2019 formulary guide · companies that make generic drugs do not have to invest large amounts of...

2019 FORMULARY GUIDE

(Employee groups)

Pharmacy Benefits Management

ii iuhealthplans.org

Table of Contents Overview ...................................................................................................................................................... iii

Important Phone Numbers ............................................................................................................................ iii

Understanding Coverage and Cost‐Sharing ................................................................................................. iii

Formulary ................................................................................................................................................ iii

Understanding Our Symbols ........................................................................................................................ iv

Prior Authorization .................................................................................................................................. iv

Step Therapy ............................................................................................................................................ iv

Quantity Limits ........................................................................................................................................ iv

About Generic Drugs .................................................................................................................................... iv

How to Fill Your Prescription Medications ................................................................................................... v

Medication Supplies Not Covered by IU Health Plans ............................................................................ vi

Formulary Listing ......................................................................................................................................... 1


iii

Overview This guide provides an overview of your pharmacy benefit. It explains the tiers for drug coverage, the process for getting certain drugs covered, your options for filling prescriptions, important phone numbers, and more.

Important Phone Numbers Pharmacy Services ‐ 844.432.0704.

Understanding Coverage and Cost‐Sharing Formulary

The Formulary, also known as your Preferred Drug List, is a list of prescription drugs that are covered

under your plan. The inclusion of specific medications on the IU Health Plans formulary is based on the

medication's effectiveness, safety, and value.

The formulary offers a wide selection of generic and brand name prescription drugs suggested by the

Pharmacy and Therapeutics (P&T) Committee, a group of physicians and pharmacists who researches and

evaluates medications. The formulary is periodically reviewed and updated throughout the year in order to

ensure that our benefits package consistently and adequately meets your needs.

When you need a prescription medication, you and your doctor can choose from five different levels of

the formulary. These are Preferred Generics – Tier 1, Generics – Tier 2, Preferred Brands – Tier 3, Non‐Preferred Brands – Tier 4 and Specialty – Tier 5. Each level has a different copayment. This gives you

and your doctor the freedom to choose the medication that is right for you. At the same time, this will

help you to better budget your health care dollars. Preferred Generic Medications – Tier 1 have the lowest copayment/co‐insurance. Generic drugs offer the same level of safety and quality as their brand‐name equivalents. They have the same amount of active ingredients as brand‐name medications. You are required to use a generic version of the drug if one is available. Generic Medications – Tier 2 have low copayment/co‐insurance. Generic drugs offer the same level of safety and quality as their brand‐name equivalents. They have the same amount of active ingredients as brand‐name medications. You are required to use a generic version of the drug if one is available.

Preferred‐Brand medications – Tier 3 have the middle level copayment/co‐insurance. These drugs are

brand medications and “preferred” because of their value and effectiveness. Non‐Preferred Brand and Generic medications – Tier 4 have a higher copayment/co‐insurance level. These medications are brand and generic drugs that are more expensive and have similar effectiveness as tier 3 medications.


iv

Specialty and High cost medications – Tier 5 have the highest copayment/co‐insurance level. These

also include Specialty medications which usually treat complex and rare conditions. These drugs can be

high‐cost medications and biologicals regardless of how they are administered (injectable, oral,

transdermal, or inhalant).

Non‐Formulary medications may be covered if the formulary medications do not work for you. If you

require a Non‐Formulary medication, your doctor may request coverage for the Tier 4 or Tier 5 copayment

by making a request for an exception.

Understanding Our Symbols

Prior Authorization

You will see the symbol “PA” next to certain drugs on our formulary tables. This is called prior

authorization. Prior authorization helps ensure that you’re using the best drugs in the safest way.

If you are currently taking or recently prescribed one of these drugs, please discuss possible alternatives or

have your doctor request authorization by calling 844.432.0704.

Drugs that require prior authorization are often:

Newer drugs for which the Health Plan wants to track usage. Non‐formulary drugs which require the use of formulary drugs prior to coverage. These drugs are

not used as a standard first option in treating a medical condition.

Drugs with potential side effects that the Health Plan wants to monitor for patient safety.

Drugs categorized as specialty medications. Step Therapy

You will see the symbol “ST” (Step Therapy) next to certain drugs on the formulary tables in this

booklet. Step therapy ensures you are taking the most effective medication at the best cost. This means

trying the least expensive medications usually generic medications or drugs that are considered as the

standard first‐line treatment. How step therapy works

Step 1: When your prescribed drug is impacted by step therapy, first you will be asked to try generic or

first‐line treatment drugs. The drug recommended will be approved by the Food and Drug Administration

(FDA) as providing the same health benefit at a much lower cost.

Step 2: If the generic drug in step 1 does not work for you, then you will have coverage for a brand‐name

drug. For more information on step therapy call 844.432.0704.

Quantity Limits

The symbol “QL” next to the drugs in this formulary booklet stands for Quantity Limits. To ensure you

are getting the most cost‐effective dose for your medication, a quantity limit or dose duration may be

placed on certain drugs. These limits are based on FDA guidelines, clinical literature, and manufacturer’s

instructions. Quantity limits promote appropriate use of the drug, prevent waste, and help control costs.


v

For some drugs, the dosing guidelines may recommend that patients take the drug one time a day in a

larger dose instead of several times a day in smaller doses. The quantity limits follow the guidelines and

cover one larger dose per day.

Prescriptions for specialty medications are limited to a 30‐day supply. For more information on

quantity limits or dose durations call 844.432.0704.

About Generic Drugs Generic drugs have the same active ingredients as their brand‐name equivalents, but cost significantly less.

Not all drugs have a generic equivalent. Generally, new drugs receive patent protection for 20 years. Once

the patent expires, other pharmaceutical companies can produce the same drug in a generic formulation.

Companies that make generic drugs do not have to invest large amounts of money in research, since the

company making the brand‐name equivalent has already done this. Also, generic companies do not need to

advertise their drugs. As a result, generic drug makers can pass these savings on to you.

Generic drugs have the same active ingredients as brand‐name drugs, but their inactive ingredients can vary.

This is why the generic drug might look different from the brand‐name drug. Inactive ingredients can be

dyes used to color the drug or powders used to shape the tablets. Inactive ingredients do not affect how the

generic drug works.

The FDA regulates generic drug manufacturers just as it regulates the makers of brand‐name medications.

The generic drug must pass strict FDA measurements to ensure that it delivers the same amount of the

active ingredient in the same time frame as its brand‐name counterpart. The manufacturer of the generic

drug must prove that it produces its product under the same strict guidelines as the brand‐name drug.

How to Fill Your Prescription Medications

Short‐term medications

These are drugs you need immediately. This includes medications used to treat short term infections, or to relieve pain temporarily. You can fill these prescriptions at network pharmacies accepting CVS prescriptions. Locate the nearest retail network pharmacy by calling 844.432.0704. To fill your prescription, present your member ID card and written prescription and pay your copayment/co‐insurance as described above.

Long‐term medications

These are drugs you take on a regular basis. These could be drugs to treat asthma, high blood pressure,

diabetes, etc. These medications can be mailed to your home for up to a 90‐day supply.

Specialty medications

Specialty medications treat specific medical conditions such as cancer, hemophilia, hepatitis, multiple

sclerosis, psoriasis, pulmonary arterial hypertension, respiratory syncytial virus, rheumatoid arthritis, and

more. You can fill these prescriptions:

Through IU Health Pharmacy


vi

o Advanced Therapies Pharmacy is a mail-order pharmacy that provides specialty

medications. Please call 844.678.7100 to learn more about filling your specialty

medication.

o All IU Health Retail pharmacies provide specialty medications. Visit

myiuhealthplans.com to find a location nearest you.

Through CVS Specialty Pharmacy

o CVS Specialty Pharmacy is a pharmacy that provides specialty medications. Please call

844.432.0704 to learn more about filling your specialty medication.

Filling Your Prescription When Traveling

When you travel outside of your local area, thousands of pharmacies across the country will honor your IU

Health Plans member ID card. To locate a participating pharmacy, contact your member services team at the phone number listed on the back of your member ID card or on 1 page of this booklet.

To fill a prescription at a participating out‐of‐area pharmacy, present your IU Health Plans member ID card. Some pharmacies may ask you to pay the full price of the medication. If that happens:

Submit a Direct Reimbursement Claim form to IU Health Plans at:

CVS Caremark - RxClaim

P.O Box 52136

Phoenix, AZ 85072-2136

Or you may call your member services team for assistance

If your claim is approved, you will be reimbursed the amount that you paid for the medication, less the

appropriate copayment.

If you will be away from home for an extended period of time, or if you will be traveling outside of the

country, you may want to use our mail‐order service so that you receive a 90‐day supply before you leave

home.

Medication Supplies Not Covered by IU Health Plans

No authorizations will be provided for medications that are reported by the member, provider, or

pharmacy to be lost, misplaced, stolen, destroyed, or damaged.

Medications received at no charge to the member (workers’ compensation, medications purchased with a

manufacturer’s coupon, etc.) will not be covered.

Prescriptions that are written more than a year ago will not be covered. Your doctor will need to write a new prescription.


vii

List of Abbreviations

ACA: Affordable Care Act.

LA: Limited Availability. This prescription may be available only at certain pharmacies. For more

information, please call Customer Service.

OTC: Over the Counter. An OTC drug is a non-prescription drug.

PA: Prior Authorization. The Plan requires you or your physician to get prior authorization for certain drugs.

This means that you will need to get approval before you fill your prescriptions. If you don’t get approval, we

may not cover the drug.

QL: Quantity Limit. For certain drugs, the Plan limits the amount of the drug that we will cover.

ST: Step Therapy. In some cases, the Plan requires you to first try certain drugs to treat your medical

condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat

your medical condition, we may not cover Drug B unless you try Drug A first. If Drug A does not work for

you, we will then cover Drug B.

PA - Prior Authorization QL - Quantity Limits ST - Step Therapy 1

Formulary Listing Effective 04/01/2019

Drug Name Drug Tier Requirements/Limits

ANALGESICS COX-II INHIBITORS

celecoxib cap 50 mg 2 ST

celecoxib cap 100 mg 2 ST; QL



GOUT allopurinol tab 100 mg 1

allopurinol tab 300 mg 1

COLCRYS TAB 0.6MG 3

ULORIC TAB 40MG 3 ST; QL

ULORIC TAB 80MG 3 ST

MISCELLANEOUS PRIALT INJ 25MCG/ML 5

PRIALT INJ 100MCG 5

PRIALT INJ 500MCG 5

NON-OPIOID ANALGESICS butalbital-acetaminophen tab 50-325 mg 2

butalbital-acetaminophen-caffeine cap

50-325-40 mg

2

butalbital-acetaminophen-caffeine tab 50-325-40 mg

2

butalbital-aspirin-caffeine cap 50-325-40 mg

2

NSAIDS choline & magnesium salicylates liq 500

mg/5ml

2

diclofenac potassium tab 50 mg 2

diclofenac sodium tab delayed release 25 mg

2


2


2

diclofenac sodium tab er 24hr 100 mg 2

diflunisal tab 500 mg 2

etodolac cap 200 mg 2

etodolac cap 300 mg 2

etodolac tab 400 mg 2

etodolac tab 500 mg 2

etodolac tab er 24hr 400 mg 2





fenoprofen calcium tab 600 mg 2

flurbiprofen tab 50 mg 2

flurbiprofen tab 100 mg 2

ibuprofen susp 100 mg/5ml 1

ibuprofen tab 400 mg 1



indomethacin cap 25 mg 2

indomethacin cap 50 mg 2

indomethacin cap er 75 mg 2

ketoprofen cap er 24hr 200 mg 2

ketorolac tromethamine tab 10 mg 2 QL

meclofenamate sodium cap 50 mg 2

meclofenamate sodium cap 100 mg 2

mefenamic acid cap 250 mg 2

meloxicam tab 7.5 mg 1

meloxicam tab 15 mg 1

nabumetone tab 500 mg 2

nabumetone tab 750 mg 2

naproxen sodium tab 275 mg 2

naproxen sodium tab 550 mg 2

naproxen susp 125 mg/5ml 2 PA

naproxen tab 250 mg 2



naproxen tab ec 375 mg 2

naproxen tab ec 500 mg 2

oxaprozin tab 600 mg 2

piroxicam cap 10 mg 2

piroxicam cap 20 mg 2

salsalate tab 500 mg 2

salsalate tab 750 mg 2

sulindac tab 150 mg 2

sulindac tab 200 mg 2

tolmetin sodium cap 400 mg 2

tolmetin sodium tab 200 mg 2

tolmetin sodium tab 600 mg 2

NSAIDS, COMBINATIONS diclofenac w/ misoprostol tab delayed

release 50-0.2 mg 2

diclofenac w/ misoprostol tab delayed

release 75-0.2 mg

2

NSAIDS, TOPICAL diclofenac sodium gel 1% 2 QL

VOLTAREN GEL 1% 4 QL



OPIOID ANALGESICS ABSTRAL SUB 100MCG 4 PA; QL

ABSTRAL SUB 200MCG 4 PA; QL





acetaminophen w/ codeine soln 120-12

mg/5ml

2 PA

acetaminophen w/ codeine tab 300-15 mg 2 PA



butalbital-acetaminophen-caff w/ cod cap

50-325-40-30 mg

2 PA

butalbital-aspirin-caff w/ codeine cap

50-325-40-30 mg

2 PA

butorphanol tartrate nasal soln 10 mg/ml 2 PA; QL

BUTRANS DIS 5MCG/HR 4 PA, ST

BUTRANS DIS 7.5/HR 4 PA, ST




codeine sulfate tab 15 mg 2 PA



endocet tab 5-325mg 2 PA

fentanyl citrate lozenge on a handle 200 mcg

2 QL


2 QL


2 QL


2 QL


2 QL

fentanyl td patch 72hr 12 mcg/hr 2 PA, ST; QL





FENTORA TAB 100MCG 4 PA; QL







hydrocodone-acetaminophen soln 7.5-325 mg/15ml

2 PA

hydrocodone-acetaminophen soln 10-325 mg/15ml

2 PA

hydrocodone-acetaminophen tab 5-325 mg 2 PA

hydrocodone-acetaminophen tab 7.5-325 mg

2 PA

hydrocodone-acetaminophen tab 10-325 mg

2 PA

hydrocodone-ibuprofen tab 5-200 mg 2 PA; QL

hydrocodone-ibuprofen tab 7.5-200 mg 2 PA; QL

hydrocodone-ibuprofen tab 10-200 mg 2 PA; QL

HYDROMORPHON SUP 3MG 2 PA

hydromorphone hcl tab 2 mg 2 PA



ibudone tab 5-200mg 4 PA; QL

ibudone tab 10-200mg 4 PA; QL

LAZANDA SPR 100MCG 4 PA; QL



meperidine hcl oral soln 50 mg/5ml 2 PA

meperidine hcl tab 50 mg 2 PA

meperidine hcl tab 100 mg 2 PA

methadone hcl soln 5 mg/5ml 2 PA, ST

methadone hcl soln 10 mg/5ml 2 PA, ST

methadone hcl tab 5 mg 2 PA, ST

methadone hcl tab 10 mg 2 PA, ST

methadone hcl tab for oral susp 40 mg 2 PA, ST

morphine sulfate oral soln 10 mg/5ml 2 PA

morphine sulfate oral soln 20 mg/5ml 2 PA

morphine sulfate oral soln 100 mg/5ml (20

mg/ml)

2 PA

morphine sulfate suppos 5 mg 2



MORPHINE SULFATE SUPPOS 30 MG 2

morphine sulfate tab 15 mg 2 PA; QL

morphine sulfate tab 30 mg 2 PA; QL

morphine sulfate tab er 15 mg 2 PA, ST; QL





oxycodone hcl cap 5 mg 2 PA

oxycodone hcl conc 100 mg/5ml (20

mg/ml)

2 PA



oxycodone hcl soln 5 mg/5ml 2 PA

oxycodone hcl tab 5 mg 2 PA





oxycodone hcl tab er 12hr deter 10 mg 4 PA, ST; QL







oxycodone w/ acetaminophen tab 2.5-325 mg

2 PA

oxycodone w/ acetaminophen tab 5-325 mg

2 PA

oxycodone w/ acetaminophen tab 7.5-325 mg

2 PA

oxycodone w/ acetaminophen tab 10-325 mg

2 PA

oxycodone-aspirin tab 4.8355-325 mg 2 PA

oxycodone-ibuprofen tab 5-400 mg 2 PA; QL

OXYCONTIN TAB 10MG CR 5 PA, ST; QL







oxymorphone hcl tab 5 mg 4 PA

oxymorphone hcl tab 10 mg 4 PA

oxymorphone hcl tab er 12hr 5 mg 4 PA, ST; QL

oxymorphone hcl tab er 12hr 7.5 mg 4 PA, ST; QL






pentazocine w/ naloxone tab 50-0.5 mg 2 PA

SUBSYS SPR 100MCG 5 PA; QL









tramadol hcl tab 50 mg 2 PA; QL

tramadol hcl tab er 24hr 100 mg 2 PA, ST; QL



tramadol-acetaminophen tab 37.5-325 mg 2 PA

ANTI-INFECTIVES AMINOGLYCOSIDES

neomycin sulfate tab 500 mg 2

paromomycin sulfate cap 250 mg 2

ANTIBACTERIALS, CEPHALOSPORINS 1ST GEN cefadroxil cap 500 mg 2

cefadroxil for susp 250 mg/5ml 2

cefadroxil for susp 500 mg/5ml 2

cefadroxil tab 1 gm 2

cephalexin cap 250 mg 1



cephalexin for susp 125 mg/5ml 2

cephalexin for susp 250 mg/5ml 2

cephalexin tab 250 mg 2

cephalexin tab 500 mg 1

ANTIBACTERIALS, CEPHALOSPORINS, 2ND GEN cefaclor cap 250 mg 2

cefaclor cap 500 mg 2

CEFACLOR ER TAB 500MG 2

cefaclor for susp 125 mg/5ml 2



cefprozil for susp 125 mg/5ml 2

cefprozil for susp 250 mg/5ml 2

cefprozil tab 250 mg 2

cefprozil tab 500 mg 2

cefuroxime axetil tab 500 mg 2

ANTIBACTERIALS, CEPHALOSPORINS, 3RD GEN cefdinir cap 300 mg 2

cefdinir for susp 125 mg/5ml 2

cefdinir for susp 250 mg/5ml 2

cefixime for susp 100 mg/5ml 2

cefixime for susp 200 mg/5ml 2

cefpodoxime proxetil for susp 50 mg/5ml 2

cefpodoxime proxetil for susp 100 mg/5ml 2

cefpodoxime proxetil tab 100 mg 2

cefpodoxime proxetil tab 200 mg 2

SUPRAX CAP 400MG 4

SUPRAX CHW 100MG 4

SUPRAX CHW 200MG 4



SUPRAX SUS 100/5ML 4



ANTIBACTERIALS, ERYTHROMYCINS/MACROLIDES azithromycin for susp 100 mg/5ml 2

azithromycin for susp 200 mg/5ml 2

azithromycin tab 250 mg 2



clarithromycin for susp 125 mg/5ml 2

clarithromycin for susp 250 mg/5ml 2

clarithromycin tab 250 mg 2

clarithromycin tab 500 mg 2

clarithromycin tab er 24hr 500 mg 2

DIFICID TAB 200MG 5 ST; QL

E.E.S. GRAN SUS 200/5ML 4

ERYPED SUS 400/5ML 5

erythromycin ethylsuccinate for susp 200 mg/5ml

4

erythromycin ethylsuccinate tab 400 mg 2

erythromycin stearate tab 250 mg 2

erythromycin tab 250 mg 2

erythromycin tab 500 mg 2

erythromycin tab delayed release 250 mg 3



erythromycin w/ delayed release particles cap 250 mg

2

ANTIBACTERIALS, FLUOROQUINOLONES AVELOX TAB 400MG 4

CIPRO (5%) SUS 250MG/5 4

CIPRO (10%) SUS 500MG/5 4

ciprofloxacin hcl tab 100 mg (base equiv) 2




ciprofloxacin-ciprofloxacin hcl tab er 24hr 500 mg (base eq)

2 QL

ciprofloxacin-ciprofloxacin hcl tab er 24hr

1000 mg(base eq)

2 QL

levofloxacin oral soln 25 mg/ml 2

moxifloxacin hcl tab 400 mg (base equiv) 2

ANTIBACTERIALS, PENICILLINS amoxicillin & k clavulanate chew tab

200-28.5 mg

2

amoxicillin & k clavulanate chew tab

400-57 mg

2



amoxicillin & k clavulanate for susp 200-28.5 mg/5ml

2


2

amoxicillin & k clavulanate for susp 400-57 mg/5ml

2


2

amoxicillin & k clavulanate tab 250-125 mg 2



amoxicillin & k clavulanate tab er 12hr 1000-62.5 mg

2

amoxicillin (trihydrate) cap 250 mg 1

amoxicillin (trihydrate) cap 500 mg 1

amoxicillin (trihydrate) chew tab 125 mg 2

amoxicillin (trihydrate) chew tab 250 mg 2

amoxicillin (trihydrate) for susp 125 mg/5ml

1


1


1


1

amoxicillin (trihydrate) tab 500 mg 1

amoxicillin (trihydrate) tab 875 mg 2

ampicillin cap 500 mg 2

dicloxacillin sodium cap 250 mg 2

dicloxacillin sodium cap 500 mg 2

penicillin v potassium for soln 125 mg/5ml 1

penicillin v potassium for soln 250 mg/5ml 1

penicillin v potassium tab 250 mg 1

penicillin v potassium tab 500 mg 2

ANTIBACTERIALS, SULFONAMIDES SULFADIAZINE TAB 500MG 2

sulfamethoxazole-trimethoprim susp 200-40 mg/5ml

2

sulfamethoxazole-trimethoprim tab 400-80 mg

1

sulfamethoxazole-trimethoprim tab 800-160 mg

1

ANTIBACTERIALS, TETRACYCLINES demeclocycline hcl tab 150 mg 2

demeclocycline hcl tab 300 mg 2

doxycycline hyclate tab 20 mg 2

doxycycline hyclate tab 100 mg 2



doxycycline hyclate tab delayed release 50 mg

2 ST


2 ST


2 ST


2 ST


2 ST

doxycycline monohydrate cap 100 mg 2

doxycycline monohydrate cap 150 mg 2

doxycycline monohydrate for susp 25

mg/5ml

2

doxycycline monohydrate tab 50 mg 2



MINOCIN CAP 50MG 4

minocycline hcl cap 50 mg 2



minocycline hcl tab 50 mg 2



tetracycline hcl cap 250 mg 2

tetracycline hcl cap 500 mg 2

VIBRAMYCIN SYP 50MG/5ML 4

ANTIFUNGALS clotrimazole troche 10 mg 2

CRESEMBA CAP 186 MG 4 QL

fluconazole for susp 10 mg/ml 2

fluconazole for susp 40 mg/ml 2

fluconazole tab 50 mg 2 QL




flucytosine cap 250 mg 2 PA

flucytosine cap 500 mg 2 PA

griseofulvin microsize susp 125 mg/5ml 2

griseofulvin microsize tab 500 mg 2

itraconazole cap 100 mg 2 PA; QL

NOXAFIL SUS 40MG/ML 5 PA

NOXAFIL TAB 100MG 5 PA; QL

nystatin susp 100000 unit/ml 2

nystatin tab 500000 unit 2

SPORANOX SOL 10MG/ML 4 PA; QL

terbinafine hcl tab 250 mg 2 QL



voriconazole for susp 40 mg/ml 2 QL

voriconazole tab 50 mg 2 QL

voriconazole tab 200 mg 2 QL

ANTIMALARIALS COARTEM TAB 20-120MG 3

ANTIRETROVIRALS, ANTIRETROVIRAL ADJUVANTS TYBOST TAB 150MG 3 QL

ANTIRETROVIRALS, ANTIRETROVIRAL COMBINATIONS abacavir sulfate-lamivudine tab 600-300

mg 2

abacavir sulfate-lamivudine-zidovudine tab 300-150-300 mg

2 QL

ATRIPLA TAB 3 QL

BIKTARVY TAB 3 QL

COMPLERA TAB 3 QL

DESCOVY TAB 200/25 3

EPZICOM TAB 600-300 4

EVOTAZ TAB 300-150 4 QL

GENVOYA TAB 3 QL

lamivudine-zidovudine tab 150-300 mg 2

PREZCOBIX TAB 800-150 4 QL

STRIBILD TAB 3 QL

TRIUMEQ TAB 3 QL

TRIZIVIR TAB 4 QL

TRUVADA TAB 100-150 3 QL




ANTIRETROVIRALS, CHEMOKINE RECEPTOR ANTAGONISTS SELZENTRY SOL 20MG/ML 3 PA; QL

SELZENTRY TAB 150MG 3 PA; QL

SELZENTRY TAB 300MG 3 PA; QL

ANTIRETROVIRALS, FUSION INHIBITORS FUZEON INJ 90MG 5 QL

ANTIRETROVIRALS, INTEGRASE INHIBITORS ISENTRESS CHW 25MG 3 QL

ISENTRESS CHW 100MG 3 QL

ISENTRESS HD TAB 600MG 3 QL

ISENTRESS POW 100MG 3 QL

ISENTRESS TAB 400MG 3 QL

TIVICAY TAB 10MG 3 QL



ANTIRETROVIRALS, PROTEASE INHIBITORS APTIVUS CAP 250MG 3 QL

APTIVUS SOL 3 QL



atazanavir sulfate cap 150 mg (base equiv) 2 QL



CRIXIVAN CAP 200MG 3 QL

CRIXIVAN CAP 400MG 3 QL

fosamprenavir calcium tab 700 mg (base equiv)

2 QL

INVIRASE TAB 500MG 3 QL

KALETRA TAB 100-25MG 3 QL

KALETRA TAB 200-50MG 3 QL

LEXIVA SUS 50MG/ML 3 QL

LEXIVA TAB 700MG 4 QL

lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml)

2 QL

NORVIR SOL 80MG/ML 3 QL

NORVIR TAB 100MG 3 QL

PREZISTA SUS 100MG/ML 3 QL

PREZISTA TAB 75MG 3 QL




REYATAZ CAP 150MG 4 QL



REYATAZ POW 50MG 3 QL

ritonavir tab 100 mg 2 QL

VIRACEPT TAB 250MG 3 QL

VIRACEPT TAB 625MG 3 QL

ANTIRETROVIRALS, REVERSE TRANSCRIPTASE INHIBITORS -

NON-NUCLEOSIDE EDURANT TAB 25MG 3 QL

efavirenz cap 50 mg 2 QL

efavirenz cap 200 mg 2 QL

efavirenz tab 600 mg 2 QL

INTELENCE TAB 25MG 3 PA; QL



nevirapine tab 200 mg 2 QL

nevirapine tab er 24hr 100 mg 2 QL

nevirapine tab er 24hr 400 mg 2 QL

RESCRIPTOR TAB 200MG 3 QL

SUSTIVA CAP 50MG 4 QL

SUSTIVA CAP 200MG 4 QL

SUSTIVA TAB 600MG 4 QL

VIRAMUNE SUS 50MG/5ML 3 QL




NUCLEOSIDE abacavir sulfate tab 300 mg (base equiv) 2 QL

didanosine delayed release capsule 200 mg 2 QL



EMTRIVA CAP 200MG 3 QL

EMTRIVA SOL 10MG/ML 3 QL

EPIVIR SOL 10MG/ML 4

lamivudine oral soln 10 mg/ml 2

lamivudine tab 150 mg 2

lamivudine tab 300 mg 2

RETROVIR INJ 10MG/ML 5

stavudine cap 15 mg 2 QL




VIDEX SOL 2GM 3 QL

VIDEX SOL 4GM 3 QL

zidovudine cap 100 mg 2 QL

zidovudine syrup 10 mg/ml 2 QL

zidovudine tab 300 mg 2 QL


NUCLEOTIDE tenofovir disoproxil fumarate tab 300 mg 2 QL

VIREAD POW 40MG/GM 3

VIREAD TAB 150MG 3 QL




ANTITUBERCULAR AGENTS cycloserine cap 250 mg 3

ethambutol hcl tab 100 mg 2

ethambutol hcl tab 400 mg 2

isoniazid syrup 50 mg/5ml 2

isoniazid tab 100 mg 2

isoniazid tab 300 mg 1

PASER GRA 4GM 3

PRIFTIN TAB 150MG 3

pyrazinamide tab 500 mg 2

RIFAMATE CAP 4

rifampin cap 150 mg 2

rifampin cap 300 mg 2

RIFATER TAB 3

SIRTURO TAB 100MG 4 PA

TRECATOR TAB 250MG 3



ANTIVIRALS, CMV AGENTS VALCYTE SOL 50MG/ML 5 QL

VALCYTE TAB 450MG 5

valganciclovir hcl tab 450 mg (base

equivalent)

4

ANTIVIRALS, HEPATITIS AGENTS - HEPATITIS B BARACLUDE SOL .05MG/ML 5 PA

BARACLUDE TAB 0.5MG 5 PA

BARACLUDE TAB 1MG 5 PA

entecavir tab 0.5 mg 5 PA

entecavir tab 1 mg 5 PA

EPIVIR HBV SOL 5MG/ML 3 PA

EPIVIR HBV TAB 100MG 4 PA

lamivudine tab 100 mg (hbv) 2 PA

ANTIVIRALS, HEPATITIS AGENTS - HEPATITIS C EPCLUSA TAB 400-100 5 PA; QL

HARVONI TAB 90-400MG 5 PA; QL

MAVYRET TAB 100-40MG 5 PA; QL

REBETOL SOL 40MG/ML 5 QL

ribasphere tab 400mg 5 QL

ribavirin cap 200 mg 5 QL

ribavirin tab 200 mg 5 QL

ribavirin tab 600 mg 5 QL

VOSEVI TAB 5 PA; QL

ANTIVIRALS, HERPES AGENTS acyclovir cap 200 mg 1

acyclovir susp 200 mg/5ml 2

acyclovir tab 400 mg 2

acyclovir tab 800 mg 2

famciclovir tab 125 mg 2 QL



valacyclovir hcl tab 1 gm 2 QL

valacyclovir hcl tab 500 mg 2 QL

ANTIVIRALS, INFLUENZA AGENTS oseltamivir phosphate cap 30 mg (base

equiv) 2 QL

oseltamivir phosphate cap 45 mg (base equiv)

2 QL

oseltamivir phosphate cap 75 mg (base

equiv)

2 QL

oseltamivir phosphate for susp 6 mg/ml

(base equiv)

2 QL

RELENZA MIS DISKHALE 4 QL

rimantadine hydrochloride tab 100 mg 2

TAMIFLU CAP 30MG 4 QL





TAMIFLU SUS 6MG/ML 4 QL

MISCELLANEOUS albendazole tab 200 mg 2

ALBENZA TAB 200MG 3

ALINIA SUS 100/5ML 3

ALINIA TAB 500MG 3

atovaquone susp 750 mg/5ml 2

BILTRICIDE TAB 600MG 3

CLEOCIN CAP 75MG 4

CLEOCIN CAP 150MG 4

CLEOCIN CAP 300MG 4

clindamycin hcl cap 75 mg 2



clindamycin palmitate hcl for soln 75 mg/5ml (base equiv)

2

dapsone tab 25 mg 3

dapsone tab 100 mg 3

ivermectin tab 3 mg 2

linezolid for susp 100 mg/5ml 4 QL

linezolid tab 600 mg 2 QL

MEPRON SUS 4

metronidazole cap 375 mg 2

metronidazole tab 250 mg 2

metronidazole tab 500 mg 2

NEBUPENT INH 300MG 3

nitrofurantoin macrocrystalline cap 50 mg 2

nitrofurantoin macrocrystalline cap 100 mg 2

nitrofurantoin monohydrate macrocrystalline cap 100 mg

2

PRIMSOL SOL 50MG/5ML 3

rifabutin cap 150 mg 2

SIVEXTRO INJ 200MG 5 QL

SIVEXTRO TAB 200MG 5 QL

STROMECTOL TAB 3MG 4

trimethoprim tab 100 mg 2

vancomycin hcl cap 125 mg (base

equivalent)

2

vancomycin hcl cap 250 mg (base

equivalent)

2

VANCOMYCIN INJ 500MG 4

VANCOMYCIN INJ 750MG 4

XIFAXAN TAB 200MG 4 QL

XIFAXAN TAB 550MG 5 PA; QL



ANTINEOPLASTIC AGENTS ALKYLATING AGENTS

ALKERAN INJ 50MG 5

ALKERAN TAB 2MG 5

BENDEKA INJ 100/4ML 5

BICNU INJ 100MG 5

busulfan inj 6 mg/ml 5

BUSULFEX INJ 6MG/ML 5

carboplatin iv soln 50 mg/5ml 5




cisplatin inj 50 mg/50ml (1 mg/ml) 5



CYCLOPHOSPH CAP 25MG 5

CYCLOPHOSPH CAP 50MG 5

cyclophosphamide for inj 1 gm 5

cyclophosphamide for inj 2 gm 5

cyclophosphamide for inj 500 mg 5

dacarbazine for inj 100 mg 5

dacarbazine for inj 200 mg 5

EMCYT CAP 140MG 5 PA

GLEOSTINE CAP 10MG 5 PA



IFEX INJ 1GM 5

ifosfamide for inj 1 gm 5

IFOSFAMIDE INJ 3GM 5

ifosfamide iv inj 1 gm/20ml (50 mg/ml) 5

ifosfamide iv inj 3 gm/60ml (50 mg/ml) 5

LEUKERAN TAB 2MG 5

melphalan hcl for inj 50 mg (base equiv) 5

MYLERAN TAB 2MG 5

oxaliplatin for iv inj 50 mg 5

oxaliplatin for iv inj 100 mg 5

oxaliplatin iv soln 50 mg/10ml 5

oxaliplatin iv soln 100 mg/20ml 5

TEMODAR CAP 5MG 5 PA






TEMODAR INJ 100MG 5 PA

temozolomide cap 5 mg 5 PA








TREANDA INJ 25MG 5

TREANDA INJ 100MG 5

VALCHLOR GEL 0.016% 5 PA

ZANOSAR INJ 1GM 5

ANTIMETABOLITES ALIMTA INJ 100MG 5

ALIMTA INJ 500MG 5

capecitabine tab 150 mg 5 PA

capecitabine tab 500 mg 5 PA

cladribine iv soln 10 mg/10ml (1 mg/ml) 2

cytarabine inj 20 mg/ml 2

cytarabine inj pf 20 mg/ml 4

cytarabine inj pf 100 mg/ml 2

floxuridine for inj 0.5 gm 5

fludarabine phosphate for inj 50 mg 5

fludarabine phosphate inj 25 mg/ml 5

fluorouracil iv soln 1 gm/20ml (50 mg/ml) 5

fluorouracil iv soln 2.5 gm/50ml (50

mg/ml)

5

fluorouracil iv soln 5 gm/100ml (50 mg/ml) 5

fluorouracil iv soln 500 mg/10ml (50 mg/ml)

5

gemcitabine hcl for inj 2 gm 2

gemcitabine hcl inj 1 gm/26.3ml (38 mg/ml) (base equiv)

2

gemcitabine hcl inj 2 gm/52.6ml (38 mg/ml) (base equiv)

2

gemcitabine hcl inj 200 mg/5.26ml (38 mg/ml) (base equiv)

2

mercaptopurine tab 50 mg 2

methotrexate sodium for inj 1 gm 2

methotrexate sodium inj 50 mg/2ml (25

mg/ml)

5

methotrexate sodium inj 250 mg/10ml (25 mg/ml)

5

methotrexate sodium inj pf 50 mg/2ml (25 mg/ml)

2


2


2

methotrexate sodium tab 2.5 mg (base equiv)

2



TABLOID TAB 40MG 5 PA

XELODA TAB 150MG 5 PA

XELODA TAB 500MG 5 PA

HORMONAL ANTINEOPLASTICS, ANTIANDROGENS abiraterone acetate tab 250 mg 5 PA; QL

bicalutamide tab 50 mg 2

ERLEADA TAB 60MG 5 PA; QL

flutamide cap 125 mg 2

NILANDRON TAB 150MG 5 PA

XTANDI CAP 40MG 5 PA; QL

ZYTIGA TAB 250MG 5 PA; QL

ZYTIGA TAB 500MG 5 PA; QL

HORMONAL ANTINEOPLASTICS, ANTIESTROGENS FARESTON TAB 60MG 5 PA

FASLODEX INJ 250/5ML 5

HORMONAL ANTINEOPLASTICS, AROMATASE INHIBITORS anastrozole tab 1 mg 2

exemestane tab 25 mg 2

letrozole tab 2.5 mg 2

HORMONAL ANTINEOPLASTICS, GONADOTROPIN RELEASING

HORMONE ANTAGONISTS FIRMAGON INJ 80MG 5 PA; QL

FIRMAGON INJ 120MG 5 PA; QL

HORMONAL ANTINEOPLASTICS, LUTEINIZING

HORMONE-RELEASING HORMONE (LHRH) AGONISTS ELIGARD INJ 7.5MG 5 PA; QL

ELIGARD INJ 22.5MG 5 PA; QL

ELIGARD INJ 30MG 5 PA; QL

ELIGARD INJ 45MG 5 PA; QL

leuprolide acetate inj kit 5 mg/ml 5 PA; QL

LUPRON DEPOT INJ 3.75MG 5 PA; QL




LUPRON DEPOT INJ 30MG 5 PA; QL

LUPRON DEPOT INJ 45MG 5 PA; QL

TRELSTAR MIX INJ 3.75MG 5 PA; QL



VANTAS KIT 50MG 5 PA; QL

ZOLADEX IMP 3.6MG 5 PA; QL

ZOLADEX IMP 10.8MG 5 PA; QL

HORMONAL ANTINEOPLASTICS, PROGESTINS DEPO-PROVERA INJ 400/ML 4 QL

megestrol acetate susp 40 mg/ml 2



megestrol acetate tab 20 mg 2

megestrol acetate tab 40 mg 2

IMMUNOMODULATORS POMALYST CAP 1MG 5 PA; QL

POMALYST CAP 2MG 5 PA; QL



REVLIMID CAP 2.5MG 5 PA; QL

REVLIMID CAP 5MG 5 PA; QL





THALOMID CAP 50MG 5 PA; QL




KINASE INHIBITORS AFINITOR DIS TAB 2MG 5 PA; QL

AFINITOR DIS TAB 3MG 5 PA; QL

AFINITOR DIS TAB 5MG 5 PA; QL

AFINITOR TAB 2.5MG 5 PA; QL

AFINITOR TAB 5MG 5 PA; QL

AFINITOR TAB 7.5MG 5 PA; QL

AFINITOR TAB 10MG 5 PA; QL

ALECENSA CAP 150MG 5 PA; QL

ALUNBRIG PAK 5 PA; QL

ALUNBRIG TAB 30MG 5 PA; QL



BOSULIF TAB 100MG 5 PA; QL

BOSULIF TAB 500MG 5 PA; QL

BRAFTOVI CAP 50MG 5 PA; QL

BRAFTOVI CAP 75MG 5 PA; QL

CABOMETYX TAB 20MG 5 PA; QL



CALQUENCE CAP 100MG 5 PA; QL

CAPRELSA TAB 100MG 5 PA; QL

CAPRELSA TAB 300MG 5 PA; QL

COMETRIQ KIT 60MG 5 PA; QL



COPIKTRA CAP 15MG 5 PA; QL

COPIKTRA CAP 25MG 5 PA; QL

COTELLIC TAB 20MG 5 PA; QL



GILOTRIF TAB 20MG 5 PA; QL



IBRANCE CAP 75MG 5 PA; QL



ICLUSIG TAB 15MG 5 PA; QL

ICLUSIG TAB 45MG 5 PA; QL

imatinib mesylate tab 100 mg (base

equivalent)

5 PA; QL

imatinib mesylate tab 400 mg (base equivalent)

5 PA; QL

IMBRUVICA CAP 140MG 5 PA; QL

IMBRUVICA TAB 140MG 5 PA; QL




INLYTA TAB 1MG 5 PA; QL

INLYTA TAB 5MG 5 PA; QL

IRESSA TAB 250MG 5 PA; QL

JAKAFI TAB 5MG 5 PA; QL





KISQALI 200 PAK FEMARA 5 PA; QL



KISQALI TAB 200DOSE 5 PA; QL



LENVIMA CAP 8 MG 5 PA; QL






MEKINIST TAB 0.5MG 5 PA; QL

MEKINIST TAB 2MG 5 PA; QL

MEKTOVI TAB 15MG 5 PA; QL

NERLYNX TAB 40MG 5 PA; QL

NEXAVAR TAB 200MG 5 PA; QL

RYDAPT CAP 25MG 5 PA; QL

SPRYCEL TAB 20MG 5 PA; QL








STIVARGA TAB 40MG 5 PA; QL

SUTENT CAP 12.5MG 5 PA; QL

SUTENT CAP 25MG 5 PA; QL

SUTENT CAP 37.5MG 5 PA; QL

SUTENT CAP 50MG 5 PA; QL

TAFINLAR CAP 50MG 5 PA; QL

TAFINLAR CAP 75MG 5 PA; QL

TAGRISSO TAB 40MG 5 PA; QL

TAGRISSO TAB 80MG 5 PA; QL

TARCEVA TAB 25MG 5 PA

TARCEVA TAB 100MG 5 PA; QL

TARCEVA TAB 150MG 5 PA; QL

TASIGNA CAP 50MG 5 PA; QL



TORISEL SOL 25MG/ML 5 QL

TYKERB TAB 250MG 5 PA; QL

VERZENIO TAB 50MG 5 PA; QL




VIZIMPRO TAB 15MG 5 PA; QL



VOTRIENT TAB 200MG 5 QL

XALKORI CAP 200MG 5 PA; QL

XALKORI CAP 250MG 5 PA; QL

ZELBORAF TAB 240MG 5 PA; QL

ZYDELIG TAB 100MG 5 PA; QL

ZYDELIG TAB 150MG 5 PA; QL

ZYKADIA CAP 150MG 5 PA; QL

MISCELLANEOUS ABRAXANE INJ 100MG 5

ADCETRIS INJ 50MG 5

ARRANON INJ 5MG/ML 5

AVASTIN INJ 5

AVASTIN INJ 400/16ML 5

bexarotene cap 75 mg 5 PA

bleomycin sulfate for inj 15 unit 5

bleomycin sulfate for inj 30 unit 5

daunorubicin hcl iv soln 20 mg/4ml (base equiv)

5

doxorubicin hcl for inj 50 mg 5

doxorubicin hcl inj 2 mg/ml 5



ELITEK INJ 1.5MG 5

ELITEK INJ 7.5MG 5

ELLENCE INJ 2MG/ML 5

epirubicin hcl iv soln 200 mg/100ml (2

mg/ml)

5

ERBITUX INJ 100MG 5

ERBITUX INJ 200MG 5

ERIVEDGE CAP 150MG 5 PA; QL

ETOPOPHOS INJ 100MG 5

etoposide cap 50 mg 5 PA

etoposide inj 1 gm/50ml (20 mg/ml) 2 PA

etoposide inj 100 mg/5ml (20 mg/ml) 2 PA

etoposide inj 500 mg/25ml (20 mg/ml) 2 PA

FARYDAK CAP 10MG 5 PA; QL



HERCEPTIN INJ 150MG 5

HERCEPTIN INJ 440MG 5

hydroxyurea cap 500 mg 2

IDAMYCIN PFS INJ 5MG/5ML 5

IDAMYCIN PFS INJ 20/20ML 5

idarubicin hcl iv inj 5 mg/5ml (1 mg/ml) 5

idarubicin hcl iv inj 20 mg/20ml (1 mg/ml) 5

IDHIFA TAB 50MG 5 PA; QL

IDHIFA TAB 100MG 5 PA; QL

IXEMPRA KIT INJ 15MG 5

IXEMPRA KIT INJ 45MG 5

JEVTANA INJ 60/1.5ML 5

KYPROLIS SOL 30MG 5

KYPROLIS SOL 60MG 5

leucovorin calcium for inj 500 mg 5

leucovorin calcium tab 5 mg 5




LONSURF TAB 15-6.14 5 PA

LONSURF TAB 20-8.19 5 PA

LYSODREN TAB 500MG 5 PA

MATULANE CAP 50MG 5

MESNEX TAB 400MG 5

mitomycin for iv soln 5 mg 5



mitoxantrone hcl inj conc 20 mg/10ml (2

mg/ml)

5

mitoxantrone hcl inj conc 25 mg/12.5ml (2 mg/ml)

5



mitoxantrone hcl inj conc 30 mg/15ml (2 mg/ml)

5

NINLARO CAP 2.3MG 5 PA; QL

NINLARO CAP 3MG 5 PA; QL

NINLARO CAP 4MG 5 PA; QL

NIPENT INJ 10MG 5

ODOMZO CAP 200MG 5 PA; QL

paclitaxel iv conc 30 mg/5ml (6 mg/ml) 2

paclitaxel iv conc 100 mg/16.7ml (6 mg/ml)

2



PERJETA INJ 420/14ML 5

PHOTOFRIN INJ 75MG 5

PROLEUKIN INJ 22MU 5

RITUXAN INJ 100MG 5 PA

RITUXAN INJ 500MG 5 PA

RUBRACA TAB 200MG 5 PA; QL



SYNRIBO INJ 3.5MG 5 PA

TARGRETIN GEL 1% 5 PA

TENIPOSIDE INJ 50MG/5ML 5

THERACYS INJ 5

TIBSOVO TAB 250MG 5 PA; QL

TICE BCG INJ 5

tretinoin cap 10 mg 5

VECTIBIX INJ 100MG 5

VECTIBIX INJ 400MG 5

VELCADE INJ 3.5MG 5

VENCLEXTA TAB 10MG 5 PA; QL



VENCLEXTA TAB START PK 5 PA; QL

vinblastine sulfate inj 1 mg/ml 2

vincristine sulfate iv soln 1 mg/ml 2

YERVOY INJ 50MG 5

YERVOY INJ 200MG 5

ZALTRAP INJ 100/4ML 5

ZALTRAP INJ 200/8ML 5

ZEJULA CAP 100MG 5 PA; QL

ZEVALIN KIT Y-90 5

ZOLINZA CAP 100MG 5 PA; QL

TOPOISOMERASE INHIBITORS CAMPTOSAR INJ 300/15ML 5

HYCAMTIN CAP 0.25MG 5 PA

HYCAMTIN CAP 1MG 5 PA



irinotecan hcl inj 500 mg/25ml (20 mg/ml) 5

TOPOTECAN INJ 4MG/4ML 5

CARDIOVASCULAR ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS

amlodipine besylate-benazepril hcl cap 2.5-10 mg

2

amlodipine besylate-benazepril hcl cap 5-10 mg

2

amlodipine besylate-benazepril hcl cap 5-20 mg

2

amlodipine besylate-benazepril hcl cap

5-40 mg

2


10-20 mg

2


10-40 mg

2

TARKA TAB 2-180 CR 4



trandolapril-verapamil hcl tab er 1-240 mg 2




ACE INHIBITOR/DIURETIC COMBINATIONS benazepril & hydrochlorothiazide tab

5-6.25 mg 2

benazepril & hydrochlorothiazide tab 10-12.5 mg

2

benazepril & hydrochlorothiazide tab 20-12.5 mg

2

benazepril & hydrochlorothiazide tab 20-25 mg

2

captopril & hydrochlorothiazide tab 25-15 mg

2


2


2


2

enalapril maleate & hydrochlorothiazide tab 5-12.5 mg

2

enalapril maleate & hydrochlorothiazide tab

10-25 mg

2

fosinopril sodium & hydrochlorothiazide tab

10-12.5 mg

2

fosinopril sodium & hydrochlorothiazide tab

20-12.5 mg

2



lisinopril & hydrochlorothiazide tab 10-12.5 mg

1

lisinopril & hydrochlorothiazide tab 20-12.5 mg

1

lisinopril & hydrochlorothiazide tab 20-25 mg

1

moexipril-hydrochlorothiazide tab 7.5-12.5 mg

2

moexipril-hydrochlorothiazide tab 15-12.5 mg

2

moexipril-hydrochlorothiazide tab 15-25 mg

2

quinapril-hydrochlorothiazide tab 10-12.5 mg

2

quinapril-hydrochlorothiazide tab 20-12.5 mg

2

quinapril-hydrochlorothiazide tab 20-25 mg 2

ACE INHIBITORS benazepril hcl tab 5 mg 1

benazepril hcl tab 10 mg 1



captopril tab 12.5 mg 2

captopril tab 25 mg 2



enalapril maleate tab 2.5 mg 2

enalapril maleate tab 5 mg 1



enalaprilat iv inj 1.25 mg/ml 2

fosinopril sodium tab 10 mg 2



lisinopril tab 2.5 mg 1

lisinopril tab 5 mg 1





moexipril hcl tab 7.5 mg 2

moexipril hcl tab 15 mg 2

perindopril erbumine tab 2 mg 2



quinapril hcl tab 5 mg 2






ramipril cap 1.25 mg 2

ramipril cap 2.5 mg 2

ramipril cap 5 mg 2

ramipril cap 10 mg 2

trandolapril tab 1 mg 2



ADRENOLYTICS, CENTRAL clonidine hcl tab 0.1 mg 1

clonidine hcl tab 0.2 mg 1

clonidine hcl tab 0.3 mg 1

clonidine td patch weekly 0.1 mg/24hr 2



guanfacine hcl tab 1 mg 1

guanfacine hcl tab 2 mg 1

AGENTS FOR PHEOCHROMOCYTOMA DEMSER CAP 250MG 4 PA

DIBENZYLINE CAP 10MG 4 PA

phenoxybenzamine hcl cap 10 mg 4 PA

ALDOSTERONE RECEPTOR ANTAGONISTS eplerenone tab 25 mg 2

eplerenone tab 50 mg 2

spironolactone tab 25 mg 1



ALPHA BLOCKERS doxazosin mesylate tab 1 mg 2

doxazosin mesylate tab 2 mg 2



prazosin hcl cap 1 mg 2



terazosin hcl cap 1 mg (base equivalent) 1




ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL

BLOCKER COMBINATIONS telmisartan-amlodipine tab 40-5 mg 2

telmisartan-amlodipine tab 40-10 mg 2





ANGIOTENSIN II RECEPTOR ANTAGONIST/DIURETIC

COMBINATIONS candesartan cilexetil-hydrochlorothiazide

tab 16-12.5 mg

2

candesartan cilexetil-hydrochlorothiazide

tab 32-12.5 mg

2

candesartan cilexetil-hydrochlorothiazide

tab 32-25 mg

2

irbesartan-hydrochlorothiazide tab

150-12.5 mg

2


300-12.5 mg

2

losartan potassium & hydrochlorothiazide tab 50-12.5 mg

2

losartan potassium & hydrochlorothiazide tab 100-12.5 mg

2

losartan potassium & hydrochlorothiazide tab 100-25 mg

2

telmisartan-hydrochlorothiazide tab 40-12.5 mg

2

telmisartan-hydrochlorothiazide tab 80-12.5 mg

2

telmisartan-hydrochlorothiazide tab 80-25 mg

2

valsartan-hydrochlorothiazide tab 80-12.5 mg

2


2

valsartan-hydrochlorothiazide tab 160-25 mg

2


2

valsartan-hydrochlorothiazide tab 320-25

mg

2

ANGIOTENSIN II RECEPTOR ANTAGONISTS candesartan cilexetil tab 4 mg 2

candesartan cilexetil tab 8 mg 2



eprosartan mesylate tab 600 mg 2

irbesartan tab 75 mg 2



losartan potassium tab 25 mg 2



telmisartan tab 20 mg 2





valsartan tab 40 mg 2




ANTIARRHYTHMICS adenosine iv soln 6 mg/2ml 2

adenosine iv soln 12 mg/4ml 2

amiodarone hcl tab 100 mg 4



disopyramide phosphate cap 100 mg 2

disopyramide phosphate cap 150 mg 2

dofetilide cap 125 mcg (0.125 mg) 2 QL



flecainide acetate tab 50 mg 2



lidocaine hcl iv inj 10 mg/ml 2

lidocaine hcl iv inj 20 mg/ml 2

lidocaine iv infusion in d5w inj 4 mg/ml 2

lidocaine iv infusion in d5w inj 8 mg/ml 2

mexiletine hcl cap 150 mg 2



MULTAQ TAB 400MG 3

NEXTERONE INJ 4

NORPACE CAP 100MG CR 4

NORPACE CAP 150MG CR 4

PROCAINAMIDE INJ 500MG/ML 2

propafenone hcl cap er 12hr 225 mg 2



propafenone hcl tab 150 mg 2



quinidine sulfate tab 200 mg 2

quinidine sulfate tab 300 mg 2

sotalol hcl (afib/afl) tab 80 mg 2



sotalol hcl tab 80 mg 1






TIKOSYN CAP 125MCG 3 QL



ANTILIPEMICS, BILE ACID RESINS cholestyramine light powder 4 gm/dose 2

cholestyramine light powder packets 4 gm 2

cholestyramine powder 4 gm/dose 2

cholestyramine powder packets 4 gm 2

colesevelam hcl tab 625 mg 2

COLESTID GRA 5GM 4

COLESTID POW 5GM 4

COLESTID TAB 1GM 4

colestipol hcl granule packets 5 gm 2

colestipol hcl granules 5 gm 2

colestipol hcl tab 1 gm 2

WELCHOL PAK 3.75GM 3

WELCHOL TAB 625MG 3

ANTILIPEMICS, CHOLESTEROL ABSORPTION INHIBITORS ezetimibe tab 10 mg 2

ANTILIPEMICS, FIBRATES choline fenofibrate cap dr 45 mg (fenofibric

acid equiv)

