2022 FL Formulary

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2022 Prescription Drug List

Effective January 1, 2022
Ambetter.SunshineHealth.com
Formulary Introduction
FORMULARY
The Ambetter from Sunshine Health Formulary, or Prescription Drug List, is a guide to available brand and generic drugs that
are approved by the Food and Drug Administration (FDA) and covered through your prescription
drug benefit. Generic drugs have the same active ingredients as their brand name counterparts and should be
considered the first line of treatment. The FDA requires generics to be safe and work the same as brand name drugs. If there
is no generic available, there may be more than one brand name drug to treat a condition. Preferred brand name drugs are
listed on Tier 2 to help identify brand drugs that are clinically appropriate, safe, and cost-effective treatment options, if a
generic medication on the formulary is not suitable for your condition.
Please note, the Formulary is not meant to be a complete list of the drugs covered under your prescription benefit.
Not all dosage forms or strengths of a drug may be covered. This list is periodically reviewed and updated and may
be subject to change. Drugs may be added or removed, or additional requirements may be added in order to approve
continued usage of a specific drug.
Specific prescription benefit plan designs may not cover certain products or categories, regardless of their appearance
in this document. Please check your benefits for coverage limitations and your share of cost for your drugs.
Drug List Key:

Brand name drugs are listed in CAPS and generic drugs are lower case.
Drugs are covered under different copay tiers depending on your benefit:
Tier 0 - No copayment for those drugs that are used for prevention and are mandated by the Affordable Care Act. Select oral
contraceptives, vitamin D, folic acid for women of child bearing age, over-the-counter (OTC) aspirin, and smoking
cessation products may be covered under this tier. Certain age limits may apply.
Tier 1A- Lowest copayment for select drugs that offer the greatest value compared to other drugs used to treat similar
conditions. Select over-the-counter (OTC) drugs may be covered under this tier.
Tier 1B- Low copayment for those drugs that offer great value compared to other drugs used to treat similar conditions. Select
over-the-counter (OTC) drugs may be covered under this tier.
Tier 2 - Medium copayment covers brand name drugs that are generally more affordable, or may be preferred compared to
other drugs to treat the same conditions.
Tier 3 - High copayment covers higher cost brand name and non-preferred generic drugs. This tier may also cover non-
specialty drugs that are not on the Prescription Drug List but approval has been granted for coverage.
Tier 4 - Highest copayment is for “specialty” drugs used to treat complex, chronic conditions that may require special
handling, storage or clinical management. Prescription drugs covered under the specialty tier require fulfillment at a
pharmacy that participates in Ambetter's "specialty" or "hemophilia" networks. For additional information on which
pharmacies are within our "specialty" or "hemophilia" networks, please consult Ambetter website's pharmacy
information section.
Prior Authorization for Non-Formulary Drugs
To obtain prior authorization for a non-formulary drug, your provider must fill out the Prior Authorization form.
Envolve Pharmacy Solutions will respond via fax or phone within 24 hours of receipt of all necessary information for
urgent requests, and within 72 hours for non-urgent requests, unless state law requires faster response. If the
request is disapproved, the notice of disapproval will contain a clear explanation of the specific reasons for
disapproving the prior authorization request, or if the request was incomplete, the explanation will identify the
missing material information that is necessary to complete the request.
Formulary Abbreviations:
Abbreviation Term What it means
AL Age Limit Some drugs are only covered for certain ages.
QL Quantity Limit Some drugs are only covered for a certain amount.
Your doctor must ask for approval from Ambetter before some
PA Prior Authorization
drugs will be covered.
In some cases, you must first try certain drugs before Ambetter
covers another drug for your medical condition. For example, if
ST Step Therapy Drug A and Drug B both treat your medical condition, Ambetter
may not cover Drug B unless you try Drug A first.
This product is not covered unless you or your provider request

NF Non-formulary an exception. Alternative medications are listed next to non-
covered product
These drugs are made in both prescription form and Over-

RX/OTC Prescription and OTC
the-counter (OTC) form.
Initially, certain medications may only be available in 15-

day-supply increments until you are stabilized on the
SF Split Fill medication. After you have been taking the medication for
90 days, this restriction may no longer apply.
Drug Requirements/ Drug Requirements/
Drug Name Tier Limits Drug Name Tier Limits
ADHD/ANTI-NARCOLEPSY/ANTI- amphetamine- QL(2 ea daily)
OBESITY/ANOREXIANTS - Drugs to Treat dextroamphetamine cp24 5
ADHD, Sleep and Eating Disorders mg-5 mg-5 mg-5 mg, 6.25 1B
mg-6.25 mg-6.25 mg-6.25
Amphetamines mg, 7.5 mg-7.5 mg-7.5 mg-
ADDERALL TABS 1.25 QL(3 ea daily) 7.5 mg
MG-1.25 MG-1.25 MG-1.25 amphetamine- QL(3 ea daily)
MG, 1.875 MG-1.875 MG- dextroamphetamine tabs
1.875 MG-1.875 MG, 2.5 1.25 mg-1.25 mg-1.25 mg-
MG-2.5 MG-2.5 MG-2.5 1.25 mg, 1.875 mg-1.875
MG, 3.125 MG-3.125 MG- NF mg-1.875 mg-1.875 mg,
3.125 MG-3.125 MG, 3.75 1B
2.5 mg-2.5 mg-2.5 mg-2.5
MG-3.75 MG-3.75 MG-3.75 mg, 3.125 mg-3.125 mg-
MG, 5 MG-5 MG-5 MG-5 3.125 mg-3.125 mg, 3.75
MG (Use amphetamine- mg-3.75 mg-3.75 mg-3.75
dextroamphetamine) mg, 5 mg-5 mg-5 mg-5 mg
ADDERALL TABS 7.5 MG- QL(2 ea daily) amphetamine- QL(2 ea daily)
7.5 MG-7.5 MG-7.5 MG NF dextroamphetamine tabs
(Use amphetamine- 1B
7.5 mg-7.5 mg-7.5 mg-7.5
dextroamphetamine) mg
ADDERALL XR CP24 1.25 QL(1 ea daily) QL(5 ea daily);
MG-1.25 MG-1.25 MG-1.25 DESOXYN TABS (Use NF AL(At least 6
MG, 2.5 MG-2.5 MG-2.5 methamphetamine hcl) yrs old)
NF
MG-2.5 MG (Use
amphetamine- DEXEDRINE CP24 10 MG, QL(4 ea daily)
dextroamphetamine) 15 MG (Use NF
dextroamphetamine
ADDERALL XR CP24 3.75 sulfate)
MG-3.75 MG-3.75 MG-3.75 NF
MG (Use amphetamine- DEXEDRINE CP24 5 MG
dextroamphetamine) (Use dextroamphetamine NF
sulfate)
ADDERALL XR CP24 5 QL(2 ea daily)
MG-5 MG-5 MG-5 MG, dextroamphetamine sulfate 1B QL(4 ea daily)
6.25 MG-6.25 MG-6.25 cp24 10 mg, 15 mg
MG-6.25 MG, 7.5 MG-7.5 NF dextroamphetamine sulfate 1B
MG-7.5 MG-7.5 MG (Use cp24 5 mg
amphetamine- dextroamphetamine sulfate QL(4 ea daily)
dextroamphetamine) 1B
tabs 10 mg, 5 mg
ADZENYS ER SUER (Use NF QL(5 ea daily);
amphetamine) methamphetamine hcl tabs 3 AL(At least 6
amphetamine- QL(1 ea daily) yrs old)
dextroamphetamine cp24 VYVANSE CAPS 10 MG, ST; QL(1 ea
1.25 mg-1.25 mg-1.25 mg- 1B 20 MG, 30 MG, 40 MG, 50 3 daily)
1.25 mg, 2.5 mg-2.5 mg- MG, 60 MG, 70 MG
2.5 mg-2.5 mg
Anorexiants Non-Amphetamine
amphetamine-
dextroamphetamine cp24 ADIPEX-P CAPS (Use NF PA
1B phentermine hcl)
3.75 mg-3.75 mg-3.75 mg-
3.75 mg phendimetrazine tartrate 1B PA
tabs 35 mg
Ambetter Sunshine Formulary Updated January 1, 2022
1
phentermine hcl caps 15 1B PA DAYTRANA PTCH 3 PA; QL(1 ea
mg, 30 mg, 37.5 mg daily)
Anti-Obesity Agents dexmethylphenidate hcl QL(1 ea daily)
PA; QL(2 ea cp24 35 mg, 10 mg, 15 mg, 1B
BELVIQ TABS 3
daily) 20 mg, 25 mg, 30 mg, 40
mg, 5 mg
PA; QL(4 ea
CONTRAVE TB12 3 QL(2 ea daily);
daily) dexmethylphenidate hcl 1B AL(At least 6
tabs 2.5 mg, 10 mg, 5 mg yrs old)
Attention-Deficit/Hyperactivity Disorder (ADHD)
QL(2 ea daily); QL(2 ea daily);
atomoxetine hcl caps 10 1B AL(At least 6 FOCALIN TABS (Use NF AL(At least 6
mg, 18 mg, 25 mg, 40 mg yrs old) dexmethylphenidate hcl) yrs old)
QL(1 ea daily); FOCALIN XR CP24 (Use NF QL(1 ea daily)
atomoxetine hcl caps 100 1B AL(At least 6 dexmethylphenidate hcl)
mg, 60 mg, 80 mg yrs old) QL(30 ml
METHYLIN SOLN (Use NF daily); AL(At
clonidine hcl (adhd) tb12 1B methylphenidate hcl) least 6 yrs old)
QL(1 ea daily); methylphenidate hcl cp24
guanfacine hcl (adhd) tb24 1B AL(At least 6 1B AL(At least 6
20 mg, 40 mg yrs old)
yrs old) QL(3 ea daily);
QL(1 ea daily); methylphenidate hcl cp24 1B AL(At least 6
INTUNIV TB24 (Use NF AL(At least 6 30 mg
guanfacine hcl (adhd)) yrs old)
yrs old) methylphenidate hcl cpcr QL(1 ea daily);
KAPVAY TB12 (Use NF 40 mg, 60 mg, 10 mg, 20 1B AL(At least 6
clonidine hcl (adhd)) mg, 30 mg, 50 mg yrs old)
STRATTERA CAPS 10 QL(2 ea daily); QL(30 ml
MG, 18 MG, 25 MG, 40 MG NF AL(At least 6 methylphenidate hcl soln 1B daily); AL(At
(Use atomoxetine hcl) yrs old) 10 mg/5ml, 5 mg/5ml least 6 yrs old)
STRATTERA CAPS 100 QL(1 ea daily); QL(5 ea daily);
MG, 60 MG, 80 MG (Use NF AL(At least 6 methylphenidate hcl tabs 1B AL(At least 6
atomoxetine hcl) yrs old) 10 mg, 20 mg yrs old)
Dopamine and Norepinephrine Reuptake QL(6 ea daily);
methylphenidate hcl tabs 5 1B AL(At least 6
SUNOSI TABS 150 MG 3 PA; QL(1 ea mg yrs old)
daily)
QL(3 ea daily);
SUNOSI TABS 75 MG 3 PA; QL(2 ea methylphenidate hcl tbcr 10 1B AL(At least 6
daily) mg, 20 mg yrs old)
Stimulants - Misc. QL(1 ea daily);
PA; QL(1 ea methylphenidate hcl tbcr 18 1B AL(At least 6
mg, 27 mg
armodafinil tabs 1B daily); AL(At yrs old)
least 17 yrs QL(2 ea daily);
old) methylphenidate hcl tbcr 36 1B AL(At least 6
CONCERTA TBCR 18 MG, QL(1 ea daily); mg, 54 mg yrs old)
27 MG (Use NF AL(At least 6 PA; QL(1 ea
methylphenidate hcl) yrs old)
CONCERTA TBCR 36 MG, QL(2 ea daily); modafinil tabs 100 mg 1B daily); AL(At
least 16 yrs
54 MG (Use NF AL(At least 6 old)
methylphenidate hcl) yrs old)
2
PA; QL(2 ea gentamicin in saline soln
modafinil tabs 200 mg 1B daily); AL(At 0.9 %-0.8 mg/ml, 0.9 %-1.2 1B
least 16 yrs mg/ml, 0.9 %-1.6 mg/ml, 1
old) mg/ml-0.9 %
PA; QL(1 ea gentamicin sulfate soln 40 1B
NUVIGIL TABS (Use NF daily); AL(At mg/ml
armodafinil) least 17 yrs HUMATIN CAPS (Use
old) NF
paromomycin sulfate)
PA; QL(1 ea KITABIS PAK NEBU (Use
PROVIGIL TABS 100 MG NF PA
NF daily); AL(At tobramycin)
(Use modafinil) least 16 yrs
old) neomycin sulfate tabs 1B
PA; QL(2 ea
PROVIGIL TABS 200 MG paromomycin sulfate caps 1B
NF daily); AL(At
(Use modafinil) least 16 yrs
old) streptomycin sulfate solr 3
RITALIN LA CP24 20 MG, AL(At least 6 TOBI NEBU (Use
40 MG (Use NF yrs old) NF PA
tobramycin)
methylphenidate hcl)
tobramycin nebu 300 4 PA
QL(3 ea daily); mg/5ml
RITALIN LA CP24 30 MG NF AL(At least 6
(Use methylphenidate hcl) tobramycin sulfate soln 10
yrs old)
mg/ml, 40 mg/ml, 80 1B
RITALIN TABS 10 MG, 20 QL(5 ea daily); mg/2ml
MG (Use methylphenidate NF AL(At least 6
hcl) yrs old) ANALGESICS - ANTI-INFLAMMATORY - Drugs
to Treat Pain, Swelling, Muscle and Joint
QL(6 ea daily);
RITALIN TABS 5 MG (Use NF AL(At least 6 Conditions
methylphenidate hcl) yrs old) Anti-TNF-alpha - Monoclonal Antibodies
PA; 1 rtl pack
ALLERGENIC EXTRACTS/BIOLOGICALS MISC lmt amt,180 rtl
Allergenic Extracts pack lmt
HUMIRA PEDIATRIC
GRASTEK SUBL 3 PA CROHNS DISEASE 4 day(s),1 mail
pack lmt
STARTER PACK PSKT amt,180 mail
AMEBICIDES pack lmt
day(s),
Amebicides HUMIRA PEN PNKT 40
PA 4 PA; QL(0.143
SOLOSEC PACK 3 MG/0.4ML, 40 MG/0.8ML ea daily)
PA; 1 rtl pack
AMINOGLYCOSIDES - Drugs to Treat Bacterial lmt amt,180 rtl
Infections pack lmt
HUMIRA PEN PNKT 80 4 day(s),1 mail
Aminoglycosides MG/0.8ML pack lmt
amikacin sulfate soln 1B amt,180 mail
pack lmt
ARIKAYCE SUSP 4 PA day(s),
HUMIRA PEN-CD/UC/HS PA; QL(0.143
STARTER PNKT 40 4 ea daily)
MG/0.8ML
3
PA; 1 rtl pack Interleukin-1 Blockers
lmt amt,180 rtl PA; QL(0.286
pack lmt ARCALYST SOLR 4
HUMIRA PEN-CD/UC/HS ea daily); SP
STARTER PNKT 80 4 day(s),1 mail
pack lmt Nonsteroidal Anti-inflammatory Agents (NSAIDs)
MG/0.8ML amt,180 mail ARTHROTEC 50 TBEC
pack lmt (Use diclofenac w/ NF
day(s), misoprostol)
PA; 1 rtl pack ARTHROTEC 75 TBEC
lmt amt,180 rtl (Use diclofenac w/ NF
pack lmt misoprostol)
HUMIRA PEN-PEDIATRIC
UC STARTER PACK 4 day(s),1 mail CELEBREX CAPS 100 PA; QL(2 ea
pack lmt
PNKT MG, 200 MG, 50 MG (Use NF daily)
amt,180 mail
pack lmt celecoxib)
day(s), CELEBREX CAPS 400 MG NF PA; QL(1 ea
PA; 1 rtl pack (Use celecoxib) daily)
lmt amt,180 rtl celecoxib caps 100 mg, 1B PA; QL(2 ea
pack lmt 200 mg, 50 mg daily)
HUMIRA PEN-PS/UV 4 day(s),1 mail
STARTER PNKT pack lmt celecoxib caps 400 mg 1B PA; QL(1 ea
daily)
amt,180 mail CHILDRENS ADVIL SUSP NF RX/OTC
pack lmt (Use ibuprofen)
day(s),
CHILDRENS MOTRIN NF RX/OTC
HUMIRA PEN-PS/UV 4 PA; QL(0.143 SUSP (Use ibuprofen)
STARTER PNKT ea daily)
DAYPRO TABS (Use NF
HUMIRA PSKT 10 PA; QL(0.143 oxaprozin)
MG/0.1ML, 10 MG/0.2ML, 4 ea daily)
40 MG/0.4ML, 40 diclofenac potassium tabs 1B
MG/0.8ML
HUMIRA PSKT 20 diclofenac sodium tb24 1B
4 PA; SL(0.143
MG/0.2ML, 20 MG/0.4ML ea daily)
diclofenac sodium tbec 1B
Antirheumatic - Enzyme Inhibitors
PA; QL(1 ea diclofenac w/ misoprostol 1B
RINVOQ TB24 4 tbec
daily)
PA; QL(2 ea EC-NAPROSYN TBEC 500 NF
XELJANZ TABS 10 MG 4 MG (Use naproxen)
daily)
PA; QL(2 ea etodolac caps 200 mg, 300 1B
XELJANZ TABS 5 MG 4 mg
daily); SP
PA; QL(1 ea etodolac tabs 400 mg, 500 1B
XELJANZ XR TB24 4 mg
daily)
Antirheumatic Antimetabolites FELDENE CAPS (Use NF
piroxicam)
PA; QL(1.714
METHOTREXATE TABS 4 fenoprofen calcium tabs ST; QL(4 ea
ea daily); SP 1B
600 mg daily)
Gold Compounds
QL(3 ea daily) flurbiprofen tabs 1B
RIDAURA CAPS 3
4
ibuprofen susp 100 mg/5ml 1B RX/OTC tolmetin sodium caps 1B
ibuprofen tabs 400 mg, 600 1A tolmetin sodium tabs 1B
mg
ibuprofen tabs 800 mg 1B Phosphodiesterase 4 (PDE4) Inhibitors
indomethacin caps 25 mg, OTEZLA TABS 4 PA; QL(2 ea

1B daily)
50 mg PA; 1 rtl pack
indomethacin cpcr 75 mg 1B OTEZLA TBPK 4 lmt amt,180 rtl
pack lmt
ketoprofen caps 50 mg, 75 1B day(s),
mg
Pyrimidine Synthesis Inhibitors
ketorolac tromethamine 1B QL(0.667 ea
tabs or 10 mg daily) ARAVA TABS (Use NF QL(1 ea daily)
leflunomide)
LODINE TABS (Use NF
etodolac) leflunomide tabs 1B QL(1 ea daily)
meclofenamate sodium 1B
caps Soluble Tumor Necrosis Factor Receptor Agents
ST; Must try ENBREL MINI SOCT 4 PA; QL(0.15 ml
mefenamic acid caps 1B ibuprofen. daily)
;QL(5 ea daily) ENBREL SOLN 25 4 PA; QL(0.146
meloxicam tabs 15 mg, 7.5 QL(1 ea daily) MG/0.5ML ml daily)
1A
mg ENBREL SOLR 25 MG 4 PA; QL(0.286
MOBIC TABS (Use ea daily); SP
NF QL(1 ea daily) ENBREL SOSY 25
meloxicam) 4 PA; QL(0.146
MG/0.5ML ml daily); SP
nabumetone tabs 1B
ENBREL SOSY 50 MG/ML 4 PA; QL(0.28 ml
NALFON TABS 600 MG daily); SP
NF ST; QL(4 ea
(Use fenoprofen calcium) daily) ENBREL SURECLICK 4 PA; QL(0.143
NAPROSYN SUSP 125 SOAJ ml daily); SP
NF PA
MG/5ML (Use naproxen) ANALGESICS - NonNarcotic - Drugs to Treat
NAPROSYN TABS 500 NF Pain, Muscle and Joint Conditions
MG (Use naproxen)
Analgesic Combinations
naproxen sodium tabs 550 1B
mg butalbital-acetaminophen 1B
tabs 50 mg-325 mg
naproxen susp 125 mg/5ml 1B PA
butalbital-acetaminophen-
naproxen tabs 250 mg, 375 caffeine caps 40 mg-50 1B
1B mg-300 mg, 40 mg-50 mg-
mg, 500 mg
325 mg
naproxen tbec 500 mg 1B butalbital-acetaminophen-
caffeine tabs 40 mg-50 mg- 1B
oxaprozin tabs 1B 325 mg
butalbital-aspirin-caffeine 1B
piroxicam caps 1B caps
sulindac tabs 1B
5
BUTALBITAL/ACETAMINO DEMEROL SOLN 100
PHEN CAPS (Use NF MG/ML, 25 MG/ML, 50 NF
butalbital-acetaminophen) MG/ML (Use meperidine
ESGIC TABS (Use hcl)
butalbital-acetaminophen- NF DILAUDID LIQD OR 1 New starts
caffeine) MG/ML (Use NF limited to 7 day
FIORICET CAPS (Use hydromorphone hcl) supply
butalbital-acetaminophen- NF DILAUDID SOLN IJ 1
caffeine) MG/ML, 2 MG/ML (Use NF
FIORINAL CAPS (Use hydromorphone hcl)
NF
butalbital-aspirin-caffeine) DILAUDID TABS OR 2 New starts
Salicylates MG, 4 MG, 8 MG (Use NF limited to 7 day
supply;QL(8 ea
AL(At least 45 hydromorphone hcl) daily)
aspirin chew or 81 mg 0 yrs old - Up to DURAGESIC PT72 (Use
79 yrs old) NF QL(0.34 ea
fentanyl) daily)
AL(At least 45
aspirin tabs or 325 mg 0 yrs old - Up to EMBEDA CPCR 3 QL(2 ea daily)
79 yrs old)
fentanyl citrate lpop bu PA; QL(4 ea
aspirin tbec or 325 mg 1A 1200 mcg, 1600 mcg, 200 1B daily)
mcg, 400 mcg, 600 mcg,
AL(At least 45 800 mcg
aspirin tbec or 81 mg 0 yrs old - Up to fentanyl pt72 td 100 QL(0.34 ea
79 yrs old) mcg/hr, 12 mcg/hr, 25 1B daily)
diflunisal tabs 1B mcg/hr, 50 mcg/hr, 75
mcg/hr
ECOTRIN REGULAR FENTORA TABS (Use
STRENGTH TBEC (Use NF NF
fentanyl citrate)
aspirin)
hydrocodone bitartrate PA; QL(2 ea
ECOTRIN TBEC (Use NF cp12 10 mg, 15 mg, 30 mg, 1B daily)
aspirin) 40 mg, 50 mg
salsalate tabs 1B hydrocodone bitartrate t24a QL(2 ea daily)
100 mg, 120 mg, 20 mg, 30 1B
ANALGESICS - OPIOID - Drugs to Treat Pain, mg, 40 mg, 60 mg, 80 mg
Muscle and Joint Conditions New starts
hydromorphone hcl liqd or 1B limited to 7 day
Opioid Agonists 1 mg/ml
ACTIQ LPOP (Use fentanyl supply
NF PA; QL(4 ea hydromorphone hcl soln ij
citrate) daily)
10 mg/ml, 50 mg/5ml, 500 1B
ARYMO ER TBEA 3 QL(3 ea daily) mg/50ml
New starts New starts
CODEINE SULFATE TABS hydromorphone hcl tabs or limited to 7 day
1B limited to 7 day 1B
15 MG, 60 MG 2 mg, 4 mg, 8 mg supply;QL(8 ea
supply
daily)
New starts
codeine sulfate tabs 30 mg 1B limited to 7 day hydromorphone hcl tb24 or 1B PA; QL(2 ea
supply 12 mg, 16 mg, 8 mg daily)
CONZIP CP24 (Use hydromorphone hcl tb24 or 1B PA; QL(1 ea
NF 32 mg daily)
tramadol hcl)
6
HYDROMORPHONE MORPHABOND ER T12A 3 PA; QL(3 ea
HYDROCHLORIDE SOLN NF 15 MG daily)
IJ 10 MG/ML (Use morphine sulfate cp24 or PA; QL(2 ea
hydromorphone hcl) 100 mg, 20 mg, 30 mg, 50 1B daily)
HYSINGLA ER T24A (Use 3 QL(2 ea daily) mg, 60 mg, 80 mg
hydrocodone bitartrate) morphine sulfate soln ij 0.5 1B
KADIAN CP24 100 MG, 20 PA; QL(2 ea mg/ml, 1 mg/ml
MG, 30 MG, 50 MG, 60 NF daily) MORPHINE SULFATE
MG, 80 MG (Use morphine SOLN IV 10 MG/ML (Use NF
sulfate) morphine sulfate)
levorphanol tartrate tabs 2 1B limited to 7 day
mg morphine sulfate soln or 10 1B limited to 7 day
supply mg/5ml supply;QL(100
meperidine hcl soln ij 100 1B ml daily)
mg/ml, 25 mg/ml, 50 mg/ml New starts
New starts morphine sulfate soln or 20 1B limited to 7 day
meperidine hcl soln or 50 1B limited to 7 day mg/5ml supply;QL(50
mg/5ml supply;QL(500 ml daily)
ml per fill retail) New starts
New starts morphine sulfate tabs or 15 1B limited to 7 day
meperidine hcl tabs or 50 1B limited to 7 day mg supply;QL(6 ea
mg supply;QL(6 ea daily)
daily) morphine sulfate tabs or 30 QL(6 ea daily)
1B
methadone hcl conc or 10 1B QL(10 ml daily) mg
mg/ml morphine sulfate tbcr or QL(2 ea daily)
methadone hcl soln ij 10 1B 100 mg, 15 mg, 200 mg, 30 1B
mg/ml mg, 60 mg
METHADONE HCL SOLN MS CONTIN TBCR (Use NF QL(2 ea daily)
IJ 10 MG/ML (Use 1B morphine sulfate)
methadone hcl) PA; QL(2 ea
NUCYNTA ER TB12 2
methadone hcl soln or 10 1B QL(50 ml daily) daily)
mg/5ml
NUCYNTA TABS 2 PA; QL(6 ea
methadone hcl soln or 5 1B QL(100 ml daily)
mg/5ml daily) OPANA TABS (Use NF PA; QL(12 ea
methadone hcl tabs or 10 1B QL(10 ea daily) oxymorphone hcl) daily)
mg oxycodone hcl t12a 15 mg, QL(2 ea daily)
methadone hcl tabs or 5 1B QL(4 ea daily) 30 mg, 60 mg, 80 mg, 10 3
mg mg, 20 mg, 40 mg
methadone hcl tbso or 40 1B QL(2 ea daily) New starts
mg oxycodone hcl tabs 10 mg, 1B limited to 7 day
METHADOSE CONC (Use 20 mg, 15 mg, 30 mg, 5 mg supply;QL(12
NF QL(10 ml daily) ea daily)
methadone hcl)
METHADOSE SUGAR- QL(10 ml daily) oxymorphone hcl tabs 10 1B PA; QL(12 ea
FREE CONC (Use NF mg, 5 mg daily)
methadone hcl) oxymorphone hcl tb12 10 PA; QL(2 ea
MORPHABOND ER T12A PA; QL(1 ea mg, 15 mg, 20 mg, 30 mg, 1B daily)
3 5 mg, 7.5 mg
100 MG, 30 MG, 60 MG daily)
7
oxymorphone hcl tb12 40 1B PA; QL(4 ea acetaminophen-caff- New starts
mg daily) dihydrocod caps 16 mg-30 1B limited to 7 day
New starts mg-320.5 mg supply
ROXICODONE TABS (Use NF limited to 7 day acetaminophen-caff- PA; New starts
oxycodone hcl) supply;QL(12 dihydrocod caps 16 mg-30 3 limited to 7 day
ea daily) mg-320.5 mg supply
ROXYBOND TABA 3 QL(12 ea daily) butalbital-acetaminophen- New starts
caffeine w/ codeine caps 1B limited to 7 day
PA; QL(3 ea 30 mg-40 mg-50 mg-300 supply
SUBSYS LIQD 100 MCG 3 mg
daily)
SUBSYS LIQD 1200 MCG, PA; QL(4 ea butalbital-acetaminophen- New starts
1600 MCG, 200 MCG, 400 3 daily) caffeine w/ codeine caps limited to 7 day
MCG, 600 MCG 30 mg-40 mg-50 mg-325 1B supply;QL(6 ea
PA; QL(8 ea mg, 325 mg-30 mg-40 mg- daily)
SUBSYS LIQD 800 MCG 3 50 mg
daily)
limited to 7 day butalbital-aspirin-caffeine 1B limited to 7 day
tramadol hcl tabs 50 mg 1A
supply;QL(8 ea w/cod caps supply;QL(6 ea
daily) daily)
tramadol hcl tb24 100 mg, QL(1 ea daily) FIORICET/CODEINE New starts
1B CAPS (Use butalbital-
200 mg, 300 mg NF limited to 7 day
acetaminophen-caffeine w/ supply
New starts codeine)
ULTRAM TABS (Use NF limited to 7 day
tramadol hcl) supply;QL(8 ea New starts
FIORINAL/CODEINE #3
daily) CAPS (Use butalbital- NF limited to 7 day
supply;QL(6 ea
aspirin-caffeine w/cod)
XTAMPZA ER C12A 2 PA; QL(2 ea daily)
daily)
hydrocodone- New starts
ZOHYDRO ER CP12 NF PA; QL(2 ea acetaminophen soln 10 1B limited to 7 day
daily) mg/15ml-325 mg/15ml supply
Opioid Combinations hydrocodone- New starts
New starts acetaminophen soln 2.5 limited to 7 day
acetaminophen w/ codeine limited to 7 day mg/5ml-108 mg/5ml, 5 1B supply;QL(180
soln 12 mg/5ml-120 1A
supply;QL(75 mg/10ml-217 mg/10ml, 7.5 ml daily)
mg/5ml ml daily) mg/15ml-325 mg/15ml
New starts hydrocodone- New starts
acetaminophen w/ codeine limited to 7 day acetaminophen tabs 10 1B limited to 7 day
1B mg-300 mg, 5 mg-300 mg, supply;QL(13
tabs 15 mg-300 mg supply;QL(13
ea daily) 7.5 mg-300 mg ea daily)
New starts hydrocodone- New starts
acetaminophen w/ codeine limited to 7 day acetaminophen tabs 5 mg- limited to 7 day
tabs 30 mg-300 mg, 300 1A
supply;QL(12 325 mg, 10 mg-325 mg, 1B supply;QL(12
mg-30 mg ea daily) 325 mg-10 mg, 325 mg-7.5 ea daily)
New starts mg, 7.5 mg-325 mg
acetaminophen w/ codeine limited to 7 day hydrocodone-ibuprofen PA
1B tabs 10 mg-200 mg, 5 mg- 1B
tabs 60 mg-300 mg supply;QL(6 ea
daily) 200 mg
8
New starts buprenorphine hcl subl sl 2 1B QL(3 ea daily)
hydrocodone-ibuprofen 1B limited to 7 day mg, 8 mg
tabs 7.5 mg-200 mg supply;QL(5 ea buprenorphine hcl- QL(3 ea daily)
daily) naloxone hcl dihydrate film 1B
New starts 0.5 mg-2 mg, 1 mg-4 mg
LORTAB ELIX 2 limited to 7 day buprenorphine hcl- QL(2 ea daily)
supply;QL(60 naloxone hcl dihydrate film 1B
ml daily) 2 mg-8 mg, 3 mg-12 mg
New starts buprenorphine hcl- QL(3 ea daily)
NORCO TABS (Use
hydrocodone- NF limited to 7 day naloxone hcl dihydrate subl 1B
supply;QL(12 0.5 mg-2 mg, 2 mg-8 mg
acetaminophen) ea daily)
buprenorphine ptwk td 10 PA; QL(0.143
oxycodone w/ New starts mcg/hr, 15 mcg/hr, 20
acetaminophen tabs 10 limited to 7 day 1B ea daily)
mcg/hr, 5 mcg/hr, 7.5
mg-325 mg, 325 mg-5 mg, 1B supply;QL(12 mcg/hr
325 mg-7.5 mg, 5 mg-325 ea daily)
mg, 7.5 mg-325 mg butorphanol tartrate soln ij 1B
1 mg/ml, 2 mg/ml
New starts
butorphanol tartrate soln na 1B PA
oxycodone-ibuprofen tabs 1B limited to 7 day 10 mg/ml
supply;QL(1 ea
daily) BUTRANS PTWK (Use NF PA; QL(0.143
PERCOCET TABS 10 MG- New starts buprenorphine) ea daily)
325 MG, 5 MG-325 MG, limited to 7 day nalbuphine hcl soln 1B QL(8 ml daily)
7.5 MG-325 MG (Use NF supply;QL(12
oxycodone w/ ea daily) New starts
pentazocine w/ naloxone 1B limited to 7 day
acetaminophen) tabs
New starts supply
tramadol-acetaminophen SUBOXONE FILM 0.5 MG- QL(3 ea daily)
1B limited to 7 day 2 MG, 1 MG-4 MG (Use
tabs supply;QL(8 ea NF
daily) buprenorphine hcl-
New starts naloxone hcl dihydrate)
TYLENOL/CODEINE #3 SUBOXONE FILM 2 MG-8 QL(2 ea daily)
TABS (Use acetaminophen NF limited to 7 day MG, 3 MG-12 MG (Use
supply;QL(12 NF
w/ codeine) ea daily) buprenorphine hcl-
New starts naloxone hcl dihydrate)
TYLENOL/CODEINE #4
TABS (Use acetaminophen NF limited to 7 day ANDROGENS-ANABOLIC - Drugs to Regulate
supply;QL(6 ea Hormones
w/ codeine) daily)
Anabolic Steroids
New starts
ULTRACET TABS (Use NF limited to 7 day ANADROL-50 TABS 3
tramadol-acetaminophen) supply;QL(8 ea
daily) oxandrolone tabs 1B
Opioid Partial Agonists
Androgens
BUPRENEX SOLN (Use NF
buprenorphine hcl) PA; QL(1 ea
ANDRODERM PT24 2
daily)
buprenorphine hcl soln ij 1B
0.3 mg/ml ANDROGEL GEL 25
MG/2.5GM, 50 MG/5GM NF
(Use testosterone)
9
danazol caps 1B ANTHELMINTICS - Drugs to Treat Worm
Infections
DEPO-TESTOSTERONE
SOLN (Use testosterone NF Anthelmintics
cypionate) albendazole tabs 1B PA
METHITEST TABS 3 ALBENZA TABS (Use NF PA
TESTIM GEL (Use albendazole)
NF BILTRICIDE TABS (Use
testosterone) NF PA
TESTOSTERONE praziquantel)
CYPIONATE SOLN IJ 200 1B QL(2 ea daily,6
MG/ML ea per fill
testosterone cypionate soln retail,6 ea per
1B fill mail)1 rtl
im 100 mg/ml, 200 mg/ml
EMVERM CHEW 2 MAX fill,60 rtl
testosterone enanthate 1B day(s) supply,1
soln im mail MAX fill,60
VOGELXO GEL (Use NF mail day(s)
testosterone) supply,
VOGELXO PUMP GEL NF
(Use testosterone) ivermectin tabs or 3 mg 1B
ANORECTAL AND RELATED PRODUCTS - praziquantel tabs 1B PA
Rectal Drugs to Treat Pain, Swelling and Itching
STROMECTOL TABS (Use NF
Intrarectal Steroids ivermectin)
CORTENEMA ENEM (Use NF
hydrocortisone (intrarectal)) ANTI-INFECTIVE AGENTS - MISC. - Drugs to
Treat Bacterial Infections
hydrocortisone (intrarectal) 1B
enem Anti-infective Agents - Misc.
UCERIS FOAM RE 2 4 PA bacitracin solr 3
MG/ACT
FLAGYL TABS 500 MG NF
Rectal Steroids (Use metronidazole)
ANUSOL-HC CREA (Use NF PA; QL(3 ea
hydrocortisone (rectal)) IMPAVIDO CAPS 3
daily)
hydrocortisone (rectal) crea 1B metronidazole tabs or 250 1B
mg, 500 mg
hydrocortisone acetate 1B
(rectal) supp trimethoprim tabs 1B
PROCTOCORT CREA PA; AL(At least
(Use hydrocortisone NF XIFAXAN TABS 3
12 yrs old)
(rectal))
PROCTOCORT SUPP Anti-infective Misc. - Combinations
(Use hydrocortisone NF BACTRIM DS TABS (Use
acetate (rectal)) sulfamethoxazole- NF
trimethoprim)
Vasodilating Agents
BACTRIM TABS (Use
RECTIV OINT 3 QL(2 gm daily) sulfamethoxazole- NF
trimethoprim)
10
sulfamethoxazole- daptomycin solr 500 mg 1B
trimethoprim soln iv 400 1B
mg/5ml-80 mg/5ml, 80 Glycopeptides
mg/5ml-400 mg/5ml
QL(300 ml per
sulfamethoxazole- FIRVANQ SOLR 2
fill retail)
trimethoprim susp or 40 1B
mg/5ml-200 mg/5ml QL(4 ea
VANCOCIN CAPS (Use NF daily,40 ea per
sulfamethoxazole- vancomycin hcl) fill retail)
trimethoprim tabs or 160
mg-800 mg, 800 mg-160 1A QL(4 ea
VANCOCIN HCL CAPS NF daily,40 ea per
mg, 400 mg-80 mg, 80 mg- (Use vancomycin hcl)
400 mg fill retail)
QL(4 ea
Antiprotozoal Agents vancomycin hcl caps or 1B daily,40 ea per
ALINIA SUSR 100 125 mg, 250 mg
2 PA fill retail)
MG/5ML vancomycin hcl solr iv 10
ALINIA TABS 500 MG (Use NF PA gm, 500 mg, 1 gm, 1000 1B
nitazoxanide) mg
atovaquone susp 1B VANCOMYCIN QL(300 ml per
HYDROCHLORIDE SOLR 2 fill retail)
MEPRON SUSP (Use NF OR 250 MG/5ML
atovaquone)
Leprostatics
nitazoxanide tabs or 1B PA
dapsone tabs 3
Carbapenems Lincosamides
ertapenem sodium solr 1B CLEOCIN CAPS OR 75
MG, 150 MG, 300 MG (Use NF
imipenem-cilastatin solr 1B clindamycin hcl)
INVANZ SOLR (Use CLEOCIN PEDIATRIC
NF GRANULES SOLR (Use
ertapenem sodium) NF
clindamycin palmitate
meropenem solr 1B hydrochloride)
MERREM SOLR (Use CLEOCIN PHOSPHATE
NF SOLN IJ 300 MG/2ML, 600
meropenem)
MG/4ML, 900 MG/6ML, 9 NF
PRIMAXIN IV SOLR (Use NF GM/60ML (Use clindamycin
imipenem-cilastatin) phosphate)
Chloramphenicols clindamycin hcl caps 1B
chloramphenicol sodium 4 PA; SP
succinate solr clindamycin palmitate 1B
hydrochloride solr
Cyclic Lipopeptides
CUBICIN RF SOLR (Use clindamycin phosphate soln 1B
NF
daptomycin) LINCOCIN SOLN (Use
CUBICIN SOLR (Use NF
NF lincomycin hcl)
daptomycin)
DAPTOMYCIN SOLR 350 lincomycin hcl soln 1B
NF
MG (Use daptomycin) Monobactams
11
AZACTAM SOLR (Use NF Antianginals-Other
aztreonam) RANEXA TB12 1000 MG NF QL(2 ea daily)
aztreonam solr 1B (Use ranolazine)
RANEXA TB12 500 MG NF QL(3 ea daily)
PA; QL(3 ml (Use ranolazine)
CAYSTON SOLR 4
daily)
ranolazine tb12 1000 mg 1B QL(2 ea daily)
Oxazolidinones
linezolid susr or 100 1B ranolazine tb12 500 mg 1B QL(3 ea daily)
mg/5ml
PA; QL(2 ea Nitrates
linezolid tabs or 600 mg 1B
daily) ISORDIL TITRADOSE
SIVEXTRO TABS OR 3 PA TABS 5 MG (Use NF
isosorbide dinitrate)
ZYVOX SUSR OR 100 NF isosorbide dinitrate tabs 30
MG/5ML (Use linezolid) 1B
mg, 10 mg, 20 mg, 5 mg
ZYVOX TABS OR 600 MG NF PA; QL(2 ea isosorbide dinitrate tbcr 40
(Use linezolid) daily) 1B
mg
Polymyxins isosorbide mononitrate tabs 1B
polymyxin b sulfate solr 1B isosorbide mononitrate 1B
tb24
Urinary Anti-infectives
fosfomycin tromethamine NITRO-BID OINT 3
1B
pack
NITRO-DUR PT24 0.1
FURADANTIN SUSP (Use NF MG/HR, 0.2 MG/HR, 0.4
nitrofurantoin) NF
MG/HR, 0.6 MG/HR (Use
HIPREX TABS (Use NF nitroglycerin)
methenamine hippurate) nitroglycerin cpcr or 6.5 QL(4 ea daily)
MACROBID CAPS (Use 1B
mg, 9 mg, 2.5 mg
nitrofurantoin monohyd NF nitroglycerin pt24 td 0.1
macro) mg/hr, 0.2 mg/hr, 0.4 1B
MACRODANTIN CAPS 50 mg/hr, 0.6 mg/hr
MG, 100 MG (Use NF NITROGLYCERIN SOLN
nitrofurantoin macrocrystal) 1B
IV 5 MG/ML
methenamine hippurate 1B nitroglycerin subl sl 0.3 mg,
tabs 1B
0.4 mg, 0.6 mg
MONUROL PACK (Use NF NITROSTAT SUBL (Use
fosfomycin tromethamine) NF
nitroglycerin)
nitrofurantoin macrocrystal 1B
caps 50 mg, 100 mg ANTIANXIETY AGENTS - Drugs to Treat Anxiety
nitrofurantoin monohyd 1B Antianxiety Agents - Misc.
macro caps
buspirone hcl tabs 10 mg, 1B
nitrofurantoin susp 1B 30 mg, 7.5 mg, 15 mg
buspirone hcl tabs 5 mg 1A QL(6 ea daily)
ANTIANGINAL AGENTS - Drugs to Treat Chest
Pain
12
hydroxyzine hcl soln im 50 1B XANAX TABS (Use NF QL(4 ea daily)
mg/ml alprazolam)
hydroxyzine hcl syrp or 10 1B XANAX XR TB24 (Use NF
mg/5ml alprazolam)
hydroxyzine hcl tabs or 10 1B ANTIARRHYTHMICS - Drugs to treat abnormal
mg, 25 mg, 50 mg heart rhythms
hydroxyzine pamoate caps 1B Antiarrhythmics Type I-A
disopyramide phosphate 1B
meprobamate tabs 1B caps
VISTARIL CAPS (Use NORPACE CAPS (Use NF
NF disopyramide phosphate)
hydroxyzine pamoate)
Benzodiazepines procainamide hcl soln 500 1B
mg/ml
alprazolam tabs 0.25 mg, 1A QL(4 ea daily)
0.5 mg, 1 mg quinidine sulfate tabs 1B
alprazolam tabs 2 mg 1B QL(4 ea daily)
Antiarrhythmics Type I-B
alprazolam tb24 0.5 mg, 1 mexiletine hcl caps 150 1B
1B mg, 200 mg, 250 mg
mg, 2 mg, 3 mg
alprazolam tbdp 0.25 mg, 1B Antiarrhythmics Type I-C
0.5 mg, 1 mg, 2 mg
ATIVAN TABS OR 0.5 MG,
flecainide acetate tabs 1B
NF QL(3 ea daily)
2 MG (Use lorazepam)
propafenone hcl cp12 1B
ATIVAN TABS OR 1 MG NF QL(4 ea daily)
(Use lorazepam) propafenone hcl tabs 1B
chlordiazepoxide hcl caps 1B RYTHMOL SR CP12 (Use NF
clorazepate dipotassium propafenone hcl)
1B
tabs Antiarrhythmics Type III
diazepam conc or 5 mg/ml 1B amiodarone hcl soln iv 150 1B
mg/3ml, 50 mg/ml
diazepam soln or 5 mg/5ml 1B amiodarone hcl tabs or 100 1B
mg, 200 mg, 400 mg
diazepam tabs or 10 mg, 2 1A QL(4 ea daily)
mg, 5 mg dofetilide caps 1B
lorazepam conc or 2 mg/ml 1B MULTAQ TABS 3
lorazepam tabs or 0.5 mg, 1A QL(3 ea daily) TIKOSYN CAPS (Use
2 mg NF
dofetilide)
lorazepam tabs or 1 mg 1A QL(4 ea daily)
ANTIASTHMATIC AND BRONCHODILATOR
AGENTS - Drugs to Treat Lung Conditions
oxazepam caps 1B
Anti-Inflammatory Agents
TRANXENE T TABS (Use NF QL(8 ml daily)
clorazepate dipotassium) cromolyn sodium nebu 1B
VALIUM TABS (Use NF QL(4 ea daily) Antiasthmatic - Monoclonal Antibodies
diazepam)
13
FASENRA PEN SOAJ 4 PA Selective Phosphodiesterase 4 (PDE4) Inhibitors
QL(1 ea
FASENRA SOSY 4 PA daily)30 rtl
MAX day(s)
NUCALA SOAJ 4 PA supply,180 rtl
DALIRESP TABS 250 3 lmt day(s),30
PA MCG
NUCALA SOLR 4 mail MAX
day(s)
NUCALA SOSY 4 PA supply,180 mail
lmt day(s),
PA; SP DALIRESP TABS 500
XOLAIR SOLR 150 MG 4 3 QL(1 ea daily)
MCG
XOLAIR SOSY 150 4 PA
MG/ML, 75 MG/0.5ML Steroid Inhalants
Bronchodilators - Anticholinergics ALVESCO AERS 3 PA
Limit 2 inhalers
per ARNUITY ELLIPTA AEPB 2
ATROVENT HFA AERS 3
month;QL(0.44 budesonide (inhalation) PA; QL(4 ml
gm daily) 1B
susp daily)
INCRUSE ELLIPTA AEPB 2 QL(1 ea daily)
FLOVENT DISKUS AEPB 2
ipratropium bromide soln 1B QL(15 ml daily)
FLOVENT HFA AERO 2
SPIRIVA HANDIHALER 2 QL(1 ea daily) PULMICORT FLEXHALER
CAPS 2
AEPB
SPIRIVA RESPIMAT QL(0.14 gm PULMICORT SUSP (Use
AERS
2
daily) NF PA; QL(4 ml
budesonide (inhalation)) daily)
Leukotriene Modulators
QVAR REDIHALER AERB 2
ACCOLATE TABS (Use NF QL(2 ea daily)
zafirlukast) Sympathomimetics
montelukast sodium chew 1B QL(1 ea daily) ADVAIR DISKUS AEPB
4 mg, 5 mg (Use fluticasone- NF
montelukast sodium pack 4 PA; QL(1 ea salmeterol)
1B
mg daily)
ADVAIR HFA AERO 2
montelukast sodium tabs 1B QL(1 ea daily)
10 mg AIRDUO RESPICLICK
SINGULAIR CHEW 4 MG, QL(1 ea daily) 113/14 AEPB (Use NF
5 MG (Use montelukast NF fluticasone-salmeterol)
sodium) AIRDUO RESPICLICK
SINGULAIR PACK 4 MG 232/14 AEPB (Use NF
NF PA; QL(1 ea fluticasone-salmeterol)
(Use montelukast sodium) daily)
SINGULAIR TABS 10 MG AIRDUO RESPICLICK
NF QL(1 ea daily) 55/14 AEPB 14 MCG/ACT-
(Use montelukast sodium) NF
QL(2 ea daily) 55 MCG/ACT (Use
zafirlukast tabs 1B fluticasone-salmeterol)
QL(4 ea daily) albuterol sulfate aers in 108 1B
zileuton tb12 1B mcg/act
14
albuterol sulfate nebu in 1B PERFOROMIST NEBU 3 PA
0.5 %, 2.5 mg/0.5ml (Use formoterol fumarate)
albuterol sulfate nebu in QL(15 ml daily) PROAIR HFA AERS (Use NF
0.63 mg/3ml, 1.25 mg/3ml, 1B albuterol sulfate)
0.083 % PROVENTIL HFA AERS NF
albuterol sulfate syrp or 2 1B (Use albuterol sulfate)
mg/5ml STRIVERDI RESPIMAT 2
albuterol sulfate tabs or 2 1B AERS
mg, 4 mg SYMBICORT AERO (Use
albuterol sulfate tb12 or 4 1B budesonide-formoterol NF
mg, 8 mg fumarate dihydrate)
ANORO ELLIPTA AEPB 2 QL(2 ea daily) terbutaline sulfate soln 1B
ARCAPTA NEOHALER 2 terbutaline sulfate tabs 1B
CAPS
PA; QL(4 ml TRELEGY ELLIPTA AEPB 2 QL(2 ea daily)
arformoterol tartrate nebu 1B
daily)
BEVESPI AEROSPHERE QL(0.36 gm UTIBRON NEOHALER 3 PA; QL(2 ea
2 CAPS daily)
AERO daily)
VENTOLIN HFA AERS NF
BREO ELLIPTA AEPB 2 (Use albuterol sulfate)
BREZTRI AEROSPHERE QL(0.38 gm XOPENEX PA
2 CONCENTRATE NEBU NF
AERO daily)
BROVANA NEBU (Use PA; QL(4 ml (Use levalbuterol hcl)
3 PA; Limit 2
arformoterol tartrate) daily)
budesonide-formoterol XOPENEX HFA AERO NF inhalers per
1B (Use levalbuterol tartrate) month;QL(1 gm
fumarate dihydrate aero
daily)
fluticasone-salmeterol aepb
50 mcg/dose-500 XOPENEX NEBU (Use NF PA; QL(12 ml
mcg/dose, 50 mcg/act-100 levalbuterol hcl) daily)
mcg/act, 50 mcg/act-250 1B Xanthines
mcg/act, 50 mcg/dose-100
mcg/dose, 50 mcg/dose- aminophylline soln 1B
250 mcg/dose
PA ELIXOPHYLLIN ELIX 1B
formoterol fumarate nebu 1B
theophylline soln 80 1B QL(56 ml daily)
ipratropium-albuterol soln 1B QL(18 ml daily) mg/15ml
theophylline tb12 300 mg, 1B
levalbuterol hcl nebu 0.31 PA; QL(12 ml 450 mg
mg/3ml, 0.63 mg/3ml, 1.25 1B daily)
mg/3ml theophylline tb24 400 mg, 1B
600 mg
levalbuterol hcl nebu 1.25 1B PA
mg/0.5ml ANTICOAGULANTS - Blood Thinners
PA; Limit 2
inhalers per Coumarin Anticoagulants
levalbuterol tartrate aero 3
month;QL(1 gm COUMADIN TABS (Use 2
daily) warfarin sodium)
15
warfarin sodium tabs 1B QL(0.8 ml
enoxaparin sodium soln sc 4 daily,30 day(s)
40 mg/0.4ml limit); SP
Direct Factor Xa Inhibitors
QL(42 ea per QL(1.2 ml
enoxaparin sodium soln sc 4 daily,30 day(s)
42 days 60 mg/0.6ml
BEVYXXA CAPS 3 limit); SP
retail,42 ea per
42 days mail) QL(7.2 ml per
QL(2.47 ea 180 days
ELIQUIS STARTER PACK fondaparinux sodium soln 4 retail,7.2 ml per
2 daily,1 ea per 10 mg/0.8ml
TBPK 180 days mail);
180 days retail)
SP
ELIQUIS TABS 2 QL(2 ea daily)
QL(4.5 ml per
1 rtl MAX 180 days
XARELTO STARTER fondaparinux sodium soln 4 retail,4.5 ml per
2 fill,365 rtl 2.5 mg/0.5ml
PACK TBPK 180 days mail);
day(s) supply,
SP
XARELTO TABS 2 QL(1 ea daily)
QL(3.6 ml per
Heparins And Heparinoid-Like Agents fondaparinux sodium soln 5 4 180 days
retail,3.6 ml per
QL(7.2 ml per mg/0.4ml 180 days mail);
ARIXTRA SOLN 10 180 days SP
MG/0.8ML (Use NF retail,7.2 ml per QL(5.4 ml per
fondaparinux sodium) 180 days mail); 180 days
SP fondaparinux sodium soln 4 retail,5.4 ml per
QL(4.5 ml per 7.5 mg/0.6ml 180 days mail);
ARIXTRA SOLN 2.5 180 days SP
MG/0.5ML (Use NF retail,4.5 ml per FRAGMIN SOLN 10000 PA; SP
fondaparinux sodium) 180 days mail); UNIT/ML, 12500
SP UNIT/0.5ML, 15000
QL(3.6 ml per UNIT/0.6ML, 18000
ARIXTRA SOLN 5 180 days 4
UNT/0.72ML, 2500
MG/0.4ML (Use NF retail,3.6 ml per UNIT/0.2ML, 5000
fondaparinux sodium) 180 days mail); UNIT/0.2ML, 7500
SP UNIT/0.3ML
QL(5.4 ml per HEPARIN LOCK FLUSH
ARIXTRA SOLN 7.5 180 days SOLN (Use heparin sodium NF
MG/0.6ML (Use NF retail,5.4 ml per (porcine) lock flush)
fondaparinux sodium) 180 days mail); heparin sod (porcine) in
SP 1B
d5w soln 5 %-40 unit/ml
enoxaparin sodium soln ij 4 QL(6 ml daily) heparin sodium (porcine)
300 mg/3ml soln 10000 unit/ml, 20000 1B
enoxaparin sodium soln sc 4 QL(2 ml daily) unit/ml, 5000 unit/ml
100 mg/ml, 150 mg/ml HEPARIN SODIUM/NACL
enoxaparin sodium soln sc 4 QL(1.6 ml 0.45% SOLN 0.45 %- 1B
120 mg/0.8ml, 80 mg/0.8ml daily) 12500 UNIT/250ML
enoxaparin sodium soln sc 4 QL(0.6 ml LOVENOX SOLN IJ 300 QL(6 ml daily)
30 mg/0.3ml daily); SP MG/3ML (Use enoxaparin NF
sodium)
16
LOVENOX SOLN SC 100 QL(2 ml daily) PA; QL(10 ea
MG/ML, 150 MG/ML (Use NF VALTOCO LIQD 4 per 30 days
enoxaparin sodium) retail)
LOVENOX SOLN SC 120 QL(1.6 ml PA; QL(10 ea
MG/0.8ML, 80 MG/0.8ML NF daily) VALTOCO LQPK 4 per 30 days
(Use enoxaparin sodium) retail)
LOVENOX SOLN SC 30 QL(0.6 ml Anticonvulsants - Misc.
MG/0.3ML (Use NF daily); SP
ST; QL(2 ea
enoxaparin sodium) APTIOM TABS 3
daily)
LOVENOX SOLN SC 40 QL(0.8 ml BANZEL SUSP 40 MG/ML NF PA; QL(80 ml
MG/0.4ML (Use NF daily,30 day(s)
(Use rufinamide) daily)
enoxaparin sodium) limit); SP
BANZEL TABS 200 MG 2 PA; QL(2 ea
LOVENOX SOLN SC 60 QL(1.2 ml (Use rufinamide) daily)
MG/0.6ML (Use NF daily,30 day(s)
enoxaparin sodium) limit); SP BANZEL TABS 400 MG 2 PA; QL(8 ea
(Use rufinamide) daily)
ANTICONVULSANTS - Drugs to Treat Seizures BRIVIACT SOLN OR 10 3 PA
MG/ML
AMPA Glutamate Receptor Antagonists
BRIVIACT TABS OR 10 PA
FYCOMPA TABS 10 MG, PA MG, 100 MG, 25 MG, 50 3
12 MG, 2 MG, 4 MG, 6 MG, 3 MG, 75 MG
8 MG
carbamazepine chew 100 1B
Anticonvulsants - Benzodiazepines mg
clobazam susp 2.5 mg/ml 1B PA; QL(16 ml carbamazepine cp12 100 1B
daily) mg
clobazam tabs 10 mg, 20 1B PA; QL(2 ea carbamazepine cp12 200 QL(6 ea daily)
mg daily) 1B
mg
clonazepam tabs 0.5 mg, 1 1A carbamazepine cp12 300 QL(4 ea daily)
mg, 2 mg 1B
mg
DIASTAT ACUDIAL GEL carbamazepine susp 100
(Use diazepam NF 1B
mg/5ml
(anticonvulsant)) carbamazepine tabs 200
DIASTAT PEDIATRIC GEL 1B
mg
(Use diazepam NF
(anticonvulsant)) carbamazepine tb12 100 1B QL(4 ea daily)
mg, 400 mg
diazepam (anticonvulsant) 3 carbamazepine tb12 200 QL(6 ea daily)
gel mg 1B
KLONOPIN TABS (Use
clonazepam) NF CARBATROL CP12 100 NF
MG (Use carbamazepine)
PA; QL(10 ea
NAYZILAM SOLN 3 per 30 days CARBATROL CP12 200 NF QL(6 ea daily)
retail) MG (Use carbamazepine)
ONFI SUSP 2.5 MG/ML CARBATROL CP12 300 NF QL(4 ea daily)
NF PA; QL(16 ml MG (Use carbamazepine)
(Use clobazam) daily)
ONFI TABS 10 MG, 20 MG NF PA; QL(2 ea PA; QL(12 ea
DIACOMIT CAPS 250 MG 4
(Use clobazam) daily) daily)
PA; QL(6 ea
DIACOMIT CAPS 500 MG 4
daily)
17
DIACOMIT PACK 250 MG 4 PA; QL(12 ea levetiracetam soln or 100 1B QL(30 ml daily)
daily) mg/ml, 500 mg/5ml
DIACOMIT PACK 500 MG 4 PA; QL(6 ea levetiracetam tabs or 1000 1B QL(3 ea daily)
daily) mg
EPIDIOLEX SOLN 3 PA levetiracetam tabs or 250 1B QL(4 ea daily)
mg, 750 mg
gabapentin caps 100 mg, 1B levetiracetam tabs or 500 QL(6 ea daily)
300 mg, 400 mg 1B
mg
gabapentin soln 250 1B QL(60 ml daily) levetiracetam tb24 or 500 QL(4 ea daily)
mg/5ml, 300 mg/6ml 1B
mg, 750 mg
gabapentin tabs 600 mg, 1B LYRICA CAPS 100 MG, PA; QL(3 ea
800 mg 150 MG, 200 MG, 25 MG, NF daily)
KEPPRA SOLN IV 500 QL(30 ml daily) 50 MG, 75 MG (Use
MG/5ML (Use NF pregabalin)
levetiracetam) LYRICA CAPS 225 MG, NF PA; QL(2 ea
KEPPRA SOLN OR 100 300 MG (Use pregabalin) daily)
NF QL(30 ml daily)
MG/ML (Use levetiracetam) LYRICA SOLN 20 MG/ML NF PA; QL(30 ml
KEPPRA TABS OR 1000 (Use pregabalin) daily)
NF QL(3 ea daily)
MG (Use levetiracetam) MYSOLINE TABS (Use NF
KEPPRA TABS OR 250 QL(4 ea daily) primidone)
MG, 750 MG (Use NF NEURONTIN CAPS 100
levetiracetam) MG, 300 MG, 400 MG (Use NF
KEPPRA TABS OR 500 gabapentin)
NF QL(6 ea daily)
MG (Use levetiracetam) NEURONTIN SOLN 250 NF QL(60 ml daily)
KEPPRA XR TB24 (Use MG/5ML (Use gabapentin)
NF QL(4 ea daily)
levetiracetam) NEURONTIN TABS 600
LAMICTAL CHEWABLE QL(20 ea daily) MG, 800 MG (Use NF
DISPERSIBLE CHEW 25 NF gabapentin)
MG (Use lamotrigine) oxcarbazepine susp 300 QL(40 ml daily)
1B
LAMICTAL CHEWABLE QL(100 ea mg/5ml, 60 mg/ml
DISPERSIBLE CHEW 5 NF daily) oxcarbazepine tabs 150 QL(3 ea daily)
MG (Use lamotrigine) 1B
mg, 300 mg
LAMICTAL ODT TBDP 100 QL(1 ea daily) QL(4 ea daily)
MG, 200 MG, 25 MG, 50 NF oxcarbazepine tabs 600 mg 1B
MG (Use lamotrigine) pregabalin caps 100 mg, PA; QL(3 ea
LAMICTAL TABS (Use NF 150 mg, 200 mg, 25 mg, 50 1B daily)
lamotrigine) mg, 75 mg
lamotrigine chew 25 mg 1B QL(20 ea daily) pregabalin caps 225 mg, 1B PA; QL(2 ea
300 mg daily)
QL(100 ea PA; QL(30 ml
lamotrigine chew 5 mg 1B
daily) pregabalin soln 20 mg/ml 1B
daily)
lamotrigine tabs 100 mg, 1B
150 mg, 200 mg, 25 mg primidone tabs 1B
lamotrigine tbdp 100 mg, 1B QL(1 ea daily) QUDEXY XR CS24 (Use NF
200 mg, 25 mg, 50 mg topiramate)
levetiracetam soln iv 500 1B QL(30 ml daily) rufinamide susp 40 mg/ml 1B PA; QL(80 ml
mg/5ml daily)
18
rufinamide tabs 200 mg 1B PA; QL(2 ea VIMPAT TABS OR 100 PA; QL(2 ea
daily) MG, 150 MG, 200 MG, 50 3 daily)
MG
rufinamide tabs 400 mg 1B PA; QL(8 ea
daily) ZONEGRAN CAPS (Use NF QL(6 ea daily)
TEGRETOL SUSP (Use zonisamide)
2
carbamazepine) zonisamide caps 1B QL(6 ea daily)
TEGRETOL TABS (Use 2
carbamazepine) Carbamates
TEGRETOL-XR TB12 100 QL(4 ea daily) felbamate susp 600 mg/5ml 1B QL(30 ml daily)
MG, 400 MG (Use NF
carbamazepine) QL(9 ea daily)
felbamate tabs 400 mg 1B
TEGRETOL-XR TB12 200 NF QL(6 ea daily)
MG (Use carbamazepine) felbamate tabs 600 mg 1B QL(6 ea daily)
TOPAMAX SPRINKLE QL(6 ea daily)
CPSP 15 MG (Use NF FELBATOL SUSP 600 NF QL(30 ml daily)
topiramate) MG/5ML (Use felbamate)
TOPAMAX SPRINKLE QL(8 ea daily) FELBATOL TABS 400 MG NF QL(9 ea daily)
CPSP 25 MG (Use NF (Use felbamate)
topiramate) FELBATOL TABS 600 MG NF QL(6 ea daily)
TOPAMAX TABS 100 MG, (Use felbamate)
NF QL(4 ea daily)
25 MG (Use topiramate) GABA Modulators
TOPAMAX TABS 200 MG NF QL(2 ea daily) GABITRIL TABS 2 MG, 4
(Use topiramate) NF
MG (Use tiagabine hcl)
TOPAMAX TABS 50 MG NF QL(6 ea daily) SABRIL PACK (Use
(Use topiramate) NF PA; QL(6 ea
vigabatrin) daily); SP
QL(6 ea daily) SABRIL TABS (Use
topiramate cpsp 15 mg 1B NF PA; QL(6 ea
vigabatrin) daily); SP
topiramate cpsp 25 mg 1B QL(8 ea daily) tiagabine hcl tabs 2 mg, 4 1B
mg
topiramate tabs 100 mg, 25 1B QL(4 ea daily)
mg PA; QL(6 ea
vigabatrin pack 4
daily); SP
topiramate tabs 200 mg 1B QL(2 ea daily)
PA; QL(6 ea
vigabatrin tabs 4
daily); SP
topiramate tabs 50 mg 1B QL(6 ea daily)
Hydantoins
TRILEPTAL SUSP 300 QL(40 ml daily) CEREBYX SOLN (Use
MG/5ML (Use NF NF
fosphenytoin sodium)
oxcarbazepine) DILANTIN CAPS 100 MG
TRILEPTAL TABS 150 QL(3 ea daily) (Use phenytoin sodium 2
MG, 300 MG (Use NF extended)
oxcarbazepine)
TRILEPTAL TABS 600 MG DILANTIN CAPS 30 MG 2
NF QL(4 ea daily)
(Use oxcarbazepine) DILANTIN INFATABS
VIMPAT SOLN IV 200 QL(40 ml daily) 2
3 CHEW (Use phenytoin)
MG/20ML DILANTIN-125 SUSP (Use
VIMPAT SOLN OR 10 PA; QL(40 ml 2
3 phenytoin)
MG/ML daily)
19
fosphenytoin sodium soln 1B Alpha-2 Receptor Antagonists (Tetracyclics)
mirtazapine tabs 15 mg 1B QL(3 ea daily)
PEGANONE TABS 3
QL(1.5 ea
PHENYTEK CAPS (Use mirtazapine tabs 30 mg 1B
daily)
phenytoin sodium 2
extended) mirtazapine tabs 45 mg, 1B QL(1 ea daily)
7.5 mg
phenytoin chew 1B QL(3 ea daily)
mirtazapine tbdp 15 mg 1B
phenytoin sodium extended 1B
caps QL(1.5 ea
daily)
phenytoin sodium soln 1B QL(1 ea daily)
phenytoin susp 1B REMERON SOLTAB TBDP NF QL(3 ea daily)
15 MG (Use mirtazapine)
Succinimides
REMERON SOLTAB TBDP NF QL(1.5 ea
CELONTIN CAPS 3 QL(4 ea daily) 30 MG (Use mirtazapine) daily)
QL(6 ea daily) REMERON SOLTAB TBDP NF QL(1 ea daily)
ethosuximide caps 250 mg 1B 45 MG (Use mirtazapine)
ethosuximide soln 250 QL(30 ml daily) REMERON TABS 15 MG NF QL(3 ea daily)
1B (Use mirtazapine)
mg/5ml
ZARONTIN CAPS 250 MG QL(6 ea daily) REMERON TABS 30 MG NF QL(1.5 ea
2 (Use mirtazapine) daily)
(Use ethosuximide)
ZARONTIN SOLN 250 QL(30 ml daily) Antidepressants - Misc.
MG/5ML (Use NF bupropion hcl tabs 100 mg, QL(3 ea daily)
ethosuximide) 1B
75 mg
Valproic Acid bupropion hcl tb12 100 mg 1B QL(4 ea daily)
DEPACON SOLN (Use NF
valproate sodium) bupropion hcl tb12 150 mg 1B QL(3 ea daily)
DEPAKENE CAPS (Use NF
valproic acid) bupropion hcl tb12 200 mg 1B QL(2 ea daily)
DEPAKOTE ER TB24 (Use NF QL(3 ea daily)
divalproex sodium) bupropion hcl tb24 150 mg 1B
DEPAKOTE TBEC (Use NF QL(1 ea daily)
divalproex sodium) bupropion hcl tb24 300 mg 1B
divalproex sodium tb24 250 1B FORFIVO XL TB24 (Use
mg, 500 mg NF
bupropion hcl)
divalproex sodium tbec 125 1B maprotiline hcl tabs 1B
mg, 250 mg, 500 mg
WELLBUTRIN SR TB12 QL(4 ea daily)
valproate sodium soln 1B 100 MG (Use bupropion NF
hcl)
valproic acid caps or 1B
WELLBUTRIN SR TB12 QL(3 ea daily)
ANTIDEPRESSANTS - Drugs to Treat 150 MG (Use bupropion NF
Depression hcl)
20
WELLBUTRIN SR TB12 QL(2 ea daily) escitalopram oxalate soln 5 1B QL(20 ml daily)
200 MG (Use bupropion NF mg/5ml
hcl) escitalopram oxalate tabs 1B QL(2 ea daily)
WELLBUTRIN XL TB24 QL(3 ea daily) 10 mg
150 MG (Use bupropion NF escitalopram oxalate tabs
hcl) 1B QL(1 ea daily)
20 mg
WELLBUTRIN XL TB24 QL(1 ea daily) escitalopram oxalate tabs 5 1B QL(4 ea daily)
300 MG (Use bupropion NF mg
hcl)
fluoxetine hcl caps 10 mg 1A QL(1 ea daily)
Monoamine Oxidase Inhibitors (MAOIs)
QL(3 ea daily)
EMSAM PT24 3 QL(1 ea daily) fluoxetine hcl caps 20 mg 1B
QL(6 ea daily) fluoxetine hcl caps 40 mg 1B QL(2 ea daily)
MARPLAN TABS 2
NARDIL TABS (Use NF fluoxetine hcl cpdr 90 mg 1B
phenelzine sulfate)
PARNATE TABS (Use fluoxetine hcl soln 20 1B QL(20 ml daily)
NF mg/5ml
tranylcypromine sulfate)
fluoxetine hcl tabs 10 mg, 1B QL(1 ea daily)
phenelzine sulfate tabs 1B 60 mg
tranylcypromine sulfate fluoxetine hcl tabs 20 mg 1B QL(3 ea daily)
1B
tabs
FLUOXETINE QL(1 ea daily)
N-Methyl-D-aspartic acid (NMDA) Receptor HYDROCHLORIDE TABS NF
SPRAVATO 56MG DOSE 4 PA (Use fluoxetine hcl)
SOPK fluvoxamine maleate tabs QL(3 ea daily)
SPRAVATO 84MG DOSE 1B
4 PA 100 mg
SOPK fluvoxamine maleate tabs QL(2 ea daily)
1B
Selective Serotonin Reuptake Inhibitors (SSRIs) 25 mg, 50 mg
CELEXA TABS 10 MG QL(4 ea daily) LEXAPRO TABS 10 MG NF QL(2 ea daily)
(Use citalopram NF (Use escitalopram oxalate)
hydrobromide) LEXAPRO TABS 20 MG NF QL(1 ea daily)
CELEXA TABS 20 MG QL(2 ea daily) (Use escitalopram oxalate)
(Use citalopram NF LEXAPRO TABS 5 MG
hydrobromide) NF QL(4 ea daily)
(Use escitalopram oxalate)
CELEXA TABS 40 MG QL(1 ea daily) QL(6 ea daily)
(Use citalopram NF paroxetine hcl tabs 10 mg 1B
hydrobromide) QL(3 ea daily)
paroxetine hcl tabs 20 mg 1B
citalopram hydrobromide 1B QL(20 ml daily)
soln 10 mg/5ml paroxetine hcl tabs 30 mg 1B QL(2 ea daily)
citalopram hydrobromide 1B QL(4 ea daily)
tabs 10 mg paroxetine hcl tabs 40 mg 1B QL(1 ea daily)
tabs 20 mg paroxetine hcl tb24 12.5 1B QL(1 ea daily)
mg
tabs 40 mg paroxetine hcl tb24 37.5 1B QL(2 ea daily)
mg, 25 mg
21
PAXIL CR TB24 12.5 MG NF QL(1 ea daily) desvenlafaxine succinate 1B QL(1 ea daily)
(Use paroxetine hcl) tb24 25 mg, 50 mg
PAXIL CR TB24 37.5 MG, NF QL(2 ea daily) duloxetine hcl cpep or 20 1B QL(2 ea daily)
25 MG (Use paroxetine hcl) mg, 60 mg, 30 mg
PAXIL TABS 10 MG (Use NF QL(6 ea daily) duloxetine hcl cpep or 40 1B
paroxetine hcl) mg
PAXIL TABS 20 MG (Use NF QL(3 ea daily) EFFEXOR XR CP24 150 NF QL(2 ea daily)
paroxetine hcl) MG (Use venlafaxine hcl)
PAXIL TABS 30 MG (Use NF QL(2 ea daily) EFFEXOR XR CP24 37.5 NF QL(4 ea daily)
PAXIL TABS 40 MG (Use NF QL(1 ea daily) EFFEXOR XR CP24 75 NF QL(5 ea daily)
PROZAC CAPS 10 MG NF QL(1 ea daily) FETZIMA CP24 3 PA
(Use fluoxetine hcl)
PROZAC CAPS 20 MG FETZIMA TITRATION PA
NF QL(3 ea daily) PACK C4PK
3
PROZAC CAPS 40 MG KHEDEZLA TB24 (Use
NF QL(2 ea daily) desvenlafaxine) NF
sertraline hcl conc 20 QL(10 ml daily) PRISTIQ TB24 100 MG QL(4 ea daily)
1B (Use desvenlafaxine NF
mg/ml
QL(2 ea daily) succinate)
sertraline hcl tabs 100 mg 1B PRISTIQ TB24 25 MG, 50 QL(1 ea daily)
sertraline hcl tabs 25 mg, QL(4 ea daily) MG (Use desvenlafaxine NF
1B succinate)
50 mg
ZOLOFT CONC 20 MG/ML venlafaxine hcl cp24 150 QL(2 ea daily)
NF QL(10 ml daily) mg 1B
(Use sertraline hcl)
ZOLOFT TABS 100 MG venlafaxine hcl cp24 37.5 QL(4 ea daily)
NF QL(2 ea daily) mg 1B
(Use sertraline hcl)
ZOLOFT TABS 25 MG, 50 QL(5 ea daily)
NF QL(4 ea daily) venlafaxine hcl cp24 75 mg 1B
MG (Use sertraline hcl)
venlafaxine hcl tabs 100 QL(3 ea daily)
Serotonin Modulators mg, 25 mg, 37.5 mg, 50 1B
nefazodone hcl tabs 1B mg, 75 mg
venlafaxine hcl tb24 150 1B QL(2 ea daily)
trazodone hcl tabs 1B mg
venlafaxine hcl tb24 225 1B ST; QL(1 ea
PA; QL(1 ea mg daily)
TRINTELLIX TABS 3
daily)
venlafaxine hcl tb24 75 mg, 1B QL(1 ea daily)
VIIBRYD STARTER PACK 3 PA; QL(0.18 ea 37.5 mg
KIT daily)
PA; QL(1 ea Tricyclic Agents
VIIBRYD TABS 3
daily) amitriptyline hcl tabs 1B
Serotonin-Norepinephrine Reuptake Inhibitors
CYMBALTA CPEP (Use amoxapine tabs 3
NF QL(2 ea daily)
duloxetine hcl) ANAFRANIL CAPS (Use
desvenlafaxine succinate NF PA
1B QL(4 ea daily) clomipramine hcl)
tb24 100 mg
22
clomipramine hcl caps 1B PA DUETACT TABS (Use QL(1 ea daily)
pioglitazone hcl- NF
desipramine hcl tabs 1B glimepiride)
glipizide-metformin hcl tabs QL(2 ea daily)
doxepin hcl caps 1B 2.5 mg-250 mg, 2.5 mg- 1B
500 mg
doxepin hcl conc 1B glipizide-metformin hcl tabs 1B QL(4 ea daily)
5 mg-500 mg
imipramine hcl tabs 1B glyburide-metformin tabs QL(2 ea daily)
1.25 mg-250 mg, 250 mg- 1B
imipramine pamoate caps 1B 1.25 mg
NORPRAMIN TABS (Use glyburide-metformin tabs QL(4 ea daily)
NF 2.5 mg-500 mg, 5 mg-500 1B
desipramine hcl)
mg
nortriptyline hcl caps 1B QL(1 ea daily)
GLYXAMBI TABS 2
nortriptyline hcl soln 1B QL(2 ea daily)
JANUMET TABS 2
PAMELOR CAPS (Use NF
nortriptyline hcl) JANUMET XR TB24 2 QL(1 ea daily)
protriptyline hcl tabs 1B KAZANO TABS (Use NF

alogliptin-metformin hcl)
TOFRANIL TABS (Use NF
imipramine hcl) OSENI TABS (Use NF
alogliptin-pioglitazone)
trimipramine maleate caps 1B pioglitazone hcl-glimepiride QL(1 ea daily)
1B
tabs
ANTIDIABETICS - Drugs to Regulate Blood
Sugar pioglitazone hcl-metformin 1B QL(2 ea daily)
hcl tabs
Alpha-Glucosidase Inhibitors repaglinide-metformin hcl QL(2 ea daily)
QL(3 ea daily) 1B
acarbose tabs 1B tabs
SYNJARDY TABS 2 QL(2 ea daily)
GLYSET TABS (Use NF
miglitol) SYNJARDY XR TB24 10 QL(2 ea daily)
miglitol tabs 1B MG-1000 MG, 12.5 MG- 2
1000 MG, 5 MG-1000 MG
PRECOSE TABS (Use NF QL(3 ea daily) SYNJARDY XR TB24 25 QL(1 ea daily)
acarbose) 2
MG-1000 MG
Antidiabetic - Amylin Analogs TRIJARDY XR TB24 2.5 QL(2 ea daily)
PA; QL(0.36 ml MG-12.5 MG-1000 MG, 2.5 2
SYMLINPEN 120 SOPN 2 MG-5 MG-1000 MG
daily)
PA; QL(0.2 ml TRIJARDY XR TB24 5 MG- QL(1 ea daily)
SYMLINPEN 60 SOPN 2 10 MG-1000 MG, 5 MG-25 2
daily)
MG-1000 MG
Antidiabetic Combinations PA; QL(0.5 ml
ACTOPLUS MET TABS QL(2 ea daily) XULTOPHY 100/3.6 SOPN 2
daily)
(Use pioglitazone hcl- NF
metformin hcl) Biguanides
23
metformin hcl tabs 1000 1B QL(2.5 ea pioglitazone hcl tabs 1B QL(1 ea daily)
mg daily)
metformin hcl tabs 500 mg 1B QL(5 ea daily) Insulin
APIDRA SOLN 3 PA
metformin hcl tabs 850 mg 1B QL(3 ea daily)
APIDRA SOLOSTAR 3 PA
metformin hcl tb24 500 mg 1B QL(4 ea daily) SOPN
BASAGLAR KWIKPEN 2
metformin hcl tb24 750 mg 1B QL(3 ea daily) SOPN
FIASP FLEXTOUCH 2
Diabetic Other SOPN
diazoxide susp 1B FIASP PENFILL SOCT 2
GLUCAGEN HYPOKIT 3 QL(0.035 ea
SOLR daily) FIASP SOLN 2
glucagon (rdna) kit 1B QL(0.035 ea HUMULIN R U-500 2 QL(1.35 ml
daily) (CONCENTRATED) SOLN daily)
GLUCAGON QL(0.035 ea HUMULIN R U-500 QL(1.35 ml
EMERGENCY KIT KIT NF daily) 2
KWIKPEN SOPN daily)
(Use glucagon (rdna)) LEVEMIR FLEXTOUCH
PROGLYCEM SUSP (Use 2
NF SOPN
diazoxide)
LEVEMIR SOLN 2
Dipeptidyl Peptidase-4 (DPP-4) Inhibitors
NOVOLIN 70/30 FLEXPEN
alogliptin benzoate tabs 1B QL(1 ea daily) RELION SUPN
2
JANUVIA TABS 2 QL(1 ea daily) NOVOLIN 70/30 FLEXPEN 2

