2020 tier one formulary - shieldpbmacyclovir 200 mg capsule 25 generic acyclovir 200 mg/5 ml...

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1 of 21 2020 TIER ONE FORMULARY A B C D E F G–H I K–L M N O–P Q–R S T U–V W–Z SUBSCRIPTION DETAILS Name/Strength/Form Default Qty. Brand/Generic 0.9 % Sodium Chloride 0.9% Solution 4 Generic 0.9 % Sodium Chloride 0.9% Syringe 40 Generic AA 3%/Electrolyte-TPN Soln/Gly 3% Parenteral Solution 30 Brand Acamprosate Calcium 333 MG Tablet DR/EC 90 Generic Acarbose 100 MG Tablet 30 Generic Acarbose 25 MG Tablet 30 Generic Acarbose 50 MG Tablet 90 Generic Acebutolol HCL 200 MG Capsule 30 Generic Acebutolol HCL 400 MG Capsule 8 Generic Acetaminophen 1000 MG/100 Solution 30 Brand Acetaminophen 325 MG Tablet 30 Generic Acetaminophen w/ Codeine 120-12 MG/5 Solution 60 Generic Acetaminophen w/ Codeine 300 MG-15 MG Tablet 30 Generic Acetaminophen w/ Codeine 300 MG-30 MG Tablet 30 Generic Acetaminophen w/ Codeine 300 MG-60 MG Tablet 30 Generic Acetazolamide 125 MG Tablet 14 Generic Acetazolamide 250 MG Tablet 30 Generic Acetazolamide 500 MG Capsule ER 30 Generic Acetic Acid 2% Solution 60 Generic Acyclovir 200 MG Capsule 25 Generic Acyclovir 200 MG/5 ML Suspension 100 Generic Acyclovir 400 MG Tablet 30 Generic Acyclovir 5% Ointment 5 Generic Acyclovir 800 MG Tablet 30 Generic Adapalene 0.1% Gel 45 Generic Adapalene 0.3% Gel 45 Generic Adapalene/Benzoyl Peroxide 0.1%-2.5% Gel 45 Generic Albumin Human 25% Parenteral Solution 30 Generic Albumin Human 25% Parenteral Solution 30 Generic Albumin Human 5% Parenteral Solution 30 Generic Albumin Human 5% Parenteral Solution 30 Generic Albuterol Sulfate 4 MG Tablet 12-Hr ER 30 Brand Albuterol Sulfate 90 MCG HFA Aerosol Inhaler 8 Brand Albuterol Sulfate Syrup 2 MG/5 ML 2 MG/5 ML Syrup 30 Generic Alclometasone Dipropionate 0.05% Cream 30 Generic Alclometasone Dipropionate 0.05% Ointment 15 Generic Alendronate Sodium 10 MG Tablet 5 Generic Alendronate Sodium 35 MG Tablet 4 Generic Alendronate Sodium 5 MG Tablet 30 Generic Alendronate Sodium 70 MG Tablet 4 Generic Alfuzosin HCL ER 10 MG Tablet 24-Hr ER 30 Generic Allopurinol 100 MG Tablet 30 Generic Allopurinol 300 MG Tablet 30 Generic Alprazolam 0.25 MG Disintegrating Tablet 6 Generic Alprazolam 0.25 MG Tablet 10 Generic Alprazolam 0.5 MG Disintegrating Tablet 1 Generic Alprazolam 0.5 MG Tablet 20 Generic Alprazolam 0.5 MG Tablet 24-Hr ER 10 Generic Alprazolam 1 MG Disintegrating Tablet 20 Generic Alprazolam 1 MG Tablet 30 Generic Name/Strength/Form Default Qty. Brand/Generic Alprazolam 1 MG Tablet 24-Hr ER 30 Generic Alprazolam 2 MG Tablet 30 Generic Alprazolam 2 MG Tablet 24-Hr ER 30 Generic Alprazolam 3 MG Tablet 24-Hr ER 30 Generic Amantadine HCL 100 MG Capsule 30 Generic Amantadine HCL 100 MG Tablet 10 Generic Amantadine HCL 50 MG/5 ML Solution 50 Generic Amiloride HCL 5 MG Tablet 30 Generic Amiloride/Hydrochlorothiazide 5 MG-50 MG Tablet 30 Generic Amiodarone HCL 100 MG Tablet 15 Generic Amiodarone HCL 200 MG Tablet 30 Generic Amiodarone HCL 400 MG Tablet 5 Generic Amitriptyline HCL 10 MG Tablet 30 Generic Amitriptyline HCL 100 MG Tablet 30 Generic Amitriptyline HCL 150 MG Tablet 30 Generic Amitriptyline HCL 25 MG Tablet 30 Generic Amitriptyline HCL 50 MG Tablet 30 Generic Amitriptyline HCL 75 MG Tablet 30 Generic Amitriptyline/Chlordiazepoxide 12.5 MG-5 MG Tablet 30 Brand Amitriptyline/Chlordiazepoxide 25 MG-10 MG Tablet 30 Brand Amlodipine Bes/Olmesartan Med 10 MG-20 MG Tablet 30 Generic Amlodipine Bes/Olmesartan Med 10 MG-40 MG Tablet 30 Generic Amlodipine Bes/Olmesartan Med 5 MG-20 MG Tablet 30 Generic Amlodipine Besylate 10 MG Tablet 30 Generic Amlodipine Besylate 2.5 MG Tablet 30 Generic Amlodipine Besylate 5 MG Tablet 30 Generic Amlodipine Besylate/Benazepril 10 MG-20 MG Capsule 30 Generic Amlodipine Besylate/Benazepril 10 MG-40 MG Capsule 30 Generic Amlodipine Besylate/Benazepril 2.5 MG-10 MG Capsule 30 Generic Amlodipine Besylate/Benazepril 5 MG-10 MG Capsule 30 Generic Amlodipine Besylate/Benazepril 5 MG-20 MG Capsule 30 Generic Amlodipine Besylate/Benazepril 5 MG-40 MG Capsule 30 Generic Amlodipine/Atorvastatin 10 MG-20 MG Tablet 30 Generic Amlodipine/Atorvastatin 10 MG-40 MG Tablet 30 Generic Amlodipine/Atorvastatin 5 MG-20 MG Tablet 30 Generic Amlodipine/Atorvastatin 5 MG-40 MG Tablet 30 Generic Amlodipine/Valsartan 10 MG-160 MG Tablet 30 Generic Amlodipine/Valsartan 10 MG-320 MG Tablet 30 Generic Amlodipine/Valsartan 5 MG-160 MG Tablet 30 Generic Amlodipine/Valsartan 5 MG-320 MG Tablet 30 Generic Amlodipine/Valsartan/Hcthiazid 10 MG-160 MG Tablet 30 Generic Amlodipine/Valsartan/Hcthiazid 10-160-25 Tablet 30 Generic Amlodipine/Valsartan/Hcthiazid 10-320-25 Tablet 30 Generic Amlodipine/Valsartan/Hcthiazid 5-160-12.5 Tablet 30 Generic Ammonium Lactate 12% Cream 140 Generic Ammonium Lactate 12% Lotion 30 Generic Ammonium Lactate 12% Lotion 225 Generic Amoxapine 100 MG Tablet 30 Brand Amoxapine 150 MG Tablet 30 Brand Amoxapine 25 MG Tablet 30 Brand

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Page 1: 2020 TIER ONE FORMULARY - ShieldPBMAcyclovir 200 MG Capsule 25 Generic Acyclovir 200 MG/5 ML Suspension 100 Generic Acyclovir 400 MG Tablet 30 Generic Acyclovir 5% Ointment 5 Generic

1 of 21 2020 TIER ONE FORMULARY

A B C D E F G–H I K–L M N O–P Q–R S T U–V W–Z SUBSCRIPTION DETAILS

Name/Strength/Form Default Qty. Brand/Generic

0.9 % Sodium Chloride 0.9% Solution 4 Generic

0.9 % Sodium Chloride 0.9% Syringe 40 Generic

AA 3%/Electrolyte-TPN Soln/Gly 3% Parenteral Solution 30 Brand

Acamprosate Calcium 333 MG Tablet DR/EC 90 Generic

Acarbose 100 MG Tablet 30 Generic

Acarbose 25 MG Tablet 30 Generic

Acarbose 50 MG Tablet 90 Generic

Acebutolol HCL 200 MG Capsule 30 Generic

Acebutolol HCL 400 MG Capsule 8 Generic

Acetaminophen 1000 MG/100 Solution 30 Brand

Acetaminophen 325 MG Tablet 30 Generic

Acetaminophen w/ Codeine 120-12 MG/5 Solution 60 Generic

Acetaminophen w/ Codeine 300 MG-15 MG Tablet 30 Generic

Acetaminophen w/ Codeine 300 MG-30 MG Tablet 30 Generic

Acetaminophen w/ Codeine 300 MG-60 MG Tablet 30 Generic

Acetazolamide 125 MG Tablet 14 Generic

Acetazolamide 250 MG Tablet 30 Generic

Acetazolamide 500 MG Capsule ER 30 Generic

Acetic Acid 2% Solution 60 Generic

Acyclovir 200 MG Capsule 25 Generic

Acyclovir 200 MG/5 ML Suspension 100 Generic

Acyclovir 400 MG Tablet 30 Generic

Acyclovir 5% Ointment 5 Generic

Acyclovir 800 MG Tablet 30 Generic

Adapalene 0.1% Gel 45 Generic

Adapalene 0.3% Gel 45 Generic

Adapalene/Benzoyl Peroxide 0.1%-2.5% Gel 45 Generic

Albumin Human 25% Parenteral Solution 30 Generic

Albumin Human 25% Parenteral Solution 30 Generic

Albumin Human 5% Parenteral Solution 30 Generic

Albumin Human 5% Parenteral Solution 30 Generic

Albuterol Sulfate 4 MG Tablet 12-Hr ER 30 Brand

Albuterol Sulfate 90 MCG HFA Aerosol Inhaler 8 Brand

Albuterol Sulfate Syrup 2 MG/5 ML 2 MG/5 ML Syrup 30 Generic

Alclometasone Dipropionate 0.05% Cream 30 Generic

Alclometasone Dipropionate 0.05% Ointment 15 Generic

Alendronate Sodium 10 MG Tablet 5 Generic

Alendronate Sodium 35 MG Tablet 4 Generic

Alendronate Sodium 5 MG Tablet 30 Generic

Alendronate Sodium 70 MG Tablet 4 Generic

Alfuzosin HCL ER 10 MG Tablet 24-Hr ER 30 Generic

Allopurinol 100 MG Tablet 30 Generic

Allopurinol 300 MG Tablet 30 Generic

Alprazolam 0.25 MG Disintegrating Tablet 6 Generic

Alprazolam 0.25 MG Tablet 10 Generic

Alprazolam 0.5 MG Disintegrating Tablet 1 Generic

Alprazolam 0.5 MG Tablet 20 Generic

Alprazolam 0.5 MG Tablet 24-Hr ER 10 Generic

Alprazolam 1 MG Disintegrating Tablet 20 Generic

Alprazolam 1 MG Tablet 30 Generic

Name/Strength/Form Default Qty. Brand/Generic

Alprazolam 1 MG Tablet 24-Hr ER 30 Generic

Alprazolam 2 MG Tablet 30 Generic

Alprazolam 2 MG Tablet 24-Hr ER 30 Generic

Alprazolam 3 MG Tablet 24-Hr ER 30 Generic

Amantadine HCL 100 MG Capsule 30 Generic

Amantadine HCL 100 MG Tablet 10 Generic

Amantadine HCL 50 MG/5 ML Solution 50 Generic

Amiloride HCL 5 MG Tablet 30 Generic

Amiloride/Hydrochlorothiazide 5 MG-50 MG Tablet 30 Generic

Amiodarone HCL 100 MG Tablet 15 Generic

Amiodarone HCL 200 MG Tablet 30 Generic

Amiodarone HCL 400 MG Tablet 5 Generic

Amitriptyline HCL 10 MG Tablet 30 Generic

Amitriptyline HCL 100 MG Tablet 30 Generic

Amitriptyline HCL 150 MG Tablet 30 Generic

Amitriptyline HCL 25 MG Tablet 30 Generic

Amitriptyline HCL 50 MG Tablet 30 Generic

Amitriptyline HCL 75 MG Tablet 30 Generic

Amitriptyline/Chlordiazepoxide 12.5 MG-5 MG Tablet 30 Brand

Amitriptyline/Chlordiazepoxide 25 MG-10 MG Tablet 30 Brand

Amlodipine Bes/Olmesartan Med 10 MG-20 MG Tablet 30 Generic

Amlodipine Bes/Olmesartan Med 10 MG-40 MG Tablet 30 Generic

Amlodipine Bes/Olmesartan Med 5 MG-20 MG Tablet 30 Generic

Amlodipine Besylate 10 MG Tablet 30 Generic

Amlodipine Besylate 2.5 MG Tablet 30 Generic

Amlodipine Besylate 5 MG Tablet 30 Generic

Amlodipine Besylate/Benazepril 10 MG-20 MG Capsule 30 Generic

Amlodipine Besylate/Benazepril 10 MG-40 MG Capsule 30 Generic

Amlodipine Besylate/Benazepril 2.5 MG-10 MG Capsule 30 Generic

Amlodipine Besylate/Benazepril 5 MG-10 MG Capsule 30 Generic

Amlodipine Besylate/Benazepril 5 MG-20 MG Capsule 30 Generic

Amlodipine Besylate/Benazepril 5 MG-40 MG Capsule 30 Generic

Amlodipine/Atorvastatin 10 MG-20 MG Tablet 30 Generic

Amlodipine/Atorvastatin 10 MG-40 MG Tablet 30 Generic

Amlodipine/Atorvastatin 5 MG-20 MG Tablet 30 Generic

Amlodipine/Atorvastatin 5 MG-40 MG Tablet 30 Generic

Amlodipine/Valsartan 10 MG-160 MG Tablet 30 Generic

Amlodipine/Valsartan 10 MG-320 MG Tablet 30 Generic

Amlodipine/Valsartan 5 MG-160 MG Tablet 30 Generic

Amlodipine/Valsartan 5 MG-320 MG Tablet 30 Generic

Amlodipine/Valsartan/Hcthiazid 10 MG-160 MG Tablet 30 Generic

Amlodipine/Valsartan/Hcthiazid 10-160-25 Tablet 30 Generic

Amlodipine/Valsartan/Hcthiazid 10-320-25 Tablet 30 Generic

Amlodipine/Valsartan/Hcthiazid 5-160-12.5 Tablet 30 Generic

Ammonium Lactate 12% Cream 140 Generic

Ammonium Lactate 12% Lotion 30 Generic

Ammonium Lactate 12% Lotion 225 Generic

Amoxapine 100 MG Tablet 30 Brand

Amoxapine 150 MG Tablet 30 Brand

Amoxapine 25 MG Tablet 30 Brand

Page 2: 2020 TIER ONE FORMULARY - ShieldPBMAcyclovir 200 MG Capsule 25 Generic Acyclovir 200 MG/5 ML Suspension 100 Generic Acyclovir 400 MG Tablet 30 Generic Acyclovir 5% Ointment 5 Generic

