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2014 Comprehensive Dual Preferred Drug List (List of Covered Drugs) WellCare of New Jersey 00 9 Please read: This document contains information about the drugs we cover in this plan. Last updated (01/01/2014)
39

MCD-NJ STAT 2 - WellCare...duratuss dm elixir su-tuss dm elixir mucus relief cough liquid diabetic tussin dm liquid simuc-dm elixir guaifenesin dm syrup q-tussin-dm syrup extra action

Feb 25, 2020

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Page 1: MCD-NJ STAT 2 - WellCare...duratuss dm elixir su-tuss dm elixir mucus relief cough liquid diabetic tussin dm liquid simuc-dm elixir guaifenesin dm syrup q-tussin-dm syrup extra action

2014 Comprehensive Dual Preferred Drug List (List of Covered Drugs)

WellCare of New Jersey

00 9

Please read: This document contains information about the drugs we cover in this plan. Last updated (01/01/2014)

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TESSALON 200 MG CAPSULE BENZONATATE 100 MG CAPSULE BENZONATATE 200 MG CAPSULE

DELSYM 30 MG/5 ML EXTENDED-RELEASE SUSPENSION

ROBITUSSIN PEDIATRIC COUGH SYP

DELSYM COUGH RELIEF PLUS LOZENGE

ALLANHIST PDX DROPS BROMHIST PDX DROPS BROTAPP DM LIQUID Q-TAPP DM ELIXIRBROMFED DM SYRUP ENDACOF-PD DROPS

COLD/COUGH CHILDRENS ELIXIRRYNEX DM DIMAPHEN DM ELIXIR

C-PHEN DM RONDEX-DM SYRUP DE-CHLOR DM LIQUID NOHIST-DM

PD-COF SYRUP SILDEC PE-DM SYRUP CORFEN DM TRI-DEX PE

PEDIATRIC COUGH-COLD LIQUID MESEHIST DMKIDKARE COUGH/COLD

VANACOF LIQUID

DIMETAPP LONG-ACTING COUGH LIQ ROBITUSSIN LONG ACTING LIQUID

PROMETHAZINE-DM SYRUP

DELSYM NIGHTTIME MULTI-SYMPTOM

DONATUSSIN DROPS PE-GUAI DROPS DESPEC LIQUID RESCON-GG LIQUID

Chlorpheniramine/Dextromethorphan HBr

Promethazine HCl/Dextromethorphan HBr

Guaifenesin/Phenylephrine HCl

EXPECTORANTS

NON-NARC ANTITUSS-1ST GEN. ANTIHIST-ANALGESIC COMBINATIONDextromethorphan HBr/Acetaminophen/Doxylamine

DECONGESTANT-EXPECTORANT COMBINATIONS

Dexchlorpheniramine/Pseudoephedrine HCl/Chlophedianol HCl

NON-NARC ANTITUSS-1ST GEN. ANTIHISTAMINE-DECONGESTBrompheniramine/Dextromethorphan HBr/Pseudoephedrine HCl

Brophenaramine/Dextromethorphan HBr/Phenylephrine HCl

Chlorpheniramine/Dextromethorphan HBr/Phenylephrine HCl

Chlorpheniramine/Dextromethorphan HBr/Pseudoephedrine HCl

WellCare of New Jersey Dual Eligible Medicaid Cough & Cold Drug List

Preferred Drugs

Benzonatate

Non-Preferred DrugsANTITUSSIVES,NON-NARCOTIC

Dextromethorphan HBr/Menthol

Dextromethorphan Polistirex

Dextromethorphan HBr

Last updated 01/01/14 Page 1 of 2

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WellCare of New Jersey Dual Eligible Medicaid Cough & Cold Drug List

Preferred DrugsNon-Preferred Drugs

ROBAFEN CF SYRUP

DURATUSS DM ELIXIR SU-TUSS DM ELIXIR MUCUS RELIEF COUGH LIQUID DIABETIC TUSSIN DM LIQUIDSIMUC-DM ELIXIR GUAIFENESIN DM SYRUP Q-TUSSIN-DM SYRUP

EXTRA ACTION COUGH SILTUSSIN DM COUGH SYRUPREFENESEN DM SILTUSSIN DM DAS COUGH SYRUPMUCOSA DM

TUSSIONEX PENNKINETIC SUSP TUSSICAPS (min. age 6 years old) HYDROCODONE-CHLORPHENIRAMINE SUSPENSION (min. age 6 years old)

CYTUSS-HC NR SYRUP HC/PE/DBROM SYRUP PROMETH VC W/COD SYRUP PROMETHAZINE VC/COD SYRUPHC 2.5-PE 5-DBROM 1 MG SYRUP

PHENYLHISTINE DH

HYDROMET SYRUP HYDROCODONE-HOMATROPINE

HYDROCODONE-GUAIFENESIN SYRUP CHERATUSSIN AC SYRUPNARCOF SYRUP TUSSICLEAR DH SYRUP GUAIFENESIN-CODEINE SYRUP IOPHEN C-NR

CHERATUSSIN DAC SYRUP

NARCOTIC ANTITUSSIVE-DECONGESTANT-EXPECTORANT COMBINATIONSCodeine Phosphate/Guaifenesin/Pseudoephedrine HCl

Dexbrompheniramine/Hydrocodone Bit/Phenylephrine HCl Codeine/Phenylephrine HCl/Promethazine

Pseudoephedrine HCl/Codeine/Chlorpheniramine

NARCOTIC ANTITUSSIVE-ANTICHOLINERGIC COMBINATIONHydrocodone Bit/Homatropine

Guaifenesin/Hydrocodone Bit Codeine Phosphate/Guaifenesin

Guaifenesin/Dextromethorphan HBr/Phenylephreine

NON-NARCOTIC ANTITUSSIVE AND EXPECTORANT COMB.Dextromethorphan HBr/Guaifenesin

ROBITUSSIN COUGH CHEST CONGESTION DM LIQUID

NARCOTIC ANTITUSSIVE-1ST GENERATION ANTIHISTAMINE

Codeine Phosphate/Promethazine HCl

Chlorpheniramine/Hydrocodone Polistirex

NARCOTIC ANTITUSSIVE-1ST GEN. ANTIHISTAMINE-DECONGESTANT

NARCOTIC ANTITUSSIVE-EXPECTORANT COMBINATION

NON-NARCOTIC DECONGESTANT-EXPECTORANT-ANTITUSSIVE

PROMETHAZINE-CODEINE SYRUP (min. age 6 years old)

Last updated 01/01/14 Page 2 of 2

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UPPERCASE = Brand name drugs italics = Generic drugs

Preference DetailsP = PreferredDagger (†) = N/AAsterisk (*) = N/AAsterisk (**) = N/AAsterisk (***) = N/AXX = N/A

Coverage DetailsPA = Prior AuthorizationST = Step TherapyQL = Quantity LimitAL = Age LimitOTC = OTC- Covered w/Rx

Drug Name Preference Details Coverage Details

*Analgesics - Anti-Inflammatory*

*Nonsteroidal Anti-Inflammatory Agents (Nsaids)**

*Nonsteroidal Anti-Inflammatory Agents (Nsaids)***

Childrens Ibuprofen ORAL SUSPENSION 40 MG/ML

P OTC

Ibuprofen ORAL SUSPENSION 100 MG/5ML

P OTC

Ibuprofen ORAL TABLET 200 MG P OTC

*Analgesics - Nonnarcotic*

*Analgesics Other**

*Analgesics Other***

Acetaminophen ORAL SOLUTION 160 MG/5ML

P OTC

Acetaminophen ORAL TABLET 325 MG P OTC; QL (279 EA per 31 day(s))

Acetaminophen ORAL TABLET 500 MG P OTC; QL (186 EA per 31 day(s))

Acetaminophen ORAL TABLET CHEWABLE80 MG

P OTC

APAP ORAL TABLET 325 MG P OTC; QL (279 EA per 31 day(s))

APAP Drops ORAL SOLUTION 100 MG/ML P OTC

1

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Drug Name Preference Details Coverage Details

APAP Extra Strength ORAL TABLET 500 MG

P OTC; QL (186 EA per 31 day(s))

Childrens Non-ASA Pain Relief ORAL TABLET CHEWABLE 80 MG

P OTC

Childrens Non-Aspirin ORAL TABLET CHEWABLE 80 MG

P OTC

Childrens Non-Aspirin Pain ORAL TABLET CHEWABLE 80 MG

P OTC

Childrens Pain Reliever ORAL TABLET CHEWABLE 80 MG

P OTC

Childrens Silapap ORAL LIQUID† 160 MG/5ML

P OTC

Childrens Tactinal ORAL TABLET CHEWABLE 80 MG

P OTC

Ed-APAP ORAL LIQUID† 160 MG/5ML P OTC

Mapap ORAL CAPSULE 500 MG P OTC; QL (186 EA per 31 day(s))

Mapap ORAL LIQUID† 160 MG/5ML P OTC

Mapap ORAL TABLET 325 MG P OTC; QL (279 EA per 31 day(s))

Mapap ORAL TABLET 500 MG P OTC; QL (186 EA per 31 day(s))

Mapap ORAL TABLET CHEWABLE 80 MG P OTC

Mapap Arthritis Pain ORAL TABLET EXTENDEDRELEASE* 650 MG

P OTC; QL (93 EA per 31 day(s))

MAPAP CHILDRENS ORAL SUSPENSION 160 MG/5ML

P OTC

Maxapap Maximum Strength ORAL TABLET500 MG

P OTC; QL (186 EA per 31 day(s))

Maxapap Regular Strength ORAL TABLET325 MG

P OTC; QL (279 EA per 31 day(s))

Non-Aspirin ORAL TABLET 325 MG P OTC; QL (279 EA per 31 day(s))

Non-Aspirin Extra Strength ORAL TABLET500 MG

P OTC; QL (186 EA per 31 day(s))

Non-Aspirin Pain Relief ORAL TABLET 325 MG

P OTC; QL (279 EA per 31 day(s))

Nortemp Infants ORAL SUSPENSION 80 MG/0.8ML

P OTC

Pain & Fever Childrens ORAL SOLUTION160 MG/5ML

P OTC

Pain Relief ORAL TABLET 500 MG P OTC; QL (186 EA per 31 day(s))

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Drug Name Preference Details Coverage Details

Pain Relief Extra Strength ORAL TABLET500 MG

P OTC; QL (186 EA per 31 day(s))

PHARBETOL ORAL TABLET 325 MG P OTC; QL (279 EA per 31 day(s))

PHARBETOL EXTRA STRENGTH ORAL TABLET 500 MG

P OTC; QL (186 EA per 31 day(s))

Q-PAP ORAL TABLET 325 MG P OTC; QL (279 EA per 31 day(s))

Tactinal ORAL TABLET 325 MG P OTC; QL (279 EA per 31 day(s))

Tactinal Extra Strength ORAL TABLET 500 MG

P OTC; QL (186 EA per 31 day(s))

*Salicylates**

*Salicylate Combinations***

Tri-Buffered Aspirin ORAL TABLET 325 MG P OTC

*Salicylates***

Aspirin ORAL TABLET 325 MG, 81 MG P OTC

Aspirin ORAL TABLET CHEWABLE 81 MG P OTC

Aspirin ORAL TABLET DELAYED RELEASE 81 MG

P OTC

Aspirin RE SUPPOSITORY 300 MG, 600 MG P OTC

Aspirin Childrens ORAL TABLET CHEWABLE 81 MG

P OTC

Aspirin EC ORAL TABLET DELAYED RELEASE 325 MG, 81 MG

P OTC

Aspirin EC Low Dose ORAL TABLET DELAYED RELEASE 81 MG

P OTC

Aspirin Low Dose ORAL TABLET 81 MG P OTC

ECPIRIN ORAL TABLET DELAYED RELEASE 325 MG

P OTC

*Antacids*

*Antacid Combinations**

*Antacid & Simethicone***

Alamag Plus ORAL TABLET CHEWABLE200-200-25 MG

P OTC

ALMACONE ORAL SUSPENSION 200-200-20 MG/5ML

P OTC

Antacid ORAL SUSPENSION 200-200-20 MG/5ML

P OTC

Antacid Anti-Gas ORAL SUSPENSION200-200-20 MG/5ML

P OTC

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Drug Name Preference Details Coverage Details

