 50 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
OMEP20C OMEPRAZOLE 20 MG SRCAPSULE Medication
OMEP40C OMEPRAZOLE 40 MG SRCAPSULE Medication
ONDA4SOL5 ONDANSETRON 4 MG/5 ML ORAL SYRINGE Medication
ONDANS1MG ONDANSETRON 2 MG/ML 20ML MDVIAL Medication
ONDANS1MG ONDANSETRON 2 MG/ML 20ML MDVIAL Medication as an Additive
ONDANS2ML ONDANSETRON 4 MG/2 ML VIAL Medication
ONDANS2ML ONDANSETRON 4 MG/2 ML VIAL Medication as an Additive
ONDANS4OD ONDANSETRON 4 MG ORALLY DISINTEGRATING TABLET Medication
ONDANS8OD ONDANSETRON 8 MG ORALLY DISINTEGRATING TABLET Medication
ONQPRE550 ROPIVACAINE 0.2% ON-Q 400 ML PUMP - 550 ML PREFILLED SINGLE LUMEN Medication
ONQPRE750 ROPIVACAINE 0.2% ON-Q 600 ML PUMP - 750 ML PREFILLED DOUBLE LUMEN Medication
ONQPRE750S ROPIVACAINE 0.2% ON-Q 600 ML PUMP - 750 ML PREFILLED SINGLE LUMEN Medication
OPIUMPERML OPIUM TINCTURE 10 MG/ML ORAL LIQUID (DISPENSE PER ML) Medication
OPIUMTINCT OPIUM TINCTURE 10 MG/ML 120 ML BOT Medication
ORABLEND ORA-BLEND SF 473 ML BOTTLE Medication
ORABLEND ORA-BLEND SF 473 ML BOTTLE Medication as a Compound
ORAPLUS ORA-PLUS 30 ML BOT Medication
ORASWEET ORA-SWEET 473 ML BOTTLE Medication
ORIT400 ORITAVANCIN 400 MG/40 ML VIAL Medication
ORIT400 ORITAVANCIN 400 MG/40 ML VIAL Medication as an Additive
ORPHENA100 ORPHENADRINE CITRATE 100 MG SRTABLET Medication
ORPHENA60A ORPHENADRINE CITRATE 60 MG/2 ML AMP Medication
OSCAL250 CALCIUM CARBONATE 625 MG (CA 250MG) + VIT D 125 UNIT TABLET Medication
OSCAL500 CALCIUM CARBONATE 1250 MG TAB (CA 500MG ELEMENTAL) Medication
OSCAL500+D CALCIUM CARBONATE 1250 MG (CA 500MG) + VIT D 200 UNIT TAB Medication
OSEL30CA OSELTAMIVIR PHOSPHATE 30 MG CAP Medication
OSEL45CA OSELTAMIVIR PHOSPHATE 45 MG CAPSULE Medication
OSEL6PDR OSELTAMIVIR PHOSPHATE 6 MG/ML 60 ML BOT Medication
OSELT75 OSELTAMIVIR PHOSPHATE 75 MG CAP Medication
OXACIL1INJ OXACILLIN SOD 1000 MG VIAL Medication
OXACIL1INJ OXACILLIN SOD 1000 MG VIAL Medication as an Additive
OXACIL2INJ OXACILLIN SOD 2000 MG VIAL Medication
OXACIL2INJ OXACILLIN SOD 2000 MG VIAL Medication as an Additive
OXAL100 OXALIPLATIN 100 MG/20 ML VIAL Medication
OXAND2.5 OXANDROLONE 2.5 MG TAB Medication
OXAPRO600 OXAPROZIN 600 MG TAB Medication
OXAZEP10C OXAZEPAM 10 MG CAP Medication
OXAZEP15C OXAZEPAM 15 MG CAP Medication
OXCARB150 OXcarbazepine 150 MG TAB Medication
OXCARB300 OXcarbazepine 300 MG TAB Medication
OXCARBSUSP OXcarbazepine SUSP 300 MG/5 ML ORAL SYRINGE Medication
OXY30LR OXYTOCIN 30,000 MILLIUNIT/500 ML LR COMPOUNDED Medication
Page 51 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
OXY5XL OXYBUTYNIN XL 5 MG ER TAB Medication
OXYBUTYL OXYBUTYNIN CHLORIDE 5 MG/5 ML BOT Medication
OXYBUTYNIN OXYBUTYNIN CHLORIDE 5 MG TAB Medication
OXYC15TE2 oxyCODONE CR 15 MG TAB Medication
OXYCOD30 oxyCODONE IR 30 MG TAB Medication
OXYCOD5 oxyCODONE IR 5 MG TAB Medication
OXYCODLIQ oxyCODONE IR 5 MG/5 ML CUP Medication
OXYCON10SR oxyCODONE CR 10 MG TAB Medication
OXYCON20SR oxyCODONE CR 20 MG TAB Medication
OXYCON40SR oxyCODONE CR 40 MG TAB Medication
OXYF oxyCODONE 20 MG/ML 30 ML BOTTLE Medication
OXYMETAZ30 OXYMETAZOLINE HCL 0.05% NASAL SPRAY 30 ML Medication
OXYMOR10ER oxyMORphone ER 10 MG TAB Medication
OXYMOR5IR oxyMORphone 5 MG TAB Medication
OXYTO10V OXYTOCIN 10 U/ML 10 ML VIAL Medication
OXYTO10V OXYTOCIN 10 U/ML 10 ML VIAL Medication as an Additive
OXYTO30PRE OXYTOCIN 30,000 MILLIUNIT/500 ML LR 500 ML PREMIX BAG Medication
OXYTOCIAMP OXYTOCIN 10 UNIT/ML VIAL Medication
OXYTOCIAMP OXYTOCIN 10 UNIT/ML VIAL Medication as an Additive
PACLIT100V PACLitaxel PROTEIN-BOUND 100 MG/50 ML VIAL Medication
PACLIT100V PACLitaxel PROTEIN-BOUND 100 MG/50 ML VIAL Medication as an Additive
PACLIT30 PACLitaxel 30 MG/5 ML VIAL Medication
PACLIT30 PACLitaxel 30 MG/5 ML VIAL Medication as an Additive
PALIP1.5T PALIPERIDONE 1.5 MG ER TAB Medication
PALIP117 PALIPERIDONE PALMITATE 117 MG/0.75 ML INJ Medication
PALIP156 PALIPERIDONE PALMITATE 156 MG/1 ML INJ Medication
PALIP234 PALIPERIDONE PALMITATE 234 MG/1.5 ML INJ Medication
PALIP3T PALIPERIDONE 3 MG ER TABLET Medication
PALIV50V PALIVIZUMAB 50 MG/0.5 ML VIAL Medication
PALIV50V PALIVIZUMAB 50 MG/0.5 ML VIAL Medication as an Additive
PALON0.075 PALONOSETRON HCL 0.075 MG/1.5 ML SYRINGE Medication
PALON0.25V PALONOSETRON HCL 0.25 MG/5 ML VIAL Medication
PALON0.25V PALONOSETRON HCL 0.25 MG/5 ML VIAL Medication as an Additive
PAMIDR30V PAMIDRONATE DISODIUM 30 MG/10 ML VIAL Medication
PANCURONIU PANCURONIUM BROMIDE 1 MG/1 ML 10ML VIAL Medication
PANI400V PANITUMUMAB 400 MG/20 ML INJ Medication
PANI400V PANITUMUMAB 400 MG/20 ML INJ Medication as an Additive
PANT20T PANTOPRAZOLE SODIUM 20 MG DR TABLET Medication
PANT40IV PANTOPRAZOLE SODIUM 40 MG/10 ML INJ Medication
PANT40IV PANTOPRAZOLE SODIUM 40 MG/10 ML INJ Medication as an Additive
PANT40T PANTOPRAZOLE SODIUM 40 MG DR TABLET Medication
PAPAVERAMP PAPAVERINE HCL 60 MG/2 ML VIAL Medication
Page 52 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
PAPAVERAMP PAPAVERINE HCL 60 MG/2 ML VIAL Medication as an Additive
PAR25/100 PARCOPA (CARBIDOPA/LEVODOPA) 25/100 MG ODT Medication
PARIC1C PARICALCITOL 1 MCG CAPSULE Medication
PAROXE10T PARoxetine 10 MG TAB Medication
PAROXE20T PARoxetine 20 MG TAB Medication
PAROXSUSP PARoxetine 10 MG/5 ML CUP Medication
PATIRO84 PATIROMER 8.4 GM ORAL SUSP PACKET Medication
PCC500U PCC (KCENTRA, FACTOR II,VII,IX,X,C,S) ~500 UNIT VIAL (CHARGE PER UNIT) Medication
PCC500U PCC (KCENTRA, FACTOR II,VII,IX,X,C,S) ~500 UNIT VIAL (CHARGE PER UNIT) Medication as an Additive
PCN500T PENICILLIN V POTASSIUM 500 MG TAB Medication
PCNBULK125 PENICILLIN VK 125 MG/5 ML SUSP 100 ML *BULK* Medication
PCNBULK250 PENICILLIN VK 250 MG/5 ML SUSP 100 ML *BULK* Medication
PEGASP5 PEGASPARGASE 3,750 UNIT/5 ML VIAL Medication
PEGASP5 PEGASPARGASE 3,750 UNIT/5 ML VIAL Medication as an Additive
PEMBRO25V PEMBROLIZUMAB 100 MG/4 ML VIAL Medication
PEMBRO25V PEMBROLIZUMAB 100 MG/4 ML VIAL Medication as an Additive
PEMET500V PEMETREXED 500 MG/20 ML VIAL Medication
PEMET500V PEMETREXED 500 MG/20 ML VIAL Medication as an Additive
PENICILGK5 PENICILLIN G POTASSIUM 5,000,000 UNIT VIAL Medication
PENICILGK5 PENICILLIN G POTASSIUM 5,000,000 UNIT VIAL Medication as an Additive
PENICILLAM PENICILLAMINE 250 MG CAP Medication
PENT20IV PENTobarbital SODIUM 50 MG/ML 20 ML AMP Medication
PENT20IV PENTobarbital SODIUM 50 MG/ML 20 ML AMP Medication as an Additive
PENTAMIINH PENTAMIDINE ISETHIONATE NEB 300 MG VIAL Medication
PENTAMIIV PENTAMIDINE ISETHIONATE IV 300 MG VIAL Medication
PENTAMIIV PENTAMIDINE ISETHIONATE IV 300 MG VIAL Medication as an Additive
PENTOS100 PENTOSAN POLYSULFATE SOD 100 MG CAP Medication
PENTOX400T PENTOXIFYLLINE ER 400 MG TAB Medication
PERAMP2T PERAMPANEL 2 MG TAB Medication
PERC0C10 oxyCODONE/APAP 10/325 MG TAB (PERCOCET) Medication
PERCOC7.5 oxyCODONE/APAP 7.5/325 MG TAB (PERCOCET) Medication
PERCOCET oxyCODONE/APAP 5/325 MG TAB (PERCOCET) Medication
PERM5CR PERMETHRIN 5% CREAM 60 GM Medication
PERMETCR PERMETHRIN CREAM RINSE 1% 59 ML BOTTLE Medication
PERPHEN4T PERPHENAZINE 4 MG TAB Medication
PETR30OINT PETROLATUM,WHITE USP 30 GM TUBE Medication
PETR30OINT PETROLATUM,WHITE USP 30 GM TUBE Medication as a Compound
PETR52.5 PETROLATUM 49 GM JAR Medication
PETR5OINT PETROLATUM, WHITE 5 GM PACKET Medication
PETR5OINT PETROLATUM, WHITE 5 GM PACKET Medication as a Compound
PETR71OINT PETROLATUM, WHITE USP 71 GM TUBE Medication
Page 53 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
PETR71OINT PETROLATUM, WHITE USP 71 GM TUBE Medication as a Compound
PHEN10TA30 PHENYLEPHRINE 10 MG TAB Medication
PHENAZOPY1 PHENAZOPYRIDINE HCL 100 MG TAB Medication
PHENAZOPY2 PHENAZOPYRIDINE HCL 200 MG TAB Medication
PHENOB100T PHENobarbital 100 MG TAB Medication
PHENOB130V PHENobarbital SODIUM 130 MG INJ Medication
PHENOB130V PHENobarbital SODIUM 130 MG INJ Medication as an Additive
PHENOB15T PHENobarbital 15 MG TAB Medication
PHENOB20L PHENobarbital 20 MG/5 ML ORAL CUP Medication
PHENOB30T PHENobarbital 32.4 MG TAB Medication
PHENOB65V PHENobarbital 65 MG/ML VIAL Medication
PHENOB65V PHENobarbital 65 MG/ML VIAL Medication as an Additive
PHENORSY PHENYLEPHRINE 10 MG/50 ML SYRINGE Medication
PHENTOL5V PHENTOLAMINE 5 MG VIAL 5 MG VIAL Medication
PHENTOL5V PHENTOLAMINE 5 MG VIAL 5 MG VIAL Medication as an Additive
PHENYL10IV PHENYLEPHRINE 10 MG/ML 1ML AMP Medication
PHENYL10IV PHENYLEPHRINE 10 MG/ML 1ML AMP Medication as an Additive
PHENYL10OP PHENYLEPHRINE 10% OPHTH SOL 5 ML Medication
PHENYL1NSO PHENYLEPHRINE 1% NASAL DROPS 30 ML Medication
PHENYL1NSP PHENYLEPHRINE 1% NASAL SPRAY 15 ML Medication
PHENYL2NSP PHENYLEPHRINE 1/2% NASAL SPRAY 15 ML Medication
PHENYL4NSP PHENYLEPHRINE 1/4% NASAL SPRAY 15 ML BOT Medication
PHENYL8NSO PHENYLEPHRINE 1/8% NASAL DROPS 15 ML Medication
PHENYORSYR PHENYLEPHRINE 100 MCG/ML 10 ML SYRINGE Medication
PHENYT100C PHENYTOIN ER 100 MG CAP Medication
PHENYT125L PHENYTOIN SODIUM 100 MG/4 ML CUP Medication
PHENYT50T PHENYTOIN SODIUM 50 MG CHEW Medication
