2021 prescription drug list/formulary premiumselectchoice

1

2021

Your Prescription Drug ListFormulary

Effective January 1 2021

Please read This document contains information about the drugs covered under your pharmacy benefit plan

For a complete list of covered drugs or if you have questions

bull Call a customer care representative toll-free at (855) 828-9834 (TTY 711)

bull Visit wwwHealthSelectRxcom

mdash Locate an OptumRx in-network pharmacy

mdash Look up possible lower-cost medication alternatives

mdash Compare medication pricing and options

HealthSelectSM

of Te

xas

2

Your Prescription Drug List Formulary

This formulary outlines the most commonly prescribed medications covered under your planrsquos prescription drug benefits The formulary is also known as the Prescription Drug List (PDL) A formulary identifies the drugs available for certain conditions and organizes them into cost levels also known as tiers An important part of the formulary is giving you choices so you and your doctor can choose the best course of treatment for you

Go to wwwHealthSelectRxcom for complete and up-to-date drug information

Since the formulary may change we encourage you to visit our website wwwHealthSelectRxcom and click on Prescription Drug List This website is the best source for up-to-date information about all of the medications your pharmacy benefit covers possible lower-cost options and cost comparisons

3

Understanding your Prescription Drug ListformularyWhat is a formulary

This document is a list of prescription medications covered by your plan for their safety cost and effectiveness Medications are listed by categories or class and are placed into cost levels known as tiers It includes both brand and generic prescription medications approved by the US Food and Drug Administration (FDA)

Where differences exist between this formulary and your benefit plan documents the benefit plan documents will rule This may not be a complete list of medications and not all medications listed may be covered under your plan Please look at the Master Benefit Plan Document (MBPD) provided by your plan for full details

How do I use my formulary

You and your doctor can consult the formulary to help you select the most cost-effective prescription medications This guide tells you if a medication is generic or brand and if special rules apply Bring this list with you when you see your doctor It is organized by common medical conditions Medications are then listed alphabetically

If your medication is not listed on this document it may not be covered by the HealthSelect Prescription Drug Program or Consumer Directed HealthSelect Prescription Drug Program Please visit wwwHealthSelectRxcom and click on Prescription Drug List for the most up to date list of medications covered under your plan If you have any questions call a customer care representative toll-free at (855) 828-9834 (TTY 711)

What are tiers

Tiers are the different cost levels you pay for a medication Each tier is assigned a cost which is determined by your plan This is how much you will pay when you fill a prescription The HealthSelect of Texas Prescription Drug Program has different copays assigned depending on which tier a drug is The Consumer Directed HealthSelect Prescription Drug Program has coinsurance assigned for each drug tier that applies once the annual combined medical and pharmacy deductible is met Tier 1 medications are your lowest-cost options If your medication is placed in Tier 2 or 3 look to see if there is a Tier 1 option available Discuss these options with your doctor

4

When does the formulary change

bull Medications may move to a lower tier at any time

bull Medications may move to a higher tier when its generic becomes available

bull Medications may move to a higher tier or be excluded from coverage on January 1 or July 1 of each year

When a medication changes tiers you may have to pay a different amount for that medication

For the most up-to-date list call a customer care representative 24 hours a day 7 days a week toll-free at (855) 828-9834 (TTY 711)

Why are some medications excluded from coverage

A medication may be excluded from coverage under your prescription drug plan when it works the same as or similar to another prescription medication or an over-the-counter (OTC) medication that is more cost-effective

What if I donrsquot agree with a decision about an excluded medication

You (or your authorized representative) and your doctor can ask for an appeal to cover an excluded medication by calling a customer care representative toll-free at (855) 828-9834 (TTY 711)

5

Medication Tips What is the difference between brand-name and generic medications

Generic medications contain the same active ingredients (what makes the medication work) as brand-name medications but they often cost less Once the patent of a brand-name medication ends the FDA can approve a generic version with the same active ingredients

What if my doctor writes a brand-name prescription

If your doctor gives you a prescription for a brand-name medication ask if a generic equivalent or lower-cost option is available and if it might be right for you Generic medications are usually your lowest-cost option but not always

An OTC medication may be the right treatment option for some conditions Talk to your doctor about available OTC options Even though these medications may not be covered under your pharmacy benefit they may cost less than prescription medications covered under your prescription drug plan

What if I am taking a specialty medication

Specialty medications treat rare or complex conditions and are typically higher cost medications Please note not all specialty medications are listed in the Formulary Optum Specialty Pharmacy can provide most of your specialty medications along with helpful programs and services Call Optum Specialty Pharmacy at (855) 427-4682 and have your prescriptions delivered right to your home or doctorrsquos office

6

Reading your formularyThe formulary give your choices so you and your doctor can determine your best course of treatment In this formulary brand-name medications are shown in UPPERCASE (for example CLOBEX) and generic medications in lowercase (for example clobetasol)

Tier information

Using lower tier or preferred medications can help you pay your lowest out-of-pocket cost Your prescription drug plan has multiple tiers Please note If you have a high deductible plan the tier cost levels will apply once you hit your deductible

Drug Tier Includes Helpful Tips

Tier 1 Lowest Cost

Lower-cost commonly used generic drugs Some low-cost brands may be included

Use Tier 1 drugs for the lowest out-of-pocket costs

Tier 2 Mid-range Cost

Many common brand-name drugs called preferred brands

Use Tier 2 drugs instead of Tier 3 to help reduce your out-of-pocket costs

Tier 3 Highest Cost

Mostly higher-cost brand drugs also known as non-preferred brands

Many Tier 3 drugs have lower-cost options in Tier 1 or 2 Ask your doctor if they could work for you

Tier E Excluded May be excluded from coverage or subject to prior authorization Lower-cost options are available and covered

Drug list information

In this drug list some medications are noted with letters next to them to help you see which ones may have coverage requirements or limits Your benefit plan determines how these medications may be covered for you

PA Prior Authorization ndash Your doctor is required to provide additional information before the drug will be covered by your prescription drug plan

ST Step Therapy ndash Requires you to first try a cost-effective medication before the more expensive medication will be covered

QL Quantity Limit ndash Limits the amount of a medication that will be covered under your prescription drug plan

SP Specialty Medication ndash Drugs that are used in the treatment of rare or complex conditions and are typically injected or infused are high cost have special delivery and storage requirements or require close monitoring or care coordination with your doctor

E Excluded ndash Drugs that are not covered by your health plan Lower-cost options are available and covered

Table of Contents

Analgesics - Drugs for Pain9Analgesics - Drugs for Pain and Inflammation 14Anesthetics17Anti-Addiction Substance Abuse Treatment Agents 20Antibacterials20Anticoagulants25Anticonvulsants - Drugs for Seizures 26Antidementia Agents - Drugs for Alzheimers Disease and Dementia 28Antidepressants29Antiemetics - Drugs for Nausea and Vomiting 30Antifungals31Antigout Agents 34Anti-inflammatory Agents 34Antimigraine Agents 34Antimyasthenic Agents35Antimycobacterials 35Antineoplastics - Drugs for Cancer35Antiparasitics 41Antiparkinson Agents 42Antiplatelets43Antipsychotics - Drugs for Mood Disorders 43Antivirals44Anxiolytics - Drugs for Anxiety47Bipolar Agents - Drugs for Mood Disorders48Blood Products and Modifiers - Drugs for Blood Disorders48Cardiovascular Agents - Drugs for Heart and Circulation Conditions 50Central Nervous System Agents - Drugs for Attention Deficit Disorder 56Central Nervous System Agents - Drugs for Multiple Sclerosis 57Central Nervous System Agents - Miscellaneous 58Dental and Oral Agents - Drugs for Mouth and Throat Conditions59Dermatological Agents - Drugs for Skin Conditions 60Diabetes - Antidiabetic Agents 72Diabetes - Glucose Monitoring 73Diabetes - Glycemic Agents 75Diabetes - Insulins75Electrolytes Minerals Metals Vitamins77Gastrointestinal Agents - Drugs for Acid Reflux and Ulcer86Gastrointestinal Agents - Drugs for Bowel Intestine and Stomach Conditions87Genetic or Enzyme Disorder - Drugs for Replacement Modification Treatment 92Genitourinary Agents - Drugs for Bladder Genital and Kidney Conditions93Genitourinary Agents - Drugs for Prostate Conditions 95Hormonal Agents - Adrenal 95Hormonal Agents - Mens Health97Hormonal Agents - Osteoporosis 98Hormonal Agents - Pituitary 98Hormonal Agents - Prostaglandins100Hormonal Agents - Sex Hormones and Birth Control100Hormonal Agents - Thyroid 105Immunological Agents - Drugs for Immune System Stimulation or Suppression 105Immunological Agents - Drugs for Vaccination 109Inflammatory Bowel Disease Agents111

7

Metabolic Bone Disease Agents - Drugs for Osteoporosis 112Metabolic Bone Disease Agents - Other 112Miscellaneous Therapeutic Agents 113Ophthalmic Agents - Drugs for Eye Allergy Infection and Inflammation121Ophthalmic Agents - Drugs for Glaucoma123Ophthalmic Agents - Drugs for Miscellaneous Eye Conditions 124Otic Agents - Drugs for Ear Conditions 127Respiratory Tract Pulmonary Agents - Drugs for Allergies Cough Cold127Respiratory Tract Pulmonary Agents - Drugs for Asthma and Other Lung Conditions 131Respiratory Tract Pulmonary Agents - Drugs for Cystic Fibrosis 134Respiratory Tract Pulmonary Agents - Drugs for Pulmonary Hypertension 134Skeletal Muscle Relaxants - Drugs for Muscle Pain and Spasm 135Sleep Disorder Agents 135

8

Drug Name Drug Tier Notes

Analgesics - Drugs for Pain

8 hour pain reliever E

8 hr arthritis pain relief E

acetaminophen 8 hour oral tablet extended release

E

acetaminophen childrens oral solution

E

acetaminophen childrens oral suspension 160 mg5ml

E

acetaminophen childrens oral tablet chewable 160 mg

E

acetaminophen er E

acetaminophen extra strength oral tablet

E

acetaminophen oral solution 160 mg5ml 325 mg1015ml 650 mg203ml

E

acetaminophen oral suspension 160 mg5ml

E

acetaminophen oral tablet

E

acetaminophen oral tablet chewable 160 mg

E

acetaminophen rectal suppository 120 mg 650 mg

E

acetaminophen-codeine

1 QL

acetaminophen-codeine 2

1 QL


1 QL


1 QL

ACTIQ 3 PA QL

ALLZITAL E

APADAZ E


apap-caff-dihydrocodeine oral capsule

1 QL

apap-caff-dihydrocodeine oral tablet 325-30-16 mg

1 QL

ARYMO ER E

ascomp-codeine 1

aurophen childrens E

BELBUCA 2 PA QL

BENZHYDROCODONE-ACETAMINOPHEN

E

BUPAP ORAL TABLET 50-300 MG

3

BUPRENEX E

buprenorphine hcl injection solution 03 mgml

E

buprenorphine transdermal

1 PA QL

butalbital-acetaminophen capsule 50-300 mg oral

1

BUTALBITAL-ACETAMINOPHEN CAPSULE 50-300 MG ORAL

E

butalbital-acetaminophen oral tablet

1

butalbital-apap-caff-cod 1

butalbital-apap-caffeine oral capsule

1

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

1

butalbital-asa-caff-codeine

1

butalbital-aspirin-caffeine

1

butorphanol tartrate injection

E

For more information regarding the tiers and designations in this drug list please see the Reading your formulary section on page 6 of this booklet

9


butorphanol tartrate nasal

1 QL

BUTRANS 3 PA QL

carisoprodol-aspirin-codeine

1

childrens acetaminophen oral suspension 160 mg5ml

E

childrens acetaminophen oral tablet dispersible

E

childrens apap E

childrens non-aspirin oral tablet chewable

E

codeine sulfate oral tablet 30 mg 60 mg

1 QL

CONZIP E

cvs acetaminophen ex st oral tablet

E

DEMEROL INJECTION SOLUTION 50 MGML

E

DILAUDID ORAL E

DOLOPHINE 3 PA

DSUVIA E

DURAGESIC-100 E

DURAGESIC-12 E

DURAGESIC-25 E

DURAGESIC-50 E

DURAGESIC-75 E

duramorph E

endocet oral tablet 10-325 mg 25-325 mg 5-325 mg 75-325 mg

1 QL

ESGIC 3

fentanyl 1 PA QL

fentanyl citrate (pf) E

fentanyl citrate buccal lozenge on a handle

1 PA QL

FENTANYL CITRATE BUCCAL TABLET

E


FENTANYL CITRATE INTRAVENOUS SOLUTION PREFILLED SYRINGE 100 MCG2ML

E

FENTANYL CITRATE-NACL INJECTION

E

FENTANYL CITRATE-NACL INTRAVENOUS SOLUTION 125-09 MG250ML- 2-09 MG100ML-

E

FENTANYL CITRATE-NACL SOLUTION 1-09 MG100ML- INTRAVENOUS

E


E

FENTANYL CITRATE-NACL SOLUTION PREFILLED SYRINGE 500-09 MCG50ML- INTRAVENOUS

E

FENTANYL-BUPIVACAINE-NACL EPIDURAL SOLUTION 02-01-09 MG100ML- 02-0125-09 MG100ML-

E

FENTANYL-BUPIVACAINE-NACL INJECTION

E

FENTANYL-BUPIVACAINE-NACL SOLUTION 05-00625-09 MG250ML- EPIDURAL

E


E


10



E

FENTORA BUCCAL TABLET 100 MCG 200 MCG 400 MCG 600 MCG 800 MCG

E

FIORICET ORAL CAPSULE

3

FIORICETCODEINE ORAL CAPSULE 50-300-40-30 MG

3

FIORINAL 3

FIORINALCODEINE 3

3

goodsense pain relief oral tablet

E

headache relief oral E

hydrocodone bitartrate er oral capsule extended release 12 hour

1 PA ST QL

hydrocodone-acetaminophen oral solution 10-325 mg15ml 75-325 mg15ml

1 QL

hydrocodone-acetaminophen oral tablet 10-300 mg 10-325 mg 5-300 mg 5-325 mg 75-300 mg 75-325 mg

1 QL

hydrocodone-ibuprofen oral tablet 10-200 mg 5-200 mg 75-200 mg

1 QL

hydromorphone hcl er oral tablet extended release 24 hour

1 PA QL

hydromorphone hcl injection solution 2 mgml

E


hydromorphone hcl oral 1 QL

hydromorphone hcl rectal

E

HYDROMORPHONE HCL-NACL INTRAVENOUS SOLUTION 25-09 MG50ML- 50-09 MG50ML-

E

HYDROMORPHONE HCL-NACL INTRAVENOUS SOLUTION PREFILLED SYRINGE 10-09 MG50ML-

E

HYSINGLA ER 2 PA QL

INFUMORPH 200 E

INFUMORPH 500 E

KADIAN ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG 100 MG 20 MG 200 MG 30 MG 40 MG 50 MG 60 MG 80 MG

E

LAZANDA E

levorphanol tartrate oral E

liquid acetaminophen E

LORTAB ORAL ELIXIR 10-300 MG15ML

3 QL

MEDI-DERM-RX E

MEDROX-RX 3

meperidine hcl injection solution 50 mgml

E

meperidine hcl oral solution

1 QL

meperidine hcl oral tablet 50 mg

1 QL

methadone hcl injection E

methadone hcl intensol 1

methadone hcl oral concentrate

1


11


methadone hcl oral solution

1

methadone hcl oral tablet

1 PA

methadone hcl oral tablet soluble

1

methadose oral concentrate 10 mgml

1

methadose oral tablet soluble

1

methadose sugar-free 1

migraine relief E

mitigo E

morphine sulfate (concentrate) oral solution 100 mg5ml 20 mgml

1 QL

morphine sulfate (pf) injection

E

morphine sulfate (pf) intravenous solution 10 mgml 2 mgml 4 mgml 8 mgml

E

morphine sulfate er beads

1 PA QL

morphine sulfate er oral capsule extended release 24 hour

1 PA QL

morphine sulfate er oral tablet extended release

1 PA QL

MORPHINE SULFATE INJECTION SOLUTION 1 MGML

E

morphine sulfate injection solution 2 mgml 4 mgml 5 mgml

E

MORPHINE SULFATE INTRAVENOUS SOLUTION 05 MGML

E

morphine sulfate intravenous solution 50 mgml

E


morphine sulfate oral 1 QL

morphine sulfate rectal E

MORPHINE SULFATE SOLUTION 1 MGML INTRAVENOUS

E

morphine sulfate solution 1 mgml intravenous

E

MORPHINE SULFATE-NACL INTRAVENOUS SOLUTION PREFILLED SYRINGE 50-09 MG50ML-

E

m-pap E

MS CONTIN ORAL TABLET EXTENDED RELEASE

E

nalbuphine hcl injection solution 20 mgml

1

NALOCET E

NORCO E

NUCYNTA E

NUCYNTA ER E

OXAYDO ORAL TABLET

E

OXYCODONE HCL ER ORAL TABLET ER 12 HOUR ABUSE-DETERRENT

E

oxycodone hcl oral capsule

1 QL

oxycodone hcl oral concentrate 100 mg5ml

1 QL

oxycodone hcl oral solution

1 QL

oxycodone hcl oral tablet

1 QL

OXYCODONE-ACETAMINOPHEN ORAL TABLET 10-300 MG 25-300 MG 5-300 MG

E


12


oxycodone-acetaminophen oral tablet 10-325 mg 25-325 mg 5-325 mg 75-325 mg

1 QL

oxycodone-aspirin oral tablet 48355-325 mg

1 QL

OXYCONTIN ORAL TABLET ER 12 HOUR ABUSE-DETERRENT

2 PA QL

oxymorphone hcl 1 QL

oxymorphone hcl er 1 PA QL

pain amp fever childrens oral suspension

E

pain amp fever infants E

pain relief childrens oral elixir

E

pain relief extra strength oral capsule 500 mg

E

pain relief extra strength oral tablet 500 mg

E

pain relief oral liquid E

pain relief regular strength

E

PANADOL CHILDRENS

E

PANADOL EXTRA E

PANADOL EXTRA STRENGTH

E

PANADOL INFANTS E

pentazocine-naloxone hcl

1 QL

PERCOCET ORAL TABLET 10-325 MG 25-325 MG 5-325 MG 75-325 MG

E

PRIALT 2 SP

PRIMLEV E

PROBUPHINE IMPLANT KIT

E


PROLATE E

QDOLO E

ra acetaminophen rapid melts oral tablet dispersible 160 mg

E

ROXICODONE ORAL TABLET

E

SUBSYS E

SYNAPRYN FUSEPAQ E

tencon oral tablet 50-325 mg

1

tramadol hcl er (biphasic) oral tablet extended release 24 hour 100 mg 200 mg 300 mg

1 ST QL

TRAMADOL HCL ER ORAL CAPSULE EXTENDED RELEASE 24 HOUR 100 MG 200 MG 300 MG

E

tramadol hcl er oral capsule extended release 24 hour 150 mg

1 PA QL

tramadol hcl er oral tablet extended release 24 hour

1 QL

tramadol hcl ir 1 QL

tramadol-acetaminophen

1 QL

TREZIX ORAL CAPSULE 3205-30-16 MG

3 QL

TYLENOL 8 HOUR E

TYLENOL EXTRA STRENGTH ORAL TABLET

E

TYLENOL INFANTS PAIN+FEVER

E

TYLENOL ORAL TABLET

E

ULTRACET E

ULTRAM E


13


VANATOL LQ E

VTOL LQ E

XTAMPZA ER 2 PA QL

ZEBUTAL ORAL CAPSULE 50-325-40 MG

3

ZOHYDRO ER ORAL CAPSULE EXTENDED RELEASE 12 HOUR

E

Analgesics - Drugs for Pain and Inflammation

ACTIVE-KETOPROFEN

E

ACTIVE-PREP KIT I E

ACTIVE-PREP KIT II E

ACTIVE-PREP KIT III E

adult aspirin regimen $0

ADVIL E

ADVIL JUNIOR STRENGTH

E

ADVIL LIQUI-GELS MINIS

E

ADVIL MIGRAINE E

aif 2 drug preparation kit

E

AIF 3 DRUG PREPARATION KIT

E

ALEVE ORAL TABLET E

ARTHROTEC ORAL TABLET DELAYED RELEASE

E

aspirin adult $0

aspirin adult low strength oral tablet delayed release

$0

aspirin childrens $0

aspirin ec low dose $0

aspirin ec low strength $0


aspirin ec oral tablet delayed release 325 mg

$0

aspirin low dose oral tablet chewable

$0

aspirin low dose oral tablet delayed release

$0

aspirin oral tablet 325 mg

$0

aspirin oral tablet delayed release 325 mg 81 mg

$0

aspirin rectal suppository 300 mg 600 mg

E

BAYER ASPIRIN EC LOW DOSE

$0

BAYER ASPIRIN ORAL TABLET

$0

BAYER ASPIRIN ORAL TABLET DELAYED RELEASE

$0

BIIFENAC 1000 E

BIIFENAC 500 E

CALDOLOR INTRAVENOUS SOLUTION 800 MG200ML 800 MG8ML

E

CAMBIA E

CAPSFENAC PAK E

CAPSINAC E

CELEBREX E

celecoxib oral 1 QL

DAYPRO 3

DERMACINRX ANALGESIC COMBOPAK

E

DERMACINRX LEXITRAL PHARMAPAK

E


14


DFS DRMSMENTHCAP PAK

E

DFSMSMENTHCAP PAK

E

DICLOFENAC E

DICLOFENAC EPOLAMINE EXTERNAL

3 QL

diclofenac potassium 1

diclofenac sodium er 1

diclofenac sodium external gel 1

1 QL

diclofenac sodium external solution

1 PA

diclofenac sodium oral 1

diclofenac-misoprostol oral tablet delayed release

1

diclofex dc combination therapy pack 15-0025

E

DICLOFONO GEL 16 EXTERNAL

3


E

DICLOPR E

diclosaicin E

DICLOSTREAM E

DICLOTREX E

DICLOVIX E

DICLOVIX M E

DICLOZOR EXTERNAL

E

diflunisal oral 1

DIMENTHO E

DUAL COMPLEX FORMULA 1 KIT

E

DUEXIS E


EC-NAPROSYN ORAL TABLET DELAYED RELEASE 375 MG

3

ec-naproxen 1

ENOVARX-DICLOFENAC SODIUM EXTERNAL

E

enovarx-ibuprofen E

enovarx-naproxen external

E

EQUAPAXIBUPROFENMINREX

E

etodolac er 1

etodolac oral 1

FBL KIT E

FELDENE 3

fenoprofen calcium oral E

fenortho oral capsule 200 mg

E

FLEXIPAK E

flurbiprofen oral 1

FROTEK E

GABAPENTIN-NAPROXEN CMPD KIT

E

gnp aspirin low dose $0

goodsense aspirin low dose

$0

goodsense ibuprofen oral capsule

E

IBUPAK E

ibuprofen 1

ibuprofen infants E

ibuprofen oral capsule E

ibuprofen oral suspension

1

ibuprofen oral tablet 200 mg

E

inavix E

INDOCIN ORAL 3 ST


15


INDOCIN RECTAL E

indomethacin er 1

INDOMETHACIN ORAL CAPSULE 20 MG

E

indomethacin oral capsule 25 mg 50 mg

1 ST

INFLAMMACIN E

INFLATHERM COMBINATION THERAPY PACK

E

KBGL IN TERODERM

E

KETOPHENE RAPIDPAQ

E

ketoprofen er 1

ketoprofen oral 1

KETOROLAC TROMETHAMINE EXTERNAL

E

ketorolac tromethamine injection solution 15 mgml

1

ketorolac tromethamine intramuscular solution 60 mg2ml

1

KETOROLAC TROMETHAMINE NASAL

3 PA QL

ketorolac tromethamine oral

1 QL

ketorolac tromethamine solution 30 mgml injection

1

KETOROLAC TROMETHAMINE SOLUTION 30 MGML INJECTION

3

LICART EXTERNAL E

LODINE 3

meclofenamate sodium oral

1


mefenamic acid oral E

meloxicam oral tablet 1

MOBIC ORAL TABLET E

MOTRIN IB ORAL CAPSULE

E

MOTRIN INFANTS DROPS

E

nabumetone oral 1

NALFON ORAL CAPSULE 400 MG

3

NALFON ORAL TABLET

3

NAPRELAN ORAL TABLET EXTENDED RELEASE 24 HOUR 375 MG 500 MG

3

NAPRELAN ORAL TABLET EXTENDED RELEASE 24 HOUR 750 MG

E

NAPROSYN ORAL SUSPENSION

3

naproxen dr 1

naproxen oral suspension

E

naproxen oral tablet 1

naproxen sodium er E

naproxen sodium oral tablet 220 mg

E

naproxen sodium oral tablet 275 mg 550 mg

1

naproxen-esomeprazole

1 PA QL

NP 2 DRUG PREPARATION KIT

E

NUDICLO SOLUPAK E

NUDICLO TABPAK E

NUDROXIPAK E

NUDROXIPAK DSDR-50

E


16


NUDROXIPAK DSDR-75

E

NUDROXIPAK E-400 E

NUDROXIPAK I-800 E

NUDROXIPAK M-15 E

NUDROXIPAK N-500 E

ORMECA E

oxaprozin 1

PENNSAID EXTERNAL

E

piroxicam oral 1

PRASTERA E

PREVIDOLRX ANALGESIC

E

previdolrx plus analgesic

E

qc aspirin low dose oral tablet delayed release

$0

QMIIZ ODT E

READYSHARP KETOROLAC

E

RELAFEN E

RELAFEN DS E

REXAPHENAC EXTERNAL

E

salsalate oral E

SPRIX 3 PA QL

ST JOSEPH LOW DOSE ORAL TABLET DELAYED RELEASE

$0

sulindac oral 1

sure result dss premium pack

E

TIVORBEX ORAL CAPSULE 20 MG

E

tolmetin sodium oral capsule

1

tolmetin sodium oral tablet 600 mg

1

TORONOVA II SUIK E


TORONOVA SUIK E

tri-buffered aspirin oral tablet 325 mg

E

TRIPLE COMPLEX FORMULA 3 KIT

E

VAROPHEN E

VENNGEL ONE E

VIMOVO E

VIVLODEX E

VOLTAREN EXTERNAL

E

VP FC KIT E

VP GKL KIT E

XRYLIX EXTERNAL E

ZIPSOR E

ZORVOLEX E

Anesthetics

1ST MEDX-PATCH LIDOCAINE EXTERNAL PATCH 4-00375-5-20

E

7T LIDO E

ACCUCAINE E

ACTIVE INJECTION LM-2

E

AGONEAZE E

ANODYNE LPT E

APRIZIO PAK E

APRIZIO PAK II E

ASTERO E

BENZO-LIDOCAINE-TETRACAINE

E

blue tube aloe E

bupivacaine fisiopharma

E

bupivacaine hcl (pf) E

BUPIVACAINE HCL INJECTION SOLUTION 0125

E


17


bupivacaine hcl injection solution 025 05

E

BUPIVACAINE HCL INJECTION SOLUTION PREFILLED SYRINGE 0125 (50 ML)

E

CADIRAMD E

CAPSAICIN-MENTHOL

E

CBD4 FREEZE PUMP MAXIMUM STR

3

CETACAINE EXTERNAL AEROSOL

E

COCAINE HCL NASAL E

DERMACINRX DUOPATCH PHARMAPAK

E

DERMACINRX EMPRICAINE

E

DERMACINRX NEUROTRAL PHARMAPAK

E

DERMACINRX PHN E

DERMACINRX PRIZOPAK

E

DERMACINRX ZRM E

EHA E

EMPRICAINE-II E

enovarx-lidocaine hcl E

ethyl chloride 1

EXPAREL E

FLEXIN E

GEBAUERS PAIN EASE

3

GEBAUERS SPRAY AND STRETCH

3

GEN7T E

GEN7T PLUS E

GOPRELTO E


LDO PLUS E

lets E

LEVATIO E

LIDO BDK E

lidocaine external cream 4

E

lidocaine external patch 5

1

lidocaine hcl (pf) injection solution

1

lidocaine hcl external cream 3

E

LIDOCAINE HCL EXTERNAL CREAM 412

E

lidocaine hcl external lotion

E

lidocaine hcl external solution

1

lidocaine hcl injection solution 05

1

LIDOCAINE HCL INJECTION SOLUTION PREFILLED SYRINGE 10 MGML 100 MG5ML 60 MG3ML

E

LIDOCAINE HCL INTRADERMAL

E

LIDOCAINE HCL SOLUTION 1 INJECTION

3

lidocaine hcl solution 1 injection

1


3


1

lidocaine hcl urethralmucosal

1

lidocaine ointment 5 external

1 QL


18



E

lidocaine-prilocaine external cream

1

lidocaine-prilocaine external kit

E

LIDOCAINE-TETRACAINE

E

LIDOCANNA E

LIDODERM E

LIDO-EPINEPHRINE-TETRACAINE SOLUTION 4-005-05 EXTERNAL

3


E

LIDOMARK 25 E

LIDOPAC E

lidopin external cream 3

E

LIDOPIN EXTERNAL CREAM 325

E

LIDOPRIL EXTERNAL KIT

E

LIDOPRIL XR E

LIDO-PRILO CAINE PACK

E

LIDOPURE PATCH E

LIDORX E

LIDO-SORB E

LIDOSTREAM E

LIDOTHOL E

LIDOTRAL E

LIDOVIX L E

LIDTOPIC MAX E

LIVIXIL PAK E

LMR PLUS E

LYDEXA E


MARCAINE E

MARCAINE PRESERVATIVE FREE

E

marlido E

MARLIDO-25 E

MARVONA SUIK E

MEDI-DERML-RX E

MEDI-PATCH RX E

NUMBRINO E

NUVAKAAN E

NUVAKAAN-II E

PAINGO KFT E

PLIAGLIS E

POINT OF CARE LM-22

E

POINT OF CARE LM-25

E

premium lidocaine E

PREMIUM SCAR E

PREPIV SUPPLY 3

PRILO PATCH E

PRILO PATCH II 3

PRILOLID E

PRILOVIX E

PRILOVIX LITE E

PRILOVIX LITE PLUS E

PRILOVIX PLUS E

prilovix ultralite E

prilovix ultralite plus E

PRILOVIXIL E

PRIZOPAK II E

PRIZOTRAL E

PRIZOTRAL-II E

READYSHARP-A E

RELADOR PAK EXTERNAL KIT

E

RELADOR PAK PLUS E


19


RENOVO E

sensorcaine E

sensorcaine-mpf E

SOOTHEE EXTERNAL PATCH 05-00375-5-2

E

SX1 MEDICATED POST-OPERATIVE

E

SYNERA E

SYNVEXIA TC E

VENIPUNCTURE PX1 PHLEBOTOMY

3

VEXATROL E

WPR PLUS WOUND HEALING SYSTEM

E

XARACOLL E

XYLOCAINE INJECTION

3

XYLOCAINE-MPF INJECTION SOLUTION 05 1 15 2

3

ZERUVIA E

ZILACAINE PATCH E

ZINGO INTRADERMAL JET-INJECTOR

E

ZIONODIL E

ZIONODIL 100 E

ZTLIDO E

Anti-Addiction Substance Abuse Treatment Agents

acamprosate calcium 1

BUNAVAIL 3 QL

buprenorphine hcl sublingual

1 QL

buprenorphine hcl-naloxone hcl

1 QL

bupropion hcl er (smoking det)

$0 QL


CHANTIX $0 QL

CHANTIX CONTINUING MONTH PAK

$0 QL

CHANTIX STARTING MONTH PAK

$0 QL

disulfiram oral 1

LUCEMYRA 3 ST QL

naloxone hcl injection solution 04 mgml 4 mg10ml

E

naloxone hcl injection solution cartridge

E

naloxone hcl injection solution prefilled syringe

E

naltrexone hcl oral 1

NALTREXONE SUBCUTANEOUS

E

NARCAN 2

NICORETTE MOUTHTHROAT GUM 2 MG

$0 QL

nicotine polacrilex mouththroat

$0 QL

nicotine step 1 $0 QL



NICOTROL $0 QL

NICOTROL NS $0 QL

SUBLOCADE 3 SP

SUBOXONE SUBLINGUAL FILM

2 QL

VIVITROL 3 SP

ZUBSOLV 2 QL

Antibacterials

ACTICLATE E

AEMCOLO 3 PA

ALTABAX 3


20


amikacin sulfate injection solution 500 mg2ml

E

amoxicillin oral capsule 1

amoxicillin oral suspension reconstituted

1

amoxicillin oral tablet 1

amoxicillin oral tablet chewable 125 mg 250 mg

1

amoxicillin-potassium clavulanate er

1

amoxicillin-potassium clavulanate oral

1

ampicillin oral capsule 500 mg

1

ampicillin-sulbactam sodium injection solution reconstituted 3 (2-1) gm

E

ARIKAYCE 3 SP

AUGMENTIN ES-600 3

AUGMENTIN ORAL SUSPENSION RECONSTITUTED 125-3125 MG5ML 250-625 MG5ML

3

AUGMENTIN ORAL TABLET 500-125 MG

3

avidoxy 1 ST

AVIDOXY DK E

azithromycin oral packet

1

azithromycin oral suspension reconstituted

1

azithromycin oral tablet 250 mg 500 mg 600 mg

1

bacitracin external E

bacitracin zinc external E


BACTRIM 3

BACTRIM DS 3

BAXDELA INTRAVENOUS

E

BAXDELA ORAL 3

BENZALKONIUM CHLORIDE EXTERNAL SOLUTION

3

benzalkonium chloride external solution 50

1

BENZODOX E

BICILLIN L-A E

cefaclor 1

cefaclor er 1

cefadroxil 1

cefazolin sodium injection solution reconstituted 1 gm 10 gm

E

cefazolin sodium-dextrose intravenous solution 2-4 gm100ml-

E

cefdinir 1

cefepime hcl injection solution reconstituted 2 gm

E

cefixime 1

CEFOTAN E

cefotaxime sodium injection solution reconstituted 1 gm 2 gm 500 mg

E

cefotetan disodium injection solution reconstituted 1 gm 2 gm

E

cefoxitin sodium injection

E

cefpodoxime proxetil 1

cefprozil 1


21


ceftazidime injection solution reconstituted 1 gm 2 gm 6 gm

E

ceftriaxone sodium injection solution reconstituted 1 gm 2 gm 250 mg 500 mg

1

cefuroxime axetil oral tablet

1

CENTANY 3

CENTANY AT E

cephalexin 1

chloramphenicol sod succinate

E

CIPRO ORAL SUSPENSION RECONSTITUTED

3

CIPRO ORAL TABLET 250 MG 500 MG

3

ciprofloxacin hcl oral 1

clarithromycin er 1

clarithromycin oral 1

CLEOCIN ORAL 3

CLEOCIN VAGINAL CREAM

3

CLEOCIN VAGINAL SUPPOSITORY

2

clindamycin hcl oral 1

clindamycin palmitate hcl

1

clindamycin phosphate vaginal

1

CLINDESSE 3

colistimethate sodium (cba)

E

COLY-MYCIN M E

coremino E

CUBICIN E

CUBICIN RF E

daptomycin E

demeclocycline hcl oral 1


dicloxacillin sodium 1

DIFICID 3

DORYX MPC E

DORYX ORAL TABLET DELAYED RELEASE 200 MG 50 MG

3 ST

DORYX ORAL TABLET DELAYED RELEASE 80 MG

E

doxy 100 E

doxycycline hyclate intravenous

E

doxycycline hyclate oral capsule

1

doxycycline hyclate oral tablet 100 mg 50 mg

1


1 ST

doxycycline hyclate oral tablet 20 mg

E

doxycycline hyclate oral tablet delayed release 100 mg 75 mg

1

doxycycline hyclate oral tablet delayed release 150 mg 200 mg 50 mg

1 ST

DOXYCYCLINE HYCLATE ORAL TABLET DELAYED RELEASE 80 MG

E

doxycycline monohydrate oral capsule 100 mg 150 mg 75 mg

1 ST

doxycycline monohydrate oral capsule 50 mg

1

doxycycline monohydrate oral suspension reconstituted

1


22


doxycycline monohydrate oral tablet

1 ST

EES GRANULES 3

ertapenem sodium E

ERYPED 200 3

ERYPED 400 3

ERY-TAB 3

ERYTHROCIN STEARATE ORAL TABLET 250 MG

3

erythromycin base oral 1

erythromycin ethylsuccinate oral

1

erythromycin oral 1

FETROJA E

FIRST-METRONIDAZOLE ORAL SUSPENSION RECONSTITUTED 50 MGML

E

FIRVANQ 3

FLAGYL ORAL CAPSULE

3

FLAGYL ORAL TABLET 500 MG

3

FORTAZ INJECTION SOLUTION RECONSTITUTED 1 GM

E

fosfomycin tromethamine

1

gentamicin sulfate external

1

HIPREX 3

imipenem-cilastatin intravenous solution reconstituted 250 mg

E

INVANZ INJECTION E

iodine tincture external tincture 2

1

KEFLEX 3


levofloxacin oral 1

LINCOCIN E

lincomycin hcl injection E

linezolid in sodium chloride

E

linezolid intravenous solution 600 mg300ml

E

linezolid oral 1 QL

MACROBID 3

MACRODANTIN 3

mafenide acetate external

1

meropenem intravenous solution reconstituted 500 mg

E

MEROPENEM-SODIUM CHLORIDE INTRAVENOUS SOLUTION RECONSTITUTED 1 GM50ML 500 MG50ML

E

MERREM INTRAVENOUS SOLUTION RECONSTITUTED 500 MG

E

methenamine hippurate 1

methenamine mandelate oral

E

METRONIDAZOLE BENZO+SYRSPEND

E

metronidazole oral 1

metronidazole vaginal 1

MINOCYCLINE HCL ER ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

minocycline hcl er oral tablet extended release 24 hour

E

minocycline hcl oral 1


23


MINOLIRA E

mondoxyne nl oral capsule 100 mg 75 mg

1 ST

MONUROL 3

MORGIDOX COMBINATION KIT 1 X 100 MG 2 X 100 MG

E

morgidox oral capsule 100 mg

1

moxifloxacin hcl in nacl E

moxifloxacin hcl oral 1

mupirocin calcium E

mupirocin external 1

nafcillin sodium injection solution reconstituted 1 gm

E

nafcillin sodium intravenous solution reconstituted 10 gm

E

neomycin sulfate oral 1

neomycin-polymyxin b gu

E

nitrofurantoin macrocrystal oral

1

nitrofurantoin monohydrate macrocrystals

1

nitrofurantoin oral suspension

1

NUTRIDOX E

NUVESSA E

NUZYRA ORAL TABLET 150 MG

3

ofloxacin oral tablet 300 mg 400 mg

1

oxacillin sodium injection solution reconstituted 1 gm

E

oxacillin sodium intravenous

E

paromomycin sulfate oral

1


penicillin g potassium injection solution reconstituted 5000000 unit

E

penicillin g procaine E

penicillin g sodium E

penicillin v potassium 1

PFIZERPEN INJECTION SOLUTION RECONSTITUTED 5000000 UNIT

E

piperacillin sod-tazobactam so intravenous solution reconstituted 45 (4-05) gm

E

polymyxin b sulfate injection

E

POLYSPORIN EXTERNAL OINTMENT 500-10000 UNITGM

E

PRIMSOL 3

RECARBRIO E

SCRUB CARE POVIDONE-IODINE

E

SEYSARA 3 ST

SILVADENE 3

silver nitrate external solution

E

silver sulfadiazine external

1

SIVEXTRO E

SOLODYN ORAL TABLET EXTENDED RELEASE 24 HOUR 105 MG 115 MG 55 MG 65 MG 80 MG

3

SOLOSEC 3

ssd 1

streptomycin sulfate intramuscular

E


24


sulfadiazine oral 1

sulfamethoxazole-trimethoprim oral suspension 200-40 mg5ml

1

sulfamethoxazole-trimethoprim oral tablet

1

SULFAMYLON EXTERNAL CREAM

E

SULFAMYLON EXTERNAL PACKET

3

sulfatrim pediatric 1

SUPRAX ORAL CAPSULE

3

SUPRAX ORAL SUSPENSION RECONSTITUTED

3

SUPRAX ORAL TABLET CHEWABLE

3

TARGADOX E

tazicef injection E

tazicef intravenous solution reconstituted 1 gm

E

TEFLARO INTRAVENOUS SOLUTION RECONSTITUTED 600 MG

E

tetracycline hcl oral 1

tigecycline E

tinidazole oral 1

trimethoprim oral 1

TYGACIL E

UNASYN INJECTION SOLUTION RECONSTITUTED 3 (2-1) GM

E

VANCOCIN 3

VANCOCIN HCL ORAL CAPSULE 125 MG

3


vancomycin hcl in nacl intravenous solution 1-09 gm200ml-

E

vancomycin hcl intravenous solution 1000 mg200ml 1250 mg250ml 1500 mg300ml 1750 mg350ml 2000 mg400ml 500 mg100ml 750 mg150ml

E

vancomycin hcl oral 1

VANCOMYCIN+SYRSPEND SF

E

vandazole 1

VIBRAMYCIN 3 ST

XENLETA INTRAVENOUS

E

XENLETA ORAL 3

XEPI 3

XIFAXAN 3 PA

XIMINO 3

ZEMDRI E

ZITHROMAX ORAL PACKET

3

ZITHROMAX ORAL SUSPENSION RECONSTITUTED

3

ZITHROMAX ORAL TABLET 250 MG 500 MG

3

ZITHROMAX TRI-PAK 3

ZITHROMAX Z-PAK 3

ZYVOX INTRAVENOUS SOLUTION 200 MG100ML 600 MG300ML

E

ZYVOX ORAL 3 QL

Anticoagulants

ACD-A NOCLOT-50 3


25


ACTIVASE E

anticoagulant cit dext soln a

1

ANTICOAGULANT SODIUM CITRATE

3

ARIXTRA 3 SP QL

CATHFLO ACTIVASE E

ELIQUIS 2 QL

ELIQUIS DVTPE STARTER PACK ORAL TABLET THERAPY PACK

2 QL

enoxaparin sodium 1 SP QL

fondaparinux sodium 1 SP QL

FRAGMIN SUBCUTANEOUS SOLUTION 10000 UNITML 12500 UNIT05ML 15000 UNIT06ML 18000 UNT072ML 2500 UNIT02ML 5000 UNIT02ML 7500 UNIT03ML 95000 UNIT38ML

3 SP QL

heparin (porcine) in nacl intravenous solution 1000-09 ut500ml- 2000-09 unitl-

E

heparin sodium (porcine) injection solution 1000 unitml 10000 unitml 20000 unitml 5000 unitml

1

heparin sodium (porcine) injection solution prefilled syringe

E

heparin sodium (porcine) pf injection solution 5000 unit05ml

1


heparin sodium (porcine) pf injection solution 5000 unitml

E

jantoven 1

LOVENOX 3 SP QL

PRADAXA 2 QL

REGIOCIT E

SAVAYSA 3 QL

THROMBATE III 3 SP

TRICITRASOL 3

warfarin sodium oral 1

XARELTO 2 QL

XARELTO STARTER PACK

2 QL

Anticonvulsants - Drugs for Seizures

APTIOM 3

BANZEL 3 PA

BRIVIACT INTRAVENOUS

E

BRIVIACT ORAL 3 ST

carbamazepine er 1

carbamazepine oral 1

CARBATROL 3

CELONTIN 3

CEREBYX INJECTION SOLUTION 500 MG PE10ML

E

clobazam 1 PA

DEPAKOTE 3

DEPAKOTE ER 3

DEPAKOTE SPRINKLES ORAL CAPSULE DELAYED RELEASE SPRINKLE

3

DIACOMIT 3 PA SP

DIASTAT ACUDIAL 3 QL

DIASTAT PEDIATRIC 3 QL

diazepam rectal 1 QL


26


DILANTIN INFATABS E

DILANTIN ORAL CAPSULE 100 MG

E


3

DILANTIN ORAL SUSPENSION

E

divalproex sodium er oral tablet extended release 24 hour

1

divalproex sodium oral capsule delayed release sprinkle

1

divalproex sodium oral tablet delayed release

1

EPIDIOLEX 3 PA SP

epitol 1

ethosuximide oral 1

FANATREX FUSEPAQ E

felbamate 1

FELBATOL 3

FINTEPLA 3 PA SP

fosphenytoin sodium injection solution 500 mg pe10ml

E

FYCOMPA 3

gabapentin oral capsule

1

gabapentin oral solution 250 mg5ml

1

gabapentin oral tablet 1

GABITRIL 3

KEPPRA INTRAVENOUS

E

KEPPRA ORAL 3

KEPPRA XR 3

LAMICTAL ODT ORAL KIT 21 X 25 MG amp 7 X 50 MG 42 X 50 MG amp 14X100 MG

2


LAMICTAL ODT ORAL KIT 25 amp 50 amp 100 MG

E

LAMICTAL ODT ORAL TABLET DISPERSIBLE

3

LAMICTAL ORAL TABLET

3

LAMICTAL ORAL TABLET CHEWABLE 25 MG 5 MG

3

LAMICTAL STARTER 3

LAMICTAL XR 3

lamotrigine er 1

lamotrigine oral kit 25 amp 50 amp 100 mg

1

lamotrigine oral tablet 1

lamotrigine oral tablet chewable

1

lamotrigine oral tablet dispersible

1

lamotrigine starter kit-blue

1

lamotrigine starter kit-green

1

lamotrigine starter kit-orange

1

levetiracetam er 1

levetiracetam intravenous

E

levetiracetam oral 1

MYSOLINE 3

NAYZILAM 3 QL

NEURONTIN 3

ONFI ORAL SUSPENSION

3 PA

ONFI ORAL TABLET 10 MG 20 MG

3 PA

oxcarbazepine 1

OXTELLAR XR E

phenobarbital oral elixir 1


27


phenobarbital oral tablet

1

PHENYTEK 3

phenytoin infatabs 1

phenytoin oral suspension 125 mg5ml

1

phenytoin oral tablet chewable

1

phenytoin sodium extended

1

primidone oral 1

QUDEXY XR 3

roweepra oral tablet 500 mg

1

rufinamide 1 PA

SABRIL ORAL PACKET

E SP

SABRIL ORAL TABLET

3 PA SP

SPRITAM E

subvenite 1

subvenite starter kit-blue

1

subvenite starter kit-green

1

subvenite starter kit-orange

1

SYMPAZAN 3 PA

TEGRETOL ORAL SUSPENSION

3

TEGRETOL ORAL TABLET

3

TEGRETOL-XR 3

tiagabine hcl 1

TOPAMAX 3

TOPAMAX SPRINKLE 3

topiramate er 1

topiramate oral 1

TRILEPTAL 3

TROKENDI XR 3 ST


valproic acid oral capsule

1

valproic acid oral solution

1

VALTOCO 10 MG DOSE

3 QL

VALTOCO 15 MG DOSE

3 QL

VALTOCO 20 MG DOSE

3 QL

VALTOCO 5 MG DOSE

3 QL

vigabatrin 1 PA SP

vigadrone 1 PA SP

VIMPAT INTRAVENOUS

E

VIMPAT ORAL 3

XCOPRI 3 ST

XCOPRI (250 MG DAILY DOSE)

3 ST


3 ST

ZARONTIN 3

ZONEGRAN 3

zonisamide oral 1

Antidementia Agents - Drugs for Alzheimers Disease and Dementia

ARICEPT 3

donepezil hcl 1

EXELON TRANSDERMAL

3

galantamine hydrobromide

1

galantamine hydrobromide er

1

memantine hcl er 1 QL

memantine hcl oral solution 2 mgml

1


28


memantine hcl oral tablet

1

NAMENDA ORAL TABLET

3

NAMENDA TITRATION PAK

3

NAMENDA XR 3 QL

NAMENDA XR TITRATION PACK

3 QL

NAMZARIC 2 QL

RAZADYNE ER 3

rivastigmine 1

rivastigmine tartrate 1

Antidepressants

amitriptyline hcl oral 1

amoxapine 1

ANAFRANIL 3

APLENZIN 3 ST QL

BRISDELLE 3 ST QL

bupropion hcl er (sr) 1 QL

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

1 QL

BUPROPION HCL ER (XL) ORAL TABLET EXTENDED RELEASE 24 HOUR 450 MG

E

bupropion hcl oral 1

CELEXA ORAL TABLET

3

chlordiazepoxide-amitriptyline

1

citalopram hydrobromide

1

clomipramine hcl oral 1

CYMBALTA E

desipramine hcl oral 1

DESVENLAFAXINE ER

3 ST QL


desvenlafaxine succinate er

1 QL

doxepin hcl oral capsule

1

doxepin hcl oral concentrate

1

DRIZALMA SPRINKLE 3 ST QL

duloxetine hcl oral 1 QL

EFFEXOR XR E

EMSAM 3 QL

escitalopram oxalate 1

FETZIMA 3 ST QL

FETZIMA TITRATION 3 ST QL

FLUOXETINE HCL (PMDD) ORAL TABLET

3

fluoxetine hcl oral capsule

1

fluoxetine hcl oral capsule delayed release

1 QL

fluoxetine hcl oral solution

1

fluoxetine hcl oral tablet 1

fluvoxamine maleate 1

fluvoxamine maleate er 1 QL

FORFIVO XL E

imipramine hcl oral 1

imipramine pamoate 1

LEXAPRO ORAL TABLET

E

maprotiline hcl 1

MARPLAN 3

mirtazapine oral 1

NARDIL 3

nefazodone hcl 1

NORPRAMIN ORAL TABLET 10 MG 25 MG

3

nortriptyline hcl oral 1


29


olanzapine-fluoxetine hcl

1 QL

PAMELOR ORAL CAPSULE

3

PARNATE 3

paroxetine hcl er 1

paroxetine hcl oral tablet

1

paroxetine mesylate 1 QL

PAXIL CR 3

PAXIL ORAL SUSPENSION

2 ST

PAXIL ORAL TABLET 3

perphenazine-amitriptyline

1

PEXEVA E

phenelzine sulfate oral 1

PRISTIQ E

protriptyline hcl 1

PROZAC ORAL CAPSULE

E

REMERON ORAL TABLET 15 MG 30 MG

3

REMERON SOLTAB 3

sertraline hcl oral 1

SPRAVATO (56 MG DOSE)

3 PA SP


3 PA SP

SYMBYAX ORAL CAPSULE 12-50 MG 3-25 MG 6-25 MG 6-50 MG

3 QL

tranylcypromine sulfate 1

trazodone hcl oral 1

trimipramine maleate oral

1

TRINTELLIX 3 ST QL

venlafaxine hcl 1


venlafaxine hcl er 1

VIIBRYD ORAL TABLET

3 QL

VIIBRYD STARTER PACK

3 QL

WELLBUTRIN SR E

WELLBUTRIN XL E

ZOLOFT E

ZULRESSO 3 PA SP

Antiemetics - Drugs for Nausea and Vomiting

AKYNZEO INTRAVENOUS

E

AKYNZEO ORAL 3 QL

ALOXI INTRAVENOUS SOLUTION 025 MG5ML

E

ANZEMET ORAL 3 QL

aprepitant 1 QL

BONJESTA 3 PA QL

compro 1

cvs motion sickness E

DICLEGIS 3 PA QL

doxylamine-pyridoxine 1 PA QL

dronabinol 1 PA QL

EMEND INTRAVENOUS SOLUTION RECONSTITUTED 150 MG

E

EMEND ORAL CAPSULE 80 MG

3 QL

EMEND ORAL SUSPENSION RECONSTITUTED

3

EMEND TRI-PACK 3 QL

fosaprepitant dimeglumine

E

GIMOTI E


30


goodsense motion sickness

E

granisetron hcl intravenous solution 1 mgml 4 mg4ml

E

granisetron hcl oral 1 QL

MARINOL 3 PA QL

meclizine hcl oral tablet 125 mg 25 mg

1

meclizine hcl oral tablet 50 mg

E

meclizine hcl tablet chewable 25 mg oral (otc)

E

meclizine hcl tablet chewable 25 mg oral (rx)

1

metoclopramide hcl oral solution 10 mg10ml 5 mg5ml

1

metoclopramide hcl oral tablet

1

metoclopramide hcl oral tablet dispersible

1

motion sickness relief E

ondansetron hcl injection solution 4 mg2ml 40 mg20ml

E

ondansetron hcl oral solution

1 QL

ondansetron hcl oral tablet 24 mg

1 QL

ondansetron hcl oral tablet 4 mg 8 mg

1

ondansetron odt 1

palonosetron hcl E

perphenazine oral 1

prochlorperazine 1

prochlorperazine maleate oral

1

REGLAN ORAL 3

SANCUSO 3 QL


scopolamine 1

SYNDROS 3 PA QL

TIGAN INTRAMUSCULAR

E

TIGAN ORAL 3

TRANSDERM SCOP (15 MG)

3

TRANSDERM-SCOP (15 MG)

3

travel sickness oral tablet chewable

E

trimethobenzamide hcl oral

1

VARUBI (180 MG DOSE)

3 QL

ZOFRAN ORAL TABLET 4 MG

3

ZUPLENZ E

Antifungals

ACTIVE-PREP KIT V E

ala-quin E

ALCORTIN A E

ALOE VESTA CLEAR ANTIFUNGAL

E

amphotericin b intravenous

E

ANCOBON 3

athletes foot (terbinafine)

E

BIO-STATIN ORAL CAPSULE

3

bio-statin oral powder E

CANCIDAS INTRAVENOUS SOLUTION RECONSTITUTED 70 MG

E

caspofungin acetate intravenous solution reconstituted 70 mg

E


31


ciclodan external solution

1

ciclopirox external 1

ciclopirox olamine external

1

ciclopirox treatment E

clotrimazole external cream

1

clotrimazole external solution

1

clotrimazole mouththroat troche

1

clotrimazole vaginal cream 1

E

clotrimazole-betamethasone

1

CRESEMBA ORAL 3

cvs clotrimazole 3 E

DERMACINRX THERAZOLE PAK

E

dermazene E

DESENEX EXTERNAL POWDER

E

DIFLUCAN ORAL SUSPENSION RECONSTITUTED

3

DIFLUCAN ORAL TABLET 100 MG 200 MG 50 MG

3

DIFMETIOXRIME E

ECONASIL E

econazole nitrate external

1

ECONAZOLE NITRATE-NIACINAMIDE

E

ECOZA E

ERAXIS INTRAVENOUS SOLUTION RECONSTITUTED 100 MG

E


ERTACZO E

EXELDERM E

exoderm external lotion 1

EXTINA 3

fluconazole oral 1

FLUCON-IBUPROF-ITRACON-TERBINA

E

flucytosine oral 1

FUNGIMEZ E

griseofulvin microsize oral

1

griseofulvin ultramicrosize

1

GYNAZOLE-1 3

hydrocortisone-iodoquinol external cream 1-1

E

IMIOXIA E

IODOQUIMEZ-HC E

iodoquinol-hc-aloe polysacch

E

IODOQUINOL-HC-KETOCONAZOLE

E

iodoquinol-hydrocortisone-aloe

E

itraconazole oral 1 PA

JUBLIA E

KERYDIN 3 PA

ketoconazole external cream

1

ketoconazole external foam

E

ketoconazole external shampoo 2

1

ketoconazole oral 1

KETOCONAZOLE-HYDROCORTISONE

E

ketodan external foam E

KETODAN EXTERNAL KIT

E


32


LOPROX EXTERNAL CREAM

3

LOPROX EXTERNAL KIT

E

LOPROX EXTERNAL SHAMPOO

3

LOPROX EXTERNAL SUSPENSION

3

LOTRIMIN AF EXTERNAL POWDER

E

LULICONAZOLE E

LUZU E

MENTAX E

micaderm E

micafungin sodium intravenous solution reconstituted 100 mg

E

miconazole 1 E

miconazole 3 vaginal suppository

1


E

miconazole nitrate external cream

E

MICONAZOLE-ZINC OXIDE-PETROLAT

E

MYCAMINE INTRAVENOUS SOLUTION RECONSTITUTED 100 MG

E

naftifine hcl 1

NAFTIN EXTERNAL CREAM 2

3

NAFTIN EXTERNAL GEL

3

NOXAFIL ORAL 3

nyamyc 1

nystatin external 1

nystatin mouththroat 1

nystatin oral tablet 1


nystatin-triamcinolone 1

nystop 1

ONYCHO-MED E

ORAVIG E

oxiconazole nitrate E

OXISTAT EXTERNAL CREAM

3

OXISTAT EXTERNAL LOTION

E

PEDIZOLPAK E

PHEODOYO E

PHEYO E

podactin external cream

E

posaconazole 1

QUINJA E

RECURA E

SPORANOX 3 PA

SPORANOX PULSEPAK

3 PA

SULCONAZOLE NITRATE

E

tavaborole 1 PA

terbinafine hcl oral 1 QL

terconazole 1

tolnaftate antifungal E

tolnaftate external powder

E

TOLSURA E

VFEND 3

voriconazole oral 1

VUSION E

VYTONE E

XOLEGEL E

XOLEGEL COREPAK E

XOLEGEL DUOHEAD amp SHOULDERS

E

XOLEGEL DUOXOLEX

E


33


ZEASORB-AF EXTERNAL POWDER

E

ZOLPAK E

Antigout Agents

allopurinol oral 1

COLCHICINE ORAL CAPSULE

E

colchicine oral tablet 1

colchicine-probenecid 1

COLCRYS E

febuxostat 1 ST

GLOPERBA E

KRYSTEXXA 3 PA SP

MITIGARE E

probenecid oral 1

ULORIC 3 ST

ZYLOPRIM 3

Anti-inflammatory Agents

EMFLAZA 3 PA SP

Antimigraine Agents

AIMOVIG 2 PA QL

AJOVY E

almotriptan malate 1 QL

AMERGE 3 QL

CAFERGOT 3

DHE 45 3 PA QL

dihydroergotamine mesylate injection

1 PA QL

dihydroergotamine mesylate nasal

1 PA QL

eletriptan hydrobromide 1 QL

EMGALITY 2 PA QL

EMGALITY (300 MG DOSE)

2 PA QL

ERGOMAR 3

ergotamine-caffeine 1

FROVA 3 QL


frovatriptan succinate 1 QL

IMITREX 3 QL

IMITREX STATDOSE REFILL SUBCUTANEOUS SOLUTION CARTRIDGE

3 QL

IMITREX STATDOSE SYSTEM SUBCUTANEOUS SOLUTION AUTO-INJECTOR

3 QL

MAXALT ORAL TABLET 10 MG

3 QL

MAXALT-MLT ORAL TABLET DISPERSIBLE 10 MG

3 QL

MIGERGOT 3

MIGRAINE PACK E

MIGRANAL 3 PA QL

MIGRANOW E

naratriptan hcl 1 QL

NURTEC 2 PA QL

ONZETRA XSAIL 3 ST QL

RELPAX 3 QL

REYVOW E

rizatriptan benzoate 1 QL

sumatriptan nasal 1 QL

sumatriptan succinate oral

1 QL

sumatriptan succinate refill subcutaneous solution cartridge

1 QL

sumatriptan succinate subcutaneous solution 6 mg05ml

1 QL

sumatriptan succinate subcutaneous solution auto-injector 4 mg05ml 6 mg05ml

1 QL


34


sumatriptan succinate subcutaneous solution prefilled syringe 6 mg05ml

1 QL

sumatriptan-naproxen sodium

1 QL

TOSYMRA E

TREXIMET ORAL TABLET 85-500 MG

3 ST QL

UBRELVY 2 PA QL

VYEPTI E

ZEMBRACE SYMTOUCH

E

zolmitriptan oral 1 QL

ZOMIG NASAL 3 ST QL

ZOMIG ORAL E

ZOMIG ZMT E

Antimyasthenic Agents

GUANIDINE HCL ORAL

3

MESTINON ORAL SOLUTION

3

MESTINON ORAL TABLET

3

MESTINON ORAL TABLET EXTENDED RELEASE

3

NEOSTIGMINE METHYLSULFATE SOLUTION PREFILLED SYRINGE 5 MG5ML INTRAVENOUS

E

pyridostigmine bromide er

1

pyridostigmine bromide oral solution

1

pyridostigmine bromide oral tablet

1

Antimycobacterials

CAPASTAT SULFATE E


cycloserine oral 1

dapsone oral 1

ethambutol hcl oral 1

isoniazid oral 1

MYAMBUTOL ORAL TABLET 400 MG

3

MYCOBUTIN 3

PASER 3

PRETOMANID 3

PRIFTIN 3

pyrazinamide oral 1

rifabutin 1

rifampin oral 1

RIFAMPIN+SYRSPEND SF

E

SIRTURO 3

TRECATOR 3

Antineoplastics - Drugs for Cancer

abiraterone acetate 1 PA SP

ABRAXANE 2 SP

ADCETRIS 2 PA SP

adriamycin intravenous solution

1 SP

adriamycin intravenous solution reconstituted 10 mg 50 mg

1 SP

AFINITOR DISPERZ 3 PA SP

AFINITOR ORAL TABLET 10 MG

2 PA SP QL

AFINITOR ORAL TABLET 25 MG 5 MG 75 MG

E SP

ALECENSA 3 PA SP

ALIMTA 2 SP

ALIQOPA 3 PA SP

ALKERAN 3 SP

ALUNBRIG 3 PA SP QL

anastrozole oral $0


35


ARIMIDEX E

AROMASIN 3

ARRANON 2 SP

arsenic trioxide intravenous

1 SP

ARZERRA 2 PA SP

ASPARLAS 3 SP

AVASTIN 3 PA SP

AYVAKIT 3 PA SP QL

azacitidine 1 PA SP

BALVERSA 3 PA SP

BAVENCIO 3 PA SP

BELEODAQ 3 PA SP

BELRAPZO E SP

BENDEKA 3 PA SP

BESPONSA 3 PA SP

bexarotene 1 PA SP

bicalutamide 1

BICNU 3 SP

BLENREP E SP

bleomycin sulfate 1 SP

BLINCYTO 3 PA SP

BORTEZOMIB 3 PA SP

BOSULIF 3 PA SP

BRAFTOVI ORAL CAPSULE 75 MG

3 PA SP

BRUKINSA 3 PA SP

busulfan 1 SP

BUSULFEX 3 SP

CABOMETYX 2 PA SP

CALQUENCE 3 PA SP

CAMPATH 2 SP

CAMPTOSAR 3 SP

capecitabine 1 PA SP

CAPRELSA ORAL TABLET 100 MG

2 PA SP QL


2 PA SP


carboplatin intravenous solution

1 SP

carmustine 1 SP

CASODEX 3

cisplatin intravenous solution 100 mg100ml 200 mg200ml 50 mg50ml

1 SP

CISPLATIN INTRAVENOUS SOLUTION RECONSTITUTED

3 SP

cladribine intravenous solution 10 mg10ml

1 SP

clofarabine 1 SP

CLOLAR 3 SP

COMETRIQ (100 MG DAILY DOSE) ORAL KIT 80 amp 20 MG

3 PA SP

COMETRIQ (140 MG DAILY DOSE) ORAL KIT 3 X 20 MG amp 80 MG

3 PA SP

COMETRIQ (60 MG DAILY DOSE)

3 PA SP

COPIKTRA 3 PA SP

COSMEGEN 3 SP

COTELLIC 3 PA SP

cyclophosphamide injection

1 SP

CYCLOPHOSPHAMIDE INTRAVENOUS

E SP

cyclophosphamide oral capsule

1

CYRAMZA 3 PA SP

cytarabine (pf) 1 SP

cytarabine injection solution

1 SP

dacarbazine intravenous

1 SP

DACOGEN 3 PA SP

dactinomycin 1 SP


36


DARZALEX 3 PA SP

DARZALEX FASPRO E SP

daunorubicin hcl intravenous solution

1 SP

DAURISMO 3 PA SP

decitabine 1 PA SP

dexrazoxane hcl 1 SP

docetaxel intravenous concentrate 160 mg8ml 20 mgml 80 mg4ml

1 SP

docetaxel intravenous solution 160 mg16ml 20 mg2ml 80 mg8ml

1 SP

DOXIL 3 SP

doxorubicin hcl intravenous solution

1 SP

doxorubicin hcl liposomal

1 SP

DROXIA 3

ELITEK 3 SP

ELLENCE 3 SP

ELZONRIS 3 PA SP

EMCYT 2

EMPLICITI 3 PA SP

ENHERTU 3 PA SP

epirubicin hcl intravenous solution 200 mg100ml 50 mg25ml

1 SP

ERBITUX 2 PA SP

ERIVEDGE 2 PA SP

ERLEADA E SP

erlotinib hcl oral tablet 100 mg 150 mg

1 PA SP

erlotinib hcl oral tablet 25 mg

1 PA SP QL

ERWINAZE INJECTION

3 SP

ETHYOL 3 SP


ETOPOPHOS 3 SP

etoposide intravenous solution 1 gm50ml 100 mg5ml 500 mg25ml

1 SP

etoposide oral 1 SP

everolimus oral tablet 25 mg 5 mg 75 mg

1 PA SP QL

EVOMELA 3 SP

exemestane $0

FARESTON 3

FARYDAK 3 PA SP

FASLODEX INTRAMUSCULAR SOLUTION 250 MG5ML

3 SP

FEMARA 3

floxuridine injection 1 SP

fludarabine phosphate 1 SP

fluorouracil intravenous 1 SP

flutamide 1

FOLOTYN 2 PA SP

fulvestrant 1 SP

GAVRETO E SP

GAZYVA 3 PA SP

gemcitabine hcl 1 SP

GILOTRIF 3 PA SP QL

GLEEVEC 3 PA SP

GLEOSTINE ORAL CAPSULE 10 MG 100 MG 40 MG

3 SP

HALAVEN 2 PA SP

HERCEPTIN HYLECTA

3 PA SP

HERCEPTIN INTRAVENOUS SOLUTION RECONSTITUTED 150 MG

3 PA SP

HERZUMA E SP


37


HYCAMTIN 3 SP

HYDREA 3

hydroxyurea oral 1

IBRANCE 3 PA SP

ICLUSIG ORAL TABLET 15 MG

3 PA SP QL


3 PA SP

IDAMYCIN PFS 3 SP

idarubicin hcl 1 SP

IDHIFA 3 PA SP QL

IFEX 3 SP

ifosfamide 1 SP

imatinib mesylate 1 PA SP

IMBRUVICA 3 PA SP

IMFINZI 3 PA SP

IMLYGIC 3 SP

INFUGEM 3 SP

INLYTA 3 PA SP

INQOVI E SP

INREBIC 3 PA SP

IRESSA 3 PA SP

irinotecan hcl 1 SP

ISTODAX (OVERFILL) 3 PA SP

IXEMPRA KIT 2 SP

JAKAFI ORAL TABLET 10 MG

2 PA SP QL

JAKAFI ORAL TABLET 15 MG 20 MG 25 MG 5 MG

2 PA SP

JELMYTO E SP

JEVTANA 2 PA SP

KADCYLA 3 PA SP

KANJINTI 2 PA SP

KEYTRUDA INTRAVENOUS SOLUTION

3 PA SP

KHAPZORY 3 ST SP


KISQALI (200 MG DOSE)

3 PA SP


3 PA SP


3 PA SP

KISQALI FEMARA (400 MG DOSE)

3 PA SP


3 PA SP

KISQALI FEMARA(200 MG DOSE)

3 PA SP

KOSELUGO 3 PA SP

KYPROLIS 2 PA SP

lapatinib ditosylate 1 PA SP

LARTRUVO 3 PA SP

LENVIMA (10 MG DAILY DOSE)

3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP

letrozole oral 1

leucovorin calcium injection

E

leucovorin calcium oral 1

LEUKERAN 2

levoleucovorin calcium intravenous solution reconstituted 50 mg

1 SP


38


levoleucovorin calcium pf

1 SP

LIBTAYO 3 PA SP

LONSURF 3 PA SP

LORBRENA 3 PA SP

LUMOXITI 3 PA SP

LUTATHERA E

LYNPARZA ORAL TABLET

2 PA SP

LYSODREN 2

MARQIBO 3 SP

MATULANE 2 SP

MEKINIST 2 PA SP

MEKTOVI 3 PA SP

melphalan 1 SP

melphalan hcl 1 SP

mercaptopurine oral 1

mesna 1 SP

MESNEX 3 SP

mitomycin intravenous 1 SP

MITOMYCIN INTRAVESICAL

E SP

mitoxantrone hcl 1 PA SP

MONJUVI E SP

mutamycin 1 SP

MVASI 2 PA SP

MYLERAN 2

MYLOTARG INTRAVENOUS SOLUTION RECONSTITUTED 45 MG

3 PA SP

NAVELBINE 3 SP

NERLYNX 3 PA SP QL

NEXAVAR 2 PA SP

nilutamide 1 SP

NINLARO 3 PA SP

NIPENT 3 SP

NUBEQA 3 PA SP


ODOMZO 3 PA SP

OGIVRI E SP

ONCASPAR INJECTION

2 SP

ONIVYDE 3 SP

ONTRUZANT E SP

ONUREG E SP

OPDIVO 3 PA SP

oxaliplatin intravenous solution 100 mg20ml 50 mg10ml

1 SP

oxaliplatin intravenous solution 200 mg40ml

E

oxaliplatin intravenous solution reconstituted

1 SP

paclitaxel 1 SP

PADCEV 3 PA SP

PANRETIN 3

paraplatin 1 SP

PEMAZYRE 3 PA SP QL

PERJETA 2 PA SP

PHESGO E SP

PHOTOFRIN 3 SP

PIQRAY (200 MG DAILY DOSE)

3 PA SP


3 PA SP


3 PA SP

POLIVY 3 PA SP

POMALYST 3 PA SP

PORTRAZZA 3 PA SP

POTELIGEO 3 PA SP

PROLEUKIN 2 SP

PURIXAN 3 SP

QINLOCK 3 PA SP

RETEVMO E SP

REVLIMID 2 PA SP

RITUXAN HYCELA 3 PA SP


39


RITUXAN INTRAVENOUS SOLUTION

3 PA SP

ROMIDEPSIN INTRAVENOUS SOLUTION

3 PA SP

ROZLYTREK 3 PA SP

RUBRACA 2 PA SP

RUXIENCE 2 PA SP

RYDAPT 3 PA SP

SARCLISA 3 PA SP

SIKLOS 3 PA

SOLTAMOX $0

SPRYCEL 2 PA SP

STIVARGA 3 PA SP

SUTENT 2 PA SP

SYLVANT 3 PA SP

SYNRIBO 3 PA SP

TABLOID 2 SP

TABRECTA E SP

TAFINLAR 2 PA SP

TAGRISSO ORAL TABLET 40 MG

3 PA SP QL


3 PA SP

TALZENNA 3 PA SP

tamoxifen citrate oral 1

TARCEVA ORAL TABLET 100 MG 150 MG

3 PA SP

TARCEVA ORAL TABLET 25 MG

3 PA SP QL

TARGRETIN EXTERNAL

3 PA SP

TARGRETIN ORAL E SP

TASIGNA 3 PA SP

TAXOTERE INTRAVENOUS CONCENTRATE 80 MG4ML

3 SP


TAZVERIK E SP

TECARTUS 3 PA SP

TECENTRIQ 3 PA SP

TEMODAR INTRAVENOUS

2 SP

TEMODAR ORAL 3 PA SP

temozolomide 1 PA SP

teniposide 1 SP

TEPADINA 3 SP

THALOMID 2 PA SP

thiotepa injection 1 SP

TIBSOVO 3 PA SP

toposar intravenous solution 1 gm50ml 100 mg5ml 500 mg25ml

1 SP

topotecan hcl 1 SP

toremifene citrate 1

TOTECT 3 SP

TRAZIMERA 2 PA SP

TREANDA INTRAVENOUS SOLUTION RECONSTITUTED

E SP

tretinoin oral 1 SP

TRISENOX INTRAVENOUS SOLUTION 12 MG6ML

3 SP

TRODELVY 3 PA SP

TRUXIMA E SP

TUKYSA 3 PA SP

TURALIO 3 PA SP

TYKERB 3 PA SP

UNITUXIN 3 PA SP

VALCHLOR 3 PA SP

valrubicin E

VALSTAR E


40


VECTIBIX INTRAVENOUS SOLUTION 100 MG5ML 400 MG20ML

3 SP

VELCADE INJECTION 2 PA SP

VENCLEXTA 3 PA SP

VENCLEXTA STARTING PACK

3 PA SP

VERZENIO 3 PA SP

VIDAZA 3 PA SP

vinblastine sulfate intravenous solution

1 SP

vincristine sulfate intravenous

1 SP

vinorelbine tartrate 1 SP

VITRAKVI 3 PA SP

VIZIMPRO 3 PA SP

VORAXAZE E

VOTRIENT 3 PA SP

VYXEOS INTRAVENOUS SUSPENSION RECONSTITUTED 44-100 MG

3 PA SP

XALKORI 2 PA SP

XELODA 3 PA SP

XOFIGO INTRAVENOUS SOLUTION 30 MCCIML

E

XOSPATA 3 PA SP

XPOVIO (100 MG ONCE WEEKLY)

3 PA SP


3 PA SP

XPOVIO (40 MG TWICE WEEKLY)

3 PA SP


3 PA SP


3 PA SP



3 PA SP


3 PA SP

XTANDI 3 PA SP

YERVOY 2 PA SP

YESCARTA 3 PA SP

YONDELIS 3 SP

YONSA E SP

ZALTRAP 2 PA SP

ZANOSAR 2 SP

ZEJULA 2 PA SP

ZELBORAF 3 PA SP

ZEPZELCA 3 PA SP

ZEVALIN Y-90 3 SP

ZIRABEV 2 PA SP

ZOLINZA 2 PA SP

ZYDELIG 3 PA SP

ZYKADIA ORAL TABLET

3 PA SP

ZYTIGA E SP

Antiparasitics

albendazole oral 1 PA

ALBENZA 3 PA

ALINIA 2

ARAKODA 3

atovaquone oral 1

atovaquone-proguanil hcl

1

BENZNIDAZOLE 3

BILTRICIDE 3

chloroquine phosphate oral

1

COARTEM 3

complete lice treatment E

crotan 1

DARAPRIM 3 PA SP

EGATEN 3


41


ELIMITE 3

EMVERM 2

hydroxychloroquine sulfate oral

1

IMPAVIDO 3

ivermectin external lotion

1

ivermectin oral 1

KRINTAFEL 3

LAMPIT E

lice killing E

lice treatment external liquid 1

E

lindane external shampoo

1

MALARONE 3

malathion external 1

mefloquine hcl 1

MEPRON 3

NATROBA 3

NEBUPENT 3

nitazoxanide 2

OVIDE 3

PENTAM E

pentamidine isethionate inhalation

1

pentamidine isethionate injection

E

permethrin external cream

1

PLAQUENIL 3

praziquantel oral 1

primaquine phosphate oral

1

pyrimethamine oral 1 PA SP

PYRIMETHAMINE-LEUCOVORIN

3

QUALAQUIN 3 PA

quinine sulfate oral 1 PA


SKLICE 3

spinosad 1

stop lice complete treatment

E

STROMECTOL 3

SULFURATED LIME 3

Antiparkinson Agents

amantadine hcl oral 1

APOKYN SUBCUTANEOUS SOLUTION CARTRIDGE

2 PA SP QL

AZILECT 3

benztropine mesylate oral

1

bromocriptine mesylate oral

1

carbidopa oral 1

carbidopa-levodopa 1

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

1

carbidopa-levodopa-entacapone

1

COMTAN 3

DUOPA ENTERAL 3 PA

entacapone 1

GOCOVRI E

INBRIJA 3 PA SP

KYNMOBI E SP

KYNMOBI TITRATION KIT

E SP

LODOSYN 3

MIRAPEX ER 3

MIRAPEX ORAL TABLET 0125 MG 05 MG 075 MG 1 MG

3

NEUPRO 3 ST

NOURIANZ 3 PA


42


ONGENTYS E

OSMOLEX ER E

PARLODEL 3

pramipexole dihydrochloride

1

pramipexole dihydrochloride er

1

rasagiline mesylate oral 1

ropinirole hcl 1

ropinirole hcl er 1

RYTARY 3 ST

selegiline hcl oral 1

SINEMET 3

STALEVO 100 3

STALEVO 125 3

STALEVO 150 3

STALEVO 200 3

STALEVO 50 3

STALEVO 75 3

TASMAR ORAL TABLET 100 MG

3

tolcapone 1

trihexyphenidyl hcl 1

XADAGO 3 ST QL

ZELAPAR 3

Antiplatelets

aspirin-dipyridamole er 1

ASPIRIN-OMEPRAZOLE

E

BRILINTA 2

CABLIVI 3 PA SP QL

cilostazol 1

clopidogrel bisulfate oral

1

dipyridamole oral 1

DURLAZA E

EFFIENT 3


PLAVIX ORAL TABLET 75 MG

3

prasugrel hcl 1

YOSPRALA E

ZONTIVITY 3

Antipsychotics - Drugs for Mood Disorders

ABILIFY MAINTENA INTRAMUSCULAR PREFILLED SYRINGE

3

ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION RECONSTITUTED ER

3

ABILIFY MYCITE E

ABILIFY ORAL TABLET

3 QL

ADASUVE 3 PA

aripiprazole 1 QL

ARISTADA E

ARISTADA INITIO E

CAPLYTA 3 ST QL

chlorpromazine hcl injection

E

chlorpromazine hcl oral 1

clozapine 1 QL

CLOZARIL 3 QL

FANAPT 3 ST QL

FANAPT TITRATION PACK

3 ST QL

fluphenazine decanoate injection

E

fluphenazine hcl injection

E

fluphenazine hcl oral 1

GEODON INTRAMUSCULAR

E

GEODON ORAL 3 QL

HALDOL DECANOATE E


43


haloperidol decanoate intramuscular solution 100 mgml 50 mgml

E

haloperidol lactate oral 1

haloperidol oral 1

INVEGA 3 QL

INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

3

INVEGA TRINZA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

3

LATUDA 3 QL

loxapine succinate oral 1

molindone hcl 1

NUPLAZID ORAL CAPSULE

3 PA

NUPLAZID ORAL TABLET 10 MG

3 PA

olanzapine intramuscular

E

olanzapine oral 1 QL

paliperidone er 1 QL

PERSERIS E

pimozide 1

quetiapine fumarate 1 QL

quetiapine fumarate er 1 QL

REXULTI 3 QL

RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION RECONSTITUTED ER

3

RISPERDAL ORAL SOLUTION

E

RISPERDAL ORAL TABLET 05 MG 1 MG 2 MG 3 MG 4 MG

E

risperidone 1 QL


SAPHRIS 2 QL

SECUADO E

SEROQUEL 3 QL

SEROQUEL XR 3 QL

thioridazine hcl oral 1

thiothixene oral 1

trifluoperazine hcl oral 1

VERSACLOZ 3 QL

VRAYLAR 3 ST QL

ziprasidone hcl 1 QL

ziprasidone mesylate E

ZYPREXA INTRAMUSCULAR

3

ZYPREXA ORAL 3 QL

ZYPREXA RELPREVV E

ZYPREXA ZYDIS 3 QL

Antivirals

abacavir sulfate 1

abacavir sulfate-lamivudine

1

abacavir-lamivudine-zidovudine

1

acyclovir external 1

acyclovir oral 1

adefovir dipivoxil 1 SP

APTIVUS 2

atazanavir sulfate 1

ATRIPLA E

BARACLUDE 3 SP QL

BIKTARVY 3

cidofovir intravenous E

CIMDUO 2

COMBIVIR 3

COMPLERA 2

CRIXIVAN ORAL CAPSULE 200 MG 400 MG

2

DELSTRIGO 3


44


DENAVIR E

DESCOVY E

didanosine oral capsule delayed release 200 mg 250 mg 400 mg

1

DOVATO 2

EDURANT 2

efavirenz 1

efavirenz-emtricitab-tenofovir

1

efavirenz-lamivudine-tenofovir

1

emtricitabine 1

emtricitabine-tenofovir df

1

EMTRIVA ORAL CAPSULE

3

EMTRIVA ORAL SOLUTION

2

entecavir 1 SP QL

EPCLUSA 2 PA SP QL

EPIVIR 3

EPIVIR HBV ORAL SOLUTION

2 SP

EPIVIR HBV ORAL TABLET

3 SP

EPZICOM 3

EVOTAZ 2

famciclovir oral 1

FAVIPIRAVIR 3

fosamprenavir calcium 1

FOSCAVIR INTRAVENOUS SOLUTION 6000 MG250ML

E

FUZEON SUBCUTANEOUS SOLUTION RECONSTITUTED

E

GENVOYA 3

HARVONI 2 PA SP QL


HEPSERA 3 SP

INTELENCE 2

INTRON A 3 PA SP

INVIRASE ORAL TABLET

2

ISENTRESS 2

ISENTRESS HD 2

JULUCA 2

KALETRA ORAL SOLUTION

3

KALETRA ORAL TABLET

2

lamivudine oral solution 1

lamivudine oral tablet 100 mg

1 SP

lamivudine oral tablet 150 mg 300 mg

1

lamivudine-zidovudine 1

LEDIPASVIR-SOFOSBUVIR

E SP

LEXIVA ORAL SUSPENSION

2

LEXIVA ORAL TABLET 3

lopinavir-ritonavir 1

MAVYRET 2 PA SP QL

nevirapine 1

nevirapine er 1

NORVIR ORAL PACKET

2

NORVIR ORAL SOLUTION

2

NORVIR ORAL TABLET

3

ODEFSEY 3

oseltamivir phosphate oral

1 QL

PEGASYS SUBCUTANEOUS SOLUTION

2 PA SP


45


PEGINTRON SUBCUTANEOUS KIT 50 MCG05ML

3 PA SP

PIFELTRO 3

PREVYMIS 3 SP

PREZCOBIX 2

PREZISTA ORAL SUSPENSION

2

PREZISTA ORAL TABLET 150 MG 600 MG 75 MG 800 MG

2

RELENZA DISKHALER 3 QL

RETROVIR INTRAVENOUS

E

RETROVIR ORAL CAPSULE

3

RETROVIR ORAL SYRUP

3

REYATAZ ORAL CAPSULE 150 MG 200 MG 300 MG

3

REYATAZ ORAL PACKET

2

ribavirin inhalation 1

ribavirin oral capsule 1 SP

ribavirin oral tablet 200 mg

1 SP

rimantadine hcl 1

ritonavir 1

RUKOBIA 3

SELZENTRY 2 PA

SITAVIG 3 QL

SOFOSBUVIR-VELPATASVIR

E SP

SOVALDI 3 PA SP QL

stavudine oral capsule 1

STRIBILD 3

SUSTIVA 3

SYMFI 2

SYMFI LO 2


SYMTUZA 3

TAMIFLU ORAL CAPSULE

E

TAMIFLU ORAL SUSPENSION RECONSTITUTED 6 MGML

E

TEMIXYS E

tenofovir disoproxil fumarate

1

TIVICAY 2

TIVICAY PD 2

TRIUMEQ 2

TRIZIVIR 3

TROGARZO 3 PA

TRUVADA ORAL TABLET 100-150 MG 133-200 MG 167-250 MG

2

TRUVADA ORAL TABLET 200-300 MG

E

TYBOST 2

valacyclovir hcl oral 1 QL

VALCYTE 3

valganciclovir hcl 1

VALTREX 3 QL

VEMLIDY 3 SP

VIEKIRA PAK 3 PA SP QL

VIRACEPT ORAL TABLET

2

VIRAMUNE ORAL SUSPENSION

3

VIRAMUNE XR ORAL TABLET EXTENDED RELEASE 24 HOUR 400 MG

3

VIRAZOLE 3

VIREAD ORAL POWDER

2


46


VIREAD ORAL TABLET 150 MG 200 MG 250 MG

2

VIREAD ORAL TABLET 300 MG

3

VOSEVI 2 PA SP QL

XERESE E

XOFLUZA (40 MG DOSE)

3 QL


3 QL

ZEPATIER 3 PA SP QL

ZIAGEN 3

zidovudine 1

ZOVIRAX EXTERNAL CREAM

3

ZOVIRAX EXTERNAL OINTMENT

E

ZOVIRAX ORAL SUSPENSION

E

Anxiolytics - Drugs for Anxiety

alprazolam er 1 QL

alprazolam intensol 1 QL

alprazolam oral 1 QL

alprazolam xr 1 QL

ATIVAN E

buspirone hcl oral 1

chlordiazepoxide hcl 1 QL

clonazepam oral 1 QL

clorazepate dipotassium

1 QL

diazepam intensol 1

diazepam oral concentrate

1

diazepam oral solution 5 mg5ml

1

diazepam oral tablet 1

DORAL 3 QL

estazolam 1 QL


HALCION 3 QL

hydroxyzine hcl oral syrup

1

hydroxyzine hcl oral tablet

1

hydroxyzine pamoate oral

1

KLONOPIN 3 QL

lorazepam injection E

lorazepam intensol 1 QL

lorazepam oral concentrate 2 mgml

1 QL

lorazepam oral tablet 1 QL

meprobamate 1

midazolam hcl oral 1

MIDAZOLAM HCL-SODIUM CHLORIDE INTRAVENOUS SOLUTION 100-08 MG100ML- 50-08 MG50ML- 50-09 MG50ML-

E

MIDAZOLAM HCL-SODIUM CHLORIDE SOLUTION 100-09 MG100ML- INTRAVENOUS

E

MIDAZOLAM+SYRSPEND SF

E

oxazepam 1 QL

quazepam 1 QL

TRANXENE-T ORAL TABLET 75 MG

3 QL

triazolam 1 QL

VALIUM E

VISTARIL 3

XANAX E

XANAX XR E


47


Bipolar Agents - Drugs for Mood Disorders

EQUETRO 3

lithium 1

lithium carbonate er 1

lithium carbonate oral 1

LITHOBID 3

Blood Products and Modifiers - Drugs for Blood Disorders

ADVATE 2 SP

ADYNOVATE 3 SP

AFSTYLA 3 SP

AGRYLIN 3

ALPHANATEVWF COMPLEXHUMAN

2 SP

ALPHANINE SD 2 SP

ALPROLIX 3 SP

AMICAR ORAL SOLUTION

3

AMICAR ORAL TABLET

3

aminocaproic acid oral solution

1

aminocaproic acid oral tablet

1

anagrelide hcl 1

ARANESP (ALBUMIN FREE) INJECTION SOLUTION 100 MCGML 200 MCGML 25 MCGML 300 MCGML 40 MCGML 60 MCGML

2 PA SP

ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED SYRINGE

2 PA SP

ASTRINGYN SOLUTION 259 MGGM EXTERNAL

3



E

BENEFIX INTRAVENOUS KIT

2 SP

CEPROTIN 3 SP

COAGADEX 3 SP

CORIFACT 2 SP

CYKLOKAPRON INTRAVENOUS SOLUTION 1000 MG10ML

E

DOPTELET ORAL TABLET 20 MG

3 PA SP

ELOCTATE 3 SP

EPOGEN INJECTION SOLUTION 10000 UNITML 2000 UNITML 20000 UNITML 3000 UNITML 4000 UNITML

E SP

ESPEROCT E SP

FEIBA INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 2500 UNIT 500 UNIT

2 SP

FIBRYGA 2 SP

FULPHILA E SP

GRANIX E SP

HEMLIBRA 3 SP

HEMOFIL M INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 1700 UNIT 250 UNIT 500 UNIT

3 SP


48


HUMATE-P INTRAVENOUS SOLUTION RECONSTITUTED 1000-2400 UNIT 250-600 UNIT 500-1200 UNIT

2 SP

IDELVION 3 SP

IXINITY 3 SP

JIVI 3 SP

KOATE 2 SP

KOATE-DVI 2 SP

KOGENATE FS 3 SP

KOVALTRY 3 SP

LEUKINE INJECTION SOLUTION RECONSTITUTED

3 PA SP

LYSTEDA 3

MIRCERA INJECTION SOLUTION PREFILLED SYRINGE

3 PA SP

MONONINE INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT

2 SP

monsels ferric subsulfate external

E

MOZOBIL 2 PA SP QL

MULPLETA 2 PA SP

NEULASTA ONPRO 3 PA SP

NEULASTA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA SP

NEUPOGEN INJECTION SOLUTION 300 MCGML 480 MCG16ML

E SP


NEUPOGEN INJECTION SOLUTION PREFILLED SYRINGE

E SP

NIVESTYM 2 PA SP

NOVOEIGHT 2 SP

NOVOSEVEN RT 2 SP

NPLATE 2 PA SP

NUWIQ 2 SP

OBIZUR 3 SP

PANHEMATIN INTRAVENOUS SOLUTION RECONSTITUTED 350 MG

3 SP

PROCRIT E SP

PROFILNINE 2 SP

PROMACTA 3 PA SP

REBINYN 3 SP

REBLOZYL 3 PA SP

RECOMBINATE 2 SP

RECOTHROM 3

RECOTHROM SPRAY KIT

3

RETACRIT INJECTION SOLUTION 10000 UNITML 2000 UNITML 20000 UNITML 3000 UNITML 4000 UNITML 40000 UNITML

2 PA SP

RIASTAP 2 SP

RIXUBIS 3 SP

SEVENFACT E SP

SOLIRIS INTRAVENOUS SOLUTION 300 MG30ML

3 PA SP

TAVALISSE 3 PA SP

THROMBIN-JMI EPISTAXIS

3


49


THROMBIN-JMI EXTERNAL KIT

3

THROMBOGEN 3

tranexamic acid intravenous solution 1000 mg10ml

E

tranexamic acid oral 1

TRANEXAMIC ACID-NACL

E

TRETTEN 3 SP

UDENYCA E SP

ULTOMIRIS INTRAVENOUS SOLUTION 1100 MG11ML 300 MG3ML

3 PA SP

ULTOMIRIS INTRAVENOUS SOLUTION 300 MG30ML

2 PA SP

VONVENDI 3 SP

WILATE INTRAVENOUS KIT

2 SP

XYNTHA INTRAVENOUS KIT 1000 UNIT 2000 UNIT 250 UNIT 500 UNIT

2 SP

XYNTHA SOLOFUSE 2 SP

ZARXIO 2 PA SP

ZIEXTENZO 3 PA SP

Cardiovascular Agents - Drugs for Heart and Circulation Conditions

ACCUPRIL 3

ACCURETIC 3

acebutolol hcl oral 1

ADALAT CC ORAL TABLET EXTENDED RELEASE 24 HOUR 60 MG

3


AKOVAZ SOLUTION 50 MGML INTRAVENOUS

E

ALDACTAZIDE 3

ALDACTONE 3

aliskiren fumarate 1 ST

ALTACE ORAL CAPSULE

E

ALTOPREV E

amiloride hcl oral 1

amiloride-hydrochlorothiazide

1

amiodarone hcl oral 1

AMLODIPINE BES+SYRSPEND SF

E

amlodipine besylate oral

1

amlodipine besylate-benazepril hcl

1

amlodipine besylate-valsartan

1

amlodipine-atorvastatin 1

amlodipine-olmesartan 1

amlodipine-valsartan-hctz

1

ANTARA ORAL CAPSULE 30 MG 90 MG

E

ATACAND E

ATACAND HCT 3

atenolol oral 1

ATENOLOL+SYRSPEND SF

E

atenolol-chlorthalidone 1

atorvastatin calcium oral

1

AVALIDE ORAL TABLET 150-125 MG 300-125 MG

3

AVAPRO 3

AZOR E


50


benazepril hcl oral 1

benazepril-hydrochlorothiazide

1

BENICAR E

BENICAR HCT E

BETAPACE AF 3

BETAPACE ORAL TABLET 120 MG 160 MG 80 MG

3

betaxolol hcl oral 1

BIDIL 3

bisoprolol fumarate 1

bisoprolol-hydrochlorothiazide

1

bumetanide oral 1

BUMEX 3

BYSTOLIC 2

CADUET ORAL TABLET 10-10 MG 10-20 MG 10-40 MG 10-80 MG 5-10 MG 5-20 MG 5-40 MG 5-80 MG

3

CALAN SR 3

candesartan cilexetil 1

candesartan cilexetil-hctz

1

captopril oral 1

captopril-hydrochlorothiazide

1

CARDIZEM CD 3

CARDIZEM LA ORAL TABLET EXTENDED RELEASE 24 HOUR 120 MG

3

CARDIZEM LA ORAL TABLET EXTENDED RELEASE 24 HOUR 180 MG 240 MG 300 MG 360 MG 420 MG

E

CARDIZEM ORAL TABLET 120 MG 30 MG 60 MG

3


CARDURA 3

CAROSPIR 3

cartia xt 1

carvedilol 1

carvedilol phosphate er 1

CATAPRES 3

CATAPRES-TTS-1 3

CATAPRES-TTS-2 3

CATAPRES-TTS-3 3

chlorthalidone oral tablet 25 mg 50 mg

1

cholestyramine light 1

cholestyramine oral 1

clonidine 1

clonidine hcl oral 1

colesevelam hcl 1

COLESTID E

COLESTID FLAVORED

E

colestipol hcl 1

CONJUPRI E

CONSENSI E

COREG 3

COREG CR 3

CORGARD 3

CORLANOR 3 PA QL

COZAAR 3

CRESTOR E

DEMSER 3

DIBENZYLINE 3

digitek 1

digox 1

digoxin oral 1

DILATRATE-SR 3

diltiazem hcl er beads 1

diltiazem hcl er coated beads

1


51


diltiazem hcl er oral capsule extended release 12 hour

1

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

1

diltiazem hcl oral 1

DILTIAZEM HCL-DEXTROSE SOLUTION 125-5 MG125ML- INTRAVENOUS

E

dilt-xr 1

DIOVAN E

DIOVAN HCT E

disopyramide phosphate oral

1

DIURIL 3

dofetilide 1

doxazosin mesylate oral

1

DUTOPROL E

DYAZIDE 3

DYRENIUM 3

EDARBI 3 ST

EDARBYCLOR 3 ST

EDECRIN 3

enalapril maleate oral 1

enalapril-hydrochlorothiazide

1

ENTRESTO 2 QL

EPANED ORAL SOLUTION

E

ephedrine sulfate intravenous solution

E

EPHEDRINE SULFATE-NACL SOLUTION PREFILLED SYRINGE 50-09 MG10ML- INTRAVENOUS

E



E

eplerenone 1

EQUAPAXATORVASTATINCOQ10

E

ethacrynic acid oral 1

EXFORGE 3

EXFORGE HCT 3

EZALLOR SPRINKLE 3 ST

ezetimibe 1

ezetimibe-simvastatin 1

felodipine er 1

fenofibrate micronized oral capsule 130 mg 43 mg

1

fenofibrate micronized oral capsule 134 mg 200 mg 67 mg

1 ST

fenofibrate oral capsule 134 mg 200 mg 67 mg

1 ST

fenofibrate oral capsule 150 mg 50 mg

1

fenofibrate oral tablet 120 mg 40 mg

E


1


1 ST

fenofibric acid oral capsule delayed release

1

fenofibric acid oral tablet

1 ST

FENOGLIDE 3 ST

FIBRICOR 3 ST

FIRST - METOPROLOL

E

FIRST-ATENOLOL E


52


flecainide acetate 1

FLOLIPID 3 ST

fluvastatin sodium 1

fluvastatin sodium er 1

fosinopril sodium 1

fosinopril sodium-hctz 1

furosemide oral solution 10 mgml 8 mgml

1

furosemide oral tablet 1

gemfibrozil oral 1

GONITRO 3

guanfacine hcl oral 1

HEMANGEOL 3

hydralazine hcl oral 1

hydrochlorothiazide oral

1

HYZAAR 3

icosapent ethyl 1 PA

indapamide oral 1

INDERAL LA E

INDERAL XL E

INNOPRAN XL E

INSPRA 3

irbesartan 1

irbesartan-hydrochlorothiazide

1

ISORDIL TITRADOSE 3

isosorbide dinitrate oral 1

isosorbide mononitrate 1

isosorbide mononitrate er

1

isoxsuprine hcl oral E

isradipine 1

JUXTAPID ORAL CAPSULE 10 MG 20 MG 30 MG 5 MG

3 PA SP QL

KAPSPARGO SPRINKLE

E


KATERZIA E

labetalol hcl oral 1

LANOXIN ORAL TABLET 125 MCG 250 MCG 625 MCG

2

LASIX 3

LESCOL XL E

LIPITOR E

LIPOFEN 3

lisinopril oral 1

lisinopril-hydrochlorothiazide

1

LIVALO E

LOPID 3

LOPRESSOR HCT ORAL TABLET 50-25 MG

3

LOPRESSOR ORAL 3

losartan potassium oral 1

losartan potassium-hctz 1

LOTENSIN HCT ORAL TABLET 10-125 MG 20-125 MG 20-25 MG

3

LOTENSIN ORAL TABLET 10 MG 20 MG 40 MG

3

LOTREL ORAL CAPSULE 10-20 MG 10-40 MG 5-10 MG 5-20 MG

3

lovastatin 1

LOVAZA E

matzim la 1

MAXZIDE 3

MAXZIDE-25 3

methyldopa oral 1

methyldopa-hydrochlorothiazide

1

metolazone 1

metoprolol succinate er 1


53


metoprolol tartrate oral 1

metoprolol-hydrochlorothiazide

1

metyrosine 1

mexiletine hcl oral 1

MICARDIS 3

MICARDIS HCT 3

midodrine hcl 1

milrinone lactate in dextrose

E

milrinone lactate intravenous solution 10 mg10ml 20 mg20ml 50 mg50ml

E

MINIPRESS 3

minitran 1

minoxidil oral 1

moexipril hcl 1

MULTAQ 3

nadolol oral tablet 20 mg 40 mg 80 mg

1

NEXLETOL 2 PA QL

NEXLIZET 2 PA QL

niacin (antihyperlipidemic)

1

niacin er (antihyperlipidemic)

1

niacor 1

NIASPAN 3

nicardipine hcl oral 1

nifedipine er 1

nifedipine er osmotic release

1

nifedipine oral 1

nimodipine oral 1

nisoldipine er 1

NITRO-BID 3

NITRO-DUR 3

nitroglycerin sublingual 1


nitroglycerin transdermal patch 24 hour

1

nitroglycerin translingual solution

1

NITROLINGUAL 3

NITROMIST 3

NITROSTAT E

nitro-time oral capsule extended release 25 mg

1

nitro-time oral capsule extended release 65 mg 9 mg

E

NORPACE 3

NORPACE CR 2

NORTHERA 3 PA SP

NORVASC E

NYMALIZE ORAL SOLUTION 6 MGML

3

olmesartan medoxomil oral

1

olmesartan medoxomil-hctz

1

olmesartan-amlodipine-hctz

1

OMEGA-3 RX COMPLETE

3

OMEGA-3D-3 WELLNESS PACK

E

omega-3-acid ethyl esters

1 PA

PACERONE ORAL TABLET 100 MG 400 MG

3

pacerone oral tablet 200 mg

1

papaverine hcl injection E

pentoxifylline er 1

perindopril erbumine 1


54


phenoxybenzamine hcl oral

1

phentolamine mesylate injection solution reconstituted

E

PHENYLEPHRINE HCL-NACL INTRAVENOUS SOLUTION PREFILLED SYRINGE 1-09 MG10ML- 20-09 MG50ML-

E

pindolol 1

PRALUENT SUBCUTANEOUS SOLUTION AUTO-INJECTOR

2 PA QL

PRAVACHOL ORAL TABLET 20 MG 40 MG

3

pravastatin sodium 1

prazosin hcl oral 1

PRESTALIA 3 ST

prevalite 1

PRINIVIL ORAL TABLET 10 MG 20 MG

3

procainamide hcl injection

E

PROCARDIA 3

PROCARDIA XL 3

propafenone hcl 1

propafenone hcl er 1

propranolol hcl er 1

propranolol hcl oral 1

propranolol-hctz 1

QBRELIS E

QUESTRAN E

QUESTRAN LIGHT ORAL POWDER

E

quinapril hcl 1


quinapril-hydrochlorothiazide

1

quinidine gluconate er 1

quinidine sulfate oral 1

ramipril 1

RANEXA 3 ST

ranolazine er 1 ST

RECTIV 3

REPATHA 2 PA QL

REPATHA PUSHTRONEX SYSTEM

2 PA QL

REPATHA SURECLICK

2 PA QL

rosuvastatin calcium 1

RYTHMOL SR 3

simvastatin oral tablet 1

sotalol hcl (af) 1

sotalol hcl oral 1

SOTYLIZE 3

spironolactone oral 1

spironolactone-hctz 1

SULAR ORAL TABLET EXTENDED RELEASE 24 HOUR 17 MG 34 MG 85 MG

3

SURE RESULT O3D3 SYSTEM

E

TARKA ORAL TABLET EXTENDED RELEASE 2-180 MG 2-240 MG 4-240 MG

3

taztia xt 1

TEKTURNA 2 ST

TEKTURNA HCT 2 ST

telmisartan 1

telmisartan-amlodipine 1

telmisartan-hctz 1

TENORETIC 100 3

TENORETIC 50 3


55


TENORMIN E

tiadylt er 1

TIAZAC 3

TIKOSYN E

timolol maleate oral 1

TOPROL XL E

torsemide oral 1

trandolapril 1

trandolapril-verapamil hcl er

1

triamterene oral 1

triamterene-hctz oral capsule 375-25 mg

1

triamterene-hctz oral tablet

1

TRIBENZOR E

TRICOR 3

TRILIPIX 3

TWYNSTA 3

valsartan 1

valsartan-hydrochlorothiazide

1

VASCEPA 2 PA

VASERETIC 3

VASOTEC 3

VECAMYL 3

verapamil hcl er oral capsule extended release 24 hour

1

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

1

verapamil hcl oral 1

VERELAN 3

VERELAN PM 3

VYNDAMAX 3 PA SP QL

VYNDAQEL 3 PA SP QL

VYTORIN E


WELCHOL 3

ZESTORETIC 3

ZESTRIL ORAL TABLET 10 MG 20 MG 5 MG

3


E

ZETIA E

ZIAC 3

ZOCOR ORAL TABLET 10 MG 20 MG 40 MG 80 MG

3

ZYPITAMAG ORAL TABLET 2 MG 4 MG

E

Central Nervous System Agents - Drugs for Attention Deficit Disorder

ADDERALL 3 PA QL

ADDERALL XR E

ADHANSIA XR E

ADZENYS ER 3 PA ST QL

ADZENYS XR-ODT 3 PA ST QL

AMPHETAMINE ER 3 PA ST QL

amphetamine sulfate 1 PA ST QL

amphetamine-dextroamphetamine

1 PA QL

amphetamine-dextroamphetamine er

1 PA QL

APTENSIO XR 3 PA ST QL

atomoxetine hcl 1 QL

clonidine hcl er 1 ST

CONCERTA E

COTEMPLA XR-ODT 3 PA ST QL

DAYTRANA 3 PA ST QL

DESOXYN 3 PA ST QL

DEXEDRINE ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3 PA QL


56


dexmethylphenidate hcl 1 PA QL

dexmethylphenidate hcl er

1 PA ST QL

dextroamphetamine sulfate er

1 PA QL

dextroamphetamine sulfate oral

1 PA ST QL

DYANAVEL XR 3 PA ST QL

EVEKEO 3 PA ST QL

EVEKEO ODT 3 PA QL

FOCALIN 3 PA QL

FOCALIN XR 3 PA ST QL

guanfacine hcl er 1

INTUNIV 3

JORNAY PM 3 PA ST QL

KAPVAY ORAL TABLET EXTENDED RELEASE 12 HOUR

3 ST

metadate er oral tablet extended release 20 mg

1 PA ST QL

methamphetamine hcl 1 PA ST QL

METHYLIN ORAL SOLUTION

3 PA ST QL

methylphenidate hcl er (cd)

1 PA ST QL

methylphenidate hcl er (la)

1 PA ST QL

methylphenidate hcl er (xr)

1 PA ST QL

methylphenidate hcl er oral tablet extended release

1 PA ST QL

methylphenidate hcl er oral tablet extended release 24 hour

1 PA QL

methylphenidate hcl oral solution

1 PA ST QL

methylphenidate hcl oral tablet

1 PA QL


methylphenidate hcl oral tablet chewable

1 PA ST QL

MYDAYIS 3 PA ST QL

PROCENTRA 3 PA ST QL

QUILLICHEW ER 3 PA ST QL

QUILLIVANT XR ORAL SUSPENSION RECONSTITUTED ER

3 PA ST QL

relexxii 1 PA ST QL

RITALIN 3 PA QL

RITALIN LA ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG 20 MG 30 MG 40 MG

3 PA ST QL

STRATTERA 3 QL

VYVANSE 2 PA QL

ZENZEDI 3 PA ST QL

Central Nervous System Agents - Drugs for Multiple Sclerosis

AMPYRA 3 PA SP QL

AUBAGIO 3 PA SP QL

AVONEX PEN INTRAMUSCULAR AUTO-INJECTOR KIT

2 PA SP QL

AVONEX PREFILLED INTRAMUSCULAR PREFILLED SYRINGE KIT

2 PA SP QL

BAFIERTAM 2 PA SP QL

BETASERON SUBCUTANEOUS KIT

2 PA SP QL

COPAXONE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

2 PA SP QL

dalfampridine er 1 PA SP QL

dimethyl fumarate oral 1 PA SP QL

dimethyl fumarate starter pack

1 PA SP QL


57


EXTAVIA SUBCUTANEOUS KIT

E SP

GILENYA 3 PA SP QL

glatiramer acetate 1 PA SP QL

glatopa 1 PA SP QL

KESIMPTA E SP

LEMTRADA 3 PA SP

MAVENCLAD (10 TABS)

3 PA SP

MAVENCLAD (4 TABS)

3 PA SP

MAVENCLAD (5 TABS)

3 PA SP

MAVENCLAD (6 TABS)

3 PA SP

MAVENCLAD (7 TABS)

3 PA SP

MAVENCLAD (8 TABS)

3 PA SP

MAVENCLAD (9 TABS)

3 PA SP

MAYZENT 3 PA SP QL

MAYZENT STARTER PACK

3 PA SP QL

OCREVUS 3 PA SP QL

PLEGRIDY E SP

PLEGRIDY STARTER PACK

E SP

REBIF REBIDOSE SUBCUTANEOUS SOLUTION AUTO-INJECTOR

E SP

REBIF REBIDOSE TITRATION PACK SUBCUTANEOUS SOLUTION AUTO-INJECTOR

E SP

REBIF SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

E SP


REBIF TITRATION PACK SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

E SP

TECFIDERA 2 PA SP QL

TYSABRI 3 PA SP QL

VUMERITY 2 PA SP QL

ZEPOSIA 3 PA SP QL

ZEPOSIA 7-DAY STARTER PACK

3 PA SP QL

ZEPOSIA STARTER KIT

3 PA SP QL

Central Nervous System Agents - Miscellaneous

ADDYI 3 PA QL

ADIPEX-P E

AUSTEDO 3 PA SP QL

benzphetamine hcl E

caffeine citrate oral 1

CONTRAVE E

CONVENIENCE PAK E

diethylpropion hcl er E

diethylpropion hcl oral E

GABACAINE E

GRALISE 3 ST QL

HORIZANT ORAL TABLET EXTENDED RELEASE

3 PA QL

INGREZZA 3 PA SP QL

LIPRITIN II COMBINATION THERAPY PACK 100 MG

E

LOMAIRA E

LYRICA CR 3 ST QL

LYRICA ORAL CAPSULE

2 QL

LYRICA ORAL SOLUTION

3 QL


58


NEURAPTINE E

NUEDEXTA 3 PA

ONPATTRO 3 PA SP

phendimetrazine tartrate

E

phendimetrazine tartrate er

E

phentermine hcl oral E

pregabalin oral 1 QL

QSYMIA E

RADICAVA 3 PA SP

RILUTEK 3 PA QL

riluzole 1 PA QL

SAVELLA 3 ST QL

SAVELLA TITRATION PACK

3 ST QL

SAXENDA E

SUCCINYLCHOLINE CHLORIDE INTRAVENOUS SOLUTION PREFILLED SYRINGE 140 MG7ML

E

TEGSEDI 3 PA SP

tetrabenazine 1 PA SP

TIGLUTIK 3 PA SP QL

VECURONIUM BROMIDE INTRAVENOUS SOLUTION PREFILLED SYRINGE

E

VYLEESI 3 PA QL

XENAZINE 3 PA SP

XENICAL E

Dental and Oral Agents - Drugs for Mouth and Throat Conditions

ARESTIN E

cavarest E

cevimeline hcl 1


chlorhexidine gluconate mouththroat

E

clinpro 5000 E

DEBACTEROL SOLUTION 30-50 MOUTHTHROAT

E

denta 5000 plus E

dentagel E

DERMACINRX CLORHEXACIN

E

DERMACINRX SURGICAL PHARMAPAK

E

easygel dental E

EVOXAC 3

FIRST-MOUTHWASH BLM

E

fluoridex E

fluoridex daily renewal E

fluoridex enhanced whitening dental paste

E

fluoridex sensitivity relief dental paste

E

KEPIVANCE 2 SP

lidocaine hcl mouththroat

1

lidocaine viscous hcl 1

MOUTH KOTE REMINT

E

MUCOSITISRX E

NAFRINSE DAILY ACIDULATED

E

NAFRINSE DAILYNEUTRAL

E

NAFRINSE WEEKLY E

NUSURGEPAK SURGICAL PREPCARE

E

oralone 1

paroex E

PERIDEX E


59


periogard E

pilocarpine hcl oral 1

PREVIDENT E

PREVIDENT 5000 BOOSTER PLUS

E

PREVIDENT 5000 DRY MOUTH DENTAL GEL

E

PREVIDENT 5000 ENAMEL PROTECT

E

PREVIDENT 5000 ORTHO DEFENSE

E

PREVIDENT 5000 PLUS

E

PREVIDENT 5000 SENSITIVE

E

SALAGEN 3

SALIVAMAX E

sf E

sf 5000 plus E

sodium fluoride 5000 plus

E

sodium fluoride 5000 ppm

E

sodium fluoride 5000 sensitive

E

sodium fluoride dental cream

E

sodium fluoride dental gel 11

E

TOPEX TOPICAL ANESTHETIC MOUTHTHROAT AEROSOL

3

triamcinolone acetonide mouththroat

1

XEROSTOMIA RELIEF SPRAY

E


Dermatological Agents - Drugs for Skin Conditions

AAGC KIT IN TERODERM

E

ABREVA E

ABSORICA E

ABSORICA LD 3 PA

ACANYA E

ACESO AG E

acitretin 1

ACTIVE-PREP KIT IV E

active-tramadol E

ACZONE EXTERNAL GEL 5

E


2

adapalene external cream

1 PA

adapalene external gel 1 PA

ADAPALENE EXTERNAL PAD

E

ADAPALENE EXTERNAL SOLUTION

3 PA

ADAPALENE-BENZOYL PER-CLINDAMY

E

ADAPALENE-BENZOYL PER-NIACINAM

E

adapalene-benzoyl peroxide

1

ADVANCED ALLERGY COLLECTION

E

AKLIEF E

ALA SCALP E

ala-cort external cream 1

alclometasone dipropionate

1


60


ALCOHOL PREP PADS EXTERNAL 70

3

ALDARA E

ALEVAMAX E

ALTRENO 3 PA

amcinonide external cream

E

amcinonide external lotion

1

amcinonide external ointment

1

AMELUZ E

ammonium lactate external

1

amnesteem 1 PA

AMZEEQ 3

ANACAINE E

APEXICON E E

AQUAPHILIC E

ARAZLO E

ARIDA E

arzol silver nit applicators

E

ATOPADERM E

ATOPICLAIR E

ATRALIN 3 PA

avar cleanser E

AVAR LS CLEANSER E

AVAR-E EMOLLIENT E

AVAR-E GREEN E

AVAR-E LS E

AVEIDAOXIA E

avita 1 PA

AZADROX E

azelaic acid external 1 ST

AZELAIC ACID-NIACINAMIDE

E

AZELEX 3


balsam peru-castor oil 1

BEAU RX E

BENSAL HP E

BENZ PER-CLIND-NIACIN-TRETIN

E

BENZAC AC WASH EXTERNAL LIQUID

E

BENZACLIN E

BENZACLIN WITH PUMP

E

BENZAMYCIN E

benzepro creamy wash E

BENZEPRO EXTERNAL

E

BENZEPRO EXTERNAL FOAM 52 97

E

benzepro external foam 53

E

BENZEPRO EXTERNAL LIQUID

E

benzepro foaming cloths

E

BENZEPRO SHORT CONTACT

E

benzoin compound E

BENZOIN EXTERNAL TINCTURE

E

BENZOYL PEROX-HYDROCORTISONE

E

benzoyl peroxide external foam 98

E

BENZOYL PEROXIDE EXTERNAL GEL 65 8

E

BENZOYL PEROXIDE FORTE- HC

E

benzoyl peroxide-erythromycin

1 ST

BESER EXTERNAL KIT

E


61


beser external lotion 1

betamethasone dipropionate aug

1

betamethasone dipropionate external

1

BETAMETHASONE DIPROP-MINOXIDIL

E

betamethasone valerate external

1

BIAFINE E

BIONECT EXTERNAL CREAM

E

blanche E

BOTOX COSMETIC 3 PA SP

bp 10-1 E

bp cleansing wash E

bp wash external liquid 25 7

E

BPCO 3

BRYHALI E

calcipotriene external cream

1 QL

CALCIPOTRIENE EXTERNAL FOAM

E

calcipotriene external ointment

1

calcipotriene external solution

1

calcipotriene-betameth diprop external ointment

E

calcipotriene-betameth diprop external suspension

1 QL

CALCIPOTRIENE-CLOBETASOL PROP

E

CALCITRENE 3

calcitriol external 1

CANTHARIDIN EXTERNAL

E

CAPEX E


capsaicin external cream 0025

E

capzix E

CARAC 3

CEM-UREA E

CERACADE E

cerovel external lotion E

CHLOOXIA E

CICLOPIROX-CLOBETASOL

E

CICLOPIROX-CLOBETASOL-SAL ACID

E

CICLOPIROX-SALICYLIC ACID

E

CIMETIDINE-LIDO-SALICYLIC ACID

E

claravis 1 PA

CLEOCIN-T EXTERNAL LOTION

3

CLINDACIN ETZ EXTERNAL KIT

E

clindacin etz external swab

1

CLINDACIN PAC E

clindacin-p 1

CLINDAGEL E

CLINDAMY-BENZOYL PER-NIACINAM

E

clindamycin phos-benzoyl perox external gel 1-5 12-25 12-5

1 ST

CLINDAMYCIN PHOS-NIACINAMIDE

E

clindamycin phosphate external foam

1

clindamycin phosphate external lotion

1

clindamycin phosphate external solution

1


62


clindamycin phosphate external swab

1

CLINDAMYCIN PHOSPHATE GEL 1 EXTERNAL

E

clindamycin phosphate gel 1 external

1

CLINDAMYCIN-NIACIN-TRETINOIN

E

clindamycin-tretinoin 1 ST

CLIND-NIACIN-SPIRONOLAC-TRETIN

E

CLINOIN E

clobetasol prop emollient base

1

clobetasol propionate e 1

clobetasol propionate emulsion

1

clobetasol propionate external

1

CLOBETASOL PROP-LEVOCETIRIZINE

E

CLOBETASOL PROP-NIACINAMIDE

E

CLOBETAVIX E

CLOBEX 3

CLOBEX SPRAY 3

clocortolone pivalate 1

CLODAN EXTERNAL KIT

E

clodan external shampoo

1

CLODERM E

COAL TAR EXTERNAL SOLUTION

3

COLLATYL E

CONDYLOX EXTERNAL GEL

3

COPADERM E

COPASIL EXTERNAL E


CORDRAN EXTERNAL CREAM 0025

E


3

CORDRAN EXTERNAL LOTION

3

CORDRAN EXTERNAL OINTMENT

3

CORDRAN EXTERNAL TAPE

E

corn amp callus remover E

CORTANE-B EXTERNAL

E

CORTISPORIN EXTERNAL

3

CUTIVATE EXTERNAL LOTION

3

dapsone external gel 5

1

DAPSONE EXTERNAL GEL 75

E

DAPSONE-NIACINAMIDE

E

DAPSONE-NIACINAMIDE-SPIRONOLAC

E

DELUO E

DEOXIA E

DERMACINRX PENETRAL

E

DERMACINRX SURGICAL COMBOPAK

E

DERMA-SMOOTHEFS BODY

3

DERMA-SMOOTHEFS SCALP

3

DERMULCERA 3

DESONATE E


63


desonide external 1

DESOWEN EXTERNAL CREAM

3

desoximetasone external cream

1

desoximetasone external gel

1

desoximetasone external liquid

E

desoximetasone external ointment 005

E


1

DEXERYL E

DIADIMAXIA E

DIAOXIA E

diaper rash external ointment

E

DIASDIMAXIA E

DIASOXIA E

diclofenac sodium gel 3 external

1 ST QL


1 PA QL


E

DICLOFENAC-NA HYALURON-NIACIN

E

DIFFERIN EXTERNAL CREAM

E

DIFFERIN EXTERNAL GEL 03

E

DIFFERIN EXTERNAL LOTION

E

diflorasone diacetate external

E

DIMOXIA E

DIPROLENE AF 3


DIPROLENE EXTERNAL OINTMENT

3

docosanol external E

DOVONEX EXTERNAL CREAM

3

doxepin hcl external 1 PA

doxycycline 1

DR SMITHS ADULT BARRIER EXTERNAL OINTMENT

E

DRAXACE E

DRAXACE LOTION CLEANSER

E

DRITHO-CREME HP E

DRIXECE E

DRYSOL 3

DUOBRII E

DUPIXENT 2 PA SP QL

ECEOXIA E

EFUDEX EXTERNAL CREAM

3

ELETONE E

ELIDEL 3 ST

ELLZIA PAK E

EMULSION SB E

enovarx-tramadol E

ENSTILAR E

ENTTY SPRAY E

ENZOCLEAR E

EPICERAM E

EPIDUO 3

EPIDUO FORTE 3

EPIFOAM 3

EPIQUIN MICRO E

ery 1

ERYGEL 3

erythromycin external gel

1


64


erythromycin external solution

1

ESKATA E

ETHOXIA E

EUCRISA 2 ST

EVOCLIN 3

FABIOR E

FINACEA 3 ST

finasteride oral tablet 1 mg

E

FINASTERIDE-MINOXIDIL

E

FLUOCINOLONE ACET-NIACINAMIDE

E

fluocinolone acetonide body

1

fluocinolone acetonide external

1

fluocinolone acetonide scalp

1

fluocinonide cream 01 external

E

fluocinonide emulsified base

1

fluocinonide external cream 005

1

fluocinonide external gel

1

fluocinonide external ointment

1

fluocinonide external solution

1

FLUOPAR E

FLUOROPLEX 3

FLUOROURACIL EXTERNAL CREAM 05

2

fluorouracil external cream 5

1

fluorouracil external solution

1


FLUOVIX E

FLUOVIX PLUS E

flurandrenolide E

fluticasone propionate external

1

FORAXA E

GENADUR E

GORDOFILM 3

grafco silver nit applicator

E

halcinonide E

halobetasol propionate external cream

1

HALOBETASOL PROPIONATE EXTERNAL FOAM

E

halobetasol propionate external ointment

1

HALOG EXTERNAL CREAM

E

HALOG EXTERNAL OINTMENT

E

HALOG EXTERNAL SOLUTION

3

HALUCORT E

HPR PLUS EXTERNAL CREAM

E

hpr plus external foam E

HPR PLUS HYDROGEL

E

HYALUCIL-4 E

HYALURONATE-NIACINAM-TRETINOIN

E

HYALURONATE-NIACIN-TACROLIMUS

E

HYALURONIC ACID-HYDROQUINONE

E

HYDRO 40 E


65


hydrocortisone ace-pramoxine external cream 25-1

E

hydrocortisone acetate external cream

E

hydrocortisone acetate external ointment 1

E

hydrocortisone butyr lipo base

E

hydrocortisone butyrate external cream

1

hydrocortisone butyrate external lotion

E

hydrocortisone butyrate external ointment

1

hydrocortisone butyrate external solution

1

hydrocortisone external cream 05

E

hydrocortisone external cream 1 25

1

hydrocortisone external lotion 25

1

hydrocortisone external ointment 1 25

1

hydrocortisone valerate 1

hydroquinone external cream

E

HYDROQUINONE EXTERNAL EMULSION

E

HYDROQUINONE-HC-TRETINOIN

E

HYDROQUINONE-HYDROCORTISONE

E

HYLATOPIC PLUS EXTERNAL CREAM

E

HYLATOPIC PLUS EXTERNAL LOTION

E

imiquimod external E


IMIQUIMOD PUMP CREAM 375 EXTERNAL

E

IMIQUIMOD-LEVOCETIRIZIN-NIACIN

E

IMIQUIMOD-LEVOCET-TRETINOIN

E

IMPEKLO E

IMPOYZ E

INOVA E

INOVA 41 ACNE CONTROL THERAPY

E


E

isotretinoin oral 1 PA

ITHOXIA E

IVERMECTIN-METRONIDAZOL-NIACIN

E

KAMDOY E

KATARYA E

KATARYAXN E

KAXM E

KEIDO E

KELARX E

KENALOG EXTERNAL 3

KERAGEL E

KERALAC EXTERNAL CREAM 47

E

KERALYT EXTERNAL GEL 6

E

KERALYT SCALP E

KERAMATRIX REPLICINE 5CMX5CM EXTERNAL SHEET

3

KETARYA E

KEVARYA E

KEXM E

KEYA E


66


KIVIK E

KLARON 3

KUTARYAXM E

KUTARYAXMPA E

KUTEA E

KUVARYA E

KUVARYE E

KUXM E

lactic acid e 1

lactic acid external lotion

1

LACTIC ACID-NIACINAMIDE

E

lavare wound wash E

LEVULAN KERASTICK 3

LEXETTE E

LIDOCAINE-HYDROCORTISONE ACE EXTERNAL CREAM 1-1

E

LIDOTREX E

LOCOID EXTERNAL LOTION

3

LOCOID LIPOCREAM E

LUXIQ 3

MEDERMA E

MEDERMA FOR KIDS E

MEDERMA SPF 30 E

MEDPURA ALCOHOL PADS

E

methoxsalen rapid 1

methyl salicylate external liquid

E

METROCREAM 3

METROGEL EXTERNAL GEL

E

METROLOTION 3

metronidazole external 1

MIMYX E


MINOXIDIL-PROGEST-TRETINOIN

E

MIRVASO 3

moisturel external lotion 3

E

mometasone furoate external

1

myorisan 1 PA

NEOCERA E

NEOSALUS E

NEOSALUS CP E

NEOSPORIN ORIGINAL EXTERNAL OINTMENT

E

NEO-SYNALAR EXTERNAL CREAM

3

NEO-SYNALAR EXTERNAL KIT

E

neuac external gel 1 ST

NEUAC EXTERNAL KIT

E

NIACINAMIDE-SPIRONOLACTONE

E

NIACINAMIDE-SULFACETAMIDE

E

NIACINAMIDE-TACROLIMUS

E

NIACINAMIDE-TAZAROTENE

E

NIACINAMIDE-TRETINOIN

E

NIACINAMIDE-TRIAMCINOLONE ACET

E

NIACIN-SPIRONOLACTON-TRETINOIN

E

NIVATOPIC PLUS E

nolix E

NORITATE E


67


NOVACORT EXTERNAL GEL 1-2

E

NUCARACLINPAK E

NUCARARXPAK E

NUCORT E

NUDERMRXPAK 120 E

NUDERMRXPAK 60 E

NUTRASEB E

NUTRIARX CREAMPAK

E

NUVAIL E

OLUX 3

OLUX-E 3

ONEXTON 3

ORACEA 3

OVACE PLUS E

OVACE PLUS WASH E

OVACE WASH E

OXSORALEN ULTRA 3

PANDEL E

PENLEN E

PHLAG SPRAY E

PICATO 3 ST

pimecrolimus 1 ST

PLEXION E

PLEXION CLEANSER EXTERNAL LIQUID

E

PLEXION CLEANSING CLOTH EXTERNAL PAD

E

podocon E

podofilox external 1

PR BENZOYL PEROXIDE

E

pr benzoyl peroxide wash

E

PR CREAM E

pramosone external cream 1-1

1


PRAMOSONE EXTERNAL CREAM 1-25

E

PRAMOSONE EXTERNAL LOTION

3

PRAMOSONE EXTERNAL OINTMENT

E

pramox E

PRE amp POST SX POUCH

E

prednicarbate 1

PRESERA E

PROGESTERONE-MINOXIDIL

E

PROMISEB E

PROPECIA E

PROSILK EXTERNAL E

PROTEXA E

PROTOPIC 3

PROTYL AG E

PRUCLAIR E

PRUDOXIN 3 PA

PRUMYX E

PSORCON E

PYROGALLIC ACID 3

QBREXZA 3 QL

QUINIXIL E

QUTENZA E

QUTENZA (2 PATCH) E

RADIAGEL E

RADIAPLEXRX GEL EXTERNAL

3


E

RECEDO E

REFISSA E

REGENECARE 3

REGRANEX 3 PA


68


remergent hq E

REMIGEN E

RENOVA E

RENOVA PUMP E

RESORCINOL-SULFUR

E

RETIN-A 3 PA

RETIN-A MICRO GEL 004 01

E

RETIN-A MICRO PUMP EXTERNAL GEL 004 01

E


2 PA

REXASIL PATCH amp VITAMIN E LIQ

E

RHOFADE 3

RIAX E

rosadan external cream 1

rosadan external gel 1

ROSADAN EXTERNAL KIT

E

SALEX EXTERNAL SHAMPOO

E

salicylic acid er E

salicylic acid external cream

E

salicylic acid external foam

E

salicylic acid external gel

E

salicylic acid external liquid 275

E

salicylic acid external lotion

E

salicylic acid external shampoo

E

salicylic acid external solution 26

E


salicylic acid wart remover

E

salicylic acid-cleanser external kit 6 (cream)

