COMMERCIAL FORMULARY - thcmi.com · Specialty Pharmacy staff ships the medication directly to the physician's office or the patient’s home. All All packages are individually marked

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COMMERCIAL FORMULARY Effective August 2019

Provided by EnvisionRx

Introduction

The Total Health Care (THC) Commercial Formulary was developed to serve as a guide for physicians, pharmacists, health care professionals and members in the selection of cost-effective drug therapy. Total Health Care recognizes that drug therapy is an integral part of effective health management.

Total Health Care continually reviews new and existing medications to ensure the Formulary remains responsive to the needs of our members and health professionals. Criteria used to evaluate drug selection for the formulary includes, but is not limited to: safety, efficacy and cost-effectiveness data, as well as comparison of relevant benefits of similar prescription or over-the counter (OTC) agents while minimizing potential duplications.

Notice

The information contained in this formulary is provided by THC, solely for the convenience of medical providers and members. THC does not warrant or assure accuracy of this information, nor is it intended to be comprehensive in nature.

This formulary is not intended to be a substitute for the knowledge, expertise, skill or judgment of the medical provider in their choice of prescription drugs. Total Health Care assumes no responsibility for the actions or omissions of any medical provider based upon reliance, in whole or in part, on the information contained herein. The medical provider should consult the drug manufacturer’s product literature or standard references for more detailed information.

How to Read the Formulary

Drug Name

All formulary drugs are listed either by their generic names (in lowercase) or by their brand names (in uppercase). Drugs are grouped together by their therapeutic drug category. Specific drug listings may be accessed by using the index, using the covered generic name or the covered brand name of the drug. The brand names listed are for reference use only, and do not denote coverage, unless specifically noted. Any drug not found in this Formulary listing shall be considered a non-formulary drug.

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Co-Pay Structure

Requirements/Limits

This field includes potential limitations to the formulary drug. It also may contain additional information about the coverage of the drug such as applicable quantity limits (QL). For certain agents within the Commercial Formulary, a recommended prescribing guideline may apply.

Prescribing Guidelines Prescribing guidelines may apply to select drugs on the THC formulary. Prescribing guidelines may vary by benefit design but may include: Prior Authorization Required (PA)

Drug requires prior authorization through a specific physician request process.

Over the Counter Drugs (OTC)

Drug coverage is available for drugs that are available OTC with an authorized prescription from your provider.

Specialty Drugs (SP)

Drug requires processing through THC’s contracted specialty pharmacy, Envision Specialty Pharmacy.

Quantity Limit (QL) Drug coverage may be limited to specific quantities per prescription and/or time period.

Age Limit (AL) Drug coverage may depend on patient age.

Gender Restriction (GR) Drug coverage may depend on patient gender.

Step Therapy Required (ST)

Drug coverage requires that an alternative or trial of another drug be used before the medication is covered.

Custom (C) Drug coverage has unique restrictions.

Benefit Coverage and Limitations

This formulary does not define benefit coverage and limitations. Members may have specific benefit inclusions, exclusions, copayments, or a lack of coverage, which are not reflected in the Total Health Care Commercial Formulary. Members should contact Total Health Care at 1-800-826-2862 if they have questions regarding their coverage. Please note that the formulary process is evolutionary and changes can occur throughout the year.

Generic Drug Generic Co-Pay Applies

Brand Drug Brand Co-Pay Applies

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Prior Authorization (PA) Drugs indicated with a “PA” require Prior Authorization for coverage. A prescriber may complete a Prior Authorization form that can be found on the Total Health Care website at www.THCmi.com. You may also request a form by calling Total Health Care at 1-844-222-5584. Completed prior authorization forms should be faxed to 1-866-422-9119. Prior Authorization review of prescribing guidelines will be evaluated utilizing the established drug review criteria approved by Total Health Care. If the request does not meet the approved criteria, the request will not be approved and alternative therapy may be recommended along with the proper course of alternative action. The requesting provider will be provided written notification of Total Health Care review decisions. THC’s website has a contact link where members can contact THC’s Pharmacy Department to ask for an exception request.

Non-Formulary Agents

A Drug not located on the Total Health Care Commercial Formulary, or any updates published by Total Health Care, shall be considered a non-formulary drug. Requests for coverage of non-formulary agents may be requested by the health professional depending on specific coverage parameters. Review for non-formulary drug requests will require a Prior Authorization request with documentation of medical necessity. Generally, the following basic medical necessity guidelines are used in conducting a review:

The patient has failed an appropriate trial of formulary or preferred agents. The use of preferred or formulary agent is contraindicated in the patient. The formulary drug or preferred agents are not suited for the present patient care need, and the drug

selected is required for patient safety.

If the request does not meet the established guidelines request, it will not be approved and alternative therapy may be recommended along with the proper course of alternative action. Common Drug Exclusions The member’s plan design may exclude certain drug classes. Prior authorization is generally not available for drugs that are specifically excluded by benefit design. Common excluded coverages may include, but are not limited to:

OTC medications or their equivalents unless otherwise specified in the Formulary listing. Drug products used for cosmetic purposes. Drug products for sexual dysfunction. Drug products for infertility treatment. Drug products for weight loss. Experimental drug products or any drug product used in an experimental manner. Foreign drugs or drugs not approved by the United States Food & Drug Administration (FDA).

Mandated Generic Substitution Total Health Care advocates the use of cost-effective generic drugs where FDA-approved generic equivalent drugs are available. Generic products are listed in the Formulary and noted in lowercase lettering wherever an FDA-approved generic drug product is available. If a member or physician requests a brand-name product in lieu of an approved generic, the member, based upon their coverage, will typically be required to pay the difference in cost between the brand and the generic drug.

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Total Health Care Pharmacy and Therapeutics (P&T) Committee

Total Health Care’s Pharmacy & Therapeutics Committee meets quarterly to review and recommend medications for formulary consideration. The Committee considers clinical information on drugs that are new to the market and drugs that are typically included in an outpatient pharmacy benefit. This assures that the formulary remains responsive to patient and physician needs. The Committee is composed of physicians, pharmacists, and health care professionals. The Committee also uses reference materials from our Pharmacy Benefits Manager's Pharmacy and Therapeutics Advisory Panel.

Product Selection Criteria The primary goal of the THC Pharmacy & Therapeutics Committee is to maintain and update the formulary based upon an objective analysis of the safety, efficacy, approved indications, adverse effects, contraindications, patient administration/compliance considerations and cost effectiveness of available drugs. When a drug is considered for formulary inclusion, it will be reviewed relative to similar drugs including those currently in the THC Commercial Formulary. Physicians may request a copy of THC’s drug criteria by calling the Pharmacy Department at 1-800-826-2862.

Diabetic Testing Supplies

Total Health Care works with J&B Medical Supply to provide diabetic testing supplies to our members. Covered diabetic testing supplies include Glucocard Vital glucometer, Glucocard Expression glucometer, and SD Biosensor GlucoNavii glucometer, Glucocard Vital test strips, Glucocard Expression test strips, SD Biosensor GlucoNavii test strips, lancets, insulin syringes, alcohol swabs and ketone strips. These supplies are to be filled through J&B Medical Supply. If you have any questions about our diabetic supply program, please contact J&B Medical Supply at 1-844-236-7933.

Specialty Bio-Pharmaceutical Pharmacy Program

Total Health Care works with Envision Specialty Pharmacy to provide Specialty Bio-Pharmaceutical Pharmacy products to our members. These medications are to be filled exclusively through Envision Specialty Pharmacy. A Specialty Drug Prior Authorization Request form must be completed and faxed to EnvisionRx at 1-866-422-9119 with supporting documentation and the prescription. A prescriber may obtain a Specialty Drug Prior Authorization Request form found on the Total Health Care website at www.THCmi.com. Once the order is received, EnvisionRx obtains authorization from Total Health Care. If the specialty prior authorization is approved, Total Health Care notifies Envision Specialty Pharmacy. Then, the Envision Specialty Pharmacy staff ships the medication directly to the physician's office or the patient’s home. All packages are individually marked for each patient and refrigerated items are shipped in insulated containers. Where appropriate, each shipment includes needles, syringes and alcohol swabs. If you have any questions about our Specialty Bio-Pharmaceutical Pharmacy program, please contact EnvisionRx at 1-844-222-5584 or Envision Specialty Pharmacy at 1-866-909-5170.

Contact Information

The Total Health Care Commercial Formulary is designed to assist physicians, members and other health care professionals in the selection of cost-effective agents. Total Health Care encourages your input and feedback on how we can assist in improving this document and the formulary management process. You may contact THC at 1-800-826-2862.

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Medication Limitations

Quantity Limitations Quantity Limitations are on medications throughout the formulary and are indicated with a "QL" notation. These are medications that have a daily dose restriction, quantity/days’ supply limitation, and/or a limitation on the duration of therapy. Age Limitations Age Limitations are on medications throughout the formulary and are indicated with an "AL" notation. Coverage for a medication is indicated by the age limitation. This could be a minimum age, maximum age, and/or the combination of a minimum and maximum age edit. Gender Restrictions Gender restrictions are indicated with a “GR” on the formulary and require the member to be a specific gender for coverage. Step Therapy Criteria Step Therapy medications are indicated with a “ST” on the formulary and require that an alternative, first line medication be tried and failed before the requested medication can be covered. The online claims adjudication system will automatically allow for the requested medication to be filled based on electronic claims history indicating that the first line medication was filled.

Step Therapy Criteria

Therapy Class First Line Second Line Third Line Step Therapy Criteria

Attention Deficit/Hyperactivity

amphetamine immediate-release

amphetamine extended-release

VYVANSE Second Line: Prior use of amphetamine immediate-release for 60 days within the last 90 days. Third Line: Prior use of amphetamine extended-release for 60 days within the last 90 days.

Antimigraine sumatriptan, rizatriptan

naratriptan, zolmitriptan, zolmitriptan- odt

Prior use of sumatriptan AND rizatriptan in the last 90 days.

Antipsychotic Agents

risperidone, quetiapine immediate-release, olanzapine

ziprasidone, quetiapine extended-release

Prior use of one step 1 agent within the last 90 days.

Osteoporosis alendronate risedronate Prior use of alendronate within the last 90 days.

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Sedatives zolpidem IR, temazepam, zaleplon

zolpidem ER, eszopiclone

Prior use for 30 days of zolpidem IR, temazepam, or zaleplon

Urinary Antispasmodics

oxybutynin, oxybutynin er, oxybutynin syrup, OXYTROL OTC

tolterodine, tolterodine er, trospium

darifenacin er, trospium er, VESICARE

Second Line: Prior use of OXYTROL OTC, oxybutynin, oxybutynin er, or oxybutynin syrup in the last 90 days. Third Line: Prior use of tolterodine, tolterodine er, or trospium in the last 90 days.

*Formulary Disclaimer: Coverage for some drugs may be limited to specific dosage forms and/or strengths. The benefit design determines what is covered and the applicable co-payment. The medications listed on this formulary are subject to change pursuant to the formulary management activities of EnvisionRx. The presence of a medication on this formulary list does not guarantee coverage.

CURRENT AS OF 8/1/2019

lowercase italics = Generic drugsUPPERCASE BOLD = Brand name drugs

StatusT1 = Covered

NotesAL = Age LimitC = Custom RestrictionGR-F = Female OnlyGR-M = Male OnlyPA = Prior AuthorizationQL = Quantity LimitST = Step Therapy

Drug Status Notes

*Adhd/Anti-Narcolepsy/Anti-Obesity/Anorexiants*amphetamine-dextroamphet er oral capsule extended release 24 hour 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 5 mg

T1ST; QL (30 EA per 30 days); AL (Min 6 Years and Max 17 Years)

amphetamine-dextroamphetamine oral tablet 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg, 5 mg, 7.5 mg

T1AL (Min 6 Years and Max 17 Years)

dexmethylphenidate hcl oral tablet 10 mg, 2.5 mg, 5 mg


dextroamphetamine sulfate er oral capsule extended release 24 hour 10 mg, 15 mg, 5 mg


dextroamphetamine sulfate oral tablet 10 mg, 5 mg


guanfacine hcl er oral tablet extended release 24 hour 1 mg, 2 mg, 3 mg, 4 mg

T1QL (30 EA per 30 days); AL (Min 6 Years and Max 17 Years)

METADATE ER ORAL TABLET EXTENDED RELEASE 20 MG T1

QL (90 EA per 30 days); AL (Min 6 Years and Max 17 Years)

methylphenidate hcl er (cd) oral capsule extended release 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg


methylphenidate hcl er oral tablet extended release 10 mg


methylphenidate hcl er oral tablet extended release 20 mg


methylphenidate hcl oral tablet 10 mg T1QL (180 EA per 30 days); AL (Min 6 Years and Max 17 Years)

methylphenidate hcl oral tablet 20 mg, 5 mg T1QL (90 EA per 30 days); AL (Min 6 Years and Max 17 Years)

modafinil oral tablet 100 mg, 200 mg T1 PA

VYVANSE ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 MG, 50 MG, 60 MG, 70 MG T1

ST; QL (30 EA per 30 days); AL (Min 6 Years and Max 17 Years)

*Aminoglycosides*neomycin sulfate oral tablet 500 mg T1

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Drug Status Notes

*Analgesics - Anti-Inflammatory*celecoxib oral capsule 100 mg, 200 mg, 400 mg, 50 mg

T1 QL (30 EA per 30 days)

diclofenac potassium oral tablet 50 mg T1

diclofenac sodium er oral tablet extended release 24 hour 100 mg

T1

diclofenac sodium oral tablet delayed release 25 mg, 50 mg, 75 mg

T1

ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 25 MG/0.5ML, 50 MG/ML

T1 PA

ENBREL SUBCUTANEOUS SOLUTION RECONSTITUTED 25 MG T1 PA

ENBREL SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR 50 MG/ML T1 PA

fenoprofen calcium oral tablet 600 mg T1

flurbiprofen oral tablet 100 mg, 50 mg T1

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 40 MG/0.8ML

T1 PA

HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML T1 PA

HUMIRA PEN-CD/UC/HS STARTER SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML

T1 PA

HUMIRA PEN-PS/UV/ADOL HS START SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML

T1 PA

HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 10 MG/0.2ML, 20 MG/0.4ML, 40 MG/0.8ML

T1 PA

ibuprofen oral capsule 200 mg T1

ibuprofen oral suspension 100 mg/5ml T1

ibuprofen oral tablet 200 mg, 400 mg, 600 mg, 800 mg

T1

INDOCIN ORAL SUSPENSION 25 MG/5ML T1

indomethacin oral capsule 25 mg, 50 mg T1

ketoprofen oral capsule 50 mg T1 QL (360 EA per 30 days)

ketoprofen oral capsule 75 mg T1 QL (120 EA per 30 days)

ketorolac tromethamine oral tablet 10 mg T1C (Max of 5 day supply); QL (20 EA per 5 days)

leflunomide oral tablet 10 mg, 20 mg T1

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Drug Status Notesmeloxicam oral tablet 15 mg, 7.5 mg T1

nabumetone oral tablet 500 mg T1 QL (120 EA per 30 days)

nabumetone oral tablet 750 mg T1 QL (60 EA per 30 days)

NAPROXEN COMFORT PAC COMBINATION KIT 500 MG T1

naproxen dr oral tablet delayed release 375 mg T1

naproxen oral tablet 250 mg, 375 mg, 500 mg T1

naproxen powder T1

naproxen sodium oral capsule 220 mg T1

naproxen sodium oral tablet 220 mg T1

oxaprozin oral tablet 600 mg T1

piroxicam oral capsule 10 mg, 20 mg T1

sulindac oral tablet 150 mg, 200 mg T1

*Analgesics - Nonnarcotic*ACEPHEN RECTAL SUPPOSITORY 325 MG T1

acetaminophen er oral tablet extended release650 mg

T1

acetaminophen oral capsule 500 mg T1

acetaminophen oral elixir 160 mg/5ml T1

acetaminophen oral suspension 160 mg/5ml T1

acetaminophen oral tablet 325 mg, 500 mg T1

acetaminophen rectal suppository 120 mg T1

adult aspirin low strength oral tablet dispersible81 mg


apap oral tablet chewable 80 mg T1

ASCRIPTIN ORAL TABLET 325 MG T1

aspirin adult low strength oral tablet delayed release 81 mg


aspirin low dose oral tablet chewable 81 mg T1QL (60 EA per 30 days); AL (Min 40 Years and Max 79 Years)

aspirin oral tablet 325 mg T1QL (30 EA per 30 days); AL (Min 40 Years and Max 79 Years)

aspirin oral tablet 81 mg T1QL (60 EA per 30 days); AL (Min 40 Years and Max 79 Years)

aspirin oral tablet delayed release 325 mg T1QL (30 EA per 30 days); AL (Min 40 Years and Max 79 Years)

aspirin rectal suppository 300 mg, 600 mg T1

aspirtab maximum strength oral tablet 500 mg T1

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Drug Status Notes

buffasal oral tablet 324 mg T1QL (30 EA per 30 days); AL (Min 40 Years and Max 79 Years)

buffered aspirin oral tablet 325 mg T1QL (30 EA per 30 days); AL (Min 40 Years and Max 79 Years)

butalbital-acetaminophen oral tablet 50-325 mg T1

butalbital-apap-caffeine oral tablet 50-325-40 mg T1

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

T1

choline & mag trisalicylate oral tablet 1000 mg T1

choline-mag trisalicylate oral liquid 500 mg/5ml T1

diflunisal oral tablet 500 mg T1

infants pain relief oral suspension 80 mg/0.8ml T1

migraine relief oral tablet 250-250-65 mg T1

q-pap infants oral solution 80 mg/0.8ml T1

q-pap oral liquid 160 mg/5ml T1

salsalate oral tablet 500 mg, 750 mg T1

*Analgesics - Opioid*acetaminophen-codeine #2 oral tablet 300-15 mg T1 QL (390 EA per 30 days)

acetaminophen-codeine #3 oral tablet 300-30 mg T1 QL (390 EA per 30 days)

acetaminophen-codeine #4 oral tablet 300-60 mg T1 QL (390 EA per 30 days)

acetaminophen-codeine oral solution 120-12 mg/5ml

T1

butalbital-apap-caff-cod oral capsule 50-325-40-30 mg

T1

butalbital-asa-caff-codeine oral capsule 50-325-40-30 mg

T1

codeine sulfate oral tablet 15 mg, 30 mg, 60 mg T1

fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr

T1 PA; QL (10 EA per 30 days)

hydrocodone-acetaminophen oral solution 10-325 mg/15ml, 7.5-325 mg/15ml

T1 QL (900 ML per 90 days)

hydrocodone-acetaminophen oral tablet 10-325 mg, 7.5-325 mg


hydrocodone-acetaminophen oral tablet 5-325 mg T1 QL (360 EA per 30 days)

hydromorphone hcl oral tablet 2 mg, 4 mg, 8 mg T1 QL (240 EA per 30 days)

LORTAB ORAL ELIXIR 10-300 MG/15ML T1 QL (900 ML per 90 days)

meperidine hcl oral tablet 100 mg, 50 mg T1

methadone hcl oral concentrate 10 mg/ml T1

methadone hcl oral solution 10 mg/5ml, 5 mg/5ml T1

methadone hcl oral tablet 10 mg T1 QL (240 EA per 30 days)

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Drug Status Notesmethadone hcl oral tablet 5 mg T1 QL (120 EA per 30 days)

methadone hcl oral tablet soluble 40 mg T1

morphine sulfate (concentrate) oral solution 100 mg/5ml

T1

morphine sulfate er oral tablet extended release100 mg, 15 mg, 30 mg, 60 mg


morphine sulfate oral solution 10 mg/5ml, 20 mg/5ml

T1

morphine sulfate oral tablet 15 mg, 30 mg T1 QL (180 EA per 30 days)

oxycodone hcl oral concentrate 100 mg/5ml T1

oxycodone hcl oral solution 5 mg/5ml T1

oxycodone hcl oral tablet 10 mg, 15 mg, 20 mg, 30 mg, 5 mg


oxycodone-acetaminophen oral tablet 10-325 mg, 7.5-325 mg


oxycodone-acetaminophen oral tablet 5-325 mg T1 QL (360 EA per 30 days)

oxycodone-aspirin oral tablet 4.8355-325 mg T1

tramadol hcl oral tablet 50 mg T1 QL (240 EA per 30 days)

*Androgens-Anabolic*testosterone cypionate intramuscular solution 100 mg/ml, 200 mg/ml

T1 GR-M

testosterone enanthate intramuscular solution200 mg/ml

T1 GR-M

*Anorectal Agents*FLEET NATURALS CLEANSING ENEMA RECTAL ENEMA T1

hemorrhoidal rectal cream 1-0.25-14.4-15 % T1

hemorrhoidal rectal suppository 51 % T1

hydrocortisone rectal cream 1 % T1 QL (120 GM per 30 days)

hydrocortisone rectal enema 100 mg/60ml T1

PROCTOZONE-HC RECTAL CREAM 2.5 % T1

*Antacids*ALKA-SELTZER HEARTBURN ORAL TABLET EFFERVESCENT 1940-1000 MG T1

ALMACONE ORAL TABLET CHEWABLE200-200-25 MG T1

antacid & antigas oral suspension 200-200-20 mg/5ml, 400-400-40 mg/5ml

T1

antacid extra strength oral tablet chewable 675-135 mg

T1

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Drug Status Notesantacid multi-symptom oral tablet chewable 675-135-60 mg

T1

antacid oral tablet chewable 1177 mg, 350-150 mg, 420 mg, 550-110 mg

T1

calcium antacid ultra oral tablet chewable 1000 mg

T1

calcium carbonate antacid oral tablet 648 mg T1

calcium carbonate antacid oral tablet chewable500 mg, 750 mg

T1

CHILDRENS SOOTHE ORAL TABLET CHEWABLE 400 MG T1

CITROCARBONATE ORAL GRANULES EFFERVESCENT 0.78-1.82 GM/DOSE T1

cvs antacid & anti-gas oral tablet chewable 1000-60 mg

T1

cvs antacid supreme oral suspension 400-135 mg/5ml

T1

cvs heartburn relief ex st oral suspension 254-237.5 mg/5ml

T1

DEWEES CARMINATIVE ORAL LIQUID 6-250 T1

E-Z-GAS II ORAL PACKET 2.21-1.53-0.04 GM T1

GAVISCON ORAL TABLET CHEWABLE80-14.2 MG T1

gnp foaming antacid oral suspension 95-358 mg/15ml

T1

gnp foaming antacid oral tablet chewable 80-20 mg

T1

heartburn antacid ex st oral tablet chewable 160-105 mg

T1

mag-al oral liquid 200-200 mg/5ml T1

magnesium oxide oral capsule 400 mg T1

magnesium oxide oral tablet 250 mg, 400 mg T1

magnesium oxide powder T1

MAOX ORAL TABLET 420 MG T1

MI-ACID ORAL TABLET CHEWABLE 700-300 MG T1

sodium bicarbonate oral powder T1

sodium bicarbonate oral tablet 325 mg, 650 mg T1

URO-MAG ORAL CAPSULE 140 MG T1

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Drug Status Notes

*Anthelmintics*ivermectin oral tablet 3 mg T1 QL (20 EA per 90 days)

PIN-X ORAL SUSPENSION 50 MG/ML T1

PIN-X ORAL TABLET CHEWABLE 720.5 MG T1

reeses pinworm medicine oral suspension 144 (50 base) mg/ml

T1

*Antianginal Agents*isosorbide dinitrate er oral tablet extended release 40 mg

T1

isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg, 5 mg

T1

isosorbide mononitrate er oral tablet extended release 24 hour 120 mg, 30 mg, 60 mg

T1

isosorbide mononitrate oral tablet 20 mg T1

NITRO-BID TRANSDERMAL OINTMENT 2 % T1

nitroglycerin er oral capsule extended release 2.5 mg, 6.5 mg, 9 mg

T1

nitroglycerin sublingual tablet sublingual 0.3 mg, 0.4 mg, 0.6 mg

T1

nitroglycerin transdermal patch 24 hour 0.1 mg/hr, 0.2 mg/hr, 0.4 mg/hr, 0.6 mg/hr

T1

*Antianxiety Agents*alprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg

T1

buspirone hcl oral tablet 10 mg, 15 mg, 30 mg, 5 mg

T1

chlordiazepoxide hcl oral capsule 10 mg, 25 mg, 5 mg

T1 AL (Max 64 Years)

clorazepate dipotassium oral tablet 15 mg, 3.75 mg, 7.5 mg

T1

diazepam injection solution 5 mg/ml T1

diazepam oral solution 1 mg/ml T1 AL (Max 64 Years)

diazepam oral tablet 10 mg, 2 mg, 5 mg T1 AL (Max 64 Years)

hydroxyzine hcl oral syrup 10 mg/5ml T1

hydroxyzine hcl oral tablet 10 mg, 25 mg, 50 mg T1

hydroxyzine pamoate oral capsule 100 mg, 25 mg, 50 mg

T1

lorazepam oral tablet 0.5 mg, 1 mg, 2 mg T1

oxazepam oral capsule 10 mg, 15 mg, 30 mg T1

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Drug Status Notes

*Antiarrhythmics*amiodarone hcl oral tablet 200 mg T1

disopyramide phosphate oral capsule 100 mg, 150 mg

T1

flecainide acetate oral tablet 100 mg, 150 mg, 50 mg

T1

NORPACE CR ORAL CAPSULE EXTENDED RELEASE 12 HOUR 100 MG T1 QL (60 EA per 30 days)

NORPACE CR ORAL CAPSULE EXTENDED RELEASE 12 HOUR 150 MG T1 QL (120 EA per 30 days)

propafenone hcl oral tablet 150 mg, 225 mg, 300 mg

T1

quinidine gluconate er oral tablet extended release 324 mg

T1

quinidine sulfate oral tablet 200 mg, 300 mg T1

*Antiasthmatic And Bronchodilator Agents*ADVAIR DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 100-50 MCG/DOSE

T1QL (60 EA per 30 days); AL (Max 11 Years)

AEROSPAN INHALATION AEROSOL SOLUTION 80 MCG/ACT T1 QL (8.9 GM per 30 days)

albuterol sulfate hfa aerosol solution 108 (90 base) mcg/act inhalation 108 (90 base) mcg/act

T1 QL (18 GM per 30 days)

albuterol sulfate inhalation nebulization solution(2.5 mg/3ml) 0.083%, (5 mg/ml) 0.5%

T1

albuterol sulfate oral syrup 2 mg/5ml T1

ANORO ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 62.5-25 MCG/INH


ATROVENT HFA INHALATION AEROSOL SOLUTION 17 MCG/ACT T1 QL (12.9 GM per 30 days)

BREO ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 100-25 MCG/INH, 200-25 MCG/INH


budesonide inhalation suspension 0.25 mg/2ml, 0.5 mg/2ml

T1 AL (Max 6 Years)

DULERA INHALATION AEROSOL 100-5 MCG/ACT, 200-5 MCG/ACT T1 QL (13 GM per 30 days)

FLOVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 100 MCG/BLIST, 50 MCG/BLIST


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Drug Status NotesFLOVENT HFA INHALATION AEROSOL44 MCG/ACT T1

QL (10.6 GM per 30 days); AL (Min 4 Years and Max 11 Years)

fluticasone-salmeterol aerosol powder breath activated 113-14 mcg/act inhalation 113-14 mcg/act






FORADIL AEROLIZER INHALATION CAPSULE 12 MCG T1 QL (60 EA per 30 days)

INCRUSE ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 62.5 MCG/INH


ipratropium bromide inhalation solution 0.02 % T1

LUFYLLIN ORAL TABLET 200 MG, 400 MG T1

metaproterenol sulfate oral syrup 10 mg/5ml T1

metaproterenol sulfate oral tablet 10 mg, 20 mg T1

montelukast sodium oral tablet 10 mg T1

montelukast sodium oral tablet chewable 4 mg, 5 mg

T1

QVAR INHALATION AEROSOL SOLUTION 40 MCG/ACT, 80 MCG/ACT T1 QL (8.7 GM per 30 days)

QVAR REDIHALER INHALATION AEROSOL BREATH ACTIVATED 40 MCG/ACT, 80 MCG/ACT

T1 QL (10.6 GM per 30 days)

SEREVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 50 MCG/DOSE


STRIVERDI RESPIMAT INHALATION AEROSOL SOLUTION 2.5 MCG/ACT T1 QL (4 GM per 30 days)

SYMBICORT INHALATION AEROSOL160-4.5 MCG/ACT, 80-4.5 MCG/ACT T1 QL (10.2 GM per 30 days)

terbutaline sulfate oral tablet 2.5 mg, 5 mg T1

THEO-24 ORAL CAPSULE EXTENDED RELEASE 24 HOUR 100 MG, 200 MG, 300 MG

T1

theophylline er oral tablet extended release 12 hour 100 mg, 200 mg, 300 mg, 450 mg

T1

theophylline er oral tablet extended release 24 hour 400 mg

T1

theophylline oral solution 80 mg/15ml T1

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Drug Status NotesTUDORZA PRESSAIR INHALATION AEROSOL POWDER BREATH ACTIVATED 400 MCG/ACT


VENTOLIN HFA INHALATION AEROSOL SOLUTION 108 (90 BASE) MCG/ACT T1 QL (36 GM per 30 days)

*Anticoagulants*enoxaparin sodium injection solution 300 mg/3ml T1 PA; C (7 day supply then PA)

enoxaparin sodium subcutaneous solution 100 mg/ml, 120 mg/0.8ml, 150 mg/ml, 30 mg/0.3ml, 40 mg/0.4ml, 60 mg/0.6ml, 80 mg/0.8ml

T1 PA; C (7 day supply then PA)

heparin sodium (porcine) injection solution 1000 unit/ml, 10000 unit/ml, 20000 unit/ml, 5000 unit/ml

T1

heparin sodium (porcine) intravenous solution2000 unit/ml

T1

heparin sodium (porcine) pf injection solution5000 unit/0.5ml

T1

JANTOVEN ORAL TABLET 1 MG, 10 MG, 2 MG, 2.5 MG, 3 MG, 4 MG, 5 MG, 6 MG, 7.5 MG

T1

warfarin sodium oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg

T1

XARELTO ORAL TABLET 10 MG T1 PA; QL (35 EA per 35 days)

*Anticonvulsants*carbamazepine er oral capsule extended release 12 hour 300 mg

T1

carbamazepine er oral tablet extended release 12 hour 200 mg, 400 mg

T1

carbamazepine oral suspension 100 mg/5ml T1

carbamazepine oral tablet 200 mg T1

carbamazepine oral tablet chewable 100 mg T1

clonazepam oral tablet 0.5 mg, 1 mg, 2 mg T1

DIASTAT ACUDIAL RECTAL GEL 10 MG, 20 MG T1 QL (2 EA per 30 days)

diazepam rectal gel 10 mg, 2.5 mg, 20 mg T1 QL (2 EA per 30 days)

DILANTIN ORAL CAPSULE 100 MG, 30 MG T1

divalproex sodium er oral tablet extended release 24 hour 250 mg, 500 mg

T1

divalproex sodium oral capsule delayed release sprinkle 125 mg

T1

divalproex sodium oral tablet delayed release 125 mg, 250 mg, 500 mg

T1

10

Drug Status NotesEPITOL ORAL TABLET 200 MG T1

ethosuximide oral capsule 250 mg T1

ethosuximide oral solution 250 mg/5ml T1

fosphenytoin sodium injection solution 100 mg pe/2ml, 500 mg pe/10ml

T1

gabapentin oral capsule 100 mg, 300 mg, 400 mg T1

gabapentin oral solution 250 mg/5ml T1

gabapentin oral tablet 600 mg, 800 mg T1

lamotrigine oral tablet 100 mg, 150 mg, 200 mg, 25 mg

T1

lamotrigine oral tablet chewable 25 mg, 5 mg T1

levetiracetam oral solution 100 mg/ml T1

levetiracetam oral tablet 1000 mg T1 QL (90 EA per 30 days)




oxcarbazepine oral tablet 150 mg, 300 mg, 600 mg

T1

phenytoin oral suspension 125 mg/5ml T1 QL (750 ML per 30 days)

phenytoin oral tablet chewable 50 mg T1

phenytoin sodium extended oral capsule 100 mg T1

phenytoin sodium injection solution 50 mg/ml T1

primidone oral tablet 250 mg, 50 mg T1

topiramate oral capsule sprinkle 15 mg, 25 mg T1

topiramate oral tablet 100 mg, 200 mg, 25 mg, 50 mg

T1

valproic acid oral capsule 250 mg T1

valproic acid oral solution 250 mg/5ml T1

zonisamide oral capsule 100 mg T1 QL (180 EA per 30 days)

zonisamide oral capsule 25 mg, 50 mg T1 QL (360 EA per 30 days)

*Antidepressants*amitriptyline hcl oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg


amoxapine oral tablet 100 mg, 150 mg, 25 mg, 50 mg


bupropion hcl er (sr) oral tablet extended release 12 hour 100 mg, 150 mg, 200 mg

T1

bupropion hcl er (xl) oral tablet extended release 24 hour 150 mg, 300 mg

T1

bupropion hcl oral tablet 100 mg, 75 mg T1

11

Drug Status Notescitalopram hydrobromide oral tablet 10 mg, 20 mg, 40 mg

T1

doxepin hcl oral capsule 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg


doxepin hcl oral concentrate 10 mg/ml T1 AL (Max 64 Years)

duloxetine hcl oral capsule delayed release particles 20 mg


duloxetine hcl oral capsule delayed release particles 30 mg, 60 mg


escitalopram oxalate oral tablet 10 mg, 5 mg T1 QL (45 EA per 30 days)

escitalopram oxalate oral tablet 20 mg T1 QL (30 EA per 30 days)

fluoxetine hcl oral capsule 10 mg, 20 mg, 40 mg T1

fluoxetine hcl oral solution 20 mg/5ml T1

fluvoxamine maleate oral tablet 100 mg, 25 mg, 50 mg

T1

imipramine hcl oral tablet 10 mg, 25 mg, 50 mg T1 AL (Max 64 Years)

mirtazapine oral tablet 15 mg, 30 mg, 45 mg T1

nortriptyline hcl oral capsule 10 mg, 25 mg, 50 mg, 75 mg

T1

nortriptyline hcl oral solution 10 mg/5ml T1

paroxetine hcl oral tablet 10 mg, 20 mg, 30 mg, 40 mg

T1

phenelzine sulfate oral tablet 15 mg T1

sertraline hcl oral tablet 100 mg, 25 mg, 50 mg T1

tranylcypromine sulfate oral tablet 10 mg T1 PA

trazodone hcl oral tablet 100 mg, 150 mg, 50 mg T1

venlafaxine hcl er oral capsule extended release 24 hour 150 mg, 37.5 mg, 75 mg

T1

venlafaxine hcl oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg, 75 mg

T1

*Antidiabetics*acarbose oral tablet 100 mg, 25 mg, 50 mg T1

alogliptin benzoate oral tablet 12.5 mg, 25 mg, 6.25 mg


alogliptin-metformin hcl oral tablet 12.5-1000 mg T1 QL (60 EA per 30 days)

alogliptin-metformin hcl oral tablet 12.5-500 mg T1 QL (30 EA per 30 days)

alogliptin-pioglitazone oral tablet 12.5-15 mg, 12.5-30 mg, 12.5-45 mg, 25-15 mg, 25-30 mg, 25-45 mg


chlorpropamide oral tablet 100 mg, 250 mg T1

12

Drug Status NotesFIASP FLEXTOUCH SOLUTION PEN-INJECTOR 100 UNIT/ML SUBCUTANEOUS100 UNIT/ML

T1

FIASP SOLUTION 100 UNIT/ML SUBCUTANEOUS 100 UNIT/ML T1

glimepiride oral tablet 1 mg, 2 mg, 4 mg T1

glipizide oral tablet 10 mg, 5 mg T1

glipizide xl oral tablet extended release 24 hour10 mg, 2.5 mg, 5 mg


glipizide-metformin hcl oral tablet 2.5-250 mg, 2.5-500 mg, 5-500 mg

T1

GLUCAGON EMERGENCY INJECTION KIT 1 MG T1 QL (2 EA per 365 days)

glyburide micronized oral tablet 1.5 mg, 3 mg, 6 mg

T1

glyburide oral tablet 1.25 mg, 2.5 mg, 5 mg T1

glyburide-metformin oral tablet 1.25-250 mg, 2.5-500 mg, 5-500 mg

T1

INVOKANA ORAL TABLET 100 MG, 300 MG T1 QL (30 EA per 30 days)