2 PA, ST

choline fenofibrate cap dr 135 mg

(fenofibric acid equiv)

2 PA, ST

fenofibrate micronized cap 43 mg 2




fenofibrate tab 48 mg 2




fenofibric acid tab 35 mg 2

fenofibric acid tab 105 mg 2

gemfibrozil tab 600 mg 2

LOPID TAB 600MG 4

TRILIPIX CAP 45MG 4 PA, ST

TRILIPIX CAP 135MG 4 PA, ST

ANTILIPEMICS, HMG-COA REDUCTASE

INHIBITORS/COMBINATIONS atorvastatin calcium tab 10 mg (base

equivalent) 2

atorvastatin calcium tab 20 mg (base equivalent)

2


2




2

ezetimibe-simvastatin tab 10-10 mg 4 QL




fluvastatin sodium cap 20 mg 2

fluvastatin sodium cap 40 mg 2

lovastatin tab 10 mg 1



pravastatin sodium tab 10 mg 2




rosuvastatin calcium tab 5 mg 2




simvastatin tab 5 mg 1





VYTORIN TAB 10-10MG 4 PA; QL




ANTILIPEMICS, MICROSOMAL TRIGLYCERIDE TRANSFER PROTEIN

INHIBITORS JUXTAPID CAP 5MG 5 PA; QL

JUXTAPID CAP 10MG 5 PA; QL





ANTILIPEMICS, MISCELLANEOUS KYNAMRO INJ 200MG/ML 5 PA; QL

ANTILIPEMICS, NIACINS/COMBINATIONS niacin tab er 500 mg (antihyperlipidemic) 4

niacin tab er 750 mg (antihyperlipidemic) 4

niacin tab er 1000 mg (antihyperlipidemic) 4

ANTILIPEMICS, OMEGA-3 FATTY ACIDS LOVAZA CAP 1GM 4

omega-3-acid ethyl esters cap 1 gm 4

VASCEPA CAP 1GM 3



ANTILIPEMICS, PCSK9 INHIBITORS REPATHA INJ 140MG/ML 5 PA; QL

REPATHA PUSH INJ 420/3.5 5 PA; QL

REPATHA SURE INJ 140MG/ML 5 PA; QL

BETA-BLOCKER/DIURETIC COMBINATIONS atenolol & chlorthalidone tab 50-25 mg 2

atenolol & chlorthalidone tab 100-25 mg 2

bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg

1

bisoprolol & hydrochlorothiazide tab 5-6.25 mg

1

bisoprolol & hydrochlorothiazide tab 10-6.25 mg

1

metoprolol & hydrochlorothiazide tab 50-25 mg

2


2


2

nadolol & bendroflumethiazide tab 40-5 mg 2

propranolol & hydrochlorothiazide tab

40-25 mg

2

propranolol & hydrochlorothiazide tab

80-25 mg

2

BETA-BLOCKERS acebutolol hcl cap 200 mg 2

acebutolol hcl cap 400 mg 2

atenolol tab 25 mg 1



betaxolol hcl tab 10 mg 2

betaxolol hcl tab 20 mg 2

bisoprolol fumarate tab 5 mg 2

bisoprolol fumarate tab 10 mg 2

BYSTOLIC TAB 2.5MG 4 PA, ST

BYSTOLIC TAB 5MG 4 PA, ST



carvedilol tab 3.125 mg 1



carvedilol tab 25 mg 1

INNOPRAN XL CAP 80MG 4 ST

INNOPRAN XL CAP 120MG 4 ST

labetalol hcl iv soln 5 mg/ml 2

labetalol hcl tab 100 mg 2





metoprolol succinate tab er 24hr 25 mg (tartrate equiv)

2


2


2


2

metoprolol tartrate iv soln 5 mg/5ml 2

metoprolol tartrate tab 25 mg 1



nadolol tab 20 mg 2

nadolol tab 40 mg 2

nadolol tab 80 mg 2

pindolol tab 5 mg 2

pindolol tab 10 mg 2

propranolol hcl cap er 24hr 60 mg 2




propranolol hcl inj 1 mg/ml 2

propranolol hcl oral soln 20 mg/5ml 2

propranolol hcl oral soln 40 mg/5ml 2

propranolol hcl tab 10 mg 1





timolol maleate tab 5 mg 2



CALCIUM CHANNEL BLOCKERS, DIHYDROPYRIDINES amlodipine besylate tab 2.5 mg (base

equivalent)

1

amlodipine besylate tab 5 mg (base

equivalent)

1

amlodipine besylate tab 10 mg (base equivalent)

1

CLEVIPREX EMU 50/100ML 4

felodipine tab er 24hr 2.5 mg 2

felodipine tab er 24hr 5 mg 2

felodipine tab er 24hr 10 mg 2

isradipine cap 2.5 mg 2

isradipine cap 5 mg 2

nicardipine hcl cap 20 mg 2



nicardipine hcl cap 30 mg 2

nicardipine hcl iv soln 2.5 mg/ml 2

nifedipine cap 20 mg 2

nifedipine tab er 24hr 30 mg 2



nifedipine tab er 24hr osmotic release 90 mg

2

nimodipine cap 30 mg 2

nisoldipine tab er 24hr 8.5 mg 2

nisoldipine tab er 24hr 17 mg 2


nisoldipine tab er 24hr 25.5 mg 2




NORVASC TAB 2.5MG 4

NORVASC TAB 5MG 4

NORVASC TAB 10MG 4

SULAR TAB 8.5MG 4

SULAR TAB 17MG 4

SULAR TAB 34MG 4

CALCIUM CHANNEL BLOCKERS, NON DIHYDROPYRIDINES CARDIZEM LA TAB 120MG 4

diltiazem hcl cap er 12hr 60 mg 2






diltiazem hcl coated beads cap er 24hr 120 mg

2


2


2


2


2

diltiazem hcl coated beads tab er 24hr 180 mg

2


2

diltiazem hcl coated beads tab er 24hr 300

mg

2




2


2

diltiazem hcl extended release beads cap er 24hr 120 mg

2


2


2


2


2


2

diltiazem hcl iv soln 25 mg/5ml (5 mg/ml) 2

diltiazem hcl iv soln 50 mg/10ml (5

mg/ml)

2


mg/ml)

2

diltiazem hcl tab 30 mg 2




DILTIAZEM INJ 100MG 2

verapamil hcl cap er 24hr 100 mg 2







verapamil hcl iv soln 2.5 mg/ml 2

verapamil hcl tab 40 mg 1



verapamil hcl tab er 120 mg 2



DIGITALIS GLYCOSIDES digoxin inj 0.25 mg/ml 2

digoxin oral soln 0.05 mg/ml 2

digoxin tab 125 mcg (0.125 mg) 2

digoxin tab 250 mcg (0.25 mg) 2

LANOXIN INJ 0.25MG/1 4

LANOXIN PED INJ 0.1MG/ML 4



LANOXIN TAB 0.25MG 4

LANOXIN TAB 0.125MG 4

DIRECT RENIN INHIBITORS/DIURETIC COMBINATIONS TEKTURNA HCT TAB 150-12.5 3 ST

TEKTURNA HCT TAB 150-25MG 3 ST

TEKTURNA HCT TAB 300-12.5 3 ST

TEKTURNA HCT TAB 300-25MG 3 ST

TEKTURNA TAB 150MG 3 ST

TEKTURNA TAB 300MG 3 ST

DIURETICS acetazolamide cap er 12hr 500 mg 2

acetazolamide sodium for inj 500 mg 2

acetazolamide tab 125 mg 2

acetazolamide tab 250 mg 2

ALDACTAZIDE TAB 50/50 4

amiloride & hydrochlorothiazide tab 5-50 mg

2

amiloride hcl tab 5 mg 2

bumetanide inj 0.25 mg/ml 2

bumetanide tab 0.5 mg 2

bumetanide tab 1 mg 2

bumetanide tab 2 mg 2

chlorothiazide sodium for inj 500 mg 2

chlorothiazide tab 250 mg 2

chlorothiazide tab 500 mg 2

chlorthalidone tab 25 mg 2

chlorthalidone tab 50 mg 2

DIURIL SUS 250/5ML 3

DYRENIUM CAP 50MG 4

DYRENIUM CAP 100MG 4

furosemide inj 10 mg/ml 2

furosemide oral soln 8 mg/ml 2

furosemide oral soln 10 mg/ml 2

furosemide tab 20 mg 1



hydrochlorothiazide cap 12.5 mg 1

hydrochlorothiazide tab 12.5 mg 1

hydrochlorothiazide tab 25 mg 1

hydrochlorothiazide tab 50 mg 1

indapamide tab 1.25 mg 2

indapamide tab 2.5 mg 2

KEVEYIS TAB 50MG 5 PA; QL

methazolamide tab 25 mg 2

methazolamide tab 50 mg 2

methyclothiazide tab 5 mg 2



metolazone tab 2.5 mg 2

metolazone tab 5 mg 2

metolazone tab 10 mg 2

spironolactone & hydrochlorothiazide tab

25-25 mg

2

torsemide tab 5 mg 2




triamterene & hydrochlorothiazide cap

37.5-25 mg

1

triamterene & hydrochlorothiazide tab

37.5-25 mg

1

triamterene & hydrochlorothiazide tab

75-50 mg

1

HEART FAILURE CORLANOR TAB 5MG 4 PA; QL

CORLANOR TAB 7.5MG 4 PA; QL

ENTRESTO TAB 24-26MG 3 PA; QL



MISCELLANEOUS atropine sulfate inj 0.4 mg/ml 2

atropine sulfate inj 1 mg/ml 2

atropine sulfate soln prefill syr 0.5 mg/5ml

(0.1 mg/ml)

2

atropine sulfate soln prefill syr 0.25

mg/5ml (0.05 mg/ml)

2

ETHAMOLIN INJ 5% 4

hydralazine hcl inj 20 mg/ml 2

hydralazine hcl tab 10 mg 2




methyldopa & hydrochlorothiazide tab 250-15 mg

2

methyldopa & hydrochlorothiazide tab 250-25 mg

2

methyldopa tab 250 mg 2

methyldopa tab 500 mg 2

midodrine hcl tab 2.5 mg 2

midodrine hcl tab 5 mg 2

midodrine hcl tab 10 mg 2

milrinone lactate in dextrose 5% iv soln 20

mg/100ml

2

milrinone lactate in dextrose 5% iv soln 40

mg/200ml

2



milrinone lactate iv soln 10 mg/10ml (base equivalent)

2


2


2

minoxidil tab 2.5 mg 2

minoxidil tab 10 mg 2

NATRECOR INJ 1.5MG 4

NORTHERA CAP 200MG 5 PA; QL

NORTHERA CAP 300MG 5 PA; QL

papaverine hcl inj 30 mg/ml 2

RANEXA TAB 500MG 3

RANEXA TAB 1000MG 3

NITRATES, INJECTABLE NITROGLYCER INJ 5MG/ML 2

NITRATES, ORAL ISORDIL TAB 40MG 4

isosorbide dinitrate tab 5 mg 2




isosorbide dinitrate tab er 40 mg 2

isosorbide mononitrate tab 10 mg 2

isosorbide mononitrate tab 20 mg 2

isosorbide mononitrate tab er 24hr 30 mg 2



nitroglycerin cap er 2.5 mg 2

nitroglycerin cap er 6.5 mg 2

nitroglycerin cap er 9 mg 2

NITRATES, SUBLINGUAL/TRANSLINGUAL nitroglycerin sl tab 0.3 mg 2

nitroglycerin sl tab 0.4 mg 2

nitroglycerin sl tab 0.6 mg 2

nitroglycerin tl soln 0.4 mg/spray (400 mcg/spray)

2

NITROLINGUAL SPR PUMPSPRA 4

NITROSTAT SUB 0.3MG 4



NITRATES, TRANSDERMAL NITRO-BID OIN 2% 2

NITRO-DUR DIS 0.1MG/HR 4








nitroglycerin td patch 24hr 0.1 mg/hr 2




PULMONARY ARTERIAL HYPERTENSION, ENDOTHELIN RECEPTOR

ANTAGONIST LETAIRIS TAB 5MG 5 PA; QL

LETAIRIS TAB 10MG 5 PA; QL

TRACLEER TAB 62.5MG 5 PA; QL

TRACLEER TAB 125MG 5 PA; QL

PULMONARY ARTERIAL HYPERTENSION, PHOSPHODIESTERASE

INHIBITOR REVATIO TAB 20MG 5 PA; QL

sildenafil citrate tab 20 mg 5 PA; QL

PULMONARY ARTERIAL HYPERTENSION, PROSTACYCLIN RECEPTOR

AGONISTS UPTRAVI TAB 200/800 4 PA; QL

UPTRAVI TAB 200MCG 5 PA; QL








PULMONARY ARTERIAL HYPERTENSION, PROSTAGLANDIN

VASODILATORS epoprostenol sodium for inj 0.5 mg 5 PA

FLOLAN INJ 0.5MG 5 PA

FLOLAN INJ 1.5MG 5 PA

ORENITRAM TAB 0.25MG 5 PA


ORENITRAM TAB 1MG 5 PA


ORENITRAM TAB 5MG 5 PA

REMODULIN INJ 1MG/ML 5 PA

REMODULIN INJ 2.5MG/ML 5 PA



TYVASO START SOL 0.6MG/ML 5 PA

VELETRI INJ 0.5MG 5 PA

VENTAVIS SOL 10MCG/ML 5 PA



VENTAVIS SOL 20MCG/ML 5 PA

PULMONARY ARTERIAL HYPERTENSION, SOLUBLE GUANYLATE

CYCLASE STIMULATORS ADEMPAS TAB 0.5MG 5 PA; QL

ADEMPAS TAB 1.5MG 5 PA; QL

ADEMPAS TAB 1MG 5 PA; QL

ADEMPAS TAB 2.5MG 5 PA; QL

ADEMPAS TAB 2MG 5 PA; QL

VASOPRESSORS dobutamine hcl inj 12.5 mg/ml 2

dobutamine inj 1 mg/ml in d5w 2



dopamine hcl inj 40 mg/ml 2



ephedrine sulfate inj 50 mg/ml 2

EPINEPHRINE INJ 1MG/ML 4

phenylephrine hcl inj 10 mg/ml 2

CENTRAL NERVOUS SYSTEM ANTIANXIETY, BENZODIAZEPINES

ALPRAZOLAM CON 1 MG/ML 2

alprazolam orally disintegrating tab 0.5 mg 2 ST

alprazolam orally disintegrating tab 0.25

mg

2 ST

alprazolam orally disintegrating tab 1 mg 2 ST

alprazolam orally disintegrating tab 2 mg 2 ST

alprazolam tab 0.5 mg 2

alprazolam tab 0.25 mg 2

alprazolam tab 1 mg 2

alprazolam tab 2 mg 2

alprazolam tab er 24hr 0.5 mg 2

alprazolam tab er 24hr 1 mg 2



chlordiazepoxide hcl cap 5 mg 2



clonazepam orally disintegrating tab 0.5

mg

2 ST

clonazepam orally disintegrating tab 0.25 mg

2 ST

clonazepam orally disintegrating tab 0.125 mg

2 ST

clonazepam orally disintegrating tab 1 mg 2 ST

clonazepam orally disintegrating tab 2 mg 2 ST



clonazepam tab 0.5 mg 2

clonazepam tab 1 mg 2

clonazepam tab 2 mg 2

clorazepate dipotassium tab 3.75 mg 2

clorazepate dipotassium tab 7.5 mg 2

clorazepate dipotassium tab 15 mg 2

diazepam conc 5 mg/ml 2

diazepam inj 5 mg/ml 2

DIAZEPAM INJ 10MG/2ML 2

diazepam oral soln 1 mg/ml 2

diazepam tab 2 mg 2

diazepam tab 5 mg 2

diazepam tab 10 mg 2

lorazepam conc 2 mg/ml 2

lorazepam inj 2 mg/ml 2

lorazepam inj 4 mg/ml 2

lorazepam tab 0.5 mg 2

lorazepam tab 1 mg 2

lorazepam tab 2 mg 2

oxazepam cap 10 mg 2



ANTIANXIETY, MISCELLANEOUS buspirone hcl tab 5 mg 1

buspirone hcl tab 7.5 mg 2

buspirone hcl tab 10 mg 1



clomipramine hcl cap 25 mg 4 ST



fluvoxamine maleate tab 25 mg 2



meprobamate tab 200 mg 2

meprobamate tab 400 mg 2

ANTICONVULSANTS APTIOM TAB 200MG 4 PA; QL

APTIOM TAB 400MG 4 PA; QL



BANZEL SUS 40MG/ML 4 PA

BANZEL TAB 200MG 4 PA

BANZEL TAB 400MG 4 PA

BRIVIACT INJ 50MG/5ML 4 PA; QL

BRIVIACT SOL 10MG/ML 4 PA; QL



BRIVIACT TAB 10MG 4 PA; QL





carbamazepine cap er 12hr 100 mg 2



carbamazepine chew tab 100 mg 2

carbamazepine susp 100 mg/5ml 2

carbamazepine tab 200 mg 1

carbamazepine tab er 12hr 100 mg 2



CARBATROL CAP 100MG 4



CELONTIN CAP 300MG 3

clobazam suspension 2.5 mg/ml 5 PA; QL

clobazam tab 10 mg 5 PA; QL

clobazam tab 20 mg 5 PA; QL

DEPAKOTE ER TAB 500MG 4

DIASTAT ACDL GEL 5-10MG 4

DIASTAT ACDL GEL 12.5-20 4

DIASTAT PED GEL 2.5M GEL 4

DILANTIN CAP 30MG 3

DILANTIN CAP 100MG 4

DILANTIN CHW 50MG 4

DILANTIN-125 SUS 125/5ML 4

divalproex sodium cap delayed release sprinkle 125 mg

2

divalproex sodium tab delayed release 125 mg

2


2


2

divalproex sodium tab er 24 hr 250 mg 2

divalproex sodium tab er 24 hr 500 mg 2

EPIDIOLEX SOL 100MG/ML 5 PA

ethosuximide cap 250 mg 2

ethosuximide soln 250 mg/5ml 2

felbamate susp 600 mg/5ml 2

felbamate tab 400 mg 2

felbamate tab 600 mg 2

FYCOMPA SUS 0.5MG/ML 4 PA; QL

FYCOMPA TAB 2MG 4 PA; QL








gabapentin cap 100 mg 1



gabapentin oral soln 250 mg/5ml 2

gabapentin tab 600 mg 2

gabapentin tab 800 mg 2

GABITRIL TAB 12MG 3

GABITRIL TAB 16MG 3

KEPPRA INJ 500/5ML 4

KEPPRA SOL 100MG/ML 4

KEPPRA TAB 250MG 4

KEPPRA TAB 500MG 4

KEPPRA TAB 750MG 4

KEPPRA TAB 1000MG 4

KEPPRA XR TAB 500MG 4 QL

KEPPRA XR TAB 750MG 4 QL

lamotrigine tab 25 mg 2




lamotrigine tab chewable dispersible 5 mg 2

lamotrigine tab chewable dispersible 25 mg 2

levetiracetam inj 500 mg/5ml (100 mg/ml) 2

levetiracetam oral soln 100 mg/ml 2

levetiracetam tab 250 mg 2




levetiracetam tab er 24hr 500 mg 2 QL

levetiracetam tab er 24hr 750 mg 2 QL

ONFI SUS 2.5MG/ML 5 PA; QL

ONFI TAB 10MG 5 PA; QL

ONFI TAB 20MG 5 PA; QL

oxcarbazepine susp 300 mg/5ml (60 mg/ml)

2

oxcarbazepine tab 150 mg 2



PHENOBARB INJ 65MG/ML 2

phenobarbital elixir 20 mg/5ml 2

phenobarbital sodium inj 130 mg/ml 2

phenobarbital tab 15 mg 2



phenobarbital tab 16.2 mg 2







PHENYTEK CAP 200MG 4

PHENYTEK CAP 300MG 4

phenytoin chew tab 50 mg 2

phenytoin sodium extended cap 100 mg 2



phenytoin sodium inj 50 mg/ml 2

phenytoin susp 125 mg/5ml 2

primidone tab 50 mg 2

primidone tab 250 mg 2

SABRIL TAB 500MG 5 PA; QL

TEGRETOL SUS 100/5ML 4

TEGRETOL-XR TAB 100MG 4



tiagabine hcl tab 2 mg 2




topiramate sprinkle cap 15 mg 2 QL

topiramate sprinkle cap 25 mg 2 QL

topiramate tab 25 mg 2




valproate sodium inj 100 mg/ml 2

valproate sodium oral soln 250 mg/5ml (base equiv)

2

valproic acid cap 250 mg 2

vigabatrin powd pack 500 mg 5 PA; QL

VIMPAT INJ 200MG/20 4 PA

VIMPAT SOL 10MG/ML 4 PA

VIMPAT TAB 50MG 4 PA




zonisamide cap 25 mg 2





ANTIDEMENTIA donepezil hydrochloride orally

disintegrating tab 5 mg 2

donepezil hydrochloride orally disintegrating tab 10 mg

2

donepezil hydrochloride tab 5 mg 2

donepezil hydrochloride tab 10 mg 2

galantamine hydrobromide cap er 24hr 8 mg

2 PA


2 PA


2 PA

galantamine hydrobromide oral soln 4 mg/ml

2 PA

galantamine hydrobromide tab 4 mg 2 PA



memantine hcl oral solution 2 mg/ml 2

memantine hcl tab 5 mg 2

memantine hcl tab 5 mg (28) & 10 mg (21) titration pak

2

memantine hcl tab 10 mg 2

rivastigmine tartrate cap 1.5 mg (base

equivalent)

2 PA

rivastigmine tartrate cap 3 mg (base

equivalent)

2 PA

rivastigmine tartrate cap 4.5 mg (base

equivalent)

2 PA


equivalent)

2 PA

rivastigmine td patch 24hr 4.6 mg/24hr 2 PA



ANTIDEPRESSANTS, MAOIS MARPLAN TAB 10MG 3

phenelzine sulfate tab 15 mg 2

tranylcypromine sulfate tab 10 mg 2

ANTIDEPRESSANTS, MISCELLANEOUS bupropion hcl tab 75 mg 2

bupropion hcl tab 100 mg 2

bupropion hcl tab er 12hr 100 mg 2







chlordiazepoxide-amitriptyline tab 5-12.5 mg

2

chlordiazepoxide-amitriptyline tab 10-25 mg

2

maprotiline hcl tab 25 mg 2



mirtazapine orally disintegrating tab 15 mg 2



mirtazapine tab 7.5 mg 2

mirtazapine tab 15 mg 2



trazodone hcl tab 50 mg 1




ANTIDEPRESSANTS, SNRIS DESVENLAFAX TAB 50MG ER 4 ST; QL

desvenlafaxine succinate tab er 24hr 25 mg (base equiv)

4 ST; QL


4 ST; QL


4 ST; QL

desvenlafaxine tab er 24hr 50 mg 4 ST; QL

desvenlafaxine tab er 24hr 100 mg 4 ST; QL

duloxetine hcl enteric coated pellets cap 20 mg (base eq)

2 QL


2 QL


2 QL

FETZIMA CAP 20MG 4 PA; QL




FETZIMA CAP TITRATIO 4 PA; QL

KHEDEZLA TAB 50MG ER 4 ST; QL

KHEDEZLA TAB 100MG ER 4 ST; QL

PRISTIQ TAB 25MG 4 ST; QL



venlafaxine hcl cap er 24hr 37.5 mg (base

equivalent)

2



venlafaxine hcl cap er 24hr 75 mg (base equivalent)

2

venlafaxine hcl cap er 24hr 150 mg (base equivalent)

2

venlafaxine hcl tab 25 mg 2

venlafaxine hcl tab 37.5 mg 2




venlafaxine hcl tab er 24hr 37.5 mg (base equivalent)

2 ST

venlafaxine hcl tab er 24hr 75 mg (base equivalent)

2 ST


2 ST


2 ST

ANTIDEPRESSANTS, SSRIS citalopram hydrobromide oral soln 10

mg/5ml 2

citalopram hydrobromide tab 10 mg (base equiv)

1 QL


1 QL


1 QL

escitalopram oxalate soln 5 mg/5ml (base equiv)

2 QL

escitalopram oxalate tab 5 mg (base equiv)

2 QL

escitalopram oxalate tab 10 mg (base equiv)

2 QL

escitalopram oxalate tab 20 mg (base

equiv)

2 QL

fluoxetine hcl (pmdd) cap 10 mg 1

fluoxetine hcl (pmdd) cap 20 mg 1

fluoxetine hcl (pmdd) tab 10 mg 1

fluoxetine hcl (pmdd) tab 20 mg 1

fluoxetine hcl cap 10 mg 1



fluoxetine hcl cap delayed release 90 mg 2 QL

fluoxetine hcl solution 20 mg/5ml 2

fluoxetine hcl tab 10 mg 1 ST

fluoxetine hcl tab 20 mg 1 ST

paroxetine hcl tab 10 mg 1 QL






paroxetine hcl tab er 24hr 12.5 mg 2 QL

paroxetine hcl tab er 24hr 25 mg 2 QL

paroxetine hcl tab er 24hr 37.5 mg 2 QL

PAXIL SUS 10MG/5ML 3 QL

sertraline hcl oral concentrate for solution 20 mg/ml

2

sertraline hcl tab 25 mg 1



TRINTELLIX TAB 5MG 4 PA; QL



VIIBRYD KIT STARTER 4 PA; QL

VIIBRYD TAB 10MG 4 PA; QL



ANTIDEPRESSANTS, TCAS amitriptyline hcl tab 10 mg 1

amitriptyline hcl tab 25 mg 1





amoxapine tab 25 mg 2




desipramine hcl tab 10 mg 2






doxepin hcl cap 10 mg 2






doxepin hcl conc 10 mg/ml 2

imipramine hcl tab 10 mg 2



imipramine pamoate cap 75 mg 2






nortriptyline hcl cap 10 mg 1




nortriptyline hcl soln 10 mg/5ml 2

protriptyline hcl tab 5 mg 2

protriptyline hcl tab 10 mg 2

SURMONTIL CAP 25MG 4



ANTIPARKINSONIAN AGENTS amantadine hcl cap 100 mg 2

amantadine hcl syrup 50 mg/5ml 2

amantadine hcl tab 100 mg 2

APOKYN INJ 10MG/ML 5 PA; QL

benztropine mesylate inj 1 mg/ml 2

benztropine mesylate tab 0.5 mg 1

benztropine mesylate tab 1 mg 1

benztropine mesylate tab 2 mg 1

bromocriptine mesylate cap 5 mg (base equivalent)

2

bromocriptine mesylate tab 2.5 mg (base equivalent)

2

carbidopa & levodopa orally disintegrating tab 10-100 mg

2

carbidopa & levodopa orally disintegrating

tab 25-100 mg

2

carbidopa & levodopa orally disintegrating

tab 25-250 mg

2

carbidopa & levodopa tab 10-100 mg 2



carbidopa & levodopa tab er 25-100 mg 2

carbidopa & levodopa tab er 50-200 mg 2

carbidopa tab 25 mg 2

carbidopa-levodopa-entacapone tabs 12.5-50-200 mg

2


2

carbidopa-levodopa-entacapone tabs 25-100-200 mg

2


2


2



carbidopa-levodopa-entacapone tabs 50-200-200 mg

2

DUOPA SUS 4.63-20 4 PA

entacapone tab 200 mg 2

pramipexole dihydrochloride tab 0.5 mg 2




pramipexole dihydrochloride tab 1 mg 2


pramipexole dihydrochloride tab er 24hr 0.75 mg

2


2


2


2

pramipexole dihydrochloride tab er 24hr 3 mg

2


2


2

rasagiline mesylate tab 0.5 mg (base equiv)

2

rasagiline mesylate tab 1 mg (base equiv) 2

ropinirole hydrochloride tab 0.5 mg 2

ropinirole hydrochloride tab 0.25 mg 2

ropinirole hydrochloride tab 1 mg 2





ropinirole hydrochloride tab er 24hr 2 mg (base equivalent)

2 ST


2 ST


2 ST

ropinirole hydrochloride tab er 24hr 8 mg

(base equivalent)

2 ST

ropinirole hydrochloride tab er 24hr 12 mg

(base equivalent)

2 ST

selegiline hcl cap 5 mg 2

selegiline hcl tab 5 mg 2

trihexyphenidyl hcl elixir 0.4 mg/ml 2

trihexyphenidyl hcl tab 2 mg 1



trihexyphenidyl hcl tab 5 mg 2

ANTIPSYCHOTICS, ATYPICALS ABILIFY MAIN INJ 300MG 4 PA; QL

ABILIFY MAIN INJ 400MG 4 PA; QL

aripiprazole oral solution 1 mg/ml 4 ST; QL

aripiprazole orally disintegrating tab 10 mg 4 ST; QL

aripiprazole orally disintegrating tab 15 mg 4 ST; QL

aripiprazole tab 2 mg 4 ST; QL






ARISTADA INJ 441MG/1. 5 QL

ARISTADA INJ 662MG/2 5 QL

ARISTADA INJ 882MG/3 5 QL

ARISTADA INJ 1064MG 5 PA; QL

clozapine orally disintegrating tab 12.5 mg 2 QL

clozapine orally disintegrating tab 25 mg 2 QL




clozapine tab 25 mg 2




FANAPT PAK 4 PA; QL

FANAPT TAB 1MG 4 PA; QL







GEODON INJ 20MG 4

INVEGA SUST INJ 39/0.25 5 PA; QL

INVEGA SUST INJ 78/0.5ML 5 PA; QL


INVEGA SUST INJ 156MG/ML 5 PA; QL


INVEGA TRINZ INJ 273MG 5 PA; QL




LATUDA TAB 20MG 4 ST; QL







loxapine succinate cap 5 mg 2




NUPLAZID TAB 17MG 5 PA; QL

olanzapine for im inj 10 mg 2

olanzapine orally disintegrating tab 5 mg 2 QL




olanzapine tab 2.5 mg 2 QL

olanzapine tab 5 mg 2 QL

olanzapine tab 7.5 mg 2 QL




paliperidone tab er 24hr 1.5 mg 4 PA; QL

paliperidone tab er 24hr 3 mg 4 PA; QL



quetiapine fumarate tab 25 mg 2 QL






RISPERDAL INJ 12.5MG 4 QL

RISPERDAL INJ 25MG 4 QL

RISPERDAL INJ 37.5MG 5 QL

RISPERDAL INJ 50MG 4 QL

risperidone orally disintegrating tab 0.5 mg 2 QL

risperidone orally disintegrating tab 0.25 mg

2 QL

risperidone orally disintegrating tab 1 mg 2 QL

risperidone orally disintegrating tab 2 mg 2 QL

risperidone soln 1 mg/ml 2 QL

risperidone tab 0.5 mg 2 QL

risperidone tab 0.25 mg 2 QL

risperidone tab 1 mg 2 QL




SAPHRIS SUB 2.5MG 4 ST; QL

SAPHRIS SUB 5MG 4 ST; QL



SAPHRIS SUB 10MG 4 ST; QL

ziprasidone hcl cap 20 mg 2 QL




ZYPREXA RELP INJ 210MG 4 PA; QL



ANTIPSYCHOTICS, MISCELLANEOUS CHLORPROMAZ INJ 25MG/ML 2

CHLORPROMAZ INJ 50MG/2ML 2

chlorpromazine hcl tab 10 mg 2





fluphenazine decanoate inj 25 mg/ml 2

fluphenazine hcl elixir 2.5 mg/5ml 2

fluphenazine hcl inj 2.5 mg/ml 2

fluphenazine hcl oral conc 5 mg/ml 2

fluphenazine hcl tab 1 mg 2

fluphenazine hcl tab 2.5 mg 2



HALDOL DECAN INJ 50MG/ML 4

HALDOL DECAN INJ 100MG/ML 4

HALDOL INJ 5MG/ML 4

haloperidol decanoate im soln 50 mg/ml 2

haloperidol decanoate im soln 100 mg/ml 2

haloperidol lactate inj 5 mg/ml 2

haloperidol lactate oral conc 2 mg/ml 2

haloperidol tab 0.5 mg 1

haloperidol tab 1 mg 1





perphenazine tab 2 mg 2




perphenazine-amitriptyline tab 2-10 mg 2







pimozide tab 1 mg 2

pimozide tab 2 mg 2

thioridazine hcl tab 10 mg 2




thiothixene cap 1 mg 2




trifluoperazine hcl tab 1 mg (base equivalent)

2

trifluoperazine hcl tab 2 mg (base equivalent)

2

trifluoperazine hcl tab 5 mg (base

equivalent)

2


equivalent)

2

ATTENTION DEFICIT HYPERACTIVITY DISORDER ADDERALL TAB 5MG 4 QL

ADDERALL TAB 7.5MG 4 QL

ADDERALL TAB 10MG 4 QL

ADDERALL TAB 12.5MG 4 QL




amphetamine-dextroamphetamine cap er

24hr 5 mg

2 QL

amphetamine-dextroamphetamine cap er 24hr 10 mg

2 QL


2 QL


2 QL


2 QL


2 QL

amphetamine-dextroamphetamine tab 5 mg

2 QL

amphetamine-dextroamphetamine tab 7.5 mg

2 QL


2 QL

amphetamine-dextroamphetamine tab 12.5 mg

2 QL


2 QL




2 QL


2 QL

atomoxetine hcl cap 10 mg (base equiv) 2 QL







clonidine hcl tab er 12hr 0.1 mg 2 QL

DESOXYN TAB 5MG 4 QL

DEXEDRINE CAP 5MG CR 4 QL



dexmethylphenidate hcl cap er 24 hr 5 mg 2 QL

dexmethylphenidate hcl cap er 24 hr 10 mg

2 QL


2 QL


2 QL


2 QL


2 QL

dexmethylphenidate hcl cap er 24 hr 35

mg

2 QL


mg

2 QL

dexmethylphenidate hcl tab 2.5 mg 2 QL

dexmethylphenidate hcl tab 5 mg 2 QL

dexmethylphenidate hcl tab 10 mg 2 QL

dextroamphetamine sulfate cap er 24hr 5 mg

2 QL


2 QL


2 QL

dextroamphetamine sulfate tab 5 mg 2 QL

dextroamphetamine sulfate tab 10 mg 2 QL

FOCALIN XR CAP 25MG 4 QL

FOCALIN XR CAP 35MG 4 QL

guanfacine hcl tab er 24hr 1 mg (base

equiv)

2 QL

guanfacine hcl tab er 24hr 2 mg (base

equiv)

2 QL



guanfacine hcl tab er 24hr 3 mg (base equiv)

2 QL

guanfacine hcl tab er 24hr 4 mg (base equiv)

2 QL

methamphetamine hcl tab 5 mg 2 QL

methylphenidate hcl cap er 10 mg (cd) 2 QL


methylphenidate hcl cap er 24hr 20 mg

(la)

2 QL


(la)

2 QL

methylphenidate hcl cap er 24hr 40 mg (la)

2 QL





methylphenidate hcl chew tab 2.5 mg 2 QL

methylphenidate hcl chew tab 5 mg 2 QL

methylphenidate hcl chew tab 10 mg 2 QL

methylphenidate hcl soln 5 mg/5ml 2 QL

methylphenidate hcl soln 10 mg/5ml 2 QL

methylphenidate hcl tab 5 mg 2 QL



methylphenidate hcl tab er 10 mg 2 QL

methylphenidate hcl tab er 24hr 18 mg 2 QL




methylphenidate hcl tab er osmotic release (osm) 18 mg

2 QL


2 QL


2 QL


2 QL

STRATTERA CAP 10MG 4 QL







VYVANSE CAP 10MG 4 PA; QL









FIBROMYALGIA LYRICA CAP 25MG 4 PA; QL

LYRICA CAP 50MG 4 PA; QL







LYRICA SOL 20MG/ML 4 PA; QL

SAVELLA MIS TITR PAK 4 PA; QL

SAVELLA TAB 12.5MG 4 PA; QL

SAVELLA TAB 25MG 4 PA; QL



HUNTINGTON'S DISEASE AGENTS tetrabenazine tab 12.5 mg 5 PA; QL

tetrabenazine tab 25 mg 4 PA; QL

XENAZINE TAB 12.5MG 5 PA; QL

XENAZINE TAB 25MG 5 PA; QL

HYPNOTICS, BENZODIAZEPINES estazolam tab 1 mg 2

estazolam tab 2 mg 2

flurazepam hcl cap 15 mg 2

flurazepam hcl cap 30 mg 2

midazolam hcl inj 2 mg/2ml (base equivalent)

2


2

midazolam hcl inj 5 mg/ml (base equivalent)

2


2


2

midazolam hcl inj 25 mg/5ml (base

equivalent)

2

midazolam hcl inj 50 mg/10ml (base

equivalent)

2

midazolam hcl syrup 2 mg/ml (base

equivalent)

2

temazepam cap 7.5 mg 2



temazepam cap 15 mg 2

temazepam cap 22.5 mg 2

temazepam cap 30 mg 2

triazolam tab 0.25 mg 2

triazolam tab 0.125 mg 2

HYPNOTICS, NON-BENZODIAZEPINES AMYTAL SOD INJ 500MG 4

eszopiclone tab 1 mg 2 QL



HETLIOZ CAP 20MG 5 PA; QL

zaleplon cap 5 mg 2 QL

zaleplon cap 10 mg 2 QL

zolpidem tartrate tab 5 mg 2 QL

zolpidem tartrate tab 10 mg 2 QL

MIGRAINE, ERGOTAMINE DERIVATIVES dihydroergotamine mesylate nasal spray 4

mg/ml

2

MIGRAINE, MONOCLONAL ANTIBODIES AIMOVIG INJ 70MG/ML 5 PA; QL

AIMOVIG INJ 140MG/ML 5 PA; QL

AJOVY INJ 225/1.5 5 PA; QL

EMGALITY INJ 120MG/ML 5 PA; QL

MIGRAINE, SELECTIVE SEROTONIN AGONISTS almotriptan malate tab 6.25 mg 4 ST; QL

almotriptan malate tab 12.5 mg 4 ST; QL

eletriptan hydrobromide tab 20 mg (base equivalent)

2 QL

eletriptan hydrobromide tab 40 mg (base equivalent)

2 QL

frovatriptan succinate tab 2.5 mg (base equivalent)

4 ST; QL

naratriptan hcl tab 1 mg (base equiv) 2 QL

naratriptan hcl tab 2.5 mg (base equiv) 2 QL

rizatriptan benzoate oral disintegrating tab

5 mg (base eq)

2 QL

rizatriptan benzoate oral disintegrating tab

10 mg (base eq)

2 QL

rizatriptan benzoate tab 5 mg (base equivalent)

2 QL

rizatriptan benzoate tab 10 mg (base equivalent)

2 QL

sumatriptan nasal spray 5 mg/act 4 QL

sumatriptan nasal spray 20 mg/act 4 QL

sumatriptan succinate inj 6 mg/0.5ml 4 QL

sumatriptan succinate solution

auto-injector 4 mg/0.5ml

2 QL



sumatriptan succinate solution auto-injector 6 mg/0.5ml

2 QL

sumatriptan succinate solution cartridge 4 mg/0.5ml

2 QL

sumatriptan succinate solution cartridge 6 mg/0.5ml

2 QL

sumatriptan succinate tab 25 mg 2 QL



zolmitriptan orally disintegrating tab 2.5

mg

2 QL

zolmitriptan orally disintegrating tab 5 mg 2 QL

zolmitriptan tab 2.5 mg 2 QL

zolmitriptan tab 5 mg 2 QL

ZOMIG SPR 2.5MG 4 QL

ZOMIG SPR 5MG 4 QL

MISCELLANEOUS BOTOX INJ 100UNIT 5 PA; QL

BOTOX INJ 200UNIT 5 PA; QL

caffeine & sodium benzoate inj 125-125 mg/ml (500 mg/2ml)

2

DYSPORT INJ 300UNIT 5 PA; QL

DYSPORT INJ 500UNIT 5 PA; QL

GUANIDINE TAB 125MG 2

REGONOL INJ 5MG/ML 4

riluzole tab 50 mg 5 PA; QL

XEOMIN INJ 50 UNIT 5 PA; QL

XEOMIN INJ 100UNIT 5 PA; QL

XEOMIN INJ 200UNIT 5 PA; QL

MOOD STABILIZERS lithium carbonate cap 150 mg 1

lithium carbonate cap 300 mg 1

lithium carbonate cap 600 mg 2

lithium carbonate tab 300 mg 2

lithium carbonate tab er 300 mg 2

lithium carbonate tab er 450 mg 2

LITHIUM SOL 8MEQ/5ML 2

MULTIPLE SCLEROSIS AMPYRA TAB 10MG 5 PA; QL

AUBAGIO TAB 7MG 5 PA; QL

AUBAGIO TAB 14MG 5 PA; QL

AVONEX KIT 30MCG 5 PA; QL

AVONEX PEN KIT 30MCG 5 PA; QL

AVONEX PREFL KIT 30MCG 5 PA; QL

BETASERON INJ 0.3MG 5 PA; QL

COPAXONE INJ 20MG/ML 5 PA; QL

COPAXONE INJ 40MG/ML 5 PA; QL



dalfampridine tab er 12hr 10 mg 5 PA; QL

GILENYA CAP 0.5MG 5 PA; QL

glatiramer acetate soln prefilled syringe 20 mg/ml

5 PA; QL

glatiramer acetate soln prefilled syringe 40

mg/ml

5 PA; QL

glatopa inj 20mg/ml 5 PA; QL

glatopa inj 40mg/ml 5 PA; QL

LEMTRADA INJ 12/1.2ML 5 PA

PLEGRIDY INJ 5 PA; QL

PLEGRIDY INJ PEN 5 PA; QL

PLEGRIDY INJ STARTER 5 PA; QL

PLEGRIDY PEN INJ STARTER 5 PA; QL

REBIF INJ 22/0.5 5 PA; QL

REBIF INJ 44/0.5 5 PA; QL

REBIF REBIDO INJ 22/0.5 5 PA; QL

REBIF REBIDO INJ 44/0.5 5 PA; QL

REBIF REBIDO INJ TITRATN 5 PA; QL

REBIF TITRTN INJ PACK 5 PA; QL

TECFIDERA CAP 120MG 5 PA; QL

TECFIDERA CAP 240MG 5 PA; QL

TECFIDERA MIS STARTER 5 PA; QL

TYSABRI INJ 300/15ML 5 PA; QL

MUSCULOSKELETAL THERAPY AGENTS baclofen tab 10 mg 2

baclofen tab 20 mg 2

carisoprodol tab 250 mg 2 QL

carisoprodol tab 350 mg 2 QL

carisoprodol w/ aspirin & codeine tab 200-325-16 mg

2

carisoprodol w/ aspirin tab 200-325 mg 2

chlorzoxazone tab 500 mg 2

cyclobenzaprine hcl tab 5 mg 1

cyclobenzaprine hcl tab 10 mg 1

dantrolene sodium cap 25 mg 2



dantrolene sodium for iv soln 20 mg 2

GABLOFEN INJ 10000/20 4



LIORESAL INT INJ 0.05MG/1 4

LIORESAL INT INJ 10MG/5ML 4

LIORESAL INT INJ 10MG/20 4

LIORESAL INT INJ 40MG/20 4

metaxalone tab 800 mg 2

methocarbamol inj 1000 mg/10ml 2



methocarbamol tab 500 mg 2

methocarbamol tab 750 mg 2

orphenadrine citrate inj 30 mg/ml 2

orphenadrine citrate tab er 12hr 100 mg 2

tizanidine hcl tab 2 mg (base equivalent) 2

tizanidine hcl tab 4 mg (base equivalent) 2

MYASTHENIA GRAVIS MESTINON SYP 60MG/5ML 3

pyridostigmine bromide tab 60 mg 2

pyridostigmine bromide tab er 180 mg 5

NARCOLEPSY/CATAPLEXY armodafinil tab 50 mg 4 PA; QL

armodafinil tab 150 mg 4 PA; QL



modafinil tab 100 mg 4 PA; QL

modafinil tab 200 mg 4 PA; QL

PROVIGIL TAB 100MG 4 PA; QL

PROVIGIL TAB 200MG 4 PA; QL

XYREM SOL 500MG/ML 5 PA; QL

NONDEPOLARIZING MUSCLE RELAXANTS ANECTINE INJ 20MG/ML 2

POSTHERPETIC NEURALGIA GRALISE STAR MIS 300/600 4 PA; QL

GRALISE TAB 300MG 4 PA; QL

GRALISE TAB 600MG 4 PA; QL

PSYCHOTHERAPEUTIC-MISC, ALCOHOL DETERRENTS acamprosate calcium tab delayed release

333 mg 2

disulfiram tab 250 mg 2

disulfiram tab 500 mg 2

VIVITROL INJ 380MG 5 PA

PSYCHOTHERAPEUTIC-MISC, OPIOID ANTAGONIST naloxone hcl inj 0.4 mg/ml 2

naloxone hcl inj 4 mg/10ml 2

naloxone hcl soln cartridge 0.4 mg/ml 2

naloxone hcl soln prefilled syringe 2 mg/2ml

2

naltrexone hcl tab 50 mg 2

NARCAN SPR 3 QL

PSYCHOTHERAPEUTIC-MISC, OPIOID WITHDRAWAL LUCEMYRA TAB 0.18MG 4 PA; QL

PSYCHOTHERAPEUTIC-MISC, PARTIAL OPIOID AGONIST/OPIOID

ANTAGONIST COMBINATIONS BUNAVAIL MIS 2.1-0.3 4 PA; QL



BUNAVAIL MIS 4.2-0.7 4 PA; QL

BUNAVAIL MIS 6.3-1MG 4 PA; QL

buprenorphine hcl-naloxone hcl sl film 2-0.5 mg (base equiv)

2 PA; QL

buprenorphine hcl-naloxone hcl sl film 4-1

mg (base equiv)

2 PA; QL


mg (base equiv)

2 PA; QL


mg (base equiv)

2 PA; QL

buprenorphine hcl-naloxone hcl sl tab

2-0.5 mg (base equiv)

4 PA; QL

buprenorphine hcl-naloxone hcl sl tab 8-2

mg (base equiv)

4 PA; QL

SUBOXONE MIS 2-0.5MG 3 PA; QL

SUBOXONE MIS 4-1MG 3 PA; QL



ZUBSOLV SUB 0.7-0.18 3 PA; QL






PSYCHOTHERAPEUTIC-MISC, PARTIAL OPIOID AGONISTS buprenorphine hcl sl tab 2 mg (base equiv) 2 PA; QL

buprenorphine hcl sl tab 8 mg (base equiv) 2 PA; QL

PROBUPHINE IMP KIT 74.2 5 PA; QL

PSYCHOTHERAPEUTIC-MISC, PSEUDOBULBAR AFFECT NUEDEXTA CAP 20-10MG 5 PA; QL

PSYCHOTHERAPEUTIC-MISC, SMOKING DETERRENTS bupropion hcl (smoking deterrent) tab er

12hr 150 mg 2

NICOTROL INH 3

NICOTROL NS SPR 10MG/ML 3

ENDOCRINE AND METABOLIC ANDROGENS

ANDRODERM DIS 2MG/24HR 4 PA

ANDRODERM DIS 4MG/24HR 4 PA

ANDROGEL GEL 1.62% 3 PA

ANDROGEL GEL PUMP 1% 3 PA

AVEED INJ 750/3ML 4 PA

FORTESTA GEL 10MG/ACT 4 PA

methyltestosterone cap 10 mg 5 PA

STRIANT MIS 30MG 4 PA

TESTIM GEL 1%(50MG) 4 PA

TESTOPEL MIS PELLETS 4 PA



testosterone cypionate im inj in oil 100 mg/ml

2

testosterone cypionate im inj in oil 200 mg/ml

2

testosterone enanthate im inj in oil 200 mg/ml

2 PA

testosterone td gel 10mg/act (2%) 4 PA

testosterone td gel 12.5 mg/act (1%) 2 PA

testosterone td gel 25 mg/2.5gm (1%) 4 PA

testosterone td gel 50 mg/5gm (1%) 2 PA

ANTIDIABETICS, ALPHA-GLUCOSIDASE INHIBITORS acarbose tab 25 mg 2

acarbose tab 50 mg 2

acarbose tab 100 mg 2

miglitol tab 25 mg 2



ANTIDIABETICS, AMYLIN ANALOGS SYMLINPEN 60 INJ 1000MCG 3 ST; QL

SYMLNPEN 120 INJ 1000MCG 3 ST; QL

ANTIDIABETICS, BIGUANIDE/SULFONYLUREA COMBINATIONS glipizide-metformin hcl tab 2.5-250 mg 2

glipizide-metformin hcl tab 2.5-500 mg 2

glipizide-metformin hcl tab 5-500 mg 2

glyburide-metformin tab 1.25-250 mg 2

glyburide-metformin tab 2.5-500 mg 2

glyburide-metformin tab 5-500 mg 2

ANTIDIABETICS, BIGUANIDES metformin hcl tab 500 mg 1

metformin hcl tab 850 mg 1

metformin hcl tab 1000 mg 1

metformin hcl tab er 24hr 500 mg 2

metformin hcl tab er 24hr 750 mg 2

RIOMET SOL 4

ANTIDIABETICS, DIPEPTIDYL PEPTIDASE-4 (DPP-4)

INHIBITOR/BIGUANIDE COMBINATIONS JANUMET TAB 50-500MG 3

JANUMET TAB 50-1000 3

JANUMET XR TAB 50-500MG 3

JANUMET XR TAB 50-1000 3

JANUMET XR TAB 100-1000 3

JENTADUETO TAB 2.5-500 3



JENTADUETO TAB XR 3 QL



ANTIDIABETICS, DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS JANUVIA TAB 25MG 3

