Antihistamine Drugs - Molina Healthcare
Antihistamine Drugs - Molina Healthcare
Antihistamine Drugs - Molina Healthcare
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<strong>Antihistamine</strong> <strong>Drugs</strong><br />
First Generation <strong>Antihistamine</strong>s<br />
Ethanolamine Derivatives<br />
ACETAMINOPHEN-PHENYLTOLOXAMINE-CAFFEINE CAP 425-45-35 MG<br />
ALAHIST LQ LIQ 25-7.5<br />
ALDEX-CT CHW 12.5-5MG<br />
alergy/sinus tab headache OTC<br />
all/sinus tab head OTC<br />
allergy mult tab nighttim OTC<br />
allergy relf tab 1.34mg OTC<br />
allergy sinu tab headache OTC<br />
allergy/sinu tab 25-60mg OTC<br />
allergy/sinu tab headache OTC<br />
allergy/sinu tab headache OTC<br />
allergy/sinu tab headache OTC<br />
allergy/sinu tab headache OTC<br />
allerhist-1 tab 1.34mg OTC<br />
allgy/sinus tab headache OTC<br />
allrgy sinus tab headache OTC<br />
allrgy/sinus tab strength OTC<br />
andehist nr dro 1-15/ml<br />
ARIDEX-D DRO PED<br />
as non asa tab sinus OTC<br />
BENADRYL ALL LIQ SINUS OTC<br />
BENADRYL ALL TAB COLD OTC<br />
BENADRYL ALL TAB SINUS OTC<br />
benadryl all tab sinus ha OTC<br />
benadryl sev tab all/sinu OTC<br />
BENADRYL-D LIQ ALLRGY/S OTC<br />
BENADRYL-D SOL CHILD OTC<br />
BENAPHEN CAP PLUS OTC<br />
BIODEC DRO 2-25/ML<br />
bromdec dro 1-15mg/m<br />
carbaxefed dro 1-15/ml<br />
carbic ds syp 2-25/5ml<br />
carbino-pse syp 2-25mg<br />
carbino-pse syp 2-25mg<br />
carbinox tan-pseudoephed tan susp 3.2-45.2 mg/5ml<br />
CARBINOX TAN-PSEUDOEPHED TAN SUSP 3.6-45.2 MG/5ML<br />
CARBINOXAMINE & PHENYLEPHRINE LIQUID 1-2 MG/ML<br />
CARBINOXAMINE & PHENYLEPHRINE LIQUID 1.5-1.5 MG/ML<br />
carbinoxamine & phenylephrine liquid 2-2 mg/ml<br />
CARBINOXAMINE & PHENYLEPHRINE TAB SR 12HR 8-40 MG<br />
carbinoxamine & pseudoephedrine liquid 1-15 mg/ml<br />
carbinoxamine & pseudoephedrine liquid 1.67-12.5 mg/5ml<br />
carbinoxamine & pseudoephedrine liquid 2-12.5 mg/5ml<br />
CARBINOXAMINE & PSEUDOEPHEDRINE LIQUID 2-17.5 MG/5ML<br />
CARBINOXAMINE & PSEUDOEPHEDRINE LIQUID 2-20 MG/5ML<br />
CARBINOXAMINE & PSEUDOEPHEDRINE SOLN 2-25 MG/ML<br />
carbinoxamine & pseudoephedrine syrup 2-25 mg/5ml<br />
carbinoxamine & pseudoephedrine tab 4-60 mg<br />
CARBINOXAMINE & PSEUDOEPHEDRINE TAB SR 12HR 8-120 MG<br />
carbinoxamine & pseudoephedrine tab sr 12hr 8-120 mg<br />
carbinoxamine & pseudoephedrine tab sr 12hr 8-80 mg<br />
carbinoxamine-pseudoeph-methscop syrup 2-15-1.25 mg/5ml<br />
carbinoxamine-pseudoeph-methscop tab sr 12hr 8-90-2.5 mg<br />
carbo-pseudo syp 2-25mg/5<br />
carboxine 12 sus d<br />
CARBOXINE- LIQ PSE<br />
carboxine-d liq<br />
cld cntrl pe tab cld/flu OTC<br />
clemastine syp 0.5/5ml<br />
clemastine tab 1.34mg OTC<br />
clemastine tab 2.68mg<br />
clemastine fumarate syrup 0.67 mg/5ml (0.5 mg/5ml base eq)<br />
clemastine fumarate tab 1.34 mg (1 mg base equiv) OTC<br />
clemastine fumarate tab 2.68 mg<br />
clemastine-1 tab 1.34mg OTC<br />
cold control tab OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 1
cold/allery sus child OTC<br />
cold/flu tab intense OTC<br />
coldec tab 4-60mg<br />
coldec d tab 8-80mg<br />
coldec-tr tab 8-120mg<br />
CONTAC DAY/N PAK AL/SINUS OTC<br />
CORDRON-12 D SUS<br />
CORDRON-D LIQ<br />
cordron-d nr liq<br />
CORICIDIN NT LIQ COLD/CGH OTC<br />
cvs dayhist tab 1.34mg OTC<br />
cvs flu/cold liq nightime OTC<br />
d-tann chw 25-10mg<br />
d-tann sus 25-7.5mg<br />
dailyhist-1 tab 1.34mg OTC<br />
dayhist alrg tab 12 hour OTC<br />
dayhist-1 tab 1.34mg OTC<br />
decongestant tab allergy OTC<br />
dimetapp liq nighttim OTC<br />
DIPHENHYD-PHENYLEPH TAB 25-10 MG & PHENYLEPH TAB 10 MG PAK OTC<br />
diphenhydram cap 50mg<br />
diphenhydram cap 50mg OTC<br />
DIPHENHYDRAMINE & PSEUDOEPHEDRINE CAP CR 25-60 MG OTC<br />
DIPHENHYDRAMINE & PSEUDOEPHEDRINE LIQUID 12.5-30 MG/5ML OTC<br />
diphenhydramine & pseudoephedrine tab 25-60 mg OTC<br />
DIPHENHYDRAMINE & PSEUDOEPHEDRINE TAB SR 12HR 100-120 MG<br />
DIPHENHYDRAMINE & PSEUDOEPHEDRINE TAB SR 12HR 37.5-58 MG<br />
DIPHENHYDRAMINE CITRATE-PSEUDOEPHEDRINE TAB DISP 19-30 MG OTC<br />
diphenhydramine hcl cap 50 mg<br />
diphenhydramine hcl cap 50 mg OTC<br />
diphenhydramine hcl inj 50 mg/ml PA<br />
DIPHENHYDRAMINE HCL-PHENYLEPH HCL TANNATE CHEW TAB 12.5-5 MG<br />
DIPHENHYDRAMINE TAN-PHENYLEPHRINE TAN CHEW TAB 25-10 MG<br />
diphenhydramine tan-phenylephrine tan chew tab 25-10 mg<br />
diphenhydramine tan-phenylephrine tan susp 25-7.5 mg/5ml<br />
DIPHENHYDRAMINE W/ APAP LIQUID 12.5-325 MG/15ML OTC<br />
DIPHENHYDRAMINE W/ APAP LIQUID 25-500 MG/15ML OTC<br />
diphenhydramine w/ apap tab 12.5-500 mg OTC<br />
diphenhydramine w/ apap tab 25-500 mg OTC<br />
DIPHENHYDRAMINE-PHENYLEPHRINE LIQ 25-7.5 MG/5ML<br />
diphenhydramine-phenylephrine liq 6.25-2.5 mg/5ml OTC<br />
DIPHENHYDRAMINE-PHENYLEPHRINE ORAL STRIP 12.5-5 MG OTC<br />
DIPHENHYDRAMINE-PHENYLEPHRINE ORAL STRIP 25-10 MG OTC<br />
DIPHENHYDRAMINE-PHENYLEPHRINE SOLN 12.5-5 MG/5ML OTC<br />
diphenhydramine-phenylephrine tab 25-10 mg OTC<br />
diphenhydramine-phenylephrine-apap liq 12.5-5-325 mg/15ml OTC<br />
diphenhydramine-phenylephrine-apap packet 25-10-650 mg OTC<br />
diphenhydramine-phenylephrine-apap susp 12.5-2.5-160 mg/5ml OTC<br />
diphenhydramine-phenylephrine-apap tab 12.5-5-325 mg OTC<br />
diphenhydramine-phenylephrine-apap tab 25-10-650 mg OTC<br />
diphenhydramine-phenylephrine-apap tab 25-5-325 mg OTC<br />
DIPHENHYDRAMINE-PSE W/ APAP SUSP 12.5-15-160 MG/5ML OTC<br />
diphenhydramine-pse w/ apap tab 12.5-30-500 mg OTC<br />
diphenhydramine-pse w/ apap tab 25-30-500 mg OTC<br />
diphenhydramine-pse w/ apap tab 25-60-500 mg OTC<br />
DIPHENMAX D CHW 25/10MG<br />
diphentann-d sus<br />
doxylamine-phenylephrine-apap cap 6.25-5-325 mg OTC<br />
doxylamine-pseudoephedrine w/ apap tab 6.25-30-500 mg OTC<br />
eq dayhist tab 1.34mg OTC<br />
eql dayhist tab 1.34mg OTC<br />
ex-dec-tr tab 8-120mg<br />
FLEXTRA CAP<br />
flu relief liq nightime OTC<br />
gnp dayhist tab 1.34mg OTC<br />
hca cold cap tab OTC<br />
HISTAMAX D DRO<br />
hydro-tussin syp cbx<br />
intense cold tab /flu med OTC<br />
intense cold tab medicine OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 2
mintex pse liq<br />
nacon tab<br />
night time cap sinus OTC<br />
night-time cap sinus OTC<br />
nite-time cap cold/flu OTC<br />
non-asa seve tab allergy OTC<br />
NOREL LA TAB 8-40MG<br />
pain relief tab severe OTC<br />
pain relieve tab pm OTC<br />
PEDIACARE LIQ ALRG/CLD OTC<br />
PEDIACARE LIQ NITEREST OTC<br />
PEDIATANN-CT CHW 12.5-5MG<br />
percogesic tab xs OTC<br />
pharbedryl cap 50mg OTC<br />
pse allergy liq<br />
PSE-APAP & PSE-APAP-DIPHENHYD TAB 60-650/60-650-50 MG OTC<br />
PSE-APAP TAB 30-500MG &DOXYL-PSE-APAP TAB 6.25-30-500MG PACK OTC<br />
pseudo carb liq<br />
pseudox m syp<br />
px dayhist tab 1.34mg OTC<br />
qc allergy tab multi-sy OTC<br />
qc allergy/ tab sinus OTC<br />
qc allergy/ tab sinus-d OTC<br />
qc cold tab relief OTC<br />
qc cold/cgh pow nighttim OTC<br />
qc flu relf liq nightime OTC<br />
qc intense tab cold OTC<br />
qc nighttime cap sinus OTC<br />
qc severe tab allergy OTC<br />
ra allergy tab multi-sy OTC<br />
ra apap flu tab pm max OTC<br />
re tann d chw 25-10mg<br />
RESPA SA TAB<br />
robitussin liq nighttim OTC<br />
RONDEC TR TAB 8-120<br />
RONDEC-TR TAB 8-120<br />
sb allergy tab sinus/ha OTC<br />
sb allergy/ tab cold pe OTC<br />
sb flu relf liq nightime OTC<br />
sb nighttime cap sinus OTC<br />
sb severe tab cold pe OTC<br />
severe alrgy tab OTC<br />
sildec dro 1-15/ml<br />
sine-off nit tab time OTC<br />
soba dayhist tab 1.34mg OTC<br />
SUDAFED PE PAK DAY&NGHT OTC<br />
sudafed pe tab nght/cld OTC<br />
TEKRAL TAB<br />
theraflu liq warm rlf OTC<br />
THERAFLU CLD MIS CGH NT OTC<br />
theraflu nt liq warm rlf OTC<br />
triacting nt liq cold/cgh OTC<br />
triacting nt liq cold/cgh OTC<br />
TRIAMINIC NT MIS COLD/CGH OTC<br />
TYLENOL CHLD SUS PLUS OTC<br />
TYLENOL COLD LIQ RELIEF OTC<br />
TYLENOL SINU MIS DAY/NITE OTC<br />
TYLENOL SORE LIQ THROAT OTC<br />
uni-tann d chw 25-10mg<br />
uni-tann d sus<br />
wal-dryl tab sinus OTC<br />
wal-dryl-d tab 25-60mg OTC<br />
wal-dryl-d tab alrg/sin OTC<br />
wal-flu liq nightime OTC<br />
wal-hist tab 1.34mg OTC<br />
wal-phed pe tab severe OTC<br />
x-hist dro 2-2mg/ml<br />
Ethylenediamine Derivatives<br />
allanvan-s sus 30-12.5<br />
k-tan tab 60-25mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 3
k-tan 4 sus<br />
pyrilafen ta sus 30-5mg/5<br />
PYRILAMINE MAL-PSEUDOEPHEDRINE HCL TANN SUSP 15-15 MG/5ML<br />
PYRILAMINE TAN-PHENYLEPH TAN CHEW TAB 30-25 MG<br />
PYRILAMINE TAN-PHENYLEPH TAN SUSP 12-9 MG/5ML<br />
pyrilamine tan-phenyleph tan susp 30-12.5 mg/5ml<br />
PYRILAMINE TAN-PHENYLEPH TAN SUSP 30-5 MG/5ML<br />
pyrilamine tan-phenyleph tan susp 30-5 mg/5ml<br />
pyrilamine tan-phenyleph tan tab 60-25 mg<br />
PYRILAMINE-PHENYLEPHRINE TAB 30-10 MG OTC<br />
PYRLEX PD SUS 12-9MG<br />
RU-HIST-D TAB 30-10MG OTC<br />
ry-t-12 sus 30-5/5ml<br />
RYNA-12 S SUS<br />
rynesa 12s sus<br />
tana r-12 sus 30-5/5ml<br />
tanavan sus 30-12.5<br />
V-TANN CHW 30-25MG<br />
v-tann b.i.d sus 30-12.5<br />
VIRAVAN-P SUS 15-15MG<br />
VIRAVAN-T CHW 30-25MG<br />
Phenothiazine Derivatives<br />
phenadoz sup 12.5mg<br />
phenadoz sup 25mg<br />
prometh vc syp 6.25-5/5<br />
prometh vc syp plain<br />
prometh/pe syp 6.25-5/5<br />
promethazine & phenylephrine syrup 6.25-5 mg/5ml<br />
promethazine hcl inj 25 mg/ml<br />
promethazine hcl inj 50 mg/ml<br />
promethazine hcl suppos 12.5 mg<br />
promethazine hcl suppos 25 mg<br />
PROMETHAZINE HCL SUPPOS 25 MG<br />
promethazine hcl suppos 50 mg<br />
promethazine hcl syrup 6.25 mg/5ml<br />
promethazine hcl tab 12.5 mg<br />
promethazine hcl tab 25 mg<br />
promethazine hcl tab 50 mg<br />
promethazine inj 25mg/ml<br />
promethazine inj 50mg/ml<br />
promethazine sol 6.25/5ml<br />
promethazine sup 12.5mg<br />
PROMETHAZINE SUP 25MG<br />
promethazine sup 25mg<br />
promethazine sup 50mg<br />
promethazine syp 6.25/5ml<br />
promethazine tab 12.5mg<br />
promethazine tab 25mg<br />
promethazine tab 50mg<br />
promethegan sup 12.5mg<br />
promethegan sup 25mg<br />
promethegan sup 50mg<br />
Proplamine Derivatives<br />
*CHLORPHEN-PSE CAP SR 12HR 8-120 MG & HOMEOPATH LOZ KIT***<br />
*CPM-PE-METHSCOP SOLN 2-10-1.25 MG/5ML & HOMEOPATH LOZ KIT**<br />
12 hr ah/dec tab 6-120 cr OTC<br />
12 hr nasal tab 6-120 cr OTC<br />
40pse/4brm tab 40-4mg OTC<br />
A-PHEDRIN CAP 2.5-60MG OTC<br />
a.r.m. tab caplet OTC<br />
ACCUHIST DRO 1-2.5MG<br />
actanol tab 2.5-60mg OTC<br />
actifed cold tab /sinus OTC<br />
ACTIFED PLUS TAB OTC<br />
actified cld tab /allergy OTC<br />
active syp 1.25-30 OTC<br />
ADVIL ALLERG TAB SINUS OTC<br />
ADVIL COLD TAB MULTI-SY OTC<br />
aerohist plu tab 8-20-2.5<br />
AEROKID SYP<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 4
af-aphedrid tab 2.5-60mg OTC<br />
af-dibromm elx 1-15/5ml OTC<br />
af-effer tab cold OTC<br />
ah-chew chw<br />
AH-CHEW CHW ULTRA<br />
AH-CHEW SUS<br />
AH-CHEW SUS ULTRA<br />
AH-CHEW II CHW<br />
ALA-HIST D TAB 6-25-20<br />
ALA-HIST PE TAB 2-10MG OTC<br />
ALACOL DRO 0.4-1MG<br />
ALACOL SYP 2-5MG<br />
ALENAZE-D LIQ<br />
alenaze-d nr liq<br />
ALKA-SELTZER TAB PLS COLD OTC<br />
allantan sus pedi<br />
allepak tab dose pac<br />
aller-time tab 2.5-60mg OTC<br />
allerfed tab 2.5-60mg OTC<br />
allerfrim syp 1.25-30 OTC<br />
allerfrim tab 2.5-60mg OTC<br />
allergy tab am/pm<br />
allergy tab multi-sy OTC<br />
allergy tab sinus-d OTC<br />
allergy dn mis<br />
allergy dn tab<br />
allergy mult pak day/nght OTC<br />
allergy mult tab daytime OTC<br />
allergy/sinu tab max str OTC<br />
allergy/sinu tab non-asa OTC<br />
allergy/sinu tab non-asa OTC<br />
ALLERSCRIPT MIS TABLETS<br />
ALLERTAN SUS<br />
ALLERX MIS<br />
ALLERX SUS<br />
ALLERX PE MIS<br />
altafed syp 1.25-30 OTC<br />
ambi 10peh/ tab 4cpm OTC<br />
ambi 60pse/ tab 4cpm OTC<br />
amdry-c tab<br />
AMERIFED LIQ 4-80MG/5<br />
andehist nr syp 4-45mg/m<br />
antihis/dec tab 2.5-60mg OTC<br />
antihist nas tab deconges OTC<br />
antihistabs tab 2.5-60mg OTC<br />
ANTIHISTAMIN TAB 2.5-30MG OTC<br />
apap allergy tab sinus OTC<br />
aphedrid tab 2.5-60mg OTC<br />
aprodine syp 1.25-30 OTC<br />
aprodine tab 2.5-60mg OTC<br />
b-vex d sus<br />
b-vex pd sus<br />
bellahist-d tab la<br />
bidhist-d tab 6-45mg<br />
biofed-pe syp 1.25-30 OTC<br />
bl triacting syp cold/all OTC<br />
blanex-a tab 4-40-20<br />
bpm pe liq<br />
bpm pseudo tab 6-45mg<br />
BPM-PSE TBCR 6-45 MG & CPM-PE-METHSCOP TBCR 8-25-2.5 MG PACK<br />
bpm/pse cap 6-60mgcr<br />
BROFED ELX 4-30/5<br />
brom/pe tann sus 4-5mg<br />
bromaline sol 1-15/5ml OTC<br />
bromaphedrin sus d<br />
bromax d tab<br />
bromaxefed syp rf<br />
bromdec syp 4-45/5ml<br />
BROMFED SYP 2-30/5 OTC<br />
BROMFED TAB 4-60MG<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 5
omfenex cap 12-120cr<br />
bromfenex pd cap 6-60mgcr<br />
bromfenex pe cap 12-15mg<br />
bromfenex pe cap pedi<br />
bromhist dro ped<br />
bromhist-nr dro<br />
bromphen tan-phenyleph tan chew tab 2.2-1.58 mg (base equiv)<br />
BROMPHEN TAN-PHENYLEPH TAN SUSP 2.2-1.58 MG/5ML (BASE EQUIV)<br />
BROMPHEN-DIPHENHYDRAMINE-PHENYLEPH TAB SR 12HR 6-25-20 MG<br />
bromphen-pse dro 1-7.5mg<br />
bromphen/pe sus tann<br />
bromphen/pse cap 9-90mg<br />
brompheniram sus phenyl<br />
brompheniram syp pse<br />
brompheniramine & phenylephrine cap sr 12hr 12-15 mg<br />
brompheniramine & phenylephrine cap sr 12hr 6-7.5 mg<br />
BROMPHENIRAMINE & PHENYLEPHRINE CHEW TAB 1-2.5 MG OTC<br />
BROMPHENIRAMINE & PHENYLEPHRINE CHEW TAB 6-15 MG<br />
BROMPHENIRAMINE & PHENYLEPHRINE DROPS 0.4-1 MG/ML<br />
brompheniramine & phenylephrine elixir 1-2.5 mg/5ml OTC<br />
BROMPHENIRAMINE & PHENYLEPHRINE ELIXIR 2-5 MG/5ML<br />
BROMPHENIRAMINE & PHENYLEPHRINE LIQD 2-5 MG/ML OTC<br />
BROMPHENIRAMINE & PHENYLEPHRINE LIQD 2-7.5 MG/5ML<br />
BROMPHENIRAMINE & PHENYLEPHRINE LIQD 4-10 MG/5ML<br />
brompheniramine & phenylephrine liqd 4-7.5 mg/5ml<br />
brompheniramine & phenylephrine susp 6-10 mg/5ml<br />
BROMPHENIRAMINE & PHENYLEPHRINE SYRUP 2-5 MG/5ML<br />
BROMPHENIRAMINE & PHENYLEPHRINE TAB 4-10 MG OTC<br />
brompheniramine & phenylephrine tab sr 12hr 6-19 mg<br />
brompheniramine & phenylephrine tab sr 12hr 6-30 mg<br />
brompheniramine & pseudoephedrine cap cr 12-120 mg<br />
BROMPHENIRAMINE & PSEUDOEPHEDRINE CAP CR 5.75-60 MG<br />
brompheniramine & pseudoephedrine cap cr 6-60 mg<br />
BROMPHENIRAMINE & PSEUDOEPHEDRINE CAP SR 12HR 10-120 MG<br />
brompheniramine & pseudoephedrine cap sr 12hr 10-120 mg<br />
brompheniramine & pseudoephedrine cap sr 12hr 9-90 mg<br />
BROMPHENIRAMINE & PSEUDOEPHEDRINE CAP SR 24HR 12-90 MG<br />
brompheniramine & pseudoephedrine elixir 1-15 mg/5ml OTC<br />
BROMPHENIRAMINE & PSEUDOEPHEDRINE ELIXIR 4-30 MG/5ML<br />
brompheniramine & pseudoephedrine liquid 1-12.5 mg/ml<br />
brompheniramine & pseudoephedrine liquid 1-15 mg/ml OTC<br />
brompheniramine & pseudoephedrine liquid 1-15 mg/ml<br />
BROMPHENIRAMINE & PSEUDOEPHEDRINE LIQUID 1-7.5 MG/ML<br />
brompheniramine & pseudoephedrine liquid 1-7.5 mg/ml<br />
BROMPHENIRAMINE & PSEUDOEPHEDRINE LIQUID 4-20 MG/5ML<br />
brompheniramine & pseudoephedrine liquid 4-60 mg/5ml<br />
BROMPHENIRAMINE & PSEUDOEPHEDRINE SYRUP 2-30 MG/5ML OTC<br />
brompheniramine & pseudoephedrine syrup 4-45 mg/5ml<br />
brompheniramine & pseudoephedrine syrup 4-45 mg/5ml<br />
brompheniramine & pseudoephedrine tab 4-40 mg OTC<br />
BROMPHENIRAMINE & PSEUDOEPHEDRINE TAB 4-60 MG<br />
BROMPHENIRAMINE & PSEUDOEPHEDRINE TAB SR 12HR 10-120 MG<br />
brompheniramine & pseudoephedrine tab sr 12hr 6-45 mg<br />
BROMPHENIRAMINE MAL-PHENYLEPHRINE HCL TANN CHEW TAB 6-15 MG<br />
BROMPHENIRAMINE TAN-PHENYLEPHRINE TAN SUSP 12-10 MG/5ML<br />
brompheniramine tan-phenylephrine tan susp 12-20 mg/5ml<br />
brompheniramine tan-phenylephrine tan susp 4-5 mg/5ml<br />
BROMPHENIRAMINE TAN-PHENYLEPHRINE TAN SUSP 5-5 MG/5ML<br />
BROMPHENIRAMINE TAN-PSEUDOEPHEDRINE TAN SUSP 6-30 MG/5ML<br />
brompheniramine tan-pseudoephedrine tan susp 6-30 mg/5ml<br />
BROMPHENIRAMINE TAN-PSEUDOEPHEDRINE TAN SUSP 8-90 MG/5ML<br />
BROMPHENIRAMINE-PSE W/ APAP LIQUID 4-60-1000 MG/30ML OTC<br />
BROMPHENIRAMINE-PSE W/ APAP SUSP 1-15-160 MG/5ML OTC<br />
BROMPHENIRAMINE-PSE W/ APAP TAB 2-30-500 MG OTC<br />
bromtapp col elx 1-15/5ml OTC<br />
brotapp liq OTC<br />
BROVEX ADT SUS 12-10<br />
BROVEX PB TAB 4-10MG OTC<br />
BROVEX PD SUS<br />
BROVEX PEB LIQ<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 6
BROVEX PSB LIQ<br />
C-HIST SR CAP<br />
c-phed tanna sus 4.5-75/5<br />
c-phen dro<br />
c-phen syp<br />
c-tan d sus 4-5mg<br />
C-TAN D PLUS SUS<br />
cardec dro<br />
cardec syp 4-12.5mg<br />
cardec syp 4-45mg/5<br />
CENHIST CHW 6-15MG<br />
centergy dro 1-2mg/ml<br />
ceron dro<br />
ceron syp<br />
child pain liq rel cold OTC<br />
child pain liq rel cold OTC<br />
CHILDRENS CHW CLD/PAIN OTC<br />
chlor-mes tab<br />
chlor-mes d syp liquid<br />
chlor-mes jr cap 4-20mg<br />
chlor-tan sus a 12<br />
chlor-trimet tab 4-60mg OTC<br />
chlorex-a tab 4-40-20<br />
chlorex-a 12 sus<br />
CHLORPHEN MAL-PE HCL-METHSCOP NIT TAN SUSP 2-10-1.5 MG/5ML<br />
CHLORPHEN POLACRILEX-PSEUDOEPH POLISTIREX CHEW TAB 4-30 MG<br />
CHLORPHEN TAB 4 MG & PSEUDOEPHED TAB 60 MG THERAPY PACK<br />
CHLORPHEN TAN & PHENYLEPH TAN CHEW TAB 4.5-5 MG<br />
CHLORPHEN TAN & PHENYLEPH TAN TAB 8-25 MG<br />
chlorphen tan & phenyleph tan tab 9-25 mg<br />
chlorphen tan & pseudoeph tan susp 4.5-75 mg/5ml<br />
CHLORPHEN TAN & PSEUDOEPH TAN SUSP 5-75 MG/5ML<br />
CHLORPHEN TAN-PE TAN-METHSCOPOLAMINE CHEW TAB 2-10-1.5 MG<br />
chlorphen tan-pe tan-methscopolamine susp 2-10-1.5 mg/5ml<br />
CHLORPHEN TAN-PE TAN-METHSCOPOLAMINE SUSP 2-10-1.5 MG/5ML<br />
chlorphen tan-pyrilamine tan-pe tan susp 2-12.5-5 mg/5ml<br />
CHLORPHEN TAN-PYRILAMINE TAN-PE TAN SUSP 8-12.5-15 MG/5ML<br />
chlorphen tan-pyrilamine tan-pe tan susp 8-12.5-15 mg/5ml<br />
chlorphen-pe-apap tab & diphenhyd-pe-apap tab day/night pack OTC<br />
chlorphen-pe-apap tab 2-5-325 mg & pe-apap tab 5-325 mg pack OTC<br />
CHLORPHEN-PE-APAP TAB 2-5-500 MG & PE-APAP TAB 5-500 MG PACK OTC<br />
chlorphen-pe-atropine-hyos-scopol tab sr 12hr 8-20 mg<br />
CHLORPHEN-PE-METHSCOPOLAMINE CAP SR 12HR 8-20-2.5 MG<br />
chlorphen-pe-methscopolamine syrup 2-10-0.625 mg/5ml<br />
CHLORPHEN-PE-METHSCOPOLAMINE TAB 4-10-1.25 MG<br />
CHLORPHEN-PE-METHSCOPOLAMINE TAB CR 8-20-2.5 MG<br />
chlorphen-pe-methscopolamine tab cr 8-20-2.5 mg<br />
CHLORPHEN-PE-METHSCOPOLAMINE TAB SR 12HR 12-20-2.5 MG<br />
chlorphen-pe-methscopolamine tab sr 12hr 12-20-2.5 mg<br />
CHLORPHEN-PE-METHSCOPOLAMINE TAB SR 12HR 12-40-1.25 MG<br />
CHLORPHEN-PE-METHSCOPOLAMINE TAB SR 12HR 12-40-2 MG<br />
chlorphen-pe-methscopolamine tab sr 12hr 4-10-1.25 mg<br />
chlorphen-pe-methscopolamine tab sr 12hr 8-20-1.25 mg<br />
chlorphen-pe-methscopolamine tab sr 12hr 8-20-2.5 mg<br />
CHLORPHEN-PE-METHSCOPOLAMINE TAB SR 12HR 8-25-2.5 MG<br />
CHLORPHEN-PE-METHSCOPOLAMINE TAB SR 12HR 8-40-2.5 MG<br />
chlorphen-pe-methscopolamine tab sr 12hr 8-40-2.5 mg<br />
chlorphen-phenylephrine w/ apap effer tab 2-5-250 mg OTC<br />
CHLORPHEN-PHENYLEPHRINE W/ APAP PACKET 4-10-650 MG OTC<br />
CHLORPHEN-PHENYLEPHRINE W/ APAP SUSP 1-2.5-160 MG/5ML OTC<br />
CHLORPHEN-PHENYLEPHRINE W/ APAP TAB 2-5-162 MG OTC<br />
chlorphen-phenylephrine w/ apap tab 2-5-325 mg OTC<br />
CHLORPHEN-PHENYLEPHRINE W/ APAP TAB 2-5-500 MG OTC<br />
chlorphen-phenylephrine w/ apap tab 2-5-500 mg OTC<br />
chlorphen-phenylephrine w/ apap tab 4-10-650 mg OTC<br />
CHLORPHEN-PHENYLEPHRINE W/ APAP TAB CR 8-40-500 MG<br />
CHLORPHEN-PSE & BELLADONNA ALK TAB SR 12HR 8-90-0.24 MG<br />
CHLORPHEN-PSE & METHSCOPOLAMINE SYRUP 4-30-1.25 MG/5ML<br />
CHLORPHEN-PSE & METHSCOPOLAMINE TAB SR 12HR 4-60-1.25 MG<br />
chlorphen-pse & methscopolamine tab sr 12hr 8-120-2.5 mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 7
chlorphen-pse & methscopolamine tab sr 12hr 8-60-1.25 mg<br />
chlorphen-pse & methscopolamine tab sr 12hr 8-90-2.5 mg<br />
CHLORPHEN-PSE & METHSCOPOLAMINE TAB SR 24HR 6-120-2.5 MG<br />
chlorphen-pse-atropine-hyos-scopol tab sr 12hr 8-90 mg<br />
CHLORPHEN-PSEUDOEPHED-ASPIRIN EFFER TAB 2-30-325 MG OTC<br />
chlorphen-pseudoephedrine w/ apap cap 2-30-325 mg OTC<br />
CHLORPHEN-PSEUDOEPHEDRINE W/ APAP CHEW TAB 0.5-7.5-80 MG OTC<br />
chlorphen-pseudoephedrine w/ apap chew tab 0.5-7.5-80 mg OTC<br />
chlorphen-pseudoephedrine w/ apap liquid 1-15-160 mg/5ml OTC<br />
CHLORPHEN-PSEUDOEPHEDRINE W/ APAP LIQUID 4-60-1000 MG/30ML OTC<br />
CHLORPHEN-PSEUDOEPHEDRINE W/ APAP PACK 4-60-1000 MG OTC<br />
CHLORPHEN-PSEUDOEPHEDRINE W/ APAP PACK 4-60-500 MG OTC<br />
chlorphen-pseudoephedrine w/ apap pack 4-60-650 mg OTC<br />
chlorphen-pseudoephedrine w/ apap tab 2-30-325 mg OTC<br />
chlorphen-pseudoephedrine w/ apap tab 2-30-500 mg OTC<br />
CHLORPHEN-PSEUDOEPHEDRINE W/ APAP TAB 4-60-650 MG OTC<br />
chlorphen-pseudoephedrine w/ apap tab 4-60-650 mg OTC<br />
CHLORPHEN-PTOLOX-PHENYLEPH CAP SR 12HR 4-50-20 MG<br />
chlorphen-ptolox-phenyleph liquid 2.5-7.5-5 mg/5ml<br />
CHLORPHEN-PTOLOX-PHENYLEPH TAB 2-25-10 MG<br />
chlorphen-ptolox-phenyleph tab cr 4-40-20 mg<br />
chlorphen-pyrilamine & pe liqd 2-10-10 mg/5ml<br />
chlorphen-pyrilamine & pe liqd 2-12.5-7.5 mg/5ml<br />
CHLORPHEN-PYRILAMINE & PE TAB 2-10-10 MG<br />
chlorphen-pyrilamine & pe tab cr 4-25-10 mg<br />
CHLORPHENIR MAL-PSEUDOEPHEDRINE HCL TANNATE CHEW TAB 4-30 MG<br />
chlorpheniramine & phenylephrine cap sr 12hr 4-20 mg<br />
chlorpheniramine & phenylephrine liquid 1-2 mg/ml<br />
CHLORPHENIRAMINE & PHENYLEPHRINE LIQUID 1-2.5 MG/5ML OTC<br />
CHLORPHENIRAMINE & PHENYLEPHRINE LIQUID 1-2.5 MG/ML<br />
chlorpheniramine & phenylephrine liquid 1-3.5 mg/ml<br />
CHLORPHENIRAMINE & PHENYLEPHRINE LIQUID 4-10 MG/5ML<br />
CHLORPHENIRAMINE & PHENYLEPHRINE SOLN 4-12.5 MG/5ML OTC<br />
CHLORPHENIRAMINE & PHENYLEPHRINE SYRUP 1-2.5 MG/5ML OTC<br />
chlorpheniramine & phenylephrine syrup 4-12.5 mg/5ml<br />
chlorpheniramine & phenylephrine tab 4-10 mg OTC<br />
chlorpheniramine & phenylephrine tab cr 8-20 mg<br />
chlorpheniramine & phenylephrine tab sr 12hr 4-20 mg<br />
CHLORPHENIRAMINE & PHENYLEPHRINE TAB SR 12HR 4-20 MG<br />
chlorpheniramine & pseudoephedrine cap cr 8-120 mg<br />
CHLORPHENIRAMINE & PSEUDOEPHEDRINE CAP SR 12HR 12-120 MG<br />
chlorpheniramine & pseudoephedrine cap sr 12hr 12-120 mg<br />
CHLORPHENIRAMINE & PSEUDOEPHEDRINE CAP SR 12HR 4-60 MG<br />
chlorpheniramine & pseudoephedrine cap sr 12hr 4-60 mg<br />
chlorpheniramine & pseudoephedrine cap sr 24hr 12-100 mg<br />
CHLORPHENIRAMINE & PSEUDOEPHEDRINE CAP SR 24HR 12-100 MG<br />
CHLORPHENIRAMINE & PSEUDOEPHEDRINE CHEW TAB 1-15 MG OTC<br />
chlorpheniramine & pseudoephedrine chew tab 2-15 mg<br />
chlorpheniramine & pseudoephedrine drops 0.8-9 mg/ml OTC<br />
chlorpheniramine & pseudoephedrine drops 0.8-9 mg/ml<br />
chlorpheniramine & pseudoephedrine liquid 2-30 mg/5ml<br />
CHLORPHENIRAMINE & PSEUDOEPHEDRINE LIQUID 4-80 MG/5ML<br />
chlorpheniramine & pseudoephedrine soln 2-30 mg/5ml OTC<br />
chlorpheniramine & pseudoephedrine syrup 1-15 mg/5ml OTC<br />
CHLORPHENIRAMINE & PSEUDOEPHEDRINE SYRUP 2-30 MG/5ML<br />
chlorpheniramine & pseudoephedrine syrup 2-30 mg/5ml<br />
chlorpheniramine & pseudoephedrine tab 4-60 mg OTC<br />
CHLORPHENIRAMINE & PSEUDOEPHEDRINE TAB SR 12HR 12-120 MG<br />
chlorpheniramine & pseudoephedrine tab sr 12hr 12-120 mg<br />
CHLORPHENIRAMINE TAN-PHENYLEPHRINE TAN SUSP 2-6 MG/ML<br />
chlorpheniramine tan-phenylephrine tan susp 2-6 mg/ml<br />
CHLORPHENIRAMINE TAN-PHENYLEPHRINE TAN SUSP 3-7.5 MG/5ML<br />
CHLORPHENIRAMINE TAN-PHENYLEPHRINE TAN SUSP 4-20 MG/5ML<br />
chlorpheniramine tan-phenylephrine tan susp 4-20 mg/5ml<br />
CHLORPHENIRAMINE TAN-PHENYLEPHRINE TAN SUSP 4-5 MG/5ML<br />
chlorpheniramine tan-phenylephrine tan susp 4.5-5 mg/5ml<br />
chlorpheniramine tan-phenylephrine tan susp 8-10 mg/5ml<br />
chlorpheniramine w/ apap tab 2-325 mg OTC<br />
chlorpheniramine-pe-methscopolamine chew tab 2-10-1.25 mg<br />
CHLORPHENIRAMINE-PE-METHSCOPOLAMINE CHEW TAB 2-15-1.25 MG<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 8
CHLORPHENIRAMINE-PE-METHSCOPOLAMINE SOLN 2-10-1.25 MG/5ML<br />
CHLORPHENIRAMINE-PE-METHSCOPOLAMINE SYRUP 2-10-0.75 MG/5ML<br />
chlorpheniramine-pe-methscopolamine syrup 2-10-0.75 mg/5ml<br />
chlorpheniramine-pe-methscopolamine syrup 2-10-1.25 mg/5ml<br />
chlorpheniramine-pe-methscopolamine syrup 2-10-1.25 mg/5ml<br />
chlorpheniramine-pe-methscopolamine syrup 2-8-0.75 mg/5ml<br />
CHLORPHENIRAMINE-PE-METHSCOPOLAMINE SYRUP 4-10-1.25 MG/5ML<br />
chlorpheniramine-pe-methscopolamine syrup 4-10-1.25 mg/5ml<br />
CHLORPHENIRAMINE-PHENYLEPHRINE-ASA EFFER TAB 2-7.8-325 MG OTC<br />
CHLORPHENIRAMINE-PSEUDOEPHEDRINE-IBUPROFEN TAB 2-30-200 MG OTC<br />
chlorphn mal dro pse hcl<br />
chlortan d sus<br />
CNTC CLD/FLU PAK DAY/NGHT OTC<br />
CNTC CLD/FLU TAB MAX ST OTC<br />
cold medicin cap plus OTC<br />
cold multi- tab symptom OTC<br />
cold relief tab eff OTC<br />
cold relief tab plus OTC<br />
cold relief tab plus OTC<br />
cold relieve tab original OTC<br />
cold&allergy tab relief OTC<br />
cold/allergy elx OTC<br />
cold/allergy elx OTC<br />
cold/allergy elx OTC<br />
cold/allergy elx 1-15/5ml OTC<br />
cold/allergy elx children OTC<br />
cold/allergy elx children OTC<br />
cold/allergy elx children OTC<br />
cold/allergy elx children OTC<br />
cold/allergy elx children OTC<br />
cold/allergy elx childs OTC<br />
cold/allergy elx dibromm OTC<br />
cold/allergy elx relief OTC<br />
cold/allergy tab OTC<br />
cold/allergy tab 2.5-60mg OTC<br />
cold/allergy tab 2.5-60mg OTC<br />
cold/allergy tab 2.5-60mg OTC<br />
cold/allergy tab 4-10mg OTC<br />
cold/allergy tab 4-10mg OTC<br />
cold/allergy tab max str OTC<br />
cold/allergy tab pe OTC<br />
cold/allergy tab relief OTC<br />
coldamine tab 8-90-2.5<br />
coldex-a sr tab 4-40-20<br />
colfed-a cap 8-120 cr<br />
COMHIST TAB<br />
COMPLETE SIN TAB RELIEF OTC<br />
comtrex pak cld/sinu OTC<br />
COMTREX TAB HEAD CLD OTC<br />
COMTREX D/NT MIS FLU THER OTC<br />
comtrex flu pak therapy OTC<br />
COMTREX NT LIQ FLU THER OTC<br />
COMTREX NT LIQ HEAD CLD OTC<br />
comtrex sev pak cld/sinu OTC<br />
comtrex sinu tab & nasal OTC<br />
conal sus<br />
CONEX SOL CLD/ALRG OTC<br />
CONEX TAB 2-60MG OTC<br />
congestant tab OTC<br />
COPHENE #2 CAP CR<br />
coricidin d tab OTC<br />
coricidin d tab OTC<br />
coryza-d tab<br />
cough/cold liq sf OTC<br />
cp dec dro<br />
cp dec syp 4-12.5mg<br />
cpm 8/pe 20/ tab msc 1.25<br />
CPM TAN-PE TAN-METHSCOP CHEW & CPM TAN- METHSCOP CHEW PACK<br />
cpm-meth-pse tab<br />
cpm-pe-msc syp<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 9
cpm/pe cap 4-20mg<br />
cpm/pe tab 4-20mg<br />
cpm/pe tab 8-20 cr<br />
cpm/pse cap 8-120 cr<br />
cpm/pse cap 8-120 sr<br />
cpm/pse dro 0.8-9mg OTC<br />
CPM/PSE SYP<br />
cpm/pse tab 12-120mg<br />
cpm/pse/msc tab<br />
cpm/pse/msc tab 12hr<br />
cpm/ptolox/ liq pe<br />
cvs children liq cold OTC<br />
cvs cld/alle elx children OTC<br />
d-amine-sr cap 8-120 cr<br />
d-hist d tab<br />
DALLERGY TAB<br />
DALLERGY TAB ER<br />
DALLERGY PE SYP<br />
DALLERGY PSE TAB<br />
DALLERGY-JR SUS<br />
dec-chlorphn liq<br />
dec-chlorphn syp<br />
DECON-A ELX 2-5MG/5M<br />
DECON-A LIQ DROPS OTC<br />
decon/antihi tab 60-2.5mg OTC<br />
decongestant tab OTC<br />
decongestant tab 4-60mg OTC<br />
decongestant tab cold OTC<br />
decongestant tab plus OTC<br />
decongestant tab plus OTC<br />
decongestine cap 8-120 tr<br />
DECONSAL CT CHW 16-10MG<br />
dehistine syp<br />
denaze syp<br />
dexaphen sa tab 6-120<br />
DEXBROMPHEN TAN-PYRILAMINE MAL-PE TAN SUSP 4-3.5-25 MG/5ML<br />
dexbromphen-pse w/ apap tab 2-60-500 mg OTC<br />
DEXBROMPHEN-PSE W/ APAP TAB CR 3-60-500 MG OTC<br />
DEXBROMPHENIRAMINE & PSEUDOEPHEDRINE SOLN 1-30 MG/5ML OTC<br />
DEXBROMPHENIRAMINE & PSEUDOEPHEDRINE TAB 2-60 MG OTC<br />
dexbrompheniramine & pseudoephedrine tab sr 12hr 6-120 mg<br />
dexbrompheniramine & pseudoephedrine tab sr 12hr 6-120 mg OTC<br />
DEXBROMPHENIRAMINE-PHENYLEPHRINE TAB 2-10 MG OTC<br />
DEXBROMPHENIRAMINE-PHENYLEPHRINE-APAP TAB 2-10-500 MG OTC<br />
DEXBROMPHENIRAMINE-PHENYLEPHRINE-APAP TAB 2-10-650 MG OTC<br />
DEXCHLORPHEN TAN & PSEUDOEPHED TAN SUSP 2.5-75 MG/5ML<br />
DEXCHLORPHEN TAN & PSEUDOEPHED TAN SUSP 3-50 MG/5ML<br />
DEXCHLORPHEN TAN-PYRIL TAN-PSE TAN SUSP 2.5-12.5-75 MG/5ML<br />
dexchlorphen-phenyleph-methscop soln 1-10-1.25 mg/5ml<br />
DEXCHLORPHEN-PHENYLEPH-METHSCOP SOLN 1-10-1.25 MG/5ML<br />
dexchlorphen-pseudoephed-methscop tab sr 12hr 3.5-45-1 mg<br />
DEXCHLORPHENIRAMINE & PSEUDOEPHEDRINE TAB CR 4-60 MG<br />
DEXCHLORPHENIRAMINE-PHENYLEPHRINE TAB 2-10 MG OTC<br />
DEXCHLORPHENIRAMINE-PHENYLEPHRINE TAB SR 12HR 3-20 MG<br />
DEXCHLORPHENIRAMINE-PHENYLEPHRINE TAB SR 12HR 3.5-18.5 MG<br />
DEXCHLORPHENIRAMINE-PHENYLEPHRINE TAB SR 12HR 6-40 MG<br />
DEXCHLORPHENIRAMINE-PSEUDOEPHED-APAP TAB 2-45-650 MG<br />
dexphen m sol<br />
di brom c/a elx cld/alle OTC<br />
DICEL SUS<br />
dimaphen elx OTC<br />
dimaphen elx children OTC<br />
DIMETAPP SUS COLD/FVR OTC<br />
DIMETAPP CLD CHW /ALLERGY OTC<br />
disophrol tab 6-120 cr OTC<br />
dixaphedrine tab 6-120 cr OTC<br />
drihist tab sr<br />
DRINEX TAB OTC<br />
drinex tab OTC<br />
dristan cold tab OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 10
drixomed tab 6-120 cr<br />
DRIXORAL TAB ALLERGY OTC<br />
DRIXORAL TAB COLD/FLU OTC<br />
DRYMAX SYP<br />
dryphen tab OTC<br />
drysec tab cr<br />
DUOTAN PD SUS<br />
duradryl chw<br />
duradryl syp<br />
duradryl sr tab<br />
duratan pe sus<br />
duratuss da cap 12-100mg<br />
duravent chw<br />
duravent-da tab<br />
DYNAHIST ER CAP 4-60MG<br />
eck non-asa tab allergy OTC<br />
eck sinus tab OTC<br />
ED A-HIST LIQ 4-10/5ML<br />
ed a-hist tab 8-20 cr<br />
ED CHLORPED SUS D<br />
effer antaci tab pain OTC<br />
EFFERVESCENT TAB COLD REL OTC<br />
effervescent tab plus cld OTC<br />
entre-b sus 6-10mg/5<br />
eq allergy tab sinus OTC<br />
eq childrens liq cold OTC<br />
eq cold plus cap OTC<br />
eq effervesc tab cld plus OTC<br />
eq triacting syp cold/all OTC<br />
eql allergy tab multi-sy OTC<br />
eql efferves tab plus cld OTC<br />
eql sinus tab allergy OTC<br />
eql triactin syp cold/all OTC<br />
EXTENDRYL SYP<br />
EXTENDRYL SR CAP<br />
extendryl sr tab<br />
FLU/COLD POW MEDICINE OTC<br />
flu/cold med pow OTC<br />
genac tab 2.5-60mg OTC<br />
genaphed tab plus OTC<br />
gnp allergy tab multi-sy OTC<br />
gnp allergy tab sinus pe OTC<br />
gnp cld/alle elx children OTC<br />
gnp di bromm elx childs OTC<br />
GNP FLU/COLD PAK NIGHT OTC<br />
gnp histafed syp 1.25-30 OTC<br />
gnp histafed tab 2.5-60mg OTC<br />
gnp sinus pak cng/pain OTC<br />
gnp sinus tab cng/pain OTC<br />
gnp triactin syp cold/all OTC<br />
hayfebrol sol sf OTC<br />
hca cold/flu tab medicine OTC<br />
hca complete tab sinus OTC<br />
hca sinus tab OTC<br />
hca suphedri tab plus OTC<br />
hca tri-afed tab 2.5-60mg OTC<br />
hca triactin syp cold/all OTC<br />
HEXAFED TAB 4-60MG<br />
HEXAFLU TAB 2-45-650<br />
hist-pse dro OTC<br />
hista-tabs tab 2.5-60mg OTC<br />
hista-vent tab 12hr<br />
hista-vent tab da<br />
histacol la tab<br />
histade mx tab<br />
histade sr cap 12-120mg<br />
HISTADEC SOL 4-12.5MG OTC<br />
histafed tab 2.5/60mg OTC<br />
histatab tab<br />
histatab d tab<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 11
histatab ph tab<br />
HISTEX SR CAP<br />
HISTEX SR TAB 10-120MG<br />
iso-chlor sol OTC<br />
J-TAN D SUS<br />
J-TAN D PD DRO 1-7.5MG<br />
kolephrin tab OTC<br />
kronofed-a cap 8-120 cr<br />
kronofed-a cap jr<br />
LODRANE 24D CAP 12-90MG<br />
LODRANE D SUS<br />
lodrane ld cap 6-60mgcr<br />
lohist-12d tab 6-45mg<br />
lohist-d liq<br />
lohist-lq liq<br />
lohist-pd dro ped<br />
maxichlor tab peh OTC<br />
maxichlor tab pse OTC<br />
medi-brom elx 1-15/5ml OTC<br />
medi-phedrin tab plus OTC<br />
medi-tabs tab alrg/sin OTC<br />
medicidin-d tab OTC<br />
mintex liq 2-30mg/5<br />
multi symptm tab allergy OTC<br />
myhist-pd liq<br />
NALDEX TAB<br />
nalex-a 12 sus<br />
NALFRX SUS<br />
nasal decon liq 1-15/5ml OTC<br />
nasal decon tab antihist OTC<br />
nasal decon/ liq antihist OTC<br />
nasal decong tab 2.5-60mg OTC<br />
nasal decong tab 60-2.5mg OTC<br />
nasal decong tab antihist OTC<br />
nasohist dro 1-2mg/ml<br />
neutrahist dro 0.8-9mg<br />
night time tab OTC<br />
nohist tab 8-20mg<br />
nohist-a liq<br />
nohist-pe syp<br />
nohist-plus chw<br />
nohist-plus tab jr<br />
non-asa algy tab sinus OTC<br />
non-asa cold chw child OTC<br />
non-asa sinu tab allergy OTC<br />
norel sd syp<br />
nuhist sus pedi<br />
ny-tannic tab 9-25mg<br />
omnihist tab l.a.<br />
OMNIHIST II TAB LA<br />
ONSET FORTE TAB OTC<br />
p-tann d sus<br />
pain relief tab alrg/sin OTC<br />
pain relief tab alrg/sin OTC<br />
pain relieve tab alrg/sin OTC<br />
pain relieve tab alrg/sin OTC<br />
pain relievr tab algy-sin OTC<br />
pcm chw<br />
pcm allergy tab<br />
pcm la tab<br />
pd-hist d dro<br />
pd-hist d syp 4-12.5mg<br />
PE-CPM-METHSCOP 20-8-2.5MG & CPM-METHSCOP 8-2.5MG TAB CR PK<br />
pe-cpm-scop tab 12hr<br />
PE-GG TAB 15-600 MG & CPM-PE-METHSCOP TBCR 8-25-2.5 MG PACK<br />
pe-methscop tab 40-2.5 mg & cpm-pe-methscop tab 8-10-2.5 mg<br />
PE-METHSCOP TAB 40-2.5 MG & CPM-PE-METHSCOP TAB 8-10-2.5 MG<br />
pe/bpm cap 15-12mg<br />
pe/bpm cap 7.5-6mg<br />
pe/cp tann sus 20-4/5ml<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 12
pe/cpm sus<br />
pe/cpm sus tannate<br />
pe/phenyltol tab cpm<br />
ped tan/chlo sus<br />
pediaphyl d sus<br />
PHENA-PLUS TAB<br />
phenabid tab 12hr<br />
phenclor tan sus pedi<br />
phenir-pe w/ sod salicyl & caff cit liq 13-4-83-25 mg/5ml OTC<br />
PHENIRAMINE-PHENYLEPHRINE W/ APAP POWD PACK 20-10-325 MG OTC<br />
PHENIRAMINE-PHENYLEPHRINE W/ APAP POWD PACK 20-10-650 MG OTC<br />
phenydryl syp<br />
phenyl chlor sus tan<br />
phenyleph cm tab<br />
POLY TAN D SUS<br />
pre-hist-d tab er<br />
pro-tannate sus pedi<br />
PROTID TAB CR<br />
pse 15/cpm 2 chw<br />
pse bpm liq<br />
pse cpm chw 15-2mg<br />
PSE-APAP & CPM-PSE-APAP TAB THERAPY PK 30-500 & 2-30-500 MG OTC<br />
PSE-CPM-METHSCOP 120-8-2.5MG & CPM-METHSCOP 8-2.5MG TBCR PAK<br />
PSE-METHSCOP TAB CR & CPM-PE-METHSCOP TAB CR THERAPY PACK<br />
pse-methscopol & cpm-methscopol tab cr 120-2.5 & 8-2.5 mg<br />
pse/bpm cap 60-6mgcr<br />
pse/cpm cap 100-12mg<br />
pse/cpm cap 120-8 sa<br />
pse/cpm cap 120-8mg<br />
pse/cpm tab 12hr<br />
pse/cpm/meth tab sr<br />
pse/cpm/scop tab 12hr<br />
pse/tripol tab 60-2.5mg OTC<br />
pse/tripol tab 60-2.5mg OTC<br />
pseubrom cap 12-120cr<br />
pseubrom tr cap 12-120cr<br />
pseubrom-pd cap 6-60mgcr<br />
pseudo cm tab<br />
pseudo-plus tab 4-60mg OTC<br />
pseudo/bpm tab 45-6mg<br />
pseudoephed tab cld/alrg OTC<br />
pseudoephed tab plus OTC<br />
px allergy tab sinus pe OTC<br />
px dibromm elx cld/alrg OTC<br />
pyrichlor pe liq<br />
pyril d sus 16-5mg/5<br />
pyril mal/pe sus 16-5mg/5<br />
pyrilamine mal-phenylephrine hcl tann susp 16-5 mg/5ml<br />
PYRILAMINE MAL-PHENYLEPHRINE HCL TANNATE CHEW TAB 16-10 MG<br />
q-tapp elx 1-15/5ml OTC<br />
qc allergy tab relief OTC<br />
qc suphedrin tab cld/alrg OTC<br />
qc suphedrin tab sinus OTC<br />
QDALL CAP 12-100MG<br />
qv-allergy syp<br />
r-tanna sus pedi<br />
r-tanna tab 9-25mg<br />
r-tannamine sus ped<br />
ra acta-tabs tab 2.5-60mg OTC<br />
ra acta-tabs tab pe OTC<br />
ra allergy tab multi-sy OTC<br />
ra cld/alrgy elx 1-2.5mg OTC<br />
ra cold/flu tab OTC<br />
ra nas decon tab antihist OTC<br />
ra sinus pak cng/pain OTC<br />
ra sinus tab OTC<br />
ra sinus tab ex str OTC<br />
ra suphedrin tab 4-60mg OTC<br />
ra suphedrin tab 4-60mg OTC<br />
ralix tab<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 13
RE-DRYLEX SYP<br />
re-drylex jr tab<br />
re2+30 syp<br />
redur-pcm sus<br />
RELCOF DN MIS PSE<br />
RELCOF DN PE MIS<br />
RELCOF PE TAB<br />
relcof pse tab<br />
relera tab<br />
RESCON TAB<br />
RESCON-JR TAB<br />
RESCON-MX TAB<br />
RESPA-A.R. TAB<br />
respahist cap 6-60mgcr<br />
rhinabid cap 12-15mg<br />
rhinabid pd cap 6-7.5mg<br />
rhinaclear tab dose pac<br />
rhinacon a liq<br />
rhinacon a tab<br />
RHINAHIST TAB<br />
RICOBID SUS<br />
RICOBID TAB 8-25MG<br />
rinate sus pedi<br />
ritifed syp 1.25-30 OTC<br />
robitussin tab cold/cng OTC<br />
rondex dro<br />
rondex syp<br />
ru-hist tab forte<br />
ru-tuss tab<br />
ry-tann tab 9-25mg<br />
RYMED TAB 2-10MG OTC<br />
RYNATAN PEDI CHW 4.5-5MG<br />
sb allergy tab multi-sy OTC<br />
sb antihist tab 2.5-60mg OTC<br />
sb cld/alrgy elx children OTC<br />
sb cold/flu tab hbp OTC<br />
sb pseudoeph tab plus OTC<br />
sb sinus cng pak /pain OTC<br />
sb sinus cng tab /pain OTC<br />
scopohist syp<br />
scopohist tab<br />
scopohist-pe tab<br />
seradex-la tab 6-19mg<br />
sg nas decon tab antihist OTC<br />
sg su-phedri tab plus OTC<br />
silafed syp 1.25-30 OTC<br />
sildec syp 4-45/5ml<br />
sildec-pe dro<br />
sildec-pe syp<br />
SINADRIN PE TAB 2-10-650 OTC<br />
sine-off tab OTC<br />
sinuhist tab<br />
sinus tab OTC<br />
sinus tab OTC<br />
sinus tab ex st OTC<br />
sinus tab max str OTC<br />
sinus tab max-st OTC<br />
sinus congst pak /pain OTC<br />
sinus congst pak day/nght OTC<br />
sinus congst tab night OTC<br />
sinus congst tab night OTC<br />
sinus congst tab nighttim OTC<br />
sinus max tab 2-30-500 OTC<br />
sinus relief tab OTC<br />
sinus/alergy tab max st OTC<br />
sinus/alergy tab max st OTC<br />
sinus/alergy tab pe max OTC<br />
sinus/alergy tab pe max OTC<br />
sinus/allerg tab 4-10mg OTC<br />
sinus/allerg tab max st OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 14
sinus/allerg tab max st OTC<br />
sinus/allerg tab pe OTC<br />
sinus/allrgy tab max st OTC<br />
sinutab m-s tab sin/alrg OTC<br />
sm allergy tab multi-sy OTC<br />
sm cld/alrgy elx children OTC<br />
sm cold tab alrgy pe OTC<br />
sm non-asa tab sin/alrg OTC<br />
soba sinus tab OTC<br />
sonahist dro 1-2mg/ml<br />
ss sinadrin tab 4-10-650 OTC<br />
suclor cap 8-120 cr<br />
sudafed pe tab 4-10mg OTC<br />
sudafed plus tab 4-60mg OTC<br />
sudafed sinu tab 2.5-60mg OTC<br />
SUDAHIST TAB 12-120MG<br />
SUDAL 12 CHW 4-30MG<br />
SUDAL 12 TAN CHW 4-30MG<br />
sudogest tab cld/alrg OTC<br />
super cold tab 4-10-650 OTC<br />
suphedrin tab plus OTC<br />
suphedrine tab cld/alrg OTC<br />
suphedrine tab cld/alrg OTC<br />
suphedrine tab pe OTC<br />
SUTAN SUS<br />
SYMPAK MIS<br />
SYMPAK II MIS<br />
SYMPAK PDX MIS<br />
tana pse sus<br />
tanabid chw 2.2-1.58<br />
tanabid da sus 4-5mg<br />
tanabid sr tab 6-30mg<br />
tanatan rf sus<br />
tanhst-d ped sus 2-6mg/ml<br />
tannate ped sus<br />
theraflu pak OTC<br />
theraflu pow flu/cold OTC<br />
THERAFLU CLD PAK /SORE TH OTC<br />
THERAFLU FLU PAK SORE THR OTC<br />
THERAFLU FLU POW /CLD/S-T OTC<br />
THERAFLU SEV PAK COLD NT OTC<br />
tibamine la tab 12-120mg<br />
TIME-HIST QD TAB<br />
TOURO ALLERG CAP CR<br />
touro allerg tab 6-45mg<br />
tri acting syp cold/all OTC<br />
tri-afed tab 2.5-60mg OTC<br />
tri-fed cold tab 2.5-60mg OTC<br />
tri-gestan s sus<br />
tri-hist ped sus<br />
tri-pseudaph tab 2.5-60mg OTC<br />
tri-tannate sus ped<br />
triacing ora syp 1-15mg/5 OTC<br />
triactin cld syp /allergy OTC<br />
triactin cld syp 1-15mg/5 OTC<br />
triacting syp cold/all OTC<br />
triall syp<br />
TRIAMINIC CHW OTC<br />
TRIAMINIC LIQ CLD/ALLR OTC<br />
TRIAMINIC SYP COLD/ALL OTC<br />
trifed tab 2.5-60mg OTC<br />
trifedrine tab 2.5-60mg OTC<br />
triotann sus ped<br />
triotann-s sus ped<br />
trip-pse liq OTC<br />
triplex ad liq<br />
TRIPOHIST D LIQ 1.25-45<br />
triprol/pse syp 1.25-30 OTC<br />
triprol/pse tab 2.5-60mg OTC<br />
TRIPROLIDINE & PSEUDOEPHEDRINE CAP 2.5-60 MG OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 15
triprolidine & pseudoephedrine liquid 0.938-10 mg/ml OTC<br />
TRIPROLIDINE & PSEUDOEPHEDRINE LIQUID 1.25-45 MG/5ML<br />
triprolidine & pseudoephedrine syrup 1.25-30 mg/5ml OTC<br />
TRIPROLIDINE & PSEUDOEPHEDRINE TAB 2.5-30 MG OTC<br />
triprolidine & pseudoephedrine tab 2.5-60 mg OTC<br />
TRIPROLIDINE TAN-PSEUDOEPHEDRINE TAN SUSP 2.5-45 MG/5ML<br />
TRIPROLIDINE-PSEUDOEPHEDRINE W/ APAP TAB 1.25-30-500 MG OTC<br />
trisofed tab 2.5-60mg OTC<br />
tylenol alle tab multi rr OTC<br />
tylenol alle tab multi-sy OTC<br />
TYLENOL CHLD SUS PLUS CLD OTC<br />
tylenol sinu tab cng/pain OTC<br />
ultrabrom cap 12-120cr<br />
ultrabrom pd cap 6-60mgcr<br />
uni-hist dro<br />
uni-tex er cap 120/10<br />
v-hist sus 6-10mg/5<br />
vaso dose tab pack 10<br />
vaso dose tab pack 30<br />
VAZOTAB CHW<br />
visrx tab dose pac<br />
wal-act tab 2.5-60mg OTC<br />
wal-finate d tab OTC<br />
WAL-FLU SVR PAK COLD NT OTC<br />
wal-phed tab 4-60mg OTC<br />
wal-phed pe tab 4-10mg OTC<br />
wal-tap elx children OTC<br />
wal-tap elx cld/alle OTC<br />
we allergy syp<br />
west-decon m tab 4-40-20<br />
xiral sr tab<br />
ZINX ALLERGY KIT<br />
ZINX KIDS KIT SNEEZE<br />
zotex-pe tab 6-30mg<br />
ZYMINE DXR SUS 2.5-45MG<br />
Derivatives, Miscellaneous<br />
CHLORPHEN-PHENYLTOLOX-PE- APAP TAB SR 12HR 8-50-40-325 MG<br />
chlorphen-phenyltolox-pe- apap tab sr 12hr 8-50-40-325 mg<br />
CHLORPHEN-PYRIL TAN-PE HCL-PE TAN SUSP 2-10-2.5-7.5 MG/5ML<br />
cyproheptad syp 2mg/5ml<br />
cyproheptad tab 4mg<br />
cyproheptadine hcl syrup 2 mg/5ml<br />
cyproheptadine hcl tab 4 mg<br />
NOREL SR TAB<br />
PHENA-S 12 SUS<br />
trital sr tab<br />
Second Generation <strong>Antihistamine</strong>s<br />
ACRIVASTINE & PSEUDOEPHEDRINE CAP 8-60 MG<br />
alavert syp OTC<br />
alavert tab 10mg OTC<br />
all day allg tab 10mg OTC<br />
ALLEGRA-D TAB 24 HOUR<br />
allerclear tab 10mg OTC<br />
allergy tab 10mg OTC<br />
allergy relf syp 5mg/5ml OTC<br />
allergy relf syp child OTC<br />
allergy relf tab 10mg OTC<br />
cetirizine tab 10mg OTC<br />
cetirizine tab 5mg OTC<br />
cetirizine hcl tab 10 mg OTC<br />
cetirizine hcl tab 5 mg OTC<br />
CLARINEX TAB 5MG PA<br />
CLARINEX-D TAB 2.5-120<br />
CLARINEX-D TAB 5-240MG<br />
CLARITIN CHW 5MG OTC<br />
claritin syp 5mg/5ml OTC<br />
claritin tab 10mg OTC<br />
claritin rdt tab 10mg OTC<br />
CLARITIN RDT TAB 5MG PA OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 16
clear-atadin syp 5mg/5ml OTC<br />
cvs allergy syp children OTC<br />
cvs allergy tab 10mg OTC<br />
DESLORATADINE & PSEUDOEPHEDRINE TAB SR 12HR 2.5-120 MG<br />
DESLORATADINE & PSEUDOEPHEDRINE TAB SR 24HR 5-240 MG<br />
dimetapp nd tab 10mg OTC<br />
eql all day tab allergy OTC<br />
fexofen/pse tab 60-120mg<br />
fexofenadine hcl tab 180 mg<br />
fexofenadine hcl tab 30 mg<br />
fexofenadine hcl tab 60 mg<br />
fexofenadine tab 180mg<br />
fexofenadine tab 30mg<br />
fexofenadine tab 60mg<br />
fexofenadine-pseudoephedrine tab sr 12hr 60-120 mg<br />
FEXOFENADINE-PSEUDOEPHEDRINE TAB SR 24HR 180-240 MG<br />
gnp all day tab allergy OTC<br />
loradamed tab 10mg OTC<br />
loratadine sol 5mg/5ml OTC<br />
loratadine syp 10/10ml OTC<br />
loratadine syp 5mg/5ml OTC<br />
loratadine syp allg rel OTC<br />
loratadine tab 10mg OTC<br />
loratadine tab allg rel OTC<br />
loratadine tab disinteg OTC<br />
loratadine & pseudoephedrine tab sr 12hr 5-120 mg PA OTC<br />
loratadine & pseudoephedrine tab sr 24hr 10-240 mg PA OTC<br />
LORATADINE CHEW TAB 5 MG OTC<br />
loratadine rapidly-disintegrating tab 10 mg PA OTC<br />
loratadine rapidly-disintegrating tab 10 mg OTC<br />
loratadine syrup 5 mg/5ml PA OTC<br />
loratadine syrup 5 mg/5ml OTC<br />
loratadine tab 10 mg PA OTC<br />
loratadine tab 10 mg OTC<br />
ra cetirizin tab 10mg OTC<br />
SEMPREX-D CAP 8-60MG<br />
sm loratadin syp 5mg/5ml OTC<br />
sm loratadin tab 10mg OTC<br />
tavist nd tab 10mg OTC<br />
triaminic tab OTC<br />
wal-itin syp 5mg/5ml OTC<br />
wal-itin tab 10mg OTC<br />
wal-itin tab aller-ml OTC<br />
wal-vert tab 10mg OTC<br />
wal-zyr tab 10mg OTC<br />
Anti-infective Agents<br />
Anthelmintics<br />
MEBENDAZOLE CHW 100MG<br />
mebendazole chw 100mg<br />
MEBENDAZOLE CHEW TAB 100 MG<br />
mebendazole chew tab 100 mg<br />
Antibacterials<br />
Aminoglycosides<br />
amikacin sulfate inj 250 mg/ml PA<br />
amikacin sulfate inj 50 mg/ml PA<br />
GENTAM/NACL INJ 0.9MG/ML PA<br />
GENTAM/NACL INJ 1.4MG/ML PA<br />
GENTAM/NACL INJ 100MG PB PA<br />
gentamicin in saline inj 0.6 mg/ml PA<br />
gentamicin in saline inj 0.8 mg/ml PA<br />
gentamicin in saline inj 1 mg/ml PA<br />
gentamicin in saline inj 1.2 mg/ml PA<br />
gentamicin in saline inj 1.6 mg/ml PA<br />
gentamicin sulfate inj 10 mg/ml PA<br />
gentamicin sulfate inj 40 mg/ml PA<br />
gentamicin sulfate iv soln 10 mg/ml PA<br />
KANAMYCIN INJ 333MG/ML PA<br />
neomycin tab 500mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 17
neomycin sulfate tab 500 mg<br />
STREPTOMYCIN INJ 1GM PA<br />
TOBRA/NACL INJ 60/0.9 PA<br />
TOBRA/NACL INJ 80/0.9 PA<br />
TOBRAMYCIN INJ 10MG/ML PA<br />
tobramycin sulfate for inj 1.2 gm PA<br />
tobramycin sulfate inj 10 mg/ml PA<br />
tobramycin sulfate inj 40 mg/ml PA<br />
First Generation Cephalosporins<br />
cefadroxil cap 500mg<br />
cefadroxil sus 250/5ml<br />
cefadroxil sus 500/5ml<br />
cefadroxil tab 1000mg<br />
cefadroxil tab 1gm<br />
cefadroxil cap 500 mg<br />
cefadroxil for susp 250 mg/5ml<br />
cefadroxil for susp 500 mg/5ml<br />
cefadroxil tab 1 gm<br />
CEFAZOL/DEX SOL 1GM PA<br />
CEFAZOLIN INJ 100GM PA<br />
CEFAZOLIN INJ 1GM/50ML PA<br />
CEFAZOLIN INJ 300GM PA<br />
CEFAZOLIN INJ 500MG PA<br />
cefazolin sodium for inj 1 gm PA<br />
cefazolin sodium for inj 10 gm PA<br />
cefazolin sodium for inj 20 gm PA<br />
cefazolin sodium for inj 500 mg PA<br />
cefazolin sodium for iv soln 1 gm PA<br />
cephalexin cap 250mg<br />
cephalexin cap 500mg<br />
cephalexin sus 125/5ml<br />
cephalexin sus 250/5ml<br />
cephalexin cap 250 mg<br />
cephalexin cap 500 mg<br />
cephalexin for susp 125 mg/5ml<br />
cephalexin for susp 250 mg/5ml<br />
KEFLEX CAP 750MG PA<br />
Second Generation Cephalosporins<br />
cefaclor cap 250mg<br />
cefaclor cap 500mg<br />
CEFACLOR SUS 125/5ML<br />
cefaclor sus 125/5ml<br />
cefaclor sus 125/5ml<br />
cefaclor sus 250/5ml<br />
cefaclor sus 250/5ml<br />
CEFACLOR SUS 250/5ML<br />
CEFACLOR SUS 375/5ML<br />
cefaclor cap 250 mg<br />
cefaclor cap 500 mg<br />
CEFACLOR ER TAB 500MG<br />
cefaclor er tab 500mg<br />
CEFACLOR FOR SUSP 125 MG/5ML<br />
cefaclor for susp 125 mg/5ml<br />
cefaclor for susp 125 mg/5ml<br />
CEFACLOR FOR SUSP 250 MG/5ML<br />
cefaclor for susp 250 mg/5ml<br />
cefaclor for susp 250 mg/5ml<br />
CEFACLOR FOR SUSP 375 MG/5ML<br />
cefaclor monohydrate tab sr 12hr 500 mg<br />
CEFACLOR MONOHYDRATE TAB SR 12HR 500 MG<br />
cefprozil sus 125/5ml<br />
cefprozil sus 250/5ml<br />
cefprozil tab 250mg<br />
cefprozil tab 500mg<br />
cefprozil for susp 125 mg/5ml<br />
cefprozil for susp 250 mg/5ml<br />
cefprozil tab 250 mg<br />
cefprozil tab 500 mg<br />
CEFUROX/DEXT INJ 1.5GM PA<br />
CEFUROX/DEXT INJ 750MG PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 18
CEFUROXIME INJ 225GM PA<br />
CEFUROXIME INJ 7.5GM PA<br />
CEFUROXIME INJ 75GM PA<br />
cefuroxime sodium for inj 1.5 gm PA<br />
cefuroxime sodium for inj 7.5 gm PA<br />
cefuroxime sodium for inj 750 mg PA<br />
cefuroxime sodium for iv soln 1.5 gm PA<br />
ZINACEF INJ 1.5GM PA<br />
ZINACEF INJ 750MG PA<br />
ZINACEF/D5W INJ 750MG PB PA<br />
ZINACEF/H20 INJ 1.5GM PB PA<br />
Third Generation Cephalosporins<br />
cefdinir cap 300mg<br />
cefdinir sus 125/5ml<br />
cefdinir sus 250/5ml<br />
cefdinir cap 300 mg<br />
cefdinir for susp 125 mg/5ml<br />
cefdinir for susp 250 mg/5ml<br />
CEFIXIME FOR SUSP 100 MG/5ML<br />
CEFIXIME FOR SUSP 200 MG/5ML<br />
CEFIXIME TAB 400 MG<br />
CEFIZOX INJ 10GM PA<br />
CEFIZOX INJ 1GM PA<br />
CEFIZOX INJ 2GM PA<br />
CEFIZOX/D5W INJ 1GM PA<br />
CEFIZOX/D5W INJ 2GM PA<br />
CEFOTAXIME INJ 20GM PA<br />
cefotaxime sodium for inj 1 gm PA<br />
cefotaxime sodium for inj 10 gm PA<br />
cefotaxime sodium for inj 2 gm PA<br />
cefotaxime sodium for inj 500 mg PA<br />
cefpodo prox sus 100/5ml NF<br />
cefpodo prox sus 50mg/5ml NF<br />
cefpodoxime tab 100mg NF<br />
cefpodoxime tab 200mg NF<br />
cefpodoxime proxetil for susp 100 mg/5ml NF<br />
cefpodoxime proxetil for susp 50 mg/5ml NF<br />
cefpodoxime proxetil tab 100 mg NF<br />
cefpodoxime proxetil tab 200 mg NF<br />
CEFTAZIDIME INJ 100GM PA<br />
ceftazidime for inj 1 gm PA<br />
ceftazidime for inj 2 gm PA<br />
ceftazidime for inj 6 gm PA<br />
ceftazidime for iv soln 1 gm PA<br />
ceftazidime for iv soln 2 gm PA<br />
CEFTRIAX/DEX INJ 1GM PA<br />
CEFTRIAX/DEX INJ 2GM PA<br />
CEFTRIAXONE INJ 100GM PA<br />
ceftriaxone sodium for inj 1 gm PA<br />
ceftriaxone sodium for inj 10 gm PA<br />
ceftriaxone sodium for inj 2 gm PA<br />
ceftriaxone sodium for inj 250 mg PA<br />
ceftriaxone sodium for inj 500 mg PA<br />
ceftriaxone sodium for iv soln 1 gm PA<br />
ceftriaxone sodium for iv soln 2 gm PA<br />
ceftriaxone sodium in dextrose inj 20 mg/ml PA<br />
ceftriaxone sodium in dextrose inj 40 mg/ml PA<br />
CLAFORAN INJ 1GM PA<br />
CLAFORAN INJ 2GM PA<br />
CLAFORAN/D5W INJ 1GM PA<br />
CLAFORAN/D5W INJ 2GM PA<br />
FORTAZ INJ 1GM PA<br />
FORTAZ INJ 2GM PA<br />
FORTAZ INJ 500MG PA<br />
ROCEPHIN INJ 1GM PA<br />
ROCEPHIN INJ 2GM PA<br />
SUPRAX SUS 100/5ML<br />
SUPRAX SUS 200/5ML<br />
SUPRAX TAB 400MG<br />
TAZICEF INJ 1GM/50ML PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 19
Fourth Generation Cephalosporins<br />
CEFEPIME INJ 1GM PA<br />
CEFEPIME INJ 2GM PA<br />
cefepime hcl for inj 1 gm PA<br />
cefepime hcl for inj 2 gm PA<br />
MAXIPIME INJ 1GM PA<br />
MAXIPIME INJ 2GM PA<br />
MAXIPIME INJ 500MG PA<br />
Miscellaneous B-Lactam Antibiotics<br />
INVANZ INJ 1GM PA<br />
Carbacepnems<br />
LORABID CAP 200MG NF<br />
LORABID CAP 400MG NF<br />
LORABID SUS 100/5ML NF<br />
LORABID SUS 200/5ML NF<br />
LORACARBEF CAP 200 MG NF<br />
LORACARBEF CAP 400 MG NF<br />
LORACARBEF FOR SUSP 100 MG/5ML NF<br />
LORACARBEF FOR SUSP 200 MG/5ML NF<br />
Carbapenems<br />
DORIBAX INJ 500MG PA<br />
INVANZ INJ 1GM PA<br />
MERREM INJ 1GM PA<br />
MERREM INJ 500MG PA<br />
PRIMAXIN IM INJ 500MG PA<br />
PRIMAXIN IV INJ 250MG PA<br />
PRIMAXIN IV INJ 500MG PA<br />
Cephamycins<br />
CEFOTAN INJ 1GM/50ML PA<br />
CEFOTAN INJ 2GM/50ML PA<br />
CEFOTET/DEX INJ 1-3.58% PA<br />
CEFOTET/DEX INJ 2-2.08% PA<br />
CEFOTETAN INJ 10G PA<br />
CEFOTETAN INJ 1GM/10ML PA<br />
CEFOTETAN INJ 2GM/20ML PA<br />
CEFOXITIN INJ 100GM PA<br />
CEFOXITIN INJ 1GM PA<br />
CEFOXITIN INJ 2GM PA<br />
cefoxitin sodium for inj 1 gm PA<br />
cefoxitin sodium for inj 10 gm PA<br />
cefoxitin sodium for inj 2 gm PA<br />
MEFOXIN/DEX INJ 1GM PA<br />
MEFOXIN/DEX INJ 2GM PA<br />
Monobactams<br />
AZACTAM INJ 1GM PA<br />
AZACTAM INJ 2GM PA<br />
AZACTAM INJ 500MG PA<br />
AZACTAM/DEX INJ 1GM PA<br />
AZACTAM/DEX INJ 2GM PA<br />
Chloramphenicol<br />
CHLORAMPHEN INJ 1GM PA<br />
Macrolides<br />
clarithromyc tab 500mg<br />
clarithromycin tab 500 mg<br />
Erythromycins<br />
e.e.s. 200 sus 200/5ml<br />
e.e.s. 400 sus 400/5ml<br />
e.e.s. 400 tab 400mg<br />
E.E.S. GRAN SUS 200/5ML<br />
e.s.p. sus 200-600<br />
ees/sulfisox sus 200-600<br />
ery-tab tab 250mg ec<br />
ERY-TAB TAB 250MG EC<br />
ery-tab tab 333mg ec<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 20
ERY-TAB TAB 500MG EC<br />
ery-tab tab 500mg ec<br />
ERYPED DRO 100/2.5<br />
ERYPED 200 SUS 200/5ML<br />
ERYPED 400 SUS 400/5ML<br />
ERYTHROCIN INJ 1000MG PA<br />
ERYTHROCIN INJ 500MG PA<br />
ERYTHROCIN TAB 250MG<br />
erythrocin tab 500mg<br />
ERYTHROCIN TAB 500MG<br />
erythrom eth sus 200/5ml<br />
erythrom eth sus 400/5ml<br />
erythrom eth tab 400mg<br />
erythrom st tab 250mg<br />
ERYTHROM ST TAB 250MG<br />
ERYTHROM ST TAB 500MG<br />
erythrom st tab 500mg<br />
ERYTHROMYCIN ETHYLSUCCINATE FOR SUSP 100 MG/2.5ML<br />
ERYTHROMYCIN ETHYLSUCCINATE FOR SUSP 200 MG/5ML<br />
ERYTHROMYCIN ETHYLSUCCINATE FOR SUSP 400 MG/5ML<br />
erythromycin ethylsuccinate susp 200 mg/5ml<br />
erythromycin ethylsuccinate susp 400 mg/5ml<br />
erythromycin ethylsuccinate tab 400 mg<br />
ERYTHROMYCIN STEARATE TAB 250 MG<br />
erythromycin stearate tab 250 mg<br />
erythromycin stearate tab 500 mg<br />
erythromycin stearate tab 500 mg<br />
ERYTHROMYCIN STEARATE TAB 500 MG<br />
erythromycin tab 250 mg<br />
ERYTHROMYCIN TAB 250 MG<br />
ERYTHROMYCIN TAB 250MG BS<br />
ERYTHROMYCIN TAB 250MG BS<br />
erythromycin tab 250mg bs<br />
erythromycin tab 333mg ec<br />
ERYTHROMYCIN TAB 500 MG<br />
erythromycin tab 500 mg<br />
erythromycin tab 500mg bs<br />
ERYTHROMYCIN TAB 500MG BS<br />
ERYTHROMYCIN TAB DELAYED RELEASE 250 MG<br />
erythromycin tab delayed release 250 mg<br />
erythromycin tab delayed release 333 mg<br />
erythromycin tab delayed release 500 mg<br />
ERYTHROMYCIN TAB DELAYED RELEASE 500 MG<br />
erythromycin-sulfisoxazole for susp 200-600 mg/5ml<br />
Other Macrolides<br />
AZITHROMYCIN EXTENDED RELEASE FOR ORAL SUSP 2 GM<br />
azithromycin for susp 100 mg/5ml<br />
azithromycin for susp 200 mg/5ml<br />
AZITHROMYCIN INJ 2.5GM PA<br />
AZITHROMYCIN INJ 500MG PA<br />
azithromycin iv for soln 500 mg PA<br />
AZITHROMYCIN POW 1GM PAK<br />
AZITHROMYCIN POWD PACK FOR SUSP 1 GM<br />
azithromycin sus 100/5ml<br />
azithromycin sus 200/5ml<br />
azithromycin tab 250 mg<br />
azithromycin tab 250mg<br />
azithromycin tab 500 mg<br />
azithromycin tab 500mg<br />
azithromycin tab 600 mg<br />
azithromycin tab 600mg<br />
clarithromyc sus 125/5ml<br />
clarithromyc sus 250/5ml<br />
clarithromyc tab 250mg<br />
clarithromyc tab 500mg<br />