PHOSPHOR K-PHOS NEUTRAL PHOSPHOROUS TAB 250 MG Medication
PHYSOST2IV PHYSOSTIGMINE SALICYLATE 2 MG/2 ML AMP Medication
PHYTON10IM PHYTONADIONE 10 MG/1 ML AMP Medication
PHYTON10IM PHYTONADIONE 10 MG/1 ML AMP Medication as an Additive
PHYTON1IM PHYTONADIONE NEONATAL 1 MG/0.5 ML AMP Medication
PILOCAR1OP PILOCARPINE 1% OPTHALMIC SOLUTION 15 ML Medication
PILOCAR2OP PILOCARPINE 2% OPHTHALMIC SOLUTION 15 ML Medication
PILOCAR4OP PILOCARPINE 4% OPTHALMIC SOLUTION 15 ML Medication
PILOCAR5 PILOCARPINE 5 MG TAB Medication
PINDOL10T PINDOLOL 10 MG TAB Medication
PINDOL5T PINDOLOL 5 MG TAB Medication
PIOGL15 PIOGLITAZONE 15 MG TAB Medication
PIOGL30 PIOGLITAZONE 30 MG TAB Medication
PIROXI10C PIROXICAM 10 MG CAP Medication
PLASLYTEA1 PLASMALYTE A 1000 ML BAG Medication
Page 54 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
PLASLYTEA5 PLASMALYTE A 500 ML BAG Medication
PNEUMOVAX PNEUMOCOCCAL 23 VACCINE 0.5 ML SYRINGE Medication
POLYSPOINT POLYSPORIN OINTMENT 30 GM TUBE Medication
POLYSPOPOI BACITRACIN ZINC/POLYMYXIN B OPTHALMIC OINTMENT 3.5 GM TUBE Medication
POTACE20ME POTASSIUM ACETATE 40 MEQ/20 ML VIAL Medication
POTACE20ME POTASSIUM ACETATE 40 MEQ/20 ML VIAL Medication as an Additive
POTCITRAT5 POTASSIUM CITRATE 5 MEQ ER TAB (540MG) Medication
POTGLU550T POTASSIUM GLUCONATE 550 MG TAB (K ELEMENTAL 90MG) Medication
POTIODLIQ POTASSIUM IODIDE 1 GM/ML 30 ML ORAL DROPS (SSKI) Medication
POTPHOS10 POTASSIUM PHOSPHATE 4.4 MEQ/ML 15 ML VIAL Medication
POTPHOS10 POTASSIUM PHOSPHATE 4.4 MEQ/ML 15 ML VIAL Medication as an Additive
POTPHOSMM POTASSIUM PHOSPHATE 3 MMOL/ML 15 ML VIAL Medication
POTPHOSMM POTASSIUM PHOSPHATE 3 MMOL/ML 15 ML VIAL Medication as an Additive
POVIDO30OI POVIDONE IODINE 10% OINTMENT 30 GM TUBE Medication
POVIDO4SOL POVIDONE IODINE 10% SOLUTION 120 ML Medication
POVIDO4SOL POVIDONE IODINE 10% SOLUTION 120 ML Medication as an Additive
POVIDOSTIK POVIDONE IODINE SWAB STICKS (3/PKG) Medication
PPN PPN PERIPHERAL LINE FORMULA WITH LIPIDS 24 HR BAG Medication
PRA1 PRAMIPEXOLE 1 MG TAB Medication
PRALIDOX1G PRALIDOXIME CHLORIDE 1 GM/20 ML VIAL Medication
PRALIDOX1G PRALIDOXIME CHLORIDE 1 GM/20 ML VIAL Medication as an Additive
PRAM1000 PRAMLINTIDE 60 PEN 1,000 MCG/ML 1.5 ML PEN Medication
PRAM125T PRAMIPEXOLE 0.125 MG TAB Medication
PRAM15T PRAMIPEXOLE 1.5 MG TAB Medication
PRAM25T PRAMIPEXOLE 0.25 MG TAB Medication
PRAM375ER PRAMIPEXOLE 0.375 MG ER TAB Medication
PRASU10T PRASUGREL 10 MG TAB Medication
PRAVAS10 PRAVASTATIN 10 MG TAB Medication
PRAVAS20 PRAVASTATIN 20 MG TAB Medication
PRAVAS40 PRAVASTATIN 40 MG TAB Medication
PRAVAS80 PRAVASTATIN 80 MG TAB Medication
PRAX2.5V PRAXBIND (idaruCIZUMAB) 2.5 GM/50 ML VIAL Medication
PRAX2.5V PRAXBIND (idaruCIZUMAB) 2.5 GM/50 ML VIAL Medication as an Additive
PRAZOS1C PRAZOSIN 1 MG CAP Medication
PRAZOS5C PRAZOSIN 5 MG CAP Medication
PRED10T predniSONE 10 MG TAB Medication
PRED1OPSOL prednisoLONE 1% OPHTH SOLN 10 ML BOT Medication
PRED1T predniSONE 1 MG TAB Medication
PRED20T predniSONE 20 MG TAB Medication
PRED50T predniSONE 50 MG TAB Medication
PRED5L predniSONE 5 MG/5 ML LIQUID CUP Medication
PRED5T predniSONE 5 MG TAB Medication
Page 55 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
PREDFORTE prednisoLONE ACETATE 1% 5 ML OPHTH SUSP Medication
PREDMILD prednisoLONE ACETATE 0.12% 5 ML OPHTH SOL Medication
PREDNISOL5 prednisoLONE 5 MG TAB Medication
PREDNN prednisoLONE 15 MG/5 ML CUP Medication
PREGAB100 PREGABALIN 100 MG CAP Medication
PREGAB25 PREGABALIN 25 MG CAP Medication
PREGAB50 PREGABALIN 50 MG CAP Medication
PREGAB75 PREGABALIN 75 MG CAP Medication
PREMPRO PREMPRO 0.625 MG-2.5 MG TAB Medication
PREMPRO1.5 PREMPRO 0.3 MG-1.5 MG TAB Medication
PREMPRO45 PREMPRO 0.45 MG-1.5 MG TAB Medication
PRENATVITT PRENATAL VITAMINS (60 MG FE) TAB Medication
PREPHOINT PREPARATION H 60 GM TUBE Medication
PREPHSUPP PREPARATION H SUPP Medication
PRIMAQU263 PRIMAQUINE PHOS 26.3 MG TAB Medication
PRIMID250T PRIMIDONE 250 MG TAB Medication
PRIMID50T PRIMIDONE 50 MG TAB Medication
PROBEN500T PROBENECID 500 MG TAB Medication
PROC500V PROCAINAMIDE 1,000 MG/2 ML VIAL Medication
PROC500V PROCAINAMIDE 1,000 MG/2 ML VIAL Medication as an Additive
PROCAIN1IV PROCAINAMIDE 1,000 MG/10 ML VIAL Medication
PROCHL10T PROCHLORPERAZINE 10 MG TAB Medication
PROCHL10V PROCHLORPERAZINE 10 MG/2 ML VIAL Medication
PROCHL10V PROCHLORPERAZINE 10 MG/2 ML VIAL Medication as an Additive
PROCHL25S PROCHLORPERAZINE 25 MG SUPP Medication
PROCHL5T PROCHLORPERAZINE 5 MG TAB Medication
PROCTOFOAM PRAMOXINE 1% FOAM 15 GM Medication
PROCTOFOHC PROCTOFOAM HC 10 GM CAN Medication
PROG100 PROGESTERONE 100 MG CAP Medication
PROGESOIL5 PROGESTERONE IN OIL 50 MG/ML 10 ML VIAL Medication
PROMETH12S PROMETHAZINE 12.5 MG SUPP Medication
PROMETH25P PROMETHAZINE IV 25 MG/50 ML KIT Medication
PROMETH25P PROMETHAZINE IV 25 MG/50 ML KIT Medication as an Additive
PROMETH25S PROMETHAZINE 25 MG SUPP Medication
PROMETH25T PROMETHAZINE 25 MG TAB Medication
PROMETH25V PROMETHAZINE 25 MG/1 ML AMP Medication
PROMETH25V PROMETHAZINE 25 MG/1 ML AMP Medication as an Additive
PROMETH50S PROMETHAZINE 50 MG SUPP Medication
PROMETHLIQ PROMETHAZINE 6.25 MG/5 ML CUP Medication
PROMETHVCC PROMETHAZINE VC/CODEINE 5 ML CUP Medication
PROP325C PROPAFENONE 325 MG SR CAP Medication
PROP425C PROPAFENONE 425 MG SR CAP Medication
Page 56 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
PROPA225SR PROPAFENONE 225 MG SR CAP Medication
PROPAFE225 PROPAFENONE 225 MG TAB Medication
PROPAFEN15 PROPAFENONE 150 MG TAB Medication
PROPARAOPH PROPARACAINE HCL 0.5% OPHTH SOL 15 ML Medication
PROPO100ML PROPOFOL 10,000 MCG/ML-100ML Medication
PROPO200MG PROPOFOL 10 MG/ML 20 ML VIAL (DIPRIVAN) Medication
PROPO50ML PROPOFOL 10 MG/ML 50 ML VIAL (DIPRIVAN) Medication
PROPRAN10T PROPRANOLOL 10 MG TAB Medication
PROPRAN120 PROPRANOLOL-LA 120 MG CAP Medication
PROPRAN160 PROPRANOLOL-LA 160 MG CAP Medication
PROPRAN1I PROPRANOLOL 1 MG/ML AMP Medication
PROPRAN1I PROPRANOLOL 1 MG/ML AMP Medication as an Additive
PROPRAN20L PROPRANOLOL 4 MG/ML NEONATAL ORAL SYRINGE Medication
PROPRAN20T PROPRANOLOL 20 MG TAB Medication
PROPRAN40T PROPRANOLOL 40 MG TAB Medication
PROPRAN60C PROPRANOLOL-LA 60 MG CAP Medication
PROPRAN80C PROPRANOLOL-LA 80 MG CAP Medication
PROPRAN80T PROPRANOLOL 80 MG TAB Medication
PROPRANL PROPRANOLOL 40 MG/5 ML CUP Medication
PROPYLTH50 PROPYLTHIOURICIL 50 MG TAB Medication
PROTAM250I PROTAMINE SULFATE 250 MG/25 ML SDV Medication
PROTAM50I PROTAMINE SULFATE 50 MG/5 ML SDV VIAL Medication
PROTRIP5T PROTRIPTYLINE 5 MG TAB Medication
PSEUDO120C PSEUDOEPHEDRINE 120 MG ER TAB Medication
PSEUDO30T PSEUDOEPHEDRINE 30 MG TAB Medication
PSEUDO60L PSEUDOEPHEDRINE LIQUID 60 MG/10 ML CUP Medication
PSEUDO60L PSEUDOEPHEDRINE LIQUID 60 MG/10 ML CUP Medication as a Compound
PSYLLIPKT PSYLLIUM PACKET Medication
PUMPREFILL PUMP REFILL *SPECIAL ORDER* Medication
PYRAZI500 PYRAZINAMIDE 500 MG TAB Medication
PYRIDOST10 PYRIDOSTIGMINE 10 MG/2 ML AMP Medication
PYRIDOST10 PYRIDOSTIGMINE 10 MG/2 ML AMP Medication as an Additive
PYRIDOST60 PYRIDOSTIGMINE 60 MG TAB Medication
PYRIDOX100 PYRIDOXINE 100 MG/ML VIAL Medication
PYRIDOX100 PYRIDOXINE 100 MG/ML VIAL Medication as an Additive
PYRIDOX1T PYRIDOXINE 100 MG TAB Medication
PYRIDOX50T PYRIDOXINE 50 MG TAB Medication
QUE100T QUEtiapine FUMARATE 100 MG TAB Medication
QUE200XRT QUEtiapine FUMARATE 200 MG XR TABLET Medication
QUE25T QUEtiapine FUMARATE 25 MG TAB Medication
QUE300T QUEtiapine FUMARATE 300 MG TAB Medication
QUE300XRT QUEtiapine FUMARATE 300 MG XR TABLET Medication
Page 57 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
QUE400T QUEtiapine FUMARATE 400MG TAB Medication
QUE50XRT QUEtiapine FUMARATE 50 MG XR TABLET Medication
QUINAP20 QUINAPRIL 20 MG TAB Medication
QUINAP40 QUINAPRIL 40 MG TAB Medication
QUINAP5 QUINAPRIL 5 MG TAB Medication
QUININE32C quiNINE SO4 324 MG CAP Medication
RABIESEMB RABIES VACCINE CHICK EMBRYO CELL 2.5 UNIT/1 ML VIAL Medication
RABIESIG10 RABIES IMMUNE GLOBULIN 1500 UNIT/10 ML VIAL Medication
RABIESIG2 RABIES IMMUNE GLOBULIN 300 UNIT/2 ML VIAL Medication
RABIESV RABIES VACCINE HUMAN DIPLOID 2.5 UNITS/1 ML VIAL Medication
RACEPI0.5 RACEMIC EPINEPHRINE 2.25% 0.5 ML NEBSOL Medication
RAL60 RALOXIFENE 60 MG TAB Medication
RALT400T RALTEGRAVIR POTASSIUM 400 MG TABLET Medication
RAMEL8 RAMELTEON 8 MG TAB Medication
RAMIPR125 RAMIPRIL 1.25 MG CAP Medication
RAMIPRI5 RAMIPRIL 5 MG CAP Medication
RANITI150L raNITIdine 150 MG/10 ML CUP Medication
RANOL500T RANOLAZINE 500 MG ER TAB Medication
RASA1TAB RASAGILINE MESYLATE 1 MG TAB Medication
RASB1.5V RASBURICASE 1.5 MG/ML VIAL Medication
RASB1.5V RASBURICASE 1.5 MG/ML VIAL Medication as an Additive
RASB7.5V RASBURICASE 7.5 MG/5 ML VIAL Medication
RASB7.5V RASBURICASE 7.5 MG/5 ML VIAL Medication as an Additive
REFRESHP REFRESH PLUS 0.5% (SENSITIVE/PF) 0.4 ML UD Medication
REGA0.4D REGADENOSON 0.4 MG/5 ML INJECTION Medication
REMIFENT REMIFENTANIL 1 MG VIAL Medication