JANUMET ORAL TABLET 50-1000 MG, 50-500 MG T1 QL (60 EA per 30 days)

JANUMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 100-1000 MG, 50-1000 MG, 50-500 MG


JANUVIA ORAL TABLET 100 MG, 25 MG, 50 MG T1 QL (30 EA per 30 days)

JARDIANCE ORAL TABLET 10 MG, 25 MG T1 QL (30 EA per 30 days)

LANTUS SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML T1

LANTUS SUBCUTANEOUS SOLUTION 100 UNIT/ML T1

LEVEMIR FLEXTOUCH SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML T1

LEVEMIR SUBCUTANEOUS SOLUTION100 UNIT/ML T1

metformin hcl er oral tablet extended release 24 hour 500 mg, 750 mg

T1

metformin hcl oral tablet 1000 mg, 500 mg, 850 mg

T1

nateglinide oral tablet 120 mg, 60 mg T1 QL (90 EA per 30 days)

NOVOLIN 70/30 RELION SUBCUTANEOUS SUSPENSION (70-30) 100 UNIT/ML T1

13

Drug Status NotesNOVOLIN 70/30 SUBCUTANEOUS SUSPENSION (70-30) 100 UNIT/ML T1

NOVOLIN N RELION SUBCUTANEOUS SUSPENSION 100 UNIT/ML T1

NOVOLIN N SUBCUTANEOUS SUSPENSION 100 UNIT/ML T1

NOVOLIN R INJECTION SOLUTION 100 UNIT/ML T1

NOVOLIN R RELION INJECTION SOLUTION 100 UNIT/ML T1

NOVOLOG FLEXPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML T1

NOVOLOG MIX 70/30 FLEXPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR (70-30) 100 UNIT/ML

T1

NOVOLOG MIX 70/30 SUBCUTANEOUS SUSPENSION (70-30) 100 UNIT/ML T1

NOVOLOG SUBCUTANEOUS SOLUTION100 UNIT/ML T1

OZEMPIC SUBCUTANEOUS SOLUTION PEN-INJECTOR 0.25 OR 0.5 MG/DOSE T1 QL (1.5 ML per 30 days)

OZEMPIC SUBCUTANEOUS SOLUTION PEN-INJECTOR 1 MG/DOSE T1 QL (3 ML per 30 days)

pioglitazone hcl oral tablet 15 mg, 30 mg, 45 mg T1 QL (30 EA per 30 days)

pioglitazone hcl-metformin hcl oral tablet 15-500 mg, 15-850 mg


TANZEUM SUBCUTANEOUS PEN-INJECTOR 30 MG, 50 MG T1 PA

TOUJEO SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR 300 UNIT/ML T1

TRESIBA FLEXTOUCH SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML, 200 UNIT/ML

T1

VICTOZA SUBCUTANEOUS SOLUTION PEN-INJECTOR 18 MG/3ML T1 QL (9 ML per 30 days)

*Antidiarrheal/Probiotic Agents*acidophilus/citrus pectin oral tablet T1

acidophilus/pectin oral capsule T1

bismuth oral tablet chewable 262 mg T1

CULTURELLE DIGESTIVE HEALTH ORAL CAPSULE T1

CULTURELLE DIGESTIVE HEALTH ORAL TABLET CHEWABLE T1

14

Drug Status Notespink bismuth maximum strength oral suspension525 mg/15ml

T1

pink bismuth oral suspension 262 mg/15ml T1

probiotic-prebiotic oral capsule 1-250 billion-mg T1

ra pink bismuth oral tablet 262 mg T1

ra probiotic digestive care oral capsule T1

*Antidiarrheals*acidophilus/citrus pectin oral tablet T1

acidophilus/pectin oral capsule T1

bismuth oral tablet chewable 262 mg T1

CULTURELLE DIGESTIVE HEALTH ORAL CAPSULE T1

CULTURELLE DIGESTIVE HEALTH ORAL TABLET CHEWABLE T1

diphenoxylate-atropine oral liquid 2.5-0.025 mg/5ml

T1

diphenoxylate-atropine oral tablet 2.5-0.025 mg T1

IMODIUM A-D ORAL TABLET CHEWABLE 2 MG T1

loperamide hcl oral capsule 2 mg T1

loperamide hcl oral liquid 1 mg/5ml T1

loperamide hcl oral suspension 1 mg/7.5ml T1

loperamide hcl oral tablet 2 mg T1

pink bismuth maximum strength oral suspension525 mg/15ml

T1

pink bismuth oral suspension 262 mg/15ml T1

probiotic-prebiotic oral capsule 1-250 billion-mg T1

ra pink bismuth oral tablet 262 mg T1

ra probiotic digestive care oral capsule T1

*Antidotes*CHEMET ORAL CAPSULE 100 MG T1

naloxone hcl injection solution 0.4 mg/ml, 1 mg/ml


naloxone hcl injection solution cartridge 0.4 mg/ml


naltrexone hcl oral tablet 50 mg T1 QL (40 EA per 30 days)

*Antiemetics*dimenhydrinate injection solution 50 mg/ml T1

dimenhydrinate oral tablet 50 mg T1

15

Drug Status NotesDRAMAMINE ORAL TABLET CHEWABLE50 MG T1

dronabinol oral capsule 10 mg, 2.5 mg, 5 mg T1 PA

granisetron hcl oral tablet 1 mg T1 QL (10 EA per 30 days)

meclizine hcl oral tablet 12.5 mg, 25 mg T1

meclizine hcl oral tablet chewable 25 mg T1

meclizine hcl powder T1

ondansetron hcl oral solution 4 mg/5ml T1 QL (50 ML per 30 days)

ondansetron hcl oral tablet 4 mg, 8 mg T1

ondansetron oral tablet dispersible 4 mg, 8 mg T1

trimethobenzamide hcl oral capsule 300 mg T1

*Antifungals*fluconazole oral suspension reconstituted 10 mg/ml

T1

fluconazole oral suspension reconstituted 40 mg/ml


fluconazole oral tablet 100 mg, 50 mg T1

fluconazole oral tablet 150 mg T1 QL (4 EA per 30 days)

fluconazole oral tablet 200 mg T1 QL (30 EA per 30 days)

griseofulvin microsize oral suspension 125 mg/5ml

T1

griseofulvin microsize oral tablet 500 mg T1

griseofulvin ultramicrosize oral tablet 125 mg, 250 mg

T1

ketoconazole oral tablet 200 mg T1

nystatin oral powder T1

nystatin oral tablet 500000 unit T1

terbinafine hcl oral tablet 250 mg T1

*Antihistamines*

aler-dryl oral tablet 50 mg T1PA; C (covered up to age 65, then PA required)

aller-chlor oral syrup 2 mg/5ml T1

cetirizine hcl oral syrup 5 mg/5ml T1

cetirizine hcl oral tablet 10 mg, 5 mg T1

chlorpheniramine maleate er oral tablet extended release 12 mg

T1

chlorpheniramine maleate oral tablet 4 mg T1

chlorpheniramine maleate powder T1

CLARITIN CHILDRENS ORAL TABLET CHEWABLE 5 MG T1

16

Drug Status Notesclemastine fumarate oral syrup 0.67 mg/5ml T1

clemastine fumarate oral tablet 1.34 mg, 2.68 mg T1

cvs allergy childrens oral tablet chewable 12.5 mg

T1PA; C (covered up to age 65, then PA required)

cyproheptadine hcl oral syrup 2 mg/5ml T1

cyproheptadine hcl oral tablet 4 mg T1

dexchlorpheniramine maleate oral syrup 2 mg/5ml

T1

diphenhist oral liquid 12.5 mg/5ml T1PA; C (covered up to age 65, then PA required)

diphenhydramine hcl oral capsule 25 mg, 50 mg T1PA; C (covered up to age 65, then PA required)

diphenhydramine hcl oral elixir 12.5 mg/5ml T1PA; C (covered up to age 65, then PA required)

diphenhydramine hcl oral tablet 25 mg T1PA; C (covered up to age 65, then PA required)

ED CHLORPED ORAL LIQUID 2 MG/ML T1

fexofenadine hcl childrens oral suspension 30 mg/5ml

T1

fexofenadine hcl oral tablet 180 mg T1

levocetirizine dihydrochloride oral tablet 5 mg T1 QL (30 EA per 30 days)

loratadine allergy relief oral tablet dispersible 10 mg

T1

loratadine childrens oral solution 5 mg/5ml T1

loratadine oral tablet 10 mg T1

promethazine hcl oral solution 6.25 mg/5ml T1

promethazine hcl oral tablet 12.5 mg, 25 mg, 50 mg

T1

promethazine hcl rectal suppository 12.5 mg, 25 mg, 50 mg


ra allergy relief childrens oral tablet dispersible12.5 mg

T1PA; C (covered up to age 65, then PA required)

silphen cough oral syrup 12.5 mg/5ml T1PA; C (covered up to age 65, then PA required)

TRIAMINIC COUGH/RUNNY NOSE ORAL STRIP 12.5 MG T1

*Antihyperlipidemics*atorvastatin calcium oral tablet 10 mg, 20 mg, 40 mg, 80 mg


cholestyramine light oral powder 4 gm/dose T1

cholestyramine oral powder 4 gm/dose T1

17

Drug Status Notescolestipol hcl oral granules 5 gm T1

colestipol hcl oral tablet 1 gm T1

ezetimibe oral tablet 10 mg T1 QL (30 EA per 30 days)

fenofibrate micronized oral capsule 134 mg, 200 mg, 67 mg

T1

fenofibrate oral tablet 145 mg, 48 mg T1

fenofibrate oral tablet 160 mg, 54 mg T1 QL (30 EA per 30 days)

gemfibrozil oral tablet 600 mg T1

lovastatin oral tablet 10 mg, 20 mg, 40 mg T1

NIACOR ORAL TABLET 500 MG T1

pravastatin sodium oral tablet 10 mg, 20 mg, 40 mg, 80 mg

T1

rosuvastatin calcium oral tablet 10 mg, 20 mg, 40 mg, 5 mg

T1

simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg T1

simvastatin oral tablet 80 mg T1 QL (30 EA per 30 days)

*Antihypertensives*amlodipine besy-benazepril hcl oral capsule 10-20 mg, 10-40 mg, 2.5-10 mg, 5-10 mg, 5-20 mg, 5-40 mg

T1

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


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


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

T1

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

T1

benazepril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg, 5-6.25 mg

T1

bisoprolol-hydrochlorothiazide oral tablet 10-6.25 mg, 2.5-6.25 mg, 5-6.25 mg

T1

captopril oral tablet 100 mg T1

captopril oral tablet 12.5 mg, 25 mg, 50 mg T1 QL (90 EA per 30 days)

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

T1

clonidine hcl oral tablet 0.1 mg, 0.2 mg, 0.3 mg T1

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

T1

enalapril maleate oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg

T1

18

Drug Status Notesenalapril-hydrochlorothiazide oral tablet 10-25 mg, 5-12.5 mg

T1

fosinopril sodium oral tablet 10 mg, 20 mg, 40 mg T1

fosinopril sodium-hctz oral tablet 10-12.5 mg, 20-12.5 mg

T1

guanfacine hcl oral tablet 1 mg, 2 mg T1

hydralazine hcl oral tablet 10 mg, 100 mg, 25 mg, 50 mg

T1

irbesartan oral tablet 150 mg, 300 mg, 75 mg T1 QL (30 EA per 30 days)

irbesartan-hydrochlorothiazide oral tablet 150-12.5 mg, 300-12.5 mg


lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 30 mg, 40 mg, 5 mg

T1

lisinopril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg

T1

losartan potassium oral tablet 100 mg, 25 mg, 50 mg

T1

losartan potassium-hctz oral tablet 100-12.5 mg, 100-25 mg, 50-12.5 mg

T1

methyldopa oral tablet 250 mg, 500 mg T1

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

T1

minoxidil oral tablet 10 mg, 2.5 mg T1

moexipril hcl oral tablet 15 mg, 7.5 mg T1

olmesartan medoxomil oral tablet 20 mg, 40 mg, 5 mg

T1

prazosin hcl oral capsule 1 mg, 2 mg, 5 mg T1

propranolol-hctz oral tablet 40-25 mg, 80-25 mg T1 QL (60 EA per 30 days)

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

T1

quinapril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg


ramipril oral capsule 1.25 mg, 10 mg, 2.5 mg, 5 mg

T1

telmisartan oral tablet 20 mg, 40 mg, 80 mg T1

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

T1

trandolapril oral tablet 1 mg, 2 mg, 4 mg T1

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

T1

19

Drug Status Notesvalsartan-hydrochlorothiazide oral tablet 160-12.5 mg, 160-25 mg, 320-12.5 mg, 320-25 mg, 80-12.5 mg

T1

*Anti-Infective Agents - Misc.*atovaquone oral suspension 750 mg/5ml T1 QL (210 ML per 18 days)

clindamycin hcl oral capsule 150 mg, 300 mg, 75 mg

T1

clindamycin palmitate hcl oral solution reconstituted 75 mg/5ml

T1

dapsone oral tablet 100 mg, 25 mg T1

DORIBAX INTRAVENOUS SOLUTION RECONSTITUTED 250 MG, 500 MG T1

metronidazole oral tablet 250 mg, 500 mg T1

PRIMSOL ORAL SOLUTION 50 MG/5ML T1 QL (600 ML per 30 days)

sulfamethoxazole-trimethoprim oral suspension200-40 mg/5ml

T1

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

T1

tinidazole oral tablet 500 mg T1

trimethoprim oral tablet 100 mg T1 QL (60 EA per 30 days)

vancomycin hcl intravenous solution reconstituted1000 mg, 5000 mg

T1

*Antimalarials*chloroquine phosphate oral tablet 250 mg T1 PA

DARAPRIM ORAL TABLET 25 MG T1 PA

hydroxychloroquine sulfate oral tablet 200 mg T1

mefloquine hcl oral tablet 250 mg T1 QL (5 EA per 30 days)

primaquine phosphate oral tablet 26.3 mg T1 QL (14 EA per 30 days)

quinine sulfate oral capsule 324 mg T1

*Antimyasthenic Agents*pyridostigmine bromide oral tablet 60 mg T1

*Antimycobacterial Agents*ethambutol hcl oral tablet 100 mg, 400 mg T1

isoniazid oral syrup 50 mg/5ml T1

isoniazid oral tablet 100 mg, 300 mg T1

pyrazinamide oral tablet 500 mg T1

rifampin oral capsule 150 mg, 300 mg T1

RIFATER ORAL TABLET 50-120-300 MG T1

TRECATOR ORAL TABLET 250 MG T1

20

Drug Status Notes

*Antineoplastics And Adjunctive Therapies*anastrozole oral tablet 1 mg T1 GR-F

bicalutamide oral tablet 50 mg T1

capecitabine oral tablet 150 mg, 500 mg T1 PA

cyclophosphamide oral capsule 25 mg, 50 mg T1

cyclophosphamide oral tablet 25 mg, 50 mg T1

ELIGARD SUBCUTANEOUS KIT 22.5 MG, 45 MG T1 PA

ELIGARD SUBCUTANEOUS KIT 30 MG, 7.5 MG T1

ERLEADA ORAL TABLET 60 MG T1 PA

flutamide oral capsule 125 mg T1 PA

GLEOSTINE ORAL CAPSULE 10 MG, 100 MG, 40 MG T1 PA

HEXALEN ORAL CAPSULE 50 MG T1 PA

hydroxyurea oral capsule 500 mg T1

imatinib mesylate oral tablet 100 mg, 400 mg T1 PA

INTRON A INJECTION SOLUTION10000000 UNIT/ML, 6000000 UNIT/ML T1 PA

INTRON A INJECTION SOLUTION RECONSTITUTED 10000000 UNIT, 18000000 UNIT, 50000000 UNIT

T1 PA

letrozole oral tablet 2.5 mg T1 QL (30 EA per 30 days)

leucovorin calcium oral tablet 15 mg, 25 mg, 5 mg

T1

LEUKERAN ORAL TABLET 2 MG T1

LUPRON DEPOT (1-MONTH) INTRAMUSCULAR KIT 3.75 MG, 7.5 MG T1 PA

LUPRON DEPOT (3-MONTH) INTRAMUSCULAR KIT 11.25 MG, 22.5 MG T1 PA

LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30 MG T1 PA

MATULANE ORAL CAPSULE 50 MG T1 PA

megestrol acetate oral suspension 40 mg/ml, 400 mg/10ml

T1

megestrol acetate oral tablet 20 mg, 40 mg T1

mercaptopurine oral tablet 50 mg T1

methotrexate oral tablet 2.5 mg T1

methotrexate sodium (pf) injection solution 50 mg/2ml

T1

21

Drug Status Notesmethotrexate sodium injection solution 50 mg/2ml T1

MYLERAN ORAL TABLET 2 MG T1

TABLOID ORAL TABLET 40 MG T1

tamoxifen citrate oral tablet 10 mg, 20 mg T1 GR-F; AL (Min 35 Years)

tretinoin oral capsule 10 mg T1 PA

*Antiparkinson Agents*amantadine hcl oral capsule 100 mg T1

amantadine hcl oral syrup 50 mg/5ml T1

benztropine mesylate oral tablet 0.5 mg, 1 mg, 2 mg

T1

bromocriptine mesylate oral capsule 5 mg T1

bromocriptine mesylate oral tablet 2.5 mg T1

carbidopa oral tablet 25 mg T1

carbidopa-levodopa er oral tablet extended release 25-100 mg, 50-200 mg

T1

carbidopa-levodopa oral tablet 10-100 mg, 25-100 mg, 25-250 mg

T1

entacapone oral tablet 200 mg T1

pramipexole dihydrochloride oral tablet 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg

T1

ropinirole hcl oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg

T1

selegiline hcl oral capsule 5 mg T1

trihexyphenidyl hcl oral elixir 0.4 mg/ml T1

trihexyphenidyl hcl oral tablet 2 mg, 5 mg T1

*Antipsychotics/Antimanic Agents*aripiprazole oral tablet 10 mg, 15 mg, 2 mg, 20 mg, 30 mg, 5 mg


clozapine oral tablet 100 mg, 200 mg, 25 mg, 50 mg

T1

fluphenazine hcl injection solution 2.5 mg/ml T1

fluphenazine hcl oral concentrate 5 mg/ml T1

fluphenazine hcl oral elixir 2.5 mg/5ml T1

fluphenazine hcl oral tablet 1 mg, 10 mg, 2.5 mg, 5 mg

T1

haloperidol decanoate intramuscular solution100 mg/ml

T1

haloperidol oral tablet 0.5 mg, 1 mg, 10 mg, 2 mg, 20 mg, 5 mg

T1

lithium carbonate er oral tablet extended release300 mg, 450 mg

T1

22

Drug Status Noteslithium carbonate oral capsule 150 mg, 300 mg, 600 mg

T1

lithium carbonate oral tablet 300 mg T1

loxapine succinate oral capsule 10 mg, 25 mg, 5 mg, 50 mg

T1

olanzapine oral tablet 10 mg, 15 mg, 2.5 mg, 20 mg, 5 mg, 7.5 mg

T1

perphenazine oral tablet 16 mg, 2 mg, 4 mg, 8 mg T1

prochlorperazine maleate oral tablet 10 mg, 5 mg T1

prochlorperazine rectal suppository 25 mg T1 QL (60 EA per 30 days)

quetiapine fumarate er oral tablet extended release 24 hour 150 mg, 200 mg, 300 mg, 400 mg, 50 mg

T1 ST; QL (30 EA per 30 days)

quetiapine fumarate oral tablet 100 mg, 200 mg, 25 mg, 300 mg, 400 mg, 50 mg

T1

risperidone oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg

T1

thiothixene oral capsule 1 mg, 10 mg, 2 mg, 5 mg T1

trifluoperazine hcl oral tablet 1 mg, 10 mg, 2 mg, 5 mg

T1

ziprasidone hcl oral capsule 20 mg, 40 mg, 60 mg, 80 mg

T1 ST

*Antiseptics & Disinfectants*povidone-iodine external pad 10 % T1

povidone-iodine external solution 10 % T1

*Antivirals*abacavir sulfate oral solution 20 mg/ml T1 QL (900 ML per 30 days)

abacavir sulfate oral tablet 300 mg T1 QL (60 EA per 30 days)

abacavir sulfate-lamivudine oral tablet 600-300 mg


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


acyclovir oral capsule 200 mg T1

acyclovir oral suspension 200 mg/5ml T1 AL (Max 12 Years)

acyclovir oral tablet 400 mg, 800 mg T1

APTIVUS ORAL CAPSULE 250 MG T1 QL (120 EA per 30 days)

APTIVUS ORAL SOLUTION 100 MG/ML T1 QL (300 ML per 30 days)

atazanavir sulfate oral capsule 150 mg, 200 mg T1 QL (60 EA per 30 days)

atazanavir sulfate oral capsule 300 mg T1 QL (30 EA per 30 days)

ATRIPLA ORAL TABLET 600-200-300 MG T1 QL (30 EA per 30 days)

23

Drug Status NotesCOMPLERA ORAL TABLET 200-25-300 MG T1 QL (30 EA per 30 days)

CRIXIVAN ORAL CAPSULE 200 MG T1 QL (360 EA per 30 days)

CRIXIVAN ORAL CAPSULE 400 MG T1 QL (180 EA per 30 days)

didanosine oral capsule delayed release 125 mg, 200 mg


didanosine oral capsule delayed release 250 mg, 400 mg


EDURANT ORAL TABLET 25 MG T1 QL (30 EA per 30 days)

efavirenz oral capsule 200 mg T1 QL (90 EA per 30 days)

efavirenz oral capsule 50 mg T1 QL (360 EA per 30 days)

efavirenz oral tablet 600 mg T1 QL (30 EA per 30 days)

EMTRIVA ORAL CAPSULE 200 MG T1 QL (30 EA per 30 days)

EMTRIVA ORAL SOLUTION 10 MG/ML T1 QL (600 ML per 30 days)

EPIVIR HBV ORAL SOLUTION 5 MG/ML T1 QL (1800 ML per 30 days)

famciclovir oral tablet 125 mg, 250 mg, 500 mg T1 QL (90 EA per 30 days)

fosamprenavir calcium oral tablet 700 mg T1 QL (120 EA per 30 days)

INTELENCE ORAL TABLET 100 MG T1 QL (120 EA per 30 days)

INTELENCE ORAL TABLET 200 MG T1 QL (60 EA per 30 days)

INTELENCE ORAL TABLET 25 MG T1

INVIRASE ORAL CAPSULE 200 MG T1 QL (300 EA per 30 days)

INVIRASE ORAL TABLET 500 MG T1 QL (120 EA per 30 days)

ISENTRESS ORAL TABLET 400 MG T1 QL (60 EA per 30 days)

ISENTRESS ORAL TABLET CHEWABLE100 MG, 25 MG T1

KALETRA ORAL TABLET 100-25 MG T1 QL (360 EA per 30 days)

KALETRA ORAL TABLET 200-50 MG T1 QL (180 EA per 30 days)

lamivudine oral solution 10 mg/ml T1 QL (900 ML per 30 days)

lamivudine oral tablet 100 mg T1

lamivudine oral tablet 150 mg T1 QL (60 EA per 30 days)

lamivudine oral tablet 300 mg T1 QL (30 EA per 30 days)

lamivudine-zidovudine oral tablet 150-300 mg T1 QL (60 EA per 30 days)

LEXIVA ORAL SUSPENSION 50 MG/ML T1 QL (360 ML per 60 days)

lopinavir-ritonavir oral solution 400-100 mg/5ml T1 QL (450 ML per 30 days)

nevirapine er oral tablet extended release 24 hour400 mg


nevirapine oral suspension 50 mg/5ml T1 QL (1200 ML per 30 days)

nevirapine oral tablet 200 mg T1 QL (60 EA per 30 days)

NORVIR ORAL CAPSULE 100 MG T1 QL (360 EA per 30 days)

24

Drug Status NotesNORVIR ORAL SOLUTION 80 MG/ML T1 QL (450 ML per 30 days)

oseltamivir phosphate oral capsule 30 mg, 45 mg, 75 mg


oseltamivir phosphate oral suspension reconstituted 6 mg/ml

T1QL (120 ML per 10 days); AL (Max 12 Years)

PEG-INTRON REDIPEN PAK 4 SUBCUTANEOUS KIT 120 MCG/0.5ML, 150 MCG/0.5ML, 50 MCG/0.5ML, 80 MCG/0.5ML

T1 PA

PEG-INTRON REDIPEN SUBCUTANEOUS KIT 120 MCG/0.5ML, 150 MCG/0.5ML, 50 MCG/0.5ML, 80 MCG/0.5ML

T1 PA

PEGINTRON SUBCUTANEOUS KIT 120 MCG/0.5ML, 150 MCG/0.5ML, 50 MCG/0.5ML, 80 MCG/0.5ML

T1 PA

PEG-INTRON SUBCUTANEOUS KIT 120 MCG/0.5ML, 150 MCG/0.5ML, 50 MCG/0.5ML, 80 MCG/0.5ML

T1 PA

PREZISTA ORAL TABLET 150 MG T1 QL (240 EA per 30 days)




RELENZA DISKHALER INHALATION AEROSOL POWDER BREATH ACTIVATED 5 MG/BLISTER


RESCRIPTOR ORAL TABLET 100 MG T1 QL (360 EA per 30 days)

RESCRIPTOR ORAL TABLET 200 MG T1

RIBASPHERE ORAL CAPSULE 200 MG T1 PA

ribavirin oral capsule 200 mg T1 PA

rimantadine hcl oral tablet 100 mg T1

ritonavir oral tablet 100 mg T1 QL (360 EA per 30 days)

SELZENTRY ORAL TABLET 150 MG T1 QL (120 EA per 30 days)

SELZENTRY ORAL TABLET 300 MG T1

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


stavudine oral solution reconstituted 1 mg/ml T1 QL (1200 ML per 30 days)

STRIBILD ORAL TABLET 150-150-200-300 MG T1 QL (30 EA per 30 days)

SYMFI LO ORAL TABLET 400-300-300 MG T1 QL (30 EA per 30 days)

SYMFI ORAL TABLET 600-300-300 MG T1 QL (30 EA per 30 days)

tenofovir disoproxil fumarate oral tablet 300 mg T1 QL (30 EA per 30 days)

TIVICAY ORAL TABLET 50 MG T1 QL (30 EA per 30 days)

25

Drug Status NotesTRIUMEQ ORAL TABLET 600-50-300 MG T1 QL (30 EA per 30 days)

TRUVADA ORAL TABLET 100-150 MG, 133-200 MG, 167-250 MG, 200-300 MG T1 QL (30 EA per 30 days)

valacyclovir hcl oral tablet 1 gm, 500 mg T1

VIDEX ORAL SOLUTION RECONSTITUTED 2 GM, 4 GM T1 QL (603 ML per 30 days)

VIRACEPT ORAL TABLET 250 MG T1 QL (300 EA per 30 days)

VIRACEPT ORAL TABLET 625 MG T1 QL (120 EA per 30 days)

VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG T1 QL (30 EA per 30 days)

zidovudine oral capsule 100 mg T1 QL (180 EA per 30 days)

zidovudine oral syrup 50 mg/5ml T1 QL (1800 ML per 30 days)

zidovudine oral tablet 300 mg T1 QL (60 EA per 30 days)

*Assorted Classes*ARGYLE STERILE WATER IRRIGATION SOLUTION T1

azathioprine oral tablet 50 mg T1

CELLCEPT ORAL SUSPENSION RECONSTITUTED 200 MG/ML T1 PA

cyclosporine modified oral capsule 100 mg, 25 mg, 50 mg

T1

cyclosporine modified oral solution 100 mg/ml T1

cyclosporine oral capsule 100 mg, 25 mg T1

GENGRAF ORAL CAPSULE 100 MG, 25 MG T1

GENGRAF ORAL SOLUTION 100 MG/ML T1

KIONEX ORAL POWDER T1

mycophenolate mofetil oral capsule 250 mg T1

mycophenolate mofetil oral suspension reconstituted 200 mg/ml

T1 PA

mycophenolate mofetil oral tablet 500 mg T1

sodium polystyrene sulfonate oral powder T1

sterile water for irrigation irrigation solution T1

tacrolimus oral capsule 0.5 mg, 1 mg, 5 mg T1

*Beta Blockers*acebutolol hcl oral capsule 200 mg, 400 mg T1

atenolol oral tablet 100 mg, 25 mg, 50 mg T1

bisoprolol fumarate oral tablet 10 mg, 5 mg T1

BYSTOLIC ORAL TABLET 10 MG, 2.5 MG, 20 MG, 5 MG T1 QL (30 EA per 30 days)

26

Drug Status Notescarvedilol oral tablet 12.5 mg, 25 mg, 3.125 mg, 6.25 mg

T1

labetalol hcl oral tablet 100 mg, 200 mg, 300 mg T1

metoprolol succinate er oral tablet extended release 24 hour 100 mg, 25 mg, 50 mg


metoprolol succinate er oral tablet extended release 24 hour 200 mg


metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg

T1

nadolol oral tablet 20 mg, 40 mg, 80 mg T1

pindolol oral tablet 10 mg, 5 mg T1

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

T1

propranolol hcl oral solution 20 mg/5ml, 40 mg/5ml

T1

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

T1

sotalol hcl (af) oral tablet 120 mg, 160 mg, 80 mg T1

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

T1

timolol maleate oral tablet 10 mg, 20 mg, 5 mg T1

*Calcium Channel Blockers*amlodipine besylate oral tablet 10 mg, 2.5 mg, 5 mg


CARTIA XT ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG, 180 MG, 240 MG, 300 MG


diltiazem cd oral capsule extended release 24 hour 120 mg, 180 mg


diltiazem hcl er beads oral capsule extended release 24 hour 420 mg


diltiazem hcl er coated beads oral capsule extended release 24 hour 300 mg


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


diltiazem hcl er oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg


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

T1

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


felodipine er oral tablet extended release 24 hour10 mg, 2.5 mg, 5 mg


27

Drug Status Notesisradipine oral capsule 2.5 mg, 5 mg T1

nicardipine hcl oral capsule 20 mg, 30 mg T1

nifedipine er oral tablet extended release 24 hour30 mg, 60 mg, 90 mg


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


nifedipine oral capsule 10 mg, 20 mg T1

nimodipine oral capsule 30 mg T1 PA

TAZTIA XT ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG, 180 MG, 240 MG, 300 MG, 360 MG


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


verapamil hcl er oral capsule extended release 24 hour 180 mg


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


verapamil hcl oral tablet 120 mg, 40 mg, 80 mg T1

*Cardiotonics*digoxin oral tablet 125 mcg, 250 mcg T1

*Cephalosporins*cefaclor oral capsule 250 mg, 500 mg T1

cefaclor oral suspension reconstituted 125 mg/5ml, 250 mg/5ml, 375 mg/5ml


cefadroxil oral capsule 500 mg T1 QL (40 EA per 10 days)

cefadroxil oral suspension reconstituted 250 mg/5ml, 500 mg/5ml

T1

cefadroxil oral tablet 1 gm T1 QL (20 EA per 10 days)

cefdinir oral capsule 300 mg T1

cefdinir oral suspension reconstituted 125 mg/5ml, 250 mg/5ml


cefpodoxime proxetil oral suspension reconstituted 100 mg/5ml, 50 mg/5ml

T1

cefpodoxime proxetil oral tablet 100 mg, 200 mg T1

cefprozil oral suspension reconstituted 125 mg/5ml, 250 mg/5ml

T1

cefprozil oral tablet 250 mg, 500 mg T1

CEFTIN ORAL SUSPENSION RECONSTITUTED 125 MG/5ML, 250 MG/5ML


28

Drug Status Notesceftriaxone sodium injection solution reconstituted 1 gm, 500 mg


ceftriaxone sodium injection solution reconstituted 250 mg


ceftriaxone sodium intravenous solution reconstituted 1 gm

T1

cefuroxime axetil oral suspension reconstituted125 mg/5ml


cefuroxime axetil oral tablet 250 mg, 500 mg T1

cephalexin oral capsule 250 mg, 500 mg T1

cephalexin oral suspension reconstituted 125 mg/5ml, 250 mg/5ml

T1

*Chemicals*acetone solution T1

ACTIPHYTE OF LEMONGRASS LIQUID T1

ammonium lactate solution 70 % T1

benzyl benzoate liquid T1

camphor spirit spirit T1

chlorhexidine gluconate solution T1

chloroform solution T1

cottonseed oil oil T1

CRYOSERV SOLUTION T1

dimethyl sulfoxide solution , 100 % T1

ether solution T1

ethyl alcohol (rubbing) solution 70 % T1

ethyl alcohol external solution 95 % T1

ethyl alcohol solution 95 % T1

eugenol solution T1

glycerin liquid T1

glycerin solution T1

glycerine liquid T1

glycerol formal liquid T1

glycine soya extract solution T1

glycine soya protein solution T1

gnp alcohol denatured solution T1

gnp peppermint spirit spirit T1

gnp sodium silicate solution T1

guaiacol solution T1

hydroxyprogesterone caproate powder T1

29

Drug Status Notesisopropyl alcohol (rubbing) solution 70 % T1

isopropyl alcohol solution , 50 %, 70 %, 91 %, 99 %

T1

isopropyl palmitate liquid T1

methanol solution , 99 % T1

methyl alcohol solution T1

peppermint spirit spirit T1

pine tar liquid T1

polysorbate 20 solution T1

polysorbate 40 solution T1

polysorbate 60 liquid T1

polysorbate 80 oral liquid T1

PRETZ SOLUTION 10 % T1

ra ethyl alcohol solution 70 % T1

sm camphor spirit spirit T1

sodium bicarbonate powder T1

sodium silicate solution 40 % T1

turpentine liquid T1

undecylenic acid liquid T1

*Contraceptives*ARANELLE ORAL TABLET 0.5/1/0.5-35 MG-MCG T1 QL (28 EA per 28 days)

desogestrel-ethinyl estradiol oral tablet 0.15-30 mg-mcg

T1 GR-F; QL (28 EA per 21 days)

ELLA ORAL TABLET 30 MG T1 GR-F; QL (1 EA per 30 days)

KELNOR 1/35 ORAL TABLET 1-35 MG-MCG T1 GR-F; QL (28 EA per 21 days)

levonorgest-eth estrad 91-day oral tablet 0.15-0.03 mg


levonorgestrel oral tablet 0.75 mg T1 GR-F; QL (2 EA per 30 days)

levonorgestrel oral tablet 1.5 mg T1 GR-F; QL (1 EA per 30 days)

levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg, 0.15-30 mg-mcg


LOW-OGESTREL ORAL TABLET 0.3-30 MG-MCG T1 GR-F; QL (28 EA per 21 days)

medroxyprogesterone acetate intramuscular suspension 150 mg/ml

T1 GR-F; QL (1 ML per 90 days)

MICROGESTIN 1.5/30 ORAL TABLET 1.5-30 MG-MCG T1 GR-F; QL (21 EA per 21 days)

30

Drug Status NotesMICROGESTIN FE 1.5/30 ORAL TABLET1.5-30 MG-MCG T1 GR-F; QL (28 EA per 21 days)

NECON 0.5/35 (28) ORAL TABLET 0.5-35 MG-MCG T1 GR-F; QL (28 EA per 21 days)

NECON 1/35 (28) ORAL TABLET 1-35 MG-MCG T1 GR-F; QL (28 EA per 21 days)

NECON 1/50 (28) ORAL TABLET 1-50 MG-MCG T1 GR-F; QL (28 EA per 21 days)

NECON 10/11 (28) ORAL TABLET 35 MCG T1 GR-F; QL (28 EA per 21 days)