clarithromycin for susp 125 mg/5ml<br />
clarithromycin for susp 250 mg/5ml<br />
clarithromycin tab 250 mg<br />
clarithromycin tab 500 mg<br />
ZITHROMAX POW 1GM PAK<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 21
ZMAX SUS 2GM<br />
ZMAX PEDIATR SUS 2GM<br />
Penicillins<br />
amox/k clav chw 400mg<br />
amox/k clav tab 500mg<br />
amox/k clav tab 875mg<br />
amoxicillin cap 250mg<br />
amoxicillin cap 500mg<br />
amoxicillin chw 125mg<br />
amoxicillin chw 250mg<br />
amoxicillin & k clavulanate chew tab 400-57 mg<br />
amoxicillin & k clavulanate tab 500-125 mg<br />
amoxicillin & k clavulanate tab 875-125 mg<br />
amoxicillin (trihydrate) cap 250 mg<br />
amoxicillin (trihydrate) cap 500 mg<br />
amoxicillin (trihydrate) chew tab 125 mg<br />
amoxicillin (trihydrate) chew tab 250 mg<br />
Natural Penicillins<br />
BICILLIN C-R INJ 1200000 PA<br />
BICILLIN C-R INJ 2400000 PA<br />
BICILLIN C-R INJ 600000 PA<br />
BICILLIN C-R INJ 900/300 PA<br />
BICILLIN L-A INJ 1200000 PA<br />
BICILLIN L-A INJ 2400000 PA<br />
BICILLIN L-A INJ 600000 PA<br />
PEN G PROC INJ 600000 PA<br />
PEN G PROC INJ 600000 PA<br />
PEN G SOD INJ 5000000 PA<br />
PENICILL GK/ INJ DEX 1MU PA<br />
PENICILL GK/ INJ DEX 2MU PA<br />
PENICILL GK/ INJ DEX 3MU PA<br />
penicillin g potassium for inj 20000000 unit PA<br />
penicillin g potassium for inj 5000000 unit PA<br />
penicillin v potassium for soln 125 mg/5ml<br />
penicillin v potassium for soln 250 mg/5ml<br />
penicillin v potassium tab 250 mg<br />
penicillin v potassium tab 500 mg<br />
penicilln vk sol 125/5ml<br />
penicilln vk sol 250/5ml<br />
penicilln vk tab 250mg<br />
penicilln vk tab 500mg<br />
veetids sol 125/5ml<br />
veetids sol 250/5ml<br />
veetids tab 250mg<br />
veetids tab 500mg<br />
Aminopenicillins<br />
amoclan sus 200/5ml<br />
amoclan sus 400/5ml<br />
amoclan sus 600-42.9<br />
amox/k clav chw 200mg<br />
amox/k clav chw 200mg<br />
amox/k clav chw 400mg<br />
amox/k clav chw 400mg<br />
amox/k clav sus 200/5ml<br />
amox/k clav sus 200/5ml<br />
amox/k clav sus 250/5ml<br />
amox/k clav sus 400/5ml<br />
amox/k clav sus 400/5ml<br />
amox/k clav sus 600/5ml<br />
amox/k clav tab 250mg<br />
amox/k clav tab 500mg<br />
amox/k clav tab 500mg<br />
amox/k clav tab 875mg<br />
amox/k clav tab 875mg<br />
amoxicillin cap 250mg<br />
amoxicillin cap 500mg<br />
amoxicillin chw 125mg<br />
amoxicillin chw 200mg<br />
AMOXICILLIN CHW 200MG<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 22
amoxicillin chw 250mg<br />
AMOXICILLIN CHW 400MG<br />
amoxicillin chw 400mg<br />
amoxicillin chw 400mg<br />
amoxicillin sus 125/5ml<br />
amoxicillin sus 200/5ml<br />
amoxicillin sus 250/5ml<br />
amoxicillin sus 400/5ml<br />
amoxicillin tab 500mg<br />
amoxicillin tab 875mg QL<br />
AMOXICILLIN & K CLAVULANATE CHEW TAB 125-31.25 MG<br />
amoxicillin & k clavulanate chew tab 200-28.5 mg<br />
AMOXICILLIN & K CLAVULANATE CHEW TAB 250-62.5 MG<br />
amoxicillin & k clavulanate chew tab 400-57 mg<br />
AMOXICILLIN & K CLAVULANATE FOR SUSP 125-31.25 MG/5ML<br />
amoxicillin & k clavulanate for susp 200-28.5 mg/5ml<br />
AMOXICILLIN & K CLAVULANATE FOR SUSP 250-62.5 MG/5ML<br />
amoxicillin & k clavulanate for susp 250-62.5 mg/5ml<br />
amoxicillin & k clavulanate for susp 400-57 mg/5ml<br />
amoxicillin & k clavulanate for susp 600-42.9 mg/5ml<br />
amoxicillin & k clavulanate tab 250-125 mg<br />
amoxicillin & k clavulanate tab 500-125 mg<br />
amoxicillin & k clavulanate tab 875-125 mg<br />
amoxicillin (trihydrate) cap 250 mg<br />
amoxicillin (trihydrate) cap 500 mg<br />
amoxicillin (trihydrate) chew tab 125 mg<br />
AMOXICILLIN (TRIHYDRATE) CHEW TAB 200 MG<br />
amoxicillin (trihydrate) chew tab 200 mg<br />
amoxicillin (trihydrate) chew tab 250 mg<br />
AMOXICILLIN (TRIHYDRATE) CHEW TAB 400 MG<br />
amoxicillin (trihydrate) chew tab 400 mg<br />
amoxicillin (trihydrate) chew tab 400 mg<br />
amoxicillin (trihydrate) for susp 125 mg/5ml<br />
amoxicillin (trihydrate) for susp 200 mg/5ml<br />
amoxicillin (trihydrate) for susp 250 mg/5ml<br />
amoxicillin (trihydrate) for susp 400 mg/5ml<br />
AMOXICILLIN (TRIHYDRATE) FOR SUSP 50 MG/ML<br />
amoxicillin (trihydrate) tab 500 mg<br />
amoxicillin (trihydrate) tab 875 mg QL<br />
amoxil cap 500mg<br />
AMOXIL DRO 50MG/ML<br />
amoxil sus 250/5ml<br />
ampicillin cap 250mg<br />
ampicillin cap 500mg<br />
AMPICILLIN INJ 125MG PA<br />
AMPICILLIN SUS 125/5ML<br />
AMPICILLIN SUS 250/5ML<br />
ampicillin sus 250/5ml<br />
ampicillin & sulbactam sodium for inj 1-0.5 gm PA<br />
ampicillin & sulbactam sodium for inj 10-5 gm PA<br />
ampicillin & sulbactam sodium for inj 2-1 gm PA<br />
ampicillin & sulbactam sodium for iv soln 1-0.5 gm PA<br />
ampicillin & sulbactam sodium for iv soln 2-1 gm PA<br />
ampicillin cap 250 mg<br />
ampicillin cap 500 mg<br />
AMPICILLIN FOR SUSP 125 MG/5ML<br />
AMPICILLIN FOR SUSP 250 MG/5ML<br />
ampicillin for susp 250 mg/5ml<br />
ampicillin sodium for inj 1 gm PA<br />
ampicillin sodium for inj 10 gm PA<br />
ampicillin sodium for inj 2 gm PA<br />
ampicillin sodium for inj 250 mg PA<br />
ampicillin sodium for inj 500 mg PA<br />
ampicillin sodium for iv soln 1 gm PA<br />
ampicillin sodium for iv soln 1 gm PA<br />
ampicillin sodium for iv soln 2 gm PA<br />
ampicillin sodium for iv soln 2 gm PA<br />
AUGMENTIN CHW 125MG<br />
AUGMENTIN CHW 250MG<br />
AUGMENTIN SUS 125/5ML<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 23
AUGMENTIN SUS 250/5ML<br />
MOXATAG TAB 775MG PA<br />
trimox cap 500mg<br />
trimox sus 250/5ml<br />
Penicillinase-resistant Penicillins<br />
BACTOCILL INJ DEX 1GM PA<br />
BACTOCILL INJ DEX 2GM PA<br />
dicloxacill cap 250mg<br />
dicloxacill cap 500mg<br />
dicloxacillin sodium cap 250 mg<br />
dicloxacillin sodium cap 500 mg<br />
NAFCILLIN INJ 10GM PA<br />
NAFCILLIN INJ 1GM PA<br />
NAFCILLIN INJ 200GM PA<br />
NAFCILLIN INJ 2GM PA<br />
nafcillin sodium for inj 1 gm PA<br />
nafcillin sodium for inj 10 gm PA<br />
nafcillin sodium for iv soln 1 gm PA<br />
nafcillin sodium for iv soln 2 gm PA<br />
NALLPEN/DEX INJ 1GM/50ML PA<br />
NALLPEN/DEX INJ 2GM PA<br />
NALLPEN/DEX INJ 2GM/100 PA<br />
OXACILLIN INJ 10GM PA<br />
OXACILLIN INJ 1GM PA<br />
OXACILLIN INJ 2GM PA<br />
oxacillin sodium for inj 10 gm PA<br />
Extended-spectrum Penicillins<br />
PIPERACILLIN INJ 2GM PA<br />
PIPERACILLIN INJ 3GM PA<br />
PIPERACILLIN INJ 40GM PA<br />
PIPERACILLIN INJ 4GM PA<br />
piperacillin sodium-tazobactam sodium for inj 2-0.25 gm PA<br />
piperacillin sodium-tazobactam sodium for inj 3-0.375 gm PA<br />
piperacillin sodium-tazobactam sodium for inj 36-4.5 gm PA<br />
piperacillin sodium-tazobactam sodium for inj 4-0.5 gm PA<br />
TIMENTIN INJ 3.1GM PA<br />
TIMENTIN INJ 31GM PA<br />
ZOSYN INJ 2G-0.25G PA<br />
ZOSYN INJ 36-4.5GM PA<br />
ZOSYN SOL 2-0.25GM PA<br />
ZOSYN SOL 3-0.375G PA<br />
ZOSYN SOL 4-0.50GM PA<br />
Quinolones<br />
AVELOX INJ PA<br />
ciprofloxacin 0.2% in d5w PA<br />
ciprofloxacin hcl tab 100 mg (base equiv)<br />
ciprofloxacin hcl tab 250 mg (base equiv)<br />
ciprofloxacin hcl tab 500 mg (base equiv)<br />
ciprofloxacin hcl tab 750 mg (base equiv)<br />
ciprofloxacin iv soln 1% PA<br />
ciprofloxacn tab 100mg<br />
ciprofloxacn tab 250mg<br />
ciprofloxacn tab 500mg<br />
ciprofloxacn tab 750mg<br />
LEVAQUIN INJ 25MG/ML PA<br />
LEVAQUIN SOL 25MG/ML<br />
LEVAQUIN TAB 250MG<br />
LEVAQUIN TAB 500MG<br />
LEVAQUIN TAB 750MG<br />
LEVAQUIN TAB LEVA-PAK<br />
LEVAQUIN/D5W INJ 250/50ML PA<br />
LEVAQUIN/D5W INJ 500/100 PA<br />
LEVAQUIN/D5W INJ 750/150 PA<br />
LEVOFLOXACIN ORAL SOLN 25 MG/ML<br />
LEVOFLOXACIN TAB 250 MG<br />
LEVOFLOXACIN TAB 500 MG<br />
LEVOFLOXACIN TAB 750 MG<br />
ofloxacin tab 200mg<br />
ofloxacin tab 300mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 24
ofloxacin tab 400mg<br />
ofloxacin tab 200 mg<br />
ofloxacin tab 300 mg<br />
ofloxacin tab 400 mg<br />
TEQUIN INJ 2MG/ML PA<br />
Sulfonamides<br />
SMZ-TMP INJ 400-80/5 PA<br />
smz-tmp sus<br />
smz-tmp sus 200-40/5<br />
smz-tmp tab 400-80mg<br />
smz-tmp ds tab 800-160<br />
smz/tmp ds tab 800-160<br />
sulfamethoxazole-trimethoprim susp 200-40 mg/5ml<br />
sulfamethoxazole-trimethoprim tab 400-80 mg<br />
sulfamethoxazole-trimethoprim tab 800-160 mg<br />
sulfasalazin tab 500mg<br />
sulfasalazin tab 500mg dr<br />
sulfasalazin tab 500mg ec<br />
sulfasalazine tab 500 mg<br />
sulfasalazine tab delayed release 500 mg<br />
sulfatrim sus 200-40/5<br />
sulfazine tab 500mg<br />
sulfazine ec tab 500mg<br />
SULFISOXAZOL TAB 0.5GM<br />
SULFISOXAZOLE TAB 500 MG<br />
tmp/smz ds tab 160-800<br />
Tetracyclines<br />
avidoxy tab 100mg<br />
DORYX TAB 100MG<br />
DORYX TAB 150MG<br />
DORYX TAB 75MG<br />
doxy-caps cap 100mg<br />
doxycyc mono cap 100mg<br />
doxycyc mono cap 50mg<br />
doxycyc mono tab 100mg<br />
doxycyc mono tab 150mg<br />
doxycyc mono tab 50mg<br />
doxycyc mono tab 75mg<br />
doxycycl hyc cap 100mg<br />
DOXYCYCL HYC CAP 100MG<br />
doxycycl hyc cap 50mg<br />
DOXYCYCL HYC CAP 75MG<br />
doxycycl hyc tab 100mg<br />
doxycycline sus 25mg/5ml<br />
doxycycline tab 20mg<br />
DOXYCYCLINE CALCIUM SYRUP 50 MG/5ML<br />
doxycycline hyclate cap 100 mg<br />
DOXYCYCLINE HYCLATE CAP 20 MG<br />
doxycycline hyclate cap 50 mg<br />
DOXYCYCLINE HYCLATE CAP DR PARTICLES 100 MG<br />
DOXYCYCLINE HYCLATE CAP DR PARTICLES 75 MG<br />
doxycycline hyclate for inj 100 mg PA<br />
doxycycline hyclate tab 100 mg<br />
doxycycline hyclate tab 20 mg<br />
DOXYCYCLINE HYCLATE TAB DELAYED RELEASE 100 MG<br />
DOXYCYCLINE HYCLATE TAB DELAYED RELEASE 150 MG<br />
DOXYCYCLINE HYCLATE TAB DELAYED RELEASE 75 MG<br />
doxycycline monohydrate cap 100 mg<br />
doxycycline monohydrate cap 50 mg<br />
doxycycline monohydrate for susp 25 mg/5ml<br />
DOXYCYCLINE MONOHYDRATE FOR SUSP 25 MG/5ML<br />
doxycycline monohydrate tab 100 mg<br />
doxycycline monohydrate tab 150 mg<br />
doxycycline monohydrate tab 50 mg<br />
doxycycline monohydrate tab 75 mg<br />
MINOCIN INJ 100MG PA<br />
minocycline hcl cap 100 mg PA<br />
minocycline hcl cap 50 mg PA<br />
ORAXYL CAP 20MG<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 25
SUMYCIN SYP 125/5ML<br />
SUMYCIN TAB 250MG<br />
SUMYCIN TAB 500MG<br />
tetracycline cap 250mg<br />
tetracycline cap 500mg<br />
tetracycline hcl cap 250 mg<br />
tetracycline hcl cap 500 mg<br />
TETRACYCLINE HCL SYRUP 125 MG/5ML<br />
TETRACYCLINE HCL TAB 250 MG<br />
TETRACYCLINE HCL TAB 500 MG<br />
VIBRAMYCIN SUS 25MG/5ML<br />
VIBRAMYCIN SYP 50MG/5ML<br />
Glycylcyclines<br />
TYGACIL INJ 50MG PA<br />
Bacitracins<br />
bacitracin intramuscular for soln 50000 unit PA<br />
Cyclic Lipopeptides<br />
CUBICIN SOL 500MG PA<br />
Glycopeptides<br />
VANCOMYC/DEX INJ 1GM PA<br />
VANCOMYC/DEX INJ 500MG PA<br />
VANCOMYCIN INJ 750MG PA<br />
vancomycin hcl for inj 10 gm PA<br />
vancomycin hcl for inj 1000 mg PA<br />
vancomycin hcl for inj 500 mg PA<br />
vancomycin hcl for inj 5000 mg PA<br />
VIBATIV INJ 250MG PA<br />
VIBATIV INJ 750MG PA<br />
Lincomycins<br />
CLEOCIN INJ 300MG PA<br />
CLEOCIN INJ 600MG PA<br />
CLEOCIN INJ 900MG PA<br />
clindamycin cap 150mg<br />
clindamycin hcl cap 150 mg<br />
clindamycin hcl cap 300 mg PA<br />
clindamycin phosphate inj 150 mg/ml PA<br />
clindamycin phosphate iv soln 150 mg/ml PA<br />
LINCOCIN INJ 300MG/ML PA<br />
Oxazolidinones<br />
ZYVOX SOL 2MG/ML PA<br />
Polymyxins<br />
colistimethate sodium for inj 150 mg PA<br />
polymyxin b sulfate for inj 500000 unit PA<br />
Streptogramins<br />
SYNERCID INJ 500MG PA<br />
Antifungals<br />
Allylamines<br />
terbinafine tab 250mg NF<br />
terbinafine hcl tab 250 mg NF<br />
Azoles<br />
fluconazole sus 10mg/ml NF<br />
fluconazole sus 40mg/ml NF<br />
fluconazole tab 150mg QL<br />
fluconazole for susp 10 mg/ml NF<br />
fluconazole for susp 40 mg/ml NF<br />
fluconazole in dextrose inj 200 mg/100ml PA<br />
fluconazole in dextrose inj 400 mg/200ml PA<br />
fluconazole in nacl 0.9% inj 200 mg/100ml PA<br />
fluconazole in nacl 0.9% inj 400 mg/200ml PA<br />
fluconazole tab 100 mg PA<br />
fluconazole tab 150 mg QL<br />
fluconazole tab 200 mg PA<br />
fluconazole tab 50 mg PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 26
FLUCONAZOLE/ INJ NACL 100 PA<br />
itraconazole cap 100 mg PA<br />
ketoconazole tab 200 mg<br />
ketoconazole tab 200mg<br />
SPORANOX KIT 250MG PA<br />
VFEND SUS 40MG/ML PA<br />
VFEND TAB 200MG PA<br />
VFEND TAB 50MG PA<br />
VFEND IV INJ 200MG PA<br />
Echinocandins<br />
CANCIDAS INJ 50MG PA<br />
CANCIDAS INJ 70MG PA<br />
ERAXIS INJ 100MG PA<br />
ERAXIS INJ 50MG PA<br />
MYCAMINE INJ 100MG PA<br />
MYCAMINE INJ 50MG PA<br />
Polyenes<br />
ABELCET INJ 5MG/ML PA<br />
AMBISOME INJ 50MG PA<br />
AMPHOTEC INJ 100MG PA<br />
AMPHOTEC INJ 50MG PA<br />
amphotericin b for inj 50 mg PA<br />
nystatin sus 100000<br />
nystatin susp 100000 unit/ml<br />
Antifungals, Miscellaneous<br />
GRIFULVIN V TAB 500MG<br />
GRIS-PEG TAB 125MG<br />
GRIS-PEG TAB 250MG<br />
griseofulvin microsize susp 125 mg/5ml<br />
GRISEOFULVIN MICROSIZE TAB 500 MG<br />
griseofulvin sus 125/5ml<br />
GRISEOFULVIN TAB 250 ULTR<br />
GRISEOFULVIN ULTRAMICROSIZE TAB 125 MG<br />
GRISEOFULVIN ULTRAMICROSIZE TAB 250 MG<br />
Antimycobacterials<br />
Antituberculosis Agents<br />
CAPASTAT SUL INJ 1GM PA<br />
ethambutol tab 100mg<br />
ethambutol tab 400mg<br />
ethambutol hcl tab 100 mg<br />
ethambutol hcl tab 400 mg<br />
ISONIAZID INJ 100MG/ML PA<br />
ISONIAZID SYP 50MG/5ML<br />
isoniazid tab 100mg<br />
isoniazid tab 300mg<br />
ISONIAZID SYRUP 50 MG/5ML<br />
isoniazid tab 100 mg<br />
isoniazid tab 300 mg<br />
pyrazinamide tab 500 mg<br />
pyrazinamide tab 500mg<br />
rifampin cap 150mg<br />
rifampin cap 300mg<br />
rifampin cap 150 mg<br />
rifampin cap 300 mg<br />
rifampin for inj 600 mg PA<br />
Antivirals<br />
HIV Fusion Inhibitors<br />
FUZEON KIT PA<br />
HIV Protease Inhibitors<br />
AGENERASE CAP 50MG PA<br />
AGENERASE SOL 15MG/ML PA<br />
CRIXIVAN CAP 100MG PA<br />
CRIXIVAN CAP 200MG PA<br />
CRIXIVAN CAP 333MG PA<br />
CRIXIVAN CAP 400MG PA<br />
INVIRASE CAP 200MG PA<br />
NORVIR CAP 100MG PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 27
NORVIR SOL 80MG/ML PA<br />
VIRACEPT POW 50MG/GM PA<br />
VIRACEPT TAB 250MG PA<br />
VIRACEPT TAB 625MG PA<br />
Nonnucleoside Reverse Transcriptase Inhibitors<br />
INTELENCE TAB 100MG PA QL<br />
RESCRIPTOR TAB 100 MG PA<br />
RESCRIPTOR TAB 200MG PA<br />
SUSTIVA CAP 100MG PA<br />
SUSTIVA CAP 200MG PA<br />
SUSTIVA CAP 50MG PA<br />
VIRAMUNE TAB 200MG PA<br />
Nucleoside & Nucleotide Rev Transcriptase Inhib<br />
COMBIVIR TAB PA<br />
EPIVIR SOL 10MG/ML PA<br />
EPIVIR TAB 150MG PA<br />
EPIVIR TAB 300MG PA<br />
EPIVIR HBV SOL 5MG/ML PA<br />
EPIVIR HBV TAB 100MG PA<br />
HIVID TAB 0.375MG PA<br />
HIVID TAB 0.75MG PA<br />
RETROVIR INJ 10MG/ML PA<br />
stavudine cap 15 mg PA<br />
stavudine cap 20 mg PA<br />
stavudine cap 30 mg PA<br />
stavudine cap 40 mg PA<br />
stavudine for oral soln 1 mg/ml PA<br />
VIDEX SOL 2GM PA<br />
VIDEX SOL 4GM PA<br />
ZIAGEN SOL 20MG/ML PA<br />
ZIAGEN TAB 300MG PA<br />
zidovudine cap 100 mg PA<br />
zidovudine syrup 10 mg/ml PA<br />
zidovudine tab 300 mg PA<br />
Interferons<br />
INFERGEN INJ 15MCG PA<br />
INFERGEN INJ 9MCG PA<br />
PEG-INTRON KIT 120 RP PA<br />
PEG-INTRON KIT 120MCG PA<br />
PEG-INTRON KIT 150 RP PA<br />
PEG-INTRON KIT 150MCG PA<br />
PEG-INTRON KIT 50MCG PA<br />
PEG-INTRON KIT 50MCG RP PA<br />
PEG-INTRON KIT 80MCG PA<br />
PEG-INTRON KIT 80MCG RP PA<br />
PEGASYS INJ 180MCG/M PA<br />
PEGASYS KIT PA<br />
Monoclonal Antibodies<br />
SYNAGIS INJ 100MG/ML PA<br />
SYNAGIS INJ 50MG PA<br />
Neuraminidase Inhibitors<br />
OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)<br />
OSELTAMIVIR PHOSPHATE CAP 45 MG (BASE EQUIV)<br />
OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV)<br />
OSELTAMIVIR PHOSPHATE FOR SUSP 12 MG/ML (BASE EQUIV)<br />
RELENZA AER DISKHALE QL<br />
RELENZA MIS DISKHALE QL<br />
TAMIFLU CAP 30MG<br />
TAMIFLU CAP 45MG<br />
TAMIFLU CAP 75MG<br />
TAMIFLU SUS 12MG/ML<br />
ZANAMIVIR AERO POWDER BREATH ACTIVATED 5 MG/BLISTER QL<br />
Nucleosides and Nucleotides<br />
acyclovir cap 200mg<br />
acyclovir sus 200/5ml<br />
acyclovir tab 400mg<br />
acyclovir tab 800mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 28
acyclovir cap 200 mg<br />
ACYCLOVIR NA INJ 1000MG PA<br />
ACYCLOVIR NA INJ 50MG/ML PA<br />
acyclovir sodium for inj 500 mg PA<br />
acyclovir susp 200 mg/5ml<br />
acyclovir tab 400 mg<br />
acyclovir tab 800 mg<br />
CYTOVENE INJ 500MG PA<br />
GANCICLOVIR CAP 500MG PA<br />
ganciclovir cap 250 mg PA<br />
ganciclovir cap 500 mg PA<br />
HEPSERA TAB 10MG PA<br />
ribavirin cap 200 mg PA<br />
VALCYTE TAB 450MG<br />
VALGANCICLOVIR HCL TAB 450 MG<br />
VISTIDE INJ 75MG/ML PA<br />
Antivirals, Miscellaneous<br />
FOSCARNET INJ 24MG/ML PA<br />
Antiprotozoals<br />
Antimalarials<br />
DARAPRIM TAB 25MG<br />
hydroxychlor tab 200mg<br />
hydroxychloroquine sulfate tab 200 mg<br />
PRIMAQUINE TAB 26.3MG<br />
PRIMAQUINE PHOSPHATE TAB 26.3 MG<br />
PYRIMETHAMINE TAB 25 MG<br />
Antiprotozoals, Miscellaneous<br />
ALINIA SUS 100MG/5M PA QL<br />
ALINIA TAB 500MG PA QL<br />
METRO IV INJ 5MG/ML PA<br />
metronidazol tab 250mg<br />
metronidazol tab 500mg<br />
metronidazole in nacl 0.79% iv soln 500 mg/100ml PA<br />
metronidazole tab 250 mg<br />
metronidazole tab 500 mg<br />
NEBUPENT INH 300MG PA<br />
NEUTREXIN INJ 200MG PA<br />
NEUTREXIN INJ 25MG PA<br />
PENTAM 300 INJ 300MG PA<br />
pentamidine isethionate for soln 300 mg PA<br />
Urinary Anti-infectives<br />
FURADANTIN SUS 25MG/5ML<br />
MACRODANTIN CAP 25MG<br />
nitrofur mac cap 100mg<br />
nitrofur mac cap 50mg<br />
nitrofurantn cap 100mg<br />
nitrofuranto cap 100mg<br />
nitrofurantoin macrocrystalline cap 100 mg<br />
NITROFURANTOIN MACROCRYSTALLINE CAP 25 MG<br />
nitrofurantoin macrocrystalline cap 50 mg<br />
nitrofurantoin monohydrate macrocrystalline cap 100 mg<br />
NITROFURANTOIN SUSP 25 MG/5ML<br />
trimethoprim tab 100 mg<br />
trimethoprim tab 100mg<br />
Anti-infectives, Miscellaneous<br />
HELIDAC MIS<br />
METRONIDAZ TAB-TETRACYC CAP-BIS SUBSAL CHEW TAB THERAPY PACK<br />
Antineoplastic Agents<br />
ABRAXANE INJ 100MG PA<br />
ADRIAMYCIN INJ 20MG PA<br />
ALFERON N INJ 5MU/ML PA<br />
ALIMTA INJ 100MG PA<br />
ALIMTA INJ 500MG PA<br />
ALKERAN INJ 50MG PA<br />
ALKERAN TAB 2MG<br />
ALTRETAMINE CAP 50 MG<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 29
ARRANON INJ 5MG/ML PA<br />
ARZERRA CON 100/5ML PA<br />
AVASTIN INJ PA<br />
BEXAROTENE CAP 75 MG<br />
BEXXAR CON 14MG/ML PA<br />
BEXXAR 131 I INJ 0.61/ML PA<br />
BEXXAR 131 I INJ 5.6MCI/M PA<br />
BICNU INJ 100MG PA<br />
bleomycin sulfate for inj 15 unit PA<br />
bleomycin sulfate for inj 30 unit PA<br />
BUSULFAN TAB 2 MG<br />
BUSULFEX INJ 6MG/ML PA<br />
CAMPATH INJ 10MG/ML PA<br />
CAMPATH INJ 30MG/ML PA<br />
carboplatin iv for inj 150 mg PA<br />
carboplatin iv for inj 450 mg PA<br />
carboplatin iv for inj 450 mg PA<br />
carboplatin iv for inj 50 mg PA<br />
carboplatin iv for inj 50 mg PA<br />
carboplatin iv soln 10 mg/ml PA<br />
CEENU CAP 100MG<br />
CEENU CAP 10MG<br />
CEENU CAP 40MG<br />
CEENU PAK DOSEPACK<br />
CHLORAMBUCIL TAB 2 MG<br />
cisplatin inj 1 mg/ml PA<br />
cladribine inj 1 mg/ml PA<br />
CLOLAR INJ 1MG/ML PA<br />
COSMEGEN INJ 0.5MG PA<br />
CYCLOPHOSPH INJ 1GM PA<br />
CYCLOPHOSPH INJ 2GM PA<br />
CYCLOPHOSPH INJ 500MG PA<br />
CYCLOPHOSPH TAB 25MG<br />
cyclophosph tab 25mg<br />
cyclophosph tab 25mg<br />
CYCLOPHOSPH TAB 50MG<br />
cyclophosph tab 50mg<br />
cyclophosph tab 50mg<br />
cyclophosphamide tab 25 mg<br />
CYCLOPHOSPHAMIDE TAB 25 MG<br />
cyclophosphamide tab 25 mg<br />
CYCLOPHOSPHAMIDE TAB 50 MG<br />
cyclophosphamide tab 50 mg<br />
cyclophosphamide tab 50 mg<br />
CYTARABINE INJ 100MG PA<br />
CYTARABINE INJ 20MG/ML PA<br />
cytarabine for inj 1 gm PA<br />
cytarabine for inj 2 gm PA<br />
cytarabine for inj 500 mg PA<br />
cytarabine inj 100 mg/ml PA<br />
DACARBAZINE INJ 100MG PA<br />
dacarbazine for inj 200 mg PA<br />
DACOGEN INJ 50MG PA<br />
daunorubicin hcl for inj 20 mg PA<br />
daunorubicin hcl inj 5 mg/ml (base equiv) PA<br />
DAUNOXOME INJ 2MG/ML PA<br />
DEPOCYT INJ 50MG/5ML PA<br />
DOXIL INJ 2MG/ML PA<br />
doxorubicin hcl for inj 10 mg PA<br />
doxorubicin hcl for inj 50 mg PA<br />
doxorubicin hcl inj 2 mg/ml PA<br />
ELIGARD INJ 22.5MG PA<br />
ELIGARD INJ 30MG PA<br />
ELIGARD INJ 45MG PA<br />
ELIGARD INJ 7.5MG PA<br />
ELOXATIN INJ 100MG PA<br />
ELOXATIN INJ 50MG PA<br />
ELSPAR INJ 10000UNT PA<br />
EPIRUBICIN INJ 200MG PA<br />
EPIRUBICIN INJ 50MG PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 30
epirubicin hcl inj 2 mg/ml PA<br />
ERBITUX INJ 100MG PA<br />
ERBITUX INJ 200MG PA<br />
ETOPOPHOS INJ 100MG PA<br />
ETOPOSIDE CAP 50MG<br />
etoposide cap 50mg<br />
etoposide cap 50 mg<br />
ETOPOSIDE CAP 50 MG<br />
etoposide inj 20 mg/ml PA<br />
FASLODEX INJ 125MG PA<br />
FASLODEX INJ 250MG PA<br />
FIRMAGON INJ 120MG PA<br />
FIRMAGON INJ 80MG PA<br />
floxuridine for inj 0.5 gm PA<br />
fludarabine phosphate for inj 50 mg PA<br />
fludarabine phosphate inj 25 mg/ml PA<br />
fluorouracil inj 50 mg/ml PA<br />
FOLOTYN INJ 20MG/ML PA<br />
FOLOTYN INJ 40MG/2ML PA<br />
GEMZAR INJ 1 GM PA<br />
GEMZAR INJ 200MG PA<br />
HERCEPTIN INJ 440MG PA<br />
HEXALEN CAP 50MG<br />
HYCAMTIN INJ 4MG PA<br />
hydroxyurea cap 500mg<br />
hydroxyurea cap 500 mg<br />
idarubicin hcl iv inj 1 mg/ml PA<br />
IFEX INJ 3GM PA<br />
IFOSFAMIDE INJ 3GM PA<br />
IFOSFAMIDE KIT MESNA PA<br />
ifosfamide & mesna inj kit 1000-1000 mg PA<br />
ifosfamide & mesna inj kit 3000-1000 mg PA<br />
ifosfamide for inj 1 gm PA<br />
ifosfamide iv inj 50 mg/ml PA<br />
INTRON-A INJ 10MU PA<br />
INTRON-A INJ 10MU PEN PA<br />
INTRON-A INJ 18MU PA<br />
INTRON-A INJ 25MU PA<br />
INTRON-A INJ 3MU PEN PA<br />
INTRON-A INJ 50MU PA<br />
INTRON-A INJ 5MU PEN PA<br />
INTRON-A KIT 10MU/ML PA<br />
IRESSA TAB 250MG PA<br />
irinotecan hcl inj 20 mg/ml PA<br />
ISTODAX INJ 10MG PA<br />
IXEMPRA KIT INJ 15MG PA<br />
IXEMPRA KIT INJ 45MG PA<br />
LEUKERAN TAB 2MG<br />
LEUPROLIDE INJ 1MG/0.2 PA<br />
leuprolide acetate inj kit 5 mg/ml PA<br />
LOMUSTINE CAP 10 MG<br />
LOMUSTINE CAP 100 MG<br />
LOMUSTINE CAP 40 MG<br />
LOMUSTINE CAP DOSE PACK<br />
LUPR DEP-PED INJ 11.25MG PA<br />
LUPR DEP-PED INJ 15MG PA<br />
LUPR DEP-PED INJ 7.5MG PA<br />
LUPRON DEPOT INJ 11.25MG PA<br />
LUPRON DEPOT INJ 22.5MG PA<br />
LUPRON DEPOT INJ 3.75MG PA<br />
LUPRON DEPOT INJ 30MG PA<br />
LUPRON DEPOT INJ 7.5MG PA<br />
LYSODREN TAB 500MG<br />
MATULANE CAP 50MG<br />
megestrol ac sus 400mg/10<br />
megestrol ac sus 40mg/ml<br />
megestrol ac sus 800mg/20<br />
megestrol ac tab 20mg<br />
megestrol ac tab 40mg<br />
megestrol acetate susp 40 mg/ml<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 31
megestrol acetate tab 20 mg<br />
megestrol acetate tab 40 mg<br />
melphalan hcl for inj 50 mg (base equiv) PA<br />
MELPHALAN TAB 2 MG<br />
mercaptopur tab 50mg<br />
mercaptopurine tab 50 mg<br />
methotrexate sodium for inj 1 gm PA<br />
methotrexate sodium inj 25 mg/ml PA<br />
methotrexate sodium inj pf 25 mg/ml PA<br />
METHOTREXATE SODIUM TAB 2.5 MG (ANTIRHEUMATIC)<br />
methotrexate sodium tab 2.5 mg (antirheumatic)<br />
methotrexate sodium tab 2.5 mg (base equiv) NF<br />
methotrexate tab 2.5mg<br />
methotrexate tab 2.5mg NF<br />
mitomycin for inj 20 mg PA<br />
mitomycin for inj 40 mg PA<br />
mitomycin for inj 5 mg PA<br />
MITOTANE TAB 500 MG<br />
mitoxantrone hcl inj conc 2 mg/ml PA<br />
MUSTARGEN INJ 10MG PA<br />
MYLERAN TAB 2MG<br />
MYLOTARG INJ 5MG PA<br />
ONCASPAR INJ 750/ML PA<br />
ONTAK INJ 150/ML PA<br />
oxaliplatin iv soln 5 mg/ml PA<br />
oxaliplatin for iv inj 100 mg PA<br />
oxaliplatin for iv inj 50 mg PA<br />
paclitaxel iv conc 6 mg/ml PA<br />
pentostatin for inj 10 mg PA<br />
PHOTOFRIN INJ 75MG PA<br />
PLENAXIS INJ 100MG PA<br />
PROCARBAZINE HCL CAP 50 MG<br />
PROLEUKIN INJ 22MU PA<br />
PROVENGE INJ PA<br />
RHEUMATREX TAB 2.5MG<br />
RITUXAN INJ 100MG PA<br />
RITUXAN INJ 500MG PA<br />
ROFERON-A KIT 3MU/0.5 PA<br />
ROFERON-A KIT 6MU/0.5 PA<br />
ROFERON-A KIT 9MU/0.5 PA<br />
SUPPRELIN LA KIT 50MG PA<br />
TABLOID TAB 40MG<br />
TARGRETIN CAP 75MG<br />
TAXOTERE INJ 20/0.5ML PA<br />
TAXOTERE INJ 80MG/2ML PA<br />
TEMODAR INJ 100MG PA<br />
THIOGUANINE TAB 40 MG<br />
THIOTEPA INJ 15MG PA<br />
thiotepa for inj 15 mg PA<br />
TORISEL SOL 25MG/ML PA<br />
TREANDA INJ 100MG PA<br />
TREANDA INJ 25MG PA<br />
TRELSTAR DEP INJ 3.75MG PA<br />
TRELSTAR LA INJ 11.25MG PA<br />
TRELSTAR MIX INJ 22.5MG PA<br />
tretinoin cap 10mg<br />
tretinoin cap 10 mg<br />
TRISENOX SOL 10MG/10M PA<br />
VANTAS KIT 50MG PA<br />
VECTIBIX INJ 100MG PA<br />
VECTIBIX INJ 200MG PA<br />
VECTIBIX INJ 400MG PA<br />
VELCADE INJ 3.5MG PA<br />
VIADUR KIT PA<br />
VIDAZA INJ 100MG PA<br />
VINBLASTINE INJ 10MG PA<br />
VINBLASTINE INJ 1MG/ML PA<br />
vincristine sulfate iv soln 1 mg/ml PA<br />
vinorelbine tartrate inj 10 mg/ml PA<br />
VUMON INJ 50MG/5ML PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 32
ZANOSAR INJ 1GM PA<br />
ZEVALIN KIT IN-111 PA<br />
ZEVALIN KIT Y-90 PA<br />
ZOLADEX IMP 10.8MG PA<br />
ZOLADEX IMP 3.6MG PA<br />
Autonomic <strong>Drugs</strong><br />
Parasympathomimetic (Cholinergic) Agents<br />
bethanechol tab 10mg<br />
bethanechol tab 25mg<br />
bethanechol tab 50mg<br />
bethanechol tab 5mg<br />
bethanechol chloride tab 10 mg<br />
bethanechol chloride tab 25 mg<br />
bethanechol chloride tab 5 mg<br />
bethanechol chloride tab 50 mg<br />
ENLON-PLUS INJ PA<br />
ENLON-PLUS INJ 10-0.14 PA<br />
MESTINON SYP 60MG/5ML<br />
MESTINON TAB TIMESPAN<br />
neostigmine methylsulfate inj 0.5 mg/ml (1:2000) PA<br />
neostigmine methylsulfate inj 1 mg/ml PA<br />
PHYSOS SALIC INJ 1MG/ML PA<br />
physostigmine salicylate inj 1 mg/ml PA<br />
pyridostigm tab 60mg<br />
PYRIDOSTIGMINE BROMIDE SYRUP 60 MG/5ML<br />
pyridostigmine bromide tab 60 mg<br />
PYRIDOSTIGMINE BROMIDE TAB CR 180 MG<br />
REGONOL INJ 5MG/ML PA<br />
Anticholinergic Agents<br />
Antimuscarinics/Antispasmodics<br />
alkabel-sr tab<br />
antispasmod elx<br />
ATROPINE SUL INJ 0.05MG/1 PA<br />
ATROPINE SUL INJ 0.4/0.5 PA<br />
atropine sulfate inj 0.1 mg/ml PA<br />
atropine sulfate inj 0.4 mg/ml PA<br />
atropine sulfate inj 1 mg/ml PA<br />
ATROVENT HFA AER 17MCG QL<br />
bella alk/pb elx<br />
bella alk/pb elx<br />
bella alk/pb tab 16.2mg<br />
belladonna alkaloids-phenobarbital elixir 16 mg/5ml<br />
belladonna alkaloids-phenobarbital tab 16.2 mg<br />
belladonna alkaloids-phenobarbital tab cr 48 mg<br />
chlord/clidi cap 5-2.5mg<br />
chlord/clidi cap 5-2.5mg<br />
chlord/clidi cap 5-2.5mg<br />
clidi/chlord cap 2.5-5mg<br />
clidinium & chlordiazepoxide cap 2.5-5 mg<br />
colidrops dro 0.125/ml<br />
COLYTROL DRO PEDS PA<br />
dicyclomine cap 10mg<br />
dicyclomine tab 20mg<br />
dicyclomine hcl cap 10 mg<br />
dicyclomine hcl inj 10 mg/ml PA<br />
dicyclomine hcl oral soln 10 mg/5ml PA<br />
dicyclomine hcl tab 20 mg<br />
donnaphen tab<br />
glycopyrrolate inj 0.2 mg/ml PA<br />
haponal tab<br />
hyomax tab 0.125mg<br />
hyomax-sl sub 0.125mg<br />
hyoscyamine cap 0.375 cr<br />
hyoscyamine cap 0.375 er<br />
hyoscyamine cap 0.375 sr<br />
hyoscyamine cap 0.375 tr<br />
hyoscyamine dro 0.125/ml<br />
hyoscyamine elx 0.125/5<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 33
hyoscyamine sub 0.125mg<br />
hyoscyamine tab 0.125mg<br />
hyoscyamine sulfate cap sr 12hr 0.375 mg<br />
hyoscyamine sulfate elixir 0.125 mg/5ml<br />
hyoscyamine sulfate soln 0.125 mg/ml<br />
hyoscyamine sulfate tab 0.125 mg<br />
hyoscyamine sulfate tab sl 0.125 mg<br />
hyosyne dro 0.125/ml<br />
hyosyne elx 0.125/5<br />
ipratropium sol inhal<br />
ipratropium spr 0.03% QL<br />
IPRATROPIUM BROMIDE HFA INHAL AEROSOL 17 MCG/ACT QL<br />
ipratropium bromide inhal soln 0.02%<br />
ipratropium bromide nasal soln 0.03% (21 mcg/spray) QL<br />
lahey mixtur elx #3<br />
LEVSIN INJ 0.5MG/ML PA<br />
PROPANTHELIN TAB 15MG<br />
propanthelin tab 15mg<br />
propantheline bromide tab 15 mg<br />
PROPANTHELINE BROMIDE TAB 15 MG<br />
re-pb hyos elx 16mg/5ml<br />
SCOPOLAMINE INJ 0.4MG/ML PA<br />
servira tab 48mg<br />
spasdel dro 0.125/ml<br />
spasdel elx 0.125/5<br />
spasdel tab 0.125mg<br />
symax-sl sub 0.125mg<br />
Sympathomimetic (Adrenergic) Agents<br />
alpha-Adrenergic Agonists<br />
666 cold tab 5-325mg OTC<br />
contac tab cold+flu OTC<br />
cvs daytime cap sinus OTC<br />
day-time cap sinus OTC<br />
eql sinus tab cng/pain OTC<br />
EXTENDRYL TAB PEM<br />
flu/cold pak daytime OTC<br />
gnp day time cap sinus OTC<br />
gnp flu/cold pak daytime OTC<br />
gnp sinus tab 5-325mg OTC<br />
gnp sinus tab cng/pain OTC<br />
mapap sinus tab max st OTC<br />
non-pseudo tab sinus OTC<br />
pain relief tab sinus pe OTC<br />
pain relievr tab sinus pe OTC<br />
pain rlf sin tab pe day OTC<br />
phenylephrine hcl inj 10 mg/ml PA<br />
phenylephrine w/ acetaminophen cap 5-325 mg OTC<br />
PHENYLEPHRINE W/ ACETAMINOPHEN DROPS 1.25-80 MG/0.8ML OTC<br />
phenylephrine w/ acetaminophen powd pack 10-650 mg OTC<br />
phenylephrine w/ acetaminophen tab 5-325 mg OTC<br />
phenylephrine w/ acetaminophen tab 5-500 mg OTC<br />
PHENYLEPHRINE-METHSCOPOLAMINE TAB CR 30-1.25 MG<br />
pyrroxate tab 5-325mg OTC<br />
qc daytime cap sinus OTC<br />
qc sinus pai tab relief OTC<br />
ra sinus cng tab /pain dt OTC<br />
sb daytime cap sinus OTC<br />
sb sinus cng tab /pain dt OTC<br />
sinus congst tab /pain dt OTC<br />
sinus congst tab /pain dt OTC<br />
sinus congst tab daytime OTC<br />
sinus congst tab expr gel OTC<br />
sinus formul tab daytime OTC<br />
sinus pain tab day/rr OTC<br />
sinus pain tab daytime OTC<br />
sinus relief tab 5-325mg OTC<br />
sinutab sinu tab max st OTC<br />
sudafed pe tab sinus OTC<br />
suphedrine tab pe OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 34
suphedrn pe tab 5-325mg OTC<br />
TYLENOL INF DRO PLUS CLD OTC<br />
tylenol sinu tab cng/pain OTC<br />
tylenol sinu tab cng/rr OTC<br />
wal-flu cold pak daytime OTC<br />
wal-phed pe tab sinus ha OTC<br />
beta-Adrenergic Agonists<br />
ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)<br />
PROAIR HFA AER<br />
Non-selective beta-Adrenergic Agonists<br />
ISUPREL INJ 0.2MG/ML PA<br />
Selective beta-1-Adrenergic Agonists<br />
dobutamine hcl inj 12.5 mg/ml PA<br />
dobutamine inj 1 mg/ml in d5w PA<br />
dobutamine inj 2 mg/ml in d5w PA<br />
dobutamine inj 4 mg/ml in d5w PA<br />
DOPAMINE INJ 160MG/ML PA<br />
dopamine hcl inj 40 mg/ml PA<br />
dopamine hcl inj 80 mg/ml PA<br />
dopamine inj 0.8 mg/ml in d5w PA<br />
dopamine inj 1.6 mg/ml in d5w PA<br />
dopamine inj 3.2 mg/ml in d5w PA<br />
Selective beta-2-Adrenergic Agonists<br />
ADVAIR DISKU AER 100/50 QL<br />
ADVAIR DISKU AER 250/50 QL<br />
ADVAIR DISKU AER 500/50 QL<br />
ADVAIR HFA AER 115/21 PA<br />
ADVAIR HFA AER 230/21 PA<br />
ADVAIR HFA AER 45/21 PA<br />
albuterol neb 0.083%<br />
albuterol neb 0.5%<br />
albuterol neb 0.63mg/3<br />
albuterol neb 1.25mg/3<br />
albuterol syp 2mg/5ml<br />
albuterol tab 2mg<br />
albuterol tab 4mg<br />
albuterol tab 4mg er<br />
albuterol tab 8mg er<br />
ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)<br />
albuterol sulfate soln nebu 0.083% (2.5 mg/3ml)<br />
albuterol sulfate soln nebu 0.5% (5 mg/ml)<br />
albuterol sulfate soln nebu 0.63 mg/3ml (base equiv)<br />
albuterol sulfate soln nebu 1.25 mg/3ml (base equiv)<br />
albuterol sulfate syrup 2 mg/5ml<br />
albuterol sulfate tab 2 mg<br />
albuterol sulfate tab 4 mg<br />
albuterol sulfate tab sr 12hr 4 mg<br />
albuterol sulfate tab sr 12hr 8 mg<br />
ALUPENT INH AER 0.65/ACT QL<br />
FLUTICASONE-SALMETEROL AER POWDER BA 100-50 MCG/DOSE QL<br />
FLUTICASONE-SALMETEROL AER POWDER BA 250-50 MCG/DOSE QL<br />
FLUTICASONE-SALMETEROL AER POWDER BA 500-50 MCG/DOSE QL<br />
FORADIL CAP AEROLIZE QL<br />
FORMOTEROL FUMARATE INHAL CAP 12 MCG QL<br />
MAXAIR AUTOH AER 200MCG<br />
metaproteren neb 0.4%<br />
metaproteren neb 0.6%<br />
metaproteren syp 10mg/5ml<br />
metaproteren tab 10mg<br />
METAPROTEREN TAB 10MG<br />
METAPROTEREN TAB 20MG<br />
metaproteren tab 20mg<br />
METAPROTERENOL SULFATE INHAL AEROSOL POW 0.65 MG/ACT QL<br />
metaproterenol sulfate soln nebu 0.4%<br />
metaproterenol sulfate soln nebu 0.6%<br />
metaproterenol sulfate syrup 10 mg/5ml<br />
METAPROTERENOL SULFATE TAB 10 MG<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 35
metaproterenol sulfate tab 10 mg<br />
METAPROTERENOL SULFATE TAB 20 MG<br />
metaproterenol sulfate tab 20 mg<br />
PIRBUTEROL ACETATE BREATH ACTIVATED INHAL AEROSOL 200MCG/INH<br />
PROAIR HFA AER<br />
PROVENTIL AER HFA<br />
SALMETEROL XINAFOATE AER POW BA 50 MCG/DOSE (BASE EQUIV) QL<br />
SEREVENT DIS AER 50MCG QL<br />
terbutaline tab 2.5mg<br />
terbutaline tab 5mg<br />
terbutaline sulfate inj 1 mg/ml PA<br />
terbutaline sulfate tab 2.5 mg<br />
terbutaline sulfate tab 5 mg<br />
VENTOLIN HFA AER<br />
alpha- and beta-Adrenergic Agonists<br />
666 cold tab 30-500mg OTC<br />
ADRENACLICK INJ 0.15MG PA<br />
ADRENACLICK INJ 0.3MG QL<br />
ADVIL COLD/ CAP SINUS OTC<br />
af-ibup sinu tab 30-200mg OTC<br />
amdry-d tab 120-2.5<br />
apap sinus tab 30-500mg OTC<br />
bl ibu-profe tab cold/sin OTC<br />
child advil sus cold OTC<br />
child ibupro sus cold OTC<br />
cold tab 30-325mg OTC<br />
cvs ibuprofn tab cold/sin OTC<br />
cvs si/ha/de tab 30-500mg OTC<br />
cvs sinus tab max-str OTC<br />
dilotab tab OTC<br />
dimetapp sus cold/fvr OTC<br />
dristan tab sinus OTC<br />
dristan cold tab no-drows OTC<br />
eck ibuprofn tab cold/sin OTC<br />
eck infant dro cold OTC<br />
eck sinus tab headache OTC<br />
ephedrine sulfate inj 50 mg/ml PA<br />
EPHEDRINE W/ ASPIRIN-CAFF-ACETANILID CAP 30-180-15-60 MG OTC<br />
EPINEPHRINE INJ PA<br />
EPINEPHRINE INJ 0.15MG PA<br />
EPINEPHRINE INJ 0.3MG QL<br />
epinephrine hcl inj 0.1 mg/ml PA<br />
epinephrine hcl inj 1 mg/ml PA<br />
EPINEPHRINE INJ DEVICE 0.15 MG/0.3ML (1:2000) QL<br />
EPINEPHRINE INJ DEVICE 0.3 MG/0.3ML (1:1000) QL<br />
EPINEPHRINE INJ DEVICE 0.3 MG/0.3ML (1:1000) QL<br />
EPIPEN INJ 0.3MG QL<br />
EPIPEN 2-PAK INJ 0.3MG QL<br />
EPIPEN-JR INJ 0.15MG QL<br />
EPIPEN-JR INJ 2-PAK QL<br />
eq ibuprofen sus cold OTC<br />
eq ibuprofen tab cold/sin OTC<br />
eq sinus rel tab max st OTC<br />
eql ibuprofn tab cold/sin OTC<br />
eql sinus tab headache OTC<br />
extendryl tab pse<br />
genapap sinu tab max-str OTC<br />
gnp chld ibu sus cold OTC<br />
gnp ibuprofn tab cold/sin OTC<br />
HAYSMA CAP OTC<br />
ibu-profen tab cold/sin OTC<br />
ibu/pse tab cold/sin OTC<br />
ibuprofen sus cold OTC<br />
ibuprofen sus cold OTC<br />
ibuprofen tab cold/sin OTC<br />
ibuprofen tab cold/sin OTC<br />
ibuprofn/pse tab 200/30mg OTC<br />
infant pain dro rel/cold OTC<br />
infant pain dro rel/cold OTC<br />
iprin cold/ tab sinus OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 36
mapap sinus tab max-str OTC<br />
medi-profen tab cold/sin OTC<br />
medi-synal tab 30-325mg OTC<br />
medi-tabs tab sinus OTC<br />
motrin cold tab & sinus OTC<br />
nasal decon tab sinus OTC<br />
non aspirin sol OTC<br />
non-asa tab sinus OTC<br />
non-asa sinu tab 30-500mg OTC<br />
non-asa sinu tab 30-500mg OTC<br />
non-asa sinu tab max str OTC<br />
non-drowsy tab sinus OTC<br />
norepinephrine bitartrate inj 1 mg/ml PA<br />
ornex tab max st OTC<br />
ornex tab max str OTC<br />
pain relief tab sinus OTC<br />
pain relief tab sinus OTC<br />
pain relief tab sinus OTC<br />
pain relieve tab 30-500mg OTC<br />
pain relieve tab sinus OTC<br />
pain relievr tab sinus OTC<br />
profen ib tab cold/sin OTC<br />
pse/methscop tab 120/2.5<br />
pseudoephedrine w/ acetaminophen cap 30-325 mg OTC<br />
PSEUDOEPHEDRINE W/ ACETAMINOPHEN CAP 30-500 MG OTC<br />
PSEUDOEPHEDRINE W/ ACETAMINOPHEN LIQUID 15-160 MG/5ML OTC<br />
pseudoephedrine w/ acetaminophen soln 7.5-80 mg/0.8ml OTC<br />
pseudoephedrine w/ acetaminophen tab 30-325 mg OTC<br />
pseudoephedrine w/ acetaminophen tab 30-500 mg OTC<br />
PSEUDOEPHEDRINE-IBUPROFEN CAP 30-200 MG OTC<br />
pseudoephedrine-ibuprofen susp 15-100 mg/5ml OTC<br />
pseudoephedrine-ibuprofen tab 30-200 mg OTC<br />
pseudoephedrine-methscopolamine tab sr 12hr 120-2.5 mg<br />
px ibuprofen tab cold/sin OTC<br />
qc daytime cap sinus OTC<br />
qc ibuprofen tab cold/sin OTC<br />
ra ibu-profe tab cold/sin OTC<br />
ra ibuprofen sus cold OTC<br />
ra sinus tab formula OTC<br />
respivent-d tab<br />
sb ibuprofen tab cold/sin OTC<br />
SB NON ASA CAP SINUS OTC<br />
sb pseudoeph tab sinus OTC<br />
sg su-phedri tab max st OTC<br />
sinus tab OTC<br />
sinus tab 30-325mg OTC<br />
sinus headac tab no drows OTC<br />
sinus max tab 30-500mg OTC<br />
sinus max st tab 30-500mg OTC<br />
sinus max st tab 30-500mg OTC<br />
sinus no drw tab max str OTC<br />
sinus non- tab drowsy OTC<br />
sinus non-dr tab max str OTC<br />
sinus pain tab max str OTC<br />
sinus pain/ tab pressure OTC<br />
sinus relief tab 30-325mg OTC<br />
sinus w/o tab drows OTC<br />
sinus w/o tab drowsy OTC<br />
sinutab m/s tab non-drow OTC<br />
sinutab sinu tab no drows OTC<br />
sm ibuprofen sus cold OTC<br />
sm non asa tab sinus OTC<br />
sm sinus tab headache OTC<br />
sm sinus tab max st OTC<br />
su-phedrin tab sinus ms OTC<br />
sudafed tab sinus OTC<br />
sudafed sinu tab ext str OTC<br />
sudatrate tab<br />
suphedrin tab sinus ms OTC<br />
suphedrine tab sinus OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 37
suphedrine tab sinus OTC<br />
sw cold/sinu tab pain rel OTC<br />
tavist sinus tab nd/ms OTC<br />
TWINJECT INJ 0.15MG PA<br />
TWINJECT INJ 0.15MG PA<br />
TWINJECT INJ 0.3MG QL<br />
TWINJECT INJ 0.3MG QL<br />
TYLENOL CHLD LIQ SINUS OTC<br />
tylenol inf dro plus cld OTC<br />
wal-profen tab cold/sin OTC<br />
Sympatholytic (Adrenergic Block) Agents<br />
Skeletal Muscle Relaxants<br />
CENTRALLY ACTING SKELETAL MUSCLE RELAXANTS<br />
AMRIX CAP 15MG<br />
AMRIX CAP 30MG<br />
carisopr/asa tab 200-325 QL<br />
CARISOPRODOL TAB 250 MG QL<br />
carisoprodol tab 350 mg QL<br />
carisoprodol tab 350mg QL<br />
carisoprodol w/ aspirin tab 200-325 mg QL<br />
cyclobenzapr tab 10mg<br />
cyclobenzapr tab 5mg<br />
CYCLOBENZAPRINE HCL CAP SR 24HR 15 MG<br />
CYCLOBENZAPRINE HCL CAP SR 24HR 30 MG<br />
cyclobenzaprine hcl tab 10 mg<br />
cyclobenzaprine hcl tab 5 mg<br />
CYCLOBENZAPRINE HCL TAB 7.5 MG<br />
FEXMID TAB 7.5MG<br />
FEXMID TAB 7.5MG PA<br />
ROBAXIN INJ 100MG/ML PA<br />
SOMA TAB 250MG QL<br />
SOMA TAB 250MG PA<br />
DIRECT ACTING SKELETAL MUSCLE RELAXANTS<br />
DANTRIUM IV INJ 20MG PA<br />
dantrolene sodium for iv soln 20 mg PA<br />
GABA DERIVATIVE SKELETAL MUSCLE RELAXANTS<br />
baclofen tab 10mg<br />
baclofen tab 20mg<br />
baclofen tab 10 mg<br />
baclofen tab 20 mg<br />
LIORESAL INT INJ 0.05MG/1 PA<br />
LIORESAL INT INJ 10MG/20 PA<br />
LIORESAL INT INJ 10MG/5ML PA<br />
LIORESAL INT INJ 40MG/20 PA<br />
NEUROMUSCULAR BLOCKING AGENTS<br />
atracurium besylate iv soln 10 mg/ml PA<br />
NIMBEX INJ 10MG/ML PA<br />
NIMBEX INJ 2MG/ML PA<br />
pancuronium bromide inj 1 mg/ml PA<br />
pancuronium bromide inj 2 mg/ml PA<br />
QUELICIN INJ -1000 PA<br />
rocuronium bromide iv soln 10 mg/ml PA<br />
tizanidine tab 2mg NF<br />
tizanidine hcl tab 2 mg NF<br />
vecuronium bromide for inj 10 mg PA<br />
vecuronium bromide for inj 20 mg PA<br />
SKELETAL MUSCLE RELAXANTS<br />
orphenadrine citrate inj 30 mg/ml PA<br />
orphenadrine citrate tab sr 12hr 100 mg<br />
orphenadrine tab 100mg cr<br />
orphenadrine tab 100mg er<br />
Autonomic <strong>Drugs</strong>, Miscellaneous<br />
CHANTIX PAK 0.5& 1MG PA<br />
CHANTIX PAK 1MG PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 38
CHANTIX TAB 0.5MG PA<br />
CHANTIX TAB 1MG PA<br />
nicotine polacrilex gum 2 mg PA OTC<br />
nicotine polacrilex gum 4 mg PA OTC<br />
nicotine polacrilex lozenge 2 mg PA OTC<br />
nicotine polacrilex lozenge 4 mg PA OTC<br />
NICOTINE SYS KIT TRANSDER PA OTC<br />
nicotine td patch 24hr 11 mg/24hr PA OTC<br />
nicotine td patch 24hr 14 mg/24hr PA OTC<br />
nicotine td patch 24hr 14 mg/24hr PA<br />
nicotine td patch 24hr 21 mg/24hr PA OTC<br />
nicotine td patch 24hr 21 mg/24hr PA<br />
nicotine td patch 24hr 22 mg/24hr PA OTC<br />
nicotine td patch 24hr 7 mg/24hr PA OTC<br />
nicotine td patch 24hr 7 mg/24hr PA<br />
NICOTROL INH PA<br />
NICOTROL NS SPR 10MG/ML PA<br />
Blood Derivatives<br />
albumin, human inj 25% PA<br />
albumin, human inj 5% PA<br />
PANHEMATIN INJ 313MG PA<br />
PLAS/SD SOL GROUP B PA<br />
PLASBUMIN-20 INJ PA<br />
PLASMANATE INJ 5% PA<br />
Blood Formation, Coagulation & Thrombosis<br />
Antianemia <strong>Drugs</strong><br />
Iron Preparations<br />
*IRON COMBINATION CAP CR*** NF<br />
*iron combination cap***<br />
conison cap<br />
fe fumarate w/ b12-vit c-fa-ifc cap 110-0.015-75-0.5-240 mg<br />
feogen cap<br />
FERAHEME INJ 510/17ML PA<br />
ferocon cap<br />
ferotrin cap<br />
ferotrinsic cap<br />
ferragen cap<br />
ferrex 150 cap forte<br />
FERRLECIT INJ 12.5MG/M PA<br />
FETRIN CAP NF<br />
foltrin cap<br />
hematogen cap<br />
ICAR PEDS SUS OTC<br />
ICAR PEDS SUS GRAPE OTC<br />
iferex 150 cap forte<br />
IROFOL LIQ<br />
iron dextran inj 50 mg/ml PA<br />
iron polysacch complex-vit b12-fa cap 150-0.025-1 mg<br />
IRON SUSP 15 MG/1.25ML OTC<br />
IRON SUSP 15 MG/1.5ML OTC<br />
IRON-FOLIC ACID LIQUID 100-1 MG/5ML<br />
martinic cap<br />
myferon 150 cap forte<br />
MYKIDZ IRON SUS 15/1.5ML OTC<br />
NEOTRON-S INJ PA<br />
poly/iron cap 150 fort<br />
polysacchari cap iron<br />
tl icon cap<br />
tricon cap<br />
VENOFER INJ 20MG/ML PA<br />
Antithrombotic Agents<br />
Coumarin Derivatives<br />
COUMADIN INJ 5 MG PA<br />
COUMADIN TAB 10MG<br />
COUMADIN TAB 1MG<br />
COUMADIN TAB 2.5MG<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 39
COUMADIN TAB 2MG<br />
COUMADIN TAB 3MG<br />
COUMADIN TAB 4MG<br />
COUMADIN TAB 5MG<br />
COUMADIN TAB 6MG<br />
COUMADIN TAB 7.5MG<br />
jantoven tab 10mg<br />
jantoven tab 1mg<br />
jantoven tab 2.5mg<br />
jantoven tab 2mg<br />
jantoven tab 3mg<br />
jantoven tab 4mg<br />
jantoven tab 5mg<br />
jantoven tab 6mg<br />
jantoven tab 7.5mg<br />
warfarin tab 10mg<br />
warfarin tab 1mg<br />
warfarin tab 2.5mg<br />
warfarin tab 2mg<br />
warfarin tab 3mg<br />
warfarin tab 4mg<br />
warfarin tab 5mg<br />
warfarin tab 6mg<br />
warfarin tab 7.5mg<br />
warfarin sodium tab 1 mg<br />
WARFARIN SODIUM TAB 1 MG<br />
WARFARIN SODIUM TAB 10 MG<br />
warfarin sodium tab 10 mg<br />
WARFARIN SODIUM TAB 2 MG<br />
warfarin sodium tab 2 mg<br />
WARFARIN SODIUM TAB 2.5 MG<br />
warfarin sodium tab 2.5 mg<br />
WARFARIN SODIUM TAB 3 MG<br />
warfarin sodium tab 3 mg<br />
warfarin sodium tab 4 mg<br />
WARFARIN SODIUM TAB 4 MG<br />
WARFARIN SODIUM TAB 5 MG<br />
warfarin sodium tab 5 mg<br />
warfarin sodium tab 6 mg<br />
WARFARIN SODIUM TAB 6 MG<br />
warfarin sodium tab 7.5 mg<br />
WARFARIN SODIUM TAB 7.5 MG<br />
Direct Thrombin Inhibitors<br />
ANGIOMAX INJ 250MG PA<br />
ARGATROBAN INJ 100MG/ML PA<br />
REFLUDAN INJ 50MG PA<br />
Heparins<br />
FRAGMIN INJ 10000/ML PA<br />
FRAGMIN INJ 12500UNT PA<br />
FRAGMIN INJ 15000UNT PA<br />
FRAGMIN INJ 18000UNT PA<br />
FRAGMIN INJ 2500/0.2 PA<br />
FRAGMIN INJ 25000/ML PA<br />
FRAGMIN INJ 5000/0.2 PA<br />
FRAGMIN INJ 7500/0.3 PA<br />
HEP SOD/NACL INJ 12500UNT PA<br />
HEP SOD/NACL INJ 25000UNT PA<br />
HEPARIN LOCK INJ 2UNIT/ML PA<br />
HEPARIN SOD INJ 2000/ML PA<br />
HEPARIN SOD INJ 20000/ML PA<br />
HEPARIN SOD INJ 2500/ML PA<br />
heparin sodium (porcine) 100 unit/ml in d5w PA<br />
heparin sodium (porcine) 100 unit/ml in sodium chloride 0.9% PA<br />
heparin sodium (porcine) 2 unit/ml in sodium chloride 0.9% PA<br />
heparin sodium (porcine) 40 unit/ml in d5w PA<br />
heparin sodium (porcine) 50 unit/ml in d5w PA<br />
heparin sodium (porcine) inj 1000 unit/ml PA<br />
heparin sodium (porcine) inj 10000 unit/ml PA<br />
heparin sodium (porcine) inj 5000 unit/ml PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 40
heparin sodium (porcine) lock flush iv soln 1 unit/ml PA<br />
heparin sodium (porcine) lock flush iv soln 10 unit/ml PA<br />
heparin sodium (porcine) lock flush iv soln 100 unit/ml PA<br />
heparin sodium (porcine) lock flush soln 10 unit/ml PA<br />
heparin sodium (porcine) lock flush soln 100 unit/ml PA<br />
heparin sodium (porcine) w/ nacl lock flush kit 10 unit/ml PA<br />
heparin sodium (porcine) w/ nacl lock flush kit 100 unit/ml PA<br />
INNOHEP INJ 20000/ML PA<br />
LOVENOX INJ 100/1ML PA<br />
LOVENOX INJ 120/0.8 PA<br />
LOVENOX INJ 150/1ML PA<br />
LOVENOX INJ 30/0.3ML PA<br />
LOVENOX INJ 300/3ML PA<br />
LOVENOX INJ 40/0.4ML PA<br />
LOVENOX INJ 60/0.6ML PA<br />
LOVENOX INJ 80/0.8ML PA<br />
Miscellaneous Anticoagulants<br />
ARIXTRA SOL 10/0.8 PA<br />
ARIXTRA SOL 2.5/0.5 PA<br />
ARIXTRA SOL 5.0/0.4 PA<br />
ARIXTRA SOL 7.5/0.6 PA<br />
ATRYN INJ 1750 PA<br />
CEPROTIN INJ 1000UNIT PA<br />
CEPROTIN INJ 500 UNIT PA<br />
THROMBAT III INJ 1000UNIT PA<br />
THROMBAT III INJ 500UNIT PA<br />
Platelet-Aggregation Inhibitors<br />
AGGRASTAT INJ 12.5/50 PA<br />
AGGRASTAT INJ 25MG/500 PA<br />
clopidogrel tab 75mg<br />
CLOPIDOGREL BISULFATE TAB 300 MG (BASE EQUIV)<br />
clopidogrel bisulfate tab 75 mg (base equiv)<br />
CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV)<br />
INTEGRILIN INJ 0.75MG/1 PA<br />
INTEGRILIN INJ 2MG/ML PA<br />
PLAVIX TAB 300MG<br />
PLAVIX TAB 75MG<br />
REOPRO INJ 2MG/ML PA<br />
Thrombolytic Agents<br />
ABBOKINASE INJ 250000 PA<br />
ACTIVASE INJ 100MG PA<br />
ACTIVASE INJ 50MG PA<br />
CATHFLO ACTI INJ VASE PA<br />
KINLYTIC INJ 250000 PA<br />
RETAVASE INJ PA<br />
RETAVASE INJ HALF-KIT PA<br />
TNKASE KIT 50MG PA<br />
Hematopoietic Agents<br />
ARANESP INJ 100MCG PA<br />
ARANESP INJ 100MCG PA<br />
ARANESP INJ 100MCG PA<br />
ARANESP INJ 150MCG PA<br />
ARANESP INJ 150MCG PA<br />
ARANESP INJ 150MCG PA<br />
ARANESP INJ 200MCG PA<br />
ARANESP INJ 200MCG PA<br />
ARANESP INJ 200MCG PA<br />
ARANESP INJ 25MCG PA<br />
ARANESP INJ 25MCG PA<br />
ARANESP INJ 25MCG PA<br />
ARANESP INJ 25MCG/ML PA<br />
ARANESP INJ 300MCG PA<br />
ARANESP INJ 300MCG PA<br />
ARANESP INJ 300MCG PA<br />
ARANESP INJ 40MCG PA<br />
ARANESP INJ 40MCG PA<br />
ARANESP INJ 40MCG PA<br />
ARANESP INJ 40MCG/ML PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 41
ARANESP INJ 500MCG PA<br />
ARANESP INJ 60MCG PA<br />
ARANESP INJ 60MCG PA<br />
ARANESP INJ 60MCG PA<br />
ARANESP INJ 60MCG/ML PA<br />
EPOGEN INJ 10000/ML PA<br />
EPOGEN INJ 2000/ML PA<br />
EPOGEN INJ 20000/ML PA<br />
EPOGEN INJ 3000/ML PA<br />
EPOGEN INJ 4000/ML PA<br />
EPOGEN INJ 40000/ML PA<br />
LEUKINE INJ 250MCG PA<br />
LEUKINE INJ 500 MCG PA<br />
NEULASTA INJ 6MG/0.6M PA<br />
NEUMEGA INJ 5MG PA<br />
NEUPOGEN INJ 300/0.5 PA<br />
NEUPOGEN INJ 300MCG PA<br />
NEUPOGEN INJ 480/0.8 PA<br />
NEUPOGEN INJ 480MCG PA<br />
NPLATE INJ 250MCG PA<br />
NPLATE INJ 500MCG PA<br />
PROCRIT INJ 10000/ML PA<br />
PROCRIT INJ 2000/ML PA<br />
PROCRIT INJ 20000/ML PA<br />
PROCRIT INJ 3000/ML PA<br />
PROCRIT INJ 4000/ML PA<br />
PROCRIT INJ 40000/ML PA<br />
Antihemorrhagic Agents<br />
Antiheparin Agents<br />
PROTAMINE SU SOL 10MG/ML PA<br />
Hemostatics<br />
ADVATE INJ 1000UNIT PA<br />
ADVATE INJ 1500UNIT PA<br />
ADVATE INJ 2000UNIT PA<br />
ADVATE INJ 250UNIT PA<br />
ADVATE INJ 3000UNIT PA<br />
ADVATE INJ 500UNIT PA<br />
ALPHANATE INJ PA<br />
ALPHANATE INJ 250-500 PA<br />
ALPHANATE INJ VWF/HUM PA<br />
ALPHANINE SD INJ 1000UNIT PA<br />
ALPHANINE SD INJ 1500UNIT PA<br />
ALPHANINE SD INJ 250-1500 PA<br />
ALPHANINE SD INJ 500UNIT PA<br />
aminocaproic acid inj 250 mg/ml PA<br />
BEBULIN VH INJ 200-1200 PA<br />
BENEFIX INJ 1000UNIT PA<br />
BENEFIX INJ 2000UNIT PA<br />
BENEFIX INJ 250UNIT PA<br />
BENEFIX INJ 500UNIT PA<br />
CYKLOKAPRON INJ 100MG/ML PA<br />
FEIBA NF INJ PA<br />
FEIBA VH INJ IMMUNO PA<br />
GENARC INJ 1000UNIT PA<br />
GENARC INJ 250 UNIT PA<br />
GENARC INJ 500 UNIT PA<br />
HELIXATE INJ 2000UNIT PA<br />
HELIXATE FS INJ 1000UNIT PA<br />
HELIXATE FS INJ 250UNIT PA<br />
HELIXATE FS INJ 3000UNIT PA<br />
HELIXATE FS INJ 500UNIT PA<br />
HELIXATE FS SOL 1000UNIT PA<br />
HELIXATE FS SOL 250UNIT PA<br />
HELIXATE FS SOL 500UNIT PA<br />
HEMOFIL M INJ 1701+ PA<br />
HEMOFIL M INJ 220-400 PA<br />
HEMOFIL M INJ 401-800 PA<br />
HEMOFIL M INJ 801-1700 PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 42
HUMATE-P INJ 1000UNIT PA<br />
HUMATE-P INJ 2000UNIT PA<br />
HUMATE-P INJ 500UNIT PA<br />
HUMATE-P SOL 1200UNIT PA<br />
HUMATE-P SOL 2400UNIT PA<br />
HUMATE-P SOL 600UNIT PA<br />
KOATE-DVI INJ 1000UNIT PA<br />
KOATE-DVI INJ 250UNIT PA<br />
KOATE-DVI INJ 500UNIT PA<br />
KOGENATE FS INJ 1000/BS PA<br />
KOGENATE FS INJ 1000UNIT PA<br />
KOGENATE FS INJ 2000/BS PA<br />
KOGENATE FS INJ 2000UNIT PA<br />
KOGENATE FS INJ 250/BS PA<br />
KOGENATE FS INJ 250UNIT PA<br />
KOGENATE FS INJ 3000/BS PA<br />
KOGENATE FS INJ 3000UNIT PA<br />
KOGENATE FS INJ 500/BS PA<br />
KOGENATE FS INJ 500UNIT PA<br />
MONARC-M INJ 1701+ PA<br />
MONARC-M INJ 220-400 PA<br />
MONARC-M INJ 250-1100 PA<br />
MONARC-M INJ 401-800 PA<br />
MONARC-M INJ 801-1700 PA<br />
MONOCLATE-P INJ 1000UNIT PA<br />
MONOCLATE-P INJ 1500UNIT PA<br />
MONOCLATE-P INJ 250UNIT PA<br />
MONOCLATE-P INJ 500UNIT PA<br />
MONONINE INJ 1000UNIT PA<br />
MONONINE INJ 250UNIT PA<br />
MONONINE INJ 500UNIT PA<br />
NOVOSEVEN INJ 1200MCG PA<br />
NOVOSEVEN INJ 2400MCG PA<br />
NOVOSEVEN INJ 4800MCG PA<br />
NOVOSEVEN RT INJ 1MG PA<br />
NOVOSEVEN RT INJ 2MG PA<br />
NOVOSEVEN RT INJ 5MG PA<br />
PROFILNINE INJ PA<br />
PROFILNINE INJ 1000UNIT PA<br />
PROFILNINE INJ 1500UNIT PA<br />
PROFILNINE INJ 500UNIT PA<br />
PROPLEX T INJ FACT IX PA<br />
RECOMBINATE INJ 220-400 PA<br />
RECOMBINATE INJ 401-800 PA<br />
RECOMBINATE INJ 801-1240 PA<br />
REFACTO INJ 1000UNIT PA<br />
REFACTO INJ 2000UNIT PA<br />
REFACTO INJ 250UNIT PA<br />
REFACTO INJ 500UNIT PA<br />
RIASTAP SOL 1GM PA<br />
TRASYLOL INJ 10000/ML PA<br />
WILATE INJ PA<br />
XYNTHA INJ 1000UNIT PA<br />
XYNTHA INJ 2000UNIT PA<br />
XYNTHA INJ 250UNIT PA<br />
XYNTHA INJ 500UNIT PA<br />
Cardiovascular <strong>Drugs</strong><br />
Cardiac <strong>Drugs</strong><br />
Antiarrhythmic Agents<br />
procainamide hcl tab cr 750 mg NF<br />
procainamide tab 750mg er NF<br />
Class Ia Antiarrhythmics<br />
procainamide cap 250mg<br />
procainamide cap 500mg<br />
procainamide hcl cap 250 mg<br />
PROCAINAMIDE HCL CAP 375 MG<br />
procainamide hcl cap 500 mg<br />
PROCAINAMIDE HCL TAB 375 MG<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 43
PROCAINAMIDE HCL TAB 500 MG<br />
PROCAINAMIDE HCL TAB SR 12HR 1000 MG<br />
PROCAINAMIDE HCL TAB SR 12HR 500 MG<br />
PROCAINAMIDE INJ 100MG/ML PA<br />
PROCAINAMIDE INJ 500MG/ML PA<br />
PROCANBID TAB 1000 MG<br />
PROCANBID TAB 500MG CR<br />
PRONESTYL CAP 375MG<br />
PRONESTYL TAB 375MG<br />
PRONESTYL TAB 500MG<br />
QUINIDINE GL INJ 80MG/ML PA<br />
quinidine gl tab 324mg cr<br />
quinidine gl tab 324mg er<br />
quinidine gl tab 324mg sa<br />
quinidine gluconate tab cr 324 mg<br />
quinidine su tab 200mg<br />
quinidine su tab 300mg<br />
quinidine sulfate tab 200 mg<br />
quinidine sulfate tab 300 mg<br />
Class Ib Antiarrhythmics<br />
LIDOCAINE INJ 10MG/ML PA<br />
lidocaine hcl iv inj 10 mg/ml PA<br />
lidocaine hcl iv inj 10 mg/ml PA<br />
lidocaine hcl iv inj 20 mg/ml PA<br />
lidocaine iv infusion in d5w inj 2 mg/ml PA<br />
lidocaine iv infusion in d5w inj 4 mg/ml PA<br />
lidocaine iv infusion in d5w inj 8 mg/ml PA<br />
Class Ic Antiarrhythmics<br />
FLECAINIDE TAB 100MG<br />
FLECAINIDE ACETATE TAB 100 MG<br />
Class III Antiarrhythmics<br />
amiodarone tab 200mg<br />
amiodarone hcl inj 50 mg/ml PA<br />
amiodarone hcl tab 200 mg<br />
ibutilide fumarate inj 0.1 mg/ml PA<br />
pacerone tab 200mg<br />
Class IV Antiarrhythmics<br />
adenosine iv soln 3 mg/ml PA<br />
Cardiotonic Agents<br />
DIGOXIN SOL 50MCG/ML PA<br />
digoxin tab 0.125mg<br />
digoxin tab 0.25mg<br />
digoxin inj 0.25 mg/ml PA<br />
DIGOXIN TAB 0.125 MG<br />
digoxin tab 0.125 mg<br />
digoxin tab 0.25 mg<br />
DIGOXIN TAB 0.25 MG<br />
INAMRINONE INJ 5MG/ML PA<br />
LANOXIN INJ 0.1MG/ML PA<br />
LANOXIN TAB 0.125MG<br />
LANOXIN TAB 0.25MG<br />
milrinone in dextrose iv soln 200 mcg/ml PA<br />
milrinone lactate iv soln 1 mg/ml (base equivalent) PA<br />
Hypotensive Agents<br />
Central Alpha-Agonists<br />
clonidine tab 0.1mg<br />
clonidine tab 0.2mg<br />
clonidine tab 0.3mg<br />
clonidine hcl inj (for epidural infusion) 100 mcg/ml PA<br />
clonidine hcl inj (for epidural infusion) 500 mcg/ml PA<br />
clonidine hcl tab 0.1 mg<br />
clonidine hcl tab 0.2 mg<br />
clonidine hcl tab 0.3 mg<br />
DURACLON INJ PA<br />
methyldopa tab 250mg<br />
methyldopa tab 500mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 44
methyldopa tab 125mg<br />
methyldopa tab 125mg<br />
methyldopa tab 250 mg<br />
methyldopa tab 500 mg<br />
METHYLDOPATE INJ 250/5ML PA<br />
Direct Vasodilators<br />
fenoldopam mesylate iv inj 10 mg/ml (base equiv) PA<br />
hydralazine tab 100mg<br />
hydralazine tab 10mg<br />
hydralazine tab 25mg<br />
hydralazine tab 50mg<br />
hydralazine hcl inj 20 mg/ml PA<br />
hydralazine hcl tab 10 mg<br />
hydralazine hcl tab 100 mg<br />
hydralazine hcl tab 25 mg<br />
hydralazine hcl tab 50 mg<br />
HYPERSTAT IV INJ 15MG/ML PA<br />
NITROPRESS INJ 25MG/ML PA<br />
Vasodilating Agents<br />
Nitrates and Nitrites<br />
DILATRATE SR CAP 40MG<br />
ISOSORBIDE DINITRATE CAP CR 40 MG<br />