E

SALICYLIC ACID-SULFACETAMIDE

E

salimez E

SALIMEZ FORTE E

SALVAX E

SALVAX DUO PLUS E

SANADERMRX SKIN REPAIR

E

SANTYL 3

SCALACORT DK E

SCARCARE GEL-PAD KITLARGE

E

SCARCIN E

SCARSILK EXTERNAL E

SCARZEN SKIN REPAIR

E

SCENESSE 3 PA SP

selenium sulfide external lotion

1

selenium sulfide external shampoo

E

SELRX E

SERNIVO 3

SILA III E

SILIPAC E

SILVERSEAL HYDROGEL DRESSING EXTERNAL PAD 2X3

E

skarjel E

sodium hyaluronate external gel

E

sodium sulfacetamide external shampoo

E

sodium sulfacetamide wash liquid 10 external

E


69


SODIUM SULFACETAMIDE-BAKUCHIOL LIQUID 10 EXTERNAL

E

SOLARAVIX EXTERNAL

E

SOLOX E

SOOLANTRA 3

SORIATANE ORAL CAPSULE 10 MG 25 MG

3

SORILUX E

sss 10-5 E

STRATA CTX E

STRATA GRT E

STRATA MARK E

STRATA TRIZ E

STRATA XRT E

sulfacetamide sodium (acne)

1

sulfacetamide sodium external gel

E

sulfacetamide sodium external liquid

E

sulfacetamide sodium-sulfur external cream

E

sulfacetamide sodium-sulfur external emulsion

E

sulfacetamide sodium-sulfur external liquid

E

sulfacetamide sodium-sulfur external lotion

E

sulfacetamide sodium-sulfur external pad 10-4

E

sulfacetamide sodium-sulfur external suspension

E

sulfacetamide sod-sulfur wash external kit

E


sulfacetamide sod-sulfur wash external liquid

E

sulfacetamide-sulfur in urea external emulsion

E

sulfacleanse 84 E

sulfamez wash E

SUMADAN E

SUMADAN WASH E

SUMADAN XLT E

SUMAXIN E

SUMAXIN CP E

SUMAXIN WASH E

SUVICORT E

SYNALAR 3

SYNALAR (CREAM) E

SYNALAR (OINTMENT)

E

SYNALAR TS E

SYNERDERM E

TACLONEX EXTERNAL OINTMENT

E

TACLONEX EXTERNAL SUSPENSION

3 QL

TACROLIMUS EXTERNAL CREAM

E

tacrolimus external ointment

1

TARDEOXIA E

TARDIMAXIA E

TAROXIA E

TASOPROL E

tazarotene external 1 PA

TAZORAC EXTERNAL CREAM

3 PA

TAZORAC EXTERNAL GEL 005

3 PA


70



E

TEMOVATE EXTERNAL CREAM

3

TEMOVATE EXTERNAL OINTMENT

3

TETRIX EXTERNAL CREAM

E

TEXACORT 3

tl hydroquinone E

TOLAK 3 ST

TOPICORT EXTERNAL CREAM

3

TOPICORT EXTERNAL GEL

3

TOPICORT EXTERNAL OINTMENT

3

TOPICORT SPRAY E

tovet external foam 1

TOVET EXTERNAL KIT

E

tretinoin (emollient) E

tretinoin external 1 PA

tretinoin microsphere 1 PA

tretinoin microsphere pump external gel 004

1 PA

triamcinolone acetonide external aerosol solution

E

triamcinolone acetonide external cream

1

triamcinolone acetonide external lotion

1

triamcinolone acetonide external ointment

1

TRIAMSIL COMBIPAK EXTERNAL THERAPY PACK

E

TRIAMSIL MULTIPAK E


trianex E

TRI-CHLOR 3

triderm external cream 1

TRIDESILON 3

TRI-LUMA E

triple antibiotic external ointment 35-400-5000 5-400-5000

E

triple antibiotic+pain relief

E

TRIVIX E

TURPENTINE EXTERNAL

E

ULTRASAL-ER E

ULTRAVATE EXTERNAL LOTION

E

UMECTA MOUSSE E

URAMAXIN EXTERNAL GEL

E

urea external cream 39 40 41 45 47

E

UREA EXTERNAL FOAM

E

urea external lotion 40

E

urea external suspension 40

E

urea hydrating E

urea nail external gel 45

E

urea-c40 E

ureacin-10 E

ureacin-20 E

uredeb E

uremez-40 E

URESOL E

UTOPIC E


71


VANICREAM EXTERNAL OINTMENT

E

VANIQA E

VANOS 3

VANOXIDE-HC E

VARDIMAXIA E

VAROXIA E

VECTICAL E

VELTIN E

VENELEX 3

VERDESO E

VEREGEN E

VEXASYN E

VIRASAL E

XALIX E

XERAC AC 3

XERALUX E

xurea E

ZACARE E

zaclir cleansing external lotion 8

E

zenatane 1 PA

ZIANA E

ZILXI E

ZITHRANOL E

ZONALON 3 PA

ZYCLARA E

ZYCLARA PUMP E

Diabetes - Antidiabetic Agents

acarbose oral 1

ACTOPLUS MET 3

ACTOS 3

ADLYXIN E

ADLYXIN STARTER PACK

E


ALOGLIPTIN BENZOATE

E

ALOGLIPTIN-METFORMIN HCL

E

ALOGLIPTIN-PIOGLITAZONE

E

AMARYL 3

AVANDIA ORAL TABLET 2 MG 4 MG

3 ST

BYDUREON BCISE AUTOINJECTOR

2 ST QL

BYDUREON PEN 2 ST QL

BYETTA 10 MCG PEN 2 ST QL


CYCLOSET 3 ST

DUETACT 3

FARXIGA 2 ST

FORTAMET E

glimepiride 1

glipizide er 1

glipizide ir 1

glipizide xl 1

glipizide-metformin hcl 1 ST

GLUCOTROL 3

GLUCOTROL XL 3

GLUCOVANCE ORAL TABLET 5-500 MG

3

GLUMETZA E

glyburide micronized 1

glyburide oral 1

glyburide-metformin 1

GLYNASE 3

GLYSET 3

GLYXAMBI 2 ST

INVOKAMET E

INVOKAMET XR E

INVOKANA E

JANUMET 2 ST


72


JANUMET XR 2 ST

JANUVIA 2 ST

JARDIANCE 2 ST

JENTADUETO 2 ST

JENTADUETO XR 2 ST

KAZANO E

KOMBIGLYZE XR E

metformin hcl er 1

metformin hcl er (mod) E

metformin hcl er (osm) oral tablet extended release 24 hour 1000 mg 500 mg

E

metformin hcl ir 1

miglitol 1

nateglinide 1

NESINA E

ONGLYZA E

OSENI E

OZEMPIC 2 ST QL

pioglitazone hcl 1

pioglitazone hcl-glimepiride

1

pioglitazone hcl-metformin hcl

1

PRECOSE 3

QTERN E

repaglinide 1

RIOMET 3 ST

RIOMET ER 3 ST

RYBELSUS 2 ST QL

SEGLUROMET E

SOLIQUA 2 ST QL

STARLIX 3

STEGLATRO E

STEGLUJAN E

SYMLINPEN 120 3 PA

SYMLINPEN 60 3 PA


SYNJARDY 2 ST

SYNJARDY XR 2 ST

tolbutamide 1 ST

TRADJENTA 2 ST

TRIJARDY XR 2 ST

TRULICITY 2 ST QL

VICTOZA 2 ST QL

XIGDUO XR 2 ST

XULTOPHY 3 ST QL

Diabetes - Glucose Monitoring

ACCU-CHEK AVIVA DEVICE

E

ACCU-CHEK AVIVA CONNECT KIT WDEVICE

E

ACCU-CHEK AVIVA IN VITRO SOLUTION

E

ACCU-CHEK AVIVA PLUS KIT WDEVICE

E

ACCU-CHEK COMPACT PLUS CARE KIT

E

ACCU-CHEK COMPACT PLUS CONTROL

E

ACCU-CHEK COMPACT PLUS TEST STRIPS

E

ACCU-CHEK FASTCLIX LANCET KIT

$0

ACCU-CHEK GUIDE KIT WDEVICE

E

ACCU-CHEK GUIDE CONTROL

E

ACCU-CHEK MULTICLIX LANCET DEVICE KIT

$0

ACCU-CHEK NANO SMARTVIEW KIT WDEVICE

E


73


ACCU-CHEK SMARTVIEW CONTROL

E

ACCU-CHEK SMARTVIEW TEST STRIPS

E

ACCU-CHEK SOFTCLIX LANCET DEVICE KIT

$0

AUTOLET II CLINISAFE

$0

AUTOLET LANCING DEVICE

$0

BLUESTAR E

CARETOUCH CONTROL SOL LEVEL 2

E

CARETOUCH LANCINGEJECTOR

$0

CARETOUCH TEST E

CEQUR SIMPLICITY 2U

3

CHEMSTRIP UGK 3

CONTOUR CONTROL E

CONTOUR NEXT CONTROL

E

CONTOUR NEXT LINK E

CONTOUR NEXT MONITOR

E

CONTOUR NEXT TEST

E

CONTOUR TEST E

EASYMAX 15 LEVEL 2-3 CONTROL

E

EASYMAX CONTROL IN VITRO SOLUTION NORMAL

E

EASYMAX CONTROL NORMALHIGH

E

ENLITE GLUCOSE SENSOR

E


FORTISCARE CONTROL

E

FORTISCARE GLUCOSE SYSTEM DEVICE

E

FORTISCARE T1 GLUCOSE SYSTEM

E

FREESTYLE LIBRE 14 DAY READER

E

FREESTYLE LIBRE 14 DAY SENSOR

E

FREESTYLE LIBRE 2 READER SYSTM

E

FREESTYLE LIBRE 2 SENSOR SYSTM

E

FREESTYLE LIBRE READER

E

FREESTYLE LIBRE SENSOR SYSTEM

E

FREESTYLE PRECISION NEO TEST

E

GUARDIAN CONNECT TRANSMITTER

E

GUARDIAN LINK 3 TRANSMITTER

E

GUARDIAN SENSOR (3)

E

KETONE TEST 3

KETOSTIX 3

LANCETS $0

MICRODOT TEST E

MICROLET NEXT LANCING DEVICE

$0

NOVOPEN ECHO 3

ONETOUCH DELICA LANCING DEV

$0

ONETOUCH DELICA PLUS LANCING

$0

ONETOUCH ULTRA $0 QL

ONETOUCH ULTRA 2 KIT WDEVICE

2


74


ONETOUCH ULTRA MINI KIT WDEVICE

2

ONETOUCH VERIO KIT WDEVICE

2

ONETOUCH VERIO FLEX SYSTEM KIT WDEVICE

2

ONETOUCH VERIO IN VITRO SOLUTION HIGH

3

ONETOUCH VERIO TEST STRIPS

$0 QL

ONETOUCH VERIO IQ SYSTEM

2

ONETOUCH VERIO REFLECT

2

ONETOUCH VERIO SYNC SYSTEM KIT WDEVICE

2

PRECISION LINK E

PRECISION PCX PLUS TEST

E

PRECISION QID MONITOR

E

PRECISION QID TEST E

PRECISION SOF-TACT MONITOR

E

PRECISION SOF-TACT TEST

E

PRECISION XTRA BLOOD GLUCOSE

E

PRECISION XTRA DEVICE

E

PRECISION XTRA KETONE

3

PRECISION XTRA KIT E

PRECISION XTRA MONITOR

E

RELION BLOOD GLUCOSE TEST

E

RELION ULTIMA TEST E


SURESTEP PRO HIGH GLUCOSE

3

SURESTEP PRO LOW GLUCOSE

3

SURESTEP PRO NORMAL GLUCOSE

3

TRUE METRIX BLOOD GLUCOSE TEST

E

TRUE METRIX LEVEL 1

E

TRUE METRIX LEVEL 2

E

TRUE METRIX LEVEL 3

E

TRUE METRIX PRO BLOOD GLUCOSE

E

TRUETRACK TEST E

UNISTRIP CONTROL IN VITRO SOLUTION LOW

E

Diabetes - Glycemic Agents

BAQSIMI ONE PACK 2

BAQSIMI TWO PACK 2

diazoxide oral 1

GLUCAGEN HYPOKIT 3 ST

GLUCAGON EMERGENCY KIT

2 Made by Lilly


2Made by Fresenius

GVOKE HYPOPEN 1-PACK

2


2

GVOKE PFS 2

PROGLYCEM 3

Diabetes - Insulins

ADMELOG E

ADMELOG SOLOSTAR

E


75


AFREZZA INHALATION POWDER 12 UNIT 4 amp 8 amp 12 UNIT 4 UNIT 8 UNIT 90 X 4 UNIT amp 90X8 UNIT 90 X 8 UNIT amp 90X12 UNIT

3 PA

APIDRA SOLOSTAR E

APIDRA VIAL E

BASAGLAR KWIKPEN E

FIASP E

FIASP FLEXTOUCH E

FIASP PENFILL E

HUMALOG U-100 AND U-200 KWIKPEN

2

HUMALOG MIX 5050 KWIKPEN

2

HUMALOG MIX 5050 VIAL

2


2


2

HUMALOG U-100 JUNIOR KWIKPEN

2

HUMALOG VIAL 2

HUMULIN 7030 KWIKPEN

2

HUMULIN 7030 VIAL 2

HUMULIN N KWIKPEN 2

HUMULIN N VIAL 2

HUMULIN R U-500 KWIKPEN

2

HUMULIN R U-500 VIAL

2

HUMULIN R VIAL 2

INSULIN ASP PROT amp ASP FLEXPEN

E

INSULIN ASPART E

INSULIN ASPART FLEXPEN

E


INSULIN ASPART PENFILL

E

INSULIN ASPART PROT amp ASPART

E

INSULIN LISPRO (1 UNIT DIAL)

E

INSULIN LISPRO JUNIOR KWIKPEN

E

INSULIN LISPRO PROT amp LISPRO

E

INSULIN LISPRO SUBCUTANEOUS SOLUTION

E

INSULIN PEN NEEDLES 29G X 127MM 29G X 12MM 29G X 5MM 29G X 8MM 31G X 5 MM 31G X 6 MM 31G X 8 MM 32G X 4 MM 33G X 4 MM

$0

INSULIN SYRINGES $0

LANTUS U-100 SOLOSTAR

2

LANTUS U-100 VIAL 2

LEVEMIR U-100 FLEXTOUCH

E

LEVEMIR U-100 VIAL E

LYUMJEV 2

LYUMJEV KWIKPEN 2

MAXICOMFORT SYR 27G X 12

$0

MYXREDLIN 3

NOVOFINE AUTOCOVER PEN NEEDLE

$0

NOVOFINE PEN NEEDLE 32G X 6 MM

$0

NOVOFINE PLUS PEN NEEDLE

$0

NOVOLIN 7030 FLEXPEN

E


76


NOVOLIN 7030 FLEXPEN RELION

E

NOVOLIN 7030 RELION

E

NOVOLIN 7030 VIAL E

NOVOLIN N FLEXPEN E

NOVOLIN N FLEXPEN RELION

E

NOVOLIN N RELION E

NOVOLIN N VIAL E

NOVOLIN R FLEXPEN E

NOVOLIN R FLEXPEN RELION

E

NOVOLIN R RELION E

NOVOLIN R VIAL E

NOVOLOG U-100 FLEXPEN

E

NOVOLOG MIX 7030 FLEXPEN

E

NOVOLOG MIX 7030 VIAL

E

NOVOLOG U-100 PENFILL

E

NOVOLOG U-100 VIAL E

NOVOTWIST PEN NEEDLE 32G X 5 MM

$0

SEMGLEE E

TOUJEO MAX SOLOSTAR

2

TOUJEO SOLOSTAR 2

TRESIBA E

TRESIBA FLEXTOUCH

E

Electrolytes Minerals Metals Vitamins

ABANEU-SL E

ACTITROM-D E

active fe E

ACTIVITE E

adcf (05mgml) 1


ADRENAL C FORMULA

E

airavite E

aminoamrms E

aminobenzoate potassium oral packet

E

aminoreliefrms E

animal shapes E

ANIMI-3 E

ANIMI-3VITAMIN D E

AQUASOL A INTRAMUSCULAR SOLUTION 15 MGML

E

ASCOR E

ASCORBIC ACID SOLUTION 500 MGML INJECTION

E

ascorbic acid solution 500 mgml injection

E

ATABEX OB 2

AZESCHEW PRENATALPOSTNATAL

E

AZESCO E

B-12 COMPLIANCE INJECTION

E

b-6 folic acid oral capsule 8333-100-1 mg

E

BACMIN E

b-complexb-12 oral E

biocel E

biopetit E

biotin oral tablet 1000 mcg

E

bp vit 3 E

b-plex E

b-plex plus E

calcidol oral solution 200 mcgml

E


77


CALCIFOL 3

calcitrate oral tablet 950 mg

E

calcium carb-cholecalciferol oral tablet 600-400 mg-unit

E

calcium carbonate oral tablet 600 mg

E

calcium carbonate-vitamin d oral tablet 600-400 mg-unit

E

calcium-folic acid plus d E

CARBAGLU 2 SP

CARDIOPLEGIA DEL NIDO FORMULA

E

CARDIOPLEGIA IND PLASMA HIGH K

E

CARDIOPLEGIA IND PLASMA-TROMET

E

CARDIOPLEGIA INDUCTION HIGH K

E

CARDIOPLEGIA INDUCTION LOW DEX

E

CARDIOPLEGIA INDUCTION NON-ENR

E

CARDIOPLEGIA MAIN LOW DEXTROSE

E

CARDIOPLEGIA MAIN LOW TROMETHA

E

CARDIOPLEGIA MAIN PLASMA-TROME

E

CARDIOPLEGIA MAINTENANCE

E

CARDIOPLEGIA REPERFUSATE 41

E

CARNITOR INTRAVENOUS

E

CARNITOR ORAL 3

CARNITOR SF 3

CENFOL E

CENTRATEX E


CEREFOLIN E

cerefolin nac oral tablet 6-90314-2-600 mg

E

CHEMET 3

childrens chewable vitamins

E

CHOLECAL DF E

chromagen oral capsule

E

CIFEREX E

CIFRAZOL E

CITRANATAL BLOOM E

CITRANATAL ESSENCE

E

CITRANATAL MEDLEY

E

clovique 1 PA SP

COD LIVER OIL ORAL OIL

E

corvita E

corvita 150 E

CORVITE 150 E

corvite fe E

cvs vitamin e oral capsule 1000 unit

E

cyanocobalamin injection solution 1000 mcgml

1

CYANOCOBALAMIN INJECTION SOLUTION 2000 MCGML

3

cytra k crystals E

d3 high potency oral capsule 25 mcg (1000 ut)

E

d3 super strength E

daflonex-xl oral capsule E

decara oral capsule 125 mg (50000 ut) 250 mcg (10000 ut)

E


78


DECARA ORAL CAPSULE 625 MCG (25000 UT)

E

deferasirox 1 PA

deferasirox granules 1 PA

deferiprone 1 PA

dehydrated alcohol solution 98 injection

E

DEPLIN 15 E

DEPLIN 75 E

DERMACINRX PUREFOLIX

E

dexifol E

dialyvite E

DIALYVITE 3000 E

DIALYVITE 5000 E

DIALYVITE SUPREME D

E

DIALYVITEZINC E

DRISDOL ORAL CAPSULE

3

DURACHOL E

d-vite pediatric E

EFFER-K ORAL TABLET EFFERVESCENT 10 MEQ 20 MEQ

3

effer-k oral tablet effervescent 25 meq

1

ELFOLATE E

ELFOLATE PLUS ORAL TABLET 3-35-2 MG

E

ELITE-OB 2

ENBRACE HR E

ERGOCAL E

ergocalciferol oral capsule

1

ergocalciferol oral solution 200 mcgml

E


EXJADE 3 PA

fabb E

fa-vitamin b-6-vitamin b-12

E

FERAHEME E

FERIVA 217 E

FERIVAFA E

ferocon E

ferotrinsic E

FERRALET 90 E

ferraplus 90 E

FERRIPROX 3 PA

FERRIPROX TWICE-A-DAY

3 PA

FERRLECIT E

ferrocite plus oral tablet E

FERRO-PLEX HEMATINIC

E

FERROTRIN E

ferrous sulfate oral solution 75 (15 fe) mgml

E

ferrous sulfate oral syrup

E

ferrous sulfate oral tablet 325 (65 fe) mg

E

ferrous sulfate oral tablet delayed release 324 (65 fe) mg 325 (65 fe) mg

E

FLORIVA E

FLORIVA PLUS E

FLUORABON $0

fluoritab $0

FLURA-DROPS ORAL SOLUTION 055 (025 F) MGDROP

$0

folbee E

folbee plus E

folbee plus cz E


79


FOLBIC RF E

FOLGARD OS E

FOLGARD RX E

folic acid injection E

folic acid oral tablet 1 mg

1

folic acid oral tablet 800 mcg

$0

FOLIC D3 E

FOLIC-K E

FOLI-D E

FOLITE E

FOLIVANE-F E

FOLIVANE-PLUS E

FOLIXAPURE E

folplex 22 E

foltanx E

FOLTANX RF E

FOLTRATE E

FOLTREXYL E

foltrin E

FOLTX ORAL TABLET 113-25-2 MG

E

FOLVITE-D E

FOSTEUM E

FUSION PLUS E

GALZIN 3

GENICIN VITA-D E

GENICIN VITA-Q E

GENICIN VITA-S E

hematinic plus vitminerals

E

hematinicfolic acid E

HEMATOGEN E

HEMATOGEN FA E

HEMATRON-AF E

HEMETAB E

HEMOCYTE PLUS E


hemocyte-f oral tablet E

hemocyte-plus oral tablet 106-1 mg

E

HYLAVITE E

HYLAZINC E

ICAR-C PLUS E

iferex 150 forte E

INFED E

INFUVITE ADULT E

INFUVITE PEDIATRIC INTRAVENOUS SOLUTION

E

INTEGRA F E

INTEGRA PLUS E

IODINE STRONG ORAL

3

IROSPAN 246 E

ISOLYTE-S E

JADENU 3 PA

JADENU SPRINKLE 3 PA

JYNARQUE 3 SP QL

KCL-LIDOCAINE-NACL

E

kionex oral suspension 1

klor-con 10 1

klor-con m10 1

KLOR-CON M15 3

klor-con m20 1

klor-con oral packet 20 meq

1

klor-con oral tablet extended release

1

klor-con sprinkle 1

klor-conef 1

K-PHOS NO 2 E

K-PHOS TABLET 500 MG ORAL

3


E


80


K-PHOS-NEUTRAL 3

k-prime 1

K-TAB 3

k-tan plus E

L-CYSTINE E

levocarnitine oral solution

1

levocarnitine oral tablet 1

levocarnitine sf 1

L-ISOLEUCINE E

l-methylfolate E

l-methylfolate ca me-cbl nac

E

l-methylfolate calcium oral

E

l-methylfolate forte E

l-methylfolate-algae oral capsule 15-90314 mg

E

l-methylfolate-algae-b12-b6

E

l-methylfolate-b6-b12 oral tablet 3-35-2 mg

E

l-methyl-mc E

l-methyl-mc nac E

LOKELMA 3

LORID E

lysiplex plus oral tablet E

MVI ADULT E

MVI PEDIATRIC INTRAVENOUS SOLUTION RECONSTITUTED

E

MAGNEBIND 400 3

magnesium oxide oral tablet 400 (2413 mg) mg

E


magnesium sulfate intravenous solution 2 gm50ml 20 gm500ml 4 gm100ml 4 gm50ml 40 gm1000ml

E

MAGNESIUM SULFATE SOLUTION 50 INJECTION

E

magnesium sulfate solution 50 injection

E

magnesium-oxide E

mag-oxide oral tablet 200 mg

E

MEPHYTON 3

metafolbic E

metafolbic plus E

metafolbic plus rf E

METANX ORAL CAPSULE

E

methylfol-algae-b12-acetylcyst

E

MICROPLEGIA MSA-MSG

E

MIFEPREX 3

mifepristone 1

M-NATAL PLUS 2

MULTIGEN E

MULTIGEN FOLIC E

MULTIGEN PLUS E

multiple vitamin-folic acid

E

MULTIPRO E

multi-vitironfluoride 1

multivitaminfluoride oral solution

1

multi-vitaminfluoride oral solution

1

multivitaminfluoride oral tablet chewable 025 mg 05 mg 1 mg

1


81


MULTIVITAMINFLUORIDE ORAL TABLET CHEWABLE 025-03 MG 05-03 MG 1-03 MG

E

multi-vitaminfluorideiron

1

multivitaminsfluoride oral tablet chewable 05 mg

1

mynephrocaps capsule 1 mg oral

E

mynephron E

na ferric gluc cplx in sucrose

E

n-acetyl-l-cysteine oral 1

nafrinse $0

nafrinse drops $0

NASCOBAL 3

NEONATAL + DHA E

NEONATAL 19 2

NEONATAL COMPLETE

E

NEONATAL FE E

NEONATAL PLUS 2

NEOVITE E

NEPHPLEX RX E

NEPHRON FA E

nephronex oral tablet E

NEPHRO-VITE RX E

NESTABS 2

NESTABS ONE E

NEURIN-SL E

niacin oral tablet 100 mg

E

NICADAN E

NICAZEL E

NICAZEL FORTE E


NICOMIDE ORAL TABLET 750-27-2-05 MG

E

NIFEREX ORAL TABLET

E

novamv pediatric multi-vitamin

E

NUFERA E

nufol E

NUTRICAP E

nutrifac zx E

NUTRIVIT E

OCUVEL ORAL CAPSULE 05 MG

E

one daily E

ONE VITE WOMENS $0

ONE VITE WOMENS PLUS

2

ONEVITE E

ORACIT 3

ORTHO DF E

OVEEZA E

oyster shell calciumd oral tablet 250-250 mg-unit 500-200 mg-unit 500-400 mg-unit

E

oyster shell calciumvitamin d oral tablet 500-200 mg-unit

E

PEDIALYTE ORAL SOLUTION

E

pediatric electrolyte oral solution

E

pediavit E

phospha 250 neutral 1

phosphorous 1

phosphorus supplement

E

phosphorus wsod amp potassium

E


82


phospho-trin 250 neutral

1

PHOXILLUM BK425 E

PHYSICIANS EZ USE B-12

E

PHYSIOLYTE E

PHYSIOSOL IRRIGATION

E

phytonadione injection solution 1 mg05ml 10 mgml

E

phytonadione oral 1

PLASMA-LYTE 148 E

PLASMA-LYTE A E

PODIAPN ORAL CAPSULE

E

poly-iron 150 forte E

POLY-VI-FLOR FS 3

POLY-VI-FLOR ORAL SUSPENSION

3

POLY-VI-FLOR ORAL TABLET CHEWABLE

E

POLY-VI-FLORIRON ORAL SUSPENSION

2

POLY-VI-FLORIRON ORAL TABLET CHEWABLE

E

poly-vite pediatric E

POTABA ORAL CAPSULE

E

potassium chloride crys er

1

potassium chloride er 1

potassium chloride in nacl intravenous solution 20-045 meql- 20-09 meql- 40-09 meql-

E

potassium chloride oral packet

1


potassium chloride oral solution 20 meq15ml (10) 40 meq15ml (20)

1

potassium citrate er 1

potassium citrate-citric acid oral solution

E

PREGENNA E

PREMESISRX E

PRENAISSANCE E

PRENARA E

prenatal oral tablet 27-08 mg 28-08 mg

$0

prenatal plus iron 1

prenatal tablet 27-1 mg oral

1


E

prenatal vitamin plus low iron

1

PRENATE E

PRENATE DHA ORAL CAPSULE 18-06-04-300 MG

E

PRENATE ELITE ORAL TABLET 20-06-04 MG

E

PRENATE ENHANCE E

PRENATE ESSENTIAL ORAL CAPSULE 18-06-04-300 MG

E

PRENATE MINI ORAL CAPSULE 18-06-04-350 MG

E

PRENATE PIXIE E

PRENATE RESTORE E

PRENATRIX E

PRENATRYL E

PRENATVITE COMPLETE

E

PRENATVITE PLUS 2


83


PRENATVITE RX 2

preplus 1

pretab 1

PRIMACARE ORAL CAPSULE

E

PROTEINEX P18 E

purevit dualfe plus E

PYRIDOXINE HCL SOLUTION 100 MGML INJECTION

E

pyridoxine hcl solution 100 mgml injection

E

QUFLORA FE E

QUFLORA FE PEDIATRIC

E

QUFLORA GUMMIES E

QUFLORA PEDIATRIC E

RELNATE DHA 2

REMEDIENT E

RENAL MULTIVITAMIN FORMULA

E

renal oral capsule E

RENATABS E

RENATABS WITH IRON

E

rena-vite E

reno caps capsule 1 mg oral (rx)

E

REQ 49+ E

REVESTA E

ringers irrigation E

SAMSCA ORAL TABLET 15 MG

2 SP QL


3 SP QL

SELECT-OB ORAL TABLET CHEWABLE 29-1 MG

E

se-tan plus E


SIDEROL ORAL TABLET

E

SLOWMAG MG MUSCLEHEART

E

sod citrate-citric acid 1

sodium bicarbonate intravenous solution 75

E

sodium bicarbonate solution 42 intravenous

E


E

SODIUM BICARBONATE SOLUTION 84 INTRAVENOUS

E

sodium chloride (pf) solution 09 injection

E

sodium chloride injection solution 25 meqml

E

sodium chloride intravenous solution 045 09 3 5

E

sodium chloride solution 4 meqml intravenous

E

sodium fluoride oral $0

sodium polystyrene sulfonate oral

1

sodium polystyrene sulfonate rectal

1

soluvita e E

sps 1

STROVITE FORTE E

STROVITE ONE E

SUPERVITE E

support E

SUPPORT-500 E


84


SYNAGEX E

SYPRINE 3 PA SP

SYSTANE ICAPS AREDS2 ORAL TABLET CHEWABLE

E

TALIVA E

TARON FORTE E

taron-crystals E

thiamine hcl injection E

tis-u-sol E

tl-hem 150 E

TOLVAPTAN ORAL TABLET 15 MG

E SP

tolvaptan oral tablet 30 mg

1 SP QL

TRICARE PRENATAL DHA ONE ORAL CAPSULE 27-1-500 MG

2

tricitrates E

tricon E

trientine hcl 1 PA SP

TRIFERIC HEMODIALYSIS PACKET

E

trinate 1

TRINAZ E

triphrocaps E

TRISTART ONE E

TRI-VI-FLOR 3

TRI-VI-FLORO 3

tri-vite pediatric E

tri-vitefluoride 1

TRONVITE E

TRYPTOPHAN ORAL E

UDAMIN SP E

UROCIT-K 10 3

UROCIT-K 15 3

UROCIT-K 5 3


urosex E

v-c forte E

VELTASSA 3

VENOFER E

vic-forte E

vinate one 1

virt-caps E

VIRT-FEFA PLUS E

virt-gard E

virt-phos 250 neutral 1

vita s forte E

vitacel E

VITAFOL FE+ ORAL CAPSULE

E

VITAFOL ORAL TABLET

E

VITAFOL STRIPS 2

VITAFOL-OB+DHA E

VITAL-D RX E

VITAMAX PEDIATRIC E

VITAMEZ E

vita-min E

vitamin b complex 100 E

vitamin b-6 oral tablet 100 mg 25 mg 50 mg

E

vitamin b-complex 100 E

vitamin c oral tablet 1000 mg

E

vitamin d (cholecalciferol) oral tablet 25 mcg (1000 ut)

E

vitamin d (ergocalciferol) oral capsule 125 mg (50000 ut)

1

vitamin d3 oral capsule 250 mcg (10000 ut)

E


85


vitamin d3 oral tablet 10 mcg (400 unit) 125 mcg (5000 ut) 50 mcg (2000 ut)

E

VITAMIN DEFICIENCY SYSTEM-B12

E

vitamin e oral capsule 1000 unit

E

vitamin k1 injection solution 1 mg05ml 10 mgml

E

vitamins acd-fluoride 1

VITAROCA PLUS E

VITA-RX DIABETIC VITAMIN

E

VITASURE E

VITATHELY WITH GINGER

E

VITREXATE E

VITREXATE FE E

VITREXYL E

VITREXYL + IRON E

vp-pnv-dha 1

vp-vite rx E

weekly-d E

westab mini E

westab one E

WESTAB PLUS 2

WESTGEL DHA E

WHEAT GERM OIL ORAL OIL

E

XAQUIL XR E

XVITE E

ZALVIT E

zinc sulfate oral tablet 220 (50 zn) mg

E


Gastrointestinal Agents - Drugs for Acid Reflux and Ulcer

acid reducer oral tablet 10 mg

E

acid reducer oral tablet delayed release

E

ACIPHEX E

ACIPHEX SPRINKLE E

CARAFATE ORAL SUSPENSION

3

CARAFATE ORAL TABLET

E

cimetidine hcl oral 1

cimetidine oral 1

CYTOTEC 3

DEXILANT 2 QL

ESOMEP-EZS E

esomeprazole magnesium oral capsule delayed release

1 QL

esomeprazole magnesium oral packet

1 QL

ESOMEPRAZOLE STRONTIUM ORAL CAPSULE DELAYED RELEASE 493 MG

E

famotidine oral suspension reconstituted

1

famotidine oral tablet 20 mg 40 mg

1

FIRST-LANSOPRAZOLE

3 ST

FIRST-OMEPRAZOLE 3 ST

heartburn relief oral tablet 200 mg

E

lansoprazole oral capsule delayed release

1 ST QL


86


lansoprazole oral tablet delayed release dispersible

1 QL

misoprostol oral 1

NEXIUM ORAL CAPSULE DELAYED RELEASE

E

NEXIUM ORAL PACKET

3 QL

nizatidine 1

omeprazole magnesium oral tablet delayed release

E

omeprazole oral capsule delayed release

1 ST QL

omeprazole oral tablet delayed release

E

OMEPRAZOLE+SYRSPEND SF ALKA

3 ST

omeprazole-sodium bicarbonate

E

pantoprazole sodium oral

1 ST QL

PEPCID ORAL TABLET

3

PREVACID E

PREVACID 24HR E

PREVACID SOLUTAB ORAL TABLET DELAYED RELEASE DISPERSIBLE

3 ST QL

PRILOSEC ORAL PACKET

3 ST QL

PROTONIX ORAL 3 ST QL

ra omeprazole-sodium bicarb

E

RABEPRAZOLE SODIUM ORAL CAPSULE SPRINKLE

E

rabeprazole sodium oral tablet delayed release

1 ST QL


sucralfate oral 1

ZEGERID E

Gastrointestinal Agents - Drugs for Bowel Intestine and Stomach Conditions

ACTIGALL 3

ACTIPHLORA E

alosetron hcl 1 PA

alum amp mag hydroxide-simeth

E

alumina-magnesia-simethicone

E

alvimopan 1

AMITIZA E

amoxicill-clarithro-lansopraz

1 ST

ANASPAZ 3

antacid anti-gas max strength

E

antacid calcium E

antacid calcium rich E

antacid extra strength oral tablet chewable 160-105 mg 750 mg

E

antacid maximum E

antacid oral tablet chewable 500 mg

E

antacid regular strength E

antacid ultra strength oral tablet chewable 1000 mg

E

anti-diarrheal oral liquid E

anti-diarrheal oral tablet E

ATROPEN INTRAMUSCULAR SOLUTION AUTO-INJECTOR

E

atropine sulfate injection solution 04 mgml 1 mgml

E


87


atropine sulfate injection solution prefilled syringe 025 mg5ml

E

ATROPINE SULFATE INTRAVENOUS SOLUTION PREFILLED SYRINGE 1 MG25ML 12 MG3ML

E

atropine sulfate solution 8 mg20ml injection

E

atropine sulfate solution prefilled syringe 05 mg5ml injection

E


E

BACICAP E

belladonna alkaloids-opium

E

bisacodyl ec $0 QL

bisacodyl rectal E

bismuth subsalicylate oral suspension 525 mg30ml

E

cascara sagrada oral fluid extract

1

CHENODAL 3 PA SP

chlordiazepoxide-clidinium

E

chocolated laxative E

citroma $0 QL

clearlax oral powder $0 QL

CLENPIQ 3

constulose 1

cromolyn sodium oral 1

CUVPOSA 3

cvs antacid extra strength oral tablet chewable 750 mg

E


cvs gentle laxative rectal

E

cvs stool softener oral capsule 250 mg

E

dicyclomine hcl oral 1

diotame instydose E

diphenoxylate-atropine 1

docusate mini E

docusate sodium oral capsule

E

docusate sodium oral syrup

E

docuzen E

dok oral tablet E

DONNATAL E

ed-spaz 1

ENTEREG 3

enulose 1

eq anti-diarrheal oral tablet

E

EX-LAX ULTRA E

fiber laxative oral tablet E

fiber oral powder 283

E

FOLIKA PROBIOTIC E

gas relief extra strength oral capsule

E

gas relief oral tablet chewable

E

GASTROCROM 3

GATTEX 3 PA SP

gavilax oral powder $0 QL

gavilyte-c $0 QL

gavilyte-g $0 QL

gavilyte-h 1

gavilyte-n with flavor pack

$0 QL

GELUSIL E

generlac 1


88


gentle laxative oral $0 QL

gentle laxative rectal E

geri-kot E

GIALAX E

GLYCATE E

glycolax $0 QL

GLYCOPYRROLATE INJECTION SOLUTION PREFILLED SYRINGE

E

GLYCOPYRROLATE INTRAVENOUS SOLUTION PREFILLED SYRINGE 06 MG3ML 1 MG5ML

E

glycopyrrolate oral tablet 1 mg 2 mg

1

GLYCOPYRROLATE ORAL TABLET 15 MG

E

glycopyrrolate pf E

gnp senna lax E

GOLYTELY ORAL SOLUTION RECONSTITUTED 236 GM

3

goodsense antacid oral tablet chewable 500 mg 750 mg

E

goodsense anti-diarrheal

E

HELIDAC THERAPY 3

high potency probiotic E

hm stomach relief oral suspension 525 mg30ml

E

hm stool softener oral capsule 100 mg

E

hyoscyamine sulfate er oral tablet extended release 12 hour

E


hyoscyamine sulfate oral elixir

1

hyoscyamine sulfate oral tablet

1

hyoscyamine sulfate oral tablet dispersible

1

hyoscyamine sulfate sl 1

hyoscyamine sulfate solution 0125 mgml oral

E


1

hyoscyamine sulfate tablet sublingual 0125 mg sublingual

1


E

hyosyne 1

IMODIUM A-D ORAL TABLET

E

IMODIUM MULTI-SYMPTOM RELIEF ORAL TABLET

E

infants gas relief oral suspension 20 mg03ml

E

KRISTALOSE ORAL PACKET 20 GM

E

lactobacillus oral tablet E

LACTOJEN E

lactulose encephalopathy

1

lactulose oral 1

laxative max str E

laxative regular strength

E

LEVBID E

LEVSIN ORAL TABLET

E

LEVSINSL E


89


LIBRAX 3

LINZESS 2 ST QL

LOMOTIL ORAL TABLET

3

loperamide hcl oral capsule

1

loperamide hcl oral solution

E

loperamide hcl oral suspension

E

LOTRONEX 3 PA

MAALOX MULTI SYMPTOM MAX ST ORAL SUSPENSION

E

magnesium citrate oral solution 1745 gm30ml

$0 QL

magnesium oxide oral tablet 400 mg 420 mg

E

methscopolamine bromide oral

1

mi-acid maximum strength

E

mi-acid oral suspension E

milk of magnesia oral suspension 400 mg5ml

E

mineral oil heavy oral 1

mm stool softener laxative

E

MOTEGRITY 3 ST QL

MOTOFEN E

MOVANTIK E

MOVIPREP E

MYTESI 3 QL

natural fiber laxative oral powder 283

E

natural senna laxative oral tablet 86 mg

E

NULEV 3

NULYTELY LEMON-LIME

3


NULYTELY WITH FLAVOR PACKS

3

OMECLAMOX-PAK 2

opium E

oscimin oral tablet 1

oscimin sr E

oscimin sublingual 1

OSMOPREP E

pb-hyoscy-atropine-scopolamine

E

PCP 100 E

peg 3350-kcl-na bicarb-nacl

$0 QL

peg-3350electrolytes $0 QL

peg-3350electrolytesascorbat

1

peg-kcl-nacl-nasulf-na asc-c

1

peg-prep 1

PEPTO-BISMOL ORAL TABLET

E

PERDIEM OVERNIGHT RELIEF

E

phenobarbital-belladonna alk oral elixir

E

phenobarbital-belladonna alk oral tablet

1

phenohytro E

pink bismuth maximum strength

E

PLENVU E

PROBICHEW E

PRODIGEN E

PROMELLA IN PREBIOTIC

E

propantheline bromide oral

1

PYLERA 2


90


qc magnesium citrate $0 QL

QUAD-PROBIOTIC E

RELISTOR ORAL E

RELISTOR SUBCUTANEOUS SOLUTION 12 MG06ML 8 MG04ML

E

RESTORA RX 3

saccharomyces boulardii

E

senexon-s E

senna oral liquid E

senna oral syrup 88 mg5ml

E

senna oral tablet 86 mg

E

senna plus oral tablet E

senna s E

senna smooth E

senna-docusate sodium

E

senna-plus E

SENOKOT EXTRA STRENGTH

E

SENOKOT S E

SEROSTIM SUBCUTANEOUS SOLUTION RECONSTITUTED 4 MG 5 MG 6 MG

3 PA SP

simethicone oral capsule

E

simethicone oral suspension 40 mg06ml

E

simethicone oral tablet chewable 80 mg

E

SODIUM BICARBONATE ORAL POWDER

3


sodium bicarbonate oral tablet 325 mg 650 mg

E

soothe oral tablet E

stimulant laxative oral tablet

E

stomach relief oral suspension 525 mg30ml

E

stomach relief oral tablet chewable

E

stool softener laxative oral capsule 100 mg

E

stool softener oral capsule 100 mg 250 mg

E

stool softener plus laxative

E

stool softenerlaxative oral tablet

E

SUPREP BOWEL PREP KIT

3

SUTAB E

SYMAX DUOTAB E

symax-sl E

symax-sr E

SYMPROIC 2 ST QL

TALICIA 3

trilyte $0 QL

TRULANCE E

TUMS CHEWY BITES E

URSO 250 3

URSO FORTE 3

ursodiol oral 1

URSODIOL+SYRSPEND SF

E

vegetable lax+stool softener

E

VIBERZI 3 PA QL

VISBIOME E


91


XERMELO 3 PA SP QL

ZELAC E

ZELNORM 3 PA QL

ZORBTIVE 3 PA SP

Genetic or Enzyme Disorder - Drugs for Replacement Modification Treatment

ALDURAZYME 2 PA SP

BRINEURA KIT 3 PA SP

BUPHENYL ORAL POWDER 3 GMTSP

3 SP

BUPHENYL ORAL TABLET

3 SP

CERDELGA 3 PA SP

CEREZYME INTRAVENOUS SOLUTION RECONSTITUTED 400 UNIT

2 PA SP

CHOLBAM 3 PA SP

CREON 2

CRYSVITA 3 PA SP

CYSTADANE 3 SP

CYSTAGON 3 SP

ELAPRASE 2 PA SP

ELELYSO 3 PA SP

ENZADYNE E

EXONDYS 51 E SP

FABRAZYME 2 PA SP

GALAFOLD 3 PA SP QL

KANUMA 3 PA SP

KUVAN 3 PA SP

LUMIZYME 2 PA SP

MEPSEVII 3 PA SP

miglustat 1 PA SP

MYALEPT 3 PA SP

NAGLAZYME 2 PA SP


nitisinone 1 PA SP

NITYR 3 PA SP

OCALIVA 3 PA SP QL

ORFADIN 3 PA SP

PALYNZIQ 3 PA SP QL

PANCREAZE E

PERTZYE E

PROCYSBI 3 PA SP

RAVICTI 3 PA SP

REVCOVI 3 PA SP

sapropterin dihydrochloride

1 PA SP

sodium phenylbutyrate oral powder 3 gmtsp

1 SP

sodium phenylbutyrate oral tablet

1 SP

STRENSIQ 2 PA SP

SUCRAID 3 SP

VIMIZIM 3 PA SP

VIOKACE E

VPRIV 3 PA SP

VYONDYS 53 E SP

XURIDEN 3 PA SP QL

ZAVESCA 3 PA SP

ZENPEP ORAL CAPSULE DELAYED RELEASE PARTICLES 10000-32000 UNIT 15000-47000 UNIT 20000-63000 UNIT 25000-79000 UNIT 3000-14000 UNIT 40000-126000 UNIT 5000-24000 UNIT

2

ZOLGENSMA 101-105 KG

3 PA SP


3 PA SP


3 PA SP


92



3 PA SP


3 PA SP


3 PA SP


3 PA SP

ZOLGENSMA 26-30 KG

3 PA SP

ZOLGENSMA 31-35 KG

3 PA SP

ZOLGENSMA 36-40 KG

3 PA SP

ZOLGENSMA 41-45 KG

3 PA SP

ZOLGENSMA 46-50 KG

3 PA SP

ZOLGENSMA 51-55 KG

3 PA SP

ZOLGENSMA 56-60 KG

3 PA SP

ZOLGENSMA 61-65 KG

3 PA SP

ZOLGENSMA 66-70 KG

3 PA SP

ZOLGENSMA 71-75 KG

3 PA SP

ZOLGENSMA 76-80 KG

3 PA SP

ZOLGENSMA 81-85 KG

3 PA SP

ZOLGENSMA 86-90 KG

3 PA SP

ZOLGENSMA 91-95 KG

3 PA SP

ZOLGENSMA 96-100 KG

3 PA SP


Genitourinary Agents - Drugs for Bladder Genital and Kidney Conditions

aminoacetic acid E

AURYXIA 3

azo tabs E

bethanechol chloride oral

1

BI-MIX 3

calcium acetate (phos binder)

1

calcium acetate oral tablet 667 mg

1

CAVERJECT IMPULSE

3 QL

CAVERJECT INTRACAVERNOSAL SOLUTION RECONSTITUTED 40 MCG

3 QL

CERVIDIL 3

CIALIS 3 QL

CUPRIMINE ORAL CAPSULE 250 MG

3 PA SP

darifenacin hydrobromide er

1

DEPEN TITRATABS 2 SP

DETROL 3

DETROL LA 3

DITROPAN XL ORAL TABLET EXTENDED RELEASE 24 HOUR 10 MG 5 MG

3

EDEX 3 QL

ELMIRON 2

ENABLEX ORAL TABLET EXTENDED RELEASE 24 HOUR 75 MG

3

FEM PH E

flavoxate hcl 1


93


FOSRENOL ORAL PACKET

3

FOSRENOL ORAL TABLET CHEWABLE 1000 MG 500 MG 750 MG

3

GELNIQUE TRANSDERMAL GEL 10

3 ST

glycine irrigation E

glycine urologic E

hyophen E

INTRAROSA 3 ST

lanthanum carbonate 1

LEVITRA ORAL TABLET 10 MG 20 MG

E

LITHOSTAT 3

menaphosmbhyo1 E

MUSE 3 QL

MYRBETRIQ 2

oxybutynin chloride er 1

oxybutynin chloride oral 1

OXYTROL 3 ST QL

OXYTROL FOR WOMEN

E

penicillamine oral capsule

1 PA SP

penicillamine oral tablet 1 SP

PENTOSAN POLYSULFATE SODIUM ORAL

E

phenazo oral tablet 200 mg

1

phenazopyridine hcl oral tablet 100 mg 200 mg

1

PHENYLEPHRINE HCL INTRACAVERNOSAL

E

PHOSLYRA 3


phosphasal E

PREPIDIL 3

PROSTIN E2 3

PYRIDIUM E

QUAD-MIX 3

RENACIDIN E

RENAGEL ORAL TABLET 800 MG

E

RENVELA 3

RIMSO-50 E

sevelamer carbonate 1

sevelamer hcl 1

sildenafil citrate oral tablet 100 mg 25 mg 50 mg

1 QL

solifenacin succinate 1

STAXYN E

STENDRA E

SUPER BI-MIX 3

SUPER QUAD-MIX 3

SUPER TRI-MIX E

tadalafil oral 1 QL

THIOLA 3 SP

THIOLA EC 3 SP

tolterodine tartrate 1

tolterodine tartrate er 1

TOVIAZ 3

TRI-MIX E

trospium chloride 1 ST

trospium chloride er 1

URELLE E

uretron ds oral tablet 816 mg

1

URIBEL E

URIMAR-T E

urin ds oral tablet 816 mg

1


94


urinary pain relief oral tablet 95 mg

E

URO-458 E

UROGESIC-BLUE E

uro-mp E

ustell E

uticap E

utira-c E

utrona-c 1

vardenafil hcl oral 1 QL

VELPHORO 3

VESICARE 3

VIAGRA E

vilamit mb E

VILEVEV MB E

Genitourinary Agents - Drugs for Prostate Conditions

alfuzosin hcl er 1

AVODART 3

CARDURA XL 3 ST

dutasteride oral 1

dutasteride-tamsulosin hcl

1


1

FLOMAX E

JALYN 3

PROSCAR 3

RAPAFLO 3

silodosin 1

tamsulosin hcl 1

terazosin hcl oral 1

UROXATRAL 3

Hormonal Agents - Adrenal

ACTIVE INJECTION D E

ACTIVE INJECTION KIT L

E


ACTIVE INJECTION KL-3

E

ACTIVE INJECTION LM-DEP-2

E

ALKINDI SPRINKLE E

BETA 1 KIT E

BETALOAN SUIK E

BETAMETHASONE COMBO

E

BETAMETHASONE SOD PHOS amp ACET INJECTION SUSPENSION 7 (4-3) MGML

E

BETAMETHASONE SOD PHOS amp ACET SUSPENSION 6 (3-3) MGML INJECTION

E

betamethasone sod phos amp acet suspension 6 (3-3) mgml injection

E

BSP 0820 E

CELESTONE SOLUSPAN

E

CONTRAST ALLERGY PREMED PACK

E

CORTEF 3

cortisone acetate oral 1

DECADRON ORAL TABLET

E

DEPO-MEDROL E

DEXABLISS E

dexamethasone intensol

1

dexamethasone oral 1

dexamethasone sod phosphate pf

E


95


dexamethasone sodium phosphate injection solution 100 mg10ml 120 mg30ml 20 mg5ml

E

DEXAMETHASONE SODIUM PHOSPHATE SOLUTION 10 MGML INJECTION

E

dexamethasone sodium phosphate solution 10 mgml injection

E


E


E

DEXONTO 04 3

DMT SUIK E

DOUBLEDEX E

DXEVO 11-DAY E

DYURAL-40 E

DYURAL-80 E

DYURAL-L E

DYURAL-LM E

fludrocortisone acetate oral

1

HEMADY E

HIDEX 6-DAY E

hydrocortisone oral 1

KENALOG INJECTION 3

KENALOG-80 3

MAS CARE-PAK E

MEDROL ORAL TABLET 16 MG 32 MG 4 MG 8 MG

3

MEDROL ORAL TABLET 2 MG

2


MEDROL ORAL TABLET THERAPY PACK

3

MEDROLOAN II SUIK E

MEDROLOAN SUIK E

METHYLPREDNISOLONE ACETATE INJECTION SUSPENSION 50 MGML

E

METHYLPREDNISOLONE ACETATE SUSPENSION 40 MGML INJECTION

E

methylprednisolone acetate suspension 40 mgml injection

E


E


E

methylprednisolone oral

1

MILLIPRED DP 12-DAY ORAL TABLET THERAPY PACK

3

MILLIPRED ORAL TABLET

E

MULTI-SPECIALTY E

ORAPRED ODT 3

P-CARE K40 E

P-CARE K40G E

P-CARE K40MX E

P-CARE K80 E

P-CARE K80G E

P-CARE K80MX E

PEDIAPRED 3

physicians ez use jointtunnel

E


96


PHYSICIANS EZ USE M-PRED

E

POD-CARE 100K E

POINT OF CARE L2 E

POINT OF CARE L5 E

POINT OF CARE LM DEP 2

E

prednisolone oral solution

1

prednisolone sodium phosphate oral solution 10 mg5ml 15 mg5ml 20 mg5ml 25 mg5ml 67 (5 base) mg5ml

1

prednisolone sodium phosphate oral tablet dispersible

1

prednisone intensol 1

prednisone oral 1

PRO-C-DURE 5 E

PRO-C-DURE 6 E

RAYOS E

READYSHARP ANESTH + METHYLPRED

E

READYSHARP BETAMETHASONE

E

READYSHARP DEXAMETHASONE

E

SOLU-CORTEF INJECTION SOLUTION RECONSTITUTED 100 MG

3

TAPERDEX 12-DAY E

TAPERDEX 6-DAY E

TAPERDEX 7-DAY ORAL TABLET THERAPY PACK 15 MG (27)

E

TOPIDEX E


TRIAMCINOLONE ACETONIDE INJECTION SUSPENSION 50 MGML

E

triamcinolone acetonide suspension 40 mgml injection

1

TRIAMCINOLONE ACETONIDE SUSPENSION 40 MGML INJECTION

3


E

TRILOAN II SUIK E

TRILOAN SUIK E

ZCORT 7-DAY E

ZILRETTA E

Hormonal Agents - Mens Health

ANADROL-50 3 PA

ANDRODERM TRANSDERMAL PATCH 24 HOUR

2 PA

ANDROGEL PUMP TRANSDERMAL GEL 2025 MGACT (162)

3 PA

ANDROGEL TRANSDERMAL GEL 2025 MG125GM (162) 405 MG25GM (162)

3 PA


E

AVEED E

danazol oral 1

DEPO-TESTOSTERONE INTRAMUSCULAR SOLUTION

E


97


EC-RX TESTOSTERONE

E

FORTESTA E

JATENZO E

METHITEST 3 PA

methyltestosterone oral 1 PA

NATESTO E

oxandrolone oral 1 PA QL

TESTIM E

TESTONE CIK E

TESTOPEL E

TESTOSTERONE COMPOUNDING KIT

E

TESTOSTERONE CYPIONATE INJECTION SOLUTION 200 MGML

E

testosterone cypionate intramuscular solution 100 mgml 200 mgml

1 PA

testosterone enanthate intramuscular solution

1 PA

TESTOSTERONE IMPLANT PELLET 100 MG 200 MG 25 MG 50 MG

E

testosterone transdermal gel 162 10 mgact (2) 125 mgact (1) 2025 mg125gm (162) 2025 mgact (162) 25 mg25gm (1) 405 mg25gm (162) 50 mg5gm (1)

1 PA

testosterone transdermal solution

1 PA

VOGELXO PUMP E

VOGELXO TRANSDERMAL GEL 50 MG5GM (1)

E


XYOSTED 3 PA

Hormonal Agents - Osteoporosis

EVISTA 3

OSPHENA 3

raloxifene hcl 1

Hormonal Agents - Pituitary

ACTHAR 2 PA SP

BYNFEZIA PEN E SP

cabergoline 1

CETROTIDE SUBCUTANEOUS KIT 025 MG

E SP

chorionic gonadotropin intramuscular

1 PA SP

clomiphene citrate oral 1 PA

DDAVP INJECTION SOLUTION 4 MCGML

3

DDAVP NASAL 3

DDAVP ORAL 3

DDAVP RHINAL TUBE 2

desmopressin ace spray refrig

1

desmopressin acetate injection

1

desmopressin acetate oral

1

desmopressin acetate spray

1

EGRIFTA SV 3 PA SP QL

ELIGARD 3 PA SP QL

FENSOLVI (6 MONTH) E SP

FIRMAGON (240 MG DOSE)

3 PA SP QL

FIRMAGON SUBCUTANEOUS SOLUTION RECONSTITUTED 80 MG

3 PA SP QL


98


FOLLISTIM AQ SUBCUTANEOUS

2 PA SP

ganirelix acetate solution prefilled syringe 250 mcg05ml subcutaneous

1 PA SP


1PA Made by OrganonMerck SP

GENOTROPIN E SP

GENOTROPIN MINIQUICK

E SP

GONAL-F E SP

GONAL-F RFF E SP

GONAL-F RFF REDIJECT

E SP

HUMATROPE E SP

INCRELEX 2 PA SP

ISTURISA E SP

leuprolide acetate injection

1 PA SP

LUPANETA PACK 3 PA SP QL

LUPRON DEPOT (1-MONTH) INTRAMUSCULAR KIT 375 MG

3 PA SP


2 PA SP


3 PA SP


2 PA SP

LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG

2 PA SP



2 PA SP

LUPRON DEPOT-PED (1-MONTH) INTRAMUSCULAR KIT 1125 MG

3 PA SP

LUPRON DEPOT-PED (1-MONTH) INTRAMUSCULAR KIT 15 MG 75 MG

2 PA SP

LUPRON DEPOT-PED (3-MONTH) INTRAMUSCULAR KIT 1125 MG (PED)

3 PA SP


2 PA SP

MENOPUR 3 PA SP

MYCAPSSA E SP

NOCDURNA 3

NORDITROPIN FLEXPRO SUBCUTANEOUS SOLUTION PEN-INJECTOR

2 PA SP

novarel intramuscular solution reconstituted 10000 unit

1 PA SP

NOVAREL INTRAMUSCULAR SOLUTION RECONSTITUTED 5000 UNIT

3 PA SP

NUTROPIN AQ NUSPIN 10 SUBCUTANEOUS SOLUTION PEN-INJECTOR

2 PA SP


99



2 PA SP


2 PA SP

octreotide acetate injection solution 100 mcgml 1000 mcgml 200 mcgml 50 mcgml 500 mcgml

1 PA SP

OMNITROPE SUBCUTANEOUS SOLUTION CARTRIDGE

E SP

OMNITROPE SUBCUTANEOUS SOLUTION RECONSTITUTED

E SP

ORILISSA 2 PA QL

OVIDREL 3 PA SP

OXYTOCIN-LACTATED RINGERS INTRAVENOUS SOLUTION 30 UNIT500ML

E

OXYTOCIN-SODIUM CHLORIDE INTRAVENOUS SOLUTION 20-09 UNTL-

E

pregnyl 1 PA SP

SAIZEN E SP

SAIZENPREP E SP

SANDOSTATIN INJECTION SOLUTION 100 MCGML 50 MCGML 500 MCGML

E SP

SANDOSTATIN LAR DEPOT

E SP


SIGNIFOR 3 PA SP QL

SIGNIFOR LAR INTRAMUSCULAR SUSPENSION RECONSTITUTED ER

3 PA SP QL

SOMATULINE DEPOT 3 PA SP

SOMAVERT 3 PA SP

STIMATE 3

SUPPRELIN LA 2 PA SP QL

SYNAREL 2

TEPEZZA 3 PA SP

TRELSTAR MIXJECT 3 PA SP QL

TRIPTODUR 3 PA SP QL

VANTAS 3 PA SP QL

ZOLADEX SUBCUTANEOUS IMPLANT 108 MG

3 SP QL


2 SP QL

ZOMACTON E SP

ZOMACTON (FOR ZOMA-JET 10)

E SP

Hormonal Agents - Prostaglandins

KORLYM 3 PA SP QL

Hormonal Agents - Sex Hormones and Birth Control

ACTIVELLA ORAL TABLET 1-05 MG

3

afirmelle $0 QL

ALORA 3 ST

altavera $0 QL

alyacen 135 $0 QL

alyacen 777 $0 QL

amabelz 1

amethia $0 QL

amethia lo $0 QL

amethyst $0 QL


100


ANGELIQ 3

ANNOVERA E

apri $0 QL

aranelle $0 QL

ashlyna $0 QL

aubra $0 QL

aubra eq $0 QL

aurovela 1530 $0 QL

aurovela 120 $0 QL

aurovela 24 fe $0 QL

aurovela fe 1530 $0 QL


aviane $0 QL

AYGESTIN 3

ayuna $0 QL

azurette $0 QL

BALCOLTRA E

balziva $0 QL

bekyree $0 QL

BEYAZ E

BI-EST 8020 PROGESTERONE

E

BIESTPROGESTERONE

E

BIJUVA 3

blisovi 24 fe $0 QL

blisovi fe 1530 $0 QL


briellyn $0 QL

camila $0 QL

camrese $0 QL

camrese lo $0 QL

caziant $0 QL

charlotte 24 fe $0 QL

chateal $0 QL

chateal eq $0 QL

CLIMARA 3


CLIMARA PRO 2

COMBIPATCH 3

covaryx E

covaryx hs E

CRINONE VAGINAL GEL 4

3 QL


3 PA QL

cryselle-28 $0 QL

cyclafem 135 $0 QL

cyclafem 777 $0 QL

cyred $0 QL

cyred eq $0 QL

dasetta 135 $0 QL

dasetta 777 $0 QL

daysee $0 QL

deblitane $0 QL

DELESTROGEN 3

delyla $0 QL

DEPO-ESTRADIOL 3

DEPO-PROVERA INTRAMUSCULAR SUSPENSION 150 MGML

3 QL

DEPO-PROVERA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

3 QL

DEPO-SUBQ PROVERA 104 SUBCUTANEOUS SUSPENSION PREFILLED SYRINGE

$0 QL

desogestrel-ethinyl estradiol oral tablet 015-002001 mg (215)

$0 QL

DIVIGEL 3

dotti 1

drospiren-eth estrad-levomefol

$0 QL


101


drospirenone-ethinyl estradiol

$0 QL

DUAVEE 2

EC-RX ESTRADIOL E

EC-RX PROGESTERONE

E

eemt E

eemt hs E

ELESTRIN 3

elinest $0 QL

ELLA $0 QL

eluryng $0 QL

emoquette $0 QL

ENDOMETRIN 2 PA

enpresse-28 $0 QL

enskyce oral tablet 015-30 mg-mcg

$0 QL

errin $0 QL

est estrogens-methyltest

E

est estrogens-methyltest ds

E

est estrogens-methyltest hs

E

estarylla $0 QL

ESTRACE 3

estradiol oral 1

estradiol transdermal 1

estradiol vaginal 1

estradiol valerate intramuscular oil 20 mgml 40 mgml

1

estradiol-norethindrone acet

1

ESTRING 3 QL

ESTROGEL 3

ESTROSTEP FE 3 QL

ethynodiol diac-eth estradiol

$0 QL


etonogestrel-ethinyl estradiol

$0 QL

EVAMIST 3

FALESSA ORAL KIT 20-1-01 MCG-MG

E

falmina $0 QL

fayosim $0 QL

FEMHRT LOW DOSE 3

FEMRING 3 ST QL

femynor $0 QL

FIRST-PROGESTERONE VGS VAGINAL SUPPOSITORY 100 MG 200 MG

E

fyavolv 1

gemmily $0 QL

GENERESS FE 3 QL

gianvi $0 QL

hailey 1530 $0 QL

hailey 24 fe $0 QL

hailey fe 1530 $0 QL

hailey fe 120 $0 QL

heather $0 QL

hydroxyprogesterone caproate intramuscular

1 PA SP

IMVEXXY MAINTENANCE PACK

3

IMVEXXY STARTER PACK

3

incassia $0 QL

introvale $0 QL

isibloom $0 QL

jaimiess $0 QL

jasmiel $0 QL

jencycla $0 QL

jinteli 1

jolessa $0 QL

juleber $0 QL


102


junel 1530 $0 QL

junel 120 $0 QL

junel fe 1530 $0 QL

junel fe 120 $0 QL

junel fe 24 $0 QL

kaitlib fe $0 QL

kalliga $0 QL

kariva $0 QL

kelnor 135 $0 QL

kelnor 150 $0 QL

kurvelo $0 QL

KYLEENA E

larin 1530 $0 QL

larin 120 $0 QL

larin 24 fe $0 QL

larin fe 1530 $0 QL

larin fe 120 $0 QL

larissia $0 QL

layolis fe $0 QL

leena $0 QL

lessina $0 QL

levonest $0 QL

levonorgest-eth est amp eth est

$0 QL

levonorgest-eth estrad 91-day

$0 QL

levonorgestrel oral tablet 15 mg

$0 QL

levonorgestrel-ethinyl estrad

$0 QL

levonorg-eth estrad triphasic oral tablet 50-3075-40 125-30 mcg

$0 QL

levora 01530 (28) $0 QL

LILETTA (52 MG) INTRAUTERINE INTRAUTERINE DEVICE 195 MCGDAY

E


lillow $0 QL

LO LOESTRIN FE $0 QL

LOESTRIN 1530 (21) 3 QL


LOESTRIN FE 1530 3 QL


lojaimiess $0 QL

loryna $0 QL

LOSEASONIQUE 3 QL

low-ogestrel $0 QL

lo-zumandimine $0 QL

lutera $0 QL

lyllana 1

lyza $0 QL

MAKENA 2 PA SP

marlissa $0 QL

medroxyprogesterone acetate intramuscular

$0 QL

medroxyprogesterone acetate oral

1

megestrol acetate oral suspension 40 mgml 625 mg5ml

1

megestrol acetate oral tablet

1

melodetta 24 fe $0 QL

MENEST ORAL TABLET 03 MG 0625 MG 125 MG

2

MENOSTAR 3 ST

mibelas 24 fe $0 QL

microgestin 1530 $0 QL


microgestin fe 1530 $0 QL


mili $0 QL

mimvey 1

MINASTRIN 24 FE E

MINIVELLE 3 ST


103


MIRCETTE 3 QL

MIRENA (52 MG) E

mono-linyah $0 QL

NATAZIA $0 QL

necon 0535 (28) $0 QL

NEXPLANON E

nikki $0 QL

nora-be $0 QL

norethin ace-eth estrad-fe oral capsule

$0 QL

norethin ace-eth estrad-fe oral tablet 1-20 mg-mcg 15-30 mg-mcg

$0 QL

norethin ace-eth estrad-fe oral tablet chewable

$0 QL

norethindrone acetate oral

1

norethindrone acet-ethinyl est oral tablet

$0 QL

norethindrone oral $0 QL

norethindrone-eth estradiol

1

norethin-eth estradiol-fe $0 QL

norgestimate-eth estradiol oral tablet 025-35 mg-mcg

$0 QL

norgestimate-ethinyl estradiol triphasic

$0 QL

norlyda $0 QL

norlyroc $0 QL

nortrel 0535 (28) $0 QL

nortrel 135 (21) $0 QL


nortrel 777 $0 QL

NUVARING 3 QL

ocella $0 QL

ORIAHNN 2 PA QL

orsythia $0 QL


ORTHO MICRONOR E

PARAGARD INTRAUTERINE COPPER

E

philith $0 QL

pimtrea $0 QL

pirmella 135 $0 QL

pirmella 777 $0 QL

PLAN B ONE-STEP $0 QL

portia-28 $0 QL

PREFEST 3

PREMARIN ORAL 2

PREMARIN VAGINAL 2

PREMPHASE 2

PREMPRO 2

previfem $0 QL

PROGESTERONE COMPOUNDING KIT

E

progesterone intramuscular

1

progesterone micronized oral

1

PROGESTERONE MICRONIZED TRANSDERMAL

E

PROMETRIUM 3

PROVERA 3

QUARTETTE 3 QL

reclipsen $0 QL

rivelsa $0 QL

SAFYRAL 3 QL

SEASONIQUE 3 QL

setlakin $0 QL

sharobel $0 QL

simliya $0 QL

simpesse $0 QL

SKYLA E

SLYND E

sprintec 28 $0 QL


104


sronyx $0 QL

syeda $0 QL

tarina 24 fe $0 QL

tarina fe 120 $0 QL

tarina fe 120 eq $0 QL

TAYTULLA E

tilia fe $0 QL

tri femynor $0 QL

tri-estarylla $0 QL

tri-legest fe $0 QL

tri-linyah $0 QL

tri-lo-estarylla $0 QL

tri-lo-marzia $0 QL

tri-lo-mili $0 QL

tri-lo-sprintec $0 QL

tri-mili $0 QL

tri-previfem $0 QL

tri-sprintec $0 QL

trivora (28) $0 QL

tri-vylibra $0 QL

tri-vylibra lo $0 QL

tulana $0 QL

TWIRLA 3 QL

tyblume $0 QL

tydemy $0 QL

VAGIFEM VAGINAL TABLET 10 MCG

E

velivet $0 QL

vienva $0 QL

viorele $0 QL

VIVELLE-DOT E

volnea $0 QL

vyfemla $0 QL

vylibra $0 QL

wera $0 QL

wymzya fe $0 QL

xulane $0 QL


YASMIN 28 3 QL

YAZ E

yuvafem 1

zarah $0 QL

zovia 135 (28) $0 QL

zovia 135e (28) $0 QL

zumandimine $0 QL

Hormonal Agents - Thyroid

ARMOUR THYROID 3 ST

CYTOMEL E

euthyrox 1

levo-t 1

LEVOTHYROXINE SODIUM ORAL CAPSULE

E

levothyroxine sodium oral tablet

1

levoxyl 1

liothyronine sodium oral 1

methimazole oral 1

NATURE-THROID 3 ST

np thyroid 1

propylthiouracil oral 1

SYNTHROID 3

TAPAZOLE 3

TIROSINT E

TIROSINT-SOL 3

unithroid 1

WESTHROID ORAL TABLET 130 MG 195 MG 325 MG 65 MG 975 MG

3 ST

WP THYROID 3 ST

Immunological Agents - Drugs for Immune System Stimulation or Suppression

ACTEMRA 3 PA SP


105


ACTEMRA ACTPEN 3 PA SP

ACTIMMUNE 2 PA SP

ALFERON N 2 SP

ARAVA 3

ARCALYST 3 PA SP

ASCENIV E SP

ASTAGRAF XL 3 SP

ATGAM 2 SP

AVSOLA 3 PA SP

AZASAN 3

azathioprine oral 1

azathioprine sodium E

BENLYSTA 3 PA SP

BERINERT 3 PA SP QL

BIVIGAM INTRAVENOUS SOLUTION 5 GM50ML

3 PA SP

CARIMUNE NF INTRAVENOUS SOLUTION RECONSTITUTED 12 GM 6 GM

3 PA SP

CELLCEPT 3 SP

CELLCEPT INTRAVENOUS

3 SP

CIMZIA PREFILLED KIT

2 PA SP

CIMZIA STARTER KIT 2 PA SP

CIMZIA VIAL KIT 2 PA SP

CINRYZE 2 PA SP

COSENTYX (300 MG DOSE)

E SP

COSENTYX 150 MGML

E SP

COSENTYX SENSOREADY (300 MG)

E SP


COSENTYX SENSOREADY PEN SUBCUTANEOUS SOLUTION AUTO-INJECTOR 150 MGML

E SP

CUTAQUIG E SP

CUVITRU 3 PA SP

cyclosporine intravenous

1 SP

cyclosporine modified 1 SP

cyclosporine oral capsule

1 SP

CYTOGAM 2 PA SP

ENBREL MINI 3 PA SP

ENBREL SUBCUTANEOUS SOLUTION 25 MG05ML

3 PA SP

ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA SP

ENBREL SUBCUTANEOUS SOLUTION RECONSTITUTED

3 PA SP

ENBREL SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR

3 PA SP

ENSPRYNG E SP

ENTYVIO 3 PA SP

ENVARSUS XR 3 SP


1 PA SP

FIRAZYR 3 PA SP QL

FLEBOGAMMA DIF 3 PA SP

GAMASTAN 2 PA SP

GAMIFANT 3 PA SP

GAMMAGARD 3 PA SP


106


GAMMAGARD SD LESS IGA

3 PA SP

GAMMAKED INJECTION SOLUTION 1 GM10ML 10 GM100ML 20 GM200ML 5 GM50ML

3 PA SP

GAMMAPLEX INTRAVENOUS SOLUTION 10 GM100ML 10 GM200ML 20 GM200ML 20 GM400ML 5 GM100ML 5 GM50ML

3 PA SP

GAMUNEX-C 3 PA SP

gengraf oral capsule 100 mg 25 mg

1 SP

gengraf oral solution 1 SP

HAEGARDA 3 PA SP

HEPAGAM B E

HIZENTRA SUBCUTANEOUS SOLUTION 1 GM5ML 10 GM50ML 2 GM10ML 4 GM20ML

3 PA SP

HIZENTRA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA SP

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 80 MG08ML 80 MG08ML amp 40MG04ML

2 PA SP

HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT

2 PA SP

HUMIRA PEN-CDUCHS STARTER

2 PA SP


HUMIRA PEN-PSUVADOL HS START SUBCUTANEOUS PEN-INJECTOR KIT 40 MG08ML

2 PA SP

HUMIRA PEN-PSORUVEIT STARTER

2 PA SP

HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT

2 PA SP

HYPERHEP B SD E

HYPERRAB E

HYPERRAB SD INJECTION

E

HYPERRHO SD INTRAMUSCULAR SOLUTION PREFILLED SYRINGE

2 SP

HYPERTET SD E

HYQVIA 3 PA SP

icatibant acetate 1 PA SP QL

ILARIS SUBCUTANEOUS SOLUTION

2 PA SP QL

ILUMYA 3 PA SP

IMOGAM RABIES-HT INJECTION

E

IMURAN 3

INFLECTRA 2 PA SP

KALBITOR 3 PA SP QL

KEDRAB INJECTION E

KEVZARA 3 PA SP

KINERET SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA SP

KYMRIAH 3 PA SP

leflunomide oral 1

methotrexate oral 1


107


methotrexate sodium (pf) injection solution 1 gm40ml 250 mg10ml 50 mg2ml

1

methotrexate sodium injection solution 250 mg10ml 50 mg2ml

1

methotrexate sodium injection solution reconstituted

1

methotrexate sodium oral

1

MICRHOGAM ULTRA-FILTERED PLUS INTRAMUSCULAR SOLUTION PREFILLED SYRINGE

2 SP

mycophenolate mofetil 1 SP

mycophenolate mofetil hcl

1 SP

mycophenolate sodium 1 SP

MYFORTIC 3 SP

NABI-HB E

NEORAL 3 SP

NULOJIX 3 PA SP

OCTAGAM 3 PA SP

OLUMIANT E SP

ORENCIA CLICKJECT 3 PA SP

ORENCIA INTRAVENOUS

3 PA SP

ORENCIA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA SP

OTEZLA ORAL TABLET

2 PA SP

OTEZLA ORAL TABLET THERAPY PACK

2 PA SP


OTREXUP SUBCUTANEOUS SOLUTION AUTO-INJECTOR 10 MG04ML 15 MG04ML 20 MG04ML 25 MG04ML

3 PA QL

OTREXUP SUBCUTANEOUS SOLUTION AUTO-INJECTOR 125 MG04ML 175 MG04ML 225 MG04ML

E

PANZYGA E SP

PRIVIGEN 3 PA SP

PROGRAF 3 SP

PROVENGE 2 PA SP

RAPAMUNE 3 SP

RASUVO SUBCUTANEOUS SOLUTION AUTO-INJECTOR 10 MG02ML 125 MG025ML 15 MG03ML 175 MG035ML 20 MG04ML 225 MG045ML 25 MG05ML 30 MG06ML 75 MG015ML

2 PA QL

REDITREX E

REMICADE E SP

RENFLEXIS 2 PA SP

RHOGAM ULTRA-FILTERED PLUS INTRAMUSCULAR SOLUTION PREFILLED SYRINGE

2 SP

RHOPHYLAC INJECTION SOLUTION PREFILLED SYRINGE

E


108


RIDAURA 3 SP

RINVOQ 2 PA SP

RUCONEST 3 PA SP QL

SANDIMMUNE INTRAVENOUS

2 SP

SANDIMMUNE ORAL CAPSULE

3 SP

SANDIMMUNE ORAL SOLUTION

2 SP

SILIQ 3 PA SP

SIMPONI ARIA 2 PA SP

SIMPONI SUBCUTANEOUS SOLUTION AUTO-INJECTOR

2 PA SP

SIMPONI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

2 PA SP

SIMULECT E

sirolimus oral 1 SP

SKYRIZI (150 MG DOSE)

2 PA SP

STELARA INTRAVENOUS

2 PA SP

STELARA SUBCUTANEOUS SOLUTION 45 MG05ML

2 PA SP QL

STELARA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

2 PA SP QL

SYNAGIS 2 PA SP

tacrolimus oral 1 SP

TAKHZYRO 3 PA SP

TALTZ 3 PA SP

temsirolimus 1 SP

THYMOGLOBULIN E

TICE BCG 2 SP

TORISEL 3 SP


TREMFYA 2 PA SP

TREXALL 3

UPLIZNA 3 PA SP

VARIZIG INTRAMUSCULAR SOLUTION

E

WINRHO SDF 2 SP

XATMEP 3

XELJANZ 2 PA SP

XELJANZ XR 2 PA SP

XEMBIFY 3 PA SP

ZINPLAVA E

ZORTRESS 3 PA SP

Immunological Agents - Drugs for Vaccination

ACTHIB $0

ADACEL INTRAMUSCULAR SUSPENSION 5-2-155 LF-MCG05

$0

AFLURIA QUADRIVALENT

$0

BCG VACCINE E

BEXSERO $0

BIOTHRAX E

BOOSTRIX INTRAMUSCULAR SUSPENSION 5-25-185 LF-MCG05

$0

DAPTACEL INTRAMUSCULAR SUSPENSION 23-15-5

$0

DIPHTHERIA-TETANUS TOXOIDS DT

$0

ENGERIX-B INJECTION SUSPENSION 10 MCG05ML 20 MCGML

$0

FLUAD $0


109


FLUAD QUADRIVALENT

$0

FLUARIX QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

$0

FLUCELVAX QUADRIVALENT

$0

FLULAVAL QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

$0

FLUMIST QUADRIVALENT

$0

FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION 05 ML

$0

FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 05 ML

$0

GARDASIL 9 $0

HAVRIX INTRAMUSCULAR SUSPENSION 1440 EL UML 720 EL U05ML

$0

HEPLISAV-B INTRAMUSCULAR SOLUTION PREFILLED SYRINGE

$0

HIBERIX INJECTION $0

IMOVAX RABIES E

INFANRIX $0

IPOL INJECTION INJECTABLE

$0

IXIARO E

MENACTRA $0

MENQUADFI $0


MENVEO $0

M-M-R II INJECTION $0

PEDVAX HIB INTRAMUSCULAR SUSPENSION

$0

PNEUMOVAX 23 $0

PREVNAR 13 $0

RABAVERT E

RECOMBIVAX HB INJECTION SUSPENSION 10 MCGML 40 MCGML 5 MCG05ML

$0

ROTARIX $0

ROTATEQ ORAL SOLUTION

$0

SHINGRIX INTRAMUSCULAR SUSPENSION RECONSTITUTED 50 MCG05ML

$0

STAMARIL E

TDVAX $0

TENIVAC $0

TETANUS-DIPHTHERIA TOXOIDS TD

$0

TRUMENBA $0

TWINRIX INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

$0

TYPHIM VI INTRAMUSCULAR SOLUTION 25 MCG05ML

E

VAQTA INTRAMUSCULAR SUSPENSION 25 UNIT05ML 50 UNITML

$0

VARIVAX $0

VAXCHORA E


110


VIVOTIF E

YF-VAX E

Inflammatory Bowel Disease Agents

ana-lex E

ANALPRAM HC EXTERNAL

E

ANALPRAM HC SINGLES EXTERNAL

E

ANALPRAM-HC EXTERNAL CREAM

3

ANALPRAM-HC EXTERNAL LOTION

E

anucort-hc E

ANUSOL-HC EXTERNAL

3

ANUSOL-HC RECTAL SUPPOSITORY

E

APRISO 2

ASACOL HD E

AZULFIDINE 3

AZULFIDINE EN-TABS 3

balsalazide disodium 1

budesonide er oral tablet extended release 24 hour

1

budesonide oral 1

CANASA E

COLAZAL 3

CORTENEMA 3

CORTIFOAM EXTERNAL

3

DELZICOL E

DIPENTUM E

ENTOCORT EC ORAL CAPSULE DELAYED RELEASE PARTICLES

3

hemmorex-hc rectal suppository 25 mg

E


hemorrhoidal-hc rectal suppository

E

hydrocortisone (perianal)

1


1

hydrocortisone acetate rectal

E

hydrocortisone rectal enema

1

hydrocort-pramoxine (perianal)

E

LIALDA E

lidocaine-hydrocort (perianal)

E

LIDOCAINE-HYDROCORTISONE ACE RECTAL GEL

E

lidocaine-hydrocortisone ace rectal kit

E

LIDOCORT EXTERNAL

E

mesalamine er 1

mesalamine oral 1

mesalamine rectal 1

mesalamine-cleanser 1

ORTIKOS E

PENTASA 3

PROCORT EXTERNAL E

PROCTOCORT EXTERNAL

3

PROCTOCORT RECTAL SUPPOSITORY

E

PROCTOFOAM HC EXTERNAL

2

procto-med hc external 1

procto-pak external 1

proctozone-hc external 1


111


ROWASA RECTAL 3

SFROWASA 2

sulfasalazine oral 1

UCERIS 3

Metabolic Bone Disease Agents - Drugs for Osteoporosis

ACTONEL ORAL TABLET 150 MG 35 MG

3 QL

alendronate sodium oral solution

1

alendronate sodium oral tablet 10 mg 5 mg

1


1 QL

ATELVIA 3 QL

BINOSTO 3 QL

BONIVA INTRAVENOUS

E

BONIVA ORAL TABLET 150 MG

3 QL

calcitonin (salmon) 1 QL

EVENITY 3 PA SP QL

FORTEO SUBCUTANEOUS SOLUTION PEN-INJECTOR

2 PA SP

FOSAMAX ORAL TABLET 70 MG

3 QL

FOSAMAX PLUS D E

ibandronate sodium intravenous solution 3 mg3ml

E

ibandronate sodium oral

1 QL

MIACALCIN INJECTION

3

pamidronate disodium 1 SP


PROLIA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

2 PA SP QL

RAYALDEE 3

RECLAST 3 SP

risedronate sodium oral tablet 150 mg 35 mg

1 QL


1

risedronate sodium oral tablet delayed release

1 QL

TERIPARATIDE (RECOMBINANT)

2 PA SP

TYMLOS 2 PA SP

XGEVA 2 PA SP

zoledronic acid intravenous concentrate

1 SP

zoledronic acid intravenous solution

1 SP

Metabolic Bone Disease Agents - Other

calcitriol intravenous solution 1 mcgml

E

calcitriol oral 1

cinacalcet hcl 1 PA

doxercalciferol oral 1

NATPARA 3 PA SP QL

paricalcitol intravenous E

paricalcitol oral 1

PARSABIV 3 SP

ROCALTROL 3

SENSIPAR 3 PA

ZEMPLAR INTRAVENOUS

E

ZEMPLAR ORAL CAPSULE 1 MCG 2 MCG

3


112


Miscellaneous Therapeutic Agents

3232a infant formula E

ACACIA SUBCUTANEOUS

E

ACCU-CHEK FLEXLINK PLUS 6MM

E

ACCU-CHEK TENDER 1 INFUSION

E

ACCU-CHEK ULTRAFLEX INF SET

E

ACREMONIUM E

ACTHREL 3 SP

ACTIFOAM COLLAGEN SPONGE

E

ACUNOL E

ADAKVEO 3 PA SP

ADULT AEROSOL MASK

E

AERIVA CONCENTRATOR NEBULIZER

E

ALCOHOL PREP PADS PAD

3

ALCOHOL PREP PADS PAD 70

3

ALDER E

ALTERNARIA E

AMERICAN BEECH E

AMERICAN COCKROACH

E

AMERICAN ELM E

AMERICAN SYCAMORE

E

AMINOPMRMS E

ANDEXXA INTRAVENOUS SOLUTION RECONSTITUTED 200 MG

E


ANTIVENIN LATRODECTUS MACTANS

E

ANTIVENIN MICRURUS FULVIUS INTRAVENOUS

E

APP SLIM RMS E

APPTRIM E

APPTRIM-D E

ARIDOL INHALATION KIT 0 amp 5 amp 10 amp 20 amp 40 MG

E

ARIZONA CYPRESS E

ARTISS EXTERNAL SOLUTION

3

asilnasalrms E

ASPARTAME E

ASPARTAME (NUTRASWEET)

E

AUREOBASIDIUM E

AUSTRALIAN PINE E

AUTOSOFT 30 INFUSION SET

E


E

AUTOSOFT XC INFUSION SET

E

AVAILNEX E

AVITENE E

AVITENE FLOUR E

AXONA E

AZALGIA E

BAHIA E

BALD CYPRESS E

BAYBERRY (WAX MYRTLE)

E

BERMUDA GRASS SUBCUTANEOUS

E

BHI URI-CONTROL E


113


BLACK WALNUT POLLEN

E

BLACK WILLOW E

BOTOX 2PA Non-Cosmetic SP

BOTRYTIS SUBCUTANEOUS

E

BOX ELDER E

BREATHE EASE HUMIDIFIER

E

BREATHE EASE NEB MASKCHILD

E

BREATHE EASE NEB MASKINFANT

E

BRIDION INTRAVENOUS SOLUTION 500 MG5ML

E

BRIDION SOLUTION 200 MG2ML INTRAVENOUS

E

BROME E

CALIFORNIA PEPPER TREE

E

CAMINO PRO COMPLETEGLYTACTIN

E

CANDIDA ALBICANS EXTRACT SUBCUTANEOUS

E

CARDIOVID PLUS E

CARETOUCH 2 CPAP HOSE HANGER

E

CARETOUCH CPAP amp BIPAP HOSE

E

CARETOUCH CPAP MASK WIPES

E

CARETOUCH CPAP PRE-WASH SOLN

E

CARETOUCH CPAP TUBE BRUSH

E


CARETOUCH UNIVERSL CPAP FILTER

E

CARTICEL E

CAT HAIR EXTRACT SUBCUTANEOUS

E

CATTLE EPITHELIUM E

CAYA $0 QL

CEDAR ELM E

CLADOSPORIUM CLADOSPORIOIDES SUBCUTANEOUS

E

CLADOSPORIUM SPHAEROSPERMUM

E

COCKLEBUR E

coenzyme q10 oral capsule 50 mg

E

COLCIGEL E

COLD-EEZE NATURAL MULTI-SYMP MOUTHTHROAT

E

COLD-EEZE PLUS DEFENSE MOUTHTHROAT

E

COLD-EEZE SUGAR FREE MOUTHTHROAT LOZENGE

E

CONDOMS E

CORN POLLEN E

CORTROSYN E

cosyntropin injection E

CROFAB E

CURVULARIA E

DANDELION E

deferoxamine mesylate E

DELTEC COZMO CLEO SET 24 6MM

E


114


DESFERAL INJECTION SOLUTION RECONSTITUTED 500 MG

E

desflurane 1

dexmedetomidine hcl in nacl intravenous solution 200-09 mcg50ml- 400-09

E

dexmedetomidine hcl in nacl solution 200 mcg50ml intravenous

E


E


E

dexmedetomidine hcl intravenous solution 200 mcg2ml

E

DIGIFAB E

DOG EPITHELIUM E

DOG FENNEL E

DOJOLVI E

DRECHSLERA E

DUROLANE INTRA-ARTICULAR

2 PA SP

DUST MITE MIXED ALLERGEN EXT SUBCUTANEOUS

E

DYSPORT 3 PA SP

EASIVENT 2

EASTERN COTTONWOOD

E

EC-RX DHEA E

ECZEMOL E

ENDARI 3 PA

ENDO AVITENE E


ENFAGROW NEUROPRO TODDLER

E

ENFAMIL GENTLEASE ORAL POWDER

E

ENFAMIL INFANT ORAL POWDER

E

ENFAMIL NEUROPRO SENSITIVE

E

ENFAMIL NUTRAMIGEN LIPIL ORAL LIQUID

E

ENFAMIL NUTRAMIGEN LIPIL ORAL POWDER

E

ENFAMIL NUTRAMIGEN ORAL LIQUID

E

ENGLISH PLANTAIN E

ENLYTE E

enovarx-amitriptyline E

ENTERAGAM E

enteric fish oil E

EPICOCCUM E

EPISIL E

EQUACARE JR E

ergoloid mesylates oral 1

ESSENTIAL CARE JR E

EUFLEXXA INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

2 PA SP

EVRYSDI E SP

FIRDAPSE E SP

FIRE ANT E

FLEXICHAMBER ADULT MASKSMALL

2

FLEXICHAMBER CHILD MASKLARGE

2


115


FLEXICHAMBER CHILD MASKSMALL

2

FORANE 3

formaldehyde external solution 10

E

FORMALDEHYDE SOLUTION 37 EXTERNAL (RX)

3


E

FOSTEUM PLUS E

FOVEX E

FUSARIUM E

GABADONE E

GELCLAIR E

GELFILM EXTERNAL E

GEL-FLOW E

GEL-FLOW NT E

GELFOAM E

GELFOAM COMPRESSED SIZE 100

E

GELFOAM DENTAL PACK SIZE 4

E

GELFOAM SPONGE E

GELFOAM SPONGE SIZE 100

E


E


E

GELFOAM-JMI POWDER

E

GELFOAM-JMI SPONGE

E

GELSYN-3 2 PA SP

GELX E

GERMAN COCKROACH

E

GIVLAARI 3 PA SP


GLEOLAN E

GLUTARALDEHYDE EXTERNAL

3

GLYTACTIN BETTERMILK 15

E

GLYTACTIN BETTERMILK DE-LITE

E

GLYTACTIN BUILD 10PE

E

GLYTACTIN BUILD 2020

E

GLYTACTIN BUILD 2020 PKU

E

GLYTACTIN BURST E

GLYTACTIN COMPLETE 10PE

E

GLYTACTIN RESTORE 10

E

GLYTACTIN RESTORE 5

E

GLYTACTIN RESTORE LITE 10

E

GLYTACTIN RESTORE LITE 10PE

E

GLYTACTIN RTD 10 LIQUID ORAL

E

GLYTACTIN RTD 15 E

GLYTACTIN RTD LITE 15 LIQUID ORAL

E

GLYTACTIN SWIRL 15PE

E

GOLDENROD E

GRASTEK 3 PA QL

H2Q ORAL POWDER E

HACKBERRY E

heparin lock flush intravenous solution 10 unitml

1

heparin sodium lock flush intravenous solution 100 unitml

1


116


HEPMED E

HIBICLENS E

HOMACTIN AA PLUS E

HOME PAP KIT E

HONEY BEE VENOM SUBCUTANEOUS SOLUTION RECONSTITUTED 1100 MCG

E

HORSE EPITHELIUM E

HUMATROPEN FOR 12MG

E

HUMATROPEN FOR 24MG

E

HUMATROPEN FOR 6MG

E

HYALGAN E SP

HYLAFEM E

HYMOVIS E SP

HYPERTENSA E

INSPIREASE RESERVOIR BAGS

2

INTERCEED E

IOSAT E

isoflurane 1

ISOVACTIN AA PLUS E

JOHNSON GRASS E

JUNE GRASS POLLEN STANDARDIZED

E

KAPOK E

KETAMINE HCL SUBLINGUAL

3

KETAMINE HCL-SODIUM CHLORIDE INTRAVENOUS SOLUTION PREFILLED SYRINGE 50-09 MG5ML-

E

KETOVIE LIQUID ORAL

E


KETOVIE PEPTIDE E

KOCHIA E

LAMBS QUARTERS E

LENSCALE E

LIMBREL E

LIMBREL250 E

LIMBREL500 E

LISTER-V E

LORMATE E

MACRILEN E

MACUTEK E

MASK VORTEX E

MEADOW FESCUE GRASS POLLEN

E

MELALEUCA E

MESQUITE E

METHACHOLINE CHLORIDE INHALATION

E

METHAVER E

methergine oral 1 QL

METHOHEXITAL SODIUM INTRAVENOUS SOLUTION PREFILLED SYRINGE 100 MG10ML

E

methylergonovine maleate oral

1 QL

METOPIRONE E

MINIMED PUMP RESERVOIR 3ML

E

MITE (D FARINAE) SUBCUTANEOUS

E

MITE (D PTERONYSSINUS) SUBCUTANEOUS

E

MIXED ASPERGILLUS E

MIXED FEATHERS E

MIXED RAGWEED E


117


MIXED VESPID VENOM PROTEIN SUBCUTANEOUS SOLUTION RECONSTITUTED 1100-1100-1100 MCG

E

MKO MELT DOSE PACK

E

mlk f1 E

mlk f2 E

mlk f3 E

mlk f4 E

MONOVISC E SP

MORCIN E

MOUNTAIN CEDAR E

MOUSE EPITHELIUM E

MUCOR SUBCUTANEOUS

E

MUCOTROL E

MUGARD E

MUGWORT E

MYOBLOC 3 PA SP

NEODOT THERMOMETER

E

NEUREPA E

NICAPRIN E

NICAZYME E

NORDIPEN 5 INJECTION DEVICE

E

odorless coated fish oil E

OLIVE TREE E

OMNIVEX E

OPTIONS CONCEPTROL

$0 QL

ORALAIR 3 PA QL

ORALAIR ADULT SAMPLE KIT

3 PA QL

ORALAIR ADULT STARTER PACK

3 PA QL


ORALAIR CHILDRENS SAMPLE KIT

3 PA QL

ORALAIR CHILDRENS STARTER PACK

3 PA QL

ORAMAGICRX E

ORCHARD GRASS POLLEN

E

ORTHOVISC INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

E SP

OXBRYTA E SP

PALFORZIA (12 MG DAILY DOSE)

E SP


E SP


E SP


E SP


E SP


E SP


E SP

PALFORZIA (300 MG MAINTENANCE)

E SP

PALFORZIA (300 MG TITRATION)

E SP


E SP


E SP


E SP

PALFORZIA INITIAL ESCALATION

E SP

PARADIGM QUICK-SET 23 9MM

E


118


PARI ALTERA NEBULIZER HANDSET

E

PARI TREK S COMBO PACK

E

PARI VORTEX ADULT MASK

E

PECAN POLLEN E

PENICILLIUM NOTATUM SUBCUTANEOUS

E

PERCURA E

PERENNIAL RYE GRASS POLLEN SUBCUTANEOUS

E

PH STRIPS E

PHENACTIN AA PLUS E

PHEXXI E

PHOMA EXIGUA E

PHOTREXA-PHOTREXA VISCOUS KIT

3

PRAXBIND E

PRECEDEX INTRAVENOUS SOLUTION 1000 MCG250ML 200 MCG2ML 200 MCG50ML 400 MCG100ML 80 MCG20ML

E

PREMIUM CONDOMS LUBRICATED

E

PRID E

PRIVET E

PRO-CRITIC E

PROFESSIONAL DNA COLLECTION

E

PROLEVA E

PROMACTIN AA PLUS 20PE

E


PRONEB ULTRA FILTER SET

E

PSORIZIDE FORTE E

PSORIZIDE ULTRA E

PULMONA E

PURAMINO DHAARA E

QUEEN PALM E

RABBIT EPITHELIUM E

RADIOGARDASE 3

RAGWITEK 3 PA QL

RAPID GEL RX E

RED BIRCH E

RED CEDAR E

RED MAPLE E

RED MULBERRY E

RED TOP GRASS POLLEN

E

RESECTISOL E

RESOURCE THICKENUP JUICE

E

RHEUMATE E

RHIZOPUS E

RIBOZEL E

ROUGH MARSH ELDER

E

ROUGH PIGWEED E

RUSSIAN THISTLE E

RUZURGI 3 PA SP

SACCHAROMYCES CEREVISIAE SUBCUTANEOUS

E

SAGEBRUSH E

SALICEPT MOUTHTHROAT SUSPENSION RECONSTITUTED

E

SENTRA AM E

SENTRA PM E

sevoflurane 1


119


SHAGBARK HICKORY E

SHARPS CONTAINER E

SHEEP SORREL E

SHORT RAGWEED POLLEN EXT

E

SILTREX E

SODIUM HYALURONATE INTRA-ARTICULAR

E SP

SORBITOL IRRIGATION

E

sorbitol-mannitol E

SORRELDOCK MIX E

SPEEDGEL RX E

SPINRAZA 3 PA SP

SPINY PIGWEED E

STEMPHYLIUM E

SUPARTZ FX E SP

SUPRANE 3

SWEET GUM E

SWEET VERNAL GRASS POLLEN

E

SYNVISC INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

E SP

SYNVISC ONE INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

E SP

SYRINGE AVITENE E

TACHOSIL 3

TALL RAGWEED E

terrell 1

THERAMINE E

THERAMINE PLUS E

THROMBI-GEL 10 E

THROMBI-GEL 100 E

THROMBI-GEL 40 E

THROMBI-PAD E


THYROGEN 2 PA SP

TIMOTHY GRASS POLLEN ALLERGEN SUBCUTANEOUS

E

TISSEEL EXTERNAL KIT

3

TL-ICARE E

TOBAKIENT E

TOXICOLOGY SALIVA COLLECTION

E

TRANZGEL E

TRAUMEEL EXTERNAL OINTMENT

E

TRAUMEEL ORAL TABLET

E

TREPADONE E

TRICHOPHYTON MENTAGROPHYTES

E

TRICHOPHYTON SUBCUTANEOUS

E

TRILURON E SP

TRUSTEEL INFUSION SET

E

T-SUPPORT MAX E

TYLACTIN BUILD 20PE TYR

E

TYLACTIN COMPLETE 15 PE

E

TYLACTIN RESTORE 10

E

TYLACTIN RESTORE 5PE

E

TYLACTIN RTD 15 E

TYROS 2 E

ULTANE 3

ULTRAFOAM SPONGE 2X625X7CM

E


E


120



E


E


E

VARISOFT INFUSION SET

E

VASCULERA E

VCF VAGINAL CONTRACEPTIVE VAGINAL FILM

$0 QL

vcf vaginal contraceptive vaginal gel

$0 QL

VILACTIN AA PLUS E

VILTEPSO E SP

VIRGINIA LIVE OAK E

VISTOGARD 3

VITRASE INJECTION SOLUTION

E

VORTEX HOLDING CHAMBERMASK

E

WASP VENOM PROTEIN SUBCUTANEOUS SOLUTION RECONSTITUTED 1100 MCG

E

WELLMIND VERTIGO E

westab max E

WESTERN JUNIPER E

WHITE ASH E

WHITE BIRCH E

WHITE FACED HORNET VENOM SUBCUTANEOUS SOLUTION RECONSTITUTED 1100 MCG

E

WHITE MULBERRY E

WHITE OAK E


WHITE PINE E

WIDE-SEAL DIAPHRAGM 60

$0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL

XEOMIN 3 PA SP

XIAFLEX 2 PA SP

XYZBAC E

XYZMUNE E

YELLOW DOCK E

YELLOW HORNET VENOM PROTEIN SUBCUTANEOUS SOLUTION RECONSTITUTED 1100 MCG

E

YELLOW JACKET VENOM PROTEIN SUBCUTANEOUS

E

ZYVEXOL E

ZYVIT E

Ophthalmic Agents - Drugs for Eye Allergy Infection and Inflammation

ACULAR 3

ACULAR LS 3

ALAWAY E

ALOCRIL E


121


ALOMIDE 3

ALREX E

AZASITE 3

azelastine hcl ophthalmic

1

bacitracin ophthalmic 1

BEPREVE 3 ST

BESIVANCE 3

BETADINE OPHTHALMIC PREP

3

BLEPH-10 3

bromfenac sodium (once-daily)

1 QL

BROMSITE E

CILOXAN 3

ciprofloxacin hcl ophthalmic

1

cromolyn sodium ophthalmic

1

dexamethasone sodium phosphate ophthalmic

1

DEXTENZA E SP

DEXYCU E

diclofenac sodium ophthalmic

1

DUREZOL E

epinastine hcl 1

erythromycin ophthalmic

1

eye itch relief E

EYSUVIS E

FLAREX 3

fluorometholone ophthalmic

1

flurbiprofen sodium 1

FML 2

FML FORTE 3

FML LIQUIFILM 3


gatifloxacin ophthalmic 1

gentak ophthalmic ointment

1

gentamicin sulfate ophthalmic solution

1

ILEVRO E

ILUVIEN INTRAVITREAL

E SP

INVELTYS 3

ketorolac tromethamine ophthalmic

1

KLARITY-A E

KLARITY-L E

levofloxacin ophthalmic 1

LOTEMAX OPHTHALMIC GEL

E

LOTEMAX OPHTHALMIC OINTMENT

E

LOTEMAX OPHTHALMIC SUSPENSION

3

LOTEMAX SM 3

loteprednol etabonate 1

MAXIDEX 3

MITOSOL 3

MOXEZA 2

moxifloxacin hcl (2x day)

1

moxifloxacin hcl ophthalmic solution

1

NATACYN 2

NEVANAC E

OCUFLOX 3

ofloxacin ophthalmic 1

olopatadine hcl solution 01 ophthalmic (otc)

E

olopatadine hcl solution 01 ophthalmic (rx)

1


122



E


1

OZURDEX INTRAVITREAL

3 SP

PATADAY E

POVIDONE-IODINE OPHTHALMIC

3

PRED FORTE 3

PRED MILD 3

PREDNISOL ACE-MOXIFLOX-BROMFEN

E

prednisolone acetate ophthalmic

1

prednisolone acetate p-f

E

prednisolone sodium phosphate ophthalmic

1

PREDNISOLON-MOXIFLOX-NEPAFENAC

E

PROLENSA 2 QL

RETISERT INTRAVITREAL

E SP

sulfacetamide sodium ophthalmic

1

tobramycin ophthalmic 1

TOBREX 3

trifluridine ophthalmic 1

TRIPLE PMB E

TRIPLE PMK E

UPNEEQ E

VIGAMOX 3

YUTIQ E SP

ZADITOR E

ZERVIATE E

ZIRGAN 3

ZYMAXID 3


Ophthalmic Agents - Drugs for Glaucoma

acetazolamide er 1

acetazolamide oral 1

ALPHAGAN P OPHTHALMIC SOLUTION 01

2


E

apraclonidine hcl 1

AZOPT 2

betaxolol hcl ophthalmic

1

BETIMOL 3

BETOPTIC-S 3

bimatoprost ophthalmic 1 QL

brimonidine tartrate ophthalmic

1

BRIMONIDINE-DORZOLAMIDE

E

carteolol hcl 1

COMBIGAN 2

COSOPT 3

COSOPT PF OPHTHALMIC SOLUTION 2-05

3

DORZOLAMIDE HCL SOLUTION 2 OPHTHALMIC

3

dorzolamide hcl solution 2 ophthalmic

1

dorzolamide hcl-timolol mal

1

dorzolamide hcl-timolol mal pf

1

DURYSTA E

IOPIDINE OPHTHALMIC SOLUTION 1

3

ISOPTO CARPINE 3


123


ISTALOL 3

KEVEYIS 3 PA SP QL

latanoprost ophthalmic 1

LATANOPROST-TIMOLOL MALEATE

E

levobunolol hcl ophthalmic solution 05

1

LUMIGAN OPHTHALMIC SOLUTION 001

2 QL

methazolamide oral 1

PHOSPHOLINE IODIDE

2

pilocarpine hcl ophthalmic solution 1 2 4

1

RHOPRESSA 3 QL

ROCKLATAN 3 QL

SIMBRINZA 2

timolol maleate ophthalmic

1

timolol maleate pf 1

TIMOLOL-BRIMON-DORZOL-LATANOPR

E

TIMOLOL-BRIMONIDINE-DORZOLAMID

E

TIMOLOL-DORZOLAMID-LATANOPROST

E

TIMOPTIC E

TIMOPTIC OCUDOSE OPHTHALMIC SOLUTION 025

3


E

TIMOPTIC-XE E

TRAVATAN Z 3 QL

travoprost (bak free) 1 QL


TRUSOPT 3

VYZULTA E

XALATAN 3

XELPROS 3 ST QL

ZIOPTAN E

Ophthalmic Agents - Drugs for Miscellaneous Eye Conditions

ak-poly-bac 1

AKTEN 3

ALCAINE 3

altacaine 1

altachlore E

altafluor benox E

altafrin ophthalmic solution 10 25

1

artificial tears ophthalmic solution 05-06 14

E

atropine sulfate ophthalmic ointment

1

ATROPINE SULFATE OPHTHALMIC SOLUTION 001

E

atropine sulfate ophthalmic solution 1

1

bacitracin-polymyxin b ophthalmic ointment 500-10000 unitgm

1

bacitra-neomycin-polymyxin-hc

1

BEOVU E SP

BEVACIZUMAB 3 SP

bimatoprost external E

bio glo E

BLEPHAMIDE 3

BLEPHAMIDE SOP 3

CEQUA E


124


CHONDROITIN SULFATE OPHTHALMIC

E

cvs lubricant eye drops ophthalmic solution 04-03

E

CYCLOGYL 3

CYCLOMYDRIL 3

cyclopentolate hcl ophthalmic

1

CYCLOSPORINE IN KLARITY

E

CYSTADROPS E SP

CYSTARAN 3 PA SP QL

DOUBLE PM E

EYLEA INTRAVITREAL

3 PA SP

flucaine E

fluorescein-benoxinate E

fluor-i-strips at E

FLURA-SAFE E

FUL-GLO OPHTHALMIC STRIP 06 MG

E

ful-glo ophthalmic strip 1 mg

E

GELFILM OPHTHALMIC

E

GENTEAL TEARS NIGHT-TIME

E

GENTEAL TEARS OPHTHALMIC SOLUTION 01-03

E

glostrips ophthalmic strip 1 mg

E

green glo lissamine green

E

homatropaire 1

HYPOCYN EXTERNAL SOLUTION

E

ISOPTO ATROPINE 3


LACRISERT 3

LASTACAFT 3 ST

LATISSE E

lissamine green E

lubricant eye drops ophthalmic solution 04-03

E

lubricant eye drops pf E

lubricant eye pm E

lubricant pm E

lubricating eye drops E

lubricating plus eye drops

E

LUCENTIS INTRAVITREAL

2 PA SP

LUXTURNA INTRAOCULAR SUSPENSION 5000000000000 VGML

3 PA SP

MAXITROL 3

MEMBRANEBLUE 3

MURO 128 OPHTHALMIC OINTMENT

E

MURO 128 OPHTHALMIC SOLUTION 5

E

MYDRIACYL E

neomycin-bacitracin zn-polymyx

1

neomycin-polymyxin-dexameth ophthalmic ointment

1

neomycin-polymyxin-dexameth ophthalmic suspension 35-10000-01

1

neomycin-polymyxin-gramicidin ophthalmic solution 175-10000-025

1


125


neomycin-polymyxin-hc ophthalmic suspension 35-10000-1

1

neo-polycin 1

neo-polycin hc 1

OXERVATE 3 PA SP QL

PAREMYD E

phenylephrine hcl ophthalmic solution 10 25

1

polycin 1

polymyxin b-trimethoprim

1

POLYTRIM 3

PRED-G 3

PRED-G SOP 3

PREDNISOLONE ACETATE-NEPAFENAC

E

PREDNISOLONE ACET-MOXIFLOXACIN

E

PREDNISOLONE-BROMFENAC

E

PREDNISOLONE-GATIFLOXACIN OPHTHALMIC SUSPENSION

E

PREDNISOLONE-MOXIFLOXACIN

E

PREDNISOLON-GATIFLOX-BROMFENAC

E

PREDNISOLON-MOXIFLOX-BROMFENAC OPHTHALMIC SOLUTION 1-05-0075

E

proparacaine hcl ophthalmic

1

proparacaine-fluorescein

E


REFRESH RELIEVA E

REFRESH RELIEVA PF OPHTHALMIC SOLUTION 05-09

E

RESTASIS 2 PA

RESTASIS MULTIDOSE OPHTHALMIC EMULSION 005

2 PA

ROSE GLO E

sodium chloride (hypertonic)