2 of 21 2020 TIER ONE FORMULARY

A B C D E F G–H I K–L M N O–P Q–R S T U–V W–Z SUBSCRIPTION DETAILS

Name/Strength/Form Default Qty. Brand/Generic

Amoxapine 50 MG Tablet 30 Brand

Amoxicillin 125 MG Chewable Tablet 15 Brand

Amoxicillin 125 MG/5 ML Suspension for Reconstitution 80 Generic

Amoxicillin 200 MG/5 ML Suspension for Reconstitution 75 Generic

Amoxicillin 250 MG Capsule 30 Generic

Amoxicillin 250 MG/5 ML Suspension for Reconstitution 80 Generic

Amoxicillin 400 MG/5 ML Suspension for Reconstitution 75 Generic

Amoxicillin 500 MG Capsule 20 Generic

Amoxicillin 500 MG Tablet 30 Generic

Amoxicillin 875 MG Tablet 14 Generic

Amoxicillin/Potassium Clav 1000-62.5 Tablet 12-Hr ER 14 Generic

Amoxicillin/Potassium Clav 200-28.5 MG Chewable Tablet 14 Brand

Amoxicillin/Potassium Clav 200-28.5/5 Suspension for Reconstitution 50 Generic

Amoxicillin/Potassium Clav 250-125 MG Tablet 30 Generic

Amoxicillin/Potassium Clav 250-62.5/5 Suspension for Reconstitution 75 Generic

Amoxicillin/Potassium Clav 400-57 MG Chewable Tablet 14 Brand

Amoxicillin/Potassium Clav 400-57 MG/5 Suspension for Recon 50 Generic

Amoxicillin/Potassium Clav 500-125 MG Tablet 10 Generic

Amoxicillin/Potassium Clav 600-42.9/5 Suspension for Reconstitution 75 Generic

Amoxicillin/Potassium Clav 875-125 MG Tablet 14 Generic

Ampicillin Trihydrate 250 MG Capsule 30 Generic

Ampicillin Trihydrate 500 MG Capsule 30 Brand

Antihemoph.FVIII, Brand-Domain Del 1000 (+/-) Solution 30 Brand

Antihemoph.FVIII, Brand-Domain Del 2000 (+/-) Solution 30 Brand

Antihemoph.FVIII, Brand-Domain Del 250 (+/-) Solution 30 Brand

Antihemoph.FVIII, Brand-Domain Del 3000 (+/-) Syringe 30 Brand

Antihemoph.FVIII, Brand-Domain Del 500 (+/-) Solution 30 Brand

Antihemoph.FVIII, Full Length 4000 (+/-) Recon Solution 30 Brand

Antihemoph.FVIII, Full Length 500 (+/-) Recon Solution 30 Brand

Antihemophilic Factor/VWF 1000 (400) Recon Solution 30 Brand

Antihemophilic Factor/VWF 1500 (600) Recon Solution 30 Brand

Antihemophilic Factor/VWF 2000 (800) Recon Solution 30 Brand

Antihemophilic Factor/VWF 250 (100) Recon Solution 30 Brand

Antihemophilic Factor/VWF 500 (200) Recon Solution 30 Brand

Apraclonidine HCL 0.5% Drops 5 Generic

Aprepitant 40 MG Capsule 1 Generic

Aripiprazole 10 MG Disintegrating Tablet 2 Generic

Aspirin/Dipyridamole 25 MG-200 MG Multiphase Capsule 12-Hr ER 30 Generic

Atenolol 100 MG Tablet 30 Generic

Atenolol 25 MG Tablet 15 Generic

Atenolol 50 MG Tablet 30 Generic

Atenolol/Chlorthalidone 100 MG-25 MG Tablet 30 Generic

Atenolol/Chlorthalidone 50 MG-25 MG Tablet 30 Generic

Atomoxetine HCL 10 MG Capsule 5 Generic

Atomoxetine HCL 18 MG Capsule 7 Generic

Atorvastatin Calcium 10 MG Tablet 30 Generic

Atorvastatin Calcium 20 MG Tablet 30 Generic

Atorvastatin Calcium 40 MG Tablet 30 Generic

Atorvastatin Calcium 80 MG Tablet 30 Generic

Atovaquone/Proguanil HCL 250-100 MG Tablet 30 Generic

Name/Strength/Form Default Qty. Brand/Generic

Atovaquone/Proguanil HCL 62.5-25 MG Tablet 30 Generic

Atropine Sulfate 1% Ointment 4 Brand

Azathioprine 50 MG Tablet 30 Generic

Azelastine HCL 0.05% Drops 6 Generic

Azelastine HCL 137 MCG (0.1%) Nasal Spray 30 Generic

Azelastine HCL 205.5 MCG Non-Aerosol Spray 30 Generic

Azithromycin 100 MG/5 ML Suspension for Reconstitution 15 Generic

Azithromycin 200 MG/5 ML Suspension for Reconstitution 15 Generic

Azithromycin 250 MG Tablet 6 Generic

Azithromycin 500 MG Tablet 3 Generic

Azithromycin 600 MG Tablet 3 Generic

B Complex & C No. 20/Folic Acid 1 MG Capsule 30 Generic

B3/Azel Ac/Zinc/B6/Copper/FA 600-5-500 Tablet 30 Generic

Bacitracin/Polymyxin Brand Sulfate 500-10 K/Generic Ointment 4 Generic

Baclofen 10 MG Tablet 30 Generic

Baclofen 20 MG Tablet 30 Generic

Baclofen 5 MG Tablet 30 Generic

Bacteriostatic Sodium Chloride 0.9% Solution 30 Generic

Balsalazide Disodium 750 MG Capsule 90 Generic

Benazepril HCL 10 MG Tablet 30 Generic

Benazepril HCL 20 MG Tablet 30 Generic

Benazepril HCL 40 MG Tablet 30 Generic

Benazepril HCL 5 MG Tablet 15 Generic

Benazepril/Hydrochlorothiazide 10-12.5 MG Tablet 30 Generic

Benazepril/Hydrochlorothiazide 20 MG-25 MG Tablet 30 Generic

Benazepril/Hydrochlorothiazide 20-12.5 MG Tablet 30 Generic

Benazepril/Hydrochlorothiazide 5-6.25 MG Tablet 30 Generic

Benzocaine 10% Gel 30 Generic

Benzonatate 100 MG Capsule 30 Generic

Benzonatate 200 MG Capsule 30 Generic

Benzoyl Peroxide 10% Cleanser 227 Generic

Benzoyl Peroxide 10% Gel 60 Generic

Benzoyl Peroxide 2.5% Cleanser 30 Generic

Benzoyl Peroxide 5% Gel 60 Generic

Benzoyl Peroxide 7% Cleanser 360 Generic

Benzoyl Peroxide 9.5% Foam 1 Brand

Benzphetamine HCL 25 MG Tablet 30 Generic

Benzphetamine HCL 50 MG Tablet 30 Generic

Benztropine Mesylate 0.5 MG Tablet 30 Generic

Benztropine Mesylate 1 MG Tablet 30 Generic

Benztropine Mesylate 2 MG Tablet 30 Generic

Betamet Acet/Betamet Na Ph 6 MG/ML Suspension 5 Generic

Betamethasone Dipropionate 0.05% Cream 30 Generic

Betamethasone Dipropionate 0.05% Lotion 60 Generic

Betamethasone Dipropionate 0.05% Ointment 15 Generic

Betamethasone Valerate 0.1% Cream 30 Generic

Betamethasone Valerate 0.1% Lotion 60 Generic

Betamethasone Valerate 0.1% Ointment 15 Generic

Betamethasone Valerate 0.12% Foam 30 Generic

Betamethasone/Propylene Glyc 0.05% Lotion 30 Generic

Page 3: 2020 TIER ONE FORMULARY - ShieldPBMAcyclovir 200 MG Capsule 25 Generic Acyclovir 200 MG/5 ML Suspension 100 Generic Acyclovir 400 MG Tablet 30 Generic Acyclovir 5% Ointment 5 Generic

3 of 21 2020 TIER ONE FORMULARY

A B C D E F G–H I K–L M N O–P Q–R S T U–V W–Z SUBSCRIPTION DETAILS

Name/Strength/Form Default Qty. Brand/Generic

Betamethasone/Propylene Glyc 0.05% Ointment 15 Generic

Betaxolol HCL 0.5% Drops 5 Generic

Betaxolol HCL 10 MG Tablet 30 Generic

Betaxolol HCL 20 MG Tablet 30 Generic

Bethanechol Chloride 10 MG Tablet 30 Generic

Bethanechol Chloride 25 MG Tablet 30 Generic

Bethanechol Chloride 5 MG Tablet 60 Generic

Bethanechol Chloride 50 MG Tablet 2 Generic

Bisac/NaCl/NaHCo3/KCL/Peg 3350 5 MG-210 Generic Kit 1 Generic

Bisoprolol Fumarate 10 MG Tablet 30 Generic

Bisoprolol Fumarate 5 MG Tablet 15 Generic

Bisoprolol Fumarate/HCTZ 10-6.25 MG Tablet 30 Generic

Bisoprolol Fumarate/HCTZ 2.5-6.25 MG Tablet 30 Generic

Bisoprolol Fumarate/HCTZ 5-6.25 MG Tablet 30 Generic

Brimonidine Tartrate 0.2% Drops 5 Generic

Bromocriptine Mesylate 2.5 MG Tablet 30 Generic

Brompheniramine/Pseudoephed/DM 2-30-10/5 Syrup 120 Generic

Budesonide 0.25 MG/2 ML Suspension for Nebulization 60 Generic

Budesonide 0.5 MG/2 ML Suspension for Nebulization 60 Generic

Budesonide 32 MCG Non-Aerosol Spray 9 Generic

Bumetanide 0.25 MG/ML Solution 30 Generic

Bumetanide 0.5 MG Tablet 12 Generic

Bumetanide 1 MG Tablet 15 Generic

Bumetanide 2 MG Tablet 30 Generic

Bupivacaine HCL 2.5 MG/ML Solution 30 Brand

Bupivacaine HCL 5 MG/ML Solution 100 Generic

Bupivacaine HCL/Dex-Water/PF 0.75% Solution 30 Brand

Bupivacaine HCL/Epinephrine 0.25-.0005 Solution 30 Brand

Bupivacaine HCL/Epinephrine 0.5-1:200 K Solution 30 Brand

Bupivacaine HCL/Epinephrine/PF 0.5-1:200 K Solution 30 Generic

Bupivacaine HCL/Epinephrine/PF 0.75-.0005 Solution 30 Brand

Bupivacaine HCL/PF 2.5 MG/ML Solution 30 Generic

Bupivacaine HCL/PF 5 MG/ML Solution 30 Generic

Bupivacaine HCL/PF 7.5 MG/ML Solution 30 Generic

Buprenorphine HCL 8 MG Sublingual Tablet 30 Generic

Bupropion HCL 100 MG Tablet 30 Generic

Bupropion HCL 150 MG Tablet 12-Hr SR 30 Brand

Bupropion HCL 200 MG Tablet ER 30 Generic

Bupropion HCL 300 MG Tablet 24-Hr ER 30 Generic

Bupropion HCL 75 MG Tablet 30 Generic

Bupropion HCL SR 150 MG Tablet 12-Hr SR 60 Generic

Bupropion SR 100 MG Tablet ER 30 Generic

Bupropion XL 150 MG Tablet 24-Hr ER 30 Generic

Buspirone HCL 10 MG Tablet 30 Generic

Buspirone HCL 15 MG Tablet 60 Generic

Buspirone HCL 30 MG Tablet 30 Generic

Buspirone HCL 5 MG Tablet 30 Generic

Buspirone HCL 7.5 MG Tablet 30 Generic

Butalb/Acetaminophen/Caffeine 50-300-40 Capsule 30 Generic

Butalb/Acetaminophen/Caffeine 50-325-40 Capsule 30 Generic

Name/Strength/Form Default Qty. Brand/Generic

Butalb/Acetaminophen/Caffeine 50-325-40 Tablet 30 Generic

Butalbital/Acetamin/Caff/Codeine 50-325-30 Capsule 30 Generic

Butalbital/Acetaminophen 50 MG-325 MG Tablet 30 Generic

Butalbital/Aspirin/Caffeine 50-325-40 Capsule 30 Generic

Butorphanol Tartrate 10 MG/ML Non-Aerosol Spray 5 Generic

Calcipotriene 0.005% Solution 60 Generic

Calcitonin,Salmon,Synthetic 200/Spray Non-Aerosol Spray 4 Generic

Calcitriol 0.25 MCG Capsule 30 Brand

Calcitriol 0.5 MCG Capsule 12 Generic

Calcitriol 1 MCG/ML Solution 10 Generic

Calcium Acetate 667 MG Capsule 90 Generic

Calcium Acetate 667 MG Tablet 90 Generic

Calcium Acetate 667 MG/5 ML Solution 30 Brand

Calcium Carbonate/Mag Carb/FA 200-400-1 Tablet 100 Brand

Candesartan Cilexetil 16 MG Tablet 30 Generic

Candesartan Cilexetil 32 MG Tablet 30 Generic

Candesartan Cilexetil 4 MG Tablet 30 Generic

Candesartan Cilexetil 8 MG Tablet 15 Generic

Candesartan/Hydrochlorothiazid 16-12.5 MG Tablet 30 Generic

Candesartan/Hydrochlorothiazid 32 MG-25 MG Tablet 30 Generic

Candesartan/Hydrochlorothiazid 32-12.5 MG Tablet 30 Generic

Captopril 100 MG Tablet 30 Generic

Captopril 12.5 MG Tablet 15 Generic

Captopril 25 MG Tablet 30 0

Captopril 50 MG Tablet 30 Generic

Captopril/Hydrochlorothiazide 25 MG-25 MG Tablet 30 Brand

Carbamazepine 100 MG Chewable Tablet 30 Generic

Carbamazepine 100 MG Tablet 12-Hr ER 30 Generic

Carbamazepine 100 MG/5 ML Suspension 150 Generic

Carbamazepine 200 MG Multiphase Capsule 12-Hr ER 30 Generic

Carbamazepine 200 MG Tablet 30 Generic

Carbamazepine 200 MG Tablet 12-Hr ER 90 Generic

Carbamazepine 300 MG Multiphase Capsule 12-Hr ER 30 Generic

Carbamazepine 400 MG Tablet 12-Hr ER 30 Generic

Carbidopa/Levodopa 10 MG-100 MG Disintegrating Tablet 30 Generic

Carbidopa/Levodopa 10 MG-100 MG Tablet 30 Generic

Carbidopa/Levodopa 25 MG-100 MG Disintegrating Tablet 90 Generic

Carbidopa/Levodopa 25 MG-100 MG Tablet 30 Generic

Carbidopa/Levodopa 25 MG-100 MG Tablet ER 30 Generic

Carbidopa/Levodopa 25 MG-250 MG Tablet 30 Generic

Carbidopa/Levodopa 50 MG-200 MG Tablet ER 30 Generic

Carbinoxamine Maleate 4 MG Tablet 30 Generic

Carbinoxamine Maleate 4 MG/5 ML Liquid 30 Generic

Carisoprodol 250 MG Tablet 30 Generic

Carisoprodol 350 MG Tablet 30 Generic

Carvedilol 12.5 MG Tablet 30 Generic

Carvedilol 25 MG Tablet 60 Generic

Carvedilol 3.125 MG Tablet 30 Generic

Carvedilol 6.25 MG Tablet 30 Generic

Cefaclor 250 MG Capsule 30 Generic

Page 4: 2020 TIER ONE FORMULARY - ShieldPBMAcyclovir 200 MG Capsule 25 Generic Acyclovir 200 MG/5 ML Suspension 100 Generic Acyclovir 400 MG Tablet 30 Generic Acyclovir 5% Ointment 5 Generic

4 of 21 2020 TIER ONE FORMULARY

A B C D E F G–H I K–L M N O–P Q–R S T U–V W–Z SUBSCRIPTION DETAILS

Name/Strength/Form Default Qty. Brand/Generic

Cefaclor 500 MG Capsule 14 Generic

Cefadroxil 250 MG/5 ML Suspension for Reconstitution 100 Generic

Cefadroxil 500 MG Capsule 30 Generic

Cefadroxil 500 MG/5 ML Suspension for Reconstitution 75 Generic

Cefazolin Sodium 10 Generic Recon Solution 1 Generic

Cefdinir 125 MG/5 ML Suspension for Reconstitution 60 Generic

Cefdinir 250 MG/5 ML Suspension for Reconstitution 60 Generic

Cefdinir 300 MG Capsule 20 Generic

Cefixime 100 MG/5 ML Suspension for Reconstitution 50 Generic

Cefixime 400 MG Capsule 1 Brand

Cefpodoxime Proxetil 100 MG Tablet 14 Generic

Cefpodoxime Proxetil 100 MG/5 ML Suspension for Reconstitution 100 Generic

Cefpodoxime Proxetil 200 MG Tablet 20 Generic

Cefpodoxime Proxetil 50 MG/5 ML Suspension for Reconstitution 30 Generic

Cefprozil 125 MG/5 ML Suspension for Reconstitution 100 Generic

Cefprozil 250 MG Tablet 14 Generic

Cefprozil 250 MG/5 ML Suspension for Reconstitution 50 Generic

Cefprozil 500 MG Tablet 10 Generic

Ceftriaxone Sodium 1 G Recon Solution (Injection) 5 Generic

Ceftriaxone Sodium 250 MG Recon Solution 1 Generic

Cefuroxime Axetil 250 MG Tablet 30 Generic

Cefuroxime Axetil 500 MG Tablet 10 Generic

Cefuroxime Sodium 750 MG Recon Solution (Injection) 30 Generic

Celecoxib 100 MG Capsule 30 Generic

Celecoxib 200 MG Capsule 30 Generic

Celecoxib 400 MG Capsule 15 Generic

Celecoxib 50 MG Capsule 20 Generic

Cephalexin 125 MG/5 ML Suspension for Reconstitution 100 Generic

Cephalexin 250 MG Capsule 30 Generic

Cephalexin 250 MG Tablet 21 Brand

Cephalexin 250 MG/5 ML Suspension for Reconstitution 100 Generic

Cephalexin 500 MG Capsule 30 Generic

Cephalexin 500 MG Tablet 10 Brand

Cephalexin 750 MG Capsule 30 Generic

Cetirizine HCL 1 MG/ML Solution 120 Generic

Cetirizine HCL 5 MG/5 ML Solution 75 Generic

Cevimeline HCL 30 MG Capsule 30 Generic

Chlordiazepoxide HCL 10 MG Capsule 30 Generic

Chlordiazepoxide HCL 25 MG Capsule 30 Generic

Chlordiazepoxide HCL 5 MG Capsule 30 Generic

Chlordiazepoxide-Clidinium BR 5 MG-2.5 MG Capsule 30 Generic

Chlorhexidine Gluconate 0.12% Mouthwash 473 Generic

Chloroprocaine HCL 10 MG/ML Solution 30 Brand

Chloroprocaine HCL 20 MG/ML Solution 30 Brand

Chloroprocaine HCL/PF 20 MG/ML Solution 30 Brand

Chloroquine Phosphate 500 MG Tablet 4 Generic

Chlorothiazide 250 MG Tablet 30 Brand

Chlorothiazide 250 MG/5 ML Suspension 40 Brand

Chlorothiazide 500 MG Tablet 30 Generic

Chlorpheniramine/Phenyleph/DM 4-10-15/5 Liquid 60 Generic

Name/Strength/Form Default Qty. Brand/Generic

Chlorpheniramine/Pseudoephed 2-30 MG/5 ML Liquid 30 Generic

Chlorpromazine HCL 10 MG Tablet 30 Generic

Chlorpromazine HCL 25 MG Tablet 20 Generic

Chlorpropamide 100 MG Tablet 30 Brand

Chlorpropamide 250 MG Tablet 90 Brand

Chlorthalidone 25 MG Tablet 30 Generic

Chlorthalidone 50 MG Tablet 30 Generic

Chlorzoxazone 500 MG Tablet 30 Brand

Cholestyramine (w/ Sugar) 4 Generic Powder 30 Generic

Cholestyramine (w/ Sugar) 4 Generic Powder in Packet 30 Generic

Cholestyramine/Aspartame - No Sugar 4 Generic Powder 210 Generic

Cholestyramine/Aspartame 4 Generic Powder in Packet 30 Generic

Choline Sal/Mag Salicylate 500 MG/5 ML Liquid 30 Generic

Ciclopirox 0.77% Gel 30 Generic

Ciclopirox 0.77% Suspension 30 Generic

Ciclopirox 1% Shampoo 120 Generic

Ciclopirox 8% Solution 20 Generic

Ciclopirox Olamine 0.77% Cream 30 Generic

Cilostazol 100 MG Tablet 30 Generic

Cilostazol 50 MG Tablet 30 Generic

Cimetidine 200 MG Tablet 30 Generic

Cimetidine 300 MG Tablet 1 Generic

Cimetidine 400 MG Tablet 30 Generic

Cimetidine 800 MG Tablet 30 Generic

Cimetidine HCL 300 MG/5 ML Solution 150 Brand

Ciprofloxacin 500 MG/5 ML Suspension, Micro-capsule Recon 50 Generic

Ciprofloxacin Eye Preparations 0.3% Ophthalm Solution 5 Generic

Ciprofloxacin HCL 250 MG Tablet 30 Generic

Ciprofloxacin HCL 250 MG/5 ML Suspension, Micro-capsule Recon 45 Generic

Ciprofloxacin HCL 500 MG Tablet 14 Generic

Ciprofloxacin HCL 750 MG Tablet 4 Generic

Citalopram Hydrobromide 10 MG Tablet 15 Generic

Citalopram Hydrobromide 10 MG/5 ML Solution 90 Generic

Citalopram Hydrobromide 20 MG Tablet 30 Generic

Citalopram Hydrobromide 40 MG Tablet 30 Generic

Citric Ac/Gluconolact/Mag Carb 6.602 Generic/100 Solution 30 Brand

Citric Acid/Sodium Citrate 334-500 MG Solution 180 Generic

Clarithromycin 250 MG Tablet 30 Generic

Clarithromycin 500 MG Tablet 10 Generic

Clarithromycin 500 MG Tablet 24-Hr ER 20 Generic

Clemastine Fumarate 2.68 MG Tablet 30 Brand

Clindamycin HCL 150 MG Capsule 21 Generic

Clindamycin HCL 150 MG/ML Solution 180 Generic

Clindamycin HCL 2% Cream 40 Generic

Clindamycin HCL 300 MG Capsule 30 Generic

Clindamycin HCL 600 MG/4 ML Solution 30 Generic

Clindamycin HCL 75 MG Capsule 30 Generic

Clindamycin HCL 75 MG/5 ML Recon Solution 100 Generic

Clindamycin HCL 900 MG/6 ML Solution 30 Generic

Clindamycin Phos/Benzoyl Peroxide 1.2 (1)%-5% Gel 45 Generic

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Name/Strength/Form Default Qty. Brand/Generic