SUPN
NESINA TABS (Use NF NOVOLIN 70/30 RELION
alogliptin benzoate) 2
SUSP
Dopamine Receptor Agonists - Antidiabetic NOVOLIN 70/30 SUSP 2
CYCLOSET TABS 3 QL(6 ea daily) NOVOLIN N RELION 2
SUSP
Incretin Mimetic Agents (GLP-1 Receptor
OZEMPIC SOPN 2 NOVOLIN N SUSP 2
2 PA; QL(0.054
MG/1.5ML ml daily)
NOVOLIN R RELION 2
OZEMPIC SOPN 2 2 PA; QL(0.108 SOLN
MG/1.5ML, 4 MG/3ML ml daily)
NOVOLIN R SOLN 2
TRULICITY SOPN 2 PA; QL(0.143
ml daily) NOVOLOG FLEXPEN 2
VICTOZA SOPN 2 PA; QL(0.3 ml SOPN
daily) NOVOLOG MIX 70/30
Insulin Sensitizing Agents PREFILLED FLEXPEN 2
ACTOS TABS (Use SUPN
NF QL(1 ea daily) NOVOLOG MIX 70/30
pioglitazone hcl) 2
QL(1 ea daily) SUSP
AVANDIA TABS 3
24
NOVOLOG PENFILL 2 tolbutamide tabs 1B QL(6 ea daily)
SOCT
NOVOLOG SOLN 2 ANTIDIARRHEAL/PROBIOTIC AGENTS - Drugs
to Treat Diarrhea
TRESIBA FLEXTOUCH PA; QL(1.5 ml
3 Antiperistaltic Agents
SOPN 100 UNIT/ML daily)
diphenoxylate w/ atropine 1B
TRESIBA FLEXTOUCH 3 PA; QL(0.9 ml liqd
SOPN 200 UNIT/ML daily)
diphenoxylate w/ atropine 1B
PA; QL(1.5 ml tabs
TRESIBA SOLN 3
daily)
IMODIUM A-D CAPS 2 MG NF RX/OTC
Meglitinide Analogues (Use loperamide hcl)
nateglinide tabs 1B QL(3 ea daily) LOMOTIL TABS (Use NF
diphenoxylate w/ atropine)
repaglinide tabs 0.5 mg, 1 1B QL(4 ea daily) RX/OTC
mg loperamide hcl caps 2 mg 1B
repaglinide tabs 2 mg 1B QL(8 ea daily)
MOTOFEN TABS 3
STARLIX TABS (Use NF QL(3 ea daily)
nateglinide) ANTIDOTES AND SPECIFIC ANTAGONISTS
Sodium-Glucose Co-Transporter 2 (SGLT2) Antidotes - Chelating Agents
JARDIANCE TABS 2 QL(1 ea daily) CHEMET CAPS 3
Sulfonylureas deferasirox pack 180 mg, 4 PA
AMARYL TABS 1 MG, 2 360 mg, 90 mg
NF QL(4 ea daily) deferasirox tabs 180 mg, PA; SP
MG (Use glimepiride) 4
AMARYL TABS 4 MG (Use 360 mg, 90 mg
NF QL(2 ea daily) deferasirox tbso 125 mg, PA; SP
glimepiride) 4
glimepiride tabs 1 mg, 2 QL(4 ea daily) 250 mg, 500 mg
1B
mg deferiprone tabs 1B
glimepiride tabs 4 mg 1B QL(2 ea daily)
EXJADE TBSO (Use NF PA; SP
QL(4 ea daily) deferasirox)
glipizide tabs 10 mg, 5 mg 1B FERRIPROX TABS 500 NF
glipizide tb24 10 mg, 2.5 QL(2 ea daily) MG (Use deferiprone)
1B
mg, 5 mg JADENU SPRINKLE PACK NF PA
GLUCOTROL TABS (Use (Use deferasirox)
NF QL(4 ea daily)
glipizide) JADENU TABS (Use NF PA; SP
GLUCOTROL XL TB24 deferasirox)
NF QL(2 ea daily)
(Use glipizide) Antidotes and Specific Antagonists
glyburide micronized tabs 1B QL(4 ea daily) PA
deferoxamine mesylate solr 4
glyburide tabs 1B QL(4 ea daily) DESFERAL SOLR (Use PA
4
deferoxamine mesylate)
GLYNASE TABS (Use NF QL(4 ea daily) PA
glyburide micronized) VISTOGARD PACK 4
Opioid Antagonists
25
naloxone hcl soln 0.4 1B Antiemetics - Anticholinergic
mg/ml, 4 mg/10ml RX/OTC
meclizine hcl tabs 12.5 mg 1A
naltrexone hcl tabs 1B
meclizine hcl tabs 25 mg 1B RX/OTC
QL(2 ea per fill
retail)2 rtl MAX QL(0.34 ea
NARCAN LIQD 3 scopolamine pt72 1B
fill,30 rtl day(s) daily)
supply,
TIGAN CAPS OR 300 MG
ANTIEMETICS - Drugs to Treat Nausea and (Use trimethobenzamide NF
Vomiting hcl)
5-HT3 Receptor Antagonists TRANSDERM SCOP PT72 NF QL(0.34 ea
ALOXI SOLN (Use (Use scopolamine) daily)
NF TRANSDERM-SCOP PT72
palonosetron hcl) NF QL(0.34 ea
PA; QL(0.167 (Use scopolamine) daily)
ANZEMET TABS 3 trimethobenzamide hcl
ea daily) 1B
granisetron hcl soln iv 1 caps
1B
mg/ml Antiemetics - Miscellaneous
granisetron hcl tabs or 1 1B QL(0.34 ea AKYNZEO CAPS OR 0.5 PA
mg daily) 3
MG-300 MG
ondansetron hcl soln ij 4 1B AKYNZEO SOLR IV 0.25 PA
mg/2ml 4
MG-235 MG
ondansetron hcl soln or 4 1B QL(3.34 ml CESAMET CAPS 3
mg/5ml daily)
ondansetron hcl tabs or 24 QL(0.143 ea PA; QL(4 ea
1B daily)3 rtl MAX
mg daily)
QL(4 ea fill,365 rtl
DICLEGIS TBEC (Use NF day(s) supply,3
ondansetron hcl tabs or 4 1B daily,60 ea per doxylamine-pyridoxine)
mg fill retail,60 ea mail MAX
per fill mail) fill,365 mail
day(s) supply,
QL(3 ea
ondansetron hcl tabs or 8 daily,45 ea per PA; QL(4 ea
1B daily)3 rtl MAX
mg fill retail,45 ea
per fill mail) fill,365 rtl
doxylamine-pyridoxine tbec 1B day(s) supply,3
ondansetron tbdp 4 mg 1B QL(1 ea daily) mail MAX
fill,365 mail
ondansetron tbdp 8 mg 1B day(s) supply,
dronabinol caps 1B
palonosetron hcl soln 1B
MARINOL CAPS (Use NF
QL(4 ea dronabinol)
ZOFRAN TABS 4 MG (Use NF daily,60 ea per
ondansetron hcl) fill retail,60 ea Substance P/Neurokinin 1 (NK1) Receptor
per fill mail)
aprepitant caps 1B PA
QL(3 ea
ZOFRAN TABS 8 MG (Use NF daily,45 ea per aprepitant caps 125 mg, 40 PA; QL(0.067
ondansetron hcl) fill retail,45 ea 1B
mg ea daily)
per fill mail)
26
aprepitant caps 80 mg 1B PA; QL(0.134 griseofulvin ultramicrosize 1B
ea daily) tabs
aprepitant misc 1B PA nystatin tabs 1B
EMEND CAPS OR 125 PA; QL(0.067 terbinafine hcl tabs 1B QL(1 ea daily)
MG, 40 MG (Use NF ea daily)
aprepitant) Imidazole-Related Antifungals
EMEND CAPS OR 80 MG NF PA; QL(0.134 CRESEMBA CAPS OR
(Use aprepitant) ea daily) 3 PA
186 MG
EMEND SOLR IV 150 MG PA DIFLUCAN SUSR (Use
(Use fosaprepitant 4 NF
fluconazole)
dimeglumine)
DIFLUCAN TABS (Use NF
EMEND TRIPACK CAPS NF PA fluconazole)
(Use aprepitant)
fosaprepitant dimeglumine PA fluconazole susr 1B
4
solr
PA fluconazole tabs 1B
VARUBI TBPK 3
PA; QL(4 ea
itraconazole caps 100 mg 1B
daily)
ANTIFUNGALS - Drugs to Treat Fungal Infections
PA; QL(20 ml
Antifungal - Glucan Synthesis Inhibitors itraconazole soln 10 mg/ml 1B
daily)
CANCIDAS SOLR (Use NF ketoconazole tabs 1B
caspofungin acetate)
caspofungin acetate solr 50 1B NOXAFIL SUSP OR 40 3 QL(20 ml daily)
mg, 70 mg MG/ML
SPORANOX CAPS 100 NF PA; QL(4 ea
ERAXIS SOLR 3 MG (Use itraconazole) daily)
PA SPORANOX PULSEPAK
micafungin sodium solr 1B NF PA; QL(4 ea
CAPS (Use itraconazole) daily)
MYCAMINE SOLR (Use NF PA SPORANOX SOLN 10
micafungin sodium) NF PA; QL(20 ml
MG/ML (Use itraconazole) daily)
Antifungals TOLSURA CAPS 4 PA
ABELCET SUSP 3 VFEND TABS 200 MG, 50 NF QL(4 ea daily)
MG (Use voriconazole)
AMBISOME SUSR 3
voriconazole tabs or 200 1B QL(4 ea daily)
amphotericin b solr 3 mg, 50 mg
ANCOBON CAPS (Use ANTIHISTAMINES - Drugs to Treat Allergies

NF
flucytosine) Antihistamines - Alkylamines
flucytosine caps 1B dexchlorpheniramine 1B
maleate soln
griseofulvin microsize susp 1B AL(At least 2
125 mg/5ml yrs old) Antihistamines - Ethanolamines
griseofulvin microsize tabs carbinoxamine maleate 1B
1B soln 4 mg/5ml
500 mg
27
carbinoxamine maleate 1B loratadine chew 5 mg 1B
tabs 4 mg
CLEMASTINE FUMARATE 1B loratadine soln 5 mg/5ml 1B
SYRP 0.67 MG/5ML
clemastine fumarate tabs 1B loratadine syrp 5 mg/5ml 1B
2.68 mg
diphenhydramine hcl caps loratadine tabs 10 mg 1A
1A
or 50 mg
diphenhydramine hcl elix or 1B loratadine tbdp 10 mg 1B
12.5 mg/5ml XYZAL ALLERGY 24HR QL(10 ml
diphenhydramine hcl liqd or 1B CHILDRENS SOLN (Use
12.5 mg/5ml NF daily); RX/OTC
levocetirizine
diphenhydramine hcl soln ij 1B dihydrochloride)
50 mg/ml XYZAL ALLERGY 24HR QL(1 ea daily);
Antihistamines - Non-Sedating TABS (Use levocetirizine NF RX/OTC
dihydrochloride)
cetirizine hcl tabs 5 mg, 10 1A QL(1 ea daily)
mg ZYRTEC ALLERGY TABS NF QL(1 ea daily)
(Use cetirizine hcl)
CLARINEX TABS (Use NF QL(1 ea daily)
desloratadine) Antihistamines - Phenothiazines
CLARITIN ALLERGY PHENERGAN SOLN (Use NF
CHILDRENS SYRP (Use NF promethazine hcl)
loratadine) promethazine hcl soln 1B
CLARITIN CAPS (Use NF
loratadine) promethazine hcl supp 1B
CLARITIN CHEW (Use NF
loratadine) promethazine hcl syrp 1B
CLARITIN CHILDRENS NF
CHEW (Use loratadine) promethazine hcl tabs 1B
CLARITIN REDITABS
TBDP 10 MG (Use NF Antihistamines - Piperidines
loratadine) cyproheptadine hcl syrp 1B
CLARITIN SYRP (Use NF
loratadine) cyproheptadine hcl tabs 1B
CLARITIN TABS (Use NF
loratadine) ANTIHYPERLIPIDEMICS - Drugs to Treat High
Cholesterol
desloratadine tabs 5 mg 1B QL(1 ea daily)
Antihyperlipidemics - Combinations
desloratadine tbdp 2.5 mg 1B QL(1 ea daily) ezetimibe-simvastatin tabs 1B QL(1 ea daily)
levocetirizine QL(10 ml VYTORIN TABS (Use
dihydrochloride soln 2.5 1B daily); RX/OTC NF QL(1 ea daily)
ezetimibe-simvastatin)
mg/5ml
Antihyperlipidemics - Misc.
levocetirizine 1B QL(1 ea daily);
dihydrochloride tabs 5 mg RX/OTC PA; QL(4 ea
icosapent ethyl caps 1B
daily)
loratadine caps 10 mg 1B LOVAZA CAPS (Use NF QL(4 ea daily)
omega-3-acid ethyl esters)
28
omega-3-acid ethyl esters 1B QL(4 ea daily) Fibric Acid Derivatives
caps fenofibrate micronized caps QL(1 ea daily)
PA; QL(8 ea 1B
VASCEPA CAPS 0.5 GM 3 134 mg, 200 mg, 67 mg
daily) fenofibrate tabs 145 mg, 48 1B QL(1 ea daily)
Bile Acid Sequestrants mg, 54 mg, 160 mg
cholestyramine light pack 4 1B QL(6 ea daily) FIBRICOR TABS (Use NF
gm fenofibric acid)
cholestyramine light powd 1B QL(24 gm gemfibrozil tabs 1B QL(2 ea daily)
4 gm/dose daily)
QL(6 ea daily) LIPOFEN CAPS (Use NF
cholestyramine pack 4 gm 1B fenofibrate)
cholestyramine powd 4 1B QL(25.2 gm LOPID TABS (Use NF QL(2 ea daily)
gm/dose daily) gemfibrozil)
colesevelam hcl pack 3.75 1B PA; QL(1 ea TRICOR TABS (Use NF QL(1 ea daily)
gm daily) fenofibrate)
colesevelam hcl tabs 625 1B QL(7 ea daily) HMG CoA Reductase Inhibitors
mg ST; QL(1 ea
COLESTID FLAVORED QL(6 gm daily) ALTOPREV TB24 3
daily)
GRAN 5 GM (Use NF
atorvastatin calcium tabs 1B QL(1 ea daily)
colestipol hcl)
COLESTID FLAVORED QL(6 ea daily) CRESTOR TABS (Use
PACK 5 GM/7.5GM (Use NF NF QL(1 ea daily)
rosuvastatin calcium)
colestipol hcl)
fluvastatin sodium caps 20 3 QL(1 ea daily)
COLESTID GRAN 5 GM NF QL(6 gm daily) mg
(Use colestipol hcl)
fluvastatin sodium caps 40 3 QL(2 ea daily)
COLESTID PACK 5 GM NF QL(6 ea daily) mg
LIPITOR TABS (Use NF QL(1 ea daily)
COLESTID TABS 1 GM NF QL(16 ea daily) atorvastatin calcium)
$0 copay for
colestipol hcl gran 5 gm 1B QL(6 gm daily) generic only,
lovastatin tabs 10 mg, 20 1B age 40 to
QL(6 ea daily) mg 76;QL(1 ea
colestipol hcl pack 5 gm 1B
daily); PV
colestipol hcl tabs 1 gm 1B QL(16 ea daily) $0 copay for
generic only,
QUESTRAN LIGHT POWD NF QL(24 gm lovastatin tabs 40 mg 1B age 40 to
(Use cholestyramine light) daily) 76;QL(2 ea
QUESTRAN PACK 4 GM NF QL(6 ea daily) daily); PV
(Use cholestyramine) PRAVACHOL TABS (Use
QUESTRAN POWD 4 QL(25.2 gm NF QL(1 ea daily)
pravastatin sodium)
GM/DOSE (Use NF daily) QL(1 ea daily)
cholestyramine) pravastatin sodium tabs 1B
WELCHOL PACK 3.75 GM NF PA; QL(1 ea QL(1 ea daily)
(Use colesevelam hcl) daily) rosuvastatin calcium tabs 3
WELCHOL TABS 625 MG simvastatin tabs 5 mg, 80 QL(1 ea daily)
NF QL(7 ea daily) mg, 10 mg, 20 mg, 40 mg 1B
(Use colesevelam hcl)
29
ZOCOR TABS (Use NF QL(1 ea daily) quinapril hcl tabs 1B
simvastatin)
Intestinal Cholesterol Absorption Inhibitors ramipril caps 1B
ezetimibe tabs 1B QL(1 ea daily) trandolapril tabs 1B
ZETIA TABS (Use NF QL(1 ea daily) VASOTEC TABS (Use
ezetimibe) NF
enalapril maleate)
Nicotinic Acid Derivatives ZESTRIL TABS (Use NF
niacin (antihyperlipidemic) QL(2 ea daily) lisinopril)
tbcr 1000 mg, 500 mg, 750 1B Agents for Pheochromocytoma
mg
DIBENZYLINE CAPS (Use NF PA
NIASPAN TBCR (Use NF QL(2 ea daily) phenoxybenzamine hcl)
niacin (antihyperlipidemic))
phenoxybenzamine hcl 3 PA
Proprotein Convertase Subtilisin/Kexin Type 9 caps
REPATHA PUSHTRONEX 4 PA; QL(0.25 ml Angiotensin II Receptor Antagonists
SYSTEM SOCT daily)
ATACAND TABS (Use NF QL(1 ea daily)
REPATHA SOSY 4 PA; QL(0.0714 candesartan cilexetil)
ml daily)
AVAPRO TABS (Use NF QL(1 ea daily)
REPATHA SURECLICK 4 PA; QL(0.0714 irbesartan)
SOAJ ml daily)
BENICAR TABS (Use NF QL(1 ea daily)
ANTIHYPERTENSIVES - Drugs to Treat High olmesartan medoxomil)
Blood Pressure
candesartan cilexetil tabs 1B QL(1 ea daily)
ACE Inhibitors
ACCUPRIL TABS (Use COZAAR TABS (Use NF QL(1 ea daily)
NF losartan potassium)
quinapril hcl)
ALTACE CAPS (Use DIOVAN TABS (Use NF QL(1 ea daily)
NF valsartan)
ramipril)
ST; QL(1 ea
benazepril hcl tabs 1B EDARBI TABS 3
daily)
captopril tabs 1B eprosartan mesylate tabs 1B QL(1 ea daily)
enalapril maleate tabs 10 irbesartan tabs 1B QL(1 ea daily)

1B
mg, 2.5 mg, 20 mg, 5 mg
losartan potassium tabs or 1B QL(1 ea daily)
fosinopril sodium tabs 1B 100 mg, 25 mg, 50 mg
lisinopril tabs 1B MICARDIS TABS (Use NF QL(1 ea daily)
telmisartan)
LOTENSIN TABS (Use QL(1 ea daily)
benazepril hcl) NF olmesartan medoxomil tabs 1B
moexipril hcl tabs 1B telmisartan tabs 1B QL(1 ea daily)
perindopril erbumine tabs 1B valsartan tabs 1B QL(1 ea daily)
PRINIVIL TABS (Use NF Antiadrenergic Antihypertensives

lisinopril)
30
CARDURA TABS (Use NF AVALIDE TABS (Use
doxazosin mesylate) irbesartan- NF
CATAPRES TABS (Use hydrochlorothiazide)
NF QL(8 ea daily)
clonidine hcl) AZOR TABS (Use ST
CATAPRES-TTS-1 PTWK amlodipine besylate- NF
NF QL(0.15 ea olmesartan medoxomil)
(Use clonidine) daily)
CATAPRES-TTS-2 PTWK benazepril &
NF QL(0.15 ea hydrochlorothiazide tabs 1B
CATAPRES-TTS-3 PTWK BENICAR HCT TABS (Use
NF QL(0.15 ea olmesartan medoxomil- NF
hydrochlorothiazide)
clonidine hcl tabs 1B QL(8 ea daily) bisoprolol & QL(2 ea daily)
1B
QL(0.15 ea hydrochlorothiazide tabs
clonidine ptwk 3
daily) candesartan cilexetil- 1B
hydrochlorothiazide tabs
doxazosin mesylate tabs 1B
DIOVAN HCT TABS (Use
valsartan- NF
guanfacine hcl tabs 1B hydrochlorothiazide)
MINIPRESS CAPS (Use NF QL(4 ea daily) enalapril maleate &
prazosin hcl) 1B
prazosin hcl caps 1B QL(4 ea daily) EXFORGE HCT TABS 2
terazosin hcl caps 1B EXFORGE TABS (Use

amlodipine besylate- NF
Antihypertensive Combinations valsartan)
ACCURETIC TABS 12.5 QL(3 ea daily) fosinopril sodium & 1B
MG-10 MG (Use quinapril- NF hydrochlorothiazide tabs
hydrochlorothiazide) HYZAAR TABS 100 MG-25 QL(1 ea daily)
ACCURETIC TABS 12.5 QL(4 ea daily) MG, 12.5 MG-100 MG, 25
MG-20 MG (Use quinapril- NF MG-100 MG (Use losartan NF
hydrochlorothiazide) potassium &
ACCURETIC TABS 20 QL(2 ea daily)
MG-25 MG (Use quinapril- NF HYZAAR TABS 12.5 MG- QL(2 ea daily)
hydrochlorothiazide) 50 MG (Use losartan NF
potassium &
amlodipine besylate- 1B hydrochlorothiazide)
benazepril hcl caps
irbesartan- 1B
amlodipine besylate- ST hydrochlorothiazide tabs
olmesartan medoxomil tabs 1B
lisinopril & 1B
amlodipine besylate- 1B hydrochlorothiazide tabs
valsartan tabs
LOPRESSOR HCT TABS
amlodipine-valsartan- 1B (Use metoprolol & NF
hydrochlorothiazide tabs hydrochlorothiazide)
ATACAND HCT TABS losartan potassium & QL(1 ea daily)
(Use candesartan cilexetil- NF hydrochlorothiazide tabs
hydrochlorothiazide) 1B
12.5 mg-100 mg, 25 mg-
atenolol & chlorthalidone 1B 100 mg
tabs
31
losartan potassium & QL(2 ea daily) TWYNSTA TABS (Use NF
hydrochlorothiazide tabs 1B telmisartan-amlodipine)
12.5 mg-50 mg, 50 mg- valsartan-
12.5 mg 1B
LOTENSIN HCT TABS VASERETIC TABS (Use
(Use benazepril & NF enalapril maleate & NF
hydrochlorothiazide) hydrochlorothiazide)
LOTREL CAPS (Use ZESTORETIC TABS (Use
amlodipine besylate- NF lisinopril & NF
benazepril hcl) hydrochlorothiazide)
metoprolol & ZIAC TABS (Use bisoprolol
hydrochlorothiazide tabs 1B NF QL(2 ea daily)
& hydrochlorothiazide)
MICARDIS HCT TABS
(Use telmisartan- NF Antihypertensives - Misc.
hydrochlorothiazide) VECAMYL TABS 3 PA
olmesartan medoxomil- ST
amlodipine- 1B Direct Renin Inhibitors
hydrochlorothiazide tabs aliskiren fumarate tabs 1B QL(1 ea daily)
olmesartan medoxomil- 1B
hydrochlorothiazide tabs TEKTURNA TABS (Use NF QL(1 ea daily)
quinapril- QL(3 ea daily) aliskiren fumarate)
hydrochlorothiazide tabs 10 1B Selective Aldosterone Receptor Antagonists
mg-12.5 mg
quinapril- QL(4 ea daily) eplerenone tabs 1B
hydrochlorothiazide tabs 1B INSPRA TABS (Use
12.5 mg-20 mg NF
eplerenone)
quinapril- QL(2 ea daily) Vasodilators
hydrochlorothiazide tabs 20 1B
mg-25 mg hydralazine hcl soln 1B
TARKA TBCR (Use NF
trandolapril-verapamil hcl) hydralazine hcl tabs 1B
telmisartan-amlodipine tabs 1B minoxidil tabs 1B
telmisartan- 1B
hydrochlorothiazide tabs ANTIMALARIALS - Drugs to Treat Malaria
(Parasitic Infections)
TENORETIC 100 TABS
(Use atenolol & NF Antimalarial Combinations
chlorthalidone)
TENORETIC 50 TABS
(Use atenolol & NF
chlorthalidone)
trandolapril-verapamil hcl 1B
tbcr
TRIBENZOR TABS (Use ST
olmesartan medoxomil- NF
amlodipine-
32
Covered for 3 QL(2 ea per 30
KRINTAFEL TABS
malaria days retail)
treatment only. Covered for
Limit 1 fill every malaria
180 treatment only.
days;QL(12 ea Limit 1 fill every
atovaquone-proguanil hcl 1B per fill retail,12 180 days;QL(5
tabs ea per fill mefloquine hcl tabs 1B ea daily)1 rtl
mail)1 rtl MAX MAX fill,180 rtl
fill,180 rtl day(s) supply,1
day(s) supply,1 mail MAX
mail MAX fill,180 mail
fill,180 mail day(s) supply,
day(s) supply,
PLAQUENIL TABS (Use NF
Covered for hydroxychloroquine sulfate)
malaria
treatment only. primaquine phosphate tabs 3
Limit 1 fill every
180 PRIMAQUINE
days;QL(24 ea PHOSPHATE TABS (Use NF
primaquine phosphate)
COARTEM TABS 2 per fill retail,24 PA; QL(3 ea
ea per fill pyrimethamine tabs 1B
mail)1 rtl MAX daily)
fill,180 rtl QUALAQUIN CAPS (Use
day(s) supply,1 NF PA;
quinine sulfate)
mail MAX PA;
fill,180 mail quinine sulfate caps 1B
day(s) supply,
Covered for ANTIMYASTHENIC/CHOLINERGIC AGENTS
malaria
treatment only. Antimyasthenic/Cholinergic Agents
Limit 1 fill every FIRDAPSE TABS 4 PA
180
days;QL(12 ea GUANIDINE HCL TABS 2
MALARONE TABS (Use NF per fill retail,12
atovaquone-proguanil hcl) ea per fill MESTINON SOLN (Use NF
mail)1 rtl MAX pyridostigmine bromide)
fill,180 rtl MESTINON TABS (Use
day(s) supply,1 NF
pyridostigmine bromide)
mail MAX
fill,180 mail MESTINON TIMESPAN
day(s) supply, TBCR (Use pyridostigmine NF
bromide)
Antimalarials NEOSTIGMINE PA
chloroquine phosphate 1B METHYLSULFATE SOSY 3
tabs 3 MG/3ML
DARAPRIM TABS (Use NF PA; QL(3 ea pyridostigmine bromide
pyrimethamine) daily) 1B
soln 60 mg/5ml
hydroxychloroquine sulfate 1B pyridostigmine bromide
tabs 200 mg 1B
tabs 60 mg
33
pyridostigmine bromide 1B TRECATOR TABS 3 QL(4 ea daily)
tbcr 180 mg
PA; QL(10 ea ANTINEOPLASTICS AND ADJUNCTIVE
RUZURGI TABS 4
daily) THERAPIES - Drugs to Treat Cancer
ANTIMYCOBACTERIAL AGENTS - Drugs to Alkylating Agents
Treat Tuberculosis (Bacterial Infections) ALKERAN SOLR (Use NF
Anti TB Combinations melphalan hcl)
ALKERAN TABS (Use NF
RIFAMATE CAPS 3 melphalan)
RIFATER TABS 3 QL(6 ea daily) BELRAPZO SOLN 4 PA
Antimycobacterial Agents BENDAMUSTINE 4 PA

HYDROCHLORIDE SOLN
CAPASTAT SULFATE 3
SOLR BENDEKA SOLN 4 PA
cycloserine caps 1B QL(4 ea daily)
BICNU SOLR (Use NF PA; SP
carmustine)
ethambutol hcl tabs 1B PA; SP
busulfan soln 4
isoniazid soln 1B BUSULFEX SOLN (Use NF PA; SP
busulfan)
isoniazid syrp 1B
carboplatin soln 450 PA
mg/45ml, 150 mg/15ml, 50 4
isoniazid tabs 1B mg/5ml
MYAMBUTOL TABS (Use NF carboplatin soln 50 mg/5ml 4 PA; SP
ethambutol hcl)
MYCOBUTIN CAPS (Use PA; SP
NF PA carmustine solr 4
rifabutin)
QL(3 ea daily) cisplatin soln 100 4 PA; SP
PASER PACK 3 mg/100ml
cisplatin soln 200 4 PA
PRIFTIN TABS 3 mg/200ml, 50 mg/50ml
pyrazinamide tabs 1B cyclophosphamide caps or 1B PA
25 mg, 50 mg
rifabutin caps 1B PA cyclophosphamide solr ij 1 PA; SP
4
gm, 2 gm, 500 mg
RIFADIN CAPS (Use NF PA
rifampin) EVOMELA SOLR 4
RIFADIN SOLR (Use NF PA; SP
rifampin) GLEOSTINE CAPS 10 MG 4
rifampin caps 1B GLEOSTINE CAPS 100 4 PA

MG, 40 MG
rifampin solr 1B IFEX SOLR 1 GM (Use NF PA; SP
ifosfamide)
SIRTURO TABS 100 MG 3 PA PA
IFEX SOLR 3 GM 4
34
ifosfamide soln 1 gm/20ml 4 PA; SP cladribine soln 4 PA
ifosfamide solr 1 gm 4 PA; SP clofarabine soln 4 PA; SP
IFOSFAMIDE SOLR 3 GM 4 PA CLOLAR SOLN (Use NF PA; SP

clofarabine)
LEUKERAN TABS 4 PA; SP cytarabine soln 100 mg/ml, PA; SP
4
20 mg/ml
melphalan hcl solr 1B DACOGEN SOLR (Use NF PA; SP
decitabine)
melphalan tabs 1B PA; SP
decitabine solr 4
MYLERAN TABS 4 PA; SP
floxuridine solr 4 PA; SP
oxaliplatin soln 100 4 PA; SP
mg/20ml, 50 mg/10ml fludarabine phosphate soln 4 PA; SP
TEMODAR CAPS OR 100 PA; SP PA; SP
MG, 140 MG, 180 MG, 20 fludarabine phosphate solr 4
NF
MG, 250 MG, 5 MG (Use fluorouracil soln 1 gm/20ml, PA
temozolomide) 4
2.5 gm/50ml, 5 gm/100ml
TEMODAR SOLR IV 100 4 PA; SP fluorouracil soln 500 PA; SP
MG 4
mg/10ml
temozolomide caps 4 PA; SP PA;
FOLOTYN SOLN 4
TEPADINA SOLR 100 MG 4 PA PA
(Use thiotepa) gemcitabine hcl solr 1 gm 4
TEPADINA SOLR 15 MG NF PA; SP PA;
(Use thiotepa) gemcitabine hcl solr 2 gm 4
thiotepa solr 100 mg 4 PA gemcitabine hcl solr 200 PA; SP

4
mg
thiotepa solr 15 mg 4 PA; SP GEMCITABINE
HYDROCHLORIDE SOLN
TREANDA SOLR 4 PA; SP 1 GM/10ML, 2 GM/20ML, NF
200 MG/2ML (Use
YONDELIS SOLR 4 PA gemcitabine hcl)
PA; SP mercaptopurine tabs 1B
ZANOSAR SOLR 4
methotrexate sodium soln ij 1B
Antimetabolites 250 mg/10ml, 50 mg/2ml
ALIMTA SOLR 100 MG 4 PA methotrexate sodium solr ij SP
1B
1 gm
ALIMTA SOLR 500 MG 4 PA; SP methotrexate sodium tabs SP
1B
or 2.5 mg
ARRANON SOLN 4 PA; SP PA; SP
TABLOID TABS 4
azacitidine susr 4 PA; SP PA; SP
TREXALL TABS 4
capecitabine tabs 4 PA; SP
35
VIDAZA SUSR (Use NF PA; SP BLINCYTO SOLR 4 PA
azacitidine)
XELODA TABS (Use PA
NF PA; SP DARZALEX SOLN 4
capecitabine)
EMPLICITI SOLR 4 PA
Antineoplastic - Angiogenesis Inhibitors
CYRAMZA SOLN 4 PA GAZYVA SOLN 4 PA
PA; QL(2 ea PA
INLYTA TABS 4 IMFINZI SOLN 4
daily); SP
LENVIMA 10 MG DAILY 4 PA; QL(1 ea KADCYLA SOLR 4 PA
DOSE CPPK daily)
LENVIMA 12MG DAILY PA; QL(3 ea KEYTRUDA SOLN 4 PA
4
DOSE CPPK daily)
LENVIMA 14 MG DAILY PA; QL(2 ea LIBTAYO SOLN 4 PA
4
DOSE CPPK daily)
LUMOXITI SOLR 4 PA
LENVIMA 18 MG DAILY 4 PA; QL(3 ea
DOSE CPPK daily)
MYLOTARG SOLR 4 PA
LENVIMA 20 MG DAILY 4 PA; QL(2 ea
DOSE CPPK daily) OPDIVO SOLN 100 PA
LENVIMA 24 MG DAILY 4 PA; QL(3 ea MG/10ML, 240 MG/24ML, 4
DOSE CPPK daily) 40 MG/4ML
LENVIMA 4 MG DAILY 4 PA; QL(1 ea POTELIGEO SOLN 4 PA
DOSE CPPK daily)
LENVIMA 8 MG DAILY PA; QL(2 ea RITUXAN SOLN 4 PA; SP
4
DOSE CPPK daily)
PA RUXIENCE SOLN 4 PA
MVASI SOLN 4
ZALTRAP SOLN 100 PA; SP TECENTRIQ SOLN 1200 4 PA
4 MG/20ML
MG/4ML
PA YERVOY SOLN 4 PA; SP
ZIRABEV SOLN 4
Antineoplastic - Anti-HER2 Agents Antineoplastic - Cellular Immunotherapy
PERJETA SOLN 4 PA; SP PROVENGE SUSP 4 PA
TUKYSA TABS 4 PA Antineoplastic - EGFR Inhibitors

ERBITUX SOLN 4 PA; SP
Antineoplastic - Antibodies
PA; SP PA; QL(1 ea
ADCETRIS SOLR 4 erlotinib hcl tabs 4
daily); SP
PA; SP PA; QL(1 ea
ARZERRA CONC 4 GILOTRIF TABS 4
daily)
BAVENCIO SOLN 4 PA IRESSA TABS 4 PA
BESPONSA SOLR 4 PA PORTRAZZA SOLN 4 PA
36
TARCEVA TABS (Use NF PA; QL(1 ea FEMARA TABS (Use NF
erlotinib hcl) daily); SP letrozole)
VECTIBIX SOLN 100 4 PA; SP PA; QL(0.143
FIRMAGON SOLR 4
MG/5ML ea daily); SP
VECTIBIX SOLN 400 PA PA; QL(6 ea
MG/20ML
4 flutamide caps 4
daily); SP
VIZIMPRO TABS 4 PA PA; QL(0.357
fulvestrant soln 4
ml daily); SP
Antineoplastic - Hedgehog Pathway Inhibitors letrozole tabs 1B
DAURISMO TABS 4 PA PA; SP
leuprolide acetate kit 4
PA; QL(1 ea
ERIVEDGE CAPS 4 LUPRON DEPOT (1- PA; QL(0.0357
daily); SP 4
PA; QL(1 ea MONTH) KIT ea daily); SP
ODOMZO CAPS 4 LUPRON DEPOT (3- PA; SP
daily) 4
MONTH) KIT
Antineoplastic - Hormonal and Related Agents
LUPRON DEPOT (4- 4 PA; QL(0.1339
abiraterone acetate tabs 4 PA; QL(4 ea MONTH) KIT ea daily); SP
250 mg daily); SP
LUPRON DEPOT (6- 4 PA; QL(0.0089
abiraterone acetate tabs 4 PA; QL(2 ea MONTH) KIT ea daily); SP
500 mg daily)
LYSODREN TABS 4 PA; SP
anastrozole tabs 1B QL(1 ea daily)
ARIMIDEX TABS (Use megestrol acetate susp 1B
NF QL(1 ea daily)
anastrozole)
AROMASIN TABS (Use
megestrol acetate tabs 1B
NF QL(1 ea daily);
exemestane) SP NILANDRON TABS (Use NF QL(2 ea daily)
nilutamide)
bicalutamide tabs 4 PA; QL(1 ea
daily); SP QL(2 ea daily)
nilutamide tabs 1B
CASODEX TABS (Use NF PA; QL(1 ea
bicalutamide) daily); SP PA; QL(4 ea
NUBEQA TABS 4
daily)
ELIGARD KIT 22.5 MG 4 PA; SP
tamoxifen citrate tabs 0
ELIGARD KIT 30 MG 4 PA; SP
toremifene citrate tabs 1B
ELIGARD KIT 45 MG 4 PA; SP
TRELSTAR MIXJECT 4 PA; SP
PA; QL(0.0089 SUSR
ELIGARD KIT 7.5 MG 4
ea daily); SP PA
VANTAS KIT 4
EMCYT CAPS 4 PA; SP
PA; QL(4 ea
XTANDI CAPS 40 MG 4
QL(1 ea daily); daily); SP
exemestane tabs 4
SP PA; QL(4 ea
YONSA TABS 4
FARESTON TABS (Use daily)
NF
toremifene citrate) PA; QL(0.0119
ZOLADEX IMPL 10.8 MG 4
FASLODEX SOLN (Use ea daily); SP
NF PA; QL(0.357
fulvestrant) ml daily); SP
37
ZOLADEX IMPL 3.6 MG 4 PA; QL(0.0357 doxorubicin hcl solr 10 mg 4 PA
ea daily); SP
ZYTIGA TABS 250 MG PA; SP
NF PA; QL(4 ea doxorubicin hcl solr 50 mg 4
(Use abiraterone acetate) daily); SP
ZYTIGA TABS 500 MG ELLENCE SOLN 50 PA; SP
NF PA; QL(2 ea MG/25ML (Use epirubicin NF
(Use abiraterone acetate) daily)
hcl)
Antineoplastic - Immunomodulators epirubicin hcl soln 50 PA; SP
4
POMALYST CAPS 4 PA; QL(1 ea mg/25ml
daily) IDAMYCIN PFS SOLN 10 PA; SP
Antineoplastic - PDGFR-alpha Inhibitors MG/10ML, 5 MG/5ML (Use NF
AYVAKIT TABS 100 MG, idarubicin hcl)
4 PA; SL(1 ea IDAMYCIN PFS SOLN 20 PA
200 MG, 300 MG daily)
MG/20ML (Use idarubicin NF
LARTRUVO SOLN 4 PA hcl)
Antineoplastic - XPO1 Inhibitors idarubicin hcl soln 10 4 PA; SP
mg/10ml, 5 mg/5ml
XPOVIO 100 MG ONCE 4 PA
WEEKLY TBPK idarubicin hcl soln 20 4 PA
mg/20ml
XPOVIO 60 MG ONCE 4 PA
WEEKLY TBPK mitomycin solr iv 20 mg 4 PA; SP
XPOVIO 80 MG ONCE 4 PA PA; SP
WEEKLY TBPK mitoxantrone hcl conc 4
XPOVIO 80 MG TWICE 4 PA PA; SP
WEEKLY TBPK valrubicin soln 4
Antineoplastic Antibiotics VALSTAR SOLN (Use NF PA; SP
bleomycin sulfate solr 15 PA; SP valrubicin)
4
unit Antineoplastic Combinations
COSMEGEN SOLR (Use NF PA; SP VYXEOS SUSR 4 PA
dactinomycin)
dactinomycin solr 4 PA; SP Antineoplastic Enzyme Inhibitors
AFINITOR TABS 2.5 MG, 5 PA; QL(1 ea
daunorubicin hcl soln 4 PA; MG, 7.5 MG (Use NF daily); SP
everolimus)
DAUNORUBICIN PA;
HYDROCHLORIDE SOLN ALECENSA CAPS 4 PA; QL(4 ea
4 daily)
20 MG/4ML (Use
daunorubicin hcl) ALUNBRIG TABS 4 PA; QL(1 ea
daily)
DAUNORUBICIN PA;
HYDROCHLORIDE SOLN 4 ALUNBRIG TBPK 4 PA; QL(1 ea
50 MG/10ML daily)
DOXIL INJ (Use NF PA; SP BALVERSA TABS 4 PA
doxorubicin hcl liposomal)
doxorubicin hcl liposomal PA; SP BELEODAQ SOLR 4 PA
4
inj
BORTEZOMIB SOLR 4 PA;
doxorubicin hcl soln 2 4 PA; SP
mg/ml, 200 mg/100ml
38
BOSULIF TABS 100 MG, 4 PA; QL(1 ea KOSELUGO CAPS 4 PA
500 MG daily); SP
PA
BOSULIF TABS 400 MG 4 PA; KYPROLIS SOLR 4
PA; SP PA; QL(6 ea
BRAFTOVI CAPS 4 lapatinib ditosylate tabs 4
daily); SP
BRUKINSA CAPS 4 PA PA; QL(1 ea
LORBRENA TABS 4
daily)
PA; QL(1 ea PA; QL(4 ea
CAPRELSA TABS 4 LYNPARZA TABS 4
daily); SP daily)
COMETRIQ KIT 4 MEKINIST TABS 0.5 MG 4
daily); SP daily)
COMETRIQ KIT 4 MEKINIST TABS 2 MG 4
daily); SP daily)
PA; QL(3 ea PA; SP
COMETRIQ KIT 4 MEKTOVI TABS 4
daily); SP
COPIKTRA CAPS 4 PA PA; QL(4 ea
NEXAVAR TABS 4
daily); SP
PA; QL(1 ea PA; QL(0.143
everolimus tabs 4
daily); SP NINLARO CAPS 4
ea daily)
GLEEVEC TABS (Use NF PA; QL(2 ea PA; QL(1 ea
imatinib mesylate) daily); SP PEMAZYRE TABS 4
daily)
IBRANCE CAPS 3 PA PIQRAY 200MG DAILY 4 PA
DOSE TBPK
IBRANCE TABS 3 PA PIQRAY 250MG DAILY PA
4
DOSE TBPK
ICLUSIG TABS 10 MG, 15 4 PA; QL(1 ea
MG, 30 MG, 45 MG daily) PIQRAY 300MG DAILY 4 PA
DOSE TBPK
PA; QL(2 ea
imatinib mesylate tabs 4
daily); SP QINLOCK TABS 4 PA
IMBRUVICA CAPS 140 4 PA; QL(3 ea PA
MG daily) RETEVMO CAPS 4
PA; QL(1 ea ROMIDEPSIN SOLR 10 PA; SP
IMBRUVICA CAPS 70 MG 4 4
daily) MG
IMBRUVICA TABS 140 PA; QL(1 ea PA
MG, 280 MG, 420 MG, 560 4 daily) ROZLYTREK CAPS 4
MG PA; QL(4 ea
RUBRACA TABS 4
INREBIC CAPS 4 PA daily)
PA; QL(1 ea
ISTODAX (OVERFILL) PA; SP SPRYCEL TABS 4
4 daily); SP
SOLR PA; QL(4 ea
JAKAFI TABS 10 MG, 20 PA; SP STIVARGA TABS 4
4 daily); SP
MG sunitinib malate caps 12.5 PA; QL(1 ea
JAKAFI TABS 15 MG, 25 PA; QL(2 ea 4
4 mg, 25 mg, 50 mg daily); SP
MG, 5 MG daily); SP SUTENT CAPS 12.5 MG, PA; QL(1 ea
KISQALI TBPK 3 PA 25 MG, 50 MG (Use 4 daily); SP
sunitinib malate)
39
TABRECTA TABS 4 PA ERWINASE SOLR 4 PA; SP
PA; QL(4 ea ERWINAZE SOLR 4 PA; SP
TAFINLAR CAPS 4
daily)
PA; QL(1 ea ONCASPAR SOLN 4 PA; SP
TALZENNA CAPS 4
daily)
TASIGNA CAPS 150 MG, PA; QL(4 ea Antineoplastics Misc.
4
200 MG daily); SP PA; SP
ACTIMMUNE SOLN 4
PA; QL(4 ea
TASIGNA CAPS 50 MG 4 arsenic trioxide soln 10 PA; SP
daily) 4
PA mg/10ml
TAZVERIK TABS 4
bexarotene caps 4 PA; SP
PA; QL(0.143
temsirolimus soln 4
ml daily); SP PA
dacarbazine solr 100 mg 4
TIBSOVO TABS 4 PA
dacarbazine solr 200 mg 4 PA; SP
TORISEL SOLN (Use NF PA; QL(0.143
temsirolimus) ml daily); SP HYDREA CAPS (Use NF
hydroxyurea)
TURALIO CAPS 4 PA; AC
hydroxyurea caps 1B
TYKERB TABS (Use NF PA; QL(6 ea
lapatinib ditosylate) daily); SP INTRON A SOLN 10 4 PA
MU/ML, 6000000 UNIT/ML
VELCADE SOLR 4 PA; SP PA; SP
INTRON A SOLR 18 MU 4
VERZENIO TABS 4 PA
MATULANE CAPS 4 PA; SP
VITRAKVI CAPS 4 PA
NIPENT SOLR 4 PA; SP
VITRAKVI SOLN 4 PA
PHOTOFRIN SOLR 4 PA; SP
PA; QL(4 ea
VOTRIENT TABS 4 PA; SP
daily); SP PROLEUKIN SOLR 4
PA; QL(2 ea
XALKORI CAPS 4 SYLATRON KIT 4 PA; SP
daily); SP
XOSPATA TABS 4 PA PA; SP
SYNRIBO SOLR 4
PA; QL(3 ea TARGRETIN CAPS OR 75
ZEJULA CAPS 4
daily) NF PA; SP
MG (Use bexarotene)
ZELBORAF TABS 4 PA; SP PA
TICE BCG SUSR 4
PA; QL(4 ea tretinoin (chemotherapy)
ZOLINZA CAPS 4 1B
daily); SP caps
PA; QL(2 ea PA; SP
ZYDELIG TABS 4 UVADEX SOLN 4
daily)
PA; QL(5 ea Chemotherapy Adjuncts
ZYKADIA CAPS 4
daily)
ELITEK SOLR 4 PA
Antineoplastic Enzymes
40
KEPIVANCE SOLR 4 PA; SP NAVELBINE SOLN 10 PA; SP
MG/ML (Use vinorelbine NF
Chemotherapy Rescue/Antidote/Protective Agents tartrate)
NAVELBINE SOLN 50 PA
KHAPZORY SOLR 4 PA MG/5ML (Use vinorelbine NF
leucovorin calcium solr ij tartrate)
500 mg, 100 mg, 200 mg, 1B paclitaxel conc 150 PA; SP
350 mg, 50 mg mg/25ml, 100 mg/16.7ml, 6 4
leucovorin calcium tabs or mg/ml
1B paclitaxel conc 30 mg/5ml, PA
10 mg, 15 mg, 25 mg, 5 mg 4
PA 300 mg/50ml, 6 mg/ml
mesna soln 4 TAXOTERE CONC (Use NF PA; SP
MESNEX SOLN IV 100 PA docetaxel)
4
MG/ML (Use mesna) TENIPOSIDE SOLN 4 PA; SP
VORAXAZE SOLR 4 PA; SP
vinblastine sulfate soln 4 PA
Mitotic Inhibitors
vincristine sulfate soln 4 PA; SP
ABRAXANE SUSR 4 PA; SP
vinorelbine tartrate soln 10 4 PA; SP
docetaxel conc 20 mg/ml 4 PA; SP mg/ml
DOCETAXEL CONC 20 vinorelbine tartrate soln 50 PA
NF PA; SP mg/5ml 4
MG/ML (Use docetaxel)
DOCETAXEL CONC 80 Oncolytic Viral Agents
NF
MG/4ML (Use docetaxel) IMLYGIC SUSP 4 PA
DOCETAXEL SOLN 20 4 PA; SP
MG/2ML Topoisomerase I Inhibitors
docetaxel soln 20 mg/2ml 4 PA; SP CAMPTOSAR SOLN 100 PA; SP
MG/5ML, 40 MG/2ML (Use NF
DOCETAXEL SOLN 20 4 PA; SP irinotecan hcl)
MG/2ML (Use docetaxel) CAMPTOSAR SOLN 300 PA
ETOPOPHOS SOLR 4 PA; SP MG/15ML (Use irinotecan 4
hcl)
etoposide caps 4 PA; SP HYCAMTIN CAPS OR 0.25 PA; SP
4
MG, 1 MG
etoposide soln PA; SP HYCAMTIN SOLR IV 4 MG
4 NF PA; SP
(Use topotecan hcl)
HALAVEN SOLN 4 PA; SP
irinotecan hcl soln 100 4 PA; SP
IXEMPRA KIT SOLR 15 PA; SP mg/5ml, 40 mg/2ml
4 irinotecan hcl soln 300 PA
MG 4
IXEMPRA KIT SOLR 45 PA mg/15ml
4 PA
MG ONIVYDE INJ 4
JEVTANA SOLN 4 PA; SP
TOPOTECAN HCL SOLN 4 PA
PA 4 MG/4ML
MARQIBO SUSP 4
41
topotecan hcl soln 4 4 PA bromocriptine mesylate 1B
mg/4ml tabs
TOPOTECAN HCL SOLN PA carbidopa-levodopa tabs 1B
4 MG/4ML (Use topotecan 4
hcl) carbidopa-levodopa tbcr 1B
topotecan hcl solr 4 mg 4 PA; SP
carbidopa-levodopa tbdp 1B
ANTIPARKINSON AND RELATED THERAPY
AGENTS - Drugs to Treat Parkinson's Disease carbidopa-levodopa- 1B
entacapone tabs
Antiparkinson Adjunctive Therapy MIRAPEX TABS 0.125 MG QL(4 ea daily)
carbidopa tabs 1B (Use pramipexole NF
dihydrochloride)
LODOSYN TABS (Use NF MIRAPEX TABS 0.25 MG,
carbidopa) 0.5 MG, 0.75 MG, 1 MG, NF
Antiparkinson Anticholinergics 1.5 MG (Use pramipexole
dihydrochloride)
benztropine mesylate soln 1B
NEUPRO PT24 2
benztropine mesylate tabs 1B PARLODEL CAPS (Use NF
COGENTIN SOLN (Use bromocriptine mesylate)
NF
benztropine mesylate) PARLODEL TABS (Use NF
bromocriptine mesylate)
trihexyphenidyl hcl soln 1B
pramipexole QL(4 ea daily)
trihexyphenidyl hcl tabs 1B dihydrochloride tabs 0.125 1B
mg
Antiparkinson COMT Inhibitors pramipexole
COMTAN TABS (Use dihydrochloride tabs 0.25
NF QL(8 ea daily) mg, 0.5 mg, 0.75 mg, 1 mg, 1B
entacapone)
1.5 mg
entacapone tabs 1B QL(8 ea daily) REQUIP XL TB24 12 MG, ST; QL(2 ea
TASMAR TABS (Use 8 MG (Use ropinirole NF daily)
3 hydrochloride)
tolcapone)
REQUIP XL TB24 4 MG, 6 ST; QL(1 ea
tolcapone tabs 3 MG (Use ropinirole NF daily)
hydrochloride)
Antiparkinson Dopaminergics ropinirole hydrochloride
amantadine hcl caps 1B tabs 0.25 mg, 3 mg, 0.5 1B
mg, 1 mg, 2 mg, 4 mg, 5
amantadine hcl syrp 1B mg
ropinirole hydrochloride 1B ST; QL(2 ea
amantadine hcl tabs 1B tb24 12 mg, 8 mg daily)
PA; ropinirole hydrochloride 1B ST; QL(1 ea
APOKYN SOCT 4 tb24 2 mg, 4 mg, 6 mg daily)
bromocriptine mesylate SINEMET CR TBCR (Use NF
1B carbidopa-levodopa)
caps
SINEMET TABS (Use NF
carbidopa-levodopa)
42
STALEVO 100 TABS (Use 3 ST; QL(4 ea
EQUETRO CP12 300 MG
carbidopa-levodopa- NF daily)
entacapone) GEODON CAPS OR 20 QL(2 ea daily);
STALEVO 125 TABS (Use MG, 40 MG, 60 MG, 80 MG NF AL(At least 18
carbidopa-levodopa- NF (Use ziprasidone hcl) yrs old)
entacapone)
LATUDA TABS 3 PA; QL(1 ea
STALEVO 150 TABS (Use daily)
carbidopa-levodopa- NF QL(2 ea daily);
entacapone) ziprasidone hcl caps 1B AL(At least 18
STALEVO 200 TABS (Use yrs old)
carbidopa-levodopa- NF
entacapone) Benzisoxazoles
PA; QL(2 ea
STALEVO 50 TABS (Use FANAPT TABS 2
daily)
carbidopa-levodopa- NF
entacapone) FANAPT TITRATION 2 PA
PACK TABS
STALEVO 75 TABS (Use
carbidopa-levodopa- NF INVEGA TB24 1.5 MG, 3 QL(1 ea daily)
entacapone) MG, 9 MG (Use NF
paliperidone)
Antiparkinson Monoamine Oxidase Inhibitors
INVEGA TB24 6 MG (Use NF QL(2 ea daily)
AZILECT TABS (Use NF PA; QL(1 ea paliperidone)
rasagiline mesylate) daily)
paliperidone tb24 1.5 mg, 3 1B QL(1 ea daily)
rasagiline mesylate tabs 1B PA; QL(1 ea mg, 9 mg
daily)
paliperidone tb24 6 mg 1B QL(2 ea daily)
selegiline hcl caps 1B
PA; QL(0.072
PERSERIS PRSY 2
selegiline hcl tabs 1B ea daily)
RISPERDAL CONSTA 2 PA; QL(0.072
ANTIPSYCHOTICS/ANTIMANIC AGENTS - SRER ea daily)
Drugs to Treat Mood Disorders RISPERDAL SOLN 1 NF QL(8 ml daily)
Antimanic Agents MG/ML (Use risperidone)
lithium carbonate caps 1B RISPERDAL TABS 0.25 QL(4 ea daily)
MG, 0.5 MG, 1 MG, 2 MG, NF
3 MG, 4 MG (Use
lithium carbonate tabs 1B risperidone)
lithium carbonate tbcr 1B risperidone soln 1 mg/ml 1B QL(8 ml daily)
LITHIUM SOLN 1B risperidone tabs 0.25 mg, QL(4 ea daily)