NITROGLYCER INJ 5MG/ML PA<br />
nitroglycerin iv soln 100 mcg/ml in d5w PA<br />
nitroglycerin iv soln 200 mcg/ml in d5w PA<br />
nitroglycerin iv soln 400 mcg/ml in d5w PA<br />
NITROGLYCERIN SL TAB 0.3 MG<br />
NITROGLYCERIN SL TAB 0.4 MG<br />
NITROGLYCERIN SL TAB 0.6 MG<br />
NITROLINGUAL SPR DUO PACK PA<br />
NITROLINGUAL SPR PUMPSPRA PA<br />
NITROSTAT SUB 0.3MG<br />
NITROSTAT SUB 0.4MG<br />
NITROSTAT SUB 0.6MG<br />
Phosphodiesterase Inhibitors<br />
REVATIO INJ PA<br />
SILDENAFIL CITRATE TAB 50 MG NF<br />
VIAGRA TAB 50MG NF<br />
Vasodilating Agents, Miscellaneous<br />
alprostadil inj 500 mcg/ml PA<br />
CAVERJECT INJ 20MCG PA<br />
CAVERJECT INJ 40MCG PA<br />
CAVERJECT KIT 10MCG PA<br />
CAVERJECT KIT 20MCG PA<br />
dipyridamole iv soln 5 mg/ml PA<br />
EDEX KIT 10MCG PA<br />
EDEX KIT 20MCG PA<br />
EDEX KIT 40MCG PA<br />
epoprostenol sodium for inj 0.5 mg PA<br />
epoprostenol sodium for inj 1.5 mg PA<br />
NATRECOR INJ 1.5MG PA<br />
papaverine hcl inj 30 mg/ml PA<br />
REMODULIN INJ 10MG/ML PA<br />
REMODULIN INJ 1MG/ML PA<br />
REMODULIN INJ 2.5MG/ML PA<br />
REMODULIN INJ 5MG/ML PA<br />
Sclerosing Agents<br />
ETHAMOLIN INJ 5% PA<br />
morrhuate sodium inj 5% PA<br />
SOTRADECOL INJ 1% PA<br />
SOTRADECOL INJ 3% PA<br />
Alpha-Adrenergic Blocking Agents<br />
doxazosin tab 1mg<br />
doxazosin tab 2mg<br />
doxazosin tab 4mg<br />
doxazosin tab 8mg<br />
doxazosin mesylate tab 1 mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 45
doxazosin mesylate tab 2 mg<br />
doxazosin mesylate tab 4 mg<br />
doxazosin mesylate tab 8 mg<br />
prazosin hcl cap 1 mg<br />
prazosin hcl cap 1mg<br />
prazosin hcl cap 2 mg<br />
prazosin hcl cap 2mg<br />
prazosin hcl cap 5 mg<br />
prazosin hcl cap 5mg<br />
terazosin hcl cap 1 mg PA<br />
terazosin hcl cap 10 mg PA<br />
terazosin hcl cap 2 mg PA<br />
terazosin hcl cap 5 mg PA<br />
Beta-Adrenergic Blocking Agents<br />
atenolol tab 100mg<br />
atenolol tab 25mg<br />
atenolol tab 50mg<br />
atenolol tab 100 mg<br />
atenolol tab 25 mg<br />
atenolol tab 50 mg<br />
bisoprl/hctz tab 10/6.25<br />
bisoprl/hctz tab 2.5/6.25<br />
bisoprl/hctz tab 5/6.25mg<br />
bisoprol fum tab 10mg<br />
bisoprol fum tab 5mg<br />
bisoprolol & hydrochlorothiazide tab 10-6.25 mg<br />
bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg<br />
bisoprolol & hydrochlorothiazide tab 5-6.25 mg<br />
bisoprolol fumarate tab 10 mg<br />
bisoprolol fumarate tab 5 mg<br />
BREVIBLOC INJ 20MG/ML PA<br />
BREVIBLOC INJ 250MG/ML PA<br />
BREVIBLOC SOL PA<br />
BREVIBLOC SOL 10MG/ML PA<br />
COREG CR CAP 10MG PA<br />
COREG CR CAP 20MG PA<br />
COREG CR CAP 40MG PA<br />
COREG CR CAP 80MG PA<br />
esmolol hcl inj 10 mg/ml PA<br />
INNOPRAN XL CAP 120MG PA<br />
INNOPRAN XL CAP 80MG PA<br />
labetalol tab 100mg<br />
labetalol tab 200mg<br />
labetalol tab 300mg<br />
labetalol hcl iv soln 5 mg/ml PA<br />
labetalol hcl tab 100 mg<br />
labetalol hcl tab 200 mg<br />
labetalol hcl tab 300 mg<br />
LEVATOL TAB 20MG<br />
metoprol tar tab 100mg<br />
metoprol tar tab 25mg<br />
metoprol tar tab 50mg<br />
metoprolol tab 100mg er<br />
metoprolol tab 200mg er<br />
metoprolol tab 25mg er<br />
metoprolol tab 50mg er<br />
metoprolol succinate tab sr 24hr 100 mg<br />
metoprolol succinate tab sr 24hr 200 mg<br />
metoprolol succinate tab sr 24hr 25 mg<br />
metoprolol succinate tab sr 24hr 50 mg<br />
metoprolol tartrate inj 1 mg/ml PA<br />
metoprolol tartrate tab 100 mg<br />
metoprolol tartrate tab 25 mg<br />
metoprolol tartrate tab 50 mg<br />
NADOLOL TAB 160MG<br />
nadolol tab 20mg<br />
nadolol tab 40mg<br />
nadolol tab 80mg<br />
NADOLOL TAB 160 MG<br />
nadolol tab 20 mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 46
nadolol tab 40 mg<br />
nadolol tab 80 mg<br />
PENBUTOLOL SULFATE TAB 20 MG<br />
PROPRANOLOL SOL 20MG/5ML PA<br />
PROPRANOLOL SOL 40MG/5ML PA<br />
propranolol tab 10mg<br />
propranolol tab 20mg<br />
propranolol tab 40mg<br />
propranolol tab 60mg<br />
propranolol tab 80mg<br />
propranolol hcl inj 1 mg/ml PA<br />
propranolol hcl tab 10 mg<br />
propranolol hcl tab 20 mg<br />
propranolol hcl tab 40 mg<br />
propranolol hcl tab 60 mg<br />
propranolol hcl tab 80 mg<br />
SOTALOL HCL INJ 150/10ML PA<br />
TENORMIN INJ 5MG/10ML PA<br />
Calcium-Channel Blocking Agents<br />
Dihydropyridines<br />
afeditab tab 30mg cr<br />
afeditab tab 60mg cr<br />
amlod/benazp cap 10-20mg<br />
amlod/benazp cap 2.5-10mg<br />
amlod/benazp cap 5-10mg<br />
amlod/benazp cap 5-20mg<br />
amlodipine besylate-benazepril hcl cap 10-20 mg<br />
AMLODIPINE BESYLATE-BENAZEPRIL HCL CAP 10-40 MG<br />
amlodipine besylate-benazepril hcl cap 2.5-10 mg<br />
amlodipine besylate-benazepril hcl cap 5-10 mg<br />
amlodipine besylate-benazepril hcl cap 5-20 mg<br />
AMLODIPINE BESYLATE-BENAZEPRIL HCL CAP 5-40 MG<br />
CARDENE IV INJ 40/200ML PA<br />
CARDENE IV SOL 20/200ML PA<br />
CLEVIPREX EMU 0.5MG/ML PA<br />
DYNACIRC CR TAB 10MG<br />
DYNACIRC CR TAB 5MG<br />
felodipine tab 10mg er<br />
felodipine tab 2.5mg er<br />
felodipine tab 5mg er<br />
felodipine tab sr 24hr 10 mg<br />
felodipine tab sr 24hr 2.5 mg<br />
felodipine tab sr 24hr 5 mg<br />
ISRADIPINE CAP 2.5MG<br />
isradipine cap 2.5mg<br />
isradipine cap 5mg<br />
ISRADIPINE CAP 2.5 MG<br />
isradipine cap 2.5 mg<br />
isradipine cap 5 mg<br />
ISRADIPINE TAB SR 24HR 10 MG<br />
ISRADIPINE TAB SR 24HR 5 MG<br />
LOTREL CAP 10-40MG<br />
LOTREL CAP 5-40MG<br />
nicardipine hcl iv soln 2.5 mg/ml PA<br />
nifediac cc tab 30mg er<br />
nifediac cc tab 60mg er<br />
nifediac cc tab 90mg er<br />
nifedical xl tab 30mg<br />
nifedical xl tab 60mg<br />
nifedipine tab 30mg er<br />
nifedipine tab 60mg er<br />
nifedipine tab 90mg cr<br />
nifedipine tab 90mg er<br />
nifedipine tab sr 24hr 30 mg<br />
nifedipine tab sr 24hr 60 mg<br />
nifedipine tab sr 24hr 90 mg<br />
nifedipine tab sr 24hr osmotic 30 mg<br />
nifedipine tab sr 24hr osmotic 60 mg<br />
nifedipine tab sr 24hr osmotic 90 mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 47
Calcium-Channel Blocking Agents, Misc<br />
CARDIZEM CD CAP 360MG/24<br />
cartia xt cap 120/24hr<br />
cartia xt cap 180/24hr<br />
cartia xt cap 240/24hr<br />
cartia xt cap 300/24hr<br />
COVERA-HS TAB 180MG NF<br />
COVERA-HS TAB 240MG NF<br />
dilt-cd cap 120mg<br />
dilt-cd cap 180mg<br />
dilt-cd cap 240mg<br />
dilt-cd cap 300mg<br />
dilt-xr cap 120mg<br />
dilt-xr cap 180mg<br />
dilt-xr cap 240mg<br />
diltiazem cap 120mg cd<br />
diltiazem cap 120mg er<br />
diltiazem cap 120mg sr<br />
diltiazem cap 120mg/24<br />
diltiazem cap 180mg cd<br />
diltiazem cap 180mg er<br />
diltiazem cap 180mg/24<br />
diltiazem cap 240mg cd<br />
diltiazem cap 240mg er<br />
diltiazem cap 240mg xr<br />
diltiazem cap 240mg/24<br />
diltiazem cap 300mg cd<br />
diltiazem cap 300mg er<br />
diltiazem cap 300mg/24<br />
diltiazem cap 360mg/24<br />
diltiazem cap 420mg/24<br />
diltiazem cap 60mg er<br />
diltiazem cap 90mg er<br />
DILTIAZEM INJ 100MG PA<br />
diltiazem tab 120mg<br />
diltiazem tab 30mg<br />
diltiazem tab 60mg<br />
diltiazem tab 90mg<br />
diltiazem hcl cap sr 12hr 120 mg<br />
diltiazem hcl cap sr 12hr 60 mg<br />
diltiazem hcl cap sr 12hr 90 mg<br />
diltiazem hcl cap sr 24hr 120 mg<br />
diltiazem hcl cap sr 24hr 180 mg<br />
diltiazem hcl cap sr 24hr 240 mg<br />
diltiazem hcl coated beads cap sr 24hr 120 mg<br />
diltiazem hcl coated beads cap sr 24hr 180 mg<br />
diltiazem hcl coated beads cap sr 24hr 240 mg<br />
diltiazem hcl coated beads cap sr 24hr 300 mg<br />
DILTIAZEM HCL COATED BEADS CAP SR 24HR 360 MG<br />
diltiazem hcl extended release beads cap sr 24hr 120 mg<br />
diltiazem hcl extended release beads cap sr 24hr 180 mg<br />
diltiazem hcl extended release beads cap sr 24hr 240 mg<br />
diltiazem hcl extended release beads cap sr 24hr 300 mg<br />
diltiazem hcl extended release beads cap sr 24hr 360 mg<br />
diltiazem hcl extended release beads cap sr 24hr 420 mg<br />
diltiazem hcl iv soln 5 mg/ml PA<br />
diltiazem hcl tab 120 mg<br />
diltiazem hcl tab 30 mg<br />
diltiazem hcl tab 60 mg<br />
diltiazem hcl tab 90 mg<br />
diltzac cap 120mg/24<br />
diltzac cap 180mg/24<br />
diltzac cap 240mg/24<br />
diltzac cap 300mg/24<br />
diltzac cap 360mg/24<br />
taztia xt cap 120mg/24<br />
taztia xt cap 180mg/24<br />
taztia xt cap 240mg/24<br />
taztia xt cap 300mg/24<br />
taztia xt cap 360mg/24<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 48
verapamil tab 120mg<br />
verapamil tab 120mg er<br />
verapamil tab 120mg sr<br />
verapamil tab 180mg cr<br />
verapamil tab 180mg er<br />
verapamil tab 180mg sa<br />
verapamil tab 180mg sr<br />
verapamil tab 240mg cr<br />
verapamil tab 240mg er<br />
verapamil tab 240mg sa<br />
verapamil tab 240mg sr<br />
verapamil tab 40mg<br />
verapamil tab 80mg<br />
verapamil hcl iv soln 2.5 mg/ml PA<br />
verapamil hcl tab 120 mg<br />
verapamil hcl tab 40 mg<br />
verapamil hcl tab 80 mg<br />
verapamil hcl tab cr 120 mg<br />
verapamil hcl tab cr 180 mg<br />
verapamil hcl tab cr 240 mg<br />
VERAPAMIL HCL TAB SR 24HR (CONTROLLED ONSET) 180 MG NF<br />
VERAPAMIL HCL TAB SR 24HR (CONTROLLED ONSET) 240 MG NF<br />
Rennin-Angiotensin-Aldosterone Sys Inhib<br />
Angiotensin-Converting Enzyme Inhibitors<br />
benazep/hctz tab 10-12.5<br />
benazep/hctz tab 20-12.5<br />
benazep/hctz tab 20-25mg<br />
benazep/hctz tab 5-6.25<br />
benazepril tab 10mg<br />
benazepril tab 20mg<br />
benazepril tab 40mg<br />
benazepril tab 5mg<br />
benazepril & hydrochlorothiazide tab 10-12.5 mg<br />
benazepril & hydrochlorothiazide tab 20-12.5 mg<br />
benazepril & hydrochlorothiazide tab 20-25 mg<br />
benazepril & hydrochlorothiazide tab 5-6.25 mg<br />
benazepril hcl tab 10 mg<br />
benazepril hcl tab 20 mg<br />
benazepril hcl tab 40 mg<br />
benazepril hcl tab 5 mg<br />
captopr/hctz tab 25-15mg<br />
captopr/hctz tab 25-25mg<br />
captopr/hctz tab 50-15mg<br />
captopr/hctz tab 50-25mg<br />
captopril tab 100mg<br />
captopril tab 12.5mg<br />
captopril tab 25mg<br />
captopril tab 50mg<br />
captopril & hydrochlorothiazide tab 25-15 mg<br />
captopril & hydrochlorothiazide tab 25-25 mg<br />
captopril & hydrochlorothiazide tab 50-15 mg<br />
captopril & hydrochlorothiazide tab 50-25 mg<br />
captopril tab 100 mg<br />
captopril tab 12.5 mg<br />
captopril tab 25 mg<br />
captopril tab 50 mg<br />
enalapril maleate tab 10 mg PA<br />
enalapril maleate tab 2.5 mg PA<br />
enalapril maleate tab 20 mg PA<br />
enalapril maleate tab 5 mg PA<br />
enalaprilat iv inj 1.25 mg/ml PA<br />
fosinopril sodium tab 10 mg PA<br />
fosinopril sodium tab 20 mg PA<br />
fosinopril sodium tab 40 mg PA<br />
lisinop/hctz tab 10-12.5<br />
lisinop/hctz tab 20-12.5<br />
lisinop/hctz tab 20-25mg<br />
lisinopril tab 10mg<br />
lisinopril tab 2.5mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 49
lisinopril tab 20mg<br />
lisinopril tab 30mg<br />
lisinopril tab 40mg<br />
lisinopril tab 5mg<br />
lisinopril & hydrochlorothiazide tab 10-12.5 mg<br />
lisinopril & hydrochlorothiazide tab 20-12.5 mg<br />
lisinopril & hydrochlorothiazide tab 20-25 mg<br />
lisinopril tab 10 mg<br />
lisinopril tab 2.5 mg<br />
lisinopril tab 20 mg<br />
lisinopril tab 30 mg<br />
lisinopril tab 40 mg<br />
lisinopril tab 5 mg<br />
quinapril tab 10mg<br />
quinapril tab 20mg<br />
quinapril tab 40mg<br />
quinapril tab 5mg<br />
quinapril hcl tab 10 mg<br />
quinapril hcl tab 20 mg<br />
quinapril hcl tab 40 mg<br />
quinapril hcl tab 5 mg<br />
ramipril cap 1.25 mg PA<br />
ramipril cap 10 mg PA<br />
ramipril cap 2.5 mg PA<br />
ramipril cap 5 mg PA<br />
Angiotensin II Receptor Antagonists<br />
AVAPRO TAB 150MG PA<br />
AVAPRO TAB 300MG PA<br />
AVAPRO TAB 75MG PA<br />
BENICAR TAB 20MG<br />
BENICAR TAB 40MG<br />
BENICAR TAB 5MG<br />
BENICAR HCT TAB 20-12.5<br />
BENICAR HCT TAB 40-12.5<br />
BENICAR HCT TAB 40-25MG<br />
DIOVAN TAB 160MG<br />
DIOVAN TAB 320MG<br />
DIOVAN TAB 40MG<br />
DIOVAN TAB 80MG<br />
DIOVAN HCT TAB 160/12.5<br />
DIOVAN HCT TAB 160/25MG<br />
DIOVAN HCT TAB 320/12.5<br />
DIOVAN HCT TAB 320/25MG<br />
DIOVAN HCT TAB 80/12.5<br />
losartan potassium tab 100 mg PA<br />
losartan potassium tab 25 mg PA<br />
losartan potassium tab 50 mg PA<br />
OLMESARTAN MEDOXOMIL TAB 20 MG<br />
OLMESARTAN MEDOXOMIL TAB 40 MG<br />
OLMESARTAN MEDOXOMIL TAB 5 MG<br />
OLMESARTAN MEDOXOMIL-HYDROCHLOROTHIAZIDE TAB 20-12.5 MG<br />
OLMESARTAN MEDOXOMIL-HYDROCHLOROTHIAZIDE TAB 40-12.5 MG<br />
OLMESARTAN MEDOXOMIL-HYDROCHLOROTHIAZIDE TAB 40-25 MG<br />
VALSARTAN TAB 160 MG<br />
VALSARTAN TAB 320 MG<br />
VALSARTAN TAB 40 MG<br />
VALSARTAN TAB 80 MG<br />
VALSARTAN-HYDROCHLOROTHIAZIDE TAB 160-12.5 MG<br />
VALSARTAN-HYDROCHLOROTHIAZIDE TAB 160-25 MG<br />
VALSARTAN-HYDROCHLOROTHIAZIDE TAB 320-12.5 MG<br />
VALSARTAN-HYDROCHLOROTHIAZIDE TAB 320-25 MG<br />
VALSARTAN-HYDROCHLOROTHIAZIDE TAB 80-12.5 MG<br />
Central Nervous System Agents<br />
General Anesthetics<br />
BARBITURATES<br />
BREVITAL SOD INJ 2.5GM PA<br />
BREVITAL SOD INJ 500MG PA<br />
PENTOTHAL INJ 1GM PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 50
PENTOTHAL INJ 250MG PA<br />
PENTOTHAL INJ 400MG PA<br />
PENTOTHAL INJ 500MG PA<br />
GENERAL ANESTHETICS<br />
etomidate iv soln 2 mg/ml PA<br />
KETALAR INJ 10MG/ML PA<br />
ketamine hcl inj 10 mg/ml PA<br />
ketamine hcl inj 100 mg/ml PA<br />
ketamine hcl inj 50 mg/ml PA<br />
LUSEDRA INJ PA<br />
propofol iv emul 10 mg/ml PA<br />
Analgesics and Antipyretics<br />
Nonsteroidal Anti-inflammatory Agents<br />
butalbital-aspirin-caffeine tab 50-325-40 mg<br />
etodolac tab 500mg<br />
etodolac tab 500 mg<br />
farbital tab<br />
ibuprofen tab 400mg<br />
ibuprofen tab 600mg<br />
ibuprofen tab 800mg<br />
ibuprofen tab 400 mg<br />
ibuprofen tab 600 mg<br />
ibuprofen tab 800 mg<br />
INDOCIN SUP 50MG<br />
INDOCIN SUS 25MG/5ML<br />
indomethacin cap 25 mg<br />
indomethacin cap 25mg<br />
indomethacin cap 50 mg<br />
indomethacin cap 50mg<br />
INDOMETHACIN SUPPOS 50 MG<br />
INDOMETHACIN SUSP 25 MG/5ML<br />
nabumetone tab 750mg NF<br />
nabumetone tab 750 mg NF<br />
naproxen tab 250mg<br />
naproxen tab 375mg<br />
naproxen tab 500mg<br />
naproxen tab 250 mg<br />
naproxen tab 375 mg<br />
naproxen tab 500 mg<br />
Cyclooxygenase-2 (COX-2) Inhibitors<br />
CELEBREX CAP 100MG PA<br />
CELEBREX CAP 200MG PA<br />
CELEBREX CAP 400MG PA<br />
CELEBREX CAP 50MG PA<br />
Salicylates<br />
amigesic tab 500mg<br />
amigesic tab 750mg<br />
asa/caff/but cap 325-40-5<br />
ASPIRIN-ACETAMINOPHEN-CAFFEINE TAB 250-250-65 MG OTC<br />
but/asa/caff cap<br />
but/asa/caff cap<br />
but/asa/caff tab<br />
but/asa/caff tab<br />
butalbital cap cpd<br />
butalbital tab cpd<br />
butalbital-aspirin-caffeine cap 50-325-40 mg<br />
butalbital-aspirin-caffeine tab 50-325-40 mg<br />
EXCEDRIN TAB MIGRAINE OTC<br />
fortabs tab<br />
ORPH/ASA/CAF TAB<br />
orph/asa/caf tab<br />
orphen cpd tab ds<br />
ORPHEN CPD TAB DS<br />
orphenadrine w/ aspirin & caffeine tab 25-385-30 mg<br />
ORPHENADRINE W/ ASPIRIN & CAFFEINE TAB 50-770-60 MG<br />
orphenadrine w/ aspirin & caffeine tab 50-770-60 mg<br />
salflex tab 500mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 51
salflex tab 750mg<br />
salsalate tab 500mg<br />
salsalate tab 750mg<br />
salsalate tab 500 mg<br />
salsalate tab 750 mg<br />
Other Nonsteroidal Anti-inflammtory Agents<br />
advil jr st tab 100mg OTC<br />
ARTHROTEC 50 TAB PA<br />
ARTHROTEC 75 TAB PA<br />
CALDOLOR INJ 400/4ML PA<br />
CALDOLOR INJ 800/8ML PA<br />
DICLOFENAC TAB 25MG EC<br />
diclofenac tab 50mg dr<br />
diclofenac tab 50mg ec<br />
diclofenac tab 75mg dr<br />
diclofenac tab 75mg ec<br />
DICLOFENAC SODIUM TAB DELAYED RELEASE 25 MG<br />
diclofenac sodium tab delayed release 50 mg<br />
diclofenac sodium tab delayed release 75 mg<br />
eck ibuprofe tab 100mg OTC<br />
etodolac cap 200mg<br />
etodolac cap 300mg<br />
etodolac tab 400mg<br />
etodolac tab 500mg<br />
etodolac cap 200 mg<br />
etodolac cap 300 mg<br />
etodolac er tab 400mg NF<br />
etodolac er tab 500mg NF<br />
etodolac er tab 600mg<br />
etodolac tab 400 mg<br />
etodolac tab 500 mg<br />
etodolac tab sr 24hr 400 mg NF<br />
etodolac tab sr 24hr 500 mg NF<br />
etodolac tab sr 24hr 600 mg<br />
ibu tab 400mg<br />
ibu tab 600mg<br />
ibu tab 800mg<br />
ibuprofen sus 100/5ml<br />
ibuprofen tab 400mg<br />
ibuprofen tab 600mg<br />
ibuprofen tab 800mg<br />
ibuprofen jr tab 100mg OTC<br />
ibuprofen susp 100 mg/5ml<br />
ibuprofen tab 100 mg OTC<br />
ibuprofen tab 400 mg<br />
ibuprofen tab 600 mg<br />
ibuprofen tab 800 mg<br />
INDOCIN SUS 25MG/5ML<br />
indomethacin cap 25 mg<br />
indomethacin cap 25mg<br />
indomethacin cap 50 mg<br />
indomethacin cap 50mg<br />
indomethacin cap 75mg cr<br />
indomethacin cap 75mg er<br />
indomethacin cap 75mg sa<br />
indomethacin cap 75mg sr<br />
indomethacin cap cr 75 mg<br />
indomethacin sodium iv for soln 1 mg PA<br />
INDOMETHACIN SUP 50MG<br />
INDOMETHACIN SUPPOS 50 MG<br />
INDOMETHACIN SUSP 25 MG/5ML<br />
ketoprofen cap 200mg er NF<br />
KETOPROFEN CAP 200MG ER NF<br />
ketoprofen cap 200mg er NF<br />
ketoprofen cap sr 24hr 200 mg NF<br />
KETOPROFEN CAP SR 24HR 200 MG NF<br />
ketoprofen cap sr 24hr 200 mg NF<br />
ketorolac tab 10mg QL<br />
ketorolac tromethamine im inj 30 mg/ml PA<br />
ketorolac tromethamine inj 15 mg/ml PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 52
ketorolac tromethamine inj 30 mg/ml PA<br />
ketorolac tromethamine tab 10 mg QL<br />
nabumetone tab 500mg NF<br />
nabumetone tab 750mg NF<br />
nabumetone tab 500 mg NF<br />
nabumetone tab 750 mg NF<br />
naproxen sus 125/5ml<br />
naproxen tab 250mg<br />
naproxen tab 375mg<br />
naproxen tab 500mg<br />
naproxen dr tab 375mg<br />
naproxen dr tab 500mg<br />
naproxen ec tab 375mg<br />
naproxen ec tab 500mg<br />
naproxen sod tab 275mg<br />
naproxen sod tab 550mg<br />
naproxen sodium tab 275 mg<br />
naproxen sodium tab 550 mg<br />
naproxen susp 125 mg/5ml<br />
naproxen tab 250 mg<br />
naproxen tab 375 mg<br />
naproxen tab 500 mg<br />
naproxen tab ec 375 mg<br />
naproxen tab ec 500 mg<br />
NEOPROFEN SOL 10MG/ML PA<br />
oxaprozin tab 600mg NF<br />
oxaprozin tab 600 mg NF<br />
piroxicam cap 10mg<br />
piroxicam cap 20mg<br />
piroxicam cap 10 mg<br />
piroxicam cap 20 mg<br />
PREVACID NAP KIT 500MG PA<br />
profen ib tab jun str OTC<br />
pseudoephedrine-naproxen sodium tab sr 12hr 120-220 mg OTC<br />
sm ibuprofen tab 100mg jr OTC<br />
sudafed sinu tab /pain OTC<br />
sulindac tab 150mg<br />
sulindac tab 200mg<br />
sulindac tab 150 mg<br />
sulindac tab 200 mg<br />
Opiate Agonists<br />
acetaminophen w/ codeine soln 120-12 mg/5ml<br />
ACETAMINOPHEN W/ CODEINE SUSP 120-12 MG/5ML<br />
acetaminophen w/ codeine tab 300-15 mg<br />
acetaminophen w/ codeine tab 300-30 mg<br />
acetaminophen w/ codeine tab 300-60 mg<br />
ACETAMINOPHEN W/ CODEINE TAB 650-30 MG<br />
acetaminophen-caffeine-dihydrocodeine cap 356.4-30-16 mg<br />
acetaminophen-caffeine-dihydrocodeine cap 356.4-30-16 mg<br />
acetaminophen-caffeine-dihydrocodeine tab 712.8-60-32 mg<br />
alfentanil inj 500 mcg/ml PA<br />
anexsia tab 5-325mg<br />
anexsia tab 7.5-325<br />
apap/caff/di tab hydrocod<br />
apap/codeine sol 120-12/5<br />
apap/codeine tab 300-15mg<br />
apap/codeine tab 300-15mg<br />
apap/codeine tab 300-30mg<br />
apap/codeine tab 300-30mg<br />
apap/codeine tab 300-30mg<br />
apap/codeine tab 300-60mg<br />
apap/codeine tab 300-60mg<br />
apap/codeine tab 300-60mg<br />
apap/codeine tab 300-60mg<br />
apap/hydroco tab 500-5mg<br />
apap/oxycod tab 325-10mg<br />
apap/oxycod tab 325-5mg<br />
balacet 325 tab<br />
CAPITAL/COD SUS 120-12/5<br />
co-gesic tab 500-5mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 53
COCET TAB 650-30MG<br />
CODEINE PHOS INJ 30MG/2ML PA<br />
CODEINE PHOS INJ 60MG/2ML PA<br />
CODEINE PHOS TAB SOL 30MG PA<br />
CODEINE PHOS TAB SOL 60MG PA<br />
codeine/apap tab 15-300mg<br />
codeine/apap tab 30-300mg<br />
codeine/apap tab 30-300mg<br />
codeine/apap tab 30-300mg<br />
codeine/apap tab 60-300mg<br />
DEMEROL INJ 75MG/ML<br />
DILAUDID-HP INJ 250MG PA<br />
dolacet cap 5-500mg<br />
dolagesic cap 500-5mg<br />
dolorex fort cap 5-500mg<br />
endocet tab 10-325mg<br />
endocet tab 10-650mg<br />
endocet tab 5-325mg<br />
endocet tab 7.5-325m<br />
endocet tab 7.5-500m<br />
endodan tab<br />
FENT/BUPI/NS SOL 2MCG/ML PA<br />
FENT/BUPI/NS SOL 4MCG/ML PA<br />
FENT/BUPI/NS SOL 5MCG/ML PA<br />
FENT/ROPIV/ INJ NACL PA<br />
FENT/ROPIV/ INJ NACL PA<br />
fentanyl citrate inj 0.05 mg/ml PA<br />
FENTANYL/NS SOL 10MCG/ML PA<br />
FENTANYL/NS SOL 5MCG/ML PA<br />
HYCET SOL 7.5-325<br />
HYDR/BUPI/NS SOL 20MCG PA<br />
HYDR/BUPI/NS SOL 20MCG/ML PA<br />
hydrocet cap 500-5mg<br />
hydroco/apap tab 10-325mg<br />
hydroco/apap tab 10-500mg<br />
hydroco/apap tab 10-650mg<br />
hydroco/apap tab 10-660mg<br />
hydroco/apap tab 10-750mg<br />
hydroco/apap tab 2.5-500<br />
hydroco/apap tab 5-325mg<br />
hydroco/apap tab 5-500mg<br />
hydroco/apap tab 5-500mg<br />
hydroco/apap tab 5-500mg<br />
hydroco/apap tab 7.5-325<br />
hydroco/apap tab 7.5-500<br />
hydroco/apap tab 7.5-500<br />
hydroco/apap tab 7.5-650<br />
hydroco/apap tab 7.5-750<br />
hydrocod/ibu tab 7.5-200<br />
hydrocodone-acetaminophen cap 5-500 mg<br />
HYDROCODONE-ACETAMINOPHEN SOLN 10-500 MG/15ML<br />
HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML<br />
hydrocodone-acetaminophen soln 7.5-500 mg/15ml<br />
HYDROCODONE-ACETAMINOPHEN TAB 10-300 MG<br />
hydrocodone-acetaminophen tab 10-325 mg<br />
HYDROCODONE-ACETAMINOPHEN TAB 10-400 MG<br />
hydrocodone-acetaminophen tab 10-500 mg<br />
hydrocodone-acetaminophen tab 10-650 mg<br />
hydrocodone-acetaminophen tab 10-660 mg<br />
hydrocodone-acetaminophen tab 10-750 mg<br />
hydrocodone-acetaminophen tab 2.5-500 mg<br />
HYDROCODONE-ACETAMINOPHEN TAB 5-300 MG<br />
hydrocodone-acetaminophen tab 5-325 mg<br />
HYDROCODONE-ACETAMINOPHEN TAB 5-400 MG<br />
hydrocodone-acetaminophen tab 5-500 mg<br />
HYDROCODONE-ACETAMINOPHEN TAB 7.5-300 MG<br />
hydrocodone-acetaminophen tab 7.5-325 mg<br />
HYDROCODONE-ACETAMINOPHEN TAB 7.5-400 MG<br />
hydrocodone-acetaminophen tab 7.5-500 mg<br />
hydrocodone-acetaminophen tab 7.5-650 mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 54
hydrocodone-acetaminophen tab 7.5-750 mg<br />
hydrocodone-ibuprofen tab 10-200 mg<br />
HYDROCODONE-IBUPROFEN TAB 2.5-200 MG<br />
HYDROCODONE-IBUPROFEN TAB 5-200 MG<br />
hydrocodone-ibuprofen tab 5-200 mg<br />
hydrocodone-ibuprofen tab 7.5-200 mg<br />
hydrocodone/ sol apap<br />
hydrogesic cap 5-500mg<br />
HYDROMOR/NS INJ 1MG/ML PA<br />
HYDROMOR/NS SOL 1MG/ML PA<br />
HYDROMORPHON INJ /NACL PA<br />
HYDROMORPHON INJ /NS PA<br />
hydromorphone hcl inj 1 mg/ml PA<br />
hydromorphone hcl inj 10 mg/ml PA<br />
hydromorphone hcl inj 2 mg/ml PA<br />
hydromorphone hcl inj 4 mg/ml PA<br />
ibudone tab 10-200mg<br />
ibudone tab 5-200mg<br />
INFUMORPH INJ 10MG/ML PA<br />
INFUMORPH INJ 25MG/ML PA<br />
KADIAN CAP 100MG CR<br />
KADIAN CAP 10MG CR<br />
KADIAN CAP 200MG CR<br />
KADIAN CAP 20MG CR<br />
KADIAN CAP 20MG SR<br />
KADIAN CAP 30MG CR<br />
KADIAN CAP 50MG CR<br />
KADIAN CAP 60MG CR<br />
KADIAN CAP 80MG CR<br />
LEVO DROMORA INJ 2MG/ML PA<br />
LIQUICET SOL 10-500MG<br />
LYNOX TAB 10-300MG<br />
LYNOX TAB 2.5-300<br />
LYNOX TAB 5-300MG<br />
LYNOX TAB 7.5-300<br />
MAGNACET TAB 10-400MG<br />
MAGNACET TAB 2.5-400<br />
MAGNACET TAB 5-400MG<br />
MAGNACET TAB 7.5-400<br />
margesic-h cap 500-5mg<br />
MEPERIDI/NS SOL 10MG/ML<br />
meperidine inj 100mg/ml<br />
meperidine inj 10mg/ml<br />
meperidine inj 25mg/ml<br />
meperidine inj 300mg<br />
meperidine inj 50mg/ml<br />
meperidine inj 75mg/ml<br />
MEPERIDINE SOL 50MG/5ML<br />
meperidine tab 100mg<br />
meperidine tab 50mg<br />
meperidine hcl inj 10 mg/ml<br />
meperidine hcl inj 100 mg/ml<br />
meperidine hcl inj 25 mg/ml<br />
meperidine hcl inj 50 mg/ml<br />
meperidine hcl inj 75 mg/ml<br />
MEPERIDINE HCL INJ 75 MG/ML<br />
MEPERIDINE HCL ORAL SOLN 50 MG/5ML<br />
meperidine hcl tab 100 mg<br />
meperidine hcl tab 50 mg<br />
MEPERIDINE HCL-SODIUM CHLORIDE 0.9% INJ 10 MG/ML<br />
MEPERIDINE HCL-SODIUM CHLORIDE 0.9% IV SOLN 1000 MG/0.1L<br />
meperidine w/ promethazine cap 50-25 mg<br />
MEPERIDINE W/ PROMETHAZINE CAP 50-25 MG<br />
meperidine/ cap prometh<br />
MEPERIDNE/NS SOL 10MG/ML<br />
meperitab tab 100mg<br />
meperitab tab 50mg<br />
MEPROZINE CAP 50-25MG<br />
METHADONE INJ 10MG/ML PA<br />
methadone tab 10mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 55
methadone tab 40mg<br />
methadone tab 40mg<br />
methadone tab 5mg<br />
methadone hcl soln 10 mg/5ml PA<br />
methadone hcl soln 5 mg/5ml PA<br />
methadone hcl tab 10 mg<br />
methadone hcl tab 5 mg<br />
methadone hcl tab for oral susp 40 mg<br />
methadose tab 10mg<br />
methadose tab 40mg<br />
methadose tab 5mg<br />
MORPHINE SUL INJ 150/30ML PA<br />
MORPHINE SUL INJ 1MG/ML PA<br />
MORPHINE SUL INJ 2MG/ML PA<br />
MORPHINE SUL INJ 4MG/ML PA<br />
MORPHINE SUL INJ 5MG/ML PA<br />
MORPHINE SUL SOL 10MG/5ML PA<br />
MORPHINE SUL SOL 20MG/5ML PA<br />
morphine sul tab 100mg cr<br />
morphine sul tab 100mg er<br />
MORPHINE SUL TAB 10MG PA<br />
morphine sul tab 15mg cr<br />
morphine sul tab 15mg er<br />
morphine sul tab 200mg cr<br />
morphine sul tab 200mg er<br />
morphine sul tab 30mg cr<br />
morphine sul tab 30mg er<br />
morphine sul tab 60mg cr<br />
morphine sul tab 60mg er<br />
MORPHINE SULFATE CAP SR 24HR 10 MG<br />
MORPHINE SULFATE CAP SR 24HR 100 MG<br />
MORPHINE SULFATE CAP SR 24HR 20 MG<br />
MORPHINE SULFATE CAP SR 24HR 200 MG<br />
MORPHINE SULFATE CAP SR 24HR 30 MG<br />
MORPHINE SULFATE CAP SR 24HR 50 MG<br />
MORPHINE SULFATE CAP SR 24HR 60 MG<br />
MORPHINE SULFATE CAP SR 24HR 80 MG<br />
morphine sulfate inj 10 mg/ml PA<br />
morphine sulfate inj 15 mg/ml PA<br />
morphine sulfate inj 4 mg/ml PA<br />
morphine sulfate inj 8 mg/ml PA<br />
morphine sulfate inj pf 0.5 mg/ml PA<br />
morphine sulfate inj pf 1 mg/ml PA<br />
morphine sulfate iv soln 1 mg/ml PA<br />
morphine sulfate iv soln 25 mg/ml PA<br />
morphine sulfate iv soln 5 mg/ml PA<br />
morphine sulfate iv soln 50 mg/ml PA<br />
morphine sulfate oral soln 10 mg/5ml PA<br />
morphine sulfate oral soln 20 mg/5ml PA<br />
morphine sulfate oral soln 20 mg/ml PA<br />
morphine sulfate tab sol 10 mg (for parenteral use) PA<br />
morphine sulfate tab sol 15 mg (for parenteral use) PA<br />
morphine sulfate tab sol 30 mg (for parenteral use) PA<br />
MORPHINE SULFATE TAB SR 12HR 100 MG<br />
morphine sulfate tab sr 12hr 100 mg<br />
MORPHINE SULFATE TAB SR 12HR 15 MG<br />
morphine sulfate tab sr 12hr 15 mg<br />
morphine sulfate tab sr 12hr 200 mg<br />
MORPHINE SULFATE TAB SR 12HR 30 MG<br />
morphine sulfate tab sr 12hr 30 mg<br />
MORPHINE SULFATE TAB SR 12HR 60 MG<br />
morphine sulfate tab sr 12hr 60 mg<br />
MORPHINE/D5W INJ 1MG/ML PA<br />
MORPHINE/D5W INJ 2MG/ML PA<br />
MORPHINE/D5W SOL 1MG/ML PA<br />
MORPHINE/DW5 INJ 2MG/ML PA<br />
MORPHINE/NS INJ 1MG/ML PA<br />
MORPHINE/NS SOL 0.1MG/ML PA<br />
MORPHINE/NS SOL 1MG/ML PA<br />
narvox tab 10-500mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 56
NUMORPHAN INJ 1MG/ML PA<br />
OPANA INJ 1MG/ML PA<br />
ORAMORPH SR TAB 100MG<br />
ORAMORPH SR TAB 15MG<br />
ORAMORPH SR TAB 30MG<br />
ORAMORPH SR TAB 60MG<br />
oxycod/apap tab 10-325mg<br />
oxycod/apap tab 10-325mg<br />
oxycod/apap tab 10-325mg<br />
oxycod/apap tab 10-650mg<br />
oxycod/apap tab 2.5-325<br />
oxycod/apap tab 5-325mg<br />
oxycod/apap tab 5-325mg<br />
oxycod/apap tab 5-325mg<br />
oxycod/apap tab 7.5-325<br />
oxycod/apap tab 7.5-325<br />
oxycod/apap tab 7.5-500<br />
oxycod/apap tab 7.5-500<br />
oxycod/asa tab<br />
oxycodone tab 15mg NF<br />
oxycodone hcl tab 15 mg NF<br />
oxycodone hcl tab sr 12hr 10 mg PA<br />
oxycodone hcl tab sr 12hr 20 mg PA<br />
oxycodone hcl tab sr 12hr 40 mg PA<br />
oxycodone hcl tab sr 12hr 80 mg PA<br />
OXYCODONE W/ ACETAMINOPHEN TAB 10-300 MG<br />
OXYCODONE W/ ACETAMINOPHEN TAB 10-300 MG<br />
oxycodone w/ acetaminophen tab 10-325 mg<br />
OXYCODONE W/ ACETAMINOPHEN TAB 10-400 MG<br />
oxycodone w/ acetaminophen tab 10-500 mg<br />
OXYCODONE W/ ACETAMINOPHEN TAB 10-500 MG<br />
oxycodone w/ acetaminophen tab 10-650 mg<br />
OXYCODONE W/ ACETAMINOPHEN TAB 2.5-300 MG<br />
OXYCODONE W/ ACETAMINOPHEN TAB 2.5-300 MG<br />
oxycodone w/ acetaminophen tab 2.5-325 mg<br />
OXYCODONE W/ ACETAMINOPHEN TAB 2.5-400 MG<br />
OXYCODONE W/ ACETAMINOPHEN TAB 5-300 MG<br />
OXYCODONE W/ ACETAMINOPHEN TAB 5-300 MG<br />
oxycodone w/ acetaminophen tab 5-325 mg<br />
OXYCODONE W/ ACETAMINOPHEN TAB 5-400 MG<br />
OXYCODONE W/ ACETAMINOPHEN TAB 5-500 MG<br />
OXYCODONE W/ ACETAMINOPHEN TAB 7.5-300 MG<br />
OXYCODONE W/ ACETAMINOPHEN TAB 7.5-300 MG<br />
oxycodone w/ acetaminophen tab 7.5-325 mg<br />
OXYCODONE W/ ACETAMINOPHEN TAB 7.5-400 MG<br />
oxycodone w/ acetaminophen tab 7.5-500 mg<br />
oxycodone w/ aspirin tab full strength<br />
OXYCONTIN TAB 10MG CR PA<br />
OXYCONTIN TAB 15MG CR PA<br />
OXYCONTIN TAB 20MG CR PA<br />
OXYCONTIN TAB 30MG CR PA<br />
OXYCONTIN TAB 40MG CR PA<br />
OXYCONTIN TAB 60MG CR PA<br />
OXYCONTIN TAB 80MG CR PA<br />
PERLOXX TAB 10-300MG<br />
PERLOXX TAB 2.5-300<br />
PERLOXX TAB 5-300MG<br />
PERLOXX TAB 7.5-300<br />
polygesic cap 500-5mg<br />
PRIMALEV TAB 2.5-300<br />
PRIMLEV TAB 10-300MG<br />
PRIMLEV TAB 5-300MG<br />
PRIMLEV TAB 7.5-300<br />
propo-n/apap tab 100-650<br />
propo-n/apap tab 50/325<br />
propoxacet-n tab 100-650<br />
propoxyphene tab 100-325<br />
propoxyphene-n w/ apap tab 100-325 mg<br />
propoxyphene-n w/ apap tab 100-500 mg PA<br />
propoxyphene-n w/ apap tab 100-650 mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 57
propoxyphene-n w/ apap tab 50-325 mg<br />
reprexain tab 10-200mg<br />
REPREXAIN TAB 2.5-200<br />
REPREXAIN TAB 5-200MG<br />
reprexain tab 7.5-200<br />
roxicet tab 5-325mg<br />
ROXICET TAB 5-500MG<br />
RYBIX ODT TAB 50MG NF<br />
stagesic cap 500-5mg<br />
sufentanil citrate inj 50 mcg/ml PA<br />
TRAMADOL HCL SOLUBLE TAB 50 MG NF<br />
tramadol hcl tab 50 mg<br />
tramadol hcl tab 50mg<br />
trezix cap<br />
trezix cap<br />
ULTIVA INJ 1MG PA<br />
ULTIVA INJ 2MG PA<br />
ULTIVA INJ 5MG PA<br />
vanacet tab 5-500mg<br />
vicodin hp tab 10-660mg<br />
VOPAC TAB 650-30MG<br />
XODOL TAB 10-300MG<br />
XODOL TAB 5-300MG<br />
XODOL TAB 7.5-300<br />
XOLOX TAB 10-500MG<br />
zerlor tab<br />
ZYDONE TAB 10-400MG<br />
ZYDONE TAB 5-400MG<br />
ZYDONE TAB 7.5-400<br />
Opiate Partial Agonists<br />
buprenorphine hcl inj 0.3 mg/ml (base equiv) PA<br />
butorphanol tartrate inj 1 mg/ml PA<br />
butorphanol tartrate inj 2 mg/ml PA<br />
butorphanol tartrate nasal soln 10 mg/ml PA<br />
nalbuphine hcl inj 10 mg/ml PA<br />
nalbuphine hcl inj 20 mg/ml PA<br />
SUBOXONE SUB 2-0.5MG PA<br />
SUBOXONE SUB 8-2MG PA<br />
TALWIN INJ 30MG/ML PA<br />
Analgesics and Antipyretics, Misc<br />
8 hour pain tab 650mg OTC<br />
acephen sup 120mg OTC<br />
acephen sup 325mg OTC<br />
acephen sup 650mg OTC<br />
acetamin cap 500mg OTC<br />
acetamin chw 160mg OTC<br />
acetamin chw 80mg OTC<br />
acetamin chw 80mg frt OTC<br />
acetamin chw 80mg frt OTC<br />
acetamin chw 80mg grp OTC<br />
acetamin dro 100mg/ml OTC<br />
acetamin dro 80/0.8ml OTC<br />
acetamin dro 80/0.8ml OTC<br />
acetamin elx 160/5ml OTC<br />
acetamin liq 160/5ml OTC<br />
acetamin liq 500/15ml OTC<br />
acetamin sol 160/5ml OTC<br />
acetamin sup 120mg OTC<br />
acetamin sup 325mg OTC<br />
acetamin sup 650mg OTC<br />
acetamin tab 325mg OTC<br />
acetamin tab 500mg OTC<br />
acetamin tab 500mg es OTC<br />
acetamin tab 650mg cr OTC<br />
acetamin jr chw 160mg fr OTC<br />
acetamin jr tab 160mg rt OTC<br />
acetaminophen cap 500 mg OTC<br />
ACETAMINOPHEN CAP SPRINKLE 160 MG OTC<br />
ACETAMINOPHEN CAP SPRINKLE 80 MG OTC<br />
acetaminophen chew tab 160 mg OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 58
ACETAMINOPHEN CHEW TAB 500 MG OTC<br />
acetaminophen chew tab 80 mg OTC<br />
acetaminophen dispersible tab 160 mg OTC<br />
ACETAMINOPHEN DISPERSIBLE TAB 325 MG OTC<br />
ACETAMINOPHEN DISPERSIBLE TAB 500 MG OTC<br />
acetaminophen dispersible tab 80 mg OTC<br />
acetaminophen elixir 160 mg/5ml OTC<br />
ACETAMINOPHEN GEL SYRUP 160 MG/5ML OTC<br />
acetaminophen liquid 160 mg/5ml OTC<br />
acetaminophen liquid 167 mg/5ml OTC<br />
ACETAMINOPHEN LIQUID 500 MG/5ML OTC<br />
acetaminophen soln 100 mg/ml OTC<br />
acetaminophen soln 160 mg/5ml OTC<br />
ACETAMINOPHEN SOLN 325 MG/5ML OTC<br />
ACETAMINOPHEN SOLN 80 MG/ML OTC<br />
acetaminophen suppos 120 mg OTC<br />
acetaminophen suppos 325 mg OTC<br />
acetaminophen suppos 650 mg OTC<br />
ACETAMINOPHEN SUPPOS 80 MG OTC<br />
acetaminophen susp 160 mg/5ml OTC<br />
acetaminophen susp 80 mg/0.8ml OTC<br />
acetaminophen tab 160 mg OTC<br />
acetaminophen tab 325 mg OTC<br />
acetaminophen tab 500 mg OTC<br />
acetaminophen tab cr 650 mg OTC<br />
ACETAMINOPHEN W/ CALCIUM CARBONATE TAB 500-250 MG OTC<br />
acetaminophen w/ calcium carbonate tab 500-250 mg OTC<br />
ACETAMINOPHEN W/ PAMABROM TAB 325-25 MG OTC<br />
acetaminophen w/ pamabrom tab 500-25 mg OTC<br />
ACETAMINOPHEN-BROMELAINS TAB 500 MG-100000 UNIT OTC<br />
acetaminophen-caffeine tab 500-65 mg OTC<br />
acetaminophen-caffeine-pyrilamine tab 500-60-15 mg OTC<br />
ACETAMINOPHEN-MAGNESIUM SALICYLATE-CAFF TAB 250-290-50 MG OTC<br />
acetaminophen-pamabrom-pyrilamine cap 500-25-15 mg OTC<br />
acetaminophen-pamabrom-pyrilamine tab 500-25-15 mg OTC<br />
ACETAMINOPHEN-SALICYLAMIDE TAB 250-600 MG<br />
ACETAMINOPHEN-SALICYLAMIDE-CAFFEINE CAP 227-97-32 MG OTC<br />
ACETAMINOPHEN-SALICYLAMIDE-CAFFEINE TAB 226.8-97.2-32.4 MG OTC<br />
acetaminophen-salicylamide-phenyltoloxamine cap 300-200-20mg<br />
ACETAMINOPHEN-SALICYLAMIDE-PHENYLTOLOXAMINE CAP 325-200-25MG<br />
ACETAMINOPHEN-SALICYLAMIDE-PHENYLTOLOXAMINE TAB 300-200-20MG<br />
acetaminophn sus 160/5ml OTC<br />
acetaminophn sus 325mg OTC<br />
acetaminophn sus 650mg OTC<br />
af-apap infa dro 80/0.8ml OTC<br />
aminofen tab 325mg OTC<br />
aminofen tab 500mg OTC<br />
ANABAR TAB<br />
anacin af tab 500mg OTC<br />
apap cap 500mg OTC<br />
apap chw 80mg OTC<br />
apap dro 80/0.8ml OTC<br />
apap elx 80mg/2.5 OTC<br />
apap sol 80mg/2.5 OTC<br />
apap tab 325mg OTC<br />
apap tab 500mg OTC<br />
APAP 500 LIQ 500/5ML OTC<br />
apap child chw 80mg OTC<br />
apap child elx 160/5ml OTC<br />
apap child sus 160/5ml OTC<br />
apap ex str tab 500mg OTC<br />
apap-plus tab 500-65 OTC<br />
apara sol 160/5ml OTC<br />
apra elx 160/5ml OTC<br />
arthritis tab pain rel OTC<br />
arthrts pain tab 650mg OTC<br />
asa free chw 160mg jr OTC<br />
asp 300/200/ cap 20<br />
aspirin free tab 325mg OTC<br />
aspirin free tab 500mg OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 59
BACK PAINOFF TAB OTC<br />
be-flex plus cap<br />
bl pain reli chw 80mg OTC<br />
bl womens tab 500-25mg OTC<br />
but/apap/caf tab<br />
BUTALBITAL-ACETAMINOPHEN CAP 50-650 MG<br />
butalbital-acetaminophen-caffeine tab 50-325-40 mg<br />
by-ache cap<br />
chd pain rel chw 80mg OTC<br />
child apap chw 80mg OTC<br />
child apap chw 80mg grp OTC<br />
child apap chw 80mg gum OTC<br />
child apap elx 160/5ml OTC<br />
child apap tab 80mg OTC<br />
child nonasa chw 80mg OTC<br />
child nonasa chw pain/rel OTC<br />
child pain liq reliever OTC<br />
child pn rel chw 80mg OTC<br />
child pn rel elx 160/5ml OTC<br />
child pn/fev dro 80/0.8ml OTC<br />
child pn/fev dro 80/0.8ml OTC<br />
childrens chw 80mg OTC<br />
childs apap sus 160/5ml OTC<br />
childs apap sus 320/10ml OTC<br />
childs apap sus 325mg OTC<br />
childs apap sus 640/20ml OTC<br />
childs apap sus 650mg OTC<br />
childs pain sus relief OTC<br />
chld asafree elx 80/2.5ml OTC<br />
chld asafree sus 80/2.5ml OTC<br />
chld meditab chw 80mg OTC<br />
chld meditab sus 80/2.5ml OTC<br />
chld non-asa chw 80mg OTC<br />
chld non-asa chw 80mg grp OTC<br />
chld non-asa elx 160/5ml OTC<br />
chld non-asa tab 80mg OTC<br />
chld non-asa tab 80mg qm OTC<br />
chld non-asa tab 80mg qm OTC<br />
chld non-asa tab 80mg qm OTC<br />
chld pain rl tab 80mg OTC<br />
chld pn rel chw 80mg frt OTC<br />
chld pn rel chw 80mg grp OTC<br />
chld pn rel chw 80mg grp OTC<br />
chld pn rel elx 160/5ml OTC<br />
chld silapap liq 160/5ml OTC<br />
chlds mapap tab 80mg rt OTC<br />
chloraseptic liq sore thr OTC<br />
comtrex sore liq throat OTC<br />
CRAMP TAB OTC<br />
cvs 8 hour tab 650mg OTC<br />
cvs childs chw 80mg OTC<br />
cvs infants dro 80/0.8ml OTC<br />
cvs non-asa dro 80/0.8ml OTC<br />
cvs pain rel tab 500mg/rr OTC<br />
DAYTON ANASE TAB CAPLET OTC<br />
dolorex cap<br />
duraxin cap<br />
DURAXIN CAP<br />
eck acetamin tab 325mg OTC<br />
eck child sus non-asa OTC<br />
eck non-asa chw 80mg OTC<br />
eck pms tab relief OTC<br />
ed-apap liq 80mg/2.5 OTC<br />
ed-flex cap<br />
ELIXSURE GEL F/P BGUM OTC<br />
ELIXSURE GEL F/P CHRY OTC<br />
ELIXSURE GEL F/P GRPE OTC<br />
eq arthritis tab 650mg OTC<br />
eql acetamin tab 160mg OTC<br />
eql acetamin tab 650mg OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 60
eql acetamin tab 80mg OTC<br />
eql arthrits tab 650mg OTC<br />
eql infant dro 80/0.8ml OTC<br />
ex str pain tab reliever OTC<br />
FEBROL SOL 325/5ML OTC<br />
feverall sup 120mg OTC<br />
feverall sup 325mg OTC<br />
feverall sup 650mg OTC<br />
FEVERALL INF SUP 80MG OTC<br />
FEVERALL SPR CAP 160MG JR OTC<br />
FEVERALL SPR CAP 80MG CH OTC<br />
fp multi-sym tab pms OTC<br />
FRENADOL TAB<br />
genapap chw 80mg OTC<br />
genapap chw 80mg grp OTC<br />
genapap dro 80/0.8ml OTC<br />
genapap elx 160/5ml OTC<br />
genapap tab 325mg OTC<br />
genapap tab 500mg OTC<br />
genapap tab 500mg es OTC<br />
genebs tab 325mg OTC<br />
genebs tab 500mg OTC<br />
gnp acetamin sup 120mg OTC<br />
gnp headache tab relief OTC<br />
gnp pain rel chw 80mg OTC<br />
gnp pain rel tab ex st OTC<br />
gnp womens tab 500-25mg OTC<br />
hca child chw non-asa OTC<br />
hca child elx non-asa OTC<br />
hca child sus non-asa OTC<br />
hca infants dro non-asa OTC<br />
hca non-asa cap 500mg OTC<br />
ILARIS INJ 180MG PA<br />
inf asa free dro 80/0.8ml OTC<br />
inf mapap dro 80/0.8ml OTC<br />
inf non-asa dro 80/0.8ml OTC<br />
inf silapap dro 80/0.8ml OTC<br />
infant apap dro 80/0.8ml OTC<br />
infant apap sus 200/2ml OTC<br />
infantaire dro 80/0.8ml OTC<br />
infants apap dro 80/0.8ml OTC<br />
jr non-asa chw 160mg OTC<br />
jr non-asa tab 160mg qm OTC<br />
jr non-asa tab 160mg qm OTC<br />
jr non-asa tab 160mg qm OTC<br />
jr str pain chw reliever OTC<br />
jr. acetamin chw 80mg OTC<br />
junior mapap tab 160mg rt OTC<br />
LITTLE FEVER DRO FEV/PAIN OTC<br />
mapap cap 500mg OTC<br />
mapap chw 80mg OTC<br />
mapap dro 80/0.8ml OTC<br />
mapap liq 160/5ml OTC<br />
mapap tab 325mg OTC<br />
mapap tab 500mg OTC<br />
mapap tab 500mg/rr OTC<br />
mapap apap liq 500/15ml OTC<br />
mapap arthri tab 650mg OTC<br />
mapap child sus 160/5ml OTC<br />
mapap child tab 80mg rt OTC<br />
mapap jr str tab 160mg OTC<br />
MAPAP PLUS TAB HEADACHE OTC<br />
masophen tab 500mg OTC<br />
maxapap ms tab 500mg OTC<br />
maxapap rs tab 325mg OTC<br />
MEDI-GRAINE TAB OTC<br />
medi-tabs dro 80/0.8ml OTC<br />
medi-tabs elx 80/2.5ml OTC<br />
medi-tabs tab 325mg OTC<br />
medi-tabs tab 500mg OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 61
medi-tabs jr chw 160mg OTC<br />
menstrual tab 500-25mg OTC<br />
menstrual tab complete OTC<br />
menstrual tab max st OTC<br />
menstrual tab pms OTC<br />
midol tab 500/65mg OTC<br />
mp acetamin chw 80mg OTC<br />
ms.-aid tab 500-25mg OTC<br />
mult-sym pms tab menstrua OTC<br />
non aspirin elx 160/5ml OTC<br />
non aspirin sus 160/5ml OTC<br />
non aspirin tab 650mg er OTC<br />
non-asa chld dro 80/0.8ml OTC<br />
non-asa chld elx 160/5ml OTC<br />
non-asa chld liq 160/5ml OTC<br />
non-asa chld sus 160/5ml OTC<br />
non-asa infa dro 80/0.8ml OTC<br />
non-asa jr tab 160mg OTC<br />
non-asa jr tab 160mg qm OTC<br />
non-asa pain sus 160/5ml OTC<br />
non-aspirin cap 500mg OTC<br />
non-aspirin chw 160mg jr OTC<br />
non-aspirin chw 160mg jr OTC<br />
non-aspirin chw 160mg jr OTC<br />
non-aspirin chw 160mg jr OTC<br />
non-aspirin chw 80mg OTC<br />
non-aspirin elx 160/5ml OTC<br />
non-aspirin sol ex str OTC<br />
non-aspirin sus 160/5ml OTC<br />
non-aspirin sus child OTC<br />
non-aspirin tab 325mg OTC<br />
NON-ASPIRIN TAB 325MG QM OTC<br />
non-aspirin tab 500mg OTC<br />
NON-ASPIRIN TAB 500MG QM OTC<br />
non-aspirin tab 650mg OTC<br />
nortemp sol 160/5ml OTC<br />
nortemp sus 160/5ml OTC<br />
pain ex str tab 500mg OTC<br />
pain rel 8hr tab 650mg OTC<br />
pain rel cld chw 160mg OTC<br />
pain relief cap 500mg OTC<br />
pain relief chw 160mg jr OTC<br />
pain relief chw 160mg jr OTC<br />
pain relief chw 80mg OTC<br />
pain relief dro 100mg/ml OTC<br />
pain relief dro 80/0.8ml OTC<br />
pain relief dro 80/0.8ml OTC<br />
pain relief dro infants OTC<br />
pain relief liq 160/5ml OTC<br />
pain relief sus 160/5ml OTC<br />
pain relief sus child OTC<br />
pain relief tab 325mg OTC<br />
pain relief tab 500mg OTC<br />
pain relief tab 500mg/rr OTC<br />
pain relief tab 650mg OTC<br />
pain relief tab 650mg cr OTC<br />
pain relieve cap 500mg OTC<br />
pain relieve chw 160mg OTC<br />
pain relieve chw 160mg jr OTC<br />
pain relieve chw 160mg jr OTC<br />
pain relieve chw 160mg jr OTC<br />
pain relieve chw 160mg jr OTC<br />
pain relieve dro 80/0.8ml OTC<br />
pain relieve sup 120mg OTC<br />
pain relieve sus 160/5ml OTC<br />
pain relieve tab 160mg OTC<br />
pain relieve tab 325mg OTC<br />
pain relieve tab 500mg OTC<br />
pain relieve tab 500mg es OTC<br />
pain relieve tab 500mg es OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 62
pain relieve tab 500mg/rr OTC<br />
pain relievr chw 80mg OTC<br />
pain relievr tab 160mg OTC<br />
painaid pmf tab 500-25mg OTC<br />
pamprin ms cap mult-sym OTC<br />
pharbetol tab 325mg OTC<br />
pharbetol tab 500mg OTC<br />
PHENYLEPHRINE-APAP-CAFFEINE TAB 5-500-75 MG OTC<br />
PHRENILIN CAP FORTE<br />
pms tab mult-sym OTC<br />
pms formula tab 500-25-1 OTC<br />
premsyn pms cap max st OTC<br />
premsyn pms tab OTC<br />
PRIALT INJ 100MCG PA<br />
PRIALT INJ 25MCG/ML PA<br />
PRIALT INJ 500MCG PA<br />
q-pap liq 160/5ml OTC<br />
q-pap tab 325mg OTC<br />
q-pap child sus 160/5ml OTC<br />
q-pap child sus cherry OTC<br />
q-pap ex st tab 500mg OTC<br />
q-pap infant dro 80/0.8ml OTC<br />
qc arthritis tab 650mg cr OTC<br />
qc infants dro 80/0.8ml OTC<br />
qc non-asa sus children OTC<br />
qc pms multi tab symptom OTC<br />
ra acetamin chw 80mg OTC<br />
ra acetamin dro 100mg/ml OTC<br />
ra acetamin elx 160/5ml OTC<br />
ra acetamin tab 325mg OTC<br />
ra acetamin tab 500mg OTC<br />
ra acetamin tab 500mg/rr OTC<br />
ra acetamin tab 650mg er OTC<br />
ra acetamin tab plus ex OTC<br />
ra athenol tab 500mg OTC<br />
ra chld apap elx 160/5ml OTC<br />
ra menstrual tab relief OTC<br />
ra non-asa dro 80/0.8ml OTC<br />
ra non-asa sus 160/5ml OTC<br />
ra premnstrl tab relief OTC<br />
repan tab<br />
RID-A-PAIN CAP CPD OTC<br />
RID-A-PAIN TAB CPD OTC<br />
sb infants dro cherry OTC<br />
sb infants dro grape OTC<br />
sb non-asa chw 160mg OTC<br />
sb non-asa chw 80mg frt OTC<br />
sb non-asa chw 80mg grp OTC<br />
sb non-asa tab 500mg es OTC<br />
sb pain rel sus children OTC<br />
sg ex-prin chw 160mg jr OTC<br />
sg ex-prin chw 80mg frt OTC<br />
sg ex-prin chw 80mg grp OTC<br />
sg ex-prin chw 80mg gum OTC<br />
sg ex-prin dro infant OTC<br />
sg ex-prin elx 160/5ml OTC<br />
sg ex-prin sus 160/5ml OTC<br />
sg ex-prin tab 325mg OTC<br />
sg ex-prin tab 500mg OTC<br />
sm arthritis tab 650mg OTC<br />
sm non-asa chw 80mg OTC<br />
sm non-asa chw 80mg grp OTC<br />
sm non-asa elx 160/5ml OTC<br />
sm pain rel cap 500mg OTC<br />
sm pain rel tab 500mg/rr OTC<br />
sm pain rel tab 8 hour OTC<br />
sm tension tab headache OTC<br />
soba child p chw 80mg frt OTC<br />
soba childrn chw 80mg OTC<br />
soba pain re chw 160mg jr OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 63
sodium thiosalicylate inj 50 mg/ml PA<br />
tactinal chw children OTC<br />
tactinal tab 325mg OTC<br />
tactinal tab 500mg OTC<br />
tgt acetamin sus child OTC<br />
tgt acetamin tab 500mg OTC<br />
tgt acetamin tab 500mg/rr OTC<br />
tgt apap dro infants OTC<br />
tycolene tab 325mg OTC<br />
tycolene tab 500mg OTC<br />
tylenol chld tab 80mg OTC<br />
TYLENOL GO CHW EXTRA ST OTC<br />
tylophen cap 500mg OTC<br />
tylophen tab 325mg OTC<br />
un-aspirin tab 500mg OTC<br />
v-r non-asa dro 100mg/ml OTC<br />
v-r non-asa dro 80/0.8ml OTC<br />
v-r non-asa elx 160/5ml OTC<br />
womens menst tab relief OTC<br />
womns tylenl tab 500-25mg OTC<br />
Opiate Antagonists<br />
naloxone hcl inj 0.4 mg/ml PA<br />
naloxone hcl inj 1 mg/ml PA<br />
REVEX INJ 100MCG PA<br />
REVEX INJ 1MG/ML PA<br />
VIVITROL INJ 380MG PA<br />
Anticonvulsants<br />
Anticonvulsant Barbiturates<br />
primidone tab 250mg<br />
primidone tab 50mg<br />
primidone tab 250 mg<br />
primidone tab 50 mg<br />
Anticonvulsant Benzodiazepines<br />
clonazepam tab 0.5mg<br />
clonazepam tab 1mg<br />
clonazepam tab 2mg<br />
clonazepam tab 0.5 mg<br />
clonazepam tab 1 mg<br />
clonazepam tab 2 mg<br />
Hydantoins<br />
DILANTIN CAP 100MG<br />
DILANTIN CAP 30MG<br />
DILANTIN CHW 50MG<br />
DILANTIN-125 SUS 125/5ML<br />
DILANTIN-125 SUS 125/5ML<br />
fosphenytoin sodium inj 75 mg/ml (phenytoin equiv 50 mg/ml) PA<br />
PHENYTEK CAP 200MG<br />
PHENYTEK CAP 300MG<br />
phenytoin sus 100/4ml<br />
phenytoin sus 125/5ml<br />
PHENYTOIN CHEW TAB 50 MG<br />
phenytoin ex cap 100mg<br />
phenytoin ex cap 200mg<br />
phenytoin ex cap 300mg<br />
PHENYTOIN SODIUM EXTENDED CAP 100 MG<br />
phenytoin sodium extended cap 100 mg<br />
phenytoin sodium extended cap 200 mg<br />
PHENYTOIN SODIUM EXTENDED CAP 200 MG<br />
PHENYTOIN SODIUM EXTENDED CAP 30 MG<br />
phenytoin sodium extended cap 300 mg<br />
PHENYTOIN SODIUM EXTENDED CAP 300 MG<br />
phenytoin sodium inj 50 mg/ml PA<br />
PHENYTOIN SUSP 125 MG/5ML<br />
phenytoin susp 125 mg/5ml<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 64
Succinimides<br />
ethosuximide cap 250 mg<br />
ethosuximide cap 250mg<br />
ethosuximide sol 250/5ml<br />
ethosuximide soln 250 mg/5ml<br />
Anticonvulsants, Miscellaneous<br />
BANZEL TAB 200MG PA QL<br />
BANZEL TAB 400MG PA QL<br />
carbamazepin chw 100mg<br />
carbamazepin sus 100/5ml<br />
carbamazepin tab 200mg<br />
carbamazepin tab 200mg er<br />
carbamazepin tab 400mg er<br />
CARBAMAZEPINE CHEW TAB 100 MG<br />
carbamazepine chew tab 100 mg<br />
CARBAMAZEPINE SUSP 100 MG/5ML<br />
carbamazepine susp 100 mg/5ml<br />
carbamazepine tab 200 mg<br />
CARBAMAZEPINE TAB 200 MG<br />
CARBAMAZEPINE TAB SR 12HR 100 MG<br />
carbamazepine tab sr 12hr 200 mg<br />
CARBAMAZEPINE TAB SR 12HR 200 MG<br />
CARBAMAZEPINE TAB SR 12HR 400 MG<br />
CARBAMAZEPINE TAB SR 12HR 400 MG<br />
carbamazepine tab sr 12hr 400 mg<br />
divalproex cap 125mg<br />
divalproex tab 125mg dr<br />
divalproex tab 250mg dr<br />
divalproex tab 250mg ec<br />
divalproex tab 250mg er QL<br />
divalproex tab 500mg dr<br />
divalproex tab 500mg er QL<br />
divalproex sodium cap sprinkle 125 mg<br />
divalproex sodium tab delayed release 125 mg<br />
divalproex sodium tab delayed release 250 mg<br />
divalproex sodium tab delayed release 500 mg<br />
divalproex sodium tab sr 24 hr 250 mg QL<br />
divalproex sodium tab sr 24 hr 500 mg QL<br />
epitol tab 200mg<br />
KEPPRA INJ 500/5ML PA<br />
LAMICTAL CHW 2MG PA<br />
LAMICTAL ODT KIT PA<br />
LAMICTAL ODT TAB 100MG PA<br />
LAMICTAL ODT TAB 200MG PA<br />
LAMICTAL ODT TAB 25MG PA<br />
LAMICTAL ODT TAB 50MG PA<br />
LAMICTAL XR KIT PA<br />
LAMICTAL XR TAB 100MG PA<br />
LAMICTAL XR TAB 200MG PA<br />
LAMICTAL XR TAB 25MG PA<br />
LAMICTAL XR TAB 50MG PA<br />
lamotrigine tab 100 mg PA<br />
lamotrigine tab 150 mg PA<br />
lamotrigine tab 200 mg PA<br />
lamotrigine tab 25 mg PA<br />
lamotrigine tab 25 mg (35) starter kit PA<br />
lamotrigine tab 25 mg (42) & 100 mg (7) starter kit PA<br />
lamotrigine tab 25 mg (84) & 100 mg (14) starter kit PA<br />
lamotrigine tab chewable dispersible 25 mg PA<br />
lamotrigine tab chewable dispersible 5 mg PA<br />
levetiracetam oral soln 100 mg/ml PA<br />
levetiracetam tab 1000 mg PA<br />
levetiracetam tab 250 mg PA<br />
levetiracetam tab 500 mg PA<br />
levetiracetam tab 750 mg PA<br />
LYRICA CAP 300MG<br />
MAGNESIUM SU INJ 40MG/ML PA<br />
MAGNESIUM SU INJ 80MG/ML PA<br />
magnesium sulfate inj 50% PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 65
oxcarbazepine susp 300 mg/5ml (60 mg/ml) PA<br />
oxcarbazepine tab 150 mg PA<br />
oxcarbazepine tab 300 mg PA<br />
oxcarbazepine tab 600 mg PA<br />
PREGABALIN CAP 300 MG<br />
TEGRETOL CHW 100MG<br />
TEGRETOL SUS 100/5ML<br />
TEGRETOL TAB 200MG<br />
TEGRETOL XR TAB 100MG<br />
TEGRETOL XR TAB 200MG<br />
TEGRETOL XR TAB 400MG<br />
TEGRETOL XR TAB 400MG<br />
topiramate sprinkle cap 15 mg PA<br />
topiramate sprinkle cap 25 mg PA<br />
topiramate tab 100 mg PA<br />
topiramate tab 200 mg PA<br />
topiramate tab 25 mg PA<br />
topiramate tab 50 mg PA<br />
valproate sodium inj 100 mg/ml PA<br />
valproate sodium syrup 250 mg/5ml (base equiv)<br />
valproic acd cap 250mg<br />
valproic acd syp 250/5ml<br />
valproic acid cap 250 mg<br />
VIMPAT INJ 200MG/20 PA<br />
Psychotherapeutic Agents<br />
Antidepressants<br />
citalopram tab 10mg<br />
citalopram tab 20mg<br />
citalopram tab 40mg<br />
citalopram hydrobromide tab 10 mg (base equiv)<br />
citalopram hydrobromide tab 20 mg (base equiv)<br />
citalopram hydrobromide tab 40 mg (base equiv)<br />
fluoxetine cap 10mg<br />
fluoxetine cap 20mg<br />
fluoxetine sol 20mg/5ml<br />
fluoxetine hcl cap 10 mg<br />
fluoxetine hcl cap 20 mg<br />
fluoxetine hcl solution 20 mg/5ml<br />
nortriptylin cap 25mg<br />
nortriptyline hcl cap 25 mg<br />
paroxetine tab 20mg<br />
paroxetine hcl tab 20 mg<br />
trazodone tab 100mg<br />
trazodone tab 150mg<br />
trazodone tab 300mg<br />
trazodone tab 50mg<br />
trazodone hcl tab 100 mg<br />
trazodone hcl tab 150 mg<br />
trazodone hcl tab 300 mg<br />
trazodone hcl tab 50 mg<br />
Monomine Oxidase Inhibitors<br />
ISOCARBOXAZID TAB 10 MG<br />
MARPLAN TAB 10MG<br />
NARDIL TAB 15MG<br />
PHENELZINE SULFATE TAB 15 MG<br />
tranylcyprom tab 10mg<br />
tranylcypromine sulfate tab 10 mg<br />
Selective Serotonin- and Norepinephrine-reuptake<br />
CYMBALTA CAP 20MG PA<br />
CYMBALTA CAP 30MG PA<br />
CYMBALTA CAP 60MG PA<br />
EFFEXOR XR CAP 150MG<br />
EFFEXOR XR CAP 37.5MG<br />
EFFEXOR XR CAP 75MG<br />
venlafaxine tab 100mg<br />
venlafaxine tab 25mg<br />
venlafaxine tab 37.5mg<br />
venlafaxine tab 50mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 66
venlafaxine tab 75mg<br />
VENLAFAXINE HCL CAP SR 24HR 150 MG (BASE EQUIVALENT)<br />
VENLAFAXINE HCL CAP SR 24HR 37.5 MG (BASE EQUIVALENT)<br />
VENLAFAXINE HCL CAP SR 24HR 75 MG (BASE EQUIVALENT)<br />
venlafaxine hcl tab 100 mg<br />
venlafaxine hcl tab 25 mg<br />
venlafaxine hcl tab 37.5 mg<br />
venlafaxine hcl tab 50 mg<br />
venlafaxine hcl tab 75 mg<br />
Selective-serotonin Reuptake Inhibitors<br />
citalopram tab 10mg<br />
citalopram tab 20mg<br />
citalopram tab 40mg<br />
citalopram hydrobromide tab 10 mg (base equiv)<br />
citalopram hydrobromide tab 20 mg (base equiv)<br />
citalopram hydrobromide tab 40 mg (base equiv)<br />
ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV) NF<br />
fluoxetine cap 10mg<br />
fluoxetine cap 20mg<br />
fluoxetine cap 40mg<br />
fluoxetine cap 90mg dr<br />
fluoxetine sol 20mg/5ml<br />
fluoxetine tab 10mg<br />
fluoxetine tab 20mg<br />
FLUOXETINE HCL (PMDD) CAP 10 MG<br />
fluoxetine hcl (pmdd) cap 10 mg<br />
fluoxetine hcl (pmdd) cap 20 mg<br />
fluoxetine hcl cap 10 mg<br />
fluoxetine hcl cap 20 mg<br />
fluoxetine hcl cap 40 mg<br />
fluoxetine hcl cap delayed release 90 mg<br />
FLUOXETINE HCL CAP DELAYED RELEASE 90 MG<br />
fluoxetine hcl solution 20 mg/5ml<br />
fluoxetine hcl tab 10 mg<br />
fluoxetine hcl tab 20 mg<br />
LEXAPRO TAB 10MG NF<br />
paroxetine tab 10mg<br />
paroxetine tab 20mg<br />
paroxetine tab 30mg<br />
paroxetine tab 40mg<br />
paroxetine hcl tab 10 mg<br />
paroxetine hcl tab 20 mg<br />
paroxetine hcl tab 30 mg<br />
paroxetine hcl tab 40 mg<br />
paroxetine hcl tab sr 24hr 12.5 mg PA<br />
paroxetine hcl tab sr 24hr 25 mg PA<br />
paroxetine hcl tab sr 24hr 37.5 mg PA<br />
PAXIL CR TAB 37.5MG PA<br />
PROZAC WEEKL CAP 90MG<br />
SARAFEM CAP 10MG<br />
selfemra cap 10mg<br />
selfemra cap 20mg<br />
sertraline tab 100mg<br />
sertraline tab 25mg<br />
sertraline tab 50mg<br />
sertraline hcl tab 100 mg<br />
sertraline hcl tab 25 mg<br />
sertraline hcl tab 50 mg<br />
Serotonin Modulators<br />
nefazodone tab 100mg<br />
nefazodone tab 100mg<br />
nefazodone tab 150mg<br />
nefazodone tab 150mg<br />
nefazodone tab 200mg<br />
nefazodone tab 200mg<br />
nefazodone tab 250mg<br />
nefazodone tab 250mg<br />
nefazodone tab 50mg<br />
nefazodone tab 50mg<br />
nefazodone hcl tab 100 mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 67
nefazodone hcl tab 100 mg<br />
nefazodone hcl tab 150 mg<br />
nefazodone hcl tab 150 mg<br />
nefazodone hcl tab 200 mg<br />
nefazodone hcl tab 200 mg<br />
nefazodone hcl tab 250 mg<br />
nefazodone hcl tab 250 mg<br />
nefazodone hcl tab 50 mg<br />
nefazodone hcl tab 50 mg<br />
trazodone tab 100mg<br />
trazodone tab 150mg<br />
trazodone tab 300mg<br />
trazodone tab 50mg<br />