E

sulfacetamide-prednisolone ophthalmic solution

1

SYSTANE COMPLETE E

SYSTANE HYDRATION PF

E

SYSTANE ULTRA PF E

tetracaine hcl ophthalmic

1

TOBRADEX OPHTHALMIC OINTMENT

3

TOBRADEX OPHTHALMIC SUSPENSION

E

TOBRADEX ST 3

tobramycin-dexamethasone

1

tropicamide ophthalmic E

TROPICAMIDE-CYCLOPENTOLATE-PE

E

TROPICAMIDE-PHENYLEPHRINE

E

TROPIC-CYCLOPENT-PE-KETOROLAC

E

TROPIC-CYCLOP-PE-KETO-PROPAR

E


126


TROPIC-PROPARACA-PE-KETOROLAC

E

ultra fresh pm E

ultra lubricating eye drops

E

VISIONBLUE 3

VISUDYNE 3 SP

XIIDRA 2 PA

ZYLET 3

Otic Agents - Drugs for Ear Conditions

acetic acid otic 1

CETRAXAL 3 ST

CIPRO HC 3

CIPRODEX 2

ciprofloxacin hcl otic 1 ST

ciprofloxacin-dexamethasone

1

CIPROFLOXACIN-FLUOCINOLONE PF

E

cortic-nd 1

DERMOTIC 3

exotic-hc 1

flac 1

fluocinolone acetonide otic

1

hydrocortisone-acetic acid

1

neomycin-polymyxin-hc otic

1

ofloxacin otic 1

OTICIN HC NR 3

OTIPRIO E

OTOVEL E

PRAMOTIC 3


Respiratory Tract Pulmonary Agents - Drugs for Allergies Cough Cold

12 hour allergy-d E

12 hour nasal decongestant nasal

E

12hr allergy amp congestion

E

24hr allergy relief E

ADRENALIN NASAL E

all day allergy d E

all day allergy d-12 E

allergy 24hour indooroutdoor

E

allergy 24-hr E

allergy childrens E

allergy rel child (loratadine)

E

allergy relief cetirizine E

allergy relief childrens oral liquid

E

allergy relief d-12 E

allergy relief oral capsule 10 mg

E

allergy relief oral tablet 10 mg 180 mg 25 mg 4 mg

E

allergy relief oral tablet dispersible

E

allergy reliefindooroutdoor

E

allergy reliefnasal decongest oral tablet extended release 12 hour

E

allergy relief-d oral tablet extended release 12 hour

E

ALZAIR ALLERGY NASAL SPRAY

E


127


antihistamine amp nasal deconges

E

aurodryl allergy childrens

E

azelastine hcl nasal 1 QL

azelastine-fluticasone 1 QL

banophen oral capsule 25 mg

E

banophen oral tablet E

BECONASE AQ 3 QL

benzonatate 1

bromfed dm 1

carbinoxamine maleate oral solution

1

carbinoxamine maleate oral tablet 4 mg

1


E

cetirizine hcl childrens oral tablet chewable 5 mg

E

cetirizine hcl oral solution

1

cetirizine hcl oral tablet E

cetirizine hcl oral tablet chewable 10 mg

E

chest congestion relief dm oral syrup

E

chest congestion relief oral syrup

E

chlorpheniramine maleate er

E

CHLOR-TRIMETON ORAL TABLET

E

CINQAIR 3 PA SP

CLARINEX ORAL TABLET

E

CLARINEX-D 12 HOUR

E

CLARITIN ORAL TABLET

E


CLARITIN REDITABS ORAL TABLET DISPERSIBLE 10 MG

E

CLARITIN-D 12 HOUR E

clemastine fumarate oral tablet 268 mg

1

cold amp flu relief daytime E

coldflu daytime relief E

cough dm oral suspension extended release

E

coughchest congestion dm

E

CUROSURF INTRATRACHEAL SUSPENSION 120 MG15ML

3

cyproheptadine hcl oral 1

dayhist allergy 12 hour relief

E

daytime cold amp flu relief oral capsule

E

daytime coldflu relief oral capsule

E

DERMACINRX AZENASE PAK

E

DERMACINRX TICANASE PAK

E

desloratadine oral tablet

1

desloratadine oral tablet dispersible 5 mg

1

dexchlorpheniramine maleate oral solution

E

DICOPANOL FUSEPAQ

E

DICOPANOL RAPIDPAQ

E

dimaphen dm coldcough oral liquid

E

DI-PHEN E

diphen oral elixir 1


128


diphenhydramine hcl injection

E

diphenhydramine hcl oral capsule

E

diphenhydramine hcl oral elixir

1

diphenhydramine hcl oral liquid 125 mg5ml

E

diphenhydramine hcl oral tablet 25 mg

E

DYMISTA 2 QL

epinephrine hcl (nasal) E

FASENRA 2 PA SP

FASENRA PEN 2 PA SP

fexofenadine hcl oral tablet 180 mg 60 mg

E

fexofenadine-pseudoephed er oral tablet extended release 12 hour

E

flunisolide nasal solution 25 mcgact (0025)

1 QL

fluticasone propionate nasal

1

geri-dryl oral liquid E

geri-dryl oral tablet E

GILPHEX TR E

GILTUSS TR ORAL TABLET

E

goodsense tussin dm max

E

guaiatussin ac 1 PA QL

guaifenesin ac 1 PA QL

guaifenesin oral tablet 400 mg

E

guaifenesin-dm oral syrup

E

hm adult tussin cough amp chest

E

hm loratadine E


HYCODAN 3 PA QL

hydrocodone polst-chlorphen polst er susp oral suspension extended release

1 PA QL

hydrocodone-homatropine

1 PA QL

hydromet 1 PA QL

HYPERSAL 3

INFASURF INTRATRACHEAL

3

ipratropium bromide nasal

1

KARBINAL ER ORAL SUSPENSION EXTENDED RELEASE

E

levocetirizine dihydrochloride oral

1

loratadine oral syrup E

loratadine oral tablet E

loratadine-d 12hr E

loratadine-d 24hr E

maxi-tuss ac 1 PA QL

maxi-tuss gmx E

maxi-tuss pe max E

m-dryl E

MICLARA LQ E

mometasone furoate nasal

1 QL

MUCINEX CHILDRENS FREEFROM ORAL LIQUID 5-100 MG5ML

E

MUCINEX CHILDRENS STUFFY NOSE

E

MUCINEX DM E

MUCINEX FAST-MAX DM MAX

E

mucus dm E


129


mucus relief d oral tablet extended release 12 hour

E

mucus relief dm oral liquid

E

mucus relief max st E

mucus-d E

mucus-er max E

NASACORT ALLERGY 24HR

E

nasal decongestant oral tablet 30 mg

E

nasal decongestant pe E

nasal moisturizing spray

E

nasal spray 12 hour E

nasal spray no drip E

NASONEX E

NEO-SYNEPHRINE COLDALLRG MILD

E

NEO-SYNEPHRINE COLDALLRGY EXT

E

NEO-SYNEPHRINE COLDALLRGY REG

E

NEOTUSS PLUS E

NUCALA 2 PA SP QL

olopatadine hcl nasal 1 QL

OMNARIS 3 QL

PATANASE 3 QL

pediaclear pd childrens E

PHENERGAN INJECTION

E

promethazine hcl injection

E

promethazine hcl oral 1

promethazine hcl rectal suppository 125 mg 25 mg

1

promethazine-codeine 1 PA QL


promethazine-dm oral syrup

1

promethazine-phenyleph-codeine

1 PA QL

promethazine-phenylephrine

1

promethegan 1

PROPEL E

PROPEL MINI E

pseudoephedrine hcl er E

pseudoephedrine-bromphen-dm oral syrup 30-2-10 mg5ml

1

pseudoephedrine-guaifenesin er

E

QNASL 3 QL

QNASL CHILDRENS 3 QL

ROBITUSSIN 12 HOUR COUGH CHILD

E

ROBITUSSIN COUGH+CHEST CONG DM ORAL LIQUID 20-400 MG20ML

E

RYCLORA ORAL SOLUTION

3

ryvent E

SEMPREX-D E

sinus 12 hour E

SINUVA 3

sodium chloride inhalation nebulization solution 09 10 3 7

1

SSKI E

SUDAFED CONGESTION

E

sudogest 12 hour E

sudogest maximum strength

E


130


sudogest oral tablet 30 mg

E

SURVANTA INTRATRACHEAL

3

TESSALON PERLES 3

triprolidine hcl oral liquid 0313 mgml 0625 mgml 0938 mgml 25 mg5ml

E

TUSSICAPS ORAL CAPSULE EXTENDED RELEASE 12 HOUR 10-8 MG

E

tussin cf multi-symptom cold

E

tussin dm max adult E

tussin dm max oral liquid 20-400 mg20ml

E

tussin dm oral syrup 100-10 mg5ml

E

TUXARIN ER E

TUZISTRA XR ORAL SUSPENSION EXTENDED RELEASE

E

virtussin ac walc 1 PA QL

wal-tap coldallergy oral elixir

E

wal-zyr oral tablet E

XHANCE E

XOLAIR 2 PA SP

ZETONNA 3 QL

ZYRTEC ALLERGY ORAL TABLET

E

Respiratory Tract Pulmonary Agents - Drugs for Asthma and Other Lung Conditions

ACCOLATE 3

acetylcysteine inhalation

1


ADRENALIN INJECTION SOLUTION 1 MGML

3

ADVAIR DISKUS 1 QL

ADVAIR HFA 2 QL

ADYPHREN E

ADYPHREN AMP E

ADYPHREN AMP II E

ADYPHREN II E

AIRDUO DIGIHALER E

AIRDUO RESPICLICK 11314

E


E


E

albuterol sulfate er 1

albuterol sulfate hfa aerosol solution 108 (90 base) mcgact inhalation

1 QL

ALBUTEROL SULFATE HFA AEROSOL SOLUTION 108 (90 BASE) MCGACT INHALATION

E

albuterol sulfate inhalation nebulization solution (25 mg3ml) 0083 063 mg3ml 125 mg3ml 25 mg05ml

1 QL

ALBUTEROL SULFATE NEBULIZATION SOLUTION (5 MGML) 05 INHALATION

E

albuterol sulfate nebulization solution (5 mgml) 05 inhalation

1 QL

albuterol sulfate oral 1

ALVESCO E


131


ANORO ELLIPTA 2 QL

ARALAST NP INTRAVENOUS SOLUTION RECONSTITUTED 1000 MG 500 MG

3 PA SP

ARCAPTA NEOHALER 3 ST

ARMONAIR DIGIHALER

E

ARNUITY ELLIPTA 2 QL

ASMANEX (120 METERED DOSES)

E


E


E


E


E

ASMANEX HFA E

ATROVENT HFA 3 QL

AUVI-Q INJECTION SOLUTION AUTO-INJECTOR 01 MG01ML

3 QL

AUVI-Q INJECTION SOLUTION AUTO-INJECTOR 015 MG015ML 03 MG03ML

E

BEVESPI AEROSPHERE

E

BREO ELLIPTA 2 QL

BREZTRI AEROSPHERE

E

BROVANA 3 QL

budesonide inhalation 1 QL

BUDESONIDE-FORMOTEROL FUMARATE

E


COMBIVENT RESPIMAT

2 QL

cromolyn sodium inhalation

1

DALIRESP 3 PA

difil-g forte 1

DUAKLIR PRESSAIR E

DULERA E

ELIXOPHYLLIN 2

epinephrine injection solution auto-injector 015 mg015ml

1 ST


1

EPINEPHRINE PROFESSIONAL

E

epinephrine solution auto-injector 03 mg03ml injection

1 ST


1

EPINEPHRINESNAP-EMS

E

EPINEPHRINESNAP-V E

EPIPEN 2-PAK INJECTION SOLUTION AUTO-INJECTOR

3 ST

EPIPEN JR 2-PAK INJECTION SOLUTION AUTO-INJECTOR

E

EPISNAP E

ESBRIET 3 PA SP

FLOVENT DISKUS 2 QL

FLOVENT HFA 2 QL


132


fluticasone-salmeterol inhalation aerosol powder breath activated 100-50 mcgdose 250-50 mcgdose 500-50 mcgdose

E

FLUTICASONE-SALMETEROL INHALATION AEROSOL POWDER BREATH ACTIVATED 113-14 MCGACT 232-14 MCGACT 55-14 MCGACT

1 ST QL

GLASSIA 3 PA SP

INCRUSE ELLIPTA E

ipratropium bromide inhalation

1 QL

ipratropium-albuterol 1 QL

levalbuterol hcl inhalation nebulization solution 031 mg3ml 063 mg3ml 125 mg05ml 125 mg3ml

1 QL

LEVALBUTEROL HFA INHALATION AEROSOL 45 MCGACT

E

LONHALA MAGNAIR REFILL KIT

3 QL

LONHALA MAGNAIR STARTER KIT

3 QL

montelukast sodium oral

1

OFEV 3 PA SP

PERFOROMIST 3 QL

PROAIR DIGIHALER E

PROAIR HFA E

PROAIR RESPICLICK E

PROLASTIN-C INTRAVENOUS SOLUTION

3 PA SP


PROLASTIN-C INTRAVENOUS SOLUTION RECONSTITUTED 1000 MG

3 PA SP

PROVENTIL HFA E

PULMICORT FLEXHALER

2 QL

PULMICORT SUSPENSION

E

QVAR REDIHALER E

SEEBRI NEOHALER E

SEREVENT DISKUS 2 QL

SINGULAIR E

SPIRIVA HANDIHALER

2 QL

SPIRIVA RESPIMAT INHALATION AEROSOL SOLUTION 125 MCGACT 25 MCGACT

2 QL

STERITALC 3

STIOLTO RESPIMAT INHALATION AEROSOL SOLUTION 25-25 MCGACT

2 QL

STRIVERDI RESPIMAT

2 ST QL

SYMBICORT 2 QL

SYMJEPI 3

terbutaline sulfate injection

E

terbutaline sulfate oral 1

THEO-24 3

theophylline 1

theophylline er oral tablet extended release 12 hour 300 mg 450 mg

1

theophylline er oral tablet extended release 24 hour

1


133

INHALATION AEROSOL POWDER BREATH ACTIVATED 400 MCGACT

E

UTIBRON NEOHALER E

VENTOLIN HFA E

wixela inhub E

XOPENEX NEB 3 QL

XOPENEX CONCENTRATE

3 QL

XOPENEX HFA E

YUPELRI 3 QL

zafirlukast 1

ZEMAIRA 3 PA SP

zileuton er 1 ST

ZYFLO E

Respiratory Tract Pulmonary Agents - Drugs for Cystic Fibrosis

BETHKIS 2 SP

CAYSTON 3 PA SP

KALYDECO 3 PA SP

KITABIS PAK E SP

ORKAMBI 3 PA SP QL

PULMOZYME 2 PA SP

SYMDEKO 3 PA SP QL

TOBI NEBULIZER E SP

TOBI PODHALER 3 ST SP QL

tobramycin inhalation nebulization solution 300 mg4ml

1 SP

tobramycin nebulization solution 300 mg5ml inhalation

E SP

TOBRAMYCIN NEBULIZATION SOLUTION 300 MG5ML INHALATION

E SP


TRIKAFTA 3 PA SP QL

Respiratory Tract Pulmonary Agents - Drugs for Pulmonary Hypertension

ADCIRCA 3 PA SP QL

ADEMPAS 2 PA SP QL

alyq 1 PA SP QL

ambrisentan 1 PA SP QL

bosentan 1 PA SP QL

epoprostenol sodium 1 PA SP

FLOLAN 3 PA SP

LETAIRIS 3 PA SP QL

OPSUMIT 2 PA SP QL

ORENITRAM 3 PA SP

REMODULIN INJECTION SOLUTION 100 MG20ML 20 MG20ML 200 MG20ML 50 MG20ML

E SP

REVATIO INTRAVENOUS

3 PA SP

REVATIO ORAL 3 PA SP QL

sildenafil citrate intravenous

1 PA SP

sildenafil citrate oral suspension reconstituted

1 PA SP QL

sildenafil citrate oral tablet 20 mg

1 PA SP QL

tadalafil (pah) 1 PA SP QL

TRACLEER 625 MG 125 MG

E SP

TRACLEER 32 MG 3 PA SP QL

treprostinil 1 PA SP

TYVASO 3 PA SP QL

TYVASO REFILL 3 PA SP QL

TYVASO STARTER 3 PA SP QL

UPTRAVI 3 PA SP QL


134


TRELEGY ELLIPTA 2 QL

TUDORZA PRESSAIR


VELETRI 3 PA SP

VENTAVIS 3 PA SP QL

Skeletal Muscle Relaxants - Drugs for Muscle Pain and Spasm

active-cyclobenzaprine E

AMRIX E

BACLOFEN EXTERNAL

E

baclofen intrathecal E

baclofen oral 1

carisoprodol oral 1

chlorzoxazone oral tablet 250 mg

1 QL

chlorzoxazone oral tablet 375 mg 500 mg 750 mg

1

CYCLOGABA 10300 E

cyclobenzaprine hcl er 1

cyclobenzaprine hcl oral tablet 5 mg 75 mg

1

cyclobenzaprine hcl tablet 10 mg oral

1


E

CYCLOPAK 3

CYCLOPHENE RAPIDPAQ

E

DANTRIUM ORAL CAPSULE 25 MG 50 MG

3

dantrolene sodium oral 1

enovarx-baclofen E

enovarx-cyclobenzaprine hcl

E

FEXMID 3

FIRST-BACLOFEN E


GABLOFEN INTRATHECAL SOLUTION 10000 MCG20ML 20000 MCG20ML 40000 MCG20ML

E

GABLOFEN INTRATHECAL SOLUTION PREFILLED SYRINGE 10000 MCG20ML 20000 MCG20ML 40000 MCG20ML 50 MCGML

E

LIORESAL E

LORZONE 3

METAXALL CP E

metaxalone 1

methocarbamol oral 1

NOPIOID-LMC KIT E

NORGESIC FORTE E

orphenadrine citrate er 1

orphenadrine-asa-caffeine

1

ORPHENGESIC FORTE ORAL TABLET 50-770-60 MG

E

OZOBAX E

ROBAXIN-750 3

SKELAXIN E

SOMA 3

TABRADOL FUSEPAQ E

TABRADOL RAPIDPAQ

E

tizanidine hcl oral 1

VANADOM 3

ZANAFLEX E

Sleep Disorder Agents

AMBIEN E

AMBIEN CR E


135


armodafinil 1 PA QL

BELSOMRA 3 ST QL

DAYVIGO 3 ST QL

doxepin hcl oral tablet 1 QL

EDLUAR E

eszopiclone 1 QL

flurazepam hcl 1 PA QL

HETLIOZ 3 PA SP QL

INTERMEZZO SUBLINGUAL TABLET SUBLINGUAL 175 MG

3 QL

LUNESTA E

modafinil 1 PA QL

NUVIGIL E

PROVIGIL E

ramelteon 1 QL

RESTORIL E

ROZEREM 3 QL

SILENOR 3 QL

sleep aid (diphenhydramine)

E

sleep-aid oral capsule E

SUNOSI 2 PA QL

temazepam 1 QL

WAKIX 3 PA SP QL

XYREM 3 PA SP QL

XYWAV E SP

zaleplon 1 QL

zolpidem tartrate 1 QL

zolpidem tartrate er 1 QL

ZOLPIMIST 3 ST QL


136

Index of Drugs

12 hour allergy-d 12712 hour nasal decongestant12712hr allergy amp congestion 1271ST MEDX-PATCH LIDOCAINE1724hr allergy relief 1273232a infant formula 1137T LIDO 178 hour pain reliever 98 hr arthritis pain relief 9AAGC KIT IN TERODERM 60abacavir sulfate44abacavir sulfate-lamivudine 44abacavir-lamivudine-zidovudine44ABANEU-SL77ABILIFY43ABILIFY MAINTENA 43ABILIFY MYCITE 43abiraterone acetate 35ABRAXANE 35ABREVA 60ABSORICA 60ABSORICA LD60ACACIA113acamprosate calcium 20ACANYA 60acarbose 72ACCOLATE131ACCUCAINE17ACCU-CHEK AVIVA CONNECT KIT WDEVICE73ACCU-CHEK AVIVA DEVICE73ACCU-CHEK AVIVA PLUS KIT WDEVICE73ACCU-CHEK COMPACT PLUS CARE KIT 73ACCU-CHEK COMPACT PLUS CONTROL 73ACCU-CHEK COMPACT PLUS TEST STRIPS 73ACCU-CHEK FASTCLIX LANCET KIT 73ACCU-CHEK FLEXLINK PLUS 6MM 113ACCU-CHEK GUIDE CONTROL 73ACCU-CHEK GUIDE KIT WDEVICE 73ACCU-CHEK MULTICLIX LANCET DEVICE KIT73ACCU-CHEK NANO SMARTVIEW KIT WDEVICE73

ACCU-CHEK SMARTVIEW CONTROL 74ACCU-CHEK SMARTVIEW TEST STRIPS74ACCU-CHEK SOFTCLIX LANCET DEVICE KIT74ACCU-CHEK TENDER 1 INFUSION113ACCU-CHEK ULTRAFLEX INF SET 113ACCUPRIL50ACCURETIC 50ACD-A NOCLOT-5025acebutolol hcl 50ACESO AG 60acetaminophen 9acetaminophen 8 hour 9acetaminophen childrens 9acetaminophen er 9acetaminophen extra strength 9acetaminophen-codeine9acetaminophen-codeine 29acetaminophen-codeine 39acetaminophen-codeine 49acetazolamide123acetazolamide er123acetic acid 127acetylcysteine 131acid reducer 86ACIPHEX 86ACIPHEX SPRINKLE 86acitretin 60ACREMONIUM 113ACTEMRA 105ACTEMRA ACTPEN106ACTHAR 98ACTHIB109ACTHREL 113ACTICLATE 20ACTIFOAM COLLAGEN SPONGE113ACTIGALL87ACTIMMUNE 106ACTIPHLORA 87ACTIQ 9ACTITROM-D 77ACTIVASE 26active fe77ACTIVE INJECTION D 95ACTIVE INJECTION KIT L 95ACTIVE INJECTION KL-3 95ACTIVE INJECTION LM-217

ACTIVE INJECTION LM-DEP-2 95active-cyclobenzaprine 135ACTIVE-KETOPROFEN 14ACTIVELLA100ACTIVE-PREP KIT I 14ACTIVE-PREP KIT II 14ACTIVE-PREP KIT III 14ACTIVE-PREP KIT IV 60ACTIVE-PREP KIT V 31active-tramadol 60ACTIVITE77ACTONEL 112ACTOPLUS MET 72ACTOS72ACULAR 121ACULAR LS 121ACUNOL 113acyclovir 44ACZONE 60ADACEL109ADAKVEO113ADALAT CC50adapalene 60ADAPALENE 60ADAPALENE-BENZOYL PER-CLINDAMY 60ADAPALENE-BENZOYL PER-NIACINAM 60adapalene-benzoyl peroxide60ADASUVE43adcf (05mgml) 77ADCETRIS35ADCIRCA134ADDERALL 56ADDERALL XR 56ADDYI 58adefovir dipivoxil 44ADEMPAS 134ADHANSIA XR56ADIPEX-P 58ADLYXIN72ADLYXIN STARTER PACK 72ADMELOG 75ADMELOG SOLOSTAR 75ADRENAL C FORMULA77ADRENALIN 127 131adriamycin35ADULT AEROSOL MASK113adult aspirin regimen14ADVAIR DISKUS 131ADVAIR HFA 131

137

ADVANCED ALLERGY COLLECTION 60ADVATE48ADVIL14ADVIL JUNIOR STRENGTH 14ADVIL LIQUI-GELS MINIS 14ADVIL MIGRAINE14ADYNOVATE48ADYPHREN 131ADYPHREN AMP 131ADYPHREN AMP II 131ADYPHREN II 131ADZENYS ER 56ADZENYS XR-ODT 56AEMCOLO 20AERIVA CONCENTRATOR NEBULIZER113AFINITOR 35AFINITOR DISPERZ35afirmelle 100AFLURIA QUADRIVALENT109AFREZZA76AFSTYLA 48AGONEAZE 17AGRYLIN 48aif 2 drug preparation kit 14AIF 3 DRUG PREPARATION KIT 14AIMOVIG34airavite 77AIRDUO DIGIHALER131AIRDUO RESPICLICK 11314131AIRDUO RESPICLICK 23214131AIRDUO RESPICLICK 5514131AJOVY 34AKLIEF60AKOVAZ 50ak-poly-bac 124AKTEN 124AKYNZEO30ALA SCALP 60ala-cort 60ala-quin 31ALAWAY 121albendazole41ALBENZA41albuterol sulfate131ALBUTEROL SULFATE 131albuterol sulfate er 131albuterol sulfate hfa131ALBUTEROL SULFATE HFA 131ALCAINE124alclometasone dipropionate 60

ALCOHOL PREP PADS 61 113ALCORTIN A 31ALDACTAZIDE 50ALDACTONE 50ALDARA61ALDER 113ALDURAZYME 92ALECENSA35alendronate sodium 112ALEVAMAX61ALEVE 14ALFERON N 106alfuzosin hcl er 95ALIMTA 35ALINIA41ALIQOPA 35aliskiren fumarate50ALKERAN 35ALKINDI SPRINKLE 95all day allergy d 127all day allergy d-12127allergy 24hour indooroutdoor 127allergy 24-hr 127allergy childrens 127allergy rel child (loratadine)127allergy relief127allergy relief cetirizine 127allergy relief childrens 127allergy relief d-12 127allergy reliefindooroutdoor 127allergy reliefnasal decongest 127allergy relief-d 127allopurinol34ALLZITAL9almotriptan malate 34ALOCRIL121ALOE VESTA CLEAR ANTIFUNGAL 31ALOGLIPTIN BENZOATE 72ALOGLIPTIN-METFORMIN HCL72ALOGLIPTIN-PIOGLITAZONE 72ALOMIDE122ALORA100alosetron hcl87ALOXI 30ALPHAGAN P 123ALPHANATEVWF COMPLEXHUMAN 48ALPHANINE SD48alprazolam 47alprazolam er 47alprazolam intensol 47

alprazolam xr 47ALPROLIX 48ALREX 122ALTABAX20altacaine124ALTACE 50altachlore 124altafluor benox 124altafrin 124altavera 100ALTERNARIA 113ALTOPREV50ALTRENO 61alum amp mag hydroxide-simeth 87alumina-magnesia-simethicone 87ALUNBRIG35ALVESCO 131alvimopan87alyacen 135100alyacen 777100alyq 134ALZAIR ALLERGY NASAL SPRAY127amabelz 100amantadine hcl42AMARYL 72AMBIEN 135AMBIEN CR 135ambrisentan 134amcinonide61AMELUZ 61AMERGE 34AMERICAN BEECH113AMERICAN COCKROACH113AMERICAN ELM113AMERICAN SYCAMORE 113amethia 100amethia lo 100amethyst 100AMICAR 48amikacin sulfate 21amiloride hcl50amiloride-hydrochlorothiazide 50aminoacetic acid 93aminoamrms 77aminobenzoate potassium 77aminocaproic acid 48AMINOPMRMS113aminoreliefrms 77amiodarone hcl 50AMITIZA87amitriptyline hcl 29

138

AMLODIPINE BES+SYRSPEND SF 50amlodipine besylate 50amlodipine besylate-benazepril hcl 50amlodipine besylate-valsartan 50amlodipine-atorvastatin50amlodipine-olmesartan50amlodipine-valsartan-hctz 50ammonium lactate61amnesteem 61amoxapine 29amoxicill-clarithro-lansopraz 87amoxicillin 21amoxicillin-potassium clavulanate21amoxicillin-potassium clavulanate er21AMPHETAMINE ER56amphetamine sulfate56amphetamine-dextroamphetamine 56amphetamine-dextroamphetamine er 56amphotericin b 31ampicillin 21ampicillin-sulbactam sodium 21AMPYRA57AMRIX135AMZEEQ61ANACAINE61ANADROL-50 97ANAFRANIL29anagrelide hcl48ana-lex 111ANALPRAM HC 111ANALPRAM HC SINGLES 111ANALPRAM-HC111ANASPAZ 87anastrozole 35ANCOBON31ANDEXXA113ANDRODERM 97ANDROGEL97ANDROGEL PUMP 97ANGELIQ 101animal shapes77ANIMI-377ANIMI-3VITAMIN D77ANNOVERA101ANODYNE LPT17ANORO ELLIPTA 132antacid 87

antacid anti-gas max strength87antacid calcium 87antacid calcium rich 87antacid extra strength 87antacid maximum87antacid regular strength 87antacid ultra strength 87ANTARA 50anticoagulant cit dext soln a26ANTICOAGULANT SODIUM CITRATE26anti-diarrheal 87antihistamine amp nasal deconges 128ANTIVENIN LATRODECTUS MACTANS 113ANTIVENIN MICRURUS FULVIUS113anucort-hc 111ANUSOL-HC111ANZEMET30APADAZ9apap-caff-dihydrocodeine 9APEXICON E 61APIDRA SOLOSTAR 76APIDRA VIAL76APLENZIN 29APOKYN 42APP SLIM RMS 113APPTRIM 113APPTRIM-D 113apraclonidine hcl 123aprepitant 30apri 101APRISO 111APRIZIO PAK 17APRIZIO PAK II 17APTENSIO XR56APTIOM 26APTIVUS44AQUAPHILIC 61AQUASOL A 77ARAKODA 41ARALAST NP132aranelle 101ARANESP (ALBUMIN FREE)48ARAVA106ARAZLO61ARCALYST 106ARCAPTA NEOHALER 132ARESTIN 59ARICEPT 28ARIDA 61

ARIDOL113ARIKAYCE21ARIMIDEX36aripiprazole 43ARISTADA 43ARISTADA INITIO 43ARIXTRA 26ARIZONA CYPRESS113armodafinil 136ARMONAIR DIGIHALER 132ARMOUR THYROID105ARNUITY ELLIPTA132AROMASIN36ARRANON 36arsenic trioxide36ARTHROTEC14artificial tears124ARTISS 113ARYMO ER9ARZERRA36arzol silver nit applicators61ASACOL HD 111ASCENIV 106ascomp-codeine9ASCOR 77ASCORBIC ACID77ascorbic acid 77ashlyna101asilnasalrms 113ASMANEX (120 METERED DOSES) 132ASMANEX (14 METERED DOSES) 132ASMANEX (30 METERED DOSES) 132ASMANEX (60 METERED DOSES) 132ASMANEX (7 METERED DOSES) 132ASMANEX HFA 132ASPARLAS 36ASPARTAME113ASPARTAME (NUTRASWEET) 113aspirin 14aspirin adult14aspirin adult low strength 14aspirin childrens 14aspirin ec14aspirin ec low dose 14aspirin ec low strength 14aspirin low dose 14aspirin-dipyridamole er43

139

ASPIRIN-OMEPRAZOLE 43ASTAGRAF XL 106ASTERO 17ASTRINGYN 48ATABEX OB77ATACAND50ATACAND HCT 50atazanavir sulfate44ATELVIA 112atenolol 50ATENOLOL+SYRSPEND SF 50atenolol-chlorthalidone50ATGAM 106athletes foot (terbinafine) 31ATIVAN 47atomoxetine hcl56ATOPADERM 61ATOPICLAIR61atorvastatin calcium 50atovaquone 41atovaquone-proguanil hcl41ATRALIN61ATRIPLA 44ATROPEN87atropine sulfate 87 88 124ATROPINE SULFATE 88 124ATROVENT HFA 132AUBAGIO57aubra101aubra eq101AUGMENTIN 21AUGMENTIN ES-600 21AUREOBASIDIUM113aurodryl allergy childrens 128aurophen childrens 9aurovela 1530 101aurovela 120 101aurovela 24 fe 101aurovela fe 1530 101aurovela fe 120 101AURYXIA 93AUSTEDO58AUSTRALIAN PINE 113AUTOLET II CLINISAFE74AUTOLET LANCING DEVICE 74AUTOSOFT 30 INFUSION SET 113AUTOSOFT 90 INFUSION SET 113AUTOSOFT XC INFUSION SET 113AUVI-Q132AVAILNEX 113

AVALIDE50AVANDIA 72AVAPRO 50avar cleanser 61AVAR LS CLEANSER 61AVAR-E EMOLLIENT 61AVAR-E GREEN61AVAR-E LS 61AVASTIN36AVEED97AVEIDAOXIA 61aviane 101avidoxy21AVIDOXY DK 21avita 61AVITENE113AVITENE FLOUR 113AVODART95AVONEX PEN57AVONEX PREFILLED 57AVSOLA106AXONA 113AYGESTIN101ayuna 101AYVAKIT36azacitidine 36AZADROX61AZALGIA113AZASAN106AZASITE 122azathioprine 106azathioprine sodium106azelaic acid 61AZELAIC ACID-NIACINAMIDE61azelastine hcl 122 128azelastine-fluticasone 128AZELEX 61AZESCHEW PRENATALPOSTNATAL77AZESCO 77AZILECT 42azithromycin21azo tabs 93AZOPT 123AZOR 50AZULFIDINE 111AZULFIDINE EN-TABS 111azurette 101B-12 COMPLIANCE INJECTION 77b-6 folic acid77BACICAP 88bacitracin21 122

bacitracin zinc 21bacitracin-polymyxin b 124bacitra-neomycin-polymyxin-hc 124BACLOFEN135baclofen 135BACMIN 77BACTRIM21BACTRIM DS21BAFIERTAM 57BAHIA 113BALCOLTRA101BALD CYPRESS 113balsalazide disodium111balsam peru-castor oil 61BALVERSA 36balziva101banophen 128BANZEL 26BAQSIMI ONE PACK 75BAQSIMI TWO PACK75BARACLUDE 44BASAGLAR KWIKPEN 76BAVENCIO 36BAXDELA 21BAYBERRY (WAX MYRTLE) 113BAYER ASPIRIN 14BAYER ASPIRIN EC LOW DOSE14BCG VACCINE 109b-complexb-12 77BEAU RX 61BECONASE AQ128bekyree 101BELBUCA 9BELEODAQ 36belladonna alkaloids-opium 88BELRAPZO36BELSOMRA 136benazepril hcl51benazepril-hydrochlorothiazide 51BENDEKA36BENEFIX48BENICAR 51BENICAR HCT51BENLYSTA 106BENSAL HP61BENZ PER-CLIND-NIACIN-TRETIN 61BENZAC AC WASH61BENZACLIN61BENZACLIN WITH PUMP 61BENZALKONIUM CHLORIDE 21

140

benzalkonium chloride 21BENZAMYCIN 61BENZEPRO 61benzepro 61benzepro creamy wash61benzepro foaming cloths61BENZEPRO SHORT CONTACT61BENZHYDROCODONE-ACETAMINOPHEN9BENZNIDAZOLE 41BENZODOX21BENZOIN 61benzoin compound61BENZO-LIDOCAINE-TETRACAINE 17benzonatate 128BENZOYL PEROX-HYDROCORTISONE61benzoyl peroxide61BENZOYL PEROXIDE61BENZOYL PEROXIDE FORTE- HC 61benzoyl peroxide-erythromycin 61benzphetamine hcl58benztropine mesylate42BEOVU 124BEPREVE 122BERINERT106BERMUDA GRASS 113BESER61beser 62BESIVANCE 122BESPONSA 36BETA 1 KIT 95BETADINE OPHTHALMIC PREP 122BETALOAN SUIK 95BETAMETHASONE COMBO 95betamethasone dipropionate 62betamethasone dipropionate aug 62BETAMETHASONE DIPROP-MINOXIDIL62BETAMETHASONE SOD PHOS amp ACET95betamethasone sod phos amp acet 95betamethasone valerate 62BETAPACE51BETAPACE AF 51BETASERON57betaxolol hcl 51 123

bethanechol chloride93BETHKIS134BETIMOL 123BETOPTIC-S 123BEVACIZUMAB 124BEVESPI AEROSPHERE132bexarotene 36BEXSERO109BEYAZ 101BHI URI-CONTROL 113BIAFINE 62bicalutamide36BICILLIN L-A21BICNU36BIDIL 51BI-EST 8020 PROGESTERONE101BIESTPROGESTERONE 101BIIFENAC 1000 14BIIFENAC 500 14BIJUVA 101BIKTARVY 44BILTRICIDE 41bimatoprost 123 124BI-MIX 93BINOSTO112bio glo 124biocel77BIONECT 62biopetit 77BIO-STATIN31bio-statin 31BIOTHRAX109biotin 77bisacodyl 88bisacodyl ec 88bismuth subsalicylate88bisoprolol fumarate 51bisoprolol-hydrochlorothiazide 51BIVIGAM 106BLACK WALNUT POLLEN114BLACK WILLOW114blanche 62BLENREP 36bleomycin sulfate 36BLEPH-10 122BLEPHAMIDE124BLEPHAMIDE SOP 124BLINCYTO 36blisovi 24 fe 101blisovi fe 1530 101blisovi fe 120 101blue tube aloe 17

BLUESTAR 74BONIVA 112BONJESTA 30BOOSTRIX 109BORTEZOMIB 36bosentan 134BOSULIF36BOTOX 114BOTOX COSMETIC 62BOTRYTIS 114BOX ELDER 114bp 10-162bp cleansing wash 62bp vit 3 77bp wash62BPCO62b-plex 77b-plex plus77BRAFTOVI 36BREATHE EASE HUMIDIFIER 114BREATHE EASE NEB MASKCHILD 114BREATHE EASE NEB MASKINFANT114BREO ELLIPTA 132BREZTRI AEROSPHERE132BRIDION 114briellyn101BRILINTA43brimonidine tartrate 123BRIMONIDINE-DORZOLAMIDE123BRINEURA 92BRISDELLE 29BRIVIACT 26BROME114bromfed dm128bromfenac sodium (once-daily) 122bromocriptine mesylate42BROMSITE 122BROVANA 132BRUKINSA36BRYHALI62BSP 082095budesonide 111 132budesonide er 111BUDESONIDE-FORMOTEROL FUMARATE132bumetanide 51BUMEX 51BUNAVAIL 20

141

BUPAP9BUPHENYL92bupivacaine fisiopharma 17BUPIVACAINE HCL17 18bupivacaine hcl 18bupivacaine hcl (pf)17BUPRENEX 9buprenorphine9buprenorphine hcl 9 20buprenorphine hcl-naloxone hcl 20bupropion hcl 29bupropion hcl er (smoking det) 20bupropion hcl er (sr)29bupropion hcl er (xl) 29BUPROPION HCL ER (XL) 29buspirone hcl47busulfan 36BUSULFEX 36butalbital-acetaminophen9BUTALBITAL-ACETAMINOPHEN9butalbital-apap-caff-cod 9butalbital-apap-caffeine9butalbital-asa-caff-codeine9butalbital-aspirin-caffeine 9butorphanol tartrate9 10BUTRANS10BYDUREON72BYDUREON BCISE AUTOINJECTOR 72BYETTA 10 MCG PEN 72BYETTA 5 MCG PEN 72BYNFEZIA PEN 98BYSTOLIC 51cabergoline 98CABLIVI 43CABOMETYX 36CADIRAMD18CADUET 51CAFERGOT 34caffeine citrate58CALAN SR 51calcidol 77CALCIFOL 78calcipotriene62CALCIPOTRIENE 62calcipotriene-betameth diprop62CALCIPOTRIENE-CLOBETASOL PROP62calcitonin (salmon) 112calcitrate78CALCITRENE 62

calcitriol 62 112calcium acetate 93calcium acetate (phos binder)93calcium carb-cholecalciferol78calcium carbonate78calcium carbonate-vitamin d 78calcium-folic acid plus d 78CALDOLOR 14CALIFORNIA PEPPER TREE 114CALQUENCE36CAMBIA 14camila101CAMINO PRO COMPLETEGLYTACTIN 114CAMPATH 36CAMPTOSAR 36camrese 101camrese lo 101CANASA 111CANCIDAS 31candesartan cilexetil 51candesartan cilexetil-hctz51CANDIDA ALBICANS EXTRACT 114CANTHARIDIN 62CAPASTAT SULFATE35capecitabine36CAPEX62CAPLYTA43CAPRELSA36capsaicin 62CAPSAICIN-MENTHOL18CAPSFENAC PAK14CAPSINAC14captopril 51captopril-hydrochlorothiazide 51capzix62CARAC 62CARAFATE86CARBAGLU 78carbamazepine 26carbamazepine er 26CARBATROL 26carbidopa 42carbidopa-levodopa 42carbidopa-levodopa er 42carbidopa-levodopa-entacapone 42carbinoxamine maleate128carboplatin 36CARDIOPLEGIA DEL NIDO FORMULA 78

CARDIOPLEGIA IND PLASMA HIGH K78CARDIOPLEGIA IND PLASMA-TROMET 78CARDIOPLEGIA INDUCTION HIGH K78CARDIOPLEGIA INDUCTION LOW DEX 78CARDIOPLEGIA INDUCTION NON-ENR 78CARDIOPLEGIA MAIN LOW DEXTROSE 78CARDIOPLEGIA MAIN LOW TROMETHA78CARDIOPLEGIA MAIN PLASMA-TROME 78CARDIOPLEGIA MAINTENANCE78CARDIOPLEGIA REPERFUSATE 41 78CARDIOVID PLUS114CARDIZEM 51CARDIZEM CD 51CARDIZEM LA51CARDURA 51CARDURA XL95CARETOUCH 2 CPAP HOSE HANGER114CARETOUCH CONTROL SOL LEVEL 274CARETOUCH CPAP amp BIPAP HOSE114CARETOUCH CPAP MASK WIPES 114CARETOUCH CPAP PRE-WASH SOLN 114CARETOUCH CPAP TUBE BRUSH 114CARETOUCH LANCINGEJECTOR 74CARETOUCH TEST 74CARETOUCH UNIVERSL CPAP FILTER114CARIMUNE NF 106carisoprodol 135carisoprodol-aspirin-codeine10carmustine 36CARNITOR 78CARNITOR SF78CAROSPIR 51carteolol hcl123cartia xt 51CARTICEL 114

142

carvedilol51carvedilol phosphate er51cascara sagrada 88CASODEX 36caspofungin acetate31CAT HAIR EXTRACT 114CATAPRES51CATAPRES-TTS-1 51CATAPRES-TTS-2 51CATAPRES-TTS-3 51CATHFLO ACTIVASE 26CATTLE EPITHELIUM114cavarest 59CAVERJECT93CAVERJECT IMPULSE93CAYA 114CAYSTON134caziant101CBD4 FREEZE PUMP MAXIMUM STR 18CEDAR ELM 114cefaclor 21cefaclor er 21cefadroxil 21cefazolin sodium 21cefazolin sodium-dextrose 21cefdinir 21cefepime hcl21cefixime21CEFOTAN21cefotaxime sodium 21cefotetan disodium21cefoxitin sodium 21cefpodoxime proxetil 21cefprozil 21ceftazidime22ceftriaxone sodium22cefuroxime axetil 22CELEBREX14celecoxib 14CELESTONE SOLUSPAN95CELEXA29CELLCEPT 106CELLCEPT INTRAVENOUS 106CELONTIN26CEM-UREA62CENFOL 78CENTANY22CENTANY AT 22CENTRATEX 78cephalexin22CEPROTIN 48CEQUA 124

CEQUR SIMPLICITY 2U 74CERACADE 62CERDELGA 92CEREBYX26CEREFOLIN 78cerefolin nac78CEREZYME 92cerovel 62CERVIDIL 93CETACAINE 18cetirizine hcl 128cetirizine hcl childrens128CETRAXAL 127CETROTIDE 98cevimeline hcl 59CHANTIX 20CHANTIX CONTINUING MONTH PAK20CHANTIX STARTING MONTH PAK20charlotte 24 fe 101chateal 101chateal eq 101CHEMET78CHEMSTRIP UGK 74CHENODAL 88chest congestion relief 128chest congestion relief dm 128childrens acetaminophen 10childrens apap10childrens chewable vitamins 78childrens non-aspirin10CHLOOXIA 62chloramphenicol sod succinate22chlordiazepoxide hcl 47chlordiazepoxide-amitriptyline29chlordiazepoxide-clidinium88chlorhexidine gluconate 59chloroquine phosphate41chlorpheniramine maleate er 128chlorpromazine hcl43chlorthalidone51CHLOR-TRIMETON 128chlorzoxazone135chocolated laxative 88CHOLBAM 92CHOLECAL DF78cholestyramine51cholestyramine light 51CHONDROITIN SULFATE 125chorionic gonadotropin98chromagen 78CIALIS93

ciclodan32ciclopirox 32ciclopirox olamine 32ciclopirox treatment32CICLOPIROX-CLOBETASOL62CICLOPIROX-CLOBETASOL-SAL ACID62CICLOPIROX-SALICYLIC ACID 62cidofovir44CIFEREX 78CIFRAZOL 78cilostazol 43CILOXAN 122CIMDUO 44cimetidine86cimetidine hcl 86CIMETIDINE-LIDO-SALICYLIC ACID 62CIMZIA106CIMZIA PREFILLED KIT106CIMZIA STARTER KIT 106cinacalcet hcl 112CINQAIR 128CINRYZE 106CIPRO22CIPRO HC 127CIPRODEX 127ciprofloxacin hcl 22 122 127ciprofloxacin-dexamethasone 127CIPROFLOXACIN-FLUOCINOLONE PF 127cisplatin 36CISPLATIN 36citalopram hydrobromide 29CITRANATAL BLOOM78CITRANATAL ESSENCE 78CITRANATAL MEDLEY78citroma 88CLADOSPORIUM CLADOSPORIOIDES 114CLADOSPORIUM SPHAEROSPERMUM 114cladribine36claravis62CLARINEX 128CLARINEX-D 12 HOUR128clarithromycin22clarithromycin er22CLARITIN128CLARITIN REDITABS128CLARITIN-D 12 HOUR 128clearlax88

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clemastine fumarate128CLENPIQ 88CLEOCIN 22CLEOCIN-T62CLIMARA 101CLIMARA PRO 101CLINDACIN ETZ62clindacin etz 62CLINDACIN PAC 62clindacin-p62CLINDAGEL62CLINDAMY-BENZOYL PER-NIACINAM 62clindamycin hcl22clindamycin palmitate hcl 22CLINDAMYCIN PHOS-NIACINAMIDE 62clindamycin phosphate 22 62 63CLINDAMYCIN PHOSPHATE 63clindamycin phosphate-benzoyl peroxide62CLINDAMYCIN-NIACIN-TRETINOIN63clindamycin-tretinoin 63CLINDESSE22CLIND-NIACIN-SPIRONOLAC-TRETIN 63CLINOIN 63clinpro 5000 59clobazam26clobetasol prop emollient base 63clobetasol propionate63clobetasol propionate e63clobetasol propionate emulsion 63CLOBETASOL PROP-LEVOCETIRIZINE 63CLOBETASOL PROP-NIACINAMIDE 63CLOBETAVIX 63CLOBEX 63CLOBEX SPRAY 63clocortolone pivalate 63CLODAN 63clodan 63CLODERM 63clofarabine 36CLOLAR36clomiphene citrate98clomipramine hcl 29clonazepam47clonidine51clonidine hcl 51clonidine hcl er 56

clopidogrel bisulfate 43clorazepate dipotassium 47clotrimazole32clotrimazole-betamethasone32clovique78clozapine43CLOZARIL 43COAGADEX48COAL TAR 63COARTEM 41COCAINE HCL 18COCKLEBUR114COD LIVER OIL78codeine sulfate10coenzyme q10114COLAZAL111COLCHICINE34colchicine 34colchicine-probenecid 34COLCIGEL114COLCRYS34cold amp flu relief daytime128coldflu daytime relief 128COLD-EEZE NATURAL MULTI-SYMP114COLD-EEZE PLUS DEFENSE 114COLD-EEZE SUGAR FREE 114colesevelam hcl 51COLESTID 51COLESTID FLAVORED51colestipol hcl 51colistimethate sodium (cba) 22COLLATYL63COLY-MYCIN M 22COMBIGAN 123COMBIPATCH 101COMBIVENT RESPIMAT 132COMBIVIR 44COMETRIQ (100 MG DAILY DOSE)36COMETRIQ (140 MG DAILY DOSE)36COMETRIQ (60 MG DAILY DOSE)36COMPLERA44complete lice treatment41compro 30COMTAN 42CONCERTA56CONDOMS 114CONDYLOX63CONJUPRI51

CONSENSI 51constulose88CONTOUR CONTROL 74CONTOUR NEXT CONTROL74CONTOUR NEXT LINK 74CONTOUR NEXT MONITOR 74CONTOUR NEXT TEST 74CONTOUR TEST74CONTRAST ALLERGY PREMED PACK95CONTRAVE 58CONVENIENCE PAK 58CONZIP 10COPADERM 63COPASIL 63COPAXONE57COPIKTRA36CORDRAN63COREG51COREG CR51coremino 22CORGARD51CORIFACT48CORLANOR51corn amp callus remover 63CORN POLLEN 114CORTANE-B63CORTEF 95CORTENEMA 111cortic-nd 127CORTIFOAM 111cortisone acetate95CORTISPORIN 63CORTROSYN 114corvita 78corvita 150 78CORVITE 150 78corvite fe 78COSENTYX (300 MG DOSE)106COSENTYX 150 MGML 106COSENTYX SENSOREADY (300 MG)106COSENTYX SENSOREADY PEN106COSMEGEN 36COSOPT123COSOPT PF 123cosyntropin114COTELLIC 36COTEMPLA XR-ODT 56cough dm 128coughchest congestion dm 128covaryx101

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covaryx hs101COZAAR 51CREON 92CRESEMBA32CRESTOR 51CRINONE 101CRIXIVAN 44CROFAB 114cromolyn sodium88 122 132crotan 41cryselle-28101CRYSVITA 92CUBICIN 22CUBICIN RF 22CUPRIMINE93CUROSURF128CURVULARIA114CUTAQUIG 106CUTIVATE 63CUVITRU 106CUVPOSA 88cvs acetaminophen ex st 10cvs antacid extra strength 88cvs clotrimazole 3 32cvs gentle laxative88cvs lubricant eye drops 125cvs motion sickness 30cvs stool softener 88cvs vitamin e 78cyanocobalamin 78CYANOCOBALAMIN 78cyclafem 135101cyclafem 777101CYCLOGABA 10300135cyclobenzaprine hcl 135cyclobenzaprine hcl er 135CYCLOGYL 125CYCLOMYDRIL 125CYCLOPAK 135cyclopentolate hcl 125CYCLOPHENE RAPIDPAQ135cyclophosphamide 36CYCLOPHOSPHAMIDE 36cycloserine 35CYCLOSET72cyclosporine 106CYCLOSPORINE IN KLARITY 125cyclosporine modified 106CYKLOKAPRON48CYMBALTA29cyproheptadine hcl128CYRAMZA 36

cyred 101cyred eq 101CYSTADANE 92CYSTADROPS 125CYSTAGON92CYSTARAN 125cytarabine 36cytarabine (pf) 36CYTOGAM106CYTOMEL105CYTOTEC86cytra k crystals 78DHE 45 34d3 high potency78d3 super strength 78dacarbazine 36DACOGEN36dactinomycin 36daflonex-xl78dalfampridine er 57DALIRESP 132danazol 97DANDELION 114DANTRIUM 135dantrolene sodium 135dapsone 35 63DAPSONE 63DAPSONE-NIACINAMIDE63DAPSONE-NIACINAMIDE-SPIRONOLAC 63DAPTACEL 109daptomycin22DARAPRIM 41darifenacin hydrobromide er 93DARZALEX 37DARZALEX FASPRO 37dasetta 135 101dasetta 777 101daunorubicin hcl37DAURISMO37dayhist allergy 12 hour relief 128DAYPRO14daysee 101daytime cold amp flu relief128daytime coldflu relief 128DAYTRANA 56DAYVIGO136DDAVP98DDAVP RHINAL TUBE98DEBACTEROL59deblitane 101DECADRON 95decara 78

DECARA 79decitabine37deferasirox 79deferasirox granules 79deferiprone79deferoxamine mesylate114dehydrated alcohol79DELESTROGEN101DELSTRIGO 44DELTEC COZMO CLEO SET 24 6MM114DELUO63delyla101DELZICOL 111demeclocycline hcl22DEMEROL 10DEMSER51DENAVIR 45denta 5000 plus 59dentagel 59DEOXIA 63DEPAKOTE 26DEPAKOTE ER 26DEPAKOTE SPRINKLES 26DEPEN TITRATABS93DEPLIN 15 79DEPLIN 75 79DEPO-ESTRADIOL 101DEPO-MEDROL 95DEPO-PROVERA 101DEPO-SUBQ PROVERA 104101DEPO-TESTOSTERONE 97DERMACINRX ANALGESIC COMBOPAK 14DERMACINRX AZENASE PAK128DERMACINRX CLORHEXACIN 59DERMACINRX DUOPATCH PHARMAPAK 18DERMACINRX EMPRICAINE 18DERMACINRX LEXITRAL PHARMAPAK 14DERMACINRX NEUROTRAL PHARMAPAK 18DERMACINRX PENETRAL63DERMACINRX PHN 18DERMACINRX PRIZOPAK18DERMACINRX PUREFOLIX 79DERMACINRX SURGICAL COMBOPAK 63DERMACINRX SURGICAL PHARMAPAK 59

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DERMACINRX THERAZOLE PAK32DERMACINRX TICANASE PAK128DERMACINRX ZRM 18DERMA-SMOOTHEFS BODY63DERMA-SMOOTHEFS SCALP 63dermazene 32DERMOTIC127DERMULCERA63DESCOVY 45DESENEX32DESFERAL 115desflurane 115desipramine hcl29desloratadine 128desmopressin ace spray refrig98desmopressin acetate98desmopressin acetate spray 98desogestrel-ethinyl estradiol 101DESONATE 63desonide 64DESOWEN 64desoximetasone64DESOXYN 56DESVENLAFAXINE ER29desvenlafaxine succinate er29DETROL 93DETROL LA 93DEXABLISS 95dexamethasone 95dexamethasone intensol 95dexamethasone sod phosphate pf 95dexamethasone sodium phosphate 96 122DEXAMETHASONE SODIUM PHOSPHATE96dexchlorpheniramine maleate128DEXEDRINE 56DEXERYL 64dexifol79DEXILANT 86dexmedetomidine hcl 115dexmedetomidine hcl in nacl115dexmethylphenidate hcl 57dexmethylphenidate hcl er 57DEXONTO 04 96dexrazoxane hcl37DEXTENZA122dextroamphetamine sulfate57dextroamphetamine sulfate er 57

DEXYCU 122DFS DRMSMENTHCAP PAK15DFSMSMENTHCAP PAK 15DIACOMIT 26DIADIMAXIA 64dialyvite 79DIALYVITE 300079DIALYVITE 500079DIALYVITE SUPREME D 79DIALYVITEZINC 79DIAOXIA 64diaper rash 64DIASDIMAXIA64DIASOXIA 64DIASTAT ACUDIAL 26DIASTAT PEDIATRIC26diazepam 26 47diazepam intensol 47diazoxide75DIBENZYLINE 51DICLEGIS 30DICLOFENAC15DICLOFENAC EPOLAMINE15diclofenac potassium 15diclofenac sodium 15 64 122diclofenac sodium er 15diclofenac-misoprostol 15DICLOFENAC-NA HYALURON-NIACIN64diclofex dc 15DICLOFONO15DICLOPR 15diclosaicin 15DICLOSTREAM 15DICLOTREX 15DICLOVIX 15DICLOVIX M 15dicloxacillin sodium 22DICLOZOR 15DICOPANOL FUSEPAQ128DICOPANOL RAPIDPAQ 128dicyclomine hcl88didanosine45diethylpropion hcl 58diethylpropion hcl er58DIFFERIN 64DIFICID 22difil-g forte 132diflorasone diacetate64DIFLUCAN 32diflunisal 15DIFMETIOXRIME 32

DIGIFAB115digitek51digox 51digoxin51dihydroergotamine mesylate34DILANTIN27DILANTIN INFATABS 27DILATRATE-SR 51DILAUDID 10diltiazem hcl 52diltiazem hcl er 52diltiazem hcl er beads 51diltiazem hcl er coated beads 51DILTIAZEM HCL-DEXTROSE 52dilt-xr 52dimaphen dm coldcough128DIMENTHO15dimethyl fumarate 57dimethyl fumarate starter pack57DIMOXIA64diotame instydose 88DIOVAN 52DIOVAN HCT52DIPENTUM 111diphen 128DI-PHEN 128diphenhydramine hcl129diphenoxylate-atropine88DIPHTHERIA-TETANUS TOXOIDS DT 109DIPROLENE 64DIPROLENE AF64dipyridamole43disopyramide phosphate52disulfiram20DITROPAN XL 93DIURIL 52divalproex sodium 27divalproex sodium er27DIVIGEL101DMT SUIK96docetaxel37docosanol64docusate mini88docusate sodium88docuzen 88dofetilide52DOG EPITHELIUM 115DOG FENNEL115DOJOLVI115dok 88DOLOPHINE10donepezil hcl 28

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DONNATAL 88DOPTELET 48DORAL47DORYX 22DORYX MPC 22DORZOLAMIDE HCL 123dorzolamide hcl123dorzolamide hcl-timolol mal 123dorzolamide hcl-timolol mal pf 123dotti 101DOUBLE PM125DOUBLEDEX96DOVATO45DOVONEX 64doxazosin mesylate 52doxepin hcl29 64 136doxercalciferol112DOXIL 37doxorubicin hcl 37doxorubicin hcl liposomal37doxy 100 22doxycycline 64doxycycline hyclate 22DOXYCYCLINE HYCLATE22doxycycline monohydrate 22 23doxylamine-pyridoxine 30DR SMITHS ADULT BARRIER 64DRAXACE64DRAXACE LOTION CLEANSER64DRECHSLERA 115DRISDOL 79DRITHO-CREME HP 64DRIXECE 64DRIZALMA SPRINKLE 29dronabinol 30drospiren-eth estrad-levomefol101drospirenone-ethinyl estradiol102DROXIA 37DRYSOL 64DSUVIA10DUAKLIR PRESSAIR 132DUAL COMPLEX FORMULA 1 KIT 15DUAVEE 102DUETACT 72DUEXIS15DULERA 132duloxetine hcl 29DUOBRII 64DUOPA 42DUPIXENT64DURACHOL79

DURAGESIC-100 10DURAGESIC-12 10DURAGESIC-25 10DURAGESIC-50 10DURAGESIC-75 10duramorph10DUREZOL122DURLAZA 43DUROLANE 115DURYSTA123DUST MITE MIXED ALLERGEN EXT115dutasteride 95dutasteride-tamsulosin hcl 95DUTOPROL 52d-vite pediatric79DXEVO 11-DAY96DYANAVEL XR57DYAZIDE 52DYMISTA 129DYRENIUM52DYSPORT115DYURAL-40 96DYURAL-80 96DYURAL-L 96DYURAL-LM 96EES GRANULES 23EASIVENT 115EASTERN COTTONWOOD 115easygel59EASYMAX 15 LEVEL 2-3 CONTROL 74EASYMAX CONTROL 74EASYMAX CONTROL NORMALHIGH74ECEOXIA 64EC-NAPROSYN15ec-naproxen 15ECONASIL32econazole nitrate32ECONAZOLE NITRATE-NIACINAMIDE 32ECOZA32EC-RX DHEA115EC-RX ESTRADIOL 102EC-RX PROGESTERONE 102EC-RX TESTOSTERONE 98ECZEMOL115EDARBI52EDARBYCLOR 52EDECRIN52EDEX 93EDLUAR 136

ed-spaz 88EDURANT45eemt 102eemt hs 102efavirenz 45efavirenz-emtricitab-tenofovir45efavirenz-lamivudine-tenofovir 45EFFER-K79effer-k79EFFEXOR XR 29EFFIENT 43EFUDEX 64EGATEN 41EGRIFTA SV98EHA18ELAPRASE 92ELELYSO92ELESTRIN 102ELETONE 64eletriptan hydrobromide 34ELFOLATE79ELFOLATE PLUS 79ELIDEL64ELIGARD 98ELIMITE 42elinest102ELIQUIS26ELIQUIS DVTPE STARTER PACK 26ELITEK37ELITE-OB79ELIXOPHYLLIN 132ELLA 102ELLENCE37ELLZIA PAK64ELMIRON93ELOCTATE 48eluryng 102ELZONRIS 37EMCYT 37EMEND 30EMEND TRI-PACK 30EMFLAZA 34EMGALITY34EMGALITY (300 MG DOSE) 34emoquette 102EMPLICITI 37EMPRICAINE-II 18EMSAM29emtricitabine45emtricitabine-tenofovir df45EMTRIVA 45EMULSION SB 64

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EMVERM 42ENABLEX 93enalapril maleate52enalapril-hydrochlorothiazide 52ENBRACE HR 79ENBREL106ENBREL MINI 106ENBREL SURECLICK 106ENDARI 115ENDO AVITENE 115endocet 10ENDOMETRIN102ENFAGROW NEUROPRO TODDLER115ENFAMIL GENTLEASE115ENFAMIL INFANT 115ENFAMIL NEUROPRO SENSITIVE 115ENFAMIL NUTRAMIGEN 115ENFAMIL NUTRAMIGEN LIPIL115ENGERIX-B 109ENGLISH PLANTAIN115ENHERTU37ENLITE GLUCOSE SENSOR74ENLYTE 115enovarx-amitriptyline115enovarx-baclofen 135enovarx-cyclobenzaprine hcl 135ENOVARX-DICLOFENAC SODIUM15enovarx-ibuprofen 15enovarx-lidocaine hcl 18enovarx-naproxen 15enovarx-tramadol 64enoxaparin sodium26enpresse-28 102enskyce102ENSPRYNG106ENSTILAR 64entacapone 42entecavir 45ENTERAGAM 115ENTEREG88enteric fish oil 115ENTOCORT EC111ENTRESTO 52ENTTY SPRAY 64ENTYVIO 106enulose 88ENVARSUS XR 106ENZADYNE 92ENZOCLEAR 64

EPANED 52EPCLUSA 45ephedrine sulfate 52EPHEDRINE SULFATE-NACL 52EPICERAM 64EPICOCCUM 115EPIDIOLEX 27EPIDUO 64EPIDUO FORTE 64EPIFOAM64epinastine hcl 122epinephrine 132epinephrine hcl (nasal)129EPINEPHRINE PROFESSIONAL 132EPINEPHRINESNAP-EMS132EPINEPHRINESNAP-V 132EPIPEN 2-PAK 132EPIPEN JR 2-PAK 132EPIQUIN MICRO 64epirubicin hcl 37EPISIL115EPISNAP 132epitol 27EPIVIR 45EPIVIR HBV45eplerenone 52EPOGEN48epoprostenol sodium134EPZICOM45eq anti-diarrheal 88EQUACARE JR 115EQUAPAXATORVASTATINCOQ10 52EQUAPAXIBUPROFENMINREX 15EQUETRO 48ERAXIS32ERBITUX 37ERGOCAL 79ergocalciferol79ergoloid mesylates 115ERGOMAR 34ergotamine-caffeine 34ERIVEDGE 37ERLEADA 37erlotinib hcl37errin102ERTACZO32ertapenem sodium 23ERWINAZE 37ery 64ERYGEL 64

ERYPED 200 23ERYPED 400 23ERY-TAB 23ERYTHROCIN STEARATE 23erythromycin 23 64 65 122erythromycin base23erythromycin ethylsuccinate23ESBRIET132escitalopram oxalate 29ESGIC10ESKATA65ESOMEP-EZS 86esomeprazole magnesium86ESOMEPRAZOLE STRONTIUM86ESPEROCT 48ESSENTIAL CARE JR115est estrogens-methyltest102est estrogens-methyltest ds 102est estrogens-methyltest hs 102estarylla102estazolam47ESTRACE 102estradiol 102estradiol valerate102estradiol-norethindrone acet 102ESTRING 102ESTROGEL 102ESTROSTEP FE102eszopiclone 136ethacrynic acid 52ethambutol hcl35ethosuximide27ETHOXIA 65ethyl chloride18ethynodiol diac-eth estradiol 102ETHYOL37etodolac 15etodolac er 15etonogestrel-ethinyl estradiol 102ETOPOPHOS 37etoposide 37EUCRISA 65EUFLEXXA 115euthyrox 105EVAMIST 102EVEKEO 57EVEKEO ODT57EVENITY112everolimus37 106EVISTA 98EVOCLIN 65EVOMELA37

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EVOTAZ45EVOXAC 59EVRYSDI 115EXELDERM 32EXELON 28exemestane 37EXFORGE 52EXFORGE HCT 52EXJADE 79EX-LAX ULTRA 88exoderm 32EXONDYS 51 92exotic-hc127EXPAREL 18EXTAVIA58EXTINA 32eye itch relief122EYLEA 125EYSUVIS 122EZALLOR SPRINKLE52ezetimibe52ezetimibe-simvastatin 52fabb 79FABIOR65FABRAZYME 92FALESSA102falmina 102famciclovir 45famotidine 86FANAPT43FANAPT TITRATION PACK 43FANATREX FUSEPAQ27FARESTON 37FARXIGA 72FARYDAK 37FASENRA 129FASENRA PEN129FASLODEX37FAVIPIRAVIR45fa-vitamin b-6-vitamin b-12 79fayosim102FBL KIT15febuxostat 34FEIBA48felbamate 27FELBATOL27FELDENE 15felodipine er 52FEM PH 93FEMARA 37FEMHRT LOW DOSE102FEMRING 102femynor 102

fenofibrate 52fenofibrate micronized52fenofibric acid52FENOGLIDE 52fenoprofen calcium15fenortho15FENSOLVI (6 MONTH)98fentanyl 10fentanyl citrate10FENTANYL CITRATE10fentanyl citrate (pf) 10FENTANYL CITRATE-NACL 10FENTANYL-BUPIVACAINE-NACL 10 11FENTORA11FERAHEME 79FERIVA 217 79FERIVAFA 79ferocon 79ferotrinsic 79FERRALET 90 79ferraplus 90 79FERRIPROX 79FERRIPROX TWICE-A-DAY 79FERRLECIT 79ferrocite plus 79FERRO-PLEX HEMATINIC 79FERROTRIN 79ferrous sulfate 79FETROJA23FETZIMA29FETZIMA TITRATION29FEXMID 135fexofenadine hcl129fexofenadine-pseudoephed er 129FIASP76FIASP FLEXTOUCH76FIASP PENFILL 76fiber 88fiber laxative88FIBRICOR52FIBRYGA 48FINACEA 65finasteride 65 95FINASTERIDE-MINOXIDIL65FINTEPLA27FIORICET 11FIORICETCODEINE11FIORINAL 11FIORINALCODEINE 3 11FIRAZYR106FIRDAPSE 115FIRE ANT115

FIRMAGON98FIRMAGON (240 MG DOSE) 98FIRST - METOPROLOL 52FIRST-ATENOLOL 52FIRST-BACLOFEN 135FIRST-LANSOPRAZOLE 86FIRST-METRONIDAZOLE 23FIRST-MOUTHWASH BLM 59FIRST-OMEPRAZOLE 86FIRST-PROGESTERONE VGS 102FIRVANQ 23flac 127FLAGYL 23FLAREX 122flavoxate hcl 93FLEBOGAMMA DIF106flecainide acetate 53FLEXICHAMBER ADULT MASKSMALL 115FLEXICHAMBER CHILD MASKLARGE115FLEXICHAMBER CHILD MASKSMALL 116FLEXIN 18FLEXIPAK15FLOLAN 134FLOLIPID 53FLOMAX 95FLORIVA79FLORIVA PLUS 79FLOVENT DISKUS 132FLOVENT HFA 132floxuridine37FLUAD 109FLUAD QUADRIVALENT 110FLUARIX QUADRIVALENT110flucaine125FLUCELVAX QUADRIVALENT 110fluconazole32FLUCON-IBUPROF-ITRACON-TERBINA 32flucytosine 32fludarabine phosphate 37fludrocortisone acetate96FLULAVAL QUADRIVALENT 110FLUMIST QUADRIVALENT110flunisolide 129FLUOCINOLONE ACET-NIACINAMIDE 65fluocinolone acetonide 65 127fluocinolone acetonide body 65

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fluocinolone acetonide scalp65fluocinonide65fluocinonide emulsified base65FLUOPAR 65FLUORABON79fluorescein-benoxinate125fluoridex 59fluoridex daily renewal 59fluoridex enhanced whitening 59fluoridex sensitivity relief 59fluor-i-strips at 125fluoritab 79fluorometholone 122FLUOROPLEX65fluorouracil 37 65FLUOROURACIL65FLUOVIX65FLUOVIX PLUS 65fluoxetine hcl 29FLUOXETINE HCL (PMDD) 29fluphenazine decanoate43fluphenazine hcl 43FLURA-DROPS 79flurandrenolide 65FLURA-SAFE125flurazepam hcl136flurbiprofen 15flurbiprofen sodium 122flutamide 37fluticasone propionate65 129fluticasone-salmeterol 133FLUTICASONE-SALMETEROL133fluvastatin sodium 53fluvastatin sodium er 53fluvoxamine maleate 29fluvoxamine maleate er29FLUZONE QUADRIVALENT 110FML122FML FORTE122FML LIQUIFILM 122FOCALIN 57FOCALIN XR 57folbee 79folbee plus79folbee plus cz 79FOLBIC RF 80FOLGARD OS 80FOLGARD RX80folic acid 80FOLIC D380FOLIC-K80FOLI-D 80

FOLIKA PROBIOTIC 88FOLITE 80FOLIVANE-F80FOLIVANE-PLUS80FOLIXAPURE 80FOLLISTIM AQ 99FOLOTYN 37folplex 2280foltanx 80FOLTANX RF80FOLTRATE 80FOLTREXYL 80foltrin 80FOLTX 80FOLVITE-D 80fondaparinux sodium26FORANE 116FORAXA 65FORFIVO XL29formaldehyde 116FORMALDEHYDE 116FORTAMET 72FORTAZ23FORTEO 112FORTESTA98FORTISCARE CONTROL 74FORTISCARE GLUCOSE SYSTEM 74FORTISCARE T1 GLUCOSE SYSTEM 74FOSAMAX 112FOSAMAX PLUS D 112fosamprenavir calcium 45fosaprepitant dimeglumine30FOSCAVIR45fosfomycin tromethamine23fosinopril sodium 53fosinopril sodium-hctz 53fosphenytoin sodium 27FOSRENOL 94FOSTEUM 80FOSTEUM PLUS 116FOVEX116FRAGMIN 26FREESTYLE LIBRE 14 DAY READER 74FREESTYLE LIBRE 14 DAY SENSOR74FREESTYLE LIBRE 2 READER SYSTM74FREESTYLE LIBRE 2 SENSOR SYSTM 74FREESTYLE LIBRE READER74

FREESTYLE LIBRE SENSOR SYSTEM 74FREESTYLE PRECISION NEO TEST 74FROTEK 15FROVA34frovatriptan succinate34FUL-GLO 125ful-glo 125FULPHILA48fulvestrant 37FUNGIMEZ 32furosemide 53FUSARIUM 116FUSION PLUS 80FUZEON 45fyavolv102FYCOMPA 27GABACAINE 58GABADONE116gabapentin 27GABAPENTIN-NAPROXEN CMPD KIT15GABITRIL27GABLOFEN 135GALAFOLD92galantamine hydrobromide 28galantamine hydrobromide er 28GALZIN 80GAMASTAN106GAMIFANT 106GAMMAGARD 106GAMMAGARD SD LESS IGA107GAMMAKED 107GAMMAPLEX 107GAMUNEX-C 107ganirelix acetate99GARDASIL 9110gas relief 88gas relief extra strength 88GASTROCROM88gatifloxacin 122GATTEX88gavilax88gavilyte-c88gavilyte-g88gavilyte-h88gavilyte-n with flavor pack88GAVRETO 37GAZYVA 37GEBAUERS PAIN EASE 18GEBAUERS SPRAY AND STRETCH 18

150

GELCLAIR 116GELFILM116 125GEL-FLOW 116GEL-FLOW NT 116GELFOAM 116GELFOAM COMPRESSED SIZE 100 116GELFOAM DENTAL PACK SIZE 4 116GELFOAM SPONGE 116GELFOAM SPONGE SIZE 100 116GELFOAM SPONGE SIZE 200 116GELFOAM SPONGE SIZE 50 116GELFOAM-JMI POWDER 116GELFOAM-JMI SPONGE 116GELNIQUE 94GELSYN-3 116GELUSIL88GELX 116gemcitabine hcl 37gemfibrozil 53gemmily102GEN7T 18GEN7T PLUS18GENADUR 65GENERESS FE 102generlac 88gengraf107GENICIN VITA-D 80GENICIN VITA-Q 80GENICIN VITA-S 80GENOTROPIN99GENOTROPIN MINIQUICK99gentak 122gentamicin sulfate 23 122GENTEAL TEARS 125GENTEAL TEARS NIGHT-TIME 125gentle laxative 89GENVOYA 45GEODON 43geri-dryl 129geri-kot 89GERMAN COCKROACH116GIALAX 89gianvi102GILENYA 58GILOTRIF 37GILPHEX TR129GILTUSS TR129GIMOTI 30

GIVLAARI 116GLASSIA133glatiramer acetate 58glatopa 58GLEEVEC 37GLEOLAN 116GLEOSTINE 37glimepiride72glipizide er72glipizide ir 72glipizide xl 72glipizide-metformin hcl 72GLOPERBA 34glostrips125GLUCAGEN HYPOKIT 75GLUCAGON EMERGENCY KIT 75GLUCOTROL72GLUCOTROL XL 72GLUCOVANCE72GLUMETZA 72GLUTARALDEHYDE 116glyburide 72glyburide micronized 72glyburide-metformin 72GLYCATE 89glycine94glycine urologic 94glycolax 89GLYCOPYRROLATE89glycopyrrolate89glycopyrrolate pf89GLYNASE 72GLYSET72GLYTACTIN BETTERMILK 15116GLYTACTIN BETTERMILK DE-LITE 116GLYTACTIN BUILD 10PE 116GLYTACTIN BUILD 2020 116GLYTACTIN BUILD 2020 PKU116GLYTACTIN BURST116GLYTACTIN COMPLETE 10PE 116GLYTACTIN RESTORE 10 116GLYTACTIN RESTORE 5 116GLYTACTIN RESTORE LITE 10 116GLYTACTIN RESTORE LITE 10PE 116GLYTACTIN RTD 10 116GLYTACTIN RTD 15 116GLYTACTIN RTD LITE 15116

GLYTACTIN SWIRL 15PE116GLYXAMBI72gnp aspirin low dose 15gnp senna lax89GOCOVRI 42GOLDENROD116GOLYTELY 89GONAL-F 99GONAL-F RFF 99GONAL-F RFF REDIJECT 99GONITRO 53goodsense antacid89goodsense anti-diarrheal 89goodsense aspirin low dose15goodsense ibuprofen 15goodsense motion sickness31goodsense pain relief11goodsense tussin dm max 129GOPRELTO 18GORDOFILM 65grafco silver nit applicator 65GRALISE 58granisetron hcl 31GRANIX 48GRASTEK116green glo lissamine green125griseofulvin microsize32griseofulvin ultramicrosize32guaiatussin ac 129guaifenesin129guaifenesin ac129guaifenesin-dm 129guanfacine hcl53guanfacine hcl er57GUANIDINE HCL35GUARDIAN CONNECT TRANSMITTER 74GUARDIAN LINK 3 TRANSMITTER 74GUARDIAN SENSOR (3) 74GVOKE HYPOPEN 1-PACK75GVOKE HYPOPEN 2-PACK75GVOKE PFS 75GYNAZOLE-1 32H2Q116HACKBERRY116HAEGARDA107hailey 1530102hailey 24 fe102hailey fe 1530102hailey fe 120102HALAVEN 37halcinonide65

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HALCION 47HALDOL DECANOATE 43halobetasol propionate65HALOBETASOL PROPIONATE 65HALOG 65haloperidol 44haloperidol decanoate44haloperidol lactate44HALUCORT 65HARVONI45HAVRIX110headache relief 11heartburn relief86heather102HELIDAC THERAPY 89HEMADY96HEMANGEOL 53hematinic plus vitminerals80hematinicfolic acid80HEMATOGEN80HEMATOGEN FA 80HEMATRON-AF80HEMETAB80HEMLIBRA48hemmorex-hc 111HEMOCYTE PLUS 80hemocyte-f 80hemocyte-plus80HEMOFIL M 48hemorrhoidal-hc 111HEPAGAM B107heparin (porcine) in nacl 26heparin lock flush 116heparin sodium (porcine) 26heparin sodium (porcine) pf 26heparin sodium lock flush 116HEPLISAV-B110HEPMED117HEPSERA45HERCEPTIN 37HERCEPTIN HYLECTA37HERZUMA 37HETLIOZ136HIBERIX110HIBICLENS 117HIDEX 6-DAY 96high potency probiotic 89HIPREX23HIZENTRA 107hm adult tussin cough amp chest 129hm loratadine 129hm stomach relief89

hm stool softener 89HOMACTIN AA PLUS117homatropaire125HOME PAP KIT 117HONEY BEE VENOM117HORIZANT58HORSE EPITHELIUM117HPR PLUS 65hpr plus 65HPR PLUS HYDROGEL65HUMALOG KWIKPEN 76HUMALOG MIX 5050 KWIKPEN 76HUMALOG MIX 5050 VIAL76HUMALOG MIX 7525 KWIKPEN 76HUMALOG MIX 7525 VIAL76HUMALOG U-100 JUNIOR KWIKPEN 76HUMALOG VIAL 76HUMATE-P 49HUMATROPE 99HUMATROPEN FOR 12MG 117HUMATROPEN FOR 24MG 117HUMATROPEN FOR 6MG 117HUMIRA107HUMIRA PEDIATRIC CROHNS START107HUMIRA PEN 107HUMIRA PEN-CDUCHS STARTER 107HUMIRA PEN-PSUVADOL HS START 107HUMIRA PEN-PSORUVEIT STARTER 107HUMULIN 7030 KWIKPEN 76HUMULIN 7030 VIAL76HUMULIN N KWIKPEN 76HUMULIN N VIAL 76HUMULIN R U-500 KWIKPEN76HUMULIN R U-500 VIAL 76HUMULIN R VIAL 76HYALGAN117HYALUCIL-4 65HYALURONATE-NIACINAM-TRETINOIN65HYALURONATE-NIACIN-TACROLIMUS 65HYALURONIC ACID-HYDROQUINONE 65HYCAMTIN 38HYCODAN 129hydralazine hcl 53

HYDREA 38HYDRO 40 65hydrochlorothiazide53hydrocodone bitartrate er11hydrocodone polst-chlorphen polst er susp129hydrocodone-acetaminophen 11hydrocodone-homatropine 129hydrocodone-ibuprofen 11hydrocortisone 66 96 111hydrocortisone (perianal) 111hydrocortisone ace-pramoxine 66 111hydrocortisone acetate66 111hydrocortisone butyr lipo base 66hydrocortisone butyrate 66hydrocortisone valerate66hydrocortisone-acetic acid 127hydrocortisone-iodoquinol32hydrocort-pramoxine (perianal) 111hydromet 129hydromorphone hcl 11hydromorphone hcl er 11HYDROMORPHONE HCL-NACL 11hydroquinone 66HYDROQUINONE 66HYDROQUINONE-HC-TRETINOIN66HYDROQUINONE-HYDROCORTISONE66hydroxychloroquine sulfate 42hydroxyprogesterone caproate102hydroxyurea 38hydroxyzine hcl 47hydroxyzine pamoate47HYLAFEM 117HYLATOPIC PLUS 66HYLAVITE80HYLAZINC 80HYMOVIS 117hyophen 94hyoscyamine sulfate 89hyoscyamine sulfate er 89hyoscyamine sulfate sl89hyosyne89HYPERHEP B SD107HYPERRAB 107HYPERRAB SD 107HYPERRHO SD107HYPERSAL129HYPERTENSA117

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HYPERTET SD107HYPOCYN 125HYQVIA 107HYSINGLA ER11HYZAAR 53ibandronate sodium 112IBRANCE 38IBUPAK15ibuprofen 15ibuprofen infants 15ICAR-C PLUS 80icatibant acetate107ICLUSIG38icosapent ethyl 53IDAMYCIN PFS 38idarubicin hcl 38IDELVION 49IDHIFA 38iferex 150 forte 80IFEX 38ifosfamide38ILARIS107ILEVRO122ILUMYA107ILUVIEN 122imatinib mesylate 38IMBRUVICA 38IMFINZI 38IMIOXIA 32imipenem-cilastatin 23imipramine hcl29imipramine pamoate 29imiquimod66IMIQUIMOD PUMP66IMIQUIMOD-LEVOCETIRIZIN-NIACIN66IMIQUIMOD-LEVOCET-TRETINOIN66IMITREX 34IMITREX STATDOSE REFILL34IMITREX STATDOSE SYSTEM 34IMLYGIC 38IMODIUM A-D89IMODIUM MULTI-SYMPTOM RELIEF 89IMOGAM RABIES-HT107IMOVAX RABIES110IMPAVIDO 42IMPEKLO 66IMPOYZ 66IMURAN107

IMVEXXY MAINTENANCE PACK 102IMVEXXY STARTER PACK 102inavix15INBRIJA 42incassia 102INCRELEX 99INCRUSE ELLIPTA 133indapamide 53INDERAL LA 53INDERAL XL 53INDOCIN15 16INDOMETHACIN 16indomethacin16indomethacin er 16INFANRIX 110infants gas relief89INFASURF 129INFED 80INFLAMMACIN 16INFLATHERM 16INFLECTRA 107INFUGEM 38INFUMORPH 200 11INFUMORPH 500 11INFUVITE ADULT80INFUVITE PEDIATRIC 80INGREZZA58INLYTA 38INNOPRAN XL53INOVA66INOVA 41 ACNE CONTROL THERAPY 66INOVA 82 ACNE CONTROL THERAPY 66INQOVI 38INREBIC 38INSPIREASE RESERVOIR BAGS 117INSPRA53INSULIN ASP PROT amp ASP FLEXPEN76INSULIN ASPART 76INSULIN ASPART FLEXPEN 76INSULIN ASPART PENFILL76INSULIN ASPART PROT amp ASPART76INSULIN LISPRO76INSULIN LISPRO (1 UNIT DIAL)76INSULIN LISPRO JUNIOR KWIKPEN 76

INSULIN LISPRO PROT amp LISPRO76INSULIN PEN NEEDLES76INSULIN SYRINGES 76INTEGRA F80INTEGRA PLUS80INTELENCE45INTERCEED 117INTERMEZZO136INTRAROSA 94INTRON A45introvale 102INTUNIV57INVANZ23INVEGA 44INVEGA SUSTENNA44INVEGA TRINZA 44INVELTYS122INVIRASE 45INVOKAMET72INVOKAMET XR72INVOKANA 72IODINE STRONG 80iodine tincture23IODOQUIMEZ-HC 32iodoquinol-hc-aloe polysacch32IODOQUINOL-HC-KETOCONAZOLE 32iodoquinol-hydrocortisone-aloe32IOPIDINE 123IOSAT 117IPOL110ipratropium bromide 129 133ipratropium-albuterol 133irbesartan 53irbesartan-hydrochlorothiazide53IRESSA38irinotecan hcl38IROSPAN 24680ISENTRESS45ISENTRESS HD 45isibloom102isoflurane 117ISOLYTE-S 80isoniazid 35ISOPTO ATROPINE 125ISOPTO CARPINE 123ISORDIL TITRADOSE 53isosorbide dinitrate53isosorbide mononitrate53isosorbide mononitrate er 53isotretinoin66ISOVACTIN AA PLUS 117

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isoxsuprine hcl 53isradipine53ISTALOL 124ISTODAX (OVERFILL) 38ISTURISA 99ITHOXIA66itraconazole32ivermectin42IVERMECTIN-METRONIDAZOL-NIACIN 66IXEMPRA KIT 38IXIARO110IXINITY 49JADENU80JADENU SPRINKLE80jaimiess 102JAKAFI38JALYN95jantoven 26JANUMET 72JANUMET XR 73JANUVIA73JARDIANCE73jasmiel102JATENZO98JELMYTO 38jencycla 102JENTADUETO 73JENTADUETO XR 73JEVTANA38jinteli 102JIVI49JOHNSON GRASS117jolessa102JORNAY PM 57JUBLIA32juleber 102JULUCA 45JUNE GRASS POLLEN STANDARDIZED 117junel 1530 103junel 120 103junel fe 1530 103junel fe 120 103junel fe 24 103JUXTAPID53JYNARQUE 80KBGL IN TERODERM 16KADCYLA 38KADIAN11kaitlib fe103KALBITOR 107KALETRA45

kalliga103KALYDECO 134KAMDOY 66KANJINTI 38KANUMA92KAPOK117KAPSPARGO SPRINKLE53KAPVAY57KARBINAL ER 129kariva 103KATARYA 66KATARYAXN 66KATERZIA 53KAXM66KAZANO 73KCL-LIDOCAINE-NACL80KEDRAB 107KEFLEX 23KEIDO66KELARX66kelnor 135 103kelnor 150 103KENALOG66 96KENALOG-80 96KEPIVANCE 59KEPPRA 27KEPPRA XR 27KERAGEL 66KERALAC 66KERALYT66KERALYT SCALP66KERAMATRIX REPLICINE 5CMX5CM 66KERYDIN 32KESIMPTA58KETAMINE HCL 117KETAMINE HCL-SODIUM CHLORIDE 117KETARYA 66ketoconazole32KETOCONAZOLE-HYDROCORTISONE32ketodan 32KETODAN32KETONE TEST 74KETOPHENE RAPIDPAQ 16ketoprofen 16ketoprofen er16KETOROLAC TROMETHAMINE16ketorolac tromethamine 16 122KETOSTIX 74KETOVIE 117

KETOVIE PEPTIDE 117KEVARYA 66KEVEYIS124KEVZARA 107KEXM66KEYA 66KEYTRUDA 38KHAPZORY 38KINERET 107kionex80KISQALI (200 MG DOSE)38KISQALI (400 MG DOSE)38KISQALI (600 MG DOSE)38KISQALI FEMARA (400 MG DOSE)38KISQALI FEMARA (600 MG DOSE)38KISQALI FEMARA(200 MG DOSE)38KITABIS PAK 134KIVIK67KLARITY-A 122KLARITY-L122KLARON 67KLONOPIN 47klor-con 80klor-con 10 80klor-con m10 80KLOR-CON M15 80klor-con m20 80klor-con sprinkle80klor-conef 80KOATE49KOATE-DVI49KOCHIA 117KOGENATE FS 49KOMBIGLYZE XR73KORLYM100KOSELUGO38KOVALTRY49K-PHOS 80K-PHOS NO 280K-PHOS-NEUTRAL 81k-prime 81KRINTAFEL 42KRISTALOSE 89KRYSTEXXA 34K-TAB 81k-tan plus 81kurvelo 103KUTARYAXM67KUTARYAXMPA67KUTEA 67

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KUVAN92KUVARYA67KUVARYE67KUXM67KYLEENA 103KYMRIAH107KYNMOBI 42KYNMOBI TITRATION KIT42KYPROLIS 38labetalol hcl 53LACRISERT125lactic acid 67lactic acid e 67LACTIC ACID-NIACINAMIDE67lactobacillus 89LACTOJEN 89lactulose89lactulose encephalopathy 89LAMBS QUARTERS117LAMICTAL 27LAMICTAL ODT27LAMICTAL STARTER27LAMICTAL XR 27lamivudine45lamivudine-zidovudine 45lamotrigine 27lamotrigine er 27lamotrigine starter kit-blue27lamotrigine starter kit-green 27lamotrigine starter kit-orange 27LAMPIT 42LANCETS 74LANOXIN 53lansoprazole86 87lanthanum carbonate 94LANTUS SOLOSTAR 76LANTUS U-100 VIAL 76lapatinib ditosylate 38larin 1530 103larin 120 103larin 24 fe 103larin fe 1530 103larin fe 120 103larissia103LARTRUVO 38LASIX53LASTACAFT 125latanoprost 124LATANOPROST-TIMOLOL MALEATE 124LATISSE 125LATUDA44lavare wound wash 67

laxative max str 89laxative regular strength89layolis fe 103LAZANDA 11L-CYSTINE 81LDO PLUS 18LEDIPASVIR-SOFOSBUVIR 45leena 103leflunomide107LEMTRADA 58LENSCALE 117LENVIMA (10 MG DAILY DOSE)38LENVIMA (12 MG DAILY DOSE)38LENVIMA (14 MG DAILY DOSE)38LENVIMA (18 MG DAILY DOSE)38LENVIMA (20 MG DAILY DOSE)38LENVIMA (24 MG DAILY DOSE)38LENVIMA (4 MG DAILY DOSE)38LENVIMA (8 MG DAILY DOSE)38LESCOL XL 53lessina103LETAIRIS 134letrozole 38lets 18leucovorin calcium 38LEUKERAN38LEUKINE49leuprolide acetate99levalbuterol hcl 133LEVALBUTEROL HFA133LEVATIO18LEVBID 89LEVEMIR U-100 FLEXTOUCH76LEVEMIR U-100 VIAL76levetiracetam27levetiracetam er 27LEVITRA 94levobunolol hcl 124levocarnitine81levocarnitine sf 81levocetirizine dihydrochloride129levofloxacin 23 122levoleucovorin calcium38levoleucovorin calcium pf39levonest103

levonorgest-eth est amp eth est 103levonorgest-eth estrad 91-day 103levonorgestrel 103levonorgestrel-ethinyl estrad103levonorg-eth estrad triphasic103levora 01530 (28)103levorphanol tartrate 11levo-t 105LEVOTHYROXINE SODIUM 105levothyroxine sodium 105levoxyl 105LEVSIN 89LEVSINSL89LEVULAN KERASTICK 67LEXAPRO 29LEXETTE 67LEXIVA 45LIALDA111LIBRAX 90LIBTAYO39LICART 16lice killing42lice treatment 42LIDO BDK 18lidocaine18 19lidocaine hcl 18 59LIDOCAINE HCL 18lidocaine hcl (pf)18lidocaine hcl urethralmucosal18lidocaine viscous hcl 59lidocaine-hydrocort (perianal) 111LIDOCAINE-HYDROCORTISONE ACE67 111lidocaine-hydrocortisone ace 111lidocaine-prilocaine 19LIDOCAINE-TETRACAINE19LIDOCANNA 19LIDOCORT 111LIDODERM 19LIDO-EPINEPHRINE-TETRACAINE 19LIDOMARK 25 19LIDOPAC 19lidopin19LIDOPIN19LIDOPRIL19LIDOPRIL XR19LIDO-PRILO CAINE PACK19LIDOPURE PATCH 19LIDORX19LIDO-SORB 19LIDOSTREAM19LIDOTHOL 19

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LIDOTRAL 19LIDOTREX 67LIDOVIX L19LIDTOPIC MAX19LILETTA (52 MG)103lillow 103LIMBREL117LIMBREL250117LIMBREL500117LINCOCIN23lincomycin hcl23lindane 42linezolid 23linezolid in sodium chloride 23LINZESS 90LIORESAL 135liothyronine sodium 105LIPITOR 53LIPOFEN53LIPRITIN II 58liquid acetaminophen 11lisinopril 53lisinopril-hydrochlorothiazide53L-ISOLEUCINE 81lissamine green125LISTER-V117lithium48lithium carbonate48lithium carbonate er 48LITHOBID 48LITHOSTAT 94LIVALO 53LIVIXIL PAK 19l-methylfolate81l-methylfolate ca me-cbl nac 81l-methylfolate calcium 81l-methylfolate forte 81l-methylfolate-algae81l-methylfolate-algae-b12-b6 81l-methylfolate-b6-b12 81l-methyl-mc 81l-methyl-mc nac81LMR PLUS 19LO LOESTRIN FE103LOCOID 67LOCOID LIPOCREAM 67LODINE16LODOSYN 42LOESTRIN 1530 (21)103LOESTRIN 120 (21)103LOESTRIN FE 1530 103LOESTRIN FE 120 103lojaimiess 103

LOKELMA 81LOMAIRA58LOMOTIL 90LONHALA MAGNAIR REFILL KIT 133LONHALA MAGNAIR STARTER KIT133LONSURF39loperamide hcl90LOPID 53lopinavir-ritonavir45LOPRESSOR53LOPRESSOR HCT 53LOPROX 33loratadine 129loratadine-d 12hr129loratadine-d 24hr129lorazepam 47lorazepam intensol47LORBRENA 39LORID 81LORMATE117LORTAB11loryna 103LORZONE135losartan potassium53losartan potassium-hctz 53LOSEASONIQUE 103LOTEMAX122LOTEMAX SM 122LOTENSIN 53LOTENSIN HCT53loteprednol etabonate 122LOTREL 53LOTRIMIN AF 33LOTRONEX 90lovastatin53LOVAZA53LOVENOX26low-ogestrel103loxapine succinate 44lo-zumandimine103lubricant eye drops125lubricant eye drops pf125lubricant eye pm125lubricant pm 125lubricating eye drops125lubricating plus eye drops 125LUCEMYRA 20LUCENTIS 125LULICONAZOLE33LUMIGAN124LUMIZYME 92

LUMOXITI 39LUNESTA 136LUPANETA PACK 99LUPRON DEPOT (1-MONTH)99LUPRON DEPOT (3-MONTH)99LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG99LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG99LUPRON DEPOT-PED (1-MONTH)99LUPRON DEPOT-PED (3-MONTH)99LUTATHERA39lutera 103LUXIQ 67LUXTURNA125LUZU33LYDEXA19lyllana103LYNPARZA 39LYRICA 58LYRICA CR58lysiplex plus81LYSODREN 39LYSTEDA49LYUMJEV 76LYUMJEV KWIKPEN76lyza103MVI ADULT81MVI PEDIATRIC 81MAALOX MULTI SYMPTOM MAX ST90MACRILEN 117MACROBID23MACRODANTIN 23MACUTEK 117mafenide acetate 23MAGNEBIND 400 81magnesium citrate90magnesium oxide81 90magnesium sulfate81MAGNESIUM SULFATE81magnesium-oxide81mag-oxide 81MAKENA103MALARONE42malathion 42maprotiline hcl29MARCAINE 19MARCAINE PRESERVATIVE FREE 19MARINOL31

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marlido 19MARLIDO-25 19marlissa103MARPLAN29MARQIBO 39MARVONA SUIK 19MAS CARE-PAK96MASK VORTEX 117MATULANE 39matzim la53MAVENCLAD (10 TABS)58MAVENCLAD (4 TABS)58MAVENCLAD (5 TABS)58MAVENCLAD (6 TABS)58MAVENCLAD (7 TABS)58MAVENCLAD (8 TABS)58MAVENCLAD (9 TABS)58MAVYRET45MAXALT34MAXALT-MLT 34MAXICOMFORT SYR 27G X 1276MAXIDEX122MAXITROL125maxi-tuss ac129maxi-tuss gmx129maxi-tuss pe max129MAXZIDE 53MAXZIDE-2553MAYZENT58MAYZENT STARTER PACK 58m-dryl 129menaphosmbhyo1 94MEADOW FESCUE GRASS POLLEN117meclizine hcl 31meclofenamate sodium16MEDERMA67MEDERMA FOR KIDS67MEDERMA SPF 3067MEDI-DERML-RX 19MEDI-DERM-RX 11MEDI-PATCH RX19MEDPURA ALCOHOL PADS 67MEDROL96MEDROLOAN II SUIK 96MEDROLOAN SUIK 96MEDROX-RX 11medroxyprogesterone acetate 103mefenamic acid16mefloquine hcl42megestrol acetate 103MEKINIST 39

MEKTOVI39MELALEUCA 117melodetta 24 fe 103meloxicam16melphalan 39melphalan hcl39memantine hcl28 29memantine hcl er 28MEMBRANEBLUE125MENACTRA110MENEST 103MENOPUR99MENOSTAR103MENQUADFI 110MENTAX 33MENVEO 110meperidine hcl11MEPHYTON81meprobamate47MEPRON 42MEPSEVII 92mercaptopurine 39meropenem23MEROPENEM-SODIUM CHLORIDE 23MERREM 23mesalamine111mesalamine er 111mesalamine-cleanser111mesna 39MESNEX39MESQUITE 117MESTINON 35metadate er57metafolbic81metafolbic plus 81metafolbic plus rf81METANX 81METAXALL CP 135metaxalone 135metformin hcl er 73metformin hcl er (mod)73metformin hcl er (osm) 73metformin hcl ir 73METHACHOLINE CHLORIDE 117methadone hcl 11 12methadone hcl intensol 11methadose 12methadose sugar-free12methamphetamine hcl57METHAVER 117methazolamide124methenamine hippurate 23

methenamine mandelate 23methergine 117methimazole105METHITEST98methocarbamol 135METHOHEXITAL SODIUM117methotrexate 107methotrexate sodium 108methotrexate sodium (pf) 108methoxsalen rapid67methscopolamine bromide90methyl salicylate67methyldopa 53methyldopa-hydrochlorothiazide53methylergonovine maleate117methylfol-algae-b12-acetylcyst 81METHYLIN57methylphenidate hcl 57methylphenidate hcl er57methylphenidate hcl er (cd)57methylphenidate hcl er (la)57methylphenidate hcl er (xr) 57methylprednisolone96METHYLPREDNISOLONE ACETATE 96methylprednisolone acetate 96methyltestosterone98metoclopramide hcl31metolazone 53METOPIRONE117metoprolol succinate er53metoprolol tartrate54metoprolol-hydrochlorothiazide54METROCREAM 67METROGEL67METROLOTION67metronidazole 23 67METRONIDAZOLE BENZO+SYRSPEND23metyrosine 54mexiletine hcl 54MIACALCIN 112mi-acid 90mi-acid maximum strength90mibelas 24 fe103micaderm 33micafungin sodium 33MICARDIS 54MICARDIS HCT 54MICLARA LQ 129miconazole 133miconazole 333

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miconazole 733miconazole nitrate33MICONAZOLE-ZINC OXIDE-PETROLAT 33MICRHOGAM ULTRA-FILTERED PLUS 108MICRODOT TEST 74microgestin 1530103microgestin 120103microgestin fe 1530103microgestin fe 120103MICROLET NEXT LANCING DEVICE74MICROPLEGIA MSA-MSG81midazolam hcl 47MIDAZOLAM HCL-SODIUM CHLORIDE 47MIDAZOLAM+SYRSPEND SF 47midodrine hcl54MIFEPREX81mifepristone 81MIGERGOT 34miglitol73miglustat92MIGRAINE PACK 34migraine relief 12MIGRANAL 34MIGRANOW 34mili 103milk of magnesia 90MILLIPRED 96MILLIPRED DP 12-DAY 96milrinone lactate54milrinone lactate in dextrose 54mimvey103MIMYX 67MINASTRIN 24 FE103mineral oil heavy 90MINIMED PUMP RESERVOIR 3ML 117MINIPRESS 54minitran 54MINIVELLE 103minocycline hcl23MINOCYCLINE HCL ER23minocycline hcl er 23MINOLIRA24minoxidil 54MINOXIDIL-PROGEST-TRETINOIN67MIRAPEX42MIRAPEX ER42MIRCERA 49

MIRCETTE104MIRENA (52 MG)104mirtazapine 29MIRVASO 67misoprostol87MITE (D FARINAE)117MITE (D PTERONYSSINUS)117MITIGARE34mitigo 12mitomycin39MITOMYCIN 39MITOSOL122mitoxantrone hcl39MIXED ASPERGILLUS117MIXED FEATHERS 117MIXED RAGWEED 117MIXED VESPID VENOM PROTEIN 118MKO MELT DOSE PACK 118mlk f1 118mlk f2 118mlk f3 118mlk f4 118mm stool softener laxative 90M-M-R II 110M-NATAL PLUS81MOBIC 16modafinil 136moexipril hcl 54moisturel 67molindone hcl44mometasone furoate 67 129mondoxyne nl24MONJUVI39mono-linyah 104MONONINE 49MONOVISC 118monsels ferric subsulfate 49montelukast sodium 133MONUROL24MORCIN 118MORGIDOX 24morgidox 24MORPHINE SULFATE 12morphine sulfate 12morphine sulfate (concentrate) 12morphine sulfate (pf) 12morphine sulfate er 12morphine sulfate er beads 12MORPHINE SULFATE-NACL12MOTEGRITY90motion sickness relief31MOTOFEN 90

MOTRIN IB 16MOTRIN INFANTS DROPS16MOUNTAIN CEDAR 118MOUSE EPITHELIUM 118MOUTH KOTE REMINT 59MOVANTIK 90MOVIPREP 90MOXEZA122moxifloxacin hcl24 122moxifloxacin hcl (2x day)122moxifloxacin hcl in nacl 24MOZOBIL49m-pap12MS CONTIN12MUCINEX CHILDRENS FREEFROM129MUCINEX CHILDRENS STUFFY NOSE129MUCINEX DM129MUCINEX FAST-MAX DM MAX 129MUCOR 118MUCOSITISRX 59MUCOTROL 118mucus dm 129mucus relief d130mucus relief dm130mucus relief max st 130mucus-d 130mucus-er max 130MUGARD 118MUGWORT118MULPLETA 49MULTAQ 54MULTIGEN 81MULTIGEN FOLIC81MULTIGEN PLUS 81multiple vitamin-folic acid 81MULTIPRO 81MULTI-SPECIALTY 96multi-vitironfluoride81multivitaminfluoride 81MULTIVITAMINFLUORIDE 82multi-vitaminfluoride 81multi-vitaminfluorideiron 82multivitaminsfluoride 82mupirocin 24mupirocin calcium 24MURO 128 125MUSE94mutamycin39MVASI39MYALEPT 92

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MYAMBUTOL 35MYCAMINE33MYCAPSSA 99MYCOBUTIN 35mycophenolate mofetil 108mycophenolate mofetil hcl 108mycophenolate sodium 108MYDAYIS57MYDRIACYL 125MYFORTIC 108MYLERAN39MYLOTARG39mynephrocaps 82mynephron 82MYOBLOC 118myorisan 67MYRBETRIQ94MYSOLINE 27MYTESI90MYXREDLIN 76na ferric gluc cplx in sucrose82NABI-HB 108nabumetone 16n-acetyl-l-cysteine 82nadolol 54nafcillin sodium 24nafrinse 82NAFRINSE DAILY ACIDULATED 59NAFRINSE DAILYNEUTRAL59nafrinse drops 82NAFRINSE WEEKLY59naftifine hcl33NAFTIN 33NAGLAZYME92nalbuphine hcl12NALFON 16NALOCET 12naloxone hcl20NALTREXONE20naltrexone hcl20NAMENDA 29NAMENDA TITRATION PAK29NAMENDA XR 29NAMENDA XR TITRATION PACK 29NAMZARIC 29NAPRELAN16NAPROSYN16naproxen 16naproxen dr16naproxen sodium 16naproxen sodium er 16

naproxen-esomeprazole 16naratriptan hcl 34NARCAN20NARDIL29NASACORT ALLERGY 24HR 130nasal decongestant130nasal decongestant pe130nasal moisturizing spray 130nasal spray 12 hour 130nasal spray no drip130NASCOBAL 82NASONEX 130NATACYN122NATAZIA104nateglinide73NATESTO 98NATPARA 112NATROBA42natural fiber laxative90natural senna laxative 90NATURE-THROID 105NAVELBINE39NAYZILAM 27NEBUPENT 42necon 0535 (28)104nefazodone hcl29NEOCERA 67NEODOT THERMOMETER 118neomycin sulfate 24neomycin-bacitracin zn-polymyx125neomycin-polymyxin b gu 24neomycin-polymyxin-dexameth 125neomycin-polymyxin-gramicidin125neomycin-polymyxin-hc 126 127NEONATAL + DHA82NEONATAL 1982NEONATAL COMPLETE82NEONATAL FE 82NEONATAL PLUS 82neo-polycin126neo-polycin hc126NEORAL 108NEOSALUS 67NEOSALUS CP 67NEOSPORIN ORIGINAL 67NEOSTIGMINE METHYLSULFATE 35NEO-SYNALAR 67NEO-SYNEPHRINE COLDALLRG MILD130

NEO-SYNEPHRINE COLDALLRGY EXT130NEO-SYNEPHRINE COLDALLRGY REG 130NEOTUSS PLUS 130NEOVITE 82NEPHPLEX RX82NEPHRON FA 82nephronex 82NEPHRO-VITE RX 82NERLYNX 39NESINA73NESTABS 82NESTABS ONE 82neuac 67NEUAC 67NEULASTA 49NEULASTA ONPRO49NEUPOGEN 49NEUPRO42NEURAPTINE59NEUREPA118NEURIN-SL82NEURONTIN27NEVANAC122nevirapine 45nevirapine er 45NEXAVAR39NEXIUM 87NEXLETOL 54NEXLIZET54NEXPLANON104niacin82niacin (antihyperlipidemic) 54niacin er (antihyperlipidemic) 54NIACINAMIDE-SPIRONOLACTONE 67NIACINAMIDE-SULFACETAMIDE67NIACINAMIDE-TACROLIMUS67NIACINAMIDE-TAZAROTENE 67NIACINAMIDE-TRETINOIN67NIACINAMIDE-TRIAMCINOLONE ACET 67NIACIN-SPIRONOLACTON-TRETINOIN67niacor 54NIASPAN 54NICADAN82NICAPRIN118nicardipine hcl 54NICAZEL82NICAZEL FORTE82

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NICAZYME 118NICOMIDE 82NICORETTE 20nicotine polacrilex 20nicotine step 120nicotine step 220nicotine step 320NICOTROL 20NICOTROL NS 20nifedipine54nifedipine er 54nifedipine er osmotic release 54NIFEREX 82nikki104nilutamide39nimodipine54NINLARO 39NIPENT39nisoldipine er54nitazoxanide42nitisinone92NITRO-BID54NITRO-DUR54nitrofurantoin 24nitrofurantoin macrocrystal24nitrofurantoin monohydrate macrocrystals24nitroglycerin54NITROLINGUAL 54NITROMIST 54NITROSTAT54nitro-time 54NITYR 92NIVATOPIC PLUS 67NIVESTYM49nizatidine87NOCDURNA 99nolix67NOPIOID-LMC KIT 135nora-be104NORCO12NORDIPEN 5 INJECTION DEVICE118NORDITROPIN FLEXPRO 99norethin ace-eth estrad-fe104norethindrone104norethindrone acetate 104norethindrone acet-ethinyl est104norethindrone-eth estradiol 104norethin-eth estradiol-fe 104NORGESIC FORTE135norgestimate-eth estradiol 104

norgestimate-ethinyl estradiol triphasic104NORITATE67norlyda 104norlyroc 104NORPACE 54NORPACE CR 54NORPRAMIN 29NORTHERA54nortrel 0535 (28) 104nortrel 135 (21) 104nortrel 135 (28) 104nortrel 777104nortriptyline hcl29NORVASC 54NORVIR 45NOURIANZ 42NOVACORT68novamv pediatric multi-vitamin82novarel 99NOVAREL99NOVOEIGHT 49NOVOFINE AUTOCOVER PEN NEEDLE 76NOVOFINE PEN NEEDLE 76NOVOFINE PLUS PEN NEEDLE76NOVOLIN 7030 FLEXPEN 76NOVOLIN 7030 FLEXPEN RELION77NOVOLIN 7030 RELION 77NOVOLIN 7030 VIAL 77NOVOLIN N FLEXPEN77NOVOLIN N FLEXPEN RELION77NOVOLIN N RELION77NOVOLIN N VIAL 77NOVOLIN R FLEXPEN77NOVOLIN R FLEXPEN RELION77NOVOLIN R RELION77NOVOLIN R VIAL 77NOVOLOG FLEXPEN 77NOVOLOG MIX 7030 FLEXPEN77NOVOLOG MIX 7030 VIAL77NOVOLOG PENFILL 77NOVOLOG U-100 VIAL 77NOVOPEN ECHO74NOVOSEVEN RT 49NOVOTWIST PEN NEEDLE 77NOXAFIL33

NP 2 DRUG PREPARATION KIT 16np thyroid 105NPLATE 49NUBEQA39NUCALA 130NUCARACLINPAK 68NUCARARXPAK68NUCORT68NUCYNTA12NUCYNTA ER12NUDERMRXPAK 120 68NUDERMRXPAK 60 68NUDICLO SOLUPAK16NUDICLO TABPAK16NUDROXIPAK 16NUDROXIPAK DSDR-5016NUDROXIPAK DSDR-7517NUDROXIPAK E-40017NUDROXIPAK I-800 17NUDROXIPAK M-15 17NUDROXIPAK N-500 17NUEDEXTA 59NUFERA 82nufol 82NULEV 90NULOJIX108NULYTELY LEMON-LIME 90NULYTELY WITH FLAVOR PACKS90NUMBRINO 19NUPLAZID 44NURTEC 34NUSURGEPAK SURGICAL PREPCARE 59NUTRASEB 68NUTRIARX CREAMPAK 68NUTRICAP82NUTRIDOX 24nutrifac zx82NUTRIVIT 82NUTROPIN AQ NUSPIN 10 99NUTROPIN AQ NUSPIN 20 100NUTROPIN AQ NUSPIN 5 100NUVAIL 68NUVAKAAN 19NUVAKAAN-II 19NUVARING 104NUVESSA24NUVIGIL136NUWIQ49NUZYRA 24nyamyc33

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NYMALIZE 54nystatin33nystatin-triamcinolone 33nystop 33OBIZUR 49OCALIVA 92ocella104OCREVUS 58OCTAGAM108octreotide acetate 100OCUFLOX122OCUVEL 82ODEFSEY45ODOMZO39odorless coated fish oil 118OFEV 133ofloxacin24 122 127OGIVRI 39olanzapine44olanzapine-fluoxetine hcl 30OLIVE TREE118olmesartan medoxomil54olmesartan medoxomil-hctz 54olmesartan-amlodipine-hctz54olopatadine hcl122 123 130OLUMIANT 108OLUX 68OLUX-E68OMECLAMOX-PAK 90OMEGA-3 RX COMPLETE54OMEGA-3D-3 WELLNESS PACK 54omega-3-acid ethyl esters54omeprazole 87omeprazole magnesium87OMEPRAZOLE+SYRSPEND SF ALKA 87omeprazole-sodium bicarbonate 87OMNARIS 130OMNITROPE 100OMNIVEX 118ONCASPAR39ondansetron hcl 31ondansetron odt 31one daily82ONE VITE WOMENS82ONE VITE WOMENS PLUS 82ONETOUCH DELICA LANCING DEV74ONETOUCH DELICA PLUS LANCING 74ONETOUCH ULTRA74

ONETOUCH ULTRA 2 KIT WDEVICE 74ONETOUCH ULTRA MINI KIT WDEVICE 75ONETOUCH VERIO FLEX SYSTEM KIT WDEVICE75ONETOUCH VERIO IQ SYSTEM 75ONETOUCH VERIO KIT WDEVICE 75ONETOUCH VERIO REFLECT75ONETOUCH VERIO SYNC SYSTEM KIT WDEVICE75ONEVITE 82ONEXTON 68ONFI 27ONGENTYS43ONGLYZA73ONIVYDE39ONPATTRO 59ONTRUZANT39ONUREG 39ONYCHO-MED 33ONZETRA XSAIL34OPDIVO 39opium 90OPSUMIT134OPTIONS CONCEPTROL118ORACEA68ORACIT 82ORALAIR 118ORALAIR ADULT SAMPLE KIT 118ORALAIR ADULT STARTER PACK 118ORALAIR CHILDRENS SAMPLE KIT118ORALAIR CHILDRENS STARTER PACK 118oralone 59ORAMAGICRX 118ORAPRED ODT96ORAVIG 33ORCHARD GRASS POLLEN 118ORENCIA108ORENCIA CLICKJECT 108ORENITRAM 134ORFADIN92ORIAHNN 104ORILISSA 100ORKAMBI 134ORMECA 17

orphenadrine citrate er135orphenadrine-asa-caffeine 135ORPHENGESIC FORTE 135orsythia 104ORTHO DF 82ORTHO MICRONOR 104ORTHOVISC118ORTIKOS111oscimin90oscimin sr90oseltamivir phosphate 45OSENI73OSMOLEX ER 43OSMOPREP 90OSPHENA 98OTEZLA 108OTICIN HC NR 127OTIPRIO 127OTOVEL 127OTREXUP108OVACE PLUS 68OVACE PLUS WASH 68OVACE WASH68OVEEZA 82OVIDE42OVIDREL 100oxacillin sodium24oxaliplatin 39oxandrolone 98oxaprozin 17OXAYDO12oxazepam 47OXBRYTA118oxcarbazepine27OXERVATE 126oxiconazole nitrate 33OXISTAT33OXSORALEN ULTRA68OXTELLAR XR 27oxybutynin chloride 94oxybutynin chloride er 94oxycodone hcl 12OXYCODONE HCL ER 12OXYCODONE-ACETAMINOPHEN12oxycodone-acetaminophen13oxycodone-aspirin13OXYCONTIN13oxymorphone hcl13oxymorphone hcl er 13OXYTOCIN-LACTATED RINGERS100

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OXYTOCIN-SODIUM CHLORIDE 100OXYTROL94OXYTROL FOR WOMEN 94oyster shell calciumd82oyster shell calciumvitamin d 82OZEMPIC73OZOBAX 135OZURDEX 123PACERONE54pacerone 54paclitaxel 39PADCEV 39pain amp fever childrens 13pain amp fever infants 13pain relief 13pain relief childrens 13pain relief extra strength 13pain relief regular strength 13PAINGO KFT 19PALFORZIA (12 MG DAILY DOSE)118PALFORZIA (120 MG DAILY DOSE)118PALFORZIA (160 MG DAILY DOSE)118PALFORZIA (20 MG DAILY DOSE)118PALFORZIA (200 MG DAILY DOSE)118PALFORZIA (240 MG DAILY DOSE)118PALFORZIA (3 MG DAILY DOSE)118PALFORZIA (300 MG MAINTENANCE)118PALFORZIA (300 MG TITRATION)118PALFORZIA (40 MG DAILY DOSE)118PALFORZIA (6 MG DAILY DOSE)118PALFORZIA (80 MG DAILY DOSE)118PALFORZIA INITIAL ESCALATION 118paliperidone er 44palonosetron hcl31PALYNZIQ 92PAMELOR 30pamidronate disodium112PANADOL CHILDRENS 13PANADOL EXTRA13