0.5 mg, 1 mg, 2 mg, 3 mg, 1B
LITHOBID TBCR (Use NF 4 mg
lithium carbonate) risperidone tbdp 0.25 mg, QL(2 ea daily)
Antipsychotics - Misc. 0.5 mg, 1 mg, 2 mg, 3 mg, 1B
ST; QL(2 ea 4 mg
EQUETRO CP12 100 MG 3
daily) Butyrophenones
ST; QL(8 ea HALDOL DECANOATE QL(0.036 ml
EQUETRO CP12 200 MG 3
daily) 100 SOLN (Use haloperidol NF daily)
decanoate)
43
HALDOL DECANOATE 50 QL(0.036 ml olanzapine tbdp or 10 mg, 1B QL(2 ea daily)
SOLN (Use haloperidol NF daily) 15 mg, 5 mg
decanoate) QL(1 ea daily)
olanzapine tbdp or 20 mg 1B
HALDOL SOLN (Use NF
haloperidol lactate) quetiapine fumarate tabs QL(4 ea daily);
100 mg, 200 mg, 25 mg, 50 1B AL(At least 10
haloperidol decanoate soln 1B QL(0.036
daily)
ml
mg yrs old)
QL(2 ea daily);
haloperidol lactate conc 1B quetiapine fumarate tabs 1B AL(At least 10
300 mg, 400 mg yrs old)
haloperidol lactate soln 1B
quetiapine fumarate tb24 1B QL(1 ea daily)
haloperidol tabs 1B 150 mg, 200 mg, 50 mg
quetiapine fumarate tb24 1B QL(2 ea daily)
Dibenzapines 300 mg, 400 mg
asenapine maleate subl 10 PA; QL(2 ea SAPHRIS SUBL 10 MG, 5 PA; QL(2 ea
1B MG (Use asenapine NF daily)
mg, 5 mg daily)
asenapine maleate subl 2.5 PA; QL(4 ea maleate)
1B SAPHRIS SUBL 2.5 MG
mg daily) NF PA; QL(4 ea
clozapine tabs 200 mg, 50 (Use asenapine maleate) daily)
1B SEROQUEL TABS 100 QL(4 ea daily);
mg, 100 mg, 25 mg
QL(9 ea daily) MG, 200 MG, 25 MG, 50 NF AL(At least 10
clozapine tbdp 100 mg 1B MG (Use quetiapine yrs old)
clozapine tbdp 12.5 mg, QL(6 ea daily) fumarate)
1B SEROQUEL TABS 300 QL(2 ea daily);
150 mg
QL(4 ea daily) MG, 400 MG (Use NF AL(At least 10
clozapine tbdp 200 mg 1B quetiapine fumarate) yrs old)
QL(3 ea daily) SEROQUEL XR TB24 150 QL(1 ea daily)
clozapine tbdp 25 mg 1B MG, 200 MG, 50 MG (Use NF
CLOZARIL TABS (Use quetiapine fumarate)
NF SEROQUEL XR TB24 300 QL(2 ea daily)
clozapine)
FAZACLO TBDP 100 MG MG, 400 MG (Use NF
NF QL(9 ea daily) quetiapine fumarate)
(Use clozapine)
FAZACLO TBDP 12.5 MG, ZYPREXA SOLR IM 10 NF QL(0.215 ea
NF QL(6 ea daily) MG (Use olanzapine) daily)
150 MG (Use clozapine)
FAZACLO TBDP 200 MG QL(4 ea daily) ZYPREXA TABS OR 10 QL(2 ea daily)
1B MG, 15 MG, 20 MG, 7.5 NF
(Use clozapine)
MG (Use olanzapine)
FAZACLO TBDP 25 MG NF QL(3 ea daily)
(Use clozapine) ZYPREXA TABS OR 2.5 QL(4 ea daily)
MG, 5 MG (Use NF
loxapine succinate caps 1B olanzapine)
QL(0.215 ea ZYPREXA ZYDIS TBDP 10 QL(2 ea daily)
olanzapine solr im 10 mg 1B
daily) MG, 15 MG, 5 MG (Use NF
olanzapine)
olanzapine tabs or 10 mg, 1B QL(2 ea daily)
15 mg, 20 mg, 7.5 mg ZYPREXA ZYDIS TBDP 20 NF QL(1 ea daily)
MG (Use olanzapine)
olanzapine tabs or 2.5 mg, 1B QL(4 ea daily)
5 mg Phenothiazines
44
chlorpromazine hcl soln ij 3 abacavir sulfate- 1B QL(2 ea daily)
25 mg/ml, 50 mg/2ml lamivudine-zidovudine tabs
chlorpromazine hcl tabs or APTIVUS CAPS 250 MG 2 QL(4 ea daily)
10 mg, 100 mg, 200 mg, 25 1B
mg, 50 mg APTIVUS SOLN 100 QL(10 ml daily)
2
MG/ML
fluphenazine hcl conc 1B
atazanavir sulfate caps 150 1B QL(1 ea daily)
fluphenazine hcl elix 1B mg, 300 mg
atazanavir sulfate caps 200 1B QL(2 ea daily)
fluphenazine hcl soln 1B mg
ATRIPLA TABS (Use QL(1 ea daily)
fluphenazine hcl tabs 1B efavirenz-emtricitabine- NF
tenofovir disoproxil
perphenazine tabs 1B fumarate)
BIKTARVY TABS 2 QL(1 ea daily)
prochlorperazine maleate 1B
tabs
CIMDUO TABS 2 QL(1 ea daily)
prochlorperazine supp 1B
COMBIVIR TABS (Use 3
thioridazine hcl tabs 1B lamivudine-zidovudine)
COMPLERA TABS 2 QL(1 ea daily)
trifluoperazine hcl tabs 1B
CRIXIVAN CAPS 200 MG 2 QL(9 ea daily)
Quinolinone Derivatives
QL(1 ea daily); CRIXIVAN CAPS 400 MG 2 QL(6 ea daily)
ABILIFY TABS (Use NF AL(At least 6
aripiprazole) yrs old)
DELSTRIGO TABS 2 QL(1 ea daily)
QL(30 ml
aripiprazole soln 1 mg/ml 3 daily); AL(At PA; QL(1 ea
DESCOVY TABS 2
least 6 yrs old) daily)
aripiprazole tabs 10 mg, 15 QL(1 ea daily); didanosine cpdr 200 mg 1B QL(2 ea daily)
mg, 2 mg, 20 mg, 30 mg, 5 1B AL(At least 6
mg yrs old) didanosine cpdr 250 mg 1B
REXULTI TABS 3 PA QL(1 ea daily)
didanosine cpdr 400 mg 1B
Thioxanthenes
DOVATO TABS 2 QL(1 ea daily)
thiothixene caps 1B
EDURANT TABS 2 QL(1 ea daily)
ANTIVIRALS - Drugs to Treat Viral Infections
efavirenz caps 200 mg 1B QL(2 ea daily)
Antiretrovirals
abacavir sulfate soln 20 QL(32 ml daily) efavirenz caps 50 mg 1B QL(3 ea daily)
1B
mg/ml
abacavir sulfate tabs 300 efavirenz tabs 600 mg 1B QL(1 ea daily)
1B
mg
abacavir sulfate-lamivudine QL(1 ea daily) efavirenz-emtricitabine- QL(1 ea daily)
1B tenofovir disoproxil 1B
tabs
fumarate tabs
45
efavirenz-lamivudine- QL(1 ea daily) INTELENCE TABS 25 MG 2 QL(8 ea daily)
tenofovir disoproxil 1B
fumarate tabs INVIRASE TABS 2 QL(4 ea daily)
emtricitabine caps 1B QL(1 ea daily)
ISENTRESS CHEW 100 2 QL(6 ea daily)
emtricitabine-tenofovir QL(1 ea MG, 25 MG
disoproxil fumarate tabs 1B daily,30 day(s) ISENTRESS HD TABS 2 QL(2 ea daily)
100 mg-150 mg, 133 mg- limit)
200 mg, 167 mg-250 mg ISENTRESS PACK 100 QL(8 ea daily)
2
emtricitabine-tenofovir QL(1 ea daily) MG
disoproxil fumarate tabs 0 ISENTRESS TABS 400 QL(2 ea daily)
200 mg-300 mg, 300 mg- 2
MG
200 mg QL(1 ea daily)
emtricitabine-tenofovir QL(1 ea JULUCA TABS 2
disoproxil fumarate tabs 0 daily,30 day(s) KALETRA SOLN 100 QL(12.5 ml
300 mg-200 mg limit) MG/5ML-400 MG/5ML 3 daily)
EMTRIVA CAPS 200 MG QL(1 ea daily) (Use lopinavir-ritonavir)
2
(Use emtricitabine) KALETRA TABS 200 MG- QL(4 ea daily)
EMTRIVA SOLN 10 QL(24 ml daily) 50 MG, 25 MG-100 MG, 50 2
2 MG-200 MG (Use lopinavir-
MG/ML
EPIVIR SOLN 10 MG/ML QL(30 ml daily) ritonavir)
3 QL(30 ml daily)
(Use lamivudine) lamivudine soln 10 mg/ml 1B
EPIVIR TABS 150 MG 3 QL(2 ea daily)
(Use lamivudine) lamivudine tabs 150 mg 1B QL(2 ea daily)
EPIVIR TABS 300 MG 3 QL(1 ea daily)
(Use lamivudine) lamivudine tabs 300 mg 1B QL(1 ea daily)
EPZICOM TABS (Use QL(1 ea daily)
abacavir sulfate- 2 lamivudine-zidovudine tabs 1B
lamivudine) QL(56 ml daily)
QL(4 ea daily) LEXIVA SUSP 50 MG/ML 2
etravirine tabs 100 mg 1B
LEXIVA TABS 700 MG QL(4 ea daily)
etravirine tabs 200 mg 1B QL(2 ea daily) (Use fosamprenavir 3
calcium)
QL(1 ea lopinavir-ritonavir soln 100 QL(12.5 ml
daily)30 rtl lmt 1B
EVOTAZ TABS 2 mg/5ml-400 mg/5ml daily)
day(s),30 mail
lmt day(s), lopinavir-ritonavir tabs 25 1B QL(4 ea daily)
mg-100 mg, 50 mg-200 mg
fosamprenavir calcium tabs 1B QL(4 ea daily)
nevirapine susp 50 mg/5ml 1B QL(40 ml daily)
FUZEON SOLR 4 PA; SP
nevirapine tabs 200 mg 1B
GENVOYA TABS 2 QL(1 ea daily)
nevirapine tb24 100 mg 1B QL(3 ea daily)
INTELENCE TABS 100 2 QL(4 ea daily)
MG (Use etravirine) nevirapine tb24 400 mg 1B QL(1 ea daily)
INTELENCE TABS 200 2 QL(2 ea daily)
MG (Use etravirine)
46
QL(12 ea STAVUDINE CAPS 15 MG, 2 QL(2 ea daily)
NORVIR PACK 100 MG 2 daily)30 rtl lmt 30 MG
day(s),30 mail STAVUDINE CAPS 20 MG, 1B QL(2 ea daily)
lmt day(s), 40 MG
NORVIR SOLN 80 MG/ML 2 QL(15 ml daily) STRIBILD TABS 2 QL(1 ea daily)
NORVIR TABS 100 MG 3 QL(12 ea daily) SUSTIVA CAPS 200 MG QL(2 ea daily)
(Use ritonavir) 3
(Use efavirenz)
ODEFSEY TABS 2 QL(1 ea daily) SUSTIVA CAPS 50 MG QL(3 ea daily)
3
(Use efavirenz)
PIFELTRO TABS 2 QL(1 ea daily) SUSTIVA TABS 600 MG QL(1 ea daily)
3
(Use efavirenz)
PREZCOBIX TABS 2 QL(1 ea daily)
SYMFI LO TABS (Use QL(1 ea daily)
PREZISTA SUSP 100 QL(12 ml daily) efavirenz-lamivudine- 2
2 tenofovir disoproxil
MG/ML
fumarate)
PREZISTA TABS 150 MG, 2 QL(2 ea daily)
600 MG, 75 MG SYMFI TABS (Use QL(1 ea daily)
efavirenz-lamivudine- 2
PREZISTA TABS 800 MG 2 QL(1 ea daily) tenofovir disoproxil
fumarate)
RESCRIPTOR TABS 2 QL(6 ea daily) ST; QL(1 ea
SYMTUZA TABS 2
daily)
RETROVIR CAPS (Use 3
zidovudine) TEMIXYS TABS 2 QL(1 ea daily)
RETROVIR IV INFUSION 1B tenofovir disoproxil
SOLN 1B
fumarate tabs
RETROVIR SYRP (Use 3
zidovudine) TIVICAY PD TBSO 2
REYATAZ CAPS 150 MG, QL(1 ea daily) QL(2 ea daily)
300 MG (Use atazanavir 3 TIVICAY TABS 2
sulfate) QL(1 ea daily)
REYATAZ CAPS 200 MG QL(2 ea daily) TRIUMEQ TABS 2
3
(Use atazanavir sulfate) TRIZIVIR TABS (Use QL(2 ea daily)
REYATAZ PACK 50 MG 2 abacavir sulfate- 3
lamivudine-zidovudine)
ritonavir tabs 1B QL(12 ea daily) TRUVADA TABS (Use QL(1 ea
emtricitabine-tenofovir 2 daily,30 day(s)
RUKOBIA TB12 2 PA disoproxil fumarate) limit)
TYBOST TABS 2 QL(1 ea daily)
SELZENTRY SOLN 20 2 QL(30 ml daily)
MG/ML VIDEX EC CPDR 200 MG QL(2 ea daily)
SELZENTRY TABS 150 QL(2 ea daily) 3
2 (Use didanosine)
MG, 25 MG, 75 MG VIDEX EC CPDR 250 MG
SELZENTRY TABS 300 QL(4 ea daily) 3
2 (Use didanosine)
MG VIDEX EC CPDR 400 MG
stavudine caps 15 mg, 20 QL(2 ea daily) NF QL(1 ea daily)
1B (Use didanosine)
mg, 30 mg, 40 mg
VIDEXPEDIATRIC SOLR 2
47
VIRACEPT TABS 250 MG 2 QL(10 ea daily) EPCLUSA TABS 100 MG- 4 PA; QL(1 ea
400 MG daily)
QL(4 ea daily) EPIVIR HBV SOLN 5
VIRACEPT TABS 625 MG 2 2 PA; QL(60 ml
MG/ML daily); SP
VIRAMUNE SUSP 50 QL(40 ml daily) EPIVIR HBV TABS 100
MG/5ML (Use nevirapine)
1B 3 QL(3 ea daily);
MG (Use lamivudine (hbv)) SP
VIRAMUNE TABS 200 MG HEPSERA TABS (Use
(Use nevirapine)
3 4 PA; QL(1 ea
adefovir dipivoxil) daily); SP
VIRAMUNE XR TB24 (Use QL(1 ea daily)
nevirapine) 3 lamivudine (hbv) tabs 1B QL(3 ea daily);
SP
VIREAD POWD 40 MG/GM 2 PEGASYS PROCLICK 4 PA; QL(0.0714
SOLN ml daily); SP
VIREAD TABS 150 MG, 2 QL(1 ea daily)
200 MG, 250 MG PEGASYS SOLN 4 PA; QL(0.0714
ml daily); SP
VIREAD TABS 300 MG
(Use tenofovir disoproxil 2 PEGINTRON KIT 4 PA; QL(0.143
fumarate) ea daily); SP
ZIAGEN SOLN 20 MG/ML QL(32 ml daily) RIBASPHERE RIBAPAK 4 PA
3 TBPK
(Use abacavir sulfate)
ZIAGEN TABS 300 MG RIBASPHERE TABS 4 PA
3
(Use abacavir sulfate)
ribavirin (hepatitis c) caps 1B QL(7 ea daily)
zidovudine caps 1B 200 mg
ribavirin (hepatitis c) tabs 1B QL(7 ea daily)
zidovudine syrp 1B 200 mg
ribavirin (hepatitis c) tabs 4 PA
zidovudine tabs 1B 600 mg
CMV Agents SOFOSBUVIR/VELPATAS 4 PA; QL(1 ea
VIR TABS daily)
cidofovir soln 3 PA; QL(1 ea
VEMLIDY TABS 4
CYTOVENE SOLR (Use daily); SP
NF PA; QL(1 ea
ganciclovir sodium) VOSEVI TABS 4
daily)
ganciclovir sodium solr 1B
Herpes Agents
VALCYTE TABS 450 MG NF PA; QL(4 ea QL(5 ea
(Use valganciclovir hcl) daily) daily,50 ea per
valganciclovir hcl tabs 450 acyclovir caps 200 mg 1A
1B PA; QL(4 ea fill retail,50 ea
mg daily) per fill mail)
Hepatitis Agents QL(13.34 ml
acyclovir susp 200 mg/5ml 1B
daily)
adefovir dipivoxil tabs 4 PA; QL(1 ea acyclovir tabs 400 mg, 800 QL(5 ea daily)
daily); SP 1B
BARACLUDE SOLN 0.05 mg
4 PA; QL(20 ml famciclovir tabs 125 mg, QL(3 ea daily)
MG/ML daily); SP 1B
BARACLUDE TABS 0.5 250 mg
NF PA; QL(1 ea QL(4 ea daily)
MG, 1 MG (Use entecavir) daily); SP famciclovir tabs 500 mg 1B
entecavir tabs 4 PA; QL(1 ea
daily); SP
48
valacyclovir hcl tabs 1 gm, 1B QL(4 ea daily) Limit 1 fill every
1000 mg 90
valacyclovir hcl tabs 500 QL(2 ea daily) TAMIFLU SUSR 6 MG/ML days.;QL(125
1B (Use oseltamivir NF ml per fill
mg
phosphate) retail)1 rtl MAX
VALTREX TABS 1 GM NF QL(4 ea daily) fill,90 rtl day(s)
(Use valacyclovir hcl) supply,
VALTREX TABS 500 MG NF QL(2 ea daily)
(Use valacyclovir hcl) BETA BLOCKERS - Drugs to Treat High Blood
Pressure
QL(5 ea
ZOVIRAX CAPS OR 200 Alpha-Beta Blockers
NF daily,50 ea per
MG (Use acyclovir) fill retail,50 ea
per fill mail) carvedilol tabs 1B
ZOVIRAX SUSP OR 200 NF QL(13.34 ml COREG TABS (Use
MG/5ML (Use acyclovir) daily) NF
carvedilol)
ZOVIRAX TABS OR 400 QL(5 ea daily) labetalol hcl soln 1B
MG, 800 MG (Use NF
acyclovir) labetalol hcl tabs 1B
Influenza Agents
FLUMADINE TABS (Use Beta Blockers Cardio-Selective
NF QL(2 ea daily)
rimantadine hydrochloride) acebutolol hcl caps 1B
QL(10 ea per
fill retail,10 ea atenolol tabs 1B
per fill mail)1 rtl
oseltamivir phosphate caps 1B MAX fill,90 rtl betaxolol hcl tabs 1B
or 30 mg, 45 mg, 75 mg day(s) supply,1
mail MAX fill,90 bisoprolol fumarate tabs or 1B
mail day(s) 10 mg, 5 mg
supply, BYSTOLIC TABS 10 MG, PA; QL(1 ea
2
Limit 1 fill every 2.5 MG, 5 MG daily)
90 PA; QL(2 ea
days.;QL(125 BYSTOLIC TABS 20 MG 2
oseltamivir phosphate susr daily)
1B ml per fill LOPRESSOR TABS (Use
or 6 mg/ml retail)1 rtl MAX NF
metoprolol tartrate)
fill,90 rtl day(s)
supply, metoprolol succinate tb24 1B
1 rtl pack lmt
RELENZA DISKHALER metoprolol tartrate soln iv 5
2 amt,30 rtl pack 1B
AEPB mg/5ml
lmt day(s),
rimantadine hydrochloride QL(2 ea daily) metoprolol tartrate tabs or 1B
tabs 1B 100 mg, 25 mg, 50 mg
QL(10 ea per nebivolol hcl tabs 10 mg, 1B PA; QL(1 ea
fill retail,10 ea 2.5 mg, 5 mg daily)
per fill mail)1 rtl PA; QL(2 ea
TAMIFLU CAPS 30 MG, 45 nebivolol hcl tabs 20 mg 1B
daily)
MG, 75 MG (Use NF MAX fill,90 rtl
day(s) supply,1 TENORMIN TABS (Use
oseltamivir phosphate) mail MAX fill,90 NF
atenolol)
mail day(s) TOPROL XL TB24 (Use
supply, NF
metoprolol succinate)
49
Beta Blockers Non-Selective CARDIZEM TABS (Use NF
BETAPACE AF TABS (Use NF diltiazem hcl)
sotalol hcl (afib/afl)) diltiazem hcl coated beads 1B
BETAPACE TABS (Use cp24
NF QL(2 ea daily) diltiazem hcl coated beads
sotalol hcl) 1B
CORGARD TABS (Use tb24
NF diltiazem hcl cp12 or 120
nadolol) 1B
mg, 60 mg, 90 mg
HEMANGEOL SOLN 4 PA; QL(75 ml diltiazem hcl cp24 or 120
daily) 1B
INDERAL LA CP24 (Use mg, 180 mg, 240 mg
NF diltiazem hcl extended
propranolol hcl)
release beads cp24 120 1B
nadolol tabs 1B mg, 180 mg, 240 mg, 300
mg, 360 mg
pindolol tabs 1B diltiazem hcl soln iv 50 1B
mg/10ml
propranolol hcl cp24 1B DILTIAZEM HCL SOLR IV 1B
100 MG
propranolol hcl soln 1B
diltiazem hcl tabs or 120 1B
propranolol hcl tabs 1B mg, 30 mg, 60 mg, 90 mg
felodipine tb24 1B
sotalol hcl (afib/afl) tabs 1B
sotalol hcl tabs 120 mg, QL(2 ea daily) isradipine caps 1B
1B
160 mg, 80 mg
nicardipine hcl caps 1B
sotalol hcl tabs 240 mg 1B
nicardipine hcl soln 1B
timolol maleate tabs 1B
nifedipine caps 1B
CALCIUM CHANNEL BLOCKERS - Drugs to
Treat High Blood Pressure nifedipine tb24 1B
Calcium Channel Blockers
ADALAT CC TB24 (Use nimodipine caps 1B
NF
nifedipine) nisoldipine tb24 17 mg, 20
amlodipine besylate tabs 1B mg, 30 mg, 34 mg, 40 mg, 1B
8.5 mg
CALAN SR TBCR (Use NF NORVASC TABS (Use
verapamil hcl) NF
amlodipine besylate)
CALAN TABS (Use NF PROCARDIA CAPS (Use
verapamil hcl) NF
nifedipine)
CARDIZEM CD CP24 (Use NF PROCARDIA XL TB24
diltiazem hcl coated beads) NF
(Use nifedipine)
CARDIZEM LA TB24 180 SULAR TB24 (Use
MG, 240 MG, 300 MG, 360 NF
NF nisoldipine)
MG, 420 MG (Use
diltiazem hcl coated beads)
50
TIAZAC CP24 120 MG, PA; BPH
CIALIS TABS 5 MG (Use
180 MG, 240 MG, 300 MG, NF Only;QL(1 ea
360 MG (Use diltiazem hcl
NF tadalafil) daily)
extended release beads)
sildenafil citrate tabs 1B PA; QL(0.1334
verapamil hcl cp24 1B ea daily)
STENDRA TABS 3 QL(0.134 ea
verapamil hcl soln 1B daily)
PA; BPH
verapamil hcl tabs 1B tadalafil tabs 5 mg 1B Only;QL(1 ea
daily)
verapamil hcl tbcr 1B VIAGRA TABS (Use NF PA; QL(0.1334
sildenafil citrate) ea daily)
VERELAN CP24 (Use NF
verapamil hcl) Prostaglandin Vasodilators
VERELAN PM CP24 (Use epoprostenol sodium solr 4 PA
NF
verapamil hcl)
CARDIOTONICS - Drugs to Treat Heart Failure FLOLAN SOLR (Use NF PA
and Abnormal Heart Rhythm epoprostenol sodium)
ORENITRAM TBCR 0.125 PA
Cardiac Glycosides MG, 0.25 MG, 1 MG, 2.5 3
digoxin soln 1B MG
treprostinil soln 4 PA; SP
digoxin tabs 1B
VELETRI SOLR (Use NF PA
LANOXIN SOLN IJ 0.25 2 epoprostenol sodium)
MG/ML (Use digoxin)
VENTAVIS SOLN 4 PA; SP
LANOXIN TABS OR 250
MCG, 125 MCG (Use 2
digoxin) Pulmonary Hypertension - Endothelin Receptor
LANOXIN TABS OR 62.5 2 ambrisentan tabs 4 PA; QL(1 ea
MCG daily); SP
CARDIOVASCULAR AGENTS - MISC. - Drugs to bosentan tabs 125 mg 4 PA; QL(2 ea
daily); SP
Treat Heart and Circulation Conditions
Cardioplegic Solutions bosentan tabs 62.5 mg 4 PA; QL(2 ea
daily)
PLEGISOL SOLN (Use LETAIRIS TABS (Use
cardioplegic soln) NF NF PA; QL(1 ea
ambrisentan) daily); SP
Cardiovascular Agents Misc. - Combinations OPSUMIT TABS 4 PA; QL(1 ea
amlodipine besylate- daily)
1B QL(1 ea daily) TRACLEER TABS 125 MG NF PA; QL(2 ea
atorvastatin calcium tabs
(Use bosentan) daily); SP
BIDIL TABS 2 TRACLEER TABS 62.5 NF PA; QL(2 ea
CADUET TABS (Use QL(1 ea daily) MG (Use bosentan) daily)
amlodipine besylate- NF
atorvastatin calcium) TRACLEER TBSO 32 MG 4 PA; QL(2 ea
daily)
PA; QL(2 ea Pulmonary Hypertension - Phosphodiesterase
ENTRESTO TABS 3
daily)
Impotence Agents
51
ADCIRCA TABS (Use PA; QL(2 ea cefadroxil tabs 1B
tadalafil (pulmonary NF daily); SP
hypertension)) cefazolin sodium solr ij 20 1B
REVATIO SOLN IV 10 PA; QL(37.5 ml gm, 500 mg, 1 gm, 10 gm
MG/12.5ML (Use sildenafil NF daily); SP cephalexin caps 1B
citrate (pulmonary
hypertension))
cephalexin susr 1B
REVATIO SUSR OR 10 PA; QL(6 ml
MG/ML (Use sildenafil NF daily) cephalexin tabs 1B
citrate (pulmonary
hypertension)) KEFLEX CAPS (Use NF
REVATIO TABS OR 20 PA; QL(3 ea cephalexin)
MG (Use sildenafil citrate NF daily); SP Cephalosporins - 2nd Generation
(pulmonary hypertension))
sildenafil citrate (pulmonary PA; QL(37.5 ml cefaclor caps 1B
hypertension) soln iv 10 4 daily); SP
mg/12.5ml cefaclor susr 1B
sildenafil citrate (pulmonary PA; QL(6 ml CEFOTAN SOLR (Use
hypertension) susr or 10 4 daily) NF
cefotetan disodium)
mg/ml cefotetan disodium solr 1
sildenafil citrate (pulmonary PA; QL(3 ea 1B
gm, 2 gm
hypertension) tabs or 20 4 daily); SP cefotetan disodium solr 10
mg 3
gm
tadalafil (pulmonary 4 PA; QL(2 ea cefoxitin sodium solr ij 10
hypertension) tabs daily); SP 1B
gm
Pulmonary Hypertension - Sol Guanylate Cyclase cefoxitin sodium solr iv 2 1B
ADEMPAS TABS 0.5 MG, gm, 1 gm
4 PA; QL(3 ea
1.5 MG, 2 MG, 2.5 MG daily)
cefprozil susr 1B
Sinus Node Inhibitors
CORLANOR SOLN 5 PA; QL(15 ml cefprozil tabs 1B
3
MG/5ML daily)
CORLANOR TABS 5 MG, PA; QL(2 ea cefuroxime axetil tabs 1B
3
7.5 MG daily) cefuroxime sodium solr ij 1B
Transthyretin Stabilizers 750 mg
PA; QL(1 ea Cephalosporins - 3rd Generation
VYNDAMAX CAPS 4
daily)
PA; QL(4 ea cefdinir caps 1B
VYNDAQEL CAPS 4
daily)
cefdinir susr 1B
CEPHALOSPORINS - Drugs to Treat Bacterial
Infections cefditoren pivoxil tabs 200 3
mg
Cephalosporins - 1st Generation
cefditoren pivoxil tabs 400 1B
cefadroxil caps 1B mg
cefixime susr 100 mg/5ml, 1B ST
cefadroxil susr 1B 200 mg/5ml
52
cefotaxime sodium solr 1B ESTROSTEP FE TABS
(Use norethindrone NF
cefpodoxime proxetil susr 1B acetate-ethinyl estradiol-fe)
ethynodiol diacet & eth 0
cefpodoxime proxetil tabs 1B estrad tabs
GENERESS FE CHEW
ceftazidime solr ij 2 gm, 1 1B (Use norethindrone & NF
gm, 6 gm ethinyl estradiol-fe)
ceftriaxone sodium solr ij 1 1B levonorgestrel & eth
gm, 2 gm, 500 mg 0
estradiol tabs
ceftriaxone sodium solr ij 1A levonorgestrel-eth estradiol
250 mg 0
(triphasic) tabs
FORTAZ SOLR IJ 1 GM NF levonorgestrel-ethinyl
(Use ceftazidime) 0
estradiol (91-day) tabs
SUPRAX SUSR 100 ST levonorgestrel-ethinyl
MG/5ML, 200 MG/5ML NF 0
estradiol (continuous) tabs
(Use cefixime)
LO LOESTRIN FE TABS 0
Cephalosporins - 4th Generation
LOSEASONIQUE TABS
cefepime hcl solr 1B (Use levonorgestrel-ethinyl NF
MAXIPIME SOLR IJ 1 GM, estradiol (91-day))
NF
2 GM (Use cefepime hcl) MINASTRIN 24 FE CHEW
Cephalosporins - 5th Generation (Use norethin acet & NF
estrad-fe)
TEFLARO SOLR 3 MIRCETTE TABS (Use
desogestrel-ethinyl NF
CONTRACEPTIVES - Drugs to Prevent estradiol (biphasic))
Pregnancy
NATAZIA TABS 0
Combination Contraceptives - Oral
norethin acet & estrad-fe 0
BALCOLTRA TABS 0 caps
BEYAZ TABS (Use norethin acet & estrad-fe
drospirenone-ethinyl 0
NF chew
estradiol-levomefolate norethin acet & estrad-fe
calcium) 0
tabs
desogestrel & ethinyl 0 norethindrone & eth
estradiol tabs 0
estradiol tabs
desogestrel-ethinyl 0 norethindrone & ethinyl
estradiol (biphasic) tabs 0
estradiol-fe chew
desogestrel-ethinyl 0 norethindrone acet & eth
estradiol (triphasic) tabs 0
estra tabs
drospirenone-ethinyl 0 norethindrone acetate-
estradiol tabs 0
ethinyl estradiol-fe tabs
drospirenone-ethinyl norethindrone-eth estradiol
estradiol-levomefolate 0 0
(triphasic) tabs
calcium tabs
norgestimate-ethinyl 0
estradiol (triphasic) tabs
53
norgestimate-ethinyl 0 Emergency Contraceptives
estradiol tabs
norgestrel & ethinyl ELLA TABS 0
0
estradiol tabs levonorgestrel (emergency
ORTHO TRI-CYCLEN LO 0
oc) tabs
TABS (Use norgestimate- NF PLAN B ONE-STEP TABS
ethinyl estradiol (triphasic)) (Use levonorgestrel NF
ORTHO-NOVUM 1/35 (emergency oc))
TABS (Use norethindrone NF
& eth estradiol) Progestin Contraceptives - Injectable
ORTHO-NOVUM 7/7/7 DEPO-PROVERA QL(1 ml per 90
TABS (Use norethindrone- NF CONTRACEPTIVE SUSP NF days retail)
eth estradiol (triphasic)) (Use medroxyprogesterone
acetate (contraceptive))
QUARTETTE TABS (Use
levonorgestrel-ethinyl NF DEPO-PROVERA QL(1 ml per 90
estradiol (91-day)) CONTRACEPTIVE SUSY NF days retail)
(Use medroxyprogesterone
SAFYRAL TABS (Use acetate (contraceptive))
drospirenone-ethinyl NF
estradiol-levomefolate DEPO-SUBQ PROVERA 0
calcium) 104 SUSY
SEASONIQUE TABS (Use medroxyprogesterone QL(1 ml per 90
levonorgestrel-ethinyl NF acetate (contraceptive) 0 days retail)
estradiol (91-day)) susp
TAYTULLA CAPS (Use medroxyprogesterone QL(1 ml per 90
NF acetate (contraceptive) 0 days retail)
norethin acet & estrad-fe)
susy
TYBLUME CHEW 0 Progestin Contraceptives - Oral
YASMIN 28 TABS (Use norethindrone 0
drospirenone-ethinyl NF (contraceptive) tabs
estradiol) ORTHO MICRONOR
YAZ TABS (Use TABS (Use norethindrone NF
drospirenone-ethinyl NF (contraceptive))
estradiol)
SLYND TABS 0 PA; QL(1 ea
Combination Contraceptives - Transdermal daily)
norelgestromin-ethinyl CORTICOSTEROIDS - Steroid Hormone Drugs to
0 Treat Systemic Swelling Conditions
estradiol ptwk
TWIRLA PTWK 0 QL(3 ea per 28 Glucocorticosteroids
days retail)
budesonide cpep 3 mg 1B QL(3 ea daily)
Combination Contraceptives - Vaginal
CELESTONE SOLUSPAN
ANNOVERA RING 0 PA SUSP (Use betamethasone NF
etonogestrel-ethinyl sod phosphate & acetate)
0 CELESTONE-SOLUSPAN
estradiol ring
NUVARING RING (Use SUSP (Use betamethasone NF
etonogestrel-ethinyl NF sod phosphate & acetate)
estradiol) CORTEF TABS (Use NF
hydrocortisone)
54
cortisone acetate tabs 1B MILLIPRED DP TBPK 3
DEPO-MEDROL SUSP 20 3 MILLIPRED TABS 3
MG/ML
DEPO-MEDROL SUSP 80 ORAPRED ODT TBDP
MG/ML, 40 MG/ML (Use (Use prednisolone sodium NF
NF phosphate)
methylprednisolone
acetate) PEDIAPRED SOLN (Use
dexamethasone elix 0.5 prednisolone sodium NF
1B phosphate)
mg/5ml
DEXAMETHASONE prednisolone sodium
1B phosphate soln or 10
INTENSOL CONC
dexamethasone sodium mg/5ml, 15 mg/5ml, 20 1B
phosphate soln ij 120 mg/5ml, 25 mg/5ml, 5
1B mg/5ml, 6.7 mg/5ml
mg/30ml, 20 mg/5ml, 4
mg/ml prednisolone sodium
dexamethasone soln 0.5 phosphate tbdp or 10 mg, 3
1B 15 mg, 30 mg
mg/5ml
dexamethasone tabs 0.5 prednisolone soln 1B
1A
mg, 0.75 mg
dexamethasone tabs 1 mg, prednisone soln 5 mg/5ml 1B
1B
1.5 mg, 2 mg, 4 mg, 6 mg prednisone tabs 1 mg, 5
PA 1B
EMFLAZA SUSP 4 mg
prednisone tabs 10 mg, 2.5 1A
EMFLAZA TABS 4 PA mg, 50 mg, 20 mg
ENTOCORT EC CPEP prednisone tbpk 10 mg, 5
NF QL(3 ea daily) mg 1B
(Use budesonide)
2 rtl MAX fill,30
hydrocortisone tabs 1B SOLU-CORTEF SOLR 100 3 rtl day(s)
MG, 1000 MG, 500 MG supply,
KENALOG-40 SUSP (Use NF
triamcinolone acetonide) SOLU-CORTEF SOLR 250 3
MG
MEDROL DOSEPAK TBPK NF
(Use methylprednisolone) SOLU-MEDROL SOLR 2 3
GM
MEDROL TABS 16 MG, 32
MG, 8 MG, 4 MG (Use NF SOLU-MEDROL SOLR 500
methylprednisolone) MG, 1000 MG, 125 MG, 40
MG (Use NF
MEDROL TABS 2 MG 3 methylprednisolone sod
succ)
methylprednisolone acetate 1B
susp 80 mg/ml, 40 mg/ml triamcinolone acetonide
susp 200 mg/5ml, 40 1B
methylprednisolone sod 1B mg/ml, 400 mg/10ml
succ solr
Mineralocorticoids
methylprednisolone tabs 1B
fludrocortisone acetate tabs 1B
methylprednisolone tbpk 1B
55
COUGH/COLD/ALLERGY - Drugs to Treat TUZISTRA XR SUER 2 PA
Cough, Cold and Allergy Symptoms
ZYRTEC-D QL(2 ea daily)
Antitussives ALLERGY/CONGESTION
QL(6 ea daily) NF
benzonatate caps 100 mg 1B TB12 (Use cetirizine-
pseudoephedrine)
benzonatate caps 150 mg 1B Misc. Respiratory Inhalants
QL(3 ea daily) HYPER-SAL NEBU (Use NF
benzonatate caps 200 mg 1B sodium chloride (inhalant))
TESSALON PERLES NF QL(6 ea daily) HYPERSAL NEBU 3.5 % 1B
CAPS (Use benzonatate)
HYPERSAL NEBU 7 %
Cough/Cold/Allergy Combinations (Use sodium chloride NF
ALLEGRA-D 12 HOUR QL(2 ea daily) (inhalant))
ALLERGY &
CONGESTION TB12 (Use NF NEBUSAL NEBU 1B
fexofenadine-
pseudoephedrine) sodium chloride (inhalant) 1B
nebu 7 %
ALLEGRA-D 24 HOUR QL(1 ea daily)
ALLERGY & Mucolytics
CONGESTION TB24 (Use NF acetylcysteine soln 1B
fexofenadine-
pseudoephedrine) DERMATOLOGICALS - Drugs to Treat Skin
cetirizine-pseudoephedrine 1B QL(2 ea daily) Conditions
tb12
Acne Products
CLARITIN-D 12 HOUR QL(2 ea daily)
TB12 (Use loratadine & NF ABSORICA CAPS 30 MG, PA; AL(At least
pseudoephedrine) 10 MG, 20 MG, 40 MG NF 12 yrs old)
(Use isotretinoin)
CLARITIN-D 24 HOUR QL(1 ea daily)
TB24 (Use loratadine & NF PA; AL(At least
adapalene crea 0.1 % 1B
12 yrs old)
pseudoephedrine)
fexofenadine- QL(2 ea daily) PA; AL(At least
pseudoephedrine tb12 120 1B adapalene gel 0.1 % 1B 12 yrs old);
mg-60 mg, 60 mg-120 mg RX/OTC
fexofenadine- QL(1 ea daily) adapalene gel 0.3 % 1B ST; AL(At least
pseudoephedrine tb24 180 1B 12 yrs old)
mg-240 mg adapalene lotn 0.1 % 1B ST; AL(At least
hydrocodone polistirex- 12 yrs old)
chlorpheniramine polistirex 1B adapalene-benzoyl 1B ST; AL(At least
suer peroxide gel 12 yrs old)
loratadine & QL(2 ea daily) AZELEX CREA 3 ST; AL(At least
pseudoephedrine tb12 5 1B 12 yrs old)
mg-120 mg BENZACLIN GEL (Use PA; AL(At least
loratadine & QL(1 ea daily) clindamycin phosphate- NF 12 yrs old)
pseudoephedrine tb24 10 benzoyl peroxide)
mg-10 mg-240 mg-240 mg, 1B
240 mg-10 mg
56
BENZACLIN WITH PUMP PA; AL(At least clindamycin phosphate- 1B ST; AL(At least
GEL (Use clindamycin NF 12 yrs old) tretinoin gel 12 yrs old)
phosphate-benzoyl DIFFERIN CREA 0.1 %
peroxide) NF PA; AL(At least
(Use adapalene) 12 yrs old)
BENZAMYCIN GEL (Use PA; AL(At least
DIFFERIN GEL 0.1 % (Use NF PA; AL(At least
benzoyl peroxide- NF 12 yrs old) 12 yrs old);
erythromycin) adapalene) RX/OTC
BENZOYL PEROXIDE 2 AL(At least 12 DIFFERIN GEL 0.3 % (Use NF ST; AL(At least
CLEANSER LIQD yrs old) adapalene) 12 yrs old)
AL(At least 12
benzoyl peroxide foam 5.3 1B yrs old); DIFFERIN LOTN 0.1 % 2 ST; AL(At least
% 12 yrs old)
RX/OTC
DUAC GEL (Use PA; AL(At least
benzoyl peroxide foam 9.8 AL(At least 12 clindamycin phosphate-
% 1B
yrs old) NF 12 yrs old)
benzoyl peroxide
benzoyl peroxide gel 5 %, 1B AL(At least 12 (refrigerate))
10 % yrs old) EPIDUO GEL (Use ST; AL(At least
benzoyl peroxide liqd 4 %, 1B AL(At least 12 adapalene-benzoyl NF 12 yrs old)
7 %, 10 % yrs old) peroxide)
benzoyl peroxide- 1B PA; AL(At least erythromycin (acne aid) 1B AL(At least 12
erythromycin gel 12 yrs old) pads yrs old)
CLEOCIN-T GEL (Use erythromycin (acne aid) 1B AL(At least 12
clindamycin phosphate NF soln yrs old)
(topical)) EVOCLIN FOAM (Use PA; AL(At least
CLEOCIN-T LOTN (Use AL(At least 12 clindamycin phosphate NF 12 yrs old)
clindamycin phosphate NF yrs old) (topical))
(topical)) isotretinoin caps 30 mg, 10 3 PA; AL(At least
CLINDAGEL GEL (Use mg, 20 mg, 40 mg 12 yrs old)
clindamycin phosphate NF KLARON LOTN (Use AL(At least 12
(topical)) sulfacetamide sodium NF yrs old)
clindamycin phosphate 1B PA; AL(At least (acne))
(topical) foam 12 yrs old) AL(At least 12
RETIN-A CREA (Use
clindamycin phosphate 1B tretinoin) NF yrs old - Up to
(topical) gel 30 yrs old)
clindamycin phosphate 1B AL(At least 12 RETIN-A GEL (Use AL(At least 12
(topical) lotn yrs old) tretinoin) NF yrs old - Up to
QL(4 ml daily); 30 yrs old)
clindamycin phosphate 1B AL(At least 12 RETIN-A MICRO GEL 0.1 PA; AL(At least
(topical) soln yrs old) % (Use tretinoin NF 12 yrs old - Up
clindamycin phosphate AL(At least 12 microsphere) to 30 yrs old)
1B
(topical) swab yrs old) RETIN-A MICRO PUMP PA; AL(At least
clindamycin phosphate- PA; AL(At least GEL 0.1 % (Use tretinoin NF 12 yrs old - Up
benzoyl peroxide 1B 12 yrs old) microsphere) to 30 yrs old)
(refrigerate) gel sulfacetamide sodium 1B AL(At least 12
clindamycin phosphate- PA; AL(At least (acne) lotn yrs old)
benzoyl peroxide gel 1 %-5 1B 12 yrs old) sulfacetamide sodium w/ AL(At least 12
% sulfur crea 10 %-5 %, 5 %- 1B yrs old)
10 %
57
sulfacetamide sodium w/ AL(At least 12 mupirocin oint 1B
sulfur emul 10 %-5 %, 5 %- 1B yrs old)
10 % NEO-SYNALAR CREA 3 PA
sulfacetamide sodium w/ ST; AL(At least
sulfur liqd 4.5 %-9 %, 9 %- 1B 12 yrs old) Antifungals - Topical
4.5 % RX/OTC
sulfacetamide sodium- butenafine hcl crea 1B
1B AL(At least 12
sulfur in urea vehicle emul yrs old) CICLODAN SOLUTION NF
SUMADAN WASH LIQD ST; AL(At least KIT KIT (Use ciclopirox)
(Use sulfacetamide sodium NF 12 yrs old)
w/ sulfur) ciclopirox gel ex 0.77 % 1B
AL(At least 12 QL(90 gm per
tretinoin crea 0.05 %, 0.1 1B yrs old - Up to
%, 0.025 % fill retail)1 rtl
30 yrs old) ciclopirox olamine crea 1B
MAX fill,30 rtl
AL(At least 12 day(s) supply,
tretinoin gel 0.01 %, 0.025 1B yrs old - Up to
% ciclopirox olamine susp 1B
30 yrs old)
PA; AL(At least ciclopirox sham ex 1 % 1B
tretinoin microsphere gel 1B 12 yrs old - Up
0.1 % to 30 yrs old) ciclopirox soln ex 8 % 1B
VELTIN GEL (Use ST; AL(At least
clindamycin phosphate- NF 12 yrs old) clotrimazole (topical) crea 1B RX/OTC
tretinoin)
ZIANA GEL (Use ST; AL(At least clotrimazole (topical) soln 1B RX/OTC
clindamycin phosphate- NF 12 yrs old)
tretinoin) clotrimazole w/ 1B
betamethasone crea
Agents for External Genital and Perianal Warts clotrimazole w/ 1B
VEREGEN OINT 3 betamethasone lotn
QL(85 gm per
Anti-inflammatory Agents - Topical econazole nitrate crea 1B fill retail,85 gm
PA; QL(2 ea per fill mail)
diclofenac epolamine ptch 1B
daily) QL(2.15 gm
ERTACZO CREA 3
diclofenac sodium (topical) daily)
1B QL(3.34 gm
gel 1 % daily); RX/OTC EXELDERM CREA (Use NF
FLECTOR PTCH (Use sulconazole nitrate)
NF PA; QL(2 ea
diclofenac epolamine) daily) 1 rtl MAX fill,90
VOLTAREN GEL (Use rtl day(s)
NF QL(3.34 gm EXELDERM SOLN (Use NF supply,1 mail
diclofenac sodium (topical)) daily); RX/OTC sulconazole nitrate) MAX fill,90 mail
Antibiotics - Topical day(s) supply,
ALTABAX OINT 2 JUBLIA SOLN 3 PA
gentamicin sulfate (topical) QL(1 gm daily) KERYDIN SOLN (Use
crea 1B NF PA
tavaborole)
gentamicin sulfate (topical) 1B ketoconazole (topical) crea
oint 1B
2%
58
ketoconazole (topical) 1B QL(2 gm
sham 2 % daily)1 rtl MAX
QL(90 gm per NAFTIFINE fill,180 rtl
LOPROX CREA (Use HYDROCHLORIDE CREA NF day(s) supply,1
NF fill retail)1 rtl (Use naftifine hcl) mail MAX
ciclopirox olamine) MAX fill,30 rtl
day(s) supply, fill,180 mail
day(s) supply,
LOPROX SHAMPOO NF
SHAM (Use ciclopirox) QL(2 gm
daily)1 rtl MAX
LOPROX SUSP (Use NF fill,180 rtl
ciclopirox olamine) NAFTIN CREA 2 % (Use NF day(s) supply,1
LOTRIMIN AF CREA (Use naftifine hcl)
NF RX/OTC mail MAX
clotrimazole (topical)) fill,180 mail
LOTRIMIN AF JOCK ITCH RX/OTC day(s) supply,
CREA (Use clotrimazole NF QL(3 gm
(topical)) daily)1 rtl MAX
LOTRIMIN ULTRA CREA fill,180 rtl
NF RX/OTC NAFTIN GEL 1 % (Use NF day(s) supply,1
(Use butenafine hcl) naftifine hcl)
LOTRISONE CREA (Use mail MAX
clotrimazole w/ NF fill,180 mail
betamethasone) day(s) supply,
PA NIZORAL SHAM (Use NF
luliconazole crea 1B ketoconazole (topical))
LUZU CREA (Use NF PA nystatin (topical) crea 1B
luliconazole)
QL(3 gm nystatin (topical) oint 1B
daily)1 rtl MAX
fill,180 rtl nystatin (topical) powd 1B
naftifine hcl crea 1 % 1B day(s) supply,1
mail MAX nystatin-triamcinolone crea 1B
fill,180 mail
day(s) supply, nystatin-triamcinolone oint 1B
QL(2 gm
daily)1 rtl MAX Limit 1 Fill per
fill,180 rtl 180 days;QL(3
naftifine hcl crea 2 % 1B day(s) supply,1 gm daily)1 rtl
mail MAX oxiconazole nitrate crea 1B MAX fill,180 rtl
fill,180 mail day(s) supply,1
day(s) supply, mail MAX
fill,180 mail
QL(3 gm day(s) supply,
daily)1 rtl MAX
fill,180 rtl Limit 1 Fill per
naftifine hcl gel 1 % 1B day(s) supply,1 180 days;QL(3
mail MAX gm daily)1 rtl
fill,180 mail OXISTAT CREA (Use NF MAX fill,180 rtl
day(s) supply, oxiconazole nitrate) day(s) supply,1
mail MAX
fill,180 mail
day(s) supply,
59
Limit 1 Fill per QL(2 ea per fill
180 days;QL(2 retail,2 ea per
ml daily)1 rtl fill mail)1 rtl
OXISTAT LOTN 2 MAX fill,180 rtl PICATO GEL 0.05 % 2 MAX fill,60 rtl
day(s) supply,1 day(s) supply,1
mail MAX mail MAX fill,60
fill,180 mail mail day(s)
day(s) supply, supply,
PENLAC NAIL LACQUER NF TARGRETIN GEL EX 1 % 4 PA; SP
SOLN (Use ciclopirox)
sulconazole nitrate crea 1B Antipruritics - Topical
PA; Limit 1 fill
1 rtl MAX fill,90 every 180
rtl day(s) days;QL(45 gm
sulconazole nitrate soln 1B supply,1 mail per fill retail,45
MAX fill,90 mail gm per fill
day(s) supply, doxepin hcl (antipruritic) 3 mail)1 rtl MAX
crea fill,180 rtl
tavaborole soln 1B PA
day(s) supply,1
VUSION OINT (Use mail MAX
miconazole-zinc oxide- NF fill,180 mail
white petrolatum) day(s) supply,
Antineoplastic or Premalignant Lesion Agents - PA; Limit 1 fill
every 180
CARAC CREA (Use NF days;QL(45 gm
fluorouracil (topical)) per fill retail,45
diclofenac sodium (actinic 1B PA; QL(3.34 gm per fill
keratoses) gel gm daily) PRUDOXIN CREA (Use NF mail)1 rtl MAX
doxepin hcl (antipruritic)) fill,180 rtl
EFUDEX CREA (Use NF
fluorouracil (topical)) day(s) supply,1
fluorouracil (topical) crea 5 mail MAX
1B fill,180 mail
%
day(s) supply,
fluorouracil (topical) soln 2 1B
%, 5 % PA; Limit 1 fill
every 180
PANRETIN GEL 3 days;QL(45 gm
per fill retail,45
QL(3 ea per fill gm per fill
retail,3 ea per ZONALON CREA (Use NF mail)1 rtl MAX
fill mail)1 rtl doxepin hcl (antipruritic)) fill,180 rtl
MAX fill,60 rtl day(s) supply,1
PICATO GEL 0.015 % 2
day(s) supply,1 mail MAX
mail MAX fill,60 fill,180 mail
mail day(s) day(s) supply,
supply,
Antipsoriatics
acitretin caps 17.5 mg, 10 1B QL(1 ea daily)
mg
acitretin caps 25 mg 1B QL(2 ea daily)
60
1B PA; QL(4 gm VECTICAL OINT (Use NF QL(3.34 gm
calcipotriene crea daily) calcitriol (topical)) daily)
calcipotriene oint 1B PA; QL(4 gm Antiseborrheic Products
daily)
selenium sulfide lotn 2.5 % 1B
calcipotriene soln 1B PA; QL(4 ml
daily)
Antivirals - Topical
calcitriol (topical) oint 1B QL(3.34 gm acyclovir topical crea 1B
daily)
COSENTYX 4 PA; QL(0.072
SENSOREADY PEN SOAJ ml daily) acyclovir topical oint 1B
COSENTYX SOSY 150 4 PA; QL(0.036 QL(0.18 gm
MG/ML ml daily) DENAVIR CREA 3
daily)
COSENTYX SOSY 150 4 PA; QL(0.072 ZOVIRAX CREA EX 5 %
MG/ML ml daily) NF
(Use acyclovir topical)
DOVONEX CREA (Use NF PA; QL(4 gm ZOVIRAX OINT EX 5 %
calcipotriene) daily) NF
(Use acyclovir topical)
methoxsalen rapid caps 1B QL(4 ea daily) Burn Products
OXSORALEN ULTRA QL(4 ea daily) mafenide acetate pack 3
CAPS (Use methoxsalen NF
rapid) SILVADENE CREA (Use NF
silver sulfadiazine)
SKYRIZI PEN SOAJ 4 PA; QL(0.25 ml
daily) silver sulfadiazine crea 1B
SKYRIZI PSKT 75 4 PA; QL(0.025 SULFAMYLON CREA 85
MG/0.83ML ea daily) 3
MG/GM
SKYRIZI SOSY 150 4 PA; QL(0.25 ml SULFAMYLON PACK 5 %
MG/ML daily) NF
(Use mafenide acetate)
SORIATANE CAPS 10 MG NF QL(1 ea daily)
(Use acitretin) Corticosteroids - Topical
SORIATANE CAPS 25 MG alclometasone dipropionate
NF QL(2 ea daily) crea 1B
(Use acitretin)
STELARA SOLN SC 45 PA; QL(0.012 alclometasone dipropionate 1B
4 oint
MG/0.5ML ml daily)
STELARA SOSY SC 45 QL(60 gm per
4 PA; QL(0.012 fill retail,60 gm
MG/0.5ML ml daily)
per fill mail)1 rtl
STELARA SOSY SC 90 4 PA; QL(0.018 MAX fill,30 rtl
MG/ML ml daily); SP amcinonide crea 1B
day(s) supply,1
QL(1 gm mail MAX fill,30
tazarotene crea 1B
daily) mail day(s)
TAZORAC CREA 0.1 % NF PA supply,
(Use tazarotene)
amcinonide lotn 3
PA; QL(0.018
TREMFYA SOPN 4
ml daily)
AMCINONIDE OINT 3
PA; QL(0.018
TREMFYA SOSY 4 betamethasone
ml daily) 1B
dipropionate (topical) crea
61
betamethasone 1B CORDRAN LOTN 0.05 % NF
dipropionate (topical) lotn (Use flurandrenolide)
betamethasone 1B CORDRAN TAPE 4 3
dipropionate (topical) oint MCG/SQCM
betamethasone CUTIVATE LOTN (Use NF QL(6 ml daily)
dipropionate augmented 1B fluticasone propionate)
crea QL(118.28 ml
DERMA-SMOOTHE/FS
betamethasone BODY OIL (Use NF per fill retail)1
dipropionate augmented 1B
fluocinolone acetonide) rtl MAX fill,30 rtl
lotn day(s) supply,
betamethasone DERMA-SMOOTHE/FS
dipropionate augmented 1B SCALP OIL (Use NF
oint fluocinolone acetonide)
betamethasone valerate 1B desonide crea 1B QL(4 gm daily)
crea 0.1 %
betamethasone valerate QL(1.67 gm desonide lotn 1B QL(4 ml daily)
1B
foam 0.12 % daily)
betamethasone valerate desonide oint 1B QL(3 gm daily)
1B
lotn 0.1 %
DESOWEN CREA (Use NF QL(4 gm daily)
betamethasone valerate 1B desonide)
oint 0.1 %
desoximetasone crea 0.25 1B
calcipotriene- ST %
betamethasone 1B
dipropionate oint desoximetasone gel 0.05 % 1B
calcipotriene- ST
betamethasone 1B desoximetasone oint 0.25 1B
dipropionate susp %
PA; QL(3 gm diflorasone diacetate crea 1B PA
clobetasol propionate crea 1B
daily)
diflorasone diacetate oint 1B PA
clobetasol propionate 1B PA; QL(1 gm
emollient base crea daily) DIPROLENE AF CREA
ST; QL(3 gm (Use betamethasone NF
clobetasol propionate foam 1B
daily) dipropionate augmented)
ST; QL(2 gm DIPROLENE OINT (Use
clobetasol propionate gel 1B
daily) betamethasone NF
PA; QL(1 gm dipropionate augmented)
clobetasol propionate oint 1B
daily) ELOCON CREA (Use NF
PA; QL(3.34 ml mometasone furoate)
clobetasol propionate soln 1B
daily) fluocinolone acetonide crea 1B
0.01 %, 0.025 %
clocortolone pivalate crea 3
QL(118.28 ml
CLODERM CREA (Use NF fluocinolone acetonide oil per fill retail)1
clocortolone pivalate) 1B
0.01 % rtl MAX fill,30 rtl
CORDRAN CREA 0.05 % day(s) supply,
NF
(Use flurandrenolide) fluocinolone acetonide oil 1B
0.01 %
62
fluocinolone acetonide oint 1B hydrocortisone butyrate 1B
0.025 % oint
fluocinolone acetonide soln 1B hydrocortisone butyrate 1B
0.01 % soln
fluocinonide crea 0.05 % 1B QL(2 gm daily) hydrocortisone valerate 1B
crea
fluocinonide emulsified 1B QL(2 gm daily)
base crea hydrocortisone valerate oint 1B
fluocinonide gel 0.05 % 1B LOCOID CREA (Use NF

hydrocortisone butyrate)
fluocinonide oint 0.05 % 1B QL(2 gm daily) LOCOID SOLN (Use NF
hydrocortisone butyrate)
QL(2 ml daily) LUXIQ FOAM (Use
fluocinonide soln 0.05 % 1B NF QL(1.67 gm
betamethasone valerate) daily)
flurandrenolide crea 2 QL(2 gm daily)
mometasone furoate crea 1B
flurandrenolide lotn 2 QL(2 ml daily)
mometasone furoate oint 1B
fluticasone propionate crea 1B
0.05 % mometasone furoate soln 1B
fluticasone propionate lotn 1B QL(6 ml daily) MONISTAT SOOTHING RX/OTC
0.05 % CARE ITCH RELIEF CREA
fluticasone propionate oint NF
1B (Use hydrocortisone
0.005 % (topical))
PA OLUX FOAM (Use
halcinonide crea 1B NF ST; QL(3 gm
clobetasol propionate) daily)
halobetasol propionate 1B
crea prednicarbate crea 1B
halobetasol propionate oint 1B prednicarbate oint 1B
HALOG CREA (Use NF PA SYNALAR CREA (Use
halcinonide) NF
fluocinolone acetonide)
HALOG OINT 3 PA SYNALAR OINT (Use NF
hydrocortisone (topical) 1B RX/OTC SYNALAR SOLN (Use
crea 1 % NF
hydrocortisone (topical) 1B TACLONEX OINT (Use ST
crea 2.5 % calcipotriene-
hydrocortisone (topical) NF
1B betamethasone
lotn 2.5 % dipropionate)
hydrocortisone (topical) 1B RX/OTC TACLONEX SUSP (Use ST
oint 1 % calcipotriene- NF
hydrocortisone (topical) betamethasone
1B dipropionate)
oint 2.5 %
hydrocortisone butyrate TEMOVATE CREA (Use NF PA; QL(3 gm
1B clobetasol propionate) daily)
crea
63
TEMOVATE OINT (Use NF PA; QL(1 gm Immunomodulating Agents - Topical
clobetasol propionate) daily) QL(12 ea per
TOPICORT CREA 0.25 % ALDARA CREA (Use NF fill retail,12 ea
NF imiquimod)
(Use desoximetasone) per fill mail)
TOPICORT GEL 0.05 % NF QL(12 ea per
(Use desoximetasone) imiquimod crea 5 % 1B fill retail,12 ea
TOPICORT OINT 0.25 % per fill mail)
NF
(Use desoximetasone) ZYCLARA CREA (Use NF
triamcinolone acetonide imiquimod)
(topical) crea 0.025 %, 0.5 1B ZYCLARA PUMP CREA
% NF
3.75 % (Use imiquimod)
triamcinolone acetonide 1B QL(3.34 gm Immunosuppressive Agents - Topical
(topical) crea 0.1 % daily)
ELIDEL CREA (Use NF PA; AL(At least
triamcinolone acetonide pimecrolimus) 2 yrs old)
(topical) lotn 0.025 %, 0.1 1B
% pimecrolimus crea 1B PA; AL(At least
2 yrs old)
triamcinolone acetonide
(topical) oint 0.025 %, 0.1 1B PROTOPIC OINT (Use NF PA; AL(At least
%, 0.5 % tacrolimus (topical)) 2 yrs old)
triamcinolone acetonide- 1B PA tacrolimus (topical) oint 1B PA; AL(At least
dimethicone-silicone kit 2 yrs old)
TRIDESILON CREA (Use Keratolytic/Antimitotic Agents
NF QL(4 gm daily)
desonide)
podofilox soln 1B
Eczema Agents
DUPIXENT SOPN 300 PA Local Anesthetics - Topical
4
MG/2ML lidocaine hcl gel ex 2 % 1B QL(4 ml daily)
DUPIXENT SOSY 200 4 PA
MG/1.14ML, 300 MG/2ML QL(4 ml daily);
lidocaine hcl gel ex 2 % 1B
RX/OTC
Emollient/Keratolytic Agents
lidocaine hcl prsy ex 2 % 1B QL(4 ml daily)
HYDRO 35 FOAM (Use NF
urea in lactic acid vehicle)
lidocaine hcl soln ex 4 % 1B
Emollients
LAC-HYDRIN CREA (Use RX/OTC lidocaine ptch ex 5 % 1B PA
lactic acid (ammonium NF
lactate)) lidocaine-prilocaine crea 1B QL(1 gm daily)
LAC-HYDRIN TWELVE RX/OTC
LOTN (Use lactic acid NF LIDODERM PTCH (Use NF PA
(ammonium lactate)) lidocaine)
lactic acid (ammonium RX/OTC QL(10 ea per
1B fill retail,10 ea
lactate) crea 12 %
per fill mail)1 rtl
lactic acid (ammonium 1B RX/OTC MAX fill,30 rtl
lactate) lotn 12 % SYNERA PTCH 3
day(s) supply,1
Enzymes - Topical mail MAX fill,30
PA mail day(s)
SANTYL OINT 3 supply,
64
Phosphodiesterase 4 (PDE4) Inhibitors - Topical NIX CREME RINSE LIQD NF
(Use permethrin)
EUCRISA OINT 3 PA; QL(2 gm OVIDE LOTN (Use
daily) NF
malathion)
Rosacea Agents
PA permethrin crea ex 5 % 1B
azelaic acid gel 1B
FINACEA GEL (Use permethrin liqd ex 1 % 1B
NF PA
azelaic acid) SKLICE LOTN (Use
METROCREAM CREA NF PA; RX/OTC
ivermectin (pediculicide))
(Use metronidazole NF PA
(topical)) spinosad susp 1B
METROGEL GEL (Use NF
metronidazole (topical)) ULESFIA LOTN 3
METROLOTION LOTN Wound Care Products
(Use metronidazole NF
(topical)) REGRANEX GEL 3
metronidazole (topical) 1B
crea DIAGNOSTIC PRODUCTS
metronidazole (topical) gel 1B Diagnostic Drugs
GLUCAGEN DIAGNOSTIC 3 QL(0.035 ea
metronidazole (topical) lotn 1B SOLR daily)
PA; QL(1 gm PA; 1 rtl MAX
MIRVASO GEL 3 fill,365 rtl
daily)
day(s) supply,1
ORACEA CPDR (Use THYROGEN SOLR 3
NF mail MAX
doxycycline (rosacea)) fill,365 mail
SOOLANTRA CREA (Use NF day(s) supply,
ivermectin (rosacea))
Diagnostic Tests
Scabicides & Pediculicides
PA CHEMSTRIP-K STRP 1B
crotamiton lotn 1B
FORA GTEL BLOOD
ELIMITE CREA (Use NF KETONE TEST STRIPS 1B
permethrin) STRP
EURAX CREA 3 GOJJI BLOOD KETONE 1B
TEST STRIPS STRP
EURAX LOTN (Use NF PA
crotamiton) KETONE STRP 1B
ivermectin (pediculicide) 1B PA; RX/OTC KETONE TEST STRIPS
lotn 1B
STRP
lindane sham 1B KETOSTIX STRP 1B
malathion lotn 1B NOVA MAX PLUS
KETONE TESTSTRIPS 1B
NATROBA SUSP (Use NF PA STRP
spinosad) PRECISION XTRA STRP 1B
VI
65
PTS PANELS KETONE 1B DYAZIDE CAPS (Use
TEST STRP triamterene & NF
RELION KETONE TEST hydrochlorothiazide)
1B
STRIPS STRP MAXZIDE TABS (Use
RELION TRUE METRIX QL(3.34 ea triamterene & NF
BLOODGLUCOSE TEST 1B daily); RX/OTC hydrochlorothiazide)
STRIPS STRP MAXZIDE-25 TABS (Use
Limit 100 per triamterene & NF
TRUE METRIX BLOOD hydrochlorothiazide)
month;QL(3.34
GLUCOSETEST STRIPS 1B
STRP ea daily); spironolactone & 1B
RX/OTC hydrochlorothiazide tabs
Limit 100 per triamterene & 1B
TRUETRACK TEST STRP 1B month;QL(3.34 hydrochlorothiazide caps
ea daily); triamterene &
RX/OTC 1B
DIGESTIVE AIDS - Drugs to Treat Low Digestive Loop Diuretics
Enzymes
bumetanide soln ij 0.25 1B
Digestive Enzymes mg/ml
CREON CPEP 2 PA bumetanide tabs or 0.5 mg, QL(5 ea daily)
1B
1 mg, 2 mg
SUCRAID SOLN 3 BUMEX TABS (Use NF QL(5 ea daily)
bumetanide)
PA EDECRIN TABS (Use
ZENPEP CPEP 2 NF QL(16 ea daily)
ethacrynic acid)
DIURETICS - Drugs to Treat Heart, Circulation QL(16 ea daily)
Conditions and Blood Pressure ethacrynic acid tabs 1B
Carbonic Anhydrase Inhibitors furosemide soln 1B
acetazolamide cp12 500 1B QL(2 ea daily)
mg furosemide tabs 1B
acetazolamide sodium solr 1B LASIX TABS (Use NF
furosemide)
acetazolamide tabs 125 mg 1B QL(8 ea daily)
torsemide tabs 1B
acetazolamide tabs 250 mg 1B QL(4 ea daily)
Potassium Sparing Diuretics
PA; QL(4 ea ALDACTONE TABS (Use
KEVEYIS TABS 4 NF
daily) spironolactone)
methazolamide tabs 1B QL(6 ea daily)
amiloride hcl tabs 1B
Diuretic Combinations DYRENIUM CAPS (Use NF QL(3 ea daily)
ALDACTAZIDE TABS 25 triamterene)
MG-25 MG (Use NF spironolactone tabs 1B
spironolactone &
hydrochlorothiazide) triamterene caps 1B QL(3 ea daily)
amiloride & 1B
hydrochlorothiazide tabs Thiazides and Thiazide-Like Diuretics
66
chlorthalidone tabs 1B ibandronate sodium tabs or 1B QL(0.036 ea
150 mg daily)
hydrochlorothiazide caps QL(2 ea daily) pamidronate disodium soln
12.5 mg 1B 4 PA; SP
30 mg/10ml, 90 mg/10ml
hydrochlorothiazide tabs 1B QL(2 ea daily) PAMIDRONATE PA; SP
12.5 mg DISODIUM SOLN 6 4
hydrochlorothiazide tabs 25 QL(2 ea daily) MG/ML
1A
mg, 50 mg pamidronate disodium solr 4 PA; SP
indapamide tabs 1.25 mg 1B QL(1 ea daily) 30 mg, 90 mg
PA; 1 rtl MAX
QL(2 ea daily)
indapamide tabs 2.5 mg 1B PROLIA SOSY 4 fill,180 rtl
day(s) supply,;
metolazone tabs 1B QL(2 ea daily) SP
RECLAST SOLN (Use NF PA; SP
ENDOCRINE AND METABOLIC AGENTS - zoledronic acid)
MISC. - Drugs to Treat Bone Disease and risedronate sodium tabs
Regulate Hormones 1B PA; QL(0.036
150 mg ea daily)
Bone Density Regulators risedronate sodium tabs 30 1B PA; QL(1 ea
ACTONEL TABS 150 MG mg, 5 mg daily)
NF PA; QL(0.036
(Use risedronate sodium) ea daily) risedronate sodium tabs 35 1B PA; QL(0.143
ACTONEL TABS 35 MG mg ea daily)
NF PA; QL(0.143
(Use risedronate sodium) ea daily) risedronate sodium tbec 35 1B PA
ACTONEL TABS 5 MG mg
NF PA; QL(1 ea
(Use risedronate sodium) daily) TYMLOS SOPN 4 PA;
alendronate sodium tabs 1B QL(0.143 ea
35 mg, 70 mg daily) XGEVA SOLN 4 PA; SP
alendronate sodium tabs 1B QL(1 ea daily)
40 mg, 5 mg, 10 mg zoledronic acid conc 4 4 PA; SP
mg/5ml
ATELVIA TBEC (Use NF PA
risedronate sodium) zoledronic acid soln 4 4 PA; SP
mg/100ml, 5 mg/100ml
BONIVA SOLN IV 3 PA; SP
MG/3ML (Use ibandronate NF ZOLEDRONIC ACID SOLR 4 PA; SP
sodium) 4 MG
BONIVA TABS OR 150 MG Corticotropin
NF QL(0.036 ea
(Use ibandronate sodium) daily) PA
ACTHAR GEL 4
calcitonin (salmon) soln na 1B
200 unit/act Fertility Regulators
etidronate disodium tabs 1B CHORIONIC 4 PA; SP
GONADOTROPIN SOLR
PA; QL(0.143 NOVAREL SOLR 10000 PA; SP
FOSAMAX PLUS D TABS 3 4
ea daily) UNIT
FOSAMAX TABS (Use NF QL(0.143 ea PREGNYL W/DILUENT PA; SP
alendronate sodium) daily) BENZYLALCOHOL/NACL 4
ibandronate sodium soln iv 4 PA; SP SOLR
3 mg/3ml
GnRH/LHRH Antagonists
67
CETROTIDE KIT 4 PA ALDURAZYME SOLN 4 PA; SP
ganirelix acetate sosy 4 PA BUPHENYL POWD (Use NF PA

sodium phenylbutyrate)
GANIRELIX ACETATE PA BUPHENYL TABS (Use
SOSY (Use ganirelix NF NF PA
sodium phenylbutyrate)
acetate)
calcitriol caps 1B
Growth Hormone Receptor Antagonists
SOMAVERT SOLR 10 MG, 4 PA; SP calcitriol soln 1B
15 MG, 20 MG
CARBAGLU TABS 4 PA; SP
Growth Hormone Releasing Hormones (GHRH)
EGRIFTA SOLR 4 PA cinacalcet hcl tabs 4 PA; QL(4 ea
daily); SP
EGRIFTA SV SOLR 4 PA PA; SP
CYSTADANE POWD 4
Growth Hormones
doxercalciferol caps 1B
NORDITROPIN FLEXPRO PA; SP
SOPN 10 MG/1.5ML, 15 4 doxercalciferol soln 1B
MG/1.5ML, 5 MG/1.5ML
NORDITROPIN FLEXPRO PA ELAPRASE SOLN 4 PA; SP
4
SOPN 30 MG/3ML
PA; SP FABRAZYME SOLR 35 4 PA; SP
ZORBTIVE SOLR 4 MG
PA; QL(0.5 ea
Hormone Receptor Modulators GALAFOLD CAPS 4
daily)
EVISTA TABS (Use NF QL(1 ea daily)
raloxifene hcl) HECTOROL SOLN 4
MCG/2ML (Use NF
OSPHENA TABS 3 PA doxercalciferol)
KUVAN PACK (Use PA
raloxifene hcl tabs 0 QL(1 ea daily) sapropterin NF
dihydrochloride)
Insulin-Like Growth Factors (Somatomedins) KUVAN TABS (Use PA
INCRELEX SOLN 4 PA; SP sapropterin NF
dihydrochloride)
LHRH/GnRH Agonist Analog Pituitary LUMIZYME SOLR 4 PA; SP
FENSOLVI KIT 4 PA; SP PA
MYALEPT SOLR 4
LUPANETA PACK KIT 4 PA
NAGLAZYME SOLN 4 PA; SP
LUPRON DEPOT-PED (1- 4 PA; SP
MONTH) KIT nitisinone caps 4 PA; SP
LUPRON DEPOT-PED (3- 4 PA; SP
MONTH) KIT 30 MG ORFADIN CAPS 10 MG, 2 NF PA; SP
MG, 5 MG (Use nitisinone)
SYNAREL SOLN 4 PA; SP
PALYNZIQ SOSY 4 PA
Metabolic Modifiers
68
paricalcitol caps 1B desmopressin acetate tabs 1B QL(8 ea daily)
or 0.2 mg
paricalcitol soln 1B STIMATE SOLN 4 PA; SP
ROCALTROL CAPS (Use NF Prolactin Inhibitors
calcitriol)
ROCALTROL SOLN (Use cabergoline tabs 1B
NF
calcitriol)
Somatostatic Agents
sapropterin dihydrochloride 4 PA
pack octreotide acetate soln 4 PA; SP
sapropterin dihydrochloride 4 PA
tabs SANDOSTATIN LAR 4 PA
DEPOT KIT
SENSIPAR TABS (Use NF PA; QL(4 ea
cinacalcet hcl) daily); SP SANDOSTATIN SOLN NF PA; SP
(Use octreotide acetate)
sodium phenylbutyrate 1B PA
powd SIGNIFOR SOLN 4 PA
sodium phenylbutyrate tabs 1B PA SOMATULINE DEPOT PA; QL(0.0179

4
SOLN 120 MG/0.5ML ml daily); SP
ZEMPLAR CAPS (Use NF
paricalcitol) SOMATULINE DEPOT 4 PA; QL(0.0075
ZEMPLAR SOLN (Use NF
paricalcitol) SOMATULINE DEPOT 4 PA; QL(0.011
Posterior Pituitary Hormones
Vasopressin Receptor Antagonists
DDAVP SOLN IJ 4 PA
MCG/ML (Use NF JYNARQUE TABS 15 MG, 4 PA; QL(2 ea
desmopressin acetate) 30 MG daily); SP
DDAVP SOLN NA 0.01 % JYNARQUE TBPK 4 PA; SP
(Use desmopressin acetate NF
spray) SAMSCA TABS (Use 4 PA; QL(2 ea
tolvaptan) daily); SP
DDAVP TABS OR 0.1 MG QL(6 ea daily)
(Use desmopressin NF PA; QL(2 ea
tolvaptan tabs 4
daily); SP
acetate)
DDAVP TABS OR 0.2 MG QL(8 ea daily) ESTROGENS - Hormone Replacement/Modifying
(Use desmopressin NF Drugs
acetate) Estrogen Combinations
desmopressin acetate soln 1B PA
ij 4 mcg/ml CLIMARA PRO PTWK 3
DESMOPRESSIN PA; SP PA
ACETATE SOLN NA 1.5 4 DUAVEE TABS 3
MG/ML FEMHRT TABS (Use
desmopressin acetate 1B norethindrone acetate- NF
spray refrigerated soln ethinyl estradiol)
desmopressin acetate 1B norethindrone acetate- 1B
spray soln ethinyl estradiol tabs
desmopressin acetate tabs 1B QL(6 ea daily) PREMPHASE TABS 2
or 0.1 mg
69
PREMPRO TABS 2 FLUOROQUINOLONES - Drugs to Treat Bacterial
Infections
Estrogens Fluoroquinolones
CLIMARA PTWK (Use NF AVELOX SOLN (Use
estradiol) moxifloxacin hcl in sodium 1B
DELESTROGEN OIL 10 1B chloride)
MG/ML PA
DELESTROGEN OIL 20 BAXDELA SOLR 3
MG/ML, 40 MG/ML (Use NF PA
estradiol valerate) BAXDELA TABS 3
DEPO-ESTRADIOL OIL 3 2 rtl MAX fill,30

CIPRO SUSR 5 2 rtl day(s)
GM/100ML, 500 MG/5ML
DIVIGEL GEL 0.25 supply,
MG/0.25GM, 0.5 3 CIPRO TABS 250 MG, 500
MG/0.5GM, 1 MG/GM NF
MG (Use ciprofloxacin hcl)
ELESTRIN GEL 3 ciprofloxacin hcl tabs 1B
ESTRACE TABS (Use NF ciprofloxacin in d5w soln
estradiol) 200 mg/100ml-5 %, 5 %- 3
estradiol pttw td 0.025 QL(0.286 ea 200 mg/100ml
mg/24hr, 0.0375 mg/24hr, 1B daily) 2 rtl MAX fill,30
0.05 mg/24hr, 0.075 ciprofloxacin susr 1B rtl day(s)
mg/24hr, 0.1 mg/24hr supply,
estradiol ptwk td 0.025 LEVAQUIN TABS (Use
mg/24hr, 0.075 mg/24hr, NF
levofloxacin)
0.1 mg/24hr, 0.05 mg/24hr, 1B
0.06 mg/24hr, 37.5 levofloxacin in d5w soln 5 1B
mcg/24hr %-500 mg/100ml
estradiol tabs or 0.5 mg, 1 levofloxacin soln iv 25 1B
mg, 2 mg 1B mg/ml
levofloxacin soln or 25 1B
estradiol valerate oil 1B mg/ml
levofloxacin tabs or 250 1B
ESTROGEL GEL 3 mg, 750 mg
EVAMIST SOLN 3 levofloxacin tabs or 500 mg 1A
MENEST TABS 3
moxifloxacin hcl in sodium 1B
chloride soln
MENOSTAR PTWK 3 moxifloxacin hcl tabs 1B
MINIVELLE PTTW (Use NF QL(0.286 ea ofloxacin tabs 1B
estradiol) daily)
PREMARIN SOLR 2 GASTROINTESTINAL AGENTS - MISC. -
Miscellaneous Gastrointestinal Drugs
PREMARIN TABS 2 Bile Acid Synthesis Disorder Agents
VIVELLE-DOT PTTW (Use NF QL(0.286 ea CHOLBAM CAPS 4 PA; SP
estradiol) daily)
70
Gallstone Solubilizing Agents DIPENTUM CAPS 2
ACTIGALL CAPS (Use NF
ursodiol) PA; 30 rtl lmt
INFLECTRA SOLR 4 day(s),30 mail
URSO 250 TABS (Use NF lmt day(s),
ursodiol)
LIALDA TBEC (Use NF
URSO FORTE TABS (Use NF mesalamine)
ursodiol)
mesalamine cp24 or 0.375 1B
ursodiol caps 300 mg 1B gm
ursodiol tabs 250 mg, 500 mesalamine cpdr or 400 1B
mg 1B mg
Gastrointestinal Chloride Channel Activators mesalamine enem re 4 gm 1B
AMITIZA CAPS (Use NF PA; QL(2 ea mesalamine supp re 1000
lubiprostone) daily) 1B
mg
lubiprostone caps 1B PA; QL(2 ea mesalamine tbec or 1.2 gm 1B
daily)
Gastrointestinal Stimulants mesalamine tbec or 800 1B QL(6 ea daily)
mg
metoclopramide hcl soln ij 1B
5 mg/ml PA; 30 rtl lmt
RENFLEXIS SOLR 4 day(s),30 mail
metoclopramide hcl soln or 1B QL(60 ml daily) lmt day(s),
10 mg/10ml, 5 mg/5ml
STELARA SOLN IV 130 4 PA
metoclopramide hcl tabs or 1A QL(6 ea daily) MG/26ML
10 mg, 5 mg
REGLAN TABS (Use sulfasalazine tabs 1B
NF QL(6 ea daily)
metoclopramide hcl)
sulfasalazine tbec 1B
Inflammatory Bowel Agents
APRISO CP24 (Use NF Intestinal Acidifiers
mesalamine) lactulose (encephalopathy)
ASACOL HD TBEC (Use 1B
NF QL(6 ea daily) soln
mesalamine)
Irritable Bowel Syndrome (IBS) Agents
AVSOLA SOLR 4 PA
alosetron hcl tabs 1B QL(2 ea daily)
AZULFIDINE EN-TABS NF
TBEC (Use sulfasalazine) PA; QL(1 ea
LINZESS CAPS 2
daily)
AZULFIDINE TABS (Use
sulfasalazine) NF LOTRONEX TABS (Use NF QL(2 ea daily)
alosetron hcl)
balsalazide disodium caps 1B Peripheral Opioid Receptor Antagonists
CANASA SUPP (Use NF alvimopan caps 1B
mesalamine)
COLAZAL CAPS (Use ENTEREG CAPS (Use NF
NF alvimopan)
balsalazide disodium)
DELZICOL CPDR (Use RELISTOR SOLN SC 12 3 PA
NF MG/0.6ML, 8 MG/0.4ML
mesalamine)
Phosphate Binder Agents
71
calcium acetate (phosphate 1B SORBITOL SOLN IR 3 %, 1B
binder) caps 3.3 %
calcium acetate (phosphate 1B RX/OTC SORBITOL-MANNITOL 1B
binder) tabs SOLN
FOSRENOL CHEW 1000 SORBITOL/MANNITOL 1B
MG, 500 MG, 750 MG (Use NF IRRIGATION SOLN
lanthanum carbonate)
Interstitial Cystitis Agents
lanthanum carbonate chew 1B
ELMIRON CAPS 2
PHOSLYRA SOLN 2 Prostatic Hypertrophy Agents
RENVELA PACK (Use alfuzosin hcl tb24 1B QL(1 ea daily)
NF
sevelamer carbonate)
RENVELA TABS (Use AVODART CAPS (Use NF QL(1 ea daily)
NF dutasteride)
sevelamer carbonate)
dutasteride caps 1B QL(1 ea daily)
sevelamer carbonate pack 1B
dutasteride-tamsulosin hcl 1B PA
sevelamer carbonate tabs 1B caps
VELPHORO CHEW 3 PA finasteride tabs 1B 5 mg only
GENITOURINARY AGENTS - MISCELLANEOUS FLOMAX CAPS (Use NF