Antacid Anti-Gas Max Strength ORAL SUSPENSION 400-400-40 MG/5ML

P OTC

Antacid Extra Strength ORAL SUSPENSION400-400-40 MG/5ML

P OTC

Antacid I ORAL SUSPENSION 200-200-20 MG/5ML

P OTC

Antacid III ORAL SUSPENSION 400-400-40 MG/5ML

P OTC

Geri-Lanta ORAL SUSPENSION 200-200-20 MG/5ML

P OTC

MAALOX ADVANCED ORAL SUSPENSION 200-200-20 MG/5ML

P OTC

MAALOX ADVANCED MAX ST ORAL SUSPENSION 400-400-40 MG/5ML

P OTC

MAALOX MAX ORAL SUSPENSION 400-400-40 MG/5ML

P OTC

MAALOX MULTI SYMPTOM MAX ST ORAL SUSPENSION 400-400-40 MG/5ML

P OTC

MAALOX REGULAR STRENGTH ORAL SUSPENSION 200-200-20 MG/5ML

P OTC

Milantex ORAL SUSPENSION 200-200-20 MG/5ML

P OTC

Milantex Extra Strength ORAL SUSPENSION 400-400-40 MG/5ML

P OTC

MINTOX PLUS ORAL TABLET CHEWABLE 200-200-25 MG

P OTC

*Antacid Combinations***

ACID GONE ORAL TABLET CHEWABLE 160-105 MG, 80-20 MG

P OTC

MI-ACID ORAL TABLET CHEWABLE 700-300 MG

P OTC

*Antacids - Aluminum Salts**

*Antacids - Aluminum Salts***

Aluminum Hydroxide Gel ORAL SUSPENSION 320 MG/5ML

P OTC

*Antacids - Bicarbonate**

*Antacids - Bicarbonate***

Sodium Bicarbonate ORAL TABLET 325 MG, 650 MG

P OTC

*Antacids - Calcium Salts**

4

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Drug Name Preference Details Coverage Details

*Antacids - Calcium Salts***

Alcalak ORAL TABLET CHEWABLE 420 MG

P OTC

Antacid ORAL TABLET CHEWABLE 420 MG, 500 MG

P OTC

CAL-GEST ANTACID ORAL TABLET CHEWABLE 500 MG

P OTC

Calcium Antacid ORAL TABLET CHEWABLE 500 MG

P OTC

Calcium Antacid Extra Strength ORAL TABLET CHEWABLE 750 MG

P OTC

Calcium Carbonate Antacid ORAL TABLET648 MG

P OTC

Calcium Carbonate Antacid ORAL TABLET CHEWABLE 500 MG

P OTC

MAALOX ORAL TABLET CHEWABLE 600 MG

P OTC

TITRALAC ORAL TABLET CHEWABLE 420 MG

P OTC

*Antacids - Magnesium Salts**

*Antacids - Magnesium Salts***

Magnesium Oxide ORAL TABLET 250 MG, 400 MG, 420 MG

P OTC

*Anthelmintics*

*Anthelmintics**

*Anthelmintics***

Reeses Pinworm Medicine ORAL SUSPENSION 144 MG/ML

P OTC

*Antidiabetics*

*Diabetic Other**

*Diabetic Other***

BD GLUCOSE ORAL TABLET CHEWABLE 5 GM

P OTC

Glucose ORAL TABLET CHEWABLE 4 GM P OTC

Ultilet Glucose ORAL TABLET CHEWABLE4 GM

P OTC

*Antidiarrheals*

*Antidiarrheal Agents - Misc.**

*Antidiarrheal Agents - Misc.***

5

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Drug Name Preference Details Coverage Details

Bismatrol ORAL SUSPENSION 262 MG/15ML

P OTC

Bismatrol ORAL TABLET CHEWABLE 262 MG

P OTC

Bismuth ORAL TABLET CHEWABLE 262 MG

P OTC

Diotame ORAL TABLET CHEWABLE 262 MG

P OTC

Kao-Tin ORAL SUSPENSION 262 MG/15ML P OTC

KAOPECTATE ORAL SUSPENSION 262 MG/15ML

P OTC

KAOPECTATE EXTRA STRENGTH ORAL SUSPENSION 525 MG/15ML

P OTC

Pink Bismuth ORAL SUSPENSION 262 MG/15ML

P OTC

Pink Bismuth ORAL TABLET CHEWABLE262 MG

P OTC

Stomach Relief ORAL SUSPENSION 262 MG/15ML, 527 MG/30ML

P OTC

Stomach Relief ORAL TABLET CHEWABLE262 MG

P OTC

Stomach Relief Plus ORAL SUSPENSION525 MG/15ML

P OTC

*Antiperistaltic Agents**

*Antiperistaltic Agents***

Anti-Diarrheal ORAL LIQUID† 1 MG/5ML P OTC

LOPERAMIDE A-D ORAL TABLET 2 MG P OTC

Loperamide HCl ORAL LIQUID† 1 MG/5ML P OTC

*Antidotes*

*Antidotes**

*Antidotes***

Ipecac ORAL SYRUP P OTC

*Antiemetics*

*Antiemetics - Anticholinergic**

*Antiemetics - Anticholinergic***

Meclizine HCl ORAL TABLET 12.5 MG, 25 MG

P OTC

Travel Sickness ORAL TABLET CHEWABLE25 MG

P OTC

6

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Drug Name Preference Details Coverage Details

*Antihistamines*

*Antihistamines - Alkylamines**

*Antihistamines - Alkylamines***

Aller-Chlor ORAL SYRUP 2 MG/5ML P OTC

Aller-Chlor ORAL TABLET 4 MG P OTC

Allergy ORAL TABLET 4 MG P OTC

Allergy Relief ORAL TABLET 4 MG P OTC

ChlorHist ORAL TABLET 4 MG P OTC

Chlorphen ORAL TABLET 4 MG P OTC

DIABETIC TUSSIN ALLERGY ORAL SYRUP 2 MG/5ML

P OTC

*Antihistamines - Ethanolamines**

*Antihistamines - Ethanolamines***

Aler-Cap ORAL CAPSULE 25 MG P OTC

Aler-Dryl ORAL TABLET 50 MG P OTC

AlerTab ORAL TABLET 25 MG P OTC

Allergy Relief Childrens ORAL LIQUID† 12.5 MG/5ML

P OTC

Altaryl ORAL ELIXIR 12.5 MG/5ML P OTC

Altaryl ORAL SYRUP 12.5 MG/5ML P OTC

Anti-Hist ORAL CAPSULE 25 MG P OTC

Anti-Hist Allergy ORAL TABLET 25 MG P OTC

BANOPHEN ORAL CAPSULE 25 MG P OTC

BANOPHEN ORAL LIQUID† 12.5 MG/5ML

P OTC

BANOPHEN ORAL TABLET 25 MG P OTC

BENADRYL ALLERGY CHILDRENS ORAL LIQUID† 12.5 MG/5ML

P OTC

Complete Allergy Medication ORAL TABLET25 MG

P OTC

Complete Allergy Relief ORAL TABLET 25 MG

P OTC

Diphenhist ORAL CAPSULE 25 MG P OTC

Diphenhist ORAL LIQUID† 12.5 MG/5ML P OTC

Diphenhist ORAL TABLET 25 MG P OTC

DiphenhydrAMINE HCl ORAL CAPSULE 25 MG, 50 MG

P OTC

7

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Drug Name Preference Details Coverage Details

DiphenhydrAMINE HCl ORAL TABLET 25 MG

P OTC

DORMIN ORAL CAPSULE 25 MG P OTC

Genahist ORAL CAPSULE 25 MG P OTC

Pharbedryl ORAL CAPSULE 25 MG, 50 MG P OTC

Q-Dryl ORAL CAPSULE 25 MG P OTC

Q-Dryl ORAL LIQUID† 12.5 MG/5ML P OTC

Quenalin ORAL SYRUP 12.5 MG/5ML P OTC

SCOT-TUSSIN ALLERGY RELIEF ORAL LIQUID† 12.5 MG/5ML

P OTC

Siladryl Allergy ORAL LIQUID† 12.5 MG/5ML

P OTC

Silphen Cough ORAL SYRUP 12.5 MG/5ML P OTC

SIMPLY ALLERGY ORAL TABLET 25 MG

P OTC

Total Allergy ORAL TABLET 25 MG P OTC

TOTAL ALLERGY MEDICINE ORAL LIQUID† 12.5 MG/5ML

P OTC

*Antihistamines - Non-Sedating**

*Antihistamines - Non-Sedating***

ALLEGRA ALLERGY CHILDRENS ORAL TABLET 30 MG

P OTC

Allergy ORAL TABLET DISPERSIBLE 10 MG

P OTC

Cetirizine HCl ORAL SYRUP 5 MG/5ML P OTC; QL (300 ML per 31 day(s))

Cetirizine HCl ORAL TABLET 10 MG, 5 MG P OTC

Cetirizine HCl Childrens ORAL SOLUTION 1 MG/ML

P OTC; QL (300 ML per 31 day(s))

Cetirizine HCl Childrens Alrgy ORAL SYRUP1 MG/ML

P OTC; QL (300 ML per 31 day(s))

Childrens Loratadine ORAL SYRUP 5 MG/5ML

P OTC; QL (300 ML per 31 day(s))

Fexofenadine HCl ORAL TABLET 180 MG, 60 MG

P OTC

Loratadine ORAL TABLET 10 MG P OTC

Loratadine Hives Relief ORAL SOLUTION 5 MG/5ML

P OTC; QL (300 ML per 31 day(s))

*Antiseptics & Disinfectants*

8

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Drug Name Preference Details Coverage Details

*Chlorine Antiseptics**

*Chlorine Antiseptics***

Chlorhexidine Gluconate EXTERNAL LIQUID† 4 %

P OTC; QL (480 ML per 31 day(s))

*Iodine Antiseptics**

*Iodine Antiseptics***

OPERAND POVIDONE-IODINE EXTERNAL SOLUTION 10 %

P OTC

Povidone-Iodine EXTERNAL SOLUTION 10 %

P OTC

*Cough/Cold/Allergy*

*Cough/Cold/Allergy Combinations**

*Decongestant & Antihistamine***

ALAVERT ALLERGY/SINUS ORAL TABLET EXTENDED RELEASE 12 HR* 5-120 MG

P OTC

ALLEGRA-D ALLERGY & CONGESTION ORAL TABLET EXTENDED RELEASE 12 HR* 60-120 MG

P OTC

Allergy Relief/Nasal Decongest ORAL TABLET EXTENDED RELEASE 24 HR*10-240 MG

P OTC

Antihistamine Decongestant ORAL TABLET2.5-60 MG

P OTC

BROTAPP ORAL LIQUID† 1-15 MG/5ML P OTC

Cetirizine-Pseudoephedrine ER ORAL TABLET EXTENDED RELEASE 12 HR*5-120 MG

P OTC

Fexofenadine-Pseudoephed ER ORAL TABLET EXTENDED RELEASE 24 HR*180-240 MG

P OTC

Q-TAPP ORAL ELIXIR 1-15 MG/5ML P OTC

*Expectorants**

*Expectorants***

Chest Congestion Relief ORAL TABLET 400 MG

P OTC

Mucus Relief ORAL TABLET 400 MG P OTC

Refenesen ORAL TABLET 200 MG P OTC

Refenesen 400 ORAL TABLET 400 MG P OTC

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Drug Name Preference Details Coverage Details

Robafen ORAL SYRUP 100 MG/5ML P OTC

*Misc. Respiratory Inhalants**

*Misc. Respiratory Inhalants***

BRONCHO SALINE INHALATION AEROSOL, SOLUTION 0.9 %

P OTC

Sodium Chloride INHALATION NEBULIZATION SOLUTION 0.9 %

P OTC

*Dermatologicals*

*Acne Products**

*Acne Products***

Acne Medication 5 EXTERNAL LOTION 5 % P OTC

Benzoyl Peroxide EXTERNAL GEL 10 %, 5 % P OTC

*Antibiotics - Topical**

*Antibiotic Mixtures Topical***

Bacitracin-Neomycin-Polymyxin EXTERNAL OINTMENT 400-5-5000

P OTC

Double Antibiotic EXTERNAL OINTMENT500-10000 UNIT/GM

P OTC

Triple Antibiotic EXTERNAL OINTMENT3.5-400-5000 , 5-400-5000

P OTC

*Antibiotics - Topical***

Bacitracin EXTERNAL OINTMENT 500 UNIT/GM

P OTC

Bacitracin Zinc EXTERNAL OINTMENT 500 UNIT/GM

P OTC

*Antifungals - Topical**

*Antifungals - Topical***

Terbinafine HCl EXTERNAL CREAM 1 % P OTC

*Imidazole-Related Antifungals - Topical***

Baza Antifungal EXTERNAL CREAM 2 % P OTC

Clotrimazole EXTERNAL CREAM 1 % P OTC

Clotrimazole EXTERNAL SOLUTION 1 % P OTC

*Antihistamines-Topical**

*Antihistamines - Topical***

Allergy EXTERNAL CREAM 2 % P OTC

Anti-Itch Maximum Strength EXTERNAL CREAM 2 %

P OTC

10

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Drug Name Preference Details Coverage Details