NECON 7/7/7 ORAL TABLET 0.5/0.75/1-35 MG-MCG T1 GR-F; QL (28 EA per 21 days)

norethin ace-eth estrad-fe oral tablet 1-20 mg-mcg, 1-20 mg-mcg(24)


norethindrone acet-ethinyl est oral tablet 1-20 mg-mcg


norethindrone oral tablet 0.35 mg T1 GR-F; QL (28 EA per 21 days)

norgestimate-eth estradiol oral tablet 0.25-35 mg-mcg


TRINESSA (28) ORAL TABLET0.18/0.215/0.25 MG-35 MCG T1 GR-F; QL (28 EA per 21 days)

TRINESSA LO ORAL TABLET0.18/0.215/0.25 MG-25 MCG T1 GR-F; QL (28 EA per 21 days)

TRIVORA (28) ORAL TABLET T1 GR-F; QL (28 EA per 21 days)

VELIVET ORAL TABLET 0.1/0.125/0.15 -0.025 MG T1 GR-F; QL (28 EA per 21 days)

ZENCHENT ORAL TABLET 0.4-35 MG-MCG T1 GR-F; QL (28 EA per 21 days)

ZOVIA 1/50E (28) ORAL TABLET 1-50 MG-MCG T1 GR-F; QL (28 EA per 21 days)

*Corticosteroids*cortisone acetate oral tablet 25 mg T1

DEXAMETHASONE INTENSOL ORAL CONCENTRATE 1 MG/ML T1

dexamethasone oral elixir 0.5 mg/5ml T1

dexamethasone oral solution 0.5 mg/5ml T1

dexamethasone oral tablet 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg

T1

dexamethasone oral tablet therapy pack 1.5 mg (21), 1.5 mg (35), 1.5 mg (51)

T1

fludrocortisone acetate oral tablet 0.1 mg T1

hydrocortisone oral tablet 10 mg, 20 mg, 5 mg T1

31

Drug Status Notesmethylprednisolone oral tablet 16 mg, 32 mg, 4 mg, 8 mg

T1

methylprednisolone oral tablet therapy pack 4 mg T1

prednisolone oral solution 15 mg/5ml T1

prednisolone sodium phosphate oral solution 15 mg/5ml, 6.7 (5 base) mg/5ml

T1

prednisone oral solution 5 mg/5ml T1

prednisone oral tablet 1 mg, 10 mg, 2.5 mg, 20 mg, 5 mg, 50 mg

T1

prednisone oral tablet therapy pack 10 mg (21), 10 mg (48), 5 mg (21), 5 mg (48)

T1

*Cough/Cold/Allergy*ACETA-GESIC ORAL TABLET 12.5-325 MG T1

acetylcysteine inhalation solution 10 %, 20 % T1

ADVIL ALLERGY & CONGESTION ORAL TABLET 4-10-200 MG T1

ADVIL ALLERGY SINUS ORAL TABLET 2-30-200 MG T1

ADVIL COLD & SINUS LIQUI-GELS ORAL CAPSULE 30-200 MG T1

ALA-HIST PE ORAL TABLET 2-10 MG T1

ALKA-SELTZER PLS ALLERGY & CGH ORAL CAPSULE 5-6.25-10-325 MG T1

ALKA-SELTZER PLUS COLD & COUGH ORAL CAPSULE 5-2-10-325 MG T1

ALKA-SELTZER PLUS COLD & COUGH ORAL TABLET EFFERVESCENT 7.8-2-10-325 MG

T1

ALKA-SELTZER PLUS COLD & FLU ORAL TABLET EFFERVESCENT 5-2-10-250 MG

T1

ALKA-SELTZER PLUS DAY/NIGHT ORAL T1

ALKA-SELTZER PLUS NIGHT COLD ORAL TABLET EFFERVESCENT 7.8-6.25-10-500 MG

T1

ALKA-SELTZER PLUS SINUS ORAL TABLET EFFERVESCENT 7.8-325 MG T1

all day pain relf sinus/cold d oral tablet extended release 12 hour 120-220 mg

T1

allergy multi-symptom day/nght oral T1

aller-time oral tablet 2.5-60 mg T1

32

Drug Status Notesambi 12.5cpd/100gfn/30pse oral liquid 30-12.5-100 mg/5ml

T1

ambi 12.5cpd/1dcpm/30pse oral liquid 30-1-12.5 mg/5ml

T1

ap-hist dm oral liquid 7.5-4-15 mg/5ml T1

benzonatate oral capsule 100 mg, 200 mg T1

biobron sf oral syrup 10-15-350 mg/5ml T1

biodesp dm oral syrup 5-15-100 mg/5ml T1

biogtuss oral liquid 10-15-300 mg/5ml T1

bionatuss dxp oral liquid 10-2-20 mg/5ml T1

bionel oral liquid 30-15-200 mg/5ml T1

bionel pediatric oral liquid 15-5-50 mg/5ml T1

biospec dmx oral liquid 15-25 mg/5ml T1

bpm-dm-phen oral syrup 5-2-10 mg/5ml T1

bronchial asthma relief oral tablet 12.5-200 mg T1

BRONCOTRON PED DROPS ORAL LIQUID 2.5-5-100 MG/ML T1

BRONCOTRON PED ORAL LIQUID 10-15-350 MG/5ML T1

BRONCOTRON-S ORAL LIQUID 20-400 MG/5ML T1

BRONKAID ORAL TABLET 25-400 MG T1

bronkids oral liquid 1.5-0.6-2.75 mg/ml, 10-4-10 mg/5ml

T1

brotapp dm oral liquid 15-1-5 mg/5ml T1

capcof oral syrup 5-2-10 mg/5ml T1 QL (240 ML per 30 days)

capmist dm oral tablet 60-15-400 mg T1

capron dm oral liquid 7.5-7.5 mg/5ml T1

CARBAPHEN CH ORAL SUSPENSION 10-4-24 MG/5ML T1

CARBAPHEN PED CH ORAL SUSPENSION2.5-1.25-8 MG/ML T1

CCP CAFFEINE FREE ORAL TABLET 325-200-10 MG T1

CERTUSS-D ORAL TABLET 60-25-400 MG T1

cetirizine-pseudoephedrine er oral tablet extended release 12 hour 5-120 mg

T1

cheratussin ac oral syrup 100-10 mg/5ml T1

cheratussin dac oral solution 30-10-100 mg/5ml T1

chest congestion daytime oral tablet 325-200 mg T1

chest congestion relief pe oral tablet 10-400 mg T1

33

Drug Status Noteschest congestion/pain & sinus oral tablet 10-650-400 mg

T1

childrens cough oral liquid 5-100 mg/5ml T1

childrens cough/runny nose oral suspension 5-160-1 mg/5ml

T1

childrens plus cold & allergy oral suspension12.5-2.5-160 mg/5ml

T1

childrens plus cold oral suspension 1-2.5-160 mg/5ml

T1

childrens plus flu oral suspension 2.5-1-5-160 mg/5ml

T1

chlo tuss ex oral liquid 12.5-100 mg/5ml T1

CHLO TUSS ORAL LIQUID 30-1-12.5 MG/5ML T1

chlophed oral liquid 5-12.5-100 mg/5ml T1

codituss dm oral syrup 5-8.33-10 mg/5ml T1

cold & cough childrens oral elixir 2.5-1-5 mg/5ml T1

cold & cough day/night child oral 2.5-5 &2.5-6.25 mg/5ml

T1

cold & cough daytime oral liquid 1000-30 mg/30ml

T1

cold & flu nighttime/daytime oral (liquid) T1

cold & flu relief nighttime d oral liquid 60-12.5-30-1000 mg/30ml

T1

cold & flu severe daytime oral tablet 5-10-200-325 mg

T1

cold control pe cold/flu med oral tablet 25-10-650 mg

T1

cold head congestion daytime oral tablet 10-5-325 mg

T1

cold head congestion nighttime oral tablet 5-2-10-325 mg

T1

cold multi-symptom day/night oral 5-2-10-325 mg T1

cold multi-symptom warm night oral liquid 5-6.25-10-325 mg/15ml

T1

cold relief plus oral tablet effervescent 2-7.8-325 mg

T1

cold/flu relief day/night oral T1

cold/flu relief nighttime oral liquid 15-6.25-325 mg/15ml

T1

cold/flu relief oral liquid 10-5-325 mg/15ml T1

complete sinus relief oral tablet 2-10-500 mg T1

34

Drug Status NotesCONEX COLD/ALLERGY ORAL SOLUTION 1-30 MG/5ML T1

CONEX COLD/ALLERGY ORAL TABLET2-60 MG T1

CONTAC COLD+FLU MAX ST ORAL TABLET 2-5-500 MG T1

CORICIDIN HBP CONGESTION/COUGH ORAL CAPSULE 10-200 MG T1

CORICIDIN HBP DAY/NIGHT COLD ORAL 10-20 &15-200-2 MG T1

CORICIDIN NIGHTTIME COLD-COUGH ORAL LIQUID 12.5-325 MG/15ML T1

cough & cold oral tablet 4-30 mg T1

cough & sore throat nighttime oral liquid 30-12.5-1000 mg/30ml

T1

cough daytime/nighttime oral liquid therapy pack6.25-15 & 15 mg/15ml

T1

cvs cough & sore throat child oral liquid 160-5 mg/5ml

T1

cvs non-drying sinus pe oral tablet 5-200 mg T1

DALLERGY ORAL LIQUID 1-2.5 MG/ML T1

DALLERGY ORAL TABLET 1-5 MG T1

day time pe cold/flu relief oral capsule 10-5-325 mg

T1

daytime cold & cough childrens oral solution 2.5-5 mg/5ml

T1

DAYTIME COLD MEDICINE ORAL LIQUID 325-15 MG/15ML T1

DELSYM CGH/CLD NIGHTTIME CHILD ORAL LIQUID 12.5-5-325 MG/10ML T1

DELTUSS DMX ORAL LIQUID 30-1-15 MG/5ML T1

DELTUSS DP ORAL LIQUID 1-30 MG/5ML T1

DESGEN DM ORAL SYRUP 5-15-100 MG/5ML T1

DESGEN PEDIATRIC ORAL LIQUID 2.5-5-50 MG/ML T1

despec dm oral syrup 5-10-100 mg/5ml T1

despec-dm oral tablet 40-30-400 mg T1

dextromethorphan-guaifenesin oral solution 10-100 mg/5ml

T1

DIABETIC TUSSIN COLD & FLU ORAL LIQUID 10-12.5-325 MG/5ML T1

35

Drug Status NotesDIABETIC TUSSIN NIGHT COLD/FLU ORAL LIQUID 10-12.5-325 MG/5ML T1

DIMETAPP LONG ACT COUGH/COLD ORAL SYRUP 1-7.5 MG/5ML T1

DOLOGEN ORAL TABLET 2-650 MG T1

dometuss-da/children oral liquid 1-2.5 mg/5ml T1

dometuss-dmx oral liquid 10-30-200 mg/5ml T1

doxylamine-phenylephrine oral tablet 7.5-10 mg T1

DURAVENT PE ORAL TABLET 10-395 MG T1

ed bron gp oral liquid 5-100 mg/5ml T1

ED CHLORPED D ORAL LIQUID 2-5 MG/ML T1

ed-a-hist dm oral liquid 10-4-15 mg/5ml T1

ENDACOF-DM ORAL LIQUID 2.5-1-5 MG/5ML T1

ENDACON ORAL SYRUP 10-20-100 MG/5ML T1

ENTEX LQ ORAL LIQUID 10-100 MG/5ML T1

ENTEX T ORAL TABLET 60-375 MG T1

entre-cough oral liquid 30-15-175 mg/5ml T1

eq allergy/sinus headache oral tablet 12.5-30-500 mg

T1

eq childrens cold oral liquid 1-15-160 mg/5ml T1

eq cold plus oral capsule 2-30-325 mg T1

eq cold relief complete oral tablet 30-2-15-325 mg

T1

eq cold/cough plus oral capsule 30-2-10-325 mg T1

eq daytime cold/flu relief oral capsule 30-325-15 mg

T1

eq daytime cold/flu relief oral liquid 30-325-15 mg/15ml

T1

eq flu & severe cold & cough oral packet 25-10-650 mg

T1

eq flu relief oral tablet 30-500-15 mg T1

eq flu/severe cold/congestion oral packet 60-4-30-1000 mg

T1

eq night time cold & cough oral liquid 6.25-2.5 mg/5ml

T1

eq nite time cold/flu relief oral capsule 30-6.25-15-325 mg

T1

eq nitetime cold/flu ms relief oral capsule 15-6.25-325 mg

T1

36

Drug Status Noteseq non-drying sinus oral capsule 30-200 mg T1

eq sinus congestion & pain oral tablet 5-325-200 mg

T1

eq triacting cold/allergy oral syrup 1-15 mg/5ml T1

eql congestion relief oral tablet 10-200 mg T1

FENESIN DM IR ORAL TABLET 15-400 MG T1

flu & sore throat oral packet 20-10-650 mg T1

flu/severe cold & cough day oral packet 20-10-650 mg

T1

GENCONTUSS ORAL LIQUID 5-2-10 MG/5ML T1

gnp night time sinus oral capsule 6.25-5-325 mg T1

G-P-TUSS DXP ORAL LIQUID 10-2-20 MG/5ML T1

G-TRON PEDIATRIC DROPS ORAL LIQUID 2.5-5-100 MG/ML T1

guaifenesin dm oral tablet 400-20 mg T1

guaifenesin er oral tablet extended release 12 hour 1200 mg, 600 mg

T1

guaifenesin oral solution 100 mg/5ml T1

guaifenesin oral tablet 200 mg, 400 mg T1

guaifenesin powder T1

guaifenesin-dm oral syrup 100-10 mg/5ml T1

G-ZYNCOF ORAL SYRUP 20-400 MG/5ML T1

HERBAL EXPEC ORAL LIQUID 150 MG/15ML T1

HISTEX-DM ORAL SYRUP 10-2.5-20 MG/5ML T1

HISTEX-PE ORAL SYRUP 2.5-10 MG/5ML T1

hist-pse oral liquid 0.938-10 mg/ml T1

hydrocod polst-cpm polst er oral suspension extended release 10-8 mg/5ml


hydrocodone-homatropine oral syrup 5-1.5 mg/5ml


hydrocodone-homatropine oral tablet 5-1.5 mg T1

ibu-profen cold/sinus oral tablet 30-200 mg T1

intense cough reliever oral liquid 20-300 mg/5ml, 30-200 mg/5ml

T1

lexuss 210 oral liquid 2-10 mg/5ml T1 QL (240 ML per 30 days)

liquituss gg oral liquid 200 mg/5ml T1

37

Drug Status NotesLITTLE REMEDIES FOR COLDS ORAL LIQUID 2.5-1.25-80 MG/ML T1

LODRANE D ORAL CAPSULE 4-60 MG T1

LOHIST-D ORAL LIQUID 2-30 MG/5ML T1

loratadine-d 12hr oral tablet extended release 12 hour 5-120 mg

T1

loratadine-d 24hr oral tablet extended release 24 hour 10-240 mg

T1

LORTUSS DM ORAL LIQUID 30-6.25-15 MG/5ML T1

LORTUSS LQ ORAL LIQUID 6.25-30 MG/5ML T1

MAR-COF BP ORAL LIQUID 30-2-7.5 MG/5ML T1 QL (240 ML per 30 days)

m-end dmx oral liquid 20-0.667-10 mg/5ml T1

M-END PE ORAL LIQUID 3.33-1.33-6.33 MG/5ML T1 QL (240 ML per 30 days)

MUCINEX CHILD MS DAY-NIGHT CLD ORAL T1

MUCINEX COUGH FOR KIDS ORAL PACKET 5-100 MG T1

MUCINEX FAST-MAX CONGEST COUGH ORAL TABLET 5-10-200 MG T1

MUCINEX FOR KIDS ORAL PACKET 100 MG T1

MUCINEX SINUS-MAX DAY/NIGHT ORALT1

mucus d oral tablet extended release 12 hour 120-1200 mg

T1

mucus relief cold flu throat oral liquid 5-10-200-325 mg/10ml

T1

mucus relief cold/sinus max st oral liquid 10-650-400 mg/20ml

T1

mucus relief d oral tablet 40-400 mg T1

mucus relief severe congst/cgh oral liquid 10-20-400 mg/20ml

T1

mucus-dm max oral tablet extended release 12 hour 60-1200 mg

T1

mucus-dm oral tablet extended release 12 hour30-600 mg

T1

nasal mist inhalation aerosol solution 0.9 % T1

NASOPEN ORAL LIQUID 9.375-30 MG/5ML T1

38

Drug Status NotesNASOPEN PE ORAL LIQUID 50-10 MG/15ML T1

NEOTUSS PLUS ORAL LIQUID 7.5-4-30 MG/5ML T1

NEOTUSS-D ORAL LIQUID 7.5-30-200 MG/5ML T1

nighttime cough oral liquid 6.25-15 mg/15ml T1

nighttime pain plus sleep oral liquid 25-500 mg/15ml

T1

nite-time cold/flu relief oral liquid 5-6.25-15-500 mg/15ml

T1

NIVANEX DMX ORAL TABLET 10-15-380 MG T1

nohist-lq oral liquid 4-10 mg/5ml T1

non-pseudo cold relief oral tablet 5-15-200-325 mg

T1

NOREL AD ORAL TABLET 4-10-325 MG T1

nortuss-ex oral liquid 20-200 mg/5ml T1

PANATUSS PED DROPS ORAL LIQUID 15-0.5-6.25 MG/ML T1

PANATUSS PED ORAL LIQUID 60-2-25 MG/5ML T1

PECGEN DMX ORAL LIQUID 15-125 MG/5ML T1

PEDIACARE CHILD ALLERGY/COLD ORAL LIQUID 12.5-5 MG/5ML T1

pediatric cough/cold oral liquid 15-1-5 mg/5ml T1

phenylephrine-chlorphen-dm oral liquid 1.75-0.75-2.75 mg/ml

T1

phenylephrine-dm-gg oral liquid 10-18-200 mg/15ml

T1

phenylhistine dh oral liquid 30-2-10 mg/5ml T1 QL (240 ML per 30 days)

poly-hist dm oral liquid 5-25-10 mg/5ml T1

poly-hist pd oral liquid 6.25-6.25 mg/ml T1

poly-tussin ac oral liquid 10-4-10 mg/5ml T1 QL (240 ML per 30 days)

POLY-VENT DM ORAL TABLET 60-20-380 MG T1

POLY-VENT IR ORAL TABLET 60-380 MG T1

pres gen pediatric oral liquid 2.5-5-75 mg/5ml T1

pro-chlo oral liquid 5-12.5-12.5 mg/5ml T1

PRO-CLEAR AC ORAL SYRUP 9-8.33 MG/5ML T1 QL (240 ML per 30 days)

39

Drug Status Notespromethazine vc plain oral syrup 6.25-5 mg/5ml T1

promethazine vc/codeine oral syrup 6.25-5-10 mg/5ml


promethazine-codeine oral syrup 6.25-10 mg/5ml T1 QL (240 ML per 30 days)

promethazine-dm oral syrup 6.25-15 mg/5ml T1

PRO-RED AC ORAL SYRUP 5-1-9 MG/5ML T1 QL (240 ML per 30 days)

pseudoeph-bromphen-dm oral syrup 30-2-10 mg/5ml

T1

pseudoephedrine-guaifenesin er oral tablet extended release 12 hour 60-600 mg

T1

pyrilamine-phenylephrine oral suspension 5-16 mg/5ml

T1

pyrilamine-phenylephrine oral tablet 25-10 mg T1

qc cold relief oral tablet 12.5-500 mg T1

qc cold relief plus oral tablet effervescent 2-5-250 mg

T1

qc flu relief therapy night oral liquid 12.5-5-325 mg/15ml

T1

qc medifin cp oral tablet 650-400 mg T1

Q-TAPP ORAL ELIXIR 1-15 MG/5ML T1

ra allergy multi-symptom night oral tablet 25-5-325 mg

T1

ra allergy multi-symptom oral tablet 2-5-325 mg T1

ra allergy plus sinus oral tablet 25-10 mg T1

ra childrens cold & allergy oral elixir 1-2.5 mg/5ml

T1

ra cold & flu oral tablet 2-325 mg T1

ra cold/cough sinus relief pe oral tablet 5-10-100-325 mg

T1

ra flu maximum strength oral tablet 15-500-2 mg T1

ra severe cold/night cold&flu oral T1

ra severe cold/sinus relief pe oral tablet 12.5-5-325 mg

T1

ra sinus congst/pain day/night oral 2-5-325 & 5-325 mg

T1

ra suphedrine day/night combo oral T1

ra suphedrine pe oral tablet 4-10 mg, 5-325 mg T1

ra tussin nighttime cough dm oral liquid 12.5-30 mg/10ml

T1

REFENESEN CHEST CONG/PAIN RLF ORAL TABLET 650-400 MG T1

40

Drug Status Notesrefenesen plus oral tablet 60-400 mg T1

relcof c oral solution 100-6.3 mg/5ml T1

RESCON DM ORAL SYRUP 30-2-10 MG/5ML T1

RESPAIRE-30 ORAL CAPSULE 30-150 MG T1

ROBITUSSIN CHILD COUGH/COLD CF ORAL LIQUID 2.5-5-50 MG/5ML T1

ROBITUSSIN CHILD COUGH/COLD LA ORAL LIQUID 1-7.5 MG/5ML T1

ROBITUSSIN DAY/NIGHT VALUE PAK ORAL T1

ROBITUSSIN PEAK COLD MULTI-SYM ORAL LIQUID 6.25-2.5-160 MG/5ML T1

ROBITUSSIN PK COLD DAY/NGHT DM ORAL T1

ROBITUSSIN PK COLD DAY/NGHT MS ORAL T1

ru-hist d oral tablet 4-10 mg T1

rymed oral tablet 2-10 mg T1

SAFE TUSSIN PM ORAL LIQUID 3.125-7.5 MG/5ML T1

sb daytime sinus oral capsule 5-325 mg T1

sb severe cold congestion oral tablet 30-15-200-325 mg

T1

SCOT-TUSSIN DM ORAL LIQUID 2-15 MG/5ML T1

SCOT-TUSSIN SENIOR ORAL LIQUID 15-200 MG/5ML T1

SINADRIN PE COMPLETE SINUS REL ORAL TABLET 2-10-650 MG T1

sinus daytime/nighttime oral T1

sinus maximum strength oral tablet 30-500 mg T1

sm cough/runny nose childrens oral liquid 1-5 mg/5ml

T1

sm ibuprofren cold childrens oral suspension 15-100 mg/5ml

T1

sm pain reliever sinus pe oral tablet 5-500 mg T1

sm tussin cf oral liquid 30-10-100 mg/5ml T1

sodium chloride inhalation nebulization solution0.9 %

T1

sonahist dm oral liquid† 2-1-3 mg/ml T1

stahist ad oral liquid 25-60 mg/5ml T1

41

Drug Status Notesstahist ad oral tablet 25-60 mg T1

SUDAFED PE DAY & NIGHT ORAL 25-10 & 10 MG T1

SUDOGEST SINUS/ALLERGY ORAL TABLET 4-60 MG T1

super strength sinadrin oral tablet 4-10-650 mg T1

supress a pediatric oral liquid 5-1-10 mg/ml T1

supress dm pediatric oral liquid 5-50 mg/ml T1

SUPRESS-PE PEDIATRIC ORAL LIQUID2.5-50 MG/ML T1

terpin hydrate powder T1

tg 10peh/380gfn oral tablet 10-380 mg T1

tgq 15dm/5peh/2cpm oral syrup 15-5-2 mg/5ml T1

tgq 30pse/150gfn/15dm oral syrup 30-150-15 mg/5ml

T1

tgq 30pse/3brm/15dm oral syrup 30-3-15 mg/5ml T1

theracaps cough/cold reliever oral tablet 30-2-15-500 mg

T1

THERAFLU MAX-D COLD & FLU ORAL PACKET 60-30-400-1000 MG T1

THERAFLU SEVERE COLD & COUGH ORAL PACKET T1

THERAFLU SEVERE COLD DAYTIME ORAL TABLET 15-5-325 MG T1

TREXBROM ORAL LIQUID 10-4-25 MG/5ML T1

triactin chest congestion oral solution 50 mg/5ml T1

TRIAMINIC CHEST/NASAL CONGEST ORAL SYRUP 2.5-50 MG/5ML T1

TRIAMINIC COLD/ALLERGY CHILD ORAL SYRUP 1-2.5 MG/5ML T1

TRIAMINIC COLD/COUGH DAY TIME ORAL SOLUTION 2.5-5 MG/5ML T1

TRIAMINIC COUGH & SORE THROAT ORAL SYRUP 160-5 MG/5ML T1

TRIAMINIC COUGH/SORE THROAT ORAL TABLET CHEWABLE 160-5 MG T1

TRIAMINIC NIGHT TIME COLD/CGH ORAL SYRUP 6.25-2.5 MG/5ML T1

trigofen dm oral liquid 2-1-3 mg/ml T1

TRISPEC DMX ORAL LIQUID 10-187 MG/5ML T1

42

Drug Status NotesTRISPEC PSE PEDIATRIC ORAL LIQUID30-10-187 MG/5ML T1

trymine cg oral liquid 225-7.5 mg/5ml T1

TUSICOF ORAL LIQUID 10-20-400 MG/5ML T1

TUSICOF ORAL TABLET 10-20-400 MG T1

TUSNEL C ORAL SYRUP 30-10-100 MG/5ML T1

TUSNEL ORAL CAPSULE 2-15-200 MG T1

TUSNEL ORAL LIQUID 30-15-200 MG/5ML T1

TUSNEL PEDIATRIC ORAL LIQUID 15-5-50 MG/5ML T1

tussafex ex oral liquid 10-30-200 mg/5ml T1

tussafex-a oral liquid 6-2-15 mg/5ml T1

tussin cf cough & cold oral liquid 5-10-100 mg/5ml

T1

tussin cf max multi-symptom oral liquid 5-10-200 mg/5ml

T1

tussin chest congestion oral syrup 100 mg/5ml T1

tussin cold/congestion oral capsule 30-10-200 mg T1

tussin cough oral syrup 15 mg/5ml T1

tussin dm max oral liquid 10-200 mg/5ml T1

tussi-pres b oral liquid 10-4-20 mg/5ml T1

TUSSLIN ORAL LIQUID 10-28-388 MG/5ML T1

TUSSLIN PEDIATRIC ORAL LIQUID 2.5-7.5-88 MG/ML T1

TYLENOL CHILDRENS COLD/STUFFY ORAL SUSPENSION 2.5-160 MG/5ML T1

TYLENOL CHILDRENS PLUS CLD/CGH ORAL SUSPENSION 5-2.5-160 MG/5ML T1

VANACOF APE ORAL LIQUID 10-50-25 MG/15ML T1

VANACOF G ORAL LIQUID 25-200 MG/5ML T1

VANACOF GPE ORAL LIQUID 10-25-200 MG/15ML T1

VANACOF-8 ORAL LIQUID 25-50 MG/15ML T1

VANATAB DX ORAL TABLET 30-12.5-200 MG T1

vaporizing steam inhalation liquid 6.2 % T1

43

Drug Status NotesVAZOBID-PD ORAL SUSPENSION 6-10 MG/5ML T1

VICKS DAYQUIL MUCUS CONTROL DM ORAL LIQUID 10-200 MG/15ML T1

VICKS DAYQUIL SEVERE COLD/FLU ORAL LIQUID 5-10-200-325 MG/15ML T1

VICKS NATURE FUSION COLD & FLU ORAL LIQUID 30-7.5-650 MG/30ML T1

VICKS NATURE FUSION CONGEST ORAL LIQUID 20-200 MG/30ML T1

VICKS NYQUIL CHILDRENS CLD/CGH ORAL LIQUID 2-15 MG/15ML T1

VICKS NYQUIL COLD & FLU NIGHT ORAL LIQUID 30-650-4 MG/30ML T1

virdec dm oral liquid 3.5-1-3 mg/ml T1

virdec oral liquid 1-3.5 mg/ml T1

WAL-FLU COLD & SORE THROAT ORAL PACKET 20-10-325 MG T1

WAL-FLU SEVERE COLD DAYTIME ORAL PACKET 10-650 MG T1

ZODRYL DEC 25 ORAL SUSPENSION 5-1-20 MG/ML T1

ZODRYL DEC 30 ORAL SUSPENSION4.286-1-20 MG/ML T1

ZODRYL DEC 35 ORAL SUSPENSION 3.75-1-20 MG/ML T1

ZODRYL DEC 40 ORAL SUSPENSION3.333-1-20 MG/ML T1

Z-TUSS AC ORAL LIQUID 2-9 MG/5ML T1 QL (240 ML per 30 days)

ZYNCOF ORAL SYRUP 20-400 MG/5ML T1

*Dermatologicals*acne medication 10 external lotion 10 % T1

acne medication 5 external lotion 5 % T1

ADULT ACNOMEL EXTERNAL CREAM 2-8 % T1

alclometasone dipropionate external cream 0.05 %

T1

alclometasone dipropionate external ointment0.05 %

T1

alevazol external ointment 1 % T1

ammonium lactate external cream 12 % T1

ammonium lactate external lotion 12 % T1

44

Drug Status NotesANECREAM EXTERNAL CREAM 4 % T1

ASPERCREME LIDOCAINE PATCH 4 % EXTERNAL 4 % T1 QL (30 EA per 30 days)

ASPERCREME W/LIDOCAINE EXTERNAL CREAM 4 % T1

bacitracin external ointment 500 unit/gm T1

bacitracin zinc external ointment 500 unit/gm T1

bacitracin-neomycin-polymyxin external ointment400-5-5000

T1

BASIS OVERNIGHT EXTERNAL CREAM T1

benzoyl peroxide cleanser external lotion 6 % T1

benzoyl peroxide external gel 10 %, 2.5 %, 5 % T1

benzoyl peroxide wash external liquid 10 %, 5 % T1

benzoyl peroxide-erythromycin external gel 5-3 % T1 QL (46.6 GM per 30 days)

betamethasone dipropionate aug external cream0.05 %


betamethasone dipropionate external cream 0.05 %


betamethasone dipropionate external lotion 0.05 %

T1

betamethasone dipropionate external ointment0.05 %


betamethasone valerate external cream 0.1 % T1 QL (90 GM per 30 days)

betamethasone valerate external lotion 0.1 % T1 QL (120 ML per 30 days)

betamethasone valerate external ointment 0.1 % T1 QL (90 GM per 30 days)

bp cleansing external lotion 4 % T1

bp cleansing wash external emulsion 10-4 % T1

BRASIVOL EXTERNAL PASTE T1

CALAGESIC EXTERNAL LOTION 1-8 % T1

capsaicin external cream 0.025 %, 0.1 % T1

CAPZASIN EXTERNAL LIQUID 0.15 % T1

CASTIVA WARMING EXTERNAL LOTION0.035 % T1

ciclopirox external solution 8 % T1 QL (6.6 ML per 30 days)

CLEAN & CLEAR ACNE CONTROL EXTERNAL KIT 0.5 & 2 & 10 % T1

clindamycin phosphate external solution 1 % T1

clindamycin phosphate external swab 1 % T1

clobetasol propionate external solution 0.05 % T1 QL (100 ML per 30 days)

clotrimazole external cream 1 % T1

45

Drug Status Notesclotrimazole external solution 1 % T1

clotrimazole-betamethasone external cream 1-0.05 %


clotrimazole-betamethasone external lotion 1-0.05 %


CORTISPORIN EXTERNAL OINTMENT 1 % T1

CORTIZONE-10/ALOE EXTERNAL LIQUID 1 % T1 QL (36 ML per 30 days)

cvs cortisone cooling relief external gel 1 % T1 QL (60 GM per 30 days)

cvs hydrocortisone acetate external cream 0.5 % T1 QL (120 GM per 30 days)

cvs targeted acne spot external cream 2.5 % T1

DENOREX DUAL FORCE EXTERNAL SHAMPOO 1 & 3 % T1

desonide external ointment 0.05 % T1 QL (120 GM per 30 days)

diclofenac sodium transdermal gel 1 % T1 QL (200 GM per 30 days)

DIFFERIN GEL 0.1 % EXTERNAL (OTC)0.1 % T1 QL (45 GM per 30 days)

diflorasone diacetate external ointment 0.05 % T1

docosanol external cream 10 % T1

econazole nitrate external cream 1 % T1

effaclar duo external solution 5.5 % T1

erythromycin external gel 2 % T1

erythromycin external solution 2 % T1

ethyl chloride external aerosol T1

EUCERIN EXTERNAL CREAM T1

EXODERM EXTERNAL BAR 10-3 % T1

first aid antibiotic external ointment 4 % T1

fluocinolone acetonide body external oil 0.01 % T1 QL (120 ML per 30 days)

fluocinolone acetonide external cream 0.01 %, 0.025 %


fluocinolone acetonide external ointment 0.025 % T1 QL (120 GM per 30 days)

fluocinolone acetonide scalp external oil 0.01 % T1 QL (120 ML per 30 days)

fluocinonide external cream 0.05 % T1 QL (120 GM per 30 days)

fluocinonide external gel 0.05 % T1 QL (120 GM per 30 days)

fluocinonide external ointment 0.05 % T1 QL (120 GM per 30 days)

fluocinonide external solution 0.05 % T1 QL (120 ML per 30 days)

fluocinonide-e external cream 0.05 % T1 QL (120 GM per 30 days)

fluorouracil external cream 5 % T1

fluorouracil external solution 2 %, 5 % T1

46

Drug Status Notesfluticasone propionate external cream 0.05 % T1 QL (120 GM per 30 days)

fluticasone propionate external ointment 0.005 % T1

FUNGOID TINCTURE EXTERNAL SOLUTION 2 % T1

gentamicin sulfate external cream 0.1 % T1

gentamicin sulfate external ointment 0.1 % T1

glycerin external liquid T1

GRANDPAS THYLOX SOAP EXTERNAL BAR 3 % T1

granulderm external aerosol, solution 650-72.5-0.1 mg/0.82ml


halobetasol propionate external cream 0.05 % T1

halobetasol propionate external ointment 0.05 % T1 QL (100 GM per 30 days)

HC DERMAPAX EXTERNAL LIQUID 0.5-0.5 % T1

hydrocortisone external cream 0.5 % T1 QL (60 GM per 30 days)

hydrocortisone external cream 2.5 % T1 QL (90 GM per 30 days)

hydrocortisone external lotion 1 % T1 QL (240 GM per 30 days)

hydrocortisone external lotion 2.5 % T1 QL (120 ML per 30 days)

hydrocortisone external ointment 0.5 %, 1 % T1 QL (60 GM per 30 days)

hydrocortisone external ointment 2.5 % T1 QL (90 GM per 30 days)

hydrocortisone max st external cream 1 % T1 QL (120 GM per 30 days)

hydrocortisone valerate external cream 0.2 % T1

hydrocortisone valerate external ointment 0.2 % T1 QL (120 GM per 30 days)

hydrocortisone-aloe external cream 0.5 %, 1 % T1 QL (90 GM per 30 days)

isopropyl alcohol wipes external 70 % T1

ketoconazole external cream 2 % T1

ketoconazole external shampoo 2 % T1

LAC-HYDRIN FIVE EXTERNAL LOTION 5 % T1

lactic acid e external cream 10-3500 %-unt/30gm T1

lactic acid external lotion 10 % T1

lc-4 lidocaine external cream 4 % T1

lice killing maximum strength external shampoo0.33-4 %

T1

lice solution combination kit 0.33-4-0.5 % T1

lice treatment external liquid 0.33-4 %, 1 % T1

LICEMD EXTERNAL GEL 0.33-4 % T1

LICIDE TREATMENT COMBINATION KITT1

47

Drug Status Noteslidocaine external cream 4 % T1 QL (90 GM per 30 days)

lidocaine hcl external cream 3 % T1 QL (85 GM per 30 days)

lidocaine hcl external gel 2 % T1

lidocaine hcl external solution 4 % T1

lidocaine-prilocaine external cream 2.5-2.5 % T1 QL (30 GM per 30 days)

lindane external lotion 1 % T1

lindane external shampoo 1 % T1

LIQUIMAT EXTERNAL LOTION 5 % T1

LMX 4 EXTERNAL CREAM 4 % T1

LOTRIMIN AF EXTERNAL AEROSOL 2 % T1

malathion external lotion 0.5 % T1

medi-first hydrocortisone external cream 1 % T1 QL (60 EA per 30 days)

metronidazole external cream 0.75 % T1

metronidazole external gel 0.75 % T1

metronidazole external lotion 0.75 % T1

miconazole nitrate external aerosol powder 2 % T1

miconazole nitrate external cream 2 % T1

miconazorb af external powder 2 % T1

mometasone furoate external cream 0.1 % T1 QL (60 GM per 30 days)

mometasone furoate external ointment 0.1 % T1 QL (60 GM per 30 days)

mometasone furoate external solution 0.1 % T1 QL (60 ML per 30 days)

mupirocin external ointment 2 % T1

NEOSPORIN ESSENTIALS TRIAL PK EXTERNAL KIT 1 & 1 % T1

NEUTROGENA CLEAR PORE EXTERNAL LIQUID 3.5 % T1

NOBLE MYSTIQUE EMU-LAC EXTERNAL CREAM 10 % T1

NUOX EXTERNAL GEL 6-3 % T1

nystatin external cream 100000 unit/gm T1

nystatin external ointment 100000 unit/gm T1

nystatin external powder 100000 unit/gm T1

nystatin-triamcinolone external cream 100000-0.1 unit/gm-%

T1

nystatin-triamcinolone external ointment 100000-0.1 unit/gm-%

T1

OC8 EXTERNAL GEL 7 % T1

PANOXYL-8 CREAMY WASH EXTERNAL LIQUID 8 % T1

permethrin external cream 5 % T1 QL (120 GM per 30 days)

