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American Hospital Formulary Service (AHFS)Pharmacologic-Therapeutic Classification
4:00 Antihistamine Drugs 56:00 Gastrointestinal Drugs
8:00 Anti-Infective Agents 64:00 Heavy Metal Antagonists
10:00 Antineoplastic Agents 68:00 Hormones and Synthetic Substitutes
12:00 Autonomic Drugs 72:00 Local Anesthetics
16:00 Blood Derivatives 76:00 Oxytocics
20:00 Blood Formation and Coagulation 80:00 Serums, Toxoids, and Vaccines
24:00 Cardiovascular Drugs 84:00 Skin and Mucous Membrane Agents
28:00 Central Nervous System Agents 86:00 Smooth Muscle Relaxants
36:00 Diagnostic Agents 88:00 Vitamins
38:00 Disinfectants 92:00 Miscellaneous Therapeutic Agents
40:00 Electrolyte, Caloric and Water Balance 94:00 Devices
44:00 Enzymes 96:00 Pharmaceutical Aids
48:00 Antitussives, Expectorants, and Mucolytic Agents Non-AHFS Category Formulary Agents
52:00 Eye, Ear, Nose, and Throat (EENT) Preparations
Last Updated on June 21, 2017
AHFA Pharmacological Therapeutic Classification4:00 Antihistamine Drugs
4:04 - First Generation Antihistamines
04:04.04 Ethanolamine Derivatives
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Diphenhydramine 4 Pack Benadryl 4 Pack (Equiv) CAP 25 Mg Po 1 CAP
Diphenhydramine HCl Benadryl (Equiv) CAP 25 Mg Po 1 CAP
Diphenhydramine HCl Benadryl (Equiv) Elixir 25 Mg Po 10 mL
Diphenhydramine HCl Benadryl (Equiv) CAP 50 Mg Po 1 CAP
Diphenhydramine HCl Benadryl (Equiv) Vial 50 Mg IV 1 mL
04:04.12 Phenothiazine Derivatives
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Promethazine HCl Phenergan (Equiv) Supp 12.5 Mg Rec 1 Supp
Promethazine HCl Phenergan Homepack (Equiv) Qa 2 Supp Rec 1 Package
Promethazine HCl Phenergan Homepack (Equiv) Supp 2 Supp Rec 1 Package
Promethazine HCl Phenergan (Equiv) Ta 25 Mg Po 1 TAB
Promethazine HCl Phnergan (Equiv) Supp 25 Mg Rec 1 Supp
Promethazine HCl Phenergan Homepack (Equiv) TAB 4 TAB Po 1 Package
Promethazine HCl Phenergan (Equiv) Syrup 6.25 Mg Po 5 mL
Promethazine VC Phenergan Vc (Equiv) Syrup 5 mL Po 1 Cup
04:04.20 Propylamine Derivatives
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Chlorpheniramine Maleate Chlor Trimeton (Equiv) TAB 4 Mg Po 1 TAB
4:08 – Second Generation Antihistamines
04:08.00 Second Generation
Antihistamines
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Loratadine Claritin (Equiv) TAB 10 Mg Po 1 TAB
P-Ephed Sul/Loratadine Claritin-D 24 Hour (Equiv) T Sr 24 1 TAB Po 1 T Sr 24
8:00 Anti-Infective Agents
8:12 - Antibacterials 08:12.02 Aminoglycosides GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Amikacin Sulfate Amikacin Sulfate Vial 500 MG IV 2 mL
Gentamicin Gentamicin Opth 0.2 MG EYE 0.1 mL
Gentamicin 80mg In NS Garamycin 80 Mg (Equiv) In NS PB 80 MG IV 50 mL
Gentamicin Sulfate Garamycin Pf (Equiv) Vial 20 MG IV 2 mL
Gentamicin Sulfate Garamycin (Equiv) Vial 80 MG IV 2 mL
Kanamycin Sulfate Kantrex (Equiv) Vial 1,000 MG IV 3 mL
Neomycin Sulfate Neomycin (Equiv) TAB 500 MG PO 1 TAB
Streptomycin Sulfate Streptomycin Sulfate Vial 1 GM IM 1 Vial
Tobramycin Sulfate Tobramycin Sulfate HS 1.2 G INJ 1 Vial
Tobramycin Sulfate Nebcin (Equiv) Vial 80 MG IV 2 mL
08:12.06 Cephalosporins
08:12.06.04 First Generation GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Cefazolin Sodium Ancef (Equiv) Vial 1,000 MG IV 1 Vial
Cefazolin Sodium Ancef (Equiv) Vial 500 MG IV 1 Vial
Cefazolin/Dextrose 1gm PM Ancef PM (Equiv) Fz Pigg 1,000 MG IV 50 mL
Cephalexin Monohydrate Keflex (Equiv) CAP 250 MG PO 1 CAP
Cephalexin Monohydrate Keflex (Equiv) CAP 500 MG PO 1 CAP
Cephalexin Monohydrate Cephalexin PD 250 MG PO 5 mL
Cephalexin Monohydrate Keflex (Equiv) Sus Rec 125 MG PO 5 mL
Cephalexin Monohydrate Keflex (Equiv) Sus Rec 250 MG PO 5 mL
08:12.06.08 Second Generation GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
08:12.06.12 Third Generation GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Restricted to SANE Cefixime Suprax Tab 400 MG PO 1 Tab
Cefotaxime Sodium Claforan (Equiv) Vial 1,000 Mg IV 1 Vial
Ceftazidime Fortaz (Equiv) Vial 1,000 Mg IV 1 Vial
Ceftazidime/Dex-Water 1gm Fortaz (Equiv) 1gm PM Fz Pigg 1,000 Mg IV 50 mL
Ceftazidime – Avibactam Avycaz Vial 2.5 MG IV 1 Vial
Cefdinir Omnicef (Equiv) Suspension 125 MG PO 5 mL
Ceftriaxone Sodium Rocephin (Equiv) Vial 1,000 Mg IV 1 Vial
Ceftriaxone Sodium Rocephin (Equiv) Vial 2,000 Mg IV 1 Vial
Ceftriaxone Sodium Rocephin (Equiv) Vial 250 Mg IV 1 Vial
Ceftriaxone Sodium Rocephin (Equiv) Vial 500 Mg IV 1 Vial
Ceftriaxone/Dextrose 1gm PM Rocephin (Equiv) 1gm PM Fz Pigg 1,000 Mg IV 50 mL
Ceftriaxone/Dextrose 2gm PM Rocephin (Equiv) 2gm PM Fz Pigg 2,000 Mg IV 50 mL
08:12.06.16 Fourth Generation GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Cefepime HCl Maxipime (Equiv) Hs 1,000 Mg IV 15 mL
08:12.06.20 Fifth Generation GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Ceftaroline Teflaro Vial 400 MG IV 1 VIAL
Ceftaroline Teflaro Vial 600 MG IV 1 VIAL
08:12:07 Miscellaneous beta- lactams
08:12.07.08 Carbapenems GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Ertapenem* Invanz (Equiv) Vial 1,000 Mg IV 30 mL
Imipenem/Cilastatin Sodium Primaxin (Equiv) Vial 500 Mg IV 1 Vial
Meropenem Merrem (Equiv) Hs 1,000 Mg IV 30 mL
08:12.07.12 Cephamycins GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Cefotetan Cefotan (generic) Vial 1 Gram IV 1 Gram
Cefotetan Cefotan (generic) Vial 2 Gram IV 2 Gram
08:12.07.16 Monobactam GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Aztreonam Azactam (Equiv) Vial 1,000 Mg IV 1 Vial
Aztreonam 1000mg PM Azactam 1000mg PM (Equiv) Hk 1,000 Mg IV 50 mL
08:12.08 Chloramphenicol GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
ChloramphenicolSodium Succinate Chloromycetin (Equiv) Vial 1,000 mg IV 1 Vial
08:12:12 Macrolides
08:12.12.04 Erythromycin GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Erythromycin Lactobionate Erythrocin Lactobionate VIAL 1,000 MG IV 1 VIAL
Erythromycin Lactobionate Erythrocin Lactobionate VIAL 500 MG IV 1 VIAL
Erythromycin Ethylsuccinate EES 200mg Granules (Equiv) SUSP 200 MG PO 5 ML
Erythromycin Ethylsuccinate EES 400 (Equiv) TAB 400 MG PO 1 TAB
08:12.12.92 Other Macrolides GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Azithromycin Zithromax (Equiv) VIAL 500 MG IV 1 VIAL
Azithromycin Zithromax (Equiv) PACKET 1,000 MG PO 1 PACKET
Azithromycin Zithromax (Equiv) SUS REC 200 MG PO 5 ML
Azithromycin Zithromax (Equiv) TAB 250 MG PO 1 TAB
Clarithromycin Biaxin (Equiv) Tab 250 MG PO 1 Tab
Fidaxomicin Dificid (Equiv) Tab 200 MG PO 1 Tab
08:12.16 Penicillins
08:12.16.04 Natural Penicillins GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Penicillin G Benzathine Bicillin L-A (Equiv) SYRING 600,000 UNITS IM 2 ML
Penicillin G Benzathine Bicillin L-A (Equiv) SYRING 1,200,000 UNITS IM 1 SYRING
Penicillin G Potassium Penicillin G Potassium VIAL 5,000,000 UNITS IV 1 VIAL
Penicillin V Potassium Veetids 250 (Equiv) PD 250 MG PO 5 ML
Penicillin V Potassium Veetids 250 (Equiv) SUS REC 250 MG PO 5 ML
Penicillin V Potassium Pen Vee K (Equiv) TAB 250 MG PO 1 TAB
08:12.16 Penicillins - Continued
08:12.16.08 Aminopenicillins GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Amoxicillin Trihydrate Trimox (Equiv) CAP 250 MG PO 1 CAP
Amoxicillin Trihydrate Trimox (Equiv) SUS REC 250 MG PO 5 ML
Amoxicillin Trihydrate Triamox (Equiv) TAB 500 MG PO 1 TAB
Amox Tr/Pot Clavlante 200-28.5 Augmentin (Equiv) 200-28.5 SUS REC 1 BOTTLE PO 50 ML
Amox Tr/Pot Clavlante 200-28.5 Augmentin (Equiv) 200-28.5 SUS REC 1 CUP PO 5 ML
Amox Tr/Pot Clavulante 400-57 Augmentin (Equiv) 400-57 SUS REC 1 BOTTLE PO 50 ML
Amox Tr/Pot Clavulante 400-57 Augmentin (Equiv) 400-57 SUS REC 1 CUP PO 5 ML
Amox Tr/Pot Clavulante 500-125 Augmentin (Equiv) 500-125 TAB 1 TAB PO 1 TAB
Amox Tr/Pot Clavulante 875-125 Augmentin (Equiv) 875-125 TAB 1 TAB PO 1 TAB
Ampicillin Sodium Ampicillin Sodium VIAL 1,000 MG IV 1 VIAL
Ampicillin Sodium Ampicillin Sodium VIAL 2,000 MG IV 1 VIAL
Ampicillin Sodium Ampicillin Sodium VIAL 250 MG IV 1 VIAL
Ampicillin Sodium Ampicillin Sodium VIAL 500 MG IV 1 VIAL
Ampicillin Trihydrate Principen 250 (Equiv) SUS REC 250 MG PO 5 ML
Ampicillin Trihydrate Principen 250 (Equiv) SUS REC 250 MG PO 5 ML
Ampicillin Sodium/Sulbactam Na Unasyn (Equiv) VIAL 1.5 GM IV 1 VIAL
Ampicillin Sodium/Sulbactam Na Unasyn (Equiv) VIAL 3 GM IV 1 VIAL
08:12.16.12 Penicillinase Resistant
Penicillins GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Dicloxacillin Sodium Dynapen (Equiv) CAP 250 MG PO 1 CAP Oxacillin Sod/Dextrose 2gm PM Bactocill/Dextrose PM (Equiv) FZ PIGG 2000 MG IV 50 ML
Oxacillin Sodium Bactocil (Equiv) VIAL 1 GM IV 1 VIAL Oxacillin Sodium Bactocil (Equiv) VIAL 2 GM IV 1 VIAL
08:12.1608:12.16.16 Extended Spectrum
Penicillins GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Piperacill/Tazo 2.25gm/D5w PM Zosyn (Equiv) 2.25gm PM FZ PIGG 2.25 GM IV 50 ML
Piperacill/Tazo/D5w 3/375gm PM Zosyn (Equiv) 3.375gm PM FZ PIGG 3.375 GM IV 50 ML
Piperacill/Tazobactam 2.25gm Zosyn (Equiv) VIAL 2.25 GM IV 1 VIAL
Piperacill/Tazobactam 3.375gm Zosyn (Equiv) VIAL 3.375 GM IV 1 VIAL
Piperacill/Tazobactam 4.5gm Zosyn (Equiv) VIAL 4.5 GM IV 1 VIAL
08:12.18 Quinolones
08:12.18 Quinolones GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Ciprofloxacin HCl Cipro TAB 250 MG PO 1 TAB
Ciprofloxacin HCl Cipro (Equiv) TAB 500 MG PO 1 TAB
Ciprofloxacin Lactate Cipro I.V. (Equiv) PM 200 MG IV 100 ML
Ciprofloxacin Lactate Cipro I.V. (Equiv) PM 400 MG IV 200 ML
Levofloxacin Levaquin (Equiv) VIAL 500 MG IV 20 ML
Levofloxacin/Dext 500mg PM Levaquin/Dex 500mg PM (Equiv) PB 500 MG IV 100 ML
Levofloxacin/Dext 750mg PM Levaquin/Dex 750mg PM (Equiv) PB 750 MG IV 150 ML
Levofloxacin/Dextrose 250mg PM Levaquin/Dextrose 250mg (Equiv PB 250 MG IV 50 ML
Levofloxacin Levaquin (Equiv) TAB 250 MG PO 1 TAB
Levofloxacin Levaquin (Equiv) TAB 500 MG PO 1 TAB
08:12.20 Sulfonamides
08:12.20 Sufonamides GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Sulfamethoxazole/Trimethoprim Bactrim Ds (Equiv) TAB 1 TAB PO 1 TAB
Sulfamethoxazole/Trimethoprim Bactrim Ds (Equiv) 800/160mg SUSP 1 CUP PO 20 ML
Sulfmth/Tmp 80mg-16mg/Ml Bactrim 80mg-16mg/Ml (Equiv) VIAL 1 VIAL IV 30 ML
Sulfadiazine Sulfadiazine Tab 500 MG PO 1 TAB
Sulfasalazine Azulfidine (Equiv) TAB 500 MG PO 1 TAB
08:12.24 Tetracylcines
08:12.24 Tetracyclines GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Demeclocycline HCl Declomycin (Equiv) TAB 150 MG PO 1 TAB
Doxycycline Hyclate Vibramycin (Equiv) CAP 100 MG PO 1 CAP
Doxycycline Hyclate Vibramycin (Equiv) VIAL 100 MG IV 1 VIAL
Minocycline Minocin (Equiv) Vial 100 MG IV 1 VIAL
Tetracycline HCl Sumycin (Equiv) CAP 250 MG PO 1 CAP
08:12.24.12 Glycylcylines08:12.24.12 Glycylcyclines GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Tigecycline Tygacil (Equiv) VIALS 50 mg IV 1 Vial
08:12.28Miscellaneous Antibacterials
08:12.28.08 Bacitracin GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Bacitracin Bacitracin Sterile VIAL 50000 UNITS IM 30 ML
08:12.28.16 Glycopeptides GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Oritavancion Orbactiv Vial 400 mg IV 1 Vial
Currently Restricted to Riverside for Ordering Process Evaluation
Vancomycin HCl Vancomycin HCl (Equiv) OPTH 20 MG TOP 0.4 ML
Vancomycin HCl Vancomycin HCl (Equiv) ORAL 125 MG PO 1.25 ML
Vancomycin HCl Vancomycin HCl (Equiv) ORAL 250 MG PO 2.5 ML
Vancomycin HCl Vancomycin HCl (Equiv) ORAL 500 MG PO 5 ML
Vancomycin HCl Vancomycin (Equiv) VIAL 1,000 MG IV 1 VIAL
Vancomycin/D5w 1000mg PM Vancocin 1000mg PM (Equiv) FZ PIGG 1,000 MG IV 200 ML
Vancomycin HCl Vancomycin (Equiv) VIAL 500 MG IV 1 VIAL
08:12.28.20 Lincomycins GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Clindamycin HCl Cleocin (Equiv) CAP 150 MG PO 1 CAP
Clindamycin Palmitate Cleocin Palmitate (Equiv) SOL REC 75 MG PO 5 ML
Clindamycin Phosphate Cleocin (Equiv) VIAL 600 MG IV 4 ML
08:12.28.24 Oxazolidinones GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Linezolid Zyvox (Equiv) TAB 600 MG PO 1 TAB
Linezolid 600mg PM Zyvox (Equiv) INJ 600 MG IV 300 ML
08:12.28.28 Polymyxins GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Colistimethate Sodium Coly-Mycin M (Equiv) VIAL 150 MG IV 1 Vial
Polymyxin B Sulfate Polymyxin B (Equiv) VIAL 500,000 UNITS IV 1 VIAL
8:14 - Antifungals
08:14.08 Azoles GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Fluconazole Diflucan (Equiv) TAB 100 MG PO 1 TAB
Fluconazole/NS 100mg/50ml Diflucan/NS 200mg PM (Equiv) PB 100 MG IV 50 ML
Fluconazole/NS 200mg Diflucan/NS 200mg PM (Equiv) PB 200 MG IV 100 ML
Fluconazole/NS 400mg PM Diflucan/ NS 400mg PM (Equiv) PB 400 MG IV 200 ML
Itraconazole Sporanox (Equiv) CAP 100 MG PO 1 CAP
Itraconazole Oral Solution Sporanox Oral Solution Dose Cup 100 MG PO 10 ML
Ketoconazole Ketoconazole Tablet 200 mg PO 1 Capsule
Ketoconazole Ketoconazole Cream 2 % TOP 1 Tube
Ketoconazole Ketoconazole Shampoo 2 % TOP 1 Tube
Posaconazole Noxafil (Equiv) Susp 40 MG PO 1 ML
Voriconazole VFEND (Equiv) Vial 200 MG IV 20 ML
Voriconazole VFEND (Equiv) Tablet 200 MG PO 1 TAB
Voriconazole VFEND (Equiv) Susp 40 MG PO 5 mL
08:14.28 Polyenes GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Amphotericin B Fungizone Iv (Equiv) HS 50 MG IV 1 VIAL
Amphotericin B Lipid Complex Abelcet (Equiv) Vial 5 Mg IV 20 mL
Nystatin Mycostatin (Equiv) SUSP 500 MU PO 5 ML
08:14.32 Pyrimidines GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Flucytosine Ancobon (Equiv) Cap 250 MG PO 1 CAP
8:16 - Antimycobacterials
08:16.04 Antituberculosis GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Ethambutol HCl Myambutol (Equiv) TAB 100 MG PO 1 TAB Isoniazid Isoniazid TAB 300 MG PO 1 TAB Pyrazinamide Pyrazinamide TAB 500 MG PO 1 TAB Rifampin Rifadin (Equiv) CAP 150 MG PO 1 CAP Rifampin Rifadin (Equiv) CAP 300 MG PO 1 CAP Rifampin Rifadin (Equiv) VIAL 600 MG IV 1 VIAL
08:16.92 Miscellaneous
Antimycobacterials GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Dapsone Dapsone TAB 100 MG PO 1 TAB
8:18 - Antivirals 8.08 / 8.12 / 8.20 Combination HIV
Antivirals GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Abacavir and Lamivudine Epzicom (Equiv) Tab 600/300 MG PO 1 TAB
Albendazole Albenza Tab 200 MG PO 1 TAB
Efavirenz/emtricitabine/tenofovir Atripla (Equiv) Tab 600/200/300 MG PO 1 TAB
Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Disoproxil Fumarate Stribild (Equiv) Tab 150/150/200/3
00 MG PO 1 TAB
Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Alafenamide Genvoya (Equiv) Tab 150/150/200/3
00 MG PO 1 TAB
Emtricitabine/Tenofovir Truvada (Equiv) Tablet 200/300 MG PO 1 Tablet
Emtricitabine/Tenofovir alafenamide Descovy (Equiv) Tablet 200/25 MG PO 1 Tablet
Emtricitabine/Ripivirne/Tenofovir Complera (Equiv) Tablet 200/25/300 MG PO 1 Tablet
Emtricitabine / rilpivirine / tenofovir alafenamide Odefsey (Equiv) Tablet 200/25/25 MG PO 1 Tablet
Lamivudine/Zidovudine300-150mg Combivir 300-150mg (Equiv) TAB 1 TAB PO 1 TAB
08:18.08.04 HIV Entry and Fusion Inhibitors GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Maraviroc Selzentry (Equiv) TAB 150 MG PO 1 TAB
08:18.08.08 HIV Protease Inhibitor GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Atazanavir Reyataz (Equiv) Cap 200 MG PO 1 TAB
Atazanavir Reyataz (Equiv) Cap 300 MG PO 1 TAB
Darunavir Prezista (Equiv) TAB 600 MG PO 1 TAB
Darunavir Prezista (Equiv) TAB 800 MG PO 1 TAB
Nevirapime Viramune Sol 50 MG PO 1 ML
Rilpivirine Edurant TAB 25 MG PO 1 TAB
Ritonavir Norvir (Equiv) TAB 100 MG PO 1 TAB
08:18.08.12 Intergrase Inhibitors GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Dolutegravir Tivacay TAB 50 MG PO 1 TAB
Raltegravir Isentress (Equiv) TAB 400 MG PO 1 Tablet
08:18.08.16 Non- Nucleoside
Reverse Transcriptase Inhibitors
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Efaviranz Sustiva (Equiv) CAP 200 MG PO 1 CAP
Efaviranz Sustiva (Equiv) Tab 600 MG PO 1 TAB
Etravirine Intelence TAB 100 MG PO 1 TAB
Nivriapine Viramune Tab 200 MG PO 1 TAB
08:18.08.20 Nucleoside and
Nucleoside Reverse Transcriptase
Inhibitors
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Abacavir Ziagen (Equiv) TAB 300 MG PO 1 TAB