REMIFENT REMIFENTANIL 1 MG VIAL Medication as an Additive
REMIFENT2 REMIFENTANIL 2 MG VIAL Medication
REMIFENT2 REMIFENTANIL 2 MG VIAL Medication as an Additive
REP5 REPAGLINIDE 0.5 MG TAB Medication
RHODIMM300 RHO(D) IMMUNE GLOBULIN 300 MCG (1500 UNIT) 2 ML SYRINGE Medication
RIFA550T rifAXIMin 550 MG TAB Medication
RIFAMP150C rifAMPin 150 MG CAP Medication
RIFAMP300C rifAMPin 300 MG CAP Medication
RIFAMP600V rifAMPin 600 MG VIAL Medication
RIFAMP600V rifAMPin 600 MG VIAL Medication as an Additive
RIFAX200T rifAXIMin 200 MG TAB Medication
RIS0.25 RisperiDONE 0.25 MG TAB Medication
RIS35T RISEDRONATE SODIUM 35 MG TAB Medication
RISE3OT RISEDRONATE SODIUM 30 MG TAB Medication
RISPER1ODT RisperiDONE M-TAB 1 MG ODT Medication
RISPER1S RisperiDONE ORAL SOLUTION 1 MG/ML 30ML BULK Medication
Page 58 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
RISPER37.5 RisperiDONE 37.5 MG LONG ACTING INJECTION Medication
RISPER5ODT RisperiDONE M-TAB 0.5 MG ODT Medication
RISPERKIT RisperiDONE 25 MG LONG ACTING INJECTION Medication
RITON100T RITONAVIR 100 MG TAB Medication
RITUX100 riTUXimab 100 MG/10 ML VIAL Medication
RITUX100 riTUXimab 100 MG/10 ML VIAL Medication as an Additive
RIVA10T RIVAROXABAN 10 MG TAB Medication
RIVA15TA1 RIVAROXABAN 15 MG TAB Medication
RIVA20T RIVAROXABAN 20 MG TAB Medication
RIVAR2.5T RIVAROXABAN 2.5 MG TABLET Medication
RIVAS46P RIVASTIGMINE 4.6 MG/24 HOUR PATCH Medication
RIVAS95P RIVASTIGMINE 9.5 MG/24 HOUR PATCH Medication
RIVASC RIVASTIGMINE 1.5 MG CAP Medication
RIZAT10 RIZATRIPTAN BENZOATE-MLT 10 MG ODT Medication
RIZAT5 RIZATRIPTAN BENZOATE-MLT 5 MG ODT Medication
ROBITDM5 guaiFENesin/DEXTROMETHORPHAN 100-10 MG/5 ML CUP Medication
ROBITDMSF guaiFENesin 200 MG/DEXTROMETHORPHAN 20 MG-10 ML CUP (ALCOHOL FREE) Medication
ROBITUAC10 guaiFENesin/CODEINE 200/20 MG 10 ML CUP (ROBITUSSIN AC SUGAR FREE) Medication
ROBITUAC5 guaiFENesin 100 MG/CODEINE 10 MG-5 ML CUP(ROBITUSSIN AC SUGAR FREE) Medication
ROCUR10ML ROCURONIUM 10 MG/ML 10ML VIAL Medication
ROCUR10ML ROCURONIUM 10 MG/ML 10ML VIAL Medication as an Additive
ROCUR5ML ROCURONIUM 10 MG/ML 5ML VIAL Medication
ROFL500T ROFLUMILAST 500 MCG TAB Medication
ROMIP250 ROMIPLOSTIM 250 MCG VIAL Medication
ROP1 rOPINIRole 1 MG TAB Medication
ROP2 rOPINIRole 2 MG TAB Medication
ROP25 rOPINIRole 0.25 MG TAB Medication
ROP5T rOPINIRole 5 MG TAB Medication
ROPI2TAB rOPINIRole 2 MG ER TAB Medication
ROPI4TAB rOPINIRole 4 MG ER TAB Medication
ROPIV2SDV ROPIVACAINE HCL 0.2% (2 MG/ML) SDV 200 ML Medication
ROPIV2SDV ROPIVACAINE HCL 0.2% (2 MG/ML) SDV 200 ML Medication as a Carrier
ROPIV2SDV ROPIVACAINE HCL 0.2% (2 MG/ML) SDV 200 ML Medication as an Additive
ROPIV2SDV1 ROPIVACAINE HCL 0.2% (2MG/ML) SDV 100 ML Medication
ROPIV2SDV1 ROPIVACAINE HCL 0.2% (2MG/ML) SDV 100 ML Medication as a Carrier
ROPIV2SDV1 ROPIVACAINE HCL 0.2% (2MG/ML) SDV 100 ML Medication as an Additive
ROPIV5S20 ROPIVACAINE 0.5% (5 MG/ML) 20 ML SDV Medication
ROPIV5S20 ROPIVACAINE 0.5% (5 MG/ML) 20 ML SDV Medication as a Carrier
ROPIV5S20 ROPIVACAINE 0.5% (5 MG/ML) 20 ML SDV Medication as an Additive
ROPIV5SDV ROPIVACAINE HCL 0.5% (5 MG/ML) SDV 30 ML Medication
ROPIV5SDV ROPIVACAINE HCL 0.5% (5 MG/ML) SDV 30 ML Medication as a Carrier
ROPIV5SDV ROPIVACAINE HCL 0.5% (5 MG/ML) SDV 30 ML Medication as an Additive
Page 59 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
ROSUVAST10 ROSUVASTATIN 10 MG TAB Medication
ROSUVAST20 ROSUVASTATIN 20 MG TAB Medication
ROSUVAST40 ROSUVASTATIN 40 MG TAB Medication
ROSUVAST5 ROSUVASTATIN 5 MG TAB Medication
ROTI1P ROTIGOTINE 1 MG/24 HR PATCH Medication
ROTI2TDM ROTIGOTINE 2 MG/24 HR PATCH Medication
ROTI6TDM2 ROTIGOTINE 6 MG/24 HR PATCH Medication
RTNACL4 SODIUM CHLORIDE 3% INHALATION SOL 4 ML Medication
RTNACL7% SODIUM CHLORIDE 7% INHALATION SOL 4 ML Medication
RUFI200T RUFINAMIDE 200 MG TABLET Medication
SACUB2426T SACUBITRIL/VALSARTAN 24-26 MG TAB Medication
SACUB4951T SACUBITRIL/VALSARTAN 49-51 MG TAB Medication
SACUB97/10 SACUBITRIL/VALSARTAN 97-103 MG TAB Medication
SALIVAGEL BIOTENE DRY MOUTH ORALBALANCE GEL 42 GM TUBE Medication
SALSAL500T SALSALATE 500 MG TAB Medication
SALSAL750T SALSALATE 750 MG TAB Medication
SARNALOT SARNA LOTION (CAMPHOR 0.5%/MENTHOL 0.5%) 222 ML BOTTLE Medication
SCOPPATCH SCOPOLAMINE 1.5 MG PATCH (3 DAY) Medication
SECR16VI SECRETIN ACETATE HUMAN 16 MCG/8 ML VIAL Medication
SELEG5T SELEGILINE 5 MG CAP Medication
SELEG6P SELEGILINE HCL 6 MG/24 HR PATCH Medication
SELEN25SHA SELENIUM SULFIDE 2.5% LOTION/SHAMPOO 120 ML BOTTLE Medication
SENNA10ML SENNA LIQUID 17.6 MG/10 ML CUP Medication
SENNATAB SENNA TABLET (CONTAINS 8.6 MG SENNOSIDES) Medication
SENOKOTSTB SENNOSIDES 8.6/DOCUSATE 50MG TAB Medication
SEPTRA5INJ COTRIMOXAZOLE (SMX 800MG/TMP 160MG) 10 ML VIAL Medication
SEPTRA5INJ COTRIMOXAZOLE (SMX 800MG/TMP 160MG) 10 ML VIAL Medication as an Additive
SEPTRADSTB COTRIMOXAZOLE DOUBLE STRENGTH (SMX 800MG/TMP 160MG) 1 DS TAB Medication
SEPTRASUSP COTRIMOXAZOLE SUSP (SMX 800MG/TMP 160MG) 20 ML CUP Medication
SEPTRATAB COTRIMOXAZOLE SINGLE STRENTH (SMX 400MG/TMP 80MG) 1 SS TAB Medication
SERTRA100T SERTRALINE 100 MG TAB Medication
SERTRA25T SERTRALINE 25 MG TAB Medication
SERTRA50T SERTRALINE 50 MG TAB Medication
SEVEL0.8P SEVELAMER CARBONATE 0.8 GM PACKET Medication
SEVEL2.4P SEVELAMER CARBONATE 2.4 GM PACKET Medication
SEVEL800 SEVELAMER CARBONATE 800 MG TAB Medication
SILD10S SILDENAFIL CITRATE 10 MG/12.5 ML INJ Medication
SILD20 SILDENAFIL CITRATE 20 MG TAB Medication
SILNITSTIK SILVER NITRATE 5 STICK BAG Medication
SILSULF400 SILVER sulfADIAZINE CREAM 400 GM JAR Medication
SILSULF50 SILVER sulfADIAZINE CREAM 50 GM JAR Medication
SILVNITSOL SILVER NITRATE 0.5% 960 ML SOL Medication
Page 60 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
SILVNITSOL SILVER NITRATE 0.5% 960 ML SOL Medication as an Additive
SIMETH80T SIMETHICONE 80 MG CHEWABLE TAB Medication
SIMETHDROP SIMETHICONE 20 MG/0.3 ML DROPS 30 ML Medication
SIMVAS10 SIMVASTATIN 10 MG TAB Medication
SIMVAS20 SIMVASTATIN 20 MG TAB Medication
SIMVAS40 SIMVASTATIN 40 MG TAB Medication
SIMVAS5 SIMVASTATIN 5 MG TAB Medication
SIN25100CR SINEMET-CR (CARBIDOPA/LEVODOPA) 25/100 MG CR TAB Medication
SINC5VIA SINCALIDE 5 MCG POWDER VIAL Medication
SINC5VIA SINCALIDE 5 MCG POWDER VIAL Medication as an Additive
SINEM10100 SINEMET (CARBIDOPA/LEVODOPA) 10/100 MG TAB Medication
SINEM25100 SINEMET (CARBIDOPA/LEVODOPA) 25/100 MG TAB Medication
SINEM25250 SINEMET (CARBIDOPA/LEVODOPA) 25/250 MG TAB Medication
SINEM50200 SINEMET-CR (CARBIDOPA/LEVODOPA) 50/200 MG CR TAB Medication
SIROL0.5T SIROLIMUS 0.5 MG TAB Medication
SLOWMAGTAB MAGNESIUM CHLORIDE 64 MG SRTABLET Medication
SNAKEANTEQ CROTALIDAE IMMUNE FAB (EQUINE) ANAVIP VIAL Medication
SNAKEANTEQ CROTALIDAE IMMUNE FAB (EQUINE) ANAVIP VIAL Medication as an Additive
SNAKEANTI CROTALIDAE IMMUNE FAB (OVINE) CROFAB 1 VIAL Medication
SNAKEANTI CROTALIDAE IMMUNE FAB (OVINE) CROFAB 1 VIAL Medication as an Additive
SODACE20VL SODIUM ACETATE 2 MEQ/ML 20 ML VIAL Medication
SODACE20VL SODIUM ACETATE 2 MEQ/ML 20 ML VIAL Medication as an Additive
SODBIC10SY SODIUM BICARBONATE 8.4% *PEDIATRIC* 10 MEQ/10 ML SYRINGE Medication
SODBIC325T SODIUM BICARBONATE 325 MG TAB Medication
SODBIC44SY SODIUM BICARBONATE 7.5% 44.6 MEQ/50 ML SYRINGE Medication
SODBIC44SY SODIUM BICARBONATE 7.5% 44.6 MEQ/50 ML SYRINGE Medication as an Additive
SODBIC50SY SODIUM BICARBONATE 8.4% 50 MEQ/50 ML SYRINGE Medication
SODBIC50SY SODIUM BICARBONATE 8.4% 50 MEQ/50 ML SYRINGE Medication as an Additive
SODBIC50VL SODIUM BICARBONATE 8.4% 50 MEQ/50 ML VIAL Medication
SODBIC50VL SODIUM BICARBONATE 8.4% 50 MEQ/50 ML VIAL Medication as a Carrier
SODBIC50VL SODIUM BICARBONATE 8.4% 50 MEQ/50 ML VIAL Medication as an Additive
SODBIC5SY SODIUM BICARBONATE 4.2% *INFANT* 5 MEQ/10 ML SYRINGE Medication
SODBIC625T SODIUM BICARBONATE 650 MG TAB Medication
SODCHL1T SODIUM CHLORIDE 1 GM TAB Medication
SODCHL234 SODIUM CHLORIDE 23.4% 120 MEQ/30 ML VIAL Medication
SODCHL234 SODIUM CHLORIDE 23.4% 120 MEQ/30 ML VIAL Medication as a Carrier
SODCHL234 SODIUM CHLORIDE 23.4% 120 MEQ/30 ML VIAL Medication as an Additive
SODCHL50IV SODIUM CHLORIDE 23.4% 400 MEQ/100 ML VIAL Medication
SODCHL50IV SODIUM CHLORIDE 23.4% 400 MEQ/100 ML VIAL Medication as a Carrier
SODCHL50IV SODIUM CHLORIDE 23.4% 400 MEQ/100 ML VIAL Medication as an Additive
SODI10VI2 SODIUM TETRADECYL 1% 2 ML VIAL Medication
SODI30VI3 SODIUM TETRADECYL 3% 2 ML VIAL Medication
Page 61 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
SODI30VI3 SODIUM TETRADECYL 3% 2 ML VIAL Medication as an Additive
SODPHOS3VL SODIUM PHOSPHATE 4 MEQ/ML 15 ML VIAL Medication
SODPHOS3VL SODIUM PHOSPHATE 4 MEQ/ML 15 ML VIAL Medication as an Additive
SODPHOSMM SODIUM PHOSPHATE 3 MMOL/ML 15 ML VIAL Medication
SODPHOSMM SODIUM PHOSPHATE 3 MMOL/ML 15 ML VIAL Medication as an Additive
SODZIRC10 SODIUM ZIRCONIUM CYCLOSILICATE 10 GM PACKET Medication
SOLIFEN5 SOLIFENACIN SUCCINATE 5 MG TAB Medication