48

Drug Status Notespermethrin external lotion 1 % T1

podofilox external solution 0.5 % T1

PRAMOSONE EXTERNAL CREAM 1-1 % T1 QL (30 GM per 30 days)

prednicarbate external ointment 0.1 % T1 QL (60 GM per 30 days)

PRO:12 MOUSSE AL12 EXTERNAL FOAM12 % T1

PRONTO AEROSOL 0.4 % T1

pyrethins-piperonyl butoxide external liquid 0.2-2 %

T1

ra acne maximum external pad 2 % T1

ra acne treatment external cream 10 % T1

ra first aid anti-itch spray external solution 1 % T1 QL (90 GM per 30 days)

ra lice bedding aerosol 0.5 % T1

ra lice egg remover external gel T1

ra lice solution combination kit 0.5-0.33-4 % T1

ra wart remover external pad 40 % T1

resorcinol-sulfur external lotion 2-5 % T1

RID ESSENTIAL LICE ELIMINATION EXTERNAL KIT 0.33-4 % T1

SANTYL EXTERNAL OINTMENT 250 UNIT/GM T1 QL (60 GM per 30 days)

SCHOOLTIME SHAMPOO EXTERNAL SHAMPOO T1

sebex external shampoo 2-2 % T1

selenium sulfide external lotion 2.5 % T1

silver sulfadiazine external cream 1 % T1

STEP 2 EXTERNAL SOLUTION 8 % T1

sulfacetamide sodium (acne) external lotion 10 % T1

sulfacetamide sodium-sulfur external emulsion10-5 %

T1

sulfacetamide sodium-sulfur external liquid 9-4.5 %

T1

sulfurated lime external solution T1

tbc external aerosol solution 650-72.5-0.1 mg/0.82ml


terbinafine hcl external cream 1 % T1

triamcinolone acetonide external cream 0.025 %, 0.1 %


triamcinolone acetonide external cream 0.5 % T1 QL (60 GM per 30 days)

triamcinolone acetonide external lotion 0.025 %, 0.1 %


49

Drug Status Notestriamcinolone acetonide external ointment 0.025 %, 0.1 %


triamcinolone acetonide external ointment 0.5 % T1 QL (60 GM per 30 days)

triple paste af external ointment 2 % T1

trixaicin hp external cream 0.075 % T1

urea external cream 40 % T1

VASOLEX EXTERNAL OINTMENT T1 QL (60 GM per 30 days)

ZEASORB-AF EXTERNAL LOTION 2 % T1

*Diagnostic Products*GLUCOCARD EXPRESSION TEST IN VITRO STRIP T1

GLUCOCARD VITAL TEST IN VITRO STRIP T1

KETOSTIX IN VITRO STRIP T1

ONETOUCH VERIO STRIP IN VITRO T1C (QL 100/90 for members not on insulin and QL 300/90 for members on insulin)

PRECISION XTRA KETONE IN VITRO STRIP T1

*Dietary Products/Dietary Management Products*complete protein/vitamin shake oral powder T1

*Digestive Aids*CREON ORAL CAPSULE DELAYED RELEASE PARTICLES 12000 UNIT, 24000-76000 UNIT, 3000-9500 UNIT, 36000 UNIT, 6000 UNIT

T1

PANCREAZE ORAL CAPSULE DELAYED RELEASE PARTICLES 10500 UNIT, 16800 UNIT, 21000 UNIT, 4200 UNIT

T1

pancrelipase (lip-prot-amyl) oral capsule delayed release particles 5000 unit

T1

PERTZYE ORAL CAPSULE DELAYED RELEASE PARTICLES 16000 UNIT, 8000 UNIT

T1

ULTRESA ORAL CAPSULE DELAYED RELEASE PARTICLES 13800 UNIT, 20700 UNIT, 23000 UNIT

T1

VIOKACE ORAL TABLET 10440 UNIT, 20880 UNIT T1

50

Drug Status NotesZENPEP ORAL CAPSULE DELAYED RELEASE PARTICLES 10000 UNIT, 15000-51000 UNIT, 20000-68000 UNIT, 25000 UNIT, 3000-10000 UNIT, 40000-136000 UNIT, 5000 UNIT

T1

*Direct-Acting P2y12 Inhibitors***BRILINTA ORAL TABLET 60 MG, 90 MG T1 QL (60 EA per 30 days)

*Diuretics*acetazolamide er oral capsule extended release 12 hour 500 mg


acetazolamide oral tablet 125 mg, 250 mg T1

amiloride hcl oral tablet 5 mg T1

amiloride-hydrochlorothiazide oral tablet 5-50 mg

T1

bumetanide oral tablet 0.5 mg, 1 mg, 2 mg T1

chlorothiazide oral tablet 250 mg, 500 mg T1

chlorthalidone oral tablet 100 mg, 25 mg, 50 mg T1

DIURIL ORAL SUSPENSION 250 MG/5ML T1QL (600 ML per 30 days); AL (Max 12 Years)

furosemide injection solution 10 mg/ml T1

furosemide oral solution 10 mg/ml T1

furosemide oral tablet 20 mg, 40 mg, 80 mg T1

hydrochlorothiazide oral capsule 12.5 mg T1

hydrochlorothiazide oral tablet 12.5 mg, 25 mg, 50 mg

T1

indapamide oral tablet 1.25 mg, 2.5 mg T1

methazolamide oral tablet 25 mg T1

methyclothiazide oral tablet 5 mg T1

metolazone oral tablet 10 mg, 2.5 mg, 5 mg T1

spironolactone oral tablet 100 mg, 25 mg, 50 mg T1

spironolactone-hctz oral tablet 25-25 mg T1

torsemide oral tablet 10 mg, 100 mg, 20 mg, 5 mg T1

triamterene-hctz oral capsule 37.5-25 mg T1

triamterene-hctz oral tablet 37.5-25 mg, 75-50 mg T1

*Endocrine And Metabolic Agents - Misc.*alendronate sodium oral tablet 10 mg, 35 mg, 40 mg, 5 mg, 70 mg

T1

calcitonin (salmon) nasal solution 200 unit/act T1

calcitriol oral capsule 0.25 mcg, 0.5 mcg T1

51

Drug Status Notesdesmopressin ace spray refrig nasal solution 0.01 %

T1

desmopressin acetate oral tablet 0.1 mg, 0.2 mg T1

desmopressin acetate spray nasal solution 0.01 % T1

GENOTROPIN MINIQUICK SUBCUTANEOUS SOLUTION RECONSTITUTED 0.2 MG, 0.4 MG, 0.6 MG, 0.8 MG, 1 MG, 1.2 MG, 1.4 MG, 1.6 MG, 1.8 MG, 2 MG

T1 PA

GENOTROPIN SUBCUTANEOUS SOLUTION RECONSTITUTED 12 MG, 5 MG

T1 PA

ibandronate sodium oral tablet 150 mg T1 QL (1 EA per 28 days)

LUPRON DEPOT-PED (1-MONTH) INTRAMUSCULAR KIT 11.25 MG, 15 MG, 7.5 MG

T1 PA

NORDITROPIN FLEXPRO SUBCUTANEOUS SOLUTION 10 MG/1.5ML, 15 MG/1.5ML, 30 MG/3ML, 5 MG/1.5ML

T1 PA

raloxifene hcl oral tablet 60 mg T1

risedronate sodium oral tablet 150 mg, 30 mg, 35 mg, 5 mg

T1

SENSIPAR ORAL TABLET 30 MG, 60 MG, 90 MG T1 PA

*Estrogens*estradiol oral tablet 0.5 mg, 1 mg, 2 mg T1 GR-F

estradiol transdermal patch twice weekly 0.025 mg/24hr, 0.0375 mg/24hr, 0.05 mg/24hr, 0.075 mg/24hr, 0.1 mg/24hr


estradiol transdermal patch weekly 0.025 mg/24hr, 0.0375 mg/24hr, 0.05 mg/24hr, 0.06 mg/24hr, 0.075 mg/24hr, 0.1 mg/24hr


estradiol-norethindrone acet oral tablet 0.5-0.1 mg, 1-0.5 mg


estropipate oral tablet 0.75 mg, 1.5 mg, 3 mg T1 GR-F; QL (21 EA per 28 days)

JINTELI ORAL TABLET 1-5 MG-MCG T1 GR-F; QL (21 EA per 28 days)

MENEST ORAL TABLET 0.3 MG, 0.625 MG, 1.25 MG, 2.5 MG T1 GR-F

norethindrone-eth estradiol oral tablet 0.5-2.5 mg-mcg


PREMARIN ORAL TABLET 0.3 MG, 0.45 MG, 0.625 MG, 0.9 MG, 1.25 MG T1 GR-F; QL (30 EA per 30 days)

52

Drug Status NotesPREMPHASE ORAL TABLET 0.625-5 MG T1 GR-F; QL (30 EA per 30 days)

PREMPRO ORAL TABLET 0.3-1.5 MG, 0.45-1.5 MG, 0.625-2.5 MG, 0.625-5 MG T1 GR-F; QL (30 EA per 30 days)

*Fluoroquinolones*ciprofloxacin hcl oral tablet 250 mg, 500 mg, 750 mg

T1

levofloxacin oral tablet 250 mg, 500 mg, 750 mg T1

ofloxacin oral tablet 400 mg T1

*Gastrointestinal Agents - Misc.*APRISO ORAL CAPSULE EXTENDED RELEASE 24 HOUR 0.375 GM T1 QL (120 EA per 30 days)

balsalazide disodium oral capsule 750 mg T1

BICARSIM FORTE ORAL TABLET 125 MG T1

BICARSIM ORAL TABLET 80 MG T1

calcium acetate (phos binder) oral capsule 667 mg

T1

calcium acetate (phos binder) oral tablet 667 mg T1

cvs gas relief drops ex st oral liquid 40 mg/0.6ml T1

GAS-X EXTRA STRENGTH ORAL STRIP62.5 MG T1

lactulose encephalopathy oral solution 10 gm/15ml

T1

mesalamine oral capsule delayed release 400 mg T1 QL (180 EA per 30 days)

mesalamine rectal enema 4 gm T1 QL (240 ML per 30 days)

metoclopramide hcl oral solution 10 mg/10ml, 5 mg/5ml

T1

metoclopramide hcl oral tablet 10 mg, 5 mg T1

RENAGEL ORAL TABLET 400 MG T1 PA

sevelamer hcl oral tablet 800 mg T1 PA

SFROWASA RECTAL ENEMA 4 GM/60ML T1 QL (240 ML per 30 days)

simethicone oral capsule 125 mg, 180 mg T1

simethicone oral suspension 20 mg/0.3ml T1

simethicone oral tablet chewable 125 mg, 80 mg T1

sulfasalazine oral tablet 500 mg T1

sulfasalazine oral tablet delayed release 500 mg T1

ursodiol oral capsule 300 mg T1

ursodiol oral tablet 250 mg, 500 mg T1

*Genitourinary Agents - Miscellaneous*alfuzosin hcl er oral tablet extended release 24 hour 10 mg

T1

53

Drug Status Notescitric acid-sodium citrate oral solution 334-500 mg/5ml

T1

cytra k crystals oral packet 3300-1002 mg T1

cytra-2 oral solution 500-334 mg/5ml T1

CYTRA-3 ORAL SYRUP 550-500-334 MG/5ML T1

cytra-k oral solution 1100-334 mg/5ml T1

finasteride oral tablet 5 mg T1

K-PHOS NO 2 ORAL TABLET 305-700 MG T1

ORACIT ORAL SOLUTION 490-640 MG/5ML T1

phenazopyridine hcl oral tablet 100 mg, 200 mg, 95 mg

T1

potassium citrate-citric acid oral packet 3300-1002 mg

T1

potassium citrate-citric acid oral solution 1100-334 mg/5ml

T1

sodium chloride irrigation solution 0.9 % T1

tamsulosin hcl oral capsule 0.4 mg T1

*Glycopeptides***FIRST-VANCOMYCIN 25 ORAL SOLUTION 25 MG/ML T1

FIRST-VANCOMYCIN 50 ORAL SOLUTION 50 MG/ML T1

FIRVANQ ORAL SOLUTION RECONSTITUTED 25 MG/ML, 50 MG/ML T1

vancomycin hcl intravenous solution reconstituted10 gm, 500 mg, 750 mg

T1

*Gout Agents*allopurinol oral tablet 100 mg, 300 mg T1

colchicine oral tablet 0.6 mg T1 QL (20 EA per 30 days)

colchicine-probenecid oral tablet 0.5-500 mg T1

probenecid oral tablet 500 mg T1

*Hematological Agents - Misc.*anagrelide hcl oral capsule 0.5 mg, 1 mg T1

BRILINTA ORAL TABLET 60 MG, 90 MG T1 QL (60 EA per 30 days)

cilostazol oral tablet 100 mg, 50 mg T1

clopidogrel bisulfate oral tablet 300 mg T1

clopidogrel bisulfate oral tablet 75 mg T1 QL (30 EA per 30 days)

dipyridamole oral tablet 25 mg, 50 mg, 75 mg T1

54

Drug Status Notespentoxifylline er oral tablet extended release 400 mg


prasugrel hcl oral tablet 10 mg, 5 mg T1 PA

ticlopidine hcl oral tablet 250 mg T1

*Hematopoietic Agents*cyanocobalamin injection solution 1000 mcg/ml T1

ELITE IRON ORAL TABLET 15 MG T1

EPOGEN INJECTION SOLUTION 10000 UNIT/ML, 2000 UNIT/ML, 20000 UNIT/ML, 3000 UNIT/ML, 4000 UNIT/ML

T1 PA

EZFE 200 ORAL CAPSULE 434.8 (200 FE) MG T1

FEMIRON ORAL TABLET 63 (20 FE) MG T1

ferretts chewable iron oral tablet chewable 18 mg T1

ferretts ips oral solution 40 mg/15ml T1

ferretts oral tablet 325 (106 fe) mg T1

FERRIMIN 150 ORAL TABLET 150 MG T1

ferrous aspartate oral tablet 112 (18 fe) mg T1

ferrous fumarate oral tablet 29 mg, 324 (106 fe) mg

T1

ferrous gluconate oral tablet 225 (27 fe) mg, 240 (27 fe) mg, 324 (37.5 fe) mg, 324 (38 fe) mg, 325 (36 fe) mg

T1

ferrous sulfate er oral tablet extended release 140 (45 fe) mg, 50 mg

T1

ferrous sulfate granules T1

ferrous sulfate oral elixir 220 (44 fe) mg/5ml T1 AL (Max 12 Years)

ferrous sulfate oral solution 75 (15 fe) mg/ml T1 AL (Max 12 Years)

ferrous sulfate oral syrup 300 (60 fe) mg/5ml T1 AL (Max 12 Years)

ferrous sulfate oral tablet 27 mg, 325 (65 fe) mg T1

ferrous sulfate oral tablet delayed release 324 (65 fe) mg, 325 (65 fe) mg

T1

folic acid oral tablet 1 mg T1

folic acid oral tablet 400 mcg, 800 mcg T1GR-F; QL (30 EA per 30 days); AL (Min 14 Years and Max 50 Years)

FOLITAB 500 ORAL TABLET EXTENDED RELEASE 105-500-0.8 MG T1

HEMATOGEN FORTE ORAL CAPSULE460-60-0.01-1 MG T1

high potency iron oral capsule 86 (27 fe) mg T1

55

Drug Status Noteshigh potency iron oral tablet 134 mg T1

hm iron oral tablet 200 (65 fe) mg T1

IFEREX 150 ORAL CAPSULE 150 MG T1

iron (ferrous gluconate) oral tablet 256 (28 fe) mg

T1

iron chews pediatric oral tablet chewable 15 mg T1

iron complex oral capsule T1

iron oral tablet 90 (18 fe) mg T1

iron oral tablet extended release 18 mg T1

IRON UP ORAL LIQUID 15 MG/0.5ML T1

MYKIDZ IRON 10 ORAL SUSPENSION 15 MG/1.5ML T1

NOVAFERRUM 50 ORAL CAPSULE 50 MG T1

NOVAFERRUM PEDIATRIC DROPS ORAL LIQUID 15 MG/ML T1

PERFECT IRON ORAL TABLET 25 MG T1

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

T1

PROCRIT INJECTION SOLUTION 10000 UNIT/ML, 2000 UNIT/ML, 20000 UNIT/ML, 3000 UNIT/ML, 4000 UNIT/ML, 40000 UNIT/ML

T1 PA

PROFE ORAL CAPSULE 391.3 (180 FE) MG T1

PROFERRIN ES ORAL TABLET 12 MG T1

RETACRIT INJECTION SOLUTION 10000 UNIT/ML, 2000 UNIT/ML, 3000 UNIT/ML, 4000 UNIT/ML

T1 PA

slow iron oral tablet extended release 160 (50 fe) mg

T1

slow release iron oral tablet extended release 45 mg, 47.5 mg

T1

sm slow release iron oral tablet extended release142 (45 fe) mg, 143 (45 fe) mg

T1

SPATONE PUR-ABSORB IRON ORAL LIQUID 5 MG/20ML T1 AL (Max 12 Years)

tl icon oral capsule T1

vitamin b-12 oral tablet 1000 mcg T1

wee care oral suspension 15 mg/1.25ml T1

ZARXIO INJECTION SOLUTION PREFILLED SYRINGE 300 MCG/0.5ML, 480 MCG/0.8ML

T1 PA

56

Drug Status Notes

*Hepatitis C Agent - Combinations***MAVYRET ORAL TABLET 100-40 MG T1 PA

sofosbuvir-velpatasvir tablet 400-100 mg oral400-100 mg


*Hypnotics*ACETADRYL ORAL TABLET 25-500 MG T1

diphenhydramine hcl (sleep) oral tablet 50 mg T1PA; C (PA for members over age 65)

diphenhydramine-apap (sleep) oral tablet 25-500 mg

T1

estazolam oral tablet 1 mg, 2 mg T1

eszopiclone oral tablet 1 mg, 2 mg, 3 mg T1ST; QL (30 EA per 30 days); AL (Max 64 Years)

flurazepam hcl oral capsule 15 mg, 30 mg T1

ibuprofen pm oral tablet 200-38 mg T1

phenobarbital oral solution 20 mg/5ml T1

phenobarbital oral tablet 100 mg, 15 mg, 16.2 mg, 30 mg, 32.4 mg, 60 mg, 64.8 mg, 97.2 mg

T1

ra sleep aid (diphenhydramine) oral tablet 25 mg T1PA; C (PA for members over age 65)

ra sleep aid oral capsule 50 mg T1PA; C (PA for members over age 65)

ra sleep aid oral liquid 50 mg/30ml T1PA; C (PA for members over age 65)

ra sleep-aid nighttime oral capsule 25 mg T1PA; C (PA for members over age 65)

temazepam oral capsule 15 mg, 30 mg T1QL (30 EA per 30 days); AL (Max 64 Years)

triazolam oral tablet 0.125 mg, 0.25 mg T1 AL (Max 64 Years)

wal-som oral tablet dispersible 25 mg T1PA; C (PA for members over age 65)

zaleplon oral capsule 10 mg, 5 mg T1

zolpidem tartrate er oral tablet extended release12.5 mg, 6.25 mg

T1ST; QL (30 EA per 30 days); AL (Max 64 Years)

zolpidem tartrate oral tablet 10 mg, 5 mg T1 QL (30 EA per 30 days)

*Laxatives*AGORAL MAXIMUM STRENGTH ORAL LIQUID 25 MG/15ML T1

bisacodyl ec oral tablet delayed release 5 mg T1

bisacodyl rectal suppository 10 mg T1

CORRECTOL HERBAL TEA ORAL 30 MG T1

57

Drug Status Notescvs mini enema kids rectal enema 100 mg/5ml T1

cvs natural fiber supplement oral packet 58.6 % T1

diocto oral syrup 60 mg/15ml T1

docusate calcium oral capsule 240 mg T1

docusate sodium oral capsule 100 mg, 250 mg T1

docusate sodium oral liquid 50 mg/5ml T1

docusate sodium oral tablet 100 mg T1

DOCUSOL MINI RECTAL ENEMA 283 MG T1

DOCUSOL PLUS MINI-ENEMA RECTAL ENEMA 20-283 MG T1

EQUALACTIN ORAL TABLET CHEWABLE 625 MG T1

EVAC-U-GEN ORAL TABLET CHEWABLE10 MG T1

fiber laxative oral capsule 0.52 gm T1

fiber laxative oral tablet 625 mg T1

fiber therapy oral powder 58.6 % T1

FLEET BISACODYL RECTAL ENEMA 10 MG/30ML T1

GAVILYTE-C ORAL SOLUTION RECONSTITUTED 240 GM T1

QL (4000 ML per 365 days); AL (Min 50 Years and Max 75 Years)

GAVILYTE-G ORAL SOLUTION RECONSTITUTED 236 GM T1


geri-mucil oral powder 68 % T1

glycerin (adult) rectal suppository 2.1 gm T1

glycerin (infants & children) rectal suppository 1 gm, 1.2 gm

T1

glycerin adult rectal suppository 2 gm T1

GOLYTELY ORAL SOLUTION RECONSTITUTED 227.1 GM T1 QL (1 EA per 365 days)

HYDROCIL ORAL PACKET 95 % T1

konsyl daily fiber oral packet 100 % T1

KONSYL ORAL PACKET 28.3 %, 60.3 % T1

KONSYL ORAL POWDER 60.3 %, 71.67 % T1

KONSYL-D ORAL POWDER 52.3 % T1

lactulose oral solution 10 gm/15ml T1

laxative pills oral tablet 15 mg T1

magnesium citrate oral solution 1.745 gm/30ml T1

METAMUCIL MULTIHEALTH FIBER ORAL POWDER 55.46 % T1

58

Drug Status NotesMETAMUCIL ORAL WAFER T1

METAMUCIL SMOOTH TEXTURE ORAL PACKET 28 % T1

natural fiber laxative oral powder 28.3 %, 48.57 %

T1

natural psyllium seed oral powder 100 % T1

natural senna laxative oral tablet 64.8-324 mg T1

PEDIA-LAX ORAL LIQUID 50 MG/15ML T1

PEDIA-LAX RECTAL SUPPOSITORY 2.8 GM T1

peg 3350 oral packet T1

peg 3350/electrolytes oral solution reconstituted240 gm

T1QL (4000 ML per 365 days); AL (Min 50 Years and Max 75 Years)

polyethylene glycol 3350 oral powder T1

qc natural vegetable oral powder 95 % T1

ra col-rite oral capsule 50 mg T1

ra glycerin child rectal suppository 80.7 % T1

ra laxative extra strength oral tablet 17.2 mg T1

ra laxative oral tablet chewable 15 mg T1

sb natural fiber laxative oral powder 49 % T1

senna laxative oral tablet 25 mg T1

senna leaves oral leaves T1

senna oral capsule 8.6 mg T1

senna oral syrup 176 mg/5ml, 8.8 mg/5ml T1

senna oral tablet 8.6 mg T1

senna-docusate sodium oral tablet 8.6-50 mg T1

SOLUBLE FIBER THERAPY ORAL POWDER T1

TRILYTE ORAL SOLUTION RECONSTITUTED 420 GM T1


*Local Anesthetics-Parenteral*lidocaine hcl (pf) injection solution 4 % T1

*Macrolides*azithromycin oral packet 1 gm T1 QL (2 EA per 30 days)

azithromycin oral suspension reconstituted 100 mg/5ml, 200 mg/5ml

T1

azithromycin oral tablet 250 mg T1 QL (12 EA per 30 days)

azithromycin oral tablet 500 mg T1 QL (6 EA per 30 days)

azithromycin oral tablet 600 mg T1

59

Drug Status Notesclarithromycin oral suspension reconstituted 125 mg/5ml, 250 mg/5ml

T1

clarithromycin oral tablet 250 mg, 500 mg T1

*Medical Devices*1st tier unifine pentips 29g x 12mm , 31g x 5 mm , 31g x 6 mm , 31g x 8 mm , 32g x 4 mm


1st tier unifine pentips plus 29g x 12mm , 31g x 5 mm , 31g x 6 mm , 31g x 8 mm , 32g x 4 mm


ACCU-CHEK TENDER 1 INFUSION KIT T1 QL (200 EA per 30 days)

administration set T1 QL (200 EA per 30 days)

ADVOCATE INSULIN PEN NEEDLES 31G X 5 MM , 31G X 8 MM T1 QL (200 EA per 30 days)

ADVOCATE INSULIN SYRINGE 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML


air eliminating tpn iv set T1 QL (200 EA per 30 days)

anesthesia extension tubing T1 QL (200 EA per 30 days)

anti-stick insulin syringe 29g x 1/2" 1 ml T1 QL (200 EA per 30 days)

ARGYLE EXTENSION TUBE 20" T1 QL (200 EA per 30 days)

ASSURE DOSE CONTROL IN VITRO SOLUTION NORMAL T1

ASSURE ID INSULIN SAFETY SYR 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML T1 QL (200 EA per 30 days)

aurora pen needles 29g x 12mm , 31g x 6 mm , 31g x 8 mm


aurora unifine pentips 31g x 5 mm , 32g x 4 mm T1 QL (200 EA per 30 days)

AUTOJECT 2 T1 QL (200 EA per 30 days)

autopen device T1 QL (200 EA per 30 days)

BD ANGIOCATH AUTOGUARD T1 QL (200 EA per 30 days)

BD AUTOSHIELD 29G X 12MM , 29G X 5MM , 29G X 8MM T1 QL (200 EA per 30 days)

BD AUTOSHIELD DUO 30G X 5 MM T1 QL (200 EA per 30 days)

BD ECLIPSE SYRINGE 25G X 5/8" 1 ML T1 QL (200 EA per 30 days)

BD FIRST MIDCATH 18G/4FRX20CM T1 QL (200 EA per 30 days)

BD FIRST MIDCATH 18G/4FRX20CM KIT T1 QL (200 EA per 30 days)

BD FIRST MIDCATH 20G/3FRX20CM T1 QL (200 EA per 30 days)

BD FIRST MIDCATH 20G/3FRX20CM KIT T1 QL (200 EA per 30 days)

BD FIRST PICC 16G/5FRX65CM T1 QL (200 EA per 30 days)

BD FIRST PICC 16G/5FRX65CM KIT T1 QL (200 EA per 30 days)

60

Drug Status NotesBD FIRST PICC 18G/4FRX65CM T1 QL (200 EA per 30 days)


BD FIRST PICC 20G/3FRX65CM T1 QL (200 EA per 30 days)


BD FIRST PICC 22G/2.8FRX50CM T1 QL (200 EA per 30 days)

BD FIRST PICC 26G/1.9FRX50CM T1 QL (200 EA per 30 days)

BD FIRST PICC 26G/1.9FRX50CM KIT T1 QL (200 EA per 30 days)

BD INSULIN SYR ULTRAFINE II 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML T1 QL (200 EA per 30 days)

BD INSULIN SYRINGE 25G X 1" 1 ML, 25G X 5/8" 1 ML, 26G X 1/2" 1 ML, 27G X 1/2" 1 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 1/2" 0.5 ML, U-100 1 ML


BD INSULIN SYRINGE HALF-UNIT 31G X 5/16" 0.3 ML T1 QL (200 EA per 30 days)

BD INSULIN SYRINGE MICROFINE 27G X 5/8" 1 ML, 28G X 1/2" 0.3 ML, 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML


BD INSULIN SYRINGE U/F 30G X 1/2" 1 ML, 31G X 5/16" 0.3 ML T1 QL (200 EA per 30 days)

BD INSULIN SYRINGE U-40 25G X 5/8" 1 ML T1 QL (200 EA per 30 days)

BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 1/2" 0.3 ML, 30G X 1/2" 0.5 ML, 31G X 15/64" 0.3 ML, 31G X 15/64" 0.5 ML, 31G X 15/64" 1 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML


BD INTEGRA INSULIN SYRINGE 29G X 1/2" 1 ML T1 QL (200 EA per 30 days)

BD INTEGRA SYRINGE 25G X 1" 1 ML, 25G X 5/8" 1 ML T1 QL (200 EA per 30 days)

BD L-CATH 16G/5FR KIT T1 QL (200 EA per 30 days)

BD L-CATH 16G/5FRX60CM T1 QL (200 EA per 30 days)

BD L-CATH 18G/3.5FR KIT T1 QL (200 EA per 30 days)

BD L-CATH 18G/3.5FRX60CM T1 QL (200 EA per 30 days)

BD L-CATH 20G/2.6FR KIT T1 QL (200 EA per 30 days)

BD L-CATH 20G/2.6FRX60CM T1 QL (200 EA per 30 days)

BD L-CATH 20G/3FR KIT T1 QL (200 EA per 30 days)

BD L-CATH 20G/3FRX60CM T1 QL (200 EA per 30 days)

BD L-CATH 28G/1.2FRX25CM KIT T1 QL (200 EA per 30 days)

61

Drug Status NotesBD L-CATH MIDLINE 18G/3.5FRX20 T1 QL (200 EA per 30 days)

BD L-CATH MIDLINE 18G/3.5FRX20 KIT T1 QL (200 EA per 30 days)

BD L-CATH MIDLINE 20G/3FRX20CM T1 QL (200 EA per 30 days)

BD LUER-LOK SYRINGE 20G X 1" 1 ML, 25G X 5/8" 1 ML T1 QL (200 EA per 30 days)

BD NEXIVA 18GX1.25" T1 QL (200 EA per 30 days)


BD NEXIVA 20GX1" T1 QL (200 EA per 30 days)



BD NEXIVA 22GX1" T1 QL (200 EA per 30 days)



BD PEN NEEDLE MINI U/F 31G X 5 MM T1 QL (200 EA per 30 days)

BD PEN NEEDLE NANO U/F 32G X 4 MM T1 QL (200 EA per 30 days)

BD PEN NEEDLE ORIGINAL U/F 29G X 12.7MM T1 QL (200 EA per 30 days)

BD PEN NEEDLE SHORT U/F 31G X 8 MM T1 QL (200 EA per 30 days)

BD SAFETYGLIDE INSULIN SYRINGE 30G X 5/16" 0.5 ML, 31G X 5/16" 0.3 ML T1 QL (200 EA per 30 days)

BD SAFETY-LOK INSULIN SYRINGE 29G X 1/2" 1 ML T1 QL (200 EA per 30 days)

BD SAFETY-LOK SET T1 QL (200 EA per 30 days)

BD SAFETY-LOK VACUTAINER SET T1 QL (200 EA per 30 days)

BD SAF-T E-Z SET T1 QL (200 EA per 30 days)

BD SAF-T-INTIMA 18G X 1" KIT T1 QL (200 EA per 30 days)

BD SAF-T-INTIMA 20GX1" T1 QL (200 EA per 30 days)

BD SAF-T-INTIMA 22G X 0.75" KIT T1 QL (200 EA per 30 days)

BD SAF-T-INTIMA 22GX3/4" T1 QL (200 EA per 30 days)

BD SAF-T-INTIMA 24G X 0.75" KIT T1 QL (200 EA per 30 days)

BD SAF-T-INTIMA 24GX3/4" T1 QL (200 EA per 30 days)

BD SYRINGE/NEEDLE 25G X 5/8" 1 ML T1 QL (200 EA per 30 days)

BD SYRINGE/NEEDLE SLIP TIP 26G X 5/8" 1 ML T1 QL (200 EA per 30 days)

BD VACUTAINER SET T1 QL (200 EA per 30 days)

CAREFINE PEN NEEDLES 29G X 12MM , 30G X 8 MM , 31G X 6 MM , 31G X 8 MM , 32G X 4 MM , 32G X 5 MM , 32G X 6 MM


62

Drug Status Notescareone insulin syringe 30g x 1/2" 0.3 ml, 30g x 1/2" 0.5 ml, 30g x 1/2" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml


careone unifine pentips 29g x 12mm , 31g x 5 mm , 31g x 6 mm , 31g x 8 mm , 32g x 4 mm


careone unifine pentips plus 29g x 12mm , 31g x 5 mm , 31g x 6 mm , 31g x 8 mm , 32g x 4 mm


clickfine pen needles 31g x 6 mm , 31g x 8 mm , 32g x 4 mm


COMFORT EZ INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 1/2" 0.3 ML, 30G X 1/2" 0.5 ML, 30G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML


COMFORT EZ PEN NEEDLES 31G X 5 MM , 31G X 6 MM , 31G X 8 MM , 32G X 4 MM T1 QL (200 EA per 30 days)

cool mist humidifier T1

CORNWALL METAL PIPETTING T1 QL (200 EA per 30 days)

CURITY ALCOHOL PREPS PAD 70 % T1

denture adhesive cream T1

drug mart unifine pentips 29g x 12mm , 31g x 5 mm , 31g x 6 mm , 31g x 8 mm , 32g x 4 mm


drug mart unifine pentips plus 32g x 4 mm T1 QL (200 EA per 30 days)

duane reade unifine pentips 29g x 12mm , 31g x 6 mm , 31g x 8 mm


EASIVENT T1 QL (2 EA per 365 days)

EASIVENT MASK LARGE T1 QL (2 EA per 365 days)

EASIVENT MASK MEDIUM T1 QL (2 EA per 365 days)

EASIVENT MASK SMALL T1 QL (2 EA per 365 days)

easy comfort insulin syringe 30g x 1/2" 0.5 ml, 30g x 1/2" 1 ml, 30g x 5/16" 0.3 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml


easy comfort pen needles 31g x 5 mm , 31g x 8 mm , 32g x 4 mm


EASY TOUCH FLURINGE 25G X 1" 1 ML, 25G X 5/8" 1 ML T1 QL (200 EA per 30 days)

EASY TOUCH INSULIN SAFETY SYR 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 1/2" 1 ML, 30G X 5/16" 0.5 ML


63

Drug Status NotesEASY TOUCH INSULIN SYRINGE 27G X 1/2" 0.5 ML, 27G X 1/2" 1 ML, 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 1/2" 0.3 ML, 30G X 1/2" 0.5 ML, 30G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML


EASY TOUCH PEN NEEDLES 29G X 12MM , 31G X 5 MM , 31G X 6 MM , 31G X 8 MM , 32G X 4 MM , 32G X 5 MM , 32G X 6 MM


EASY TOUCH SAFETY SYRINGE 25G X 1" 1 ML, 25G X 5/8" 1 ML T1 QL (200 EA per 30 days)

elite-thin insulin syringe 28g x 5/16" 0.5 ml T1 QL (100 EA per 30 days)

eql insulin syringe 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.3 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml


eql short pen needle 31g x 8 mm T1 QL (200 EA per 30 days)

eql ultra comfort insulin syr 31g x 5/16" 0.3 ml T1 QL (200 EA per 30 days)

eql ultra short pen needle 31g x 6 mm T1 QL (200 EA per 30 days)

EXCEL COMFORT POINT PEN NEEDLE29G X 12MM , 31G X 6 MM , 31G X 8 MM T1 QL (200 EA per 30 days)

EXEL COMFORT POINT INSULIN SYR28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML


FIFTY50 PEN NEEDLES 31G X 5 MM , 31G X 8 MM T1 QL (200 EA per 30 days)

FIFTY50 SUPERIOR COMFORT SYR 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML


fluid administration set T1 QL (200 EA per 30 days)

freds pharmacy unifine pentip+ 31g x 5 mm , 31g x 8 mm


freds pharmacy unifine pentips 32g x 4 mm T1 QL (200 EA per 30 days)

FREESTYLE CONTROL SOLUTION IN VITRO LIQUID T1

FREESTYLE PRECISION INS SYR 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML


gauze sponge pad 4"x4" T1

global ease inject pen needles 29g x 12mm , 31g x 5 mm , 31g x 8 mm , 32g x 4 mm


64

Drug Status Notesglobal inject ease insulin syr 28g x 1/2" 0.5 ml, 28g x 1/2" 1 ml, 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 1/2" 0.3 ml, 30g x 1/2" 0.5 ml, 30g x 1/2" 1 ml, 30g x 5/16" 0.3 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml


GLUCOCARD EXPRESSION CONTROL IN VITRO SOLUTION T1

GLUCOPRO INSULIN SYRINGE 30G X 1/2" 0.3 ML, 30G X 1/2" 0.5 ML, 30G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML


gnp clickfine pen needles 31g x 6 mm , 31g x 8 mm


gnp insulin syringe 28g x 1/2" 0.5 ml, 28g x 1/2" 1 ml, 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.3 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml


gnp ultra com insulin syringe 28g x 1/2" 0.5 ml, 28g x 1/2" 1 ml, 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.3 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml


H 468L TUBING T1 QL (200 EA per 30 days)

healthwise mini pen needles 31g x 6 mm T1 QL (200 EA per 30 days)

healthwise pen needles 29g x 12mm T1 QL (200 EA per 30 days)

healthwise short pen needles 31g x 8 mm T1 QL (200 EA per 30 days)

healthwise unifine pentips 32g x 4 mm T1 QL (200 EA per 30 days)

healthy accents unifine pentip 29g x 12mm , 31g x 5 mm , 31g x 6 mm , 31g x 8 mm , 32g x 4 mm


h-e-b incontrol pen needles 29g x 12mm , 31g x 5 mm , 31g x 6 mm , 31g x 8 mm , 32g x 4 mm


HM ULTICARE INSULIN SYRINGE 31G X 5/16" 0.3 ML T1 QL (200 EA per 30 days)

HUBER INFUSION SET T1 QL (200 EA per 30 days)

HUMAPEN LUXURA HD DEVICE T1 QL (200 EA per 30 days)

HUMATROPEN FOR 12MG DEVICE T1 QL (200 EA per 30 days)



infusion set T1 QL (200 EA per 30 days)

infusion set 23" comfort T1 QL (200 EA per 30 days)

inject-ease T1 QL (200 EA per 30 days)

65

Drug Status NotesINJECT-EASE AUTOMATIC INJECTOR T1 QL (200 EA per 30 days)

INSUFLON 25G X 0.71" T1 QL (200 EA per 30 days)

insulin syringe 28g x 1/2" 0.5 ml, 28g x 1/2" 1 ml, 29g x 1" 0.3 ml, 30g x 1/2" 0.5 ml, 30g x 5/16" 1 ml


insulin syringe 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.5 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml

T1

insulin syringe/needle 27g x 1/2" 0.5 ml, 28g x 1/2" 0.5 ml, 28g x 1/2" 1 ml


insupen pen needles 32g x 4 mm T1 QL (200 EA per 30 days)

INSUPEN SENSITIVE 32G X 6 MM , 32G X 8 MM T1 QL (200 EA per 30 days)

INSUPEN ULTRAFIN 29G X 12MM , 30G X 8 MM , 31G X 6 MM , 31G X 8 MM T1 QL (200 EA per 30 days)

INSYTE AUTOGUARD 14GX1.75" T1 QL (200 EA per 30 days)


INSYTE AUTOGUARD 20GX1" T1 QL (200 EA per 30 days)


INSYTE AUTOGUARD 22GX1" T1 QL (200 EA per 30 days)

INSYTE AUTOGUARD 24GX3/4" T1 QL (200 EA per 30 days)

INTERLINK INJECT SITE/LUER LOC T1 QL (200 EA per 30 days)

KANGAROO BURETTE SET T1 QL (200 EA per 30 days)

kinray insulin syringe 29g x 1/2" 0.5 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml


kmart valu insulin syringe 29g u-100 0.5 ml, u-100 1 ml


kmart valu insulin syringe 30g u-100 0.3 ml, u-100 0.5 ml, u-100 1 ml


kroger insulin syringe 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.3 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml


kroger pen needles 29g x 12mm , 31g x 6 mm , 31g x 8 mm


L606 TUBING T1 QL (200 EA per 30 days)

L609 TUBING T1 QL (200 EA per 30 days)

leader insulin syringe 28g x 1/2" 0.5 ml, 28g x 1/2" 1 ml, 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.3 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml


66

Drug Status NotesLEADER UNIFINE PENTIPS 31G X 5 MM , 32G X 4 MM T1 QL (200 EA per 30 days)

LEADER UNIFINE PENTIPS PLUS 31G X 5 MM , 31G X 8 MM , 32G X 4 MM T1 QL (200 EA per 30 days)

LITE TOUCH PEN NEEDLES 31G X 5 MM T1 QL (200 EA per 30 days)

LITETOUCH INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML


LITETOUCH PEN NEEDLES 29G X 12.7MM , 31G X 6 MM , 31G X 8 MM T1 QL (200 EA per 30 days)

live better pen needles 29g x 12mm , 31g x 6 mm , 31g x 8 mm


longs insulin syringe 31g x 5/16" 0.5 ml T1 QL (200 EA per 30 days)

LTXF PRIM CNV PIN MICRODRIP T1 QL (200 EA per 30 days)

LTXF PRIM IV SET/CNVT PIN T1 QL (200 EA per 30 days)

LTXF SECONDARY/CNV PIN/32INC T1 QL (200 EA per 30 days)

MAGELLAN INSULIN SAFETY SYR 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML


medic insulin syringe 30g x 5/16" 0.3 ml, 30g x 5/16" 0.5 ml


medicine shoppe pen needles 29g x 12mm , 31g x 6 mm , 31g x 8 mm


MEDSAVER SYRINGE 25G X 5/8" 1 ML T1 QL (200 EA per 30 days)

meijer pen needles 29g x 12mm , 31g x 6 mm , 31g x 8 mm


MONOJECT INSULIN SYRINGE 25G X 5/8" 1 ML, 27G X 1/2" 1 ML, 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 1 ML, U-100 1 ML


MONOJECT LIFESHIELD SYRINGE 18G X 1" 1 ML T1 QL (200 EA per 30 days)

MONOJECT MAGELLAN SYRINGE 23G X 1" 1 ML, 25G X 1" 1 ML, 25G X 5/8" 1 ML T1 QL (200 EA per 30 days)

MONOJECT ULTRA COMFORT SYRINGE28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML


67

Drug Status NotesMOORE MONO INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML


ms insulin syringe 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml


NERIA 29G INFUSION SET 10MM T1 QL (200 EA per 30 days)



NERIA MULTI 27G 2X10MM T1 QL (200 EA per 30 days)



NERIA SOFT 25G INFUSION 13MM T1 QL (200 EA per 30 days)

NERIA SOFT 25G INFUSION 17MM T1 QL (200 EA per 30 days)

NORDIPEN 5 INJECTION DEVICE T1 QL (200 EA per 30 days)

NORDIPEN DELIVERY SYSTEM T1 QL (200 EA per 30 days)

NOVOFINE 30G X 8 MM , 32G X 6 MM T1 QL (200 EA per 30 days)

NOVOFINE AUTOCOVER 30G X 8 MM T1 QL (200 EA per 30 days)

NOVOFINE PLUS 32G X 4 MM T1 QL (200 EA per 30 days)

NOVOPEN ECHO DEVICE T1 QL (200 EA per 30 days)

NOVOTWIST 30G X 8 MM , 32G X 5 MM T1 QL (200 EA per 30 days)

OMNIFLEX DIAPHRAGM VAGINAL DIAPHRAGM T1 GR-F; QL (1 EA per 365 days)

OMNITROPE PEN 10 INJ DEVICE T1 QL (200 EA per 30 days)

OMNITROPE PEN 5 INJ DEVICE T1 QL (200 EA per 30 days)

ONETOUCH DELICA LANCETS 33G T1C (QL 100/90 for members not on insulin and QL 300/90 for members on insulin)

ONETOUCH DELICA LANCETS FINE T1C (QL 100/90 for members not on insulin and QL 300/90 for members on insulin)

ONETOUCH ULTRA CONTROL IN VITRO SOLUTION T1

ONETOUCH VERIO SOLUTION IN VITRO T1 QL (1 EA per 365 days)

ORTHO DIAPHRAGM ALL-FLEX VAGINAL DIAPHRAGM 65 MM, 70 MM, 75 MM, 80 MM


ORTHO DIAPHRAGM COIL VAGINAL KIT 100 MM, 105 MM, 50 MM T1 GR-F; QL (1 EA per 365 days)

ORTHO DIAPHRAGM FLAT VAGINAL KIT 55 MM, 60 MM, 65 MM, 70 MM, 75 MM, 80 MM, 85 MM, 90 MM, 95 MM


68

Drug Status Notespc unifine pentips 29g x 12mm , 31g x 5 mm , 31g x 6 mm , 31g x 8 mm


pen needles 1/2" 29g x 12mm T1 QL (200 EA per 30 days)

pen needles 29g x 12mm , 31g x 6 mm T1 QL (200 EA per 30 days)

pen needles 3/16" 31g x 5 mm T1 QL (200 EA per 30 days)

pen needles 5/16" 30g x 8 mm , 31g x 8 mm T1 QL (200 EA per 30 days)

plastic adapter , 1 ml T1 QL (200 EA per 30 days)

PRECISION SUREDOSE PLUS SYR 29G X 1/2" 0.3 ML, 29G X 1/2" 1 ML T1 QL (200 EA per 30 days)

PRECISION SURE-DOSE SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.5 ML, 30G X 3/8" 0.5 ML


preferred plus insulin syringe 28g x 1/2" 0.5 ml, 28g x 1/2" 1 ml, 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.3 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml


preferred plus unifine pentips 29g x 12mm , 31g x 5 mm , 31g x 6 mm , 31g x 8 mm , 32g x 4 mm


PRODIGY INSULIN SYRINGE 28G X 1/2" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML T1 QL (200 EA per 30 days)

px extra short pen needles 31g x 6 mm T1 QL (200 EA per 30 days)

px insulin syringe 30g x 1/2" 0.3 ml, 30g x 1/2" 0.5 ml, 30g x 1/2" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml


px mini pen needles 31g x 5 mm T1 QL (200 EA per 30 days)

px pen needle 29g x 12mm , 31g x 8 mm T1 QL (200 EA per 30 days)

qc pen needles 29g x 12mm , 31g x 6 mm , 31g x 8 mm


qc unifine pentips 32g x 4 mm T1 QL (200 EA per 30 days)

ra insulin syringe 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml


ra pen needles 31g x 5 mm , 31g x 8 mm T1 QL (200 EA per 30 days)

RELI-ON INSULIN SYRINGE 29G 0.3 ML, 29G 0.5 ML, 29G X 1/2" 1 ML T1 QL (200 EA per 30 days)

RELION INSULIN SYRINGE 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML


RELI-ON INSULIN SYRINGE 30G 1 ML T1 QL (100 EA per 30 days)

RELION INSULIN SYRINGE 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML

T1

RELION MINI PEN NEEDLES 31G X 6 MM T1 QL (200 EA per 30 days)

69

Drug Status NotesRELION PEN NEEDLES 29G X 12MM , 31G X 8 MM , 32G X 4 MM T1 QL (200 EA per 30 days)

RELION SHORT PEN NEEDLES 31G X 8 MM T1 QL (200 EA per 30 days)

SAFELET IV CATHETER T1 QL (200 EA per 30 days)

SAFESNAP INSULIN SYRINGE 28G X 1/2" 1 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML


SAFETY-GLIDE SYRINGE 29G X 1/2" 0.3 ML T1 QL (200 EA per 30 days)

sb insulin syringe 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml, 31g x 5/16" 1 ml


scalp vein set T1 QL (200 EA per 30 days)

schnucks insulin syringe 29g x 1/2" 0.5 ml, 30g x 5/16" 0.5 ml


SHOPKO UNIFINE PENTIPS 29G X 12MM , 31G X 5 MM , 31G X 8 MM , 32G X 4 MM T1 QL (200 EA per 30 days)

sm insulin syringe 31g x 5/16" 1 ml T1 QL (200 EA per 30 days)

solution administration set T1 QL (200 EA per 30 days)

solution transfer device T1 QL (200 EA per 30 days)

sure comfort insulin syringe 28g x 1/2" 0.5 ml, 28g x 1/2" 1 ml, 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 1/2" 0.3 ml, 30g x 1/2" 0.5 ml, 30g x 1/2" 1 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml


sure comfort pen needles 30g x 8 mm , 31g x 5 mm , 31g x 8 mm , 32g x 4 mm


SURE-FINE PEN NEEDLES 29G X 12.7MM , 31G X 5 MM , 31G X 8 MM T1 QL (200 EA per 30 days)

SURE-JECT INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML


SURE-T INFUSION SET 18" T1 QL (200 EA per 30 days)



surgical dressing pad 5"x9" T1

syringe luer slip 25g x 5/8" 1 ml, 26g x 3/8" 1 ml T1 QL (200 EA per 30 days)

70

Drug Status NotesTERUMO INSULIN SYRINGE 27G X 1/2" 0.5 ML, 27G X 1/2" 1 ML, 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 3/8" 0.5 ML, 30G X 3/8" 1 ML


TERUMO SURGUARD INSULIN SYR 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML


TERUMO SURGUARD2 SYRINGE 25G X 5/8" 1 ML, 26G X 3/8" 1 ML T1 QL (200 EA per 30 days)

THINPRO INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 3/8" 0.5 ML, 30G X 3/8" 1 ML, 31G X 3/8" 0.3 ML, 31G X 3/8" 0.5 ML, 31G X 3/8" 1 ML


THINPRO INSULIN SYRINGE 30G X 3/8" 0.3 ML T1 QL (100 EA per 30 days)

todays health mini pen needles 31g x 6 mm T1 QL (200 EA per 30 days)

todays health pen needles 29g x 12mm T1 QL (200 EA per 30 days)

todays health short pen needle 31g x 8 mm T1 QL (200 EA per 30 days)

topcare clickfine pen needles 31g x 6 mm , 31g x 8 mm


topcare ultra comfort ins syr 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.3 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml


TRUEPLUS INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML


ULTICARE INSULIN SAFETY SYR 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML T1 QL (200 EA per 30 days)

ULTICARE INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 1/2" 0.3 ML, 30G X 1/2" 0.5 ML, 30G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML


ULTICARE MICRO PEN NEEDLES 32G X 4 MM T1 QL (200 EA per 30 days)

ULTICARE MINI PEN NEEDLES 31G X 6 MM T1 QL (200 EA per 30 days)

71

Drug Status NotesULTICARE PEN NEEDLES 29G X 12.7MM , 29G X 12MM T1 QL (200 EA per 30 days)

ULTICARE SHORT PEN NEEDLES 31G X 8 MM T1 QL (200 EA per 30 days)

ULTICARE SYRINGE 22G X 1-1/2" 1 ML T1 QL (200 EA per 30 days)

ULTILET INSULIN SYRINGE SHORT 30G X 5/16" 0.3 ML, 30G X 5/16" 1 ML T1

ULTILET INSULIN SYRINGE SHORT 30G X 5/16" 0.5 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML


ULTILET PEN NEEDLE 31G X 8 MM T1 QL (200 EA per 30 days)

ultra comfort insulin syringe 30g x 5/16" 0.3 ml T1 QL (200 EA per 30 days)

ultra-comfort insulin syringe 28g x 1/2" 0.5 ml, 28g x 1/2" 1 ml, 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.3 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml


ULTRA-THIN II INS SYR SHORT 31G X 5/16" 1 ML T1 QL (200 EA per 30 days)

UNIFINE PENTIPS 29G X 12MM , 31G X 5 MM , 31G X 6 MM , 31G X 8 MM , 32G X 4 MM


unifine pentips plus 29g x 12mm , 31g x 5 mm , 31g x 6 mm , 31g x 8 mm , 32g x 4 mm


VACUTAINER TUBING T1 QL (200 EA per 30 days)

value health insulin syringe 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml


valumark pen needles 29g x 12mm , 31g x 6 mm , 31g x 8 mm


VANISHPOINT 18GX1-1/4" FEP T1 QL (200 EA per 30 days)

VANISHPOINT 18GX1-1/4" PUR T1 QL (200 EA per 30 days)

VANISHPOINT 20GX1-1/4" FEP T1 QL (200 EA per 30 days)

VANISHPOINT 20GX1-1/4" PUR T1 QL (200 EA per 30 days)

VANISHPOINT 22GX1" FEP T1 QL (200 EA per 30 days)

VANISHPOINT 22GX1" PUR T1 QL (200 EA per 30 days)

VANISHPOINT 24GX3/4" FEP T1 QL (200 EA per 30 days)

VANISHPOINT 24GX3/4" PUR T1 QL (200 EA per 30 days)

VANISHPOINT INSULIN SYRINGE 29G X 1/2" 1 ML, 30G X 1/2" 0.5 ML T1 QL (200 EA per 30 days)

VANISHPOINT SYRINGE 25G X 1" 1 ML T1 QL (200 EA per 30 days)

VIDA MIA UNIFINE PENTIPS 29G X 12MM , 31G X 6 MM , 31G X 8 MM , 32G X 4 MM T1 QL (200 EA per 30 days)

72

Drug Status Notesvp insulin syringe 29g x 1/2" 0.3 ml T1 QL (200 EA per 30 days)

V-R MONO INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML


warm mist vaporizer T1

wegmans unifine pentips plus 31g x 5 mm , 31g x 6 mm , 31g x 8 mm , 32g x 4 mm


WIDE-SEAL DIAPHRAGM 60 VAGINAL DIAPHRAGM 2 % T1 GR-F; QL (1 EA per 365 days)








*Migraine Products*naratriptan hcl oral tablet 1 mg, 2.5 mg T1 ST; QL (9 EA per 30 days)

rizatriptan benzoate oral tablet 10 mg, 5 mg T1 QL (12 EA per 30 days)

rizatriptan benzoate oral tablet dispersible 10 mg, 5 mg


sumatriptan succinate oral tablet 100 mg, 25 mg, 50 mg


zolmitriptan oral tablet 2.5 mg, 5 mg T1 ST

zolmitriptan oral tablet dispersible 2.5 mg, 5 mg T1 ST

*Minerals & Electrolytes*cal/mag oral tablet 200-100 mg T1

CALCET CREAMY BITES ORAL TABLET CHEWABLE 500-400 MG-UNIT T1

cal-citrate plus vitamin d oral tablet 250-100 mg-unit

T1

calcium + d3 oral tablet 600-200 mg-unit T1

calcium 1000 + d oral tablet 1000-800 mg-unit T1

calcium 500 + d oral tablet 500-125 mg-unit T1

calcium 500/d oral tablet 500-200 mg-unit T1

73

Drug Status Notescalcium 500/d oral tablet chewable 500-400 mg-unit

T1

calcium 500+d high potency oral tablet 500-400 mg-unit

T1

calcium 500+d oral tablet 500-200 mg-unit, 500-400 mg-unit

T1

calcium 600/vitamin d oral tablet chewable 600-400 mg-unit

T1

calcium 600+d oral tablet 600-200 mg-unit, 600-400 mg-unit

T1

calcium 600+d3 oral tablet 600-400 mg-unit, 600-800 mg-unit

T1

calcium carbonate oral suspension 1250 (500 ca) mg/5ml

T1

calcium carbonate oral tablet 1250 (500 ca) mg T1

calcium carbonate-vitamin d oral capsule 600-200 mg-unit

T1

calcium citrate + d oral tablet 315-200 mg-unit T1

calcium citrate + d3 oral tablet 250-200 mg-unit, 315-250 mg-unit

T1

calcium citrate malate-vit d oral tablet 250-100 mg-unit

T1

calcium citrate oral granules 760 mg/3.5gm T1

calcium citrate oral tablet 200 mg, 250 mg, 950 mg

T1

calcium citrate+d3 petites oral tablet 200-250 mg-unit

T1

calcium citrate-vitamin d oral tablet 250-50 mg-unit

T1

calcium citrate-vitamin d3 oral liquid 1000-400 T1

calcium magnesium 750 oral tablet 300-300 mg T1

calcium oral tablet chewable 500-100 mg-unit, 600-400 mg-unit

T1

calcium plus vitamin d oral capsule 300-100 mg-unit, 500-50 mg-unit

T1

calcium/vitamin d3 gummies oral tablet chewable200-200 mg-unit

T1

calcium-carb 600 + d oral tablet 600-125 mg-unit T1

calcium-magnesium oral tablet 250-125 mg, 250-155 mg, 500-250 mg

T1

calcium-vitamin d oral tablet 600-200 mg-unit T1

calcium-vitamin d3 oral capsule 600-400 mg-unit, 600-500 mg-unit

T1

74

Drug Status Notescalcium-vitamin d3 oral tablet 250-125 mg-unit T1

cal-mag aspartate oral tablet 333.33-167 mg T1

CAL-MAG CHELA-MAX ORAL CAPSULE70-83 MG T1

calmag thins oral tablet 200-50 mg T1

CAL-QUICK ORAL LIQUID 500-400 MG-UNT/5ML T1

chelated magnesium oral tablet 100 mg T1

cvs calcium oral tablet chewable 250-400 mg-unit T1

cvs oyster shell calcium+vit d oral tablet 500-125 mg-unit

T1

elite ca/mg oral tablet 100-50 mg T1

eql calcium/vitamin d oral capsule 600-100 mg-unit

T1

eql vitamin d-3 high potency oral tablet 115-2000 mg-unit

T1

gnp calcium 500 +d3 oral tablet 500-600 mg-unit T1

KLOR-CON M15 ORAL TABLET EXTENDED RELEASE 15 MEQ T1

K-PHOS ORAL TABLET 500 MG T1

K-TAB ORAL TABLET EXTENDED RELEASE 20 MEQ T1

liquid calcium with d3 oral capsule 600-1000 mg-unit

T1

m2 magnesium oral capsule 100 mg T1

MAG64 ORAL TABLET DELAYED RELEASE 64 MG T1

MAGINEX DS ORAL PACKET 1230 MG T1

MAGINEX ORAL TABLET DELAYED RELEASE 615 MG T1

magnesium aspartate oral tablet 65 mg T1

magnesium carbonate oral powder 250 mg/gm T1

magnesium carbonate powder T1

magnesium chloride crystals T1

magnesium chloride powder T1

magnesium citrate oral tablet 100 mg T1

magnesium gluconate oral tablet 27.5 mg, 30 mg, 500 (27 mg) mg, 500 mg, 550 mg

T1

magnesium lactate oral tablet extended release 84 mg (7meq)

T1

magnesium oral capsule 300 mg, 500 mg T1

75

Drug Status Notesmagnesium oral tablet 200 mg, 250 mg, 30 mg, 400 mg

T1

magnesium oxide -mg supplement oral capsule400 mg

T1

magnesium oxide -mg supplement oral tablet 250 mg

T1

magnesium oxide oral powder T1

magnesium oxide oral tablet 400 (240 mg) mg, 400 (241.3 mg) mg, 500 mg

T1

magnesium sulfate in d5w intravenous solution 1-5 gm/100ml-%

T1

magnesium sulfate injection solution 50 % T1

magnesium sulfate intravenous solution 2 gm/50ml, 20 gm/500ml, 4 gm/100ml, 4 gm/50ml, 40 gm/1000ml

T1

magnesium sulfate oral capsule 70 mg T1

MAGONATE ORAL LIQUID 54 (MAG EQUIV) MG/5ML T1

ORAZINC ORAL TABLET 110 MG T1

OSTEO-PORETICAL ORAL TABLET 600-1000 MG-UNIT T1

OSTIGEN ORAL 350 MG T1

OYSCO 500+D ORAL TABLET CHEWABLE 500-600 MG-UNIT T1

oyster shell calcium plus d oral tablet 333-133 mg-unit

T1

oyster shell calcium/d oral tablet 250-125 mg-unit, 250-250 mg-unit

T1

parva-cal oral tablet 250-100 mg-unit, 500-200 mg-unit

T1

PEDIALYTE ORAL SOLUTION T1

PHOSPHA 250 NEUTRAL ORAL TABLET155-852-130 MG T1

phosphorus supplement oral packet 280-160-250 mg

T1

pot bicarb-pot chloride oral tablet effervescent 25 meq

T1

potassium bicarbonate oral tablet effervescent 25 meq

T1

potassium chloride crys er oral tablet extended release 10 meq, 20 meq

T1

potassium chloride er oral capsule extended release 10 meq, 8 meq

T1

76

Drug Status Notespotassium chloride er oral tablet extended release10 meq, 8 meq

T1

potassium chloride oral packet 20 meq T1

potassium chloride oral solution 20 meq/15ml (10%)

T1

ra calcium hi-cal/vitamin d oral tablet 500-125 mg-unit

T1

ra calcium-boron oral tablet 500-1.5 mg T1

sodium chloride flush intravenous solution 0.9 % T1

sodium chloride injection solution 0.9 % T1

sodium chloride intravenous solution 0.9 % T1

sodium chloride oral tablet 1 gm T1

sodium fluoride oral solution 1.1 (0.5 f) mg/ml T1QL (30 ML per 30 days); AL (Max 10 Years)

sodium fluoride oral tablet chewable 1.1 (0.5 f) mg, 2.2 (1 f) mg

T1QL (30 EA per 30 days); AL (Max 10 Years)

UPCAL D ORAL PACKET 500-500 MG-UNIT T1

UPCAL D ORAL POWDER 500-500 MG-UNT/5GM T1

VITALINE BUFFERED ZINC-220 ORAL TABLET EXTENDED RELEASE 220 (50 ZN) MG

T1

yl oyster shell calcium/d oral tablet 250-125 mg-unit

T1

ZINC 15 ORAL TABLET 66 MG T1

zinc sulfate granules T1

zinc sulfate intravenous solution 1 mg/ml, 5 mg/ml

T1

zinc sulfate oral capsule 220 (50 zn) mg T1

zinc sulfate oral tablet 140 (50 zn) mg, 220 (50 zn) mg

T1

zinc sulfate powder T1

*Mouth/Throat/Dental Agents*ANBESOL MOUTH/THROAT LIQUID 10 % T1

BENZ-O-STHETIC MOUTH/THROAT SOLUTION 20 % T1

BENZ-O-STHETIC MOUTH/THROAT SWAB 20 % T1

chlorhexidine gluconate mouth/throat solution0.12 %

T1

clotrimazole mouth/throat lozenge 10 mg T1

77

Drug Status NotesDENTS TOOTHACHE MOUTH/THROAT GUM 20 % T1

GEL-TIN DENTAL GEL 0.4 % T1

lidocaine hcl mouth/throat solution 4 % T1

lidocaine viscous mouth/throat solution 2 % T1

LITTLE TEETHERS PAIN RELIEF MOUTH/THROAT SWAB 7.5 % T1

nystatin mouth/throat suspension 100000 unit/ml T1

ORA-FILM MOUTH/THROAT STRIP 6 % T1

oral analgesic max st mouth/throat gel 20 % T1

oral analgesic max st mouth/throat liquid 20 % T1

oral anesthetic mouth/throat paste 20 % T1

ORAMAGIC PLUS MOUTH/THROAT SUSPENSION RECONSTITUTED 10 % T1

PERIOMED MOUTH/THROAT CONCENTRATE 0.63 % T1

pilocarpine hcl oral tablet 5 mg T1

ra baby care oral pain relief mouth/throat gel 7.5 %

T1

sf 5000 plus dental cream 1.1 % T1

triamcinolone acetonide mouth/throat paste 0.1 % T1

*Multivitamins*adult gummy oral tablet chewable T1

antioxidant formula sg oral capsule extended release

T1

ATABEX EC ORAL TABLET DELAYED RELEASE 29-1 MG T1 GR-F

ATABEX ORAL TABLET CHEWABLE 18-0.8 MG T1 GR-F

b-complex balanced oral tablet T1

b-complex/vitamin c oral tablet T1

biovol oral syrup T1

BRAINSTRONG PRENATAL ORAL 33-0.8 & 350 MG T1 GR-F

CENTRUM SPECIALIST PRENATAL ORAL 27-0.8 & 200 MG T1 GR-F

child chewable vitamins/iron oral tablet chewableT1 AL (Max 9 Years)

childrens gummies oral tablet chewable T1 AL (Max 9 Years)

childrens multivitamin oral tablet chewable 60 mg

T1 AL (Max 9 Years)

78

Drug Status NotesCLINICAL NUTRIENTS PRENATAL ORAL TABLET 7.5-0.2 MG T1 GR-F

COMPLETE FORMULATION PEDIATRIC ORAL SOLUTION 45 MG/0.5ML T1 AL (Max 9 Years)

complete natal dha oral 29-1-200 & 250 mg T1 GR-F

complete prenatal/dha oral 30-0.975 & 300 mg T1 GR-F

CORVITA ORAL TABLET 1.25 MG T1

cvs prenatal gummy oral tablet chewable 0.4-113.5 mg

T1 GR-F

daily multiple vitamins/min oral tablet T1

DAILY PAK MAXIMUM MULTIVITAMIN ORAL T1

daily vitamin plus oral capsule T1

daily-vitamin oral tablet T1

DIALYVITE SUPREME D ORAL TABLET 3 MG T1

ELDERTONIC ORAL ELIXIR T1

eql childrens multivitamins oral tablet chewable T1

eql gummies childrens oral tablet chewable 30 mg

T1 AL (Max 9 Years)

FLINTSTONES TODDLER ORAL TABLET CHEWABLE 40 MG T1

FOLGARD OS ORAL TABLET 500-1.1 MG T1GR-F; QL (30 EA per 30 days); AL (Min 14 Years and Max 50 Years)

HEALTHY MAMA BE WELL ROUNDED ORAL THERAPY PACK 28-0.8 & 450 MG T1 GR-F

HONEY BEARS W/IRON-ZINC ORAL TABLET CHEWABLE 30-200-3 T1 AL (Max 9 Years)

kpn prenatal oral tablet 0.1 mg T1 GR-F

MEGA MULTIVITAMIN ORAL POWDER T1

multi-delyn oral liquid T1 AL (Max 9 Years)

multi-delyn/iron oral liquid T1

multivitamins oral tablet chewable T1

multivitamins pediatric oral solution T1 AL (Max 9 Years)

MYKIDZ IRON ORAL SUSPENSION 10 MG/2ML T1

MYNATAL ORAL CAPSULE T1 GR-F

mynatal plus oral tablet T1 GR-F

mynate 90 plus oral tablet extended release T1 GR-F

NANOVM T/F ORAL LIQUID T1 AL (Max 9 Years)

79

Drug Status NotesNANOVM T/F ORAL POWDER T1

NATALVIT ORAL TABLET T1 GR-F

OBSTETRIX DHA ORAL 29-1 & 387 MG T1 GR-F

OBSTETRIX EC ORAL TABLET 29-1 MG T1 GR-F

O-CAL PRENATAL ORAL TABLET T1 GR-F

ONE-A-DAY WOMENS PRENATAL ORAL28-0.8 & 223 MG T1 GR-F

pa prenatal formula oral tablet 9-0.5 mg T1 GR-F

PERRY PRENATAL ORAL CAPSULE 13.5-0.4 MG T1 GR-F

poly vitamin oral tablet chewable T1 AL (Max 9 Years)

polyvitamin oral solution 35 mg/ml T1 AL (Max 9 Years)

polyvitamin/iron oral solution 10 mg/ml T1 AL (Max 9 Years)

PR NATAL 400 ORAL 29-1-200 & 400 MG T1 GR-F

PR NATAL 430 ORAL 29-1-200 & 430 MG T1 GR-F

PRENATA ORAL TABLET CHEWABLE 29-1 MG T1 GR-F

prenatabs fa oral tablet T1 GR-F

prenatal 19 oral tablet 29-1 mg T1 GR-F

prenatal 19 oral tablet chewable 29-1 mg T1 GR-F

prenatal complete oral tablet 14-0.4 mg T1 GR-F

prenatal formula a-free oral tablet 9-0.267 mg T1 GR-F

prenatal formula oral capsule 28-0.8-235 mg T1 GR-F

prenatal multi +dha oral capsule 27-0.8-228 mg T1 GR-F

PRENATAL MULTIVITAMIN + DHA ORAL28-0.8 & 200 MG T1 GR-F

prenatal oral tablet 27-0.8 mg, 28-0.8 mg, 6.75-0.2 mg

T1 GR-F

prenatal plus iron oral tablet 29-1 mg T1 GR-F

prenatal plus oral tablet 27-1 mg T1 GR-F

prenatal vitamins oral tablet 0.8 mg T1 GR-F

prenatal/omega-3/fa/iron oral capsule 28-0.8-530 mg

T1 GR-F

prenatal+dha oral 28-0.975 & 200 mg T1 GR-F

PRENATAL-U ORAL CAPSULE 106.5-1 MG T1 GR-F

profe forte oral capsule 155-1 mg T1 GR-F

purefe ob plus oral capsule 162-115.2-1 mg T1 GR-F

qc childrens vitamins/extra c oral tablet chewableT1 AL (Max 9 Years)

ra one daily oral 28-0.8 & 440 mg T1 GR-F

80

Drug Status NotesRENAL ORAL CAPSULE 1 MG T1

SCOOBY-DOO ONE A DAY ORAL TABLET CHEWABLE T1

stress formula/iron oral tablet T1

stress formula/zinc oral tablet T1

STUART ONE ORAL CAPSULE 27-0.8-200 MG T1 GR-F

super b complex/vitamin c oral tablet T1

SUPERVITE EC ORAL TABLET DELAYED RELEASE 1 MG T1

SYNATEK ORAL CAPSULE 1.25 MG T1

TARON-BC ORAL 20-1 MG & 2 X 25 MG T1 GR-F

THERANATAL COMPLETE ORAL 27-1 & 300 MG T1 GR-F

therapeutic liquid oral solution T1

trinatal rx 1 oral tablet 60-1 mg T1 GR-F

tri-vit/fluoride oral solution 0.25 mg/ml T1 AL (Max 9 Years)

tri-vitamin/fluoride oral solution 0.5 mg/ml T1 AL (Max 9 Years)

UDAMIN SP ORAL TABLET 1 MG T1

ultra-mega oral tablet extended release T1

VINATE II ORAL TABLET 29-1 MG T1 GR-F

VINATE M ORAL TABLET 27-1 MG T1 GR-F

virt-vite gt oral tablet 90-1 mg T1 GR-F

vitamin c-electrolytes oral packet T1

zinc oral lozenge T1

*Musculoskeletal Therapy Agents*baclofen oral tablet 10 mg, 20 mg T1

chlorzoxazone oral tablet 500 mg T1

cyclobenzaprine hcl oral tablet 10 mg, 5 mg T1

methocarbamol oral tablet 500 mg, 750 mg T1

tizanidine hcl oral tablet 2 mg, 4 mg T1 QL (90 EA per 30 days)