Abacavir Ziagen (Equiv) Sol 20 MG PO 1 mL
Didanosine Videx TAB 125 MG PO 1 TAB
Didanosine Videx TAB 200 MG PO 1 TAB
Emtricitabine Emtriva (Equiv) TAB 200 MG PO 1 Tablet
Lamivudine Epivir (Equiv) TAB 150 MG PO 1 TAB
Tenofovir Disoproxil Fumarate Viread (Equiv) TA 300 MG PO 1 TABLET
Zidovudine Retrovir (Equiv) CAP 100 MG PO 1 CAP
08:18.20 Interferons GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Interferon Alfa-2b,Recomb. Intron A (Equiv) VIAL 10,000,000 UNITS IV 2 ML Interferon Alfa-2b,Recomb.-6ds Intron A (Equiv) - 6dose Pen SYRING 5,000,000 UNITS IV 0.2 ML
08:18.28 Neuramidase Inhibitors GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Oseltamivir Tamiflu CAP 75 MG PO 1 CAP
Oseltamivir Tamiflu Solution 6 MG PO 1 ML
Peramavir Rapivab VIAL 200 MG IV 20 ML
08:18.32 Nucleosides and Nucleotides GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Acyclovir Zovirax (Equiv) SUSP 200 MG PO 5 ML
Acyclovir Zovirax (Equiv) CAP 200 MG PO 1 CAP
Acyclovir Zovirax (Equiv) TAB 800 MG PO 1 TAB
Acyclovir Sodium Zovirax (Equiv) VIAL 500 MG IV 10 ML
Entecavir Baraclude (Equiv) Tab 150 MG PO 1 TAB
Ganciclovir Sodium Cytovene (Equiv) VIAL 500 MG IV 1 VIAL
Ribaviran Rebetol (Equiv) TAB 200 MG PO 1 TAB
Valganciclovir Valcyte (Equiv) TAB 450 MG PO 1 TAB
8:30- Protozoals 08:30.08 Antimalarials GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Hydroxychloroquine Sulfate Plaquenil (Equiv) TAB 200 MG PO 1 TAB
Quinine Sulfate Qualaquin (Equiv) CAP 324 MG PO 1 CAP
08:30.92 Miscellaneous
Antiprotozoals GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Atovaquone Mepron (Equiv) Susp 750 MG PO 5 mL
Metronidazole Flagyl (Equiv) TAB 250 MG PO 1 TAB
Metronidazole/Nacl 500mg/100ml Flagyl (Equiv)PM 500mg/100ml PB 500 MG IV 100 ML
Metronidazole/Nacl Additive Flagyl (Equiv)Additive PB 500 MG IV 100 ML
Pentamidine Isethionate Pentam 300 (Equiv) VIAL 300 MG IV 1 VIAL
8:36 - Urinary Anti-Infectives
08:36.00Urinary Anti-Infectives GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Fosfomycin Monurol (Equiv) Packet 3 Gram PO 1 Packet
Mth/Me Blue/Ba/Salicy/Atp/Hyos Usept (Equiv) TAB 1 TAB PO 1 TAB
Nitrofurantoin Macrocrystal Macrodantin (Equiv) CAP 50 MG PO 1 CAP
Nitrofurantoin/Nitrofuran Mac Macrobid (Equiv) CAP 100 MG PO 1 CAP
Trimethoprim Primsol Tablet 100 Mg PO 1 Tablet
10:00 - Antineoplastic Agents
10:00.00 GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Aldesleukin Proleukin (Equiv) VIAL 22,000 UNITS IV 1 VIAL
Alemtuzumab Lemtrada (Equiv) INJ 12 MG IV 1.2 ML
Arsenic Trioxide Trisenox (Equiv) HH 10 MG IV 10 ML
Asparaginase Elspar (Equiv) VIAL 10,000 UNITS IV 10 ML
Atezolizumab Tecentriq VIAL 1200 MG IV 20 ML
Azacitidine Vidaza HS 100 MG 1 VIAL
Bendamustine Bendeka VIAL 100 MG IV 4 ML
Bevacizumab Avastin (Equiv) VIAL 100 MG IV 4 ML
Bevacizumab Avastin (Equiv) VIAL 400 MG IV 16 ML
Bicalutamide Casodex TAB 50 MG PO 1 TAB
Bleomycin Sulfate Bleomycin Sulfate VIAL 15 UNITS IV 1 VIAL
Bortezomib Velcade (Equiv) HS 3.5 MG IV 1 VIAL
Carboplatin Paraplatin (Equiv) VIAL 150 MG IV 1 VIAL
Carboplatin Paraplatin (Equiv) VIAL 450 MG IV 1 VIAL
Carboplatin Paraplatin (Equiv) VIAL 50 MG IV 1 VIAL
Carfilzomib Kyprolis (Equiv) VIAL 60 MG IV 1 VIAL
Carmustine Bicnu (Equiv) VIAL 100 MG IV 1 VIAL
Carmustine/Polfeprosan Gliadel Wafer 1 WAFER 1 WAFER
Cetuximab Erbitux HV 100 MG 50 ML
Chlorambucil Leukeran (Equiv) TAB 2 MG PO 1 TAB
Cisplatin Platinol (Equiv) VIAL 50 MG IV 50 ML
Cladribine Cladribine (Equiv) HV 1 MG IV 1 ML
Cyclophosphamide Cytoxan (Equiv) TAB 50 MG PO 1 TAB
Cyclophosphamide Cytoxan Lyophilized (Equiv) VIAL 1,000 MG IV 1 VIAL
Cyclophosphamide Cytoxan Lyophilized (Equiv) VIAL 500 MG IV 1 VIAL
Cytarabine Cytosar U (Equiv) VIAL 100 MG IV 5 ML
Cytarabine Cytosar U (Equiv) VIAL 1,000 MG IV 1 VIAL
Cytarabine Cytosar U (Equiv) VIAL 500 MG IV 10 ML
Dacarbazine Dtic Dome (Equiv) VIAL 200 MG IV 20 ML
Dactinomycin Cosmegan VIAL 0.5 MG IV 1 VIAL
Daratumumab Darzelex VIAL 100 MG IV 5 ML
Daratumumab Darzelex VIAL 400 MG IV 20 ML
Dasatinib Sprycel Tab 50 MG PO 1 TAB
Dasatinib Sprycel Tab 100 MG PO 1 TAB
Daunorubicin HCl Cerubidine (Equiv) VIAL 20 MG IV 4 ML
Docetaxel Taxotere (Equiv) VIAL 20 MG IV 0.5 ML
Docetaxel Taxotere (Equiv) VIAL 80 MG IV 2 ML
Doxorubicin HCl Adriamycin (Equiv) VIAL 20 MG IV 10 ML
Doxorubicin HCl Adriamycin (Equiv) VIAL 50 MG IV 25 ML
Doxorubicin HCl Liposomal Doxil (Equiv) HV 20 MG IV 10 ML
Doxorubicin Pf Adriamycin Pfs (Equiv) VIAL 10 MG IV 5 ML
Epirubicin HCl Ellence (Equiv) VIAL 50 MG IV 25 ML
Eribulin Halaven VIAL 1 MG IV 2 ML
Estramustine Phosphate Sodium Emcyt (Equiv) CAPSULE 140 MG PO 1 CAP
Etoposide Vepesid (Equiv) VIAL 100 MG IV 5 ML
Fludarabine Phosphate Fludara (Equiv) VIAL 50 MG IV 1 VIAL
Fluorouracil Fluorouracil VIAL 1,000 MG IV 20 ML
Flutamide Eulexin (Equiv) CAP 125 MG PO 1 CAP
Fulvestrant Faslodex (Equiv) SYRING 250 MG IM 5 ML
Gemcitabine HCl Gemzar (Equiv) VIAL 1,000 MG IV 1 VIAL
Gemcitabine HCl Gemzar (Equiv) VIAL 200 MG IV 10 ML
Hydroxyurea Hydrea (Equiv) CAP 500 MG PO 1 CAP
Idarubicin HCl Idarubicin HCl HV 10 MG IV 10 ML
Ifosfamide Ifex (Equiv) KIT 1,000 MG IV 1 VIAL
Imatinib Gleevec TAB 100 MG PO 1 TAB
Imatinib Gleevec TAB 400 MG PO 1 TAB
Interferon Alfa 2B Intron A Vial 10 MU IV 1 EACH
Interferon Alfa 2B Intron A Vial 18 MU IV 1 EACH
Interferon Alfa 2B Intron A Vial 50 MU IV 1 EACH
Ipilimumab Yervoy Vial 50 MG IV 1 VIAL
Ipilimumab Yervoy Vial 200 MG IV 1 VIAL
Irinotecan HCl Camptosar (Equiv) VIAL 100 MG IV 5 ML
Irinotecan HCl Camptosar (Equiv) VIAL 40 MG IV 2 ML
Irinotecan Liposomal Onivyde Vial 13 mg IV 10 mL
Letrozole Femara TAB 2.5 MG PO 1 TAB
Leuprolide Acetate Lupron Depot (Equiv) SYRING 7.5 MG IM 1 SYRINGE
Lomustine CeeNu Tab 10 MG PO 1 TAB
Lomustine CeeNu Tab 40 MG PO 1 TAB
Mechlorethamine HCl Mustargen VIAL 10 MG IV 1 VIAL
Megestrol Acetate Megace (Equiv) TAB 40 MG PO 1 TAB
Megestrol Acetate Megace (Equiv) SUSP 400 MG PO 10 ML
Melphalan Alkeran (Equiv) TAB 2 MG PO 1 TAB
Mercaptopurine Purinethol (Equiv) TAB 50 MG PO 1 TAB
Methotrexate Sodium Methotrexate TAB 2.5 MG PO 1 TAB
Methotrexate Sodium/Pf Methotrexate VIAL 100 MG IV 4 ML
Methotrexate Sodium/Pf Methotrexate VIAL 1,000 MG IV 40 ML
Methotrexate Sodium/Pf Methotrexate VIAL 20 MG IV 1 VIAL
Methotrexate Sodium/Pf Methotrexate VIAL 250 MG IV 10 ML
Methotrexate Sodium/Pf Methotrexate VIAL 50 MG IV 2 ML
Mitomycin Mutamycin (Equiv) VIAL 20 MG IV 1 VIAL
Mitomycin Mutamycin (Equiv) VIAL 5 MG IV 1 VIAL
Mitomycin Opth Mutamycin Opth (Equiv) VIAL 5 MG OPH 10 ML
Mitoxantrone HCl Novantrone (Equiv) VIAL 20 MG IV 10 ML
Mitoxantrone HCl Novantrone (Equiv) HV 25 MG IV 12.5 ML
Nivolumab Opdivo VIAL 40 MG IV 4 ML
Nivolumab Opdivo VIAL 100 MG IV 10 ML
Obinutuzumab Gazyva VIAL 1000 MG IV 40 ML
Oxaliplatin Eloxatin (Equiv) VIAL 100 MG IV 1 VIAL
Paclitaxel,Semi-Synthetic Taxol (Equiv) VIAL 30 MG IV 5 ML
Paclitaxel,Semi-Synthetic Taxol (Equiv) VIAL 300 MG IV 50 ML
Pembrolizumab Keytruda VIAL 100 MG IV 4 ML
Pentostatin Nipent (Equiv) HS 10 MG 1 VIAL
Ramucirumab Cyramza Vial 100 MG IV 10 ML
Ramucirumab Cyramza Vial 500 MG IV 50 ML
Rituximab Rituxan (Equiv0 VIAL 100 MG IV 10 ML
Rituximab Rituxan (Equiv) VIAL 500 MG IV 50 ML
Sorafenib Nexavar TAB 200 MG PO 1 TAB
Tamoxifen Citrate Nolvadex (Equiv) TAB 10 MG PO 1 TAB
Tamoxifen Citrate Soltamox SOL 10 MG PO 5 ML
Temozolomide Temodar CAPSULE 100 MG PO 1 CAP
Thioguanine Tabloid TAB 40 MG PO 1 TAB
Topotecan HCl Hycamtin (Equiv) VIAL 4 MG IV 1 VIAL
Trastuzumab Herceptin (Equiv) VIAL 440 MG IV 1 VIAL
Trastuzumab (Nci Study Drug) Herceptin (Nci Study Drug) HS 440 MG 1 HS
Tretinoin/ATRA Vesanoid CAP 10 MG PO 1 CAP
Valrubicin Valstar VIAL 40 MG IV 1 ML
Vinblastine Sulfate Vinblastine (Equiv) VIAL 10 MG IV 10 ML
Vincristine Sulfate Vincristine (Equiv) VIAL 2 MG IV 2 ML
Vinorelbine Tartrate Navelbine (Equiv) VIAL 10 MG IV 1 ML
12:00 Autonomic Drugs
12:04.00 Parasympathetic GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Bethanechol Chloride Urecholine (Equiv) TAB 25 MG PO 1 TAB
Donepezil HCl Aricept (Equiv) TAB 5 MG PO 1 TAB
Galantamine Hydrobromide Razadyne (Reminyl - Equiv) TA 4 MG PO 1 TA
Neostigmine Methylsulfate Neostigmine 1:1000 VIAL 10 MG IV 10 ML
Neostigmine Methylsulfate Neostigmine 1:2000 VIAL 5 MG IV 10 ML
Physostigmine Salicylate Physostigmine INJ 2 MG IV 2 ML
Pyridostigmine Bromide Mestinon (Equiv) TAB 60 MG PO 1 TAB
Rivastigmine Tartrate Exelon (Equiv) CAP 1.5 MG PO 1 CAP
Rivastigmine Tartrate Exelon (Equiv) CAP 3 MG PO 1 CAP
12:08.04 Antiparkinsonian Agents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Benztropine Mesylate Cogentin (Equiv) TAB 0.5 MG PO 1 TAB
Benztropine Mesylate Cogentin (Equiv) TAB 1 MG PO 1 TAB
Benztropine Mesylate Cogentin (Equiv) TAB 2 MG PO 1 TAB
Benztropine Mesylate Cogentin (Equiv) INJ 2 MG IV 2 ML
Trihexyphenidyl HCl Artane (Equiv) TAB 2 MG PO 1 TAB
Trihexyphenidyl HCl Artane (Equiv) TAB 5 MG PO 1 TAB
12:08.08 Antimuscarinics / Antispasmodics GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Atropine Sulfate Atropine Sulfate VIAL 0.4 MG IV 1 ML
Atropine Sulfate Atropine Sulfate VIAL 1 MG IV 1 ML
Atropine Sulfate Atropine Sulfate SYRING 1 MG IV 10 ML
Belladonna Alkaloids/Phenobarb Donnatal (Equiv) TAB 1 TAB PO 1 TAB
Belladonna Alkaloids/Phenobarb Donnatal (Equiv) ELIXIR 5 ML PO 5 ML
Dicyclomine HCl Bentyl (Equiv) CAP 10 MG PO 1 CAP
Dicyclomine HCl Bentyl (Equiv) TAB 20 MG PO 1 TAB
Dicyclomine HCl Bentyl (Equiv) INJ 20 MG IM 2 ML
Glycopyrrolate Robinul (Equiv) VIAL 0.4 MG IV 2 ML
Glycopyrrolate Robinul (Equiv) TAB 1 MG IV 1 TAB
Hyoscyamine Sulfate Levsin (Equiv) TAB 0.125 MG PO 1 TAB
Hyoscyamine Sulfate Levsinex (Equiv) C SR 12 0.375 MG PO 1 C SR 1
Hyoscyamine Sulfate Levsinex (Equiv) VIAL 0.5 MG IV 1 ML
Ipratropium Bromide Atrovent (Equiv) AER 18 MCG RT 1 PUFF
Ipratropium Bromide 0.02% Atrovent (Equiv) 0.02% SOLN 0.5 MG RT 2.5 ML
Scopolamine Hydrobromide Scopolamine Hydrobromide(Equiv HV 0.4 MG IV 1 ML
Tiotropium Bromide Spiriva (Equiv) CD 18 MCG RT 1 CD
12:12.00 Sympathomimetic (Andrenergic) Agents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Albuterol Albuterol AER 90 MCG RT 1 PUFF
Albuterol Sulfate Albuterol Sulfate TAB 2 MG PO 1 TAB
Albuterol Sulfate Albuterol Sulfate SYRUP 2 MG PO 5 ML
Albuterol Sulfate Proventil (Equiv) SOLN 5 MG RT 1 ML
Albuterol Sulfate 0.083% Albuterol Sulfate 0.083% SOLN 2.49 MG RT 3 ML
Albuterol Sulfate/Ipratropium Combivent (Equiv) AER 1 DOSE RT 1 PUFF
Albuterol Sulfate/Ipratropium Duoneb (Equiv) SOLN 1 AMPULE RT 3 ML
Budesonide and Formoterol Symbicort INH 80/4.5 MCG RT 1 PUFF
Budesonide and Formoterol Symbicort INH 160/4.5 MCG RT 1 PUFF
Dobutamine HCl Dobutamine HCl VIAL 500 MG IV 40 ML
Dobutamine HCl/D5w 500mg PM Dobutamine HCl/D5w 500mg PM INJ 500 MG IV 250 ML
Dopamine 400mg D5w Dopamine 400mg In 5% Dextrose INJBAG 400 MG IV 250 ML
Dopamine 800mg / D5w Dopamine 800mg In 5% Dextrose INJBAG 800 MG IV 250 ML
Dopamine HCl Dopamine HCl VIAL 400 MG IV 5 ML
Ephedrine Sulfate Ephedrine Sulfate VIAL 50 MG IV 1 ML
Epinephrine Epinephrine INJ 1 MG IV 1 ML
Epinephrine Epinephrine SYRING 1 MG IV 10 ML
Epinephrine Epinephrine VIAL 30 MG IV 30 ML
Epinephrine 1:1,000 Epinephrine 1:1,000 SYRINGE 0.3 MG IV 0.3 ML
Epinephrine X4/ D5w 250ml Kit Epinephrine Kit (Open Heart) HH 1 EACH IV 1 KIT
Isoproterenol HCl Isuprel (Equiv) INJ 1 MG IV 5 ML
Levalbuterol HCl Xopenex (Equiv) SOLN 1.25 MG RT 3 ML
Midodrine HCl Proamatine (Equiv) TAB 5 MG PO 1 TAB
Norepinephrine Bitartrate Levophed (Equiv) INJ 4 MG IV 4 ML
Phenylephrine HCl Neo-Synephrine (Equiv) INJ 10 MG IV 1 ML
Phenylephrine HCl Neosynephrine (Equiv) VIAL 50 MG IV 5 ML
Pirbuterol Acetate Maxair Autohaler (Equiv) AEO BRE 200 MCG RT 1 PUFF
Pseudoephedrine HCl Sudafed (Equiv) TAB 30 MG PO 1 TAB
Racepinephrine HCl 2.25% Vaponephrine (Equiv) SOLN 1 SYRINGE INH 0.5 ML
Terbutaline Sulfate Brethine (Equiv) INJ 1 MG IV 1 ML
Terbutaline Sulfate Brethine (Equiv) TAB 2.5 MG PO 1 TAB
12:12.12 Alpha- and Beta- Agonists GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Droxidopa Northera CAP 100 MG PO 1 CAP
Droxidopa Northera CAP 200 MG PO 1 CAP
Droxidopa Northera CAP 300 MG PO 1 CAP
12:16.00 Sympatholytic (Andrenergic Blocker)
Agents
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Dihydroergotamine Mesylate D.H.E.45 (Equiv) INJ 1 MG IV 1 ML
Phentolamine Mesylate Regitine (Equiv) VIAL 5 MG IM 2 ML
12:20.00 Skeletal Muscle Blockers GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Atracurium Besylate Tracrium (Equiv) VIAL 100 MG IV 10 ML
Baclofen Baclofen TAB 10 MG PO 1 TAB
Baclofen Lioresal Intrathecal VIAL 10 MG IT 20 ML
Cisatracurium Besylate Nimbex (Equiv) VIAL 10 MG IV 5 ML
Cyclobenzaprine HCl Flexeril (Equiv) TAB 10 MG PO 1 TAB
Dantrolene Sodium Dantrium Iv VIAL 20 MG IV 70 ML
Dantrolene Sodium Ryanodex VIAL 250 MG IV 1 Vial
Methocarbamol Robaxin (Equiv) TAB 500 MG PO 1 TAB
Orphenadrine Citrate Norflex (Equiv) INJ 60 MG IV 2 ML
Pancuronium Bromide Pavulon (Equiv) VIAL 10 MG IV 5 ML
Pancuronium Bromide Pavulon (Equiv) INJ 4 MG IV 2 ML
Rocuronium Bromide Zemuron (Equiv) VIAL 50 MG IV 5 ML
Succinylcholine Chloride Quelicin (Equiv) VIAL 200 MG IV 10 ML
Vecuronium Bromide Norcuron (Equiv) VIAL 10 MG IV 1 VIAL
12:20.04 Centrally Acting Skeletal Muscle GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Relaxants Carisprodol Soma Currently Non-stocked
Metaxolone Skelaxin Currently Non-stocked
Tizanidine Zanaflex Currently Non-stocked
12:92.00 Miscellaneous
Autonomic Drugs GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Non Stocked Item Nicotine Habitorol INH
Nicotine Nicoderm (Equiv) PAT 24H 14 MG TD 1 PATCH
Nicotine Nicoderm (Equiv) PAT 24H 21 MG TD 1 PATCH
Nicotine Nicoderm (Equiv) PAT 24H 7 MG TD 1 PATCH
Nicotine Polacrilex Nicorette Gum (Equiv) CHGUM 10 CHGUM BUC 1 PACKAGE
16:00 Blood Derivatives
16:00.00 Blood Derivative GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Albumin Human 25% Albuminar-25 VIAL 25 GM IV 100 ML
Albumin Human 25% Albuminar-25 VIAL 50 ML IV 1 VIAL
Albumin Human 5% Albumin 5% VIAL 12.5 GM IV 250 ML
20:00 Blood Formation and Coagulation
20:04 Antianemia Drugs20:04.4 Iron Preparations GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Ferric carboxymaltose Injectafer IV 750 MG IV 15 ML
Ferrous Sulfate Ferrous Sulfate LIQUID 300 MG PO 5 ML
Ferrous Sulfate Ferrous Sulfate ECTAB 325 MG PO 1 ECTAB
Ferrous Sulfate/Vit C/Fa Fero Folic 500 (Equiv) SR TAB 1 SR TAB PO 1 SR TAB
Iron Dextran Complex Infed (Equiv) VIAL 100 MG IV 2 ML
Iron Polysaccharides Complex Niferex (Equiv) CAP 150 MG PO 1 CAP
Iron Polysaccharides B12 / FA Niferex Plus (Equiv) Capsule 150 mg PO 1 Capsule
Iron Sucrose Complex Venofer (Equiv) HV 100 MG IV 5 ML
Sodium Ferric Gluconate Ferrlcit Vial 12.5 MG IV 1 ML
20:12 Coagulants and Anticoagulants
20:12.04 Anticoagulants GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
20:12.04.08 Coumarin and Indandione
Warfarin Sodium Coumadin (Equiv) TAB 1 MG PO 1 TAB
Warfarin Sodium Coumadin (Equiv) TAB 10 MG PO 1 TAB
Warfarin Sodium Coumadin (Equiv) TAB 2 MG PO 1 TAB
Warfarin Sodium Coumadin (Equiv) TAB 2.5 MG PO 1 TAB
Warfarin Sodium Coumadin (Equiv) TAB 3 MG PO 1 TAB
Warfarin Sodium Coumadin (Equiv) TAB 5 MG PO 1 TAB
Warfarin Sodium Coumadin (Equiv) TAB 7.5 MG PO 1 TAB
20:12.04.12 Direct Thrombin Inhibitors GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Argatroban Argatroban VIAL 250 MG IV 2.5 ML
Bivalirudin Angiomax (Equiv) VIAL 250 MG IV 1 VIAL
Dabigatran Pradaxa (Equiv) Tablet 75 mg PO 1 Tab
Dabigatran Pradaxa (Equiv) Tablet 150 mg PO 1 Tab
20:12.04.14 Direct Factor Xa Inhibitors GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Fondaparinux Sodium Arixtra (Equiv) HQ 2.5 MG SQ 0.5 ML
Apixaban Eliquis (Equiv) Tab 2.5 MG PO 1 TAB
Apixaban Eliquis (Equiv) Tab 5 MG PO 1 TAB
Edoxaban Savasya Tab 15 MG PO 1 TAB
Edoxaban Savasya Tab 30 MG PO 1 TAB
Edoxaban Savasya Tab 60 MG PO 1 TAB
Rivaroxaban Xarelto TAB 10 MG PO 1 TAB
Rivaroxaban Xarelto TAB 15 MG PO 1 TAB
Rivaroxaban Xarelto TAB 20 MG PO 1 TAB
20:12.04.16 Heparins GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Heparin Sodium,Porcine Heparin Lock Flush SYRING 10 UNITS IV 1 ML