BENADRYL ITCH STOPPING EXTERNAL GEL 2 %

P OTC

Itch Relief EXTERNAL CREAM 2 % P OTC

*Corticosteroids - Topical**

*Corticosteroids - Topical***

Hydrocortisone EXTERNAL CREAM 0.5 %, 1 %

P OTC

Hydrocortisone EXTERNAL LOTION 1 % P OTC

Hydrocortisone EXTERNAL OINTMENT 0.5 %, 1 %

P OTC

Hydrocortisone Max St EXTERNAL CREAM1 %

P OTC

Hydrocortisone Max St/12 Moist EXTERNAL CREAM 1 %

P OTC

HYDROSKIN EXTERNAL CREAM 1 % P OTC

PREPARATION H HYDROCORTISONE EXTERNAL CREAM 1 %

P OTC

*Topical Steroid Combinations***

Hydrocortisone-Aloe EXTERNAL CREAM 1 %

P OTC

*Emollients**

*Emollients***

AMLACTIN EXTERNAL LOTION 12 % POTC; QL (400 GM per 31 day(s))

Ammonium Lactate EXTERNAL CREAM 12 %

POTC; QL (400 GM per 31 day(s))

Ammonium Lactate EXTERNAL LOTION 12 %

POTC; QL (400 GM per 31 day(s))

*Keratolytic/Antimitotic Agents**

*Keratolytic/Antimitotic Agents***

CLEAR AWAY 1-STEP WART REMOVER EXTERNAL PAD 40 %

P OTC

COMPOUND W EXTERNAL LIQUID† 17 %

P OTC

COMPOUND W MAXIMUM STRENGTH EXTERNAL GEL 17 %

P OTC

FREEZONE EXTERNAL LIQUID† 17.6 % P OTC

SALACTIC FILM EXTERNAL SOLUTION 17 %

P OTC

11

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Drug Name Preference Details Coverage Details

*Local Anesthetics - Topical**

*Local Anesthetics - Topical***

Capsaicin EXTERNAL CREAM 0.025 % P OTC

*Scabicides & Pediculicides**

*Scabicides & Pediculicides***

Permethrin EXTERNAL LOTION 1 % P OTC; QL (60 ML per 31 day(s))

*Diagnostic Products*

*Diagnostic Tests**

*Diagnostic Tests***

Pregnancy Test IN VITRO DIAGNOSTIC TEST†

P OTC

*Gastrointestinal Agents - Misc.*

*Antiflatulents**

*Antiflatulents***

Mi-Acid Gas Relief ORAL TABLET CHEWABLE 80 MG

P OTC

Mytab Gas ORAL TABLET CHEWABLE 80 MG

P OTC

Simethicone ORAL SUSPENSION 40 MG/0.6ML

P OTC

Simethicone ORAL TABLET CHEWABLE 80 MG

P OTC

*Genitourinary Agents - Miscellaneous*

*Alkalinizers**

*Citrates***

Sodium Citrate ORAL GRANULES P

*Hematopoietic Agents*

*Cobalamins**

*Cobalamins***

Cyanocobalamin INJECTION SOLUTION1000 MCG/ML

P

Vitamin B-12 ORAL TABLET 1000 MCG, 500 MCG

P OTC

Vitamin B-12 SUBLINGUAL TABLET SUBLINGUAL 1000 MCG

P OTC

Vitamin B-12 ER ORAL TABLET EXTENDEDRELEASE* 1000 MCG

P OTC

*Folic Acid/Folates**

12

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Drug Name Preference Details Coverage Details

*Folic Acid/Folates***

Folic Acid ORAL TABLET 1 MG, 400 MCG, 800 MCG

P OTC

*Iron**

*Iron***

Ferro-Bob ORAL TABLET 325 (65 Fe) MG P OTC

Ferrous Sulfate ORAL ELIXIR 220 (44 Fe) MG/5ML

P OTC

Ferrous Sulfate ORAL TABLET 325 (65 Fe) MG

P OTC

Ferrous Sulfate ORAL TABLET DELAYED RELEASE 324 (65 Fe) MG, 325 (65 Fe) MG

P OTC

FerrouSul ORAL TABLET 325 (65 Fe) MG P OTC

Iron ORAL TABLET 325 (65 Fe) MG, 90 (18 Fe) MG

P OTC

POLY-IRON 150 ORAL CAPSULE 150 MG P OTC

Slow Release Iron ORAL TABLET EXTENDEDRELEASE* 160 (50 Fe) MG

P OTC

*Hypnotics*

*Antihistamine Hypnotics**

*Antihistamine Hypnotic Combinations***

Acetaminophen PM ORAL TABLET 500-25 MG

P OTC; QL (62 EA per 31 Day(s))

Headache PM ORAL TABLET 25-500 MG P OTC; QL (62 EA per 31 day(s))

Mapap PM ORAL TABLET 500-25 MG P OTC; QL (62 EA per 31 day(s))

Pain Relief PM Extra Strength ORAL TABLET 500-25 MG

P OTC; QL (62 EA per 31 day(s))

Pain Reliever PM ORAL TABLET 500-25 MG P OTC; QL (62 EA per 31 day(s))

*Antihistamine Hypnotics***

Compoz ORAL CAPSULE 50 MG P OTC

Compoz ORAL TABLET 50 MG P OTC

NYTOL ORAL TABLET 25 MG P OTC

SIMPLY SLEEP ORAL TABLET 25 MG P OTC

Sleep Tabs ORAL TABLET 25 MG P OTC

Sleep-Tabs ORAL TABLET 25 MG P OTC

SOMINEX ORAL TABLET 25 MG P OTC

SOMINEX MAXIMUM STRENGTH ORAL TABLET 50 MG

P OTC

13

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Drug Name Preference Details Coverage Details

Tetra-Formula Nighttime Sleep ORAL TABLET 50 MG

P OTC

*Laxatives*

*Bulk Laxatives**

*Bulk Laxatives***

Fiber ORAL TABLET 625 MG P OTC

Fiber Laxative ORAL TABLET 625 MG P OTC

Fiber Therapy ORAL POWDER 58.6 % P OTC

Fiber-Lax ORAL TABLET 625 MG P OTC

FIBERGEN ORAL TABLET 625 MG P OTC

KONSYL ORAL PACKET 100 % P OTC

KONSYL FIBER ORAL TABLET 625 MG P OTC

METAMUCIL ORAL CAPSULE 0.52 GM P OTC

METAMUCIL ORAL POWDER 30.9 % P OTC

METAMUCIL ORAL WAFER P OTC

METAMUCIL MULTIHEALTH FIBER ORAL POWDER 58.6 %

P OTC

METAMUCIL SMOOTH TEXTURE ORAL PACKET 28 %

P OTC

METAMUCIL SMOOTH TEXTURE ORAL POWDER 28.3 %, 58.6 %

P OTC

Natural Fiber Therapy ORAL POWDER 30.9 %, 48.57 %

P OTC

Natural Vegetable Fiber ORAL POWDER48.57 %

P OTC

REGULOID ORAL CAPSULE 0.52 GM P OTC

*Laxative Combinations**

*Laxatives & Dss***

DOC-Q-LAX ORAL TABLET 8.6-50 MG P OTC

PERI-COLACE ORAL TABLET 8.6-50 MG P OTC

Senna Plus ORAL TABLET 8.6-50 MG P OTC

Senna S ORAL TABLET 8.6-50 MG P OTC

Senna-Docusate Sodium ORAL TABLET8.6-50 MG

P OTC

Senna-S ORAL TABLET 8.6-50 MG P OTC

Senna-Time S ORAL TABLET 8.6-50 MG P OTC

SENNALAX-S ORAL TABLET 8.6-50 MG P OTC

14

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Drug Name Preference Details Coverage Details

Sennosides-Docusate Sodium ORAL TABLET8.6-50 MG

P OTC

*Laxatives - Miscellaneous**

*Laxatives - Miscellaneous***

Sorbitol ORAL SOLUTION 70 % P OTC

*Saline Laxatives**

*Saline Laxative Mixtures***

Enema RE ENEMA 7-19 GM/118ML P OTC

Phosphate Laxative ORAL SOLUTION0.9-2.4 GM/5ML

P OTC

*Saline Laxatives***

Citrate of Magnesia ORAL SOLUTION 1.745 GM/30ML

P OTC

CITROMA ORAL SOLUTION 1.745 GM/30ML

P OTC

DULCOLAX MILK OF MAGNESIA ORAL SUSPENSION 400 MG/5ML

P OTC

Magnesium Citrate ORAL SOLUTION 1.745 GM/30ML

P OTC

Milk of Magnesia ORAL SUSPENSION 400 MG/5ML, 7.75 %

P OTC

*Stimulant Laxatives**

*Stimulant Laxatives***

BISAC-EVAC ORAL TABLET DELAYED RELEASE 5 MG

P OTC

BISAC-EVAC RE SUPPOSITORY 10 MG P OTC

Biscolax RE SUPPOSITORY 10 MG P OTC

CARTERS LITTLE PILLS ORAL TABLET DELAYED RELEASE 5 MG

P OTC

Correct ORAL TABLET DELAYED RELEASE 5 MG

P OTC

CORRECTOL ORAL TABLET DELAYED RELEASE 5 MG

P OTC

Ducodyl ORAL TABLET DELAYED RELEASE 5 MG

P OTC

EX-LAX ORAL TABLET CHEWABLE 15 MG

P OTC

EX-LAX ULTRA ORAL TABLET DELAYED RELEASE 5 MG

P OTC

15

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Drug Name Preference Details Coverage Details

FEENAMINT ORAL TABLET DELAYED RELEASE 5 MG

P OTC

FLEET LAXATIVE ORAL TABLET DELAYED RELEASE 5 MG

P OTC

Gentle Laxative ORAL TABLET DELAYED RELEASE 5 MG

P OTC

Laxative RE SUPPOSITORY 10 MG P OTC

Magic Bullets RE SUPPOSITORY 10 MG P OTC

Natural Senna Laxative ORAL TABLET64.8-324 MG

P OTC

Senexon ORAL LIQUID† 8.8 MG/5ML P OTC

Senexon ORAL TABLET 8.6 MG P OTC

Senna ORAL SYRUP 8.8 MG/5ML P OTC

Senna ORAL TABLET 15 MG, 8.6 MG P OTC

Senna Lax ORAL TABLET 8.6 MG P OTC

Senna Laxative ORAL TABLET 8.6 MG P OTC

Senna Maximum Strength ORAL TABLET 25 MG

P OTC

SENNA SMOOTH ORAL TABLET 15 MG P OTC

Senna-Lax ORAL TABLET 8.6 MG P OTC

Senna-Tabs ORAL TABLET 8.6 MG P OTC

Senna-Time ORAL TABLET 8.6 MG P OTC

SENNACON ORAL TABLET 8.6 MG P OTC

SENNO ORAL TABLET 8.6 MG P OTC

Stimulant Laxative ORAL TABLET DELAYED RELEASE 5 MG

P OTC

Womens Laxative ORAL TABLET DELAYED RELEASE 5 MG

P OTC

*Surfactant Laxatives**

*Surfactant Laxatives***

CORRECTOL EXTRA GENTLE ORAL CAPSULE 100 MG

P OTC

D.O.S. ORAL CAPSULE 250 MG P OTC

Diocto ORAL LIQUID† 50 MG/5ML P OTC

Diocto ORAL SYRUP 60 MG/15ML P OTC

DocQLace ORAL CAPSULE 100 MG P OTC

Docu Soft ORAL CAPSULE 100 MG P OTC

16

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Drug Name Preference Details Coverage Details

Docusate Calcium ORAL CAPSULE 240 MG P OTC

Docusate Sodium ORAL CAPSULE 250 MG P OTC

Docusate Sodium ORAL TABLET 100 MG P OTC

DOCUSIL ORAL CAPSULE 100 MG P OTC

DOK ORAL CAPSULE 100 MG, 250 MG P OTC

DOK ORAL TABLET 100 MG P OTC

DSS ORAL CAPSULE 100 MG, 250 MG P OTC

DULCOLAX STOOL SOFTENER ORAL CAPSULE 100 MG

P OTC

Kao-Tin ORAL CAPSULE 240 MG P OTC

Laxa Basic ORAL CAPSULE 100 MG, 250 MG

P OTC

Silace ORAL LIQUID† 150 MG/15ML P OTC

Silace ORAL SYRUP 60 MG/15ML P OTC

SOF-LAX ORAL CAPSULE 100 MG P OTC

Stool Softener ORAL CAPSULE 100 MG, 250 MG

P OTC

Stool Softener Laxative DC ORAL CAPSULE240 MG

P OTC

Sur-Q-Lax ORAL CAPSULE 240 MG P OTC

SURFAK ORAL CAPSULE 240 MG P OTC

*Medical Devices*

*Contraceptives**

*Condoms - Male***

TROJAN RIBBED XX MISC P OTC

*Contraceptive Sponge***

TODAY SPONGE VAGINAL MISC P OTC

*Respiratory Therapy Supplies**

*Peak Flow Meters***

Peak Flow Meter XX DEVICE P OTC; QL (2 EA per 365 day(s))