trazodone hcl tab 100 mg<br />
trazodone hcl tab 150 mg<br />
trazodone hcl tab 300 mg<br />
trazodone hcl tab 50 mg<br />
Tricyclics and Other Norepinephrine-reuptake Inhib<br />
amitriptylin tab 100mg<br />
amitriptylin tab 10mg<br />
amitriptylin tab 150mg<br />
amitriptylin tab 25mg<br />
amitriptylin tab 50mg<br />
amitriptylin tab 75mg<br />
amitriptyline hcl tab 10 mg<br />
amitriptyline hcl tab 100 mg<br />
amitriptyline hcl tab 150 mg<br />
amitriptyline hcl tab 25 mg<br />
amitriptyline hcl tab 50 mg<br />
amitriptyline hcl tab 75 mg<br />
clomipramine cap 25mg<br />
clomipramine cap 50mg<br />
clomipramine cap 75mg<br />
clomipramine hcl cap 25 mg<br />
clomipramine hcl cap 50 mg<br />
clomipramine hcl cap 75 mg<br />
desipramine tab 100mg<br />
desipramine tab 10mg<br />
desipramine tab 150mg<br />
desipramine tab 25mg<br />
desipramine tab 50mg<br />
desipramine tab 75mg<br />
desipramine hcl tab 10 mg<br />
desipramine hcl tab 100 mg<br />
desipramine hcl tab 150 mg<br />
desipramine hcl tab 25 mg<br />
desipramine hcl tab 50 mg<br />
desipramine hcl tab 75 mg<br />
doxepin hcl cap 100mg<br />
doxepin hcl cap 10mg<br />
doxepin hcl cap 150mg<br />
DOXEPIN HCL CAP 150MG<br />
doxepin hcl cap 150mg<br />
doxepin hcl cap 25mg<br />
doxepin hcl cap 50mg<br />
doxepin hcl cap 75mg<br />
doxepin hcl con 10mg/ml<br />
doxepin hcl cap 10 mg<br />
doxepin hcl cap 100 mg<br />
doxepin hcl cap 150 mg<br />
doxepin hcl cap 150 mg<br />
DOXEPIN HCL CAP 150 MG<br />
doxepin hcl cap 25 mg<br />
doxepin hcl cap 50 mg<br />
doxepin hcl cap 75 mg<br />
doxepin hcl conc 10 mg/ml<br />
imipram hcl tab 10mg<br />
imipram hcl tab 25mg<br />
imipram hcl tab 50mg<br />
imipram pam cap 100mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 68
imipram pam cap 125mg<br />
imipram pam cap 150mg<br />
imipram pam cap 75mg<br />
imipramine hcl tab 10 mg<br />
imipramine hcl tab 25 mg<br />
imipramine hcl tab 50 mg<br />
imipramine pamoate cap 100 mg<br />
imipramine pamoate cap 125 mg<br />
imipramine pamoate cap 150 mg<br />
IMIPRAMINE PAMOATE CAP 75 MG<br />
imipramine pamoate cap 75 mg<br />
nortriptylin cap 10mg<br />
nortriptylin cap 25mg<br />
nortriptylin cap 50mg<br />
nortriptylin cap 75mg<br />
nortriptylin sol 10mg/5ml<br />
nortriptyline hcl cap 10 mg<br />
nortriptyline hcl cap 25 mg<br />
nortriptyline hcl cap 50 mg<br />
nortriptyline hcl cap 75 mg<br />
nortriptyline hcl soln 10 mg/5ml<br />
TOFRANIL-PM CAP 75MG<br />
Miscellaneous Antidepressants<br />
budeprion tab 100mg sr<br />
budeprion tab 150mg sr<br />
bupropion tab 100mg<br />
bupropion tab 100mg er<br />
bupropion tab 100mg sr<br />
bupropion tab 150mg er<br />
bupropion tab 150mg sr<br />
bupropion tab 200mg sr<br />
bupropion tab 75mg<br />
bupropion hcl (smoking deterrent) tab sr 12hr 150 mg PA<br />
bupropion hcl tab 100 mg<br />
bupropion hcl tab 75 mg<br />
bupropion hcl tab sr 12hr 100 mg<br />
bupropion hcl tab sr 12hr 150 mg<br />
bupropion hcl tab sr 12hr 200 mg<br />
mirtazapine tab 15mg<br />
mirtazapine tab 30mg<br />
mirtazapine tab 45mg<br />
mirtazapine tab 7.5mg<br />
mirtazapine tab 15 mg<br />
mirtazapine tab 30 mg<br />
mirtazapine tab 45 mg<br />
mirtazapine tab 7.5 mg<br />
Antipsychotics<br />
risperidone sol 1mg/ml PA<br />
risperidone soln 1 mg/ml PA<br />
SEROQUEL XR TAB 150MG PA<br />
SEROQUEL XR TAB 50MG PA<br />
Atypical Antipsychotics<br />
ABILIFY INJ 9.75MG PA<br />
ABILIFY SOL 1MG/ML PA<br />
ABILIFY TAB 10MG PA<br />
ABILIFY TAB 15MG PA<br />
ABILIFY TAB 20MG PA<br />
ABILIFY TAB 2MG PA<br />
ABILIFY TAB 30MG PA<br />
ABILIFY TAB 5MG PA<br />
ABILIFY DISC TAB 10MG PA<br />
ABILIFY DISC TAB 15MG PA<br />
CLOZAPINE TAB 12.5 PA<br />
CLOZAPINE TAB 200MG PA<br />
clozapine tab 100 mg PA<br />
clozapine tab 200 mg PA<br />
clozapine tab 25 mg PA<br />
clozapine tab 50 mg PA<br />
FAZACLO TAB 100MG PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 69
FAZACLO TAB 12.5MG PA<br />
FAZACLO TAB 25MG PA<br />
GEODON CAP 20MG PA<br />
GEODON CAP 40MG PA<br />
GEODON CAP 60MG PA<br />
GEODON CAP 80MG PA<br />
GEODON INJ 20MG PA<br />
INVEGA SUST INJ 117/0.75 PA<br />
INVEGA SUST INJ 156MG/ML PA<br />
INVEGA SUST INJ 234/1.5 PA<br />
INVEGA SUST INJ 39/0.25 PA<br />
INVEGA SUST INJ 78/0.5ML PA<br />
RISPERDAL INJ 12.5MG PA<br />
RISPERDAL INJ 25MG PA<br />
RISPERDAL INJ 37.5MG PA<br />
RISPERDAL INJ 50MG PA<br />
RISPERIDONE TAB 0.25 ODT PA QL<br />
risperidone orally disintegrating tab 0.5 mg PA QL<br />
risperidone orally disintegrating tab 1 mg PA QL<br />
risperidone orally disintegrating tab 2 mg PA QL<br />
risperidone orally disintegrating tab 3 mg PA QL<br />
risperidone orally disintegrating tab 4 mg PA QL<br />
risperidone soln 1 mg/ml PA<br />
risperidone tab 0.25 mg PA<br />
risperidone tab 0.5 mg PA<br />
risperidone tab 1 mg PA QL<br />
risperidone tab 2 mg PA QL<br />
risperidone tab 3 mg PA QL<br />
risperidone tab 4 mg PA QL<br />
SAPHRIS SUB 10MG PA<br />
SAPHRIS SUB 5MG PA<br />
SEROQUEL TAB 100MG PA<br />
SEROQUEL TAB 200MG PA<br />
SEROQUEL TAB 25MG PA<br />
SEROQUEL TAB 300MG PA<br />
SEROQUEL TAB 400MG PA<br />
SEROQUEL TAB 50MG PA<br />
SEROQUEL XR TAB 150MG PA<br />
SEROQUEL XR TAB 200MG PA<br />
SEROQUEL XR TAB 300MG PA<br />
SEROQUEL XR TAB 400MG PA<br />
SEROQUEL XR TAB 50MG PA<br />
ZYPREXA INJ 10MG PA<br />
ZYPREXA TAB 10MG PA<br />
ZYPREXA TAB 15MG PA<br />
ZYPREXA TAB 2.5MG PA<br />
ZYPREXA TAB 20MG PA<br />
ZYPREXA TAB 5MG PA<br />
ZYPREXA TAB 7.5MG PA<br />
ZYPREXA RELP INJ 210MG PA<br />
ZYPREXA RELP INJ 300MG PA<br />
ZYPREXA RELP INJ 405MG PA<br />
ZYPREXA ZYDI TAB 10MG PA<br />
ZYPREXA ZYDI TAB 15MG PA<br />
ZYPREXA ZYDI TAB 20MG PA<br />
ZYPREXA ZYDI TAB 5MG PA<br />
Butyrophenones<br />
haloperidol con 2mg/ml<br />
haloperidol tab 0.5mg<br />
haloperidol tab 10mg<br />
haloperidol tab 1mg<br />
haloperidol tab 20mg<br />
haloperidol tab 2mg<br />
haloperidol tab 5mg<br />
haloperidol decanoate im soln 100 mg/ml PA<br />
haloperidol decanoate im soln 50 mg/ml PA<br />
haloperidol lactate inj 5 mg/ml PA<br />
haloperidol lactate oral conc 2 mg/ml<br />
haloperidol tab 0.5 mg<br />
haloperidol tab 1 mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 70
haloperidol tab 10 mg<br />
haloperidol tab 2 mg<br />
haloperidol tab 20 mg<br />
haloperidol tab 5 mg<br />
Phenothiazines<br />
CHLORPROMAZ INJ 25MG/ML PA<br />
chlorpromaz tab 100mg<br />
chlorpromaz tab 10mg<br />
chlorpromaz tab 200mg<br />
chlorpromaz tab 25mg<br />
chlorpromaz tab 50mg<br />
chlorpromazine hcl tab 10 mg<br />
chlorpromazine hcl tab 100 mg<br />
chlorpromazine hcl tab 200 mg<br />
chlorpromazine hcl tab 25 mg<br />
chlorpromazine hcl tab 50 mg<br />
CHLORPROMAZINE SUPPOS 100 MG<br />
compro sup 25mg<br />
fluphenazine con 5mg/ml<br />
fluphenazine decanoate inj 25 mg/ml PA<br />
FLUPHENAZINE ELX 2.5/5ML<br />
fluphenazine elx 2.5/5ml<br />
fluphenazine hcl elixir 2.5 mg/5ml<br />
FLUPHENAZINE HCL ELIXIR 2.5 MG/5ML<br />
fluphenazine hcl oral conc 5 mg/ml<br />
fluphenazine hcl tab 1 mg<br />
fluphenazine hcl tab 10 mg<br />
fluphenazine hcl tab 2.5 mg<br />
fluphenazine hcl tab 5 mg<br />
FLUPHENAZINE INJ 2.5MG/ML PA<br />
fluphenazine tab 10mg<br />
fluphenazine tab 1mg<br />
fluphenazine tab 2.5mg<br />
fluphenazine tab 5mg<br />
perphenazine tab 16 mg<br />
perphenazine tab 16mg<br />
perphenazine tab 2 mg<br />
perphenazine tab 2mg<br />
perphenazine tab 4 mg<br />
perphenazine tab 4mg<br />
perphenazine tab 8 mg<br />
perphenazine tab 8mg<br />
prochlorper sup 25mg<br />
prochlorper tab 10mg<br />
prochlorper tab 5mg<br />
prochlorperazine edisylate inj 5 mg/ml PA<br />
prochlorperazine maleate tab 10 mg<br />
prochlorperazine maleate tab 5 mg<br />
prochlorperazine suppos 25 mg<br />
thioridazine hcl tab 10 mg<br />
thioridazine hcl tab 100 mg<br />
thioridazine hcl tab 25 mg<br />
thioridazine hcl tab 50 mg<br />
thioridazine tab 100mg<br />
thioridazine tab 10mg<br />
thioridazine tab 25mg<br />
thioridazine tab 50mg<br />
THORAZINE SUP 100MG<br />
trifluoperaz tab 10mg<br />
trifluoperaz tab 1mg<br />
trifluoperaz tab 2mg<br />
trifluoperaz tab 5mg<br />
trifluoperazine hcl tab 1 mg<br />
trifluoperazine hcl tab 10 mg<br />
trifluoperazine hcl tab 2 mg<br />
trifluoperazine hcl tab 5 mg<br />
Thioxanthenes<br />
NAVANE CAP 20MG<br />
thiothixene cap 10mg<br />
thiothixene cap 1mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 71
thiothixene cap 2mg<br />
thiothixene cap 5mg<br />
thiothixene cap 1 mg<br />
thiothixene cap 10 mg<br />
thiothixene cap 2 mg<br />
THIOTHIXENE CAP 20 MG<br />
thiothixene cap 5 mg<br />
Miscellaneous Antipsychotics<br />
loxapine cap 10mg<br />
loxapine cap 25mg<br />
loxapine cap 50mg<br />
loxapine cap 5mg<br />
loxapine succinate cap 10 mg<br />
loxapine succinate cap 25 mg<br />
loxapine succinate cap 5 mg<br />
loxapine succinate cap 50 mg<br />
Anorexigenics & Resp & Cereb Stimulants<br />
Amphetamines<br />
amphetamine cap 10mg er QL<br />
amphetamine cap 15mg er QL<br />
amphetamine cap 20mg er QL<br />
amphetamine cap 25mg er QL<br />
amphetamine cap 30mg er QL<br />
amphetamine cap 5mg er QL<br />
amphetamine tab 10mg QL<br />
amphetamine tab 12.5mg QL<br />
amphetamine tab 15mg QL<br />
amphetamine tab 20mg QL<br />
amphetamine tab 30mg QL<br />
amphetamine tab 5mg QL<br />
amphetamine tab 5mg NF<br />
amphetamine tab 7.5mg QL<br />
amphetamine-dextroamphetamine cap sr 24hr 10 mg QL<br />
amphetamine-dextroamphetamine cap sr 24hr 15 mg QL<br />
amphetamine-dextroamphetamine cap sr 24hr 20 mg QL<br />
amphetamine-dextroamphetamine cap sr 24hr 25 mg QL<br />
amphetamine-dextroamphetamine cap sr 24hr 30 mg QL<br />
amphetamine-dextroamphetamine cap sr 24hr 5 mg QL<br />
amphetamine-dextroamphetamine tab 10 mg QL<br />
amphetamine-dextroamphetamine tab 12.5 mg QL<br />
amphetamine-dextroamphetamine tab 15 mg QL<br />
amphetamine-dextroamphetamine tab 20 mg QL<br />
amphetamine-dextroamphetamine tab 30 mg QL<br />
amphetamine-dextroamphetamine tab 5 mg QL<br />
amphetamine-dextroamphetamine tab 5 mg NF<br />
amphetamine-dextroamphetamine tab 7.5 mg QL<br />
dextroamphet cap 10mg cr<br />
dextroamphet cap 10mg er<br />
dextroamphet cap 15mg cr<br />
dextroamphet cap 15mg er<br />
dextroamphet cap 5mg cr<br />
dextroamphet cap 5mg er<br />
dextroamphet tab 10mg<br />
dextroamphet tab 10mg<br />
dextroamphet tab 5mg<br />
dextroamphetamine sulfate cap sr 24hr 10 mg<br />
dextroamphetamine sulfate cap sr 24hr 15 mg<br />
dextroamphetamine sulfate cap sr 24hr 5 mg<br />
dextroamphetamine sulfate tab 10 mg<br />
dextroamphetamine sulfate tab 10 mg<br />
dextroamphetamine sulfate tab 5 mg<br />
dextrostat tab 10mg<br />
dextrostat tab 5mg<br />
LIQUADD SOL 5MG/5ML PA<br />
PROCENTRA SOL 5MG/5ML PA<br />
VYVANSE CAP 20MG PA<br />
VYVANSE CAP 30MG PA<br />
VYVANSE CAP 40MG PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 72
VYVANSE CAP 50MG PA<br />
VYVANSE CAP 60MG PA<br />
VYVANSE CAP 70MG PA<br />
Anorexigenics & Resp & Cereb Stim, Misc<br />
caffeine citrate inj 20 mg/ml (10 mg/ml base equiv) PA<br />
CAFFEINE/SOD INJ BENZOATE PA<br />
CONCERTA TAB 18MG PA ST<br />
CONCERTA TAB 18MG ST QL<br />
CONCERTA TAB 27MG PA ST<br />
CONCERTA TAB 27MG ST QL<br />
CONCERTA TAB 36MG PA ST<br />
CONCERTA TAB 36MG ST QL<br />
CONCERTA TAB 54MG PA ST<br />
CONCERTA TAB 54MG ST QL<br />
DAYTRANA DIS 10MG/9HR PA<br />
DAYTRANA DIS 15MG/9HR PA<br />
DAYTRANA DIS 20MG/9HR PA<br />
DAYTRANA DIS 30MG/9HR PA<br />
doxapram hcl inj 20 mg/ml PA<br />
FOCALIN XR CAP 10MG PA<br />
FOCALIN XR CAP 15MG PA<br />
FOCALIN XR CAP 20MG PA<br />
FOCALIN XR CAP 30MG PA<br />
FOCALIN XR CAP 5MG PA<br />
metadate tab 20mg er ST QL<br />
METADATE CD CAP 10MG QL<br />
METADATE CD CAP 20MG QL<br />
METADATE CD CAP 30MG QL<br />
METADATE CD CAP 40MG QL<br />
METADATE CD CAP 50MG QL<br />
METADATE CD CAP 60MG QL<br />
METHYLIN CHW 10MG QL<br />
METHYLIN CHW 2.5MG QL<br />
METHYLIN CHW 5MG QL<br />
METHYLIN SOL 10MG/5ML<br />
METHYLIN SOL 5MG/5ML<br />
methylin tab 10mg QL<br />
methylin tab 20mg QL<br />
methylin tab 5mg QL<br />
methylin er tab 10mg ST QL<br />
methylin er tab 20mg ST QL<br />
methylphenid tab 10mg QL<br />
methylphenid tab 10mg ST QL<br />
methylphenid tab 20mg QL<br />
methylphenid tab 20mg cr ST QL<br />
methylphenid tab 20mg er ST QL<br />
methylphenid tab 20mg sr ST QL<br />
methylphenid tab 5mg QL<br />
METHYLPHENIDATE HCL CAP CR 10 MG QL<br />
METHYLPHENIDATE HCL CAP CR 20 MG QL<br />
METHYLPHENIDATE HCL CAP CR 30 MG QL<br />
METHYLPHENIDATE HCL CAP CR 40 MG QL<br />
METHYLPHENIDATE HCL CAP CR 50 MG QL<br />
METHYLPHENIDATE HCL CAP CR 60 MG QL<br />
METHYLPHENIDATE HCL CAP SR 24HR 10 MG QL<br />
METHYLPHENIDATE HCL CAP SR 24HR 20 MG QL<br />
METHYLPHENIDATE HCL CAP SR 24HR 30 MG QL<br />
METHYLPHENIDATE HCL CAP SR 24HR 40 MG QL<br />
METHYLPHENIDATE HCL CHEW TAB 10 MG QL<br />
METHYLPHENIDATE HCL CHEW TAB 2.5 MG QL<br />
METHYLPHENIDATE HCL CHEW TAB 5 MG QL<br />
METHYLPHENIDATE HCL SOLN 10 MG/5ML<br />
METHYLPHENIDATE HCL SOLN 5 MG/5ML<br />
methylphenidate hcl tab 10 mg QL<br />
methylphenidate hcl tab 20 mg QL<br />
methylphenidate hcl tab 5 mg QL<br />
methylphenidate hcl tab cr 10 mg ST QL<br />
methylphenidate hcl tab cr 20 mg ST QL<br />
METHYLPHENIDATE HCL TAB SA OSM 18 MG ST QL<br />
METHYLPHENIDATE HCL TAB SA OSM 27 MG ST QL<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 73
METHYLPHENIDATE HCL TAB SA OSM 36 MG ST QL<br />
METHYLPHENIDATE HCL TAB SA OSM 54 MG ST QL<br />
MODAFINIL TAB 200 MG NF<br />
PROVIGIL TAB 200MG NF<br />
RITALIN LA CAP 10MG QL<br />
RITALIN LA CAP 20MG QL<br />
RITALIN LA CAP 30MG QL<br />
RITALIN LA CAP 40MG QL<br />
Anxiolytics, Sedatives and Hypnotics<br />
Barbiturates<br />
AMYTAL SOD INJ 500MG PA<br />
LUMINAL INJ 60MG/ML PA<br />
NEMBUTAL INJ 50MG/ML PA<br />
phenobarb elx 20mg/5ml<br />
PHENOBARB INJ 65MG/ML PA<br />
phenobarb tab 100mg<br />
phenobarb tab 15mg<br />
phenobarb tab 16.2mg<br />
phenobarb tab 30mg<br />
phenobarb tab 32.4mg<br />
phenobarb tab 60mg<br />
PHENOBARB TAB 64.8MG<br />
PHENOBARB TAB 97.2MG<br />
phenobarb tab 97.2mg<br />
phenobarbital elixir 20 mg/5ml<br />
phenobarbital sodium inj 130 mg/ml PA<br />
phenobarbital tab 100 mg<br />
phenobarbital tab 15 mg<br />
phenobarbital tab 16.2 mg<br />
phenobarbital tab 30 mg<br />
phenobarbital tab 32.4 mg<br />
phenobarbital tab 60 mg<br />
PHENOBARBITAL TAB 64.8 MG<br />
phenobarbital tab 97.2 mg<br />
PHENOBARBITAL TAB 97.2 MG<br />
Benzodiazepines<br />
alprazolam tab 0.25mg<br />
alprazolam tab 0.5mg<br />
alprazolam tab 1mg<br />
alprazolam tab 2mg<br />
alprazolam orally disintegrating tab 0.25 mg PA<br />
alprazolam orally disintegrating tab 0.5 mg PA<br />
alprazolam orally disintegrating tab 1 mg PA<br />
alprazolam orally disintegrating tab 2 mg PA<br />
alprazolam tab 0.25 mg<br />
alprazolam tab 0.5 mg<br />
alprazolam tab 1 mg<br />
alprazolam tab 2 mg<br />
chlordiazep cap 10mg<br />
chlordiazep cap 25mg<br />
chlordiazep cap 5mg<br />
chlordiazepoxide hcl cap 10 mg<br />
chlordiazepoxide hcl cap 25 mg<br />
chlordiazepoxide hcl cap 5 mg<br />
DIAZEPAM INJ 5MG/ML PA<br />
DIAZEPAM SOL 1MG/ML PA<br />
diazepam tab 10mg<br />
diazepam tab 2mg<br />
diazepam tab 5mg<br />
diazepam inj 5 mg/ml PA<br />
diazepam tab 10 mg<br />
diazepam tab 2 mg<br />
diazepam tab 5 mg<br />
estazolam tab 1mg<br />
estazolam tab 2mg<br />
estazolam tab 1 mg<br />
estazolam tab 2 mg<br />
flurazepam cap 15mg<br />
flurazepam cap 30mg<br />
flurazepam hcl cap 15 mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 74
flurazepam hcl cap 30 mg<br />
LIBRIUM INJ 100MG PA<br />
lorazepam tab 0.5mg<br />
lorazepam tab 1mg<br />
lorazepam tab 2mg<br />
lorazepam inj 2 mg/ml PA<br />
lorazepam inj 4 mg/ml PA<br />
lorazepam tab 0.5 mg<br />
lorazepam tab 1 mg<br />
lorazepam tab 2 mg<br />
midazolam hcl inj 1 mg/ml (base equivalent) PA<br />
midazolam hcl inj 5 mg/ml (base equivalent) PA<br />
MIDAZOLAM/ INJ NACL PA<br />
oxazepam cap 10mg<br />
oxazepam cap 15mg<br />
oxazepam cap 30mg<br />
oxazepam cap 10 mg<br />
oxazepam cap 15 mg<br />
oxazepam cap 30 mg<br />
RESTORIL CAP 7.5MG<br />
temazepam cap 15mg<br />
temazepam cap 30mg<br />
temazepam cap 7.5mg<br />
temazepam cap 15 mg<br />
temazepam cap 22.5 mg PA<br />
temazepam cap 30 mg<br />
TEMAZEPAM CAP 7.5 MG<br />
temazepam cap 7.5 mg<br />
triazolam tab 0.125mg<br />
triazolam tab 0.25mg<br />
triazolam tab 0.125 mg<br />
triazolam tab 0.25 mg<br />
Anxiolytics, Sedatives, & Hypnotics Misc<br />
acetamin pm tab 25-500mg OTC<br />
acetamin pm tab 25-500mg OTC<br />
acetamin pm tab 25-500mg OTC<br />
acetamin pm tab ex str OTC<br />
apap sleep tab x-str pm OTC<br />
apap/diphen tab 500-25mg OTC<br />
buspirone tab 10mg<br />
buspirone tab 15mg<br />
buspirone tab 30mg<br />
buspirone tab 5mg<br />
buspirone tab 7.5mg<br />
BUSPIRONE TAB 7.5MG<br />
buspirone hcl tab 10 mg<br />
buspirone hcl tab 15 mg<br />
buspirone hcl tab 30 mg<br />
buspirone hcl tab 5 mg<br />
BUSPIRONE HCL TAB 7.5 MG<br />
buspirone hcl tab 7.5 mg<br />
chloral hydr syp 500/5ml<br />
CHLORAL HYDR SYP 500/5ML<br />
CHLORAL HYDRATE CAP 500 MG<br />
CHLORAL HYDRATE SYRUP 500 MG/5ML<br />
chloral hydrate syrup 500 mg/5ml<br />
diphenhydramine w/ apap tab 25-500 mg (sleep) OTC<br />
droperidol inj 2.5 mg/ml PA<br />
eql headache tab pm OTC<br />
ex str apap tab 25-500mg OTC<br />
hca non-asa tab pm OTC<br />
hca non-asp tab pm ex st OTC<br />
headache tab pm OTC<br />
hydroxyz hcl inj 25mg/ml<br />
hydroxyz hcl inj 50mg/ml<br />
hydroxyz hcl syp 10mg/5ml<br />
hydroxyz hcl tab 10mg<br />
hydroxyz hcl tab 25mg<br />
hydroxyz hcl tab 50mg<br />
hydroxyz pam cap 100mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 75
hydroxyz pam cap 25mg<br />
hydroxyz pam cap 50mg<br />
hydroxyzine hcl im soln 25 mg/ml<br />
hydroxyzine hcl im soln 50 mg/ml<br />
hydroxyzine hcl syrup 10 mg/5ml<br />
hydroxyzine hcl tab 10 mg<br />
hydroxyzine hcl tab 25 mg<br />
hydroxyzine hcl tab 50 mg<br />
hydroxyzine pamoate cap 100 mg<br />
hydroxyzine pamoate cap 25 mg<br />
hydroxyzine pamoate cap 50 mg<br />
HYDROXYZINE PAMOATE SUSP 25 MG/5ML<br />
mapap pm tab 25-500mg OTC<br />
medi-tabs pm tab 25-500mg OTC<br />
night time tab 25-500mg OTC<br />
non-asa pm tab 25-500mg OTC<br />
non-asa pm tab 25-500mg OTC<br />
non-asa pm tab 25-500mg OTC<br />
non-asa pm tab ex st OTC<br />
non-aspirin tab pm OTC<br />
non-aspirin tab pm OTC<br />
non-aspirin tab pm OTC<br />
pain pm e/s tab 25-500mg OTC<br />
pain relf pm tab ex st/rr OTC<br />
pain relief tab pm OTC<br />
pain relief tab pm OTC<br />
pain relief tab pm OTC<br />
pain relief tab pm ex st OTC<br />
pain relief tab pm ex st OTC<br />
pain relieve tab 25-500mg OTC<br />
pain relieve tab 25-500mg OTC<br />
pain relieve tab 500-25mg OTC<br />
pain relieve tab expr gel OTC<br />
pain relieve tab pm OTC<br />
pain relieve tab pm ex st OTC<br />
pain relieve tab pm ex st OTC<br />
pain relieve tab pm qr OTC<br />
pain reliver tab 25-500mg OTC<br />
PRECEDEX INJ 100MCG PA<br />
ra acetam pm tab ex st/rr OTC<br />
ra acetamin tab pm ex st OTC<br />
sb non-asa tab 25-500mg OTC<br />
sb non-asa tab night OTC<br />
sg ex-prin tab pm xs OTC<br />
SOMNOTE CAP 500MG<br />
VISTARIL SUS 25MG/5ML<br />
zaleplon cap 10mg<br />
zaleplon cap 5mg<br />
zaleplon cap 10 mg<br />
zaleplon cap 5 mg<br />
zolpidem tartrate tab 10 mg PA<br />
zolpidem tartrate tab 5 mg PA<br />
Antimanic Agents<br />
lithium carb cap 150mg<br />
lithium carb cap 300mg<br />
lithium carb cap 600mg<br />
lithium carb tab 300mg<br />
lithium carb tab 300mg er<br />
lithium carb tab 450mg er<br />
lithium carbonate cap 150 mg<br />
lithium carbonate cap 300 mg<br />
lithium carbonate cap 600 mg<br />
lithium carbonate tab 300 mg<br />
lithium carbonate tab cr 300 mg<br />
lithium carbonate tab cr 450 mg<br />
Antimigraine Agents<br />
Selective Serotonin Agonists<br />
ELETRIPTAN HYDROBROMIDE TAB 20 MG (BASE EQUIVALENT) QL<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 76
ELETRIPTAN HYDROBROMIDE TAB 40 MG (BASE EQUIVALENT) QL<br />
IMITREX KIT 4MG/0.5 PA<br />
IMITREX KIT 4MG/0.5 PA<br />
IMITREX SPR 20MG/ACT PA<br />
IMITREX SPR 5MG/ACT PA<br />
IMITREX TAB 100MG QL<br />
MAXALT TAB 10MG QL<br />
MAXALT TAB 5MG QL<br />
MAXALT-MLT TAB 10MG QL<br />
MAXALT-MLT TAB 5MG QL<br />
RELPAX TAB 20MG QL<br />
RELPAX TAB 40MG QL<br />
RIZATRIPTAN BENZOATE ORALLY DISINTEGRATING TAB 10 MG QL<br />
RIZATRIPTAN BENZOATE ORALLY DISINTEGRATING TAB 5 MG QL<br />
RIZATRIPTAN BENZOATE TAB 10 MG QL<br />
RIZATRIPTAN BENZOATE TAB 5 MG QL<br />
SUMATRIPTAN KIT 4MG/0.5 PA<br />
SUMATRIPTAN KIT 4MG/0.5 PA<br />
SUMATRIPTAN SPR 20MG/ACT PA<br />
SUMATRIPTAN SPR 5MG/ACT PA<br />
sumatriptan tab 100mg QL<br />
sumatriptan tab 25mg QL<br />
sumatriptan tab 50mg QL<br />
sumatriptan succinate inj 12 mg/ml PA<br />
sumatriptan succinate inj 4 mg/0.5ml PA<br />
sumatriptan succinate inj kit 6 mg/0.5ml PA<br />
SUMATRIPTAN SUCCINATE TAB 100 MG QL<br />
sumatriptan succinate tab 100 mg QL<br />
sumatriptan succinate tab 25 mg QL<br />
sumatriptan succinate tab 50 mg QL<br />
SUMAVEL DOSE INJ 6MG/0.5 PA<br />
ZOLMITRIPTAN ORALLY DISINTEGRATING TAB 2.5 MG QL<br />
ZOLMITRIPTAN ORALLY DISINTEGRATING TAB 5 MG QL<br />
ZOLMITRIPTAN TAB 2.5 MG QL<br />
ZOLMITRIPTAN TAB 5 MG QL<br />
ZOMIG TAB 2.5MG QL<br />
ZOMIG TAB 5MG QL<br />
ZOMIG ZMT TAB 2.5 MG QL<br />
ZOMIG ZMT TAB 5MG QL<br />
Antimigraine Agents, Miscellaneous<br />
amidrine cap<br />
apap-isometheptene-dichloral cap 325-65-100 mg<br />
diacetazone cap<br />
duradrin cap<br />
epidrin cap<br />
ergotam/caff tab 1/100<br />
ERGOTAMINE W/ CAFFEINE SUPPOS 2-100 MG<br />
ergotamine w/ caffeine tab 1-100 mg<br />
isometh/apap cap dichlor<br />
isometh/apap cap dichlor<br />
MIGERGOT SUP 2/100<br />
migquin cap<br />
migratine cap<br />
migrazone cap<br />
migrin-a cap<br />
va-zone cap<br />
Antidepressants, Miscellaneous<br />
selegiline hcl tab 5 mg PA<br />
Central Nervous System Agents, Misc<br />
ATOMOXETINE HCL CAP 10 MG (BASE EQUIV)<br />
ATOMOXETINE HCL CAP 100 MG (BASE EQUIV)<br />
ATOMOXETINE HCL CAP 18 MG (BASE EQUIV)<br />
ATOMOXETINE HCL CAP 25 MG (BASE EQUIV)<br />
ATOMOXETINE HCL CAP 40 MG (BASE EQUIV)<br />
ATOMOXETINE HCL CAP 60 MG (BASE EQUIV)<br />
ATOMOXETINE HCL CAP 80 MG (BASE EQUIV)<br />
flumazenil iv soln 0.1 mg/ml PA<br />
STRATTERA CAP 100MG<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 77
STRATTERA CAP 10MG<br />
STRATTERA CAP 18MG<br />
STRATTERA CAP 25MG<br />
STRATTERA CAP 40MG<br />
STRATTERA CAP 60MG<br />
STRATTERA CAP 80MG<br />
Contraceptives<br />
*CERVICAL CAPS***<br />
*DIAPHRAGMS*** NF<br />
CERVICAL CAP 22 MM<br />
CERVICAL CAP 25 MM<br />
CERVICAL CAP 26 MM<br />
CERVICAL CAP 28 MM<br />
CERVICAL CAP 30 MM<br />
CERVICAL CAP 31 MM<br />
DIAPHRAGM ARC-SPRING 65 MM NF<br />
DIAPHRAGM ARC-SPRING 70 MM NF<br />
DIAPHRAGM ARC-SPRING 75 MM NF<br />
DIAPHRAGM ARC-SPRING 80 MM NF<br />
DIAPHRAGM ARC-SPRING KIT 55 MM NF<br />
DIAPHRAGM ARC-SPRING KIT 60 MM NF<br />
DIAPHRAGM ARC-SPRING KIT 65 MM NF<br />
DIAPHRAGM ARC-SPRING KIT 70 MM NF<br />
DIAPHRAGM ARC-SPRING KIT 75 MM NF<br />
DIAPHRAGM ARC-SPRING KIT 80 MM NF<br />
DIAPHRAGM ARC-SPRING KIT 85 MM NF<br />
DIAPHRAGM ARC-SPRING KIT 90 MM NF<br />
DIAPHRAGM ARC-SPRING KIT 95 MM NF<br />
DIAPHRAGM COIL SPRING KIT 100 MM NF<br />
DIAPHRAGM COIL SPRING KIT 105 MM NF<br />
DIAPHRAGM COIL SPRING KIT 50 MM NF<br />
DIAPHRAGM COIL SPRING KIT 55 MM NF<br />
DIAPHRAGM COIL SPRING KIT 60 MM NF<br />
DIAPHRAGM COIL SPRING KIT 65 MM NF<br />
DIAPHRAGM COIL SPRING KIT 70 MM NF<br />
DIAPHRAGM COIL SPRING KIT 75 MM NF<br />
DIAPHRAGM COIL SPRING KIT 80 MM NF<br />
DIAPHRAGM COIL SPRING KIT 85 MM NF<br />
DIAPHRAGM COIL SPRING KIT 90 MM NF<br />
DIAPHRAGM COIL SPRING KIT 95 MM NF<br />
DIAPHRAGM FLAT SPRING KIT 55 MM NF<br />
DIAPHRAGM FLAT SPRING KIT 60 MM NF<br />
DIAPHRAGM FLAT SPRING KIT 65 MM NF<br />
DIAPHRAGM FLAT SPRING KIT 70 MM NF<br />
DIAPHRAGM FLAT SPRING KIT 75 MM NF<br />
DIAPHRAGM FLAT SPRING KIT 80 MM NF<br />
DIAPHRAGM FLAT SPRING KIT 85 MM NF<br />
DIAPHRAGM FLAT SPRING KIT 90 MM NF<br />
DIAPHRAGM FLAT SPRING KIT 95 MM NF<br />
FEMCAP MIS 22MM<br />
FEMCAP MIS 26MM<br />
FEMCAP MIS 30MM<br />
NONOXYNOL-9 FOAM 12.5% OTC<br />
OMNIFLEX DPR NF<br />
ORTHO COIL DPR KIT 100 NF<br />
ORTHO COIL DPR KIT 105 NF<br />
ORTHO COIL DPR KIT 50 NF<br />
ORTHO COIL DPR KIT 55 NF<br />
ORTHO COIL DPR KIT 60 NF<br />
ORTHO COIL DPR KIT 65 NF<br />
ORTHO COIL DPR KIT 70 NF<br />
ORTHO COIL DPR KIT 75 NF<br />
ORTHO COIL DPR KIT 80 NF<br />
ORTHO COIL DPR KIT 85 NF<br />
ORTHO COIL DPR KIT 90 NF<br />
ORTHO COIL DPR KIT 95 NF<br />
ORTHO FLAT DPR KIT 55 NF<br />
ORTHO FLAT DPR KIT 60 NF<br />
ORTHO FLAT DPR KIT 65 NF<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 78
ORTHO FLAT DPR KIT 70 NF<br />
ORTHO FLAT DPR KIT 75 NF<br />
ORTHO FLAT DPR KIT 80 NF<br />
ORTHO FLAT DPR KIT 85 NF<br />
ORTHO FLAT DPR KIT 90 NF<br />
ORTHO FLAT DPR KIT 95 NF<br />
ORTHO FLEX DPR 55MM NF<br />
ORTHO FLEX DPR 60MM NF<br />
ORTHO FLEX DPR 65MM NF<br />
ORTHO FLEX DPR 65MM NF<br />
ORTHO FLEX DPR 70MM NF<br />
ORTHO FLEX DPR 70MM NF<br />
ORTHO FLEX DPR 75MM NF<br />
ORTHO FLEX DPR 75MM NF<br />
ORTHO FLEX DPR 80MM NF<br />
ORTHO FLEX DPR 85MM NF<br />
ORTHO FLEX DPR 90MM NF<br />
ORTHO FLEX DPR 95MM NF<br />
ORTHO INTROD DPR UNIVRSL NF<br />
PRENTIF MIS 22MM<br />
PRENTIF MIS 25MM<br />
PRENTIF MIS 28MM<br />
PRENTIF MIS 31MM<br />
PRENTIF MIS FITTING<br />
VCF VAGINAL AER CONTRACP OTC<br />
Diagnostic Agents<br />
ASPERGILLUS INJ 1:500 PA<br />
DIAGNOSTIC KIT PA<br />
LYMPHAZURIN INJ 1% PA<br />
MAGNEVIST INJ 46.9% PA<br />
OMNISCAN INJ 287MG/ML PA<br />
OMNISCAN KIT SAFEPAK PA<br />
PROHANCE INJ 279.3/ML PA<br />
TESLASCAN INJ PA<br />
THYREL TRH INJ 0.5MG/ML PA<br />
Adrenocortical Insufficiency<br />
cosyntropin for inj 0.25 mg PA<br />
Cardiac Function<br />
ADENOSCAN INJ 3MG/ML PA<br />
indocyanine green for inj 25 mg PA<br />
Diabetes Mellitus<br />
ACCU-CHEK TES ACTIVE PA OTC<br />
ACCU-CHEK TES ADVANTAG PA OTC<br />
ACCU-CHEK TES AVIVA PA OTC<br />
ACCU-CHEK TES COMFORT PA OTC<br />
ACCU-CHEK TES COMPACT PA OTC<br />
ACCU-CHEK TES DRUM PA OTC<br />
ACCU-CHEK TES INST GLC PA OTC<br />
ACCU-CHEK TES INST PLS PA OTC<br />
ACCUTREND TES GLUCOSE PA OTC<br />
ACURA TES STRIPS PA OTC<br />
ADVANCE TES INTUITIO PA OTC<br />
ADVANCE TES MICRO-DW PA OTC<br />
ADVOCATE TES PA OTC<br />
ADVOCATE TES REDICODE PA OTC<br />
ALBERTSONS TES PA OTC<br />
ASCENSIA TES ELITE PA OTC<br />
ASSURE 3 TES PA OTC<br />
ASSURE 4 TES PA OTC<br />
ASSURE II TES PA OTC<br />
ASSURE II TES PA OTC<br />
ASSURE II TES CHECK PA OTC<br />
ASSURE PRO TES PA OTC<br />
AT LAST TES PA OTC<br />
AUTOCODE GLUC TEST STRIPS PA OTC<br />
BAYER CONTOR TES BLD GLUC PA OTC<br />
BD TEST MIS PA OTC<br />
BIOSCANNER TES GLUCOSE PA OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 79
BL TEST MIS PA OTC<br />
BL TEST MIS PACK PA OTC<br />
BLOOD GLUCOS TES PA OTC<br />
BLOOD GLUCOS TES PA OTC<br />
CLEVER CHEK TES PA OTC<br />
CLEVER CHEK TES AUTO CD PA OTC<br />
CLEVER CHEK TES VOICE PA OTC<br />
CLEVR CHOICE TES AUTO-CD PA OTC<br />
COMPACT TES PA OTC<br />
CONTROL TES PA OTC<br />
CONTROL AST TES PA OTC<br />
CVS BLOOD TES GLUCOSE PA OTC<br />
CVS BLOOD TES GLUCOSE PA OTC<br />
DIABETIC.COM TES PA OTC<br />
DISCOUNT DRG TES BLD GLUC PA OTC<br />
DRG EMPORIUM TES PA OTC<br />
DUANE READE TES PA OTC<br />
DUO-CARE TES PA OTC<br />
EASY CHECK TES GLUCOSE PA OTC<br />
EASY STEP TES PA OTC<br />
EASYGLUCO TES PA OTC<br />
EASYMAX TES PA OTC<br />
EASYPRO TES BLD GLUC PA OTC<br />
EASYPRO PLUS TES PA OTC<br />
ECLIPSE TES PA OTC<br />
ELEMENT TES PA OTC<br />
EMBRACE TES STRIPS PA OTC<br />
ENVISION TES AUTOCODE PA OTC<br />
EVENCARE TES BLD GLUC PA OTC<br />
EVENCARE + TES BLD GLUC PA OTC<br />
EVOLUTION TES AUTOCODE PA OTC<br />
EXACTECH TES PA OTC<br />
EXACTECH TES R-S-G PA OTC<br />
EXCEL G TES PA OTC<br />
EXP MED TES STP PACK PA OTC<br />
EZ SMART TES BLD GLUC PA OTC<br />
EZ SMART PLS TES BLD GLUC PA OTC<br />
FASTTAKE TES PA OTC<br />
FIFTY50 GLUC TES 2.0 PA OTC<br />
FORA D10 TES BLD GLUC PA OTC<br />
FORA D15C TES BLD GLUC PA OTC<br />
FORA D15G TES BLD GLUC PA OTC<br />
FORA D15Z TES BLD GLUC PA OTC<br />
FORA G20 TES BLD GLUC PA OTC<br />
FORA V10 TES BLD GLUC PA OTC<br />
FORA V12 TES BLD GLUC PA OTC<br />
FORA V20 TES BLD GLUC PA OTC<br />
FORA V22 TES BLD GLUC PA OTC<br />
FREESTYLE TES PA OTC<br />
FREESTYLE TES LITE PA OTC<br />
GIANT EAGLE TES PHARMACY PA OTC<br />
GLUCO DEX TES SENSORS PA OTC<br />
GLUCO ELITE TES PA OTC<br />
GLUCOCARD TES VITAL PA OTC<br />
GLUCOCARD TES X-SENSOR PA OTC<br />
GLUCOCARD 01 TES PA OTC<br />
GLUCOCARD 01 TES SENSOR PA OTC<br />
GLUCOCOM TES PA OTC<br />
GLUCOFILM TES PA OTC<br />
GLUCOLAB TES PA OTC<br />
GLUCOMETER TES ENCORE PA OTC<br />
GLUCOSE BLOOD TEST STRIP OTC QL<br />
GLUCOSTIX TES PA OTC<br />
GNP TEST MIS PA OTC<br />
GNP TRUEREAD TES PA OTC<br />
GNP TRUETRAC TES SMRT SYS PA OTC<br />
HCA TEST TES PA OTC<br />
HLTH ALLIANC TES PA OTC<br />
INFINITY TES BLD GLUC PA OTC<br />
INFINITY TES GLUCOSE PA OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 80
KERR DRUG TES STP PACK PA OTC<br />
KINRAY TES PA OTC<br />
KROGER TES PA OTC<br />
KROGER BLOOD TES GLUCOSE PA OTC<br />
LIBERTY TES PA OTC<br />
LIFE MEDICAL TES PA OTC<br />
LONG TES PA OTC<br />
MAXIMA BLOOD TES GLUCOSE PA OTC<br />
MEIJER TES PA OTC<br />
MICRODOT TES STRIPS PA OTC<br />
NAVARRO TES BLD GLUC PA OTC<br />
NEXGEN TES PA OTC<br />
NOVA MAX TES GLUCOSE PA OTC<br />
ONETOUCH TES PA OTC<br />
ONETOUCH TES PA OTC<br />
ONETOUCH TES PA OTC<br />
ONETOUCH TES PA OTC<br />
ONETOUCH TES ULTRA PA OTC<br />
OPTIUM TES PA OTC<br />
POCKETCHEM TES EZ PA OTC<br />
PRECISION TES PCX PA OTC<br />
PRECISION TES PCX PLUS PA OTC<br />
PRECISION TES QID PA OTC<br />
PRECISION TES SOF-TACT PA OTC<br />
PRECISION TES XTRA PA OTC<br />
PRECISION PT TES OF CARE PA OTC<br />
PRESTIGE TES PA OTC<br />
PRESTIGE TES SMRT SYS PA OTC<br />
PRESTIGE VAL MIS PACK PA OTC<br />
PRODIGY TES BLD GLUC PA OTC<br />
PRODIGY AUTO TES BLD GLUC PA OTC<br />
PRODIGY EJCT TES BLD GLUC PA OTC<br />
PRODIGY NO TES CODING PA OTC<br />
PRODIGY VOIC TES BLD GLUC PA OTC<br />
PTS PANELS TES GLUCOSE PA OTC<br />
QUICKTEK TES PA OTC<br />
RA BLOOD TES GLUCOSE PA OTC<br />
RA TRUETEST TES PA OTC<br />
REFUAH PLUS TES GLUCOSE PA OTC<br />
RELION TES ULTIMA PA OTC<br />
RELION BLOOD TES GLUCOSE PA OTC<br />
RELION MICRO TES GLUCOSE PA OTC<br />
RIGHTEST TES GS100 PA OTC<br />
RIGHTEST TES GS300 PA OTC<br />
SENTRY TES PA OTC<br />
SHOPRITE TES PA OTC<br />
SM GLUCOSE TES PA OTC<br />
SMARTEST TES BLD GLUC PA OTC<br />
SOLO V2 TES PA OTC<br />
SUPREME TES PA OTC<br />
SURE EDGE TES PA OTC<br />
SURE-TEST TES EASYPLUS PA OTC<br />
SURECHEK TES BLD GLUC PA OTC<br />
SURESTEP TES PA OTC<br />
SURESTEP PRO TES PA OTC<br />
TRUE CARE TES STP PACK PA OTC<br />
TRUETEST TES OTC QL<br />
TRUETRACK TES OTC QL<br />
ULTIMA TES PA OTC<br />
ULTRATRK PRO TES PA OTC<br />
VICTORY TES AGM-4000 PA OTC<br />
WAVESENSE TES AMP PA OTC<br />
WAVESENSE TES JAZZ PA OTC<br />
WAVESENSE TES KEYNOTE PA OTC<br />
WAVESENSE TES PRESTO PA OTC<br />
WINN DIXIE TES MEDIC PA OTC<br />
Drug Hypersensitivity<br />
CANDIN INJ PA<br />
PRE-PEN INJ PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 81
Fungi<br />
HYSTOLYN-CYL INJ 1:100 PA<br />
SPHERULIN INJ 1:10 PA<br />
SPHERULIN INJ 1:100 PA<br />
Gallbladder Function<br />
KINEVAC INJ 5MCG PA<br />
Kidney Function<br />
AMINOHIPPURA INJ 20% PA<br />
indigotindisulfonate sodium inj 8 mg/ml PA<br />
INULIN INJ 100MG/ML PA<br />
Myasthenia Gravis<br />
edrophonium chloride inj 10 mg/ml PA<br />
ENLON INJ 150/15ML PA<br />
TENSILON INJ 10MG/ML PA<br />
Ocular Disorders<br />
fluorescein sodium inj 10% PA<br />
fluorescein sodium inj 25% PA<br />
Thyroid Function<br />
IODOPEN INJ 100MCG PA<br />
THYROGEN INJ 1.1MG PA<br />
Pheochromocytoma<br />
HISTATROL INJ 0.275/ML PA<br />
Pituitary Function<br />
ACTHREL INJ 100MCG PA<br />
FACTREL INJ 100MCG PA<br />
GEREF DIAG INJ 50MCG PA<br />
R-GENE 10 INJ 10% PA<br />
Roentgenography<br />
CHOLOGRAFIN INJ 52% PA<br />
CONRAY INJ 60% PA<br />
CONRAY 30 INJ 30% PA<br />
CONRAY 400 INJ 66.8% PA<br />
CONRAY 43 INJ 43% PA<br />
CYSTO-CONRAY INJ II 17.2% PA<br />
CYSTOGRAFIN INJ 30% PA<br />
CYSTOGRAFIN- INJ DILUTE PA<br />
diatrizoate meglumine & sodium oral soln 66-10% PA<br />
ETHIODOL INJ 37% PA<br />
FERIDEX I.V. INJ 11.2MF F PA<br />
GLOFIL-125 INJ 0.1% PA<br />
HEXABRIX INJ PA<br />
HYPAQUE MEGL INJ 30% PA<br />
HYPAQUE MEGL INJ 60% PA<br />
HYPAQUE SOD INJ 20% PA<br />
HYPAQUE SOD INJ 25% PA<br />
HYPAQUE SOD INJ 50% PA<br />
HYPAQUE-76 INJ PA<br />
HYPAQUE-CYST INJ 30% PA<br />
HYPAQUE-CYST INJ 30% PED PA<br />
ISOVUE-200 INJ 41% PA<br />
ISOVUE-250 INJ 51% PA<br />
ISOVUE-250 INJ 51%MLTPK PA<br />
ISOVUE-300 INJ 61% PA<br />
ISOVUE-300 INJ 61%MLTPK PA<br />
ISOVUE-370 INJ 76% PA<br />
ISOVUE-370 INJ 76%MLTPK PA<br />
ISOVUE-M 200 INJ 41% PA<br />
ISOVUE-M 300 INJ 61% PA<br />
MD-76 R INJ PA<br />
MD-GASTROVIE SOL 66-10% PA<br />
MYELO-KIT INJ 180MG/ML PA<br />
MYELO-KIT INJ 240MG/ML PA<br />
OMNIPAQUE INJ 140MG/ML PA<br />
OMNIPAQUE INJ 180MG/ML PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 82
OMNIPAQUE INJ 210MG/ML PA<br />
OMNIPAQUE INJ 240MG/ML PA<br />
OMNIPAQUE INJ 300MG/ML PA<br />
OMNIPAQUE INJ 350MG/ML PA<br />
OPTIRAY 160 INJ 34% PA<br />
OPTIRAY 240 INJ 51% PA<br />
OPTIRAY 300 INJ 64% PA<br />
OPTIRAY 320 INJ 68% PA<br />
OPTIRAY 350 INJ 74% PA<br />
RENO-30 INJ 30% PA<br />
RENO-60 INJ 60% PA<br />
RENO-CAL-76 INJ PA<br />
RENO-DIP INJ 30% PA<br />
RENOGRAFIN INJ -60 PA<br />
SINOGRAFIN INJ PA<br />
ULTRAVIST INJ 150MG/ML PA<br />
ULTRAVIST INJ 240MG/ML PA<br />
ULTRAVIST INJ 300MG/ML PA<br />
ULTRAVIST INJ 370MG/ML PA<br />
VISIPAQUE INJ 270MG/ML PA<br />
VISIPAQUE INJ 320MG/ML PA<br />
Trichinosis<br />
TRICHOPHYTON INJ 1:200 PA<br />
TRICHOPHYTON INJ 1:500 PA<br />
Tuberculosis<br />
APLISOL INJ 5/0.1ML PA<br />
TUBERSOL INJ 5/0.1ML PA<br />
TUBERSOL INJ 5/0.1ML PA<br />
TUBERSOL INJ 5/0.1ML PA<br />
Urine and Feces Contents<br />
Ketones<br />
ACETEST TAB TABLETS OTC<br />
ACETONE (URINE) TEST STRIP OTC<br />
ACETONE (URINE) TEST TAB OTC<br />
CHEK-STIX TES CONTROL OTC<br />
CHEK-STIX TES CONTROL OTC<br />
CHEMSTRIP K TES OTC<br />
KETOCARE TES OTC<br />
KETOSTIX TES OTC<br />
KETOSTIX TES STRIP OTC<br />
RELION KETON TES OTC<br />
Electrolytic, Caloric and Water Balance<br />
Acidifying Agents<br />
AMMONIUM CHL INJ 5MEQ/ML PA<br />
Alkalinizing Agents<br />
NEUT INJ 4% PA<br />
SOD LACTATE INJ 1/6M PA<br />
sodium acetate inj 2 meq/ml PA<br />
sodium acetate inj 4 meq/ml PA<br />
sodium bicarbonate inj 4.2% PA<br />
sodium bicarbonate inj 5% PA<br />
sodium bicarbonate inj 7.5% PA<br />
sodium bicarbonate inj 8.4% PA<br />
sodium lactate inj 5 meq/ml PA<br />
sodium lactate iv soln 167 meq/l (1/6m) PA<br />
THAM INJ 30MEQ PA<br />
Ammonia Detoxicants<br />
AMMONUL INJ 10% PA<br />
constulose sol 10gm/15<br />
enulose sol 10gm/15<br />
generlac sol 10gm/15<br />
lactulose sol 10gm/15<br />
lactulose sol 20gm/30<br />
lactulose (encephalopathy) solution 10 gm/15ml<br />
lactulose solution 10 gm/15ml<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 83
Replacement Preparations<br />
*electrolyte-75 in d5w soln*** PA<br />
*electrolyte-m in d5w soln*** PA<br />
*electrolyte-r in d5w soln*** PA<br />
*electrolyte-r solution*** PA<br />
*ORAL ELECTROLYTE SOLUTION*** OTC NF<br />
*parenteral electrolyte conc*** PA<br />
*parenteral electrolyte soln*** PA<br />
AMMON MOLYBD INJ 25MCG/ML PA<br />
ammonium molybdate inj 25 mcg/ml PA<br />
calc acetate cap 667mg<br />
calcium acetate (phosphate binder) cap 667 mg (169 mg ca)<br />
CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA)<br />
CALCIUM ACETATE (PHOSPHATE BINDER) TAB 667 MG<br />
calcium chloride inj 10% PA<br />
calcium gluconate inj 10% PA<br />
CALPHOSAN INJ PA<br />
chromium chloride inj 4 mcg/ml PA<br />
COPPER SULF INJ 0.4MG/ML PA<br />
CUPRIC CHLOR INJ 0.4MG/ML PA<br />
D10W/NACL INJ 0.225% PA<br />
D10W/NACL INJ 0.45% PA<br />
D5W/LYTES INJ #48 PA<br />
D5W/NACL INJ 0.225% PA<br />
D5W/NACL INJ 0.3% PA<br />
dextran 40 inj 10% in d5w PA<br />
dextran 40 inj 10% in saline PA<br />
DEXTRAN 70 INJ 6% PA<br />
dextran 70 6% in saline iv soln PA<br />
DEXTRAN HM INJ 32% PA<br />
dextrose 10% w/ sodium chloride 0.2% PA<br />
dextrose 10% w/ sodium chloride 0.9% PA<br />
dextrose 2.5% in lactated ringers 1/2 strength PA<br />
dextrose 2.5% w/ sodium chloride 0.45% PA<br />
dextrose 5% in lactated ringers PA<br />
dextrose 5% in ringers PA<br />
dextrose 5% w/ sodium chloride 0.2% PA<br />
dextrose 5% w/ sodium chloride 0.33% PA<br />
dextrose 5% w/ sodium chloride 0.45% PA<br />
dextrose 5% w/ sodium chloride 0.9% PA<br />
ed k+10 tab 10meq cr<br />
ELECTROLYTE SOL -48/DEX PA<br />
ELIPHOS TAB 667MG<br />
ELLIOTTS B INJ PA<br />
ENFALYTE SOL OTC NF<br />
hetastarch in sodium chloride inj 6-0.9% PA<br />
HEXTEND SOL 6% PA<br />
IONOSOL-B/ INJ D5W PA<br />
IONOSOL-MB INJ /D5W PA<br />
IONOSOL-T INJ /D5W PA<br />
ISOLYTE-H INJ /D5W PA<br />
ISOLYTE-P INJ /D5W PA<br />
ISOLYTE-S INJ PA<br />
ISOLYTE-S INJ /D5W PA<br />
ISOLYTE-S INJ PH 7.4 PA<br />
kaon-cl-10 tab 10meq cr<br />
kcl 10 meq/l (0.075%) in dextrose 5% & nacl 0.2% inj PA<br />
kcl 10 meq/l (0.075%) in dextrose 5% & nacl 0.45% inj PA<br />
kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.2% inj PA<br />
kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.33% inj PA<br />
kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.45% inj PA<br />
kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.9% inj PA<br />
kcl 20 meq/l (0.15%) in nacl 0.45% inj PA<br />
kcl 20 meq/l (0.15%) in nacl 0.9% inj PA<br />
kcl 30 meq/l (0.224%) in dextrose 5% & nacl 0.2% inj PA<br />
kcl 30 meq/l (0.224%) in dextrose 5% & nacl 0.45% inj PA<br />
kcl 40 meq/l (0.3%) in dextrose 5% & nacl 0.2% inj PA<br />
kcl 40 meq/l (0.3%) in dextrose 5% & nacl 0.45% inj PA<br />
kcl 40 meq/l (0.3%) in nacl 0.9% inj PA<br />
KCL/D10/NACL INJ 0.15/0.2 PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 84
KCL/D5W INJ 0.075% PA<br />
KCL/D5W/LR INJ 0.15% PA<br />
KCL/D5W/LR INJ 0.3% PA<br />
KCL/D5W/LR INJ 0.3% PA<br />
KCL/D5W/NACL INJ .224/.33 PA<br />
KCL/D5W/NACL INJ 0.15/0.2 PA<br />
KCL/D5W/NACL INJ 0.3/0.9% PA<br />
klor-con 10 tab 10meq er<br />
klor-con m10 tab 10meq er<br />
klor-con m20 tab 20meq er<br />
klotrix tab 10meq cr<br />
lactated ringer's solution PA<br />
magnesium chloride inj 20% PA<br />
MANGANESE CL INJ 0.1MG/ML PA<br />
MANGANESE SU INJ 0.1MG/ML PA<br />
MG SO4/D5W INJ 10MG/ML PA<br />
MG SO4/D5W INJ 20MG/ML PA<br />
MULTITRACE-4 INJ PA<br />
MULTITRACE-4 INJ NEONATAL PA<br />
MULTITRACE-4 INJ PED PA<br />
MULTITRACE-5 INJ REGULAR PA<br />
NACL/BACT INJ 0.9%BENZ PA<br />
NORMOSOL-R INJ PH 7.4 PA<br />
PENTASPAN INJ PA<br />
PHOSLO CAP 667MG<br />
PLASMA-LYTE INJ -148 PA<br />
PLASMA-LYTE INJ -A PA<br />
PLASMA-LYTE INJ /D5W PA<br />
PLASMA-LYTE INJ 56 PA<br />
PLASMA-LYTE INJ 56/D5W PA<br />
pot bicarbonate & chloride effer tab 25 meq<br />
POT CHLORIDE INJ 10MEQ PA<br />
pot chloride liq 10%<br />
pot chloride liq 10% sf<br />
pot chloride liq 20%<br />
pot chloride liq 20% sf<br />
pot chloride sol 10% sf<br />
pot chloride tab 10meq cr<br />
pot chloride tab 10meq er<br />
pot chloride tab 10meq sr<br />
pot chloride tab 25meq ef<br />
pot cl micro tab 10meq cr<br />
pot cl micro tab 10meq er<br />
pot cl micro tab 20meq cr<br />
pot cl micro tab 20meq er<br />
pot/chloride tab 25meq ef<br />
potassium acetate inj 2 meq/ml PA<br />
potassium acetate inj 4 meq/ml PA<br />
potassium chloride 20 meq/l (0.15%) in dextrose 5% inj PA<br />
potassium chloride 30 meq/l (0.224%) in dextrose 5% inj PA<br />
potassium chloride 40 meq/l (0.3%) in dextrose 5% inj PA<br />
potassium chloride inj 10 meq/100 ml PA<br />
potassium chloride inj 2 meq/ml PA<br />
potassium chloride inj 20 meq/100 ml PA<br />
potassium chloride inj 20 meq/50 ml PA<br />
potassium chloride inj 30 meq/100 ml PA<br />
potassium chloride inj 40 meq/100 ml PA<br />
potassium chloride microencapsulated crys cr tab 10 meq<br />
potassium chloride microencapsulated crys cr tab 20 meq<br />
potassium chloride oral liq 10% (20 meq/15ml)<br />
potassium chloride oral liq 20% (40 meq/15ml)<br />
potassium chloride tab cr 10 meq<br />
potassium phosphate dibasic inj 3 mmole/ml PA<br />
PRISMASOL SOL 0/0/1.2 PA<br />
PRISMASOL SOL 0/2.5 PA<br />
PRISMASOL SOL 2/0 PA<br />
PRISMASOL SOL 2/3.5 PA<br />
PRISMASOL SOL 4/0/1.2 PA<br />
PRISMASOL SOL 4/2.5 PA<br />
PRISMASOL SOL B22GK2/0 PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 85
PROMIT INJ 150MG/ML PA<br />
ringer's solution PA<br />
saline injection bacteriostatic PA<br />
SALINE/PHENO SOL PA<br />
SELENIUM INJ 40MCG/ML PA<br />
sodium chloride inj 0.45% PA<br />
sodium chloride inj 0.9% PA<br />
sodium chloride inj 2.5 meq/ml (14.6%) PA<br />
sodium chloride inj 3% PA<br />
sodium chloride inj 4 meq/ml (23.4%) PA<br />
sodium chloride inj 5% PA<br />
sodium chloride iv soln 0.9% PA<br />
sodium phosphate inj 3 mmole/ml PA<br />
TRACE ELEM 4 INJ PED PA<br />
TRACE METALS INJ PA<br />
trace min (cr-cu-mn-se-zn) inj 10-1000-500-60-5000 mcg/ml PA<br />
trace min (cr-cu-mn-zn) inj 0.01-1-0.5-5 mg/ml PA<br />
VOLUVEN INJ 6%/NACL PA<br />
ZINC SULFATE INJ 1MG/ML PA<br />
ZINC SULFATE INJ 5MG/ML PA<br />
ZINC TRACE INJ 1MG/ML PA<br />
Caloric Agents<br />
*amino acid electrolyte infusion 8.5%*** PA<br />
*amino acid infusion 15%*** PA<br />
*amino acid infusion 6%*** PA<br />
*amino acid infusion 8%*** PA<br />
*amino acid infusion 8.5%*** PA<br />
*INFANT FOODS LIQUID** OTC NF<br />
*NUTRITIONAL SUPPLEMENT LIQUID** OTC NF<br />
ALCOHOL INJ 95% PA<br />
alcohol absolute inj 98% PA<br />
ALCOHOL/D5W INJ 10% PA<br />
ALCOHOL/D5W INJ 5% PA<br />
AMINESS INJ 5.2% PA<br />
AMINOSYN INJ 10% PA<br />
AMINOSYN INJ 3.5% PA<br />
AMINOSYN INJ 5% PA<br />
AMINOSYN INJ 7% PA<br />
AMINOSYN INJ 8.5% PA<br />
AMINOSYN 2-M INJ 4.25/D10 PA<br />
AMINOSYN 7% INJ /LYTES PA<br />
AMINOSYN II INJ 10% PA<br />
AMINOSYN II INJ 3.5/D25 PA<br />
AMINOSYN II INJ 3.5/D5 PA<br />
AMINOSYN II INJ 4.25/D10 PA<br />
AMINOSYN II INJ 4.25/D20 PA<br />
AMINOSYN II INJ 4.25/D25 PA<br />
AMINOSYN II INJ 5/D25 PA<br />
AMINOSYN II INJ 7% PA<br />
AMINOSYN II INJ 8.5% PA<br />
AMINOSYN IIM INJ 3.5%/D5W PA<br />
AMINOSYN M INJ 3.5% PA<br />
AMINOSYN-HBC INJ 7% PA<br />
AMINOSYN-PF INJ 10% PA<br />
AMINOSYN-PF INJ 7% PA<br />
AMINOSYN-RF INJ 5.2% PA<br />
AMINOSYN-RF INJ 5.2% PA<br />
AMINOSYN/D20 INJ II 4.25% PA<br />
AMINOSYN/D25 INJ II 3.5% PA<br />
AMINOSYN/D25 INJ II 4.25% PA<br />
BRANCHAMIN INJ 4% PA<br />
CLINIMIX INJ 2.75/D5W PA<br />
CLINIMIX INJ 4.25/D10 PA<br />
CLINIMIX INJ 4.25/D20 PA<br />
CLINIMIX INJ 4.25/D25 PA<br />
CLINIMIX INJ 4.25/D5W PA<br />
CLINIMIX INJ 5%/D15W PA<br />
CLINIMIX INJ 5%/D20W PA<br />
CLINIMIX INJ 5%/D25W PA<br />
CLINIMIX E INJ 2.75/D10 PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 86
CLINIMIX E INJ 2.75/D5W PA<br />
CLINIMIX E INJ 4.25/D10 PA<br />
CLINIMIX E INJ 4.25/D25 PA<br />
CLINIMIX E INJ 4.25/D5W PA<br />
CLINIMIX E INJ 5%/D15W PA<br />
CLINIMIX E INJ 5%/D20W PA<br />
CLINIMIX E INJ 5%/D25W PA<br />
CLINIMIX E INJ 5%/D35W PA<br />
cysteine hcl inj 50 mg/ml PA<br />
DEXTROSE INJ 2.5% PA<br />
dextrose inj 10% PA<br />
dextrose inj 20% PA<br />
dextrose inj 25% PA<br />
dextrose inj 30% PA<br />
dextrose inj 40% PA<br />
dextrose inj 5% PA<br />
dextrose inj 50% PA<br />
dextrose inj 60% PA<br />
dextrose inj 70% PA<br />
fat emulsion iv soln 10% PA<br />
fat emulsion iv soln 20% PA<br />
fat emulsion iv soln 30% PA<br />
FREAMINE HBC INJ 6.9% PA<br />
FREAMINE III INJ 10% PA<br />
FREAMINE III INJ 3% PA<br />
FREAMINE III INJ 8.5%/D50 PA<br />
HEPATASOL INJ 8% PA<br />
MICROLIPID EMU 50% PA<br />
NEPHRAMINE INJ 5.4% PA<br />
PREMASOL SOL 10% PA<br />
PROCALAMINE INJ 3% PA<br />
PROMOTE LIQ R-T-HANG OTC NF<br />
PROSOL INJ 20% PA<br />
RENAMIN INJ 6.5% PA<br />
SIMILAC RTF LIQ LOW-IRON OTC NF<br />
SIMILAC/IRON LIQ RTF OTC NF<br />
TRAVASOL INJ 10% PA<br />
TRAVASOL INJ 5.5% PA<br />
TRAVASOL INJ 8.5% PA<br />
TRAVASOL 3.5 INJ /LYTES PA<br />
TRAVASOL 5.5 INJ /LYTES PA<br />
TRAVASOL/D10 INJ 2.75% PA<br />
TRAVASOL/D10 INJ 4.25% PA<br />
TRAVASOL/D10 INJ 5.5% PA<br />
TRAVASOL/D10 INJ 8.5% PA<br />
TRAVASOL/D20 INJ 5.5% PA<br />
TRAVASOL/D20 INJ 8.5% PA<br />
TRAVASOL/D25 INJ 4.25% PA<br />
TRAVASOL/D5 INJ 2.75% PA<br />
TRAVASOL/D50 INJ 8.5% PA<br />
TROPHAMINE INJ 10% PA<br />
Diuretics<br />
Loop Diuretics<br />
bumetanide inj 0.25 mg/ml PA<br />
DEMADEX INJ 20MG/2ML PA<br />
DEMADEX INJ 50MG/5ML PA<br />
furosemide sol 10mg/ml<br />
furosemide sol 40mg/4ml<br />
furosemide tab 20mg<br />
furosemide tab 40mg<br />
furosemide tab 80mg<br />
furosemide inj 10 mg/ml PA<br />
furosemide oral soln 10 mg/ml<br />
furosemide oral soln 8 mg/ml PA<br />
furosemide tab 20 mg<br />
furosemide tab 40 mg<br />
furosemide tab 80 mg<br />
SOD EDECRIN INJ 50MG PA<br />
TORSEMIDE INJ 20MG/2ML PA<br />
TORSEMIDE INJ 50MG/5ML PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 87
Osmotic Diuretics<br />
mannitol iv soln 10% PA<br />
mannitol iv soln 15% PA<br />
mannitol iv soln 20% PA<br />
mannitol iv soln 25% PA<br />
mannitol iv soln 5% PA<br />
Potassium-sparing Diuretics<br />
hctz/triamt cap 25-50mg<br />
hctz/triamt tab 25-37.5<br />
hctz/triamt tab 50-75mg<br />
triam/hctz cap 37.5-25<br />
triamt/hctz cap 50-25mg<br />
triamt/hctz tab 37.5-25<br />
triamt/hctz tab 75-50mg<br />
triamterene & hydrochlorothiazide cap 37.5-25 mg<br />
triamterene & hydrochlorothiazide cap 50-25 mg<br />
triamterene & hydrochlorothiazide tab 37.5-25 mg<br />
triamterene & hydrochlorothiazide tab 75-50 mg<br />
Thiazide Diuretics<br />
chlorothiazide sodium for inj 500 mg PA<br />
hydrochlorot tab 12.5mg<br />
hydrochlorot tab 25mg<br />
hydrochlorot tab 50mg<br />
hydrochlorothiazide tab 12.5 mg<br />
hydrochlorothiazide tab 25 mg<br />
hydrochlorothiazide tab 50 mg<br />
Thiazide-like Diuretics<br />
metolazone tab 10mg<br />
metolazone tab 2.5mg<br />
metolazone tab 5mg<br />
metolazone tab 10 mg<br />
metolazone tab 2.5 mg<br />
metolazone tab 5 mg<br />
Diuretics, Miscellaneous<br />
VAPRISOL INJ PA<br />
VAPRISOL INJ 20MG/4ML PA<br />
Enzymes<br />
ADAGEN INJ 250/ML PA<br />
ALDURAZYME INJ 2.9MG/5M PA<br />
AMPHADASE INJ 150/ML PA<br />
CEREDASE INJ 80UNT/ML PA<br />
CEREZYME INJ 200UNIT PA<br />
CEREZYME INJ 400UNIT PA<br />
ELAPRASE INJ 6MG/3ML PA<br />
ELITEK INJ 1.5MG PA<br />
ELITEK INJ 7.5MG PA<br />
FABRAZYME INJ 35MG PA<br />
FABRAZYME INJ 5MG PA<br />
HYDASE INJ 150/ML PA<br />
HYLENEX INJ 150 UNIT PA<br />
MYOZYME SOL 50MG PA<br />
NAGLAZYME INJ 1MG/ML PA<br />
VITRASE INJ 200/ML PA<br />
VITRASE INJ 6200UNIT PA<br />
VPRIV INJ 400UNIT PA<br />
XIAFLEX INJ 0.9MG PA<br />
Respiratory Tract Agents<br />
Antitussives<br />
*PE TAN-CARBETA TAN SUSP 25-30 MG/5ML & HOMEOPATH LOZ KIT***<br />
*PE-CARBETA-GG SOLN 5-15-100 MG/5ML & HOMEOPATH LOZ KIT***<br />
*PE-PHENIRAMINE-COD-SOD SALICYLATE-SOD CIT-CAFF LIQUID***<br />
*PE-PHENIRAMINE-COD-SOD SALICYLATE-SOD CIT-CAFF SYRUP***<br />
*PHENYLEPH-DM-PYRIL-POT GUAI-SOD CIT-CIT ACID LIQUID***<br />
*phenyleph-dm-pyril-pot guai-sod cit-cit acid liquid***<br />
10peh/380gfn tab /15dm OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 88
10peh/400gfn tab /20dm OTC<br />
10peh/4cpm/ tab 20dm OTC<br />
40pse/400gfn tab /20dm<br />
45pse/400gfn tab /15dm OTC<br />
60pse/400gfn tab /20dm<br />
60pse/4cpm/ tab 20dm OTC<br />
666 cold liq prep OTC<br />
666 cold liq prepartn OTC<br />
a-cof dh syp<br />
aber-tuss dr syp 6-2-15<br />
aber-tuss hc syp 10-2-2.5<br />
ACCUHIST DRO PDX<br />
ACETAMINOPHEN W/ DM CAP 325-15 MG OTC<br />
ACETAMINOPHEN W/ DM CHEW TAB 160-5 MG OTC<br />
acetaminophen w/ dm drops 80-2.5 mg/0.8ml OTC<br />
acetaminophen w/ dm liq 1000-30 mg/30ml OTC<br />
acetaminophen w/ dm liq 160-5 mg/5ml OTC<br />
ACETAMINOPHEN W/ DM LIQ 160-7.5 MG/5ML OTC<br />
ACETAMINOPHEN W/ DM LIQ 325-15 MG/15ML OTC<br />
ACETAMINOPHEN W/ DM SYRUP 160-5 MG/5ML OTC<br />
AEROTUSS 12 SUS 30MG/5ML<br />
af-cough fm liq decong OTC<br />
af-dibromm elx dm OTC<br />
af-flu cough tab /cold ms OTC<br />
af-nitetime liq OTC<br />
af-nitetime liq cough OTC<br />
af-triacting liq nitetime OTC<br />
af-triacting liq sore thr OTC<br />
af-tussin cf syp OTC<br />
af-tussin dm liq 100-10/5 OTC<br />
af-tussin dm syp 100-10/5 OTC<br />
AIRACOF LIQ<br />
ALACOL DM DRO<br />
ALAHIST AC LIQ 7.5-10<br />
ALAHIST DHC LIQ 7.5-3<br />
ALBATUSSIN CAP<br />
ALBATUSSIN CAP SR<br />
ALBATUSSIN DRO DM PED<br />
ALBATUSSIN DRO PED<br />
ALBATUSSIN DRO PEDI NR OTC<br />
ALBATUSSIN LIQ OTC<br />
ALBATUSSIN LIQ NN<br />
albatussin liq nn<br />
albatussin liq ped<br />
ALBATUSSIN SYP PEDI<br />
albatussin tab sr<br />
ALBATUSSIN TAB SR<br />
ALBATUSSN CF DRO PED<br />
ALKA-SELT PL CAP COLD/CGH OTC<br />
all-nite liq cold/flu OTC<br />
all-nite cld liq formula OTC<br />
allanhist dro pdx<br />
allanhist syp pdx<br />
allanvan-dm sus<br />
ALLFEN C TAB 5-1000MG<br />
ALLFEN CD TAB 400-10MG<br />
ALLFEN CDX LIQ<br />
ALLFEN CDX TAB 400-20MG<br />
ALLFEN CX TAB<br />
ALLFEN DM TAB<br />
allfen dm tab 400-20mg<br />
ALLFEN DMA TAB 4-20-400<br />
ALLRES D SUS<br />
ALLRES G SUS<br />
ALLRES PD SUS<br />
altarussin liq 100-10/5 OTC<br />
altarussn dm syp 100-10/5 OTC<br />
ambi 1000/5 tab<br />
ambi 1000/55 tab<br />
ambi 20dm/ tab 4cpm OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 89
ambi 40/1000 tab /60<br />
ambi 45/800/ tab 30<br />
AMBI 5/15/ LIQ 100<br />
ambi 60/1000 tab /30<br />
ambi 60/580/ tab 30<br />
ambi 80/700/ tab 40<br />
ambi 80/780/ tab 40<br />
AMBIFED CD TAB<br />
AMBIFED CDX TAB<br />
AMBIFED DM TAB OTC<br />
AMBIFED-G TAB CDX<br />
AMBIFED-G CD TAB<br />
AMBIFED-G DM TAB OTC<br />
AMERIFED DM SYP<br />
AMERITUSS AD LIQ 10-3-15<br />
amibid dm tab 30-600cr<br />
ANAPLEX DMX SUS<br />
andehist dm dro nr<br />
andehist dm syp nr<br />
anextuss tab<br />
aquabid-dm tab 30-600cr<br />
AQUATAB C TAB<br />
AQUATAB DM TAB<br />
ARIDEX DRO PED<br />
ATUSS HD CAP 30-2-5MG<br />
ATUSS HS SUS<br />
ATUSS HX CAP 5-300MG<br />
balacall dm syp 5-2-10mg<br />
benzonatate cap 100mg<br />
benzonatate cap 200mg<br />
benzonatate cap 100 mg<br />
BENZONATATE CAP 150 MG<br />
benzonatate cap 200 mg<br />
BETATAN SUS<br />
betavent liq 20-100mg<br />
BIDEX-A TAB 25-600MG<br />
bidex-dmi tab 20-400mg OTC<br />
BIO-TUSSI LIQ OTC<br />
BIO-TUSSI LIQ PEDIATRC OTC<br />
BIOBRON SF SYP OTC<br />
biocotron liq 100-10/5 OTC<br />
biodec-dm dro<br />
biodec-dm syp<br />
BIODESP DM SYP OTC<br />
biogil liq OTC<br />
BIONEL LIQ OTC<br />
BIONEL LIQ PEDIATRC OTC<br />
BIOSPEC DMX LIQ OTC<br />
biotuss liq<br />
biotuss liq pediatrc<br />
biotuss dm liq 100-10/5 OTC<br />
biotussin sol dac<br />
biotussin syp ac<br />
bl pain reli dro OTC<br />
bl severe tab cold/flu OTC<br />
bl tussin cf syp OTC<br />
bp 8 cough sus<br />
bpm pe dm syp 5-2-10mg<br />
bpm pe hc liq<br />
bpm-pe-dm liq 4-10-20<br />
bpm-pe-dmhbr liq 4-10-20<br />
bpm-pse-dm liq 4-20-20<br />
bpm-pse-dmhb liq 4-20-20<br />
bpm/dm/pse syp<br />
bpm/hydrocod liq /pse<br />
brom mal/pe liq dex hbr<br />
brom t/dm t/ sus pse t<br />
brom/pe/dm syp 5-2-10mg<br />
brom/pseud/ elx dm OTC<br />
brom/pseud/ syp dm<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 90
omaline dm elx 15-1-5/5 OTC<br />
BROMATAN SUS PLUS<br />
bromatan-dm sus<br />
bromatane dx syp<br />
bromaxefed syp dm rf<br />
bromcomp hc liq<br />
bromdec dm dro<br />
bromdec dm syp<br />
bromdex d syp<br />
brometane dx syp<br />
bromfed dm syp<br />
bromhist pdx dro<br />
bromhist-dm dro<br />
bromhist-dm syp ped<br />
BROMHIST-PDX SYP<br />
bromophed dx syp<br />
bromphen/dm/ syp pse<br />
bromphenex syp dm OTC<br />
bromphenex syp dm<br />
BROMPHENEX SYP HD<br />
BROMPHENIRAMINE W/ HYDROCODONE-GG LIQD 2-5-200 MG/5ML<br />
bromplex dm syp<br />
bromplex hd sol 30-2-1.7<br />
bromtuss dm liq<br />
BRONCOPECTOL SYP<br />
broncotron liq 10-100/5 OTC<br />
BRONCOTRON-D SUS<br />
BRONKIDS DRO<br />
bronkids syp 10-2-15<br />
BRONTEX LIQ<br />
brontuss la tab<br />
BRONTUSS SF SYP<br />
brotapp dm liq 15-1-5/5 OTC<br />
BROVEX CB TAB 10-4MG<br />
BROVEX CBX TAB 20-4MG<br />
BROVEX PB C TAB 10-4-10<br />
BROVEX PB CX TAB 10-4-20<br />
BROVEX PB DM TAB 10-4-20 OTC<br />
BROVEX PSE TAB DM<br />
BUCKLEYS LIQ COUGH OTC<br />
c-phed dpd sus tannate<br />
c-phen dm dro<br />
c-phen dm syp<br />
c-tanna 12 sus 4-30mg/5<br />
c-tanna 12d sus<br />
CANGES-HC LIQ<br />
canges-hc nr liq<br />
canges-xp liq 5-150mg<br />
CAPMIST DM TAB OTC<br />
car-b-pen tab chlor-ta<br />
carb pse 12 sus dm<br />
carb pseudo- sus tan<br />
carb/pe/gg liq<br />
carb/pe/gg syp<br />
carb/phenyl sus 12<br />
CARBAPHEN 12 LIQ<br />
CARBAPHEN 12 SUS<br />
CARBAPHEN 12 SUS PED<br />
carbatab-12 tab<br />
CARBATUSS-12 SUS<br />
CARBATUSS-CL LIQ<br />
carbaxefed d dro rf<br />
CARBET CIT-CARBET TAN-PE HCL-PE TAN SUS 10-20-2.5-7.5 MG/5ML<br />
carbetapen/ tab chlorphn<br />
CARBETAPENTANE CIT-GUAIFENESIN TANNATE SUSP 7.5-200 MG/5ML<br />
CARBETAPENTANE CIT-GUAIFENESIN TANNATE SUSP 7.5-200 MG/5ML<br />
CARBETAPENTANE CIT-PSEUDOEPH HCL TANNATE SUSP 7.5-30 MG/5ML<br />
CARBETAPENTANE CIT-PSEUDOEPH HCL TANNATE SUSP 7.5-30 MG/5ML<br />
CARBETAPENTANE CIT-PSEUDOEPHED HCL TANNATE CHEW TAB 20-30 MG<br />
CARBETAPENTANE CIT-PSEUDOEPHED HCL TANNATE SUSP 20-30 MG/5ML<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 91
CARBETAPENTANE CIT-PSEUDOEPHED HCL TANNATE SUSP 20-30 MG/5ML<br />
CARBETAPENTANE TAN-PYRILAMINE TAN SUSP 22.5-12 MG/5ML<br />