PANADOL EXTRA STRENGTH 13PANADOL INFANTS 13PANCREAZE 92PANDEL68PANHEMATIN 49PANRETIN39pantoprazole sodium87PANZYGA108papaverine hcl54PARADIGM QUICK-SET 23 9MM 118PARAGARD INTRAUTERINE COPPER104paraplatin 39PAREMYD 126PARI ALTERA NEBULIZER HANDSET119PARI TREK S COMBO PACK 119PARI VORTEX ADULT MASK 119paricalcitol 112PARLODEL43PARNATE 30paroex 59paromomycin sulfate24paroxetine hcl30paroxetine hcl er 30paroxetine mesylate30PARSABIV 112PASER35PATADAY 123PATANASE130PAXIL30PAXIL CR30pb-hyoscy-atropine-scopolamine90P-CARE K40 96P-CARE K40G 96P-CARE K40MX96P-CARE K80 96P-CARE K80G 96P-CARE K80MX96PCP 10090PECAN POLLEN 119pediaclear pd childrens 130PEDIALYTE 82PEDIAPRED 96pediatric electrolyte 82pediavit 82PEDIZOLPAK 33PEDVAX HIB 110peg 3350-kcl-na bicarb-nacl90peg-3350electrolytes90

peg-3350electrolytesascorbat90PEGASYS45PEGINTRON46peg-kcl-nacl-nasulf-na asc-c 90peg-prep90PEMAZYRE 39penicillamine 94penicillin g potassium24penicillin g procaine 24penicillin g sodium24penicillin v potassium 24PENICILLIUM NOTATUM119PENLEN68PENNSAID17PENTAM 42pentamidine isethionate 42PENTASA 111pentazocine-naloxone hcl 13PENTOSAN POLYSULFATE SODIUM94pentoxifylline er 54PEPCID87PEPTO-BISMOL 90PERCOCET 13PERCURA 119PERDIEM OVERNIGHT RELIEF 90PERENNIAL RYE GRASS POLLEN119PERFOROMIST133PERIDEX 59perindopril erbumine 54periogard60PERJETA39permethrin42perphenazine 31perphenazine-amitriptyline30PERSERIS44PERTZYE 92PEXEVA30PFIZERPEN24PH STRIPS 119PHENACTIN AA PLUS 119phenazo 94phenazopyridine hcl 94phendimetrazine tartrate 59phendimetrazine tartrate er59phenelzine sulfate 30PHENERGAN 130phenobarbital 27 28phenobarbital-belladonna alk90phenohytro 90phenoxybenzamine hcl 55

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phentermine hcl 59phentolamine mesylate 55PHENYLEPHRINE HCL 94phenylephrine hcl126PHENYLEPHRINE HCL-NACL55PHENYTEK28phenytoin 28phenytoin infatabs28phenytoin sodium extended 28PHEODOYO 33PHESGO39PHEXXI119PHEYO 33philith104PHLAG SPRAY68PHOMA EXIGUA 119PHOSLYRA 94phospha 250 neutral 82phosphasal94PHOSPHOLINE IODIDE124phosphorous 82phosphorus supplement82phosphorus wsod amp potassium82phospho-trin 250 neutral 83PHOTOFRIN39PHOTREXA-PHOTREXA VISCOUS KIT 119PHOXILLUM BK425 83PHYSICIANS EZ USE B-1283physicians ez use jointtunnel 96PHYSICIANS EZ USE M-PRED 97PHYSIOLYTE 83PHYSIOSOL IRRIGATION 83phytonadione 83PICATO68PIFELTRO 46pilocarpine hcl 60 124pimecrolimus68pimozide44pimtrea 104pindolol55pink bismuth maximum strength 90pioglitazone hcl 73pioglitazone hcl-glimepiride73pioglitazone hcl-metformin hcl 73piperacillin sod-tazobactam so24PIQRAY (200 MG DAILY DOSE)39PIQRAY (250 MG DAILY DOSE)39

PIQRAY (300 MG DAILY DOSE)39pirmella 135 104pirmella 777 104piroxicam17PLAN B ONE-STEP104PLAQUENIL42PLASMA-LYTE 148 83PLASMA-LYTE A83PLAVIX 43PLEGRIDY58PLEGRIDY STARTER PACK 58PLENVU90PLEXION 68PLEXION CLEANSER 68PLEXION CLEANSING CLOTH68PLIAGLIS 19PNEUMOVAX 23 110podactin 33POD-CARE 100K97PODIAPN83podocon 68podofilox68POINT OF CARE L2 97POINT OF CARE L5 97POINT OF CARE LM DEP 297POINT OF CARE LM-2219POINT OF CARE LM-2519POLIVY 39polycin126poly-iron 150 forte 83polymyxin b sulfate 24polymyxin b-trimethoprim126POLYSPORIN24POLYTRIM126POLY-VI-FLOR 83POLY-VI-FLOR FS 83POLY-VI-FLORIRON 83poly-vite pediatric 83POMALYST 39portia-28104PORTRAZZA 39posaconazole33POTABA 83potassium chloride 83potassium chloride crys er 83potassium chloride er83potassium chloride in nacl83potassium citrate er83potassium citrate-citric acid83POTELIGEO 39POVIDONE-IODINE 123

PR BENZOYL PEROXIDE68pr benzoyl peroxide wash 68PR CREAM 68PRADAXA26PRALUENT55pramipexole dihydrochloride 43pramipexole dihydrochloride er43pramosone 68PRAMOSONE68PRAMOTIC 127pramox 68PRASTERA17prasugrel hcl 43PRAVACHOL55pravastatin sodium55PRAXBIND119praziquantel 42prazosin hcl55PRE amp POST SX POUCH68PRECEDEX 119PRECISION LINK 75PRECISION PCX PLUS TEST 75PRECISION QID MONITOR75PRECISION QID TEST75PRECISION SOF-TACT MONITOR 75PRECISION SOF-TACT TEST 75PRECISION XTRA75PRECISION XTRA BLOOD GLUCOSE 75PRECISION XTRA KETONE75PRECISION XTRA MONITOR75PRECOSE 73PRED FORTE123PRED MILD 123PRED-G 126PRED-G SOP 126prednicarbate 68PREDNISOL ACE-MOXIFLOX-BROMFEN 123prednisolone 97prednisolone acetate123prednisolone acetate p-f 123PREDNISOLONE ACETATE-NEPAFENAC 126PREDNISOLONE ACET-MOXIFLOXACIN126prednisolone sodium phosphate 97 123PREDNISOLONE-BROMFENAC 126PREDNISOLONE-GATIFLOXACIN126

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PREDNISOLONE-MOXIFLOXACIN126PREDNISOLON-GATIFLOX-BROMFENAC 126PREDNISOLON-MOXIFLOX-BROMFENAC 126PREDNISOLON-MOXIFLOX-NEPAFENAC 123prednisone 97prednisone intensol97PREFEST 104pregabalin 59PREGENNA83pregnyl 100PREMARIN 104PREMESISRX 83PREMIUM CONDOMS LUBRICATED 119premium lidocaine19PREMIUM SCAR 19PREMPHASE 104PREMPRO104PRENAISSANCE83PRENARA83prenatal 83prenatal plus iron 83prenatal vitamin plus low iron83PRENATE 83PRENATE DHA 83PRENATE ELITE 83PRENATE ENHANCE 83PRENATE ESSENTIAL 83PRENATE MINI 83PRENATE PIXIE83PRENATE RESTORE83PRENATRIX 83PRENATRYL 83PRENATVITE COMPLETE83PRENATVITE PLUS 83PRENATVITE RX 84PREPIDIL94PREPIV SUPPLY19preplus 84PRESERA68PRESTALIA 55pretab84PRETOMANID 35PREVACID87PREVACID 24HR 87PREVACID SOLUTAB87prevalite 55PREVIDENT 60

PREVIDENT 5000 BOOSTER PLUS60PREVIDENT 5000 DRY MOUTH60PREVIDENT 5000 ENAMEL PROTECT60PREVIDENT 5000 ORTHO DEFENSE 60PREVIDENT 5000 PLUS 60PREVIDENT 5000 SENSITIVE60PREVIDOLRX ANALGESIC 17previdolrx plus analgesic17previfem 104PREVNAR 13110PREVYMIS 46PREZCOBIX 46PREZISTA 46PRIALT 13PRID 119PRIFTIN 35PRILO PATCH 19PRILO PATCH II 19PRILOLID19PRILOSEC87PRILOVIX 19PRILOVIX LITE19PRILOVIX LITE PLUS 19PRILOVIX PLUS 19prilovix ultralite 19prilovix ultralite plus19PRILOVIXIL 19PRIMACARE84primaquine phosphate 42primidone 28PRIMLEV 13PRIMSOL24PRINIVIL 55PRISTIQ30PRIVET 119PRIVIGEN108PRIZOPAK II19PRIZOTRAL19PRIZOTRAL-II19PROAIR DIGIHALER133PROAIR HFA 133PROAIR RESPICLICK133probenecid 34PROBICHEW90PROBUPHINE IMPLANT KIT 13procainamide hcl55PROCARDIA55PROCARDIA XL 55PRO-C-DURE 5 97

PRO-C-DURE 6 97PROCENTRA 57prochlorperazine 31prochlorperazine maleate 31PROCORT 111PROCRIT49PRO-CRITIC 119PROCTOCORT 111PROCTOFOAM HC 111procto-med hc 111procto-pak 111proctozone-hc 111PROCYSBI 92PRODIGEN90PROFESSIONAL DNA COLLECTION 119PROFILNINE 49progesterone104PROGESTERONE COMPOUNDING KIT104progesterone micronized 104PROGESTERONE MICRONIZED 104PROGESTERONE-MINOXIDIL68PROGLYCEM 75PROGRAF 108PROLASTIN-C133PROLATE 13PROLENSA 123PROLEUKIN 39PROLEVA 119PROLIA112PROMACTA49PROMACTIN AA PLUS 20PE 119PROMELLA IN PREBIOTIC 90promethazine hcl130promethazine-codeine 130promethazine-dm 130promethazine-phenyleph-codeine 130promethazine-phenylephrine 130promethegan130PROMETRIUM 104PROMISEB 68PRONEB ULTRA FILTER SET 119propafenone hcl 55propafenone hcl er 55propantheline bromide 90proparacaine hcl 126proparacaine-fluorescein 126PROPECIA 68

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PROPEL 130PROPEL MINI130propranolol hcl 55propranolol hcl er 55propranolol-hctz 55propylthiouracil 105PROSCAR 95PROSILK 68PROSTIN E294PROTEINEX P1884PROTEXA68PROTONIX 87PROTOPIC 68protriptyline hcl30PROTYL AG 68PROVENGE108PROVENTIL HFA 133PROVERA 104PROVIGIL 136PROZAC 30PRUCLAIR68PRUDOXIN 68PRUMYX68pseudoephedrine hcl er 130pseudoephedrine-bromphen-dm 130pseudoephedrine-guaifenesin er130PSORCON68PSORIZIDE FORTE 119PSORIZIDE ULTRA119PULMICORT FLEXHALER133PULMICORT SUSPENSION 133PULMONA 119PULMOZYME 134PURAMINO DHAARA119purevit dualfe plus84PURIXAN 39PYLERA90pyrazinamide35PYRIDIUM 94pyridostigmine bromide35pyridostigmine bromide er35PYRIDOXINE HCL84pyridoxine hcl 84pyrimethamine 42PYRIMETHAMINE-LEUCOVORIN 42PYROGALLIC ACID 68QBRELIS 55QBREXZA68qc aspirin low dose 17qc magnesium citrate91

QDOLO 13QINLOCK39QMIIZ ODT 17QNASL130QNASL CHILDRENS 130QSYMIA 59QTERN 73QUAD-MIX 94QUAD-PROBIOTIC91QUALAQUIN42QUARTETTE 104quazepam 47QUDEXY XR28QUEEN PALM 119QUESTRAN 55QUESTRAN LIGHT 55quetiapine fumarate 44quetiapine fumarate er 44QUFLORA FE 84QUFLORA FE PEDIATRIC84QUFLORA GUMMIES 84QUFLORA PEDIATRIC 84QUILLICHEW ER57QUILLIVANT XR 57quinapril hcl55quinapril-hydrochlorothiazide 55quinidine gluconate er55quinidine sulfate 55quinine sulfate42QUINIXIL68QUINJA33QUTENZA68QUTENZA (2 PATCH) 68QVAR REDIHALER 133ra acetaminophen rapid melts13ra omeprazole-sodium bicarb 87RABAVERT110RABBIT EPITHELIUM 119RABEPRAZOLE SODIUM 87rabeprazole sodium 87RADIAGEL68RADIAPLEXRX68RADICAVA59RADIOGARDASE 119RAGWITEK119raloxifene hcl98ramelteon 136ramipril 55RANEXA 55ranolazine er 55RAPAFLO 95RAPAMUNE108RAPID GEL RX119

rasagiline mesylate 43RASUVO108RAVICTI92RAYALDEE112RAYOS 97RAZADYNE ER 29READYSHARP ANESTH + METHYLPRED 97READYSHARP BETAMETHASONE97READYSHARP DEXAMETHASONE 97READYSHARP KETOROLAC 17READYSHARP-A19REBIF 58REBIF REBIDOSE58REBIF REBIDOSE TITRATION PACK 58REBIF TITRATION PACK58REBINYN 49REBLOZYL 49RECARBRIO24RECEDO68RECLAST 112reclipsen104RECOMBINATE49RECOMBIVAX HB 110RECOTHROM 49RECOTHROM SPRAY KIT49RECTIV55RECURA33RED BIRCH 119RED CEDAR119RED MAPLE 119RED MULBERRY 119RED TOP GRASS POLLEN 119REDITREX108REFISSA68REFRESH RELIEVA126REFRESH RELIEVA PF 126REGENECARE68REGIOCIT26REGLAN 31REGRANEX68RELADOR PAK 19RELADOR PAK PLUS 19RELAFEN 17RELAFEN DS 17RELENZA DISKHALER 46relexxii 57RELION BLOOD GLUCOSE TEST75RELION ULTIMA TEST 75

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RELISTOR 91RELNATE DHA84RELPAX34REMEDIENT84remergent hq69REMERON30REMERON SOLTAB 30REMICADE 108REMIGEN 69REMODULIN 134RENACIDIN 94RENAGEL94renal 84RENAL MULTIVITAMIN FORMULA 84RENATABS84RENATABS WITH IRON 84rena-vite 84RENFLEXIS 108reno caps 84RENOVA69RENOVA PUMP 69RENOVO 20RENVELA 94repaglinide 73REPATHA 55REPATHA PUSHTRONEX SYSTEM 55REPATHA SURECLICK 55REQ 49+ 84RESECTISOL 119RESORCINOL-SULFUR69RESOURCE THICKENUP JUICE119RESTASIS 126RESTASIS MULTIDOSE 126RESTORA RX91RESTORIL 136RETACRIT 49RETEVMO 39RETIN-A69RETIN-A MICRO GEL 004 01 69RETIN-A MICRO PUMP 69RETISERT 123RETROVIR 46REVATIO 134REVCOVI92REVESTA 84REVLIMID 39REXAPHENAC 17REXASIL PATCH amp VITAMIN E LIQ69

REXULTI44REYATAZ 46REYVOW 34RHEUMATE119RHIZOPUS 119RHOFADE 69RHOGAM ULTRA-FILTERED PLUS108RHOPHYLAC108RHOPRESSA 124RIASTAP49RIAX69ribavirin 46RIBOZEL119RIDAURA109rifabutin 35rifampin 35RIFAMPIN+SYRSPEND SF 35RILUTEK59riluzole59rimantadine hcl46RIMSO-50 94ringers irrigation 84RINVOQ109RIOMET 73RIOMET ER 73risedronate sodium 112RISPERDAL44RISPERDAL CONSTA44risperidone 44RITALIN 57RITALIN LA57ritonavir 46RITUXAN 40RITUXAN HYCELA39rivastigmine29rivastigmine tartrate 29rivelsa104RIXUBIS49rizatriptan benzoate 34ROBAXIN-750135ROBITUSSIN 12 HOUR COUGH CHILD130ROBITUSSIN COUGH+CHEST CONG DM130ROCALTROL 112ROCKLATAN 124ROMIDEPSIN 40ropinirole hcl43ropinirole hcl er 43rosadan 69ROSADAN 69ROSE GLO 126

rosuvastatin calcium 55ROTARIX 110ROTATEQ110ROUGH MARSH ELDER119ROUGH PIGWEED119ROWASA 112roweepra 28ROXICODONE 13ROZEREM 136ROZLYTREK 40RUBRACA 40RUCONEST109rufinamide 28RUKOBIA46RUSSIAN THISTLE 119RUXIENCE 40RUZURGI119RYBELSUS73RYCLORA130RYDAPT 40RYTARY 43RYTHMOL SR 55ryvent 130SABRIL 28saccharomyces boulardii 91SACCHAROMYCES CEREVISIAE 119SAFYRAL104SAGEBRUSH 119SAIZEN 100SAIZENPREP 100SALAGEN 60SALEX 69SALICEPT119salicylic acid 69salicylic acid er69salicylic acid wart remover 69salicylic acid-cleanser 69SALICYLIC ACID-SULFACETAMIDE69salimez69SALIMEZ FORTE 69SALIVAMAX60salsalate17SALVAX 69SALVAX DUO PLUS69SAMSCA84SANADERMRX SKIN REPAIR69SANCUSO 31SANDIMMUNE 109SANDOSTATIN 100SANDOSTATIN LAR DEPOT 100SANTYL 69

166

SAPHRIS 44sapropterin dihydrochloride92SARCLISA 40SAVAYSA 26SAVELLA 59SAVELLA TITRATION PACK 59SAXENDA59SCALACORT DK 69SCARCARE GEL-PAD KITLARGE 69SCARCIN69SCARSILK 69SCARZEN SKIN REPAIR 69SCENESSE 69scopolamine31SCRUB CARE POVIDONE-IODINE24SEASONIQUE 104SECUADO 44SEEBRI NEOHALER 133SEGLUROMET73SELECT-OB84selegiline hcl 43selenium sulfide 69SELRX 69SELZENTRY46SEMGLEE77SEMPREX-D130senexon-s 91senna 91senna plus91senna s 91senna smooth 91senna-docusate sodium91senna-plus 91SENOKOT EXTRA STRENGTH 91SENOKOT S 91SENSIPAR112sensorcaine20sensorcaine-mpf 20SENTRA AM 119SENTRA PM 119SEREVENT DISKUS 133SERNIVO69SEROQUEL 44SEROQUEL XR 44SEROSTIM 91sertraline hcl30se-tan plus 84setlakin104sevelamer carbonate 94sevelamer hcl94

SEVENFACT 49sevoflurane 119SEYSARA 24sf 60sf 5000 plus60SFROWASA 112SHAGBARK HICKORY120sharobel 104SHARPS CONTAINER 120SHEEP SORREL 120SHINGRIX110SHORT RAGWEED POLLEN EXT 120SIDEROL 84SIGNIFOR100SIGNIFOR LAR100SIKLOS 40SILA III 69sildenafil citrate 94 134SILENOR 136SILIPAC 69SILIQ109silodosin 95SILTREX 120SILVADENE24silver nitrate24silver sulfadiazine24SILVERSEAL HYDROGEL DRESSING 69SIMBRINZA 124simethicone91simliya 104simpesse104SIMPONI109SIMPONI ARIA 109SIMULECT109simvastatin 55SINEMET 43SINGULAIR133sinus 12 hour 130SINUVA130sirolimus109SIRTURO35SITAVIG46SIVEXTRO24skarjel69SKELAXIN 135SKLICE 42SKYLA 104SKYRIZI (150 MG DOSE)109sleep aid (diphenhydramine)136sleep-aid 136

SLOWMAG MG MUSCLEHEART84SLYND 104sod citrate-citric acid 84sodium bicarbonate84 91SODIUM BICARBONATE84 91sodium chloride84 130sodium chloride (hypertonic)126sodium chloride (pf) 84sodium fluoride60 84sodium fluoride 5000 plus 60sodium fluoride 5000 ppm60sodium fluoride 5000 sensitive60sodium hyaluronate69SODIUM HYALURONATE120sodium phenylbutyrate92sodium polystyrene sulfonate 84sodium sulfacetamide 69sodium sulfacetamide wash69SODIUM SULFACETAMIDE-BAKUCHIOL 70SOFOSBUVIR-VELPATASVIR46SOLARAVIX70solifenacin succinate94SOLIQUA 73SOLIRIS49SOLODYN 24SOLOSEC24SOLOX70SOLTAMOX 40SOLU-CORTEF 97soluvita e84SOMA 135SOMATULINE DEPOT 100SOMAVERT100SOOLANTRA70soothe 91SOOTHEE 20SORBITOL120sorbitol-mannitol120SORIATANE 70SORILUX 70SORRELDOCK MIX 120sotalol hcl 55sotalol hcl (af)55SOTYLIZE55SOVALDI 46SPEEDGEL RX120spinosad42SPINRAZA 120SPINY PIGWEED 120SPIRIVA HANDIHALER133SPIRIVA RESPIMAT 133

167

spironolactone55spironolactone-hctz55SPORANOX33SPORANOX PULSEPAK33SPRAVATO (56 MG DOSE) 30SPRAVATO (84 MG DOSE) 30sprintec 28 104SPRITAM 28SPRIX 17SPRYCEL 40sps 84sronyx 105ssd 24SSKI130sss 10-5 70ST JOSEPH LOW DOSE17STALEVO 100 43STALEVO 125 43STALEVO 150 43STALEVO 200 43STALEVO 50 43STALEVO 75 43STAMARIL 110STARLIX 73stavudine46STAXYN94STEGLATRO 73STEGLUJAN73STELARA109STEMPHYLIUM 120STENDRA94STERITALC 133STIMATE 100stimulant laxative 91STIOLTO RESPIMAT 133STIVARGA40stomach relief91stool softener 91stool softener laxative 91stool softener plus laxative91stool softenerlaxative 91stop lice complete treatment 42STRATA CTX70STRATA GRT 70STRATA MARK 70STRATA TRIZ70STRATA XRT70STRATTERA57STRENSIQ92streptomycin sulfate 24STRIBILD46STRIVERDI RESPIMAT 133STROMECTOL 42

STROVITE FORTE84STROVITE ONE 84SUBLOCADE20SUBOXONE20SUBSYS 13subvenite28subvenite starter kit-blue28subvenite starter kit-green 28subvenite starter kit-orange 28SUCCINYLCHOLINE CHLORIDE 59SUCRAID92sucralfate 87SUDAFED CONGESTION130sudogest 131sudogest 12 hour 130sudogest maximum strength130SULAR 55SULCONAZOLE NITRATE33sulfacetamide sodium 70 123sulfacetamide sodium (acne) 70sulfacetamide sodium-sulfur 70sulfacetamide sod-sulfur wash70sulfacetamide-prednisolone 126sulfacetamide-sulfur in urea70sulfacleanse 84 70sulfadiazine 25sulfamethoxazole-trimethoprim25sulfamez wash 70SULFAMYLON25sulfasalazine 112sulfatrim pediatric25SULFURATED LIME42sulindac17SUMADAN 70SUMADAN WASH 70SUMADAN XLT 70sumatriptan 34sumatriptan succinate 34 35sumatriptan succinate refill 34sumatriptan-naproxen sodium 35SUMAXIN70SUMAXIN CP70SUMAXIN WASH70SUNOSI 136SUPARTZ FX120SUPER BI-MIX94SUPER QUAD-MIX94SUPER TRI-MIX 94SUPERVITE84support 84SUPPORT-500 84SUPPRELIN LA 100

SUPRANE120SUPRAX 25SUPREP BOWEL PREP KIT91sure result dss premium pack 17SURE RESULT O3D3 SYSTEM 55SURESTEP PRO HIGH GLUCOSE 75SURESTEP PRO LOW GLUCOSE 75SURESTEP PRO NORMAL GLUCOSE 75SURVANTA 131SUSTIVA46SUTAB 91SUTENT40SUVICORT 70SWEET GUM120SWEET VERNAL GRASS POLLEN120SX1 MEDICATED POST-OPERATIVE 20syeda 105SYLVANT40SYMAX DUOTAB 91symax-sl91symax-sr 91SYMBICORT133SYMBYAX30SYMDEKO 134SYMFI 46SYMFI LO 46SYMJEPI133SYMLINPEN 120 73SYMLINPEN 60 73SYMPAZAN 28SYMPROIC91SYMTUZA46SYNAGEX85SYNAGIS 109SYNALAR 70SYNALAR (CREAM)70SYNALAR (OINTMENT) 70SYNALAR TS70SYNAPRYN FUSEPAQ 13SYNAREL 100SYNDROS 31SYNERA 20SYNERDERM 70SYNJARDY73SYNJARDY XR73SYNRIBO40SYNTHROID105

168

SYNVEXIA TC 20SYNVISC 120SYNVISC ONE 120SYPRINE 85SYRINGE AVITENE 120SYSTANE COMPLETE 126SYSTANE HYDRATION PF 126SYSTANE ICAPS AREDS2 85SYSTANE ULTRA PF126TABLOID40TABRADOL FUSEPAQ 135TABRADOL RAPIDPAQ 135TABRECTA40TACHOSIL 120TACLONEX70TACROLIMUS 70tacrolimus70 109tadalafil 94tadalafil (pah) 134TAFINLAR40TAGRISSO 40TAKHZYRO 109TALICIA 91TALIVA85TALL RAGWEED120TALTZ 109TALZENNA 40TAMIFLU46tamoxifen citrate40tamsulosin hcl 95TAPAZOLE 105TAPERDEX 12-DAY 97TAPERDEX 6-DAY 97TAPERDEX 7-DAY 97TARCEVA 40TARDEOXIA 70TARDIMAXIA 70TARGADOX25TARGRETIN 40tarina 24 fe 105tarina fe 120 105tarina fe 120 eq 105TARKA 55TARON FORTE 85taron-crystals 85TAROXIA 70TASIGNA 40TASMAR 43TASOPROL 70tavaborole 33TAVALISSE 49TAXOTERE40TAYTULLA105

tazarotene 70tazicef25TAZORAC70 71taztia xt55TAZVERIK 40TDVAX 110TECARTUS40TECENTRIQ 40TECFIDERA58TEFLARO 25TEGRETOL28TEGRETOL-XR 28TEGSEDI 59TEKTURNA55TEKTURNA HCT 55telmisartan 55telmisartan-amlodipine55telmisartan-hctz55temazepam 136TEMIXYS 46TEMODAR 40TEMOVATE 71temozolomide40temsirolimus109tencon 13teniposide40TENIVAC 110tenofovir disoproxil fumarate46TENORETIC 100 55TENORETIC 50 55TENORMIN56TEPADINA 40TEPEZZA100terazosin hcl95terbinafine hcl33terbutaline sulfate133terconazole 33TERIPARATIDE (RECOMBINANT) 112terrell 120TESSALON PERLES131TESTIM98TESTONE CIK 98TESTOPEL 98TESTOSTERONE98testosterone 98TESTOSTERONE COMPOUNDING KIT98TESTOSTERONE CYPIONATE 98testosterone cypionate98testosterone enanthate 98

TETANUS-DIPHTHERIA TOXOIDS TD 110tetrabenazine 59tetracaine hcl126tetracycline hcl 25TETRIX 71TEXACORT 71THALOMID 40THEO-24133theophylline133theophylline er133THERAMINE120THERAMINE PLUS 120thiamine hcl85THIOLA 94THIOLA EC 94thioridazine hcl 44thiotepa 40thiothixene44THROMBATE III 26THROMBI-GEL 10 120THROMBI-GEL 100 120THROMBI-GEL 40 120THROMBIN-JMI50THROMBIN-JMI EPISTAXIS 49THROMBI-PAD120THROMBOGEN50THYMOGLOBULIN109THYROGEN120tiadylt er 56tiagabine hcl28TIAZAC 56TIBSOVO 40TICE BCG 109TIGAN 31tigecycline 25TIGLUTIK59TIKOSYN 56tilia fe105timolol maleate56 124timolol maleate pf124TIMOLOL-BRIMON-DORZOL-LATANOPR124TIMOLOL-BRIMONIDINE-DORZOLAMID 124TIMOLOL-DORZOLAMID-LATANOPROST 124TIMOPTIC124TIMOPTIC OCUDOSE124TIMOPTIC-XE124TIMOTHY GRASS POLLEN ALLERGEN120tinidazole25

169

TIROSINT 105TIROSINT-SOL105TISSEEL 120tis-u-sol 85TIVICAY 46TIVICAY PD 46TIVORBEX17tizanidine hcl 135tl hydroquinone 71tl-hem 150 85TL-ICARE120TOBAKIENT120TOBI NEBULIZER 134TOBI PODHALER134TOBRADEX 126TOBRADEX ST126tobramycin 123 134TOBRAMYCIN 134tobramycin-dexamethasone126TOBREX 123TOLAK 71tolbutamide 73tolcapone 43tolmetin sodium17tolnaftate 33tolnaftate antifungal33TOLSURA 33tolterodine tartrate94tolterodine tartrate er94TOLVAPTAN85tolvaptan 85TOPAMAX 28TOPAMAX SPRINKLE28TOPEX TOPICAL ANESTHETIC 60TOPICORT 71TOPICORT SPRAY 71TOPIDEX 97topiramate 28topiramate er28toposar 40topotecan hcl40TOPROL XL56toremifene citrate 40TORISEL109TORONOVA II SUIK 17TORONOVA SUIK 17torsemide 56TOSYMRA 35TOTECT40TOUJEO MAX SOLOSTAR 77TOUJEO SOLOSTAR77tovet 71

TOVET 71TOVIAZ 94TOXICOLOGY SALIVA COLLECTION 120TRACLEER134TRADJENTA73TRAMADOL HCL ER13tramadol hcl er 13tramadol hcl er (biphasic)13tramadol hcl ir 13tramadol-acetaminophen 13trandolapril 56trandolapril-verapamil hcl er56tranexamic acid50TRANEXAMIC ACID-NACL 50TRANSDERM SCOP (15 MG)31TRANSDERM-SCOP (15 MG)31TRANXENE-T 47tranylcypromine sulfate 30TRANZGEL120TRAUMEEL 120TRAVATAN Z124travel sickness 31travoprost (bak free)124TRAZIMERA 40trazodone hcl 30TREANDA40TRECATOR 35TRELEGY ELLIPTA134TRELSTAR MIXJECT100TREMFYA109TREPADONE120treprostinil 134TRESIBA77TRESIBA FLEXTOUCH77tretinoin 40 71tretinoin (emollient) 71tretinoin microsphere 71tretinoin microsphere pump 71TRETTEN 50TREXALL 109TREXIMET35TREZIX 13tri femynor 105triamcinolone acetonide 60 71 97TRIAMCINOLONE ACETONIDE 97TRIAMSIL COMBIPAK 71TRIAMSIL MULTIPAK 71triamterene56triamterene-hctz 56trianex 71triazolam 47

TRIBENZOR 56tri-buffered aspirin 17TRICARE PRENATAL DHA ONE 85TRI-CHLOR 71TRICHOPHYTON 120TRICHOPHYTON MENTAGROPHYTES120TRICITRASOL 26tricitrates 85tricon 85TRICOR 56triderm71TRIDESILON 71trientine hcl85tri-estarylla 105TRIFERIC 85trifluoperazine hcl44trifluridine 123trihexyphenidyl hcl 43TRIJARDY XR 73TRIKAFTA134tri-legest fe 105TRILEPTAL28tri-linyah 105TRILIPIX 56TRILOAN II SUIK 97TRILOAN SUIK 97tri-lo-estarylla 105tri-lo-marzia 105tri-lo-mili 105tri-lo-sprintec 105TRI-LUMA 71TRILURON120trilyte 91trimethobenzamide hcl31trimethoprim 25tri-mili 105trimipramine maleate 30TRI-MIX94trinate 85TRINAZ 85TRINTELLIX30triphrocaps 85triple antibiotic 71triple antibiotic+pain relief 71TRIPLE COMPLEX FORMULA 3 KIT 17TRIPLE PMB123TRIPLE PMK123tri-previfem 105triprolidine hcl131TRIPTODUR 100

170

TRISENOX40tri-sprintec 105TRISTART ONE85TRIUMEQ 46TRI-VI-FLOR85TRI-VI-FLORO 85tri-vite pediatric85tri-vitefluoride 85TRIVIX 71trivora (28)105tri-vylibra 105tri-vylibra lo105TRIZIVIR 46TRODELVY40TROGARZO46TROKENDI XR 28TRONVITE85tropicamide 126TROPICAMIDE-CYCLOPENTOLATE-PE 126TROPICAMIDE-PHENYLEPHRINE126TROPIC-CYCLOPENT-PE-KETOROLAC126TROPIC-CYCLOP-PE-KETO-PROPAR126TROPIC-PROPARACA-PE-KETOROLAC127trospium chloride94trospium chloride er 94TRUE METRIX BLOOD GLUCOSE TEST 75TRUE METRIX LEVEL 1 75TRUE METRIX LEVEL 2 75TRUE METRIX LEVEL 3 75TRUE METRIX PRO BLOOD GLUCOSE 75TRUETRACK TEST75TRULANCE91TRULICITY 73TRUMENBA110TRUSOPT124TRUSTEEL INFUSION SET 120TRUVADA46TRUXIMA40TRYPTOPHAN 85T-SUPPORT MAX 120TUDORZA PRESSAIR 134TUKYSA40tulana 105TUMS CHEWY BITES 91TURALIO 40TURPENTINE 71

TUSSICAPS131tussin cf multi-symptom cold131tussin dm131tussin dm max131tussin dm max adult 131TUXARIN ER 131TUZISTRA XR 131TWINRIX110TWIRLA 105TWYNSTA 56tyblume 105TYBOST46tydemy 105TYGACIL25TYKERB40TYLACTIN BUILD 20PE TYR 120TYLACTIN COMPLETE 15 PE 120TYLACTIN RESTORE 10 120TYLACTIN RESTORE 5PE 120TYLACTIN RTD 15 120TYLENOL13TYLENOL 8 HOUR 13TYLENOL EXTRA STRENGTH 13TYLENOL INFANTS PAIN+FEVER13TYMLOS 112TYPHIM VI 110TYROS 2120TYSABRI58TYVASO 134TYVASO REFILL 134TYVASO STARTER134UBRELVY 35UCERIS 112UDAMIN SP 85UDENYCA 50ULORIC 34ULTANE120ULTOMIRIS 50ultra fresh pm 127ultra lubricating eye drops127ULTRACET 13ULTRAFOAM SPONGE 2X625X7CM120ULTRAFOAM SPONGE 8X125X1CM120ULTRAFOAM SPONGE 8X125X3CM121ULTRAFOAM SPONGE 8X25X1CM121

ULTRAFOAM SPONGE 8X625X1CM121ULTRAM 13ULTRASAL-ER 71ULTRAVATE71UMECTA MOUSSE 71UNASYN 25UNISTRIP CONTROL75unithroid 105UNITUXIN 40UPLIZNA109UPNEEQ123UPTRAVI 134URAMAXIN 71urea71UREA 71urea hydrating 71urea nail 71urea-c4071ureacin-10 71ureacin-20 71uredeb71URELLE 94uremez-4071URESOL 71uretron ds94URIBEL 94URIMAR-T 94urin ds 94urinary pain relief 95URO-45895UROCIT-K 1085UROCIT-K 1585UROCIT-K 585UROGESIC-BLUE 95uro-mp95urosex 85UROXATRAL 95URSO 25091URSO FORTE 91ursodiol 91URSODIOL+SYRSPEND SF91ustell 95UTIBRON NEOHALER 134uticap 95utira-c 95UTOPIC 71utrona-c95VAGIFEM105valacyclovir hcl46VALCHLOR40VALCYTE46valganciclovir hcl46

171

VALIUM47valproic acid 28valrubicin40valsartan 56valsartan-hydrochlorothiazide 56VALSTAR40VALTOCO 10 MG DOSE28VALTOCO 15 MG DOSE28VALTOCO 20 MG DOSE28VALTOCO 5 MG DOSE28VALTREX46VANADOM135VANATOL LQ 14VANCOCIN 25VANCOCIN HCL25vancomycin hcl 25vancomycin hcl in nacl 25VANCOMYCIN+SYRSPEND SF 25vandazole25VANICREAM72VANIQA 72VANOS 72VANOXIDE-HC 72VANTAS100VAQTA110vardenafil hcl95VARDIMAXIA72VARISOFT INFUSION SET121VARIVAX 110VARIZIG109VAROPHEN17VAROXIA 72VARUBI (180 MG DOSE) 31VASCEPA 56VASCULERA 121VASERETIC56VASOTEC56VAXCHORA110v-c forte 85VCF VAGINAL CONTRACEPTIVE 121vcf vaginal contraceptive121VECAMYL56VECTIBIX41VECTICAL 72VECURONIUM BROMIDE59vegetable lax+stool softener 91VELCADE 41VELETRI 135velivet105VELPHORO 95VELTASSA 85

VELTIN 72VEMLIDY 46VENCLEXTA41VENCLEXTA STARTING PACK 41VENELEX 72VENIPUNCTURE PX1 PHLEBOTOMY 20venlafaxine hcl 30venlafaxine hcl er 30VENNGEL ONE 17VENOFER85VENTAVIS 135VENTOLIN HFA134verapamil hcl56verapamil hcl er56VERDESO 72VEREGEN 72VERELAN 56VERELAN PM56VERSACLOZ 44VERZENIO41VESICARE95VEXASYN 72VEXATROL20VFEND33VIAGRA 95VIBERZI 91VIBRAMYCIN25vic-forte 85VICTOZA 73VIDAZA 41VIEKIRA PAK46vienva105vigabatrin 28vigadrone 28VIGAMOX 123VIIBRYD30VIIBRYD STARTER PACK 30VILACTIN AA PLUS121vilamit mb95VILEVEV MB95VILTEPSO 121VIMIZIM 92VIMOVO17VIMPAT28vinate one 85vinblastine sulfate 41vincristine sulfate 41vinorelbine tartrate 41VIOKACE 92viorele 105VIRACEPT 46

VIRAMUNE 46VIRAMUNE XR 46VIRASAL72VIRAZOLE 46VIREAD46 47VIRGINIA LIVE OAK121virt-caps 85VIRT-FEFA PLUS 85virt-gard85virt-phos 250 neutral 85virtussin ac walc131VISBIOME91VISIONBLUE 127VISTARIL 47VISTOGARD121VISUDYNE127vita s forte 85vitacel85VITAFOL 85VITAFOL FE+ 85VITAFOL STRIPS 85VITAFOL-OB+DHA85VITAL-D RX 85VITAMAX PEDIATRIC 85VITAMEZ 85vita-min 85vitamin b complex 100 85vitamin b-6 85vitamin b-complex 100 85vitamin c85vitamin d (cholecalciferol) 85vitamin d (ergocalciferol)85vitamin d385 86VITAMIN DEFICIENCY SYSTEM-B1286vitamin e86vitamin k186vitamins acd-fluoride 86VITAROCA PLUS 86VITA-RX DIABETIC VITAMIN86VITASURE 86VITATHELY WITH GINGER 86VITRAKVI41VITRASE121VITREXATE 86VITREXATE FE 86VITREXYL86VITREXYL + IRON86VIVELLE-DOT105VIVITROL20VIVLODEX 17VIVOTIF 111VIZIMPRO41

172

VOGELXO 98VOGELXO PUMP 98volnea 105VOLTAREN17VONVENDI 50VORAXAZE 41voriconazole33VORTEX HOLDING CHAMBERMASK121VOSEVI47VOTRIENT41VP FC KIT17VP GKL KIT 17vp-pnv-dha 86VPRIV 92vp-vite rx 86VRAYLAR 44VTOL LQ14VUMERITY 58VUSION 33VYEPTI 35vyfemla105VYLEESI 59vylibra105VYNDAMAX56VYNDAQEL 56VYONDYS 53 92VYTONE 33VYTORIN 56VYVANSE 57VYXEOS 41VYZULTA124WAKIX 136wal-tap coldallergy 131wal-zyr131warfarin sodium26WASP VENOM PROTEIN 121weekly-d86WELCHOL 56WELLBUTRIN SR30WELLBUTRIN XL 30WELLMIND VERTIGO121wera 105westab max121westab mini 86westab one86WESTAB PLUS 86WESTERN JUNIPER121WESTGEL DHA86WESTHROID 105WHEAT GERM OIL 86WHITE ASH 121WHITE BIRCH 121

WHITE FACED HORNET VENOM121WHITE MULBERRY 121WHITE OAK121WHITE PINE 121WIDE-SEAL DIAPHRAGM 60 121WIDE-SEAL DIAPHRAGM 65 121WIDE-SEAL DIAPHRAGM 70 121WIDE-SEAL DIAPHRAGM 75 121WIDE-SEAL DIAPHRAGM 80 121WIDE-SEAL DIAPHRAGM 85 121WIDE-SEAL DIAPHRAGM 90 121WIDE-SEAL DIAPHRAGM 95 121WILATE50WINRHO SDF109wixela inhub 134WP THYROID 105WPR PLUS WOUND HEALING SYSTEM 20wymzya fe 105XADAGO43XALATAN124XALIX72XALKORI 41XANAX47XANAX XR47XAQUIL XR86XARACOLL20XARELTO 26XARELTO STARTER PACK26XATMEP 109XCOPRI 28XCOPRI (250 MG DAILY DOSE)28XCOPRI (350 MG DAILY DOSE)28XELJANZ 109XELJANZ XR 109XELODA 41XELPROS 124XEMBIFY 109XENAZINE 59XENICAL59XENLETA25XEOMIN121XEPI25XERAC AC72XERALUX 72XERESE 47XERMELO 92XEROSTOMIA RELIEF SPRAY60XGEVA112

XHANCE 131XIAFLEX 121XIFAXAN25XIGDUO XR73XIIDRA 127XIMINO 25XOFIGO 41XOFLUZA (40 MG DOSE) 47XOFLUZA (80 MG DOSE) 47XOLAIR131XOLEGEL 33XOLEGEL COREPAK33XOLEGEL DUOHEAD amp SHOULDERS33XOLEGEL DUOXOLEX 33XOPENEX CONCENTRATE 134XOPENEX HFA 134XOPENEX NEB 134XOSPATA 41XPOVIO (100 MG ONCE WEEKLY)41XPOVIO (40 MG ONCE WEEKLY)41XPOVIO (40 MG TWICE WEEKLY)41XPOVIO (60 MG ONCE WEEKLY)41XPOVIO (60 MG TWICE WEEKLY)41XPOVIO (80 MG ONCE WEEKLY)41XPOVIO (80 MG TWICE WEEKLY)41XRYLIX 17XTAMPZA ER 14XTANDI41xulane 105XULTOPHY73xurea 72XURIDEN92XVITE86XYLOCAINE 20XYLOCAINE-MPF20XYNTHA 50XYNTHA SOLOFUSE50XYOSTED98XYREM 136XYWAV 136XYZBAC121XYZMUNE 121YASMIN 28 105YAZ 105YELLOW DOCK121

173

YELLOW HORNET VENOM PROTEIN 121YELLOW JACKET VENOM PROTEIN 121YERVOY 41YESCARTA41YF-VAX 111YONDELIS41YONSA 41YOSPRALA43YUPELRI134YUTIQ 123yuvafem 105ZACARE 72zaclir cleansing 72ZADITOR 123zafirlukast134zaleplon136ZALTRAP41ZALVIT86ZANAFLEX 135ZANOSAR41zarah 105ZARONTIN28ZARXIO50ZAVESCA 92ZCORT 7-DAY 97ZEASORB-AF 34ZEBUTAL14ZEGERID 87ZEJULA41ZELAC 92ZELAPAR43ZELBORAF 41ZELNORM 92ZEMAIRA 134ZEMBRACE SYMTOUCH 35ZEMDRI 25ZEMPLAR 112zenatane 72ZENPEP92ZENZEDI57ZEPATIER 47ZEPOSIA 58ZEPOSIA 7-DAY STARTER PACK 58ZEPOSIA STARTER KIT 58ZEPZELCA 41ZERUVIA 20ZERVIATE 123ZESTORETIC 56ZESTRIL 56ZETIA56

ZETONNA131ZEVALIN Y-90 41ZIAC56ZIAGEN47ZIANA 72zidovudine47ZIEXTENZO50ZILACAINE PATCH 20zileuton er 134ZILRETTA 97ZILXI 72zinc sulfate 86ZINGO20ZINPLAVA109ZIONODIL 20ZIONODIL 100 20ZIOPTAN 124ziprasidone hcl 44ziprasidone mesylate 44ZIPSOR17ZIRABEV41ZIRGAN 123ZITHRANOL72ZITHROMAX25ZITHROMAX TRI-PAK25ZITHROMAX Z-PAK 25ZOCOR 56ZOFRAN 31ZOHYDRO ER 14ZOLADEX 100zoledronic acid 112ZOLGENSMA 101-105 KG 92ZOLGENSMA 106-110 KG 92ZOLGENSMA 111-115 KG 92ZOLGENSMA 116-120 KG 93ZOLGENSMA 121-125 KG 93ZOLGENSMA 126-130 KG 93ZOLGENSMA 131-135 KG 93ZOLGENSMA 26-30 KG 93ZOLGENSMA 31-35 KG 93ZOLGENSMA 36-40 KG 93ZOLGENSMA 41-45 KG 93ZOLGENSMA 46-50 KG 93ZOLGENSMA 51-55 KG 93ZOLGENSMA 56-60 KG 93ZOLGENSMA 61-65 KG 93ZOLGENSMA 66-70 KG 93ZOLGENSMA 71-75 KG 93ZOLGENSMA 76-80 KG 93ZOLGENSMA 81-85 KG 93ZOLGENSMA 86-90 KG 93ZOLGENSMA 91-95 KG 93ZOLGENSMA 96-100 KG 93

ZOLINZA41zolmitriptan35ZOLOFT30ZOLPAK34zolpidem tartrate 136zolpidem tartrate er 136ZOLPIMIST 136ZOMACTON 100ZOMACTON (FOR ZOMA-JET 10)100ZOMIG 35ZOMIG ZMT35ZONALON72ZONEGRAN28zonisamide28ZONTIVITY 43ZORBTIVE 92ZORTRESS 109ZORVOLEX 17zovia 135 (28) 105zovia 135e (28) 105ZOVIRAX 47ZTLIDO 20ZUBSOLV 20ZULRESSO30zumandimine105ZUPLENZ31ZYCLARA 72ZYCLARA PUMP 72ZYDELIG41ZYFLO 134ZYKADIA41ZYLET127ZYLOPRIM34ZYMAXID 123ZYPITAMAG 56ZYPREXA 44ZYPREXA RELPREVV 44ZYPREXA ZYDIS44ZYRTEC ALLERGY 131ZYTIGA 41ZYVEXOL 121ZYVIT121ZYVOX25

174

ldquoMy Medicationsrdquo worksheet

Take this worksheet with you each time you visit a doctor Each of your doctors should be aware of every drug you take and you should have a list as well

Name of Medicine and Strength

Drug Tier

I Take This Medicine For

Directions Doctor

Example Lisinopril 20 mg Tier 1 High blood pressure One tablet daily Dr Johnson

-Continued on back-

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bull Qualified sign language interpreters bull Written information in other formats (large print audio accessible electronic formats other formats) bull Provides free language services to people whose primary language is not English such as

Qualified interpreters bull Information written in other languages

If you need these services please call toll-free (855) 828-9834 (TTY 711) 24 hours a day 7 days a week If you believe that the Company has failed to provide these services or discriminated in another way on the basis of race color national origin age disability or sex you can file a grievance in writing by mail or email A grievance must be sent within 60 calendar days of the date that you become aware of the discriminatory action and contain the name and address of the person filing it along with the problem and the requested remedy A written decision will be sent to you within 30 calendar days If you disagree with the decision you may file an appeal within 15 calendar days of receiving the decision

Optum Civil Rights Coordinator 11000 Optum Circle Eden Prairie MN 55344 Phone (888) 445-8745 (TTY 711) Fax (855) 351-5495 Email Optum_Civil_RightsOptumcom

If you need help filing a grievance please call toll-free (855) 828-9834 (TTY 711) 24 hours a day 7 days a week You can also file a complaint directly with the US Dept of Health and Human services online by phone or mail Online httpsocrportalhhsgovocrportallobbyjsf Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml Phone Toll-free (800) 868-1019 (800) 537-7697 (TDD) Mail US Dept of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 English Text You have the right to get help and information in your language at no cost To request an interpreter please call toll-free (855) 828-9834 (TTY 711) 24 hours a day 7 days a week This letter is also available in other formats like large print To request the document in another format please call toll-free (855) 828-9834 (TTY 711) 24 hours a day 7 days a week

1 Spanish Tiene derecho a recibir ayuda e informacioacuten en su idioma sin costo Para solicitar un inteacuterprete llame al nuacutemero de teleacutefono gratuito para miembros que se encuentra en su tarjeta de identificacioacuten del plan de salud y presione 0 TTY 711

2 Vietnamese Quyacute vị coacute quyền được giuacutep đỡ vagrave cấp thocircng tin bằng ngocircn ngữ của quyacute vị miễn phiacute Để yecircu cầu được thocircng dịch viecircn giuacutep đỡ vui lograveng gọi số điện thoại miễn phiacute dagravenh cho hội viecircn được necircu trecircn thẻ ID chương trigravenh bảo hiểm y tế của quyacute vị bấm số 0 TTY 711

3 Chinese 您有權利免費以您的母語得到幫助和訊息洽詢一位翻譯員請撥打您健保計劃會員卡上的免付費會員電話號碼再按 0聽力語言殘障服務專線 711

4 Korean 귀하는 도움과 정보를 귀하의 언어로 비용 부담없이 얻을 수 있는 권리가 있습니다 통역사를 요청하기 위해서는 귀하의 플랜 ID카드에 기재된 무료 회원 전화번호로 전화하여 0번을 누르십시오 TTY 711

5 Arabic يناجملا فتاھلا مقرب لصتا يروف مجرتم بلطل ةفلكت يأ لمحت نود كتغلب تامولعملاو ةدعاسملا ىلع لوصحلا يف قحلا كل TTY( 711( يصنلا فتاھلا 0 ىلع طغضاو ةیحصلا كتطخب ةصاخلا ةیوضعلا فرعم ةقاطبب جردملا ءاضعلأاب صاخلا

6 Urdu یرف لوٹ ےئل ےک ےنرک تاب ےس نامجرت یسک ےہ قح اک ےنرک لصاح تامولعم روا ددم تفم ںیم نابز ینپا وک پآ TTY 711 ںیئابد 0 ےہ جرد رپ ڈراک یڈ یئآ نلاپ ھتلیہ ےک پآ وج ںیرک لاک رپ ربمن نوف ربمم

7 Tagalog May karapatan kang makatanggap ng tulong at impormasyon sa iyong wika nang walang bayad Upang humiling ng tagasalin tawagan ang toll-free na numero ng telepono na nakalagay sa iyong ID card ng planong pangkalusugan pindutin ang 0 TTY 711

8 French Vous avez le droit dobtenir gratuitement de laide et des renseignements dans votre langue Pour demander agrave parler agrave un interpregravete appelez le numeacutero de teacuteleacutephone sans frais figurant sur votre carte drsquoaffilieacute du reacutegime de soins de santeacute et appuyez sur la touche 0 ATS 711

9 Hindi आप क पास अपनी भाषा म- सहायता एव जानकार6 7नशक ाltत करन का अ=धकार ह दभाBषए क Cलएअनरोध करन क Cलए अपन हथ ltलान ID काडH पर सचीबLध टोल-NO नबर पर फ़ोन कर- 0 दबाए TTY711

10 Persian هرامش اب یھافش مجرتم تساوخرد یارب دییامن تفایرد ناگیار روط ھب ار دوخ نابز ھب تاعلاطا و کمک ھک دیراد قح امش TTY 711 دیھد راشف ار 0 و هدومن لصاح سامت دوخ یتشادھب ھمانرب ییاسانش تراک رد هدش دیق ناگیار نفلت

11 German Sie haben das Recht kostenlose Hilfe und Informationen in Ihrer Sprache zu erhalten Um einen Dolmetscher anzufordern rufen Sie die gebuumlhrenfreie Nummer auf Ihrer Krankenversicherungskarte an und druumlcken Sie die 0 TTY 711

12 Gujarati તમન િવના (ય મદદ અન તમાર ભાષામા મા3હતી મળવવાનો અિધકાર છ ભાિષયા માટgt િવનતી કરવા તમારા હgtથ લાન ID કાડC પરની Eચીમા આપલ ટોલ-H મIબર ફોન નબર ઉપર કોલ કરો ૦

દબાવો TTY 711 13 Russian Вы имеете право на бесплатное получение помощи и информации на вашем языке

Чтобы подать запрос переводчика позвоните по бесплатному номеру телефона указанному на обратной стороне вашей идентификационной карты и нажмите 0 Линия TTY 711

14 Japanese ご希望の言語でサポートを受けたり情報を入手したりすることができます料金はか

かりません通訳をご希望の場合は医療プランのID カードに記載されているメンバー用のフリーダイヤルまでお電話の上0を押してくださいTTY専用番号は 711です

15 Laotian ທານມສ ດທ ຈະໄດຮບການຊວຍເຫອແລະຂມນຂາວສານທ ເປນພາສາຂອງທານບ ມຄາໃຊຈາຍ ເພອຂ ຮອງນາຍພາສາໂທຟຣ ຫາຫມາຍເລກໂທລະສບສ າລບ ສະມາຊ ກທ ໄດລະບໄວໃນບດສະມາຊ ກຂອງທານກດເລກ 0 TTY 711

72462-022018 INV-PSI3637-INS-MMISC-13918_MC_021318

(Farsi)

HealthSelectSM

of Te

xas

All Optum trademarks and logos are owned by Optum Inc in the US and other jurisdictions All other trademarks are the property of their respective owners

copy 2020 Optum Inc All rights reserved WF3870643 12082020 Premium standard



Anesthetics


Antibacterials

Anticoagulants



Antidepressants


Antifungals

Antigout Agents


Antimigraine Agents


Antimycobacterials


Antiparasitics


Antiplatelets


Antivirals













Diabetes - Insulins






























2

Your Prescription Drug List Formulary

This formulary outlines the most commonly prescribed medications covered under your planrsquos prescription drug benefits The formulary is also known as the Prescription Drug List (PDL) A formulary identifies the drugs available for certain conditions and organizes them into cost levels also known as tiers An important part of the formulary is giving you choices so you and your doctor can choose the best course of treatment for you

Go to wwwHealthSelectRxcom for complete and up-to-date drug information

Since the formulary may change we encourage you to visit our website wwwHealthSelectRxcom and click on Prescription Drug List This website is the best source for up-to-date information about all of the medications your pharmacy benefit covers possible lower-cost options and cost comparisons

3







What are tiers


4











5








6


Tier information



Tier 1 Lowest Cost






Tier 3 Highest Cost











Table of Contents


7


8






E


E


E


E

acetaminophen er E


E


E


E


E


E


E


1 QL


1 QL


1 QL


1 QL

ACTIQ 3 PA QL

ALLZITAL E

APADAZ E



1 QL


1 QL

ARYMO ER E

ascomp-codeine 1


BELBUCA 2 PA QL


E


3

BUPRENEX E


E


1 PA QL


1


E


1



1


1


1


1


E


9



1 QL

BUTRANS 3 PA QL


1


E


E

childrens apap E


E


1 QL

CONZIP E


E


E

DILAUDID ORAL E

DOLOPHINE 3 PA

DSUVIA E

DURAGESIC-100 E

DURAGESIC-12 E

DURAGESIC-25 E

DURAGESIC-50 E

DURAGESIC-75 E

duramorph E


1 QL

ESGIC 3

fentanyl 1 PA QL



1 PA QL


E



E


E


E


E


E


E


E


E


E


E


10



E


E


3


3

FIORINAL 3

FIORINALCODEINE 3

3


E



1 PA ST QL


1 QL


1 QL


1 QL


1 PA QL


E




E


E


E

HYSINGLA ER 2 PA QL

INFUMORPH 200 E

INFUMORPH 500 E


E

LAZANDA E




3 QL

MEDI-DERM-RX E

MEDROX-RX 3


E


1 QL


1 QL




1


11



1


1 PA


1


1


1


migraine relief E

mitigo E


1 QL


E


E


1 PA QL


1 PA QL


1 PA QL


E


E


E


E





E


E


E

m-pap E


E


1

NALOCET E

NORCO E

NUCYNTA E

NUCYNTA ER E

OXAYDO ORAL TABLET

E


E


1 QL


1 QL


1 QL


1 QL


E


12



1 QL


1 QL


2 PA QL




E



E


E


E



E

PANADOL CHILDRENS

E

PANADOL EXTRA E


E

PANADOL INFANTS E


1 QL


E

PRIALT 2 SP

PRIMLEV E


E


PROLATE E

QDOLO E


E


E

SUBSYS E

SYNAPRYN FUSEPAQ E


1


1 ST QL


E


1 PA QL


1 QL



1 QL


3 QL

TYLENOL 8 HOUR E


E


E

TYLENOL ORAL TABLET

E

ULTRACET E

ULTRAM E


13


VANATOL LQ E

VTOL LQ E

XTAMPZA ER 2 PA QL


3


E


ACTIVE-KETOPROFEN

E

ACTIVE-PREP KIT I E




ADVIL E


E


E

ADVIL MIGRAINE E


E


E

ALEVE ORAL TABLET E


E

aspirin adult $0


$0






$0


$0


$0


$0


$0


E


$0


$0


$0

BIIFENAC 1000 E

BIIFENAC 500 E


E

CAMBIA E

CAPSFENAC PAK E

CAPSINAC E

CELEBREX E

celecoxib oral 1 QL

DAYPRO 3


E


E


14



E

DFSMSMENTHCAP PAK

E

DICLOFENAC E


3 QL




1 QL


1 PA



1


E


3


E

DICLOPR E

diclosaicin E

DICLOSTREAM E

DICLOTREX E

DICLOVIX E

DICLOVIX M E

DICLOZOR EXTERNAL

E

diflunisal oral 1

DIMENTHO E


E

DUEXIS E



3

ec-naproxen 1


E

enovarx-ibuprofen E


E


E

etodolac er 1

etodolac oral 1

FBL KIT E

FELDENE 3



E

FLEXIPAK E

flurbiprofen oral 1

FROTEK E


E



$0


E

IBUPAK E

ibuprofen 1

ibuprofen infants E



1


E

inavix E

INDOCIN ORAL 3 ST


15


INDOCIN RECTAL E

indomethacin er 1


E


1 ST

INFLAMMACIN E


E

KBGL IN TERODERM

E

KETOPHENE RAPIDPAQ

E

ketoprofen er 1

ketoprofen oral 1


E


1


1


3 PA QL


1 QL


1


3

LICART EXTERNAL E

LODINE 3


1




MOBIC ORAL TABLET E


E


E

nabumetone oral 1


3

NALFON ORAL TABLET

3


3


E


3

naproxen dr 1


E




E


1


1 PA QL


E

NUDICLO SOLUPAK E

NUDICLO TABPAK E

NUDROXIPAK E

NUDROXIPAK DSDR-50

E


16


NUDROXIPAK DSDR-75

E

NUDROXIPAK E-400 E

NUDROXIPAK I-800 E

NUDROXIPAK M-15 E

NUDROXIPAK N-500 E

ORMECA E

oxaprozin 1

PENNSAID EXTERNAL

E

piroxicam oral 1

PRASTERA E


E


E


$0

QMIIZ ODT E


E

RELAFEN E

RELAFEN DS E

REXAPHENAC EXTERNAL

E

salsalate oral E

SPRIX 3 PA QL


$0

sulindac oral 1


E


E


1


1

TORONOVA II SUIK E


TORONOVA SUIK E


E


E

VAROPHEN E

VENNGEL ONE E

VIMOVO E

VIVLODEX E

VOLTAREN EXTERNAL

E

VP FC KIT E

VP GKL KIT E

XRYLIX EXTERNAL E

ZIPSOR E

ZORVOLEX E

Anesthetics


E

7T LIDO E

ACCUCAINE E


E

AGONEAZE E

ANODYNE LPT E

APRIZIO PAK E

APRIZIO PAK II E

ASTERO E


E

blue tube aloe E


E



E


17



E


E

CADIRAMD E

CAPSAICIN-MENTHOL

E


3


E

COCAINE HCL NASAL E


E


E


E

DERMACINRX PHN E

DERMACINRX PRIZOPAK

E

DERMACINRX ZRM E

EHA E

EMPRICAINE-II E


ethyl chloride 1

EXPAREL E

FLEXIN E

GEBAUERS PAIN EASE

3


3

GEN7T E

GEN7T PLUS E

GOPRELTO E


LDO PLUS E

lets E

LEVATIO E

LIDO BDK E


E


1


1


E


E


E


1


1


E


E


3


1


3


1


1


1 QL


18



E


1


E


E

LIDOCANNA E

LIDODERM E


3


E

LIDOMARK 25 E

LIDOPAC E


E


E


E

LIDOPRIL XR E


E

LIDOPURE PATCH E

LIDORX E

LIDO-SORB E

LIDOSTREAM E

LIDOTHOL E

LIDOTRAL E

LIDOVIX L E

LIDTOPIC MAX E

LIVIXIL PAK E

LMR PLUS E

LYDEXA E


MARCAINE E


E

marlido E

MARLIDO-25 E

MARVONA SUIK E

MEDI-DERML-RX E

MEDI-PATCH RX E

NUMBRINO E

NUVAKAAN E

NUVAKAAN-II E

PAINGO KFT E

PLIAGLIS E

POINT OF CARE LM-22

E

POINT OF CARE LM-25

E

premium lidocaine E

PREMIUM SCAR E

PREPIV SUPPLY 3

PRILO PATCH E

PRILO PATCH II 3

PRILOLID E

PRILOVIX E

PRILOVIX LITE E


PRILOVIX PLUS E



PRILOVIXIL E

PRIZOPAK II E

PRIZOTRAL E

PRIZOTRAL-II E

READYSHARP-A E


E

RELADOR PAK PLUS E


19


RENOVO E

sensorcaine E

sensorcaine-mpf E


E


E

SYNERA E

SYNVEXIA TC E


3

VEXATROL E


E

XARACOLL E

XYLOCAINE INJECTION

3


3

ZERUVIA E

ZILACAINE PATCH E


E

ZIONODIL E

ZIONODIL 100 E

ZTLIDO E



BUNAVAIL 3 QL


1 QL


1 QL


$0 QL


CHANTIX $0 QL


$0 QL


$0 QL

disulfiram oral 1

LUCEMYRA 3 ST QL


E


E


E



E

NARCAN 2


$0 QL


$0 QL




NICOTROL $0 QL

NICOTROL NS $0 QL

SUBLOCADE 3 SP


2 QL

VIVITROL 3 SP

ZUBSOLV 2 QL

Antibacterials

ACTICLATE E

AEMCOLO 3 PA

ALTABAX 3


20



E



1



1


1


1


1


E

ARIKAYCE 3 SP

AUGMENTIN ES-600 3


3


3

avidoxy 1 ST

AVIDOXY DK E


1


1


1




BACTRIM 3

BACTRIM DS 3

BAXDELA INTRAVENOUS

E

BAXDELA ORAL 3


3


1

BENZODOX E

BICILLIN L-A E

cefaclor 1

cefaclor er 1

cefadroxil 1


E


E

cefdinir 1


E

cefixime 1

CEFOTAN E


E


E


E


cefprozil 1


21



E


1


1

CENTANY 3

CENTANY AT E

cephalexin 1


E


3


3


clarithromycin er 1


CLEOCIN ORAL 3


3


2



1


1

CLINDESSE 3


E

COLY-MYCIN M E

coremino E

CUBICIN E

CUBICIN RF E

daptomycin E




DIFICID 3

DORYX MPC E


3 ST


E

doxy 100 E


E


1


1


1 ST


E


1


1 ST


E


1 ST


1


1


22



1 ST

EES GRANULES 3

ertapenem sodium E

ERYPED 200 3

ERYPED 400 3

ERY-TAB 3


3



1

erythromycin oral 1

FETROJA E


E

FIRVANQ 3

FLAGYL ORAL CAPSULE

3


3


E


1


1

HIPREX 3


E

INVANZ INJECTION E


1

KEFLEX 3


levofloxacin oral 1

LINCOCIN E



E


E

linezolid oral 1 QL

MACROBID 3

MACRODANTIN 3


1


E


E


E



E


E




3


E



23


MINOLIRA E


1 ST

MONUROL 3


E


1



mupirocin calcium E



E


E



E


1


1


1

NUTRIDOX E

NUVESSA E


3


1


E


E


1



E





E


E


E


E

PRIMSOL 3

RECARBRIO E


E

SEYSARA 3 ST

SILVADENE 3


E


1

SIVEXTRO E


3

SOLOSEC 3

ssd 1


E


24


sulfadiazine oral 1


1


1


E


3


SUPRAX ORAL CAPSULE

3


3


3

TARGADOX E

tazicef injection E


E


E


tigecycline E

tinidazole oral 1

trimethoprim oral 1

TYGACIL E


E

VANCOCIN 3


3



E


E



E

vandazole 1

VIBRAMYCIN 3 ST

XENLETA INTRAVENOUS

E

XENLETA ORAL 3

XEPI 3

XIFAXAN 3 PA

XIMINO 3

ZEMDRI E


3


3


3

ZITHROMAX TRI-PAK 3

ZITHROMAX Z-PAK 3


E

ZYVOX ORAL 3 QL

Anticoagulants

ACD-A NOCLOT-50 3


25


ACTIVASE E


1


3

ARIXTRA 3 SP QL

CATHFLO ACTIVASE E

ELIQUIS 2 QL


2 QL




3 SP QL


E


1


E


1



E

jantoven 1

LOVENOX 3 SP QL

PRADAXA 2 QL

REGIOCIT E

SAVAYSA 3 QL

THROMBATE III 3 SP

TRICITRASOL 3


XARELTO 2 QL


2 QL


APTIOM 3

BANZEL 3 PA


E

BRIVIACT ORAL 3 ST

carbamazepine er 1


CARBATROL 3

CELONTIN 3


E

clobazam 1 PA

DEPAKOTE 3

DEPAKOTE ER 3


3

DIACOMIT 3 PA SP





26


DILANTIN INFATABS E


E


3


E


1


1


1

EPIDIOLEX 3 PA SP

epitol 1

ethosuximide oral 1

FANATREX FUSEPAQ E

felbamate 1

FELBATOL 3

FINTEPLA 3 PA SP


E

FYCOMPA 3


1


1


GABITRIL 3

KEPPRA INTRAVENOUS

E

KEPPRA ORAL 3

KEPPRA XR 3


2



E


3


3


3

LAMICTAL STARTER 3

LAMICTAL XR 3

lamotrigine er 1


1



1


1


1


1


1

levetiracetam er 1


E


MYSOLINE 3

NAYZILAM 3 QL

NEURONTIN 3


3 PA


3 PA

oxcarbazepine 1

OXTELLAR XR E



27



1

PHENYTEK 3



1


1


1

primidone oral 1

QUDEXY XR 3


1

rufinamide 1 PA

SABRIL ORAL PACKET

E SP

SABRIL ORAL TABLET

3 PA SP

SPRITAM E

subvenite 1


1


1


1

SYMPAZAN 3 PA


3


3

TEGRETOL-XR 3

tiagabine hcl 1

TOPAMAX 3

TOPAMAX SPRINKLE 3

topiramate er 1

topiramate oral 1

TRILEPTAL 3

TROKENDI XR 3 ST



1


1

VALTOCO 10 MG DOSE

3 QL

VALTOCO 15 MG DOSE

3 QL

VALTOCO 20 MG DOSE

3 QL

VALTOCO 5 MG DOSE

3 QL

vigabatrin 1 PA SP

vigadrone 1 PA SP

VIMPAT INTRAVENOUS

E

VIMPAT ORAL 3

XCOPRI 3 ST


3 ST


3 ST

ZARONTIN 3

ZONEGRAN 3

zonisamide oral 1


ARICEPT 3

donepezil hcl 1

EXELON TRANSDERMAL

3


1


1



1


28



1

NAMENDA ORAL TABLET

3


3

NAMENDA XR 3 QL


3 QL

NAMZARIC 2 QL

RAZADYNE ER 3

rivastigmine 1


Antidepressants


amoxapine 1

ANAFRANIL 3

APLENZIN 3 ST QL

BRISDELLE 3 ST QL



1 QL


E


CELEXA ORAL TABLET

3


1


1


CYMBALTA E


DESVENLAFAXINE ER

3 ST QL



1 QL


1


1



EFFEXOR XR E

EMSAM 3 QL


FETZIMA 3 ST QL



3


1


1 QL


1




FORFIVO XL E



LEXAPRO ORAL TABLET

E

maprotiline hcl 1

MARPLAN 3

mirtazapine oral 1

NARDIL 3

nefazodone hcl 1


3



29



1 QL


3

PARNATE 3

paroxetine hcl er 1


1


PAXIL CR 3


2 ST

PAXIL ORAL TABLET 3


1

PEXEVA E


PRISTIQ E

protriptyline hcl 1

PROZAC ORAL CAPSULE

E


3

REMERON SOLTAB 3



3 PA SP


3 PA SP


3 QL




1

TRINTELLIX 3 ST QL

venlafaxine hcl 1



VIIBRYD ORAL TABLET

3 QL


3 QL

WELLBUTRIN SR E

WELLBUTRIN XL E

ZOLOFT E

ZULRESSO 3 PA SP


AKYNZEO INTRAVENOUS

E

AKYNZEO ORAL 3 QL


E

ANZEMET ORAL 3 QL

aprepitant 1 QL

BONJESTA 3 PA QL

compro 1


DICLEGIS 3 PA QL


dronabinol 1 PA QL


E


3 QL


3

EMEND TRI-PACK 3 QL


E

GIMOTI E


30



E


E


MARINOL 3 PA QL


1


E


E


1


1


1


1



E


1 QL


1 QL


1

ondansetron odt 1

palonosetron hcl E

perphenazine oral 1

prochlorperazine 1


1

REGLAN ORAL 3

SANCUSO 3 QL


scopolamine 1

SYNDROS 3 PA QL

TIGAN INTRAMUSCULAR

E

TIGAN ORAL 3


3


3


E


1


3 QL


3

ZUPLENZ E

Antifungals

ACTIVE-PREP KIT V E

ala-quin E

ALCORTIN A E


E


E

ANCOBON 3


E


3



E


E


31



1



1



1


1


1


E


1

CRESEMBA ORAL 3



E

dermazene E


E


3


3

DIFMETIOXRIME E

ECONASIL E


1


E

ECOZA E


E


ERTACZO E

EXELDERM E


EXTINA 3

fluconazole oral 1


E

flucytosine oral 1

FUNGIMEZ E


1


1

GYNAZOLE-1 3


E

IMIOXIA E

IODOQUIMEZ-HC E


E


E


E


JUBLIA E

KERYDIN 3 PA


1


E


1

ketoconazole oral 1


E



E


32



3

LOPROX EXTERNAL KIT

E


3


3


E

LULICONAZOLE E

LUZU E

MENTAX E

micaderm E


E

miconazole 1 E


1


E


E


E


E

naftifine hcl 1


3

NAFTIN EXTERNAL GEL

3

NOXAFIL ORAL 3

nyamyc 1

nystatin external 1





nystop 1

ONYCHO-MED E

ORAVIG E



3


E

PEDIZOLPAK E

PHEODOYO E

PHEYO E


E

posaconazole 1

QUINJA E

RECURA E

SPORANOX 3 PA

SPORANOX PULSEPAK

3 PA

SULCONAZOLE NITRATE

E

tavaborole 1 PA


terconazole 1



E

TOLSURA E

VFEND 3

voriconazole oral 1

VUSION E

VYTONE E

XOLEGEL E

XOLEGEL COREPAK E


E

XOLEGEL DUOXOLEX

E


33



E

ZOLPAK E

Antigout Agents

allopurinol oral 1


E



COLCRYS E

febuxostat 1 ST

GLOPERBA E

KRYSTEXXA 3 PA SP

MITIGARE E

probenecid oral 1

ULORIC 3 ST

ZYLOPRIM 3


EMFLAZA 3 PA SP

Antimigraine Agents

AIMOVIG 2 PA QL

AJOVY E


AMERGE 3 QL

CAFERGOT 3

DHE 45 3 PA QL


1 PA QL


1 PA QL


EMGALITY 2 PA QL


2 PA QL

ERGOMAR 3


FROVA 3 QL



IMITREX 3 QL


3 QL


3 QL


3 QL


3 QL

MIGERGOT 3

MIGRAINE PACK E

MIGRANAL 3 PA QL

MIGRANOW E


NURTEC 2 PA QL


RELPAX 3 QL

REYVOW E




1 QL


1 QL


1 QL


1 QL


34



1 QL


1 QL

TOSYMRA E


3 ST QL

UBRELVY 2 PA QL

VYEPTI E

ZEMBRACE SYMTOUCH

E


ZOMIG NASAL 3 ST QL

ZOMIG ORAL E

ZOMIG ZMT E


GUANIDINE HCL ORAL

3


3


3


3


E


1


1


1

Antimycobacterials

CAPASTAT SULFATE E


cycloserine oral 1

dapsone oral 1


isoniazid oral 1


3

MYCOBUTIN 3

PASER 3

PRETOMANID 3

PRIFTIN 3

pyrazinamide oral 1

rifabutin 1

rifampin oral 1


E

SIRTURO 3

TRECATOR 3



ABRAXANE 2 SP

ADCETRIS 2 PA SP


1 SP


1 SP



2 PA SP QL


E SP

ALECENSA 3 PA SP

ALIMTA 2 SP

ALIQOPA 3 PA SP

ALKERAN 3 SP

ALUNBRIG 3 PA SP QL

anastrozole oral $0


35


ARIMIDEX E

AROMASIN 3

ARRANON 2 SP


1 SP

ARZERRA 2 PA SP

ASPARLAS 3 SP

AVASTIN 3 PA SP

AYVAKIT 3 PA SP QL

azacitidine 1 PA SP

BALVERSA 3 PA SP

BAVENCIO 3 PA SP

BELEODAQ 3 PA SP

BELRAPZO E SP

BENDEKA 3 PA SP

BESPONSA 3 PA SP

bexarotene 1 PA SP

bicalutamide 1

BICNU 3 SP

BLENREP E SP


BLINCYTO 3 PA SP

BORTEZOMIB 3 PA SP

BOSULIF 3 PA SP


3 PA SP

BRUKINSA 3 PA SP

busulfan 1 SP

BUSULFEX 3 SP

CABOMETYX 2 PA SP

CALQUENCE 3 PA SP

CAMPATH 2 SP

CAMPTOSAR 3 SP



2 PA SP QL


2 PA SP



1 SP

carmustine 1 SP

CASODEX 3


1 SP


3 SP


1 SP

clofarabine 1 SP

CLOLAR 3 SP


3 PA SP


3 PA SP


3 PA SP

COPIKTRA 3 PA SP

COSMEGEN 3 SP

COTELLIC 3 PA SP


1 SP


E SP


1

CYRAMZA 3 PA SP



1 SP


1 SP

DACOGEN 3 PA SP

dactinomycin 1 SP


36


DARZALEX 3 PA SP



1 SP

DAURISMO 3 PA SP

decitabine 1 PA SP



1 SP


1 SP

DOXIL 3 SP


1 SP


1 SP

DROXIA 3

ELITEK 3 SP

ELLENCE 3 SP

ELZONRIS 3 PA SP

EMCYT 2

EMPLICITI 3 PA SP

ENHERTU 3 PA SP


1 SP

ERBITUX 2 PA SP

ERIVEDGE 2 PA SP

ERLEADA E SP


1 PA SP


1 PA SP QL

ERWINAZE INJECTION

3 SP

ETHYOL 3 SP


ETOPOPHOS 3 SP


1 SP

etoposide oral 1 SP


1 PA SP QL

EVOMELA 3 SP

exemestane $0

FARESTON 3

FARYDAK 3 PA SP


3 SP

FEMARA 3




flutamide 1

FOLOTYN 2 PA SP

fulvestrant 1 SP

GAVRETO E SP

GAZYVA 3 PA SP


GILOTRIF 3 PA SP QL

GLEEVEC 3 PA SP


3 SP

HALAVEN 2 PA SP

HERCEPTIN HYLECTA

3 PA SP


3 PA SP

HERZUMA E SP


37


HYCAMTIN 3 SP

HYDREA 3

hydroxyurea oral 1

IBRANCE 3 PA SP


3 PA SP QL


3 PA SP

IDAMYCIN PFS 3 SP

idarubicin hcl 1 SP

IDHIFA 3 PA SP QL

IFEX 3 SP

ifosfamide 1 SP


IMBRUVICA 3 PA SP

IMFINZI 3 PA SP

IMLYGIC 3 SP

INFUGEM 3 SP

INLYTA 3 PA SP

INQOVI E SP

INREBIC 3 PA SP

IRESSA 3 PA SP

irinotecan hcl 1 SP


IXEMPRA KIT 2 SP


2 PA SP QL


2 PA SP

JELMYTO E SP

JEVTANA 2 PA SP

KADCYLA 3 PA SP

KANJINTI 2 PA SP


3 PA SP

KHAPZORY 3 ST SP



3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP

KOSELUGO 3 PA SP

KYPROLIS 2 PA SP


LARTRUVO 3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP

letrozole oral 1


E


LEUKERAN 2


1 SP


38



1 SP

LIBTAYO 3 PA SP

LONSURF 3 PA SP

LORBRENA 3 PA SP

LUMOXITI 3 PA SP

LUTATHERA E


2 PA SP

LYSODREN 2

MARQIBO 3 SP

MATULANE 2 SP

MEKINIST 2 PA SP

MEKTOVI 3 PA SP

melphalan 1 SP

melphalan hcl 1 SP


mesna 1 SP

MESNEX 3 SP



E SP


MONJUVI E SP

mutamycin 1 SP

MVASI 2 PA SP

MYLERAN 2


3 PA SP

NAVELBINE 3 SP

NERLYNX 3 PA SP QL

NEXAVAR 2 PA SP

nilutamide 1 SP

NINLARO 3 PA SP

NIPENT 3 SP

NUBEQA 3 PA SP


ODOMZO 3 PA SP

OGIVRI E SP

ONCASPAR INJECTION

2 SP

ONIVYDE 3 SP

ONTRUZANT E SP

ONUREG E SP

OPDIVO 3 PA SP


1 SP


E


1 SP

paclitaxel 1 SP

PADCEV 3 PA SP

PANRETIN 3

paraplatin 1 SP

PEMAZYRE 3 PA SP QL

PERJETA 2 PA SP

PHESGO E SP

PHOTOFRIN 3 SP


3 PA SP


3 PA SP


3 PA SP

POLIVY 3 PA SP

POMALYST 3 PA SP

PORTRAZZA 3 PA SP

POTELIGEO 3 PA SP

PROLEUKIN 2 SP

PURIXAN 3 SP

QINLOCK 3 PA SP

RETEVMO E SP

REVLIMID 2 PA SP



39



3 PA SP


3 PA SP

ROZLYTREK 3 PA SP

RUBRACA 2 PA SP

RUXIENCE 2 PA SP

RYDAPT 3 PA SP

SARCLISA 3 PA SP

SIKLOS 3 PA

SOLTAMOX $0

SPRYCEL 2 PA SP

STIVARGA 3 PA SP

SUTENT 2 PA SP

SYLVANT 3 PA SP

SYNRIBO 3 PA SP

TABLOID 2 SP

TABRECTA E SP

TAFINLAR 2 PA SP


3 PA SP QL


3 PA SP

TALZENNA 3 PA SP



3 PA SP


3 PA SP QL

TARGRETIN EXTERNAL

3 PA SP

TARGRETIN ORAL E SP

TASIGNA 3 PA SP


3 SP


TAZVERIK E SP

TECARTUS 3 PA SP

TECENTRIQ 3 PA SP

TEMODAR INTRAVENOUS

2 SP



teniposide 1 SP

TEPADINA 3 SP

THALOMID 2 PA SP


TIBSOVO 3 PA SP


1 SP

topotecan hcl 1 SP


TOTECT 3 SP

TRAZIMERA 2 PA SP


E SP

tretinoin oral 1 SP


3 SP

TRODELVY 3 PA SP

TRUXIMA E SP

TUKYSA 3 PA SP

TURALIO 3 PA SP

TYKERB 3 PA SP

UNITUXIN 3 PA SP

VALCHLOR 3 PA SP

valrubicin E

VALSTAR E


40



3 SP


VENCLEXTA 3 PA SP


3 PA SP

VERZENIO 3 PA SP

VIDAZA 3 PA SP


1 SP


1 SP


VITRAKVI 3 PA SP

VIZIMPRO 3 PA SP

VORAXAZE E

VOTRIENT 3 PA SP


3 PA SP

XALKORI 2 PA SP

XELODA 3 PA SP


E

XOSPATA 3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP



3 PA SP


3 PA SP

XTANDI 3 PA SP

YERVOY 2 PA SP

YESCARTA 3 PA SP

YONDELIS 3 SP

YONSA E SP

ZALTRAP 2 PA SP

ZANOSAR 2 SP

ZEJULA 2 PA SP

ZELBORAF 3 PA SP

ZEPZELCA 3 PA SP

ZEVALIN Y-90 3 SP

ZIRABEV 2 PA SP

ZOLINZA 2 PA SP

ZYDELIG 3 PA SP

ZYKADIA ORAL TABLET

3 PA SP

ZYTIGA E SP

Antiparasitics


ALBENZA 3 PA

ALINIA 2

ARAKODA 3

atovaquone oral 1


1

BENZNIDAZOLE 3

BILTRICIDE 3


1

COARTEM 3


crotan 1

DARAPRIM 3 PA SP

EGATEN 3


41


ELIMITE 3

EMVERM 2


1

IMPAVIDO 3


1

ivermectin oral 1

KRINTAFEL 3

LAMPIT E

lice killing E


E


1

MALARONE 3


mefloquine hcl 1

MEPRON 3

NATROBA 3

NEBUPENT 3

nitazoxanide 2

OVIDE 3

PENTAM E


1


E


1

PLAQUENIL 3

praziquantel oral 1


1



3

QUALAQUIN 3 PA



SKLICE 3

spinosad 1


E

STROMECTOL 3

SULFURATED LIME 3




2 PA SP QL

AZILECT 3


1


1

carbidopa oral 1



1


1

COMTAN 3

DUOPA ENTERAL 3 PA

entacapone 1

GOCOVRI E

INBRIJA 3 PA SP

KYNMOBI E SP


E SP

LODOSYN 3

MIRAPEX ER 3


3

NEUPRO 3 ST

NOURIANZ 3 PA


42


ONGENTYS E

OSMOLEX ER E

PARLODEL 3


1


1


ropinirole hcl 1

ropinirole hcl er 1

RYTARY 3 ST


SINEMET 3

STALEVO 100 3

STALEVO 125 3

STALEVO 150 3

STALEVO 200 3

STALEVO 50 3

STALEVO 75 3


3

tolcapone 1


XADAGO 3 ST QL

ZELAPAR 3

Antiplatelets


ASPIRIN-OMEPRAZOLE

E

BRILINTA 2

CABLIVI 3 PA SP QL

cilostazol 1


1

dipyridamole oral 1

DURLAZA E

EFFIENT 3



3

prasugrel hcl 1

YOSPRALA E

ZONTIVITY 3



3


3

ABILIFY MYCITE E

ABILIFY ORAL TABLET

3 QL

ADASUVE 3 PA

aripiprazole 1 QL

ARISTADA E

ARISTADA INITIO E

CAPLYTA 3 ST QL


E


clozapine 1 QL

CLOZARIL 3 QL

FANAPT 3 ST QL


3 ST QL


E


E



E

GEODON ORAL 3 QL

HALDOL DECANOATE E


43



E


haloperidol oral 1

INVEGA 3 QL


3


3

LATUDA 3 QL


molindone hcl 1


3 PA


3 PA


E



PERSERIS E

pimozide 1



REXULTI 3 QL


3


E


E

risperidone 1 QL


SAPHRIS 2 QL

SECUADO E

SEROQUEL 3 QL

SEROQUEL XR 3 QL


thiothixene oral 1


VERSACLOZ 3 QL

VRAYLAR 3 ST QL




3

ZYPREXA ORAL 3 QL

ZYPREXA RELPREVV E

ZYPREXA ZYDIS 3 QL

Antivirals

abacavir sulfate 1


1


1


acyclovir oral 1


APTIVUS 2


ATRIPLA E

BARACLUDE 3 SP QL

BIKTARVY 3


CIMDUO 2

COMBIVIR 3

COMPLERA 2


2

DELSTRIGO 3


44


DENAVIR E

DESCOVY E


1

DOVATO 2

EDURANT 2

efavirenz 1


1


1

emtricitabine 1


1


3


2

entecavir 1 SP QL

EPCLUSA 2 PA SP QL

EPIVIR 3


2 SP


3 SP

EPZICOM 3

EVOTAZ 2

famciclovir oral 1

FAVIPIRAVIR 3



E


E

GENVOYA 3

HARVONI 2 PA SP QL


HEPSERA 3 SP

INTELENCE 2

INTRON A 3 PA SP


2

ISENTRESS 2

ISENTRESS HD 2

JULUCA 2


3

KALETRA ORAL TABLET

2



1 SP


1



E SP


2



MAVYRET 2 PA SP QL

nevirapine 1

nevirapine er 1

NORVIR ORAL PACKET

2


2

NORVIR ORAL TABLET

3

ODEFSEY 3


1 QL


2 PA SP


45



3 PA SP

PIFELTRO 3

PREVYMIS 3 SP

PREZCOBIX 2


2


2



E


3

RETROVIR ORAL SYRUP

3


3

REYATAZ ORAL PACKET

2




1 SP

rimantadine hcl 1

ritonavir 1

RUKOBIA 3

SELZENTRY 2 PA

SITAVIG 3 QL


E SP

SOVALDI 3 PA SP QL


STRIBILD 3

SUSTIVA 3

SYMFI 2

SYMFI LO 2


SYMTUZA 3


E


E

TEMIXYS E


1

TIVICAY 2

TIVICAY PD 2

TRIUMEQ 2

TRIZIVIR 3

TROGARZO 3 PA


2


E

TYBOST 2


VALCYTE 3


VALTREX 3 QL

VEMLIDY 3 SP



2


3


3

VIRAZOLE 3

VIREAD ORAL POWDER

2


46



2


3

VOSEVI 2 PA SP QL

XERESE E


3 QL


3 QL

ZEPATIER 3 PA SP QL

ZIAGEN 3

zidovudine 1


3


E


E


alprazolam er 1 QL



alprazolam xr 1 QL

ATIVAN E





1 QL

diazepam intensol 1


1


1


DORAL 3 QL

estazolam 1 QL


HALCION 3 QL


1


1


1

KLONOPIN 3 QL




1 QL


meprobamate 1



E


E


E

oxazepam 1 QL

quazepam 1 QL


3 QL

triazolam 1 QL

VALIUM E

VISTARIL 3

XANAX E

XANAX XR E


47



EQUETRO 3

lithium 1



LITHOBID 3


ADVATE 2 SP

ADYNOVATE 3 SP

AFSTYLA 3 SP

AGRYLIN 3


2 SP

ALPHANINE SD 2 SP

ALPROLIX 3 SP


3

AMICAR ORAL TABLET

3


1


1

anagrelide hcl 1


2 PA SP


2 PA SP


3



E


2 SP

CEPROTIN 3 SP

COAGADEX 3 SP

CORIFACT 2 SP


E


3 PA SP

ELOCTATE 3 SP


E SP

ESPEROCT E SP


2 SP

FIBRYGA 2 SP

FULPHILA E SP

GRANIX E SP

HEMLIBRA 3 SP


3 SP


48



2 SP

IDELVION 3 SP

IXINITY 3 SP

JIVI 3 SP

KOATE 2 SP

KOATE-DVI 2 SP

KOGENATE FS 3 SP

KOVALTRY 3 SP


3 PA SP

LYSTEDA 3


3 PA SP


2 SP


E

MOZOBIL 2 PA SP QL

MULPLETA 2 PA SP



3 PA SP


E SP



E SP

NIVESTYM 2 PA SP

NOVOEIGHT 2 SP

NOVOSEVEN RT 2 SP

NPLATE 2 PA SP

NUWIQ 2 SP

OBIZUR 3 SP


3 SP

PROCRIT E SP

PROFILNINE 2 SP

PROMACTA 3 PA SP

REBINYN 3 SP

REBLOZYL 3 PA SP

RECOMBINATE 2 SP

RECOTHROM 3

RECOTHROM SPRAY KIT

3


2 PA SP

RIASTAP 2 SP

RIXUBIS 3 SP

SEVENFACT E SP


3 PA SP

TAVALISSE 3 PA SP


3


49



3

THROMBOGEN 3


E



E

TRETTEN 3 SP

UDENYCA E SP


3 PA SP


2 PA SP

VONVENDI 3 SP


2 SP


2 SP


ZARXIO 2 PA SP

ZIEXTENZO 3 PA SP


ACCUPRIL 3

ACCURETIC 3



3



E

ALDACTAZIDE 3

ALDACTONE 3


ALTACE ORAL CAPSULE

E

ALTOPREV E



1



E


1


1


1




1


E

ATACAND E

ATACAND HCT 3

atenolol oral 1


E



1


3

AVAPRO 3

AZOR E


50




1

BENICAR E

BENICAR HCT E

BETAPACE AF 3


3


BIDIL 3



1

bumetanide oral 1

BUMEX 3

BYSTOLIC 2


3

CALAN SR 3



1

captopril oral 1


1

CARDIZEM CD 3


3


E


3


CARDURA 3

CAROSPIR 3

cartia xt 1

carvedilol 1


CATAPRES 3

CATAPRES-TTS-1 3

CATAPRES-TTS-2 3

CATAPRES-TTS-3 3


1



clonidine 1


colesevelam hcl 1

COLESTID E

COLESTID FLAVORED

E

colestipol hcl 1

CONJUPRI E

CONSENSI E

COREG 3

COREG CR 3

CORGARD 3

CORLANOR 3 PA QL

COZAAR 3

CRESTOR E

DEMSER 3

DIBENZYLINE 3

digitek 1

digox 1

digoxin oral 1

DILATRATE-SR 3



1


51



1


1



E

dilt-xr 1

DIOVAN E

DIOVAN HCT E


1

DIURIL 3

dofetilide 1


1

DUTOPROL E

DYAZIDE 3

DYRENIUM 3

EDARBI 3 ST

EDARBYCLOR 3 ST

EDECRIN 3



1

ENTRESTO 2 QL


E


E


E



E

eplerenone 1


E


EXFORGE 3

EXFORGE HCT 3


ezetimibe 1


felodipine er 1


1


1 ST


1 ST


1


E


1


1 ST


1


1 ST

FENOGLIDE 3 ST

FIBRICOR 3 ST

FIRST - METOPROLOL

E

FIRST-ATENOLOL E


52



FLOLIPID 3 ST



fosinopril sodium 1



1


gemfibrozil oral 1

GONITRO 3


HEMANGEOL 3



1

HYZAAR 3


indapamide oral 1

INDERAL LA E

INDERAL XL E

INNOPRAN XL E

INSPRA 3

irbesartan 1


1

ISORDIL TITRADOSE 3




1


isradipine 1


3 PA SP QL

KAPSPARGO SPRINKLE

E


KATERZIA E



2

LASIX 3

LESCOL XL E

LIPITOR E

LIPOFEN 3

lisinopril oral 1


1

LIVALO E

LOPID 3


3

LOPRESSOR ORAL 3




3


3


3

lovastatin 1

LOVAZA E

matzim la 1

MAXZIDE 3

MAXZIDE-25 3

methyldopa oral 1


1

metolazone 1



53




1

metyrosine 1


MICARDIS 3

MICARDIS HCT 3

midodrine hcl 1


E


E

MINIPRESS 3

minitran 1

minoxidil oral 1

moexipril hcl 1

MULTAQ 3


1

NEXLETOL 2 PA QL

NEXLIZET 2 PA QL


1


1

niacor 1

NIASPAN 3


nifedipine er 1


1

nifedipine oral 1

nimodipine oral 1

nisoldipine er 1

NITRO-BID 3

NITRO-DUR 3




1


1

NITROLINGUAL 3

NITROMIST 3

NITROSTAT E


1


E

NORPACE 3

NORPACE CR 2

NORTHERA 3 PA SP

NORVASC E


3


1


1


1

OMEGA-3 RX COMPLETE

3


E


1 PA


3


1


pentoxifylline er 1



54



1


E


E

pindolol 1


2 PA QL


3


prazosin hcl oral 1

PRESTALIA 3 ST

prevalite 1


3


E

PROCARDIA 3

PROCARDIA XL 3

propafenone hcl 1




propranolol-hctz 1

QBRELIS E

QUESTRAN E


E

quinapril hcl 1



1



ramipril 1

RANEXA 3 ST

ranolazine er 1 ST

RECTIV 3

REPATHA 2 PA QL


2 PA QL

REPATHA SURECLICK

2 PA QL


RYTHMOL SR 3


sotalol hcl (af) 1

sotalol hcl oral 1

SOTYLIZE 3




3


E


3

taztia xt 1

TEKTURNA 2 ST

TEKTURNA HCT 2 ST

telmisartan 1


telmisartan-hctz 1

TENORETIC 100 3

TENORETIC 50 3


55


TENORMIN E

tiadylt er 1

TIAZAC 3

TIKOSYN E


TOPROL XL E

torsemide oral 1

trandolapril 1


1

triamterene oral 1


1


1

TRIBENZOR E

TRICOR 3

TRILIPIX 3

TWYNSTA 3

valsartan 1


1

VASCEPA 2 PA

VASERETIC 3

VASOTEC 3

VECAMYL 3


1


1


VERELAN 3

VERELAN PM 3

VYNDAMAX 3 PA SP QL

VYNDAQEL 3 PA SP QL

VYTORIN E


WELCHOL 3

ZESTORETIC 3


3


E

ZETIA E

ZIAC 3


3


E


ADDERALL 3 PA QL

ADDERALL XR E

ADHANSIA XR E






1 PA QL


1 PA QL




CONCERTA E


DAYTRANA 3 PA ST QL

DESOXYN 3 PA ST QL


3 PA QL


56




1 PA ST QL


1 PA QL


1 PA ST QL


EVEKEO 3 PA ST QL

EVEKEO ODT 3 PA QL

FOCALIN 3 PA QL


guanfacine hcl er 1

INTUNIV 3



3 ST


1 PA ST QL



3 PA ST QL


1 PA ST QL


1 PA ST QL


1 PA ST QL


1 PA ST QL


1 PA QL


1 PA ST QL


1 PA QL



1 PA ST QL

MYDAYIS 3 PA ST QL




3 PA ST QL

relexxii 1 PA ST QL

RITALIN 3 PA QL


3 PA ST QL

STRATTERA 3 QL

VYVANSE 2 PA QL

ZENZEDI 3 PA ST QL


AMPYRA 3 PA SP QL

AUBAGIO 3 PA SP QL


2 PA SP QL


2 PA SP QL



2 PA SP QL


2 PA SP QL




1 PA SP QL


57



E SP

GILENYA 3 PA SP QL


glatopa 1 PA SP QL

KESIMPTA E SP

LEMTRADA 3 PA SP

MAVENCLAD (10 TABS)

3 PA SP

MAVENCLAD (4 TABS)

3 PA SP

MAVENCLAD (5 TABS)

3 PA SP

MAVENCLAD (6 TABS)

3 PA SP

MAVENCLAD (7 TABS)

3 PA SP

MAVENCLAD (8 TABS)

3 PA SP

MAVENCLAD (9 TABS)

3 PA SP

MAYZENT 3 PA SP QL


3 PA SP QL

OCREVUS 3 PA SP QL

PLEGRIDY E SP


E SP


E SP


E SP


E SP



E SP


TYSABRI 3 PA SP QL

VUMERITY 2 PA SP QL

ZEPOSIA 3 PA SP QL


3 PA SP QL

ZEPOSIA STARTER KIT

3 PA SP QL


ADDYI 3 PA QL

ADIPEX-P E

AUSTEDO 3 PA SP QL

benzphetamine hcl E


CONTRAVE E

CONVENIENCE PAK E



GABACAINE E

GRALISE 3 ST QL


3 PA QL

INGREZZA 3 PA SP QL


E

LOMAIRA E

LYRICA CR 3 ST QL

LYRICA ORAL CAPSULE

2 QL


3 QL


58


NEURAPTINE E

NUEDEXTA 3 PA

ONPATTRO 3 PA SP


E


E



QSYMIA E

RADICAVA 3 PA SP

RILUTEK 3 PA QL

riluzole 1 PA QL

SAVELLA 3 ST QL


3 ST QL

SAXENDA E


E

TEGSEDI 3 PA SP


TIGLUTIK 3 PA SP QL


E

VYLEESI 3 PA QL

XENAZINE 3 PA SP

XENICAL E


ARESTIN E

cavarest E

cevimeline hcl 1



E

clinpro 5000 E


E

denta 5000 plus E

dentagel E


E


E

easygel dental E

EVOXAC 3

FIRST-MOUTHWASH BLM

E

fluoridex E



E


E

KEPIVANCE 2 SP


1


MOUTH KOTE REMINT

E

MUCOSITISRX E


E


E

NAFRINSE WEEKLY E


E

oralone 1

paroex E

PERIDEX E


59


periogard E


PREVIDENT E


E


E


E


E

PREVIDENT 5000 PLUS

E


E

SALAGEN 3

SALIVAMAX E

sf E

sf 5000 plus E


E


E


E


E


E


3


1


E




E

ABREVA E

ABSORICA E

ABSORICA LD 3 PA

ACANYA E

ACESO AG E

acitretin 1


active-tramadol E


E


2


1 PA



E


3 PA


E


E


1


E

AKLIEF E

ALA SCALP E



1


60



3

ALDARA E

ALEVAMAX E

ALTRENO 3 PA


E


1


1

AMELUZ E


1

amnesteem 1 PA

AMZEEQ 3

ANACAINE E

APEXICON E E

AQUAPHILIC E

ARAZLO E

ARIDA E


E

ATOPADERM E

ATOPICLAIR E

ATRALIN 3 PA

avar cleanser E

AVAR LS CLEANSER E

AVAR-E EMOLLIENT E

AVAR-E GREEN E

AVAR-E LS E

AVEIDAOXIA E

avita 1 PA

AZADROX E



E

AZELEX 3



BEAU RX E

BENSAL HP E


E


E

BENZACLIN E

BENZACLIN WITH PUMP

E

BENZAMYCIN E


BENZEPRO EXTERNAL

E


E


E


E


E


E

benzoin compound E


E


E


E


E


E


1 ST

BESER EXTERNAL KIT

E


61




1


1


E


1

BIAFINE E


E

blanche E


bp 10-1 E

bp cleansing wash E


E

BPCO 3

BRYHALI E


1 QL


E


1


1


E


1 QL


E

CALCITRENE 3



E

CAPEX E



E

capzix E

CARAC 3

CEM-UREA E

CERACADE E


CHLOOXIA E


E


E


E


E

claravis 1 PA


3


E


1

CLINDACIN PAC E

clindacin-p 1

CLINDAGEL E


E


1 ST


E


1


1


1


62



1


E


1


E



E

CLINOIN E


1



1


1


E


E

CLOBETAVIX E

CLOBEX 3

CLOBEX SPRAY 3


CLODAN EXTERNAL KIT

E


1

CLODERM E


3

COLLATYL E


3

COPADERM E

COPASIL EXTERNAL E



E


3


3


3


E


CORTANE-B EXTERNAL

E


3


3


1


E

DAPSONE-NIACINAMIDE

E


E

DELUO E

DEOXIA E

DERMACINRX PENETRAL

E


E


3


3

DERMULCERA 3

DESONATE E


63


desonide external 1


3


1


1


E


E


1

DEXERYL E

DIADIMAXIA E

DIAOXIA E


E

DIASDIMAXIA E

DIASOXIA E


1 ST QL


1 PA QL


E


E


E


E


E


E

DIMOXIA E

DIPROLENE AF 3



3



3


doxycycline 1


E

DRAXACE E


E

DRITHO-CREME HP E

DRIXECE E

DRYSOL 3

DUOBRII E

DUPIXENT 2 PA SP QL

ECEOXIA E


3

ELETONE E

ELIDEL 3 ST

ELLZIA PAK E

EMULSION SB E

enovarx-tramadol E

ENSTILAR E

ENTTY SPRAY E

ENZOCLEAR E

EPICERAM E

EPIDUO 3

EPIDUO FORTE 3

EPIFOAM 3

EPIQUIN MICRO E

ery 1

ERYGEL 3


1


64



1

ESKATA E

ETHOXIA E

EUCRISA 2 ST

EVOCLIN 3

FABIOR E

FINACEA 3 ST


E


E


E


1


1


1


E


1


1


1


1


1

FLUOPAR E

FLUOROPLEX 3


2


1


1


FLUOVIX E

FLUOVIX PLUS E

flurandrenolide E


1

FORAXA E

GENADUR E

GORDOFILM 3


E

halcinonide E


1


E


1


E


E


3

HALUCORT E


E


HPR PLUS HYDROGEL

E

HYALUCIL-4 E


E


E


E

HYDRO 40 E


65



E


E


E


E


1


E


1


1


E


1


1


1



E


E


E


E


E


E




E


E


E

IMPEKLO E

IMPOYZ E

INOVA E


E


E


ITHOXIA E


E

KAMDOY E

KATARYA E

KATARYAXN E

KAXM E

KEIDO E

KELARX E

KENALOG EXTERNAL 3

KERAGEL E


E


E

KERALYT SCALP E


3

KETARYA E

KEVARYA E

KEXM E

KEYA E


66


KIVIK E

KLARON 3

KUTARYAXM E

KUTARYAXMPA E

KUTEA E

KUVARYA E

KUVARYE E

KUXM E

lactic acid e 1


1


E

lavare wound wash E

LEVULAN KERASTICK 3

LEXETTE E


E

LIDOTREX E


3

LOCOID LIPOCREAM E

LUXIQ 3

MEDERMA E

MEDERMA FOR KIDS E

MEDERMA SPF 30 E


E

methoxsalen rapid 1


E

METROCREAM 3


E

METROLOTION 3


MIMYX E



E

MIRVASO 3


E


1

myorisan 1 PA

NEOCERA E

NEOSALUS E

NEOSALUS CP E


E


3


E


NEUAC EXTERNAL KIT

E


E


E


E


E


E


E


E

NIVATOPIC PLUS E

nolix E

NORITATE E


67



E

NUCARACLINPAK E

NUCARARXPAK E

NUCORT E

NUDERMRXPAK 120 E

NUDERMRXPAK 60 E

NUTRASEB E

NUTRIARX CREAMPAK

E

NUVAIL E

OLUX 3

OLUX-E 3

ONEXTON 3

ORACEA 3

OVACE PLUS E

OVACE PLUS WASH E

OVACE WASH E

OXSORALEN ULTRA 3

PANDEL E

PENLEN E

PHLAG SPRAY E

PICATO 3 ST

pimecrolimus 1 ST

PLEXION E


E


E

podocon E


PR BENZOYL PEROXIDE

E


E

PR CREAM E


1



E


3


E

pramox E


E

prednicarbate 1

PRESERA E


E

PROMISEB E

PROPECIA E

PROSILK EXTERNAL E

PROTEXA E

PROTOPIC 3

PROTYL AG E

PRUCLAIR E

PRUDOXIN 3 PA

PRUMYX E

PSORCON E

PYROGALLIC ACID 3

QBREXZA 3 QL

QUINIXIL E

QUTENZA E

QUTENZA (2 PATCH) E

RADIAGEL E


3


E

RECEDO E

REFISSA E

REGENECARE 3

REGRANEX 3 PA


68


remergent hq E

REMIGEN E

RENOVA E

RENOVA PUMP E

RESORCINOL-SULFUR

E

RETIN-A 3 PA


E


E


2 PA


E

RHOFADE 3

RIAX E




E


E

salicylic acid er E


E


E


E


E


E


E


E



E


E


E

salimez E

SALIMEZ FORTE E

SALVAX E

SALVAX DUO PLUS E


E

SANTYL 3

SCALACORT DK E


E

SCARCIN E

SCARSILK EXTERNAL E

SCARZEN SKIN REPAIR

E

SCENESSE 3 PA SP


1


E

SELRX E

SERNIVO 3

SILA III E

SILIPAC E


E

skarjel E


E


E


E


69



E

SOLARAVIX EXTERNAL

E

SOLOX E

SOOLANTRA 3


3

SORILUX E

sss 10-5 E

STRATA CTX E

STRATA GRT E

STRATA MARK E

STRATA TRIZ E

STRATA XRT E


1


E


E


E


E


E


E


E


E


E



E


E

sulfacleanse 84 E

sulfamez wash E

SUMADAN E

SUMADAN WASH E

SUMADAN XLT E

SUMAXIN E

SUMAXIN CP E

SUMAXIN WASH E

SUVICORT E

SYNALAR 3

SYNALAR (CREAM) E

SYNALAR (OINTMENT)

E

SYNALAR TS E

SYNERDERM E


E


3 QL


E


1

TARDEOXIA E

TARDIMAXIA E

TAROXIA E

TASOPROL E



3 PA


3 PA


70



E


3


3


E

TEXACORT 3

tl hydroquinone E

TOLAK 3 ST


3


3


3

TOPICORT SPRAY E


TOVET EXTERNAL KIT

E





1 PA


E


1


1


1


E

TRIAMSIL MULTIPAK E


trianex E

TRI-CHLOR 3


TRIDESILON 3

TRI-LUMA E


E


E

TRIVIX E

TURPENTINE EXTERNAL

E

ULTRASAL-ER E


E

UMECTA MOUSSE E


E


E

UREA EXTERNAL FOAM

E


E


E

urea hydrating E


E

urea-c40 E

ureacin-10 E

ureacin-20 E

uredeb E

uremez-40 E

URESOL E

UTOPIC E


71



E

VANIQA E

VANOS 3

VANOXIDE-HC E

VARDIMAXIA E

VAROXIA E

VECTICAL E

VELTIN E

VENELEX 3

VERDESO E

VEREGEN E

VEXASYN E

VIRASAL E

XALIX E

XERAC AC 3

XERALUX E

xurea E

ZACARE E


E

zenatane 1 PA

ZIANA E

ZILXI E

ZITHRANOL E

ZONALON 3 PA

ZYCLARA E

ZYCLARA PUMP E


acarbose oral 1

ACTOPLUS MET 3

ACTOS 3

ADLYXIN E


E


ALOGLIPTIN BENZOATE

E


E


E

AMARYL 3


3 ST


2 ST QL




CYCLOSET 3 ST

DUETACT 3

FARXIGA 2 ST

FORTAMET E

glimepiride 1

glipizide er 1

glipizide ir 1

glipizide xl 1


GLUCOTROL 3

GLUCOTROL XL 3


3

GLUMETZA E


glyburide oral 1


GLYNASE 3

GLYSET 3

GLYXAMBI 2 ST

INVOKAMET E

INVOKAMET XR E

INVOKANA E

JANUMET 2 ST


72


JANUMET XR 2 ST

JANUVIA 2 ST

JARDIANCE 2 ST

JENTADUETO 2 ST

JENTADUETO XR 2 ST

KAZANO E

KOMBIGLYZE XR E

metformin hcl er 1



E

metformin hcl ir 1

miglitol 1

nateglinide 1

NESINA E

ONGLYZA E

OSENI E

OZEMPIC 2 ST QL

pioglitazone hcl 1


1


1

PRECOSE 3

QTERN E

repaglinide 1

RIOMET 3 ST

RIOMET ER 3 ST

RYBELSUS 2 ST QL

SEGLUROMET E

SOLIQUA 2 ST QL

STARLIX 3

STEGLATRO E

STEGLUJAN E

SYMLINPEN 120 3 PA

SYMLINPEN 60 3 PA


SYNJARDY 2 ST

SYNJARDY XR 2 ST

tolbutamide 1 ST

TRADJENTA 2 ST

TRIJARDY XR 2 ST

TRULICITY 2 ST QL

VICTOZA 2 ST QL

XIGDUO XR 2 ST

XULTOPHY 3 ST QL



E


E


E


E


E


E


E


$0


E


E


$0


E


73



E


E


$0


$0


$0

BLUESTAR E


E


$0

CARETOUCH TEST E

CEQUR SIMPLICITY 2U

3

CHEMSTRIP UGK 3

CONTOUR CONTROL E


E

CONTOUR NEXT LINK E


E

CONTOUR NEXT TEST

E

CONTOUR TEST E


E


E


E


E


FORTISCARE CONTROL

E


E


E


E


E


E


E


E


E


E


E


E

GUARDIAN SENSOR (3)