SORBITOL30 SORBITOL SOLUTION 70% W/W 30ML BOT Medication
SOTAF80 SOTALOL AF 80 MG TAB Medication
SOTALO120 SOTALOL 120 MG TAB Medication
SOTALO80 SOTALOL 80 MG TAB Medication
SPIRON100T SPIRONOLACTONE 100 MG TAB Medication
SPIRON12T SPIRONOLACTONE 12.5 MG TAB Medication
SPIRON25T SPIRONOLACTONE 25 MG TAB Medication
SPS15 SODIUM POLYSTYRENE SULFONATE 15 GM/60 ML CUP Medication
SPS30ENEMA SODIUM POLYSTYRENE SULFONATE 30 GM/120 ML ENEMA Medication
STALEV0150 STALEVO 150 (LEVODOPA 150MG, CARBIDOPA 37.5MG, ENTACAPONE 200MG) TAB Medication
STALEV100 STALEVO 100 (LEVODOPA 100MG, CARBIDOPA 25MG, ENTACAPONE 200MG) TAB Medication
STALEV50 STALEVO 50 (LEVODOPA 50MG, CARBIDOPA 12.5MG, ENTACAPONE 200MG) TAB Medication
STANFMW15M STANFORD MOUTH WASH 15 ML CUP Medication
STRESSTBZN STRESSTABS ADVANCED (MVI/ZINC) TAB Medication
SUBOX2/0.5 BUPRENORPHINE/NALOXONE 2/0.5 MG SL FILM Medication
SUBOX4/1FT BUPRENORPHINE/NALOXONE (SUBOXONE) 4/1 MG SL FILM Medication
SUBOX8/2SL BUPRENORPHINE/NALOXONE (SUBOXONE) 8/2 MG SL FILM Medication
SUCCI20MDV SUCCINYLCHOLINE 20 MG/ML 10 ML VIAL Medication
SUCCIM5 SUCCIMER POWDER 5 GM JAR Medication
SUCRAL1T SUCRALFATE 1 GM TAB Medication
SUFENTA1ML SUFENTANIL CITRATE 50 MCG/ML 1 ML AMP Medication
SUFENTA1ML SUFENTANIL CITRATE 50 MCG/ML 1 ML AMP Medication as an Additive
SUFENTA2ML SUFENTANIL 50 MCG/ML 2 ML AMP Medication
SUFENTA2ML SUFENTANIL 50 MCG/ML 2 ML AMP Medication as an Additive
SUFENTA5ML SUFentanil CITRATE 50 MCG/ML 5ML AMP Medication
SUFENTA5ML SUFentanil CITRATE 50 MCG/ML 5ML AMP Medication as an Additive
SUGAM200V SUGAMMADEX *MD/CRNA ORDER ENTRY* 200 MG/2 ML VIAL Medication
SUGAM500V SUGAMMADEX *MD/CRNA ORDER ENTRY* 500 MG/5 ML VIAL Medication
SULF10OPSO SULFACETAMIDE SODIUM 10% OPHTHALMIC SOL 15 ML BOTTLE Medication
SULFAD500T sulfADIAZINE 500 MG TAB Medication
SULFASAL5 SULFASALAZINE 500 MG TAB Medication
SULFASAL5E SULFASALAZINE 500 MG EC TAB Medication
SULFPRED10 SULFACETAMIDE/PREDNISOLONE 40 DROP/10 ML BOT Medication
SULINDA150 SULINDAC 150 MG TAB Medication
Page 62 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
SULINDA200 SULINDAC 200 MG TAB Medication
SUMAT25T SUMAtriptan 25 MG TAB Medication
SUMAT50T SUMAtriptan 50 MG TAB Medication
SUMATR6V SUMAtriptan 6 MG/0.5 ML VIAL Medication
SURGICEL24 OXIDIZED CELLULOSE FIBRILLAR HEMOSTAT 2"X4" PLEDG Medication
SURGICEL44 OXIDIZED CELLULOSE SNOW HEMOSTAT 4"X4" PLEDG Medication
SURGICEL48 OXIDIZED CELLULOSE HEMOSTAT 4"X8" PLEDG Medication
SURGIFOAM5 GELATIN SPONGE ABSORBABLE (SURGIFOAM 50 8CM X 6.25CM X 1CM) Medication
SYMBY6/25 OLANZapine/FLUoxetine 6/25 MG CAP Medication
T15ML APAP 360MG + CODEINE 36MG (TYLENOL+CODEINE ELIXIR)15 ML CUP Medication
T2 APAP 300MG/CODEINE 15MG (TYLENOL #2) TAB Medication
T3 APAP 300MG/CODEINE 30MG (TYLENOL#3) TAB Medication
T4 APAP 300MG/CODEINE 60MG(TYLENOL #4) TAB Medication
TACOINT TACROLIMUS 0.03% OINT 30 GM TUBE Medication
TACOINT TACROLIMUS 0.03% OINT 30 GM TUBE Medication as an Additive
TACR5V TACROLIMUS ANHYDROUS 5 MG/ML AMP Medication
TACR5V TACROLIMUS ANHYDROUS 5 MG/ML AMP Medication as an Additive
TACROL0.5 TACROLIMUS ANHYDROUS 0.5 MG CAP Medication
TACROL1C TACROLIMUS ANHYDROUS 1 MG CAP Medication
TADA20TA TADALAFIL 20 MG TAB Medication
TADALA5T TADALAFIL 5 MG TAB Medication
TAFL0.3S TAFLUPROST 0.0015 % OPH SOL UD (0.3 ML) Medication
TALC30AE TALC POWDER STERILE 4 GM INTRAPLEURAL AEROSOL Medication
TALC4 TALC POWDER STERILE 4 GM VIAL Medication
TALC4 TALC POWDER STERILE 4 GM VIAL Medication as an Additive
TALC5 TALC POWDER STERILE 5 GM VIAL Medication
TALC5 TALC POWDER STERILE 5 GM VIAL Medication as an Additive
TALWNX PENTAZOCINE/NALOXONE 50-0.5 MG TAB Medication
TAM4 TAMSULOSIN 0.4 MG CAP Medication
TAMOX10T TAMOXIFEN CITRATE 10 MG TAB Medication
TAPE50TA TAPENTADOL 50 MG TAB Medication
TAPE75TA TAPENTADOL 75 MG TAB Medication
TAZAROT TAZAROTENE 0.1% CREAM 30 GM TUBE Medication
TB TUBERCULIN PPD 5 TU/0.1 ML SKIN TEST Medication
TCN250C TETRACYCLINE 250 MG CAP Medication
TDAP ADACEL (TETANUS,DIPHTHERIA,PERTUSSIS VACCINE)11-64 YR Medication
TEDI200P TEDIZOLID PHOSPHATE 200 MG VIAL Medication
TEDI200P TEDIZOLID PHOSPHATE 200 MG VIAL Medication as an Additive
TEDI200T TEDIZOLID PHOSPHATE 200MG TAB Medication
TELA750P TELAVANCIN 750 MG VIAL Medication
TELA750P TELAVANCIN 750 MG VIAL Medication as an Additive
TEMAZE15C TEMAZEPAM 15 MG CAP Medication
Page 63 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
TEMAZE7.5C TEMAZEPAM 7.5 MG CAP Medication
TEMOZ250 TEMOZOLOMIDE 250 MG CAP Medication
TEMSI25 TEMSIROLIMUS 25 MG/ML 1 ML INJ Medication
TEMSI25 TEMSIROLIMUS 25 MG/ML 1 ML INJ Medication as an Additive
TENOFOV TENOFOVIR 300 MG TAB Medication
TERAZO1C TERAZOSIN 1 MG CAP Medication
TERAZO2C TERAZOSIN 2 MG CAP Medication
TERAZO5C TERAZOSIN 5 MG CAP Medication
TERB1CR15 TERBINAFINE 1% CREAM 12GM TUBE Medication
TERB250T TERBINAFINE 250 MG TAB Medication
TERBUT1A TERBUTALINE SULFATE 1 MG/ML 1ML AMP Medication
TERBUT1A TERBUTALINE SULFATE 1 MG/ML 1ML AMP Medication as an Additive
TERBUT25T TERBUTALINE SULFATE 2.5 MG TAB Medication
TESTCYP200 TESTOSTERONE CYPIONATE 200 MG/1 ML VIAL Medication
TESTOSGEL1 TESTOSTERONE 1% GEL 5 GM PACKET Medication
TETRAB12.5 TETRABENAZINE 12.5 MG TAB Medication
TETRAC20IN TETRACAINE 1%-10MG/ML 2ML AMP Medication
TETRACAOPS TETRACAINE 0.5% OPHTHALMIC SOLUTION 4 ML BOTTLE Medication
TETRAHOPTI TETRAHYDROZOLINE 0.05% OPTH SOL 15 ML BOT Medication
THALID50 THALIDOMIDE 50 MG CAP Medication
THEO24100C THEOPHYLLINE-SR 100 MG 24-HR CAP Medication
THEOER100 THEOPHYLLINE-ER 100 MG 12-HR TAB Medication
THEOER300 THEOPHYLLINE-ER 300 MG 12-HR TAB Medication
THEOP400P THEOPHYLLINE 400 MG/500 ML PREMIX Medication
THEOP80LIQ THEOPHYLLINE 80 MG/15 ML ELIXIR CUP Medication
THERALIQ THERAGRAN 5 ML CUP Medication
THERAMTAB THERAGRAN M TAB Medication
THERATAB THERAGRAN TAB Medication
THIAM100T THIAMINE HCL 100 MG TAB Medication
THIAM100V THIAMINE 100 MG/ML 2 ML VIAL Medication
THIAM100V THIAMINE 100 MG/ML 2 ML VIAL Medication as an Additive
THIORI25T THIORIDAZINE HCL 25 MG TAB Medication
THIOTH1C THIOTHIXENE 1 MG CAP Medication
THIOTH5C THIOTHIXENE 5 MG CAP Medication
THRO5000 THROMBIN (RECOMB) 5,000 UNIT VIAL Medication
THRO50002 THROMBIN (BOVINE) 5,000 UNIT VIAL Medication
THRO50004 THROMBIN (BOVINE) 5000 UNIT EPISTAXIS KIT Medication
THYROID15 THYROID 15 MG TAB Medication
THYROID60 THYROID 60 MG TAB Medication
TIAGAB4 tiaGABine 4 MG TAB Medication
TICA60T TICAGRELOR 60 MG TAB Medication
TICA90TA TICAGRELOR 90 MG TAB Medication
Page 64 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
TIGECY50VL TIGECYCLINE 50 MG/5 ML PWVL Medication
TIGECY50VL TIGECYCLINE 50 MG/5 ML PWVL Medication as an Additive
TIMOLO25OP TIMOLOL MALEATE 0.25% OPHTHALMIC SOLUTION 5 ML Medication
TIMOLO5OPS TIMOLOL MALEATE 0.5% OPHTH SOL 5 ML Medication
TIMOLXE5OP TIMOLOL MALEATE-XE 0.5% OPTH GEL 5 ML Medication
TISSEEL4 TISSEEL 4 ML KIT Medication
TISSEEL5 TISSEEL VH 10 ML KIT Medication
TIZ2 tizANidine 2 MG TAB Medication
TIZ4 tizANidine 4 MG TAB Medication
TNKK TENECTEPLASE 50 MG VIAL Medication
TOBRAM12V TOBRAMYCIN SULFATE 1.2 GM VIAL Medication
TOBRAM300S TOBRAMYCIN 300 MG/7.5 ML NEB SYRINGE Medication
TOBRAM80V TOBRAMYCIN SULFATE 80 MG/2 ML VIAL Medication
TOBRAM80V TOBRAMYCIN SULFATE 80 MG/2 ML VIAL Medication as an Additive
TOBRAMOPOT TOBRAMYCIN 0.3% OPTHALMIC OINTMENT 3.5 GM TUBE Medication
TOBRAMOPSO TOBRAMYCIN 0.3% OPHTHALMIC SOLUTION 5 ML Medication
TOBRDEXOPO TOBRADEX (TOBRAMYCIN 0.3%/DEXAMETHASONE 0.1%) OPHTH OINT 3.5 GM TUBE Medication
TOBRDEXOPS TOBRADEX(TOBRAMYCIN 0.3%/DEXAMETHASONE 0.1%) OPTHALMIC SUSP 5 ML Medication
TOCILI200V TOCILIZUMAB 200 MG/10 ML VIAL Medication
TOCILI200V TOCILIZUMAB 200 MG/10 ML VIAL Medication as an Additive
TOLNAF1CRM TOLNAFTATE 1% CREAM 15 GM TUBE Medication
TOLNAF1PWD TOLNAFTATE 45 GM POWDER Medication
TOLV15TA TOLVAPTAN 15 MG TABLET Medication
TOLV30TA TOLVAPTAN 30 MG TABLET Medication
TOP15 TOPIRAMATE 15 MG SPRINKLE CAP Medication
TOP25 TOPIRAMATE 25 MG TAB Medication
TOP25S TOPIRAMATE 25 MG SPRINKLE CAP Medication
TOPI100T TOPIRAMATE 100 MG TAB Medication
TOPOT4MG TOPOTECAN 4 MG/4 ML VIAL Medication
TORSEM10 TORSEMIDE 10 MG TAB Medication
TORSEM100 TORSEMIDE 100 MG TAB Medication
TPA100IV TPA 100 MG VIAL Medication
TPA100IV TPA 100 MG VIAL Medication as an Additive
TPA50V TPA 50 MG VIAL Medication
TPA50V TPA 50 MG VIAL Medication as an Additive
TPNCLI515 TPN-CLINIMIX 5/15 2000 ML BAG Medication
TPNCLI515E TPN-CLINIMIX E 5/15 1000ML BAG Medication
TPNCLI520 TPN-CLINIMIX 5/20 2000 ML BAG Medication
TPNCLI520E TPN-CLINIMIX E 5/20 1000ML BAG Medication
TPNCLIE515 TPN-CLINIMIX E 5/15 2000ML BAG Medication
TPNCLIE520 TPN-CLINIMIX E 5/20 2000ML BAG Medication
TPNCUSNOL TPN-CUSTOM-OUTSOURCED NOLIPIDS Medication
Page 65 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
TPNCUSTOM TPN-CUSTOM-OUTSOURCED W/LIPIDS Medication
TRAMAD50T traMADol 50 MG TAB Medication
TRAMER100T traMADol ER 100 MG TAB Medication