Heparin Sodium,Porcine Heparin Lock VIAL 100 UNITS IV 1 ML
Heparin Sodium,Porcine Heparin Lock VIAL 1,000 UNITS IV 10 ML
Heparin Sodium,Porcine Heparin Sodium VIAL 1,000 UNITS IV 1 ML
Heparin Sodium,Porcine Heparin Sodium HV 1,000 UNITS IV 1 ML
Heparin Sodium,Porcine Heparin Sodium VIAL 10,000 UNITS IV 1 ML
Heparin Sodium,Porcine Heparin Sodium VIAL 5,000 UNITS SQ 1 ML
Heparin 25,000 Units D5w Heparin 25,000 Units D5w INJ 25,000 UNITS IV 500 ML
Heparin 2,000 Units,Porcine/NS Heparin 2,000 Units/ 0.9% Nacl INJ 2,000 UNITS IV 1000 ML
Heparin 1,000 Unit,Porcine/NS Heparin 1,000unit In 0.9% Nacl INJ 1,000 UNITS IV 500 ML
Enoxaparin Sodium Lovenox (Equiv) SYRING 80 MG SUB 0.8 ML
Enoxaparin Sodium Lovenox (Equiv) SYRING 60 MG SUB 0.6 ML
Enoxaparin Sodium Lovenox (Equiv) SYRING 40 MG SUB 0.4 ML
Enoxaparin Sodium Lovenox (Equiv) SYRING 30 MG SUB 0.3 ML
Enoxaparin Sodium Lovenox (Equiv) SYRING 150 MG SUB 1 ML Enoxaparin Sodium Lovenox (Equiv) SYRING 120 MG SUB 0.8 ML
20:12.08 Antiheparin Agents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Protamine Sulfate Protamine (Equiv) VIAL 250 MG IV 25 ML
Protamine Sulfate Protamine (Equiv) VIAL 50 MG IV 5 ML
20:12.14 Platelet-Reducing Agents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Anagrelide Agrylin TAB 0.5 MG PO 1 TAB
20:12.18 Platelet Aggregation Inhibitors GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Abciximab Reopro (Equiv) VIAL 10 MG IV 5 ML
Cilostazol Pletal (Equiv) TAB 100 MG PO 1 TAB
Clopidogrel Bisulfate Plavix (Equiv) TAB 75 MG PO 1 TAB
Eptifibatide Integrilin (Equiv) HV 20 MG IV 10 ML
Eptifibatide Integrilin (Equiv) HV 200 MG IV 100 ML
Prasugrel Effient (Equiv) TAB 10 MG PO 10 MG
Ticagrelor Brilinta (Equiv) TAB 90 MG PO 90 MG
20:16.00 Hematopoietic Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Epoetin Alfa Epogen (Equiv) VIAL 2,000 UNITS SQ 1 ML
Epoetin Alfa Epogen (Equiv) VIAL 3,000 UNITS SQ 1 ML
Epoetin Alfa Epogen (Equiv) VIAL 4,000 UNITS SQ 1 ML
Epoetin Alfa Epogen (Equiv) VIAL 10,000 UNITS SQ 1 ML
Epoetin Alfa Epogen (Equiv) VIAL 20,000 UNITS SQ 1 ML
Epoetin Alfa Epogen (Equiv) VIAL 40,000 UNITS SQ 1 ML
Filgrastim-sndz Zarxio (Equiv) VIAL 300 MCG SQ 1 ML
Filgrastim-sndz Zarxio (Equiv) VIAL 480 MCG SQ 1.6 ML
Pegfilgrastim – Device Neulasta On Body Injector
Pegfilgrastim Neulasta (Equiv) SYRING 6 MG SUB 0.6 ML
Romiplostim NPLate Vial 250 MCG SUB 1 VIAL
Romiplostim NPLate Vial 500 MCG SUB 1 VIAL
20:24.00 Hemorrheologic
Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Pentoxifylline Trental (Equiv) SR TAB 400 MG PO 1 SR TAB
20:28.16 Hemostatics GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Aminocaproic Acid Amicar (Equiv) TAB 500 MG PO 1 TAB
Aminocaproic Acid Amicar (Equiv) VIAL 5,000 MG IV 20 ML
Antihemophilic Factor 8 Human Koate-Dvi (Equiv) KIT 100 UNITS IV 100 UNITS
Antihemophilic Factor, Hum Rec Recombinate (Equiv) VIAL 1,000 UNITS IV 1 VIAL
Anti-Inhibitor Coagulant Comp. Feiba Vh Immuno (Equiv) HS 1 UNIT IV 1 UNIT
Aprotinin Trasylol (Equiv) VIAL 10,000 UNITS IV 100 ML
Factor Ix Human Recombinant Benefix (Equiv) KIT 1 UNIT IV 1 UNIT
Non-stocked Ferric Subsulfate Monsel’s Solution Solution
Prothrombin Complex Concentrate KCentra (equiv) Vial 500 IU IV 1 Vial
Thrombin 2,000units/Cacl Thrombin Tissue Adhesive SYRINGE 1 EACH TOP 1 SYRINGE
Tranexamic Acid Cyklokapron™ (Equiv) Vial 1 100 mg IV 1 mL
Tranexamic Acid Lysteda TAB 650 MG PO 1 TAB
20:40.00 Thrombolytic Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Alteplase Activase (Equiv) VIAL 50 MG IV 50 ML
Alteplase Activase (Equiv) VIAL 100 MG IV 100 ML
Alteplase Cathflo Activase VIAL 2 MG IV 1 VIAL
Tenecteplase TNKase Kit 50 MG IV 1 Kit
24:00 Cardiovascular Drugs
24:04 Cardiac Drugs
24:04.04 Antiarrythmic Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Adenosine Adenocard Iv (Equiv) VIAL 6 MG IV 2 ML
Amiodarone HCl Pacerone (Equiv) TAB 200 MG PO 1 TAB
Amiodarone HCl Amiodarone HCl VIAL 50 MG IV 1 ML
Amiodarone HCl Amiodarone HCl HV 900 MG IV 18 ML
Disopyramide Phosphate Norpace Cr (Equiv) SR CAPS 100 MG PO 1 SR CAP
Disopyramide Phosphate Norpace Cr (Equiv) SR CAPS 150 MG PO 1 SR CAP
Dofetilide Tikosyn (Equiv) CAP 0.125 MG PO 1 CAP
Dofetilide Tikosyn (Equiv) CAP 0.25 MG PO 1 CAP
Dofetilide Tikosyn (Equiv) CAP 0.5 MG PO 1 CAP
Dronedarone Multaq TAB 400 MG PO 1 TAB
Ibutilide Fumarate Corvert (Equiv) HV 1 MG IV 10 ML
Lidocaine 2gm HCl/D5w Xylocaine 2gm /D5w (Equiv) INJ 500 ML IV 500 ML
Lidocaine HCl 2% Lidocaine HCl 2% SYRING 100 MG IV 5 ML
Mexiletine HCl Mexitil (Equiv) CAP 150 MG PO 1 CAP
Mexiletine HCl Mexitil (Equiv) CAP 200 MG PO 1 CAP
Mexiletine HCl Mexitil (Equiv) CAP 250 MG PO 1 CAP
Procainamide HCl Procainamide HCl VIAL 1000 MG IV 10 ML
Propafenone HCl Rythmol (Equiv) TAB 150 MG PO 1 TAB
Quinidine Gluconate Quinidine Gluconate (Equiv) SR TAB 324 MG PO 1 SR TAB
Quinidine Gluconate Quinidine Gluconate (Equiv) VIAL 800 MG IV 10 ML
Quinidine Sulfate Quinidine Extendtab (Equiv) SR TAB 300 MG PO 1 SR TAB
Quinidine Sulfate Quinidine (Equiv) TAB 300 MG PO 1 TAB
24:04.08 Cardiotonic Agents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Digoxin Digoxin ELIXIR 0.25 MG PO 5 ML
Digoxin Lanoxin (Equiv) INJ 0.5 MG IV 2 ML
Digoxin Lanoxin Pediatric (Equiv) INJ 100 MCG IV 1 ML
Digoxin Lanoxin (Equiv) TAB 125 MCG PO 1 TAB
Digoxin Lanoxin (Equiv) TAB 250 MCG PO 1 TAB
Inamrinone Lactate Inocor (Equiv) INJ 100 MG IV 20 ML
Milrinone Lactate Primacor (Equiv) VIAL 20 MG IV 20 ML
Milrinone Lactate/D5w PM Primacor/D5w PM (Equiv) PB 20 MG IV 100 ML
24:04.92 Miscellaneous GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Ivabradine Corlanor TAB 5 MG PO 1 TAB
Ivabradine Corlanor TAB 7.5 MG PO 1 TAB
Regadenoson Lexiscan (Equiv) Syringe 0.4 MG IV 5 ML
24:06 Antilipemic Agents
Bile Acid Sequestrants24:06.04 GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Cholestyramine/AspartameQuestran
Light (Equiv)
PACKET 4 GM PO 1 PACKET
2-Azetidinone24:06.05 GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Ezetimibe Zetia (Equiv) TA 10 MG PO 1 TABLET
24:06.06 Fibric Acid Derivatives GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Fenofibrate,Micronized Lofibra (Equiv) TA 54 MG PO 1 TABLET
Fenofibrate,Micronized Lofibra (Equiv) TA 160 MG PO 1 TABLET
Gemfibrozil Lopid (Equiv) TAB 600 MG PO 1 TAB
24:06.08 HMG-CoA Reductase
Inhibitors GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Atorvastatin Lipitor TAB 10 MG PO 1 TAB
Atorvastatin Lipitor TAB 20 MG PO 1 TAB
Atorvastatin Lipitor TAB 40 MG PO 1 TAB
Atorvastatin Lipitor TAB 80 MG PO 1 TAB
Pravastatin Pravachol (Equiv) TAB 20 MG PO 1 TAB
Pravastatin Pravachol (Equiv) TAB 40 MG PO 1 TAB
Simvastatin Simvastatin (Equiv) TAB 10 MG PO 1 TAB
Simvastatin Simvastatin (Equiv) TAB 20 MG PO 1 TAB
Simvastatin Simvastatin (Equiv) TAB 40 MG PO 1 TAB
24:06.92 Antilipemic Agents
Miscellaneous GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Niacin Niacin TAB 100 MG PO 1 TAB
Omega-3-Ethyl Esters
Niacin Niaspan (Equiv) SR TAB 500 MG PO 1 SR TAB
Lovaza Tab 1 Gram PO 1 TAB
24:08 Hypotensive Agents
24:08.16 Central Alpha AgonitsGENERIC NAME BRAND
NAMEDOSAGE
FORMSTRENGT
H UNIT ROUTE VOLUMEVOLU
ME UNIT
Clonidine HCl Catapres (Equiv) TAB 0.1 MG PO 1 TAB
Clonidine HCl Catapres (Equiv) TAB 0.2 MG PO 1 TAB
Clonidine HCl Catapres-Tts 1 (Equiv) PAT TDW 0.1 MG TD 1 PATCH
Clonidine HCl Catapres-Tts 2 (Equiv) PAT TDW 0.2 MG TD 1 PATCH
Clonidine HCl Catapres-Tts 3 (Equiv) PAT TDW 0.3 MG TD 1 PATCH
Guanfacine HCl Tenex (Equiv) TAB 1 MG PO 1 TAB
Methyldopa Aldomet (Equiv) TAB 250 MG PO 1 TAB
Methyldopa Aldomet (Equiv) TAB 500 MG PO 1 TAB
Methyldopate HCl Aldomet (Equiv) VIAL 250 MG IV 5 ML
24:08.20 Direct Vasodilators GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Diazoxide Hyperstat I.V. INJ 300 MG IV 20 ML
Hydralazine HCl Apresoline (Equiv) TAB 10 MG PO 1 TAB
Hydralazine HCl Apresoline (Equiv) TAB 25 MG PO 1 TAB
Hydralazine HCl Apresoline (Equiv) TAB 50 MG PO 1 TAB
Hydralazine HCl Apresoline (Equiv) VIAL 20 MG IV 1 ML
Minoxidil Loniten (Equiv) TAB 3 MG PO 1 TAB
Minoxidil Loniten (Equiv) TAB 10 MG PO 1 TAB
Nitroprusside Sodium Nitropress (Equiv) VIAL 50 MG IV 2 ML
24:12 Vasodilating Agents
24:12.08 Nitrates and Nitrites GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Amyl Nitrite Amyl Nitrite AMP 0.3 ML INH 1 INJ
Isosorbide Dinitrate Isordil (Equiv) TAB 5 MG PO 1 TAB
Isosorbide Dinitrate Isordil (Equiv) TAB 10 MG PO 1 TAB
Isosorbide Dinitrate Isordil (Equiv) TAB 20 MG PO 1 TAB
Isosorbide Mononitrate Imdur (Equiv) T SR 24 30 MG PO 1 T SR 24
Isosorbide Mononitrate Imdur (Equiv) T SR 24 60 MG PO 1 T SR 24
Nitroglycerin Nitrostat (Equiv) SL TAB 0.4 MG SL 1 SL TAB
Nitroglycerin Nitroglycerin Sr SR CAPS 6.5 MG PO 1 SR CAP
Nitroglycerin 0.1mg/Hr Nitrodur (Equiv) 0.1mg/Hr PAT 24H 2.5 MG TD 1 PATCH
Nitroglycerin 0.2mg/Hr Nitrodur (Equiv) 0.2mg/Hr PAT 24H 5 MG TD 1 PATCH
Nitroglycerin 0.3mg/Hr Nitrodur (Equiv) 0.3mg/Hr PAT 24H 7.5 MG TD 1 PATCH
Nitroglycerin 0.4mg/Hr Nitrodur (Equiv) 0.4mg/Hr PAT 24H 10 MG TD 1 PATCH
Nitroglycerin 0.6mg/Hr Nitrodur (Equiv) 0.6mg/Hr PAT 24H 15 MG TD 1 PATCH
Nitroglycerin 2% Nitroglycerin 2% OINT 1 GM TD 1 PACKET
Nitroglycerin Nitroglycerin VIAL 50 MG IV 10 ML
Nitroglycerin/D5w PM Nitroglycerin In D5w PM INFUS 50 MG IV 250 ML
24:12.92 Vasodilating Agents,
Miscellaneous GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Aspirin/Dipyridamole 200/25 Mg Aggrenox (Equiv)200mg/25mg CM 1 TAB PO 1 TAB
Dipyridamole Persantine (Equiv) INJ 10 MG IV 2 ML
Dipyridamole Persantine (Equiv) TAB 25 MG PO 1 TAB
Papaverine HCl Papaverine VIAL 60 MG IV 2 ML
Papaverine HCl Papaverine VIAL 300 MG IV 10 ML
24:16 Sclerosing Agents
24:16.00 Sclerosing Agents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Ethanolamine Oleate 5% Ethamolin 5% (Equiv) INJ 100 MG IV 2 INJ
Sodium Morrhuate Morrhuate Sodium VIAL 50 MG IV 1 ML
Sodium Morrhuate Morrhuate Sodium VIAL 1500 MG IV 30 ML
24:20 Alpha Adrenergic Blocking Agents
24:20.00 Alpha Adrenergic
Blocking Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Doxazosin Mesylate Cardura (Equiv) TA 2 MG PO 1 Tab
Doxazosin Mesylate Cardura (Equiv) TA 4 MG PO 1 Tab
Prazosin HCl Minipres (Equiv) CAP 1 MG PO 1 CAP
Prazosin HCl Minipres (Equiv) CAP 2 MG PO 1 CAP
Prazosin HCl Minipres (Equiv) CAP 5 MG PO 1 CAP
Terazosin HCl Hytrin (Equiv) CAP 1 MG PO 1 CAP
Terazosin HCl Hytrin (Equiv) CAP 5 MG PO 1 CAP
24:24 Beta-Adrenergic Blocking Agents
24:24.00Beta-Adrenergic Blocking Agents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Atenolol Tenormin (Equiv) TAB 25 MG PO 1 TAB
Atenolol Tenormin (Equiv) TAB 50 MG PO 1 TAB
Bisoprolol Bisoprolol TAB 2.5 MG PO 1 TAB
Bisoprolol Bisoprolol TAB 5 MG PO 1 TAB
Bisoprolol Bisoprolol TAB 10 MG PO 1 TAB
Carvedilol Coreg (Equiv) TAB 3.125 MG PO 1 TAB
Carvedilol Coreg (Equiv) TAB 6.25 MG PO 1 TAB
Esmolol HCl Brevibloc (Equiv) VIAL 100 MG IV 10 ML
Esmolol HCl Brevibloc (Equiv) INJ 2500 MG IV 10 ML
Esmolol HCl/Nacl Iso Osm Brevibloc (Equiv) IV 2500 MG IV 250 ML
Labetalol HCl Trandate (Equiv) VIAL 100 MG IV 20 ML
Labetalol HCl Normodyne (Equiv) SYRING 20 MG IV 4 ML
Labetalol HCl Normodyne (Equiv) TAB 200 MG PO 1 TAB
Labetalol HCl Normodyne (Equiv) TAB 300 MG PO 1 TAB
Metoprolol Succinate Toprol Xl (Equiv) T SR 24 50 MG PO 1 T SR 24
Metoprolol Succinate Toprol Xl (Equiv) T SR 24 100 MG PO 1 T SR 24
Metoprolol Tartrate Lopressor (Equiv) INJ 5 MG IV 5 ML
Metoprolol Tartrate Lopressor (Equiv) TAB 25 MG PO 1 TAB
Metoprolol Tartrate Lopressor (Equiv) TAB 50 MG PO 1 TAB
Nebivolol Bystolic TAB 2.5 MG PO 1 TAB
Nebivolol Bystolic TAB 5 MG PO 1 TAB
Nebivolol Bystolic TAB 10 MG PO 1 TAB
Pindolol Visken (Equiv) TAB 5 MG PO 1 TAB
Propranolol HCl Inderal (Equiv) INJ 1 MG IV 1 ML
Propranolol HCl Inderal (Equiv) TAB 10 MG PO 1 TAB
Propranolol HCl Inderal (Equiv) TAB 20 MG PO 1 TAB
Propranolol HCl Inderal (Equiv) TAB 40 MG PO 1 TAB
Propranolol HCl Inderal La (Equiv) SR CAPS 60 MG PO 1 SR CAP
Propranolol HCl Inderal La (Equiv) SR CAPS 80 MG PO 1 SR CAP
Sotalol HCl Betapace (Equiv) TAB 80 MG PO 1 TAB
24:28 Calcium-Channel Blocking Agents
24:28.08 Dihydropyridines GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Amlodipine Besylate Norvasc (Equiv) TAB 5 MG PO 1 TAB
Clevidipine Butyrate Cleviprex (Equiv) Vial 0.5 MG IV 50 ML
Nicardipine HCl Cardene (Equiv) 2.5mg/Ml INJ 25 MG IV 10 ML
Nifedipine Procardia (Equiv) CAP 10 MG PO 1 CAP
Nifedipine Procardia (Equiv) CAP 20 MG PO 1 CAP
Nifedipine Adalat Cc/Procardia Xl (Equiv) SR TAB 30 MG PO 1 SR TAB
Nifedipine Adalat Cc/Procardia Xl (Equiv) SR TAB 60 MG PO 1 SR TAB
Nimodipine Nimotop (Equiv) CAP 30 MG PO 1 CAP
Nimodipine Nimotop (Equiv) Solution 60 mg PO 20 mL
24:28.92 Calcium-Channel Blocking Agents,
MiscellaneousGENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Diltiazem Cd Cardizem Cd (Equiv) C SR 24 120 MG PO 1 C SR 2
Diltiazem Cd Cardizem Cd (Equiv) C SR 24 180 MG PO 1 C SR 2
Diltiazem Cd Cardizem Cd (Equiv) C SR 24 240 MG PO 1 C SR 2
Diltiazem Cd Cardizem Cd (Equiv) C SR 24 300 MG PO 1 C SR 2
Diltiazem HCl Cardizem (Equiv) VIAL 25 MG IV 5 ML
Diltiazem HCl Cardizem (Equiv) VIAL 50 MG IV 10 ML
Diltiazem Cardizem (Equiv) TAB 30 MG PO 1 TAB
Diltiazem HCl Cardizem (Equiv) TAB 60 MG PO 1 TAB
Diltiazem HCl Cardizem (Equiv) TAB 90 MG PO 1 TAB
24:28.92 Calcium-Channel
Blocking Agents, Miscellaneous
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
(continued) Verapamil HCl Calan (Equiv) TAB 120 MG PO 1 TAB
Verapamil HCl Calan (Equiv) TAB 40 MG PO 1 TAB
Verapamil HCl Calan (Equiv) TAB 80 MG PO 1 TAB
Verapamil HCl Verapamil ER (Equiv) ER TAB 120 MG PO 1 ER TAB
Verapamil HCl Verapamil ER (Equiv) ER TAB 180 MG PO 1 ER TAB
Verapamil HCl Verapamil ER (Equiv) ER TAB 240 MG PO 1 ER TAB
Verapamil HCl Calan (Equiv) VIAL 5 MG IV 2 ML
24:32 Renin-Angiotensin-Aldosterone Sytem Inhibitors
24:32.04 Angiotensin-
Converting Enzyme Inhibitors
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Captopril Captopril TAB 12.5 MG PO 1
Captopril Captopril TAB 25 MG PO 1 TAB
Captopril Capoten (Equiv) TAB 50 MG PO 1 TAB
Enalaprilat Dihydrate Vasotec (Equiv) VIAL 2.5 MG IV 2 ML
Lisinopril Prinivl/Zestril (Equiv) TAB 5 MG PO 1 TAB
Lisinopril Prinivil/Zestril (Equiv) TAB 10 MG PO 1 TAB
Lisinopril Prinivil/Zestril (Equiv) TAB 20 MG PO 1 TAB
24:32.08 Agiontensin II
Receptor Antagonists GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Losartan Cozaar (Equiv) TAB 25 MG PO 1 TAB
Losartan Cozaar (Equiv) TAB 50 MG PO 1 TAB
Losartan Cozaar (Equiv) TAB 100 MG PO 1 TAB
Valsartan Diovan (Equiv) TAB 20 `MG PO 1 TAB
Valsartan Diovan (Equiv) TAB 40 `MG PO 1 TAB
24:32.20 Mineralocorticoid (Aldosterone) Receptor
GENERIC NAME BRAND NAME DOSAGE FORM
STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
AntagonistsSpironolactone Aldactone (Equiv) TAB 25 MG PO 1 TAB
24:32.40 Renin Inhibitors GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Aliskerin Tecturna TAB 150 MG PO 1 TAB
Aliskerin Tecturna TAB 300 MG PO 1 TAB
28:04.04.92 GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Desflurane Suprane (Equiv) LIQUID 60 CC INH 1 HOUR
Etomidate Amidate (Equiv) SYRING 40 MG IV 20 ML
Isoflurane Isoflurane LIQUID 8 ML INH 1 DOSE
Ketamine HCl Ketalar (Equiv) VIAL 200 MG IV 20 ML
Ketamine HCl 10mg Charge Dose Ketamine HCl 10mg Charge Dose HV 10 MG INJ 0.2 ML
Propofol Diprivan (Equiv) VIAL 1000 MG IV 100 ML
Propofol Diprivan (Equiv) VIAL 200 MG IV 20 ML
Propofol Diprivan (Equiv) VIAL 500 MG IV 50 ML
Sevoflurane Ultane (Equiv) LIQUID 15 ML INH 1 UNIT
28:08 Analgesics and Antipyretics
28:08.04 Nonsteroidal Anti-inflammatory Agents
28:08.04.08 COX-II Inhibitors GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Celecoxib Celebrex Capsule 100 mg PO 1 Capsule
Celecoxib Celebrex Capsule 200 mg PO 1 Capsule
28:08.04.24 Salicylicylates GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Aspirin Aspirin CHWTAB 81 MG PO 1 CHWTAB
Aspirin Ecotrin (Equiv) ECTAB 81 MG PO 1 ECTAB
Aspirin Aspirin ECTAB 325 MG PO 1 ECTAB
Aspirin Aspirin TAB 325 MG PO 1 TAB
Aspirin Aspirin SUPP 300 MG REC 1 SUPP
Aspirin Aspirin SUPP 600 MG REC 1 SUPP
Aspirin/Caffeine/Butalbital Fiorinal (Equiv) CAP 1 CAP PO 1 CAP