Clindamycin Phosphate 1% Lotion 60 Generic

Clindamycin Phosphate 1% Solution 30 Generic

Clindamycin Phosphate 1% Swab 60 Generic

Clindamycin Phosphate/D5W 300 MG/50 ML Piggyback 30 Generic

Clindamycin Phosphate/D5W 600 MG/50 ML Piggyback 30 Generic

Clindamycin Phosphate/D5W 900 MG/50 ML Piggyback 30 Generic

Clobetasol Propionate 0.05% Cream 15 Generic

Clobetasol Propionate 0.05% Gel 30 Generic

Clobetasol Propionate 0.05% Solution 50 Generic

Clobetasol Propionate/Emoll 0.05% Cream 30 Generic

Clomiphene Citrate 50 MG Tablet 5 Generic

Clonazepam 0.125 MG Disintegrating Tablet 10 Generic

Clonazepam 0.25 MG Disintegrating Tablet 15 Generic

Clonazepam 0.5 MG Disintegrating Tablet 15 Generic

Clonazepam 0.5 MG Tablet 30 Generic

Clonazepam 1 MG Disintegrating Tablet 12 Generic

Clonazepam 1 MG Tablet 30 Generic

Clonazepam 2 MG Disintegrating Tablet 6 Generic

Clonazepam 2 MG Tablet 30 Generic

Clonidine 0.1 MG/24-Hr Weekly Patch 2 Generic

Clonidine HCL 0.1 MG Tablet 30 Generic

Clonidine HCL 0.1 MG Tablet 12-Hr ER 30 Generic

Clonidine HCL 0.2 MG Tablet 30 Generic

Clonidine HCL 0.3 MG Tablet 30 Generic

Clopidogrel Bi-sulfate 300 MG Tablet 1 Generic

Clopidogrel Bi-sulfate 75 MG Tablet 30 Generic

Clorazepate Dipotassium 15 MG Tablet 30 Generic

Clorazepate Dipotassium 3.75 MG Tablet 30 Generic

Clorazepate Dipotassium 7.5 MG Tablet 30 Generic

Clotrimazole 1% Cream & Gel Combo Pack 30 Generic

Clotrimazole 1% Solution 30 Generic

Clotrimazole 10 MG Troche 30 Generic

Clotrimazole/Betamethasone Dip 1%-0.05% Cream 30 Generic

Clotrimazole/Betamethasone Dip 1%-0.05% Lotion 30 Generic

Clozapine 100 MG Tablet 90 Generic

Clozapine 12.5 MG Disintegrating Tablet 30 Generic

Clozapine 200 MG Tablet 7 Generic

Clozapine 25 MG Disintegrating Tablet 30 Generic

Clozapine 25 MG Tablet 21 Generic

Clozapine 50 MG Tablet 20 Generic

Codeine Poli/Chlorphenir Polis 14.7-2.8/5 Suspension 12-Hr ER 30 Brand

Codeine/Butalbital/Asa/Caffeine 30-50-325 Capsule 30 Generic

Colchicine/Probenecid 0.5-500 MG Tablet 30 Generic

Colestipol HCL 1 Generic Tablet 30 Generic

Colestipol HCL 5 Generic Granules 30 Generic

Colestipol HCL 5 Generic Packet 1 Generic

Cortisone Acetate 25 MG Tablet 30 Brand

Cromolyn Sodium 4% Drops 20 Generic

Cyanocobalamin (Vitamin Brand-12) 1000 MCG/ML Solution 10 Generic

Cyanocobalamin/FA/Pyridoxine 1-2.2-25 MG Tablet 30 Generic

Name/Strength/Form Default Qty. Brand/Generic

Cyanocobalamin/FA/Pyridoxine 2-2.5-25 MG Tablet 30 Generic

Cyanocobalamin/Folic Acid 0.5 MG-1 MG Tablet 30 Brand

Cyclobenzaprine HCL 10 MG Tablet 30 Generic

Cyclobenzaprine HCL 5 MG Tablet 15 Generic

Cyclobenzaprine HCL 7.5 MG Tablet 30 Generic

Cyclopentolate HCL 1% Drops 15 Generic

Cyclosporine, Modified 100 MG Capsule 30 Generic

Cyclosporine, Modified 25 MG Capsule 60 Generic

Cyclosporine, Modified 50 MG Capsule 30 Generic

Cyproheptadine HCL 2 MG/5 ML Syrup 120 Generic

Cyproheptadine HCL 4 MG Tablet 30 Generic

Danazol 100 MG Capsule 12 Generic

Danazol 50 MG Capsule 30 Generic

Dantrolene Sodium 25 MG Capsule 30 Generic

Dapsone 25 MG Tablet 22 Generic

Delavirdine Mesylate 100 MG Dispersible Tablet 30 Brand

Delavirdine Mesylate 200 MG Tablet 30 Brand

Desipramine HCL 10 MG Tablet 30 Generic

Desipramine HCL 25 MG Tablet 30 Generic

Desipramine HCL 50 MG Tablet 30 Generic

Desloratadine 2.5 MG/5 ML Syrup 75 Brand

Desloratadine 5 MG Tablet 30 Generic

Desmopressin Acetate 0.1 MG Tablet 30 Generic

Desmopressin Acetate 0.2 MG Tablet 30 Generic

Desmopressin Acetate 10/Spray Aerosol 5 Generic

Desog-E.estradiol/E.estradiol 21-5 Tablet 28 Generic

Desogestrel-Ethinyl Estradiol 0.15-0.03 Tablet 28 Generic

Desogestrel-Ethinyl Estradiol 7 Days x3 Tablet 28 Generic

Desonide 0.05% Cream 30 Generic

Desonide 0.05% Ointment 15 Generic

Desoximetasone 0.25% Cream 15 Generic

Desoximetasone 0.25% Ointment 15 Generic

Desvenlafaxine Succinate 100 MG Tablet 24-Hr ER 30 Generic

Desvenlafaxine Succinate 25 MG Tablet 24-Hr ER 30 Generic

Desvenlafaxine Succinate 50 MG Tablet 24-Hr ER 30 Generic

Dexamethasone 0.1% Solution 30 Generic

Dexamethasone 0.1% Suspension Drops 5 Brand

Dexamethasone 0.5 MG Tablet 30 Generic

Dexamethasone 0.5 MG/5 ML Elixir 30 Generic

Dexamethasone 1 MG Tablet 30 Brand

Dexamethasone 1 MG/ML Drops 30 Brand

Dexamethasone 2 MG Tablet 30 Brand

Dexamethasone Sod Phosphate 0.75 MG Tablet 15 Generic

Dexamethasone Sod Phosphate 1.5 MG Tablet 8 Generic

Dexamethasone Sod Phosphate 4 MG Tablet 30 Generic

Dexamethasone Sod Phosphate 4 MG/ML Solution 5 Generic

Dexamethasone Sod Phosphate 6 MG Tablet 1 Generic

Dexmethylphenidate HCL 10 MG Biphasic Capsule ER 50-50 30 Generic

Dexmethylphenidate HCL 10 MG Tablet 30 Generic

Dexmethylphenidate HCL 15 MG Biphasic Capsule ER 50-50 30 Generic

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Name/Strength/Form Default Qty. Brand/Generic

Dexmethylphenidate HCL 2.5 MG Tablet 30 Generic

Dexmethylphenidate HCL 20 MG Biphasic Capsule ER 50-50 30 Generic

Dexmethylphenidate HCL 30 MG Biphasic Capsule ER 50-50 30 Generic

Dexmethylphenidate HCL 40 MG Biphasic Capsule ER 50-50 30 Generic

Dexmethylphenidate HCL 5 MG Biphasic Capsule ER 50-50 30 Generic

Dexmethylphenidate HCL 5 MG Tablet 15 Generic

Dextroamphet/Amphet (Base) 2.5 MG/ML Susp, IR-ER, Biphasic 24-Hr 30 Brand

Dextroamphetamine Sulfate 10 MG Capsule ER 30 Generic

Dextroamphetamine Sulfate 10 MG Tablet 30 Generic

Dextroamphetamine Sulfate 15 MG Capsule ER 30 Generic

Dextroamphetamine Sulfate 5 MG Capsule ER 30 Generic

Dextroamphetamine Sulfate 5 MG Tablet 30 Generic

Dextroamphetamine/Amphetamine 10 MG Capsule 24-Hr ER 30 Generic

Dextroamphetamine/Amphetamine 10 MG Tablet 30 Generic

Dextroamphetamine/Amphetamine 12.5 MG Tablet 14 Generic

Dextroamphetamine/Amphetamine 15 MG Capsule 24-Hr ER 30 Generic

Dextroamphetamine/Amphetamine 15 MG Tablet 30 Generic

Dextroamphetamine/Amphetamine 20 MG Capsule 24-Hr ER 30 Generic

Dextroamphetamine/Amphetamine 20 MG Tablet 30 Generic

Dextroamphetamine/Amphetamine 25 MG Capsule 24-Hr ER 30 Generic

Dextroamphetamine/Amphetamine 30 MG Capsule 24-Hr ER 30 Generic

Dextroamphetamine/Amphetamine 30 MG Tablet 30 Generic

Dextroamphetamine/Amphetamine 5 MG Capsule 24-Hr ER 30 Generic

Dextroamphetamine/Amphetamine 5 MG Tablet 30 Generic

Dextroamphetamine/Amphetamine 7.5 MG Tablet 6 Generic

Diazepam 10 MG Tablet 30 Generic

Diazepam 2 MG Tablet 15 Generic

Diazepam 5 MG Tablet 30 Generic

Diclofenac Potassium 50 MG Tablet 30 Generic

Diclofenac Sodium 0.1% Drops 2 Generic

Diclofenac Sodium 1% Gel 100 Generic

Diclofenac Sodium 1.5% Drops 150 Generic

Diclofenac Sodium 100 MG Tablet 24-Hr ER 30 Generic

Diclofenac Sodium 25 MG Tablet DR/EC 10 Generic

Diclofenac Sodium 50 MG Tablet DR/EC 30 Generic

Diclofenac Sodium 75 MG Tablet DR/EC 20 Generic

Diclofenac Sodium/Misoprostol 50 MG-200 Tablet, IR, DR, Biphasic 30 Generic

Diclofenac Sodium/Misoprostol 75 MG-200 Tablet, IR, DR, Biphasic 30 Generic

Dicloxacillin Sodium 250 MG Capsule 90 Generic

Dicloxacillin Sodium 500 MG Capsule 14 Generic

Dicyclomine HCL 10 MG Capsule 30 Generic

Dicyclomine HCL 20 MG Tablet 30 Generic

Didanosine FNL 10 MG/ML Recon Solution 30 Brand

Diethylpropion HCL 25 MG Tablet 30 Generic

Diethylpropion HCL 75 MG Tablet ER 30 Brand

Diflunisal 500 MG Tablet 30 Generic

Digoxin 125 MCG Tablet 15 Generic

Digoxin 250 MCG Tablet 30 Generic

Digoxin 250 MCG/ML Solution 30 Generic

Diltiazem HCL 120 MG Capsule 12-Hr ER 30 Generic

Name/Strength/Form Default Qty. Brand/Generic

Diltiazem HCL 120 MG Capsule 24-Hr ER 30 Generic

Diltiazem HCL 120 MG Capsule ER 30 Generic

Diltiazem HCL 120 MG Degradable Capsule ER 30 Generic

Diltiazem HCL 120 MG Tablet 30 Generic

Diltiazem HCL 180 MG Capsule 24-Hr ER 30 Generic

Diltiazem HCL 180 MG Capsule ER 15 Generic

Diltiazem HCL 180 MG Degradable Capsule ER 30 Generic

Diltiazem HCL 180 MG Tablet 24-Hr ER 30 Generic

Diltiazem HCL 240 MG Capsule 24-Hr ER 30 Generic

Diltiazem HCL 240 MG Capsule ER 30 Generic

Diltiazem HCL 240 MG Degradable Capsule ER 30 Generic

Diltiazem HCL 240 MG Tablet 24-Hr ER 30 Generic

Diltiazem HCL 30 MG Tablet 30 Generic

Diltiazem HCL 300 MG Capsule 24-Hr ER 30 Generic

Diltiazem HCL 300 MG Capsule ER 28 Generic

Diltiazem HCL 300 MG Tablet 24-Hr ER 30 Generic

Diltiazem HCL 360 MG Capsule ER 30 Generic

Diltiazem HCL 360 MG Tablet 24-Hr ER 7 Generic

Diltiazem HCL 420 MG Capsule ER 30 Generic

Diltiazem HCL 60 MG Capsule 12-Hr ER 30 Generic

Diltiazem HCL 60 MG Tablet 30 Generic

Diltiazem HCL 90 MG Capsule 12-Hr ER 30 Generic

Diltiazem HCL 90 MG Tablet 34 Generic

Dimenhydrinate 50 MG Tablet 30 Generic

Diphenhydramine HCL 12.5 MG/5 ML Elixir 30 Generic

Diphenhydramine HCL 25 MG Capsule 30 Generic

Diphenhydramine HCL 50 MG Capsule 30 Generic

Diphenoxylate HCL/Atropine 2.5-.025 MG Tablet 30 Generic

Diphenoxylate HCL/Atropine 2.5-.025/5 Liquid 30 Brand

Dipyridamole 25 MG Tablet 30 Generic

Dipyridamole 50 MG Tablet 30 Generic

Dipyridamole 75 MG Tablet 30 Generic

Disopyramide Phosphate 100 MG Capsule 30 Generic

Disulfiram 250 MG Tablet 30 Generic

Disulfiram 500 MG Tablet 14 Generic

Divalproex Sodium 125 MG Tablet DR/EC 30 Generic

Divalproex Sodium 250 MG Tablet 24-Hr ER 30 Generic

Divalproex Sodium 250 MG Tablet DR/EC 30 Generic

Divalproex Sodium 500 MG Tablet 24-Hr ER 30 Generic

Divalproex Sodium 500 MG Tablet DR/EC 30 Generic

Docusate Sodium 250 MG Capsule 30 Generic

Dofetilide 125 MCG Capsule 56 Brand

Dofetilide 250 MCG Capsule 60 Brand

Dofetilide 500 MCG Capsule 60 Brand

Donepezil HCL 10 MG Tablet 30 Generic

Donepezil HCL 23 MG Tablet 25 Generic

Donepezil HCL 5 MG Tablet 15 Generic

Dorzolamide HCL 2% Drops 30 Generic

Dorzolamide HCL/Timolol Maleat 22.3-6.8/1 Drops 30 Generic

Doxazosin Mesylate 1 MG Tablet 30 Generic

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Name/Strength/Form Default Qty. Brand/Generic

Doxazosin Mesylate 2 MG Tablet 30 Generic

Doxazosin Mesylate 4 MG Tablet 15 Generic

Doxazosin Mesylate 8 MG Tablet 30 Generic

Doxepin HCL 10 MG Capsule 30 Generic

Doxepin HCL 10 MG/ML Concentrate 20 Generic

Doxepin HCL 100 MG Capsule 30 Generic

Doxepin HCL 150 MG Capsule 24 Generic

Doxepin HCL 25 MG Capsule 30 Generic

Doxepin HCL 50 MG Capsule 30 Generic

Doxepin HCL 75 MG Capsule 5 Generic

Doxercalciferol 0.5 MCG Capsule 30 Generic

Doxercalciferol 4 MCG/2 ML Solution 30 Generic

Doxycycline Calcium 50 MG/5 ML Syrup 60 Brand

Doxycycline Hyclate 100 MG Capsule 30 Generic

Doxycycline Hyclate 100 MG Tablet 30 Generic

Doxycycline Hyclate 100 MG Tablet DR/EC 14 Generic

Doxycycline Hyclate 20 MG Tablet 30 Generic

Doxycycline Hyclate 50 MG Capsule 30 Generic

Doxycycline Mono-hydrate 100 MG Capsule 30 Generic

Doxycycline Mono-hydrate 100 MG Tablet 30 Generic

Doxycycline Mono-hydrate 150 MG Tablet 20 Generic

Doxycycline Mono-hydrate 25 MG/5 ML Suspension for Reconstitution 300 Generic

Doxycycline Mono-hydrate 50 MG Capsule 30 Generic

Doxycycline Mono-hydrate 50 MG Tablet 30 Generic

Doxylamine Succinate 25 MG Tablet 30 Generic

Dronabinol 2.5 MG Capsule 14 Generic

Dronabinol 5 MG Capsule 20 Generic

Drospir/Eth Estra/Levomefolate Ca 3-0.02(24) Tablet 28 Generic

Duloxetine HCL 20 MG Capsule DR/EC 30 Generic

Duloxetine HCL 30 MG Capsule DR/EC 30 Generic

Duloxetine HCL 40 MG Capsule DR/EC 30 Generic

Duloxetine HCL 60 MG Capsule DR/EC 30 Generic

Dutasteride 0.5 MG Capsule 30 Generic

Dutasteride/Tamsulosin HCL 0.5-0.4 MG Multiphase Cap 24-Hr ER 30 Generic

Econazole Nitrate 1% Cream 30 Generic

Efavirenz 50 MG Capsule 30 Brand

Emtricitabine 10 MG/ML Solution 30 Brand

Enalapril Maleate 10 MG Tablet 30 Generic

Enalapril Maleate 2.5 MG Tablet 30 Generic

Enalapril Maleate 20 MG Tablet 30 Generic

Enalapril Maleate 5 MG Tablet 30 Generic

Enalapril/Hydrochlorothiazide 10 MG-25 MG Tablet 30 Generic

Enalapril/Hydrochlorothiazide 5 MG-12.5 MG Tablet 30 Generic

Enoxaparin Sodium 30 MG/0.3 ML Syringe 3 Generic

Enoxaparin Sodium 40 MG/0.4 ML Syringe 3 Generic

Entecavir 1 MG Tablet 4 Generic

Epinastine HCL 0.05% Drops 5 Generic

Eplerenone 25 MG Tablet 30 Generic

Eplerenone 50 MG Tablet 30 Generic

Erythromycin Base 5 MG/Generic Capsule 30 Generic

Name/Strength/Form Default Qty. Brand/Generic

Erythromycin Base 5 MG/Generic Ointment 4 Generic

Erythromycin Base/Ethanol 2% Gel 30 Generic

Erythromycin Base/Ethanol 2% Solution 60 Generic

Erythromycin Base/Ethanol 2% Swab 30 Generic

Erythromycin Ethylsuccinate 400 MG Tablet 30 Brand

Erythromycin/Benzoyl Peroxide 3%-5% Gel 23 Generic

Escitalopram Oxalate 10 MG Tablet 30 Generic

Escitalopram Oxalate 20 MG Tablet 30 Generic

Escitalopram Oxalate 5 MG Tablet 15 Generic

Esmolol HCL 100 MG/10 ML Solution 30 Generic

Esmolol in NaCl, ISO 2.5 Generic/250 ML Parenteral Solution 30 Brand

Esomeprazole Magnesium 20 MG Capsule DR/EC 30 Generic

Estazolam 1 MG Tablet 14 Generic

Estazolam 2 MG Tablet 30 Generic

Estradiol .025 MG/24-Hr Weekly Patch 4 Generic

Estradiol .0375 MG/24 Weekly Patch 4 Generic

Estradiol .075 MG/24-Hr Semiweekly Patch 8 Generic

Estradiol .075 MG/24-Hr Weekly Patch 4 Generic

Estradiol 0.0375 MG/24-Hr Twice Weekly Patch 8 Generic

Estradiol 0.05 MG/24-Hr Semiweekly Patch 8 Generic

Estradiol 0.06 MG/24-Hr Weekly Patch 4 Generic

Estradiol 0.1 MG/24-Hr Weekly Patch 4 Generic

Estradiol 0.5 MG Tablet 30 Generic

Estradiol 1 MG Tablet 30 Generic

Estradiol 2 MG Tablet 30 Generic

Estradiol Transdermal Patch 0.05 MG/24-Hr Weekly Patch 4 Generic

Estradiol/Norethindrone Acet 0.5-0.1 MG Tablet 28 Generic

Estradiol/Norethindrone Acet 1 MG-0.5 MG Tablet 28 Generic

Estrogen, Ester/Me-Testosterone 0.625-1.25 Tablet 30 Generic

Estrogen, Ester/Me-Testosterone 1.25-2.5 MG Tablet 30 Generic

Estrogens, Esterified 0.3 MG Tablet 30 Brand

Estropipate 0.75 MG Tablet 30 Generic

Estropipate 1.5 MG Tablet 30 Generic

Eszopiclone 1 MG Tablet 15 Generic

Eszopiclone 2 MG Tablet 30 Generic

Eszopiclone 3 MG Tablet 15 Generic

Ethambutol HCL 100 MG Tablet 180 Generic

Ethambutol HCL 400 MG Tablet 30 Generic

Ethinyl Estradiol/Drospirenone 0.03 MG-3 MG Tablet 28 Generic

Ethosuximide 250 MG Capsule 90 Generic

Ethosuximide 250 MG/5 ML Solution 240 Generic

Ethynodiol D-Ethinyl Estradiol 1 MG-35 MCG Tablet 28 Generic

Ethynodiol D-Ethinyl Estradiol 1 MG-50 MCG Tablet 28 Generic

Etodolac 200 MG Capsule 20 Generic

Etodolac 300 MG Capsule 15 Generic

Etodolac 400 MG Tablet 20 Generic

Etodolac 400 MG Tablet 24-Hr ER 14 Generic

Etodolac 500 MG Tablet 30 Generic

Etodolac 500 MG Tablet 24-Hr ER 30 Generic

Etodolac 600 MG Tablet 24-Hr ER 30 Generic

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Name/Strength/Form Default Qty. Brand/Generic