CARBETAPENTANE TANNATE SUSP 30 MG/5ML<br />
CARBETAPENTANE-GUAIFENESIN CAP 8-200 MG<br />
CARBETAPENTANE-GUAIFENESIN CAP SR 12 HR 30-400 MG<br />
CARBETAPENTANE-GUAIFENESIN LIQUID 10-100 MG/5ML<br />
carbetapentane-guaifenesin liquid 20-100 mg/5ml<br />
CARBETAPENTANE-GUAIFENESIN LIQUID 20-75 MG/5ML<br />
CARBETAPENTANE-GUAIFENESIN SYRUP 7.5-150 MG/5ML<br />
CARBETAPENTANE-GUAIFENESIN TAB SR 12 HR 5-1000 MG<br />
carbetapentane-guaifenesin tab sr 12 hr 5-1000 mg<br />
CARBETAPENTANE-GUAIFENESIN TAB SR 12 HR 60-1000 MG<br />
CARBETAPENTANE-GUAIFENESIN TAB SR 12 HR 60-1200 MG<br />
carbetapentane-guaifenesin tab sr 12 hr 60-600 mg<br />
CARBETAPENTANE-GUAIFENESIN TAB SR 12 HR 60-600 MG<br />
CARBETAPENTANE-GUAIFENESIN TAB SR 12 HR 60-900 MG<br />
CARBETAPENTANE-PSEUDOEPHEDRINE LIQUID 20-30 MG/5ML<br />
carbetaplex sus ts<br />
carbetaplex syp<br />
carbinoxamin syp cpd<br />
carbodex dm dro<br />
carbodex dm syp<br />
carbofed dm dro<br />
carbofed dm syp<br />
carboxine 12 sus dm<br />
carboxine dm liq<br />
cardec dm dro<br />
cardec dm syp<br />
centergy dm dro<br />
ceron-dm dro 3.5-1-3<br />
ceron-dm syp<br />
CERTUSS TAB<br />
cgh reliever liq doubl st OTC<br />
cgh suppress syp 15mg/5ml OTC<br />
cgh/cold plu liq childs OTC<br />
cgh/cold/flu liq relief OTC<br />
cgh/cold/flu liq relief m OTC<br />
cheratussin sol dac<br />
cheratussin syp ac OTC<br />
cheratussin syp ac<br />
chest conges tab 20-400mg OTC<br />
chest conges tab 20-400mg OTC<br />
chest conges tab 20-400mg OTC<br />
chest conges tab 20-400mg OTC<br />
child cold syp OTC<br />
child cold/ chw cough OTC<br />
child pain liq cold/cgh OTC<br />
child plus sus cold OTC<br />
childrens liq 5-100mg OTC<br />
childrens liq nitetime OTC<br />
childs aller liq cold/cgh OTC<br />
chld cough/ sus runny ns OTC<br />
chld tylenol liq plus OTC<br />
CHLO TUSS LIQ OTC<br />
CHLOPHEDIANOL-PSEUDOEPHEDRINE LIQD 12.5-30 MG/5ML OTC<br />
chlor/phen dro dm<br />
chlor/pse/dm sus<br />
chlordex gp syp<br />
chlorphen dm dro pse hcl<br />
chlorphen hd syp 5-2-1.67<br />
chlorphen tannate-carbetapentane tannate susp 4-30 mg/5ml<br />
chlorphen tannate-carbetapentane tannate tab 5-60 mg<br />
CHLORPHEN TANNATE-CARBETAPENTANE TANNATE TAB 5-60 MG<br />
CHLORPHENIRAMINE TANNATE-HYDROCODONE TANNATE SUSP 4-5 MG/5ML<br />
chlorpheniramine w/ codeine liquid 2-10 mg/5ml<br />
CHLORPHENIRAMINE W/ CODEINE LIQUID 2-9 MG/5ML<br />
CHLORPHENIRAMINE W/ CODEINE SUSP 0.2-1 MG/ML<br />
CHLORPHENIRAMINE W/ CODEINE SUSP 0.222-1 MG/ML OTC<br />
CHLORPHENIRAMINE W/ CODEINE SUSP 0.25-1 MG/ML OTC<br />
CHLORPHENIRAMINE W/ CODEINE SUSP 0.267-1 MG/ML<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 92
CHLORPHENIRAMINE W/ CODEINE SUSP 0.286-1 MG/ML OTC<br />
CHLORPHENIRAMINE W/ CODEINE SUSP 0.333-1 MG/ML OTC<br />
CHLORPHENIRAMINE W/ CODEINE SUSP 0.4-1 MG/ML<br />
CHLORPHENIRAMINE W/ CODEINE TAB 4-10 MG<br />
CHLORPHENIRAMINE W/ CODEINE TAB 4-20 MG<br />
CHLORPHENIRAMINE W/ DM-GG TAB 4-20-400 MG<br />
CHLORPHENIRAMINE W/ HYDROCODONE CR SUSP 8-10 MG/5ML<br />
CHLORPHENIRAMINE W/ HYDROCODONE LIQUID 2-2.5 MG/5ML<br />
CHLORPHENIRAMINE-DM CHEW TAB 1-5 MG OTC<br />
chlorpheniramine-dm liquid 1-5 mg/5ml OTC<br />
chlorpheniramine-dm liquid 1-7.5 mg/5ml OTC<br />
CHLORPHENIRAMINE-DM LIQUID 2-15 MG/15ML OTC<br />
chlorpheniramine-dm liquid 2-15 mg/5ml OTC<br />
CHLORPHENIRAMINE-DM SYRUP 1-7.5 MG/5ML OTC<br />
CHLORPHENIRAMINE-DM SYRUP 2-10 MG/5ML OTC<br />
chlorpheniramine-dm tab 4-20 mg OTC<br />
chlorpheniramine-dm tab 4-30 mg OTC<br />
cld head cng tab nighttim OTC<br />
cld head cng tab nighttim OTC<br />
cld head cng tab nighttim OTC<br />
clear cough syp dm OTC<br />
CLOFERA LIQ OTC<br />
codafed syp expect<br />
codafed exp sol ped<br />
codal-dh syp<br />
codal-dm syp OTC<br />
codeine-brompheniramine syrup 10-2 mg/5ml<br />
CODEINE-BROMPHENIRAMINE TAB 10-4 MG<br />
CODEINE-BROMPHENIRAMINE TAB 20-4 MG<br />
CODEINE-CHLORPHENIRAMINE-ACETAMINOPHEN TAB 20-4-500 MG<br />
CODEINE-PYRILAMINE SYRUP 9-8.33 MG/5ML<br />
codeine/gg tab 10-300<br />
codeine/guai liq 10-300mg<br />
codiclear dh syp 5-100/5<br />
CODIMAL DH SYP<br />
CODIMAL PH SYP OTC<br />
CODIMAL PH SYP<br />
codituss dh syp<br />
codituss dm syp OTC<br />
cofex-dm tab 55-1000<br />
cold & cough elx dm OTC<br />
cold caplets tab OTC<br />
cold head pak day/nght OTC<br />
cold head pak day/nght OTC<br />
cold head tab cong dt OTC<br />
cold head tab congest OTC<br />
cold head tab congesti OTC<br />
cold mult-sy tab daytime OTC<br />
cold mult-sy tab daytime OTC<br />
cold mult-sy tab daytime OTC<br />
cold mult-sy tab expr gel OTC<br />
cold mult-sy tab sevr day OTC<br />
cold mult-sy tab sevr day OTC<br />
cold multi pak day/nght OTC<br />
cold multi pak day/nght OTC<br />
cold multi- tab symptom OTC<br />
cold multi-s tab night OTC<br />
cold multi-s tab night OTC<br />
cold multi-s tab nighttim OTC<br />
cold relief pak day/nght OTC<br />
COLD RELIEF TAB OTC<br />
cold relief tab complete OTC<br />
cold relief tab max str OTC<br />
cold relief tab multi-s OTC<br />
cold relieve tab OTC<br />
cold symptom tab relief OTC<br />
cold-allergy elx dm relie OTC<br />
cold/allergy elx dm OTC<br />
cold/allergy elx dm OTC<br />
cold/allergy elx dm OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 93
cold/cough cap 30-10-20 OTC<br />
cold/cough cap multisym OTC<br />
cold/cough elx child OTC<br />
cold/cough elx children OTC<br />
cold/cough elx dm OTC<br />
cold/cough elx dm OTC<br />
cold/cough elx dm child OTC<br />
cold/flu liq daytime OTC<br />
cold/flu liq daytime OTC<br />
cold/flu rel cap daytime OTC<br />
cold/flu rel cap night OTC<br />
cold/flu rel pak day/nght OTC<br />
cold/flu rel pak day/nght OTC<br />
cold/flu rel pak day/nght OTC<br />
cold/flu rlf liq cherry OTC<br />
cold/flu rlf liq orig flv OTC<br />
coldcough syp<br />
COLDCOUGH SYP HCM<br />
coldcough hc syp<br />
coldcough pd syp<br />
coldec dm syp<br />
coldmist dm tab 12hr<br />
coldtuss-dr syp 6-2-15<br />
complete tab max str OTC<br />
complete tab relief OTC<br />
comtrex tab cold/cgh OTC<br />
comtrex tab n-d OTC<br />
comtrex cold tab & cough OTC<br />
COMTREX D/NT KIT COLD/CGH OTC<br />
COMTREX DAY KIT DAY&NGHT OTC<br />
comtrex deep cap chst/cld OTC<br />
COMTREX NT LIQ COLD/CGH OTC<br />
comtrex nt tab cold/cgh OTC<br />
condasin syp<br />
congesta dm tab 20-400mg OTC<br />
CONTAC DAY/N PAK COLD/FLU OTC<br />
contac sever tab no-drows OTC<br />
CORDRON-12 SUS DM<br />
CORDRON-DM LIQ<br />
cordron-dm liq nr<br />
CORDRON-HC LIQ<br />
cordron-hc liq nr<br />
corfen-dm liq<br />
CORICIDIN CAP CONG/CGH OTC<br />
coricidin liq hbp OTC<br />
coryza-dm syp<br />
CORZALL LIQ 20-30MG<br />
CORZALL PLUS LIQ<br />
COTAB A TAB 4-10MG<br />
COTAB AX TAB 4-20MG<br />
COTABFLU TAB 20-4-500<br />
cotuss ex syp 2.5-120m<br />
cotuss hd syp<br />
cotuss ms syp<br />
cotuss-v syp 5-100/5<br />
cough & cold liq OTC<br />
cough & cold tab OTC<br />
cough & sore liq day time OTC<br />
cough & sore liq ngt time OTC<br />
cough & sore liq thrt day OTC<br />
cough cold liq flu rel OTC<br />
COUGH D SYP OTC<br />
cough dm syp 100-10/5 OTC<br />
COUGH FORM M SYP OTC<br />
cough formul elx relief d OTC<br />
cough m syp OTC<br />
cough relief liq 15mg/5ml OTC<br />
COUGH/COLD CAP PLUS OTC<br />
cough/head elx relief d OTC<br />
coughtuss liq 5-2-5<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 94
cp dec-dm dro 3.5-1-3<br />
cp dec-dm syp<br />
cpm/codeine liq 2-10mg/5<br />
cpm/pe/dm syp<br />
cpm/pse dm dro OTC<br />
CRANTEX HC SYP<br />
CREO-TERPIN SYP 10/15ML OTC<br />
CREOMULSION SYP 20/15ML OTC<br />
cvs children liq cold/cou OTC<br />
cvs cold rlf pak day/nght OTC<br />
cvs cold/cgh cap OTC<br />
cvs cold/cgh elx dm child OTC<br />
cvs daytime cap cold/flu OTC<br />
cvs infants dro cold OTC<br />
cvs infants dro dcon/cgh OTC<br />
cvs night ti liq formula OTC<br />
cvs non-aspi tab cold OTC<br />
cvs triactin liq cgh/run OTC<br />
cvs triactin liq cgh/runn OTC<br />
cvs tussin liq cf OTC<br />
cvs tussin liq cgh/cld OTC<br />
cvs tussin syp cgh/cold OTC<br />
cytuss hc syp<br />
cytuss-hc nr syp<br />
D-TANN AT SUS<br />
D-TANN CD SUS 15-25-30<br />
d-tann ct sus<br />
d-tann ct tab<br />
d-tann dm sus<br />
d-tann hc sus<br />
dacex-a liq<br />
dacex-dm syp<br />
dacex-pe tab<br />
day time cap OTC<br />
day time cap cold/flu OTC<br />
day time liq OTC<br />
day time d cap cold/flu OTC<br />
day-time cap cold/flu OTC<br />
day-time liq OTC<br />
day-time liq cold/flu OTC<br />
day-time liq cold/flu OTC<br />
day-time liq cold/flu OTC<br />
day-time pe cap OTC<br />
day-time pe cap cold/flu OTC<br />
daytime cap OTC<br />
daytime cap cold/flu OTC<br />
daytime cap cold/flu OTC<br />
daytime cap cold/flu OTC<br />
DAYTIME LIQ COLD MED OTC<br />
daytime liq cold/flu OTC<br />
daytime liq cold/flu OTC<br />
daytime liq cold/flu OTC<br />
daytime liq cold/flu OTC<br />
daytime cld/ sol cgh chld OTC<br />
daytime pe cap 10-5-325 OTC<br />
daytime pe cap cold/flu OTC<br />
de-chlor dm syp liquid<br />
de-chlor dr syp liquid<br />
de-chlor g syp<br />
de-chlor hc syp liquid<br />
de-chlor hd syp liquid<br />
de-chlor mr syp<br />
de-chlor nx sol liquid<br />
dec-chlorphn dro dm<br />
dec-chlorphn syp dm<br />
DECAHIST-DM SOL LIQUID<br />
decon dm syp 30-2-10<br />
DECONEX DM CAP OTC<br />
DECONEX DM TAB<br />
DECONGEST D SYP COUGH OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 95
decongestant elx d OTC<br />
decongestant syp formula OTC<br />
DECONSAL DM CHW<br />
decorel tab forte pl OTC<br />
DEKA LIQ<br />
DEKA PED DRO<br />
DELSYM LIQ 30MG/5ML OTC<br />
DELTUSS DMX LIQ<br />
DESPEC DRO<br />
DESPEC DRO<br />
DESPEC DM SYP OTC<br />
DESPEC DM SYP<br />
DESPEC DM TAB<br />
DESPEC NR DRO<br />
DESPEC-DM TAB OTC<br />
DESPEC-EXP SYP<br />
despec-pd syp<br />
detuss liq<br />
dex pc syp<br />
dex-tuss liq<br />
dex-tuss dm liq<br />
DEXALL SYP 10-2-20<br />
DEXALONE CAP 30MG OTC<br />
dexatrex d elx cf-nasal OTC<br />
dexcon-dm syp<br />
dexcon-pe tab<br />
dextromethorphan hbr cap 15 mg OTC<br />
DEXTROMETHORPHAN HBR CAP 30 MG OTC<br />
DEXTROMETHORPHAN HBR DROPS 3.75 MG/0.8ML OTC<br />
DEXTROMETHORPHAN HBR FREEZER POP 7.5 MG (7.5 MG/25ML) OTC<br />
DEXTROMETHORPHAN HBR GEL SYRUP 7.5 MG/5ML OTC<br />
DEXTROMETHORPHAN HBR LIQUID 10 MG/5ML OTC<br />
DEXTROMETHORPHAN HBR LIQUID 12.5 MG/5ML OTC<br />
DEXTROMETHORPHAN HBR LIQUID 15 MG/15ML OTC<br />
dextromethorphan hbr liquid 15 mg/5ml OTC<br />
dextromethorphan hbr liquid 7.5 mg/5ml OTC<br />
DEXTROMETHORPHAN HBR LIQUID 7.5 MG/ML OTC<br />
DEXTROMETHORPHAN HBR LOZENGE 10 MG OTC<br />
DEXTROMETHORPHAN HBR LOZENGE 2.5 MG OTC<br />
DEXTROMETHORPHAN HBR LOZENGE 7.5 MG OTC<br />
DEXTROMETHORPHAN HBR ORAL STRIP 15 MG (11 MG BASE EQUIV) OTC<br />
DEXTROMETHORPHAN HBR ORAL STRIP 7.5 MG (5.5 MG BASE EQUIV) OTC<br />
DEXTROMETHORPHAN HBR SYRUP 10 MG/15ML OTC<br />
dextromethorphan hbr syrup 10 mg/5ml OTC<br />
dextromethorphan hbr syrup 15 mg/5ml OTC<br />
DEXTROMETHORPHAN HBR SYRUP 20 MG/15ML OTC<br />
dextromethorphan hbr syrup 5 mg/5ml OTC<br />
dextromethorphan hbr syrup 7.5 mg/5ml OTC<br />
DEXTROMETHORPHAN HBR TAB 30 MG OTC<br />
DEXTROMETHORPHAN HBR-GUAIFENESIN TANNATE SUSP 15-225 MG/5ML<br />
DEXTROMETHORPHAN POLISTIREX LIQUID CR 30 MG/5ML OTC<br />
DEXTROMETHORPHAN TANNATE SUSP 30 MG/5ML<br />
DEXTROMETHORPHAN-APAP-CHLORPHEN LIQUID 30-650-4 MG/15ML OTC<br />
DEXTROMETHORPHAN-APAP-CHLORPHEN LIQUID 7.5-160-1 MG/5ML OTC<br />
DEXTROMETHORPHAN-APAP-CHLORPHEN LIQUID 7.5-162.5-1 MG/5ML OTC<br />
DEXTROMETHORPHAN-APAP-CHLORPHEN SYRUP 7.5-160-1 MG/5ML OTC<br />
DEXTROMETHORPHAN-APAP-CHLORPHENIRAMINE CAP 15-325-4 MG OTC<br />
dextromethorphan-apap-chlorpheniramine susp 5-160-1 mg/5ml OTC<br />
dextromethorphan-apap-chlorpheniramine tab 15-500-2 mg OTC<br />
DEXTROMETHORPHAN-CHLORPHEN-METHSCOP TAB SR 12HR 30-8-2.5 MG<br />
DEXTROMETHORPHAN-DIPHENHYD-APAP LIQUID 10-12.5-325 MG/5ML OTC<br />
DEXTROMETHORPHAN-DOXYLAMINE-APAP CAP 15-6.25-325 MG OTC<br />
dextromethorphan-doxylamine-apap cap 15-6.25-325 mg OTC<br />
dextromethorphan-doxylamine-apap liquid 30-12.5-1000 mg/30ml OTC<br />
DEXTROMETHORPHAN-GG-POT CITRATE LIQD 10-100-85 MG/5ML<br />
DEXTROMETHORPHAN-GG-POT CITRATE LIQD 10-100-85 MG/5ML OTC<br />
DEXTROMETHORPHAN-GUAIFENESIN CAP 10-200 MG OTC<br />
dextromethorphan-guaifenesin elixir 20-200 mg/5ml<br />
dextromethorphan-guaifenesin elixir 20-200 mg/5ml<br />
DEXTROMETHORPHAN-GUAIFENESIN GRANULES PACKET 5-100 MG OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 96
dextromethorphan-guaifenesin liquid 10-100 mg/5ml<br />
dextromethorphan-guaifenesin liquid 10-100 mg/5ml OTC<br />
DEXTROMETHORPHAN-GUAIFENESIN LIQUID 10-150 MG/5ML OTC<br />
dextromethorphan-guaifenesin liquid 10-200 mg/5ml OTC<br />
dextromethorphan-guaifenesin liquid 10-300 mg/5ml<br />
DEXTROMETHORPHAN-GUAIFENESIN LIQUID 15-200 MG/5ML OTC<br />
DEXTROMETHORPHAN-GUAIFENESIN LIQUID 15-25 MG/5ML OTC<br />
DEXTROMETHORPHAN-GUAIFENESIN LIQUID 15-25 MG/5ML<br />
dextromethorphan-guaifenesin liquid 20-200 mg/5ml<br />
DEXTROMETHORPHAN-GUAIFENESIN LIQUID 20-300 MG/5ML OTC<br />
dextromethorphan-guaifenesin liquid 20-300 mg/5ml OTC<br />
dextromethorphan-guaifenesin liquid 3.5-25 mg/5ml OTC<br />
dextromethorphan-guaifenesin liquid 30-200 mg/5ml OTC<br />
dextromethorphan-guaifenesin liquid 5-100 mg/5ml OTC<br />
DEXTROMETHORPHAN-GUAIFENESIN SOLN 15-250 MG/5ML (3-50 MG/ML)<br />
dextromethorphan-guaifenesin solution 25-225 mg/5ml<br />
dextromethorphan-guaifenesin syrup 10-100 mg/5ml<br />
dextromethorphan-guaifenesin syrup 10-100 mg/5ml OTC<br />
dextromethorphan-guaifenesin syrup 15-100 mg/5ml OTC<br />
DEXTROMETHORPHAN-GUAIFENESIN SYRUP 20-200 MG/15ML OTC<br />
DEXTROMETHORPHAN-GUAIFENESIN SYRUP 3.33-33.3 MG/5ML OTC<br />
dextromethorphan-guaifenesin tab 15-200 mg OTC<br />
DEXTROMETHORPHAN-GUAIFENESIN TAB 15-400 MG OTC<br />
dextromethorphan-guaifenesin tab 20-400 mg<br />
dextromethorphan-guaifenesin tab 20-400 mg OTC<br />
DEXTROMETHORPHAN-GUAIFENESIN TAB CR 25-600 MG<br />
dextromethorphan-guaifenesin tab sr 12hr 20-1200 mg<br />
DEXTROMETHORPHAN-GUAIFENESIN TAB SR 12HR 28-600 MG<br />
DEXTROMETHORPHAN-GUAIFENESIN TAB SR 12HR 28-835 MG<br />
dextromethorphan-guaifenesin tab sr 12hr 30-500 mg<br />
DEXTROMETHORPHAN-GUAIFENESIN TAB SR 12HR 30-575 MG<br />
dextromethorphan-guaifenesin tab sr 12hr 30-600 mg<br />
DEXTROMETHORPHAN-GUAIFENESIN TAB SR 12HR 30-600 MG OTC<br />
DEXTROMETHORPHAN-GUAIFENESIN TAB SR 12HR 30-600 MG<br />
dextromethorphan-guaifenesin tab sr 12hr 30-650 mg<br />
DEXTROMETHORPHAN-GUAIFENESIN TAB SR 12HR 30-675 MG<br />
dextromethorphan-guaifenesin tab sr 12hr 30-800 mg<br />
DEXTROMETHORPHAN-GUAIFENESIN TAB SR 12HR 30-835 MG<br />
DEXTROMETHORPHAN-GUAIFENESIN TAB SR 12HR 45-1200 MG<br />
DEXTROMETHORPHAN-GUAIFENESIN TAB SR 12HR 50-1000 MG<br />
dextromethorphan-guaifenesin tab sr 12hr 55-1000 mg<br />
DEXTROMETHORPHAN-GUAIFENESIN TAB SR 12HR 57.5-775 MG<br />
DEXTROMETHORPHAN-GUAIFENESIN TAB SR 12HR 58-1000 MG<br />
dextromethorphan-guaifenesin tab sr 12hr 60-1000 mg<br />
dextromethorphan-guaifenesin tab sr 12hr 60-1200 mg OTC<br />
dextromethorphan-guaifenesin tab sr 12hr 60-1200 mg<br />
DEXTROMETHORPHAN-GUAIFENESIN TAB SR 12HR 60-800 MG<br />
dextromethorphan-phenylephrine-apap cap 10-5-325 mg OTC<br />
DEXTROMETHORPHAN-PHENYLEPHRINE-APAP LIQ 2.5-1.25-80 MG/0.8ML OTC<br />
dextromethorphan-phenylephrine-apap liqd 10-5-325 mg/15ml OTC<br />
DEXTROMETHORPHAN-PHENYLEPHRINE-APAP LIQD 2.5-1.25-80 MG/ML OTC<br />
dextromethorphan-phenylephrine-apap powd pack 20-10-650 mg OTC<br />
dextromethorphan-phenylephrine-apap tab 10-5-325 mg OTC<br />
dextromethorphan-phenylephrine-apap tab 15-5-325 mg OTC<br />
DEXTROMETHORPHAN-POT GUAIACOLSULFONATE LIQD 15-100 MG/5ML<br />
dextromethorphan-pot guaiacolsulfonate liqd 15-300 mg/5ml<br />
DIABETIC CAP COLD/FLU OTC<br />
DIABETIC LIQ TUSSIN C<br />
diabetic tus liq children OTC<br />
DIABETIC TUS LIQ COLD/FLU OTC<br />
DIABETIC TUS LIQ COLD/FLU OTC<br />
diabetic tus liq dm OTC<br />
diabetic tus liq max str OTC<br />
diabetic tus liq max str OTC<br />
dibromm dm elx cold/cgh OTC<br />
DICEL DM SUS<br />
dihistine dh liq OTC<br />
dihistine dh liq<br />
DIHYDRO-CP SYP<br />
dihydro-gp syp<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 97
dihydrocode liq bpm/pe<br />
DIHYDROCODEINE-GUAIFENESIN LIQUID 7.5-100 MG/5ML<br />
dihyrdo-pe syp<br />
dimaphen dm elx OTC<br />
dimaphen dm elx cold/cgh OTC<br />
DIMETAPP DRO DCON/CGH OTC<br />
DIMETAPP SYP CGH/COLD OTC<br />
DIMETAPP CLD TAB CONGESTI OTC<br />
dimetapp flu sus nighttme OTC<br />
DIPHEN/PE/CT CHW 25-10-30<br />
DIPHENHYDRAMINE TAN-CARBETAPENTANE TAN SUSP 25-30 MG/5ML<br />
ditussin hc syp<br />
dm hb/pe/cpm syp strawber<br />
DM-DOXYLAMINE-APAP LIQ & DM-APAP LIQ DAY/NIGHT THERAPY PACK OTC<br />
dm-gg-pot cit-citric acid liqd 10-100-85-35 mg/5ml OTC<br />
DM-GG-SOD CITRATE LIQUID 20-30-100 MG/10ML (10-15-50MG/5ML)<br />
dm-pe-chlor dro<br />
DM-POT GUAIACOLSULFONATE LIQD 10-75 MG/5ML (2-15 MG/ML)<br />
dm/cpm/pe dro<br />
dm/cpm/pe liq<br />
dm/gg syp 10-100/5 OTC<br />
dm/guai liq 10-300mg<br />
dm/pe/bpm sus tannate<br />
dm/pe/cpm dro<br />
dm/pe/cpm liq<br />
dm/pe/dexchl sus tannate<br />
dm/pe/pyrila sus tannate<br />
dm/pot guaia liq 15-300mg<br />
DM/PSE/CPM SUS 30-30-4 OTC<br />
dm/pse/gg tab<br />
dm/pse/gg tab<br />
DMAX SYP 8-4-15/5<br />
DMAX PEDI LIQ 2-2-4/5<br />
DMT/PET/ SUS BROM T<br />
dometuss cap cough/cl<br />
dometuss dm liq 200-20/5<br />
DONATUSS DC SYP<br />
DONATUSS XP SUS<br />
DONATUSSIN LIQ MAX<br />
DONATUSSIN SUS DM<br />
donatussin syp dc<br />
doxylamine-dm liquid 6.25-15 mg/15ml OTC<br />
drituss dm elx 200-20/5<br />
drituss hd elx<br />
DRIXORAL CAP CGH & ST OTC<br />
DROCON-CS SYP<br />
drotuss liq<br />
drotuss-cp liq<br />
DUOHIST DH LIQ 5-2-7.25<br />
dur-tann sus forte<br />
dur-tann dm sus<br />
DURADEX TAB FORTE<br />
DURAMAX TAB<br />
DURATUSS SUS AC 12<br />
DURATUSS SUS DM 12<br />
DURATUSS CS TAB 60-900MG<br />
duravent-dpb syp 5-2-10mg<br />
dynatuss syp<br />
dynatuss ex syp<br />
dynatuss hc syp<br />
DYNEX 12 SUS<br />
DYNEX VR CAP<br />
DYTAN-CS SUS SUSP<br />
DYTAN-CS TAB<br />
DYTAN-HC SUS<br />
eck bromtapp elx dm OTC<br />
eck child na liq flu OTC<br />
eck max n-d pak cold/flu OTC<br />
eck non-asa tab congestn OTC<br />
eck tussin cap cold/cgh OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 98
eck tussin syp cf OTC<br />
ED DM CHW<br />
ed-a-hist dm liq<br />
ed-tlc syp 5-2-1.67<br />
ed-tuss hc syp<br />
ELIXSURE GEL COUGH OTC<br />
endacof-ac syp 10-2mg<br />
endacof-c liq 2-10mg/5<br />
endacof-dc liq<br />
endacof-dh liq<br />
endacof-dm syp<br />
endacof-hc sol 30-2-1.7<br />
endacof-pd dro<br />
endacof-plus liq<br />
endacof-tab tab<br />
endacof-xp syp<br />
ENDACON LIQ OTC<br />
endacon-dm tab<br />
ENDAL CD SYP<br />
ENTEX HC LIQ<br />
entre-s sus<br />
eq cold tab relief OTC<br />
eq cold plus chw cough OTC<br />
EQ COLD PLUS LIQ COUGH OTC<br />
eq cold relf mis day/nite OTC<br />
eq daytime cap cold/flu OTC<br />
eq daytime liq cold/flu OTC<br />
eq flu/cold pak congesti OTC<br />
eq infants dro cold/cgh OTC<br />
eq nite time cap cold/flu OTC<br />
eq nite time liq cold/flu OTC<br />
eq triacting liq cold/cgh OTC<br />
eq triacting liq night tm OTC<br />
eq triacting liq sore thr OTC<br />
eq tussin cap cld/cong OTC<br />
eq tussin syp dm OTC<br />
eq tussin cf liq OTC<br />
eql cold/cgh cap OTC<br />
eql daytime cap cold/flu OTC<br />
eql daytime cap cold/flu OTC<br />
eql daytime liq cold/flu OTC<br />
EQL FLU/COLD PAK /CONGEST OTC<br />
eql flu/cold pak /cough OTC<br />
eql flu/cold pak congesti OTC<br />
EQL INFANT DRO DCON/CGH OTC<br />
eql nighttim cap cold/flu OTC<br />
eql pain rel dro cold/cgh OTC<br />
eql pain rel liq plus flu OTC<br />
eql severe tab cold/flu OTC<br />
eql triactin elx cld/cgh OTC<br />
eql triactin liq cold/cgh OTC<br />
eql tussin liq cf OTC<br />
eql tussin liq cgh/cold OTC<br />
eql tussin syp 15mg/5ml OTC<br />
eql tussin syp cgh/cold OTC<br />
eql tussin syp dm OTC<br />
EXALL LIQ 10-100MG<br />
EXALL-D LIQ<br />
excof liq<br />
excof-sf liq<br />
execlear syp 3.5-100<br />
execlear-c liq 200-10mg<br />
execlear-dm syp<br />
execof tab<br />
execof-xp syp<br />
exefen dmx tab OTC<br />
exefen-dm tab 55-1000<br />
exefen-dmx tab<br />
exetuss-dm tab<br />
exetuss-hc liq<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 99
EXPECTUSS LIQ 20-75MG/<br />
exratuss sus<br />
extendryl sol gcp<br />
EXTENDRYL HC TAB<br />
extuss la tab 30-650mg<br />
extussive liq 100-10/5 OTC<br />
FATHER JOHNS SOL PLUS OTC<br />
father johns syp 10mg/5ml OTC<br />
FENESIN DM TAB 15-400MG OTC<br />
flu bp tab max st OTC<br />
FLU FORMULA CAP OTC<br />
flu formula liq childs OTC<br />
flu non-drow tab OTC<br />
flu relief liq daytime OTC<br />
flu relief tab OTC<br />
flu/cgh/cold pow max st OTC<br />
flu/cgh/cold pow nite OTC<br />
flu/cold/cg pow medicine OTC<br />
flu/cold/cgh pak max st OTC<br />
flu/cold/cgh pak ms n/d OTC<br />
flu/cold/cgh pow OTC<br />
flu/cold/cgh pow OTC<br />
flu/cold/cgh pow hot med OTC<br />
flu/cold/cgh pow max nite OTC<br />
flu/cold/cgh pow medicine OTC<br />
flu/cold/cgh pow medicine OTC<br />
flu/cold/cgh pow medicine OTC<br />
flu/cold/cgh pow medicine OTC<br />
flu/cold/cgh pow ms n/d OTC<br />
flu/cough/ pow /cold ms OTC<br />
flutabs tab<br />
FORMULA 44 LIQ CGH/CLD OTC<br />
formula d liq OTC<br />
g phen dm tab<br />
g-bid dm tab<br />
g-fen dm tab 20-400mg OTC<br />
gani-tuss dm liq 100-10/5<br />
gani-tuss nr liq 100-10/5<br />
gdp-ex liq<br />
genacol ms tab cold/flu OTC<br />
genantuss liq<br />
genantusside liq<br />
genatuss dm syp 100-10/5 OTC<br />
gene-t-press liq<br />
genebrom dm syp<br />
GENEBRONCO-D LIQ<br />
genecof-hc liq<br />
GENECOF-HC LIQ<br />
genecof-xp liq<br />
GENECOF-XP LIQ<br />
GENEDEL LIQ<br />
genedotuss liq -dm<br />
GENEPATUSS SYP<br />
genetuss sol<br />
genetuss sol OTC<br />
genetuss-2 liq OTC<br />
genetuss-2 liq<br />
GENEXPECT DM LIQ<br />
GENEXPECT-PE LIQ<br />
GENEXPECT-SF LIQ<br />
GENTEX HC LIQ<br />
gentex-lq syp<br />
geri-tussin syp dm OTC<br />
gestuss-hc syp<br />
GFN/DM/PSE TAB<br />
gfn/pse/dm tab<br />
GFN1000/DM50 TAB<br />
gfn1000/dm60 tab<br />
gfn1200/dm20 tab /pe40<br />
gfn1200/dm60 tab<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 100
gfn1200/dm60 tab /pse 120<br />
gfn500/dm30 tab<br />
GFN550/PSE60 TAB /DM 30<br />
gfn595/pse48 tab /dm32<br />
gfn600/pse60 tab /dm30 sa<br />
gfn800/dm30 tab<br />
gfn800/pse60 tab /dm 30<br />
gg/carbeta tab<br />
gg/codeine liq 200-10mg<br />
gg/codeine sol 100-10/5<br />
gg/codeine sol 100-10/5<br />
gg/codeine syp 100-10/5 OTC<br />
gg/codeine syp 100-10/5<br />
gg/codeine tab 300-10<br />
gg/codeine tab 300-10<br />
gg/dm syp 100-10/5 OTC<br />
gg/dm tab<br />
gg/dm tab 1200-20<br />
gg/dm cr tab 600-30mg<br />
gg/dm la tab<br />
gg/dm nr liq 100-10/5 OTC<br />
gg/dm sr tab 600-30mg<br />
gg/pse/ syp hydrocod<br />
gg/pse/cod sol<br />
GILTUSS LIQ<br />
GILTUSS LIQ PED-C<br />
GILTUSS HC LIQ<br />
GILTUSS PED LIQ<br />
GILTUSS TR CAP 7-14-288<br />
GILTUSS TR TAB<br />
gnp cgh relf liq 15mg/5ml OTC<br />
gnp children liq plus cgh OTC<br />
gnp cold tab daytime OTC<br />
gnp cold tab head con OTC<br />
gnp cold/cgh elx child OTC<br />
gnp complete tab relief OTC<br />
gnp cough liq sore thr OTC<br />
gnp cough liq sore thr OTC<br />
gnp day time cap 30-250-1 OTC<br />
gnp day time cap cold/flu OTC<br />
gnp day time liq cold/flu OTC<br />
gnp di bromm elx dm OTC<br />
gnp pain rel dro cold OTC<br />
gnp severe tab cold/flu OTC<br />
gnp triactin liq nitetime OTC<br />
gnp tussin liq dm OTC<br />
gnp tussin liq dm cough OTC<br />
gnp tussin syp cf OTC<br />
gnp tussin syp cf OTC<br />
GUACOL DM DRO PED<br />
guai 800/pse tab 60/dm 30<br />
guai/dm tab 800-30mg<br />
guaiasorb dm liq 100-10/5 OTC<br />
guaiatussin syp ac OTC<br />
guaiatussin syp ac<br />
guaiatussin syp dm OTC<br />
guaicon dm syp 100-10/5 OTC<br />
guaicon dms syp 100-10/5 OTC<br />
guaidex-tr tab<br />
guaif/dm/pse liq OTC<br />
guaifen dm tab<br />
guaifen dm tab 600-30mg<br />
guaifen dm tab 600-30mg<br />
guaifen-c liq<br />
guaifenesin liq ac OTC<br />
guaifenesin liq ac<br />
guaifenesin liq ac expct<br />
guaifenesin liq dm OTC<br />
guaifenesin liq dm<br />
guaifenesin liq dm nr<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 101
guaifenesin liq nr<br />
guaifenesin sol dac<br />
guaifenesin syp ac<br />
guaifenesin syp dm OTC<br />
guaifenesin syp dm OTC<br />
guaifenesin syp pse/dm OTC<br />
guaifenesin tab /dm er<br />
guaifenesin tab /dm sr<br />
guaifenesin tab dm<br />
guaifenesin-codeine cap 200-9 mg<br />
GUAIFENESIN-CODEINE LIQUID 200-10 MG/5ML<br />
guaifenesin-codeine liquid 200-10 mg/5ml<br />
GUAIFENESIN-CODEINE LIQUID 200-20 MG/5ML<br />
GUAIFENESIN-CODEINE LIQUID 225-7.5 MG/5ML<br />
GUAIFENESIN-CODEINE LIQUID 300-10 MG/20ML<br />
guaifenesin-codeine liquid 300-10 mg/20ml<br />
guaifenesin-codeine liquid 300-10 mg/5ml<br />
guaifenesin-codeine soln 100-10 mg/5ml OTC<br />
guaifenesin-codeine soln 100-10 mg/5ml<br />
guaifenesin-codeine soln 100-6.3 mg/5ml<br />
guaifenesin-codeine tab 300-10 mg<br />
GUAIFENESIN-CODEINE TAB 400-10 MG<br />
GUAIFENESIN-CODEINE TAB 400-20 MG<br />
guaifenesin/ liq codeine<br />
guaifenex dm tab 30-600cr<br />
guaimist dm syp<br />
guaitussin liq dac<br />
guaitussin syp ac<br />
guapetex hc syp<br />
guaphen tab forte<br />
guaphen ii tab dm<br />
guia-d tab<br />
guiadex dm liq<br />
guiadrine dx liq<br />
guiafen ii tab dm<br />
GUIAPLEX HC LIQ<br />
guiat clr dm syp 100-10/5 OTC<br />
guiatuss ac syp 100-10/5 OTC<br />
guiatuss ac syp 100-10/5<br />
guiatuss dac sol OTC<br />
guiatuss dac sol<br />
guiatuss dm syp 100-10/5 OTC<br />
hc tuss-nr syp<br />
hc tussive syp<br />
hc tussive-d sol 60-5/5ml<br />
hc/guai syp 3.5-300<br />
hc/pe/dbrom syp 2.5-5-1<br />
hca cough liq formula OTC<br />
hca cough-ex tab OTC<br />
hca day-time cap OTC<br />
hca day-time liq OTC<br />
HCA INTENSE LIQ COUGH OTC<br />
hca nite-tim liq cold/flu OTC<br />
hca nte-time cap OTC<br />
HCA SEVERE TAB COUGH OTC<br />
hca triactin liq cold/cgh OTC<br />
hca tussin cap cold/cgh OTC<br />
hca tussin liq 100-10/5 OTC<br />
hca tussin liq cf OTC<br />
hca tussin syp dm OTC<br />
hcod/pe/cpm liq<br />
hcod/pe/cpm liq 5-5-2mg<br />
hcod/pe/gg syp 2-10-100<br />
hdc dm syp<br />
healtussin syp dm OTC<br />
histacol bd dro<br />
histacol dm syp<br />
HISTADEC DM SOL OTC<br />
HISTENOL FOR TAB OTC<br />
HISTENOL-FOR TAB OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 102
histinex hc syp<br />
histinex pv syp<br />
histuss hc liq<br />
histussin d sol 60-5/5ml<br />
histussin hc syp<br />
honey tussin syp 10mg/5ml OTC<br />
hpb max liq<br />
hpr end liq<br />
ht-tuss dm elx 200-20/5<br />
hy-kxp syp<br />
hycomal dh syp<br />
hydex pd liq<br />
hydro gp syp<br />
hydro-dp syp<br />
hydro-pc ii syp<br />
hydro-pc ii syp plus<br />
hydro-tussin elx dm<br />
HYDRO-TUSSIN SOL HD<br />
hydro-tussin syp 15-2-3mg<br />
hydro-tussin syp dhc<br />
hydro-tussin syp exp<br />
hydro-tussin syp hg<br />
hydro-tussin syp xp<br />
hydro/pe/ctm syp<br />
hydro/pseudo sol /brom<br />
HYDROCOD POLST-CHLORPHEN POLST CAP SR 12HR 10-8 MG<br />
HYDROCOD POLST-CHLORPHEN POLST CAP SR 12HR 5-4 MG<br />
hydrocod/cp/ syp pseud<br />
hydrocod/gg syp 3.5-100<br />
hydrocod/gg syp 5-100/5<br />
hydrocod/gg syp 5-100/5<br />
hydrocod/gg tab 2.5-300<br />
hydrocod/hom syp 5-1.5/5<br />
hydrocod/hom syp 5-1.5/5<br />
hydrocodone syp pe/cpm<br />
hydrocodone syp pot guai<br />
hydrocodone w/ homatropine syrup 5-1.5 mg/5ml<br />
HYDROCODONE W/ HOMATROPINE TAB 5-1.5 MG<br />
hydrocodone w/ homatropine tab 5-1.5 mg<br />
HYDROCODONE-GUAIFENESIN CAP CR 5-300 MG<br />
HYDROCODONE-GUAIFENESIN LIQUID 4-100 MG/5ML<br />
HYDROCODONE-GUAIFENESIN LIQUID 5-100 MG/5ML<br />
hydrocodone-guaifenesin liquid 5-150 mg/5ml<br />
HYDROCODONE-GUAIFENESIN LIQUID 6-200 MG/5ML<br />
hydrocodone-guaifenesin liquid 7.5-200 mg/5ml<br />
HYDROCODONE-GUAIFENESIN SYRUP 2.5-100 MG/5ML<br />
hydrocodone-guaifenesin syrup 2.5-200 mg/5ml<br />
hydrocodone-guaifenesin syrup 3-90 mg/5ml<br />
hydrocodone-guaifenesin syrup 3.5-100 mg/5ml<br />
hydrocodone-guaifenesin syrup 3.5-300 mg/5ml<br />
hydrocodone-guaifenesin syrup 5-100 mg/5ml<br />
hydrocodone-guaifenesin tab 2.5-300 mg<br />
HYDROCODONE-GUAIFENESIN TAB SR 12HR 10-1000 MG<br />
HYDROCODONE-GUAIFENESIN TAB SR 12HR 10-1200 MG<br />
HYDROCODONE-GUAIFENESIN TAB SR 12HR 5-575 MG<br />
HYDROCODONE-GUAIFENESIN TAB SR 12HR 5-600 MG<br />
hydrocodone-pot guaiaco soln 5-300 mg/5ml<br />
hydrocodone-pot guaiaco syrup 2.5-120 mg/5ml<br />
hydrocodone-pot guaiaco syrup 2.5-175 mg/5ml<br />
hydrocodone-pot guaiaco syrup 3-150 mg/5ml<br />
HYDROCODONE-POT GUAIACO SYRUP 3-350 MG/5ML<br />
hydrocodone-pot guaiaco syrup 4.5-300 mg/5ml<br />
HYDROCODONE-POT GUAIACO SYRUP 5-300 MG/5ML<br />
hydrocodone-pot guaiaco syrup 5-350 mg/5ml<br />
hydrocodone-pot guaiaco syrup 5-400 mg/5ml<br />
hydrocodone/ tab homatrop<br />
hydrocof-hc syp<br />
hydrofed syp<br />
hydromet syp 5-1.5/5<br />
hydron cp syp liquid<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 103
hydron ex syp liquid<br />
HYDRON KGS SYP<br />
hydron psc liq<br />
hyphed syp<br />
hyphen-hd syp 5-2-1.67<br />
indamix dm sus<br />
inf pain rlf dro 15/160/5 OTC<br />
infants pain dro rlvr cld OTC<br />
infants pain dro rlvr cld OTC<br />
intense coug liq reliever OTC<br />
intense coug liq reliever OTC<br />
intense coug liq reliever OTC<br />
intense coug liq reliever OTC<br />
iobid dm tab 30-600cr<br />
iophen c-nr liq 100-10/5<br />
iophen dm liq 100-10/5 OTC<br />
iophen dm-nr liq 100-10/5 OTC<br />
iophen dm-nr liq 100-10/5<br />
J-COF DHC LIQ<br />
J-MAX DHC LIQ<br />
J-TAN D HC LIQ<br />
jaycof syp 5-350/5<br />
jaycof-hc liq<br />
jaycof-xp liq<br />
ken-tuss sf syp 10-100/5 OTC<br />
kgs-hc syp<br />
kidkare liq cgh/cold OTC<br />
KOLEPHRIN LIQ -GG/DM OTC<br />
kolephrin/dm tab OTC<br />
kwelcof syp 5-100/5<br />
l-all 12 sus<br />
l-all 12 nf sus 25-30mg<br />
lanzatuss liq n.f.<br />
LARTUS LIQ<br />
LEVALL 5.0 SOL<br />
lexuss 210 liq<br />
liquicough liq dm<br />
liquicough liq hc<br />
LITTLE COLDS DRO 7.5MG/ML OTC<br />
LITTLE COLDS DRO DECONGES OTC<br />
LITTLE COLDS DRO MULTI-S OTC<br />
livetan dm sus<br />
lohist-dm syp 5-2-10mg<br />
m-clear cap 200-9mg<br />
m-clear syp<br />
m-clear jr syp<br />
m-clear wc liq<br />
m-end liq (reform)<br />
m-end dm syp<br />
m-end max liq<br />
M-END PE LIQ<br />
m-end wc liq<br />
mapap child sus cgh/sinu OTC<br />
mapap cold tab OTC<br />
mapap cold tab formula OTC<br />
mapap cold tab formula OTC<br />
MAR-COF BP LIQ<br />
MAR-COF CG LIQ EXPECT<br />
marcof syp expctrnt<br />
MARDROPS-DX LIQ OTC<br />
MAXI-TUSS LIQ HCG<br />
MAXIFED CD TAB<br />
MAXIFED CDX TAB<br />
MAXIFED DM LIQ OTC<br />
MAXIFED DM TAB<br />
maxifed dmx tab OTC<br />
MAXIFED-G TAB CDX<br />
MAXIFED-G CD TAB<br />
MAXIFLU CD TAB<br />
MAXIFLU CDX TAB<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 104
MAXIFLU DM TAB<br />
MAXIFLU-G TAB<br />
MAXIPHEN ADT TAB<br />
MAXIPHEN CD TAB<br />
MAXIPHEN CDX TAB<br />
MAXIPHEN-G TAB DM<br />
mc jr cough syp<br />
medent-dmi tab OTC<br />
medi-brom elx cld/allg OTC<br />
medi-phedrin tab sev cold OTC<br />
medi-tabs tab cold OTC<br />
medi-tabs tab flu OTC<br />
medi-tuss dm liq dbl str OTC<br />
medi-tuss dm liq diabetic OTC<br />
medi-tussin cap cgh/cold OTC<br />
medi-tussin cap cgh/cold OTC<br />
medi-tussin liq OTC<br />
medi-tussin syp dm OTC<br />
medi-tussin syp max st OTC<br />
medi-tussin syp max str OTC<br />
METHSCOPOLAM TAB DM/CPM<br />
miltuss syp 15mg/5ml OTC<br />
mintex dm liq<br />
mintex hc liq 30-2-5/5<br />
mintuss dr syp<br />
mintuss g syp<br />
mintuss hc syp<br />
mintuss hd syp 10-4-2.5<br />
mintuss mr liq<br />
mintuss ms syp 10-2-5<br />
mintuss nx syp 3-150mg/<br />
MONTE-G HC LIQ<br />
MONTEFLU HC LIQ<br />
mp tussin cf liq OTC<br />
mp tussin dm syp 100-10/5 OTC<br />
MUCINEX CGH GRA 5-100MG OTC<br />
MUCINEX CGH GRA 5-100MG OTC<br />
mucinex cgh liq 5-100mg OTC<br />
mucinex cgh liq 5-100mg OTC<br />
MUCINEX DM TAB 30-600ER<br />
MUCINEX DM TAB 30-600ER OTC<br />
mucinex dm tab 60-1200 OTC<br />
mucosa dm tab 20-400mg OTC<br />
mucus relief liq 5-100mg OTC<br />
mucus relief liq 5-100mg OTC<br />
mucus relief liq 5-100mg OTC<br />
mucus relief liq 5-100mg OTC<br />
mucus relief liq 5-100mg OTC<br />
mucus relief tab dm OTC<br />
mucus relief tab dm OTC<br />
mucus relief tab dm cough OTC<br />
mucusrelief tab dm OTC<br />
mult symptom tab cold rlf OTC<br />
multi sympt tab cold OTC<br />
multi sympto tab cold OTC<br />
multi-sympt liq cold OTC<br />
multi-sympt tab cold rel OTC<br />
multi-symptm tab daytime OTC<br />
multi-symptm tab nighttim OTC<br />
multi-sympto cap cold/cgh OTC<br />
multi-sympto tab cold/cgh OTC<br />
MULTIDEXOL M SYP OTC<br />
myci-gc sol 100-10/5 OTC<br />
myci-gc sol 100-10/5<br />
myhist-dm liq<br />
myphetane dx syp<br />
mytussin ac syp 100-10/5 OTC<br />
mytussin ac syp 100-10/5<br />
mytussin dac sol OTC<br />
mytussin dac sol<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 105
nalex sol expect<br />
NALEX DH LIQ<br />
narcof syp 3.5-100<br />
NARIZ-HC LIQ<br />
nazarin hc liq<br />
NEO AC SYP<br />
NEO DM SUS<br />
NEO HC SYP<br />
neotuss liq OTC<br />
NEOTUSS PLUS LIQ<br />
NEOTUSS-D LIQ<br />
neutrahist dro<br />
night flu/ pow cold/cgh OTC<br />
night time cap OTC<br />
night time cap OTC<br />
night time cap cold/flu OTC<br />
night time cap cold/flu OTC<br />
night time cap cold/flu OTC<br />
NIGHT TIME CAP COLD/FLU OTC<br />
night time liq cold OTC<br />
night time liq cold OTC<br />
night time liq cold/flu OTC<br />
night time liq cold/flu OTC<br />
night time liq cold/flu OTC<br />
night time liq cold/flu OTC<br />
night time liq cold/flu OTC<br />
night time liq cough OTC<br />
night time liq cough OTC<br />
night time liq cough OTC<br />
night time liq cough OTC<br />
night time liq formula OTC<br />
night time d cap cold/flu OTC<br />
night-time cap cold/flu OTC<br />
night-time liq cold OTC<br />
night-time liq cold/flu OTC<br />
night-time liq cough OTC<br />
nighttime cap cold/flu OTC<br />
nighttime cap cold/flu OTC<br />
nighttime cap cold/flu OTC<br />
nighttime liq cold OTC<br />
nighttime liq cold OTC<br />
nighttime liq cold med OTC<br />
nighttime liq cold/flu OTC<br />
nighttime liq cold/flu OTC<br />
nighttime liq cough OTC<br />
nighttime tab cold/cgh OTC<br />
nighttime tab cold/cgh OTC<br />
NITE TIME CAP LIQUID OTC<br />
nite time liq OTC<br />
nite time liq OTC<br />
nite time liq cherry OTC<br />
nite time liq child OTC<br />
nite time liq child OTC<br />
nite time liq cold med OTC<br />
nite time liq cold/flu OTC<br />
nite time liq regular OTC<br />
nite-time cap OTC<br />
nite-time cap cold/flu OTC<br />
nite-time liq OTC<br />
nite-time liq cgh chry OTC<br />
NITE-TIME LIQ COLD/FLU OTC<br />
nite-time liq cold/flu OTC<br />
nite-time liq cough OTC<br />
nite-time ms liq cold/flu OTC<br />
nitetime cap cold/flu OTC<br />
nitetime liq cold/flu OTC<br />
nohist dmx tab<br />
nohist-pdx dro<br />
non aspirin dro OTC<br />
non-asa cold chw cough OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 106
non-asa cold syp child OTC<br />
non-asa cold syp cough OTC<br />
non-asa cold tab OTC<br />
non-asa flu tab max st OTC<br />
non-aspirin tab cold OTC<br />
non-aspirin tab congest OTC<br />
non-aspirin tab max str OTC<br />
non-pseudo tab cld rel OTC<br />
nortuss-de dro<br />
nortuss-de liq drops OTC<br />
nortuss-ex liq 200-20/5<br />
NOTUSS-FORTE SYP<br />
NOTUSS-PE LIQ<br />
novadyne sol expect OTC<br />
novadyne dh liq OTC<br />
novagest/cod sol expect<br />
NOVAHISTINE LIQ DH<br />
NOVASUS SUS<br />
NUCOFED CAP<br />
NUMOBID DX TAB<br />
NUMONYL DX DRO PED<br />
NUMONYL DX SOL<br />
nycair liq cherry OTC<br />
nycair liq original OTC<br />
nyquil d liq cold/flu OTC<br />
p-hist syp<br />
p-hist dm dro<br />
p-tuss dm tab<br />
P-V TUSSIN TAB<br />
pain rel cld tab pe day OTC<br />
PAIN RELIEF CAP FLU OTC<br />
pain relief chw cld-coug OTC<br />
pain relief chw cold+cgh OTC<br />
pain relief dro plus cgh OTC<br />
pain relief dro plus cgh OTC<br />
pain relief sus pls cold OTC<br />
pain relief syp cold/cgh OTC<br />
pain relief tab cold OTC<br />
pain relief tab cold OTC<br />
pain relief tab cold OTC<br />
pain relief tab cold OTC<br />
pain relief tab cold pe OTC<br />
pain relief tab cold pe OTC<br />
pain relief/ liq flu chld OTC<br />
pain relieve tab /cold OTC<br />
pain relieve tab cold OTC<br />
pain relieve tab flu OTC<br />
PANATUSS DXP LIQ<br />
PANATUSS DXP LIQ PEDIATRI<br />
pbm allergy syp<br />
pd-cof dro<br />
pd-cof syp<br />
pdm gg syp 10-30-20<br />
PE HCL-BROMPHEN MAL-HYDROCOD BITART TAN SUSP 10-6-5 MG/5ML<br />
PE HCL-DM HBR-GUAIFENESIN TANNATE SUSP 20-40-200 MG/10ML<br />
PE TAN -DIPHENHYD TAN-HYDROCOD TAN SUSP 7.5-25-3.5 MG/5ML<br />
pe tan -diphenhyd tan-hydrocod tan susp 7.5-25-3.5 mg/5ml<br />
PE TAN-DEXBROMPHEN TAN-PYRIL-DM TAN SUSP 25-4-3.5-30 MG/5ML<br />
PE TAN-DEXCHLORPHEN TAN-HYDROCOD TAN SUSP 10-2-6 MG/5ML<br />
PE TAN-DEXCHLORPHENIRAMINE TAN-DM TAN SUSP 20-2-30 MG/5ML<br />
pe tan-dexchlorpheniramine tan-dm tan susp 20-2-30 mg/5ml<br />
pe-dm-apap & pe-cpm-dm-apap tab day/night therapy pack OTC<br />
pe-dm-apap cap & doxylamine-dm-apap cap day/night ther pack OTC<br />
PE-DM-GG LIQ 5-10-100MG/5ML & DPH-PE LIQ 6.25-2.5MG/5ML PAK OTC<br />
PE-DM-GG TAB 15-30-600 & CPM-PE-METHSCOP TBCR 8-25-2.5 PACK<br />
PE-DM-GG-APAP TAB & PE-DIPHENHYD-APAP TAB THERAPY PACK OTC<br />
pe-hist dm syp 5-2-15mg<br />
PE-PSE-CPM-PYRIL W/ HYDROCOD LIQD 5-3.3-2-3.3-2.5 MG/5ML<br />
pe/guai/dm tab<br />
pe/hcod/cpm liq<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 107
pe/hcod/cpm syp<br />
pe/pyril/hyd syp<br />
ped formula liq 100-10/5 OTC<br />
ped sup tuss liq cgh/cold OTC<br />
pedi cgh/cld liq 15-1-5mg OTC<br />
pedi cou/cld liq 15-1-5mg OTC<br />
pedi-atric liq cgh/cold OTC<br />
pedi-atric liq niterest OTC<br />
pedia relief dro infant OTC<br />
pedia relief dro infant OTC<br />
pedia relief dro infant OTC<br />
pedia relief dro infant OTC<br />
pedia relief liq cgh/cold OTC<br />
pedia relief liq cgh/cold OTC<br />
pedia relief liq cgh/cold OTC<br />
pedia relief liq for chld OTC<br />
PEDIACARE CHW OTC<br />
pediacare dro infant OTC<br />
PEDIACARE DRO LONG-ACT OTC<br />
pediacare liq children OTC<br />
pediacare liq long-act OTC<br />
pediacare liq long-act OTC<br />
PEDIACARE MIS LA COUGH OTC<br />
pediahist dm dro 15-1-4mg<br />
pediahist dm syp<br />
PEDIATEX-JR SUS DM<br />
pediatric dro dcon/cgh OTC<br />
pediatric liq cgh/cold OTC<br />
pentuss sus<br />
pertussin liq 3.5-25/5 OTC<br />
pertussin 8h syp 15mg/5ml OTC<br />
phanatuss dm syp 100-10/5 OTC<br />
PHANATUSS HC LIQ 5-100/5M<br />
pharmatuss syp 100-10/5 OTC<br />
phen/chlor syp hc<br />
PHENA-HC LIQ<br />
phencarb gg syp<br />
phendacof hc syp<br />
PHENDACOF PL LIQ<br />
PHENFLU CD TAB<br />
PHENFLU CDX TAB<br />
PHENFLU DM TAB<br />
PHENFLU G TAB<br />
phenhist sol expect<br />
PHENYDEX LIQ<br />
PHENYLEPH HCL-DIPHENHYD HCL-DM HBR TAN SUS 15-12.5-15 MG/5ML<br />
PHENYLEPH HCL-PYRIL MAL-DM HBR TANNATE CHEW TAB 10-16-15 MG<br />
PHENYLEPH TAN-BROMPHEN TAN-CARBETA TAN SUSP 7.5-4-30 MG/5ML<br />
phenyleph tan-bromphen tan-carbeta tan susp 7.5-4-30 mg/5ml<br />
phenyleph tan-bromphen tan-dm tan susp 20-8-20 mg/5ml<br />
PHENYLEPH TAN-BROMPHEN TAN-DM TAN SUSP 25-10-30 MG/5ML<br />
phenyleph tan-bromphen tan-dm tan susp 25-10-30 mg/5ml<br />
phenyleph tan-chlorphen tan-carbet tan susp 12.5-4-30 mg/5ml<br />
PHENYLEPH TAN-CHLORPHEN TAN-CARBET TAN SUSP 2.5-2-15 MG/ML<br />
PHENYLEPH TAN-CHLORPHEN TAN-CARBET TAN SUSP 20-8-60 MG/5ML<br />
PHENYLEPH TAN-CHLORPHEN TAN-CARBETA TAN SUSP 10-8-60 MG/5ML<br />
phenyleph tan-chlorphen tan-carbeta tan susp 5-4-30 mg/5ml<br />
PHENYLEPH TAN-CHLORPHEN TAN-CARBETAPENT TAN TAB 10-5-60 MG<br />
phenyleph tan-chlorphen tan-carbetapent tan tab 10-5-60 mg<br />
PHENYLEPH TAN-CHLORPHEN TAN-DM TAN TAB 20-2-30 MG<br />
PHENYLEPH TAN-DIPHENHYD TAN-CARBETA TAN CHEW TAB 10-25-30 MG<br />
PHENYLEPH TAN-DIPHENHYD TAN-CARBETA TAN SUS 15-25-30 MG/5ML<br />
phenyleph tan-diphenhyd tan-carbeta tan sus 7.5-25-30 mg/5ml<br />
PHENYLEPH TAN-DIPHENHYD TAN-CARBETA TAN SUS 7.5-25-30 MG/5ML<br />
phenyleph tan-diphenhyd tan-carbeta tan tab 10-25-30 mg<br />
PHENYLEPH TAN-DIPHENHYD TAN-CARBETA TAN TAB 10-25-30 MG<br />
phenyleph tan-diphenhyd tan-dm tan susp 7.5-25-75 mg/5ml<br />
PHENYLEPH TAN-PYRILAMINE TAN-CARBETA TAN SUSP 5-30-30 MG/5ML<br />
phenyleph tan-pyrilamine tan-carbeta tan susp 5-30-30 mg/5ml<br />
PHENYLEPH TAN-PYRILAMINE TAN-CARBETA TAN TAB 10-40-60 MG<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 108
PHENYLEPH TAN-PYRILAMINE TAN-DM TAN CHEW TAB 25-30-25 MG<br />
phenyleph tan-pyrilamine tan-dm tan susp 12.5-30-25 mg/5ml<br />
phenyleph tan-pyrilamine tan-dm tan susp 15.5-15.5-25 mg/5ml<br />
phenyleph tan-pyrilamine tan-dm tan susp 15.5-15.5-25 mg/5ml<br />
PHENYLEPH-BROMPHEN-DM-GUAIFENESIN SYRUP 5-2-5-50 MG/5ML<br />
phenyleph-bromphen-dm-guaifenesin syrup 5-2-5-50 mg/5ml<br />
PHENYLEPH-BROMPHEN-HYDROCODONE LIQD 7.5-2-2.5 MG/5ML<br />
phenyleph-bromphen-hydrocodone liqd 7.5-2-5 mg/5ml<br />
phenyleph-bromphen-hydrocodone liqd 7.5-4-2.5 mg/5ml<br />
PHENYLEPH-CARBETAPENTANE-POT GUAIACO LIQD 10-20-100 MG/5ML<br />
phenyleph-chlorphen w/ dm-gg liquid 10-2-15-100 mg/5ml<br />
PHENYLEPH-CHLORPHEN W/ DM-GG LIQUID 5-2-15-150 MG/5ML<br />
phenyleph-chlorphen w/ dm-gg syrup 10-2-15-100 mg/5ml<br />
phenyleph-chlorphen w/ dm-gg syrup 10-2-7.5-100 mg/5ml<br />
PHENYLEPH-CHLORPHEN W/ DM-GG SYRUP 5-2-15-100 MG/5ML<br />
PHENYLEPH-CHLORPHEN W/ DM-GG SYRUP 5-2-5-75 MG/5ML<br />
PHENYLEPH-CHLORPHEN W/ DM-GG SYRUP 8.5-2.5-22.5-125 MG/5ML<br />
phenyleph-chlorphen w/ hydrocodone liqd 12-2-6 mg/5ml<br />
phenyleph-chlorphen w/ hydrocodone liqd 5-2-1.67 mg/5ml<br />
phenyleph-chlorphen w/ hydrocodone liqd 5-2-5 mg/5ml<br />
phenyleph-chlorphen w/ hydrocodone liqd 8-2.5-3.25 mg/5ml<br />
phenyleph-chlorphen w/ hydrocodone liqd 8-2.5-3.5 mg/5ml<br />
phenyleph-chlorphen w/ hydrocodone syrup 10-2-2.5 mg/5ml<br />
phenyleph-chlorphen w/ hydrocodone syrup 10-2-5 mg/5ml<br />
PHENYLEPH-CHLORPHEN W/ HYDROCODONE SYRUP 10-2.5-3.5 MG/5ML<br />
phenyleph-chlorphen w/ hydrocodone syrup 10-4-2.5 mg/5ml<br />
phenyleph-chlorphen w/ hydrocodone syrup 5-2-1.67 mg/5ml<br />
phenyleph-chlorphen w/ hydrocodone syrup 5-2-2.5 mg/5ml<br />
PHENYLEPH-CHLORPHEN W/ HYDROCODONE SYRUP 5-2-6 MG/5ML<br />
phenyleph-chlorphen w/ hydrocodone syrup 7.5-2-2 mg/5ml<br />
phenyleph-chlorphen w/ hydrocodone syrup 7.5-2-3.5 mg/5ml<br />
PHENYLEPH-CHLORPHEN W/ HYDROCODONE SYRUP 7.5-3-5 MG/5ML<br />
PHENYLEPH-CHLORPHEN-CARBETAPENTANE LIQD 10-4-27.5 MG/5ML<br />
PHENYLEPH-CHLORPHEN-CARBETAPENTANE SUSP 2.5-1.25-7.5 MG/ML<br />
phenyleph-chlorphen-dm w/apap susp 2.5-1-5-160 mg/5ml OTC<br />
phenyleph-chlorphen-dm w/apap tab 5-2-10-325 mg OTC<br />
phenyleph-chlorphen-dm w/apap tab 5-2-15-325 mg OTC<br />
PHENYLEPH-CHLORPHEN-PYRIL-HYDROCODONE LIQD 5-2-6-2.5 MG/5ML<br />
phenyleph-dexchlorphen-pyril-dm syrup 5-1.25-5-5 mg/5ml<br />
phenyleph-dexchlorpheniramine-hydrocodone liqd 5-2-4 mg/5ml<br />
PHENYLEPH-DEXCHLORPHENIRAMINE-HYDROCODONE SYRUP 5-1-2 MG/5ML<br />
PHENYLEPH-DEXCHLORPHENIRAMINE-HYDROCODONE SYRUP 5-2-4 MG/5ML<br />
PHENYLEPH-DIPHENHYD-CODEINE LIQUID 7.5-12.5-7.5 MG/5ML<br />
PHENYLEPH-DIPHENHYD-CODEINE SYRUP 7.5-10-7.5 MG/5ML<br />
PHENYLEPH-DIPHENHYD-CODEINE SYRUP 7.5-12.5-7.5 MG/5ML<br />
PHENYLEPH-DIPHENHYD-DM-APAP TAB SR 12HR 18-37.5-30-575 MG<br />
phenyleph-diphenhyd-hydrocodone syrup 5-12.5-3.5 mg/5ml<br />
phenyleph-diphenhyd-hydrocodone syrup 7.5-12.5-2 mg/5ml<br />
PHENYLEPH-DM-APAP & PHENYLEPH-DIPHENHYD-APAP CAP THERAPY PK OTC<br />
phenyleph-dm-sod cit-citric acid liq 2.5-7.5-150-40 mg/5ml<br />
phenyleph-ephed-cpm w/ carbetapentane susp 5-5-4-30 mg/5ml<br />
PHENYLEPH-EPHED-CPM W/ CARBETAPENTANE TAB 10-10-5-60 MG<br />
phenyleph-ephed-cpm w/ carbetapentane tab 10-10-5-60 mg<br />
PHENYLEPH-HYDROCODONE LIQ 5-1.67 MG/5ML<br />
phenyleph-hydrocodone liq 5-2.5 mg/5ml<br />
PHENYLEPH-HYDROCODONE LIQ 7.5-3.75 MG/5ML<br />
PHENYLEPH-PYRIL-DM W/APAP SYRUP 1.67-8.3-5-108.3 MG/5ML OTC<br />
PHENYLEPH-PYRILAMINE W/ DM-POT GUAIACOL CAP 20-25-40-600 MG<br />
PHENYLEPH-PYRILAMINE W/ HYDROCODONE LIQ 7.5-12.5-3.5 MG/5ML<br />
PHENYLEPH-PYRILAMINE W/ HYDROCODONE LIQUID 5-12-6 MG/5ML<br />
PHENYLEPH-PYRILAMINE W/ HYDROCODONE SYRUP 5-12-6 MG/5ML<br />
phenyleph-pyrilamine w/ hydrocodone syrup 5-12-6 mg/5ml<br />
phenyleph-pyrilamine w/ hydrocodone syrup 5-5-5 mg/5ml<br />
phenyleph-pyrilamine w/ hydrocodone syrup 5-8.33-1.66 mg/5ml<br />
PHENYLEPH-PYRILAMINE W/ HYDROCODONE SYRUP 5-8.33-2 MG/5ML<br />
phenylephrin liq complex<br />
phenylephrin liq hd<br />
phenylephrine tan-carbetapentane tan susp 25-30 mg/5ml<br />
phenylephrine tan-carbetapentane tan susp 30-30 mg/5ml<br />
PHENYLEPHRINE TAN-CARBETAPENTANE TAN SUSP 9-22.5 MG/5ML<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 109
PHENYLEPHRINE W/ CODEINE LIQD 10-10 MG/5ML<br />
PHENYLEPHRINE W/ CODEINE LIQD 7.5-10 MG/5ML<br />
PHENYLEPHRINE W/ CODEINE-GG LIQUID 2.5-3-50 MG/ML<br />
PHENYLEPHRINE W/ CODEINE-GG SYRUP 4-12.5-125 MG/5ML<br />
PHENYLEPHRINE W/ CODEINE-GG TAB 10-10-400 MG<br />
PHENYLEPHRINE W/ CODEINE-GG TAB 10-20-400 MG<br />
PHENYLEPHRINE W/ DM-GG CAP 10-15-390 MG OTC<br />
PHENYLEPHRINE W/ DM-GG CAP 7-14-288 MG<br />
PHENYLEPHRINE W/ DM-GG LIQD 1.5-4-20 MG/ML<br />
PHENYLEPHRINE W/ DM-GG LIQD 10-15-225 MG/5ML (2-3-45 MG/ML)<br />
phenylephrine w/ dm-gg liqd 10-15-300 mg/5ml OTC<br />
phenylephrine w/ dm-gg liqd 10-15-300 mg/5ml<br />
PHENYLEPHRINE W/ DM-GG LIQD 10-28-388 MG/5ML<br />
phenylephrine w/ dm-gg liqd 10-30-200 mg/5ml<br />
phenylephrine w/ dm-gg liqd 2.5-3-35 mg/ml<br />
PHENYLEPHRINE W/ DM-GG LIQD 2.5-5-100 MG/2.5ML OTC<br />
phenylephrine w/ dm-gg liqd 2.5-5-50 mg/5ml OTC<br />
phenylephrine w/ dm-gg liqd 2.5-5-50 mg/ml OTC<br />
phenylephrine w/ dm-gg liqd 2.5-5-50 mg/ml<br />
PHENYLEPHRINE W/ DM-GG LIQD 2.5-5-75 MG/5ML<br />
PHENYLEPHRINE W/ DM-GG LIQD 2.5-5-75 MG/5ML OTC<br />
PHENYLEPHRINE W/ DM-GG LIQD 2.5-7.5-88 MG/ML<br />
phenylephrine w/ dm-gg liqd 5-10-100 mg/5ml OTC<br />
phenylephrine w/ dm-gg liqd 5-15-200 mg/5ml<br />
PHENYLEPHRINE W/ DM-GG LIQUID 10-20-100 MG/5ML OTC<br />
phenylephrine w/ dm-gg soln 10-10-100 mg/5ml<br />
phenylephrine w/ dm-gg soln 10-10-100 mg/5ml OTC<br />
PHENYLEPHRINE W/ DM-GG SOLN 10-15-225 MG/5ML<br />
PHENYLEPHRINE W/ DM-GG SUSP 10-40-400 MG/10ML<br />
PHENYLEPHRINE W/ DM-GG SYRUP 10-15-133 MG/5ML<br />
PHENYLEPHRINE W/ DM-GG SYRUP 10-15-350 MG/5ML<br />
PHENYLEPHRINE W/ DM-GG SYRUP 10-15-350 MG/5ML OTC<br />
phenylephrine w/ dm-gg syrup 10-20-100 mg/5ml<br />
phenylephrine w/ dm-gg syrup 10-30-200 mg/5ml<br />
phenylephrine w/ dm-gg syrup 12.5-25-175 mg/5ml<br />
phenylephrine w/ dm-gg syrup 5-10-100 mg/5ml OTC<br />
PHENYLEPHRINE W/ DM-GG SYRUP 5-15-100 MG/5ML OTC<br />
PHENYLEPHRINE W/ DM-GG SYRUP 5-15-100 MG/5ML<br />
phenylephrine w/ dm-gg tab 10-15-380 mg OTC<br />
phenylephrine w/ dm-gg tab 10-20-400 mg OTC<br />
PHENYLEPHRINE W/ DM-GG TAB 10-28-388 MG<br />
PHENYLEPHRINE W/ DM-GG TAB 12-15-350 MG<br />
PHENYLEPHRINE W/ DM-GG TAB 15-30-600 MG<br />
PHENYLEPHRINE W/ DM-GG TAB CR 15-30-600 MG<br />
phenylephrine w/ dm-gg tab cr 15-30-600 mg<br />
PHENYLEPHRINE W/ DM-GG TAB CR 30-50-825 MG<br />
phenylephrine w/ dm-gg tab sr 12hr 10-30-600 mg<br />
phenylephrine w/ dm-gg tab sr 12hr 20-20-800 mg<br />
PHENYLEPHRINE W/ DM-GG TAB SR 12HR 20-25-550 MG<br />
phenylephrine w/ dm-gg tab sr 12hr 20-25-550 mg<br />
phenylephrine w/ dm-gg tab sr 12hr 20-25-600 mg<br />
PHENYLEPHRINE W/ DM-GG TAB SR 12HR 20-30-1000 MG<br />
phenylephrine w/ dm-gg tab sr 12hr 20-30-600 mg<br />
PHENYLEPHRINE W/ DM-GG TAB SR 12HR 20-30-600 MG<br />
PHENYLEPHRINE W/ DM-GG TAB SR 12HR 25-45-1200 MG<br />
phenylephrine w/ dm-gg tab sr 12hr 30-30-1200 mg<br />
PHENYLEPHRINE W/ DM-GG TAB SR 12HR 30-30-900 MG<br />
phenylephrine w/ dm-gg tab sr 12hr 40-20-1200 mg<br />
phenylephrine w/ dm-gg tab sr 12hr 40-60-1000 mg<br />
phenylephrine w/ dm-gg tab sr 12hr 40-60-600 mg<br />
PHENYLEPHRINE W/ DM-GG TAB SR 12HR 9-23-600 MG<br />
PHENYLEPHRINE W/ HYDROCODONE-GG LIQUID 10-4-100 MG/5ML<br />
PHENYLEPHRINE W/ HYDROCODONE-GG LIQUID 10-5-200 MG/5ML<br />
PHENYLEPHRINE W/ HYDROCODONE-GG LIQUID 10-5-300 MG/5ML<br />
PHENYLEPHRINE W/ HYDROCODONE-GG LIQUID 15-5-100 MG/5ML<br />
PHENYLEPHRINE W/ HYDROCODONE-GG LIQUID 7.5-2.5-100 MG/5ML<br />
PHENYLEPHRINE W/ HYDROCODONE-GG LIQUID 7.5-2.5-200 MG/5ML<br />
phenylephrine w/ hydrocodone-gg liquid 7.5-2.5-200 mg/5ml<br />
phenylephrine w/ hydrocodone-gg solution 10-2.5-225 mg/5ml<br />
PHENYLEPHRINE W/ HYDROCODONE-GG SOLUTION 5-2.5-100 MG/5ML<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 110
phenylephrine w/ hydrocodone-gg syrup 10-2-100 mg/5ml<br />
PHENYLEPHRINE W/ HYDROCODONE-GG SYRUP 15-5-100 MG/5ML<br />
phenylephrine w/ hydrocodone-gg syrup 6-2.5-120 mg/5ml<br />
phenylephrine w/ hydrocodone-gg syrup 6-2.5-150 mg/5ml<br />
phenylephrine w/ hydrocodone-gg syrup 7.5-2.5-50 mg/5ml<br />
PHENYLEPHRINE W/ HYDROCODONE-GG SYRUP 7.5-5-100 MG/5ML<br />
phenylephrine w/ hydrocodone-gg syrup 7.5-5-100 mg/5ml<br />
PHENYLEPHRINE-BROMPHEN W/ CODEINE LIQD 3.33-1.33-6.33 MG/5ML<br />
phenylephrine-bromphen w/ codeine liqd 7.5-4-10 mg/5ml<br />
PHENYLEPHRINE-BROMPHEN W/ CODEINE TAB 10-4-10 MG<br />
PHENYLEPHRINE-BROMPHEN W/ CODEINE TAB 10-4-20 MG<br />
phenylephrine-bromphen-carbetapentane liq 10-6-30 mg/5ml<br />
phenylephrine-bromphen-carbetapentane susp 10-6-25 mg/5ml<br />
phenylephrine-bromphen-dihydrocodeine liqd 7.5-4-3 mg/5ml<br />
PHENYLEPHRINE-BROMPHENIRAMINE-DM DROPS 1-0.4-2 MG/ML<br />
phenylephrine-brompheniramine-dm elixir 2.5-1-5 mg/5ml OTC<br />
phenylephrine-brompheniramine-dm liquid 10-4-20 mg/5ml<br />
PHENYLEPHRINE-BROMPHENIRAMINE-DM LIQUID 10-4-30 MG/5ML OTC<br />
PHENYLEPHRINE-BROMPHENIRAMINE-DM LIQUID 7.5-2-15 MG/5ML<br />
phenylephrine-brompheniramine-dm liquid 7.5-2-15 mg/5ml<br />
phenylephrine-brompheniramine-dm liquid 7.5-4-15 mg/5ml<br />
phenylephrine-brompheniramine-dm syrup 5-2-10 mg/5ml<br />
PHENYLEPHRINE-BROMPHENIRAMINE-DM TAB 10-4-20 MG OTC<br />
PHENYLEPHRINE-CARBETAPENTANE-GG CAP 10-25-400 MG<br />
phenylephrine-carbetapentane-gg liqd 8-30-200 mg/5ml<br />
phenylephrine-carbetapentane-gg soln 5-15-100 mg/5ml<br />
phenylephrine-carbetapentane-gg syrup 10-20-100 mg/5ml<br />
phenylephrine-carbetapentane-gg syrup 15-20-100 mg/5ml<br />
PHENYLEPHRINE-CARBETAPENTANE-GG TAB 10-30-400 MG<br />
phenylephrine-carbetapentane-gg tab sr 12hr 15-60-600 mg<br />
PHENYLEPHRINE-CARBINOXAMINE W/ HYDROCODONE LIQD 6-2-5 MG/5ML<br />
phenylephrine-carbinoxamine w/ hydrocodone liqd 8-4-5 mg/5ml<br />
PHENYLEPHRINE-CARBINOXAMINE-CARBETAPENTANE LIQ 2-1-4 MG/ML<br />
phenylephrine-carbinoxamine-dm liquid 2-1-2 mg/ml<br />
phenylephrine-carbinoxamine-dm liquid 2-2-3 mg/ml<br />
PHENYLEPHRINE-CARBINOXAMINE-DM LIQUID 2-2-4 MG/ML<br />
PHENYLEPHRINE-CARBINOXAMINE-DM SYRUP 8-4-15 MG/5ML<br />
PHENYLEPHRINE-CHLORPHEN-DIHYDROCODEINE LIQD 4-2-6.5 MG/5ML<br />
PHENYLEPHRINE-CHLORPHEN-DIHYDROCODEINE LIQD 5-2-7.25 MG/5ML<br />
phenylephrine-chlorphen-dihydrocodeine syrup 20-5-3 mg/5ml<br />
phenylephrine-chlorphen-dihydrocodeine syrup 7.5-2-3 mg/5ml<br />
PHENYLEPHRINE-CHLORPHEN-DM CHEW TAB SR 12HR 30-4-30 MG<br />
PHENYLEPHRINE-CHLORPHEN-DM LIQUID 1.5-0.6-2.75 MG/ML<br />
phenylephrine-chlorphen-dm liquid 1.5-1-3 mg/ml<br />
phenylephrine-chlorphen-dm liquid 1.75-0.75-2.75 mg/ml<br />
PHENYLEPHRINE-CHLORPHEN-DM LIQUID 10-3-15 MG/5ML<br />
phenylephrine-chlorphen-dm liquid 10-4-15 mg/5ml<br />
phenylephrine-chlorphen-dm liquid 2-1-3 mg/ml<br />
PHENYLEPHRINE-CHLORPHEN-DM LIQUID 2.5-1-2.5 MG/ML<br />
phenylephrine-chlorphen-dm liquid 3.5-1-3 mg/ml<br />
PHENYLEPHRINE-CHLORPHEN-DM LIQUID 5-2-10 MG/5ML OTC<br />
PHENYLEPHRINE-CHLORPHEN-DM LIQUID 7.5-4-30 MG/5ML<br />
PHENYLEPHRINE-CHLORPHEN-DM SOLN 10-4-10 MG/30ML OTC<br />
phenylephrine-chlorphen-dm soln 10-4-15 mg/5ml<br />
PHENYLEPHRINE-CHLORPHEN-DM SOLN 12.5-4-15 MG/5ML OTC<br />
PHENYLEPHRINE-CHLORPHEN-DM SUSP 7.5-2-15 MG/5ML<br />
phenylephrine-chlorphen-dm syrup 10-2-15 mg/5ml<br />
phenylephrine-chlorphen-dm syrup 12.5-4-15 mg/5ml<br />
phenylephrine-chlorphen-dm syrup 5-2-15 mg/5ml<br />
phenylephrine-chlorphen-dm syrup 6-2-15 mg/5ml<br />
phenylephrine-chlorphen-dm tab 10-4-20 mg OTC<br />
phenylephrine-chlorphen-dm tab sr 12hr 20-8-30 mg<br />
PHENYLEPHRINE-CODEINE-GUAIFENESIN-APAP TAB 10-10-400-500 MG<br />
PHENYLEPHRINE-CODEINE-GUAIFENESIN-APAP TAB 10-20-400-500 MG<br />
PHENYLEPHRINE-DEXBROMPHEN-CHLOPHEDIANOL LIQD 5-1-12.5 MG/5ML OTC<br />
PHENYLEPHRINE-DEXBROMPHEN-DM-GG LIQUID 2-0.5-5-50 MG/ML<br />
PHENYLEPHRINE-DEXBROMPHEN-DM-GG LIQUID 5-1-15-100 MG/5ML<br />
phenylephrine-dexbromphen-hydrocodone syrup 5-1-2.5 mg/5ml<br />
PHENYLEPHRINE-DEXBROMPHENIRAMINE-DM SYRUP 10-2-20 MG/5ML<br />
PHENYLEPHRINE-DEXBROMPHENIRAMINE-DM TAB SR 12HR 20-6-30 MG<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 111
PHENYLEPHRINE-DEXCHLORPHENIR-CODEINE LIQUID 5-1-10 MG/5ML<br />
PHENYLEPHRINE-DIHYDROCODEINE LIQD 7.5-3 MG/5ML<br />
PHENYLEPHRINE-DIHYDROCODEINE-GG SYRUP 7.5-7.5-50 MG/5ML<br />
PHENYLEPHRINE-DIPHENHYDRAMINE-DM-APAP TAB 10-37.5-20-575 MG<br />
PHENYLEPHRINE-DM DROPS 1.25-2.5 MG/0.8ML OTC<br />
phenylephrine-dm drops 1.25-2.5 mg/0.8ml OTC<br />
PHENYLEPHRINE-DM LIQUID 10-20 MG/15ML OTC<br />
PHENYLEPHRINE-DM LIQUID 2.5-5 MG/ML OTC<br />
PHENYLEPHRINE-DM LIQUID 5-30 MG/10ML OTC<br />