- Miscellaneous Drugs to Treat Reproductive tamsulosin hcl)
Organs and Urinary System JALYN CAPS (Use 3 PA
dutasteride-tamsulosin hcl)
Alkalinizers
PROSCAR TABS (Use NF 5 mg only
potassium citrate finasteride)
(alkalinizer) tbcr 10 meq, 1B
1080 mg RAPAFLO CAPS (Use NF
silodosin)
sodium citrate & citric acid 1B RX/OTC
soln silodosin caps 1B
UROCIT-K 10 TBCR (Use
potassium citrate NF tamsulosin hcl caps 1B
(alkalinizer))
UROXATRAL TB24 (Use NF QL(1 ea daily)
Cystinosis Agents alfuzosin hcl)
CYSTAGON CAPS 3 PA Urinary Analgesics
phenazopyridine hcl tabs 1B
Genitourinary Irrigants 100 mg, 200 mg
acetic acid soln 1B PYRIDIUM TABS (Use NF
phenazopyridine hcl)
glycine (gu irrigant) soln 1B
GOUT AGENTS - Drugs to Treat Gout
RESECTISOL SOLN 1B Gout Agent Combinations
sodium chloride (gu colchicine w/ probenecid 1B
1B tabs
irrigant) soln
Gout Agents
72
allopurinol tabs 1B anagrelide hcl caps 1B
colchicine tabs 1B QL(1 ea daily) PA; QL(2 ea