Etomidate 2 MG/ML Solution 30 Generic

Etomidate 2 MG/ML Syringe 30 Generic

Etoposide 20 MG/ML Solution 30 Generic

Ezetimibe 10 MG Tablet 30 Generic

Ezetimibe/Simvastatin 10 MG-10 MG Tablet 30 Generic

Ezetimibe/Simvastatin 10 MG-40 MG Tablet 30 Generic

Famciclovir 125 MG Tablet 10 Generic

Famciclovir 250 MG Tablet 30 Generic

Famciclovir 500 MG Tablet 3 Generic

Famotidine 10 MG/ML Solution 30 Generic

Famotidine 20 MG Tablet 30 Generic

Famotidine 40 MG Tablet 30 Generic

Famotidine 40 MG/5 ML Suspension 50 Generic

Fat Emulsions 20% Emulsion 30 Generic

Fe Fumarate/Vit C/B12-If/FA 110-0.5 MG Capsule 30 Generic

Felbamate 600 MG/5 ML Suspension 30 Generic

Felodipine 10 MG Tablet 24-Hr ER 30 Generic

Felodipine 2.5 MG Tablet 24-Hr ER 29 Generic

Felodipine 5 MG Tablet 24-Hr ER 30 Generic

Fenofibrate Nanocrystallized 145 MG Tablet 30 Generic

Fenofibrate Nanocrystallized 160 MG Tablet 30 Generic

Fenofibrate Nanocrystallized 48 MG Tablet 30 Generic

Fenofibrate Micronized 160 MG Tablet 30 Generic

Fenofibrate Micronized 54 MG Tablet 30 Generic

Fenofibrate Micronized 130 MG Capsule 30 Generic

Fenofibrate Micronized 134 MG Capsule 30 Generic

Fenofibrate Micronized 200 MG Capsule 30 Generic

Fenofibrate Micronized 43 MG Capsule 30 Generic

Fenofibrate Micronized 67 MG Capsule 30 Generic

Fenofibric Acid DR Capsules 135 MG Capsule DR/EC 30 Generic

Fenofibric Acid DR Capsules 45 MG Capsule DR/EC 30 Generic

Fentanyl 12 MCG/Hr 75-Hr Patch 5 Generic

Fentanyl 25 MCG/Hr 75-Hr Patch 5 Generic

Fentanyl 50 MCG/Hr 75-Hr Patch 5 Generic

Fentanyl 75 MCG/Hr 75-Hr Patch 5 Generic

Ferrous Fumarate/Folic Acid 106 MG-1 MG Tablet 30 Generic

Finasteride 1 MG Tablet 30 Generic

Finasteride 5 MG Tablet 30 Generic

Flavoxate HCL 100 MG Tablet 30 Generic

Flecainide Acetate 100 MG Tablet 30 Generic

Flecainide Acetate 150 MG Tablet 30 Generic

Flecainide Acetate 50 MG Tablet 30 Generic

Fluconazole 10 MG/ML Suspension for Reconstitution 35 Generic

Fluconazole 100 MG Tablet 3 Generic

Fluconazole 150 MG Tablet 1 Generic

Fluconazole 200 MG Tablet 1 Generic

Fluconazole 40 MG/ML Suspension for Reconstitution 35 Generic

Fluconazole 50 MG Tablet 30 Generic

Fludrocortisone Acetate 0.1 MG Tablet 30 Generic

Fluocinolone Acetonide 0.01% Cream 30 Generic

Name/Strength/Form Default Qty. Brand/Generic

Fluocinolone Acetonide 0.01% Oil 118 Generic

Fluocinolone Acetonide 0.01% Solution 60 Generic

Fluocinolone Acetonide 0.025% Cream 30 Generic

Fluocinolone Acetonide 0.025% Ointment 15 Generic

Fluocinolone Acetonide Oil 0.01% Drops 20 Generic

Fluocinolone/Shower Cap 0.01% Oil 30 Generic

Fluocinonide 0.05% Cream 30 Generic

Fluocinonide 0.05% Gel 30 Generic

Fluocinonide 0.05% Ointment 15 Generic

Fluocinonide 0.05% Solution 60 Generic

Fluocinonide/Emollient Base 0.05% Cream 30 Generic

Fluorometholone 0.1% Suspension Drops 5 Generic

Fluorouracil 1 Generic/20 ML Solution 30 Generic

Fluorouracil 2% Solution 10 Brand

Fluorouracil 2.5 Generic/50 ML Solution 30 Generic

Fluorouracil 5 Generic/100 ML Solution 30 Generic

Fluorouracil 500 MG/10 ML Solution 50 Generic

Fluoxetine HCL 10 MG Capsule 30 Generic

Fluoxetine HCL 10 MG Tablet 15 Generic

Fluoxetine HCL 20 MG Capsule 30 Generic

Fluoxetine HCL 20 MG Tablet 30 Generic

Fluoxetine HCL 20 MG/5 ML Solution 30 Generic

Fluphenazine Decanoate 25 MG/ML Solution 5 Generic

Fluphenazine HCL 5 MG Tablet 7 Generic

Fluphenazine HCL 5 MG/ML Concentrate 30 Brand

Flurazepam HCL 15 MG Capsule 30 Brand

Flurazepam HCL 30 MG Capsule 15 Brand

Flurbiprofen 100 MG Tablet 10 Generic

Flurbiprofen 50 MG Tablet 30 Generic

Flurbiprofen Sodium 0.03% Drops 5 Generic

Flutamide 125 MG Capsule 24 Generic

Fluticasone Propionate 0.005% Ointment 15 Generic

Fluticasone Propionate 0.05% Cream 15 Generic

Fluticasone Propionate 50 MCG Suspension Spray 16 Generic

Fluticasone Propionate 50 MCG Suspension Spray 30 Generic

Fluvastatin Sodium 20 MG Capsule 30 Generic

Fluvoxamine Maleate 100 MG Capsule 24-Hr ER 30 Generic

Fluvoxamine Maleate 100 MG Tablet 15 Generic

Fluvoxamine Maleate 150 MG Capsule 24-Hr ER 14 Generic

Fluvoxamine Maleate 50 MG Tablet 30 Generic

Folic Acid 1 MG Tablet 30 Generic

Folic Acid 5 MG/ML Solution 10 Brand

Foltanx Tablet 2-3-35 MG Tablet 30 Brand

Formaldehyde 10% Solution 30 Generic

Formaldehyde 10% Solution w/ Applicator 30 Generic

Fosamprenavir Calcium 50 MG/ML Suspension 30 Brand

Fosinopril Sodium 10 MG Tablet 30 Generic

Fosinopril Sodium 20 MG Tablet 30 Generic

Fosinopril Sodium 40 MG Tablet 30 Generic

Fosinopril/Hydrochlorothiazide 10-12.5 MG Tablet 30 Generic

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Name/Strength/Form Default Qty. Brand/Generic

Fosinopril/Hydrochlorothiazide 20-12.5 MG Tablet 30 Generic

Furosemide 10 MG/ML Solution 12 Generic

Furosemide 10 MG/ML Solution (Oral) 30 Generic

Furosemide 20 MG Tablet 30 Generic

Furosemide 40 MG Tablet 30 Generic

Furosemide 80 MG Tablet 30 Generic

Gabapentin 100 MG Capsule 30 Generic

Gabapentin 250 MG/5 ML Solution 150 Generic

Gabapentin 300 MG Capsule 30 Generic

Gabapentin 400 MG Capsule 30 Generic

Gabapentin 600 MG Tablet 30 Generic

Gabapentin 800 MG Tablet 30 Generic

Galantamine HBR 12 MG Tablet 60 Generic

Galantamine HBR 16 MG Capsule 24-Hr ER Pellets 30 Generic

Galantamine HBR 8 MG Tablet 30 Generic

Gatifloxacin Opthalmic Solution 0.5% Drops 5 Generic

Gemfibrozil 600 MG Tablet 30 Generic

Generic for Procardia XL 30 MG Tablet 24-Hr ER 30 Generic

Generic for Procardia XL 60 MG Tablet 24-Hr ER 30 Generic

Gentamicin Sulfate 0.1% Cream 30 Generic

Gentamicin Sulfate 0.1% Ointment 30 Generic

Gentamicin Sulfate 0.3% Drops 5 Generic

Gentamicin Sulfate 0.3% Ointment 4 Generic

Gentamicin Sulfate 40 MG/ML Solution 10 Generic

Glimepiride 1 MG Tablet 15 Generic

Glimepiride 2 MG Tablet 30 Generic

Glimepiride 4 MG Tablet 30 Generic

Glipizide 10 MG Tablet 60 Generic

Glipizide 10 MG Tablet 24-Hr ER 30 Generic

Glipizide 2.5 MG Tablet 24-Hr ER 30 Generic

Glipizide 5 MG Tablet 30 Generic

Glipizide 5 MG Tablet 24-Hr ER 30 Generic

Glipizide/Metformin HCL 2.5-250 MG Tablet 60 Generic

Glipizide/Metformin HCL 2.5-500 MG Tablet 30 Generic

Glipizide/Metformin HCL 5 MG-500 MG Tablet 60 Generic

Glyburide 1.25 MG Tablet 30 Generic

Glyburide 2.5 MG Tablet 30 Generic

Glyburide 5 MG Tablet 30 Generic

Glyburide,Micronized 1.5 MG Tablet 30 Generic

Glyburide,Micronized 3 MG Tablet 15 Generic

Glyburide,Micronized 6 MG Tablet 30 Generic

Glyburide/Metformin HCL 1.25-250 MG Tablet 30 Generic

Glyburide/Metformin HCL 2.5-500 MG Tablet 60 Generic

Glyburide/Metformin HCL 5 MG-500 MG Tablet 90 Generic

Glycopyrrolate 1 MG Tablet 30 Generic

Glycopyrrolate 2 MG Tablet 30 Generic

Griseofulvin Ultramicrosize 250 MG Tablet 30 Generic

Griseofulvin, Micro-size 125 MG/5 ML Suspension 150 Generic

Guaifenesin 600 MG Tablet 12-Hr ER 30 Generic

Guaifenesin/D-Methorphan HB/PE 30-10-250 Capsule 30 Generic

Name/Strength/Form Default Qty. Brand/Generic

Guaifenesin/Pseudoephedrine HCL 400 MG-60 MG Tablet 30 Generic

Guanfacine HCL 1 MG Tablet 15 Generic

Guanfacine HCL 1 MG Tablet 24-Hr ER 7 Generic

Guanfacine HCL 2 MG Tablet 30 Generic

Guanfacine HCL 2 MG Tablet 24-Hr ER 30 Generic

Halobetasol Propionate 0.05% Cream 15 Generic

Halobetasol Propionate 0.05% Ointment 50 Generic

Haloperidol 5 MG Tablet 30 Generic

Haloperidol Lactate 0.5 MG Tablet 15 Generic

Haloperidol Lactate 1 MG Tablet 30 Generic

Haloperidol Lactate 10 MG Tablet 30 Generic

Haloperidol Lactate 2 MG Tablet 30 Generic

Haloperidol Lactate 2 MG/ML Concentrate 50 Generic

Haloperidol Lactate 20 MG Tablet 60 Generic

Haloperidol Lactate 5 MG/ML Solution 30 Generic

Heparin Sodium,Porcine 5000/ML Solution 30 Generic

Heparin Sodium,Porcine/PF 10 Unit/ML Syringe 20 Generic

Hepatitis A Virus Vaccine/PF 25/0.5 ML Suspension 30 Generic

Hepatitis A Virus Vaccine/PF 25/0.5 ML Syringe 30 Brand

Hepatitis A Virus Vaccine/PF 50 Unit/ML Suspension 30 Brand

Hepatitis A Virus Vaccine/PF 50 Unit/ML Syringe 30 Generic

Hepatitis Brand Virus Vaccine/PF 10 MCG/ML Suspension 30 Generic

Hepatitis Brand Virus Vaccine/PF 40 MCG/ML Suspension 30 Brand

Hepatitis Brand Virus Vaccine/PF 5 MCG/0.5 ML Suspension 30 Brand

Hepatitis Brand Virus Vaccine/PF 5 MCG/0.5 ML Syringe 30 Generic

Hetastarch in 0.9 % NaCl 6%-0.9% Solution 30 Generic

Homatropine HBR 5% Drops 5 Generic

Hyaluronate Sodium 0.2% Gel 30 Generic

Hydralazine HCL 10 MG Tablet 30 Generic

Hydralazine HCL 100 MG Tablet 60 Generic

Hydralazine HCL 25 MG Tablet 30 Generic

Hydralazine HCL 50 MG Tablet 90 Generic

Hydrochlorothiazide 12.5 MG Capsule 30 Generic

Hydrochlorothiazide 12.5 MG Tablet 15 Generic

Hydrochlorothiazide 25 MG Tablet 30 Generic

Hydrochlorothiazide 50 MG Tablet 30 Generic

Hydrocodone Bit/Homatrop ME-BR 5 MG-1.5 MG Tablet 30 Generic

Hydrocodone Bit/Homatrop Me-BR 5-1.5 MG/5 Syrup 100 Generic

Hydrocodone/Acetaminophen 10 MG-325 MG Tablet 30 Generic

Hydrocodone/Acetaminophen 10-300/15 Solution 100 Brand

Hydrocodone/Acetaminophen 2.5-325 MG Tablet 30 Generic

Hydrocodone/Acetaminophen 5 MG-300 MG Tablet 30 Generic

Hydrocodone/Acetaminophen 5 MG-325 MG Tablet 30 Generic

Hydrocodone/Acetaminophen 7.5-300 MG Tablet 30 Generic

Hydrocodone/Acetaminophen 7.5-325 MG Tablet 30 Generic

Hydrocodone/Acetaminophen 7.5-325/15 Solution 120 Generic

Hydrocodone/Cpm/Pseudoephed 5-4-60 MG/5 Solution 60 Brand

Hydrocodone/Ibuprofen 5 MG-200 MG Tablet 30 Generic

Hydrocodone/Ibuprofen 7.5-200 MG Tablet 30 Generic

Hydrocort/Pramoxin/Emol/Pram#1 2.5%-1%-1% Cream & Towelette Kit 1 Generic

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Name/Strength/Form Default Qty. Brand/Generic

Hydrocort/Pramoxin/Emol/Pram #1 2.5-1% (4 Generic) Cream & Towelette Kit 1 Generic