Salsalate Disalcid (Equiv) TAB 500 MG PO 1 TAB
28:08.04.92 Other Nonsteroidal Anti-Inflammatory
AgentsGENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Ibuprofen Motrin (Equiv) SUSP 100 MG PO 5 ML
Ibuprofen Motrin (Equiv) TAB 200 MG PO 1 TAB
Ibuprofen Motrin (Equiv) TAB 400 MG PO 1 TAB
Ibuprofen Motrin (Equiv) TAB 600 MG PO 1 TAB
Ibuprofen Ibuprofen TAB 800 MG PO 1 TAB
Indomethacin Indocin (Equiv) CAP 25 MG PO 1 CAP
Ketorolac Tromethamine Toradol (Equiv) TAB 10 MG PO 1 TAB
Ketorolac Tromethamine Toradol (Equiv) VIAL 15 MG IM 1 ML
Ketorolac Tromethamine Toradol (Equiv) VIAL 30 MG IM 1 ML
Ketorolac Tromethamine Toradol (Equiv) VIAL 60 MG IM 2 ML
Meloxicam Mobic (Equiv) Tablet 7.5 MG PO 1 Tablet
Meloxicam Mobic (Equiv) Tablet 15 MG PO 1 Tablet
Naproxen Naprosyn (Equiv) TAB 250 MG PO 1 TAB
Naproxen Naprosyn (Equiv) TAB 375 MG PO 1 TAB
28:08.08 Opiate Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Acetaminophen/Cod. #3 300/30mg Tylenol #3 (Equiv) 300/30mg TAB 1 TAB PO 1 TAB
Acetaminophen/Codeine 300/30 Tylenol #3 (Equiv) 300/30 TAB 4 TAB PO 1 PACKAGE
Acetaminophen W/Cod Elixi(4pk) Acetaminophen W/Cod Elixi(4pk) SE 4 PACK PO 4 PACK
Acetaminophen/Codeine 120mg/12mg Tylenol W/Codeine (Equiv) SUSP 5 ML PO 5 ML
Aspirin/Buta/Caff/Cod #3 Fiorinal #3 (Equiv) CAP 1 CAP PO 1 CAP
Belladonna/Opium 60/16.2 Mg Belladonna & Opium 60/16.2mg SUPP 1 SUPP REC 1 SUPP
Codeine Sulf Codeine Sulfate TAB 30 MG PO 1 TAB
Fentanyl 12 Mcg/Hr Duragesic (Equiv) 12 Mcg/Hr PAT 12H 1.2 MG TD 1 PATCH
Fentanyl 25 Mcg/Hr Duragesic (Equiv) 25 Mcg/Hr PAT 12H 2.5 MG TD 1 PATCH
Fentanyl 50 Mcg/Hr Duragesic (Equiv) 50 Mcg/Hr PAT 12H 5 MG TD 1 PATCH
Fentanyl 75 Mcg/Hr Duragesic (Equiv) 75 Mcg/Hr PAT 12H 7.5 MG TD 1 PATCH
Fentanyl 100 Mcg/Hr Duragesic (Equiv) 100 Mcg/Hr PAT 12H 10 MG TD 1 PATCH
Fentanyl Citrate/Pf Sublimaze (Equiv) INJ 0.1 MG IV 2 ML
Fentanyl Citrate/Pf Sublimaze (Equiv) INJ 0.25 MG IV 5 ML
Fentanyl Citrate/Pf Sublimaze (Equiv) INJ 1 MG IV 20 ML
Hydrocodone Bit/Acetaminophen Vicodin (Equiv) TAB 1 TAB PO 1 TAB
Hydrocodone Bit/Acetaminophen Hydrocodone W/Acetaminophen TAB 6 TAB PO 1 PACKAGE
Hydrocodone Bit/Acetaminophen Vicodin (Equiv) SOLN 5 ML PO 5 ML
Hydromorphone HCl Dilaudid (Equiv) SYRING 1 MG IV 1 ML
Hydromorphone HCl Dilaudid (Equiv) SYRING 2 MG IV 1 ML
Hydromorphone HCl Dilaudid-Hp (Equiv) INJ 50 MG IV 5 ML
Hydromorphone HCl Dilaudid (Equiv) SOL 1 MG PO 1 ML
Hydromorphone HCl Dilaudid (Equiv) TAB 2 MG PO 1 TAB
Hydromorphone HCl Dilaudid (Equiv) TAB 4 MG PO 1 TAB
Hydromorphone HCl Hydromorphone HCl TAB 8 MG PO 1 TABLET
Hydromorphone HCl Dilaudid (Equiv) SUPP 3 MG REC 1 SUPP
Meperidine HCl Demerol (Equiv) SYRING 25 MG IV 1 ML
Meperidine HCl Demerol (Equiv) SYRING 50 MG IV 1 ML
Meperidine HCl Demerol (Equiv) SYRING 100 MG IV 1 ML
Meperidine HCl Demerol (Equiv) VIAL 100 MG IV 1 ML
Meperidine HCl Pca Demerol (Equiv) Pca SYRING 500 MG IV 50 ML
Meperidine HCl Demerol (Equiv) TAB 50 MG PO 1 TAB
Methadone HCl Methadone HCl TAB 5 MG PO 1 TAB
Methadone HCl Methadone HCl SOLN 5 MG PO 5 ML
Morphine Liposomol Pf Depodur VIAL 15 MG EPI 1.5 ML
Morphine Sulfate Morphine SYRING 2 MG IV 1 ML
Morphine Sulfate Morphine SYRING 4 MG IV 1 ML
Morphine Sulfate Morphine SYRING 10 MG IV 1 ML
Morphine Sulfate Morphine 15mg/Ml VIAL 300 MG IV 20 ML
Morphine Sulfate Pca Morphine Pca SYRING 50 MG IV 50 ML
Morphine Sulfate Morphine Sulfate SOLN 10 MG PO 5 ML
Morphine Sulfate Ms Contin (Equiv) SR TAB 15 MG PO 1 SR TAB
Morphine Sulfate Ms Contin (Equiv) SR TAB 100 MG PO 1 SR TAB
Morphine Sulfate Morphine Sulfate SOLN 20 MG PO 10 ML
Morphine Sulfate Roxanol (Equiv) SOLN 20 MG PO 1 ML
Morphine Sulfate Morphine SOLTAB 30 MG PO 1 SOLTAB
Morphine Sulfate Ms Contin (Equiv) SR TAB 30 MG PO 1 SR TAB
Morphine Sulfate Ms Contin(Equiv) SR TAB 60 MG PO 1 SR TAB
Morphine Sulfate Morphine Sulfate SUPP 10 MG REC 1 SUPP
Morphine Sulfate Morphine SUPP 5 MG REC 1 SUPP
Morphine Sulfate/Pf Astramorph-Pf (Equiv) INJ 2 MG IV 2 ML
Morphine Sulfate/Pf Duramorph (Equiv) INJ 10 MG IV 10 ML
Morphine Sulfate/Pf Morphine Pres-Free SYRING 250 MG IV 10 ML
Morphine Sulfate/Pf Morphine Pres-Free SYRING 500 MG IV 20 ML
Morphine Sulfate/Pf Morphine Pres-Free SYRING 1,000 MG IV 20 ML
Oxycodone HCl Oxycontin (Equiv) T SR 12 10 MG PO 1 T SR 1
Oxycodone HCl Oxycontin (Equiv) T SR 12 20 MG PO 1 T SR 1
Oxycodone HCl Oxycontin (Equiv) T SR 12 40 MG PO 1 T SR 1
Oxycodone HCl Oxy Ir (Equiv) TAB 5 MG PO 1 TAB
Oxycodone HCl/Acetaminophen Percocet (Equiv) TAB 1 TAB PO 1 TAB
Oxycodone HCl/Acetaminophen Percocet Home Pack (Equiv) TA 4 TAB PO 1 PACKAGE
Oxycodone HCl/Acetaminophen Roxicet (Equiv) SJ 5 ML PO 1 SJ
Remifentanil HCl Ultiva (Equiv) VIAL 5 MG IV 1 VIAL
Sufentanil Citrate Sufenta (Equiv) INJ 100 MCG IV 2 ML
Tapentadol Nucynta TAB 50 MG PO 1 TAB
Tapentadol Nucynta TAB 75 MG PO 1 TAB
Tramadol 50mg Home Pack X4 Ultram 50mg(Equiv) Homepack X4 TA 1 PACKAGE PO 4 TABLET
Tramadol HCl Ultram (Equiv) TAB 50 MG PO 1 TAB
28:08.12 Opiate Partial Agonists GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Nalbuphine HCl Nubain (Equiv) IM 10 MG IV 1 ML
28:08.92 Analgesics and
Antipyretis, Miscellaneous
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Acetaminophen Tylenol (Equiv) TAB 325 MG PO 1 TAB
Acetaminophen Tylenol (Equiv) TAB 500 MG PO 1 TAB
Acetaminophen Tylenol (Equiv) CUP 650 MG PO 20.3 ML
Acetaminophen Tylenol (Equiv) SUPP 120 MG REC 1 EA
Acetaminophen Feverall (Equiv) SUPP 325 MG REC 1 SUPP
Acetaminophen Acephen SUPP 650 MG REC 1 SUPP
Acetaminophen/Caffeine/Butalb Fioricet (Equiv) TAB 1 TAB PO 1 TAB
Clonidine HCl Duraclon (Equiv) VIAL 1 MG EPI 10 ML
28:10 Opiate Antagonists
28:10.00Opiate Antagonists GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Methylnaltrexone Bromide Relistor Vial 12 MG SQ 0.6 ML
Naloxone HCl Narcan (Equiv) VIAL 0.4 MG IV 1 ML
Naloxone HCl Narcan (Equiv) INJ 2 MG IV 2 ML
Naloxone HCl Multi-Dose Narcan (Equiv) Multi-Dose VIAL 4 MG IV 10 ML
Non-stocked Naloxone HCl Narcan (Equiv) Spray 4 MG NAS 0.1 ML
Naltrexone HCl Revia (Equiv) TAB 50 MG PO 1 TAB
28:12 Anticonvulsants
28:12.04 Barbiturates GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Primidone Mysoline (Equiv) TAB 250 MG PO 1 TAB
Primidone Mysoline (Equiv) TAB 50 MG PO 1 TAB
28:12.08 Benzdiazepines GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Clobazam Onfi Tab 10 MG PO 1 TAB
Clonazepam Klonopin (Equiv) TAB 0.5 MG PO 1 TAB
Clonazepam Klonopin (Equiv) TAB 1 MG PO 1 TAB
Diazepam Diastat Rectal Gel Gel 2.5 MG REC 1 EACH
28:12.12 Hydantoins GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Fosphenytoin Sodium Cerebyx (Equiv) VIAL 100 MG IV 2 ML
Fosphenytoin Sodium Cerebyx (Equiv) VIAL 500 MG IV 10 ML
Phenytoin Dilantin (Equiv) VIAL 100 MG IV 2 ML
Phenytoin Dilantin (Equiv) VIAL 250 MG IV 5 ML
Phenytoin Sodium Dilantin (Equiv) CAP 30 MG PO 1 CAP
Phenytoin Sodium Dilantin (Equiv) CAP 100 MG PO 1 CAP
Phenytoin Sodium Extended Dilantin (Equiv) CHWTAB 50 MG PO 1 CHWTAB
Phenytoin Sodium Extended Dilantin (Equiv) SUSP 100 MG PO 4 ML
28:12.92 Anticonvulsants,
Miscellaneous GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Brivaracetam Briviact TAB 50 MG PO 1 TAB
Brivaracetam Briviact IV 50 MG PO 5 ML
Carbamazepine Tegretol (Equiv) CHWTAB 100 MG PO 1 CHWTAB
Carbamazepine Tegretol (Equiv) TAB 200 MG PO 1 TAB
Carbamazepine Tegretol (Equiv) SUSP 200 MG PO 10 ML
Divalproex Er Depakote Er (Equiv) T SR 24 250 MG PO 1 T SR 24
Divalproex Er Depakote Er (Equiv) T SR 24 500 MG PO 1 T SR 24
Divalproex Sodium Depakote (Equiv) ECTAB 250 MG PO 1 ECTAB
Divalproex Sodium Depakote (Equiv) ECTAB 500 MG PO 1 ECTAB
Divalproex Sprinkle Depakote Sprinkle (Equiv) CAPSP 125 MG PO 1 CAP Spinkle
Eslicarbazepine acetate Aptiom Tab 200 MG PO 1 TAB
Eslicarbazepine acetate Aptiom Tab 400 MG PO 1 TAB
Felbamate Felbatol (Equiv) Tablet 400 MG PO 1 TAB
Gabapentin Neurontin (Equiv) CAP 100 MG PO 1 CAP
Gabapentin Neurontin (Equiv) CAP 300 MG PO 1 CAP
Gabapentin Neurontin (Equiv) CAP 400 MG PO 1 CAP
Gabapentin Neurontin (Equiv) SOL 250 MG PO 5 ML
Lamotrigine Lamictal (Equiv) TAB 25 MG PO 1 TAB
Lamotrigine Lamictal (Equiv) TAB 200 MG PO 1 TAB
Levetiracetam Keppra (Equiv) TAB 500 MG PO 1 TAB
Levetiracetam I.V. Keppra I.V. (Equiv) VIAL 500 MG IV 5 mL
Magnesium Sulfate Epsom Salt (Equiv) CRYSTL 1 PACKAGE MSC 1 PACKAGE
Magnesium Sulfate 50% Magnesium Sulfate 50% VIAL 500 MG IV 1 ML
Oxcarbazepine Trileptal (Equiv) TAB 150 MG PO 1 TAB
Oxcarbazepine Trileptal (Equiv) TAB 300 MG PO 1 TAB
Rufinamide Banzel TAB 400 MG PO 1 TAB
Tiagabine Gabitril TAB 4 MG PO 1 TAB
Topiramate Topamax (Equiv) TAB 25 MG PO 1 TAB
Topiramate Topamax (Equiv) TAB 100 MG PO 1 TAB
Valproic Acid Depakene (Equiv) CAP 250 MG PO 1 CAP
Valproic Acid Depekene (Equiv) SYRUP 250 MG PO 5 ML
Valproate Sodium Depacon (Equiv) VIAL 500 MG IV 5 ML
Zonisamide Zonegran (Equiv) CAP 25 MG PO 1 CAP
Zonisamide Zonegran (Equiv) CAP 100 MG PO 1 CAP
28:16 Psychotherapeutic Agents
28:16.04 Antidepressants28:16.04.20 Selective Seratonin Reuptake Inhibitors
GENERIC NAME BRAND NAME
DOSAGE FORM
STRENGTH UNIT ROUTE VOLUME
VOLUME
UNIT Citalopram Hydrobromide Celexa (Equiv) TAB 20 MG PO 1 TAB
Escitalopram Oxalate Lexapro (Equiv) TAB 10 MG PO 1 TAB
Fluoxetine HCl Prozac (Equiv) TAB 20 MG PO 1 TAB
Fluvoxamine Maleate Luvox (Equiv) TAB 50 MG PO 1 TAB
Paroxetine HCl Paxil (Equiv) TAB 10 MG PO 1 TAB
Paroxetine HCl Paxil (Equiv) TAB 20 MG PO 1 TAB
Paroxetine HCl Paxil (Equiv) TAB 30 MG PO 1 TAB
Paroxetine HCl Paxil (Equiv) TAB 40 MG PO 1 TAB
Non-stocked Paroxetine Paxil (equiv) Sol’n 10 mg PO 5 mL
Sertraline HCl Zoloft (Equiv) TAB 50 MG PO 1 TAB
28:16.04.24 Seratonin Modulators GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Trazodone HCl Desyrel (Equiv) TAB 50 MG PO 1 TAB
Trazodone HCl Desyrel (Equiv) TAB 150 MG PO 1 TAB
Vortioexetine Trintellix Tab 5 MG PO 1 TAB
Vortioexetine Trintellix Tab 10 MG PO 1 TAB
28:16.04.28 Tricylics and Other
Norepinephrine Reuptake Inhibitors
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Amitriptyline HCl Elavil (Equiv) TAB 10 MG PO 1 TAB
Amitriptyline HCl Elavil (Equiv) TAB 25 MG PO 1 TAB
Desipramine HCl Norpramin (Equiv) TAB 25 MG PO 1 TAB
Doxepin HCl Sinequan (Equiv) CAP 10 MG PO 1 CAP
Nortriptyline HCl Pamelor (Equiv) CAP 10 MG PO 1 CAP
Nortriptyline HCl Pamelor (Equiv) CAP 25 MG PO 1 CAP
28:16.04.92 Antidepressants,
Miscellaneous GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Bupropion HCl Wellbutrin (Equiv) TAB 75 MG PO 1 TAB
Bupropion HCl Wellbutrin (Equiv) TAB 100 MG PO 1 TAB
Bupropion Sr HCl Wellbutrin Sr (Equiv) SR TAB 100 MG PO 1 SR TAB
Bupropion Sr HCl Wellbutrin Sr (Equiv) SR TAB 150 MG PO 1 SR TAB
Bupropion Xl HCl Wellbutrin Xl (Equiv) T 24 150 MG PO 1 T 24
Mirtazapine Remeron Solutab (Equiv) TAB LN 15 MG PO 1 TAB LN
Mirtazapine Remeron Solutab (Equiv) TAB LN 30 MG PO 1 TAB LN
Venlafaxine HCl Effexor (Equiv) TAB 37.5 MG PO 1 TAB
Venlafaxine HCl Effexor (Equiv) TAB 50 MG PO 1 TAB
Venlafaxine HCl Effexor Xr (Equiv) C SR 24 37.5 MG PO 1 C SR 2
Venlafaxine HCl Effexor Xr (Equiv) C SR 24 75 MG PO 1
28:16.08 Antipsychotics C SR 2
28:16.08.04 Atypical Antipsychotics GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Aripiprazole Abilify (Equiv) TAB 2 MG PO 1 TAB
Aripiprazole Abilify (Equiv) TAB 10 MG PO 1 TAB
Aripiprazole Abilify (Equiv) TAB 15 MG PO 1 TAB
Non-Stocked Aripiprazole Abilify (Equiv) ODT 10 MG PO 1 ODT
Non-Stocked Aripiprazole Abilify (Equiv) ODT 15 MG PO 1 ODT
Company Aripiprazole Aristada Lauroxil SYR 441 MG IM 1 SYR
Replacement Aripiprazole Aristada Lauroxil SYR 662 MG IM 1 SYR
Program Aripiprazole Aristada Lauroxil SYR 882 MG IM 1 SYR
Asenapine Saphris (Equiv) CAP 5 mg PO 1 CAP
Clozapine Clozaril (Equiv) TAB 100 MG PO 1 TAB
Clozapine Clozaril (Equiv) TAB 25 MG PO 1 TAB
Iloperidone Fanapt (Equiv) TAB 2 MG PO 1 TAB
Iloperidone Fanapt (Equiv) TAB 6 MG PO 1 TAB
Lurasidone Latuda (Equiv) Tab 40 mg PO 1 TAB
Lurasidone Latuda (Equiv) Tab 80 mg PO 1 TAB
Olanzapine Zyprexa (Equiv) TAB 5 MG PO 1 TAB
Olanzapine Zyprexa (Equiv) TAB 10 MG PO 1 TAB
Olanzapine Zyprexa Zydis (Equiv) TAB LN 5 MG PO 1 TAB LN
Olanzapine Zyprexa (Equiv) HS 10 MG IM 1 VIAL
Paliperidone Invega (Equiv) Tablet 3 mg PO 1 Tablet
Paliperidone Invega (Equiv) Tablet 6 mg PO 1 Tablet
Paliperidone injection Invega Sustenna SYR 234 MG IM 1 SYRINGE
Paliperidone injection Invega Sustenna SYR 156 MG IM 1 SYRINGE(Conditionally approved until voucher
replacement program ends)28:16.08.04 Atypical
Antipsychotics (continued)
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Quetiapine Fumarate Seroquel (Equiv) TAB 25 MG PO 1 TAB
Quetiapine Fumarate Seroquel (Equiv) TAB 100 MG PO 1 TAB
Risperidone Risperdal (Equiv) TAB 0.25 MG PO 1 TAB
Risperidone Risperdal (Equiv) TAB 1 MG PO 1 TAB
Risperidone Risperdal (Equiv) TAB 2 MG PO 1 TAB
Risperidone Risperdal (Equiv) TAB 3 MG PO 1 TAB
Risperidone M Risperdal M (Equiv) TAB LN 0.5 MG PO 1 TAB LN
Risperidone M Risperdal M (Equiv) TAB LN 1 MG PO 1 TAB LN
Risperidone Microspheres Risperdal Consta HX 25 MG IM 2 ML
Ziprasidone HCl Geodon (Equiv) CA 20 MG PO 1 CAP
Ziprasidone Mesylate Geodon (Equiv) VIAL 20 MG IM 1 VIAL
28:16.08.08 Butyrophenones GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Haloperidol Haldol (Equiv) TAB 0.5 MG PO 1 TAB
Haloperidol Haldol (Equiv) TAB 1 MG PO 1 TAB
Haloperidol Haldol (Equiv) TAB 2 MG PO 1 TAB
Haloperidol Haldol (Equiv) TAB 5 MG PO 1 TAB
Haloperidol Lactate Haldol (Equiv) PO CON 10 MG PO 5 ML
Haloperidol Lactate Haldol (Equiv) INJ 5 MG IM 1 ML
Haloperidol Decanoate Haldol Decanoate (Equiv) INJ 50 MG IM 1 ML
28:16.08.24 Phenothiazines GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Chlorpromazine HCl Thorazine (Equiv) TAB 10 MG PO 1 TAB
Chlorpromazine HCl Thorazine (Equiv) TAB 25 MG PO 1 TAB
Chlorpromazine HCl Thorazine (Equiv) INJ 25 MG IV 1 ML
Fluphenazine Decanoate Prolixin Dc (Equiv) VIAL 125 MG IM 5 ML
Fluphenazine HCl Prolixin (Equiv) TAB 1 MG PO 1 TAB
Fluphenazine HCl Prolixin (Equiv) TAB 2.5 MG PO 1 TAB
Fluphenazine HCl Prolixin (Equiv) VIAL 25 MG IM 10 ML
Perphenazine Trilafon (Equiv) TAB 2 MG PO 1 TAB
Thioridazine HCl Mellaril (Equiv) TAB 10 MG PO 1 TAB
Thioridazine HCl Mellaril (Equiv) TAB 25 MG PO 1 TAB
28:16.08.32 Thioxanthenes GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Thiothixene Navane (Equiv) CAP 2 MG PO 1 CAP
Thiothixene Navane (Equiv) CAP 5 MG PO 1 CAP
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
28:16.08.92Antipsychotics, Miscellaneous
28:20
Anorexigenic and Respiratory and Cerebral Stimulants28:20.04 Amphetamines GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Amphet Asp/Amphet/D-Amphet Adderal (Equiv) TAB 10 MG PO 1 TAB
Non-stocked Dextroamphetamine Salts Dexedrine Spansule CAP ER 5 MG PO 1 CAP
Non-stocked Dextroamphetamine Salts Dexedrine Spansule CAP ER 10 MG PO 1 CAP
Methylphenidate HCl Ritalin (Equiv) TAB 5 MG PO 1 TAB
Methylphenidate HCl Concerta (Equiv) TAB SA 18 MG PO 1 TAB SA
Modafinil Provigil (Equiv) TABLET 100 MG PO 1 TAB
28:20.92 Anorexigenic and
Respiratory and Cerebral Stimulants,
Miscellaneous
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Caffeine/Sodium Benzoate Caffeine And Sodium Benzoate INJ 500 MG IV 2
Anxiolytics, Sedatives, and HypnoticsBarbiturates
28:2428:24.04 GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Pentobarbital Sodium Nembutal Sodium HV 50 MG IV 1 ML
Pentobarbital Sodium Nembutal (Equiv) VIAL 1000 MG IV 20 ML
Phenobarbital Phenobarbital TAB 32.4 MG PO 1 TAB
Phenobarbital Phenobarbital TAB 97.2 MG PO 1 TAB
Phenobarbital Phenobarbital SE 30 MG PO 7.5 ML
Phenobarbital Sodium Phenobarbital VIAL 65 MG IV 1 ML
Phenobarbital Sodium Luminal (Equiv) SYRING 130 MG IV 1 ML
28:24.08 Benzodiazepines GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Alprazolam Xanax (Equiv) TAB 0.25 MG PO 1 TAB
Alprazolam Xanax (Equiv) TA 0.5 MG PO 1 TAB
Diazepam Valium (Equiv) SYRING 10 MG IV 2 ML
Diazepam Valium (Equiv) TAB 2 MG PO 1 TAB
Diazepam Valium (Equiv) TAB 5 MG PO 1 TAB
Diazepam Valium (Equiv) TAB 10 MG PO 1 TAB
Non-stocked Diazepam Diastat Gel
Lorazepam Ativan (Equiv) TAB 1 MG PO 1 TAB
Lorazepam Ativan (Equiv) VIAL 2 MG IV 1 ML