*Nasal Agents - Systemic And Topical*allergy spray 24 hour aerosol 55 mcg/act nasal55 mcg/act

T1 QL (16.9 ML per 30 days)

anefrin spray nasal solution 0.05 % T1

childrens silfedrine oral liquid 15 mg/5ml T1

cromolyn sodium nasal aerosol solution 5.2 mg/act

T1

cvs nasal allergy spray aerosol 55 mcg/act nasal55 mcg/act


81

Drug Status Noteseq nasal allergy aerosol 55 mcg/act nasal 55 mcg/act


fluticasone propionate nasal suspension 50 mcg/act


gnp 24 hour nasal allergy aerosol 55 mcg/act nasal 55 mcg/act


goodsense nasal allergy spray aerosol 55 mcg/act nasal 55 mcg/act


ipratropium bromide nasal solution 0.03 % T1 QL (30 ML per 30 days)

ipratropium bromide nasal solution 0.06 % T1 QL (15 ML per 30 days)

NASACORT ALLERGY 24HR NASAL AEROSOL 55 MCG/ACT T1

nasal allergy 24 hour aerosol 55 mcg/act nasal55 mcg/act


nasal decongestant oral liquid 30 mg/5ml T1

nasal decongestant oral syrup 30 mg/5ml T1

NEXAFED ORAL TABLET ABUSE-DETERRENT 30 MG T1

pseudoephedrine hcl er oral tablet extended release 12 hour 120 mg

T1

pseudoephedrine hcl oral tablet 30 mg, 60 mg T1

ra nasal allergy aerosol 55 mcg/act nasal 55 mcg/act


RHINOCORT ALLERGY NASAL SUSPENSION 32 MCG/ACT T1

saline nasal spray nasal solution 0.65 % T1 QL (90 ML per 30 days)

triamcinolone acetonide aerosol 55 mcg/act nasal (otc) 55 mcg/act

T1 QL (16.9 GM per 30 days)

*Ophthalmic Agents*advanced lubricant ophthalmic solution 0.05-1 % T1

artificial tears ophthalmic ointment 83-15 % T1

artificial tears ophthalmic solution 0.1-0.3 %, 0.2-0.2-1 %, 0.4 %, 1-0.3 %, 1.4 %, 5-6 mg/ml

T1

atropine sulfate ophthalmic ointment 1 % T1

atropine sulfate ophthalmic solution 1 % T1

azelastine hcl ophthalmic solution 0.05 % T1

bacitracin ophthalmic ointment 500 unit/gm T1

bacitracin-polymyxin b ophthalmic ointment 500-10000 unit/gm

T1

bacitra-neomycin-polymyxin-hc ophthalmic ointment 1 %

T1

82

Drug Status Notesbetaxolol hcl ophthalmic solution 0.5 % T1

bimatoprost ophthalmic solution 0.03 % T1 ST; QL (5 ML per 30 days)

BLEPHAMIDE S.O.P. OPHTHALMIC OINTMENT 10-0.2 % T1

BLINK TEARS OPHTHALMIC GEL 0.25 % T1

BLINK TEARS OPHTHALMIC SOLUTION0.25 % T1

brimonidine tartrate ophthalmic solution 0.2 % T1

carteolol hcl ophthalmic solution 1 % T1

CILOXAN OPHTHALMIC OINTMENT 0.3 % T1

ciprofloxacin hcl ophthalmic solution 0.3 % T1

cromolyn sodium ophthalmic solution 4 % T1

cvs lubricant drops ophthalmic gel 0.25-0.3 %, 1 %

T1

CYCLOMYDRIL OPHTHALMIC SOLUTION 0.2-1 % T1

cyclopentolate hcl ophthalmic solution 1 % T1

dexamethasone sodium phosphate ophthalmic solution 0.1 %

T1

diclofenac sodium ophthalmic solution 0.1 % T1

dorzolamide hcl ophthalmic solution 2 % T1

dorzolamide hcl-timolol mal ophthalmic solution22.3-6.8 mg/ml

T1

epinastine hcl ophthalmic solution 0.05 % T1

EQ GENTLE LUBRICANT OPHTHALMIC SOLUTION 0.3 % T1

eq lubricating eye drops ophthalmic solution 0.5-0.9 %

T1

erythromycin ophthalmic ointment 5 mg/gm T1

eye allergy relief ophthalmic solution 0.025-0.3 %, 0.027-0.315 %

T1

eye drops allergy relief ophthalmic solution 0.05-0.25 %

T1

eye drops ophthalmic solution 0.012-0.2 % T1

eye lubricant ophthalmic ointment T1

FLAREX OPHTHALMIC SUSPENSION 0.1 % T1

fluorometholone ophthalmic suspension 0.1 % T1

flurbiprofen sodium ophthalmic solution 0.03 % T1

FML OPHTHALMIC OINTMENT 0.1 % T1

83

Drug Status NotesGENTAK OPHTHALMIC OINTMENT 0.3 % T1

gentamicin sulfate ophthalmic solution 0.3 % T1

GENTEAL MILD OPHTHALMIC SOLUTION 0.2 % T1

GONIOTAIRE OPHTHALMIC SOLUTION2.5 % T1

homatropine hbr ophthalmic solution 5 % T1

HYPOTEARS OPHTHALMIC SOLUTION 1-1 % T1

ISOPTO CARBACHOL OPHTHALMIC SOLUTION 3 % T1

ISOPTO HOMATROPINE OPHTHALMIC SOLUTION 2 % T1

ISOPTO TEARS OPHTHALMIC SOLUTION 0.5 % T1

ketorolac tromethamine ophthalmic solution 0.4 %, 0.5 %

T1

ketotifen fumarate ophthalmic solution 0.025 % T1 QL (5 ML per 30 days)

latanoprost ophthalmic solution 0.005 % T1 QL (5 ML per 30 days)

levobunolol hcl ophthalmic solution 0.25 % T1

levobunolol hcl ophthalmic solution 0.5 % T1 QL (5 ML per 18 days)

lubricant eye drops ophthalmic solution 0.4-0.3 %, 0.5 %, 0.6 %

T1

metipranolol ophthalmic solution 0.3 % T1

multi-purpose solution solution T1

MURO 128 OPHTHALMIC SOLUTION 2 % T1

naphazoline hcl ophthalmic solution 0.1 % T1

neomycin-bacitracin zn-polymyx ophthalmic ointment 5-400-10000

T1

neomycin-polymyxin-dexameth ophthalmic ointment 3.5-10000-0.1

T1

neomycin-polymyxin-dexameth ophthalmic suspension 3.5-10000-0.1

T1

neomycin-polymyxin-gramicidin ophthalmic solution 1.75-10000-.025

T1

neomycin-polymyxin-hc ophthalmic suspension3.5-10000-1

T1

NEO-POLYCIN HC OPHTHALMIC OINTMENT 1 % T1

NUTRATEAR OPHTHALMIC SOLUTION0.6 % T1

84

Drug Status Notesofloxacin ophthalmic solution 0.3 % T1

olopatadine hcl ophthalmic solution 0.1 % T1

PHOSPHOLINE IODIDE OPHTHALMIC SOLUTION RECONSTITUTED 0.125 % T1

polymyxin b-trimethoprim ophthalmic solution10000-0.1 unit/ml-%

T1

PRED MILD OPHTHALMIC SUSPENSION0.12 % T1

prednisolone acetate ophthalmic suspension 1 % T1

prednisolone sodium phosphate ophthalmic solution 1 %

T1

proparacaine hcl ophthalmic solution 0.5 % T1

ra sterile eye drops ophthalmic solution 0.03-0.5 %

T1

redness relief max strength ophthalmic solution0.03-0.5 %

T1

REDNESS RELIEF OPHTHALMIC SOLUTION 0.012-0.25 % T1

redness reliever eye drops ophthalmic solution0.05 %

T1

REFRESH CELLUVISC OPHTHALMIC GEL 1 % T1

REFRESH LIQUIGEL OPHTHALMIC SOLUTION 1 % T1

REFRESH OPTIVE ADVANCED PF OPHTHALMIC SOLUTION 0.5-1-0.5 % T1

REFRESH OPTIVE SENSITIVE OPHTHALMIC SOLUTION 0.5-0.9 % T1

RETAINE MGD OPHTHALMIC EMULSION 0.5-0.5 % T1

sm redness relief ophthalmic solution 0.012-0.2 % T1

sodium chloride (hypertonic) ophthalmic ointment5 %

T1

sodium chloride (hypertonic) ophthalmic solution5 %

T1

SOOTHE OPHTHALMIC SOLUTION 0.6-0.6 % T1

STERILE LUBRICANT OPHTHALMIC LIQUID 0.7 % T1

sulfacetamide sodium ophthalmic ointment 10 % T1

sulfacetamide sodium ophthalmic solution 10 % T1

sulfacetamide-prednisolone ophthalmic solution10-0.23 %

T1

85

Drug Status NotesSYSTANE OPHTHALMIC GEL 0.4-0.3 % T1

SYSTANE OVERNIGHT THERAPY OPHTHALMIC GEL 0.3 % T1

tgt lubricant eye drops ophthalmic solution 0.95 %

T1

THERATEARS PF OPHTHALMIC SOLUTION 0.25 % T1

timolol maleate ophthalmic solution 0.25 %, 0.5 %

T1

TIMOPTIC OCUDOSE OPHTHALMIC SOLUTION 0.25 %, 0.5 % T1

TOBRADEX OPHTHALMIC OINTMENT0.3-0.1 % T1

tobramycin ophthalmic solution 0.3 % T1

tobramycin-dexamethasone ophthalmic suspension 0.3-0.1 %


TOBREX OPHTHALMIC OINTMENT 0.3 % T1

travoprost ophthalmic solution 0.004 % T1 ST; QL (5 ML per 30 days)

trifluridine ophthalmic solution 1 % T1

tropicamide ophthalmic solution 0.5 %, 1 % T1

VASOCLEAR-A OPHTHALMIC SOLUTION 0.02-0.25 % T1

VISINE TEARS OPHTHALMIC SOLUTION0.2-0.36-1 % T1

*Otic Agents*acetic acid otic solution 2 % T1

acetic acid-aluminum acetate otic solution 2 % T1

antipyrine-benzocaine otic solution 5.4-1.4 % T1

ciprofloxacin hcl otic solution 0.2 % T1

ear drops otic solution 6.5 % T1

ear wax cleansing otic kit 6.5 % T1

hydrocortisone-acetic acid otic solution 1-2 % T1

neomycin-polymyxin-hc otic solution 1 % T1

neomycin-polymyxin-hc otic suspension 3.5-10000-1

T1

ofloxacin otic solution 0.3 % T1

pinnacaine otic otic solution 20 % T1

*Oxytocics*methylergonovine maleate oral tablet 0.2 mg T1 QL (28 EA per 365 days)

86

Drug Status Notes

*Passive Immunizing Agents*RHOGAM ULTRA-FILTERED PLUS INTRAMUSCULAR SOLUTION PREFILLED SYRINGE 1500 UNIT

T1

SYNAGIS INTRAMUSCULAR SOLUTION100 MG/ML, 50 MG/0.5ML T1 PA

*Penicillins*amoxicillin oral capsule 250 mg, 500 mg T1

amoxicillin oral suspension reconstituted 125 mg/5ml, 200 mg/5ml, 250 mg/5ml, 400 mg/5ml

T1

amoxicillin oral tablet 500 mg, 875 mg T1

amoxicillin oral tablet chewable 125 mg, 250 mg T1

amoxicillin-pot clavulanate oral suspension reconstituted 200-28.5 mg/5ml, 400-57 mg/5ml, 600-42.9 mg/5ml

T1

amoxicillin-pot clavulanate oral tablet 250-125 mg


amoxicillin-pot clavulanate oral tablet 500-125 mg, 875-125 mg


amoxicillin-pot clavulanate oral tablet chewable200-28.5 mg, 400-57 mg


ampicillin oral capsule 250 mg, 500 mg T1

ampicillin oral suspension reconstituted 125 mg/5ml, 250 mg/5ml

T1

BICILLIN C-R 900/300 INTRAMUSCULAR SUSPENSION 900000-300000 UNIT/2ML T1 QL (4 ML per 28 days)

BICILLIN C-R INTRAMUSCULAR SUSPENSION 1200000 UNIT/2ML T1 QL (4 ML per 28 days)

dicloxacillin sodium oral capsule 250 mg, 500 mg T1

penicillin v potassium oral solution reconstituted125 mg/5ml, 250 mg/5ml

T1

penicillin v potassium oral tablet 250 mg, 500 mg T1

*Pharmaceutical Adjuvants*benzyl alcohol liquid T1

cherry concentrate oral syrup T1

cherry oral syrup T1

FLAVOR BLEND ORAL SUSPENSION T1

flavor plus oral liquid T1

flavor sweet oral syrup T1

flavor sweet-sf oral liquid† T1

grape syrup oral syrup T1

87

Drug Status NotesORA-BLEND ORAL SUSPENSION T1

ORA-BLEND SF ORAL SUSPENSION T1

ORAL MIX ORAL LIQUID T1

ORAL MIX SF ORAL LIQUID T1

oral suspend oral liquid T1

oral syrup oral liquid T1

oral syrup sf oral liquid T1

ORA-PLUS ORAL LIQUID T1

ORA-SWEET ORAL SYRUP T1

ORA-SWEET SF ORAL SYRUP T1

PCCA SWEET-SF ORAL SYRUP T1

PCCA SYRUP VEHICLE ORAL SYRUP T1

PCCA-PLUS ORAL SUSPENSION T1

polyethylene glycol 3350 powder T1

simple syrup oral syrup T1

SYRPALTA (RED) ORAL SYRUP T1

syrpalta oral syrup T1

SYRSPEND SF ORAL LIQUID T1

VERSAFREE ORAL SYRUP T1

VERSAPLUS ORAL SYRUP T1

*Potassium Removing Agents***KIONEX ORAL POWDER T1

sodium polystyrene sulfonate oral powder T1

*Prenatal Mv & Minerals W/ Fa-Omega Fatty Acids W/O Iron***cvs prenatal gummy oral tablet chewable 0.4-113.5 mg

T1 GR-F

*Progestins*medroxyprogesterone acetate oral tablet 10 mg, 2.5 mg, 5 mg


norethindrone acetate oral tablet 5 mg T1 GR-F; QL (60 EA per 30 days)

*Psychotherapeutic And Neurological Agents - Misc.*AVONEX INTRAMUSCULAR KIT 30 MCG T1 PA

AVONEX PEN INTRAMUSCULAR AUTO-INJECTOR KIT 30 MCG/0.5ML T1 PA

AVONEX PREFILLED INTRAMUSCULAR PREFILLED SYRINGE KIT 30 MCG/0.5ML T1 PA

88

Drug Status NotesBETASERON SUBCUTANEOUS KIT 0.3 MG T1 PA

bupropion hcl er (smoking det) oral tablet extended release 12 hour 150 mg


disulfiram oral tablet 250 mg, 500 mg T1

donepezil hcl oral tablet 10 mg, 5 mg T1

EXTAVIA SUBCUTANEOUS KIT 0.3 MG T1 PA

galantamine hydrobromide oral tablet 12 mg, 4 mg, 8 mg

T1

glatiramer acetate subcutaneous solution prefilled syringe 40 mg/ml

T1 PA

GLATOPA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 20 MG/ML T1 PA

memantine hcl oral tablet 10 mg, 5 mg T1 QL (60 EA per 30 days)

memantine hcl oral tablet 28 x 5 mg & 21 x 10 mg T1 QL (49 EA per 365 days)

nicotine mini mouth/throat lozenge 2 mg T1C (90 days of coverage per year); QL (270 EA per 30 days)

nicotine polacrilex mouth/throat gum 2 mg, 4 mg T1C (90 days of coverage per year); QL (270 EA per 30 days)

nicotine polacrilex mouth/throat lozenge 4 mg T1C (90 days of coverage per year); QL (270 EA per 30 days)

nicotine transdermal kit 21-14-7 mg/24hr T1 C (90 days of coverage per year)

nicotine transdermal patch 24 hour 14 mg/24hr, 21 mg/24hr, 7 mg/24hr

T1 C (90 days of coverage per year)

NICOTROL INHALATION INHALER 10 MG T1 C (90 days of coverage per year)

NICOTROL NS NASAL SOLUTION 10 MG/ML T1 C (90 days of coverage per year)

*Respiratory Agents - Misc.*PULMOZYME INHALATION SOLUTION 1 MG/ML T1 PA

*Serotonin Modulators***trazodone hcl oral tablet 100 mg, 150 mg, 300 mg, 50 mg

T1

*Sodium-Glucose Co-Transporter 2 Inhibitor-Biguanide Comb***INVOKAMET ORAL TABLET 150-1000 MG, 150-500 MG, 50-1000 MG, 50-500 MG T1 QL (60 EA per 30 days)

INVOKAMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 150-1000 MG, 150-500 MG, 50-1000 MG, 50-500 MG


89

Drug Status NotesSYNJARDY ORAL TABLET 12.5-1000 MG, 12.5-500 MG, 5-1000 MG, 5-500 MG T1 QL (60 EA per 30 days)

SYNJARDY XR ORAL TABLET EXTENDED RELEASE 24 HOUR 10-1000 MG, 12.5-1000 MG, 25-1000 MG, 5-1000 MG


*Steroids - Mouth/Throat/Dental***triamcinolone acetonide mouth/throat paste 0.1 % T1

*Sulfonamides*sulfadiazine oral tablet 500 mg T1

*Tetracyclines*doxycycline hyclate oral capsule 100 mg, 50 mg T1

doxycycline hyclate oral tablet 100 mg T1

doxycycline monohydrate oral suspension reconstituted 25 mg/5ml

T1

minocycline hcl oral capsule 100 mg, 50 mg, 75 mg

T1

VIBRAMYCIN ORAL SYRUP 50 MG/5ML T1

*Thyroid Agents*ARMOUR THYROID ORAL TABLET 120 MG, 15 MG, 180 MG, 240 MG, 30 MG, 300 MG, 60 MG, 90 MG

T1

levothyroxine sodium oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg

T1

LEVOXYL ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 50 MCG, 75 MCG, 88 MCG

T1

liothyronine sodium oral tablet 25 mcg, 5 mcg, 50 mcg

T1

methimazole oral tablet 10 mg, 5 mg T1

NATURE-THROID ORAL TABLET 113.75 MG, 130 MG, 146.25 MG, 16.25 MG, 162.5 MG, 195 MG, 260 MG, 32.5 MG, 325 MG, 48.75 MG, 65 MG, 81.25 MG, 97.5 MG

T1

np thyroid oral tablet 120 mg, 15 mg, 30 mg, 60 mg, 90 mg

T1

propylthiouracil oral tablet 50 mg T1

SYNTHROID ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG

T1

thyroid oral tablet 65 mg T1

90

Drug Status NotesUNITHROID ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG

T1

WESTHROID ORAL TABLET 130 MG, 195 MG, 32.5 MG, 65 MG, 97.5 MG T1

WP THYROID ORAL TABLET 113.75 MG, 130 MG, 16.25 MG, 32.5 MG, 48.75 MG, 65 MG, 81.25 MG, 97.5 MG

T1

*Topical Anesthetic Gases***ethyl chloride external aerosol T1

*Ulcer Drugs*cimetidine hcl oral solution 300 mg/5ml T1

cimetidine oral tablet 200 mg, 300 mg, 400 mg, 800 mg

T1

cvs esomeprazole magnesium capsule delayed release 20 mg oral 20 mg


dicyclomine hcl oral capsule 10 mg T1

dicyclomine hcl oral solution 10 mg/5ml T1

dicyclomine hcl oral tablet 20 mg T1

esomeprazole magnesium capsule delayed release 20 mg oral (otc) 20 mg


famotidine intravenous solution 20 mg/2ml, 200 mg/20ml, 40 mg/4ml, 500 mg/50ml

T1

famotidine oral suspension reconstituted 40 mg/5ml

T1

famotidine oral tablet 10 mg, 20 mg, 40 mg T1

famotidine premixed intravenous solution 20-0.9 mg/50ml-%

T1

FIRST-LANSOPRAZOLE ORAL SUSPENSION 3 MG/ML T1 QL (150 ML per 30 days)

FIRST-OMEPRAZOLE ORAL SUSPENSION 2 MG/ML T1 QL (150 ML per 30 days)

glycopyrrolate oral tablet 1 mg, 2 mg T1

GOODSENSE ESOMEPRAZOLE CAPSULE DELAYED RELEASE 20 MG ORAL 20 MG T1 QL (60 EA per 30 days)

heartburn treatment 24 hour capsule delayed release 20 mg oral 20 mg


hm esomeprazole magnesium dr capsule delayed release 20 mg oral 20 mg


hyoscyamine sulfate er oral tablet extended release 12 hour 0.375 mg

T1

91

Drug Status Noteshyoscyamine sulfate oral elixir 0.125 mg/5ml T1

hyoscyamine sulfate oral solution 0.125 mg/ml T1

hyoscyamine sulfate oral tablet 0.125 mg T1

hyoscyamine sulfate oral tablet dispersible 0.125 mg

T1

hyoscyamine sulfate sublingual tablet sublingual0.125 mg

T1

lansoprazole oral capsule delayed release 15 mg T1 QL (60 EA per 30 days)

lansoprazole oral capsule delayed release 30 mg T1 QL (30 EA per 30 days)

misoprostol oral tablet 100 mcg, 200 mcg T1

omeprazole oral capsule delayed release 10 mg, 40 mg


omeprazole oral capsule delayed release 20 mg T1 QL (60 EA per 30 days)

omeprazole-sodium bicarbonate capsule 20-1100 mg oral (otc) 20-1100 mg


pantoprazole sodium oral tablet delayed release20 mg


pantoprazole sodium oral tablet delayed release40 mg


PEPCID AC MAXIMUM STRENGTH ORAL TABLET CHEWABLE 20 MG T1

phenobarbital-belladonna alk oral elixir 16.2 mg/5ml

T1

PRILOSEC OTC ORAL TABLET DELAYED RELEASE 20 MG T1 QL (60 EA per 30 days)

propantheline bromide oral tablet 15 mg T1

ra omeprazole-sodium bicarb capsule 20-1100 mg oral 20-1100 mg


ranitidine hcl oral capsule 150 mg T1

ranitidine hcl oral syrup 15 mg/ml T1

ranitidine hcl oral tablet 150 mg, 300 mg, 75 mg T1

sm esomeprazole magnesium capsule delayed release 20 mg oral 20 mg


sucralfate oral tablet 1 gm T1

*Urinary Anti-Infectives*methenamine hippurate oral tablet 1 gm T1

methenamine mandelate oral tablet 0.5 gm, 1 gm T1

nitrofurantoin macrocrystal oral capsule 100 mg, 50 mg


nitrofurantoin macrocrystal oral capsule 25 mg T1

92

Drug Status Notesnitrofurantoin monohyd macro oral capsule 100 mg


nitrofurantoin oral suspension 25 mg/5ml T1 AL (Max 12 Years)

*Urinary Antispasmodics*bethanechol chloride oral tablet 10 mg, 25 mg, 5 mg, 50 mg

T1

darifenacin hydrobromide er oral tablet extended release 24 hour 15 mg, 7.5 mg

T1 ST

oxybutynin chloride er oral tablet extended release 24 hour 10 mg, 15 mg, 5 mg

T1

oxybutynin chloride oral syrup 5 mg/5ml T1

oxybutynin chloride oral tablet 5 mg T1

OXYTROL FOR WOMEN TRANSDERMAL PATCH TWICE WEEKLY 3.9 MG/24HR T1

OXYTROL TRANSDERMAL PATCH TWICE WEEKLY 3.9 MG/24HR T1

solifenacin succinate oral tablet 10 mg, 5 mg T1

tolterodine tartrate er oral capsule extended release 24 hour 2 mg, 4 mg

T1 ST

tolterodine tartrate oral tablet 1 mg, 2 mg T1 ST

TOVIAZ ORAL TABLET EXTENDED RELEASE 24 HOUR 4 MG, 8 MG T1 ST

trospium chloride er oral capsule extended release 24 hour 60 mg

T1 ST

trospium chloride oral tablet 20 mg T1 ST

VESICARE ORAL TABLET 10 MG, 5 MG T1 ST

*Vaccines*AFLURIA INTRAMUSCULAR SUSPENSION T1

QL (0.5 ML per 365 days); AL (Min 5 Years)

AFLURIA PRESERVATIVE FREE INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML

T1QL (0.5 ML per 365 days); AL (Min 5 Years)

AFLURIA QUADRIVALENT SUSPENSION PREFILLED SYRINGE 0.5 ML INTRAMUSCULAR 0.5 ML

T1QL (0 ML per 365 days); AL (Min 5 Years)

AFLURIA QUADRIVALENT SUSPENSION PREFILLED SYRINGE 0.5 ML INTRAMUSCULAR 0.5 ML


FLUAD SUSPENSION PREFILLED SYRINGE 0.5 ML INTRAMUSCULAR 0.5 ML


93

Drug Status NotesFLUARIX QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML

T1QL (0.5 ML per 365 days); AL (Min 6 Months)

FLUCELVAX INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML


FLULAVAL QUADRIVALENT INTRAMUSCULAR SUSPENSION T1

QL (0.5 ML per 365 days); AL (Min 6 Months)

FLULAVAL QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML


FLUVIRIN INTRAMUSCULAR SUSPENSION T1


FLUVIRIN INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML


FLUVIRIN PRESERVATIVE FREE INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML


FLUZONE HIGH-DOSE SUSPENSION PREFILLED SYRINGE 0.5 ML INTRAMUSCULAR 0.5 ML


FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION T1

QL (0.5 ML per 365 days); AL (Min 6 Months)

FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION 0.5 ML T1


FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.25 ML

T1QL (0.25 ML per 365 days); AL (Min 6 Months and Max 35 Months)

FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML


SHINGRIX INTRAMUSCULAR SUSPENSION RECONSTITUTED 50 MCG/0.5ML

T1 QL (2 EA per 2 lifetimes)

ZOSTAVAX SUBCUTANEOUS SOLUTION RECONSTITUTED 19400 UNT/0.65ML T1 AL (Min 60 Years)

*Vaginal Products*CLEOCIN VAGINAL SUPPOSITORY 100 MG T1 GR-F

clindamycin phosphate vaginal cream 2 % T1 GR-F

clotrimazole 3 vaginal cream 2 % T1 GR-F

clotrimazole-7 vaginal cream 1 % T1 GR-F

estradiol vaginal cream 0.1 mg/gm T1 GR-F

94

Drug Status NotesFIRST-PROGESTERONE VGS 100 VAGINAL SUPPOSITORY 100 MG T1

FIRST-PROGESTERONE VGS 200 VAGINAL SUPPOSITORY 200 MG T1




GYNAZOLE-1 VAGINAL CREAM 2 % T1 GR-F

metronidazole vaginal gel 0.75 % T1 GR-F

miconazole 3 combo pack vaginal kit 200 & 2 mg-% (9gm)

T1 GR-F

miconazole 3 vaginal suppository 200 mg T1 GR-F

miconazole 7 vaginal cream 2 % T1 GR-F

miconazole 7 vaginal suppository 100 mg T1 GR-F

OPERAND POVIDONE-IODINE VAGINAL SOLUTION 10 % T1

terconazole vaginal cream 0.4 %, 0.8 % T1 GR-F

terconazole vaginal suppository 80 mg T1 GR-F

*Vasopressors*epinephrine solution auto-injector 0.15 mg/0.15ml injection 0.15 mg/0.15ml


epinephrine solution auto-injector 0.15 mg/0.3ml injection 0.15 mg/0.3ml


epinephrine solution auto-injector 0.3 mg/0.3ml injection 0.3 mg/0.3ml


midodrine hcl oral tablet 10 mg, 2.5 mg, 5 mg T1 QL (90 EA per 30 days)

*Vitamins*ACEROLA C 500 ORAL WAFER 500 MG T1

ascocid-iso-ph oral powder effervescent T1

ascorbic acid injection solution 500 mg/ml T1

b1 natural oral tablet 250 mg T1

b-1 oral tablet 500 mg T1

B-2-400 ORAL CAPSULE 400 MG T1

benfotiamine oral capsule 150 mg T1

biotin 5000 oral capsule 5 mg T1

biotin forte oral tablet 3 mg T1

biotin oral capsule 1 mg, 2500 mcg T1

95

Drug Status Notesbiotin oral tablet 10 mg, 1000 mcg, 300 mcg, 5 mg, 7500 mcg, 800 mcg

T1

B-NATAL MOUTH/THROAT LOZENGE 25 MG T1

B-NATAL MOUTH/THROAT LOZENGE ON A HANDLE 25 MG T1

BPROTECTED VITAMIN C ORAL LIQUID500 MG/5ML T1

buffered vitamin c oral capsule 1000 mg T1

calcium ascorbate oral tablet 500 mg T1

calcium pantothenate oral tablet 100 mg, 200 mg, 500 mg

T1

cvs biotin oral capsule 10 mg T1

cvs vitamin c oral tablet chewable 1000 mg T1

CYTO B2 ORAL POWDER 343 MG/GM T1

d 1000 oral tablet 1000 unit T1

d 5000 oral tablet 5000 unit T1

fruit c oral tablet chewable 100 mg T1

LEXINAL ORAL TABLET 2.5 MG T1

LIQUID C 500 ORAL LIQUID 500 MG/15ML T1

M2 POTASSIUM ORAL CAPSULE 60 MG T1

NEURO-K-250 T.D. ORAL CAPSULE 250 MG T1

niacin er oral capsule extended release 250 mg, 500 mg

T1

niacin er oral tablet extended release 1000 mg, 250 mg, 500 mg, 750 mg

T1

niacin oral tablet 100 mg, 250 mg, 50 mg, 500 mg T1

niacinamide oral tablet 100 mg, 500 mg T1

niacinamide oral tablet extended release 500 mg T1

paba oral tablet 100 mg T1

panto-250 oral capsule 250 mg T1

pantothenic acid oral tablet 500 mg T1

phytonadione oral tablet 5 mg T1

POTABA ORAL CAPSULE 500 MG T1

PROTEXIN ORAL SYRUP 500 MG/15ML T1

ra vitamin c oral tablet chewable 300 mg T1

riboflavin oral capsule 100 mg, 50 mg T1

riboflavin oral tablet 400 mg T1

sodium ascorbate granules T1

96

Drug Status Notesthiamine oral capsule 50 mg T1

vita-c oral crystals T1

vitamin b1 oral tablet 100 mg T1

vitamin b-1 oral tablet 100 mg, 250 mg, 50 mg T1

vitamin b-2 oral tablet 100 mg, 25 mg, 50 mg T1

vitamin b-6 er oral tablet extended release 200 mg

T1

vitamin b-6 oral tablet 100 mg, 25 mg, 250 mg, 50 mg, 500 mg

T1

vitamin b6 oral tablet 200 mg T1

vitamin c (calcium ascorbate) oral solution reconstituted

T1

vitamin c drops mouth/throat lozenge 60 mg T1

vitamin c er oral capsule extended release 500 mg T1

vitamin c er oral tablet extended release 1500 mg, 500 mg

T1

vitamin c gummie oral tablet chewable 120 mg T1

vitamin c oral capsule 500 mg T1

vitamin c oral syrup 500 mg/5ml T1

vitamin c oral tablet 100 mg, 1000 mg, 250 mg, 500 mg

T1

vitamin c oral tablet chewable 250 mg, 500 mg T1

vitamin c-rose hips er oral tablet extended release1000 mg

T1

vitamin d (cholecalciferol) oral capsule 400 unit T1 AL (Min 65 Years)

vitamin d (ergocalciferol) oral capsule 50000 unit T1 QL (4 EA per 28 days)

vitamin d3 oral tablet 400 unit T1QL (60 EA per 30 days); AL (Min 65 Years)

vitamin e oral capsule 400 unit T1

vitamin k (phytonadione) oral tablet 100 mcg T1

97

98

Index1st tier unifine pentips ................ 601st tier unifine pentips plus .........60abacavir sulfate .......................... 23abacavir sulfate-lamivudine ....... 23abacavir-lamivudine-zidovudine 23acarbose ......................................12ACCU-CHEK TENDER 1 INFUSION .................................60acebutolol hcl ..............................26ACEPHEN ...................................3ACEROLA C 500 ..................... 95ACETADRYL ........................... 57ACETA-GESIC .........................32acetaminophen ..............................3acetaminophen er ..........................3acetaminophen-codeine ................ 4acetaminophen-codeine #2 ........... 4acetaminophen-codeine #3 ........... 4acetaminophen-codeine #4 ........... 4acetazolamide ............................. 51acetazolamide er .........................51acetic acid ...................................86acetic acid-aluminum acetate ..... 86acetone ........................................29acetylcysteine .............................. 32acidophilus/citrus pectin .......14, 15acidophilus/pectin .................14, 15acne medication 10 ..................... 44acne medication 5 ....................... 44ACTIPHYTE OF LEMONGRASS ........................29acyclovir ......................................23administration set ....................... 60ADULT ACNOMEL ................ 44adult aspirin low strength .............3adult gummy ................................78ADVAIR DISKUS ...................... 8advanced lubricant ..................... 82ADVIL ALLERGY & CONGESTION ......................... 32ADVIL ALLERGY SINUS ......32ADVIL COLD & SINUS LIQUI-GELS .............................32ADVOCATE INSULIN PEN NEEDLES ..................................60ADVOCATE INSULIN SYRINGE .................................. 60AEROSPAN ................................ 8AFLURIA .................................. 93AFLURIA PRESERVATIVE FREE ..........................................93

AFLURIA QUADRIVALENT 93AGORAL MAXIMUM STRENGTH .............................. 57air eliminating tpn iv set ............. 60ALA-HIST PE ...........................32albuterol sulfate ............................ 8albuterol sulfate hfa ......................8alclometasone dipropionate ........44alendronate sodium .................... 51aler-dryl ...................................... 16alevazol ....................................... 44alfuzosin hcl er ............................53ALKA-SELTZER HEARTBURN .............................5ALKA-SELTZER PLS ALLERGY & CGH .................. 32ALKA-SELTZER PLUS COLD & COUGH .................... 32ALKA-SELTZER PLUS COLD & FLU ........................... 32ALKA-SELTZER PLUS DAY/NIGHT ............................. 32ALKA-SELTZER PLUS NIGHT COLD .......................... 32ALKA-SELTZER PLUS SINUS .........................................32all day pain relf sinus/cold d ...... 32aller-chlor ................................... 16allergy multi-symptom day/nght . 32allergy spray 24 hour ..................81aller-time .....................................32allopurinol .................................. 54ALMACONE ...............................5alogliptin benzoate ......................12alogliptin-metformin hcl ............. 12alogliptin-pioglitazone ................12alprazolam .................................... 7amantadine hcl ............................22ambi 12.5cpd/100gfn/30pse ........33ambi 12.5cpd/1dcpm/30pse ........ 33amiloride hcl ...............................51amiloride-hydrochlorothiazide ... 51amiodarone hcl ............................. 8amitriptyline hcl ..........................11amlodipine besy-benazepril hcl .. 18amlodipine besylate .................... 27amlodipine besylate-valsartan ....18amlodipine-olmesartan ............... 18ammonium lactate .................29, 44amoxapine ...................................11amoxicillin .................................. 87

amoxicillin-pot clavulanate ........ 87amphetamine-dextroamphet er ..... 1amphetamine-dextroamphetamine .......................1ampicillin .................................... 87anagrelide hcl ............................. 54anastrozole ..................................21ANBESOL ................................. 77ANECREAM .............................45anefrin spray ...............................81anesthesia extension tubing ........ 60ANORO ELLIPTA .....................8antacid .......................................... 6antacid & antigas ......................... 5antacid extra strength ................... 5antacid multi-symptom ..................6antioxidant formula sg ................78antipyrine-benzocaine .................86anti-stick insulin syringe .............60apap .............................................. 3ap-hist dm ................................... 33APRISO ..................................... 53APTIVUS ...................................23ARANELLE .............................. 30ARGYLE EXTENSION TUBE 20" .................................. 60ARGYLE STERILE WATER .26aripiprazole .................................22ARMOUR THYROID ..............90artificial tears ............................. 82ascocid-iso-ph .............................95ascorbic acid ...............................95ASCRIPTIN ................................ 3ASPERCREME LIDOCAINE 45ASPERCREME W/LIDOCAINE ........................ 45aspirin ........................................... 3aspirin adult low strength .............3aspirin low dose ............................3aspirtab maximum strength .......... 3ASSURE DOSE CONTROL ... 60ASSURE ID INSULIN SAFETY SYR ............................60ATABEX ....................................78ATABEX EC ............................. 78atazanavir sulfate ........................23atenolol ....................................... 26atenolol-chlorthalidone .............. 18atorvastatin calcium ................... 17atovaquone ..................................20ATRIPLA .................................. 23