TRAN1000P TRANEXAMIC ACID IN 0.7% NACL 1,000 MG/100 ML PIGGYBACK Medication
TRAN100A2 TRANEXAMIC ACID 1000 MG/10 ML AMP Medication
TRAN100A2 TRANEXAMIC ACID 1000 MG/10 ML AMP Medication as an Additive
TRANDOL1 TRANDOLAPRIL 1 MG TAB Medication
TRANEX650T TRANEXAMIC ACID 650 MG TAB Medication
TRAV2.5D TRAVOPROST Z 0.004% OPTH SOL 2.5 ML Medication
TRAZOD100T traZODone 100 MG TAB Medication
TRAZOD150T traZODone 150 MG TAB Medication
TRAZOD50T traZODone 50 MG TAB Medication
TREP10S TREPROSTINIL 10 MG/ML 20 ML VIAL Medication
TREP10S TREPROSTINIL 10 MG/ML 20 ML VIAL Medication as an Additive
TREP1S TREPROSTINIL 1 MG/ML 20 ML VIAL Medication
TREP1S TREPROSTINIL 1 MG/ML 20 ML VIAL Medication as an Additive
TREP2.5S TREPROSTINIL 2.5 MG/ML 20 ML VIAL Medication
TREP2.5S TREPROSTINIL 2.5 MG/ML 20 ML VIAL Medication as an Additive
TREP5S TREPROSTINIL 5 MG/ML 30 ML VIAL Medication
TREP5S TREPROSTINIL 5 MG/ML 30 ML VIAL Medication as an Additive
TRETIN25CR TRETINOIN 0.025% CREAM 20 GM TUBE Medication
TRETIN25GL TRETINOIN GEL 0.025% 15 GM TUBE Medication
TRIAM1C15 TRIAMCINOLONE ACETONIDE 0.1% CREAM 15 GM TUBE Medication
TRIAM1C1LB TRIAMCINOLONE 0.1% CREAM 454 GM JAR Medication
TRIAM1C80 TRIAMCINOLONE ACETONIDE 0.1% CREAM 80 GM TUBE Medication
TRIAM1L60 TRIAMCINOLONE ACETONIDE 0.1% LOTION 60 ML BOT Medication
TRIAM1O15 TRIAMCINOLONE ACETONIDE 0.1% OINTMENT 15 GM TUBE Medication
TRIAM1O1LB TRIAMCINOLONE ACETONIDE 0.1% OINTMENT 454 GM JAR Medication
TRIAM1O80 TRIAMCINOLONE ACETONIDE 0.1% OINTMENT 80 GM TUBE Medication
TRIAM25C1 TRIAMCINOLONE ACETONIDE 0.025% CREAM 454 GM JAR Medication
TRIAM25C15 TRIAMCINOLONE ACETONIDE 0.025% CREAM 15 GM TUBE Medication
TRIAM25C80 TRIAMCINOLONE ACETONIDE 0.025% CREAM 80 GM TUBE Medication
TRIAM25O15 TRIAMCINOLONE ACETONIDE 0.025% OINTMENT 15 GM TUBE Medication
TRIAM25O80 TRIAMCINOLONE ACETONIDE 0.025% OINTMENT 80 GM TUBE Medication
TRIAM5C15 TRIAMCINOLONE ACETONIDE 0.5% CREAM 15 GM TUBE Medication
TRIAMAC105 TRIAMCINOLONE ACETONIDE 10 MG/ML 5 ML VIAL Medication
TRIAMAC401 TRIAMCINOLONE ACETONIDE 40 MG/ML 1ML VIAL Medication
TRIAMC405 TRIAMCINOLONE ACETONIDE 40 MG/ML 5ML VIAL Medication
TRIAMORABA TRIAMCINOLONE ACETONIDE 0.1% DENTAL PASTE 5 GM TUBE Medication
TRIAMSPRAY TRIAMCINOLONE ACETONIDE SPRAY 63 GRAM Medication
TRIAMT50C TRIAMTERENE 50 MG CAP Medication
TRIAZO125 TRIAZOLAM 0.125 MG TAB Medication
Page 66 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
TRIAZO25 TRIAZOLAM 0.25 MG TAB Medication
TRIFLU2T TRIFLUOPERAZINE 2 MG TAB Medication
TRIFLU5T TRIFLUOPERAZINE 5 MG TAB Medication
TRIFLUR10P TRIFLURIDINE 1 % OPHTH SOLUTION 7.5 ML Medication
TRIHEXYPH2 TRIHEXYPHENIDYL 2 MG TAB Medication
TRIHEXYPH5 TRIHEXYPHENIDYL 5 MG TAB Medication
TRIMETHO2A TRIMETHOBENZAMIDE 200 MG/2 ML VIAL Medication
TRIMETHO3C TRIMETHOBENZAMIDE 300 MG CAP Medication
TRIMETHOPR TRIMETHOPRIM 100 MG TAB Medication
TROPICAM.5 TROPICAMIDE 0.5% OPTHALMIC SOLUTION 15 ML BOTTLE Medication
TROPICAM1 TROPICAMIDE 1% 15 ML OPTHALMIC SOLUTION Medication
TRUV2/3 TRUVADA (EMTRICITABINE/TENOFOVIR 200 MG/300 MG) TAB Medication
TUSSION5S HYDROCODONE 10MG/CHLORPHENIRAMINE 8MG-5 ML CUP (TUSSIONEX) Medication
ULTRACET traMADol/ACETAMINOPHEN 37.5/325 MG TAB Medication
UNASYN15 UNASYN (AMPICILLIN/SULBACTAM) 1.5 GM VIAL Medication
UNASYN15 UNASYN (AMPICILLIN/SULBACTAM) 1.5 GM VIAL Medication as an Additive
UNASYN3 UNASYN(AMPICILLIN/SULBACTAM) 3 GM VIAL Medication
UNASYN3 UNASYN(AMPICILLIN/SULBACTAM) 3 GM VIAL Medication as an Additive
UREA20CRM UREA 20% CREAM 85 GM Medication
URSO500T2 URSODIOL 500 MG TABLET Medication
URSODI300C URSODIOL 300 MG CAP Medication
USTEK130V USTEKINUMAB 130 MG/26 ML VIAL Medication
USTEK130V USTEKINUMAB 130 MG/26 ML VIAL Medication as an Additive
VALA500C VALACYCLOVIR 500 MG TAB Medication
VALGA VALGANCICLOVIR 450 MG TAB Medication
VALISO45C BETAMETHASONE VALERATE 0.1% CREAM 45 GM TUBE Medication
VALPRO250C VALPROIC ACID 250 MG CAP Medication
VALPRO500V VALPROATE SODIUM 500 MG/5 ML VIAL Medication
VALPRO500V VALPROATE SODIUM 500 MG/5 ML VIAL Medication as an Additive
VALPROL VALPROIC ACID 250 MG/5 ML UD LIQ Medication
VANC125S2 VANCOMYCIN 125 MG/2.5 ML ORAL SYRINGE Medication
VANC750BAG VANCOMYCIN 750 MG/250 ML PREMIX BAG Medication
VANC750FRB VANCOMYCIN 750 MG/150 ML PREMIX BAG IN NS (FROZEN) Medication
VANCO1.25P VANCOMYCIN 1.25 GM/250 ML PREMIX BAG IN NS Medication
VANCO1.5PR VANCOMYCIN 1.5 GM/500 ML PREMIX BAG IN NS Medication
VANCO1.75P VANCOMYCIN 1.75 GM/500 ML PREMIX BAG IN NS Medication
VANCO1FRB VANCOMYCIN 1 GM/200 ML PREMIX BAG IN NS (FROZEN) Medication
VANCO1GMC VANCOMYCIN HCL 1000 MG/10 ML VIAL & NS 250 ML BAG VIALMATE Medication
VANCO1GMI VANCOMYCIN 1000 MG/10 ML VIAL Medication
VANCO1GMI VANCOMYCIN 1000 MG/10 ML VIAL Medication as an Additive
VANCO2PRE VANCOMYCIN 2 GM/500 ML PREMIX BAG IN NS Medication
VANCOLOCK VANCO: LOCK THERAPY W/HEPARIN Medication
Page 67 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
VANCOLOCK VANCO: LOCK THERAPY W/HEPARIN Medication as an Additive
VAREN0.5 VARENICLINE 0.5 MG Medication
VARICELLA VARICELLA VIRUS VACCINE Medication
VASOP20INJ VASOPRESSIN 20 UNIT/1 ML AMP Medication
VASOP20INJ VASOPRESSIN 20 UNIT/1 ML AMP Medication as an Additive
VECU20VI4 VECURONIUM BROMIDE 20 MG VIAL Medication
VECUR10INJ VECURONIUM 10 MG VIAL Medication
VECUR10INJ VECURONIUM 10 MG VIAL Medication as an Additive
VEDO300 VEDOLIZUMAB 300 MG VIAL Medication
VEDO300 VEDOLIZUMAB 300 MG VIAL Medication as an Additive
VENLAF100 VENLAFAXINE 100 MG TAB Medication
VENLAF150X VENLAFAXINE XR 150 MG ER CAP Medication
VENLAF25 VENLAFAXINE 25 MG TAB Medication
VENLAF375X VENLAFAXINE XR 37.5 MG ER CAP Medication
VENLAF50 VENLAFAXINE 50 MG TAB Medication
VENLAF75X VENLAFAXINE XR 75 MG ER CAP Medication
VER120ERG VERAPAMIL ER 120 MG TAB Medication
VER180ERG VERAPAMIL ER 180 MG TAB Medication
VER240ERG VERAPAMIL ER 240 MG TAB Medication
VERA40TA5 VERAPAMIL 40 MG TAB Medication
VERA5INJ VERAPAMIL HCL 5 MG/2 ML VIAL Medication
VERAP120T VERAPAMIL 120 MG TAB Medication
VERAP80T VERAPAMIL 80 MG TAB Medication
VICOP HYDROcodone 7.5 MG/IBUPROFEN 200MG TAB (VICOPROFEN) Medication
VILA10TA VILAZODONE 10 MG TAB Medication
VILA20TA VILAZODONE 20 MG TAB Medication
VILA40TA VILAZODONE 40 MG TAB Medication
VINBLAST10 vinBLAStine SULFATE 10 MG/10 ML VIAL Medication
VINBLAST10 vinBLAStine SULFATE 10 MG/10 ML VIAL Medication as an Additive
VINCRI1INJ vinCRIStine SULFATE 1 MG/ML INJECTION Medication
VINCRI1INJ vinCRIStine SULFATE 1 MG/ML INJECTION Medication as an Additive
VINOR50 VINORELBINE 50 MG/5 ML VIAL Medication
VINOR50 VINORELBINE 50 MG/5 ML VIAL Medication as an Additive
VISCOAT5OP CHONDROITIN/HYALURONATE (VISCOAT) 0.5 ML OPHTH INJ Medication
VITA10MUC VITAMIN A 10000 UNIT LCAP Medication
VITAMINCR VITAMIN E CREAM 120 GM JAR Medication
VITB2100 RIBOFLAVIN (VIT B2) 100 MG TAB Medication
VITBCOMPLX VITAMIN B COMPLEX CAP Medication
VITC250T ASCORBIC ACID 250 MG TAB Medication
VITC500T ASCORBIC ACID (VIT C) 500 MG TAB Medication
VITC500V ASCORBIC ACID (VIT C) 500 MG/ML 50 ML VIAL Medication
VITC500V ASCORBIC ACID (VIT C) 500 MG/ML 50 ML VIAL Medication as an Additive
Page 68 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
VITCHEWFE CHEWABLE VITAMINS W/IRON Medication
VITCHEWTAB CHEWABLE VITAMINS (NO IRON) Medication
VITD1000U CHOLECALCIFEROL (VIT D3) 1000 UNIT TAB Medication
VITD2000U CHOLECALCIFEROL (VIT D3) 2000 UNIT TAB Medication
VITD400IU CHOLECALCIFEROL (VIT D3) 400 UNIT TAB Medication
VITD400L CHOLECALCIFEROL (VIT D3) 400 UNIT/ML ORAL LIQ 50ML BOT Medication
VITD5000U CHOLECALCIFEROL (VIT D3) 5000 UNIT CAP Medication
VITD50MUC ERGOCALCIFEROL (VIT D2) 50000 UNIT CAP Medication
VITE1000C VITAMIN E 1000 UNIT CAP Medication
VITE100C VITAMIN E 100 UNIT CAP Medication
VITE200C VITAMIN E 200 UNIT CAP Medication
VITE400C VITAMIN E 400 UNIT CAP Medication
VITEGTTS VITAMIN E 15 UNIT/0.3 ML-12 ML BOTTLE Medication
VOLUV500 HYDROXYETHYL STARCH 6%NS 500 ML BAG Medication
VOLUV500 HYDROXYETHYL STARCH 6%NS 500 ML BAG Medication as a Carrier
VORIC200 VORICONAZOLE 200 MG TAB Medication
VORIC200S VORICONAZOLE 200 MG/5 ML ORAL SUSP (75 ML BOTTLE) Medication
VORICON2 VORICONAZOLE 10 MG/ML 20 ML VIAL Medication
VORICON2 VORICONAZOLE 10 MG/ML 20 ML VIAL Medication as an Additive
VORT10TA1 VORTIOXETINE 10 MG TAB Medication
VWF1200 VON WILLEBRAND FACTOR ~1,200 UNIT/10 ML KIT (HUMATE-P) (CHARGE PER UNIT) Medication
VWF1200 VON WILLEBRAND FACTOR ~1,200 UNIT/10 ML KIT (HUMATE-P) (CHARGE PER UNIT) Medication as an Additive
VWF2400 VON WILLEBRAND FACTOR ~2,400 UNIT/15 ML KIT (HUMATE-P) (CHARGE PER UNIT) Medication
VWF2400 VON WILLEBRAND FACTOR ~2,400 UNIT/15 ML KIT (HUMATE-P) (CHARGE PER UNIT) Medication as an Additive
VWF600 VON WILLEBRAND FACTOR ~600 UNIT/5 ML KIT (HUMATE-P) (CHARGE PER UNIT) Medication
VWF600 VON WILLEBRAND FACTOR ~600 UNIT/5 ML KIT (HUMATE-P) (CHARGE PER UNIT) Medication as an Additive
WARFAR05T WARFARIN SODIUM 0.5 MG TAB Medication
WARFAR10T WARFARIN SODIUM 10 MG TAB Medication