Hydrocort/Sal Acid/Sulf/Shmp #1 2%-2%-2% Combo Pack 30 Brand

Hydrocortisone 1% Cream 28 Generic

Hydrocortisone 1% Cream 30 Generic

Hydrocortisone 1% Ointment 30 Generic

Hydrocortisone 10 MG Tablet 30 Generic

Hydrocortisone 2% Lotion 30 Generic

Hydrocortisone 2.5% Cream 30 Generic

Hydrocortisone 2.5% Cream & Gel Combo Pack (Topical) 30 Generic

Hydrocortisone 2.5% Lotion 59 Generic

Hydrocortisone 2.5% Ointment 20 Generic

Hydrocortisone 20 MG Tablet 30 Generic

Hydrocortisone 5 MG Tablet 30 Generic

Hydrocortisone Acetate 1% Cream 30 Generic

Hydrocortisone Acetate 1% Ointment 30 Generic

Hydrocortisone Butyrate 0.1% Cream 15 Generic

Hydrocortisone Butyrate 0.1% Ointment 30 Generic

Hydrocortisone Butyrate 0.1% Solution 60 Generic

Hydrocortisone Valerate 0.2% Cream 30 Generic

Hydrocortisone Valerate 0.2% Ointment 30 Generic

Hydrocortisone/Aloe Vera 1% Cream 30 Generic

Hydrocortisone/Iodoquinol 1%-1% Cream 28 Generic

Hydrocortisone/Pramoxine 1%-1% Foam 10 Brand

Hydromorphone HCL 1 MG/ML Liquid 100 Generic

Hydromorphone HCL 12 MG Tablet 24-Hr ER 10 Generic

Hydromorphone HCL 2 MG Tablet 30 Generic

Hydromorphone HCL 4 MG Tablet 30 Generic

Hydromorphone HCL 8 MG Tablet 60 Generic

Hydromorphone HCL 8 MG Tablet 24-Hr ER 30 Generic

Hydromorphone HCL/PF 10 MG/ML Solution 30 Generic

Hydroquinone 4% Cream 28 Generic

Hydroxychloroquine Sulfate 200 MG Tablet 30 Generic

Hydroxyurea 200 MG Capsule 30 Brand

Hydroxyurea 300 MG Capsule 30 Brand

Hydroxyurea 400 MG Capsule 60 Brand

Hydroxyurea 500 MG Capsule 30 Generic

Hydroxyzine HCL 10 MG Tablet 30 Generic

Hydroxyzine HCL 10 MG/5 ML Solution 60 Generic

Hydroxyzine HCL 25 MG Tablet 30 Generic

Hydroxyzine HCL 50 MG Tablet 20 Generic

Hydroxyzine Pamoate 100 MG Capsule 15 Brand

Hydroxyzine Pamoate 25 MG Capsule 30 Generic

Hydroxyzine Pamoate 50 MG Capsule 30 Generic

Hyoscyamine Sulfate 0.125 MG Disintegrating Tablet 30 Brand

Hyoscyamine Sulfate 0.125 MG Sublingual Tablet 30 Generic

Hyoscyamine Sulfate 0.125 MG Tablet 30 Generic

Hyoscyamine Sulfate 0.125 MG/ML Drops 30 Generic

Hyoscyamine Sulfate 0.125-0.25 Multiphase Tablet ER 30 Brand

Hyoscyamine Sulfate 0.375 MG Tablet 12-Hr ER 30 Generic

Hyoscyamine Sulfate 125 MCG/5 ML Elixir 30 Generic

Name/Strength/Form Default Qty. Brand/Generic

Ibandronate Sodium 150 MG Tablet 1 Generic

Ibuprofen 100 MG/5 ML Suspension 118 Generic

Ibuprofen 400 MG Tablet 30 Generic

Ibuprofen 600 MG Tablet 30 Generic

Ibuprofen 800 MG Tablet 30 Generic

Icosapent Ethyl 0.5 Generic Capsule 30 Brand

Icosapent Ethyl 1 Generic Capsule 30 Brand

Imipramine HCL 10 MG Tablet 30 Generic

Imipramine HCL 25 MG Tablet 30 Generic

Imipramine HCL 50 MG Tablet 30 Generic

Imiquimod 5% Cream Packet 24 Generic

Indapamide 1.25 MG Tablet 30 Generic

Indapamide 2.5 MG Tablet 30 Generic

Indinavir Sulfate 200 MG Capsule 30 Brand

Indomethacin 25 MG Capsule 30 Generic

Indomethacin 50 MG Capsule 30 Generic

Indomethacin 75 MG Capsule ER 30 Generic

Influenza Vaccine Injection Vaccine 1 Generic

Ipratropium Bromide 0.2 MG/ML Solution 62 Generic

Ipratropium Bromide 21 MCG Non-Aerosol Spray 30 Generic

Ipratropium Bromide 42 MCG Non-Aerosol Spray 30 Generic

Ipratropium/Albuterol Sulfate 0.5-3 MG/3 Solution for Nebulization 90 Generic

Irbesartan 150 MG Tablet 15 Generic

Irbesartan 300 MG Tablet 30 Generic

Irbesartan 75 MG Tablet 15 Generic

Irbesartan/Hydrochlorothiazide 150-12.5 MG Tablet 30 Generic

Irbesartan/Hydrochlorothiazide 300-12.5 MG Tablet 30 Generic

Iron Carb, GL/FA/B12/C/Docusate 90-1-50 MG Tablet 30 Brand

Iron Dextran Complex 100 MG/2 ML Solution 2 Brand

Iron Fum & PS Cmp/FA/Vit C/B3 125-1-40-3 Capsule 30 Brand

Iron Fum & Polysac #1/FA/MV No.18 106 MG-1 MG Capsule 30 Brand

Iron Fumarate/Vit C/Vit B12/FA 200-250 MG Capsule 30 Brand

Iron Fumarate/Vit C/Vit B12/FA 460-60 MG Capsule 30 Generic

Iron Polysac/Iron Heme/FA/B12 22-6-1-25 Tablet 30 Brand

Iron PS Cmplx/Vit B12/FA 150-25-1 Capsule 30 Generic

Iron, Carb/DSS/B12 IF/FA/MV-MN 150-50-1 MG Tablet 24-Hr ER 30 Generic

Iron,Carbonyl/Vit C/Vit B12/FA 100-250-1 Tablet 30 Brand

Iron/FA/B12/C/Docusate Sodium 90-1-50 MG Tablet 30 Brand

Isoflurane 99.9% Liquid 30 Generic

Isomethepten/Caf/Acetaminophen 65-20-325 Tablet 30 Generic

Isoniazid 300 MG Tablet 30 Generic

Isosorbide Dinitrate 10 MG Tablet 30 Generic

Isosorbide Dinitrate 20 MG Tablet 30 Generic

Isosorbide Dinitrate 30 MG Tablet 30 Generic

Isosorbide Dinitrate 5 MG Tablet 30 Generic

Isosorbide Mono-nitrate 10 MG Tablet 30 Generic

Isosorbide Mono-nitrate 120 MG Tablet 24-Hr ER 30 Generic

Isosorbide Mono-nitrate 20 MG Tablet 30 Generic

Isosorbide Mono-nitrate 30 MG Tablet 24-Hr ER 15 Generic

Isosorbide Mono-nitrate 60 MG Tablet 24-Hr ER 30 Generic

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Name/Strength/Form Default Qty. Brand/Generic

Isoxsuprine HCL 10 MG Tablet 30 Generic

Isoxsuprine HCL 20 MG Tablet 30 Generic

Isradipine 2.5 MG Capsule 30 Generic

Isradipine 5 MG Capsule 30 Generic

Ivermectin 3 MG Tablet 10 Generic

Ketamine HCL 10 MG/ML Solution 30 Brand

Ketamine HCL 100 MG/ML Solution 30 Generic

Ketamine HCL 50 MG/ML Solution 30 Generic

Ketoconazole 2% Cream 30 Generic

Ketoconazole 2% Shampoo 120 Generic

Ketoconazole 200 MG Tablet 2 Generic

Ketoprofen 75 MG Capsule 15 Generic

Ketorolac Tromethamine 0.4% Drops 5 Generic

Ketorolac Tromethamine 0.5% Drops 5 Generic

Ketorolac Tromethamine 10 MG Tablet 30 Generic

Ketorolac Tromethamine 30 MG/ML(1) Solution 1 Generic

Ketorolac Tromethamine/PF 0.45% Dropperette 5 Brand

Ketotifen Fumarate 0.025% Drops 5 Generic

Labetalol HCL 100 MG Tablet 30 Generic

Labetalol HCL 200 MG Tablet 30 Generic

Labetalol HCL 300 MG Tablet 30 Generic

Lactic Acid 10% Cream 113 Generic

Lactic Acid 10% Lotion 355 Generic

Lactobacillus Casei/Folic Acid 60-1.25 MG Capsule 30 Brand

Lactulose 10 Generic/15 ML Solution 300 Generic

Lactulose 10 Generic/15 ML Solution 300 Generic

Lactulose 10 G/15 ML (15 ML) Solution 100 Generic

Lactulose 20 Generic/30 ML Solution 30 Generic

Lamivudine 25 MG/5 ML Solution 30 Brand

Lamotrigine 100 MG Tablet 30 Generic

Lamotrigine 200 MG Tablet 30 Generic

Lamotrigine 25 MG Chewable Dispersible Tablet 60 Generic

Lamotrigine 25 MG Tablet 30 Generic

Lamotrigine 250 MG Tablet 24-Hr ER 3 Generic

Lansoprazole 15 MG Capsule DR/EC 28 Generic

Lansoprazole 30 MG Capsule DR/EC 30 Generic

Latanoprost 0.005% Drops 5 Generic

Letrozole 2.5 MG Tablet 5 Generic

Leucovorin Calcium 15 MG Tablet 6 Brand

Leucovorin Calcium 5 MG Tablet 4 Generic

Levalbuterol HCL 0.31 MG/3 ML Solution for Nebulization 72 Generic

Levalbuterol HCL 1.25 MG/0.5 Solution for Nebulization 30 Generic

Levalbuterol HCL 1.25 MG/3 ML Solution for Nebulization 72 Generic

Levetiracetam 100 MG/ML Solution 90 Generic

Levetiracetam 250 MG Tablet 30 Generic

Levetiracetam 500 MG Tablet 24-Hr ER 60 Generic

Levetiracetam 500 MG/5 ML Solution 30 Generic

Levetiracetam 750 MG Tablet 60 Generic

Levetiracetam 750 MG Tablet 24-Hr ER 30 Generic

Levobunolol HCL 0.5% Drops 5 Generic

Name/Strength/Form Default Qty. Brand/Generic

Levocarnitine 100 MG/ML Solution 30 Generic

Levocarnitine 100 MG/ML Solution 60 Brand

Levocarnitine 330 MG Tablet 30 Generic

Levocetirizine Dihydrochloride 2.5 MG/5 ML Solution 75 Generic

Levocetirizine Dihydrochloride 5 MG Tablet 30 Generic

Levofloxacin 0.5% Drops 5 Generic

Levofloxacin 250 MG Tablet 5 Generic

Levofloxacin 250 MG/10 ML Solution 40 Generic

Levofloxacin 500 MG Tablet 7 Generic

Levofloxacin 750 MG Tablet 5 Generic

Levomefolate Calcium 15 MG Tablet 30 Brand

Levomilnacipran HCL 20 MG Capsule 24-Hr ER 2 Brand

Levonorgestrel 1.5 MG Tablet 1 Generic

Levonorgestrel-Ethin Estradiol 0.1-0.02 Tablet 28 Generic

Levonorgestrel-Ethin Estradiol 0.15-0.03 Tablet 28 Generic

Levonorgestrel-Ethin Estradiol 6-5-10 Tablet 28 Generic

Levonorgestrel-Ethin Estradiol 90-20 MCG Tablet 28 Generic

Levothyroxine Sodium 100 MCG Tablet 30 Generic

Levothyroxine Sodium 112 MCG Tablet 30 Generic

Levothyroxine Sodium 125 MCG Tablet 30 Generic

Levothyroxine Sodium 137 MCG Tablet 30 Generic

Levothyroxine Sodium 150 MCG Tablet 30 Generic

Levothyroxine Sodium 175 MCG Tablet 15 Generic

Levothyroxine Sodium 200 MCG Tablet 30 Generic

Levothyroxine Sodium 25 MCG Capsule 12 Brand

Levothyroxine Sodium 25 MCG Tablet 15 Generic

Levothyroxine Sodium 300 MCG Tablet 30 Generic

Levothyroxine Sodium 50 MCG Tablet 30 Generic

Levothyroxine Sodium 75 MCG Capsule 14 Brand

Levothyroxine Sodium 75 MCG Tablet 30 Generic

Levothyroxine Sodium 88 MCG Tablet 30 Generic

Lidocaine 5% Ointment 30 Generic

Lidocaine HCL 10 MG/ML Solution 30 Generic

Lidocaine HCL 15 MG/ML Solution 30 Brand

Lidocaine HCL 2% Solution 40 Generic

Lidocaine HCL 20 MG/ML Solution 30 Brand

Lidocaine HCL 3% Cream 28 Generic

Lidocaine HCL 3% Lotion 30 Generic

Lidocaine HCL 40 MG/ML Solution 50 Generic

Lidocaine HCL 5 MG/ML Solution 30 Generic

Lidocaine HCL 5 MG/ML Solution 30 Generic

Lidocaine HCL/Epinephrine 0.5-1:200 K Solution 30 Brand

Lidocaine HCL/Epinephrine 1%-1:100 K Solution 30 Generic

Lidocaine HCL/Epinephrine 2%-1:100 K Solution 20 Generic

Lidocaine HCL/Epinephrine Bit 2%-1:100 K Cartridge 30 Generic

Lidocaine HCL/Epinephrine Bit 2%-1:50000 Cartridge 30 Generic

Lidocaine HCL/Epinephrine/PF 1.5-1:200 K Solution 30 Generic

Lidocaine HCL/Epinephrine/PF 2%-1:200 K Solution 30 Generic

Lidocaine HCL/PF 10 MG/ML Solution 5 Generic

Lidocaine/Prilocaine 2.5%-2.5% Cream 30 Generic

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12 of 21 2020 TIER ONE FORMULARY

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Name/Strength/Form Default Qty. Brand/Generic

Lidocaine-Hydrocortisone Acetate 3%-0.5% Cream Kit 30 Generic

Linezolid 200 MG/0.1l Parenteral Solution 30 Brand

Liothyronine Sodium 25 MCG Tablet 15 Generic

Liothyronine Sodium 5 MCG Tablet 30 Generic

Liothyronine Sodium 50 MCG Tablet 30 Generic

Liotrix 25-100 MCG Tablet 30 Brand

Liotrix 3.1-12.5 Tablet 30 Brand

Liotrix 37.5-150 Tablet 30 Brand

Liotrix 6.25-25 MCG Tablet 30 Brand

Lipase/Protease/Amylase 8 K-28.75 K Capsule DR/EC 30 Brand

Lisinopril 10 MG Tablet 30 Generic

Lisinopril 2.5 MG Tablet 30 Generic

Lisinopril 20 MG Tablet 30 Generic

Lisinopril 30 MG Tablet 30 Generic

Lisinopril 40 MG Tablet 30 Generic

Lisinopril 5 MG Tablet 30 Generic

Lisinopril/Hydrochlorothiazide 10-12.5 MG Tablet 30 Generic

Lisinopril/Hydrochlorothiazide 20 MG-25 MG Tablet 30 Generic

Lisinopril/Hydrochlorothiazide 20-12.5 MG Tablet 30 Generic

Lithium Carbonate 150 MG Capsule 30 Generic

Lithium Carbonate 300 MG Capsule 30 Generic

Lithium Carbonate 300 MG Tablet 30 Generic

Lithium Carbonate 300 MG Tablet ER 30 Generic

Lithium Carbonate 450 MG Tablet ER 30 Generic

Lithium Carbonate 600 MG Capsule 30 Generic

Lithium Citrate 8 MEQ/5 ML Solution 150 Brand

L-Norgest/E.estradiol-E.estrad 150-30 (84) 3-Mo Tablet Dose Pack 91 Generic

Loperamide HCL 2 MG Capsule 30 Generic

Lorazepam 0.5 MG Tablet 15 Generic

Lorazepam 1 MG Tablet 20 Generic

Lorazepam 2 MG Tablet 30 Generic

Lorazepam 2 MG/ML Concentrate 30 Generic

Lorazepam 2 MG/ML Solution 1 Generic

Lorazepam 2 MG/ML Syringe 30 Generic

Lorazepam 4 MG/ML Solution 30 Generic

Lorazepam 4 MG/ML Syringe 30 Generic

Losartan Potassium 100 MG Tablet 30 Generic

Losartan Potassium 25 MG Tablet 15 Generic

Losartan Potassium 50 MG Tablet 30 Generic

Losartan/Hydrochlorothiazide 100 MG-25 MG Tablet 30 Generic

Losartan/Hydrochlorothiazide 100-12.5 MG Tablet 30 Generic

Losartan/Hydrochlorothiazide 50-12.5 MG Tablet 30 Generic

Lovastatin 10 MG Tablet 30 Generic

Lovastatin 20 MG Tablet 30 Generic

Lovastatin 40 MG Tablet 30 Generic

Loxapine Succinate 10 MG Capsule 30 Generic

Loxapine Succinate 25 MG Capsule 60 Generic

Loxapine Succinate 5 MG Capsule 30 Generic

Loxapine Succinate 50 MG Capsule 60 Generic

Mag Hydrox/Al Hydrox/Simeth 700-300 MG Chewable Tablet 30 Generic

Name/Strength/Form Default Qty. Brand/Generic

Magnesium Oxide 420 MG Tablet 30 Generic

Maprotiline HCL 25 MG Tablet 46 Brand

Maprotiline HCL 75 MG Tablet 15 Brand

Measles, Mumps & Rubella Vacc/PF 12500/0.5 Recon Solution 30 Brand

Meclizine HCL 12.5 MG Tablet 30 Generic

Meclizine HCL 25 MG Chewable Tablet 30 Generic

Meclizine HCL 25 MG Tablet 30 Generic

Medroxyprogesterone Acetate 10 MG Tablet 30 Generic

Medroxyprogesterone Acetate 150 MG/ML Suspension 1 Generic

Medroxyprogesterone Acetate 150 MG/ML Syringe 1 Generic

Medroxyprogesterone Acetate 2.5 MG Tablet 30 Generic

Medroxyprogesterone Acetate 5 MG Tablet 10 Generic

Mefloquine HCL 250 MG Tablet 4 Brand

Megestrol Acetate 20 MG Tablet 30 Generic

Megestrol Acetate 40 MG Tablet 30 Generic

Megestrol Acetate 400 MG/10 ML Suspension 150 Generic

Megestrol Acetate 800 MG/20 ML Suspension 30 Generic

Meloxicam 15 MG Tablet 30 Generic

Meloxicam 7.5 MG Tablet 30 Generic

Memantine HCL 10 MG Tablet 30 Generic

Memantine HCL 2 MG/ML Solution 30 Generic

Memantine HCL 5 MG Tablet 14 Generic

Meningococcin Vac A, C, Y, W-135/PF 50 MCG Recon Solution 30 Generic

Meperidine HCL 100 MG Tablet 10 Generic

Meperidine HCL 100 MG/ML Solution 30 Generic

Meperidine HCL 50 MG Tablet 30 Generic

Meperidine HCL 50 MG/5 ML Solution 3 Brand

Meperidine HCL 50 MG/ML Solution 30 Generic

Meperidine HCL/PF 100 MG/2 ML Solution 30 Brand

Meperidine HCL/PF 100 MG/ML Solution 30 Generic

Meperidine HCL/PF 100 MG/ML Syringe 30 Generic

Meperidine HCL/PF 25 MG/ML Syringe 30 Generic

Meperidine HCL/PF 50 MG/ML Solution 30 Generic

Meperidine HCL/PF 50 MG/ML Syringe 30 Generic

Meperidine HCL/PF 75 MG/1.5 ML Solution 30 Brand

Mepivacaine HCL 10 MG/ML Solution 30 Brand

Mepivacaine HCL 20 MG/ML Solution 30 Brand

Mepivacaine HCL/PF 10 MG/ML Solution 30 Brand

Mepivacaine HCL/PF 15 MG/ML Solution 30 Brand

Mepivacaine HCL/PF 20 MG/ML Solution 30 Generic

Meprobamate 400 MG Tablet 30 Generic

Mercaptopurine 50 MG Tablet 30 Generic

Mesna 100 MG/ML Solution 30 Generic

Metaproterenol Sulfate 10 MG Tablet 90 Brand

Metaproterenol Sulfate 10 MG/5 ML Syrup 30 Brand

Metaproterenol Sulfate 20 MG Tablet 30 Brand

Metaxalone 800 MG Tablet 30 Generic

Metformin HCL 1000 MG Tablet 30 Generic

Metformin HCL 500 MG Tablet 60 Generic

Metformin HCL 850 MG Tablet 30 Generic

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Name/Strength/Form Default Qty. Brand/Generic