99

atropine sulfate ........................... 82ATROVENT HFA ...................... 8aurora pen needles ......................60aurora unifine pentips .................60AUTOJECT 2 ............................60autopen ....................................... 60AVONEX ................................... 88AVONEX PEN .......................... 88AVONEX PREFILLED ........... 88azathioprine ................................ 26azelastine hcl .............................. 82azithromycin ............................... 59b-1 ............................................... 95b1 natural ....................................95B-2-400 ....................................... 95bacitracin ..............................45, 82bacitracin zinc ............................ 45bacitracin-neomycin-polymyxin ..45bacitracin-polymyxin b ............... 82bacitra-neomycin-polymyxin-hc . 82baclofen .......................................81balsalazide disodium .................. 53BASIS OVERNIGHT ...............45b-complex balanced .................... 78b-complex/vitamin c ....................78BD ANGIOCATH AUTOGUARD .......................... 60BD AUTOSHIELD ................... 60BD AUTOSHIELD DUO ......... 60BD ECLIPSE SYRINGE ......... 60BD FIRST MIDCATH 18G/4FRX20CM ....................... 60BD FIRST MIDCATH 20G/3FRX20CM ....................... 60BD FIRST PICC 16G/5FRX65CM ....................... 60BD FIRST PICC 18G/4FRX65CM ....................... 61BD FIRST PICC 20G/3FRX65CM ....................... 61BD FIRST PICC 22G/2.8FRX50CM .................... 61BD FIRST PICC 26G/1.9FRX50CM .................... 61BD INSULIN SYR ULTRAFINE II .........................61BD INSULIN SYRINGE ..........61BD INSULIN SYRINGE HALF-UNIT ..............................61BD INSULIN SYRINGE MICROFINE .............................61BD INSULIN SYRINGE U/F .. 61

BD INSULIN SYRINGE U-40 .61BD INSULIN SYRINGE ULTRAFINE .............................61BD INTEGRA INSULIN SYRINGE .................................. 61BD INTEGRA SYRINGE ........61BD L-CATH 16G/5FR ..............61BD L-CATH 16G/5FRX60CM 61BD L-CATH 18G/3.5FR ...........61BD L-CATH 18G/3.5FRX60CM .................... 61BD L-CATH 20G/2.6FR ...........61BD L-CATH 20G/2.6FRX60CM .................... 61BD L-CATH 20G/3FR ..............61BD L-CATH 20G/3FRX60CM 61BD L-CATH 28G/1.2FRX25CM .................... 61BD L-CATH MIDLINE 18G/3.5FRX20 ...........................62BD L-CATH MIDLINE 20G/3FRX20CM ....................... 62BD LUER-LOK SYRINGE ..... 62BD NEXIVA 18GX1.25" ..........62BD NEXIVA 18GX1.75" ..........62BD NEXIVA 20GX1" ...............62BD NEXIVA 20GX1.25" ..........62BD NEXIVA 20GX1.75" ..........62BD NEXIVA 22GX1" ...............62BD NEXIVA 24GX0.56" ..........62BD NEXIVA 24GX0.75" ..........62BD PEN NEEDLE MINI U/F .. 62BD PEN NEEDLE NANO U/F ..............................................62BD PEN NEEDLE ORIGINAL U/F ........................ 62BD PEN NEEDLE SHORT U/F ..............................................62BD SAFETYGLIDE INSULIN SYRINGE ................ 62BD SAFETY-LOK INSULIN SYRINGE .................................. 62BD SAFETY-LOK SET ........... 62BD SAFETY-LOK VACUTAINER SET .................62BD SAF-T E-Z SET .................. 62BD SAF-T-INTIMA 18G X 1" 62BD SAF-T-INTIMA 20GX1" .. 62BD SAF-T-INTIMA 22G X 0.75" ........................................... 62BD SAF-T-INTIMA 22GX3/4" ................................... 62

BD SAF-T-INTIMA 24G X 0.75" ........................................... 62BD SAF-T-INTIMA 24GX3/4" ................................... 62BD SYRINGE/NEEDLE .......... 62BD SYRINGE/NEEDLE SLIP TIP ....................................62BD VACUTAINER SET .......... 62benazepril hcl ..............................18benazepril-hydrochlorothiazide ..18benfotiamine ............................... 95benzonatate ................................. 33BENZ-O-STHETIC ..................77benzoyl peroxide ......................... 45benzoyl peroxide cleanser ...........45benzoyl peroxide wash ................45benzoyl peroxide-erythromycin ...45benztropine mesylate ...................22benzyl alcohol ............................. 87benzyl benzoate ...........................29betamethasone dipropionate .......45betamethasone dipropionate aug .............................................. 45betamethasone valerate .............. 45BETASERON ............................89betaxolol hcl ................................83bethanechol chloride ...................93bicalutamide ............................... 21BICARSIM ................................53BICARSIM FORTE ................. 53BICILLIN C-R ..........................87BICILLIN C-R 900/300 ............87bimatoprost ................................. 83biobron sf .................................... 33biodesp dm .................................. 33biogtuss ....................................... 33bionatuss dxp .............................. 33bionel .......................................... 33bionel pediatric ...........................33biospec dmx .................................33biotin ..................................... 95, 96biotin 5000 .................................. 95biotin forte .................................. 95biovol .......................................... 78bisacodyl ..................................... 57bisacodyl ec .................................57bismuth ..................................14, 15bisoprolol fumarate .................... 26bisoprolol-hydrochlorothiazide .. 18BLEPHAMIDE S.O.P. ............. 83BLINK TEARS ......................... 83B-NATAL .................................. 96

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bp cleansing ................................ 45bp cleansing wash .......................45bpm-dm-phen .............................. 33BPROTECTED VITAMIN C ..96BRAINSTRONG PRENATAL .............................. 78BRASIVOL ............................... 45BREO ELLIPTA ........................ 8BRILINTA ...........................51, 54brimonidine tartrate ....................83bromocriptine mesylate ...............22bronchial asthma relief ...............33BRONCOTRON PED .............. 33BRONCOTRON PED DROPS .......................................33BRONCOTRON-S ....................33BRONKAID .............................. 33bronkids ...................................... 33brotapp dm ..................................33budesonide .................................... 8buffasal ......................................... 4buffered aspirin .............................4buffered vitamin c ....................... 96bumetanide ..................................51bupropion hcl ..............................11bupropion hcl er (smoking det) ...89bupropion hcl er (sr) ...................11bupropion hcl er (xl) ...................11buspirone hcl ................................ 7butalbital-acetaminophen ............. 4butalbital-apap-caff-cod ............... 4butalbital-apap-caffeine ............... 4butalbital-asa-caff-codeine ...........4butalbital-aspirin-caffeine ............ 4BYSTOLIC ................................26cal/mag ....................................... 73CALAGESIC .............................45CALCET CREAMY BITES ....73calcitonin (salmon) ..................... 51cal-citrate plus vitamin d ............ 73calcitriol ......................................51calcium ........................................74calcium + d3 ............................... 73calcium 1000 + d ........................ 73calcium 500 + d .......................... 73calcium 500/d ........................73, 74calcium 500+d ............................ 74calcium 500+d high potency ...... 74calcium 600/vitamin d .................74calcium 600+d ............................ 74calcium 600+d3 .......................... 74calcium acetate (phos binder) .....53

calcium antacid ultra ....................6calcium ascorbate .......................96calcium carbonate .......................74calcium carbonate antacid ............6calcium carbonate-vitamin d ...... 74calcium citrate ............................ 74calcium citrate + d ......................74calcium citrate + d3 ....................74calcium citrate malate-vit d ........ 74calcium citrate+d3 petites .......... 74calcium citrate-vitamin d ............74calcium citrate-vitamin d3 ..........74calcium magnesium 750 ..............74calcium pantothenate ..................96calcium plus vitamin d ................ 74calcium/vitamin d3 gummies ...... 74calcium-carb 600 + d ................. 74calcium-magnesium .................... 74calcium-vitamin d ....................... 74calcium-vitamin d3 ............... 74, 75cal-mag aspartate ....................... 75CAL-MAG CHELA-MAX .......75calmag thins ................................75CAL-QUICK ............................. 75camphor spirit .............................29capcof ..........................................33capecitabine ................................21capmist dm .................................. 33capron dm ................................... 33capsaicin ..................................... 45captopril ......................................18captopril-hydrochlorothiazide ....18CAPZASIN ................................45carbamazepine ............................10carbamazepine er ........................10CARBAPHEN CH .................... 33CARBAPHEN PED CH ........... 33carbidopa ....................................22carbidopa-levodopa ....................22carbidopa-levodopa er ................22CAREFINE PEN NEEDLES ...62careone insulin syringe ...............63careone unifine pentips ...............63careone unifine pentips plus ....... 63carteolol hcl ................................ 83CARTIA XT .............................. 27carvedilol .................................... 27CASTIVA WARMING ............ 45CCP CAFFEINE FREE ........... 33cefaclor ....................................... 28cefadroxil .................................... 28cefdinir ........................................28

cefpodoxime proxetil ...................28cefprozil ...................................... 28CEFTIN ..................................... 28ceftriaxone sodium ......................29cefuroxime axetil .........................29celecoxib ....................................... 2CELLCEPT ...............................26CENTRUM SPECIALIST PRENATAL .............................. 78cephalexin ................................... 29CERTUSS-D ..............................33cetirizine hcl ................................16cetirizine-pseudoephedrine er .....33chelated magnesium ....................75CHEMET ...................................15cheratussin ac ............................. 33cheratussin dac ........................... 33cherry ..........................................87cherry concentrate ...................... 87chest congestion daytime ............ 33chest congestion relief pe ............33chest congestion/pain & sinus .... 34child chewable vitamins/iron ......78childrens cough ...........................34childrens cough/runny nose ........34childrens gummies ...................... 78childrens multivitamin ................ 78childrens plus cold ......................34childrens plus cold & allergy ..... 34childrens plus flu .........................34childrens silfedrine ..................... 81CHILDRENS SOOTHE .............6CHLO TUSS ..............................34chlo tuss ex ..................................34chlophed ......................................34chlordiazepoxide hcl .....................7chlorhexidine gluconate ........29, 77chloroform .................................. 29chloroquine phosphate ................20chlorothiazide ............................. 51chlorpheniramine maleate .......... 16chlorpheniramine maleate er ......16chlorpropamide ...........................12chlorthalidone .............................51chlorzoxazone ............................. 81cholestyramine ............................17cholestyramine light ....................17choline & mag trisalicylate .......... 4choline-mag trisalicylate .............. 4ciclopirox .................................... 45cilostazol ..................................... 54CILOXAN ................................. 83

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cimetidine ....................................91cimetidine hcl ..............................91ciprofloxacin hcl ............. 53, 83, 86citalopram hydrobromide ........... 12citric acid-sodium citrate ............54CITROCARBONATE ................6clarithromycin .............................60CLARITIN CHILDRENS ........16CLEAN & CLEAR ACNE CONTROL ................................ 45clemastine fumarate ....................17CLEOCIN ..................................94clickfine pen needles ................... 63clindamycin hcl ...........................20clindamycin palmitate hcl ...........20clindamycin phosphate ......... 45, 94CLINICAL NUTRIENTS PRENATAL .............................. 79clobetasol propionate ................. 45clonazepam ................................. 10clonidine hcl ................................18clopidogrel bisulfate ................... 54clorazepate dipotassium ............... 7clotrimazole .................... 45, 46, 77clotrimazole 3 ............................. 94clotrimazole-7 ............................. 94clotrimazole-betamethasone ....... 46clozapine ..................................... 22codeine sulfate .............................. 4codituss dm ................................. 34colchicine ....................................54colchicine-probenecid .................54cold & cough childrens ...............34cold & cough day/night child ..... 34cold & cough daytime .................34cold & flu nighttime/daytime ...... 34cold & flu relief nighttime d ........34cold & flu severe daytime ........... 34cold control pe cold/flu med ....... 34cold head congestion daytime .....34cold head congestion nighttime .. 34cold multi-symptom day/night .....34cold multi-symptom warm night . 34cold relief plus ............................ 34cold/flu relief ...............................34cold/flu relief day/night ...............34cold/flu relief nighttime ...............34colestipol hcl ...............................18COMFORT EZ INSULIN SYRINGE .................................. 63COMFORT EZ PEN NEEDLES ..................................63

COMPLERA ............................. 24COMPLETE FORMULATION PEDIATRIC ..............................79complete natal dha ......................79complete prenatal/dha ................ 79complete protein/vitamin shake .. 50complete sinus relief ................... 34CONEX COLD/ALLERGY .... 35CONTAC COLD+FLU MAX ST ............................................... 35cool mist humidifier .................... 63CORICIDIN HBP CONGESTION/COUGH ......... 35CORICIDIN HBP DAY/NIGHT COLD .................35CORICIDIN NIGHTTIME COLD-COUGH ........................ 35CORNWALL METAL PIPETTING .............................. 63CORRECTOL HERBAL TEA ............................................ 57cortisone acetate .........................31CORTISPORIN ........................ 46CORTIZONE-10/ALOE .......... 46CORVITA ................................. 79cottonseed oil .............................. 29cough & cold ...............................35cough & sore throat nighttime ....35cough daytime/nighttime .............35CREON ......................................50CRIXIVAN ................................24cromolyn sodium ...................81, 83CRYOSERV ..............................29CULTURELLE DIGESTIVE HEALTH ............................. 14, 15CURITY ALCOHOL PREPS . 63cvs allergy childrens ................... 17cvs antacid & anti-gas .................. 6cvs antacid supreme ......................6cvs biotin .....................................96cvs calcium ..................................75cvs cortisone cooling relief .........46cvs cough & sore throat child .....35cvs esomeprazole magnesium ..... 91cvs gas relief drops ex st .............53cvs heartburn relief ex st ...............6cvs hydrocortisone acetate ..........46cvs lubricant drops ..................... 83cvs mini enema kids .................... 58cvs nasal allergy spray ............... 81cvs natural fiber supplement .......58

cvs non-drying sinus pe ...............35cvs oyster shell calcium+vit d .....75cvs prenatal gummy .............. 79, 88cvs targeted acne spot .................46cvs vitamin c ................................96cyanocobalamin ..........................55cyclobenzaprine hcl .................... 81CYCLOMYDRIL ..................... 83cyclopentolate hcl ....................... 83cyclophosphamide .......................21cyclosporine ................................26cyclosporine modified .................26cyproheptadine hcl ......................17CYTO B2 ................................... 96cytra k crystals ............................54cytra-2 .........................................54CYTRA-3 ...................................54cytra-k ......................................... 54d 1000 ......................................... 96d 5000 ......................................... 96daily multiple vitamins/min .........79DAILY PAK MAXIMUM MULTIVITAMIN .....................79daily vitamin plus ........................79daily-vitamin ............................... 79DALLERGY ..............................35dapsone ....................................... 20DARAPRIM .............................. 20darifenacin hydrobromide er ......93day time pe cold/flu relief ........... 35daytime cold & cough childrens . 35DAYTIME COLD MEDICINE ............................... 35DELSYM CGH/CLD NIGHTTIME CHILD .............. 35DELTUSS DMX ........................35DELTUSS DP ............................35DENOREX DUAL FORCE ..... 46DENTS TOOTHACHE ............78denture adhesive ......................... 63DESGEN DM ............................ 35DESGEN PEDIATRIC ............ 35desmopressin ace spray refrig .... 52desmopressin acetate .................. 52desmopressin acetate spray ........ 52desogestrel-ethinyl estradiol .......30desonide ...................................... 46despec dm ....................................35despec-dm ................................... 35DEWEES CARMINATIVE .......6dexamethasone ............................31

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DEXAMETHASONE INTENSOL ................................31dexamethasone sodium phosphate ....................................83dexchlorpheniramine maleate .....17dexmethylphenidate hcl .................1dextroamphetamine sulfate ...........1dextroamphetamine sulfate er .......1dextromethorphan-guaifenesin ... 35DIABETIC TUSSIN COLD & FLU ............................................ 35DIABETIC TUSSIN NIGHT COLD/FLU ................................36DIALYVITE SUPREME D ..... 79DIASTAT ACUDIAL ...............10diazepam ................................. 7, 10diclofenac potassium .................... 2diclofenac sodium ............. 2, 46, 83diclofenac sodium er .....................2dicloxacillin sodium ....................87dicyclomine hcl ........................... 91didanosine ...................................24DIFFERIN ................................. 46diflorasone diacetate .................. 46diflunisal ....................................... 4digoxin ........................................ 28DILANTIN ................................ 10diltiazem cd .................................27diltiazem hcl ................................27diltiazem hcl er ........................... 27diltiazem hcl er beads ................. 27diltiazem hcl er coated beads ......27dilt-xr .......................................... 27dimenhydrinate ........................... 15DIMETAPP LONG ACT COUGH/COLD .........................36dimethyl sulfoxide ....................... 29diocto .......................................... 58diphenhist ....................................17diphenhydramine hcl ...................17diphenhydramine hcl (sleep) .......57diphenhydramine-apap (sleep) ... 57diphenoxylate-atropine ............... 15dipyridamole ............................... 54disopyramide phosphate ............... 8disulfiram ....................................89DIURIL ......................................51divalproex sodium .......................10divalproex sodium er .................. 10docosanol ....................................46docusate calcium .........................58docusate sodium ..........................58

DOCUSOL MINI ......................58DOCUSOL PLUS MINI-ENEMA ..................................... 58DOLOGEN ................................36dometuss-da/children ..................36dometuss-dmx ..............................36donepezil hcl ............................... 89DORIBAX ................................. 20dorzolamide hcl .......................... 83dorzolamide hcl-timolol mal .......83doxazosin mesylate ..................... 18doxepin hcl ..................................12doxycycline hyclate ..................... 90doxycycline monohydrate ........... 90doxylamine-phenylephrine ..........36DRAMAMINE .......................... 16dronabinol ...................................16drug mart unifine pentips ............63drug mart unifine pentips plus ....63duane reade unifine pentips ........63DULERA ..................................... 8duloxetine hcl ..............................12DURAVENT PE ........................36ear drops .....................................86ear wax cleansing ....................... 86EASIVENT ................................63EASIVENT MASK LARGE ....63EASIVENT MASK MEDIUM 63EASIVENT MASK SMALL ....63easy comfort insulin syringe ....... 63easy comfort pen needles ............ 63EASY TOUCH FLURINGE ....63EASY TOUCH INSULIN SAFETY SYR ............................63EASY TOUCH INSULIN SYRINGE .................................. 64EASY TOUCH PEN NEEDLES ..................................64EASY TOUCH SAFETY SYRINGE .................................. 64econazole nitrate .........................46ed bron gp ................................... 36ED CHLORPED ....................... 17ED CHLORPED D ................... 36ed-a-hist dm ................................ 36EDURANT .................................24efavirenz ......................................24effaclar duo .................................46ELDERTONIC ......................... 79ELIGARD ..................................21elite ca/mg ...................................75ELITE IRON .............................55

elite-thin insulin syringe ............. 64ELLA ......................................... 30EMTRIVA ................................. 24enalapril maleate ........................ 18enalapril-hydrochlorothiazide ....19ENBREL ......................................2ENBREL SURECLICK ............. 2ENDACOF-DM .........................36ENDACON ................................ 36enoxaparin sodium ......................10entacapone ..................................22ENTEX LQ ................................36ENTEX T ...................................36entre-cough ................................. 36epinastine hcl .............................. 83epinephrine ................................. 95EPITOL ..................................... 11EPIVIR HBV .............................24EPOGEN ................................... 55eq allergy/sinus headache ...........36eq childrens cold .........................36eq cold plus ................................. 36eq cold relief complete ................36eq cold/cough plus ...................... 36eq daytime cold/flu relief ............ 36eq flu & severe cold & cough ..... 36eq flu relief ..................................36eq flu/severe cold/congestion ......36EQ GENTLE LUBRICANT ....83eq lubricating eye drops ............. 83eq nasal allergy ...........................82eq night time cold & cough .........36eq nite time cold/flu relief ........... 36eq nitetime cold/flu ms relief .......36eq non-drying sinus .....................37eq sinus congestion & pain .........37eq triacting cold/allergy ............. 37eql calcium/vitamin d ..................75eql childrens multivitamins .........79eql congestion relief ....................37eql gummies childrens ................ 79eql insulin syringe .......................64eql short pen needle .................... 64eql ultra comfort insulin syr ....... 64eql ultra short pen needle ........... 64eql vitamin d-3 high potency .......75EQUALACTIN ......................... 58ERLEADA .................................21erythromycin ......................... 46, 83escitalopram oxalate ...................12esomeprazole magnesium ........... 91estazolam .................................... 57

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estradiol ................................ 52, 94estradiol-norethindrone acet ...... 52estropipate .................................. 52eszopiclone ..................................57ethambutol hcl ............................ 20ether ............................................ 29ethosuximide ............................... 11ethyl alcohol ................................29ethyl alcohol (rubbing) ............... 29ethyl chloride ........................ 46, 91EUCERIN ..................................46eugenol ........................................29EVAC-U-GEN ...........................58EXCEL COMFORT POINT PEN NEEDLE ...........................64EXEL COMFORT POINT INSULIN SYR ...........................64EXODERM ............................... 46EXTAVIA ..................................89eye allergy relief ......................... 83eye drops .....................................83eye drops allergy relief ............... 83eye lubricant ............................... 83ezetimibe ..................................... 18EZFE 200 ...................................55E-Z-GAS II .................................. 6famciclovir .................................. 24famotidine ................................... 91famotidine premixed ................... 91felodipine er ................................ 27FEMIRON ................................. 55FENESIN DM IR ......................37fenofibrate ...................................18fenofibrate micronized ................ 18fenoprofen calcium ....................... 2fentanyl ......................................... 4ferretts .........................................55ferretts chewable iron ................. 55ferretts ips ................................... 55FERRIMIN 150 .........................55ferrous aspartate .........................55ferrous fumarate ......................... 55ferrous gluconate ........................ 55ferrous sulfate ............................. 55ferrous sulfate er .........................55fexofenadine hcl .......................... 17fexofenadine hcl childrens .......... 17FIASP .........................................13FIASP FLEXTOUCH .............. 13fiber laxative ............................... 58fiber therapy ................................58FIFTY50 PEN NEEDLES ........64

FIFTY50 SUPERIOR COMFORT SYR ...................... 64finasteride ................................... 54first aid antibiotic ....................... 46FIRST-LANSOPRAZOLE ...... 91FIRST-OMEPRAZOLE .......... 91FIRST-PROGESTERONE VGS 100 ..................................... 95FIRST-PROGESTERONE VGS 200 ..................................... 95FIRST-PROGESTERONE VGS 25 ....................................... 95FIRST-PROGESTERONE VGS 400 ..................................... 95FIRST-PROGESTERONE VGS 50 ....................................... 95FIRST-VANCOMYCIN 25 ......54FIRST-VANCOMYCIN 50 ......54FIRVANQ ..................................54FLAREX ....................................83FLAVOR BLEND .....................87flavor plus ................................... 87flavor sweet .................................87flavor sweet-sf .............................87flecainide acetate .......................... 8FLEET BISACODYL .............. 58FLEET NATURALS CLEANSING ENEMA ...............5FLINTSTONES TODDLER ....79FLOVENT DISKUS ................... 8FLOVENT HFA ..........................9flu & sore throat ......................... 37flu/severe cold & cough day ....... 37FLUAD .......................................93FLUARIX QUADRIVALENT 94FLUCELVAX ........................... 94fluconazole ..................................16fludrocortisone acetate ............... 31fluid administration set ............... 64FLULAVAL QUADRIVALENT ................... 94fluocinolone acetonide ................46fluocinolone acetonide body ....... 46fluocinolone acetonide scalp ...... 46fluocinonide ................................ 46fluocinonide-e ............................. 46fluorometholone ..........................83fluorouracil ................................. 46fluoxetine hcl ...............................12fluphenazine hcl .......................... 22flurazepam hcl ............................ 57flurbiprofen ................................... 2

flurbiprofen sodium .................... 83flutamide ..................................... 21fluticasone propionate .......... 47, 82fluticasone-salmeterol ...................9FLUVIRIN .................................94FLUVIRIN PRESERVATIVE FREE ..........................................94fluvoxamine maleate ................... 12FLUZONE HIGH-DOSE .........94FLUZONE QUADRIVALENT ................... 94FML ........................................... 83FOLGARD OS .......................... 79folic acid ..................................... 55FOLITAB 500 ........................... 55FORADIL AEROLIZER ...........9fosamprenavir calcium ............... 24fosinopril sodium ........................ 19fosinopril sodium-hctz ................ 19fosphenytoin sodium ................... 11freds pharmacy unifine pentip+ ..64freds pharmacy unifine pentips ...64FREESTYLE CONTROL SOLUTION ............................... 64FREESTYLE PRECISION INS SYR .....................................64fruit c ...........................................96FUNGOID TINCTURE ........... 47furosemide ...................................51gabapentin .................................. 11galantamine hydrobromide .........89GAS-X EXTRA STRENGTH ..53gauze sponge ...............................64GAVILYTE-C ...........................58GAVILYTE-G ...........................58GAVISCON .................................6GEL-TIN ................................... 78gemfibrozil .................................. 18GENCONTUSS .........................37GENGRAF ................................ 26GENOTROPIN ......................... 52GENOTROPIN MINIQUICK .52GENTAK ................................... 84gentamicin sulfate .................47, 84GENTEAL MILD .....................84geri-mucil ....................................58glatiramer acetate .......................89GLATOPA .................................89GLEOSTINE .............................21glimepiride ..................................13glipizide .......................................13glipizide xl ...................................13

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glipizide-metformin hcl ...............13global ease inject pen needles .... 64global inject ease insulin syr ...... 65GLUCAGON EMERGENCY . 13GLUCOCARD EXPRESSION CONTROL ......65GLUCOCARD EXPRESSION TEST ................50GLUCOCARD VITAL TEST . 50GLUCOPRO INSULIN SYRINGE .................................. 65glyburide ..................................... 13glyburide micronized .................. 13glyburide-metformin ................... 13glycerin ................................. 29, 47glycerin (adult) ........................... 58glycerin (infants & children) ...... 58glycerin adult .............................. 58glycerine ......................................29glycerol formal ............................29glycine soya extract .................... 29glycine soya protein ....................29glycopyrrolate .............................91gnp 24 hour nasal allergy ...........82gnp alcohol denatured ................ 29gnp calcium 500 +d3 .................. 75gnp clickfine pen needles ............ 65gnp foaming antacid ..................... 6gnp insulin syringe ......................65gnp night time sinus .................... 37gnp peppermint spirit ..................29gnp sodium silicate ..................... 29gnp ultra com insulin syringe ..... 65GOLYTELY ..............................58GONIOTAIRE ..........................84GOODSENSE ESOMEPRAZOLE ...................91goodsense nasal allergy spray ....82G-P-TUSS DXP .........................37GRANDPAS THYLOX SOAP ..........................................47granisetron hcl ............................16granulderm ................................. 47grape syrup ................................. 87griseofulvin microsize .................16griseofulvin ultramicrosize ......... 16G-TRON PEDIATRIC DROPS .......................................37guaiacol ...................................... 29guaifenesin ..................................37guaifenesin dm ............................ 37guaifenesin er ..............................37

guaifenesin-dm ............................37guanfacine hcl .............................19guanfacine hcl er .......................... 1GYNAZOLE-1 .......................... 95G-ZYNCOF ............................... 37H 468L TUBING .......................65halobetasol propionate ............... 47haloperidol ..................................22haloperidol decanoate ................ 22HC DERMAPAX ...................... 47healthwise mini pen needles ....... 65healthwise pen needles ................65healthwise short pen needles ...... 65healthwise unifine pentips ...........65healthy accents unifine pentip .....65HEALTHY MAMA BE WELL ROUNDED ................... 79heartburn antacid ex st ................. 6heartburn treatment 24 hour ...... 91h-e-b incontrol pen needles .........65HEMATOGEN FORTE ...........55hemorrhoidal ................................ 5heparin sodium (porcine) ............10heparin sodium (porcine) pf ....... 10HERBAL EXPEC .....................37HEXALEN .................................21high potency iron .................. 55, 56HISTEX-DM ............................. 37HISTEX-PE ...............................37hist-pse ........................................37hm esomeprazole magnesium dr .91hm iron ........................................56HM ULTICARE INSULIN SYRINGE .................................. 65homatropine hbr ......................... 84HONEY BEARS W/IRON-ZINC .......................................... 79HUBER INFUSION SET ......... 65HUMAPEN LUXURA HD .......65HUMATROPEN FOR 12MG ..65HUMATROPEN FOR 24MG ..65HUMATROPEN FOR 6MG ....65HUMIRA ..................................... 2HUMIRA PEDIATRIC CROHNS START .......................2HUMIRA PEN ............................ 2HUMIRA PEN-CD/UC/HS STARTER ................................... 2HUMIRA PEN-PS/UV/ADOL HS START ...................................2hydralazine hcl ............................19hydrochlorothiazide ....................51

HYDROCIL .............................. 58hydrocod polst-cpm polst er ....... 37hydrocodone-acetaminophen ........4hydrocodone-homatropine ..........37hydrocortisone .................. 5, 31, 47hydrocortisone max st .................47hydrocortisone valerate .............. 47hydrocortisone-acetic acid ......... 86hydrocortisone-aloe ....................47hydromorphone hcl .......................4hydroxychloroquine sulfate .........20hydroxyprogesterone caproate ... 29hydroxyurea ................................ 21hydroxyzine hcl ............................. 7hydroxyzine pamoate .................... 7hyoscyamine sulfate .................... 92hyoscyamine sulfate er ................91HYPOTEARS ........................... 84ibandronate sodium .................... 52ibuprofen .......................................2ibu-profen cold/sinus .................. 37ibuprofen pm ...............................57IFEREX 150 .............................. 56imatinib mesylate ........................ 21imipramine hcl ............................ 12IMODIUM A-D .........................15INCRUSE ELLIPTA ..................9indapamide ................................. 51INDOCIN .....................................2indomethacin .................................2infants pain relief ..........................4infusion set .................................. 65infusion set 23" comfort ..............65inject-ease ................................... 65INJECT-EASE AUTOMATIC INJECTOR ..... 66INSUFLON ................................66insulin syringe .............................66insulin syringe/needle ................. 66insupen pen needles .................... 66INSUPEN SENSITIVE ............ 66INSUPEN ULTRAFIN .............66INSYTE AUTOGUARD 14GX1.75" ................................. 66INSYTE AUTOGUARD 18GX1.16" ................................. 66INSYTE AUTOGUARD 20GX1" ...................................... 66INSYTE AUTOGUARD 20GX1.16" ................................. 66INSYTE AUTOGUARD 22GX1" ...................................... 66

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INSYTE AUTOGUARD 24GX3/4" ................................... 66INTELENCE .............................24intense cough reliever .................37INTERLINK INJECT SITE/LUER LOC ..................... 66INTRON A ................................ 21INVIRASE .................................24INVOKAMET ...........................89INVOKAMET XR .................... 89INVOKANA .............................. 13ipratropium bromide ...............9, 82irbesartan ....................................19irbesartan-hydrochlorothiazide ..19iron ..............................................56iron (ferrous gluconate) ..............56iron chews pediatric ................... 56iron complex ............................... 56IRON UP ....................................56ISENTRESS .............................. 24isoniazid ......................................20isopropyl alcohol ........................ 30isopropyl alcohol (rubbing) ........30isopropyl alcohol wipes .............. 47isopropyl palmitate ..................... 30ISOPTO CARBACHOL .......... 84ISOPTO HOMATROPINE ..... 84ISOPTO TEARS .......................84isosorbide dinitrate .......................7isosorbide dinitrate er ...................7isosorbide mononitrate ................. 7isosorbide mononitrate er .............7isradipine .................................... 28ivermectin ......................................7JANTOVEN .............................. 10JANUMET .................................13JANUMET XR ..........................13JANUVIA .................................. 13JARDIANCE .............................13JINTELI .................................... 52KALETRA .................................24KANGAROO BURETTE SET .............................................66KELNOR 1/35 ...........................30ketoconazole ..........................16, 47ketoprofen ..................................... 2ketorolac tromethamine .......... 2, 84KETOSTIX ............................... 50ketotifen fumarate ....................... 84kinray insulin syringe ................. 66KIONEX .............................. 26, 88KLOR-CON M15 ......................75

kmart valu insulin syringe 29g ... 66kmart valu insulin syringe 30g ... 66KONSYL ................................... 58konsyl daily fiber .........................58KONSYL-D ............................... 58K-PHOS ..................................... 75K-PHOS NO 2 ........................... 54kpn prenatal ................................ 79kroger insulin syringe ................. 66kroger pen needles ...................... 66K-TAB ........................................75L606 TUBING ...........................66L609 TUBING ...........................66labetalol hcl ................................ 27LAC-HYDRIN FIVE ................47lactic acid ....................................47lactic acid e .................................47lactulose ......................................58lactulose encephalopathy ............53lamivudine ...................................24lamivudine-zidovudine ................24lamotrigine ..................................11lansoprazole ................................92LANTUS .................................... 13LANTUS SOLOSTAR ............. 13latanoprost ..................................84laxative pills ................................58lc-4 lidocaine .............................. 47leader insulin syringe ................. 66LEADER UNIFINE PENTIPS ................................... 67LEADER UNIFINE PENTIPS PLUS ........................ 67leflunomide ................................... 2letrozole ...................................... 21leucovorin calcium ......................21LEUKERAN ..............................21LEVEMIR ................................. 13LEVEMIR FLEXTOUCH .......13levetiracetam ...............................11levobunolol hcl ............................84levocetirizine dihydrochloride .... 17levofloxacin .................................53levonorgest-eth estrad 91-day .... 30levonorgestrel ............................. 30levonorgestrel-ethinyl estrad ...... 30levothyroxine sodium .................. 90LEVOXYL .................................90LEXINAL .................................. 96LEXIVA .....................................24lexuss 210 ....................................37lice killing maximum strength .....47

lice solution .................................47lice treatment .............................. 47LICEMD ....................................47LICIDE TREATMENT ........... 47lidocaine ..................................... 48lidocaine hcl ..........................48, 78lidocaine hcl (pf) .........................59lidocaine viscous .........................78lidocaine-prilocaine ....................48lindane ........................................ 48liothyronine sodium .................... 90LIQUID C 500 ...........................96liquid calcium with d3 ................ 75LIQUIMAT ............................... 48liquituss gg ..................................37lisinopril ......................................19lisinopril-hydrochlorothiazide ....19LITE TOUCH PEN NEEDLES ..................................67LITETOUCH INSULIN SYRINGE .................................. 67LITETOUCH PEN NEEDLES ..................................67lithium carbonate ........................23lithium carbonate er ................... 22LITTLE REMEDIES FOR COLDS .......................................38LITTLE TEETHERS PAIN RELIEF ..................................... 78live better pen needles .................67LMX 4 ........................................ 48LODRANE D ............................ 38LOHIST-D .................................38longs insulin syringe ................... 67loperamide hcl ............................ 15lopinavir-ritonavir ...................... 24loratadine ....................................17loratadine allergy relief ..............17loratadine childrens ....................17loratadine-d 12hr ........................38loratadine-d 24hr ........................38lorazepam ..................................... 7LORTAB ..................................... 4LORTUSS DM .......................... 38LORTUSS LQ ...........................38losartan potassium ......................19losartan potassium-hctz .............. 19LOTRIMIN AF .........................48lovastatin .....................................18LOW-OGESTREL ................... 30loxapine succinate .......................23