JANUVIA TAB 50MG 3

JANUVIA TAB 100MG 3

TRADJENTA TAB 5MG 3 QL

ANTIDIABETICS, INCRETIN MIMETIC AGENTS TRULICITY INJ 0.75/0.5 3 QL

TRULICITY INJ 1.5/0.5 3 QL

VICTOZA INJ 18MG/3ML 3

ANTIDIABETICS, INSULIN SENSITIZER/BIGUANIDE COMBINATION pioglitazone hcl-metformin hcl tab 15-500

mg 2

pioglitazone hcl-metformin hcl tab 15-850 mg

2

ANTIDIABETICS, INSULIN SENSITIZER/SULFONYLUREA COMBO pioglitazone hcl-glimepiride tab 30-2 mg 2

pioglitazone hcl-glimepiride tab 30-4 mg 2

ANTIDIABETICS, INSULIN SENSITIZERS pioglitazone hcl tab 15 mg (base equiv) 2

pioglitazone hcl tab 30 mg (base equiv) 2

pioglitazone hcl tab 45 mg (base equiv) 2

ANTIDIABETICS, INSULINS HUMULIN R INJ U-500 3 QL

LANTUS INJ 100/ML 3

LANTUS SOLOS INJ 100/ML 3

LEVEMIR INJ 3

LEVEMIR INJ FLEXTOUC 3

NOVOLIN INJ 70/30 3 QL

NOVOLIN N INJ U-100 3 QL

NOVOLIN R INJ U-100 3 QL

NOVOLOG INJ 100/ML 3 QL

NOVOLOG INJ FLEXPEN 3 QL

NOVOLOG INJ PENFILL 3 QL

NOVOLOG MIX INJ 70/30 3 QL

NOVOLOG MIX INJ FLEXPEN 3 QL

TOUJEO SOLO INJ 300IU/ML 3

TRESIBA FLEX INJ 100UNIT 3 QL

TRESIBA FLEX INJ 200UNIT 3 QL

TRESIBA INJ 100UNIT 3 QL

ANTIDIABETICS, MEGLITINIDE nateglinide tab 60 mg 2

nateglinide tab 120 mg 2

repaglinide tab 0.5 mg 2

repaglinide tab 1 mg 2

repaglinide tab 2 mg 2



ANTIDIABETICS, MEGLITINIDE/BIGUANIDE COMBINATIONS repaglinide-metformin hcl tab 1-500 mg 2

repaglinide-metformin hcl tab 2-500 mg 2

ANTIDIABETICS, MISCELLANEOUS CYCLOSET TAB 0.8MG 4

ANTIDIABETICS, SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2)

INHIBITOR/BIGUANIDE COMBINATIONS INVOKAMET TAB 50-500MG 3 QL

INVOKAMET TAB 50-1000 3 QL



INVOKAMET XR TAB 50-500MG 3 QL

INVOKAMET XR TAB 50-1000 3 QL



SYNJARDY TAB 3 QL

SYNJARDY TAB 5-500MG 3 QL

SYNJARDY TAB 5-1000MG 3 QL

SYNJARDY TAB 12.5-500 3 QL

SYNJARDY XR TAB 3 QL

SYNJARDY XR TAB 5-1000MG 3 QL

SYNJARDY XR TAB 10-1000 3 QL

SYNJARDY XR TAB 25-1000 3 QL

ANTIDIABETICS, SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2)

INHIBITORS INVOKANA TAB 100MG 3 QL

INVOKANA TAB 300MG 3 QL

JARDIANCE TAB 10MG 3 QL

JARDIANCE TAB 25MG 3 QL

ANTIDIABETICS, SODIUM-GLUCOSE CO-TRANSPORTER 2

INHIBITOR/DPP-4 INHIBITOR COMBINATIONS GLYXAMBI TAB 10-5 MG 3 QL

GLYXAMBI TAB 25-5 MG 3 QL

ANTIDIABETICS, SULFONYLUREAS chlorpropamide tab 100 mg 2

chlorpropamide tab 250 mg 2

glimepiride tab 1 mg 1



glipizide tab 5 mg 1

glipizide tab 10 mg 1

glipizide tab er 24hr 2.5 mg 2

glipizide tab er 24hr 5 mg 2

glipizide tab er 24hr 10 mg 2

glyburide micronized tab 1.5 mg 2



glyburide micronized tab 3 mg 1

glyburide micronized tab 6 mg 1

glyburide tab 1.25 mg 1

glyburide tab 2.5 mg 1

glyburide tab 5 mg 2

tolbutamide tab 500 mg 2

ANTIDIABETICS, SUPPLIES AUTOPEN MIS 1 UNIT 3

AUTOPEN MIS 1-21UNIT 3

AUTOPEN MIS 2 UNIT 3



AUTOSHIELD MIS 29X3/16" 3

BD PEN MINI MIS 3

BD PEN NEEDL MIS 29GX12.7 3

BD PEN NEEDL MIS 31GX5MM 3



CONTROL KIT MONITOR 3

EASY TOUCH MIS 32GX5MM 3

INSULIN PEN MIS 29GX12MM 3

INSULIN SYRG MIS 0.3/29G 3












INSULIN SYRG MIS 1ML 3

INSULIN SYRG MIS 1ML/28G 3





INSULIN SYRG MIS 28GX1/2" 3

INSUPEN SENS MIS 32GX6MM 3

INSUPEN SENS MIS 32GX8MM 3

KETONE TEST TES 3

KETOSTIX TES STRIP 3

LANCET CARRY MIS CASE 3 QL

LANCETS MIS 3 QL



LANCING DEVI MIS 3

MULTI-LANCET KIT DEVICE 3

NOVOFINE MIS 30GX8MM 3

NOVOTWIST MIS 32GX5MM 3

ONETOUCH KIT ULT MINI 3

ONETOUCH KIT ULTRA 2 3

ONETOUCH KIT ULTRALNK 3

ONETOUCH KIT VERIO 3

ONETOUCH KIT VERIO FL 3

ONETOUCH KIT VERIO IQ 3

ONETOUCH TES ULTRA BL 3 QL

ONETOUCH TES VERIO 3 QL

PEN NEEDLES MIS 31GX6MM 3

SURESTEP PRO TES HIGH CON 3

SURESTEP PRO TES NORM CON 4

1ST TIER UNI MIS 29GX12MM 3

ULTRAFLEX MIS 24"/10MM 4

V-GO 20 KIT 4 PA

V-GO 30 KIT 4 PA

V-GO 40 KIT 4 PA

ANTIDOTES acetylcysteine inj 200 mg/ml 2

CETYLEV TAB 2.5GM 4 PA

CETYLEV TAB 500MG 4 PA

DIGIFAB INJ 40MG 4

flumazenil iv soln 0.5 mg/5ml (0.1 mg/ml) 2

flumazenil iv soln 1 mg/10ml (0.1 mg/ml) 2

fomepizole inj 1 gm/ml (for iv infusion) 2

PHYSOS SALIC INJ 1MG/ML 2

PROTOPAM CHL INJ 1GM 4

sodium thiosulfate inj 25% 2

CALCIUM RECEPTOR ANTAGONISTS SENSIPAR TAB 30MG 3

SENSIPAR TAB 60MG 3

SENSIPAR TAB 90MG 3

CALCIUM REGULATORS, BISPHOSPHONATES alendronate sodium oral soln 70 mg/75ml 2 QL

alendronate sodium tab 5 mg 2





BONIVA INJ 3MG/3ML 5 ST; QL

BONIVA TAB 150MG 4 QL

etidronate disodium tab 400 mg 2



ibandronate sodium iv soln 3 mg/3ml (base equivalent)

5 ST; QL

ibandronate sodium tab 150 mg (base equivalent)

2 QL

pamidronate disodium for inj 30 mg 2

pamidronate disodium for inj 90 mg 2

pamidronate disodium iv soln 3 mg/ml 2

pamidronate disodium iv soln 9 mg/ml 2

PAMIDRONATE INJ 6MG/ML 2

risedronate sodium tab 5 mg 2 ST; QL




risedronate sodium tab delayed release 35 mg

2 ST; QL

zoledronic acid inj conc for iv infusion 4 mg/5ml

5 QL

zoledronic acid iv soln 5 mg/100ml 5 ST; QL

ZOMETA INJ 4MG/100 5 ST; QL

CALCIUM REGULATORS, CALCITONINS calcitonin (salmon) nasal soln 200 unit/act 2

MIACALCIN INJ 200/ML 4

CALCIUM REGULATORS, MISCELLANEOUS PROLIA SOL 60MG/ML 5 PA; QL

XGEVA INJ 5 PA; QL

CALCIUM REGULATORS, PARATHYROID HORMONES FORTEO SOL 600/2.4 5 ST; QL

NATPARA INJ 25MCG 5 PA; QL




CONTRACEPTIVES, BIPHASIC LO LOESTRIN TAB 1-10-10 3

CONTRACEPTIVES, INJECTABLE DEPO-PROVERA INJ 150MG/ML 4 QL

ENDOMETRIOSIS danazol cap 50 mg 2 PA

danazol cap 100 mg 2 PA

danazol cap 200 mg 2 PA

LUPANETA KIT 3.75-5 5 PA; QL

LUPANETA KIT 11.25-5 5 PA; QL

SYNAREL SOL 2MG/ML 5 PA; QL

ESTROGEN/PROGESTIN, ORAL ANGELIQ TAB 0.5-1MG 4

estradiol & norethindrone acetate tab 0.5-0.1 mg

2



estradiol & norethindrone acetate tab 1-0.5 mg

2

norethindrone acetate-ethinyl estradiol tab 0.5 mg-2.5 mcg

2

norethindrone acetate-ethinyl estradiol tab 1 mg-5 mcg

2

PREFEST TAB 4

PREMPHASE TAB 3

PREMPRO TAB 0.3-1.5 3

PREMPRO TAB 0.45-1.5 3

PREMPRO TAB 0.625-5 3

PREMPRO TAB .625-2.5 3

ESTROGEN/PROGESTIN, TRANSDERMAL CLIMARA PRO DIS WEEKLY 4 QL

COMBIPATCH DIS .05/.14 4 QL

COMBIPATCH DIS .05/.25 4 QL

ESTROGEN/SELECTIVE ESTROGEN RECEPTOR MODULATOR

COMBINATIONS DUAVEE TAB 0.45-20 3

ESTROGENS, INJECTABLE DEPO-ESTRADI INJ 5MG/ML 4

estradiol valerate im in oil 20 mg/ml 2

estradiol valerate im in oil 40 mg/ml 2

PREMARIN INJ 25MG 4

ESTROGENS, ORAL estradiol tab 0.5 mg 1

estradiol tab 1 mg 1

estradiol tab 2 mg 1

MENEST TAB 0.3MG 4

MENEST TAB 0.625MG 4

MENEST TAB 1.25MG 4

PREMARIN TAB 0.3MG 3





ESTROGENS, TRANSDERMAL ALORA DIS 0.1MG 4 QL

ALORA DIS 0.05MG 4 QL



DIVIGEL GEL 0.5MG 4

DIVIGEL GEL 0.25MG 4

DIVIGEL GEL 1MG/GM 4

estradiol td patch twice weekly 0.1 mg/24hr

2 QL




2 QL


2 QL


2 QL


2 QL

estradiol td patch weekly 0.1 mg/24hr 2 QL





estradiol td patch weekly 0.0375 mg/24hr (37.5 mcg/24hr)

2 QL

ESTROGEL GEL 4 QL

EVAMIST SPR 1.53MG 4

MENOSTAR DIS 14MCG 4 QL

MINIVELLE DIS 0.1MG 4 QL





ESTROGENS, VAGINAL ESTRACE VAG CRE 0.01% 4

estradiol vaginal cream 0.1 mg/gm 2

estradiol vaginal tab 10 mcg 2

ESTRING MIS 2MG 4

FEMRING MIS 0.1MG/24 4

FEMRING MIS 0.05/24H 4

PREMARIN VAG CRE 0.625MG 3

VAGIFEM TAB 10MCG 4

GLUCOCORTICOIDS CORTEF TAB 5MG 4

CORTEF TAB 10MG 4

CORTEF TAB 20MG 4

cortisone acetate tab 25 mg 2

DEPO-MEDROL INJ 20MG/ML 4



DEXAMETHASON CON 1MG/ML 2

dexamethasone elixir 0.5 mg/5ml 2

dexamethasone sod phosphate

preservative free inj 10 mg/ml

2

dexamethasone sodium phosphate inj 4

mg/ml

2



dexamethasone sodium phosphate inj 10 mg/ml

2

dexamethasone sodium phosphate inj 20 mg/5ml

2


2


2

dexamethasone soln 0.5 mg/5ml 2

dexamethasone tab 0.5 mg 1


dexamethasone tab 1 mg 1





DEXPAK PAK 6 DAY 3

DEXPAK PAK 10 DAY 3

DEXPAK PAK 13 DAY 3

fludrocortisone acetate tab 0.1 mg 2

hydrocortisone tab 5 mg 2



KENALOG-10 INJ 10MG/ML 4

KENALOG-40 INJ 40MG/ML 4

METHYLPR ACE INJ 80MG/ML 4

methylprednisolone acetate inj susp 40

mg/ml

2

methylprednisolone acetate inj susp 80

mg/ml

2

methylprednisolone sod succ for inj 40 mg

(base equiv)

2

methylprednisolone sod succ for inj 125

mg (base equiv)

2

methylprednisolone sod succ for inj 1000

mg (base equiv)

2

methylprednisolone tab 4 mg 2




methylprednisolone tab therapy pack 4 mg

(21)

2

MILLIPRED DP PAK 5MG 2

prednisolone sod phosph oral soln 6.7 mg/5ml (5 mg/5ml base)

2

prednisolone sod phosphate oral soln 10 mg/5ml (base equiv)

2




2


2

prednisolone sodium phosphate oral soln 25 mg/5ml (base eq)

2

prednisolone syrup 15 mg/5ml (usp solution equivalent)

2

prednisone oral soln 5 mg/5ml 2

prednisone tab 1 mg 2

prednisone tab 2.5 mg 1





SOLU-CORTEF INJ 100MG 4




SOLU-MEDROL INJ 1GM 4

SOLU-MEDROL INJ 2GM 4

SOLU-MEDROL INJ 40MG 4



GLUCOSE ELEVATING AGENT GLUCAGEN INJ HYPOKIT 3 QL

GLUCAGON KIT 1MG 3 QL

PROGLYCEM SUS 50MG/ML 3

HEREDITARY TYROSINEMIA TYPE 1 AGENTS ORFADIN CAP 2MG 5 PA

ORFADIN CAP 5MG 5 PA

ORFADIN CAP 10MG 5 PA

ORFADIN SUS 4MG/ML 5 PA

HUMAN GROWTH HORMONES HUMATROPE INJ 5MG 5 PA

HUMATROPE INJ 6MG 5 PA



NORDITROPIN INJ 5/1.5ML 5 PA



NORDITROPIN INJ 30/3ML 5 PA

SEROSTIM INJ 4MG 5 PA





HYPERPARATHYROID TREATMENT, VITAMIN D ANALOGS calcitriol cap 0.5 mcg 2

calcitriol cap 0.25 mcg 2

calcitriol inj 1 mcg/ml 2

calcitriol oral soln 1 mcg/ml 2

doxercalciferol cap 0.5 mcg 2

doxercalciferol cap 1 mcg 2

doxercalciferol cap 2.5 mcg 2

HECTOROL INJ 2MCG/ML 3

paricalcitol cap 1 mcg 2



ROCALTROL CAP 0.5MCG 4

ROCALTROL CAP 0.25MCG 4

ROCALTROL SOL 1MCG/ML 4

ZEMPLAR CAP 2MCG 4

INSULIN-LIKE GROWTH FACTOR INCRELEX INJ 40MG/4ML 5 PA

LYSOSOMAL STORAGE DISORDERS ALDURAZYME INJ 2.9MG/5M 5 PA

CEREZYME INJ 400UNIT 5 PA

ELAPRASE INJ 6MG/3ML 5 PA

ELELYSO INJ 200UNIT 5 PA

FABRAZYME INJ 5MG 5 PA

FABRAZYME INJ 35MG 5 PA

NAGLAZYME INJ 1MG/ML 5 PA

VIMIZIM INJ 5MG/5ML 5 PA

VPRIV INJ 400UNIT 5 PA

ZAVESCA CAP 100MG 5 PA

MISCELLANEOUS ADAGEN INJ 250/ML 5 PA

cabergoline tab 0.5 mg 2

CARBAGLU TAB 200MG 5 PA

CERVIDIL VAG MIS 10MG INS 3

CYSTADANE POW 5 PA

GALAFOLD CAP 123MG 5 PA; QL

H.P. ACTHAR INJ 80UNIT 5 PA; QL

HEMABATE INJ 250MCG 4

KANUMA INJ 20/10ML 5

KORLYM TAB 300MG 5 PA; QL

levocarnitine oral soln 1 gm/10ml (10%) 2

levocarnitine tab 330 mg 2

LUPR DEP-PED INJ 3M 30MG 5 PA; QL

LUPR DEP-PED INJ 7.5MG 5 PA; QL

LUPR DEP-PED INJ 11.25MG 5 PA; QL

LUPR DEP-PED INJ 15MG 5 PA; QL



methylergonovine maleate inj 0.2 mg/ml 4

MYALEPT INJ 11.3MG 5 PA; QL

octreotide acetate inj 50 mcg/ml (0.05 mg/ml)

5

octreotide acetate inj 100 mcg/ml (0.1

mg/ml)

5


mg/ml)

5


mg/ml)

5

octreotide acetate inj 1000 mcg/ml (1

mg/ml)

5

PREPIDIL GEL 0.5MG/3G 3

PROSTIN E2 SUP 20MG 3

RAVICTI LIQ 1.1GM/ML 5 PA; QL

SANDOSTATIN INJ 50MCG/ML 5

SANDOSTATIN INJ 100MCG 5

SANDOSTATIN INJ 500MCG 5

SANDOSTATIN KIT LAR 10MG 5 PA; QL



SIGNIFOR INJ 0.3MG/ML 5 PA; QL



SIGNIFOR LAR INJ 20MG 5 PA; QL



sodium phenylbutyrate tab 500 mg 4 PA

SOMATULINE INJ 60/0.2ML 5 PA; QL

SOMATULINE INJ 90/0.3ML 5 PA; QL

SOMATULINE INJ 120/.5ML 5 PA; QL

SOMAVERT INJ 10MG 5 PA; QL





STRENSIQ INJ 18/0.45 5 PA

STRENSIQ INJ 28/0.7ML 5 PA

STRENSIQ INJ 40MG/ML 5 PA

STRENSIQ INJ 80/0.8ML 5 PA

SUPPRELIN LA KIT 50MG 5 PA; QL

SYPRINE CAP 250MG 5 PA

THYROGEN INJ 1.1MG 5

trientine hcl cap 250 mg 5 PA

PHENYLKETONURIA TREATMENT AGENTS KUVAN POW 100MG 5 PA

KUVAN POW 500MG 5 PA



KUVAN TAB 100MG 5 PA

PALYNZIQ INJ 2.5/0.5 5 PA; QL

PALYNZIQ INJ 10/0.5ML 5 PA; QL

PALYNZIQ INJ 20MG/ML 5 PA; QL

PHOSPHATE BINDER AGENTS AURYXIA TAB 210MG 3

calcium acetate (phosphate binder) cap

667 mg (169 mg ca)

2

calcium acetate (phosphate binder) tab

667 mg

2

RENAGEL TAB 800MG 5

sevelamer carbonate packet 0.8 gm 2

sevelamer carbonate packet 2.4 gm 2

sevelamer carbonate tab 800 mg 2

POTASSIUM-REMOVING AGENTS LOKELMA PAK 5GM 5 PA; QL

LOKELMA PAK 10GM 5 PA; QL

sodium polystyrene sulfonate oral susp 15 gm/60ml

2

sodium polystyrene sulfonate powder 2

VELTASSA POW 8.4GM 5 PA; QL



PROGESTINS, INJECTABLE MAKENA INJ 250MG/ML 5 PA

PROGESTINS, ORAL medroxyprogesterone acetate tab 2.5 mg 1

medroxyprogesterone acetate tab 5 mg 1

medroxyprogesterone acetate tab 10 mg 1

norethindrone acetate tab 5 mg 2

progesterone micronized cap 100 mg 2

progesterone micronized cap 200 mg 2

PROGESTINS, VAGINAL CRINONE GEL 4% VAG 3

ENDOMETRIN SUP 100MG 4

THYROID AGENTS, ANTITHYROID AGENTS iodine solution strong 5% (lugol's) 2

methimazole tab 5 mg 2

methimazole tab 10 mg 2

propylthiouracil tab 50 mg 2

SSKI SOL 1GM/ML 2

THYROID SUPPLEMENTS CYTOMEL TAB 5MCG 4

CYTOMEL TAB 25MCG 4

CYTOMEL TAB 50MCG 4

LEVOTHYROXIN INJ 200MCG 2



levothyroxine sodium for iv inj 100 mcg 2

levothyroxine sodium for iv inj 500 mcg 2

levothyroxine sodium tab 25 mcg 2












liothyronine sodium iv soln 10 mcg/ml 2

liothyronine sodium tab 5 mcg 2



NATURE THROI TAB 162.5MG 2

NATURE-THROI TAB 16.25MG 4






NATURE-THROI TAB 130MG 2





SYNTHROID TAB 25MCG 4












THYROLAR-1 TAB 60MG 3

THYROLAR-1/2 TAB 30MG 3

THYROLAR-1/4 TAB 15MG 3





TIROSINT CAP 13MCG 4










TRIOSTAT INJ 10MCG/ML 4

WESTHROID TAB 32.5MG 2

WESTHROID TAB 97.5MG 2

WESTHROID TAB 130MG 2

VASOPRESSIN RECEPTOR ANTAGONISTS JYNARQUE PAK 45-15MG 5 PA; QL

JYNARQUE PAK 60-30MG 5 PA; QL

JYNARQUE PAK 90-30MG 5 PA; QL

SAMSCA TAB 15MG 5 PA; QL

SAMSCA TAB 30MG 5 PA; QL

VASOPRESSINS desmopressin acetate inj 4 mcg/ml 5

desmopressin acetate nasal spray soln 0.01%

5

desmopressin acetate nasal spray soln 0.01% (refrigerated)

5

desmopressin acetate tab 0.1 mg 2

desmopressin acetate tab 0.2 mg 2

STIMATE SOL 1.5MG/ML 5

GASTROINTESTINAL ANTIDIARRHEALS

diphenoxylate w/ atropine liq 2.5-0.025 mg/5ml

2

diphenoxylate w/ atropine tab 2.5-0.025 mg

2

loperamide hcl cap 2 mg 2

ANTIEMETICS AKYNZEO CAP 300-0.5 4 QL

ALOXI INJ 0.25MG/5 4

aprepitant capsule 40 mg 3 QL



aprepitant capsule therapy pack 80 & 125 mg

3 QL

CESAMET CAP 1MG 3



DIMENHYDRIN INJ 50MG/ML 2

dronabinol cap 2.5 mg 2

dronabinol cap 5 mg 2

dronabinol cap 10 mg 2

droperidol inj 2.5 mg/ml 2

EMEND SOL 150MG 4 QL

granisetron hcl inj 1 mg/ml 2 ST; QL

granisetron hcl inj 4 mg/4ml (1 mg/ml) 2 ST; QL

granisetron hcl tab 1 mg 2 ST; QL

meclizine hcl tab 12.5 mg 2

meclizine hcl tab 25 mg 2

metoclopramide hcl inj 5 mg/ml (base

equivalent)

2

metoclopramide hcl soln 5 mg/5ml (10

mg/10ml) (base equiv)

1

metoclopramide hcl tab 5 mg (base

equivalent)

1

metoclopramide hcl tab 10 mg (base

equivalent)

1

ondansetron hcl inj 4 mg/2ml (2 mg/ml) 2

ondansetron hcl inj 40 mg/20ml (2 mg/ml) 2

ondansetron hcl oral soln 4 mg/5ml 2

ondansetron hcl tab 4 mg 2 QL



ondansetron orally disintegrating tab 4 mg 2 QL

ondansetron orally disintegrating tab 8 mg 2 QL

prochlorperazine edisylate inj 5 mg/ml 2

prochlorperazine maleate tab 5 mg (base equivalent)

1

prochlorperazine maleate tab 10 mg (base equivalent)

1

prochlorperazine suppos 25 mg 2

promethazine hcl inj 25 mg/ml 2

promethazine hcl inj 50 mg/ml 2

promethazine hcl suppos 12.5 mg 2

promethazine hcl suppos 25 mg 2

promethazine hcl suppos 50 mg 2

promethazine hcl syrup 6.25 mg/5ml 1

promethazine hcl tab 12.5 mg 2

promethazine hcl tab 25 mg 1

promethazine hcl tab 50 mg 2

SANCUSO DIS 3.1MG 4 ST; QL

TIGAN INJ 100MG/ML 4

TRANSDERM-SC DIS 1.5MG 4

trimethobenzamide hcl cap 300 mg 2



ANTISPASMODICS BELLA/OPIUM SUP 16.2-30 2

chlordiazepoxide hcl-clidinium bromide cap

5-2.5 mg

2

CUVPOSA SOL 1MG/5ML 4 PA

dicyclomine hcl cap 10 mg 1

dicyclomine hcl oral soln 10 mg/5ml 2

dicyclomine hcl tab 20 mg 1

GLYCOPYRROLA INJ 1MG/5ML 2

glycopyrrolate inj 0.2 mg/ml 2

glycopyrrolate inj 0.4 mg/2ml (0.2 mg/ml) 2

glycopyrrolate inj 1 mg/5ml (0.2 mg/ml) 2

glycopyrrolate inj 4 mg/20ml (0.2 mg/ml) 2

glycopyrrolate tab 1 mg 2

glycopyrrolate tab 2 mg 2

hyoscyamine sulfate elixir 0.125 mg/5ml 2

hyoscyamine sulfate sl tab 0.125 mg 2

hyoscyamine sulfate soln 0.125 mg/ml 2

hyoscyamine sulfate tab 0.125 mg 2

hyoscyamine sulfate tab disint 0.125 mg 2

hyoscyamine sulfate tab er 12hr 0.375 mg 2

LEVSIN INJ 0.5MG/ML 4

methscopolamine bromide tab 2.5 mg 2

methscopolamine bromide tab 5 mg 2

propantheline bromide tab 15 mg 2

SYMAX DUOTAB TAB 4

CHOLELITHOLYTICS ursodiol cap 300 mg 2

ursodiol tab 250 mg 2

ursodiol tab 500 mg 2

INFLAMMATORY BOWEL DISEASE, ORAL AGENTS APRISO CAP 0.375GM 3

ASACOL HD TAB 800MG 3

balsalazide disodium cap 750 mg 2

budesonide delayed release particles cap 3

mg

4

DELZICOL CAP 400MG 3

DIPENTUM CAP 250MG 4 ST

mesalamine tab delayed release 1.2 gm 2

PENTASA CAP 250MG CR 4

PENTASA CAP 500MG CR 4

sulfasalazine tab 500 mg 2

sulfasalazine tab delayed release 500 mg 2

UCERIS TAB 9MG 5 PA

INFLAMMATORY BOWEL DISEASE, RECTAL AGENTS CANASA SUP 1000MG 5



CORTIFOAM AER 90MG 4

hydrocortisone enema 100 mg/60ml 2

mesalamine enema 4 gm 2

UCERIS AER 2MG/ACT 5

IRRITABLE BOWEL SYNDROME WITH CONSTIPATION AMITIZA CAP 8MCG 4 ST; QL

AMITIZA CAP 24MCG 4 ST; QL

LINZESS CAP 72MCG 3 QL



IRRITABLE BOWEL SYNDROME WITH DIARRHEA alosetron hcl tab 0.5 mg (base equiv) 4 PA; QL

alosetron hcl tab 1 mg (base equiv) 4 PA; QL

LOTRONEX TAB 0.5MG 4 PA; QL

LOTRONEX TAB 1MG 4 PA; QL

VIBERZI TAB 75MG 5 PA; QL

VIBERZI TAB 100MG 5 PA; QL

LAXATIVES/STOOL SOFTENERS GOLYTELY SOL 3

lactulose solution 10 gm/15ml 2

OSMOPREP TAB 1.5GM 4

peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm

2

peg 3350-kcl-sod bicarb-nacl for soln 420 gm

2

polyethylene glycol 3350 oral powder 2

MISCELLANEOUS BUPHENYL POW 4 PA

BUPHENYL TAB 500MG 4 PA

CARAFATE SUS 1GM/10ML 3

cromolyn sodium oral conc 100 mg/5ml 2

GATTEX KIT 5MG 5 PA; QL

KEPIVANCE INJ 6.25MG 5

lactulose (encephalopathy) solution 10 gm/15ml

2

OCALIVA TAB 5MG 5 PA

OCALIVA TAB 10MG 5 PA

RECTIV OIN 0.4% 4 PA

sodium phenylbutyrate oral powder 3 gm/teaspoonful

4 PA

SUCRAID SOL 8500/ML 5 PA

sucralfate tab 1 gm 2

OPIOID-INDUCED CONSTIPATION MOVANTIK TAB 12.5MG 3 QL

MOVANTIK TAB 25MG 3 QL



PANCREATIC ENZYMES CREON CAP 3000UNIT 3

CREON CAP 6000UNIT 3

CREON CAP 12000UNT 3



PANCREAZE CAP 4200UNIT 4 ST

PANCREAZE CAP 10500UNT 4 ST



PERTZYE CAP 8000UNIT 4 ST

PERTZYE CAP 16000U 4 ST

VIOKACE TAB 10440 4 ST

VIOKACE TAB 20880 4 ST

ZENPEP CAP 3000UNIT 4 ST

ZENPEP CAP 15000UNT 4 ST


ZENPEP CAP 25000 4 ST


ZENPEP CAP 40000 4 ST


PROSTAGLANDINS misoprostol tab 100 mcg 2

misoprostol tab 200 mcg 2

SALIVA STIMULANTS cevimeline hcl cap 30 mg 2

pilocarpine hcl tab 5 mg 2

pilocarpine hcl tab 7.5 mg 2

STEROIDS, RECTAL EPIFOAM AER 1% 4

hydrocortisone acetate suppos 25 mg 2

hydrocortisone acetate suppos 30 mg 2

hydrocortisone acetate w/ pramoxine rectal

cream 1-1%

2

hydrocortisone acetate w/ pramoxine rectal

cream 2.5-1%

2

hydrocortisone rectal cream 1% 2

hydrocortisone rectal cream 2.5% 2

lidocaine-hydrocortisone acetate rectal cream 3-0.5%

2

lidocaine-hydrocortisone acetate rectal cream kit 2-2%

2

lidocaine-hydrocortisone acetate rectal

cream kit 3-0.5%

2

lidocaine-hydrocortisone acetate rectal

cream kit 3-1%

2



lidocaine-hydrocortisone acetate rectal gel kit 3-2.5%

2

PROCTOFOAM AER HC 1% 4

ULCER THERAPY COMBINATION amoxicillin cap-clarithro tab-lansopraz cap

dr therapy pack

2

OMECLAMOX- MIS PAK 4

GENITOURINARY BENIGN PROSTATIC HYPERPLASIA

alfuzosin hcl tab er 24hr 10 mg 2

CARDURA XL TAB 4MG 4 QL

CARDURA XL TAB 8MG 4 QL

dutasteride cap 0.5 mg 2

dutasteride-tamsulosin hcl cap 0.5-0.4 mg 2

finasteride tab 5 mg 2

RAPAFLO CAP 4MG 4 PA; QL

RAPAFLO CAP 8MG 4 PA; QL

silodosin cap 4 mg 2 PA; QL

silodosin cap 8 mg 2 PA; QL

tamsulosin hcl cap 0.4 mg 2

UROXATRAL TAB 10MG 4

GENITOURINARY IRRIGANTS acetic acid irrigation soln 0.25% 2

glycine irrigation soln 1.5% 2

neomycin-polymyxin b gu irrigation soln 2

RESECTISOL SOL 5% 3

sodium chloride irrigation soln 0.9% 2

MISCELLANEOUS acetic acid-oxyquinoline vaginal gel

0.9-0.025% 4

bethanechol chloride tab 5 mg 2




CYSTAGON CAP 50MG 5 PA

CYSTAGON CAP 150MG 5 PA

ELMIRON CAP 100MG 3

FEM PH GEL 2

mannitol iv soln 25% 2

methenamine hippurate tab 1 gm 2

methenamine-hyosc-meth blue-benz

acid-phenyl sal tab 81.6mg

2

ORACIT SOL 3

phenazopyridine hcl tab 100 mg 2

phenazopyridine hcl tab 200 mg 2



pot & sod citrates w/ cit ac soln 550-500-334 mg/5ml

2

potassium citrate & citric acid powder pack 3300-1002 mg

2

potassium citrate & citric acid soln 1100-334 mg/5ml

2

potassium citrate tab er 5 meq (540 mg) 2



PROCYSBI CAP 25MG 5 PA; QL

PROCYSBI CAP 75MG 5 PA; QL

RIMSO-50 SOL 50% 3

sodium citrate & citric acid soln 500-334

mg/5ml

2

THIOLA TAB 100MG 5

PERITONEAL DIALYSIS SOLUTION DELFLEX-LC/ SOL 2.5% DEX 4

URINARY ANTISPASMODICS MYRBETRIQ TAB 25MG 3 QL

MYRBETRIQ TAB 50MG 3 QL

oxybutynin chloride syrup 5 mg/5ml 2

oxybutynin chloride tab 5 mg 2

oxybutynin chloride tab er 24hr 5 mg 2



tolterodine tartrate cap er 24hr 2 mg 2

tolterodine tartrate cap er 24hr 4 mg 2

tolterodine tartrate tab 1 mg 2

tolterodine tartrate tab 2 mg 2

trospium chloride cap er 24hr 60 mg 2

trospium chloride tab 20 mg 2

VESICARE TAB 5MG 3

VESICARE TAB 10MG 3

VAGINAL ANTI-INFECTIVES CLEOCIN SUP 100MG 3

clindamycin phosphate vaginal cream 2% 2

GYNAZOLE-1 CRE 2% 4

metronidazole vaginal gel 0.75% 2

terconazole vaginal suppos 80 mg 2

HEMATOLOGIC ANTICOAGULANTS, INJECTABLE

ARGATROBAN INJ 50MG/50M 4

argatroban inj 250 mg/2.5ml (concentrate

for iv infusion)

4

enoxaparin sodium inj 30 mg/0.3ml 2






enoxaparin sodium inj 100 mg/ml 2


enoxaparin sodium inj 150 mg/ml 2

enoxaparin sodium inj 300 mg/3ml 2

fondaparinux sodium subcutaneous inj 2.5 mg/0.5ml

5 QL

fondaparinux sodium subcutaneous inj 5 mg/0.4ml

5 QL

fondaparinux sodium subcutaneous inj 7.5

mg/0.6ml

5 QL

fondaparinux sodium subcutaneous inj 10

mg/0.8ml

5 QL

FRAGMIN INJ 2500/0.2 5 QL



FRAGMIN INJ 10000/ML 5 QL

FRAGMIN INJ 12500UNT 5 QL




heparin sodium (porcine) inj 1000 unit/ml 2




heparin sodium (porcine) pf inj 5000

unit/0.5ml

2

ANTICOAGULANTS, ORAL ELIQUIS TAB 2.5MG 3 QL

ELIQUIS TAB 5MG 3 QL

warfarin sodium tab 1 mg 1


warfarin sodium tab 2.5 mg 1





warfarin sodium tab 7.5 mg 1


XARELTO STAR TAB 15/20MG 3 QL

XARELTO TAB 2.5MG 3 QL

XARELTO TAB 10MG 3 QL



ANTIHEMOPHILIC AGENTS OBIZUR INJ 500 UNIT 4



HEMATOPOIETIC GROWTH FACTORS ARANESP INJ 10MCG 5 PA

ARANESP INJ 25MCG 5 PA








EPOGEN INJ 2000/ML 5 PA





GRANIX INJ 300/0.5 5 PA

GRANIX INJ 300/1ML 5 PA



LEUKINE INJ 250MCG 5 PA

NEULASTA INJ 6MG/0.6M 5 PA

NEUPOGEN INJ 300/0.5 5 PA

NEUPOGEN INJ 300MCG 5 PA

NEUPOGEN INJ 480/0.8 5 PA

NEUPOGEN INJ 480MCG 5 PA

PROCRIT INJ 40000/ML 5 PA

ZARXIO INJ 300/0.5 5 PA

ZARXIO INJ 480/0.8 5 PA

HEMOSTATICS, SYSTEMIC aminocaproic acid inj 250 mg/ml 2

tranexamic acid iv soln 1000 mg/10ml

(100 mg/ml)

2

tranexamic acid tab 650 mg 2 QL

HEMOSTATICS, TOPICAL AVITENE PAD 35X35MM 4

AVITENE POW FLOUR 4

AVITENE SYRG MIS 1GM 4

ENDO AVITENE MIS 5MM DIA 4

ENDO AVITENE MIS 10MM DIA 4

GELFOAM MIS DENTAL 4 4

GELFOAM MIS SPON COM 4

GELFOAM POW 4

MONSELS FERR SOL SUBSULF 4

THROMBIN-JMI KIT 20000UNT 4

HEREDITARY ANGIOEDEMA AGENTS BERINERT INJ 500UNIT 5 PA; QL



CINRYZE SOL 500 UNIT 5 PA; QL

FIRAZYR INJ 30MG/3ML 5 PA; QL

KALBITOR INJ 10MG/ML 5 PA

RUCONEST INJ 2100UNIT 5 PA

MISCELLANEOUS ACD FORMULA SOL A 4

ACTIVASE INJ 50MG 4

ACTIVASE INJ 100MG 4

ANTICOAG CIT SOL DEX SOL 4

ANTICOAG CPD SOL 3

CATHFLO ACTI INJ VASE 4

CEPROTIN INJ 1000UNIT 4

CHEMET CAP 100MG 4 PA

cilostazol tab 50 mg 2

cilostazol tab 100 mg 2

deferoxamine mesylate for inj 2 gm 2

EXJADE TAB 125MG 5 PA



FERRIPROX SOL 100MG/ML 4 PA

FERRIPROX TAB 500MG 5 PA

JADENU TAB 90MG 5 PA



NOCLOT-50 SOL ACD-A 4

pentoxifylline tab er 400 mg 2

protamine sulfate inj 10 mg/ml 2

THROMBAT III INJ 500UNIT 4

TRICITRASOL CON 4

PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH) AGENTS SOLIRIS INJ 10MG/ML 5 PA

PLATELET AGGREGATION INHIBITORS AGGRENOX CAP 25-200MG 4

aspirin-dipyridamole cap er 12hr 25-200 mg

2

BRILINTA TAB 60MG 3 QL

BRILINTA TAB 90MG 3 QL

clopidogrel bisulfate tab 75 mg (base equiv)

1

clopidogrel bisulfate tab 300 mg (base

equiv)

2

dipyridamole tab 25 mg 2



prasugrel hcl tab 5 mg (base equiv) 2 QL

prasugrel hcl tab 10 mg (base equiv) 2 QL



REOPRO INJ 2MG/ML 4

ZONTIVITY TAB 2.08MG 4 PA; QL

PLATELET SYNTHESIS INHIBITOR anagrelide hcl cap 0.5 mg 2

anagrelide hcl cap 1 mg 2

STEM CELL MOBILIZERS MOZOBIL INJ 5 PA; QL

THROMBOCYTOPENIA AGENTS DOPTELET TAB 20MG 5 PA; QL

MULPLETA TAB 3MG 5 PA; QL

NPLATE INJ 250MCG 5 PA

NPLATE INJ 500MCG 5 PA

PROMACTA TAB 12.5MG 5 PA; QL

PROMACTA TAB 25MG 5 PA; QL



IMMUNOLOGIC AGENTS AUTOIMMUNE AGENTS

COSENTYX INJ 150MG/ML 5 PA; QL

COSENTYX PEN INJ 300DOSE 5 PA; QL

ENBREL INJ 25/0.5ML 5 PA; QL

ENBREL INJ 25MG 5 PA; QL

ENBREL INJ 50MG/ML 5 PA; QL

ENBREL MINI INJ 50MG/ML 5 PA; QL

ENBREL SRCLK INJ 50MG/ML 5 PA; QL

HUMIRA INJ 10/0.1ML 5 PA; QL

HUMIRA INJ 10MG/0.2 5 PA; QL



HUMIRA KIT 20MG/0.4 5 PA; QL

HUMIRA KIT 40MG/0.8 5 PA; QL

HUMIRA PEDIA INJ CROHNS 5 PA; QL

HUMIRA PEN INJ 40/0.4ML 5 PA; QL

HUMIRA PEN INJ 40MG/0.8 5 PA; QL

HUMIRA PEN KIT CD/UC/HS 5 PA; QL

HUMIRA PEN KIT PS/UV 5 PA; QL

STELARA INJ 5MG/ML 5 PA; QL

STELARA INJ 45MG/0.5 5 PA; QL

STELARA INJ 90MG/ML 5 PA; QL

DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDS) DEPEN TITRA TAB 250MG 5 PA

hydroxychloroquine sulfate tab 200 mg 2

leflunomide tab 10 mg 2

leflunomide tab 20 mg 2

OTREXUP INJ 10MG 5 PA; QL

OTREXUP INJ 12.5/0.4 5 QL








RASUVO INJ 7.5MG 5 PA; QL

RASUVO INJ 10MG 5 PA; QL








IMMUNE GLOBULINS ATGAM INJ 250MG 5

CARIMUNE NF INJ 6GM 5 PA

CARIMUNE NF INJ 12GM 5 PA

FLEBOGAMMA INJ 20/400ML 5 PA

FLEBOGAMMA INJ DIF 5% 5 PA

GAMASTAN S/D INJ 5 PA

GAMMAGARD INJ 1GM/10ML 5 PA

GAMMAGARD INJ 2.5GM/25 5 PA

GAMMAGARD INJ 5GM/50ML 5 PA

GAMMAGARD INJ 10GM/100 5 PA



GAMMAGARD SD INJ 5GM HU 5 PA

GAMMAGARD SD INJ 10GM HU 5 PA

GAMUNEX-C INJ 40/400ML 5 PA

HIZENTRA INJ 1GM/5ML 5 PA



HIZENTRA INJ 10/50ML 5 PA

HYQVIA INJ 2.5-200 5 PA

HYQVIA INJ 5-400 5 PA




OCTAGAM INJ 1GM 5 PA

OCTAGAM INJ 2.5GM 5 PA

OCTAGAM INJ 2GM/20ML 5 PA




PRIVIGEN INJ 5 GRAMS 5 PA



PRIVIGEN INJ 10GRAMS 5 PA



THYMOGLOBULN INJ 25MG 5

IMMUNOMODULATORS, INTERFERONS ACTIMMUNE INJ 2MU/0.5 5 PA

ALFERON N INJ 5MU/ML 5 PA

INTRON A INJ 18MU 5 PA

INTRON A INJ 25MU 5 PA

PEG-INTRON KIT 50MCG 5 PA; QL

PEGASYS INJ 180MCG/M 5 PA; QL

PEGASYS INJ PROCLICK 5 PA; QL

SYLATRON KIT 200MCG 5 PA



IMMUNOMODULATORS, MISCELLANEOUS ARCALYST INJ 220MG 5 PA; QL

ILARIS INJ 150MG/ML 5 PA; QL

OTEZLA TAB 10/20/30 5 PA; QL

OTEZLA TAB 30MG 5 PA; QL

IMMUNOSUPPRESSANTS, ANTIMETABOLITES azathioprine tab 50 mg 2

CELLCEPT CAP 250MG 4

CELLCEPT SUS 200MG/ML 4

CELLCEPT TAB 500MG 4

mycophenolate mofetil cap 250 mg 2

mycophenolate mofetil for oral susp 200 mg/ml

2

mycophenolate mofetil tab 500 mg 2

mycophenolate sodium tab dr 180 mg

(mycophenolic acid equiv)

2


(mycophenolic acid equiv)

2

IMMUNOSUPPRESSANTS, CALCINEURIN INHIBITORS cyclosporine cap 25 mg 2

cyclosporine cap 100 mg 2

cyclosporine iv soln 50 mg/ml 2

cyclosporine modified cap 50 mg 2

cyclosporine modified oral soln 100 mg/ml 2

NEORAL CAP 25MG 4

NEORAL CAP 100MG 4

NEORAL SOL 100MG/ML 4

PROGRAF CAP 0.5MG 4

PROGRAF CAP 1MG 4

PROGRAF CAP 5MG 4

PROGRAF INJ 5MG/ML 5



SANDIMMUNE CAP 25MG 4

SANDIMMUNE CAP 100MG 4

SANDIMMUNE INJ 50MG/ML 5

SANDIMMUNE SOL 100MG/ML 3

tacrolimus cap 0.5 mg 2

tacrolimus cap 1 mg 2

tacrolimus cap 5 mg 2

IMMUNOSUPPRESSANTS, MISCELLANEOUS BENLYSTA INJ 120MG 5 PA

BENLYSTA INJ 400MG 5 PA

NULOJIX INJ 250MG 5 PA

SIMULECT INJ 10MG 5

SIMULECT INJ 20MG 5

IMMUNOSUPPRESSANTS, RAPAMYCIN DERIVATIVE RAPAMUNE SOL 1MG/ML 3 PA

RAPAMUNE TAB 0.5MG 5 PA

RAPAMUNE TAB 1MG 5 PA

RAPAMUNE TAB 2MG 5 PA

sirolimus tab 0.5 mg 2 PA

sirolimus tab 1 mg 2 PA

sirolimus tab 2 mg 2 PA

ZORTRESS TAB 0.5MG 3 PA



MONOCLONAL ANTIBODIES SYNAGIS INJ 50MG 5 PA; QL

SYNAGIS INJ 100MG/ML 5 PA; QL

VACCINES BCG VACCINE INJ 5

NUTRITIONAL / SUPPLEMENTS DIETARY MANAGEMENT PRODUCTS

CARDIOTEK-RX TAB 4

FOLTANX TAB 2

METAFOLBIC TAB PLUS 2

PHENYLADE POW GMP 4

ELECTROLYTES, MISCELLANEOUS K-PHOS TAB 4

K-PHOS TAB NEUTRAL 2

K-PHOS TAB NO 2 4

pot phos monobasic w/sod phos di & monobas tab 155-852-130mg

2

ELECTROLYTES, POTASSIUM EFFER-K TAB 10MEQ 3

EFFER-K TAB 20MEQ 3

pot bicarbonate & chloride effer tab 25

meq

2



potassium bicarbonate effer tab 25 meq 2

potassium chloride cap er 8 meq 2

potassium chloride cap er 10 meq 2

potassium chloride microencapsulated crys

er tab 10 meq

2

POTASSIUM CHLORIDE

MICROENCAPSULATED CRYS ER TAB 15 MEQ

2

potassium chloride microencapsulated crys er tab 20 meq

2

potassium chloride oral soln 10% (20 meq/15ml)

2

potassium chloride oral soln 20% (40 meq/15ml)

2

potassium chloride powder packet 20 meq 2

potassium chloride tab er 8 meq (600 mg) 2

potassium chloride tab er 10 meq 2

potassium chloride tab er 20 meq (1500 mg)

2

VITAMINS AND MINERALS, FOLIC ACID / COMBINATIONS ANIMI-3 CAP 4

ANIMI-3 CAP VIT D 4

BP VIT 3 CAP 4

FOLGARD RX TAB 4

folic acid tab 1 mg 1

folic acid-vitamin b6-vitamin b12 tab 2.2-25-0.5 mg

2

folic acid-vitamin b6-vitamin b12 tab 2.2-25-1 mg

2

folic acid-vitamin b6-vitamin b12 tab 2.5-25-1 mg

2

FOLTRATE TAB 3

VITAMINS AND MINERALS, MISCELLANEOUS ACTIVE FE TAB 75-1.25 4

AQUASOL A INJ 50000/ML 4

b-complex w/ c & folic acid cap 1 mg 2

b-complex w/ c & folic acid tab 1 mg 2

CALCIUM-FA WAF PLUS D 2

CORVITE 150 TAB 4

CORVITE FE TAB 4

ergocalciferol cap 50000 unit 2

ESCAVITE CHW 4

ESCAVITE D CHW 4

fe asp gly-fe polysacch-succ ac-c-threon ac-b12-fa cap

2

fe asparto gly-fe fum-b12-fa-c-succinic ac tab ther pack

2



fe fumarate w/ b12-vit c-fa-ifc cap 110-0.015-75-0.5-240 mg

2

FERAHEME INJ 510/17ML 4

FERRALET 90 TAB 4

FERRAPLUS 90 TAB 2

ferrex 150 cap 150mg 2

FLORIVA CHW 0.5MG 4

FLORIVA CHW 0.25MG 4

FLORIVA CHW 1MG 4

FLORIVA DRO 0.25MG 4

FUSION PAK SPRINKLE 4

FUSION PLUS CAP 4

GALZIN CAP 25MG 3 PA

GALZIN CAP 50MG 3 PA

HEMATOGEN FA CAP 2

HEMATRON-AF TAB 4

HEMETAB TAB 2

hydroxocobalamin acetate inj 1000 mcg/ml

(base equivalent)

2

INFED INJ 50MG/ML 2

INTEGRA F CAP 4

INTEGRA PLUS CAP 4

iron combination cap 2

iron polysacch complex-vit b12-fa cap

150-0.025-1 mg

2

iron polysacch complex-vit b12-fa cap

150-0.025-1 mg

2

iron-folic acid-vit c-vit b6-vit b12-zinc tab

150-1.25 mg

2

IROSPAN 24/6 MIS 4

MAGNEBIND TAB 400 3

MEPHYTON TAB 5MG 4

NEPHPLEX RX TAB 2

NEPHRON FA TAB 4

NEURIN-SL SUB 4

NICADAN TAB 4

pediatric multiple vitamin w/ minerals & c

drops 45 mg/ml

4

pediatric multiple vitamins w/ fl-fe drops

0.25-6 mg/ml

4


0.25-10 mg/ml

2

pediatric multiple vitamins w/ fluoride

chew tab 0.5 mg

2

phytonadione tab 5 mg 4

POLY-VI-FLOR CHW 0.5MG 4

POLY-VI-FLOR CHW 0.25MG 4



POLY-VI-FLOR CHW 1MG 4

POLY-VI-FLOR SUS 0.25/ML 4

POLY-VI-FLOR SUS /IRON 4

PROFERRIN- TAB FORTE 4

PUREFE CAP PLUS 4

pyridoxine hcl inj 100 mg/ml 2

QUFLORA PED CHW 0.5MG 4

QUFLORA PED CHW 0.25MG 4

QUFLORA PED CHW 1MG 4

sodium fluoride chew tab 1 mg f (from 2.2 mg naf)

2

sodium fluoride tab 1 mg f (from 2.2 mg naf)