aspirin-dipyridamole cp12 1B
daily)
COLCRYS TABS (Use NF QL(1 ea daily) QL(2 ea daily)
colchicine) BRILINTA TABS 2
PA; QL(1 ea CABLIVI KIT 4 PA
febuxostat tabs 1B
daily)
MITIGARE CAPS (Use NF cilostazol tabs 1B
colchicine)
ULORIC TABS (Use clopidogrel bisulfate tabs
NF PA; QL(1 ea 300 mg 1B
febuxostat) daily)
ZYLOPRIM TABS (Use clopidogrel bisulfate tabs 1B QL(1 ea daily)
NF 75 mg
allopurinol)
Uricosurics dipyridamole tabs 1B
probenecid tabs 1B EFFIENT TABS (Use NF QL(1 ea daily)
prasugrel hcl)
HEMATOLOGICAL AGENTS - MISC. - Drugs to PLAVIX TABS (Use
Treat Blood Disorders NF QL(1 ea daily)
clopidogrel bisulfate)
Bradykinin B2 Receptor Antagonists prasugrel hcl tabs 1B QL(1 ea daily)
FIRAZYR SOLN (Use NF PA; QL(9 ml
icatibant acetate) daily) REOPRO SOLN 3
icatibant acetate soln 4 PA; QL(9 ml ZONTIVITY TABS 3 PA
daily)
Complement Inhibitors HEMATOPOIETIC AGENTS - Drugs to Treat
CINRYZE SOLR 4 PA Blood Disorders
PA Agents for Gaucher Disease
HAEGARDA SOLR 4 PA; QL(2 ea
CERDELGA CAPS 4
PA; QL(0.143 daily)
RUCONEST SOLR 4 PA; SP
ea daily) CEREZYME SOLR 4
SOLIRIS SOLN 4 PA
miglustat caps PA; QL(3 ea
4
daily); SP
Hematorheologic Agents
ZAVESCA CAPS (Use NF PA; QL(3 ea
pentoxifylline tbcr 1B QL(3 ea daily) miglustat) daily); SP
Plasma Kallikrein Inhibitors Agents for Sickle Cell Disease
TAKHZYRO SOLN 4 PA; DROXIA CAPS 3
OXBRYTA TABS 4 PA
Platelet Aggregation Inhibitors
AGGRENOX CP12 (Use NF PA; QL(2 ea Cobalamins
aspirin-dipyridamole) daily)
cyanocobalamin soln ij QL(1 ml daily)
AGRYLIN CAPS (Use NF 1000 mcg/ml 1B
anagrelide hcl)
Folic Acid/Folates
73
folic acid tabs or 1 mg 0 RX/OTC PA; 30 rtl lmt
ZARXIO SOSY 4 day(s),30 mail
folic acid tabs or 800 mcg, lmt day(s),
0
400 mcg
ZIEXTENZO SOSY 4 PA;
Hematopoietic Growth Factors
ARANESP ALBUMIN PA; SP Hematopoietic Mixtures
FREE SOLN 100 MCG/ML, 4 ferrous fumarate-folic acid 1B QL(1 ea daily)
40 MCG/ML, 60 MCG/ML tabs
ARANESP ALBUMIN 4 SP Iron
FREE SOLN 25 MCG/ML FER-IN-SOL SOLN (Use 0 AL(Up to 1 yrs
ARANESP ALBUMIN PA; SP ferrous sulfate) old )
FREE SOSY 150
MCG/0.3ML, 200 4 ferrous sulfate soln or 15 0 AL(Up to 1 yrs
MCG/0.4ML, 300 mg/ml old )
MCG/0.6ML, 500 MCG/ML ferrous sulfate tabs or 325 0
PA; QL(3 ea mg, 65 mg
DOPTELET TABS 4
daily) ferrous sulfate tbec or 325 0
PA; SP mg
EPOGEN SOLN 3 PA
INFED SOLN 4
GRANIX SOLN 4 PA
VENOFER SOLN 4 PA
GRANIX SOSY 4 PA
Stem Cell Mobilizers
LEUKINE SOLR 4 PA; SP PA; SP
MOZOBIL SOLN 4
MIRCERA SOSY 4 PA HEMOSTATICS - Drugs to Stop Bleeding/Treat
Blood Disorders
PA; QL(1 ea
MULPLETA TABS 4 Hemostatics - Systemic
daily)
NPLATE SOLR 250 MCG, PA; SP AMICAR TABS 1000 MG, PA
4 500 MG (Use aminocaproic NF
500 MCG
PROCRIT SOLN 10000 PA; SP acid)
UNIT/ML, 2000 UNIT/ML, aminocaproic acid tabs or 1B PA
3 1000 mg, 500 mg
20000 UNIT/ML, 3000
UNIT/ML, 4000 UNIT/ML CYKLOKAPRON SOLN NF
PROCRIT SOLN 40000 PA; SP (Use tranexamic acid)
4
UNIT/ML LYSTEDA TABS (Use NF
PROMACTA PACK 12.5 PA; QL(1 ea tranexamic acid)
4
MG daily)
tranexamic acid soln 1B
PROMACTA TABS 12.5 4 PA; SP
MG, 25 MG, 50 MG, 75 MG tranexamic acid tabs 1B
RETACRIT SOLN 10000 PA
UNIT/ML, 2000 UNIT/ML, HYPNOTICS/SEDATIVES/SLEEP DISORDER
20000 UNIT/2ML, 3000 4 AGENTS
UNIT/ML, 4000 UNIT/ML,
40000 UNIT/ML Barbiturate Hypnotics
phenobarbital elix 20 1B
mg/5ml
74
phenobarbital soln 20 1B zolpidem tartrate tabs or 10 1A QL(1 ea daily);
mg/5ml mg, 5 mg AL(At least 18
phenobarbital tabs 100 mg, yrs old)
16.2 mg, 32.4 mg, 64.8 mg, 1B ST; Must try
97.2 mg, 15 mg, 30 mg zolpidem tartrate tbcr or immediate
1B release
Hypnotics - Tricyclic Agents 6.25 mg, 12.5 mg zolpidem.;QL(1
PA; QL(1 ea ea daily)
doxepin hcl (sleep) tabs 1B
daily)
Orexin Receptor Antagonists
SILENOR TABS (Use NF PA; QL(1 ea
doxepin hcl (sleep)) daily) BELSOMRA TABS 3 PA
Non-Barbiturate Hypnotics
Selective Melatonin Receptor Agonists
ST; Must try
AMBIEN CR TBCR (Use immediate HETLIOZ CAPS 3 PA; QL(1 ea
NF release daily)
zolpidem tartrate) zolpidem.;QL(1 ST; QL(1 ea
ea daily) ramelteon tabs 1B daily); AL(At
QL(1 ea daily); least 18 yrs
AMBIEN TABS (Use NF AL(At least 18 old)
zolpidem tartrate) yrs old) ST; QL(1 ea
DORAL TABS (Use ROZEREM TABS (Use NF daily); AL(At
NF ramelteon) least 18 yrs
quazepam)
old)
estazolam tabs 1B
LAXATIVES - Bowel Treatment Drugs
ST; QL(1 ea
daily); AL(At Bulk Laxatives
eszopiclone tabs 1B
least 18 yrs calcium polycarbophil tabs 1B
old)
HALCION TABS (Use FIBERCON TABS (Use NF
NF calcium polycarbophil)
triazolam)
ST; QL(1 ea Laxative Combinations
LUNESTA TABS (Use NF daily); AL(At COLYTE-FLAVOR PACKS
eszopiclone) least 18 yrs SOLR (Use peg 3350-kcl-
old) NF
sod bicarb-sod chloride-sod
RESTORIL CAPS (Use NF QL(1 ea daily) sulfate)
temazepam) GOLYTELY SOLR 2.97
temazepam caps 15 mg, 1A QL(1 ea daily) GM-5.86 GM-6.74 GM-
30 mg 22.74 GM-236 GM (Use 0
temazepam caps 22.5 mg, QL(1 ea daily) peg 3350-kcl-sod bicarb-
1B sod chloride-sod sulfate)
7.5 mg
MOVIPREP SOLR (Use PA
triazolam tabs 1B peg 3350-kcl-nacl-na NF
QL(2 ea daily); sulfate-na ascorbate-
zaleplon caps 10 mg 1B AL(At least 18 ascorbic acid)
yrs old) NULYTELY SOLR (Use PA
QL(1 ea daily); peg 3350-potassium 3
zaleplon caps 5 mg 1B AL(At least 18 chloride-sod bicarbonate-
yrs old) sod chloride)
75
NULYTELY/FLAVOR XYLOCAINE SOLN 0.5 %,
PACKS SOLR (Use peg 1 % (Use lidocaine hcl NF
3350-potassium chloride- NF (local anesth.))
sod bicarbonate-sod XYLOCAINE-MPF SOLN
chloride) (Use lidocaine hcl (local NF
peg 3350-kcl-nacl-na PA anesth.))
sulfate-na ascorbate- 1B ZINGO JTAJ (Use
ascorbic acid solr lidocaine hcl (local NF
peg 3350-kcl-sod bicarb- anesth.))
sod chloride-sod sulfate
solr 2.97 gm-5.86 gm-6.74 MACROLIDES - Drugs to Treat Bacterial
0 Infections
gm-22.74 gm-236 gm,
22.74 gm-2.97 gm-5.86 Azithromycin
gm-6.74 gm-236 gm
azithromycin pack or 1 gm 1B
Laxatives - Miscellaneous
lactulose soln 10 gm/15ml, 1B azithromycin solr iv 500 mg 1B
20 gm/30ml
azithromycin susr or 100 1B
Saline Laxatives mg/5ml, 200 mg/5ml
OSMOPREP TABS 3 PA QL(6 ea per fill
azithromycin tabs or 250 1B retail,6 ea per
mg fill mail)
Stimulant Laxatives
QL(4 ea per fill
bisacodyl supp 1A azithromycin tabs or 500 1B retail,4 ea per
mg fill mail)
bisacodyl tbec 1A
azithromycin tabs or 600 1B QL(0.286 ea
DULCOLAX SUPP (Use mg daily)
NF
bisacodyl) ZITHROMAX PACK OR 1 NF
DULCOLAX TBEC (Use GM (Use azithromycin)
NF
bisacodyl) ZITHROMAX SOLR IV 500 NF
Surfactant Laxatives MG (Use azithromycin)
COLACE CAPS (Use ZITHROMAX SUSR OR
NF 100 MG/5ML, 200 MG/5ML NF
docusate sodium)
(Use azithromycin)
docusate calcium caps 1A QL(6 ea per fill
ZITHROMAX TABS OR NF retail,6 ea per
docusate sodium caps or 1A 250 MG (Use azithromycin)
250 mg, 100 mg fill mail)
QL(4 ea per fill
LOCAL ANESTHETICS-Parenteral - Drugs for ZITHROMAX TABS OR NF retail,4 ea per
Numbing 500 MG (Use azithromycin) fill mail)
Local Anesthetics - Amides ZITHROMAX TABS OR NF QL(0.286 ea
lidocaine hcl (local anesth.) 1B 600 MG (Use azithromycin) daily)
soln ij 0.5 %, 1 %, 2 % QL(4 ea per fill
ZITHROMAX TRI-PAK NF retail,4 ea per
MARCAINE SOLN 0.5 % NF TABS (Use azithromycin)
(Use bupivacaine hcl) fill mail)
NAROPIN SOLN 5 MG/ML, QL(6 ea per fill
ZITHROMAX Z-PAK TABS NF retail,6 ea per
2 MG/ML (Use ropivacaine NF (Use azithromycin)
hcl) fill mail)
76
Clarithromycin FC FEMALE CONDOM 0 QL(1 ea daily)
MISC
clarithromycin susr 1B
FEMCAP DEVI 0
clarithromycin tabs 1B K-Y ME & YOU EXTRA QL(2 ea daily)
0
LUBRICATED DEVI
clarithromycin tb24 1B
K-Y ME & YOU INTENSE 0 QL(2 ea daily)
Erythromycins DEVI
E.E.S. GRANULES SUSR KAMELEON LUBRICATED 0 QL(2 ea daily)
(Use erythromycin NF MISC
ethylsuccinate) KIMONO COLORS DEVI 0 QL(2 ea daily)
ERYPED 200 SUSR (Use
erythromycin NF KIMONO LUBRICATED 0 QL(2 ea daily)
ethylsuccinate) MISC
ERYPED 400 SUSR (Use KIMONO MICRO THIN QL(2 ea daily)
erythromycin 3 PLUS SPERMICIDE 0
ethylsuccinate) LUBRICATED MISC
erythromycin base cpep KIMONO PLUS QL(2 ea daily)
3 SPERMICIDE 0
250 mg
LUBRICATED MISC
erythromycin base tabs 3
250 mg, 500 mg KIMONO PLUS QL(2 ea daily)
SPERMICIDE/LUBRICATE 0
erythromycin base tbec 1B D MISC
250 mg, 333 mg, 500 mg
KIMONO PS LUBRICATED 0 QL(2 ea daily)
erythromycin MISC
ethylsuccinate susr 200 1B
mg/5ml, 400 mg/5ml KIMONO PS PLUS QL(2 ea daily)
SPERMICIDE/LUBRICATE 0
erythromycin 3 D MISC
ethylsuccinate tabs 400 mg
KIMONO SENSATION 0 QL(2 ea daily)
Fidaxomicin LUBRICATED MISC
DIFICID TABS 200 MG 2 KIMONO SENSATION QL(2 ea daily)
PLUS SPERMICIDE 0
MEDICAL DEVICES AND SUPPLIES LUBRICATED MISC
KIMONO SPECIAL DEVI 0 QL(2 ea daily)
Contraceptives
AIMSCO LUBRICATED QL(2 ea daily) MAXX LUBRICATED MISC 0 QL(2 ea daily)
0
MISC
MAXX PLUS SPERMICIDE 0 QL(2 ea daily)
CAYA DPRH 0 LUBRICATED MISC
DUREX EXTRA QL(2 ea daily) OMNIFLEX DIAPHRAGM 0
0 DPRH
SENSITIVE DEVI
FANTASY LUBRICATED QL(2 ea daily) PREMIUM CONDOMS 0 QL(2 ea daily)
0 LUBRICATED MISC
MISC
FANTASY QL(2 ea daily) REALITY LATEX QL(2 ea daily)
LUBRICATED/SPERMICID 0 CONDOMS/LUBRICATED 0
E MISC MISC
77
REALITY LATEX/ULTRA 0 QL(2 ea daily) WIDE-SEAL SILICONE
TEXTURED DEVI DIAPHRAGM KIT 70 0
REALITY LATEX/ULTRA QL(2 ea daily) DPRH
0
THIN DEVI WIDE-SEAL SILICONE
TRUSTEX COLOR QL(2 ea daily) DIAPHRAGM KIT 75 0
0 DPRH
CONDOMS + LUBE MISC
TRUSTEX LUBRICATED QL(2 ea daily) WIDE-SEAL SILICONE
0 DIAPHRAGM KIT 80 0
EXTRALARGE MISC
DPRH
TRUSTEX LUBRICATED 0 QL(2 ea daily)
EXTRASTRENGTH MISC WIDE-SEAL SILICONE
DIAPHRAGM KIT 85 0
TRUSTEX LUBRICATED 0 QL(2 ea daily) DPRH
MISC
WIDE-SEAL SILICONE
TRUSTEX QL(2 ea daily) DIAPHRAGM KIT 90 0
LUBRICATED/RIBBED/ST 0 DPRH
UDDED MISC
WIDE-SEAL SILICONE
TRUSTEX QL(2 ea daily) DIAPHRAGM KIT 95 0
LUBRICATED/SPERMICID 0 DPRH
E EXTRA LARGE MISC
TRUSTEX QL(2 ea daily) Diabetic Supplies
LUBRICATED/SPERMICID 1ST TIER UNILET QL(6.6667 ea
0 COMFORTOUCH 1B daily)
E EXTRA STRENGTH
MISC LANCETS 28G MISC
TRUSTEX QL(2 ea daily) 1ST TIER UNILET QL(6.6667 ea
LUBRICATED/SPERMICID 0 COMFORTOUCH 1B daily)
E MISC LANCETS 30G MISC
TRUSTEX NATURAL QL(2 ea daily) ACCU-CHEK FASTCLIX 1B QL(6.6667 ea
CONDOMS LANCETS MISC daily)
0
+LUBE/LUBRICATED ACCU-CHEK MULTICLIX QL(6.6667 ea
MISC 1B
LANCETS MISC daily)
TRUSTEX WITH QL(2 ea daily) ACCU-CHEK SAFE-T-PRO QL(6.6667 ea
NONOXYNOL- 1B
0 LANCETS MISC daily)
9/RIBBED/STUDDED ACCU-CHEK SAFE-T-PRO QL(6.6667 ea
MISC 1B
PLUSLANCETS MISC daily)
TRUSTEX/RIA QL(2 ea daily)
0 ACCU-CHEK SOFTCLIX QL(6.6667 ea
LUBRICATED MISC 1B
LANCETS MISC daily)
TRUSTEX/RIA QL(2 ea daily) ACTI-LANCE LANCETS QL(6.6667 ea
LUBRICATED 0 1B
28G MISC daily)
SPERMICIDE MISC
ACTI-LANCE LITE QL(6.6667 ea
TRUSTEX/RIA QL(2 ea daily) SAFETY LANCETS 28G 1B daily)
LUBRICATED/SPERMICID 0
MISC
E MISC
ACTI-LANCE SPECIAL QL(6.6667 ea
WIDE-SEAL SILICONE SAFETY LANCETS 17G 1B daily)
DIAPHRAGM KIT 60 0
MISC
DPRH
ACTI-LANCE SPECIAL QL(6.6667 ea
WIDE-SEAL SILICONE SAFETYLANCETS 17G 1B daily)
DIAPHRAGM KIT 65 0
MISC
DPRH
78
ACTI-LANCE UNIVERSAL QL(6.6667 ea ASSURE HAEMOLANCE QL(6.6667 ea
SAFETY LANCETS 23G 1B daily) PLUS NORMAL FLOW 1B daily)
MISC 21G MISC
ADJUSTABLE LANCING 1B ASSURE HAEMOLANCE QL(6.6667 ea
DEVICE MISC PLUS PEDIATRIC BLADE 1B daily)
ADVANCED MOBILE MISC
1B QL(6.6667 ea
LANCET 30G MISC daily) ASSURE LANCE 1B QL(6.6667 ea
ADVOCATE CONTROL LANCETS 21G MISC daily)
1B
SOLUTIONHIGH LIQD ASSURE LANCE 1B QL(6.6667 ea
ADVOCATE LANCETS LANCETS MISC daily)
1B QL(6.6667 ea
30G MISC daily) ASSURE LANCE PLUS QL(6.6667 ea
ADVOCATE LANCETS SAFETYLANCETS 25G 1B daily)
1B QL(6.6667 ea MISC
MISC daily)
ADVOCATE LANCING ASSURE LANCE PLUS QL(6.6667 ea
1B SAFETYLANCETS 30G 1B daily)
DEVICE MISC
MISC
ADVOCATE RAPID-SAFE 1B
LANCING DEVICE MISC ASSURE LANCE SAFETY 1B QL(6.6667 ea
LANCET 28G MISC daily)
ADVOCATE REDI-CODE+
CONTROL SOLUTION 1B QL(6.6667 ea
ASSURE LANCETS MISC 1B
HIGH SOLN daily)
ADVOCATE SAFETY AURORA LANCET SUPER QL(6.6667 ea
1B QL(6.6667 ea THIN30G MISC
1B
daily)
LANCETS 26G MISC daily)
ADVOCATE SAFETY AURORA LANCET THIN QL(6.6667 ea
1B QL(6.6667 ea 23G MISC
1B
daily)
LANCETS MISC daily)
AGAMATRIX CONTROL 1B AUTO-LANCET MINI MISC 1B
HIGH SOLN
AGAMATRIX ULTRA-THIN 1B QL(6.6667 ea AUTO-LANCET MISC 1B
AUTOLET IMPRESSION 1B
AIMSCO TWIST LANCETS 1B QL(6.6667 ea LANCING DEVICE MISC
32G MISC daily)
AUTOLET LANCING 1B
AIMSCO TWIST LANCETS 1B QL(6.6667 ea DEVICE MISC
33G MISC daily)
ALTERNATE SITE AUTOLET MINI MISC 1B
1B
LANCING DEVICE MISC
AQUA LANCE AUTOLET PLUS MISC 1B
ADJUSTABLE LANCING 1B BD LANCET ULTRAFINE QL(6.6667 ea
DEVICE DEVI 1B
30G MISC daily)
ASSURE HAEMOLANCE QL(6.6667 ea BD LANCET ULTRAFINE QL(6.6667 ea
PLUS HIGH FLOW 18G 1B daily) 1B
33G MISC daily)
MISC
BD MICROTAINER 1B QL(6.6667 ea
ASSURE HAEMOLANCE QL(6.6667 ea LANCETS MISC daily)
PLUS LOW FLOW 25G 1B daily)
MISC BULLSEYE MINI SAFETY 1B QL(6.6667 ea
LANCETS MISC daily)
ASSURE HAEMOLANCE QL(6.6667 ea
PLUS MICRO FLOW 28G 1B daily) BULLSEYE SAFETY 1B QL(6.6667 ea
MISC LANCETS MISC daily)
79
CARDIOCOM LANCING 1B CVS LANCETS MICRO- 1B QL(6.6667 ea
DEVICE MISC THIN 33G MISC daily)
CAREONE ADVANCED 1B CVS LANCETS ORIGINAL 1B QL(6.6667 ea
LANCINGDEVICE MISC MISC daily)
CAREONE LANCET 1B QL(6.6667 ea CVS LANCETS THIN 26G 1B QL(6.6667 ea
SUPER THIN/30G MISC daily) MISC daily)
CAREONE LANCET THIN 1B QL(6.6667 ea CVS LANCETS ULTRA 1B QL(6.6667 ea
MISC daily) THIN 30G MISC daily)
CARESENS LANCETS 1B QL(6.6667 ea CVS LANCETS ULTRA- 1B QL(6.6667 ea
MISC daily) THIN 30G MISC daily)
CARETOUCH LANCING CVS LANCING DEVICE 1B
DEVICEWITH EJECTOR 1B MISC
MISC CVS ULTRA THIN 1B QL(6.6667 ea
CARETOUCH SAFETY 1B QL(6.6667 ea LANCETS MISC daily)
LANCETS/26G MISC daily) DIATHRIVE LANCETS 1B QL(6.6667 ea
CARETOUCH SAFETY 1B QL(6.6667 ea MISC daily)
LANCETS/28G MISC daily) DIATHRIVE LANCETS 1B QL(6.6667 ea
CARETOUCH SAFETY 1B QL(6.6667 ea ULTRA THIN 30G MISC daily)
LANCETS/30G MISC daily) DIATHRIVE LANCING 1B
CARETOUCH TWIST 1B QL(6.6667 ea DEVICE MISC
LANCETS 28G MISC daily) DIATRUE GLUCOSE
CARETOUCH TWIST 1B QL(6.6667 ea CONTROL SOLUTION 1B
LANCETS 30G MISC daily) LEVEL 3 SOLN
CARETOUCH TWIST 1B QL(6.6667 ea DROPLET GENTEEL 1B
LANCETS 33G MISC daily) LANCING DEVICE MISC
CLEANLET LANCETS 28G 1B QL(6.6667 ea DROPLET LANCETS 1B QL(6.6667 ea
MISC daily) ULTRA THIN 30G MISC daily)
CLEVER CHOICE DROPLET LANCING 1B
GLUCOSE CONTROL 1B DEVICE MISC
HIGH LIQD DROPLET PERSONAL 1B QL(6.6667 ea
COAGUCHEK LANCETS 1B QL(6.6667 ea LANCETS30G MISC daily)
MISC daily) DRUG MART
COMFORT ASSURED QL(6.6667 ea ADJUSTABLE LANCING 1B
LANCETS MICRO THIN 1B daily) DEVICE MISC
33G MISC DRUG MART LANCETS 1B QL(6.6667 ea
COMFORT ASSURED QL(6.6667 ea THIN MISC daily)
LANCETS SUPER THIN 1B daily) DRUG MART ON-THE-GO QL(6.6667 ea
28G MISC LANCETS GENTLE 30G 1B daily)
COMFORT LANCETS 1B QL(6.6667 ea MISC
MISC daily) DRUG MART UNILET QL(6.6667 ea
CONTOUR HIGH 1B LANCETSSUPER THIN 1B daily)
CONTROL LIQD 30G MISC
QL(6.6667 ea DRUG MART UNILET QL(6.6667 ea
CVS LANCETS 21G MISC 1B
daily) LANCETSULTRA THIN 1B daily)
CVS LANCETS MICRO QL(6.6667 ea 28G MISC
1B
THIN 33G MISC daily)
80
DRUG MART UNILET QL(6.6667 ea EASY TOUCH LANCETS QL(6.6667 ea
MICRO THIN LANCETS 1B daily) 30G/PRESSURE 1B daily)
33G MISC ACTIVATED MISC
E-Z JECT LANCETS 21G 1B QL(6.6667 ea EASY TOUCH LANCETS 1B QL(6.6667 ea
MISC daily) 30G/PULL-TOP MISC daily)
E-Z JECT LANCETS 1B QL(6.6667 ea EASY TOUCH LANCETS 1B QL(6.6667 ea
COLOR MISC daily) 30G/TWIST MISC daily)
QL(6.6667 ea EASY TOUCH LANCETS QL(6.6667 ea
E-Z JECT LANCETS MISC 1B
daily) 32G/PRESSURE 1B daily)
E-Z JECT LANCETS QL(6.6667 ea ACTIVATED MISC
1B
SUPER THIN 30G MISC daily) EASY TOUCH LANCETS 1B QL(6.6667 ea
E-Z JECT LANCETS THIN QL(6.6667 ea 32G/PULL-TOP MISC daily)
1B
26G MISC daily) EASY TOUCH LANCETS 1B QL(6.6667 ea
E-ZJECT LANCETS QL(6.6667 ea 32G/TWIST MISC daily)
1B
MICRO-THIN 33G MISC daily) EASY TOUCH LANCETS 1B QL(6.6667 ea
EASY MINI EJECT 33G/TWIST MISC daily)
1B
LANCING DEVICE MISC EASY TOUCH LANCING 1B
EASY MINI LANCING DEVICE/EJECTOR MISC
1B
DEVICE MISC EASY TOUCH SAFETY QL(6.6667 ea
EASY PLUS II CONTROL LANCETS21G/PRESSURE 1B daily)
1B ACTIVATED MISC
SOLUTION HIGH SOLN
EASY STEP CONTROL EASY TOUCH SAFETY QL(6.6667 ea
1B LANCETS23G/PRESSURE 1B daily)
SOLUTION HIGH SOLN
ACTIVATED MISC
EASY TALK CONTROL 1B
SOLUTION HIGH SOLN EASY TOUCH SAFETY QL(6.6667 ea
LANCETS26G/BUTTON 1B daily)
EASY TOUCH LANCETS QL(6.6667 ea ACTIVATED MISC
21G/PRESSURE 1B daily)
ACTIVATED MISC EASY TOUCH SAFETY QL(6.6667 ea
LANCETS26G/PRESSURE 1B daily)
LANCETS28G/BUTTON 1B daily)
LANCETS28G/PRESSURE 1B daily)
EASY TOUCH LANCETS 1B QL(6.6667 ea ACTIVATED MISC
26G/PULL-TOP MISC daily)
EASY TRAK GLUCOSE
EASY TOUCH LANCETS QL(6.6667 ea CONTROLSOLUTION 1B
28G/PRESSURE 1B daily) HIGH SOLN
ACTIVATED MISC
EASY TWIST & CAP 1B QL(6.6667 ea
EASY TOUCH LANCETS 1B QL(6.6667 ea LANCETS MISC daily)
28G/PULL-TOP MISC daily)
EASYGLUCO CONTROL 1B
EASY TOUCH LANCETS 1B QL(6.6667 ea SOLUTION HIGH SOLN
28G/TWIST MISC daily)
ELEMENT HIGH 1B
EASY TOUCH LANCETS QL(6.6667 ea CONTROL LIQD
30G/BUTTON-ACTIVATED 1B daily)
MISC
81
EMBRACE GLUCOSE FORACARE GDH
CONTROL SOLUTION 1B CONTROL SOLUTION 1B
HIGH LIQD HIGH SOLN
EMBRACE LANCETS 1B QL(6.6667 ea FORTISCARE CONTROL 1B
ULTRA THIN 30G MISC daily) SOLUTIONS HIGH SOLN
EMBRACE LANCING FREDS PHARMACY
DEVICE WITH EJECTOR 1B AUTOLET LANCING 1B
MISC DEVICE MISC
EMBRACE TALK FREDS PHARMACY QL(6.6667 ea
GLUCOSE CONTROL 1B UNILET LANCETS SUPER 1B daily)
SOLUTION HIGH SOLN THIN 30G MISC
EQL COLOR LANCETS 1B QL(6.6667 ea FREDS PHARMACY QL(6.6667 ea
21G MISC daily) UNILET LANCETS ULTRA 1B daily)
EQL COLOR LANCETS QL(6.6667 ea THIN 28G MISC
1B
MICRO THIN 33G MISC daily) FREESTYLE LANCETS 1B QL(6.6667 ea
EQL SUPER THIN QL(6.6667 ea MISC daily)
1B
LANCETS 30G MISC daily) FREESTYLE UNISTICK II 1B QL(6.6667 ea
EQL THIN LANCETS 26G QL(6.6667 ea LANCETS MISC daily)
1B
MISC daily) GENTEEL BUTTERFLY 1B QL(6.6667 ea
EZ-LETS LANCETS 21G QL(6.6667 ea TOUCH LANCETS MISC daily)
1B
MISC daily) GENTEEL LANCING
EZ-LETS LANCETS 26G QL(6.6667 ea DEVICE/GLORIOUS 1B
1B GOLD MISC
SUPER-SOFT MISC daily)
EZ-LETS LANCETS 28G QL(6.6667 ea GENTEEL LANCING
1B DEVICE/PRECIOUS 1B
ULTRA-SOFT MISC daily)
PLATINUM MISC
EZ-LETS LANCETS 30G 1B QL(6.6667 ea
MISC daily) GENTEEL LANCING
DEVICE/STATELY SILVER 1B
FIFTY50 SAFETY SEAL 1B QL(6.6667 ea MISC
GENTEEL PLUS LANCING
FIFTY50 SAFETY SEAL 1B QL(6.6667 ea DEVICE/BUFF BLACK 1B
LANCETS 32G MISC daily) MISC
FIFTY50 UNILET 1B QL(6.6667 ea GENTEEL PLUS LANCING
LANCETS 33G MISC daily) DEVICE/BUTTERFLY 1B
QL(6.6667 ea BLUE MISC
FINE 30 MISC 1B
daily) GENTEEL PLUS LANCING
FINGERSTIX LANCETS 1B QL(6.6667 ea DEVICE/PLAYFUL 1B
MISC daily) PURPLE MISC
FORA CONTROL 1B GENTEEL PLUS LANCING
SOLUTION HIGH SOLN DEVICE/PRINCESS PINK 1B
QL(6.6667 ea MISC
FORA LANCETS MISC 1B
daily) GENTEEL PLUS LANCING
FORA LANCING DEVICE DEVICE/WILLOWY WHITE 1B
1B MISC
MISC
FORA LANCING GENTLE-LET GP 1B QL(6.6667 ea
1B LANCETS MISC daily)
DEVICE/CLEARCAP MISC
82
GENTLE-LET LANCETS QL(6.6667 ea GOODSENSE LANCETS QL(6.6667 ea
GENERAL PURPOSE 1B daily) ULTRA-THIN 26G 1B daily)
STYLE/FINE POINT MISC UNIVERSAL MISC
GENTLE-LET LANCETS QL(6.6667 ea GOODSENSE LANCETS 1B QL(6.6667 ea
GENERAL PURPOSE 1B daily) ULTRA-THIN 30G MISC daily)
STYLE/MEDIUM POINT GOODSENSE LANCETS QL(6.6667 ea
MISC ULTRA-THIN 30G 1B daily)
GENTLE-LET LANCETS QL(6.6667 ea UNIVERSAL MISC
SAFETY STYLE/FINE 1B daily) GOODSENSE LANCING
POINT MISC 1B
DEVICE MISC
GENTLE-LET LANCETS QL(6.6667 ea H-E-B INCONTROL
SAFETY STYLE/MEDIUM 1B daily) ADVANCEDLANCING 1B
POINT MISC DEVICE MISC
GLOBAL LANCING 1B H-E-B INCONTROL QL(6.6667 ea
DEVICE MISC LANCETS MICRO THIN 1B daily)
GLUCOCOM HIGH 1B 33G MISC
CONTROL LIQD H-E-B INCONTROL QL(6.6667 ea
GLUCOCOM LANCETS 1B QL(6.6667 ea LANCETS SUPER THIN 1B daily)
28G MISC daily) 30G MISC
GLUCOCOM LANCETS 1B QL(6.6667 ea H-E-B INCONTROL QL(6.6667 ea
30G MISC daily) LANCETS ULTRA THIN 1B daily)
GLUCOCOM LANCETS QL(6.6667 ea 28G MISC
1B
33G MISC daily) HAEMOLANCE LOW 1B QL(6.6667 ea
QL(6.6667 ea FLOW LANCETS MISC daily)
GNP LANCETS 21G MISC 1B
daily) QL(6.6667 ea
HAEMOLANCE MISC 1B
GNP LANCETS MICRO QL(6.6667 ea daily)
1B
THIN 33G MISC daily) HAEMOLANCE PLUS 1B QL(6.6667 ea
GNP LANCETS SUPER QL(6.6667 ea HIGH FLOW MISC daily)
1B
THIN 30G MISC daily) HAEMOLANCE PLUS 1B QL(6.6667 ea
GNP LANCETS THIN 26G QL(6.6667 ea LOW FLOW MISC daily)
1B
MISC daily) HAEMOLANCE PLUS 1B QL(6.6667 ea
GNP LANCETS THIN QL(6.6667 ea MAX FLOW MISC daily)
1B
MISC daily) HAEMOLANCE PLUS 1B QL(6.6667 ea
GOJJI LANCING MISC daily)
DEVICE/CLEAR CAP 1B HAEMOLANCE PLUS 1B QL(6.6667 ea
MISC PEDIATRIC FLOW MISC daily)
GOJJI STERILE LANCETS 1B QL(6.6667 ea HEALTH CARE LANCING 1B
30G MISC daily) DEVICE MISC
GOODSENSE COLOR QL(6.6667 ea HEALTHY ACCENTS
LANCETS MICRO-THIN 1B daily) AUTOLET IMPRESSION 1B
33G UNIVERSAL MISC LANCING DEVICE MISC
GOODSENSE LANCETS 1B QL(6.6667 ea HEALTHY ACCENTS QL(6.6667 ea
MICRO-THIN 33G MISC daily) UNILET LANCETS SUPER 1B daily)
GOODSENSE LANCETS QL(6.6667 ea THIN 30G MISC
MICRO-THIN 33G 1B daily) QL(6.6667 ea
HY-VEE LANCETS MISC 1B
UNIVERSAL MISC daily)
83
HY-VEE THIN LANCETS 1B QL(6.6667 ea LANCETS 31G TWIST 1B QL(6.6667 ea
MISC daily) TOP MISC daily)
IN TOUCH LANCING 1B LANCETS 33G EXTRA 1B QL(6.6667 ea
DEVICE MISC FINE MISC daily)
IN TOUCH STERILE 1B QL(6.6667 ea LANCETS MICRO THIN 1B QL(6.6667 ea
LANCETS30G MISC daily) 33G MISC daily)
INFINITY CONTROL 1B QL(6.6667 ea
1B LANCETS MISC
SOLUTION HIGH SOLN daily)
QL(6.6667 ea LANCETS SAFETY SEAL 1B QL(6.6667 ea
KINNEY LANCETS MISC 1B
daily) 21G MISC daily)
KINNEY THIN LANCETS 1B QL(6.6667 ea LANCETS SAFETY SEAL 1B QL(6.6667 ea
MISC daily) 26G MISC daily)
KROGER AUTOLET 1B LANCETS SAFETY SEAL 1B QL(6.6667 ea
LANCING DEVICE MISC 28G MISC daily)
KROGER HEALTHPRO QL(6.6667 ea LANCETS SAFETY SEAL 1B QL(6.6667 ea
TWIST LANCETS/26G 1B daily) 30G MISC daily)
MISC LANCETS SUPER THIN 1B QL(6.6667 ea
KROGER LANCETS 21G 1B QL(6.6667 ea 28G MISC daily)
MISC daily)
LANCETS THIN MISC 1B QL(6.6667 ea
KROGER LANCETS 1B QL(6.6667 ea daily)
MICRO THIN33G MISC daily) LANCETS TWIST TOP 1B QL(6.6667 ea
QL(6.6667 ea MISC daily)
KROGER LANCETS MISC 1B
daily) LANCETS ULTRA THIN 1B QL(6.6667 ea
KROGER LANCETS 1B QL(6.6667 ea 30G MISC daily)
SUPER THIN MISC daily) LANCETS ULTRA THIN 1B QL(6.6667 ea
KROGER LANCETS THIN 1B QL(6.6667 ea MISC daily)
26G MISC daily) LANCETSBULLSEYE 1B QL(6.6667 ea
KROGER LANCETS THIN 1B QL(6.6667 ea SAFETY MISC daily)
MISC daily) LANCING DEVICE 1B
KROGER LANCETS 1B QL(6.6667 ea ADJUSTABLE MISC
ULTRATHIN30G MISC daily)
LANCING DEVICE MISC 1B
KROGER LANCING 1B
DEVICE MISC LANZO MISC 1B
LANCET DEVICE 1B
ADJUSTABLE MISC LEADER ADVANCED 1B
LANCET DEVICE WITH LANCING DEVICE MISC
1B LIBERTY CONTROL
EJECTOR MISC 1B
LANCETS 26G TWIST QL(6.6667 ea SOLUTION HIGH SOLN
1B LIBERTY MEDICAL QL(6.6667 ea
TOP MISC daily) 1B
QL(6.6667 ea LANCETS 30G MISC daily)
LANCETS 30G MISC 1B LIBERTY MINI LANCING
daily) 1B
LANCETS 30G TWIST QL(6.6667 ea DEVICE MISC
1B LIFESCAN UNISTIK 2 QL(6.6667 ea
TOP MISC daily)
LANCETS 30G/TWIST QL(6.6667 ea DEEP PENETRATION 1B daily)
1B MISC
TOP MISC daily)
84
LIFESCAN UNISTIK II 1B QL(6.6667 ea MEDLANCE PLUS QL(6.6667 ea
LANCETS MISC daily) SPECIAL LANCETS 1B daily)
LITE TOUCH LANCETS 0.8MM MISC
1B QL(6.6667 ea
MISC daily) MEDLANCE PLUS 1B QL(6.6667 ea
LITE TOUCH LANCING SUPERLITE 30G MISC daily)
1B
PEN MISC MEDLANCE PLUS QL(6.6667 ea
LITETOUCH LANCETS QL(6.6667 ea SUPERLITE 1B daily)
1B 30G/COMFORT MAX
MICRO THIN 33G MISC daily)
MISC
LIVE BETTER ADVANCED 1B
LANCING DEVICE MISC MEDLANCE PLUS QL(6.6667 ea
UNIVERSAL LANCETS 1B daily)
LIVE BETTER LANCET 1B QL(6.6667 ea 21G MISC
SUPERTHIN 30G MISC daily)
MEDLANCE PLUS/LITE 1B QL(6.6667 ea
LIVE BETTER LANCET 1B QL(6.6667 ea 25G MISC daily)
ULTRATHIN 28G MISC daily)
QL(6.6667 ea
LONGS LANCETS QL(6.6667 ea MEDLANCE/EXTRA MISC 1B
1B daily)
STANDARD MISC daily)
QL(6.6667 ea
LONGS LANCETS THIN QL(6.6667 ea MEDLANCE/LITE MISC 1B
1B daily)
MISC daily)
MEDLANCE/UNIVERSAL 1B QL(6.6667 ea
LONGS LANCETS ULTRA 1B QL(6.6667 ea MISC daily)
THIN MISC daily)
MEIJER COLOR QL(6.6667 ea
MEDICHOICE PRE-SET QL(6.6667 ea LANCETS UNIVERSAL 1B daily)
SAFETY LANCET DUAL 1B daily) 33G MISC
USE MISC
QL(6.6667 ea
MEDICHOICE PRE-SET QL(6.6667 ea MEIJER LANCETS MISC 1B
daily)
SAFETY LANCET LOW 1B daily)
FLOW MISC MEIJER LANCETS THIN 1B QL(6.6667 ea
MISC daily)
MEDICHOICE PRE-SET QL(6.6667 ea
SAFETY LANCET 1B daily) MEIJER LANCETS 1B QL(6.6667 ea
MEDIUM FLOW MISC UNIVERSAL21G MISC daily)
MEDICHOICE PRE-SET QL(6.6667 ea MEIJER LANCETS 1B QL(6.6667 ea
SAFETY LANCET 1B daily) UNIVERSAL30G MISC daily)
MODERATE FLOW MISC MEIJER LANCETS 1B QL(6.6667 ea
MEDICHOICE SAFETY QL(6.6667 ea UNIVERSAL33G MISC daily)
1B
LANCETEXTRA MISC daily) MEIJER SUPER THIN 1B QL(6.6667 ea
MEDICHOICE SAFETY QL(6.6667 ea LANCETS MISC daily)
1B
LANCETNORMAL MISC daily) MICROLET LANCETS 1B QL(6.6667 ea
MEDISENSE THIN QL(6.6667 ea MISC daily)
1B
LANCETS MISC daily) MICROLET NEXT MISC 1B
MEDLANCE PLUS EXTRA 1B QL(6.6667 ea
LANCETS 21G MISC daily) MINI LANCING DEVICE 1B
MEDLANCE PLUS QL(6.6667 ea MISC
1B MM LANCING DEVICE
LANCETS LITE 25G MISC daily) 1B
MEDLANCE PLUS QL(6.6667 ea MISC
1B MM TWIST LANCETS QL(6.6667 ea
LANCETS MISC daily) 1B
MEDLANCE PLUS LITE QL(6.6667 ea MISC daily)
1B
85
MONOLET LANCETS 1B QL(6.6667 ea ONETOUCH DELICA QL(6.6667 ea
MISC daily) PLUS LANCETS FINE 30G 1B daily)
MONOLET OPD LANCETS 1B QL(6.6667 ea MISC
MISC daily) ONETOUCH DELICA
MONOLETTOR SAFETY PLUS LANCING DEVICE 1B
1B QL(6.6667 ea MISC
LANCETS MISC daily)
MPD SAFETY LANCET ONETOUCH DELICA
1B QL(6.6667 ea SAFETY LACING DEVICE 1B
21G/1.8MM MISC daily)
MISC
MPD SAFETY LANCET 1B QL(6.6667 ea
28G/1.8MM MISC daily) ONETOUCH FINEPOINT 1B QL(6.6667 ea
LANCETS MISC daily)
MPD SAFETY LANCET 1B QL(6.6667 ea
30G/1.8MM MISC daily) ONETOUCH ULTRASOFT 1B QL(6.6667 ea
LANCETS MISC daily)
MPD SAFETY LANCETS 1B QL(6.6667 ea
23G/1.8MM MISC daily) ONETOUCH VERIO
CONTROL SOLUTION 1B
MULTI-LANCET DEVICE 1B HIGH SOLN
MISC
PC LANCETS SUPER 1B QL(6.6667 ea
MYGLUCOHEALTH MGH QL(6.6667 ea THIN 30G MISC daily)
SOFTLANCE LANCETS 1B daily)
30G MISC PERFECT LANCETS 30G 1B QL(6.6667 ea
MISC daily)
NOVA SAFETY LANCETS 1B QL(6.6667 ea
23G MISC daily) PERFECT PRESSURE QL(6.6667 ea
ACTIVATED SAFETY 1B daily)
NOVA SAFETY LANCETS 1B QL(6.6667 ea LANCETS 28G MISC
28G MISC daily)
PHARMACY COUNTER 1B QL(6.6667 ea
NOVA SUREFLEX 1B QL(6.6667 ea LANCETS MISC daily)
LANCETS MISC daily)
NOVA SUREFLEX PIP LANCETS/28G MISC 1B QL(6.6667 ea
1B daily)
LANCING DEVICE MISC
ON CALL LANCING PIP LANCETS/30G MISC 1B QL(6.6667 ea
1B daily)
DEVICE MISC
PRECISION THINS GP 1B QL(6.6667 ea
ON CALL PLUS LANCING 1B LANCET MISC daily)
DEVICE MISC
PREFERRED PLUS QL(6.6667 ea
ONETOUCH CLUB QL(6.6667 ea LANCETS COLORED 21G 1B daily)
LANCETS FINE POINT 1B daily) MISC
MISC
PREFERRED PLUS QL(6.6667 ea
ONETOUCH DELICA QL(6.6667 ea LANCETS SUPER THIN 1B daily)
LANCETS EXTRA FINE 1B daily) 30G MISC
33G MISC
PREFERRED PLUS 1B QL(6.6667 ea
ONETOUCH DELICA 1B QL(6.6667 ea LANCETS THIN 26G MISC daily)
LANCETS FINE 30G MISC daily)
PRESSURE ACTIVATED QL(6.6667 ea
ONETOUCH DELICA 1B SAFETYLANCET 21G 1B daily)
LANCING DEVICE MISC MISC
ONETOUCH DELICA QL(6.6667 ea PRODIGY CONTROL
PLUS LANCETS EXTRA 1B daily) 1B
SOLUTIONHIGH SOLN
FINE 33G MISC
PRODIGY LANCING 1B
DEVICE MISC
86
PRODIGY PRESSURE QL(6.6667 ea READYLANCE SAFETY QL(6.6667 ea
ACTIVATED SAFETY 1B daily) LANCETS/23G/1.8MM 1B daily)
LANCETS MISC MISC
PRODIGY SAFETY 1B QL(6.6667 ea READYLANCE SAFETY QL(6.6667 ea
LANCETS MISC daily) LANCETS/26G/1.8MM 1B daily)
PRODIGY TWIST TOP QL(6.6667 ea MISC
1B
LANCETS MISC daily) READYLANCE SAFETY QL(6.6667 ea
PSS SELECT GP QL(6.6667 ea LANCETS/28G/1.8MM 1B daily)
1B MISC
LANCETS MISC daily)
PSS SELECT SAFETY QL(6.6667 ea READYLANCE SAFETY QL(6.6667 ea
1B LANCETS/30G/1.6MM 1B daily)
LANCETS MISC daily)
MISC
PUSH BUTTON SAFETY 1B QL(6.6667 ea
LANCETS 21G MISC daily) QL(6.6667 ea
REALITY LANCETS MISC 1B
daily)
PUSH BUTTON SAFETY 1B QL(6.6667 ea
LANCETS 28G MISC daily) REALITY TRIGGER 1B QL(6.6667 ea
LANCETS MISC daily)
PX ADVANCED LANCING 1B
DEVICE MISC RELION 2-IN-1 LANCET 1B
DEVICES 30G MISC
PX LANCET AUTO 1B
INJECTOR MISC RELION 2-IN-1 LANCING 1B
DEVICE 25G MISC
PX LANCETS ULTRA 1B QL(6.6667 ea
THIN 28G MISC daily) RELION 2-IN-1 LANCING 1B
DEVICE 30G MISC
PX LANCETS ULTRA 1B QL(6.6667 ea
THIN MISC daily) RELION LANCETS 1B QL(6.6667 ea
MICRO-THIN33G MISC daily)
QC ADVANCED LANCING 1B
DEVICE MISC RELION LANCETS THIN 1B QL(6.6667 ea
26G MISC daily)
QC LANCETS SUPER 1B QL(6.6667 ea
THIN MISC daily) RELION LANCETS 1B QL(6.6667 ea
ULTRA-THIN30G MISC daily)
QC LANCETS ULTRA 1B QL(6.6667 ea
THIN MISC daily) RELION LANCING 1B
DEVICE MISC
QC UNILET LANCETS 1B QL(6.6667 ea
28G/ULTRA THIN MISC daily) RELION ULTRA THIN 1B QL(6.6667 ea
LANCETS/30G MISC daily)
QC UNILET LANCETS 1B QL(6.6667 ea
33G/MICRO THIN MISC daily) RELION ULTRA THIN 1B QL(6.6667 ea
LANCETS30G MISC daily)
RA E-ZJECT LANCETS 1B QL(6.6667 ea
28G MISC daily) RELION ULTRA THIN QL(6.6667 ea
PLUS LANCETS 32G 1B daily)
RA E-ZJECT LANCETS 1B QL(6.6667 ea MISC
THIN 26G MISC daily)
RELION ULTRA THIN QL(6.6667 ea
RA E-ZJECT LANCETS 1B QL(6.6667 ea PLUS LANCETS 33G 1B daily)
THIN 28G MISC daily) MISC
RA E-ZJECT LANCETS 1B QL(6.6667 ea REXALL LANCETS ULTRA QL(6.6667 ea
ULTRATHIN 30G MISC daily) 1B
THIN MISC daily)
READYLANCE SAFETY QL(6.6667 ea RIGHTEST GC300 HIGH
LANCETS/21G/2.2MM 1B daily) 1B
CONTROL LIQD
MISC
RIGHTEST GD500 1B
LANCING DEVICE MISC
87
RIGHTEST GL300 1B QL(6.6667 ea SIDE BUTTON SAFETY 1B QL(6.6667 ea
LANCETS MISC daily) LANCET21G MISC daily)
SAFE-T-LANCE LOW 1B QL(6.6667 ea SIMPLE DIAGNOSTICS 1B
FLOW 25G MISC daily) LANCING DEVICE MISC
SAFE-T-LANCE NORMAL 1B QL(6.6667 ea QL(6.6667 ea
SINGLE-LET MISC 1B
FLOW21G MISC daily) daily)
SAFE-T-LANCE PLUS QL(6.6667 ea SM MICRO THIN 1B QL(6.6667 ea
SAFETYLANCET HIGH 1B daily) LANCETS 33G MISC daily)
FLOW MISC SM TRUEDRAW LANCING 1B
SAFE-T-LANCE PLUS QL(6.6667 ea DEVICE MISC
SAFETYLANCET LOW 1B daily) SMART DIABETES
FLOW MISC VANTAGE LANCING 1B
SAFE-T-LANCE PLUS QL(6.6667 ea DEVICE MISC
SAFETYLANCET 1B daily) SMART SENSE COLOR QL(6.6667 ea
NORMAL FLOW MISC LANCETS UNIVERSAL 1B daily)
SAFETY LANCET QL(6.6667 ea 33G MISC
21G/PRESSURE 1B daily) SMART SENSE QL(6.6667 ea
ACTIVATED MISC STANDARD LANCETS 1B daily)
SAFETY LANCET QL(6.6667 ea UNIVERSAL 21G MISC
23G/PRESSURE 1B daily) SMART SENSE SUPER QL(6.6667 ea
ACTIVATED MISC THIN LANCETS 1B daily)
SAFETY LANCET QL(6.6667 ea UNIVERSAL 30G MISC
28G/PRESSURE 1B daily) SMART SENSE THIN QL(6.6667 ea
ACTIVATED MISC LANCETSUNIVERSAL 1B daily)
SAFETY LANCETS 21G 1B QL(6.6667 ea 26G MISC
MISC daily) SMARTEST LANCETS QL(6.6667 ea
1B
SAFETY LANCETS 28G 1B QL(6.6667 ea 28G MISC daily)
MISC daily) SOLUS V2 CONTROL 1B
SAFETY LET LANCETS 1B QL(6.6667 ea HIGH SOLN
MISC daily) SOLUS V2 LANCING 1B
QL(6.6667 ea DEVICE MISC
SB LANCETS THIN MISC 1B
daily) SOLUS V2 PRESSURE QL(6.6667 ea
SB LANCETS ULTRA 1B QL(6.6667 ea ACTIVATED SAFETY 1B daily)
THIN MISC daily) LANCETS 28G MISC
SELECT-LITE LANCING 1B SOLUS V2 TWIST 1B QL(6.6667 ea
DEVICE MISC LANCETS 30G MISC daily)
SHOPKO AUTOLET QL(6.6667 ea
1B STERILANCE TL MISC 1B
LANCING DEVICE MISC daily)
SHOPKO ON-THE-GO QL(6.6667 ea SUPER THIN LANCETS 1B QL(6.6667 ea
COMFORTLANCETS 30G 1B daily) MISC daily)
MISC SURE COMFORT QL(6.6667 ea
1B
SHOPKO UNILET QL(6.6667 ea LANCETS 18G MISC daily)
LANCETS SUPER THIN 1B daily) SURE COMFORT QL(6.6667 ea
30G MISC 1B
SHOPKO UNILET QL(6.6667 ea SURE COMFORT QL(6.6667 ea
LANCETS ULTRA THIN 1B daily) 1B
28G MISC
88
SURE COMFORT 1B QL(6.6667 ea TOPCARE LANCETS 1B QL(6.6667 ea
LANCETS 28G MISC daily) MICRO-THIN 33G MISC daily)
SURE COMFORT 1B QL(6.6667 ea TRAVEL LANCETS 30G 1B QL(6.6667 ea
LANCETS 30G MISC daily) MISC daily)
SURE COMFORT 1B TRAVEL LANCETS 1B QL(6.6667 ea
LANCING PEN MISC ADVANCED 28G MISC daily)
SURE-LANCE FLAT 1B QL(6.6667 ea TRUE METRIX CONTROL
LANCETS MISC daily) SOLUTION LEVEL 3 1B
SURE-LANCE LANCETS QL(6.6667 ea SOLN
1B
26G MISC daily) TRUEDRAW LANCING 1B
SURE-LANCE THIN QL(6.6667 ea DEVICE MISC
1B
LANCETS 28G MISC daily) TRUEPLUS LANCETS 1B QL(6.6667 ea
SURE-LANCE ULTRA QL(6.6667 ea 26G MISC daily)
1B
THIN LANCETS MISC daily) TRUEPLUS LANCETS 1B QL(6.6667 ea
28G MISC daily)
SURE-PEN MISC 1B
TRUEPLUS LANCETS 1B QL(6.6667 ea
SURE-TOUCH LANCETS QL(6.6667 ea 28G SUPER THIN MISC daily)
1B
UNIVERSAL MISC daily) TRUEPLUS LANCETS QL(6.6667 ea
1B
SURELITE LANCETS QL(6.6667 ea 30G MISC daily)
1B
MISC daily) TRUEPLUS LANCETS QL(6.6667 ea
1B
SURESTEP PRO HIGH 30G ULTRA THIN MISC daily)
GLUCOSECONTROL 1B TRUEPLUS LANCETS QL(6.6667 ea
LIQD 1B
33G MICRO THIN MISC daily)
TECHLITE AST LANCETS 1B QL(6.6667 ea TRUEPLUS LANCETS QL(6.6667 ea
MISC daily) 1B
33G MISC daily)
TECHLITE LANCETS 30G 1B QL(6.6667 ea TRUEPLUS SAFETY QL(6.6667 ea
MISC daily) 1B
TECHLITE LANCETS 1B QL(6.6667 ea ULTI-LANCE AUTOMATIC/
MISC daily) 1B
CLEAR TIP MISC
TGT LANCET MICRO 1B QL(6.6667 ea ULTILET CLASSIC QL(6.6667 ea
THIN 33G MISC daily) 1B
LANCETS MISC daily)
TGT LANCET THIN 26G 1B QL(6.6667 ea ULTILET LANCETS 33G QL(6.6667 ea
MISC daily) 1B
MISC daily)
TGT LANCET ULTRA 1B QL(6.6667 ea QL(6.6667 ea
THIN 30G MISC daily) ULTILET LANCETS MISC 1B
daily)
TGT LANCING DEVICE 1B ULTILET SAFETY QL(6.6667 ea
MISC LANCETS 21G X 2.2MM 1B daily)
THINLETS GP LANCETS QL(6.6667 ea MISC
1B
MISC daily) ULTILET SAFETY QL(6.6667 ea
1B
TODAYS HEALTH LANCETS 23G MISC daily)
ADVANCED LANCING 1B ULTRA THIN LANCETS QL(6.6667 ea
DEVICE MISC 1B
31G MISC daily)
TODAYS HEALTH SUPER 1B QL(6.6667 ea ULTRA-THIN II AUTO QL(6.6667 ea
THINLANCETS 30G MISC daily) 1B
LANCET MISC daily)
TODAYS HEALTH ULTRA 1B QL(6.6667 ea ULTRA-THIN II LANCETS QL(6.6667 ea
THINLANCETS 28G MISC daily) 1B
28G MISC daily)
89
ULTRA-THIN II LANCETS 1B QL(6.6667 ea UNIVERSAL 1 LANCETS 1B QL(6.6667 ea
30G MISC daily) THIN26G MISC daily)
UNILET COMFORTOUCH 1B QL(6.6667 ea UNIVERSAL 1 LANCETS 1B QL(6.6667 ea
LANCET MISC daily) ULTRA THIN 30G MISC daily)
UNILET EXCELITE II MISC 1B QL(6.6667 ea UNIVERSAL 1 QL(6.6667 ea
daily) LANCETS/33G/MICRO- 1B daily)
THIN MISC
UNILET EXCELITE MISC 1B QL(6.6667 ea
daily) VALUE PLUS LANCETS 1B QL(6.6667 ea
UNILET G.P. LANCET STANDARD 21G MISC daily)
1B QL(6.6667 ea
MISC daily) VALUE PLUS LANCETS 1B QL(6.6667 ea
UNILET G.P. SUPERLITE SUPERTHIN 30G MISC daily)
1B QL(6.6667 ea
LANCET MISC daily) VALUE PLUS LANCETS 1B QL(6.6667 ea
UNILET GP 28 ULTRA THIN 26G MISC daily)
1B QL(6.6667 ea
THIN MISC daily) VALUE PLUS LANCING 1B
DEVICE MISC
UNILET LANCET MISC 1B QL(6.6667 ea
daily) VALUMARK LANCET 1B QL(6.6667 ea
UNILET LANCETS SUPER THIN 30G MISC daily)
1B QL(6.6667 ea
MICRO-THIN33G MISC daily) VALUMARK LANCET 1B QL(6.6667 ea
UNILET LANCETS ULTRA THIN 28G MISC daily)
1B QL(6.6667 ea
SUPER-THIN30G MISC daily) VIDA MIA AUTOLET 1B
UNILET LANCETS LANCINGDEVICE MISC
1B QL(6.6667 ea
ULTRA-THIN 28G MISC daily) VIDA MIA UNILET QL(6.6667 ea
UNILET SUPERLITE LANCETS SUPER THIN 1B daily)
1B QL(6.6667 ea 30G MISC
LANCET MISC daily)
VIDA MIA UNILET QL(6.6667 ea
UNISTIK 3 GENTLE MISC 1B QL(6.6667 ea LANCETS ULTRA THIN 1B daily)
daily)
28G MISC
UNISTIK PRO SAFETY 1B QL(6.6667 ea
LANCET 21G MISC daily) VIVAGUARD LANCETS 1B QL(6.6667 ea
MISC daily)
LANCET 25G MISC daily) VIVAGUARD LANCING 1B
DEVICE MISC
LANCET 28G MISC daily) WALGREENS ADVANCED QL(6.6667 ea
TRAVELLANCETS 28G 1B daily)
UNISTIK SAFETY 1B QL(6.6667 ea MISC
WALGREENS COMFORT QL(6.6667 ea
UNISTIK SAFETY 1B QL(6.6667 ea ASSUREDLANCETS 1B daily)
LANCETS 30G MISC daily) MICRO THIN/33G MISC
UNISTIK TOUCH SAFETY 1B QL(6.6667 ea WALGREENS COMFORT QL(6.6667 ea
LANCETS 21G MISC daily) ASSUREDLANCETS 1B daily)
UNISTIK TOUCH SAFETY 1B QL(6.6667 ea SUPER THIN/28G MISC
LANCETS 23G MISC daily) WALGREENS LANCETS QL(6.6667 ea
UNISTIK TOUCH SAFETY 1B
1B QL(6.6667 ea MISC daily)
LANCETS 28G MISC daily) WALGREENS THIN QL(6.6667 ea
UNISTIK TOUCH SAFETY 1B
1B QL(6.6667 ea LANCETS MISC daily)
LANCETS 30G MISC daily) WALGREENS ULTRA QL(6.6667 ea
UNISTRIP CONTROL 1B
1B THIN LANCETS MISC daily)
SOLUTIONHIGH SOLN
90
Parenteral Therapy Supplies B-D INSULIN SYRINGE QL(5 ea daily)
ULTRAFINE/0.3ML/30G X 1B
ADVOCATE INSULIN QL(5 ea daily); 1/2" MISC
SYRINGE/U- 1B RX/OTC
100/0.3ML/29GX1/2" MISC B-D INSULIN SYRINGE QL(5 ea daily)
ULTRAFINE/0.5ML/30G X 1B
100/0.3ML/30GX5/16" BD LO-DOSE INSULIN QL(5 ea daily);
MISC SYRINGE MICROFINE 1B RX/OTC
IV/0.5ML/28G X 1/2" MISC
ADVOCATE INSULIN QL(5 ea daily)
SYRINGE/U- BD AUTOSHIELD 29G X 1B QL(5 ea daily)
1B 3/16" MISC
100/0.3ML/31GX5/16"
MISC BD AUTOSHIELD 29G X QL(5 ea daily)
1B
SYRINGE/U- 1B RX/OTC BD AUTOSHIELD DUO QL(5 ea daily)
100/0.5ML/29GX1/2" MISC 1B
30G X 5MM MISC
ADVOCATE INSULIN QL(5 ea daily); BD INSULIN SYRINGE QL(5 ea daily);
SYRINGE/U- 1B RX/OTC LUER-LOK/U-100/1ML 1B RX/OTC
100/0.5ML/30GX5/16" MISC
MISC BD INSULIN SYRINGE QL(5 ea daily);
ADVOCATE INSULIN QL(5 ea daily) MICROFINE IV/U- RX/OTC
SYRINGE/U- 1B
1B 100/0.5ML/28G X 1/2"
100/0.5ML/31GX5/16" MISC
MISC BD INSULIN SYRINGE QL(5 ea daily)
ADVOCATE INSULIN QL(5 ea daily); MICROFINE IV/U- 1B
SYRINGE/U- 1B RX/OTC 100/1ML/27G X 5/8" MISC
100/1ML/29GX1/2" MISC BD INSULIN SYRINGE QL(5 ea daily);
ADVOCATE INSULIN QL(5 ea daily); MICROFINE IV/U- 1B RX/OTC
SYRINGE/U- 1B RX/OTC 100/1ML/28G X 1/2" MISC
100/1ML/30GX5/16" MISC BD INSULIN SYRINGE QL(5 ea daily);
ADVOCATE INSULIN QL(5 ea daily) MICROFINE/U- RX/OTC
SYRINGE/U- 1B 1B
100/0.5ML/28G X 1/2"
100/1ML/31GX5/16" MISC MISC
ASSURE ID INSULIN QL(5 ea daily); BD INSULIN SYRINGE QL(5 ea daily)
SAFETYSYRINGE/U- 1B RX/OTC MICROFINE/U- 1B
100/0.5ML/29G X 1/2" 100/1ML/27G X 5/8" MISC
MISC BD INSULIN SYRINGE QL(5 ea daily);
ASSURE ID INSULIN QL(5 ea daily); MICROFINE/U- 1B RX/OTC
SAFETYSYRINGE/U- 1B RX/OTC 100/1ML/28G X 1/2" MISC
100/1ML/29G X 1/2" MISC BD INSULIN SYRINGE QL(5 ea daily);
B-D INSULIN SYRINGE QL(5 ea daily) SAFETYGLIDE/1ML/29G X 1B RX/OTC
ULTRAFINE II/0.3ML/31G 1B 1/2" MISC
X 5/16" MISC BD INSULIN SYRINGE QL(5 ea daily);
B-D INSULIN SYRINGE QL(5 ea daily) 1B
SLIP TIP/U-100/1ML MISC RX/OTC
ULTRAFINE II/0.5ML/31G 1B BD INSULIN SYRINGE QL(5 ea daily)
X 5/16" MISC ULTRA-FINE/0.3ML/30G X 1B
B-D INSULIN SYRINGE QL(5 ea daily) 12.7MM MISC
ULTRAFINE II/1ML/31G X 1B
5/16" MISC
91
BD INSULIN SYRINGE QL(5 ea daily) BD INSULIN SYRINGE QL(5 ea daily);
ULTRA-FINE/0.3ML/31G X 1B ULTRAFINE/U- 1B RX/OTC
8MM MISC 100/1ML/29G X 1/2" MISC
BD INSULIN SYRINGE QL(5 ea daily) BD INSULIN SYRINGE QL(5 ea daily)
ULTRA-FINE/0.5ML/30G X 1B ULTRAFINE/U- 1B
12.7MM MISC 100/1ML/31G X 5/16"
BD INSULIN SYRINGE QL(5 ea daily) MISC
ULTRA-FINE/0.5ML/31G X 1B BD INSULIN QL(5 ea daily);
8MM MISC SYRINGE/0.3ML/29G X 1B RX/OTC
BD INSULIN SYRINGE QL(5 ea daily) 12.7MM MISC
ULTRA-FINE/1/2 1B BD INSULIN QL(5 ea daily);
UNIT/0.3ML/31G X 8MM SYRINGE/0.5ML/29G X 1B RX/OTC
MISC 12.7MM MISC
BD INSULIN SYRINGE QL(5 ea daily) BD INSULIN QL(5 ea daily);
ULTRA-FINE/1ML/30G X 1B SYRINGE/1ML/27G X 1B RX/OTC
12.7MM MISC 12.7MM MISC
BD INSULIN SYRINGE QL(5 ea daily) BD INSULIN QL(5 ea daily);
ULTRA-FINE/1ML/31G X 1B SYRINGE/1ML/29G X 1B RX/OTC
8MM MISC 12.7MM MISC
BD INSULIN SYRINGE QL(5 ea daily) BD INSULIN QL(5 ea daily)
ULTRAFINE HALF- 1B SYRINGE/DETACHABLE 1B
UNIT/0.3ML/31G X 5/16" NEEDLE/U-100/1ML/25G
MISC X 1" MISC
BD INSULIN SYRINGE QL(5 ea daily) BD INSULIN QL(5 ea daily)
ULTRAFINE/0.3ML/30G X 1B SYRINGE/DETACHABLE 1B
1/2" MISC NEEDLE/U-100/1ML/25G
BD INSULIN SYRINGE QL(5 ea daily) X 5/8" MISC
ULTRAFINE/0.3ML/31G X 1B BD INSULIN QL(5 ea daily)
5/16" MISC SYRINGE/DETACHABLE 1B
BD INSULIN SYRINGE QL(5 ea daily) NEEDLE/U-100/1ML/26G
ULTRAFINE/0.5ML/30G X 1B X 1/2" MISC
1/2" MISC BD INSULIN SYRINGE/U- 1B QL(5 ea daily);
BD INSULIN SYRINGE QL(5 ea daily) 100/1ML/27G X 1/2" MISC RX/OTC
ULTRAFINE/0.5ML/31G X 1B BD PEN QL(5 ea daily)
5/16" MISC NEEDLE/MICRO/ULTRA- 1B
BD INSULIN SYRINGE QL(5 ea daily) FINE/32G X 6MM MISC
ULTRAFINE/1ML/30G X 1B BD PEN QL(5 ea daily);
1/2" MISC NEEDLE/MINI/ULTRA- 1B RX/OTC
BD INSULIN SYRINGE QL(5 ea daily); FINE/31G X 5MM MISC
ULTRAFINE/U- 1B RX/OTC BD PEN NEEDLE/NANO QL(5 ea daily);
100/0.3ML/29G X 1/2" 2ND GEN/32G X 5/32" 1B RX/OTC
MISC MISC
BD INSULIN SYRINGE QL(5 ea daily); BD PEN QL(5 ea daily);
ULTRAFINE/U- 1B RX/OTC NEEDLE/NANO/ULTRA- 1B RX/OTC
100/0.5ML/29G X 1/2" FINE/32G X 4MM MISC
MISC
92
BD PEN QL(5 ea daily) CAREONE INSULIN QL(5 ea daily)
NEEDLE/ORIGINAL/ULTR 1B SYRINGES/0.5ML/31G X 1B
A-FINE/29G X 12.7MM 5/16" MISC
MISC CAREONE INSULIN QL(5 ea daily)
BD PEN QL(5 ea daily); SYRINGES/1ML/30G X 1B
NEEDLE/SHORT/ULTRA- 1B RX/OTC 1/2" MISC
FINE/31G X 8MM MISC CAREONE INSULIN QL(5 ea daily)
BD SAFETY-GLIDE QL(5 ea daily); SYRINGES/1ML/31GX5/16 1B
INSULIN 1B RX/OTC " MISC
SYRINGE/0.5ML/29G X CARETOUCH INSULIN QL(5 ea daily)
1/2" MISC SYRINGE/0.3ML/31GX5/1 1B
BD SAFETY-LOK INSULIN QL(5 ea daily); 6" MISC
SYRINGE/PERM 1B RX/OTC CARETOUCH INSULIN QL(5 ea daily)
NEEDLE/UF/1ML/29G X SYRINGE/0.5ML/31GX5/1 1B
1/2" MISC 6" MISC
BD SAFETYGLIDE QL(5 ea daily); CARETOUCH INSULIN QL(5 ea daily);
INSULIN 1B RX/OTC SYRINGE/1ML/30GX5/16" 1B RX/OTC
SYRINGE/0.3ML/29G X MISC
1/2" MISC
CARETOUCH INSULIN QL(5 ea daily)
BD SAFETYGLIDE QL(5 ea daily) SYRINGE/1ML/31GX5/16" 1B
INSULIN 1B MISC
SYRINGE/0.3ML/31G X
5/16" MISC CARETOUCH INSULIN QL(5 ea daily);
SYRINGE0.5ML/30GX5/16 1B RX/OTC
BD SAFETYGLIDE QL(5 ea daily) " MISC
INSULIN 1B
SYRINGE/1ML/31G X CLEVER CHOICE QL(5 ea daily);
15/64" MISC COMFORT EZINSULIN 1B RX/OTC
SYRINGE/0.3ML/29G X
BD SAFETYGLIDE QL(5 ea daily); 1/2" MISC
INSULIN 1B RX/OTC
SYSYRINGE/0.5ML/30G X CLEVER CHOICE QL(5 ea daily)
5/16" MISC COMFORT EZINSULIN 1B
SYRINGE/0.3ML/30G X
BD VEO INSULIN QL(5 ea daily) 1/2" MISC
SYRINGE ULTRA- 1B
FINE/1ML/31G X 6MM CLEVER CHOICE QL(5 ea daily);
MISC COMFORT EZINSULIN 1B RX/OTC
SYRINGE/0.3ML/30G X
BD VEO INSULIN QL(5 ea daily) 5/16" MISC
SYRINGE ULTRA-FINE/U- 1B
100/1ML/31G X 15/64" CLEVER CHOICE QL(5 ea daily)
MISC COMFORT EZINSULIN 1B
SYRINGE/0.3ML/31G X
CAREONE INSULIN QL(5 ea daily) 5/16" MISC
SYRINGES/0.3ML/30G X 1B
1/2" MISC CLEVER CHOICE QL(5 ea daily);
COMFORT EZINSULIN 1B RX/OTC
CAREONE INSULIN QL(5 ea daily) SYRINGE/0.5ML/28G X
SYRINGES/0.3ML/31G X 1B 1/2" MISC
5/16" MISC
CLEVER CHOICE QL(5 ea daily);
CAREONE INSULIN QL(5 ea daily) COMFORT EZINSULIN RX/OTC
SYRINGES/0.5ML/30G X 1B 1B
SYRINGE/0.5ML/29G X
1/2" MISC 1/2" MISC
93
CLEVER CHOICE QL(5 ea daily) COMFORT ASSIST QL(5 ea daily);
COMFORT EZINSULIN 1B INSULIN 1B RX/OTC
SYRINGE/0.5ML/30G X SYRINGE/0.5ML/30G X
1/2" MISC 5/16" MISC
CLEVER CHOICE QL(5 ea daily); COMFORT ASSIST QL(5 ea daily)
COMFORT EZINSULIN 1B RX/OTC INSULIN 1B
SYRINGE/0.5ML/30G X SYRINGE/0.5ML/31G X
5/16" MISC 5/16" MISC
SYRINGE/0.5ML/31G X SYRINGE/1ML/29G X 1/2"
5/16" MISC MISC
SYRINGE/1.0ML/30G X SYRINGE/1ML/30G X
CLEVER CHOICE QL(5 ea daily); COMFORT ASSIST QL(5 ea daily)
COMFORT EZINSULIN 1B RX/OTC INSULIN 1B
SYRINGE/1ML/28G X 1/2" SYRINGE/1ML/31G X
MISC 5/16" MISC
CLEVER CHOICE QL(5 ea daily); COMFORT EZ INSULIN QL(5 ea daily)
COMFORT EZINSULIN 1B RX/OTC SYRINGE/U- 1B
SYRINGE/1ML/29G X 1/2" 100/0.5ML/31G X 5/16"
MISC MISC
CLEVER CHOICE QL(5 ea daily); COMFORT EZ INSULIN QL(5 ea daily)
COMFORT EZINSULIN 1B RX/OTC SYRINGE/U-100/1ML/31G 1B
SYRINGE/1ML/30G X X 5/16" MISC
5/16" MISC DROPLET INSULIN QL(5 ea daily);
CLEVER CHOICE QL(5 ea daily) SYRINGE 0.3ML/29G X 1B RX/OTC
COMFORT EZINSULIN 1B 1/2" MISC
SYRINGE/U- DROPLET INSULIN QL(5 ea daily);
100/1ML/31GX5/16" MISC SYRINGE 0.5ML/29G X 1B RX/OTC
COMFORT ASSIST QL(5 ea daily); 1/2" MISC
INSULIN SYRINGE 1B RX/OTC DROPLET INSULIN QL(5 ea daily);
0.3ML/29G X 1/2" MISC SYRINGE 1ML/29G X 1/2" 1B RX/OTC
COMFORT ASSIST QL(5 ea daily); MISC
INSULIN 1B RX/OTC DROPLET INSULIN QL(5 ea daily)
SYRINGE/0.3ML/30G X SYRINGE U-100/0.3/31G X 1B
5/16" MISC 5/16" MISC
COMFORT ASSIST QL(5 ea daily) DROPLET INSULIN QL(5 ea daily)
INSULIN 1B SYRINGE U-
SYRINGE/0.3ML/31G X 1B
100/0.3ML/30G X 1/2"
5/16" MISC MISC
COMFORT ASSIST QL(5 ea daily); DROPLET INSULIN QL(5 ea daily);
INSULIN 1B RX/OTC SYRINGE U- RX/OTC
100/0.3ML/30G X 5/16"
1/2" MISC MISC
94
DROPLET INSULIN QL(5 ea daily) EASY COMFORT INSULIN QL(5 ea daily)
SYRINGE U- 1B SYRINGE/0.5ML/31G X 1B
100/0.5ML/30G X 1/2" 5/16" MISC
MISC EASY COMFORT INSULIN QL(5 ea daily);
DROPLET INSULIN QL(5 ea daily); SYRINGE/1ML/30G X 1B RX/OTC
SYRINGE U- 1B RX/OTC 5/16" MISC
100/0.5ML/30G X 5/16" EASY COMFORT INSULIN QL(5 ea daily)
MISC SYRINGE/1ML/31G X 1B
DROPLET INSULIN QL(5 ea daily) 5/16" MISC
SYRINGE U- 1B EASY COMFORT INSULIN QL(5 ea daily)
100/0.5ML/31G X 5/16" SYRINGE/U-
MISC 1B
100/0.5ML/30G X 1/2"
DROPLET INSULIN QL(5 ea daily) MISC
SYRINGE U-100/1ML/30G 1B EASY COMFORT INSULIN QL(5 ea daily)
X 1/2" MISC SYRINGE/U-100/1ML/30G 1B
DROPLET INSULIN QL(5 ea daily); X 1/2" MISC
SYRINGE U-100/1ML/30G 1B RX/OTC EASY TOUCH FLIPLOCK QL(5 ea daily);
X 5/16" MISC SAFETY INSULIN 1B RX/OTC
DROPLET INSULIN QL(5 ea daily) SYRINGE 1ML/29GX1/2"
SYRINGE U-100/1ML/31G 1B MISC
X 15/64" MISC EASY TOUCH FLIPLOCK QL(5 ea daily)
DROPLET INSULIN QL(5 ea daily) SAFETY INSULIN 1B
SYRINGE U-100/1ML/31G 1B SYRINGE 1ML/30GX1/2"
X 5/16" MISC MISC
DROPLET INSULIN QL(5 ea daily) EASY TOUCH FLIPLOCK QL(5 ea daily);
SYRINGE/U- 1B SAFETY INSULIN 1B RX/OTC
100/0.3ML/31G X 5/16" SYRINGE 1ML/30GX5/16"
MISC MISC
DROPLET INSULIN QL(5 ea daily) EASY TOUCH FLIPLOCK QL(5 ea daily)
SYRINGE/U- 1B SAFETY INSULIN 1B
MISC MISC
DROPLET INSULIN QL(5 ea daily) EASY TOUCH INSULIN QL(5 ea daily);
SYRINGE/U- 1B SYRINGE/0.3ML/30G X 1B RX/OTC
100/0.5ML/31G X 5/16" 5/16" MISC
MISC EASY TOUCH INSULIN QL(5 ea daily)
DROPLET INSULIN QL(5 ea daily) SYRINGE/0.3ML/31G X 1B
SYRINGE/U-100/1ML/30G 1B 5/16" MISC
X 1/2" MISC EASY TOUCH INSULIN QL(5 ea daily);
DROPLET INSULIN QL(5 ea daily) SYRINGE/0.5ML/29G X 1B RX/OTC
DROPLET INSULIN QL(5 ea daily) SYRINGE/0.5ML/30G X 1B RX/OTC
EASY COMFORT INSULIN QL(5 ea daily); SYRINGE/1ML/30G X 1B RX/OTC
SYRINGE/0.5ML/30G X 1B RX/OTC 5/16" MISC
5/16" MISC
95
EASY TOUCH INSULIN QL(5 ea daily); EASY TOUCH INSULIN QL(5 ea daily)
SYRINGE/SAFETY/U- 1B RX/OTC SYRINGE/U-100/1ML/30G 1B
100/0.5ML/29G X 1/2" X 1/2" MISC
MISC EASY TOUCH INSULIN QL(5 ea daily)
EASY TOUCH INSULIN QL(5 ea daily); SYRINGE/U-100/1ML/31G 1B
SYRINGE/SAFETY/U- 1B RX/OTC X 5/16" MISC
100/0.5ML/30G X 5/16" EASY TOUCH QL(5 ea daily);
MISC SHEATHLOCK SAFETY RX/OTC
1B
EASY TOUCH INSULIN QL(5 ea daily); INSULIN SYRINGE
SYRINGE/SAFETY/U- 1B RX/OTC 1ML/29GX1/2" MISC
100/1ML/29G X 1/2" MISC EASY TOUCH QL(5 ea daily);
EASY TOUCH INSULIN QL(5 ea daily) SHEATHLOCK SAFETY 1B RX/OTC
SYRINGE/SAFETY/U- 1B INSULIN SYRINGE
100/1ML/30G X 1/2" MISC 1ML/30GX5/16" MISC
EASY TOUCH INSULIN QL(5 ea daily) EASY TOUCH QL(5 ea daily)
SYRINGE/U- 1B SHEATHLOCK SAFETY 1B
100/0.3ML/30G X 1/2" INSULIN SYRINGE
MISC 1ML/31GX5/16" MISC
EASY TOUCH INSULIN QL(5 ea daily) EASY TOUCH QL(5 ea daily)
SYRINGE/U- 1B SHEATHLOCK SAFETY 1B
MISC MISC
EASY TOUCH INSULIN QL(5 ea daily); ELITE-THIN INSULIN QL(5 ea daily)
SYRINGE/U- 1B RX/OTC SYRINGE/0.3ML/31G X 1B
100/0.5ML/28G X 1/2" 5/16" MISC
MISC ELITE-THIN INSULIN QL(5 ea daily);
EASY TOUCH INSULIN QL(5 ea daily); SYRINGE/0.5ML/29G X 1B RX/OTC
SYRINGE/U- 1B RX/OTC 1/2" MISC
100/0.5ML/29G X 1/2" ELITE-THIN INSULIN QL(5 ea daily);
MISC SYRINGE/0.5ML/30G X 1B RX/OTC
EASY TOUCH INSULIN QL(5 ea daily) 5/16" MISC
SYRINGE/U- 1B ELITE-THIN INSULIN QL(5 ea daily);
100/0.5ML/30G X 1/2" SYRINGE/1ML/30G X 1B RX/OTC
MISC 5/16" MISC
EASY TOUCH INSULIN QL(5 ea daily) ELITE-THIN INSULIN QL(5 ea daily);
SYRINGE/U- 1B SYRINGE/U- RX/OTC
100/0.5ML/31G X 5/16" 1B
100/0.5ML/28G X 1/2"
MISC MISC
EASY TOUCH INSULIN QL(5 ea daily); ELITE-THIN INSULIN QL(5 ea daily)
SYRINGE/U-100/1ML/27G 1B RX/OTC SYRINGE/U-
X 1/2" MISC 1B
100/0.5ML/31G X 5/16"
EASY TOUCH INSULIN QL(5 ea daily); MISC
SYRINGE/U-100/1ML/28G 1B RX/OTC ELITE-THIN INSULIN QL(5 ea daily);
X 1/2" MISC SYRINGE/U-100/1ML/28G 1B RX/OTC
EASY TOUCH INSULIN QL(5 ea daily); X 1/2" MISC
SYRINGE/U-100/1ML/29G 1B RX/OTC ELITE-THIN INSULIN QL(5 ea daily);
X 1/2" MISC SYRINGE/U-100/1ML/29G 1B RX/OTC
X 1/2" MISC
96
ELITE-THIN INSULIN QL(5 ea daily) EXEL COMFORT POINT QL(5 ea daily);
SYRINGE/U-100/1ML/31G 1B INSULIN 1B RX/OTC
X 5/16" MISC SYRINGE/0.5ML/30G X
EQL INSULIN QL(5 ea daily); 5/16" MISC
SYRINGE/0.3ML/29G X 1B RX/OTC EXEL COMFORT POINT QL(5 ea daily);
1/2" MISC INSULIN 1B RX/OTC
EQL INSULIN QL(5 ea daily); SYRINGE/1ML/28G X 1/2"
SYRINGE/0.3ML/30G X 1B RX/OTC MISC
5/16" MISC EXEL COMFORT POINT QL(5 ea daily);
EQL INSULIN QL(5 ea daily) INSULIN 1B RX/OTC
SYRINGE/0.3ML/31G X 1B SYRINGE/1ML/29G X 1/2"
5/16" MISC MISC
EQL INSULIN QL(5 ea daily); EXEL COMFORT POINT QL(5 ea daily);
SYRINGE/0.5ML/29G X 1B RX/OTC INSULIN 1B RX/OTC
1/2" MISC SYRINGE/1ML/30G X
5/16" MISC
EQL INSULIN QL(5 ea daily);
SYRINGE/0.5ML/30G X 1B RX/OTC FIFTY50 SUPERIOR QL(5 ea daily)
5/16" MISC COMFORTINSULIN 1B
SYRINGE/0.3ML/31G X
EQL INSULIN QL(5 ea daily) 5/16" MISC
5/16" MISC FIFTY50 SUPERIOR QL(5 ea daily)
COMFORTINSULIN 1B
EQL INSULIN QL(5 ea daily); SYRINGE/0.5ML/31G X
SYRINGE/1ML/29G X 1/2" 1B RX/OTC 5/16" MISC
MISC
FIFTY50 SUPERIOR QL(5 ea daily)
EQL INSULIN QL(5 ea daily); COMFORTINSULIN
SYRINGE/1ML/30G X 1B RX/OTC 1B
SYRINGE/1ML/31G X
5/16" MISC 5/16" MISC
EQL INSULIN QL(5 ea daily) FREESTYLE PRECISION QL(5 ea daily);
SYRINGE/1ML/31G X 1B INSULIN SYRINGE/U- RX/OTC
5/16" MISC 1B
100/0.5ML/30G X 5/16"
EXEL COMFORT POINT QL(5 ea daily); MISC
INSULIN 1B RX/OTC FREESTYLE PRECISION QL(5 ea daily)
SYRINGE/0.3ML/29G X INSULIN SYRINGE/U-
1/2" MISC 1B
100/0.5ML/31G X 5/16"
INSULIN 1B RX/OTC FREESTYLE PRECISION QL(5 ea daily)
SYRINGE/0.3ML/30G X INSULIN SYRINGE/U-
5/16" MISC 1B
100/1ML/31G X 5/16"
INSULIN 1B RX/OTC FREESTYLE PRECISION QL(5 ea daily);
SYRINGE/0.5ML/28G X INSULIN SYRINGES/U- RX/OTC
1/2" MISC 1B
100/1ML/30G X 5/16"
INSULIN 1B RX/OTC GLOBAL EASY GLIDE QL(5 ea daily)
SYRINGE/0.5ML/29G X INSULIN
1/2" MISC 1B
SYRINGE/1ML/31G X
15/64" MISC
97
GLOBAL EASY GLIDE QL(5 ea daily) GLOBAL INJECT EASE QL(5 ea daily)
INSULINSYRINGE/U- 1B INSULIN SYRINGE/U- 1B
100/0.3ML/31G X 5/16" 100/1ML/30G X 1/2" MISC
MISC GLOBAL INJECT EASE QL(5 ea daily);
GLOBAL INJECT EASE QL(5 ea daily); INSULIN SYRINGE/U- 1B RX/OTC
INSULIN SYRINGE/U- 1B RX/OTC 100/1ML/30G X 5/16"
100/0.3ML/29G X 1/2" MISC
MISC GLOBAL INJECT EASE QL(5 ea daily)
GLOBAL INJECT EASE QL(5 ea daily) INSULIN SYRINGE/U- 1B
INSULIN SYRINGE/U- 1B 100/1ML/31G X 5/16"
100/0.3ML/30G X 1/2" MISC
MISC GLOBAL INSULIN QL(5 ea daily)
GLOBAL INJECT EASE QL(5 ea daily); SYRINGE/U- 1B
INSULIN SYRINGE/U- 1B RX/OTC 100/0.3ML/30G X 1/2"
100/0.3ML/30G X 5/16" MISC
MISC GLOBAL INSULIN QL(5 ea daily);
GLOBAL INJECT EASE QL(5 ea daily) SYRINGES/U- 1B RX/OTC
INSULIN SYRINGE/U- 1B 100/0.3ML/30GX5/16"
100/0.3ML/31G X 5/16" MISC
MISC GLUCOPRO INSULIN QL(5 ea daily)
100/0.5ML/28G X 1/2" MISC
MISC GLUCOPRO INSULIN QL(5 ea daily);
GLOBAL INJECT EASE QL(5 ea daily); SYRINGE/U- 1B RX/OTC
100/0.5ML/29G X 1/2" MISC
GLOBAL INJECT EASE QL(5 ea daily) SYRINGE/U- 1B
INSULIN SYRINGE/U- 1B 100/0.3ML/31G X 5/16"
100/0.5ML/30G X 1/2" MISC
100/0.5ML/30G X 5/16" MISC
MISC GLUCOPRO INSULIN QL(5 ea daily);
GLOBAL INJECT EASE QL(5 ea daily) SYRINGE/U- 1B RX/OTC
INSULIN SYRINGE/U- 1B 100/0.5ML/30G X 5/16"
100/0.5ML/31G X 5/16" MISC
100/1ML/28G X 1/2" MISC MISC
GLOBAL INJECT EASE QL(5 ea daily); GLUCOPRO INSULIN QL(5 ea daily)
INSULIN SYRINGE/U- 1B RX/OTC SYRINGE/U-100/1ML/30G 1B
100/1ML/29G X 1/2" MISC X 1/2" MISC
98
GLUCOPRO INSULIN QL(5 ea daily); GNP INSULIN QL(5 ea daily)
SYRINGE/U-100/1ML/30G 1B RX/OTC SYRINGES/3ML/31GX5/16 1B
X 5/16" MISC " MISC
GLUCOPRO INSULIN QL(5 ea daily) GNP ULTRA COMFORT QL(5 ea daily);
SYRINGE/U-100/1ML/31G 1B INSULIN 1B RX/OTC
X 5/16" MISC SYRINGE/0.3ML/29G X
GNP INSULIN QL(5 ea daily); 1/2" MISC
SYRINGE/0.3ML/29G X 1B RX/OTC GNP ULTRA COMFORT QL(5 ea daily);
GNP INSULIN QL(5 ea daily); SYRINGE/0.3ML/30G X
SYRINGE/0.3ML/30G X 1B RX/OTC 5/16" SHORT MISC
5/16" MISC GNP ULTRA COMFORT QL(5 ea daily);
GNP INSULIN QL(5 ea daily) INSULIN 1B RX/OTC
SYRINGE/0.3ML/31G X 1B SYRINGE/0.5ML/28G X
GNP INSULIN QL(5 ea daily); GNP ULTRA COMFORT QL(5 ea daily);
SYRINGE/0.5ML/28G X 1B RX/OTC INSULIN 1B RX/OTC
1/2" MISC SYRINGE/0.5ML/29G X
1/2" MISC
GNP INSULIN QL(5 ea daily);
SYRINGE/0.5ML/29G X 1B RX/OTC GNP ULTRA COMFORT QL(5 ea daily);
SYRINGE/1ML/28G X 1/2"
GNP INSULIN QL(5 ea daily); MISC
SYRINGE/0.5ML/30G X 1B RX/OTC
5/16" MISC GNP ULTRA COMFORT QL(5 ea daily);
INSULIN 1B RX/OTC
GNP INSULIN QL(5 ea daily) SYRINGE/1ML/29G X 1/2"
SYRINGE/0.5ML/31G X 1B MISC
5/16" MISC
HEALTHWISE INSULIN QL(5 ea daily);
GNP INSULIN QL(5 ea daily); SYRINGE/U-
SYRINGE/1ML/28G X 1/2" 1B RX/OTC 1B RX/OTC
100/0.3ML/30G X 5/16"
MISC MISC
GNP INSULIN QL(5 ea daily); HEALTHWISE INSULIN QL(5 ea daily)
SYRINGE/1ML/29G X 1/2" 1B RX/OTC SYRINGE/U-
MISC 1B
100/0.3ML/31G X 5/16"
GNP INSULIN QL(5 ea daily); MISC
SYRINGE/1ML/30G X 1B RX/OTC HEALTHWISE INSULIN QL(5 ea daily);
5/16" MISC SYRINGE/U-
GNP INSULIN QL(5 ea daily) 1B RX/OTC
100/0.5ML/30G X 5/16"
SYRINGE/1ML/31G X 1B MISC
5/16" MISC HEALTHWISE INSULIN QL(5 ea daily)
GNP INSULIN QL(5 ea daily); SYRINGE/U-
SYRINGES/0.3ML/30GX5/ 1B RX/OTC 1B
100/0.5ML/31G X 5/16"
16" MISC MISC
GNP INSULIN QL(5 ea daily); HEALTHWISE INSULIN QL(5 ea daily);
SYRINGES/1/2ML/29GX1/ 1B RX/OTC SYRINGE/U-100/1ML/30G 1B RX/OTC
2" MISC X 5/16" MISC
GNP INSULIN QL(5 ea daily);
SYRINGES/1ML/28GX1/2" 1B RX/OTC
MISC
99
HEALTHWISE INSULIN QL(5 ea daily) INSULIN QL(5 ea daily);
SYRINGE/U-100/1ML/31G 1B SYRINGE/NEEDLE 1B RX/OTC
X 5/16" MISC 0.3ML/30G X 5/16" MISC
HM ULTICARE INSULIN QL(5 ea daily) INSULIN QL(5 ea daily)
SYRINGE/1ML/30G X 1/2" 1B SYRINGE/NEEDLE 1B
MISC 0.3ML/31G X 5/16" MISC
HM ULTICARE INSULIN QL(5 ea daily) INSULIN QL(5 ea daily);
SYRINGE/U- 1B SYRINGE/NEEDLE 1B RX/OTC
100/0.3ML/31G X 5/16" 0.5ML/29G X 1/2" MISC
MISC INSULIN QL(5 ea daily);
INSULIN QL(5 ea daily) SYRINGE/NEEDLE 1B RX/OTC
SYRINGE/0.3ML/29G X 1" 1B 0.5ML/30G X 5/16" MISC
MISC INSULIN QL(5 ea daily)
INSULIN QL(5 ea daily); SYRINGE/NEEDLE 1B
SYRINGE/0.3ML/29G X 1B RX/OTC 0.5ML/31G X 5/16" MISC
1/2" MISC INSULIN QL(5 ea daily);
INSULIN QL(5 ea daily); SYRINGE/NEEDLE 1B RX/OTC
SYRINGE/0.3ML/30G X 1B RX/OTC 1ML/29G X 1/2" MISC
5/16" MISC INSULIN QL(5 ea daily);
INSULIN QL(5 ea daily) SYRINGE/NEEDLE 1B RX/OTC
SYRINGE/0.3ML/31G X 1B 1ML/30G X 5/16" MISC
5/16" MISC INSULIN QL(5 ea daily)
INSULIN QL(5 ea daily) SYRINGE/NEEDLE 1B
SYRINGE/0.5ML/27G X 1B 1ML/31G X 5/16" MISC
1/2" MISC INSULIN SYRINGE/U- QL(5 ea daily);
INSULIN QL(5 ea daily); 100/0.3ML/29G X 1/2" 1B RX/OTC
INSULIN QL(5 ea daily) 100/0.5ML/29G X 1/2" 1B RX/OTC
1B
INSULIN QL(5 ea daily); 100/1ML/29G X 1/2" MISC RX/OTC
SYRINGE/0.5ML/30G X 1B RX/OTC INSULIN SYRINGE/U- QL(5 ea daily)
5/16" MISC 100/1ML/30G X 5/16" 1B
INSULIN QL(5 ea daily) MISC
SYRINGE/0.5ML/31G X 1B INSULIN SYRINGE/U- QL(5 ea daily);
5/16" MISC 100/1ML/30G X 5/16" 1B RX/OTC
INSULIN QL(5 ea daily); MISC
SYRINGE/1ML/28G X 1/2" 1B RX/OTC INSULIN SYRINGE/U- QL(5 ea daily)
MISC 100/1ML/31G X 5/16" 1B
INSULIN QL(5 ea daily); MISC
SYRINGE/1ML/29G X 1/2" 1B RX/OTC INSULIN QL(5 ea daily)
MISC SYRINGES/0.5ML/27GX1/ 1B
INSULIN QL(5 ea daily); 2" MISC
SYRINGE/1ML/30G X 1B RX/OTC INSULIN QL(5 ea daily);
5/16" MISC SYRINGES/0.5ML/28GX1/ 1B RX/OTC
2" MISC
100
INSULIN QL(5 ea daily); KMART VALU PLUS QL(5 ea daily);
SYRINGES/0.5ML/29GX1/ 1B RX/OTC INSULIN 1B RX/OTC
2" MISC SYRINGE/1ML/30G MISC
INSULIN QL(5 ea daily); KROGER INSULIN QL(5 ea daily);
SYRINGES/0.5ML/30GX5/ 1B RX/OTC SYRINGE/0.3ML/29G X 1B RX/OTC
16" MISC 1/2" MISC
INSULIN QL(5 ea daily) KROGER INSULIN QL(5 ea daily);
SYRINGES/0.5ML/31GX 1B SYRINGE/0.3ML/30G X 1B RX/OTC
5/16" MISC 5/16" MISC
INSULIN QL(5 ea daily) KROGER INSULIN QL(5 ea daily)
SYRINGES/0.5ML/31GX5/ 1B SYRINGE/0.3ML/31G X 1B
16" MISC 5/16" MISC
SYRINGES/1ML/27GX/1/2" 1B RX/OTC SYRINGE/0.5ML/29G X 1B RX/OTC
MISC 1/2" MISC
SYRINGES/1ML/27GX1/2" 1B RX/OTC SYRINGE/0.5ML/30G X 1B RX/OTC
MISC 5/16" MISC
INSULIN QL(5 ea daily); KROGER INSULIN QL(5 ea daily)
SYRINGES/1ML/28GX1/2" 1B RX/OTC SYRINGE/0.5ML/31G X 1B
MISC 5/16" MISC
SYRINGES/1ML/29GX1/2" 1B RX/OTC SYRINGE/1ML/29G X 1/2" 1B RX/OTC
MISC MISC
INSULIN QL(5 ea daily) KROGER INSULIN QL(5 ea daily);
SYRINGES/1ML/30GX1/2" 1B SYRINGE/1ML/30G X 1B RX/OTC
MISC 5/16" MISC
INSULIN QL(5 ea daily) KROGER INSULIN QL(5 ea daily)
SYRINGES/1ML/31GX5/16 1B SYRINGE/1ML/31G X 1B
" MISC 5/16" MISC
KINRAY INSULIN QL(5 ea daily) LEADER INSULIN QL(5 ea daily);
SYRINGE PREFERRED 1B SYRINGE/0.3ML/29G X 1B RX/OTC
PLUS/0.3ML/31G X 5/16" 1/2" MISC
MISC LEADER INSULIN QL(5 ea daily);
KINRAY INSULIN QL(5 ea daily) SYRINGE/0.3ML/30G X 1B RX/OTC
SYRINGE PREFERRED 1B 5/16" MISC
PLUS/0.5ML/31G X 5/16" LEADER INSULIN QL(5 ea daily)
MISC SYRINGE/0.3ML/31G X 1B
KINRAY INSULIN QL(5 ea daily) 5/16" MISC
SYRINGE PREFERRED 1B LEADER INSULIN QL(5 ea daily);
PLUS/1ML/31G X 5/16" SYRINGE/0.5ML/28G X 1B RX/OTC
MISC 1/2" MISC
KINRAY INSULIN QL(5 ea daily); LEADER INSULIN QL(5 ea daily);
SYRINGE/0.5ML/29G X 1B RX/OTC SYRINGE/0.5ML/29G X 1B RX/OTC
1/2" MISC 1/2" MISC
KMART VALU PLUS QL(5 ea daily); LEADER INSULIN QL(5 ea daily);
INSULIN 1B RX/OTC SYRINGE/0.5ML/30G X 1B RX/OTC
SYRINGE/1ML/29G MISC 5/16" MISC
101
LEADER INSULIN QL(5 ea daily) LITETOUCH INSULIN QL(5 ea daily);
SYRINGE/0.5ML/31G X 1B SYRINGE/U- 1B RX/OTC
5/16" MISC 100/0.5ML/29G X 1/2"
LEADER INSULIN QL(5 ea daily); MISC
SYRINGE/1ML/28G X 1/2" 1B RX/OTC LITETOUCH INSULIN QL(5 ea daily);
MISC SYRINGE/U- 1B RX/OTC
LEADER INSULIN QL(5 ea daily); 100/0.5ML/30G X 5/16"
SYRINGE/1ML/29G X 1/2" 1B RX/OTC MISC
MISC LITETOUCH INSULIN QL(5 ea daily)
LEADER INSULIN QL(5 ea daily); SYRINGE/U- 1B
SYRINGE/1ML/30G X 1B RX/OTC 100/0.5ML/31G X 5/16"
5/16" MISC MISC
LEADER INSULIN QL(5 ea daily) LITETOUCH INSULIN QL(5 ea daily);
SYRINGE/1ML/31G X 1B SYRINGE/U-100/1ML/28G 1B RX/OTC
5/16" MISC X 1/2" MISC
LITETOUCH INSULIN QL(5 ea daily); LITETOUCH INSULIN QL(5 ea daily);
SYRINGE/0.3ML/29G X 1B RX/OTC SYRINGE/U-100/1ML/29G 1B RX/OTC
1/2" MISC X 1/2" MISC
LITETOUCH INSULIN QL(5 ea daily); LITETOUCH INSULIN QL(5 ea daily);
SYRINGE/0.3ML/30G X 1B RX/OTC SYRINGE/U-100/1ML/30G 1B RX/OTC
5/16" MISC X 5/16" MISC
LITETOUCH INSULIN QL(5 ea daily) LITETOUCH INSULIN QL(5 ea daily)
SYRINGE/0.3ML/31G X 1B SYRINGE/U-100/1ML/31G 1B
5/16" MISC X 5/16" MISC
LITETOUCH INSULIN QL(5 ea daily); LONGS INSULIN QL(5 ea daily)
SYRINGE/0.5ML/30G X 1B RX/OTC SYRINGE/0.5ML/31G X 1B
5/16" MISC 5/16" MISC
LITETOUCH INSULIN QL(5 ea daily) MAGELLAN INSULIN QL(5 ea daily);
SYRINGE/0.5ML/31G X 1B SAFETY SYRINGE/U- 1B RX/OTC
5/16" MISC 100/0.3ML/29G X 1/2"
MISC
LITETOUCH INSULIN QL(5 ea daily);
SYRINGE/1ML/30G X 1B RX/OTC MAGELLAN INSULIN QL(5 ea daily);
5/16" MISC SAFETY SYRINGE/U- 1B RX/OTC
100/0.3ML/30G X 5/16"
LITETOUCH INSULIN QL(5 ea daily); MISC
100/0.3ML/30G X 5/16" MAGELLAN INSULIN QL(5 ea daily);
MISC SAFETY SYRINGE/U- 1B RX/OTC
100/0.5ML/29G X 1/2"
LITETOUCH INSULIN QL(5 ea daily) MISC
SYRINGE/U- 1B
100/0.5ML/30G X 5/16"
LITETOUCH INSULIN QL(5 ea daily); MISC
100/1ML/29G X 1/2" MISC
102
MAGELLAN INSULIN QL(5 ea daily); MONOJECT INSULIN QL(5 ea daily)
SAFETY SYRINGE/U- 1B RX/OTC SYRINGE/DETACH 1B
100/1ML/30G X 5/16" NEEDLE/1ML/25G X 5/8"
MISC MISC
MAXI-COMFORT INSULIN QL(5 ea daily); MONOJECT INSULIN QL(5 ea daily);
SYRINGE/U- 1B RX/OTC SYRINGE/DETACH 1B RX/OTC
100/0.5ML/28GX1/2" MISC NEEDLE/1ML/27G X 1/2"
MAXI-COMFORT INSULIN QL(5 ea daily); MISC
SYRINGE/U- 1B RX/OTC MONOJECT INSULIN QL(5 ea daily);
100/1ML/28GX1/2" MISC SYRINGE/PERM 1B RX/OTC
MAXICOMFORT INSULIN QL(5 ea daily) NEEDLE/1ML/28G X 1/2"
SYRINGES 27G X 1/2" 1B MISC
MISC MONOJECT INSULIN QL(5 ea daily);
MAXICOMFORT INSULIN QL(5 ea daily); SYRINGE/PERM 1B RX/OTC
SYRINGES 27G X 1/2" 1B RX/OTC NEEDLE/U-100/0.5ML/28G
MISC X 1/2" MISC
MEDIC INSULIN QL(5 ea daily); MONOJECT INSULIN QL(5 ea daily);
SYRINGE/0.3ML/30G X 1B RX/OTC SYRINGE/SAFETY/PERM 1B RX/OTC
5/16" MISC NEEDLE/0.3ML/29G X 1/2"
MISC
MEDIC INSULIN QL(5 ea daily);
SYRINGE/0.5ML/30G X 1B RX/OTC MONOJECT INSULIN QL(5 ea daily);
5/16" MISC SYRINGE/SAFETY/PERM 1B RX/OTC
NEEDLE/0.3ML/29GX1/2"
MM INSULIN SYRINGE/U- QL(5 ea daily); MISC
100/0.3ML/30G X 5/16" 1B RX/OTC
MISC MONOJECT INSULIN QL(5 ea daily);
SYRINGE/SAFETY/PERM 1B RX/OTC
MM INSULIN SYRINGE/U- QL(5 ea daily) NEEDLE/0.5ML/29G X 1/2"
100/0.3ML/31G X 5/16" 1B MISC
MISC
MONOJECT INSULIN QL(5 ea daily);
MM INSULIN SYRINGE/U- QL(5 ea daily); SYRINGE/SAFETY/PERM RX/OTC
100/1/2ML/30G X 5/16" 1B RX/OTC 1B
NEEDLE/1ML/29G X 1/2"
MISC MISC
MM INSULIN SYRINGE/U- QL(5 ea daily) MONOJECT INSULIN QL(5 ea daily);
100/1/2ML/31G X 5/16" 1B SYRINGE/SOFTPACK/1M 1B RX/OTC
MISC L/27G X 1/2" MISC
MM INSULIN SYRINGE/U- QL(5 ea daily); MONOJECT INSULIN QL(5 ea daily);
100/1ML/30G X 5/16" 1B RX/OTC SYRINGE/SOFTPACK/U- RX/OTC
MISC 1B
100/0.5ML/28G X 1/2"
MM INSULIN SYRINGE/U- QL(5 ea daily) MISC
100/1ML/31G X 5/16" 1B MONOJECT INSULIN QL(5 ea daily);
MISC SYRINGE/U- RX/OTC
MONOJECT INSULIN QL(5 ea daily); 1B
1B 100/0.3ML/30G X 5/16"
SYRINGE/1ML MISC RX/OTC MISC
MONOJECT INSULIN QL(5 ea daily) MONOJECT INSULIN QL(5 ea daily);
SYRINGE/1ML/31G X 1B SYRINGE/U- RX/OTC
5/16" MISC 1B
100/0.5ML/30G X 5/16"
MISC
103
MONOJECT INSULIN QL(5 ea daily); MS INSULIN QL(5 ea daily)
SYRINGE/U-100/1ML/28G 1B RX/OTC SYRINGE/0.5ML/31G X 1B
X 1/2" MISC 5/16" MISC
MONOJECT INSULIN QL(5 ea daily); MS INSULIN QL(5 ea daily)
SYRINGE/U-100/1ML/30G 1B RX/OTC SYRINGE/1ML/31G X 1B
X 5/16" MISC 5/16" MISC
MONOJECT INSULIN QL(5 ea daily); PRECISION SURE-DOSE QL(5 ea daily);
SYRINGEREGULAR LUER 1B RX/OTC INSULIN 1B RX/OTC
TIP/SOFTPACK/1ML MISC SYRINGE/0.3ML/30G X
MONOJECT ULTRA QL(5 ea daily); 5/16" MISC
COMFORT INSULIN 1B RX/OTC PRECISION SURE-DOSE QL(5 ea daily);
SYRINGE/0.3ML/29G X INSULIN 1B RX/OTC
MONOJECT ULTRA QL(5 ea daily) 1/2" MISC
COMFORT INSULIN 1B PRECISION SURE-DOSE QL(5 ea daily)
SYRINGE/0.3ML/31G X INSULIN 1B
1/2" MISC SYRINGE/1ML/28G X 1/2"
MONOJECT ULTRA QL(5 ea daily); MISC
SYRINGE/0.5ML/29G X PLUSINSULIN 1B RX/OTC
SYRINGE/0.5ML/30G X PLUSINSULIN 1B RX/OTC
5/16" MISC SYRINGE/1ML/29G X 1/2"
MONOJECT ULTRA QL(5 ea daily) MISC
COMFORT INSULIN 1B PREFERRED PLUS QL(5 ea daily);
SYRINGE/0.5ML/31G X INSULIN SYRINGE/U- 1B RX/OTC
5/16" MISC 100/0.3ML/29G X 1/2"
COMFORT INSULIN 1B RX/OTC PREFERRED PLUS QL(5 ea daily);
SYRINGE/1ML/28G X 1/2" INSULIN SYRINGE/U- 1B RX/OTC
MISC 100/0.3ML/30G X 5/16"
COMFORT INSULIN 1B RX/OTC PREFERRED PLUS QL(5 ea daily);
SYRINGE/1ML/29G X 1/2" INSULIN SYRINGE/U- 1B RX/OTC
MISC 100/0.5ML/28G X 1/2"
MS INSULIN QL(5 ea daily) MISC
5/16" MISC
104
PREFERRED PLUS QL(5 ea daily); RA INSULIN QL(5 ea daily);
INSULIN SYRINGE/U- 1B RX/OTC SYRINGE/0.5ML/29G X 1B RX/OTC
100/0.5ML/29G X 1/2" 1/2" MISC
MISC RA INSULIN QL(5 ea daily);
PREFERRED PLUS QL(5 ea daily); SYRINGE/1ML/29G X 1/2" 1B RX/OTC
INSULIN SYRINGE/U- 1B RX/OTC MISC
100/0.5ML/30G X 5/16" RA INSULIN SYRINGE/U- QL(5 ea daily);
MISC 100/0.5ML/30G X 5/16" 1B RX/OTC
PREFERRED PLUS QL(5 ea daily); MISC
INSULIN SYRINGE/U- 1B RX/OTC RA INSULIN SYRINGE/U- QL(5 ea daily);
100/1ML/28G X 1/2" MISC 100/1 ML/30G X 5/16" 1B RX/OTC
PREFERRED PLUS QL(5 ea daily); MISC
INSULIN SYRINGE/U- 1B RX/OTC REALITY INSULIN QL(5 ea daily);
100/1ML/29G X 1/2" MISC SYRINGE/U- RX/OTC
1B
PREFERRED PLUS QL(5 ea daily); 100/0.5ML/28G X 1/2"
INSULIN SYRINGE/U- 1B RX/OTC MISC
100/1ML/30G X 5/16" REALITY INSULIN QL(5 ea daily);
1B
PRO COMFORT INSULIN QL(5 ea daily) 100/0.5ML/29G X 1/2"
SYRINGES/0.5ML/30G X 1B MISC
1/2" MISC REALITY INSULIN QL(5 ea daily);
PRO COMFORT INSULIN QL(5 ea daily); SYRINGE/U-100/1ML/28G 1B RX/OTC
SYRINGES/0.5ML/30G X 1B RX/OTC X 1/2" MISC
5/16" MISC REALITY INSULIN QL(5 ea daily);
PRO COMFORT INSULIN QL(5 ea daily) SYRINGE/U-100/1ML/29G 1B RX/OTC
SYRINGES/0.5ML/31G X 1B X 1/2" MISC
5/16" MISC RELION INSULIN QL(5 ea daily)
PRO COMFORT INSULIN QL(5 ea daily) SYRINGE 1B
SYRINGES/1ML/30G X 1B 1ML/31GX15/64" MISC
PRO COMFORT INSULIN QL(5 ea daily); SYRINGE/U- 1B
SYRINGES/1ML/30G X 1B RX/OTC 100/0.3ML/31G X 5/16"
5/16" MISC MISC
PRO COMFORT INSULIN QL(5 ea daily) RELION INSULIN QL(5 ea daily);
SYRINGES/1ML/31G X 1B SYRINGE/U- 1B RX/OTC
5/16" MISC 100/0.5ML/29G X 1/2"
PRODIGY INSULIN QL(5 ea daily) MISC
SYRING/U-100/0.3ML/31G 1B RELION INSULIN QL(5 ea daily)
X 5/16" MISC SYRINGE/U- 1B
PRODIGY INSULIN QL(5 ea daily) 100/0.5ML/31G X 5/16"
SYRINGE/1/2ML/31G X 1B MISC
PRODIGY INSULIN QL(5 ea daily); SYRINGE/U-100/1ML/31G 1B
SYRINGE/1ML/28G X 1/2" 1B RX/OTC X 15/64" MISC
MISC RELION INSULIN QL(5 ea daily)
PX INSULIN SYRINGE/U- QL(5 ea daily) SYRINGE/U-100/1ML/31G 1B
100/0.5ML/30G X 1/2" 1B X 5/16" MISC
MISC
105
SAFESNAP INSULIN QL(5 ea daily); SECURESAFE SAFETY QL(5 ea daily);
SYRINGE/0.3ML/30G X 1B RX/OTC INSULIN SYRINGES/U- 1B RX/OTC
5/16" MISC 100/1ML/29GX1/2" MISC
SAFESNAP INSULIN QL(5 ea daily); SURE COMFORT QL(5 ea daily);
SYRINGE/0.5ML/29G X 1B RX/OTC INSULIN SYRINGE/U- 1B RX/OTC
1/2" MISC 100/0.3ML/29G X 1/2"
SAFESNAP INSULIN QL(5 ea daily); MISC
SYRINGE/0.5ML/30G X 1B RX/OTC SURE COMFORT QL(5 ea daily)
5/16" MISC INSULIN SYRINGE/U- 1B
SAFESNAP INSULIN QL(5 ea daily); 100/0.3ML/30G X 1/2"
SYRINGE/1ML/28G X 1/2" 1B RX/OTC MISC
MISC SURE COMFORT QL(5 ea daily);
SAFESNAP INSULIN QL(5 ea daily); INSULIN SYRINGE/U- 1B RX/OTC
SYRINGE/1ML/29G X 1/2" 1B RX/OTC 100/0.3ML/30G X 5/16"
MISC MISC
SAFETY INSULIN QL(5 ea daily); SURE COMFORT QL(5 ea daily)
SYRINGES 1B RX/OTC INSULIN SYRINGE/U- 1B
0.5ML/29GX1/2" MISC 100/0.3ML/31G X 5/16
MISC
SAFETY INSULIN QL(5 ea daily);
SYRINGES 1B RX/OTC SURE COMFORT QL(5 ea daily)
0.5ML/30GX5/16" MISC INSULIN SYRINGE/U- 1B
100/0.3ML/31G X 5/16"
SAFETY INSULIN QL(5 ea daily); MISC
SYRINGES 1ML/27GX1/2" 1B RX/OTC
MISC SURE COMFORT QL(5 ea daily);
INSULIN SYRINGE/U- 1B RX/OTC
SAFETY INSULIN QL(5 ea daily); 100/0.5ML/28G X 1/2"
SYRINGES 1ML/29GX1/2" 1B RX/OTC MISC
MISC
SURE COMFORT QL(5 ea daily);
SAFETY INSULIN QL(5 ea daily) INSULIN SYRINGE/U- RX/OTC
SYRINGES 1ML/30GX1/2" 1B 1B
100/0.5ML/29G X 1/2"
MISC MISC
SB INSULIN SYRINGE/U- QL(5 ea daily); SURE COMFORT QL(5 ea daily)
100/0.5ML/29G X 1/2" 1B RX/OTC INSULIN SYRINGE/U-
MISC 1B
100/0.5ML/30G X 1/2"
SB INSULIN SYRINGE/U- QL(5 ea daily); MISC
100/0.5ML/30G X 5/16" 1B RX/OTC SURE COMFORT QL(5 ea daily);
MISC INSULIN SYRINGE/U- RX/OTC
SB INSULIN SYRINGE/U- QL(5 ea daily); 1B
1B 100/0.5ML/30G X 5/16"
100/1ML/29G X 1/2" MISC RX/OTC MISC
SB INSULIN SYRINGE/U- QL(5 ea daily); SURE COMFORT QL(5 ea daily)
100/1ML/30G X 5/16" 1B RX/OTC INSULIN SYRINGE/U-
MISC 1B
100/0.5ML/31G X 5/16
SB INSULIN SYRINGE/U- QL(5 ea daily) MISC
100/1ML/31G X 5/16" 1B SURE COMFORT QL(5 ea daily);
MISC INSULIN SYRINGE/U- 1B RX/OTC
SECURESAFE SAFETY QL(5 ea daily); 100/1ML/28G X 1/2" MISC
INSULIN SYRINGES/U- 1B RX/OTC
100/0.5ML/29GX1/2" MISC
106
SURE COMFORT QL(5 ea daily); SURE-JECT INSULIN QL(5 ea daily);
INSULIN SYRINGE/U- 1B RX/OTC SYRINGE/U-100/1ML/30G 1B RX/OTC
100/1ML/29G X 1/2" MISC X 5/16" MISC
SURE COMFORT QL(5 ea daily) SURE-JECT INSULIN QL(5 ea daily)
INSULIN SYRINGE/U- 1B SYRINGE/U-100/1ML/31G 1B
100/1ML/30G X 1/2" MISC X 5/16" MISC
SURE COMFORT QL(5 ea daily); TECHLITE INSULIN QL(5 ea daily);
INSULIN SYRINGE/U- 1B RX/OTC SYRINGEU- 1B RX/OTC
100/1ML/30G X 5/16" 100/0.3ML/29G X 1/2"
MISC MISC
SURE COMFORT QL(5 ea daily) TECHLITE INSULIN QL(5 ea daily)
INSULIN SYRINGE/U- 1B SYRINGEU- 1B
100/1ML/31G X 5/16" 100/0.3ML/30G X 1/2"
MISC MISC
SURE-JECT INSULIN QL(5 ea daily); TECHLITE INSULIN QL(5 ea daily);
SYRINGE/U- 1B RX/OTC SYRINGEU- 1B RX/OTC
100/0.3ML/29G X 1/2" 100/0.3ML/30G X 5/16"
MISC MISC
SURE-JECT INSULIN QL(5 ea daily); TECHLITE INSULIN QL(5 ea daily)
SYRINGE/U- 1B RX/OTC SYRINGEU- 1B
100/0.3ML/30G X 5/16" 100/0.3ML/31G X 5/16"
MISC MISC
SURE-JECT INSULIN QL(5 ea daily) TECHLITE INSULIN QL(5 ea daily);
SYRINGE/U- 1B SYRINGEU- 1B RX/OTC
100/0.3ML/31G X 5/16" 100/0.5ML/29G X 1/2"
MISC MISC
100/0.5ML/28G X 1/2" 100/0.5ML/30G X 1/2"
MISC MISC
SURE-JECT INSULIN QL(5 ea daily); TECHLITE INSULIN QL(5 ea daily);
SYRINGE/U- 1B RX/OTC SYRINGEU- 1B RX/OTC
100/0.5ML/29G X 1/2" 100/0.5ML/30G X 5/16"
MISC MISC
100/0.5ML/30G X 5/16" 100/0.5ML/31G X 5/16"
MISC MISC
SURE-JECT INSULIN QL(5 ea daily) TECHLITE INSULIN QL(5 ea daily);
SYRINGE/U- 1B SYRINGEU-100/1ML/29G 1B RX/OTC
100/0.5ML/31G X 5/16" X 1/2" MISC
MISC TECHLITE INSULIN QL(5 ea daily)
SURE-JECT INSULIN QL(5 ea daily); SYRINGEU-100/1ML/30G 1B
SYRINGE/U-100/1ML/28G 1B RX/OTC X 1/2" MISC
X 1/2" MISC TECHLITE INSULIN QL(5 ea daily);
SURE-JECT INSULIN QL(5 ea daily); SYRINGEU-100/1ML/30G 1B RX/OTC
SYRINGE/U-100/1ML/29G 1B RX/OTC X 5/16" MISC
X 1/2" MISC
107
TECHLITE INSULIN QL(5 ea daily) TRUE COMFORT INSULIN QL(5 ea daily)
SYRINGEU-100/1ML/31G 1B SYRINGE/1ML/31G X 1B
X 15/64" MISC 5/16" MISC
TECHLITE INSULIN QL(5 ea daily) TRUE COMFORT PRO QL(5 ea daily);
SYRINGEU-100/1ML/31G 1B INSULINSYRINGE/0.5ML/ 1B RX/OTC
X 5/16" MISC 30G X 5/16" MISC
TOPCARE ULTRA QL(5 ea daily); TRUE COMFORT PRO QL(5 ea daily)
COMFORT INSULIN 1B RX/OTC INSULINSYRINGE/0.5ML/ 1B
SYRINGE/0.3ML/30G X 31G X 5/16" MISC
5/16" MISC TRUE COMFORT PRO QL(5 ea daily);
TOPCARE ULTRA QL(5 ea daily) INSULINSYRINGE/1ML/30 1B RX/OTC
COMFORT INSULIN 1B G X 5/16" MISC
SYRINGE/0.3ML/31G X TRUE COMFORT PRO QL(5 ea daily)
5/16" MISC INSULINSYRINGE/1ML/31 1B
TOPCARE ULTRA QL(5 ea daily); G X 5/16" MISC
COMFORT INSULIN 1B RX/OTC TRUE COMFORT PRO QL(5 ea daily)
SYRINGE/0.5ML/30G X INSULINSYRINGE/U-
5/16" MISC 1B
100/0.5ML/30G X 1/2"
TOPCARE ULTRA QL(5 ea daily) MISC
COMFORT INSULIN 1B TRUE COMFORT PRO QL(5 ea daily)
SYRINGE/0.5ML/31G X INSULINSYRINGE/U- 1B
5/16" MISC 100/1ML/30G X 1/2" MISC
TOPCARE ULTRA QL(5 ea daily); TRUEPLUS INSULIN QL(5 ea daily);
COMFORT INSULIN RX/OTC SYRINGE/U-
SYRINGE/1ML/30G X
1B 1B RX/OTC
100/0.3ML/29G X 1/2"
5/16" MISC MISC
TOPCARE ULTRA QL(5 ea daily) TRUEPLUS INSULIN QL(5 ea daily);
COMFORT INSULIN SYRINGE/U-
SYRINGE/1ML/31G X
1B 1B RX/OTC
100/0.3ML/30G X 5/16"
5/16" MISC MISC
TOPCARE ULTRA QL(5 ea daily); TRUEPLUS INSULIN QL(5 ea daily)
COMFORT INSULIN RX/OTC SYRINGE/U-
SYRINGE/U- 1B 1B
100/0.3ML/31G X 5/16"
100/0.3ML/29G X 1/2" MISC
MISC
TRUEPLUS INSULIN QL(5 ea daily);
TOPCARE ULTRA QL(5 ea daily); SYRINGE/U-
COMFORT INSULIN RX/OTC 1B RX/OTC
100/0.5ML/28G X 1/2"
SYRINGE/U- 1B MISC
100/0.5ML/29G X 1/2"
MISC TRUEPLUS INSULIN QL(5 ea daily);
TOPCARE ULTRA QL(5 ea daily); 100/0.5ML/29G X 1/2"
COMFORT INSULIN 1B RX/OTC MISC
SYRINGE/U-100/1ML/29G
X 1/2" MISC TRUEPLUS INSULIN QL(5 ea daily);
TRUE COMFORT INSULIN QL(5 ea daily) 100/0.5ML/30G X 5/16"
5/16" MISC
108
TRUEPLUS INSULIN QL(5 ea daily) ULTICARE INSULIN QL(5 ea daily);
SYRINGE/U- 1B SYRINGE/1ML/29G X 1/2" 1B RX/OTC
100/0.5ML/31G X 5/16" MISC
MISC ULTICARE INSULIN QL(5 ea daily)
TRUEPLUS INSULIN QL(5 ea daily); SYRINGE/1ML/30G X 1/2" 1B
SYRINGE/U-100/1ML/28G 1B RX/OTC MISC
X 1/2" MISC ULTICARE INSULIN QL(5 ea daily);
TRUEPLUS INSULIN QL(5 ea daily); SYRINGE/1ML/30G X 1B RX/OTC
SYRINGE/U-100/1ML/29G 1B RX/OTC 5/16" MISC
TRUEPLUS INSULIN QL(5 ea daily); SYRINGE/SHORT/0.3ML/3 1B RX/OTC
SYRINGE/U-100/1ML/30G 1B RX/OTC 0G X 5/16" MISC
X 5/16" MISC ULTICARE INSULIN QL(5 ea daily)
TRUEPLUS INSULIN QL(5 ea daily) SYRINGE/SHORT/0.3ML/3 1B
SYRINGE/U-100/1ML/31G 1B 1G X 5/16" MISC
ULTICARE INSULIN QL(5 ea daily); SYRINGE/SHORT/0.5ML/3 1B RX/OTC
SAFETY 1B RX/OTC 0G X 5/16" MISC
SYRINGE/0.5ML/29G X ULTICARE INSULIN QL(5 ea daily)
1/2" MISC SYRINGE/SHORT/0.5ML/3 1B
ULTICARE INSULIN QL(5 ea daily); 1G X 5/16" MISC
SAFETY 1B RX/OTC ULTICARE INSULIN QL(5 ea daily);
SYRINGE/1ML/29G X 1/2" SYRINGE/SHORT/1ML/30 1B RX/OTC
MISC G X 5/16" MISC
ULTICARE INSULIN QL(5 ea daily); ULTICARE INSULIN QL(5 ea daily)
SYRINGE/0.3ML/29G X 1B RX/OTC SYRINGE/SHORT/1ML/31 1B
1/2" MISC G X 5/16" MISC
ULTICARE INSULIN QL(5 ea daily) ULTICARE INSULIN QL(5 ea daily)
SYRINGE/0.3ML/30G X 1B SYRINGE/U-
1/2" MISC 1B
100/0.3ML/30G X 1/2"
ULTICARE INSULIN QL(5 ea daily); MISC
SYRINGE/0.3ML/30G X 1B RX/OTC ULTICARE INSULIN QL(5 ea daily)
5/16" MISC SYRINGE/U- 1B
ULTICARE INSULIN QL(5 ea daily); 100/0.3ML/31G X 5/16"
1/2" MISC ULTICARE INSULIN QL(5 ea daily)
ULTICARE INSULIN QL(5 ea daily); SYRINGE/U- 1B
SYRINGE/0.5ML/29G X 1B RX/OTC 100/0.5ML/30G X 1/2"
1/2" MISC MISC
ULTICARE INSULIN QL(5 ea daily) ULTICARE INSULIN QL(5 ea daily)
SYRINGE/0.5ML/30G X 1B SYRINGE/U- 1B
1/2" MISC 100/0.5ML/31G X 5/16"
ULTICARE INSULIN QL(5 ea daily); MISC
SYRINGE/0.5ML/30G X 1B RX/OTC ULTICARE INSULIN QL(5 ea daily)
5/16" MISC SYRINGE/U-100/1ML/30G 1B
ULTICARE INSULIN QL(5 ea daily); X 1/2" MISC
SYRINGE/1ML/28G X 1/2" 1B RX/OTC
MISC
109
ULTICARE INSULIN QL(5 ea daily) ULTILET INSULIN QL(5 ea daily);
SYRINGE/U-100/1ML/31G 1B SYRINGE/0.3ML/30G X 1B RX/OTC
X 5/16" MISC 8MM MISC
ULTICARE INSULIN QL(5 ea daily) ULTILET INSULIN QL(5 ea daily)
SYRINGEULTRAFINE U- 1B SYRINGE/0.3ML/31G X 1B
100/0.3ML/31G X 5/16" 8MM MISC
MISC ULTILET INSULIN QL(5 ea daily);
ULTICARE INSULIN QL(5 ea daily) SYRINGE/0.5ML/30G X 1B RX/OTC
SYRINGEULTRAFINE U- 1B 8MM MISC
100/0.5ML/31G X 5/16" ULTILET INSULIN QL(5 ea daily);
MISC SYRINGE/1ML/30G X 1B RX/OTC
ULTICARE INSULIN QL(5 ea daily) 8MM MISC
SYRINGEULTRAFINE U- 1B ULTILET INSULIN QL(5 ea daily)
100/1ML/31G X 5/16" SYRINGE/1ML/31G X 1B
MISC 8MM MISC
ULTIGUARD SAFEPACK QL(5 ea daily) ULTILET INSULIN QL(5 ea daily)
INSULIN SYRINGE 1B SYRINGE/SHORT/0.3ML/3 1B
0.3ML/30G X 0G X 12.7MM MISC
1/2"/SHARPS C MISC
ULTILET INSULIN QL(5 ea daily);
ULTIGUARD SAFEPACK QL(5 ea daily) SYRINGE/SHORT/0.3ML/3 1B RX/OTC
INSULIN SYRINGE 1/2ML 1B 0G X 5/16" MISC
30G X 1/2"/SHARPS C
MISC ULTILET INSULIN QL(5 ea daily)
SYRINGE/SHORT/0.3ML/3 1B
ULTIGUARD SAFEPACK QL(5 ea daily) 1G X 5/16" MISC
INSULIN SYRINGE 1ML 1B
30G X 1/2"/SHARPS CON ULTILET INSULIN QL(5 ea daily);
MISC SYRINGE/SHORT/0.5ML/3 1B RX/OTC
0G X 5/16" MISC
ULTIGUARD SAFEPACK QL(5 ea daily)
INSULIN SYRINGE 1ML ULTILET INSULIN QL(5 ea daily)
1B SYRINGE/SHORT/0.5ML/3 1B
31G X 5/16"/SHARPS CO
MISC 1G X 5/16" MISC
ULTIGUARD SAFEPACK QL(5 ea daily) ULTILET INSULIN QL(5 ea daily);
INSULIN SYRINGE/SHORT/1ML/30 1B RX/OTC
1B G X 5/16" MISC
SYRINGE/0.3ML/30G X
1/2"/SHARPS C MISC ULTILET INSULIN QL(5 ea daily)
ULTIGUARD SAFEPACK QL(5 ea daily) SYRINGE/SHORT/1ML/31 1B
INSULIN G X 5/16" MISC
1B ULTILET INSULIN QL(5 ea daily)
SYRINGE/0.3ML/31G X
5/16"/SHARPS MISC SYRINGE/U- 1B
ULTIGUARD SAFEPACK QL(5 ea daily) 100/0.5ML/30G X 1/2"
INSULIN MISC
1B ULTILET INSULIN QL(5 ea daily)
SYRINGE/0.5ML/30G X
1/2"/SHARPS C MISC SYRINGE/U-100/1ML/30G 1B
ULTIGUARD QL(5 ea daily) X 1/2" MISC
SAFEPACK/SYRINGE/NE ULTRA COMFORT QL(5 ea daily);
EDLE/31G X 1B INSULIN SYRINGE/U- 1B RX/OTC
5/16"/SHARPS CONTAIN 100/0.3ML/30G X 5/16"
MISC MISC
110
ULTRA FLO INSULIN QL(5 ea daily); ULTRA-COMFORT QL(5 ea daily);
SYRINGE 0.3ML/29G X 1B RX/OTC INSULIN SYRINGE/U- 1B RX/OTC
1/2" MISC 100/0.3ML/29G X 1/2"
ULTRA FLO INSULIN QL(5 ea daily) MISC
SYRINGE 0.3ML/30GX1/2" 1B ULTRA-COMFORT QL(5 ea daily);
ULTRA FLO INSULIN QL(5 ea daily); 100/0.3ML/30G X 5/16"
SYRINGE 1B RX/OTC MISC
0.3ML/30GX5/16" MISC ULTRA-COMFORT QL(5 ea daily)
ULTRA FLO INSULIN QL(5 ea daily) INSULIN SYRINGE/U- 1B
SYRINGE 1B 100/0.3ML/31G X 5/16"
0.3ML/31GX5/16" MISC MISC
ULTRA FLO INSULIN QL(5 ea daily); ULTRA-COMFORT QL(5 ea daily);
SYRINGE 0.5ML/29GX1/2" 1B RX/OTC INSULIN SYRINGE/U- 1B RX/OTC
MISC 100/0.5ML/28G X 1/2"
MISC
ULTRA FLO INSULIN QL(5 ea daily)
SYRINGE 0.5ML/30GX1/2" 1B ULTRA-COMFORT QL(5 ea daily);
100/0.5ML/29G X 1/2"
ULTRA FLO INSULIN QL(5 ea daily); MISC
SYRINGE 1B RX/OTC
0.5ML/30GX5/16" MISC ULTRA-COMFORT QL(5 ea daily);
ULTRA FLO INSULIN QL(5 ea daily) 100/0.5ML/30G X 5/16"
SYRINGE 1B MISC
0.5ML/31GX5/16" MISC
ULTRA-COMFORT QL(5 ea daily)
ULTRA FLO INSULIN QL(5 ea daily) INSULIN SYRINGE/U-
SYRINGE 1/2 1B
1B 100/0.5ML/31G X 5/16"
UNIT/0.3ML/30GX1/2" MISC
MISC
ULTRA-COMFORT QL(5 ea daily);
ULTRA FLO INSULIN QL(5 ea daily); INSULIN SYRINGE/U- 1B RX/OTC
SYRINGE 1/2 1B RX/OTC 100/1ML/28G X 1/2" MISC
UNIT/0.3ML/30GX5/16"
MISC ULTRA-COMFORT QL(5 ea daily);
ULTRA FLO INSULIN QL(5 ea daily) 100/1ML/29G X 1/2" MISC
SYRINGE 1/2 1B
UNIT/0.3ML/31GX5/16" ULTRA-COMFORT QL(5 ea daily);
100/1ML/30G X 5/16"
ULTRA FLO INSULIN QL(5 ea daily); MISC
SYRINGE 1M/29GX1/2" 1B RX/OTC
MISC ULTRA-COMFORT QL(5 ea daily)
INSULIN SYRINGE/U- 1B
ULTRA FLO INSULIN QL(5 ea daily) 100/1ML/31G X 5/16"
SYRINGE 1ML/30GX1/2" 1B MISC
MISC
ULTRA-THIN II INSULIN QL(5 ea daily);
ULTRA FLO INSULIN QL(5 ea daily); SYRINGE SHORT/U- RX/OTC
SYRINGE 1ML/30GX5/16" 1B RX/OTC 1B
100/0.3ML/30GX5/16"
MISC MISC
ULTRA FLO INSULIN QL(5 ea daily)
SYRINGE 1ML/31GX5/16" 1B
MISC
111
ULTRA-THIN II INSULIN QL(5 ea daily) ULTRACARE INSULIN QL(5 ea daily);
SYRINGE SHORT/U- 1B SYRINGE/U-100/1ML/30G 1B RX/OTC
100/0.3ML/31GX5/16" X 5/16" MISC
MISC ULTRACARE INSULIN QL(5 ea daily)
ULTRA-THIN II INSULIN QL(5 ea daily); SYRINGE/U-100/1ML/31G 1B
SYRINGE SHORT/U- 1B RX/OTC X 5/16" MISC
100/0.5ML/30GX5/16" VALUE HEALTH INSULIN QL(5 ea daily);
1B
ULTRA-THIN II INSULIN QL(5 ea daily) 100/0.5ML/29G X 1/2"
SYRINGE SHORT/U- 1B MISC
100/0.5ML/31GX5/16" VALUE HEALTH INSULIN QL(5 ea daily);
MISC SYRINGE/U-100/1ML/29G 1B RX/OTC
ULTRA-THIN II INSULIN QL(5 ea daily); X 1/2" MISC
SYRINGE SHORT/U- 1B RX/OTC VANISHPOINT INSULIN QL(5 ea daily)
100/1ML/30GX5/16" MISC SYRINGE/0.5ML/30G X 1B
ULTRA-THIN II INSULIN QL(5 ea daily) 1/2" MISC
SYRINGE SHORT/U- 1B VANISHPOINT INSULIN QL(5 ea daily);
100/1ML/31GX5/16" MISC SYRINGE/0.5ML/30G X 1B RX/OTC
ULTRA-THIN II INSULIN QL(5 ea daily); 5/16" MISC
SYRINGE/U- 1B RX/OTC VANISHPOINT INSULIN QL(5 ea daily);
100/0.5ML/29GX1/2" MISC SYRINGE/1ML/29G X 1/2" 1B RX/OTC
ULTRA-THIN II INSULIN QL(5 ea daily); MISC
SYRINGE/U- 1B RX/OTC VANISHPOINT INSULIN QL(5 ea daily);
100/1ML/29GX1/2" MISC SYRINGE/1ML/30G X 1B RX/OTC
ULTRACARE INSULIN QL(5 ea daily); 5/16" MISC
SYRINGE/U- 1B RX/OTC VP INSULIN SYRINGE/U- QL(5 ea daily);
100/0.3ML/30G X 5/16" 100/0.3ML/29G X 1/2" 1B RX/OTC
MISC MISC
ULTRACARE INSULIN QL(5 ea daily) ZEVRX INSULIN QL(5 ea daily)
SYRINGE/U- 1B SYRINGE/0.5ML/30G X 1B
100/0.3ML/31G X 5/16" 1/2" MISC
MISC
ZEVRX INSULIN QL(5 ea daily);
ULTRACARE INSULIN QL(5 ea daily) SYRINGE/0.5ML/30G X 1B RX/OTC
SYRINGE/U- 1B 5/16" MISC
100/0.5ML/30G X 1/2"
MISC ZEVRX INSULIN QL(5 ea daily)
SYRINGE/1ML/30G X 1/2" 1B
ULTRACARE INSULIN QL(5 ea daily); MISC
100/0.5ML/30G X 5/16" ZEVRX INSULIN QL(5 ea daily);
MISC SYRINGE/1ML/30G X 1B RX/OTC
5/16" MISC
ULTRACARE INSULIN QL(5 ea daily)
SYRINGE/U- MIGRAINE PRODUCTS - Drugs to Treat Migraine
1B Headaches
100/0.5ML/31G X 5/16"
MISC Calcitonin Gene-Related Peptide (CGRP)
ULTRACARE INSULIN QL(5 ea daily)
SYRINGE/U-100/1ML/30G 1B AIMOVIG SOAJ 2 PA; QL(0.04 ml
daily)
X 1/2" MISC
EMGALITY SOAJ 120 2 PA; QL(0.07 ml
MG/ML daily)
112
EMGALITY SOSY 100 3 PA; QL(0.07 ml ST; QL(0.2 ea
MG/ML daily) eletriptan hydrobromide 1B daily); AL(At
EMGALITY SOSY 120 tabs least 18 yrs
2 PA; QL(0.07 ml old)
MG/ML daily)
ST; QL(0.4 ea
Migraine Combinations FROVA TABS (Use
CAFERGOT TABS (Use NF daily); AL(At
NF QL(1.5 ea frovatriptan succinate) least 18 yrs
ergotamine w/ caffeine) daily) old)
ergotamine w/ caffeine tabs 1B QL(1.5 ea ST; QL(0.4 ea
or 1 mg-100 mg daily)
frovatriptan succinate tabs 1B daily); AL(At
QL(10 ea per least 18 yrs
sumatriptan-naproxen old)
3 30 days
sodium tabs retail,10 ea per QL(0.2 ea
30 days mail) IMITREX SOLN NA 20
MG/ACT, 5 MG/ACT (Use NF daily); AL(At
QL(10 ea per least 18 yrs
TREXIMET TABS (Use sumatriptan) old)
sumatriptan-naproxen NF 30 days
retail,10 ea per QL(0.134 ml
sodium) 30 days mail) IMITREX SOLN SC 6
MG/0.5ML (Use NF daily); AL(At
Migraine Products least 18 yrs
sumatriptan succinate) old)
D.H.E. 45 SOLN (Use
dihydroergotamine NF QL(0.134 ml
IMITREX STATDOSE
mesylate) REFILL SOCT (Use NF daily); AL(At
least 18 yrs
dihydroergotamine sumatriptan succinate) old)
1B
mesylate soln ij 1 mg/ml
QL(0.134 ml
dihydroergotamine QL(0.267 ml IMITREX STATDOSE
mesylate soln na 4 mg/ml 1B
daily) SYSTEM SOAJ (Use NF daily); AL(At
least 18 yrs
sumatriptan succinate)
ERGOMAR SUBL 3 QL(0.667 ea old)
daily) QL(0.3 ea
MIGRANAL SOLN (Use QL(0.267 ml IMITREX TABS OR 50 MG,
dihydroergotamine NF daily) 100 MG, 25 MG (Use NF daily); AL(At
least 18 yrs
mesylate) sumatriptan succinate) old)
Serotonin Agonists QL(0.6 ea
MAXALT TABS (Use NF daily); AL(At
ST; QL(0.4 ea rizatriptan benzoate)
almotriptan malate tabs least 6 yrs old)
1B daily); AL(At QL(0.6 ea
12.5 mg least 12 yrs MAXALT-MLT TBDP (Use
old) NF daily); AL(At
rizatriptan benzoate) least 6 yrs old)
ST; QL(0.3 ea
almotriptan malate tabs QL(0.3 ea
1B daily); AL(At
6.25 mg least 12 yrs naratriptan hcl tabs 1B daily); AL(At
old) least 18 yrs
QL(0.3 ea old)
AMERGE TABS (Use ST; QL(0.2 ea
NF daily); AL(At RELPAX TABS (Use
naratriptan hcl) least 18 yrs NF daily); AL(At
old) eletriptan hydrobromide) least 18 yrs
old)
113
QL(0.6 ea ST; QL(0.2 ea
rizatriptan benzoate tabs 1B daily); AL(At ZOMIG SOLN NA 2.5 MG,
10 mg 3 daily); AL(At
least 6 yrs old) 5 MG (Use zolmitriptan) least 12 yrs
QL(0.4 ea old)
rizatriptan benzoate tabs 5 1B daily); AL(At ST; QL(0.3 ea
mg least 6 yrs old) ZOMIG TABS OR 2.5 MG, NF daily); AL(At
QL(0.6 ea 5 MG (Use zolmitriptan) least 12 yrs
rizatriptan benzoate tbdp 1B daily); AL(At old)
10 mg least 6 yrs old) ST; QL(0.3 ea
QL(0.4 ea ZOMIG ZMT TBDP (Use NF daily); AL(At
rizatriptan benzoate tbdp 5 1B daily); AL(At zolmitriptan) least 12 yrs
mg least 6 yrs old) old)
QL(0.2 ea MINERALS & ELECTROLYTES
sumatriptan soln 1B daily); AL(At
least 18 yrs Bicarbonates
old) SODIUM ACETATE SOLN
QL(0.134 ml 1B
2 MEQ/ML
sumatriptan succinate soaj 1B daily); AL(At SODIUM ACETATE SOLN
sc 4 mg/0.5ml, 6 mg/0.5ml least 18 yrs 2 MEQ/ML (Use sodium 1B
old) acetate)
QL(0.134 ml sodium acetate soln 2
sumatriptan succinate soct 1B
1B daily); AL(At meq/ml, 4 meq/ml
sc 4 mg/0.5ml, 6 mg/0.5ml least 18 yrs
old) Calcium
QL(0.134 ml calcium chloride (dihydrate) 1B
sumatriptan succinate soln soln
1B daily); AL(At
sc 6 mg/0.5ml least 18 yrs Electrolyte Mixtures
old)
DEXTROSE 5%/NACL
QL(0.134 ml 0.3% SOLN (Use dextrose NF
sumatriptan succinate sosy 1B daily); AL(At w/ sodium chloride)
sc 6 mg/0.5ml least 18 yrs
old) dextrose in lactated ringers 1B
soln
QL(0.3 ea
sumatriptan succinate tabs DEXTROSE/SODIUM
1B daily); AL(At CHLORIDE SOLN (Use
or 50 mg, 100 mg, 25 mg least 18 yrs NF
old) dextrose w/ sodium
chloride)
ST; QL(0.2 ea
zolmitriptan soln na 2.5 mg, ELLIOTTS B SOLN 4 PA
1B daily); AL(At
5 mg least 12 yrs
old) IONOSOL-MB/DEXTROSE
5% SOLN 3 MEQ/L-3
ST; QL(0.3 ea MEQ/L-5 %-20 MEQ/L-22
zolmitriptan tabs or 2.5 mg, 1B daily); AL(At MEQ/L-23 MEQ/L-25
5 mg least 12 yrs 1B
MEQ/L, 3 MEQ/L-3
old) MMOLE/L-5 %-20 MEQ/L-
ST; QL(0.3 ea 22 MEQ/L-23 MEQ/L-25
zolmitriptan tbdp or 2.5 mg, 1B daily); AL(At MEQ/L
5 mg least 12 yrs ISOLYTE-P/DEXTROSE
old) 1B
5% SOLN
114
ISOLYTE-S SOLN 1B sodium fluoride chew 1 mg, 0 QL(1 ea daily)
2.2 mg
KCL 0.3%/D5W/NACL 1B Magnesium
0.9% SOLN
magnesium sulfate soln ij 1B
lactated ringer's soln 1B 50 %
NORMOSOL-M IN D5W Phosphate
1B
SOLN potassium phosphates soln 1B
NORMOSOL-M/D5W 224 mg/ml-236 mg/ml
1B
SOLN Potassium
NORMOSOL-R SOLN 1B K-TAB TBCR 10 MEQ, 8
MEQ (Use potassium NF
PLASMA-LYTE A SOLN 1B chloride)
potassium acetate soln 1B
PLASMA-LYTE-148 SOLN 1B
potassium chloride in potassium bicarbonate tbef 1B
dextrose & sodium chloride 1B
soln potassium chloride cpcr or 1B
10 meq, 8 meq
potassium chloride in
dextrose soln 1B potassium chloride
microencapsulated crystals 1B
potassium chloride in nacl 1B er tbcr
soln
potassium chloride pack or 1B PA
POTASSIUM 20 meq
CHLORIDE/DEXTROSE/L
ACTATED RINGERS POTASSIUM CHLORIDE 1B
SOLN 2.7 MEQ/L-5 %-24 SOLN IV 10 MEQ/50ML
MEQ/L-28 MEQ/L-129 1B potassium chloride soln iv
MEQ/L-130 MEQ/L, 3 10 meq/50ml, 20 1B
MEQ/L-5 %-24 MEQ/L-28 meq/50ml, 2 meq/ml
MEQ/L-130 MEQ/L-149 potassium chloride soln or
MEQ/L 1B
10 %
POTASSIUM potassium chloride tbcr or
CHLORIDE/SODIUM 1B
10 meq, 8 meq
CHLORIDE SOLN 0.45 %- 1B
20 MEQ/L (Use potassium Sodium
chloride in nacl) sodium chloride soln ij 2.5 1B
POTASSIUM meq/ml
CHLORIDE/SODIUM sodium chloride soln iv 3
CHLORIDE SOLN 0.9 %- NF %, 5 %, 0.9 %, 4 meq/ml, 1B
40 MEQ/L (Use potassium 0.45 %
chloride in nacl)
MISCELLANEOUS THERAPEUTIC CLASSES
ringer's soln 1B
Chelating Agents
Fluoride CUPRIMINE CAPS (Use NF PA
sodium fluoride chew 0.25 penicillamine)
1A
mg, 0.5 mg DEPEN TITRATABS TABS NF QL(8 ea daily)
(Use penicillamine)
115
penicillamine caps 1B PA mycophenolate sodium 1B
tbec
penicillamine tabs 1B QL(8 ea daily) MYFORTIC TBEC (Use NF
mycophenolate sodium)
SYPRINE CAPS (Use NF PA; QL(8 ea NEORAL CAPS (Use
trientine hcl) daily); SP cyclosporine modified (for NF
trientine hcl caps 4 PA; QL(8 ea microemulsion))
daily); SP NEORAL SOLN (Use
Immunomodulators cyclosporine modified (for NF
REVLIMID CAPS 10 MG, PA; QL(1 ea microemulsion))
15 MG, 2.5 MG, 25 MG, 5 4 daily); SP NULOJIX SOLR 4 PA; SP
MG
PA; PROGRAF CAPS OR 0.5
REVLIMID CAPS 20 MG 4 MG, 1 MG, 5 MG (Use NF
PA; QL(3 ea tacrolimus)
THALOMID CAPS 4 PROGRAF PACK OR 0.2 PA
daily); SP 2
MG, 1 MG
Immunosuppressive Agents
PROGRAF SOLN IV 5 2
ATGAM INJ 4 PA; SP MG/ML
RAPAMUNE TABS 0.5
AZASAN TABS 3 MG, 1 MG, 2 MG (Use NF
sirolimus)
AZATHIOPRINE SOLR IJ 1B
100 MG SANDIMMUNE CAPS OR
100 MG, 25 MG (Use NF
azathioprine tabs or 50 mg 1B cyclosporine)
CELLCEPT CAPS 250 MG SANDIMMUNE SOLN IV
(Use mycophenolate NF 50 MG/ML (Use NF
mofetil) cyclosporine)
CELLCEPT TABS 500 MG SIMULECT SOLR 3
(Use mycophenolate NF
mofetil) sirolimus tabs 0.5 mg, 1 1B
mg, 2 mg
cyclosporine caps 1B
tacrolimus caps 1B
cyclosporine modified (for 1B
microemulsion) caps THYMOGLOBULIN SOLR 4 PA; SP
cyclosporine modified (for 1B
microemulsion) soln ZORTRESS TABS 0.25 PA; QL(20 ea
MG, 0.5 MG, 0.75 MG (Use NF daily); SP
cyclosporine soln 1B everolimus
(immunosuppressant))
everolimus 4 PA; QL(20 ea
(immunosuppressant) tabs daily); SP Irrigation Solutions
IMURAN TABS (Use irrigation solutions, 1B
NF physiological soln
azathioprine)
mycophenolate mofetil lactated ringer's (irrigation) 1B
1B soln
caps or 250 mg
mycophenolate mofetil tabs 1B ringer's irrigation soln 1B
or 500 mg
116
water for irrigation, sterile 1B Ped MV w/ Fluoride
soln pediatric multivitamins w/fl RX/OTC
Potassium Removing Agents chew 0.25 mg-0.3 mg-1.05
sodium polystyrene mg-1.05 mg-1.2 mg-4.5
1B mcg-13.5 mg-15 unit-60
sulfonate powd
mg-400 unit-2500 unit, 0.25
sodium polystyrene 1B mg-1.05 mg-1.05 mg-1.2
sulfonate susp mg-4.5 mcg-13.5 mg-15
MOUTH/THROAT/DENTAL AGENTS unit-60 mg-300 mcg-400
unit-2500 unit, 0.3 mg-1
Anesthetics Topical Oral mg-1.05 mg-1.05 mg-1.2
lidocaine hcl (mouth-throat) QL(4 ml daily) mg-4.5 mcg-13.5 mg-15
1B unit-60 mg-400 unit-2500
soln 2 %
unit, 1 mg-1.05 mg-1.05
lidocaine hcl (mouth-throat) 1B mg-1.2 mg-4.5 mcg-13.5 1A
soln 4 % mg-15 unit-60 mg-300
Anti-infectives - Throat mcg-400 unit-2500 unit, 0.3
mg-0.5 mg-1.05 mg-1.05
clotrimazole troc 1B mg-1.2 mg-4.5 mcg-13.5
mg-15 unit-60 mg-400 unit-
nystatin (mouth-throat) 1B 2500 unit, 0.5 mg-1.05 mg-
susp 1.05 mg-1.2 mg-4.5 mcg-
Antiseptics - Mouth/Throat 13.5 mg-15 unit-60 mg-300
chlorhexidine gluconate mcg-400 unit-2500 unit,
1B 1.05 mg-0.3 mg-0.5 mg-
(mouth-throat) soln
1.05 mg-1.2 mg-4.5 mcg-
DEBACTEROL SOLN 2 13.5 mg-15 unit-60 mg-400
unit-2500 unit
PERIDEX SOLN (Use
chlorhexidine gluconate NF Prenatal Vitamins
(mouth-throat)) CLASSIC PRENATAL QL(1 ea daily)
2
Dental Products TABS
stannous fluoride conc mt RX/OTC CVS PRENATAL TABS 2 QL(1 ea daily)
0
0.63 %
EQL PRENATAL 2 QL(1 ea daily)
Steroids - Mouth/Throat/Dental FORMULA TABS
triamcinolone acetonide 1B QL(1 ea daily)
(mouth) pste GNP PRENATAL TABS 2
Throat Products - Misc. GOODSENSE PRENATAL 2 QL(1 ea daily)
VITAMINS TABS
cevimeline hcl caps 1B QL(1 ea daily)
HM PRENATAL TABS 2
EVOXAC CAPS (Use NF
cevimeline hcl) KP PRENATAL 2 QL(1 ea daily)
MULTIVITAMINS TABS
pilocarpine hcl (oral) tabs 1B QL(1 ea daily);
M-NATAL PLUS TABS 2
SALAGEN TABS (Use RX/OTC
NF QL(1 ea daily)
pilocarpine hcl (oral)) MULTI PRENATAL TABS 2
MULTIVITAMINS
117
NEONATAL COMPLETE QL(1 ea daily); PRENATAL TABS 0.8 MG- QL(1 ea daily)
TABS 0.2 MG-1.84 MG-2 RX/OTC 1.5 MG-1.7 MG-2.6 MG-4
MG-2 MG-3 MG-5 MG-9.2 MCG-11 UNIT-18 MG-25
MG-10 MCG-10 MG-12 2 MG-27 MG-100 MG-263
MCG-20 MG-25 MG-27 MG-400 UNIT-4000 UNIT,
MG-120 MG-200 MG-1000 0.8 MG-1.5 MG-1.7 MG-2.6
MCG-1200 MCG MG-4 MCG-18 MG-27 MG-
QL(1 ea daily); 100 MG-263 MG-400
NEONATAL PLUS TABS 2 UNIT-4000 UNIT-25 MG-11
RX/OTC
UNIT, 0.8 MG-1.7 MG-1.8
NEONATAL VITAMIN 2 QL(1 ea daily) MG-2.6 MG-8 MCG-20
TABS MG-25 MG-28 MG-30
QL(1 ea daily); UNIT-120 MG-200 MG-400
NIVA-PLUS TABS 2
RX/OTC UNIT-4000 UNIT, 1.5 MG-
QL(1 ea daily); 1.7 MG-2.6 MG-4 MCG-5
O-CAL FA TABS 2 MG-10 MCG-18 MG-25
RX/OTC
ONE VITE WOMENS QL(1 ea daily); MG-27 MG-100 MG-200 2
PRENATALVITAMIN PLUS 2 RX/OTC MG-800 MCG-1200 MCG,
TABS 1.7 MG-1.8 MG-2.6 MG-8
MCG-20 MG-25 MG-28
ONE VITE WOMENS 2 QL(1 ea daily) MG-30 UNIT-120 MG-200
PRENATALVITAMIN TABS MG-400 UNIT-800 MCG-
PRENATAL LOW IRON 2 QL(1 ea daily) 4000 UNIT, 1.7 MG-1.84
TABS MG-2.6 MG-4 MCG-11
PRENATAL QL(1 ea daily) UNIT-18 MG-25 MG-27
2 MG-100 MG-160 MG-200
MULTIVITAMIN TABS
PRENATAL ONE DAILY QL(1 ea daily) MG-400 UNIT-800 MCG-
2 4000 UNIT, 1.7 MG-2.6
TABS
MG-8 MCG-20 MG-28 MG-
120 MG-200 MG-400
UNIT-800 MCG-4000
UNIT-25 MG-1.8 MG-30
UNIT
PRENATAL TABS 1 MG- QL(1 ea daily);
1.84 MG-2 MG-3 MG-10 RX/OTC
MCG-10 MG-10 MG-12 2
MCG-20 MG-25 MG-27
MG-120 MG-200 MG-1200
MCG
PRENATAL VITAMIN & 2 QL(1 ea daily)
MINERAL TABS
PRENATAL VITAMIN 2 QL(1 ea daily)
TABS
PRENATAL 2 QL(1 ea daily)
VITAMIN/IRON TABS
PRENATAL VITAMINS 2 QL(1 ea daily);
PLUS LOW IRON TABS RX/OTC
PRENATAL VITAMINS 2 QL(1 ea daily)
TABS
118
2 QL(1 ea daily); ROBAXIN-750 TABS (Use
PRENATRIX TABS NF
RX/OTC methocarbamol)
2 QL(1 ea daily); SKELAXIN TABS (Use NF QL(4 ea daily)
PRENATRYL TABS RX/OTC metaxalone)
2 QL(1 ea daily); SOMA TABS (Use
PREPLUS TABS NF
RX/OTC carisoprodol)
PX PRENATAL 2 QL(1 ea daily) tizanidine hcl caps 1B
MULTIVITAMINS TABS
QC PRENATAL TABS 2 QL(1 ea daily) tizanidine hcl tabs 1B
RA PRENATAL QL(1 ea daily) ZANAFLEX CAPS (Use NF
FORMULA/FOLICACID 2 tizanidine hcl)
TABS ZANAFLEX TABS (Use NF
QL(1 ea daily) tizanidine hcl)
RA PRENATAL TABS 2
Direct Muscle Relaxants
RIGHT STEP PRENATAL QL(1 ea daily)
2 DANTRIUM CAPS (Use NF QL(4 ea daily)
TABS dantrolene sodium)
SM PRENATAL VITAMINS QL(1 ea daily)
TABS
2 dantrolene sodium caps or 1B QL(4 ea daily)
100 mg, 25 mg, 50 mg
THERANATAL CORE 2 QL(1 ea daily);
NUTRITION TABS RX/OTC NASAL AGENTS - SYSTEMIC AND TOPICAL -
Drugs to treat the Nose or Sinus
QL(1 ea daily);
TRICARE TABS 2
RX/OTC Nasal Antiallergy
VITATHELY/GINGER 2 QL(1 ea daily); azelastine hcl soln 1B
TABS RX/OTC
QL(1 ea daily); olopatadine hcl (nasal) soln 1B
VOL-PLUS TABS 2
RX/OTC
QL(1 ea daily); PATANASE SOLN (Use NF
WESTAB PLUS TABS 2 olopatadine hcl (nasal))
RX/OTC
MUSCULOSKELETAL THERAPY AGENTS - Nasal Anticholinergics
Drugs to Treat Spasms ipratropium bromide (nasal) 1B QL(1 ml daily)
soln 0.03 %
Central Muscle Relaxants
ipratropium bromide (nasal) 1B
baclofen tabs or 10 mg, 20 1B soln 0.06 %
mg
Nasal Steroids
carisoprodol tabs 1B
budesonide (nasal) susp 1B
chlorzoxazone tabs 500 mg 1B QL(6 ea daily)
Limit 2 inhalers
FLONASE ALLERGY
cyclobenzaprine hcl tabs QL(3 ea daily) per
1A RELIEF CHILDRENS NF month;QL(32
10 mg, 5 mg SUSP (Use fluticasone ml per 30 days
metaxalone tabs 800 mg 1B QL(4 ea daily) propionate (nasal)) retail); RX/OTC
methocarbamol tabs or 500 Limit 2 inhalers
1B FLONASE ALLERGY
mg, 750 mg per
RELIEF SUSP (Use NF month;QL(32
orphenadrine citrate tb12 QL(2 ea daily) fluticasone propionate ml per 30 days
1B (nasal))
or 100 mg retail); RX/OTC
119
flunisolide (nasal) soln 1B 1 rtl pack lmt CLINIMIX
per fill, 4.25%/DEXTROSE 5% 3
Limit 2 inhalers SOLN
per CLINIMIX 5%/DEXTROSE
fluticasone propionate 1B month;QL(32 25% SOLN
3
(nasal) susp ml per 30 days CLINIMIX E
retail); RX/OTC 5%/DEXTROSE 20% 3
mometasone furoate 1B PA; QL(1.14 SOLN
(nasal) susp gm daily)
NASACORT ALLERGY OPHTHALMIC AGENTS - Drugs to Treat the Eye
24HR AERO (Use NF Artificial Tears and Lubricants
triamcinolone acetonide
(nasal)) LACRISERT INST 3
NASACORT ALLERGY
24HR CHILDRENS AERO Beta-blockers - Ophthalmic
NF
(Use triamcinolone betaxolol hcl (ophth) soln 1B
acetonide (nasal))
NASONEX SUSP (Use PA; QL(1.14 carteolol hcl (ophth) soln 1B
mometasone furoate NF gm daily)
(nasal)) COMBIGAN SOLN 2
triamcinolone acetonide 1B
(nasal) aero COSOPT SOLN (Use
dorzolamide hcl-timolol NF
NEUROMUSCULAR AGENTS - Drugs to maleate)
Relax/Paralyze Muscles dorzolamide hcl-timolol
ALS Agents maleate soln 2 %-0.5 %,
RILUTEK TABS (Use 22.3 mg/ml-6.8 mg/ml, 5 1B
NF mg/ml-20 mg/ml, 6.8
riluzole)
mg/ml-22.3 mg/ml
riluzole tabs 3
levobunolol hcl soln 1B
Neuromuscular Blocking Agent - Neurotoxins timolol maleate (ophth) solg 1B
BOTOX SOLR 3 PA 0.25 %, 0.5 %
timolol maleate (ophth) soln 1B
DYSPORT SOLR 3 PA 0.25 %, 0.5 %
TIMOPTIC SOLN (Use NF
XEOMIN SOLR 3 PA timolol maleate (ophth))
TIMOPTIC-XE SOLG (Use NF
NUTRIENTS timolol maleate (ophth))
Proteins Cycloplegic Mydriatics
CLINIMIX MYDRIACYL SOLN (Use NF
4.25%/DEXTROSE 10% 3 tropicamide)
SOLN
tropicamide soln 1B
CLINIMIX
4.25%/DEXTROSE 25% 3 Miotics
SOLN ISOPTO CARPINE SOLN NF
(Use pilocarpine hcl)
120
PHOSPHOLINE IODIDE 3 neomycin-bacitracin zn- 1B
SOLR polymyxin oint
pilocarpine hcl soln 1B OCUFLOX SOLN (Use NF
ofloxacin (ophth))
Ophthalmic Adrenergic Agents ofloxacin (ophth) soln 1B
ALPHAGAN P SOLN 0.15
% (Use brimonidine NF polymyxin b-trimethoprim 1B
tartrate) soln
POLYTRIM SOLN (Use NF
apraclonidine hcl soln 1B polymyxin b-trimethoprim)
brimonidine tartrate soln 1B sulfacetamide sodium 1B
(ophth) soln
IOPIDINE SOLN 3 tobramycin (ophth) soln 1B
SIMBRINZA SUSP 3 PA TOBREX SOLN (Use NF
tobramycin (ophth))
Ophthalmic Anti-infectives trifluridine soln 1B
AZASITE SOLN 3
VIGAMOX SOLN (Use NF
moxifloxacin hcl (ophth))
bacitracin (ophthalmic) oint 3
ZIRGAN GEL 2
BESIVANCE SUSP 3 PA
ZYMAXID SOLN (Use NF
BLEPH-10 SOLN (Use gatifloxacin (ophth))
sulfacetamide sodium NF
(ophth)) Ophthalmic Local Anesthetics
CILOXAN SOLN (Use ALCAINE SOLN (Use NF
NF proparacaine hcl)
ciprofloxacin hcl (ophth))
ciprofloxacin hcl (ophth) proparacaine hcl soln 1B
1B
soln
Ophthalmic Nerve Growth Factors
erythromycin (ophth) oint 1B PA
OXERVATE SOLN 4
gatifloxacin (ophth) soln 1B
Ophthalmic Steroids
gentamicin sulfate (ophth) 1B PA
oint ALREX SUSP 3
gentamicin sulfate (ophth) 1B dexamethasone sodium
soln 1B
phosphate (ophth) soln
KLARITY-A SOLN 3 DUREZOL EMUL 3 PA
levofloxacin (ophth) soln 1B fluorometholone (ophth) 1B