Metformin HCL ER 500 MG Tablet 24-Hr ER 30 Generic

Metformin HCL ER 750 MG Tablet 24-Hr ER 30 Generic

Meth/Meblue/Sod Phos/Psal/Hyos 118-10-36 Capsule 30 Generic

Methadone HCL 10 MG Tablet 90 Generic

Methadone HCL 40 MG Soluble Tablet 30 Generic

Methadone HCL 5 MG Tablet 30 Generic

Methazolamide 25 MG Tablet 60 Generic

Methazolamide 50 MG Tablet 30 Generic

Methen/M-Blue/Sal/Na Phos/Hyos 120-0.12 MG Capsule 30 Generic

Methenam/Me Blue/Ba/Salicy/Hyo 81.6-0.12 Tablet 30 Brand

Methenamine Hippurate 1 Generic Tablet 30 Generic

Methenamine Mandelate 1 Generic Tablet 30 Generic

Methenamine Mandelate 500 MG Tablet 90 Generic

Methimazole 10 MG Tablet 30 Generic

Methimazole 5 MG Tablet 15 Generic

Methocarbamol 500 MG Tablet 30 Generic

Methocarbamol 750 MG Tablet 30 Generic

Methotrexate Sodium 2.5 MG Tablet 20 Generic

Methotrexate Sodium 2.5 MG Tablet Dose Pack 24 Generic

Methscopolamine Bromide 2.5 MG Tablet 30 Generic

Methscopolamine Bromide 5 MG Tablet 30 Generic

Methyclothiazide 5 MG Tablet 30 Brand

Methyldopa 250 MG Tablet 30 Generic

Methyldopa 500 MG Tablet 30 Generic

Methyldopa/Hydrochlorothiazide 250 MG-15 MG Tablet 30 Brand

Methylphenidate HCL 10 MG Biphasic Capsule ER 30-70 30 Generic

Methylphenidate HCL 10 MG Tablet 30 Generic

Methylphenidate HCL 10 MG Tablet ER 30 Generic

Methylphenidate HCL 10 MG/5 ML Solution 150 Brand

Methylphenidate HCL 2.5 MG Chewable Tablet 30 Generic

Methylphenidate HCL 20 MG Biphasic Capsule ER 30-70 30 Generic

Methylphenidate HCL 20 MG Biphasic Capsule ER 50-50 30 Generic

Methylphenidate HCL 20 MG Tablet 30 Generic

Methylphenidate HCL 20 MG Tablet ER 30 Generic

Methylphenidate HCL 30 MG Biphasic Capsule ER 30-70 30 Generic

Methylphenidate HCL 30 MG Biphasic Capsule ER 50-50 30 Generic

Methylphenidate HCL 40 MG Biphasic Capsule ER 30-70 30 Generic

Methylphenidate HCL 40 MG Biphasic Capsule ER 50-50 30 Generic

Methylphenidate HCL 5 MG Chewable Tablet 30 Generic

Methylphenidate HCL 5 MG Tablet 30 Generic

Methylphenidate HCL 5 MG/5 ML Solution 150 Brand

Methylphenidate HCL 50 MG Biphasic Capsule ER 30-70 28 Generic

Methylphenidate HCL 60 MG Biphasic Capsule ER 30-70 30 Generic

Methylprednisolone 16 MG Tablet 4 Generic

Methylprednisolone 2 MG Tablet 30 Brand

Methylprednisolone 32 MG Tablet 2 Generic

Methylprednisolone 4 MG Tablet 30 Generic

Methylprednisolone 8 MG Tablet 8 Generic

Methylprednisolone Acetate 80 MG/ML Suspension 5 Generic

Methylprednisolone Sod Succ/PF 125 MG/2 ML Recon Solution 1 Generic

Name/Strength/Form Default Qty. Brand/Generic

Methylprednisolone Sod Succ/PF 40 MG/ML Recon Solution 3 Generic

Metoclopramide HCL 10 MG Tablet 30 Generic

Metoclopramide HCL 5 MG Tablet 20 Generic

Metoclopramide HCL 5 MG/5 ML Solution 30 Generic

Metoclopramide HCL 5 MG/ML Solution 30 Generic

Metolazone 10 MG Tablet 30 Generic

Metolazone 5 MG Tablet 12 Generic

Metoprolol Succinate ER 100 MG Tablet 24-Hr ER 30 Generic

Metoprolol Succinate ER 200 MG Tablet 24-Hr ER 15 Generic

Metoprolol Succinate ER 25 MG Tablet 24-Hr ER 15 Generic

Metoprolol Succinate ER 50 MG Tablet 24-Hr ER 30 Generic

Metoprolol Tartrate 100 MG Tablet 30 Generic

Metoprolol Tartrate 25 MG Tablet 30 Generic

Metoprolol Tartrate 5 MG/5 ML Solution 30 Generic

Metoprolol Tartrate 50 MG Tablet 30 Generic

Metoprolol Tartrate 75 MG Tablet 30 Brand

Metoprolol/Hydrochlorothiazide 100 MG-25 MG Tablet 30 Generic

Metoprolol/Hydrochlorothiazide 100 MG-50 MG Tablet 15 Brand

Metoprolol/Hydrochlorothiazide 50 MG-25 MG Tablet 30 Generic

Metronidazole 0.75% Gel 70 Generic

Metronidazole 0.75% Gel 45 Generic

Metronidazole 0.75% Lotion 59 Generic

Metronidazole 1% Gel 60 Generic

Metronidazole 1% Gel Pump 30 Generic

Metronidazole 250 MG Tablet 30 Generic

Metronidazole 500 MG Tablet 30 Generic

Metronidazole/Sodium Chloride 500 MG/0.1 L Piggyback 30 Generic

Midodrine HCL 10 MG Tablet 30 Generic

Midodrine HCL 2.5 MG Tablet 30 Generic

Midodrine HCL 5 MG Tablet 30 Generic

Minocycline HCL 100 MG Capsule 14 Generic

Minocycline HCL 100 MG Tablet 20 Generic

Minocycline HCL 50 MG Capsule 30 Generic

Minocycline HCL 50 MG Tablet 30 Generic

Minocycline HCL 75 MG Capsule 30 Generic

Minoxidil 10 MG Tablet 30 Generic

Minoxidil 2.5 MG Tablet 30 Generic

Mirtazapine 15 MG Disintegrating Tablet 30 Generic

Mirtazapine 15 MG Tablet 30 Generic

Mirtazapine 30 MG Disintegrating Tablet 30 Generic

Mirtazapine 30 MG Tablet 15 Generic

Mirtazapine 45 MG Disintegrating Tablet 30 Generic

Mirtazapine 45 MG Tablet 30 Generic

Mirtazapine 7.5 MG Tablet 15 Generic

Misoprostol 100 MCG Tablet 60 Generic

Misoprostol 200 MCG Tablet 1 Generic

Moexipril HCL 15 MG Tablet 30 Generic

Moexipril HCL 7.5 MG Tablet 30 Generic

Moexipril/Hydrochlorothiazide 15-12.5 MG Tablet 30 Generic

Moexipril/Hydrochlorothiazide 15-25 MG Tablet 15 Generic

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Name/Strength/Form Default Qty. Brand/Generic

Moexipril/Hydrochlorothiazide 7.5-12.5 MG Tablet 7 Generic

Mometasone Furoate 0.1% Cream 30 Generic

Mometasone Furoate 0.1% Ointment 15 Generic

Mometasone Furoate 0.1% Solution 30 Generic

Mometasone Furoate 50 MCG Non-Aerosol Spray 17 Generic

Montelukast Sodium 10 MG Tablet 30 Generic

Montelukast Sodium 4 MG Chewable Tablet 30 Generic

Montelukast Sodium 4 MG Granules Packet 15 Generic

Montelukast Sodium 5 MG Chewable Tablet 30 Generic

Morphine Sulfate 10 MG Capsule ER Pellets 30 Generic

Morphine Sulfate 10 MG/5 ML Solution 30 Generic

Morphine Sulfate 100 MG Tablet ER 30 Generic

Morphine Sulfate 100 MG/5 ML Solution 15 Generic

Morphine Sulfate 15 MG Tablet ER 30 Generic

Morphine Sulfate 20 MG Capsule ER Pellets 30 Generic

Morphine Sulfate 20 MG/5 ML Solution 120 Generic

Morphine Sulfate 30 MG Capsule ER Pellets 30 Generic

Morphine Sulfate 30 MG Tablet ER 30 Generic

Morphine Sulfate 60 MG Tablet ER 30 Generic

Morphine Sulfate/PF 0.5 MG/ML Solution 30 Generic

Morphine Sulfate/PF 1 MG/ML Solution 30 Generic

Morphine Sulfate/PF 1 MG/ML Solution 30 Generic

Morphine Sulfate/PF 10 MG/ML Solution 30 Brand

Morphine Sulfate/PF 25 MG/ML Solution 30 Brand

Moxifloxacin HCL 0.5% Drops 3 Generic

Moxifloxacin HCL 400 MG Tablet 5 Generic

Moxifloxacin in Na Cl (ISO-OSM) 400 MG/.25l Piggyback 30 Generic

Multivitamin w/ Folic Acid 1 MG 1 MG Capsule 30 Brand

Mupirocin 2% Ointment 22 Generic

Mycophenolate Mofetil 250 MG Capsule 60 Generic

Mycophenolate Sodium 180 MG Tablet DR/EC 60 Generic

Nabumetone 500 MG Tablet 30 Generic

Nabumetone 750 MG Tablet 20 Generic

Nadolol 20 MG Tablet 30 Generic

Nadolol 40 MG Tablet 15 Generic

Nadolol 80 MG Tablet 15 Generic

Naftifine HCL 1% Cream 30 Generic

Nalbuphine HCL 20 MG/ML Solution 10 Generic

Naltrexone HCL 50 MG Tablet 30 Generic

Naproxen 125 MG/5 ML Suspension 120 Generic

Naproxen 250 MG Tablet 10 Generic

Naproxen 375 MG Tablet 14 Generic

Naproxen 375 MG Tablet DR/EC 6 Generic

Naproxen 500 MG Tablet 30 Generic

Naproxen 500 MG Tablet DR/EC 30 Generic

Naproxen Sodium 275 MG Tablet 30 Generic

Naproxen Sodium 550 MG Tablet 30 Generic

Naratriptan HCL 1 MG Tablet 5 Generic

Naratriptan HCL 2.5 MG Tablet 6 Generic

Nateglinide 120 MG Tablet 30 Generic

Name/Strength/Form Default Qty. Brand/Generic

Nateglinide 60 MG Tablet 30 Generic

Nebivolol HCL 20 MG Tablet 15 Brand

Needles & Syringes 3 ML / 22 Generic / 1.5 Inch Syringe 30 Brand

Needles & Syringes 3 ML / 25 Generic / 1 Inch Syringe 30 Brand

Nefazodone HCL 100 MG Tablet 30 Brand

Nefazodone HCL 200 MG Tablet 30 Brand

Nefazodone HCL 250 MG Tablet 60 Generic

Nefazodone HCL 50 MG Tablet 30 Generic

Neo/Polymyx Brand Sulf/Dexameth 3.5-10 K-.1 Ointment 4 Generic

Neomycin Su/Bacitra/Polymyxin 3.5 MG-400 Ointment 10 Generic

Neomycin Su/Polymyx Brand Sulf 40-200 K/ML Solution 1 Generic

Neomycin Sulfate 500 MG Tablet 20 Generic

Neomycin/Fluocinolone/Emol #65 0.5-0.025% Cream 30 Brand

Neomycin/Polymyx Brand Sulf/Dexamethasone 0.1% Susp Drops 30 Generic

Neostigmine Methylsulfate 0.5 MG/ML Solution 30 Brand

Nevirapine 50 MG/5 ML Suspension 4 Generic

Niacin 1000 MG Tablet 24-Hr ER 30 Generic

Niacin 500 MG Tablet 24-Hr ER 30 Generic

Niacin 750 MG Tablet 24-Hr ER 30 Generic

Nicardipine in Na Cl, ISO-OSM 40 MG/200 ML Piggyback 30 Brand

Nifedipine 10 MG Capsule 30 Generic

Nifedipine 20 MG Capsule 30 Generic

Nifedipine 30 MG Tablet ER 30 Generic

Nifedipine 60 MG Tablet ER 30 Generic

Nifedipine 90 MG Tablet 24-Hr ER 30 Generic

Nifedipine 90 MG Tablet ER 30 Generic

Nisoldipine 20 MG Tablet 24-Hr ER 5 Brand

Nisoldipine 34 MG Tablet 24-Hr ER 30 Generic

Nitrofurantoin 25 MG/5 ML Suspension 60 Generic

Nitrofurantoin Macro-crystal 100 MG Capsule 10 Generic

Nitrofurantoin Macro-crystal 50 MG Capsule 30 Generic

Nitrofurantoin Monohyd/M-Cryst 100 MG Capsule 30 Generic

Nitroglycerin 0.1 MG/Hr 24-Hr Patch 10 Generic

Nitroglycerin 0.2 MG/Hr 24-Hr Patch 30 Generic

Nitroglycerin 0.4 MG/Hr 24-Hr Patch 30 Generic

Nitroglycerin 0.4% (W/W) Ointment 30 Brand

Nitroglycerin 0.6 MG/Hr 24-Hr Patch 30 Generic

Nitroglycerin 400 MCG/Spray Non-Aerosol Spray 5 Generic

Nitroglycerin 6.5 MG Capsule ER 90 Generic

Nitroglycerin Tablets 0.3 MG Sublingual Tablet 100 Brand

Nitroglycerin Tablets 0.4 MG Sublingual Tablet 30 Brand

Nitroglycerin Tablets 0.6 MG Sublingual Tablet 100 Brand

Nizatidine 15 MG/ML Solution (Oral) 30 Brand

Nizatidine 150 MG Capsule 30 Generic

Noreth-Ethinyl Estradiol/Iron 0.4-35 (21) Chewable Tablet 28 Generic

Noreth-Ethinyl Estradiol/Iron 0.8-25 (24) Chewable Tablet 28 Generic

Norethindrone 0.35 MG Tablet 28 Generic

Norethindrone Acetate 5 MG Tablet 30 Generic

Norethindrone Ac-Eth Estradiol 0.5 MG-2.5 Tablet 28 Generic

Norethindrone Ac-Eth Estradiol 1 MG-20 MCG Tablet 21 Generic

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Name/Strength/Form Default Qty. Brand/Generic

Norethindrone Ac-Eth Estradiol 1 MG-5 MCG Tablet 28 Generic

Norethindrone Ac-Eth Estradiol 1.5-0.03 MG Tablet 21 Generic

Norethindrone-E.estradiol-Iron 1 MG-20(21) Tablet 28 Generic

Norethindrone-E.estradiol-Iron 1.5-30(21) Tablet 28 Generic

Norethindrone-E.estradiol-Iron 5-7-9-7 Tablet 28 Generic

Norethindrone-Ethinyl Estrad 0.4-0.035 Tablet 28 Generic

Norethindrone-Ethinyl Estrad 0.5-0.035 Tablet 28 Generic

Norethindrone-Ethinyl Estrad 1 MG-35 MCG Tablet 28 Generic

Norethindrone-Ethinyl Estrad 7 Days x3 Tablet 28 Generic

Norethindrone-Ethinyl Estrad 7-9-5 Tablet 28 Generic

Norgestimate-Ethinyl Estradiol .18-.215-.25---.025 7 Days x3 Lo Tablet 28 Generic

Norgestimate-Ethinyl Estradiol .18-.215-.25---.035 7 Days x3 28 Tablet 28 Generic

Norgestimate-Ethinyl Estradiol 0.25-0.035 Tablet 28 Generic

Norgestrel-Ethinyl Estradiol 0.3-0.03 MG Tablet 28 Generic

Norgestrel-Ethinyl Estradiol 0.5 MG-50 Tablet 28 Brand

Nortriptyline HCL 10 MG Capsule 30 Generic

Nortriptyline HCL 25 MG Capsule 30 Generic

Nortriptyline HCL 50 MG Capsule 30 Generic

Nortriptyline HCL 75 MG Capsule 30 Generic

Nystatin 100000/Generic Cream 15 Generic

Nystatin 100000/Generic Ointment 15 Generic

Nystatin 100000/ML Suspension 60 Generic

Nystatin 500k Unit Tablet 30 Generic

Nystatin/Triamcin 100000-0.1 Cream 30 Generic

Nystatin/Triamcin 100000-0.1 Ointment 30 Generic

Olanzapine 2.5 MG Tablet 15 Generic

Olanzapine 5 MG Disintegrating Tablet 14 Generic

Olanzapine 5 MG Tablet 15 Generic

Olanzapine 7.5 MG Tablet 14 Generic

Olanzapine/Fluoxetine HCL 6 MG-25 MG Capsule 15 Generic

Olmesartan Medoxomil 20 MG Tablet 30 Generic

Olmesartan Medoxomil 40 MG Tablet 30 Generic

Olmesartan Medoxomil 5 MG Tablet 30 Generic

Olmesartan/Hydrochlorothiazide 20-12.5 MG Tablet 30 Generic

Olmesartan/Hydrochlorothiazide 40-12.5 MG Tablet 30 Generic

Olopatadine HCL 0.1% Drops 5 Generic

Olopatadine HCL 0.6% Non-Aerosol Spray 30 Generic

Omega-3 Acid Ethyl Esters 1 Generic Capsule 30 Generic

Omeprazole 20 MG Capsule DR/EC 30 Generic

Omeprazole 40 MG Capsule DR/EC 30 Generic

Once Daily Multivitamin N/A Tablet 30 Generic

Ondansetron HCL 2 MG/ML Solution 30 Generic

Ondansetron HCL 4 MG/5 ML Solution 15 Generic

Ondansetron HCL/PF 4 MG/2 ML Syringe 30 Generic

Orlistat 120 MG Capsule 30 Brand

Orphenadrine Citrate 100 MG Tablet ER 30 Generic

Oseltamivir Phosphate 30 MG Capsule 20 Generic

Oseltamivir Phosphate 45 MG Capsule 10 Generic

Oseltamivir Phosphate 6 MG/ML Suspension for Reconstitution 60 Generic

Oseltamivir Phosphate 75 MG Capsule 10 Generic

Name/Strength/Form Default Qty. Brand/Generic

Oxandrolone 2.5 MG Tablet 30 Generic

Oxaprozin 600 MG Tablet 30 Generic

Oxazepam 10 MG Capsule 30 Generic

Oxazepam 15 MG Capsule 6 Generic

Oxazepam 30 MG Capsule 12 Brand

Oxcarbazepine 150 MG Tablet 30 Generic

Oxcarbazepine 300 MG Tablet 30 Generic

Oxcarbazepine 300 MG/5 ML Suspension 150 Generic

Oxcarbazepine 600 MG Tablet 60 Generic

Oxybutynin Chloride 10 MG Tablet 24-Hr ER 30 Generic

Oxybutynin Chloride 15 MG Tablet 24-Hr ER 30 Generic

Oxybutynin Chloride 5 MG Tablet 30 Generic

Oxybutynin Chloride 5 MG Tablet 24-Hr ER 30 Generic

Oxybutynin Chloride 5 MG/5 ML Syrup 100 Generic

Oxycodone HCL 10 MG Tablet 30 Generic

Oxycodone HCL 15 MG Tablet 60 Generic

Oxycodone HCL 20 MG Tablet 40 Generic

Oxycodone HCL 30 MG Tablet 60 Generic

Oxycodone HCL 5 MG Capsule 30 Generic

Oxycodone HCL 5 MG Tablet 30 Generic

Oxycodone HCL 5 MG/5 ML Solution 15 Generic

Oxycodone HCL ER (Generic) 10 MG Oral Tablet 12-Hr ER 30 Brand

Oxycodone HCL/Acetaminophen 10 MG-325 MG Tablet 30 Generic

Oxycodone HCL/Acetaminophen 2.5-325 MG Tablet 8 Generic

Oxycodone HCL/Acetaminophen 5 MG-325 MG Tablet 30 Generic

Oxycodone HCL/Acetaminophen 7.5-325 MG Tablet 20 Generic

Oxycodone HCL/Aspirin 4.8355-325 Tablet 30 Generic

Oxymorphone HCL 10 MG Tablet 30 Generic

Oxymorphone HCL 5 MG Oral Tablet 12-Hr ER 30 Brand

Oxymorphone HCL 5 MG Tablet 30 Generic

Oxymorphone HCL ER 20 MG Tablet 12-Hr ER 30 Generic

Oxyquinoline/Sod.lauryl Sulfate 0.025-0.01 Gel 30 Brand

Oxytocin 10 Unit/ML Solution 30 Generic

Paliperidone 3 MG Tablet 24-Hr ER 6 Generic

Pantoprazole Sodium 20 MG Tablet DR/EC 30 Generic

Pantoprazole Sodium 40 MG Tablet DR/EC 30 Generic

Parenteral Amino Acid 10% No.4 10% Parenteral Solution 30 Brand

Parenteral Amino Acid 15% No. 1 15% Parenteral Solution 30 Generic

Paroxetine HCL 10 MG Tablet 15 Generic

Paroxetine HCL 12.5 MG Tablet 24-Hr ER 30 Generic

Paroxetine HCL 20 MG Tablet 30 Generic

Paroxetine HCL 25 MG Tablet 24-Hr ER 30 Generic

Paroxetine HCL 30 MG Tablet 15 Generic

Paroxetine HCL 37.5 MG Tablet 24-Hr ER 30 Generic

Paroxetine HCL 40 MG Tablet 15 Generic

Pedi MVI No.12/Sodium Fluoride 0.25 MG Chewable Tablet 25 Generic

Pedi MVI No.12/Sodium Fluoride 0.5 MG Chewable Tablet 30 Generic

Pedi MVI No.12/Sodium Fluoride 1 MG Chewable Tablet 30 Generic

Pedi MVI No.16 w/ Fluoride 0.25 MG Chewable Tablet 30 Generic

Pedi MVI No.16 w/ Fluoride 0.5 MG Chewable Tablet 30 Generic

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Name/Strength/Form Default Qty. Brand/Generic