E

KETONE TEST 3

KETOSTIX 3

LANCETS $0

MICRODOT TEST E


$0

NOVOPEN ECHO 3


$0


$0



2


74



2


2


2


3


$0 QL


2


2


2

PRECISION LINK E


E


E



E


E


E


E


3



E


E




3


3


3


E

TRUE METRIX LEVEL 1

E

TRUE METRIX LEVEL 2

E

TRUE METRIX LEVEL 3

E


E

TRUETRACK TEST E


E


BAQSIMI ONE PACK 2

BAQSIMI TWO PACK 2

diazoxide oral 1



2 Made by Lilly


2Made by Fresenius


2


2

GVOKE PFS 2

PROGLYCEM 3

Diabetes - Insulins

ADMELOG E

ADMELOG SOLOSTAR

E


75



3 PA

APIDRA SOLOSTAR E

APIDRA VIAL E

BASAGLAR KWIKPEN E

FIASP E

FIASP FLEXTOUCH E

FIASP PENFILL E


2


2


2


2


2


2

HUMALOG VIAL 2


2

HUMULIN 7030 VIAL 2

HUMULIN N KWIKPEN 2

HUMULIN N VIAL 2


2


2

HUMULIN R VIAL 2


E

INSULIN ASPART E


E



E


E


E


E


E


E


$0

INSULIN SYRINGES $0


2

LANTUS U-100 VIAL 2


E


LYUMJEV 2

LYUMJEV KWIKPEN 2


$0

MYXREDLIN 3


$0


$0


$0


E


76



E

NOVOLIN 7030 RELION

E

NOVOLIN 7030 VIAL E

NOVOLIN N FLEXPEN E


E

NOVOLIN N RELION E

NOVOLIN N VIAL E

NOVOLIN R FLEXPEN E


E

NOVOLIN R RELION E

NOVOLIN R VIAL E


E


E


E


E



$0

SEMGLEE E

TOUJEO MAX SOLOSTAR

2

TOUJEO SOLOSTAR 2

TRESIBA E

TRESIBA FLEXTOUCH

E


ABANEU-SL E

ACTITROM-D E

active fe E

ACTIVITE E

adcf (05mgml) 1


ADRENAL C FORMULA

E

airavite E

aminoamrms E


E

aminoreliefrms E

animal shapes E

ANIMI-3 E

ANIMI-3VITAMIN D E


E

ASCOR E


E


E

ATABEX OB 2


E

AZESCO E


E


E

BACMIN E


biocel E

biopetit E


E

bp vit 3 E

b-plex E

b-plex plus E


E


77


CALCIFOL 3


E


E


E


E


CARBAGLU 2 SP


E


E


E


E


E


E


E


E


E


E


E


E

CARNITOR ORAL 3

CARNITOR SF 3

CENFOL E

CENTRATEX E


CEREFOLIN E


E

CHEMET 3


E

CHOLECAL DF E


E

CIFEREX E

CIFRAZOL E

CITRANATAL BLOOM E

CITRANATAL ESSENCE

E

CITRANATAL MEDLEY

E

clovique 1 PA SP


E

corvita E

corvita 150 E

CORVITE 150 E

corvite fe E


E


1


3

cytra k crystals E


E

d3 super strength E



E


78



E

deferasirox 1 PA


deferiprone 1 PA


E

DEPLIN 15 E

DEPLIN 75 E


E

dexifol E

dialyvite E

DIALYVITE 3000 E

DIALYVITE 5000 E

DIALYVITE SUPREME D

E

DIALYVITEZINC E


3

DURACHOL E

d-vite pediatric E


3


1

ELFOLATE E


E

ELITE-OB 2

ENBRACE HR E

ERGOCAL E


1


E


EXJADE 3 PA

fabb E


E

FERAHEME E

FERIVA 217 E

FERIVAFA E

ferocon E

ferotrinsic E

FERRALET 90 E

ferraplus 90 E

FERRIPROX 3 PA


3 PA

FERRLECIT E



E

FERROTRIN E


E


E


E


E

FLORIVA E

FLORIVA PLUS E

FLUORABON $0

fluoritab $0


$0

folbee E

folbee plus E

folbee plus cz E


79


FOLBIC RF E

FOLGARD OS E

FOLGARD RX E



1


$0

FOLIC D3 E

FOLIC-K E

FOLI-D E

FOLITE E

FOLIVANE-F E

FOLIVANE-PLUS E

FOLIXAPURE E

folplex 22 E

foltanx E

FOLTANX RF E

FOLTRATE E

FOLTREXYL E

foltrin E


E

FOLVITE-D E

FOSTEUM E

FUSION PLUS E

GALZIN 3

GENICIN VITA-D E

GENICIN VITA-Q E

GENICIN VITA-S E


E


HEMATOGEN E

HEMATOGEN FA E

HEMATRON-AF E

HEMETAB E

HEMOCYTE PLUS E




E

HYLAVITE E

HYLAZINC E

ICAR-C PLUS E

iferex 150 forte E

INFED E

INFUVITE ADULT E


E

INTEGRA F E

INTEGRA PLUS E

IODINE STRONG ORAL

3

IROSPAN 246 E

ISOLYTE-S E

JADENU 3 PA


JYNARQUE 3 SP QL

KCL-LIDOCAINE-NACL

E


klor-con 10 1

klor-con m10 1

KLOR-CON M15 3

klor-con m20 1


1


1

klor-con sprinkle 1

klor-conef 1

K-PHOS NO 2 E


3


E


80


K-PHOS-NEUTRAL 3

k-prime 1

K-TAB 3

k-tan plus E

L-CYSTINE E


1


levocarnitine sf 1

L-ISOLEUCINE E

l-methylfolate E


E


E



E


E


E

l-methyl-mc E

l-methyl-mc nac E

LOKELMA 3

LORID E


MVI ADULT E


E

MAGNEBIND 400 3


E



E


E


E

magnesium-oxide E


E

MEPHYTON 3

metafolbic E

metafolbic plus E


METANX ORAL CAPSULE

E


E

MICROPLEGIA MSA-MSG

E

MIFEPREX 3

mifepristone 1

M-NATAL PLUS 2

MULTIGEN E

MULTIGEN FOLIC E

MULTIGEN PLUS E


E

MULTIPRO E



1


1


1


81



E


1


1


E

mynephron E


E


nafrinse $0

nafrinse drops $0

NASCOBAL 3

NEONATAL + DHA E

NEONATAL 19 2

NEONATAL COMPLETE

E

NEONATAL FE E

NEONATAL PLUS 2

NEOVITE E

NEPHPLEX RX E

NEPHRON FA E


NEPHRO-VITE RX E

NESTABS 2

NESTABS ONE E

NEURIN-SL E


E

NICADAN E

NICAZEL E

NICAZEL FORTE E



E

NIFEREX ORAL TABLET

E


E

NUFERA E

nufol E

NUTRICAP E

nutrifac zx E

NUTRIVIT E


E

one daily E

ONE VITE WOMENS $0


2

ONEVITE E

ORACIT 3

ORTHO DF E

OVEEZA E


E


E


E


E

pediavit E


phosphorous 1


E


E


82



1

PHOXILLUM BK425 E


E

PHYSIOLYTE E


E


E

phytonadione oral 1

PLASMA-LYTE 148 E

PLASMA-LYTE A E


E


POLY-VI-FLOR FS 3


3


E


2


E


POTABA ORAL CAPSULE

E


1



E


1



1



E

PREGENNA E

PREMESISRX E

PRENAISSANCE E

PRENARA E


$0



1


E


1

PRENATE E


E


E

PRENATE ENHANCE E


E


E

PRENATE PIXIE E

PRENATE RESTORE E

PRENATRIX E

PRENATRYL E

PRENATVITE COMPLETE

E

PRENATVITE PLUS 2


83


PRENATVITE RX 2

preplus 1

pretab 1


E

PROTEINEX P18 E



E


E

QUFLORA FE E


E

QUFLORA GUMMIES E

QUFLORA PEDIATRIC E

RELNATE DHA 2

REMEDIENT E


E


RENATABS E

RENATABS WITH IRON

E

rena-vite E


E

REQ 49+ E

REVESTA E



2 SP QL


3 SP QL


E

se-tan plus E


SIDEROL ORAL TABLET

E


E



E


E


E


E


E


E


E


E



1


1

soluvita e E

sps 1

STROVITE FORTE E

STROVITE ONE E

SUPERVITE E

support E

SUPPORT-500 E


84


SYNAGEX E

SYPRINE 3 PA SP


E

TALIVA E

TARON FORTE E

taron-crystals E


tis-u-sol E

tl-hem 150 E


E SP


1 SP QL


2

tricitrates E

tricon E



E

trinate 1

TRINAZ E

triphrocaps E

TRISTART ONE E

TRI-VI-FLOR 3

TRI-VI-FLORO 3


tri-vitefluoride 1

TRONVITE E

TRYPTOPHAN ORAL E

UDAMIN SP E

UROCIT-K 10 3

UROCIT-K 15 3

UROCIT-K 5 3


urosex E

v-c forte E

VELTASSA 3

VENOFER E

vic-forte E

vinate one 1

virt-caps E

VIRT-FEFA PLUS E

virt-gard E


vita s forte E

vitacel E


E

VITAFOL ORAL TABLET

E

VITAFOL STRIPS 2

VITAFOL-OB+DHA E

VITAL-D RX E

VITAMAX PEDIATRIC E

VITAMEZ E

vita-min E



E



E


E


1


E


85



E


E


E


E


VITAROCA PLUS E


E

VITASURE E


E

VITREXATE E

VITREXATE FE E

VITREXYL E

VITREXYL + IRON E

vp-pnv-dha 1

vp-vite rx E

weekly-d E

westab mini E

westab one E

WESTAB PLUS 2

WESTGEL DHA E


E

XAQUIL XR E

XVITE E

ZALVIT E


E




E


E

ACIPHEX E

ACIPHEX SPRINKLE E


3


E


cimetidine oral 1

CYTOTEC 3

DEXILANT 2 QL

ESOMEP-EZS E


1 QL


1 QL


E


1


1

FIRST-LANSOPRAZOLE

3 ST



E


1 ST QL


86



1 QL

misoprostol oral 1


E

NEXIUM ORAL PACKET

3 QL

nizatidine 1


E


1 ST QL


E


3 ST


E


1 ST QL

PEPCID ORAL TABLET

3

PREVACID E

PREVACID 24HR E


3 ST QL


3 ST QL



E


E


1 ST QL


sucralfate oral 1

ZEGERID E


ACTIGALL 3

ACTIPHLORA E

alosetron hcl 1 PA


E


E

alvimopan 1

AMITIZA E


1 ST

ANASPAZ 3


E

antacid calcium E



E

antacid maximum E


E



E




E


E


87



E


E


E


E


E

BACICAP E


E

bisacodyl ec $0 QL

bisacodyl rectal E


E


1

CHENODAL 3 PA SP


E


citroma $0 QL


CLENPIQ 3

constulose 1


CUVPOSA 3


E



E


E


diotame instydose E


docusate mini E


E


E

docuzen E

dok oral tablet E

DONNATAL E

ed-spaz 1

ENTEREG 3

enulose 1


E

EX-LAX ULTRA E



E

FOLIKA PROBIOTIC E


E


E

GASTROCROM 3

GATTEX 3 PA SP


gavilyte-c $0 QL

gavilyte-g $0 QL

gavilyte-h 1


$0 QL

GELUSIL E

generlac 1


88




geri-kot E

GIALAX E

GLYCATE E

glycolax $0 QL


E


E


1


E

glycopyrrolate pf E

gnp senna lax E


3


E


E

HELIDAC THERAPY 3



E


E


E



1


1


1



E


1


1


E

hyosyne 1


E


E


E


E


LACTOJEN E


1

lactulose oral 1

laxative max str E


E

LEVBID E

LEVSIN ORAL TABLET

E

LEVSINSL E


89


LIBRAX 3

LINZESS 2 ST QL

LOMOTIL ORAL TABLET

3


1


E


E

LOTRONEX 3 PA


E


$0 QL


E


1


E



E



E

MOTEGRITY 3 ST QL

MOTOFEN E

MOVANTIK E

MOVIPREP E

MYTESI 3 QL


E


E

NULEV 3

NULYTELY LEMON-LIME

3



3

OMECLAMOX-PAK 2

opium E


oscimin sr E


OSMOPREP E


E

PCP 100 E


$0 QL



1


1

peg-prep 1


E


E


E


1

phenohytro E


E

PLENVU E

PROBICHEW E

PRODIGEN E


E


1

PYLERA 2


90



QUAD-PROBIOTIC E

RELISTOR ORAL E


E

RESTORA RX 3


E

senexon-s E

senna oral liquid E


E


E


senna s E

senna smooth E


E

senna-plus E


E

SENOKOT S E


3 PA SP


E


E


E


3



E



E


E


E


E


E


E


E


3

SUTAB E

SYMAX DUOTAB E

symax-sl E

symax-sr E

SYMPROIC 2 ST QL

TALICIA 3

trilyte $0 QL

TRULANCE E

TUMS CHEWY BITES E

URSO 250 3

URSO FORTE 3

ursodiol oral 1


E


E

VIBERZI 3 PA QL

VISBIOME E


91


XERMELO 3 PA SP QL

ZELAC E

ZELNORM 3 PA QL

ZORBTIVE 3 PA SP


ALDURAZYME 2 PA SP



3 SP


3 SP

CERDELGA 3 PA SP


2 PA SP

CHOLBAM 3 PA SP

CREON 2

CRYSVITA 3 PA SP

CYSTADANE 3 SP

CYSTAGON 3 SP

ELAPRASE 2 PA SP

ELELYSO 3 PA SP

ENZADYNE E

EXONDYS 51 E SP

FABRAZYME 2 PA SP

GALAFOLD 3 PA SP QL

KANUMA 3 PA SP

KUVAN 3 PA SP

LUMIZYME 2 PA SP

MEPSEVII 3 PA SP

miglustat 1 PA SP

MYALEPT 3 PA SP

NAGLAZYME 2 PA SP


nitisinone 1 PA SP

NITYR 3 PA SP

OCALIVA 3 PA SP QL

ORFADIN 3 PA SP

PALYNZIQ 3 PA SP QL

PANCREAZE E

PERTZYE E

PROCYSBI 3 PA SP

RAVICTI 3 PA SP

REVCOVI 3 PA SP


1 PA SP


1 SP


1 SP

STRENSIQ 2 PA SP

SUCRAID 3 SP

VIMIZIM 3 PA SP

VIOKACE E

VPRIV 3 PA SP

VYONDYS 53 E SP

XURIDEN 3 PA SP QL

ZAVESCA 3 PA SP


2


3 PA SP


3 PA SP


3 PA SP


92



3 PA SP


3 PA SP


3 PA SP


3 PA SP

ZOLGENSMA 26-30 KG

3 PA SP

ZOLGENSMA 31-35 KG

3 PA SP

ZOLGENSMA 36-40 KG

3 PA SP

ZOLGENSMA 41-45 KG

3 PA SP

ZOLGENSMA 46-50 KG

3 PA SP

ZOLGENSMA 51-55 KG

3 PA SP

ZOLGENSMA 56-60 KG

3 PA SP

ZOLGENSMA 61-65 KG

3 PA SP

ZOLGENSMA 66-70 KG

3 PA SP

ZOLGENSMA 71-75 KG

3 PA SP

ZOLGENSMA 76-80 KG

3 PA SP

ZOLGENSMA 81-85 KG

3 PA SP

ZOLGENSMA 86-90 KG

3 PA SP

ZOLGENSMA 91-95 KG

3 PA SP

ZOLGENSMA 96-100 KG

3 PA SP



aminoacetic acid E

AURYXIA 3

azo tabs E


1

BI-MIX 3


1


1

CAVERJECT IMPULSE

3 QL


3 QL

CERVIDIL 3

CIALIS 3 QL


3 PA SP


1


DETROL 3

DETROL LA 3


3

EDEX 3 QL

ELMIRON 2


3

FEM PH E

flavoxate hcl 1


93



3


3


3 ST


glycine urologic E

hyophen E

INTRAROSA 3 ST



E

LITHOSTAT 3

menaphosmbhyo1 E

MUSE 3 QL

MYRBETRIQ 2



OXYTROL 3 ST QL

OXYTROL FOR WOMEN

E


1 PA SP



E


1


1


E

PHOSLYRA 3


phosphasal E

PREPIDIL 3

PROSTIN E2 3

PYRIDIUM E

QUAD-MIX 3

RENACIDIN E


E

RENVELA 3

RIMSO-50 E


sevelamer hcl 1


1 QL


STAXYN E

STENDRA E

SUPER BI-MIX 3

SUPER QUAD-MIX 3

SUPER TRI-MIX E

tadalafil oral 1 QL

THIOLA 3 SP

THIOLA EC 3 SP



TOVIAZ 3

TRI-MIX E



URELLE E


1

URIBEL E

URIMAR-T E


1


94



E

URO-458 E

UROGESIC-BLUE E

uro-mp E

ustell E

uticap E

utira-c E

utrona-c 1


VELPHORO 3

VESICARE 3

VIAGRA E

vilamit mb E

VILEVEV MB E


alfuzosin hcl er 1

AVODART 3

CARDURA XL 3 ST

dutasteride oral 1


1


1

FLOMAX E

JALYN 3

PROSCAR 3

RAPAFLO 3

silodosin 1

tamsulosin hcl 1


UROXATRAL 3




E



E


E

ALKINDI SPRINKLE E

BETA 1 KIT E

BETALOAN SUIK E

BETAMETHASONE COMBO

E


E


E


E

BSP 0820 E

CELESTONE SOLUSPAN

E


E

CORTEF 3



E

DEPO-MEDROL E

DEXABLISS E


1



E


95



E


E


E


E


E

DEXONTO 04 3

DMT SUIK E

DOUBLEDEX E

DXEVO 11-DAY E

DYURAL-40 E

DYURAL-80 E

DYURAL-L E

DYURAL-LM E


1

HEMADY E

HIDEX 6-DAY E


KENALOG INJECTION 3

KENALOG-80 3

MAS CARE-PAK E


3


2



3

MEDROLOAN II SUIK E

MEDROLOAN SUIK E


E


E


E


E


E


1


3


E

MULTI-SPECIALTY E

ORAPRED ODT 3

P-CARE K40 E

P-CARE K40G E

P-CARE K40MX E

P-CARE K80 E

P-CARE K80G E

P-CARE K80MX E

PEDIAPRED 3


E


96



E

POD-CARE 100K E

POINT OF CARE L2 E

POINT OF CARE L5 E


E


1


1


1


prednisone oral 1

PRO-C-DURE 5 E

PRO-C-DURE 6 E

RAYOS E


E


E


E


3

TAPERDEX 12-DAY E

TAPERDEX 6-DAY E


E

TOPIDEX E



E


1


3


E

TRILOAN II SUIK E

TRILOAN SUIK E

ZCORT 7-DAY E

ZILRETTA E


ANADROL-50 3 PA


2 PA


3 PA


3 PA


E

AVEED E

danazol oral 1


E


97


EC-RX TESTOSTERONE

E

FORTESTA E

JATENZO E

METHITEST 3 PA


NATESTO E


TESTIM E

TESTONE CIK E

TESTOPEL E


E


E


1 PA


1 PA


E


1 PA


1 PA

VOGELXO PUMP E


E


XYOSTED 3 PA


EVISTA 3

OSPHENA 3

raloxifene hcl 1


ACTHAR 2 PA SP

BYNFEZIA PEN E SP

cabergoline 1


E SP


1 PA SP



3

DDAVP NASAL 3

DDAVP ORAL 3

DDAVP RHINAL TUBE 2


1


1


1


1


ELIGARD 3 PA SP QL



3 PA SP QL


3 PA SP QL


98



2 PA SP


1 PA SP



GENOTROPIN E SP


E SP

GONAL-F E SP

GONAL-F RFF E SP


E SP

HUMATROPE E SP

INCRELEX 2 PA SP

ISTURISA E SP


1 PA SP



3 PA SP


2 PA SP


3 PA SP


2 PA SP


2 PA SP



2 PA SP


3 PA SP


2 PA SP


3 PA SP


2 PA SP

MENOPUR 3 PA SP

MYCAPSSA E SP

NOCDURNA 3


2 PA SP


1 PA SP


3 PA SP


2 PA SP


99



2 PA SP


2 PA SP


1 PA SP


E SP


E SP

ORILISSA 2 PA QL

OVIDREL 3 PA SP


E


E

pregnyl 1 PA SP

SAIZEN E SP

SAIZENPREP E SP


E SP


E SP


SIGNIFOR 3 PA SP QL


3 PA SP QL


SOMAVERT 3 PA SP

STIMATE 3


SYNAREL 2

TEPEZZA 3 PA SP



VANTAS 3 PA SP QL


3 SP QL


2 SP QL

ZOMACTON E SP


E SP


KORLYM 3 PA SP QL



3

afirmelle $0 QL

ALORA 3 ST

altavera $0 QL

alyacen 135 $0 QL

alyacen 777 $0 QL

amabelz 1

amethia $0 QL

amethia lo $0 QL

amethyst $0 QL


100


ANGELIQ 3

ANNOVERA E

apri $0 QL

aranelle $0 QL

ashlyna $0 QL

aubra $0 QL

aubra eq $0 QL

aurovela 1530 $0 QL

aurovela 120 $0 QL




aviane $0 QL

AYGESTIN 3

ayuna $0 QL

azurette $0 QL

BALCOLTRA E

balziva $0 QL

bekyree $0 QL

BEYAZ E


E

BIESTPROGESTERONE

E

BIJUVA 3

blisovi 24 fe $0 QL



briellyn $0 QL

camila $0 QL

camrese $0 QL

camrese lo $0 QL

caziant $0 QL


chateal $0 QL

chateal eq $0 QL

CLIMARA 3


CLIMARA PRO 2

COMBIPATCH 3

covaryx E

covaryx hs E


3 QL


3 PA QL

cryselle-28 $0 QL

cyclafem 135 $0 QL

cyclafem 777 $0 QL

cyred $0 QL

cyred eq $0 QL

dasetta 135 $0 QL

dasetta 777 $0 QL

daysee $0 QL

deblitane $0 QL

DELESTROGEN 3

delyla $0 QL

DEPO-ESTRADIOL 3


3 QL


3 QL


$0 QL


$0 QL

DIVIGEL 3

dotti 1


$0 QL


101



$0 QL

DUAVEE 2

EC-RX ESTRADIOL E

EC-RX PROGESTERONE

E

eemt E

eemt hs E

ELESTRIN 3

elinest $0 QL

ELLA $0 QL

eluryng $0 QL

emoquette $0 QL

ENDOMETRIN 2 PA

enpresse-28 $0 QL


$0 QL

errin $0 QL


E


E


E

estarylla $0 QL

ESTRACE 3

estradiol oral 1


estradiol vaginal 1


1


1

ESTRING 3 QL

ESTROGEL 3

ESTROSTEP FE 3 QL


$0 QL



$0 QL

EVAMIST 3


E

falmina $0 QL

fayosim $0 QL

FEMHRT LOW DOSE 3

FEMRING 3 ST QL

femynor $0 QL


E

fyavolv 1

gemmily $0 QL

GENERESS FE 3 QL

gianvi $0 QL

hailey 1530 $0 QL

hailey 24 fe $0 QL


hailey fe 120 $0 QL

heather $0 QL


1 PA SP


3


3

incassia $0 QL

introvale $0 QL

isibloom $0 QL

jaimiess $0 QL

jasmiel $0 QL

jencycla $0 QL

jinteli 1

jolessa $0 QL

juleber $0 QL


102


junel 1530 $0 QL

junel 120 $0 QL

junel fe 1530 $0 QL

junel fe 120 $0 QL

junel fe 24 $0 QL

kaitlib fe $0 QL

kalliga $0 QL

kariva $0 QL

kelnor 135 $0 QL

kelnor 150 $0 QL

kurvelo $0 QL

KYLEENA E

larin 1530 $0 QL

larin 120 $0 QL

larin 24 fe $0 QL

larin fe 1530 $0 QL

larin fe 120 $0 QL

larissia $0 QL

layolis fe $0 QL

leena $0 QL

lessina $0 QL

levonest $0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL

levora 01530 (28) $0 QL


E


lillow $0 QL






lojaimiess $0 QL

loryna $0 QL

LOSEASONIQUE 3 QL

low-ogestrel $0 QL


lutera $0 QL

lyllana 1

lyza $0 QL

MAKENA 2 PA SP

marlissa $0 QL


$0 QL


1


1


1



2

MENOSTAR 3 ST

mibelas 24 fe $0 QL





mili $0 QL

mimvey 1

MINASTRIN 24 FE E

MINIVELLE 3 ST


103


MIRCETTE 3 QL

MIRENA (52 MG) E

mono-linyah $0 QL

NATAZIA $0 QL

necon 0535 (28) $0 QL

NEXPLANON E

nikki $0 QL

nora-be $0 QL


$0 QL


$0 QL


$0 QL


1


$0 QL



1



$0 QL


$0 QL

norlyda $0 QL

norlyroc $0 QL

nortrel 0535 (28) $0 QL



nortrel 777 $0 QL

NUVARING 3 QL

ocella $0 QL

ORIAHNN 2 PA QL

orsythia $0 QL


ORTHO MICRONOR E


E

philith $0 QL

pimtrea $0 QL

pirmella 135 $0 QL

pirmella 777 $0 QL


portia-28 $0 QL

PREFEST 3

PREMARIN ORAL 2

PREMARIN VAGINAL 2

PREMPHASE 2

PREMPRO 2

previfem $0 QL


E


1


1


E

PROMETRIUM 3

PROVERA 3

QUARTETTE 3 QL

reclipsen $0 QL

rivelsa $0 QL

SAFYRAL 3 QL

SEASONIQUE 3 QL

setlakin $0 QL

sharobel $0 QL

simliya $0 QL

simpesse $0 QL

SKYLA E

SLYND E

sprintec 28 $0 QL


104


sronyx $0 QL

syeda $0 QL

tarina 24 fe $0 QL

tarina fe 120 $0 QL


TAYTULLA E

tilia fe $0 QL

tri femynor $0 QL

tri-estarylla $0 QL

tri-legest fe $0 QL

tri-linyah $0 QL


tri-lo-marzia $0 QL

tri-lo-mili $0 QL


tri-mili $0 QL

tri-previfem $0 QL

tri-sprintec $0 QL

trivora (28) $0 QL

tri-vylibra $0 QL


tulana $0 QL

TWIRLA 3 QL

tyblume $0 QL

tydemy $0 QL


E

velivet $0 QL

vienva $0 QL

viorele $0 QL

VIVELLE-DOT E

volnea $0 QL

vyfemla $0 QL

vylibra $0 QL

wera $0 QL

wymzya fe $0 QL

xulane $0 QL


YASMIN 28 3 QL

YAZ E

yuvafem 1

zarah $0 QL

zovia 135 (28) $0 QL

zovia 135e (28) $0 QL

zumandimine $0 QL


ARMOUR THYROID 3 ST

CYTOMEL E

euthyrox 1

levo-t 1


E


1

levoxyl 1


methimazole oral 1

NATURE-THROID 3 ST

np thyroid 1


SYNTHROID 3

TAPAZOLE 3

TIROSINT E

TIROSINT-SOL 3

unithroid 1


3 ST

WP THYROID 3 ST


ACTEMRA 3 PA SP


105



ACTIMMUNE 2 PA SP

ALFERON N 2 SP

ARAVA 3

ARCALYST 3 PA SP

ASCENIV E SP

ASTAGRAF XL 3 SP

ATGAM 2 SP

AVSOLA 3 PA SP

AZASAN 3

azathioprine oral 1


BENLYSTA 3 PA SP

BERINERT 3 PA SP QL


3 PA SP


3 PA SP

CELLCEPT 3 SP


3 SP


2 PA SP



CINRYZE 2 PA SP


E SP

COSENTYX 150 MGML

E SP


E SP



E SP

CUTAQUIG E SP

CUVITRU 3 PA SP


1 SP



1 SP

CYTOGAM 2 PA SP

ENBREL MINI 3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP

ENSPRYNG E SP

ENTYVIO 3 PA SP

ENVARSUS XR 3 SP


1 PA SP

FIRAZYR 3 PA SP QL


GAMASTAN 2 PA SP

GAMIFANT 3 PA SP

GAMMAGARD 3 PA SP


106



3 PA SP


3 PA SP


3 PA SP

GAMUNEX-C 3 PA SP


1 SP


HAEGARDA 3 PA SP

HEPAGAM B E


3 PA SP


3 PA SP


2 PA SP


2 PA SP


2 PA SP



2 PA SP


2 PA SP


2 PA SP

HYPERHEP B SD E

HYPERRAB E


E


2 SP

HYPERTET SD E

HYQVIA 3 PA SP



2 PA SP QL

ILUMYA 3 PA SP


E

IMURAN 3

INFLECTRA 2 PA SP

KALBITOR 3 PA SP QL

KEDRAB INJECTION E

KEVZARA 3 PA SP


3 PA SP

KYMRIAH 3 PA SP

leflunomide oral 1

methotrexate oral 1


107



1


1


1


1


2 SP



1 SP


MYFORTIC 3 SP

NABI-HB E

NEORAL 3 SP

NULOJIX 3 PA SP

OCTAGAM 3 PA SP

OLUMIANT E SP


ORENCIA INTRAVENOUS

3 PA SP


3 PA SP

OTEZLA ORAL TABLET

2 PA SP


2 PA SP



3 PA QL


E

PANZYGA E SP

PRIVIGEN 3 PA SP

PROGRAF 3 SP

PROVENGE 2 PA SP

RAPAMUNE 3 SP


2 PA QL

REDITREX E

REMICADE E SP

RENFLEXIS 2 PA SP


2 SP


E


108


RIDAURA 3 SP

RINVOQ 2 PA SP

RUCONEST 3 PA SP QL


2 SP


3 SP


2 SP

SILIQ 3 PA SP



2 PA SP


2 PA SP

SIMULECT E

sirolimus oral 1 SP


2 PA SP

STELARA INTRAVENOUS

2 PA SP


2 PA SP QL


2 PA SP QL

SYNAGIS 2 PA SP


TAKHZYRO 3 PA SP

TALTZ 3 PA SP

temsirolimus 1 SP

THYMOGLOBULIN E

TICE BCG 2 SP

TORISEL 3 SP


TREMFYA 2 PA SP

TREXALL 3

UPLIZNA 3 PA SP


E

WINRHO SDF 2 SP

XATMEP 3

XELJANZ 2 PA SP

XELJANZ XR 2 PA SP

XEMBIFY 3 PA SP

ZINPLAVA E

ZORTRESS 3 PA SP


ACTHIB $0


$0


$0

BCG VACCINE E

BEXSERO $0

BIOTHRAX E


$0


$0


$0


$0

FLUAD $0


109


FLUAD QUADRIVALENT

$0


$0


$0


$0


$0


$0


$0

GARDASIL 9 $0


$0


$0


IMOVAX RABIES E

INFANRIX $0


$0

IXIARO E

MENACTRA $0

MENQUADFI $0


MENVEO $0



$0

PNEUMOVAX 23 $0

PREVNAR 13 $0

RABAVERT E


$0

ROTARIX $0


$0


$0

STAMARIL E

TDVAX $0

TENIVAC $0


$0

TRUMENBA $0


$0


E


$0

VARIVAX $0

VAXCHORA E


110


VIVOTIF E

YF-VAX E


ana-lex E


E


E


3


E

anucort-hc E

ANUSOL-HC EXTERNAL

3


E

APRISO 2

ASACOL HD E

AZULFIDINE 3




1

budesonide oral 1

CANASA E

COLAZAL 3

CORTENEMA 3

CORTIFOAM EXTERNAL

3

DELZICOL E

DIPENTUM E


3


E



E


1


1


E


1


E

LIALDA E


E


E


E

LIDOCORT EXTERNAL

E

mesalamine er 1

mesalamine oral 1

mesalamine rectal 1


ORTIKOS E

PENTASA 3

PROCORT EXTERNAL E

PROCTOCORT EXTERNAL

3


E


2





111


ROWASA RECTAL 3

SFROWASA 2


UCERIS 3



3 QL


1


1


1 QL

ATELVIA 3 QL

BINOSTO 3 QL

BONIVA INTRAVENOUS

E


3 QL


EVENITY 3 PA SP QL


2 PA SP


3 QL

FOSAMAX PLUS D E


E


1 QL

MIACALCIN INJECTION

3




2 PA SP QL

RAYALDEE 3

RECLAST 3 SP


1 QL


1


1 QL


2 PA SP

TYMLOS 2 PA SP

XGEVA 2 PA SP


1 SP


1 SP



E

calcitriol oral 1

cinacalcet hcl 1 PA


NATPARA 3 PA SP QL


paricalcitol oral 1

PARSABIV 3 SP

ROCALTROL 3

SENSIPAR 3 PA

ZEMPLAR INTRAVENOUS

E


3


112




ACACIA SUBCUTANEOUS

E


E


E


E

ACREMONIUM E

ACTHREL 3 SP


E

ACUNOL E

ADAKVEO 3 PA SP

ADULT AEROSOL MASK

E


E


3


3

ALDER E

ALTERNARIA E

AMERICAN BEECH E

AMERICAN COCKROACH

E

AMERICAN ELM E

AMERICAN SYCAMORE

E

AMINOPMRMS E


E



E


E

APP SLIM RMS E

APPTRIM E

APPTRIM-D E


E

ARIZONA CYPRESS E


3

asilnasalrms E

ASPARTAME E


E

AUREOBASIDIUM E

AUSTRALIAN PINE E


E


E


E

AVAILNEX E

AVITENE E

AVITENE FLOUR E

AXONA E

AZALGIA E

BAHIA E

BALD CYPRESS E


E


E

BHI URI-CONTROL E


113


BLACK WALNUT POLLEN

E

BLACK WILLOW E



E

BOX ELDER E


E


E


E


E


E

BROME E


E


E


E

CARDIOVID PLUS E


E


E


E


E


E



E

CARTICEL E


E

CATTLE EPITHELIUM E

CAYA $0 QL

CEDAR ELM E


E


E

COCKLEBUR E


E

COLCIGEL E


E


E


E

CONDOMS E

CORN POLLEN E

CORTROSYN E


CROFAB E

CURVULARIA E

DANDELION E



E


114



E

desflurane 1


E


E


E


E


E

DIGIFAB E

DOG EPITHELIUM E

DOG FENNEL E

DOJOLVI E

DRECHSLERA E


2 PA SP


E

DYSPORT 3 PA SP

EASIVENT 2

EASTERN COTTONWOOD

E

EC-RX DHEA E

ECZEMOL E

ENDARI 3 PA

ENDO AVITENE E



E


E


E


E


E


E


E

ENGLISH PLANTAIN E

ENLYTE E


ENTERAGAM E

enteric fish oil E

EPICOCCUM E

EPISIL E

EQUACARE JR E


ESSENTIAL CARE JR E


2 PA SP

EVRYSDI E SP

FIRDAPSE E SP

FIRE ANT E


2


2


115



2

FORANE 3


E


3


E

FOSTEUM PLUS E

FOVEX E

FUSARIUM E

GABADONE E

GELCLAIR E

GELFILM EXTERNAL E

GEL-FLOW E

GEL-FLOW NT E

GELFOAM E


E


E

GELFOAM SPONGE E


E


E


E

GELFOAM-JMI POWDER

E

GELFOAM-JMI SPONGE

E

GELSYN-3 2 PA SP

GELX E

GERMAN COCKROACH

E

GIVLAARI 3 PA SP


GLEOLAN E


3


E


E


E


E


E

GLYTACTIN BURST E


E


E

GLYTACTIN RESTORE 5

E


E


E


E

GLYTACTIN RTD 15 E


E


E

GOLDENROD E

GRASTEK 3 PA QL

H2Q ORAL POWDER E

HACKBERRY E


1


1


116


HEPMED E

HIBICLENS E

HOMACTIN AA PLUS E

HOME PAP KIT E


E

HORSE EPITHELIUM E

HUMATROPEN FOR 12MG

E

HUMATROPEN FOR 24MG

E

HUMATROPEN FOR 6MG

E

HYALGAN E SP

HYLAFEM E

HYMOVIS E SP

HYPERTENSA E


2

INTERCEED E

IOSAT E

isoflurane 1

ISOVACTIN AA PLUS E

JOHNSON GRASS E


E

KAPOK E


3


E

KETOVIE LIQUID ORAL

E


KETOVIE PEPTIDE E

KOCHIA E

LAMBS QUARTERS E

LENSCALE E

LIMBREL E

LIMBREL250 E

LIMBREL500 E

LISTER-V E

LORMATE E

MACRILEN E

MACUTEK E

MASK VORTEX E


E

MELALEUCA E

MESQUITE E


E

METHAVER E



E


1 QL

METOPIRONE E


E


E


E

MIXED ASPERGILLUS E

MIXED FEATHERS E

MIXED RAGWEED E


117



E

MKO MELT DOSE PACK

E

mlk f1 E

mlk f2 E

mlk f3 E

mlk f4 E

MONOVISC E SP

MORCIN E

MOUNTAIN CEDAR E

MOUSE EPITHELIUM E

MUCOR SUBCUTANEOUS

E

MUCOTROL E

MUGARD E

MUGWORT E

MYOBLOC 3 PA SP

NEODOT THERMOMETER

E

NEUREPA E

NICAPRIN E

NICAZYME E


E


OLIVE TREE E

OMNIVEX E

OPTIONS CONCEPTROL

$0 QL

ORALAIR 3 PA QL


3 PA QL


3 PA QL



3 PA QL


3 PA QL

ORAMAGICRX E


E


E SP

OXBRYTA E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E


118



E


E


E

PECAN POLLEN E


E

PERCURA E


E

PH STRIPS E

PHENACTIN AA PLUS E

PHEXXI E

PHOMA EXIGUA E


3

PRAXBIND E


E


E

PRID E

PRIVET E

PRO-CRITIC E


E

PROLEVA E


E



E

PSORIZIDE FORTE E

PSORIZIDE ULTRA E

PULMONA E

PURAMINO DHAARA E

QUEEN PALM E

RABBIT EPITHELIUM E

RADIOGARDASE 3

RAGWITEK 3 PA QL

RAPID GEL RX E

RED BIRCH E

RED CEDAR E

RED MAPLE E

RED MULBERRY E


E

RESECTISOL E


E

RHEUMATE E

RHIZOPUS E

RIBOZEL E

ROUGH MARSH ELDER

E

ROUGH PIGWEED E

RUSSIAN THISTLE E

RUZURGI 3 PA SP


E

SAGEBRUSH E


E

SENTRA AM E

SENTRA PM E

sevoflurane 1


119


SHAGBARK HICKORY E

SHARPS CONTAINER E

SHEEP SORREL E


E

SILTREX E


E SP

SORBITOL IRRIGATION

E

sorbitol-mannitol E

SORRELDOCK MIX E

SPEEDGEL RX E

SPINRAZA 3 PA SP

SPINY PIGWEED E

STEMPHYLIUM E

SUPARTZ FX E SP

SUPRANE 3

SWEET GUM E


E


E SP


E SP

SYRINGE AVITENE E

TACHOSIL 3

TALL RAGWEED E

terrell 1

THERAMINE E

THERAMINE PLUS E

THROMBI-GEL 10 E

THROMBI-GEL 100 E

THROMBI-GEL 40 E

THROMBI-PAD E


THYROGEN 2 PA SP


E


3

TL-ICARE E

TOBAKIENT E


E

TRANZGEL E


E


E

TREPADONE E


E


E

TRILURON E SP


E

T-SUPPORT MAX E


E


E

TYLACTIN RESTORE 10

E


E

TYLACTIN RTD 15 E

TYROS 2 E

ULTANE 3


E


E


120



E


E


E


E

VASCULERA E


$0 QL


$0 QL

VILACTIN AA PLUS E

VILTEPSO E SP

VIRGINIA LIVE OAK E

VISTOGARD 3


E


E


E

WELLMIND VERTIGO E

westab max E

WESTERN JUNIPER E

WHITE ASH E

WHITE BIRCH E


E

WHITE MULBERRY E

WHITE OAK E


WHITE PINE E


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL

XEOMIN 3 PA SP

XIAFLEX 2 PA SP

XYZBAC E

XYZMUNE E

YELLOW DOCK E


E


E

ZYVEXOL E

ZYVIT E


ACULAR 3

ACULAR LS 3

ALAWAY E

ALOCRIL E


121


ALOMIDE 3

ALREX E

AZASITE 3


1


BEPREVE 3 ST

BESIVANCE 3


3

BLEPH-10 3


1 QL

BROMSITE E

CILOXAN 3


1


1


1

DEXTENZA E SP

DEXYCU E


1

DUREZOL E

epinastine hcl 1


1

eye itch relief E

EYSUVIS E

FLAREX 3


1


FML 2

FML FORTE 3

FML LIQUIFILM 3




1


1

ILEVRO E


E SP

INVELTYS 3


1

KLARITY-A E

KLARITY-L E



E


E


3

LOTEMAX SM 3


MAXIDEX 3

MITOSOL 3

MOXEZA 2


1


1

NATACYN 2

NEVANAC E

OCUFLOX 3



E


1


122



E


1


3 SP

PATADAY E


3

PRED FORTE 3

PRED MILD 3


E


1


E


1


E

PROLENSA 2 QL


E SP


1


TOBREX 3


TRIPLE PMB E

TRIPLE PMK E

UPNEEQ E

VIGAMOX 3

YUTIQ E SP

ZADITOR E

ZERVIATE E

ZIRGAN 3

ZYMAXID 3



acetazolamide er 1



2


E

apraclonidine hcl 1

AZOPT 2


1

BETIMOL 3

BETOPTIC-S 3



1


E

carteolol hcl 1

COMBIGAN 2

COSOPT 3


3


3


1


1


1

DURYSTA E


3

ISOPTO CARPINE 3


123


ISTALOL 3

KEVEYIS 3 PA SP QL



E


1


2 QL


PHOSPHOLINE IODIDE

2


1

RHOPRESSA 3 QL

ROCKLATAN 3 QL

SIMBRINZA 2


1



E


E


E

TIMOPTIC E


3


E

TIMOPTIC-XE E

TRAVATAN Z 3 QL



TRUSOPT 3

VYZULTA E

XALATAN 3

XELPROS 3 ST QL

ZIOPTAN E


ak-poly-bac 1

AKTEN 3

ALCAINE 3

altacaine 1

altachlore E

altafluor benox E


1


E


1


E


1


1


1

BEOVU E SP

BEVACIZUMAB 3 SP


bio glo E

BLEPHAMIDE 3

BLEPHAMIDE SOP 3

CEQUA E


124



E


E

CYCLOGYL 3

CYCLOMYDRIL 3


1


E

CYSTADROPS E SP

CYSTARAN 3 PA SP QL

DOUBLE PM E

EYLEA INTRAVITREAL

3 PA SP

flucaine E


fluor-i-strips at E

FLURA-SAFE E


E


E

GELFILM OPHTHALMIC

E


E


E


E


E

homatropaire 1


E

ISOPTO ATROPINE 3


LACRISERT 3

LASTACAFT 3 ST

LATISSE E

lissamine green E


E


lubricant eye pm E

lubricant pm E



E


2 PA SP


3 PA SP

MAXITROL 3

MEMBRANEBLUE 3


E


E

MYDRIACYL E


1


1


1


1


125



1

neo-polycin 1

neo-polycin hc 1

OXERVATE 3 PA SP QL

PAREMYD E


1

polycin 1


1

POLYTRIM 3

PRED-G 3

PRED-G SOP 3


E


E


E


E


E


E


E


1


E


REFRESH RELIEVA E


E

RESTASIS 2 PA


2 PA

ROSE GLO E


E


1

SYSTANE COMPLETE E


E

SYSTANE ULTRA PF E


1


3


E

TOBRADEX ST 3


1



E


E


E


E


126



E

ultra fresh pm E


E

VISIONBLUE 3

VISUDYNE 3 SP

XIIDRA 2 PA

ZYLET 3


acetic acid otic 1

CETRAXAL 3 ST

CIPRO HC 3

CIPRODEX 2



1


E

cortic-nd 1

DERMOTIC 3

exotic-hc 1

flac 1


1


1


1

ofloxacin otic 1

OTICIN HC NR 3

OTIPRIO E

OTOVEL E

PRAMOTIC 3



12 hour allergy-d E


E


E


ADRENALIN NASAL E

all day allergy d E



E

allergy 24-hr E

allergy childrens E


E



E



E


E


E


E


E


E


E


127



E


E




E


BECONASE AQ 3 QL

benzonatate 1

bromfed dm 1


1


1


E


E


1



E


E


E


E


E

CINQAIR 3 PA SP


E

CLARINEX-D 12 HOUR

E


E



E



1




E


E


3



E


E


E


E


E


1


1


E

DICOPANOL FUSEPAQ

E

DICOPANOL RAPIDPAQ

E


E

DI-PHEN E



128



E


E


1


E


E

DYMISTA 2 QL


FASENRA 2 PA SP

FASENRA PEN 2 PA SP


E


E


1 QL


1



GILPHEX TR E


E


E




E


E


E

hm loratadine E


HYCODAN 3 PA QL


1 PA QL


1 PA QL

hydromet 1 PA QL

HYPERSAL 3


3


1


E


1



loratadine-d 12hr E

loratadine-d 24hr E


maxi-tuss gmx E

maxi-tuss pe max E

m-dryl E

MICLARA LQ E


1 QL


E


E

MUCINEX DM E


E

mucus dm E


129



E


E


mucus-d E

mucus-er max E


E


E



E



NASONEX E


E


E


E

NEOTUSS PLUS E

NUCALA 2 PA SP QL


OMNARIS 3 QL

PATANASE 3 QL


PHENERGAN INJECTION

E


E



1




1


1 PA QL


1

promethegan 1

PROPEL E

PROPEL MINI E



1


E

QNASL 3 QL



E


E


3

ryvent E

SEMPREX-D E

sinus 12 hour E

SINUVA 3


1

SSKI E

SUDAFED CONGESTION

E

sudogest 12 hour E


E


130



E


3

TESSALON PERLES 3


E


E


E



E


E

TUXARIN ER E


E



E


XHANCE E

XOLAIR 2 PA SP

ZETONNA 3 QL


E


ACCOLATE 3


1



3

ADVAIR DISKUS 1 QL

ADVAIR HFA 2 QL

ADYPHREN E

ADYPHREN AMP E

ADYPHREN AMP II E

ADYPHREN II E

AIRDUO DIGIHALER E


E


E


E



1 QL


E


1 QL


E


1 QL


ALVESCO E


131


ANORO ELLIPTA 2 QL


3 PA SP


ARMONAIR DIGIHALER

E



E


E


E


E


E

ASMANEX HFA E

ATROVENT HFA 3 QL


3 QL


E

BEVESPI AEROSPHERE

E

BREO ELLIPTA 2 QL

BREZTRI AEROSPHERE

E

BROVANA 3 QL



E


COMBIVENT RESPIMAT

2 QL


1

DALIRESP 3 PA

difil-g forte 1

DUAKLIR PRESSAIR E

DULERA E

ELIXOPHYLLIN 2


1 ST


1


E


1 ST


1

EPINEPHRINESNAP-EMS

E

EPINEPHRINESNAP-V E


3 ST


E

EPISNAP E

ESBRIET 3 PA SP

FLOVENT DISKUS 2 QL

FLOVENT HFA 2 QL


132



E


1 ST QL

GLASSIA 3 PA SP

INCRUSE ELLIPTA E


1 QL



1 QL


E


3 QL


3 QL


1

OFEV 3 PA SP

PERFOROMIST 3 QL

PROAIR DIGIHALER E

PROAIR HFA E

PROAIR RESPICLICK E


3 PA SP



3 PA SP

PROVENTIL HFA E

PULMICORT FLEXHALER

2 QL


E

QVAR REDIHALER E

SEEBRI NEOHALER E


SINGULAIR E

SPIRIVA HANDIHALER

2 QL


2 QL

STERITALC 3


2 QL

STRIVERDI RESPIMAT

2 ST QL

SYMBICORT 2 QL

SYMJEPI 3


E


THEO-24 3

theophylline 1


1


1


133


E

UTIBRON NEOHALER E

VENTOLIN HFA E

wixela inhub E

XOPENEX NEB 3 QL

XOPENEX CONCENTRATE

3 QL

XOPENEX HFA E

YUPELRI 3 QL

zafirlukast 1

ZEMAIRA 3 PA SP

zileuton er 1 ST

ZYFLO E


BETHKIS 2 SP

CAYSTON 3 PA SP

KALYDECO 3 PA SP

KITABIS PAK E SP

ORKAMBI 3 PA SP QL

PULMOZYME 2 PA SP

SYMDEKO 3 PA SP QL

TOBI NEBULIZER E SP



1 SP


E SP


E SP


TRIKAFTA 3 PA SP QL


ADCIRCA 3 PA SP QL

ADEMPAS 2 PA SP QL

alyq 1 PA SP QL


bosentan 1 PA SP QL


FLOLAN 3 PA SP

LETAIRIS 3 PA SP QL

OPSUMIT 2 PA SP QL

ORENITRAM 3 PA SP


E SP

REVATIO INTRAVENOUS

3 PA SP



1 PA SP


1 PA SP QL


1 PA SP QL



E SP



TYVASO 3 PA SP QL



UPTRAVI 3 PA SP QL


134



TUDORZA PRESSAIR


VELETRI 3 PA SP

VENTAVIS 3 PA SP QL



AMRIX E

BACLOFEN EXTERNAL

E


baclofen oral 1

carisoprodol oral 1


1 QL


1

CYCLOGABA 10300 E



1


1


E

CYCLOPAK 3

CYCLOPHENE RAPIDPAQ

E


3


enovarx-baclofen E


E

FEXMID 3

FIRST-BACLOFEN E



E


E

LIORESAL E

LORZONE 3

METAXALL CP E

metaxalone 1


NOPIOID-LMC KIT E

NORGESIC FORTE E



1


E

OZOBAX E

ROBAXIN-750 3

SKELAXIN E

SOMA 3

TABRADOL FUSEPAQ E

TABRADOL RAPIDPAQ

E


VANADOM 3

ZANAFLEX E


AMBIEN E

AMBIEN CR E


135


armodafinil 1 PA QL

BELSOMRA 3 ST QL

DAYVIGO 3 ST QL


EDLUAR E

eszopiclone 1 QL


HETLIOZ 3 PA SP QL


3 QL

LUNESTA E

modafinil 1 PA QL

NUVIGIL E

PROVIGIL E

ramelteon 1 QL

RESTORIL E

ROZEREM 3 QL

SILENOR 3 QL


E


SUNOSI 2 PA QL

temazepam 1 QL

WAKIX 3 PA SP QL

XYREM 3 PA SP QL

XYWAV E SP

zaleplon 1 QL



ZOLPIMIST 3 ST QL


136

Index of Drugs




137




138




139




140




141




142




143




144




145




146




147




148




149




150




151




152




153




154




155




156




157




158




159




160




161




162




163




164




165




166




167




168




169




170




171




172




173




174




Drug Tier


Directions Doctor


-Continued on back-


























(Farsi)

HealthSelectSM

of Te

xas





Anesthetics


Antibacterials

Anticoagulants



Antidepressants


Antifungals

Antigout Agents


Antimigraine Agents


Antimycobacterials


Antiparasitics


Antiplatelets


Antivirals













Diabetes - Insulins






























3







What are tiers


4











5








6


Tier information



Tier 1 Lowest Cost






Tier 3 Highest Cost











Table of Contents


7


8






E


E


E


E

acetaminophen er E


E


E


E


E


E


E


1 QL


1 QL


1 QL


1 QL

ACTIQ 3 PA QL

ALLZITAL E

APADAZ E



1 QL


1 QL

ARYMO ER E

ascomp-codeine 1


BELBUCA 2 PA QL


E


3

BUPRENEX E


E


1 PA QL


1


E


1



1


1


1


1


E


9



1 QL

BUTRANS 3 PA QL


1


E


E

childrens apap E


E


1 QL

CONZIP E


E


E

DILAUDID ORAL E

DOLOPHINE 3 PA

DSUVIA E

DURAGESIC-100 E

DURAGESIC-12 E

DURAGESIC-25 E

DURAGESIC-50 E

DURAGESIC-75 E

duramorph E


1 QL

ESGIC 3

fentanyl 1 PA QL



1 PA QL


E



E


E


E


E


E


E


E


E


E


E


10



E


E


3


3

FIORINAL 3

FIORINALCODEINE 3

3


E



1 PA ST QL


1 QL


1 QL


1 QL


1 PA QL


E




E


E


E

HYSINGLA ER 2 PA QL

INFUMORPH 200 E

INFUMORPH 500 E


E

LAZANDA E




3 QL

MEDI-DERM-RX E

MEDROX-RX 3


E


1 QL


1 QL




1


11



1


1 PA


1


1


1


migraine relief E

mitigo E


1 QL


E


E


1 PA QL


1 PA QL


1 PA QL


E


E


E


E





E


E


E

m-pap E


E


1

NALOCET E

NORCO E

NUCYNTA E

NUCYNTA ER E

OXAYDO ORAL TABLET

E


E


1 QL


1 QL


1 QL


1 QL


E


12



1 QL


1 QL


2 PA QL




E



E


E


E



E

PANADOL CHILDRENS

E

PANADOL EXTRA E


E

PANADOL INFANTS E


1 QL


E

PRIALT 2 SP

PRIMLEV E


E


PROLATE E

QDOLO E


E


E

SUBSYS E

SYNAPRYN FUSEPAQ E


1


1 ST QL


E


1 PA QL


1 QL



1 QL


3 QL

TYLENOL 8 HOUR E


E


E

TYLENOL ORAL TABLET

E

ULTRACET E

ULTRAM E


13


VANATOL LQ E

VTOL LQ E

XTAMPZA ER 2 PA QL


3


E


ACTIVE-KETOPROFEN

E

ACTIVE-PREP KIT I E




ADVIL E


E


E

ADVIL MIGRAINE E


E


E

ALEVE ORAL TABLET E


E

aspirin adult $0


$0






$0


$0


$0


$0


$0


E


$0


$0


$0

BIIFENAC 1000 E

BIIFENAC 500 E


E

CAMBIA E

CAPSFENAC PAK E

CAPSINAC E

CELEBREX E

celecoxib oral 1 QL

DAYPRO 3


E


E


14



E

DFSMSMENTHCAP PAK

E

DICLOFENAC E


3 QL




1 QL


1 PA



1


E


3


E

DICLOPR E

diclosaicin E

DICLOSTREAM E

DICLOTREX E

DICLOVIX E

DICLOVIX M E

DICLOZOR EXTERNAL

E

diflunisal oral 1

DIMENTHO E


E

DUEXIS E



3

ec-naproxen 1


E

enovarx-ibuprofen E


E


E

etodolac er 1

etodolac oral 1

FBL KIT E

FELDENE 3



E

FLEXIPAK E

flurbiprofen oral 1

FROTEK E


E



$0


E

IBUPAK E

ibuprofen 1

ibuprofen infants E



1


E

inavix E

INDOCIN ORAL 3 ST


15


INDOCIN RECTAL E

indomethacin er 1


E


1 ST

INFLAMMACIN E


E

KBGL IN TERODERM

E

KETOPHENE RAPIDPAQ

E

ketoprofen er 1

ketoprofen oral 1


E


1


1


3 PA QL


1 QL


1


3

LICART EXTERNAL E

LODINE 3


1




MOBIC ORAL TABLET E


E


E

nabumetone oral 1


3

NALFON ORAL TABLET

3


3


E


3

naproxen dr 1


E




E


1


1 PA QL


E

NUDICLO SOLUPAK E

NUDICLO TABPAK E

NUDROXIPAK E

NUDROXIPAK DSDR-50

E


16


NUDROXIPAK DSDR-75

E

NUDROXIPAK E-400 E

NUDROXIPAK I-800 E

NUDROXIPAK M-15 E

NUDROXIPAK N-500 E

ORMECA E

oxaprozin 1

PENNSAID EXTERNAL

E

piroxicam oral 1

PRASTERA E


E


E


$0

QMIIZ ODT E


E

RELAFEN E

RELAFEN DS E

REXAPHENAC EXTERNAL

E

salsalate oral E

SPRIX 3 PA QL


$0

sulindac oral 1


E


E


1


1

TORONOVA II SUIK E


TORONOVA SUIK E


E


E

VAROPHEN E

VENNGEL ONE E

VIMOVO E

VIVLODEX E

VOLTAREN EXTERNAL

E

VP FC KIT E

VP GKL KIT E

XRYLIX EXTERNAL E

ZIPSOR E

ZORVOLEX E

Anesthetics


E

7T LIDO E

ACCUCAINE E


E

AGONEAZE E

ANODYNE LPT E

APRIZIO PAK E

APRIZIO PAK II E

ASTERO E


E

blue tube aloe E


E



E


17



E


E

CADIRAMD E

CAPSAICIN-MENTHOL

E


3


E

COCAINE HCL NASAL E


E


E


E

DERMACINRX PHN E

DERMACINRX PRIZOPAK

E

DERMACINRX ZRM E

EHA E

EMPRICAINE-II E


ethyl chloride 1

EXPAREL E

FLEXIN E

GEBAUERS PAIN EASE

3


3

GEN7T E

GEN7T PLUS E

GOPRELTO E


LDO PLUS E

lets E

LEVATIO E

LIDO BDK E


E


1


1


E


E


E


1


1


E


E


3


1


3


1


1


1 QL


18



E


1


E


E

LIDOCANNA E

LIDODERM E


3


E

LIDOMARK 25 E

LIDOPAC E


E


E


E

LIDOPRIL XR E


E

LIDOPURE PATCH E

LIDORX E

LIDO-SORB E

LIDOSTREAM E

LIDOTHOL E

LIDOTRAL E

LIDOVIX L E

LIDTOPIC MAX E

LIVIXIL PAK E

LMR PLUS E

LYDEXA E


MARCAINE E


E

marlido E

MARLIDO-25 E

MARVONA SUIK E

MEDI-DERML-RX E

MEDI-PATCH RX E

NUMBRINO E

NUVAKAAN E

NUVAKAAN-II E

PAINGO KFT E

PLIAGLIS E

POINT OF CARE LM-22

E

POINT OF CARE LM-25

E

premium lidocaine E

PREMIUM SCAR E

PREPIV SUPPLY 3

PRILO PATCH E

PRILO PATCH II 3

PRILOLID E

PRILOVIX E

PRILOVIX LITE E


PRILOVIX PLUS E



PRILOVIXIL E

PRIZOPAK II E

PRIZOTRAL E

PRIZOTRAL-II E

READYSHARP-A E


E

RELADOR PAK PLUS E


19


RENOVO E

sensorcaine E

sensorcaine-mpf E


E


E

SYNERA E

SYNVEXIA TC E


3

VEXATROL E


E

XARACOLL E

XYLOCAINE INJECTION

3


3

ZERUVIA E

ZILACAINE PATCH E


E

ZIONODIL E

ZIONODIL 100 E

ZTLIDO E



BUNAVAIL 3 QL


1 QL


1 QL


$0 QL


CHANTIX $0 QL


$0 QL


$0 QL

disulfiram oral 1

LUCEMYRA 3 ST QL


E


E


E



E

NARCAN 2


$0 QL


$0 QL




NICOTROL $0 QL

NICOTROL NS $0 QL

SUBLOCADE 3 SP


2 QL

VIVITROL 3 SP

ZUBSOLV 2 QL

Antibacterials

ACTICLATE E

AEMCOLO 3 PA

ALTABAX 3


20



E



1



1


1


1


1


E

ARIKAYCE 3 SP

AUGMENTIN ES-600 3


3


3

avidoxy 1 ST

AVIDOXY DK E


1


1


1




BACTRIM 3

BACTRIM DS 3

BAXDELA INTRAVENOUS

E

BAXDELA ORAL 3


3


1

BENZODOX E

BICILLIN L-A E

cefaclor 1

cefaclor er 1

cefadroxil 1


E


E

cefdinir 1


E

cefixime 1

CEFOTAN E


E


E


E


cefprozil 1


21



E


1


1

CENTANY 3

CENTANY AT E

cephalexin 1


E


3


3


clarithromycin er 1


CLEOCIN ORAL 3


3


2



1


1

CLINDESSE 3


E

COLY-MYCIN M E

coremino E

CUBICIN E

CUBICIN RF E

daptomycin E




DIFICID 3

DORYX MPC E


3 ST


E

doxy 100 E


E


1


1


1 ST


E


1


1 ST


E


1 ST


1


1


22



1 ST

EES GRANULES 3

ertapenem sodium E

ERYPED 200 3

ERYPED 400 3

ERY-TAB 3


3



1

erythromycin oral 1

FETROJA E


E

FIRVANQ 3

FLAGYL ORAL CAPSULE

3


3


E


1


1

HIPREX 3


E

INVANZ INJECTION E


1

KEFLEX 3


levofloxacin oral 1

LINCOCIN E



E


E

linezolid oral 1 QL

MACROBID 3

MACRODANTIN 3


1


E


E


E



E


E




3


E



23


MINOLIRA E


1 ST

MONUROL 3


E


1



mupirocin calcium E



E


E



E


1


1


1

NUTRIDOX E

NUVESSA E


3


1


E


E


1



E





E


E


E


E

PRIMSOL 3

RECARBRIO E


E

SEYSARA 3 ST

SILVADENE 3


E


1

SIVEXTRO E


3

SOLOSEC 3

ssd 1


E


24


sulfadiazine oral 1


1


1


E


3


SUPRAX ORAL CAPSULE

3


3


3

TARGADOX E

tazicef injection E


E


E


tigecycline E

tinidazole oral 1

trimethoprim oral 1

TYGACIL E


E

VANCOCIN 3


3



E


E



E

vandazole 1

VIBRAMYCIN 3 ST

XENLETA INTRAVENOUS

E

XENLETA ORAL 3

XEPI 3

XIFAXAN 3 PA

XIMINO 3

ZEMDRI E


3


3


3

ZITHROMAX TRI-PAK 3

ZITHROMAX Z-PAK 3


E

ZYVOX ORAL 3 QL

Anticoagulants

ACD-A NOCLOT-50 3


25


ACTIVASE E


1


3

ARIXTRA 3 SP QL

CATHFLO ACTIVASE E

ELIQUIS 2 QL


2 QL




3 SP QL


E


1


E


1



E

jantoven 1

LOVENOX 3 SP QL

PRADAXA 2 QL

REGIOCIT E

SAVAYSA 3 QL

THROMBATE III 3 SP

TRICITRASOL 3


XARELTO 2 QL


2 QL


APTIOM 3

BANZEL 3 PA


E

BRIVIACT ORAL 3 ST

carbamazepine er 1


CARBATROL 3

CELONTIN 3


E

clobazam 1 PA

DEPAKOTE 3

DEPAKOTE ER 3


3

DIACOMIT 3 PA SP





26


DILANTIN INFATABS E


E


3


E


1


1


1

EPIDIOLEX 3 PA SP

epitol 1

ethosuximide oral 1

FANATREX FUSEPAQ E

felbamate 1

FELBATOL 3

FINTEPLA 3 PA SP


E

FYCOMPA 3


1


1


GABITRIL 3

KEPPRA INTRAVENOUS

E

KEPPRA ORAL 3

KEPPRA XR 3


2



E


3


3


3

LAMICTAL STARTER 3

LAMICTAL XR 3

lamotrigine er 1


1



1


1


1


1


1

levetiracetam er 1


E


MYSOLINE 3

NAYZILAM 3 QL

NEURONTIN 3


3 PA


3 PA

oxcarbazepine 1

OXTELLAR XR E



27



1

PHENYTEK 3



1


1


1

primidone oral 1

QUDEXY XR 3


1

rufinamide 1 PA

SABRIL ORAL PACKET

E SP

SABRIL ORAL TABLET

3 PA SP

SPRITAM E

subvenite 1


1


1


1

SYMPAZAN 3 PA


3


3

TEGRETOL-XR 3

tiagabine hcl 1

TOPAMAX 3

TOPAMAX SPRINKLE 3

topiramate er 1

topiramate oral 1

TRILEPTAL 3

TROKENDI XR 3 ST



1


1

VALTOCO 10 MG DOSE

3 QL

VALTOCO 15 MG DOSE

3 QL

VALTOCO 20 MG DOSE

3 QL

VALTOCO 5 MG DOSE

3 QL

vigabatrin 1 PA SP

vigadrone 1 PA SP

VIMPAT INTRAVENOUS

E

VIMPAT ORAL 3

XCOPRI 3 ST


3 ST


3 ST

ZARONTIN 3

ZONEGRAN 3

zonisamide oral 1


ARICEPT 3

donepezil hcl 1

EXELON TRANSDERMAL

3


1


1



1


28



1

NAMENDA ORAL TABLET

3


3

NAMENDA XR 3 QL


3 QL

NAMZARIC 2 QL

RAZADYNE ER 3

rivastigmine 1


Antidepressants


amoxapine 1

ANAFRANIL 3

APLENZIN 3 ST QL

BRISDELLE 3 ST QL



1 QL


E


CELEXA ORAL TABLET

3


1


1


CYMBALTA E


DESVENLAFAXINE ER

3 ST QL



1 QL


1


1



EFFEXOR XR E

EMSAM 3 QL


FETZIMA 3 ST QL



3


1


1 QL


1




FORFIVO XL E



LEXAPRO ORAL TABLET

E

maprotiline hcl 1

MARPLAN 3

mirtazapine oral 1

NARDIL 3

nefazodone hcl 1


3



29



1 QL


3

PARNATE 3

paroxetine hcl er 1


1


PAXIL CR 3


2 ST

PAXIL ORAL TABLET 3


1

PEXEVA E


PRISTIQ E

protriptyline hcl 1

PROZAC ORAL CAPSULE

E


3

REMERON SOLTAB 3



3 PA SP


3 PA SP


3 QL




1

TRINTELLIX 3 ST QL

venlafaxine hcl 1



VIIBRYD ORAL TABLET

3 QL


3 QL

WELLBUTRIN SR E

WELLBUTRIN XL E

ZOLOFT E

ZULRESSO 3 PA SP


AKYNZEO INTRAVENOUS

E

AKYNZEO ORAL 3 QL


E

ANZEMET ORAL 3 QL

aprepitant 1 QL

BONJESTA 3 PA QL

compro 1


DICLEGIS 3 PA QL


dronabinol 1 PA QL


E


3 QL


3

EMEND TRI-PACK 3 QL


E

GIMOTI E


30



E


E


MARINOL 3 PA QL


1


E


E


1


1


1


1



E


1 QL


1 QL


1

ondansetron odt 1

palonosetron hcl E

perphenazine oral 1

prochlorperazine 1


1

REGLAN ORAL 3

SANCUSO 3 QL


scopolamine 1

SYNDROS 3 PA QL

TIGAN INTRAMUSCULAR

E

TIGAN ORAL 3


3


3


E


1


3 QL


3

ZUPLENZ E

Antifungals

ACTIVE-PREP KIT V E

ala-quin E

ALCORTIN A E


E


E

ANCOBON 3


E


3



E


E


31



1



1



1


1


1


E


1

CRESEMBA ORAL 3



E

dermazene E


E


3


3

DIFMETIOXRIME E

ECONASIL E


1


E

ECOZA E


E


ERTACZO E

EXELDERM E


EXTINA 3

fluconazole oral 1


E

flucytosine oral 1

FUNGIMEZ E


1


1

GYNAZOLE-1 3


E

IMIOXIA E

IODOQUIMEZ-HC E


E


E


E


JUBLIA E

KERYDIN 3 PA


1


E


1

ketoconazole oral 1


E



E


32



3

LOPROX EXTERNAL KIT

E


3


3


E

LULICONAZOLE E

LUZU E

MENTAX E

micaderm E


E

miconazole 1 E


1


E


E


E


E

naftifine hcl 1


3

NAFTIN EXTERNAL GEL

3

NOXAFIL ORAL 3

nyamyc 1

nystatin external 1





nystop 1

ONYCHO-MED E

ORAVIG E



3


E

PEDIZOLPAK E

PHEODOYO E

PHEYO E


E

posaconazole 1

QUINJA E

RECURA E

SPORANOX 3 PA

SPORANOX PULSEPAK

3 PA

SULCONAZOLE NITRATE

E

tavaborole 1 PA


terconazole 1



E

TOLSURA E

VFEND 3

voriconazole oral 1

VUSION E

VYTONE E

XOLEGEL E

XOLEGEL COREPAK E


E

XOLEGEL DUOXOLEX

E


33



E

ZOLPAK E

Antigout Agents

allopurinol oral 1


E



COLCRYS E

febuxostat 1 ST

GLOPERBA E

KRYSTEXXA 3 PA SP

MITIGARE E

probenecid oral 1

ULORIC 3 ST

ZYLOPRIM 3


EMFLAZA 3 PA SP

Antimigraine Agents

AIMOVIG 2 PA QL

AJOVY E


AMERGE 3 QL

CAFERGOT 3

DHE 45 3 PA QL


1 PA QL


1 PA QL


EMGALITY 2 PA QL


2 PA QL

ERGOMAR 3


FROVA 3 QL



IMITREX 3 QL


3 QL


3 QL


3 QL


3 QL

MIGERGOT 3

MIGRAINE PACK E

MIGRANAL 3 PA QL

MIGRANOW E


NURTEC 2 PA QL


RELPAX 3 QL

REYVOW E




1 QL


1 QL


1 QL


1 QL


34



1 QL


1 QL

TOSYMRA E


3 ST QL

UBRELVY 2 PA QL

VYEPTI E

ZEMBRACE SYMTOUCH

E


ZOMIG NASAL 3 ST QL

ZOMIG ORAL E

ZOMIG ZMT E


GUANIDINE HCL ORAL

3


3


3


3


E


1


1


1

Antimycobacterials

CAPASTAT SULFATE E


cycloserine oral 1

dapsone oral 1


isoniazid oral 1


3

MYCOBUTIN 3

PASER 3

PRETOMANID 3

PRIFTIN 3

pyrazinamide oral 1

rifabutin 1

rifampin oral 1


E

SIRTURO 3

TRECATOR 3



ABRAXANE 2 SP

ADCETRIS 2 PA SP


1 SP


1 SP



2 PA SP QL


E SP

ALECENSA 3 PA SP

ALIMTA 2 SP

ALIQOPA 3 PA SP

ALKERAN 3 SP

ALUNBRIG 3 PA SP QL

anastrozole oral $0


35


ARIMIDEX E

AROMASIN 3

ARRANON 2 SP


1 SP

ARZERRA 2 PA SP

ASPARLAS 3 SP

AVASTIN 3 PA SP

AYVAKIT 3 PA SP QL

azacitidine 1 PA SP

BALVERSA 3 PA SP

BAVENCIO 3 PA SP

BELEODAQ 3 PA SP

BELRAPZO E SP

BENDEKA 3 PA SP

BESPONSA 3 PA SP

bexarotene 1 PA SP

bicalutamide 1

BICNU 3 SP

BLENREP E SP


BLINCYTO 3 PA SP

BORTEZOMIB 3 PA SP

BOSULIF 3 PA SP


3 PA SP

BRUKINSA 3 PA SP

busulfan 1 SP

BUSULFEX 3 SP

CABOMETYX 2 PA SP

CALQUENCE 3 PA SP

CAMPATH 2 SP

CAMPTOSAR 3 SP



2 PA SP QL


2 PA SP



1 SP

carmustine 1 SP

CASODEX 3


1 SP


3 SP


1 SP

clofarabine 1 SP

CLOLAR 3 SP


3 PA SP


3 PA SP


3 PA SP

COPIKTRA 3 PA SP

COSMEGEN 3 SP

COTELLIC 3 PA SP


1 SP


E SP


1

CYRAMZA 3 PA SP



1 SP


1 SP

DACOGEN 3 PA SP

dactinomycin 1 SP


36


DARZALEX 3 PA SP



1 SP

DAURISMO 3 PA SP

decitabine 1 PA SP



1 SP


1 SP

DOXIL 3 SP


1 SP


1 SP

DROXIA 3

ELITEK 3 SP

ELLENCE 3 SP

ELZONRIS 3 PA SP

EMCYT 2

EMPLICITI 3 PA SP

ENHERTU 3 PA SP


1 SP

ERBITUX 2 PA SP

ERIVEDGE 2 PA SP

ERLEADA E SP


1 PA SP


1 PA SP QL

ERWINAZE INJECTION

3 SP

ETHYOL 3 SP


ETOPOPHOS 3 SP


1 SP

etoposide oral 1 SP


1 PA SP QL

EVOMELA 3 SP

exemestane $0

FARESTON 3

FARYDAK 3 PA SP


3 SP

FEMARA 3




flutamide 1

FOLOTYN 2 PA SP

fulvestrant 1 SP

GAVRETO E SP

GAZYVA 3 PA SP


GILOTRIF 3 PA SP QL

GLEEVEC 3 PA SP


3 SP

HALAVEN 2 PA SP

HERCEPTIN HYLECTA

3 PA SP


3 PA SP

HERZUMA E SP


37


HYCAMTIN 3 SP

HYDREA 3

hydroxyurea oral 1

IBRANCE 3 PA SP


3 PA SP QL


3 PA SP

IDAMYCIN PFS 3 SP

idarubicin hcl 1 SP

IDHIFA 3 PA SP QL

IFEX 3 SP

ifosfamide 1 SP


IMBRUVICA 3 PA SP

IMFINZI 3 PA SP

IMLYGIC 3 SP

INFUGEM 3 SP

INLYTA 3 PA SP

INQOVI E SP

INREBIC 3 PA SP

IRESSA 3 PA SP

irinotecan hcl 1 SP


IXEMPRA KIT 2 SP


2 PA SP QL


2 PA SP

JELMYTO E SP

JEVTANA 2 PA SP

KADCYLA 3 PA SP

KANJINTI 2 PA SP


3 PA SP

KHAPZORY 3 ST SP



3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP

KOSELUGO 3 PA SP

KYPROLIS 2 PA SP


LARTRUVO 3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP

letrozole oral 1


E


LEUKERAN 2


1 SP


38



1 SP

LIBTAYO 3 PA SP

LONSURF 3 PA SP

LORBRENA 3 PA SP

LUMOXITI 3 PA SP

LUTATHERA E


2 PA SP

LYSODREN 2

MARQIBO 3 SP

MATULANE 2 SP

MEKINIST 2 PA SP

MEKTOVI 3 PA SP

melphalan 1 SP

melphalan hcl 1 SP


mesna 1 SP

MESNEX 3 SP



E SP


MONJUVI E SP

mutamycin 1 SP

MVASI 2 PA SP

MYLERAN 2


3 PA SP

NAVELBINE 3 SP

NERLYNX 3 PA SP QL

NEXAVAR 2 PA SP

nilutamide 1 SP

NINLARO 3 PA SP

NIPENT 3 SP

NUBEQA 3 PA SP


ODOMZO 3 PA SP

OGIVRI E SP

ONCASPAR INJECTION

2 SP

ONIVYDE 3 SP

ONTRUZANT E SP

ONUREG E SP

OPDIVO 3 PA SP


1 SP


E


1 SP

paclitaxel 1 SP

PADCEV 3 PA SP

PANRETIN 3

paraplatin 1 SP

PEMAZYRE 3 PA SP QL

PERJETA 2 PA SP

PHESGO E SP

PHOTOFRIN 3 SP


3 PA SP


3 PA SP


3 PA SP

POLIVY 3 PA SP

POMALYST 3 PA SP

PORTRAZZA 3 PA SP

POTELIGEO 3 PA SP

PROLEUKIN 2 SP

PURIXAN 3 SP

QINLOCK 3 PA SP

RETEVMO E SP

REVLIMID 2 PA SP



39



3 PA SP


3 PA SP

ROZLYTREK 3 PA SP

RUBRACA 2 PA SP

RUXIENCE 2 PA SP

RYDAPT 3 PA SP

SARCLISA 3 PA SP

SIKLOS 3 PA

SOLTAMOX $0

SPRYCEL 2 PA SP

STIVARGA 3 PA SP

SUTENT 2 PA SP

SYLVANT 3 PA SP

SYNRIBO 3 PA SP

TABLOID 2 SP

TABRECTA E SP

TAFINLAR 2 PA SP


3 PA SP QL


3 PA SP

TALZENNA 3 PA SP



3 PA SP


3 PA SP QL

TARGRETIN EXTERNAL

3 PA SP

TARGRETIN ORAL E SP

TASIGNA 3 PA SP


3 SP


TAZVERIK E SP

TECARTUS 3 PA SP

TECENTRIQ 3 PA SP

TEMODAR INTRAVENOUS

2 SP



teniposide 1 SP

TEPADINA 3 SP

THALOMID 2 PA SP


TIBSOVO 3 PA SP


1 SP

topotecan hcl 1 SP


TOTECT 3 SP

TRAZIMERA 2 PA SP


E SP

tretinoin oral 1 SP


3 SP

TRODELVY 3 PA SP

TRUXIMA E SP

TUKYSA 3 PA SP

TURALIO 3 PA SP

TYKERB 3 PA SP

UNITUXIN 3 PA SP

VALCHLOR 3 PA SP

valrubicin E

VALSTAR E


40



3 SP


VENCLEXTA 3 PA SP


3 PA SP

VERZENIO 3 PA SP

VIDAZA 3 PA SP


1 SP


1 SP


VITRAKVI 3 PA SP

VIZIMPRO 3 PA SP

VORAXAZE E

VOTRIENT 3 PA SP


3 PA SP

XALKORI 2 PA SP

XELODA 3 PA SP


E

XOSPATA 3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP



3 PA SP


3 PA SP

XTANDI 3 PA SP

YERVOY 2 PA SP

YESCARTA 3 PA SP

YONDELIS 3 SP

YONSA E SP

ZALTRAP 2 PA SP

ZANOSAR 2 SP

ZEJULA 2 PA SP

ZELBORAF 3 PA SP

ZEPZELCA 3 PA SP

ZEVALIN Y-90 3 SP

ZIRABEV 2 PA SP

ZOLINZA 2 PA SP

ZYDELIG 3 PA SP

ZYKADIA ORAL TABLET

3 PA SP

ZYTIGA E SP

Antiparasitics


ALBENZA 3 PA

ALINIA 2

ARAKODA 3

atovaquone oral 1


1

BENZNIDAZOLE 3

BILTRICIDE 3


1

COARTEM 3


crotan 1

DARAPRIM 3 PA SP

EGATEN 3


41


ELIMITE 3

EMVERM 2


1

IMPAVIDO 3


1

ivermectin oral 1

KRINTAFEL 3

LAMPIT E

lice killing E


E


1

MALARONE 3


mefloquine hcl 1

MEPRON 3

NATROBA 3

NEBUPENT 3

nitazoxanide 2

OVIDE 3

PENTAM E


1


E


1

PLAQUENIL 3

praziquantel oral 1


1



3

QUALAQUIN 3 PA



SKLICE 3

spinosad 1


E

STROMECTOL 3

SULFURATED LIME 3




2 PA SP QL

AZILECT 3


1


1

carbidopa oral 1



1


1

COMTAN 3

DUOPA ENTERAL 3 PA

entacapone 1

GOCOVRI E

INBRIJA 3 PA SP

KYNMOBI E SP


E SP

LODOSYN 3

MIRAPEX ER 3


3

NEUPRO 3 ST

NOURIANZ 3 PA


42


ONGENTYS E

OSMOLEX ER E

PARLODEL 3


1


1


ropinirole hcl 1

ropinirole hcl er 1

RYTARY 3 ST


SINEMET 3

STALEVO 100 3

STALEVO 125 3

STALEVO 150 3

STALEVO 200 3

STALEVO 50 3

STALEVO 75 3


3

tolcapone 1


XADAGO 3 ST QL

ZELAPAR 3

Antiplatelets


ASPIRIN-OMEPRAZOLE

E

BRILINTA 2

CABLIVI 3 PA SP QL

cilostazol 1


1

dipyridamole oral 1

DURLAZA E

EFFIENT 3



3

prasugrel hcl 1

YOSPRALA E

ZONTIVITY 3



3


3

ABILIFY MYCITE E

ABILIFY ORAL TABLET

3 QL

ADASUVE 3 PA

aripiprazole 1 QL

ARISTADA E

ARISTADA INITIO E

CAPLYTA 3 ST QL


E


clozapine 1 QL

CLOZARIL 3 QL

FANAPT 3 ST QL


3 ST QL


E


E



E

GEODON ORAL 3 QL

HALDOL DECANOATE E


43



E


haloperidol oral 1

INVEGA 3 QL


3


3

LATUDA 3 QL


molindone hcl 1


3 PA


3 PA


E



PERSERIS E

pimozide 1



REXULTI 3 QL


3


E


E

risperidone 1 QL


SAPHRIS 2 QL

SECUADO E

SEROQUEL 3 QL

SEROQUEL XR 3 QL


thiothixene oral 1


VERSACLOZ 3 QL

VRAYLAR 3 ST QL




3

ZYPREXA ORAL 3 QL

ZYPREXA RELPREVV E

ZYPREXA ZYDIS 3 QL

Antivirals

abacavir sulfate 1


1


1


acyclovir oral 1


APTIVUS 2


ATRIPLA E

BARACLUDE 3 SP QL

BIKTARVY 3


CIMDUO 2

COMBIVIR 3

COMPLERA 2


2

DELSTRIGO 3


44


DENAVIR E

DESCOVY E


1

DOVATO 2

EDURANT 2

efavirenz 1


1


1

emtricitabine 1


1


3


2

entecavir 1 SP QL

EPCLUSA 2 PA SP QL

EPIVIR 3


2 SP


3 SP

EPZICOM 3

EVOTAZ 2

famciclovir oral 1

FAVIPIRAVIR 3



E


E

GENVOYA 3

HARVONI 2 PA SP QL


HEPSERA 3 SP

INTELENCE 2

INTRON A 3 PA SP


2

ISENTRESS 2

ISENTRESS HD 2

JULUCA 2


3

KALETRA ORAL TABLET

2



1 SP


1



E SP


2



MAVYRET 2 PA SP QL

nevirapine 1

nevirapine er 1

NORVIR ORAL PACKET

2


2

NORVIR ORAL TABLET

3

ODEFSEY 3


1 QL


2 PA SP


45



3 PA SP

PIFELTRO 3

PREVYMIS 3 SP

PREZCOBIX 2


2


2



E


3

RETROVIR ORAL SYRUP

3


3

REYATAZ ORAL PACKET

2




1 SP

rimantadine hcl 1

ritonavir 1

RUKOBIA 3

SELZENTRY 2 PA

SITAVIG 3 QL


E SP

SOVALDI 3 PA SP QL


STRIBILD 3

SUSTIVA 3

SYMFI 2

SYMFI LO 2


SYMTUZA 3


E


E

TEMIXYS E


1

TIVICAY 2

TIVICAY PD 2

TRIUMEQ 2

TRIZIVIR 3

TROGARZO 3 PA


2


E

TYBOST 2


VALCYTE 3


VALTREX 3 QL

VEMLIDY 3 SP



2


3


3

VIRAZOLE 3

VIREAD ORAL POWDER

2


46



2


3

VOSEVI 2 PA SP QL

XERESE E


3 QL


3 QL

ZEPATIER 3 PA SP QL

ZIAGEN 3

zidovudine 1


3


E


E


alprazolam er 1 QL



alprazolam xr 1 QL

ATIVAN E





1 QL

diazepam intensol 1


1


1


DORAL 3 QL

estazolam 1 QL


HALCION 3 QL


1


1


1

KLONOPIN 3 QL




1 QL


meprobamate 1



E


E


E

oxazepam 1 QL

quazepam 1 QL


3 QL

triazolam 1 QL

VALIUM E

VISTARIL 3

XANAX E

XANAX XR E


47



EQUETRO 3

lithium 1



LITHOBID 3


ADVATE 2 SP

ADYNOVATE 3 SP

AFSTYLA 3 SP

AGRYLIN 3


2 SP

ALPHANINE SD 2 SP

ALPROLIX 3 SP


3

AMICAR ORAL TABLET

3


1


1

anagrelide hcl 1


2 PA SP


2 PA SP


3



E


2 SP

CEPROTIN 3 SP

COAGADEX 3 SP

CORIFACT 2 SP


E


3 PA SP

ELOCTATE 3 SP


E SP

ESPEROCT E SP


2 SP

FIBRYGA 2 SP

FULPHILA E SP

GRANIX E SP

HEMLIBRA 3 SP


3 SP


48



2 SP

IDELVION 3 SP

IXINITY 3 SP

JIVI 3 SP

KOATE 2 SP

KOATE-DVI 2 SP

KOGENATE FS 3 SP

KOVALTRY 3 SP


3 PA SP

LYSTEDA 3


3 PA SP


2 SP


E

MOZOBIL 2 PA SP QL

MULPLETA 2 PA SP



3 PA SP


E SP



E SP

NIVESTYM 2 PA SP

NOVOEIGHT 2 SP

NOVOSEVEN RT 2 SP

NPLATE 2 PA SP

NUWIQ 2 SP

OBIZUR 3 SP


3 SP

PROCRIT E SP

PROFILNINE 2 SP

PROMACTA 3 PA SP

REBINYN 3 SP

REBLOZYL 3 PA SP

RECOMBINATE 2 SP

RECOTHROM 3

RECOTHROM SPRAY KIT

3


2 PA SP

RIASTAP 2 SP

RIXUBIS 3 SP

SEVENFACT E SP


3 PA SP

TAVALISSE 3 PA SP


3


49



3

THROMBOGEN 3


E



E

TRETTEN 3 SP

UDENYCA E SP


3 PA SP


2 PA SP

VONVENDI 3 SP


2 SP


2 SP


ZARXIO 2 PA SP

ZIEXTENZO 3 PA SP


ACCUPRIL 3

ACCURETIC 3



3



E

ALDACTAZIDE 3

ALDACTONE 3


ALTACE ORAL CAPSULE

E

ALTOPREV E



1



E


1


1


1




1


E

ATACAND E

ATACAND HCT 3

atenolol oral 1


E



1


3

AVAPRO 3

AZOR E


50




1

BENICAR E

BENICAR HCT E

BETAPACE AF 3


3


BIDIL 3



1

bumetanide oral 1

BUMEX 3

BYSTOLIC 2


3

CALAN SR 3



1

captopril oral 1


1

CARDIZEM CD 3


3


E


3


CARDURA 3

CAROSPIR 3

cartia xt 1

carvedilol 1


CATAPRES 3

CATAPRES-TTS-1 3

CATAPRES-TTS-2 3

CATAPRES-TTS-3 3


1



clonidine 1


colesevelam hcl 1

COLESTID E

COLESTID FLAVORED

E

colestipol hcl 1

CONJUPRI E

CONSENSI E

COREG 3

COREG CR 3

CORGARD 3

CORLANOR 3 PA QL

COZAAR 3

CRESTOR E

DEMSER 3

DIBENZYLINE 3

digitek 1

digox 1

digoxin oral 1

DILATRATE-SR 3



1


51



1


1



E

dilt-xr 1

DIOVAN E

DIOVAN HCT E


1

DIURIL 3

dofetilide 1


1

DUTOPROL E

DYAZIDE 3

DYRENIUM 3

EDARBI 3 ST

EDARBYCLOR 3 ST

EDECRIN 3



1

ENTRESTO 2 QL


E


E


E



E

eplerenone 1


E


EXFORGE 3

EXFORGE HCT 3


ezetimibe 1


felodipine er 1


1


1 ST


1 ST


1


E


1


1 ST


1


1 ST

FENOGLIDE 3 ST

FIBRICOR 3 ST

FIRST - METOPROLOL

E

FIRST-ATENOLOL E


52



FLOLIPID 3 ST



fosinopril sodium 1



1


gemfibrozil oral 1

GONITRO 3


HEMANGEOL 3



1

HYZAAR 3


indapamide oral 1

INDERAL LA E

INDERAL XL E

INNOPRAN XL E

INSPRA 3

irbesartan 1


1

ISORDIL TITRADOSE 3




1


isradipine 1


3 PA SP QL

KAPSPARGO SPRINKLE

E


KATERZIA E



2

LASIX 3

LESCOL XL E

LIPITOR E

LIPOFEN 3

lisinopril oral 1


1

LIVALO E

LOPID 3


3

LOPRESSOR ORAL 3




3


3


3

lovastatin 1

LOVAZA E

matzim la 1

MAXZIDE 3

MAXZIDE-25 3

methyldopa oral 1


1

metolazone 1



53




1

metyrosine 1


MICARDIS 3

MICARDIS HCT 3

midodrine hcl 1


E


E

MINIPRESS 3

minitran 1

minoxidil oral 1

moexipril hcl 1

MULTAQ 3


1

NEXLETOL 2 PA QL

NEXLIZET 2 PA QL


1


1

niacor 1

NIASPAN 3


nifedipine er 1


1

nifedipine oral 1

nimodipine oral 1

nisoldipine er 1

NITRO-BID 3

NITRO-DUR 3




1


1

NITROLINGUAL 3

NITROMIST 3

NITROSTAT E


1


E

NORPACE 3

NORPACE CR 2

NORTHERA 3 PA SP

NORVASC E


3


1


1


1

OMEGA-3 RX COMPLETE

3


E


1 PA


3


1


pentoxifylline er 1



54



1


E


E

pindolol 1


2 PA QL


3


prazosin hcl oral 1

PRESTALIA 3 ST

prevalite 1


3


E

PROCARDIA 3

PROCARDIA XL 3

propafenone hcl 1




propranolol-hctz 1

QBRELIS E

QUESTRAN E


E

quinapril hcl 1



1



ramipril 1

RANEXA 3 ST

ranolazine er 1 ST

RECTIV 3

REPATHA 2 PA QL


2 PA QL

REPATHA SURECLICK

2 PA QL


RYTHMOL SR 3


sotalol hcl (af) 1

sotalol hcl oral 1

SOTYLIZE 3




3


E


3

taztia xt 1

TEKTURNA 2 ST

TEKTURNA HCT 2 ST

telmisartan 1


telmisartan-hctz 1

TENORETIC 100 3

TENORETIC 50 3


55


TENORMIN E

tiadylt er 1

TIAZAC 3

TIKOSYN E


TOPROL XL E

torsemide oral 1

trandolapril 1


1

triamterene oral 1


1


1

TRIBENZOR E

TRICOR 3

TRILIPIX 3

TWYNSTA 3

valsartan 1


1

VASCEPA 2 PA

VASERETIC 3

VASOTEC 3

VECAMYL 3


1


1


VERELAN 3

VERELAN PM 3

VYNDAMAX 3 PA SP QL

VYNDAQEL 3 PA SP QL

VYTORIN E


WELCHOL 3

ZESTORETIC 3


3


E

ZETIA E

ZIAC 3


3


E


ADDERALL 3 PA QL

ADDERALL XR E

ADHANSIA XR E






1 PA QL


1 PA QL




CONCERTA E


DAYTRANA 3 PA ST QL

DESOXYN 3 PA ST QL


3 PA QL


56




1 PA ST QL


1 PA QL


1 PA ST QL


EVEKEO 3 PA ST QL

EVEKEO ODT 3 PA QL

FOCALIN 3 PA QL


guanfacine hcl er 1

INTUNIV 3



3 ST


1 PA ST QL



3 PA ST QL


1 PA ST QL


1 PA ST QL


1 PA ST QL


1 PA ST QL


1 PA QL


1 PA ST QL


1 PA QL



1 PA ST QL

MYDAYIS 3 PA ST QL




3 PA ST QL

relexxii 1 PA ST QL

RITALIN 3 PA QL


3 PA ST QL

STRATTERA 3 QL

VYVANSE 2 PA QL

ZENZEDI 3 PA ST QL


AMPYRA 3 PA SP QL

AUBAGIO 3 PA SP QL


2 PA SP QL


2 PA SP QL



2 PA SP QL


2 PA SP QL




1 PA SP QL


57



E SP

GILENYA 3 PA SP QL


glatopa 1 PA SP QL

KESIMPTA E SP

LEMTRADA 3 PA SP

MAVENCLAD (10 TABS)

3 PA SP

MAVENCLAD (4 TABS)

3 PA SP

MAVENCLAD (5 TABS)

3 PA SP

MAVENCLAD (6 TABS)

3 PA SP

MAVENCLAD (7 TABS)

3 PA SP

MAVENCLAD (8 TABS)

3 PA SP

MAVENCLAD (9 TABS)

3 PA SP

MAYZENT 3 PA SP QL


3 PA SP QL

OCREVUS 3 PA SP QL

PLEGRIDY E SP


E SP


E SP


E SP


E SP



E SP


TYSABRI 3 PA SP QL

VUMERITY 2 PA SP QL

ZEPOSIA 3 PA SP QL


3 PA SP QL

ZEPOSIA STARTER KIT

3 PA SP QL


ADDYI 3 PA QL

ADIPEX-P E

AUSTEDO 3 PA SP QL

benzphetamine hcl E


CONTRAVE E

CONVENIENCE PAK E



GABACAINE E

GRALISE 3 ST QL


3 PA QL

INGREZZA 3 PA SP QL


E

LOMAIRA E

LYRICA CR 3 ST QL

LYRICA ORAL CAPSULE

2 QL


3 QL


58


NEURAPTINE E

NUEDEXTA 3 PA

ONPATTRO 3 PA SP


E


E



QSYMIA E

RADICAVA 3 PA SP

RILUTEK 3 PA QL

riluzole 1 PA QL

SAVELLA 3 ST QL


3 ST QL

SAXENDA E


E

TEGSEDI 3 PA SP


TIGLUTIK 3 PA SP QL


E

VYLEESI 3 PA QL

XENAZINE 3 PA SP

XENICAL E


ARESTIN E

cavarest E

cevimeline hcl 1



E

clinpro 5000 E


E

denta 5000 plus E

dentagel E


E


E

easygel dental E

EVOXAC 3

FIRST-MOUTHWASH BLM

E

fluoridex E



E


E

KEPIVANCE 2 SP


1


MOUTH KOTE REMINT

E

MUCOSITISRX E


E


E

NAFRINSE WEEKLY E


E

oralone 1

paroex E

PERIDEX E


59


periogard E


PREVIDENT E


E


E


E


E

PREVIDENT 5000 PLUS

E


E

SALAGEN 3

SALIVAMAX E

sf E

sf 5000 plus E


E


E


E


E


E


3


1


E




E

ABREVA E

ABSORICA E

ABSORICA LD 3 PA

ACANYA E

ACESO AG E

acitretin 1


active-tramadol E


E


2


1 PA



E


3 PA


E


E


1


E

AKLIEF E

ALA SCALP E



1


60



3

ALDARA E

ALEVAMAX E

ALTRENO 3 PA


E


1


1

AMELUZ E


1

amnesteem 1 PA

AMZEEQ 3

ANACAINE E

APEXICON E E

AQUAPHILIC E

ARAZLO E

ARIDA E


E

ATOPADERM E

ATOPICLAIR E

ATRALIN 3 PA

avar cleanser E

AVAR LS CLEANSER E

AVAR-E EMOLLIENT E

AVAR-E GREEN E

AVAR-E LS E

AVEIDAOXIA E

avita 1 PA

AZADROX E



E

AZELEX 3



BEAU RX E

BENSAL HP E


E


E

BENZACLIN E

BENZACLIN WITH PUMP

E

BENZAMYCIN E


BENZEPRO EXTERNAL

E


E


E


E


E


E

benzoin compound E


E


E


E


E


E


1 ST

BESER EXTERNAL KIT

E


61




1


1


E


1

BIAFINE E


E

blanche E


bp 10-1 E

bp cleansing wash E


E

BPCO 3

BRYHALI E


1 QL


E


1


1


E


1 QL


E

CALCITRENE 3



E

CAPEX E



E

capzix E

CARAC 3

CEM-UREA E

CERACADE E


CHLOOXIA E


E


E


E


E

claravis 1 PA


3


E


1

CLINDACIN PAC E

clindacin-p 1

CLINDAGEL E


E


1 ST


E


1


1


1


62



1


E


1


E



E

CLINOIN E


1



1


1


E


E

CLOBETAVIX E

CLOBEX 3

CLOBEX SPRAY 3


CLODAN EXTERNAL KIT

E


1

CLODERM E


3

COLLATYL E


3

COPADERM E

COPASIL EXTERNAL E



E


3


3


3


E


CORTANE-B EXTERNAL

E


3


3


1


E

DAPSONE-NIACINAMIDE

E


E

DELUO E

DEOXIA E

DERMACINRX PENETRAL

E


E


3


3

DERMULCERA 3

DESONATE E


63


desonide external 1


3


1


1


E


E


1

DEXERYL E

DIADIMAXIA E

DIAOXIA E


E

DIASDIMAXIA E

DIASOXIA E


1 ST QL


1 PA QL


E


E


E


E


E


E

DIMOXIA E

DIPROLENE AF 3



3



3


doxycycline 1


E

DRAXACE E


E

DRITHO-CREME HP E

DRIXECE E

DRYSOL 3

DUOBRII E

DUPIXENT 2 PA SP QL

ECEOXIA E


3

ELETONE E

ELIDEL 3 ST

ELLZIA PAK E

EMULSION SB E

enovarx-tramadol E

ENSTILAR E

ENTTY SPRAY E

ENZOCLEAR E

EPICERAM E

EPIDUO 3

EPIDUO FORTE 3

EPIFOAM 3

EPIQUIN MICRO E

ery 1

ERYGEL 3


1


64



1

ESKATA E

ETHOXIA E

EUCRISA 2 ST

EVOCLIN 3

FABIOR E

FINACEA 3 ST


E


E


E


1


1


1


E


1


1


1


1


1

FLUOPAR E

FLUOROPLEX 3


2


1


1


FLUOVIX E

FLUOVIX PLUS E

flurandrenolide E


1

FORAXA E

GENADUR E

GORDOFILM 3


E

halcinonide E


1


E


1


E


E


3

HALUCORT E


E


HPR PLUS HYDROGEL

E

HYALUCIL-4 E


E


E


E

HYDRO 40 E


65



E


E


E


E


1


E


1


1


E


1


1


1



E


E


E


E


E


E




E


E


E

IMPEKLO E

IMPOYZ E

INOVA E


E


E


ITHOXIA E


E

KAMDOY E

KATARYA E

KATARYAXN E

KAXM E

KEIDO E

KELARX E

KENALOG EXTERNAL 3

KERAGEL E


E


E

KERALYT SCALP E


3

KETARYA E

KEVARYA E

KEXM E

KEYA E


66


KIVIK E

KLARON 3

KUTARYAXM E

KUTARYAXMPA E

KUTEA E

KUVARYA E

KUVARYE E

KUXM E

lactic acid e 1


1


E

lavare wound wash E

LEVULAN KERASTICK 3

LEXETTE E


E

LIDOTREX E


3

LOCOID LIPOCREAM E

LUXIQ 3

MEDERMA E

MEDERMA FOR KIDS E

MEDERMA SPF 30 E


E

methoxsalen rapid 1


E

METROCREAM 3


E

METROLOTION 3


MIMYX E



E

MIRVASO 3


E


1

myorisan 1 PA

NEOCERA E

NEOSALUS E

NEOSALUS CP E


E


3


E


NEUAC EXTERNAL KIT

E


E


E


E


E


E


E


E

NIVATOPIC PLUS E

nolix E

NORITATE E


67



E

NUCARACLINPAK E

NUCARARXPAK E

NUCORT E

NUDERMRXPAK 120 E

NUDERMRXPAK 60 E

NUTRASEB E

NUTRIARX CREAMPAK

E

NUVAIL E

OLUX 3

OLUX-E 3

ONEXTON 3

ORACEA 3

OVACE PLUS E

OVACE PLUS WASH E

OVACE WASH E

OXSORALEN ULTRA 3

PANDEL E

PENLEN E

PHLAG SPRAY E

PICATO 3 ST

pimecrolimus 1 ST

PLEXION E


E


E

podocon E


PR BENZOYL PEROXIDE

E


E

PR CREAM E


1



E


3


E

pramox E


E

prednicarbate 1

PRESERA E


E

PROMISEB E

PROPECIA E

PROSILK EXTERNAL E

PROTEXA E

PROTOPIC 3

PROTYL AG E

PRUCLAIR E

PRUDOXIN 3 PA

PRUMYX E

PSORCON E

PYROGALLIC ACID 3

QBREXZA 3 QL

QUINIXIL E

QUTENZA E

QUTENZA (2 PATCH) E

RADIAGEL E


3


E

RECEDO E

REFISSA E

REGENECARE 3

REGRANEX 3 PA


68


remergent hq E

REMIGEN E

RENOVA E

RENOVA PUMP E

RESORCINOL-SULFUR

E

RETIN-A 3 PA


E


E


2 PA


E

RHOFADE 3

RIAX E




E


E

salicylic acid er E


E


E


E


E


E


E


E



E


E


E

salimez E

SALIMEZ FORTE E

SALVAX E

SALVAX DUO PLUS E


E

SANTYL 3

SCALACORT DK E


E

SCARCIN E

SCARSILK EXTERNAL E

SCARZEN SKIN REPAIR

E

SCENESSE 3 PA SP


1


E

SELRX E

SERNIVO 3

SILA III E

SILIPAC E


E

skarjel E


E


E


E


69



E

SOLARAVIX EXTERNAL

E

SOLOX E

SOOLANTRA 3


3

SORILUX E

sss 10-5 E

STRATA CTX E

STRATA GRT E

STRATA MARK E

STRATA TRIZ E

STRATA XRT E


1


E


E


E


E


E


E


E


E


E



E


E

sulfacleanse 84 E

sulfamez wash E

SUMADAN E

SUMADAN WASH E

SUMADAN XLT E

SUMAXIN E

SUMAXIN CP E

SUMAXIN WASH E

SUVICORT E

SYNALAR 3

SYNALAR (CREAM) E

SYNALAR (OINTMENT)

E

SYNALAR TS E

SYNERDERM E


E


3 QL


E


1

TARDEOXIA E

TARDIMAXIA E

TAROXIA E

TASOPROL E



3 PA


3 PA


70



E


3


3


E

TEXACORT 3

tl hydroquinone E

TOLAK 3 ST


3


3


3

TOPICORT SPRAY E


TOVET EXTERNAL KIT

E





1 PA


E


1


1


1


E

TRIAMSIL MULTIPAK E


trianex E

TRI-CHLOR 3


TRIDESILON 3

TRI-LUMA E


E


E

TRIVIX E

TURPENTINE EXTERNAL

E

ULTRASAL-ER E


E

UMECTA MOUSSE E


E


E

UREA EXTERNAL FOAM

E


E


E

urea hydrating E


E

urea-c40 E

ureacin-10 E

ureacin-20 E

uredeb E

uremez-40 E

URESOL E

UTOPIC E


71



E

VANIQA E

VANOS 3

VANOXIDE-HC E

VARDIMAXIA E

VAROXIA E

VECTICAL E

VELTIN E

VENELEX 3

VERDESO E

VEREGEN E

VEXASYN E

VIRASAL E

XALIX E

XERAC AC 3

XERALUX E

xurea E

ZACARE E


E

zenatane 1 PA

ZIANA E

ZILXI E

ZITHRANOL E

ZONALON 3 PA

ZYCLARA E

ZYCLARA PUMP E


acarbose oral 1

ACTOPLUS MET 3

ACTOS 3

ADLYXIN E


E


ALOGLIPTIN BENZOATE

E


E


E

AMARYL 3


3 ST


2 ST QL




CYCLOSET 3 ST

DUETACT 3

FARXIGA 2 ST

FORTAMET E

glimepiride 1

glipizide er 1

glipizide ir 1

glipizide xl 1


GLUCOTROL 3

GLUCOTROL XL 3


3

GLUMETZA E


glyburide oral 1


GLYNASE 3

GLYSET 3

GLYXAMBI 2 ST

INVOKAMET E

INVOKAMET XR E

INVOKANA E

JANUMET 2 ST


72


JANUMET XR 2 ST

JANUVIA 2 ST

JARDIANCE 2 ST

JENTADUETO 2 ST

JENTADUETO XR 2 ST

KAZANO E

KOMBIGLYZE XR E

metformin hcl er 1



E

metformin hcl ir 1

miglitol 1

nateglinide 1

NESINA E

ONGLYZA E

OSENI E

OZEMPIC 2 ST QL

pioglitazone hcl 1


1


1

PRECOSE 3

QTERN E

repaglinide 1

RIOMET 3 ST

RIOMET ER 3 ST

RYBELSUS 2 ST QL

SEGLUROMET E

SOLIQUA 2 ST QL

STARLIX 3

STEGLATRO E

STEGLUJAN E

SYMLINPEN 120 3 PA

SYMLINPEN 60 3 PA


SYNJARDY 2 ST

SYNJARDY XR 2 ST

tolbutamide 1 ST

TRADJENTA 2 ST

TRIJARDY XR 2 ST

TRULICITY 2 ST QL

VICTOZA 2 ST QL

XIGDUO XR 2 ST

XULTOPHY 3 ST QL



E


E


E


E


E


E


E


$0


E


E


$0


E


73



E


E


$0


$0


$0

BLUESTAR E


E


$0

CARETOUCH TEST E

CEQUR SIMPLICITY 2U

3

CHEMSTRIP UGK 3

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CONTOUR NEXT LINK E


E

CONTOUR NEXT TEST

E

CONTOUR TEST E


E


E


E


E


FORTISCARE CONTROL

E


E


E


E


E


E


E


E


E


E


E


E

GUARDIAN SENSOR (3)