2

TANDEM PLUS CAP 4

TARON FORTE CAP 2

TEXAVITE LQ LIQ 4

thiamine hcl inj 100 mg/ml 2

TRI-VI-FLOR SUS 0.5MG/ML 4

TRI-VI-FLOR SUS 0.25/ML 4

VENOFER INJ 20MG/ML 4

VITAMINS AND MINERALS, PRENATAL VITAMINS ATABEX EC TAB 29-1MG 4

C-NATE DHA CAP 28-1-200 2

CITRANATAL CAP HARMONY 4

CITRANATAL MIS 90 DHA 4

CITRANATAL MIS B-CALM 4

CITRANATAL PAK ASSURE 4

CITRANATAL PAK DHA 4

CITRANATAL TAB RX 4

COMPLETE NAT PAK DHA 2

COMPLETENATE CHW 2

CONCEPT DHA CAP 4

CONCEPT OB CAP 4

DOTHELLE DHA CAP 2

DUET DHA 400 MIS 25-1-400 4

DUET DHA MIS BALANCED 4

ENBRACE HR CAP 4

FOLET DHA PAK 4

FOLET ONE CAP 38-1-225 4

FOLIVANE-OB CAP 2

M-VIT TAB 27-1MG 3

MARNATAL-F CAP 4

MYNATAL CAP 2

MYNATAL TAB 2

MYNATAL TAB ADVANCE 2

MYNATAL-Z TAB 2

MYNATE 90 TAB PLUS 2



NATACHEW CHW 4

NATELLE ONE CAP 4

NEEVO DHA CAP 27-1.13 4

NESTABS ABC MIS 4

NESTABS DHA PAK 4

NEWGEN TAB 32-1MG 2

NIVA-PLUS TAB 4

O-CAL FA TAB 3

O-CAL TAB PRENATAL 3

OB COMPLETE CAP ONE 4

OB COMPLETE CAP PETITE 4

OB COMPLETE TAB 3

OB COMPLETE TAB PREMIER 4

OBSTETRIX EC TAB 3

OBSTETRIX PAK DHA 4

PNV OB+DHA PAK 2

PNV PRENATAL TAB PLUS 2

PNV PRENATAL TAB PLUS 2

PNV TABS TAB 29-1MG 2

PNV-DHA CAP DOCUSATE 2

PR NATAL 400 PAK 2

PR NATAL 430 PAK 2

PR NATAL 430 PAK EC 2

PRENAISSANCE CAP PLUS 2

PRENAT PLUS TAB 27-1MG 2

prenat w/o a w/fefum-methfol-fa-dha cap 27-0.6-0.4-300 mg

2

PRENATA CHW 29-1MG 4

PRENATAL TAB 27-1MG 2

PRENATAL TAB PLUS 2

PRENATAL VIT TAB LOW IRON 2

prenatal vit w/ dss-fe fumarate-fa tab 29-1 mg

2

prenatal vit w/ fe fum-methylfolate-fa tab 27-0.6-0.4 mg

2

prenatal vit w/ fe fumarate-fa chew tab 29-1 mg

2

prenatal vit w/ fe fumarate-fa tab 27-1 mg 2

prenatal vit w/ fe fumarate-fa tab 28-1 mg 2

PRENATAL+FE TAB 29-1MG 2

PRENATAL-U CAP 106.5-1 2

PRENATE AM TAB 1MG 4

PRENATE CAP ENHANCE 4

PRENATE CAP PIXIE 4

PRENATE CAP RESTORE 4

PRENATE CHW 0.6-0.4 4

PRENATE DHA CAP 4



PRENATE MINI CAP 4

PRENATE TAB ELITE 4

PREPLUS TAB 27-1MG 2

PRETAB TAB 29-1MG 2

PROVIDA DHA CAP 4

PROVIDA OB CAP 4

PUREFE OB CAP PLUS 4

REDICHEW RX CHW 4

RELNATE DHA CAP 2

SE-NATAL 19 TAB 2

SELECT-OB CHW 4

SELECT-OB+ PAK DHA 4

TARON-C DHA CAP 2

TARON-PREX CAP 2

TL-SELECT CAP 2

TRI-TABS DHA MIS 2

TRICARE PRE CAP 27-1-500 4

TRICARE TAB PRENATAL 4

TRISTART DHA CAP 4

VENA-BAL MIS DHA 2

VINATE II TAB 2

VINATE M TAB 2

VINATE ONE TAB 2

VIRT-C DHA CAP 2

VIRT-NATE CAP DHA 2

VIRT-PN PLUS CAP 2

VIRT-PN TAB 2

VITAFOL CAP ULTRA 4

VITAFOL FE+ CAP 4

VITAFOL-NANO TAB 4

VITAFOL-OB PAK +DHA 4

VITAFOL-ONE CAP 4

VITAMEDMD CAP ONE RX 4

VITAPEARL CAP 4

VITATRUE MIS 4

VIVA DHA CAP 4

VOL-PLUS TAB 2

VOL-TAB RX TAB 4

VP-PNV-DHA CAP 4

ZATEAN-PN CAP DHA 2

ZATEAN-PN CAP PLUS 2

RESPIRATORY ANAPHYLAXIS TREATMENT AGENTS

ADRENALIN INJ 1MG/ML 4

ADRENALIN INJ 30/30ML 4

epinephrine pf inj 1 mg/ml 2



epinephrine pf soln prefilled syringe 1 mg/10ml (0.1 mg/ml)

2

epinephrine solution auto-injector 0.3 mg/0.3ml (1:1000)

2

epinephrine solution auto-injector 0.15 mg/0.15ml (1:1000)

2

EPIPEN 2-PAK INJ 0.3MG 4

EPIPEN-JR INJ 0.15MG 3

ANTICHOLINERGIC/BETA AGONIST COMBINATIONS, LONG ACTING ANORO ELLIPT AER 62.5-25 3

STIOLTO AER 2.5-2.5 3

UTIBRON CAP NEOHALER 4

ANTICHOLINERGIC/BETA AGONIST COMBINATIONS, SHORT

ACTING COMBIVENT AER 20-100 3

ipratropium-albuterol nebu soln 0.5-2.5(3) mg/3ml

2

ANTICHOLINERGICS ATROVENT HFA AER 17MCG 4

ipratropium bromide inhal soln 0.02% 2

SEEBRI NEOHA CAP 15.6MCG 4

SPIRIVA AER 1.25MCG 3

SPIRIVA CAP HANDIHLR 3

SPIRIVA SPR 2.5MCG 3

ANTIHISTAMINES, LOW-SEDATING levocetirizine dihydrochloride soln 2.5

mg/5ml (0.5 mg/ml)

2

levocetirizine dihydrochloride tab 5 mg 2

ANTIHISTAMINES, SEDATING carbinoxamine maleate soln 4 mg/5ml 2

carbinoxamine maleate tab 4 mg 2

clemastine fumarate tab 2.68 mg 2

cyproheptadine hcl syrup 2 mg/5ml 2

cyproheptadine hcl tab 4 mg 2

diphenhydramine hcl cap 50 mg 5

diphenhydramine hcl elixir 12.5 mg/5ml 5

diphenhydramine hcl inj 50 mg/ml 5

hydroxyzine hcl im soln 25 mg/ml 2

hydroxyzine hcl im soln 50 mg/ml 2

hydroxyzine hcl syrup 10 mg/5ml 2

hydroxyzine hcl tab 10 mg 2



hydroxyzine pamoate cap 25 mg 2





ANTITUSSIVE COMBINATIONS, NON-OPIOID promethazine-dm syrup 6.25-15 mg/5ml 1

pseudoephed-bromphen-dm syrup 30-2-10

mg/5ml

4

ANTITUSSIVE COMBINATIONS, OPIOID CAPCOF SYP 5-2-10MG 4

guaifenesin-codeine soln 100-10 mg/5ml 2

hydrocod polst-chlorphen polst er susp

10-8 mg/5ml

2

hydrocodone w/ homatropine syrup 5-1.5

mg/5ml

2

m-clear wc liq 100-6.3 2

M-END PE LIQ 4

promethazine w/ codeine syrup 6.25-10 mg/5ml

2

TUSSICAPS CAP 10-8MG 4

Z-TUSS AC LIQ 2-9/5ML 4

ANTITUSSIVES benzonatate cap 100 mg 1

benzonatate cap 200 mg 2

BETA AGONISTS, INHALANTS, LONG ACTING, Hand-held Active

Inhalation ARCAPTA CAP 75MCG 4 ST

SEREVENT DIS AER 50MCG 3

STRIVERDI AER 2.5MCG 4

BETA AGONISTS, INHALANTS, LONG ACTING, Nebulized Passive

Inhalation BROVANA NEB 15MCG 4

PERFOROMIST NEB 20MCG 4

BETA AGONISTS, INHALANTS, SHORT ACTING albuterol sulfate soln nebu 0.5% (5 mg/ml) 2

albuterol sulfate soln nebu 0.63 mg/3ml

(base equiv)

2

albuterol sulfate soln nebu 0.083% (2.5

mg/3ml)

1

albuterol sulfate soln nebu 1.25 mg/3ml

(base equiv)

2

levalbuterol hcl soln nebu 0.31 mg/3ml (base equiv)

2


2


2

levalbuterol hcl soln nebu conc 1.25 mg/0.5ml (base equiv)

2

levalbuterol tartrate inhal aerosol 45 mcg/act (base equiv)

4 QL



metaproterenol sulfate syrup 10 mg/5ml 2

metaproterenol sulfate tab 10 mg 2

metaproterenol sulfate tab 20 mg 2

PROVENTIL AER HFA 4 PA; QL

VENTOLIN HFA AER 3 QL

XOPENEX HFA AER 4 QL

BETA AGONISTS, INJECTABLE ISUPREL INJ 0.2MG/ML 4

terbutaline sulfate inj 1 mg/ml 2

BETA AGONISTS, ORAL AGENTS albuterol sulfate syrup 2 mg/5ml 1

albuterol sulfate tab 2 mg 1

albuterol sulfate tab 4 mg 2

albuterol sulfate tab er 12hr 4 mg 2

albuterol sulfate tab er 12hr 8 mg 2

terbutaline sulfate tab 2.5 mg 2

terbutaline sulfate tab 5 mg 2

CYSTIC FIBROSIS BETHKIS NEB 300/4ML 5 QL

CAYSTON INH 75MG 5 QL

KALYDECO PAK 50MG 5 PA; QL

KALYDECO PAK 75MG 5 PA; QL

KALYDECO TAB 150MG 5 PA; QL

ORKAMBI TAB 200-125 5 PA; QL

PULMOZYME SOL 1MG/ML 5 PA; QL

SYMDEKO TAB 100-150 5 PA; QL

TOBI PODHALR CAP 28MG 5 QL

tobramycin nebu soln 300 mg/5ml 5 QL

LEUKOTRIENE MODIFIERS montelukast sodium chew tab 4 mg (base

equiv) 2 QL

montelukast sodium chew tab 5 mg (base equiv)

2 QL

montelukast sodium oral granules packet 4 mg (base equiv)

2 QL

montelukast sodium tab 10 mg (base

equiv)

2 QL

zafirlukast tab 10 mg 2

zafirlukast tab 20 mg 2

MAST CELL STABILIZERS cromolyn sodium soln nebu 20 mg/2ml 2

MEDICAL SUPPLIES AEROCHAMBER MIS PLUS 4

MISCELLANEOUS acetylcysteine inhal soln 10% 2

acetylcysteine inhal soln 20% 2



ARALAST NP INJ 500MG 5 PA

CINQAIR INJ 5 PA

GLASSIA INJ 5 PA

HYPER-SAL NEB 7% 4

HYPERSAL NEB 3.5% 4

ipratropium bromide nasal soln 0.03% (21 mcg/spray)

2

ipratropium bromide nasal soln 0.06% (42 mcg/spray)

2

NEBUSAL NEB 6% 4

NUCALA INJ 100MG 5 PA; QL

PROLASTIN-C INJ 1000MG 5 PA

sodium chloride soln nebu 0.9% 2

sodium chloride soln nebu 3% 2



XOLAIR INJ 75/0.5 5 PA; QL

XOLAIR INJ 150MG/ML 5 PA; QL

XOLAIR SOL 150MG 5 PA; QL

ZEMAIRA INJ 1000MG 5 PA

NASAL ANTIHISTAMINES azelastine hcl nasal spray 0.1% (137

mcg/spray)

2

azelastine hcl nasal spray 0.15% (205.5

mcg/spray)

2

olopatadine hcl nasal soln 0.6% 2

PATANASE SPR 0.6% 4

PHOSPHODIESTERASE-4 INHIBITORS DALIRESP TAB 500MCG 4 PA

PULMONARY FIBROSIS AGENTS ESBRIET CAP 267MG 5 PA

ESBRIET TAB 267MG 5 PA

ESBRIET TAB 801MG 5 PA

OFEV CAP 100MG 5 PA

OFEV CAP 150MG 5 PA

STEROID INHALANTS ARNUITY ELPT INH 100MCG 3

ARNUITY ELPT INH 200MCG 3

ASMANEX 30 AER 110MCG 3

ASMANEX 120 AER 220MCG 3

ASMANEX HFA AER 100 MCG 3

ASMANEX HFA AER 200 MCG 3

budesonide inhalation susp 0.5 mg/2ml 2

budesonide inhalation susp 0.25 mg/2ml 2

budesonide inhalation susp 1 mg/2ml 2

FLOVENT DISK AER 50MCG 3





FLOVENT HFA AER 44MCG 3



PULMICORT INH 90MCG 3

PULMICORT INH 180MCG 3

QVAR REDIHA AER 80MCG 3

QVAR REDIHAL AER 40MCG 3

STEROID/BETA AGONIST COMBINATIONS ADVAIR DISKU AER 100/50 3

ADVAIR DISKU AER 250/50 3

ADVAIR DISKU AER 500/50 3

ADVAIR HFA AER 45/21 3



BREO ELLIPTA INH 100-25 3

BREO ELLIPTA INH 200-25 3

SYMBICORT AER 80-4.5 3

SYMBICORT AER 160-4.5 3

TOPICAL DECONGESTANTS ADRENALIN SOL 1:1000 3

XANTHINES ELIXOPHYLLIN ELX 80/15ML 4

THEO-24 CAP 100MG CR 4



THEO-24 CAP 400MG ER 4

theophylline soln 80 mg/15ml 2

theophylline tab er 12hr 100 mg 2






TOPICAL DERMATOLOGY, ACNE: ORAL

isotretinoin cap 10 mg 2




DERMATOLOGY, ACNE: TOPICAL ACZONE GEL 5% 4 PA

ACZONE GEL 7.5% 4 PA

adapalene cream 0.1% 2 PA

adapalene gel 0.3% 2 PA



AZELEX CRE 20% 4 PA

benzoyl peroxide-erythromycin gel 5-3% 2

clindamycin phosphate foam 1% 2

clindamycin phosphate gel 1% 2

clindamycin phosphate lotion 1% 2

clindamycin phosphate soln 1% 2

clindamycin phosphate swab 1% 2

creamy face liq wash 4% 2

dapsone gel 5% 2 PA

erythromycin gel 2% 2

erythromycin pads 2% 2

erythromycin soln 2% 2

sulfacetamide sodium w/ sulfur emulsion

10-1%

2

sulfacetamide sodium w/ sulfur wash 9-4.5%

2

tazarotene cream 0.1% 2 PA

TAZORAC CRE 0.1% 4 PA

TAZORAC CRE 0.05% 4 PA

TAZORAC GEL 0.1% 4 PA

TAZORAC GEL 0.05% 4 PA

tretinoin cream 0.1% 2



tretinoin gel 0.01% 2

tretinoin gel 0.025% 2

DERMATOLOGY, ACTINIC KERATOSIS fluorouracil cream 5% 4

fluorouracil soln 2% 4

fluorouracil soln 5% 5

DERMATOLOGY, ANTI-INFECTIVE/ANTI-INFLAMMATORY

COMBINATIONS CORTISPORIN CRE 0.5% 4

CORTISPORIN OIN 1% 4

DERMATOLOGY, ANTIBIOTICS ALTABAX OIN 1% 4

BACTROBAN OIN NASAL 2% 4

gentamicin sulfate cream 0.1% 2

gentamicin sulfate oint 0.1% 2

mupirocin calcium cream 2% 2 ST

mupirocin oint 2% 2

silver sulfadiazine cream 1% 2

DERMATOLOGY, ANTIFUNGALS ciclopirox gel 0.77% 2

ciclopirox olamine cream 0.77% (base equiv)

2



ciclopirox olamine susp 0.77% (base equiv)

2

ciclopirox solution 8% 2

clotrimazole cream 1% 2

clotrimazole w/ betamethasone cream

1-0.05%

2

clotrimazole w/ betamethasone lotion

1-0.05%

2

econazole nitrate cream 1% 2

EXELDERM CRE 1% 4

EXELDERM SOL 1% 4

EXODERM LOT 25-1% 4

ketoconazole cream 2% 2

ketoconazole shampoo 2% 2

nystatin cream 100000 unit/gm 2

nystatin oint 100000 unit/gm 2

nystatin topical powder 100000 unit/gm 2

nystatin-triamcinolone cream 100000-0.1

unit/gm-%

2

nystatin-triamcinolone oint 100000-0.1

unit/gm-%

2

oxiconazole nitrate cream 1% 2 PA; QL

PENLAC SOL 8% 4

DERMATOLOGY, ANTIPSORIATICS, ORAL acitretin cap 10 mg 4

acitretin cap 17.5 mg 4

methoxsalen rapid cap 10 mg 5 PA

OXSORALEN-UL CAP 10MG 5 PA

DERMATOLOGY, ANTIPSORIATICS, TOPICAL calcipotriene cream 0.005% 2 QL

calcipotriene oint 0.005% 2 QL

calcipotriene soln 0.005% (50 mcg/ml) 2 QL

calcitriol oint 3 mcg/gm 2

DRITHO-CREME CRE HP 1% 3

DERMATOLOGY, ANTISEBORRHEICS selenium sulfide shampoo 2.25% 2

DERMATOLOGY, ANTISEPTICS/DISINFECTANTS formaldehyde solution 20% 4

PHENOL LIQ 89% 2

DERMATOLOGY, ATOPIC DERMATITIS, Topical ELIDEL CRE 1% 4 PA

pimecrolimus cream 1% 4 PA

tacrolimus oint 0.1% 2 PA; QL

tacrolimus oint 0.03% 2 PA; QL

DERMATOLOGY, CORTICOSTEROID COMBINATIONS pramoxine-hc cream 1-2.5% 2



DERMATOLOGY, CORTICOSTEROIDS: HIGH POTENCY amcinonide cream 0.1% 2

amcinonide lotion 0.1% 2

AMCINONIDE OIN 0.1% 2

betamethasone dipropionate augmented cream 0.05%

2

betamethasone dipropionate augmented lotion 0.05%

2

betamethasone dipropionate cream 0.05% 2

betamethasone dipropionate lotion 0.05% 2

desoximetasone cream 0.25% 2

desoximetasone gel 0.05% 2

desoximetasone oint 0.25% 2

fluocinonide cream 0.05% 2 QL

fluocinonide emulsified base cream 0.05% 2

fluocinonide gel 0.05% 2

fluocinonide oint 0.05% 2

fluocinonide soln 0.05% 2

triamcinolone acetonide cream 0.5% 1

triamcinolone acetonide oint 0.5% 2

DERMATOLOGY, CORTICOSTEROIDS: LOW POTENCY alclometasone dipropionate cream 0.05% 2

alclometasone dipropionate oint 0.05% 2

desonide cream 0.05% 2

desonide lotion 0.05% 2

desonide oint 0.05% 2

fluocinolone acetonide cream 0.01% 2

fluocinolone acetonide oil 0.01% (body oil) 2

fluocinolone acetonide oil 0.01% (scalp oil) 2

fluocinolone acetonide soln 0.01% 2

hydrocortisone cream 2.5% 2

hydrocortisone lotion 2.5% 2

hydrocortisone oint 1% 2

DERMATOLOGY, CORTICOSTEROIDS: MEDIUM POTENCY betamethasone valerate cream 0.1% (base

equivalent) 2

betamethasone valerate lotion 0.1% (base equivalent)

2

betamethasone valerate oint 0.1% (base equivalent)

2

desoximetasone cream 0.05% 2

desoximetasone oint 0.05% 2

fluocinolone acetonide cream 0.025% 2

fluocinolone acetonide oint 0.025% 2

fluticasone propionate cream 0.05% 2

fluticasone propionate oint 0.005% 2

hydrocortisone butyrate cream 0.1% 2



hydrocortisone butyrate oint 0.1% 2

hydrocortisone butyrate soln 0.1% 2

hydrocortisone valerate cream 0.2% 2

hydrocortisone valerate oint 0.2% 2

mometasone furoate cream 0.1% 2

mometasone furoate oint 0.1% 2

mometasone furoate solution 0.1% (lotion) 2

prednicarbate cream 0.1% 2

prednicarbate oint 0.1% 2



triamcinolone acetonide lotion 0.1% 2

triamcinolone acetonide lotion 0.025% 2



DERMATOLOGY, CORTICOSTEROIDS: VERY HIGH POTENCY betamethasone dipropionate augmented

gel 0.05% 2

betamethasone dipropionate augmented oint 0.05%

2

clobetasol propionate cream 0.05% 2 QL

clobetasol propionate emollient base cream

0.05%

2 QL

clobetasol propionate gel 0.05% 2 QL

clobetasol propionate oint 0.05% 2 QL

clobetasol propionate soln 0.05% 2 QL

halobetasol propionate cream 0.05% 2 QL

halobetasol propionate oint 0.05% 2 QL

DERMATOLOGY, EMOLLIENTS lactic acid (ammonium lactate) cream 12% 2

lactic acid (ammonium lactate) lotion 10% 2

DERMATOLOGY, LOCAL ANALGESIC lidocaine patch 5% 4 PA; QL

LIDODERM DIS 5% 4 PA; QL

DERMATOLOGY, LOCAL ANESTHETICS ANACAINE OIN 3

CETACAINE AER 4

cocaine hcl soln 4% 2

lidocaine hcl gel 2% 2

LIDOCAINE HCL LOTION 3% 2

lidocaine hcl soln 4% 2 PA; QL

lidocaine oint 5% 2 PA; QL

lidocaine-prilocaine cream 2.5-2.5% 2 PA; QL

lidocaine-prilocaine cream kit 2.5-2.5% 2 PA

QUTENZA KIT 8% 1-PCH 5 PA; QL



DERMATOLOGY, MISCELLANEOUS SKIN AND MUCOUS MEMBRANE acyclovir oint 5% 4

ARZOL SILVER MIS NITR APP 3

BUCALSEP SOL 3

BUCALSEP SPR 3

CONDYLOX GEL 0.5% 4

DENAVIR CRE 1% 4

DRYSOL SOL 20% 4

GEBAUERS SPR AER /STRETCH 4

GORDOFILM SOL 3

imiquimod cream 5% 2

PANRETIN GEL 0.1% 5 PA

PODOCON SOL 25% 3

podofilox soln 0.5% 2

PR CREAM KIT 2

salicylic acid cream 6% 2

salicylic acid film forming liquid 27.5% 2

salicylic acid lotion 6% 2

salicylic acid shampoo 6% 2

SALICYLIC ACID SOLN 26% 2

salisol fort sol 26% 2

SANTYL OIN 250/GM 3 PA

SILVER NITRA OIN 10% 2

SILVER NITRA SOL 0.5% 2

SILVER NITRA SOL 10% 2



SULFAMYLON CRE 85MG/GM 3

TRI-CHLOR LIQ 80% 3

DERMATOLOGY, ROSACEA FINACEA GEL 15% 4

metronidazole cream 0.75% 2

metronidazole gel 0.75% 2

metronidazole lotion 0.75% 2

MIRVASO GEL 0.33% 4 PA

DERMATOLOGY, SCABICIDES AND PEDICULICIDES EURAX CRE 10% 3

EURAX LOT 10% 3

lindane shampoo 1% 3

malathion lotion 0.5% 2

permethrin cream 5% 2

ULESFIA LOT 5% 4

DERMATOLOGY, WOUND CARE PRODUCTS AVO CREAM EMU 2

BIAFINE EMU 4

PRUTECT EMU 2



REGENECARE GEL 3

SILVRSTAT GEL DRESSING 4

SONAFINE EMU 4

IRRIGATION SOLUTIONS irrigation solution, physiological 4

lactated ringer's for irrigation 2

ringer's solution for irrigation 2

water for irrigation, sterile irrigation soln 2

MOUTH/THROAT/DENTAL AGENTS, MISCELLANEOUS AQUORAL SPR 4

BIOTENE DRY SPR MOIST 3

BIOTENE SPR MOUTH 3

CAPHOSOL SOL 3

chlorhexidine gluconate soln 0.12% 1

DEBACTEROL SOL 30-50% 3

fluorid sens pst 1.1-5% 4

GELCLAIR GEL 4

lidocaine hcl laryngotracheal soln 4% 2

lidocaine hcl viscous soln 2% 1

MOI-STIR SOL 3

MOUTHKOTE SOL 3

NUMOISYN LOZ 4

PREVDNT 5000 PST 1.1% 4

PREVDNT 5000 PST 1.1-5% 4

PREVIDENT GEL 1.1% 4

PREVIDENT GEL 1.1% BER 4

PREVIDENT GEL 1.1% CHR 4

PREVIDENT GEL 1.1% MIN 4

sodium fluoride cream 1.1% 2

sodium fluoride gel 1.1% (0.5% f) 2

sodium fluoride paste 1.1% 4

sodium fluoride rinse 0.2% 2

sodium fluoride rinse 0.2% 2

triamcinolone acetonide dental paste 0.1% 2

MOUTH/THROAT/DENTAL AGENTS, PROTECTANTS ORAMAGICRX SUS 4

OPHTHALMIC, ANTI-INFECTIVE/ANTI-INFLAMMATORY

COMBINATIONS bacitracin-polymyxin-neomycin-hc ophth

oint 1%

2

BLEPHAMIDE OIN S.O.P. 3

BLEPHAMIDE SUS OP 3

neomycin-polymyxin-dexamethasone ophth oint 0.1%

2

neomycin-polymyxin-dexamethasone ophth susp 0.1%

2



neomycin-polymyxin-hc ophth susp 2

PRED-G S.O.P OIN OP 3

PRED-G SUS OP 3

sulfacetamide sodium-prednisolone ophth

soln 10-0.23(0.25)%

2

TOBRADEX OIN 0.3-0.1% 4

TOBRADEX ST SUS 0.3-0.05 4

tobramycin-dexamethasone ophth susp 0.3-0.1%

2

ZYLET SUS 0.5-0.3% 4

OPHTHALMIC, ANTI-INFECTIVES AZASITE SOL 1% 4

bacitracin ophth oint 500 unit/gm 2

bacitracin-polymyxin b ophth oint 2

BESIVANCE SUS 0.6% 4

BETADINE SOL 5% OP 3

CILOXAN OIN 0.3% OP 4

ciprofloxacin hcl ophth soln 0.3% 2

erythromycin ophth oint 5 mg/gm 1

gatifloxacin ophth soln 0.5% 2

gentamicin sulfate ophth oint 0.3% 1

gentamicin sulfate ophth soln 0.3% 1

levofloxacin ophth soln 0.5% 2

MOXEZA SOL 0.5% 3

moxifloxacin hcl ophth soln 0.5% (base equiv)

2

neomycin-bacitrac zn-polymyx 5(3.5)mg-400unt-10000unt op oin

2

neomycin-polymy-gramicid op sol 1.75-10000-0.025mg-unt-mg/ml

2

ofloxacin ophth soln 0.3% 2

polymyxin b-trimethoprim ophth soln

10000 unit/ml-0.1%

2

sulfacetamide sodium ophth oint 10% 2

sulfacetamide sodium ophth soln 10% 2

tobramycin ophth soln 0.3% 1

TOBREX OIN 0.3% OP 4

ZYMAXID SOL 0.5% 3

OPHTHALMIC, ANTI-INFLAMMATORY: NONSTEROIDAL ACUVAIL SOL 0.45% 4 QL

bromfenac sodium ophth soln 0.09% (base

equiv) (once-daily)

2

diclofenac sodium ophth soln 0.1% 1

flurbiprofen sodium ophth soln 0.03% 2

ketorolac tromethamine ophth soln 0.4% 2 QL

ketorolac tromethamine ophth soln 0.5% 2 QL

NEVANAC SUS 0.1% 4



PROLENSA SOL 0.07% 4

OPHTHALMIC, ANTI-INFLAMMATORY: STEROIDAL ALREX SUS 0.2% 4

dexamethasone sodium phosphate ophth soln 0.1%

2

DUREZOL EMU 0.05% 3

FLAREX SUS 0.1% OP 4

fluorometholone ophth susp 0.1% 2

FML FORTE SUS 0.25% OP 4

FML LIQUIFLM SUS 0.1% OP 4

FML OIN 0.1% OP 3

ILUVIEN IMP 0.19MG 5 PA; QL

LOTEMAX GEL 0.5% 4

LOTEMAX OIN 0.5% 4

LOTEMAX SUS 0.5% 4

MAXIDEX SUS 0.1% OP 4

OMNIPRED SUS 1% OP 4

PRED MILD SUS 0.12% OP 4

prednisolone acetate ophth susp 1% 2

TRIESENCE INJ 40MG/ML 4

OPHTHALMIC, ANTIALLERGICS ALOCRIL SOL 2% 4

ALOMIDE SOL 0.1% OP 4

azelastine hcl ophth soln 0.05% 2

BEPREVE DRO 1.5% 4

cromolyn sodium ophth soln 4% 2

EMADINE SOL 0.05% OP 4

epinastine hcl ophth soln 0.05% 2

olopatadine hcl ophth soln 0.1% (base equivalent)

2

olopatadine hcl ophth soln 0.2% (base equivalent)

2

PAZEO DRO 0.7% 3

OPHTHALMIC, ANTIFUNGALS NATACYN SUS 5% OP 3

OPHTHALMIC, ANTIVIRAL trifluridine ophth soln 1% 2

ZIRGAN GEL 0.15% 3

OPHTHALMIC, BETA-BLOCKERS: NONSELECTIVE BETIMOL SOL 0.5% 4

BETIMOL SOL 0.25% 4

carteolol hcl ophth soln 1% 2

ISTALOL SOL 0.5% OP 4

levobunolol hcl ophth soln 0.5% 2

timolol maleate ophth gel forming soln 0.5%

2



timolol maleate ophth gel forming soln 0.25%

2

timolol maleate ophth soln 0.5% 2

timolol maleate ophth soln 0.5% (once-daily)

2

timolol maleate ophth soln 0.25% 2

TIMOPTIC OCU SOL 0.5% OP 4

TIMOPTIC OCU SOL 0.25% OP 4

OPHTHALMIC, BETA-BLOCKERS: SELECTIVE betaxolol hcl ophth soln 0.5% 2

BETOPTIC-S SUS 0.25% OP 3

OPHTHALMIC, CARBONIC ANHYDRASE INHIBITOR/BETA-BLOCKER

COMBINATIONS COSOPT PF SOL 4

dorzolamide hcl-timolol maleate ophth soln 22.3-6.8 mg/ml

2

OPHTHALMIC, CARBONIC ANHYDRASE

INHIBITOR/SYMPATHOMIMETIC COMBINATIONS SIMBRINZA SUS 1-0.2% 3

OPHTHALMIC, CARBONIC ANHYDRASE INHIBITORS: TOPICAL AZOPT SUS 1% OP 3

dorzolamide hcl ophth soln 2% 2

OPHTHALMIC, DIAGNOSTIC PRODUCTS fluorescein sodium ophth strips 1 mg 4

fluorescein w/ benoxinate ophth soln 0.25-0.4%

2

OPHTHALMIC, DRY EYE DISEASE RESTASIS EMU 0.05% 3 QL

OPHTHALMIC, MISCELLANEOUS AMVISC INJ 12MG/ML 4

AMVISC PLUS INJ 16MG/ML 4

CYSTARAN SOL 0.44% 5 PA; QL

EYLEA INJ 2/0.05ML 5 PA

LACRISERT MIS 5MG OP 4

LUCENTIS SOL 0.3MG 5 PA

LUCENTIS SOL 0.5MG 5 PA

MACUGEN INJ 5

MEMBRANEBLUE SOL 0.15% 4

phenylephrine hcl ophth soln 2.5% 2

phenylephrine hcl ophth soln 10% 2

PROVISC INJ 1% 4

RHOPRESSA SOL 0.02% 4 ST

tetracaine hcl ophth soln 0.5% 2

tetracaine hcl ophth soln 0.5% 4

VISUDYNE INJ 15MG 5



OPHTHALMIC, MYDRIATICS ATROPINE SUL OIN 1% OP 2

atropine sulfate ophth soln 1% 2

CYCLOMYDRIL SOL OP 3

cyclopentolate hcl ophth soln 0.5% 2

cyclopentolate hcl ophth soln 1% 2

cyclopentolate hcl ophth soln 2% 2

homatropine hbr ophth soln 5% 2

tropicamide ophth soln 0.5% 2

tropicamide ophth soln 1% 2

OPHTHALMIC, PARASYMPATHOMIMETICS MIOSTAT INJ 0.01% OP 4

pilocarpine hcl ophth soln 1% 2

pilocarpine hcl ophth soln 4% 2

OPHTHALMIC, PROSTAGLANDINS bimatoprost ophth soln 0.03% 2 ST

latanoprost ophth soln 0.005% 2

LUMIGAN SOL 0.01% 3

TRAVATAN Z DRO 0.004% 4 ST

ZIOPTAN DRO 0.0015% 4 ST

OPHTHALMIC, SYMPATHOMIMETIC/BETA-BLOCKER COMBINATIONS COMBIGAN SOL 0.2/0.5% 3

OPHTHALMIC, SYMPATHOMIMETICS ALPHAGAN P SOL 0.1% 3

brimonidine tartrate ophth soln 0.2% 2

brimonidine tartrate ophth soln 0.15% 2

PHOSPHOLINE SOL 0.125%OP 4

OTIC, ANTI-INFECTIVE/ANTI-INFLAMMATORY COMBINATIONS CIPRO HC SUS OTIC 3

CIPRODEX SUS 0.3-0.1% 3

neomycin-polymyxin-hc otic soln 1% 2

neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000 unit/ml-1%

2

OTIC, ANTI-INFECTIVES acetic acid otic soln 2% 2

CETRAXAL SOL 0.2% 4

ciprofloxacin hcl otic soln 0.2% (base equivalent)

2

ofloxacin otic soln 0.3% 2

OTIC, MISCELLANEOUS DERMOTIC OIL 0.01% 4

fluocinolone acetonide (otic) oil 0.01% 2

109

Index 1 1ST TIER UNI MIS 29GX12MM ............ 65

A abacavir sulfate tab 300 mg (base equiv)

...................................................... 12 abacavir sulfate-lamivudine tab 600-300

mg .................................................. 10

abacavir sulfate-lamivudine-zidovudine tab 300-150-300 mg ......................... 10

ABILIFY MAIN INJ 300MG .................. 49 ABILIFY MAIN INJ 400MG .................. 49

abiraterone acetate tab 250 mg .......... 17 ABRAXANE INJ 100MG ....................... 20

ABSTRAL SUB 100MCG ....................... 3 ABSTRAL SUB 200MCG ....................... 3



acamprosate calcium tab delayed release 333 mg ........................................... 59

acarbose tab 100 mg ......................... 61

acarbose tab 25 mg .......................... 61 acarbose tab 50 mg .......................... 61

ACD FORMULA SOL A ........................ 84 acebutolol hcl cap 200 mg ................. 30

acebutolol hcl cap 400 mg ................. 30 acetaminophen w/ codeine soln 120-12

mg/5ml ............................................ 3 acetaminophen w/ codeine tab 300-15

mg ................................................... 3 acetaminophen w/ codeine tab 300-30

mg ................................................... 3 acetaminophen w/ codeine tab 300-60

mg ................................................... 3 acetazolamide cap er 12hr 500 mg ..... 34

acetazolamide sodium for inj 500 mg .. 34

acetazolamide tab 125 mg ................. 34 acetazolamide tab 250 mg ................. 34

acetic acid irrigation soln 0.25% ......... 80 acetic acid otic soln 2% ................... 108

acetic acid-oxyquinoline vaginal gel 0.9-0.025% ..................................... 80

acetylcysteine inhal soln 10% ............. 96 acetylcysteine inhal soln 20% ............. 96

acetylcysteine inj 200 mg/ml .............. 65 acitretin cap 10 mg ......................... 100

acitretin cap 17.5 mg ...................... 100 ACTIMMUNE INJ 2MU/0.5 .................. 87

ACTIVASE INJ 100MG ....................... 84 ACTIVASE INJ 50MG ......................... 84

ACTIVE FE TAB 75-1.25 .................... 89 ACUVAIL SOL 0.45% ...................... 105

acyclovir cap 200 mg ........................ 13

acyclovir oint 5% ........................... 103 acyclovir susp 200 mg/5ml ................ 13

acyclovir tab 400 mg ........................ 13 acyclovir tab 800 mg ........................ 13

ACZONE GEL 5% .............................. 98 ACZONE GEL 7.5% ........................... 98

ADAGEN INJ 250/ML ......................... 71 adapalene cream 0.1% ..................... 98

adapalene gel 0.3% .......................... 98 ADCETRIS INJ 50MG ......................... 20

ADDERALL TAB 10MG ....................... 52 ADDERALL TAB 12.5MG .................... 52

ADDERALL TAB 15MG ....................... 52 ADDERALL TAB 20MG ....................... 52

ADDERALL TAB 30MG ....................... 52

ADDERALL TAB 5MG ......................... 52 ADDERALL TAB 7.5MG ...................... 52

ADEMPAS TAB 0.5MG ....................... 38 ADEMPAS TAB 1.5MG ....................... 38

ADEMPAS TAB 1MG .......................... 38 ADEMPAS TAB 2.5MG ....................... 38

ADEMPAS TAB 2MG .......................... 38 adenosine iv soln 12 mg/4ml ............. 27

adenosine iv soln 6 mg/2ml ............... 27 ADRENALIN INJ 1MG/ML ................... 93

ADRENALIN INJ 30/30ML .................. 93 ADRENALIN SOL 1:1000 ................... 98

ADVAIR DISKU AER 100/50 ............... 98 ADVAIR DISKU AER 250/50 ............... 98

ADVAIR DISKU AER 500/50 ............... 98

ADVAIR HFA AER 115/21 .................. 98 ADVAIR HFA AER 230/21 .................. 98

ADVAIR HFA AER 45/21 .................... 98 AEROCHAMBER MIS PLUS ................. 96

AFINITOR DIS TAB 2MG .................... 18 AFINITOR DIS TAB 3MG .................... 18

AFINITOR DIS TAB 5MG .................... 18 AFINITOR TAB 10MG ........................ 18

AFINITOR TAB 2.5MG ....................... 18 AFINITOR TAB 5MG .......................... 18

110

AFINITOR TAB 7.5MG ........................ 18

AGGRENOX CAP 25-200MG ................ 84 AIMOVIG INJ 140MG/ML .................... 56

AIMOVIG INJ 70MG/ML ...................... 56 AJOVY INJ 225/1.5 ............................ 56

AKYNZEO CAP 300-0.5 ...................... 75 albendazole tab 200 mg .................... 14

ALBENZA TAB 200MG ........................ 14 albuterol sulfate soln nebu 0.083% (2.5

mg/3ml) .......................................... 95 albuterol sulfate soln nebu 0.5% (5

mg/ml) ............................................ 95 albuterol sulfate soln nebu 0.63 mg/3ml

(base equiv) ..................................... 95 albuterol sulfate soln nebu 1.25 mg/3ml

(base equiv) ..................................... 95

albuterol sulfate syrup 2 mg/5ml ........ 96 albuterol sulfate tab 2 mg .................. 96

albuterol sulfate tab 4 mg .................. 96 albuterol sulfate tab er 12hr 4 mg ....... 96

albuterol sulfate tab er 12hr 8 mg ....... 96 alclometasone dipropionate cream 0.05%

.................................................... 101 alclometasone dipropionate oint 0.05%

.................................................... 101 ALDACTAZIDE TAB 50/50 .................. 34

ALDURAZYME INJ 2.9MG/5M .............. 71 ALECENSA CAP 150MG ...................... 18

alendronate sodium oral soln 70 mg/75ml ......................................... 65

alendronate sodium tab 10 mg ........... 65

alendronate sodium tab 35 mg ........... 65 alendronate sodium tab 40 mg ........... 65

alendronate sodium tab 5 mg ............. 65 alendronate sodium tab 70 mg ........... 65

ALFERON N INJ 5MU/ML .................... 87 alfuzosin hcl tab er 24hr 10 mg .......... 80

ALIMTA INJ 100MG ........................... 16 ALIMTA INJ 500MG ........................... 16

ALINIA SUS 100/5ML ........................ 14 ALINIA TAB 500MG ........................... 14

ALKERAN INJ 50MG ........................... 15 ALKERAN TAB 2MG ........................... 15

allopurinol tab 100 mg........................ 1 allopurinol tab 300 mg........................ 1

almotriptan malate tab 12.5 mg ......... 56

almotriptan malate tab 6.25 mg ......... 56 ALOCRIL SOL 2% ............................ 106

ALOMIDE SOL 0.1% OP................... 106

ALORA DIS 0.025MG ........................ 67 ALORA DIS 0.05MG .......................... 67

ALORA DIS 0.075MG ........................ 67 ALORA DIS 0.1MG ............................ 67

alosetron hcl tab 0.5 mg (base equiv) . 78 alosetron hcl tab 1 mg (base equiv) ... 78

ALOXI INJ 0.25MG/5......................... 75 ALPHAGAN P SOL 0.1%................... 108

ALPRAZOLAM CON 1 MG/ML .............. 38 alprazolam orally disintegrating tab 0.25

mg ................................................. 38 alprazolam orally disintegrating tab 0.5

mg ................................................. 38 alprazolam orally disintegrating tab 1 mg

...................................................... 38

alprazolam orally disintegrating tab 2 mg...................................................... 38

alprazolam tab 0.25 mg .................... 38 alprazolam tab 0.5 mg ...................... 38

alprazolam tab 1 mg ......................... 38 alprazolam tab 2 mg ......................... 38

alprazolam tab er 24hr 0.5 mg ........... 38 alprazolam tab er 24hr 1 mg ............. 38

alprazolam tab er 24hr 2 mg ............. 38 alprazolam tab er 24hr 3 mg ............. 38

ALREX SUS 0.2% ........................... 106 ALTABAX OIN 1% ............................. 99

ALUNBRIG PAK ................................ 18 ALUNBRIG TAB 180MG ...................... 18

ALUNBRIG TAB 30MG ....................... 18

ALUNBRIG TAB 90MG ....................... 18 amantadine hcl cap 100 mg ............... 47

amantadine hcl syrup 50 mg/5ml ....... 47 amantadine hcl tab 100 mg ............... 47

amcinonide cream 0.1% ................. 101 amcinonide lotion 0.1% .................. 101

AMCINONIDE OIN 0.1% .................. 101 amiloride & hydrochlorothiazide tab 5-50

mg ................................................. 34 amiloride hcl tab 5 mg ...................... 34

aminocaproic acid inj 250 mg/ml ........ 83 amiodarone hcl tab 100 mg ............... 27

amiodarone hcl tab 200 mg ............... 27 amiodarone hcl tab 400 mg ............... 27

AMITIZA CAP 24MCG ........................ 78

AMITIZA CAP 8MCG .......................... 78 amitriptyline hcl tab 10 mg ................ 46

111

amitriptyline hcl tab 100 mg .............. 46

amitriptyline hcl tab 150 mg .............. 46 amitriptyline hcl tab 25 mg ................ 46

amitriptyline hcl tab 50 mg ................ 46 amitriptyline hcl tab 75 mg ................ 46

amlodipine besylate tab 10 mg (base equivalent) ...................................... 31

amlodipine besylate tab 2.5 mg (base equivalent) ...................................... 31

amlodipine besylate tab 5 mg (base equivalent) ...................................... 31

amlodipine besylate-benazepril hcl cap 10-20 mg ........................................ 23

amlodipine besylate-benazepril hcl cap 10-40 mg ........................................ 23


2.5-10 mg ....................................... 23 amlodipine besylate-benazepril hcl cap

5-10 mg .......................................... 23 amlodipine besylate-benazepril hcl cap

5-20 mg .......................................... 23 amlodipine besylate-benazepril hcl cap

5-40 mg .......................................... 23 amoxapine tab 100 mg ...................... 46

amoxapine tab 150 mg ...................... 46 amoxapine tab 25 mg ........................ 46

amoxapine tab 50 mg ........................ 46 amoxicillin & k clavulanate chew tab

200-28.5 mg ..................................... 7 amoxicillin & k clavulanate chew tab

400-57 mg ........................................ 7

amoxicillin & k clavulanate for susp 200-28.5 mg/5ml .............................. 8


amoxicillin & k clavulanate for susp 400-57 mg/5ml ................................. 8


amoxicillin & k clavulanate tab 250-125 mg ................................................... 8



amoxicillin & k clavulanate tab er 12hr

1000-62.5 mg ................................... 8 amoxicillin (trihydrate) cap 250 mg ...... 8

amoxicillin (trihydrate) cap 500 mg ...... 8

amoxicillin (trihydrate) chew tab 125 mg........................................................ 8

amoxicillin (trihydrate) chew tab 250 mg........................................................ 8

amoxicillin (trihydrate) for susp 125 mg/5ml ............................................. 8




amoxicillin (trihydrate) tab 500 mg ...... 8 amoxicillin (trihydrate) tab 875 mg ...... 8

amoxicillin cap-clarithro tab-lansopraz

cap dr therapy pack .......................... 80 amphetamine-dextroamphetamine cap er

24hr 10 mg ..................................... 52 amphetamine-dextroamphetamine cap er





24hr 5 mg ....................................... 52 amphetamine-dextroamphetamine tab

10 mg ............................................. 52

amphetamine-dextroamphetamine tab 12.5 mg .......................................... 52

amphetamine-dextroamphetamine tab 15 mg ............................................. 52



amphetamine-dextroamphetamine tab 5 mg ................................................. 52

amphetamine-dextroamphetamine tab 7.5 mg ............................................ 52

ampicillin cap 500 mg ......................... 8 AMPYRA TAB 10MG ........................... 57

AMVISC INJ 12MG/ML ..................... 107

AMVISC PLUS INJ 16MG/ML ............. 107 AMYTAL SOD INJ 500MG ................... 56

112

ANACAINE OIN ............................... 102

anagrelide hcl cap 0.5 mg .................. 85 anagrelide hcl cap 1 mg ..................... 85

anastrozole tab 1 mg ........................ 17 ANDRODERM DIS 2MG/24HR .............. 60

ANDRODERM DIS 4MG/24HR .............. 60 ANDROGEL GEL 1.62% ...................... 60

ANDROGEL GEL PUMP 1% .................. 60 ANECTINE INJ 20MG/ML .................... 59

ANGELIQ TAB 0.5-1MG ...................... 66 ANIMI-3 CAP .................................... 89

ANIMI-3 CAP VIT D ........................... 89 ANORO ELLIPT AER 62.5-25 ............... 94

ANTICOAG CIT SOL DEX SOL ............. 84 ANTICOAG CPD SOL .......................... 84

APOKYN INJ 10MG/ML ....................... 47

aprepitant capsule 125 mg ................. 75 aprepitant capsule 40 mg .................. 75

aprepitant capsule 80 mg .................. 75 aprepitant capsule therapy pack 80 &

125 mg ........................................... 75 APRISO CAP 0.375GM ....................... 77

APTIOM TAB 200MG .......................... 39 APTIOM TAB 400MG .......................... 39

APTIOM TAB 600MG .......................... 39 APTIOM TAB 800MG .......................... 39

APTIVUS CAP 250MG ......................... 10 APTIVUS SOL ................................... 10

AQUASOL A INJ 50000/ML ................. 89 AQUORAL SPR ................................ 104

ARALAST NP INJ 500MG .................... 97

ARANESP INJ 100MCG ....................... 83 ARANESP INJ 10MCG ......................... 83

ARANESP INJ 150MCG ....................... 83 ARANESP INJ 200MCG ....................... 83

ARANESP INJ 25MCG ......................... 83 ARANESP INJ 300MCG ....................... 83

ARANESP INJ 40MCG ......................... 83 ARANESP INJ 500MCG ....................... 83

ARANESP INJ 60MCG ......................... 83 ARCALYST INJ 220MG ....................... 87

ARCAPTA CAP 75MCG ........................ 95 argatroban inj 250 mg/2.5ml

(concentrate for iv infusion) ............... 81 ARGATROBAN INJ 50MG/50M ............. 81

aripiprazole oral solution 1 mg/ml ....... 49

aripiprazole orally disintegrating tab 10 mg .................................................. 49

aripiprazole orally disintegrating tab 15

mg ................................................. 49 aripiprazole tab 10 mg ...................... 49

aripiprazole tab 15 mg ...................... 49 aripiprazole tab 2 mg ........................ 49

aripiprazole tab 20 mg ...................... 49 aripiprazole tab 30 mg ...................... 49

aripiprazole tab 5 mg ........................ 49 ARISTADA INJ 1064MG ..................... 49

ARISTADA INJ 441MG/1. ................... 49 ARISTADA INJ 662MG/2 .................... 49

ARISTADA INJ 882MG/3 .................... 49 armodafinil tab 150 mg ..................... 59

armodafinil tab 200 mg ..................... 59 armodafinil tab 250 mg ..................... 59

armodafinil tab 50 mg ...................... 59

ARNUITY ELPT INH 100MCG .............. 97 ARNUITY ELPT INH 200MCG .............. 97

ARRANON INJ 5MG/ML ...................... 20 ARZOL SILVER MIS NITR APP .......... 103

ASACOL HD TAB 800MG .................... 77 ASMANEX 120 AER 220MCG .............. 97

ASMANEX 30 AER 110MCG ................ 97 ASMANEX HFA AER 100 MCG ............. 97

ASMANEX HFA AER 200 MCG ............. 97 aspirin-dipyridamole cap er 12hr 25-200

mg ................................................. 84 ATABEX EC TAB 29-1MG ................... 91

atazanavir sulfate cap 150 mg (base equiv) ............................................. 11

atazanavir sulfate cap 200 mg (base

equiv) ............................................. 11 atazanavir sulfate cap 300 mg (base

equiv) ............................................. 11 atenolol & chlorthalidone tab 100-25 mg

...................................................... 30 atenolol & chlorthalidone tab 50-25 mg

...................................................... 30 atenolol tab 100 mg ......................... 30

atenolol tab 25 mg ........................... 30 atenolol tab 50 mg ........................... 30

ATGAM INJ 250MG ........................... 86 atomoxetine hcl cap 10 mg (base equiv)

...................................................... 53 atomoxetine hcl cap 100 mg (base

equiv) ............................................. 53

atomoxetine hcl cap 18 mg (base equiv)...................................................... 53

113

atomoxetine hcl cap 25 mg (base equiv)

...................................................... 53 atomoxetine hcl cap 40 mg (base equiv)



...................................................... 53 atorvastatin calcium tab 10 mg (base

equivalent) ...................................... 28 atorvastatin calcium tab 20 mg (base



equivalent) ...................................... 29

atovaquone susp 750 mg/5ml ............ 14 ATRIPLA TAB .................................... 10

ATROPINE SUL OIN 1% OP .............. 108 atropine sulfate inj 0.4 mg/ml ............ 35

atropine sulfate inj 1 mg/ml ............... 35 atropine sulfate ophth soln 1% ......... 108

atropine sulfate soln prefill syr 0.25 mg/5ml (0.05 mg/ml) ....................... 35

atropine sulfate soln prefill syr 0.5 mg/5ml (0.1 mg/ml) ......................... 35

ATROVENT HFA AER 17MCG ............... 94 AUBAGIO TAB 14MG ......................... 57

AUBAGIO TAB 7MG ........................... 57 AURYXIA TAB 210MG ........................ 73

AUTOPEN MIS 1 UNIT ........................ 64

AUTOPEN MIS 1-21UNIT .................... 64 AUTOPEN MIS 2 UNIT ........................ 64

AUTOPEN MIS 2-32UNIT .................... 64 AUTOPEN MIS 2-42UNIT .................... 64

AUTOSHIELD MIS 29X3/16 ................ 64 AVASTIN INJ .................................... 20

AVASTIN INJ 400/16ML ..................... 20 AVEED INJ 750/3ML .......................... 60

AVELOX TAB 400MG ........................... 7 AVITENE PAD 35X35MM ..................... 83

AVITENE POW FLOUR ........................ 83 AVITENE SYRG MIS 1GM .................... 83

AVO CREAM EMU ............................ 103 AVONEX KIT 30MCG .......................... 57

AVONEX PEN KIT 30MCG ................... 57

AVONEX PREFL KIT 30MCG ................ 57 AZASITE SOL 1% ............................ 105

azathioprine tab 50 mg ..................... 87

azelastine hcl nasal spray 0.1% (137 mcg/spray) ..................................... 97

azelastine hcl nasal spray 0.15% (205.5 mcg/spray) ..................................... 97

azelastine hcl ophth soln 0.05% ....... 106 AZELEX CRE 20% ............................. 99

azithromycin for susp 100 mg/5ml ....... 7 azithromycin for susp 200 mg/5ml ....... 7

azithromycin tab 250 mg .................... 7 azithromycin tab 500 mg .................... 7

azithromycin tab 600 mg .................... 7 AZOPT SUS 1% OP ......................... 107