Pedi MVI No.16 w/ Fluoride 1 MG Chewable Tablet 30 Generic

Pen Needles 5mm / 31 Generic (3/16") Pen Needles 30 Generic

Penicillin V Potassium 250 MG Tablet 30 Generic

Penicillin V Potassium 500 MG Tablet 30 Generic

Pentazocine HCL/Naloxone HCL 50 MG-0.5 MG Tablet 30 Generic

Pentoxifylline 400 MG Tablet ER 30 Generic

Perindopril Erbumine 2 MG Tablet 30 Generic

Perindopril Erbumine 4 MG Tablet 30 Generic

Perindopril Erbumine 8 MG Tablet 30 Generic

Permethrin 5% Cream 60 Generic

Perphenazine 16 MG Tablet 30 Generic

Perphenazine 4 MG Tablet 45 Generic

Perphenazine 8 MG Tablet 30 Generic

Perphenazine/Amitriptyline HCL 2 MG-10 MG Tablet 30 Brand

Perphenazine/Amitriptyline HCL 2 MG-25 MG Tablet 30 Brand

Petrolatum,White 61% Cream 30 Generic

Phenazopyridine HCL 100 MG Tablet 30 Generic

Phenazopyridine HCL 200 MG Tablet 30 Generic

Phendimetrazine Tartrate 35 MG Tablet 30 Generic

Phenelzine Sulfate 15 MG Tablet 30 Generic

Phenobarbital 100 MG Tablet 30 Generic

Phenobarbital 15 MG Tablet 30 Brand

Phenobarbital 16.2 MG Tablet 30 Generic

Phenobarbital 20 MG/5 ML Elixir 300 Generic

Phenobarbital 30 MG Tablet 30 Generic

Phenobarbital 60 MG Tablet 10 Generic

Phenobarbital 64.8 MG Tablet 30 Generic

Phentermine HCL 15 MG Capsule 30 Generic

Phentermine HCL 30 MG Capsule 30 Generic

Phentermine HCL 37.5 MG Capsule 30 Generic

Phentermine HCL 37.5 MG Tablet 30 Generic

Phentermine/Topiramate 3.75-23 MG Multiphase Capsule 24-Hr ER 5 Brand

Phenytoin 50 MG Chewable Tablet 30 Generic

Phenytoin Sodium Extended 100 MG Capsule 90 Generic

Phenytoin Sodium Extended 30 MG Capsule 30 Brand

Phenytoin Sodium Extended 300 MG Capsule 14 Brand

Phosphorus #1 250 MG Tablet 30 Generic

Pilocarpine HCL 1% Drops 30 Generic

Pilocarpine HCL 2% Drops 15 Generic

Pilocarpine HCL 5 MG Tablet 90 Generic

Pimozide 1 MG Tablet 30 Generic

Pimozide 2 MG Tablet 30 Generic

Pindolol 10 MG Tablet 30 Generic

Pindolol 5 MG Tablet 15 Generic

Pioglitazone HCL 15 MG Tablet 30 Generic

Pioglitazone HCL 30 MG Tablet 30 Generic

Pioglitazone HCL 45 MG Tablet 30 Generic

Pioglitazone HCL/Metformin HCL 15 MG-850 MG Tablet 30 Generic

Piroxicam 10 MG Capsule 30 Generic

Piroxicam 20 MG Capsule 30 Generic

Name/Strength/Form Default Qty. Brand/Generic

PNV #15/Iron Fum,PS/Folic Acid 85 MG-1 MG Capsule 30 Brand

PNV Prenatal Plus Tablet 27 MG-1 MG Tablet 30 Brand

Pnv39/Iron Fumarate/FA/DSS/DHA 30-1.2-55 Capsule 30 Brand

Podofilox 0.5% Solution 4 Generic

Polyethylene Glycol 3350 17 Generic Powder in Packet 30 Generic

Polymyxin Brand Sulf/Trimethoprim 10000-1/ML Drops 30 Generic

Polyvinyl Alcohol 1.4% Drops 30 Generic

Pot Chloride/Pot Bicarb/Cit Ac 25 MEQ Effervescent Tablet 30 Generic

Potassium Aminobenzoate 500 MG Capsule 30 Brand

Potassium Bicarbonate/Cit Ac 10 MEQ Effervescent Tablet 15 Brand

Potassium Bicarbonate/Cit Ac 20 MEQ Effervescent Tablet 30 Brand

Potassium Bicarbonate/Cit Ac 25 MEQ Effervescent Tablet 30 Generic

Potassium Chloride 10 MEQ Capsule ER 30 Generic

Potassium Chloride 10 MEQ Particles/Crystals Tablet ER 30 Generic

Potassium Chloride 10 MEQ Tablet ER 30 Generic

Potassium Chloride 15 MEQ Particles/Crystals Tablet ER 30 Brand

Potassium Chloride 20 MEQ Packet 30 Generic

Potassium Chloride 20 MEQ Particles/Crystals Tablet ER 30 Generic

Potassium Chloride 20 MEQ Tablet ER 30 Generic

Potassium Chloride 20 MEQ/15 ML Liquid 240 Generic

Potassium Chloride 40 MEQ/15 ML Liquid 100 Generic

Potassium Chloride 8 MEQ Capsule ER 15 Generic

Potassium Chloride 8 MEQ Tablet ER 30 Generic

Potassium Citrate 10 MEQ Tablet ER 30 Generic

Potassium Citrate 15 MEQ Tablet ER 30 Generic

Potassium Citrate 5 MEQ Tablet ER 30 Generic

Potassium Citrate/Citric Acid 1100-334/5 Solution 540 Generic

Potassium Citrate/Citric Acid 3300-1002 Packet 60 Generic

Potassium Phosphate, Mono-basic 500 MG Soluble Tablet 30 Brand

Povidone-Iodine 5% Solution 30 Brand

Pramipexole Di-HCL 0.125 MG Tablet 30 Generic

Pramipexole Di-HCL 0.25 MG Tablet 30 Generic

Pramipexole Di-HCL 0.5 MG Tablet 30 Generic

Pramipexole Di-HCL 0.75 MG Tablet 30 Generic

Pramipexole Di-HCL 1 MG Tablet 30 Generic

Pramipexole Di-HCL 1.5 MG Tablet 30 Generic

Pramoxine HCL/Calamine 1%-8% Lotion 30 Generic

Pravastatin Sodium 10 MG Tablet 30 Generic

Pravastatin Sodium 20 MG Tablet 30 Generic

Pravastatin Sodium 40 MG Tablet 30 Generic

Pravastatin Sodium 80 MG Tablet 30 Generic

Prazosin HCL 1 MG Capsule 30 Generic

Prazosin HCL 2 MG Capsule 30 Generic

Prazosin HCL 5 MG Capsule 30 Generic

Prednisolone Acetate 1% Suspension Drops 5 Generic

Prednisolone Sod Phosphate 1% Drops 10 Brand

Prednisolone Sod Phosphate 10 MG Disintegrating Tablet 5 Generic

Prednisolone Sod Phosphate 15 MG Disintegrating Tablet 3 Generic

Prednisolone Sod Phosphate 15 MG/5 ML Solution 30 Generic

Prednisolone Sod Phosphate 30 MG Disintegrating Tablet 3 Generic

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Name/Strength/Form Default Qty. Brand/Generic

Prednisolone Sod Phosphate 5 MG/5 ML Solution 30 Generic

Prednisone 1 MG Tablet 30 Generic

Prednisone 10 MG Tablet 30 Generic

Prednisone 10 MG Tablet Dose Pack 30 Generic

Prednisone 2.5 MG Tablet 15 Generic

Prednisone 20 MG Tablet 5 Generic

Prednisone 5 MG Tablet 30 Generic

Prednisone 5 MG Tablet Dose Pack 21 Brand

Prednisone 50 MG Tablet 5 Brand

Pregabalin 20 MG/ML Solution 30 Brand

Prilosec 10 MG Capsule DR/EC 30 Generic

Primidone 250 MG Tablet 30 Generic

Primidone 50 MG Tablet 30 Generic

Probenecid 500 MG Tablet 30 Generic

Prochlorperazine Maleate 10 MG Tablet 30 Generic

Prochlorperazine Maleate 5 MG Tablet 15 Generic

Progesterone IM in Oil 50 MG/ML 50 MG/ML Oil 30 Generic

Progesterone, Micronized 100 MG Capsule 10 Generic

Progesterone, Micronized 200 MG Capsule 30 Generic

Promethazine HCL 12.5 MG Suppository 5 Generic

Promethazine HCL 12.5 MG Tablet 10 Generic

Promethazine HCL 25 MG Suppository 5 Generic

Promethazine HCL 25 MG Tablet 10 Generic

Promethazine HCL 25 MG/ML Solution 25 Generic

Promethazine HCL 50 MG Tablet 30 Generic

Promethazine HCL 6.25 MG/5 ML Syrup 60 Generic

Promethazine HCL/Codeine 6.25-10/5 Syrup 120 Generic

Promethazine/Dextromethorphan 6.25-15 MG/5 ML Syrup 30 Generic

Promethazine/Phenyleph/Codeine 6.25-5-10 Syrup 120 Generic

Promethazine-Phenylephrine .025 MG/24-Hr Syrup 30 Generic

Propafenone HCL 150 MG Tablet 30 Generic

Propafenone HCL 225 MG Capsule 12-Hr ER 30 Generic

Propafenone HCL 225 MG Tablet 30 Generic

Propafenone HCL 300 MG Tablet 30 Generic

Proparacaine HCL 0.5% Drops 15 Generic

Propranolol HCL 10 MG Tablet 30 Generic

Propranolol HCL 120 MG Capsule 24-Hr ER 30 Generic

Propranolol HCL 160 MG Capsule 24-Hr ER 30 Generic

Propranolol HCL 20 MG Tablet 30 Generic

Propranolol HCL 20 MG/ML Solution 30 Generic

Propranolol HCL 40 MG Tablet 30 Generic

Propranolol HCL 60 MG Capsule 24-Hr ER 30 Generic

Propranolol HCL 60 MG Tablet 30 Generic

Propranolol HCL 80 MG Capsule 24-Hr ER 30 Generic

Propranolol HCL 80 MG Tablet 30 Generic

Propranolol/Hydrochlorothiazid 80 MG-25 MG Tablet 30 Brand

Propylthiouracil 50 MG Tablet 30 Generic

Protriptyline HCL 5 MG Tablet 30 Generic

Pseudoephedrine HCL 60 MG Tablet 30 Generic

Pyridostigmine Bromide 60 MG Tablet 30 Generic

Name/Strength/Form Default Qty. Brand/Generic

Pyridostigmine Bromide 60 MG/5 ML Syrup 30 Brand

Quetiapine Fumarate 100 MG Tablet 15 Generic

Quetiapine Fumarate 25 MG Tablet 15 Generic

Quetiapine Fumarate 50 MG Tablet 30 Generic

Quetiapine Fumarate ER 50 MG Tablet 24-Hr ER 30 Generic

Quinapril HCL 10 MG Tablet 30 Generic

Quinapril HCL 20 MG Tablet 30 Generic

Quinapril HCL 40 MG Tablet 30 Generic

Quinapril HCL 5 MG Tablet 30 Generic

Quinapril/Hydrochlorothiazide 10-12.5 MG Tablet 30 Generic

Quinapril/Hydrochlorothiazide 20 MG-25 MG Tablet 30 Generic

Quinapril/Hydrochlorothiazide 20-12.5 MG Tablet 30 Generic

Quinidine Sulfate 200 MG Tablet 30 Brand

Quinidine Sulfate 300 MG Tablet 45 Brand

Quinine Sulfate 324 MG Capsule 30 Generic

Rabeprazole Sodium 20 MG Tablet DR/EC 30 Generic

Raloxifene HCL 60 MG Tablet 30 Generic

Raltegravir Potassium 25 MG Chewable Tablet 30 Brand

Ramipril 1.25 MG Capsule 30 Generic

Ramipril 10 MG Capsule 30 Generic

Ramipril 2.5 MG Capsule 30 Generic

Ramipril 5 MG Capsule 30 Generic

Ranitidine HCL 15 MG/ML Syrup 60 Generic

Ranitidine HCL 150 MG Capsule 30 Generic

Ranitidine HCL 150 MG Tablet 30 Generic

Ranitidine HCL 300 MG Capsule 30 Generic

Ranitidine HCL 300 MG Tablet 30 Generic

Repaglinide 0.5 MG Tablet 30 Generic

Repaglinide 1 MG Tablet 60 Generic

Repaglinide 2 MG Tablet 90 Generic

Ribavirin 40 MG/ML Solution 30 Brand

Rifampin 150 MG Capsule 20 Generic

Rifampin 300 MG Capsule 30 Generic

Rimantadine HCL 100 MG Tablet 20 Generic

Risedronate Sodium 150 MG Tablet 1 Generic

Risedronate Sodium 35 MG Tablet 4 Generic

Risedronate Sodium 5 MG Tablet 30 Generic

Risperidone 0.25 MG Tablet 30 Generic

Risperidone 0.5 MG Disintegrating Tablet 28 Generic

Risperidone 0.5 MG Tablet 30 Generic

Risperidone 1 MG Disintegrating Tablet 15 Generic

Risperidone 1 MG Tablet 30 Generic

Risperidone 1 MG/ML Solution 30 Generic

Risperidone 2 MG Tablet 30 Generic

Risperidone 3 MG Tablet 15 Generic

Rivastigmine Tartrate 1.5 MG Capsule 60 Generic

Rivastigmine Tartrate 3 MG Capsule 30 Generic

Rivastigmine Tartrate 4.5 MG Capsule 60 Generic

Rivastigmine Tartrate 6 MG Capsule 30 Generic

Rizatriptan Benzoate 10 MG Disintegrating Tablet 10 Generic

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Name/Strength/Form Default Qty. Brand/Generic

Rizatriptan Benzoate 10 MG Tablet 10 Generic

Rizatriptan Benzoate 5 MG Disintegrating Tablet 6 Generic

Rizatriptan Benzoate 5 MG Tablet 6 Generic

Ropinirole HCL 0.25 MG Tablet 30 Generic

Ropinirole HCL 0.5 MG Tablet 30 Generic

Ropinirole HCL 1 MG Tablet 30 Generic

Ropinirole HCL 12 MG Tablet 24-Hr ER 3 Generic

Ropinirole HCL 2 MG Tablet 30 Generic

Ropinirole HCL 2 MG Tablet 24-Hr ER 30 Generic

Ropinirole HCL 3 MG Tablet 30 Generic

Ropinirole HCL 4 MG Tablet 30 Generic

Ropinirole HCL 4 MG Tablet 24-Hr ER 15 Generic

Ropinirole HCL 5 MG Tablet 30 Generic

Ropinirole HCL 6 MG Tablet 24-Hr ER 15 Generic

Ropinirole HCL 8 MG Tablet 24-Hr ER 30 Generic

Ropivacaine HCL/PF 2 MG/ML Solution 30 Generic

Ropivacaine HCL/PF 5 MG/ML Solution 30 Generic

Ropivacaine HCL/PF 7.5 MG/ML Solution 30 Brand

Rosiglitazone Maleate 2 MG Tablet 30 Brand

Rosuvastatin Calcium 10 MG Tablet 30 Generic

Rosuvastatin Calcium 20 MG Tablet 30 Generic

Rosuvastatin Calcium 40 MG Tablet 30 Generic

Rosuvastatin Calcium 5 MG Tablet 15 Generic

Salicylic Acid 17% Gel 7 Generic

Salicylic Acid 6% Combo Pack 400 Generic

Salicylic Acid 6% Cream 400 Generic

Salicylic Acid 6% Lotion 414 Generic

Salicylic Acid 6%-6% Shampoo & Gel Kit 1 Brand

Salsalate 500 MG Tablet 30 Generic

Salsalate 750 MG Tablet 90 Generic

Selegiline HCL 5 MG Capsule 90 Generic

Selenium Sulfide 2.5% Prescription Only 2.5% Shampoo 30 Generic

Sertraline HCL 20 MG/ML Concentrate 30 Generic

Sertraline HCL 25 MG Tablet 15 Generic

Sertraline HCL 50 MG Tablet 15 Generic

Sildenafil Citrate 100 MG Tablet 3 Generic

Sildenafil Citrate 25 MG Tablet 3 Generic

Sildenafil Citrate 50 MG Tablet 5 Generic

Silodosin 4 MG Capsule 30 Generic

Silver Sulfadiazine 1% Cream 20 Generic

Simvastatin 10 MG Tablet 30 Generic

Simvastatin 20 MG Tablet 30 Generic

Simvastatin 40 MG Tablet 30 Generic

Simvastatin 5 MG Tablet 30 Generic

Simvastatin 80 MG Tablet 15 Generic

Sirolimus 1 MG Tablet 15 Generic

Sod/Pot/K Cit/Sod Cit/Cit Acid 500-550/5 Solution 30 Brand

Sodium Bicarbonate 0.48 MEQ/ML Solution 30 Brand

Sodium Chloride 0.9% Vial 30 Generic

Sodium Chloride for Inhalation 3.5% Solution for Nebulization 240 Brand

Name/Strength/Form Default Qty. Brand/Generic

Sodium Chloride for Inhalation 6% Solution for Nebulization 30 Brand

Sodium Chloride for Inhalation 7% Solution for Nebulization 360 Generic

Sodium Fluoride 0.125/Drop Drops 30 Generic

Sodium Fluoride 0.2% Solution 473 Generic

Sodium Fluoride 0.25 MG/0.6 Drops 60 Brand

Sodium Fluoride 0.25(0.55) Chewable Tablet 30 Generic

Sodium Fluoride 0.5 MG/ML Drops 50 Generic

Sodium Fluoride 0.5(1.1)MG Chewable Tablet 30 Generic

Sodium Fluoride 1 MG(2.2 MG) Chewable Tablet 30 Generic

Sodium Fluoride 1.1% Cream 51 Brand

Sodium Fluoride 1.1% Gel 60 Generic

Sodium Fluoride 1.1% Gel 100 Brand

Sodium Fluoride 2.5 MG/ML Drops 30 Generic

Sodium Fluoride Paste 1.1% Paste 30 Brand

Sodium Fluoride/Potassium Nit 1.1%-5% Paste 100 Brand

Sodium Polystyrene Sulfonate 15 Generic/60 ML Suspension 60 Generic

Sodium Polystyrene Sulfonate 30 Generic/120 ML Enema 30 Generic

Sodium Polystyrene Sulfonate N/A Powder 30 Generic

Sodium/K+/Mag/Ca/Chlor/Acetate 35-20-5 MEQ Solution 30 Generic

Sotalol HCL 120 MG Tablet 30 Generic

Sotalol HCL 160 MG Tablet 30 Generic

Sotalol HCL 240 MG Tablet 6 Generic

Sotalol HCL 5 MG/ML Solution 30 Brand

Sotalol HCL 80 MG Tablet 15 Generic

Spironolactone 100 MG Tablet 30 Generic

Spironolactone 25 MG Tablet 30 Generic

Spironolactone 50 MG Tablet 30 Generic

Spironolactone/Hydrochlorothiazide 25 MG-25 MG Tablet 30 Generic

Stannous Fluoride 0.4% Gel 122 Generic

Stavudine 1 MG/ML Recon Solution 30 Brand

Succinylcholine Chloride 20 MG/ML Solution 30 Generic

Sucralfate 1 Generic Tablet 30 Generic

Sufentanil Citrate 50 MCG/ML Solution 30 Generic

Sulfacetamide Sod/Sulfur/Urea 10%-5%-10% Cleanser 30 Brand

Sulfacetamide Sodium 10% Cleanser 180 Generic

Sulfacetamide Sodium 10% Cleanser ER 30 Generic

Sulfacetamide Sodium 10% Drops 5 Generic

Sulfacetamide Sodium 10% Ointment 4 Brand

Sulfacetamide Sodium 10% Shampoo 30 Brand

Sulfacetamide Sodium 10% Suspension 118 Generic

Sulfacetamide Sodium/Sulfur 10-5% (W/W) Cleanser 227 Generic

Sulfacetamide Sodium/Sulfur 9%-4.5% Cleanser 454 Generic

Sulfacetamide/Prednisolone Sp 10%-0.23% Drops 5 Generic

Sulfamethoxazole/Trimethoprim 200-40 MG/5 Suspension 100 Generic

Sulfamethoxazole/Trimethoprim 400 MG-80 MG Tablet 30 Generic

Sulfamethoxazole/Trimethoprim 800-160 MG Tablet 20 Generic

Sulfasalazine 500 MG Tablet 90 Generic

Sulfasalazine 500 MG Tablet DR/EC 90 Generic

Sulindac 150 MG Tablet 28 Generic

Sulindac 200 MG Tablet 30 Generic

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19 of 21 2020 TIER ONE FORMULARY