E

KETONE TEST 3

KETOSTIX 3

LANCETS $0

MICRODOT TEST E


$0

NOVOPEN ECHO 3


$0


$0



2


74



2


2


2


3


$0 QL


2


2


2

PRECISION LINK E


E


E



E


E


E


E


3



E


E




3


3


3


E

TRUE METRIX LEVEL 1

E

TRUE METRIX LEVEL 2

E

TRUE METRIX LEVEL 3

E


E

TRUETRACK TEST E


E


BAQSIMI ONE PACK 2

BAQSIMI TWO PACK 2

diazoxide oral 1



2 Made by Lilly


2Made by Fresenius


2


2

GVOKE PFS 2

PROGLYCEM 3

Diabetes - Insulins

ADMELOG E

ADMELOG SOLOSTAR

E


75



3 PA

APIDRA SOLOSTAR E

APIDRA VIAL E

BASAGLAR KWIKPEN E

FIASP E

FIASP FLEXTOUCH E

FIASP PENFILL E


2


2


2


2


2


2

HUMALOG VIAL 2


2

HUMULIN 7030 VIAL 2

HUMULIN N KWIKPEN 2

HUMULIN N VIAL 2


2


2

HUMULIN R VIAL 2


E

INSULIN ASPART E


E



E


E


E


E


E


E


$0

INSULIN SYRINGES $0


2

LANTUS U-100 VIAL 2


E


LYUMJEV 2

LYUMJEV KWIKPEN 2


$0

MYXREDLIN 3


$0


$0


$0


E


76



E

NOVOLIN 7030 RELION

E

NOVOLIN 7030 VIAL E

NOVOLIN N FLEXPEN E


E

NOVOLIN N RELION E

NOVOLIN N VIAL E

NOVOLIN R FLEXPEN E


E

NOVOLIN R RELION E

NOVOLIN R VIAL E


E


E


E


E



$0

SEMGLEE E

TOUJEO MAX SOLOSTAR

2

TOUJEO SOLOSTAR 2

TRESIBA E

TRESIBA FLEXTOUCH

E


ABANEU-SL E

ACTITROM-D E

active fe E

ACTIVITE E

adcf (05mgml) 1


ADRENAL C FORMULA

E

airavite E

aminoamrms E


E

aminoreliefrms E

animal shapes E

ANIMI-3 E

ANIMI-3VITAMIN D E


E

ASCOR E


E


E

ATABEX OB 2


E

AZESCO E


E


E

BACMIN E


biocel E

biopetit E


E

bp vit 3 E

b-plex E

b-plex plus E


E


77


CALCIFOL 3


E


E


E


E


CARBAGLU 2 SP


E


E


E


E


E


E


E


E


E


E


E


E

CARNITOR ORAL 3

CARNITOR SF 3

CENFOL E

CENTRATEX E


CEREFOLIN E


E

CHEMET 3


E

CHOLECAL DF E


E

CIFEREX E

CIFRAZOL E

CITRANATAL BLOOM E

CITRANATAL ESSENCE

E

CITRANATAL MEDLEY

E

clovique 1 PA SP


E

corvita E

corvita 150 E

CORVITE 150 E

corvite fe E


E


1


3

cytra k crystals E


E

d3 super strength E



E


78



E

deferasirox 1 PA


deferiprone 1 PA


E

DEPLIN 15 E

DEPLIN 75 E


E

dexifol E

dialyvite E

DIALYVITE 3000 E

DIALYVITE 5000 E

DIALYVITE SUPREME D

E

DIALYVITEZINC E


3

DURACHOL E

d-vite pediatric E


3


1

ELFOLATE E


E

ELITE-OB 2

ENBRACE HR E

ERGOCAL E


1


E


EXJADE 3 PA

fabb E


E

FERAHEME E

FERIVA 217 E

FERIVAFA E

ferocon E

ferotrinsic E

FERRALET 90 E

ferraplus 90 E

FERRIPROX 3 PA


3 PA

FERRLECIT E



E

FERROTRIN E


E


E


E


E

FLORIVA E

FLORIVA PLUS E

FLUORABON $0

fluoritab $0


$0

folbee E

folbee plus E

folbee plus cz E


79


FOLBIC RF E

FOLGARD OS E

FOLGARD RX E



1


$0

FOLIC D3 E

FOLIC-K E

FOLI-D E

FOLITE E

FOLIVANE-F E

FOLIVANE-PLUS E

FOLIXAPURE E

folplex 22 E

foltanx E

FOLTANX RF E

FOLTRATE E

FOLTREXYL E

foltrin E


E

FOLVITE-D E

FOSTEUM E

FUSION PLUS E

GALZIN 3

GENICIN VITA-D E

GENICIN VITA-Q E

GENICIN VITA-S E


E


HEMATOGEN E

HEMATOGEN FA E

HEMATRON-AF E

HEMETAB E

HEMOCYTE PLUS E




E

HYLAVITE E

HYLAZINC E

ICAR-C PLUS E

iferex 150 forte E

INFED E

INFUVITE ADULT E


E

INTEGRA F E

INTEGRA PLUS E

IODINE STRONG ORAL

3

IROSPAN 246 E

ISOLYTE-S E

JADENU 3 PA


JYNARQUE 3 SP QL

KCL-LIDOCAINE-NACL

E


klor-con 10 1

klor-con m10 1

KLOR-CON M15 3

klor-con m20 1


1


1

klor-con sprinkle 1

klor-conef 1

K-PHOS NO 2 E


3


E


80


K-PHOS-NEUTRAL 3

k-prime 1

K-TAB 3

k-tan plus E

L-CYSTINE E


1


levocarnitine sf 1

L-ISOLEUCINE E

l-methylfolate E


E


E



E


E


E

l-methyl-mc E

l-methyl-mc nac E

LOKELMA 3

LORID E


MVI ADULT E


E

MAGNEBIND 400 3


E



E


E


E

magnesium-oxide E


E

MEPHYTON 3

metafolbic E

metafolbic plus E


METANX ORAL CAPSULE

E


E

MICROPLEGIA MSA-MSG

E

MIFEPREX 3

mifepristone 1

M-NATAL PLUS 2

MULTIGEN E

MULTIGEN FOLIC E

MULTIGEN PLUS E


E

MULTIPRO E



1


1


1


81



E


1


1


E

mynephron E


E


nafrinse $0

nafrinse drops $0

NASCOBAL 3

NEONATAL + DHA E

NEONATAL 19 2

NEONATAL COMPLETE

E

NEONATAL FE E

NEONATAL PLUS 2

NEOVITE E

NEPHPLEX RX E

NEPHRON FA E


NEPHRO-VITE RX E

NESTABS 2

NESTABS ONE E

NEURIN-SL E


E

NICADAN E

NICAZEL E

NICAZEL FORTE E



E

NIFEREX ORAL TABLET

E


E

NUFERA E

nufol E

NUTRICAP E

nutrifac zx E

NUTRIVIT E


E

one daily E

ONE VITE WOMENS $0


2

ONEVITE E

ORACIT 3

ORTHO DF E

OVEEZA E


E


E


E


E

pediavit E


phosphorous 1


E


E


82



1

PHOXILLUM BK425 E


E

PHYSIOLYTE E


E


E

phytonadione oral 1

PLASMA-LYTE 148 E

PLASMA-LYTE A E


E


POLY-VI-FLOR FS 3


3


E


2


E


POTABA ORAL CAPSULE

E


1



E


1



1



E

PREGENNA E

PREMESISRX E

PRENAISSANCE E

PRENARA E


$0



1


E


1

PRENATE E


E


E

PRENATE ENHANCE E


E


E

PRENATE PIXIE E

PRENATE RESTORE E

PRENATRIX E

PRENATRYL E

PRENATVITE COMPLETE

E

PRENATVITE PLUS 2


83


PRENATVITE RX 2

preplus 1

pretab 1


E

PROTEINEX P18 E



E


E

QUFLORA FE E


E

QUFLORA GUMMIES E

QUFLORA PEDIATRIC E

RELNATE DHA 2

REMEDIENT E


E


RENATABS E

RENATABS WITH IRON

E

rena-vite E


E

REQ 49+ E

REVESTA E



2 SP QL


3 SP QL


E

se-tan plus E


SIDEROL ORAL TABLET

E


E



E


E


E


E


E


E


E


E



1


1

soluvita e E

sps 1

STROVITE FORTE E

STROVITE ONE E

SUPERVITE E

support E

SUPPORT-500 E


84


SYNAGEX E

SYPRINE 3 PA SP


E

TALIVA E

TARON FORTE E

taron-crystals E


tis-u-sol E

tl-hem 150 E


E SP


1 SP QL


2

tricitrates E

tricon E



E

trinate 1

TRINAZ E

triphrocaps E

TRISTART ONE E

TRI-VI-FLOR 3

TRI-VI-FLORO 3


tri-vitefluoride 1

TRONVITE E

TRYPTOPHAN ORAL E

UDAMIN SP E

UROCIT-K 10 3

UROCIT-K 15 3

UROCIT-K 5 3


urosex E

v-c forte E

VELTASSA 3

VENOFER E

vic-forte E

vinate one 1

virt-caps E

VIRT-FEFA PLUS E

virt-gard E


vita s forte E

vitacel E


E

VITAFOL ORAL TABLET

E

VITAFOL STRIPS 2

VITAFOL-OB+DHA E

VITAL-D RX E

VITAMAX PEDIATRIC E

VITAMEZ E

vita-min E



E



E


E


1


E


85



E


E


E


E


VITAROCA PLUS E


E

VITASURE E


E

VITREXATE E

VITREXATE FE E

VITREXYL E

VITREXYL + IRON E

vp-pnv-dha 1

vp-vite rx E

weekly-d E

westab mini E

westab one E

WESTAB PLUS 2

WESTGEL DHA E


E

XAQUIL XR E

XVITE E

ZALVIT E


E




E


E

ACIPHEX E

ACIPHEX SPRINKLE E


3


E


cimetidine oral 1

CYTOTEC 3

DEXILANT 2 QL

ESOMEP-EZS E


1 QL


1 QL


E


1


1

FIRST-LANSOPRAZOLE

3 ST



E


1 ST QL


86



1 QL

misoprostol oral 1


E

NEXIUM ORAL PACKET

3 QL

nizatidine 1


E


1 ST QL


E


3 ST


E


1 ST QL

PEPCID ORAL TABLET

3

PREVACID E

PREVACID 24HR E


3 ST QL


3 ST QL



E


E


1 ST QL


sucralfate oral 1

ZEGERID E


ACTIGALL 3

ACTIPHLORA E

alosetron hcl 1 PA


E


E

alvimopan 1

AMITIZA E


1 ST

ANASPAZ 3


E

antacid calcium E



E

antacid maximum E


E



E




E


E


87



E


E


E


E


E

BACICAP E


E

bisacodyl ec $0 QL

bisacodyl rectal E


E


1

CHENODAL 3 PA SP


E


citroma $0 QL


CLENPIQ 3

constulose 1


CUVPOSA 3


E



E


E


diotame instydose E


docusate mini E


E


E

docuzen E

dok oral tablet E

DONNATAL E

ed-spaz 1

ENTEREG 3

enulose 1


E

EX-LAX ULTRA E



E

FOLIKA PROBIOTIC E


E


E

GASTROCROM 3

GATTEX 3 PA SP


gavilyte-c $0 QL

gavilyte-g $0 QL

gavilyte-h 1


$0 QL

GELUSIL E

generlac 1


88




geri-kot E

GIALAX E

GLYCATE E

glycolax $0 QL


E


E


1


E

glycopyrrolate pf E

gnp senna lax E


3


E


E

HELIDAC THERAPY 3



E


E


E



1


1


1



E


1


1


E

hyosyne 1


E


E


E


E


LACTOJEN E


1

lactulose oral 1

laxative max str E


E

LEVBID E

LEVSIN ORAL TABLET

E

LEVSINSL E


89


LIBRAX 3

LINZESS 2 ST QL

LOMOTIL ORAL TABLET

3


1


E


E

LOTRONEX 3 PA


E


$0 QL


E


1


E



E



E

MOTEGRITY 3 ST QL

MOTOFEN E

MOVANTIK E

MOVIPREP E

MYTESI 3 QL


E


E

NULEV 3

NULYTELY LEMON-LIME

3



3

OMECLAMOX-PAK 2

opium E


oscimin sr E


OSMOPREP E


E

PCP 100 E


$0 QL



1


1

peg-prep 1


E


E


E


1

phenohytro E


E

PLENVU E

PROBICHEW E

PRODIGEN E


E


1

PYLERA 2


90



QUAD-PROBIOTIC E

RELISTOR ORAL E


E

RESTORA RX 3


E

senexon-s E

senna oral liquid E


E


E


senna s E

senna smooth E


E

senna-plus E


E

SENOKOT S E


3 PA SP


E


E


E


3



E



E


E


E


E


E


E


E


3

SUTAB E

SYMAX DUOTAB E

symax-sl E

symax-sr E

SYMPROIC 2 ST QL

TALICIA 3

trilyte $0 QL

TRULANCE E

TUMS CHEWY BITES E

URSO 250 3

URSO FORTE 3

ursodiol oral 1


E


E

VIBERZI 3 PA QL

VISBIOME E


91


XERMELO 3 PA SP QL

ZELAC E

ZELNORM 3 PA QL

ZORBTIVE 3 PA SP


ALDURAZYME 2 PA SP



3 SP


3 SP

CERDELGA 3 PA SP


2 PA SP

CHOLBAM 3 PA SP

CREON 2

CRYSVITA 3 PA SP

CYSTADANE 3 SP

CYSTAGON 3 SP

ELAPRASE 2 PA SP

ELELYSO 3 PA SP

ENZADYNE E

EXONDYS 51 E SP

FABRAZYME 2 PA SP

GALAFOLD 3 PA SP QL

KANUMA 3 PA SP

KUVAN 3 PA SP

LUMIZYME 2 PA SP

MEPSEVII 3 PA SP

miglustat 1 PA SP

MYALEPT 3 PA SP

NAGLAZYME 2 PA SP


nitisinone 1 PA SP

NITYR 3 PA SP

OCALIVA 3 PA SP QL

ORFADIN 3 PA SP

PALYNZIQ 3 PA SP QL

PANCREAZE E

PERTZYE E

PROCYSBI 3 PA SP

RAVICTI 3 PA SP

REVCOVI 3 PA SP


1 PA SP


1 SP


1 SP

STRENSIQ 2 PA SP

SUCRAID 3 SP

VIMIZIM 3 PA SP

VIOKACE E

VPRIV 3 PA SP

VYONDYS 53 E SP

XURIDEN 3 PA SP QL

ZAVESCA 3 PA SP


2


3 PA SP


3 PA SP


3 PA SP


92



3 PA SP


3 PA SP


3 PA SP


3 PA SP

ZOLGENSMA 26-30 KG

3 PA SP

ZOLGENSMA 31-35 KG

3 PA SP

ZOLGENSMA 36-40 KG

3 PA SP

ZOLGENSMA 41-45 KG

3 PA SP

ZOLGENSMA 46-50 KG

3 PA SP

ZOLGENSMA 51-55 KG

3 PA SP

ZOLGENSMA 56-60 KG

3 PA SP

ZOLGENSMA 61-65 KG

3 PA SP

ZOLGENSMA 66-70 KG

3 PA SP

ZOLGENSMA 71-75 KG

3 PA SP

ZOLGENSMA 76-80 KG

3 PA SP

ZOLGENSMA 81-85 KG

3 PA SP

ZOLGENSMA 86-90 KG

3 PA SP

ZOLGENSMA 91-95 KG

3 PA SP

ZOLGENSMA 96-100 KG

3 PA SP



aminoacetic acid E

AURYXIA 3

azo tabs E


1

BI-MIX 3


1


1

CAVERJECT IMPULSE

3 QL


3 QL

CERVIDIL 3

CIALIS 3 QL


3 PA SP


1


DETROL 3

DETROL LA 3


3

EDEX 3 QL

ELMIRON 2


3

FEM PH E

flavoxate hcl 1


93



3


3


3 ST


glycine urologic E

hyophen E

INTRAROSA 3 ST



E

LITHOSTAT 3

menaphosmbhyo1 E

MUSE 3 QL

MYRBETRIQ 2



OXYTROL 3 ST QL

OXYTROL FOR WOMEN

E


1 PA SP



E


1


1


E

PHOSLYRA 3


phosphasal E

PREPIDIL 3

PROSTIN E2 3

PYRIDIUM E

QUAD-MIX 3

RENACIDIN E


E

RENVELA 3

RIMSO-50 E


sevelamer hcl 1


1 QL


STAXYN E

STENDRA E

SUPER BI-MIX 3

SUPER QUAD-MIX 3

SUPER TRI-MIX E

tadalafil oral 1 QL

THIOLA 3 SP

THIOLA EC 3 SP



TOVIAZ 3

TRI-MIX E



URELLE E


1

URIBEL E

URIMAR-T E


1


94



E

URO-458 E

UROGESIC-BLUE E

uro-mp E

ustell E

uticap E

utira-c E

utrona-c 1


VELPHORO 3

VESICARE 3

VIAGRA E

vilamit mb E

VILEVEV MB E


alfuzosin hcl er 1

AVODART 3

CARDURA XL 3 ST

dutasteride oral 1


1


1

FLOMAX E

JALYN 3

PROSCAR 3

RAPAFLO 3

silodosin 1

tamsulosin hcl 1


UROXATRAL 3




E



E


E

ALKINDI SPRINKLE E

BETA 1 KIT E

BETALOAN SUIK E

BETAMETHASONE COMBO

E


E


E


E

BSP 0820 E

CELESTONE SOLUSPAN

E


E

CORTEF 3



E

DEPO-MEDROL E

DEXABLISS E


1



E


95



E


E


E


E


E

DEXONTO 04 3

DMT SUIK E

DOUBLEDEX E

DXEVO 11-DAY E

DYURAL-40 E

DYURAL-80 E

DYURAL-L E

DYURAL-LM E


1

HEMADY E

HIDEX 6-DAY E


KENALOG INJECTION 3

KENALOG-80 3

MAS CARE-PAK E


3


2



3

MEDROLOAN II SUIK E

MEDROLOAN SUIK E


E


E


E


E


E


1


3


E

MULTI-SPECIALTY E

ORAPRED ODT 3

P-CARE K40 E

P-CARE K40G E

P-CARE K40MX E

P-CARE K80 E

P-CARE K80G E

P-CARE K80MX E

PEDIAPRED 3


E


96



E

POD-CARE 100K E

POINT OF CARE L2 E

POINT OF CARE L5 E


E


1


1


1


prednisone oral 1

PRO-C-DURE 5 E

PRO-C-DURE 6 E

RAYOS E


E


E


E


3

TAPERDEX 12-DAY E

TAPERDEX 6-DAY E


E

TOPIDEX E



E


1


3


E

TRILOAN II SUIK E

TRILOAN SUIK E

ZCORT 7-DAY E

ZILRETTA E


ANADROL-50 3 PA


2 PA


3 PA


3 PA


E

AVEED E

danazol oral 1


E


97


EC-RX TESTOSTERONE

E

FORTESTA E

JATENZO E

METHITEST 3 PA


NATESTO E


TESTIM E

TESTONE CIK E

TESTOPEL E


E


E


1 PA


1 PA


E


1 PA


1 PA

VOGELXO PUMP E


E


XYOSTED 3 PA


EVISTA 3

OSPHENA 3

raloxifene hcl 1


ACTHAR 2 PA SP

BYNFEZIA PEN E SP

cabergoline 1


E SP


1 PA SP



3

DDAVP NASAL 3

DDAVP ORAL 3

DDAVP RHINAL TUBE 2


1


1


1


1


ELIGARD 3 PA SP QL



3 PA SP QL


3 PA SP QL


98



2 PA SP


1 PA SP



GENOTROPIN E SP


E SP

GONAL-F E SP

GONAL-F RFF E SP


E SP

HUMATROPE E SP

INCRELEX 2 PA SP

ISTURISA E SP


1 PA SP



3 PA SP


2 PA SP


3 PA SP


2 PA SP


2 PA SP



2 PA SP


3 PA SP


2 PA SP


3 PA SP


2 PA SP

MENOPUR 3 PA SP

MYCAPSSA E SP

NOCDURNA 3


2 PA SP


1 PA SP


3 PA SP


2 PA SP


99



2 PA SP


2 PA SP


1 PA SP


E SP


E SP

ORILISSA 2 PA QL

OVIDREL 3 PA SP


E


E

pregnyl 1 PA SP

SAIZEN E SP

SAIZENPREP E SP


E SP


E SP


SIGNIFOR 3 PA SP QL


3 PA SP QL


SOMAVERT 3 PA SP

STIMATE 3


SYNAREL 2

TEPEZZA 3 PA SP



VANTAS 3 PA SP QL


3 SP QL


2 SP QL

ZOMACTON E SP


E SP


KORLYM 3 PA SP QL



3

afirmelle $0 QL

ALORA 3 ST

altavera $0 QL

alyacen 135 $0 QL

alyacen 777 $0 QL

amabelz 1

amethia $0 QL

amethia lo $0 QL

amethyst $0 QL


100


ANGELIQ 3

ANNOVERA E

apri $0 QL

aranelle $0 QL

ashlyna $0 QL

aubra $0 QL

aubra eq $0 QL

aurovela 1530 $0 QL

aurovela 120 $0 QL




aviane $0 QL

AYGESTIN 3

ayuna $0 QL

azurette $0 QL

BALCOLTRA E

balziva $0 QL

bekyree $0 QL

BEYAZ E


E

BIESTPROGESTERONE

E

BIJUVA 3

blisovi 24 fe $0 QL



briellyn $0 QL

camila $0 QL

camrese $0 QL

camrese lo $0 QL

caziant $0 QL


chateal $0 QL

chateal eq $0 QL

CLIMARA 3


CLIMARA PRO 2

COMBIPATCH 3

covaryx E

covaryx hs E


3 QL


3 PA QL

cryselle-28 $0 QL

cyclafem 135 $0 QL

cyclafem 777 $0 QL

cyred $0 QL

cyred eq $0 QL

dasetta 135 $0 QL

dasetta 777 $0 QL

daysee $0 QL

deblitane $0 QL

DELESTROGEN 3

delyla $0 QL

DEPO-ESTRADIOL 3


3 QL


3 QL


$0 QL


$0 QL

DIVIGEL 3

dotti 1


$0 QL


101



$0 QL

DUAVEE 2

EC-RX ESTRADIOL E

EC-RX PROGESTERONE

E

eemt E

eemt hs E

ELESTRIN 3

elinest $0 QL

ELLA $0 QL

eluryng $0 QL

emoquette $0 QL

ENDOMETRIN 2 PA

enpresse-28 $0 QL


$0 QL

errin $0 QL


E


E


E

estarylla $0 QL

ESTRACE 3

estradiol oral 1


estradiol vaginal 1


1


1

ESTRING 3 QL

ESTROGEL 3

ESTROSTEP FE 3 QL


$0 QL



$0 QL

EVAMIST 3


E

falmina $0 QL

fayosim $0 QL

FEMHRT LOW DOSE 3

FEMRING 3 ST QL

femynor $0 QL


E

fyavolv 1

gemmily $0 QL

GENERESS FE 3 QL

gianvi $0 QL

hailey 1530 $0 QL

hailey 24 fe $0 QL


hailey fe 120 $0 QL

heather $0 QL


1 PA SP


3


3

incassia $0 QL

introvale $0 QL

isibloom $0 QL

jaimiess $0 QL

jasmiel $0 QL

jencycla $0 QL

jinteli 1

jolessa $0 QL

juleber $0 QL


102


junel 1530 $0 QL

junel 120 $0 QL

junel fe 1530 $0 QL

junel fe 120 $0 QL

junel fe 24 $0 QL

kaitlib fe $0 QL

kalliga $0 QL

kariva $0 QL

kelnor 135 $0 QL

kelnor 150 $0 QL

kurvelo $0 QL

KYLEENA E

larin 1530 $0 QL

larin 120 $0 QL

larin 24 fe $0 QL

larin fe 1530 $0 QL

larin fe 120 $0 QL

larissia $0 QL

layolis fe $0 QL

leena $0 QL

lessina $0 QL

levonest $0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL

levora 01530 (28) $0 QL


E


lillow $0 QL






lojaimiess $0 QL

loryna $0 QL

LOSEASONIQUE 3 QL

low-ogestrel $0 QL


lutera $0 QL

lyllana 1

lyza $0 QL

MAKENA 2 PA SP

marlissa $0 QL


$0 QL


1


1


1



2

MENOSTAR 3 ST

mibelas 24 fe $0 QL





mili $0 QL

mimvey 1

MINASTRIN 24 FE E

MINIVELLE 3 ST


103


MIRCETTE 3 QL

MIRENA (52 MG) E

mono-linyah $0 QL

NATAZIA $0 QL

necon 0535 (28) $0 QL

NEXPLANON E

nikki $0 QL

nora-be $0 QL


$0 QL


$0 QL


$0 QL


1


$0 QL



1



$0 QL


$0 QL

norlyda $0 QL

norlyroc $0 QL

nortrel 0535 (28) $0 QL



nortrel 777 $0 QL

NUVARING 3 QL

ocella $0 QL

ORIAHNN 2 PA QL

orsythia $0 QL


ORTHO MICRONOR E


E

philith $0 QL

pimtrea $0 QL

pirmella 135 $0 QL

pirmella 777 $0 QL


portia-28 $0 QL

PREFEST 3

PREMARIN ORAL 2

PREMARIN VAGINAL 2

PREMPHASE 2

PREMPRO 2

previfem $0 QL


E


1


1


E

PROMETRIUM 3

PROVERA 3

QUARTETTE 3 QL

reclipsen $0 QL

rivelsa $0 QL

SAFYRAL 3 QL

SEASONIQUE 3 QL

setlakin $0 QL

sharobel $0 QL

simliya $0 QL

simpesse $0 QL

SKYLA E

SLYND E

sprintec 28 $0 QL


104


sronyx $0 QL

syeda $0 QL

tarina 24 fe $0 QL

tarina fe 120 $0 QL


TAYTULLA E

tilia fe $0 QL

tri femynor $0 QL

tri-estarylla $0 QL

tri-legest fe $0 QL

tri-linyah $0 QL


tri-lo-marzia $0 QL

tri-lo-mili $0 QL


tri-mili $0 QL

tri-previfem $0 QL

tri-sprintec $0 QL

trivora (28) $0 QL

tri-vylibra $0 QL


tulana $0 QL

TWIRLA 3 QL

tyblume $0 QL

tydemy $0 QL


E

velivet $0 QL

vienva $0 QL

viorele $0 QL

VIVELLE-DOT E

volnea $0 QL

vyfemla $0 QL

vylibra $0 QL

wera $0 QL

wymzya fe $0 QL

xulane $0 QL


YASMIN 28 3 QL

YAZ E

yuvafem 1

zarah $0 QL

zovia 135 (28) $0 QL

zovia 135e (28) $0 QL

zumandimine $0 QL


ARMOUR THYROID 3 ST

CYTOMEL E

euthyrox 1

levo-t 1


E


1

levoxyl 1


methimazole oral 1

NATURE-THROID 3 ST

np thyroid 1


SYNTHROID 3

TAPAZOLE 3

TIROSINT E

TIROSINT-SOL 3

unithroid 1


3 ST

WP THYROID 3 ST


ACTEMRA 3 PA SP


105



ACTIMMUNE 2 PA SP

ALFERON N 2 SP

ARAVA 3

ARCALYST 3 PA SP

ASCENIV E SP

ASTAGRAF XL 3 SP

ATGAM 2 SP

AVSOLA 3 PA SP

AZASAN 3

azathioprine oral 1


BENLYSTA 3 PA SP

BERINERT 3 PA SP QL


3 PA SP


3 PA SP

CELLCEPT 3 SP


3 SP


2 PA SP



CINRYZE 2 PA SP


E SP

COSENTYX 150 MGML

E SP


E SP



E SP

CUTAQUIG E SP

CUVITRU 3 PA SP


1 SP



1 SP

CYTOGAM 2 PA SP

ENBREL MINI 3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP

ENSPRYNG E SP

ENTYVIO 3 PA SP

ENVARSUS XR 3 SP


1 PA SP

FIRAZYR 3 PA SP QL


GAMASTAN 2 PA SP

GAMIFANT 3 PA SP

GAMMAGARD 3 PA SP


106



3 PA SP


3 PA SP


3 PA SP

GAMUNEX-C 3 PA SP


1 SP


HAEGARDA 3 PA SP

HEPAGAM B E


3 PA SP


3 PA SP


2 PA SP


2 PA SP


2 PA SP



2 PA SP


2 PA SP


2 PA SP

HYPERHEP B SD E

HYPERRAB E


E


2 SP

HYPERTET SD E

HYQVIA 3 PA SP



2 PA SP QL

ILUMYA 3 PA SP


E

IMURAN 3

INFLECTRA 2 PA SP

KALBITOR 3 PA SP QL

KEDRAB INJECTION E

KEVZARA 3 PA SP


3 PA SP

KYMRIAH 3 PA SP

leflunomide oral 1

methotrexate oral 1


107



1


1


1


1


2 SP



1 SP


MYFORTIC 3 SP

NABI-HB E

NEORAL 3 SP

NULOJIX 3 PA SP

OCTAGAM 3 PA SP

OLUMIANT E SP


ORENCIA INTRAVENOUS

3 PA SP


3 PA SP

OTEZLA ORAL TABLET

2 PA SP


2 PA SP



3 PA QL


E

PANZYGA E SP

PRIVIGEN 3 PA SP

PROGRAF 3 SP

PROVENGE 2 PA SP

RAPAMUNE 3 SP


2 PA QL

REDITREX E

REMICADE E SP

RENFLEXIS 2 PA SP


2 SP


E


108


RIDAURA 3 SP

RINVOQ 2 PA SP

RUCONEST 3 PA SP QL


2 SP


3 SP


2 SP

SILIQ 3 PA SP



2 PA SP


2 PA SP

SIMULECT E

sirolimus oral 1 SP


2 PA SP

STELARA INTRAVENOUS

2 PA SP


2 PA SP QL


2 PA SP QL

SYNAGIS 2 PA SP


TAKHZYRO 3 PA SP

TALTZ 3 PA SP

temsirolimus 1 SP

THYMOGLOBULIN E

TICE BCG 2 SP

TORISEL 3 SP


TREMFYA 2 PA SP

TREXALL 3

UPLIZNA 3 PA SP


E

WINRHO SDF 2 SP

XATMEP 3

XELJANZ 2 PA SP

XELJANZ XR 2 PA SP

XEMBIFY 3 PA SP

ZINPLAVA E

ZORTRESS 3 PA SP


ACTHIB $0


$0


$0

BCG VACCINE E

BEXSERO $0

BIOTHRAX E


$0


$0


$0


$0

FLUAD $0


109


FLUAD QUADRIVALENT

$0


$0


$0


$0


$0


$0


$0

GARDASIL 9 $0


$0


$0


IMOVAX RABIES E

INFANRIX $0


$0

IXIARO E

MENACTRA $0

MENQUADFI $0


MENVEO $0



$0

PNEUMOVAX 23 $0

PREVNAR 13 $0

RABAVERT E


$0

ROTARIX $0


$0


$0

STAMARIL E

TDVAX $0

TENIVAC $0


$0

TRUMENBA $0


$0


E


$0

VARIVAX $0

VAXCHORA E


110


VIVOTIF E

YF-VAX E


ana-lex E


E


E


3


E

anucort-hc E

ANUSOL-HC EXTERNAL

3


E

APRISO 2

ASACOL HD E

AZULFIDINE 3




1

budesonide oral 1

CANASA E

COLAZAL 3

CORTENEMA 3

CORTIFOAM EXTERNAL

3

DELZICOL E

DIPENTUM E


3


E



E


1


1


E


1


E

LIALDA E


E


E


E

LIDOCORT EXTERNAL

E

mesalamine er 1

mesalamine oral 1

mesalamine rectal 1


ORTIKOS E

PENTASA 3

PROCORT EXTERNAL E

PROCTOCORT EXTERNAL

3


E


2





111


ROWASA RECTAL 3

SFROWASA 2


UCERIS 3



3 QL


1


1


1 QL

ATELVIA 3 QL

BINOSTO 3 QL

BONIVA INTRAVENOUS

E


3 QL


EVENITY 3 PA SP QL


2 PA SP


3 QL

FOSAMAX PLUS D E


E


1 QL

MIACALCIN INJECTION

3




2 PA SP QL

RAYALDEE 3

RECLAST 3 SP


1 QL


1


1 QL


2 PA SP

TYMLOS 2 PA SP

XGEVA 2 PA SP


1 SP


1 SP



E

calcitriol oral 1

cinacalcet hcl 1 PA


NATPARA 3 PA SP QL


paricalcitol oral 1

PARSABIV 3 SP

ROCALTROL 3

SENSIPAR 3 PA

ZEMPLAR INTRAVENOUS

E


3


112




ACACIA SUBCUTANEOUS

E


E


E


E

ACREMONIUM E

ACTHREL 3 SP


E

ACUNOL E

ADAKVEO 3 PA SP

ADULT AEROSOL MASK

E


E


3


3

ALDER E

ALTERNARIA E

AMERICAN BEECH E

AMERICAN COCKROACH

E

AMERICAN ELM E

AMERICAN SYCAMORE

E

AMINOPMRMS E


E



E


E

APP SLIM RMS E

APPTRIM E

APPTRIM-D E


E

ARIZONA CYPRESS E


3

asilnasalrms E

ASPARTAME E


E

AUREOBASIDIUM E

AUSTRALIAN PINE E


E


E


E

AVAILNEX E

AVITENE E

AVITENE FLOUR E

AXONA E

AZALGIA E

BAHIA E

BALD CYPRESS E


E


E

BHI URI-CONTROL E


113


BLACK WALNUT POLLEN

E

BLACK WILLOW E



E

BOX ELDER E


E


E


E


E


E

BROME E


E


E


E

CARDIOVID PLUS E


E


E


E


E


E



E

CARTICEL E


E

CATTLE EPITHELIUM E

CAYA $0 QL

CEDAR ELM E


E


E

COCKLEBUR E


E

COLCIGEL E


E


E


E

CONDOMS E

CORN POLLEN E

CORTROSYN E


CROFAB E

CURVULARIA E

DANDELION E



E


114



E

desflurane 1


E


E


E


E


E

DIGIFAB E

DOG EPITHELIUM E

DOG FENNEL E

DOJOLVI E

DRECHSLERA E


2 PA SP


E

DYSPORT 3 PA SP

EASIVENT 2

EASTERN COTTONWOOD

E

EC-RX DHEA E

ECZEMOL E

ENDARI 3 PA

ENDO AVITENE E



E


E


E


E


E


E


E

ENGLISH PLANTAIN E

ENLYTE E


ENTERAGAM E

enteric fish oil E

EPICOCCUM E

EPISIL E

EQUACARE JR E


ESSENTIAL CARE JR E


2 PA SP

EVRYSDI E SP

FIRDAPSE E SP

FIRE ANT E


2


2


115



2

FORANE 3


E


3


E

FOSTEUM PLUS E

FOVEX E

FUSARIUM E

GABADONE E

GELCLAIR E

GELFILM EXTERNAL E

GEL-FLOW E

GEL-FLOW NT E

GELFOAM E


E


E

GELFOAM SPONGE E


E


E


E

GELFOAM-JMI POWDER

E

GELFOAM-JMI SPONGE

E

GELSYN-3 2 PA SP

GELX E

GERMAN COCKROACH

E

GIVLAARI 3 PA SP


GLEOLAN E


3


E


E


E


E


E

GLYTACTIN BURST E


E


E

GLYTACTIN RESTORE 5

E


E


E


E

GLYTACTIN RTD 15 E


E


E

GOLDENROD E

GRASTEK 3 PA QL

H2Q ORAL POWDER E

HACKBERRY E


1


1


116


HEPMED E

HIBICLENS E

HOMACTIN AA PLUS E

HOME PAP KIT E


E

HORSE EPITHELIUM E

HUMATROPEN FOR 12MG

E

HUMATROPEN FOR 24MG

E

HUMATROPEN FOR 6MG

E

HYALGAN E SP

HYLAFEM E

HYMOVIS E SP

HYPERTENSA E


2

INTERCEED E

IOSAT E

isoflurane 1

ISOVACTIN AA PLUS E

JOHNSON GRASS E


E

KAPOK E


3


E

KETOVIE LIQUID ORAL

E


KETOVIE PEPTIDE E

KOCHIA E

LAMBS QUARTERS E

LENSCALE E

LIMBREL E

LIMBREL250 E

LIMBREL500 E

LISTER-V E

LORMATE E

MACRILEN E

MACUTEK E

MASK VORTEX E


E

MELALEUCA E

MESQUITE E


E

METHAVER E



E


1 QL

METOPIRONE E


E


E


E

MIXED ASPERGILLUS E

MIXED FEATHERS E

MIXED RAGWEED E


117



E

MKO MELT DOSE PACK

E

mlk f1 E

mlk f2 E

mlk f3 E

mlk f4 E

MONOVISC E SP

MORCIN E

MOUNTAIN CEDAR E

MOUSE EPITHELIUM E

MUCOR SUBCUTANEOUS

E

MUCOTROL E

MUGARD E

MUGWORT E

MYOBLOC 3 PA SP

NEODOT THERMOMETER

E

NEUREPA E

NICAPRIN E

NICAZYME E


E


OLIVE TREE E

OMNIVEX E

OPTIONS CONCEPTROL

$0 QL

ORALAIR 3 PA QL


3 PA QL


3 PA QL



3 PA QL


3 PA QL

ORAMAGICRX E


E


E SP

OXBRYTA E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E


118



E


E


E

PECAN POLLEN E


E

PERCURA E


E

PH STRIPS E

PHENACTIN AA PLUS E

PHEXXI E

PHOMA EXIGUA E


3

PRAXBIND E


E


E

PRID E

PRIVET E

PRO-CRITIC E


E

PROLEVA E


E



E

PSORIZIDE FORTE E

PSORIZIDE ULTRA E

PULMONA E

PURAMINO DHAARA E

QUEEN PALM E

RABBIT EPITHELIUM E

RADIOGARDASE 3

RAGWITEK 3 PA QL

RAPID GEL RX E

RED BIRCH E

RED CEDAR E

RED MAPLE E

RED MULBERRY E


E

RESECTISOL E


E

RHEUMATE E

RHIZOPUS E

RIBOZEL E

ROUGH MARSH ELDER

E

ROUGH PIGWEED E

RUSSIAN THISTLE E

RUZURGI 3 PA SP


E

SAGEBRUSH E


E

SENTRA AM E

SENTRA PM E

sevoflurane 1


119


SHAGBARK HICKORY E

SHARPS CONTAINER E

SHEEP SORREL E


E

SILTREX E


E SP

SORBITOL IRRIGATION

E

sorbitol-mannitol E

SORRELDOCK MIX E

SPEEDGEL RX E

SPINRAZA 3 PA SP

SPINY PIGWEED E

STEMPHYLIUM E

SUPARTZ FX E SP

SUPRANE 3

SWEET GUM E


E


E SP


E SP

SYRINGE AVITENE E

TACHOSIL 3

TALL RAGWEED E

terrell 1

THERAMINE E

THERAMINE PLUS E

THROMBI-GEL 10 E

THROMBI-GEL 100 E

THROMBI-GEL 40 E

THROMBI-PAD E


THYROGEN 2 PA SP


E


3

TL-ICARE E

TOBAKIENT E


E

TRANZGEL E


E


E

TREPADONE E


E


E

TRILURON E SP


E

T-SUPPORT MAX E


E


E

TYLACTIN RESTORE 10

E


E

TYLACTIN RTD 15 E

TYROS 2 E

ULTANE 3


E


E


120



E


E


E


E

VASCULERA E


$0 QL


$0 QL

VILACTIN AA PLUS E

VILTEPSO E SP

VIRGINIA LIVE OAK E

VISTOGARD 3


E


E


E

WELLMIND VERTIGO E

westab max E

WESTERN JUNIPER E

WHITE ASH E

WHITE BIRCH E


E

WHITE MULBERRY E

WHITE OAK E


WHITE PINE E


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL

XEOMIN 3 PA SP

XIAFLEX 2 PA SP

XYZBAC E

XYZMUNE E

YELLOW DOCK E


E


E

ZYVEXOL E

ZYVIT E


ACULAR 3

ACULAR LS 3

ALAWAY E

ALOCRIL E


121


ALOMIDE 3

ALREX E

AZASITE 3


1


BEPREVE 3 ST

BESIVANCE 3


3

BLEPH-10 3


1 QL

BROMSITE E

CILOXAN 3


1


1


1

DEXTENZA E SP

DEXYCU E


1

DUREZOL E

epinastine hcl 1


1

eye itch relief E

EYSUVIS E

FLAREX 3


1


FML 2

FML FORTE 3

FML LIQUIFILM 3




1


1

ILEVRO E


E SP

INVELTYS 3


1

KLARITY-A E

KLARITY-L E



E


E


3

LOTEMAX SM 3


MAXIDEX 3

MITOSOL 3

MOXEZA 2


1


1

NATACYN 2

NEVANAC E

OCUFLOX 3



E


1


122



E


1


3 SP

PATADAY E


3

PRED FORTE 3

PRED MILD 3


E


1


E


1


E

PROLENSA 2 QL


E SP


1


TOBREX 3


TRIPLE PMB E

TRIPLE PMK E

UPNEEQ E

VIGAMOX 3

YUTIQ E SP

ZADITOR E

ZERVIATE E

ZIRGAN 3

ZYMAXID 3



acetazolamide er 1



2


E

apraclonidine hcl 1

AZOPT 2


1

BETIMOL 3

BETOPTIC-S 3



1


E

carteolol hcl 1

COMBIGAN 2

COSOPT 3


3


3


1


1


1

DURYSTA E


3

ISOPTO CARPINE 3


123


ISTALOL 3

KEVEYIS 3 PA SP QL



E


1


2 QL


PHOSPHOLINE IODIDE

2


1

RHOPRESSA 3 QL

ROCKLATAN 3 QL

SIMBRINZA 2


1



E


E


E

TIMOPTIC E


3


E

TIMOPTIC-XE E

TRAVATAN Z 3 QL



TRUSOPT 3

VYZULTA E

XALATAN 3

XELPROS 3 ST QL

ZIOPTAN E


ak-poly-bac 1

AKTEN 3

ALCAINE 3

altacaine 1

altachlore E

altafluor benox E


1


E


1


E


1


1


1

BEOVU E SP

BEVACIZUMAB 3 SP


bio glo E

BLEPHAMIDE 3

BLEPHAMIDE SOP 3

CEQUA E


124



E


E

CYCLOGYL 3

CYCLOMYDRIL 3


1


E

CYSTADROPS E SP

CYSTARAN 3 PA SP QL

DOUBLE PM E

EYLEA INTRAVITREAL

3 PA SP

flucaine E


fluor-i-strips at E

FLURA-SAFE E


E


E

GELFILM OPHTHALMIC

E


E


E


E


E

homatropaire 1


E

ISOPTO ATROPINE 3


LACRISERT 3

LASTACAFT 3 ST

LATISSE E

lissamine green E


E


lubricant eye pm E

lubricant pm E



E


2 PA SP


3 PA SP

MAXITROL 3

MEMBRANEBLUE 3


E


E

MYDRIACYL E


1


1


1


1


125



1

neo-polycin 1

neo-polycin hc 1

OXERVATE 3 PA SP QL

PAREMYD E


1

polycin 1


1

POLYTRIM 3

PRED-G 3

PRED-G SOP 3


E


E


E


E


E


E


E


1


E


REFRESH RELIEVA E


E

RESTASIS 2 PA


2 PA

ROSE GLO E


E


1

SYSTANE COMPLETE E


E

SYSTANE ULTRA PF E


1


3


E

TOBRADEX ST 3


1



E


E


E


E


126



E

ultra fresh pm E


E

VISIONBLUE 3

VISUDYNE 3 SP

XIIDRA 2 PA

ZYLET 3


acetic acid otic 1

CETRAXAL 3 ST

CIPRO HC 3

CIPRODEX 2



1


E

cortic-nd 1

DERMOTIC 3

exotic-hc 1

flac 1


1


1


1

ofloxacin otic 1

OTICIN HC NR 3

OTIPRIO E

OTOVEL E

PRAMOTIC 3



12 hour allergy-d E


E


E


ADRENALIN NASAL E

all day allergy d E



E

allergy 24-hr E

allergy childrens E


E



E



E


E


E


E


E


E


E


127



E


E




E


BECONASE AQ 3 QL

benzonatate 1

bromfed dm 1


1


1


E


E


1



E


E


E


E


E

CINQAIR 3 PA SP


E

CLARINEX-D 12 HOUR

E


E



E



1




E


E


3



E


E


E


E


E


1


1


E

DICOPANOL FUSEPAQ

E

DICOPANOL RAPIDPAQ

E


E

DI-PHEN E



128



E


E


1


E


E

DYMISTA 2 QL


FASENRA 2 PA SP

FASENRA PEN 2 PA SP


E


E


1 QL


1



GILPHEX TR E


E


E




E


E


E

hm loratadine E


HYCODAN 3 PA QL


1 PA QL


1 PA QL

hydromet 1 PA QL

HYPERSAL 3


3


1


E


1



loratadine-d 12hr E

loratadine-d 24hr E


maxi-tuss gmx E

maxi-tuss pe max E

m-dryl E

MICLARA LQ E


1 QL


E


E

MUCINEX DM E


E

mucus dm E


129



E


E


mucus-d E

mucus-er max E


E


E



E



NASONEX E


E


E


E

NEOTUSS PLUS E

NUCALA 2 PA SP QL


OMNARIS 3 QL

PATANASE 3 QL


PHENERGAN INJECTION

E


E



1




1


1 PA QL


1

promethegan 1

PROPEL E

PROPEL MINI E



1


E

QNASL 3 QL



E


E


3

ryvent E

SEMPREX-D E

sinus 12 hour E

SINUVA 3


1

SSKI E

SUDAFED CONGESTION

E

sudogest 12 hour E


E


130



E


3

TESSALON PERLES 3


E


E


E



E


E

TUXARIN ER E


E



E


XHANCE E

XOLAIR 2 PA SP

ZETONNA 3 QL


E


ACCOLATE 3


1



3

ADVAIR DISKUS 1 QL

ADVAIR HFA 2 QL

ADYPHREN E

ADYPHREN AMP E

ADYPHREN AMP II E

ADYPHREN II E

AIRDUO DIGIHALER E


E


E


E



1 QL


E


1 QL


E


1 QL


ALVESCO E


131


ANORO ELLIPTA 2 QL


3 PA SP


ARMONAIR DIGIHALER

E



E


E


E


E


E

ASMANEX HFA E

ATROVENT HFA 3 QL


3 QL


E

BEVESPI AEROSPHERE

E

BREO ELLIPTA 2 QL

BREZTRI AEROSPHERE

E

BROVANA 3 QL



E


COMBIVENT RESPIMAT

2 QL


1

DALIRESP 3 PA

difil-g forte 1

DUAKLIR PRESSAIR E

DULERA E

ELIXOPHYLLIN 2


1 ST


1


E


1 ST


1

EPINEPHRINESNAP-EMS

E

EPINEPHRINESNAP-V E


3 ST


E

EPISNAP E

ESBRIET 3 PA SP

FLOVENT DISKUS 2 QL

FLOVENT HFA 2 QL


132



E


1 ST QL

GLASSIA 3 PA SP

INCRUSE ELLIPTA E


1 QL



1 QL


E


3 QL


3 QL


1

OFEV 3 PA SP

PERFOROMIST 3 QL

PROAIR DIGIHALER E

PROAIR HFA E

PROAIR RESPICLICK E


3 PA SP



3 PA SP

PROVENTIL HFA E

PULMICORT FLEXHALER

2 QL


E

QVAR REDIHALER E

SEEBRI NEOHALER E


SINGULAIR E

SPIRIVA HANDIHALER

2 QL


2 QL

STERITALC 3


2 QL

STRIVERDI RESPIMAT

2 ST QL

SYMBICORT 2 QL

SYMJEPI 3


E


THEO-24 3

theophylline 1


1


1


133


E

UTIBRON NEOHALER E

VENTOLIN HFA E

wixela inhub E

XOPENEX NEB 3 QL

XOPENEX CONCENTRATE

3 QL

XOPENEX HFA E

YUPELRI 3 QL

zafirlukast 1

ZEMAIRA 3 PA SP

zileuton er 1 ST

ZYFLO E


BETHKIS 2 SP

CAYSTON 3 PA SP

KALYDECO 3 PA SP

KITABIS PAK E SP

ORKAMBI 3 PA SP QL

PULMOZYME 2 PA SP

SYMDEKO 3 PA SP QL

TOBI NEBULIZER E SP



1 SP


E SP


E SP


TRIKAFTA 3 PA SP QL


ADCIRCA 3 PA SP QL

ADEMPAS 2 PA SP QL

alyq 1 PA SP QL


bosentan 1 PA SP QL


FLOLAN 3 PA SP

LETAIRIS 3 PA SP QL

OPSUMIT 2 PA SP QL

ORENITRAM 3 PA SP


E SP

REVATIO INTRAVENOUS

3 PA SP



1 PA SP


1 PA SP QL


1 PA SP QL



E SP



TYVASO 3 PA SP QL



UPTRAVI 3 PA SP QL


134



TUDORZA PRESSAIR


VELETRI 3 PA SP

VENTAVIS 3 PA SP QL



AMRIX E

BACLOFEN EXTERNAL

E


baclofen oral 1

carisoprodol oral 1


1 QL


1

CYCLOGABA 10300 E



1


1


E

CYCLOPAK 3

CYCLOPHENE RAPIDPAQ

E


3


enovarx-baclofen E


E

FEXMID 3

FIRST-BACLOFEN E



E


E

LIORESAL E

LORZONE 3

METAXALL CP E

metaxalone 1


NOPIOID-LMC KIT E

NORGESIC FORTE E



1


E

OZOBAX E

ROBAXIN-750 3

SKELAXIN E

SOMA 3

TABRADOL FUSEPAQ E

TABRADOL RAPIDPAQ

E


VANADOM 3

ZANAFLEX E


AMBIEN E

AMBIEN CR E


135


armodafinil 1 PA QL

BELSOMRA 3 ST QL

DAYVIGO 3 ST QL


EDLUAR E

eszopiclone 1 QL


HETLIOZ 3 PA SP QL


3 QL

LUNESTA E

modafinil 1 PA QL

NUVIGIL E

PROVIGIL E

ramelteon 1 QL

RESTORIL E

ROZEREM 3 QL

SILENOR 3 QL


E


SUNOSI 2 PA QL

temazepam 1 QL

WAKIX 3 PA SP QL

XYREM 3 PA SP QL

XYWAV E SP

zaleplon 1 QL



ZOLPIMIST 3 ST QL


136

Index of Drugs




137




138




139




140




141




142




143




144




145




146




147




148




149




150




151




152




153




154




155




156




157




158




159




160




161




162




163




164




165




166




167




168




169




170




171




172




173




174




Drug Tier


Directions Doctor


-Continued on back-


























(Farsi)

HealthSelectSM

of Te

xas





Anesthetics


Antibacterials

Anticoagulants



Antidepressants


Antifungals

Antigout Agents


Antimigraine Agents


Antimycobacterials


Antiparasitics


Antiplatelets


Antivirals













Diabetes - Insulins






























4











5








6


Tier information



Tier 1 Lowest Cost






Tier 3 Highest Cost











Table of Contents


7


8






E


E


E


E

acetaminophen er E


E


E


E


E


E


E


1 QL


1 QL


1 QL


1 QL

ACTIQ 3 PA QL

ALLZITAL E

APADAZ E



1 QL


1 QL

ARYMO ER E

ascomp-codeine 1


BELBUCA 2 PA QL


E


3

BUPRENEX E


E


1 PA QL


1


E


1



1


1


1


1


E


9



1 QL

BUTRANS 3 PA QL


1


E


E

childrens apap E


E


1 QL

CONZIP E


E


E

DILAUDID ORAL E

DOLOPHINE 3 PA

DSUVIA E

DURAGESIC-100 E

DURAGESIC-12 E

DURAGESIC-25 E

DURAGESIC-50 E

DURAGESIC-75 E

duramorph E


1 QL

ESGIC 3

fentanyl 1 PA QL



1 PA QL


E



E


E


E


E


E


E


E


E


E


E


10



E


E


3


3

FIORINAL 3

FIORINALCODEINE 3

3


E



1 PA ST QL


1 QL


1 QL


1 QL


1 PA QL


E




E


E


E

HYSINGLA ER 2 PA QL

INFUMORPH 200 E

INFUMORPH 500 E


E

LAZANDA E




3 QL

MEDI-DERM-RX E

MEDROX-RX 3


E


1 QL


1 QL




1


11



1


1 PA


1


1


1


migraine relief E

mitigo E


1 QL


E


E


1 PA QL


1 PA QL


1 PA QL


E


E


E


E





E


E


E

m-pap E


E


1

NALOCET E

NORCO E

NUCYNTA E

NUCYNTA ER E

OXAYDO ORAL TABLET

E


E


1 QL


1 QL


1 QL


1 QL


E


12



1 QL


1 QL


2 PA QL




E



E


E


E



E

PANADOL CHILDRENS

E

PANADOL EXTRA E


E

PANADOL INFANTS E


1 QL


E

PRIALT 2 SP

PRIMLEV E


E


PROLATE E

QDOLO E


E


E

SUBSYS E

SYNAPRYN FUSEPAQ E


1


1 ST QL


E


1 PA QL


1 QL



1 QL


3 QL

TYLENOL 8 HOUR E


E


E

TYLENOL ORAL TABLET

E

ULTRACET E

ULTRAM E


13


VANATOL LQ E

VTOL LQ E

XTAMPZA ER 2 PA QL


3


E


ACTIVE-KETOPROFEN

E

ACTIVE-PREP KIT I E




ADVIL E


E


E

ADVIL MIGRAINE E


E


E

ALEVE ORAL TABLET E


E

aspirin adult $0


$0






$0


$0


$0


$0


$0


E


$0


$0


$0

BIIFENAC 1000 E

BIIFENAC 500 E


E

CAMBIA E

CAPSFENAC PAK E

CAPSINAC E

CELEBREX E

celecoxib oral 1 QL

DAYPRO 3


E


E


14



E

DFSMSMENTHCAP PAK

E

DICLOFENAC E


3 QL




1 QL


1 PA



1


E


3


E

DICLOPR E

diclosaicin E

DICLOSTREAM E

DICLOTREX E

DICLOVIX E

DICLOVIX M E

DICLOZOR EXTERNAL

E

diflunisal oral 1

DIMENTHO E


E

DUEXIS E



3

ec-naproxen 1


E

enovarx-ibuprofen E


E


E

etodolac er 1

etodolac oral 1

FBL KIT E

FELDENE 3



E

FLEXIPAK E

flurbiprofen oral 1

FROTEK E


E



$0


E

IBUPAK E

ibuprofen 1

ibuprofen infants E



1


E

inavix E

INDOCIN ORAL 3 ST


15


INDOCIN RECTAL E

indomethacin er 1


E


1 ST

INFLAMMACIN E


E

KBGL IN TERODERM

E

KETOPHENE RAPIDPAQ

E

ketoprofen er 1

ketoprofen oral 1


E


1


1


3 PA QL


1 QL


1


3

LICART EXTERNAL E

LODINE 3


1




MOBIC ORAL TABLET E


E


E

nabumetone oral 1


3

NALFON ORAL TABLET

3


3


E


3

naproxen dr 1


E




E


1


1 PA QL


E

NUDICLO SOLUPAK E

NUDICLO TABPAK E

NUDROXIPAK E

NUDROXIPAK DSDR-50

E


16


NUDROXIPAK DSDR-75

E

NUDROXIPAK E-400 E

NUDROXIPAK I-800 E

NUDROXIPAK M-15 E

NUDROXIPAK N-500 E

ORMECA E

oxaprozin 1

PENNSAID EXTERNAL

E

piroxicam oral 1

PRASTERA E


E


E


$0

QMIIZ ODT E


E

RELAFEN E

RELAFEN DS E

REXAPHENAC EXTERNAL

E

salsalate oral E

SPRIX 3 PA QL


$0

sulindac oral 1


E


E


1


1

TORONOVA II SUIK E


TORONOVA SUIK E


E


E

VAROPHEN E

VENNGEL ONE E

VIMOVO E

VIVLODEX E

VOLTAREN EXTERNAL

E

VP FC KIT E

VP GKL KIT E

XRYLIX EXTERNAL E

ZIPSOR E

ZORVOLEX E

Anesthetics


E

7T LIDO E

ACCUCAINE E


E

AGONEAZE E

ANODYNE LPT E

APRIZIO PAK E

APRIZIO PAK II E

ASTERO E


E

blue tube aloe E


E



E


17



E


E

CADIRAMD E

CAPSAICIN-MENTHOL

E


3


E

COCAINE HCL NASAL E


E


E


E

DERMACINRX PHN E

DERMACINRX PRIZOPAK

E

DERMACINRX ZRM E

EHA E

EMPRICAINE-II E


ethyl chloride 1

EXPAREL E

FLEXIN E

GEBAUERS PAIN EASE

3


3

GEN7T E

GEN7T PLUS E

GOPRELTO E


LDO PLUS E

lets E

LEVATIO E

LIDO BDK E


E


1


1


E


E


E


1


1


E


E


3


1


3


1


1


1 QL


18



E


1


E


E

LIDOCANNA E

LIDODERM E


3


E

LIDOMARK 25 E

LIDOPAC E


E


E


E

LIDOPRIL XR E


E

LIDOPURE PATCH E

LIDORX E

LIDO-SORB E

LIDOSTREAM E

LIDOTHOL E

LIDOTRAL E

LIDOVIX L E

LIDTOPIC MAX E

LIVIXIL PAK E

LMR PLUS E

LYDEXA E


MARCAINE E


E

marlido E

MARLIDO-25 E

MARVONA SUIK E

MEDI-DERML-RX E

MEDI-PATCH RX E

NUMBRINO E

NUVAKAAN E

NUVAKAAN-II E

PAINGO KFT E

PLIAGLIS E

POINT OF CARE LM-22

E

POINT OF CARE LM-25

E

premium lidocaine E

PREMIUM SCAR E

PREPIV SUPPLY 3

PRILO PATCH E

PRILO PATCH II 3

PRILOLID E

PRILOVIX E

PRILOVIX LITE E


PRILOVIX PLUS E



PRILOVIXIL E

PRIZOPAK II E

PRIZOTRAL E

PRIZOTRAL-II E

READYSHARP-A E


E

RELADOR PAK PLUS E


19


RENOVO E

sensorcaine E

sensorcaine-mpf E


E


E

SYNERA E

SYNVEXIA TC E


3

VEXATROL E


E

XARACOLL E

XYLOCAINE INJECTION

3


3

ZERUVIA E

ZILACAINE PATCH E


E

ZIONODIL E

ZIONODIL 100 E

ZTLIDO E



BUNAVAIL 3 QL


1 QL


1 QL


$0 QL


CHANTIX $0 QL


$0 QL


$0 QL

disulfiram oral 1

LUCEMYRA 3 ST QL


E


E


E



E

NARCAN 2


$0 QL


$0 QL




NICOTROL $0 QL

NICOTROL NS $0 QL

SUBLOCADE 3 SP


2 QL

VIVITROL 3 SP

ZUBSOLV 2 QL

Antibacterials

ACTICLATE E

AEMCOLO 3 PA

ALTABAX 3


20



E



1



1


1


1


1


E

ARIKAYCE 3 SP

AUGMENTIN ES-600 3


3


3

avidoxy 1 ST

AVIDOXY DK E


1


1


1




BACTRIM 3

BACTRIM DS 3

BAXDELA INTRAVENOUS

E

BAXDELA ORAL 3


3


1

BENZODOX E

BICILLIN L-A E

cefaclor 1

cefaclor er 1

cefadroxil 1


E


E

cefdinir 1


E

cefixime 1

CEFOTAN E


E


E


E


cefprozil 1


21



E


1


1

CENTANY 3

CENTANY AT E

cephalexin 1


E


3


3


clarithromycin er 1


CLEOCIN ORAL 3


3


2



1


1

CLINDESSE 3


E

COLY-MYCIN M E

coremino E

CUBICIN E

CUBICIN RF E

daptomycin E




DIFICID 3

DORYX MPC E


3 ST


E

doxy 100 E


E


1


1


1 ST


E


1


1 ST


E


1 ST


1


1


22



1 ST

EES GRANULES 3

ertapenem sodium E

ERYPED 200 3

ERYPED 400 3

ERY-TAB 3


3



1

erythromycin oral 1

FETROJA E


E

FIRVANQ 3

FLAGYL ORAL CAPSULE

3


3


E


1


1

HIPREX 3


E

INVANZ INJECTION E


1

KEFLEX 3


levofloxacin oral 1

LINCOCIN E



E


E

linezolid oral 1 QL

MACROBID 3

MACRODANTIN 3


1


E


E


E



E


E




3


E



23


MINOLIRA E


1 ST

MONUROL 3


E


1



mupirocin calcium E



E


E



E


1


1


1

NUTRIDOX E

NUVESSA E


3


1


E


E


1



E





E


E


E


E

PRIMSOL 3

RECARBRIO E


E

SEYSARA 3 ST

SILVADENE 3


E


1

SIVEXTRO E


3

SOLOSEC 3

ssd 1


E


24


sulfadiazine oral 1


1


1


E


3


SUPRAX ORAL CAPSULE

3


3


3

TARGADOX E

tazicef injection E


E


E


tigecycline E

tinidazole oral 1

trimethoprim oral 1

TYGACIL E


E

VANCOCIN 3


3



E


E



E

vandazole 1

VIBRAMYCIN 3 ST

XENLETA INTRAVENOUS

E

XENLETA ORAL 3

XEPI 3

XIFAXAN 3 PA

XIMINO 3

ZEMDRI E


3


3


3

ZITHROMAX TRI-PAK 3

ZITHROMAX Z-PAK 3


E

ZYVOX ORAL 3 QL

Anticoagulants

ACD-A NOCLOT-50 3


25


ACTIVASE E


1


3

ARIXTRA 3 SP QL

CATHFLO ACTIVASE E

ELIQUIS 2 QL


2 QL




3 SP QL


E


1


E


1



E

jantoven 1

LOVENOX 3 SP QL

PRADAXA 2 QL

REGIOCIT E

SAVAYSA 3 QL

THROMBATE III 3 SP

TRICITRASOL 3


XARELTO 2 QL


2 QL


APTIOM 3

BANZEL 3 PA


E

BRIVIACT ORAL 3 ST

carbamazepine er 1


CARBATROL 3

CELONTIN 3


E

clobazam 1 PA

DEPAKOTE 3

DEPAKOTE ER 3


3

DIACOMIT 3 PA SP





26


DILANTIN INFATABS E


E


3


E


1


1


1

EPIDIOLEX 3 PA SP

epitol 1

ethosuximide oral 1

FANATREX FUSEPAQ E

felbamate 1

FELBATOL 3

FINTEPLA 3 PA SP


E

FYCOMPA 3


1


1


GABITRIL 3

KEPPRA INTRAVENOUS

E

KEPPRA ORAL 3

KEPPRA XR 3


2



E


3


3


3

LAMICTAL STARTER 3

LAMICTAL XR 3

lamotrigine er 1


1



1


1


1


1


1

levetiracetam er 1


E


MYSOLINE 3

NAYZILAM 3 QL

NEURONTIN 3


3 PA


3 PA

oxcarbazepine 1

OXTELLAR XR E



27



1

PHENYTEK 3



1


1


1

primidone oral 1

QUDEXY XR 3


1

rufinamide 1 PA

SABRIL ORAL PACKET

E SP

SABRIL ORAL TABLET

3 PA SP

SPRITAM E

subvenite 1


1


1


1

SYMPAZAN 3 PA


3


3

TEGRETOL-XR 3

tiagabine hcl 1

TOPAMAX 3

TOPAMAX SPRINKLE 3

topiramate er 1

topiramate oral 1

TRILEPTAL 3

TROKENDI XR 3 ST



1


1

VALTOCO 10 MG DOSE

3 QL

VALTOCO 15 MG DOSE

3 QL

VALTOCO 20 MG DOSE

3 QL

VALTOCO 5 MG DOSE

3 QL

vigabatrin 1 PA SP

vigadrone 1 PA SP

VIMPAT INTRAVENOUS

E

VIMPAT ORAL 3

XCOPRI 3 ST


3 ST


3 ST

ZARONTIN 3

ZONEGRAN 3

zonisamide oral 1


ARICEPT 3

donepezil hcl 1

EXELON TRANSDERMAL

3


1


1



1


28



1

NAMENDA ORAL TABLET

3


3

NAMENDA XR 3 QL


3 QL

NAMZARIC 2 QL

RAZADYNE ER 3

rivastigmine 1


Antidepressants


amoxapine 1

ANAFRANIL 3

APLENZIN 3 ST QL

BRISDELLE 3 ST QL



1 QL


E


CELEXA ORAL TABLET

3


1


1


CYMBALTA E


DESVENLAFAXINE ER

3 ST QL



1 QL


1


1



EFFEXOR XR E

EMSAM 3 QL


FETZIMA 3 ST QL



3


1


1 QL


1




FORFIVO XL E



LEXAPRO ORAL TABLET

E

maprotiline hcl 1

MARPLAN 3

mirtazapine oral 1

NARDIL 3

nefazodone hcl 1


3



29



1 QL


3

PARNATE 3

paroxetine hcl er 1


1


PAXIL CR 3


2 ST

PAXIL ORAL TABLET 3


1

PEXEVA E


PRISTIQ E

protriptyline hcl 1

PROZAC ORAL CAPSULE

E


3

REMERON SOLTAB 3



3 PA SP


3 PA SP


3 QL




1

TRINTELLIX 3 ST QL

venlafaxine hcl 1



VIIBRYD ORAL TABLET

3 QL


3 QL

WELLBUTRIN SR E

WELLBUTRIN XL E

ZOLOFT E

ZULRESSO 3 PA SP


AKYNZEO INTRAVENOUS

E

AKYNZEO ORAL 3 QL


E

ANZEMET ORAL 3 QL

aprepitant 1 QL

BONJESTA 3 PA QL

compro 1


DICLEGIS 3 PA QL


dronabinol 1 PA QL


E


3 QL


3

EMEND TRI-PACK 3 QL


E

GIMOTI E


30



E


E


MARINOL 3 PA QL


1


E


E


1


1


1


1



E


1 QL


1 QL


1

ondansetron odt 1

palonosetron hcl E

perphenazine oral 1

prochlorperazine 1


1

REGLAN ORAL 3

SANCUSO 3 QL


scopolamine 1

SYNDROS 3 PA QL

TIGAN INTRAMUSCULAR

E

TIGAN ORAL 3


3


3


E


1


3 QL


3

ZUPLENZ E

Antifungals

ACTIVE-PREP KIT V E

ala-quin E

ALCORTIN A E


E


E

ANCOBON 3


E


3



E


E


31



1



1



1


1


1


E


1

CRESEMBA ORAL 3



E

dermazene E


E


3


3

DIFMETIOXRIME E

ECONASIL E


1


E

ECOZA E


E


ERTACZO E

EXELDERM E


EXTINA 3

fluconazole oral 1


E

flucytosine oral 1

FUNGIMEZ E


1


1

GYNAZOLE-1 3


E

IMIOXIA E

IODOQUIMEZ-HC E


E


E


E


JUBLIA E

KERYDIN 3 PA


1


E


1

ketoconazole oral 1


E



E


32



3

LOPROX EXTERNAL KIT

E


3


3


E

LULICONAZOLE E

LUZU E

MENTAX E

micaderm E


E

miconazole 1 E


1


E


E


E


E

naftifine hcl 1


3

NAFTIN EXTERNAL GEL

3

NOXAFIL ORAL 3

nyamyc 1

nystatin external 1





nystop 1

ONYCHO-MED E

ORAVIG E



3


E

PEDIZOLPAK E

PHEODOYO E

PHEYO E


E

posaconazole 1

QUINJA E

RECURA E

SPORANOX 3 PA

SPORANOX PULSEPAK

3 PA

SULCONAZOLE NITRATE

E

tavaborole 1 PA


terconazole 1



E

TOLSURA E

VFEND 3

voriconazole oral 1

VUSION E

VYTONE E

XOLEGEL E

XOLEGEL COREPAK E


E

XOLEGEL DUOXOLEX

E


33



E

ZOLPAK E

Antigout Agents

allopurinol oral 1


E



COLCRYS E

febuxostat 1 ST

GLOPERBA E

KRYSTEXXA 3 PA SP

MITIGARE E

probenecid oral 1

ULORIC 3 ST

ZYLOPRIM 3


EMFLAZA 3 PA SP

Antimigraine Agents

AIMOVIG 2 PA QL

AJOVY E


AMERGE 3 QL

CAFERGOT 3

DHE 45 3 PA QL


1 PA QL


1 PA QL


EMGALITY 2 PA QL


2 PA QL

ERGOMAR 3


FROVA 3 QL



IMITREX 3 QL


3 QL


3 QL


3 QL


3 QL

MIGERGOT 3

MIGRAINE PACK E

MIGRANAL 3 PA QL

MIGRANOW E


NURTEC 2 PA QL


RELPAX 3 QL

REYVOW E




1 QL


1 QL


1 QL


1 QL


34



1 QL


1 QL

TOSYMRA E


3 ST QL

UBRELVY 2 PA QL

VYEPTI E

ZEMBRACE SYMTOUCH

E


ZOMIG NASAL 3 ST QL

ZOMIG ORAL E

ZOMIG ZMT E


GUANIDINE HCL ORAL

3


3


3


3


E


1


1


1

Antimycobacterials

CAPASTAT SULFATE E


cycloserine oral 1

dapsone oral 1


isoniazid oral 1


3

MYCOBUTIN 3

PASER 3

PRETOMANID 3

PRIFTIN 3

pyrazinamide oral 1

rifabutin 1

rifampin oral 1


E

SIRTURO 3

TRECATOR 3



ABRAXANE 2 SP

ADCETRIS 2 PA SP


1 SP


1 SP



2 PA SP QL


E SP

ALECENSA 3 PA SP

ALIMTA 2 SP

ALIQOPA 3 PA SP

ALKERAN 3 SP

ALUNBRIG 3 PA SP QL

anastrozole oral $0


35


ARIMIDEX E

AROMASIN 3

ARRANON 2 SP


1 SP

ARZERRA 2 PA SP

ASPARLAS 3 SP

AVASTIN 3 PA SP

AYVAKIT 3 PA SP QL

azacitidine 1 PA SP

BALVERSA 3 PA SP

BAVENCIO 3 PA SP

BELEODAQ 3 PA SP

BELRAPZO E SP

BENDEKA 3 PA SP

BESPONSA 3 PA SP

bexarotene 1 PA SP

bicalutamide 1

BICNU 3 SP

BLENREP E SP


BLINCYTO 3 PA SP

BORTEZOMIB 3 PA SP

BOSULIF 3 PA SP


3 PA SP

BRUKINSA 3 PA SP

busulfan 1 SP

BUSULFEX 3 SP

CABOMETYX 2 PA SP

CALQUENCE 3 PA SP

CAMPATH 2 SP

CAMPTOSAR 3 SP



2 PA SP QL


2 PA SP



1 SP

carmustine 1 SP

CASODEX 3


1 SP


3 SP


1 SP

clofarabine 1 SP

CLOLAR 3 SP


3 PA SP


3 PA SP


3 PA SP

COPIKTRA 3 PA SP

COSMEGEN 3 SP

COTELLIC 3 PA SP


1 SP


E SP


1

CYRAMZA 3 PA SP



1 SP


1 SP

DACOGEN 3 PA SP

dactinomycin 1 SP


36


DARZALEX 3 PA SP



1 SP

DAURISMO 3 PA SP

decitabine 1 PA SP



1 SP


1 SP

DOXIL 3 SP


1 SP


1 SP

DROXIA 3

ELITEK 3 SP

ELLENCE 3 SP

ELZONRIS 3 PA SP

EMCYT 2

EMPLICITI 3 PA SP

ENHERTU 3 PA SP


1 SP

ERBITUX 2 PA SP

ERIVEDGE 2 PA SP

ERLEADA E SP


1 PA SP


1 PA SP QL

ERWINAZE INJECTION

3 SP

ETHYOL 3 SP


ETOPOPHOS 3 SP


1 SP

etoposide oral 1 SP


1 PA SP QL

EVOMELA 3 SP

exemestane $0

FARESTON 3

FARYDAK 3 PA SP


3 SP

FEMARA 3




flutamide 1

FOLOTYN 2 PA SP

fulvestrant 1 SP

GAVRETO E SP

GAZYVA 3 PA SP


GILOTRIF 3 PA SP QL

GLEEVEC 3 PA SP


3 SP

HALAVEN 2 PA SP

HERCEPTIN HYLECTA

3 PA SP


3 PA SP

HERZUMA E SP


37


HYCAMTIN 3 SP

HYDREA 3

hydroxyurea oral 1

IBRANCE 3 PA SP


3 PA SP QL


3 PA SP

IDAMYCIN PFS 3 SP

idarubicin hcl 1 SP

IDHIFA 3 PA SP QL

IFEX 3 SP

ifosfamide 1 SP


IMBRUVICA 3 PA SP

IMFINZI 3 PA SP

IMLYGIC 3 SP

INFUGEM 3 SP

INLYTA 3 PA SP

INQOVI E SP

INREBIC 3 PA SP

IRESSA 3 PA SP

irinotecan hcl 1 SP


IXEMPRA KIT 2 SP


2 PA SP QL


2 PA SP

JELMYTO E SP

JEVTANA 2 PA SP

KADCYLA 3 PA SP

KANJINTI 2 PA SP


3 PA SP

KHAPZORY 3 ST SP



3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP

KOSELUGO 3 PA SP

KYPROLIS 2 PA SP


LARTRUVO 3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP

letrozole oral 1


E


LEUKERAN 2


1 SP


38



1 SP

LIBTAYO 3 PA SP

LONSURF 3 PA SP

LORBRENA 3 PA SP

LUMOXITI 3 PA SP

LUTATHERA E


2 PA SP

LYSODREN 2

MARQIBO 3 SP

MATULANE 2 SP

MEKINIST 2 PA SP

MEKTOVI 3 PA SP

melphalan 1 SP

melphalan hcl 1 SP


mesna 1 SP

MESNEX 3 SP



E SP


MONJUVI E SP

mutamycin 1 SP

MVASI 2 PA SP

MYLERAN 2


3 PA SP

NAVELBINE 3 SP

NERLYNX 3 PA SP QL

NEXAVAR 2 PA SP

nilutamide 1 SP

NINLARO 3 PA SP

NIPENT 3 SP

NUBEQA 3 PA SP


ODOMZO 3 PA SP

OGIVRI E SP

ONCASPAR INJECTION

2 SP

ONIVYDE 3 SP

ONTRUZANT E SP

ONUREG E SP

OPDIVO 3 PA SP


1 SP


E


1 SP

paclitaxel 1 SP

PADCEV 3 PA SP

PANRETIN 3

paraplatin 1 SP

PEMAZYRE 3 PA SP QL

PERJETA 2 PA SP

PHESGO E SP

PHOTOFRIN 3 SP


3 PA SP


3 PA SP


3 PA SP

POLIVY 3 PA SP

POMALYST 3 PA SP

PORTRAZZA 3 PA SP

POTELIGEO 3 PA SP

PROLEUKIN 2 SP

PURIXAN 3 SP

QINLOCK 3 PA SP

RETEVMO E SP

REVLIMID 2 PA SP



39



3 PA SP


3 PA SP

ROZLYTREK 3 PA SP

RUBRACA 2 PA SP

RUXIENCE 2 PA SP

RYDAPT 3 PA SP

SARCLISA 3 PA SP

SIKLOS 3 PA

SOLTAMOX $0

SPRYCEL 2 PA SP

STIVARGA 3 PA SP

SUTENT 2 PA SP

SYLVANT 3 PA SP

SYNRIBO 3 PA SP

TABLOID 2 SP

TABRECTA E SP

TAFINLAR 2 PA SP


3 PA SP QL


3 PA SP

TALZENNA 3 PA SP



3 PA SP


3 PA SP QL

TARGRETIN EXTERNAL

3 PA SP

TARGRETIN ORAL E SP

TASIGNA 3 PA SP


3 SP


TAZVERIK E SP

TECARTUS 3 PA SP

TECENTRIQ 3 PA SP

TEMODAR INTRAVENOUS

2 SP



teniposide 1 SP

TEPADINA 3 SP

THALOMID 2 PA SP


TIBSOVO 3 PA SP


1 SP

topotecan hcl 1 SP


TOTECT 3 SP

TRAZIMERA 2 PA SP


E SP

tretinoin oral 1 SP


3 SP

TRODELVY 3 PA SP

TRUXIMA E SP

TUKYSA 3 PA SP

TURALIO 3 PA SP

TYKERB 3 PA SP

UNITUXIN 3 PA SP

VALCHLOR 3 PA SP

valrubicin E

VALSTAR E


40



3 SP


VENCLEXTA 3 PA SP


3 PA SP

VERZENIO 3 PA SP

VIDAZA 3 PA SP


1 SP


1 SP


VITRAKVI 3 PA SP

VIZIMPRO 3 PA SP

VORAXAZE E

VOTRIENT 3 PA SP


3 PA SP

XALKORI 2 PA SP

XELODA 3 PA SP


E

XOSPATA 3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP



3 PA SP


3 PA SP

XTANDI 3 PA SP

YERVOY 2 PA SP

YESCARTA 3 PA SP

YONDELIS 3 SP

YONSA E SP

ZALTRAP 2 PA SP

ZANOSAR 2 SP

ZEJULA 2 PA SP

ZELBORAF 3 PA SP

ZEPZELCA 3 PA SP

ZEVALIN Y-90 3 SP

ZIRABEV 2 PA SP

ZOLINZA 2 PA SP

ZYDELIG 3 PA SP

ZYKADIA ORAL TABLET

3 PA SP

ZYTIGA E SP

Antiparasitics


ALBENZA 3 PA

ALINIA 2

ARAKODA 3

atovaquone oral 1


1

BENZNIDAZOLE 3

BILTRICIDE 3


1

COARTEM 3


crotan 1

DARAPRIM 3 PA SP

EGATEN 3


41


ELIMITE 3

EMVERM 2


1

IMPAVIDO 3


1

ivermectin oral 1

KRINTAFEL 3

LAMPIT E

lice killing E


E


1

MALARONE 3


mefloquine hcl 1

MEPRON 3

NATROBA 3

NEBUPENT 3

nitazoxanide 2

OVIDE 3

PENTAM E


1


E


1

PLAQUENIL 3

praziquantel oral 1


1



3

QUALAQUIN 3 PA



SKLICE 3

spinosad 1


E

STROMECTOL 3

SULFURATED LIME 3




2 PA SP QL

AZILECT 3


1


1

carbidopa oral 1



1


1

COMTAN 3

DUOPA ENTERAL 3 PA

entacapone 1

GOCOVRI E

INBRIJA 3 PA SP

KYNMOBI E SP


E SP

LODOSYN 3

MIRAPEX ER 3


3

NEUPRO 3 ST

NOURIANZ 3 PA


42


ONGENTYS E

OSMOLEX ER E

PARLODEL 3


1


1


ropinirole hcl 1

ropinirole hcl er 1

RYTARY 3 ST


SINEMET 3

STALEVO 100 3

STALEVO 125 3

STALEVO 150 3

STALEVO 200 3

STALEVO 50 3

STALEVO 75 3


3

tolcapone 1


XADAGO 3 ST QL

ZELAPAR 3

Antiplatelets


ASPIRIN-OMEPRAZOLE

E

BRILINTA 2

CABLIVI 3 PA SP QL

cilostazol 1


1

dipyridamole oral 1

DURLAZA E

EFFIENT 3



3

prasugrel hcl 1

YOSPRALA E

ZONTIVITY 3



3


3

ABILIFY MYCITE E

ABILIFY ORAL TABLET

3 QL

ADASUVE 3 PA

aripiprazole 1 QL

ARISTADA E

ARISTADA INITIO E

CAPLYTA 3 ST QL


E


clozapine 1 QL

CLOZARIL 3 QL

FANAPT 3 ST QL


3 ST QL


E


E



E

GEODON ORAL 3 QL

HALDOL DECANOATE E


43



E


haloperidol oral 1

INVEGA 3 QL


3


3

LATUDA 3 QL


molindone hcl 1


3 PA


3 PA


E



PERSERIS E

pimozide 1



REXULTI 3 QL


3


E


E

risperidone 1 QL


SAPHRIS 2 QL

SECUADO E

SEROQUEL 3 QL

SEROQUEL XR 3 QL


thiothixene oral 1


VERSACLOZ 3 QL

VRAYLAR 3 ST QL




3

ZYPREXA ORAL 3 QL

ZYPREXA RELPREVV E

ZYPREXA ZYDIS 3 QL

Antivirals

abacavir sulfate 1


1


1


acyclovir oral 1


APTIVUS 2


ATRIPLA E

BARACLUDE 3 SP QL

BIKTARVY 3


CIMDUO 2

COMBIVIR 3

COMPLERA 2


2

DELSTRIGO 3


44


DENAVIR E

DESCOVY E


1

DOVATO 2

EDURANT 2

efavirenz 1


1


1

emtricitabine 1


1


3


2

entecavir 1 SP QL

EPCLUSA 2 PA SP QL

EPIVIR 3


2 SP


3 SP

EPZICOM 3

EVOTAZ 2

famciclovir oral 1

FAVIPIRAVIR 3



E


E

GENVOYA 3

HARVONI 2 PA SP QL


HEPSERA 3 SP

INTELENCE 2

INTRON A 3 PA SP


2

ISENTRESS 2

ISENTRESS HD 2

JULUCA 2


3

KALETRA ORAL TABLET

2



1 SP


1



E SP


2



MAVYRET 2 PA SP QL

nevirapine 1

nevirapine er 1

NORVIR ORAL PACKET

2


2

NORVIR ORAL TABLET

3

ODEFSEY 3


1 QL


2 PA SP


45



3 PA SP

PIFELTRO 3

PREVYMIS 3 SP

PREZCOBIX 2


2


2



E


3

RETROVIR ORAL SYRUP

3


3

REYATAZ ORAL PACKET

2




1 SP

rimantadine hcl 1

ritonavir 1

RUKOBIA 3

SELZENTRY 2 PA

SITAVIG 3 QL


E SP

SOVALDI 3 PA SP QL


STRIBILD 3

SUSTIVA 3

SYMFI 2

SYMFI LO 2


SYMTUZA 3


E


E

TEMIXYS E


1

TIVICAY 2

TIVICAY PD 2

TRIUMEQ 2

TRIZIVIR 3

TROGARZO 3 PA


2


E

TYBOST 2


VALCYTE 3


VALTREX 3 QL

VEMLIDY 3 SP



2


3


3

VIRAZOLE 3

VIREAD ORAL POWDER

2


46



2


3

VOSEVI 2 PA SP QL

XERESE E


3 QL


3 QL

ZEPATIER 3 PA SP QL

ZIAGEN 3

zidovudine 1


3


E


E


alprazolam er 1 QL



alprazolam xr 1 QL

ATIVAN E





1 QL

diazepam intensol 1


1


1


DORAL 3 QL

estazolam 1 QL


HALCION 3 QL


1


1


1

KLONOPIN 3 QL




1 QL


meprobamate 1



E


E


E

oxazepam 1 QL

quazepam 1 QL


3 QL

triazolam 1 QL

VALIUM E

VISTARIL 3

XANAX E

XANAX XR E


47



EQUETRO 3

lithium 1



LITHOBID 3


ADVATE 2 SP

ADYNOVATE 3 SP

AFSTYLA 3 SP

AGRYLIN 3


2 SP

ALPHANINE SD 2 SP

ALPROLIX 3 SP


3

AMICAR ORAL TABLET

3


1


1

anagrelide hcl 1


2 PA SP


2 PA SP


3



E


2 SP

CEPROTIN 3 SP

COAGADEX 3 SP

CORIFACT 2 SP


E


3 PA SP

ELOCTATE 3 SP


E SP

ESPEROCT E SP


2 SP

FIBRYGA 2 SP

FULPHILA E SP

GRANIX E SP

HEMLIBRA 3 SP


3 SP


48



2 SP

IDELVION 3 SP

IXINITY 3 SP

JIVI 3 SP

KOATE 2 SP

KOATE-DVI 2 SP

KOGENATE FS 3 SP

KOVALTRY 3 SP


3 PA SP

LYSTEDA 3


3 PA SP


2 SP


E

MOZOBIL 2 PA SP QL

MULPLETA 2 PA SP



3 PA SP


E SP



E SP

NIVESTYM 2 PA SP

NOVOEIGHT 2 SP

NOVOSEVEN RT 2 SP

NPLATE 2 PA SP

NUWIQ 2 SP

OBIZUR 3 SP


3 SP

PROCRIT E SP

PROFILNINE 2 SP

PROMACTA 3 PA SP

REBINYN 3 SP

REBLOZYL 3 PA SP

RECOMBINATE 2 SP

RECOTHROM 3

RECOTHROM SPRAY KIT

3


2 PA SP

RIASTAP 2 SP

RIXUBIS 3 SP

SEVENFACT E SP


3 PA SP

TAVALISSE 3 PA SP


3


49



3

THROMBOGEN 3


E



E

TRETTEN 3 SP

UDENYCA E SP


3 PA SP


2 PA SP

VONVENDI 3 SP


2 SP


2 SP


ZARXIO 2 PA SP

ZIEXTENZO 3 PA SP


ACCUPRIL 3

ACCURETIC 3



3



E

ALDACTAZIDE 3

ALDACTONE 3


ALTACE ORAL CAPSULE

E

ALTOPREV E



1



E


1


1


1




1


E

ATACAND E

ATACAND HCT 3

atenolol oral 1


E



1


3

AVAPRO 3

AZOR E


50




1

BENICAR E

BENICAR HCT E

BETAPACE AF 3


3


BIDIL 3



1

bumetanide oral 1

BUMEX 3

BYSTOLIC 2


3

CALAN SR 3



1

captopril oral 1


1

CARDIZEM CD 3


3


E


3


CARDURA 3

CAROSPIR 3

cartia xt 1

carvedilol 1


CATAPRES 3

CATAPRES-TTS-1 3

CATAPRES-TTS-2 3

CATAPRES-TTS-3 3


1



clonidine 1


colesevelam hcl 1

COLESTID E

COLESTID FLAVORED

E

colestipol hcl 1

CONJUPRI E

CONSENSI E

COREG 3

COREG CR 3

CORGARD 3

CORLANOR 3 PA QL

COZAAR 3

CRESTOR E

DEMSER 3

DIBENZYLINE 3

digitek 1

digox 1

digoxin oral 1

DILATRATE-SR 3



1


51



1


1



E

dilt-xr 1

DIOVAN E

DIOVAN HCT E


1

DIURIL 3

dofetilide 1


1

DUTOPROL E

DYAZIDE 3

DYRENIUM 3

EDARBI 3 ST

EDARBYCLOR 3 ST

EDECRIN 3



1

ENTRESTO 2 QL


E


E


E



E

eplerenone 1


E


EXFORGE 3

EXFORGE HCT 3


ezetimibe 1


felodipine er 1


1


1 ST


1 ST


1


E


1


1 ST


1


1 ST

FENOGLIDE 3 ST

FIBRICOR 3 ST

FIRST - METOPROLOL

E

FIRST-ATENOLOL E


52



FLOLIPID 3 ST



fosinopril sodium 1



1


gemfibrozil oral 1

GONITRO 3


HEMANGEOL 3



1

HYZAAR 3


indapamide oral 1

INDERAL LA E

INDERAL XL E

INNOPRAN XL E

INSPRA 3

irbesartan 1


1

ISORDIL TITRADOSE 3




1


isradipine 1


3 PA SP QL

KAPSPARGO SPRINKLE

E


KATERZIA E



2

LASIX 3

LESCOL XL E

LIPITOR E

LIPOFEN 3

lisinopril oral 1


1

LIVALO E

LOPID 3


3

LOPRESSOR ORAL 3




3


3


3

lovastatin 1

LOVAZA E

matzim la 1

MAXZIDE 3

MAXZIDE-25 3

methyldopa oral 1


1

metolazone 1



53




1

metyrosine 1


MICARDIS 3

MICARDIS HCT 3

midodrine hcl 1


E


E

MINIPRESS 3

minitran 1

minoxidil oral 1

moexipril hcl 1

MULTAQ 3


1

NEXLETOL 2 PA QL

NEXLIZET 2 PA QL


1


1

niacor 1

NIASPAN 3


nifedipine er 1


1

nifedipine oral 1

nimodipine oral 1

nisoldipine er 1

NITRO-BID 3

NITRO-DUR 3




1


1

NITROLINGUAL 3

NITROMIST 3

NITROSTAT E


1


E

NORPACE 3

NORPACE CR 2

NORTHERA 3 PA SP

NORVASC E


3


1


1


1

OMEGA-3 RX COMPLETE

3


E


1 PA


3


1


pentoxifylline er 1



54



1


E


E

pindolol 1


2 PA QL


3


prazosin hcl oral 1

PRESTALIA 3 ST

prevalite 1


3


E

PROCARDIA 3

PROCARDIA XL 3

propafenone hcl 1




propranolol-hctz 1

QBRELIS E

QUESTRAN E


E

quinapril hcl 1



1



ramipril 1

RANEXA 3 ST

ranolazine er 1 ST

RECTIV 3

REPATHA 2 PA QL


2 PA QL

REPATHA SURECLICK

2 PA QL


RYTHMOL SR 3


sotalol hcl (af) 1

sotalol hcl oral 1

SOTYLIZE 3




3


E


3

taztia xt 1

TEKTURNA 2 ST

TEKTURNA HCT 2 ST

telmisartan 1


telmisartan-hctz 1

TENORETIC 100 3

TENORETIC 50 3


55


TENORMIN E

tiadylt er 1

TIAZAC 3

TIKOSYN E


TOPROL XL E

torsemide oral 1

trandolapril 1


1

triamterene oral 1


1


1

TRIBENZOR E

TRICOR 3

TRILIPIX 3

TWYNSTA 3

valsartan 1


1

VASCEPA 2 PA

VASERETIC 3

VASOTEC 3

VECAMYL 3


1


1


VERELAN 3

VERELAN PM 3

VYNDAMAX 3 PA SP QL

VYNDAQEL 3 PA SP QL

VYTORIN E


WELCHOL 3

ZESTORETIC 3


3


E

ZETIA E

ZIAC 3


3


E


ADDERALL 3 PA QL

ADDERALL XR E

ADHANSIA XR E






1 PA QL


1 PA QL




CONCERTA E


DAYTRANA 3 PA ST QL

DESOXYN 3 PA ST QL


3 PA QL


56




1 PA ST QL


1 PA QL


1 PA ST QL


EVEKEO 3 PA ST QL

EVEKEO ODT 3 PA QL

FOCALIN 3 PA QL


guanfacine hcl er 1

INTUNIV 3



3 ST


1 PA ST QL



3 PA ST QL


1 PA ST QL


1 PA ST QL


1 PA ST QL


1 PA ST QL


1 PA QL


1 PA ST QL


1 PA QL



1 PA ST QL

MYDAYIS 3 PA ST QL




3 PA ST QL

relexxii 1 PA ST QL

RITALIN 3 PA QL


3 PA ST QL

STRATTERA 3 QL

VYVANSE 2 PA QL

ZENZEDI 3 PA ST QL


AMPYRA 3 PA SP QL

AUBAGIO 3 PA SP QL


2 PA SP QL


2 PA SP QL



2 PA SP QL


2 PA SP QL




1 PA SP QL


57



E SP

GILENYA 3 PA SP QL


glatopa 1 PA SP QL

KESIMPTA E SP

LEMTRADA 3 PA SP

MAVENCLAD (10 TABS)

3 PA SP

MAVENCLAD (4 TABS)

3 PA SP

MAVENCLAD (5 TABS)

3 PA SP

MAVENCLAD (6 TABS)

3 PA SP

MAVENCLAD (7 TABS)

3 PA SP

MAVENCLAD (8 TABS)

3 PA SP

MAVENCLAD (9 TABS)

3 PA SP

MAYZENT 3 PA SP QL


3 PA SP QL

OCREVUS 3 PA SP QL

PLEGRIDY E SP


E SP


E SP


E SP


E SP



E SP


TYSABRI 3 PA SP QL

VUMERITY 2 PA SP QL

ZEPOSIA 3 PA SP QL


3 PA SP QL

ZEPOSIA STARTER KIT

3 PA SP QL


ADDYI 3 PA QL

ADIPEX-P E

AUSTEDO 3 PA SP QL

benzphetamine hcl E


CONTRAVE E

CONVENIENCE PAK E



GABACAINE E

GRALISE 3 ST QL


3 PA QL

INGREZZA 3 PA SP QL


E

LOMAIRA E

LYRICA CR 3 ST QL

LYRICA ORAL CAPSULE

2 QL


3 QL


58


NEURAPTINE E

NUEDEXTA 3 PA

ONPATTRO 3 PA SP


E


E



QSYMIA E

RADICAVA 3 PA SP

RILUTEK 3 PA QL

riluzole 1 PA QL

SAVELLA 3 ST QL


3 ST QL

SAXENDA E


E

TEGSEDI 3 PA SP


TIGLUTIK 3 PA SP QL


E

VYLEESI 3 PA QL

XENAZINE 3 PA SP

XENICAL E


ARESTIN E

cavarest E

cevimeline hcl 1



E

clinpro 5000 E


E

denta 5000 plus E

dentagel E


E


E

easygel dental E

EVOXAC 3

FIRST-MOUTHWASH BLM

E

fluoridex E



E


E

KEPIVANCE 2 SP


1


MOUTH KOTE REMINT

E

MUCOSITISRX E


E


E

NAFRINSE WEEKLY E


E

oralone 1

paroex E

PERIDEX E


59


periogard E


PREVIDENT E


E


E


E


E

PREVIDENT 5000 PLUS

E


E

SALAGEN 3

SALIVAMAX E

sf E

sf 5000 plus E


E


E


E


E


E


3


1


E




E

ABREVA E

ABSORICA E

ABSORICA LD 3 PA

ACANYA E

ACESO AG E

acitretin 1


active-tramadol E


E


2


1 PA



E


3 PA


E


E


1


E

AKLIEF E

ALA SCALP E



1


60



3

ALDARA E

ALEVAMAX E

ALTRENO 3 PA


E


1


1

AMELUZ E


1

amnesteem 1 PA

AMZEEQ 3

ANACAINE E

APEXICON E E

AQUAPHILIC E

ARAZLO E

ARIDA E


E

ATOPADERM E

ATOPICLAIR E

ATRALIN 3 PA

avar cleanser E

AVAR LS CLEANSER E

AVAR-E EMOLLIENT E

AVAR-E GREEN E

AVAR-E LS E

AVEIDAOXIA E

avita 1 PA

AZADROX E



E

AZELEX 3



BEAU RX E

BENSAL HP E


E


E

BENZACLIN E

BENZACLIN WITH PUMP

E

BENZAMYCIN E


BENZEPRO EXTERNAL

E


E


E


E


E


E

benzoin compound E


E


E


E


E


E


1 ST

BESER EXTERNAL KIT

E


61




1


1


E


1

BIAFINE E


E

blanche E


bp 10-1 E

bp cleansing wash E


E

BPCO 3

BRYHALI E


1 QL


E


1


1


E


1 QL


E

CALCITRENE 3



E

CAPEX E



E

capzix E

CARAC 3

CEM-UREA E

CERACADE E


CHLOOXIA E


E


E


E


E

claravis 1 PA


3


E


1

CLINDACIN PAC E

clindacin-p 1

CLINDAGEL E


E


1 ST


E


1


1


1


62



1


E


1


E



E

CLINOIN E


1



1


1


E


E

CLOBETAVIX E

CLOBEX 3

CLOBEX SPRAY 3


CLODAN EXTERNAL KIT

E


1

CLODERM E


3

COLLATYL E


3

COPADERM E

COPASIL EXTERNAL E



E


3


3


3


E


CORTANE-B EXTERNAL

E


3


3


1


E

DAPSONE-NIACINAMIDE

E


E

DELUO E

DEOXIA E

DERMACINRX PENETRAL

E


E


3


3

DERMULCERA 3

DESONATE E


63


desonide external 1


3


1


1


E


E


1

DEXERYL E

DIADIMAXIA E

DIAOXIA E


E

DIASDIMAXIA E

DIASOXIA E


1 ST QL


1 PA QL


E


E


E


E


E


E

DIMOXIA E

DIPROLENE AF 3



3



3


doxycycline 1


E

DRAXACE E


E

DRITHO-CREME HP E

DRIXECE E

DRYSOL 3

DUOBRII E

DUPIXENT 2 PA SP QL

ECEOXIA E


3

ELETONE E

ELIDEL 3 ST

ELLZIA PAK E

EMULSION SB E

enovarx-tramadol E

ENSTILAR E

ENTTY SPRAY E

ENZOCLEAR E

EPICERAM E

EPIDUO 3

EPIDUO FORTE 3

EPIFOAM 3

EPIQUIN MICRO E

ery 1

ERYGEL 3


1


64



1

ESKATA E

ETHOXIA E

EUCRISA 2 ST

EVOCLIN 3

FABIOR E

FINACEA 3 ST


E


E


E


1


1


1


E


1


1


1


1


1

FLUOPAR E

FLUOROPLEX 3


2


1


1


FLUOVIX E

FLUOVIX PLUS E

flurandrenolide E


1

FORAXA E

GENADUR E

GORDOFILM 3


E

halcinonide E


1


E


1


E


E


3

HALUCORT E


E


HPR PLUS HYDROGEL

E

HYALUCIL-4 E


E


E


E

HYDRO 40 E


65



E


E


E


E


1


E


1


1


E


1


1


1



E


E


E


E


E


E




E


E


E

IMPEKLO E

IMPOYZ E

INOVA E


E


E


ITHOXIA E


E

KAMDOY E

KATARYA E

KATARYAXN E

KAXM E

KEIDO E

KELARX E

KENALOG EXTERNAL 3

KERAGEL E


E


E

KERALYT SCALP E


3

KETARYA E

KEVARYA E

KEXM E

KEYA E


66


KIVIK E

KLARON 3

KUTARYAXM E

KUTARYAXMPA E

KUTEA E

KUVARYA E

KUVARYE E

KUXM E

lactic acid e 1


1


E

lavare wound wash E

LEVULAN KERASTICK 3

LEXETTE E


E

LIDOTREX E


3

LOCOID LIPOCREAM E

LUXIQ 3

MEDERMA E

MEDERMA FOR KIDS E

MEDERMA SPF 30 E


E

methoxsalen rapid 1


E

METROCREAM 3


E

METROLOTION 3


MIMYX E



E

MIRVASO 3


E


1

myorisan 1 PA

NEOCERA E

NEOSALUS E

NEOSALUS CP E


E


3


E


NEUAC EXTERNAL KIT

E


E


E


E


E


E


E


E

NIVATOPIC PLUS E

nolix E

NORITATE E


67



E

NUCARACLINPAK E

NUCARARXPAK E

NUCORT E

NUDERMRXPAK 120 E

NUDERMRXPAK 60 E

NUTRASEB E

NUTRIARX CREAMPAK

E

NUVAIL E

OLUX 3

OLUX-E 3

ONEXTON 3

ORACEA 3

OVACE PLUS E

OVACE PLUS WASH E

OVACE WASH E

OXSORALEN ULTRA 3

PANDEL E

PENLEN E

PHLAG SPRAY E

PICATO 3 ST

pimecrolimus 1 ST

PLEXION E


E


E

podocon E


PR BENZOYL PEROXIDE

E


E

PR CREAM E


1



E


3


E

pramox E


E

prednicarbate 1

PRESERA E


E

PROMISEB E

PROPECIA E

PROSILK EXTERNAL E

PROTEXA E

PROTOPIC 3

PROTYL AG E

PRUCLAIR E

PRUDOXIN 3 PA

PRUMYX E

PSORCON E

PYROGALLIC ACID 3

QBREXZA 3 QL

QUINIXIL E

QUTENZA E

QUTENZA (2 PATCH) E

RADIAGEL E


3


E

RECEDO E

REFISSA E

REGENECARE 3

REGRANEX 3 PA


68


remergent hq E

REMIGEN E

RENOVA E

RENOVA PUMP E

RESORCINOL-SULFUR

E

RETIN-A 3 PA


E


E


2 PA


E

RHOFADE 3

RIAX E




E


E

salicylic acid er E


E


E


E


E


E


E


E



E


E


E

salimez E

SALIMEZ FORTE E

SALVAX E

SALVAX DUO PLUS E


E

SANTYL 3

SCALACORT DK E


E

SCARCIN E

SCARSILK EXTERNAL E

SCARZEN SKIN REPAIR

E

SCENESSE 3 PA SP


1


E

SELRX E

SERNIVO 3

SILA III E

SILIPAC E


E

skarjel E


E


E


E


69



E

SOLARAVIX EXTERNAL

E

SOLOX E

SOOLANTRA 3


3

SORILUX E

sss 10-5 E

STRATA CTX E

STRATA GRT E

STRATA MARK E

STRATA TRIZ E

STRATA XRT E


1


E


E


E


E


E


E


E


E


E



E


E

sulfacleanse 84 E

sulfamez wash E

SUMADAN E

SUMADAN WASH E

SUMADAN XLT E

SUMAXIN E

SUMAXIN CP E

SUMAXIN WASH E

SUVICORT E

SYNALAR 3

SYNALAR (CREAM) E

SYNALAR (OINTMENT)

E

SYNALAR TS E

SYNERDERM E


E


3 QL


E


1

TARDEOXIA E

TARDIMAXIA E

TAROXIA E

TASOPROL E



3 PA


3 PA


70



E


3


3


E

TEXACORT 3

tl hydroquinone E

TOLAK 3 ST


3


3


3

TOPICORT SPRAY E


TOVET EXTERNAL KIT

E





1 PA


E


1


1


1


E

TRIAMSIL MULTIPAK E


trianex E

TRI-CHLOR 3


TRIDESILON 3

TRI-LUMA E


E


E

TRIVIX E

TURPENTINE EXTERNAL

E

ULTRASAL-ER E


E

UMECTA MOUSSE E


E


E

UREA EXTERNAL FOAM

E


E


E

urea hydrating E


E

urea-c40 E

ureacin-10 E

ureacin-20 E

uredeb E

uremez-40 E

URESOL E

UTOPIC E


71



E

VANIQA E

VANOS 3

VANOXIDE-HC E

VARDIMAXIA E

VAROXIA E

VECTICAL E

VELTIN E

VENELEX 3

VERDESO E

VEREGEN E

VEXASYN E

VIRASAL E

XALIX E

XERAC AC 3

XERALUX E

xurea E

ZACARE E


E

zenatane 1 PA

ZIANA E

ZILXI E

ZITHRANOL E

ZONALON 3 PA

ZYCLARA E

ZYCLARA PUMP E


acarbose oral 1

ACTOPLUS MET 3

ACTOS 3

ADLYXIN E


E


ALOGLIPTIN BENZOATE

E


E


E

AMARYL 3


3 ST


2 ST QL




CYCLOSET 3 ST

DUETACT 3

FARXIGA 2 ST

FORTAMET E

glimepiride 1

glipizide er 1

glipizide ir 1

glipizide xl 1


GLUCOTROL 3

GLUCOTROL XL 3


3

GLUMETZA E


glyburide oral 1


GLYNASE 3

GLYSET 3

GLYXAMBI 2 ST

INVOKAMET E

INVOKAMET XR E

INVOKANA E

JANUMET 2 ST


72


JANUMET XR 2 ST

JANUVIA 2 ST

JARDIANCE 2 ST

JENTADUETO 2 ST

JENTADUETO XR 2 ST

KAZANO E

KOMBIGLYZE XR E

metformin hcl er 1



E

metformin hcl ir 1

miglitol 1

nateglinide 1

NESINA E

ONGLYZA E

OSENI E

OZEMPIC 2 ST QL

pioglitazone hcl 1


1


1

PRECOSE 3

QTERN E

repaglinide 1

RIOMET 3 ST

RIOMET ER 3 ST

RYBELSUS 2 ST QL

SEGLUROMET E

SOLIQUA 2 ST QL

STARLIX 3

STEGLATRO E

STEGLUJAN E

SYMLINPEN 120 3 PA

SYMLINPEN 60 3 PA


SYNJARDY 2 ST

SYNJARDY XR 2 ST

tolbutamide 1 ST

TRADJENTA 2 ST

TRIJARDY XR 2 ST

TRULICITY 2 ST QL

VICTOZA 2 ST QL

XIGDUO XR 2 ST

XULTOPHY 3 ST QL



E


E


E


E


E


E


E


$0


E


E


$0


E


73



E


E


$0


$0


$0

BLUESTAR E


E


$0

CARETOUCH TEST E

CEQUR SIMPLICITY 2U

3

CHEMSTRIP UGK 3

CONTOUR CONTROL E


E

CONTOUR NEXT LINK E


E

CONTOUR NEXT TEST

E

CONTOUR TEST E


E


E


E


E


FORTISCARE CONTROL

E


E


E


E


E


E


E


E


E


E


E


E

GUARDIAN SENSOR (3)