Lorazepam Ativan (Equiv) SYRING 2 MG IV 1 ML
Midazolam HCl Versed (Equiv) VIAL 2 MG IV 2 ML
Midazolam HCl Versed (Equiv) VIAL 10 MG IV 2 ML
Midazolam HCl Versed (Equiv) VIAL 5 MG IV 5 ML
Midazolam HCl Versed (Equiv) SYRUP 2 MG PO 1 ML
Midazolam HCl Versed (Equiv) ST 10 MG PO 5 ML
28:24.92 Miscellaneous
Anxiolytics, Sedatives, and Hypnotics
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Buspirone HCl Buspar (Equiv) TAB 5 MG PO 1 TAB
Dexmedetomidine (Precedex) Vial 200 mcg IV 2 mL
Droperidol Inapsine (Equiv) VIAL 5 MG IM 2 ML
Hydroxyzine 10mg/5ml (Ud) Vistaril (Equiv.) 10mg/5ml ST 10 MG PO 5 ML
Hydroxyzine HCl Atarax (Equiv) TAB 10 MG PO 1 TAB
Hydroxyzine HCl Vistaril (Equiv) VIAL 50 MG IM 1 ML
Hydroxyzine Pam Vistaril (Equiv) CAP 25 MG PO 1 CAP
Hydroxyzine Pamoate Vistaril (Equiv) CAP 50 MG PO 1 CAP
Zolpidem Tartrate Ambien (Equiv) TAB 5 MG PO 1 TAB
28:28 ANTIMANIC AGENTS
28:28.00 Antimanic Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Lithium Carbonate Lithobid (Equiv) SR TAB 300 MG PO 1 SR TAB
Lithium Carbonate Lithium Carbonate CAP 300 MG PO 1 CAP
Lithium Carbonate Lithium Carbonate TAB 300 MG PO 1 TAB
Lithium Carbonate Eskalith Cr (Equiv) SR TAB 450 MG PO 1 SR TAB
Lithium Citrate Lithium Citrate SYRUP 8 MEQ PO 5 ML
28:32ANTIMIGRAINE AGENTS
28:32.28 Selective Seratonin Agonists GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Sumatriptan Succinate Imitrex (Equiv) TAB 25 MG PO 1 TAB
Sumatriptan Succinate Imitrex (Equiv) VIAL 6 MG SUB 0.5 ML
28:36.20.04
Ergot derived Dopamine Receptor
AntagonistGENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Bromocriptine Mesylate Parlodel (Equiv) TAB 2.5 MG PO 1 TAB
28:36.20.08Non-Ergot Derivative Dopamine Receptor
AntagonistsGENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Apomorphine Apokyn Vial 10 mg/mL SQ 1 VIAL
Rotigotine Neupro Patch 2 MG 24 HR PATCH
28:36.32.00 Monoamine Oxidase-B Inhibitors GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Rasalagine Azilect (Equiv) TAB 0.5 MG PO 1 TAB
Selegiline Eldepryl (Equiv) CAP 0.5 MG PO 1 TAB
28:40 Fibromyalgia Agents
28:40 Fibromyalgia Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Non-stocked Milnaciprin Savella TAB 12.5 MG PO 1 TAB
Non-stocked Milnaciprin Savella TAB 50 MG PO 1 TAB
28:92
Central Nervous System Agents, Miscellaneous
28:92.00 Central Nervous System Agents, Miscellaneous
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Non-stocked Acamprosate Campral TAB ER 333 MG PO 1 TAB
Amantadine HCl Amantadine HCl CAP 100 MG PO 1 CAP
Atomoxetine HCl Strattera (Equiv) CAP 25 MG PO 1 CA
Atomoxetine HCl Strattera (Equiv) CAP 40 MG PO 1 CAP
Atomoxetine HCl Strattera (Equiv) CAP 60 MG PO 1 CAP
Carbidopa/Levodopa 10/100mg Sinemet (Equiv) 10/100mg TAB 1 TAB PO 1 TAB
Carbidopa/Levodopa 25/100mg Sinemet (Equiv) 25/100 Mg TAB 1 TAB PO 1 TAB
Carbidopa/Levodopa 25/250mg Sinemet (Equiv) 25/250mg TAB 1 EACH PO 1 TAB
Carbidopa/Levodopa Cr 50/200mg Sinemet Cr (Equiv) 50/200 Mg SR TAB 1 SR TAB PO 1 SR TAB
Carbidopa/Levodopa/Entacapone Stalevo Tab 1 50/12.5/100 PO 1 Tab
Carbidopa/Levodopa/Entacapone Stalevo Tab 1 100/25/200 PO 1 Tab
Carbidopa/Levodopa/Entacapone Stalevo Tab 1 150/37.5/200 PO 1 Tab
Carbidopa/Levodopa/Entacapone Stalevo Tab 1 200/37.5/200 PO 1 Tab
Dextromethorphan hydrobromide/quinidine sulfate Nuedexta CAP 20 / 10 Mg PO 1 CAP
Entacapone Comtan (Equiv) TAB 200 MG PO 1 TABLET
Flumazenil Romazicon (Equiv) VIAL 0.5 MG IV 5 ML
Memantine HCl Namenda TAB 5 MG PO 1 TABLET
Memantine HCl Namenda (Equiv) TAB 10 MG PO 1 TABLET
Selegiline HCl Eldepryl (Equiv) CAP 5 MG PO 1 CAP
36:00 Diagnostic Agents
36:00.00 Diagnostic Agents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Fluorescein Sodium Fluor-I-Strip (Equiv) STRIP 1 MG EYE 1 STRIP
Fluorescein Sodium 10% Fluorescite 10% (Equiv) INJ 5 ML IV 1 AMP
Methacholine Challenge Test Provocholine (Equiv) Challenge VIAL 100 MG RT 1 VIAL
36:04.00 Adrenocorticoid
Insufficiency GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Cosyntropin Cortrosyn (Equiv) VIAL 0.25 MG IV 1 VIAL
Fungi36:32.00 GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Candida Antigen Candida (Equiv) ALLERGE 1 VIAL ID 1 ML
36:34.00 Gallbladder Function GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Sincalide Kinevac (Equiv) VIAL 5 MCG IV 1 VIAL
36:40.00 Kidney Function GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Indigotindisulfonate 0.8% Indigo Carmine 0.8% (Equiv) INJ 5 ML IV 5 ML
36:44.00 Liver Function GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Indocyanine Green Ic Green (Equiv) VIAL 25 MG IV 10 ML
36:56.00 Myasthenia Gravis GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Edrophonium Chloride Enlon (Equiv) VIAL 100 MG IV 10 ML
36:60.00 Thyroid Function GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Thyrotropin Alfa Thyrogen (Equiv) VIAL 1.1 MG IM 1
36:68.00 Roentgenography GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Diatrizoate Sodium 50% Hypaque Sodium 50% VIAL 1 BAG IV 50 ML
Iohexol Omnipaque (Equiv) INFUS 240 MG IV 1 ML
Iohexol Omnipaque (Equiv) INJBAG 240 MG IV 1 ML
36:84.00 Tuberculosis GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Tuberculin,Purif.Prot.Deriv. Tubersol (Equiv) VIAL 5 TEST UNITS ID 0.1 ML
38:00 Disinfectants 38:00.00 Disinfectants GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Na Hypochlorite Qtr Str 0.125% Dakin's Qtr Str 0.125% (Equiv) SL 1000 ML MSC 1 BOTTLE
Na Hypochlorite Half Str 0.25% Dakin's Half Str 0.25% (Equiv) SL 473 ML MSC 1 BOTTLE
40:00 Electrolyte, Caloric and Water Balance
40:08.00 Alkalinizing Agents
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Potassium Citrate Urocit-K Tablet ER 10 mEq PO 1 tablet
Citric Acid/Sodium Citrate Bicitra (Equiv) SOLN 1 CUP PO 1 CUP
Sodium Bicarbonate 4.2% Sodium Bicarbonate 4.2% VIAL 0.5 MEQ IV 1 ML
Sodium Bicarbonate 4.2% Sodium Bicarbonate 4.2% SYRING 0.5 MEQ IV 1 ML
Sodium Bicarbonate 5% Sodium Bicarbonate 5% INJ 500 ML IV 500 ML
Sodium Bicarbonate 8.4% Sodium Bicarbonate 8.4% SYRING 1 MEQ IV 1 ML
Sodium Bicarbonate 8.4% Sodium Bicarbonate 8.4% SYRING 50 MEQ IV 50 ML
Tromethamine Tham (Equiv) INJ 1 BOTTLE IV 500 ML
40:10.00 Ammonia Detoxicants GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Lactulose Kristalose (Equiv) PACKET 10 GM PO 1 PACKET
Lactulose Kristalose (Equiv) PACKET 20 GM PO 1 PACKET
40:12.00 Replacement
Preparations GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Calcium Carb/Vit D 250/125mg Oscal D (Equiv) 250mg/125unit TAB 1 TAB PO 1 TAB
Calcium Carb/Vit D 600mg/200un Caltrate D (Equiv)600mg/200unt TAB 1 TAB PO 1 TAB
Calcium Carbonate Os-Cal (Equiv) TAB 500 MG PO 1 TAB
Calcium Carbonate Calcium Carbonate TAB 650 MG PO 1 TAB
Calcium Chloride 10% Calcium Chloride 10% SYRING 1,000 MG IV 10 ML
Calcium Citrate, Combinations Citracal + D Tab 600/200 Mg PO 1 TAB
Calcium Gluconate Calcium Gluconate VIAL 1,000 MG IV 10 ML
Calcium Gluconate Calcium Gluconate HV 10,000 MG IV 100 ML
Calcium Gluconate Calcium Gluconate TAB 500 MG PO 1 TAB
Copper Chloride Copper Chloride Vial 0.4 Mg IV 1 mL
Dextran 10% (40)/Normal Saline Gentran 10% (40) Normal Saline INJ 500 ML IV 500 ML
Dextran 40/Dextrose 5%-Water Gentran 40 In Dextrose 5% INJ 500 ML IV 500 ML
Dextran 75/Normal Saline Gentran 75 In Normal Saline INJ 500 ML IV 500 ML
Dextrose 5%-Lactated Ringers Dextrose 5% Lactated Ringers INJ 500 ML IV 500 ML
Dextrose 5%-Lactated Ringers Dextrose 5% Lactated Ringers INJ 1,000 ML IV 1000 ML
Dextrose 2.50% Dextrose 2.50% IV Various See Lexi
Dextrose 10% Dextrose 10% IV Various See Lexi
Dextrose 15% Dextrose 15% IV Various See Lexi
Dextrose 20% Dextrose 20% IV Various See Lexi
Dextrose - Aviva Bag Dextrose - Aviva Bag IV Various See Lexi
40:12.00 Replacement Preparations GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Dextrose - Excel Bag Dextrose - Excel Bag IV Various See Lexi
D10 / 0.9 NaCl D10 / 0.9 NaCl IV Various See Lexi
D10 / 0.45 NaCl D10 / 0.45 NaCl IV Various See Lexi
D 12.5 / 0.2% NaCl D 12.5 / 0.2% NaCl IV Various See Lexi
D 12.5 / 0.45% NaCl D 12.5 / 0.45% NaCl IV Various See Lexi
D 15 / 0.2% NaCl D 15 / 0.2% NaCl IV Various See Lexi
Electrolyte-48 Solution/D5w Dextrose 5%-Electrolyte #48 INJ 500 ML IV 500 ML
Electrolyte-48 Solution/D5w Dextrose 5%-Electrolyte #48 INJ 1,000 ML IV 1000 ML
Electrolyte-75 Solution/D5w Dextrose 5%-Electrolyte #75 INJ 1,000 ML IV 1000 ML
Electrolyte-M Solution/D5w Plasma-Lyte M In Dextrose INJ 500 ML IV 500 ML
Electrolyte-M Solution/D5w Plasma-Lyte M In Dextrose INJ 1,000 ML IV 1000 ML
Electrolyte-R Solution Plasma-Lyte R INJ 1,000 ML IV 1000 ML
Electrolyte-R Solution/D5w Plasma-Lyte R In Dextrose INJ 1,000 ML IV 1000 ML
Electrolyte Solution, Renal Replacement Prismasol B22GK 4/0 Bag 5 Liter IV 5000 mL
Electrolyte Solution, Renal Replacement PrismaSol BGK 2/0 Bag 5 Liter IV 5000 mL
Electrolyte Solution, Renal Replacement PrismaSol BGK 4/0/1.2 Bag 5 5 Liter IV 5000
Electrolyte Solution, Renal Replacement PrismaSol BK 0/3.5 Bag 5 Liter IV 5000 mL
Hetastarch/Normal Saline Hespan (Equiv) INJBAG 30,000 MG IV 500 ML
Naph,Mb-Db/K Ph,Mbdb Neutra-Phos (Equiv) PACKET 1 PACKET PO 1 PACKET
Normal Saline 0.45% Sodium Chloride 0.45% INJ 500 ML IV 500 ML
Normal Saline 0.45% Sodium Chloride 0.45% INJ 1,000 ML IV 1000 ML
Normal Saline 0.9% Sodium Chloride 0.9% IV 25 ML IV 25 ML
Normal Saline 0.9% Sodium Chloride 0.9% INJ 50 ML IV 50 ML
Normal Saline 0.9% Sodium Chloride 0.9% INJ 100 ML IV 100 ML
Normal Saline 0.9% Sodium Chloride 0.9% INJ 150 ML IV 150 ML
Normal Saline 0.9% Sodium Chloride 0.9% INJ 250 ML IV 250 ML
Normal Saline 0.9% Sodium Chloride 0.9% INJ 500 ML IV 500 ML
Normal Saline 0.9% Sodium Chloride 0.9% INJ 1,000 ML IV 1000 ML
Normal Saline 0.9% Pres-Free Sodium Chloride 0.9% Pres-Free VIAL 10 ML IV 1 VIAL
Normal Saline 0.9% Syringe Sodium Chloride 0.9% Syringe HQ 10 ML INJ 1 DISP SY
Potassium Acetate Potassium Acetate VIAL 200 MEQ IV 100 ML
Potassium Bicarbonate/Cit Ac K-Lyte (Equiv) EFFTAB 25 MEQ PO 1 EFFTAB
Potassium Cl Micro-K (Equiv) SR CAPS 8 MEQ PO 1 SR CAP
Potassium Chloride Klor-Con 10 (Equiv) TAB 10 MEQ PO 1 TAB
Potassium Chloride Kdur (Equiv) TAB SR 20 MEQ PO 1 TAB SR
Potassium Chloride 10% Potassium Chloride 10% LIQUID 20 MEQ PO 15 ML
Potassium Chloride 20meq PM Potassium Chloride 20meq PM PB 20 MEQ IV 100 ML
40:12.00 Replacement Preparations GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Potassium Chloride 40meq PM Potassium Chloride 40meq PM PB 40 MEQ IV 100 ML
Potassium Cl 20meq/D5 0.45 Nac Potassium Cl 20meq/D5 0.45 Nac HM 1000 ML IV 1000 ML
Potassium Cl/NS 20meq PM Potassium Cl/NS 20meq PM INJ 20 MEQ IV 1000 ML
Potassium Chloride/D5-NS 20meq Potassium Chloride In D5w/Nacl HM 20 MEQ IV 1000 ML
Potassium Cl Potassium Cl VIAL 20 MEQ IV 10 ML
Potassium Cl Potassium Cl VIAL 40 MEQ IV 20 ML
Potassium Phos,M-Basic-D-Basic Potassium Phosphate VIAL 220 MEQ IV 50 ML
Ringers Solution Ringers Solution INJ 1000 ML IV 1000 ML
Ringers Solution,Lactated Lactated Ringers INJ 250 ML IV 250 ML
Ringers Solution,Lactated Lactated Ringers INJ 500 ML IV 500 ML
Ringers Solution,Lactated Lactated Ringers IV 1,000 ML IV 1000 ML
Selenium IV Selenium IV IV 40 mcg IV 10 mL
Sodium Acetate Sodium Acetate VIAL 2 MEQ IV 1 ML
Sodium Chloride Sodium Chloride TAB 1 GM PO 1 TAB
Sodium Chloride 0.9 Bacteriost Sodium Chloride 0.9% Bacterios VIAL 30 ML IV 1 VIAL
Sodium Chloride 14.6% Sodium Chloride 14.6% VIAL 2.5 MEQ IV 1 ML
Sodium Chloride 23.4% Sodium Chloride 23.4% HV 1000 MEQ IV 250 ML
Sodium Chloride 3% Sodium Chloride 3% INJ 500 ML IV 500 ML
Sodium Chloride 5% Sodium Chloride 5% INJ 500 ML IV 500 ML
Sodium Cl For Inhalation 0.9% Sodium Chloride 0.9% INH 3 ML RT 1 VIAL
Sodium Cl For Inhalation 0.9% Sodium Chloride 0.9% INH 5 ML RT 1 VIAL
Sodium Phosphate Sodium Phosphate VIAL 4 MEQ IV 1 ML
Zinc Sulfate Zinc-220 (Equiv) CAP 220 MG PO 1 CAP
Zinc Sulfate Zinc Zulfate IV 1 Mg IV 1 mL
Zinc Sulfate Concentrate Zinc Zulfate Concetnrate IV 5 Mg IV 1 mL
Znso4 Hep/Cuso4 P-Hyd/Mn/Cr/Se Multitrace-5 (Equiv) VIAL 1 VIAL IV 10 ML
40:18 Ion Removing Agents Diagnostic Agents
40:18.18 Potassium Removing Agents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Sodium Polystyrene Sulfonate Sps (Equiv) SUSP 15 GM PO 1 BOTTLE
Phosphate Removing Agents40:18.19 GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Calcium Acetate Phoslo (Equiv) TAB 667 MG PO 1 TAB
Sevelamer Carbonate Renvela (Equiv) TAB 800 MG PO 1 TAB
40:18.92 Ion-removing Agents,
other GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Ferric hexacyanoferrate (Prussian blue) Radiogardase CAP 0.5 gram PO 1 CAP
40:20.00 Caloric Agents GENERIC NAME BRAND NAME DOSAGE STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
FORMAmino Acids 15% Novamine (Equiv) INJ 500 MG IV 500 ML
Amino Acids 8% Hepatamine 8% (Equv) INJ 500 ML IV 500 ML
Dextrose Glucose Tab (Equiv) TAB 5 GM PO 1 TAB
Dextrose Glucose Gel Gel 40 % PO 50 %
Dextrose 10%-Normal Saline Dextrose 10% Sodium Chloride INJ 1,000 ML IV 1000 ML
Dextrose 10%-Water Dextrose 10% In Water INJ 500 ML IV 500 ML
Dextrose 10%-Water Dextrose 10% In Water INJ 1,000 ML IV 1000 ML
Dextrose 25%-Water Dextrose 25% In Water SYRING 10 ML IV 1 SYRINGE
Dextrose 5%-0.2% Normal Saline Dextrose 5%-0.2% Sodium Chlrde INJ 500 ML IV 500 ML
Dextrose 5%-0.2% Normal Saline Dextrose 5%-0.2% Sodium Chlrde INJ 1,000 ML IV 1000 ML
Dextrose 5%-0.33 Normal Saline Dextrose 5%-0.33 Sodium Chlrde INJ 500 ML IV 500 ML
Dextrose 5%-0.33 Normal Saline Dextrose 5%-0.33 Sodium Chlrde INJ 1,000 ML IV 1000 ML
Dextrose 5%-0.45% Normal Salne Dextrose 5%-0.45% Sod Chloride INJ 250 ML IV 250 ML
Dextrose 5%-0.45% Normal Salne Dextrose 5%-0.45% Sod Chloride INJ 500 ML IV 500 ML
Dextrose 5%-0.45% Normal Salne Dextrose 5%-0.45% Sod Chloride INJ 1,000 ML IV 1000 ML
Dextrose 5%-0.9% Nacl Dextrose 5% / 0.9% Nacl INJ 250 ML IV 250 ML
Dextrose 5%-Normal Saline Dextrose 5% Sodium Chloride INJ 500 ML IV 500 ML
Dextrose 5%-Normal Saline Dextrose 5% Sodium Chloride INJ 1,000 ML IV 1000 ML
Dextrose 5%-Water Dextrose 5% In Water INJ 25 ML IV 25 ML
Dextrose 5%-Water Dextrose 5% In Water INJ 50 ML IV 50 ML
Dextrose 5%-Water Dextrose 5% In Water INJ 100 ML IV 100 ML
Dextrose 5%-Water Dextrose 5% In Water INJ 150 ML IV 150 ML
Dextrose 5%-Water Dextrose 5% In Water INJ 250 ML IV 250 ML
Dextrose 5%-Water Dextrose 5% In Water INJ 500 ML IV 500 ML
Dextrose 5%-Water Dextrose 5% In Water INJ 1,000 ML IV 1000 ML
Dextrose 5%-Water Poly Dextrose 5% In Water Poly INJ 250 ML IV 250 ML
Dextrose 50%-Water Dextrose 50% In Water SYRING 50 ML IV 1 SYRINGE
Ethyl Alcohol/D5w Alcohol In Dextrose INJ 1,000 ML IV 1000 ML
Fatty Acid Solution MCT Oil (oral) PO 14 GRAM PO 15 ML
Fat Emulsions 20% Intralipid 20% (Equiv) EMULSN 1 BAG IV 500 ML
L-cysteine L-Cysteine IV 50 Mg IV 1 mL
40:28 DiureticsGENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
40:28.08 Loop Diuretics Bumetanide Bumex (Equiv) TAB 0.5 MG PO 1 TAB
Bumetanide Bumex (Equiv) TAB 1 MG PO 1 TAB
Bumetanide Bumex (Equiv) VIAL 1 MG IV 4 ML
Bumetanide Bumex (Equiv) VIAL 2.5 MG IV 10 ML
Furosemide Lasix (Equiv) VIAL 100 MG IV 10 ML
Furosemide Lasix (Equiv) TAB 20 MG PO 1 TAB
Furosemide Lasix (Equiv) VIAL 20 MG IV 2 ML
Furosemide Lasix (Equiv) SOLN 40 MG PO 5 ML
Furosemide Lasix (Equiv) TAB 40 MG PO 1 TAB
Furosemide Lasix (Equiv) VIAL 40 MG IV 4 ML
40:28.16Potassium Sparing
Diuretics GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Amiloride Amiloride TAB 5 MG PO 1 TAB
Triamterene/Hctz 37.5/25 Maxzide-25mg (Equiv) TAB 1 TAB PO 1 TAB
Triamterene/Hctz 75/50 Maxzide (Equiv) 75/50 TAB 1 TAB PO 1 TAB
40:28.20 Thiazide Diuretics GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Chlorothiazide Sodium Diuril Sodium (Equiv) VIAL 500 MG IV 20 ML
Hydrochlorothiazide Hydrochlorothiazide TAB 12.5 MG PO 1 TAB
Hydrochlorothiazide Hydrochlorothiazide TAB 25 MG PO 1 TAB
Hydrochlorothiazide Hydrochlorothiazide TAB 50 MG PO 1 TAB
Mannitol 20% Osmitrol (Equiv) 20% INJ 200 MG IV 1 ML
Mannitol 20% Osmitrol 20% (Equiv) INJ 500 ML IV 500 ML
Mannitol 25% Mannitol 25% VIAL 12.5 GM IV 50 ML