B bacitracin ophth oint 500 unit/gm .... 105

bacitracin-polymyxin b ophth oint .... 105

bacitracin-polymyxin-neomycin-hc ophth oint 1% ........................................ 104

baclofen tab 10 mg .......................... 58 baclofen tab 20 mg .......................... 58

BACTROBAN OIN NASAL 2% .............. 99 balsalazide disodium cap 750 mg ....... 77

BANZEL SUS 40MG/ML ..................... 39 BANZEL TAB 200MG ......................... 39

BANZEL TAB 400MG ......................... 39 BARACLUDE SOL .05MG/ML ............... 13

BARACLUDE TAB 0.5MG .................... 13 BARACLUDE TAB 1MG ....................... 13

BCG VACCINE INJ ............................ 88 b-complex w/ c & folic acid cap 1 mg .. 89

b-complex w/ c & folic acid tab 1 mg .. 89

BD PEN MINI MIS ............................. 64 BD PEN NEEDL MIS 29GX12.7 ........... 64

BD PEN NEEDL MIS 31GX5MM ........... 64 BD PEN NEEDL MIS 31GX8MM ........... 64

BD PEN NEEDL MIS 32GX4MM ........... 64 BELLA/OPIUM SUP 16.2-30................ 77

benazepril & hydrochlorothiazide tab 10-12.5 mg ..................................... 23

benazepril & hydrochlorothiazide tab 20-12.5 mg ..................................... 23

benazepril & hydrochlorothiazide tab 20-25 mg ........................................ 23

benazepril & hydrochlorothiazide tab 5-6.25 mg ....................................... 23

benazepril hcl tab 10 mg ................... 24

benazepril hcl tab 20 mg ................... 24 benazepril hcl tab 40 mg ................... 24

114

benazepril hcl tab 5 mg ..................... 24

BENDEKA INJ 100/4ML ...................... 15 BENLYSTA INJ 120MG ....................... 88

BENLYSTA INJ 400MG ....................... 88 benzonatate cap 100 mg ................... 95

benzonatate cap 200 mg ................... 95 benzoyl peroxide-erythromycin gel 5-3%

...................................................... 99 benztropine mesylate inj 1 mg/ml ....... 47

benztropine mesylate tab 0.5 mg ........ 47 benztropine mesylate tab 1 mg .......... 47

benztropine mesylate tab 2 mg .......... 47 BEPREVE DRO 1.5% ........................ 106

BERINERT INJ 500UNIT ..................... 83 BESIVANCE SUS 0.6% ..................... 105

BETADINE SOL 5% OP ..................... 105

betamethasone dipropionate augmented cream 0.05% ................................. 101

betamethasone dipropionate augmented gel 0.05% ...................................... 102

betamethasone dipropionate augmented lotion 0.05% .................................. 101

betamethasone dipropionate augmented oint 0.05% ..................................... 102

betamethasone dipropionate cream 0.05% ........................................... 101

betamethasone dipropionate lotion 0.05% ........................................... 101

betamethasone valerate cream 0.1% (base equivalent) ............................ 101

betamethasone valerate lotion 0.1%

(base equivalent) ............................ 101 betamethasone valerate oint 0.1% (base

equivalent) .................................... 101 BETASERON INJ 0.3MG ...................... 57

betaxolol hcl ophth soln 0.5% .......... 107 betaxolol hcl tab 10 mg ..................... 30

betaxolol hcl tab 20 mg ..................... 30 bethanechol chloride tab 10 mg .......... 80

bethanechol chloride tab 25 mg .......... 80 bethanechol chloride tab 5 mg ............ 80

bethanechol chloride tab 50 mg .......... 80 BETHKIS NEB 300/4ML ...................... 96

BETIMOL SOL 0.25% ....................... 106 BETIMOL SOL 0.5% ........................ 106

BETOPTIC-S SUS 0.25% OP ............. 107

bexarotene cap 75 mg ....................... 20 BIAFINE EMU ................................. 103

bicalutamide tab 50 mg .................... 17

BICNU INJ 100MG ............................ 15 BIKTARVY TAB ................................. 10

BILTRICIDE TAB 600MG .................... 14 bimatoprost ophth soln 0.03% ......... 108

BIOTENE DRY SPR MOIST ............... 104 BIOTENE SPR MOUTH ..................... 104

bisoprolol & hydrochlorothiazide tab 10-6.25 mg ..................................... 30

bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg .................................... 30

bisoprolol & hydrochlorothiazide tab 5-6.25 mg ....................................... 30

bisoprolol fumarate tab 10 mg ........... 30 bisoprolol fumarate tab 5 mg ............. 30

bleomycin sulfate for inj 15 unit ......... 20

bleomycin sulfate for inj 30 unit ......... 20 BLEPHAMIDE OIN S.O.P. ................. 104

BLEPHAMIDE SUS OP ...................... 104 BONIVA INJ 3MG/3ML ....................... 65

BONIVA TAB 150MG ......................... 65 BOSULIF TAB 100MG ........................ 18

BOSULIF TAB 500MG ........................ 18 BOTOX INJ 100UNIT ......................... 57

BOTOX INJ 200UNIT ......................... 57 BP VIT 3 CAP ................................... 89

BRAFTOVI CAP 50MG ........................ 18 BRAFTOVI CAP 75MG ........................ 18

BREO ELLIPTA INH 100-25 ................ 98 BREO ELLIPTA INH 200-25 ................ 98

BRILINTA TAB 60MG ......................... 84

BRILINTA TAB 90MG ......................... 84 brimonidine tartrate ophth soln 0.15%

.................................................... 108 brimonidine tartrate ophth soln 0.2% 108

BRIVIACT INJ 50MG/5ML .................. 39 BRIVIACT SOL 10MG/ML ................... 39

BRIVIACT TAB 100MG ....................... 40 BRIVIACT TAB 10MG ........................ 40

BRIVIACT TAB 25MG ........................ 40 BRIVIACT TAB 50MG ........................ 40

BRIVIACT TAB 75MG ........................ 40 bromfenac sodium ophth soln 0.09%

(base equiv) (once-daily) ................ 105 bromocriptine mesylate cap 5 mg (base

equivalent) ...................................... 47

bromocriptine mesylate tab 2.5 mg (base equivalent) ...................................... 47

115

BROVANA NEB 15MCG ....................... 95

BUCALSEP SOL ............................... 103 BUCALSEP SPR ............................... 103

budesonide delayed release particles cap 3 mg ............................................... 77

budesonide inhalation susp 0.25 mg/2ml ...................................................... 97

budesonide inhalation susp 0.5 mg/2ml ...................................................... 97

budesonide inhalation susp 1 mg/2ml .. 97 bumetanide inj 0.25 mg/ml ................ 34

bumetanide tab 0.5 mg ..................... 34 bumetanide tab 1 mg ........................ 34

bumetanide tab 2 mg ........................ 34 BUNAVAIL MIS 2.1-0.3 ...................... 59

BUNAVAIL MIS 4.2-0.7 ...................... 60

BUNAVAIL MIS 6.3-1MG .................... 60 BUPHENYL POW ................................ 78

BUPHENYL TAB 500MG ...................... 78 buprenorphine hcl sl tab 2 mg (base

equiv) ............................................. 60 buprenorphine hcl sl tab 8 mg (base

equiv) ............................................. 60 buprenorphine hcl-naloxone hcl sl film

12-3 mg (base equiv) ........................ 60 buprenorphine hcl-naloxone hcl sl film

2-0.5 mg (base equiv) ....................... 60 buprenorphine hcl-naloxone hcl sl film

4-1 mg (base equiv) ......................... 60 buprenorphine hcl-naloxone hcl sl film

8-2 mg (base equiv) ......................... 60

buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg (base equiv) ....................... 60

buprenorphine hcl-naloxone hcl sl tab 8-2 mg (base equiv) ......................... 60

bupropion hcl (smoking deterrent) tab er 12hr 150 mg .................................... 60

bupropion hcl tab 100 mg .................. 43 bupropion hcl tab 75 mg .................... 43

bupropion hcl tab er 12hr 100 mg ....... 43 bupropion hcl tab er 12hr 150 mg ....... 43

bupropion hcl tab er 12hr 200 mg ....... 43 bupropion hcl tab er 24hr 150 mg ....... 43

bupropion hcl tab er 24hr 300 mg ....... 43 buspirone hcl tab 10 mg .................... 39

buspirone hcl tab 15 mg .................... 39

buspirone hcl tab 30 mg .................... 39 buspirone hcl tab 5 mg ...................... 39

buspirone hcl tab 7.5 mg .................. 39

busulfan inj 6 mg/ml ........................ 15 BUSULFEX INJ 6MG/ML ..................... 15

butalbital-acetaminophen tab 50-325 mg........................................................ 1

butalbital-acetaminophen-caff w/ cod cap 50-325-40-30 mg .............................. 3

butalbital-acetaminophen-caffeine cap 50-325-40 mg ................................... 1

butalbital-acetaminophen-caffeine tab 50-325-40 mg ................................... 1

butalbital-aspirin-caff w/ codeine cap 50-325-40-30 mg .............................. 3

butalbital-aspirin-caffeine cap 50-325-40 mg ................................................... 1

butorphanol tartrate nasal soln 10 mg/ml

........................................................ 3 BUTRANS DIS 10MCG/HR .................... 3

BUTRANS DIS 15MCG/HR .................... 3 BUTRANS DIS 20MCG/HR .................... 3

BUTRANS DIS 5MCG/HR ..................... 3 BUTRANS DIS 7.5/HR ......................... 3

BYSTOLIC TAB 10MG ........................ 30 BYSTOLIC TAB 2.5MG ....................... 30

BYSTOLIC TAB 20MG ........................ 30 BYSTOLIC TAB 5MG .......................... 30

C cabergoline tab 0.5 mg ..................... 71

CABOMETYX TAB 20MG ..................... 18 CABOMETYX TAB 40MG ..................... 18

CABOMETYX TAB 60MG ..................... 18

caffeine & sodium benzoate inj 125-125 mg/ml (500 mg/2ml) ........................ 57

calcipotriene cream 0.005% ............ 100 calcipotriene oint 0.005% ................ 100

calcipotriene soln 0.005% (50 mcg/ml).................................................... 100

calcitonin (salmon) nasal soln 200 unit/act ........................................... 66

calcitriol cap 0.25 mcg ...................... 71 calcitriol cap 0.5 mcg ........................ 71

calcitriol inj 1 mcg/ml ....................... 71 calcitriol oint 3 mcg/gm .................. 100

calcitriol oral soln 1 mcg/ml ............... 71 calcium acetate (phosphate binder) cap

667 mg (169 mg ca)......................... 73

calcium acetate (phosphate binder) tab 667 mg ........................................... 73

116

CALCIUM-FA WAF PLUS D .................. 89

CALQUENCE CAP 100MG .................... 18 CAMPTOSAR INJ 300/15ML ................ 22

CANASA SUP 1000MG ....................... 77 candesartan cilexetil tab 16 mg .......... 26

candesartan cilexetil tab 32 mg .......... 26 candesartan cilexetil tab 4 mg ............ 26

candesartan cilexetil tab 8 mg ............ 26 candesartan cilexetil-hydrochlorothiazide

tab 16-12.5 mg ................................ 26 candesartan cilexetil-hydrochlorothiazide

tab 32-12.5 mg ................................ 26 candesartan cilexetil-hydrochlorothiazide

tab 32-25 mg ................................... 26 CAPCOF SYP 5-2-10MG ...................... 95

capecitabine tab 150 mg .................... 16

capecitabine tab 500 mg .................... 16 CAPHOSOL SOL .............................. 104

CAPRELSA TAB 100MG ...................... 18 CAPRELSA TAB 300MG ...................... 18

captopril & hydrochlorothiazide tab 25-15 mg .................................................. 23




captopril tab 100 mg ......................... 24 captopril tab 12.5 mg ........................ 24

captopril tab 25 mg ........................... 24

captopril tab 50 mg ........................... 24 CARAFATE SUS 1GM/10ML ................. 78

CARBAGLU TAB 200MG ...................... 71 carbamazepine cap er 12hr 100 mg .... 40

carbamazepine cap er 12hr 200 mg .... 40 carbamazepine cap er 12hr 300 mg .... 40

carbamazepine chew tab 100 mg ........ 40 carbamazepine susp 100 mg/5ml ........ 40

carbamazepine tab 200 mg ................ 40 carbamazepine tab er 12hr 100 mg ..... 40

carbamazepine tab er 12hr 200 mg ..... 40 carbamazepine tab er 12hr 400 mg ..... 40

CARBATROL CAP 100MG .................... 40 CARBATROL CAP 200MG .................... 40

CARBATROL CAP 300MG .................... 40

carbidopa & levodopa orally disintegrating tab 10-100 mg ............. 47

carbidopa & levodopa orally

disintegrating tab 25-100 mg ............ 47 carbidopa & levodopa orally

disintegrating tab 25-250 mg ............ 47 carbidopa & levodopa tab 10-100 mg . 47

carbidopa & levodopa tab 25-100 mg . 47 carbidopa & levodopa tab 25-250 mg . 47

carbidopa & levodopa tab er 25-100 mg...................................................... 47

carbidopa & levodopa tab er 50-200 mg...................................................... 47

carbidopa tab 25 mg......................... 47 carbidopa-levodopa-entacapone tabs

12.5-50-200 mg .............................. 47 carbidopa-levodopa-entacapone tabs

18.75-75-200 mg ............................. 47

carbidopa-levodopa-entacapone tabs 25-100-200 mg ............................... 47

carbidopa-levodopa-entacapone tabs 31.25-125-200 mg ........................... 47

carbidopa-levodopa-entacapone tabs 37.5-150-200 mg ............................. 47

carbidopa-levodopa-entacapone tabs 50-200-200 mg ............................... 48

carbinoxamine maleate soln 4 mg/5ml 94 carbinoxamine maleate tab 4 mg ....... 94

carboplatin iv soln 150 mg/15ml ........ 15 carboplatin iv soln 450 mg/45ml ........ 15

carboplatin iv soln 50 mg/5ml ............ 15 carboplatin iv soln 600 mg/60ml ........ 15

CARDIOTEK-RX TAB ......................... 88

CARDIZEM LA TAB 120MG ................. 32 CARDURA XL TAB 4MG ...................... 80

CARDURA XL TAB 8MG ...................... 80 CARIMUNE NF INJ 12GM ................... 86

CARIMUNE NF INJ 6GM ..................... 86 carisoprodol tab 250 mg ................... 58

carisoprodol tab 350 mg ................... 58 carisoprodol w/ aspirin & codeine tab

200-325-16 mg ............................... 58 carisoprodol w/ aspirin tab 200-325 mg

...................................................... 58 carteolol hcl ophth soln 1% ............. 106

carvedilol tab 12.5 mg ...................... 30 carvedilol tab 25 mg ......................... 30

carvedilol tab 3.125 mg .................... 30

carvedilol tab 6.25 mg ...................... 30 CATHFLO ACTI INJ VASE ................... 84

117

CAYSTON INH 75MG ......................... 96

cefaclor cap 250 mg ........................... 6 cefaclor cap 500 mg ........................... 6

CEFACLOR ER TAB 500MG .................. 6 cefaclor for susp 125 mg/5ml .............. 6

cefaclor for susp 250 mg/5ml .............. 6 cefaclor for susp 375 mg/5ml .............. 6

cefadroxil cap 500 mg ........................ 6 cefadroxil for susp 250 mg/5ml ........... 6

cefadroxil for susp 500 mg/5ml ........... 6 cefadroxil tab 1 gm ............................ 6

cefdinir cap 300 mg ........................... 6 cefdinir for susp 125 mg/5ml ............... 6

cefdinir for susp 250 mg/5ml ............... 6 cefixime for susp 100 mg/5ml ............. 6

cefixime for susp 200 mg/5ml ............. 6

cefpodoxime proxetil for susp 100 mg/5ml ............................................ 6

cefpodoxime proxetil for susp 50 mg/5ml ....................................................... 6

cefpodoxime proxetil tab 100 mg ......... 6 cefpodoxime proxetil tab 200 mg ......... 6

cefprozil for susp 125 mg/5ml ............. 6 cefprozil for susp 250 mg/5ml ............. 6

cefprozil tab 250 mg .......................... 6 cefprozil tab 500 mg .......................... 6

cefuroxime axetil tab 500 mg .............. 6 celecoxib cap 100 mg ......................... 1

celecoxib cap 200 mg ......................... 1 celecoxib cap 400 mg ......................... 1

celecoxib cap 50 mg ........................... 1

CELLCEPT CAP 250MG ....................... 87 CELLCEPT SUS 200MG/ML .................. 87

CELLCEPT TAB 500MG ....................... 87 CELONTIN CAP 300MG ...................... 40

cephalexin cap 250 mg ....................... 6 cephalexin cap 500 mg ....................... 6

cephalexin cap 750 mg ....................... 6 cephalexin for susp 125 mg/5ml .......... 6

cephalexin for susp 250 mg/5ml .......... 6 cephalexin tab 250 mg ....................... 6

cephalexin tab 500 mg ....................... 6 CEPROTIN INJ 1000UNIT ................... 84

CEREZYME INJ 400UNIT .................... 71 CERVIDIL VAG MIS 10MG INS ............ 71

CESAMET CAP 1MG ........................... 75

CETACAINE AER ............................. 102 CETRAXAL SOL 0.2% ...................... 108

CETYLEV TAB 2.5GM ......................... 65

CETYLEV TAB 500MG ........................ 65 cevimeline hcl cap 30 mg .................. 79

CHEMET CAP 100MG ......................... 84 chlordiazepoxide hcl cap 10 mg ......... 38

chlordiazepoxide hcl cap 25 mg ......... 38 chlordiazepoxide hcl cap 5 mg ........... 38

chlordiazepoxide hcl-clidinium bromide cap 5-2.5 mg ................................... 77

chlordiazepoxide-amitriptyline tab 10-25 mg ................................................. 44

chlordiazepoxide-amitriptyline tab 5-12.5 mg ................................................. 44

chlorhexidine gluconate soln 0.12%.. 104 chlorothiazide sodium for inj 500 mg .. 34

chlorothiazide tab 250 mg ................. 34

chlorothiazide tab 500 mg ................. 34 CHLORPROMAZ INJ 25MG/ML ............ 51

CHLORPROMAZ INJ 50MG/2ML .......... 51 chlorpromazine hcl tab 10 mg ............ 51

chlorpromazine hcl tab 100 mg .......... 51 chlorpromazine hcl tab 200 mg .......... 51

chlorpromazine hcl tab 25 mg ............ 51 chlorpromazine hcl tab 50 mg ............ 51

chlorpropamide tab 100 mg ............... 63 chlorpropamide tab 250 mg ............... 63

chlorthalidone tab 25 mg .................. 34 chlorthalidone tab 50 mg .................. 34

chlorzoxazone tab 500 mg................. 58 cholestyramine light powder 4 gm/dose

...................................................... 28

cholestyramine light powder packets 4 gm ................................................. 28

cholestyramine powder 4 gm/dose ..... 28 cholestyramine powder packets 4 gm . 28

choline & magnesium salicylates liq 500 mg/5ml ............................................. 1

choline fenofibrate cap dr 135 mg (fenofibric acid equiv) ....................... 28

choline fenofibrate cap dr 45 mg (fenofibric acid equiv) ....................... 28

ciclopirox gel 0.77% ......................... 99 ciclopirox olamine cream 0.77% (base

equiv) ............................................. 99 ciclopirox olamine susp 0.77% (base

equiv) ........................................... 100

ciclopirox solution 8% ..................... 100 cilostazol tab 100 mg ........................ 84

118

cilostazol tab 50 mg .......................... 84

CILOXAN OIN 0.3% OP .................... 105 CINQAIR INJ .................................... 97

CINRYZE SOL 500 UNIT ..................... 84 CIPRO (10%) SUS 500MG/5 ................ 7

CIPRO (5%) SUS 250MG/5 ................. 7 CIPRO HC SUS OTIC ....................... 108

CIPRODEX SUS 0.3-0.1% ................ 108 ciprofloxacin hcl ophth soln 0.3% ...... 105

ciprofloxacin hcl otic soln 0.2% (base equivalent) .................................... 108

ciprofloxacin hcl tab 100 mg (base equiv) ....................................................... 7

ciprofloxacin hcl tab 250 mg (base equiv) ....................................................... 7

ciprofloxacin hcl tab 500 mg (base equiv)

....................................................... 7 ciprofloxacin hcl tab 750 mg (base equiv)

....................................................... 7 ciprofloxacin-ciprofloxacin hcl tab er 24hr

1000 mg(base eq) ............................. 7 ciprofloxacin-ciprofloxacin hcl tab er 24hr

500 mg (base eq) .............................. 7 cisplatin inj 100 mg/100ml (1 mg/ml) . 15

cisplatin inj 200 mg/200ml (1 mg/ml) . 15 cisplatin inj 50 mg/50ml (1 mg/ml) ..... 15

citalopram hydrobromide oral soln 10 mg/5ml ........................................... 45

citalopram hydrobromide tab 10 mg (base equiv) ..................................... 45

citalopram hydrobromide tab 20 mg

(base equiv) ..................................... 45 citalopram hydrobromide tab 40 mg

(base equiv) ..................................... 45 CITRANATAL CAP HARMONY ............... 91

CITRANATAL MIS 90 DHA .................. 91 CITRANATAL MIS B-CALM .................. 91

CITRANATAL PAK ASSURE.................. 91 CITRANATAL PAK DHA ....................... 91

CITRANATAL TAB RX ......................... 91 cladribine iv soln 10 mg/10ml (1 mg/ml)

...................................................... 16 clarithromycin for susp 125 mg/5ml ..... 7

clarithromycin for susp 250 mg/5ml ..... 7 clarithromycin tab 250 mg .................. 7

clarithromycin tab 500 mg .................. 7

clarithromycin tab er 24hr 500 mg ....... 7 clemastine fumarate tab 2.68 mg ....... 94

CLEOCIN CAP 150MG ........................ 14

CLEOCIN CAP 300MG ........................ 14 CLEOCIN CAP 75MG ......................... 14

CLEOCIN SUP 100MG ........................ 81 CLEVIPREX EMU 50/100ML ................ 31

CLIMARA PRO DIS WEEKLY ............... 67 clindamycin hcl cap 150 mg ............... 14

clindamycin hcl cap 300 mg ............... 14 clindamycin hcl cap 75 mg ................ 14

clindamycin palmitate hcl for soln 75 mg/5ml (base equiv) ........................ 14

clindamycin phosphate foam 1% ........ 99 clindamycin phosphate gel 1% ........... 99

clindamycin phosphate lotion 1% ....... 99 clindamycin phosphate soln 1% ......... 99

clindamycin phosphate swab 1% ........ 99

clindamycin phosphate vaginal cream 2%...................................................... 81

clobazam suspension 2.5 mg/ml ........ 40 clobazam tab 10 mg ......................... 40

clobazam tab 20 mg ......................... 40 clobetasol propionate cream 0.05% .. 102

clobetasol propionate emollient base cream 0.05% ................................. 102

clobetasol propionate gel 0.05% ...... 102 clobetasol propionate oint 0.05% ..... 102

clobetasol propionate soln 0.05% ..... 102 clomipramine hcl cap 25 mg .............. 39

clomipramine hcl cap 50 mg .............. 39 clomipramine hcl cap 75 mg .............. 39

clonazepam orally disintegrating tab

0.125 mg ........................................ 38 clonazepam orally disintegrating tab 0.25

mg ................................................. 38 clonazepam orally disintegrating tab 0.5

mg ................................................. 38 clonazepam orally disintegrating tab 1

mg ................................................. 38 clonazepam orally disintegrating tab 2

mg ................................................. 38 clonazepam tab 0.5 mg ..................... 39

clonazepam tab 1 mg ....................... 39 clonazepam tab 2 mg ....................... 39

clonidine hcl tab 0.1 mg .................... 25 clonidine hcl tab 0.2 mg .................... 25

clonidine hcl tab 0.3 mg .................... 25

clonidine hcl tab er 12hr 0.1 mg ......... 53 clonidine td patch weekly 0.1 mg/24hr 25

119


clonidine td patch weekly 0.3 mg/24hr 25 clopidogrel bisulfate tab 300 mg (base

equiv) ............................................. 84 clopidogrel bisulfate tab 75 mg (base

equiv) ............................................. 84 clorazepate dipotassium tab 15 mg ..... 39

clorazepate dipotassium tab 3.75 mg .. 39 clorazepate dipotassium tab 7.5 mg .... 39

clotrimazole cream 1% .................... 100 clotrimazole troche 10 mg ................... 9

clotrimazole w/ betamethasone cream 1-0.05% ........................................ 100

clotrimazole w/ betamethasone lotion 1-0.05% ........................................ 100

clozapine orally disintegrating tab 100

mg .................................................. 49 clozapine orally disintegrating tab 12.5

mg .................................................. 49 clozapine orally disintegrating tab 150

mg .................................................. 49 clozapine orally disintegrating tab 200

mg .................................................. 49 clozapine orally disintegrating tab 25 mg

...................................................... 49 clozapine tab 100 mg ........................ 49

clozapine tab 200 mg ........................ 49 clozapine tab 25 mg .......................... 49

clozapine tab 50 mg .......................... 49 C-NATE DHA CAP 28-1-200 ................ 91

COARTEM TAB 20-120MG .................. 10

cocaine hcl soln 4% ........................ 102 codeine sulfate tab 15 mg ................... 3

codeine sulfate tab 30 mg ................... 3 codeine sulfate tab 60 mg ................... 3

COLCRYS TAB 0.6MG.......................... 1 colesevelam hcl tab 625 mg ............... 28

COLESTID GRA 5GM .......................... 28 COLESTID POW 5GM ......................... 28

COLESTID TAB 1GM .......................... 28 colestipol hcl granule packets 5 gm ..... 28

colestipol hcl granules 5 gm ............... 28 colestipol hcl tab 1 gm ....................... 28

COMBIGAN SOL 0.2/0.5% ................ 108 COMBIPATCH DIS .05/.14 .................. 67

COMBIPATCH DIS .05/.25 .................. 67

COMBIVENT AER 20-100 .................... 94 COMETRIQ KIT 100MG ...................... 18

COMETRIQ KIT 140MG ...................... 18

COMETRIQ KIT 60MG ....................... 18 COMPLERA TAB ................................ 10

COMPLETE NAT PAK DHA .................. 91 COMPLETENATE CHW ....................... 91

CONCEPT DHA CAP ........................... 91 CONCEPT OB CAP ............................. 91

CONDYLOX GEL 0.5% ..................... 103 CONTROL KIT MONITOR .................... 64

COPAXONE INJ 20MG/ML .................. 57 COPAXONE INJ 40MG/ML .................. 57

COPIKTRA CAP 15MG ........................ 18 COPIKTRA CAP 25MG ........................ 18

CORLANOR TAB 5MG ........................ 35 CORLANOR TAB 7.5MG ..................... 35

CORTEF TAB 10MG ........................... 68

CORTEF TAB 20MG ........................... 68 CORTEF TAB 5MG ............................. 68

CORTIFOAM AER 90MG ..................... 78 cortisone acetate tab 25 mg .............. 68

CORTISPORIN CRE 0.5%................... 99 CORTISPORIN OIN 1% ..................... 99

CORVITE 150 TAB ............................ 89 CORVITE FE TAB .............................. 89

COSENTYX INJ 150MG/ML ................. 85 COSENTYX PEN INJ 300DOSE ............ 85

COSOPT PF SOL ............................. 107 COTELLIC TAB 20MG ........................ 18

creamy face liq wash 4% .................. 99 CREON CAP 12000UNT...................... 79

CREON CAP 24000UNT...................... 79

CREON CAP 3000UNIT ...................... 79 CREON CAP 36000UNT...................... 79

CREON CAP 6000UNIT ...................... 79 CRESEMBA CAP 186 MG ...................... 9

CRINONE GEL 4% VAG ..................... 73 CRIXIVAN CAP 200MG ...................... 11

CRIXIVAN CAP 400MG ...................... 11 cromolyn sodium ophth soln 4% ...... 106

cromolyn sodium oral conc 100 mg/5ml...................................................... 78

cromolyn sodium soln nebu 20 mg/2ml...................................................... 96

CUVPOSA SOL 1MG/5ML ................... 77 cyclobenzaprine hcl tab 10 mg ........... 58

cyclobenzaprine hcl tab 5 mg ............. 58

CYCLOMYDRIL SOL OP .................... 108 cyclopentolate hcl ophth soln 0.5% .. 108

120

cyclopentolate hcl ophth soln 1% ...... 108

cyclopentolate hcl ophth soln 2% ...... 108 CYCLOPHOSPH CAP 25MG .................. 15

CYCLOPHOSPH CAP 50MG .................. 15 cyclophosphamide for inj 1 gm ........... 15

cyclophosphamide for inj 2 gm ........... 15 cyclophosphamide for inj 500 mg ........ 15

cycloserine cap 250 mg ..................... 12 CYCLOSET TAB 0.8MG ....................... 63

cyclosporine cap 100 mg ................... 87 cyclosporine cap 25 mg ..................... 87

cyclosporine iv soln 50 mg/ml ............ 87 cyclosporine modified cap 50 mg ........ 87

cyclosporine modified oral soln 100 mg/ml ............................................. 87

cyproheptadine hcl syrup 2 mg/5ml .... 94

cyproheptadine hcl tab 4 mg .............. 94 CYSTADANE POW .............................. 71

CYSTAGON CAP 150MG ..................... 80 CYSTAGON CAP 50MG ....................... 80

CYSTARAN SOL 0.44% .................... 107 cytarabine inj 20 mg/ml .................... 16

cytarabine inj pf 100 mg/ml ............... 16 cytarabine inj pf 20 mg/ml ................. 16

CYTOMEL TAB 25MCG ........................ 73 CYTOMEL TAB 50MCG ........................ 73

CYTOMEL TAB 5MCG ......................... 73 D dacarbazine for inj 100 mg ................ 15 dacarbazine for inj 200 mg ................ 15

dalfampridine tab er 12hr 10 mg ........ 58

DALIRESP TAB 500MCG ..................... 97 danazol cap 100 mg .......................... 66

danazol cap 200 mg .......................... 66 danazol cap 50 mg ............................ 66

dantrolene sodium cap 100 mg ........... 58 dantrolene sodium cap 25 mg ............ 58

dantrolene sodium cap 50 mg ............ 58 dantrolene sodium for iv soln 20 mg ... 58

dapsone gel 5% ................................ 99 dapsone tab 100 mg ......................... 14

dapsone tab 25 mg ........................... 14 daunorubicin hcl iv soln 20 mg/4ml (base

equiv) ............................................. 20 DEBACTEROL SOL 30-50%............... 104

deferoxamine mesylate for inj 2 gm .... 84

DELFLEX-LC/ SOL 2.5% DEX .............. 81 DELZICOL CAP 400MG ....................... 77

demeclocycline hcl tab 150 mg ............ 8

demeclocycline hcl tab 300 mg ............ 8 DEMSER CAP 250MG ........................ 25

DENAVIR CRE 1% .......................... 103 DEPAKOTE ER TAB 500MG................. 40

DEPEN TITRA TAB 250MG ................. 85 DEPO-ESTRADI INJ 5MG/ML .............. 67

DEPO-MEDROL INJ 20MG/ML ............. 68 DEPO-MEDROL INJ 40MG/ML ............. 68

DEPO-MEDROL INJ 80MG/ML ............. 68 DEPO-PROVERA INJ 150MG/ML .......... 66

DEPO-PROVERA INJ 400/ML .............. 17 DERMOTIC OIL 0.01% .................... 108

DESCOVY TAB 200/25 ...................... 10 desipramine hcl tab 10 mg ................ 46

desipramine hcl tab 100 mg .............. 46

desipramine hcl tab 150 mg .............. 46 desipramine hcl tab 25 mg ................ 46

desipramine hcl tab 50 mg ................ 46 desipramine hcl tab 75 mg ................ 46

desmopressin acetate inj 4 mcg/ml .... 75 desmopressin acetate nasal spray soln

0.01% ............................................ 75 desmopressin acetate nasal spray soln

0.01% (refrigerated) ........................ 75 desmopressin acetate tab 0.1 mg ....... 75

desmopressin acetate tab 0.2 mg ....... 75 desonide cream 0.05% ................... 101

desonide lotion 0.05% .................... 101 desonide oint 0.05%....................... 101

desoximetasone cream 0.05% ......... 101

desoximetasone cream 0.25% ......... 101 desoximetasone gel 0.05%.............. 101

desoximetasone oint 0.05% ............ 101 desoximetasone oint 0.25% ............ 101

DESOXYN TAB 5MG .......................... 53 DESVENLAFAX TAB 50MG ER ............. 44

desvenlafaxine succinate tab er 24hr 100 mg (base equiv) ............................... 44



desvenlafaxine tab er 24hr 100 mg .... 44 desvenlafaxine tab er 24hr 50 mg ...... 44

DEXAMETHASON CON 1MG/ML .......... 68

dexamethasone elixir 0.5 mg/5ml ...... 68 dexamethasone sod phosphate

121

preservative free inj 10 mg/ml ........... 68

dexamethasone sodium phosphate inj 10 mg/ml ............................................. 69

dexamethasone sodium phosphate inj 100 mg/10ml ................................... 69

dexamethasone sodium phosphate inj 120 mg/30ml ................................... 69

dexamethasone sodium phosphate inj 20 mg/5ml ........................................... 69

dexamethasone sodium phosphate inj 4 mg/ml ............................................. 68

dexamethasone sodium phosphate ophth soln 0.1% ...................................... 106

dexamethasone soln 0.5 mg/5ml ........ 69 dexamethasone tab 0.5 mg ................ 69

dexamethasone tab 0.75 mg .............. 69

dexamethasone tab 1 mg .................. 69 dexamethasone tab 1.5 mg ................ 69

dexamethasone tab 2 mg .................. 69 dexamethasone tab 4 mg .................. 69

dexamethasone tab 6 mg .................. 69 DEXEDRINE CAP 10MG CR ................. 53

DEXEDRINE CAP 15MG CR ................. 53 DEXEDRINE CAP 5MG CR ................... 53

dexmethylphenidate hcl cap er 24 hr 10 mg .................................................. 53




mg .................................................. 53 dexmethylphenidate hcl cap er 24 hr 30




mg .................................................. 53 dexmethylphenidate hcl tab 10 mg ..... 53

dexmethylphenidate hcl tab 2.5 mg .... 53 dexmethylphenidate hcl tab 5 mg ....... 53

DEXPAK PAK 10 DAY ......................... 69 DEXPAK PAK 13 DAY ......................... 69

DEXPAK PAK 6 DAY ........................... 69

dextroamphetamine sulfate cap er 24hr 10 mg ............................................. 53

dextroamphetamine sulfate cap er 24hr

15 mg ............................................. 53 dextroamphetamine sulfate cap er 24hr 5

mg ................................................. 53 dextroamphetamine sulfate tab 10 mg 53

dextroamphetamine sulfate tab 5 mg . 53 DIASTAT ACDL GEL 12.5-20 .............. 40

DIASTAT ACDL GEL 5-10MG .............. 40 DIASTAT PED GEL 2.5M GEL .............. 40

diazepam conc 5 mg/ml .................... 39 DIAZEPAM INJ 10MG/2ML ................. 39

diazepam inj 5 mg/ml ....................... 39 diazepam oral soln 1 mg/ml .............. 39

diazepam tab 10 mg ......................... 39 diazepam tab 2 mg........................... 39

diazepam tab 5 mg........................... 39

DIBENZYLINE CAP 10MG ................... 25 diclofenac potassium tab 50 mg ........... 1

diclofenac sodium gel 1% .................... 2 diclofenac sodium ophth soln 0.1% .. 105

diclofenac sodium tab delayed release 25 mg ................................................... 1



diclofenac sodium tab er 24hr 100 mg .. 1 diclofenac w/ misoprostol tab delayed

release 50-0.2 mg .............................. 2 diclofenac w/ misoprostol tab delayed

release 75-0.2 mg .............................. 2

dicloxacillin sodium cap 250 mg ........... 8 dicloxacillin sodium cap 500 mg ........... 8

dicyclomine hcl cap 10 mg ................ 77 dicyclomine hcl oral soln 10 mg/5ml ... 77

dicyclomine hcl tab 20 mg ................. 77 didanosine delayed release capsule 200

mg ................................................. 12 didanosine delayed release capsule 250

mg ................................................. 12 didanosine delayed release capsule 400

mg ................................................. 12 DIFICID TAB 200MG ........................... 7

diflunisal tab 500 mg .......................... 1 DIGIFAB INJ 40MG ........................... 65

digoxin inj 0.25 mg/ml ...................... 33

digoxin oral soln 0.05 mg/ml ............. 33 digoxin tab 125 mcg (0.125 mg) ........ 33

122

digoxin tab 250 mcg (0.25 mg) .......... 33

dihydroergotamine mesylate nasal spray 4 mg/ml .......................................... 56

DILANTIN CAP 100MG ....................... 40 DILANTIN CAP 30MG ......................... 40

DILANTIN CHW 50MG ........................ 40 DILANTIN-125 SUS 125/5ML .............. 40

diltiazem hcl cap er 12hr 120 mg ........ 32 diltiazem hcl cap er 12hr 60 mg .......... 32

diltiazem hcl cap er 12hr 90 mg .......... 32 diltiazem hcl cap er 24hr 120 mg ........ 32

diltiazem hcl cap er 24hr 180 mg ........ 32 diltiazem hcl cap er 24hr 240 mg ........ 32

diltiazem hcl coated beads cap er 24hr 120 mg ........................................... 32

diltiazem hcl coated beads cap er 24hr

180 mg ........................................... 32 diltiazem hcl coated beads cap er 24hr



360 mg ........................................... 32 diltiazem hcl coated beads tab er 24hr




360 mg ........................................... 33

diltiazem hcl coated beads tab er 24hr 420 mg ........................................... 33

diltiazem hcl extended release beads cap er 24hr 120 mg ................................ 33







mg/ml) ............................................ 33 diltiazem hcl iv soln 25 mg/5ml (5

mg/ml) ........................................... 33

diltiazem hcl iv soln 50 mg/10ml (5 mg/ml) ........................................... 33

diltiazem hcl tab 120 mg ................... 33 diltiazem hcl tab 30 mg ..................... 33

diltiazem hcl tab 60 mg ..................... 33 diltiazem hcl tab 90 mg ..................... 33

DILTIAZEM INJ 100MG ...................... 33 DIMENHYDRIN INJ 50MG/ML ............. 76

DIPENTUM CAP 250MG ..................... 77 diphenhydramine hcl cap 50 mg ......... 94

diphenhydramine hcl elixir 12.5 mg/5ml...................................................... 94

diphenhydramine hcl inj 50 mg/ml ..... 94 diphenoxylate w/ atropine liq 2.5-0.025

mg/5ml ........................................... 75

diphenoxylate w/ atropine tab 2.5-0.025 mg ................................................. 75

dipyridamole tab 25 mg .................... 84 dipyridamole tab 50 mg .................... 84

dipyridamole tab 75 mg .................... 84 disopyramide phosphate cap 100 mg .. 27

disopyramide phosphate cap 150 mg .. 27 disulfiram tab 250 mg ....................... 59

disulfiram tab 500 mg ....................... 59 DIURIL SUS 250/5ML........................ 34

divalproex sodium cap delayed release sprinkle 125 mg ............................... 40

divalproex sodium tab delayed release 125 mg ........................................... 40

divalproex sodium tab delayed release

250 mg ........................................... 40 divalproex sodium tab delayed release

500 mg ........................................... 40 divalproex sodium tab er 24 hr 250 mg

...................................................... 40 divalproex sodium tab er 24 hr 500 mg

...................................................... 40 DIVIGEL GEL 0.25MG ....................... 67

DIVIGEL GEL 0.5MG ......................... 67 DIVIGEL GEL 1MG/GM ...................... 67

dobutamine hcl inj 12.5 mg/ml .......... 38 dobutamine inj 1 mg/ml in d5w ......... 38

dobutamine inj 2 mg/ml in d5w ......... 38 dobutamine inj 4 mg/ml in d5w ......... 38

dofetilide cap 125 mcg (0.125 mg) ..... 27

dofetilide cap 250 mcg (0.25 mg) ....... 27 dofetilide cap 500 mcg (0.5 mg) ........ 27

123

donepezil hydrochloride orally

disintegrating tab 10 mg .................... 43 donepezil hydrochloride orally

disintegrating tab 5 mg ..................... 43 donepezil hydrochloride tab 10 mg ...... 43

donepezil hydrochloride tab 5 mg ....... 43 dopamine hcl inj 160 mg/ml ............... 38

dopamine hcl inj 40 mg/ml ................ 38 dopamine hcl inj 80 mg/ml ................ 38

DOPTELET TAB 20MG ........................ 85 dorzolamide hcl ophth soln 2% ......... 107

dorzolamide hcl-timolol maleate ophth soln 22.3-6.8 mg/ml ....................... 107

DOTHELLE DHA CAP .......................... 91 doxazosin mesylate tab 1 mg ............. 25

doxazosin mesylate tab 2 mg ............. 25

doxazosin mesylate tab 4 mg ............. 25 doxazosin mesylate tab 8 mg ............. 25

doxepin hcl cap 10 mg ....................... 46 doxepin hcl cap 100 mg ..................... 46

doxepin hcl cap 150 mg ..................... 46 doxepin hcl cap 25 mg ....................... 46

doxepin hcl cap 50 mg ....................... 46 doxepin hcl cap 75 mg ....................... 46

doxepin hcl conc 10 mg/ml ................ 46 doxercalciferol cap 0.5 mcg ................ 71

doxercalciferol cap 1 mcg................... 71 doxercalciferol cap 2.5 mcg ................ 71

doxorubicin hcl for inj 50 mg .............. 20 doxorubicin hcl inj 2 mg/ml ................ 20

doxycycline hyclate tab 100 mg ........... 8

doxycycline hyclate tab 20 mg ............. 8 doxycycline hyclate tab delayed release

100 mg ............................................ 9 doxycycline hyclate tab delayed release



50 mg .............................................. 9 doxycycline hyclate tab delayed release

75 mg .............................................. 9 doxycycline monohydrate cap 100 mg .. 9

doxycycline monohydrate cap 150 mg .. 9 doxycycline monohydrate for susp 25

mg/5ml ............................................ 9

doxycycline monohydrate tab 100 mg .. 9 doxycycline monohydrate tab 50 mg .... 9

doxycycline monohydrate tab 75 mg .... 9

DRITHO-CREME CRE HP 1% ............ 100 dronabinol cap 10 mg ....................... 76

dronabinol cap 2.5 mg ...................... 76 dronabinol cap 5 mg ......................... 76

droperidol inj 2.5 mg/ml ................... 76 DRYSOL SOL 20% .......................... 103

DUAVEE TAB 0.45-20 ....................... 67 DUET DHA 400 MIS 25-1-400 ............ 91

DUET DHA MIS BALANCED ................ 91 duloxetine hcl enteric coated pellets cap

20 mg (base eq) .............................. 44 duloxetine hcl enteric coated pellets cap

30 mg (base eq) .............................. 44 duloxetine hcl enteric coated pellets cap

60 mg (base eq) .............................. 44

DUOPA SUS 4.63-20 ......................... 48 DUREZOL EMU 0.05% ..................... 106

dutasteride cap 0.5 mg ..................... 80 dutasteride-tamsulosin hcl cap 0.5-0.4

mg ................................................. 80 DYRENIUM CAP 100MG ..................... 34

DYRENIUM CAP 50MG ....................... 34 DYSPORT INJ 300UNIT ..................... 57

DYSPORT INJ 500UNIT ..................... 57 E E.E.S. GRAN SUS 200/5ML .................. 7 EASY TOUCH MIS 32GX5MM .............. 64

econazole nitrate cream 1% ............ 100 EDURANT TAB 25MG ........................ 11

efavirenz cap 200 mg ....................... 11

efavirenz cap 50 mg ......................... 11 efavirenz tab 600 mg ........................ 11

EFFER-K TAB 10MEQ ........................ 88 EFFER-K TAB 20MEQ ........................ 88

ELAPRASE INJ 6MG/3ML ................... 71 ELELYSO INJ 200UNIT ...................... 71

eletriptan hydrobromide tab 20 mg (base equivalent) ...................................... 56

eletriptan hydrobromide tab 40 mg (base equivalent) ...................................... 56

ELIDEL CRE 1% ............................. 100 ELIGARD INJ 22.5MG ........................ 17

ELIGARD INJ 30MG .......................... 17 ELIGARD INJ 45MG .......................... 17

ELIGARD INJ 7.5MG ......................... 17

ELIQUIS TAB 2.5MG ......................... 82 ELIQUIS TAB 5MG ............................ 82

124

ELITEK INJ 1.5MG ............................. 21

ELITEK INJ 7.5MG ............................. 21 ELIXOPHYLLIN ELX 80/15ML .............. 98

ELLENCE INJ 2MG/ML ........................ 21 ELMIRON CAP 100MG ........................ 80

EMADINE SOL 0.05% OP ................. 106 EMCYT CAP 140MG ........................... 15

EMEND SOL 150MG ........................... 76 EMGALITY INJ 120MG/ML .................. 56

EMTRIVA CAP 200MG ........................ 12 EMTRIVA SOL 10MG/ML ..................... 12

enalapril maleate & hydrochlorothiazide tab 10-25 mg ................................... 23

enalapril maleate & hydrochlorothiazide tab 5-12.5 mg .................................. 23

enalapril maleate tab 10 mg ............... 24

enalapril maleate tab 2.5 mg .............. 24 enalapril maleate tab 20 mg ............... 24

enalapril maleate tab 5 mg ................ 24 enalaprilat iv inj 1.25 mg/ml .............. 24

ENBRACE HR CAP ............................. 91 ENBREL INJ 25/0.5ML........................ 85

ENBREL INJ 25MG ............................. 85 ENBREL INJ 50MG/ML ........................ 85

ENBREL MINI INJ 50MG/ML ................ 85 ENBREL SRCLK INJ 50MG/ML ............. 85

ENDO AVITENE MIS 10MM DIA ........... 83 ENDO AVITENE MIS 5MM DIA ............. 83

endocet tab 5-325mg ......................... 3 ENDOMETRIN SUP 100MG .................. 73

enoxaparin sodium inj 100 mg/ml ....... 82

enoxaparin sodium inj 120 mg/0.8ml .. 82 enoxaparin sodium inj 150 mg/ml ....... 82

enoxaparin sodium inj 30 mg/0.3ml .... 81 enoxaparin sodium inj 300 mg/3ml ..... 82

enoxaparin sodium inj 40 mg/0.4ml .... 81 enoxaparin sodium inj 60 mg/0.6ml .... 82

enoxaparin sodium inj 80 mg/0.8ml .... 82 entacapone tab 200 mg ..................... 48

entecavir tab 0.5 mg ......................... 13 entecavir tab 1 mg ............................ 13

ENTRESTO TAB 24-26MG ................... 35 ENTRESTO TAB 49-51MG ................... 35

ENTRESTO TAB 97-103MG ................. 35 EPCLUSA TAB 400-100 ...................... 13

ephedrine sulfate inj 50 mg/ml ........... 38

EPIDIOLEX SOL 100MG/ML ................ 40 EPIFOAM AER 1% ............................. 79

epinastine hcl ophth soln 0.05% ...... 106

EPINEPHRINE INJ 1MG/ML................. 38 epinephrine pf inj 1 mg/ml ................ 93

epinephrine pf soln prefilled syringe 1 mg/10ml (0.1 mg/ml) ....................... 94

epinephrine solution auto-injector 0.15 mg/0.15ml (1:1000) ........................ 94

epinephrine solution auto-injector 0.3 mg/0.3ml (1:1000) .......................... 94

EPIPEN 2-PAK INJ 0.3MG .................. 94 EPIPEN-JR INJ 0.15MG ...................... 94

epirubicin hcl iv soln 200 mg/100ml (2 mg/ml) ........................................... 21

EPIVIR HBV SOL 5MG/ML .................. 13 EPIVIR HBV TAB 100MG .................... 13

EPIVIR SOL 10MG/ML ....................... 12

eplerenone tab 25 mg ....................... 25 eplerenone tab 50 mg ....................... 25

EPOGEN INJ 10000/ML ..................... 83 EPOGEN INJ 2000/ML ....................... 83

EPOGEN INJ 20000/ML ..................... 83 EPOGEN INJ 3000/ML ....................... 83

EPOGEN INJ 4000/ML ....................... 83 epoprostenol sodium for inj 0.5 mg .... 37

eprosartan mesylate tab 600 mg ........ 26 EPZICOM TAB 600-300 ..................... 10

ERBITUX INJ 100MG ......................... 21 ERBITUX INJ 200MG ......................... 21

ergocalciferol cap 50000 unit ............. 89 ERIVEDGE CAP 150MG ...................... 21

ERLEADA TAB 60MG ......................... 17

ERYPED SUS 400/5ML ......................... 7 erythromycin ethylsuccinate for susp 200

mg/5ml ............................................. 7 erythromycin ethylsuccinate tab 400 mg

........................................................ 7 erythromycin gel 2% ........................ 99

erythromycin ophth oint 5 mg/gm .... 105 erythromycin pads 2% ...................... 99

erythromycin soln 2% ....................... 99 erythromycin stearate tab 250 mg ....... 7

erythromycin tab 250 mg .................... 7 erythromycin tab 500 mg .................... 7

erythromycin tab delayed release 250 mg ................................................... 7

erythromycin tab delayed release 333

mg ................................................... 7 erythromycin tab delayed release 500

125

mg ................................................... 7

erythromycin w/ delayed release particles cap 250 mg .......................... 7

ESBRIET CAP 267MG ......................... 97 ESBRIET TAB 267MG ......................... 97

ESBRIET TAB 801MG ......................... 97 ESCAVITE CHW ................................ 89

ESCAVITE D CHW ............................. 89 escitalopram oxalate soln 5 mg/5ml

(base equiv) ..................................... 45 escitalopram oxalate tab 10 mg (base

equiv) ............................................. 45 escitalopram oxalate tab 20 mg (base

equiv) ............................................. 45 escitalopram oxalate tab 5 mg (base

equiv) ............................................. 45

estazolam tab 1 mg .......................... 55 estazolam tab 2 mg .......................... 55

ESTRACE VAG CRE 0.01% ................. 68 estradiol & norethindrone acetate tab

0.5-0.1 mg ...................................... 66 estradiol & norethindrone acetate tab

1-0.5 mg ......................................... 67 estradiol tab 0.5 mg .......................... 67

estradiol tab 1 mg ............................. 67 estradiol tab 2 mg ............................. 67

estradiol td patch twice weekly 0.025 mg/24hr .......................................... 68

estradiol td patch twice weekly 0.0375 mg/24hr .......................................... 68

estradiol td patch twice weekly 0.05

mg/24hr .......................................... 68 estradiol td patch twice weekly 0.075

mg/24hr .......................................... 68 estradiol td patch twice weekly 0.1

mg/24hr .......................................... 67 estradiol td patch weekly 0.025 mg/24hr

...................................................... 68 estradiol td patch weekly 0.0375

mg/24hr (37.5 mcg/24hr) .................. 68 estradiol td patch weekly 0.05 mg/24hr