E

KETONE TEST 3

KETOSTIX 3

LANCETS $0

MICRODOT TEST E


$0

NOVOPEN ECHO 3


$0


$0



2


74



2


2


2


3


$0 QL


2


2


2

PRECISION LINK E


E


E



E


E


E


E


3



E


E




3


3


3


E

TRUE METRIX LEVEL 1

E

TRUE METRIX LEVEL 2

E

TRUE METRIX LEVEL 3

E


E

TRUETRACK TEST E


E


BAQSIMI ONE PACK 2

BAQSIMI TWO PACK 2

diazoxide oral 1



2 Made by Lilly


2Made by Fresenius


2


2

GVOKE PFS 2

PROGLYCEM 3

Diabetes - Insulins

ADMELOG E

ADMELOG SOLOSTAR

E


75



3 PA

APIDRA SOLOSTAR E

APIDRA VIAL E

BASAGLAR KWIKPEN E

FIASP E

FIASP FLEXTOUCH E

FIASP PENFILL E


2


2


2


2


2


2

HUMALOG VIAL 2


2

HUMULIN 7030 VIAL 2

HUMULIN N KWIKPEN 2

HUMULIN N VIAL 2


2


2

HUMULIN R VIAL 2


E

INSULIN ASPART E


E



E


E


E


E


E


E


$0

INSULIN SYRINGES $0


2

LANTUS U-100 VIAL 2


E


LYUMJEV 2

LYUMJEV KWIKPEN 2


$0

MYXREDLIN 3


$0


$0


$0


E


76



E

NOVOLIN 7030 RELION

E

NOVOLIN 7030 VIAL E

NOVOLIN N FLEXPEN E


E

NOVOLIN N RELION E

NOVOLIN N VIAL E

NOVOLIN R FLEXPEN E


E

NOVOLIN R RELION E

NOVOLIN R VIAL E


E


E


E


E



$0

SEMGLEE E

TOUJEO MAX SOLOSTAR

2

TOUJEO SOLOSTAR 2

TRESIBA E

TRESIBA FLEXTOUCH

E


ABANEU-SL E

ACTITROM-D E

active fe E

ACTIVITE E

adcf (05mgml) 1


ADRENAL C FORMULA

E

airavite E

aminoamrms E


E

aminoreliefrms E

animal shapes E

ANIMI-3 E

ANIMI-3VITAMIN D E


E

ASCOR E


E


E

ATABEX OB 2


E

AZESCO E


E


E

BACMIN E


biocel E

biopetit E


E

bp vit 3 E

b-plex E

b-plex plus E


E


77


CALCIFOL 3


E


E


E


E


CARBAGLU 2 SP


E


E


E


E


E


E


E


E


E


E


E


E

CARNITOR ORAL 3

CARNITOR SF 3

CENFOL E

CENTRATEX E


CEREFOLIN E


E

CHEMET 3


E

CHOLECAL DF E


E

CIFEREX E

CIFRAZOL E

CITRANATAL BLOOM E

CITRANATAL ESSENCE

E

CITRANATAL MEDLEY

E

clovique 1 PA SP


E

corvita E

corvita 150 E

CORVITE 150 E

corvite fe E


E


1


3

cytra k crystals E


E

d3 super strength E



E


78



E

deferasirox 1 PA


deferiprone 1 PA


E

DEPLIN 15 E

DEPLIN 75 E


E

dexifol E

dialyvite E

DIALYVITE 3000 E

DIALYVITE 5000 E

DIALYVITE SUPREME D

E

DIALYVITEZINC E


3

DURACHOL E

d-vite pediatric E


3


1

ELFOLATE E


E

ELITE-OB 2

ENBRACE HR E

ERGOCAL E


1


E


EXJADE 3 PA

fabb E


E

FERAHEME E

FERIVA 217 E

FERIVAFA E

ferocon E

ferotrinsic E

FERRALET 90 E

ferraplus 90 E

FERRIPROX 3 PA


3 PA

FERRLECIT E



E

FERROTRIN E


E


E


E


E

FLORIVA E

FLORIVA PLUS E

FLUORABON $0

fluoritab $0


$0

folbee E

folbee plus E

folbee plus cz E


79


FOLBIC RF E

FOLGARD OS E

FOLGARD RX E



1


$0

FOLIC D3 E

FOLIC-K E

FOLI-D E

FOLITE E

FOLIVANE-F E

FOLIVANE-PLUS E

FOLIXAPURE E

folplex 22 E

foltanx E

FOLTANX RF E

FOLTRATE E

FOLTREXYL E

foltrin E


E

FOLVITE-D E

FOSTEUM E

FUSION PLUS E

GALZIN 3

GENICIN VITA-D E

GENICIN VITA-Q E

GENICIN VITA-S E


E


HEMATOGEN E

HEMATOGEN FA E

HEMATRON-AF E

HEMETAB E

HEMOCYTE PLUS E




E

HYLAVITE E

HYLAZINC E

ICAR-C PLUS E

iferex 150 forte E

INFED E

INFUVITE ADULT E


E

INTEGRA F E

INTEGRA PLUS E

IODINE STRONG ORAL

3

IROSPAN 246 E

ISOLYTE-S E

JADENU 3 PA


JYNARQUE 3 SP QL

KCL-LIDOCAINE-NACL

E


klor-con 10 1

klor-con m10 1

KLOR-CON M15 3

klor-con m20 1


1


1

klor-con sprinkle 1

klor-conef 1

K-PHOS NO 2 E


3


E


80


K-PHOS-NEUTRAL 3

k-prime 1

K-TAB 3

k-tan plus E

L-CYSTINE E


1


levocarnitine sf 1

L-ISOLEUCINE E

l-methylfolate E


E


E



E


E


E

l-methyl-mc E

l-methyl-mc nac E

LOKELMA 3

LORID E


MVI ADULT E


E

MAGNEBIND 400 3


E



E


E


E

magnesium-oxide E


E

MEPHYTON 3

metafolbic E

metafolbic plus E


METANX ORAL CAPSULE

E


E

MICROPLEGIA MSA-MSG

E

MIFEPREX 3

mifepristone 1

M-NATAL PLUS 2

MULTIGEN E

MULTIGEN FOLIC E

MULTIGEN PLUS E


E

MULTIPRO E



1


1


1


81



E


1


1


E

mynephron E


E


nafrinse $0

nafrinse drops $0

NASCOBAL 3

NEONATAL + DHA E

NEONATAL 19 2

NEONATAL COMPLETE

E

NEONATAL FE E

NEONATAL PLUS 2

NEOVITE E

NEPHPLEX RX E

NEPHRON FA E


NEPHRO-VITE RX E

NESTABS 2

NESTABS ONE E

NEURIN-SL E


E

NICADAN E

NICAZEL E

NICAZEL FORTE E



E

NIFEREX ORAL TABLET

E


E

NUFERA E

nufol E

NUTRICAP E

nutrifac zx E

NUTRIVIT E


E

one daily E

ONE VITE WOMENS $0


2

ONEVITE E

ORACIT 3

ORTHO DF E

OVEEZA E


E


E


E


E

pediavit E


phosphorous 1


E


E


82



1

PHOXILLUM BK425 E


E

PHYSIOLYTE E


E


E

phytonadione oral 1

PLASMA-LYTE 148 E

PLASMA-LYTE A E


E


POLY-VI-FLOR FS 3


3


E


2


E


POTABA ORAL CAPSULE

E


1



E


1



1



E

PREGENNA E

PREMESISRX E

PRENAISSANCE E

PRENARA E


$0



1


E


1

PRENATE E


E


E

PRENATE ENHANCE E


E


E

PRENATE PIXIE E

PRENATE RESTORE E

PRENATRIX E

PRENATRYL E

PRENATVITE COMPLETE

E

PRENATVITE PLUS 2


83


PRENATVITE RX 2

preplus 1

pretab 1


E

PROTEINEX P18 E



E


E

QUFLORA FE E


E

QUFLORA GUMMIES E

QUFLORA PEDIATRIC E

RELNATE DHA 2

REMEDIENT E


E


RENATABS E

RENATABS WITH IRON

E

rena-vite E


E

REQ 49+ E

REVESTA E



2 SP QL


3 SP QL


E

se-tan plus E


SIDEROL ORAL TABLET

E


E



E


E


E


E


E


E


E


E



1


1

soluvita e E

sps 1

STROVITE FORTE E

STROVITE ONE E

SUPERVITE E

support E

SUPPORT-500 E


84


SYNAGEX E

SYPRINE 3 PA SP


E

TALIVA E

TARON FORTE E

taron-crystals E


tis-u-sol E

tl-hem 150 E


E SP


1 SP QL


2

tricitrates E

tricon E



E

trinate 1

TRINAZ E

triphrocaps E

TRISTART ONE E

TRI-VI-FLOR 3

TRI-VI-FLORO 3


tri-vitefluoride 1

TRONVITE E

TRYPTOPHAN ORAL E

UDAMIN SP E

UROCIT-K 10 3

UROCIT-K 15 3

UROCIT-K 5 3


urosex E

v-c forte E

VELTASSA 3

VENOFER E

vic-forte E

vinate one 1

virt-caps E

VIRT-FEFA PLUS E

virt-gard E


vita s forte E

vitacel E


E

VITAFOL ORAL TABLET

E

VITAFOL STRIPS 2

VITAFOL-OB+DHA E

VITAL-D RX E

VITAMAX PEDIATRIC E

VITAMEZ E

vita-min E



E



E


E


1


E


85



E


E


E


E


VITAROCA PLUS E


E

VITASURE E


E

VITREXATE E

VITREXATE FE E

VITREXYL E

VITREXYL + IRON E

vp-pnv-dha 1

vp-vite rx E

weekly-d E

westab mini E

westab one E

WESTAB PLUS 2

WESTGEL DHA E


E

XAQUIL XR E

XVITE E

ZALVIT E


E




E


E

ACIPHEX E

ACIPHEX SPRINKLE E


3


E


cimetidine oral 1

CYTOTEC 3

DEXILANT 2 QL

ESOMEP-EZS E


1 QL


1 QL


E


1


1

FIRST-LANSOPRAZOLE

3 ST



E


1 ST QL


86



1 QL

misoprostol oral 1


E

NEXIUM ORAL PACKET

3 QL

nizatidine 1


E


1 ST QL


E


3 ST


E


1 ST QL

PEPCID ORAL TABLET

3

PREVACID E

PREVACID 24HR E


3 ST QL


3 ST QL



E


E


1 ST QL


sucralfate oral 1

ZEGERID E


ACTIGALL 3

ACTIPHLORA E

alosetron hcl 1 PA


E


E

alvimopan 1

AMITIZA E


1 ST

ANASPAZ 3


E

antacid calcium E



E

antacid maximum E


E



E




E


E


87



E


E


E


E


E

BACICAP E


E

bisacodyl ec $0 QL

bisacodyl rectal E


E


1

CHENODAL 3 PA SP


E


citroma $0 QL


CLENPIQ 3

constulose 1


CUVPOSA 3


E



E


E


diotame instydose E


docusate mini E


E


E

docuzen E

dok oral tablet E

DONNATAL E

ed-spaz 1

ENTEREG 3

enulose 1


E

EX-LAX ULTRA E



E

FOLIKA PROBIOTIC E


E


E

GASTROCROM 3

GATTEX 3 PA SP


gavilyte-c $0 QL

gavilyte-g $0 QL

gavilyte-h 1


$0 QL

GELUSIL E

generlac 1


88




geri-kot E

GIALAX E

GLYCATE E

glycolax $0 QL


E


E


1


E

glycopyrrolate pf E

gnp senna lax E


3


E


E

HELIDAC THERAPY 3



E


E


E



1


1


1



E


1


1


E

hyosyne 1


E


E


E


E


LACTOJEN E


1

lactulose oral 1

laxative max str E


E

LEVBID E

LEVSIN ORAL TABLET

E

LEVSINSL E


89


LIBRAX 3

LINZESS 2 ST QL

LOMOTIL ORAL TABLET

3


1


E


E

LOTRONEX 3 PA


E


$0 QL


E


1


E



E



E

MOTEGRITY 3 ST QL

MOTOFEN E

MOVANTIK E

MOVIPREP E

MYTESI 3 QL


E


E

NULEV 3

NULYTELY LEMON-LIME

3



3

OMECLAMOX-PAK 2

opium E


oscimin sr E


OSMOPREP E


E

PCP 100 E


$0 QL



1


1

peg-prep 1


E


E


E


1

phenohytro E


E

PLENVU E

PROBICHEW E

PRODIGEN E


E


1

PYLERA 2


90



QUAD-PROBIOTIC E

RELISTOR ORAL E


E

RESTORA RX 3


E

senexon-s E

senna oral liquid E


E


E


senna s E

senna smooth E


E

senna-plus E


E

SENOKOT S E


3 PA SP


E


E


E


3



E



E


E


E


E


E


E


E


3

SUTAB E

SYMAX DUOTAB E

symax-sl E

symax-sr E

SYMPROIC 2 ST QL

TALICIA 3

trilyte $0 QL

TRULANCE E

TUMS CHEWY BITES E

URSO 250 3

URSO FORTE 3

ursodiol oral 1


E


E

VIBERZI 3 PA QL

VISBIOME E


91


XERMELO 3 PA SP QL

ZELAC E

ZELNORM 3 PA QL

ZORBTIVE 3 PA SP


ALDURAZYME 2 PA SP



3 SP


3 SP

CERDELGA 3 PA SP


2 PA SP

CHOLBAM 3 PA SP

CREON 2

CRYSVITA 3 PA SP

CYSTADANE 3 SP

CYSTAGON 3 SP

ELAPRASE 2 PA SP

ELELYSO 3 PA SP

ENZADYNE E

EXONDYS 51 E SP

FABRAZYME 2 PA SP

GALAFOLD 3 PA SP QL

KANUMA 3 PA SP

KUVAN 3 PA SP

LUMIZYME 2 PA SP

MEPSEVII 3 PA SP

miglustat 1 PA SP

MYALEPT 3 PA SP

NAGLAZYME 2 PA SP


nitisinone 1 PA SP

NITYR 3 PA SP

OCALIVA 3 PA SP QL

ORFADIN 3 PA SP

PALYNZIQ 3 PA SP QL

PANCREAZE E

PERTZYE E

PROCYSBI 3 PA SP

RAVICTI 3 PA SP

REVCOVI 3 PA SP


1 PA SP


1 SP


1 SP

STRENSIQ 2 PA SP

SUCRAID 3 SP

VIMIZIM 3 PA SP

VIOKACE E

VPRIV 3 PA SP

VYONDYS 53 E SP

XURIDEN 3 PA SP QL

ZAVESCA 3 PA SP


2


3 PA SP


3 PA SP


3 PA SP


92



3 PA SP


3 PA SP


3 PA SP


3 PA SP

ZOLGENSMA 26-30 KG

3 PA SP

ZOLGENSMA 31-35 KG

3 PA SP

ZOLGENSMA 36-40 KG

3 PA SP

ZOLGENSMA 41-45 KG

3 PA SP

ZOLGENSMA 46-50 KG

3 PA SP

ZOLGENSMA 51-55 KG

3 PA SP

ZOLGENSMA 56-60 KG

3 PA SP

ZOLGENSMA 61-65 KG

3 PA SP

ZOLGENSMA 66-70 KG

3 PA SP

ZOLGENSMA 71-75 KG

3 PA SP

ZOLGENSMA 76-80 KG

3 PA SP

ZOLGENSMA 81-85 KG

3 PA SP

ZOLGENSMA 86-90 KG

3 PA SP

ZOLGENSMA 91-95 KG

3 PA SP

ZOLGENSMA 96-100 KG

3 PA SP



aminoacetic acid E

AURYXIA 3

azo tabs E


1

BI-MIX 3


1


1

CAVERJECT IMPULSE

3 QL


3 QL

CERVIDIL 3

CIALIS 3 QL


3 PA SP


1


DETROL 3

DETROL LA 3


3

EDEX 3 QL

ELMIRON 2


3

FEM PH E

flavoxate hcl 1


93



3


3


3 ST


glycine urologic E

hyophen E

INTRAROSA 3 ST



E

LITHOSTAT 3

menaphosmbhyo1 E

MUSE 3 QL

MYRBETRIQ 2



OXYTROL 3 ST QL

OXYTROL FOR WOMEN

E


1 PA SP



E


1


1


E

PHOSLYRA 3


phosphasal E

PREPIDIL 3

PROSTIN E2 3

PYRIDIUM E

QUAD-MIX 3

RENACIDIN E


E

RENVELA 3

RIMSO-50 E


sevelamer hcl 1


1 QL


STAXYN E

STENDRA E

SUPER BI-MIX 3

SUPER QUAD-MIX 3

SUPER TRI-MIX E

tadalafil oral 1 QL

THIOLA 3 SP

THIOLA EC 3 SP



TOVIAZ 3

TRI-MIX E



URELLE E


1

URIBEL E

URIMAR-T E


1


94



E

URO-458 E

UROGESIC-BLUE E

uro-mp E

ustell E

uticap E

utira-c E

utrona-c 1


VELPHORO 3

VESICARE 3

VIAGRA E

vilamit mb E

VILEVEV MB E


alfuzosin hcl er 1

AVODART 3

CARDURA XL 3 ST

dutasteride oral 1


1


1

FLOMAX E

JALYN 3

PROSCAR 3

RAPAFLO 3

silodosin 1

tamsulosin hcl 1


UROXATRAL 3




E



E


E

ALKINDI SPRINKLE E

BETA 1 KIT E

BETALOAN SUIK E

BETAMETHASONE COMBO

E


E


E


E

BSP 0820 E

CELESTONE SOLUSPAN

E


E

CORTEF 3



E

DEPO-MEDROL E

DEXABLISS E


1



E


95



E


E


E


E


E

DEXONTO 04 3

DMT SUIK E

DOUBLEDEX E

DXEVO 11-DAY E

DYURAL-40 E

DYURAL-80 E

DYURAL-L E

DYURAL-LM E


1

HEMADY E

HIDEX 6-DAY E


KENALOG INJECTION 3

KENALOG-80 3

MAS CARE-PAK E


3


2



3

MEDROLOAN II SUIK E

MEDROLOAN SUIK E


E


E


E


E


E


1


3


E

MULTI-SPECIALTY E

ORAPRED ODT 3

P-CARE K40 E

P-CARE K40G E

P-CARE K40MX E

P-CARE K80 E

P-CARE K80G E

P-CARE K80MX E

PEDIAPRED 3


E


96



E

POD-CARE 100K E

POINT OF CARE L2 E

POINT OF CARE L5 E


E


1


1


1


prednisone oral 1

PRO-C-DURE 5 E

PRO-C-DURE 6 E

RAYOS E


E


E


E


3

TAPERDEX 12-DAY E

TAPERDEX 6-DAY E


E

TOPIDEX E



E


1


3


E

TRILOAN II SUIK E

TRILOAN SUIK E

ZCORT 7-DAY E

ZILRETTA E


ANADROL-50 3 PA


2 PA


3 PA


3 PA


E

AVEED E

danazol oral 1


E


97


EC-RX TESTOSTERONE

E

FORTESTA E

JATENZO E

METHITEST 3 PA


NATESTO E


TESTIM E

TESTONE CIK E

TESTOPEL E


E


E


1 PA


1 PA


E


1 PA


1 PA

VOGELXO PUMP E


E


XYOSTED 3 PA


EVISTA 3

OSPHENA 3

raloxifene hcl 1


ACTHAR 2 PA SP

BYNFEZIA PEN E SP

cabergoline 1


E SP


1 PA SP



3

DDAVP NASAL 3

DDAVP ORAL 3

DDAVP RHINAL TUBE 2


1


1


1


1


ELIGARD 3 PA SP QL



3 PA SP QL


3 PA SP QL


98



2 PA SP


1 PA SP



GENOTROPIN E SP


E SP

GONAL-F E SP

GONAL-F RFF E SP


E SP

HUMATROPE E SP

INCRELEX 2 PA SP

ISTURISA E SP


1 PA SP



3 PA SP


2 PA SP


3 PA SP


2 PA SP


2 PA SP



2 PA SP


3 PA SP


2 PA SP


3 PA SP


2 PA SP

MENOPUR 3 PA SP

MYCAPSSA E SP

NOCDURNA 3


2 PA SP


1 PA SP


3 PA SP


2 PA SP


99



2 PA SP


2 PA SP


1 PA SP


E SP


E SP

ORILISSA 2 PA QL

OVIDREL 3 PA SP


E


E

pregnyl 1 PA SP

SAIZEN E SP

SAIZENPREP E SP


E SP


E SP


SIGNIFOR 3 PA SP QL


3 PA SP QL


SOMAVERT 3 PA SP

STIMATE 3


SYNAREL 2

TEPEZZA 3 PA SP



VANTAS 3 PA SP QL


3 SP QL


2 SP QL

ZOMACTON E SP


E SP


KORLYM 3 PA SP QL



3

afirmelle $0 QL

ALORA 3 ST

altavera $0 QL

alyacen 135 $0 QL

alyacen 777 $0 QL

amabelz 1

amethia $0 QL

amethia lo $0 QL

amethyst $0 QL


100


ANGELIQ 3

ANNOVERA E

apri $0 QL

aranelle $0 QL

ashlyna $0 QL

aubra $0 QL

aubra eq $0 QL

aurovela 1530 $0 QL

aurovela 120 $0 QL




aviane $0 QL

AYGESTIN 3

ayuna $0 QL

azurette $0 QL

BALCOLTRA E

balziva $0 QL

bekyree $0 QL

BEYAZ E


E

BIESTPROGESTERONE

E

BIJUVA 3

blisovi 24 fe $0 QL



briellyn $0 QL

camila $0 QL

camrese $0 QL

camrese lo $0 QL

caziant $0 QL


chateal $0 QL

chateal eq $0 QL

CLIMARA 3


CLIMARA PRO 2

COMBIPATCH 3

covaryx E

covaryx hs E


3 QL


3 PA QL

cryselle-28 $0 QL

cyclafem 135 $0 QL

cyclafem 777 $0 QL

cyred $0 QL

cyred eq $0 QL

dasetta 135 $0 QL

dasetta 777 $0 QL

daysee $0 QL

deblitane $0 QL

DELESTROGEN 3

delyla $0 QL

DEPO-ESTRADIOL 3


3 QL


3 QL


$0 QL


$0 QL

DIVIGEL 3

dotti 1


$0 QL


101



$0 QL

DUAVEE 2

EC-RX ESTRADIOL E

EC-RX PROGESTERONE

E

eemt E

eemt hs E

ELESTRIN 3

elinest $0 QL

ELLA $0 QL

eluryng $0 QL

emoquette $0 QL

ENDOMETRIN 2 PA

enpresse-28 $0 QL


$0 QL

errin $0 QL


E


E


E

estarylla $0 QL

ESTRACE 3

estradiol oral 1


estradiol vaginal 1


1


1

ESTRING 3 QL

ESTROGEL 3

ESTROSTEP FE 3 QL


$0 QL



$0 QL

EVAMIST 3


E

falmina $0 QL

fayosim $0 QL

FEMHRT LOW DOSE 3

FEMRING 3 ST QL

femynor $0 QL


E

fyavolv 1

gemmily $0 QL

GENERESS FE 3 QL

gianvi $0 QL

hailey 1530 $0 QL

hailey 24 fe $0 QL


hailey fe 120 $0 QL

heather $0 QL


1 PA SP


3


3

incassia $0 QL

introvale $0 QL

isibloom $0 QL

jaimiess $0 QL

jasmiel $0 QL

jencycla $0 QL

jinteli 1

jolessa $0 QL

juleber $0 QL


102


junel 1530 $0 QL

junel 120 $0 QL

junel fe 1530 $0 QL

junel fe 120 $0 QL

junel fe 24 $0 QL

kaitlib fe $0 QL

kalliga $0 QL

kariva $0 QL

kelnor 135 $0 QL

kelnor 150 $0 QL

kurvelo $0 QL

KYLEENA E

larin 1530 $0 QL

larin 120 $0 QL

larin 24 fe $0 QL

larin fe 1530 $0 QL

larin fe 120 $0 QL

larissia $0 QL

layolis fe $0 QL

leena $0 QL

lessina $0 QL

levonest $0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL

levora 01530 (28) $0 QL


E


lillow $0 QL






lojaimiess $0 QL

loryna $0 QL

LOSEASONIQUE 3 QL

low-ogestrel $0 QL


lutera $0 QL

lyllana 1

lyza $0 QL

MAKENA 2 PA SP

marlissa $0 QL


$0 QL


1


1


1



2

MENOSTAR 3 ST

mibelas 24 fe $0 QL





mili $0 QL

mimvey 1

MINASTRIN 24 FE E

MINIVELLE 3 ST


103


MIRCETTE 3 QL

MIRENA (52 MG) E

mono-linyah $0 QL

NATAZIA $0 QL

necon 0535 (28) $0 QL

NEXPLANON E

nikki $0 QL

nora-be $0 QL


$0 QL


$0 QL


$0 QL


1


$0 QL



1



$0 QL


$0 QL

norlyda $0 QL

norlyroc $0 QL

nortrel 0535 (28) $0 QL



nortrel 777 $0 QL

NUVARING 3 QL

ocella $0 QL

ORIAHNN 2 PA QL

orsythia $0 QL


ORTHO MICRONOR E


E

philith $0 QL

pimtrea $0 QL

pirmella 135 $0 QL

pirmella 777 $0 QL


portia-28 $0 QL

PREFEST 3

PREMARIN ORAL 2

PREMARIN VAGINAL 2

PREMPHASE 2

PREMPRO 2

previfem $0 QL


E


1


1


E

PROMETRIUM 3

PROVERA 3

QUARTETTE 3 QL

reclipsen $0 QL

rivelsa $0 QL

SAFYRAL 3 QL

SEASONIQUE 3 QL

setlakin $0 QL

sharobel $0 QL

simliya $0 QL

simpesse $0 QL

SKYLA E

SLYND E

sprintec 28 $0 QL


104


sronyx $0 QL

syeda $0 QL

tarina 24 fe $0 QL

tarina fe 120 $0 QL


TAYTULLA E

tilia fe $0 QL

tri femynor $0 QL

tri-estarylla $0 QL

tri-legest fe $0 QL

tri-linyah $0 QL


tri-lo-marzia $0 QL

tri-lo-mili $0 QL


tri-mili $0 QL

tri-previfem $0 QL

tri-sprintec $0 QL

trivora (28) $0 QL

tri-vylibra $0 QL


tulana $0 QL

TWIRLA 3 QL

tyblume $0 QL

tydemy $0 QL


E

velivet $0 QL

vienva $0 QL

viorele $0 QL

VIVELLE-DOT E

volnea $0 QL

vyfemla $0 QL

vylibra $0 QL

wera $0 QL

wymzya fe $0 QL

xulane $0 QL


YASMIN 28 3 QL

YAZ E

yuvafem 1

zarah $0 QL

zovia 135 (28) $0 QL

zovia 135e (28) $0 QL

zumandimine $0 QL


ARMOUR THYROID 3 ST

CYTOMEL E

euthyrox 1

levo-t 1


E


1

levoxyl 1


methimazole oral 1

NATURE-THROID 3 ST

np thyroid 1


SYNTHROID 3

TAPAZOLE 3

TIROSINT E

TIROSINT-SOL 3

unithroid 1


3 ST

WP THYROID 3 ST


ACTEMRA 3 PA SP


105



ACTIMMUNE 2 PA SP

ALFERON N 2 SP

ARAVA 3

ARCALYST 3 PA SP

ASCENIV E SP

ASTAGRAF XL 3 SP

ATGAM 2 SP

AVSOLA 3 PA SP

AZASAN 3

azathioprine oral 1


BENLYSTA 3 PA SP

BERINERT 3 PA SP QL


3 PA SP


3 PA SP

CELLCEPT 3 SP


3 SP


2 PA SP



CINRYZE 2 PA SP


E SP

COSENTYX 150 MGML

E SP


E SP



E SP

CUTAQUIG E SP

CUVITRU 3 PA SP


1 SP



1 SP

CYTOGAM 2 PA SP

ENBREL MINI 3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP

ENSPRYNG E SP

ENTYVIO 3 PA SP

ENVARSUS XR 3 SP


1 PA SP

FIRAZYR 3 PA SP QL


GAMASTAN 2 PA SP

GAMIFANT 3 PA SP

GAMMAGARD 3 PA SP


106



3 PA SP


3 PA SP


3 PA SP

GAMUNEX-C 3 PA SP


1 SP


HAEGARDA 3 PA SP

HEPAGAM B E


3 PA SP


3 PA SP


2 PA SP


2 PA SP


2 PA SP



2 PA SP


2 PA SP


2 PA SP

HYPERHEP B SD E

HYPERRAB E


E


2 SP

HYPERTET SD E

HYQVIA 3 PA SP



2 PA SP QL

ILUMYA 3 PA SP


E

IMURAN 3

INFLECTRA 2 PA SP

KALBITOR 3 PA SP QL

KEDRAB INJECTION E

KEVZARA 3 PA SP


3 PA SP

KYMRIAH 3 PA SP

leflunomide oral 1

methotrexate oral 1


107



1


1


1


1


2 SP



1 SP


MYFORTIC 3 SP

NABI-HB E

NEORAL 3 SP

NULOJIX 3 PA SP

OCTAGAM 3 PA SP

OLUMIANT E SP


ORENCIA INTRAVENOUS

3 PA SP


3 PA SP

OTEZLA ORAL TABLET

2 PA SP


2 PA SP



3 PA QL


E

PANZYGA E SP

PRIVIGEN 3 PA SP

PROGRAF 3 SP

PROVENGE 2 PA SP

RAPAMUNE 3 SP


2 PA QL

REDITREX E

REMICADE E SP

RENFLEXIS 2 PA SP


2 SP


E


108


RIDAURA 3 SP

RINVOQ 2 PA SP

RUCONEST 3 PA SP QL


2 SP


3 SP


2 SP

SILIQ 3 PA SP



2 PA SP


2 PA SP

SIMULECT E

sirolimus oral 1 SP


2 PA SP

STELARA INTRAVENOUS

2 PA SP


2 PA SP QL


2 PA SP QL

SYNAGIS 2 PA SP


TAKHZYRO 3 PA SP

TALTZ 3 PA SP

temsirolimus 1 SP

THYMOGLOBULIN E

TICE BCG 2 SP

TORISEL 3 SP


TREMFYA 2 PA SP

TREXALL 3

UPLIZNA 3 PA SP


E

WINRHO SDF 2 SP

XATMEP 3

XELJANZ 2 PA SP

XELJANZ XR 2 PA SP

XEMBIFY 3 PA SP

ZINPLAVA E

ZORTRESS 3 PA SP


ACTHIB $0


$0


$0

BCG VACCINE E

BEXSERO $0

BIOTHRAX E


$0


$0


$0


$0

FLUAD $0


109


FLUAD QUADRIVALENT

$0


$0


$0


$0


$0


$0


$0

GARDASIL 9 $0


$0


$0


IMOVAX RABIES E

INFANRIX $0


$0

IXIARO E

MENACTRA $0

MENQUADFI $0


MENVEO $0



$0

PNEUMOVAX 23 $0

PREVNAR 13 $0

RABAVERT E


$0

ROTARIX $0


$0


$0

STAMARIL E

TDVAX $0

TENIVAC $0


$0

TRUMENBA $0


$0


E


$0

VARIVAX $0

VAXCHORA E


110


VIVOTIF E

YF-VAX E


ana-lex E


E


E


3


E

anucort-hc E

ANUSOL-HC EXTERNAL

3


E

APRISO 2

ASACOL HD E

AZULFIDINE 3




1

budesonide oral 1

CANASA E

COLAZAL 3

CORTENEMA 3

CORTIFOAM EXTERNAL

3

DELZICOL E

DIPENTUM E


3


E



E


1


1


E


1


E

LIALDA E


E


E


E

LIDOCORT EXTERNAL

E

mesalamine er 1

mesalamine oral 1

mesalamine rectal 1


ORTIKOS E

PENTASA 3

PROCORT EXTERNAL E

PROCTOCORT EXTERNAL

3


E


2





111


ROWASA RECTAL 3

SFROWASA 2


UCERIS 3



3 QL


1


1


1 QL

ATELVIA 3 QL

BINOSTO 3 QL

BONIVA INTRAVENOUS

E


3 QL


EVENITY 3 PA SP QL


2 PA SP


3 QL

FOSAMAX PLUS D E


E


1 QL

MIACALCIN INJECTION

3




2 PA SP QL

RAYALDEE 3

RECLAST 3 SP


1 QL


1


1 QL


2 PA SP

TYMLOS 2 PA SP

XGEVA 2 PA SP


1 SP


1 SP



E

calcitriol oral 1

cinacalcet hcl 1 PA


NATPARA 3 PA SP QL


paricalcitol oral 1

PARSABIV 3 SP

ROCALTROL 3

SENSIPAR 3 PA

ZEMPLAR INTRAVENOUS

E


3


112




ACACIA SUBCUTANEOUS

E


E


E


E

ACREMONIUM E

ACTHREL 3 SP


E

ACUNOL E

ADAKVEO 3 PA SP

ADULT AEROSOL MASK

E


E


3


3

ALDER E

ALTERNARIA E

AMERICAN BEECH E

AMERICAN COCKROACH

E

AMERICAN ELM E

AMERICAN SYCAMORE

E

AMINOPMRMS E


E



E


E

APP SLIM RMS E

APPTRIM E

APPTRIM-D E


E

ARIZONA CYPRESS E


3

asilnasalrms E

ASPARTAME E


E

AUREOBASIDIUM E

AUSTRALIAN PINE E


E


E


E

AVAILNEX E

AVITENE E

AVITENE FLOUR E

AXONA E

AZALGIA E

BAHIA E

BALD CYPRESS E


E


E

BHI URI-CONTROL E


113


BLACK WALNUT POLLEN

E

BLACK WILLOW E



E

BOX ELDER E


E


E


E


E


E

BROME E


E


E


E

CARDIOVID PLUS E


E


E


E


E


E



E

CARTICEL E


E

CATTLE EPITHELIUM E

CAYA $0 QL

CEDAR ELM E


E


E

COCKLEBUR E


E

COLCIGEL E


E


E


E

CONDOMS E

CORN POLLEN E

CORTROSYN E


CROFAB E

CURVULARIA E

DANDELION E



E


114



E

desflurane 1


E


E


E


E


E

DIGIFAB E

DOG EPITHELIUM E

DOG FENNEL E

DOJOLVI E

DRECHSLERA E


2 PA SP


E

DYSPORT 3 PA SP

EASIVENT 2

EASTERN COTTONWOOD

E

EC-RX DHEA E

ECZEMOL E

ENDARI 3 PA

ENDO AVITENE E



E


E


E


E


E


E


E

ENGLISH PLANTAIN E

ENLYTE E


ENTERAGAM E

enteric fish oil E

EPICOCCUM E

EPISIL E

EQUACARE JR E


ESSENTIAL CARE JR E


2 PA SP

EVRYSDI E SP

FIRDAPSE E SP

FIRE ANT E


2


2


115



2

FORANE 3


E


3


E

FOSTEUM PLUS E

FOVEX E

FUSARIUM E

GABADONE E

GELCLAIR E

GELFILM EXTERNAL E

GEL-FLOW E

GEL-FLOW NT E

GELFOAM E


E


E

GELFOAM SPONGE E


E


E


E

GELFOAM-JMI POWDER

E

GELFOAM-JMI SPONGE

E

GELSYN-3 2 PA SP

GELX E

GERMAN COCKROACH

E

GIVLAARI 3 PA SP


GLEOLAN E


3


E


E


E


E


E

GLYTACTIN BURST E


E


E

GLYTACTIN RESTORE 5

E


E


E


E

GLYTACTIN RTD 15 E


E


E

GOLDENROD E

GRASTEK 3 PA QL

H2Q ORAL POWDER E

HACKBERRY E


1


1


116


HEPMED E

HIBICLENS E

HOMACTIN AA PLUS E

HOME PAP KIT E


E

HORSE EPITHELIUM E

HUMATROPEN FOR 12MG

E

HUMATROPEN FOR 24MG

E

HUMATROPEN FOR 6MG

E

HYALGAN E SP

HYLAFEM E

HYMOVIS E SP

HYPERTENSA E


2

INTERCEED E

IOSAT E

isoflurane 1

ISOVACTIN AA PLUS E

JOHNSON GRASS E


E

KAPOK E


3


E

KETOVIE LIQUID ORAL

E


KETOVIE PEPTIDE E

KOCHIA E

LAMBS QUARTERS E

LENSCALE E

LIMBREL E

LIMBREL250 E

LIMBREL500 E

LISTER-V E

LORMATE E

MACRILEN E

MACUTEK E

MASK VORTEX E


E

MELALEUCA E

MESQUITE E


E

METHAVER E



E


1 QL

METOPIRONE E


E


E


E

MIXED ASPERGILLUS E

MIXED FEATHERS E

MIXED RAGWEED E


117



E

MKO MELT DOSE PACK

E

mlk f1 E

mlk f2 E

mlk f3 E

mlk f4 E

MONOVISC E SP

MORCIN E

MOUNTAIN CEDAR E

MOUSE EPITHELIUM E

MUCOR SUBCUTANEOUS

E

MUCOTROL E

MUGARD E

MUGWORT E

MYOBLOC 3 PA SP

NEODOT THERMOMETER

E

NEUREPA E

NICAPRIN E

NICAZYME E


E


OLIVE TREE E

OMNIVEX E

OPTIONS CONCEPTROL

$0 QL

ORALAIR 3 PA QL


3 PA QL


3 PA QL



3 PA QL


3 PA QL

ORAMAGICRX E


E


E SP

OXBRYTA E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E


118



E


E


E

PECAN POLLEN E


E

PERCURA E


E

PH STRIPS E

PHENACTIN AA PLUS E

PHEXXI E

PHOMA EXIGUA E


3

PRAXBIND E


E


E

PRID E

PRIVET E

PRO-CRITIC E


E

PROLEVA E


E



E

PSORIZIDE FORTE E

PSORIZIDE ULTRA E

PULMONA E

PURAMINO DHAARA E

QUEEN PALM E

RABBIT EPITHELIUM E

RADIOGARDASE 3

RAGWITEK 3 PA QL

RAPID GEL RX E

RED BIRCH E

RED CEDAR E

RED MAPLE E

RED MULBERRY E


E

RESECTISOL E


E

RHEUMATE E

RHIZOPUS E

RIBOZEL E

ROUGH MARSH ELDER

E

ROUGH PIGWEED E

RUSSIAN THISTLE E

RUZURGI 3 PA SP


E

SAGEBRUSH E


E

SENTRA AM E

SENTRA PM E

sevoflurane 1


119


SHAGBARK HICKORY E

SHARPS CONTAINER E

SHEEP SORREL E


E

SILTREX E


E SP

SORBITOL IRRIGATION

E

sorbitol-mannitol E

SORRELDOCK MIX E

SPEEDGEL RX E

SPINRAZA 3 PA SP

SPINY PIGWEED E

STEMPHYLIUM E

SUPARTZ FX E SP

SUPRANE 3

SWEET GUM E


E


E SP


E SP

SYRINGE AVITENE E

TACHOSIL 3

TALL RAGWEED E

terrell 1

THERAMINE E

THERAMINE PLUS E

THROMBI-GEL 10 E

THROMBI-GEL 100 E

THROMBI-GEL 40 E

THROMBI-PAD E


THYROGEN 2 PA SP


E


3

TL-ICARE E

TOBAKIENT E


E

TRANZGEL E


E


E

TREPADONE E


E


E

TRILURON E SP


E

T-SUPPORT MAX E


E


E

TYLACTIN RESTORE 10

E


E

TYLACTIN RTD 15 E

TYROS 2 E

ULTANE 3


E


E


120



E


E


E


E

VASCULERA E


$0 QL


$0 QL

VILACTIN AA PLUS E

VILTEPSO E SP

VIRGINIA LIVE OAK E

VISTOGARD 3


E


E


E

WELLMIND VERTIGO E

westab max E

WESTERN JUNIPER E

WHITE ASH E

WHITE BIRCH E


E

WHITE MULBERRY E

WHITE OAK E


WHITE PINE E


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL

XEOMIN 3 PA SP

XIAFLEX 2 PA SP

XYZBAC E

XYZMUNE E

YELLOW DOCK E


E


E

ZYVEXOL E

ZYVIT E


ACULAR 3

ACULAR LS 3

ALAWAY E

ALOCRIL E


121


ALOMIDE 3

ALREX E

AZASITE 3


1


BEPREVE 3 ST

BESIVANCE 3


3

BLEPH-10 3


1 QL

BROMSITE E

CILOXAN 3


1


1


1

DEXTENZA E SP

DEXYCU E


1

DUREZOL E

epinastine hcl 1


1

eye itch relief E

EYSUVIS E

FLAREX 3


1


FML 2

FML FORTE 3

FML LIQUIFILM 3




1


1

ILEVRO E


E SP

INVELTYS 3


1

KLARITY-A E

KLARITY-L E



E


E


3

LOTEMAX SM 3


MAXIDEX 3

MITOSOL 3

MOXEZA 2


1


1

NATACYN 2

NEVANAC E

OCUFLOX 3



E


1


122



E


1


3 SP

PATADAY E


3

PRED FORTE 3

PRED MILD 3


E


1


E


1


E

PROLENSA 2 QL


E SP


1


TOBREX 3


TRIPLE PMB E

TRIPLE PMK E

UPNEEQ E

VIGAMOX 3

YUTIQ E SP

ZADITOR E

ZERVIATE E

ZIRGAN 3

ZYMAXID 3



acetazolamide er 1



2


E

apraclonidine hcl 1

AZOPT 2


1

BETIMOL 3

BETOPTIC-S 3



1


E

carteolol hcl 1

COMBIGAN 2

COSOPT 3


3


3


1


1


1

DURYSTA E


3

ISOPTO CARPINE 3


123


ISTALOL 3

KEVEYIS 3 PA SP QL



E


1


2 QL


PHOSPHOLINE IODIDE

2


1

RHOPRESSA 3 QL

ROCKLATAN 3 QL

SIMBRINZA 2


1



E


E


E

TIMOPTIC E


3


E

TIMOPTIC-XE E

TRAVATAN Z 3 QL



TRUSOPT 3

VYZULTA E

XALATAN 3

XELPROS 3 ST QL

ZIOPTAN E


ak-poly-bac 1

AKTEN 3

ALCAINE 3

altacaine 1

altachlore E

altafluor benox E


1


E


1


E


1


1


1

BEOVU E SP

BEVACIZUMAB 3 SP


bio glo E

BLEPHAMIDE 3

BLEPHAMIDE SOP 3

CEQUA E


124



E


E

CYCLOGYL 3

CYCLOMYDRIL 3


1


E

CYSTADROPS E SP

CYSTARAN 3 PA SP QL

DOUBLE PM E

EYLEA INTRAVITREAL

3 PA SP

flucaine E


fluor-i-strips at E

FLURA-SAFE E


E


E

GELFILM OPHTHALMIC

E


E


E


E


E

homatropaire 1


E

ISOPTO ATROPINE 3


LACRISERT 3

LASTACAFT 3 ST

LATISSE E

lissamine green E


E


lubricant eye pm E

lubricant pm E



E


2 PA SP


3 PA SP

MAXITROL 3

MEMBRANEBLUE 3


E


E

MYDRIACYL E


1


1


1


1


125



1

neo-polycin 1

neo-polycin hc 1

OXERVATE 3 PA SP QL

PAREMYD E


1

polycin 1


1

POLYTRIM 3

PRED-G 3

PRED-G SOP 3


E


E


E


E


E


E


E


1


E


REFRESH RELIEVA E


E

RESTASIS 2 PA


2 PA

ROSE GLO E


E


1

SYSTANE COMPLETE E


E

SYSTANE ULTRA PF E


1


3


E

TOBRADEX ST 3


1



E


E


E


E


126



E

ultra fresh pm E


E

VISIONBLUE 3

VISUDYNE 3 SP

XIIDRA 2 PA

ZYLET 3


acetic acid otic 1

CETRAXAL 3 ST

CIPRO HC 3

CIPRODEX 2



1


E

cortic-nd 1

DERMOTIC 3

exotic-hc 1

flac 1


1


1


1

ofloxacin otic 1

OTICIN HC NR 3

OTIPRIO E

OTOVEL E

PRAMOTIC 3



12 hour allergy-d E


E


E


ADRENALIN NASAL E

all day allergy d E



E

allergy 24-hr E

allergy childrens E


E



E



E


E


E


E


E


E


E


127



E


E




E


BECONASE AQ 3 QL

benzonatate 1

bromfed dm 1


1


1


E


E


1



E


E


E


E


E

CINQAIR 3 PA SP


E

CLARINEX-D 12 HOUR

E


E



E



1




E


E


3



E


E


E


E


E


1


1


E

DICOPANOL FUSEPAQ

E

DICOPANOL RAPIDPAQ

E


E

DI-PHEN E



128



E


E


1


E


E

DYMISTA 2 QL


FASENRA 2 PA SP

FASENRA PEN 2 PA SP


E


E


1 QL


1



GILPHEX TR E


E


E




E


E


E

hm loratadine E


HYCODAN 3 PA QL


1 PA QL


1 PA QL

hydromet 1 PA QL

HYPERSAL 3


3


1


E


1



loratadine-d 12hr E

loratadine-d 24hr E


maxi-tuss gmx E

maxi-tuss pe max E

m-dryl E

MICLARA LQ E


1 QL


E


E

MUCINEX DM E


E

mucus dm E


129



E


E


mucus-d E

mucus-er max E


E


E



E



NASONEX E


E


E


E

NEOTUSS PLUS E

NUCALA 2 PA SP QL


OMNARIS 3 QL

PATANASE 3 QL


PHENERGAN INJECTION

E


E



1




1


1 PA QL


1

promethegan 1

PROPEL E

PROPEL MINI E



1


E

QNASL 3 QL



E


E


3

ryvent E

SEMPREX-D E

sinus 12 hour E

SINUVA 3


1

SSKI E

SUDAFED CONGESTION

E

sudogest 12 hour E


E


130



E


3

TESSALON PERLES 3


E


E


E



E


E

TUXARIN ER E


E



E


XHANCE E

XOLAIR 2 PA SP

ZETONNA 3 QL


E


ACCOLATE 3


1



3

ADVAIR DISKUS 1 QL

ADVAIR HFA 2 QL

ADYPHREN E

ADYPHREN AMP E

ADYPHREN AMP II E

ADYPHREN II E

AIRDUO DIGIHALER E


E


E


E



1 QL


E


1 QL


E


1 QL


ALVESCO E


131


ANORO ELLIPTA 2 QL


3 PA SP


ARMONAIR DIGIHALER

E



E


E


E


E


E

ASMANEX HFA E

ATROVENT HFA 3 QL


3 QL


E

BEVESPI AEROSPHERE

E

BREO ELLIPTA 2 QL

BREZTRI AEROSPHERE

E

BROVANA 3 QL



E


COMBIVENT RESPIMAT

2 QL


1

DALIRESP 3 PA

difil-g forte 1

DUAKLIR PRESSAIR E

DULERA E

ELIXOPHYLLIN 2


1 ST


1


E


1 ST


1

EPINEPHRINESNAP-EMS

E

EPINEPHRINESNAP-V E


3 ST


E

EPISNAP E

ESBRIET 3 PA SP

FLOVENT DISKUS 2 QL

FLOVENT HFA 2 QL


132



E


1 ST QL

GLASSIA 3 PA SP

INCRUSE ELLIPTA E


1 QL



1 QL


E


3 QL


3 QL


1

OFEV 3 PA SP

PERFOROMIST 3 QL

PROAIR DIGIHALER E

PROAIR HFA E

PROAIR RESPICLICK E


3 PA SP



3 PA SP

PROVENTIL HFA E

PULMICORT FLEXHALER

2 QL


E

QVAR REDIHALER E

SEEBRI NEOHALER E


SINGULAIR E

SPIRIVA HANDIHALER

2 QL


2 QL

STERITALC 3


2 QL

STRIVERDI RESPIMAT

2 ST QL

SYMBICORT 2 QL

SYMJEPI 3


E


THEO-24 3

theophylline 1


1


1


133


E

UTIBRON NEOHALER E

VENTOLIN HFA E

wixela inhub E

XOPENEX NEB 3 QL

XOPENEX CONCENTRATE

3 QL

XOPENEX HFA E

YUPELRI 3 QL

zafirlukast 1

ZEMAIRA 3 PA SP

zileuton er 1 ST

ZYFLO E


BETHKIS 2 SP

CAYSTON 3 PA SP

KALYDECO 3 PA SP

KITABIS PAK E SP

ORKAMBI 3 PA SP QL

PULMOZYME 2 PA SP

SYMDEKO 3 PA SP QL

TOBI NEBULIZER E SP



1 SP


E SP


E SP


TRIKAFTA 3 PA SP QL


ADCIRCA 3 PA SP QL

ADEMPAS 2 PA SP QL

alyq 1 PA SP QL


bosentan 1 PA SP QL


FLOLAN 3 PA SP

LETAIRIS 3 PA SP QL

OPSUMIT 2 PA SP QL

ORENITRAM 3 PA SP


E SP

REVATIO INTRAVENOUS

3 PA SP



1 PA SP


1 PA SP QL


1 PA SP QL



E SP



TYVASO 3 PA SP QL



UPTRAVI 3 PA SP QL


134



TUDORZA PRESSAIR


VELETRI 3 PA SP

VENTAVIS 3 PA SP QL



AMRIX E

BACLOFEN EXTERNAL

E


baclofen oral 1

carisoprodol oral 1


1 QL


1

CYCLOGABA 10300 E



1


1


E

CYCLOPAK 3

CYCLOPHENE RAPIDPAQ

E


3


enovarx-baclofen E


E

FEXMID 3

FIRST-BACLOFEN E



E


E

LIORESAL E

LORZONE 3

METAXALL CP E

metaxalone 1


NOPIOID-LMC KIT E

NORGESIC FORTE E



1


E

OZOBAX E

ROBAXIN-750 3

SKELAXIN E

SOMA 3

TABRADOL FUSEPAQ E

TABRADOL RAPIDPAQ

E


VANADOM 3

ZANAFLEX E


AMBIEN E

AMBIEN CR E


135


armodafinil 1 PA QL

BELSOMRA 3 ST QL

DAYVIGO 3 ST QL


EDLUAR E

eszopiclone 1 QL


HETLIOZ 3 PA SP QL


3 QL

LUNESTA E

modafinil 1 PA QL

NUVIGIL E

PROVIGIL E

ramelteon 1 QL

RESTORIL E

ROZEREM 3 QL

SILENOR 3 QL


E


SUNOSI 2 PA QL

temazepam 1 QL

WAKIX 3 PA SP QL

XYREM 3 PA SP QL

XYWAV E SP

zaleplon 1 QL



ZOLPIMIST 3 ST QL


136

Index of Drugs




137




138




139




140




141




142




143




144




145




146




147




148




149




150




151




152




153




154




155




156




157




158




159




160




161




162




163




164




165




166




167




168




169




170




171




172




173




174




Drug Tier


Directions Doctor


-Continued on back-


























(Farsi)

HealthSelectSM

of Te

xas





Anesthetics


Antibacterials

Anticoagulants



Antidepressants


Antifungals

Antigout Agents


Antimigraine Agents


Antimycobacterials


Antiparasitics


Antiplatelets


Antivirals













Diabetes - Insulins






























5








6


Tier information



Tier 1 Lowest Cost






Tier 3 Highest Cost











Table of Contents


7


8






E


E


E


E

acetaminophen er E


E


E


E


E


E


E


1 QL


1 QL


1 QL


1 QL

ACTIQ 3 PA QL

ALLZITAL E

APADAZ E



1 QL


1 QL

ARYMO ER E

ascomp-codeine 1


BELBUCA 2 PA QL


E


3

BUPRENEX E


E


1 PA QL


1


E


1



1


1


1


1


E


9



1 QL

BUTRANS 3 PA QL


1


E


E

childrens apap E


E


1 QL

CONZIP E


E


E

DILAUDID ORAL E

DOLOPHINE 3 PA

DSUVIA E

DURAGESIC-100 E

DURAGESIC-12 E

DURAGESIC-25 E

DURAGESIC-50 E

DURAGESIC-75 E

duramorph E


1 QL

ESGIC 3

fentanyl 1 PA QL



1 PA QL


E



E


E


E


E


E


E


E


E


E


E


10



E


E


3


3

FIORINAL 3

FIORINALCODEINE 3

3


E



1 PA ST QL


1 QL


1 QL


1 QL


1 PA QL


E




E


E


E

HYSINGLA ER 2 PA QL

INFUMORPH 200 E

INFUMORPH 500 E


E

LAZANDA E




3 QL

MEDI-DERM-RX E

MEDROX-RX 3


E


1 QL


1 QL




1


11



1


1 PA


1


1


1


migraine relief E

mitigo E


1 QL


E


E


1 PA QL


1 PA QL


1 PA QL


E


E


E


E





E


E


E

m-pap E


E


1

NALOCET E

NORCO E

NUCYNTA E

NUCYNTA ER E

OXAYDO ORAL TABLET

E


E


1 QL


1 QL


1 QL


1 QL


E


12



1 QL


1 QL


2 PA QL




E



E


E


E



E

PANADOL CHILDRENS

E

PANADOL EXTRA E


E

PANADOL INFANTS E


1 QL


E

PRIALT 2 SP

PRIMLEV E


E


PROLATE E

QDOLO E


E


E

SUBSYS E

SYNAPRYN FUSEPAQ E


1


1 ST QL


E


1 PA QL


1 QL



1 QL


3 QL

TYLENOL 8 HOUR E


E


E

TYLENOL ORAL TABLET

E

ULTRACET E

ULTRAM E


13


VANATOL LQ E

VTOL LQ E

XTAMPZA ER 2 PA QL


3


E


ACTIVE-KETOPROFEN

E

ACTIVE-PREP KIT I E




ADVIL E


E


E

ADVIL MIGRAINE E


E


E

ALEVE ORAL TABLET E


E

aspirin adult $0


$0






$0


$0


$0


$0


$0


E


$0


$0


$0

BIIFENAC 1000 E

BIIFENAC 500 E


E

CAMBIA E

CAPSFENAC PAK E

CAPSINAC E

CELEBREX E

celecoxib oral 1 QL

DAYPRO 3


E


E


14



E

DFSMSMENTHCAP PAK

E

DICLOFENAC E


3 QL




1 QL


1 PA



1


E


3


E

DICLOPR E

diclosaicin E

DICLOSTREAM E

DICLOTREX E

DICLOVIX E

DICLOVIX M E

DICLOZOR EXTERNAL

E

diflunisal oral 1

DIMENTHO E


E

DUEXIS E



3

ec-naproxen 1


E

enovarx-ibuprofen E


E


E

etodolac er 1

etodolac oral 1

FBL KIT E

FELDENE 3



E

FLEXIPAK E

flurbiprofen oral 1

FROTEK E


E



$0


E

IBUPAK E

ibuprofen 1

ibuprofen infants E



1


E

inavix E

INDOCIN ORAL 3 ST


15


INDOCIN RECTAL E

indomethacin er 1


E


1 ST

INFLAMMACIN E


E

KBGL IN TERODERM

E

KETOPHENE RAPIDPAQ

E

ketoprofen er 1

ketoprofen oral 1


E


1


1


3 PA QL


1 QL


1


3

LICART EXTERNAL E

LODINE 3


1




MOBIC ORAL TABLET E


E


E

nabumetone oral 1


3

NALFON ORAL TABLET

3


3


E


3

naproxen dr 1


E




E


1


1 PA QL


E

NUDICLO SOLUPAK E

NUDICLO TABPAK E

NUDROXIPAK E

NUDROXIPAK DSDR-50

E


16


NUDROXIPAK DSDR-75

E

NUDROXIPAK E-400 E

NUDROXIPAK I-800 E

NUDROXIPAK M-15 E

NUDROXIPAK N-500 E

ORMECA E

oxaprozin 1

PENNSAID EXTERNAL

E

piroxicam oral 1

PRASTERA E


E


E


$0

QMIIZ ODT E


E

RELAFEN E

RELAFEN DS E

REXAPHENAC EXTERNAL

E

salsalate oral E

SPRIX 3 PA QL


$0

sulindac oral 1


E


E


1


1

TORONOVA II SUIK E


TORONOVA SUIK E


E


E

VAROPHEN E

VENNGEL ONE E

VIMOVO E

VIVLODEX E

VOLTAREN EXTERNAL

E

VP FC KIT E

VP GKL KIT E

XRYLIX EXTERNAL E

ZIPSOR E

ZORVOLEX E

Anesthetics


E

7T LIDO E

ACCUCAINE E


E

AGONEAZE E

ANODYNE LPT E

APRIZIO PAK E

APRIZIO PAK II E

ASTERO E


E

blue tube aloe E


E



E


17



E


E

CADIRAMD E

CAPSAICIN-MENTHOL

E


3


E

COCAINE HCL NASAL E


E


E


E

DERMACINRX PHN E

DERMACINRX PRIZOPAK

E

DERMACINRX ZRM E

EHA E

EMPRICAINE-II E


ethyl chloride 1

EXPAREL E

FLEXIN E

GEBAUERS PAIN EASE

3


3

GEN7T E

GEN7T PLUS E

GOPRELTO E


LDO PLUS E

lets E

LEVATIO E

LIDO BDK E


E


1


1


E


E


E


1


1


E


E


3


1


3


1


1


1 QL


18



E


1


E


E

LIDOCANNA E

LIDODERM E


3


E

LIDOMARK 25 E

LIDOPAC E


E


E


E

LIDOPRIL XR E


E

LIDOPURE PATCH E

LIDORX E

LIDO-SORB E

LIDOSTREAM E

LIDOTHOL E

LIDOTRAL E

LIDOVIX L E

LIDTOPIC MAX E

LIVIXIL PAK E

LMR PLUS E

LYDEXA E


MARCAINE E


E

marlido E

MARLIDO-25 E

MARVONA SUIK E

MEDI-DERML-RX E

MEDI-PATCH RX E

NUMBRINO E

NUVAKAAN E

NUVAKAAN-II E

PAINGO KFT E

PLIAGLIS E

POINT OF CARE LM-22

E

POINT OF CARE LM-25

E

premium lidocaine E

PREMIUM SCAR E

PREPIV SUPPLY 3

PRILO PATCH E

PRILO PATCH II 3

PRILOLID E

PRILOVIX E

PRILOVIX LITE E


PRILOVIX PLUS E



PRILOVIXIL E

PRIZOPAK II E

PRIZOTRAL E

PRIZOTRAL-II E

READYSHARP-A E


E

RELADOR PAK PLUS E


19


RENOVO E

sensorcaine E

sensorcaine-mpf E


E


E

SYNERA E

SYNVEXIA TC E


3

VEXATROL E


E

XARACOLL E

XYLOCAINE INJECTION

3


3

ZERUVIA E

ZILACAINE PATCH E


E

ZIONODIL E

ZIONODIL 100 E

ZTLIDO E



BUNAVAIL 3 QL


1 QL


1 QL


$0 QL


CHANTIX $0 QL


$0 QL


$0 QL

disulfiram oral 1

LUCEMYRA 3 ST QL


E


E


E



E

NARCAN 2


$0 QL


$0 QL




NICOTROL $0 QL

NICOTROL NS $0 QL

SUBLOCADE 3 SP


2 QL

VIVITROL 3 SP

ZUBSOLV 2 QL

Antibacterials

ACTICLATE E

AEMCOLO 3 PA

ALTABAX 3


20



E



1



1


1


1


1


E

ARIKAYCE 3 SP

AUGMENTIN ES-600 3


3


3

avidoxy 1 ST

AVIDOXY DK E


1


1


1




BACTRIM 3

BACTRIM DS 3

BAXDELA INTRAVENOUS

E

BAXDELA ORAL 3


3


1

BENZODOX E

BICILLIN L-A E

cefaclor 1

cefaclor er 1

cefadroxil 1


E


E

cefdinir 1


E

cefixime 1

CEFOTAN E


E


E


E


cefprozil 1


21



E


1


1

CENTANY 3

CENTANY AT E

cephalexin 1


E


3


3


clarithromycin er 1


CLEOCIN ORAL 3


3


2



1


1

CLINDESSE 3


E

COLY-MYCIN M E

coremino E

CUBICIN E

CUBICIN RF E

daptomycin E




DIFICID 3

DORYX MPC E


3 ST


E

doxy 100 E


E


1


1


1 ST


E


1


1 ST


E


1 ST


1


1


22



1 ST

EES GRANULES 3

ertapenem sodium E

ERYPED 200 3

ERYPED 400 3

ERY-TAB 3


3



1

erythromycin oral 1

FETROJA E


E

FIRVANQ 3

FLAGYL ORAL CAPSULE

3


3


E


1


1

HIPREX 3


E

INVANZ INJECTION E


1

KEFLEX 3


levofloxacin oral 1

LINCOCIN E



E


E

linezolid oral 1 QL

MACROBID 3

MACRODANTIN 3


1


E


E


E



E


E




3


E



23


MINOLIRA E


1 ST

MONUROL 3


E


1



mupirocin calcium E



E


E



E


1


1


1

NUTRIDOX E

NUVESSA E


3


1


E


E


1



E





E


E


E


E

PRIMSOL 3

RECARBRIO E


E

SEYSARA 3 ST

SILVADENE 3


E


1

SIVEXTRO E


3

SOLOSEC 3

ssd 1


E


24


sulfadiazine oral 1


1


1


E


3


SUPRAX ORAL CAPSULE

3


3


3

TARGADOX E

tazicef injection E


E


E


tigecycline E

tinidazole oral 1

trimethoprim oral 1

TYGACIL E


E

VANCOCIN 3


3



E


E



E

vandazole 1

VIBRAMYCIN 3 ST

XENLETA INTRAVENOUS

E

XENLETA ORAL 3

XEPI 3

XIFAXAN 3 PA

XIMINO 3

ZEMDRI E


3


3


3

ZITHROMAX TRI-PAK 3

ZITHROMAX Z-PAK 3


E

ZYVOX ORAL 3 QL

Anticoagulants

ACD-A NOCLOT-50 3


25


ACTIVASE E


1


3

ARIXTRA 3 SP QL

CATHFLO ACTIVASE E

ELIQUIS 2 QL


2 QL




3 SP QL


E


1


E


1



E

jantoven 1

LOVENOX 3 SP QL

PRADAXA 2 QL

REGIOCIT E

SAVAYSA 3 QL

THROMBATE III 3 SP

TRICITRASOL 3


XARELTO 2 QL


2 QL


APTIOM 3

BANZEL 3 PA


E

BRIVIACT ORAL 3 ST

carbamazepine er 1


CARBATROL 3

CELONTIN 3


E

clobazam 1 PA

DEPAKOTE 3

DEPAKOTE ER 3


3

DIACOMIT 3 PA SP





26


DILANTIN INFATABS E


E


3


E


1


1


1

EPIDIOLEX 3 PA SP

epitol 1

ethosuximide oral 1

FANATREX FUSEPAQ E

felbamate 1

FELBATOL 3

FINTEPLA 3 PA SP


E

FYCOMPA 3


1


1


GABITRIL 3

KEPPRA INTRAVENOUS

E

KEPPRA ORAL 3

KEPPRA XR 3


2



E


3


3


3

LAMICTAL STARTER 3

LAMICTAL XR 3

lamotrigine er 1


1



1


1


1


1


1

levetiracetam er 1


E


MYSOLINE 3

NAYZILAM 3 QL

NEURONTIN 3


3 PA


3 PA

oxcarbazepine 1

OXTELLAR XR E



27



1

PHENYTEK 3



1


1


1

primidone oral 1

QUDEXY XR 3


1

rufinamide 1 PA

SABRIL ORAL PACKET

E SP

SABRIL ORAL TABLET

3 PA SP

SPRITAM E

subvenite 1


1


1


1

SYMPAZAN 3 PA


3


3

TEGRETOL-XR 3

tiagabine hcl 1

TOPAMAX 3

TOPAMAX SPRINKLE 3

topiramate er 1

topiramate oral 1

TRILEPTAL 3

TROKENDI XR 3 ST



1


1

VALTOCO 10 MG DOSE

3 QL

VALTOCO 15 MG DOSE

3 QL

VALTOCO 20 MG DOSE

3 QL

VALTOCO 5 MG DOSE

3 QL

vigabatrin 1 PA SP

vigadrone 1 PA SP

VIMPAT INTRAVENOUS

E

VIMPAT ORAL 3

XCOPRI 3 ST


3 ST


3 ST

ZARONTIN 3

ZONEGRAN 3

zonisamide oral 1


ARICEPT 3

donepezil hcl 1

EXELON TRANSDERMAL

3


1


1



1


28



1

NAMENDA ORAL TABLET

3


3

NAMENDA XR 3 QL


3 QL

NAMZARIC 2 QL

RAZADYNE ER 3

rivastigmine 1


Antidepressants


amoxapine 1

ANAFRANIL 3

APLENZIN 3 ST QL

BRISDELLE 3 ST QL



1 QL


E


CELEXA ORAL TABLET

3


1


1


CYMBALTA E


DESVENLAFAXINE ER

3 ST QL



1 QL


1


1



EFFEXOR XR E

EMSAM 3 QL


FETZIMA 3 ST QL



3


1


1 QL


1




FORFIVO XL E



LEXAPRO ORAL TABLET

E

maprotiline hcl 1

MARPLAN 3

mirtazapine oral 1

NARDIL 3

nefazodone hcl 1


3



29



1 QL


3

PARNATE 3

paroxetine hcl er 1


1


PAXIL CR 3


2 ST

PAXIL ORAL TABLET 3


1

PEXEVA E


PRISTIQ E

protriptyline hcl 1

PROZAC ORAL CAPSULE

E


3

REMERON SOLTAB 3



3 PA SP


3 PA SP


3 QL




1

TRINTELLIX 3 ST QL

venlafaxine hcl 1



VIIBRYD ORAL TABLET

3 QL


3 QL

WELLBUTRIN SR E

WELLBUTRIN XL E

ZOLOFT E

ZULRESSO 3 PA SP


AKYNZEO INTRAVENOUS

E

AKYNZEO ORAL 3 QL


E

ANZEMET ORAL 3 QL

aprepitant 1 QL

BONJESTA 3 PA QL

compro 1


DICLEGIS 3 PA QL


dronabinol 1 PA QL


E


3 QL


3

EMEND TRI-PACK 3 QL


E

GIMOTI E


30



E


E


MARINOL 3 PA QL


1


E


E


1


1


1


1



E


1 QL


1 QL


1

ondansetron odt 1

palonosetron hcl E

perphenazine oral 1

prochlorperazine 1


1

REGLAN ORAL 3

SANCUSO 3 QL


scopolamine 1

SYNDROS 3 PA QL

TIGAN INTRAMUSCULAR

E

TIGAN ORAL 3


3


3


E


1


3 QL


3

ZUPLENZ E

Antifungals

ACTIVE-PREP KIT V E

ala-quin E

ALCORTIN A E


E


E

ANCOBON 3


E


3



E


E


31



1



1



1


1


1


E


1

CRESEMBA ORAL 3



E

dermazene E


E


3


3

DIFMETIOXRIME E

ECONASIL E


1


E

ECOZA E


E


ERTACZO E

EXELDERM E


EXTINA 3

fluconazole oral 1


E

flucytosine oral 1

FUNGIMEZ E


1


1

GYNAZOLE-1 3


E

IMIOXIA E

IODOQUIMEZ-HC E


E


E


E


JUBLIA E

KERYDIN 3 PA


1


E


1

ketoconazole oral 1


E



E


32



3

LOPROX EXTERNAL KIT

E


3


3


E

LULICONAZOLE E

LUZU E

MENTAX E

micaderm E


E

miconazole 1 E


1


E


E


E


E

naftifine hcl 1


3

NAFTIN EXTERNAL GEL

3

NOXAFIL ORAL 3

nyamyc 1

nystatin external 1





nystop 1

ONYCHO-MED E

ORAVIG E



3


E

PEDIZOLPAK E

PHEODOYO E

PHEYO E


E

posaconazole 1

QUINJA E

RECURA E

SPORANOX 3 PA

SPORANOX PULSEPAK

3 PA

SULCONAZOLE NITRATE

E

tavaborole 1 PA


terconazole 1



E

TOLSURA E

VFEND 3

voriconazole oral 1

VUSION E

VYTONE E

XOLEGEL E

XOLEGEL COREPAK E


E

XOLEGEL DUOXOLEX

E


33



E

ZOLPAK E

Antigout Agents

allopurinol oral 1


E



COLCRYS E

febuxostat 1 ST

GLOPERBA E

KRYSTEXXA 3 PA SP

MITIGARE E

probenecid oral 1

ULORIC 3 ST

ZYLOPRIM 3


EMFLAZA 3 PA SP

Antimigraine Agents

AIMOVIG 2 PA QL

AJOVY E


AMERGE 3 QL

CAFERGOT 3

DHE 45 3 PA QL


1 PA QL


1 PA QL


EMGALITY 2 PA QL


2 PA QL

ERGOMAR 3


FROVA 3 QL



IMITREX 3 QL


3 QL


3 QL


3 QL


3 QL

MIGERGOT 3

MIGRAINE PACK E

MIGRANAL 3 PA QL

MIGRANOW E


NURTEC 2 PA QL


RELPAX 3 QL

REYVOW E




1 QL


1 QL


1 QL


1 QL


34



1 QL


1 QL

TOSYMRA E


3 ST QL

UBRELVY 2 PA QL

VYEPTI E

ZEMBRACE SYMTOUCH

E


ZOMIG NASAL 3 ST QL

ZOMIG ORAL E

ZOMIG ZMT E


GUANIDINE HCL ORAL

3


3


3


3


E


1


1


1

Antimycobacterials

CAPASTAT SULFATE E


cycloserine oral 1

dapsone oral 1


isoniazid oral 1


3

MYCOBUTIN 3

PASER 3

PRETOMANID 3

PRIFTIN 3

pyrazinamide oral 1

rifabutin 1

rifampin oral 1


E

SIRTURO 3

TRECATOR 3



ABRAXANE 2 SP

ADCETRIS 2 PA SP


1 SP


1 SP



2 PA SP QL


E SP

ALECENSA 3 PA SP

ALIMTA 2 SP

ALIQOPA 3 PA SP

ALKERAN 3 SP

ALUNBRIG 3 PA SP QL

anastrozole oral $0


35


ARIMIDEX E

AROMASIN 3

ARRANON 2 SP


1 SP

ARZERRA 2 PA SP

ASPARLAS 3 SP

AVASTIN 3 PA SP

AYVAKIT 3 PA SP QL

azacitidine 1 PA SP

BALVERSA 3 PA SP

BAVENCIO 3 PA SP

BELEODAQ 3 PA SP

BELRAPZO E SP

BENDEKA 3 PA SP

BESPONSA 3 PA SP

bexarotene 1 PA SP

bicalutamide 1

BICNU 3 SP

BLENREP E SP


BLINCYTO 3 PA SP

BORTEZOMIB 3 PA SP

BOSULIF 3 PA SP


3 PA SP

BRUKINSA 3 PA SP

busulfan 1 SP

BUSULFEX 3 SP

CABOMETYX 2 PA SP

CALQUENCE 3 PA SP

CAMPATH 2 SP

CAMPTOSAR 3 SP



2 PA SP QL


2 PA SP



1 SP

carmustine 1 SP

CASODEX 3


1 SP


3 SP


1 SP

clofarabine 1 SP

CLOLAR 3 SP


3 PA SP


3 PA SP


3 PA SP

COPIKTRA 3 PA SP

COSMEGEN 3 SP

COTELLIC 3 PA SP


1 SP


E SP


1

CYRAMZA 3 PA SP



1 SP


1 SP

DACOGEN 3 PA SP

dactinomycin 1 SP


36


DARZALEX 3 PA SP



1 SP

DAURISMO 3 PA SP

decitabine 1 PA SP



1 SP


1 SP

DOXIL 3 SP


1 SP


1 SP

DROXIA 3

ELITEK 3 SP

ELLENCE 3 SP

ELZONRIS 3 PA SP

EMCYT 2

EMPLICITI 3 PA SP

ENHERTU 3 PA SP


1 SP

ERBITUX 2 PA SP

ERIVEDGE 2 PA SP

ERLEADA E SP


1 PA SP


1 PA SP QL

ERWINAZE INJECTION

3 SP

ETHYOL 3 SP


ETOPOPHOS 3 SP


1 SP

etoposide oral 1 SP


1 PA SP QL

EVOMELA 3 SP

exemestane $0

FARESTON 3

FARYDAK 3 PA SP


3 SP

FEMARA 3




flutamide 1

FOLOTYN 2 PA SP

fulvestrant 1 SP

GAVRETO E SP

GAZYVA 3 PA SP


GILOTRIF 3 PA SP QL

GLEEVEC 3 PA SP


3 SP

HALAVEN 2 PA SP

HERCEPTIN HYLECTA

3 PA SP


3 PA SP

HERZUMA E SP


37


HYCAMTIN 3 SP

HYDREA 3

hydroxyurea oral 1

IBRANCE 3 PA SP


3 PA SP QL


3 PA SP

IDAMYCIN PFS 3 SP

idarubicin hcl 1 SP

IDHIFA 3 PA SP QL

IFEX 3 SP

ifosfamide 1 SP


IMBRUVICA 3 PA SP

IMFINZI 3 PA SP

IMLYGIC 3 SP

INFUGEM 3 SP

INLYTA 3 PA SP

INQOVI E SP

INREBIC 3 PA SP

IRESSA 3 PA SP

irinotecan hcl 1 SP


IXEMPRA KIT 2 SP


2 PA SP QL


2 PA SP

JELMYTO E SP

JEVTANA 2 PA SP

KADCYLA 3 PA SP

KANJINTI 2 PA SP


3 PA SP

KHAPZORY 3 ST SP



3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP

KOSELUGO 3 PA SP

KYPROLIS 2 PA SP


LARTRUVO 3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP

letrozole oral 1


E


LEUKERAN 2


1 SP


38



1 SP

LIBTAYO 3 PA SP

LONSURF 3 PA SP

LORBRENA 3 PA SP

LUMOXITI 3 PA SP

LUTATHERA E


2 PA SP

LYSODREN 2

MARQIBO 3 SP

MATULANE 2 SP

MEKINIST 2 PA SP

MEKTOVI 3 PA SP

melphalan 1 SP

melphalan hcl 1 SP


mesna 1 SP

MESNEX 3 SP



E SP


MONJUVI E SP

mutamycin 1 SP

MVASI 2 PA SP

MYLERAN 2


3 PA SP

NAVELBINE 3 SP

NERLYNX 3 PA SP QL

NEXAVAR 2 PA SP

nilutamide 1 SP

NINLARO 3 PA SP

NIPENT 3 SP

NUBEQA 3 PA SP


ODOMZO 3 PA SP

OGIVRI E SP

ONCASPAR INJECTION

2 SP

ONIVYDE 3 SP

ONTRUZANT E SP

ONUREG E SP

OPDIVO 3 PA SP


1 SP


E


1 SP

paclitaxel 1 SP

PADCEV 3 PA SP

PANRETIN 3

paraplatin 1 SP

PEMAZYRE 3 PA SP QL

PERJETA 2 PA SP

PHESGO E SP

PHOTOFRIN 3 SP


3 PA SP


3 PA SP


3 PA SP

POLIVY 3 PA SP

POMALYST 3 PA SP

PORTRAZZA 3 PA SP

POTELIGEO 3 PA SP

PROLEUKIN 2 SP

PURIXAN 3 SP

QINLOCK 3 PA SP

RETEVMO E SP

REVLIMID 2 PA SP



39



3 PA SP


3 PA SP

ROZLYTREK 3 PA SP

RUBRACA 2 PA SP

RUXIENCE 2 PA SP

RYDAPT 3 PA SP

SARCLISA 3 PA SP

SIKLOS 3 PA

SOLTAMOX $0

SPRYCEL 2 PA SP

STIVARGA 3 PA SP

SUTENT 2 PA SP

SYLVANT 3 PA SP

SYNRIBO 3 PA SP

TABLOID 2 SP

TABRECTA E SP

TAFINLAR 2 PA SP


3 PA SP QL


3 PA SP

TALZENNA 3 PA SP



3 PA SP


3 PA SP QL

TARGRETIN EXTERNAL

3 PA SP

TARGRETIN ORAL E SP

TASIGNA 3 PA SP


3 SP


TAZVERIK E SP

TECARTUS 3 PA SP

TECENTRIQ 3 PA SP

TEMODAR INTRAVENOUS

2 SP



teniposide 1 SP

TEPADINA 3 SP

THALOMID 2 PA SP


TIBSOVO 3 PA SP


1 SP

topotecan hcl 1 SP


TOTECT 3 SP

TRAZIMERA 2 PA SP


E SP

tretinoin oral 1 SP


3 SP

TRODELVY 3 PA SP

TRUXIMA E SP

TUKYSA 3 PA SP

TURALIO 3 PA SP

TYKERB 3 PA SP

UNITUXIN 3 PA SP

VALCHLOR 3 PA SP

valrubicin E

VALSTAR E


40



3 SP


VENCLEXTA 3 PA SP


3 PA SP

VERZENIO 3 PA SP

VIDAZA 3 PA SP


1 SP


1 SP


VITRAKVI 3 PA SP

VIZIMPRO 3 PA SP

VORAXAZE E

VOTRIENT 3 PA SP


3 PA SP

XALKORI 2 PA SP

XELODA 3 PA SP


E

XOSPATA 3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP



3 PA SP


3 PA SP

XTANDI 3 PA SP

YERVOY 2 PA SP

YESCARTA 3 PA SP

YONDELIS 3 SP

YONSA E SP

ZALTRAP 2 PA SP

ZANOSAR 2 SP

ZEJULA 2 PA SP

ZELBORAF 3 PA SP

ZEPZELCA 3 PA SP

ZEVALIN Y-90 3 SP

ZIRABEV 2 PA SP

ZOLINZA 2 PA SP

ZYDELIG 3 PA SP

ZYKADIA ORAL TABLET

3 PA SP

ZYTIGA E SP

Antiparasitics


ALBENZA 3 PA

ALINIA 2

ARAKODA 3

atovaquone oral 1


1

BENZNIDAZOLE 3

BILTRICIDE 3


1

COARTEM 3


crotan 1

DARAPRIM 3 PA SP

EGATEN 3


41


ELIMITE 3

EMVERM 2


1

IMPAVIDO 3


1

ivermectin oral 1

KRINTAFEL 3

LAMPIT E

lice killing E


E


1

MALARONE 3


mefloquine hcl 1

MEPRON 3

NATROBA 3

NEBUPENT 3

nitazoxanide 2

OVIDE 3

PENTAM E


1


E


1

PLAQUENIL 3

praziquantel oral 1


1



3

QUALAQUIN 3 PA



SKLICE 3

spinosad 1


E

STROMECTOL 3

SULFURATED LIME 3




2 PA SP QL

AZILECT 3


1


1

carbidopa oral 1



1


1

COMTAN 3

DUOPA ENTERAL 3 PA

entacapone 1

GOCOVRI E

INBRIJA 3 PA SP

KYNMOBI E SP


E SP

LODOSYN 3

MIRAPEX ER 3


3

NEUPRO 3 ST

NOURIANZ 3 PA


42


ONGENTYS E

OSMOLEX ER E

PARLODEL 3


1


1


ropinirole hcl 1

ropinirole hcl er 1

RYTARY 3 ST


SINEMET 3

STALEVO 100 3

STALEVO 125 3

STALEVO 150 3

STALEVO 200 3

STALEVO 50 3

STALEVO 75 3


3

tolcapone 1


XADAGO 3 ST QL

ZELAPAR 3

Antiplatelets


ASPIRIN-OMEPRAZOLE

E

BRILINTA 2

CABLIVI 3 PA SP QL

cilostazol 1


1

dipyridamole oral 1

DURLAZA E

EFFIENT 3



3

prasugrel hcl 1

YOSPRALA E

ZONTIVITY 3



3


3

ABILIFY MYCITE E

ABILIFY ORAL TABLET

3 QL

ADASUVE 3 PA

aripiprazole 1 QL

ARISTADA E

ARISTADA INITIO E

CAPLYTA 3 ST QL


E


clozapine 1 QL

CLOZARIL 3 QL

FANAPT 3 ST QL


3 ST QL


E


E



E

GEODON ORAL 3 QL

HALDOL DECANOATE E


43



E


haloperidol oral 1

INVEGA 3 QL


3


3

LATUDA 3 QL


molindone hcl 1


3 PA


3 PA


E



PERSERIS E

pimozide 1



REXULTI 3 QL


3


E


E

risperidone 1 QL


SAPHRIS 2 QL

SECUADO E

SEROQUEL 3 QL

SEROQUEL XR 3 QL


thiothixene oral 1


VERSACLOZ 3 QL

VRAYLAR 3 ST QL




3

ZYPREXA ORAL 3 QL

ZYPREXA RELPREVV E

ZYPREXA ZYDIS 3 QL

Antivirals

abacavir sulfate 1


1


1


acyclovir oral 1


APTIVUS 2


ATRIPLA E

BARACLUDE 3 SP QL

BIKTARVY 3


CIMDUO 2

COMBIVIR 3

COMPLERA 2


2

DELSTRIGO 3


44


DENAVIR E

DESCOVY E


1

DOVATO 2

EDURANT 2

efavirenz 1


1


1

emtricitabine 1


1


3


2

entecavir 1 SP QL

EPCLUSA 2 PA SP QL

EPIVIR 3


2 SP


3 SP

EPZICOM 3

EVOTAZ 2

famciclovir oral 1

FAVIPIRAVIR 3



E


E

GENVOYA 3

HARVONI 2 PA SP QL


HEPSERA 3 SP

INTELENCE 2

INTRON A 3 PA SP


2

ISENTRESS 2

ISENTRESS HD 2

JULUCA 2


3

KALETRA ORAL TABLET

2



1 SP


1



E SP


2



MAVYRET 2 PA SP QL

nevirapine 1

nevirapine er 1

NORVIR ORAL PACKET

2


2

NORVIR ORAL TABLET

3

ODEFSEY 3


1 QL


2 PA SP


45



3 PA SP

PIFELTRO 3

PREVYMIS 3 SP

PREZCOBIX 2


2


2



E


3

RETROVIR ORAL SYRUP

3


3

REYATAZ ORAL PACKET

2




1 SP

rimantadine hcl 1

ritonavir 1

RUKOBIA 3

SELZENTRY 2 PA

SITAVIG 3 QL


E SP

SOVALDI 3 PA SP QL


STRIBILD 3

SUSTIVA 3

SYMFI 2

SYMFI LO 2


SYMTUZA 3


E


E

TEMIXYS E


1

TIVICAY 2

TIVICAY PD 2

TRIUMEQ 2

TRIZIVIR 3

TROGARZO 3 PA


2


E

TYBOST 2


VALCYTE 3


VALTREX 3 QL

VEMLIDY 3 SP



2


3


3

VIRAZOLE 3

VIREAD ORAL POWDER

2


46



2


3

VOSEVI 2 PA SP QL

XERESE E


3 QL


3 QL

ZEPATIER 3 PA SP QL

ZIAGEN 3

zidovudine 1


3


E


E


alprazolam er 1 QL



alprazolam xr 1 QL

ATIVAN E





1 QL

diazepam intensol 1


1


1


DORAL 3 QL

estazolam 1 QL


HALCION 3 QL


1


1


1

KLONOPIN 3 QL




1 QL


meprobamate 1



E


E


E

oxazepam 1 QL

quazepam 1 QL


3 QL

triazolam 1 QL

VALIUM E

VISTARIL 3

XANAX E

XANAX XR E


47



EQUETRO 3

lithium 1



LITHOBID 3


ADVATE 2 SP

ADYNOVATE 3 SP

AFSTYLA 3 SP

AGRYLIN 3


2 SP

ALPHANINE SD 2 SP

ALPROLIX 3 SP


3

AMICAR ORAL TABLET

3


1


1

anagrelide hcl 1


2 PA SP


2 PA SP


3



E


2 SP

CEPROTIN 3 SP

COAGADEX 3 SP

CORIFACT 2 SP


E


3 PA SP

ELOCTATE 3 SP


E SP

ESPEROCT E SP


2 SP

FIBRYGA 2 SP

FULPHILA E SP

GRANIX E SP

HEMLIBRA 3 SP


3 SP


48



2 SP

IDELVION 3 SP

IXINITY 3 SP

JIVI 3 SP

KOATE 2 SP

KOATE-DVI 2 SP

KOGENATE FS 3 SP

KOVALTRY 3 SP


3 PA SP

LYSTEDA 3


3 PA SP


2 SP


E

MOZOBIL 2 PA SP QL

MULPLETA 2 PA SP



3 PA SP


E SP



E SP

NIVESTYM 2 PA SP

NOVOEIGHT 2 SP

NOVOSEVEN RT 2 SP

NPLATE 2 PA SP

NUWIQ 2 SP

OBIZUR 3 SP


3 SP

PROCRIT E SP

PROFILNINE 2 SP

PROMACTA 3 PA SP

REBINYN 3 SP

REBLOZYL 3 PA SP

RECOMBINATE 2 SP

RECOTHROM 3

RECOTHROM SPRAY KIT

3


2 PA SP

RIASTAP 2 SP

RIXUBIS 3 SP

SEVENFACT E SP


3 PA SP

TAVALISSE 3 PA SP


3


49



3

THROMBOGEN 3


E



E

TRETTEN 3 SP

UDENYCA E SP


3 PA SP


2 PA SP

VONVENDI 3 SP


2 SP


2 SP


ZARXIO 2 PA SP

ZIEXTENZO 3 PA SP


ACCUPRIL 3

ACCURETIC 3



3



E

ALDACTAZIDE 3

ALDACTONE 3


ALTACE ORAL CAPSULE

E

ALTOPREV E



1



E


1


1


1




1


E

ATACAND E

ATACAND HCT 3

atenolol oral 1


E



1


3

AVAPRO 3

AZOR E


50




1

BENICAR E

BENICAR HCT E

BETAPACE AF 3


3


BIDIL 3



1

bumetanide oral 1

BUMEX 3

BYSTOLIC 2


3

CALAN SR 3



1

captopril oral 1


1

CARDIZEM CD 3


3


E


3


CARDURA 3

CAROSPIR 3

cartia xt 1

carvedilol 1


CATAPRES 3

CATAPRES-TTS-1 3

CATAPRES-TTS-2 3

CATAPRES-TTS-3 3


1



clonidine 1


colesevelam hcl 1

COLESTID E

COLESTID FLAVORED

E

colestipol hcl 1

CONJUPRI E

CONSENSI E

COREG 3

COREG CR 3

CORGARD 3

CORLANOR 3 PA QL

COZAAR 3

CRESTOR E

DEMSER 3

DIBENZYLINE 3

digitek 1

digox 1

digoxin oral 1

DILATRATE-SR 3



1


51



1


1



E

dilt-xr 1

DIOVAN E

DIOVAN HCT E


1

DIURIL 3

dofetilide 1


1

DUTOPROL E

DYAZIDE 3

DYRENIUM 3

EDARBI 3 ST

EDARBYCLOR 3 ST

EDECRIN 3



1

ENTRESTO 2 QL


E


E


E



E

eplerenone 1


E


EXFORGE 3

EXFORGE HCT 3


ezetimibe 1


felodipine er 1


1


1 ST


1 ST


1


E


1


1 ST


1


1 ST

FENOGLIDE 3 ST

FIBRICOR 3 ST

FIRST - METOPROLOL

E

FIRST-ATENOLOL E


52



FLOLIPID 3 ST



fosinopril sodium 1



1


gemfibrozil oral 1

GONITRO 3


HEMANGEOL 3



1

HYZAAR 3


indapamide oral 1

INDERAL LA E

INDERAL XL E

INNOPRAN XL E

INSPRA 3

irbesartan 1


1

ISORDIL TITRADOSE 3




1


isradipine 1


3 PA SP QL

KAPSPARGO SPRINKLE

E


KATERZIA E



2

LASIX 3

LESCOL XL E

LIPITOR E

LIPOFEN 3

lisinopril oral 1


1

LIVALO E

LOPID 3


3

LOPRESSOR ORAL 3




3


3


3

lovastatin 1

LOVAZA E

matzim la 1

MAXZIDE 3

MAXZIDE-25 3

methyldopa oral 1


1

metolazone 1



53




1

metyrosine 1


MICARDIS 3

MICARDIS HCT 3

midodrine hcl 1


E


E

MINIPRESS 3

minitran 1

minoxidil oral 1

moexipril hcl 1

MULTAQ 3


1

NEXLETOL 2 PA QL

NEXLIZET 2 PA QL


1


1

niacor 1

NIASPAN 3


nifedipine er 1


1

nifedipine oral 1

nimodipine oral 1

nisoldipine er 1

NITRO-BID 3

NITRO-DUR 3




1


1

NITROLINGUAL 3

NITROMIST 3

NITROSTAT E


1


E

NORPACE 3

NORPACE CR 2

NORTHERA 3 PA SP

NORVASC E


3


1


1


1

OMEGA-3 RX COMPLETE

3


E


1 PA


3


1


pentoxifylline er 1



54



1


E


E

pindolol 1


2 PA QL


3


prazosin hcl oral 1

PRESTALIA 3 ST

prevalite 1


3


E

PROCARDIA 3

PROCARDIA XL 3

propafenone hcl 1




propranolol-hctz 1

QBRELIS E

QUESTRAN E


E

quinapril hcl 1



1



ramipril 1

RANEXA 3 ST

ranolazine er 1 ST

RECTIV 3

REPATHA 2 PA QL


2 PA QL

REPATHA SURECLICK

2 PA QL


RYTHMOL SR 3


sotalol hcl (af) 1

sotalol hcl oral 1

SOTYLIZE 3




3


E


3

taztia xt 1

TEKTURNA 2 ST

TEKTURNA HCT 2 ST

telmisartan 1


telmisartan-hctz 1

TENORETIC 100 3

TENORETIC 50 3


55


TENORMIN E

tiadylt er 1

TIAZAC 3

TIKOSYN E


TOPROL XL E

torsemide oral 1

trandolapril 1


1

triamterene oral 1


1


1

TRIBENZOR E

TRICOR 3

TRILIPIX 3

TWYNSTA 3

valsartan 1


1

VASCEPA 2 PA

VASERETIC 3

VASOTEC 3

VECAMYL 3


1


1


VERELAN 3

VERELAN PM 3

VYNDAMAX 3 PA SP QL

VYNDAQEL 3 PA SP QL

VYTORIN E


WELCHOL 3

ZESTORETIC 3


3


E

ZETIA E

ZIAC 3


3


E


ADDERALL 3 PA QL

ADDERALL XR E

ADHANSIA XR E






1 PA QL


1 PA QL




CONCERTA E


DAYTRANA 3 PA ST QL

DESOXYN 3 PA ST QL


3 PA QL


56




1 PA ST QL


1 PA QL


1 PA ST QL


EVEKEO 3 PA ST QL

EVEKEO ODT 3 PA QL

FOCALIN 3 PA QL


guanfacine hcl er 1

INTUNIV 3



3 ST


1 PA ST QL



3 PA ST QL


1 PA ST QL


1 PA ST QL


1 PA ST QL


1 PA ST QL


1 PA QL


1 PA ST QL


1 PA QL



1 PA ST QL

MYDAYIS 3 PA ST QL




3 PA ST QL

relexxii 1 PA ST QL

RITALIN 3 PA QL


3 PA ST QL

STRATTERA 3 QL

VYVANSE 2 PA QL

ZENZEDI 3 PA ST QL


AMPYRA 3 PA SP QL

AUBAGIO 3 PA SP QL


2 PA SP QL


2 PA SP QL



2 PA SP QL


2 PA SP QL




1 PA SP QL


57



E SP

GILENYA 3 PA SP QL


glatopa 1 PA SP QL

KESIMPTA E SP

LEMTRADA 3 PA SP

MAVENCLAD (10 TABS)

3 PA SP

MAVENCLAD (4 TABS)

3 PA SP

MAVENCLAD (5 TABS)

3 PA SP

MAVENCLAD (6 TABS)

3 PA SP

MAVENCLAD (7 TABS)

3 PA SP

MAVENCLAD (8 TABS)

3 PA SP

MAVENCLAD (9 TABS)

3 PA SP

MAYZENT 3 PA SP QL


3 PA SP QL

OCREVUS 3 PA SP QL

PLEGRIDY E SP


E SP


E SP


E SP


E SP



E SP


TYSABRI 3 PA SP QL

VUMERITY 2 PA SP QL

ZEPOSIA 3 PA SP QL


3 PA SP QL

ZEPOSIA STARTER KIT

3 PA SP QL


ADDYI 3 PA QL

ADIPEX-P E

AUSTEDO 3 PA SP QL

benzphetamine hcl E


CONTRAVE E

CONVENIENCE PAK E



GABACAINE E

GRALISE 3 ST QL


3 PA QL

INGREZZA 3 PA SP QL


E

LOMAIRA E

LYRICA CR 3 ST QL

LYRICA ORAL CAPSULE

2 QL


3 QL


58


NEURAPTINE E

NUEDEXTA 3 PA

ONPATTRO 3 PA SP


E


E



QSYMIA E

RADICAVA 3 PA SP

RILUTEK 3 PA QL

riluzole 1 PA QL

SAVELLA 3 ST QL


3 ST QL

SAXENDA E


E

TEGSEDI 3 PA SP


TIGLUTIK 3 PA SP QL


E

VYLEESI 3 PA QL

XENAZINE 3 PA SP

XENICAL E


ARESTIN E

cavarest E

cevimeline hcl 1



E

clinpro 5000 E


E

denta 5000 plus E

dentagel E


E


E

easygel dental E

EVOXAC 3

FIRST-MOUTHWASH BLM

E

fluoridex E



E


E

KEPIVANCE 2 SP


1


MOUTH KOTE REMINT

E

MUCOSITISRX E


E


E

NAFRINSE WEEKLY E


E

oralone 1

paroex E

PERIDEX E


59


periogard E


PREVIDENT E


E


E


E


E

PREVIDENT 5000 PLUS

E


E

SALAGEN 3

SALIVAMAX E

sf E

sf 5000 plus E


E


E


E


E


E


3


1


E




E

ABREVA E

ABSORICA E

ABSORICA LD 3 PA

ACANYA E

ACESO AG E

acitretin 1


active-tramadol E


E


2


1 PA



E


3 PA


E


E


1


E

AKLIEF E

ALA SCALP E



1


60



3

ALDARA E

ALEVAMAX E

ALTRENO 3 PA


E


1


1

AMELUZ E


1

amnesteem 1 PA

AMZEEQ 3

ANACAINE E

APEXICON E E

AQUAPHILIC E

ARAZLO E

ARIDA E


E

ATOPADERM E

ATOPICLAIR E

ATRALIN 3 PA

avar cleanser E

AVAR LS CLEANSER E

AVAR-E EMOLLIENT E

AVAR-E GREEN E

AVAR-E LS E

AVEIDAOXIA E

avita 1 PA

AZADROX E



E

AZELEX 3



BEAU RX E

BENSAL HP E


E


E

BENZACLIN E

BENZACLIN WITH PUMP

E

BENZAMYCIN E


BENZEPRO EXTERNAL

E


E


E


E


E


E

benzoin compound E


E


E


E


E


E


1 ST

BESER EXTERNAL KIT

E


61




1


1


E


1

BIAFINE E


E

blanche E


bp 10-1 E

bp cleansing wash E


E

BPCO 3

BRYHALI E


1 QL


E


1


1


E


1 QL


E

CALCITRENE 3



E

CAPEX E



E

capzix E

CARAC 3

CEM-UREA E

CERACADE E


CHLOOXIA E


E


E


E


E

claravis 1 PA


3


E


1

CLINDACIN PAC E

clindacin-p 1

CLINDAGEL E


E


1 ST


E


1


1


1


62



1


E


1


E



E

CLINOIN E


1



1


1


E


E

CLOBETAVIX E

CLOBEX 3

CLOBEX SPRAY 3


CLODAN EXTERNAL KIT

E


1

CLODERM E


3

COLLATYL E


3

COPADERM E

COPASIL EXTERNAL E



E


3


3


3


E


CORTANE-B EXTERNAL

E


3


3


1


E

DAPSONE-NIACINAMIDE

E


E

DELUO E

DEOXIA E

DERMACINRX PENETRAL

E


E


3


3

DERMULCERA 3

DESONATE E


63


desonide external 1


3


1


1


E


E


1

DEXERYL E

DIADIMAXIA E

DIAOXIA E


E

DIASDIMAXIA E

DIASOXIA E


1 ST QL


1 PA QL


E


E


E


E


E


E

DIMOXIA E

DIPROLENE AF 3



3



3


doxycycline 1


E

DRAXACE E


E

DRITHO-CREME HP E

DRIXECE E

DRYSOL 3

DUOBRII E

DUPIXENT 2 PA SP QL

ECEOXIA E


3

ELETONE E

ELIDEL 3 ST

ELLZIA PAK E

EMULSION SB E

enovarx-tramadol E

ENSTILAR E

ENTTY SPRAY E

ENZOCLEAR E

EPICERAM E

EPIDUO 3

EPIDUO FORTE 3

EPIFOAM 3

EPIQUIN MICRO E

ery 1

ERYGEL 3


1


64



1

ESKATA E

ETHOXIA E

EUCRISA 2 ST

EVOCLIN 3

FABIOR E

FINACEA 3 ST


E


E


E


1


1


1


E


1


1


1


1


1

FLUOPAR E

FLUOROPLEX 3


2


1


1


FLUOVIX E

FLUOVIX PLUS E

flurandrenolide E


1

FORAXA E

GENADUR E

GORDOFILM 3


E

halcinonide E


1


E


1


E


E


3

HALUCORT E


E


HPR PLUS HYDROGEL

E

HYALUCIL-4 E


E


E


E

HYDRO 40 E


65



E


E


E


E


1


E


1


1


E


1


1


1



E


E


E


E


E


E




E


E


E

IMPEKLO E

IMPOYZ E

INOVA E


E


E


ITHOXIA E


E

KAMDOY E

KATARYA E

KATARYAXN E

KAXM E

KEIDO E

KELARX E

KENALOG EXTERNAL 3

KERAGEL E


E


E

KERALYT SCALP E


3

KETARYA E

KEVARYA E

KEXM E

KEYA E


66


KIVIK E

KLARON 3

KUTARYAXM E

KUTARYAXMPA E

KUTEA E

KUVARYA E

KUVARYE E

KUXM E

lactic acid e 1


1


E

lavare wound wash E

LEVULAN KERASTICK 3

LEXETTE E


E

LIDOTREX E


3

LOCOID LIPOCREAM E

LUXIQ 3

MEDERMA E

MEDERMA FOR KIDS E

MEDERMA SPF 30 E


E

methoxsalen rapid 1


E

METROCREAM 3


E

METROLOTION 3


MIMYX E



E

MIRVASO 3


E


1

myorisan 1 PA

NEOCERA E

NEOSALUS E

NEOSALUS CP E


E


3


E


NEUAC EXTERNAL KIT

E


E


E


E


E


E


E


E

NIVATOPIC PLUS E

nolix E

NORITATE E


67



E

NUCARACLINPAK E

NUCARARXPAK E

NUCORT E

NUDERMRXPAK 120 E

NUDERMRXPAK 60 E

NUTRASEB E

NUTRIARX CREAMPAK

E

NUVAIL E

OLUX 3

OLUX-E 3

ONEXTON 3

ORACEA 3

OVACE PLUS E

OVACE PLUS WASH E

OVACE WASH E

OXSORALEN ULTRA 3

PANDEL E

PENLEN E

PHLAG SPRAY E

PICATO 3 ST

pimecrolimus 1 ST

PLEXION E


E


E

podocon E


PR BENZOYL PEROXIDE

E


E

PR CREAM E


1



E


3


E

pramox E


E

prednicarbate 1

PRESERA E


E

PROMISEB E

PROPECIA E

PROSILK EXTERNAL E

PROTEXA E

PROTOPIC 3

PROTYL AG E

PRUCLAIR E

PRUDOXIN 3 PA

PRUMYX E

PSORCON E

PYROGALLIC ACID 3

QBREXZA 3 QL

QUINIXIL E

QUTENZA E

QUTENZA (2 PATCH) E

RADIAGEL E


3


E

RECEDO E

REFISSA E

REGENECARE 3

REGRANEX 3 PA


68


remergent hq E

REMIGEN E

RENOVA E

RENOVA PUMP E

RESORCINOL-SULFUR

E

RETIN-A 3 PA


E


E


2 PA


E

RHOFADE 3

RIAX E




E


E

salicylic acid er E


E


E


E


E


E


E


E



E


E


E

salimez E

SALIMEZ FORTE E

SALVAX E

SALVAX DUO PLUS E


E

SANTYL 3

SCALACORT DK E


E

SCARCIN E

SCARSILK EXTERNAL E

SCARZEN SKIN REPAIR

E

SCENESSE 3 PA SP


1


E

SELRX E

SERNIVO 3

SILA III E

SILIPAC E


E

skarjel E


E


E


E


69



E

SOLARAVIX EXTERNAL

E

SOLOX E

SOOLANTRA 3


3

SORILUX E

sss 10-5 E

STRATA CTX E

STRATA GRT E

STRATA MARK E

STRATA TRIZ E

STRATA XRT E


1


E


E


E


E


E


E


E


E


E



E


E

sulfacleanse 84 E

sulfamez wash E

SUMADAN E

SUMADAN WASH E

SUMADAN XLT E

SUMAXIN E

SUMAXIN CP E

SUMAXIN WASH E

SUVICORT E

SYNALAR 3

SYNALAR (CREAM) E

SYNALAR (OINTMENT)

E

SYNALAR TS E

SYNERDERM E


E


3 QL


E


1

TARDEOXIA E

TARDIMAXIA E

TAROXIA E

TASOPROL E



3 PA


3 PA


70



E


3


3


E

TEXACORT 3

tl hydroquinone E

TOLAK 3 ST


3


3


3

TOPICORT SPRAY E


TOVET EXTERNAL KIT

E





1 PA


E


1


1


1


E

TRIAMSIL MULTIPAK E


trianex E

TRI-CHLOR 3


TRIDESILON 3

TRI-LUMA E


E


E

TRIVIX E

TURPENTINE EXTERNAL

E

ULTRASAL-ER E


E

UMECTA MOUSSE E


E


E

UREA EXTERNAL FOAM

E


E


E

urea hydrating E


E

urea-c40 E

ureacin-10 E

ureacin-20 E

uredeb E

uremez-40 E

URESOL E

UTOPIC E


71



E

VANIQA E

VANOS 3

VANOXIDE-HC E

VARDIMAXIA E

VAROXIA E

VECTICAL E

VELTIN E

VENELEX 3

VERDESO E

VEREGEN E

VEXASYN E

VIRASAL E

XALIX E

XERAC AC 3

XERALUX E

xurea E

ZACARE E


E

zenatane 1 PA

ZIANA E

ZILXI E

ZITHRANOL E

ZONALON 3 PA

ZYCLARA E

ZYCLARA PUMP E


acarbose oral 1

ACTOPLUS MET 3

ACTOS 3

ADLYXIN E


E


ALOGLIPTIN BENZOATE

E


E


E

AMARYL 3


3 ST


2 ST QL




CYCLOSET 3 ST

DUETACT 3

FARXIGA 2 ST

FORTAMET E

glimepiride 1

glipizide er 1

glipizide ir 1

glipizide xl 1


GLUCOTROL 3

GLUCOTROL XL 3


3

GLUMETZA E


glyburide oral 1


GLYNASE 3

GLYSET 3

GLYXAMBI 2 ST

INVOKAMET E

INVOKAMET XR E

INVOKANA E

JANUMET 2 ST


72


JANUMET XR 2 ST

JANUVIA 2 ST

JARDIANCE 2 ST

JENTADUETO 2 ST

JENTADUETO XR 2 ST

KAZANO E

KOMBIGLYZE XR E

metformin hcl er 1



E

metformin hcl ir 1

miglitol 1

nateglinide 1

NESINA E

ONGLYZA E

OSENI E

OZEMPIC 2 ST QL

pioglitazone hcl 1


1


1

PRECOSE 3

QTERN E

repaglinide 1

RIOMET 3 ST

RIOMET ER 3 ST

RYBELSUS 2 ST QL

SEGLUROMET E

SOLIQUA 2 ST QL

STARLIX 3

STEGLATRO E

STEGLUJAN E

SYMLINPEN 120 3 PA

SYMLINPEN 60 3 PA


SYNJARDY 2 ST

SYNJARDY XR 2 ST

tolbutamide 1 ST

TRADJENTA 2 ST

TRIJARDY XR 2 ST

TRULICITY 2 ST QL

VICTOZA 2 ST QL

XIGDUO XR 2 ST

XULTOPHY 3 ST QL



E


E


E


E


E


E


E


$0


E


E


$0


E


73



E


E


$0


$0


$0

BLUESTAR E


E


$0

CARETOUCH TEST E

CEQUR SIMPLICITY 2U

3

CHEMSTRIP UGK 3

CONTOUR CONTROL E


E

CONTOUR NEXT LINK E


E

CONTOUR NEXT TEST

E

CONTOUR TEST E


E


E


E


E


FORTISCARE CONTROL

E


E


E


E


E


E


E


E


E


E


E


E

GUARDIAN SENSOR (3)

E

KETONE TEST 3

KETOSTIX 3

LANCETS $0

MICRODOT TEST E


$0

NOVOPEN ECHO 3


$0


$0



2


74



2


2


2


3


$0 QL


2


2


2

PRECISION LINK E


E


E



E


E


E


E


3



E


E




3


3


3


E

TRUE METRIX LEVEL 1

E

TRUE METRIX LEVEL 2

E

TRUE METRIX LEVEL 3

E


E

TRUETRACK TEST E


E


BAQSIMI ONE PACK 2

BAQSIMI TWO PACK 2

diazoxide oral 1



2 Made by Lilly


2Made by Fresenius


2


2

GVOKE PFS 2

PROGLYCEM 3

Diabetes - Insulins

ADMELOG E

ADMELOG SOLOSTAR

E


75



3 PA

APIDRA SOLOSTAR E

APIDRA VIAL E

BASAGLAR KWIKPEN E

FIASP E

FIASP FLEXTOUCH E

FIASP PENFILL E


2


2


2


2


2


2

HUMALOG VIAL 2


2

HUMULIN 7030 VIAL 2

HUMULIN N KWIKPEN 2

HUMULIN N VIAL 2


2


2

HUMULIN R VIAL 2


E

INSULIN ASPART E


E



E


E


E


E


E


E


$0

INSULIN SYRINGES $0


2

LANTUS U-100 VIAL 2


E


LYUMJEV 2

LYUMJEV KWIKPEN 2


$0

MYXREDLIN 3


$0


$0


$0


E


76



E

NOVOLIN 7030 RELION

E

NOVOLIN 7030 VIAL E

NOVOLIN N FLEXPEN E


E

NOVOLIN N RELION E

NOVOLIN N VIAL E

NOVOLIN R FLEXPEN E


E

NOVOLIN R RELION E

NOVOLIN R VIAL E


E


E


E


E



$0

SEMGLEE E

TOUJEO MAX SOLOSTAR

2

TOUJEO SOLOSTAR 2

TRESIBA E

TRESIBA FLEXTOUCH

E


ABANEU-SL E

ACTITROM-D E

active fe E

ACTIVITE E

adcf (05mgml) 1


ADRENAL C FORMULA

E

airavite E

aminoamrms E


E

aminoreliefrms E

animal shapes E

ANIMI-3 E

ANIMI-3VITAMIN D E


E

ASCOR E


E


E

ATABEX OB 2


E

AZESCO E


E


E

BACMIN E


biocel E

biopetit E


E

bp vit 3 E

b-plex E

b-plex plus E


E


77


CALCIFOL 3


E


E


E


E


CARBAGLU 2 SP


E


E


E


E


E


E


E


E


E


E


E


E

CARNITOR ORAL 3

CARNITOR SF 3

CENFOL E

CENTRATEX E


CEREFOLIN E


E

CHEMET 3


E

CHOLECAL DF E


E

CIFEREX E

CIFRAZOL E

CITRANATAL BLOOM E

CITRANATAL ESSENCE

E

CITRANATAL MEDLEY

E

clovique 1 PA SP


E

corvita E

corvita 150 E

CORVITE 150 E

corvite fe E


E


1


3

cytra k crystals E


E

d3 super strength E



E


78



E

deferasirox 1 PA


deferiprone 1 PA


E

DEPLIN 15 E

DEPLIN 75 E


E

dexifol E

dialyvite E

DIALYVITE 3000 E

DIALYVITE 5000 E

DIALYVITE SUPREME D

E

DIALYVITEZINC E


3

DURACHOL E

d-vite pediatric E


3


1

ELFOLATE E


E

ELITE-OB 2

ENBRACE HR E

ERGOCAL E


1


E


EXJADE 3 PA

fabb E


E

FERAHEME E

FERIVA 217 E

FERIVAFA E

ferocon E

ferotrinsic E

FERRALET 90 E

ferraplus 90 E

FERRIPROX 3 PA


3 PA

FERRLECIT E



E

FERROTRIN E


E


E


E


E

FLORIVA E

FLORIVA PLUS E

FLUORABON $0

fluoritab $0


$0

folbee E

folbee plus E

folbee plus cz E


79


FOLBIC RF E

FOLGARD OS E

FOLGARD RX E



1


$0

FOLIC D3 E

FOLIC-K E

FOLI-D E

FOLITE E

FOLIVANE-F E

FOLIVANE-PLUS E

FOLIXAPURE E

folplex 22 E

foltanx E

FOLTANX RF E

FOLTRATE E

FOLTREXYL E

foltrin E


E

FOLVITE-D E

FOSTEUM E

FUSION PLUS E

GALZIN 3

GENICIN VITA-D E

GENICIN VITA-Q E

GENICIN VITA-S E


E


HEMATOGEN E

HEMATOGEN FA E

HEMATRON-AF E

HEMETAB E

HEMOCYTE PLUS E




E

HYLAVITE E

HYLAZINC E

ICAR-C PLUS E

iferex 150 forte E

INFED E

INFUVITE ADULT E


E

INTEGRA F E

INTEGRA PLUS E

IODINE STRONG ORAL

3

IROSPAN 246 E

ISOLYTE-S E

JADENU 3 PA


JYNARQUE 3 SP QL

KCL-LIDOCAINE-NACL

E


klor-con 10 1

klor-con m10 1

KLOR-CON M15 3

klor-con m20 1


1


1

klor-con sprinkle 1

klor-conef 1

K-PHOS NO 2 E


3


E


80


K-PHOS-NEUTRAL 3

k-prime 1

K-TAB 3

k-tan plus E

L-CYSTINE E


1


levocarnitine sf 1

L-ISOLEUCINE E

l-methylfolate E


E


E



E


E


E

l-methyl-mc E

l-methyl-mc nac E

LOKELMA 3

LORID E


MVI ADULT E


E

MAGNEBIND 400 3


E



E


E


E

magnesium-oxide E


E

MEPHYTON 3

metafolbic E

metafolbic plus E


METANX ORAL CAPSULE

E


E

MICROPLEGIA MSA-MSG

E

MIFEPREX 3

mifepristone 1

M-NATAL PLUS 2

MULTIGEN E

MULTIGEN FOLIC E

MULTIGEN PLUS E


E

MULTIPRO E



1


1


1


81



E


1


1


E

mynephron E


E


nafrinse $0

nafrinse drops $0

NASCOBAL 3

NEONATAL + DHA E

NEONATAL 19 2

NEONATAL COMPLETE

E

NEONATAL FE E

NEONATAL PLUS 2

NEOVITE E

NEPHPLEX RX E

NEPHRON FA E


NEPHRO-VITE RX E

NESTABS 2

NESTABS ONE E

NEURIN-SL E


E

NICADAN E

NICAZEL E

NICAZEL FORTE E



E

NIFEREX ORAL TABLET

E


E

NUFERA E

nufol E

NUTRICAP E

nutrifac zx E

NUTRIVIT E


E

one daily E

ONE VITE WOMENS $0


2

ONEVITE E

ORACIT 3

ORTHO DF E

OVEEZA E


E


E


E


E

pediavit E


phosphorous 1


E


E


82



1

PHOXILLUM BK425 E


E

PHYSIOLYTE E


E


E

phytonadione oral 1

PLASMA-LYTE 148 E

PLASMA-LYTE A E


E


POLY-VI-FLOR FS 3


3


E


2


E


POTABA ORAL CAPSULE

E


1



E


1



1



E

PREGENNA E

PREMESISRX E

PRENAISSANCE E

PRENARA E


$0



1


E


1

PRENATE E


E


E

PRENATE ENHANCE E


E


E

PRENATE PIXIE E

PRENATE RESTORE E

PRENATRIX E

PRENATRYL E

PRENATVITE COMPLETE

E

PRENATVITE PLUS 2


83


PRENATVITE RX 2

preplus 1

pretab 1


E

PROTEINEX P18 E



E


E

QUFLORA FE E


E

QUFLORA GUMMIES E

QUFLORA PEDIATRIC E

RELNATE DHA 2

REMEDIENT E


E


RENATABS E

RENATABS WITH IRON

E

rena-vite E


E

REQ 49+ E

REVESTA E



2 SP QL


3 SP QL


E

se-tan plus E


SIDEROL ORAL TABLET

E


E



E


E


E


E


E


E


E


E



1


1

soluvita e E

sps 1

STROVITE FORTE E

STROVITE ONE E

SUPERVITE E

support E

SUPPORT-500 E


84


SYNAGEX E

SYPRINE 3 PA SP


E

TALIVA E

TARON FORTE E

taron-crystals E


tis-u-sol E

tl-hem 150 E


E SP


1 SP QL


2

tricitrates E

tricon E



E

trinate 1

TRINAZ E

triphrocaps E

TRISTART ONE E

TRI-VI-FLOR 3

TRI-VI-FLORO 3


tri-vitefluoride 1

TRONVITE E

TRYPTOPHAN ORAL E

UDAMIN SP E

UROCIT-K 10 3

UROCIT-K 15 3

UROCIT-K 5 3


urosex E

v-c forte E

VELTASSA 3

VENOFER E

vic-forte E

vinate one 1

virt-caps E

VIRT-FEFA PLUS E

virt-gard E


vita s forte E

vitacel E


E

VITAFOL ORAL TABLET

E

VITAFOL STRIPS 2

VITAFOL-OB+DHA E

VITAL-D RX E

VITAMAX PEDIATRIC E

VITAMEZ E

vita-min E



E



E


E


1


E


85



E


E


E


E


VITAROCA PLUS E


E

VITASURE E


E

VITREXATE E

VITREXATE FE E

VITREXYL E

VITREXYL + IRON E

vp-pnv-dha 1

vp-vite rx E

weekly-d E

westab mini E

westab one E

WESTAB PLUS 2

WESTGEL DHA E


E

XAQUIL XR E

XVITE E

ZALVIT E


E




E


E

ACIPHEX E

ACIPHEX SPRINKLE E


3


E


cimetidine oral 1

CYTOTEC 3

DEXILANT 2 QL

ESOMEP-EZS E


1 QL


1 QL


E


1


1

FIRST-LANSOPRAZOLE

3 ST



E


1 ST QL


86



1 QL

misoprostol oral 1


E

NEXIUM ORAL PACKET

3 QL

nizatidine 1


E


1 ST QL


E


3 ST


E


1 ST QL

PEPCID ORAL TABLET

3

PREVACID E

PREVACID 24HR E


3 ST QL


3 ST QL



E


E


1 ST QL


sucralfate oral 1

ZEGERID E


ACTIGALL 3

ACTIPHLORA E

alosetron hcl 1 PA


E


E

alvimopan 1

AMITIZA E


1 ST

ANASPAZ 3


E

antacid calcium E



E

antacid maximum E


E



E




E


E


87



E


E


E


E


E

BACICAP E


E

bisacodyl ec $0 QL

bisacodyl rectal E


E


1

CHENODAL 3 PA SP


E


citroma $0 QL


CLENPIQ 3

constulose 1


CUVPOSA 3


E



E


E


diotame instydose E


docusate mini E


E


E

docuzen E

dok oral tablet E

DONNATAL E

ed-spaz 1

ENTEREG 3

enulose 1


E

EX-LAX ULTRA E



E

FOLIKA PROBIOTIC E


E


E

GASTROCROM 3

GATTEX 3 PA SP


gavilyte-c $0 QL

gavilyte-g $0 QL

gavilyte-h 1


$0 QL

GELUSIL E

generlac 1


88




geri-kot E

GIALAX E

GLYCATE E

glycolax $0 QL


E


E


1


E

glycopyrrolate pf E

gnp senna lax E


3


E


E

HELIDAC THERAPY 3



E


E


E



1


1


1



E


1


1


E

hyosyne 1


E


E


E


E


LACTOJEN E


1

lactulose oral 1

laxative max str E


E

LEVBID E

LEVSIN ORAL TABLET

E

LEVSINSL E


89


LIBRAX 3

LINZESS 2 ST QL

LOMOTIL ORAL TABLET

3


1


E


E

LOTRONEX 3 PA


E


$0 QL


E


1


E



E



E

MOTEGRITY 3 ST QL

MOTOFEN E

MOVANTIK E

MOVIPREP E

MYTESI 3 QL


E


E

NULEV 3

NULYTELY LEMON-LIME

3



3

OMECLAMOX-PAK 2

opium E


oscimin sr E


OSMOPREP E


E

PCP 100 E


$0 QL



1


1

peg-prep 1


E


E


E


1

phenohytro E


E

PLENVU E

PROBICHEW E

PRODIGEN E


E


1

PYLERA 2


90



QUAD-PROBIOTIC E

RELISTOR ORAL E


E

RESTORA RX 3


E

senexon-s E

senna oral liquid E


E


E


senna s E

senna smooth E


E

senna-plus E


E

SENOKOT S E


3 PA SP


E


E


E


3



E



E


E


E


E


E


E


E


3

SUTAB E

SYMAX DUOTAB E

symax-sl E

symax-sr E

SYMPROIC 2 ST QL

TALICIA 3

trilyte $0 QL

TRULANCE E

TUMS CHEWY BITES E

URSO 250 3

URSO FORTE 3

ursodiol oral 1


E


E

VIBERZI 3 PA QL

VISBIOME E


91


XERMELO 3 PA SP QL

ZELAC E

ZELNORM 3 PA QL

ZORBTIVE 3 PA SP


ALDURAZYME 2 PA SP



3 SP


3 SP

CERDELGA 3 PA SP


2 PA SP

CHOLBAM 3 PA SP

CREON 2

CRYSVITA 3 PA SP

CYSTADANE 3 SP

CYSTAGON 3 SP

ELAPRASE 2 PA SP

ELELYSO 3 PA SP

ENZADYNE E

EXONDYS 51 E SP

FABRAZYME 2 PA SP

GALAFOLD 3 PA SP QL

KANUMA 3 PA SP

KUVAN 3 PA SP

LUMIZYME 2 PA SP

MEPSEVII 3 PA SP

miglustat 1 PA SP

MYALEPT 3 PA SP

NAGLAZYME 2 PA SP


nitisinone 1 PA SP

NITYR 3 PA SP

OCALIVA 3 PA SP QL

ORFADIN 3 PA SP

PALYNZIQ 3 PA SP QL

PANCREAZE E

PERTZYE E

PROCYSBI 3 PA SP

RAVICTI 3 PA SP

REVCOVI 3 PA SP


1 PA SP


1 SP


1 SP

STRENSIQ 2 PA SP

SUCRAID 3 SP

VIMIZIM 3 PA SP

VIOKACE E

VPRIV 3 PA SP

VYONDYS 53 E SP

XURIDEN 3 PA SP QL

ZAVESCA 3 PA SP


2


3 PA SP


3 PA SP


3 PA SP


92



3 PA SP


3 PA SP


3 PA SP


3 PA SP

ZOLGENSMA 26-30 KG

3 PA SP

ZOLGENSMA 31-35 KG

3 PA SP

ZOLGENSMA 36-40 KG

3 PA SP

ZOLGENSMA 41-45 KG

3 PA SP

ZOLGENSMA 46-50 KG

3 PA SP

ZOLGENSMA 51-55 KG

3 PA SP

ZOLGENSMA 56-60 KG

3 PA SP

ZOLGENSMA 61-65 KG

3 PA SP

ZOLGENSMA 66-70 KG

3 PA SP

ZOLGENSMA 71-75 KG

3 PA SP

ZOLGENSMA 76-80 KG

3 PA SP

ZOLGENSMA 81-85 KG

3 PA SP

ZOLGENSMA 86-90 KG

3 PA SP

ZOLGENSMA 91-95 KG

3 PA SP

ZOLGENSMA 96-100 KG

3 PA SP



aminoacetic acid E

AURYXIA 3

azo tabs E


1

BI-MIX 3


1


1

CAVERJECT IMPULSE

3 QL


3 QL

CERVIDIL 3

CIALIS 3 QL


3 PA SP


1


DETROL 3

DETROL LA 3


3

EDEX 3 QL

ELMIRON 2


3

FEM PH E

flavoxate hcl 1


93



3


3


3 ST


glycine urologic E

hyophen E

INTRAROSA 3 ST



E

LITHOSTAT 3

menaphosmbhyo1 E

MUSE 3 QL

MYRBETRIQ 2



OXYTROL 3 ST QL

OXYTROL FOR WOMEN

E


1 PA SP



E


1


1


E

PHOSLYRA 3


phosphasal E

PREPIDIL 3

PROSTIN E2 3

PYRIDIUM E

QUAD-MIX 3

RENACIDIN E


E

RENVELA 3

RIMSO-50 E


sevelamer hcl 1


1 QL


STAXYN E

STENDRA E

SUPER BI-MIX 3

SUPER QUAD-MIX 3

SUPER TRI-MIX E

tadalafil oral 1 QL

THIOLA 3 SP

THIOLA EC 3 SP



TOVIAZ 3

TRI-MIX E



URELLE E


1

URIBEL E

URIMAR-T E


1


94



E

URO-458 E

UROGESIC-BLUE E

uro-mp E

ustell E

uticap E

utira-c E

utrona-c 1


VELPHORO 3

VESICARE 3

VIAGRA E

vilamit mb E

VILEVEV MB E


alfuzosin hcl er 1

AVODART 3

CARDURA XL 3 ST

dutasteride oral 1


1


1

FLOMAX E

JALYN 3

PROSCAR 3

RAPAFLO 3

silodosin 1

tamsulosin hcl 1


UROXATRAL 3




E



E


E

ALKINDI SPRINKLE E

BETA 1 KIT E

BETALOAN SUIK E

BETAMETHASONE COMBO

E


E


E


E

BSP 0820 E

CELESTONE SOLUSPAN

E


E

CORTEF 3



E

DEPO-MEDROL E

DEXABLISS E


1



E


95



E


E


E


E


E

DEXONTO 04 3

DMT SUIK E

DOUBLEDEX E

DXEVO 11-DAY E

DYURAL-40 E

DYURAL-80 E

DYURAL-L E

DYURAL-LM E


1

HEMADY E

HIDEX 6-DAY E


KENALOG INJECTION 3

KENALOG-80 3

MAS CARE-PAK E


3


2



3

MEDROLOAN II SUIK E

MEDROLOAN SUIK E


E


E


E


E


E


1


3


E

MULTI-SPECIALTY E

ORAPRED ODT 3

P-CARE K40 E

P-CARE K40G E

P-CARE K40MX E

P-CARE K80 E

P-CARE K80G E

P-CARE K80MX E

PEDIAPRED 3


E


96



E

POD-CARE 100K E

POINT OF CARE L2 E

POINT OF CARE L5 E


E


1


1


1


prednisone oral 1

PRO-C-DURE 5 E

PRO-C-DURE 6 E

RAYOS E


E


E


E


3

TAPERDEX 12-DAY E

TAPERDEX 6-DAY E


E

TOPIDEX E



E


1


3


E

TRILOAN II SUIK E

TRILOAN SUIK E

ZCORT 7-DAY E

ZILRETTA E


ANADROL-50 3 PA


2 PA


3 PA


3 PA


E

AVEED E

danazol oral 1


E


97


EC-RX TESTOSTERONE

E

FORTESTA E

JATENZO E

METHITEST 3 PA


NATESTO E


TESTIM E

TESTONE CIK E

TESTOPEL E


E


E


1 PA


1 PA


E


1 PA


1 PA

VOGELXO PUMP E


E


XYOSTED 3 PA


EVISTA 3

OSPHENA 3

raloxifene hcl 1


ACTHAR 2 PA SP

BYNFEZIA PEN E SP

cabergoline 1


E SP


1 PA SP



3

DDAVP NASAL 3

DDAVP ORAL 3

DDAVP RHINAL TUBE 2


1


1


1


1


ELIGARD 3 PA SP QL



3 PA SP QL


3 PA SP QL


98



2 PA SP


1 PA SP



GENOTROPIN E SP


E SP

GONAL-F E SP

GONAL-F RFF E SP


E SP

HUMATROPE E SP

INCRELEX 2 PA SP

ISTURISA E SP


1 PA SP



3 PA SP


2 PA SP


3 PA SP


2 PA SP


2 PA SP



2 PA SP


3 PA SP


2 PA SP


3 PA SP


2 PA SP

MENOPUR 3 PA SP

MYCAPSSA E SP

NOCDURNA 3


2 PA SP


1 PA SP


3 PA SP


2 PA SP


99



2 PA SP


2 PA SP


1 PA SP


E SP


E SP

ORILISSA 2 PA QL

OVIDREL 3 PA SP


E


E

pregnyl 1 PA SP

SAIZEN E SP

SAIZENPREP E SP


E SP


E SP


SIGNIFOR 3 PA SP QL


3 PA SP QL


SOMAVERT 3 PA SP

STIMATE 3


SYNAREL 2

TEPEZZA 3 PA SP



VANTAS 3 PA SP QL


3 SP QL


2 SP QL

ZOMACTON E SP


E SP


KORLYM 3 PA SP QL



3

afirmelle $0 QL

ALORA 3 ST

altavera $0 QL

alyacen 135 $0 QL

alyacen 777 $0 QL

amabelz 1

amethia $0 QL

amethia lo $0 QL

amethyst $0 QL


100


ANGELIQ 3

ANNOVERA E

apri $0 QL

aranelle $0 QL

ashlyna $0 QL

aubra $0 QL

aubra eq $0 QL

aurovela 1530 $0 QL

aurovela 120 $0 QL




aviane $0 QL

AYGESTIN 3

ayuna $0 QL

azurette $0 QL

BALCOLTRA E

balziva $0 QL

bekyree $0 QL

BEYAZ E


E

BIESTPROGESTERONE

E

BIJUVA 3

blisovi 24 fe $0 QL



briellyn $0 QL

camila $0 QL

camrese $0 QL

camrese lo $0 QL

caziant $0 QL


chateal $0 QL

chateal eq $0 QL

CLIMARA 3


CLIMARA PRO 2

COMBIPATCH 3

covaryx E

covaryx hs E


3 QL


3 PA QL

cryselle-28 $0 QL

cyclafem 135 $0 QL

cyclafem 777 $0 QL

cyred $0 QL

cyred eq $0 QL

dasetta 135 $0 QL

dasetta 777 $0 QL

daysee $0 QL

deblitane $0 QL

DELESTROGEN 3

delyla $0 QL

DEPO-ESTRADIOL 3


3 QL


3 QL


$0 QL


$0 QL

DIVIGEL 3

dotti 1


$0 QL


101



$0 QL

DUAVEE 2

EC-RX ESTRADIOL E

EC-RX PROGESTERONE

E

eemt E

eemt hs E

ELESTRIN 3

elinest $0 QL

ELLA $0 QL

eluryng $0 QL

emoquette $0 QL

ENDOMETRIN 2 PA

enpresse-28 $0 QL


$0 QL

errin $0 QL


E


E


E

estarylla $0 QL

ESTRACE 3

estradiol oral 1


estradiol vaginal 1


1


1

ESTRING 3 QL

ESTROGEL 3

ESTROSTEP FE 3 QL


$0 QL



$0 QL

EVAMIST 3


E

falmina $0 QL

fayosim $0 QL

FEMHRT LOW DOSE 3

FEMRING 3 ST QL

femynor $0 QL


E

fyavolv 1

gemmily $0 QL

GENERESS FE 3 QL

gianvi $0 QL

hailey 1530 $0 QL

hailey 24 fe $0 QL


hailey fe 120 $0 QL

heather $0 QL


1 PA SP


3


3

incassia $0 QL

introvale $0 QL

isibloom $0 QL

jaimiess $0 QL

jasmiel $0 QL

jencycla $0 QL

jinteli 1

jolessa $0 QL

juleber $0 QL


102


junel 1530 $0 QL

junel 120 $0 QL

junel fe 1530 $0 QL

junel fe 120 $0 QL

junel fe 24 $0 QL

kaitlib fe $0 QL

kalliga $0 QL

kariva $0 QL

kelnor 135 $0 QL

kelnor 150 $0 QL

kurvelo $0 QL

KYLEENA E

larin 1530 $0 QL

larin 120 $0 QL

larin 24 fe $0 QL

larin fe 1530 $0 QL

larin fe 120 $0 QL

larissia $0 QL

layolis fe $0 QL

leena $0 QL

lessina $0 QL

levonest $0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL

levora 01530 (28) $0 QL


E


lillow $0 QL






lojaimiess $0 QL

loryna $0 QL

LOSEASONIQUE 3 QL

low-ogestrel $0 QL


lutera $0 QL

lyllana 1

lyza $0 QL

MAKENA 2 PA SP

marlissa $0 QL


$0 QL


1


1


1



2

MENOSTAR 3 ST

mibelas 24 fe $0 QL





mili $0 QL

mimvey 1

MINASTRIN 24 FE E

MINIVELLE 3 ST


103


MIRCETTE 3 QL

MIRENA (52 MG) E

mono-linyah $0 QL

NATAZIA $0 QL

necon 0535 (28) $0 QL

NEXPLANON E

nikki $0 QL

nora-be $0 QL


$0 QL


$0 QL


$0 QL


1


$0 QL



1



$0 QL


$0 QL

norlyda $0 QL

norlyroc $0 QL

nortrel 0535 (28) $0 QL



nortrel 777 $0 QL

NUVARING 3 QL

ocella $0 QL

ORIAHNN 2 PA QL

orsythia $0 QL


ORTHO MICRONOR E


E

philith $0 QL

pimtrea $0 QL

pirmella 135 $0 QL

pirmella 777 $0 QL


portia-28 $0 QL

PREFEST 3

PREMARIN ORAL 2

PREMARIN VAGINAL 2

PREMPHASE 2

PREMPRO 2

previfem $0 QL


E


1


1


E

PROMETRIUM 3

PROVERA 3

QUARTETTE 3 QL

reclipsen $0 QL

rivelsa $0 QL

SAFYRAL 3 QL

SEASONIQUE 3 QL

setlakin $0 QL

sharobel $0 QL

simliya $0 QL

simpesse $0 QL

SKYLA E

SLYND E

sprintec 28 $0 QL


104


sronyx $0 QL

syeda $0 QL

tarina 24 fe $0 QL

tarina fe 120 $0 QL


TAYTULLA E

tilia fe $0 QL

tri femynor $0 QL

tri-estarylla $0 QL

tri-legest fe $0 QL

tri-linyah $0 QL


tri-lo-marzia $0 QL

tri-lo-mili $0 QL


tri-mili $0 QL

tri-previfem $0 QL

tri-sprintec $0 QL

trivora (28) $0 QL

tri-vylibra $0 QL


tulana $0 QL

TWIRLA 3 QL

tyblume $0 QL

tydemy $0 QL


E

velivet $0 QL

vienva $0 QL

viorele $0 QL

VIVELLE-DOT E

volnea $0 QL

vyfemla $0 QL

vylibra $0 QL

wera $0 QL

wymzya fe $0 QL

xulane $0 QL


YASMIN 28 3 QL

YAZ E

yuvafem 1

zarah $0 QL

zovia 135 (28) $0 QL

zovia 135e (28) $0 QL

zumandimine $0 QL


ARMOUR THYROID 3 ST

CYTOMEL E

euthyrox 1

levo-t 1


E


1

levoxyl 1


methimazole oral 1

NATURE-THROID 3 ST

np thyroid 1


SYNTHROID 3

TAPAZOLE 3

TIROSINT E

TIROSINT-SOL 3

unithroid 1


3 ST

WP THYROID 3 ST


ACTEMRA 3 PA SP


105



ACTIMMUNE 2 PA SP

ALFERON N 2 SP

ARAVA 3

ARCALYST 3 PA SP

ASCENIV E SP

ASTAGRAF XL 3 SP

ATGAM 2 SP

AVSOLA 3 PA SP

AZASAN 3

azathioprine oral 1


BENLYSTA 3 PA SP

BERINERT 3 PA SP QL


3 PA SP


3 PA SP

CELLCEPT 3 SP


3 SP


2 PA SP



CINRYZE 2 PA SP


E SP

COSENTYX 150 MGML

E SP


E SP



E SP

CUTAQUIG E SP

CUVITRU 3 PA SP


1 SP



1 SP

CYTOGAM 2 PA SP

ENBREL MINI 3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP

ENSPRYNG E SP

ENTYVIO 3 PA SP

ENVARSUS XR 3 SP


1 PA SP

FIRAZYR 3 PA SP QL


GAMASTAN 2 PA SP

GAMIFANT 3 PA SP

GAMMAGARD 3 PA SP


106



3 PA SP


3 PA SP


3 PA SP

GAMUNEX-C 3 PA SP


1 SP


HAEGARDA 3 PA SP

HEPAGAM B E


3 PA SP


3 PA SP


2 PA SP


2 PA SP


2 PA SP



2 PA SP


2 PA SP


2 PA SP

HYPERHEP B SD E

HYPERRAB E


E


2 SP

HYPERTET SD E

HYQVIA 3 PA SP



2 PA SP QL

ILUMYA 3 PA SP


E

IMURAN 3

INFLECTRA 2 PA SP

KALBITOR 3 PA SP QL

KEDRAB INJECTION E

KEVZARA 3 PA SP


3 PA SP

KYMRIAH 3 PA SP

leflunomide oral 1

methotrexate oral 1


107



1


1


1


1


2 SP



1 SP


MYFORTIC 3 SP

NABI-HB E

NEORAL 3 SP

NULOJIX 3 PA SP

OCTAGAM 3 PA SP

OLUMIANT E SP


ORENCIA INTRAVENOUS

3 PA SP


3 PA SP

OTEZLA ORAL TABLET

2 PA SP


2 PA SP



3 PA QL


E

PANZYGA E SP

PRIVIGEN 3 PA SP

PROGRAF 3 SP

PROVENGE 2 PA SP

RAPAMUNE 3 SP


2 PA QL

REDITREX E

REMICADE E SP

RENFLEXIS 2 PA SP


2 SP


E


108


RIDAURA 3 SP

RINVOQ 2 PA SP

RUCONEST 3 PA SP QL


2 SP


3 SP


2 SP

SILIQ 3 PA SP



2 PA SP


2 PA SP

SIMULECT E

sirolimus oral 1 SP


2 PA SP

STELARA INTRAVENOUS

2 PA SP


2 PA SP QL


2 PA SP QL

SYNAGIS 2 PA SP


TAKHZYRO 3 PA SP

TALTZ 3 PA SP

temsirolimus 1 SP

THYMOGLOBULIN E

TICE BCG 2 SP

TORISEL 3 SP


TREMFYA 2 PA SP

TREXALL 3

UPLIZNA 3 PA SP


E

WINRHO SDF 2 SP

XATMEP 3

XELJANZ 2 PA SP

XELJANZ XR 2 PA SP

XEMBIFY 3 PA SP

ZINPLAVA E

ZORTRESS 3 PA SP


ACTHIB $0


$0


$0

BCG VACCINE E

BEXSERO $0

BIOTHRAX E


$0


$0


$0


$0

FLUAD $0


109


FLUAD QUADRIVALENT

$0


$0


$0


$0


$0


$0


$0

GARDASIL 9 $0


$0


$0


IMOVAX RABIES E

INFANRIX $0


$0

IXIARO E

MENACTRA $0

MENQUADFI $0


MENVEO $0



$0

PNEUMOVAX 23 $0

PREVNAR 13 $0

RABAVERT E


$0

ROTARIX $0


$0


$0

STAMARIL E

TDVAX $0

TENIVAC $0


$0

TRUMENBA $0


$0


E


$0

VARIVAX $0

VAXCHORA E


110


VIVOTIF E

YF-VAX E


ana-lex E


E


E


3


E

anucort-hc E

ANUSOL-HC EXTERNAL

3


E

APRISO 2

ASACOL HD E

AZULFIDINE 3




1

budesonide oral 1

CANASA E

COLAZAL 3

CORTENEMA 3

CORTIFOAM EXTERNAL

3

DELZICOL E

DIPENTUM E


3


E



E


1


1


E


1


E

LIALDA E


E


E


E

LIDOCORT EXTERNAL

E

mesalamine er 1

mesalamine oral 1

mesalamine rectal 1


ORTIKOS E

PENTASA 3

PROCORT EXTERNAL E

PROCTOCORT EXTERNAL

3


E


2





111


ROWASA RECTAL 3

SFROWASA 2


UCERIS 3



3 QL


1


1


1 QL

ATELVIA 3 QL

BINOSTO 3 QL

BONIVA INTRAVENOUS

E


3 QL


EVENITY 3 PA SP QL


2 PA SP


3 QL

FOSAMAX PLUS D E


E


1 QL

MIACALCIN INJECTION

3




2 PA SP QL

RAYALDEE 3

RECLAST 3 SP


1 QL


1


1 QL


2 PA SP

TYMLOS 2 PA SP

XGEVA 2 PA SP


1 SP


1 SP



E

calcitriol oral 1

cinacalcet hcl 1 PA


NATPARA 3 PA SP QL


paricalcitol oral 1

PARSABIV 3 SP

ROCALTROL 3

SENSIPAR 3 PA

ZEMPLAR INTRAVENOUS

E


3


112




ACACIA SUBCUTANEOUS

E


E


E


E

ACREMONIUM E

ACTHREL 3 SP


E

ACUNOL E

ADAKVEO 3 PA SP

ADULT AEROSOL MASK

E


E


3


3

ALDER E

ALTERNARIA E

AMERICAN BEECH E

AMERICAN COCKROACH

E

AMERICAN ELM E

AMERICAN SYCAMORE

E

AMINOPMRMS E


E



E


E

APP SLIM RMS E

APPTRIM E

APPTRIM-D E


E

ARIZONA CYPRESS E


3

asilnasalrms E

ASPARTAME E


E

AUREOBASIDIUM E

AUSTRALIAN PINE E


E


E


E

AVAILNEX E

AVITENE E

AVITENE FLOUR E

AXONA E

AZALGIA E

BAHIA E

BALD CYPRESS E


E


E

BHI URI-CONTROL E


113


BLACK WALNUT POLLEN

E

BLACK WILLOW E



E

BOX ELDER E


E


E


E


E


E

BROME E


E


E


E

CARDIOVID PLUS E


E


E


E


E


E



E

CARTICEL E


E

CATTLE EPITHELIUM E

CAYA $0 QL

CEDAR ELM E


E


E

COCKLEBUR E


E

COLCIGEL E


E


E


E

CONDOMS E

CORN POLLEN E

CORTROSYN E


CROFAB E

CURVULARIA E

DANDELION E



E


114



E

desflurane 1


E


E


E


E


E

DIGIFAB E

DOG EPITHELIUM E

DOG FENNEL E

DOJOLVI E

DRECHSLERA E


2 PA SP


E

DYSPORT 3 PA SP

EASIVENT 2

EASTERN COTTONWOOD

E

EC-RX DHEA E

ECZEMOL E

ENDARI 3 PA

ENDO AVITENE E



E


E


E


E


E


E


E

ENGLISH PLANTAIN E

ENLYTE E


ENTERAGAM E

enteric fish oil E

EPICOCCUM E

EPISIL E

EQUACARE JR E


ESSENTIAL CARE JR E


2 PA SP

EVRYSDI E SP

FIRDAPSE E SP

FIRE ANT E


2


2


115



2

FORANE 3


E


3


E

FOSTEUM PLUS E

FOVEX E

FUSARIUM E

GABADONE E

GELCLAIR E

GELFILM EXTERNAL E

GEL-FLOW E

GEL-FLOW NT E

GELFOAM E


E


E

GELFOAM SPONGE E


E


E


E

GELFOAM-JMI POWDER

E

GELFOAM-JMI SPONGE

E

GELSYN-3 2 PA SP

GELX E

GERMAN COCKROACH

E

GIVLAARI 3 PA SP


GLEOLAN E


3


E


E


E


E


E

GLYTACTIN BURST E


E


E

GLYTACTIN RESTORE 5

E


E


E


E

GLYTACTIN RTD 15 E


E


E

GOLDENROD E

GRASTEK 3 PA QL

H2Q ORAL POWDER E

HACKBERRY E


1


1


116


HEPMED E

HIBICLENS E

HOMACTIN AA PLUS E

HOME PAP KIT E


E

HORSE EPITHELIUM E

HUMATROPEN FOR 12MG

E

HUMATROPEN FOR 24MG

E

HUMATROPEN FOR 6MG

E

HYALGAN E SP

HYLAFEM E

HYMOVIS E SP

HYPERTENSA E


2

INTERCEED E

IOSAT E

isoflurane 1

ISOVACTIN AA PLUS E

JOHNSON GRASS E


E

KAPOK E


3


E

KETOVIE LIQUID ORAL

E


KETOVIE PEPTIDE E

KOCHIA E

LAMBS QUARTERS E

LENSCALE E

LIMBREL E

LIMBREL250 E

LIMBREL500 E

LISTER-V E

LORMATE E

MACRILEN E

MACUTEK E

MASK VORTEX E


E

MELALEUCA E

MESQUITE E


E

METHAVER E



E


1 QL

METOPIRONE E


E


E


E

MIXED ASPERGILLUS E

MIXED FEATHERS E

MIXED RAGWEED E


117



E

MKO MELT DOSE PACK

E

mlk f1 E

mlk f2 E

mlk f3 E

mlk f4 E

MONOVISC E SP

MORCIN E

MOUNTAIN CEDAR E

MOUSE EPITHELIUM E

MUCOR SUBCUTANEOUS

E

MUCOTROL E

MUGARD E

MUGWORT E

MYOBLOC 3 PA SP

NEODOT THERMOMETER

E

NEUREPA E

NICAPRIN E

NICAZYME E


E


OLIVE TREE E

OMNIVEX E

OPTIONS CONCEPTROL

$0 QL

ORALAIR 3 PA QL


3 PA QL


3 PA QL



3 PA QL


3 PA QL

ORAMAGICRX E


E


E SP

OXBRYTA E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E


118



E


E


E

PECAN POLLEN E


E

PERCURA E


E

PH STRIPS E

PHENACTIN AA PLUS E

PHEXXI E

PHOMA EXIGUA E


3

PRAXBIND E


E


E

PRID E

PRIVET E

PRO-CRITIC E


E

PROLEVA E


E



E

PSORIZIDE FORTE E

PSORIZIDE ULTRA E

PULMONA E

PURAMINO DHAARA E

QUEEN PALM E

RABBIT EPITHELIUM E

RADIOGARDASE 3

RAGWITEK 3 PA QL

RAPID GEL RX E

RED BIRCH E

RED CEDAR E

RED MAPLE E

RED MULBERRY E


E

RESECTISOL E


E

RHEUMATE E

RHIZOPUS E

RIBOZEL E

ROUGH MARSH ELDER

E

ROUGH PIGWEED E

RUSSIAN THISTLE E

RUZURGI 3 PA SP


E

SAGEBRUSH E


E

SENTRA AM E

SENTRA PM E

sevoflurane 1


119


SHAGBARK HICKORY E

SHARPS CONTAINER E

SHEEP SORREL E


E

SILTREX E


E SP

SORBITOL IRRIGATION

E

sorbitol-mannitol E

SORRELDOCK MIX E

SPEEDGEL RX E

SPINRAZA 3 PA SP

SPINY PIGWEED E

STEMPHYLIUM E

SUPARTZ FX E SP

SUPRANE 3

SWEET GUM E


E


E SP


E SP

SYRINGE AVITENE E

TACHOSIL 3

TALL RAGWEED E

terrell 1

THERAMINE E

THERAMINE PLUS E

THROMBI-GEL 10 E

THROMBI-GEL 100 E

THROMBI-GEL 40 E

THROMBI-PAD E


THYROGEN 2 PA SP


E


3

TL-ICARE E

TOBAKIENT E


E

TRANZGEL E


E


E

TREPADONE E


E


E

TRILURON E SP


E

T-SUPPORT MAX E


E


E

TYLACTIN RESTORE 10

E


E

TYLACTIN RTD 15 E

TYROS 2 E

ULTANE 3


E


E


120



E


E


E


E

VASCULERA E


$0 QL


$0 QL

VILACTIN AA PLUS E

VILTEPSO E SP

VIRGINIA LIVE OAK E

VISTOGARD 3


E


E


E

WELLMIND VERTIGO E

westab max E

WESTERN JUNIPER E

WHITE ASH E

WHITE BIRCH E


E

WHITE MULBERRY E

WHITE OAK E


WHITE PINE E


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL

XEOMIN 3 PA SP

XIAFLEX 2 PA SP

XYZBAC E

XYZMUNE E

YELLOW DOCK E


E


E

ZYVEXOL E

ZYVIT E


ACULAR 3

ACULAR LS 3

ALAWAY E

ALOCRIL E


121


ALOMIDE 3

ALREX E

AZASITE 3


1


BEPREVE 3 ST

BESIVANCE 3


3

BLEPH-10 3


1 QL

BROMSITE E

CILOXAN 3


1


1


1

DEXTENZA E SP

DEXYCU E


1

DUREZOL E

epinastine hcl 1


1

eye itch relief E

EYSUVIS E

FLAREX 3


1


FML 2

FML FORTE 3

FML LIQUIFILM 3




1


1

ILEVRO E


E SP

INVELTYS 3


1

KLARITY-A E

KLARITY-L E



E


E


3

LOTEMAX SM 3


MAXIDEX 3

MITOSOL 3

MOXEZA 2


1


1

NATACYN 2

NEVANAC E

OCUFLOX 3



E


1


122



E


1


3 SP

PATADAY E


3

PRED FORTE 3

PRED MILD 3


E


1


E


1


E

PROLENSA 2 QL


E SP


1


TOBREX 3


TRIPLE PMB E

TRIPLE PMK E

UPNEEQ E

VIGAMOX 3

YUTIQ E SP

ZADITOR E

ZERVIATE E

ZIRGAN 3

ZYMAXID 3



acetazolamide er 1



2


E

apraclonidine hcl 1

AZOPT 2


1

BETIMOL 3

BETOPTIC-S 3



1


E

carteolol hcl 1

COMBIGAN 2

COSOPT 3


3


3


1


1


1

DURYSTA E


3

ISOPTO CARPINE 3


123


ISTALOL 3

KEVEYIS 3 PA SP QL



E


1


2 QL


PHOSPHOLINE IODIDE

2


1

RHOPRESSA 3 QL

ROCKLATAN 3 QL

SIMBRINZA 2


1



E


E


E

TIMOPTIC E


3


E

TIMOPTIC-XE E

TRAVATAN Z 3 QL



TRUSOPT 3

VYZULTA E

XALATAN 3

XELPROS 3 ST QL

ZIOPTAN E


ak-poly-bac 1

AKTEN 3

ALCAINE 3

altacaine 1

altachlore E

altafluor benox E


1


E


1


E


1


1


1

BEOVU E SP

BEVACIZUMAB 3 SP


bio glo E

BLEPHAMIDE 3

BLEPHAMIDE SOP 3

CEQUA E


124



E


E

CYCLOGYL 3

CYCLOMYDRIL 3


1


E

CYSTADROPS E SP

CYSTARAN 3 PA SP QL

DOUBLE PM E

EYLEA INTRAVITREAL

3 PA SP

flucaine E


fluor-i-strips at E

FLURA-SAFE E


E


E

GELFILM OPHTHALMIC

E


E


E


E


E

homatropaire 1


E

ISOPTO ATROPINE 3


LACRISERT 3

LASTACAFT 3 ST

LATISSE E

lissamine green E


E


lubricant eye pm E

lubricant pm E



E


2 PA SP


3 PA SP

MAXITROL 3

MEMBRANEBLUE 3


E


E

MYDRIACYL E


1


1


1


1


125



1

neo-polycin 1

neo-polycin hc 1

OXERVATE 3 PA SP QL

PAREMYD E


1

polycin 1


1

POLYTRIM 3

PRED-G 3

PRED-G SOP 3


E


E


E


E


E


E


E


1


E


REFRESH RELIEVA E


E

RESTASIS 2 PA


2 PA

ROSE GLO E


E


1

SYSTANE COMPLETE E


E

SYSTANE ULTRA PF E


1


3


E

TOBRADEX ST 3


1



E


E


E


E


126



E

ultra fresh pm E


E

VISIONBLUE 3

VISUDYNE 3 SP

XIIDRA 2 PA

ZYLET 3


acetic acid otic 1

CETRAXAL 3 ST

CIPRO HC 3

CIPRODEX 2



1


E

cortic-nd 1

DERMOTIC 3

exotic-hc 1

flac 1


1


1


1

ofloxacin otic 1

OTICIN HC NR 3

OTIPRIO E

OTOVEL E

PRAMOTIC 3



12 hour allergy-d E


E


E


ADRENALIN NASAL E

all day allergy d E



E

allergy 24-hr E

allergy childrens E


E



E



E


E


E


E


E


E


E


127



E


E




E


BECONASE AQ 3 QL

benzonatate 1

bromfed dm 1


1


1


E


E


1



E


E


E


E


E

CINQAIR 3 PA SP


E

CLARINEX-D 12 HOUR

E


E



E



1




E


E


3



E


E


E


E


E


1


1


E

DICOPANOL FUSEPAQ

E

DICOPANOL RAPIDPAQ

E


E

DI-PHEN E



128



E


E


1


E


E

DYMISTA 2 QL


FASENRA 2 PA SP

FASENRA PEN 2 PA SP


E


E


1 QL


1



GILPHEX TR E


E


E




E


E


E

hm loratadine E


HYCODAN 3 PA QL


1 PA QL


1 PA QL

hydromet 1 PA QL

HYPERSAL 3


3


1


E


1



loratadine-d 12hr E

loratadine-d 24hr E


maxi-tuss gmx E

maxi-tuss pe max E

m-dryl E

MICLARA LQ E


1 QL


E


E

MUCINEX DM E


E

mucus dm E


129



E


E


mucus-d E

mucus-er max E


E


E



E



NASONEX E


E


E


E

NEOTUSS PLUS E

NUCALA 2 PA SP QL


OMNARIS 3 QL

PATANASE 3 QL


PHENERGAN INJECTION

E


E



1




1


1 PA QL


1

promethegan 1

PROPEL E

PROPEL MINI E



1


E

QNASL 3 QL



E


E


3

ryvent E

SEMPREX-D E

sinus 12 hour E

SINUVA 3


1

SSKI E

SUDAFED CONGESTION

E

sudogest 12 hour E


E


130



E


3

TESSALON PERLES 3


E


E


E



E


E

TUXARIN ER E


E



E


XHANCE E

XOLAIR 2 PA SP

ZETONNA 3 QL


E


ACCOLATE 3


1



3

ADVAIR DISKUS 1 QL

ADVAIR HFA 2 QL

ADYPHREN E

ADYPHREN AMP E

ADYPHREN AMP II E

ADYPHREN II E

AIRDUO DIGIHALER E


E


E


E



1 QL


E


1 QL


E


1 QL


ALVESCO E


131


ANORO ELLIPTA 2 QL


3 PA SP


ARMONAIR DIGIHALER

E



E


E


E


E


E

ASMANEX HFA E

ATROVENT HFA 3 QL


3 QL


E

BEVESPI AEROSPHERE

E

BREO ELLIPTA 2 QL

BREZTRI AEROSPHERE

E

BROVANA 3 QL



E


COMBIVENT RESPIMAT

2 QL


1

DALIRESP 3 PA

difil-g forte 1

DUAKLIR PRESSAIR E

DULERA E

ELIXOPHYLLIN 2


1 ST


1


E


1 ST


1

EPINEPHRINESNAP-EMS

E

EPINEPHRINESNAP-V E


3 ST


E

EPISNAP E

ESBRIET 3 PA SP

FLOVENT DISKUS 2 QL

FLOVENT HFA 2 QL


132



E


1 ST QL

GLASSIA 3 PA SP

INCRUSE ELLIPTA E


1 QL



1 QL


E


3 QL


3 QL


1

OFEV 3 PA SP

PERFOROMIST 3 QL

PROAIR DIGIHALER E

PROAIR HFA E

PROAIR RESPICLICK E


3 PA SP



3 PA SP

PROVENTIL HFA E

PULMICORT FLEXHALER

2 QL


E

QVAR REDIHALER E

SEEBRI NEOHALER E


SINGULAIR E

SPIRIVA HANDIHALER

2 QL


2 QL

STERITALC 3


2 QL

STRIVERDI RESPIMAT

2 ST QL

SYMBICORT 2 QL

SYMJEPI 3


E


THEO-24 3

theophylline 1


1


1


133


E

UTIBRON NEOHALER E

VENTOLIN HFA E

wixela inhub E

XOPENEX NEB 3 QL

XOPENEX CONCENTRATE

3 QL

XOPENEX HFA E

YUPELRI 3 QL

zafirlukast 1

ZEMAIRA 3 PA SP

zileuton er 1 ST

ZYFLO E


BETHKIS 2 SP

CAYSTON 3 PA SP

KALYDECO 3 PA SP

KITABIS PAK E SP

ORKAMBI 3 PA SP QL

PULMOZYME 2 PA SP

SYMDEKO 3 PA SP QL

TOBI NEBULIZER E SP



1 SP


E SP


E SP


TRIKAFTA 3 PA SP QL


ADCIRCA 3 PA SP QL

ADEMPAS 2 PA SP QL

alyq 1 PA SP QL


bosentan 1 PA SP QL


FLOLAN 3 PA SP

LETAIRIS 3 PA SP QL

OPSUMIT 2 PA SP QL

ORENITRAM 3 PA SP


E SP

REVATIO INTRAVENOUS

3 PA SP



1 PA SP


1 PA SP QL


1 PA SP QL



E SP



TYVASO 3 PA SP QL



UPTRAVI 3 PA SP QL


134



TUDORZA PRESSAIR


VELETRI 3 PA SP

VENTAVIS 3 PA SP QL



AMRIX E

BACLOFEN EXTERNAL

E


baclofen oral 1

carisoprodol oral 1


1 QL


1

CYCLOGABA 10300 E



1


1


E

CYCLOPAK 3

CYCLOPHENE RAPIDPAQ

E


3


enovarx-baclofen E


E

FEXMID 3

FIRST-BACLOFEN E



E


E

LIORESAL E

LORZONE 3

METAXALL CP E

metaxalone 1


NOPIOID-LMC KIT E

NORGESIC FORTE E



1


E

OZOBAX E

ROBAXIN-750 3

SKELAXIN E

SOMA 3

TABRADOL FUSEPAQ E

TABRADOL RAPIDPAQ

E


VANADOM 3

ZANAFLEX E


AMBIEN E

AMBIEN CR E


135


armodafinil 1 PA QL

BELSOMRA 3 ST QL

DAYVIGO 3 ST QL


EDLUAR E

eszopiclone 1 QL


HETLIOZ 3 PA SP QL


3 QL

LUNESTA E

modafinil 1 PA QL

NUVIGIL E

PROVIGIL E

ramelteon 1 QL

RESTORIL E

ROZEREM 3 QL

SILENOR 3 QL


E


SUNOSI 2 PA QL

temazepam 1 QL

WAKIX 3 PA SP QL

XYREM 3 PA SP QL

XYWAV E SP

zaleplon 1 QL



ZOLPIMIST 3 ST QL


136

Index of Drugs




137




138




139




140




141




142




143




144




145




146




147




148




149




150




151




152




153




154




155




156




157




158




159




160




161




162




163




164




165




166




167




168




169




170




171




172




173




174




Drug Tier


Directions Doctor


-Continued on back-


























(Farsi)