*Respiratory Therapy Supplies***

ACE AEROSOL CLOUD ENHANCER XX MISC

P QL (2 EA per 365 day(s))

IN-CHECK DIAL FLOW TRAINER XX DEVICE

P QL (2 EA per 365 day(s))

Inhaler Companions XX MISC P OTC; QL (2 EA per 365 day(s))

PFLEX XX MISC P QL (2 EA per 365 day(s))

17

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Drug Name Preference Details Coverage Details

THRESHOLD IMT XX MISC P QL (2 EA per 365 day(s))

THRESHOLD PEP XX DEVICE P QL (2 EA per 365 day(s))

WINDMILL TRAINER XX MISC P QL (2 EA per 365 day(s))

*Spacer/Aerosol-Holding Chambers & Supplies***

AEROCHAMBER MV XX MISC P QL (2 EA per 365 day(s))

AEROCHAMBER PLUS FLO-VU XX MISC

P QL (2 EA per 365 day(s))

AEROCHAMBER PLUS FLO-VU LARGE XX MISC

P QL (2 EA per 365 day(s))

AEROCHAMBER PLUS FLO-VU SMALL XX MISC

P QL (2 EA per 365 day(s))

AEROCHAMBER PLUS FLO-VU W/MASK XX MISC

P QL (2 EA per 365 day(s))

AEROCHAMBER W/FLOWSIGNAL XX MISC

P QL (2 EA per 365 day(s))

AEROCHAMBER Z-STAT PLUS XX MISC P QL (2 EA per 365 day(s))

AEROCHAMBER Z-STAT PLUS CHAMBR XX MISC

P QL (2 EA per 365 day(s))

EASIVENT XX MISC P QL (2 EA per 365 day(s))

MICROCHAMBER XX MISC P QL (2 EA per 365 day(s))

MICROSPACER XX MISC P QL (2 EA per 365 day(s))

OPTICHAMBER ADVANTAGE XX MISC P QL (2 EA per 365 day(s))

OPTICHAMBER FACE MASK-LARGE XX MISC

P OTC; QL (2 EA per 365 day(s))

OPTICHAMBER FACE MASK-MEDIUM XX MISC

P OTC; QL (2 EA per 365 day(s))

OPTICHAMBER FACE MASK-SMALL XX MISC

P OTC; QL (2 EA per 365 day(s))

OPTIHALER XX DEVICE P QL (2 EA per 365 day(s))

OPTIHALER XX MISC P QL (2 EA per 365 day(s))

POCKET CHAMBER XX DEVICE P QL (2 EA per 365 day(s))

POCKET SPACER XX DEVICE P QL (2 EA per 365 day(s))

WATCHHALER XX DEVICE P QL (2 EA per 365 day(s))

*Minerals & Electrolytes*

*Calcium**

*Calcium Combinations***

Calcium ORAL TABLET 500-125 MG-UNIT P OTC

18

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Drug Name Preference Details Coverage Details

Calcium + D3 ORAL TABLET 600-200 MG-UNIT

P OTC

Calcium 600-D ORAL TABLET 600-400 MG-UNIT

P OTC

Calcium Carbonate-Vitamin D ORAL TABLET 500-400 MG-UNIT, 600-400 MG-UNIT

P OTC

Calcium High Potency/Vitamin D ORAL TABLET 600-200 MG-UNIT

P OTC

Calcium-Carb 600 + D ORAL TABLET600-125 MG-UNIT

P OTC

Calcium-Vitamin D ORAL TABLET 500-125 MG-UNIT, 600-125 MG-UNIT, 600-200 MG-UNIT

P OTC

CALTRATE 600+D ORAL TABLET 600-800 MG-UNIT

P OTC

Liquid Calcium/Vitamin D ORAL CAPSULE600-200 MG-UNIT

P OTC

OS-CAL 500 + D ORAL TABLET 500-200 MG-UNIT

P OTC

OYSCO 500+D ORAL TABLET 500-200 MG-UNIT

P OTC

OYSCO D ORAL TABLET 250-125 MG-UNIT

P OTC

Oyst-Cal D ORAL TABLET 250-125 MG-UNIT

P OTC

Oyster Calcium + D ORAL TABLET 250-125 MG-UNIT

P OTC

Oyster Shell Calcium + D ORAL TABLET500-400 MG-UNIT

P OTC

Oyster Shell Calcium 500 + D ORAL TABLET500-125 MG-UNIT

P OTC

Oyster Shell Calcium/D ORAL TABLET250-125 MG-UNIT, 500-200 MG-UNIT

P OTC

Oyster Shell Calcium/Vitamin D ORAL TABLET 500-200 MG-UNIT

P OTC

Oyster Shell/Vitamin D ORAL TABLET600-125 MG-UNIT

P OTC

*Calcium***

CAL-CARB FORTE ORAL TABLET 1250 MG

P OTC

19

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Drug Name Preference Details Coverage Details

Cal-Lac ORAL CAPSULE 500 MG P OTC

Calcarb 600 ORAL TABLET 1500 MG P OTC

CALCI-CHEW ORAL TABLET CHEWABLE 1250 MG

P OTC

Calcium 600 ORAL TABLET 600 MG P OTC

Calcium Carbonate ORAL SUSPENSION1250 MG/5ML

P OTC

Calcium Carbonate ORAL TABLET 1250 MG, 1500 MG, 600 MG

P OTC

Calcium High Potency ORAL TABLET 600 MG

P OTC

Calcium Lactate ORAL TABLET 648 MG P OTC

Calcium Oyster Shell ORAL TABLET 1250 MG

P OTC

Calcium-Carb 600 ORAL TABLET 600 MG P OTC

CALTRATE 600 ORAL TABLET 1500 MG P OTC

OS-CAL ORAL TABLET CHEWABLE 1250 MG

P OTC

OYSCO 500 ORAL TABLET 500 MG P OTC

OYSTERCAL ORAL TABLET 500 MG P OTC

*Electrolyte Mixtures**

*Electrolytes Oral***

ORALYTE ORAL SOLUTION POTC; QL (4000 ML per 31 day(s))

ORALYTE FREEZER POPS ORAL SOLUTION

POTC; QL (4000 ML per 31 day(s))

*Magnesium**

*Magnesium***

Mag-Delay ORAL TABLET EXTENDEDRELEASE* 535 (64 Mg) MG

P OTC

Mag-SR ORAL TABLET EXTENDEDRELEASE* 535 (64 Mg) MG

P OTC

MAG-TAB SR ORAL TABLET EXTENDEDRELEASE* 84 MG (7MEQ)

P OTC

MAG64 ORAL TABLET EXTENDEDRELEASE* 535 (64 MG) MG

P OTC

Magnacaps ORAL CAPSULE 100 MG P OTC

Magnesium ORAL TABLET 250 MG P OTC

20

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Drug Name Preference Details Coverage Details

Magnesium Oxide ORAL TABLET 400 (240 Mg) MG

P OTC

MAGNESIUM-OXIDE ORAL TABLET 400 (241.3 MG) MG

P OTC

*Zinc**

*Zinc***

ORAZINC ORAL CAPSULE 220 MG P OTC

Zinc Sulfate ORAL CAPSULE 220 MG P OTC

Zinc Sulfate ORAL TABLET 220 (50 Zn) MG P OTC

Zinc-220 ORAL CAPSULE 220 MG P OTC

*Multivitamins*

*B-Complex W/ C**

*B-Complex W/ C***

Vitamin B Complex-C ORAL CAPSULE P OTC

*B-Complex W/ Folic Acid**

*B-Complex W/ C & Folic Acid***

NEPHRONEX ORAL TABLET P

Rena-Vite Rx ORAL TABLET 1 MG P

RENAL ORAL CAPSULE 1 MG P

Reno Caps ORAL CAPSULE 1 MG P

*Multiple Vitamins W/ Minerals**

*Multiple Vitamins W/ Minerals***

Centamin ORAL LIQUID† P OTC

CentaVite ORAL LIQUID† P OTC

Centavite A-Z Complete-Mineral ORAL TABLET

P OTC

CEROVITE ADVANCED FORMULA ORAL TABLET

P OTC

CERTAVITE/ANTIOXIDANTS ORAL LIQUID†

P OTC

Formula Twenty-One ORAL TABLET P OTC

Gerivite Complete ORAL TABLET P OTC

Golden Age Vitamin/Minerals ORAL LIQUID†

P OTC

Multivitamin & Mineral ORAL LIQUID† P OTC

SUPER NU-THERA ORAL TABLET P OTC

Thera Vital M ORAL TABLET P OTC

21

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Drug Name Preference Details Coverage Details

Thera-M ORAL TABLET P OTC

Therabasic-M ORAL TABLET P OTC

Therapeutic Liquid ORAL SOLUTION P OTC

Therapeutic-M ORAL TABLET P OTC

TOTAL FORMULA 3 ORAL TABLET P OTC

*Multivitamins**

*Multivitamins***

Daily Multiple Vitamins ORAL TABLET P OTC

Daily Vite ORAL TABLET P OTC

Daily Vites ORAL TABLET P OTC

Multi-Day ORAL TABLET P OTC

Multi-Vitamin ORAL TABLET P OTC

Multi-Vitamins ORAL TABLET P OTC

Once Daily ORAL TABLET P OTC

One-Daily Multi Vitamins ORAL TABLET P OTC

THERA ORAL TABLET P OTC

Thera-Tabs ORAL TABLET P OTC

THERA/BETA-CAROTENE ORAL TABLET

P OTC

Therapeutic ORAL TABLET P OTC

*Ped Mv W/ Fluoride**

*Ped Mv W/ Fluoride***

Multi-Vit/Fluoride ORAL SOLUTION 0.25 MG/ML, 0.5 MG/ML

P

Multi-Vitamin/Fluoride ORAL TABLET CHEWABLE 0.25 MG, 0.5 MG, 1 MG

P

Multivitamin/Fluoride ORAL TABLET CHEWABLE 0.25 MG, 0.5 MG, 1 MG

P

Multivitamins/Fluoride ORAL TABLET CHEWABLE 0.25 MG

P

*Ped Mv W/ Iron**

*Ped Mv W/ Iron***

Poly-Vitamin/Iron ORAL SOLUTION 10 MG/ML

P OTC

*Pediatric Multiple Vitamins**

*Pediatric Multiple Vitamins W/ C***

Poly-Vitamin ORAL SOLUTION 35 MG/ML P OTC

22

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Drug Name Preference Details Coverage Details

*Pediatric Vitamins**

*Pediatric Vitamins A & D W/ C***

Tri-Vitamin ORAL SOLUTION 1500-400-35 P OTC

*Prenatal Vitamins**

*Prenatal Mv & Min W/Fe-Fa***

Prenatal Low Iron ORAL TABLET 27-0.8 MG P OTC

*Specialty Vitamins Products**

*Specialty Vitamins Products***

Vitamins for Hair ORAL TABLET P OTC

*Nasal Agents - Systemic And Topical*

*Nasal Agents - Misc.**

*Nasal Agents - Misc.***

Altamist Spray NASAL SOLUTION 0.65 % P OTC

AYR NASAL SOLUTION 0.65 % P OTC

Deep Sea Nasal Spray NASAL SOLUTION0.65 %

P OTC

HUMIST NASAL SOLUTION 0.65 % P OTC

LITTLE NOSES SALINE NASAL SOLUTION 0.65 %

P OTC

Na-Zone NASAL SOLUTION 0.65 % P OTC

NASAL MOIST NASAL SOLUTION 0.65 % P OTC

OCEAN FOR KIDS NASAL SOLUTION 0.65 %

P OTC

Saline Mist Spray NASAL SOLUTION 0.65 % P OTC

Saline Nasal Spray NASAL SOLUTION 0.65 %

P OTC

Sea Soft Nasal Mist NASAL SOLUTION 0.65 %

P OTC

*Nasal Antiallergy**

*Nasal Mast Cell Stabilizers***

Cromolyn Sodium NASAL AEROSOL, SOLUTION 5.2 MG/ACT

P OTC

*Sympathomimetic Decongestants**

*Systemic Decongestants***

Pseudoephedrine HCl ORAL TABLET 30 MG, 60 MG

P OTC

*Ophthalmic Agents*

23

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Drug Name Preference Details Coverage Details