...................................................... 68 estradiol td patch weekly 0.06 mg/24hr

...................................................... 68 estradiol td patch weekly 0.075 mg/24hr

...................................................... 68

estradiol td patch weekly 0.1 mg/24hr 68 estradiol vaginal cream 0.1 mg/gm ..... 68

estradiol vaginal tab 10 mcg .............. 68

estradiol valerate im in oil 20 mg/ml .. 67 estradiol valerate im in oil 40 mg/ml .. 67

ESTRING MIS 2MG ........................... 68 ESTROGEL GEL ................................ 68

eszopiclone tab 1 mg ........................ 56 eszopiclone tab 2 mg ........................ 56

eszopiclone tab 3 mg ........................ 56 ethambutol hcl tab 100 mg................ 12

ethambutol hcl tab 400 mg................ 12 ETHAMOLIN INJ 5%.......................... 35

ethosuximide cap 250 mg ................. 40 ethosuximide soln 250 mg/5ml .......... 40

etidronate disodium tab 400 mg......... 65 etodolac cap 200 mg .......................... 1

etodolac cap 300 mg .......................... 1

etodolac tab 400 mg ........................... 1 etodolac tab 500 mg ........................... 1

etodolac tab er 24hr 400 mg ............... 1 etodolac tab er 24hr 500 mg ............... 1

etodolac tab er 24hr 600 mg ............... 1 ETOPOPHOS INJ 100MG .................... 21

etoposide cap 50 mg ........................ 21 etoposide inj 1 gm/50ml (20 mg/ml) .. 21

etoposide inj 100 mg/5ml (20 mg/ml) 21 etoposide inj 500 mg/25ml (20 mg/ml)

...................................................... 21 EURAX CRE 10% ............................ 103

EURAX LOT 10% ............................ 103 EVAMIST SPR 1.53MG ....................... 68

EVOTAZ TAB 300-150 ....................... 10

EXELDERM CRE 1% ........................ 100 EXELDERM SOL 1% ........................ 100

exemestane tab 25 mg ..................... 17 EXJADE TAB 125MG .......................... 84

EXJADE TAB 250MG .......................... 84 EXJADE TAB 500MG .......................... 84

EXODERM LOT 25-1% ..................... 100 EYLEA INJ 2/0.05ML ....................... 107

ezetimibe tab 10 mg ......................... 28 ezetimibe-simvastatin tab 10-10 mg ... 29

ezetimibe-simvastatin tab 10-20 mg ... 29 ezetimibe-simvastatin tab 10-40 mg ... 29

ezetimibe-simvastatin tab 10-80 mg ... 29 F FABRAZYME INJ 35MG ...................... 71

FABRAZYME INJ 5MG ........................ 71 famciclovir tab 125 mg ..................... 13

126

famciclovir tab 250 mg ...................... 13

famciclovir tab 500 mg ...................... 13 FANAPT PAK ..................................... 49

FANAPT TAB 10MG ............................ 49 FANAPT TAB 12MG ............................ 49

FANAPT TAB 1MG .............................. 49 FANAPT TAB 2MG .............................. 49

FANAPT TAB 4MG .............................. 49 FANAPT TAB 6MG .............................. 49

FANAPT TAB 8MG .............................. 49 FARESTON TAB 60MG ........................ 17

FARYDAK CAP 10MG .......................... 21 FARYDAK CAP 15MG .......................... 21

FARYDAK CAP 20MG .......................... 21 FASLODEX INJ 250/5ML ..................... 17

fe asp gly-fe polysacch-succ ac-c-threon

ac-b12-fa cap ................................... 89 fe asparto gly-fe fum-b12-fa-c-succinic

ac tab ther pack ............................... 89 fe fumarate w/ b12-vit c-fa-ifc cap

110-0.015-75-0.5-240 mg ................. 90 felbamate susp 600 mg/5ml ............... 40

felbamate tab 400 mg ....................... 40 felbamate tab 600 mg ....................... 40

felodipine tab er 24hr 10 mg .............. 31 felodipine tab er 24hr 2.5 mg ............. 31

felodipine tab er 24hr 5 mg ................ 31 FEM PH GEL ..................................... 80

FEMRING MIS 0.05/24H ..................... 68 FEMRING MIS 0.1MG/24 .................... 68

fenofibrate micronized cap 134 mg ..... 28

fenofibrate micronized cap 200 mg ..... 28 fenofibrate micronized cap 43 mg ....... 28

fenofibrate micronized cap 67 mg ....... 28 fenofibrate tab 145 mg ...................... 28

fenofibrate tab 160 mg ...................... 28 fenofibrate tab 48 mg ........................ 28

fenofibrate tab 54 mg ........................ 28 fenofibric acid tab 105 mg ................. 28

fenofibric acid tab 35 mg ................... 28 fenoprofen calcium tab 600 mg ........... 2

fentanyl citrate lozenge on a handle 1200 mcg ................................................. 3

fentanyl citrate lozenge on a handle 1600 mcg ................................................. 3

fentanyl citrate lozenge on a handle 200

mcg ................................................. 3 fentanyl citrate lozenge on a handle 600

mcg .................................................. 3

fentanyl citrate lozenge on a handle 800 mcg .................................................. 3

fentanyl td patch 72hr 100 mcg/hr ....... 3 fentanyl td patch 72hr 12 mcg/hr ......... 3

fentanyl td patch 72hr 25 mcg/hr ......... 3 fentanyl td patch 72hr 50 mcg/hr ......... 3

fentanyl td patch 72hr 75 mcg/hr ......... 3 FENTORA TAB 100MCG ....................... 3

FENTORA TAB 200MCG ....................... 3 FENTORA TAB 400MCG ....................... 3

FENTORA TAB 600MCG ....................... 3 FENTORA TAB 800MCG ....................... 3

FERAHEME INJ 510/17ML .................. 90 FERRALET 90 TAB ............................ 90

FERRAPLUS 90 TAB .......................... 90

ferrex 150 cap 150mg ...................... 90 FERRIPROX SOL 100MG/ML ............... 84

FERRIPROX TAB 500MG .................... 84 FETZIMA CAP 120MG ........................ 44

FETZIMA CAP 20MG .......................... 44 FETZIMA CAP 40MG .......................... 44

FETZIMA CAP 80MG .......................... 44 FETZIMA CAP TITRATIO .................... 44

FINACEA GEL 15% ......................... 103 finasteride tab 5 mg ......................... 80

FIRAZYR INJ 30MG/3ML .................... 84 FIRMAGON INJ 120MG ...................... 17

FIRMAGON INJ 80MG ........................ 17 FLAREX SUS 0.1% OP ..................... 106

FLEBOGAMMA INJ 20/400ML ............. 86

FLEBOGAMMA INJ DIF 5% ................. 86 flecainide acetate tab 100 mg ............ 27

flecainide acetate tab 150 mg ............ 27 flecainide acetate tab 50 mg .............. 27

FLOLAN INJ 0.5MG ........................... 37 FLOLAN INJ 1.5MG ........................... 37

FLORIVA CHW 0.25MG ...................... 90 FLORIVA CHW 0.5MG........................ 90

FLORIVA CHW 1MG .......................... 90 FLORIVA DRO 0.25MG ...................... 90

FLOVENT DISK AER 100MCG ............. 98 FLOVENT DISK AER 250MCG ............. 98

FLOVENT DISK AER 50MCG ............... 97 FLOVENT HFA AER 110MCG ............... 98

FLOVENT HFA AER 220MCG ............... 98

FLOVENT HFA AER 44MCG ................. 98 floxuridine for inj 0.5 gm ................... 16

127

fluconazole for susp 10 mg/ml ............. 9

fluconazole for susp 40 mg/ml ............. 9 fluconazole tab 100 mg ...................... 9

fluconazole tab 150 mg ...................... 9 fluconazole tab 200 mg ...................... 9

fluconazole tab 50 mg ........................ 9 flucytosine cap 250 mg ....................... 9

flucytosine cap 500 mg ....................... 9 fludarabine phosphate for inj 50 mg .... 16

fludarabine phosphate inj 25 mg/ml .... 16 fludrocortisone acetate tab 0.1 mg ...... 69

flumazenil iv soln 0.5 mg/5ml (0.1 mg/ml) ............................................ 65

flumazenil iv soln 1 mg/10ml (0.1 mg/ml) ............................................ 65

fluocinolone acetonide (otic) oil 0.01%

.................................................... 108 fluocinolone acetonide cream 0.01% . 101

fluocinolone acetonide cream 0.025% 101 fluocinolone acetonide oil 0.01% (body

oil) ................................................ 101 fluocinolone acetonide oil 0.01% (scalp

oil) ................................................ 101 fluocinolone acetonide oint 0.025% ... 101

fluocinolone acetonide soln 0.01% .... 101 fluocinonide cream 0.05%................ 101

fluocinonide emulsified base cream 0.05% ........................................... 101

fluocinonide gel 0.05% .................... 101 fluocinonide oint 0.05% ................... 101

fluocinonide soln 0.05%................... 101

fluorescein sodium ophth strips 1 mg 107 fluorescein w/ benoxinate ophth soln

0.25-0.4% ..................................... 107 fluorid sens pst 1.1-5% ................... 104

fluorometholone ophth susp 0.1%..... 106 fluorouracil cream 5% ....................... 99

fluorouracil iv soln 1 gm/20ml (50 mg/ml) ............................................ 16

fluorouracil iv soln 2.5 gm/50ml (50 mg/ml) ............................................ 16

fluorouracil iv soln 5 gm/100ml (50 mg/ml) ............................................ 16

fluorouracil iv soln 500 mg/10ml (50 mg/ml) ............................................ 16

fluorouracil soln 2% .......................... 99

fluorouracil soln 5% .......................... 99 fluoxetine hcl (pmdd) cap 10 mg ........ 45

fluoxetine hcl (pmdd) cap 20 mg ........ 45

fluoxetine hcl (pmdd) tab 10 mg ........ 45 fluoxetine hcl (pmdd) tab 20 mg ........ 45

fluoxetine hcl cap 10 mg ................... 45 fluoxetine hcl cap 20 mg ................... 45

fluoxetine hcl cap 40 mg ................... 45 fluoxetine hcl cap delayed release 90 mg

...................................................... 45 fluoxetine hcl solution 20 mg/5ml ...... 45

fluoxetine hcl tab 10 mg ................... 45 fluoxetine hcl tab 20 mg ................... 45

fluphenazine decanoate inj 25 mg/ml . 51 fluphenazine hcl elixir 2.5 mg/5ml ...... 51

fluphenazine hcl inj 2.5 mg/ml ........... 51 fluphenazine hcl oral conc 5 mg/ml .... 51

fluphenazine hcl tab 1 mg ................. 51

fluphenazine hcl tab 10 mg ............... 51 fluphenazine hcl tab 2.5 mg .............. 51

fluphenazine hcl tab 5 mg ................. 51 flurazepam hcl cap 15 mg ................. 55

flurazepam hcl cap 30 mg ................. 55 flurbiprofen sodium ophth soln 0.03%

.................................................... 105 flurbiprofen tab 100 mg ...................... 2

flurbiprofen tab 50 mg ........................ 2 flutamide cap 125 mg ....................... 17

fluticasone propionate cream 0.05% . 101 fluticasone propionate oint 0.005% .. 101

fluvastatin sodium cap 20 mg ............ 29 fluvastatin sodium cap 40 mg ............ 29

fluvoxamine maleate tab 100 mg ....... 39

fluvoxamine maleate tab 25 mg ......... 39 fluvoxamine maleate tab 50 mg ......... 39

FML FORTE SUS 0.25% OP .............. 106 FML LIQUIFLM SUS 0.1% OP ........... 106

FML OIN 0.1% OP .......................... 106 FOCALIN XR CAP 25MG ..................... 53

FOCALIN XR CAP 35MG ..................... 53 FOLET DHA PAK ............................... 91

FOLET ONE CAP 38-1-225 ................. 91 FOLGARD RX TAB ............................. 89

folic acid tab 1 mg ............................ 89 folic acid-vitamin b6-vitamin b12 tab

2.2-25-0.5 mg ................................. 89 folic acid-vitamin b6-vitamin b12 tab

2.2-25-1 mg .................................... 89

folic acid-vitamin b6-vitamin b12 tab 2.5-25-1 mg .................................... 89

128

FOLIVANE-OB CAP ............................ 91

FOLTANX TAB ................................... 88 FOLTRATE TAB ................................. 89

fomepizole inj 1 gm/ml (for iv infusion) ...................................................... 65

fondaparinux sodium subcutaneous inj 10 mg/0.8ml .................................... 82

fondaparinux sodium subcutaneous inj 2.5 mg/0.5ml ................................... 82

fondaparinux sodium subcutaneous inj 5 mg/0.4ml ........................................ 82

fondaparinux sodium subcutaneous inj 7.5 mg/0.6ml ................................... 82

formaldehyde solution 20% .............. 100 FORTEO SOL 600/2.4 ........................ 66

FORTESTA GEL 10MG/ACT ................. 60

fosamprenavir calcium tab 700 mg (base equiv) ............................................. 11

fosinopril sodium & hydrochlorothiazide tab 10-12.5 mg ................................ 23

fosinopril sodium & hydrochlorothiazide tab 20-12.5 mg ................................ 23

fosinopril sodium tab 10 mg ............... 24 fosinopril sodium tab 20 mg ............... 24

fosinopril sodium tab 40 mg ............... 24 FRAGMIN INJ 10000/ML ..................... 82

FRAGMIN INJ 12500UNT .................... 82 FRAGMIN INJ 15000UNT .................... 82

FRAGMIN INJ 18000UNT .................... 82 FRAGMIN INJ 2500/0.2 ...................... 82

FRAGMIN INJ 5000/0.2 ...................... 82

FRAGMIN INJ 7500/0.3 ...................... 82 FRAGMIN INJ 95000UNT .................... 82

frovatriptan succinate tab 2.5 mg (base equivalent) ...................................... 56

furosemide inj 10 mg/ml .................... 34 furosemide oral soln 10 mg/ml ........... 34

furosemide oral soln 8 mg/ml ............. 34 furosemide tab 20 mg ....................... 34

furosemide tab 40 mg ....................... 34 furosemide tab 80 mg ....................... 34

FUSION PAK SPRINKLE ...................... 90 FUSION PLUS CAP ............................. 90

FUZEON INJ 90MG ............................ 10 FYCOMPA SUS 0.5MG/ML ................... 40

FYCOMPA TAB 10MG ......................... 41

FYCOMPA TAB 12MG ......................... 41 FYCOMPA TAB 2MG ........................... 40

FYCOMPA TAB 4MG .......................... 41

FYCOMPA TAB 6MG .......................... 41 FYCOMPA TAB 8MG .......................... 41

G gabapentin cap 100 mg .................... 41

gabapentin cap 300 mg .................... 41 gabapentin cap 400 mg .................... 41

gabapentin oral soln 250 mg/5ml ....... 41 gabapentin tab 600 mg ..................... 41

gabapentin tab 800 mg ..................... 41 GABITRIL TAB 12MG......................... 41

GABITRIL TAB 16MG......................... 41 GABLOFEN INJ 10000/20 .................. 58

GABLOFEN INJ 20000/20 .................. 58 GABLOFEN INJ 40000/20 .................. 58

GALAFOLD CAP 123MG ..................... 71

galantamine hydrobromide cap er 24hr 16 mg ............................................. 43

galantamine hydrobromide cap er 24hr 24 mg ............................................. 43

galantamine hydrobromide cap er 24hr 8 mg ................................................. 43

galantamine hydrobromide oral soln 4 mg/ml ............................................ 43

galantamine hydrobromide tab 12 mg 43 galantamine hydrobromide tab 4 mg .. 43

galantamine hydrobromide tab 8 mg .. 43 GALZIN CAP 25MG ........................... 90

GALZIN CAP 50MG ........................... 90 GAMASTAN S/D INJ .......................... 86

GAMMAGARD INJ 10GM/100 .............. 86

GAMMAGARD INJ 1GM/10ML ............. 86 GAMMAGARD INJ 2.5GM/25 .............. 86

GAMMAGARD INJ 20GM/200 .............. 86 GAMMAGARD INJ 30GM/300 .............. 86

GAMMAGARD INJ 5GM/50ML ............. 86 GAMMAGARD SD INJ 10GM HU .......... 86

GAMMAGARD SD INJ 5GM HU ............ 86 GAMUNEX-C INJ 40/400ML ................ 86

gatifloxacin ophth soln 0.5% ........... 105 GATTEX KIT 5MG ............................. 78

GEBAUERS SPR AER /STRETCH ........ 103 GELCLAIR GEL ............................... 104

GELFOAM MIS DENTAL 4 ................... 83 GELFOAM MIS SPON COM ................. 83

GELFOAM POW ................................ 83

gemcitabine hcl for inj 2 gm .............. 16 gemcitabine hcl inj 1 gm/26.3ml (38

129

mg/ml) (base equiv) ......................... 16

gemcitabine hcl inj 2 gm/52.6ml (38 mg/ml) (base equiv) ......................... 16

gemcitabine hcl inj 200 mg/5.26ml (38 mg/ml) (base equiv) ......................... 16

gemfibrozil tab 600 mg ...................... 28 gentamicin sulfate cream 0.1% .......... 99

gentamicin sulfate oint 0.1% .............. 99 gentamicin sulfate ophth oint 0.3% ... 105

gentamicin sulfate ophth soln 0.3% .. 105 GENVOYA TAB .................................. 10

GEODON INJ 20MG ........................... 49 GILENYA CAP 0.5MG ......................... 58

GILOTRIF TAB 20MG ......................... 19 GILOTRIF TAB 30MG ......................... 19

GILOTRIF TAB 40MG ......................... 19

GLASSIA INJ .................................... 97 glatiramer acetate soln prefilled syringe

20 mg/ml......................................... 58 glatiramer acetate soln prefilled syringe

40 mg/ml......................................... 58 glatopa inj 20mg/ml .......................... 58

glatopa inj 40mg/ml .......................... 58 GLEOSTINE CAP 100MG ..................... 15

GLEOSTINE CAP 10MG ...................... 15 GLEOSTINE CAP 40MG ...................... 15

glimepiride tab 1 mg ......................... 63 glimepiride tab 2 mg ......................... 63

glimepiride tab 4 mg ......................... 63 glipizide tab 10 mg ........................... 63

glipizide tab 5 mg ............................. 63

glipizide tab er 24hr 10 mg ................ 63 glipizide tab er 24hr 2.5 mg ............... 63

glipizide tab er 24hr 5 mg .................. 63 glipizide-metformin hcl tab 2.5-250 mg

...................................................... 61 glipizide-metformin hcl tab 2.5-500 mg

...................................................... 61 glipizide-metformin hcl tab 5-500 mg .. 61

GLUCAGEN INJ HYPOKIT .................... 70 GLUCAGON KIT 1MG ......................... 70

glyburide micronized tab 1.5 mg ......... 63 glyburide micronized tab 3 mg ........... 64

glyburide micronized tab 6 mg ........... 64 glyburide tab 1.25 mg ....................... 64

glyburide tab 2.5 mg ......................... 64

glyburide tab 5 mg ............................ 64 glyburide-metformin tab 1.25-250 mg . 61

glyburide-metformin tab 2.5-500 mg .. 61

glyburide-metformin tab 5-500 mg ..... 61 glycine irrigation soln 1.5% ............... 80

GLYCOPYRROLA INJ 1MG/5ML ........... 77 glycopyrrolate inj 0.2 mg/ml .............. 77

glycopyrrolate inj 0.4 mg/2ml (0.2 mg/ml) ........................................... 77

glycopyrrolate inj 1 mg/5ml (0.2 mg/ml)...................................................... 77

glycopyrrolate inj 4 mg/20ml (0.2 mg/ml) ........................................... 77

glycopyrrolate tab 1 mg .................... 77 glycopyrrolate tab 2 mg .................... 77

GLYXAMBI TAB 10-5 MG ................... 63 GLYXAMBI TAB 25-5 MG ................... 63

GOLYTELY SOL ................................. 78

GORDOFILM SOL ............................ 103 GRALISE STAR MIS 300/600.............. 59

GRALISE TAB 300MG ........................ 59 GRALISE TAB 600MG ........................ 59

granisetron hcl inj 1 mg/ml ............... 76 granisetron hcl inj 4 mg/4ml (1 mg/ml)

...................................................... 76 granisetron hcl tab 1 mg ................... 76

GRANIX INJ 300/0.5 ......................... 83 GRANIX INJ 300/1ML ........................ 83

GRANIX INJ 480/0.8 ......................... 83 GRANIX INJ 480/1.6 ......................... 83

griseofulvin microsize susp 125 mg/5ml 9 griseofulvin microsize tab 500 mg ........ 9

guaifenesin-codeine soln 100-10 mg/5ml

...................................................... 95 guanfacine hcl tab 1 mg .................... 25

guanfacine hcl tab 2 mg .................... 25 guanfacine hcl tab er 24hr 1 mg (base

equiv) ............................................. 53 guanfacine hcl tab er 24hr 2 mg (base



equiv) ............................................. 54 GUANIDINE TAB 125MG .................... 57

GYNAZOLE-1 CRE 2% ....................... 81 H H.P. ACTHAR INJ 80UNIT .................. 71

HALDOL DECAN INJ 100MG/ML .......... 51 HALDOL DECAN INJ 50MG/ML ............ 51

130

HALDOL INJ 5MG/ML ......................... 51

halobetasol propionate cream 0.05% 102 halobetasol propionate oint 0.05% .... 102

haloperidol decanoate im soln 100 mg/ml ...................................................... 51

haloperidol decanoate im soln 50 mg/ml ...................................................... 51

haloperidol lactate inj 5 mg/ml ........... 51 haloperidol lactate oral conc 2 mg/ml .. 51

haloperidol tab 0.5 mg ...................... 51 haloperidol tab 1 mg ......................... 51

haloperidol tab 10 mg ....................... 51 haloperidol tab 2 mg ......................... 51

haloperidol tab 20 mg ....................... 51 haloperidol tab 5 mg ......................... 51

HARVONI TAB 90-400MG ................... 13

HECTOROL INJ 2MCG/ML ................... 71 HEMABATE INJ 250MCG ..................... 71

HEMATOGEN FA CAP ......................... 90 HEMATRON-AF TAB ........................... 90

HEMETAB TAB .................................. 90 heparin sodium (porcine) inj 1000

unit/ml ............................................ 82 heparin sodium (porcine) inj 10000



unit/ml ............................................ 82 heparin sodium (porcine) pf inj 5000

unit/0.5ml ........................................ 82

HERCEPTIN INJ 150MG ...................... 21 HERCEPTIN INJ 440MG ...................... 21

HETLIOZ CAP 20MG .......................... 56 HIZENTRA INJ 10/50ML ..................... 86

HIZENTRA INJ 1GM/5ML .................... 86 HIZENTRA INJ 2GM/10ML .................. 86

HIZENTRA INJ 4GM/20ML .................. 86 homatropine hbr ophth soln 5% ....... 108

HUMATROPE INJ 12MG ...................... 70 HUMATROPE INJ 24MG ...................... 70

HUMATROPE INJ 5MG ........................ 70 HUMATROPE INJ 6MG ........................ 70

HUMIRA INJ 10/0.1ML ....................... 85 HUMIRA INJ 10MG/0.2 ...................... 85

HUMIRA INJ 20/0.2ML ....................... 85

HUMIRA INJ 40/0.4ML ....................... 85 HUMIRA KIT 20MG/0.4 ...................... 85

HUMIRA KIT 40MG/0.8 ..................... 85

HUMIRA PEDIA INJ CROHNS .............. 85 HUMIRA PEN INJ 40/0.4ML ................ 85

HUMIRA PEN INJ 40MG/0.8 ............... 85 HUMIRA PEN KIT CD/UC/HS .............. 85

HUMIRA PEN KIT PS/UV .................... 85 HUMULIN R INJ U-500 ...................... 62

HYCAMTIN CAP 0.25MG .................... 22 HYCAMTIN CAP 1MG ......................... 22

hydralazine hcl inj 20 mg/ml ............. 35 hydralazine hcl tab 10 mg ................. 35

hydralazine hcl tab 100 mg ............... 35 hydralazine hcl tab 25 mg ................. 35

hydralazine hcl tab 50 mg ................. 35 hydrochlorothiazide cap 12.5 mg ........ 34

hydrochlorothiazide tab 12.5 mg ........ 34

hydrochlorothiazide tab 25 mg ........... 34 hydrochlorothiazide tab 50 mg ........... 34

hydrocod polst-chlorphen polst er susp 10-8 mg/5ml ................................... 95

hydrocodone w/ homatropine syrup 5-1.5 mg/5ml .................................. 95

hydrocodone-acetaminophen soln 10-325 mg/15ml ........................................... 4

hydrocodone-acetaminophen soln 7.5-325 mg/15ml ............................... 4

hydrocodone-acetaminophen tab 10-325 mg ................................................... 4

hydrocodone-acetaminophen tab 5-325 mg ................................................... 4

hydrocodone-acetaminophen tab 7.5-325

mg ................................................... 4 hydrocodone-ibuprofen tab 10-200 mg . 4

hydrocodone-ibuprofen tab 5-200 mg ... 4 hydrocodone-ibuprofen tab 7.5-200 mg 4

hydrocortisone acetate suppos 25 mg . 79 hydrocortisone acetate suppos 30 mg . 79

hydrocortisone acetate w/ pramoxine rectal cream 1-1% ........................... 79

hydrocortisone acetate w/ pramoxine rectal cream 2.5-1%......................... 79

hydrocortisone butyrate cream 0.1% 101 hydrocortisone butyrate oint 0.1% ... 102

hydrocortisone butyrate soln 0.1% ... 102 hydrocortisone cream 2.5% ............. 101

hydrocortisone enema 100 mg/60ml .. 78

hydrocortisone lotion 2.5% .............. 101 hydrocortisone oint 1% ................... 101

131

hydrocortisone rectal cream 1% ......... 79

hydrocortisone rectal cream 2.5%....... 79 hydrocortisone tab 10 mg .................. 69

hydrocortisone tab 20 mg .................. 69 hydrocortisone tab 5 mg .................... 69

hydrocortisone valerate cream 0.2% . 102 hydrocortisone valerate oint 0.2% .... 102

HYDROMORPHON SUP 3MG ................. 4 hydromorphone hcl tab 2 mg .............. 4

hydromorphone hcl tab 4 mg .............. 4 hydromorphone hcl tab 8 mg .............. 4

hydroxocobalamin acetate inj 1000 mcg/ml (base equivalent) .................. 90

hydroxychloroquine sulfate tab 200 mg ...................................................... 85

hydroxyurea cap 500 mg ................... 21

hydroxyzine hcl im soln 25 mg/ml ....... 94 hydroxyzine hcl im soln 50 mg/ml ....... 94

hydroxyzine hcl syrup 10 mg/5ml ....... 94 hydroxyzine hcl tab 10 mg ................. 94

hydroxyzine hcl tab 25 mg ................. 94 hydroxyzine hcl tab 50 mg ................. 94

hydroxyzine pamoate cap 100 mg ....... 94 hydroxyzine pamoate cap 25 mg ........ 94

hydroxyzine pamoate cap 50 mg ........ 94 hyoscyamine sulfate elixir 0.125 mg/5ml

...................................................... 77 hyoscyamine sulfate sl tab 0.125 mg ... 77

hyoscyamine sulfate soln 0.125 mg/ml 77 hyoscyamine sulfate tab 0.125 mg ...... 77

hyoscyamine sulfate tab disint 0.125 mg

...................................................... 77 hyoscyamine sulfate tab er 12hr 0.375

mg .................................................. 77 HYPERSAL NEB 3.5% ........................ 97

HYPER-SAL NEB 7% .......................... 97 HYQVIA INJ 10-800 ........................... 86

HYQVIA INJ 2.5-200 .......................... 86 HYQVIA INJ 20-1600 ......................... 86

HYQVIA INJ 30-2400 ......................... 86 HYQVIA INJ 5-400 ............................ 86

I ibandronate sodium iv soln 3 mg/3ml

(base equivalent) .............................. 66 ibandronate sodium tab 150 mg (base

equivalent) ...................................... 66

IBRANCE CAP 100MG ........................ 19 IBRANCE CAP 125MG ........................ 19

IBRANCE CAP 75MG ......................... 19

ibudone tab 10-200mg ....................... 4 ibudone tab 5-200mg ......................... 4

ibuprofen susp 100 mg/5ml ................. 2 ibuprofen tab 400 mg ......................... 2

ibuprofen tab 600 mg ......................... 2 ibuprofen tab 800 mg ......................... 2

ICLUSIG TAB 15MG .......................... 19 ICLUSIG TAB 45MG .......................... 19

IDAMYCIN PFS INJ 20/20ML .............. 21 IDAMYCIN PFS INJ 5MG/5ML ............. 21

idarubicin hcl iv inj 20 mg/20ml (1 mg/ml) ........................................... 21

idarubicin hcl iv inj 5 mg/5ml (1 mg/ml)...................................................... 21

IDHIFA TAB 100MG .......................... 21

IDHIFA TAB 50MG ............................ 21 IFEX INJ 1GM .................................. 15

ifosfamide for inj 1 gm ...................... 15 IFOSFAMIDE INJ 3GM ....................... 15

ifosfamide iv inj 1 gm/20ml (50 mg/ml)...................................................... 15

ifosfamide iv inj 3 gm/60ml (50 mg/ml)...................................................... 15

ILARIS INJ 150MG/ML ...................... 87 ILUVIEN IMP 0.19MG ...................... 106

imatinib mesylate tab 100 mg (base equivalent) ...................................... 19

imatinib mesylate tab 400 mg (base equivalent) ...................................... 19

IMBRUVICA CAP 140MG .................... 19

IMBRUVICA TAB 140MG .................... 19 IMBRUVICA TAB 280MG .................... 19

IMBRUVICA TAB 420MG .................... 19 IMBRUVICA TAB 560MG .................... 19

imipramine hcl tab 10 mg ................. 46 imipramine hcl tab 25 mg ................. 46

imipramine hcl tab 50 mg ................. 46 imipramine pamoate cap 100 mg ....... 46

imipramine pamoate cap 125 mg ....... 47 imipramine pamoate cap 150 mg ....... 47

imipramine pamoate cap 75 mg ......... 46 imiquimod cream 5% ...................... 103

INCRELEX INJ 40MG/4ML .................. 71 indapamide tab 1.25 mg ................... 34

indapamide tab 2.5 mg ..................... 34

indomethacin cap 25 mg ..................... 2 indomethacin cap 50 mg ..................... 2

132

indomethacin cap er 75 mg ................. 2

INFED INJ 50MG/ML .......................... 90 INLYTA TAB 1MG .............................. 19

INLYTA TAB 5MG .............................. 19 INNOPRAN XL CAP 120MG ................. 30

INNOPRAN XL CAP 80MG ................... 30 INSULIN PEN MIS 29GX12MM ............. 64

INSULIN SYRG MIS 0.3/29G ............... 64 INSULIN SYRG MIS 0.3/30G ............... 64




INSULIN SYRG MIS 1ML..................... 64

INSULIN SYRG MIS 1ML/28G .............. 64 INSULIN SYRG MIS 1ML/29G .............. 64

INSULIN SYRG MIS 1ML/30G .............. 64 INSULIN SYRG MIS 1ML/31G .............. 64

INSULIN SYRG MIS 28GX1/2 .............. 64 INSUPEN SENS MIS 32GX6MM ........... 64

INSUPEN SENS MIS 32GX8MM ........... 64 INTEGRA F CAP ................................ 90

INTEGRA PLUS CAP ........................... 90 INTELENCE TAB 100MG ..................... 11

INTELENCE TAB 200MG ..................... 11 INTELENCE TAB 25MG ....................... 11

INTRON A INJ 18MU .......................... 87 INTRON A INJ 25MU .......................... 87

INVEGA SUST INJ 117/0.75 ............... 49

INVEGA SUST INJ 156MG/ML ............. 49 INVEGA SUST INJ 234/1.5 ................. 49

INVEGA SUST INJ 39/0.25 ................. 49 INVEGA SUST INJ 78/0.5ML ............... 49

INVEGA TRINZ INJ 273MG ................. 49 INVEGA TRINZ INJ 410MG ................. 49

INVEGA TRINZ INJ 546MG ................. 49 INVEGA TRINZ INJ 819MG ................. 49

INVIRASE TAB 500MG ....................... 11 INVOKAMET TAB 150-1000 ................ 63

INVOKAMET TAB 150-500 .................. 63 INVOKAMET TAB 50-1000 .................. 63

INVOKAMET TAB 50-500MG ............... 63 INVOKAMET XR TAB 150-1000 ........... 63

INVOKAMET XR TAB 150-500 ............. 63

INVOKAMET XR TAB 50-1000 ............. 63 INVOKAMET XR TAB 50-500MG .......... 63

INVOKANA TAB 100MG ..................... 63

INVOKANA TAB 300MG ..................... 63 iodine solution strong 5% (lugol's) ..... 73

ipratropium bromide inhal soln 0.02% 94 ipratropium bromide nasal soln 0.03%

(21 mcg/spray) ................................ 97 ipratropium bromide nasal soln 0.06%

(42 mcg/spray) ................................ 97 ipratropium-albuterol nebu soln

0.5-2.5(3) mg/3ml ........................... 94 irbesartan tab 150 mg ...................... 26

irbesartan tab 300 mg ...................... 26 irbesartan tab 75 mg ........................ 26

irbesartan-hydrochlorothiazide tab 150-12.5 mg ................................... 26


300-12.5 mg ................................... 26 IRESSA TAB 250MG .......................... 19

irinotecan hcl inj 500 mg/25ml (20 mg/ml) ........................................... 23

iron combination cap ........................ 90 iron polysacch complex-vit b12-fa cap

150-0.025-1 mg .............................. 90 iron-folic acid-vit c-vit b6-vit b12-zinc

tab 150-1.25 mg .............................. 90 IROSPAN 24/6 MIS ........................... 90

irrigation solution, physiological ....... 104 ISENTRESS CHW 100MG ................... 10

ISENTRESS CHW 25MG ..................... 10 ISENTRESS HD TAB 600MG ............... 10

ISENTRESS POW 100MG ................... 10

ISENTRESS TAB 400MG .................... 10 isoniazid syrup 50 mg/5ml ................ 12

isoniazid tab 100 mg ........................ 12 isoniazid tab 300 mg ........................ 12

ISORDIL TAB 40MG .......................... 36 isosorbide dinitrate tab 10 mg ........... 36

isosorbide dinitrate tab 20 mg ........... 36 isosorbide dinitrate tab 30 mg ........... 36

isosorbide dinitrate tab 5 mg ............. 36 isosorbide dinitrate tab er 40 mg ........ 36

isosorbide mononitrate tab 10 mg ...... 36 isosorbide mononitrate tab 20 mg ...... 36

isosorbide mononitrate tab er 24hr 120 mg ................................................. 36

isosorbide mononitrate tab er 24hr 30

mg ................................................. 36 isosorbide mononitrate tab er 24hr 60

133

mg .................................................. 36

isotretinoin cap 10 mg ....................... 98 isotretinoin cap 20 mg ....................... 98

isotretinoin cap 30 mg ....................... 98 isotretinoin cap 40 mg ....................... 98

isradipine cap 2.5 mg ........................ 31 isradipine cap 5 mg ........................... 31

ISTALOL SOL 0.5% OP .................... 106 ISUPREL INJ 0.2MG/ML ...................... 96

itraconazole cap 100 mg ..................... 9 ivermectin tab 3 mg .......................... 14

IXEMPRA KIT INJ 15MG ..................... 21 IXEMPRA KIT INJ 45MG ..................... 21

J JADENU TAB 180MG .......................... 84

JADENU TAB 360MG .......................... 84

JADENU TAB 90MG............................ 84 JAKAFI TAB 10MG ............................. 19

JAKAFI TAB 15MG ............................. 19 JAKAFI TAB 20MG ............................. 19

JAKAFI TAB 25MG ............................. 19 JAKAFI TAB 5MG ............................... 19

JANUMET TAB 50-1000 ...................... 61 JANUMET TAB 50-500MG ................... 61

JANUMET XR TAB 100-1000 ............... 61 JANUMET XR TAB 50-1000 ................. 61

JANUMET XR TAB 50-500MG .............. 61 JANUVIA TAB 100MG ......................... 62

JANUVIA TAB 25MG .......................... 62 JANUVIA TAB 50MG .......................... 62

JARDIANCE TAB 10MG ....................... 63

JARDIANCE TAB 25MG ....................... 63 JENTADUETO TAB 2.5-1000 ............... 61

JENTADUETO TAB 2.5-500 ................. 61 JENTADUETO TAB 2.5-850 ................. 61

JENTADUETO TAB XR ........................ 61 JEVTANA INJ 60/1.5ML ...................... 21

JUXTAPID CAP 10MG ......................... 29 JUXTAPID CAP 20MG ......................... 29

JUXTAPID CAP 30MG ......................... 29 JUXTAPID CAP 40MG ......................... 29

JUXTAPID CAP 5MG ........................... 29 JUXTAPID CAP 60MG ......................... 29

JYNARQUE PAK 45-15MG ................... 75 JYNARQUE PAK 60-30MG ................... 75

JYNARQUE PAK 90-30MG ................... 75

K KALBITOR INJ 10MG/ML .................... 84

KALETRA TAB 100-25MG ................... 11

KALETRA TAB 200-50MG ................... 11 KALYDECO PAK 50MG ....................... 96

KALYDECO PAK 75MG ....................... 96 KALYDECO TAB 150MG ..................... 96

KANUMA INJ 20/10ML ....................... 71 KENALOG-10 INJ 10MG/ML ................ 69

KENALOG-40 INJ 40MG/ML ................ 69 KEPIVANCE INJ 6.25MG .................... 78

KEPPRA INJ 500/5ML ........................ 41 KEPPRA SOL 100MG/ML .................... 41

KEPPRA TAB 1000MG ........................ 41 KEPPRA TAB 250MG ......................... 41

KEPPRA TAB 500MG ......................... 41 KEPPRA TAB 750MG ......................... 41

KEPPRA XR TAB 500MG ..................... 41

KEPPRA XR TAB 750MG ..................... 41 ketoconazole cream 2% .................. 100

ketoconazole shampoo 2% .............. 100 KETONE TEST TES ............................ 64

ketoprofen cap er 24hr 200 mg ............ 2 ketorolac tromethamine ophth soln 0.4%

.................................................... 105 ketorolac tromethamine ophth soln 0.5%

.................................................... 105 ketorolac tromethamine tab 10 mg ....... 2

KETOSTIX TES STRIP ........................ 64 KEVEYIS TAB 50MG .......................... 34

KHEDEZLA TAB 100MG ER ................. 44 KHEDEZLA TAB 50MG ER .................. 44

KISQALI 200 PAK FEMARA ................. 19

KISQALI 400 PAK FEMARA ................. 19 KISQALI 600 PAK FEMARA ................. 19

KISQALI TAB 200DOSE ..................... 19 KISQALI TAB 400DOSE ..................... 19

KISQALI TAB 600DOSE ..................... 19 KORLYM TAB 300MG ......................... 71

K-PHOS TAB .................................... 88 K-PHOS TAB NEUTRAL ...................... 88

K-PHOS TAB NO 2 ............................ 88 KUVAN POW 100MG ......................... 72

KUVAN POW 500MG ......................... 72 KUVAN TAB 100MG .......................... 73

KYNAMRO INJ 200MG/ML .................. 29 KYPROLIS SOL 30MG ........................ 21

KYPROLIS SOL 60MG ........................ 21

L labetalol hcl iv soln 5 mg/ml .............. 30

134

labetalol hcl tab 100 mg .................... 30

labetalol hcl tab 200 mg .................... 30 labetalol hcl tab 300 mg .................... 31

LACRISERT MIS 5MG OP .................. 107 lactated ringer's for irrigation ........... 104

lactic acid (ammonium lactate) cream 12% .............................................. 102

lactic acid (ammonium lactate) lotion 10% .............................................. 102

lactulose (encephalopathy) solution 10 gm/15ml ......................................... 78

lactulose solution 10 gm/15ml ............ 78 lamivudine oral soln 10 mg/ml ........... 12

lamivudine tab 100 mg (hbv) ............. 13 lamivudine tab 150 mg ...................... 12

lamivudine tab 300 mg ...................... 12

lamivudine-zidovudine tab 150-300 mg ...................................................... 10

lamotrigine tab 100 mg ..................... 41 lamotrigine tab 150 mg ..................... 41

lamotrigine tab 200 mg ..................... 41 lamotrigine tab 25 mg ....................... 41

lamotrigine tab chewable dispersible 25 mg .................................................. 41

lamotrigine tab chewable dispersible 5 mg .................................................. 41

LANCET CARRY MIS CASE .................. 64 LANCETS MIS ................................... 64

LANCING DEVI MIS ........................... 65 LANOXIN INJ 0.25MG/1 ..................... 33

LANOXIN PED INJ 0.1MG/ML .............. 33

LANOXIN TAB 0.125MG ..................... 34 LANOXIN TAB 0.25MG ....................... 34

LANTUS INJ 100/ML .......................... 62 LANTUS SOLOS INJ 100/ML ............... 62

latanoprost ophth soln 0.005% ......... 108 LATUDA TAB 120MG .......................... 50

LATUDA TAB 20MG ........................... 49 LATUDA TAB 40MG ........................... 49

LATUDA TAB 60MG ........................... 50 LATUDA TAB 80MG ........................... 50

LAZANDA SPR 100MCG ....................... 4 LAZANDA SPR 300MCG ....................... 4

LAZANDA SPR 400MCG ....................... 4 leflunomide tab 10 mg ....................... 85

leflunomide tab 20 mg ....................... 85

LEMTRADA INJ 12/1.2ML ................... 58 LENVIMA CAP 10 MG ......................... 19

LENVIMA CAP 14 MG ........................ 19

LENVIMA CAP 18 MG ........................ 19 LENVIMA CAP 20 MG ........................ 19

LENVIMA CAP 24 MG ........................ 19 LENVIMA CAP 8 MG .......................... 19

LETAIRIS TAB 10MG ......................... 37 LETAIRIS TAB 5MG ........................... 37

letrozole tab 2.5 mg ......................... 17 leucovorin calcium for inj 500 mg ....... 21

leucovorin calcium tab 10 mg ............ 21 leucovorin calcium tab 15 mg ............ 21

leucovorin calcium tab 25 mg ............ 21 leucovorin calcium tab 5 mg .............. 21

LEUKERAN TAB 2MG ......................... 15 LEUKINE INJ 250MCG ....................... 83

leuprolide acetate inj kit 5 mg/ml ....... 17

levalbuterol hcl soln nebu 0.31 mg/3ml (base equiv) .................................... 95



levalbuterol hcl soln nebu conc 1.25 mg/0.5ml (base equiv) ..................... 95

levalbuterol tartrate inhal aerosol 45 mcg/act (base equiv) ........................ 95

LEVEMIR INJ .................................... 62 LEVEMIR INJ FLEXTOUC .................... 62

levetiracetam inj 500 mg/5ml (100 mg/ml) ........................................... 41

levetiracetam oral soln 100 mg/ml ..... 41

levetiracetam tab 1000 mg ................ 41 levetiracetam tab 250 mg ................. 41

levetiracetam tab 500 mg ................. 41 levetiracetam tab 750 mg ................. 41

levetiracetam tab er 24hr 500 mg ...... 41 levetiracetam tab er 24hr 750 mg ...... 41

levobunolol hcl ophth soln 0.5% ....... 106 levocarnitine oral soln 1 gm/10ml (10%)

...................................................... 71 levocarnitine tab 330 mg ................... 71

levocetirizine dihydrochloride soln 2.5 mg/5ml (0.5 mg/ml) ........................ 94

levocetirizine dihydrochloride tab 5 mg 94 levofloxacin ophth soln 0.5% ........... 105

levofloxacin oral soln 25 mg/ml............ 7

LEVOTHYROXIN INJ 200MCG ............. 73 levothyroxine sodium for iv inj 100 mcg

135

...................................................... 74

levothyroxine sodium for iv inj 500 mcg ...................................................... 74

levothyroxine sodium tab 100 mcg ...... 74 levothyroxine sodium tab 112 mcg ...... 74



levothyroxine sodium tab 200 mcg ...... 74 levothyroxine sodium tab 25 mcg ....... 74

levothyroxine sodium tab 300 mcg ...... 74 levothyroxine sodium tab 50 mcg ....... 74

levothyroxine sodium tab 75 mcg ....... 74 levothyroxine sodium tab 88 mcg ....... 74

LEVSIN INJ 0.5MG/ML ....................... 77

LEXIVA SUS 50MG/ML ....................... 11 LEXIVA TAB 700MG ........................... 11

lidocaine hcl gel 2% ........................ 102 lidocaine hcl iv inj 10 mg/ml ............... 27

lidocaine hcl iv inj 20 mg/ml ............... 27 lidocaine hcl laryngotracheal soln 4% 104

LIDOCAINE HCL LOTION 3% ............ 102 lidocaine hcl soln 4% ....................... 102

lidocaine hcl viscous soln 2% ........... 104 lidocaine iv infusion in d5w inj 4 mg/ml

...................................................... 27 lidocaine iv infusion in d5w inj 8 mg/ml

...................................................... 27 lidocaine oint 5% ............................ 102

lidocaine patch 5% .......................... 102

lidocaine-hydrocortisone acetate rectal cream 3-0.5% .................................. 79

lidocaine-hydrocortisone acetate rectal cream kit 2-2% ................................ 79

lidocaine-hydrocortisone acetate rectal cream kit 3-0.5%.............................. 79

lidocaine-hydrocortisone acetate rectal cream kit 3-1% ................................ 79

lidocaine-hydrocortisone acetate rectal gel kit 3-2.5% .................................. 80

lidocaine-prilocaine cream 2.5-2.5% . 102 lidocaine-prilocaine cream kit 2.5-2.5%

.................................................... 102 LIDODERM DIS 5% ......................... 102

lindane shampoo 1% ....................... 103

linezolid for susp 100 mg/5ml ............ 14 linezolid tab 600 mg .......................... 14

LINZESS CAP 145MCG ...................... 78

LINZESS CAP 290MCG ...................... 78 LINZESS CAP 72MCG ........................ 78

LIORESAL INT INJ 0.05MG/1 ............. 58 LIORESAL INT INJ 10MG/20 .............. 58

LIORESAL INT INJ 10MG/5ML ............ 58 LIORESAL INT INJ 40MG/20 .............. 58

liothyronine sodium iv soln 10 mcg/ml 74 liothyronine sodium tab 25 mcg ......... 74

liothyronine sodium tab 5 mcg ........... 74 liothyronine sodium tab 50 mcg ......... 74

lisinopril & hydrochlorothiazide tab 10-12.5 mg ..................................... 24

lisinopril & hydrochlorothiazide tab 20-12.5 mg ..................................... 24

lisinopril & hydrochlorothiazide tab 20-25

mg ................................................. 24 lisinopril tab 10 mg........................... 24

lisinopril tab 2.5 mg ......................... 24 lisinopril tab 20 mg........................... 24

lisinopril tab 30 mg........................... 24 lisinopril tab 40 mg........................... 24

lisinopril tab 5 mg ............................ 24 lithium carbonate cap 150 mg ............ 57

lithium carbonate cap 300 mg ............ 57 lithium carbonate cap 600 mg ............ 57

lithium carbonate tab 300 mg ............ 57 lithium carbonate tab er 300 mg ........ 57

lithium carbonate tab er 450 mg ........ 57 LITHIUM SOL 8MEQ/5ML ................... 57

LO LOESTRIN TAB 1-10-10 ................ 66

LOKELMA PAK 10GM ......................... 73 LOKELMA PAK 5GM ........................... 73

LONSURF TAB 15-6.14 ...................... 21 LONSURF TAB 20-8.19 ...................... 21

loperamide hcl cap 2 mg ................... 75 LOPID TAB 600MG ............................ 28

lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml) ................................. 11

lorazepam conc 2 mg/ml ................... 39 lorazepam inj 2 mg/ml ...................... 39

lorazepam inj 4 mg/ml ...................... 39 lorazepam tab 0.5 mg ....................... 39

lorazepam tab 1 mg ......................... 39 lorazepam tab 2 mg ......................... 39

losartan potassium & hydrochlorothiazide

tab 100-12.5 mg .............................. 26 losartan potassium & hydrochlorothiazide

136

tab 100-25 mg ................................. 26

losartan potassium & hydrochlorothiazide tab 50-12.5 mg ................................ 26

losartan potassium tab 100 mg .......... 26 losartan potassium tab 25 mg ............ 26

losartan potassium tab 50 mg ............ 26 LOTEMAX GEL 0.5% ........................ 106

LOTEMAX OIN 0.5% ........................ 106 LOTEMAX SUS 0.5%........................ 106

LOTRONEX TAB 0.5MG ...................... 78 LOTRONEX TAB 1MG ......................... 78

lovastatin tab 10 mg ......................... 29 lovastatin tab 20 mg ......................... 29

lovastatin tab 40 mg ......................... 29 LOVAZA CAP 1GM ............................. 29

loxapine succinate cap 10 mg ............. 50

loxapine succinate cap 25 mg ............. 50 loxapine succinate cap 5 mg............... 50

loxapine succinate cap 50 mg ............. 50 LUCEMYRA TAB 0.18MG ..................... 59

LUCENTIS SOL 0.3MG ..................... 107 LUCENTIS SOL 0.5MG ..................... 107

LUMIGAN SOL 0.01% ...................... 108 LUPANETA KIT 11.25-5 ...................... 66

LUPANETA KIT 3.75-5 ....................... 66 LUPR DEP-PED INJ 11.25MG ............... 71

LUPR DEP-PED INJ 15MG ................... 71 LUPR DEP-PED INJ 3M 30MG .............. 71

LUPR DEP-PED INJ 7.5MG .................. 71 LUPRON DEPOT INJ 11.25MG ............. 17

LUPRON DEPOT INJ 22.5MG ............... 17

LUPRON DEPOT INJ 3.75MG ............... 17 LUPRON DEPOT INJ 30MG .................. 17

LUPRON DEPOT INJ 45MG .................. 17 LUPRON DEPOT INJ 7.5MG ................. 17

LYRICA CAP 100MG ........................... 55 LYRICA CAP 150MG ........................... 55

LYRICA CAP 200MG ........................... 55 LYRICA CAP 225MG ........................... 55

LYRICA CAP 25MG ............................ 55 LYRICA CAP 300MG ........................... 55

LYRICA CAP 50MG ............................ 55 LYRICA CAP 75MG ............................ 55

LYRICA SOL 20MG/ML ....................... 55 LYSODREN TAB 500MG ...................... 21

M MACUGEN INJ ................................ 107 MAGNEBIND TAB 400 ........................ 90

MAKENA INJ 250MG/ML .................... 73

malathion lotion 0.5% .................... 103 mannitol iv soln 25% ........................ 80

maprotiline hcl tab 25 mg ................. 44 maprotiline hcl tab 50 mg ................. 44

maprotiline hcl tab 75 mg ................. 44 MARNATAL-F CAP ............................. 91

MARPLAN TAB 10MG ......................... 43 MATULANE CAP 50MG ....................... 21

MAVYRET TAB 100-40MG .................. 13 MAXIDEX SUS 0.1% OP .................. 106

m-clear wc liq 100-6.3 ...................... 95 meclizine hcl tab 12.5 mg ................. 76

meclizine hcl tab 25 mg .................... 76 meclofenamate sodium cap 100 mg...... 2

meclofenamate sodium cap 50 mg ....... 2

medroxyprogesterone acetate tab 10 mg...................................................... 73

medroxyprogesterone acetate tab 2.5 mg ................................................. 73

medroxyprogesterone acetate tab 5 mg...................................................... 73

mefenamic acid cap 250 mg ................ 2 megestrol acetate susp 40 mg/ml ...... 17

megestrol acetate tab 20 mg ............. 18 megestrol acetate tab 40 mg ............. 18