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LTXF PRIM CNV PIN MICRODRIP ............................ 67LTXF PRIM IV SET/CNVT PIN ............................................. 67LTXF SECONDARY/CNV PIN/32INC ................................. 67lubricant eye drops ..................... 84LUFYLLIN ..................................9LUPRON DEPOT (1-MONTH) ................................... 21LUPRON DEPOT (3-MONTH) ................................... 21LUPRON DEPOT (4-MONTH) ................................... 21LUPRON DEPOT-PED (1-MONTH) ................................... 52m2 magnesium ............................ 75M2 POTASSIUM ......................96MAG64 .......................................75mag-al ........................................... 6MAGELLAN INSULIN SAFETY SYR ............................67MAGINEX .................................75MAGINEX DS .......................... 75magnesium ............................ 75, 76magnesium aspartate .................. 75magnesium carbonate .................75magnesium chloride ....................75magnesium citrate .................58, 75magnesium gluconate ................. 75magnesium lactate ...................... 75magnesium oxide .....................6, 76magnesium oxide -mg supplement .................................. 76magnesium sulfate ...................... 76magnesium sulfate in d5w ...........76MAGONATE ............................ 76malathion .................................... 48MAOX ..........................................6MAR-COF BP ...........................38MATULANE ............................. 21MAVYRET ................................57meclizine hcl ............................... 16medic insulin syringe .................. 67medicine shoppe pen needles ......67medi-first hydrocortisone ............48medroxyprogesterone acetate...............................................30, 88MEDSAVER SYRINGE .......... 67mefloquine hcl .............................20MEGA MULTIVITAMIN ....... 79megestrol acetate ........................ 21

meijer pen needles ...................... 67meloxicam ..................................... 3memantine hcl .............................89m-end dmx ...................................38M-END PE .................................38MENEST ................................... 52meperidine hcl ...............................4mercaptopurine ...........................21mesalamine ................................. 53METADATE ER .........................1METAMUCIL ...........................59METAMUCIL MULTIHEALTH FIBER ........ 58METAMUCIL SMOOTH TEXTURE ................................. 59metaproterenol sulfate .................. 9metformin hcl .............................. 13metformin hcl er ..........................13methadone hcl ...........................4, 5methanol ..................................... 30methazolamide ............................ 51methenamine hippurate ...............92methenamine mandelate ............. 92methimazole ................................ 90methocarbamol ........................... 81methotrexate ................................21methotrexate sodium ...................22methotrexate sodium (pf) ............ 21methyclothiazide ......................... 51methyl alcohol .............................30methyldopa ..................................19methylergonovine maleate .......... 86methylphenidate hcl ...................... 1methylphenidate hcl er ..................1methylphenidate hcl er (cd) .......... 1methylprednisolone .....................32metipranolol ................................84metoclopramide hcl .....................53metolazone .................................. 51metoprolol succinate er .............. 27metoprolol tartrate ......................27metoprolol-hydrochlorothiazide . 19metronidazole ................. 20, 48, 95MI-ACID ......................................6miconazole 3 ............................... 95miconazole 3 combo pack ........... 95miconazole 7 ............................... 95miconazole nitrate ...................... 48miconazorb af ............................. 48MICROGESTIN 1.5/30 ............30MICROGESTIN FE 1.5/30 ......31midodrine hcl .............................. 95

migraine relief .............................. 4minocycline hcl ........................... 90minoxidil ..................................... 19mirtazapine ................................. 12misoprostol ................................. 92modafinil ....................................... 1moexipril hcl ............................... 19mometasone furoate ....................48MONOJECT INSULIN SYRINGE .................................. 67MONOJECT LIFESHIELD SYRINGE .................................. 67MONOJECT MAGELLAN SYRINGE .................................. 67MONOJECT ULTRA COMFORT SYRINGE ............ 67montelukast sodium ...................... 9MOORE MONO INSULIN SYRINGE .................................. 68morphine sulfate ........................... 5morphine sulfate (concentrate) .....5morphine sulfate er ....................... 5ms insulin syringe ....................... 68MUCINEX CHILD MS DAY-NIGHT CLD ..............................38MUCINEX COUGH FOR KIDS ...........................................38MUCINEX FAST-MAX CONGEST COUGH .................38MUCINEX FOR KIDS .............38MUCINEX SINUS-MAX DAY/NIGHT ............................. 38mucus d ....................................... 38mucus relief cold flu throat .........38mucus relief cold/sinus max st .... 38mucus relief d ..............................38mucus relief severe congst/cgh ... 38mucus-dm ....................................38mucus-dm max ............................ 38multi-delyn .................................. 79multi-delyn/iron .......................... 79multi-purpose solution ................ 84multivitamins ...............................79multivitamins pediatric ............... 79mupirocin ....................................48MURO 128 .................................84mycophenolate mofetil ................ 26MYKIDZ IRON ........................ 79MYKIDZ IRON 10 ................... 56MYLERAN ................................22MYNATAL ................................79mynatal plus ................................79

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mynate 90 plus ............................ 79nabumetone ...................................3nadolol ........................................ 27naloxone hcl ................................15naltrexone hcl ............................. 15NANOVM T/F .....................79, 80naphazoline hcl ...........................84naproxen ....................................... 3NAPROXEN COMFORT PAC .............................................. 3naproxen dr ...................................3naproxen sodium ...........................3naratriptan hcl ............................ 73NASACORT ALLERGY 24HR .......................................... 82nasal allergy 24 hour ..................82nasal decongestant ......................82nasal mist .................................... 38NASOPEN ................................. 38NASOPEN PE ........................... 39NATALVIT ............................... 80nateglinide .................................. 13natural fiber laxative .................. 59natural psyllium seed ..................59natural senna laxative .................59NATURE-THROID ..................90NECON 0.5/35 (28) ................... 31NECON 1/35 (28) ...................... 31NECON 1/50 (28) ...................... 31NECON 10/11 (28) .................... 31NECON 7/7/7 .............................31neomycin sulfate ........................... 1neomycin-bacitracin zn-polymyx ....................................... 84neomycin-polymyxin-dexameth ...84neomycin-polymyxin-gramicidin 84neomycin-polymyxin-hc ........ 84, 86NEO-POLYCIN HC .................84NEOSPORIN ESSENTIALS TRIAL PK ................................. 48NEOTUSS PLUS ...................... 39NEOTUSS-D ............................. 39NERIA 29G INFUSION SET 10MM .........................................68NERIA 29G INFUSION SET 6MM ...........................................68NERIA 29G INFUSION SET 8MM ...........................................68NERIA MULTI 27G 2X10MM ....................................68NERIA MULTI 27G 3X10MM ....................................68

NERIA MULTI 27G 4X12MM ....................................68NERIA SOFT 25G INFUSION 13MM .................... 68NERIA SOFT 25G INFUSION 17MM .................... 68NEURO-K-250 T.D. ..................96NEUTROGENA CLEAR PORE ......................................... 48nevirapine ................................... 24nevirapine er ...............................24NEXAFED ................................. 82niacin .......................................... 96niacin er ...................................... 96niacinamide .................................96NIACOR .................................... 18nicardipine hcl ............................ 28nicotine ....................................... 89nicotine mini ............................... 89nicotine polacrilex ...................... 89NICOTROL ...............................89NICOTROL NS ........................ 89nifedipine .................................... 28nifedipine er ................................ 28nifedipine er osmotic release ...... 28nighttime cough .......................... 39nighttime pain plus sleep ............ 39nimodipine .................................. 28nite-time cold/flu relief ............... 39NITRO-BID .................................7nitrofurantoin ..............................93nitrofurantoin macrocrystal ........92nitrofurantoin monohyd macro ...93nitroglycerin ................................. 7nitroglycerin er ............................. 7NIVANEX DMX ....................... 39NOBLE MYSTIQUE EMU-LAC ............................................48nohist-lq ...................................... 39non-pseudo cold relief ................ 39NORDIPEN 5 INJECTION DEVICE .....................................68NORDIPEN DELIVERY SYSTEM ....................................68NORDITROPIN FLEXPRO ... 52NOREL AD ............................... 39norethin ace-eth estrad-fe ...........31norethindrone ............................. 31norethindrone acetate .................88norethindrone acet-ethinyl est .... 31norethindrone-eth estradiol ........ 52norgestimate-eth estradiol .......... 31

NORPACE CR ............................8nortriptyline hcl .......................... 12nortuss-ex ....................................39NORVIR .............................. 24, 25NOVAFERRUM 50 .................. 56NOVAFERRUM PEDIATRIC DROPS ............... 56NOVOFINE ...............................68NOVOFINE AUTOCOVER ....68NOVOFINE PLUS ....................68NOVOLIN 70/30 ....................... 14NOVOLIN 70/30 RELION ...... 13NOVOLIN N ............................. 14NOVOLIN N RELION .............14NOVOLIN R ............................. 14NOVOLIN R RELION .............14NOVOLOG ............................... 14NOVOLOG FLEXPEN ............14NOVOLOG MIX 70/30 ............ 14NOVOLOG MIX 70/30 FLEXPEN ..................................14NOVOPEN ECHO ....................68NOVOTWIST ........................... 68np thyroid ....................................90NUOX .........................................48NUTRATEAR ........................... 84nystatin ............................16, 48, 78nystatin-triamcinolone ................48OBSTETRIX DHA ................... 80OBSTETRIX EC ...................... 80OC8 ............................................ 48O-CAL PRENATAL ................ 80ofloxacin ......................... 53, 85, 86olanzapine ...................................23olmesartan medoxomil ................19olopatadine hcl ........................... 85omeprazole ..................................92omeprazole-sodium bicarbonate .92OMNIFLEX DIAPHRAGM ....68OMNITROPE PEN 10 INJ DEVICE .....................................68OMNITROPE PEN 5 INJ DEVICE .....................................68ondansetron ................................ 16ondansetron hcl .......................... 16ONE-A-DAY WOMENS PRENATAL .............................. 80ONETOUCH DELICA LANCETS 33G ......................... 68ONETOUCH DELICA LANCETS FINE .......................68

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ONETOUCH ULTRA CONTROL ................................ 68ONETOUCH VERIO .........50, 68OPERAND POVIDONE-IODINE ......................................95ORA-BLEND ............................ 88ORA-BLEND SF .......................88ORACIT .................................... 54ORA-FILM ................................78oral analgesic max st .................. 78oral anesthetic ............................ 78ORAL MIX ................................88ORAL MIX SF ..........................88oral suspend ................................88oral syrup ....................................88oral syrup sf ................................ 88ORAMAGIC PLUS .................. 78ORA-PLUS ................................88ORA-SWEET ............................88ORA-SWEET SF ...................... 88ORAZINC ................................. 76ORTHO DIAPHRAGM ALL-FLEX ..........................................68ORTHO DIAPHRAGM COIL .......................................... 68ORTHO DIAPHRAGM FLAT ..........................................68oseltamivir phosphate .................25OSTEO-PORETICAL ............. 76OSTIGEN .................................. 76oxaprozin ...................................... 3oxazepam ...................................... 7oxcarbazepine ............................. 11oxybutynin chloride .....................93oxybutynin chloride er ................ 93oxycodone hcl ............................... 5oxycodone-acetaminophen ............5oxycodone-aspirin .........................5OXYTROL ................................ 93OXYTROL FOR WOMEN ..... 93OYSCO 500+D .......................... 76oyster shell calcium plus d ..........76oyster shell calcium/d ................. 76OZEMPIC ................................. 14pa prenatal formula .................... 80paba ............................................ 96PANATUSS PED ...................... 39PANATUSS PED DROPS ........39PANCREAZE ........................... 50pancrelipase (lip-prot-amyl) .......50PANOXYL-8 CREAMY WASH ........................................ 48

panto-250 ....................................96pantoprazole sodium ...................92pantothenic acid ..........................96paroxetine hcl ............................. 12parva-cal .....................................76pc unifine pentips ........................69PCCA SWEET-SF .................... 88PCCA SYRUP VEHICLE ....... 88PCCA-PLUS ..............................88PECGEN DMX ......................... 39PEDIACARE CHILD ALLERGY/COLD ....................39PEDIA-LAX .............................. 59PEDIALYTE ............................. 76pediatric cough/cold ................... 39peg 3350 ......................................59peg 3350/electrolytes .................. 59PEGINTRON ............................ 25PEG-INTRON ...........................25PEG-INTRON REDIPEN ........25PEG-INTRON REDIPEN PAK 4 .........................................25pen needles ..................................69pen needles 1/2" ..........................69pen needles 3/16" ........................69pen needles 5/16" ........................69penicillin v potassium ................. 87pentoxifylline er .......................... 55PEPCID AC MAXIMUM STRENGTH .............................. 92peppermint spirit .........................30PERFECT IRON ...................... 56PERIOMED .............................. 78permethrin .............................48, 49perphenazine ...............................23PERRY PRENATAL ................80PERTZYE ................................. 50phenazopyridine hcl ....................54phenelzine sulfate ........................12phenobarbital ..............................57phenobarbital-belladonna alk .... 92phenylephrine-chlorphen-dm ......39phenylephrine-dm-gg .................. 39phenylhistine dh .......................... 39phenytoin .....................................11phenytoin sodium ........................ 11phenytoin sodium extended .........11PHOSPHA 250 NEUTRAL ..... 76PHOSPHOLINE IODIDE ....... 85phosphorus supplement .............. 76phytonadione ...............................96pilocarpine hcl ............................ 78

pindolol ....................................... 27pine tar ........................................30pink bismuth ................................15pink bismuth maximum strength . 15pinnacaine otic ............................86PIN-X ........................................... 7pioglitazone hcl ...........................14pioglitazone hcl-metformin hcl ... 14piroxicam ...................................... 3plastic adapter ............................ 69podofilox ..................................... 49poly vitamin ................................ 80polyethylene glycol 3350 ...... 59, 88poly-hist dm ................................ 39poly-hist pd ................................. 39poly-iron 150 forte ......................56polymyxin b-trimethoprim ...........85polysorbate 20 ............................ 30polysorbate 40 ............................ 30polysorbate 60 ............................ 30polysorbate 80 ............................ 30poly-tussin ac .............................. 39POLY-VENT DM ..................... 39POLY-VENT IR ....................... 39polyvitamin ................................. 80polyvitamin/iron ..........................80pot bicarb-pot chloride ............... 76POTABA ....................................96potassium bicarbonate ................76potassium chloride ......................77potassium chloride crys er ..........76potassium chloride er ........... 76, 77potassium citrate-citric acid ....... 54povidone-iodine .......................... 23PR NATAL 400 ......................... 80PR NATAL 430 ......................... 80pramipexole dihydrochloride ......22PRAMOSONE .......................... 49prasugrel hcl ...............................55pravastatin sodium ......................18prazosin hcl .................................19PRECISION SUREDOSE PLUS SYR ................................. 69PRECISION SURE-DOSE SYRINGE .................................. 69PRECISION XTRA KETONE ................................... 50PRED MILD ..............................85prednicarbate ..............................49prednisolone ............................... 32prednisolone acetate ...................85

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prednisolone sodium phosphate...............................................32, 85prednisone ...................................32preferred plus insulin syringe .....69preferred plus unifine pentips .....69PREMARIN .............................. 52PREMPHASE ........................... 53PREMPRO ................................ 53PRENATA ................................. 80prenatabs fa ................................ 80prenatal .......................................80prenatal 19 ..................................80prenatal complete ....................... 80prenatal formula ......................... 80prenatal formula a-free ...............80prenatal multi +dha ....................80PRENATAL MULTIVITAMIN + DHA ....... 80prenatal plus ............................... 80prenatal plus iron ....................... 80prenatal vitamins ........................ 80prenatal/omega-3/fa/iron ............80prenatal+dha .............................. 80PRENATAL-U .......................... 80pres gen pediatric ....................... 39PRETZ ....................................... 30PREZISTA ................................ 25PRILOSEC OTC ...................... 92primaquine phosphate ................ 20primidone ....................................11PRIMSOL ..................................20PRO:12 MOUSSE AL12 .......... 49probenecid .................................. 54probiotic-prebiotic ......................15pro-chlo .......................................39prochlorperazine .........................23prochlorperazine maleate ...........23PRO-CLEAR AC ......................39PROCRIT ..................................56PROCTOZONE-HC ...................5PRODIGY INSULIN SYRINGE .................................. 69PROFE .......................................56profe forte ................................... 80PROFERRIN ES .......................56promethazine hcl .........................17promethazine vc plain .................40promethazine vc/codeine .............40promethazine-codeine .................40promethazine-dm ........................ 40PRONTO ................................... 49propafenone hcl ............................ 8

propantheline bromide ................92proparacaine hcl .........................85propranolol hcl ........................... 27propranolol hcl er .......................27propranolol-hctz ......................... 19propylthiouracil .......................... 90PRO-RED AC ........................... 40PROTEXIN ............................... 96pseudoeph-bromphen-dm ............40pseudoephedrine hcl ................... 82pseudoephedrine hcl er ...............82pseudoephedrine-guaifenesin er . 40PULMOZYME ......................... 89purefe ob plus ............................. 80px extra short pen needles .......... 69px insulin syringe ........................69px mini pen needles .....................69px pen needle .............................. 69pyrazinamide ...............................20pyrethins-piperonyl butoxide ...... 49pyridostigmine bromide .............. 20pyrilamine-phenylephrine ...........40qc childrens vitamins/extra c ...... 80qc cold relief ............................... 40qc cold relief plus ........................40qc flu relief therapy night ........... 40qc medifin cp ...............................40qc natural vegetable ....................59qc pen needles .............................69qc unifine pentips ........................69q-pap ............................................. 4q-pap infants ................................. 4Q-TAPP ..................................... 40quetiapine fumarate .................... 23quetiapine fumarate er ................23quinapril hcl ................................19quinapril-hydrochlorothiazide ....19quinidine gluconate er .................. 8quinidine sulfate ............................8quinine sulfate .............................20QVAR ...........................................9QVAR REDIHALER ................. 9ra acne maximum ........................49ra acne treatment ........................49ra allergy multi-symptom ............40ra allergy multi-symptom night .. 40ra allergy plus sinus ....................40ra allergy relief childrens ........... 17ra baby care oral pain relief .......78ra calcium hi-cal/vitamin d .........77ra calcium-boron ........................ 77ra childrens cold & allergy .........40

ra cold & flu ................................40ra cold/cough sinus relief pe .......40ra col-rite .................................... 59ra ethyl alcohol ........................... 30ra first aid anti-itch spray ...........49ra flu maximum strength .............40ra glycerin child ..........................59ra insulin syringe ........................ 69ra laxative ................................... 59ra laxative extra strength ............59ra lice bedding ............................ 49ra lice egg remover .....................49ra lice solution ............................ 49ra nasal allergy ...........................82ra omeprazole-sodium bicarb .....92ra one daily ................................. 80ra pen needles ............................. 69ra pink bismuth ........................... 15ra probiotic digestive care ..........15ra severe cold/night cold&flu ..... 40ra severe cold/sinus relief pe ...... 40ra sinus congst/pain day/night ....40ra sleep aid ................................. 57ra sleep aid (diphenhydramine) ..57ra sleep-aid nighttime ................. 57ra sterile eye drops ..................... 85ra suphedrine day/night combo .. 40ra suphedrine pe ......................... 40ra tussin nighttime cough dm ......40ra vitamin c ................................. 96ra wart remover .......................... 49raloxifene hcl .............................. 52ramipril ....................................... 19ranitidine hcl ...............................92REDNESS RELIEF .................. 85redness relief max strength .........85redness reliever eye drops .......... 85reeses pinworm medicine ..............7REFENESEN CHEST CONG/PAIN RLF .................... 40refenesen plus ............................. 41REFRESH CELLUVISC ......... 85REFRESH LIQUIGEL ............ 85REFRESH OPTIVE ADVANCED PF ........................85REFRESH OPTIVE SENSITIVE ............................... 85relcof c ........................................ 41RELENZA DISKHALER ........ 25RELION INSULIN SYRINGE .................................. 69

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RELI-ON INSULIN SYRINGE .................................. 69RELION MINI PEN NEEDLES ..................................69RELION PEN NEEDLES ........70RELION SHORT PEN NEEDLES ..................................70RENAGEL .................................53RENAL ...................................... 81RESCON DM ............................ 41RESCRIPTOR .......................... 25resorcinol-sulfur ......................... 49RESPAIRE-30 ...........................41RETACRIT ............................... 56RETAINE MGD ....................... 85RHINOCORT ALLERGY ...... 82RHOGAM ULTRA-FILTERED PLUS .....................87RIBASPHERE .......................... 25ribavirin ...................................... 25riboflavin .....................................96RID ESSENTIAL LICE ELIMINATION ........................ 49rifampin .......................................20RIFATER .................................. 20rimantadine hcl ...........................25risedronate sodium ..................... 52risperidone ..................................23ritonavir ...................................... 25rizatriptan benzoate .................... 73ROBITUSSIN CHILD COUGH/COLD CF .................. 41ROBITUSSIN CHILD COUGH/COLD LA .................. 41ROBITUSSIN DAY/NIGHT VALUE PAK .............................41ROBITUSSIN PEAK COLD MULTI-SYM .............................41ROBITUSSIN PK COLD DAY/NGHT DM ....................... 41ROBITUSSIN PK COLD DAY/NGHT MS ........................41ropinirole hcl .............................. 22rosuvastatin calcium ...................18ru-hist d .......................................41rymed .......................................... 41SAFE TUSSIN PM ................... 41SAFELET IV CATHETER ..... 70SAFESNAP INSULIN SYRINGE .................................. 70SAFETY-GLIDE SYRINGE ... 70saline nasal spray ....................... 82

salsalate ........................................ 4SANTYL .................................... 49sb daytime sinus ..........................41sb insulin syringe ........................ 70sb natural fiber laxative ..............59sb severe cold congestion ........... 41scalp vein set ...............................70schnucks insulin syringe ............. 70SCHOOLTIME SHAMPOO ...49SCOOBY-DOO ONE A DAY ..81SCOT-TUSSIN DM .................. 41SCOT-TUSSIN SENIOR ......... 41sebex ............................................49selegiline hcl ............................... 22selenium sulfide .......................... 49SELZENTRY ............................ 25senna ........................................... 59senna laxative ............................. 59senna leaves ................................ 59senna-docusate sodium ...............59SENSIPAR .................................52SEREVENT DISKUS .................9sertraline hcl ...............................12sevelamer hcl .............................. 53sf 5000 plus ................................. 78SFROWASA ..............................53SHINGRIX ................................ 94SHOPKO UNIFINE PENTIPS ................................... 70silphen cough .............................. 17silver sulfadiazine ....................... 49simethicone ................................. 53simple syrup ................................ 88simvastatin .................................. 18SINADRIN PE COMPLETE SINUS REL ............................... 41sinus daytime/nighttime .............. 41sinus maximum strength ............. 41slow iron ..................................... 56slow release iron .........................56sm camphor spirit ....................... 30sm cough/runny nose childrens ...41sm esomeprazole magnesium ......92sm ibuprofren cold childrens ...... 41sm insulin syringe ....................... 70sm pain reliever sinus pe ............ 41sm redness relief ......................... 85sm slow release iron ................... 56sm tussin cf ..................................41sodium ascorbate ........................ 96sodium bicarbonate ................ 6, 30sodium chloride .............. 41, 54, 77

sodium chloride (hypertonic) ......85sodium chloride flush ..................77sodium fluoride ........................... 77sodium polystyrene sulfonate 26, 88sodium silicate ............................ 30sofosbuvir-velpatasvir .................57solifenacin succinate ...................93SOLUBLE FIBER THERAPY .................................59solution administration set ......... 70solution transfer device ...............70sonahist dm ................................. 41SOOTHE ................................... 85sotalol hcl ....................................27sotalol hcl (af) .............................27SPATONE PUR-ABSORB IRON ..........................................56spironolactone ............................ 51spironolactone-hctz .....................51stahist ad ...............................41, 42stavudine ..................................... 25STEP 2 ....................................... 49STERILE LUBRICANT .......... 85sterile water for irrigation .......... 26stress formula/iron ......................81stress formula/zinc ...................... 81STRIBILD ................................. 25STRIVERDI RESPIMAT .......... 9STUART ONE .......................... 81sucralfate .................................... 92SUDAFED PE DAY & NIGHT ....................................... 42SUDOGEST SINUS/ALLERGY ....................42sulfacetamide sodium ..................85sulfacetamide sodium (acne) ...... 49sulfacetamide sodium-sulfur .......49sulfacetamide-prednisolone ........85sulfadiazine ................................. 90sulfamethoxazole-trimethoprim .. 20sulfasalazine ............................... 53sulfurated lime ............................ 49sulindac .........................................3sumatriptan succinate .................73super b complex/vitamin c .......... 81super strength sinadrin ............... 42SUPERVITE EC .......................81supress a pediatric ......................42supress dm pediatric ................... 42SUPRESS-PE PEDIATRIC .....42sure comfort insulin syringe ....... 70sure comfort pen needles ............ 70

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SURE-FINE PEN NEEDLES .. 70SURE-JECT INSULIN SYRINGE .................................. 70SURE-T INFUSION SET 18" . 70SURE-T INFUSION SET 23" . 70SURE-T INFUSION SET 32" . 70surgical dressing .........................70SYMBICORT ..............................9SYMFI ....................................... 25SYMFI LO .................................25SYNAGIS ...................................87SYNATEK ................................. 81SYNJARDY ...............................90SYNJARDY XR ........................ 90SYNTHROID ............................ 90syringe luer slip .......................... 70syrpalta ....................................... 88SYRPALTA (RED) ...................88SYRSPEND SF ..........................88SYSTANE ..................................86SYSTANE OVERNIGHT THERAPY .................................86TABLOID ..................................22tacrolimus ................................... 26tamoxifen citrate ......................... 22tamsulosin hcl ............................. 54TANZEUM ................................14TARON-BC ............................... 81TAZTIA XT .............................. 28tbc ............................................... 49telmisartan .................................. 19temazepam .................................. 57tenofovir disoproxil fumarate ..... 25terazosin hcl ................................19terbinafine hcl .......................16, 49terbutaline sulfate ......................... 9terconazole ..................................95terpin hydrate ..............................42TERUMO INSULIN SYRINGE .................................. 71TERUMO SURGUARD INSULIN SYR ...........................71TERUMO SURGUARD2 SYRINGE .................................. 71testosterone cypionate ...................5testosterone enanthate .................. 5tg 10peh/380gfn .......................... 42tgq 15dm/5peh/2cpm ...................42tgq 30pse/150gfn/15dm ...............42tgq 30pse/3brm/15dm ................. 42tgt lubricant eye drops ................ 86THEO-24 ..................................... 9

theophylline ...................................9theophylline er .............................. 9theracaps cough/cold reliever .... 42THERAFLU MAX-D COLD & FLU ........................................ 42THERAFLU SEVERE COLD & COUGH .................................42THERAFLU SEVERE COLD DAYTIME ................................. 42THERANATAL COMPLETE 81therapeutic liquid ........................81THERATEARS PF ...................86thiamine ...................................... 97THINPRO INSULIN SYRINGE .................................. 71thiothixene ...................................23thyroid .........................................90ticlopidine hcl ............................. 55timolol maleate ..................... 27, 86TIMOPTIC OCUDOSE ...........86tinidazole .....................................20TIVICAY ................................... 25tizanidine hcl ...............................81tl icon .......................................... 56TOBRADEX ..............................86tobramycin .................................. 86tobramycin-dexamethasone ........ 86TOBREX ................................... 86todays health mini pen needles ... 71todays health pen needles ........... 71todays health short pen needle ....71tolterodine tartrate ......................93tolterodine tartrate er ................. 93topcare clickfine pen needles ......71topcare ultra comfort ins syr ...... 71topiramate ...................................11torsemide .....................................51TOUJEO SOLOSTAR ............. 14TOVIAZ .....................................93tramadol hcl ..................................5trandolapril .................................19tranylcypromine sulfate .............. 12travoprost ....................................86trazodone hcl ........................ 12, 89TRECATOR ..............................20TRESIBA FLEXTOUCH ........ 14tretinoin .......................................22TREXBROM .............................42triactin chest congestion ............. 42triamcinolone acetonide.............................49, 50, 78, 82, 90

TRIAMINIC CHEST/NASAL CONGEST .................................42TRIAMINIC COLD/ALLERGY CHILD ......42TRIAMINIC COLD/COUGH DAY TIME ................................ 42TRIAMINIC COUGH & SORE THROAT ....................... 42TRIAMINIC COUGH/RUNNY NOSE ..........17TRIAMINIC COUGH/SORE THROAT ................................... 42TRIAMINIC NIGHT TIME COLD/CGH ...............................42triamterene-hctz ..........................51triazolam ..................................... 57trifluoperazine hcl .......................23trifluridine ...................................86trigofen dm ..................................42trihexyphenidyl hcl ......................22TRILYTE .................................. 59trimethobenzamide hcl ................16trimethoprim ............................... 20trinatal rx 1 ................................. 81TRINESSA (28) .........................31TRINESSA LO ..........................31triple paste af .............................. 50TRISPEC DMX ........................ 42TRISPEC PSE PEDIATRIC ... 43TRIUMEQ .................................26tri-vit/fluoride ............................. 81tri-vitamin/fluoride ..................... 81TRIVORA (28) ..........................31trixaicin hp ..................................50tropicamide ................................. 86trospium chloride ........................93trospium chloride er ................... 93TRUEPLUS INSULIN SYRINGE .................................. 71TRUVADA ................................ 26trymine cg ................................... 43TUDORZA PRESSAIR ............10turpentine ....................................30TUSICOF ...................................43TUSNEL .................................... 43TUSNEL C ................................ 43TUSNEL PEDIATRIC .............43tussafex ex ...................................43tussafex-a .................................... 43tussin cf cough & cold ................ 43tussin cf max multi-symptom .......43tussin chest congestion ............... 43

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tussin cold/congestion .................43tussin cough ................................ 43tussin dm max ............................. 43tussi-pres b ..................................43TUSSLIN ................................... 43TUSSLIN PEDIATRIC ............43TYLENOL CHILDRENS COLD/STUFFY ........................ 43TYLENOL CHILDRENS PLUS CLD/CGH ...................... 43UDAMIN SP ..............................81ULTICARE INSULIN SAFETY SYR ............................71ULTICARE INSULIN SYRINGE .................................. 71ULTICARE MICRO PEN NEEDLES ..................................71ULTICARE MINI PEN NEEDLES ..................................71ULTICARE PEN NEEDLES ...72ULTICARE SHORT PEN NEEDLES ..................................72ULTICARE SYRINGE ............ 72ULTILET INSULIN SYRINGE SHORT ................... 72ULTILET PEN NEEDLE ........ 72ultra comfort insulin syringe ...... 72ultra-comfort insulin syringe ...... 72ultra-mega ...................................81ULTRA-THIN II INS SYR SHORT ...................................... 72ULTRESA ................................. 50undecylenic acid ......................... 30UNIFINE PENTIPS ..................72unifine pentips plus ..................... 72UNITHROID .............................91UPCAL D ...................................77urea ............................................. 50URO-MAG .................................. 6ursodiol ....................................... 53VACUTAINER TUBING ........ 72valacyclovir hcl ...........................26valproic acid ............................... 11valsartan ..................................... 19valsartan-hydrochlorothiazide ... 20value health insulin syringe ........ 72valumark pen needles ..................72VANACOF APE ....................... 43VANACOF G ............................ 43VANACOF GPE ....................... 43VANACOF-8 ............................. 43VANATAB DX ..........................43

vancomycin hcl ..................... 20, 54VANISHPOINT 18GX1-1/4" FEP .............................................72VANISHPOINT 18GX1-1/4" PUR ............................................ 72VANISHPOINT 20GX1-1/4" FEP .............................................72VANISHPOINT 20GX1-1/4" PUR ............................................ 72VANISHPOINT 22GX1" FEP 72VANISHPOINT 22GX1" PUR ............................................ 72VANISHPOINT 24GX3/4" FEP .............................................72VANISHPOINT 24GX3/4" PUR ............................................ 72VANISHPOINT INSULIN SYRINGE .................................. 72VANISHPOINT SYRINGE .....72vaporizing steam .........................43VASOCLEAR-A ....................... 86VASOLEX ................................. 50VAZOBID-PD ........................... 44VELIVET .................................. 31venlafaxine hcl ............................ 12venlafaxine hcl er ........................12VENTOLIN HFA ......................10verapamil hcl .............................. 28verapamil hcl er ..........................28VERSAFREE ............................ 88VERSAPLUS .............................88VESICARE ................................93VIBRAMYCIN ..........................90VICKS DAYQUIL MUCUS CONTROL DM ........................ 44VICKS DAYQUIL SEVERE COLD/FLU ................................44VICKS NATURE FUSION COLD & FLU ........................... 44VICKS NATURE FUSION CONGEST .................................44VICKS NYQUIL CHILDRENS CLD/CGH .........44VICKS NYQUIL COLD & FLU NIGHT .............................. 44VICTOZA ..................................14VIDA MIA UNIFINE PENTIPS ................................... 72VIDEX ....................................... 26VINATE II .................................81VINATE M ................................ 81VIOKACE ................................. 50

VIRACEPT ............................... 26virdec .......................................... 44virdec dm .....................................44VIREAD .....................................26virt-vite gt ....................................81VISINE TEARS ........................ 86vita-c ........................................... 97VITALINE BUFFERED ZINC-220 ................................... 77vitamin b1 ................................... 97vitamin b-1 .................................. 97vitamin b-12 ................................ 56vitamin b-2 .................................. 97vitamin b6 ................................... 97vitamin b-6 .................................. 97vitamin b-6 er ..............................97vitamin c ......................................97vitamin c (calcium ascorbate) .....97vitamin c drops ........................... 97vitamin c er ................................. 97vitamin c gummie ........................97vitamin c-electrolytes ..................81vitamin c-rose hips er ................. 97vitamin d (cholecalciferol) ..........97vitamin d (ergocalciferol) ........... 97vitamin d3 ................................... 97vitamin e ......................................97vitamin k (phytonadione) ............ 97vp insulin syringe ........................73V-R MONO INSULIN SYRINGE .................................. 73VYVANSE ................................... 1WAL-FLU COLD & SORE THROAT ................................... 44WAL-FLU SEVERE COLD DAYTIME ................................. 44wal-som .......................................57warfarin sodium ..........................10warm mist vaporizer ................... 73wee care ...................................... 56wegmans unifine pentips plus ..... 73WESTHROID ........................... 91WIDE-SEAL DIAPHRAGM 60 ................................................ 73WIDE-SEAL DIAPHRAGM 65 ................................................ 73WIDE-SEAL DIAPHRAGM 70 ................................................ 73WIDE-SEAL DIAPHRAGM 75 ................................................ 73WIDE-SEAL DIAPHRAGM 80 ................................................ 73

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WIDE-SEAL DIAPHRAGM 85 ................................................ 73WIDE-SEAL DIAPHRAGM 90 ................................................ 73WIDE-SEAL DIAPHRAGM 95 ................................................ 73WP THYROID ..........................91XARELTO .................................10yl oyster shell calcium/d ............. 77zaleplon .......................................57ZARXIO .................................... 56ZEASORB-AF ...........................50ZENCHENT ..............................31ZENPEP .....................................51zidovudine ................................... 26zinc ..............................................81ZINC 15 ..................................... 77zinc sulfate .................................. 77ziprasidone hcl ............................23ZODRYL DEC 25 .....................44ZODRYL DEC 30 .....................44ZODRYL DEC 35 .....................44ZODRYL DEC 40 .....................44zolmitriptan .................................73zolpidem tartrate .........................57zolpidem tartrate er .................... 57zonisamide .................................. 11ZOSTAVAX .............................. 94ZOVIA 1/50E (28) .....................31Z-TUSS AC ................................44ZYNCOF ................................... 44

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