WARFAR1T WARFARIN SODIUM 1 MG TAB Medication
WARFAR25T WARFARIN SODIUM 2.5 MG TAB Medication
WARFAR2T WARFARIN SODIUM 2 MG TAB Medication
WARFAR3T WARFARIN SODIUM 3 MG TAB Medication
WARFAR4T WARFARIN SODIUM 4 MG TAB Medication
WARFAR5T WARFARIN SODIUM 5 MG TAB Medication
WARFAR75T WARFARIN SODIUM 7.5 MG TAB Medication
ZAFIR20T ZAFIRLUKAST 20 MG TAB Medication
ZIAC10 BISOPROLOL/HCTZ 10/6.25 MG TAB Medication
ZIAC2 BISOPROLOL/HCTZ 2.5/6.25 MG TAB Medication
ZIAC5T BISOPROLOL/HCTZ 5/6.25 MG TAB Medication
ZINCOXIDE ZINC OXIDE 20% OINT 30 GM TUBE Medication
Page 69 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
ZINCOXIDE ZINC OXIDE 20% OINT 30 GM TUBE Medication as a Compound
ZINCSULFAT ZINC SULFATE 220 MG CAP (50 MG ELEMENTAL ZINC) Medication
ZIPRA20 ZIPRASIDONE 20 MG CAP Medication
ZIPRA40 ZIPRASIDONE 40 MG CAP Medication
ZIPRAS20 ZIPRASIDONE HCL 20 MG/ML PWVL Medication
ZN50 ZINC GLUCONATE 50 MG TAB (7 MG ELEMENTAL ZINC) Medication
ZOLE4INF ZOLEDRONIC ACID (ZOMETA) 4 MG/100 ML INJ Medication
ZOLE5INF ZOLEDRONIC ACID (RECLAST) 5 MG/100 ML INJ Medication
ZOLM5OD ZOLMITRIPTAN 5 MG ORALLY DISINTEGRATING TAB Medication
ZOLMIT25OD ZOLMITRIPTAN 2.5 MG ORALLY DISINTEGRATING TAB Medication
ZOLPID10 ZOLPIDEM 10 MG TAB Medication
ZOLPID5 ZOLPIDEM 5 MG TAB Medication
ZONIS ZONISAMIDE 100 MG CAP Medication
ZONIS25 ZONISAMIDE 25 MG CAP Medication
ZOSTERVACC HERPES ZOSTER VACCINE LIVE INJECTION Medication
ZOSYN2.25 PIPERACILLIN/TAZOBACTAM 2.25 GM VIAL Medication
ZOSYN2.25 PIPERACILLIN/TAZOBACTAM 2.25 GM VIAL Medication as an Additive
ZOSYN3.375 PIPERACILLIN/TAZOBACTAM 3.375 GM VIAL Medication
ZOSYN3.375 PIPERACILLIN/TAZOBACTAM 3.375 GM VIAL Medication as an Additive
ZOSYN4.5 PIPERACILLIN/TAZOBACTAM 4.5 GM VIAL Medication
ZOSYN4.5 PIPERACILLIN/TAZOBACTAM 4.5 GM VIAL Medication as an Additive
Page 70 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
Charge
$22.00
$22.00
$10.87
$16.05
$3362.10
$3377.10
$9.69
$8.75
$35.58
$50.58
$53.18
$68.18
$8.89
$8.67
$0.09
$142.00
$0.00
$0.80
$0.93
$0.00
$0.00
$0.00
$1.54
$0.00
$0.10
$0.03
$7.84
$122.30
$174.50
$5.64
$24.40
$25.13
$40.91
$599.00
$614.00
$25.40
$85.37
$479.59
$110.00
$125.00
$9.42
Page 71 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$13.24
$75.00
$90.00
$12.62
$5352.58
$254.40
$15.99
$14.89
$9.63
$425.00
$440.00
$46.70
$329.08
$37.58
$1.06
$0.03
$25.84
$15.85
$41.75
$56.75
$26.00
$376.30
$188.15
$376.30
$188.15
$138.88
$26.00
$26.00
$8.20
$8.29
$50.67
$19.38
$257.70
$1635.00
$1650.00
$33.27
$31.85
$35.95
$71.20
$15.45
$0.23
$7.96
Page 72 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$8.33
$69.54
$35.80
$50.80
$36.30
$51.30
$8.46
$8.24
$8.37
$260.30
$390.04
$509.18
$60.00
$20.00
$178.84
$11.74
$9.41
$469.32
$469.32
$83.10
$4.60
$52.22
$7.92
$94.53
$47.62
$109.53
$39.30
$0.00
$0.00
$288.44
$36.67
$44.30
$77.00
$80.31
$69.10
$84.10
$120.96
$148.44
$60.75
$75.75
$17.05
Page 73 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$42.50
$57.50
$10.62
$7.98
$11.71
$8.36
$8.86
$9.87
$7.74
$8.61
$9.55
$0.36
$38.00
$74.48
$8.48
$7.78
$9.39
$11.35
$8.67
$27.59
$31.10
$7.89
$8.18
$161.88
$715.20
$730.20
$56.60
$71.60
$44.95
$59.95
$74.80
$89.80
$45.48
$60.48
$12.60
$110.16
$10.06
$5.36
$4535.00
$4550.00
$46.65
$52.39
Page 74 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$24.76
$18.17
$18.17
$36.98
$386.48
$138.43
$492.61
$4.69
$13.00
$1456.28
$1565.00
$1580.00
$591.58
$390.50
$45.57
$45.53
$0.00
$45.36
$0.00
$45.48
$0.00
$0.00
$20.64
$24.50
$15.07
$1.96
$3.16
$0.04
$1.28
$0.00
$1.32
$0.06
$0.03
$36.18
$2.08
$9.09
$8.55
$8.66
$11.17
$24.53
$14.63
$26.01
Page 75 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$11.17
$8.20
$8.23
$8.42
$9.91
$37.54
$59.29
$92.17
$34.80
$50.20
$106.94
$121.94
$40.20
$25.58
$38.92
$152.09
$14.64
$104.73
$12.10
$13.43
$15.91
$38.86
$345.55
$278.92
$3.44
$1517.30
$1532.30
$1579.05
$1594.05
$10.40
$75.96
$253.79
$64.21
$57.36
$64.21
$29.81
$16.39
$50.00
$65.00
$133.85
$148.85
$235.85
Page 76 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$250.85
$1.74
$0.18
$68.28
$83.28
$11.28
$156.93
$10.54
$8.62
$873.30
$94.70
$3471.90
$6.70
$200.00
$479.15
$494.15
$46.50
$2342.50
$2357.50
$8.85
$8.85
$7011.33
$7026.33
$1.17
$1.82
$40.17
$191.06
$22.82
$546.24
$3.66
$6.14
$35.37
$8.25
$1.90
$1.96
$1.72
$1.12
$8.09
$172.70
$8.22
$8.06
$1649.62
Page 77 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$941.90
$54.70
$146.30
$148.86
$9.98
$10.15
$2425.83
$2440.83
$9598.28
$9613.28
$11435.00
$11450.00
$54.48
$29.69
$323.76
$232.58
$400.38
$562.20
$240.76
$12.22
$0.76
$279.57
$0.06
$0.03
$12.07
$40.50
$7.70
$0.28
$9.21
$2878.18
$2893.18
$89.20
$138.50
$153.50
$220.75
$203.57
$4844.00
$4859.00
$47.41
$1412.30
$63.05
$60.41
Page 78 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$61.55
$126.03
$231.31
$213.11
$430.45
$12.53
$33.93
$49.77
$220.10
$26.00
$26.00
$32.27
$92.93
$54.88
$0.02
$10.13
$9.97
$29.30
$58.25
$39.72
$71.28
$13.28
$13.28
$430.70
$560.00
$28.38
$26.56
$3.86
$54.83
$31.36
$35.54
$29.52
$34.20
$27.12
$4.42
$55.53
$26.64
$3.94
$54.93
$49.56
$28.50
$34.82
Page 79 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$27.06
$4.36
$55.45
$30.50
$59.75
$28.26
$90.91
$113.12
$46.03
$12.53
$35.83
$9.61
$9.06
$8.86
$8.54
$9.21
$8.52
$9.48
$41.04
$30.03
$177.50
$8900.00
$8915.00
$51.23
$8.30
$0.05
$65.24
$125.22
$178.15
$89.70
$104.70
$8.89
$11.88
$1.23
$4.20
$0.06
$2.06
$38.98
$70.35
$24.40
$39.40
$0.03
Page 80 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$163.76
$55.28
$18.07
$9.04
$44.66
$77.45
$227.19
$3.56
$29.71
$31.13
$2282.00
$2297.00
$54.15
$10.99
$9.08
$987.57
$34.54
$9.62
$11.05
$9.05
$9.73
$9.83
$8.96
$8.36
$12.41
$8.02
$13.01
$3.56
$5.73
$0.15
$33.60
$12.18
$230.00
$245.00
$873.34
$3517.50
$3532.50
$12.15
$8.44
$0.81
$11827.35
$23684.70
Page 81 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$56383.73
$20.70
$10.10
$10.10
$10.10
$9.97
$11.88
$95.05
$39.10
$54.10
$53.70
$76.58
$65.43
$80.43
$52.10
$67.10
$347.17
$22.93
$41.73
$56.73
$92.70
$107.70
$150.40
$165.40
$64.85
$79.85
$68.14
$94.85
$109.85
$87.04
$17.67
$217.81
$350.88
$365.88
$611.38
$626.38
$50.60
$65.60
$68.00
$83.00
$1111.43
$1126.43
Page 82 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$50.95
$65.95
$322.45
$337.45
$39.50
$54.50
$37.25
$52.25
$43.55
$58.55
$52.53
$67.53
$12.84
$51.00
$66.00
$13.10
$16.57
$0.08
$3.16
$50.96
$8.64
$56.91
$9.05
$5215.62
$11.34
$2.34
$9.72
$0.13
$8.09
$9.44
$18.40
$13.59
$42.35
$7.15
$3.26
$8.34
$8.40
$8.56
$10.31
$0.00
$0.46
$73.84
Page 83 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$76.42
$8.42
$9.08
$25.32
$7.70
$16.69
$85.78
$128.85
$0.01
$0.93
$9.04
$9.37
$11.61
$12.00
$85.71
$2255.00
$2270.00
$9.90
$46.00
$45.46
$127.54
$359.85
$7.89
$7.86
$45.02
$52.49
$79.00
$85.96
$129.08
$846.50
$861.50
$58.76
$95.08
$76.89
$10.50
$10.80
$15.78
$7.72
$1340.00
$1355.00
$13.56
Page 84 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$70.95
$14.76
$0.93
$469.70
$204.90
$151.93
$8.47
$57.38
$42.35
$57.35
$67.38
$73.94
$37.40
$68.07
$36.39
$10.16
$8839.25
$8854.25
$327.89
$56.62
$20.98
$9.15
$8.68
$8.55
$124.70
$102.00
$152.00
$47.01
$7.87
$73.97
$7.98
$27.24
$8.35
$30.53
$12.79
$9.12
$9.52
$1.09
$32.92
$111.63
$14.85
$33.28
Page 85 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$17.32
$9.27
$273.11
$8.71
$0.14
$0.02
$0.45
$7.96
$20.87
$17.17
$12.31
$9.08
$116.34
$1434.64
$15.62
$735.02
$750.02
$15.62
$15.62
$15.62
$15.62
$556.14
$188.65
$83.39
$207.72
$142.51
$147.51
$9.55
$103.01
$11.34
$278.50
$369.75
$12.04
$16.41
$9.36
$9.69
$67.03
$300.00
$402.70
$7.85
$0.16
$39.28
Page 86 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$0.17
$127.72
$2095.15
$2110.15
$4155.33
$4170.33
$9.04
$71.92
$42.69
$18.74
$1065.08
$1080.08
$14.15
$9.24
$23.39
$11.77
$20.87
$116.56
$131.56
$650.40
$8.87
$53.75
$68.75
$97.70
$112.70
$22.00
$22.00
$77.50
$22.00
$22.00
$77.50
$22.00
$22.00
$77.50
$34.64
$57.76
$41.92
$74.03
$43.10
$58.10
$5.20
$22.00
Page 87 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$71.28
$8.14
$22.00
$22.00
$22.00
$77.50
$22.00
$49.86
$71.28
$22.00
$22.00
$71.28
$22.00
$22.00
$71.28
$71.28
$22.00
$71.28
$22.00
$16.43
$17.89
$17.13
$86.25
$101.25
$3721.10
$3736.10
$10.64
$10.64
$10.64
$8.67
$350.81
$9.91
$8.49
$9.17
$1370.00
$1385.00
$5586.20
$5601.20
$469.58
$737.78
$1095.26
$1810.22
Page 88 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$437.43
$452.43
$121.58
$173.60
$2321.28
$1500.35
$15.26
$27.91
$2863.22
$5344.02
$125.00
$173.00
$4.65
$6.39
$3.48
$7.98
$10.12
$2.63
$13.90
$10.97
$163.80
$226.38
$193.35
$82.75
$48.40
$50.32
$259.80
$44.12
$35.49
$21.25
$107.48
$107.48
$184.35
$36.42
$67.15
$8.04
$8.48
$9.02
$24.88
$7.85
$7.75
$27.38
Page 89 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$24.46
$9.11
$13.98
$247.70
$92.28
$107.28
$11.47
$1444.30
$1459.30
$30.31
$49.20
$58.02
$8.22
$8.40
$7.74
$7.86
$337.94
$444.05
$224.22
$190.21
$8.11
$25.86
$55.06
$7.89
$7.83
$2.95
$96.36
$54.78
$75.98
$9.29
$9.35
$9.71
$10.94
$9.19
$8.39
$8.14
$8.53
$8.03