MEKINIST TAB 0.5MG ....................... 19 MEKINIST TAB 2MG .......................... 19

MEKTOVI TAB 15MG ......................... 19 meloxicam tab 15 mg ......................... 2

meloxicam tab 7.5 mg ........................ 2

melphalan hcl for inj 50 mg (base equiv)...................................................... 15

memantine hcl oral solution 2 mg/ml .. 43 memantine hcl tab 10 mg ................. 43

memantine hcl tab 5 mg ................... 43 memantine hcl tab 5 mg (28) & 10 mg

(21) titration pak ............................. 43 MEMBRANEBLUE SOL 0.15% ........... 107

M-END PE LIQ .................................. 95 MENEST TAB 0.3MG ......................... 67

MENEST TAB 0.625MG ...................... 67 MENEST TAB 1.25MG ........................ 67

MENOSTAR DIS 14MCG ..................... 68 meperidine hcl oral soln 50 mg/5ml ...... 4

meperidine hcl tab 100 mg .................. 4

meperidine hcl tab 50 mg .................... 4 MEPHYTON TAB 5MG ........................ 90

137

meprobamate tab 200 mg .................. 39

meprobamate tab 400 mg .................. 39 MEPRON SUS ................................... 14

mercaptopurine tab 50 mg ................. 16 mesalamine enema 4 gm ................... 78

mesalamine tab delayed release 1.2 gm ...................................................... 77

MESNEX TAB 400MG ......................... 21 MESTINON SYP 60MG/5ML ................. 59

METAFOLBIC TAB PLUS...................... 88 metaproterenol sulfate syrup 10 mg/5ml

...................................................... 96 metaproterenol sulfate tab 10 mg ....... 96

metaproterenol sulfate tab 20 mg ....... 96 metaxalone tab 800 mg ..................... 58

metformin hcl tab 1000 mg ................ 61

metformin hcl tab 500 mg .................. 61 metformin hcl tab 850 mg .................. 61

metformin hcl tab er 24hr 500 mg ...... 61 metformin hcl tab er 24hr 750 mg ...... 61

methadone hcl soln 10 mg/5ml ........... 4 methadone hcl soln 5 mg/5ml ............. 4

methadone hcl tab 10 mg ................... 4 methadone hcl tab 5 mg ..................... 4

methadone hcl tab for oral susp 40 mg . 4 methamphetamine hcl tab 5 mg ......... 54

methazolamide tab 25 mg ................. 34 methazolamide tab 50 mg ................. 34

methenamine hippurate tab 1 gm ....... 80 methenamine-hyosc-meth blue-benz

acid-phenyl sal tab 81.6mg ................ 80

methimazole tab 10 mg ..................... 73 methimazole tab 5 mg ....................... 73

methocarbamol inj 1000 mg/10ml ...... 58 methocarbamol tab 500 mg ............... 59

methocarbamol tab 750 mg ............... 59 methotrexate sodium for inj 1 gm ....... 16

methotrexate sodium inj 250 mg/10ml (25 mg/ml) ...................................... 16

methotrexate sodium inj 50 mg/2ml (25 mg/ml) ............................................ 16

methotrexate sodium inj pf 1000 mg/40ml (25 mg/ml) ........................ 16

methotrexate sodium inj pf 250 mg/10ml (25 mg/ml) ...................................... 16

methotrexate sodium inj pf 50 mg/2ml

(25 mg/ml) ...................................... 16 methotrexate sodium tab 2.5 mg (base

equiv) ............................................. 16

methoxsalen rapid cap 10 mg .......... 100 methscopolamine bromide tab 2.5 mg 77

methscopolamine bromide tab 5 mg ... 77 methyclothiazide tab 5 mg ................ 34

methyldopa & hydrochlorothiazide tab 250-15 mg ...................................... 35

methyldopa & hydrochlorothiazide tab 250-25 mg ...................................... 35

methyldopa tab 250 mg .................... 35 methyldopa tab 500 mg .................... 35

methylergonovine maleate inj 0.2 mg/ml...................................................... 72

methylphenidate hcl cap er 10 mg (cd) 54 methylphenidate hcl cap er 20 mg (cd) 54


(la) ................................................. 54 methylphenidate hcl cap er 24hr 30 mg

(la) ................................................. 54 methylphenidate hcl cap er 24hr 40 mg

(la) ................................................. 54 methylphenidate hcl cap er 30 mg (cd) 54

methylphenidate hcl cap er 40 mg (cd) 54 methylphenidate hcl cap er 50 mg (cd) 54

methylphenidate hcl cap er 60 mg (cd) 54 methylphenidate hcl chew tab 10 mg .. 54

methylphenidate hcl chew tab 2.5 mg . 54 methylphenidate hcl chew tab 5 mg ... 54

methylphenidate hcl soln 10 mg/5ml .. 54 methylphenidate hcl soln 5 mg/5ml .... 54

methylphenidate hcl tab 10 mg .......... 54

methylphenidate hcl tab 20 mg .......... 54 methylphenidate hcl tab 5 mg ............ 54

methylphenidate hcl tab er 10 mg ...... 54 methylphenidate hcl tab er 24hr 18 mg

...................................................... 54 methylphenidate hcl tab er 24hr 27 mg



...................................................... 54 methylphenidate hcl tab er osmotic

release (osm) 18 mg ........................ 54 methylphenidate hcl tab er osmotic

release (osm) 27 mg ........................ 54

methylphenidate hcl tab er osmotic release (osm) 36 mg ........................ 54

138

methylphenidate hcl tab er osmotic

release (osm) 54 mg ......................... 54 METHYLPR ACE INJ 80MG/ML ............. 69

methylprednisolone acetate inj susp 40 mg/ml ............................................. 69

methylprednisolone acetate inj susp 80 mg/ml ............................................. 69

methylprednisolone sod succ for inj 1000 mg (base equiv) ............................... 69



methylprednisolone tab 16 mg ........... 69 methylprednisolone tab 32 mg ........... 69

methylprednisolone tab 4 mg ............. 69

methylprednisolone tab 8 mg ............. 69 methylprednisolone tab therapy pack 4

mg (21) ........................................... 69 methyltestosterone cap 10 mg ........... 60

metoclopramide hcl inj 5 mg/ml (base equivalent) ...................................... 76

metoclopramide hcl soln 5 mg/5ml (10 mg/10ml) (base equiv) ...................... 76

metoclopramide hcl tab 10 mg (base equivalent) ...................................... 76

metoclopramide hcl tab 5 mg (base equivalent) ...................................... 76

metolazone tab 10 mg ....................... 35 metolazone tab 2.5 mg ...................... 35

metolazone tab 5 mg ........................ 35

metoprolol & hydrochlorothiazide tab 100-25 mg ....................................... 30

metoprolol & hydrochlorothiazide tab 100-50 mg ....................................... 30

metoprolol & hydrochlorothiazide tab 50-25 mg ........................................ 30

metoprolol succinate tab er 24hr 100 mg (tartrate equiv) ................................ 31




metoprolol tartrate iv soln 5 mg/5ml ... 31

metoprolol tartrate tab 100 mg .......... 31 metoprolol tartrate tab 25 mg ............ 31

metoprolol tartrate tab 50 mg ............ 31

metronidazole cap 375 mg ................ 14 metronidazole cream 0.75% ............ 103

metronidazole gel 0.75% ................ 103 metronidazole lotion 0.75% ............. 103

metronidazole tab 250 mg ................. 14 metronidazole tab 500 mg ................. 14

metronidazole vaginal gel 0.75% ....... 81 mexiletine hcl cap 150 mg ................. 27

mexiletine hcl cap 200 mg ................. 27 mexiletine hcl cap 250 mg ................. 27

MIACALCIN INJ 200/ML ..................... 66 midazolam hcl inj 10 mg/10ml (base

equivalent) ...................................... 55 midazolam hcl inj 10 mg/2ml (base

equivalent) ...................................... 55

midazolam hcl inj 2 mg/2ml (base equivalent) ...................................... 55



midazolam hcl inj 5 mg/ml (base equivalent) ...................................... 55


midazolam hcl syrup 2 mg/ml (base equivalent) ...................................... 55

midodrine hcl tab 10 mg ................... 35 midodrine hcl tab 2.5 mg .................. 35

midodrine hcl tab 5 mg ..................... 35

miglitol tab 100 mg .......................... 61 miglitol tab 25 mg ............................ 61

miglitol tab 50 mg ............................ 61 MILLIPRED DP PAK 5MG .................... 69

milrinone lactate in dextrose 5% iv soln 20 mg/100ml ................................... 35

milrinone lactate in dextrose 5% iv soln 40 mg/200ml ................................... 35

milrinone lactate iv soln 10 mg/10ml (base equivalent) ............................. 36



MINIVELLE DIS 0.025MG................... 68

MINIVELLE DIS 0.0375MG ................. 68 MINIVELLE DIS 0.05MG .................... 68

139

MINIVELLE DIS 0.075MG ................... 68

MINIVELLE DIS 0.1MG ....................... 68 MINOCIN CAP 50MG ........................... 9

minocycline hcl cap 100 mg ................ 9 minocycline hcl cap 50 mg .................. 9

minocycline hcl cap 75 mg .................. 9 minocycline hcl tab 100 mg ................. 9

minocycline hcl tab 50 mg .................. 9 minocycline hcl tab 75 mg .................. 9

minoxidil tab 10 mg .......................... 36 minoxidil tab 2.5 mg ......................... 36

MIOSTAT INJ 0.01% OP ................... 108 mirtazapine orally disintegrating tab 15

mg .................................................. 44 mirtazapine orally disintegrating tab 30

mg .................................................. 44

mirtazapine orally disintegrating tab 45 mg .................................................. 44

mirtazapine tab 15 mg ...................... 44 mirtazapine tab 30 mg ...................... 44

mirtazapine tab 45 mg ...................... 44 mirtazapine tab 7.5 mg ..................... 44

MIRVASO GEL 0.33% ...................... 103 misoprostol tab 100 mcg ................... 79

misoprostol tab 200 mcg ................... 79 mitomycin for iv soln 20 mg ............... 21

mitomycin for iv soln 40 mg ............... 21 mitomycin for iv soln 5 mg ................. 21

mitoxantrone hcl inj conc 20 mg/10ml (2 mg/ml) ............................................ 21

mitoxantrone hcl inj conc 25 mg/12.5ml

(2 mg/ml) ........................................ 21 mitoxantrone hcl inj conc 30 mg/15ml (2

mg/ml) ............................................ 22 modafinil tab 100 mg ........................ 59

modafinil tab 200 mg ........................ 59 moexipril hcl tab 15 mg ..................... 24

moexipril hcl tab 7.5 mg .................... 24 moexipril-hydrochlorothiazide tab

15-12.5 mg ...................................... 24 moexipril-hydrochlorothiazide tab 15-25

mg .................................................. 24 moexipril-hydrochlorothiazide tab

7.5-12.5 mg ..................................... 24 MOI-STIR SOL ................................ 104

mometasone furoate cream 0.1% ..... 102

mometasone furoate oint 0.1% ........ 102 mometasone furoate solution 0.1%

(lotion) ......................................... 102

MONSELS FERR SOL SUBSULF ........... 83 montelukast sodium chew tab 4 mg

(base equiv) .................................... 96 montelukast sodium chew tab 5 mg

(base equiv) .................................... 96 montelukast sodium oral granules packet

4 mg (base equiv) ............................ 96 montelukast sodium tab 10 mg (base

equiv) ............................................. 96 morphine sulfate oral soln 10 mg/5ml ... 4

morphine sulfate oral soln 100 mg/5ml (20 mg/ml) ....................................... 4

morphine sulfate oral soln 20 mg/5ml ... 4 morphine sulfate suppos 10 mg ........... 4

morphine sulfate suppos 20 mg ........... 4

MORPHINE SULFATE SUPPOS 30 MG ..... 4 morphine sulfate suppos 5 mg ............. 4

morphine sulfate tab 15 mg ................. 4 morphine sulfate tab 30 mg ................. 4

morphine sulfate tab er 100 mg ........... 4 morphine sulfate tab er 15 mg ............. 4

morphine sulfate tab er 200 mg ........... 4 morphine sulfate tab er 30 mg ............. 4

morphine sulfate tab er 60 mg ............. 4 MOUTHKOTE SOL ........................... 104

MOVANTIK TAB 12.5MG .................... 78 MOVANTIK TAB 25MG ....................... 78

MOXEZA SOL 0.5% ........................ 105 moxifloxacin hcl ophth soln 0.5% (base

equiv) ........................................... 105

moxifloxacin hcl tab 400 mg (base equiv)........................................................ 7

MOZOBIL INJ ................................... 85 MULPLETA TAB 3MG ......................... 85

MULTAQ TAB 400MG......................... 27 MULTI-LANCET KIT DEVICE ............... 65

mupirocin calcium cream 2% ............. 99 mupirocin oint 2% ............................ 99

M-VIT TAB 27-1MG ........................... 91 MYALEPT INJ 11.3MG ........................ 72

mycophenolate mofetil cap 250 mg .... 87 mycophenolate mofetil for oral susp 200

mg/ml ............................................ 87 mycophenolate mofetil tab 500 mg..... 87


(mycophenolic acid equiv) ................. 87 mycophenolate sodium tab dr 360 mg

140

(mycophenolic acid equiv).................. 87

MYLERAN TAB 2MG ........................... 15 MYNATAL CAP................................... 91

MYNATAL TAB................................... 91 MYNATAL TAB ADVANCE .................... 91

MYNATAL-Z TAB ............................... 91 MYNATE 90 TAB PLUS ........................ 91

MYRBETRIQ TAB 25MG ...................... 81 MYRBETRIQ TAB 50MG ...................... 81

N nabumetone tab 500 mg ..................... 2

nabumetone tab 750 mg ..................... 2 nadolol & bendroflumethiazide tab 40-5

mg .................................................. 30 nadolol tab 20 mg ............................. 31

nadolol tab 40 mg ............................. 31

nadolol tab 80 mg ............................. 31 NAGLAZYME INJ 1MG/ML ................... 71

naloxone hcl inj 0.4 mg/ml................. 59 naloxone hcl inj 4 mg/10ml ................ 59

naloxone hcl soln cartridge 0.4 mg/ml . 59 naloxone hcl soln prefilled syringe 2

mg/2ml ........................................... 59 naltrexone hcl tab 50 mg ................... 59

naproxen sodium tab 275 mg .............. 2 naproxen sodium tab 550 mg .............. 2

naproxen susp 125 mg/5ml ................. 2 naproxen tab 250 mg ......................... 2

naproxen tab 375 mg ......................... 2 naproxen tab 500 mg ......................... 2

naproxen tab ec 375 mg ..................... 2

naproxen tab ec 500 mg ..................... 2 naratriptan hcl tab 1 mg (base equiv).. 56

naratriptan hcl tab 2.5 mg (base equiv) ...................................................... 56

NARCAN SPR .................................... 59 NATACHEW CHW .............................. 92

NATACYN SUS 5% OP ..................... 106 nateglinide tab 120 mg ...................... 62

nateglinide tab 60 mg ....................... 62 NATELLE ONE CAP ............................ 92

NATPARA INJ 100MCG ....................... 66 NATPARA INJ 25MCG ......................... 66

NATPARA INJ 50MCG ......................... 66 NATPARA INJ 75MCG ......................... 66

NATRECOR INJ 1.5MG ....................... 36

NATURE THROI TAB 162.5MG ............. 74 NATURE-THROI TAB 113.75MG ........... 74

NATURE-THROI TAB 130MG .............. 74

NATURE-THROI TAB 146.25MG .......... 74 NATURE-THROI TAB 16.25MG ............ 74

NATURE-THROI TAB 195MG .............. 74 NATURE-THROI TAB 260MG .............. 74

NATURE-THROI TAB 32.5MG ............. 74 NATURE-THROI TAB 325MG .............. 74

NATURE-THROI TAB 48.75MG ............ 74 NATURE-THROI TAB 81.25MG ............ 74

NATURE-THROI TAB 97.5MG ............. 74 NEBUPENT INH 300MG ..................... 14

NEBUSAL NEB 6% ............................ 97 NEEVO DHA CAP 27-1.13 .................. 92

neomycin sulfate tab 500 mg ............... 6 neomycin-bacitrac zn-polymyx

5(3.5)mg-400unt-10000unt op oin ... 105

neomycin-polymy-gramicid op sol 1.75-10000-0.025mg-unt-mg/ml ..... 105

neomycin-polymyxin b gu irrigation soln...................................................... 80

neomycin-polymyxin-dexamethasone ophth oint 0.1% ............................. 104

neomycin-polymyxin-dexamethasone ophth susp 0.1% ............................ 104

neomycin-polymyxin-hc ophth susp .. 105 neomycin-polymyxin-hc otic soln 1% 108

neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000 unit/ml-1% ............... 108

NEORAL CAP 100MG ......................... 87 NEORAL CAP 25MG ........................... 87

NEORAL SOL 100MG/ML .................... 87

NEPHPLEX RX TAB ............................ 90 NEPHRON FA TAB ............................. 90

NERLYNX TAB 40MG ......................... 19 NESTABS ABC MIS ........................... 92

NESTABS DHA PAK ........................... 92 NEULASTA INJ 6MG/0.6M .................. 83

NEUPOGEN INJ 300/0.5 .................... 83 NEUPOGEN INJ 300MCG .................... 83

NEUPOGEN INJ 480/0.8 .................... 83 NEUPOGEN INJ 480MCG .................... 83

NEURIN-SL SUB ............................... 90 NEVANAC SUS 0.1% ....................... 105

nevirapine tab 200 mg ...................... 11 nevirapine tab er 24hr 100 mg........... 11

nevirapine tab er 24hr 400 mg........... 11

NEWGEN TAB 32-1MG ...................... 92 NEXAVAR TAB 200MG ....................... 19

141

NEXTERONE INJ ................................ 27

niacin tab er 1000 mg (antihyperlipidemic) .......................... 29

niacin tab er 500 mg (antihyperlipidemic) ...................................................... 29

niacin tab er 750 mg (antihyperlipidemic) ...................................................... 29

NICADAN TAB .................................. 90 nicardipine hcl cap 20 mg .................. 31

nicardipine hcl cap 30 mg .................. 32 nicardipine hcl iv soln 2.5 mg/ml ........ 32

NICOTROL INH ................................. 60 NICOTROL NS SPR 10MG/ML .............. 60

nifedipine cap 20 mg ......................... 32 nifedipine tab er 24hr 30 mg .............. 32

nifedipine tab er 24hr 60 mg .............. 32

nifedipine tab er 24hr 90 mg .............. 32 nifedipine tab er 24hr osmotic release 90

mg .................................................. 32 NILANDRON TAB 150MG .................... 17

nimodipine cap 30 mg ....................... 32 NINLARO CAP 2.3MG ......................... 22

NINLARO CAP 3MG ............................ 22 NINLARO CAP 4MG ............................ 22

NIPENT INJ 10MG ............................. 22 nisoldipine tab er 24hr 17 mg ............. 32

nisoldipine tab er 24hr 20 mg ............. 32 nisoldipine tab er 24hr 25.5 mg .......... 32

nisoldipine tab er 24hr 30 mg ............. 32 nisoldipine tab er 24hr 34 mg ............. 32

nisoldipine tab er 24hr 40 mg ............. 32

nisoldipine tab er 24hr 8.5 mg ............ 32 NITRO-BID OIN 2% .......................... 36

NITRO-DUR DIS 0.1MG/HR ................ 36 NITRO-DUR DIS 0.2MG/HR ................ 36



nitrofurantoin macrocrystalline cap 100 mg .................................................. 14

nitrofurantoin macrocrystalline cap 50 mg .................................................. 14

nitrofurantoin monohydrate macrocrystalline cap 100 mg .............. 14

NITROGLYCER INJ 5MG/ML ................ 36

nitroglycerin cap er 2.5 mg ................ 36 nitroglycerin cap er 6.5 mg ................ 36

nitroglycerin cap er 9 mg .................. 36

nitroglycerin sl tab 0.3 mg................. 36 nitroglycerin sl tab 0.4 mg................. 36

nitroglycerin sl tab 0.6 mg................. 36 nitroglycerin td patch 24hr 0.1 mg/hr . 37

nitroglycerin td patch 24hr 0.2 mg/hr . 37 nitroglycerin td patch 24hr 0.4 mg/hr . 37

nitroglycerin td patch 24hr 0.6 mg/hr . 37 nitroglycerin tl soln 0.4 mg/spray (400

mcg/spray) ..................................... 36 NITROLINGUAL SPR PUMPSPRA ......... 36

NITROSTAT SUB 0.3MG .................... 36 NITROSTAT SUB 0.4MG .................... 36

NITROSTAT SUB 0.6MG .................... 36 NIVA-PLUS TAB ................................ 92

NOCLOT-50 SOL ACD-A .................... 84

NORDITROPIN INJ 10/1.5ML .............. 70 NORDITROPIN INJ 15/1.5ML .............. 70

NORDITROPIN INJ 30/3ML ................ 70 NORDITROPIN INJ 5/1.5ML ............... 70

norethindrone acetate tab 5 mg ......... 73 norethindrone acetate-ethinyl estradiol

tab 0.5 mg-2.5 mcg ......................... 67 norethindrone acetate-ethinyl estradiol

tab 1 mg-5 mcg ............................... 67 NORPACE CAP 100MG CR .................. 27

NORPACE CAP 150MG CR .................. 27 NORTHERA CAP 200MG ..................... 36

NORTHERA CAP 300MG ..................... 36 nortriptyline hcl cap 10 mg ................ 47

nortriptyline hcl cap 25 mg ................ 47

nortriptyline hcl cap 50 mg ................ 47 nortriptyline hcl cap 75 mg ................ 47

nortriptyline hcl soln 10 mg/5ml ........ 47 NORVASC TAB 10MG ........................ 32

NORVASC TAB 2.5MG ....................... 32 NORVASC TAB 5MG .......................... 32

NORVIR SOL 80MG/ML ...................... 11 NORVIR TAB 100MG ......................... 11

NOVOFINE MIS 30GX8MM ................. 65 NOVOLIN INJ 70/30 .......................... 62

NOVOLIN N INJ U-100 ...................... 62 NOVOLIN R INJ U-100 ...................... 62

NOVOLOG INJ 100/ML ...................... 62 NOVOLOG INJ FLEXPEN..................... 62

NOVOLOG INJ PENFILL ..................... 62

NOVOLOG MIX INJ 70/30 .................. 62 NOVOLOG MIX INJ FLEXPEN .............. 62

142

NOVOTWIST MIS 32GX5MM ............... 65

NOXAFIL SUS 40MG/ML ...................... 9 NOXAFIL TAB 100MG.......................... 9

NPLATE INJ 250MCG ......................... 85 NPLATE INJ 500MCG ......................... 85

NUCALA INJ 100MG ........................... 97 NUEDEXTA CAP 20-10MG ................... 60

NULOJIX INJ 250MG .......................... 88 NUMOISYN LOZ .............................. 104

NUPLAZID TAB 17MG ........................ 50 nystatin cream 100000 unit/gm ........ 100

nystatin oint 100000 unit/gm ........... 100 nystatin susp 100000 unit/ml .............. 9

nystatin tab 500000 unit ..................... 9 nystatin topical powder 100000 unit/gm

.................................................... 100

nystatin-triamcinolone cream 100000-0.1 unit/gm-% ................... 100

nystatin-triamcinolone oint 100000-0.1 unit/gm-% ..................................... 100

O OB COMPLETE CAP ONE ..................... 92

OB COMPLETE CAP PETITE ................. 92 OB COMPLETE TAB ............................ 92

OB COMPLETE TAB PREMIER .............. 92 OBIZUR INJ 500 UNIT ....................... 82

OBSTETRIX EC TAB ........................... 92 OBSTETRIX PAK DHA ........................ 92

O-CAL FA TAB .................................. 92 O-CAL TAB PRENATAL ....................... 92

OCALIVA TAB 10MG .......................... 78

OCALIVA TAB 5MG ............................ 78 OCTAGAM INJ 10GM .......................... 86

OCTAGAM INJ 1GM ........................... 86 OCTAGAM INJ 2.5GM ......................... 86

OCTAGAM INJ 25GM .......................... 86 OCTAGAM INJ 2GM/20ML ................... 86

OCTAGAM INJ 5GM ........................... 86 octreotide acetate inj 100 mcg/ml (0.1

mg/ml) ............................................ 72 octreotide acetate inj 1000 mcg/ml (1

mg/ml) ............................................ 72 octreotide acetate inj 200 mcg/ml (0.2

mg/ml) ............................................ 72 octreotide acetate inj 50 mcg/ml (0.05

mg/ml) ............................................ 72

octreotide acetate inj 500 mcg/ml (0.5 mg/ml) ............................................ 72

ODOMZO CAP 200MG ....................... 22

OFEV CAP 100MG ............................. 97 OFEV CAP 150MG ............................. 97

ofloxacin ophth soln 0.3% ............... 105 ofloxacin otic soln 0.3% .................. 108

olanzapine for im inj 10 mg ............... 50 olanzapine orally disintegrating tab 10

mg ................................................. 50 olanzapine orally disintegrating tab 15

mg ................................................. 50 olanzapine orally disintegrating tab 20

mg ................................................. 50 olanzapine orally disintegrating tab 5 mg

...................................................... 50 olanzapine tab 10 mg ....................... 50

olanzapine tab 15 mg ....................... 50

olanzapine tab 2.5 mg ...................... 50 olanzapine tab 20 mg ....................... 50

olanzapine tab 5 mg ......................... 50 olanzapine tab 7.5 mg ...................... 50

olopatadine hcl nasal soln 0.6% ......... 97 olopatadine hcl ophth soln 0.1% (base

equivalent) .................................... 106 olopatadine hcl ophth soln 0.2% (base

equivalent) .................................... 106 OMECLAMOX- MIS PAK ..................... 80

omega-3-acid ethyl esters cap 1 gm ... 29 OMNIPRED SUS 1% OP ................... 106

ondansetron hcl inj 4 mg/2ml (2 mg/ml)...................................................... 76

ondansetron hcl inj 40 mg/20ml (2

mg/ml) ........................................... 76 ondansetron hcl oral soln 4 mg/5ml .... 76

ondansetron hcl tab 24 mg ................ 76 ondansetron hcl tab 4 mg .................. 76

ondansetron hcl tab 8 mg .................. 76 ondansetron orally disintegrating tab 4

mg ................................................. 76 ondansetron orally disintegrating tab 8

mg ................................................. 76 ONETOUCH KIT ULT MINI .................. 65

ONETOUCH KIT ULTRA 2 ................... 65 ONETOUCH KIT ULTRALNK ................ 65

ONETOUCH KIT VERIO ...................... 65 ONETOUCH KIT VERIO FL .................. 65

ONETOUCH KIT VERIO IQ ................. 65

ONETOUCH TES ULTRA BL ................. 65 ONETOUCH TES VERIO ..................... 65

143

ONFI SUS 2.5MG/ML ......................... 41

ONFI TAB 10MG ................................ 41 ONFI TAB 20MG ................................ 41

ORACIT SOL ..................................... 80 ORAMAGICRX SUS .......................... 104

ORENITRAM TAB 0.125MG ................. 37 ORENITRAM TAB 0.25MG ................... 37

ORENITRAM TAB 1MG ....................... 37 ORENITRAM TAB 2.5MG ..................... 37

ORENITRAM TAB 5MG ....................... 37 ORFADIN CAP 10MG .......................... 70

ORFADIN CAP 2MG ........................... 70 ORFADIN CAP 5MG ........................... 70

ORFADIN SUS 4MG/ML ...................... 70 ORKAMBI TAB 200-125 ..................... 96

orphenadrine citrate inj 30 mg/ml ....... 59

orphenadrine citrate tab er 12hr 100 mg ...................................................... 59

oseltamivir phosphate cap 30 mg (base equiv) ............................................. 13



oseltamivir phosphate for susp 6 mg/ml (base equiv) ..................................... 13

OSMOPREP TAB 1.5GM ...................... 78 OTEZLA TAB 10/20/30 ....................... 87

OTEZLA TAB 30MG ............................ 87 OTREXUP INJ 10MG .......................... 85

OTREXUP INJ 12.5/0.4 ...................... 85

OTREXUP INJ 15MG .......................... 86 OTREXUP INJ 17.5/0.4 ...................... 86

OTREXUP INJ 20MG .......................... 86 OTREXUP INJ 22.5/0.4 ...................... 86

OTREXUP INJ 25MG .......................... 86 oxaliplatin for iv inj 100 mg ................ 15

oxaliplatin for iv inj 50 mg ................. 15 oxaliplatin iv soln 100 mg/20ml .......... 15

oxaliplatin iv soln 50 mg/10ml ............ 15 oxaprozin tab 600 mg ........................ 2

oxazepam cap 10 mg ........................ 39 oxazepam cap 15 mg ........................ 39

oxazepam cap 30 mg ........................ 39 oxcarbazepine susp 300 mg/5ml (60

mg/ml) ............................................ 41

oxcarbazepine tab 150 mg ................. 41 oxcarbazepine tab 300 mg ................. 41

oxcarbazepine tab 600 mg ................ 41

oxiconazole nitrate cream 1% .......... 100 OXSORALEN-UL CAP 10MG .............. 100

oxybutynin chloride syrup 5 mg/5ml ... 81 oxybutynin chloride tab 5 mg ............ 81

oxybutynin chloride tab er 24hr 10 mg 81 oxybutynin chloride tab er 24hr 15 mg 81

oxybutynin chloride tab er 24hr 5 mg . 81 oxycodone hcl cap 5 mg ...................... 4

oxycodone hcl conc 100 mg/5ml (20 mg/ml) ............................................. 4

oxycodone hcl soln 5 mg/5ml .............. 5 oxycodone hcl tab 10 mg .................... 5

oxycodone hcl tab 15 mg .................... 5 oxycodone hcl tab 20 mg .................... 5

oxycodone hcl tab 30 mg .................... 5

oxycodone hcl tab 5 mg ...................... 5 oxycodone hcl tab er 12hr deter 10 mg . 5

oxycodone hcl tab er 12hr deter 15 mg . 5 oxycodone hcl tab er 12hr deter 20 mg . 5



oxycodone w/ acetaminophen tab 10-325 mg ................................................... 5

oxycodone w/ acetaminophen tab 2.5-325 mg ....................................... 5

oxycodone w/ acetaminophen tab 5-325 mg ................................................... 5

oxycodone w/ acetaminophen tab

7.5-325 mg ....................................... 5 oxycodone-aspirin tab 4.8355-325 mg .. 5

oxycodone-ibuprofen tab 5-400 mg ...... 5 OXYCONTIN TAB 10MG CR .................. 5

OXYCONTIN TAB 15MG CR .................. 5 OXYCONTIN TAB 20MG CR .................. 5



oxymorphone hcl tab 10 mg ................ 5 oxymorphone hcl tab 5 mg .................. 5

oxymorphone hcl tab er 12hr 10 mg ..... 5 oxymorphone hcl tab er 12hr 15 mg ..... 5

oxymorphone hcl tab er 12hr 20 mg ..... 5

oxymorphone hcl tab er 12hr 30 mg ..... 5 oxymorphone hcl tab er 12hr 40 mg ..... 5

144

oxymorphone hcl tab er 12hr 5 mg ...... 5

oxymorphone hcl tab er 12hr 7.5 mg ... 5 P paclitaxel iv conc 100 mg/16.7ml (6 mg/ml) ............................................ 22

paclitaxel iv conc 150 mg/25ml (6 mg/ml) ............................................ 22

paclitaxel iv conc 30 mg/5ml (6 mg/ml) ...................................................... 22

paclitaxel iv conc 300 mg/50ml (6 mg/ml) ............................................ 22

paliperidone tab er 24hr 1.5 mg ......... 50 paliperidone tab er 24hr 3 mg ............ 50

paliperidone tab er 24hr 6 mg ............ 50 paliperidone tab er 24hr 9 mg ............ 50

PALYNZIQ INJ 10/0.5ML .................... 73

PALYNZIQ INJ 2.5/0.5 ....................... 73 PALYNZIQ INJ 20MG/ML .................... 73

pamidronate disodium for inj 30 mg .... 66 pamidronate disodium for inj 90 mg .... 66

pamidronate disodium iv soln 3 mg/ml 66 pamidronate disodium iv soln 9 mg/ml 66

PAMIDRONATE INJ 6MG/ML................ 66 PANCREAZE CAP 10500UNT ............... 79

PANCREAZE CAP 16800UNT ............... 79 PANCREAZE CAP 21000UNT ............... 79

PANCREAZE CAP 4200UNIT ................ 79 PANRETIN GEL 0.1% ....................... 103

papaverine hcl inj 30 mg/ml ............... 36 paricalcitol cap 1 mcg ........................ 71

paricalcitol cap 2 mcg ........................ 71

paricalcitol cap 4 mcg ........................ 71 paromomycin sulfate cap 250 mg ........ 6

paroxetine hcl tab 10 mg ................... 45 paroxetine hcl tab 20 mg ................... 45

paroxetine hcl tab 30 mg ................... 45 paroxetine hcl tab 40 mg ................... 46

paroxetine hcl tab er 24hr 12.5 mg ..... 46 paroxetine hcl tab er 24hr 25 mg ........ 46

paroxetine hcl tab er 24hr 37.5 mg ..... 46 PASER GRA 4GM ............................... 12

PATANASE SPR 0.6% ........................ 97 PAXIL SUS 10MG/5ML ....................... 46

PAZEO DRO 0.7% ........................... 106 pediatric multiple vitamin w/ minerals &

c drops 45 mg/ml ............................. 90

pediatric multiple vitamins w/ fl-fe drops 0.25-10 mg/ml ................................. 90


0.25-6 mg/ml .................................. 90 pediatric multiple vitamins w/ fluoride

chew tab 0.5 mg .............................. 90 peg 3350-kcl-na bicarb-nacl-na sulfate

for soln 236 gm ............................... 78 peg 3350-kcl-sod bicarb-nacl for soln

420 gm ........................................... 78 PEGASYS INJ 180MCG/M ................... 87

PEGASYS INJ PROCLICK .................... 87 PEG-INTRON KIT 50MCG ................... 87

PEN NEEDLES MIS 31GX6MM ............. 65 penicillin v potassium for soln 125

mg/5ml ............................................. 8 penicillin v potassium for soln 250

mg/5ml ............................................. 8

penicillin v potassium tab 250 mg ........ 8 penicillin v potassium tab 500 mg ........ 8

PENLAC SOL 8% ............................ 100 PENTASA CAP 250MG CR .................. 77

PENTASA CAP 500MG CR .................. 77 pentazocine w/ naloxone tab 50-0.5 mg 5

pentoxifylline tab er 400 mg .............. 84 PERFOROMIST NEB 20MCG ............... 95

perindopril erbumine tab 2 mg ........... 24 perindopril erbumine tab 4 mg ........... 24

perindopril erbumine tab 8 mg ........... 24 PERJETA INJ 420/14ML ..................... 22

permethrin cream 5% ..................... 103 perphenazine tab 16 mg ................... 51

perphenazine tab 2 mg ..................... 51

perphenazine tab 4 mg ..................... 51 perphenazine tab 8 mg ..................... 51

perphenazine-amitriptyline tab 2-10 mg...................................................... 51





PERTZYE CAP 16000U ....................... 79 PERTZYE CAP 8000UNIT .................... 79

phenazopyridine hcl tab 100 mg ........ 80

phenazopyridine hcl tab 200 mg ........ 80 phenelzine sulfate tab 15 mg ............. 43

145

PHENOBARB INJ 65MG/ML ................. 41

phenobarbital elixir 20 mg/5ml ........... 41 phenobarbital sodium inj 130 mg/ml ... 41

phenobarbital tab 100 mg .................. 42 phenobarbital tab 15 mg .................... 41

phenobarbital tab 16.2 mg ................. 42 phenobarbital tab 30 mg .................... 42

phenobarbital tab 32.4 mg ................. 42 phenobarbital tab 60 mg .................... 42

phenobarbital tab 64.8 mg ................. 42 phenobarbital tab 97.2 mg ................. 42

PHENOL LIQ 89% ........................... 100 phenoxybenzamine hcl cap 10 mg ...... 25

PHENYLADE POW GMP ....................... 88 phenylephrine hcl inj 10 mg/ml .......... 38

phenylephrine hcl ophth soln 10% .... 107

phenylephrine hcl ophth soln 2.5% ... 107 PHENYTEK CAP 200MG ...................... 42

PHENYTEK CAP 300MG ...................... 42 phenytoin chew tab 50 mg ................. 42

phenytoin sodium extended cap 100 mg ...................................................... 42



phenytoin sodium inj 50 mg/ml .......... 42 phenytoin susp 125 mg/5ml ............... 42

PHOSPHOLINE SOL 0.125%OP ......... 108 PHOTOFRIN INJ 75MG ....................... 22

PHYSOS SALIC INJ 1MG/ML ............... 65

phytonadione tab 5 mg ...................... 90 pilocarpine hcl ophth soln 1% ........... 108

pilocarpine hcl ophth soln 4% ........... 108 pilocarpine hcl tab 5 mg .................... 79

pilocarpine hcl tab 7.5 mg .................. 79 pimecrolimus cream 1% .................. 100

pimozide tab 1 mg ............................ 52 pimozide tab 2 mg ............................ 52

pindolol tab 10 mg ............................ 31 pindolol tab 5 mg .............................. 31

pioglitazone hcl tab 15 mg (base equiv) ...................................................... 62

pioglitazone hcl tab 30 mg (base equiv) ...................................................... 62

pioglitazone hcl tab 45 mg (base equiv)

...................................................... 62 pioglitazone hcl-glimepiride tab 30-2 mg

...................................................... 62

pioglitazone hcl-glimepiride tab 30-4 mg...................................................... 62

pioglitazone hcl-metformin hcl tab 15-500 mg ...................................... 62

pioglitazone hcl-metformin hcl tab 15-850 mg ...................................... 62

piroxicam cap 10 mg .......................... 2 piroxicam cap 20 mg .......................... 2

PLEGRIDY INJ .................................. 58 PLEGRIDY INJ PEN ........................... 58

PLEGRIDY INJ STARTER .................... 58 PLEGRIDY PEN INJ STARTER .............. 58

PNV OB+DHA PAK ............................ 92 PNV PRENATAL TAB PLUS .................. 92

PNV TABS TAB 29-1MG ..................... 92

PNV-DHA CAP DOCUSATE ................. 92 PODOCON SOL 25% ....................... 103

podofilox soln 0.5% ........................ 103 polyethylene glycol 3350 oral powder . 78

polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1% ....................... 105

POLY-VI-FLOR CHW 0.25MG .............. 90 POLY-VI-FLOR CHW 0.5MG ................ 90

POLY-VI-FLOR CHW 1MG ................... 91 POLY-VI-FLOR SUS /IRON ................. 91

POLY-VI-FLOR SUS 0.25/ML .............. 91 POMALYST CAP 1MG ......................... 18

POMALYST CAP 2MG ......................... 18 POMALYST CAP 3MG ......................... 18

POMALYST CAP 4MG ......................... 18

pot & sod citrates w/ cit ac soln 550-500-334 mg/5ml ....................... 81

pot bicarbonate & chloride effer tab 25 meq ............................................... 88

pot phos monobasic w/sod phos di & monobas tab 155-852-130mg ............ 88

potassium bicarbonate effer tab 25 meq...................................................... 89

potassium chloride cap er 10 meq ...... 89 potassium chloride cap er 8 meq ........ 89

potassium chloride microencapsulated crys er tab 10 meq ........................... 89

POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 15

MEQ ............................................... 89

potassium chloride microencapsulated crys er tab 20 meq ........................... 89

146

potassium chloride oral soln 10% (20

meq/15ml) ....................................... 89 potassium chloride oral soln 20% (40

meq/15ml) ....................................... 89 potassium chloride powder packet 20

meq ................................................ 89 potassium chloride tab er 10 meq ....... 89

potassium chloride tab er 20 meq (1500 mg) ................................................ 89

potassium chloride tab er 8 meq (600 mg) ................................................ 89

potassium citrate & citric acid powder pack 3300-1002 mg .......................... 81

potassium citrate & citric acid soln 1100-334 mg/5ml ............................. 81

potassium citrate tab er 10 meq (1080

mg) ................................................ 81 potassium citrate tab er 15 meq (1620

mg) ................................................ 81 potassium citrate tab er 5 meq (540 mg)

...................................................... 81 PR CREAM KIT ................................ 103

PR NATAL 400 PAK ............................ 92 PR NATAL 430 PAK ............................ 92

PR NATAL 430 PAK EC ....................... 92 pramipexole dihydrochloride tab 0.125

mg .................................................. 48 pramipexole dihydrochloride tab 0.25 mg

...................................................... 48 pramipexole dihydrochloride tab 0.5 mg

...................................................... 48

pramipexole dihydrochloride tab 0.75 mg ...................................................... 48

pramipexole dihydrochloride tab 1 mg . 48 pramipexole dihydrochloride tab 1.5 mg

...................................................... 48 pramipexole dihydrochloride tab er 24hr

0.375 mg ......................................... 48 pramipexole dihydrochloride tab er 24hr

0.75 mg .......................................... 48 pramipexole dihydrochloride tab er 24hr

1.5 mg ............................................ 48 pramipexole dihydrochloride tab er 24hr

2.25 mg .......................................... 48 pramipexole dihydrochloride tab er 24hr

3 mg ............................................... 48

pramipexole dihydrochloride tab er 24hr 3.75 mg .......................................... 48

pramipexole dihydrochloride tab er 24hr

4.5 mg ............................................ 48 pramoxine-hc cream 1-2.5% ........... 100

prasugrel hcl tab 10 mg (base equiv).. 84 prasugrel hcl tab 5 mg (base equiv) ... 84

pravastatin sodium tab 10 mg ........... 29 pravastatin sodium tab 20 mg ........... 29

pravastatin sodium tab 40 mg ........... 29 pravastatin sodium tab 80 mg ........... 29

prazosin hcl cap 1 mg ....................... 25 prazosin hcl cap 2 mg ....................... 25

prazosin hcl cap 5 mg ....................... 25 PRED MILD SUS 0.12% OP .............. 106

PRED-G S.O.P OIN OP ..................... 105 PRED-G SUS OP ............................. 105

prednicarbate cream 0.1% .............. 102

prednicarbate oint 0.1% ................. 102 prednisolone acetate ophth susp 1% 106

prednisolone sod phosph oral soln 6.7 mg/5ml (5 mg/5ml base) .................. 69

prednisolone sod phosphate oral soln 10 mg/5ml (base equiv) ........................ 69



prednisolone sodium phosphate oral soln 25 mg/5ml (base eq) ........................ 70

prednisolone syrup 15 mg/5ml (usp solution equivalent) .......................... 70

prednisone oral soln 5 mg/5ml ........... 70

prednisone tab 1 mg ......................... 70 prednisone tab 10 mg ....................... 70

prednisone tab 2.5 mg ...................... 70 prednisone tab 20 mg ....................... 70

prednisone tab 5 mg ......................... 70 prednisone tab 50 mg ....................... 70

PREFEST TAB ................................... 67 PREMARIN INJ 25MG ........................ 67

PREMARIN TAB 0.3MG ...................... 67 PREMARIN TAB 0.45MG .................... 67

PREMARIN TAB 0.625MG ................... 67 PREMARIN TAB 0.9MG ...................... 67

PREMARIN TAB 1.25MG .................... 67 PREMARIN VAG CRE 0.625MG ............ 68

PREMPHASE TAB .............................. 67

PREMPRO TAB .625-2.5 .................... 67 PREMPRO TAB 0.3-1.5 ...................... 67

147

PREMPRO TAB 0.45-1.5 ..................... 67

PREMPRO TAB 0.625-5 ...................... 67 PRENAISSANCE CAP PLUS .................. 92

PRENAT PLUS TAB 27-1MG ................ 92 prenat w/o a w/fefum-methfol-fa-dha

cap 27-0.6-0.4-300 mg ..................... 92 PRENATA CHW 29-1MG ..................... 92

PRENATAL TAB 27-1MG ..................... 92 PRENATAL TAB PLUS ......................... 92

PRENATAL VIT TAB LOW IRON ............ 92 prenatal vit w/ dss-fe fumarate-fa tab

29-1 mg .......................................... 92 prenatal vit w/ fe fumarate-fa chew tab

29-1 mg .......................................... 92 prenatal vit w/ fe fumarate-fa tab 27-1

mg .................................................. 92

prenatal vit w/ fe fumarate-fa tab 28-1 mg .................................................. 92

prenatal vit w/ fe fum-methylfolate-fa tab 27-0.6-0.4 mg ............................ 92

PRENATAL+FE TAB 29-1MG ................ 92 PRENATAL-U CAP 106.5-1 .................. 92

PRENATE AM TAB 1MG ...................... 92 PRENATE CAP ENHANCE .................... 92

PRENATE CAP PIXIE .......................... 92 PRENATE CAP RESTORE ..................... 92

PRENATE CHW 0.6-0.4 ...................... 92 PRENATE DHA CAP ............................ 92

PRENATE MINI CAP ........................... 93 PRENATE TAB ELITE .......................... 93

PREPIDIL GEL 0.5MG/3G ................... 72

PREPLUS TAB 27-1MG ....................... 93 PRETAB TAB 29-1MG ......................... 93

PREVDNT 5000 PST 1.1% ................ 104 PREVDNT 5000 PST 1.1-5% ............. 104

PREVIDENT GEL 1.1% ..................... 104 PREVIDENT GEL 1.1% BER ............... 104

PREVIDENT GEL 1.1% CHR .............. 104 PREVIDENT GEL 1.1% MIN ............... 104

PREZCOBIX TAB 800-150 .................. 10 PREZISTA SUS 100MG/ML.................. 11

PREZISTA TAB 150MG ....................... 11 PREZISTA TAB 600MG ....................... 11

PREZISTA TAB 75MG ......................... 11 PREZISTA TAB 800MG ....................... 11

PRIALT INJ 100MCG ........................... 1

PRIALT INJ 25MCG/ML ........................ 1 PRIALT INJ 500MCG ........................... 1

PRIFTIN TAB 150MG ......................... 12

primidone tab 250 mg ...................... 42 primidone tab 50 mg ........................ 42

PRIMSOL SOL 50MG/5ML .................. 14 PRISTIQ TAB 100MG ........................ 44

PRISTIQ TAB 25MG .......................... 44 PRISTIQ TAB 50MG .......................... 44

PRIVIGEN INJ 10GRAMS ................... 87 PRIVIGEN INJ 20GRAMS ................... 87

PRIVIGEN INJ 40GRAMS ................... 87 PRIVIGEN INJ 5 GRAMS .................... 86

PROBUPHINE IMP KIT 74.2 ................ 60 PROCAINAMIDE INJ 500MG/ML .......... 27

prochlorperazine edisylate inj 5 mg/ml 76 prochlorperazine maleate tab 10 mg

(base equivalent) ............................. 76

prochlorperazine maleate tab 5 mg (base equivalent) ...................................... 76

prochlorperazine suppos 25 mg.......... 76 PROCRIT INJ 40000/ML ..................... 83

PROCTOFOAM AER HC 1% ................. 80 PROCYSBI CAP 25MG ........................ 81

PROCYSBI CAP 75MG ........................ 81 PROFERRIN- TAB FORTE ................... 91

progesterone micronized cap 100 mg . 73 progesterone micronized cap 200 mg . 73

PROGLYCEM SUS 50MG/ML ............... 70 PROGRAF CAP 0.5MG ........................ 87

PROGRAF CAP 1MG .......................... 87 PROGRAF CAP 5MG .......................... 87

PROGRAF INJ 5MG/ML ...................... 87

PROLASTIN-C INJ 1000MG ................ 97 PROLENSA SOL 0.07% .................... 106

PROLEUKIN INJ 22MU ....................... 22 PROLIA SOL 60MG/ML ...................... 66

PROMACTA TAB 12.5MG .................... 85 PROMACTA TAB 25MG ...................... 85

PROMACTA TAB 50MG ...................... 85 PROMACTA TAB 75MG ...................... 85

promethazine hcl inj 25 mg/ml .......... 76 promethazine hcl inj 50 mg/ml .......... 76

promethazine hcl suppos 12.5 mg ...... 76 promethazine hcl suppos 25 mg ......... 76

promethazine hcl suppos 50 mg ......... 76 promethazine hcl syrup 6.25 mg/5ml.. 76

promethazine hcl tab 12.5 mg ........... 76

promethazine hcl tab 25 mg .............. 76 promethazine hcl tab 50 mg .............. 76

148

promethazine w/ codeine syrup 6.25-10

mg/5ml ........................................... 95 promethazine-dm syrup 6.25-15 mg/5ml

...................................................... 95 propafenone hcl cap er 12hr 225 mg ... 27

propafenone hcl cap er 12hr 325 mg ... 27 propafenone hcl cap er 12hr 425 mg ... 27

propafenone hcl tab 150 mg ............... 27 propafenone hcl tab 225 mg ............... 27

propafenone hcl tab 300 mg ............... 27 propantheline bromide tab 15 mg ....... 77

propranolol & hydrochlorothiazide tab 40-25 mg ........................................ 30

propranolol & hydrochlorothiazide tab 80-25 mg ........................................ 30

propranolol hcl cap er 24hr 120 mg ..... 31

propranolol hcl cap er 24hr 160 mg ..... 31 propranolol hcl cap er 24hr 60 mg ...... 31

propranolol hcl cap er 24hr 80 mg ...... 31 propranolol hcl inj 1 mg/ml ................ 31

propranolol hcl oral soln 20 mg/5ml .... 31 propranolol hcl oral soln 40 mg/5ml .... 31

propranolol hcl tab 10 mg .................. 31 propranolol hcl tab 20 mg .................. 31

propranolol hcl tab 40 mg .................. 31 propranolol hcl tab 60 mg .................. 31

propranolol hcl tab 80 mg .................. 31 propylthiouracil tab 50 mg ................. 73

PROSTIN E2 SUP 20MG ..................... 72 protamine sulfate inj 10 mg/ml .......... 84

PROTOPAM CHL INJ 1GM ................... 65

protriptyline hcl tab 10 mg ................. 47 protriptyline hcl tab 5 mg ................... 47

PROVENTIL AER HFA ......................... 96 PROVIDA DHA CAP ............................ 93

PROVIDA OB CAP .............................. 93 PROVIGIL TAB 100MG ....................... 59

PROVIGIL TAB 200MG ....................... 59 PROVISC INJ 1% ............................ 107

PRUTECT EMU ................................ 103 pseudoephed-bromphen-dm syrup

30-2-10 mg/5ml ............................... 95 PULMICORT INH 180MCG ................... 98

PULMICORT INH 90MCG .................... 98 PULMOZYME SOL 1MG/ML .................. 96

PUREFE CAP PLUS ............................. 91

PUREFE OB CAP PLUS ........................ 93 pyrazinamide tab 500 mg .................. 12

pyridostigmine bromide tab 60 mg ..... 59

pyridostigmine bromide tab er 180 mg 59 pyridoxine hcl inj 100 mg/ml ............. 91

Q quetiapine fumarate tab 100 mg ........ 50

quetiapine fumarate tab 200 mg ........ 50 quetiapine fumarate tab 25 mg .......... 50

quetiapine fumarate tab 300 mg ........ 50 quetiapine fumarate tab 400 mg ........ 50

quetiapine fumarate tab 50 mg .......... 50 QUFLORA PED CHW 0.25MG .............. 91