*Artificial Tears And Lubricants**

*Artificial Tear And Lubricant Combinations***

Artificial Tears OPHTHALMIC OINTMENT83-15 %

P OTC

HYPOTEARS OPHTHALMIC SOLUTION 1-1 %

P OTC

*Artificial Tear Ointments***

Tears Again OPHTHALMIC OINTMENT P OTC

ULTRA FRESH PM OPHTHALMIC OINTMENT

P OTC

*Artificial Tear Solutions***

Tears Again OPHTHALMIC SOLUTION P OTC

*Artificial Tears And Lubricants***

Artificial Tears OPHTHALMIC SOLUTION1.4 %

P OTC; QL (15 ML per 31 day(s))

Liquitears OPHTHALMIC SOLUTION 1.4 % P OTC; QL (15 ML per 31 Day(s))

Polyvinyl Alcohol OPHTHALMIC SOLUTION 1.4 %

P OTC; QL (15 ML per 31 Day(s))

*Ophthalmics - Misc.**

*Ophthalmic Antiallergic***

ALAWAY OPHTHALMIC SOLUTION 0.025 %

P OTC

Ketotifen Fumarate OPHTHALMIC SOLUTION 0.025 %

P OTC

*Otic Agents*

*Otic Agents - Miscellaneous**

*Otic Agents - Miscellaneous***

Auraphene-B OTIC SOLUTION 6.5 % P OTC

AURO EARDROPS OTIC SOLUTION 6.5 %

P OTC

E-R-O EAR DROPS OTIC SOLUTION 6.5 %

P OTC

E-R-O EAR WAX REMOVAL SYSTEM OTIC SOLUTION 6.5 %

P OTC

Ear Drops Earwax Aid OTIC SOLUTION 6.5 %

P OTC

Earwax Treatment Drops OTIC SOLUTION6.5 %

P OTC

24

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Drug Name Preference Details Coverage Details

MURINE EAR OTIC SOLUTION 6.5 % P OTC

MURINE EAR WAX REMOVAL SYSTEM OTIC SOLUTION 6.5 %

P OTC

OTIX OTIC SOLUTION 6.5 % P OTC

Thera-Ear OTIC SOLUTION 6.5 % P OTC

*Psychotherapeutic And Neurological Agents - Misc.*

*Smoking Deterrents**

*Smoking Deterrents***

Nicotine TRANSDERMAL PATCH 24 HR 14 MG/24HR, 21 MG/24HR, 7 MG/24HR

P OTC; QL (70 EA per 365 day(s))

Nicotine Polacrilex MOUTH/THROAT GUM2 MG, 4 MG

POTC; QL (4032 EA per 31 day(s))

*Ulcer Drugs*

*H-2 Antagonists**

*H-2 Antagonists***

Acid Reducer ORAL TABLET 75 MG P OTC

Cimetidine ORAL TABLET 200 MG P OTC

Famotidine ORAL TABLET 10 MG P OTC

*Proton Pump Inhibitors**

*Proton Pump Inhibitors***

Omeprazole ORAL TABLET DELAYED RELEASE 20 MG

P OTC

*Vaginal Products*

*Spermicides**

*Spermicides***

OPTIONS CONCEPTROL VAGINAL GEL 4 %

P OTC

VCF VAGINAL CONTRACEPTIVE VAGINAL FOAM 12.5 %

P OTC

*Vaginal Anti-Infectives**

*Imidazole-Related Antifungals***

GYNE-LOTRIMIN 3 VAGINAL CREAM 2 %

P OTC

Miconazole 3 Combo Pack VAGINAL KIT200-2 MG-% (9GM)

P OTC

Miconazole Nitrate VAGINAL CREAM 2 % P OTC

25

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Drug Name Preference Details Coverage Details

Miconazole Nitrate VAGINAL SUPPOSITORY 100 MG

P OTC

MONISTAT 3 VAGINAL CREAM 4 % P OTC

*Vitamins*

*Oil Soluble Vitamins**

*Vitamin A***

Vitamin A ORAL CAPSULE 10000 UNIT, 8000 UNIT

P OTC

*Vitamin D***

CALCIFEROL ORAL SOLUTION 8000 UNIT/ML

P OTC

Vitamin D ORAL CAPSULE 400 UNIT P OTC

Vitamin D ORAL TABLET 400 UNIT P OTC

Vitamin D (Ergocalciferol) ORAL CAPSULE50000 UNIT

P QL (4 EA per 31 day(s))

Vitamin D-400 ORAL TABLET 400 UNIT P OTC

Vitamin D3 ORAL CAPSULE 2000 UNIT P OTC

Vitamin D3 ORAL TABLET 1000 UNIT, 400 UNIT

P OTC

Vitamin D3 ORAL TABLET CHEWABLE400 UNIT

P OTC

*Vitamin E***

Vitamin E ORAL CAPSULE 400 UNIT P OTC

Vitamin E ORAL TABLET CHEWABLE 400 UNIT

P OTC

*Vitamin K***

Vitamin K (Phytonadione) ORAL TABLET100 MCG

P OTC

*Water Soluble Vitamins**

*Vitamin B-1***

Vitamin B-1 ORAL TABLET 100 MG, 250 MG, 50 MG

P OTC

*Vitamin B-2***

Vitamin B-2 ORAL TABLET 100 MG P OTC

*Vitamin B-3***

Niacin ORAL TABLET 100 MG, 250 MG, 50 MG, 500 MG

P OTC

26

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Drug Name Preference Details Coverage Details

Niacin ER ORAL CAPSULE EXTENDED RELEASE* 250 MG

P OTC

Niacin ER ORAL TABLET EXTENDEDRELEASE* 250 MG

P OTC

*Vitamin B-6***

Vitamin B-6 ORAL TABLET 100 MG, 25 MG, 250 MG, 50 MG, 500 MG

P OTC

Vitamin B-6 ER ORAL TABLET EXTENDEDRELEASE* 200 MG

P OTC

*Vitamin C***

Ascorbic Acid ORAL TABLET 1000 MG, 250 MG, 500 MG

P OTC

Ascorbic Acid ORAL TABLET CHEWABLE250 MG

P OTC

C-500 ORAL TABLET CHEWABLE 500 MG P OTC

Vitamin C ORAL SYRUP 500 MG/5ML P OTC

Vitamin C ORAL TABLET 100 MG, 1000 MG, 250 MG, 500 MG

P OTC

Vitamin C ORAL TABLET CHEWABLE 100 MG, 250 MG

P OTC

27

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Index

29

Acetaminophen ORAL SOLUTION 160 MG/5ML .............. 1Acetaminophen ORAL TABLET325 MG .......................................................................... 1Acetaminophen ORAL TABLET500 MG .......................................................................... 1Acetaminophen ORAL TABLET CHEWABLE 80 MG ................................ 1

APAP ORAL TABLET 325 MG.................................................................................................... 1

APAP Drops ORAL SOLUTION100 MG/ML ........................................................... 1APAP Extra Strength ORAL TABLET 500 MG .......................................... 2

Aspirin Childrens ORAL TABLET CHEWABLE 81 MG.................................................................................................... 3Aspirin EC Low Dose ORAL TABLET DELAYED RELEASE81 MG ............................................................................. 3

Alamag Plus ORAL TABLET CHEWABLE 200-200-25 MG.................................................................................................... 3

ALMACONE ORAL SUSPENSION 200-200-20 MG/5ML .................................................................... 3

Antacid ORAL SUSPENSION200-200-20 MG/5ML ................................ 3

Antacid Anti-Gas ORAL SUSPENSION 200-200-20 MG/5ML ..................................................................... 3

Antacid Anti-Gas Max Strength ORAL SUSPENSION400-400-40 MG/5ML ................................ 4

Antacid Extra Strength ORAL SUSPENSION 400-400-40 MG/5ML ..................................................................... 4Antacid I ORAL SUSPENSION200-200-20 MG/5ML ................................ 4Antacid III ORAL SUSPENSION 400-400-40 MG/5ML ..................................................................... 4

ACID GONE ORAL TABLET CHEWABLE 160-105 MG, 80-20 MG ................................................................... 4

Aluminum Hydroxide Gel ORAL SUSPENSION 320 MG/5ML.................................................................................................... 4

Alcalak ORAL TABLET CHEWABLE 420 MG ............................ 5

Antacid ORAL TABLET CHEWABLE 420 MG, 500 MG.................................................................................................... 5Anti-Diarrheal ORAL LIQUID†1 MG/5ML ............................................................... 6

Aller-Chlor ORAL SYRUP 2 MG/5ML ..................................................................... 7Aller-Chlor ORAL TABLET 4 MG ....................................................................................... 7

Allergy ORAL TABLET 4 MG.................................................................................................... 7

Allergy Relief ORAL TABLET 4 MG ....................................................................................... 7

Aler-Cap ORAL CAPSULE 25 MG ....................................................................................... 7Aler-Dryl ORAL TABLET 50 MG ....................................................................................... 7AlerTab ORAL TABLET 25 MG.................................................................................................... 7

Allergy Relief Childrens ORAL LIQUID† 12.5 MG/5ML .................... 7

Altaryl ORAL ELIXIR 12.5 MG/5ML ..................................................................... 7Altaryl ORAL SYRUP 12.5 MG/5ML ..................................................................... 7

Anti-Hist ORAL CAPSULE 25 MG ....................................................................................... 7

Anti-Hist Allergy ORAL TABLET 25 MG .............................................. 7

ALLEGRA ALLERGY CHILDRENS ORAL TABLET 30 MG ............................................................................. 8

Allergy ORAL TABLET DISPERSIBLE 10 MG ......................... 8

ALAVERT ALLERGY/SINUS ORAL TABLET EXTENDED RELEASE 12 HR* 5-120 MG.................................................................................................... 9

ALLEGRA-D ALLERGY & CONGESTION ORAL TABLET EXTENDED RELEASE 12 HR* 60-120 MG.................................................................................................... 9

Allergy Relief/Nasal Decongest ORAL TABLET EXTENDED RELEASE 24 HR* 10-240 MG.................................................................................................... 9

Antihistamine Decongestant ORAL TABLET 2.5-60 MG.................................................................................................... 9

Acne Medication 5 EXTERNAL LOTION 5 % .................................................... 10 Allergy EXTERNAL CREAM 2

% ......................................................................................... 10

Anti-Itch Maximum Strength EXTERNAL CREAM 2 % ........... 10

AMLACTIN EXTERNAL LOTION 12 % ................................................ 11Ammonium Lactate EXTERNAL CREAM 12 % .................................................. 11Ammonium Lactate EXTERNAL LOTION 12 % ................................................. 11

Acetaminophen PM ORAL TABLET 500-25 MG ............................ 13

ACE AEROSOL CLOUD ENHANCER XX MISC ................ 17

AEROCHAMBER MV XX MISC ............................................................................ 18

AEROCHAMBER PLUS FLO-VU XX MISC ................................ 18

AEROCHAMBER PLUS FLO-VU LARGE XX MISC................................................................................................ 18AEROCHAMBER PLUS FLO-VU SMALL XX MISC................................................................................................ 18AEROCHAMBER PLUS FLO-VU W/MASK XX MISC................................................................................................ 18

AEROCHAMBER W/FLOWSIGNAL XX MISC................................................................................................ 18

AEROCHAMBER Z-STAT PLUS XX MISC ......................................... 18

AEROCHAMBER Z-STAT PLUS CHAMBR XX MISC................................................................................................ 18

Altamist Spray NASAL SOLUTION 0.65 % ................................. 23 Artificial Tears OPHTHALMIC

OINTMENT 83-15 % ........................... 24Artificial Tears OPHTHALMIC SOLUTION 1.4 % .................................... 24

ALAWAY OPHTHALMIC SOLUTION 0.025 % ............................. 24

Acid Reducer ORAL TABLET 75 MG ................................................................................... 25

Ascorbic Acid ORAL TABLET1000 MG, 250 MG, 500 MG................................................................................................ 27Ascorbic Acid ORAL TABLET CHEWABLE 250 MG ........................ 27

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Aspirin ORAL TABLET 325 MG, 81 MG ............................................................. 3Aspirin ORAL TABLET CHEWABLE 81 MG ................................ 3Aspirin ORAL TABLET DELAYED RELEASE 81 MG.................................................................................................... 3Aspirin RE SUPPOSITORY 300 MG, 600 MG ......................................................... 3

Aspirin EC ORAL TABLET DELAYED RELEASE 325 MG, 81 MG ............................................................................. 3Aspirin Low Dose ORAL TABLET 81 MG .............................................. 3