40:28.24 Thiazide-like Diuretics GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Metolazone Zaroxolyn (Equiv) TAB 2.5 MG PO 1 TAB
40:28.92Diuretics,
Miscellaneous GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Tolvaptan Samsca TAB 15 TAB PO 1 TAB
40:36 Irrigating Solutions GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
40:36.00 Irrigating Solutions Acetic Acid 0.25% Acetic Acid 0.25% IRRIG 1000 ML IRR 1 BOTTLE
Dianeal Lc 1.5% Dianeal Lc 1.5% HY 1 BAG IP 2000 ML
Dianeal Lc 1.5% Dianeal Lc 1.5% HY 1 BAG IP 5000 ML
Dianeal Lc 2.5% Dianeal Lc 2.5% HY 1 BAG IP 5000 ML
Dianeal Lc 2.5% Dianeal Lc 2.5% HY 1 BAG IP 2000 ML
Dianeal W/4.25% Dextrose Dianeal W/4.25% Dextrose HY 483 MOSM IP 1 L
Glycine Glycine IRR 15 mg IRR 1 mL
Lactated Ringers Lactated Ringers IRR IRR 1000 mL
Lactated Ringers Lactated Ringers IRR IRR 3000 mL
Lactated Ringers Lactated Ringers IRR IRR 5000 mL
Renacidin Citric acid, magnesium carbonate, glucono-delta-lactone IRR
Citric acid 6.602 g,
magnesium carbonate
3.177 g, andglucono-delta-lactone 0.198
g
IRR 100 mL
Sorbitol Sorbitol IRR 3 % IRR
Water, Sterile Water, Sterile IRR IRR
40:40 Uricosuric Agents
40:40.00 Uricosuric Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Probenecid Probenecid TAB 500 MG PO 1 TAB
44:00 Enzymes
44:00.00 Enzymes GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Dornase alpha Pulmozyme Sol, Inh 1 mg/mL INH 2.5 mL
Hyaluronidase Amphadase VIAL 150 UNIT IM 1 ML
48:00 Antitussives, Expectorants, and Mucolytics Agents
48:08.00Antitussives GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Benzonatate Tessalon Perles (Equiv) CAP 100 MG PO 1 CAP
Dextromethorphan Hbr Benylin (Equiv) SYRUP 30 MG PO 10 ML
Guaifenesin/Codeine Phos Robitussin W/ Codeine (Equiv) SYRUP 5 ML PO 5 ML
Guaifenesin/D-Methorphan Hb Humibid Dm 600/30 Mg(Equiv) T SR 12 1 TAB PO 1 T SR 12
Guaifenesin/D-Methorphan Hb Robitussin Dm (Equiv) SYRUP 10 ML PO 10 ML
48:10 Anti-imflammatory Agents (Resp Tract) GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Mepolizumab Nucala Vial 100 MG SQ 1 VIAL
48:10.24 Leukotriene Modifiers GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Montelukast Sodium Singulair (Equiv) TAB 10 MG PO 1 TAB
48:16.00 Expectorants GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Guaifenesin Robitussin (Equiv) SYRUP 100 MG PO 5 ML
Guaifenesin Guaifenesin ST 200 MG PO 10 ML
48:24.00 Mucolytic Agent GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Acetylcysteine Mucomyst 10% (Equiv) VIAL 400 MG MSC 4 ML
Acetylcysteine Mucomyst 20% (Equiv) VIAL 800 MG MSC 4 ML
Acetylcysteine 20% Mucomyst 20% (Equiv) VIAL 6000 MG MSC 30 ML
48:32 Phosphodiesterase
Type 4 Inhibitor GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Roflumilast Daliresp TAB 500 MCG PO 1 TAB
48:36 Pulmonary Surfactants GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Poractant Alpha Curosruf Susp 80 mg/mL INH 1.5 mL
Poractant Alpha Curosruf Susp 80 mg/mL INH 3 mL
48:92Respiratory Tract
Agents, Misc. GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Omalizumab Xolair HS 150 MG 1 VIAL
52:00 Eye, Ear, Nose, and Throat (EENT) Preparations
52:02 Anti-allergicAgents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Azelastine (nasal) Astelin (nasal) Solution 137 mcg/mL NAS 30 mL
Optivar Azelastine (Opthalmic) Solution 0.05 % Opth 6 mL
52:04 Anti-infectives52:04.04 Antibacterials GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Bacitracin Bacitracin OINT 3.5 GM EYE 1 TUBE
Bacitracin/Polymyxin B Sulfate Polysporin (Equiv) OINT 3.5 GM EYE 1 TUBE
Cipro Otiprio Gel 6 % OTIC 1 inj
CiproDex 0.3 %Ciprofloxaxin /0.1% Dexamethasome Drops 7.5 mL Opth 1 Bottle
Erythromycin Base Erythromycin OINT 1 GM EYE 1 TUBE
Gentamicin Sulfate Gentak (Equiv) OINT 1 APPL EYE 1 APPL
Gentamicin Sulfate Genoptic (Equiv) DROPS 5 ML EYE 1 BOTTLEGentamicin Sulfate 0.3% /
Predisolone 0.6% Pred-G Susp 5 mL EYE 1 Bottle
Moxifloxacin 0.5% Vigamox 0.5% (Equiv) DROPS 3 ML EYE 1 BOTTLE
Na Sulfacetm/Prednisol Ac 0.2% Blephamide 0.2% (Equiv) DROPS 5 ML EYE 1 BOTTLE
Neo/Polymyx B Sulf/Dexameth Maxitrol (Equiv) DROPS 1 APPL EYE 1 Bottle
Neo/Polymyx B Sulf/Dexameth Maxatrol (Equiv) OINT 1 APPL EYE 1 Bottle
Neo/Polymyx B Sulf/HC PediOtic Drops 10 mL EYE 1 Bottle
Neomy Sulf/Bacitra/Polymyxin B Neosporin (Equiv) OINT 1 APPL EYE 1 Bottle
Neomy Sulf/Gramicid D/Poly Neosporin (Equiv) DROPS 1 APPL EYE 1 Bottle
Ofloxacin 0.3% Ocuflox 0.3% (Equiv) DROPS 5 ML EYE 1 BOTTLE
Ofloxacin 0.3% Ocuflox 0.3% (Equiv) DROPS 5 ML EAR 1 BOTTLE
Polymyxin B Sulfate/Tmp Polytrim (Equiv) DROPS 10 ML EYE 1 BOTTLE
Sulfacetamide Sodium 10% Bleph-10 (Equiv) DROPS 15 ML EYE 1 BOTTLE
Sulfacetamide Sodium 10% Sulfacetamide Sodium 10% OINT 3.5 GM EYE 1 TUBE
Tobramycin Sulfate 0.3% Tobrex (Equiv) 0.3% DROPS 5 ML EYE 1 BOTTLE
Tobramycin Sulfate/Dexameth Tobradex (Equiv) DROPS 2.5 ML EYE 1 BOTTLE
Tobramycin Sulfate/Dexameth Tobradex (Equiv) OINT 3.5 GM EYE 1 TUBE
52:04.92 Anti-infectives,
Miscellaneous GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Acetic Acid/Hydrocortisone Viosol Hc (Equiv) DROP 10 ML EAR 1 BOTTLE
Carbamide Peroxide 6.5% Debrox 6.5%(Equiv) DROPS 15 ML EAR 1 BOTTLE
Chlorhexidine Gluconate 0.12% Peridex (Equiv) 0.12% LIQUID 15 ML MM 1 BOTTLE
Povidone-Iodine 5% Betadine 5% (Equiv) SOLN 1 APPL EYE 1 APPL
52:08 Anti-Inflammatory Agents52:08.08 Corticosteroids GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Dexamethasone 0.1% Maxidex (Equiv) 0.1% DROPS 5 ML EYE 1 BOTTLE
Fluorometholone 0.1% Fluor-Op (Equiv) 0.1% DROPS 5 ML EYE 1 BOTTLE
Fluorometholone 0.25% Fml Forte (Equiv) 0.25% DROPS 5 ML EYE 1 BOTTLE
Fluticasone Propionate Flonase (Equiv) SPRAY 50 MCG NAS 1 SPRAY
Prednisolone Acetate 1% Pred Forte 1% (Equiv) DROPS 5 ML EYE 1 BOTTLE
52:08.20 Nonsteroidal Anti-Inflammatory Agents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Flurbiprofen Sodium 0.03% Ocufen 0.03% (Equiv) DROPS 2.5 ML EYE 1 BOTTLE Ketorolac Tromethamine 0.45% Acular 0.45% (Equiv) DROPS 3 ML EYE 1 BOTTLE
Non stocked Phenylephrine/Ketorolac Omidria (Equiv)
52:10
Carbonic Anhydrase Inhibitors
52:10.00 Carbonic Anhydrase Inhibitors GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Acetazolamide Diamox (Equiv) TAB 250 MG PO 1 TAB
Acetazolamide Diamox Sequels (Equiv) SR CAPS 500 MG PO 1 SR CAP
Acetazolamide Sodium Diamox (Equiv) VIAL 500 MG IV 1 VIAL
Dorzolamide HCl 2% Trusopt (Equiv) 2% DROPS 5 ML EYE 1 BOTTLE
52:16 Local Anesthetics52:16.00 Local Anesthetics GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Cetylpyridinium/Menthol Cepacol (Equiv) LOZ 9 LOZ MM 1 PACKAGE
Cocaine HCl 4% Cocaine HCl 4% SOLN 4 ML TOP 1 BOTTLE
Lidocaine HCl 2% Xylocaine 2% (Equiv) JEL 1 APPL MM 1 APPL
Lidocaine HCl 2% Lidocaine HCl 2% JEL 200 MG MM 10 ML
Lidocaine HCl 4% Lidocaine HCl 4% SOLN 1 APPL MM 1 APPL
Lidocaine HCl Viscous 2% Lidocaine HCl Viscous 2% SOLN 20 ML MM 1 BOTTLE
Proparacaine HCl 0.5% Alcaine 0.5% (Equiv) DROPS 15 ML EYE 1 BOTTLE
Tetracaine HCl 0.5% Tetracaine HCl 0.5% (Equiv) DROPS 2 ML EYE 1 BOTTLE
52:20 Miotics52:20.00 Miotics GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Acetylcholine Chloride Miochol-E (Equiv) DROPS 2 ML INT 1 BOTTLE
Carbachol 1.5% Isopto Carbachol 1.5% (Equiv) DROPS 15 ML EYE 1 BOTTLE
Carbachol 3% Isopto Carbachol 3% (Equiv) DROPS 15 ML EYE 1 BOTTLE
Pilocarpine 0.5% Pilocar 0.5% (Equiv) DROPS 15 ML EYE 1 BOTTLE
Pilocarpine 1% Pilocar 1% (Equiv) DROPS 2 ML EYE 1 BOTTLE
Pilocarpine 2% Pilocar 2% (Equiv) DROPS 2 ML EYE 1 BOTTLE
Pilocarpine 3 Pilocar 3% (Equiv) DROPS 15 ML EYE 1 BOTTLE
Pilocarpine HCl 4% Gel Pilopine Hs Gel (Equiv) 4% GEL 4 GM EYE 1 PACKAGE
52:24 Mydriatics52:24.00 Mydriatics GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Atropine Sulfate 1% Atropine 1% DROPS 2 ML EYE 1 BOTTLE
Atropine Sulfate 1% Atropine Sulfate 1% OINT 3.5 GM EYE 1 TUBE
Cyclopentolate HCl 1% Cyclogyl (Equiv) 1% DROPS 2 ML EYE 1 BOTTLE
Cyclopentolate HCl 2% Cyclogyl (Equiv) 2% DROPS 2 ML EYE 1 BOTTLE
Homatropine Hbr 5% Homatropine 5% DROPS 15 ML EYE 1 BOTTLE
Scopolamine Hydrobromide 0.25% Isopto Hyoscine 0.25% (Equiv) DROPS 5 ML EYE 1 BOTTLE
Tropicamide 0.5% Mydriacyl 0.5% (Equiv) DROPS 15 ML EYE 1 BOTTLE
Tropicamide 1% Mydriacyl 1% (Equiv) DROPS 3 ML EYE 1 BOTTLE
52:28.00 Mouthwashes and
Gargles GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Hydrogen Peroxide 3% Hydrogen Peroxide 3%
52:32 Vasoconstrictors52:32.00 Vasoconstrictors GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Epinephrine 1:1,000 Nasal Adrenalin Chloride Nasal (Equi SOLN 30 ML NAS 1 BOTTLE
Naphazoline HCl Naphcon Forte (Equiv) DROPS 15 ML EYE 1 BOTTLE
Oxymetazoline HCl 0.05% Afrin (Equiv) 0.05% SPRAY 15 ML NAS 1 BOTTLE
Phenylephrine HCl Mydfrin (Equiv) DROPS 3 ML EYE 1 BOTTLE
Phenylephrine HCl Ak-Dilate (Equiv) DROPS 5 ML EYE 1 BOTTLE
Phenylephrine Drops 0.5% Neo-Synephrine Drops (Equiv) DROPS 1 APPL MUC 1 APPL
Phenylephrine Spray 0.5% Neo-Synephrine Spray (Equiv) NASAL 1 APPL MUC 1 APPL
Tetrahydrozoline HCl 0.05% Visine 0.05% (Equiv) DROPS 15 ML EYE 1 BOTTLE
52:92 EENT Drugs, Miscellaneous
52:92.00 EENT Drugs Miscellaneous GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Apraclonidine HCl 1% Iopidine 1% (Equiv) DROPER 0.1 ML EYE 1 BOTTLE
Betaxolol HCl 0.5% Betoptic S 0.25% (Equiv) DROPS 2.5 ML EYE 1 BOTTLE
Botulinum Toxin Type A Botox (Equiv) VIAL 100 UNITS IM 1 ML
Brimonidine Tartrate 0.15% Alphagan P 0.15% (Equiv) SO 5 ML EYE 1 BOTTLE
Carteolol Ocupress Drops 1 % EYE 1 Bottle
Gelatin Gelfilm EA 1 EACH EYE 1 EACH
Hypromellose 2.5% Gonak 2.5% (Equiv) DROPS 15 ML EYE 1 BOTTLE
Lanolin/Min Oil/Petrolat,Wht Artificial Tears (Equiv) PACKET 3.5 GM EYE 1 TUBE
Latanoprost 0.005% Xalatan 0.005% (Equiv) DROPS EYE
Levobunolol HCl 0.5% Betagan 0.5% (Equiv) DROPS 5 ML EYE 1 BOTTLE
52:92.00 EENT Drugs Miscellaneous GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Polyvinyl Alcohol Artificial Tears (Equiv) DROPS 15 ML EYE 1 BOTTLE
Sodium Chloride 0.65% Ocean 0.65% (Equiv) SPRAY 45 ML NAS 1 BOTTLE
Sodium Chloride gel Ayr Saline Gel Gel 14.1 Gram EYE 1 BOTTLE
Sodium/Potassium/Cal/Magnesium Bss (Equiv) SOLN 15 ML EYE 1 BOTTLE
Sodium/Potassium/Sod Chl Dacriose (Equiv) DROPS 120 ML EYE 1 BOTTLE
Timolol Maleate 0.25% Timoptic 0.25% (Equiv) DROPS 5 ML EYE 1 BOTTLE
Timolol Maleate 0.5% Timoptic 0.5% (Equiv) DROPER 0.45 ML EYE 1 DROPER
Timolol Maleate 0.5% Timoptic 0.5% (Equiv) DROPS 5 ML EYE 1 BOTTLE
56:00 Gastrointestinal Drugs
56:04:00 Antacids and Adsorbents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Activated Charcoal Actidose-Aqua (Equiv) LIQUID 50 GM PO 1 TUBE
Calcium Carb 1250 mg (Equiv) Calcium Carb 1250 mg (Equiv) Tablet 1250 Tablet PO 1 PACKAGE
Calcium Carb 1250 mg / 5 mL (Equiv) Calcium Carb 1250 mg / 5 mL (Equiv) Chew Tablet 5 mL PO 1 PACKAGE
Charcoal/Sorbitol Solution Actidose / Sorbitol (Quiv) LIQUID 50 GM PO 1 TUBE
Mag Hydrox/Al Hydrox/Simeth Maalox Plus Ex Strgth (Equiv) SUSP 30 ML PO 30 ML
Magnesium Oxide Mag Ox (Equiv) TAB 400 MG PO 1 TAB
Mg Trisilicate/Alh/Nahco3/Aa Gaviscon (Equiv) CHWTAB 1 EACH PO 1 CHWTAB
Mylanta/Lido Visc/Donnatol Gi Cocktail SC 1 EA PO 50 ML
Sodium Bicarbonate Sodium Bicarbonate TAB 325 MG PO 1 TAB
56:08.00 Antidiarrhea Agents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Bismuth Subsalicylate Pepto Bismol (Equiv) SUSP 262 MG PO 15 ML
Diphenoxylate HCl/Atrop Sulf Lomotil (Equiv) TAB 1 EACH PO 1 TAB
Diphenoxylate HCl/Atrop Sulf Diphenoxylate W/Atropine LIQUID 5 ML PO 1 EACH
Loperamide HCl Imodium(Equiv) LIQUID 1 MG PO 5 ML
Loperamide HCl Imodium (Equiv) CAP 2 MG PO 1 CAP
Paregoric Paregoric LIQUID 2 MG PO 5 ML
56:10.00 Antiflatulents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Simethicone Gas-X (Equiv) CHWTAB 80 MG PO 1 CHWTAB
Simethicone 40mg/0.6ml Mylicon (Equiv) DROPS 1 BOTTLE PO 30 ML
56:12.00 Cathartics and
Laxatives GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Bisacodyl Dulcolax (Equiv) SUPP 10 MG REC 1 SUPP
Bisacodyl Dulcolax (Equiv) ECTAB 5 MG PO 1 ECTAB
Calcium Polycarbophil Fibercon (Equiv) TA 625 MG PO 1 TAB
Docusate Sodium Colace (Equiv) LIQUID 100 MG PO 10 ML
Docusate Sodium Colace (Equiv) CAP 100 MG PO 1 CAP
Glycerin Anhydrous 99.5% Glycerin Anhydrous 99.5% Liquid 1 Each
Glycerin Glycerin Top
Glycerin Glycerin (Equiv) SUPP 1 SUPP REC 1 SUPP
Glycerin Child Glycerin Child (Equiv) SUPP 1 SUPP REC 1 SUPP
Magnesium Chloride Mag Delay (Equiv) SR TAB 64 MG PO 1 SR TAB
Magnesium Citrate Citrate Of Magnesia SOLN 10 OZ PO 1 BOTTLE
Magnesium Hydroxide Milk Of Magnesia Conc. (Equiv) SUSP 2400 MG PO 10 ML
Psyllium Metamucil (Equiv) 654 MG PO 5.8 GM
Psyllium Wafers (Equiv) Metamucil Wafers (Equiv) PKG 3.4 GM PO 2 WAFERS
Sennosides Senokot (Equiv) TAB 8.6 MG PO 1 TAB
Sennosides/Docusate Sodium Senokot-S (Equiv) TAB 1 TAB PO 1 TAB
Sod Sulf/Sod/Nahco3/Kcl/Peg's Golytely (Equiv) SOL REC 4000 ML PO 1 BOTTLE
Sorbitol Solution 70% Sorbitol 70% (Equiv) SOLN 30 ML MSC 1 CUP
56:14.00 Cholelitholytic Agents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Nonstocked Ursodiol Ursodiol CAP 300 MG PO 1 CAPNonstocked Ursodiol Ursodiol SUSP 20 MG PO 1 ML
56:16.00 Digestants GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Amylase/Lipase/Protease Creon 6 (Equiv) CAP EC 1 EACH PO 1 CAP EC
Amylase/Lipase/Protease Creon 24 (Equiv) CAP EC 1 EACH PO 1 CAP EC
56:22 Antiemetics
56:22.08 Antihistamines GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Meclizine HCl Antivert (Equiv) TAB 12.5 MG PO 1 TAB
Meclizine HCl Antivert (Equiv) TAB 25 MG PO 1 TAB
Prochlorperazine Edisylate Compazine (Equiv) VIAL 10 MG IV 2 ML
Prochlorperazine Maleate Compazine (Equiv) TAB 10 MG PO 1 TAB
Prochlorperazine Maleate Compazine (Equiv) TAB 5 MG PO 1 TAB
Prochlorperazine Maleate Compazine (Equiv) SUPP 25 MG REC 1 SUPP
56:22.20 5-HT3 Receptor Antagonists GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Ondansetron HCl Zofran (Equiv) VIAL 4 MG IV 2 ML
Ondansetron HCl Zofran (Equiv) VIAL 40 MG IV 20 ML
Ondansetron HCl Zofran (Equiv) SOLN 4 MG PO 5 ML
Ondansetron HCl Zofran (Equiv) TAB 8 MG PO 1 TAB
Palonosetron HCl Aloxi (Equiv) HV 0.25 MG IV 5 ML
56:22.92 Antiemetics,
miscellaneous GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Dronabinol Marinol (Equiv) CA 2.5 MG PO 1 CAPSULE
Fosapreptitant Emend for Innjection (Equiv) Vial 115 MG IV 1 Vial
56:28 Antiulcer Agents
and Acid
Suppressants56:28.12 Histamine
H2-blockers GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Famotidine Pepcid (Equiv) TAB 20 MG PO 1 TAB
Famotidine Pepcid (Equiv) VIAL 20 MG IV 2 ML
Famotidine Pepcid (Equiv) VIAL 40 MG IV 4 ML
56:28.12 Histamine H2-blockers GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Restricted to Neonates Ranitidine Zantac Suspension Susp 15 mg PO 1 mLRestricted to Neonates Ranitidine IV Zantac IV Vial 25 mg IV 1 mL
56:28.28 Prostaglandins GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Misoprostol Cytotec (Equiv) TAB 200 MCG PO 1 TAB
56:28.32 Protectants GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Sucralfate Carafate (Equiv) SUSP 1 GM PO 10 ML
Sucralfate Carafate (Equiv) TAB 1 GM PO 1 TAB
56:28.36 Proton-Pump
Inhibitors GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Pantoprazole Suspension Protonix Suspension (equiv) UJ 40 MG NG 1 PACKET
Pantoprazole I.V. Protonix I.V. (equiv) VIAL 40 MG IV 1 VIAL
Pantoprazole Protonix (equiv) CAP 20 MG PO 1 CAP
Pantoprazole Protonix (equiv) CAP 40 MG PO 1 CAP
56:32 Prokinetic Agents
56:32.00 Prokinetic Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Metoclopramide HCl Reglan (Equiv) VIAL 10 MG IV 2 ML
Metoclopramide HCl Reglan (Equiv) TAB 5 MG PO 1 TAB
Metoclopramide HCl Reglan (Equiv) TAB 10 MG PO 1 TAB
Metoclopramide HCl Reglan (Equiv) SOLN 10 MG PO 10 ML
56:36 Anti-
Inflammatory Agents
56:36.00 Anti-Inflammatory Agents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Non-stocked Balsalazide Colazal Cap 750 MG PO 1 CAP
Mesalamine Rowasa (Equiv) ENEMA 4 GM REC 60 ML
Mesalamine Delzicol (Equiv) ECTAB 400 MG PO 1 ECTAB
Non-stocked Mesalamine Apriso (Equiv) DR/ERCap 0.375 G PO 1 Delayed And ExtendedRelease Capsules
Non-stocked Mesalamine Canasa (Equiv) Supp 1000 mg REC 1 Supp
Non-stocked Mesalamine Lialda (Equiv) EC Tab 1.2 G PO 1 Tab