A B C D E F G–H I K–L M N O–P Q–R S T U–V W–Z SUBSCRIPTION DETAILS

Name/Strength/Form Default Qty. Brand/Generic

Sumatriptan 100 MG Tablet 9 Generic

Sumatriptan 25 MG Tablet 9 Generic

Sumatriptan 4 MG/0.5 ML Pen Injector 1 Generic

Sumatriptan 50 MG Tablet 10 Generic

Sumatriptan 6 MG/0.5 ML Solution 1 Generic

Synthroid (Brand) 50 MCG Tablet 30 Generic

Tacrolimus 0.03% Ointment 30 Generic

Tacrolimus 0.1% Ointment 30 Generic

Tacrolimus 0.5 MG Capsule 30 Generic

Tacrolimus 0.5 MG Capsule 24-Hr ER 30 Brand

Tacrolimus 1 MG Capsule 60 Generic

Tadalafil Tablets 2.5 MG Tablet 18 Generic

Tadalafil Tablets 20 MG Tablet 3 Generic

Tadalafil Tablets 5 MG Tablet 6 Generic

Tamoxifen Citrate 10 MG Tablet 30 Generic

Tamoxifen Citrate 20 MG Tablet 30 Generic

Tamsulosin HCL 0.4 MG Capsule 24-Hr ER 30 Generic

Telmisartan 40 MG Tablet 30 Generic

Telmisartan 80 MG Tablet 30 Generic

Telmisartan/Amlodipine 80 MG-5 MG Tablet 10 Generic

Telmisartan/Hydrochlorothiazid 40-12.5 MG Tablet 30 Generic

Telmisartan/Hydrochlorothiazid 80 MG-25 MG Tablet 30 Generic

Telmisartan/Hydrochlorothiazid 80-12.5 MG Tablet 30 Generic

Temazepam 15 MG Capsule 30 Generic

Temazepam 22.5 MG Capsule 15 Generic

Temazepam 30 MG Capsule 15 Generic

Temazepam 7.5 MG Capsule 15 Generic

Temozolomide 20 MG Capsule 5 Generic

Terazosin HCL 1 MG Capsule 30 Generic

Terazosin HCL 10 MG Capsule 30 Generic

Terazosin HCL 2 MG Capsule 30 Generic

Terazosin HCL 5 MG Capsule 30 Generic

Terbutaline Sulfate 2.5 MG Tablet 20 Generic

Terconazole 0.4% Cream 45 Generic

Terconazole 0.8% Cream 20 Generic

Terconazole 80 MG Suppository 3 Generic

Testosterone 50 MG (1%) Gel 30 Generic

Testosterone Cypionate 100 MG/ML Oil 10 Generic

Testosterone Cypionate 200 MG/ML Oil Injection 1 Generic

Testosterone Enanthate 200 MG/ML Oil 5 Generic

Tetracaine HCL 0.5% Drops 15 Generic

Tetracaine HCL 0.5% Viscous Dropperette 30 Generic

Tetracaine HCL 0.5% Viscous Drops 30 Generic

Tetracycline HCL 250 MG Capsule 30 Generic

Theophylline Anhydrous 100 MG Tablet 12-Hr ER 30 Generic

Theophylline Anhydrous 200 MG Tablet 12-Hr ER 30 Generic

Theophylline Anhydrous 400 MG Tablet 12-Hr ER 30 Generic

Theophylline Anhydrous 400 MG Tablet ER 30 Generic

Theophylline Anhydrous 600 MG Tablet ER 30 Generic

Thiamine HCL 100 MG Tablet 30 Generic

Name/Strength/Form Default Qty. Brand/Generic

Thioridazine HCL 10 MG Tablet 90 Generic

Thioridazine HCL 100 MG Tablet 90 Generic

Thioridazine HCL 25 MG Tablet 30 Generic

Thioridazine HCL 50 MG Tablet 5 Generic

Thiothixene 1 MG Capsule 30 Generic

Thiothixene 2 MG Capsule 30 Generic

Thiothixene 5 MG Capsule 30 Generic

Thyroid (Pork) 120mg (2gr) Tablet 30 Generic

Thyroid, Pork 113.75 MG (1.75 Grain) Tablet 30 Brand

Thyroid, Pork 146.25 MG (2.25 Grain) Tablet 30 Brand

Thyroid, Pork 15 MG Tablet 30 Brand

Thyroid, Pork 16.25 MG (0.25 Grain) Tablet 30 Brand

Thyroid, Pork 162.5 MG (2.5 Grain) Tablet 30 Brand

Thyroid, Pork 180 MG Tablet 30 Brand

Thyroid, Pork 240 MG Tablet 30 Brand

Thyroid, Pork 300 MG Tablet 30 Brand

Thyroid, Pork 32.5 MG (0.5 Grain) Tablet 30 Brand

Thyroid, Pork 325 MG (5 Grain) Tablet 30 Brand

Thyroid, Pork 48.75 MG (3/4 Grain) Tablet 30 Brand

Thyroid, Pork 65 MG (1 Grain) Tablet 30 Brand

Thyroid, Pork 81.25 MG (1.25 Grain) Tablet 30 Brand

Thyroid, Pork 97.5 MG (1.5 Grain) Tablet 30 Brand

Thyroid, Pork 130 MG Tablet 30 Brand

Thyroid, Pork 195 MG Tablet 15 Brand

Ticlopidine HCL 250 MG Tablet 30 Generic

Timolol Maleate 0.25% Drops 5 Generic

Timolol Maleate 0.25% Gel Forming Solution 5 Generic

Timolol Maleate 0.5% Drops 5 Generic

Timolol Maleate 0.5% Gel Forming Solution 5 Generic

Timolol Maleate 10 MG Tablet 30 Brand

Timolol Maleate 20 MG Tablet 30 Brand

Timolol Maleate 5 MG Tablet 30 Brand

Tinidazole 250 MG Tablet 14 Generic

Tinidazole 500 MG Tablet 4 Generic

Tizanidine HCL 2 MG Capsule 15 Generic

Tizanidine HCL 2 MG Tablet 30 Generic

Tizanidine HCL 4 MG Capsule 30 Generic

Tizanidine HCL 4 MG Tablet 30 Generic

Tizanidine HCL 6 MG Capsule 28 Generic

Tobramycin 0.3% Drops 5 Generic

Tolazamide 250 MG Tablet 30 Brand

Tolmetin Sodium 200 MG Tablet 30 Brand

Tolnaftate 1% Aerosol Powder 30 Generic

Tolnaftate 1% Cream 30 Generic

Tolnaftate 1% Powder 45 Generic

Tolterodine Tartrate 1 MG Tablet 15 Generic

Tolterodine Tartrate 2 MG Tablet 30 Generic

Tolterodine Tartrate 4 MG Capsule 24-Hr ER 30 Generic

Topiramate 100 MG Tablet 30 Generic

Topiramate 15 MG Sprinkle Capsule 30 Generic

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20 of 21 2020 TIER ONE FORMULARY

A B C D E F G–H I K–L M N O–P Q–R S T U–V W–Z SUBSCRIPTION DETAILS

Name/Strength/Form Default Qty. Brand/Generic

Topiramate 200 MG Tablet 30 Generic

Topiramate 25 MG Sprinkle Capsule 30 Generic

Topiramate 25 MG Tablet 30 Generic

Topiramate 50 MG Tablet 30 Generic

Torsemide 10 MG Tablet 30 Generic

Torsemide 100 MG Tablet 15 Generic

Torsemide 20 MG Tablet 30 Generic

Torsemide 5 MG Tablet 15 Generic

Tramadol HCL 100 MG Tablet 24-Hr ER 28 Generic

Tramadol HCL 200 MG Tablet 24-Hr ER 30 Generic

Tramadol HCL 300 MG Tablet 24-Hr ER 28 Generic

Tramadol HCL 50 MG Tablet 30 Generic

Tramadol HCL/Acetaminophen 37.5-325 MG Tablet 30 Generic

Trandolapril 1 MG Tablet 15 Generic

Trandolapril 2 MG Tablet 30 Generic

Trandolapril 4 MG Tablet 30 Generic

Trandolapril/Verapamil HCL 1-240 MG Tablet, IR - ER, Biphasic 24-Hr 30 Generic

Trandolapril/Verapamil HCL 2-240 MG Tablet, IR - ER, Biphasic 24-Hr 30 Generic

Tranexamic Acid 650 MG Tablet 30 Generic

Trazodone HCL 100 MG Tablet 30 Generic

Trazodone HCL 150 MG Tablet 15 Generic

Trazodone HCL 300 MG Tablet 5 Generic

Trazodone HCL 50 MG Tablet 30 Generic

Tretinoin 0.01% Gel 15 Generic

Tretinoin 0.025% Cream 20 Generic

Tretinoin 0.025% Gel 15 Generic

Tretinoin 0.05% Cream 20 Generic

Tretinoin 0.1% Cream 20 Generic

Tretinoin Microspheres 0.04% Gel 20 Generic

Tretinoin Microspheres 0.1% Gel 20 Generic

Triamcinolone Acetonide 0.025% Cream & Gel Combo Pack 30 Generic

Triamcinolone Acetonide 0.025% Lotion 60 Generic

Triamcinolone Acetonide 0.025% Ointment 15 Generic

Triamcinolone Acetonide 0.05% Ointment 34 Brand

Triamcinolone Acetonide 0.1% Lotion 60 Generic

Triamcinolone Acetonide 0.1% Ointment 15 Generic

Triamcinolone Acetonide 0.1% Paste 5 Generic

Triamcinolone Acetonide 0.5% Cream & Gel Combo Pack 30 Generic

Triamcinolone Acetonide 0.5% Ointment 15 Generic

Triamcinolone Acetonide 10 MG/ML Suspension 5 Brand

Triamcinolone/Emollient Cmb #86 0.1% Cream 30 Brand

Triamterene/Hydrochlorothiazid 37.5-25 MG Capsule 30 Generic

Triamterene/Hydrochlorothiazid 37.5-25 MG Tablet 30 Generic

Triamterene/Hydrochlorothiazid 75 MG-50 MG Tablet 30 Generic

Triazolam 0.125 MG Tablet 30 Generic

Triazolam 0.25 MG Tablet 1 Generic

Trifluoperazine HCL 1 MG Tablet 30 Generic

Trifluoperazine HCL 2 MG Tablet 30 Generic

Trifluoperazine HCL 5 MG Tablet 30 Generic

Trihexyphenidyl HCL 2 MG Tablet 30 Generic

Name/Strength/Form Default Qty. Brand/Generic

Trihexyphenidyl HCL 2 MG/5 ML Elixir 180 Generic

Trihexyphenidyl HCL 5 MG Tablet 30 Generic

Trimethobenzamide HCL 300 MG Capsule 30 Generic

Trimethoprim 100 MG Tablet 30 Generic

Tropicamide 0.5% Drops 30 Generic

Tropicamide 1% Drops 15 Generic

Trospium Chloride 20 MG Tablet 30 Generic

Trospium Chloride 60 MG Capsule 24-Hr ER 30 Generic

Umeclidinium Brm/Vilanterol Tr 62.5-25 MCG Inhaler 1 Brand

Urea 40% Foam 30 Brand

Urea 40% Nail Film Suspension 30 Generic

Urea/Lactic Ac/Zn Undecylenate 50% Emulsion 30 Generic

Ursodiol 250 MG Tablet 90 Generic

Ursodiol 300 MG Capsule 30 Generic

Valacyclovir HCL 1000 MG Tablet 4 Generic

Valacyclovir HCL 500 MG Tablet 30 Generic

Valproic Acid (as Sodium Salt) 250 MG Capsule 30 Generic

Valproic Acid (as Sodium Salt) 500 MG/5 ML Solution 30 Generic

Valsartan 160 MG Tablet 30 Generic

Valsartan 320 MG Tablet 30 Generic

Valsartan 40 MG Tablet 15 Generic

Valsartan 80 MG Tablet 30 Generic

Valsartan/Hydrochlorothiazide 160-12.5 MG Tablet 30 Generic

Valsartan/Hydrochlorothiazide 160-25 MG Tablet 30 Generic

Valsartan/Hydrochlorothiazide 320 MG-25 MG Tablet 30 Generic

Valsartan/Hydrochlorothiazide 320-12.5 MG Tablet 30 Generic

Valsartan/Hydrochlorothiazide 80-12.5 MG Tablet 30 Generic

Vancomycin HCL 1 Generic Recon Solution 10 Generic

Vancomycin HCL 10 Generic Recon Solution 1 Generic

Vardenafil HCL 10 MG Disintegrating Tablet 2 Brand

Venlafaxine HCL 100 MG Tablet 30 Generic

Venlafaxine HCL 150 MG Capsule 24-Hr ER 30 Generic

Venlafaxine HCL 150 MG Tablet 24-Hr ER 30 Generic

Venlafaxine HCL 25 MG Tablet 30 Generic

Venlafaxine HCL 37.5 MG Capsule 24-Hr ER 7 Generic

Venlafaxine HCL 37.5 MG Tablet 30 Generic

Venlafaxine HCL 37.5 MG Tablet 24-Hr ER 30 Generic

Venlafaxine HCL 50 MG Tablet 30 Generic

Venlafaxine HCL 75 MG Capsule 24-Hr ER 30 Generic

Venlafaxine HCL 75 MG Tablet 30 Generic

Venlafaxine HCL 75 MG Tablet 24-Hr ER 30 Generic

Verapamil HCL 120 MG Capsule 24-Hr ER Pellets 30 Generic

Verapamil HCL 120 MG Tablet 30 Generic

Verapamil HCL 120 MG Tablet ER 30 Generic

Verapamil HCL 180 MG Capsule 24-Hr ER Pellets 30 Generic

Verapamil HCL 180 MG Tablet ER 30 Generic

Verapamil HCL 200 MG Capsule 24-Hr ER Pellet Ct 30 Generic

Verapamil HCL 240 MG Capsule 24-Hr ER Pellets 30 Generic

Verapamil HCL 240 MG Tablet ER 30 Generic

Verapamil HCL 40 MG Tablet 15 Generic

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21 of 21 2020 TIER ONE FORMULARY

A B C D E F G–H I K–L M N O–P Q–R S T U–V W–Z SUBSCRIPTION DETAILS

Name/Strength/Form Default Qty. Brand/Generic

Verapamil HCL 80 MG Tablet 30 Generic

Vinorelbine Tartrate 10 MG/ML Solution 30 Generic

Vit A,C & E/Lutein/Minerals 1000-60-2 Tablet 30 Generic

Vit A/Vit C/Vit E/Zinc/Copper 14320-226 Capsule 30 Generic

Vit C/E/Zn/Copper/Lutein/Zeaxan 60 MG-6 MG Capsule 30 Generic

Vit C/Vit E Ac/Lut/Copper/Zinc 226-200-5 Capsule 30 Generic

Vitamin E Mixed 200 Unit Capsule 30 Generic

Warfarin Sodium 1 MG Tablet 30 Generic

Warfarin Sodium 10 MG Tablet 30 Generic

Warfarin Sodium 2 MG Tablet 30 Generic

Warfarin Sodium 2.5 MG Tablet 30 Generic

Warfarin Sodium 3 MG Tablet 15 Generic

Warfarin Sodium 4 MG Tablet 30 Generic

Warfarin Sodium 5 MG Tablet 30 Generic

Warfarin Sodium 6 MG Tablet 30 Generic

Warfarin Sodium 7.5 MG Tablet 15 Generic

Zafirlukast 10 MG Tablet 30 Generic

Zafirlukast 20 MG Tablet 30 Generic

Zaleplon 10 MG Capsule 30 Generic

Zaleplon 5 MG Capsule 15 Generic

Name/Strength/Form Default Qty. Brand/Generic

Zanamivir 5 MG Blister w/ Device 20 Brand

Zidovudine 10 MG/ML Syrup 45 Generic

Zinc Acetate 25 MG Capsule 30 Brand

Zinc Oxide 10% Ointment 85 Generic

Zinc Sulf/Cuso 4 P-Hyd/MN/Cr/Se 20-1000 Solution 30 Brand

Zinc/Copper/Mangan/Chromic CHL 0.5-0.1-30 Solution 30 Brand

Ziprasidone HCL 20 MG Capsule 30 Generic

Ziprasidone HCL 40 MG Capsule 30 Generic

Ziprasidone HCL 60 MG Capsule 30 Generic

Ziprasidone HCL 80 MG Capsule 30 Generic

Zoledronic Acid 4 MG/100 ML Solution 30 Brand

Zolmitriptan 2.5 MG Tablet 6 Generic

Zolmitriptan 5 MG Tablet 10 Generic

Zolpidem Tartrate 10 MG Tablet 30 Generic

Zolpidem Tartrate 5 MG Tablet 15 Generic

Zolpidem Tartrate 6.25 MG Multiphase Tablet ER 15 Generic

Zolpidem Tartrate ER 12.5 MG Multiphase Tablet ER 30 Generic

Zonisamide 100 MG Capsule 30 Generic

Zonisamide 25 MG Capsule 30 Generic

Zonisamide 50 MG Capsule 30 Generic

TIER 1

• $50 deductible.

• $15 co-pay (generics/brands up to $100 cost) at retail pharmacy.

• $30 (or less) co-pay for Home Delivery, depending on medication.

• Maintenance meds allowed – 1 (one) 30-day retail pharmacy pick-up. Plan will then be converted to Home Delivery, if drug is available.

• Up to a 15-day emergency supply can be approved via SHIELD PBM or a Plan Administrator.

• Diabetic Testing Supplies will be covered at 100% when using Home Delivery.

• For assistance, please call one of our SHIELD PBM Customer Care Specialists at (877) 659 6101.