CAL-GEST ANTACID ORAL TABLET CHEWABLE 500 MG.................................................................................................... 5

Calcium Antacid ORAL TABLET CHEWABLE 500 MG.................................................................................................... 5

Calcium Antacid Extra Strength ORAL TABLET CHEWABLE750 MG .......................................................................... 5

Calcium Carbonate Antacid ORAL TABLET 648 MG ................... 5Calcium Carbonate Antacid ORAL TABLET CHEWABLE500 MG .......................................................................... 5

BD GLUCOSE ORAL TABLET CHEWABLE 5 GM .................................. 5

Bismatrol ORAL SUSPENSION262 MG/15ML .................................................... 6Bismatrol ORAL TABLET CHEWABLE 262 MG ............................ 6Bismuth ORAL TABLET CHEWABLE 262 MG ............................ 6

BANOPHEN ORAL CAPSULE 25 MG ............................................................................. 7BANOPHEN ORAL LIQUID† 12.5 MG/5ML ..................................................... 7BANOPHEN ORAL TABLET 25 MG ............................................................................. 7

BENADRYL ALLERGY CHILDRENS ORAL LIQUID† 12.5 MG/5ML ..................................................... 7

Cetirizine HCl ORAL SYRUP 5 MG/5ML ..................................................................... 8Cetirizine HCl ORAL TABLET10 MG, 5 MG ....................................................... 8

Cetirizine HCl Childrens ORAL SOLUTION 1 MG/ML ......................... 8

Cetirizine HCl Childrens Alrgy ORAL SYRUP 1 MG/ML ................ 8

BROTAPP ORAL LIQUID† 1-15 MG/5ML .................................................... 9

Cetirizine-Pseudoephedrine ER ORAL TABLET EXTENDED RELEASE 12 HR* 5-120 MG.................................................................................................... 9

BRONCHO SALINE INHALATION AEROSOL, SOLUTION 0.9 % .................................... 10

Benzoyl Peroxide EXTERNAL GEL 10 %, 5 % ................................................ 10

Bacitracin-Neomycin-Polymyxin EXTERNAL OINTMENT400-5-5000 ........................................................... 10

Bacitracin EXTERNAL OINTMENT 500 UNIT/GM................................................................................................ 10Bacitracin Zinc EXTERNAL OINTMENT 500 UNIT/GM................................................................................................ 10

Baza Antifungal EXTERNAL CREAM 2 % ...................................................... 10

BENADRYL ITCH STOPPING EXTERNAL GEL 2 % ..................... 11

Capsaicin EXTERNAL CREAM0.025 % ....................................................................... 12

BISAC-EVAC ORAL TABLET DELAYED RELEASE 5 MG................................................................................................ 15BISAC-EVAC RE SUPPOSITORY 10 MG ................. 15Biscolax RE SUPPOSITORY 10 MG ................................................................................... 15

CARTERS LITTLE PILLS ORAL TABLET DELAYED RELEASE 5 MG ........................................ 15

Calcium ORAL TABLET500-125 MG-UNIT ................................... 18

Calcium + D3 ORAL TABLET600-200 MG-UNIT ................................... 19

Calcium 600-D ORAL TABLET600-400 MG-UNIT ................................... 19

Calcium Carbonate-Vitamin D ORAL TABLET 500-400 MG-UNIT, 600-400 MG-UNIT................................................................................................ 19

Calcium High Potency/Vitamin D ORAL TABLET 600-200 MG-UNIT ............................................................. 19

Calcium-Carb 600 + D ORAL TABLET 600-125 MG-UNIT................................................................................................ 19

Calcium-Vitamin D ORAL TABLET 500-125 MG-UNIT, 600-125 MG-UNIT, 600-200 MG-UNIT ............................................................. 19

CALTRATE 600+D ORAL TABLET 600-800 MG-UNIT................................................................................................ 19

CAL-CARB FORTE ORAL TABLET 1250 MG ................................. 19

Cal-Lac ORAL CAPSULE 500 MG ................................................................................... 20

Calcarb 600 ORAL TABLET1500 MG .................................................................. 20

CALCI-CHEW ORAL TABLET CHEWABLE 1250 MG .................... 20

Calcium 600 ORAL TABLET600 MG ...................................................................... 20

Calcium Carbonate ORAL SUSPENSION 1250 MG/5ML................................................................................................ 20Calcium Carbonate ORAL TABLET 1250 MG, 1500 MG, 600 MG ...................................................................... 20

Calcium High Potency ORAL TABLET 600 MG ...................................... 20

Calcium Lactate ORAL TABLET648 MG ...................................................................... 20

Calcium Oyster Shell ORAL TABLET 1250 MG ................................... 20

Calcium-Carb 600 ORAL TABLET 600 MG ...................................... 20

CALTRATE 600 ORAL TABLET 1500 MG ................................. 20

Centamin ORAL LIQUID†................................................................................................ 21

CentaVite ORAL LIQUID†................................................................................................ 21

Centavite A-Z Complete-Mineral ORAL TABLET ....................................... 21

CEROVITE ADVANCED FORMULA ORAL TABLET................................................................................................ 21CERTAVITE/ANTIOXIDANTS ORAL LIQUID† .................................. 21

AYR NASAL SOLUTION 0.65 % ......................................................................................... 23

Auraphene-B OTIC SOLUTION6.5 % .............................................................................. 24AURO EARDROPS OTIC SOLUTION 6.5 % .................................... 24

CALCIFEROL ORAL SOLUTION 8000 UNIT/ML................................................................................................ 26

C-500 ORAL TABLET CHEWABLE 500 MG ........................ 27

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Childrens Ibuprofen ORAL SUSPENSION 40 MG/ML.................................................................................................... 1

Childrens Non-ASA Pain Relief ORAL TABLET CHEWABLE80 MG ............................................................................. 2Childrens Non-Aspirin ORAL TABLET CHEWABLE 80 MG.................................................................................................... 2Childrens Non-Aspirin Pain ORAL TABLET CHEWABLE80 MG ............................................................................. 2Childrens Pain Reliever ORAL TABLET CHEWABLE 80 MG.................................................................................................... 2Childrens Silapap ORAL LIQUID† 160 MG/5ML ...................... 2Childrens Tactinal ORAL TABLET CHEWABLE 80 MG.................................................................................................... 2

Ed-APAP ORAL LIQUID† 160 MG/5ML ..................................................................... 2

ECPIRIN ORAL TABLET DELAYED RELEASE 325 MG.................................................................................................... 3Diotame ORAL TABLET

CHEWABLE 262 MG ............................ 6

ChlorHist ORAL TABLET 4 MG.................................................................................................... 7Chlorphen ORAL TABLET 4 MG ....................................................................................... 7

DIABETIC TUSSIN ALLERGY ORAL SYRUP 2 MG/5ML .................................................................... 7

Complete Allergy Medication ORAL TABLET 25 MG ....................... 7Complete Allergy Relief ORAL TABLET 25 MG .............................................. 7

Diphenhist ORAL CAPSULE 25 MG ....................................................................................... 7Diphenhist ORAL LIQUID† 12.5 MG/5ML ..................................................................... 7Diphenhist ORAL TABLET 25 MG ....................................................................................... 7DiphenhydrAMINE HCl ORAL CAPSULE 25 MG, 50 MG .............. 7DiphenhydrAMINE HCl ORAL TABLET 25 MG .............................................. 8

DORMIN ORAL CAPSULE 25 MG ...................................................................................... 8

Childrens Loratadine ORAL SYRUP 5 MG/5ML .................................... 8

Chlorhexidine Gluconate EXTERNAL LIQUID† 4 %.................................................................................................... 9

Chest Congestion Relief ORAL TABLET 400 MG .......................................... 9

Double Antibiotic EXTERNAL OINTMENT 500-10000 UNIT/GM .............................................................. 10

Clotrimazole EXTERNAL CREAM 1 % ...................................................... 10Clotrimazole EXTERNAL SOLUTION 1 % .......................................... 10

CLEAR AWAY 1-STEP WART REMOVER EXTERNAL PAD 40 % ................................................................................ 11

COMPOUND W EXTERNAL LIQUID† 17 % .............................................. 11COMPOUND W MAXIMUM STRENGTH EXTERNAL GEL 17 % ................................................................................ 11

Cyanocobalamin INJECTION SOLUTION 1000 MCG/ML................................................................................................ 12

Compoz ORAL CAPSULE 50 MG ................................................................................... 13Compoz ORAL TABLET 50 MG................................................................................................ 13

DOC-Q-LAX ORAL TABLET 8.6-50 MG ............................................................. 14

Enema RE ENEMA 7-19 GM/118ML .......................................................... 15

Citrate of Magnesia ORAL SOLUTION 1.745 GM/30ML................................................................................................ 15CITROMA ORAL SOLUTION 1.745 GM/30ML .......................................... 15

DULCOLAX MILK OF MAGNESIA ORAL SUSPENSION 400 MG/5ML................................................................................................ 15

Correct ORAL TABLET DELAYED RELEASE 5 MG................................................................................................ 15

CORRECTOL ORAL TABLET DELAYED RELEASE 5 MG................................................................................................ 15

Ducodyl ORAL TABLET DELAYED RELEASE 5 MG................................................................................................ 15

EX-LAX ORAL TABLET CHEWABLE 15 MG ........................... 15EX-LAX ULTRA ORAL TABLET DELAYED RELEASE 5 MG ........................................ 15

CORRECTOL EXTRA GENTLE ORAL CAPSULE 100 MG .................................................................................. 16

D.O.S. ORAL CAPSULE 250 MG ................................................................................... 16

Diocto ORAL LIQUID† 50 MG/5ML ................................................................. 16Diocto ORAL SYRUP 60 MG/15ML ............................................................. 16

DocQLace ORAL CAPSULE100 MG ...................................................................... 16

Docu Soft ORAL CAPSULE 100 MG ................................................................................... 16

Docusate Calcium ORAL CAPSULE 240 MG ................................. 17Docusate Sodium ORAL CAPSULE 250 MG ................................. 17Docusate Sodium ORAL TABLET 100 MG ...................................... 17DOCUSIL ORAL CAPSULE 100 MG ..................................................................... 17DOK ORAL CAPSULE 100 MG, 250 MG ...................................................... 17DOK ORAL TABLET 100 MG................................................................................................ 17

DSS ORAL CAPSULE 100 MG, 250 MG ...................................................................... 17

DULCOLAX STOOL SOFTENER ORAL CAPSULE 100 MG ..................................................................... 17

EASIVENT XX MISC ...................... 18

Daily Multiple Vitamins ORAL TABLET .............................................................. 22Daily Vite ORAL TABLET................................................................................................ 22Daily Vites ORAL TABLET................................................................................................ 22Deep Sea Nasal Spray NASAL SOLUTION 0.65 % ................................. 23

Cromolyn Sodium NASAL AEROSOL, SOLUTION 5.2 MG/ACT ................................................................. 23

E-R-O EAR DROPS OTIC SOLUTION 6.5 % .................................... 24E-R-O EAR WAX REMOVAL SYSTEM OTIC SOLUTION 6.5 % ......................................................................................... 24

Ear Drops Earwax Aid OTIC SOLUTION 6.5 % .................................... 24Earwax Treatment Drops OTIC SOLUTION 6.5 % .................................... 24

Cimetidine ORAL TABLET 200 MG ................................................................................... 25

Famotidine ORAL TABLET 10 MG ................................................................................... 25

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Ibuprofen ORAL SUSPENSION100 MG/5ML ........................................................ 1Ibuprofen ORAL TABLET 200 MG ....................................................................................... 1

Geri-Lanta ORAL SUSPENSION 200-200-20 MG/5ML ..................................................................... 4

MAALOX ADVANCED ORAL SUSPENSION 200-200-20 MG/5ML .................................................................... 4

MAALOX ADVANCED MAX ST ORAL SUSPENSION 400-400-40 MG/5ML ................................ 4

MAALOX MAX ORAL SUSPENSION 400-400-40 MG/5ML .................................................................... 4MAALOX MULTI SYMPTOM MAX ST ORAL SUSPENSION 400-400-40 MG/5ML ................................ 4

MAALOX REGULAR STRENGTH ORAL SUSPENSION 200-200-20 MG/5ML .................................................................... 4

MAALOX ORAL TABLET CHEWABLE 600 MG ........................... 5

Glucose ORAL TABLET CHEWABLE 4 GM .................................... 5

Kao-Tin ORAL SUSPENSION262 MG/15ML .................................................... 6

KAOPECTATE ORAL SUSPENSION 262 MG/15ML.................................................................................................... 6

KAOPECTATE EXTRA STRENGTH ORAL SUSPENSION 525 MG/15ML.................................................................................................... 6