$224.44
$8.84
$9193.10
$11513.00
Page 90 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$35.90
$15.93
$10.11
$10.08
$58.80
$19.04
$36.30
$67.00
$87.70
$7.81
$30.16
$59.33
$7.93
$8.62
$9.72
$9.09
$9.17
$10.34
$834.60
$0.13
$194.76
$1597.36
$2.03
$0.02
$9.12
$24.66
$2.56
$103.30
$153.12
$28.21
$121.70
$85.57
$27.02
$148.42
$169.03
$8.86
$12.41
$8.66
$9.29
$9.69
$9.92
$11.44
Page 91 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$11.44
$67.90
$51.65
$66.65
$121.44
$91.96
$83.10
$2033.00
$2048.00
$45.13
$0.06
$28.65
$17.99
$17.96
$17.95
$90.45
$0.54
$16.87
$21.12
$16.87
$7.72
$27.22
$55.65
$68.78
$97.41
$133.48
$148.48
$9.21
$44.42
$9.98
$8.36
$11.65
$8.60
$9.00
$9.75
$13.78
$51.55
$8119.25
$8134.25
$107.63
$122.63
$10.72
Page 92 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$110.50
$125.50
$8.47
$22.87
$21.37
$22.61
$15.93
$16.94
$114.45
$42.04
$126.50
$125.73
$74.34
$15.16
$80.65
$6.89
$26.74
$9.53
$9.34
$29.68
$14.89
$9.87
$60.86
$79.94
$94.24
$51.34
$70.42
$37.02
$41.76
$12.30
$41.92
$34.77
$136.20
$191.88
$523.84
$676.43
$57.70
$93.75
$104.22
$161.80
$71.25
Page 93 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$106.38
$104.22
$161.80
$753.04
$104.22
$161.80
$46.70
$57.70
$320.88
$11.61
$83.60
$98.60
$116.58
$1.50
$439.92
$1343.42
$1343.42
$50.37
$386.20
$401.20
$37.47
$44.07
$190.93
$205.93
$303.53
$18.11
$8.18
$12.81
$17.04
$9.92
$51.28
$51.28
$40.30
$72.00
$1160.12
$142.70
$200.00
$33.90
$75.29
$8.41
$8.72
$33.90
Page 94 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$13.26
$22.07
$1252.04
$2945.90
$1048.72
$42.50
$9.72
$10.91
$8.79
$60.78
$9.31
$9.14
$11.05
$38.82
$70.15
$37.62
$68.65
$1278.95
$63.43
$78.43
$5.72
$0.18
$31.67
$1773.82
$442.56
$1773.82
$1.87
$21.05
$4822.70
$6050.00
$9622.70
$12050.00
$24022.70
$30050.00
$0.07
$22.71
$45.74
$60.74
$18.13
$0.05
$24.60
$52.38
Page 95 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$23.31
$8.30
$8.42
$9.48
$9.40
$9.98
$11.35
$8.86
$24.59
$53.02
$25.54
$54.54
$71.10
$31.76
$32.91
$53.87
$78.18
$107.70
$107.70
$2075.00
$2090.00
$0.03
$0.48
$24.83
$0.25
$0.23
$1.90
$0.39
$2.57
$7.90
$8.46
$0.20
$283.62
$684.28
$1076.26
$11.35
$8.22
$10.86
$8.31
$10.00
$14.70
$0.90
Page 96 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$1.07
$1.67
$10.48
$196.58
$19.15
$23.77
$53.30
$55.90
$177.88
$402.57
$9.50
$106.70
$38.96
$131.11
$201.13
$160.61
$31.17
$53.29
$76.07
$35.04
$75.30
$113.96
$124.16
$240.84
$74.85
$89.85
$7.82
$32.88
$10.55
$10.27
$8.35
$382.70
$8.77
$195.76
$11.00
$8.55
$8.20
$35.59
$9.19
$54.64
$13.56
$10.66
Page 97 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$7.65
$8.03
$49.70
$83.75
$3315.00
$2624.00
$3330.00
$294.30
$138.10
$197.00
$293.30
$26.00
$916.25
$931.25
$120.96
$9.02
$98.52
$144.78
$261.54
$348.55
$568.27
$36.50
$8.21
$32.58
$8.23
$8.29
$29.64
$58.68
$8.14
$44.43
$59.43
$44.43
$59.43
$44.43
$59.43
$7.73
$7.84
$7.86
$9.48
$8.54
$15.17
$5780.00
Page 98 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$5795.00
$251.00
$266.00
$495.92
$163.31
$0.03
$342.26
$262.13
$182.41
$67.09
$19.87
$182.41
$190.14
$38.06
$10.36
$47.18
$62.18
$45.52
$45.52
$38.33
$53.33
$3.66
$51.88
$66.88
$9.98
$455.52
$1103.50
$8.37
$9.06
$8.40
$8.09
$8.04
$8.09
$431.90
$12.30
$8.15
$8.22
$56.30
$17.60
$1.09
$0.51
$18.36
Page 99 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$9.16
$39.50
$22.89
$30.38
$68.30
$0.17
$0.49
$0.42
$8.79
$20.08
$8.81
$0.37
$20.00
$22.00
$24.78
$39.78
$39.78
$20.00
$25.80
$40.80
$40.80
$26.00
$41.00
$20.00
$60.20
$146.26
$57.12
$11.15
$7.93
$8.18
$9.30
$8.40
$8.81
$37.08
$652.10
$2855.76
$8.10
$7.75
$7.79
$20693.00
$20708.00
$30.12
Page 100 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$59.28
$30.28
$30.28
$64.44
$41.02
$72.90
$40.88
$45.26
$57.50
$152.12
$0.00
$0.00
$0.00
$78.10
$175.34
$77.72
$15.16
$13.55
$57.05
$21.38
$45.47
$4.90
$31.55
$463.10
$156.62
$1017.90
$152.02
$3141.38
$13.38
$7.80
$54.10
$7.81
$8.03
$61.02
$145.03
$24.70
$10.00
$27.61
$26.91
$28.53
$28.60
$2.81
Page 101 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$3.36
$14.42
$8.28
$44.12
$0.00
$6.64
$6.64
$87.22
$26.54
$56.14
$25.04
$53.74
$8.44
$24.14
$52.30
$8.44
$87.22
$54.92
$90.28
$82.32
$124.53
$141.96
$199.08
$7.95
$76.10
$8.06
$71.10
$8.93
$12.47
$8.65
$8.29
$675.17
$1582.88
$1597.88
$7.85
$0.03
$7.68
$7.84
$8.08
$0.63
$1.10
$452.34
Page 102 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$350.81
$247.29
$357.63
$372.63
$18.12
$35.61
$42.07
$8.11
$8.08
$8.36
$3109.50
$3124.50
$4312.10
$4327.10
$7012.90
$7027.90
$8589.20
$8604.20
$1985.00
$1560.00
$2000.00
$2173.55
$2188.55
$8.59
$435.20
$1292.16
$220.62
$8.08
$8.36
$11.27
$250.36
$2295.18
$2310.18
$25.00
$25.00
$287.71
$290.90
$4178.14
$1617.26
$1617.26
$1325.02
$1731.70
Page 103 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$58.98
$1.52
$135.14
$83.71
$75.56
$26.00
$43.00
$9.03
$11.99
$9.35
$113.00
$128.00
$185.00
$200.00
$788.30
$803.30
$155.31
$7.78
$7.98
$1985.00
$2000.00
$0.00
$8.47
$8.06
$9.16
$8.78
$8.66
$8.93
$9.97
$2145.34
$19.32
$7.67
$26.31
$25.45
$45.82
$8.61
$8.17
$38.00
$53.00
$29.73
$46.10
$8.41
Page 104 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$41.00
$56.00
$8.28
$8.39
$27.20
$52.86
$110.33
$34.99
$74.58
$33.68
$67.56
$10.40
$55.72
$59.47
$8.84
$10.17
$31.70
$34.70
$37.70
$53.05
$0.39
$10.31
$26.56
$54.83
$11.75
$30.38
$59.60
$38.92
$70.28
$8.86
$11.12
$30.23
$55.32
$31.58
$141.75
$156.75
$0.25
$0.82
$11.17
$155.16
$16.83
$24.30
Page 105 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$19.67
$23.18
$18.17
$8.25
$26.37
$1.60
$8.24
$14.61
$1.94
$45.83
$0.03
$27.35
$34.70
$29.17
$70.70
$46.70
$11.67
$26.09
$36.00
$36.00
$36.00
$36.00
$15.55
$109.70
$10.68
$7.87
$57.05
$72.05
$82.10
$12.15
$15.79
$29.34
$102.18
$149.35
$8.91
$25.13
$52.38
$27.62
$145.00
$160.00
$52.68
$36.89
Page 106 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$24.68
$47.67
$55.90
$276.10
$8.37
$8.46
$8.40
$8.48
$8.56
$8.33
$8.17
$8.56
$8.20
$8.31
$8.33
$54.90
$29.40
$30.46
$27.78
$37.70
$27.60
$36.44
$55.34
$34.36
$28.60
$57.38
$35.10
$29.88
$58.98
$34.90
$65.25
$47.40
$26.10
$29.74
$58.80
$27.80
$56.38
$28.00
$36.96
$67.83
$36.88
$29.88
Page 107 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$60.42
$51.70
$46.07
$32.70
$18.00
$16.10
$27.72
$56.28
$29.90
$31.54
$61.05
$38.41
$8.78
$28.82
$30.91
$26.00
$99.62
$31.26
$60.70
$34.52
$31.00
$28.02
$28.41
$379.70
$36.04
$79.90
$52.28
$33.84
$27.77
$28.37
$27.77
$151.38
$592.76
$225.37
$8.91
$8.56
$144.13
$87.30
$159.13
$158.48
$98.78
$173.48
Page 108 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$227.43
$153.94
$242.43
$668.04
$22.06
$22.06
$12.91
$12.91
$8.78
$9.17
$8.37
$9.43
$8.74
$8.16
$7.91
$8.20
$9.31
$78.93
$8.43
$8.72
$12.12
$21.11
$1.54
$0.17
$64.76
$8.91
$8.09
$0.22
$7.73
$24.04
$58.70
$57.60
$122.00
$7.71
$11.27
$9.60
$75.77
$74.54
$50.69
$222.10
$11.06
$9.11
Page 109 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$9.88
$8.78
$22.00
$22.00
$43.30
$0.33
$16.43
$16.43
$6.52
$0.03
$70.00
$38.12
$38.12
$51.14
$12.93
$87.70
$87.70
$77.90
$57.16
$1.25
$0.15
$0.05
$54.22
$1.23
$39.75
$54.75
$43.13
$58.13
$40.20
$55.20
$39.75
$54.75
$15.51
$27.96
$42.96
$154.90
$169.90
$169.90
$8.12
$10.75
$31.84
$46.48
Page 110 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$8.06
$8.92
$48.39
$0.02
$0.19
$8.48
$130.70
$8.18
$7.97
$12.63
$8.39
$9.23
$7.65
$7.80
$8.18
$27.81
$27.81
$27.81
$25.78
$293.44
$2.35
$23.28
$50.92
$26.16
$55.54
$26.30
$55.76
$9.30
$77.34
$40.14
$44.14
$6907.50
$95.00
$110.00
$9.91
$65.00
$80.00
$19.63
$10.55
$9.94
$13.15
$36.51
Page 111 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$20.26
$125.00
$140.00
$14.73
$8.43
$8.48
$9.04
$9.03
$45.45
$60.45
$134.75
$149.75
$85.95
$100.95
$12.35
$350.00
$8.61
$8.22
$8.22
$8.15
$8.43
$8.12
$11.84
$46.40
$61.40
$89.90
$134.00
$8.10
$8.47
$8.06
$8.04
$470.16
$10.88
$84.46
$86.14
$300.00
$299.98
$45.96
$79.08
$8.96
$104.82
$152.65
Page 112 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$133.88
$188.98
$37.14
$32.80
$9.56
$49.58
$83.60
$48.06
$66.72
$10.36
$8.30
$9.67
$10.19
$10.25
$7.75
$25.36
$53.33
$8.02
$10.52
$10.91
$8.68
$7.75
$8.22
$7.92
$9.08
$8.28
$8.92
$25.22
$42.08
$40.48
$55.48
$8.25
$9.00
$352.64
$47.10
$8.25
$8.37
$8.49
$4.36
$596.00
$611.00
$2.18
Page 113 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$8.58
$25.91
$85.26
$34.30
$6.11
$27.39
$57.50
$23.68
$51.95
$16.32
$103.73
$212.05
$22.93
$50.45
$24.26
$52.50
$10.82
$9.61
$18.56
$15.91
$16.69
$155.00
$170.00
$74.18
$0.83
$27.47
$14.17
$9.62
$8.53
$8.00
$1.00
$10.41
$10.49
$9.52
$9.88
$9.52
$846.78
$861.78
$3574.10
$3589.10
$12.75
$162.70
Page 114 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$716.15
$731.15
$201.90
$36.78
$9.25
$1.37
$8.08
$13.59
$13.25
$9.90
$51.08
$147.86
$64.22
$18.55
$49.96
$93.62
$8.52
$75.42
$13.23
$9.83
$9.83
$553.80
$10.59
$29.76
$10.18
$425.00
$312.00
$440.00
$25.53
$54.52
$7.97
$11.62
$14.36
$25.80
$54.96
$352.70
$12.51
$69.75
$84.75
$62.23
$113.24
$8.28