PHENYLEPHRINE-DM ORAL STRIP 1.25-2.5 MG OTC<br />
PHENYLEPHRINE-DM ORAL STRIP 10-20 MG OTC<br />
PHENYLEPHRINE-DM ORAL STRIP 2.5-5 MG OTC<br />
phenylephrine-dm soln 2.5-5 mg/5ml OTC<br />
PHENYLEPHRINE-DM SOLN 2.5-5 MG/ML<br />
PHENYLEPHRINE-DM SYRUP 2.5-5 MG/5ML OTC<br />
PHENYLEPHRINE-DM SYRUP 2.5-7.5 MG/ML<br />
PHENYLEPHRINE-DM-GG W/ APAP LIQ 5-10-100-325 MG/5ML OTC<br />
PHENYLEPHRINE-DM-GG W/ APAP LIQ 5-10-200-325 MG/15ML OTC<br />
PHENYLEPHRINE-DM-GG W/ APAP TAB 10-20-400-500 MG<br />
PHENYLEPHRINE-DM-GG W/ APAP TAB 15-30-600-500 MG<br />
PHENYLEPHRINE-DM-GG W/ APAP TAB 5-10-100-325 MG OTC<br />
phenylephrine-dm-gg w/ apap tab 5-10-200-325 mg OTC<br />
phenylephrine-dm-gg w/ apap tab 5-15-200-325 mg OTC<br />
PHENYLEPHRINE-DM-SODIUM CITRATE LIQD 2.5-5-14.7 MG/ML<br />
PHENYLEPHRINE-DOXYLAMINE-DM-APAP LIQ 5-6.25-10-325 MG/15ML OTC<br />
PHENYLEPHRINE-DOXYLAMINE-DM-APAP LIQ 5-6.25-15-500 MG/15ML OTC<br />
PHENYLEPHRINE-PHENIRAMINE-DM POWD PACK 10-20-20 MG OTC<br />
phenylephrine-promethazine w/ codeine syrup 5-6.25-10 mg/5ml<br />
PHENYLEPHRINE-PYRILAMINE W/ CODEINE SYRUP 5-5-10 MG/5ML<br />
PHENYLEPHRINE-PYRILAMINE W/ CODEINE SYRUP 5-8.33-10 MG/5ML<br />
PHENYLEPHRINE-PYRILAMINE W/ CODEINE SYRUP 5-8.33-10 MG/5ML OTC<br />
PHENYLEPHRINE-PYRILAMINE W/ CODEINE SYRUP 5-8.33-9 MG/5ML<br />
PHENYLEPHRINE-PYRILAMINE W/ DM-GG LIQUID 10-25-20-200 MG/5ML<br />
PHENYLEPHRINE-PYRILAMINE-DM LIQUID 1-1.77-2 MG/ML OTC<br />
PHENYLEPHRINE-PYRILAMINE-DM LIQUID 5-12.5-15 MG/5ML OTC<br />
phenylephrine-pyrilamine-dm liquid 7.5-12.5-15 mg/5ml<br />
phenylephrine-pyrilamine-dm susp 5-16-15 mg/5ml<br />
phenylephrine-pyrilamine-dm syrup 5-8.33-10 mg/5ml OTC<br />
PHENYLHIST LIQ DH OTC<br />
PHENYLHIST LIQ DH<br />
phenylhist liq dh OTC<br />
phenylhistin sol expect OTC<br />
phenylhistin sol expect<br />
phlemex tab<br />
phlemex tab forte<br />
phlemex-pe tab<br />
pluratuss liq<br />
POLY HIST HC LIQ<br />
POLY TAN DM SUS<br />
POLY-TUSSIN LIQ XP<br />
POLY-TUSSIN SYP<br />
POLY-TUSSIN SYP HD<br />
pot guaiaco/ syp hydrocod<br />
PRO-CLEAR SYP<br />
PRO-CLEAR AC SYP<br />
PRO-RED SYP<br />
PRO-RED AC SYP<br />
prodec-dm dro<br />
prolex dh sol expect<br />
PROLEX DMX LIQ<br />
prometh vc/ syp codeine<br />
prometh/cod syp 6.25-10<br />
promethazine syp dm<br />
promethazine syp dm<br />
promethazine w/ codeine syrup 6.25-10 mg/5ml<br />
promethazine-dm syrup 6.25-15 mg/5ml<br />
protex liq 5-300mg<br />
protex d liq<br />
pse allergy liq dm<br />
pse bpm hd liq<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 112
pse brom dm syp<br />
pse carb dm dro<br />
pse carbinox syp dm<br />
PSE HCL-CARBINOXAMINE MAL-DM HBR TANNATE SUSP 15-2-3 MG/5ML<br />
PSE HCL-CHLORPHEN MAL-HYDROCOD BITART TAN SUSP 30-4-5 MG/5ML<br />
PSE HCL-DM HBR-GUAIFENESIN TANNATE SUSP 30-15-175 MG/5ML<br />
pse w/ hydrocodone-pot guaiacol liquid 30-5-300 mg/5ml<br />
PSE-APAP-DM & PSE-APAP-DIPHENHYD TAB 60-650-30-50 MG OTC<br />
PSE-DM-APAP & PSE-DIPHENHYD-APAP TAB 30-25-15-500 MG OTC<br />
PSE-DM-APAP &PSE-DM-APAP-CPM TAB KIT 30-15-500/30-15-500-2MG OTC<br />
pse-dm-apap &pse-dm-apap-cpm tab pak 30-15-325/30-15-325-2mg OTC<br />
pse-dm-gg tab<br />
pse/carb/dm liq drops<br />
pse/codeine liq<br />
pse/dm/gg syp 40-15-10<br />
PSE/DM/GG SYP 40-15-10<br />
pse/gg/dm tab<br />
pse/gg/dm tab<br />
pse/gg/dm tab<br />
pse/hydrocod liq /carbinx<br />
PSEUDACARB CHW 75-25MG<br />
pseudatex hc liq 45-6-200<br />
pseudo carb liq dm<br />
pseudo cough liq<br />
pseudo max tab dmx<br />
pseudo-chlor liq codeine OTC<br />
PSEUDOEPH HCL-PYRIL MAL-DM HBR TANNATE SUSP 15-15-15 MG/5ML<br />
pseudoeph tan-carbinox tan-dm tan susp 45.2-3.2-27.5 mg/5ml<br />
PSEUDOEPH TAN-CARBINOX TAN-DM TAN SUSP 45.2-3.6-27.5 MG/5ML<br />
pseudoeph-bromphen w/ hydrocodone liquid 15-2-2.5 mg/5ml<br />
PSEUDOEPH-BROMPHEN W/ HYDROCODONE LIQUID 15-3-2.5 MG/5ML<br />
pseudoeph-bromphen w/ hydrocodone liquid 30-3-2.5 mg/5ml<br />
pseudoeph-bromphen w/ hydrocodone soln 30-2-1.7 mg/5ml<br />
PSEUDOEPH-BROMPHEN W/ HYDROCODONE SYRUP 30-2-1.7 MG/5ML<br />
PSEUDOEPH-BROMPHEN W/ HYDROCODONE SYRUP 30-2-2.5 MG/5ML<br />
pseudoeph-carbinoxamine w/ hydrocodone liqd 30-2-5 mg/5ml<br />
PSEUDOEPH-CHLORPHEN W/ HYDROCODONE CAP CR 30-2-5 MG<br />
PSEUDOEPH-CHLORPHEN W/ HYDROCODONE LIQ 15-2-2.5 MG/5ML<br />
pseudoeph-chlorphen w/ hydrocodone liq 15-2-3 mg/5ml<br />
pseudoeph-chlorphen w/ hydrocodone liq 17.5-2.5-1.67 mg/5ml<br />
PSEUDOEPH-CHLORPHEN W/ HYDROCODONE LIQ 20-2.5-1.67 MG/5ML<br />
pseudoeph-chlorphen w/ hydrocodone liquid 30-2-5 mg/5ml<br />
pseudoeph-chlorphen w/ hydrocodone syr 30-2-2.5 mg/5ml<br />
pseudoeph-chlorphen w/ hydrocodone syrup 15-2-3 mg/5ml<br />
PSEUDOEPH-CHLORPHEN W/ HYDROCODONE SYRUP 40-4-5 MG/5ML<br />
PSEUDOEPH-CHLORPHEN-DM W/ APAP CAP 30-2-10-250 MG OTC<br />
PSEUDOEPH-CHLORPHEN-DM W/ APAP CAP 30-2-10-325 MG OTC<br />
pseudoeph-chlorphen-dm w/ apap chew tab 7.5-0.5-2.5-80 mg OTC<br />
pseudoeph-chlorphen-dm w/ apap liqd 15-1-5-160 mg/5ml OTC<br />
PSEUDOEPH-CHLORPHEN-DM W/ APAP LIQD 15-1-5-160 MG/5ML OTC<br />
pseudoeph-chlorphen-dm w/ apap liqd 15-1-7.5-160 mg/5ml OTC<br />
pseudoeph-chlorphen-dm w/ apap liqd 15-1-7.5-162.5 mg/5ml OTC<br />
PSEUDOEPH-CHLORPHEN-DM W/ APAP LIQD 60-4-30-1000 MG/30ML OTC<br />
pseudoeph-chlorphen-dm w/ apap pack 60-4-20-500 mg OTC<br />
pseudoeph-chlorphen-dm w/ apap pack 60-4-20-650 mg OTC<br />
pseudoeph-chlorphen-dm w/ apap pack 60-4-30-1000 mg OTC<br />
pseudoeph-chlorphen-dm w/ apap syrup 15-1-5-160 mg/5ml OTC<br />
PSEUDOEPH-CHLORPHEN-DM W/ APAP SYRUP 60-4-30-500 MG/20ML OTC<br />
pseudoeph-chlorphen-dm w/ apap tab 30-2-10-325 mg OTC<br />
pseudoeph-chlorphen-dm w/ apap tab 30-2-15-325 mg OTC<br />
pseudoeph-chlorphen-dm w/ apap tab 30-2-15-500 mg OTC<br />
PSEUDOEPH-DIPHENHYDR-DM W/ APAP CAP 30-25-15-250 MG OTC<br />
pseudoeph-doxylamine-dm w/ apap cap 30-6.25-10-250 mg OTC<br />
pseudoeph-doxylamine-dm w/ apap cap 30-6.25-15-325 mg OTC<br />
pseudoeph-doxylamine-dm w/ apap liq 60-7.5-30-1000 mg/30ml OTC<br />
pseudoeph-doxylamine-dm w/apap liq 60-12.5-30-1000 mg/30ml OTC<br />
pseudoephed hcl-chlorphen mal-dm hbr tan susp 30-4-30 mg/5ml<br />
pseudoephed tan-bromphen tan-dm tan susp 90-8-60 mg/5ml<br />
PSEUDOEPHED TAN-BROMPHEN TAN-DM TAN SUSP 90-8-60 MG/5ML<br />
PSEUDOEPHED TAN-BROMPHEN TAN-HYDROCOD TAN SUSP 45-6-6 MG/5ML<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 113
PSEUDOEPHED TAN-CHLORPHEN TAN-DM TAN SUSP 75-4.5-25 MG/5ML<br />
pseudoephed tan-chlorphen tan-dm tan susp 75-4.5-25 mg/5ml<br />
PSEUDOEPHED TAN-CHLORPHEN TAN-DM TAN SUSP 75-5-25 MG/5ML<br />
PSEUDOEPHED TAN-DEXCHLORPHEN TAN-DM TAN SUS 45-3.5-30 MG/5ML<br />
pseudoephed tan-dexchlorphen tan-dm tan sus 45-3.5-30 mg/5ml<br />
pseudoephed tan-dexchlorphen tan-dm tan sus 50-3-27.5 mg/5ml<br />
pseudoephed tan-dexchlorphen tan-dm tan sus 75-2.5-25 mg/5ml<br />
PSEUDOEPHED TAN-DEXCHLORPHEN TAN-DM TAN SUS 75-2.5-25 MG/5ML<br />
PSEUDOEPHED-BROMPHEN-DIHYDROCODEINE LIQD 15-3-7.5 MG/5ML<br />
pseudoephed-bromphen-dm elixir 15-1-5 mg/5ml OTC<br />
pseudoephed-bromphen-dm liquid 12-1-5 mg/ml<br />
PSEUDOEPHED-BROMPHEN-DM LIQUID 12-1-5 MG/ML<br />
pseudoephed-bromphen-dm liquid 12.5-1-3 mg/ml<br />
pseudoephed-bromphen-dm liquid 15-1-4 mg/ml<br />
pseudoephed-bromphen-dm liquid 20-4-20 mg/5ml<br />
PSEUDOEPHED-BROMPHEN-DM LIQUID 30-1-20 MG/5ML<br />
pseudoephed-bromphen-dm syrup 30-2-10 mg/5ml<br />
pseudoephed-bromphen-dm syrup 30-2-10 mg/5ml OTC<br />
pseudoephed-bromphen-dm syrup 30-3-15 mg/5ml<br />
pseudoephed-bromphen-dm syrup 45-4-15 mg/5ml<br />
pseudoephed-bromphen-dm syrup 50-3-30 mg/5ml<br />
pseudoephed-bromphen-dm syrup 60-4-30 mg/5ml<br />
pseudoephed-bromphen-dm syrup 60-4-30 mg/5ml OTC<br />
PSEUDOEPHED-BROMPHEN-DM TAB 40-4-20 MG<br />
pseudoephed-bromphen-dm-gg syrup 30-2-5-50 mg/5ml<br />
PSEUDOEPHED-CARBETAPENTANE-GUAIFENESIN LIQD 30-10-100 MG/5ML<br />
pseudoephed-carbinoxamine-dm liquid 12.5-2.67-15 mg/5ml<br />
pseudoephed-carbinoxamine-dm liquid 12.5-3-15 mg/5ml<br />
pseudoephed-carbinoxamine-dm liquid 15-1-4 mg/ml<br />
PSEUDOEPHED-CARBINOXAMINE-DM LIQUID 15-3-15 MG/5ML<br />
pseudoephed-carbinoxamine-dm liquid 25-2-3.5 mg/ml<br />
pseudoephed-carbinoxamine-dm soln 25-2-4 mg/ml<br />
PSEUDOEPHED-CARBINOXAMINE-DM SYRUP 15-2-15 MG/5ML<br />
pseudoephed-carbinoxamine-dm syrup 60-4-12.5 mg/5ml<br />
pseudoephed-carbinoxamine-dm syrup 60-4-15 mg/5ml<br />
PSEUDOEPHED-CHLORPHEN W/ DM-GG LIQD 30-2-30-200 MG/5ML<br />
PSEUDOEPHED-CHLORPHEN-DIHYDROCODEINE SYRUP 15-2-7.5 MG/5ML<br />
pseudoephed-chlorphen-dihydrocodeine syrup 15-2-7.5 mg/5ml<br />
PSEUDOEPHED-CHLORPHEN-DM CHEW TAB 15-1-5 MG OTC<br />
pseudoephed-chlorphen-dm drops 9-0.8-3 mg/ml OTC<br />
pseudoephed-chlorphen-dm drops 9-0.8-3 mg/ml<br />
pseudoephed-chlorphen-dm liq 10-0.6-5 mg/5ml OTC<br />
pseudoephed-chlorphen-dm liq 15-1-5 mg/5ml OTC<br />
pseudoephed-chlorphen-dm liq 15-1-7.5 mg/5ml OTC<br />
PSEUDOEPHED-CHLORPHEN-DM LIQ 30-2-15 MG/5ML<br />
PSEUDOEPHED-CHLORPHEN-DM LIQ 30-2-20 MG/5ML<br />
PSEUDOEPHED-CHLORPHEN-DM SUSP 30-4-30 MG/5ML OTC<br />
PSEUDOEPHED-CHLORPHEN-DM SYRUP 15-1-7.5 MG/5ML OTC<br />
pseudoephed-chlorphen-dm syrup 15-2-15 mg/5ml<br />
PSEUDOEPHED-CHLORPHEN-DM SYRUP 30-2-10 MG/5ML OTC<br />
PSEUDOEPHED-CHLORPHEN-DM SYRUP 30-2-15 MG/15ML OTC<br />
pseudoephed-chlorphen-dm syrup 30-2-15 mg/5ml<br />
pseudoephed-chlorphen-dm syrup 30-2-15 mg/5ml OTC<br />
PSEUDOEPHED-CHLORPHEN-DM SYRUP 80-4-30 MG/5ML<br />
pseudoephed-chlorphen-dm tab 60-4-20 mg OTC<br />
PSEUDOEPHED-CODEINE-GUAIFENESIN-APAP TAB 40-10-400-500 MG<br />
PSEUDOEPHED-CODEINE-GUAIFENESIN-APAP TAB 60-20-400-500 MG<br />
PSEUDOEPHED-DEXCHLORPHEN-CHLOPHEDIANOL LIQD 30-1-12.5 MG/5ML OTC<br />
PSEUDOEPHED-PYRILAMINE-CARBETAPENTANE LIQD 30-7.5-20 MG/5ML<br />
PSEUDOEPHED-PYRILAMINE-CARBETAPENTANE SYRUP 8-7.5-20 MG/5ML<br />
PSEUDOEPHED-TRIPROLIDINE-HYDROCODONE LIQD 30-1.25-2.5 MG/5ML<br />
pseudoephedr tab /gg/dm<br />
PSEUDOEPHEDRINE TAN-CARBETAPENTANE TAN CHEW TAB 75-25 MG<br />
pseudoephedrine tan-carbetapentane tan susp 75-25 mg/5ml<br />
PSEUDOEPHEDRINE TAN-HYDROCODONE TAN SUSP 45-10 MG/5ML<br />
pseudoephedrine w/ apap-dm cap 30-325-15 mg OTC<br />
PSEUDOEPHEDRINE W/ APAP-DM CAP 30-500-15 MG OTC<br />
pseudoephedrine w/ apap-dm caps 30-250-10 mg OTC<br />
pseudoephedrine w/ apap-dm caps 30-250-10 mg<br />
PSEUDOEPHEDRINE W/ APAP-DM CHEW TAB 15-160-5 MG OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 114
pseudoephedrine w/ apap-dm liq 15-160-5 mg/1.6ml OTC<br />
pseudoephedrine w/ apap-dm liq 15-160-7.5 mg/5ml OTC<br />
pseudoephedrine w/ apap-dm liq 30-325-15 mg/15ml OTC<br />
PSEUDOEPHEDRINE W/ APAP-DM LIQ 60-1000-30 MG/30ML OTC<br />
pseudoephedrine w/ apap-dm liq 60-650-20 mg/30ml OTC<br />
PSEUDOEPHEDRINE W/ APAP-DM PACK 60-1000-30 MG OTC<br />
pseudoephedrine w/ apap-dm pack 60-1000-30 mg OTC<br />
PSEUDOEPHEDRINE W/ APAP-DM TAB 30-325-10 MG OTC<br />
pseudoephedrine w/ apap-dm tab 30-325-15 mg OTC<br />
pseudoephedrine w/ apap-dm tab 30-500-15 mg OTC<br />
pseudoephedrine w/ cod-gg soln 30-10-100 mg/5ml OTC<br />
pseudoephedrine w/ cod-gg soln 30-10-100 mg/5ml<br />
PSEUDOEPHEDRINE W/ COD-GG SUSP 3-1-20 MG/ML<br />
PSEUDOEPHEDRINE W/ COD-GG SUSP 3.333-1-20 MG/ML OTC<br />
PSEUDOEPHEDRINE W/ COD-GG SUSP 3.75-1-20 MG/ML OTC<br />
PSEUDOEPHEDRINE W/ COD-GG SUSP 4-1-20 MG/ML<br />
PSEUDOEPHEDRINE W/ COD-GG SUSP 4.286-1-20 MG/ML OTC<br />
PSEUDOEPHEDRINE W/ COD-GG SUSP 5-1-20 MG/ML OTC<br />
PSEUDOEPHEDRINE W/ COD-GG SUSP 6-1-20 MG/ML<br />
PSEUDOEPHEDRINE W/ COD-GG SYRUP 15-5-50 MG/5ML<br />
pseudoephedrine w/ cod-gg syrup 30-10-100 mg/5ml<br />
pseudoephedrine w/ cod-gg syrup 60-20-200 mg/5ml<br />
PSEUDOEPHEDRINE W/ COD-GG TAB 20-10-400 MG<br />
PSEUDOEPHEDRINE W/ COD-GG TAB 20-20-400 MG<br />
PSEUDOEPHEDRINE W/ COD-GG TAB 30-10-400 MG<br />
PSEUDOEPHEDRINE W/ COD-GG TAB 30-20-400 MG<br />
PSEUDOEPHEDRINE W/ COD-GG TAB 40-10-400 MG<br />
PSEUDOEPHEDRINE W/ COD-GG TAB 40-20-400 MG<br />
PSEUDOEPHEDRINE W/ COD-GG TAB 60-10-400 MG<br />
PSEUDOEPHEDRINE W/ COD-GG TAB 60-20-400 MG<br />
PSEUDOEPHEDRINE W/ CODEINE CAP 60-20 MG<br />
pseudoephedrine w/ codeine liquid 30-10 mg/5ml<br />
pseudoephedrine w/ dm-gg cap 30-10-200 mg OTC<br />
PSEUDOEPHEDRINE W/ DM-GG LIQUID 10-4-20 MG/ML<br />
PSEUDOEPHEDRINE W/ DM-GG LIQUID 15-5-100 MG/2.5ML OTC<br />
PSEUDOEPHEDRINE W/ DM-GG LIQUID 15-5-50 MG/5ML OTC<br />
PSEUDOEPHEDRINE W/ DM-GG LIQUID 15-5-50 MG/5ML<br />
PSEUDOEPHEDRINE W/ DM-GG LIQUID 15-5-50 MG/ML OTC<br />
PSEUDOEPHEDRINE W/ DM-GG LIQUID 20-10-200 MG/5ML OTC<br />
PSEUDOEPHEDRINE W/ DM-GG LIQUID 20-4-20 MG/ML<br />
pseudoephedrine w/ dm-gg liquid 30-10-100 mg/5ml OTC<br />
PSEUDOEPHEDRINE W/ DM-GG LIQUID 30-15-200 MG/5ML OTC<br />
PSEUDOEPHEDRINE W/ DM-GG LIQUID 30-15-200 MG/5ML<br />
PSEUDOEPHEDRINE W/ DM-GG LIQUID 30-15-25 MG/5ML<br />
pseudoephedrine w/ dm-gg liquid 32-15-175 mg/5ml<br />
pseudoephedrine w/ dm-gg liquid 32-15-200 mg/5ml<br />
PSEUDOEPHEDRINE W/ DM-GG LIQUID 36-15-200 MG/5ML<br />
PSEUDOEPHEDRINE W/ DM-GG LIQUID 45-15-100 MG/5ML<br />
PSEUDOEPHEDRINE W/ DM-GG LIQUID 5-5-25 MG/ML<br />
PSEUDOEPHEDRINE W/ DM-GG LIQUID 60-40-400 MG/10ML<br />
pseudoephedrine w/ dm-gg susp 30-15-175 mg/5ml<br />
PSEUDOEPHEDRINE W/ DM-GG SUSP 30-15-180 MG/5ML<br />
PSEUDOEPHEDRINE W/ DM-GG SYRUP 20-10-66.7 MG/5ML OTC<br />
pseudoephedrine w/ dm-gg syrup 20-10-66.7 mg/5ml OTC<br />
pseudoephedrine w/ dm-gg syrup 30-10-100 mg/5ml OTC<br />
pseudoephedrine w/ dm-gg syrup 30-15-150 mg/5ml<br />
PSEUDOEPHEDRINE W/ DM-GG SYRUP 40-15-100 MG/5ML<br />
pseudoephedrine w/ dm-gg syrup 40-15-100 mg/5ml<br />
PSEUDOEPHEDRINE W/ DM-GG SYRUP 40-15-200 MG/5ML<br />
PSEUDOEPHEDRINE W/ DM-GG SYRUP 45-15-100 MG/5ML<br />
PSEUDOEPHEDRINE W/ DM-GG TAB 20-20-400 MG OTC<br />
PSEUDOEPHEDRINE W/ DM-GG TAB 30-10-100 MG OTC<br />
PSEUDOEPHEDRINE W/ DM-GG TAB 30-10-200 MG OTC<br />
PSEUDOEPHEDRINE W/ DM-GG TAB 30-20-400 MG OTC<br />
PSEUDOEPHEDRINE W/ DM-GG TAB 30-30-400 MG OTC<br />
pseudoephedrine w/ dm-gg tab 40-20-400 mg<br />
PSEUDOEPHEDRINE W/ DM-GG TAB 40-30-400 MG OTC<br />
pseudoephedrine w/ dm-gg tab 45-15-400 mg OTC<br />
pseudoephedrine w/ dm-gg tab 60-20-400 mg OTC<br />
pseudoephedrine w/ dm-gg tab 60-20-400 mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 115
pseudoephedrine w/ dm-gg tab sr 12hr 120-60-1200 mg<br />
PSEUDOEPHEDRINE W/ DM-GG TAB SR 12HR 120-60-800 MG<br />
PSEUDOEPHEDRINE W/ DM-GG TAB SR 12HR 25-30-575 MG<br />
pseudoephedrine w/ dm-gg tab sr 12hr 45-30-800 mg<br />
pseudoephedrine w/ dm-gg tab sr 12hr 48-32-595 mg<br />
PSEUDOEPHEDRINE W/ DM-GG TAB SR 12HR 58-28-600 MG<br />
pseudoephedrine w/ dm-gg tab sr 12hr 60-30-1000 mg<br />
PSEUDOEPHEDRINE W/ DM-GG TAB SR 12HR 60-30-550 MG<br />
PSEUDOEPHEDRINE W/ DM-GG TAB SR 12HR 60-30-575 MG<br />
PSEUDOEPHEDRINE W/ DM-GG TAB SR 12HR 60-30-580 MG<br />
pseudoephedrine w/ dm-gg tab sr 12hr 60-30-580 mg<br />
pseudoephedrine w/ dm-gg tab sr 12hr 60-30-600 mg<br />
pseudoephedrine w/ dm-gg tab sr 12hr 60-30-800 mg<br />
PSEUDOEPHEDRINE W/ DM-GG TAB SR 12HR 60-60-1200 MG<br />
pseudoephedrine w/ dm-gg tab sr 12hr 80-40-700 mg<br />
pseudoephedrine w/ dm-gg tab sr 12hr 80-40-780 mg<br />
pseudoephedrine w/ dm-gg tab sr 12hr 90-60-800 mg<br />
pseudoephedrine w/ hydrocodone soln 60-5 mg/5ml<br />
pseudoephedrine w/ hydrocodone soln 60-5 mg/5ml<br />
PSEUDOEPHEDRINE W/ HYDROCODONE SYRUP 15-3 MG/5ML<br />
PSEUDOEPHEDRINE W/ HYDROCODONE TAB 60-5 MG<br />
pseudoephedrine w/ hydrocodone-gg elixir 30-2.5-100 mg/5ml<br />
PSEUDOEPHEDRINE W/ HYDROCODONE-GG LIQD 15-2.5-100 MG/5ML<br />
pseudoephedrine w/ hydrocodone-gg liqd 15-3-100 mg/5ml<br />
PSEUDOEPHEDRINE W/ HYDROCODONE-GG LIQD 22.5-3.75-50 MG/5ML<br />
pseudoephedrine w/ hydrocodone-gg liqd 45-6-200 mg/5ml<br />
PSEUDOEPHEDRINE W/ HYDROCODONE-GG SOLN 30-2.5-100 MG/5ML<br />
pseudoephedrine w/ hydrocodone-gg soln 30-2.5-100 mg/5ml<br />
pseudoephedrine w/ hydrocodone-gg soln 60-5-200 mg/5ml<br />
pseudoephedrine w/ hydrocodone-gg syrup 15-3-100 mg/5ml<br />
pseudoephedrine-bromphen-codeine liq 10-1.3-6.3 mg/5ml<br />
PSEUDOEPHEDRINE-BROMPHEN-CODEINE LIQ 10-1.33-6.33 MG/5ML<br />
PSEUDOEPHEDRINE-BROMPHEN-CODEINE LIQD 30-2-7.5 MG/5ML<br />
PSEUDOEPHEDRINE-CHLOPHEDIANOL-GG LIQD 30-12.5-100 MG/5ML OTC<br />
PSEUDOEPHEDRINE-CHLOPHEDIANOL-GG TAB 30-12.5-200 MG OTC<br />
PSEUDOEPHEDRINE-CHLORPHEN W/ CODEINE LIQ 30-2-10 MG/5ML OTC<br />
PSEUDOEPHEDRINE-CHLORPHEN W/ CODEINE LIQ 30-2-10 MG/5ML<br />
pseudoephedrine-chlorphen w/ codeine liq 30-2-10 mg/5ml<br />
pseudoephedrine-chlorphen w/ codeine liq 30-2-10 mg/5ml OTC<br />
PSEUDOEPHEDRINE-CHLORPHEN W/CODEINE SUSP 3-0.2-1 MG/ML<br />
PSEUDOEPHEDRINE-CHLORPHEN W/CODEINE SUSP 3.333-0.222-1 MG/ML OTC<br />
PSEUDOEPHEDRINE-CHLORPHEN W/CODEINE SUSP 3.75-0.25-1 MG/ML OTC<br />
PSEUDOEPHEDRINE-CHLORPHEN W/CODEINE SUSP 4-0.266-1 MG/ML<br />
PSEUDOEPHEDRINE-CHLORPHEN W/CODEINE SUSP 4.286-0.286-1 MG/ML OTC<br />
PSEUDOEPHEDRINE-CHLORPHEN W/CODEINE SUSP 5-0.333-1 MG/ML OTC<br />
PSEUDOEPHEDRINE-CHLORPHEN W/CODEINE SUSP 6-0.4-1 MG/ML<br />
pseudoephedrine-cpm-hydrocodone-gg liqd 15-2-2.5-100 mg/5ml<br />
PSEUDOEPHEDRINE-CPM-HYDROCODONE-GG LIQD 30-2-2.5-100 MG/5ML<br />
PSEUDOEPHEDRINE-DEXBROMPHEN W/DM-GG LIQ 30-1-30-200 MG/10ML<br />
PSEUDOEPHEDRINE-DEXBROMPHEN-DM-GG LIQD 12.5-0.5-4-40 MG/ML<br />
PSEUDOEPHEDRINE-DIHYDROCODEINE-GG SYRUP 15-7.5-100 MG/5ML<br />
pseudoephedrine-dihydrocodeine-gg syrup 15-7.5-100 mg/5ml<br />
pseudoephedrine-dm elixir 20-10 mg/5ml OTC<br />
PSEUDOEPHEDRINE-DM LIQD 15-5 MG/5ML OTC<br />
pseudoephedrine-dm liqd 15-7.5 mg/5ml OTC<br />
PSEUDOEPHEDRINE-DM LIQD 20-10 MG/5ML OTC<br />
pseudoephedrine-dm liqd 20-10 mg/5ml OTC<br />
PSEUDOEPHEDRINE-DM LIQD 30-15 MG/5ML OTC<br />
PSEUDOEPHEDRINE-DM SOLN 7.5-2.5 MG/0.8ML OTC<br />
pseudoephedrine-dm soln 7.5-2.5 mg/0.8ml OTC<br />
PSEUDOEPHEDRINE-DM SYRUP 15-5 MG/5ML OTC<br />
PSEUDOEPHEDRINE-DM SYRUP 15-7.5 MG/5ML OTC<br />
pseudoephedrine-dm syrup 30-15 mg/5ml OTC<br />
pseudoephedrine-dm-gg w/ apap cap 30-10-100-250 mg OTC<br />
pseudoephedrine-dm-gg w/ apap liq 30-10-100-325 mg/15ml OTC<br />
PSEUDOEPHEDRINE-DM-GG W/ APAP PACKET 60-30-400-1000 MG OTC<br />
PSEUDOEPHEDRINE-DM-GG W/ APAP SYRUP 15-7.5-50-125 MG/5ML OTC<br />
pseudoephedrine-dm-gg w/ apap tab 30-15-200-325 mg OTC<br />
pseudoephedrine-dm-gg w/ apap tab 60-20-200-500 mg<br />
PSEUDOEPHEDRINE-DM-GG W/ APAP TAB 60-20-400-500 MG<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 116
PSEUDOEPHEDRINE-DM-GG W/ APAP TAB 60-30-600-500 MG<br />
PSEUDOEPHEDRINE-DM-GG-SOD CITRATE LIQD 30-10-25-200 MG/5ML<br />
PSEUDOEPHEDRINE-PYRILAMINE-CODEINE SYRUP 30-15-10 MG/5ML<br />
pseudovent tab dm<br />
pulexn dm syp 100-10/5<br />
pulmari sus<br />
pulmari-gp liq 20-100mg<br />
px daytime cap mult-sym OTC<br />
px daytime liq cold/flu OTC<br />
px daytime tab cold OTC<br />
px nighttime tab cold OTC<br />
px nitetime cap cold/flu OTC<br />
px nitetime cap mult-sym OTC<br />
px nitetime liq cold/flu OTC<br />
px nitetime liq cough OTC<br />
px severe tab cold OTC<br />
px tussin cf liq OTC<br />
px tussin dm liq 100-10/5 OTC<br />
pyril dm sus<br />
pyril mal/pe sus dm hbr<br />
PYRILAMINE-DM-GG-SODIUM CITRATE LIQD 10-10-25-200 MG/5ML<br />
PYRLEX CB SUS<br />
q-tapp dm elx OTC<br />
q-tussin cf syp cgh/cold OTC<br />
q-tussin dm syp 100-10/5 OTC<br />
q-v tussin syp<br />
qc cgh relf liq 15mg/5ml OTC<br />
qc cgh/cold tab OTC<br />
qc cold relf sus plus ms OTC<br />
qc cold/cgh pow daytime OTC<br />
qc cold/head tab daytime OTC<br />
qc cold/head tab nighttim OTC<br />
qc cough liq sore thr OTC<br />
qc cough liq sore thr OTC<br />
qc daytime cap cold/flu OTC<br />
qc daytime liq cold med OTC<br />
qc flu relf liq daytime OTC<br />
qc medifin tab dm OTC<br />
qc nighttime cap cold/flu OTC<br />
qc nighttime liq cold/flu OTC<br />
qc nighttime liq cough OTC<br />
qc tussin cf syp OTC<br />
quad tann sus<br />
quad tann tab<br />
quad-tuss sus tann/ped<br />
quadratuss sus ped<br />
quadratuss tab<br />
qual-tussin syp<br />
qual-tussin syp dc<br />
quala-hc syp<br />
quartuss syp<br />
quartuss dm dro<br />
quindal-hd syp<br />
quintex hc liq<br />
ra apap flu tab sev cold OTC<br />
ra childrens sus pls cold OTC<br />
ra chld cgh/ sus runny ns OTC<br />
ra cold/cgh elx dm OTC<br />
ra complete tab cold rel OTC<br />
ra cough/cld elx dm OTC<br />
ra day time liq cold/flu OTC<br />
ra daytime cap cold/flu OTC<br />
ra daytime liq cold/flu OTC<br />
ra flu tab max st OTC<br />
ra flu formu liq child OTC<br />
ra inf cold/ liq cough OTC<br />
ra night flu pow c/c ms OTC<br />
ra nite time cap cold/flu OTC<br />
ra nite time liq child OTC<br />
ra nite time liq cold OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 117
a nite time liq cold/flu OTC<br />
ra nite time liq cough OTC<br />
ra nitetime liq cold/flu OTC<br />
ra triacting liq night tm OTC<br />
ra tussin syp max st OTC<br />
ra tussin cf liq OTC<br />
ra tussin dm liq 100-10/5 OTC<br />
re all 12 sus<br />
re dcp dro<br />
recofen caps tab 15-200 OTC<br />
refenesen dm tab 400-20mg OTC<br />
RELACON LAX TAB 30-835MG<br />
relacon-dm liq nr<br />
RELACON-DM SYP<br />
relacon-hc liq nr<br />
RELACON-HC SYP<br />
relahist-dm dro<br />
relasin dm liq<br />
relasin-hc liq<br />
relasin-hcx liq<br />
relatuss hc syp<br />
relcof c sol<br />
reme hist dm liq<br />
reme tussin syp dm<br />
rentamine sus ped<br />
RESCON-DM SYP OTC<br />
RESPA C&C TAB<br />
RESPA C&C IR TAB<br />
RESPA DM TAB 28-600MG<br />
resperal syp<br />
RESPERAL-DM DRO 12-1-5MG<br />
RESPI-TANN CHW<br />
RESPI-TANN SUS<br />
RESPI-TANN SUS PD<br />
RESPI-TANN G SUS<br />
rest easy nt liq cough OTC<br />
ri-tussin dm syp 100-10/5 OTC<br />
RICOTUSS SUS<br />
ricotuss sus<br />
RICOTUSS SUS 10-8-60<br />
RICOTUSS TAB<br />
rindal hd liq 5-2-1.67<br />
rindal hd syp plus<br />
rindal hpd syp<br />
robafen ac syp 100-10/5 OTC<br />
robafen ac syp 100-10/5<br />
robafen cf syp OTC<br />
robafen cf syp cgh/cold OTC<br />
robafen cgh cap 15mg OTC<br />
robafen dm syp 100-10/5 OTC<br />
robafen dm syp 100-10/5 OTC<br />
robituss ped syp 7.5/5ml OTC<br />
robitussin cap cold/flu OTC<br />
ROBITUSSIN DRO PEDIATRC OTC<br />
robitussin liq cf OTC<br />
robitussin liq cf OTC<br />
ROBITUSSIN LIQ CGH/ALRG OTC<br />
robitussin liq cgh/cld OTC<br />
ROBITUSSIN LIQ CGH/CLD OTC<br />
robitussin liq cgh/cold OTC<br />
robitussin liq to go dm OTC<br />
ROBITUSSIN MIS DAY/NGHT OTC<br />
robitussin sus cold/flu OTC<br />
robitussin syp 10mg/5ml OTC<br />
robitussin syp 15mg/5ml OTC<br />
robitussin syp 7.5/5ml OTC<br />
robitussin syp alrg/cgh OTC<br />
robitussin syp flu OTC<br />
robitussin syp max st OTC<br />
ROBITUSSIN SYP NGHT REL OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 118
ROBITUSSIN D LIQ CGH/COLD OTC<br />
romilar ac sol 100-10/5<br />
rondex-dm dro<br />
rondex-dm syp<br />
RU-TUSS DM SYP<br />
RU-TUSS DM TAB 60-800MG<br />
RYDEX LIQ<br />
RYNATUSS TAB<br />
S-T FORTE 2 LIQ SF<br />
safe tussin liq 30 OTC<br />
SAFETUSSIN LIQ CD OTC<br />
sb cgh contr cap 15mg OTC<br />
sb cgh contr liq cf OTC<br />
sb cgh relf liq 15mg/5ml OTC<br />
sb childrens liq nite tim OTC<br />
sb childrens sus pls cold OTC<br />
sb chld cgh/ sus runny ns OTC<br />
sb cold head tab congest OTC<br />
sb cold med tab OTC<br />
sb cold med tab no drows OTC<br />
sb cold mult pak day/nght OTC<br />
sb cold mult tab symp sev OTC<br />
sb cold/cgh elx dm child OTC<br />
sb cold/cgh tab hbp OTC<br />
sb day time cap cold/flu OTC<br />
sb daytime liq OTC<br />
sb flu hbp tab max st OTC<br />
sb flu relf liq daytime OTC<br />
sb flu/cold/ pak cough OTC<br />
sb nightime liq OTC<br />
sb nightime liq cherry OTC<br />
sb nighttme liq cough OTC<br />
SCOT-TUSSIN LIQ DIBTS/CF OTC<br />
scot-tussin liq dm sf OTC<br />
SCOT-TUSSIN LIQ SENIOR OTC<br />
SCOT-TUSSIN LOZ DM OTC<br />
severe cold tab OTC<br />
severe cold tab OTC<br />
severe cold tab OTC<br />
severe cold tab /congest OTC<br />
severe cold tab caplets OTC<br />
severe cold tab cold/flu OTC<br />
severe cold tab cold/flu OTC<br />
severe cold tab congesti OTC<br />
severe cold tab max str OTC<br />
severe cold tab non-asa OTC<br />
sg ex-prin chw chld/cld OTC<br />
sg exprin syp cold/cgh OTC<br />
sg flu/cold/ pow cough OTC<br />
sg night flu pow c/c ms OTC<br />
sg nighttime liq children OTC<br />
sg nighttime liq cold/flu OTC<br />
sg pedia rel liq cgh/cold OTC<br />
sg tussin dm syp 100-10/5 OTC<br />
sg tussin dm syp clear OTC<br />
sildec dm dro<br />
sildec dm syp<br />
sildec pe-dm dro<br />
sildec pe-dm syp<br />
silphen dm syp 10mg/5ml OTC<br />
siltussin dm liq das OTC<br />
siltussin-dm liq diabetic OTC<br />
siltussin-dm liq max st OTC<br />
siltussin-dm syp alc free OTC<br />
simply cough syp 5mg/5ml OTC<br />
simuc-dm sol<br />
simuc-hd sol<br />
SINUTUSS DM TAB<br />
sm cgh/cold cap multisym OTC<br />
sm childrens sus ms cold OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 119
sm cold head tab cong dt OTC<br />
sm cold head tab congest OTC<br />
sm cold/cgh elx dm child OTC<br />
sm cough liq sore thr OTC<br />
sm cough liq sore thr OTC<br />
sm cough/run liq nose chl OTC<br />
sm day time cap cold/flu OTC<br />
sm day time cap pe OTC<br />
sm day time liq cold/flu OTC<br />
sm flu/cold/ pow cough OTC<br />
sm nite time cap cold/flu OTC<br />
sm nite time cap cold/flu OTC<br />
sm nite time liq cold/flu OTC<br />
sm nite time liq cough OTC<br />
sm non asa tab cold OTC<br />
sm non-asa tab flu OTC<br />
sm tussin cap cgh/cold OTC<br />
sm tussin syp cgh/cold OTC<br />
sm tussin syp dm clear OTC<br />
sm tussin cf liq OTC<br />
sm tussin dm syp 100-10/5 OTC<br />
soba night t cap cold/fl OTC<br />
soba pain re chw cold/cgh OTC<br />
soba pedia liq relief OTC<br />
soba tussin liq cgh-cold OTC<br />
SOLOTUSS SUS 30MG/5ML<br />
sonahist dm dro<br />
SORBUTUSS LIQ<br />
sorbutuss liq 100-10/5 OTC<br />
SORBUTUSS NR LIQ OTC<br />
st joseph co syp 7.5/5ml OTC<br />
STATUSS LIQ GREEN<br />
statuss dm syp<br />
su-phedrin cap cgh/cold OTC<br />
su-tuss dm elx 200-20/5<br />
su-tuss hd elx<br />
SUCRETS DM LOZ 10MG OTC<br />
SUDAFED CHLD LIQ CLD&CGH OTC<br />
SUDAFED PE PAK COLD OTC<br />
sudafed pe sol cold/cgh OTC<br />
SUDAFED PE TAB CLD/CGH OTC<br />
sudatex-dm tab<br />
sudatuss dm syp OTC<br />
sudatuss dm syp<br />
sudatuss-2 sol<br />
sudatuss-2 sol df<br />
sudatuss-sf sol<br />
super tussin liq 100-10/5 OTC<br />
super tussin liq pediatri OTC<br />
supertussin syp dm OTC<br />
suphedrin cap cold/cgh OTC<br />
suphedrin tab sev cold OTC<br />
suphedrine tab cold/flu OTC<br />
supress-dx dro pediatrc<br />
sutan-dm sus<br />
SYMPAK DM MIS<br />
SYMTAN SUS<br />
SYMTAN A SUS<br />
T-TANNA DM SUS<br />
tana dm sus<br />
tana t-12 sus 4-30mg/5<br />
tanacof-dm sus<br />
TANAFED DMX SUS<br />
tanatuss sus<br />
tannate sus pd-dm<br />
tannate 12 s sus<br />
tannate dmp- sus dex<br />
tannate-12 sus<br />
tannate-12d sus s<br />
tannate-v-dm sus<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 120
tannic-12 sus<br />
tannic-12 tab 5-60mg<br />
tannic-12 s sus 4-30mg/5<br />
tannihist-12 sus 4-30mg/5<br />
tannihist-12 sus d<br />
tenar dm liq<br />
tetra tann sus ped<br />
tgt cold tab head con OTC<br />
tgt cold rel tab multi-sy OTC<br />
tgt cold/flu liq day time OTC<br />
tgt cold/flu liq day-time OTC<br />
tgt cold/flu liq night OTC<br />
tgt cold/flu liq night OTC<br />
tgt cough liq form dm OTC<br />
tgt ms cold sus child OTC<br />
theracaps tab OTC<br />
THERACOF PLS LIQ CGH/COLD OTC<br />
THERAFLU MIS COUGH OTC<br />
THERAFLU PAK COLD/CGH OTC<br />
THERAFLU POW OTC<br />
theraflu pow fl/cd/co OTC<br />
THERAFLU CLD MIS CGH DAY OTC<br />
theraflu dt liq warm rlf OTC<br />
theraflu flu pow /congest OTC<br />
theraflu ms tab non-drow OTC<br />
THERAFLU NIT POW MAX STR OTC<br />
theraflu nit tab max str OTC<br />
theraflu sev tab cold dt OTC<br />
theraflu sev tab cold nt OTC<br />
theraflu sev tab cold/cgh OTC<br />
thor syp cou/col OTC<br />
tidafen dm tab<br />
tl-dex dm liq<br />
tl-hist cd liq<br />
tl-hist cm liq<br />
tl-hist dm liq<br />
tolu-sed dm liq 100-10/5 OTC<br />
TOURO CC TAB<br />
TOURO CC-LD TAB<br />
TOURO DM TAB 30-575MG<br />
TOURO HC TAB<br />
trexbrom liq<br />
tri-fed x sus<br />
tri-vent dm syp<br />
tri-vent dpc syp 6-2-15/5<br />
tri-vent hc liq<br />
triacing cld liq cgh/chld OTC<br />
triactin cld liq /cough OTC<br />
triacting liq cgh/cold OTC<br />
triacting liq cgh/run OTC<br />
triacting liq cgh/run OTC<br />
TRIACTING LIQ CGH/SORE OTC<br />
triacting liq children OTC<br />
triacting liq children OTC<br />
triacting liq children OTC<br />
triacting liq cold/cgh OTC<br />
triacting liq cold/cgh OTC<br />
triacting liq cold/cgh OTC<br />
triacting liq night OTC<br />
triacting liq nite tim OTC<br />
triacting liq sore thr OTC<br />
triacting liq sore thr OTC<br />
triacting liq sore thr OTC<br />
triacting liq sore thr OTC<br />
triacting liq sore thr OTC<br />
triacting liq sore thr OTC<br />
triacting co liq 15-1-5mg OTC<br />
triacting dt liq cold/cgh OTC<br />
triacting dt liq cold/cgh OTC<br />
TRIAMIN FLU/ SYP CGH/FVR OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 121
TRIAMINIC CHW OTC<br />
TRIAMINIC CHW OTC<br />
triaminic liq OTC<br />
TRIAMINIC LIQ OTC<br />
triaminic liq OTC<br />
triaminic liq OTC<br />
triaminic liq cgh/nasl OTC<br />
triaminic liq night tm OTC<br />
TRIAMINIC MIS COLD/CGH OTC<br />
TRIAMINIC MIS COUGH OTC<br />
TRIAMINIC MIS INFANT OTC<br />
TRIAMINIC SOL COLD/CGH OTC<br />
TRIAMINIC SYP CGH/SORE OTC<br />
triaminic syp cough OTC<br />
TRIAMINIC SYP FEVER OTC<br />
triaminic am liq cgh/dec OTC<br />
TRIAMINIC CO SYP 15-5MG/5 OTC<br />
triaminic dt liq cold/cgh OTC<br />
TRIAMINIC-D SYP OTC<br />
TRICODENE SF SYP OTC<br />
tricof syp<br />
tricof exp syp<br />
tricof pd syp<br />
tricold pedi dro<br />
TRIDAL SYP<br />
tridal hd syp<br />
tridal hd syp plus<br />
TRIKOF-D TAB 12HR SR<br />
trionate sus 4-30mg/5<br />
trionate nf tab 5-60mg<br />
triplex dm liq<br />
TRISPEC DMX DRO PEDIATRC<br />
TRISPEC DMX LIQ<br />
TRISPEC PSE DRO PEDIATRC<br />
TRISPEC PSE LIQ<br />
trital dm liq<br />
TROCAL COUGH LOZ 7.5MG OTC<br />
tusana-d liq<br />
TUSDEC-DM LIQ<br />
TUSDEC-HC LIQ<br />
TUSNEL LIQ OTC<br />
TUSNEL LIQ<br />
tusnel c syp<br />
tusnel diabt liq 10-100/5 OTC<br />
TUSNEL PED-C SYP<br />
TUSNEL PEDI LIQ<br />
tusnel-a liq OTC<br />
TUSNEL-DM LIQ PEDI DRO<br />
TUSNEL-HC LIQ<br />
tusnel-hc liq<br />
TUSS-DA NR LIQ<br />
tuss-pv syp<br />
tussadur-hd sol<br />
TUSSAFED LIQ<br />
tussafed syp<br />
tussafed ex liq<br />
tussafed hc syp<br />
tussafed-la tab<br />
tusscough syp dhc<br />
tusscough hc syp<br />
TUSSI PRES-B LIQ OTC<br />
TUSSI-12 TAB 5-60MG<br />
TUSSI-12D TAB 10-40-60<br />
TUSSI-12D S SUS<br />
tussi-bid tab<br />
tussi-organi liq nr dm<br />
TUSSI-PRES LIQ PEDIATRC<br />
TUSSICAPS CAP 10-8MG<br />
TUSSICAPS CAP 5-4MG<br />
tussiclr dh syp 3.5-100<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 122
tussiden c liq 300-10mg<br />
tussiden dm liq 10-300mg<br />
TUSSIGON TAB 5MG<br />
tussin cap cgh/cold OTC<br />
tussin cap cold/cgh OTC<br />
tussin cf liq OTC<br />
tussin cf liq OTC<br />
tussin cf liq cgh/cld OTC<br />
tussin cf liq cgh/cold OTC<br />
tussin cf liq super OTC<br />
tussin cf syp OTC<br />
tussin cg/cd syp max st OTC<br />
TUSSIN CHILD SYP CGH/COLD OTC<br />
tussin cold cap cough OTC<br />
tussin cold/ cap congesti OTC<br />
tussin cold/ cap cough OTC<br />
tussin cough cap 15mg OTC<br />
tussin cough liq 10-100/5 OTC<br />
TUSSIN COUGH LIQ COLD OTC<br />
tussin cough liq congesti OTC<br />
tussin cough syp 15mg/5ml OTC<br />
tussin dm liq OTC<br />
tussin dm liq 100-10/5 OTC<br />
tussin dm liq 100-10/5 OTC<br />
tussin dm liq 100-10/5 OTC<br />
tussin dm liq clear OTC<br />
tussin dm liq max OTC<br />
tussin dm syp 100-10/5 OTC<br />
tussin dm syp 100-10/5 OTC<br />
tussin dm syp 100-10/5 OTC<br />
tussin dm syp 100-10/5 OTC<br />
tussin dm syp 100-10/5 OTC<br />
tussin dm syp clear OTC<br />
tussin max syp 15mg/5ml OTC<br />
tussin ped liq cgh/cold OTC<br />
tussin ped liq cgh/cold OTC<br />
tussin ped liq cgh/cold OTC<br />
tussin-dm syp 100-15/5 OTC<br />
tussin-v syp<br />
TUSSINAL 12 SUS<br />
TUSSIONEX SUS EXT-REL<br />
TUSSIREX SYP W/COD<br />
TUSSIREX-SF LIQ W/COD<br />
tussitab tab 1200-60m<br />
tussizone-12 sus 4-30mg/5<br />
tussizone-12 tab 5-60mg<br />
TUSSO-DF SYP 2.5-100<br />
TUSSO-DM TAB<br />
TUSSO-DMR CAP 7-14-288<br />
TUSSO-HC TAB<br />
TUSSO-XR SUS<br />
TUSSO-ZMR CAP 8-200MG<br />
TUSSO-ZR SYP 7.5-150<br />
tussplex syp<br />
tussplex dm syp<br />
tustan 12s sus<br />
tylenol cgh liq sore thr OTC<br />
TYLENOL CGH PAK SORE THR OTC<br />
TYLENOL COLD LIQ & FLU OTC<br />
TYLENOL COLD LIQ MULTI-S OTC<br />
TYLENOL COLD LIQ MULTI-SY OTC<br />
tylenol cold pak head con OTC<br />
tylenol cold pak multi-s OTC<br />
tylenol cold tab head con OTC<br />
tylenol cold tab multi rr OTC<br />
tylenol cold tab multi-s OTC<br />
TYLENOL FLU PAK DAY/NIGH OTC<br />
tylenol flu tab no-drow OTC<br />
TYLENOL INF DRO COLD/CGH OTC<br />
tylenol inf dro cold/cgh OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 123
tylenol nite liq cold/flu OTC<br />
ultratuss 12 sus s<br />
uni all 12 sus<br />
uni-cof syp<br />
uni-cof exp syp<br />
uni-hist pdx dro<br />
uni-hist pdx syp<br />
uni-tann cs sus<br />
v-cof sus<br />
VANACOF LIQ OTC<br />
VANACOF CD LIQ<br />
VANACOF DX LIQ OTC<br />
vanacon sol<br />
VANATAB DX TAB OTC<br />
VAZOTUSS HC SUS<br />
vi-q-tuss syp 5-100/5<br />
vick dayquil cap cold/flu OTC<br />
vick dayquil liq cold/flu OTC<br />
vicks liq dayquil OTC<br />
VICKS 44 LIQ CGH RELF OTC<br />
VICKS 44D LIQ COUGH OTC<br />
VICKS 44E SYP COUGH OTC<br />
VICKS 44E SYP PEDIATRI OTC<br />
VICKS 44M LIQ MULTI-SY OTC<br />
VICKS 44M LIQ PEDIATRI OTC<br />
VICKS DAYQUI LIQ COUGH OTC<br />
VICKS FORM SYP 44M PED OTC<br />
vicks nyquil cap cold/flu OTC<br />
VICKS NYQUIL LIQ CHILDREN OTC<br />
vicks nyquil liq cold/flu OTC<br />
vicoclear syp 5-100/5<br />
VIRATAN-DM CHW 25-30-25<br />
viratan-dm sus<br />
VIRAVAN-PDM SUS 15-15-15<br />
visvex hc liq<br />
vita-numonyl liq ad<br />
vita-numonyl liq nr<br />
vita-numonyl liq ped<br />
VITA-NUMONYL SOL DM<br />
vitussin syp 5-100/5<br />
wal-tap dm elx cold/cgh OTC<br />
wal-tap dm elx cold/cgh OTC<br />
wal-tussin cap cold OTC<br />
wal-tussin cap cough OTC<br />
wal-tussin liq cf OTC<br />
wal-tussin liq cgh/cld OTC<br />
wal-tussin liq cgh/cold OTC<br />
wal-tussin liq dm OTC<br />
wal-tussin syp 15mg/5ml OTC<br />
wal-tussin syp cgh/cold OTC<br />
wal-tussin syp dm clear OTC<br />
welltuss exp syp<br />
welltuss hc liq<br />
x-hist dm dro<br />
XIRATUSS TAB<br />
xiratuss tab<br />
XPECT-AT TAB<br />
XPECT-HC TAB 5-600MG<br />
Y-COF DM TAB<br />
Z-COF 12DM SUS<br />
Z-COF DMX LIQ<br />
z-dex dro<br />
z-dex syp<br />
z-dex 12d tab<br />
Z-TUSS 2 LIQ EXPECT<br />
Z-TUSS AC LIQ 2-9/5ML<br />
z-tuss dm liq<br />
zhist liq expect<br />
ZINX COLD KIT<br />
ZINX COUGH KIT<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 124
ZODRYL AC 25 SUS OTC<br />
ZODRYL AC 30 SUS OTC<br />
ZODRYL AC 35 SUS OTC<br />
ZODRYL AC 40 SUS OTC<br />
ZODRYL AC 50 SUS<br />
ZODRYL AC 60 SUS<br />
ZODRYL AC 80 SUS<br />
ZODRYL DAC SUS 25 OTC<br />
ZODRYL DAC SUS 30 OTC<br />
ZODRYL DAC SUS 35 OTC<br />
ZODRYL DAC SUS 40 OTC<br />
ZODRYL DAC SUS 50<br />
ZODRYL DAC SUS 60<br />
ZODRYL DAC SUS 80<br />
ZODRYL DEC25 SUS OTC<br />
ZODRYL DEC30 SUS OTC<br />
ZODRYL DEC35 SUS OTC<br />
ZODRYL DEC40 SUS OTC<br />
ZODRYL DEC50 SUS<br />
ZODRYL DEC60 SUS<br />
ZODRYL DEC80 SUS<br />
ZONATUSS CAP 150MG<br />
ZOTEX HC SYP<br />
zotex-12 sus<br />
zotex-12d tab<br />
ZOTEX-C SYP<br />
ZOTEX-D SYP<br />
ZOTEX-DM SYP<br />
ZOTEX-DMX TAB<br />
ZOTEX-EX TAB<br />
ZOTEX-G SYP<br />
ZOTEX-LA TAB<br />
ZYMINE HC LIQ<br />
zyrphen-hc liq<br />
Anti-inflammatory Agents<br />
Leukotriene Modifiers<br />
ACCOLATE TAB 10MG NF<br />
ACCOLATE TAB 20MG NF<br />
MONTELUKAST SODIUM CHEW TAB 4 MG (BASE EQUIV)<br />
MONTELUKAST SODIUM CHEW TAB 5 MG (BASE EQUIV)<br />
MONTELUKAST SODIUM ORAL GRANULES PACKET 4 MG (BASE EQUIV)<br />
MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV)<br />
SINGULAIR CHW 4MG<br />
SINGULAIR CHW 5MG<br />
SINGULAIR GRA 4MG<br />
SINGULAIR TAB 10MG<br />
ZAFIRLUKAST TAB 10 MG NF<br />
ZAFIRLUKAST TAB 20 MG NF<br />
Mast-cell Stabilizers<br />
cromolyn sod neb 20mg/2ml<br />
CROMOLYN SODIUM INHAL AEROSOL SOLN 800 MCG/ACT (1 MG/VALVE)<br />
cromolyn sodium soln nebu 20 mg/2ml<br />
INTAL 112 AER 800MCG<br />
INTAL 200 AER 800MCG<br />
INTAL INH AER 800MCG<br />
NEDOCROMIL SODIUM INHAL AEROSOL 1.75 MG/ACT<br />
TILADE AER 1.75/ACT<br />
Expectorants<br />
*PE-GUAIFENESIN TAB SR 12H 30-1000 MG & HOMEOPATH LOZ KIT***<br />
10peh/380gfn tab OTC<br />
45pse/400gfn tab OTC<br />
a-tan 12x sus<br />
aber-fed tab 60-500mg<br />
ACETAMINOPHEN-GUAIFENESIN LIQUID 500-200 MG/15ML OTC<br />
ACETAMINOPHEN-GUAIFENESIN POWDER PACK 1000-400 MG OTC<br />
acetaminophen-guaifenesin tab 325-200 mg OTC<br />
acetaminophen-guaifenesin tab 650-400 mg OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 125
af-pseudoeph cap non-drsy OTC<br />
ALBATUSSIN DRO EX PED<br />
ALBATUSSIN INJ NN<br />
ALBATUSSIN TAB SR F<br />
ALBATUSSIN S TAB<br />
ALBATUSSN CF DRO PED<br />
ALBATUSSN CF LIQ<br />
ALLFEN A TAB 400-4MG<br />
altarussin syp -pe OTC<br />
altarussin syp 100/5ml OTC<br />
altex-pse tab 120-600<br />
ambi 10peh/ tab 400gfn OTC<br />
ambi 40/1000 tab<br />
ambi 40pse/ tab 400gfn<br />
ambi 45/800 tab<br />
ambi 60/1000 tab<br />
ambi 60/580 tab<br />
ambi 60pse/ tab 400gfn<br />
ambi 80/700 tab<br />
ambi 80/780 tab<br />
AMBIFED TAB OTC<br />
AMBIFED-G TAB 20-400MG OTC<br />
ami-tex la tab 30-600mg<br />
amidal tab<br />
amitex pse tab 120-600<br />
AQUATAB D TAB<br />
asthma tab relief OTC<br />
BABEE COF SYP OTC<br />
bidex tab 400mg OTC<br />
biotuss pe syp 30-100/5 OTC<br />
bl triacting syp chst con OTC<br />
BROMPHENIRAMINE W/ DM-GG CAP 2-15-200 MG<br />
BROMPHENIRAMINE W/ DM-GG LIQUID 1-15-25 MG/5ML<br />
BROMPHENIRAMINE W/ DM-GG LIQUID 2-15-200 MG/5ML<br />
BRONCHOLATE SYP 6.25-100<br />
BRONKAID TAB 25-400MG OTC<br />
buckleys liq chest OTC<br />
CCP CAFFEINE TAB FREE OTC<br />
centex-pse tab 600-120<br />
cgh control syp pe OTC<br />
chest conges liq child OTC<br />
chest conges tab 400mg OTC<br />
chest conges tab daytime OTC<br />
chest conges tab relief OTC<br />
chest conges tab relief d OTC<br />
chest congst tab rlf pe OTC<br />
chest congst tab rlf pe OTC<br />
chest/nasal syp congest OTC<br />
chest/sinus tab relief OTC<br />
chest/sinus tab relief OTC<br />
chst congest tab pain rel OTC<br />
chst congest tab pain/sns OTC<br />
COCILLANA-TERPIN HYDRATE SYRUP OTC<br />
cold & cough liq formula OTC<br />
coldmist jr tab 12hr<br />
coldmist la tab 12hr<br />
comtrex deep tab chst cld OTC<br />
CONPEC SOL<br />
conpec la nr tab 15-600mg<br />
cough syp 100/5ml OTC<br />
coughtab tab 200mg OTC<br />
crantex syp 7.5/100<br />
crantex la tab 30-600mg<br />
cvs non-dryi cap 30-200mg OTC<br />
cvs tussin syp 100/5ml OTC<br />
cvs tussin syp pe OTC<br />
d-feda ii tab 60-600cr<br />
d-phen 1000 tab<br />
d-tab tab 40-1200<br />
DECON-G DRO 2-1-40MG<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 126
DECONEX CAP 10-390MG OTC<br />
decongest ii tab 60-600cr<br />
deconsal ii tab 25-275mg<br />
DECOREL FORT TAB OTC<br />
despec liq OTC<br />
DESPEC SR TAB<br />
despec-tab tab 40-400mg OTC<br />
diabetic tus liq 100/5ml OTC<br />
DIABETIC TUS LIQ 200MG/5 OTC<br />
diabtc tussn syp 100/5ml OTC<br />
donatussin dro<br />
duomax tab 40-1200<br />
DURATUSS A TAB<br />
DURATUSS PE TAB 30-1050<br />
DYNEX TAB 90-1200<br />
eck tussin cap sev cong OTC<br />
eck tussin syp pe OTC<br />
ENTEX ER CAP 10-300MG<br />
entex la tab<br />
entex pse tab 50-525mg<br />
EPHEDRINE-GUAIFENESIN SYRUP 6.25-100 MG/5ML<br />
ephedrine-guaifenesin tab 12.5-200 mg OTC<br />
EPHEDRINE-GUAIFENESIN TAB 25-400 MG OTC<br />
eq non-dry cap sinus OTC<br />
eq tussin liq 100/5ml OTC<br />
eql chest tab congest OTC<br />
eql non-dryi cap 30-200mg OTC<br />
eql tussin syp 100/5ml OTC<br />
EUCALYPTOL INJ 75 MG/ML<br />
exefen tab 80-780mg<br />
exefen-ir tab 60-400mg<br />
exefen-pd tab 10-600mg<br />
exetuss tab 25-900mg<br />
exetuss-gp tab 25-1200<br />
exp cough ct syp 100/5ml OTC<br />
extendryl g tab<br />
fenesin ir tab 400mg OTC<br />
fenesin pe tab 10-400mg OTC<br />
g p tex tab<br />
g-fen ex tab 400mg OTC<br />
g-phed cap sr<br />
g-phed-pd cap 60-300sr<br />
G/P TAB 1200-75<br />
g/p 1200/60 tab<br />
ganidin nr liq 100/5ml<br />
gen entex la cap 30-400mg<br />
GENEXA LA CAP 30-400MG<br />
GENTEX LA TAB<br />
geri-tussin syp 100/5ml OTC<br />
gfn 1200/ tab pse 50<br />
gfn/pse tab 1200/120<br />
gfn1200/pe40 tab<br />
GFN550/PSE60 TAB<br />
gfn595/pse48 tab<br />
gfn600/pe20 tab<br />
gfn600/pe40 tab<br />
gfn795/pse85 tab<br />
gfn800/pe25 tab<br />
GFN800/PSE60 TAB<br />
gg 200 nr tab 200mg OTC<br />
gg-pe tab 900-30mg<br />
gg-psed sr tab 12hr<br />
gg/pe syp<br />
gg/pe tab 1200-25<br />
gg/pe tab 400-10mg OTC<br />
gg/pe tab 600-20mg<br />
gg/pe tab 900-25mg<br />
gg/phenylep liq<br />
gg/phenylep syp<br />
gg/phenylep tab 1200-40<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 127
gg/phenylep tab 40-1200<br />
gg/phenylep tab 600-30mg<br />
gg/pse syp 30-100/5 OTC<br />
gg/pse tab 1200/120<br />
gg/pse tab 80/800mg<br />
gg/pse cr cap 300-60mg<br />
gg/pse cr tab 600-120<br />
gg/pse cr tab 600-60mg<br />
gg/pse er tab 600-120<br />
gg/pse sr tab 12hr<br />
GILPHEX TR TAB 10-388MG<br />
GILPHEX TR TAB 12HR<br />
gnp triactin syp chst con OTC<br />
gnp tussin syp 100/5ml OTC<br />
gp-1200 tab 40-1200<br />
gripex pe dro ped<br />
guaiasorb syp 100/5ml OTC<br />
guaif/phenyl tab 600-40mg<br />
guaife/pseud tab<br />
GUAIFED SYP OTC<br />
guaifen pe tab<br />
guaifen pse tab 600-120<br />
guaifen/pse syp 30-100/5 OTC<br />
guaifen/pse tab 600-120<br />
guaifenesin liq nr<br />
guaifenesin sol 100/5ml OTC<br />
guaifenesin syp 100/5ml OTC<br />
guaifenesin tab 200mg<br />
guaifenesin tab 200mg OTC<br />
guaifenesin tab 400mg OTC<br />
guaifenesin tab 600mg cr<br />
GUAIFENESIN GRANULES PACKET 100 MG OTC<br />
GUAIFENESIN GRANULES PACKET 50 MG OTC<br />
guaifenesin liquid 100 mg/5ml OTC<br />
guaifenesin liquid 100 mg/5ml<br />
GUAIFENESIN LIQUID 100 MG/6.25ML OTC<br />
GUAIFENESIN LIQUID 200 MG/5ML OTC<br />
GUAIFENESIN LIQUID 250 MG/5ML (50 MG/ML)<br />
GUAIFENESIN SOLN 250 MG/5ML (50 MG/ML)<br />
GUAIFENESIN SOLN 50 MG/5ML OTC<br />
guaifenesin syrup 100 mg/5ml OTC<br />
guaifenesin tab 200 mg<br />
guaifenesin tab 200 mg OTC<br />
guaifenesin tab 400 mg OTC<br />
GUAIFENESIN TAB SR 12HR 1200 MG OTC<br />
guaifenesin tab sr 12hr 1200 mg OTC<br />
guaifenesin tab sr 12hr 600 mg<br />
GUAIFENESIN TAB SR 12HR 600 MG OTC<br />
GUAIFENESIN TAB SR 12HR 675 MG<br />
GUAIFENESIN-CHLORPHENIRAMINE MALEATE TAB 400-4 MG<br />
guaifenesin/ tab pse sa<br />
guaifenex tab pse 120<br />
guaifenex tab pse 60<br />
guaifenex tab pse 85<br />
guaifenex gp tab 120/1200<br />
guaifenex ps tab 80-800mg<br />
GUAIMAX-D TAB 120-600<br />
guaimist s syp 40-200/5<br />
guaiphen-d tab<br />
guaiphen-d tab 1200<br />
guaiphen-pd tab<br />
guapetex syp 7.5/100<br />
GUAPHENYL II CAP 20-375MG<br />
guaphenyl la cap 30-400mg<br />
guiadex pd tab 10-600mg<br />
guiatex pe syp<br />
guiatuss syp 100/5ml OTC<br />
guiatuss pe syp 30-100/5 OTC<br />
H 9600 SR TAB 90-600MG<br />
hca expector tab 200mg OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 128
hca non-dry cap sinus OTC<br />
hca tussin syp expect OTC<br />
hca tussin syp pe OTC<br />
HUMIBID TAB 1200MG OTC<br />
humibid tab 1200mg OTC<br />
iophen-nr liq 100/5ml<br />
iosal ii tab 60-600cr<br />
iotex pse tab 120-600<br />
J-MAX TAB<br />
KGS-PE LIQ 5MG-75MG<br />
LEMOHIST CAP PLUS<br />
LEV/PSE/GG CAP 90-400MG<br />
liquibid tab 400mg OTC<br />
liquibid d-r tab 10-400mg OTC<br />
LIQUIBID-D TAB 40-1200<br />
LIQUIBID-D TAB 40-650MG<br />
LIQUIBID-PD TAB<br />
lusair liq<br />
LUSONEX PLUS TAB<br />
MARDROPS-EX LIQ OTC<br />
maxifed tab 60-400mg<br />
maxiphen tab 10-400mg<br />
MAXIPHEN-G TAB<br />
medent-ldi tab 60-400mg OTC<br />
MEDENT-PE TAB 12.5-600<br />
medent-pei tab 10-400mg OTC<br />
medi-tussin cap sev cong OTC<br />
medi-tussin syp 100/5ml OTC<br />
medi-tussin syp pe OTC<br />
miraphen pse tab 120-600<br />
montephen tab 25-600mg<br />
mp tussin pe syp 30-100/5 OTC<br />
MUCINEX TAB 1200MG OTC<br />
MUCINEX TAB 600MG ER OTC<br />
MUCINEX CHLD GRA 50MG OTC<br />
mucinex chld liq 100/5ml OTC<br />
MUCINEX D TAB 120-1200 OTC<br />
MUCINEX D TAB 60-600MG<br />
MUCINEX D TAB 60-600MG OTC<br />
MUCINEX JR GRA 100MG OTC<br />
MUCINEX/KIDS GRA 100MG OTC<br />
MUCINEX/KIDS GRA 50MG OTC<br />
mucinex/kids liq 100/5ml OTC<br />
mucosa tab 400mg OTC<br />
mucus relief liq 100/5ml OTC<br />
mucus relief liq 400/20ml OTC<br />
mucus relief liq 400/20ml OTC<br />
mucus relief tab 400mg OTC<br />
mucus relief tab d OTC<br />
mucus relief tab multi OTC<br />
mucus relief tab pe OTC<br />
mucus relief tab pe OTC<br />
mucusrelief tab sinus OTC<br />
mydex tab 30-900mg<br />
mydocs tab 20-600mg<br />
NALDECON SYP SENIOR PA OTC<br />
nasal decon cap 30-200mg OTC<br />
NASATAB LA TAB<br />
nasex tab 25-650mg<br />
nasex-g tab 25-835mg<br />
nazarin liq<br />
nescon-pd tab 25-275mg<br />
nexphen pd cap 7.5-200<br />
nomuc-pe cap<br />
non-drying cap sinus OTC<br />
NOREL EX TAB 40-800MG<br />
NUMOBID TAB 675MG<br />
numonyl liq<br />
numonyl ped dro<br />
numonyl sr tab 15-600mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 129
organ-i nr tab 200mg<br />
organidin nr tab 200mg<br />
p chlor gg sol drops<br />
pe-guai dro 1.5-20mg<br />
pe/gg tab 15-600mg<br />
pe/gg tab 20-600mg<br />
pe/gg tab 25-900<br />
pe/gg tab 30-1200<br />
pe/gg la tab 20-600mg<br />
pe/guai tab 30-1200<br />
pe/guai tab 30-900mg<br />
pe/guaifenes dro 1.5-20mg<br />
pendex tab 10-600mg<br />
PHANASIN LIQ 50MG/ML<br />
phanasin syp 100/5ml OTC<br />
pharmasin syp 100/5ml OTC<br />
phenavent cap 15-400mg<br />
phenavent d tab 40-1200<br />
phenavent la cap 30-400mg<br />
phenavent pe cap 7.5-200<br />
phenydex dro pediatri<br />
phenyleph tan-pyrilamine tan-guaifenesin sus 5-30-100 mg/5ml<br />
PHENYLEPH TAN-PYRILAMINE TAN-GUAIFENESIN SUS 5-30-100 MG/5ML<br />
PHENYLEPH TAN-PYRILAMINE TAN-GUAIFENESIN TAB 25-60-200 MG<br />
phenyleph-diphenhyd-gg w/ apap liqd 5-25-200-325 mg/10ml OTC<br />
PHENYLEPHRINE TANNATE-GUAIFENESIN SUSP 5-100 MG/5ML<br />
PHENYLEPHRINE TANNATE-GUAIFENESIN TAB 25-200 MG<br />
PHENYLEPHRINE W/ DM-POT GUAIACOLSULF LIQD 5-10-75 MG/5ML<br />
PHENYLEPHRINE W/ DM-POT GUAIACOLSULF SOLN 1-2-15 MG/ML<br />
PHENYLEPHRINE W/ DM-POT GUAIACOLSULF TAB SR 12H 15-30-600 MG<br />
PHENYLEPHRINE W/ DM-POT GUAIACOLSULF TAB SR 12H 30-50-600 MG<br />
PHENYLEPHRINE-APAP-GG LIQD 5-325-200 MG/15ML OTC<br />
PHENYLEPHRINE-APAP-GG TAB 10-325-200 MG OTC<br />
phenylephrine-apap-gg tab 10-650-400 mg OTC<br />
phenylephrine-apap-gg tab 5-325-200 mg OTC<br />
PHENYLEPHRINE-APAP-GG TAB CR 20-650-600 MG<br />
PHENYLEPHRINE-APAP-GG TAB SR 12HR 30-250-1100 MG<br />
PHENYLEPHRINE-APAP-GG-CAFF TAB 10-325-200-32.5 MG OTC<br />
PHENYLEPHRINE-BROMPHENIRAMINE-GUAIFENESIN LIQD 2-1-40 MG/ML<br />
phenylephrine-chlorphen-gg soln 2-1-20 mg/ml<br />
PHENYLEPHRINE-GG-POTASSIUM CITRATE SOLN 5-110-80 MG/5ML<br />
PHENYLEPHRINE-GUAIFENESIN CAP 10-390 MG OTC<br />
PHENYLEPHRINE-GUAIFENESIN CAP SR 12HR 10-300 MG<br />
phenylephrine-guaifenesin cap sr 12hr 15-400 mg<br />
PHENYLEPHRINE-GUAIFENESIN CAP SR 12HR 20-375 MG<br />
phenylephrine-guaifenesin cap sr 12hr 30-400 mg<br />
PHENYLEPHRINE-GUAIFENESIN CAP SR 12HR 30-400 MG<br />
phenylephrine-guaifenesin cap sr 12hr 7.5-200 mg<br />
PHENYLEPHRINE-GUAIFENESIN DROPS 2.5-50 MG/ML OTC<br />
phenylephrine-guaifenesin liqd 10-225 mg/5ml (2-45 mg/ml)<br />
phenylephrine-guaifenesin liqd 2.5-100 mg/5ml OTC<br />
PHENYLEPHRINE-GUAIFENESIN LIQD 2.5-50 MG/5ML OTC<br />
phenylephrine-guaifenesin liqd 5-100 mg/5ml OTC<br />
phenylephrine-guaifenesin liqd 7.5-100 mg/5ml (1.5-20 mg/ml)<br />
phenylephrine-guaifenesin liqd 7.5-200 mg/5ml<br />
PHENYLEPHRINE-GUAIFENESIN LIQD 7.5-75 MG/5ML<br />
PHENYLEPHRINE-GUAIFENESIN SOLN 5-110 MG/5ML<br />
PHENYLEPHRINE-GUAIFENESIN SYRUP 2.5-50 MG/5ML OTC<br />
phenylephrine-guaifenesin syrup 5-200 mg/5ml<br />
phenylephrine-guaifenesin syrup 7.5-100 mg/5ml<br />
phenylephrine-guaifenesin tab 10-380 mg OTC<br />
PHENYLEPHRINE-GUAIFENESIN TAB 10-388 MG<br />
phenylephrine-guaifenesin tab 10-400 mg OTC<br />
phenylephrine-guaifenesin tab 10-400 mg<br />
PHENYLEPHRINE-GUAIFENESIN TAB 15-600 MG<br />
phenylephrine-guaifenesin tab 5-200 mg OTC<br />
PHENYLEPHRINE-GUAIFENESIN TAB 8.5-550 MG<br />
PHENYLEPHRINE-GUAIFENESIN TAB CR 12.5-600 MG<br />
phenylephrine-guaifenesin tab cr 15-600 mg<br />
phenylephrine-guaifenesin tab cr 20-300 mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 130
PHENYLEPHRINE-GUAIFENESIN TAB CR 20-800 MG<br />
phenylephrine-guaifenesin tab sr 12hr 10-600 mg<br />
PHENYLEPHRINE-GUAIFENESIN TAB SR 12HR 18-600 MG<br />
PHENYLEPHRINE-GUAIFENESIN TAB SR 12HR 20-1000 MG<br />
PHENYLEPHRINE-GUAIFENESIN TAB SR 12HR 20-1200 MG<br />
PHENYLEPHRINE-GUAIFENESIN TAB SR 12HR 20-315 MG<br />
phenylephrine-guaifenesin tab sr 12hr 20-600 mg<br />
PHENYLEPHRINE-GUAIFENESIN TAB SR 12HR 23.75-650 MG<br />
phenylephrine-guaifenesin tab sr 12hr 25-1200 mg<br />
phenylephrine-guaifenesin tab sr 12hr 25-275 mg<br />
PHENYLEPHRINE-GUAIFENESIN TAB SR 12HR 25-600 MG<br />
phenylephrine-guaifenesin tab sr 12hr 25-600 mg<br />
phenylephrine-guaifenesin tab sr 12hr 25-650 mg<br />
phenylephrine-guaifenesin tab sr 12hr 25-800 mg<br />
phenylephrine-guaifenesin tab sr 12hr 25-835 mg<br />
phenylephrine-guaifenesin tab sr 12hr 25-900 mg<br />
phenylephrine-guaifenesin tab sr 12hr 30-1000 mg<br />
PHENYLEPHRINE-GUAIFENESIN TAB SR 12HR 30-1050 MG<br />
phenylephrine-guaifenesin tab sr 12hr 30-1100 mg<br />
phenylephrine-guaifenesin tab sr 12hr 30-1200 mg<br />
phenylephrine-guaifenesin tab sr 12hr 30-600 mg<br />
phenylephrine-guaifenesin tab sr 12hr 30-800 mg<br />
PHENYLEPHRINE-GUAIFENESIN TAB SR 12HR 30-835 MG<br />
phenylephrine-guaifenesin tab sr 12hr 30-900 mg<br />
PHENYLEPHRINE-GUAIFENESIN TAB SR 12HR 35-1200 MG<br />
phenylephrine-guaifenesin tab sr 12hr 40-1000 mg<br />
PHENYLEPHRINE-GUAIFENESIN TAB SR 12HR 40-1200 MG<br />
phenylephrine-guaifenesin tab sr 12hr 40-1200 mg<br />
phenylephrine-guaifenesin tab sr 12hr 40-600 mg<br />
PHENYLEPHRINE-GUAIFENESIN TAB SR 12HR 40-650 MG<br />
PHENYLEPHRINE-GUAIFENESIN TAB SR 12HR 40-800 MG<br />
PHENYLEPHRINE-GUAIFENESIN TAB SR 12HR 8.5-550 MG<br />
PHENYLEPHRINE-POTASSIUM GUAIACOLSULFONATE LIQD 5-75 MG/5ML<br />
POLY-VENT TAB 90/650MG<br />
POLY-VENT TAB PLUS OTC<br />
POLY-VENT JR TAB 45/650<br />
POTASSIUM GUAIACOLSULFONATE LIQUID 300 MG/5ML<br />
POTASSIUM GUAIACOLSULFONATE SOLN 75 MG/5ML (15 MG/ML)<br />
POTASSIUM IODIDE LIQUID 600 MG/15ML<br />
proset d tab 20-600mg<br />
PSE-GG TAB 90-800MG<br />
pse/gg cap 120-400<br />
PSE/GG SYP 40-200MG<br />
pse/gg tab 120-600<br />
pse/gg tab 120-600<br />
pse/gg tab 120/1200<br />
pse/gg tab 85-795mg<br />
pse/gg cr tab 120-600<br />
pse/gg cr tab 60-600mg<br />
pse/gg la tab 120-600<br />
pse/gg la tab 45-800mg<br />
pse/gg sr tab 50-1200<br />
pse/gg sr tab 60-500mg<br />
pse/gg sr tab 60-600mg<br />
pseudo gg tr tab 48-595mg<br />
pseudo max tab<br />
pseudo/gg la tab 12hr<br />
pseudoeph/gg tab 45-800mg<br />
pseudoeph/gg tab 80/800mg<br />
PSEUDOEPHED-CHLORPHEN-GG CAP 32.4-2-100 MG<br />
PSEUDOEPHEDRINE-ACETAMINOPHEN-GUAIFENESIN TAB 30-325-200 MG OTC<br />
PSEUDOEPHEDRINE-ACETAMINOPHEN-GUAIFENESIN TAB 45-500-200 MG OTC<br />
PSEUDOEPHEDRINE-GUAIFENESIN CAP 30-150 MG<br />
pseudoephedrine-guaifenesin cap 30-200 mg OTC<br />
pseudoephedrine-guaifenesin cap cr 120-250 mg<br />
pseudoephedrine-guaifenesin cap cr 120-250 mg<br />
pseudoephedrine-guaifenesin cap cr 60-200 mg<br />
pseudoephedrine-guaifenesin cap cr 60-300 mg<br />
PSEUDOEPHEDRINE-GUAIFENESIN CAP SR 12HR 120-400 MG<br />
pseudoephedrine-guaifenesin cap sr 12hr 120-400 mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 131
pseudoephedrine-guaifenesin cap sr 12hr 120-400 mg<br />
PSEUDOEPHEDRINE-GUAIFENESIN CAP SR 12HR 90-400 MG<br />
PSEUDOEPHEDRINE-GUAIFENESIN LIQD 15-50 MG/ML OTC<br />
PSEUDOEPHEDRINE-GUAIFENESIN LIQD 30-25 MG/5ML OTC<br />
PSEUDOEPHEDRINE-GUAIFENESIN LIQD 40-200 MG/5ML<br />
pseudoephedrine-guaifenesin liqd 5-50 mg/ml<br />
pseudoephedrine-guaifenesin syrup 15-50 mg/5ml OTC<br />
pseudoephedrine-guaifenesin syrup 30-100 mg/5ml OTC<br />
PSEUDOEPHEDRINE-GUAIFENESIN SYRUP 30-200 MG/5ML OTC<br />
PSEUDOEPHEDRINE-GUAIFENESIN SYRUP 40-200 MG/5ML<br />
pseudoephedrine-guaifenesin syrup 40-200 mg/5ml<br />
PSEUDOEPHEDRINE-GUAIFENESIN TAB 20-400 MG OTC<br />
PSEUDOEPHEDRINE-GUAIFENESIN TAB 30-400 MG OTC<br />
pseudoephedrine-guaifenesin tab 40-400 mg OTC<br />
pseudoephedrine-guaifenesin tab 40-400 mg<br />
pseudoephedrine-guaifenesin tab 45-400 mg OTC<br />
pseudoephedrine-guaifenesin tab 60-400 mg OTC<br />
pseudoephedrine-guaifenesin tab 60-400 mg<br />
PSEUDOEPHEDRINE-GUAIFENESIN TAB SR 12HR 120-1200 MG OTC<br />
pseudoephedrine-guaifenesin tab sr 12hr 120-1200 mg<br />
PSEUDOEPHEDRINE-GUAIFENESIN TAB SR 12HR 120-500 MG<br />
PSEUDOEPHEDRINE-GUAIFENESIN TAB SR 12HR 120-525 MG<br />
PSEUDOEPHEDRINE-GUAIFENESIN TAB SR 12HR 120-600 MG<br />
pseudoephedrine-guaifenesin tab sr 12hr 120-600 mg<br />
PSEUDOEPHEDRINE-GUAIFENESIN TAB SR 12HR 120-800 MG<br />
pseudoephedrine-guaifenesin tab sr 12hr 45-600 mg<br />
PSEUDOEPHEDRINE-GUAIFENESIN TAB SR 12HR 45-650 MG<br />
pseudoephedrine-guaifenesin tab sr 12hr 45-800 mg<br />
pseudoephedrine-guaifenesin tab sr 12hr 48-595 mg<br />