LOPERAMIDE A-D ORAL TABLET 2 MG ................................................ 6Loperamide HCl ORAL LIQUID† 1 MG/5ML ............................. 6

Ipecac ORAL SYRUP ......................... 6

Genahist ORAL CAPSULE 25 MG ....................................................................................... 8

Fexofenadine HCl ORAL TABLET 180 MG, 60 MG ................ 8

Loratadine ORAL TABLET 10 MG ....................................................................................... 8

Loratadine Hives Relief ORAL SOLUTION 5 MG/5ML ..................... 8

Fexofenadine-Pseudoephed ER ORAL TABLET EXTENDED RELEASE 24 HR* 180-240 MG.................................................................................................... 9

Itch Relief EXTERNAL CREAM2 % .................................................................................... 11

Hydrocortisone EXTERNAL CREAM 0.5 %, 1 % ................................. 11Hydrocortisone EXTERNAL LOTION 1 % .................................................... 11Hydrocortisone EXTERNAL OINTMENT 0.5 %, 1 % ................... 11Hydrocortisone Max St EXTERNAL CREAM 1 % ........... 11Hydrocortisone Max St/12 Moist EXTERNAL CREAM 1 % ........... 11

HYDROSKIN EXTERNAL CREAM 1 % ..................................................... 11

Hydrocortisone-Aloe EXTERNAL CREAM 1 % ........... 11

FREEZONE EXTERNAL LIQUID† 17.6 % ......................................... 11

Folic Acid ORAL TABLET 1 MG, 400 MCG, 800 MCG .............. 13

Ferro-Bob ORAL TABLET 325 (65 Fe) MG ......................................................... 13Ferrous Sulfate ORAL ELIXIR220 (44 Fe) MG/5ML .......................... 13Ferrous Sulfate ORAL TABLET325 (65 Fe) MG ............................................ 13Ferrous Sulfate ORAL TABLET DELAYED RELEASE 324 (65 Fe) MG, 325 (65 Fe) MG .............. 13FerrouSul ORAL TABLET 325 (65 Fe) MG ......................................................... 13

Iron ORAL TABLET 325 (65 Fe) MG, 90 (18 Fe) MG .................. 13

Headache PM ORAL TABLET25-500 MG ............................................................ 13

Fiber ORAL TABLET 625 MG................................................................................................ 14

Fiber Laxative ORAL TABLET625 MG ...................................................................... 14

Fiber Therapy ORAL POWDER58.6 % ........................................................................... 14

Fiber-Lax ORAL TABLET 625 MG ................................................................................... 14

FIBERGEN ORAL TABLET 625 MG ..................................................................... 14

KONSYL ORAL PACKET 100 % ......................................................................................... 14

KONSYL FIBER ORAL TABLET 625 MG ..................................... 14

Magnesium Citrate ORAL SOLUTION 1.745 GM/30ML................................................................................................ 15

FEENAMINT ORAL TABLET DELAYED RELEASE 5 MG................................................................................................ 16

FLEET LAXATIVE ORAL TABLET DELAYED RELEASE 5 MG ........................................ 16

Gentle Laxative ORAL TABLET DELAYED RELEASE 5 MG................................................................................................ 16

Laxative RE SUPPOSITORY 10 MG ................................................................................... 16

Magic Bullets RE SUPPOSITORY 10 MG .................. 16

Kao-Tin ORAL CAPSULE 240 MG ................................................................................... 17

Laxa Basic ORAL CAPSULE100 MG, 250 MG ......................................... 17

IN-CHECK DIAL FLOW TRAINER XX DEVICE ............... 17Inhaler Companions XX MISC................................................................................................ 17

Liquid Calcium/Vitamin D ORAL CAPSULE 600-200 MG-UNIT................................................................................................ 19

Mag-Delay ORAL TABLET EXTENDEDRELEASE* 535 (64 Mg) MG ..................................................... 20

MAG64 ORAL TABLET EXTENDEDRELEASE* 535 (64 MG) MG ..................................................... 20

Magnacaps ORAL CAPSULE100 MG ...................................................................... 20

Magnesium ORAL TABLET 250 MG ................................................................................... 20

Formula Twenty-One ORAL TABLET .............................................................. 21

Gerivite Complete ORAL TABLET .............................................................. 21

Golden Age Vitamin/Minerals ORAL LIQUID† ..................................... 21

HUMIST NASAL SOLUTION 0.65 % ........................................................................... 23

LITTLE NOSES SALINE NASAL SOLUTION 0.65 %................................................................................................ 23

HYPOTEARS OPHTHALMIC SOLUTION 1-1 % .................................... 24

Liquitears OPHTHALMIC SOLUTION 1.4 % .................................... 24

Ketotifen Fumarate OPHTHALMIC SOLUTION0.025 % ....................................................................... 24

GYNE-LOTRIMIN 3 VAGINAL CREAM 2 % ............... 25

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Mapap ORAL CAPSULE 500 MG ....................................................................................... 2Mapap ORAL LIQUID† 160 MG/5ML ..................................................................... 2Mapap ORAL TABLET 325 MG.................................................................................................... 2Mapap ORAL TABLET 500 MG.................................................................................................... 2Mapap ORAL TABLET CHEWABLE 80 MG ................................ 2

Mapap Arthritis Pain ORAL TABLET EXTENDEDRELEASE* 650 MG ....................................................................................... 2MAPAP CHILDRENS ORAL SUSPENSION 160 MG/5ML.................................................................................................... 2

Maxapap Maximum Strength ORAL TABLET 500 MG ................... 2Maxapap Regular Strength ORAL TABLET 325 MG ................... 2

Non-Aspirin ORAL TABLET 325 MG ....................................................................................... 2

Non-Aspirin Extra Strength ORAL TABLET 500 MG ................... 2

Non-Aspirin Pain Relief ORAL TABLET 325 MG .......................................... 2Nortemp Infants ORAL SUSPENSION 80 MG/0.8ML.................................................................................................... 2

Milantex ORAL SUSPENSION200-200-20 MG/5ML ................................ 4

Milantex Extra Strength ORAL SUSPENSION 400-400-40 MG/5ML ..................................................................... 4

MINTOX PLUS ORAL TABLET CHEWABLE 200-200-25 MG .................................................. 4

MI-ACID ORAL TABLET CHEWABLE 700-300 MG.................................................................................................... 4

Magnesium Oxide ORAL TABLET 250 MG, 400 MG, 420 MG ....................................................................................... 5

Meclizine HCl ORAL TABLET12.5 MG, 25 MG .............................................. 6

Mucus Relief ORAL TABLET400 MG .......................................................................... 9

Mi-Acid Gas Relief ORAL TABLET CHEWABLE 80 MG................................................................................................ 12

Mytab Gas ORAL TABLET CHEWABLE 80 MG ............................ 12

Mapap PM ORAL TABLET500-25 MG ............................................................ 13

NYTOL ORAL TABLET 25 MG .................................................................................. 13

METAMUCIL ORAL CAPSULE 0.52 GM .............................. 14METAMUCIL ORAL POWDER 30.9 % ....................................... 14METAMUCIL ORAL WAFER................................................................................................ 14

METAMUCIL MULTIHEALTH FIBER ORAL POWDER 58.6 % ............... 14

METAMUCIL SMOOTH TEXTURE ORAL PACKET 28 % ......................................................................................... 14

METAMUCIL SMOOTH TEXTURE ORAL POWDER 28.3 %, 58.6 % .................................................. 14

Natural Fiber Therapy ORAL POWDER 30.9 %, 48.57 % .......... 14

Natural Vegetable Fiber ORAL POWDER 48.57 % ................................... 14

Milk of Magnesia ORAL SUSPENSION 400 MG/5ML, 7.75 % ........................................................................... 15

Natural Senna Laxative ORAL TABLET 64.8-324 MG ....................... 16

MICROCHAMBER XX MISC................................................................................................ 18MICROSPACER XX MISC................................................................................................ 18

Mag-SR ORAL TABLET EXTENDEDRELEASE* 535 (64 Mg) MG ..................................................... 20MAG-TAB SR ORAL TABLET EXTENDEDRELEASE* 84 MG (7MEQ) ...................................................... 20

Magnesium Oxide ORAL TABLET 400 (240 Mg) MG................................................................................................ 21MAGNESIUM-OXIDE ORAL TABLET 400 (241.3 MG) MG................................................................................................ 21

NEPHRONEX ORAL TABLET................................................................................................ 21

Multivitamin & Mineral ORAL LIQUID† ............................................................ 21

Multi-Day ORAL TABLET................................................................................................ 22

Multi-Vitamin ORAL TABLET................................................................................................ 22

Multi-Vitamins ORAL TABLET................................................................................................ 22

Once Daily ORAL TABLET................................................................................................ 22

Multi-Vit/Fluoride ORAL SOLUTION 0.25 MG/ML, 0.5 MG/ML ..................................................................... 22

Multi-Vitamin/Fluoride ORAL TABLET CHEWABLE 0.25 MG, 0.5 MG, 1 MG ................................. 22

Multivitamin/Fluoride ORAL TABLET CHEWABLE 0.25 MG, 0.5 MG, 1 MG ................................. 22

Multivitamins/Fluoride ORAL TABLET CHEWABLE 0.25 MG................................................................................................ 22

Na-Zone NASAL SOLUTION0.65 % ........................................................................... 23

NASAL MOIST NASAL SOLUTION 0.65 % ................................ 23

OCEAN FOR KIDS NASAL SOLUTION 0.65 % ................................ 23

MURINE EAR OTIC SOLUTION 6.5 % .................................... 25MURINE EAR WAX REMOVAL SYSTEM OTIC SOLUTION 6.5 % .................................... 25

Nicotine TRANSDERMAL PATCH 24 HR 14 MG/24HR, 21 MG/24HR, 7 MG/24HR ................... 25

Nicotine Polacrilex MOUTH/THROAT GUM 2 MG, 4 MG ............................................................................. 25

Omeprazole ORAL TABLET DELAYED RELEASE 20 MG................................................................................................ 25

Miconazole 3 Combo Pack VAGINAL KIT 200-2 MG-% (9GM) ........................................................................ 25Miconazole Nitrate VAGINAL CREAM 2 % ...................................................... 25Miconazole Nitrate VAGINAL SUPPOSITORY 100 MG .............. 26

MONISTAT 3 VAGINAL CREAM 4 % ..................................................... 26

Niacin ORAL TABLET 100 MG, 250 MG, 50 MG, 500 MG ............... 26

Niacin ER ORAL CAPSULE EXTENDED RELEASE* 250 MG ................................................................................... 27Niacin ER ORAL TABLET EXTENDEDRELEASE* 250 MG ................................................................................... 27

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Pain & Fever Childrens ORAL SOLUTION 160 MG/5ML .............. 2

Pain Relief ORAL TABLET 500 MG ....................................................................................... 2

Pain Relief Extra Strength ORAL TABLET 500 MG .......................................... 3

PHARBETOL ORAL TABLET 325 MG ......................................................................... 3

PHARBETOL EXTRA STRENGTH ORAL TABLET 500 MG ......................................................................... 3

Q-PAP ORAL TABLET 325 MG.................................................................................................... 3

Reeses Pinworm Medicine ORAL SUSPENSION 144 MG/ML.................................................................................................... 5

Pink Bismuth ORAL SUSPENSION 262 MG/15ML.................................................................................................... 6Pink Bismuth ORAL TABLET CHEWABLE 262 MG ............................ 6

Pharbedryl ORAL CAPSULE 25 MG, 50 MG ............................................................. 8

Q-Dryl ORAL CAPSULE 25 MG ....................................................................................... 8Q-Dryl ORAL LIQUID† 12.5 MG/5ML ..................................................................... 8

Quenalin ORAL SYRUP 12.5 MG/5ML ..................................................................... 8

SCOT-TUSSIN ALLERGY RELIEF ORAL LIQUID† 12.5 MG/5ML .................................................................... 8

OPERAND POVIDONE-IODINE EXTERNAL SOLUTION 10 %.................................................................................................... 9

Povidone-Iodine EXTERNAL SOLUTION 10 % .......................................... 9

Q-TAPP ORAL ELIXIR 1-15 MG/5ML .................................................................... 9

Refenesen ORAL TABLET 200 MG ....................................................................................... 9

Refenesen 400 ORAL TABLET400 MG .......................................................................... 9

Robafen ORAL SYRUP 100 MG/5ML ................................................................. 10

PREPARATION H HYDROCORTISONE EXTERNAL CREAM 1 %................................................................................................ 11

SALACTIC FILM EXTERNAL SOLUTION 17 % ...................................... 11

Permethrin EXTERNAL LOTION 1 % .................................................... 12