56:92 GI Drugs,
Miscellaneous56:92.00 GI Drugs,
Miscellaneous GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Alvimopan Entereg Capsule 12 MG PO 1 Capsule
Stocked in Shelby
Non-stock MansfieldMethylnaltrexone Bromide Relistor Vial 12 MG SQ 0.6 ML
Naloxego Movantik TAB 12.5 MG PO 1 TAB
Naloxego Movantik TAB 25 MG PO 1 TAB
Saliva Substitute Biotene Spray 1 Appl MM 1 APPL
Vedolizumab Entyvio Vial 300 MG IV 1 Vial
64:00 Heavy Metal Antagonists
64:00.00Heavy Metal Antagonists
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Deferoxamine Mesylate Desferal Mesylate (Equiv) VIAL 500 MG IV 5 ML
Dimercaprol Bal In Oil (Equiv) INJ 300 MG IM 3 ML
Edetate Calcium Disodium Calcium Disodium Versent(Equiv INJ 1000 MG IV 5 ML
Hydroxocobalamin Cyanokit 1 KIT IV 1 KIT
Sodium Thiosulfate 25% Sodium Thiosulfate 25% VIAL 50 ML IV 1 VIAL
68:00 Hormones and Synthetic Substitutes
68:04 Adrenals
68:04.00 Adrenals GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Betamet Acet/Betamet Na Ph Celestone (Equiv) VIAL 30 MG IM 5 ML
Budesonide Entocort (Equiv) CAP 3 MG PO 1 CAP
Cortisone Acetate Cortisone Acetate TAB 25 MG PO 1 TAB
Dexamethasone Decadron (Equiv) TAB 0.75 MG PO 1 TAB
Dexamethasone Decadron (Equiv) TAB 2 MG PO 1 TAB
Dexamethasone Decadron (Equiv) TAB 4 MG PO 1 TAB
Dexamethasone Sod Phosphate Decadron (Equiv) VIAL 10 MG IV 1 ML
Dexamethasone Sod Phosphate Decadron (Equiv) VIAL 120 MG IV 30 ML
Dexamethasone Sod Phosphate Decadron (Equiv) VIAL 4 MG IV 1 ML
Fludrocortisone Acetate Florinef Acetate (Equiv) TAB 0.1 MG PO 1 TAB
Fluticasone Propionate 110 Mcg Flovent 110mcg (Equiv) AER 110 MCG RT 1 PUFF
Fluticasone Propionate 220 Mcg Flovent 220 Mcg(Equiv) AER 220 MCG RT 1 PUFF
Hydrocortisone Cortef (Equiv) TAB 10 MG PO 1 TAB
Hydrocortisone Sod Succinate Solu-Cortef (Equiv) VIAL 100 MG IV 2 ML
Hydrocortisone Sod Succinate Solu-Cortef (Equiv) VIAL 1000 MG IV 8 ML
Methylprednisolone Medrol (Equiv) TAB 4 MG PO 1 TAB
Methylprednisolone Acetate Depo-Medrol (Equiv) VIAL 40 MG IM 1 ML
Methylprednisolone Acetate Depo-Medrol (Equiv) VIAL 80 MG IM 1 ML
Methylprednisolone Sod Succ Solu-Medrol (Equiv) VIAL 1000 MG IV 8 ML
Methylprednisolone Sod Succ Solu-Medrol (Equiv) VIAL 125 MG IV 2 ML
Methylprednisolone Sod Succ Solu-Medrol (Equiv) VIAL 40 MG IV 1 ML
Methylprednisolone Sod Succ Solu-Medrol (Equiv) VIAL 500 MG IV 4 ML
Prednisolone Prelone (Equiv) SYRUP 15 MG PO 5 ML
Prednisolone Prednisolone TAB 5 MG PO 1 TAB
Prednisolone Sod Phosphate Pediapred (Equiv) SOLN 5 MG PO 5 ML
Prednisone Prednisone TAB 10 MG PO 1 TAB
Prednisone Prednisone TAB 2.5 MG PO 1 TAB
Prednisone Prednisone TAB 20 MG PO 1 TAB
Prednisone Prednisone CUP 5 MG PO 5 ML
Prednisone Prednisone TAB 5 MG PO 1 TAB
Prednisone Prednisone TAB 50 MG PO 1 TAB
Triamcinolone Acetonide Kenalog-40 (Equiv) VIAL 40 MG IM 1 ML
68:08 Androgens68:08.00 Androgens GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Danazol Danocrine (Equiv) CAP 200 MG PO 1 CAP
Me-Testosterone/Estrogen,Ester Estratest (Equiv) TAB 1 TAB PO 1 TAB
Nandrolone Deca-Durabolin INJ
68:12 Contraceptives68:12.00 Contraceptives GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Non-stocked Etonogestrel Nexplanon Implant
Levonorgestrel 0.75 Mg Plan B (Equiv) 0.75 Mg TAB 2 TAB PO 1 PACKAGE
Levonorgesterol IUD Mirena IUD IUD
Norgestrel-Ethinyl Estradiol Ovral-28 (Equiv) TAB 1 TAB PO 1 PACKAGE
68:16 Estrogens and
Anti-Estrogens
68:16.04 Estrogens GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Estradiol Estraderm (Equiv) PAT TDW 0.05 MG/24h TD 1 PAT TD
Estradiol Estraderm (Equiv) PAT TDW 0.1 MG/24h TD 1 PAT TD
Estradiol Estrace (Equiv) TA 1 MG PO 1 TAB
Estradiol Valerate Delestrogen (Equiv) VIAL 100 MG IM 5 ML
Estrogens,Conjugated Premarin (Equiv) TAB 0.3 MG PO 1 TAB
Estrogens,Conjugated Premarin (Equiv) TAB 0.625 MG PO 1 TAB
Estrogens,Conjugated Premarin (Equiv) TAB 0.9 MG PO 1 TAB
Estrogens,Conjugated Premarin (Equiv) CRM 1 APPL VAG 1 APPL
Estrogens,Conjugated Premarin (Equiv) TAB 1.25 MG PO 1 TAB
Estrogens,Conjugated Premarin (Equiv) VIAL 25 MG IV 5 ML
Estropipate Ogen 0.625 (Equiv) TAB 0.75 MG PO 1 TAB
68:18 Gonadotropins
68:18.00 Gonadotropins GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Gonadotropin,Chorionic,Human Novarel (Equiv) HS 10000 UNIT 1 VIAL
68:20 Antidiabetic68:20.02 α-glucosidase
inhibitors GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Non-stocked Acarbose Precise TAB 25 MG PO 1 TAB
Non-stocked Acarbose Precise TAB 25 MG PO 1 TAB
68:20.04 Biguanides GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Metformin HCl Glucophage (Equiv) TAB 500 MG PO 1 TAB
Metformin HCl Glucophage (Equiv) TAB 850 MG PO 1 TAB
68:20.05 Dipeptidyl Peptidase-4 Inhibitors
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Sitagliptin Januvia Tab 25 MG PO 1 TAB
Sitagliptin Januvia Tab 50 MG PO 1 TAB
Sitagliptin Januvia Tab 100 MG PO 1 TAB
68:20.06 Incretin Mimetics GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Exenatide Byetta Pen 5 Mcg SQ 1.2 mL
Exenatide Byetta Pen 10 Mcg SQ 2.4 mL
68:20.08 Insulins GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Insulin 70/30 Humulin 70/30 (Equiv) VIAL 100 UNITS SUB 1 ML
Insulin NPH Human Recom Humulin N (Equiv) VIAL 100 UNITS SUB 1 ML
Insulin Reg Human (Novolin) Humulin R (Equiv) VIAL 100 UNITS SQ 1 ML
Insulin Reg Human IV Additive Humulin R (Equiv) IV Additive HV 100 UNITS INJ 1 ML
Insulin Lispro Humalog (Equiv) HV 100 UNITS SQ 1 ML
Insulin Glargine Lantus(Equiv) Pen 100 UNITS SUB 1 ML
68:20.16 Metglitinides GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Nateglinide Starlix (Equiv) TAB 120 MG PO 1 TAB
Non-stocked Repaglinide Prandin (Equiv) TAB 0.5 MG PO 1 TAB
Non-stocked Repaglinide Prandin (Equiv) TAB 1 MG PO 1 TAB
Non-stocked Repaglinide Prandin (Equiv) TAV 2 MG PO 1 TAB
68:20.20 Sulfonylureas GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Glimepiride Amaryl (Equiv) TAB 1 MG PO 1 TAB
Glimepiride Amaryl (Equiv) TAB 2 MG PO 1 TAB
Glimepiride Amaryl (Equiv) TAB 4 MG PO 1 TAB
Glipizide Glucotrol Xl (Equiv) TAB SA 5 MG PO 1 TAB SA
Glipizide Glucotrol Xl (Equiv) TAB SA 2.5 MG PO 1 TAB SA
Glipizide Glucotrol (Equiv) TAB 5 MG PO 1 TAB
Glipizide Glucotrol (Equiv) TAB 10 MG PO 1 TAB
Glyburide Diabeta/Micronase (Equiv) TAB 2.5 MG PO 1 TAB
Glyburide Diabeta/Micronase (Equiv) TAB 5 MG PO 1 TAB
68:20.28 Thiazolidinediones GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Pioglitazone Actos (Equiv) TAB 15 MG PO 1 TAB
Pioglitazone Actos (Equiv) TAB 30 MG PO 1 TAB
Pioglitazone Actos (Equiv) TAB 45 MG PO 1 TAB
68:22Antihypoglycemic Agents
68:22.12 Glycogenolytic Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Glucagon,Human Recombinant Glucagon (Equiv) KIT 1 MG IV 1 KIT
68:24 Parathyroid68:24.00 Parathyroid GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Calcitonin,Salmon,Synthetic Miacalcin (Equiv) SPRAY 200 IU NAS 1 SPRAY
Calcitonin,Salmon,Synthetic Miacalcin (Equiv) VIAL 400 UNITS SQ 2 ML
68:28 Pituitary68:28.00 Pituitary GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Desmopressin Acetate Ddavp Rhinal Tube (Equiv) SOLN 0.25 MG NAS 2.5 ML
Desmopressin Acetate Ddavp (Equiv) INJ 4 MCG IV 1 ML
Vasopressin Pitressin (Equiv) VIAL 20 UNITS IV 1 ML
68:32 Progestins68:32.00 Progestins GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Medroxyprogesterone Acet Depo-Provera (Equiv) VIAL 150 MG IM 1 ML
Medroxyprogesterone Acet Provera (Equiv) TAB 2.5 MG PO 1 TAB
Medroxyprogesterone Acet Depo-Provera (Equiv) VIAL 400 MG IM 1 ML
Medroxyprogesterone Acet 10mg Provera (Equiv) TAB 10 MG PO 1 TAB
Non-stocked Norethindrone Aygestin (Equiv) TAB 5 MG PO 1 TAB
Non-stocked Progresterone Vaginal Gel Progesterone Vaginal Gel Gel 8%
68:36
Thyroid and Antithyroid Agents
68:36.04 Thyroid Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Levothyroxine Sodium Synthroid (Equiv) TAB 25 MCG PO 1 TAB
Levothyroxine Sodium Synthroid (Equiv) TAB 50 MCG PO 1 TAB
Levothyroxine Sodium Synthroid (Equiv) TAB 75 MCG PO 1 TAB
Levothyroxine Sodium Synthroid (Equiv) TAB 88 MCG PO 1 TAB
Levothyroxine Sodium Synthroid (Equiv) TAB 100 MCG PO 1 TAB
Levothyroxine Sodium Synthroid (Equiv) TAB 150 MCG PO 1 TAB
Levothyroxine Sodium Synthroid (Equiv) TAB 200 MCG PO 1 TAB
Levothyroxine Sodium Synthroid (Equiv) VIAL 200 MCG IV 5 ML
Liothyronine Cytomel (Equiv) Tablet 50 mcg PO 1 Tablet
Thyroid Armour Thyroid (Equiv) TAB 30 MG PO 1 TAB
68:36.08 Antithyroid Agents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Methimazole Tapazole (Equiv) TAB 10 MG PO 1 TAB
Potassium Iodide 1gm/1ml Sski (Equiv) SOLN 30 ML PO 30 ML
Non-stocked Potassium Iodide and Iodine 5% Lugol’s Solution SOLN
Propylthiouracil Propylthiouracil TAB 50 MG PO 1 TAB
72:00 Local Anesthetics
72:00.00 Local Anesthetics GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Bupivacaine 0.25% Marcaine 0.25% (Equiv) VIAL 2.5 MG IV 1 ML
Bupivacaine 0.25% Mpf Marcaine 0.25% Mpf (Equiv) VIAL 2.5 MG IV 1 ML
Bupivacaine 0.25% Mpf Marcaine 0.25% Mpf (Equiv) VIAL 2.5 MG IM 1 ML
Bupivacaine 0.5% Mpf Marcaine 0.5% Mpf (Equiv) VIAL 5 MG IV 1 ML
Bupivacaine 0.5% Mpf Marcaine 0.5% Mpf (Equiv) VIAL 5 MG IM 1 ML
Bupivacaine 0.75% Mpf Marcaine 0.75% Mpf (Equiv) VIAL 7.5 MG IM 1 ML
Bupivacaine Spinal/Mpf Marcaine Spinal Mpf 0.75%(Eqv) INJ 7.5 MG IV 1 ML
Non-stocked Bupivacaine (D8.25W PM) Bupivacaine (D8.25W PM)
Bupivacaine/Epi 0.25% Marcaine/Epi 0.25% (Equiv) HV 1 VIAL IM 50 ML
Bupivacaine/Epi 0.25% Mpf Marcaine /Epi 0.25% Mpf(Equiv) VIAL 1 VIAL IM 30 ML
Bupivacaine/Epi 0.5% Mpf Marcaine/Epi 0.5% Mpf (Equiv) VIAL 1 VIAL IM 30 ML
Chloroprocaine 3% Mpf Nesacaine 3% Mpf (Equiv) VIAL 1 VIAL IV 30 ML
Lidocaine 0.5% Xylocaine (Equiv) 0.5% HV 1 VIAL IM 50 ML
Lidocaine 0.5% Mpf Xylocaine Mpf (Equiv) 0.5% VIAL 1 VIAL IV 50 ML
Lidocaine 1.5% Mpf Dex. 7.5% Xylocaine 1.5% Mpf/Dex (Equiv INJ 1 AMPULE IV 2 ML
Lidocaine 2%/Epi 1:50,000 Mpf Xylocaine 2%/Epi 1:50,000 Mpf HV 1 VIAL IV 20 ML
Lidocaine HCl 0.5%/Epi Xylocaine 0.5% W/Epin (Equiv) VIAL 1 VIAL IM 50 ML
Lidocaine HCl 1% Lidocaine HCl 1% VIAL 1 VIAL IM 20 ML
Lidocaine HCl 1% Lidocaine HCl 1% VIAL 1 VIAL IM 50 ML
Lidocaine HCl 1% Mpf Xylocaine-Mpf 1% (Equiv) INJ 1 AMPULE IV 2 ML
Lidocaine HCl 1% Mpf Xylocaine 1% Mpf (Equiv) VIAL 1 VIAL IM 30 ML
Lidocaine HCl 1% Mpf/Epi Xylocaine 1% Mpf W/Epi (Equiv VIAL 1 VIAL IM 30 ML
Lidocaine HCl 1%/Epi Xylocaine HCl 1% W/Epi (Equiv) VIAL 1 VIAL IM 20 ML
Lidocaine HCl 1.5% Mpf Xylocaine-Mpf 1.5% (Equiv) VIAL 1 AMPULE IM 20 ML
Lidocaine HCl 1.5% Mpf/Epi Xylocaine 1.5% Mpf W/Epi (Equi VIAL 1 VIAL IM 30 ML
Lidocaine HCl 2% Lidocaine HCl 2% VIAL 1 VIAL IM 20 ML
Lidocaine HCl 2% Mpf Xylocaine-Mpf 2% (Equiv) INJ 1 AMPULE IV 10 ML
Lidocaine HCl 2%/Epi 1:100000 Xylocaine 2% W/Epi (Equiv) VIAL 1 VIAL IM 20 ML
Lidocaine HCl 2%Epi 1:200000 Xylocaine 2% Mpf W/Epi (Equiv) VIAL 1 VIAL IV 20 ML
Lidocaine HCl 4% Mpf Xylocaine-Mpf 4% (Equiv) INJ 1 AMPULE IV 5 ML
Non-stocked Lidocaine 4%-LMX-4 Kit Lidocaine 4%-LMX-4 Kit Kit 1 KIT TOP
Non-stocked Lidocaine 5% Lidocaine 5% OINT 1 APPL TOP 1 APPL
Lidocaine HCl 5% Mpf /D7.5w Lidocaine 5% Mpf / Dex 7.5% INJ 1 AMPULE INT 2 ML
Mepivacaine HCl 1.5% Mpf Carbocaine 1.5% Mpf (Equiv) VIAL 15 MG IM 1 ML
Non-stocked Chloroprocaine 2% Chloroprocaine 2% Vial
Non-stocked Chloroprocaine 3% Chloroprocaine 3% Vial
Ropivacaine HCl Naropin (Equiv) HH 40 MG INJ 20 ML
Ropivacaine HCl Naropin (Equiv) HV 150 MG INJ 30 ML
Ropivacaine HCl Naropin (Equiv) INFUS 200 MG IV 100 ML
Ropivacaine PM Naropin PM (Equiv) BAG 150 MG IV 75 ML
Tetracaine HCl 1% Pontocaine 1% (Equiv) INJ 20 MG IV 2 ML
76:00 Oxytocics 76:00.00 Oxytocics GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Carboprost Tromethamine Hemabate (Equiv) INJ 250 MCG IM 1 ML
Dinoprostone Cervidil (Equiv) SUP VA 10 MG VAG 1 QC
Dinoprostone Prostin E2 (Equiv) SUP VAG 20 MG VAG 1 SUP VA
Methylergonovine Maleate Methergine (Equiv) TA 0.2 MG PO 1 TAB
Methylergonovine Maleate Methergine (Equiv) INJ 0.2 MG IV 1 ML
Oxytocin Pitocin (Equiv) VIAL 10 UNITS IV 1 ML
80:00 Serums, Toxoids, and Vaccines
80:04.00 Antitoxins and Immune Globulins GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Antivenin (Latrodectus mactans) Antivenin Vial 6000 Unites IM/IV 1 VIALCrotalinae Polyvalent Immune Fab
(Ovine) CroFab Vial IV 1 Vial
Digoxin Immune Fab Digifab (Equiv) HS 40 MG 1 VIAL
Digoxin Immune Fab Digibind (Equiv) VIAL 40 MG IV 1 VIAL
Hepatitis B Immune Globulin Hepatitis B Immune Globulin HQ 0.5 ML IM 1 SYRINGE
Hepatitis B Immune Globulin Bayhep B (Equiv) VIAL 5 ML IM 1 VIAL
Immu Globulin,Gamma (Igg) Iveegam En (Equiv) VIAL 1 GM IV 10 ML
Immune Globgam Caprlte(Igg)10% Gamunex (Equiv)10% VIAL 1000 MG IV 10 ML
Rabies Immune Globulin Imogam Rabies-Ht (Equiv) VIAL 1500 UNITS IM 10 ML
Rabies Immune Globulin Imogam Rabies-Ht (Equiv) VIAL 300 UNITS IM 2 ML
Rho(D) Immune Globulin Rhophylac (Equiv) VIAL 300 MCG IV 2 ML
Rho(D) Immune Globulin Rhophylac (Equiv) VIAL 1500 UNITS IV 1 VIAL
Tetanus Immune Globulin Baytet (Equiv) SYRING 250 UNITS IM 1 SYRING
Varicella Immune Globulin VariZIG Vial 625 UNITS IM 1 VIAL
Zoster Zostavax Vial 1 EACH SQ 0.5 ML
80:08.00 Toxiods GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Diphth,Pertuss(Acell),Tet Ped Daptacel HV 0.5 ML IM 1 VIAL
Tetanus Toxoid,Fluid Tetanus Toxoid (Equiv) SYRING 5 ML IM 1 SYRINGE
Tetanus,Diphtheria Toxoid Adul Diphtheria-Tetanus Toxoid Adlt VIAL 0.5 ML IM 0.5 ML
Tetanus,Diphtheria Toxoid Ped Diphtheria-Tetanus Toxoid Ped HV 1 VIAL IM 0.5 ML
80:12.00 Vaccines GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Bcg Live Tice Bcg Live HS 50 MG 1 VIALDtap, poliovirus, haemophilus b
conjugate Pentecel Vial 1 EACH IM 0.5 mL vial
Haemoph B Polysac Conj-Tet Tox Acthib (Equiv) HS 10 MCG 1 VIAL
Hepatitis A (Adult) Vaqta Vial 1 EACH IM 0.5 mL vial
Hepatitis A (Pediatric) Vaqta Vial 1 EACH IM 0.5 mL vial
Hep B Vir Vacc Recomb Engerix-B (Equiv) VIAL 10 MCG IM 1 ML
Hep B Vir Vacc Recomb Recombivax Hb (Equiv) HV 5 MCG IM 0.5 ML
Influenza Virus Triv-Surf-Pure Flu Vaccine (Equiv) SYRING 1 SYRINGE IM 0.5 ML
Measles,Mumps&Rubella Vaccine M-M-R Ii Vaccine W/Dil (Equiv) VIAL 1 VIAL SUB 1 VIAL
Meningococcal Vac A,C,Y,W-135 Menomune-A/C/Y/W-135 (Equiv) HS 1 EACH SQ 1 VIAL
Meningococcal b vacc,4-comp/pf BEXSERO VIAL 1 EACH SQ 1 VIAL
Papillomavirus Gardasil Vial 1 EACH IM 1 VIAL
Pneumococcal 23-Val P-Sac Vac Pneumovax 23 Equiv) VIAL 0.5 ML IM 1 VIAL
Pneumococcal 23-Val P-Sac Vac Prevnar 13 (Equiv) Vial 0.5 mL IM 1 Vial
Rabies Vac,Pf Chick-Emb Cell Rabavert (Equiv) YK 2.5 UNIT IM 1 KIT
Rabies Vaccine,Human Diploid Imovax Rabies Vaccine (Equiv) VIAL 2.5 UNITS IM 1 ML
Rotavirus Vaccine RotaTeq®; SUSP 1 EACH PO 2.5 ML
Rubella Vaccine Meruvax Ii Vaccine W/Dil(Equiv VIAL 0.5 ML SUB 1 VIAL
Tetanus-diphtheria-pertussis Adacel SYRINGE 0.5 ML IM 1 Vial
Varicella Varivax Vial 1 EACH SQ 1 VIAL
84:00 Skin and Mucous Membrane Agents
84:04 Anti-Infectives84:04.04 Antibacterials GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Bacitracin Zinc Bacitracin Zinc OINT 1 APPL TOP 1 APPL
Bacitracin/Polymyxin B Sulfate Polysporin (Equiv) PA 1 APPL TOP 1 APPL
Non-stocked Clindamycin Cleocin T Solution 1 APPL TOP 1 APPL
Non-stocked Clindamycin Vaginal Cream Clindamycin Vaginal Cream Solution 1 APPL TOP 1 APPL
Gentamicin Sulfate 0.1% Garamycin 0.1% (Equiv) CREAM 1 APPL TOP 1 APPL
Gentamicin Sulfate 0.1% Garamycin 0.1% (Equiv) OINT 1 APPL TOP 1 APPL
Mupirocin 2% Bactroban 2% (Equiv) OINT 1 APPL TOP 1 APPL
Non-stocked Mupirocin 2% Bactroban 2% (Equiv) CREAM 1 APPL TOP 1 APPL
Neomy Sulf/Bacitra/Polymyxin B Neosporin (Equiv) OINT 1 APPL TOP 1 APPL
84:04.06 Antivirals GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Docosanol Abrevia OINT 2 GM TOP 1 Tube
84:04.08 Antifungals
84:04.08.04 Allylamines GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Terbinafine HCl 1% Lamisil At 1% (Equiv) CREAM 1 APPL TOP 1 APPL
84:04.08.08 Azoles GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Clotrimazole Mycelex Troche (Equiv) TROCHE 10 MG MM 1 TROCHE
Clotrimazole 1% Lotrimin (Equiv) 1% CREAM 1 APPL TOP 1 APPL
Non-stocked Clotrimazole 1% Vaginal Cream Cream 1 APPL TOP 1 APPL