susp
moxifloxacin hcl (ophth) 1B PA
soln FML FORTE SUSP 3
NATACYN SUSP 2 FML LIQUIFILM SUSP

(Use fluorometholone NF
(ophth))
121
FML OINT 3 PA Ophthalmics - Misc.
ACULAR LS SOLN (Use
LOTEMAX GEL (Use 3 PA ketorolac tromethamine NF
loteprednol etabonate) (ophth))
LOTEMAX OINT 3 PA ACULAR SOLN (Use
ketorolac tromethamine NF
LOTEMAX SUSP (Use NF PA (ophth))
loteprednol etabonate)
ALOCRIL SOLN 3 PA
loteprednol etabonate gel 1B PA
ALOMIDE SOLN 3 PA
loteprednol etabonate susp 1B PA
PA azelastine hcl (ophth) soln 1B

MAXIDEX SUSP 3
AZOPT SUSP (Use NF
MAXITROL OINT (Use brinzolamide)
neomycin-polymy- NF
dexameth) bepotastine besilate soln 3 PA
MAXITROL SUSP (Use BEPREVE SOLN (Use PA
neomycin-polymy- NF 3
bepotastine besilate)
dexameth)
neomycin-polymy- brinzolamide susp 1B
1B
dexameth oint bromfenac sodium (ophth)
neomycin-polymy- 1B
1B soln
dexameth susp cromolyn sodium (ophth)
neomycin-polymyxin-hc 1B
1B soln
(ophth) susp PA; QL(2.143
PRED FORTE SUSP (Use CYSTARAN SOLN 2
ml daily)
prednisolone acetate NF
diclofenac sodium (ophth)
(ophth)) soln 1B
PRED MILD SUSP 3 PA
dorzolamide hcl soln 1B
PRED-G SUSP 3 PA
epinastine hcl (ophth) soln 1B
prednisolone acetate 1B
(ophth) susp flurbiprofen sodium soln 1B
PREDNISOLONE SODIUM ST; QL(0.2 ml
PHOSPHATE SOLN OP 1 3 ILEVRO SUSP 3
daily)
%
ketorolac tromethamine 1B
sulfacetamide sod- 1B PA (ophth) soln
prednisolone soln
ketotifen fumarate (ophth) 1B
TOBRADEX SUSP (Use soln
tobramycin- NF
dexamethasone) LASTACAFT SOLN 3 PA
tobramycin- 1B ST; QL(0.2 ml
dexamethasone susp NEVANAC SUSP 3
daily)
ZYLET SUSP 3 PA RX/OTC
olopatadine hcl soln 1B
122
PATADAY SOLN (Use NF RX/OTC ciprofloxacin-fluocinolone 1B PA; QL(0.5 ea
olopatadine hcl) acetonide soln daily)
PATANOL SOLN (Use NF RX/OTC COLY-MYCIN S SUSP 3
olopatadine hcl)
TRUSOPT SOLN (Use NF CORTISPORIN-TC SUSP 3
dorzolamide hcl)
ZADITOR SOLN (Use neomycin-polymyxin-hc 1B
NF (otic) soln
ketotifen fumarate (ophth))
PA neomycin-polymyxin-hc 1B
ZERVIATE SOLN 3 (otic) susp
Prostaglandins - Ophthalmic OTOVEL SOLN (Use PA; QL(0.5 ea
ciprofloxacin-fluocinolone NF daily)
bimatoprost soln 3 acetonide)
Otic Steroids
latanoprost soln 1B
DERMOTIC OIL (Use
TRAVATAN Z SOLN (Use fluocinolone acetonide NF
NF (otic))
travoprost)
travoprost soln 1B fluocinolone acetonide 1B
(otic) oil
XALATAN SOLN (Use NF hydrocortisone w/acetic
latanoprost) 1B
acid soln
ZIOPTAN SOLN 2 PASSIVE IMMUNIZING AND TREATMENT
AGENTS - Antibody Drugs to Treat Low Immune
OTIC AGENTS - Drugs to Treat the Ear System
Immune Serums
Otic Agents - Miscellaneous
CUVITRU SOLN 1 PA; SP
acetic acid (otic) soln 1B GM/5ML, 10 GM/50ML, 2 4
GM/10ML, 4 GM/20ML
Otic Anti-infectives GAMMAGARD LIQUID PA; SP
CETRAXAL SOLN (Use NF SOLN 1 GM/10ML, 10
ciprofloxacin hcl (otic)) 4
GM/100ML, 2.5 GM/25ML,
20 GM/200ML, 5 GM/50ML
ciprofloxacin hcl (otic) soln 1B
GAMMAGARD LIQUID 4 PA
FLOXIN OTIC SOLN (Use NF SOLN 30 GM/300ML
ofloxacin (otic)) GAMMAGARD S/D IGA PA; SP
ofloxacin (otic) soln 1B LESS THAN 1MCG/ML 4
SOLR
Otic Combinations GAMMAKED SOLN 4 PA; SP
CIPRO HC SUSP 3 PA; SP
GAMUNEX-C SOLN 4
CIPRODEX SUSP (Use PA
ciprofloxacin- NF HIZENTRA SOLN 1 PA; SP
dexamethasone) GM/5ML, 10 GM/50ML, 2 4
ciprofloxacin- PA GM/10ML, 4 GM/20ML
1B
dexamethasone susp Passive Immunizing Agents - Combinations
123
HYQVIA KIT 4 PA amoxicillin & pot 1B
clavulanate tb12
PENICILLINS - Drugs to Treat Bacterial Infections ampicillin & sulbactam
sodium solr ij 1 gm-2 gm, 2 1B
Aminopenicillins gm-1 gm, 0.5 gm-1 gm, 1
amoxicillin caps 250 mg, gm-0.5 gm
1A ampicillin & sulbactam
500 mg
amoxicillin chew 125 mg, sodium solr iv 10 gm-5 gm, 1B
1B 5 gm-10 gm
250 mg
amoxicillin susr 125 AUGMENTIN ES-600
1A SUSR (Use amoxicillin & NF
mg/5ml
pot clavulanate)
amoxicillin susr 200
mg/5ml, 250 mg/5ml, 400 1B AUGMENTIN SUSR 62.5
mg/5ml MG/5ML-250 MG/5ML NF
(Use amoxicillin & pot
amoxicillin tabs 500 mg, 1B clavulanate)
875 mg
AUGMENTIN TABS 125
ampicillin caps 1B MG-500 MG (Use NF
amoxicillin & pot
ampicillin sodium solr ij 1 1B clavulanate)
gm
piperacillin sodium- 1B
ampicillin sodium solr iv 10 1B tazobactam sodium solr
gm
UNASYN BULK PACK
Natural Penicillins SOLR (Use ampicillin & NF
PENICILLIN G sulbactam sodium)
POTASSIUM IN ISO- UNASYN SOLR (Use
OSMOTIC DEXTROSE 1B ampicillin & sulbactam NF
SOLN 40000 UNIT/ML, sodium)
60000 UNIT/ML ZOSYN SOLR 0.25 GM-2
penicillin g potassium solr 1B GM, 0.375 GM-3 GM, 0.5
5000000 unit GM-4 GM, 2 GM-0.25 GM,
PENICILLIN G PROCAINE 3 GM-0.375 GM, 4.5 GM- NF
3 36 GM (Use piperacillin
SUSP
sodium-tazobactam
penicillin g sodium solr 3 sodium)
penicillin v potassium solr 1B Penicillinase-Resistant Penicillins
dicloxacillin sodium caps 1B
penicillin v potassium tabs 1B
nafcillin sodium solr ij 1 gm 1B
Penicillin Combinations
amoxicillin & pot nafcillin sodium solr iv 10 1B
1B gm
clavulanate chew
amoxicillin & pot 1B oxacillin sodium solr ij 1 gm 1B
clavulanate susr
oxacillin sodium solr iv 10
amoxicillin & pot 1B gm 1B
clavulanate tabs
124
PROGESTINS - Hormone Replacement/Modifying donepezil hydrochloride 1B QL(1 ea daily)
Drugs tabs 5 mg
Progestins donepezil hydrochloride 1B QL(2 ea daily)
tbdp 10 mg
AYGESTIN TABS (Use
norethindrone acetate) NF donepezil hydrochloride 1B QL(1 ea daily)
tbdp 5 mg
medroxyprogesterone
acetate tabs 10 mg 1A galantamine hydrobromide 1B QL(1 ea daily)
cp24 16 mg, 24 mg, 8 mg
medroxyprogesterone
acetate tabs 2.5 mg, 5 mg 1B galantamine hydrobromide 1B QL(6 ml daily)
soln 4 mg/ml
MEGACE ES SUSP (Use PA
megestrol acetate NF galantamine hydrobromide 1B QL(2 ea daily)
(appetite)) tabs 12 mg, 4 mg, 8 mg
megestrol acetate PA memantine hcl tabs 1B
1B
(appetite) susp
memantine hcl tabs 10 mg 1B QL(2 ea daily)
norethindrone acetate tabs 0
memantine hcl tabs 5 mg 1B QL(1 ea daily)
progesterone caps or 100 1B
mg, 200 mg NAMENDA TABS 10 MG
PROMETRIUM CAPS (Use NF NF QL(2 ea daily)
(Use memantine hcl)
progesterone) NAMENDA TABS 5 MG
PROVERA TABS (Use NF QL(1 ea daily)
(Use memantine hcl)
medroxyprogesterone NF NAMENDA TITRATION
acetate) PAK TABS (Use NF
PSYCHOTHERAPEUTIC AND NEUROLOGICAL memantine hcl)
AGENTS - MISC. - Drugs to Treat Mental and RAZADYNE ER CP24 (Use
Emotional Conditions NF QL(1 ea daily)
galantamine hydrobromide)
Agents for Chemical Dependency RAZADYNE TABS (Use NF QL(2 ea daily)
galantamine hydrobromide)
acamprosate calcium tbec 1B
rivastigmine tartrate caps 1B
ANTABUSE TABS (Use NF
disulfiram) Combination Psychotherapeutics
disulfiram tabs 1B chlordiazepoxide- PA
amitriptyline tabs 5 mg-12.5 1B
PA; QL(224 ea mg
LUCEMYRA TABS 3 per 14 days perphenazine-amitriptyline
retail) 1B QL(4 ea daily)
tabs
Antidementia Agents Fibromyalgia Agents
ARICEPT TABS 10 MG QL(2 ea daily) PA; QL(2 ea
(Use donepezil NF SAVELLA TABS 2
daily)
hydrochloride)
SAVELLA TITRATION 2 PA
ARICEPT TABS 5 MG QL(1 ea daily) PACK MISC
(Use donepezil NF
hydrochloride) Movement Disorder Drug Therapy
donepezil hydrochloride QL(2 ea daily) PA; QL(4 ea
1B AUSTEDO TABS 4
tabs 10 mg daily)
125
tetrabenazine tabs 4 PA; QL(3 ea TECFIDERA STARTER PA
daily); SP PACK MISC (Use dimethyl NF
XENAZINE TABS (Use fumarate)
NF PA; QL(3 ea
tetrabenazine) daily); SP TYSABRI CONC 4 PA; QL(0.536
ml daily); SP
Multiple Sclerosis Agents
AMPYRA TB12 (Use Postherpetic Neuralgia (PHN)/Neuropathic Pain
NF PA; QL(2 ea
dalfampridine) daily); SP LYRICA CR TB24 165 MG, PA; QL(1 ea
82.5 MG (Use pregabalin 3 daily)
AUBAGIO TABS 4 PA (once-daily))
PA; QL(0.0714 LYRICA CR TB24 330 MG PA; QL(2 ea
AVONEX PEN AJKT 4 (Use pregabalin (once- 3 daily)
ml daily); SP
PA; QL(0.0714 daily))
AVONEX PSKT 4 pregabalin (once-daily)
ml daily); SP 3 PA; QL(1 ea
PA; QL(0.0357 tb24 165 mg, 82.5 mg daily)
BETASERON KIT 4 pregabalin (once-daily)
ea daily); SP 3 PA; QL(2 ea
PA; QL(2 ea tb24 330 mg daily)
dalfampridine tb12 4
daily); SP Premenstrual Dysphoric Disorder (PMDD) Agents
PA fluoxetine hcl (pmdd) caps
dimethyl fumarate cpdr 4 1B QL(1 ea daily)
10 mg
PA fluoxetine hcl (pmdd) caps
dimethyl fumarate misc 4 1B QL(3 ea daily)
20 mg
PA; QL(0.0357
EXTAVIA KIT 4 Pseudobulbar Affect (PBA) Agents
ea daily); SP
PA NUEDEXTA CAPS 3 PA
GILENYA CAPS 4
MAVENCLAD TBPK 4 PA Psychotherapeutic and Neurological Agents -
PA; QL(0.036 ergoloid mesylates tabs 1B

PLEGRIDY SOPN SC 4
ml daily)
pimozide tabs 1B
PA; QL(0.036
PLEGRIDY SOSY SC 4
ml daily) Restless Leg Syndrome (RLS) Agents
PLEGRIDY STARTER PA; QL(0.036
PACK SOPN
4
ml daily) HORIZANT TBCR 3 PA; QL(2 ea
daily)
PLEGRIDY STARTER 4 PA; QL(0.036
PACK SOSY ml daily) Smoking Deterrents
PA; QL(0.214 APO-VARENICLINE TABS 0 QL(2 ea daily)
REBIF REBIDOSE SOAJ 4
ml daily); SP
bupropion hcl (smoking 0 QL(2 ea daily)
REBIF REBIDOSE 4 PA; SP deterrent) tb12
TITRATIONPACK SOAJ
CHANTIX CONTINUING 0 QL(2 ea daily)
PA; QL(0.214 MONTHPAK TABS
REBIF SOSY 4
ml daily); SP
CHANTIX STARTING 0
REBIF TITRATION PACK 4 PA; SP MONTH PAK TABS
SOSY
CHANTIX TABS 0 QL(2 ea daily)
TECFIDERA CPDR (Use NF PA
dimethyl fumarate) NICODERM CQ PT24 (Use NF QL(1 ea daily)
nicotine)
126
NICORETTE GUM (Use 4 PA; QL(2.5 ml
NF PULMOZYME SOLN
nicotine polacrilex) daily); SP
NICORETTE LOZG (Use NF TRIKAFTA TBPK 50 MG- 4 PA; QL(3 ea
nicotine polacrilex) 100 MG daily)
NICORETTE MINI LOZG NF Pulmonary Fibrosis Agents
(Use nicotine polacrilex) PA; QL(2 ea
NICORETTE STARTER OFEV CAPS 4
daily)
KIT GUM (Use nicotine NF
polacrilex) SULFONAMIDES - Drugs to Treat Bacterial
Infections
nicotine polacrilex gum 0
Sulfonamides
nicotine polacrilex lozg 0 SULFADIAZINE TABS 1B
nicotine pt24 0 QL(1 ea daily) TETRACYCLINES - Drugs to Treat Bacterial
Infections
NICOTINE
TRANSDERMAL SYSTEM 0 Glycylcyclines
KIT
tigecycline solr 1B
NICOTROL INHALER 0
INHA TYGACIL SOLR (Use NF
tigecycline)
NICOTROL NS SOLN 0
Tetracyclines
Transthyretin Amyloidosis Agents demeclocycline hcl tabs 1B
TEGSEDI SOSY 4 PA
doxycycline (monohydrate) 1B QL(2 ea daily)
RESPIRATORY AGENTS - MISC. - Drugs to caps 50 mg, 100 mg
Treat Lung Conditions doxycycline (monohydrate) 1B
caps 75 mg
Alpha-Proteinase Inhibitor (Human)
doxycycline (monohydrate) 1B QL(2 ea daily)
ARALAST NP SOLR 1000 4 PA; SP tabs 100 mg
MG
doxycycline (monohydrate) 1B
ARALAST NP SOLR 500 4 PA tabs 50 mg
MG
doxycycline hyclate caps or 1B QL(2 ea daily)
PROLASTIN-C SOLN 1000 4 PA; 50 mg, 100 mg
MG/20ML
doxycycline hyclate solr iv 1B
PROLASTIN-C SOLR 1000 4 PA; SP 100 mg
MG
doxycycline hyclate tabs or 1B QL(2 ea daily)
ZEMAIRA SOLR 4 PA; SP 100 mg, 20 mg
MINOCIN CAPS OR 50 NF QL(3 ea daily)
Cystic Fibrosis Agents MG (Use minocycline hcl)
PA; QL(2 ea minocycline hcl caps 100 QL(3 ea daily)
KALYDECO TABS 150 MG 4 1B
daily); SP mg, 50 mg, 75 mg
ORKAMBI PACK 100 MG- 4 PA; QL(2 ea minocycline hcl tabs 100 QL(3 ea daily)
125 MG, 150 MG-188 MG daily) 1B
mg, 50 mg, 75 mg
ORKAMBI TABS 100 MG- 4 PA; QL(4 ea TARGADOX TABS (Use
125 MG, 125 MG-200 MG daily) NF
doxycycline hyclate)
127
tetracycline hcl caps 1B QL(8 ea daily) WESTHROID TABS 2
VIBRAMYCIN CAPS 100 QL(2 ea daily) WP THYROID TABS 2
MG (Use doxycycline NF
hyclate)
TOXOIDS
XIMINO CP24 135 MG, 45
MG, 90 MG (Use NF Toxoid Combinations
minocycline hcl)
ADACEL SUSP 0
THYROID AGENTS - Drugs to Regulate Thyroid
Hormones BOOSTRIX SUSP 0
Antithyroid Agents
ULCER DRUGS - Drugs to Treat Bowel, Intestine
methimazole tabs 1B and Stomach Conditions
propylthiouracil tabs 1B Antispasmodics
atropine sulfate soln ij 0.4 1B
TAPAZOLE TABS (Use NF mg/ml, 1 mg/ml
methimazole) atropine sulfate sosy ij 0.25 1B
Thyroid Hormones mg/5ml
ARMOUR THYROID TABS QL(1 ea daily) chlordiazepoxide hcl- 1B
120 MG, 15 MG, 30 MG, clidinium bromide caps
2
60 MG, 90 MG (Use dicyclomine hcl caps or 10
thyroid) 1B
mg
ARMOUR THYROID TABS 2 QL(1 ea daily) dicyclomine hcl soln or 10
180 MG, 240 MG, 300 MG 1B
mg/5ml
CYTOMEL TABS (Use NF dicyclomine hcl tabs or 20
liothyronine sodium) 1B
mg
levothyroxine sodium tabs glycopyrrolate soln ij 4
or 300 mcg, 100 mcg, 112 1B
mg/20ml
mcg, 125 mcg, 137 mcg, 1B glycopyrrolate tabs or 1
150 mcg, 175 mcg, 200 1B
mg, 2 mg
mcg, 25 mcg, 50 mcg, 75
mcg, 88 mcg LIBRAX CAPS (Use
chlordiazepoxide hcl- NF
liothyronine sodium soln 1B clidinium bromide)
methscopolamine bromide 1B
liothyronine sodium tabs 1B tabs
NATURE-THROID NT-2.5 2 H-2 Antagonists
TABS cimetidine hcl soln 300 QL(20 ml daily)
1B
NATURE-THROID TABS 2 mg/5ml
cimetidine tabs 200 mg 1B RX/OTC
SYNTHROID TABS (Use 2
levothyroxine sodium) cimetidine tabs 300 mg,
QL(1 ea daily) 1B
thyroid tabs 1B 400 mg, 800 mg
TRIOSTAT SOLN (Use famotidine in nacl soln 1B
NF
liothyronine sodium) famotidine soln iv 20 1A
mg/2ml
128
famotidine soln iv 200 1B sucralfate tabs 1 gm 1B QL(4 ea daily)
mg/20ml, 40 mg/4ml
famotidine susr or 40 1B QL(10 ml daily) Proton Pump Inhibitors
mg/5ml ACIPHEX TBEC (Use
RX/OTC NF QL(1 ea daily)
famotidine tabs or 20 mg 1B rabeprazole sodium)
esomeprazole magnesium 1B QL(2 ea daily);
famotidine tabs or 40 mg 1B cpdr 20 mg RX/OTC
esomeprazole magnesium 3 QL(1 ea daily)
nizatidine caps 150 mg, 1B cpdr 40 mg
300 mg
QL(2 ea daily);
nizatidine soln 15 mg/ml 1B QL(20 ml daily) lansoprazole cpdr 15 mg 1B
RX/OTC
PEPCID AC MAXIMUM RX/OTC lansoprazole cpdr 30 mg 1B
STRENGTH TABS (Use NF
famotidine) NEXIUM 24HR TBEC 1B QL(2 ea daily)
PEPCID AC TABS 20 MG NF RX/OTC
(Use famotidine) NEXIUM CPDR 20 MG QL(2 ea daily);
(Use esomeprazole NF RX/OTC
PEPCID TABS 20 MG (Use NF RX/OTC magnesium)
famotidine) NEXIUM CPDR 40 MG QL(1 ea daily)
PEPCID TABS 40 MG (Use NF (Use esomeprazole NF
famotidine) magnesium)
ranitidine hcl caps or 150 1B omeprazole cpdr 10 mg, 40 QL(2 ea daily)
mg, 300 mg 1B
mg
ranitidine hcl soln ij 150 1B QL(2 ea daily);
mg/6ml omeprazole cpdr 20 mg 1B
RX/OTC
ranitidine hcl syrp or 15 QL(40 ml daily) omeprazole magnesium QL(4 ea daily)
mg/ml, 150 mg/10ml, 75 1B 1B
cpdr 20 mg, 20.6 mg
mg/5ml QL(2 ea daily)
ranitidine hcl tabs or 150 RX/OTC omeprazole tbec 20 mg 1B
1B
mg pantoprazole sodium tbec QL(1 ea daily)
ranitidine hcl tabs or 300 1B
1B or 20 mg
mg pantoprazole sodium tbec
TAGAMET HB TABS (Use 1B
NF RX/OTC or 40 mg
cimetidine) PREVACID 24HR CPDR
ZANTAC 150 MAXIMUM RX/OTC NF QL(2 ea daily);
(Use lansoprazole) RX/OTC
STRENGTH TABS (Use NF PREVACID CPDR 15 MG
ranitidine hcl) NF QL(2 ea daily);
(Use lansoprazole) RX/OTC
ZANTAC SOLN 25 MG/ML NF PREVACID CPDR 30 MG
(Use ranitidine hcl) NF
(Use lansoprazole)
Misc. Anti-Ulcer PROTONIX TBEC OR 20 QL(1 ea daily)
CARAFATE SUSP 1 MG (Use pantoprazole NF
NF QL(40 ml daily) sodium)
GM/10ML (Use sucralfate)
CARAFATE TABS 1 GM PROTONIX TBEC OR 40
NF QL(4 ea daily) MG (Use pantoprazole NF
(Use sucralfate)
QL(40 ml daily) sodium)
sucralfate susp 1 gm/10ml 1B QL(1 ea daily)
rabeprazole sodium tbec 1B
129
Ulcer Drugs - Prostaglandins trospium chloride tabs 20 1B
CYTOTEC TABS (Use mg
NF QL(4 ea daily) VESICARE TABS (Use
misoprostol) NF PA; QL(1 ea
solifenacin succinate) daily)
misoprostol tabs 1B QL(4 ea daily)
Urinary Antispasmodics - Cholinergic Agonists
Ulcer Therapy Combinations bethanechol chloride tabs 1B QL(4 ea daily)
omeprazole-sodium QL(1 ea daily); 10 mg, 5 mg, 50 mg
bicarbonate caps 20 mg- 1B RX/OTC bethanechol chloride tabs 1B
1100 mg 25 mg
ZEGERID CAPS 20 MG- QL(1 ea daily); URECHOLINE TABS 10 QL(4 ea daily)
1100 MG (Use RX/OTC MG, 5 MG, 50 MG (Use NF
NF bethanechol chloride)
omeprazole-sodium
bicarbonate) URECHOLINE TABS 25
ZEGERID OTC CAPS (Use QL(1 ea daily); MG (Use bethanechol NF
omeprazole-sodium NF RX/OTC chloride)
bicarbonate) Urinary Antispasmodics - Direct Muscle Relaxants
URINARY ANTISPASMODICS - Drugs to Treat
Miscellaneous Bladder Spasms flavoxate hcl tabs 1B
Urinary Antispasmodic - Antimuscarinics VACCINES
darifenacin hydrobromide 1B QL(1 ea daily)
tb24 Bacterial Vaccines
DETROL LA CP24 (Use NF QL(1 ea daily) MENACTRA INJ 0
tolterodine tartrate)
DETROL TABS (Use NF MENQUADFI INJ 0
tolterodine tartrate)
DITROPAN XL TB24 (Use MENVEO SOLR 0
NF
oxybutynin chloride)
ENABLEX TB24 (Use PNEUMOVAX 23 INJ 0
NF QL(1 ea daily)
darifenacin hydrobromide) PNEUMOVAX 23/1 DOSE 0
oxybutynin chloride syrp 1B INJ
PREVNAR 13 SUSP 0
oxybutynin chloride tabs 1B
Viral Vaccines
oxybutynin chloride tb24 1B Limit 1 dose
PA; QL(1 ea AFLURIA QUADRIVALENT 0 per season;1 rtl
solifenacin succinate tabs 1B
daily) 2019-2020 SUSP MAX fill,180 rtl
day(s) supply,
tolterodine tartrate cp24 2 1B QL(1 ea daily)
mg, 4 mg Limit 1 dose
AFLURIA QUADRIVALENT 0 per season;1 rtl
tolterodine tartrate tabs 1 1B 2019-2020 SUSY MAX fill,180 rtl
mg, 2 mg day(s) supply,
PA; QL(1 ea Limit 1 dose
TOVIAZ TB24 3
daily) AFLURIA QUADRIVALENT per season;1 rtl
trospium chloride cp24 60 QL(1 ea daily) 0
1B 2020-2021 SUSP MAX fill,180 rtl
mg day(s) supply,
130
Limit 1 dose Limit 1 dose
AFLURIA QUADRIVALENT 0 per season;1 rtl FLUARIX QUADRIVALENT 0 per season;1 rtl
2020-2021 SUSY MAX fill,180 rtl 2021-2022 SUSY MAX fill,180 rtl
day(s) supply, day(s) supply,
FLUBLOK
AFLURIA QUADRIVALENT 0 per season;1 rtl 0 per season;1 rtl
QUADRIVALENT 2019-
2021-2022 SUSP MAX fill,180 rtl MAX fill,180 rtl
2020 SOSY
FLUBLOK
AFLURIA QUADRIVALENT 0 per season;1 rtl 0 per season;1 rtl
QUADRIVALENT 2020-
2021-2022 SUSY MAX fill,180 rtl MAX fill,180 rtl
2021 SOSY
3 rtl MAX Limit 1 dose
FLUBLOK
fill,365 rtl 0 per season;1 rtl
QUADRIVALENT 2021-
ENGERIX-B INJ 0 day(s) supply,3 2022 SOSY MAX fill,180 rtl
mail MAX day(s) supply,
fill,365 mail Limit 1 dose
day(s) supply, FLUCELVAX
QUADRIVALENT 2019- 0 per season;1 rtl
3 rtl MAX MAX fill,180 rtl
2020 SUSP
fill,365 rtl day(s) supply,
ENGERIX-B SUSP 0 day(s) supply,3 FLUCELVAX Limit 1 dose
mail MAX
fill,365 mail QUADRIVALENT 2019- 0 per season;1 rtl
MAX fill,180 rtl
day(s) supply, 2020 SUSY day(s) supply,
FLUCELVAX
FLUAD 2019-2020 SUSY 0 per season;1 rtl QUADRIVALENT 2020- 0 per season;1 rtl
MAX fill,180 rtl MAX fill,180 rtl
day(s) supply, 2021 SUSP day(s) supply,
FLUCELVAX
FLUAD 2020-2021 SUSY 0 per season;1 rtl QUADRIVALENT 2020- 0 per season;1 rtl
MAX fill,180 rtl MAX fill,180 rtl
day(s) supply, 2021 SUSY day(s) supply,
1 rtl MAX Limit 1 dose
FLUAD QUADRIVALENT 0 fill,180 rtl FLUCELVAX
2021-2022 PRSY day(s) supply, QUADRIVALENT 2021- 0 per season;1 rtl
MAX fill,180 rtl
2022 SUSP
FLUAD QUADRIVALENT 1 rtl MAX day(s) supply,
INFLUENZA VACCINE 0 fill,180 rtl Limit 1 dose
FOR ADULTS PRSY day(s) supply, FLUCELVAX
Limit 1 dose MAX fill,180 rtl
2022 SUSY
FLUARIX QUADRIVALENT 0 per season;1 rtl day(s) supply,
2019-2020 SUSY MAX fill,180 rtl Limit 1 dose
day(s) supply, FLULAVAL
Limit 1 dose MAX fill,180 rtl
2020 SUSP
FLUARIX QUADRIVALENT 0 per season;1 rtl day(s) supply,
2020-2021 SUSY MAX fill,180 rtl Limit 1 dose
day(s) supply, FLULAVAL
MAX fill,180 rtl
2020 SUSY day(s) supply,
131
Limit 1 dose 3 rtl MAX
FLULAVAL
0 per season;1 rtl GARDASIL 9 SUSP 0 fill,365 rtl
QUADRIVALENT 2020- MAX fill,180 rtl day(s) supply,
2021 SUSY day(s) supply, 3 rtl MAX
Limit 1 dose GARDASIL 9 SUSY 0 fill,365 rtl
FLULAVAL
QUADRIVALENT 2021- 0 per season;1 rtl day(s) supply,
MAX fill,180 rtl 1 rtl MAX
2022 SUSY day(s) supply, HAVRIX SUSP 0 fill,365 rtl
Limit 1 dose day(s) supply,
FLUMIST 0 per season;1 rtl 1 rtl MAX
QUADRIVALENT SUSP MAX fill,180 rtl HEPLISAV-B SOLN 0 fill,365 rtl
Limit 1 dose 1 rtl MAX
FLUZONE HIGH-DOSE PF 0 per season;1 rtl HEPLISAV-B SOSY 0 fill,365 rtl
2019-2020 SUSY MAX fill,180 rtl day(s) supply,
day(s) supply,
1 rtl MAX
IPOL INACTIVATED IPV
FLUZONE HIGH-DOSE PF 0 1 rtl MAX
INJ
0 fill,365 rtl
2020-2021 SUSY day(s) supply,
1 rtl MAX
FLUZONE HIGH-DOSE PF 0 1 rtl MAX M-M-R II SOLR 0 fill,365 rtl
2021-2022 SUSY day(s) supply,
1 rtl MAX
Limit 1 dose RECOMBIVAX HB SUSP 0 fill,365 rtl
FLUZONE
MAX fill,180 rtl
2020 SUSP 1 rtl MAX
day(s) supply,
ROTARIX SUSR 0 fill,365 rtl
FLUZONE
QUADRIVALENT 2019- 0 per season;1 rtl 1 rtl MAX
MAX fill,180 rtl
2020 SUSY ROTATEQ SOLN 0 fill,365 rtl
day(s) supply,
day(s) supply,
Limit 1 dose
FLUZONE QL(0.14 ea
QUADRIVALENT 2020- 0 per season;1 rtl daily)2 rtl pack
MAX fill,180 rtl
2021 SUSP lmt amt,999 rtl
day(s) supply,
SHINGRIX SUSR 0 pack lmt
FLUZONE Limit 1 dose day(s),; AL(At
QUADRIVALENT 2020- 0 per season;1 rtl least 50 yrs
MAX fill,180 rtl old)
2021 SUSY day(s) supply,
3 rtl MAX
Limit 1 dose TWINRIX SUSY 0 fill,365 rtl
FLUZONE
MAX fill,180 rtl
2022 SUSP 1 rtl MAX
day(s) supply,
VAQTA SUSP 0 fill,365 rtl
FLUZONE
QUADRIVALENT 2021- 0 per season;1 rtl 2 rtl MAX
MAX fill,180 rtl
2022 SUSY VARIVAX INJ 0 fill,365 rtl
day(s) supply,
day(s) supply,
132
1 rtl pack lmt estradiol vaginal crea 1B
amt,999 rtl
ZOSTAVAX SUSR 0 pack lmt estradiol vaginal tabs 1B
day(s),; AL(At
least 50 yrs PA
old) FEMRING RING 3
VAGINAL AND RELATED PRODUCTS PREMARIN CREA 2