Pregnancy Test IN VITRO DIAGNOSTIC TEST† .................. 12

POLY-IRON 150 ORAL CAPSULE 150 MG ................................ 13

Pain Relief PM Extra Strength ORAL TABLET 500-25 MG................................................................................................ 13Pain Reliever PM ORAL TABLET 500-25 MG ............................ 13

REGULOID ORAL CAPSULE 0.52 GM ................................................................... 14

PERI-COLACE ORAL TABLET 8.6-50 MG ............................. 14

Phosphate Laxative ORAL SOLUTION 0.9-2.4 GM/5ML................................................................................................ 15

Peak Flow Meter XX DEVICE................................................................................................ 17

PFLEX XX MISC .................................... 17

OPTICHAMBER ADVANTAGE XX MISC ........... 18OPTICHAMBER FACE MASK-LARGE XX MISC................................................................................................ 18OPTICHAMBER FACE MASK-MEDIUM XX MISC................................................................................................ 18OPTICHAMBER FACE MASK-SMALL XX MISC................................................................................................ 18OPTIHALER XX DEVICE................................................................................................ 18OPTIHALER XX MISC ................ 18

POCKET CHAMBER XX DEVICE .................................................................. 18POCKET SPACER XX DEVICE .................................................................. 18

OS-CAL 500 + D ORAL TABLET 500-200 MG-UNIT................................................................................................ 19

OYSCO 500+D ORAL TABLET 500-200 MG-UNIT................................................................................................ 19OYSCO D ORAL TABLET 250-125 MG-UNIT ................................. 19Oyst-Cal D ORAL TABLET250-125 MG-UNIT ................................... 19Oyster Calcium + D ORAL TABLET 250-125 MG-UNIT................................................................................................ 19Oyster Shell Calcium + D ORAL TABLET 500-400 MG-UNIT................................................................................................ 19Oyster Shell Calcium 500 + D ORAL TABLET 500-125 MG-UNIT ............................................................. 19

Oyster Shell Calcium/D ORAL TABLET 250-125 MG-UNIT, 500-200 MG-UNIT ................................... 19Oyster Shell Calcium/Vitamin D ORAL TABLET 500-200 MG-UNIT ............................................................. 19Oyster Shell/Vitamin D ORAL TABLET 600-125 MG-UNIT................................................................................................ 19

OS-CAL ORAL TABLET CHEWABLE 1250 MG .................... 20

OYSCO 500 ORAL TABLET 500 MG ..................................................................... 20

OYSTERCAL ORAL TABLET 500 MG ..................................................................... 20

ORALYTE ORAL SOLUTION................................................................................................ 20

ORALYTE FREEZER POPS ORAL SOLUTION ............................... 20

ORAZINC ORAL CAPSULE 220 MG ..................................................................... 21

Rena-Vite Rx ORAL TABLET 1 MG ................................................................................... 21

RENAL ORAL CAPSULE 1 MG .................................................................................. 21

Reno Caps ORAL CAPSULE 1 MG ................................................................................... 21

One-Daily Multi Vitamins ORAL TABLET .............................................................. 22

Poly-Vitamin/Iron ORAL SOLUTION 10 MG/ML .................. 22

Poly-Vitamin ORAL SOLUTION 35 MG/ML .................. 22

Prenatal Low Iron ORAL TABLET 27-0.8 MG .............................. 23

Saline Mist Spray NASAL SOLUTION 0.65 % ................................. 23Saline Nasal Spray NASAL SOLUTION 0.65 % ................................. 23

Sea Soft Nasal Mist NASAL SOLUTION 0.65 % ................................. 23

Pseudoephedrine HCl ORAL TABLET 30 MG, 60 MG ................ 23

Polyvinyl Alcohol OPHTHALMIC SOLUTION1.4 % .............................................................................. 24

OTIX OTIC SOLUTION 6.5 %................................................................................................ 25

OPTIONS CONCEPTROL VAGINAL GEL 4 % ............................ 25

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Tactinal ORAL TABLET 325 MG ....................................................................................... 3

Tactinal Extra Strength ORAL TABLET 500 MG .......................................... 3

Tri-Buffered Aspirin ORAL TABLET 325 MG .......................................... 3

Sodium Bicarbonate ORAL TABLET 325 MG, 650 MG.................................................................................................... 4

TITRALAC ORAL TABLET CHEWABLE 420 MG ........................... 5

Stomach Relief ORAL SUSPENSION 262 MG/15ML, 527 MG/30ML .................................................... 6Stomach Relief ORAL TABLET CHEWABLE 262 MG ............................ 6Stomach Relief Plus ORAL SUSPENSION 525 MG/15ML.................................................................................................... 6

Travel Sickness ORAL TABLET CHEWABLE 25 MG ................................ 6Siladryl Allergy ORAL LIQUID†

12.5 MG/5ML ...................................................... 8Silphen Cough ORAL SYRUP12.5 MG/5ML ...................................................... 8

SIMPLY ALLERGY ORAL TABLET 25 MG ............................................ 8

Total Allergy ORAL TABLET 25 MG ....................................................................................... 8

TOTAL ALLERGY MEDICINE ORAL LIQUID† 12.5 MG/5ML ..................................................... 8

Sodium Chloride INHALATION NEBULIZATION SOLUTION0.9 % .............................................................................. 10

Triple Antibiotic EXTERNAL OINTMENT 3.5-400-5000 , 5-400-5000 ........................................................... 10

Terbinafine HCl EXTERNAL CREAM 1 % ...................................................... 10

Simethicone ORAL SUSPENSION 40 MG/0.6ML................................................................................................ 12Simethicone ORAL TABLET CHEWABLE 80 MG ............................ 12

Sodium Citrate ORAL GRANULES .................................................. 12

Slow Release Iron ORAL TABLET EXTENDEDRELEASE* 160 (50 Fe) MG ......................................................... 13

SIMPLY SLEEP ORAL TABLET 25 MG ......................................... 13Sleep Tabs ORAL TABLET 25 MG ................................................................................... 13Sleep-Tabs ORAL TABLET 25 MG ................................................................................... 13

SOMINEX ORAL TABLET 25 MG .................................................................................. 13

SOMINEX MAXIMUM STRENGTH ORAL TABLET 50 MG ......................................................................... 13

Tetra-Formula Nighttime Sleep ORAL TABLET 50 MG ................... 14

Senna Plus ORAL TABLET8.6-50 MG .............................................................. 14Senna S ORAL TABLET 8.6-50 MG ................................................................................... 14

Senna-Docusate Sodium ORAL TABLET 8.6-50 MG .............................. 14

Senna-S ORAL TABLET 8.6-50 MG ................................................................................... 14

Senna-Time S ORAL TABLET8.6-50 MG .............................................................. 14

SENNALAX-S ORAL TABLET 8.6-50 MG ............................................................. 14

Sennosides-Docusate Sodium ORAL TABLET 8.6-50 MG................................................................................................ 15

Sorbitol ORAL SOLUTION 70 % ......................................................................................... 15

Senexon ORAL LIQUID† 8.8 MG/5ML ................................................................. 16Senexon ORAL TABLET 8.6 MG ................................................................................... 16

Senna ORAL SYRUP 8.8 MG/5ML ................................................................. 16Senna ORAL TABLET 15 MG, 8.6 MG ........................................................................ 16

Senna Lax ORAL TABLET 8.6 MG ................................................................................... 16Senna Laxative ORAL TABLET8.6 MG ........................................................................ 16Senna Maximum Strength ORAL TABLET 25 MG .......................................... 16

SENNA SMOOTH ORAL TABLET 15 MG ......................................... 16

Senna-Lax ORAL TABLET 8.6 MG ................................................................................... 16

Senna-Tabs ORAL TABLET 8.6 MG ................................................................................... 16Senna-Time ORAL TABLET 8.6 MG ................................................................................... 16

SENNACON ORAL TABLET 8.6 MG ....................................................................... 16

SENNO ORAL TABLET 8.6 MG .................................................................................. 16

Stimulant Laxative ORAL TABLET DELAYED RELEASE5 MG ............................................................................. 16

Silace ORAL LIQUID† 150 MG/15ML ............................................................. 17Silace ORAL SYRUP 60 MG/15ML ............................................................. 17

SOF-LAX ORAL CAPSULE 100 MG ..................................................................... 17

Stool Softener ORAL CAPSULE100 MG, 250 MG ......................................... 17

Stool Softener Laxative DC ORAL CAPSULE 240 MG................................................................................................ 17

Sur-Q-Lax ORAL CAPSULE240 MG ...................................................................... 17

SURFAK ORAL CAPSULE 240 MG ..................................................................... 17

TODAY SPONGE VAGINAL MISC ............................................................................ 17

THRESHOLD IMT XX MISC................................................................................................ 18THRESHOLD PEP XX DEVICE .................................................................. 18

SUPER NU-THERA ORAL TABLET ................................................................. 21

Thera Vital M ORAL TABLET................................................................................................ 21

Thera-M ORAL TABLET................................................................................................ 22

Therabasic-M ORAL TABLET................................................................................................ 22

Therapeutic Liquid ORAL SOLUTION .................................................... 22

Therapeutic-M ORAL TABLET................................................................................................ 22

TOTAL FORMULA 3 ORAL TABLET ................................................................. 22

THERA ORAL TABLET ............ 22

Thera-Tabs ORAL TABLET................................................................................................ 22

THERA/BETA-CAROTENE ORAL TABLET ......................................... 22

Therapeutic ORAL TABLET................................................................................................ 22

Tri-Vitamin ORAL SOLUTION1500-400-35 ........................................................ 23

Tears Again OPHTHALMIC OINTMENT .................................................. 24Tears Again OPHTHALMIC SOLUTION .................................................... 24

Thera-Ear OTIC SOLUTION 6.5 % ......................................................................................... 25

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Ultilet Glucose ORAL TABLET CHEWABLE 4 GM .................................... 5

Vitamin B-12 ORAL TABLET1000 MCG, 500 MCG .......................... 12Vitamin B-12 SUBLINGUAL TABLET SUBLINGUAL 1000 MCG .............................................................................. 12

Vitamin B-12 ER ORAL TABLET EXTENDEDRELEASE* 1000 MCG .............................................................................. 12

Womens Laxative ORAL TABLET DELAYED RELEASE5 MG ............................................................................. 16

TROJAN RIBBED XX MISC................................................................................................ 17

WINDMILL TRAINER XX MISC ............................................................................ 18

WATCHHALER XX DEVICE................................................................................................ 18

Zinc Sulfate ORAL CAPSULE220 MG ...................................................................... 21Zinc Sulfate ORAL TABLET 220 (50 Zn) MG ....................................................... 21Zinc-220 ORAL CAPSULE 220 MG ................................................................................... 21

Vitamin B Complex-C ORAL CAPSULE ........................................................ 21

Vitamins for Hair ORAL TABLET .............................................................. 23

ULTRA FRESH PM OPHTHALMIC OINTMENT................................................................................................ 24VCF VAGINAL CONTRACEPTIVE VAGINAL FOAM 12.5 % ................................................. 25Vitamin A ORAL CAPSULE10000 UNIT, 8000 UNIT ................. 26

Vitamin D ORAL CAPSULE 400 UNIT ............................................................................ 26Vitamin D ORAL TABLET 400 UNIT ............................................................................ 26

Vitamin D (Ergocalciferol) ORAL CAPSULE 50000 UNIT................................................................................................ 26

Vitamin D-400 ORAL TABLET400 UNIT ............................................................... 26

Vitamin D3 ORAL CAPSULE2000 UNIT ............................................................ 26Vitamin D3 ORAL TABLET1000 UNIT, 400 UNIT ........................ 26Vitamin D3 ORAL TABLET CHEWABLE 400 UNIT .................. 26

Vitamin E ORAL CAPSULE 400 UNIT ............................................................................ 26Vitamin E ORAL TABLET CHEWABLE 400 UNIT .................. 26Vitamin K (Phytonadione) ORAL TABLET 100 MCG................................................................................................ 26

Vitamin B-1 ORAL TABLET 100 MG, 250 MG, 50 MG ............................ 26

Vitamin B-2 ORAL TABLET 100 MG ................................................................................... 26

Vitamin B-6 ORAL TABLET 100 MG, 25 MG, 250 MG, 50 MG, 500 MG ...................................................................... 27

Vitamin B-6 ER ORAL TABLET EXTENDEDRELEASE* 200 MG ................................................................................... 27

Vitamin C ORAL SYRUP 500 MG/5ML ................................................................. 27Vitamin C ORAL TABLET 100 MG, 1000 MG, 250 MG, 500 MG................................................................................................ 27Vitamin C ORAL TABLET CHEWABLE 100 MG, 250 MG................................................................................................ 27