pseudoephedrine-guaifenesin tab sr 12hr 50-1200 mg<br />
pseudoephedrine-guaifenesin tab sr 12hr 50-525 mg<br />
PSEUDOEPHEDRINE-GUAIFENESIN TAB SR 12HR 58-600 MG<br />
pseudoephedrine-guaifenesin tab sr 12hr 60-1000 mg<br />
pseudoephedrine-guaifenesin tab sr 12hr 60-1200 mg<br />
pseudoephedrine-guaifenesin tab sr 12hr 60-500 mg<br />
PSEUDOEPHEDRINE-GUAIFENESIN TAB SR 12HR 60-550 MG<br />
pseudoephedrine-guaifenesin tab sr 12hr 60-580 mg<br />
PSEUDOEPHEDRINE-GUAIFENESIN TAB SR 12HR 60-600 MG OTC<br />
PSEUDOEPHEDRINE-GUAIFENESIN TAB SR 12HR 60-600 MG<br />
pseudoephedrine-guaifenesin tab sr 12hr 60-600 mg<br />
PSEUDOEPHEDRINE-GUAIFENESIN TAB SR 12HR 60-800 MG<br />
PSEUDOEPHEDRINE-GUAIFENESIN TAB SR 12HR 75-1200 MG<br />
pseudoephedrine-guaifenesin tab sr 12hr 80-700 mg<br />
pseudoephedrine-guaifenesin tab sr 12hr 80-780 mg<br />
pseudoephedrine-guaifenesin tab sr 12hr 80-800 mg<br />
pseudoephedrine-guaifenesin tab sr 12hr 85-795 mg<br />
PSEUDOEPHEDRINE-GUAIFENESIN TAB SR 12HR 90-1200 MG<br />
PSEUDOEPHEDRINE-GUAIFENESIN TAB SR 12HR 90-600 MG<br />
PSEUDOEPHEDRINE-GUAIFENESIN TAB SR 12HR 90-650 MG<br />
PSEUDOEPHEDRINE-GUAIFENESIN TAB SR 12HR 90-800 MG<br />
pseudoephedrine-guaifenesin tab sr 12hr 90-800 mg<br />
PSEUDOVENT CAP 400<br />
pseudovent cap 400<br />
pseudovent cap cr<br />
pseudovent cap ped cr<br />
px tussin sol 100/5ml OTC<br />
q-tussin syp 100/5ml OTC<br />
q-tussin pe syp pe -af OTC<br />
qc medifin tab 200mg OTC<br />
qc medifin tab cp OTC<br />
qc triactin syp chst con OTC<br />
qual-tussin dro ped<br />
quintex syp 7.5-100<br />
ra decongest syp pe cough OTC<br />
ra suphedrin cap non-dry OTC<br />
ra tussin syp 100/5ml OTC<br />
ra tussin pe syp 30-100/5 OTC<br />
refenesen tab 200mg OTC<br />
refenesen tab 400mg OTC<br />
refenesen tab chst cng OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 132
efenesen tab chst pe OTC<br />
refenesen tab plus OTC<br />
refenesen pe tab 10-400mg OTC<br />
reluri tab 30-1200<br />
RESPA-1ST TAB CR<br />
RESPA-PE TAB 18-600<br />
respaire-120 cap cr<br />
RESPAIRE-30 CAP<br />
ri-tussin syp 100/5ml OTC<br />
robafen syp 100/5ml OTC<br />
robitussin liq hd/chst OTC<br />
ru-tuss jr tab 45-600mg<br />
RYNA-12X SUS 5-30-100<br />
RYNA-12X TAB<br />
sb bronchial tab 12.5-200 OTC<br />
sb cgh contr syp 100/5ml OTC<br />
sb coughtab tab 200mg OTC<br />
sb sev/conge cap OTC<br />
sb sinus cng tab /pain OTC<br />
scot-tussin liq expct sf OTC<br />
severe conge tab cough ai OTC<br />
severe conge tab cough ai OTC<br />
sg tussin syp 100/5ml OTC<br />
sil-tex syp 7.5-100<br />
siltuss das liq 100/5ml OTC<br />
siltussin sa syp 100/5ml OTC<br />
simuc tab 25-900mg<br />
simuc-gp tab 25-1200<br />
SINA-12X SUS<br />
SINA-12X TAB 25-200MG<br />
sinus conges tab pain/svr OTC<br />
sinus congst tab /pain OTC<br />
sinus congst tab severe OTC<br />
sinutab cap non-dry OTC<br />
SINUVENT PE TAB 15-600MG<br />
SITREX TAB<br />
SITREX PD LIQ 7.5-75MG<br />
sm pediatric syp 100/5ml OTC<br />
sm tussin syp 100/5ml OTC<br />
stamoist e tab 45-600mg<br />
sudafed pe tab sinus OTC<br />
SUDAFED TRPL TAB ACTION OTC<br />
sudatex syp 40-200mg<br />
sudatex g tab 40-400mg OTC<br />
sudatex-g tab 60-580mg<br />
sudex tab 20-600mg<br />
super tussin syp pe OTC<br />
supertussin syp 100/5ml OTC<br />
supherine cap non-dry OTC<br />
SUPRESS-PE DRO PEDIATRI OTC<br />
TENAR PSE LIQ<br />
THERAFLU LIQ WARM RLF OTC<br />
THERAFLU FLU PAK CHST CON OTC<br />
tidafen la tab 45-800mg<br />
TOURO LA TAB<br />
tri acting syp chst con OTC<br />
triac expect syp 15/50 OTC<br />
TRIACTIN SOL CHST CON OTC<br />
triactin syp 15-50mg OTC<br />
triactin syp chst con OTC<br />
triacting syp chst con OTC<br />
triacting ci syp 15-50mg/ OTC<br />
TRIAMINIC LIQ CHST/NAS OTC<br />
triaminic syp OTC<br />
TRIAMINIC SYP CHST/NSL OTC<br />
TRISPEC DEX LIQ OTC<br />
TRISPEC SFX LIQ<br />
TUSNEL CAP<br />
TUSSI PRES-B LIQ<br />
tussi-pres liq pe ped OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 133
tussin cap severe OTC<br />
tussin syp 100/5ml OTC<br />
tussin chest syp 100/5ml OTC<br />
tussin cold cap sev cong OTC<br />
tussin cough syp 100/5ml OTC<br />
tussin exp syp 100/5ml OTC<br />
tussin pe liq OTC<br />
tussin pe syp 30-100/5 OTC<br />
tussin pe syp 30-100/5 OTC<br />
tussin sever cap congest OTC<br />
TYLENOL CHES LIQ CONGEST OTC<br />
TYLENOL SINU TAB SEV CONG OTC<br />
v-r tussin syp 100/5ml OTC<br />
VICKS CASERO LIQ OTC<br />
visonex tab 30-900mg<br />
VITA-NUMONYL SOL<br />
VITA-NUMONYL SOL EX<br />
wal-tussin cap cold OTC<br />
wal-tussin syp 100/5ml OTC<br />
we mist ii tab la<br />
wellbid-d tab 1200<br />
wellbid-d tab 40-600mg<br />
XEDEC TAB 20-800MG<br />
xedec ii tab<br />
xpect tab 400mg OTC<br />
xpect-pe tab 25-1200<br />
YODEFAN LIQ 600MG/15<br />
YODEFAN-NF LIQ 300MG/5<br />
ZINX CONGEST KIT<br />
ZOTEX GPX TAB<br />
ZOTEX-GP TAB<br />
zyrphen liq 7.5-200<br />
Mucolytic Agents<br />
broncho sal aer 0.9% OTC<br />
HYPER-SAL NEB 7%<br />
saline spray aer 0.9% OTC<br />
simply salin aer baby OTC<br />
sod chloride neb 0.9% OTC<br />
sod chloride neb 0.9%<br />
sodium chlor neb 0.45% OTC<br />
SODIUM CHLOR NEB 0.45% OTC<br />
sodium chlor neb 10%<br />
sodium chlor neb 3%<br />
sodium chloride aero soln 0.9% OTC<br />
SODIUM CHLORIDE SOLN NEBU 0.45% OTC<br />
sodium chloride soln nebu 0.45% OTC<br />
sodium chloride soln nebu 0.9% OTC<br />
sodium chloride soln nebu 0.9%<br />
sodium chloride soln nebu 10%<br />
sodium chloride soln nebu 3%<br />
SODIUM CHLORIDE SOLN NEBU 7%<br />
Respiratory Tract Agents, Miscellaneous<br />
ARALAST INJ 400MG PA<br />
ARALAST INJ 800MG PA<br />
ARALAST NP INJ 400MG PA<br />
ARALAST NP INJ 800MG PA<br />
PROLASTIN INJ 1000MG PA<br />
PROLASTIN INJ 500MG PA<br />
PROLASTIN-C INJ 1000MG PA<br />
XOLAIR SOL 150MG PA<br />
ZEMAIRA INJ 1000MG PA<br />
Eye, Ear, Nose & Throat Preparations<br />
Antiallergic Agents<br />
ASTELIN NASA SPR 137MCG QL NF<br />
ASTEPRO SPR 0.15% QL NF<br />
ASTEPRO SPR 137MCG PA QL<br />
AZELASTINE HCL NASAL SPRAY 0.15% (205.5 MCG/SPRAY) QL NF<br />
AZELASTINE HCL NASAL SPRAY 137 MCG/SPRAY (1 MG/ML) QL NF<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 134
cromolyn sod sol 4% op<br />
cromolyn sodium ophth soln 4%<br />
ketotifen fumarate ophth soln 0.025% (base equiv) PA OTC<br />
ketotifen fumarate ophth soln 0.025% (base equiv) PA<br />
OLOPATADINE HCL OPHTH SOLN 0.1%<br />
PATADAY SOL 0.2% PA<br />
PATANOL SOL 0.1% OP<br />
ZADITOR DRO 0.025%OP PA OTC<br />
Anti-infectives<br />
Antibacterials<br />
ak-tob sol 0.3% op<br />
bac/neo/poly oin op<br />
bacitracin oin op NF<br />
bacitracin oin op NF<br />
bacitracin ophth oint 500 unit/gm NF<br />
bacitracin ophth oint 500 unit/gm NF<br />
CILOXAN OIN 0.3% OP PA<br />
ciprofloxacin hcl ophth soln 0.3%<br />
ciprofloxacn sol 0.3% op<br />
erythromycin oin op<br />
erythromycin ophth oint 5 mg/gm<br />
genoptic sol 0.3% op<br />
gentacidin sol 0.3% op<br />
gentak oin 0.3% op<br />
gentak sol 0.3% op<br />
gentamicin oin 0.3% op<br />
gentamicin sol 0.3% op<br />
gentamicin sulfate ophth oint 0.3%<br />
gentamicin sulfate ophth soln 0.3%<br />
gentasol sol 0.3% op<br />
gra/neo/poly sol op<br />
neo/bac/poly oin op<br />
neo/bac/poly oin op<br />
neo/poly/bac oin op<br />
neo/poly/gra sol op<br />
neocin oin op<br />
neocin-pg sol op<br />
neomycin-bacitrac zn-polymyx 5(3.5)mg-400unt-10000unt op oin<br />
neomycin-polymyxin b-gramicidin ophth soln<br />
ocusulf-10 sol 10% op<br />
ocutricin sol op<br />
ofloxacin dro 0.3% op<br />
ofloxacin dro 0.3%otic NF<br />
ofloxacin ophth soln 0.3%<br />
ofloxacin otic soln 0.3% NF<br />
polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1%<br />
polymyxin b/ sol trimethp<br />
romycin oin op<br />
sod sulfacet sol 10% op<br />
sulf-10 sol 10% op<br />
sulfac sol 10% op<br />
SULFACET SOD OIN 10% OP<br />
sulfacet sod sol 10% op<br />
SULFACETAMIDE SODIUM OPHTH OINT 10%<br />
sulfacetamide sodium ophth soln 10%<br />
tobramycin sol 0.3% op<br />
TOBRAMYCIN SULFATE OPHTH OINT 0.3%<br />
tobramycin sulfate ophth soln 0.3%<br />
tobrasol sol 0.3% op<br />
TOBREX OIN 0.3% OP<br />
trimethoprim sol polymyxn<br />
trimethoprim sol polymyxn<br />
triple antib oin op<br />
triple antib sol op<br />
ZYMAR DRO 0.3% PA<br />
Antifungals<br />
NATACYN SUS 5% OP<br />
NATAMYCIN OPHTH SUSP 5%<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 135
Antivirals<br />
trifluridine ophth soln 1%<br />
trifluridine sol 1% op<br />
Anti-inflammatory Agents<br />
Corticosteroids<br />
acetasol hc sol otic<br />
acetic acid dro /hc otic<br />
acetic acid sol /hc ear<br />
acetic acid sol /hc otic<br />
antibiot ear sol 1% otic<br />
antibiot ear sus 1% otic<br />
bac/poly/neo oin /hc 1%op<br />
bacitracin-polymyxin-neomycin-hc ophth oint 1%<br />
BECLOMETHASONE DIPROPIONATE MONOHYD NASAL SUSP 42 MCG/SPRAY QL<br />
BECONASE AQ SUS 0.042% QL<br />
BLEPHAMIDE OIN S.O.P. NF<br />
BLEPHAMIDE SUS LIQUIFLM NF<br />
BLEPHAMIDE SUS OP<br />
CIPRODEX SUS 0.3-0.1% PA<br />
cortomycin sol 1% otic<br />
cortomycin sus 1% otic<br />
dexameth pho sol 0.1% op<br />
dexamethasone sodium phosphate ophth soln 0.1%<br />
dexasol sol 0.1% op<br />
dexasporin sus 0.1% op<br />
DUREZOL EMU 0.05% PA<br />
flunisolide spr 0.025% QL NF<br />
FLUNISOLIDE SPR 29MCG QL NF<br />
flunisolide nasal soln 0.025% QL NF<br />
FLUNISOLIDE NASAL SOLN 29 MCG/ACT QL NF<br />
fluor-op sus 0.1% op<br />
fluoromethol sus 0.1% op<br />
FLUOROMETHOLONE OPHTH OINT 0.1%<br />
fluorometholone ophth susp 0.1%<br />
FLUOROMETHOLONE OPHTH SUSP 0.25%<br />
fluticasone spr 50mcg<br />
fluticasone propionate nasal susp 50 mcg/act<br />
FML OIN 0.1% OP<br />
FML FORTE SUS 0.25% OP<br />
GENTAMICIN-PREDNISOLONE ACE OPHTH OINT 0.3-0.6%<br />
GENTAMICIN-PREDNISOLONE ACE OPHTH SUSP 0.3-1%<br />
hc/acet acid sol otic<br />
hydrocortisone w/ acetic acid otic soln 1-2%<br />
methadex sus 0.1% op<br />
MOMETASONE FUROATE NASAL SUSP 50 MCG/ACT QL<br />
NASACORT AQ AER 55MCG/AC QL<br />
NASONEX SPR 50MCG/AC QL<br />
neo/bac/poly oin /hc 1%op<br />
neo/poly/bac oin /hc 1%op<br />
neo/poly/dex oin 0.1% op<br />
neo/poly/dex sus 0.1% op<br />
neo/poly/hc sol 1% otic<br />
neo/poly/hc sol 1% otic<br />
neo/poly/hc sus 1% otic<br />
neo/poly/hc sus 1% otic<br />
neo/poly/hc sus op<br />
neo/poly/hc sus op<br />
neomycin-polymyxin-dexamethasone ophth oint 0.1%<br />
neomycin-polymyxin-dexamethasone ophth susp 0.1%<br />
neomycin-polymyxin-hc ophth susp<br />
neomycin-polymyxin-hc ophth susp<br />
neomycin-polymyxin-hc otic soln 1%<br />
neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000 unit/ml-1%<br />
oticin hc sus 1% otic<br />
poly-dex oin 0.1% op<br />
poly-dex sus 0.1% op<br />
PRED-G SUS OP<br />
PRED-G S.O.P OIN OP<br />
prednis/sulf sol op NF<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 136
prednis/sulf sus op<br />
prednisolone acetate ophth susp 1%<br />
prednisolone sus 1% op<br />
RHINOCORT SUS AQUA PA<br />
sulf/pred na sol op NF<br />
sulf/prednis sus op<br />
SULFACETAMIDE SODIUM-PREDNISOLONE OPHTH OINT 10-0.2% NF<br />
sulfacetamide sodium-prednisolone ophth soln 10-0.23(0.25)% NF<br />
SULFACETAMIDE SODIUM-PREDNISOLONE OPHTH SUSP 10-0.2%<br />
SULFACETAMIDE SODIUM-PREDNISOLONE OPHTH SUSP 10-0.2% NF<br />
sulfacetamide sodium-prednisolone ophth susp 10-0.2%<br />
TOBRADEX OIN OP<br />
TOBRAMYCIN-DEXAMETHASONE OPHTH OINT 0.3-0.1%<br />
tobramycin-dexamethasone ophth susp 0.3-0.1%<br />
tobramycin/ sus dexameth<br />
TRIAMCINOLONE ACETONIDE NASAL INHAL 55 MCG/ACT QL<br />
triple antib oin 0.1% op<br />
Nonsteroidal Anti-inflammatory Agents<br />
ACULAR SOL 0.5% OP<br />
ACULAR PF SOL 0.5% OP<br />
ACUVAIL SOL 0.45%<br />
diclofenac sol 0.1% op<br />
diclofenac sodium ophth soln 0.1%<br />
flurbiprofen sodium ophth soln 0.03%<br />
flurbiprofen sol 0.03% op<br />
ketorolac sol 0.4%<br />
ketorolac sol 0.5%<br />
ketorolac tromethamine ophth soln 0.4%<br />
KETOROLAC TROMETHAMINE OPHTH SOLN 0.45%<br />
KETOROLAC TROMETHAMINE OPHTH SOLN 0.5%<br />
ketorolac tromethamine ophth soln 0.5%<br />
Local Anesthetics<br />
a/b otic sol<br />
allergen sol otic<br />
antiben sol otic<br />
antipy/benzo dro otic<br />
antipy/benzo sol otic<br />
aurodex sol otic<br />
auroguard sol<br />
auroto sol otic<br />
balagan sol 1.4-5.4%<br />
BENZOCAINE-ANTIPYRINE OTIC SOLN 1.4-5.4%<br />
benzocaine-antipyrine otic soln 1.4-5.4%<br />
benzotic dro otic<br />
dolotic sol otic<br />
ear drops sol otic<br />
lidocaine sol 2% visc<br />
lidocaine sol 2% visc<br />
lidocaine hcl viscous soln 2%<br />
lidomar sol 2% visc<br />
OTILAM NR SOL 1.4-5.4%<br />
otogesic sol otic<br />
ototgesic dro<br />
otra nr sol otic<br />
pro-otic sol 1.4-5.4%<br />
Mydriatics<br />
ak-pentolate sol 1% op<br />
atropin-care sol 1% op<br />
atropine sul oin 1% op<br />
atropine sul sol 1% op<br />
atropine sulfate ophth oint 1%<br />
atropine sulfate ophth soln 1%<br />
CYCLOGYL SOL 0.5% OP<br />
CYCLOGYL SOL 2% OP<br />
cyclopentol sol 1% op<br />
CYCLOPENTOLATE HCL OPHTH SOLN 0.5%<br />
cyclopentolate hcl ophth soln 1%<br />
CYCLOPENTOLATE HCL OPHTH SOLN 2%<br />
cylate sol 1% op<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 137
dipivefrin sol 0.1% op<br />
dipivefrin hcl ophth soln 0.1%<br />
DIPIVEFRIN HCL OPHTH SOLN 0.1%<br />
homatropaire sol 5% op<br />
homatropine sol 5% op<br />
HOMATROPINE HBR OPHTH SOLN 2%<br />
homatropine hbr ophth soln 5%<br />
ISO HOMATROP SOL 2% OP<br />
ISO HYOSCINE SOL 0.25% OP<br />
mydral sol 0.5% op<br />
mydral sol 1% op<br />
PROPINE SOL 0.1% OP<br />
SCOPOLAMINE HBR OPHTH SOLN 0.25%<br />
tropicacyl sol 0.5% op<br />
tropicacyl sol 1% op<br />
tropicamide sol 0.5% op<br />
tropicamide sol 1% op<br />
tropicamide ophth soln 0.5%<br />
tropicamide ophth soln 1%<br />
Vasoconstrictors<br />
4-way fast spr act 1% OTC<br />
4-way menthl spr 1% OTC<br />
4-way no drp sol 1% OTC<br />
afrin allerg spr 0.5% OTC<br />
afrin child spr 0.25% OTC<br />
ak-dilate sol 10% op<br />
ak-dilate sol 2.5% op<br />
altafrin sol 0.12% OTC<br />
altafrin sol 10% op<br />
altafrin sol 2.5% op<br />
cvs nasal spr 1% OTC<br />
cvs nose dro 1% OTC<br />
decongestant dro 1% OTC<br />
decongestant sol 1% OTC<br />
ephrine nose dro 1% OTC<br />
eq nose dro 1% ex st OTC<br />
gnp nose dro 1% ex st OTC<br />
industrial sol OTC<br />
LITTLE NOSES DRO 0.125% OTC<br />
nasal four sol 1% OTC<br />
neofrin sol 10% op<br />
neofrin sol 2.5% op<br />
nose dro 1% OTC<br />
nu-way sol 1% OTC<br />
phenoptic sol 2.5% op<br />
phenylephrin sol 0.12% OTC<br />
phenylephrin sol 10% op<br />
phenylephrin sol 2.5% op<br />
PHENYLEPHRINE HCL NASAL SOLN 0.125% OTC<br />
PHENYLEPHRINE HCL NASAL SOLN 0.16% OTC<br />
phenylephrine hcl nasal soln 0.25% OTC<br />
phenylephrine hcl nasal soln 0.5% OTC<br />
phenylephrine hcl nasal soln 1% OTC<br />
phenylephrine hcl ophth soln 0.12% OTC<br />
phenylephrine hcl ophth soln 10%<br />
phenylephrine hcl ophth soln 2.5%<br />
qc multi way spr 1% OTC<br />
ra nose dro 1% ex st OTC<br />
rhinall sol 0.25% OTC<br />
rhinall spr 0.25% OTC<br />
sm nasal spr 1% OTC<br />
sm nose nasl dro 1% ex st OTC<br />
TUR-BI-KAL DRO 0.16% OTC<br />
wal-four sol 1% OTC<br />
Antiglaucoma Agents<br />
ALPHA ADRENERGIC AGONISTS<br />
ALPHAGAN P SOL 0.1%<br />
ALPHAGAN P SOL 0.15% NF<br />
brimonidine sol 0.15% NF<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 138
imonidine sol 0.2% op<br />
BRIMONIDINE TARTRATE OPHTH SOLN 0.1%<br />
brimonidine tartrate ophth soln 0.15% NF<br />
BRIMONIDINE TARTRATE OPHTH SOLN 0.15% NF<br />
brimonidine tartrate ophth soln 0.2%<br />
BETA ADRENERGIC BLOCKING AGENTS<br />
BETAXOLOL SOL 0.5% OP<br />
BETAXOLOL HCL OPHTH SOLN 0.5%<br />
BETAXOLOL HCL OPHTH SUSP 0.25%<br />
BETIMOL SOL 0.25% PA<br />
BETIMOL SOL 0.5% PA<br />
BETOPTIC-S SUS 0.25% OP<br />
ISTALOL SOL 0.5% OP<br />
levobunolol sol 0.25% op<br />
levobunolol sol 0.25% op<br />
levobunolol sol 0.5% op<br />
levobunolol hcl ophth soln 0.25%<br />
levobunolol hcl ophth soln 0.25%<br />
levobunolol hcl ophth soln 0.5%<br />
timolol gel sol 0.25% op<br />
timolol gel sol 0.5% op<br />
timolol mal sol 0.25% op<br />
timolol mal sol 0.5% op<br />
timolol maleate ophth gel forming soln 0.25%<br />
timolol maleate ophth gel forming soln 0.5%<br />
timolol maleate ophth soln 0.25%<br />
timolol maleate ophth soln 0.5%<br />
TIMOLOL MALEATE OPHTH SOLN 0.5% (ONCE-DAILY)<br />
CARBONIC ANYDRASE INHIBITORS<br />
acetazolamid cap 500mg<br />
acetazolamid tab 125mg<br />
acetazolamid tab 250mg<br />
acetazolamide cap sr 12hr 500 mg<br />
acetazolamide sodium for inj 500 mg PA<br />
acetazolamide tab 125 mg<br />
acetazolamide tab 250 mg<br />
dorzolamide sol 2% op<br />
dorzolamide hcl ophth soln 2%<br />
methazolamid tab 25mg<br />
methazolamid tab 50mg<br />
methazolamide tab 25 mg<br />
methazolamide tab 50 mg<br />
MIOTICS<br />
carbachol ophth soln 3% PA<br />
ISO CARBACHO SOL 1.5% OP PA<br />
ISO CARBACHO SOL 3% OP PA<br />
MIOSTAT INJ 0.01% OP PA<br />
pilocar sol 0.5% op<br />
pilocar sol 1% op<br />
pilocar sol 2% op<br />
pilocar sol 4% op<br />
pilocar sol 6% op<br />
PILOCARPINE SOL 0.5% OP<br />
pilocarpine sol 0.5% op<br />
pilocarpine sol 1% op<br />
pilocarpine sol 2% op<br />
PILOCARPINE SOL 3% OP<br />
pilocarpine sol 3% op<br />
pilocarpine sol 4% op<br />
pilocarpine sol 6% op<br />
PILOCARPINE HCL OPHTH SOLN 0.5%<br />
pilocarpine hcl ophth soln 0.5%<br />
pilocarpine hcl ophth soln 1%<br />
pilocarpine hcl ophth soln 2%<br />
pilocarpine hcl ophth soln 3%<br />
PILOCARPINE HCL OPHTH SOLN 3%<br />
pilocarpine hcl ophth soln 4%<br />
pilocarpine hcl ophth soln 6%<br />
piloptic-1 sol 1% op<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 139
PILOPTIC-1/2 SOL 0.5% OP<br />
piloptic-2 sol 2% op<br />
PILOPTIC-3 SOL 3% OP<br />
piloptic-4 sol 4% op<br />
piloptic-6 sol 6% op<br />
PROSTAGLANDIN ANALOGS<br />
BIMATOPROST OPHTH SOLN 0.03%<br />
LATANOPROST OPHTH SOLN 0.005%<br />
LUMIGAN SOL 0.03%<br />
XALATAN SOL 0.005%<br />
EENT <strong>Drugs</strong>, Miscellaneous<br />
acetic acid sol 2% otic<br />
acetic acid otic soln 2%<br />
AMVISC INJ 12MG/ML PA<br />
AMVISC PLUS INJ 16MG/ML PA<br />
DISCOVISC SOL PA<br />
DUOVISC KIT 0.35/0.4 PA<br />
DUOVISC KIT 0.5/0.55 PA<br />
HEALON INJ 10MG/ML PA<br />
HEALON GV INJ 14MG/ML PA<br />
HEALON5 INJ 23MG/ML PA<br />
PROVISC INJ 1% PA<br />
SHELLGEL SOL PA<br />
VISCOAT SOL PA<br />
VISUDYNE INJ 15MG PA<br />
VITRAX INJ 30MG/ML PA<br />
Gastrointestinal <strong>Drugs</strong><br />
Antidiarrhea Agents<br />
diphen/atrop liq 2.5/5<br />
diphen/atrop tab 2.5mg<br />
diphenatol tab 2.5mg<br />
diphenoxylate w/ atropine liq 2.5-0.025 mg/5ml<br />
diphenoxylate w/ atropine tab 2.5-0.025 mg<br />
lofene tab 2.5mg<br />
lonox tab 2.5mg<br />
Cathartics and Laxatives<br />
GOLYTELY SOL NF<br />
PEG 3350-KCL-NA BICARB-NACL-NA SULFATE PACKET 227.1 GM NF<br />
Digestants<br />
AMY-LIP-PROT DR PARTICLES CAP 12000-4000-12000 UNIT<br />
AMY-LIP-PROT DR PARTICLES CAP 16600-5000-18750 UNIT<br />
AMY-LIP-PROT DR PARTICLES CAP 20000-4500-25000 UNIT<br />
amy-lip-prot dr particles cap 20000-4500-25000 unit<br />
AMY-LIP-PROT DR PARTICLES CAP 25000-4000-25000 UNIT<br />
AMY-LIP-PROT DR PARTICLES CAP 30000-10000-30000 UNIT<br />
amy-lip-prot dr particles cap 30000-10000-30000 unit<br />
AMY-LIP-PROT DR PARTICLES CAP 33200-10000-37500 UNIT<br />
amy-lip-prot dr particles cap 33200-10000-37500 unit<br />
AMY-LIP-PROT DR PARTICLES CAP 39000-12000-39000 UNIT<br />
amy-lip-prot dr particles cap 39000-12000-39000 unit<br />
AMY-LIP-PROT DR PARTICLES CAP 40000-8000-45000 UNIT<br />
AMY-LIP-PROT DR PARTICLES CAP 48000-16000-48000 UNIT<br />
amy-lip-prot dr particles cap 48000-16000-48000 unit<br />
AMY-LIP-PROT DR PARTICLES CAP 52000-16000-52000 UNIT<br />
AMY-LIP-PROT DR PARTICLES CAP 56000-20000-44000 UNIT<br />
AMY-LIP-PROT DR PARTICLES CAP 58500-18000-58500 UNIT<br />
amy-lip-prot dr particles cap 58500-18000-58500 unit<br />
AMY-LIP-PROT DR PARTICLES CAP 65000-20000-65000 UNIT<br />
amy-lip-prot dr particles cap 65000-20000-65000 unit<br />
AMY-LIP-PROT DR PARTICLES CAP 66400-20000-75000 UNIT<br />
amy-lip-prot dr particles cap 66400-20000-75000 unit<br />
AMYLASE-LIPASE-PROTEASE CAP 15000-1200-15000 UNIT<br />
AMYLASE-LIPASE-PROTEASE CAP 20000-4000-25000 UNIT<br />
AMYLASE-LIPASE-PROTEASE CAP 30000-2400-30000 UNIT<br />
AMYLASE-LIPASE-PROTEASE CAP 30000-8000-30000 UNIT<br />
AMYLASE-LIPASE-PROTEASE POWD 70000-16800-70000 UNIT<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 140
AMYLASE-LIPASE-PROTEASE TAB 12500-1000-12500 UNIT<br />
AMYLASE-LIPASE-PROTEASE TAB 30000-8000-30000 UNIT<br />
amylase-lipase-protease tab 30000-8000-30000 unit<br />
AMYLASE-LIPASE-PROTEASE TAB 60000-16000-60000 UNIT<br />
amylase-lipase-protease tab 60000-16000-60000 unit<br />
CREON 10 CAP EC<br />
CREON 20 CAP<br />
CREON 5 CAP<br />
DYGASE CAP<br />
ENZYCAP CAP<br />
ENZYMAX TAB<br />
hydrochloric acid inj 1:500 PA<br />
KU-ZYME CAP<br />
KU-ZYME-HP CAP<br />
KUTRASE CAP<br />
LAPASE CAP<br />
LIPRAM 4500 CAP<br />
LIPRAM-CR10 CAP<br />
LIPRAM-CR20 CAP<br />
lipram-pn10 cap<br />
LIPRAM-PN16 CAP<br />
LIPRAM-PN20 CAP<br />
LIPRAM-UL12 CAP<br />
LIPRAM-UL18 CAP<br />
lipram-ul20 cap<br />
PALCAPS 10 CAP<br />
PALCAPS 20 CAP<br />
PANCREASE MT CAP 10<br />
PANCREASE MT CAP 16<br />
PANCREASE MT CAP 20<br />
PANCREASE MT CAP 4<br />
PANCRECARB CAP MS-16<br />
PANCRECARB CAP MS-4<br />
PANCRECARB CAP MS-8<br />
PANCRELIPASE CAP<br />
PANCRELIPASE CAP 10000<br />
PANCRELIPASE CAP 16000<br />
PANCRELIPASE CAP 20000<br />
PANCRELIPASE CAP 4500<br />
PANCRELIPASE CAP 4500UNIT<br />
PANCRELIPASE CAP MST-16<br />
PANCRELIPASE TAB<br />
PANCRON 10 CAP EC<br />
PANCRON 20 CAP<br />
panges cn 10 cap<br />
PANGES CN 10 CAP<br />
panges cn 20 cap<br />
panges mt 16 cap<br />
panges ul 12 cap<br />
panges ul 18 cap<br />
panges ul 20 cap<br />
PANGESTYM EC CAP<br />
pangestym ec cap<br />
PANOCAPS CAP<br />
PANOCAPS CAP MT 16<br />
PANOCAPS CAP MT 20<br />
PANOKASE TAB<br />
panokase-16 tab<br />
PLARETASE TAB 8000<br />
plaretase tab 8000<br />
ULTRACAPS CAP MT 20<br />
ULTRASE CAP<br />
ULTRASE MT12 CAP<br />
ULTRASE MT18 CAP<br />
ULTRASE MT20 CAP<br />
VIOKASE POW<br />
VIOKASE 16 TAB<br />
VIOKASE 8 TAB<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 141
Antiemetics<br />
<strong>Antihistamine</strong>s<br />
DIMENHYDRIN INJ 50MG/ML PA<br />
tebamide sup 100mg<br />
tebamide sup 200mg<br />
trimethobenz cap 250mg<br />
trimethobenz cap 300mg<br />
trimethobenz sup 100mg<br />
trimethobenz sup 100mg<br />
trimethobenz sup 200mg<br />
trimethobenzamide hcl cap 250 mg<br />
trimethobenzamide hcl cap 300 mg<br />
trimethobenzamide hcl inj 100 mg/ml PA<br />
trimethobenzamide hcl suppos 100 mg<br />
trimethobenzamide-benzocaine suppos 100 mg-2%<br />
trimethobenzamide-benzocaine suppos 200 mg-2%<br />
5-HT3 Receptor Antagonists<br />
ALOXI INJ PA<br />
ALOXI INJ 0.25MG/5 PA<br />
ANZEMET INJ 20MG/ML PA<br />
granisetron hcl inj 0.1 mg/ml PA<br />
granisetron hcl inj 1 mg/ml PA<br />
granisetron hcl tab 1 mg PA<br />
GRANISOL SOL 2MG/10ML PA<br />
ONDANSETRON SOL 32MG/50M PA<br />
ondansetron hcl and dextrose inj 32 mg/50ml PA<br />
ondansetron hcl inj 2 mg/ml PA<br />
ondansetron hcl oral soln 4 mg/5ml PA<br />
ondansetron hcl tab 24 mg PA<br />
ondansetron hcl tab 4 mg PA<br />
ondansetron hcl tab 8 mg PA<br />
ondansetron orally disintegrating tab 4 mg PA<br />
ondansetron orally disintegrating tab 8 mg PA<br />
Antiemetics, Miscellaneous<br />
EMEND SOL 115MG PA<br />
Antiulcer Agents and Acid Suppressants<br />
Histamine H2-Antagonists<br />
acid reducer tab 200mg OTC<br />
acid relief tab 200mg OTC<br />
CIMETID/NACL INJ 300/50ML PA<br />
cimetidine sol 300/5ml<br />
cimetidine tab 200mg<br />
cimetidine tab 200mg OTC<br />
cimetidine tab 300mg<br />
cimetidine tab 400mg<br />
cimetidine tab 800mg<br />
cimetidine hcl inj 150 mg/ml PA<br />
cimetidine hcl soln 300 mg/5ml<br />
cimetidine tab 200 mg<br />
cimetidine tab 200 mg OTC<br />
cimetidine tab 300 mg<br />
cimetidine tab 400 mg<br />
cimetidine tab 800 mg<br />
eq heartburn tab relief OTC<br />
famotidine tab 20mg NF<br />
famotidine tab 40mg NF<br />
famotidine in nacl 0.9% iv soln 20 mg/50ml PA<br />
famotidine inj 10 mg/ml PA<br />
famotidine tab 20 mg NF<br />
famotidine tab 40 mg NF<br />
heartburn tab 200mg OTC<br />
heartburn tab relief OTC<br />
heartburn tab relief OTC<br />
heartburn tab relief OTC<br />
mp heartburn tab 200mg OTC<br />
PEPCID SUS 40MG/5ML PA<br />
qc heartburn tab 200mg OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 142
anitidine cap 150mg<br />
ranitidine cap 300mg<br />
ranitidine syp 150/10ml<br />
ranitidine syp 15mg/ml<br />
ranitidine syp 75mg/5ml<br />
ranitidine syp 75mg/5ml<br />
ranitidine hcl cap 150 mg<br />
ranitidine hcl cap 300 mg<br />
RANITIDINE HCL EFFER GRANULES PACKET 150 MG<br />
ranitidine hcl inj 25 mg/ml PA<br />
ranitidine hcl syrup 15 mg/ml (75 mg/5ml)<br />
sm acid redu tab 200mg OTC<br />
ZANTAC GRA 150MG<br />
ZANTAC INJ 50/50ML PA<br />
ZANTAC TAB 150MG EF PA<br />
ZANTAC TAB 25MG EF PA<br />
Prostaglandins<br />
misoprostol tab 100mcg<br />
misoprostol tab 200mcg<br />
misoprostol tab 100 mcg<br />
misoprostol tab 200 mcg<br />
Protectants<br />
CARAFATE SUS 1GM/10ML<br />
SUCRALFATE SUS 1GM/10ML<br />
sucralfate tab 1gm<br />
SUCRALFATE SUSP 1 GM/10ML<br />
sucralfate tab 1 gm<br />
Proton-pump Inhibitors<br />
AMOXICILLIN CAP-CLARITHRO TAB-LANSOPRAZ CAP DR THERAPY PACK<br />
lansoprazole cap delayed release 15 mg PA<br />
lansoprazole cap delayed release 30 mg PA<br />
LANSOPRAZOLE TAB DELAYED RELEASE ORALLY DISINTEGRATING 15 MG QL<br />
LANSOPRAZOLE TAB DELAYED RELEASE ORALLY DISINTEGRATING 30 MG QL<br />
NEXIUM CAP 20MG PA<br />
NEXIUM CAP 40MG PA<br />
NEXIUM I.V. INJ 20MG PA<br />
NEXIUM I.V. INJ 40MG PA<br />
omeprazole cap 20mg QL<br />
omeprazole cap delayed release 10 mg PA<br />
omeprazole cap delayed release 20 mg QL<br />
omeprazole cap delayed release 40 mg PA<br />
pantoprazole sodium ec tab 20 mg (base equiv) PA<br />
pantoprazole sodium ec tab 40 mg (base equiv) PA<br />
PREVACID CAP 15MG DR PA<br />
PREVACID CAP 30MG DR PA<br />
PREVACID GRA 15MG PA<br />
PREVACID GRA 30MG PA<br />
PREVACID TAB 15MG STB QL<br />
PREVACID TAB 30MG STB QL<br />
PREVACID 24H CAP 15MG DR PA OTC<br />
PREVACID I.V INJ 30MG PA<br />
PREVPAC MIS<br />
PROTONIX INJ 40MG PA<br />
PROTONIX TAB 40MG PA<br />
ZEGERID CAP 20-1100 PA<br />
ZEGERID CAP 40-1100 PA<br />
ZEGERID POW 20-1680 PA<br />
ZEGERID POW 40-1680 PA<br />
ZEGERID OTC CAP 20-1100 PA OTC<br />
Prokinetic Agents<br />
metoclopram syp 5mg/5ml<br />
metoclopram tab 10mg<br />
metoclopram tab 5mg<br />
metoclopramide hcl inj 5 mg/ml PA<br />
metoclopramide hcl soln 5 mg/5ml (10 mg/10ml) PA<br />
metoclopramide hcl syrup 5 mg/5ml<br />
metoclopramide hcl tab 10 mg<br />
metoclopramide hcl tab 5 mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 143
Anti-inflammatory Agents<br />
ASACOL TAB 400MG DR PA<br />
LIALDA TAB 1.2GM PA<br />
MESALAMINE CAP CR 250 MG<br />
MESALAMINE CAP CR 500 MG<br />
PENTASA CAP 250MG CR<br />
PENTASA CAP 500MG CR<br />
GI <strong>Drugs</strong>, Miscellaneous<br />
CIMZIA KIT PA<br />
CIMZIA KIT 200MG/ML PA<br />
RELISTOR INJ 12/0.6ML PA QL<br />
RELISTOR KIT 12/0.6ML PA QL<br />
XENICAL CAP 120MG PA<br />
Gold Compounds<br />
gold sodium thiomalate inj 50 mg/ml PA<br />
Heavy Metal Antagonists<br />
BAL IN OIL INJ 100MG/ML PA<br />
CALCIUM DISO INJ 200MG/ML PA<br />
CALCIUM DISO INJ 500/2.5M PA<br />
deferoxamine mesylate for inj 2 gm PA<br />
deferoxamine mesylate for inj 500 mg PA<br />
edetate disodium inj 150 mg/ml PA<br />
ENDRATE INJ 150MG/ML PA<br />
SOD NITRITE INJ 30MG/ML PA<br />
SOD THIOSULF INJ 10% PA<br />
SOD THIOSULF INJ 25% PA<br />
sodium thiosulfate inj 10% PA<br />
sodium thiosulfate inj 25% PA<br />
Hormones and Synthetic Substitutes<br />
Adrenals<br />
AEROBID AER 250MCG QL<br />
AEROBID-M AER 250MCG QL<br />
ALVESCO AER 160MCG PA<br />
ALVESCO AER 80MCG PA<br />
ARISTOSPAN INJ 20MG/ML PA<br />
ARISTOSPAN INJ 5MG/ML PA<br />
AZMACORT AER 75MCG QL<br />
baycadron elx 0.5/5ml<br />
BECLOMETHASONE DIPROPIONATE INHAL AERO SOLN 40 MCG/ACT QL<br />
BECLOMETHASONE DIPROPIONATE INHAL AERO SOLN 80 MCG/ACT QL<br />
betamethasone acetate & sod phosphate inj susp 3-3 mg/ml PA<br />
budesonide sus 0.25mg/2 QL<br />
budesonide sus 0.5mg/2 QL<br />
BUDESONIDE INHAL AERO POWD 200 MCG/INH (BREATH ACTIVATED) QL<br />
budesonide inhalation susp 0.25 mg/2ml QL<br />
budesonide inhalation susp 0.5 mg/2ml QL<br />
BUDESONIDE INHALATION SUSP 1 MG/2ML QL<br />
DEPO-MEDROL INJ 20MG/ML PA<br />
dexamethason elx 0.5/5ml<br />
dexamethason tab 0.5mg<br />
dexamethason tab 0.75mg<br />
dexamethason tab 1.5mg<br />
dexamethason tab 1mg<br />
dexamethason tab 2mg<br />
dexamethason tab 4mg<br />
dexamethason tab 6mg<br />
dexamethasone elixir 0.5 mg/5ml<br />
dexamethasone sodium phosphate inj 10 mg/ml PA<br />
dexamethasone sodium phosphate inj 4 mg/ml PA<br />
dexamethasone tab 0.5 mg<br />
dexamethasone tab 0.75 mg<br />
dexamethasone tab 1 mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 144
dexamethasone tab 1.5 mg<br />
dexamethasone tab 1.5 mg taper pack<br />
DEXAMETHASONE TAB 1.5 MG TAPER PACK<br />
dexamethasone tab 2 mg<br />
dexamethasone tab 4 mg<br />
dexamethasone tab 6 mg<br />
DEXPAK PAK 10 DAY<br />
DEXPAK PAK 13 DAY<br />
FLOVENT HFA AER 110MCG QL<br />
FLOVENT HFA AER 220MCG QL<br />
FLOVENT HFA AER 44MCG QL<br />
fludrocort tab 0.1mg NF<br />
fludrocortisone acetate tab 0.1 mg NF<br />
FLUNISOLIDE INHAL AEROSOL 250 MCG/ACT QL<br />
FLUTICASONE PROPIONATE HFA INHAL AEROSOL 110 MCG/ACT QL<br />
FLUTICASONE PROPIONATE HFA INHAL AEROSOL 220 MCG/ACT QL<br />
FLUTICASONE PROPIONATE HFA INHAL AEROSOL 44 MCG/ACT QL<br />
hydrocort tab 10mg<br />
hydrocort tab 20mg<br />
hydrocort tab 5mg<br />
hydrocortisone sodium succinate for inj 100 mg PA<br />
hydrocortisone tab 10 mg<br />
hydrocortisone tab 20 mg<br />
hydrocortisone tab 5 mg<br />
MEDROL TAB 16MG<br />
MEDROL TAB 2MG<br />
methylpred pak 4mg<br />
methylpred tab 16mg<br />
methylpred tab 32mg<br />
methylpred tab 4mg<br />
methylpred tab 8mg<br />
methylprednisolone acetate inj susp 40 mg/ml PA<br />
methylprednisolone acetate inj susp 80 mg/ml PA<br />
methylprednisolone sodium succinate for inj 1000 mg PA<br />
methylprednisolone sodium succinate for inj 125 mg PA<br />
methylprednisolone sodium succinate for inj 40 mg PA<br />
methylprednisolone sodium succinate for inj 500 mg PA<br />
METHYLPREDNISOLONE TAB 16 MG<br />
methylprednisolone tab 16 mg<br />
METHYLPREDNISOLONE TAB 2 MG<br />
methylprednisolone tab 32 mg<br />
methylprednisolone tab 4 mg<br />
methylprednisolone tab 4 mg dose pack<br />
methylprednisolone tab 8 mg<br />
MILLIPRED SOL 10MG/5ML<br />
MILLIPRED TAB 5MG<br />
pred sod pho sol 5mg/5ml<br />
pred sod pho sol 6.7/5ml<br />
PREDNISOLONE SOD PHOSPHATE ORAL SOLN 10 MG/5ML (BASE EQUIV)<br />
prednisolone sod phosphate oral soln 15 mg/5ml (base equiv)<br />
PREDNISOLONE SOD PHOSPHATE ORAL SOLN 20 MG/5ML (BASE EQUIV)<br />
prednisolone sod phosphate oral soln 5 mg/5ml (base equiv)<br />
prednisolone sol 15mg/5ml<br />
prednisolone sol 15mg/5ml<br />
prednisolone sol 15mg/5ml<br />
prednisolone syp 15mg/5ml<br />
prednisolone syp 5mg/5ml<br />
prednisolone syrup 15 mg/5ml (usp solution equivalent)<br />
prednisolone syrup 5 mg/5ml<br />
PREDNISOLONE TAB 5 MG<br />
prednisolone tab 5 mg<br />
PREDNISOLONE TAB 5MG<br />
prednisolone tab 5mg<br />
prednisone tab 10mg<br />
prednisone tab 1mg<br />
prednisone tab 2.5mg<br />
prednisone tab 20mg<br />
PREDNISONE TAB 50MG<br />
prednisone tab 50mg<br />
prednisone tab 5mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 145
prednisone tab 1 mg<br />
prednisone tab 10 mg<br />
prednisone tab 2.5 mg<br />
prednisone tab 20 mg<br />
prednisone tab 5 mg<br />
PREDNISONE TAB 50 MG<br />
prednisone tab 50 mg<br />
PULMICORT AER 200MCG QL<br />
PULMICORT INH 180MCG PA QL<br />
PULMICORT INH 200MCG QL<br />
PULMICORT INH 90MCG PA QL<br />
PULMICORT SUS 1MG/2ML QL<br />
QVAR AER 40MCG QL<br />
QVAR AER 80MCG QL<br />
SOLU-CORTEF INJ 1000MG PA<br />
SOLU-CORTEF INJ 250MG PA<br />
SOLU-CORTEF INJ 500MG PA<br />
SOLU-MEDROL INJ 2GM PA<br />
TRIAMCINOLONE ACETONIDE INHAL AEROSOL 75 MCG/ACT (200/VALVE) QL<br />
triamcinolone acetonide inj susp 10 mg/ml PA<br />
triamcinolone acetonide inj susp 40 mg/ml PA<br />
VERIPRED 20 SOL 20MG/5ML<br />
zema-pak pak 10 day<br />
zema-pak pak 13 day<br />
zema-pak pak 6 day<br />
Androgens<br />
danazol cap 100mg<br />
danazol cap 200mg<br />
danazol cap 50mg<br />
danazol cap 100 mg<br />
danazol cap 200 mg<br />
danazol cap 50 mg<br />
NANDROL DEC INJ 100MG/ML PA<br />
NANDROL DEC INJ 200MG/ML PA<br />
TESTOPEL MIS PELLETS PA<br />
testosterone cypionate im in oil 100 mg/ml PA<br />
testosterone cypionate im in oil 200 mg/ml PA<br />
testosterone enanthate im in oil 200 mg/ml PA<br />
Contraceptives<br />
apri tab<br />
aranelle tab<br />
azurette tab 28 day<br />
camila tab 0.35mg<br />
cryselle-28 tab 28 tabs<br />
desogest-eth estrad & eth estrad tab 0.15-0.02/0.01 mg(21/5)<br />
desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg<br />
DROSPIRENONE-ETHINYL ESTRADIOL TAB 3-0.02 MG NF<br />
drospirenone-ethinyl estradiol tab 3-0.03 mg<br />
DROSPIRENONE-ETHINYL ESTRADIOL TAB 3-0.03 MG<br />
enpresse-28 tab<br />
errin tab 0.35mg<br />
ETONOGESTREL-ETHINYL ESTRADIOL VA RING 0.120-0.015 MG/24HR QL<br />
IMPLANON IMP 68MG PA<br />
jolivette tab 0.35mg<br />
kariva tab 28 day<br />
leena tab<br />
levonorgestrel & ethinyl estradiol tab 0.15 mg-30 mcg<br />
levonorgestrel tab 0.75 mg QL<br />
LEVONORGESTREL TAB 1.5 MG QL<br />
levonorgestrel-eth estra tab 0.05-30/0.075-40/0.125-30mg-mcg<br />
LEVONORGESTREL-ETH ESTRA TAB 0.05-30/0.075-40/0.125-30MG-MCG<br />
levora-28 tab 0.15/30<br />
low-ogestrel tab<br />
mononessa tab<br />
necon tab 0.5/35<br />
necon tab 1/35-28<br />
necon tab 1/50-28<br />
NECON TAB 10/11-28<br />
necon 7/7/7 tab 28 day<br />
next choice tab 0.75mg QL<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 146
nora-be tab 0.35mg<br />
NORELGESTROMIN-ETHINYL ESTRADIOL TD PTWK 150-20 MCG/24HR QL<br />
norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg<br />
norethindrone & ethinyl estradiol tab 1 mg-35 mcg<br />
norethindrone & mestranol tab 1 mg-50 mcg<br />
norethindrone tab 0.35 mg<br />
norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35 mg-mcg<br />
NORETHINDRONE-ETH ESTRADIOL TAB 0.5-35/1-35 MG-MCG (10/11)<br />
norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35 mg-mcg<br />
norgest/eth tab estrad<br />
norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg<br />
norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg<br />
norgestrel & ethinyl estradiol tab 0.5 mg-50 mcg<br />
nortrel (21) tab 1/35<br />
nortrel (28) tab 1/35<br />
nortrel 28 tab 0.5/35<br />
nortrel7/7/7 tab 28 days<br />
NUVARING MIS QL<br />
OCELLA TAB 3-0.03MG<br />
ocella tab 3-0.03mg<br />
ogestrel tab<br />
ORTHO EVRA DIS WEEK QL<br />
ORTHO TRI- TAB CYCLN LO PA<br />
PLAN B TAB 1.5MG QL<br />
portia-28 tab<br />
previfem tab<br />
reclipsen tab<br />
solia tab<br />
sprintec 28 tab 28 day<br />
TRIPHASIL 28 TAB<br />
trivora-28 tab<br />
YAZ TAB 3-0.02MG NF<br />
Estrogens and Antiestrogens<br />
Estrogens<br />
DEPO-ESTRADI INJ 5MG/ML PA<br />
ESTRADIOL TD PATCH BIWEEKLY 0.0375 MG/24HR NF<br />
ESTRADIOL TD PATCH BIWEEKLY 0.05 MG/24HR NF<br />
ESTRADIOL TD PATCH BIWEEKLY 0.075 MG/24HR NF<br />
ESTRADIOL TD PATCH BIWEEKLY 0.1 MG/24HR NF<br />
estradiol valerate im in oil 10 mg/ml PA<br />
estradiol valerate im in oil 20 mg/ml PA<br />
estradiol valerate im in oil 40 mg/ml PA<br />
PREMARIN INJ 25MG PA<br />
VIVELLE-DOT DIS 0.0375MG NF<br />
VIVELLE-DOT DIS 0.05MG NF<br />
VIVELLE-DOT DIS 0.075MG NF<br />
VIVELLE-DOT DIS 0.1MG NF<br />
Gonadotropins<br />
BRAVELLE INJ 75UNIT PA<br />
chorionic gonadotropin for inj 10000 unit PA<br />
FOLLISTIM AQ INJ 150UNIT PA<br />
FOLLISTIM AQ INJ 300UNIT PA<br />
FOLLISTIM AQ INJ 600UNIT PA<br />
FOLLISTIM AQ INJ 75UNIT PA<br />
FOLLISTIM AQ INJ 900UNIT PA<br />
GONAL-F INJ 1050UNIT PA<br />
GONAL-F INJ 450UNIT PA<br />
GONAL-F RFF INJ 300 PA<br />
GONAL-F RFF INJ 450 PA<br />
GONAL-F RFF INJ 75UNIT PA<br />
GONAL-F RFF INJ 900 PA<br />
LUVERIS INJ 75UNIT PA<br />
MENOPUR INJ 75UNIT PA<br />
NAFARELIN ACETATE NASAL SOLN 2 MG/ML<br />
OVIDREL INJ PA<br />
PROFASI HP INJ 5000UNIT PA<br />
REPRONEX INJ 75UNIT PA<br />
SYNAREL SOL 2MG/ML<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 147
Antidiabetic Agents<br />
Alpha-Glucosidase Inhibitors<br />
acarbose tab 100 mg PA<br />
acarbose tab 25 mg PA<br />
acarbose tab 50 mg PA<br />
Amylinomimetics<br />
SYMLIN INJ 600MCG PA<br />
SYMLINPEN 60 INJ 1000MCG PA<br />
SYMLNPEN 120 INJ 1000MCG PA<br />
Biguanides<br />
METFORMIN TAB 850MG<br />
metformin hcl tab 1000 mg PA QL<br />
metformin hcl tab 500 mg PA<br />
METFORMIN HCL TAB 850 MG<br />
metformin hcl tab 850 mg PA<br />
Incretin Mimetics<br />
BYETTA INJ 10MCG PA<br />
BYETTA INJ 5MCG PA<br />
VICTOZA INJ 18MG/3ML PA<br />
Insulins<br />
APIDRA INJ NF<br />
APIDRA INJ SOLOSTAR NF<br />
APIDRA INJ U-100 NF<br />
EXUBERA POW KIT NF<br />
EXUBERA COMB POW PACK 12 NF<br />
EXUBERA COMB POW PACK 15 NF<br />
EXUBERA PTPK POW 1MG NF<br />
EXUBERA PTPK POW 3MG NF<br />
HUMALOG INJ 100/ML PA<br />
HUMALOG INJ 100/ML QL<br />
HUMALOG KWIK INJ 100/ML QL<br />
HUMALOG MIX INJ 50/50 QL<br />
HUMALOG MIX INJ 50/50KWP QL<br />
HUMALOG MIX INJ 75/25KWP QL<br />
HUMALOG MIX SUS 75/25 QL<br />
HUMALOG PEN INJ 100/ML QL<br />
HUMALOG PEN INJ 100/ML PA<br />
HUMALOG PEN INJ 100/ML QL<br />
HUMALOG PEN INJ 50/50 QL<br />
HUMALOG PEN INJ 75/25 QL<br />
HUMULIN INJ 50/50 OTC<br />
HUMULIN INJ 70/30 OTC<br />
HUMULIN N INJ U-100 OTC<br />
HUMULIN N PN INJ U-100 OTC<br />
HUMULIN N PN INJ U-100 OTC QL<br />
HUMULIN N PN INJ U-100 OTC<br />
HUMULIN PEN INJ 70/30 OTC QL<br />
HUMULIN PEN INJ 70/30 OTC<br />
HUMULIN R INJ U-100 OTC<br />
HUMULIN R INJ U-100 OTC<br />
HUMULIN R INJ U-500<br />
INSULIN ASPART INJ 100 UNIT/ML NF<br />
INSULIN ASPART INJ 100 UNIT/ML QL<br />
INSULIN ASPART PROT & ASPART (HUMAN) INJ 100 UNIT/ML (70-30) QL<br />
INSULIN ASPART PROT & ASPART (HUMAN) INJ 100 UNIT/ML (70-30) NF<br />
INSULIN DETEMIR INJ 100 UNIT/ML NF<br />
INSULIN GLARGINE INJ 100 UNIT/ML QL<br />
INSULIN GLARGINE INJ 100 UNIT/ML QL<br />
INSULIN GLULISINE INJ 100 UNIT/ML NF<br />
INSULIN GLULISINE SUBCUTANEOUS INJ 100 UNIT/ML NF<br />
INSULIN ISOPHANE & REGULAR (HUMAN) INJ 100 UNIT/ML (50-50) OTC<br />
INSULIN ISOPHANE & REGULAR (HUMAN) INJ 100 UNIT/ML (70-30) OTC<br />
INSULIN ISOPHANE & REGULAR (HUMAN) INJ 100 UNIT/ML (70-30) OTC QL<br />
INSULIN ISOPHANE & REGULAR (HUMAN) INJ 100 UNIT/ML (70-30) OTC NF<br />
INSULIN ISOPHANE & REGULAR (HUMAN) INJ 100 UNIT/ML (70-30) OTC<br />
INSULIN ISOPHANE (HUMAN) INJ 100 UNIT/ML OTC QL<br />
INSULIN ISOPHANE (HUMAN) INJ 100 UNIT/ML OTC NF<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 148
INSULIN ISOPHANE (HUMAN) INJ 100 UNIT/ML OTC<br />
INSULIN ISOPHANE (HUMAN) INJ 100 UNIT/ML OTC<br />
INSULIN LISPRO (HUMAN) INJ 100 UNIT/ML QL<br />
INSULIN LISPRO (HUMAN) INJ 100 UNIT/ML QL<br />
INSULIN LISPRO PROT & LISPRO (HUMAN) INJ 100 UNIT/ML (50-50) QL<br />
INSULIN LISPRO PROT & LISPRO (HUMAN) INJ 100 UNIT/ML (50-50) QL<br />
INSULIN LISPRO PROT & LISPRO (HUMAN) INJ 100 UNIT/ML (75-25) QL<br />
INSULIN LISPRO PROT & LISPRO (HUMAN) INJ 100 UNIT/ML (75-25) QL<br />
INSULIN REGULAR (HUMAN) INHALATION POWDER 1 & 3 MG/BLISTER NF<br />
INSULIN REGULAR (HUMAN) INHALATION POWDER 1 MG/BLISTER NF<br />
INSULIN REGULAR (HUMAN) INHALATION POWDER 3 MG/BLISTER NF<br />
INSULIN REGULAR (HUMAN) INJ 100 UNIT/ML OTC<br />
INSULIN REGULAR (HUMAN) INJ 100 UNIT/ML OTC NF<br />
INSULIN REGULAR (HUMAN) INJ 100 UNIT/ML OTC<br />
INSULIN REGULAR (HUMAN) INJ 500 UNIT/ML<br />
LANTUS INJ 100/ML QL<br />
LANTUS INJ SOLOSTAR QL<br />
LANTUS FOR INJ OPTICLIK QL<br />
LEVEMIR INJ NF<br />
LEVEMIR INJ FLEXPEN NF<br />
NOVOLIN INJ 70/30 OTC<br />
NOVOLIN INJ 70/30 OTC NF<br />
NOVOLIN 70/ INJ 30 INNLT OTC<br />
NOVOLIN 70/ INJ 30 PNFIL OTC NF<br />
NOVOLIN N INJ INNOLET OTC<br />
NOVOLIN N INJ PENFILL OTC NF<br />
NOVOLIN N INJ U-100 OTC NF<br />
NOVOLIN N INJ U-100 OTC<br />
NOVOLIN N INJ U-100 OTC NF<br />
NOVOLIN R INJ INNOLET OTC<br />
NOVOLIN R INJ PENFILL OTC<br />
NOVOLIN R INJ PENFILL OTC NF<br />
NOVOLIN R INJ U-100 OTC NF<br />
NOVOLIN R INJ U-100 OTC NF<br />
NOVOLIN R INJ U-100 OTC<br />
NOVOLOG INJ 100/ML NF<br />
NOVOLOG INJ FLEXPEN QL<br />
NOVOLOG INJ FLEXPEN NF<br />
NOVOLOG INJ PENFILL NF<br />
NOVOLOG MIX INJ 70/30 NF<br />
NOVOLOG MIX INJ FLEXPEN QL<br />
NOVOLOG MIX INJ FLEXPEN NF<br />
NOVOLOG MIX INJ PENFILL NF<br />
RELION 70/30 INJ 100/ML PA OTC<br />
RELION 70/30 INJ INNOLET PA OTC<br />
RELION N INJ 100/ML PA OTC<br />
RELION N INJ INNOLET PA OTC<br />
RELION R INJ 100/ML PA OTC<br />
Meglitinides<br />
PRANDIN TAB 0.5MG PA<br />
PRANDIN TAB 1MG PA<br />
PRANDIN TAB 2MG PA<br />
Sulfonylureas<br />
chlorpropam tab 100mg<br />
chlorpropam tab 250mg<br />
chlorpropamide tab 100 mg<br />
chlorpropamide tab 250 mg<br />
DIABETA TAB 2.5MG NF<br />
DIABETA TAB 5MG NF<br />
glimepiride tab 1mg<br />
glimepiride tab 2mg<br />
glimepiride tab 4mg<br />
glimepiride tab 1 mg<br />
glimepiride tab 2 mg<br />
glimepiride tab 4 mg<br />
glipizide tab 10mg<br />
glipizide tab 5mg<br />
glipizide er tab 10mg<br />
glipizide er tab 2.5mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 149
glipizide er tab 5mg<br />
glipizide tab 10 mg<br />
glipizide tab 5 mg<br />
glipizide tab sr 24hr 10 mg<br />
glipizide tab sr 24hr 2.5 mg<br />
GLIPIZIDE TAB SR 24HR 2.5 MG<br />
glipizide tab sr 24hr 5 mg<br />
glipizide xl tab 10mg<br />
glipizide xl tab 2.5mg<br />
glipizide xl tab 5mg<br />
GLUCOTROL XL TAB 2.5MG<br />
glyburid mcr tab 1.5mg<br />
glyburid mcr tab 3mg<br />
glyburide micronized tab 1.5 mg<br />
glyburide micronized tab 3 mg<br />
glyburide micronized tab 6 mg PA<br />
GLYBURIDE TAB 2.5 MG NF<br />
GLYBURIDE TAB 5 MG NF<br />
glycron tab 1.5mg<br />
glycron tab 3mg<br />
tolazamide tab 100mg<br />
TOLAZAMIDE TAB 250MG<br />
tolazamide tab 250mg<br />
tolazamide tab 500mg<br />
TOLAZAMIDE TAB 500MG<br />
tolazamide tab 100 mg<br />
TOLAZAMIDE TAB 250 MG<br />
tolazamide tab 250 mg<br />
TOLAZAMIDE TAB 500 MG<br />
tolazamide tab 500 mg<br />
tolbutamide tab 500 mg PA<br />
Thiazolidinediones<br />
ACTOS TAB 15MG PA<br />
ACTOS TAB 30MG PA<br />
ACTOS TAB 45MG PA<br />
AVANDAMET TAB 1-500MG PA<br />
AVANDAMET TAB 2-1000MG PA<br />
AVANDAMET TAB 2-500MG PA<br />
AVANDAMET TAB 4-1000MG PA<br />
AVANDAMET TAB 4-500MG PA<br />
AVANDIA TAB 2MG PA<br />
AVANDIA TAB 4MG PA<br />
AVANDIA TAB 8MG PA<br />
Antihypoglycemic Agents<br />
Glycogenolytic Agents<br />
GLUCAGEN INJ 1MG PA<br />
GLUCAGEN INJ HYPOKIT PA<br />
GLUCAGON KIT 1MG<br />
glucagon kit 1mg<br />
GLUCAGON (RDNA) FOR INJ KIT 1 MG<br />
glucagon (rdna) for inj kit 1 mg<br />
Parathyroid<br />
calcitonin (salmon) nasal soln 200 unit/act PA<br />
FORTEO SOL 600/2.4 PA<br />
FORTEO SOL 750/3ML PA<br />
MIACALCIN INJ 200/ML PA<br />
Pituitary<br />
ACTHAR HP INJ 80UNIT PA<br />
desmopressin acetate inj 4 mcg/ml PA<br />
desmopressin acetate nasal soln 0.01% (refrigerated)<br />
desmopressin acetate nasal spray soln 0.01%<br />
desmopressin acetate nasal spray soln 0.01% (refrigerated)<br />
desmopressin acetate tab 0.1 mg PA<br />
desmopressin acetate tab 0.2 mg PA<br />
desmopressin sol 0.01%<br />
desmopressin spr 0.01%<br />
minirin spr nasal<br />
STIMATE SOL 1.5MG/ML PA<br />
vasopressin inj 20 unit/ml PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 150
Somatotropin Agonists and Antagonists<br />
Somatotropin Agonists<br />
GENOTROPIN INJ 0.2MG PA<br />
GENOTROPIN INJ 0.4MG PA<br />
GENOTROPIN INJ 0.6MG PA<br />
GENOTROPIN INJ 0.8MG PA<br />
GENOTROPIN INJ 1.2MG PA<br />
GENOTROPIN INJ 1.4MG PA<br />
GENOTROPIN INJ 1.6MG PA<br />
GENOTROPIN INJ 1.8MG PA<br />
GENOTROPIN INJ 12MG PA<br />
GENOTROPIN INJ 1MG PA<br />
GENOTROPIN INJ 2MG PA<br />
GENOTROPIN INJ 5MG PA<br />
HUMATROPE INJ 12MG PA<br />
HUMATROPE INJ 24MG PA<br />
HUMATROPE INJ 5MG PA<br />
HUMATROPE INJ 6MG PA<br />
INCRELEX INJ 40MG/4ML PA<br />
IPLEX INJ 36/0.6ML PA<br />
NORDITROPIN INJ 10/1.5ML PA<br />
NORDITROPIN INJ 10/1.5ML PA<br />
NORDITROPIN INJ 15/1.5ML PA<br />
NORDITROPIN INJ 15/1.5ML PA<br />
NORDITROPIN INJ 15/1.5ML PA<br />
NORDITROPIN INJ 30/3ML PA<br />
NORDITROPIN INJ 5/1.5ML PA<br />
NORDITROPIN INJ 5/1.5ML PA<br />
NORDITROPIN INJ 5/1.5ML PA<br />
NUTROPIN INJ 10MG PA<br />
NUTROPIN INJ 5MG PA<br />
NUTROPIN AQ INJ 10MG/2ML PA<br />
NUTROPIN AQ INJ 20MG/2ML PA<br />
NUTROPIN AQ INJ NUSPIN 5 PA<br />
OMNITROPE INJ 10/1.5ML PA<br />
OMNITROPE INJ 5.8MG PA<br />
OMNITROPE INJ 5/1.5ML PA<br />
TEV-TROPIN INJ 5MG PA<br />
Somatotropin Antagonists<br />
SOMAVERT INJ 10MG PA<br />
SOMAVERT INJ 15MG PA<br />
SOMAVERT INJ 20MG PA<br />
Progestins<br />
DEPO-PROVERA INJ 400/ML PA<br />
DEPO-SQ PROV INJ 104 PA<br />
medroxypr ac tab 10mg<br />
medroxypr ac tab 2.5mg<br />
medroxypr ac tab 5mg<br />
medroxyprogesterone acetate im susp 150 mg/ml PA<br />
medroxyprogesterone acetate tab 10 mg<br />
medroxyprogesterone acetate tab 2.5 mg<br />
medroxyprogesterone acetate tab 5 mg<br />
norethin ace tab 5mg<br />
norethindrone acetate tab 5 mg<br />
progesterone im in oil 50 mg/ml PA<br />
Thyroid and Antithyroid Agents<br />
Thyroid Agents<br />
ARMOUR THYRO TAB 120MG<br />
ARMOUR THYRO TAB 15MG<br />
ARMOUR THYRO TAB 180MG<br />
ARMOUR THYRO TAB 240MG<br />
ARMOUR THYRO TAB 300MG<br />
ARMOUR THYRO TAB 30MG<br />
ARMOUR THYRO TAB 60MG<br />
ARMOUR THYRO TAB 90MG<br />
levothroid tab 100mcg<br />
levothroid tab 112mcg<br />
levothroid tab 125mcg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 151
levothroid tab 137mcg<br />
levothroid tab 150mcg<br />
levothroid tab 175mcg<br />
levothroid tab 200mcg<br />
levothroid tab 25mcg<br />
levothroid tab 300mcg<br />
levothroid tab 50mcg<br />
levothroid tab 75mcg<br />
levothroid tab 88mcg<br />
levothyroxin tab 100mcg<br />
levothyroxin tab 112mcg<br />
levothyroxin tab 125mcg<br />
levothyroxin tab 137mcg<br />
levothyroxin tab 150mcg<br />
levothyroxin tab 175mcg<br />
levothyroxin tab 200mcg<br />
levothyroxin tab 25mcg<br />
levothyroxin tab 300mcg<br />
levothyroxin tab 50mcg<br />
levothyroxin tab 75mcg<br />
levothyroxin tab 88mcg<br />
levothyroxine sodium for inj 200 mcg PA<br />
levothyroxine sodium for inj 500 mcg PA<br />
LEVOTHYROXINE SODIUM TAB 100 MCG<br />
levothyroxine sodium tab 100 mcg<br />
LEVOTHYROXINE SODIUM TAB 112 MCG<br />
levothyroxine sodium tab 112 mcg<br />
LEVOTHYROXINE SODIUM TAB 125 MCG<br />
levothyroxine sodium tab 125 mcg<br />
LEVOTHYROXINE SODIUM TAB 137 MCG<br />
levothyroxine sodium tab 137 mcg<br />
LEVOTHYROXINE SODIUM TAB 150 MCG<br />
levothyroxine sodium tab 150 mcg<br />
LEVOTHYROXINE SODIUM TAB 175 MCG<br />
levothyroxine sodium tab 175 mcg<br />
LEVOTHYROXINE SODIUM TAB 200 MCG<br />
levothyroxine sodium tab 200 mcg<br />
LEVOTHYROXINE SODIUM TAB 25 MCG<br />
levothyroxine sodium tab 25 mcg<br />
LEVOTHYROXINE SODIUM TAB 300 MCG<br />
levothyroxine sodium tab 300 mcg<br />
LEVOTHYROXINE SODIUM TAB 50 MCG<br />
levothyroxine sodium tab 50 mcg<br />
levothyroxine sodium tab 75 mcg<br />
LEVOTHYROXINE SODIUM TAB 75 MCG<br />
LEVOTHYROXINE SODIUM TAB 88 MCG<br />
levothyroxine sodium tab 88 mcg<br />
levoxyl tab 100mcg<br />
LEVOXYL TAB 100MCG<br />
levoxyl tab 112mcg<br />
LEVOXYL TAB 112MCG<br />
LEVOXYL TAB 125MCG<br />
levoxyl tab 125mcg<br />
levoxyl tab 137mcg<br />
LEVOXYL TAB 137MCG<br />
levoxyl tab 150mcg<br />
LEVOXYL TAB 150MCG<br />
levoxyl tab 175mcg<br />
LEVOXYL TAB 175MCG<br />
LEVOXYL TAB 200MCG<br />
levoxyl tab 200mcg<br />
LEVOXYL TAB 25MCG<br />
levoxyl tab 25mcg<br />
LEVOXYL TAB 300MCG<br />
levoxyl tab 300mcg<br />
levoxyl tab 50mcg<br />
LEVOXYL TAB 50MCG<br />
LEVOXYL TAB 75MCG<br />
levoxyl tab 75mcg<br />
LEVOXYL TAB 88MCG<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 152
levoxyl tab 88mcg<br />
liothyronine sodium iv soln 10 mcg/ml PA<br />
NATURE-THROI TAB 130MG<br />
NATURE-THROI TAB 16.25MG<br />
NATURE-THROI TAB 195MG<br />
NATURE-THROI TAB 32.5MG<br />
NATURE-THROI TAB 65MG<br />
SYNTHROID TAB 100MCG<br />
SYNTHROID TAB 112MCG<br />
SYNTHROID TAB 125MCG<br />
SYNTHROID TAB 137MCG<br />
SYNTHROID TAB 150MCG<br />
SYNTHROID TAB 175MCG<br />
SYNTHROID TAB 200MCG<br />
SYNTHROID TAB 25MCG<br />
SYNTHROID TAB 300MCG<br />
SYNTHROID TAB 50MCG<br />
SYNTHROID TAB 75MCG<br />
SYNTHROID TAB 88MCG<br />
thyroid tab 120mg<br />
thyroid tab 130mg<br />
thyroid tab 15mg<br />
thyroid tab 180mg<br />
thyroid tab 195mg<br />
thyroid tab 1gr<br />
thyroid tab 2gr<br />
thyroid tab 30mg<br />
thyroid tab 32.4mg<br />
thyroid tab 32.5mg<br />
thyroid tab 60mg<br />
thyroid tab 65mg<br />
thyroid tab 90mg<br />
THYROID TAB 120 MG (2 GRAIN)<br />
thyroid tab 120 mg (2 grain)<br />
THYROID TAB 130 MG<br />
thyroid tab 130 mg<br />
THYROID TAB 15 MG (1/4 GRAIN)<br />
thyroid tab 15 mg (1/4 grain)<br />
THYROID TAB 16.25 MG<br />
THYROID TAB 180 MG (3 GRAIN)<br />
thyroid tab 180 mg (3 grain)<br />
THYROID TAB 195 MG<br />
thyroid tab 195 mg<br />
THYROID TAB 240 MG (4 GRAIN)<br />
THYROID TAB 30 MG (1/2 GRAIN)<br />
thyroid tab 30 mg (1/2 grain)<br />
THYROID TAB 300 MG (5 GRAIN)<br />
thyroid tab 32.4 mg<br />
THYROID TAB 32.5 MG<br />
thyroid tab 32.5 mg<br />
THYROID TAB 60 MG (1 GRAIN)<br />
thyroid tab 60 mg (1 grain)<br />
THYROID TAB 65 MG<br />
thyroid tab 65 mg<br />
THYROID TAB 90 MG (1 1/2 GRAIN)<br />
thyroid tab 90 mg (1 1/2 grain)<br />
unith direct tab 100mcg<br />
unith direct tab 112mcg<br />
unith direct tab 125mcg<br />
unith direct tab 150mcg<br />
unith direct tab 175mcg<br />
unith direct tab 200mcg<br />
unith direct tab 25mcg<br />
unith direct tab 300mcg<br />
unith direct tab 50mcg<br />
unith direct tab 75mcg<br />
unith direct tab 88mcg<br />
unithroid tab 100mcg<br />
unithroid tab 112mcg<br />
unithroid tab 125mcg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 153
unithroid tab 137mcg<br />
unithroid tab 150mcg<br />
unithroid tab 175mcg<br />
unithroid tab 200mcg<br />
unithroid tab 25mcg<br />
unithroid tab 300mcg<br />
unithroid tab 50mcg<br />
unithroid tab 75mcg<br />
unithroid tab 88mcg<br />
WESTHROID TAB 130MG<br />
WESTHROID TAB 32.5MG<br />
WESTHROID TAB 65MG<br />
Antithyroid Agents<br />
methimazole tab 10mg<br />
methimazole tab 5mg<br />
methimazole tab 10 mg<br />
METHIMAZOLE TAB 15 MG<br />
methimazole tab 20 mg<br />
methimazole tab 5 mg<br />
northyx tab 10mg<br />
NORTHYX TAB 15MG<br />
northyx tab 20mg<br />
northyx tab 5mg<br />
propylthiour tab 50mg<br />
propylthiouracil tab 50 mg<br />
Local Anesthetics<br />
BASIC BIOPSY KIT 20GX1.5" PA<br />
BONE MARROW KIT 16G PA<br />
BONE MARROW KIT 16GX2" PA<br />
BONE MARROW KIT 16GX2" PA<br />
BONE MARROW KIT BIOPSY PA<br />
BUPIVA/NS SOL PA<br />
BUPIVA/NS SOL 0.0625% PA<br />
BUPIVA/NS SOL 0.125% PA<br />
BUPIVACA/NS SOL 0.25% PA<br />
bupivacaine 0.75% in dextrose inj 8.25% PA<br />
bupivacaine hcl inj 0.25% PA<br />
bupivacaine hcl inj 0.5% PA<br />
bupivacaine hcl inj 0.75% PA<br />
bupivacaine inj 0.25% w/ epinephrine PA<br />
bupivacaine inj 0.5% w/ epinephrine PA<br />
chloroprocaine hcl inj 2% PA<br />
chloroprocaine hcl inj 3% PA<br />
DUOCAINE INJ PA<br />
LIDO/DEXTROS INJ 5-7.5% PA<br />
lidocaine hcl local inj 0.5% PA<br />
lidocaine hcl local inj 1% PA<br />
lidocaine hcl local inj 1.5% PA<br />
lidocaine hcl local inj 2% PA<br />
lidocaine hcl local inj 4% PA<br />
lidocaine hcl local preservative free (pf) inj 1% PA<br />
lidocaine hcl local preservative free (pf) inj 2% PA<br />
lidocaine inj 0.5% w/ epinephrine-1:200000 PA<br />
lidocaine inj 1% w/ epinephrine-1:100000 PA<br />
lidocaine inj 1% w/ epinephrine-1:200000 PA<br />
lidocaine inj 1.5% w/ epinephrine-1:200000 PA<br />
lidocaine inj 2% w/ epinephrine-1:100000 PA<br />
lidocaine inj 2% w/ epinephrine-1:200000 PA<br />
lidocaine inj 2% w/ epinephrine-1:50000 PA<br />
LUMBAR PUNCT KIT 20GX3.5" PA<br />
LUMBAR PUNCT KIT 22GX2.5" PA<br />
MEPIVACAINE INJ 3% PA<br />
mepivacaine hcl inj 1% PA<br />
mepivacaine hcl inj 1.5% PA<br />
mepivacaine hcl inj 2% PA<br />
NAROPIN INJ 10MG/ML PA<br />
NAROPIN INJ 2MG/ML PA<br />
NAROPIN INJ 5MG/ML PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 154
NAROPIN INJ 7.5MG/ML PA<br />
NESACAINE INJ 1% PA<br />
NOVOCAIN INJ 1% PA<br />
NOVOCAIN INJ 10% PA<br />
PARACENTESIS KIT TRAY 8FR PA<br />
PNEUMOTHORX KIT TRAY 8FR PA<br />
PONTOCAINE INJ 20MG PA<br />
PUDEND/LOCAL KIT 1% LIDO PA<br />
SENSORCAINE INJ -MPF/EPI PA<br />
SPINAL/EPIDU KIT CL CATH PA<br />
SPINAL/EPIDU KIT OPN CATH PA<br />
tetracaine hcl inj 1% PA<br />
Oxytocics<br />
ERGOTRATE INJ 0.2MG/ML PA<br />
HEMABATE INJ 250MCG PA<br />
methylergonovine maleate inj 0.2 mg/ml PA<br />
oxytocin inj 10 unit/ml PA<br />
Radioactive Agents<br />
QUADRAMET INJ PA<br />
QUADRAMET INJ VIAL PA<br />
Serums, Toxoids and Vaccines<br />
Serums<br />
ANTIVENIN KIT LAT MACT PA<br />
ANTIVENIN CR KIT POLYVAL PA<br />
ANTIVENIN MI KIT PA<br />
CARIMUNE NF INJ 12GM PA<br />
CARIMUNE NF INJ 1GM PA<br />
CARIMUNE NF INJ 3GM PA<br />
CARIMUNE NF INJ 6GM PA<br />
CROFAB INJ PA<br />
CYTOGAM INJ PA<br />
DIGIBIND SOL PA<br />
DIGIFAB INJ PA<br />
FLEBOGAMMA INJ 5% PA<br />
FLEBOGAMMA INJ DIF 5% PA<br />
GAMASTAN S/D INJ PA<br />
GAMMAGARD INJ 10GM/100 PA<br />
GAMMAGARD INJ 1G/10ML PA<br />
GAMMAGARD INJ 2.5GM/25 PA<br />