QUFLORA PED CHW 0.5MG ................ 91 QUFLORA PED CHW 1MG ................... 91

quinapril hcl tab 10 mg ..................... 24 quinapril hcl tab 20 mg ..................... 25

quinapril hcl tab 40 mg ..................... 25

quinapril hcl tab 5 mg ....................... 24 quinapril-hydrochlorothiazide tab 10-12.5

mg ................................................. 24 quinapril-hydrochlorothiazide tab 20-12.5

mg ................................................. 24 quinapril-hydrochlorothiazide tab 20-25

mg ................................................. 24 quinidine sulfate tab 200 mg ............. 27

quinidine sulfate tab 300 mg ............. 27 QUTENZA KIT 8% 1-PCH ................. 102

QVAR REDIHA AER 80MCG ................ 98 QVAR REDIHAL AER 40MCG ............... 98

R ramipril cap 1.25 mg ........................ 25

ramipril cap 10 mg ........................... 25

ramipril cap 2.5 mg .......................... 25 ramipril cap 5 mg ............................. 25

RANEXA TAB 1000MG ....................... 36 RANEXA TAB 500MG ......................... 36

RAPAFLO CAP 4MG ........................... 80 RAPAFLO CAP 8MG ........................... 80

RAPAMUNE SOL 1MG/ML ................... 88 RAPAMUNE TAB 0.5MG ..................... 88

RAPAMUNE TAB 1MG ........................ 88 RAPAMUNE TAB 2MG ........................ 88

rasagiline mesylate tab 0.5 mg (base equiv) ............................................. 48

rasagiline mesylate tab 1 mg (base equiv) ............................................. 48

RASUVO INJ 10MG ........................... 86

RASUVO INJ 12.5MG ........................ 86 RASUVO INJ 15MG ........................... 86

149

RASUVO INJ 17.5MG ......................... 86

RASUVO INJ 20MG ............................ 86 RASUVO INJ 22.5MG ......................... 86

RASUVO INJ 25MG ............................ 86 RASUVO INJ 30MG ............................ 86

RASUVO INJ 7.5MG ........................... 86 RAVICTI LIQ 1.1GM/ML ..................... 72

REBETOL SOL 40MG/ML ..................... 13 REBIF INJ 22/0.5 .............................. 58

REBIF INJ 44/0.5 .............................. 58 REBIF REBIDO INJ 22/0.5 .................. 58

REBIF REBIDO INJ 44/0.5 .................. 58 REBIF REBIDO INJ TITRATN ............... 58

REBIF TITRTN INJ PACK ..................... 58 RECTIV OIN 0.4% ............................. 78

REDICHEW RX CHW .......................... 93

REGENECARE GEL ........................... 104 REGONOL INJ 5MG/ML ...................... 57

RELENZA MIS DISKHALE .................... 13 RELNATE DHA CAP ............................ 93

REMODULIN INJ 10MG/ML ................. 37 REMODULIN INJ 1MG/ML ................... 37

REMODULIN INJ 2.5MG/ML ................ 37 REMODULIN INJ 5MG/ML ................... 37

RENAGEL TAB 800MG ........................ 73 REOPRO INJ 2MG/ML ......................... 85

repaglinide tab 0.5 mg ...................... 62 repaglinide tab 1 mg ......................... 62

repaglinide tab 2 mg ......................... 62 repaglinide-metformin hcl tab 1-500 mg

...................................................... 63

repaglinide-metformin hcl tab 2-500 mg ...................................................... 63

REPATHA INJ 140MG/ML .................... 30 REPATHA PUSH INJ 420/3.5 ............... 30

REPATHA SURE INJ 140MG/ML ........... 30 RESCRIPTOR TAB 200MG ................... 11

RESECTISOL SOL 5% ........................ 80 RESTASIS EMU 0.05% ..................... 107

RETROVIR INJ 10MG/ML .................... 12 REVATIO TAB 20MG .......................... 37

REVLIMID CAP 10MG ......................... 18 REVLIMID CAP 15MG ......................... 18

REVLIMID CAP 2.5MG ........................ 18 REVLIMID CAP 20MG ......................... 18

REVLIMID CAP 25MG ......................... 18

REVLIMID CAP 5MG .......................... 18 REYATAZ CAP 150MG ........................ 11

REYATAZ CAP 200MG ....................... 11

REYATAZ CAP 300MG ....................... 11 REYATAZ POW 50MG ........................ 11

RHOPRESSA SOL 0.02% ................. 107 ribasphere tab 400mg ....................... 13

ribavirin cap 200 mg ......................... 13 ribavirin tab 200 mg ......................... 13

ribavirin tab 600 mg ......................... 13 rifabutin cap 150 mg ........................ 14

RIFAMATE CAP ................................. 12 rifampin cap 150 mg ........................ 12

rifampin cap 300 mg ........................ 12 RIFATER TAB ................................... 12

riluzole tab 50 mg ............................ 57 rimantadine hydrochloride tab 100 mg 13

RIMSO-50 SOL 50% ......................... 81

ringer's solution for irrigation ........... 104 RIOMET SOL .................................... 61

risedronate sodium tab 150 mg ......... 66 risedronate sodium tab 30 mg ........... 66

risedronate sodium tab 35 mg ........... 66 risedronate sodium tab 5 mg ............. 66

risedronate sodium tab delayed release 35 mg ............................................. 66

RISPERDAL INJ 12.5MG .................... 50 RISPERDAL INJ 25MG ....................... 50

RISPERDAL INJ 37.5MG .................... 50 RISPERDAL INJ 50MG ....................... 50

risperidone orally disintegrating tab 0.25 mg ................................................. 50

risperidone orally disintegrating tab 0.5

mg ................................................. 50 risperidone orally disintegrating tab 1 mg

...................................................... 50 risperidone orally disintegrating tab 2 mg

...................................................... 50 risperidone soln 1 mg/ml .................. 50

risperidone tab 0.25 mg .................... 50 risperidone tab 0.5 mg ...................... 50

risperidone tab 1 mg ........................ 50 risperidone tab 2 mg ........................ 50

risperidone tab 3 mg ........................ 50 risperidone tab 4 mg ........................ 50

ritonavir tab 100 mg ......................... 11 RITUXAN INJ 100MG......................... 22

RITUXAN INJ 500MG......................... 22

rivastigmine tartrate cap 1.5 mg (base equivalent) ...................................... 43

150


equivalent) ...................................... 43 rivastigmine tartrate cap 4.5 mg (base

equivalent) ...................................... 43 rivastigmine tartrate cap 6 mg (base

equivalent) ...................................... 43 rivastigmine td patch 24hr 13.3 mg/24hr

...................................................... 43 rivastigmine td patch 24hr 4.6 mg/24hr

...................................................... 43 rivastigmine td patch 24hr 9.5 mg/24hr

...................................................... 43 rizatriptan benzoate oral disintegrating

tab 10 mg (base eq) ......................... 56 rizatriptan benzoate oral disintegrating

tab 5 mg (base eq) ........................... 56

rizatriptan benzoate tab 10 mg (base equivalent) ...................................... 56

rizatriptan benzoate tab 5 mg (base equivalent) ...................................... 56

ROCALTROL CAP 0.25MCG ................. 71 ROCALTROL CAP 0.5MCG ................... 71

ROCALTROL SOL 1MCG/ML ................ 71 ropinirole hydrochloride tab 0.25 mg ... 48

ropinirole hydrochloride tab 0.5 mg ..... 48 ropinirole hydrochloride tab 1 mg ....... 48

ropinirole hydrochloride tab 2 mg ....... 48 ropinirole hydrochloride tab 3 mg ....... 48

ropinirole hydrochloride tab 4 mg ....... 48 ropinirole hydrochloride tab 5 mg ....... 48

ropinirole hydrochloride tab er 24hr 12

mg (base equivalent) ........................ 48 ropinirole hydrochloride tab er 24hr 2 mg

(base equivalent) .............................. 48 ropinirole hydrochloride tab er 24hr 4 mg



(base equivalent) .............................. 48 rosuvastatin calcium tab 10 mg .......... 29

rosuvastatin calcium tab 20 mg .......... 29 rosuvastatin calcium tab 40 mg .......... 29

rosuvastatin calcium tab 5 mg ............ 29 RUBRACA TAB 200MG ....................... 22

RUBRACA TAB 250MG ....................... 22

RUBRACA TAB 300MG ....................... 22 RUCONEST INJ 2100UNIT .................. 84

RYDAPT CAP 25MG ........................... 19

S SABRIL TAB 500MG .......................... 42

salicylic acid cream 6% ................... 103 salicylic acid film forming liquid 27.5%

.................................................... 103 salicylic acid lotion 6% .................... 103

salicylic acid shampoo 6% ............... 103 SALICYLIC ACID SOLN 26% ............ 103

salisol fort sol 26% ......................... 103 salsalate tab 500 mg .......................... 2

salsalate tab 750 mg .......................... 2 SAMSCA TAB 15MG .......................... 75

SAMSCA TAB 30MG .......................... 75 SANCUSO DIS 3.1MG ....................... 76

SANDIMMUNE CAP 100MG................. 88

SANDIMMUNE CAP 25MG .................. 88 SANDIMMUNE INJ 50MG/ML .............. 88

SANDIMMUNE SOL 100MG/ML ........... 88 SANDOSTATIN INJ 100MCG ............... 72

SANDOSTATIN INJ 500MCG ............... 72 SANDOSTATIN INJ 50MCG/ML ........... 72

SANDOSTATIN KIT LAR 10MG ............ 72 SANDOSTATIN KIT LAR 20MG ............ 72

SANDOSTATIN KIT LAR 30MG ............ 72 SANTYL OIN 250/GM ...................... 103

SAPHRIS SUB 10MG ......................... 51 SAPHRIS SUB 2.5MG ........................ 50

SAPHRIS SUB 5MG ........................... 50 SAVELLA MIS TITR PAK ..................... 55

SAVELLA TAB 100MG ........................ 55

SAVELLA TAB 12.5MG ....................... 55 SAVELLA TAB 25MG .......................... 55

SAVELLA TAB 50MG .......................... 55 SEEBRI NEOHA CAP 15.6MCG ............ 94

SELECT-OB CHW .............................. 93 SELECT-OB+ PAK DHA ...................... 93

selegiline hcl cap 5 mg ...................... 48 selegiline hcl tab 5 mg ...................... 48

selenium sulfide shampoo 2.25% ..... 100 SELZENTRY SOL 20MG/ML ................ 10

SELZENTRY TAB 150MG .................... 10 SELZENTRY TAB 300MG .................... 10

SE-NATAL 19 TAB ............................ 93 SENSIPAR TAB 30MG ........................ 65

SENSIPAR TAB 60MG ........................ 65

SENSIPAR TAB 90MG ........................ 65 SEREVENT DIS AER 50MCG ............... 95

151

SEROSTIM INJ 4MG ........................... 70

SEROSTIM INJ 5MG ........................... 70 SEROSTIM INJ 6MG ........................... 70

sertraline hcl oral concentrate for solution 20 mg/ml ............................. 46

sertraline hcl tab 100 mg ................... 46 sertraline hcl tab 25 mg ..................... 46

sertraline hcl tab 50 mg ..................... 46 sevelamer carbonate packet 0.8 gm .... 73

sevelamer carbonate packet 2.4 gm .... 73 sevelamer carbonate tab 800 mg ........ 73

SIGNIFOR INJ 0.3MG/ML ................... 72 SIGNIFOR INJ 0.6MG/ML ................... 72

SIGNIFOR INJ 0.9MG/ML ................... 72 SIGNIFOR LAR INJ 20MG ................... 72

SIGNIFOR LAR INJ 40MG ................... 72

SIGNIFOR LAR INJ 60MG ................... 72 sildenafil citrate tab 20 mg ................. 37

silodosin cap 4 mg ............................ 80 silodosin cap 8 mg ............................ 80

SILVER NITRA OIN 10% .................. 103 SILVER NITRA SOL 0.5% ................. 103

SILVER NITRA SOL 10% .................. 103 SILVER NITRA SOL 25% .................. 103

SILVER NITRA SOL 50% .................. 103 silver sulfadiazine cream 1% .............. 99

SILVRSTAT GEL DRESSING .............. 104 SIMBRINZA SUS 1-0.2% .................. 107

SIMULECT INJ 10MG ......................... 88 SIMULECT INJ 20MG ......................... 88

simvastatin tab 10 mg ....................... 29

simvastatin tab 20 mg ....................... 29 simvastatin tab 40 mg ....................... 29

simvastatin tab 5 mg......................... 29 simvastatin tab 80 mg ....................... 29

sirolimus tab 0.5 mg ......................... 88 sirolimus tab 1 mg ............................ 88

sirolimus tab 2 mg ............................ 88 SIRTURO TAB 100MG ........................ 12

SIVEXTRO INJ 200MG ....................... 14 SIVEXTRO TAB 200MG ...................... 14

sodium chloride irrigation soln 0.9% ... 80 sodium chloride soln nebu 0.9% ......... 97

sodium chloride soln nebu 10% .......... 97 sodium chloride soln nebu 3% ............ 97

sodium chloride soln nebu 7% ............ 97

sodium citrate & citric acid soln 500-334 mg/5ml ........................................... 81

sodium fluoride chew tab 1 mg f (from

2.2 mg naf) ..................................... 91 sodium fluoride cream 1.1% ............ 104

sodium fluoride gel 1.1% (0.5% f) ... 104 sodium fluoride paste 1.1% ............. 104

sodium fluoride rinse 0.2% .............. 104 sodium fluoride tab 1 mg f (from 2.2 mg

naf) ................................................ 91 sodium phenylbutyrate oral powder 3

gm/teaspoonful ................................ 78 sodium phenylbutyrate tab 500 mg .... 72

sodium polystyrene sulfonate oral susp 15 gm/60ml .................................... 73

sodium polystyrene sulfonate powder . 73 sodium thiosulfate inj 25% ................ 65

SOLIRIS INJ 10MG/ML ...................... 84

SOLU-CORTEF INJ 1000MG ............... 70 SOLU-CORTEF INJ 100MG ................. 70

SOLU-CORTEF INJ 250MG ................. 70 SOLU-CORTEF INJ 500MG ................. 70

SOLU-MEDROL INJ 125MG ................ 70 SOLU-MEDROL INJ 1GM .................... 70

SOLU-MEDROL INJ 2GM .................... 70 SOLU-MEDROL INJ 40MG .................. 70

SOLU-MEDROL INJ 500MG ................ 70 SOMATULINE INJ 120/.5ML ............... 72

SOMATULINE INJ 60/0.2ML ............... 72 SOMATULINE INJ 90/0.3ML ............... 72

SOMAVERT INJ 10MG ....................... 72 SOMAVERT INJ 15MG ....................... 72

SOMAVERT INJ 20MG ....................... 72

SOMAVERT INJ 25MG ....................... 72 SOMAVERT INJ 30MG ....................... 72

SONAFINE EMU .............................. 104 sotalol hcl (afib/afl) tab 120 mg ......... 27

sotalol hcl (afib/afl) tab 160 mg ......... 27 sotalol hcl (afib/afl) tab 80 mg ........... 27

sotalol hcl tab 120 mg ...................... 27 sotalol hcl tab 160 mg ...................... 27

sotalol hcl tab 240 mg ...................... 27 sotalol hcl tab 80 mg ........................ 27

SPIRIVA AER 1.25MCG ...................... 94 SPIRIVA CAP HANDIHLR ................... 94

SPIRIVA SPR 2.5MCG ....................... 94 spironolactone & hydrochlorothiazide tab

25-25 mg ........................................ 35

spironolactone tab 100 mg ................ 25 spironolactone tab 25 mg .................. 25

152

spironolactone tab 50 mg .................. 25

SPORANOX SOL 10MG/ML ................... 9 SPRYCEL TAB 100MG ........................ 20

SPRYCEL TAB 140MG ........................ 20 SPRYCEL TAB 20MG .......................... 19

SPRYCEL TAB 50MG .......................... 19 SPRYCEL TAB 70MG .......................... 19

SPRYCEL TAB 80MG .......................... 19 SSKI SOL 1GM/ML ............................ 73

stavudine cap 15 mg ......................... 12 stavudine cap 20 mg ......................... 12

stavudine cap 30 mg ......................... 12 stavudine cap 40 mg ......................... 12

STELARA INJ 45MG/0.5 ..................... 85 STELARA INJ 5MG/ML ........................ 85

STELARA INJ 90MG/ML ...................... 85

STIMATE SOL 1.5MG/ML .................... 75 STIOLTO AER 2.5-2.5 ........................ 94

STIVARGA TAB 40MG ........................ 20 STRATTERA CAP 100MG .................... 54

STRATTERA CAP 10MG ...................... 54 STRATTERA CAP 18MG ...................... 54



STRENSIQ INJ 18/0.45 ...................... 72 STRENSIQ INJ 28/0.7ML .................... 72

STRENSIQ INJ 40MG/ML .................... 72 STRENSIQ INJ 80/0.8ML .................... 72

STRIANT MIS 30MG .......................... 60

STRIBILD TAB .................................. 10 STRIVERDI AER 2.5MCG .................... 95

STROMECTOL TAB 3MG ..................... 14 SUBOXONE MIS 12-3MG .................... 60

SUBOXONE MIS 2-0.5MG ................... 60 SUBOXONE MIS 4-1MG ...................... 60

SUBOXONE MIS 8-2MG ...................... 60 SUBSYS SPR 100MCG ......................... 5

SUBSYS SPR 1200MCG ....................... 5 SUBSYS SPR 1600MCG ....................... 5

SUBSYS SPR 200MCG ......................... 5 SUBSYS SPR 400MCG ......................... 5

SUBSYS SPR 600MCG ......................... 5 SUBSYS SPR 800MCG ......................... 5

SUCRAID SOL 8500/ML ..................... 78

sucralfate tab 1 gm ........................... 78 SULAR TAB 17MG ............................. 32

SULAR TAB 34MG ............................. 32

SULAR TAB 8.5MG ............................ 32 sulfacetamide sodium ophth oint 10%

.................................................... 105 sulfacetamide sodium ophth soln 10%

.................................................... 105 sulfacetamide sodium w/ sulfur emulsion

10-1% ............................................ 99 sulfacetamide sodium w/ sulfur wash

9-4.5% ........................................... 99 sulfacetamide sodium-prednisolone

ophth soln 10-0.23(0.25)% ............. 105 SULFADIAZINE TAB 500MG ................. 8

sulfamethoxazole-trimethoprim susp 200-40 mg/5ml.................................. 8

sulfamethoxazole-trimethoprim tab

400-80 mg ........................................ 8 sulfamethoxazole-trimethoprim tab

800-160 mg ...................................... 8 SULFAMYLON CRE 85MG/GM ........... 103

sulfasalazine tab 500 mg ................... 77 sulfasalazine tab delayed release 500 mg

...................................................... 77 sulindac tab 150 mg ........................... 2

sulindac tab 200 mg ........................... 2 sumatriptan nasal spray 20 mg/act .... 56

sumatriptan nasal spray 5 mg/act ...... 56 sumatriptan succinate inj 6 mg/0.5ml . 56

sumatriptan succinate solution auto-injector 4 mg/0.5ml .................. 56

sumatriptan succinate solution

auto-injector 6 mg/0.5ml .................. 57 sumatriptan succinate solution cartridge

4 mg/0.5ml ..................................... 57 sumatriptan succinate solution cartridge

6 mg/0.5ml ..................................... 57 sumatriptan succinate tab 100 mg ..... 57

sumatriptan succinate tab 25 mg ....... 57 sumatriptan succinate tab 50 mg ....... 57

SUPPRELIN LA KIT 50MG ................... 72 SUPRAX CAP 400MG ........................... 6

SUPRAX CHW 100MG .......................... 6 SUPRAX CHW 200MG .......................... 6

SUPRAX SUS 100/5ML ........................ 7 SUPRAX SUS 200/5ML ........................ 7

SUPRAX SUS 500/5ML ........................ 7

SURESTEP PRO TES HIGH CON .......... 65 SURESTEP PRO TES NORM CON ......... 65

153

SURMONTIL CAP 100MG .................... 47

SURMONTIL CAP 25MG ...................... 47 SURMONTIL CAP 50MG ...................... 47

SUSTIVA CAP 200MG ........................ 11 SUSTIVA CAP 50MG .......................... 11

SUSTIVA TAB 600MG ........................ 11 SUTENT CAP 12.5MG ......................... 20

SUTENT CAP 25MG ........................... 20 SUTENT CAP 37.5MG ......................... 20

SUTENT CAP 50MG ........................... 20 SYLATRON KIT 200MCG ..................... 87

SYLATRON KIT 300MCG ..................... 87 SYLATRON KIT 600MCG ..................... 87

SYMAX DUOTAB TAB ......................... 77 SYMBICORT AER 160-4.5 ................... 98

SYMBICORT AER 80-4.5..................... 98

SYMDEKO TAB 100-150 ..................... 96 SYMLINPEN 60 INJ 1000MCG ............. 61

SYMLNPEN 120 INJ 1000MCG ............. 61 SYNAGIS INJ 100MG/ML .................... 88

SYNAGIS INJ 50MG ........................... 88 SYNAREL SOL 2MG/ML ...................... 66

SYNJARDY TAB ................................. 63 SYNJARDY TAB 12.5-500 ................... 63

SYNJARDY TAB 5-1000MG ................. 63 SYNJARDY TAB 5-500MG ................... 63

SYNJARDY XR TAB ............................ 63 SYNJARDY XR TAB 10-1000 ............... 63

SYNJARDY XR TAB 25-1000 ............... 63 SYNJARDY XR TAB 5-1000MG ............. 63

SYNRIBO INJ 3.5MG .......................... 22

SYNTHROID TAB 100MCG .................. 74 SYNTHROID TAB 112MCG .................. 74



SYNTHROID TAB 200MCG .................. 74 SYNTHROID TAB 25MCG .................... 74

SYNTHROID TAB 300MCG .................. 74 SYNTHROID TAB 50MCG .................... 74

SYNTHROID TAB 75MCG .................... 74 SYNTHROID TAB 88MCG .................... 74

SYPRINE CAP 250MG ......................... 72 T TABLOID TAB 40MG .......................... 17

tacrolimus cap 0.5 mg ....................... 88 tacrolimus cap 1 mg .......................... 88

tacrolimus cap 5 mg ......................... 88

tacrolimus oint 0.03% .................... 100 tacrolimus oint 0.1% ...................... 100

TAFINLAR CAP 50MG ........................ 20 TAFINLAR CAP 75MG ........................ 20

TAGRISSO TAB 40MG ....................... 20 TAGRISSO TAB 80MG ....................... 20

TAMIFLU CAP 30MG .......................... 13 TAMIFLU CAP 45MG .......................... 14

TAMIFLU CAP 75MG .......................... 14 TAMIFLU SUS 6MG/ML ...................... 14

tamsulosin hcl cap 0.4 mg ................. 80 TANDEM PLUS CAP ........................... 91

TARCEVA TAB 100MG ....................... 20 TARCEVA TAB 150MG ....................... 20

TARCEVA TAB 25MG ......................... 20

TARGRETIN GEL 1% ......................... 22 TARKA TAB 2-180 CR ....................... 23

TARKA TAB 2-240 CR ....................... 23 TARKA TAB 4-240 CR ....................... 23

TARON FORTE CAP ........................... 91 TARON-C DHA CAP ........................... 93

TARON-PREX CAP ............................. 93 TASIGNA CAP 150MG ....................... 20

TASIGNA CAP 200MG ....................... 20 TASIGNA CAP 50MG ......................... 20

tazarotene cream 0.1% .................... 99 TAZORAC CRE 0.05% ....................... 99

TAZORAC CRE 0.1% ......................... 99 TAZORAC GEL 0.05% ....................... 99

TAZORAC GEL 0.1% ......................... 99

TECFIDERA CAP 120MG .................... 58 TECFIDERA CAP 240MG .................... 58

TECFIDERA MIS STARTER ................. 58 TEGRETOL SUS 100/5ML ................... 42

TEGRETOL-XR TAB 100MG ................ 42 TEGRETOL-XR TAB 200MG ................ 42

TEGRETOL-XR TAB 400MG ................ 42 TEKTURNA HCT TAB 150-12.5 ........... 34

TEKTURNA HCT TAB 150-25MG .......... 34 TEKTURNA HCT TAB 300-12.5 ........... 34

TEKTURNA HCT TAB 300-25MG .......... 34 TEKTURNA TAB 150MG ..................... 34

TEKTURNA TAB 300MG ..................... 34 telmisartan tab 20 mg ...................... 26

telmisartan tab 40 mg ...................... 26

telmisartan tab 80 mg ...................... 27 telmisartan-amlodipine tab 40-10 mg . 25

154

telmisartan-amlodipine tab 40-5 mg ... 25

telmisartan-amlodipine tab 80-10 mg .. 25 telmisartan-amlodipine tab 80-5 mg ... 25

telmisartan-hydrochlorothiazide tab 40-12.5 mg ...................................... 26

telmisartan-hydrochlorothiazide tab 80-12.5 mg ...................................... 26

telmisartan-hydrochlorothiazide tab 80-25 mg ........................................ 26

temazepam cap 15 mg ...................... 56 temazepam cap 22.5 mg ................... 56

temazepam cap 30 mg ...................... 56 temazepam cap 7.5 mg ..................... 55

TEMODAR CAP 100MG ....................... 15 TEMODAR CAP 140MG ....................... 15

TEMODAR CAP 180MG ....................... 15

TEMODAR CAP 20MG ......................... 15 TEMODAR CAP 250MG ....................... 15

TEMODAR CAP 5MG .......................... 15 TEMODAR INJ 100MG ........................ 15

temozolomide cap 100 mg ................. 16 temozolomide cap 140 mg ................. 16

temozolomide cap 180 mg ................. 16 temozolomide cap 20 mg ................... 16

temozolomide cap 250 mg ................. 16 temozolomide cap 5 mg ..................... 15

TENIPOSIDE INJ 50MG/5ML ............... 22 tenofovir disoproxil fumarate tab 300 mg

...................................................... 12 terazosin hcl cap 1 mg (base equivalent)

...................................................... 25

terazosin hcl cap 10 mg (base equivalent) ...................................... 25

terazosin hcl cap 2 mg (base equivalent) ...................................................... 25

terazosin hcl cap 5 mg (base equivalent) ...................................................... 25

terbinafine hcl tab 250 mg .................. 9 terbutaline sulfate inj 1 mg/ml ........... 96

terbutaline sulfate tab 2.5 mg ............ 96 terbutaline sulfate tab 5 mg ............... 96

terconazole vaginal suppos 80 mg ...... 81 TESTIM GEL 1%(50MG) ..................... 60

TESTOPEL MIS PELLETS ..................... 60 testosterone cypionate im inj in oil 100

mg/ml ............................................. 61

testosterone cypionate im inj in oil 200 mg/ml ............................................. 61

testosterone enanthate im inj in oil 200

mg/ml ............................................ 61 testosterone td gel 10mg/act (2%) .... 61

testosterone td gel 12.5 mg/act (1%) . 61 testosterone td gel 25 mg/2.5gm (1%)61

testosterone td gel 50 mg/5gm (1%).. 61 tetrabenazine tab 12.5 mg ................ 55

tetrabenazine tab 25 mg ................... 55 tetracaine hcl ophth soln 0.5% ........ 107

tetracycline hcl cap 250 mg ................. 9 tetracycline hcl cap 500 mg ................. 9

TEXAVITE LQ LIQ ............................. 91 THALOMID CAP 100MG ..................... 18

THALOMID CAP 150MG ..................... 18 THALOMID CAP 200MG ..................... 18

THALOMID CAP 50MG ....................... 18

THEO-24 CAP 100MG CR ................... 98 THEO-24 CAP 200MG CR ................... 98

THEO-24 CAP 300MG CR ................... 98 THEO-24 CAP 400MG ER ................... 98

theophylline soln 80 mg/15ml ............ 98 theophylline tab er 12hr 100 mg ........ 98

theophylline tab er 12hr 200 mg ........ 98 theophylline tab er 12hr 300 mg ........ 98

theophylline tab er 12hr 450 mg ........ 98 theophylline tab er 24hr 400 mg ........ 98

theophylline tab er 24hr 600 mg ........ 98 THERACYS INJ ................................. 22

thiamine hcl inj 100 mg/ml ................ 91 THIOLA TAB 100MG .......................... 81

thioridazine hcl tab 10 mg ................. 52

thioridazine hcl tab 100 mg ............... 52 thioridazine hcl tab 25 mg ................. 52

thioridazine hcl tab 50 mg ................. 52 thiothixene cap 1 mg ........................ 52

thiothixene cap 10 mg ...................... 52 thiothixene cap 2 mg ........................ 52

thiothixene cap 5 mg ........................ 52 THROMBAT III INJ 500UNIT............... 84

THROMBIN-JMI KIT 20000UNT ........... 83 THYMOGLOBULN INJ 25MG................ 87

THYROGEN INJ 1.1MG ...................... 72 THYROLAR-1 TAB 60MG .................... 74

THYROLAR-1/2 TAB 30MG ................. 74 THYROLAR-1/4 TAB 15MG ................. 74

THYROLAR-2 TAB 120MG .................. 74

THYROLAR-3 TAB 180MG .................. 75 tiagabine hcl tab 12 mg .................... 42

155

tiagabine hcl tab 16 mg ..................... 42

tiagabine hcl tab 2 mg ....................... 42 tiagabine hcl tab 4 mg ....................... 42

TIBSOVO TAB 250MG ........................ 22 TICE BCG INJ ................................... 22

TIGAN INJ 100MG/ML ........................ 76 TIKOSYN CAP 125MCG ...................... 28

TIKOSYN CAP 250MCG ...................... 28 TIKOSYN CAP 500MCG ...................... 28

timolol maleate ophth gel forming soln 0.25% ........................................... 107

timolol maleate ophth gel forming soln 0.5% ............................................. 106

timolol maleate ophth soln 0.25% ..... 107 timolol maleate ophth soln 0.5% ...... 107

timolol maleate ophth soln 0.5%

(once-daily) ................................... 107 timolol maleate tab 10 mg ................. 31

timolol maleate tab 20 mg ................. 31 timolol maleate tab 5 mg ................... 31

TIMOPTIC OCU SOL 0.25% OP ......... 107 TIMOPTIC OCU SOL 0.5% OP ........... 107

TIROSINT CAP 100MCG ..................... 75 TIROSINT CAP 112MCG ..................... 75

TIROSINT CAP 125MCG ..................... 75 TIROSINT CAP 137MCG ..................... 75

TIROSINT CAP 13MCG ....................... 75 TIROSINT CAP 150MCG ..................... 75

TIROSINT CAP 25MCG ....................... 75 TIROSINT CAP 50MCG ....................... 75

TIROSINT CAP 75MCG ....................... 75

TIROSINT CAP 88MCG ....................... 75 TIVICAY TAB 10MG ........................... 10

TIVICAY TAB 25MG ........................... 10 TIVICAY TAB 50MG ........................... 10

tizanidine hcl tab 2 mg (base equivalent) ...................................................... 59

tizanidine hcl tab 4 mg (base equivalent) ...................................................... 59

TL-SELECT CAP ................................. 93 TOBI PODHALR CAP 28MG ................. 96

TOBRADEX OIN 0.3-0.1% ................ 105 TOBRADEX ST SUS 0.3-0.05 ............ 105

tobramycin nebu soln 300 mg/5ml ...... 96 tobramycin ophth soln 0.3% ............ 105

tobramycin-dexamethasone ophth susp

0.3-0.1% ....................................... 105 TOBREX OIN 0.3% OP ..................... 105

tolbutamide tab 500 mg .................... 64

tolmetin sodium cap 400 mg ............... 2 tolmetin sodium tab 200 mg ................ 2

tolmetin sodium tab 600 mg ................ 2 tolterodine tartrate cap er 24hr 2 mg .. 81

tolterodine tartrate cap er 24hr 4 mg .. 81 tolterodine tartrate tab 1 mg ............. 81

tolterodine tartrate tab 2 mg ............. 81 topiramate sprinkle cap 15 mg ........... 42

topiramate sprinkle cap 25 mg ........... 42 topiramate tab 100 mg ..................... 42

topiramate tab 200 mg ..................... 42 topiramate tab 25 mg ....................... 42

topiramate tab 50 mg ....................... 42 TOPOTECAN INJ 4MG/4ML ................. 23

TORISEL SOL 25MG/ML ..................... 20

torsemide tab 10 mg ........................ 35 torsemide tab 100 mg ...................... 35

torsemide tab 20 mg ........................ 35 torsemide tab 5 mg .......................... 35

TOUJEO SOLO INJ 300IU/ML ............. 62 TRACLEER TAB 125MG ...................... 37

TRACLEER TAB 62.5MG ..................... 37 TRADJENTA TAB 5MG ....................... 62

tramadol hcl tab 50 mg ....................... 6 tramadol hcl tab er 24hr 100 mg .......... 6

tramadol hcl tab er 24hr 200 mg .......... 6 tramadol hcl tab er 24hr 300 mg .......... 6

tramadol-acetaminophen tab 37.5-325 mg ................................................... 6

trandolapril tab 1 mg ........................ 25

trandolapril tab 2 mg ........................ 25 trandolapril tab 4 mg ........................ 25

trandolapril-verapamil hcl tab er 1-240 mg ................................................. 23




tranexamic acid iv soln 1000 mg/10ml (100 mg/ml) .................................... 83

tranexamic acid tab 650 mg .............. 83 TRANSDERM-SC DIS 1.5MG............... 76

tranylcypromine sulfate tab 10 mg ..... 43

TRAVATAN Z DRO 0.004% .............. 108 trazodone hcl tab 100 mg ................. 44

156

trazodone hcl tab 150 mg .................. 44

trazodone hcl tab 300 mg .................. 44 trazodone hcl tab 50 mg .................... 44

TREANDA INJ 100MG ........................ 16 TREANDA INJ 25MG .......................... 16

TRECATOR TAB 250MG ...................... 12 TRELSTAR MIX INJ 11.25MG .............. 17

TRELSTAR MIX INJ 22.5MG ................ 17 TRELSTAR MIX INJ 3.75MG ................ 17

TRESIBA FLEX INJ 100UNIT ............... 62 TRESIBA FLEX INJ 200UNIT ............... 62

TRESIBA INJ 100UNIT ....................... 62 tretinoin cap 10 mg ........................... 22

tretinoin cream 0.025% ..................... 99 tretinoin cream 0.05%....................... 99

tretinoin cream 0.1% ........................ 99

tretinoin gel 0.01% ........................... 99 tretinoin gel 0.025% ......................... 99

triamcinolone acetonide cream 0.025% .................................................... 102

triamcinolone acetonide cream 0.1% . 102 triamcinolone acetonide cream 0.5% . 101

triamcinolone acetonide dental paste 0.1% ............................................. 104

triamcinolone acetonide lotion 0.025% .................................................... 102

triamcinolone acetonide lotion 0.1% .. 102 triamcinolone acetonide oint 0.025%. 102

triamcinolone acetonide oint 0.1% .... 102 triamcinolone acetonide oint 0.5% .... 101

triamterene & hydrochlorothiazide cap

37.5-25 mg ...................................... 35 triamterene & hydrochlorothiazide tab

37.5-25 mg ...................................... 35 triamterene & hydrochlorothiazide tab

75-50 mg ........................................ 35 triazolam tab 0.125 mg ..................... 56

triazolam tab 0.25 mg ....................... 56 TRICARE PRE CAP 27-1-500 ............... 93

TRICARE TAB PRENATAL .................... 93 TRI-CHLOR LIQ 80% ....................... 103

TRICITRASOL CON ............................ 84 trientine hcl cap 250 mg .................... 72

TRIESENCE INJ 40MG/ML ................. 106 trifluoperazine hcl tab 1 mg (base

equivalent) ...................................... 52

trifluoperazine hcl tab 10 mg (base equivalent) ...................................... 52


equivalent) ...................................... 52 trifluoperazine hcl tab 5 mg (base

equivalent) ...................................... 52 trifluridine ophth soln 1% ................ 106

trihexyphenidyl hcl elixir 0.4 mg/ml .... 48 trihexyphenidyl hcl tab 2 mg ............. 48

trihexyphenidyl hcl tab 5 mg ............. 49 TRILIPIX CAP 135MG ........................ 28

TRILIPIX CAP 45MG .......................... 28 trimethobenzamide hcl cap 300 mg .... 76

trimethoprim tab 100 mg .................. 14 TRINTELLIX TAB 10MG ..................... 46

TRINTELLIX TAB 20MG ..................... 46 TRINTELLIX TAB 5MG ....................... 46

TRIOSTAT INJ 10MCG/ML .................. 75

TRISTART DHA CAP .......................... 93 TRI-TABS DHA MIS ........................... 93

TRIUMEQ TAB .................................. 10 TRI-VI-FLOR SUS 0.25/ML ................. 91

TRI-VI-FLOR SUS 0.5MG/ML .............. 91 TRIZIVIR TAB .................................. 10

tropicamide ophth soln 0.5% ........... 108 tropicamide ophth soln 1% .............. 108

trospium chloride cap er 24hr 60 mg .. 81 trospium chloride tab 20 mg .............. 81

TRULICITY INJ 0.75/0.5 .................... 62 TRULICITY INJ 1.5/0.5 ...................... 62

TRUVADA TAB 100-150 ..................... 10 TRUVADA TAB 133-200 ..................... 10

TRUVADA TAB 167-250 ..................... 10

TRUVADA TAB 200-300 ..................... 10 TUSSICAPS CAP 10-8MG ................... 95

TYBOST TAB 150MG ......................... 10 TYKERB TAB 250MG ......................... 20

TYSABRI INJ 300/15ML ..................... 58 TYVASO START SOL 0.6MG/ML .......... 37

U UCERIS AER 2MG/ACT ...................... 78

UCERIS TAB 9MG ............................. 77 ULESFIA LOT 5% ........................... 103

ULORIC TAB 40MG ............................. 1 ULORIC TAB 80MG ............................. 1

ULTRAFLEX MIS 24 ........................... 65 UPTRAVI TAB 1000MCG .................... 37

UPTRAVI TAB 1200MCG .................... 37

UPTRAVI TAB 1400MCG .................... 37 UPTRAVI TAB 1600MCG .................... 37

157

UPTRAVI TAB 200/800 ....................... 37

UPTRAVI TAB 200MCG ....................... 37 UPTRAVI TAB 400MCG ....................... 37

UPTRAVI TAB 600MCG ....................... 37 UPTRAVI TAB 800MCG ....................... 37

UROXATRAL TAB 10MG ...................... 80 ursodiol cap 300 mg .......................... 77

ursodiol tab 250 mg .......................... 77 ursodiol tab 500 mg .......................... 77

UTIBRON CAP NEOHALER .................. 94 V VAGIFEM TAB 10MCG ........................ 68 valacyclovir hcl tab 1 gm ................... 13

valacyclovir hcl tab 500 mg ................ 13 VALCHLOR GEL 0.016% ..................... 16

VALCYTE SOL 50MG/ML ..................... 13

VALCYTE TAB 450MG ........................ 13 valganciclovir hcl tab 450 mg (base

equivalent) ...................................... 13 valproate sodium inj 100 mg/ml ......... 42

valproate sodium oral soln 250 mg/5ml (base equiv) ..................................... 42

valproic acid cap 250 mg ................... 42 valsartan tab 160 mg ........................ 27

valsartan tab 320 mg ........................ 27 valsartan tab 40 mg .......................... 27

valsartan tab 80 mg .......................... 27 valsartan-hydrochlorothiazide tab

160-12.5 mg .................................... 26 valsartan-hydrochlorothiazide tab 160-25

mg .................................................. 26

valsartan-hydrochlorothiazide tab 320-12.5 mg .................................... 26

valsartan-hydrochlorothiazide tab 320-25 mg .................................................. 26

valsartan-hydrochlorothiazide tab 80-12.5 mg ...................................... 26

vancomycin hcl cap 125 mg (base equivalent) ...................................... 14

vancomycin hcl cap 250 mg (base equivalent) ...................................... 14

VANCOMYCIN INJ 500MG ................... 14 VANCOMYCIN INJ 750MG ................... 14

VANTAS KIT 50MG ............................ 17 VASCEPA CAP 1GM ........................... 29

VECTIBIX INJ 100MG ........................ 22

VECTIBIX INJ 400MG ........................ 22 VELCADE INJ 3.5MG .......................... 22

VELETRI INJ 0.5MG .......................... 37

VELTASSA POW 16.8GM .................... 73 VELTASSA POW 25.2GM .................... 73

VELTASSA POW 8.4GM ..................... 73 VENA-BAL MIS DHA .......................... 93

VENCLEXTA TAB 100MG .................... 22 VENCLEXTA TAB 10MG...................... 22

VENCLEXTA TAB 50MG...................... 22 VENCLEXTA TAB START PK ................ 22

venlafaxine hcl cap er 24hr 150 mg (base equivalent) ............................. 45

venlafaxine hcl cap er 24hr 37.5 mg (base equivalent) ............................. 44

venlafaxine hcl cap er 24hr 75 mg (base equivalent) ...................................... 45

venlafaxine hcl tab 100 mg ............... 45

venlafaxine hcl tab 25 mg ................. 45 venlafaxine hcl tab 37.5 mg .............. 45

venlafaxine hcl tab 50 mg ................. 45 venlafaxine hcl tab 75 mg ................. 45

venlafaxine hcl tab er 24hr 150 mg (base equivalent) ...................................... 45


venlafaxine hcl tab er 24hr 37.5 mg (base equivalent) ............................. 45


VENOFER INJ 20MG/ML ..................... 91 VENTAVIS SOL 10MCG/ML ................ 37

VENTAVIS SOL 20MCG/ML ................ 38

VENTOLIN HFA AER .......................... 96 verapamil hcl cap er 24hr 100 mg ...... 33

verapamil hcl cap er 24hr 120 mg ...... 33 verapamil hcl cap er 24hr 180 mg ...... 33



verapamil hcl iv soln 2.5 mg/ml ......... 33 verapamil hcl tab 120 mg .................. 33

verapamil hcl tab 40 mg ................... 33 verapamil hcl tab 80 mg ................... 33

verapamil hcl tab er 120 mg .............. 33 verapamil hcl tab er 180 mg .............. 33

verapamil hcl tab er 240 mg .............. 33

VERZENIO TAB 100MG ...................... 20 VERZENIO TAB 150MG ...................... 20

158

VERZENIO TAB 200MG ...................... 20

VERZENIO TAB 50MG ........................ 20 VESICARE TAB 10MG ........................ 81

VESICARE TAB 5MG .......................... 81 V-GO 20 KIT .................................... 65

V-GO 30 KIT .................................... 65 V-GO 40 KIT .................................... 65

VIBERZI TAB 100MG ......................... 78 VIBERZI TAB 75MG ........................... 78

VIBRAMYCIN SYP 50MG/5ML ............... 9 VICTOZA INJ 18MG/3ML .................... 62

VIDEX SOL 2GM ............................... 12 VIDEX SOL 4GM ............................... 12

vigabatrin powd pack 500 mg ............. 42 VIIBRYD KIT STARTER ....................... 46

VIIBRYD TAB 10MG ........................... 46

VIIBRYD TAB 20MG ........................... 46 VIIBRYD TAB 40MG ........................... 46

VIMIZIM INJ 5MG/5ML ....................... 71 VIMPAT INJ 200MG/20 ...................... 42

VIMPAT SOL 10MG/ML ....................... 42 VIMPAT TAB 100MG .......................... 42

VIMPAT TAB 150MG .......................... 42 VIMPAT TAB 200MG .......................... 42

VIMPAT TAB 50MG ............................ 42 VINATE II TAB .................................. 93

VINATE M TAB .................................. 93 VINATE ONE TAB .............................. 93

vinblastine sulfate inj 1 mg/ml ........... 22 vincristine sulfate iv soln 1 mg/ml ....... 22

VIOKACE TAB 10440 ......................... 79

VIOKACE TAB 20880 ......................... 79 VIRACEPT TAB 250MG ....................... 11

VIRACEPT TAB 625MG ....................... 11 VIRAMUNE SUS 50MG/5ML ................ 11

VIREAD POW 40MG/GM ..................... 12 VIREAD TAB 150MG .......................... 12

VIREAD TAB 200MG .......................... 12 VIREAD TAB 250MG .......................... 12

VIREAD TAB 300MG .......................... 12 VIRT-C DHA CAP ............................... 93

VIRT-NATE CAP DHA ......................... 93 VIRT-PN PLUS CAP ............................ 93

VIRT-PN TAB .................................... 93 VISUDYNE INJ 15MG ....................... 107

VITAFOL CAP ULTRA .......................... 93

VITAFOL FE+ CAP ............................. 93 VITAFOL-NANO TAB .......................... 93

VITAFOL-OB PAK +DHA .................... 93

VITAFOL-ONE CAP ............................ 93 VITAMEDMD CAP ONE RX .................. 93

VITAPEARL CAP ................................ 93 VITATRUE MIS ................................. 93

VIVA DHA CAP ................................. 93 VIVITROL INJ 380MG ........................ 59

VIZIMPRO TAB 15MG ........................ 20 VIZIMPRO TAB 30MG ........................ 20

VIZIMPRO TAB 45MG ........................ 20 VOL-PLUS TAB ................................. 93

VOL-TAB RX TAB .............................. 93 VOLTAREN GEL 1% ............................ 2

voriconazole for susp 40 mg/ml ......... 10 voriconazole tab 200 mg ................... 10

voriconazole tab 50 mg ..................... 10

VOSEVI TAB .................................... 13 VOTRIENT TAB 200MG ...................... 20

VP-PNV-DHA CAP ............................. 93 VPRIV INJ 400UNIT .......................... 71

VYTORIN TAB 10-10MG ..................... 29 VYTORIN TAB 10-20MG ..................... 29

VYTORIN TAB 10-40MG ..................... 29 VYTORIN TAB 10-80MG ..................... 29

VYVANSE CAP 10MG ......................... 54 VYVANSE CAP 20MG ......................... 54



VYVANSE CAP 70MG ......................... 55

W warfarin sodium tab 1 mg ................. 82

warfarin sodium tab 10 mg ................ 82 warfarin sodium tab 2 mg ................. 82

warfarin sodium tab 2.5 mg ............... 82 warfarin sodium tab 3 mg ................. 82

warfarin sodium tab 4 mg ................. 82 warfarin sodium tab 5 mg ................. 82

warfarin sodium tab 6 mg ................. 82 warfarin sodium tab 7.5 mg ............... 82

water for irrigation, sterile irrigation soln.................................................... 104

WELCHOL PAK 3.75GM ..................... 28 WELCHOL TAB 625MG ...................... 28

WESTHROID TAB 130MG ................... 75

WESTHROID TAB 32.5MG .................. 75 WESTHROID TAB 97.5MG .................. 75

159

X XALKORI CAP 200MG ........................ 20 XALKORI CAP 250MG ........................ 20

XARELTO STAR TAB 15/20MG ............. 82 XARELTO TAB 10MG .......................... 82

XARELTO TAB 15MG .......................... 82 XARELTO TAB 2.5MG ......................... 82

XARELTO TAB 20MG .......................... 82 XELODA TAB 150MG ......................... 17

XELODA TAB 500MG ......................... 17 XENAZINE TAB 12.5MG ..................... 55

XENAZINE TAB 25MG ........................ 55 XEOMIN INJ 100UNIT ........................ 57

XEOMIN INJ 200UNIT ........................ 57 XEOMIN INJ 50 UNIT ......................... 57

XGEVA INJ ....................................... 66

XIFAXAN TAB 200MG ........................ 14 XIFAXAN TAB 550MG ........................ 14

XOLAIR INJ 150MG/ML ...................... 97 XOLAIR INJ 75/0.5 ............................ 97

XOLAIR SOL 150MG .......................... 97 XOPENEX HFA AER ............................ 96

XTANDI CAP 40MG ............................ 17 XYREM SOL 500MG/ML ...................... 59

Y YERVOY INJ 200MG ........................... 22

YERVOY INJ 50MG ............................ 22 Z zafirlukast tab 10 mg ........................ 96 zafirlukast tab 20 mg ........................ 96

zaleplon cap 10 mg ........................... 56

zaleplon cap 5 mg ............................. 56 ZALTRAP INJ 100/4ML ....................... 22

ZALTRAP INJ 200/8ML ....................... 22 ZANOSAR INJ 1GM ............................ 16

ZARXIO INJ 300/0.5 .......................... 83 ZARXIO INJ 480/0.8 .......................... 83

ZATEAN-PN CAP DHA ........................ 93 ZATEAN-PN CAP PLUS ....................... 93

ZAVESCA CAP 100MG ........................ 71 ZEJULA CAP 100MG........................... 22

ZELBORAF TAB 240MG ...................... 20 ZEMAIRA INJ 1000MG ....................... 97

ZEMPLAR CAP 2MCG ......................... 71 ZENPEP CAP 15000UNT ..................... 79

ZENPEP CAP 20000UNT ..................... 79

ZENPEP CAP 25000 ........................... 79 ZENPEP CAP 25000UNT ..................... 79

ZENPEP CAP 3000UNIT ..................... 79

ZENPEP CAP 40000 .......................... 79 ZENPEP CAP 40000UNT ..................... 79

ZEVALIN KIT Y-90 ............................ 22 zidovudine cap 100 mg ..................... 12

zidovudine syrup 10 mg/ml ............... 12 zidovudine tab 300 mg ..................... 12

ZIOPTAN DRO 0.0015% .................. 108 ziprasidone hcl cap 20 mg ................. 51

ziprasidone hcl cap 40 mg ................. 51 ziprasidone hcl cap 60 mg ................. 51

ziprasidone hcl cap 80 mg ................. 51 ZIRGAN GEL 0.15% ........................ 106

ZOLADEX IMP 10.8MG ...................... 17 ZOLADEX IMP 3.6MG ........................ 17

zoledronic acid inj conc for iv infusion 4

mg/5ml ........................................... 66 zoledronic acid iv soln 5 mg/100ml ..... 66

ZOLINZA CAP 100MG ........................ 22 zolmitriptan orally disintegrating tab 2.5

mg ................................................. 57 zolmitriptan orally disintegrating tab 5

mg ................................................. 57 zolmitriptan tab 2.5 mg .................... 57

zolmitriptan tab 5 mg ....................... 57 zolpidem tartrate tab 10 mg .............. 56

zolpidem tartrate tab 5 mg ................ 56 ZOMETA INJ 4MG/100 ...................... 66

ZOMIG SPR 2.5MG ........................... 57 ZOMIG SPR 5MG .............................. 57

zonisamide cap 100 mg .................... 42

zonisamide cap 25 mg ...................... 42 zonisamide cap 50 mg ...................... 42

ZONTIVITY TAB 2.08MG .................... 85 ZORTRESS TAB 0.25MG .................... 88

ZORTRESS TAB 0.5MG ...................... 88 ZORTRESS TAB 0.75MG .................... 88

Z-TUSS AC LIQ 2-9/5ML ................... 95 ZUBSOLV SUB 0.7-0.18 .................... 60

ZUBSOLV SUB 1.4-0.36 .................... 60 ZUBSOLV SUB 11.4-2.9 .................... 60

ZUBSOLV SUB 2.9-0.71 .................... 60 ZUBSOLV SUB 5.7-1.4 ...................... 60

ZUBSOLV SUB 8.6-2.1 ...................... 60 ZYDELIG TAB 100MG ........................ 20

ZYDELIG TAB 150MG ........................ 20

ZYKADIA CAP 150MG ........................ 20 ZYLET SUS 0.5-0.3% ...................... 105

160

ZYMAXID SOL 0.5% ........................ 105

ZYPREXA RELP INJ 210MG ................. 51 ZYPREXA RELP INJ 300MG ................. 51

ZYPREXA RELP INJ 405MG ................. 51

ZYTIGA TAB 250MG .......................... 17 ZYTIGA TAB 500MG .......................... 17

2019 formulary guide · companies that make generic drugs do not have to invest large amounts of...

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