HealthSelectSM

of Te

xas





Anesthetics


Antibacterials

Anticoagulants



Antidepressants


Antifungals

Antigout Agents


Antimigraine Agents


Antimycobacterials


Antiparasitics


Antiplatelets


Antivirals













Diabetes - Insulins






























6


Tier information



Tier 1 Lowest Cost






Tier 3 Highest Cost











Table of Contents


7


8






E


E


E


E

acetaminophen er E


E


E


E


E


E


E


1 QL


1 QL


1 QL


1 QL

ACTIQ 3 PA QL

ALLZITAL E

APADAZ E



1 QL


1 QL

ARYMO ER E

ascomp-codeine 1


BELBUCA 2 PA QL


E


3

BUPRENEX E


E


1 PA QL


1


E


1



1


1


1


1


E


9



1 QL

BUTRANS 3 PA QL


1


E


E

childrens apap E


E


1 QL

CONZIP E


E


E

DILAUDID ORAL E

DOLOPHINE 3 PA

DSUVIA E

DURAGESIC-100 E

DURAGESIC-12 E

DURAGESIC-25 E

DURAGESIC-50 E

DURAGESIC-75 E

duramorph E


1 QL

ESGIC 3

fentanyl 1 PA QL



1 PA QL


E



E


E


E


E


E


E


E


E


E


E


10



E


E


3


3

FIORINAL 3

FIORINALCODEINE 3

3


E



1 PA ST QL


1 QL


1 QL


1 QL


1 PA QL


E




E


E


E

HYSINGLA ER 2 PA QL

INFUMORPH 200 E

INFUMORPH 500 E


E

LAZANDA E




3 QL

MEDI-DERM-RX E

MEDROX-RX 3


E


1 QL


1 QL




1


11



1


1 PA


1


1


1


migraine relief E

mitigo E


1 QL


E


E


1 PA QL


1 PA QL


1 PA QL


E


E


E


E





E


E


E

m-pap E


E


1

NALOCET E

NORCO E

NUCYNTA E

NUCYNTA ER E

OXAYDO ORAL TABLET

E


E


1 QL


1 QL


1 QL


1 QL


E


12



1 QL


1 QL


2 PA QL




E



E


E


E



E

PANADOL CHILDRENS

E

PANADOL EXTRA E


E

PANADOL INFANTS E


1 QL


E

PRIALT 2 SP

PRIMLEV E


E


PROLATE E

QDOLO E


E


E

SUBSYS E

SYNAPRYN FUSEPAQ E


1


1 ST QL


E


1 PA QL


1 QL



1 QL


3 QL

TYLENOL 8 HOUR E


E


E

TYLENOL ORAL TABLET

E

ULTRACET E

ULTRAM E


13


VANATOL LQ E

VTOL LQ E

XTAMPZA ER 2 PA QL


3


E


ACTIVE-KETOPROFEN

E

ACTIVE-PREP KIT I E




ADVIL E


E


E

ADVIL MIGRAINE E


E


E

ALEVE ORAL TABLET E


E

aspirin adult $0


$0






$0


$0


$0


$0


$0


E


$0


$0


$0

BIIFENAC 1000 E

BIIFENAC 500 E


E

CAMBIA E

CAPSFENAC PAK E

CAPSINAC E

CELEBREX E

celecoxib oral 1 QL

DAYPRO 3


E


E


14



E

DFSMSMENTHCAP PAK

E

DICLOFENAC E


3 QL




1 QL


1 PA



1


E


3


E

DICLOPR E

diclosaicin E

DICLOSTREAM E

DICLOTREX E

DICLOVIX E

DICLOVIX M E

DICLOZOR EXTERNAL

E

diflunisal oral 1

DIMENTHO E


E

DUEXIS E



3

ec-naproxen 1


E

enovarx-ibuprofen E


E


E

etodolac er 1

etodolac oral 1

FBL KIT E

FELDENE 3



E

FLEXIPAK E

flurbiprofen oral 1

FROTEK E


E



$0


E

IBUPAK E

ibuprofen 1

ibuprofen infants E



1


E

inavix E

INDOCIN ORAL 3 ST


15


INDOCIN RECTAL E

indomethacin er 1


E


1 ST

INFLAMMACIN E


E

KBGL IN TERODERM

E

KETOPHENE RAPIDPAQ

E

ketoprofen er 1

ketoprofen oral 1


E


1


1


3 PA QL


1 QL


1


3

LICART EXTERNAL E

LODINE 3


1




MOBIC ORAL TABLET E


E


E

nabumetone oral 1


3

NALFON ORAL TABLET

3


3


E


3

naproxen dr 1


E




E


1


1 PA QL


E

NUDICLO SOLUPAK E

NUDICLO TABPAK E

NUDROXIPAK E

NUDROXIPAK DSDR-50

E


16


NUDROXIPAK DSDR-75

E

NUDROXIPAK E-400 E

NUDROXIPAK I-800 E

NUDROXIPAK M-15 E

NUDROXIPAK N-500 E

ORMECA E

oxaprozin 1

PENNSAID EXTERNAL

E

piroxicam oral 1

PRASTERA E


E


E


$0

QMIIZ ODT E


E

RELAFEN E

RELAFEN DS E

REXAPHENAC EXTERNAL

E

salsalate oral E

SPRIX 3 PA QL


$0

sulindac oral 1


E


E


1


1

TORONOVA II SUIK E


TORONOVA SUIK E


E


E

VAROPHEN E

VENNGEL ONE E

VIMOVO E

VIVLODEX E

VOLTAREN EXTERNAL

E

VP FC KIT E

VP GKL KIT E

XRYLIX EXTERNAL E

ZIPSOR E

ZORVOLEX E

Anesthetics


E

7T LIDO E

ACCUCAINE E


E

AGONEAZE E

ANODYNE LPT E

APRIZIO PAK E

APRIZIO PAK II E

ASTERO E


E

blue tube aloe E


E



E


17



E


E

CADIRAMD E

CAPSAICIN-MENTHOL

E


3


E

COCAINE HCL NASAL E


E


E


E

DERMACINRX PHN E

DERMACINRX PRIZOPAK

E

DERMACINRX ZRM E

EHA E

EMPRICAINE-II E


ethyl chloride 1

EXPAREL E

FLEXIN E

GEBAUERS PAIN EASE

3


3

GEN7T E

GEN7T PLUS E

GOPRELTO E


LDO PLUS E

lets E

LEVATIO E

LIDO BDK E


E


1


1


E


E


E


1


1


E


E


3


1


3


1


1


1 QL


18



E


1


E


E

LIDOCANNA E

LIDODERM E


3


E

LIDOMARK 25 E

LIDOPAC E


E


E


E

LIDOPRIL XR E


E

LIDOPURE PATCH E

LIDORX E

LIDO-SORB E

LIDOSTREAM E

LIDOTHOL E

LIDOTRAL E

LIDOVIX L E

LIDTOPIC MAX E

LIVIXIL PAK E

LMR PLUS E

LYDEXA E


MARCAINE E


E

marlido E

MARLIDO-25 E

MARVONA SUIK E

MEDI-DERML-RX E

MEDI-PATCH RX E

NUMBRINO E

NUVAKAAN E

NUVAKAAN-II E

PAINGO KFT E

PLIAGLIS E

POINT OF CARE LM-22

E

POINT OF CARE LM-25

E

premium lidocaine E

PREMIUM SCAR E

PREPIV SUPPLY 3

PRILO PATCH E

PRILO PATCH II 3

PRILOLID E

PRILOVIX E

PRILOVIX LITE E


PRILOVIX PLUS E



PRILOVIXIL E

PRIZOPAK II E

PRIZOTRAL E

PRIZOTRAL-II E

READYSHARP-A E


E

RELADOR PAK PLUS E


19


RENOVO E

sensorcaine E

sensorcaine-mpf E


E


E

SYNERA E

SYNVEXIA TC E


3

VEXATROL E


E

XARACOLL E

XYLOCAINE INJECTION

3


3

ZERUVIA E

ZILACAINE PATCH E


E

ZIONODIL E

ZIONODIL 100 E

ZTLIDO E



BUNAVAIL 3 QL


1 QL


1 QL


$0 QL


CHANTIX $0 QL


$0 QL


$0 QL

disulfiram oral 1

LUCEMYRA 3 ST QL


E


E


E



E

NARCAN 2


$0 QL


$0 QL




NICOTROL $0 QL

NICOTROL NS $0 QL

SUBLOCADE 3 SP


2 QL

VIVITROL 3 SP

ZUBSOLV 2 QL

Antibacterials

ACTICLATE E

AEMCOLO 3 PA

ALTABAX 3


20



E



1



1


1


1


1


E

ARIKAYCE 3 SP

AUGMENTIN ES-600 3


3


3

avidoxy 1 ST

AVIDOXY DK E


1


1


1




BACTRIM 3

BACTRIM DS 3

BAXDELA INTRAVENOUS

E

BAXDELA ORAL 3


3


1

BENZODOX E

BICILLIN L-A E

cefaclor 1

cefaclor er 1

cefadroxil 1


E


E

cefdinir 1


E

cefixime 1

CEFOTAN E


E


E


E


cefprozil 1


21



E


1


1

CENTANY 3

CENTANY AT E

cephalexin 1


E


3


3


clarithromycin er 1


CLEOCIN ORAL 3


3


2



1


1

CLINDESSE 3


E

COLY-MYCIN M E

coremino E

CUBICIN E

CUBICIN RF E

daptomycin E




DIFICID 3

DORYX MPC E


3 ST


E

doxy 100 E


E


1


1


1 ST


E


1


1 ST


E


1 ST


1


1


22



1 ST

EES GRANULES 3

ertapenem sodium E

ERYPED 200 3

ERYPED 400 3

ERY-TAB 3


3



1

erythromycin oral 1

FETROJA E


E

FIRVANQ 3

FLAGYL ORAL CAPSULE

3


3


E


1


1

HIPREX 3


E

INVANZ INJECTION E


1

KEFLEX 3


levofloxacin oral 1

LINCOCIN E



E


E

linezolid oral 1 QL

MACROBID 3

MACRODANTIN 3


1


E


E


E



E


E




3


E



23


MINOLIRA E


1 ST

MONUROL 3


E


1



mupirocin calcium E



E


E



E


1


1


1

NUTRIDOX E

NUVESSA E


3


1


E


E


1



E





E


E


E


E

PRIMSOL 3

RECARBRIO E


E

SEYSARA 3 ST

SILVADENE 3


E


1

SIVEXTRO E


3

SOLOSEC 3

ssd 1


E


24


sulfadiazine oral 1


1


1


E


3


SUPRAX ORAL CAPSULE

3


3


3

TARGADOX E

tazicef injection E


E


E


tigecycline E

tinidazole oral 1

trimethoprim oral 1

TYGACIL E


E

VANCOCIN 3


3



E


E



E

vandazole 1

VIBRAMYCIN 3 ST

XENLETA INTRAVENOUS

E

XENLETA ORAL 3

XEPI 3

XIFAXAN 3 PA

XIMINO 3

ZEMDRI E


3


3


3

ZITHROMAX TRI-PAK 3

ZITHROMAX Z-PAK 3


E

ZYVOX ORAL 3 QL

Anticoagulants

ACD-A NOCLOT-50 3


25


ACTIVASE E


1


3

ARIXTRA 3 SP QL

CATHFLO ACTIVASE E

ELIQUIS 2 QL


2 QL




3 SP QL


E


1


E


1



E

jantoven 1

LOVENOX 3 SP QL

PRADAXA 2 QL

REGIOCIT E

SAVAYSA 3 QL

THROMBATE III 3 SP

TRICITRASOL 3


XARELTO 2 QL


2 QL


APTIOM 3

BANZEL 3 PA


E

BRIVIACT ORAL 3 ST

carbamazepine er 1


CARBATROL 3

CELONTIN 3


E

clobazam 1 PA

DEPAKOTE 3

DEPAKOTE ER 3


3

DIACOMIT 3 PA SP





26


DILANTIN INFATABS E


E


3


E


1


1


1

EPIDIOLEX 3 PA SP

epitol 1

ethosuximide oral 1

FANATREX FUSEPAQ E

felbamate 1

FELBATOL 3

FINTEPLA 3 PA SP


E

FYCOMPA 3


1


1


GABITRIL 3

KEPPRA INTRAVENOUS

E

KEPPRA ORAL 3

KEPPRA XR 3


2



E


3


3


3

LAMICTAL STARTER 3

LAMICTAL XR 3

lamotrigine er 1


1



1


1


1


1


1

levetiracetam er 1


E


MYSOLINE 3

NAYZILAM 3 QL

NEURONTIN 3


3 PA


3 PA

oxcarbazepine 1

OXTELLAR XR E



27



1

PHENYTEK 3



1


1


1

primidone oral 1

QUDEXY XR 3


1

rufinamide 1 PA

SABRIL ORAL PACKET

E SP

SABRIL ORAL TABLET

3 PA SP

SPRITAM E

subvenite 1


1


1


1

SYMPAZAN 3 PA


3


3

TEGRETOL-XR 3

tiagabine hcl 1

TOPAMAX 3

TOPAMAX SPRINKLE 3

topiramate er 1

topiramate oral 1

TRILEPTAL 3

TROKENDI XR 3 ST



1


1

VALTOCO 10 MG DOSE

3 QL

VALTOCO 15 MG DOSE

3 QL

VALTOCO 20 MG DOSE

3 QL

VALTOCO 5 MG DOSE

3 QL

vigabatrin 1 PA SP

vigadrone 1 PA SP

VIMPAT INTRAVENOUS

E

VIMPAT ORAL 3

XCOPRI 3 ST


3 ST


3 ST

ZARONTIN 3

ZONEGRAN 3

zonisamide oral 1


ARICEPT 3

donepezil hcl 1

EXELON TRANSDERMAL

3


1


1



1


28



1

NAMENDA ORAL TABLET

3


3

NAMENDA XR 3 QL


3 QL

NAMZARIC 2 QL

RAZADYNE ER 3

rivastigmine 1


Antidepressants


amoxapine 1

ANAFRANIL 3

APLENZIN 3 ST QL

BRISDELLE 3 ST QL



1 QL


E


CELEXA ORAL TABLET

3


1


1


CYMBALTA E


DESVENLAFAXINE ER

3 ST QL



1 QL


1


1



EFFEXOR XR E

EMSAM 3 QL


FETZIMA 3 ST QL



3


1


1 QL


1




FORFIVO XL E



LEXAPRO ORAL TABLET

E

maprotiline hcl 1

MARPLAN 3

mirtazapine oral 1

NARDIL 3

nefazodone hcl 1


3



29



1 QL


3

PARNATE 3

paroxetine hcl er 1


1


PAXIL CR 3


2 ST

PAXIL ORAL TABLET 3


1

PEXEVA E


PRISTIQ E

protriptyline hcl 1

PROZAC ORAL CAPSULE

E


3

REMERON SOLTAB 3



3 PA SP


3 PA SP


3 QL




1

TRINTELLIX 3 ST QL

venlafaxine hcl 1



VIIBRYD ORAL TABLET

3 QL


3 QL

WELLBUTRIN SR E

WELLBUTRIN XL E

ZOLOFT E

ZULRESSO 3 PA SP


AKYNZEO INTRAVENOUS

E

AKYNZEO ORAL 3 QL


E

ANZEMET ORAL 3 QL

aprepitant 1 QL

BONJESTA 3 PA QL

compro 1


DICLEGIS 3 PA QL


dronabinol 1 PA QL


E


3 QL


3

EMEND TRI-PACK 3 QL


E

GIMOTI E


30



E


E


MARINOL 3 PA QL


1


E


E


1


1


1


1



E


1 QL


1 QL


1

ondansetron odt 1

palonosetron hcl E

perphenazine oral 1

prochlorperazine 1


1

REGLAN ORAL 3

SANCUSO 3 QL


scopolamine 1

SYNDROS 3 PA QL

TIGAN INTRAMUSCULAR

E

TIGAN ORAL 3


3


3


E


1


3 QL


3

ZUPLENZ E

Antifungals

ACTIVE-PREP KIT V E

ala-quin E

ALCORTIN A E


E


E

ANCOBON 3


E


3



E


E


31



1



1



1


1


1


E


1

CRESEMBA ORAL 3



E

dermazene E


E


3


3

DIFMETIOXRIME E

ECONASIL E


1


E

ECOZA E


E


ERTACZO E

EXELDERM E


EXTINA 3

fluconazole oral 1


E

flucytosine oral 1

FUNGIMEZ E


1


1

GYNAZOLE-1 3


E

IMIOXIA E

IODOQUIMEZ-HC E


E


E


E


JUBLIA E

KERYDIN 3 PA


1


E


1

ketoconazole oral 1


E



E


32



3

LOPROX EXTERNAL KIT

E


3


3


E

LULICONAZOLE E

LUZU E

MENTAX E

micaderm E


E

miconazole 1 E


1


E


E


E


E

naftifine hcl 1


3

NAFTIN EXTERNAL GEL

3

NOXAFIL ORAL 3

nyamyc 1

nystatin external 1





nystop 1

ONYCHO-MED E

ORAVIG E



3


E

PEDIZOLPAK E

PHEODOYO E

PHEYO E


E

posaconazole 1

QUINJA E

RECURA E

SPORANOX 3 PA

SPORANOX PULSEPAK

3 PA

SULCONAZOLE NITRATE

E

tavaborole 1 PA


terconazole 1



E

TOLSURA E

VFEND 3

voriconazole oral 1

VUSION E

VYTONE E

XOLEGEL E

XOLEGEL COREPAK E


E

XOLEGEL DUOXOLEX

E


33



E

ZOLPAK E

Antigout Agents

allopurinol oral 1


E



COLCRYS E

febuxostat 1 ST

GLOPERBA E

KRYSTEXXA 3 PA SP

MITIGARE E

probenecid oral 1

ULORIC 3 ST

ZYLOPRIM 3


EMFLAZA 3 PA SP

Antimigraine Agents

AIMOVIG 2 PA QL

AJOVY E


AMERGE 3 QL

CAFERGOT 3

DHE 45 3 PA QL


1 PA QL


1 PA QL


EMGALITY 2 PA QL


2 PA QL

ERGOMAR 3


FROVA 3 QL



IMITREX 3 QL


3 QL


3 QL


3 QL


3 QL

MIGERGOT 3

MIGRAINE PACK E

MIGRANAL 3 PA QL

MIGRANOW E


NURTEC 2 PA QL


RELPAX 3 QL

REYVOW E




1 QL


1 QL


1 QL


1 QL


34



1 QL


1 QL

TOSYMRA E


3 ST QL

UBRELVY 2 PA QL

VYEPTI E

ZEMBRACE SYMTOUCH

E


ZOMIG NASAL 3 ST QL

ZOMIG ORAL E

ZOMIG ZMT E


GUANIDINE HCL ORAL

3


3


3


3


E


1


1


1

Antimycobacterials

CAPASTAT SULFATE E


cycloserine oral 1

dapsone oral 1


isoniazid oral 1


3

MYCOBUTIN 3

PASER 3

PRETOMANID 3

PRIFTIN 3

pyrazinamide oral 1

rifabutin 1

rifampin oral 1


E

SIRTURO 3

TRECATOR 3



ABRAXANE 2 SP

ADCETRIS 2 PA SP


1 SP


1 SP



2 PA SP QL


E SP

ALECENSA 3 PA SP

ALIMTA 2 SP

ALIQOPA 3 PA SP

ALKERAN 3 SP

ALUNBRIG 3 PA SP QL

anastrozole oral $0


35


ARIMIDEX E

AROMASIN 3

ARRANON 2 SP


1 SP

ARZERRA 2 PA SP

ASPARLAS 3 SP

AVASTIN 3 PA SP

AYVAKIT 3 PA SP QL

azacitidine 1 PA SP

BALVERSA 3 PA SP

BAVENCIO 3 PA SP

BELEODAQ 3 PA SP

BELRAPZO E SP

BENDEKA 3 PA SP

BESPONSA 3 PA SP

bexarotene 1 PA SP

bicalutamide 1

BICNU 3 SP

BLENREP E SP


BLINCYTO 3 PA SP

BORTEZOMIB 3 PA SP

BOSULIF 3 PA SP


3 PA SP

BRUKINSA 3 PA SP

busulfan 1 SP

BUSULFEX 3 SP

CABOMETYX 2 PA SP

CALQUENCE 3 PA SP

CAMPATH 2 SP

CAMPTOSAR 3 SP



2 PA SP QL


2 PA SP



1 SP

carmustine 1 SP

CASODEX 3


1 SP


3 SP


1 SP

clofarabine 1 SP

CLOLAR 3 SP


3 PA SP


3 PA SP


3 PA SP

COPIKTRA 3 PA SP

COSMEGEN 3 SP

COTELLIC 3 PA SP


1 SP


E SP


1

CYRAMZA 3 PA SP



1 SP


1 SP

DACOGEN 3 PA SP

dactinomycin 1 SP


36


DARZALEX 3 PA SP



1 SP

DAURISMO 3 PA SP

decitabine 1 PA SP



1 SP


1 SP

DOXIL 3 SP


1 SP


1 SP

DROXIA 3

ELITEK 3 SP

ELLENCE 3 SP

ELZONRIS 3 PA SP

EMCYT 2

EMPLICITI 3 PA SP

ENHERTU 3 PA SP


1 SP

ERBITUX 2 PA SP

ERIVEDGE 2 PA SP

ERLEADA E SP


1 PA SP


1 PA SP QL

ERWINAZE INJECTION

3 SP

ETHYOL 3 SP


ETOPOPHOS 3 SP


1 SP

etoposide oral 1 SP


1 PA SP QL

EVOMELA 3 SP

exemestane $0

FARESTON 3

FARYDAK 3 PA SP


3 SP

FEMARA 3




flutamide 1

FOLOTYN 2 PA SP

fulvestrant 1 SP

GAVRETO E SP

GAZYVA 3 PA SP


GILOTRIF 3 PA SP QL

GLEEVEC 3 PA SP


3 SP

HALAVEN 2 PA SP

HERCEPTIN HYLECTA

3 PA SP


3 PA SP

HERZUMA E SP


37


HYCAMTIN 3 SP

HYDREA 3

hydroxyurea oral 1

IBRANCE 3 PA SP


3 PA SP QL


3 PA SP

IDAMYCIN PFS 3 SP

idarubicin hcl 1 SP

IDHIFA 3 PA SP QL

IFEX 3 SP

ifosfamide 1 SP


IMBRUVICA 3 PA SP

IMFINZI 3 PA SP

IMLYGIC 3 SP

INFUGEM 3 SP

INLYTA 3 PA SP

INQOVI E SP

INREBIC 3 PA SP

IRESSA 3 PA SP

irinotecan hcl 1 SP


IXEMPRA KIT 2 SP


2 PA SP QL


2 PA SP

JELMYTO E SP

JEVTANA 2 PA SP

KADCYLA 3 PA SP

KANJINTI 2 PA SP


3 PA SP

KHAPZORY 3 ST SP



3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP

KOSELUGO 3 PA SP

KYPROLIS 2 PA SP


LARTRUVO 3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP

letrozole oral 1


E


LEUKERAN 2


1 SP


38



1 SP

LIBTAYO 3 PA SP

LONSURF 3 PA SP

LORBRENA 3 PA SP

LUMOXITI 3 PA SP

LUTATHERA E


2 PA SP

LYSODREN 2

MARQIBO 3 SP

MATULANE 2 SP

MEKINIST 2 PA SP

MEKTOVI 3 PA SP

melphalan 1 SP

melphalan hcl 1 SP


mesna 1 SP

MESNEX 3 SP



E SP


MONJUVI E SP

mutamycin 1 SP

MVASI 2 PA SP

MYLERAN 2


3 PA SP

NAVELBINE 3 SP

NERLYNX 3 PA SP QL

NEXAVAR 2 PA SP

nilutamide 1 SP

NINLARO 3 PA SP

NIPENT 3 SP

NUBEQA 3 PA SP


ODOMZO 3 PA SP

OGIVRI E SP

ONCASPAR INJECTION

2 SP

ONIVYDE 3 SP

ONTRUZANT E SP

ONUREG E SP

OPDIVO 3 PA SP


1 SP


E


1 SP

paclitaxel 1 SP

PADCEV 3 PA SP

PANRETIN 3

paraplatin 1 SP

PEMAZYRE 3 PA SP QL

PERJETA 2 PA SP

PHESGO E SP

PHOTOFRIN 3 SP


3 PA SP


3 PA SP


3 PA SP

POLIVY 3 PA SP

POMALYST 3 PA SP

PORTRAZZA 3 PA SP

POTELIGEO 3 PA SP

PROLEUKIN 2 SP

PURIXAN 3 SP

QINLOCK 3 PA SP

RETEVMO E SP

REVLIMID 2 PA SP



39



3 PA SP


3 PA SP

ROZLYTREK 3 PA SP

RUBRACA 2 PA SP

RUXIENCE 2 PA SP

RYDAPT 3 PA SP

SARCLISA 3 PA SP

SIKLOS 3 PA

SOLTAMOX $0

SPRYCEL 2 PA SP

STIVARGA 3 PA SP

SUTENT 2 PA SP

SYLVANT 3 PA SP

SYNRIBO 3 PA SP

TABLOID 2 SP

TABRECTA E SP

TAFINLAR 2 PA SP


3 PA SP QL


3 PA SP

TALZENNA 3 PA SP



3 PA SP


3 PA SP QL

TARGRETIN EXTERNAL

3 PA SP

TARGRETIN ORAL E SP

TASIGNA 3 PA SP


3 SP


TAZVERIK E SP

TECARTUS 3 PA SP

TECENTRIQ 3 PA SP

TEMODAR INTRAVENOUS

2 SP



teniposide 1 SP

TEPADINA 3 SP

THALOMID 2 PA SP


TIBSOVO 3 PA SP


1 SP

topotecan hcl 1 SP


TOTECT 3 SP

TRAZIMERA 2 PA SP


E SP

tretinoin oral 1 SP


3 SP

TRODELVY 3 PA SP

TRUXIMA E SP

TUKYSA 3 PA SP

TURALIO 3 PA SP

TYKERB 3 PA SP

UNITUXIN 3 PA SP

VALCHLOR 3 PA SP

valrubicin E

VALSTAR E


40



3 SP


VENCLEXTA 3 PA SP


3 PA SP

VERZENIO 3 PA SP

VIDAZA 3 PA SP


1 SP


1 SP


VITRAKVI 3 PA SP

VIZIMPRO 3 PA SP

VORAXAZE E

VOTRIENT 3 PA SP


3 PA SP

XALKORI 2 PA SP

XELODA 3 PA SP


E

XOSPATA 3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP



3 PA SP


3 PA SP

XTANDI 3 PA SP

YERVOY 2 PA SP

YESCARTA 3 PA SP

YONDELIS 3 SP

YONSA E SP

ZALTRAP 2 PA SP

ZANOSAR 2 SP

ZEJULA 2 PA SP

ZELBORAF 3 PA SP

ZEPZELCA 3 PA SP

ZEVALIN Y-90 3 SP

ZIRABEV 2 PA SP

ZOLINZA 2 PA SP

ZYDELIG 3 PA SP

ZYKADIA ORAL TABLET

3 PA SP

ZYTIGA E SP

Antiparasitics


ALBENZA 3 PA

ALINIA 2

ARAKODA 3

atovaquone oral 1


1

BENZNIDAZOLE 3

BILTRICIDE 3


1

COARTEM 3


crotan 1

DARAPRIM 3 PA SP

EGATEN 3


41


ELIMITE 3

EMVERM 2


1

IMPAVIDO 3


1

ivermectin oral 1

KRINTAFEL 3

LAMPIT E

lice killing E


E


1

MALARONE 3


mefloquine hcl 1

MEPRON 3

NATROBA 3

NEBUPENT 3

nitazoxanide 2

OVIDE 3

PENTAM E


1


E


1

PLAQUENIL 3

praziquantel oral 1


1



3

QUALAQUIN 3 PA



SKLICE 3

spinosad 1


E

STROMECTOL 3

SULFURATED LIME 3




2 PA SP QL

AZILECT 3


1


1

carbidopa oral 1



1


1

COMTAN 3

DUOPA ENTERAL 3 PA

entacapone 1

GOCOVRI E

INBRIJA 3 PA SP

KYNMOBI E SP


E SP

LODOSYN 3

MIRAPEX ER 3


3

NEUPRO 3 ST

NOURIANZ 3 PA


42


ONGENTYS E

OSMOLEX ER E

PARLODEL 3


1


1


ropinirole hcl 1

ropinirole hcl er 1

RYTARY 3 ST


SINEMET 3

STALEVO 100 3

STALEVO 125 3

STALEVO 150 3

STALEVO 200 3

STALEVO 50 3

STALEVO 75 3


3

tolcapone 1


XADAGO 3 ST QL

ZELAPAR 3

Antiplatelets


ASPIRIN-OMEPRAZOLE

E

BRILINTA 2

CABLIVI 3 PA SP QL

cilostazol 1


1

dipyridamole oral 1

DURLAZA E

EFFIENT 3



3

prasugrel hcl 1

YOSPRALA E

ZONTIVITY 3



3


3

ABILIFY MYCITE E

ABILIFY ORAL TABLET

3 QL

ADASUVE 3 PA

aripiprazole 1 QL

ARISTADA E

ARISTADA INITIO E

CAPLYTA 3 ST QL


E


clozapine 1 QL

CLOZARIL 3 QL

FANAPT 3 ST QL


3 ST QL


E


E



E

GEODON ORAL 3 QL

HALDOL DECANOATE E


43



E


haloperidol oral 1

INVEGA 3 QL


3


3

LATUDA 3 QL


molindone hcl 1


3 PA


3 PA


E



PERSERIS E

pimozide 1



REXULTI 3 QL


3


E


E

risperidone 1 QL


SAPHRIS 2 QL

SECUADO E

SEROQUEL 3 QL

SEROQUEL XR 3 QL


thiothixene oral 1


VERSACLOZ 3 QL

VRAYLAR 3 ST QL




3

ZYPREXA ORAL 3 QL

ZYPREXA RELPREVV E

ZYPREXA ZYDIS 3 QL

Antivirals

abacavir sulfate 1


1


1


acyclovir oral 1


APTIVUS 2


ATRIPLA E

BARACLUDE 3 SP QL

BIKTARVY 3


CIMDUO 2

COMBIVIR 3

COMPLERA 2


2

DELSTRIGO 3


44


DENAVIR E

DESCOVY E


1

DOVATO 2

EDURANT 2

efavirenz 1


1


1

emtricitabine 1


1


3


2

entecavir 1 SP QL

EPCLUSA 2 PA SP QL

EPIVIR 3


2 SP


3 SP

EPZICOM 3

EVOTAZ 2

famciclovir oral 1

FAVIPIRAVIR 3



E


E

GENVOYA 3

HARVONI 2 PA SP QL


HEPSERA 3 SP

INTELENCE 2

INTRON A 3 PA SP


2

ISENTRESS 2

ISENTRESS HD 2

JULUCA 2


3

KALETRA ORAL TABLET

2



1 SP


1



E SP


2



MAVYRET 2 PA SP QL

nevirapine 1

nevirapine er 1

NORVIR ORAL PACKET

2


2

NORVIR ORAL TABLET

3

ODEFSEY 3


1 QL


2 PA SP


45



3 PA SP

PIFELTRO 3

PREVYMIS 3 SP

PREZCOBIX 2


2


2



E


3

RETROVIR ORAL SYRUP

3


3

REYATAZ ORAL PACKET

2




1 SP

rimantadine hcl 1

ritonavir 1

RUKOBIA 3

SELZENTRY 2 PA

SITAVIG 3 QL


E SP

SOVALDI 3 PA SP QL


STRIBILD 3

SUSTIVA 3

SYMFI 2

SYMFI LO 2


SYMTUZA 3


E


E

TEMIXYS E


1

TIVICAY 2

TIVICAY PD 2

TRIUMEQ 2

TRIZIVIR 3

TROGARZO 3 PA


2


E

TYBOST 2


VALCYTE 3


VALTREX 3 QL

VEMLIDY 3 SP



2


3


3

VIRAZOLE 3

VIREAD ORAL POWDER

2


46



2


3

VOSEVI 2 PA SP QL

XERESE E


3 QL


3 QL

ZEPATIER 3 PA SP QL

ZIAGEN 3

zidovudine 1


3


E


E


alprazolam er 1 QL



alprazolam xr 1 QL

ATIVAN E





1 QL

diazepam intensol 1


1


1


DORAL 3 QL

estazolam 1 QL


HALCION 3 QL


1


1


1

KLONOPIN 3 QL




1 QL


meprobamate 1



E


E


E

oxazepam 1 QL

quazepam 1 QL


3 QL

triazolam 1 QL

VALIUM E

VISTARIL 3

XANAX E

XANAX XR E


47



EQUETRO 3

lithium 1



LITHOBID 3


ADVATE 2 SP

ADYNOVATE 3 SP

AFSTYLA 3 SP

AGRYLIN 3


2 SP

ALPHANINE SD 2 SP

ALPROLIX 3 SP


3

AMICAR ORAL TABLET

3


1


1

anagrelide hcl 1


2 PA SP


2 PA SP


3



E


2 SP

CEPROTIN 3 SP

COAGADEX 3 SP

CORIFACT 2 SP


E


3 PA SP

ELOCTATE 3 SP


E SP

ESPEROCT E SP


2 SP

FIBRYGA 2 SP

FULPHILA E SP

GRANIX E SP

HEMLIBRA 3 SP


3 SP


48



2 SP

IDELVION 3 SP

IXINITY 3 SP

JIVI 3 SP

KOATE 2 SP

KOATE-DVI 2 SP

KOGENATE FS 3 SP

KOVALTRY 3 SP


3 PA SP

LYSTEDA 3


3 PA SP


2 SP


E

MOZOBIL 2 PA SP QL

MULPLETA 2 PA SP



3 PA SP


E SP



E SP

NIVESTYM 2 PA SP

NOVOEIGHT 2 SP

NOVOSEVEN RT 2 SP

NPLATE 2 PA SP

NUWIQ 2 SP

OBIZUR 3 SP


3 SP

PROCRIT E SP

PROFILNINE 2 SP

PROMACTA 3 PA SP

REBINYN 3 SP

REBLOZYL 3 PA SP

RECOMBINATE 2 SP

RECOTHROM 3

RECOTHROM SPRAY KIT

3


2 PA SP

RIASTAP 2 SP

RIXUBIS 3 SP

SEVENFACT E SP


3 PA SP

TAVALISSE 3 PA SP


3


49



3

THROMBOGEN 3


E



E

TRETTEN 3 SP

UDENYCA E SP


3 PA SP


2 PA SP

VONVENDI 3 SP


2 SP


2 SP


ZARXIO 2 PA SP

ZIEXTENZO 3 PA SP


ACCUPRIL 3

ACCURETIC 3



3



E

ALDACTAZIDE 3

ALDACTONE 3


ALTACE ORAL CAPSULE

E

ALTOPREV E



1



E


1


1


1




1


E

ATACAND E

ATACAND HCT 3

atenolol oral 1


E



1


3

AVAPRO 3

AZOR E


50




1

BENICAR E

BENICAR HCT E

BETAPACE AF 3


3


BIDIL 3



1

bumetanide oral 1

BUMEX 3

BYSTOLIC 2


3

CALAN SR 3



1

captopril oral 1


1

CARDIZEM CD 3


3


E


3


CARDURA 3

CAROSPIR 3

cartia xt 1

carvedilol 1


CATAPRES 3

CATAPRES-TTS-1 3

CATAPRES-TTS-2 3

CATAPRES-TTS-3 3


1



clonidine 1


colesevelam hcl 1

COLESTID E

COLESTID FLAVORED

E

colestipol hcl 1

CONJUPRI E

CONSENSI E

COREG 3

COREG CR 3

CORGARD 3

CORLANOR 3 PA QL

COZAAR 3

CRESTOR E

DEMSER 3

DIBENZYLINE 3

digitek 1

digox 1

digoxin oral 1

DILATRATE-SR 3



1


51



1


1



E

dilt-xr 1

DIOVAN E

DIOVAN HCT E


1

DIURIL 3

dofetilide 1


1

DUTOPROL E

DYAZIDE 3

DYRENIUM 3

EDARBI 3 ST

EDARBYCLOR 3 ST

EDECRIN 3



1

ENTRESTO 2 QL


E


E


E



E

eplerenone 1


E


EXFORGE 3

EXFORGE HCT 3


ezetimibe 1


felodipine er 1


1


1 ST


1 ST


1


E


1


1 ST


1


1 ST

FENOGLIDE 3 ST

FIBRICOR 3 ST

FIRST - METOPROLOL

E

FIRST-ATENOLOL E


52



FLOLIPID 3 ST



fosinopril sodium 1



1


gemfibrozil oral 1

GONITRO 3


HEMANGEOL 3



1

HYZAAR 3


indapamide oral 1

INDERAL LA E

INDERAL XL E

INNOPRAN XL E

INSPRA 3

irbesartan 1


1

ISORDIL TITRADOSE 3




1


isradipine 1


3 PA SP QL

KAPSPARGO SPRINKLE

E


KATERZIA E



2

LASIX 3

LESCOL XL E

LIPITOR E

LIPOFEN 3

lisinopril oral 1


1

LIVALO E

LOPID 3


3

LOPRESSOR ORAL 3




3


3


3

lovastatin 1

LOVAZA E

matzim la 1

MAXZIDE 3

MAXZIDE-25 3

methyldopa oral 1


1

metolazone 1



53




1

metyrosine 1


MICARDIS 3

MICARDIS HCT 3

midodrine hcl 1


E


E

MINIPRESS 3

minitran 1

minoxidil oral 1

moexipril hcl 1

MULTAQ 3


1

NEXLETOL 2 PA QL

NEXLIZET 2 PA QL


1


1

niacor 1

NIASPAN 3


nifedipine er 1


1

nifedipine oral 1

nimodipine oral 1

nisoldipine er 1

NITRO-BID 3

NITRO-DUR 3




1


1

NITROLINGUAL 3

NITROMIST 3

NITROSTAT E


1


E

NORPACE 3

NORPACE CR 2

NORTHERA 3 PA SP

NORVASC E


3


1


1


1

OMEGA-3 RX COMPLETE

3


E


1 PA


3


1


pentoxifylline er 1



54



1


E


E

pindolol 1


2 PA QL


3


prazosin hcl oral 1

PRESTALIA 3 ST

prevalite 1


3


E

PROCARDIA 3

PROCARDIA XL 3

propafenone hcl 1




propranolol-hctz 1

QBRELIS E

QUESTRAN E


E

quinapril hcl 1



1



ramipril 1

RANEXA 3 ST

ranolazine er 1 ST

RECTIV 3

REPATHA 2 PA QL


2 PA QL

REPATHA SURECLICK

2 PA QL


RYTHMOL SR 3


sotalol hcl (af) 1

sotalol hcl oral 1

SOTYLIZE 3




3


E


3

taztia xt 1

TEKTURNA 2 ST

TEKTURNA HCT 2 ST

telmisartan 1


telmisartan-hctz 1

TENORETIC 100 3

TENORETIC 50 3


55


TENORMIN E

tiadylt er 1

TIAZAC 3

TIKOSYN E


TOPROL XL E

torsemide oral 1

trandolapril 1


1

triamterene oral 1


1


1

TRIBENZOR E

TRICOR 3

TRILIPIX 3

TWYNSTA 3

valsartan 1


1

VASCEPA 2 PA

VASERETIC 3

VASOTEC 3

VECAMYL 3


1


1


VERELAN 3

VERELAN PM 3

VYNDAMAX 3 PA SP QL

VYNDAQEL 3 PA SP QL

VYTORIN E


WELCHOL 3

ZESTORETIC 3


3


E

ZETIA E

ZIAC 3


3


E


ADDERALL 3 PA QL

ADDERALL XR E

ADHANSIA XR E






1 PA QL


1 PA QL




CONCERTA E


DAYTRANA 3 PA ST QL

DESOXYN 3 PA ST QL


3 PA QL


56




1 PA ST QL


1 PA QL


1 PA ST QL


EVEKEO 3 PA ST QL

EVEKEO ODT 3 PA QL

FOCALIN 3 PA QL


guanfacine hcl er 1

INTUNIV 3



3 ST


1 PA ST QL



3 PA ST QL


1 PA ST QL


1 PA ST QL


1 PA ST QL


1 PA ST QL


1 PA QL


1 PA ST QL


1 PA QL



1 PA ST QL

MYDAYIS 3 PA ST QL




3 PA ST QL

relexxii 1 PA ST QL

RITALIN 3 PA QL


3 PA ST QL

STRATTERA 3 QL

VYVANSE 2 PA QL

ZENZEDI 3 PA ST QL


AMPYRA 3 PA SP QL

AUBAGIO 3 PA SP QL


2 PA SP QL


2 PA SP QL



2 PA SP QL


2 PA SP QL




1 PA SP QL


57



E SP

GILENYA 3 PA SP QL


glatopa 1 PA SP QL

KESIMPTA E SP

LEMTRADA 3 PA SP

MAVENCLAD (10 TABS)

3 PA SP

MAVENCLAD (4 TABS)

3 PA SP

MAVENCLAD (5 TABS)

3 PA SP

MAVENCLAD (6 TABS)

3 PA SP

MAVENCLAD (7 TABS)

3 PA SP

MAVENCLAD (8 TABS)

3 PA SP

MAVENCLAD (9 TABS)

3 PA SP

MAYZENT 3 PA SP QL


3 PA SP QL

OCREVUS 3 PA SP QL

PLEGRIDY E SP


E SP


E SP


E SP


E SP



E SP


TYSABRI 3 PA SP QL

VUMERITY 2 PA SP QL

ZEPOSIA 3 PA SP QL


3 PA SP QL

ZEPOSIA STARTER KIT

3 PA SP QL


ADDYI 3 PA QL

ADIPEX-P E

AUSTEDO 3 PA SP QL

benzphetamine hcl E


CONTRAVE E

CONVENIENCE PAK E



GABACAINE E

GRALISE 3 ST QL


3 PA QL

INGREZZA 3 PA SP QL


E

LOMAIRA E

LYRICA CR 3 ST QL

LYRICA ORAL CAPSULE

2 QL


3 QL


58


NEURAPTINE E

NUEDEXTA 3 PA

ONPATTRO 3 PA SP


E


E



QSYMIA E

RADICAVA 3 PA SP

RILUTEK 3 PA QL

riluzole 1 PA QL

SAVELLA 3 ST QL


3 ST QL

SAXENDA E


E

TEGSEDI 3 PA SP


TIGLUTIK 3 PA SP QL


E

VYLEESI 3 PA QL

XENAZINE 3 PA SP

XENICAL E


ARESTIN E

cavarest E

cevimeline hcl 1



E

clinpro 5000 E


E

denta 5000 plus E

dentagel E


E


E

easygel dental E

EVOXAC 3

FIRST-MOUTHWASH BLM

E

fluoridex E



E


E

KEPIVANCE 2 SP


1


MOUTH KOTE REMINT

E

MUCOSITISRX E


E


E

NAFRINSE WEEKLY E


E

oralone 1

paroex E

PERIDEX E


59


periogard E


PREVIDENT E


E


E


E


E

PREVIDENT 5000 PLUS

E


E

SALAGEN 3

SALIVAMAX E

sf E

sf 5000 plus E


E


E


E


E


E


3


1


E




E

ABREVA E

ABSORICA E

ABSORICA LD 3 PA

ACANYA E

ACESO AG E

acitretin 1


active-tramadol E


E


2


1 PA



E


3 PA


E


E


1


E

AKLIEF E

ALA SCALP E



1


60



3

ALDARA E

ALEVAMAX E

ALTRENO 3 PA


E


1


1

AMELUZ E


1

amnesteem 1 PA

AMZEEQ 3

ANACAINE E

APEXICON E E

AQUAPHILIC E

ARAZLO E

ARIDA E


E

ATOPADERM E

ATOPICLAIR E

ATRALIN 3 PA

avar cleanser E

AVAR LS CLEANSER E

AVAR-E EMOLLIENT E

AVAR-E GREEN E

AVAR-E LS E

AVEIDAOXIA E

avita 1 PA

AZADROX E



E

AZELEX 3



BEAU RX E

BENSAL HP E


E


E

BENZACLIN E

BENZACLIN WITH PUMP

E

BENZAMYCIN E


BENZEPRO EXTERNAL

E


E


E


E


E


E

benzoin compound E


E


E


E


E


E


1 ST

BESER EXTERNAL KIT

E


61




1


1


E


1

BIAFINE E


E

blanche E


bp 10-1 E

bp cleansing wash E


E

BPCO 3

BRYHALI E


1 QL


E


1


1


E


1 QL


E

CALCITRENE 3



E

CAPEX E



E

capzix E

CARAC 3

CEM-UREA E

CERACADE E


CHLOOXIA E


E


E


E


E

claravis 1 PA


3


E


1

CLINDACIN PAC E

clindacin-p 1

CLINDAGEL E


E


1 ST


E


1


1


1


62



1


E


1


E



E

CLINOIN E


1



1


1


E


E

CLOBETAVIX E

CLOBEX 3

CLOBEX SPRAY 3


CLODAN EXTERNAL KIT

E


1

CLODERM E


3

COLLATYL E


3

COPADERM E

COPASIL EXTERNAL E



E


3


3


3


E


CORTANE-B EXTERNAL

E


3


3


1


E

DAPSONE-NIACINAMIDE

E


E

DELUO E

DEOXIA E

DERMACINRX PENETRAL

E


E


3


3

DERMULCERA 3

DESONATE E


63


desonide external 1


3


1


1


E


E


1

DEXERYL E

DIADIMAXIA E

DIAOXIA E


E

DIASDIMAXIA E

DIASOXIA E


1 ST QL


1 PA QL


E


E


E


E


E


E

DIMOXIA E

DIPROLENE AF 3



3



3


doxycycline 1


E

DRAXACE E


E

DRITHO-CREME HP E

DRIXECE E

DRYSOL 3

DUOBRII E

DUPIXENT 2 PA SP QL

ECEOXIA E


3

ELETONE E

ELIDEL 3 ST

ELLZIA PAK E

EMULSION SB E

enovarx-tramadol E

ENSTILAR E

ENTTY SPRAY E

ENZOCLEAR E

EPICERAM E

EPIDUO 3

EPIDUO FORTE 3

EPIFOAM 3

EPIQUIN MICRO E

ery 1

ERYGEL 3


1


64



1

ESKATA E

ETHOXIA E

EUCRISA 2 ST

EVOCLIN 3

FABIOR E

FINACEA 3 ST


E


E


E


1


1


1


E


1


1


1


1


1

FLUOPAR E

FLUOROPLEX 3


2


1


1


FLUOVIX E

FLUOVIX PLUS E

flurandrenolide E


1

FORAXA E

GENADUR E

GORDOFILM 3


E

halcinonide E


1


E


1


E


E


3

HALUCORT E


E


HPR PLUS HYDROGEL

E

HYALUCIL-4 E


E


E


E

HYDRO 40 E


65



E


E


E


E


1


E


1


1


E


1


1


1



E


E


E


E


E


E




E


E


E

IMPEKLO E

IMPOYZ E

INOVA E


E


E


ITHOXIA E


E

KAMDOY E

KATARYA E

KATARYAXN E

KAXM E

KEIDO E

KELARX E

KENALOG EXTERNAL 3

KERAGEL E


E


E

KERALYT SCALP E


3

KETARYA E

KEVARYA E

KEXM E

KEYA E


66


KIVIK E

KLARON 3

KUTARYAXM E

KUTARYAXMPA E

KUTEA E

KUVARYA E

KUVARYE E

KUXM E

lactic acid e 1


1


E

lavare wound wash E

LEVULAN KERASTICK 3

LEXETTE E


E

LIDOTREX E


3

LOCOID LIPOCREAM E

LUXIQ 3

MEDERMA E

MEDERMA FOR KIDS E

MEDERMA SPF 30 E


E

methoxsalen rapid 1


E

METROCREAM 3


E

METROLOTION 3


MIMYX E



E

MIRVASO 3


E


1

myorisan 1 PA

NEOCERA E

NEOSALUS E

NEOSALUS CP E


E


3


E


NEUAC EXTERNAL KIT

E


E


E


E


E


E


E


E

NIVATOPIC PLUS E

nolix E

NORITATE E


67



E

NUCARACLINPAK E

NUCARARXPAK E

NUCORT E

NUDERMRXPAK 120 E

NUDERMRXPAK 60 E

NUTRASEB E

NUTRIARX CREAMPAK

E

NUVAIL E

OLUX 3

OLUX-E 3

ONEXTON 3

ORACEA 3

OVACE PLUS E

OVACE PLUS WASH E

OVACE WASH E

OXSORALEN ULTRA 3

PANDEL E

PENLEN E

PHLAG SPRAY E

PICATO 3 ST

pimecrolimus 1 ST

PLEXION E


E


E

podocon E


PR BENZOYL PEROXIDE

E


E

PR CREAM E


1



E


3


E

pramox E


E

prednicarbate 1

PRESERA E


E

PROMISEB E

PROPECIA E

PROSILK EXTERNAL E

PROTEXA E

PROTOPIC 3

PROTYL AG E

PRUCLAIR E

PRUDOXIN 3 PA

PRUMYX E

PSORCON E

PYROGALLIC ACID 3

QBREXZA 3 QL

QUINIXIL E

QUTENZA E

QUTENZA (2 PATCH) E

RADIAGEL E


3


E

RECEDO E

REFISSA E

REGENECARE 3

REGRANEX 3 PA


68


remergent hq E

REMIGEN E

RENOVA E

RENOVA PUMP E

RESORCINOL-SULFUR

E

RETIN-A 3 PA


E


E


2 PA


E

RHOFADE 3

RIAX E




E


E

salicylic acid er E


E


E


E


E


E


E


E



E


E


E

salimez E

SALIMEZ FORTE E

SALVAX E

SALVAX DUO PLUS E


E

SANTYL 3

SCALACORT DK E


E

SCARCIN E

SCARSILK EXTERNAL E

SCARZEN SKIN REPAIR

E

SCENESSE 3 PA SP


1


E

SELRX E

SERNIVO 3

SILA III E

SILIPAC E


E

skarjel E


E


E


E


69



E

SOLARAVIX EXTERNAL

E

SOLOX E

SOOLANTRA 3


3

SORILUX E

sss 10-5 E

STRATA CTX E

STRATA GRT E

STRATA MARK E

STRATA TRIZ E

STRATA XRT E


1


E


E


E


E


E


E


E


E


E



E


E

sulfacleanse 84 E

sulfamez wash E

SUMADAN E

SUMADAN WASH E

SUMADAN XLT E

SUMAXIN E

SUMAXIN CP E

SUMAXIN WASH E

SUVICORT E

SYNALAR 3

SYNALAR (CREAM) E

SYNALAR (OINTMENT)

E

SYNALAR TS E

SYNERDERM E


E


3 QL


E


1

TARDEOXIA E

TARDIMAXIA E

TAROXIA E

TASOPROL E



3 PA


3 PA


70



E


3


3


E

TEXACORT 3

tl hydroquinone E

TOLAK 3 ST


3


3


3

TOPICORT SPRAY E


TOVET EXTERNAL KIT

E





1 PA


E


1


1


1


E

TRIAMSIL MULTIPAK E


trianex E

TRI-CHLOR 3


TRIDESILON 3

TRI-LUMA E


E


E

TRIVIX E

TURPENTINE EXTERNAL

E

ULTRASAL-ER E


E

UMECTA MOUSSE E


E


E

UREA EXTERNAL FOAM

E


E


E

urea hydrating E


E

urea-c40 E

ureacin-10 E

ureacin-20 E

uredeb E

uremez-40 E

URESOL E

UTOPIC E


71



E

VANIQA E

VANOS 3

VANOXIDE-HC E

VARDIMAXIA E

VAROXIA E

VECTICAL E

VELTIN E

VENELEX 3

VERDESO E

VEREGEN E

VEXASYN E

VIRASAL E

XALIX E

XERAC AC 3

XERALUX E

xurea E

ZACARE E


E

zenatane 1 PA

ZIANA E

ZILXI E

ZITHRANOL E

ZONALON 3 PA

ZYCLARA E

ZYCLARA PUMP E


acarbose oral 1

ACTOPLUS MET 3

ACTOS 3

ADLYXIN E


E


ALOGLIPTIN BENZOATE

E


E


E

AMARYL 3


3 ST


2 ST QL




CYCLOSET 3 ST

DUETACT 3

FARXIGA 2 ST

FORTAMET E

glimepiride 1

glipizide er 1

glipizide ir 1

glipizide xl 1


GLUCOTROL 3

GLUCOTROL XL 3


3

GLUMETZA E


glyburide oral 1


GLYNASE 3

GLYSET 3

GLYXAMBI 2 ST

INVOKAMET E

INVOKAMET XR E

INVOKANA E

JANUMET 2 ST


72


JANUMET XR 2 ST

JANUVIA 2 ST

JARDIANCE 2 ST

JENTADUETO 2 ST

JENTADUETO XR 2 ST

KAZANO E

KOMBIGLYZE XR E

metformin hcl er 1



E

metformin hcl ir 1

miglitol 1

nateglinide 1

NESINA E

ONGLYZA E

OSENI E

OZEMPIC 2 ST QL

pioglitazone hcl 1


1


1

PRECOSE 3

QTERN E

repaglinide 1

RIOMET 3 ST

RIOMET ER 3 ST

RYBELSUS 2 ST QL

SEGLUROMET E

SOLIQUA 2 ST QL

STARLIX 3

STEGLATRO E

STEGLUJAN E

SYMLINPEN 120 3 PA

SYMLINPEN 60 3 PA


SYNJARDY 2 ST

SYNJARDY XR 2 ST

tolbutamide 1 ST

TRADJENTA 2 ST

TRIJARDY XR 2 ST

TRULICITY 2 ST QL

VICTOZA 2 ST QL

XIGDUO XR 2 ST

XULTOPHY 3 ST QL



E


E


E


E


E


E


E


$0


E


E


$0


E


73



E


E


$0


$0


$0

BLUESTAR E


E


$0

CARETOUCH TEST E

CEQUR SIMPLICITY 2U

3

CHEMSTRIP UGK 3

CONTOUR CONTROL E


E

CONTOUR NEXT LINK E


E

CONTOUR NEXT TEST

E

CONTOUR TEST E


E


E


E


E


FORTISCARE CONTROL

E


E


E


E


E


E


E


E


E


E


E


E

GUARDIAN SENSOR (3)

E

KETONE TEST 3

KETOSTIX 3

LANCETS $0

MICRODOT TEST E


$0

NOVOPEN ECHO 3


$0


$0



2


74



2


2


2


3


$0 QL


2


2


2

PRECISION LINK E


E


E



E


E


E


E


3



E


E




3


3


3


E

TRUE METRIX LEVEL 1

E

TRUE METRIX LEVEL 2

E

TRUE METRIX LEVEL 3

E


E

TRUETRACK TEST E


E


BAQSIMI ONE PACK 2

BAQSIMI TWO PACK 2

diazoxide oral 1



2 Made by Lilly


2Made by Fresenius


2


2

GVOKE PFS 2

PROGLYCEM 3

Diabetes - Insulins

ADMELOG E

ADMELOG SOLOSTAR

E


75



3 PA

APIDRA SOLOSTAR E

APIDRA VIAL E

BASAGLAR KWIKPEN E

FIASP E

FIASP FLEXTOUCH E

FIASP PENFILL E


2


2


2


2


2


2

HUMALOG VIAL 2


2

HUMULIN 7030 VIAL 2

HUMULIN N KWIKPEN 2

HUMULIN N VIAL 2


2


2

HUMULIN R VIAL 2


E

INSULIN ASPART E


E



E


E


E


E


E


E


$0

INSULIN SYRINGES $0


2

LANTUS U-100 VIAL 2


E


LYUMJEV 2

LYUMJEV KWIKPEN 2


$0

MYXREDLIN 3


$0


$0


$0


E


76



E

NOVOLIN 7030 RELION

E

NOVOLIN 7030 VIAL E

NOVOLIN N FLEXPEN E


E

NOVOLIN N RELION E

NOVOLIN N VIAL E

NOVOLIN R FLEXPEN E


E

NOVOLIN R RELION E

NOVOLIN R VIAL E


E


E


E


E



$0

SEMGLEE E

TOUJEO MAX SOLOSTAR

2

TOUJEO SOLOSTAR 2

TRESIBA E

TRESIBA FLEXTOUCH

E


ABANEU-SL E

ACTITROM-D E

active fe E

ACTIVITE E

adcf (05mgml) 1


ADRENAL C FORMULA

E

airavite E

aminoamrms E


E

aminoreliefrms E

animal shapes E

ANIMI-3 E

ANIMI-3VITAMIN D E


E

ASCOR E


E


E

ATABEX OB 2


E

AZESCO E


E


E

BACMIN E


biocel E

biopetit E


E

bp vit 3 E

b-plex E

b-plex plus E


E


77


CALCIFOL 3


E


E


E


E


CARBAGLU 2 SP


E


E


E


E


E


E


E


E


E


E


E


E

CARNITOR ORAL 3

CARNITOR SF 3

CENFOL E

CENTRATEX E


CEREFOLIN E


E

CHEMET 3


E

CHOLECAL DF E


E

CIFEREX E

CIFRAZOL E

CITRANATAL BLOOM E

CITRANATAL ESSENCE

E

CITRANATAL MEDLEY

E

clovique 1 PA SP


E

corvita E

corvita 150 E

CORVITE 150 E

corvite fe E


E


1


3

cytra k crystals E


E

d3 super strength E



E


78



E

deferasirox 1 PA


deferiprone 1 PA


E

DEPLIN 15 E

DEPLIN 75 E


E

dexifol E

dialyvite E

DIALYVITE 3000 E

DIALYVITE 5000 E

DIALYVITE SUPREME D

E

DIALYVITEZINC E


3

DURACHOL E

d-vite pediatric E


3


1

ELFOLATE E


E

ELITE-OB 2

ENBRACE HR E

ERGOCAL E


1


E


EXJADE 3 PA

fabb E


E

FERAHEME E

FERIVA 217 E

FERIVAFA E

ferocon E

ferotrinsic E

FERRALET 90 E

ferraplus 90 E

FERRIPROX 3 PA


3 PA

FERRLECIT E



E

FERROTRIN E


E


E


E


E

FLORIVA E

FLORIVA PLUS E

FLUORABON $0

fluoritab $0


$0

folbee E

folbee plus E

folbee plus cz E


79


FOLBIC RF E

FOLGARD OS E

FOLGARD RX E



1


$0

FOLIC D3 E

FOLIC-K E

FOLI-D E

FOLITE E

FOLIVANE-F E

FOLIVANE-PLUS E

FOLIXAPURE E

folplex 22 E

foltanx E

FOLTANX RF E

FOLTRATE E

FOLTREXYL E

foltrin E


E

FOLVITE-D E

FOSTEUM E

FUSION PLUS E

GALZIN 3

GENICIN VITA-D E

GENICIN VITA-Q E

GENICIN VITA-S E


E


HEMATOGEN E

HEMATOGEN FA E

HEMATRON-AF E

HEMETAB E

HEMOCYTE PLUS E




E

HYLAVITE E

HYLAZINC E

ICAR-C PLUS E

iferex 150 forte E

INFED E

INFUVITE ADULT E


E

INTEGRA F E

INTEGRA PLUS E

IODINE STRONG ORAL

3

IROSPAN 246 E

ISOLYTE-S E

JADENU 3 PA


JYNARQUE 3 SP QL

KCL-LIDOCAINE-NACL

E


klor-con 10 1

klor-con m10 1

KLOR-CON M15 3

klor-con m20 1


1


1

klor-con sprinkle 1

klor-conef 1

K-PHOS NO 2 E


3


E


80


K-PHOS-NEUTRAL 3

k-prime 1

K-TAB 3

k-tan plus E

L-CYSTINE E


1


levocarnitine sf 1

L-ISOLEUCINE E

l-methylfolate E


E


E



E


E


E

l-methyl-mc E

l-methyl-mc nac E

LOKELMA 3

LORID E


MVI ADULT E


E

MAGNEBIND 400 3


E



E


E


E

magnesium-oxide E


E

MEPHYTON 3

metafolbic E

metafolbic plus E


METANX ORAL CAPSULE

E


E

MICROPLEGIA MSA-MSG

E

MIFEPREX 3

mifepristone 1

M-NATAL PLUS 2

MULTIGEN E

MULTIGEN FOLIC E

MULTIGEN PLUS E


E

MULTIPRO E



1


1


1


81



E


1


1


E

mynephron E


E


nafrinse $0

nafrinse drops $0

NASCOBAL 3

NEONATAL + DHA E

NEONATAL 19 2

NEONATAL COMPLETE

E

NEONATAL FE E

NEONATAL PLUS 2

NEOVITE E

NEPHPLEX RX E

NEPHRON FA E


NEPHRO-VITE RX E

NESTABS 2

NESTABS ONE E

NEURIN-SL E


E

NICADAN E

NICAZEL E

NICAZEL FORTE E



E

NIFEREX ORAL TABLET

E


E

NUFERA E

nufol E

NUTRICAP E

nutrifac zx E

NUTRIVIT E


E

one daily E

ONE VITE WOMENS $0


2

ONEVITE E

ORACIT 3

ORTHO DF E

OVEEZA E


E


E


E


E

pediavit E


phosphorous 1


E


E


82



1

PHOXILLUM BK425 E


E

PHYSIOLYTE E


E


E

phytonadione oral 1

PLASMA-LYTE 148 E

PLASMA-LYTE A E


E


POLY-VI-FLOR FS 3


3


E


2


E


POTABA ORAL CAPSULE

E


1



E


1



1



E

PREGENNA E

PREMESISRX E

PRENAISSANCE E

PRENARA E


$0



1


E


1

PRENATE E


E


E

PRENATE ENHANCE E


E


E

PRENATE PIXIE E

PRENATE RESTORE E

PRENATRIX E

PRENATRYL E

PRENATVITE COMPLETE

E

PRENATVITE PLUS 2


83


PRENATVITE RX 2

preplus 1

pretab 1


E

PROTEINEX P18 E



E


E

QUFLORA FE E


E

QUFLORA GUMMIES E

QUFLORA PEDIATRIC E

RELNATE DHA 2

REMEDIENT E


E


RENATABS E

RENATABS WITH IRON

E

rena-vite E


E

REQ 49+ E

REVESTA E



2 SP QL


3 SP QL


E

se-tan plus E


SIDEROL ORAL TABLET

E


E



E


E


E


E


E


E


E


E



1


1

soluvita e E

sps 1

STROVITE FORTE E

STROVITE ONE E

SUPERVITE E

support E

SUPPORT-500 E


84


SYNAGEX E

SYPRINE 3 PA SP


E

TALIVA E

TARON FORTE E

taron-crystals E


tis-u-sol E

tl-hem 150 E


E SP


1 SP QL


2

tricitrates E

tricon E



E

trinate 1

TRINAZ E

triphrocaps E

TRISTART ONE E

TRI-VI-FLOR 3

TRI-VI-FLORO 3


tri-vitefluoride 1

TRONVITE E

TRYPTOPHAN ORAL E

UDAMIN SP E

UROCIT-K 10 3

UROCIT-K 15 3

UROCIT-K 5 3


urosex E

v-c forte E

VELTASSA 3

VENOFER E

vic-forte E

vinate one 1

virt-caps E

VIRT-FEFA PLUS E

virt-gard E


vita s forte E

vitacel E


E

VITAFOL ORAL TABLET

E

VITAFOL STRIPS 2

VITAFOL-OB+DHA E

VITAL-D RX E

VITAMAX PEDIATRIC E

VITAMEZ E

vita-min E



E



E


E


1


E


85



E


E


E


E


VITAROCA PLUS E


E

VITASURE E


E

VITREXATE E

VITREXATE FE E

VITREXYL E

VITREXYL + IRON E

vp-pnv-dha 1

vp-vite rx E

weekly-d E

westab mini E

westab one E

WESTAB PLUS 2

WESTGEL DHA E


E

XAQUIL XR E

XVITE E

ZALVIT E


E




E


E

ACIPHEX E

ACIPHEX SPRINKLE E


3


E


cimetidine oral 1

CYTOTEC 3

DEXILANT 2 QL

ESOMEP-EZS E


1 QL


1 QL


E


1


1

FIRST-LANSOPRAZOLE

3 ST



E


1 ST QL


86



1 QL

misoprostol oral 1


E

NEXIUM ORAL PACKET

3 QL

nizatidine 1


E


1 ST QL


E


3 ST


E


1 ST QL

PEPCID ORAL TABLET

3

PREVACID E

PREVACID 24HR E


3 ST QL


3 ST QL



E


E


1 ST QL


sucralfate oral 1

ZEGERID E


ACTIGALL 3

ACTIPHLORA E

alosetron hcl 1 PA


E


E

alvimopan 1

AMITIZA E


1 ST

ANASPAZ 3


E

antacid calcium E



E

antacid maximum E


E



E




E


E


87



E


E


E


E


E

BACICAP E


E

bisacodyl ec $0 QL

bisacodyl rectal E


E


1

CHENODAL 3 PA SP


E


citroma $0 QL


CLENPIQ 3

constulose 1


CUVPOSA 3


E



E


E


diotame instydose E


docusate mini E


E


E

docuzen E

dok oral tablet E

DONNATAL E

ed-spaz 1

ENTEREG 3

enulose 1


E

EX-LAX ULTRA E



E

FOLIKA PROBIOTIC E


E


E

GASTROCROM 3

GATTEX 3 PA SP


gavilyte-c $0 QL

gavilyte-g $0 QL

gavilyte-h 1


$0 QL

GELUSIL E

generlac 1


88




geri-kot E

GIALAX E

GLYCATE E

glycolax $0 QL


E


E


1


E

glycopyrrolate pf E

gnp senna lax E


3


E


E

HELIDAC THERAPY 3



E


E


E



1


1


1



E


1


1


E

hyosyne 1


E


E


E


E


LACTOJEN E


1

lactulose oral 1

laxative max str E


E

LEVBID E

LEVSIN ORAL TABLET

E

LEVSINSL E


89


LIBRAX 3

LINZESS 2 ST QL

LOMOTIL ORAL TABLET

3


1


E


E

LOTRONEX 3 PA


E


$0 QL


E


1


E



E



E

MOTEGRITY 3 ST QL

MOTOFEN E

MOVANTIK E

MOVIPREP E

MYTESI 3 QL


E


E

NULEV 3

NULYTELY LEMON-LIME

3



3

OMECLAMOX-PAK 2

opium E


oscimin sr E


OSMOPREP E


E

PCP 100 E


$0 QL



1


1

peg-prep 1


E


E


E


1

phenohytro E


E

PLENVU E

PROBICHEW E

PRODIGEN E


E


1

PYLERA 2


90



QUAD-PROBIOTIC E

RELISTOR ORAL E


E

RESTORA RX 3


E

senexon-s E

senna oral liquid E


E


E


senna s E

senna smooth E


E

senna-plus E


E

SENOKOT S E


3 PA SP


E


E


E


3



E



E


E


E


E


E


E


E


3

SUTAB E

SYMAX DUOTAB E

symax-sl E

symax-sr E

SYMPROIC 2 ST QL

TALICIA 3

trilyte $0 QL

TRULANCE E

TUMS CHEWY BITES E

URSO 250 3

URSO FORTE 3

ursodiol oral 1


E


E

VIBERZI 3 PA QL

VISBIOME E


91


XERMELO 3 PA SP QL

ZELAC E

ZELNORM 3 PA QL

ZORBTIVE 3 PA SP


ALDURAZYME 2 PA SP



3 SP


3 SP

CERDELGA 3 PA SP


2 PA SP

CHOLBAM 3 PA SP

CREON 2

CRYSVITA 3 PA SP

CYSTADANE 3 SP

CYSTAGON 3 SP

ELAPRASE 2 PA SP

ELELYSO 3 PA SP

ENZADYNE E

EXONDYS 51 E SP

FABRAZYME 2 PA SP

GALAFOLD 3 PA SP QL

KANUMA 3 PA SP

KUVAN 3 PA SP

LUMIZYME 2 PA SP

MEPSEVII 3 PA SP

miglustat 1 PA SP

MYALEPT 3 PA SP

NAGLAZYME 2 PA SP


nitisinone 1 PA SP

NITYR 3 PA SP

OCALIVA 3 PA SP QL

ORFADIN 3 PA SP

PALYNZIQ 3 PA SP QL

PANCREAZE E

PERTZYE E

PROCYSBI 3 PA SP

RAVICTI 3 PA SP

REVCOVI 3 PA SP


1 PA SP


1 SP


1 SP

STRENSIQ 2 PA SP

SUCRAID 3 SP

VIMIZIM 3 PA SP

VIOKACE E

VPRIV 3 PA SP

VYONDYS 53 E SP

XURIDEN 3 PA SP QL

ZAVESCA 3 PA SP


2


3 PA SP


3 PA SP


3 PA SP


92



3 PA SP


3 PA SP


3 PA SP


3 PA SP

ZOLGENSMA 26-30 KG

3 PA SP

ZOLGENSMA 31-35 KG

3 PA SP

ZOLGENSMA 36-40 KG

3 PA SP

ZOLGENSMA 41-45 KG

3 PA SP

ZOLGENSMA 46-50 KG

3 PA SP

ZOLGENSMA 51-55 KG

3 PA SP

ZOLGENSMA 56-60 KG

3 PA SP

ZOLGENSMA 61-65 KG

3 PA SP

ZOLGENSMA 66-70 KG

3 PA SP

ZOLGENSMA 71-75 KG

3 PA SP

ZOLGENSMA 76-80 KG

3 PA SP

ZOLGENSMA 81-85 KG

3 PA SP

ZOLGENSMA 86-90 KG

3 PA SP

ZOLGENSMA 91-95 KG

3 PA SP

ZOLGENSMA 96-100 KG

3 PA SP



aminoacetic acid E

AURYXIA 3

azo tabs E


1

BI-MIX 3


1


1

CAVERJECT IMPULSE

3 QL


3 QL

CERVIDIL 3

CIALIS 3 QL


3 PA SP


1


DETROL 3

DETROL LA 3


3

EDEX 3 QL

ELMIRON 2


3

FEM PH E

flavoxate hcl 1


93



3


3


3 ST


glycine urologic E

hyophen E

INTRAROSA 3 ST



E

LITHOSTAT 3

menaphosmbhyo1 E

MUSE 3 QL

MYRBETRIQ 2



OXYTROL 3 ST QL

OXYTROL FOR WOMEN

E


1 PA SP



E


1


1


E

PHOSLYRA 3


phosphasal E

PREPIDIL 3

PROSTIN E2 3

PYRIDIUM E

QUAD-MIX 3

RENACIDIN E


E

RENVELA 3

RIMSO-50 E


sevelamer hcl 1


1 QL


STAXYN E

STENDRA E

SUPER BI-MIX 3

SUPER QUAD-MIX 3

SUPER TRI-MIX E

tadalafil oral 1 QL

THIOLA 3 SP

THIOLA EC 3 SP



TOVIAZ 3

TRI-MIX E



URELLE E


1

URIBEL E

URIMAR-T E


1


94



E

URO-458 E

UROGESIC-BLUE E

uro-mp E

ustell E

uticap E

utira-c E

utrona-c 1


VELPHORO 3

VESICARE 3

VIAGRA E

vilamit mb E

VILEVEV MB E


alfuzosin hcl er 1

AVODART 3

CARDURA XL 3 ST

dutasteride oral 1


1


1

FLOMAX E

JALYN 3

PROSCAR 3

RAPAFLO 3

silodosin 1

tamsulosin hcl 1


UROXATRAL 3




E



E


E

ALKINDI SPRINKLE E

BETA 1 KIT E

BETALOAN SUIK E

BETAMETHASONE COMBO

E


E


E


E

BSP 0820 E

CELESTONE SOLUSPAN

E


E

CORTEF 3



E

DEPO-MEDROL E

DEXABLISS E


1



E


95



E


E


E


E


E

DEXONTO 04 3

DMT SUIK E

DOUBLEDEX E

DXEVO 11-DAY E

DYURAL-40 E

DYURAL-80 E

DYURAL-L E

DYURAL-LM E


1

HEMADY E

HIDEX 6-DAY E


KENALOG INJECTION 3

KENALOG-80 3

MAS CARE-PAK E


3


2



3

MEDROLOAN II SUIK E

MEDROLOAN SUIK E


E


E


E


E


E


1


3


E

MULTI-SPECIALTY E

ORAPRED ODT 3

P-CARE K40 E

P-CARE K40G E

P-CARE K40MX E

P-CARE K80 E

P-CARE K80G E

P-CARE K80MX E

PEDIAPRED 3


E


96



E

POD-CARE 100K E

POINT OF CARE L2 E

POINT OF CARE L5 E


E


1


1


1


prednisone oral 1

PRO-C-DURE 5 E

PRO-C-DURE 6 E

RAYOS E


E


E


E


3

TAPERDEX 12-DAY E

TAPERDEX 6-DAY E


E

TOPIDEX E



E


1


3


E

TRILOAN II SUIK E

TRILOAN SUIK E

ZCORT 7-DAY E

ZILRETTA E


ANADROL-50 3 PA


2 PA


3 PA


3 PA


E

AVEED E

danazol oral 1


E


97


EC-RX TESTOSTERONE

E

FORTESTA E

JATENZO E

METHITEST 3 PA


NATESTO E


TESTIM E

TESTONE CIK E

TESTOPEL E


E


E


1 PA


1 PA


E


1 PA


1 PA

VOGELXO PUMP E


E


XYOSTED 3 PA


EVISTA 3

OSPHENA 3

raloxifene hcl 1


ACTHAR 2 PA SP

BYNFEZIA PEN E SP

cabergoline 1


E SP


1 PA SP



3

DDAVP NASAL 3

DDAVP ORAL 3

DDAVP RHINAL TUBE 2


1


1


1


1


ELIGARD 3 PA SP QL



3 PA SP QL


3 PA SP QL


98



2 PA SP


1 PA SP



GENOTROPIN E SP


E SP

GONAL-F E SP

GONAL-F RFF E SP


E SP

HUMATROPE E SP

INCRELEX 2 PA SP

ISTURISA E SP


1 PA SP



3 PA SP


2 PA SP


3 PA SP


2 PA SP


2 PA SP



2 PA SP


3 PA SP


2 PA SP


3 PA SP


2 PA SP

MENOPUR 3 PA SP

MYCAPSSA E SP

NOCDURNA 3


2 PA SP


1 PA SP


3 PA SP


2 PA SP


99



2 PA SP


2 PA SP


1 PA SP


E SP


E SP

ORILISSA 2 PA QL

OVIDREL 3 PA SP


E


E

pregnyl 1 PA SP

SAIZEN E SP

SAIZENPREP E SP


E SP


E SP


SIGNIFOR 3 PA SP QL


3 PA SP QL


SOMAVERT 3 PA SP

STIMATE 3


SYNAREL 2

TEPEZZA 3 PA SP



VANTAS 3 PA SP QL


3 SP QL


2 SP QL

ZOMACTON E SP


E SP


KORLYM 3 PA SP QL



3

afirmelle $0 QL

ALORA 3 ST

altavera $0 QL

alyacen 135 $0 QL

alyacen 777 $0 QL

amabelz 1

amethia $0 QL

amethia lo $0 QL

amethyst $0 QL


100


ANGELIQ 3

ANNOVERA E

apri $0 QL

aranelle $0 QL

ashlyna $0 QL

aubra $0 QL

aubra eq $0 QL

aurovela 1530 $0 QL

aurovela 120 $0 QL




aviane $0 QL

AYGESTIN 3

ayuna $0 QL

azurette $0 QL

BALCOLTRA E

balziva $0 QL

bekyree $0 QL

BEYAZ E


E

BIESTPROGESTERONE

E

BIJUVA 3

blisovi 24 fe $0 QL



briellyn $0 QL

camila $0 QL

camrese $0 QL

camrese lo $0 QL

caziant $0 QL


chateal $0 QL

chateal eq $0 QL

CLIMARA 3


CLIMARA PRO 2

COMBIPATCH 3

covaryx E

covaryx hs E


3 QL


3 PA QL

cryselle-28 $0 QL

cyclafem 135 $0 QL

cyclafem 777 $0 QL

cyred $0 QL

cyred eq $0 QL

dasetta 135 $0 QL

dasetta 777 $0 QL

daysee $0 QL

deblitane $0 QL

DELESTROGEN 3

delyla $0 QL

DEPO-ESTRADIOL 3


3 QL


3 QL


$0 QL


$0 QL

DIVIGEL 3

dotti 1


$0 QL


101



$0 QL

DUAVEE 2

EC-RX ESTRADIOL E

EC-RX PROGESTERONE

E

eemt E

eemt hs E

ELESTRIN 3

elinest $0 QL

ELLA $0 QL

eluryng $0 QL

emoquette $0 QL

ENDOMETRIN 2 PA

enpresse-28 $0 QL


$0 QL

errin $0 QL


E


E


E

estarylla $0 QL

ESTRACE 3

estradiol oral 1


estradiol vaginal 1


1


1

ESTRING 3 QL

ESTROGEL 3

ESTROSTEP FE 3 QL


$0 QL



$0 QL

EVAMIST 3


E

falmina $0 QL

fayosim $0 QL

FEMHRT LOW DOSE 3

FEMRING 3 ST QL

femynor $0 QL


E

fyavolv 1

gemmily $0 QL

GENERESS FE 3 QL

gianvi $0 QL

hailey 1530 $0 QL

hailey 24 fe $0 QL


hailey fe 120 $0 QL

heather $0 QL


1 PA SP


3


3

incassia $0 QL

introvale $0 QL

isibloom $0 QL

jaimiess $0 QL

jasmiel $0 QL

jencycla $0 QL

jinteli 1

jolessa $0 QL

juleber $0 QL


102


junel 1530 $0 QL

junel 120 $0 QL

junel fe 1530 $0 QL

junel fe 120 $0 QL

junel fe 24 $0 QL

kaitlib fe $0 QL

kalliga $0 QL

kariva $0 QL

kelnor 135 $0 QL

kelnor 150 $0 QL

kurvelo $0 QL

KYLEENA E

larin 1530 $0 QL

larin 120 $0 QL

larin 24 fe $0 QL

larin fe 1530 $0 QL

larin fe 120 $0 QL

larissia $0 QL

layolis fe $0 QL

leena $0 QL

lessina $0 QL

levonest $0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL

levora 01530 (28) $0 QL


E


lillow $0 QL






lojaimiess $0 QL

loryna $0 QL

LOSEASONIQUE 3 QL

low-ogestrel $0 QL


lutera $0 QL

lyllana 1

lyza $0 QL

MAKENA 2 PA SP

marlissa $0 QL


$0 QL


1


1


1



2

MENOSTAR 3 ST

mibelas 24 fe $0 QL





mili $0 QL

mimvey 1

MINASTRIN 24 FE E

MINIVELLE 3 ST


103


MIRCETTE 3 QL

MIRENA (52 MG) E

mono-linyah $0 QL

NATAZIA $0 QL

necon 0535 (28) $0 QL

NEXPLANON E

nikki $0 QL

nora-be $0 QL


$0 QL


$0 QL


$0 QL


1


$0 QL



1



$0 QL


$0 QL

norlyda $0 QL

norlyroc $0 QL

nortrel 0535 (28) $0 QL



nortrel 777 $0 QL

NUVARING 3 QL

ocella $0 QL

ORIAHNN 2 PA QL

orsythia $0 QL


ORTHO MICRONOR E


E

philith $0 QL

pimtrea $0 QL

pirmella 135 $0 QL

pirmella 777 $0 QL


portia-28 $0 QL

PREFEST 3

PREMARIN ORAL 2

PREMARIN VAGINAL 2

PREMPHASE 2

PREMPRO 2

previfem $0 QL


E


1


1


E

PROMETRIUM 3

PROVERA 3

QUARTETTE 3 QL

reclipsen $0 QL

rivelsa $0 QL

SAFYRAL 3 QL

SEASONIQUE 3 QL

setlakin $0 QL

sharobel $0 QL

simliya $0 QL

simpesse $0 QL

SKYLA E

SLYND E

sprintec 28 $0 QL


104


sronyx $0 QL

syeda $0 QL

tarina 24 fe $0 QL

tarina fe 120 $0 QL


TAYTULLA E

tilia fe $0 QL

tri femynor $0 QL

tri-estarylla $0 QL

tri-legest fe $0 QL

tri-linyah $0 QL


tri-lo-marzia $0 QL

tri-lo-mili $0 QL


tri-mili $0 QL

tri-previfem $0 QL

tri-sprintec $0 QL

trivora (28) $0 QL

tri-vylibra $0 QL


tulana $0 QL

TWIRLA 3 QL

tyblume $0 QL

tydemy $0 QL


E

velivet $0 QL

vienva $0 QL

viorele $0 QL

VIVELLE-DOT E

volnea $0 QL

vyfemla $0 QL

vylibra $0 QL

wera $0 QL

wymzya fe $0 QL

xulane $0 QL


YASMIN 28 3 QL

YAZ E

yuvafem 1

zarah $0 QL

zovia 135 (28) $0 QL

zovia 135e (28) $0 QL

zumandimine $0 QL


ARMOUR THYROID 3 ST

CYTOMEL E

euthyrox 1

levo-t 1


E


1

levoxyl 1


methimazole oral 1

NATURE-THROID 3 ST

np thyroid 1


SYNTHROID 3

TAPAZOLE 3

TIROSINT E

TIROSINT-SOL 3

unithroid 1


3 ST

WP THYROID 3 ST


ACTEMRA 3 PA SP


105



ACTIMMUNE 2 PA SP

ALFERON N 2 SP

ARAVA 3

ARCALYST 3 PA SP

ASCENIV E SP

ASTAGRAF XL 3 SP

ATGAM 2 SP

AVSOLA 3 PA SP

AZASAN 3

azathioprine oral 1


BENLYSTA 3 PA SP

BERINERT 3 PA SP QL


3 PA SP


3 PA SP

CELLCEPT 3 SP


3 SP


2 PA SP



CINRYZE 2 PA SP


E SP

COSENTYX 150 MGML

E SP


E SP



E SP

CUTAQUIG E SP

CUVITRU 3 PA SP


1 SP



1 SP

CYTOGAM 2 PA SP

ENBREL MINI 3 PA SP


3 PA SP


3 PA SP


3 PA SP


3 PA SP

ENSPRYNG E SP

ENTYVIO 3 PA SP

ENVARSUS XR 3 SP


1 PA SP

FIRAZYR 3 PA SP QL


GAMASTAN 2 PA SP

GAMIFANT 3 PA SP

GAMMAGARD 3 PA SP


106



3 PA SP


3 PA SP


3 PA SP

GAMUNEX-C 3 PA SP


1 SP


HAEGARDA 3 PA SP

HEPAGAM B E


3 PA SP


3 PA SP


2 PA SP


2 PA SP


2 PA SP



2 PA SP


2 PA SP


2 PA SP

HYPERHEP B SD E

HYPERRAB E


E


2 SP

HYPERTET SD E

HYQVIA 3 PA SP



2 PA SP QL

ILUMYA 3 PA SP


E

IMURAN 3

INFLECTRA 2 PA SP

KALBITOR 3 PA SP QL

KEDRAB INJECTION E

KEVZARA 3 PA SP


3 PA SP

KYMRIAH 3 PA SP

leflunomide oral 1

methotrexate oral 1


107



1


1


1


1


2 SP



1 SP


MYFORTIC 3 SP

NABI-HB E

NEORAL 3 SP

NULOJIX 3 PA SP

OCTAGAM 3 PA SP

OLUMIANT E SP


ORENCIA INTRAVENOUS

3 PA SP


3 PA SP

OTEZLA ORAL TABLET

2 PA SP


2 PA SP



3 PA QL


E

PANZYGA E SP

PRIVIGEN 3 PA SP

PROGRAF 3 SP

PROVENGE 2 PA SP

RAPAMUNE 3 SP


2 PA QL

REDITREX E

REMICADE E SP

RENFLEXIS 2 PA SP


2 SP


E


108


RIDAURA 3 SP

RINVOQ 2 PA SP

RUCONEST 3 PA SP QL


2 SP


3 SP


2 SP

SILIQ 3 PA SP



2 PA SP


2 PA SP

SIMULECT E

sirolimus oral 1 SP


2 PA SP

STELARA INTRAVENOUS

2 PA SP


2 PA SP QL


2 PA SP QL

SYNAGIS 2 PA SP


TAKHZYRO 3 PA SP

TALTZ 3 PA SP

temsirolimus 1 SP

THYMOGLOBULIN E

TICE BCG 2 SP

TORISEL 3 SP


TREMFYA 2 PA SP

TREXALL 3

UPLIZNA 3 PA SP


E

WINRHO SDF 2 SP

XATMEP 3

XELJANZ 2 PA SP

XELJANZ XR 2 PA SP

XEMBIFY 3 PA SP

ZINPLAVA E

ZORTRESS 3 PA SP


ACTHIB $0


$0


$0

BCG VACCINE E

BEXSERO $0

BIOTHRAX E


$0


$0


$0


$0

FLUAD $0


109


FLUAD QUADRIVALENT

$0


$0


$0


$0


$0


$0


$0

GARDASIL 9 $0


$0


$0


IMOVAX RABIES E

INFANRIX $0


$0

IXIARO E

MENACTRA $0

MENQUADFI $0


MENVEO $0



$0

PNEUMOVAX 23 $0

PREVNAR 13 $0

RABAVERT E


$0

ROTARIX $0


$0


$0

STAMARIL E

TDVAX $0

TENIVAC $0


$0

TRUMENBA $0


$0


E


$0

VARIVAX $0

VAXCHORA E


110


VIVOTIF E

YF-VAX E


ana-lex E


E


E


3


E

anucort-hc E

ANUSOL-HC EXTERNAL

3


E

APRISO 2

ASACOL HD E

AZULFIDINE 3




1

budesonide oral 1

CANASA E

COLAZAL 3

CORTENEMA 3

CORTIFOAM EXTERNAL

3

DELZICOL E

DIPENTUM E


3


E



E


1


1


E


1


E

LIALDA E


E


E


E

LIDOCORT EXTERNAL

E

mesalamine er 1

mesalamine oral 1

mesalamine rectal 1


ORTIKOS E

PENTASA 3

PROCORT EXTERNAL E

PROCTOCORT EXTERNAL

3


E


2





111


ROWASA RECTAL 3

SFROWASA 2


UCERIS 3



3 QL


1


1


1 QL

ATELVIA 3 QL

BINOSTO 3 QL

BONIVA INTRAVENOUS

E


3 QL


EVENITY 3 PA SP QL


2 PA SP


3 QL

FOSAMAX PLUS D E


E


1 QL

MIACALCIN INJECTION

3




2 PA SP QL

RAYALDEE 3

RECLAST 3 SP


1 QL


1


1 QL


2 PA SP

TYMLOS 2 PA SP

XGEVA 2 PA SP


1 SP


1 SP



E

calcitriol oral 1

cinacalcet hcl 1 PA


NATPARA 3 PA SP QL


paricalcitol oral 1

PARSABIV 3 SP

ROCALTROL 3

SENSIPAR 3 PA

ZEMPLAR INTRAVENOUS

E


3


112




ACACIA SUBCUTANEOUS

E


E


E


E

ACREMONIUM E

ACTHREL 3 SP


E

ACUNOL E

ADAKVEO 3 PA SP

ADULT AEROSOL MASK

E


E


3


3

ALDER E

ALTERNARIA E

AMERICAN BEECH E

AMERICAN COCKROACH

E

AMERICAN ELM E

AMERICAN SYCAMORE

E

AMINOPMRMS E


E



E


E

APP SLIM RMS E

APPTRIM E

APPTRIM-D E


E

ARIZONA CYPRESS E


3

asilnasalrms E

ASPARTAME E


E

AUREOBASIDIUM E

AUSTRALIAN PINE E


E


E


E

AVAILNEX E

AVITENE E

AVITENE FLOUR E

AXONA E

AZALGIA E

BAHIA E

BALD CYPRESS E


E


E

BHI URI-CONTROL E


113


BLACK WALNUT POLLEN

E

BLACK WILLOW E



E

BOX ELDER E


E


E


E


E


E

BROME E


E


E


E

CARDIOVID PLUS E


E


E


E


E


E



E

CARTICEL E


E

CATTLE EPITHELIUM E

CAYA $0 QL

CEDAR ELM E


E


E

COCKLEBUR E


E

COLCIGEL E


E


E


E

CONDOMS E

CORN POLLEN E

CORTROSYN E


CROFAB E

CURVULARIA E

DANDELION E



E


114



E

desflurane 1


E


E


E


E


E

DIGIFAB E

DOG EPITHELIUM E

DOG FENNEL E

DOJOLVI E

DRECHSLERA E


2 PA SP


E

DYSPORT 3 PA SP

EASIVENT 2

EASTERN COTTONWOOD

E

EC-RX DHEA E

ECZEMOL E

ENDARI 3 PA

ENDO AVITENE E



E


E


E


E


E


E


E

ENGLISH PLANTAIN E

ENLYTE E


ENTERAGAM E

enteric fish oil E

EPICOCCUM E

EPISIL E

EQUACARE JR E


ESSENTIAL CARE JR E


2 PA SP

EVRYSDI E SP

FIRDAPSE E SP

FIRE ANT E


2


2


115



2

FORANE 3


E


3


E

FOSTEUM PLUS E

FOVEX E

FUSARIUM E

GABADONE E

GELCLAIR E

GELFILM EXTERNAL E

GEL-FLOW E

GEL-FLOW NT E

GELFOAM E


E


E

GELFOAM SPONGE E


E


E


E

GELFOAM-JMI POWDER

E

GELFOAM-JMI SPONGE

E

GELSYN-3 2 PA SP

GELX E

GERMAN COCKROACH

E

GIVLAARI 3 PA SP


GLEOLAN E


3


E


E


E


E


E

GLYTACTIN BURST E


E


E

GLYTACTIN RESTORE 5

E


E


E


E

GLYTACTIN RTD 15 E


E


E

GOLDENROD E

GRASTEK 3 PA QL

H2Q ORAL POWDER E

HACKBERRY E


1


1


116


HEPMED E

HIBICLENS E

HOMACTIN AA PLUS E

HOME PAP KIT E


E

HORSE EPITHELIUM E

HUMATROPEN FOR 12MG

E

HUMATROPEN FOR 24MG

E

HUMATROPEN FOR 6MG

E

HYALGAN E SP

HYLAFEM E

HYMOVIS E SP

HYPERTENSA E


2

INTERCEED E

IOSAT E

isoflurane 1

ISOVACTIN AA PLUS E

JOHNSON GRASS E


E

KAPOK E


3


E

KETOVIE LIQUID ORAL

E


KETOVIE PEPTIDE E

KOCHIA E

LAMBS QUARTERS E

LENSCALE E

LIMBREL E

LIMBREL250 E

LIMBREL500 E

LISTER-V E

LORMATE E

MACRILEN E

MACUTEK E

MASK VORTEX E


E

MELALEUCA E

MESQUITE E


E

METHAVER E



E


1 QL

METOPIRONE E


E


E


E

MIXED ASPERGILLUS E

MIXED FEATHERS E

MIXED RAGWEED E


117



E

MKO MELT DOSE PACK

E

mlk f1 E

mlk f2 E

mlk f3 E

mlk f4 E

MONOVISC E SP

MORCIN E

MOUNTAIN CEDAR E

MOUSE EPITHELIUM E

MUCOR SUBCUTANEOUS

E

MUCOTROL E

MUGARD E

MUGWORT E

MYOBLOC 3 PA SP

NEODOT THERMOMETER

E

NEUREPA E

NICAPRIN E

NICAZYME E


E


OLIVE TREE E

OMNIVEX E

OPTIONS CONCEPTROL

$0 QL

ORALAIR 3 PA QL


3 PA QL


3 PA QL



3 PA QL


3 PA QL

ORAMAGICRX E


E


E SP

OXBRYTA E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E SP


E


118



E


E


E

PECAN POLLEN E


E

PERCURA E


E

PH STRIPS E

PHENACTIN AA PLUS E

PHEXXI E

PHOMA EXIGUA E


3

PRAXBIND E


E


E

PRID E

PRIVET E

PRO-CRITIC E


E

PROLEVA E


E



E

PSORIZIDE FORTE E

PSORIZIDE ULTRA E

PULMONA E

PURAMINO DHAARA E

QUEEN PALM E

RABBIT EPITHELIUM E

RADIOGARDASE 3

RAGWITEK 3 PA QL

RAPID GEL RX E

RED BIRCH E

RED CEDAR E

RED MAPLE E

RED MULBERRY E


E

RESECTISOL E


E

RHEUMATE E

RHIZOPUS E

RIBOZEL E

ROUGH MARSH ELDER

E

ROUGH PIGWEED E

RUSSIAN THISTLE E

RUZURGI 3 PA SP


E

SAGEBRUSH E


E

SENTRA AM E

SENTRA PM E

sevoflurane 1


119


SHAGBARK HICKORY E

SHARPS CONTAINER E

SHEEP SORREL E


E

SILTREX E


E SP

SORBITOL IRRIGATION

E

sorbitol-mannitol E

SORRELDOCK MIX E

SPEEDGEL RX E

SPINRAZA 3 PA SP

SPINY PIGWEED E

STEMPHYLIUM E

SUPARTZ FX E SP

SUPRANE 3

SWEET GUM E


E


E SP


E SP

SYRINGE AVITENE E

TACHOSIL 3

TALL RAGWEED E

terrell 1

THERAMINE E

THERAMINE PLUS E

THROMBI-GEL 10 E

THROMBI-GEL 100 E

THROMBI-GEL 40 E

THROMBI-PAD E


THYROGEN 2 PA SP


E


3

TL-ICARE E

TOBAKIENT E


E

TRANZGEL E


E


E

TREPADONE E


E


E

TRILURON E SP


E

T-SUPPORT MAX E


E


E

TYLACTIN RESTORE 10

E


E

TYLACTIN RTD 15 E

TYROS 2 E

ULTANE 3


E


E


120



E


E


E


E

VASCULERA E


$0 QL


$0 QL

VILACTIN AA PLUS E

VILTEPSO E SP

VIRGINIA LIVE OAK E

VISTOGARD 3


E


E


E

WELLMIND VERTIGO E

westab max E

WESTERN JUNIPER E

WHITE ASH E

WHITE BIRCH E


E

WHITE MULBERRY E

WHITE OAK E


WHITE PINE E


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL


$0 QL

XEOMIN 3 PA SP

XIAFLEX 2 PA SP

XYZBAC E

XYZMUNE E

YELLOW DOCK E


E


E

ZYVEXOL E

ZYVIT E


ACULAR 3

ACULAR LS 3

ALAWAY E

ALOCRIL E


121


ALOMIDE 3

ALREX E

AZASITE 3


1


BEPREVE 3 ST

BESIVANCE 3


3

BLEPH-10 3


1 QL

BROMSITE E

CILOXAN 3


1


1


1

DEXTENZA E SP

DEXYCU E


1

DUREZOL E

epinastine hcl 1


1

eye itch relief E

EYSUVIS E

FLAREX 3


1


FML 2

FML FORTE 3

FML LIQUIFILM 3




1


1

ILEVRO E


E SP

INVELTYS 3


1

KLARITY-A E

KLARITY-L E



E


E


3

LOTEMAX SM 3


MAXIDEX 3

MITOSOL 3

MOXEZA 2


1


1

NATACYN 2

NEVANAC E

OCUFLOX 3



E


1


122



E


1


3 SP

PATADAY E


3

PRED FORTE 3

PRED MILD 3


E


1


E


1


E

PROLENSA 2 QL


E SP


1


TOBREX 3


TRIPLE PMB E

TRIPLE PMK E

UPNEEQ E

VIGAMOX 3

YUTIQ E SP

ZADITOR E

ZERVIATE E

ZIRGAN 3

ZYMAXID 3



acetazolamide er 1



2


E

apraclonidine hcl 1

AZOPT 2


1

BETIMOL 3

BETOPTIC-S 3



1


E

carteolol hcl 1

COMBIGAN 2

COSOPT 3


3


3


1


1


1

DURYSTA E


3

ISOPTO CARPINE 3


123


ISTALOL 3

KEVEYIS 3 PA SP QL



E


1


2 QL


PHOSPHOLINE IODIDE

2


1

RHOPRESSA 3 QL

ROCKLATAN 3 QL

SIMBRINZA 2


1



E


E


E

TIMOPTIC E


3


E

TIMOPTIC-XE E

TRAVATAN Z 3 QL



TRUSOPT 3

VYZULTA E

XALATAN 3

XELPROS 3 ST QL

ZIOPTAN E


ak-poly-bac 1

AKTEN 3

ALCAINE 3

altacaine 1

altachlore E

altafluor benox E


1


E


1


E


1


1


1

BEOVU E SP

BEVACIZUMAB 3 SP


bio glo E

BLEPHAMIDE 3

BLEPHAMIDE SOP 3

CEQUA E


124



E


E

CYCLOGYL 3

CYCLOMYDRIL 3


1


E

CYSTADROPS E SP

CYSTARAN 3 PA SP QL

DOUBLE PM E

EYLEA INTRAVITREAL

3 PA SP

flucaine E


fluor-i-strips at E

FLURA-SAFE E


E


E

GELFILM OPHTHALMIC

E


E


E


E


E

homatropaire 1


E

ISOPTO ATROPINE 3


LACRISERT 3

LASTACAFT 3 ST

LATISSE E

lissamine green E


E


lubricant eye pm E

lubricant pm E



E


2 PA SP


3 PA SP

MAXITROL 3

MEMBRANEBLUE 3


E


E

MYDRIACYL E


1


1


1


1


125



1

neo-polycin 1

neo-polycin hc 1

OXERVATE 3 PA SP QL

PAREMYD E


1

polycin 1


1

POLYTRIM 3

PRED-G 3

PRED-G SOP 3


E


E


E


E


E


E


E


1


E


REFRESH RELIEVA E


E

RESTASIS 2 PA


2 PA

ROSE GLO E


E


1

SYSTANE COMPLETE E


E

SYSTANE ULTRA PF E


1


3


E

TOBRADEX ST 3


1



E


E


E


E


126



E

ultra fresh pm E


E

VISIONBLUE 3

VISUDYNE 3 SP

XIIDRA 2 PA

ZYLET 3


acetic acid otic 1

CETRAXAL 3 ST

CIPRO HC 3

CIPRODEX 2



1


E

cortic-nd 1

DERMOTIC 3

exotic-hc 1

flac 1


1


1


1

ofloxacin otic 1

OTICIN HC NR 3

OTIPRIO E

OTOVEL E

PRAMOTIC 3



12 hour allergy-d E


E


E


ADRENALIN NASAL E

all day allergy d E



E

allergy 24-hr E

allergy childrens E


E



E



E


E


E


E


E


E


E


127



E


E




E


BECONASE AQ 3 QL

benzonatate 1

bromfed dm 1


1


1


E


E


1



E


E


E


E


E

CINQAIR 3 PA SP


E

CLARINEX-D 12 HOUR

E


E



E



1




E


E


3



E


E


E


E


E


1


1


E

DICOPANOL FUSEPAQ

E

DICOPANOL RAPIDPAQ

E


E

DI-PHEN E



128



E


E


1


E


E

DYMISTA 2 QL


FASENRA 2 PA SP

FASENRA PEN 2 PA SP


E


E


1 QL


1



GILPHEX TR E


E


E




E


E


E

hm loratadine E


HYCODAN 3 PA QL


1 PA QL


1 PA QL

hydromet 1 PA QL

HYPERSAL 3


3


1


E


1



loratadine-d 12hr E

loratadine-d 24hr E


maxi-tuss gmx E

maxi-tuss pe max E

m-dryl E

MICLARA LQ E


1 QL


E


E

MUCINEX DM E


E

mucus dm E


129



E


E


mucus-d E

mucus-er max E


E


E



E



NASONEX E


E


E


E

NEOTUSS PLUS E

NUCALA 2 PA SP QL


OMNARIS 3 QL

PATANASE 3 QL


PHENERGAN INJECTION

E


E



1




1


1 PA QL


1

promethegan 1

PROPEL E

PROPEL MINI E



1


E

QNASL 3 QL



E


E


3

ryvent E

SEMPREX-D E

sinus 12 hour E

SINUVA 3


1

SSKI E

SUDAFED CONGESTION

E

sudogest 12 hour E


E


130



E


3

TESSALON PERLES 3


E


E


E



E


E

TUXARIN ER E


E



E


XHANCE E

XOLAIR 2 PA SP

ZETONNA 3 QL


E


ACCOLATE 3


1



3

ADVAIR DISKUS 1 QL

ADVAIR HFA 2 QL

ADYPHREN E

ADYPHREN AMP E

ADYPHREN AMP II E

ADYPHREN II E

AIRDUO DIGIHALER E


E


E


E



1 QL


E


1 QL


E


1 QL


ALVESCO E


131


ANORO ELLIPTA 2 QL


3 PA SP


ARMONAIR DIGIHALER

E



E


E


E


E


E

ASMANEX HFA E

ATROVENT HFA 3 QL


3 QL


E

BEVESPI AEROSPHERE

E

BREO ELLIPTA 2 QL

BREZTRI AEROSPHERE

E

BROVANA 3 QL



E


COMBIVENT RESPIMAT

2 QL


1

DALIRESP 3 PA

difil-g forte 1

DUAKLIR PRESSAIR E

DULERA E

ELIXOPHYLLIN 2


1 ST


1


E


1 ST


1

EPINEPHRINESNAP-EMS

E

EPINEPHRINESNAP-V E


3 ST


E

EPISNAP E

ESBRIET 3 PA SP

FLOVENT DISKUS 2 QL

FLOVENT HFA 2 QL


132



E


1 ST QL

GLASSIA 3 PA SP

INCRUSE ELLIPTA E


1 QL



1 QL


E


3 QL


3 QL


1

OFEV 3 PA SP

PERFOROMIST 3 QL

PROAIR DIGIHALER E

PROAIR HFA E

PROAIR RESPICLICK E


3 PA SP



3 PA SP

PROVENTIL HFA E

PULMICORT FLEXHALER

2 QL


E

QVAR REDIHALER E

SEEBRI NEOHALER E


SINGULAIR E

SPIRIVA HANDIHALER

2 QL


2 QL

STERITALC 3


2 QL

STRIVERDI RESPIMAT

2 ST QL

SYMBICORT 2 QL

SYMJEPI 3


E


THEO-24 3

theophylline 1


1


1


133


E

UTIBRON NEOHALER E

VENTOLIN HFA E

wixela inhub E

XOPENEX NEB 3 QL

XOPENEX CONCENTRATE

3 QL

XOPENEX HFA E

YUPELRI 3 QL

zafirlukast 1

ZEMAIRA 3 PA SP

zileuton er 1 ST

ZYFLO E


BETHKIS 2 SP

CAYSTON 3 PA SP

KALYDECO 3 PA SP

KITABIS PAK E SP

ORKAMBI 3 PA SP QL

PULMOZYME 2 PA SP

SYMDEKO 3 PA SP QL

TOBI NEBULIZER E SP



1 SP


E SP


E SP


TRIKAFTA 3 PA SP QL


ADCIRCA 3 PA SP QL

ADEMPAS 2 PA SP QL

alyq 1 PA SP QL


bosentan 1 PA SP QL


FLOLAN 3 PA SP

LETAIRIS 3 PA SP QL

OPSUMIT 2 PA SP QL

ORENITRAM 3 PA SP


E SP

REVATIO INTRAVENOUS

3 PA SP



1 PA SP


1 PA SP QL


1 PA SP QL



E SP



TYVASO 3 PA SP QL



UPTRAVI 3 PA SP QL


134



TUDORZA PRESSAIR


VELETRI 3 PA SP

VENTAVIS 3 PA SP QL



AMRIX E

BACLOFEN EXTERNAL

E


baclofen oral 1

carisoprodol oral 1


1 QL


1

CYCLOGABA 10300 E



1


1


E

CYCLOPAK 3

CYCLOPHENE RAPIDPAQ

E


3


enovarx-baclofen E


E

FEXMID 3

FIRST-BACLOFEN E



E


E

LIORESAL E

LORZONE 3

METAXALL CP E

metaxalone 1


NOPIOID-LMC KIT E

NORGESIC FORTE E



1


E

OZOBAX E

ROBAXIN-750 3

SKELAXIN E

SOMA 3

TABRADOL FUSEPAQ E

TABRADOL RAPIDPAQ

E


VANADOM 3

ZANAFLEX E


AMBIEN E

AMBIEN CR E


135


armodafinil 1 PA QL

BELSOMRA 3 ST QL

DAYVIGO 3 ST QL


EDLUAR E

eszopiclone 1 QL


HETLIOZ 3 PA SP QL


3 QL

LUNESTA E

modafinil 1 PA QL

NUVIGIL E

PROVIGIL E

ramelteon 1 QL

RESTORIL E

ROZEREM 3 QL

SILENOR 3 QL


E


SUNOSI 2 PA QL

temazepam 1 QL

WAKIX 3 PA SP QL

XYREM 3 PA SP QL

XYWAV E SP

zaleplon 1 QL



ZOLPIMIST 3 ST QL


136

Index of Drugs




137




138




139




140




141




142




143




144




145




146




147




148




149




150




151




152




153




154




155




156




157




158




159




160




161




162




163




164




165




166




167




168




169




170




171




172




173




174




Drug Tier


Directions Doctor


-Continued on back-


























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HealthSelectSM

of Te

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Anesthetics


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Antifungals

Antigout Agents


Antimigraine Agents


Antimycobacterials


Antiparasitics


Antiplatelets


Antivirals













Diabetes - Insulins






























2021 prescription drug list/formulary premiumselectchoice

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