Miscellaneous Vaginal Products VAGIFEM TABS (Use NF
estradiol vaginal)
INTRAROSA INST 3 PA
VASOPRESSORS - Drugs to Treat Heart and
Spermicides Circulation Conditions
SHUR-SEAL GEL 0 Anaphylaxis Therapy Agents
ADRENALIN SOLN IJ 30
TODAY SPONGE MISC 0 MG/30ML (Use epinephrine NF
(anaphylaxis))
Vaginal Anti-infectives QL(2 ea per fill
CLEOCIN CREA VA 2 % retail,2 ea per
(Use clindamycin NF fill mail)2 rtl
phosphate vaginal) epinephrine (anaphylaxis) 1B MAX fill,365 rtl
clindamycin phosphate soaj 0.15 mg/0.3ml day(s) supply,2
1B mail MAX
vaginal crea
fill,365 mail
clotrimazole vaginal crea 1 1B day(s) supply,
%
QL(2 ea per fill
GYNAZOLE-1 CREA 3 epinephrine (anaphylaxis) 2 retail)2 rtl MAX
soaj 0.3 mg/0.3ml fill,365 rtl
GYNE-LOTRIMIN CREA NF day(s) supply,
(Use clotrimazole vaginal) QL(2 ea per fill
METROGEL-VAGINAL retail,2 ea per
GEL (Use metronidazole NF fill mail)2 rtl
vaginal) epinephrine (anaphylaxis) MAX fill,365 rtl
2
metronidazole vaginal gel 1B
soaj 0.3 mg/0.3ml day(s) supply,2
mail MAX
miconazole nitrate vaginal fill,365 mail
1B day(s) supply,
supp 200 mg
EPIPEN 2-PAK SOAJ (Use NF
terconazole vaginal crea 1B epinephrine (anaphylaxis))
terconazole vaginal supp 1B QL(2 ea per fill
retail,2 ea per
Vaginal Contraceptive - pH Modulators fill mail)2 rtl
EPIPEN-JR 2-PAK SOAJ MAX fill,365 rtl
PHEXXI GEL 0 PV (Use epinephrine 2
day(s) supply,2
(anaphylaxis)) mail MAX
Vaginal Estrogens fill,365 mail
ESTRACE CREA (Use day(s) supply,
NF
estradiol vaginal) Vasopressors
133
Drug Requirements/
Drug Name Tier Limits
midodrine hcl tabs 1B
VITAMINS
Oil Soluble Vitamins
cholecalciferol caps 1.25
mg, 400 unit, 50000 unit, 1A
2000 unit, 50 mcg
cholecalciferol tabs 400 0
unit
DRISDOL CAPS (Use 0
ergocalciferol)
ergocalciferol caps or 1.25 0
mg, 50000 unit
ergocalciferol soln or 200 1B
mcg/ml, 8000 unit/ml
VITAMIN D2 TABS 400 0 AL(At least 65
UNIT yrs old)
Water Soluble Vitamins
niacin cpcr or 500 mg, 250 1A
mg
niacin tabs or 250 mg, 50 1A
mg, 100 mg, 500 mg
niacin tbcr or 750 mg, 250 1A
mg, 500 mg
NIACIN TR TBCR 1B
niacinamide tabs or 100 1B
mg
niacinamide tabs or 500 1A
mg
SLO-NIACIN TBCR (Use NF
niacin)
134
Index
1ST TIER UNILET ACTIMMUNE 40 ADVOCATE INSULIN
COMFORTOUCH LANCETS ACTIQ 6 SYRINGE/U-100/1ML/30GX5/16"
28G 78 91
1ST TIER UNILET ACTONEL 67 ADVOCATE INSULIN
COMFORTOUCH LANCETS ACTOPLUS MET 23 SYRINGE/U-100/1ML/31GX5/16"
30G 78 ACTOS 24 91
abacavir sulfate 45 ACULAR 122 ADVOCATE LANCETS 79
abacavir sulfate-lamivudine 45 ACULAR LS 122 ADVOCATE LANCETS 30G 79
abacavir sulfate-lamivudine- ADVOCATE LANCING
zidovudine 45 acyclovir 48 DEVICE 79
ABELCET 27 acyclovir topical 61 ADVOCATE RAPID-SAFE
ABILIFY 45 ADACEL 128 LANCING DEVICE 79
ADALAT CC 50 ADVOCATE REDI-CODE+
abiraterone acetate 37 CONTROL SOLUTION
ABRAXANE 41 adapalene 56 HIGH 79
ABSORICA 56 adapalene-benzoyl ADVOCATE SAFETY
peroxide 56 LANCETS 79
acamprosate calcium 125 ADCETRIS 36 ADVOCATE SAFETY LANCETS
acarbose 23 ADCIRCA 52 26G 79
ACCOLATE 14 ADDERALL 1 ADZENYS ER 1
ACCU-CHEK FASTCLIX AFINITOR 38
LANCETS 78 ADDERALL XR 1
AFLURIA QUADRIVALENT
ACCU-CHEK MULTICLIX adefovir dipivoxil 48 2019-2020 130
LANCETS 78 ADEMPAS 52 AFLURIA QUADRIVALENT
ACCU-CHEK SAFE-T-PRO ADIPEX-P 1 2020-2021 130
LANCETS 78 ADJUSTABLE LANCING AFLURIA QUADRIVALENT
ACCU-CHEK SAFE-T-PRO 2021-2022 131
PLUSLANCETS 78 DEVICE 79
ADRENALIN 133 AGAMATRIX CONTROL
ACCU-CHEK SOFTCLIX HIGH 79
LANCETS 78 ADVAIR DISKUS 14 AGAMATRIX ULTRA-THIN
ACCUPRIL 30 ADVAIR HFA 14 LANCETS 33G 79
ACCURETIC 31 ADVANCED MOBILE LANCET AGGRENOX 73
acebutolol hcl 49 30G 79 AGRYLIN 73
ADVOCATE CONTROL
acetaminophen w/ codeine 8 SOLUTIONHIGH 79 AIMOVIG 112
acetaminophen-caff- ADVOCATE INSULIN AIMSCO LUBRICATED 77
dihydrocod 8 SYRINGE/U- AIMSCO TWIST LANCETS
acetazolamide 66 100/0.3ML/29GX1/2" 91 32G 79
acetazolamide sodium 66 ADVOCATE INSULIN AIMSCO TWIST LANCETS
acetic acid 72 SYRINGE/U- 33G 79
100/0.3ML/30GX5/16" 91 AIRDUO RESPICLICK
acetic acid (otic) 123 ADVOCATE INSULIN 113/14 14
acetylcysteine 56 SYRINGE/U- AIRDUO RESPICLICK
ACIPHEX 129 100/0.3ML/31GX5/16" 91 232/14 14
ADVOCATE INSULIN AIRDUO RESPICLICK 55/1414
acitretin 60 SYRINGE/U-
ACTHAR 67 AKYNZEO 26
100/0.5ML/29GX1/2" 91
ACTI-LANCE LANCETS ADVOCATE INSULIN albendazole 10
28G 78 SYRINGE/U- ALBENZA 10
ACTI-LANCE LITE SAFETY 100/0.5ML/30GX5/16" 91 albuterol sulfate 14,15
LANCETS 28G 78 ADVOCATE INSULIN
ACTI-LANCE SPECIAL SAFETY ALCAINE 121
SYRINGE/U-
LANCETS 17G 78 100/0.5ML/31GX5/16" 91 alclometasone dipropionate 61
ACTI-LANCE SPECIAL ADVOCATE INSULIN ALDACTAZIDE 66
SAFETYLANCETS 17G 78 SYRINGE/U- ALDACTONE 66
ACTI-LANCE UNIVERSAL 100/1ML/29GX1/2" 91
SAFETY LANCETS 23G 79 ALDARA 64
ACTIGALL 71 ALDURAZYME 68
Index 1
ALECENSA 38 amlodipine besylate 50 ARCALYST 4
alendronate sodium 67 amlodipine besylate- ARCAPTA NEOHALER 15
alfuzosin hcl 72 atorvastatin calcium 51 arformoterol tartrate 15
amlodipine besylate-benazepril
ALIMTA 35 hcl 31 ARICEPT 125
ALINIA 11 amlodipine besylate-olmesartan ARIKAYCE 3
aliskiren fumarate 32 medoxomil 31 ARIMIDEX 37
amlodipine besylate-
ALKERAN 34 valsartan 31 aripiprazole 45
ALLEGRA-D 12 HOUR amlodipine-valsartan- ARIXTRA 16
ALLERGY & CONGESTION 56 hydrochlorothiazide 31 armodafinil 2
ALLEGRA-D 24 HOUR amoxapine 22
ALLERGY & CONGESTION 56 ARMOUR THYROID 128
allopurinol 73 amoxicillin 124 ARNUITY ELLIPTA 14
amoxicillin & pot AROMASIN 37
almotriptan malate 113 clavulanate 124
ALOCRIL 122 amphetamine- ARRANON 35
alogliptin benzoate 24 dextroamphetamine 1 arsenic trioxide 40
ALOMIDE 122 amphotericin b 27 ARTHROTEC 50 4
alosetron hcl 71 ampicillin 124 ARTHROTEC 75 4
ALOXI 26 ampicillin & sulbactam ARYMO ER 6
sodium 124
ALPHAGAN P 121 ARZERRA 36
ampicillin sodium 124
alprazolam 13 ASACOL HD 71
AMPYRA 126
ALREX 121 asenapine maleate 44
ANADROL-50 9
ALTABAX 58 aspirin 6
ANAFRANIL 22
ALTACE 30 aspirin-dipyridamole 73
anagrelide hcl 73
ALTERNATE SITE LANCING ASSURE HAEMOLANCE PLUS
DEVICE 79 anastrozole 37 HIGH FLOW 18G 79
ALTOPREV 29 ANCOBON 27 ASSURE HAEMOLANCE PLUS
ANDRODERM 9 LOW FLOW 25G 79
ALUNBRIG 38 ASSURE HAEMOLANCE PLUS
ALVESCO 14 ANDROGEL 9 MICRO FLOW 28G 79
alvimopan 71 ANNOVERA 54 ASSURE HAEMOLANCE PLUS
amantadine hcl 42 ANORO ELLIPTA 15 NORMAL FLOW 21G 79
ANTABUSE 125 ASSURE HAEMOLANCE PLUS
AMARYL 25 PEDIATRIC BLADE 79
AMBIEN 75 ANUSOL-HC 10 ASSURE ID INSULIN
AMBIEN CR 75 ANZEMET 26 SAFETYSYRINGE/U-
APIDRA 24 100/0.5ML/29G X 1/2" 91
AMBISOME 27 ASSURE ID INSULIN
ambrisentan 51 APIDRA SOLOSTAR 24 SAFETYSYRINGE/U-
amcinonide 61 APO-VARENICLINE 126 100/1ML/29G X 1/2" 91
AMCINONIDE 61 APOKYN 42 ASSURE LANCE LANCETS 79
AMERGE 113 apraclonidine hcl 121 ASSURE LANCE LANCETS
aprepitant 26,27 21G 79
AMICAR 74 ASSURE LANCE PLUS
amikacin sulfate 3 APRISO 71 SAFETYLANCETS 25G 79
amiloride & APTIOM 17 ASSURE LANCE PLUS
hydrochlorothiazide 66 APTIVUS 45 SAFETYLANCETS 30G 79
amiloride hcl 66 AQUA LANCE ADJUSTABLE ASSURE LANCE SAFETY
LANCING DEVICE 79 LANCET 28G 79
aminocaproic acid 74
ARALAST NP 127 ASSURE LANCETS 79
aminophylline 15
ARANESP ALBUMIN ATACAND 30
amiodarone hcl 13
FREE 74 ATACAND HCT 31
AMITIZA 71 ARAVA 5 atazanavir sulfate 45
amitriptyline hcl 22
Index 2
ATELVIA 67 AZILECT 43 BD INSULIN SYRINGE
atenolol 49 azithromycin 76 MICROFINE IV/U-100/1ML/28G
X 1/2" 91
atenolol & chlorthalidone 31 AZOPT 122 BD INSULIN SYRINGE
ATGAM 116 AZOR 31 MICROFINE/U-100/0.5ML/28G X
ATIVAN 13 aztreonam 12 1/2" 91
BD INSULIN SYRINGE
atomoxetine hcl 2 AZULFIDINE 71 MICROFINE/U-100/1ML/27G X
atorvastatin calcium 29 AZULFIDINE EN-TABS 71 5/8" 91
atovaquone 11 B-D INSULIN SYRINGE BD INSULIN SYRINGE
atovaquone-proguanil hcl 33 ULTRAFINE II/0.3ML/31G X MICROFINE/U-100/1ML/28G X
5/16" 91 1/2" 91
ATRIPLA 45 B-D INSULIN SYRINGE BD INSULIN SYRINGE
atropine sulfate 128 ULTRAFINE II/0.5ML/31G X SAFETYGLIDE/1ML/29G X
ATROVENT HFA 14 5/16" 91 1/2" 91
B-D INSULIN SYRINGE BD INSULIN SYRINGE SLIP
AUBAGIO 126 ULTRAFINE II/1ML/31G X TIP/U-100/1ML 91
AUGMENTIN 124 5/16" 91 BD INSULIN SYRINGE ULTRA-
AUGMENTIN ES-600 124 B-D INSULIN SYRINGE FINE/0.3ML/30G X 12.7MM 91
AURORA LANCET SUPER ULTRAFINE/0.3ML/30G X BD INSULIN SYRINGE ULTRA-
THIN30G 79 1/2" 91 FINE/0.3ML/31G X 8MM 92
AURORA LANCET THIN B-D INSULIN SYRINGE BD INSULIN SYRINGE ULTRA-
23G 79 ULTRAFINE/0.5ML/30G X FINE/0.5ML/30G X 12.7MM 92
AUSTEDO 125 1/2" 91 BD INSULIN SYRINGE ULTRA-
bacitracin 10 FINE/0.5ML/31G X 8MM 92
AUTO-LANCET 79 BD INSULIN SYRINGE ULTRA-
AUTO-LANCET MINI 79 bacitracin (ophthalmic) 121
FINE/1/2 UNIT/0.3ML/31G X
AUTOLET IMPRESSION baclofen 119 8MM 92
LANCING DEVICE 79 BACTRIM 10 BD INSULIN SYRINGE ULTRA-
AUTOLET LANCING BACTRIM DS 10 FINE/1ML/30G X 12.7MM 92
DEVICE 79 BD INSULIN SYRINGE ULTRA-
BALCOLTRA 53 FINE/1ML/31G X 8MM 92
AUTOLET MINI 79
balsalazide disodium 71 BD INSULIN SYRINGE
AUTOLET PLUS 79
BALVERSA 38 ULTRAFINE HALF-
AVALIDE 31 UNIT/0.3ML/31G X 5/16" 92
BANZEL 17
AVANDIA 24 BD INSULIN SYRINGE
BARACLUDE 48 ULTRAFINE/0.3ML/30G X
AVAPRO 30
BASAGLAR KWIKPEN 24 1/2" 92
AVELOX 70 BD INSULIN SYRINGE
BAVENCIO 36
AVODART 72 ULTRAFINE/0.3ML/31G X
BAXDELA 70 5/16" 92
AVONEX 126
BD LO-DOSE INSULIN BD INSULIN SYRINGE
AVONEX PEN 126 SYRINGE MICROFINE ULTRAFINE/0.5ML/30G X
AVSOLA 71 IV/0.5ML/28G X 1/2" 91 1/2" 92
AYGESTIN 125 BD AUTOSHIELD 29G X BD INSULIN SYRINGE
3/16" 91 ULTRAFINE/0.5ML/31G X
AYVAKIT 38 BD AUTOSHIELD 29G X
azacitidine 35 5/16" 92
5/16" 91 BD INSULIN SYRINGE
AZACTAM 12 BD AUTOSHIELD DUO 30G X ULTRAFINE/1ML/30G X
AZASAN 116 5MM 91 1/2" 92
BD INSULIN SYRINGE LUER- BD INSULIN SYRINGE
AZASITE 121 LOK/U-100/1ML 91 ULTRAFINE/U-100/0.3ML/29G X
AZATHIOPRINE 116 BD INSULIN SYRINGE 1/2" 92
azathioprine 116 MICROFINE IV/U- BD INSULIN SYRINGE
100/0.5ML/28G X 1/2" 91 ULTRAFINE/U-100/0.5ML/29G X
azelaic acid 65 BD INSULIN SYRINGE
azelastine hcl 119 1/2" 92
MICROFINE IV/U- BD INSULIN SYRINGE
azelastine hcl (ophth) 122 100/1ML/27G X 5/8" 91 ULTRAFINE/U-100/1ML/29G X
AZELEX 56 1/2" 92
Index 3
BD INSULIN SYRINGE BD SAFETYGLIDE INSULIN BEVESPI AEROSPHERE 15
ULTRAFINE/U-100/1ML/31G X SYRINGE/0.3ML/31G X BEVYXXA 16
5/16" 92 5/16" 93
BD INSULIN BD SAFETYGLIDE INSULIN bexarotene 40
SYRINGE/0.3ML/29G X SYRINGE/1ML/31G X BEYAZ 53
12.7MM 92 15/64" 93 bicalutamide 37
BD INSULIN BD SAFETYGLIDE INSULIN
SYRINGE/0.5ML/29G X SYSYRINGE/0.5ML/30G X BICNU 34
12.7MM 92 5/16" 93 BIDIL 51
BD INSULIN SYRINGE/1ML/27G BD VEO INSULIN SYRINGE BIKTARVY 45
X 12.7MM 92 ULTRA-FINE/1ML/31G X BILTRICIDE 10
BD INSULIN SYRINGE/1ML/29G 6MM 93
X 12.7MM 92 BD VEO INSULIN SYRINGE bimatoprost 123
BD INSULIN ULTRA-FINE/U-100/1ML/31G bisacodyl 76
SYRINGE/DETACHABLE X 15/64" 93 bisoprolol &
NEEDLE/U-100/1ML/25G X BELEODAQ 38 hydrochlorothiazide 31
1" 92 BELRAPZO 34 bisoprolol fumarate 49
BD INSULIN bleomycin sulfate 38
SYRINGE/DETACHABLE BELSOMRA 75
NEEDLE/U-100/1ML/25G X BELVIQ 2 BLEPH-10 121
5/8" 92 benazepril & BLINCYTO 36
BD INSULIN hydrochlorothiazide 31 BONIVA 67
SYRINGE/DETACHABLE benazepril hcl 30
NEEDLE/U-100/1ML/26G X BOOSTRIX 128
BENDAMUSTINE BORTEZOMIB 38
1/2" 92 HYDROCHLORIDE 34
BD INSULIN SYRINGE/U- BENDEKA 34 bosentan 51
100/1ML/27G X 1/2" 92 BOSULIF 39
BD LANCET ULTRAFINE BENICAR 30
30G 79 BENICAR HCT 31 BOTOX 120
BD LANCET ULTRAFINE BENZACLIN 56 BRAFTOVI 39
33G 79 BREO ELLIPTA 15
BD MICROTAINER BENZACLIN WITH PUMP 57
LANCETS 79 BENZAMYCIN 57 BREZTRI AEROSPHERE 15
BD PEN benzonatate 56 BRILINTA 73
NEEDLE/MICRO/ULTRA- benzoyl peroxide 57 brimonidine tartrate 121
FINE/32G X 6MM 92 brinzolamide 122
BD PEN NEEDLE/MINI/ULTRA- BENZOYL PEROXIDE
FINE/31G X 5MM 92 CLEANSER 57 BRIVIACT 17
BD PEN NEEDLE/NANO 2ND benzoyl peroxide- bromfenac sodium (ophth) 122
GEN/32G X 5/32" 92 erythromycin 57
bromocriptine mesylate 42
BD PEN benztropine mesylate 42
NEEDLE/NANO/ULTRA- BROVANA 15
bepotastine besilate 122
FINE/32G X 4MM 92 BRUKINSA 39
BEPREVE 122
BD PEN budesonide 54
NEEDLE/ORIGINAL/ULTRA- BESIVANCE 121
budesonide (inhalation) 14
FINE/29G X 12.7MM 93 BESPONSA 36
BD PEN betamethasone dipropionate budesonide (nasal) 119
NEEDLE/SHORT/ULTRA- (topical) 61 budesonide-formoterol fumarate
FINE/31G X 8MM 93 betamethasone dipropionate dihydrate 15
BD SAFETY-GLIDE INSULIN augmented 62 BULLSEYE MINI SAFETY
SYRINGE/0.5ML/29G X 1/2" 93 betamethasone valerate 62 LANCETS 79
BD SAFETY-LOK INSULIN BULLSEYE SAFETY
BETAPACE 50 LANCETS 79
SYRINGE/PERM
NEEDLE/UF/1ML/29G X BETAPACE AF 50 bumetanide 66
1/2" 93 BETASERON 126 BUMEX 66
BD SAFETYGLIDE INSULIN betaxolol hcl 49 BUPHENYL 68
SYRINGE/0.3ML/29G X 1/2" 93 betaxolol hcl (ophth) 120 BUPRENEX 9
bethanechol chloride 130 buprenorphine 9
Index 4
buprenorphine hcl 9 CARAFATE 129 CARETOUCH LANCING
buprenorphine hcl-naloxone hcl CARBAGLU 68 DEVICEWITH EJECTOR 80
dihydrate 9 CARETOUCH SAFETY
carbamazepine 17 LANCETS/26G 80
bupropion hcl 20
CARBATROL 17 CARETOUCH SAFETY
bupropion hcl (smoking LANCETS/28G 80
deterrent) 126 carbidopa 42
CARETOUCH SAFETY
buspirone hcl 12 carbidopa-levodopa 42 LANCETS/30G 80
busulfan 34 carbidopa-levodopa- CARETOUCH TWIST LANCETS
entacapone 42 28G 80
BUSULFEX 34
carbinoxamine maleate 27,28 CARETOUCH TWIST LANCETS
butalbital-acetaminophen 5 30G 80
carboplatin 34
butalbital-acetaminophen- CARETOUCH TWIST LANCETS
caffeine 5 CARDIOCOM LANCING
DEVICE 80 33G 80
butalbital-acetaminophen- carisoprodol 119
caffeine w/ codeine 8 CARDIZEM 50
butalbital-aspirin-caffeine 5 CARDIZEM CD 50 carmustine 34
butalbital-aspirin-caffeine CARDIZEM LA 50 carteolol hcl (ophth) 120
w/cod 8 CARDURA 31 carvedilol 49
BUTALBITAL/ACETAMINOPHEN CAREONE ADVANCED CASODEX 37
6 LANCINGDEVICE 80 caspofungin acetate 27
butenafine hcl 58 CAREONE INSULIN CATAPRES 31
butorphanol tartrate 9 SYRINGES/0.3ML/30G X
1/2" 93 CATAPRES-TTS-1 31
BUTRANS 9
CAREONE INSULIN CATAPRES-TTS-2 31
BYSTOLIC 49 SYRINGES/0.3ML/31G X CATAPRES-TTS-3 31
cabergoline 69 5/16" 93
CAREONE INSULIN CAYA 77
CABLIVI 73
SYRINGES/0.5ML/30G X CAYSTON 12
CADUET 51
1/2" 93 cefaclor 52
CAFERGOT 113 CAREONE INSULIN cefadroxil 52
CALAN 50 SYRINGES/0.5ML/31G X
5/16" 93 cefazolin sodium 52
CALAN SR 50
CAREONE INSULIN cefdinir 52
calcipotriene 61
SYRINGES/1ML/30G X cefditoren pivoxil 52
calcipotriene-betamethasone 1/2" 93
dipropionate 62 cefepime hcl 53
CAREONE INSULIN
calcitonin (salmon) 67 SYRINGES/1ML/31GX5/16" cefixime 52
calcitriol 68 93 CEFOTAN 52
calcitriol (topical) 61 CAREONE LANCET SUPER cefotaxime sodium 53
calcium acetate (phosphate THIN/30G 80
cefotetan disodium 52
binder) 72 CAREONE LANCET THIN 80
cefoxitin sodium 52
calcium chloride (dihydrate) 114 CARESENS LANCETS 80
CARETOUCH INSULIN cefpodoxime proxetil 53
calcium polycarbophil 75
SYRINGE/0.3ML/31GX5/16" cefprozil 52
CAMPTOSAR 41 93 ceftazidime 53
CANASA 71 CARETOUCH INSULIN ceftriaxone sodium 53
CANCIDAS 27 SYRINGE/0.5ML/31GX5/16"
93 cefuroxime axetil 52
candesartan cilexetil 30
CARETOUCH INSULIN cefuroxime sodium 52
candesartan cilexetil-
hydrochlorothiazide 31 SYRINGE/1ML/30GX5/16" CELEBREX 4
93 celecoxib 4
CAPASTAT SULFATE 34 CARETOUCH INSULIN
capecitabine 35 SYRINGE/1ML/31GX5/16" CELESTONE SOLUSPAN 54
CAPRELSA 39 93 CELESTONE-SOLUSPAN 54
captopril 30 CARETOUCH INSULIN CELEXA 21
SYRINGE0.5ML/30GX5/16"
CARAC 60 93 CELLCEPT 116
Index 5
CELONTIN 20 cinacalcet hcl 68 CLEVER CHOICE COMFORT
cephalexin 52 CINRYZE 73 EZINSULIN
SYRINGE/0.3ML/31G X
CERDELGA 73 CIPRO 70 5/16" 93
CEREBYX 19 CIPRO HC 123 CLEVER CHOICE COMFORT
CEREZYME 73 CIPRODEX 123 EZINSULIN
CESAMET 26 ciprofloxacin 70 SYRINGE/0.5ML/28G X 1/2" 93
CLEVER CHOICE COMFORT
cetirizine hcl 28 ciprofloxacin hcl 70 EZINSULIN
cetirizine-pseudoephedrine 56 ciprofloxacin hcl (ophth) 121 SYRINGE/0.5ML/29G X 1/2" 93
CETRAXAL 123 ciprofloxacin hcl (otic) 123 CLEVER CHOICE COMFORT
EZINSULIN
CETROTIDE 68 ciprofloxacin in d5w 70 SYRINGE/0.5ML/30G X 1/2" 94
cevimeline hcl 117 ciprofloxacin-dexamethasone CLEVER CHOICE COMFORT
CHANTIX 126 123 EZINSULIN
ciprofloxacin-fluocinolone SYRINGE/0.5ML/30G X
CHANTIX CONTINUING acetonide 123
MONTHPAK 126 5/16" 94
CHANTIX STARTING MONTH cisplatin 34 CLEVER CHOICE COMFORT
PAK 126 citalopram hydrobromide 21 EZINSULIN
CHEMET 25 cladribine 35 SYRINGE/0.5ML/31G X
5/16" 94
CHEMSTRIP-K 65 CLARINEX 28 CLEVER CHOICE COMFORT
CHILDRENS ADVIL 4 clarithromycin 77 EZINSULIN
CHILDRENS MOTRIN 4 CLARITIN 28 SYRINGE/1.0ML/30G X 1/2" 94
chloramphenicol sodium CLARITIN ALLERGY CLEVER CHOICE COMFORT
succinate 11 CHILDRENS 28 EZINSULIN SYRINGE/1ML/28G
chlordiazepoxide hcl 13 CLARITIN CHILDRENS 28 X 1/2" 94
chlordiazepoxide hcl-clidinium CLARITIN REDITABS 28 EZINSULIN SYRINGE/1ML/29G
bromide 128 CLARITIN-D 12 HOUR 56 X 1/2" 94
chlordiazepoxide-amitriptyline CLEVER CHOICE COMFORT
125 CLARITIN-D 24 HOUR 56
chlorhexidine gluconate (mouth- EZINSULIN SYRINGE/1ML/30G
CLASSIC PRENATAL 117 X 5/16" 94
throat) 117 CLEANLET LANCETS CLEVER CHOICE COMFORT
chloroquine phosphate 33 28G 80 EZINSULIN SYRINGE/U-
chlorpromazine hcl 45 CLEMASTINE 100/1ML/31GX5/16" 94
FUMARATE 28 CLEVER CHOICE GLUCOSE
chlorthalidone 67
clemastine fumarate 28 CONTROL HIGH 80
chlorzoxazone 119
CLEOCIN 11,133 CLIMARA 70
CHOLBAM 70 CLEOCIN PEDIATRIC CLIMARA PRO 69
cholecalciferol 134 GRANULES 11 CLINDAGEL 57
cholestyramine 29 CLEOCIN PHOSPHATE 11
clindamycin hcl 11
cholestyramine light 29 CLEOCIN-T 57 clindamycin palmitate
CHORIONIC CLEVER CHOICE COMFORT hydrochloride 11
GONADOTROPIN 67 EZINSULIN clindamycin phosphate 11
CIALIS 51 SYRINGE/0.3ML/29G X
1/2" 93 clindamycin phosphate
CICLODAN SOLUTION KIT 58 (topical) 57
ciclopirox 58 EZINSULIN clindamycin phosphate
ciclopirox olamine 58 SYRINGE/0.3ML/30G X vaginal 133
1/2" 93 clindamycin phosphate-benzoyl
cidofovir 48 peroxide 57
cilostazol 73 CLEVER CHOICE COMFORT
EZINSULIN clindamycin phosphate-benzoyl
CILOXAN 121 SYRINGE/0.3ML/30G X peroxide (refrigerate) 57
clindamycin phosphate-
CIMDUO 45 5/16" 93 tretinoin 57
cimetidine 128 CLINIMIX 4.25%/DEXTROSE
cimetidine hcl 128 10% 120
Index 6
CLINIMIX 4.25%/DEXTROSE COMFORT ASSIST INSULIN COSENTYX 61
25% 120 SYRINGE 0.3ML/29G X COSENTYX SENSOREADY
CLINIMIX 4.25%/DEXTROSE 1/2" 94 PEN 61
5% 120 COMFORT ASSIST INSULIN COSMEGEN 38
CLINIMIX 5%/DEXTROSE SYRINGE/0.3ML/30G X
25% 120 5/16" 94 COSOPT 120
CLINIMIX E 5%/DEXTROSE COMFORT ASSIST INSULIN COUMADIN 15
20% 120 SYRINGE/0.3ML/31G X COZAAR 30
clobazam 17 5/16" 94 CREON 66
clobetasol propionate 62 COMFORT ASSIST INSULIN
SYRINGE/0.5ML/29G X CRESEMBA 27
clobetasol propionate emollient
base 62 1/2" 94 CRESTOR 29
COMFORT ASSIST INSULIN CRIXIVAN 45
clocortolone pivalate 62 SYRINGE/0.5ML/30G X
CLODERM 62 5/16" 94 cromolyn sodium 13
clofarabine 35 COMFORT ASSIST INSULIN cromolyn sodium (ophth) 122
CLOLAR 35 SYRINGE/0.5ML/31G X crotamiton 65
5/16" 94 CUBICIN 11
clomipramine hcl 23 COMFORT ASSIST INSULIN
clonazepam 17 SYRINGE/1ML/29G X 1/2" 94 CUBICIN RF 11
clonidine 31 COMFORT ASSIST INSULIN CUPRIMINE 115
SYRINGE/1ML/30G X CUTIVATE 62
clonidine hcl 31 5/16" 94
clonidine hcl (adhd) 2 COMFORT ASSIST INSULIN CUVITRU 123
clopidogrel bisulfate 73 SYRINGE/1ML/31G X CVS LANCETS 21G 80
clorazepate dipotassium 13 5/16" 94 CVS LANCETS MICRO THIN
COMFORT ASSURED 33G 80
clotrimazole 117 LANCETS MICRO THIN CVS LANCETS MICRO-THIN
clotrimazole (topical) 58 33G 80 33G 80
clotrimazole vaginal 133 COMFORT ASSURED CVS LANCETS ORIGINAL 80
clotrimazole w/ LANCETS SUPER THIN CVS LANCETS THIN 26G 80
betamethasone 58 28G 80 CVS LANCETS ULTRA THIN
clozapine 44 COMFORT EZ INSULIN 30G 80
SYRINGE/U-100/0.5ML/31G X CVS LANCETS ULTRA-THIN
CLOZARIL 44 5/16" 94 30G 80
COAGUCHEK LANCETS 80 COMFORT EZ INSULIN
SYRINGE/U-100/1ML/31G X CVS LANCING DEVICE 80
COARTEM 33
5/16" 94 CVS PRENATAL 117
CODEINE SULFATE 6 CVS ULTRA THIN
COMFORT LANCETS 80
codeine sulfate 6 LANCETS 80
COMPLERA 45
COGENTIN 42 cyanocobalamin 73
COMTAN 42
COLACE 76 cyclobenzaprine hcl 119
CONCERTA 2
COLAZAL 71 CONTOUR HIGH cyclophosphamide 34
colchicine 73 CONTROL 80 cycloserine 34
colchicine w/ probenecid 72 CONTRAVE 2 CYCLOSET 24
COLCRYS 73 CONZIP 6 cyclosporine 116
colesevelam hcl 29 COPIKTRA 39 cyclosporine modified (for
COLESTID 29 CORDRAN 62 microemulsion) 116
CYKLOKAPRON 74
COLESTID FLAVORED 29 COREG 49
CYMBALTA 22
colestipol hcl 29 CORGARD 50
cyproheptadine hcl 28
COLY-MYCIN S 123 CORLANOR 52
CYRAMZA 36
COLYTE-FLAVOR PACKS 75 CORTEF 54
CYSTADANE 68
COMBIGAN 120 CORTENEMA 10
CYSTAGON 72
COMBIVIR 45 cortisone acetate 55
CYSTARAN 122
COMETRIQ 39 CORTISPORIN-TC 123
Index 7
cytarabine 35 DEPO-SUBQ PROVERA DIASTAT PEDIATRIC 17
CYTOMEL 128 104 54 DIATHRIVE LANCETS 80
DEPO-TESTOSTERONE 10 DIATHRIVE LANCETS ULTRA
CYTOTEC 130
DERMA-SMOOTHE/FS THIN 30G 80
CYTOVENE 48 BODY 62 DIATHRIVE LANCING
D.H.E. 45 113 DERMA-SMOOTHE/FS DEVICE 80
dacarbazine 40 SCALP 62 DIATRUE GLUCOSE CONTROL
DACOGEN 35 DERMOTIC 123 SOLUTION LEVEL 3 80
dactinomycin 38 DESCOVY 45 diazepam 13
dalfampridine 126 DESFERAL 25 diazepam (anticonvulsant) 17
DALIRESP 14 desipramine hcl 23 diazoxide 24
danazol 10 desloratadine 28 DIBENZYLINE 30
DANTRIUM 119 desmopressin acetate 69 DICLEGIS 26
DESMOPRESSIN diclofenac epolamine 58
dantrolene sodium 119 ACETATE 69
dapsone 11 diclofenac potassium 4
desmopressin acetate 69
DAPTOMYCIN 11 diclofenac sodium 4
desmopressin acetate
spray 69 diclofenac sodium (actinic
daptomycin 11 keratoses) 60
DARAPRIM 33 desmopressin acetate spray
refrigerated 69 diclofenac sodium (ophth) 122
darifenacin hydrobromide 130 desogestrel & ethinyl diclofenac sodium (topical) 58
DARZALEX 36 estradiol 53 diclofenac w/ misoprostol 4
daunorubicin hcl 38 desogestrel-ethinyl estradiol
(biphasic) 53 dicloxacillin sodium 124
DAUNORUBICIN dicyclomine hcl 128
HYDROCHLORIDE 38 desogestrel-ethinyl estradiol
(triphasic) 53 didanosine 45
DAURISMO 37
desonide 62 DIFFERIN 57
DAYPRO 4
DESOWEN 62 DIFICID 77
DAYTRANA 2
desoximetasone 62 diflorasone diacetate 62
DDAVP 69
DESOXYN 1 DIFLUCAN 27
DEBACTEROL 117
desvenlafaxine succinate 22 diflunisal 6
decitabine 35
DETROL 130 digoxin 51
deferasirox 25
DETROL LA 130 dihydroergotamine
deferiprone 25 mesylate 113
dexamethasone 55
deferoxamine mesylate 25 DEXAMETHASONE DILANTIN 19
DELESTROGEN 70 INTENSOL 55 DILANTIN INFATABS 19
DELSTRIGO 45 dexamethasone sodium DILANTIN-125 19
DELZICOL 71 phosphate 55
dexamethasone sodium DILAUDID 6
demeclocycline hcl 127 phosphate (ophth) 121 diltiazem hcl 50
DEMEROL 6 dexchlorpheniramine DILTIAZEM HCL 50
DENAVIR 61 maleate 27
diltiazem hcl 50
DEPACON 20 DEXEDRINE 1
diltiazem hcl coated beads 50
DEPAKENE 20 dexmethylphenidate hcl 2
diltiazem hcl extended release
DEPAKOTE 20 dextroamphetamine sulfate 1 beads 50
DEXTROSE 5%/NACL dimethyl fumarate 126
DEPAKOTE ER 20 0.3% 114
DEPEN TITRATABS 115 dextrose in lactated DIOVAN 30
DEPO-ESTRADIOL 70 ringers 114 DIOVAN HCT 31
DEXTROSE/SODIUM DIPENTUM 71
DEPO-MEDROL 55 CHLORIDE 114
DEPO-PROVERA diphenhydramine hcl 28
DIACOMIT 17
CONTRACEPTIVE 54 diphenoxylate w/ atropine 25
DIASTAT ACUDIAL 17
DIPROLENE 62
Index 8
DIPROLENE AF 62 DROPLET INSULIN SYRINGE DULCOLAX 76
dipyridamole 73 U-100/0.5ML/30G X 5/16" 95 duloxetine hcl 22
DROPLET INSULIN SYRINGE
disopyramide phosphate 13 U-100/0.5ML/31G X 5/16" 95 DUPIXENT 64
disulfiram 125 DROPLET INSULIN SYRINGE DURAGESIC 6
DITROPAN XL 130 U-100/1ML/30G X 1/2" 95 DUREX EXTRA SENSITIVE 77
DROPLET INSULIN SYRINGE
divalproex sodium 20 U-100/1ML/30G X 5/16" 95 DUREZOL 121
DIVIGEL 70 DROPLET INSULIN SYRINGE dutasteride 72
docetaxel 41 U-100/1ML/31G X 15/64" 95 dutasteride-tamsulosin hcl 72
DOCETAXEL 41 DROPLET INSULIN SYRINGE DYAZIDE 66
U-100/1ML/31G X 5/16" 95
docetaxel 41 DROPLET INSULIN DYRENIUM 66
docusate calcium 76 SYRINGE/U-100/0.3ML/31G X DYSPORT 120
docusate sodium 76 5/16" 95 E-Z JECT LANCETS 81
DROPLET INSULIN
dofetilide 13 SYRINGE/U-100/0.5ML/30G X E-Z JECT LANCETS 21G 81
donepezil hydrochloride 125 1/2" 95 E-Z JECT LANCETS
DOPTELET 74 DROPLET INSULIN COLOR 81
SYRINGE/U-100/0.5ML/31G X E-Z JECT LANCETS SUPER
DORAL 75 THIN 30G 81
5/16" 95
dorzolamide hcl 122 DROPLET INSULIN E-Z JECT LANCETS THIN
dorzolamide hcl-timolol SYRINGE/U-100/1ML/30G X 26G 81
maleate 120 1/2" 95 E-ZJECT LANCETS MICRO-
DOVATO 45 DROPLET INSULIN THIN 33G 81
DOVONEX 61 SYRINGE/U-100/1ML/31G X E.E.S. GRANULES 77
15/64" 95 EASY COMFORT INSULIN
doxazosin mesylate 31 DROPLET INSULIN SYRINGE/0.5ML/30G X
doxepin hcl 23 SYRINGE/U-100/1ML/31G X 5/16" 95
doxepin hcl (antipruritic) 60 5/16" 95 EASY COMFORT INSULIN
doxepin hcl (sleep) 75 DROPLET LANCETS ULTRA SYRINGE/0.5ML/31G X
THIN 30G 80 5/16" 95
doxercalciferol 68 DROPLET LANCING EASY COMFORT INSULIN
DOXIL 38 DEVICE 80 SYRINGE/1ML/30G X 5/16" 95
doxorubicin hcl 38 DROPLET PERSONAL EASY COMFORT INSULIN
LANCETS30G 80 SYRINGE/1ML/31G X 5/16" 95
doxorubicin hcl liposomal 38 drospirenone-ethinyl EASY COMFORT INSULIN
doxycycline (monohydrate) 127 estradiol 53 SYRINGE/U-100/0.5ML/30G X
doxycycline hyclate 127 drospirenone-ethinyl estradiol- 1/2" 95
doxylamine-pyridoxine 26 levomefolate calcium 53 EASY COMFORT INSULIN
DROXIA 73 SYRINGE/U-100/1ML/30G X
DRISDOL 134 1/2" 95
DRUG MART ADJUSTABLE
dronabinol 26 LANCING DEVICE 80 EASY MINI EJECT LANCING
DROPLET GENTEEL LANCING DRUG MART LANCETS DEVICE 81
DEVICE 80 THIN 80 EASY MINI LANCING
DROPLET INSULIN SYRINGE DRUG MART ON-THE-GO DEVICE 81
0.3ML/29G X 1/2" 94 LANCETS GENTLE 30G 80 EASY PLUS II CONTROL
DROPLET INSULIN SYRINGE DRUG MART UNILET SOLUTION HIGH 81
0.5ML/29G X 1/2" 94 LANCETSSUPER THIN EASY STEP CONTROL
DROPLET INSULIN SYRINGE 30G 80 SOLUTION HIGH 81
1ML/29G X 1/2" 94 DRUG MART UNILET EASY TALK CONTROL
DROPLET INSULIN SYRINGE LANCETSULTRA THIN SOLUTION HIGH 81
U-100/0.3/31G X 5/16" 94 28G 80 EASY TOUCH FLIPLOCK
DROPLET INSULIN SYRINGE DRUG MART UNILET MICRO SAFETY INSULIN SYRINGE
U-100/0.3ML/30G X 1/2" 94 THIN LANCETS 33G 81 1ML/29GX1/2" 95
DROPLET INSULIN SYRINGE DUAC 57 EASY TOUCH FLIPLOCK
U-100/0.3ML/30G X 5/16" 94 SAFETY INSULIN SYRINGE
DROPLET INSULIN SYRINGE DUAVEE 69 1ML/30GX1/2" 95
U-100/0.5ML/30G X 1/2" 95 DUETACT 23
Index 9
EASY TOUCH FLIPLOCK EASY TOUCH INSULIN EASY TOUCH SAFETY
SAFETY INSULIN SYRINGE SYRINGE/U-100/1ML/30G X LANCETS28G/BUTTON
1ML/30GX5/16" 95 1/2" 96 ACTIVATED 81
EASY TOUCH FLIPLOCK EASY TOUCH INSULIN EASY TOUCH SAFETY
SAFETY INSULIN SYRINGE SYRINGE/U-100/1ML/31G X LANCETS28G/PRESSURE
1ML/31GX5/16" 95 5/16" 96 ACTIVATED 81
EASY TOUCH INSULIN EASY TOUCH LANCETS EASY TOUCH SHEATHLOCK
SYRINGE/0.3ML/30G X 21G/PRESSURE SAFETY INSULIN SYRINGE
5/16" 95 ACTIVATED 81 1ML/29GX1/2" 96
SYRINGE/0.3ML/31G X 23G/PRESSURE SAFETY INSULIN SYRINGE
5/16" 95 ACTIVATED 81 1ML/30GX5/16" 96
SYRINGE/0.5ML/29G X 1/2" 95 26G/PRESSURE SAFETY INSULIN SYRINGE
EASY TOUCH INSULIN ACTIVATED 81 1ML/31GX5/16" 96
SYRINGE/0.5ML/30G X EASY TOUCH LANCETS EASY TOUCH SHEATHLOCK
5/16" 95 26G/PULL-TOP 81 SAFETY SYRINGE
EASY TOUCH INSULIN EASY TOUCH LANCETS 1ML/30GX1/2" 96
SYRINGE/1ML/30G X 5/16" 95 28G/PRESSURE EASY TRAK GLUCOSE
EASY TOUCH INSULIN ACTIVATED 81 CONTROLSOLUTION HIGH 81
SYRINGE/SAFETY/U- EASY TOUCH LANCETS EASY TWIST & CAP
100/0.5ML/29G X 1/2" 96 28G/PULL-TOP 81 LANCETS 81
EASY TOUCH INSULIN EASY TOUCH LANCETS EASYGLUCO CONTROL
SYRINGE/SAFETY/U- 28G/TWIST 81 SOLUTION HIGH 81
100/0.5ML/30G X 5/16" 96 EASY TOUCH LANCETS EC-NAPROSYN 4
EASY TOUCH INSULIN 30G/BUTTON-ACTIVATED econazole nitrate 58
SYRINGE/SAFETY/U- 81
100/1ML/29G X 1/2" 96 EASY TOUCH LANCETS ECOTRIN 6
EASY TOUCH INSULIN 30G/PRESSURE ECOTRIN REGULAR
SYRINGE/SAFETY/U- ACTIVATED 81 STRENGTH 6
100/1ML/30G X 1/2" 96 EASY TOUCH LANCETS EDARBI 30
EASY TOUCH INSULIN 30G/PULL-TOP 81 EDECRIN 66
SYRINGE/U-100/0.3ML/30G X EASY TOUCH LANCETS
30G/TWIST 81 EDURANT 45
1/2" 96
EASY TOUCH INSULIN EASY TOUCH LANCETS efavirenz 45
SYRINGE/U-100/0.5ML/27G X 32G/PRESSURE efavirenz-emtricitabine-tenofovir
1/2" 96 ACTIVATED 81 disoproxil fumarate 45
EASY TOUCH INSULIN EASY TOUCH LANCETS efavirenz-lamivudine-tenofovir
SYRINGE/U-100/0.5ML/28G X 32G/PULL-TOP 81 disoproxil fumarate 46
1/2" 96 EASY TOUCH LANCETS EFFEXOR XR 22
EASY TOUCH INSULIN 32G/TWIST 81 EFFIENT 73
SYRINGE/U-100/0.5ML/29G X EASY TOUCH LANCETS
1/2" 96 33G/TWIST 81 EFUDEX 60
EASY TOUCH INSULIN EASY TOUCH LANCING EGRIFTA 68
SYRINGE/U-100/0.5ML/30G X DEVICE/EJECTOR 81 EGRIFTA SV 68
1/2" 96 EASY TOUCH SAFETY
LANCETS21G/PRESSURE ELAPRASE 68
EASY TOUCH INSULIN
SYRINGE/U-100/0.5ML/31G X ACTIVATED 81 ELEMENT HIGH CONTROL 81
5/16" 96 EASY TOUCH SAFETY ELESTRIN 70
EASY TOUCH INSULIN LANCETS23G/PRESSURE eletriptan hydrobromide 113
SYRINGE/U-100/1ML/27G X ACTIVATED 81
EASY TOUCH SAFETY ELIDEL 64
1/2" 96
EASY TOUCH INSULIN LANCETS26G/BUTTON ELIGARD 37
SYRINGE/U-100/1ML/28G X ACTIVATED 81 ELIMITE 65
1/2" 96 EASY TOUCH SAFETY ELIQUIS 16
EASY TOUCH INSULIN LANCETS26G/PRESSURE
SYRINGE/U-100/1ML/29G X ACTIVATED 81 ELIQUIS STARTER PACK 16
1/2" 96
Index 10
ELITE-THIN INSULIN EMVERM 10 EQL INSULIN
SYRINGE/0.3ML/31G X ENABLEX 130 SYRINGE/0.5ML/31G X
5/16" 96 5/16" 97
ELITE-THIN INSULIN enalapril maleate 30 EQL INSULIN
SYRINGE/0.5ML/29G X 1/2" 96 enalapril maleate & SYRINGE/1ML/29G X 1/2" 97
ELITE-THIN INSULIN hydrochlorothiazide 31 EQL INSULIN
SYRINGE/0.5ML/30G X ENBREL 5 SYRINGE/1ML/30G X 5/16" 97
5/16" 96 ENBREL MINI 5 EQL INSULIN
ELITE-THIN INSULIN SYRINGE/1ML/31G X 5/16" 97
SYRINGE/1ML/30G X 5/16" 96 ENBREL SURECLICK 5 EQL PRENATAL
ELITE-THIN INSULIN ENGERIX-B 131 FORMULA 117
SYRINGE/U-100/0.5ML/28G X enoxaparin sodium 16 EQL SUPER THIN LANCETS
1/2" 96 entacapone 42 30G 82
ELITE-THIN INSULIN EQL THIN LANCETS 26G 82
SYRINGE/U-100/0.5ML/31G X entecavir 48
EQUETRO 43
5/16" 96 ENTEREG 71
ELITE-THIN INSULIN ERAXIS 27
ENTOCORT EC 55
SYRINGE/U-100/1ML/28G X ERBITUX 36
ENTRESTO 51
1/2" 96 ergocalciferol 134
ELITE-THIN INSULIN EPCLUSA 48
ergoloid mesylates 126
SYRINGE/U-100/1ML/29G X EPIDIOLEX 18
1/2" 96 ERGOMAR 113
EPIDUO 57
ELITE-THIN INSULIN ergotamine w/ caffeine 113
SYRINGE/U-100/1ML/31G X epinastine hcl (ophth) 122
ERIVEDGE 37
5/16" 97 epinephrine (anaphylaxis)133
erlotinib hcl 36
ELITEK 40 EPIPEN 2-PAK 133
ERTACZO 58
ELIXOPHYLLIN 15 EPIPEN-JR 2-PAK 133
ertapenem sodium 11
ELLA 54 epirubicin hcl 38
ERWINASE 40
ELLENCE 38 EPIVIR 46
ERWINAZE 40
ELLIOTTS B 114 EPIVIR HBV 48
ERYPED 200 77
ELMIRON 72 eplerenone 32
ERYPED 400 77
ELOCON 62 EPOGEN 74
erythromycin (acne aid) 57
EMBEDA 6 epoprostenol sodium 51
EMBRACE GLUCOSE erythromycin (ophth) 121
eprosartan mesylate 30
CONTROL SOLUTION erythromycin base 77
EPZICOM 46
HIGH 82 EQL COLOR LANCETS erythromycin ethylsuccinate 77
EMBRACE LANCETS ULTRA escitalopram oxalate 21
THIN 30G 82 21G 82
EMBRACE LANCING DEVICE EQL COLOR LANCETS ESGIC 6
WITH EJECTOR 82 MICRO THIN 33G 82 esomeprazole magnesium 129
EMBRACE TALK GLUCOSE EQL INSULIN
SYRINGE/0.3ML/29G X estazolam 75
CONTROL SOLUTION
HIGH 82 1/2" 97 ESTRACE 70
EQL INSULIN estradiol 70
EMCYT 37 SYRINGE/0.3ML/30G X
EMEND 27 5/16" 97 estradiol vaginal 133
EMEND TRIPACK 27 EQL INSULIN estradiol valerate 70
EMFLAZA 55 SYRINGE/0.3ML/31G X ESTROGEL 70
5/16" 97 ESTROSTEP FE 53
EMGALITY 112,113 EQL INSULIN
EMPLICITI 36 SYRINGE/0.5ML/29G X eszopiclone 75
EMSAM 21 1/2" 97 ethacrynic acid 66
EQL INSULIN ethambutol hcl 34
emtricitabine 46 SYRINGE/0.5ML/30G X
emtricitabine-tenofovir disoproxil ethosuximide 20
5/16" 97
fumarate 46 ethynodiol diacet & eth
EMTRIVA 46 estrad 53
Index 11
etidronate disodium 67 ezetimibe 30 FIBRICOR 29
etodolac 4 ezetimibe-simvastatin 28 FIFTY50 SAFETY SEAL
etonogestrel-ethinyl estradiol 54 FABRAZYME 68 LANCETS 30G 82
FIFTY50 SAFETY SEAL
ETOPOPHOS 41 famciclovir 48 LANCETS 32G 82
etoposide 41 famotidine 128,129 FIFTY50 SUPERIOR
etravirine 46 famotidine in nacl 128 COMFORTINSULIN
SYRINGE/0.3ML/31G X
EUCRISA 65 FANAPT 43 5/16" 97
EURAX 65 FANAPT TITRATION FIFTY50 SUPERIOR
EVAMIST 70 PACK 43 COMFORTINSULIN
FANTASY LUBRICATED 77 SYRINGE/0.5ML/31G X
everolimus 39
FANTASY 5/16" 97
everolimus LUBRICATED/SPERMICIDE
(immunosuppressant) 116 FIFTY50 SUPERIOR
77 COMFORTINSULIN
EVISTA 68 FARESTON 37 SYRINGE/1ML/31G X 5/16" 97
EVOCLIN 57 FASENRA 14 FIFTY50 UNILET LANCETS
EVOMELA 34 33G 82
FASENRA PEN 14
EVOTAZ 46 FINACEA 65
FASLODEX 37
EVOXAC 117 finasteride 72
FAZACLO 44
EXEL COMFORT POINT FINE 30 82
INSULIN SYRINGE/0.3ML/29G X FC FEMALE CONDOM 77
FINGERSTIX LANCETS 82
1/2" 97 febuxostat 73
FIORICET 6
EXEL COMFORT POINT felbamate 19
INSULIN SYRINGE/0.3ML/30G X FIORICET/CODEINE 8
FELBATOL 19
5/16" 97 FIORINAL 6
EXEL COMFORT POINT FELDENE 4
FIORINAL/CODEINE #3 8
INSULIN SYRINGE/0.5ML/28G X felodipine 50
FIRAZYR 73
1/2" 97 FEMARA 37
EXEL COMFORT POINT FIRDAPSE 33
INSULIN SYRINGE/0.5ML/29G X FEMCAP 77
FIRMAGON 37
1/2" 97 FEMHRT 69
FIRVANQ 11
EXEL COMFORT POINT FEMRING 133
INSULIN SYRINGE/0.5ML/30G X FLAGYL 10
fenofibrate 29
5/16" 97 flavoxate hcl 130
EXEL COMFORT POINT fenofibrate micronized 29
flecainide acetate 13
INSULIN SYRINGE/1ML/28G X fenoprofen calcium 4
FLECTOR 58
1/2" 97 FENSOLVI 68
EXEL COMFORT POINT FLOLAN 51
fentanyl 6
INSULIN SYRINGE/1ML/29G X FLOMAX 72
1/2" 97 fentanyl citrate 6 FLONASE ALLERGY
EXEL COMFORT POINT FENTORA 6 RELIEF 119
INSULIN SYRINGE/1ML/30G X FER-IN-SOL 74 FLONASE ALLERGY RELIEF
5/16" 97 CHILDRENS 119
FERRIPROX 25
EXELDERM 58 FLOVENT DISKUS 14
ferrous fumarate-folic acid 74
exemestane 37 FLOVENT HFA 14
ferrous sulfate 74
EXFORGE 31 FLOXIN OTIC 123
FETZIMA 22
EXFORGE HCT 31 floxuridine 35
FETZIMA TITRATION
EXJADE 25 PACK 22 FLUAD 2019-2020 131
EXTAVIA 126 fexofenadine-pseudoephedrine FLUAD 2020-2021 131
EZ-LETS LANCETS 21G 82 56 FLUAD QUADRIVALENT 2021-
EZ-LETS LANCETS 26G FIASP 24 2022 131
SUPER-SOFT 82 FIASP FLEXTOUCH 24 FLUAD QUADRIVALENT
EZ-LETS LANCETS 28G FIASP PENFILL 24 INFLUENZA VACCINE FOR
ULTRA-SOFT 82 ADULTS 131
FIBERCON 75
EZ-LETS LANCETS 30G 82
Index 12
FLUARIX QUADRIVALENT fluvoxamine maleate 21 FREDS PHARMACY UNILET
2019-2020 131 FLUZONE HIGH-DOSE PF LANCETS ULTRA THIN
FLUARIX QUADRIVALENT 2019-2020 132 28G 82
2020-2021 131 FLUZONE HIGH-DOSE PF FREESTYLE LANCETS 82
FLUARIX QUADRIVALENT 2020-2021 132 FREESTYLE PRECISION
2021-2022 131 FLUZONE HIGH-DOSE PF INSULIN SYRINGE/U-
FLUBLOK QUADRIVALENT 2021-2022 132 100/0.5ML/30G X 5/16" 97
2019-2020 131 FLUZONE QUADRIVALENT FREESTYLE PRECISION
FLUBLOK QUADRIVALENT 2019-2020 132 INSULIN SYRINGE/U-
2020-2021 131 FLUZONE QUADRIVALENT 100/0.5ML/31G X 5/16" 97
FLUBLOK QUADRIVALENT 2020-2021 132 FREESTYLE PRECISION
2021-2022 131 FLUZONE QUADRIVALENT INSULIN SYRINGE/U-
FLUCELVAX QUADRIVALENT 2021-2022 132 100/1ML/31G X 5/16" 97
2019-2020 131 FML 122 FREESTYLE PRECISION
FLUCELVAX QUADRIVALENT INSULIN SYRINGES/U-
2020-2021 131 FML FORTE 121
100/1ML/30G X 5/16" 97
FLUCELVAX QUADRIVALENT FML LIQUIFILM 121 FREESTYLE UNISTICK II
2021-2022 131 FOCALIN 2 LANCETS 82
fluconazole 27 FOCALIN XR 2 FROVA 113
flucytosine 27 folic acid 74 frovatriptan succinate 113
fludarabine phosphate 35 FOLOTYN 35 fulvestrant 37
fludrocortisone acetate 55 fondaparinux sodium 16 FURADANTIN 12
FLULAVAL QUADRIVALENT FORA CONTROL SOLUTION
2019-2020 131 furosemide 66
HIGH 82 FUZEON 46
FLULAVAL QUADRIVALENT FORA GTEL BLOOD KETONE
2020-2021 132 TEST STRIPS 65 FYCOMPA 17
FLULAVAL QUADRIVALENT gabapentin 18
2021-2022 132 FORA LANCETS 82
FLUMADINE 49 FORA LANCING DEVICE 82 GABITRIL 19
FLUMIST QUADRIVALENT132 FORA LANCING GALAFOLD 68
DEVICE/CLEARCAP 82 galantamine hydrobromide 125
flunisolide (nasal) 120 FORACARE GDH CONTROL
fluocinolone acetonide 62,63 SOLUTION HIGH 82 GAMMAGARD LIQUID 123
fluocinolone acetonide FORFIVO XL 20 GAMMAGARD S/D IGA LESS
(otic) 123 THAN 1MCG/ML 123
formoterol fumarate 15 GAMMAKED 123
fluocinonide 63 FORTAZ 53
fluocinonide emulsified base 63 GAMUNEX-C 123
FORTISCARE CONTROL
fluorometholone (ophth) 121 SOLUTIONS HIGH 82 ganciclovir sodium 48
fluorouracil 35 FOSAMAX 67 ganirelix acetate 68
fluorouracil (topical) 60 FOSAMAX PLUS D 67 GANIRELIX ACETATE 68
fluoxetine hcl 21 fosamprenavir calcium 46 GARDASIL 9 132
fluoxetine hcl (pmdd) 126 fosaprepitant dimeglumine 27 gatifloxacin (ophth) 121
FLUOXETINE fosfomycin tromethamine 12 GAZYVA 36
HYDROCHLORIDE 21 fosinopril sodium 30 gemcitabine hcl 35
fluphenazine hcl 45 fosinopril sodium & GEMCITABINE
flurandrenolide 63 hydrochlorothiazide 31 HYDROCHLORIDE 35
flurbiprofen 4 fosphenytoin sodium 20 gemfibrozil 29
flurbiprofen sodium 122 FOSRENOL 72 GENERESS FE 53
flutamide 37 FRAGMIN 16 gentamicin in saline 3
fluticasone propionate 63 FREDS PHARMACY gentamicin sulfate 3
fluticasone propionate AUTOLET LANCING gentamicin sulfate (ophth) 121
(nasal) 120 DEVICE 82 gentamicin sulfate (topical) 58
FREDS PHARMACY UNILET
fluticasone-salmeterol 15 LANCETS SUPER THIN GENTEEL BUTTERFLY TOUCH
fluvastatin sodium 29 30G 82 LANCETS 82
Index 13
GENTEEL LANCING GLOBAL INJECT EASE GLUCOPRO INSULIN
DEVICE/GLORIOUS GOLD 82 INSULIN SYRINGE/U- SYRINGE/U-100/0.3ML/30G X
GENTEEL LANCING 100/0.3ML/31G X 5/16" 98 5/16" 98
DEVICE/PRECIOUS GLOBAL INJECT EASE GLUCOPRO INSULIN
PLATINUM 82 INSULIN SYRINGE/U- SYRINGE/U-100/0.3ML/31G X
GENTEEL LANCING 100/0.5ML/28G X 1/2" 98 5/16" 98
DEVICE/STATELY SILVER 82 GLOBAL INJECT EASE GLUCOPRO INSULIN
GENTEEL PLUS LANCING INSULIN SYRINGE/U- SYRINGE/U-100/0.5ML/30G X
DEVICE/BUFF BLACK 82 100/0.5ML/29G X 1/2" 98 1/2" 98
GENTEEL PLUS LANCING GLOBAL INJECT EASE GLUCOPRO INSULIN
DEVICE/BUTTERFLY BLUE 82 INSULIN SYRINGE/U- SYRINGE/U-100/0.5ML/30G X
GENTEEL PLUS LANCING 100/0.5ML/30G X 1/2" 98 5/16" 98
DEVICE/PLAYFUL PURPLE 82 GLOBAL INJECT EASE GLUCOPRO INSULIN
GENTEEL PLUS LANCING INSULIN SYRINGE/U- SYRINGE/U-100/0.5ML/31G X
DEVICE/PRINCESS PINK 82 100/0.5ML/30G X 5/16" 98 5/16" 98
GENTEEL PLUS LANCING GLOBAL INJECT EASE GLUCOPRO INSULIN
DEVICE/WILLOWY WHITE 82 INSULIN SYRINGE/U- SYRINGE/U-100/1ML/30G X
GENTLE-LET GP LANCETS 82 100/0.5ML/31G X 5/16" 98 1/2" 98
GENTLE-LET LANCETS GLOBAL INJECT EASE GLUCOPRO INSULIN
GENERAL PURPOSE INSULIN SYRINGE/U- SYRINGE/U-100/1ML/30G X
STYLE/FINE POINT 83 100/1ML/28G X 1/2" 98 5/16" 99
GENTLE-LET LANCETS GLOBAL INJECT EASE GLUCOPRO INSULIN
GENERAL PURPOSE INSULIN SYRINGE/U- SYRINGE/U-100/1ML/31G X
STYLE/MEDIUM POINT 83 100/1ML/29G X 1/2" 98 5/16" 99
GENTLE-LET LANCETS GLOBAL INJECT EASE GLUCOTROL 25
SAFETY STYLE/FINE INSULIN SYRINGE/U- GLUCOTROL XL 25
POINT 83 100/1ML/30G X 1/2" 98
GENTLE-LET LANCETS GLOBAL INJECT EASE glyburide 25
SAFETY STYLE/MEDIUM INSULIN SYRINGE/U- glyburide micronized 25
POINT 83 100/1ML/30G X 5/16" 98 glyburide-metformin 23
GENVOYA 46 GLOBAL INJECT EASE
INSULIN SYRINGE/U- glycine (gu irrigant) 72
GEODON 43 100/1ML/31G X 5/16" 98 glycopyrrolate 128
GILENYA 126 GLOBAL INSULIN GLYNASE 25
GILOTRIF 36 SYRINGE/U-100/0.3ML/30G X GLYSET 23
GLEEVEC 39 1/2" 98
GLOBAL INSULIN GLYXAMBI 23
GLEOSTINE 34 SYRINGES/U- GNP INSULIN
glimepiride 25 100/0.3ML/30GX5/16" 98 SYRINGE/0.3ML/29G X 1/2" 99
glipizide 25 GLOBAL LANCING GNP INSULIN
DEVICE 83 SYRINGE/0.3ML/30G X
glipizide-metformin hcl 23 GLUCAGEN 5/16" 99
GLOBAL EASY GLIDE INSULIN DIAGNOSTIC 65 GNP INSULIN
SYRINGE/1ML/31G X GLUCAGEN HYPOKIT 24 SYRINGE/0.3ML/31G X
15/64" 97 5/16" 99
GLOBAL EASY GLIDE glucagon (rdna) 24 GNP INSULIN
INSULINSYRINGE/U- GLUCAGON EMERGENCY SYRINGE/0.5ML/28G X 1/2" 99
100/0.3ML/31G X 5/16" 98 KIT 24 GNP INSULIN
GLOBAL INJECT EASE INSULIN GLUCOCOM HIGH SYRINGE/0.5ML/29G X 1/2" 99
SYRINGE/U-100/0.3ML/29G X CONTROL 83 GNP INSULIN
1/2" 98 GLUCOCOM LANCETS SYRINGE/0.5ML/30G X
GLOBAL INJECT EASE INSULIN 28G 83 5/16" 99
SYRINGE/U-100/0.3ML/30G X GLUCOCOM LANCETS GNP INSULIN
1/2" 98 30G 83 SYRINGE/0.5ML/31G X
GLOBAL INJECT EASE INSULIN GLUCOCOM LANCETS 5/16" 99
SYRINGE/U-100/0.3ML/30G X 33G 83 GNP INSULIN
5/16" 98 GLUCOPRO INSULIN SYRINGE/1ML/28G X 1/2" 99
SYRINGE/U-100/0.3ML/30G X GNP INSULIN
1/2" 98 SYRINGE/1ML/29G X 1/2" 99
Index 14
GNP INSULIN GOODSENSE LANCETS HAVRIX 132
SYRINGE/1ML/30G X 5/16" 99 ULTRA-THIN 30G 83 HEALTH CARE LANCING
GNP INSULIN GOODSENSE LANCETS DEVICE 83
SYRINGE/1ML/31G X 5/16" 99 ULTRA-THIN 30G HEALTHWISE INSULIN
GNP INSULIN UNIVERSAL 83 SYRINGE/U-100/0.3ML/30G X
SYRINGES/0.3ML/30GX5/16" GOODSENSE LANCING 5/16" 99
99 DEVICE 83 HEALTHWISE INSULIN
GNP INSULIN GOODSENSE PRENATAL SYRINGE/U-100/0.3ML/31G X
SYRINGES/1/2ML/29GX1/2" VITAMINS 117 5/16" 99
99 granisetron hcl 26 HEALTHWISE INSULIN
GNP INSULIN GRANIX 74 SYRINGE/U-100/0.5ML/30G X
SYRINGES/1ML/28GX1/2" 99 5/16" 99
GNP INSULIN GRASTEK 3
HEALTHWISE INSULIN
SYRINGES/3ML/31GX5/16" 99 griseofulvin microsize 27 SYRINGE/U-100/0.5ML/31G X
GNP LANCETS 21G 83 griseofulvin ultramicrosize 27 5/16" 99
GNP LANCETS MICRO THIN guanfacine hcl 31 HEALTHWISE INSULIN
33G 83 SYRINGE/U-100/1ML/30G X
GNP LANCETS SUPER THIN guanfacine hcl (adhd) 2
5/16" 99
30G 83 GUANIDINE HCL 33 HEALTHWISE INSULIN
GNP LANCETS THIN 83 GYNAZOLE-1 133 SYRINGE/U-100/1ML/31G X
GNP LANCETS THIN 26G 83 GYNE-LOTRIMIN 133 5/16" 100
H-E-B INCONTROL HEALTHY ACCENTS AUTOLET
GNP PRENATAL 117 IMPRESSION LANCING
GNP ULTRA COMFORT ADVANCEDLANCING
DEVICE 83 DEVICE 83
INSULIN SYRINGE/0.3ML/29G X HEALTHY ACCENTS UNILET
1/2" 99 H-E-B INCONTROL LANCETS
MICRO THIN 33G 83 LANCETS SUPER THIN
GNP ULTRA COMFORT 30G 83
INSULIN SYRINGE/0.3ML/30G X H-E-B INCONTROL LANCETS
SUPER THIN 30G 83 HECTOROL 68
5/16" SHORT 99
GNP ULTRA COMFORT H-E-B INCONTROL LANCETS HEMANGEOL 50
INSULIN SYRINGE/0.5ML/28G X ULTRA THIN 28G 83 HEPARIN LOCK FLUSH 16
1/2" 99 HAEGARDA 73 heparin sod (porcine) in d5w 16
GNP ULTRA COMFORT HAEMOLANCE 83
INSULIN SYRINGE/0.5ML/29G X heparin sodium (porcine) 16
HAEMOLANCE LOW FLOW HEPARIN SODIUM/NACL
1/2" 99 LANCETS 83
GNP ULTRA COMFORT 0.45% 16
HAEMOLANCE PLUS 83 HEPLISAV-B 132
INSULIN SYRINGE/1ML/28G X HAEMOLANCE PLUS HIGH
1/2" 99 FLOW 83 HEPSERA 48
GNP ULTRA COMFORT HAEMOLANCE PLUS LOW HETLIOZ 75
INSULIN SYRINGE/1ML/29G X FLOW 83
1/2" 99 HIPREX 12
HAEMOLANCE PLUS MAX HIZENTRA 123
GOJJI BLOOD KETONE TEST FLOW 83
STRIPS 65 HAEMOLANCE PLUS HM PRENATAL 117
GOJJI LANCING PEDIATRIC FLOW 83 HM ULTICARE INSULIN
DEVICE/CLEAR CAP 83 SYRINGE/1ML/30G X 1/2" 100
GOJJI STERILE LANCETS HALAVEN 41
HM ULTICARE INSULIN
30G 83 halcinonide 63 SYRINGE/U-100/0.3ML/31G X
GOLYTELY 75 HALCION 75 5/16" 100
GOODSENSE COLOR HALDOL 44 HORIZANT 126
LANCETS MICRO-THIN 33G HALDOL DECANOATE HUMATIN 3
UNIVERSAL 83 100 43
GOODSENSE LANCETS HUMIRA 4
HALDOL DECANOATE 50 44 HUMIRA PEDIATRIC CROHNS
MICRO-THIN 33G 83
GOODSENSE LANCETS halobetasol propionate 63 DISEASE STARTER PACK 3
MICRO-THIN 33G HALOG 63 HUMIRA PEN 3
UNIVERSAL 83 haloperidol 44 HUMIRA PEN-CD/UC/HS
GOODSENSE LANCETS STARTER 3,4
ULTRA-THIN 26G haloperidol decanoate 44
HUMIRA PEN-PEDIATRIC UC
UNIVERSAL 83 haloperidol lactate 44 STARTER PACK 4
Index 15
HUMIRA PEN-PS/UV ifosfamide 35 INSULIN SYRINGE/0.5ML/31G X
STARTER 4 IFOSFAMIDE 35 5/16" 100
HUMULIN R U-500 INSULIN SYRINGE/1ML/28G X
(CONCENTRATED) 24 ILEVRO 122 1/2" 100
HUMULIN R U-500 imatinib mesylate 39 INSULIN SYRINGE/1ML/29G X
KWIKPEN 24 IMBRUVICA 39 1/2" 100
HY-VEE LANCETS 83 INSULIN SYRINGE/1ML/30G X
IMFINZI 36 5/16" 100
HY-VEE THIN LANCETS 84 imipenem-cilastatin 11 INSULIN SYRINGE/NEEDLE
HYCAMTIN 41 imipramine hcl 23 0.3ML/30G X 5/16" 100
hydralazine hcl 32 imipramine pamoate 23 INSULIN SYRINGE/NEEDLE
HYDREA 40 0.3ML/31G X 5/16" 100
imiquimod 64 INSULIN SYRINGE/NEEDLE
HYDRO 35 64 IMITREX 113 0.5ML/29G X 1/2" 100
hydrochlorothiazide 67 IMITREX STATDOSE INSULIN SYRINGE/NEEDLE
hydrocodone bitartrate 6 REFILL 113 0.5ML/30G X 5/16" 100
hydrocodone polistirex- IMITREX STATDOSE INSULIN SYRINGE/NEEDLE
chlorpheniramine polistirex 56 SYSTEM 113 0.5ML/31G X 5/16" 100
hydrocodone-acetaminophen 8 IMLYGIC 41 INSULIN SYRINGE/NEEDLE
1ML/29G X 1/2" 100
hydrocodone-ibuprofen 8,9 IMODIUM A-D 25 INSULIN SYRINGE/NEEDLE
hydrocortisone 55 IMPAVIDO 10 1ML/30G X 5/16" 100
hydrocortisone (intrarectal) 10 IMURAN 116 INSULIN SYRINGE/NEEDLE
IN TOUCH LANCING 1ML/31G X 5/16" 100
hydrocortisone (rectal) 10 INSULIN SYRINGE/U-
DEVICE 84
hydrocortisone (topical) 63 IN TOUCH STERILE 100/0.3ML/29G X 1/2" 100
hydrocortisone acetate LANCETS30G 84 INSULIN SYRINGE/U-
(rectal) 10 INCRELEX 68 100/0.5ML/29G X 1/2" 100
hydrocortisone butyrate 63 INSULIN SYRINGE/U-
INCRUSE ELLIPTA 14 100/1ML/29G X 1/2" 100
hydrocortisone valerate 63 INSULIN SYRINGE/U-
indapamide 67
hydrocortisone w/acetic 100/1ML/30G X 5/16" 100
acid 123 INDERAL LA 50
INSULIN SYRINGE/U-
hydromorphone hcl 6 indomethacin 5 100/1ML/31G X 5/16" 100
HYDROMORPHONE INFED 74 INSULIN
HYDROCHLORIDE 7 INFINITY CONTROL SYRINGES/0.5ML/27GX1/2"
hydroxychloroquine sulfate 33 SOLUTION HIGH 84 100
hydroxyurea 40 INFLECTRA 71 INSULIN
INLYTA 36 SYRINGES/0.5ML/28GX1/2"
hydroxyzine hcl 13 100
hydroxyzine pamoate 13 INREBIC 39 INSULIN
HYPER-SAL 56 INSPRA 32 SYRINGES/0.5ML/29GX1/2"
HYPERSAL 56 INSULIN SYRINGE/0.3ML/29G 101
X 1" 100 INSULIN
HYQVIA 124 INSULIN SYRINGE/0.3ML/29G SYRINGES/0.5ML/30GX5/16"
HYSINGLA ER 7 X 1/2" 100 101
HYZAAR 31 INSULIN SYRINGE/0.3ML/30G INSULIN
X 5/16" 100 SYRINGES/0.5ML/31GX
ibandronate sodium 67 5/16" 101
INSULIN SYRINGE/0.3ML/31G
IBRANCE 39 X 5/16" 100 INSULIN
ibuprofen 5 INSULIN SYRINGE/0.5ML/27G SYRINGES/0.5ML/31GX5/16"
icatibant acetate 73 X 1/2" 100 101
INSULIN SYRINGE/0.5ML/28G INSULIN
ICLUSIG 39 X 1/2" 100 SYRINGES/1ML/27GX/1/2"
icosapent ethyl 28 INSULIN SYRINGE/0.5ML/30G 101
IDAMYCIN PFS 38 X 1/2" 100 INSULIN
idarubicin hcl 38 INSULIN SYRINGE/0.5ML/30G SYRINGES/1ML/27GX1/2" 101
X 5/16" 100 INSULIN
IFEX 34 SYRINGES/1ML/28GX1/2" 101
Index 16
INSULIN JANUMET 23 KIMONO PLUS
SYRINGES/1ML/29GX1/2" 101 JANUMET XR 23 SPERMICIDE/LUBRICATED
INSULIN 77
SYRINGES/1ML/30GX1/2" 101 JANUVIA 24 KIMONO PS LUBRICATED 77
INSULIN JARDIANCE 25 KIMONO PS PLUS
SYRINGES/1ML/31GX5/16" JEVTANA 41 SPERMICIDE/LUBRICATED
101 77
JUBLIA 58
INTELENCE 46 KIMONO SENSATION
JULUCA 46 LUBRICATED 77
INTRAROSA 133
JYNARQUE 69 KIMONO SENSATION PLUS
INTRON A 40
K-TAB 115 SPERMICIDE LUBRICATED77
INTUNIV 2 KIMONO SPECIAL 77
K-Y ME & YOU EXTRA
INVANZ 11 LUBRICATED 77 KINNEY LANCETS 84
INVEGA 43 K-Y ME & YOU INTENSE 77 KINNEY THIN LANCETS 84
INVIRASE 46 KADCYLA 36 KINRAY INSULIN SYRINGE
IONOSOL-MB/DEXTROSE KADIAN 7 PREFERRED PLUS/0.3ML/31G
5% 114 X 5/16" 101
KALETRA 46
IOPIDINE 121 KINRAY INSULIN SYRINGE
KALYDECO 127 PREFERRED PLUS/0.5ML/31G
IPOL INACTIVATED IPV 132
KAMELEON X 5/16" 101
ipratropium bromide 14 LUBRICATED 77 KINRAY INSULIN SYRINGE
ipratropium bromide (nasal) 119 KAPVAY 2 PREFERRED PLUS/1ML/31G X
ipratropium-albuterol 15 KAZANO 23 5/16" 101
irbesartan 30 KCL 0.3%/D5W/NACL KINRAY INSULIN
irbesartan-hydrochlorothiazide 0.9% 115 SYRINGE/0.5ML/29G X
31 KEFLEX 52 1/2" 101
IRESSA 36 KISQALI 39
KENALOG-40 55
irinotecan hcl 41 KITABIS PAK 3
KEPIVANCE 41
irrigation solutions, KLARITY-A 121
KEPPRA 18
physiological 116 KLARON 57
KEPPRA XR 18
ISENTRESS 46 KLONOPIN 17
KERYDIN 58
ISENTRESS HD 46 KMART VALU PLUS INSULIN
ISOLYTE-P/DEXTROSE ketoconazole 27 SYRINGE/1ML/29G 101
5% 114 ketoconazole (topical) 58 KMART VALU PLUS INSULIN
ISOLYTE-S 115 KETONE 65 SYRINGE/1ML/30G 101
isoniazid 34 KETONE TEST STRIPS 65 KOSELUGO 39
KP PRENATAL
ISOPTO CARPINE 120 ketoprofen 5 MULTIVITAMINS 117
ISORDIL TITRADOSE 12 ketorolac tromethamine 5 KRINTAFEL 33
isosorbide dinitrate 12 ketorolac tromethamine KROGER AUTOLET LANCING
isosorbide mononitrate 12 (ophth) 122 DEVICE 84
KETOSTIX 65 KROGER HEALTHPRO TWIST
isotretinoin 57
ketotifen fumarate (ophth)122 LANCETS/26G 84
isradipine 50 KROGER INSULIN
KEVEYIS 66
ISTODAX (OVERFILL) 39 SYRINGE/0.3ML/29G X
KEYTRUDA 36 1/2" 101
itraconazole 27
KHAPZORY 41 KROGER INSULIN
ivermectin 10 SYRINGE/0.3ML/30G X
KHEDEZLA 22
ivermectin (pediculicide) 65 5/16" 101
KIMONO COLORS 77 KROGER INSULIN
IXEMPRA KIT 41
KIMONO LUBRICATED 77 SYRINGE/0.3ML/31G X
JADENU 25
KIMONO MICRO THIN PLUS 5/16" 101
JADENU SPRINKLE 25 SPERMICIDE KROGER INSULIN
JAKAFI 39 LUBRICATED 77 SYRINGE/0.5ML/29G X
JALYN 72 KIMONO PLUS SPERMICIDE 1/2" 101
LUBRICATED 77
Index 17
KROGER INSULIN LANCETS 30G 84 LEADER INSULIN
SYRINGE/0.5ML/30G X LANCETS 30G TWIST SYRINGE/0.5ML/29G X
5/16" 101 TOP 84 1/2" 101
KROGER INSULIN LANCETS 30G/TWIST LEADER INSULIN
SYRINGE/0.5ML/31G X TOP 84 SYRINGE/0.5ML/30G X
5/16" 101 LANCETS 31G TWIST 5/16" 101
KROGER INSULIN TOP 84 LEADER INSULIN
SYRINGE/1ML/29G X 1/2" 101 LANCETS 33G EXTRA SYRINGE/0.5ML/31G X
KROGER INSULIN FINE 84 5/16" 102
SYRINGE/1ML/30G X LANCETS MICRO THIN LEADER INSULIN
5/16" 101 33G 84 SYRINGE/1ML/28G X 1/2" 102
KROGER INSULIN LANCETS SAFETY SEAL LEADER INSULIN
SYRINGE/1ML/31G X 21G 84 SYRINGE/1ML/29G X 1/2" 102
5/16" 101 LANCETS SAFETY SEAL LEADER INSULIN
KROGER LANCETS 84 26G 84 SYRINGE/1ML/30G X
KROGER LANCETS 21G 84 LANCETS SAFETY SEAL 5/16" 102
28G 84 LEADER INSULIN
KROGER LANCETS MICRO SYRINGE/1ML/31G X
THIN33G 84 LANCETS SAFETY SEAL
30G 84 5/16" 102
KROGER LANCETS SUPER
THIN 84 LANCETS SUPER THIN leflunomide 5
28G 84 LENVIMA 10 MG DAILY
KROGER LANCETS THIN 84
LANCETS THIN 84 DOSE 36
KROGER LANCETS THIN LENVIMA 12MG DAILY
26G 84 LANCETS TWIST TOP 84
DOSE 36
KROGER LANCETS LANCETS ULTRA THIN 84 LENVIMA 14 MG DAILY
ULTRATHIN30G 84 LANCETS ULTRA THIN DOSE 36
KROGER LANCING 30G 84 LENVIMA 18 MG DAILY
DEVICE 84 LANCETSBULLSEYE DOSE 36
KUVAN 68 SAFETY 84 LENVIMA 20 MG DAILY
KYPROLIS 39 LANCING DEVICE 84 DOSE 36
labetalol hcl 49 LANCING DEVICE LENVIMA 24 MG DAILY
ADJUSTABLE 84 DOSE 36
LAC-HYDRIN 64 LENVIMA 4 MG DAILY
LANOXIN 51
LAC-HYDRIN TWELVE 64 DOSE 36
lansoprazole 129
LACRISERT 120 LENVIMA 8 MG DAILY
lanthanum carbonate 72 DOSE 36
lactated ringer's 115
LANZO 84 LETAIRIS 51
lactated ringer's (irrigation) 116
lapatinib ditosylate 39 letrozole 37
lactic acid (ammonium
lactate) 64 LARTRUVO 38 leucovorin calcium 41
lactulose 76 LASIX 66 LEUKERAN 35
lactulose (encephalopathy) 71 LASTACAFT 122 LEUKINE 74
LAMICTAL 18 latanoprost 123 leuprolide acetate 37
LAMICTAL CHEWABLE LATUDA 43 levalbuterol hcl 15
DISPERSIBLE 18 LEADER ADVANCED levalbuterol tartrate 15
LAMICTAL ODT 18 LANCING DEVICE 84
LEADER INSULIN LEVAQUIN 70
lamivudine 46
SYRINGE/0.3ML/29G X LEVEMIR 24
lamivudine (hbv) 48 1/2" 101 LEVEMIR FLEXTOUCH 24
lamivudine-zidovudine 46 LEADER INSULIN levetiracetam 18
lamotrigine 18 SYRINGE/0.3ML/30G X
5/16" 101 levobunolol hcl 120
LANCET DEVICE
ADJUSTABLE 84 LEADER INSULIN levocetirizine dihydrochloride28
LANCET DEVICE WITH SYRINGE/0.3ML/31G X levofloxacin 70
EJECTOR 84 5/16" 101 levofloxacin (ophth) 121
LANCETS 84 LEADER INSULIN
SYRINGE/0.5ML/28G X levofloxacin in d5w 70
LANCETS 26G TWIST TOP 84 1/2" 101
Index 18
levonorgestrel & eth LITETOUCH INSULIN LOMOTIL 25
estradiol 53 SYRINGE/0.3ML/31G X LONGS INSULIN
levonorgestrel (emergency 5/16" 102 SYRINGE/0.5ML/31G X
oc) 54 LITETOUCH INSULIN 5/16" 102
levonorgestrel-eth estradiol SYRINGE/0.5ML/30G X LONGS LANCETS
(triphasic) 53 5/16" 102 STANDARD 85
levonorgestrel-ethinyl estradiol LITETOUCH INSULIN LONGS LANCETS THIN 85
(91-day) 53 SYRINGE/0.5ML/31G X
levonorgestrel-ethinyl estradiol LONGS LANCETS ULTRA
5/16" 102
(continuous) 53 LITETOUCH INSULIN THIN 85
levorphanol tartrate 7 SYRINGE/1ML/30G X loperamide hcl 25
levothyroxine sodium 128 5/16" 102 LOPID 29
LITETOUCH INSULIN lopinavir-ritonavir 46
LEXAPRO 21 SYRINGE/U-100/0.3ML/30G X
LEXIVA 46 LOPRESSOR 49
5/16" 102
LIALDA 71 LITETOUCH INSULIN LOPRESSOR HCT 31
LIBERTY CONTROL SOLUTION SYRINGE/U-100/0.3ML/31G X LOPROX 59
HIGH 84 5/16" 102 LOPROX SHAMPOO 59
LIBERTY MEDICAL LANCETS LITETOUCH INSULIN
SYRINGE/U-100/0.5ML/28G X loratadine 28
30G 84 loratadine &
LIBERTY MINI LANCING 1/2" 102
LITETOUCH INSULIN pseudoephedrine 56
DEVICE 84
SYRINGE/U-100/0.5ML/29G X lorazepam 13
LIBRAX 128
1/2" 102 LORBRENA 39
LIBTAYO 36 LITETOUCH INSULIN LORTAB 9
lidocaine 64 SYRINGE/U-100/0.5ML/30G X
5/16" 102 losartan potassium 30
lidocaine hcl 64
LITETOUCH INSULIN losartan potassium &
lidocaine hcl (local anesth.) 76 hydrochlorothiazide 31,32
SYRINGE/U-100/0.5ML/31G X
lidocaine hcl (mouth-throat) 117 5/16" 102 LOSEASONIQUE 53
lidocaine-prilocaine 64 LITETOUCH INSULIN LOTEMAX 122
LIDODERM 64 SYRINGE/U-100/1ML/28G X LOTENSIN 30
LIFESCAN UNISTIK 2 DEEP 1/2" 102
LITETOUCH INSULIN LOTENSIN HCT 32
PENETRATION 84
LIFESCAN UNISTIK II SYRINGE/U-100/1ML/29G X loteprednol etabonate 122
LANCETS 85 1/2" 102 LOTREL 32
LITETOUCH INSULIN
LINCOCIN 11 SYRINGE/U-100/1ML/30G X LOTRIMIN AF 59
lincomycin hcl 11 5/16" 102 LOTRIMIN AF JOCK ITCH 59
lindane 65 LITETOUCH INSULIN LOTRIMIN ULTRA 59
linezolid 12 SYRINGE/U-100/1ML/31G X LOTRISONE 59
5/16" 102
LINZESS 71 LITETOUCH LANCETS MICRO LOTRONEX 71
liothyronine sodium 128 THIN 33G 85 lovastatin 29
LIPITOR 29 LITHIUM 43 LOVAZA 28
LIPOFEN 29 lithium carbonate 43 LOVENOX 16,17
lisinopril 30 LITHOBID 43 loxapine succinate 44
lisinopril & LIVE BETTER ADVANCED lubiprostone 71
hydrochlorothiazide 31 LANCING DEVICE 85
LIVE BETTER LANCET LUCEMYRA 125
LITE TOUCH LANCETS 85
LITE TOUCH LANCING SUPERTHIN 30G 85 luliconazole 59
PEN 85 LIVE BETTER LANCET LUMIZYME 68
LITETOUCH INSULIN ULTRATHIN 28G 85 LUMOXITI 36
SYRINGE/0.3ML/29G X LO LOESTRIN FE 53
LUNESTA 75
1/2" 102 LOCOID 63
LITETOUCH INSULIN LUPANETA PACK 68
LODINE 5 LUPRON DEPOT (1-
SYRINGE/0.3ML/30G X
5/16" 102 LODOSYN 42 MONTH) 37
Index 19
LUPRON DEPOT (3- MAXI-COMFORT INSULIN MEDLANCE PLUS UNIVERSAL
MONTH) 37 SYRINGE/U- LANCETS 21G 85
LUPRON DEPOT (4- 100/0.5ML/28GX1/2" 103 MEDLANCE PLUS/LITE
MONTH) 37 MAXI-COMFORT INSULIN 25G 85
LUPRON DEPOT (6- SYRINGE/U- MEDLANCE/EXTRA 85
MONTH) 37 100/1ML/28GX1/2" 103 MEDLANCE/LITE 85
LUPRON DEPOT-PED (1- MAXICOMFORT INSULIN
MONTH) 68 SYRINGES 27G X 1/2" 103 MEDLANCE/UNIVERSAL 85
LUPRON DEPOT-PED (3- MAXIDEX 122 MEDROL 55
MONTH) 68 MAXIPIME 53 MEDROL DOSEPAK 55
LUXIQ 63 medroxyprogesterone
MAXITROL 122
LUZU 59 acetate 125
MAXX LUBRICATED 77 medroxyprogesterone acetate
LYNPARZA 39 MAXX PLUS SPERMICIDE (contraceptive) 54
LYRICA 18 LUBRICATED 77 mefenamic acid 5
LYRICA CR 126 MAXZIDE 66 mefloquine hcl 33
LYSODREN 37 MAXZIDE-25 66 MEGACE ES 125
LYSTEDA 74 meclizine hcl 26 megestrol acetate 37
M-M-R II 132 meclofenamate sodium 5 megestrol acetate
M-NATAL PLUS 117 MEDIC INSULIN (appetite) 125
MACROBID 12 SYRINGE/0.3ML/30G X MEIJER COLOR LANCETS
5/16" 103 UNIVERSAL 33G 85
MACRODANTIN 12 MEDIC INSULIN MEIJER LANCETS 85
mafenide acetate 61 SYRINGE/0.5ML/30G X
MAGELLAN INSULIN SAFETY 5/16" 103 MEIJER LANCETS THIN 85
SYRINGE/U-100/0.3ML/29G X MEDICHOICE PRE-SET MEIJER LANCETS
1/2" 102 SAFETY LANCET DUAL UNIVERSAL21G 85
MAGELLAN INSULIN SAFETY USE 85 MEIJER LANCETS
SYRINGE/U-100/0.3ML/30G X MEDICHOICE PRE-SET UNIVERSAL30G 85
5/16" 102 SAFETY LANCET LOW MEIJER LANCETS
MAGELLAN INSULIN SAFETY FLOW 85 UNIVERSAL33G 85
SYRINGE/U-100/0.5ML/29G X MEDICHOICE PRE-SET MEIJER SUPER THIN
1/2" 102 SAFETY LANCET MEDIUM LANCETS 85
MAGELLAN INSULIN SAFETY FLOW 85 MEKINIST 39
SYRINGE/U-100/0.5ML/30G X MEDICHOICE PRE-SET MEKTOVI 39
5/16" 102 SAFETY LANCET MODERATE meloxicam 5
MAGELLAN INSULIN SAFETY FLOW 85
SYRINGE/U-100/1ML/29G X MEDICHOICE SAFETY melphalan 35
1/2" 102 LANCETEXTRA 85 melphalan hcl 35
MAGELLAN INSULIN SAFETY MEDICHOICE SAFETY memantine hcl 125
SYRINGE/U-100/1ML/30G X LANCETNORMAL 85 MENACTRA 130
5/16" 103 MEDISENSE THIN
magnesium sulfate 115 LANCETS 85 MENEST 70
MEDLANCE PLUS EXTRA MENOSTAR 70
MALARONE 33 LANCETS 21G 85
malathion 65 MENQUADFI 130
MEDLANCE PLUS
maprotiline hcl 20 LANCETS 85 MENVEO 130
MARCAINE 76 MEDLANCE PLUS LANCETS meperidine hcl 7
LITE 25G 85 meprobamate 13
MARINOL 26 MEDLANCE PLUS LITE
MARPLAN 21 LANCETS 25G 85 MEPRON 11
MARQIBO 41 MEDLANCE PLUS SPECIAL mercaptopurine 35
LANCETS 0.8MM 85 meropenem 11
MATULANE 40 MEDLANCE PLUS
MAVENCLAD 126 MERREM 11
SUPERLITE 30G 85
MAXALT 113 MEDLANCE PLUS mesalamine 71
MAXALT-MLT 113 SUPERLITE 30G/COMFORT mesna 41
MAX 85
Index 20
MESNEX 41 miglitol 23 MONOJECT INSULIN
MESTINON 33 miglustat 73 SYRINGE/DETACH
NEEDLE/1ML/27G X 1/2" 103
MESTINON TIMESPAN 33 MIGRANAL 113 MONOJECT INSULIN
metaxalone 119 MILLIPRED 55 SYRINGE/PERM
metformin hcl 24 MILLIPRED DP 55 NEEDLE/1ML/28G X 1/2" 103
MONOJECT INSULIN
methadone hcl 7 MINASTRIN 24 FE 53 SYRINGE/PERM NEEDLE/U-
METHADONE HCL 7 MINI LANCING DEVICE 85 100/0.5ML/28G X 1/2" 103
methadone hcl 7 MINIPRESS 31 MONOJECT INSULIN
METHADOSE 7 MINIVELLE 70 SYRINGE/SAFETY/PERM
NEEDLE/0.3ML/29G X 1/2" 103
METHADOSE SUGAR-FREE 7 MINOCIN 127 MONOJECT INSULIN
methamphetamine hcl 1 minocycline hcl 127 SYRINGE/SAFETY/PERM
methazolamide 66 minoxidil 32 NEEDLE/0.3ML/29GX1/2" 103
methenamine hippurate 12 MIRAPEX 42 MONOJECT INSULIN
SYRINGE/SAFETY/PERM
methimazole 128 MIRCERA 74 NEEDLE/0.5ML/29G X 1/2" 103
METHITEST 10 MIRCETTE 53 MONOJECT INSULIN
methocarbamol 119 mirtazapine 20 SYRINGE/SAFETY/PERM
NEEDLE/1ML/29G X 1/2" 103
METHOTREXATE 4 MIRVASO 65 MONOJECT INSULIN
methotrexate sodium 35 misoprostol 130 SYRINGE/SOFTPACK/1ML/27G
methoxsalen rapid 61 MITIGARE 73 X 1/2" 103
methscopolamine bromide 128 mitomycin 38 MONOJECT INSULIN
SYRINGE/SOFTPACK/U-
METHYLIN 2 mitoxantrone hcl 38 100/0.5ML/28G X 1/2" 103
methylphenidate hcl 2 MM INSULIN SYRINGE/U- MONOJECT INSULIN
methylprednisolone 55 100/0.3ML/30G X 5/16" 103 SYRINGE/U-100/0.3ML/30G X
MM INSULIN SYRINGE/U- 5/16" 103
methylprednisolone acetate 55 100/0.3ML/31G X 5/16" 103 MONOJECT INSULIN
methylprednisolone sod MM INSULIN SYRINGE/U- SYRINGE/U-100/0.5ML/30G X
succ 55 100/1/2ML/30G X 5/16" 103 5/16" 103
metoclopramide hcl 71 MM INSULIN SYRINGE/U- MONOJECT INSULIN
metolazone 67 100/1/2ML/31G X 5/16" 103 SYRINGE/U-100/1ML/28G X
metoprolol & MM INSULIN SYRINGE/U- 1/2" 104
hydrochlorothiazide 32 100/1ML/30G X 5/16" 103 MONOJECT INSULIN
MM INSULIN SYRINGE/U- SYRINGE/U-100/1ML/30G X
metoprolol succinate 49 100/1ML/31G X 5/16" 103 5/16" 104
metoprolol tartrate 49 MM LANCING DEVICE 85 MONOJECT INSULIN
METROCREAM 65 MM TWIST LANCETS 85 SYRINGEREGULAR LUER
METROGEL 65 MOBIC 5 TIP/SOFTPACK/1ML 104
METROGEL-VAGINAL 133 MONOJECT ULTRA COMFORT
modafinil 2,3 INSULIN SYRINGE/0.3ML/29G X
METROLOTION 65 moexipril hcl 30 1/2" 104
metronidazole 10 mometasone furoate 63 MONOJECT ULTRA COMFORT
metronidazole (topical) 65 mometasone furoate INSULIN SYRINGE/0.3ML/30G X
metronidazole vaginal 133 (nasal) 120 5/16" 104
MONISTAT SOOTHING CARE MONOJECT ULTRA COMFORT
mexiletine hcl 13 INSULIN SYRINGE/0.3ML/31G X
ITCH RELIEF 63
micafungin sodium 27 MONOJECT INSULIN 5/16" 104
MICARDIS 30 SYRINGE/1ML 103 MONOJECT ULTRA COMFORT
MONOJECT INSULIN INSULIN SYRINGE/0.5ML/28G X
MICARDIS HCT 32 1/2" 104
SYRINGE/1ML/31G X
miconazole nitrate vaginal 133 5/16" 103 MONOJECT ULTRA COMFORT
MICROLET LANCETS 85 MONOJECT INSULIN INSULIN SYRINGE/0.5ML/29G X
MICROLET NEXT 85 SYRINGE/DETACH 1/2" 104
midodrine hcl 134 NEEDLE/1ML/25G X 5/8" 103
Index 21
MONOJECT ULTRA COMFORT MYAMBUTOL 34 nebivolol hcl 49
INSULIN SYRINGE/0.5ML/30G X MYCAMINE 27 NEBUSAL 56
5/16" 104
MONOJECT ULTRA COMFORT MYCOBUTIN 34 nefazodone hcl 22
INSULIN SYRINGE/0.5ML/31G X mycophenolate mofetil 116 NEO-SYNALAR 58
5/16" 104 mycophenolate sodium 116 neomycin sulfate 3
MONOJECT ULTRA COMFORT neomycin-bacitracin zn-
INSULIN SYRINGE/1ML/28G X MYDRIACYL 120
MYFORTIC 116 polymyxin 121
1/2" 104 neomycin-polymy-
MONOJECT ULTRA COMFORT MYGLUCOHEALTH MGH dexameth 122
INSULIN SYRINGE/1ML/29G X SOFTLANCE LANCETS neomycin-polymyxin-hc
1/2" 104 30G 86 (ophth) 122
MONOLET LANCETS 86 MYLERAN 35 neomycin-polymyxin-hc
MONOLET OPD LANCETS 86 MYLOTARG 36 (otic) 123
MONOLETTOR SAFETY MYSOLINE 18 NEONATAL COMPLETE 118
LANCETS 86 nabumetone 5 NEONATAL PLUS 118
montelukast sodium 14 nadolol 50 NEONATAL VITAMIN 118
MONUROL 12 nafcillin sodium 124 NEORAL 116
MORPHABOND ER 7 naftifine hcl 59 NEOSTIGMINE
morphine sulfate 7 NAFTIFINE METHYLSULFATE 33
MORPHINE SULFATE 7 HYDROCHLORIDE 59 NESINA 24
morphine sulfate 7 NAFTIN 59 NEUPRO 42
MOTOFEN 25 NAGLAZYME 68 NEURONTIN 18
MOVIPREP 75 nalbuphine hcl 9 NEVANAC 122
moxifloxacin hcl 70 NALFON 5 nevirapine 46
moxifloxacin hcl (ophth) 121 naloxone hcl 26 NEXAVAR 39
moxifloxacin hcl in sodium naltrexone hcl 26 NEXIUM 129
chloride 70 NAMENDA 125 NEXIUM 24HR 129
MOZOBIL 74 NAMENDA TITRATION niacin 134
MPD SAFETY LANCET PAK 125 niacin (antihyperlipidemic) 30
21G/1.8MM 86 NAPROSYN 5
MPD SAFETY LANCET NIACIN TR 134
28G/1.8MM 86 naproxen 5 niacinamide 134
MPD SAFETY LANCET naproxen sodium 5 NIASPAN 30
30G/1.8MM 86 naratriptan hcl 113
MPD SAFETY LANCETS nicardipine hcl 50
23G/1.8MM 86 NARCAN 26 NICODERM CQ 126
MS CONTIN 7 NARDIL 21 NICORETTE 127
MS INSULIN NAROPIN 76 NICORETTE MINI 127
SYRINGE/0.3ML/31G X NASACORT ALLERGY NICORETTE STARTER
5/16" 104 24HR 120 KIT 127
MS INSULIN NASACORT ALLERGY 24HR
CHILDRENS 120 nicotine 127
SYRINGE/0.5ML/31G X
5/16" 104 NASONEX 120 nicotine polacrilex 127
MS INSULIN SYRINGE/1ML/31G NATACYN 121 NICOTINE TRANSDERMAL
X 5/16" 104 SYSTEM 127
NATAZIA 53 NICOTROL INHALER 127
MULPLETA 74
nateglinide 25 NICOTROL NS 127
MULTAQ 13
NATROBA 65 nifedipine 50
MULTI PRENATAL 117
NATURE-THROID 128 NILANDRON 37
MULTI-LANCET DEVICE 86
NATURE-THROID NT-
mupirocin 58 2.5 128 nilutamide 37
MVASI 36 NAVELBINE 41 nimodipine 50
MYALEPT 68 NAYZILAM 17 NINLARO 39
Index 22
NIPENT 40 NOVA MAX PLUS KETONE ofloxacin 70
nisoldipine 50 TESTSTRIPS 65 ofloxacin (ophth) 121
NOVA SAFETY LANCETS
nitazoxanide 11 23G 86 ofloxacin (otic) 123
nitisinone 68 NOVA SAFETY LANCETS olanzapine 44
NITRO-BID 12 28G 86 olmesartan medoxomil 30
NOVA SUREFLEX olmesartan medoxomil-
NITRO-DUR 12 LANCETS 86
nitrofurantoin 12 amlodipine-hydrochlorothiazide
NOVA SUREFLEX LANCING 32
nitrofurantoin macrocrystal 12 DEVICE 86 olmesartan medoxomil-
nitrofurantoin monohyd NOVAREL 67 hydrochlorothiazide 32
macro 12 NOVOLIN 70/30 24 olopatadine hcl 122
nitroglycerin 12 NOVOLIN 70/30 olopatadine hcl (nasal) 119
NITROGLYCERIN 12 FLEXPEN 24
NOVOLIN 70/30 FLEXPEN OLUX 63
nitroglycerin 12 omega-3-acid ethyl esters 29
RELION 24
NITROSTAT 12 NOVOLIN 70/30 RELION 24 omeprazole 129
NIVA-PLUS 118 NOVOLIN N 24 omeprazole magnesium 129
NIX CREME RINSE 65 NOVOLIN N RELION 24 omeprazole-sodium
nizatidine 129 NOVOLIN R 24 bicarbonate 130
NIZORAL 59 OMNIFLEX DIAPHRAGM 77
NOVOLIN R RELION 24
NORCO 9 ON CALL LANCING
NOVOLOG 25 DEVICE 86
NORDITROPIN FLEXPRO 68 NOVOLOG FLEXPEN 24 ON CALL PLUS LANCING
norelgestromin-ethinyl DEVICE 86
estradiol 54 NOVOLOG MIX 70/30 24
NOVOLOG MIX 70/30 ONCASPAR 40
norethin acet & estrad-fe 53
PREFILLED FLEXPEN 24 ondansetron 26
norethindrone & eth estradiol53 NOVOLOG PENFILL 25 ondansetron hcl 26
norethindrone & ethinyl estradiol-
fe 53 NOXAFIL 27 ONE VITE WOMENS
norethindrone NPLATE 74 PRENATALVITAMIN 118
(contraceptive) 54 ONE VITE WOMENS
NUBEQA 37 PRENATALVITAMIN PLUS 118
norethindrone acet & eth NUCALA 14
estra 53 ONETOUCH CLUB LANCETS
NUCYNTA 7 FINE POINT 86
norethindrone acetate 125 ONETOUCH DELICA LANCETS
norethindrone acetate-ethinyl NUCYNTA ER 7
EXTRA FINE 33G 86
estradiol 69 NUEDEXTA 126 ONETOUCH DELICA LANCETS
norethindrone acetate-ethinyl NULOJIX 116 FINE 30G 86
estradiol-fe 53 ONETOUCH DELICA LANCING
norethindrone-eth estradiol NULYTELY 75
NULYTELY/FLAVOR DEVICE 86
(triphasic) 53 ONETOUCH DELICA PLUS
norgestimate-ethinyl PACKS 76
LANCETS EXTRA FINE
estradiol 54 NUVARING 54 33G 86
norgestimate-ethinyl estradiol NUVIGIL 3 ONETOUCH DELICA PLUS
(triphasic) 53 nystatin 27 LANCETS FINE 30G 86
norgestrel & ethinyl estradiol 54 ONETOUCH DELICA PLUS
nystatin (mouth-throat) 117
NORMOSOL-M IN D5W 115 LANCING DEVICE 86
nystatin (topical) 59 ONETOUCH DELICA SAFETY
NORMOSOL-M/D5W 115
nystatin-triamcinolone 59 LACING DEVICE 86
NORMOSOL-R 115 ONETOUCH FINEPOINT
O-CAL FA 118
NORPACE 13 LANCETS 86
octreotide acetate 69 ONETOUCH ULTRASOFT
NORPRAMIN 23
OCUFLOX 121 LANCETS 86
nortriptyline hcl 23 ONETOUCH VERIO CONTROL
ODEFSEY 47
NORVASC 50 SOLUTION HIGH 86
ODOMZO 37
NORVIR 47 ONFI 17
OFEV 127
Index 23
ONIVYDE 41 PANRETIN 60 perindopril erbumine 30
OPANA 7 pantoprazole sodium 129 PERJETA 36
OPDIVO 36 paricalcitol 69 permethrin 65
OPSUMIT 51 PARLODEL 42 perphenazine 45
ORACEA 65 PARNATE 21 perphenazine-amitriptyline 125
ORAPRED ODT 55 paromomycin sulfate 3 PERSERIS 43
ORENITRAM 51 paroxetine hcl 21 PHARMACY COUNTER
ORFADIN 68 PASER 34 LANCETS 86
phenazopyridine hcl 72
ORKAMBI 127 PATADAY 123
phendimetrazine tartrate 1
orphenadrine citrate 119 PATANASE 119
phenelzine sulfate 21
ORTHO MICRONOR 54 PATANOL 123
PHENERGAN 28
ORTHO TRI-CYCLEN LO 54 PAXIL 22
phenobarbital 74,75
ORTHO-NOVUM 1/35 54 PAXIL CR 22
PC LANCETS SUPER THIN phenoxybenzamine hcl 30
ORTHO-NOVUM 7/7/7 54
30G 86 phentermine hcl 2
oseltamivir phosphate 49
PEDIAPRED 55 PHENYTEK 20
OSENI 23
pediatric multivitamins phenytoin 20
OSMOPREP 76 w/fl 117 phenytoin sodium 20
OSPHENA 68 peg 3350-kcl-nacl-na sulfate-na
ascorbate-ascorbic acid 76 phenytoin sodium extended 20
OTEZLA 5
peg 3350-kcl-sod bicarb-sod PHEXXI 133
OTOVEL 123 chloride-sod sulfate 76 PHOSLYRA 72
OVIDE 65 PEGANONE 20 PHOSPHOLINE IODIDE 121
oxacillin sodium 124 PEGASYS 48 PHOTOFRIN 40
oxaliplatin 35 PEGASYS PROCLICK 48 PICATO 60
oxandrolone 9 PEGINTRON 48 PIFELTRO 47
oxaprozin 5 PEMAZYRE 39 pilocarpine hcl 121
oxazepam 13 penicillamine 116 pilocarpine hcl (oral) 117
OXBRYTA 73 penicillin g potassium 124 pimecrolimus 64
oxcarbazepine 18 PENICILLIN G POTASSIUM IN
ISO-OSMOTIC pimozide 126
OXERVATE 121
DEXTROSE 124 pindolol 50
oxiconazole nitrate 59
PENICILLIN G pioglitazone hcl 24
OXISTAT 59 PROCAINE 124 pioglitazone hcl-glimepiride 23
OXSORALEN ULTRA 61 penicillin g sodium 124 pioglitazone hcl-metformin
oxybutynin chloride 130 penicillin v potassium 124 hcl 23
oxycodone hcl 7 PENLAC NAIL LACQUER 60 PIP LANCETS/28G 86
oxycodone w/ acetaminophen 9 pentazocine w/ naloxone 9 PIP LANCETS/30G 86
oxycodone-ibuprofen 9 pentoxifylline 73 piperacillin sodium-tazobactam
oxymorphone hcl 7,8 PEPCID 129 sodium 124
PIQRAY 200MG DAILY
OZEMPIC 24 PEPCID AC 129 DOSE 39
paclitaxel 41 PEPCID AC MAXIMUM PIQRAY 250MG DAILY
paliperidone 43 STRENGTH 129 DOSE 39
palonosetron hcl 26 PERCOCET 9 PIQRAY 300MG DAILY
PERFECT LANCETS 30G 86 DOSE 39
PALYNZIQ 68 piroxicam 5
PERFECT PRESSURE
PAMELOR 23 ACTIVATED SAFETY PLAN B ONE-STEP 54
pamidronate disodium 67 LANCETS 28G 86 PLAQUENIL 33
PAMIDRONATE DISODIUM 67 PERFOROMIST 15 PLASMA-LYTE A 115
pamidronate disodium 67 PERIDEX 117 PLASMA-LYTE-148 115
Index 24
PLAVIX 73 PRECISION SURE-DOSE PREFERRED PLUS LANCETS
PLEGISOL 51 INSULIN SYRINGE/0.5ML/30G SUPER THIN 30G 86
X 3/8" 104 PREFERRED PLUS LANCETS
PLEGRIDY 126 PRECISION SURE-DOSE THIN 26G 86
PLEGRIDY STARTER INSULIN SYRINGE/1ML/28G X pregabalin 18
PACK 126 1/2" 104 pregabalin (once-daily) 126
PNEUMOVAX 23 130 PRECISION SURE-DOSE PREGNYL W/DILUENT
PNEUMOVAX 23/1 DOSE 130 PLUSINSULIN BENZYLALCOHOL/NACL 67
podofilox 64 SYRINGE/0.3ML/29G X
1/2" 104 PREMARIN 70
polymyxin b sulfate 12 PRECISION SURE-DOSE PREMIUM CONDOMS
polymyxin b-trimethoprim 121 PLUSINSULIN LUBRICATED 77
POLYTRIM 121 SYRINGE/1ML/29G X PREMPHASE 69
1/2" 104 PREMPRO 70
POMALYST 38 PRECISION THINS GP
PORTRAZZA 36 PRENATAL 118
LANCET 86
potassium acetate 115 PRECISION XTRA 65 PRENATAL LOW IRON 118
PRENATAL
potassium bicarbonate 115 PRECOSE 23 MULTIVITAMIN 118
potassium chloride 115 PRED FORTE 122 PRENATAL ONE DAILY 118
POTASSIUM CHLORIDE 115 PRED MILD 122 PRENATAL VITAMIN 118
potassium chloride 115 PRED-G 122 PRENATAL VITAMIN &
potassium chloride in prednicarbate 63 MINERAL 118
dextrose 115 prednisolone 55 PRENATAL
potassium chloride in dextrose & VITAMIN/IRON 118
sodium chloride 115 prednisolone acetate
(ophth) 122 PRENATAL VITAMINS 118
potassium chloride in nacl 115 prednisolone sodium PRENATAL VITAMINS PLUS
potassium chloride phosphate 55 LOW IRON 118
microencapsulated crystals PREDNISOLONE SODIUM PRENATRIX 119
er 115 PHOSPHATE 122 PRENATRYL 119
POTASSIUM prednisone 55
CHLORIDE/DEXTROSE/LACTA PREPLUS 119
TED RINGERS 115 PREFERRED PLUS INSULIN PRESSURE ACTIVATED
POTASSIUM SYRINGE/U-100/0.3ML/29G X SAFETYLANCET 21G 86
CHLORIDE/SODIUM 1/2" 104 PREVACID 129
CHLORIDE 115 PREFERRED PLUS INSULIN
SYRINGE/U-100/0.3ML/30G X PREVACID 24HR 129
potassium citrate PREVNAR 13 130
(alkalinizer) 72 5/16" 104
PREFERRED PLUS INSULIN PREZCOBIX 47
potassium phosphates 115 SYRINGE/U-100/0.5ML/28G X
POTELIGEO 36 PREZISTA 47
1/2" 104
pramipexole dihydrochloride 42 PREFERRED PLUS INSULIN PRIFTIN 34
prasugrel hcl 73 SYRINGE/U-100/0.5ML/29G X primaquine phosphate 33
1/2" 105 PRIMAQUINE PHOSPHATE 33
PRAVACHOL 29 PREFERRED PLUS INSULIN
pravastatin sodium 29 SYRINGE/U-100/0.5ML/30G X PRIMAXIN IV 11
praziquantel 10 5/16" 105 primidone 18
PREFERRED PLUS INSULIN PRINIVIL 30
prazosin hcl 31 SYRINGE/U-100/1ML/28G X
PRECISION SURE-DOSE PRISTIQ 22
1/2" 105 PRO COMFORT INSULIN
INSULIN SYRINGE/0.3ML/30G X PREFERRED PLUS INSULIN
5/16" 104 SYRINGE/U-100/1ML/29G X SYRINGES/0.5ML/30G X
PRECISION SURE-DOSE 1/2" 105 1/2" 105
INSULIN SYRINGE/0.5ML/28G X PREFERRED PLUS INSULIN PRO COMFORT INSULIN
1/2" 104 SYRINGE/U-100/1ML/30G X SYRINGES/0.5ML/30G X
PRECISION SURE-DOSE 5/16" 105 5/16" 105
INSULIN SYRINGE/0.5ML/29G X PREFERRED PLUS LANCETS PRO COMFORT INSULIN
1/2" 104 COLORED 21G 86 SYRINGES/0.5ML/31G X
5/16" 105
Index 25
PRO COMFORT INSULIN protriptyline hcl 23 quetiapine fumarate 44
SYRINGES/1ML/30G X PROVENGE 36 quinapril hcl 30
1/2" 105
PRO COMFORT INSULIN PROVENTIL HFA 15 quinapril-hydrochlorothiazide
SYRINGES/1ML/30G X PROVERA 125 32
5/16" 105 quinidine sulfate 13
PROVIGIL 3
PRO COMFORT INSULIN quinine sulfate 33
SYRINGES/1ML/31G X PROZAC 22
QVAR REDIHALER 14
5/16" 105 PRUDOXIN 60
PSS SELECT GP RA E-ZJECT LANCETS 28G87
PROAIR HFA 15 RA E-ZJECT LANCETS THIN
probenecid 73 LANCETS 87
PSS SELECT SAFETY 26G 87
procainamide hcl 13 LANCETS 87 RA E-ZJECT LANCETS THIN
PROCARDIA 50 PTS PANELS KETONE 28G 87
TEST 66 RA E-ZJECT LANCETS
PROCARDIA XL 50 ULTRATHIN 30G 87
PULMICORT 14
prochlorperazine 45 RA INSULIN
PULMICORT FLEXHALER14 SYRINGE/0.5ML/29G X
prochlorperazine maleate 45
PULMOZYME 127 1/2" 105
PROCRIT 74 RA INSULIN SYRINGE/1ML/29G
PUSH BUTTON SAFETY
PROCTOCORT 10 LANCETS 21G 87 X 1/2" 105
PRODIGY CONTROL PUSH BUTTON SAFETY RA INSULIN SYRINGE/U-
SOLUTIONHIGH 86 LANCETS 28G 87 100/0.5ML/30G X 5/16" 105
PRODIGY INSULIN SYRING/U- PX ADVANCED LANCING RA INSULIN SYRINGE/U-100/1
100/0.3ML/31G X 5/16" 105 DEVICE 87 ML/30G X 5/16" 105
PRODIGY INSULIN PX INSULIN SYRINGE/U- RA PRENATAL 119
SYRINGE/1/2ML/31G X 100/0.5ML/30G X 1/2" 105 RA PRENATAL
5/16" 105 PX LANCET AUTO FORMULA/FOLICACID 119
PRODIGY INSULIN INJECTOR 87 rabeprazole sodium 129
SYRINGE/1ML/28G X 1/2" 105 PX LANCETS ULTRA
PRODIGY LANCING THIN 87 raloxifene hcl 68
DEVICE 86 PX LANCETS ULTRA THIN ramelteon 75
PRODIGY PRESSURE 28G 87 ramipril 30
ACTIVATED SAFETY PX PRENATAL
LANCETS 87 RANEXA 12
MULTIVITAMINS 119
PRODIGY SAFETY pyrazinamide 34 ranitidine hcl 129
LANCETS 87 ranolazine 12
PRODIGY TWIST TOP PYRIDIUM 72
pyridostigmine bromide 33,34 RAPAFLO 72
LANCETS 87
progesterone 125 pyrimethamine 33 RAPAMUNE 116
PROGLYCEM 24 QC ADVANCED LANCING rasagiline mesylate 43
PROGRAF 116 DEVICE 87 RAZADYNE 125
QC LANCETS SUPER RAZADYNE ER 125
PROLASTIN-C 127 THIN 87 READYLANCE SAFETY
PROLEUKIN 40 QC LANCETS ULTRA LANCETS/21G/2.2MM 87
PROLIA 67 THIN 87 READYLANCE SAFETY
PROMACTA 74 QC PRENATAL 119 LANCETS/23G/1.8MM 87
QC UNILET LANCETS READYLANCE SAFETY
promethazine hcl 28 28G/ULTRA THIN 87 LANCETS/26G/1.8MM 87
PROMETRIUM 125 QC UNILET LANCETS READYLANCE SAFETY
propafenone hcl 13 33G/MICRO THIN 87 LANCETS/28G/1.8MM 87
proparacaine hcl 121 QINLOCK 39 READYLANCE SAFETY
QUALAQUIN 33 LANCETS/30G/1.6MM 87
propranolol hcl 50 REALITY INSULIN SYRINGE/U-
propylthiouracil 128 QUARTETTE 54 100/0.5ML/28G X 1/2" 105
PROSCAR 72 QUDEXY XR 18 REALITY INSULIN SYRINGE/U-
PROTONIX 129 QUESTRAN 29 100/0.5ML/29G X 1/2" 105
QUESTRAN LIGHT 29 REALITY INSULIN SYRINGE/U-
PROTOPIC 64 100/1ML/28G X 1/2" 105
Index 26
REALITY INSULIN SYRINGE/U- RELION ULTRA THIN PLUS RIGHTEST GL300
100/1ML/29G X 1/2" 105 LANCETS 32G 87 LANCETS 88
REALITY LANCETS 87 RELION ULTRA THIN PLUS RILUTEK 120
REALITY LATEX LANCETS 33G 87 riluzole 120
CONDOMS/LUBRICATED 77 RELISTOR 71
rimantadine hydrochloride 49
REALITY LATEX/ULTRA RELPAX 113
TEXTURED 78 ringer's 115
REMERON 20
REALITY LATEX/ULTRA ringer's irrigation 116
THIN 78 REMERON SOLTAB 20
RINVOQ 4
REALITY TRIGGER RENFLEXIS 71
LANCETS 87 risedronate sodium 67
RENVELA 72
REBIF 126 RISPERDAL 43
REOPRO 73
REBIF REBIDOSE 126 RISPERDAL CONSTA 43
repaglinide 25
REBIF REBIDOSE risperidone 43
TITRATIONPACK 126 repaglinide-metformin hcl 23
RITALIN 3
REBIF TITRATION PACK 126 REPATHA 30
RITALIN LA 3
RECLAST 67 REPATHA PUSHTRONEX
SYSTEM 30 ritonavir 47
RECOMBIVAX HB 132 REPATHA SURECLICK 30 RITUXAN 36
RECTIV 10 REQUIP XL 42 rivastigmine tartrate 125
REGLAN 71 RESCRIPTOR 47 rizatriptan benzoate 114
REGRANEX 65 RESECTISOL 72 ROBAXIN-750 119
RELENZA DISKHALER 49 RESTORIL 75 ROCALTROL 69
RELION 2-IN-1 LANCET ROMIDEPSIN 39
DEVICES 30G 87 RETACRIT 74
RELION 2-IN-1 LANCING RETEVMO 39 ropinirole hydrochloride 42
DEVICE 25G 87 RETIN-A 57 rosuvastatin calcium 29
RELION 2-IN-1 LANCING RETIN-A MICRO 57 ROTARIX 132
DEVICE 30G 87
RELION INSULIN SYRINGE RETIN-A MICRO PUMP 57 ROTATEQ 132
1ML/31GX15/64" 105 RETROVIR 47 ROXICODONE 8
RELION INSULIN SYRINGE/U- RETROVIR IV INFUSION 47 ROXYBOND 8
100/0.3ML/31G X 5/16" 105 ROZEREM 75
RELION INSULIN SYRINGE/U- REVATIO 52
100/0.5ML/29G X 1/2" 105 REVLIMID 116 ROZLYTREK 39
RELION INSULIN SYRINGE/U- REXALL LANCETS ULTRA RUBRACA 39
100/0.5ML/31G X 5/16" 105 THIN 87 RUCONEST 73
RELION INSULIN SYRINGE/U- REXULTI 45
100/1ML/31G X 15/64" 105 rufinamide 18,19
RELION INSULIN SYRINGE/U- REYATAZ 47 RUKOBIA 47
100/1ML/31G X 5/16" 105 RIBASPHERE 48 RUXIENCE 36
RELION KETONE TEST RIBASPHERE RIBAPAK 48
STRIPS 66 RUZURGI 34
ribavirin (hepatitis c) 48 RYTHMOL SR 13
RELION LANCETS MICRO-
THIN33G 87 RIDAURA 4 SABRIL 19
RELION LANCETS THIN rifabutin 34 SAFE-T-LANCE LOW FLOW
26G 87 RIFADIN 34 25G 88
RELION LANCETS ULTRA- SAFE-T-LANCE NORMAL
THIN30G 87 RIFAMATE 34
FLOW21G 88
RELION LANCING DEVICE 87 rifampin 34 SAFE-T-LANCE PLUS
RELION TRUE METRIX RIFATER 34 SAFETYLANCET HIGH
BLOODGLUCOSE TEST RIGHT STEP FLOW 88
STRIPS 66 PRENATAL 119 SAFE-T-LANCE PLUS
RELION ULTRA THIN RIGHTEST GC300 HIGH SAFETYLANCET LOW
LANCETS/30G 87 CONTROL 87 FLOW 88
RELION ULTRA THIN RIGHTEST GD500 LANCING
LANCETS30G 87 DEVICE 87
Index 27
SAFE-T-LANCE PLUS SB INSULIN SYRINGE/U- simvastatin 29
SAFETYLANCET NORMAL 100/0.5ML/30G X 5/16" 106 SINEMET 42
FLOW 88 SB INSULIN SYRINGE/U-
SAFESNAP INSULIN 100/1ML/29G X 1/2" 106 SINEMET CR 42
SYRINGE/0.3ML/30G X SB INSULIN SYRINGE/U- SINGLE-LET 88
5/16" 106 100/1ML/30G X 5/16" 106 SINGULAIR 14
SAFESNAP INSULIN SB INSULIN SYRINGE/U-
SYRINGE/0.5ML/29G X 100/1ML/31G X 5/16" 106 sirolimus 116
1/2" 106 SB LANCETS THIN 88 SIRTURO 34
SAFESNAP INSULIN SB LANCETS ULTRA SIVEXTRO 12
SYRINGE/0.5ML/30G X THIN 88 SKELAXIN 119
5/16" 106 scopolamine 26
SAFESNAP INSULIN SKLICE 65
SYRINGE/1ML/28G X 1/2" 106 SEASONIQUE 54 SKYRIZI 61
SAFESNAP INSULIN SECURESAFE SAFETY SKYRIZI PEN 61
SYRINGE/1ML/29G X 1/2" 106 INSULIN SYRINGES/U-
SAFETY INSULIN SYRINGES 100/0.5ML/29GX1/2" 106 SLO-NIACIN 134
0.5ML/29GX1/2" 106 SECURESAFE SAFETY SLYND 54
SAFETY INSULIN SYRINGES INSULIN SYRINGES/U- SM MICRO THIN LANCETS
0.5ML/30GX5/16" 106 100/1ML/29GX1/2" 106 33G 88
SAFETY INSULIN SYRINGES SELECT-LITE LANCING SM PRENATAL VITAMINS 119
1ML/27GX1/2" 106 DEVICE 88 SM TRUEDRAW LANCING
SAFETY INSULIN SYRINGES selegiline hcl 43 DEVICE 88
1ML/29GX1/2" 106 selenium sulfide 61 SMART DIABETES VANTAGE
SAFETY INSULIN SYRINGES LANCING DEVICE 88
1ML/30GX1/2" 106 SELZENTRY 47
SMART SENSE COLOR
SAFETY LANCET SENSIPAR 69 LANCETS UNIVERSAL 33G 88
21G/PRESSURE SEROQUEL 44 SMART SENSE STANDARD
ACTIVATED 88 SEROQUEL XR 44 LANCETS UNIVERSAL 21G 88
SAFETY LANCET SMART SENSE SUPER THIN
23G/PRESSURE sertraline hcl 22
LANCETS UNIVERSAL 30G 88
ACTIVATED 88 sevelamer carbonate 72 SMART SENSE THIN
SAFETY LANCET SHINGRIX 132 LANCETSUNIVERSAL 26G 88
28G/PRESSURE SHOPKO AUTOLET LANCING SMARTEST LANCETS 28G 88
ACTIVATED 88 DEVICE 88 SODIUM ACETATE 114
SAFETY LANCETS 21G 88 SHOPKO ON-THE-GO
COMFORTLANCETS 30G 88 sodium acetate 114
SAFETY LANCETS 28G 88
SHOPKO UNILET LANCETS sodium chloride 115
SAFETY LET LANCETS 88
SUPER THIN 30G 88 sodium chloride (gu irrigant) 72
SAFYRAL 54 SHOPKO UNILET LANCETS sodium chloride (inhalant) 56
SALAGEN 117 ULTRA THIN 28G 88
SHUR-SEAL 133 sodium citrate & citric acid 72
salsalate 6
SIDE BUTTON SAFETY sodium fluoride 115
SAMSCA 69
LANCET21G 88 sodium phenylbutyrate 69
SANDIMMUNE 116
SIGNIFOR 69 sodium polystyrene
SANDOSTATIN 69 sulfonate 117
sildenafil citrate 51
SANDOSTATIN LAR SOFOSBUVIR/VELPATASVIR
DEPOT 69 sildenafil citrate (pulmonary
hypertension) 52 48
SANTYL 64 solifenacin succinate 130
SILENOR 75
SAPHRIS 44 SOLIRIS 73
silodosin 72
sapropterin dihydrochloride 69 SOLOSEC 3
SILVADENE 61
SAVELLA 125 SOLU-CORTEF 55
silver sulfadiazine 61
SAVELLA TITRATION SOLU-MEDROL 55
PACK 125 SIMBRINZA 121
SB INSULIN SYRINGE/U- SIMPLE DIAGNOSTICS SOLUS V2 CONTROL HIGH88
100/0.5ML/29G X 1/2" 106 LANCING DEVICE 88 SOLUS V2 LANCING
SIMULECT 116 DEVICE 88
Index 28
SOLUS V2 PRESSURE SUBSYS 8 SURE COMFORT INSULIN
ACTIVATED SAFETY LANCETS SUCRAID 66 SYRINGE/U-100/0.5ML/30G X
28G 88 5/16" 106
SOLUS V2 TWIST LANCETS sucralfate 129 SURE COMFORT INSULIN
30G 88 SULAR 50 SYRINGE/U-100/0.5ML/31G X
SOMA 119 sulconazole nitrate 60 5/16 106
SOMATULINE DEPOT 69 sulfacetamide sod- SURE COMFORT INSULIN
prednisolone 122 SYRINGE/U-100/1ML/28G X
SOMAVERT 68 1/2" 106
sulfacetamide sodium
SOOLANTRA 65 (acne) 57 SURE COMFORT INSULIN
SORBITOL 72 sulfacetamide sodium SYRINGE/U-100/1ML/29G X
SORBITOL-MANNITOL 72 (ophth) 121 1/2" 107
sulfacetamide sodium w/ SURE COMFORT INSULIN
SORBITOL/MANNITOL SYRINGE/U-100/1ML/30G X
IRRIGATION 72 sulfur 57,58
sulfacetamide sodium-sulfur in 1/2" 107
SORIATANE 61 SURE COMFORT INSULIN
urea vehicle 58
sotalol hcl 50 SULFADIAZINE 127 SYRINGE/U-100/1ML/30G X
sotalol hcl (afib/afl) 50 5/16" 107
sulfamethoxazole-trimethoprim SURE COMFORT INSULIN
spinosad 65 11 SYRINGE/U-100/1ML/31G X
SPIRIVA HANDIHALER 14 SULFAMYLON 61 5/16" 107
SPIRIVA RESPIMAT 14 sulfasalazine 71 SURE COMFORT LANCETS
spironolactone 66 sulindac 5 18G 88
SURE COMFORT LANCETS
spironolactone & SUMADAN WASH 58 21G 88
hydrochlorothiazide 66 sumatriptan 114 SURE COMFORT LANCETS
SPORANOX 27 sumatriptan succinate 114 23G 88
SPORANOX PULSEPAK 27 sumatriptan-naproxen SURE COMFORT LANCETS
SPRAVATO 56MG DOSE 21 sodium 113 28G 89
sunitinib malate 39 SURE COMFORT LANCETS
SPRAVATO 84MG DOSE 21 30G 89
SPRYCEL 39 SUNOSI 2 SURE COMFORT LANCING
STALEVO 100 43 SUPER THIN LANCETS 88 PEN 89
STALEVO 125 43 SUPRAX 53 SURE-JECT INSULIN
SURE COMFORT INSULIN SYRINGE/U-100/0.3ML/29G X
STALEVO 150 43 1/2" 107
STALEVO 200 43 1/2" 106 SURE-JECT INSULIN
STALEVO 50 43 SURE COMFORT INSULIN SYRINGE/U-100/0.3ML/30G X
SYRINGE/U-100/0.3ML/30G X 5/16" 107
STALEVO 75 43 SURE-JECT INSULIN
stannous fluoride 117 1/2" 106
STARLIX 25 SYRINGE/U-100/0.3ML/30G X 5/16" 107
stavudine 47 5/16" 106 SURE-JECT INSULIN
STAVUDINE 47 1/2" 107
STELARA 61,71 5/16 106 SURE-JECT INSULIN
STENDRA 51 SURE COMFORT INSULIN SYRINGE/U-100/0.5ML/29G X
STERILANCE TL 88 SYRINGE/U-100/0.3ML/31G X 1/2" 107
5/16" 106 SURE-JECT INSULIN
STIMATE 69 SYRINGE/U-100/0.5ML/30G X
SURE COMFORT INSULIN
STIVARGA 39 SYRINGE/U-100/0.5ML/28G X 5/16" 107
STRATTERA 2 1/2" 106 SURE-JECT INSULIN
streptomycin sulfate 3 5/16" 107
STRIBILD 47 SYRINGE/U-100/0.5ML/29G X
1/2" 106 SURE-JECT INSULIN
STRIVERDI RESPIMAT 15 SURE COMFORT INSULIN SYRINGE/U-100/1ML/28G X
STROMECTOL 10 SYRINGE/U-100/0.5ML/30G X 1/2" 107
SUBOXONE 9 1/2" 106
Index 29
SURE-JECT INSULIN TALZENNA 40 TECHLITE INSULIN SYRINGEU-
SYRINGE/U-100/1ML/29G X TAMIFLU 49 100/1ML/30G X 5/16" 107
1/2" 107 TECHLITE INSULIN SYRINGEU-
SURE-JECT INSULIN tamoxifen citrate 37 100/1ML/31G X 15/64" 108
SYRINGE/U-100/1ML/30G X tamsulosin hcl 72 TECHLITE INSULIN SYRINGEU-
5/16" 107 TAPAZOLE 128 100/1ML/31G X 5/16" 108
SURE-JECT INSULIN TECHLITE LANCETS 89
SYRINGE/U-100/1ML/31G X TARCEVA 37
TARGADOX 127 TECHLITE LANCETS 30G 89
5/16" 107
SURE-LANCE FLAT TARGRETIN 40,60 TEFLARO 53
LANCETS 89 TARKA 32 TEGRETOL 19
SURE-LANCE LANCETS TEGRETOL-XR 19
26G 89 TASIGNA 40
SURE-LANCE THIN LANCETS TASMAR 42 TEGSEDI 127
28G 89 tavaborole 60 TEKTURNA 32
SURE-LANCE ULTRA THIN telmisartan 30
LANCETS 89 TAXOTERE 41
TAYTULLA 54 telmisartan-amlodipine 32
SURE-PEN 89 telmisartan-hydrochlorothiazide
SURE-TOUCH LANCETS tazarotene 61 32
UNIVERSAL 89 TAZORAC 61 temazepam 75
SURELITE LANCETS 89 TAZVERIK 40 TEMIXYS 47
SURESTEP PRO HIGH TECENTRIQ 36
GLUCOSECONTROL 89 TEMODAR 35
SUSTIVA 47 TECFIDERA 126 TEMOVATE 63
TECFIDERA STARTER temozolomide 35
SUTENT 39 PACK 126
SYLATRON 40 TECHLITE AST LANCETS 89 temsirolimus 40
SYMBICORT 15 TECHLITE INSULIN TENIPOSIDE 41
SYMFI 47 SYRINGEU-100/0.3ML/29G X tenofovir disoproxil fumarate 47
SYMFI LO 47 1/2" 107 TENORETIC 100 32
TECHLITE INSULIN
SYMLINPEN 120 23 SYRINGEU-100/0.3ML/30G X TENORETIC 50 32
SYMLINPEN 60 23 1/2" 107 TENORMIN 49
SYMTUZA 47 TECHLITE INSULIN TEPADINA 35
SYRINGEU-100/0.3ML/30G X terazosin hcl 31
SYNALAR 63 5/16" 107
SYNAREL 68 TECHLITE INSULIN terbinafine hcl 27
SYNERA 64 SYRINGEU-100/0.3ML/31G X terbutaline sulfate 15
SYNJARDY 23 5/16" 107 terconazole vaginal 133
TECHLITE INSULIN TESSALON PERLES 56
SYNJARDY XR 23 SYRINGEU-100/0.5ML/29G X
SYNRIBO 40 1/2" 107 TESTIM 10
SYNTHROID 128 TECHLITE INSULIN TESTOSTERONE
SYRINGEU-100/0.5ML/30G X CYPIONATE 10
SYPRINE 116 testosterone cypionate 10
1/2" 107
TABLOID 35 TECHLITE INSULIN testosterone enanthate 10
TABRECTA 40 SYRINGEU-100/0.5ML/30G X
5/16" 107 tetrabenazine 126
TACLONEX 63 tetracycline hcl 128
TECHLITE INSULIN
tacrolimus 116 SYRINGEU-100/0.5ML/31G X TGT LANCET MICRO THIN
tacrolimus (topical) 64 5/16" 107 33G 89
tadalafil 51 TECHLITE INSULIN TGT LANCET THIN 26G 89
tadalafil (pulmonary SYRINGEU-100/1ML/29G X TGT LANCET ULTRA THIN
hypertension) 52 1/2" 107 30G 89
TAFINLAR 40 TECHLITE INSULIN TGT LANCING DEVICE 89
SYRINGEU-100/1ML/30G X
TAGAMET HB 129 1/2" 107 THALOMID 116
TAKHZYRO 73 theophylline 15
Index 30
THERANATAL CORE TOPCARE ULTRA COMFORT TREANDA 35
NUTRITION 119 INSULIN SYRINGE/0.3ML/30G TRECATOR 34
THINLETS GP LANCETS 89 X 5/16" 108
TOPCARE ULTRA COMFORT TRELEGY ELLIPTA 15
thioridazine hcl 45
INSULIN SYRINGE/0.3ML/31G TRELSTAR MIXJECT 37
thiotepa 35 X 5/16" 108 TREMFYA 61
thiothixene 45 TOPCARE ULTRA COMFORT
INSULIN SYRINGE/0.5ML/30G treprostinil 51
THYMOGLOBULIN 116
X 5/16" 108 TRESIBA 25
THYROGEN 65 TOPCARE ULTRA COMFORT TRESIBA FLEXTOUCH 25
thyroid 128 INSULIN SYRINGE/0.5ML/31G tretinoin 58
tiagabine hcl 19 X 5/16" 108
TOPCARE ULTRA COMFORT tretinoin (chemotherapy) 40
TIAZAC 51
INSULIN SYRINGE/1ML/30G X tretinoin microsphere 58
TIBSOVO 40 5/16" 108 TREXALL 35
TICE BCG 40 TOPCARE ULTRA COMFORT TREXIMET 113
TIGAN 26 INSULIN SYRINGE/1ML/31G X
5/16" 108 triamcinolone acetonide 55
tigecycline 127 triamcinolone acetonide
TOPCARE ULTRA COMFORT
TIKOSYN 13 INSULIN SYRINGE/U- (mouth) 117
timolol maleate 50 100/0.3ML/29G X 1/2" 108 triamcinolone acetonide
timolol maleate (ophth) 120 TOPCARE ULTRA COMFORT (nasal) 120
INSULIN SYRINGE/U- triamcinolone acetonide
TIMOPTIC 120 100/0.5ML/29G X 1/2" 108 (topical) 64
TIMOPTIC-XE 120 TOPCARE ULTRA COMFORT triamcinolone acetonide-
TIVICAY 47 INSULIN SYRINGE/U- dimethicone-silicone 64
TIVICAY PD 47 100/1ML/29G X 1/2" 108 triamterene 66
TOPICORT 64 triamterene &
tizanidine hcl 119 hydrochlorothiazide 66
TOBI 3 topiramate 19
triazolam 75
TOBRADEX 122 TOPOTECAN HCL 41
TRIBENZOR 32
tobramycin 3 topotecan hcl 42
TRICARE 119
tobramycin (ophth) 121 TOPROL XL 49
TRICOR 29
tobramycin sulfate 3 toremifene citrate 37
TRIDESILON 64
tobramycin- TORISEL 40
trientine hcl 116
dexamethasone 122 torsemide 66
TOBREX 121 trifluoperazine hcl 45
TOVIAZ 130
TODAY SPONGE 133 trifluridine 121
TRACLEER 51
TODAYS HEALTH ADVANCED trihexyphenidyl hcl 42
tramadol hcl 8
LANCING DEVICE 89 TRIJARDY XR 23
TODAYS HEALTH SUPER tramadol-acetaminophen 9
TRIKAFTA 127
THINLANCETS 30G 89 trandolapril 30
TODAYS HEALTH ULTRA TRILEPTAL 19
trandolapril-verapamil hcl 32
THINLANCETS 28G 89 trimethobenzamide hcl 26
tranexamic acid 74
TOFRANIL 23 trimethoprim 10
TRANSDERM SCOP 26
tolbutamide 25 trimipramine maleate 23
TRANSDERM-SCOP 26
tolcapone 42 TRINTELLIX 22
TRANXENE T 13
tolmetin sodium 5 TRIOSTAT 128
tranylcypromine sulfate 21
TOLSURA 27 TRIUMEQ 47
TRAVATAN Z 123
tolterodine tartrate 130 TRIZIVIR 47
TRAVEL LANCETS 30G 89
tolvaptan 69 TRAVEL LANCETS tropicamide 120
TOPAMAX 19 ADVANCED 28G 89 trospium chloride 130
TOPAMAX SPRINKLE 19 travoprost 123 TRUE COMFORT INSULIN
TOPCARE LANCETS MICRO- trazodone hcl 22 SYRINGE/0.5ML/31G X
THIN 33G 89 5/16" 108
Index 31
TRUE COMFORT INSULIN TRUEPLUS INSULIN TUZISTRA XR 56
SYRINGE/1ML/31G X SYRINGE/U-100/1ML/31G X TWINRIX 132
5/16" 108 5/16" 109
TRUE COMFORT PRO TRUEPLUS LANCETS TWIRLA 54
INSULINSYRINGE/0.5ML/30G X 26G 89 TWYNSTA 32
5/16" 108 TRUEPLUS LANCETS TYBLUME 54
TRUE COMFORT PRO 28G 89
INSULINSYRINGE/0.5ML/31G X TRUEPLUS LANCETS 28G TYBOST 47
5/16" 108 SUPER THIN 89 TYGACIL 127
TRUE COMFORT PRO TRUEPLUS LANCETS TYKERB 40
INSULINSYRINGE/1ML/30G X 30G 89 TYLENOL/CODEINE #3 9
5/16" 108 TRUEPLUS LANCETS 30G
TRUE COMFORT PRO ULTRA THIN 89 TYLENOL/CODEINE #4 9
INSULINSYRINGE/1ML/31G X TRUEPLUS LANCETS TYMLOS 67
5/16" 108 33G 89 TYSABRI 126
TRUE COMFORT PRO TRUEPLUS LANCETS 33G
MICRO THIN 89 UCERIS 10
INSULINSYRINGE/U-
100/0.5ML/30G X 1/2" 108 TRUEPLUS SAFETY ULESFIA 65
TRUE COMFORT PRO LANCETS 28G 89 ULORIC 73
INSULINSYRINGE/U- TRUETRACK TEST 66 ULTI-LANCE AUTOMATIC/
100/1ML/30G X 1/2" 108 TRULICITY 24 CLEAR TIP 89
TRUE METRIX BLOOD ULTICARE INSULIN SAFETY
GLUCOSETEST STRIPS 66 TRUSOPT 123
SYRINGE/0.5ML/29G X
TRUE METRIX CONTROL TRUSTEX COLOR CONDOMS 1/2" 109
SOLUTION LEVEL 3 89 + LUBE 78 ULTICARE INSULIN SAFETY
TRUEDRAW LANCING TRUSTEX LUBRICATED 78 SYRINGE/1ML/29G X 1/2" 109
DEVICE 89 TRUSTEX LUBRICATED ULTICARE INSULIN
TRUEPLUS INSULIN EXTRALARGE 78 SYRINGE/0.3ML/29G X
SYRINGE/U-100/0.3ML/29G X TRUSTEX LUBRICATED 1/2" 109
1/2" 108 EXTRASTRENGTH 78 ULTICARE INSULIN
TRUEPLUS INSULIN TRUSTEX SYRINGE/0.3ML/30G X
SYRINGE/U-100/0.3ML/30G X LUBRICATED/RIBBED/STUDD 1/2" 109
5/16" 108 ED 78 ULTICARE INSULIN
SYRINGE/U-100/0.3ML/31G X LUBRICATED/SPERMICIDE 5/16" 109
5/16" 108 78 ULTICARE INSULIN
1/2" 108 EXTRA LARGE 78 ULTICARE INSULIN
1/2" 108 EXTRA STRENGTH 78 ULTICARE INSULIN
TRUEPLUS INSULIN TRUSTEX NATURAL SYRINGE/0.5ML/30G X
SYRINGE/U-100/0.5ML/30G X CONDOMS 1/2" 109
5/16" 108 +LUBE/LUBRICATED 78 ULTICARE INSULIN
TRUEPLUS INSULIN TRUSTEX WITH SYRINGE/0.5ML/30G X
SYRINGE/U-100/0.5ML/31G X NONOXYNOL- 5/16" 109
5/16" 109 9/RIBBED/STUDDED 78 ULTICARE INSULIN
TRUEPLUS INSULIN TRUSTEX/RIA SYRINGE/1ML/28G X 1/2" 109
SYRINGE/U-100/1ML/28G X LUBRICATED 78 ULTICARE INSULIN
1/2" 109 TRUSTEX/RIA LUBRICATED SYRINGE/1ML/29G X 1/2" 109
TRUEPLUS INSULIN SPERMICIDE 78 ULTICARE INSULIN
SYRINGE/U-100/1ML/29G X TRUSTEX/RIA SYRINGE/1ML/30G X 1/2" 109
1/2" 109 LUBRICATED/SPERMICIDE ULTICARE INSULIN
TRUEPLUS INSULIN 78 SYRINGE/1ML/30G X
SYRINGE/U-100/1ML/30G X TRUVADA 47 5/16" 109
5/16" 109 TUKYSA 36 ULTICARE INSULIN
TURALIO 40 SYRINGE/SHORT/0.3ML/30G X
5/16" 109
Index 32
ULTICARE INSULIN ULTIGUARD SAFEPACK ULTILET SAFETY LANCETS
SYRINGE/SHORT/0.3ML/31G X INSULIN SYRINGE/0.3ML/31G 23G 89
5/16" 109 X 5/16"/SHARPS 110 ULTRA COMFORT INSULIN
ULTICARE INSULIN ULTIGUARD SAFEPACK SYRINGE/U-100/0.3ML/30G X
SYRINGE/SHORT/0.5ML/30G X INSULIN SYRINGE/0.5ML/30G 5/16" 110
5/16" 109 X 1/2"/SHARPS C 110 ULTRA FLO INSULIN SYRINGE
ULTICARE INSULIN ULTIGUARD 0.3ML/29G X 1/2" 111
SYRINGE/SHORT/0.5ML/31G X SAFEPACK/SYRINGE/NEEDL ULTRA FLO INSULIN SYRINGE
5/16" 109 E/31G X 5/16"/SHARPS 0.3ML/30GX1/2" 111
ULTICARE INSULIN CONTAIN 110 ULTRA FLO INSULIN SYRINGE
SYRINGE/SHORT/1ML/30G X ULTILET CLASSIC 0.3ML/30GX5/16" 111
5/16" 109 LANCETS 89 ULTRA FLO INSULIN SYRINGE
ULTICARE INSULIN ULTILET INSULIN 0.3ML/31GX5/16" 111
SYRINGE/SHORT/1ML/31G X SYRINGE/0.3ML/30G X ULTRA FLO INSULIN SYRINGE
5/16" 109 8MM 110 0.5ML/29GX1/2" 111
ULTICARE INSULIN ULTILET INSULIN ULTRA FLO INSULIN SYRINGE
SYRINGE/U-100/0.3ML/30G X SYRINGE/0.3ML/31G X 0.5ML/30GX1/2" 111
1/2" 109 8MM 110 ULTRA FLO INSULIN SYRINGE
ULTICARE INSULIN ULTILET INSULIN 0.5ML/30GX5/16" 111
SYRINGE/U-100/0.3ML/31G X SYRINGE/0.5ML/30G X ULTRA FLO INSULIN SYRINGE
5/16" 109 8MM 110 0.5ML/31GX5/16" 111
SYRINGE/U-100/0.5ML/30G X SYRINGE/1ML/30G X 1/2 UNIT/0.3ML/30GX1/2" 111
ULTICARE INSULIN ULTILET INSULIN 1/2 UNIT/0.3ML/30GX5/16"
SYRINGE/U-100/0.5ML/31G X SYRINGE/1ML/31G X 111
ULTICARE INSULIN ULTILET INSULIN 1/2 UNIT/0.3ML/31GX5/16"
SYRINGE/U-100/1ML/30G X SYRINGE/SHORT/0.3ML/30G 111
1/2" 109 X 12.7MM 110 ULTRA FLO INSULIN SYRINGE
ULTICARE INSULIN ULTILET INSULIN 1M/29GX1/2" 111
SYRINGE/U-100/1ML/31G X SYRINGE/SHORT/0.3ML/30G ULTRA FLO INSULIN SYRINGE
5/16" 110 X 5/16" 110 1ML/30GX1/2" 111
SYRINGEULTRAFINE U- SYRINGE/SHORT/0.3ML/31G 1ML/30GX5/16" 111
100/0.3ML/31G X 5/16" 110 X 5/16" 110 ULTRA FLO INSULIN SYRINGE
ULTICARE INSULIN ULTILET INSULIN 1ML/31GX5/16" 111
SYRINGEULTRAFINE U- SYRINGE/SHORT/0.5ML/30G ULTRA THIN LANCETS
100/0.5ML/31G X 5/16" 110 X 5/16" 110 31G 89
ULTICARE INSULIN ULTILET INSULIN ULTRA-COMFORT INSULIN
SYRINGEULTRAFINE U- SYRINGE/SHORT/0.5ML/31G SYRINGE/U-100/0.3ML/29G X
100/1ML/31G X 5/16" 110 X 5/16" 110 1/2" 111
ULTIGUARD SAFEPACK ULTILET INSULIN ULTRA-COMFORT INSULIN
INSULIN SYRINGE 0.3ML/30G X SYRINGE/SHORT/1ML/30G X SYRINGE/U-100/0.3ML/30G X
1/2"/SHARPS C 110 5/16" 110 5/16" 111
INSULIN SYRINGE 1/2ML 30G X SYRINGE/SHORT/1ML/31G X SYRINGE/U-100/0.3ML/31G X
1/2"/SHARPS C 110 5/16" 110 5/16" 111
INSULIN SYRINGE 1ML 30G X SYRINGE/U-100/0.5ML/30G X SYRINGE/U-100/0.5ML/28G X
1/2"/SHARPS CON 110 1/2" 110 1/2" 111
INSULIN SYRINGE 1ML 31G X SYRINGE/U-100/1ML/30G X SYRINGE/U-100/0.5ML/29G X
5/16"/SHARPS CO 110 1/2" 110 1/2" 111
ULTIGUARD SAFEPACK ULTILET LANCETS 89 ULTRA-COMFORT INSULIN
INSULIN SYRINGE/0.3ML/30G X SYRINGE/U-100/0.5ML/30G X
ULTILET LANCETS 33G 89 5/16" 111
1/2"/SHARPS C 110 ULTILET SAFETY LANCETS
21G X 2.2MM 89
Index 33
ULTRA-COMFORT INSULIN ULTRACARE INSULIN UNIVERSAL 1 LANCETS ULTRA
SYRINGE/U-100/0.5ML/31G X SYRINGE/U-100/0.5ML/31G X THIN 30G 90
5/16" 111 5/16" 112 UNIVERSAL 1
ULTRA-COMFORT INSULIN ULTRACARE INSULIN LANCETS/33G/MICRO-THIN
SYRINGE/U-100/1ML/28G X SYRINGE/U-100/1ML/30G X 90
1/2" 111 1/2" 112 URECHOLINE 130
ULTRA-COMFORT INSULIN ULTRACARE INSULIN UROCIT-K 10 72
SYRINGE/U-100/1ML/29G X SYRINGE/U-100/1ML/30G X
1/2" 111 5/16" 112 UROXATRAL 72
ULTRA-COMFORT INSULIN ULTRACARE INSULIN URSO 250 71
SYRINGE/U-100/1ML/30G X SYRINGE/U-100/1ML/31G X URSO FORTE 71
5/16" 111 5/16" 112 ursodiol 71
ULTRA-COMFORT INSULIN ULTRACET 9
SYRINGE/U-100/1ML/31G X UTIBRON NEOHALER 15
ULTRAM 8
5/16" 111 UVADEX 40
ULTRA-THIN II AUTO UNASYN 124
VAGIFEM 133
LANCET 89 UNASYN BULK PACK 124
ULTRA-THIN II INSULIN UNILET COMFORTOUCH valacyclovir hcl 49
SYRINGE SHORT/U- LANCET 90 VALCYTE 48
100/0.3ML/30GX5/16" 111 UNILET EXCELITE 90 valganciclovir hcl 48
ULTRA-THIN II INSULIN VALIUM 13
SYRINGE SHORT/U- UNILET EXCELITE II 90
100/0.3ML/31GX5/16" 112 UNILET G.P. LANCET 90 valproate sodium 20
ULTRA-THIN II INSULIN UNILET G.P. SUPERLITE valproic acid 20
SYRINGE SHORT/U- LANCET 90 valrubicin 38
100/0.5ML/30GX5/16" 112 UNILET GP 28 ULTRA
ULTRA-THIN II INSULIN THIN 90 valsartan 30
SYRINGE SHORT/U- UNILET LANCET 90 valsartan-hydrochlorothiazide
100/0.5ML/31GX5/16" 112 UNILET LANCETS MICRO- 32
ULTRA-THIN II INSULIN THIN33G 90 VALSTAR 38
SYRINGE SHORT/U- UNILET LANCETS SUPER- VALTOCO 17
100/1ML/30GX5/16" 112 THIN30G 90 VALTREX 49
ULTRA-THIN II INSULIN UNILET LANCETS ULTRA- VALUE HEALTH INSULIN
SYRINGE SHORT/U- THIN 28G 90 SYRINGE/U-100/0.5ML/29G X
100/1ML/31GX5/16" 112 UNILET SUPERLITE 1/2" 112
ULTRA-THIN II INSULIN LANCET 90 VALUE HEALTH INSULIN
SYRINGE/U- UNISTIK 3 GENTLE 90 SYRINGE/U-100/1ML/29G X
100/0.5ML/29GX1/2" 112 UNISTIK PRO SAFETY 1/2" 112
ULTRA-THIN II INSULIN LANCET 21G 90 VALUE PLUS LANCETS
SYRINGE/U-100/1ML/29GX1/2" UNISTIK PRO SAFETY STANDARD 21G 90
112 LANCET 25G 90 VALUE PLUS LANCETS
ULTRA-THIN II LANCETS UNISTIK PRO SAFETY SUPERTHIN 30G 90
28G 89 LANCET 28G 90 VALUE PLUS LANCETS THIN
ULTRA-THIN II LANCETS UNISTIK SAFETY LANCETS 26G 90
30G 90 28G 90 VALUE PLUS LANCING
ULTRACARE INSULIN UNISTIK SAFETY LANCETS DEVICE 90
SYRINGE/U-100/0.3ML/30G X 30G 90 VALUMARK LANCET SUPER
5/16" 112 UNISTIK TOUCH SAFETY THIN 30G 90
ULTRACARE INSULIN LANCETS 21G 90 VALUMARK LANCET ULTRA
SYRINGE/U-100/0.3ML/31G X UNISTIK TOUCH SAFETY THIN 28G 90
5/16" 112 LANCETS 23G 90
ULTRACARE INSULIN VANCOCIN 11
UNISTIK TOUCH SAFETY
SYRINGE/U-100/0.5ML/30G X LANCETS 28G 90 VANCOCIN HCL 11
1/2" 112 UNISTIK TOUCH SAFETY vancomycin hcl 11
ULTRACARE INSULIN LANCETS 30G 90 VANCOMYCIN
SYRINGE/U-100/0.5ML/30G X UNISTRIP CONTROL HYDROCHLORIDE 11
5/16" 112 SOLUTIONHIGH 90 VANISHPOINT INSULIN
UNIVERSAL 1 LANCETS SYRINGE/0.5ML/30G X
THIN26G 90 1/2" 112
Index 34
VANISHPOINT INSULIN VIIBRYD STARTER PACK 22 WELCHOL 29
SYRINGE/0.5ML/30G X VIMPAT 19 WELLBUTRIN SR 20,21
5/16" 112
VANISHPOINT INSULIN vinblastine sulfate 41 WELLBUTRIN XL 21
SYRINGE/1ML/29G X 1/2" 112 vincristine sulfate 41 WESTAB PLUS 119
VANISHPOINT INSULIN vinorelbine tartrate 41 WESTHROID 128
SYRINGE/1ML/30G X WIDE-SEAL SILICONE
5/16" 112 VIRACEPT 48
VIRAMUNE 48 DIAPHRAGM KIT 60 78
VANTAS 37 WIDE-SEAL SILICONE
VAQTA 132 VIRAMUNE XR 48 DIAPHRAGM KIT 65 78
VARIVAX 132 VIREAD 48 WIDE-SEAL SILICONE
VISTARIL 13 DIAPHRAGM KIT 70 78
VARUBI 27 WIDE-SEAL SILICONE
VASCEPA 29 VISTOGARD 25 DIAPHRAGM KIT 75 78
VASERETIC 32 VITAMIN D2 134 WIDE-SEAL SILICONE
VASOTEC 30 VITATHELY/GINGER 119 DIAPHRAGM KIT 80 78
VITRAKVI 40 WIDE-SEAL SILICONE
VECAMYL 32 DIAPHRAGM KIT 85 78
VECTIBIX 37 VIVAGUARD LANCETS 90 WIDE-SEAL SILICONE
VECTICAL 61 VIVAGUARD LANCING DIAPHRAGM KIT 90 78
DEVICE 90 WIDE-SEAL SILICONE
VELCADE 40 VIVELLE-DOT 70 DIAPHRAGM KIT 95 78
VELETRI 51 VIZIMPRO 37 WP THYROID 128
VELPHORO 72 VOGELXO 10 XALATAN 123
VELTIN 58 VOGELXO PUMP 10 XALKORI 40
VEMLIDY 48 VOL-PLUS 119 XANAX 13
venlafaxine hcl 22 VOLTAREN 58 XANAX XR 13
VENOFER 74 VORAXAZE 41 XARELTO 16
VENTAVIS 51 voriconazole 27 XARELTO STARTER PACK 16
VENTOLIN HFA 15 VOSEVI 48 XELJANZ 4
verapamil hcl 51 VOTRIENT 40 XELJANZ XR 4
VEREGEN 58 VP INSULIN SYRINGE/U- XELODA 36
VERELAN 51 100/0.3ML/29G X 1/2" 112 XENAZINE 126
VERELAN PM 51 VUSION 60 XEOMIN 120
VERZENIO 40 VYNDAMAX 52 XGEVA 67
VESICARE 130 VYNDAQEL 52 XIFAXAN 10
VFEND 27 VYTORIN 28 XIMINO 128
VIAGRA 51 VYVANSE 1 XOLAIR 14
VIBRAMYCIN 128 VYXEOS 38 XOPENEX 15
VICTOZA 24 WALGREENS ADVANCED
TRAVELLANCETS 28G 90 XOPENEX CONCENTRATE 15
VIDA MIA AUTOLET XOPENEX HFA 15
WALGREENS COMFORT
LANCINGDEVICE 90
VIDA MIA UNILET LANCETS ASSUREDLANCETS MICRO XOSPATA 40
SUPER THIN 30G 90 THIN/33G 90 XPOVIO 100 MG ONCE
VIDA MIA UNILET LANCETS WALGREENS COMFORT WEEKLY 38
ULTRA THIN 28G 90 ASSUREDLANCETS SUPER XPOVIO 60 MG ONCE
THIN/28G 90 WEEKLY 38
VIDAZA 36
WALGREENS LANCETS 90 XPOVIO 80 MG ONCE
VIDEX EC 47 WALGREENS THIN WEEKLY 38
VIDEXPEDIATRIC 47 LANCETS 90 XPOVIO 80 MG TWICE
vigabatrin 19 WALGREENS ULTRA THIN WEEKLY 38
VIGAMOX 121 LANCETS 90 XTAMPZA ER 8
warfarin sodium 16 XTANDI 37
VIIBRYD 22
water for irrigation, sterile 117
Index 35
XULTOPHY 100/3.6 23 ZIEXTENZO 74
XYLOCAINE 76 zileuton 14
XYLOCAINE-MPF 76 ZINGO 76
XYZAL ALLERGY 24HR 28 ZIOPTAN 123
XYZAL ALLERGY 24HR ziprasidone hcl 43
CHILDRENS 28 ZIRABEV 36
YASMIN 28 54
ZIRGAN 121
YAZ 54
ZITHROMAX 76
YERVOY 36
ZITHROMAX TRI-PAK 76
YONDELIS 35
ZITHROMAX Z-PAK 76
YONSA 37
ZOCOR 30
ZADITOR 123
ZOFRAN 26
zafirlukast 14
ZOHYDRO ER 8
zaleplon 75
ZOLADEX 37,38
ZALTRAP 36
zoledronic acid 67
ZANAFLEX 119
ZOLEDRONIC ACID 67
ZANOSAR 35
ZOLINZA 40
ZANTAC 129
zolmitriptan 114
ZANTAC 150 MAXIMUM
STRENGTH 129 ZOLOFT 22
ZARONTIN 20 zolpidem tartrate 75
ZARXIO 74 ZOMIG 114
ZAVESCA 73 ZOMIG ZMT 114
ZEGERID 130 ZONALON 60
ZEGERID OTC 130 ZONEGRAN 19
ZEJULA 40 zonisamide 19
ZELBORAF 40 ZONTIVITY 73
ZEMAIRA 127 ZORBTIVE 68
ZEMPLAR 69 ZORTRESS 116
ZENPEP 66 ZOSTAVAX 133
ZERVIATE 123 ZOSYN 124
ZESTORETIC 32 ZOVIRAX 49,61
ZESTRIL 30 ZYCLARA 64
ZETIA 30 ZYCLARA PUMP 64
ZEVRX INSULIN ZYDELIG 40
SYRINGE/0.5ML/30G X ZYKADIA 40
1/2" 112
ZEVRX INSULIN ZYLET 122
SYRINGE/0.5ML/30G X ZYLOPRIM 73
5/16" 112 ZYMAXID 121
ZEVRX INSULIN ZYPREXA 44
SYRINGE/1ML/30G X 1/2" 112
ZEVRX INSULIN ZYPREXA ZYDIS 44
SYRINGE/1ML/30G X ZYRTEC ALLERGY 28
5/16" 112 ZYRTEC-D
ZIAC 32 ALLERGY/CONGESTION 56
ZIAGEN 48 ZYTIGA 38
ZIANA 58 ZYVOX 12
zidovudine 48
Index 36
Ambetter from Sunshine Health is underwritten by Celtic
Insurance Company. © 2022 Celtic Insurance Company. All
AMB21-FL-C-00639
rights reserved.