Clotrimazole/Betamet Diprop Lotrisone (Equiv) CREAM 1 APPL TOP 1 APPL
Ketoconazole 2% Nizoral 2% (Equiv) CREAM 1 APPL TOP 1 APPL
Ketoconazole 2% Nizoral 2% (Equiv) SHAMPO 1 APPL TOP 1 APPL
Non-stocked Miconazole Miconazole SUPP 100 MG REC 1 SUPP
Non-stocked Miconazole Miconazole SUPP 200 MG REC 1 SUPP
Miconazole Nitrate 2% Miconazole 7 2% (Equiv) CRM 45 GM VAG 1 TUBE
Miconazole Nitrate 2% Desenex 2% (Equiv) POWDER 1 APPL TOP 1 APPL
84:04.08.20 Hydryoxypyridones GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Non-stocked Ciclodan Cream 0.77% Ciclodan Cream Cream 1 Application TOP 1 Application
84:04.08.28 Polyenes GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Nystatin Mycostatin (Equiv) CREAM 1 APPL TOP 1 APPL
Non-stocked Nystatin Nystatin Ointment 1 Application TOP 1 Application
Non-stocked Nystatin Vaginal Tablet Nystatin Vaginal Tablet TAB 100,000 Units TOP 1 Application
Nystatin/Triamcin 0.1% Mycolog Ii (Equiv) 0.1% CREAM 1 APPL TOP 1 APPL
Nystatin/Triamcin 0.1% Mycolog Ii (Equiv) 0.1% OINT 1 APPL TOP 1 APPL
Nystatin Nystatin Powder 1 Application TOP 1 Application
84:04.08.92 Antifungals, Misc GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Non-stocked Gentian Violet 0.5% Gentian Violet 0.5% Solution 1 APPL TOP 1 APPL
Non-stocked Gentian Violet 1% Gentian Violet 1% Solution 1 APPL TOP 1 APPL
84:04.12 Scabacides and
Pediculicides GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Non-stocked Benzyl Alcohol Topical 5% Lotion Benzyl Alcohol Topical 5% Lotion Lotion 1 APPL TOP 1 APPL
Lindane 1% Lindane 1% (Equiv) LOTION 1 APPL TOP 1 APPL
Lindane 1% Lindane 1% (Equiv) SHAMPO 1 APPL TOP 1 APPL
84:04.92 Miscellaneous Local
Anti-infectives GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Non-stocked Benzoin Compound Tinc Benzoin Compound Tinc 1 APPL TOP 1 APPL
Carbolic Acid 6% Phenol 6% (Equiv) LIQUID 10 ML MSC 1 BOTTLE
Carbolic Acid 9% Phenol 9% (Equiv) LIQUID 10 ML MSC 1 BOTTLE
Hexachlorophene Phisohex (Equiv) LIQUID 148 ML TOP 1 BOTTLE
Hexachlorophene Chg Dose Phisohex (Equiv) Chg Dose LIQUID 30 ML TOP 1 UNIT
Non-stocked Mafenide Sulfamylon CREAM 1 APPL TOP 1 APPL
Metronidazole 0.75% Metrogel-Vaginal 0.75% (Equiv) GEL 1 APPL VAG 1 APPL
Metronidazole 1% Noritate 1% (Equiv) CREAM 1 APPL TOP 1 APPL
Povidone-Iodine Betadine (Equiv) OINT 1 APPL TOP 1 APPL
Non-stocked Povidone-Iodine 10% Povidone-Iodine 10% Solution 1 Application TOP 1 Application
Non-stocked Selenium Sulfide 2.25% Selenium Sulfide 2.25% Shampoo 1 Application TOP 1 Application
Non-stocked Selenium Sulfide 2.5% Selenium Sulfide 2.5% Lotion 1 Application TOP 1 Application
Silver Nitrate Silver Nitrate Applicator EACH 1 STICK TOP 1 STICK
Silver Sulfadiazine 1% Thermazene 1% (Equiv) CREAM 1 APPL TOP 1 APPL
Silver Sulfadiazine 1% Thermazene 1% (Equiv) CREAM 1 APPL TOP 1 APPL
Non-stocked Sulfanilamide 15% Sulfanilamide 15% Cream 1 APPL TOP 1 APPL
84:06
Anti-inflammatory Agents
84:06.00 Anti-inflammatory Agents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Clobetasol Propionate 0.05% Temovate (Equiv) 0.05% CREAM 1 APPL TOP 1 APPL
Clobetasol Propionate 0.05% Temovate (Equiv) 0.05% OINT 15 GM TOP 1 TUBE
Desonide 0.05% Desowen (Equiv) 0.05% CREAM 1 APPL TOP 1 APPL
Desonide 0.05% Desowen (Equiv) 0.05% OINT 1 APPL TOP 1 APPL
Fluocinonide 0.05% Vanos CREAM 1 APPL TOP 1 APPL
Fluocinonide 0.05% Vanos OINT 1 APPL TOP 1 APPL
Hydrocortisone Cortenema (Equiv) ENEMA 100 MG REC 60 ML
Hydrocortisone 1% Hydrocortisone 1% CREAM 1 APPL TOP 1 APPL
Hydrocortisone Acetate Anusol Hc (Equiv) SUPP 25 MG REC 1 SUPP
Non-stocked Hydrocortisone Powder Hydrocortisone Powder Powder 1 APPL TOP 1 APPL
Non-stocked Hydrocortisone 1% Hydrocortisone 1% Lotion 1 APPL TOP 1 APPL
Non-stocked Hydrocortisone 1% Hydrocortisone 1% OINT 1 APPL TOP 1 APPL
Non-stocked Hydrocortisone 10% Hydrocortisone 10% GEL 1 APPL TOP 1 APPL
Triamcinolone Acetonide 0.1% Kenalog 0.1% (Equiv) OINT 1 APPL TOP 1 APPL
Triamcinolone Acetonide 0.1% Kenalog 0.1% (Equiv) CREAM 1 APPL TOP 1 APPL
Triamcinolone Acetonide 0.1% Kenalog In Orabase 0.1%(Equiv) PASTE 5 GM DEN 1 TUBE
Non-stocked Triamcinolone Acetonide Aerosol Triamcinolone Acetonide Aerosol Spray 0.2 Mg Top 2 Second
84:08Antipruritics and Local Anesthetics
84:08.00 Antipruritics and Local Anesthetics GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Non-stocked Calamine 8% Calamine 8% Lotion 1 Application TOP 1 Application
Non-stocked Ethyl Chloride 100 % Ethyl Chloride 100% Spray 1 Application TOP 1 Application
Non-stocked Lactic acid 12% with ammonium hydroxide Lac-Hydrin Lotion 1 Application TOP 1 Application
Non-stocked Lanolin-Mineral Oil Therma-Derm 1 Application TOP 1 Application
Lidocaine/Prilocaine Emla (Equiv) KIT 1 APPL TOP 1 APPL
Non-stocked Nivea w/clove oil Nivea w/ Clove Oil Lotion 1 Application TOP 1 Application
Phenazopyridine HCl Pyridium (Equiv) TAB 100 MG PO 1 TAB
Phenazopyridine HCl Pyridium (Equiv) TAB 200 MG PO 1 TAB
Non-stocked Pramoxine 1% Proctofoam (Equiv) Foam 15 GM TOP 1 APPL
Tetracaine HCl 2% Pontocaine 2% (Equiv) SOLN 30 ML TOP 1 BOTTLE
Tetracaine/Benzocaine/Butamben Cetacaine (Equiv) SPRAY 1 APPL TOP 1 APPL
84:24 Emoillents, Demulcents, and Protectants84:24.04 Basic Lotions and
Liniments GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Ammonium Lactate Lac-Hydrin (Equiv) LOTION 1 APPL TOP 1 APPL
Cetyl Alcohol/Propylene Glycol Cetaphil (Equiv) LOTION 1 APPL TOP 1 APPL
84:24.08 Basic Oils and Other Solvents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Mineral Oil Mineral Oil OIL 10 ML TOP 10 ML
84:24.12 Basic Ointments and
Protectants GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Mineral Oil/Pet Hy-Phl Aquaphor (Equiv) OA 1 APPL TOP 1 APPL
Vitamins A And D A & D Ointment (Equiv) OINT 1 APPL TOP 1 APPL
Zinc Oxide 20% Zinc Oxide 20% (Equiv) OINT 1 APPL TOP 1 APPL
Non-stocked Zinc Ox-Cod Liv Oil-Vit A 40% Destin 40 40% OINT 1 APPL TOP 1 APPL
Talc Talc POWDER 5 GM TOP 1 PACKAGE
84:28 Keratolytics GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Non-stocked Urea Skin Emollient 10% Aqua Care (Equiv) Lotion 1 APPL TOP 1 APPL
84:32 Keratoplastic Agents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Non-stocked Coal Tar Coar Tar Shampoo 1 APPL TOP 1 APPL
84:92Skin and Mucous Membrane Agents,
Miscellaneous84:92.00 Skin and Mucous
Membrane Agents, Miscellaneous
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Becaplermin 0.01% Regranex 0.01% (Equiv) GEL 15 GM TOP 1 APPL
Non-stocked Benzoyl Peroxide 10% Persa Gel Gel 10% APPL TOP 1 APPL
Capsaicin 0.025% Zostrix (Eqiuv) 0.025% CREAM 1 APPL TOP 1 APPL
Collagenase Santyl (Equiv) OINT 1 APPL TOP 1 APPL
Fluorouracil 2% Efudex (Equiv) 2% SOLN 1 APPL TOP 1 APPL
Fluorouracil 5% Efudex (Equiv) 5% CREAM 1 APPL TOP 1 APPL
Hydrocortisone 2.5% Anusol-Hc 2.5% (Equiv) CREAM 1 APPL REC 1 APPL
Phenylephrine 0.25% Anusol 0.25% (Equiv) QA 1 EACH REC 1 SUPP
Uskekinumab Stelara VIAL 130 MG IV 26 ML
86:00 Smooth Muscle Relaxants86:12.00 Genitourinary Smooth
Muscle Relaxants GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Oxybutynin Chloride Ditropan (Equiv) TAB 5 MG PO 1 TAB
Respiratory Smooth Muscle Relaxants86:16.00 GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Aminophylline (Anhydrous) Aminophylline TAB 100 MG PO 1 TAB
Aminophylline (Anhydrous) Aminophylline TAB 200 MG PO 1 TAB
Aminophylline Aminophylline VIAL 250 MG IV 10 ML
Aminophylline Aminophylline VIAL 500 MG IV 20 ML
Theophylline Theophylline 24hr Tab 400 MG PO 1 24 hr Tab
Theophylline Theophylline 24hr Tab 600 MG PO 1 24 hr Tab
Theophylline Theophylline Solution 80 MG PO 15 ML
88:00 Vitamins
88:04.00 Vitamin A GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Vitamin A Palmitate Aquasol A (Equiv) TAB 100000 UNIT PO 1 TAB
Vitamin A Palmitate Aquasol A (Equiv) HV 100000 UNIT IM 2 ML
88:08.00 Vitamin B Complex GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Cyanocobalamin Vitamin B12 (Equiv) VIAL 1,000 MCG IM 1 ML
Folic Acid Folic Acid VIAL 1 MG IV 0.2 ML
Folic Acid Folic Acid VIAL 50 MG IV 10 ML
Folic Acid Folic Acid TAB 1 MG PO 1 TABFolic Acid, Cyanocobalamin, and
Pyridoxine Fol-Tx Tab 1 Each PO 1 Tablet
Folic Acid/Vitamin B Comp W-C Nephrocaps (Equiv) CAP 1 CAP PO 1 CAP
Pyridoxine HCl Vitamin B6 (Equiv) VIAL 100 MG IV 1 ML
Pyridoxine HCl Vitamin B6 (Equiv) TAB 50 MG PO 1 TAB
Thiamine HCl Vitamin B1 (Equiv) VIAL 100 MG IV 1 ML
Thiamine HCl Vitamin B1 (Equiv) TAB 100 MG PO 1 TAB
88:12.00 Vitamin C GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Ascorbic Acid Vitamin C (Equiv) TAB 250 MG PO 1 TAB
Ascorbic Acid Vitamin C (Equiv) TAB 500 MG PO 1 TAB
Ascorbic Acid Vitamin C (Equiv) Solution 500 MG PO 1 ml
Ascorbic Acid Ascorbic Acid VIAL 25000 MG IV 50 ML
88:16.00 Vitamin D GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Calcitriol Rocaltrol (Equiv) CAP 0.25 MCG PO 1 CAP
Cholecalciferol Vitamin D 5000 UNIT TAB 5000 Int Units PO 1 TAB
Cholecalciferol Vitamin D 400 IU Drops DROPS 400 Int Units PO 1 ML
Ergocalciferol Drisdol (Equiv) CAP 50000 UNITS PO 1 CAP
Non-stocked Ergocalciferol Calciferol Solution 8000 UNITS PO 1 ML
Non-stocked Parecalcitol Zemplar Cap 1 mcg PO 1 CAP
Non-stocked Parecalcitol Zemplar INJ 2 mcg IV 1 EACH
Non-stocked Parecalcitol Zemplar INJ 5 mcg IV 1 EACH
88:20.00 Vitamin E GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Vitamin E Vitamin E (Equiv) CAP 100 UNITS PO 1 CAP
Vitamin E Vitamin E (Equiv) CAP 400 UNITS PO 1 CAP
Non-stocked Vitamin E Vitamin E (Equiv) DROP 50 UNITS PO 1 DROP
Non-stocked Vitamin E Vitamin E (Equiv) Solution 15 UNITS PO 0.3 ML
Non-stocked Vitamin E Vitamin E (Equiv) Cream 50 UNITS TOP 1 GRAM
88:24.00 Vitamin K GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Phytonadione Vitamin K (Equiv) SYRING 1 MG SQ 0.5 ML
Phytonadione Vitamin K (Equiv) INJ 10 MG SQ 1 ML
Phytonadione Mephyton (Equiv) TAB 5 MG PO 1 TAB
88:28.00 Multivitamin Preparations GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Multivitamins Infuvite VIAL 1 VIAL IV 10 ML
Multivitamins Mvi-12 VIAL 1 VIAL IV 10 ML
Multivitamins, Therapeutic Poly-ViSol (Equiv) Liquid PO 50 mL
Multivitamins, Therapeutic Poly-ViSol w/ Iron(Equiv) Liquid PO 50 mL
Multivitamins,Therapeutic Theragran (Equiv) TAB 1 TAB PO 1 TAB
Multivits,Th W-Ca,Fe,Oth Min Theragran M (Equiv) TAB 1 TAB PO 1 TAB
92:00 Miscellaneous Therapeutic Agents
92:08 5-α Reductase Inhibitor GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Finasteride Proscar (Equiv) TAB 5 MG PO 1 TAB
Tamsulosin HCl Flomax (Equiv) C SR 24 0.4 MG PO 1 C SR 24
92:12 Antidotes GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Acetylcysteine 20% 200mg/mL Acetadote (Equiv) 20% IV 6000 MG IV 30 ML
Glucarpidase Voraxaze VIAL 1000 Units IV 1 VIAL
Fomepizole Antizol (Equiv) VIAL 1500 MG IV 1.5 ML
Leucovorin Calcium Leucovorin Calcium VIAL 100 MG IV 1 VIA
Leucovorin Calcium Leucovorin Calcium VIAL 350 MG IV 1 VIAL
Leucovorin Calcium Leucovorin Calcium TAB 5 MG PO 1 TAB
Leucovorin Calcium Leucovorin Calcium VIAL 50 MG IV 1 VIAL
Pralidoxime Chloride Protopam Chloride (Equiv) VIAL 1000 MG IV 1 VIAL
Uridine Triacetat Vistogard Packet 10 Gram PO 1 Packet
92:16 Antigout Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Allopurinol Allopurinol TAB 100 MG PO 1 TAB
Allopurinol Allopurinol TAB 300 MG PO 1 TAB
Colchicine Colchicine TAB 0.6 MG PO 1 TAB
92:16Bone Resorption
Inhibitors GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Ibandronate Boniva IV Vial 1 ML IV 1 mL
Pamidronate Disodium Aredia (Equiv) VIAL 30 MG IV 1 VIAL
Pamidronate Disodium Aredia (Equiv) VIAL 90 MG IV 1 VIAL
Zoledronic Acid Zometa (Equiv) VIAL 4 MG IV 5 ML
Zoledronic Acid Reclast (Equiv) VIAL 5 MG IV 5 ML
92:20Biologic Response
Modifiers GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Glatiramer Acetate Copaxone Syringe 20 MG SQ 1 ML
Glatiramer Acetate Copaxone Syringe 40 MG SQ 1 ML
Interferon Beta-1b Betaseron HS 0.3 MG 1 VIAL
Natalizumab Tysabri Vial 300 MG IV 1 Vial
Ocrelizumab Ocrevus) VIAL 300 MG IV 10 ML
92:32Complement Inhibitors GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
C1-Esterase Inhibitor Berinert VIAL 500 UNITS IV 1 VIAL
92:36Disease Modifying
Antirheumatic Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Abatacept Orencia (Equiv) VIAL 250 MG IV 1 VIAL
Adalumumab Humira KIT 150 MG SQ 1 KIT
Infliximab Remicade (Equiv) VIAL 100 MG IV 1 VIAL
Tocilizumab Actemera (Equiv) VIAL 200 MG IV 1 VIAL
Tocilizumab Actemera (Equiv) VIAL 400 MG IV 1 VIAL
92:44Immunosuppresant
Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Azathioprine Azathioprine (Equiv) TAB 50 MG PO 1 TAB
Belimumab Benlysta (Equiv) VIAL 120 MG IV 1 VIAL
Belimumab Benlysta (Equiv) VIAL 400 MG IV 1 VIAL
Cyclosporine Sandimmune (Equiv) CAP 100 MG PO 1 CAP
Cyclosporine Sandimmune (Equiv) LIQUID 100 MG PO 1 ML
Cyclosporine Sandimmune (Equiv) CAP 25 MG PO 1 CAP
Cyclosporine Sandimmune (Equiv) IV 50 MG IV 5 ML
Cyclosporine, Modified Neoral (Equiv) CAP 100 MG PO 1 CAP
Cyclosporine, Modified Neoral (Equiv) SOLN 100 MG PO 1 ML
Cyclosporine, Modified Neoral (Equiv) CAP 25 MG PO 1 CAP
Mycophenolate Mofetil Cellcept (Equiv) CAP 250 MG PO 1 CAP
Mycophenolate Mofetil Myfortic (Equiv) CAP 180 MG PO 1 CAP
Mycophenolate Mofetil Myfortic (Equiv) CAP 360 MG PO 1 CAP
Sirolimus Rapamune TAB 0.5 MG PO 1 Tab
Sirolimus Rapamune TAB 1 MG PO 1 Tab
Sirolimus Rapamune Solution 1 MG PO 1 ML
92:56 Protective Agents GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Amifostine Crystalline Ethyol (Equiv) VIAL 500 MG IV 1 VIAL
Dexrazoxane Totect, Zinecard VIAL 500 MG IV 1 ML
Mesna Mesna (Equiv) VIAL 100 MG IV 1 ML
92:92.00 Miscellaneous Therapeutic Agents GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Chondro Su A/Hyalur Sod Duovisc (Equiv) KIT 1 KIT INT 1 KIT
Chondro Su A/Hyalur Sod Viscoat (Equiv) SYRING 1 SYRINGE INT 1 SYRINGE
Cobicistat TYBOST Tab 150 MG PO 1 TAB
Ethyl Alcohol 98% Alcohol,Dehydrated 98% INJ 5 ML IV 1 AMP
Levocarnitine Levocarnitine TAB 330 MG PO 1 TAB
Methylene Blue 1% Methylene Blue 1% (Equiv) VIAL 1 VIAL IV 1 VIAL
Octreotide Acetate Sandostatin (Equiv) INJ 0.05 MG IV 1 ML
Octreotide Acetate Sandostatin (Equiv) VIAL 1 MG IV 5 ML
Octreotide Acetate Sandostatin Lar (Equiv) KIT 20 MG IM 1 KIT
Octreotide Acetate Sandostatin Lar (Equiv) YK 30 MG IM 1 KIT
94:00 Devices 94:00.00 Devices GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Hyaluronate Sodium Synvisc (Equiv) SYRING 16 MG INT 2 ML
Hyaluronate Sodium Synvisc one (Equiv) SYRING 8 MG INT 1 mL
96:00 Pharmaceutical Aids96:00.00 Pharmaceutical Aids GENERIC NAME BRAND NAME DOSAGE
FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Water For Inj.,Bacteriostatic Water VIAL 1 VIAL IV 30 ML
Water For Injection,Sterile Water VIAL 1 EACH IV 10 ML
Water For Injection,Sterile Water VIAL 1 VIAL IV 100 ML
Water For Injection,Sterile Water For Injection Sterile IV 1000 ML IV 1000 ML
Non-AHFS Catergory Formulary Agents
GENERIC NAME BRAND NAME DOSAGE FORM STRENGTH UNIT ROUTE VOLUME VOLUME UNIT
Acd-Solution Formula A Anticoagulant Dextrose Solutio IV 1 BAG IV 1000 MLAlum So4/ Ca Acetate Domeboro Pdr (Equiv) PACKET 1 PACKET TOP 1 PACKETBupivacaine/Epi 0.5% Marcaine / Epi 0.5% (Equiv) AMPULE 1 AMPULE IV 1.8 ML
Cepacol (Equiv) Cepacol (Equiv) LOZENGE 6 TABLETS PO 1 PACKAGEColloidal Oatmeal Pkt Aveeno Bath Reg (Equiv) POWDER 1 PACKET TOP 1 PACKET
Hepatitis B Ped Amin. Charge Hepatitis B Ped Admin. Charge EACH 1 EACH IM 1 CHARGEInspirease Drug Del System Inspirease KIT 1 EACH RT 1 KIT
Isosulfan Blue 1% Lymphazurin 1% (Equiv) AMPULE 1 AMPULE IM 5 ML
Lozengers, Cherry Sf Nice Lozengers Sf,Cherry(Equiv LOZENGE 8 TAB PO 1 PACKAGEMenthol/Benzocaine Chloraseptic (Equiv) LOZENGE 1 PACKAGE PO 6 TABLETS
Methylsalicylate/Mentol Bengay (Equiv) TUBE 1 APPL TOP 1 APPLPadimate/Oxyben/Dime Oint Blistex (Equiv) TUBE 1 APPL TOP 1 APPL
Prismasate Bgk2/0 Prismasate Bgk2/0 EACH 5000 ML IV 1 BAGPrismasate Bko / 3.5 Prismasate Bko / 3.5 EACH 5,000 ML IV 1 BAG
Talc, Aerosol Talc, Aerosol EA 1 BOTTLE TOP 4 GMUndecylenate Acid 10% Caldesene Pdr (Equiv) POWDER 1 APPL TOP 1 APPL
Zinc Oxide/Calamine/Gelatin Dome Paste Bandage (Equiv) BANDAGE 1 PACKAGE TOP 1 PACKAGE