Page 115 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$0.58
$314.44
$73.57
$17.48
$6.56
$6.55
$35.12
$65.53
$60.64
$97.43
$13.04
$332.00
$347.00
$155.91
$155.91
$12.31
$1747.61
$2.42
$8.72
$9.42
$122.66
$81.50
$96.50
$13.15
$14.09
$62.74
$100.05
$31.40
$60.88
$391.23
$406.23
$70.14
$109.30
$64.06
$101.70
$24.52
$3164.30
$11.69
$47.20
$62.20
$26.72
$34.60
Page 116 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$33.21
$0.04
$8.52
$8.78
$7.91
$8.74
$27248.24
$9.66
$62.50
$77.50
$61.63
$76.63
$37.25
$52.25
$58.22
$11.77
$14.42
$14.42
$30.00
$142.57
$13.18
$13.42
$0.11
$30.90
$60.25
$82.66
$124.95
$300.00
$42.08
$9.54
$24.74
$53.26
$67.78
$82.78
$58.44
$1.40
$85.22
$0.04
$3.62
$84.45
$66.76
$105.08
Page 117 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$388.63
$0.12
$41.02
$56.02
$0.42
$25.40
$54.32
$11.25
$8.02
$41.10
$56.10
$0.04
$0.04
$0.04
$281.66
$75.82
$116.40
$0.41
$0.58
$0.22
$0.24
$10.15
$10.15
$10.15
$9.25
$10.55
$11.21
$8.87
$22.55
$30.48
$289.82
$9.04
$26.50
$9.11
$11.81
$169.70
$742.70
$950.00
$50.66
$11.53
$11.25
$9.90
Page 118 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$9.04
$8.42
$8.66
$66.34
$104.55
$93.74
$10.75
$8.47
$10.50
$9.35
$10.90
$12.62
$38.03
$53.03
$22.00
$22.00
$77.50
$22.00
$5.38
$22.00
$22.00
$22.00
$22.00
$77.50
$9.42
$71.28
$26.00
$3.30
$22.00
$22.00
$4.64
$20.00
$8.25
$71.28
$22.00
$22.00
$5.38
$22.00
$22.00
$10.88
$8.67
$8.10
Page 119 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$8.28
$30.00
$55.20
$90.63
$114.93
$8.71
$84.08
$600.00
$400.00
$52.78
$67.78
$1.78
$0.19
$9.62
$42.86
$29.79
$15.00
$39.36
$43.53
$51.89
$17373.30
$17388.30
$0.64
$48785.00
$48800.00
$34.84
$65.18
$46.56
$61.56
$106.70
$121.70
$7.71
$47.62
$56.99
$31.30
$23.33
$236.19
$248.61
$2625.88
$3303.98
$10.06
$12.00
Page 120 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$0.19
$10.04
$25.83
$27.34
$55.80
$24.98
$52.85
$34.13
$51.78
$1685.00
$2635.00
$1685.00
$14.95
$889.60
$31.76
$32.00
$9.11
$9.11
$2935.00
$2950.00
$10.18
$67.70
$0.02
$0.04
$0.04
$24.47
$24.47
$217.68
$25.97
$71.25
$86.25
$102.50
$117.50
$852.00
$12.74
$8.96
$9.84
$10.19
$9.40
$10.92
$10.16
$53.70
Page 121 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$11.25
$8.52
$8.50
$16.28
$11.84
$8.17
$17.87
$13.50
$18.60
$26.41
$50.38
$1.61
$13.30
$10.59
$41.42
$73.40
$51.76
$26.28
$54.48
$4029.23
$4044.23
$73.40
$88.40
$51.19
$3024.66
$0.00
$0.00
$43.93
$3548.10
$4456.75
$385.10
$702.20
$899.38
$115.02
$25.32
$13113.00
$13128.00
$12.12
$54.50
$69.50
$8.14
$108.56
Page 122 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$157.33
$9.23
$20.80
$8.52
$11.10
$10.63
$63.52
$42.25
$57.25
$8.53
$33.56
$34.89
$43668.63
$43683.63
$13574.60
$13589.60
$9521.00
$9536.00
$53.12
$88.03
$8.60
$77.13
$158.85
$554.00
$346.25
$361.25
$20.75
$9.39
$25.45
$11.82
$10.82
$9.27
$66.21
$8.02
$10.44
$2.46
$11.00
$1.40
$0.13
$8.00
$2.75
Page 123 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$11.00
$0.04
$10.81
$11.07
$8.48
$107.65
$185.92
$7.77
$7.78
$8.15
$55.43
$102.36
$26.37
$1042.70
$1057.70
$31.50
$61.00
$82.20
$1.75
$26.91
$3.22
$2.77
$4.04
$27.76
$8.36
$17.88
$7.79
$8.21
$111.74
$138.48
$194.73
$32.90
$139.99
$142.66
$148.47
$11.17
$8.43
$9.17
$15.94
$20.34
$10.69
$68.18
Page 124 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$49.50
$263.14
$2.30
$56.79
$42.13
$57.13
$9.68
$0.02
$28.13
$78.70
$93.70
$97.30
$112.30
$1.34
$0.00
$55.58
$0.10
$400.00
$11.57
$230.78
$245.78
$1095.02
$11.46
$11.27
$11.07
$24.64
$27.25
$11.43
$10.58
$13.30
$13.30
$4222.70
$5300.00
$8.67
$8.79
$7.92
$38.28
$7.93
$7.93
$8.10
$14.15
$7.90
Page 125 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$37.69
$35.65
$27.54
$11.79
$19.86
$18.74
$19.86
$10.86
$16.98
$11.03
$16.98
$0.14
$2.48
$0.34
$8.18
$8.02
$8.20
$9.74
$250.05
$265.05
$226.70
$8.75
$67.10
$105.50
$22.57
$8.31
$7.80
$226.14
$10.10
$100.20
$28.67
$35.70
$50.70
$28.67
$8.73
$27.14
$55.55
$50.17
$8.42
$8.00
$17.23
$17.23
Page 126 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$15.78
$10.37
$9.55
$74.92
$89.00
$32.98
$71.90
$8.02
$11.15
$10.03
$41.90
$56.90
$35.60
$8.21
$8.46
$10.03
$10.47
$8.67
$9.27
$9.67
$111.16
$52.20
$12.46
$0.37
$0.02
$0.17
$8.00
$0.38
$530.00
$14.92
$99.50
$114.50
$9.12
$59.18
$74.18
$0.02
$0.02
$8.27
$8.86
$14.97
$8.24
$9.05
Page 127 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$31.33
$18.16
$9.12
$9.05
$9.05
$13.90
$831.50
$12836.94
$3231.92
$877.94
$26.00
$16.32
$30.22
$26.12
$9.42
$8.48
$17.27
$15.24
$37.33
$2341.25
$2356.25
$5610.75
$5625.75
$0.21
$485.94
$218.88
$233.88
$402.75
$417.75
$11.96
$206.70
$63.97
$11.46
$13.06
$494.00
$509.00
$37.17
$11.86
$34.05
$34.05
$14.15
$181.51
Page 128 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$1767.88
$13.45
$1186.10
$18.62
$2745.15
$2760.15
$28.92
$28.92
$28.92
$18.26
$17.87
$27.71
$12.65
$47.16
$24.64
$1.51
$0.24
$8.49
$8.16
$39.72
$71.28
$31.54
$24.80
$4353.38
$10.58
$10.59
$10.58
$10.69
$10.86
$14.11
$217.86
$195.16
$293.95
$120.28
$97.58
$171.98
$57.46
$34.76
$93.45
$90.42
$67.72
$134.65
Page 129 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$18.24
$18.24
$18.25
$18.24
$38.37
$28.57
$38.37
$26.00
$26.00
$23.21
$19.71
$19.71
$19.71
$4.81
$9.63
$8.05
$9.06
$38.02
$1035.30
$10.34
$26.26
$36.27
$1.93
$0.03
$0.03
$72.60
$87.60
$8.04
$18.29
$8.39
$8.08
$8.08
$8.08
$21.11
$16.82
$13.05
$267.20
$9.25
$11.56
$106.79
$40.41
$44.36
Page 130 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$95.50
$0.09
$1.67
$10.92
$13.45
$13.45
$9.87
$8.86
$265.50
$353.50
$8.97
$8.30
$8.62
$9.75
$17.68
$7.72
$3695.00
$3710.00
$8325.50
$8340.50
$30.26
$45.26
$56.42
$0.06
$57.82
$93.90
$48.04
$81.68
$45.96
$23.26
$79.08
$48.64
$0.07
$0.07
$33.48
$10.78
$63.48
$35.30
$12.60
$65.75
$82.70
$210.20
Page 131 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$284.38
$42.45
$57.45
$42.45
$57.45
$38.78
$25.95
$0.26
$10.47
$11.67
$10.65
$9.36
$7.86
$8.10
$20.99
$37.81
$10.37
$12.06
$10.37
$7.60
$0.15
$14.42
$15.62
$19.82
$70.66
$241.01
$7.99
$46.70
$88.40
$46.70
$88.40
$31.43
$63.96
$262.08
$440.30
$88.92
$13.61
$8.27
$8.05
$438.22
$8.77
Page 132 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$9.03
$39.79
$28.85
$192.70
$210.57
$257.52
$132.30
$34.39
$18.07
$8.60
$7.92
$8.03
$8.16
$481.10
$623.00
$475.96
$616.58
$10.30
$12.91
$102.99
$23.88
$15.56
$168.48
$207.70
$281.25
$207.70
$281.25
$8.46
$8.16
$8.28
$16.68
$10.67
$138.80
$171.82
$16.98
$131.00
$865.28
$880.28
$287.25
$1159.83
$1174.83
$7.86
Page 133 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$13.23
$759.22
$4916.88
$4931.88
$11.94
$9.52
$9.52
$9.52
$32.40
$16.29
$65.88
$103.98
$8.11
$49.70
$14.43
$101.29
$204.96
$22.20
$1.32
$131.74
$10.74
$8.12
$8.41
$46.04
$12.04
$0.29
$0.05
$0.03
$0.14
$47.58
$81.10
$8.50
$8.03
$10.43
$229.10
$194.94
$228.22
$7.72
$8.49
$14.07
$14.93
$16.50
Page 134 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$504.50
$519.50
$37.87
$42.93
$281.25
$591.74
$1850.02
$9.05
$9.69
$14091.18
$1071.92
$96.85
$40.95
$55.95
$313.70
$39.19
$44.72
$195.77
$3161.00
$3176.00
$1.33
$1.99
$485.12
$643.61
$10.48
$10.10
$11.07
$14.98
$1017.79
$8.43
$10.41
$26436.08
$26451.08
$13235.55
$13250.55
$400.00
$400.00
$400.00
$400.00
$400.00
$400.00
$400.00
Page 135 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$400.00
$7.71
$11.93
$88.10
$99.70
$114.70
$9.08
$13.81
$174.43
$8.53
$10.92
$7.78
$36324.63
$36339.63
$3719.38
$3734.38
$9245.95
$9260.95
$18456.88
$18471.88
$174.51
$41.34
$29.34
$48.88
$40.01
$33.09
$29.34
$47.69
$39.29
$31.42
$28.01
$40.97
$25.00
$34.73
$34.73
$51.72
$43.10
$126.74
$118.60
$241.18
$7.95
$14.79
Page 136 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$11.97
$7.72
$7.73
$234.85
$7.81
$7.67
$115.22
$10.08
$8.40
$28.69
$29.99
$91.28
$10.99
$8.81
$57.80
$72.80
$54.05
$69.05
$12.20
$15.20
$18.29
$4835.00
$4850.00
$16.19
$84.24
$90.64
$8.79
$64.18
$101.85
$10.17
$9.16
$60.50
$105.42
$68.10
$77.04
$77.78
$105.42
$87.26
$83.13
$98.13
$76.74
$35.00
Page 137 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$50.00
$18.35
$298.78
$424.08
$551.73
$54.36
$37.82
$68.90
$17624.15
$17639.15
$10.36
$8.43
$9.91
$12.55
$10.12
$8.35
$8.66
$9.31
$9.04
$7.93
$92.16
$8.20
$8.08
$8.83
$19.43
$19.43
$20.56
$164.20
$179.20
$52.25
$67.25
$1036.40
$1051.40
$974.29
$0.06
$5.24
$0.04
$0.02
$0.02
$0.02
$306.45
$321.45
Page 138 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$0.02
$0.02
$0.04
$0.21
$0.03
$2.55
$0.25
$9.94
$0.11
$0.02
$0.03
$0.07
$11.11
$162.50
$102.00
$68.04
$1278.51
$482.58
$497.58
$25.87
$38.93
$53.93
$38.93
$53.93
$38.93
$53.93
$8.12
$12.17
$10.54
$10.77
$10.67
$10.78
$10.79
$10.91
$12.00
$11.16
$8.71
$8.66
$8.66
$0.67
Page 139 of 140
Parkview Medical Center Formulary Drug Charges as of *** Charges subject to change at any time due to manufacturer price updates and/or product availability ***
$9.00
$0.07
$11.57
$17.68
$141.94
$0.02
$469.70
$757.70
$49.85
$67.25
$13.10
$13.10
$9.65
$8.25
$518.52
$65.78
$80.78
$68.00
$83.00
$93.48
$108.48
Page 140 of 140
Top Related