2022 FL Formulary

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indomethacin caps 25 mg, OTEZLA TABS 4 PA; QL(2 ea

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protriptyline hcl tabs 1B KAZANO TABS (Use NF

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JANUVIA TABS 2 QL(1 ea daily) NOVOLIN 70/30 FLEXPEN 2

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ANCOBON CAPS (Use ANTIHISTAMINES - Drugs to Treat Allergies

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enalapril maleate tabs 10 irbesartan tabs 1B QL(1 ea daily)

moexipril hcl tabs 1B telmisartan tabs 1B QL(1 ea daily)

perindopril erbumine tabs 1B valsartan tabs 1B QL(1 ea daily)

PRINIVIL TABS (Use NF Antiadrenergic Antihypertensives

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terazosin hcl caps 1B EXFORGE TABS (Use

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Antimycobacterial Agents BENDAMUSTINE 4 PA

rifampin caps 1B GLEOSTINE CAPS 100 4 PA

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ifosfamide solr 1 gm 4 PA; SP clofarabine soln 4 PA; SP

IFOSFAMIDE SOLR 3 GM 4 PA CLOLAR SOLN (Use NF PA; SP

thiotepa solr 100 mg 4 PA gemcitabine hcl solr 200 PA; SP

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TUKYSA TABS 4 PA Antineoplastic - EGFR Inhibitors

BESPONSA SOLR 4 PA PORTRAZZA SOLN 4 PA

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LITHIUM SOLN 1B risperidone tabs 0.25 mg, QL(4 ea daily)

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