GAMMAGARD INJ 20GM/200 PA<br />
GAMMAGARD INJ 5GM/50ML PA<br />
GAMMAGARD SD INJ 0.5GM HU PA<br />
GAMMAGARD SD INJ 10GM HU PA<br />
GAMMAGARD SD INJ 10GM HU PA<br />
GAMMAGARD SD INJ 2.5GM HU PA<br />
GAMMAGARD SD INJ 5GM HU PA<br />
GAMMAGARD SD INJ 5GM HU PA<br />
GAMMAPLEX INJ 10GM PA<br />
GAMMAPLEX INJ 2.5GM PA<br />
GAMMAPLEX INJ 5GM PA<br />
GAMUNEX INJ 10% PA<br />
HEPAGAM B INJ PA<br />
HIZENTRA INJ 1GM/5ML PA<br />
HIZENTRA INJ 2GM/10ML PA<br />
HIZENTRA INJ 4GM/20ML PA<br />
HYPERHEP B INJ S/D PA<br />
HYPERRAB S/D INJ 150/ML PA<br />
HYPERRHO S/D INJ 300MCG PA<br />
HYPERRHO S/D INJ 50MCG PA<br />
HYPERTET S/D INJ 250/ML PA<br />
IMMUNE GLOBU INJ HUMAN PA<br />
IMOGAM RABIE INJ 150/ML PA<br />
IVEEGAM EN INJ 5GM HU PA<br />
MICRHOGAM PL INJ 50MCG PA<br />
NABI-HB INJ PA<br />
NP NABI-HB INJ PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 155
OCTAGAM INJ 10GM PA<br />
OCTAGAM INJ 1GM PA<br />
OCTAGAM INJ 2.5GM PA<br />
OCTAGAM INJ 25GM PA<br />
OCTAGAM INJ 5GM PA<br />
PANGLOBULIN INJ 12GM PA<br />
PANGLOBULIN INJ 1GM PA<br />
PANGLOBULIN INJ 3GM PA<br />
PANGLOBULIN INJ 6GM PA<br />
PANGLOBULIN SOL 12GM PA<br />
PANGLOBULIN SOL 6GM PA<br />
POLYGAM S/D SOL 0.5GM PA<br />
POLYGAM S/D SOL 10GM PA<br />
POLYGAM S/D SOL 2.5GM PA<br />
POLYGAM S/D SOL 5GM PA<br />
PRIVIGEN INJ 10GRAMS PA QL<br />
PRIVIGEN INJ 20GRAMS PA QL<br />
PRIVIGEN INJ 5 GRAMS PA QL<br />
RESPIGAM SOL 50MG/ML PA<br />
RHOGAM HUMAN INJ 300MCG PA<br />
RHOGAM PLUS INJ 300MCG PA<br />
RHOPHYLAC INJ 1500/2ML PA<br />
VARICELLA-ZO INJ 125UNIT PA<br />
VARICELLA-ZO INJ 625UNIT PA<br />
VENOGLOBUL-S INJ 10% PA<br />
VIVAGLOBIN SOL 160MG/ML PA<br />
WINRHO SDF INJ 15000UNT PA<br />
WINRHO SDF INJ 1500UNIT PA<br />
WINRHO SDF INJ 1500UNIT PA<br />
WINRHO SDF INJ 2500UNIT PA<br />
WINRHO SDF INJ 5000UNIT PA<br />
WINRHO SDF INJ 5000UNIT PA<br />
WINRHO SDF INJ 600UNIT PA<br />
WINRHO SDF INJ 600UNIT PA<br />
Toxoids<br />
ADACEL INJ PA<br />
BOOSTRIX INJ PA<br />
DAPTACEL INJ PA<br />
DECAVAC INJ 5-2LF PA<br />
DIP/TET PED INJ 6.7-5LF PA<br />
DTP ADSORBED INJ 6.7-5-4 PA<br />
INFANRIX INJ PA<br />
KINRIX INJ PA<br />
TE ANATOXAL INJ BERNA PA<br />
TET/DIP TOX INJ 2-2 LF PA<br />
TETANUS TOX INJ 4LF PA<br />
TETANUS TOX INJ 5LF ADS PA<br />
TRIHIBIT KIT P/F PA<br />
TRIPEDIA SUS P/F PA<br />
Vaccines<br />
ACTHIB INJ PA<br />
AFLURIA INJ 2007-08<br />
AFLURIA INJ 2008-09<br />
AFLURIA INJ 2009-10<br />
AFLURIA INJ PF 07-08<br />
AFLURIA INJ PF 08-09<br />
AGRIFLU INJ 09/10 PA<br />
ALFURIA INJ PF 09-10<br />
ATTENUVAX INJ LIVE PA<br />
CERVARIX INJ PA<br />
COMVAX INJ PA<br />
ENGERIX-B INJ 10/0.5ML PA<br />
ENGERIX-B INJ 20MCG/ML PA<br />
FLUARIX INJ PF 05-06<br />
FLUARIX INJ PF 06-07<br />
FLUARIX INJ PF 07-08<br />
FLUARIX INJ PF 08-09<br />
FLUARIX INJ PF 09-10<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 156
FLULAVAL INJ 2008-09<br />
FLULAVAL INJ 2009-10<br />
FLULAVAL INJ SPLIT<br />
FLUVIRIN INJ 2005-06<br />
FLUVIRIN INJ 2006-07<br />
FLUVIRIN INJ 2007-08<br />
FLUVIRIN INJ 2008-09<br />
FLUVIRIN INJ 2009-10<br />
FLUZONE INJ PF 05-06<br />
FLUZONE INJ PF 06-07<br />
FLUZONE INJ PF 07-08<br />
FLUZONE INJ PF 08-09<br />
FLUZONE INJ PF 09-10<br />
FLUZONE INJ PF 09-10<br />
FLUZONE PED/ INJ PF 05-06<br />
FLUZONE PED/ INJ PF 06-07<br />
FLUZONE PED/ INJ PF 07-08<br />
FLUZONE PED/ INJ PF 08-09<br />
FLUZONE PED/ INJ PF 09-10<br />
FLUZONE SPLT INJ 2005-06<br />
FLUZONE SPLT INJ 2006-07<br />
FLUZONE SPLT INJ 2007-08<br />
FLUZONE SPLT INJ 2008-09<br />
FLUZONE SPLT INJ 2009-10<br />
GARDASIL INJ PA<br />
HAVRIX INJ 1440UNIT PA<br />
HAVRIX INJ 720UNIT PA<br />
HIBERIX SOL 10-25MCG PA<br />
HIBTITER INJ PA<br />
IMOVAX RABIE INJ 2.5/ML PA<br />
INFLUENZA A INJ 09 H1N1<br />
INFLUENZA A INJ PF09H1N1 PA<br />
INFLUENZA A SPR 09 H1N1<br />
INFLUENZA A (H1N1) MONOVALENT VACCINE LIVE INTRANASAL LIQUID<br />
INFLUENZA A (H1N1) MONOVALENT VACCINE SPLIT INJ<br />
INFLUENZA VIRUS VACCINE SPLIT INJ<br />
INFLUENZA VIRUS VACCINE SPLIT PRESERVATIVE FREE INJ<br />
INFLUENZA VIRUS VACCINE TYPES A & B SURFACE ANTIGEN INJ<br />
IPOL INJ INACTIVE PA<br />
IXIARO INJ PA<br />
JE-VAX INJ PA<br />
M-M-R II INJ LIVE PA<br />
M-M-R II INJ LIVE PA<br />
M-M-R II INJ LIVE PA<br />
M-R-VAX II INJ PA<br />
MENACTRA INJ PA<br />
MENOMUNE INJ A/C/Y/W PA<br />
MENVEO INJ PA<br />
MERUVAX II INJ LIVE PA<br />
MUMPSVAX INJ LIVE PA<br />
PEDIARIX INJ 0.5ML PA<br />
PEDVAX HIB INJ PA<br />
PENTACEL INJ PA<br />
PNEUMOVAX 23 INJ 25/0.5 PA<br />
PNEUMOVAX 23 INJ 25/0.5 PA<br />
PREVNAR INJ PA<br />
PREVNAR 13 INJ PA<br />
PROQUAD INJ PA<br />
RABAVERT INJ PA<br />
RECOMBIVA HB INJ 10MCG/ML PA<br />
RECOMBIVA HB INJ 5MCG/0.5 PA<br />
RECOMBIVA-HB INJ 10MCG/ML PA<br />
RECOMBIVA-HB INJ 40MCG/ML PA<br />
TWINRIX INJ PA<br />
TYPHIM VI INJ PA<br />
TYPHOID VI SOL PA<br />
VAQTA INJ 25/0.5ML PA<br />
VAQTA INJ 50UNT/ML PA<br />
VARIVAX INJ PA<br />
YF-VAX INJ PA<br />
ZOSTAVAX INJ PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 157
Skin and Mucous Membrane Preparations<br />
Anti-infectives<br />
Antibacterials<br />
ACANYA GEL 1.2-2.5% PA<br />
ACZONE GEL 5% QL<br />
BENZAMYCIN GEL PAK<br />
benzoyl peroxide-erythromycin gel 5-3%<br />
BENZOYL PEROXIDE-ERYTHROMYCIN GEL PACK 5-3%<br />
CLINDAGEL GEL 1%<br />
clindamax cre 2% vag<br />
clindamax gel 1%<br />
clindamax lot 10mg/ml<br />
clindamycin cre 2% vag<br />
clindamycin gel 1%<br />
clindamycin lot 1%<br />
clindamycin lot 10mg/ml<br />
clindamycin pad 1%<br />
clindamycin sol 1%<br />
CLINDAMYCIN PHOSPHATE GEL 1%<br />
clindamycin phosphate gel 1%<br />
clindamycin phosphate lotion 1%<br />
clindamycin phosphate soln 1%<br />
clindamycin phosphate swab 1%<br />
CLINDAMYCIN PHOSPHATE SWAB KIT 1%<br />
clindamycin phosphate vaginal cream 2%<br />
clindamycin phosphate-benzoyl peroxide gel 1-5% PA<br />
CLINDAREACH KIT 1%<br />
DAPSONE GEL 5% QL<br />
emcin clear pad 2%<br />
ery pad 2%<br />
eryderm sol 2%<br />
erythromycin gel /benzoyl<br />
erythromycin pad 2%<br />
erythromycin pads 2%<br />
erythromycin sol 2%<br />
erythromycin soln 2%<br />
gentamicin cre 0.1%<br />
gentamicin oin 0.1%<br />
gentamicin sulfate cream 0.1%<br />
gentamicin sulfate oint 0.1%<br />
METROGEL-VAG GEL 0.75% QL<br />
metronidazol gel 0.75%vag QL<br />
metronidazole vaginal gel 0.75% QL<br />
METRONIDAZOLE VAGINAL GEL 0.75% QL<br />
pledgaclin pad 1%<br />
vandazole gel 0.75% QL<br />
Antifungals<br />
ciclopirox cre 0.77% NF<br />
ciclopirox sus 0.77% NF<br />
ciclopirox olamine cream 0.77% (base equiv) NF<br />
ciclopirox olamine susp 0.77% (base equiv) NF<br />
clotrim/beta cre diprop NF<br />
clotrimazole w/ betamethasone cream 1-0.05% NF<br />
nystatin cre 100000<br />
nystatin oin 100000<br />
nystatin cream 100000 unit/gm<br />
nystatin oint 100000 unit/gm<br />
Azoles<br />
clotrim/beta cre diprop NF<br />
clotrimazole loz 10mg QL<br />
clotrimazole tro 10mg QL<br />
clotrimazole troche 10 mg QL<br />
CLOTRIMAZOLE VAGINAL TAB 100 MG & 1% CREAM KIT OTC NF<br />
clotrimazole w/ betamethasone cream 1-0.05% NF<br />
ketoconazole cre 2%<br />
ketoconazole cream 2%<br />
KETOCONAZOLE GEL 2%<br />
KETOCONAZOLE GEL 2% & PYRITHIONE ZINC SHAMPOO 1% KIT<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 158
ketoconazole sha 2%<br />
KETOCONAZOLE SHAMPOO 1% OTC<br />
ketoconazole shampoo 2%<br />
kuric cre 2%<br />
MYCELEX-7 KIT COMBO PK OTC NF<br />
NIZORAL A-D SHA 1% OTC<br />
XOLEGEL GEL 2%<br />
XOLEGEL DUO/ KIT HEAD&SHD<br />
XOLEGEL DUO/ KIT XOLEX<br />
Hydroxypyridones<br />
ciclopirox cre 0.77% NF<br />
ciclopirox sus 0.77% NF<br />
ciclopirox olamine cream 0.77% (base equiv) NF<br />
ciclopirox olamine susp 0.77% (base equiv) NF<br />
Polyenes<br />
nystatin cre 100000<br />
nystatin oin 100000<br />
NYSTATIN TAB 100000<br />
nystatin cream 100000 unit/gm<br />
nystatin oint 100000 unit/gm<br />
NYSTATIN VAG TAB 100000<br />
NYSTATIN VAGINAL TAB 100000 UNIT<br />
Scabicides and Pediculicides<br />
acticin cre 5%<br />
lindane lot 1%<br />
LINDANE SHA 1%<br />
lindane sha 1%<br />
lindane lotion 1%<br />
LINDANE SHAMPOO 1%<br />
lindane shampoo 1%<br />
permethrin cre 5%<br />
permethrin cream 5%<br />
Local Anti-infectives, Miscellaneous<br />
acne 10 gel 10% OTC<br />
acne 10 lot 10% OTC<br />
acne medicat gel -5<br />
acne medicat lot 10% OTC<br />
acne treat cre 10% OTC<br />
acne treat cre 10% vf OTC<br />
acne-clear gel 10% OTC<br />
anti-dandruf sha 1% OTC<br />
benprox gel 2.75%<br />
benprox gel 5.25%<br />
benprox liq 5.25%<br />
benzashave cre 10%<br />
BENZASHAVE 5 CRE 5%<br />
BENZIQ GEL 5.25%<br />
benzl perox cre 6.5-10%<br />
benzl perox cre 8.5-10%<br />
benzl perox gel 4.5-10%<br />
benzl perox gel 6.5-10%<br />
benzl perox gel 8.5-10%<br />
benzl perox liq 4.5-10%<br />
benzl perox liq 6.5-10%<br />
benzl perox liq 8.5-10%<br />
benzl perox pad 4.5-10%<br />
benzl perox pad 6.5-10%<br />
benzl perox pad 8.5-10%<br />
benzoyl per gel 10% OTC<br />
benzoyl per gel 10%<br />
benzoyl per gel 2.5%<br />
benzoyl per gel 4%<br />
benzoyl per gel 5%<br />
benzoyl per gel 5% OTC<br />
benzoyl per gel 8%<br />
benzoyl per kit 4% wash<br />
benzoyl per kit 8% wash<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 159
enzoyl per liq 10%<br />
benzoyl per liq 10% wash<br />
benzoyl per liq 2.5%wash<br />
BENZOYL PER LIQ 2.5%WASH<br />
benzoyl per liq 4% crem<br />
benzoyl per liq 5%<br />
benzoyl per liq 5% wash<br />
benzoyl per liq 5.75-10%<br />
benzoyl per liq 7% wash<br />
benzoyl per liq 8% crem<br />
benzoyl per lot 10% OTC<br />
benzoyl per lot 3%<br />
benzoyl per lot 4%<br />
benzoyl per lot 5% OTC<br />
BENZOYL PER LOT 5% OTC<br />
benzoyl per lot 6%<br />
benzoyl per lot 8%<br />
benzoyl per lot 9%<br />
benzoyl per pad 3%<br />
benzoyl per pad 6%<br />
benzoyl per pad 9%<br />
benzoyl pero cre 3.5%<br />
benzoyl pero cre 5.5%<br />
benzoyl pero cre 8.5%<br />
benzoyl pero lot 10% OTC<br />
BENZOYL PEROXIDE BAR 10% OTC<br />
BENZOYL PEROXIDE BAR 10%<br />
BENZOYL PEROXIDE BAR 10% OTC<br />
BENZOYL PEROXIDE BAR 5% OTC<br />
BENZOYL PEROXIDE CLEANSER 4.25%<br />
benzoyl peroxide cream 10% OTC<br />
benzoyl peroxide cream 10%<br />
benzoyl peroxide cream 3.5%<br />
BENZOYL PEROXIDE CREAM 5%<br />
benzoyl peroxide cream 5.5%<br />
benzoyl peroxide cream 8.5%<br />
benzoyl peroxide creamy wash 4% & cleanser lotion kit<br />
benzoyl peroxide creamy wash 8% & cleanser lotion kit<br />
benzoyl peroxide gel 10% OTC<br />
benzoyl peroxide gel 10%<br />
benzoyl peroxide gel 2.5% OTC<br />
benzoyl peroxide gel 2.5%<br />
benzoyl peroxide gel 2.75%<br />
benzoyl peroxide gel 4%<br />
benzoyl peroxide gel 5%<br />
benzoyl peroxide gel 5% OTC<br />
benzoyl peroxide gel 5.25 %<br />
BENZOYL PEROXIDE GEL 5.25 %<br />
BENZOYL PEROXIDE GEL 6%<br />
BENZOYL PEROXIDE GEL 7%<br />
benzoyl peroxide gel 8%<br />
benzoyl peroxide liq 10% OTC<br />
benzoyl peroxide liq 10%<br />
benzoyl peroxide liq 2.5%<br />
BENZOYL PEROXIDE LIQ 2.5%<br />
BENZOYL PEROXIDE LIQ 4%<br />
benzoyl peroxide liq 4%<br />
benzoyl peroxide liq 5%<br />
benzoyl peroxide liq 5.25%<br />
benzoyl peroxide liq 7%<br />
BENZOYL PEROXIDE LIQ 8%<br />
benzoyl peroxide liq 8%<br />
benzoyl peroxide lotion 10% OTC<br />
benzoyl peroxide lotion 3%<br />
benzoyl peroxide lotion 4%<br />
BENZOYL PEROXIDE LOTION 5% OTC<br />
benzoyl peroxide lotion 5% OTC<br />
BENZOYL PEROXIDE LOTION 5.5% OTC<br />
benzoyl peroxide lotion 6%<br />
benzoyl peroxide lotion 8%<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 160
enzoyl peroxide lotion 9%<br />
BENZOYL PEROXIDE MASK 5% OTC<br />
benzoyl peroxide pad 3%<br />
benzoyl peroxide pad 6%<br />
benzoyl peroxide pad 9%<br />
benzoyl peroxide-urea cleanser 4.5-10%<br />
benzoyl peroxide-urea cleanser 5.75-10%<br />
benzoyl peroxide-urea cleanser 6.5-10%<br />
benzoyl peroxide-urea cleanser 8.5-10%<br />
BENZOYL PEROXIDE-UREA CREAM 4.5-10%<br />
BENZOYL PEROXIDE-UREA CREAM 6.5-10%<br />
benzoyl peroxide-urea cream 6.5-10%<br />
BENZOYL PEROXIDE-UREA CREAM 8.5-10%<br />
benzoyl peroxide-urea cream 8.5-10%<br />
benzoyl peroxide-urea gel 4.5-10%<br />
benzoyl peroxide-urea gel 6.5-10%<br />
benzoyl peroxide-urea gel 8.5-10%<br />
benzoyl peroxide-urea pad 4.5-10%<br />
benzoyl peroxide-urea pad 6.5-10%<br />
benzoyl peroxide-urea pad 8.5-10%<br />
bl acne 10 gel 10% OTC<br />
bp wash liq 7%<br />
bpo gel 4%<br />
bpo gel 8%<br />
BREVOXYL-4 LIQ CREM WSH<br />
BREVOXYL-8 LIQ CREM WSH<br />
clean&clear cre 10% OTC<br />
clearplex v gel 5% OTC<br />
clearplex x gel 10%<br />
clearskin cre 10% OTC<br />
CLINAC BPO GEL 7%<br />
cvs acne cre 10% OTC<br />
dandrex sha 1% OTC<br />
dandruff sha 1% OTC<br />
del-aqua cre 10% OTC<br />
del-aqua gel 5%<br />
desquam-e gel 2.5%<br />
DESQUAM-X BAR 10%<br />
ethexderm liq bpw-10<br />
ethexderm liq bpw-5<br />
gnp acne 10 gel 10% OTC<br />
invisible cre acne 10% OTC<br />
lavoclen-4 kit acne wsh<br />
lavoclen-4 liq crem wsh<br />
lavoclen-8 kit acne wsh<br />
lavoclen-8 liq crem wsh<br />
LOROXIDE LOT 5.5% OTC<br />
neutrogena gel 2.5% OTC<br />
NEUTROGENA MIS MASK 5% OTC<br />
oscion pad 3%<br />
oscion pad 6%<br />
oscion pad 9%<br />
oscion clnsr lot 3%<br />
oscion clnsr lot 6%<br />
oscion clnsr lot 9%<br />
oxy 10 balan gel 10% OTC<br />
oxy 10 balan liq 10% wash OTC<br />
oxy balance gel 5% OTC<br />
PACNEX MX LIQ 4.25%<br />
pacnex wash liq 7%<br />
PANOXYL BAR 10% OTC<br />
PANOXYL BAR 10% OTC<br />
PANOXYL BAR 5% OTC<br />
panoxyl aqua gel 10% OTC<br />
panoxyl wash liq 10% OTC<br />
peroderm gel 4.5-10%<br />
peroderm gel 6.5-10%<br />
peroderm gel 8.5-10%<br />
peroderm liq 4.5-10%<br />
peroderm liq 6.5-10%<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 161
peroderm liq 8.5-10%<br />
persa-gel gel 10% max OTC<br />
persa-gel gel 5% x-s OTC<br />
pr benzoyl liq 7% wash<br />
ra acne cre 10% OTC<br />
ra benzoyl lot 10% OTC<br />
ra dandruff sha 1% OTC<br />
se bpo wash liq 7%<br />
selenium sul lot 2.5%<br />
selenium sul sha 1% OTC<br />
selenium sul sha 2.5%<br />
selenium sulfide lotion 1% OTC<br />
selenium sulfide lotion 2.5%<br />
silver sulfa cre 1%<br />
silver sulfadiazine cream 1%<br />
soluclenz rx gel 5%<br />
ssd cre 1%<br />
ssd af cre 1%<br />
thermazene cre 1%<br />
TRIAZ GEL 6%<br />
zaclir lot 4%<br />
zaclir lot 8%<br />
ZODERM CRE 4.5%-10%<br />
ZODERM CRE 6.5-10%<br />
ZODERM CRE 8.5-10%<br />
Anti-inflammatory Agents<br />
ala cort cre 1%<br />
ala-cort lot 1%<br />
alphatrex gel 0.05% NF<br />
anti-itch cre /aloe/e OTC<br />
anti-itch cre /oatmeal OTC<br />
anti-itch cre 1%max st OTC<br />
anti-itch cre 1%max st OTC<br />
anti-itch oin max st OTC<br />
anti-itch/ cre aloe OTC<br />
anucort-hc sup 25mg<br />
anumed-hc sup 25mg<br />
apexicon oin 0.05% NF<br />
aquanil hc lot 1% OTC<br />
aristocort a cre 0.5%<br />
aug betamet cre 0.05% NF<br />
aug betamet gel 0.05% NF<br />
aug betamet lot 0.05% NF<br />
aug betamet oin 0.05% NF<br />
aveeno cre 1%max st OTC<br />
BALNEOL LOT 0.25% OTC<br />
beta diprop gel 0.05% NF<br />
beta hc lot 1% OTC<br />
beta-val cre 0.1% NF<br />
beta-val lot 0.1% NF<br />
betameth dip cre 0.05% NF<br />
betameth dip lot 0.05% NF<br />
betameth dip oin 0.05% NF<br />
betameth val cre 0.1% NF<br />
betameth val lot 0.1% NF<br />
betameth val oin 0.1% NF<br />
betamethasone dipropionate augmented cream 0.05% NF<br />
betamethasone dipropionate augmented gel 0.05% NF<br />
betamethasone dipropionate augmented lotion 0.05% NF<br />
betamethasone dipropionate augmented oint 0.05% NF<br />
betamethasone dipropionate cream 0.05% NF<br />
betamethasone dipropionate lotion 0.05% NF<br />
betamethasone dipropionate oint 0.05% NF<br />
betamethasone valerate cream 0.1% NF<br />
betamethasone valerate lotion 0.1% NF<br />
betamethasone valerate oint 0.1% NF<br />
caldecort cre 1% OTC<br />
cetacort lot 1%<br />
cortaid cre 1% OTC<br />
cortaid cre 1%max st OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 162
cortaid adv cre 1% 12 hr OTC<br />
CORTIFOAM AER 90MG<br />
cortisone cre 1%max st OTC<br />
cortisone + cre 1%max st OTC<br />
cortizone-10 cre /aloe 1% OTC<br />
cortizone-10 cre 1% OTC<br />
cortizone-10 cre anal itc OTC<br />
cortizone-10 cre healing OTC<br />
cortizone-10 cre plus OTC<br />
cortizone-10 oin 1% OTC<br />
cortizone-5 oin 0.5% OTC<br />
del-beta lot 0.05% NF<br />
DERMTEX HC LOT 0.5% OTC<br />
desonide cre 0.05%<br />
desonide oin 0.05% NF<br />
desonide cream 0.05%<br />
desonide oint 0.05% NF<br />
desoximetas cre 0.05% NF<br />
desoximetas cre 0.25% NF<br />
desoximetas gel 0.05% NF<br />
desoximetas oin 0.25%<br />
desoximetasone cream 0.05% NF<br />
desoximetasone cream 0.25% NF<br />
desoximetasone gel 0.05% NF<br />
desoximetasone oint 0.25%<br />
diflorasone cre 0.05% NF<br />
diflorasone oin 0.05% NF<br />
diflorasone diacetate cream 0.05% NF<br />
diflorasone diacetate oint 0.05% NF<br />
EPIFOAM AER 1%<br />
FLUOCIN ACET CRE 0.01%<br />
fluocin acet cre 0.025%<br />
FLUOCIN ACET OIN 0.025%<br />
FLUOCIN ACET SOL 0.01%<br />
FLUOCINOLONE ACETONIDE CREAM 0.01%<br />
fluocinolone acetonide cream 0.025%<br />
FLUOCINOLONE ACETONIDE OINT 0.025%<br />
FLUOCINOLONE ACETONIDE SOLN 0.01%<br />
fluocinonide cre 0.05% NF<br />
fluocinonide cream 0.05% NF<br />
FLUOCINONIDE CREAM 0.1% NF<br />
fluocinonide gel 0.05% NF<br />
fluocinonide gel 0.05% NF<br />
fluocinonide oin 0.05% NF<br />
fluocinonide oint 0.05% NF<br />
fluocinonide sol 0.05% NF<br />
fluocinonide soln 0.05% NF<br />
gnp hydrocor cre 1% OTC<br />
gnp hydrocor cre 1% plus OTC<br />
HALCINONIDE CREAM 0.1% NF<br />
HALCINONIDE OINT 0.1% NF<br />
HALCINONIDE SOLN 0.1% NF<br />
halobetasol cre 0.05% NF<br />
halobetasol oin 0.05% NF<br />
halobetasol propionate cream 0.05% NF<br />
halobetasol propionate oint 0.05% NF<br />
HALOG CRE 0.1% NF<br />
HALOG OIN 0.1% NF<br />
HALOG SOL 0.1% NF<br />
hc ac/aloe cre 0.5% OTC<br />
HC/ALOE CRE 0.5% OTC<br />
hca hydrocor oin 1% OTC<br />
hca max st cre hydrocor OTC<br />
hemorrhoidal cre -hc 2.5%<br />
hemorrhoidal sup -hc 25mg<br />
hemril-30 sup 30mg<br />
hydro-lotion lot 1% OTC<br />
hydrocort cre 0.5% OTC<br />
hydrocort cre 1% OTC<br />
hydrocort cre 1%<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 163
hydrocort cre 1% plus OTC<br />
hydrocort cre 1%max st OTC<br />
hydrocort cre 1%max st OTC<br />
hydrocort cre 1%max st OTC<br />
hydrocort cre 1%pls 12 OTC<br />
hydrocort cre 2.5%<br />
hydrocort lot 1%<br />
hydrocort lot 1% OTC<br />
hydrocort lot 2.5%<br />
hydrocort oin 0.5% OTC<br />
hydrocort oin 1% OTC<br />
hydrocort oin 1%<br />
hydrocort oin 2.5%<br />
hydrocort ac cre 0.5% OTC<br />
hydrocort ac sup 25mg<br />
hydrocort ac sup 30mg<br />
hydrocort/ cre aloe 1% OTC<br />
hydrocort/ cre aloe 1% OTC<br />
hydrocort/ cre aloe 1% OTC<br />
hydrocort/ oin aloe 1% OTC<br />
HYDROCORT/ OIN ALOE 1% OTC<br />
hydrocort/ab oin 1%<br />
hydrocortiso cre 2.5%<br />
HYDROCORTISONE ACETATE RECTAL FOAM 90 MG/DOSE<br />
hydrocortisone acetate suppos 25 mg<br />
hydrocortisone acetate suppos 30 mg<br />
hydrocortisone acetate-aloe vera cream 0.5% OTC<br />
hydrocortisone cream 0.5% OTC<br />
hydrocortisone cream 1%<br />
hydrocortisone cream 1% OTC<br />
hydrocortisone cream 2.5%<br />
HYDROCORTISONE LOTION 0.25% OTC<br />
HYDROCORTISONE LOTION 0.5% OTC<br />
hydrocortisone lotion 1% OTC<br />
hydrocortisone lotion 1%<br />
hydrocortisone lotion 2%<br />
hydrocortisone lotion 2.5%<br />
hydrocortisone oint 0.5% OTC<br />
hydrocortisone oint 1% OTC<br />
hydrocortisone oint 1%<br />
hydrocortisone oint 2.5%<br />
hydrocortisone rectal cream 2.5%<br />
hydrocortisone valerate cream 0.2% PA<br />
hydrocortisone valerate oint 0.2% PA<br />
HYDROCORTISONE-ALOE VERA CREAM 0.5% OTC<br />
hydrocortisone-aloe vera cream 1% OTC<br />
HYDROCORTISONE-ALOE VERA OINT 1% OTC<br />
hydrocortisone-aloe vera oint 1% OTC<br />
hytone cre 1% OTC<br />
instacort 5 cre 0.5% OTC<br />
itch-x lot 1% OTC<br />
kericort 10 cre 1% OTC<br />
med-derm hc cre 0.5% OTC<br />
med-derm hc cre 1% OTC<br />
mometasone cre 0.1% NF<br />
mometasone oin 0.1% NF<br />
mometasone sol 0.1% NF<br />
mometasone furoate cream 0.1% NF<br />
mometasone furoate oint 0.1% NF<br />
mometasone furoate solution 0.1% (lotion) NF<br />
monistat cre 1% OTC<br />
mp hydrocort cre 0.5% OTC<br />
mp hydrocort cre 1% OTC<br />
mp hydrocort cre 1%max st OTC<br />
mp hydrocort oin 1% OTC<br />
nupercainal cre 1% OTC<br />
nupercainal cre hc 1% OTC<br />
nystat/triam cre<br />
nystat/triam oin<br />
nystatin-triamcinolone cream 100000-0.1 unit/gm-%<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 164
nystatin-triamcinolone oint 100000-0.1 unit/gm-%<br />
PRAMOXINE-HC AEROSOL FOAM 1-1%<br />
prednicarbat cre 0.1% NF<br />
prednicarbate cream 0.1% NF<br />
prep h hc cre 1% OTC<br />
procto-kit cre 1%<br />
procto-kit cre 2.5%<br />
procto-pak cre 1%<br />
proctocare cre -hc 2.5%<br />
proctocream cre -hc 2.5%<br />
proctosert h sup 30 mg<br />
proctosol hc cre 2.5%<br />
proctozone cre -hc 2.5%<br />
qc hydrocort cre 1% OTC<br />
qc hydrocort cre 1%max st OTC<br />
ra hydrocort cre 0.5% OTC<br />
ra hydrocort cre 1% OTC<br />
ra hydrocort cre 1%max st OTC<br />
ra hydrocort cre 1%pls 12 OTC<br />
ra hydrocort oin 1% OTC<br />
recort plus cre 1% OTC<br />
recort plus lot 1% OTC<br />
rectasol-hc sup 25mg<br />
rederm lot 1% OTC<br />
sarnol-hc lot 1% OTC<br />
sb hydrocort cre 1% OTC<br />
sb hydrocort oin 1% OTC<br />
scalacort lot 2%<br />
sg hc/aloe cre 0.5% OTC<br />
sg hydrocort cre 1% OTC<br />
sm hydrocort cre 1% OTC<br />
sm hydrocort cre 1% OTC<br />
sm hydrocort oin 1% OTC<br />
theracort lot 1% OTC<br />
triam/nystat cre<br />
triam/nystat oin<br />
triamcinolon cre 0.025%<br />
triamcinolon cre 0.1%<br />
triamcinolon cre 0.5%<br />
triamcinolon lot 0.025%<br />
triamcinolon lot 0.1%<br />
triamcinolon oin 0.025%<br />
TRIAMCINOLON OIN 0.05%<br />
triamcinolon oin 0.1%<br />
triamcinolon oin 0.5%<br />
triamcinolon oin 0.5%<br />
triamcinolone acetonide cream 0.025%<br />
triamcinolone acetonide cream 0.1%<br />
triamcinolone acetonide cream 0.5%<br />
triamcinolone acetonide lotion 0.025%<br />
triamcinolone acetonide lotion 0.1%<br />
triamcinolone acetonide oint 0.025%<br />
TRIAMCINOLONE ACETONIDE OINT 0.05%<br />
triamcinolone acetonide oint 0.1%<br />
triamcinolone acetonide oint 0.5%<br />
triamcinolone acetonide oint 0.5%<br />
triderm cre 0.1%<br />
triderm oin 0.1%<br />
VANOS CRE 0.1% NF<br />
Antipruritics and Local Anesthetics<br />
azo dine tab 95mg OTC<br />
azo dine tab max st OTC<br />
azo tabs tab 95mg OTC<br />
azo-dine tab 97.2mg OTC<br />
azo-gesic tab 95mg OTC<br />
azo-septic tab 95mg OTC<br />
azo-standard tab 95mg OTC<br />
hca azo tab OTC<br />
HYDROCORTISONE ACETATE W/ PRAMOXINE RECTAL FOAM 1-1%<br />
mp azodine tab uranary OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 165
phenazo tab 200mg<br />
phenazo tab 95mg OTC<br />
phenazopyrid tab 100mg<br />
phenazopyrid tab 200mg<br />
phenazopyridine hcl tab 100 mg<br />
phenazopyridine hcl tab 200 mg<br />
phenazopyridine hcl tab 95 mg OTC<br />
phenazopyridine hcl tab 97 mg OTC<br />
phenazopyridine hcl tab 97.5 mg OTC<br />
phenazoyrid tab 95mg OTC<br />
PROCTOFOAM AER HC 1%<br />
qc azo tab 95mg OTC<br />
ra urinary tab 95mg OTC<br />
re-azo tab 97 mg OTC<br />
urinary anal tab 95mg OTC<br />
urinary pain tab 95mg OTC<br />
Astringents<br />
ALUMINUM CHLORIDE SOLN 12% OTC<br />
aluminum chloride soln 20%<br />
aluminum cl sol 20%<br />
ANTI-PERSPIR SOL 12% OTC<br />
CERTAIN DRI SOL OTC<br />
CERTAIN DRI SOL UNSCENT OTC<br />
hypercare sol 20%<br />
Cell Stimulants and Proliferants<br />
avita cre 0.025%<br />
avita gel 0.025%<br />
KEPIVANCE INJ 6.25MG PA<br />
REFISSA CRE 0.05%<br />
RENOVA CRE 0.02%<br />
RENOVA PUMP CRE 0.02%<br />
RETIN-A MICR GEL 0.04%<br />
RETIN-A MICR GEL 0.04%PMP<br />
RETIN-A MICR GEL 0.1%<br />
RETIN-A MICR GEL 0.1%PUMP<br />
TRETIN-X CRE KIT 0.025%<br />
TRETIN-X CRE KIT 0.05%<br />
TRETIN-X CRE KIT 0.1%<br />
TRETIN-X GEL KIT 0.01%<br />
TRETIN-X GEL KIT 0.025%<br />
tretinoin cre 0.025%<br />
tretinoin cre 0.05%<br />
tretinoin cre 0.1%<br />
tretinoin gel 0.01%<br />
tretinoin gel 0.025%<br />
TRETINOIN (FACIAL WRINKLES) CREAM 0.02%<br />
TRETINOIN (FACIAL WRINKLES) CREAM 0.05%<br />
tretinoin cream 0.025%<br />
TRETINOIN CREAM 0.025% W/ CLEANSER & MOISTURIZER KIT<br />
tretinoin cream 0.05%<br />
TRETINOIN CREAM 0.05% W/ CLEANSER & MOISTURIZER KIT<br />
tretinoin cream 0.1%<br />
TRETINOIN CREAM 0.1% W/ CLEANSER & MOISTURIZER KIT<br />
TRETINOIN EM CRE 0.05%<br />
tretinoin gel 0.01%<br />
TRETINOIN GEL 0.01% W/ CLEANSER & MOISTURIZER KIT<br />
tretinoin gel 0.025%<br />
TRETINOIN GEL 0.025% W/ CLEANSER & MOISTURIZER KIT<br />
TRETINOIN MICROSPHERE GEL 0.04%<br />
TRETINOIN MICROSPHERE GEL 0.1%<br />
Depigmenting and Pigmenting Agents<br />
Pigmenting Agents<br />
UVADEX INJ 20MCG/ML PA<br />
Skin and Mucous Membrane Agents, Misc<br />
AMEVIVE INJ 15MG PA<br />
ANTHRALIN CREAM 0.5%<br />
anthralin cream 1%<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 166
ANTHRALIN CREAM 1%<br />
ANTHRALIN CREAM 1.2%<br />
benzoyl peroxide-sulfur gel 6-3%<br />
BENZOYL PEROXIDE-SULFUR LOTION 10-5%<br />
BENZOYL PEROXIDE-SULFUR LOTION 5-2%<br />
BEXAROTENE GEL 1%<br />
bps gel 6-3%<br />
CALCIPOTRIENE CREAM 0.005% NF<br />
CALCIPOTRIENE OINT 0.005% NF<br />
CARAC CRE 0.5% NF<br />
DOVONEX CRE 0.005% NF<br />
DOVONEX OIN 0.005% NF<br />
DRITHO-CREME CRE HP 1%<br />
DRITHO-SCALP CRE 0.5%<br />
ELIDEL CRE 1% PA<br />
FLUOROPLEX CRE 1% NF<br />
fluorouracil cre 5% NF<br />
FLUOROURACIL CREAM 0.5% NF<br />
FLUOROURACIL CREAM 1% NF<br />
fluorouracil cream 5% NF<br />
PROTOPIC OIN 0.03% PA<br />
PROTOPIC OIN 0.1% PA<br />
psoriatec cre 1%<br />
RAPTIVA KIT 125MG PA<br />
SULFOXYL LOT<br />
SULFOXYL LOT STRONG<br />
TARGRETIN GEL 1%<br />
TAZAROTENE GEL 0.05% NF<br />
TAZAROTENE GEL 0.1% NF<br />
TAZORAC GEL 0.05% NF<br />
TAZORAC GEL 0.1% NF<br />
ZITHRANOL-RR CRE 1.2%<br />
Smooth Muscle Relaxants<br />
Genitourinary Smooth Muscle Relaxants<br />
oxybutynin syp 5mg/5ml<br />
oxybutynin tab 5mg<br />
oxybutynin chloride syrup 5 mg/5ml<br />
oxybutynin chloride tab 5 mg<br />
Respiratory Smooth Muscle Relaxants<br />
aminophylline inj 25 mg/ml PA<br />
ELIXOPHYLLIN ELX 80/15ML NF<br />
THEO-24 CAP 100MG CR NF<br />
THEO-24 CAP 200MG CR NF<br />
THEO-24 CAP 300MG CR NF<br />
THEO-24 CAP 300MG CR<br />
THEO-24 CAP 400MG ER NF<br />
THEOCAP CAP 125MG CR<br />
THEOCAP CAP 200MG CR<br />
theocap cap 300mg cr<br />
theochron tab 100mg cr<br />
theochron tab 200mg cr<br />
theochron tab 300mg cr<br />
theochron tab 450mg<br />
theophylline cap 125mg er<br />
theophylline cap 200mg er<br />
theophylline cap 300mg er<br />
THEOPHYLLINE CAP SR 12HR 125 MG<br />
theophylline cap sr 12hr 125 mg<br />
THEOPHYLLINE CAP SR 12HR 200 MG<br />
theophylline cap sr 12hr 200 mg<br />
theophylline cap sr 12hr 300 mg<br />
THEOPHYLLINE CAP SR 24HR 100 MG NF<br />
THEOPHYLLINE CAP SR 24HR 200 MG NF<br />
THEOPHYLLINE CAP SR 24HR 300 MG NF<br />
THEOPHYLLINE CAP SR 24HR 300 MG<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 167
THEOPHYLLINE CAP SR 24HR 400 MG NF<br />
THEOPHYLLINE ELIXIR 80 MG/15ML NF<br />
theophylline in d5w inj 0.8 mg/ml PA<br />
theophylline in d5w inj 1.6 mg/ml PA<br />
theophylline in d5w inj 2 mg/ml PA<br />
theophylline in d5w inj 3.2 mg/ml PA<br />
theophylline in d5w inj 4 mg/ml PA<br />
theophylline tab 100mg cr<br />
theophylline tab 100mg er<br />
theophylline tab 100mg td<br />
theophylline tab 200mg cr<br />
theophylline tab 200mg er<br />
theophylline tab 200mg sr<br />
theophylline tab 200mg td<br />
theophylline tab 300mg cr<br />
theophylline tab 300mg er<br />
theophylline tab 300mg sr<br />
theophylline tab 300mg td<br />
theophylline tab 300mgsr<br />
theophylline tab 400mg er<br />
theophylline tab 450mg cr<br />
theophylline tab 450mg er<br />
theophylline tab 600mg er<br />
theophylline tab sr 12hr 100 mg<br />
theophylline tab sr 12hr 200 mg<br />
theophylline tab sr 12hr 300 mg<br />
theophylline tab sr 12hr 450 mg<br />
theophylline tab sr 24hr 400 mg<br />
THEOPHYLLINE TAB SR 24HR 400 MG<br />
theophylline tab sr 24hr 600 mg<br />
THEOPHYLLINE TAB SR 24HR 600 MG<br />
UNIPHYL TAB 400MG CR<br />
UNIPHYL TAB 600MG CR<br />
Vitamins<br />
Vitamin A<br />
AQUASOL A INJ 50000/ML PA<br />
Vitamin B Complex<br />
*b-complex vitamin inj** PA<br />
b-6 tab 100mg OTC<br />
b-6 tab 250mg OTC<br />
b-6 tab 50mg OTC<br />
bl vit b-6 tab 100mg OTC<br />
bl vit b-6 tab 50mg OTC<br />
CALOMIST SPR 25MCG PA<br />
cvs vit b-6 tab 100mg OTC<br />
cvs vit b-6 tab 200mg OTC<br />
cvs vit b-6 tab 50mg OTC<br />
cyanocobalamin inj 1000 mcg/ml PA<br />
dexpanthenol inj 250 mg/ml PA<br />
DEXPANTHENOL INJ 250MG/ML PA<br />
FOLIC ACID INJ 5MG/ML PA<br />
gnp vit b-6 tab 100mg OTC<br />
gnp vit b-6 tab 50mg OTC<br />
hca vit b6 tab 100mg OTC<br />
HYDROXOCOBAL INJ 1000MCG PA<br />
MAGNESIUM W/ POTASSIUM-PYRIDOXINE CAP 100-99-200 MG OTC<br />
NASCOBAL SPR 500MCG PA<br />
NERVIDOX-6 INJ NR PA<br />
nestrex tab 25mg OTC<br />
NEURO-B12 INJ FORTE PA<br />
NEURO-B12 INJ FORTE NR PA<br />
neuro-k-250 tab 250mg OTC<br />
neuro-k-50 tab OTC<br />
neuro-k-500 tab OTC<br />
pyri 500 tab 500mg OTC<br />
pyridoxine tab 100mg OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 168
pyridoxine tab 25mg OTC<br />
pyridoxine tab 50mg OTC<br />
pyridoxine hcl inj 100 mg/ml PA<br />
pyridoxine hcl tab 100 mg OTC<br />
pyridoxine hcl tab 200 mg OTC<br />
pyridoxine hcl tab 25 mg OTC<br />
pyridoxine hcl tab 250 mg OTC<br />
pyridoxine hcl tab 50 mg OTC<br />
pyridoxine hcl tab 500 mg OTC<br />
PYRIDOXINE/ CAP MINERALS OTC<br />
ra vit b-6 tab 50mg OTC<br />
SHERI-B-12 LIQ PA OTC<br />
sm vit b-6 tab 100mg OTC<br />
sm vit b-6 tab 50mg OTC<br />
thiamine hcl inj 100 mg/ml PA<br />
v-r vit b-6 tab 100mg OTC<br />
v-r vit b-6 tab 50mg OTC<br />
vitamin b-6 tab 100mg OTC<br />
vitamin b-6 tab 200mg OTC<br />
vitamin b-6 tab 250mg OTC<br />
vitamin b-6 tab 25mg OTC<br />
vitamin b-6 tab 500mg OTC<br />
vitamin b-6 tab 50mg OTC<br />
vitamin b1 & b12 inj 100-1 mg/ml PA<br />
yl vit b-6 tab 100mg OTC<br />
Vitamin C<br />
ascorbic acid inj 500 mg/ml PA<br />
CECON SOL 90MG/ML PA OTC<br />
sodium ascorbate inj 250 mg/ml PA<br />
sodium ascorbate inj 500 mg/ml PA<br />
Vitamin D<br />
calcitriol cap 0.25mcg<br />
calcitriol cap 0.5mcg<br />
CALCITRIOL INJ 2MCG/ML PA<br />
calcitriol cap 0.25 mcg<br />
calcitriol cap 0.5 mcg<br />
calcitriol inj 1 mcg/ml PA<br />
calcitriol oral soln 1 mcg/ml PA<br />
ergocalciferol soln 8000 unit/ml PA OTC<br />
HECTOROL INJ 4MCG/2ML PA<br />
ZEMPLAR INJ 2MCG/ML PA<br />
ZEMPLAR INJ 5MCG/ML PA<br />
Vitamin K Activity<br />
MEPHYTON TAB 5MG<br />
phytonadione inj 2 mg/ml PA<br />
PHYTONADIONE TAB 5 MG<br />
VITAMIN K1 INJ 10MG/ML PA<br />
Multivitamin Preparations<br />
*multiple vitamin inj** PA<br />
*pediatric multiple vitamins w/ fl-fe chew tab 0.5-12 mg**<br />
*pediatric multiple vitamins w/ fl-fe chew tab 1-12 mg**<br />
*pediatric multiple vitamins w/ fl-fe drops 0.25-10 mg/ml**<br />
*pediatric multiple vitamins w/ fl-fe drops 0.5-10 mg/ml**<br />
*pediatric multiple vitamins w/ fl-fe drops 0.5-10 mg/ml**<br />
*pediatric multiple vitamins w/ fluoride chew tab 0.25 mg***<br />
*pediatric multiple vitamins w/ fluoride chew tab 0.5 mg***<br />
*pediatric multiple vitamins w/ fluoride chew tab 1 mg***<br />
*pediatric multiple vitamins w/ fluoride soln 0.25 mg/ml***<br />
*pediatric multiple vitamins w/ fluoride soln 0.5 mg/ml***<br />
*pediatric vitamins acd fluoride & fe drops 0.25-10 mg/ml***<br />
*pediatric vitamins acd w/ fluoride chew tab 1 mg***<br />
*pediatric vitamins acd w/ fluoride soln 0.25 mg/ml***<br />
*pediatric vitamins acd w/ fluoride soln 0.5 mg/ml***<br />
*prenatal multivitamins & minerals w/ iron & fa tab 1 mg***<br />
*prenatal multivitamins & minerals w/iron & fa tab 0.8 mg*** OTC<br />
*prenatal multivitamins & minerals w/iron & fa tab 0.8 mg***<br />
*prenatal vit w/ dss-fe fumarate-fa tab cr 90-1 mg***<br />
*prenatal vit w/ fe fumarate-fa tab 27-0.5 mg***<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 169
*prenatal vit w/ fe fumarate-fa tab 27-0.8 mg*** OTC<br />
*prenatal vit w/ fe fumarate-fa tab 27-0.8 mg***<br />
*prenatal vit w/ fe fumarate-fa tab 27-1 mg***<br />
*prenatal vit w/ fe fumarate-fa tab 28-0.8 mg*** OTC<br />
*prenatal vit w/ fe fumarate-fa tab 28-1 mg***<br />
*prenatal vit w/ fe fumarate-fa tab 29-1 mg***<br />
*prenatal vit w/ fe fumarate-fa tab 60-0.8 mg*** OTC<br />
*prenatal vit w/ fe fumarate-fa tab 60-1 mg***<br />
*prenatal vit w/ fe fumarate-fa tab 65-1 mg***<br />
*prenatal vit w/ fe fumarate-fa tab 65-1 mg***<br />
*PRENATAL VIT W/ FE FUMARATE-FA TAB 65-1 MG*** NF<br />
*PRENATAL VIT W/ FE GLUCONATE-FA TAB 30-0.4 MG*** OTC<br />
*prenatal vit w/ fe gluconate-fa tab 30-0.8 mg*** OTC<br />
*prenatal vit w/ fe polysac cmplx-fa tab 60-1 mg***<br />
*prenatal vit w/ iron carbonyl-fe sulf-fa tab 60-1 mg***<br />
*PRENATAL VIT W/ IRON CARBONYL-FE SULF-FA TAB 60-1 MG***<br />
*PRENATAL VIT W/ SEL-FE FUMARATE-FA TAB 27-1 MG***<br />
*prenatal vit w/ sel-fe fumarate-fa tab 27-1 mg***<br />
*prenatal w/o a vit w/ fe fumarate-fa tab 30-1 mg***<br />
*PRENATAL W/O A VIT W/ FE FUMARATE-FA TAB 40-1 MG***<br />
*prenatal w/o a vit w/ fe fumarate-fa tab dr 30-1 mg***<br />
adc/fluoride dro 0.25mg<br />
ALBAFORT INJ PA<br />
ALBAFORT S INJ PA<br />
aminate fe tab 90mg<br />
bl prenatal tab OTC<br />
bp multinatl tab plus<br />
cavan tab prenatal<br />
CERNEVIT INJ PA<br />
co-natal fa tab 29-1mg<br />
cvs prenatal tab OTC<br />
eck prenatal tab OTC<br />
eql prenatal tab formula OTC<br />
gnp prenatal tab 28-0.8mg OTC<br />
m-vit tab 27-1mg<br />
M.V.I PEDIAT INJ PA<br />
M.V.I-12 W/O INJ VIT K PA<br />
M.V.I. ADULT INJ PA<br />
maternity tab<br />
maternity-90 tab<br />
MISSION PREN TAB OTC<br />
mission pren tab /fa OTC<br />
mission pren tab hp OTC<br />
mult vit-bet chw /fl 1mg<br />
mult vit-bet chw fe/fl0.5<br />
mult vit-bet chw fe/fl1mg<br />
mult vit-bet chw fl 0.5mg<br />
mult vit-bet chw fl0.25mg<br />
mult-vit/fl chw 0.5mg<br />
mult-vit/fl chw 0.5mg<br />
multi prenat tab OTC<br />
multi vit/fl chw 0.25mg<br />
multi vit/fl chw 1mg<br />
multi vit/fl dro 0.25mg<br />
multi-vit/fe dro /fl 0.25<br />
multi-vit/fe dro /fl 0.5<br />
multi-vit/fe dro fl 0.25<br />
multi-vit/fl chw 0.25mg<br />
multi-vit/fl chw 0.25mg<br />
multi-vit/fl chw 0.5mg<br />
multi-vit/fl chw 0.5mg<br />
multi-vit/fl chw 0.5mg<br />
multi-vit/fl chw 1mg<br />
multi-vit/fl chw 1mg<br />
multi-vit/fl dro 0.25mg<br />
multi-vit/fl dro 0.25mg<br />
multi-vit/fl dro 0.25mg<br />
multi-vit/fl dro 0.5mg/ml<br />
multi-vit/fl dro 0.5mg/ml<br />
multifol plu tab 65-1mg<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 170
multivit/fl chw 0.25mg<br />
multivit/fl chw 0.25mg<br />
multivit/fl chw 0.25mg<br />
multivit/fl chw 0.5/fe12<br />
multivit/fl chw 0.5mg<br />
multivit/fl chw 0.5mg<br />
multivit/fl chw 0.5mg<br />
multivit/fl chw 1mg<br />
multivit/fl chw 1mg<br />
multivit/fl chw 1mg<br />
multivitamin chw fl1/fe12<br />
multivitamin chw w/fl/fe<br />
multivitamin dro /fluorid<br />
multivitamin dro fluor/fe<br />
multivite/fl chw 0.5mg<br />
mvc-fluoride chw 0.25mg<br />
mvc-fluoride chw 0.5mg<br />
mvc-fluoride chw 1mg<br />
mynatal plus tab<br />
mynatal-z tab<br />
mynate 90 tab plus<br />
NATAFORT TAB<br />
natalcare tab pic<br />
natalcare tab picforte<br />
natalcare tab plus<br />
natalcare tab three<br />
natalcare rx tab<br />
natamar rx tab<br />
natatab fa tab<br />
NEURODEP SOL PA<br />
niferex-pn tab forte<br />
OCTRON INJ PA<br />
p d natal/fa tab OTC<br />
p-d natal tab plus OTC<br />
poly iron pn tab<br />
poly iron pn tab forte<br />
poly-vit w/f dro 0.25mg<br />
poly-vit/fe chw /fl 1mg<br />
poly-vit/fe dro /fl 0.25<br />
poly-vit/fe dro /fl 0.5<br />
poly-vit/fl chw 0.5mg<br />
poly-vit/fl dro 0.25mg<br />
poly-vit/fl dro 0.5mg<br />
polyvit/fl dro 0.5mg/ml<br />
polyvites/fl chw 0.25mg<br />
polyvits/fe dro 0.25/fl<br />
pre-natal tab OTC<br />
pre-natal tab formula OTC<br />
PRECARE TAB PRENATAL<br />
prenaplus tab<br />
prenatabs fa tab<br />
prenatal tab<br />
prenatal tab<br />
prenatal tab OTC<br />
prenatal tab 27-0.8mg<br />
prenatal tab formula OTC<br />
prenatal tab formula<br />
prenatal tab forte OTC<br />
prenatal tab low iron OTC<br />
prenatal tab low iron<br />
prenatal tab plus<br />
prenatal tab plus/fe<br />
prenatal tab vitamins OTC<br />
prenatal 1 tab plus 1<br />
prenatal fa tab<br />
prenatal for tab 28-1mg<br />
prenatal mr tab 90 fe<br />
prenatal mtr tab selenium<br />
prenatal nf tab plus<br />
prenatal pls tab /betacar<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 171
prenatal pls tab /iron<br />
prenatal rx tab<br />
prenatal rx tab beta-car<br />
prenatal rx1 tab<br />
prenatal s tab OTC<br />
prenatal s tab<br />
prenatal vit tab OTC<br />
prenatal z tab<br />
prenatal z tab adv form<br />
prenatal/fa tab<br />
prenatal/fe tab OTC<br />
prenavite tab mult vit OTC<br />
prenavite pr tab coated OTC<br />
px prenatal tab multivit OTC<br />
qc prenatal tab 27-0.8mg OTC<br />
ra prenatal tab /fa OTC<br />
ra prenatal tab 27-0.8mg OTC<br />
ra prenatal tab 28-0.8mg OTC<br />
se-care tab conceive<br />
se-natal 90 tab<br />
se-natal one tab<br />
sm prenatal tab vitamins OTC<br />
taron-ec cal tab 28-1mg<br />
ternamar tab<br />
tri-a-vite chw w/fl 1mg<br />
tri-vit/fe dro /fl 0.25<br />
tri-vit/fe dro /fl 0.25<br />
tri-vit/fl chw<br />
tri-vit/fl dro 0.25mg<br />
tri-vit/fl dro 0.5mg<br />
tri-vit/fluo dro 0.25mg<br />
tri-vit/fluo dro 0.5mg<br />
tri-vita bet chw /fluorid<br />
tricare tab prenatal<br />
trinatal rx tab 1<br />
verotin-by tab<br />
verotin-gr tab<br />
vinatal tab forte<br />
vinate c tab<br />
VINATE M TAB<br />
vinate one tab<br />
VITA-NUMONYL INJ PA<br />
vitafol-ob tab 65-1mg<br />
VITAFOL-PN TAB NF<br />
VITAJECT INJ PA<br />
vitl nestabs tab OTC<br />
vynatal fa tab<br />
Miscellaneous Therapeutic Agents<br />
sod fluoride chw 0.5mg<br />
sodium fluoride chew tab 0.5 mg f (from 1.1 mg naf)<br />
Biologic Response Modifiers<br />
ACTIMMUNE INJ 2MU/0.5 PA<br />
AVONEX KIT 30MCG PA<br />
AVONEX PREFL KIT 30MCG PA<br />
BETASERON INJ 0.3MG PA<br />
COPAXONE KIT 20MG/ML PA<br />
EXTAVIA INJ 0.3MG PA<br />
REBIF INJ 22/0.5 PA<br />
REBIF INJ 44/0.5 PA<br />
REBIF TITRTN SOL PACK PA<br />
TYSABRI INJ PA<br />
Bone Resorption Inhibitors<br />
BONIVA KIT 3MG/3ML PA<br />
GANITE INJ 25MG/ML PA<br />
PAMIDRONATE INJ 6MG/ML PA<br />
pamidronate disodium for inj 30 mg PA<br />
pamidronate disodium for inj 90 mg PA<br />
pamidronate disodium iv soln 3 mg/ml PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 172
pamidronate disodium iv soln 9 mg/ml PA<br />
RECLAST INJ 5/100ML PA<br />
ZOMETA INJ 4MG/5ML PA<br />
Disease-Modifying Antirheumatic Agents<br />
ACTEMRA INJ 200/10ML PA<br />
ACTEMRA INJ 400/20ML PA<br />
ACTEMRA INJ 80MG/4ML PA<br />
ENBREL INJ 25/0.5ML PA<br />
ENBREL INJ 25MG PA<br />
ENBREL INJ 50MG/ML PA<br />
ENBREL SRCLK INJ 50MG/ML PA<br />
HUMIRA KIT 20MG/0.4 PA<br />
HUMIRA KIT 40MG/0.8 PA<br />
HUMIRA PEN KIT 40MG/0.8 PA<br />
HUMIRA PEN KIT CROHNS PA<br />
HUMIRA PEN KIT PSORIASI PA<br />
KINERET INJ PA<br />
ORENCIA INJ 250MG PA<br />
REMICADE INJ 100MG PA<br />
SIMPONI INJ 50MG PA<br />
Immunosuppressive Agents<br />
ATGAM INJ 250MG PA<br />
AZATHIOPRINE INJ 100MG PA<br />
CELLCEPT IV INJ 500MG PA<br />
cyclosporine cap 100 mg<br />
cyclosporine cap 100mg<br />
cyclosporine cap 100mg md<br />
cyclosporine cap 25 mg<br />
cyclosporine cap 25mg<br />
cyclosporine cap 25mg mod<br />
cyclosporine cap 50mg mod<br />
cyclosporine inj 50mg/ml<br />
cyclosporine iv soln 50 mg/ml<br />
cyclosporine modified cap 100 mg<br />
cyclosporine modified cap 25 mg<br />
cyclosporine modified cap 50 mg<br />
cyclosporine modified oral soln 100 mg/ml<br />
cyclosporine oral soln 100 mg/ml<br />
cyclosporine sol 100mg/ml<br />
cyclosporine sol modified<br />
gengraf cap 100mg<br />
gengraf cap 25mg<br />
gengraf sol 100mg/ml<br />
ORTHOCLONE INJ OKT3 PA<br />
PROGRAF INJ 5MG/ML PA<br />
RAPAMUNE SOL 1MG/ML<br />
SIMULECT INJ 10MG PA<br />
SIMULECT INJ 20MG PA<br />
SIROLIMUS ORAL SOLN 1 MG/ML<br />
STELARA INJ 45MG/0.5 PA<br />
STELARA INJ 90MG/ML PA<br />
tacrolimus cap 0.5mg<br />
tacrolimus cap 1mg<br />
tacrolimus cap 5mg<br />
tacrolimus cap 0.5 mg<br />
tacrolimus cap 1 mg<br />
tacrolimus cap 5 mg<br />
THYMOGLOBULN INJ 25MG PA<br />
ZENAPAX INJ 25MG/5ML PA<br />
Other Misc Therapeutic Agents<br />
*aromatic inhalants - inhalant*** OTC<br />
*camphor-eucalyptus-menthol - cream*** OTC<br />
*CAMPHOR-EUCALYPTUS-MENTHOL - LIQUID*** OTC<br />
*camphor-eucalyptus-menthol - liquid*** OTC<br />
*CAMPHOR-EUCALYPTUS-MENTHOL - OINT*** OTC<br />
*CAMPHOR-EUCALYPTUS-MENTHOL - SOLUBLE TAB FOR INHALATION*** OTC<br />
*CAMPHOR-EUCALYPTUS-MENTHOL - TOPICAL PATCH*** OTC<br />
*CAMPHOR-EUCALYPTUS-MENTHOL-BENZOIN - LIQUID*** OTC<br />
*camphor-eucalyptus-menthol-turp oil-white pet -oint*** OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 173
*CAMPHOR-MENTHOL - OINTMENT*** OTC<br />
ARCALYST INJ 220MG PA QL<br />
ARGENTUM MET INJ 8X PA<br />
ARGENTUM-D20 INJ PA<br />
ayr inh OTC<br />
BEE VENOM INJ 1300MCG PA<br />
BEE VENOM INJ 550MCG PA<br />
BL HOT STEAM LIQ OTC<br />
BOTOX INJ 100UNIT PA<br />
BOTOX INJ 200UNIT PA<br />
BOTOX COSMET INJ 100UNIT PA<br />
BOTOX COSMET INJ 50UNIT PA<br />
camphor inhalant liquid 6.2% OTC<br />
CAMPHOR-MENTHOL PATCH 4.7-2.6% OTC<br />
CAT HAIR INJ EXTRACT PA<br />
CERECOMP INJ PA<br />
chest rub oin medicate OTC<br />
COENZYME INJ COMPOSIT PA<br />
deconges rub mis OTC<br />
decongestant inh OTC<br />
decongestant inh nasal OTC<br />
decongestant inh vapor OTC<br />
DISCUS INJ COMPOSIT PA<br />
DYSPORT INJ 500UNIT PA<br />
ENGYSTOL INJ PA<br />
eq medicated oin chst rub OTC<br />
EUFLEXXA INJ 10MG/ML PA<br />
GALIUM-HEEL INJ PA<br />
GLYOXAL INJ COMPOSIT PA<br />
gnp hot liq steam OTC<br />
GRIPP-HEEL INJ PA<br />
HEPAR INJ COMPOSIT PA<br />
HONEY BEE INJ 1000MCG PA<br />
HONEY BEE KIT 100MCG PA<br />
HORNET VENOM INJ 1300MCG PA<br />
HORNET VENOM INJ 550MCG PA<br />
hot steam liq OTC<br />
hot steam liq 6.2% OTC<br />
hot steam liq medicati OTC<br />
HYALGAN INJ 20MG/2ML PA<br />
inhaler inh deconges OTC<br />
ISCAR MALI INJ PA<br />
ISCAR MALI INJ 100MG/ML PA<br />
ISCAR MALI INJ 50MG/ML PA<br />
ISCAR MALI INJ 5MG/ML PA<br />
ISCAR MALI INJ SERIES I PA<br />
ISCAR MALI INJ SERIES O PA<br />
ISCAR MALI INJ SERIESII PA<br />
ISCAR MALI INJ SPECIAL PA<br />
ISCAR PINI INJ 0.005MG/ PA<br />
ISCAR PINI INJ 0.05MG/M PA<br />
ISCAR PINI INJ 0.5MG/ML PA<br />
ISCAR PINI INJ 100MG/ML PA<br />
ISCAR PINI INJ 50MG/ML PA<br />
ISCAR PINI INJ 5MG/ML PA<br />
ISCAR PINI INJ SERIES I PA<br />
ISCAR PINI INJ SERIES I PA<br />
ISCAR PINI INJ SERIES O PA<br />
ISCAR QUERCU INJ PA<br />
ISCAR QUERCU INJ 100MG/ML PA<br />
ISCAR QUERCU INJ 25MG/ML PA<br />
ISCAR QUERCU INJ 50MG/ML PA<br />
ISCAR QUERCU INJ 5MG/ML PA<br />
ISCAR QUERCU INJ SERIES I PA<br />
ISCAR QUERCU INJ SERIES O PA<br />
ISCAR QUERCU INJ SERIESII PA<br />
KALBITOR INJ 10MG/ML PA<br />
levocarnitin tab 330mg<br />
levocarnitine inj 200 mg/ml PA<br />
levocarnitine oral soln 1 gm/10ml (10%) PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 174
levocarnitine tab 330 mg<br />
LYMPHOMYOSOT INJ PA<br />
MEDICATED OIN RUB OTC<br />
medicated oin rub OTC<br />
METASTRON INJ PA<br />
MIXED VESPID INJ 1650MCG PA<br />
MIXED VESPID INJ 3900MCG PA<br />
MIXED VESPID KIT 3000MCG PA<br />
MIXED VESPID KIT 300MCG PA<br />
MUCOSA INJ COMPOSIT PA<br />
MYOBLOC INJ 10000/2 PA<br />
MYOBLOC INJ 2500/0.5 PA<br />
MYOBLOC INJ 5000/ML PA<br />
NEXAVIR INJ PA<br />
OCTREOSCAN KIT PA<br />
octreotide acetate inj 100 mcg/ml (0.1 mg/ml) PA<br />
octreotide acetate inj 1000 mcg/ml (1 mg/ml) PA<br />
octreotide acetate inj 200 mcg/ml (0.2 mg/ml) PA<br />
octreotide acetate inj 50 mcg/ml (0.05 mg/ml) PA<br />
octreotide acetate inj 500 mcg/ml (0.5 mg/ml) PA<br />
PROSTASCINT KIT PA<br />
PX MEDICATED OIN CHESTRUB OTC<br />
QC HOT STEAM LIQ OTC<br />
ra decongest inh nasal OTC<br />
RA MEDICATED OIN RUB OTC<br />
ra vaporizin liq steam OTC<br />
SANDOSTATIN KIT LAR 10MG PA<br />
SANDOSTATIN KIT LAR 20MG PA<br />
SANDOSTATIN KIT LAR 30MG PA<br />
SARAPIN INJ PA<br />
SHOWER TAB OTC<br />
SHOWER TAB SOOTHERS OTC<br />
sm medicated mis chst rub OTC<br />
SOMATULINE INJ 120/.5ML PA<br />
SOMATULINE INJ 60/0.2ML PA<br />
SOMATULINE INJ 90/0.3ML PA<br />
SPASCUPREEL INJ PA<br />
STAPHAGE LYS INJ PA<br />
SUPARTZ INJ 25/2.5ML PA<br />
SYNVISC INJ 8MG/ML PA<br />
SYNVISC ONE INJ 8MG/ML PA<br />
TIGER BALM OIN 11%-10% OTC<br />
TIGER BALM OIN 11%-11% OTC<br />
TIGER BALM OIN 11%-8% OTC<br />
TRAUMEEL INJ PA<br />
TRAUMEEL INJ PA<br />
TRIAMINIC DIS CHERRY OTC<br />
TRIAMINIC DIS MENTHOL OTC<br />
UBICHINON INJ COMPOSIT PA<br />
vapor inhale inh OTC<br />
VAPOR PATCH DIS OTC<br />
vaporizing cre OTC<br />
vaporizing liq steam OTC<br />
VAPORIZING OIN RUB OTC<br />
VAPORX BALM OIN OTC<br />
VENOMIL KIT HONEYBEE PA<br />
VENOMIL KIT WASP PA<br />
VENOMIL KIT WHT HORN PA<br />
VENOMIL KIT YEL HORN PA<br />
VENOMIL KIT YEL JACK PA<br />
VENOMIL MIX INJ VESPID PA<br />
VICK VAPORUB OIN OTC<br />
VICKS CASERO OIN LEMON OTC<br />
WASP VENOM INJ 1000MCG PA<br />
WASP VENOM INJ 1300MCG PA<br />
WASP VENOM INJ 550MCG PA<br />
WASP VENOM KIT 100MCG PA<br />
WHITE HORNET KIT 100MCG PA<br />
WHITE HORNET SOL 1000MCG PA<br />
XIGRIS INJ 20MG PA<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 175
XIGRIS INJ 5MG PA<br />
YELLOW HORN INJ 550MCG PA<br />
YELLOW HORNT KIT 100MCG PA<br />
YELLOW HORNT SOL 1000MCG PA<br />
YELLOW JACK INJ 1300MCG PA<br />
YELLOW JACK INJ 550MCG PA<br />
YELLOW JACKT KIT 100MCG PA<br />
YELLOW JACKT SOL 1000MCG PA<br />
ZEEL INJ PA<br />
Devices<br />
*BLOOD GLUCOSE MONITORING DEVICES*** OTC QL<br />
*BLOOD GLUCOSE MONITORING KIT W/ DEVICE*** OTC QL<br />
*FEEDING TUBES - SETS*** OTC NF<br />
*FEEDING TUBES - TUBING*** OTC NF<br />
*INJECTION DEVICE - MISC*** OTC<br />
*INSULIN PEN NEEDLE*** OTC QL<br />
*lancets*** OTC<br />
*RESPIRATORY THERAPY SUPPLIES - MISC** QL<br />
*SPACER/AEROSOL-HOLDING CHAMBER SUPPLIES - BAGS*** QL<br />
*SPACER/AEROSOL-HOLDING CHAMBER SUPPLIES - MOUTHPIECES*** QL<br />
*SPACER/AEROSOL-HOLDING CHAMBERS - DEVICE*** OTC QL<br />
*SPACER/AEROSOL-HOLDING CHAMBERS - DEVICE*** QL<br />
1/2ML ALLERG KIT 27GX3/8" OTC<br />
1ML ALLERGIS KIT TRAY SYR OTC<br />
1ML ALLERGIS KIT TRAY SYR OTC<br />
1ML ALLR SYR MIS 27GX1/2" OTC<br />
1ML SYRINGE MIS 28GX1/2" OTC<br />
1st choice mis lancets OTC<br />
1st choice mis lancets OTC<br />
1st choice mis lancets OTC<br />
1ST TIER UNI MIS 29GX12MM OTC QL<br />
1ST TIER UNI MIS 31GX6MM OTC QL<br />
1ST TIER UNI MIS 31GX8MM OTC QL<br />
A1C NOW KIT PA OTC<br />
A1C NOW KIT SELFCHEC PA OTC<br />
ACCU-CHEK KIT ACTIVE PA OTC<br />
ACCU-CHEK KIT ADVANTAG PA OTC<br />
ACCU-CHEK KIT AVIVA PA OTC<br />
ACCU-CHEK KIT COMPACT PA OTC<br />
ACCU-CHEK KIT COMPACT PA OTC<br />
ACCU-CHEK KIT COMPACT PA OTC<br />
ACCU-CHEK KIT VOICEMAT PA OTC<br />
ACCU-CHEK MIS ACTIVE PA OTC<br />
ACCU-CHEK MIS AVIVA PA OTC<br />
accu-chek mis mlticlix OTC<br />
ACCU-CHEK MIS TRANSFER PA OTC<br />
ACCU-CHEK AD MIS METER PA OTC<br />
ACURA BLOOD KIT METER PA OTC<br />
ACURA BLOOD KIT STARTER PA OTC<br />
ADULT MASK MIS LARGE QL<br />
ADVANCE KIT INTUITIO PA OTC<br />
ADVANCE MIS INTUITIO PA OTC<br />
ADVANCE MIS MICRO-DW PA OTC<br />
ADVOCATE KIT PA OTC<br />
ADVOCATE KIT REDICODE PA OTC<br />
ADVOCATE MIS PA OTC<br />
advocate mis lancets OTC<br />
advocate mis lancets OTC<br />
ADVOCATE MIS REDICODE PA OTC<br />
ADVOCATE RED MIS PA OTC<br />
AERCHMBR PLS MIS LRG MASK QL<br />
AERCHMBR PLS MIS MASK QL<br />
AERCHMBR PLS MIS SM MASK QL<br />
AERCHMBR Z- MIS STAT PLS QL<br />
AERCHMBR Z- MIS STAT PLS QL<br />
AERCHMBR Z- MIS STAT PLS QL<br />
AERCHMBR Z- MIS STAT PLS QL<br />
AEROCHAMBER KIT ACTION QL<br />
AEROCHAMBER MIS FLOSIGNA QL<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 176
AEROCHAMBER MIS MV QL<br />
AEROCHAMBER MIS PLUS QL<br />
af lancets mis thin OTC<br />
ALBERTSONS KIT STARTER PA OTC<br />
ALLERGIST KIT 27GX1/2" OTC<br />
ALLERGIST KIT PACK OTC<br />
ALLERGIST KIT PACKAGE OTC<br />
ALLERGY TRAY KIT 1 ML 26 X 1/2" OTC<br />
ALLERGY TRAY KIT 1 ML 26 X 3/8" OTC<br />
ALLERGY TRAY KIT 1 ML 27 X 1/2" OTC<br />
ALLERGY TRAY KIT 1 ML 27 X 3/8" OTC<br />
ALLERGY TRAY KIT 1/2 ML 27 X 3/8" OTC<br />
ames glu sys mis OTC<br />
ASCENSIA KIT BREEZE PA OTC<br />
ASCENSIA KIT BRIO PA OTC<br />
ASCENSIA KIT DIAB XL PA OTC<br />
ASSURE 3 KIT METER PA OTC<br />
ASSURE 4 MIS PA OTC<br />
assure lance mis low flow OTC<br />
assure lance mis micro OTC<br />
ASSURE PRO MIS METER PA OTC<br />
AT LAST KIT GLUCOSE PA OTC<br />
at last mis lancets OTC<br />
aurora mis lancets OTC<br />
aurora lance mis 30g OTC<br />
aurora lance mis thin 23g OTC<br />
auto lancet mis OTC<br />
AUTOCODE SYS KIT GLUCOSE PA OTC<br />
AUTOSHIELD MIS 29GX1/2" OTC QL<br />
AUTOSHIELD MIS 29X3/16" OTC QL<br />
AUTOSHIELD MIS 29X5/16" OTC QL<br />
BAYER BREEZE KIT 2 SYSTEM PA OTC<br />
BAYER CONTOR KIT MONITOR PA OTC<br />
bayer micrlt mis lancets OTC<br />
bd genie mis lancet OTC<br />
bd genie mis lancets OTC<br />
bd lancet uf mis 30g OTC<br />
bd lancet uf mis 33g OTC<br />
BD LATITUDE KIT PA OTC<br />
BD LATITUDE KIT SYSTEM PA OTC<br />
BD LOGIC KIT MONITOR PA OTC<br />
bd microtain mis lancets OTC<br />
BD PEN NEEDL MIS 29GX1/2" OTC QL<br />
BD PEN NEEDL MIS 31GX3/16 OTC QL<br />
BD PEN NEEDL MIS 31GX3/16 OTC QL<br />
BD PEN NEEDL MIS 31GX5/16 OTC QL<br />
BD PEN NEEDL MIS 31GX5/16 OTC QL<br />
BD PEN NEEDL MIS 32GX4MM OTC QL<br />
bd ult fine mis lancets OTC<br />
bl lancets mis OTC<br />
bl lancets mis color OTC<br />
bl lancets mis thin OTC<br />
bl lancets mis thin OTC<br />
BLOOD GLUC KIT SYSTEM PA OTC<br />
BLOOD GLUC MIS METER PA OTC<br />
BLOOD GLUC MIS MONITOR PA OTC<br />
BLOOD GLUCOS KIT METER PA OTC<br />
BLOOD GLUCOS KIT MONITOR PA OTC<br />
BLOOD GLUCOS KIT MONITOR PA OTC<br />
BLOOD GLUCOS KIT MONITOR PA OTC<br />
BLOOD GLUCOS KIT MONITOR PA OTC<br />
BLOOD GLUCOS KIT SYSTEM PA OTC<br />
BLOOD GLUCOS KIT SYSTEM PA OTC<br />
BLOOD GLUCOS MIS METER PA OTC<br />
BREEZE 2 MIS SYSTEM PA OTC<br />
bullseye mis lancets OTC<br />
careone lanc mis 26g OTC<br />
careone lanc mis 28g OTC<br />
careone lanc mis 30g OTC<br />
careone lanc mis thin OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 177
careone lanc mis thin 23g OTC<br />
CHOICE DM KIT RISK TST PA OTC<br />
cleanlet 28g mis lancets OTC<br />
clever check mis OTC<br />
clever check mis 30g OTC<br />
CLEVER CHEK KIT SYSTEM PA OTC<br />
CLEVER CHEK MIS AUTO-CD PA OTC<br />
CLEVER CHEK MIS VOICE PA OTC<br />
CLEVER CHEK MIS VOICE PA OTC<br />
CLEVR CHOICE MIS AUTO-CD PA OTC<br />
CLEVR CHOICE MIS MINI PA OTC<br />
CLICKFINE MIS 31GX1/4" OTC QL<br />
CLICKFINE MIS 31GX1/4" OTC QL<br />
CLICKFINE MIS 31GX1/4" OTC QL<br />
CLICKFINE MIS 31GX5/16 OTC QL<br />
CLICKFINE MIS 31GX5/16 OTC QL<br />
CLICKFINE MIS 31GX5/16 OTC QL<br />
coaguchek mis lancets OTC<br />
color lancet mis OTC<br />
comfort mis lancets OTC<br />
comfortouch mis lancet OTC<br />
CONTOUR KIT BLUE PA OTC<br />
CONTOUR KIT ORANGE PA OTC<br />
CONTOUR MIS SYSTEM PA OTC<br />
CONTOUR USB KIT SYSTEM PA OTC<br />
CONTROL KIT MONITOR PA OTC<br />
CVS BLOOD GL MIS MONITOR PA OTC<br />
CVS BLOOD GL MIS MONITOR PA OTC<br />
cvs lancets mis 21g OTC<br />
cvs lancets mis original OTC<br />
cvs lancets mis thin OTC<br />
cvs lancets mis thin 26g OTC<br />
cvs lancets mis thin 30g OTC<br />
cvs lancets mis thin 33g OTC<br />
DAILY KIT DIABETIC PA OTC<br />
dd lancets mis OTC<br />
dd lancets mis thin OTC<br />
de lancets mis OTC<br />
de lancets mis thin OTC<br />
diabetic mis lancets OTC<br />
DIABETIC.COM KIT STARTER PA OTC<br />
DIDGET KIT PA OTC<br />
dr lancets mis colored OTC<br />
dr lancets mis thin OTC<br />
DRUG EMP KIT STARTER PA OTC<br />
DUANE READE KIT STARTER PA OTC<br />
e-z ject mis OTC<br />
e-z ject mis 21g colr OTC<br />
e-z ject mis 32g colr OTC<br />
e-z ject mis lanc 21g OTC<br />
e-z ject mis lancets OTC<br />
e-z ject mis lancets OTC<br />
e-z ject mis lancets OTC<br />
e-z ject mis thin OTC<br />
e-z ject mis thin 26g OTC<br />
e-z ject xl mis OTC<br />
E-Z SPACER MIS QL<br />
E-Z SPACER MIS MASK QL<br />
E-Z SPACER/ MIS MASK QL<br />
EASIVENT MIS QL<br />
EASIVENT MIS MASK LG QL<br />
EASIVENT MIS MASK SM QL<br />
EASIVENT MIS MASK MED QL<br />
EASY CHECK KIT PA OTC<br />
EASY CHECK MIS PA OTC<br />
EASY STEP KIT MONITOR PA OTC<br />
EASY STEP MIS MONITOR PA OTC<br />
easy touch mis 28g OTC<br />
EASY TOUCH MIS 29GX1/2" OTC QL<br />
easy touch mis 30g OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 178
EASY TOUCH MIS 31GX1/4" OTC QL<br />
EASY TOUCH MIS 31GX3/16 OTC QL<br />
EASY TOUCH MIS 31GX5/16 OTC QL<br />
EASYGLUCO KIT PA OTC<br />
EASYGLUCO KIT VALUE PK PA OTC<br />
EASYMAX N KIT SYSTEM PA OTC<br />
EASYMAX V MIS SYSTEM PA OTC<br />
EASYPRO KIT MONITOR PA OTC<br />
EASYPRO PLUS KIT PA OTC<br />
easytest mis lancets OTC<br />
easytest ii mis lancets OTC<br />
eck lancets mis thin OTC<br />
ECLIPSE KIT MONITOR PA OTC<br />
ELEMENT AUTO KIT SYSTEM PA OTC<br />
EMBRACE MIS PA OTC<br />
ENVISION KIT AUTOCODE PA OTC<br />
eql lancets mis 21g colr OTC<br />
eql lancets mis thin 26g OTC<br />
eql lancets mis thin 30g OTC<br />
equate reg mis lancets OTC<br />
equate thin mis lancets OTC<br />
EVENCARE SYS KIT BG MONIT PA OTC<br />
EVOLUTION MIS AUTOCODE PA OTC<br />
EXP MED STAR KIT PA OTC<br />
EZ SMART MIS PA OTC<br />
ez smart mis lancets OTC<br />
EZ SMART PLS MIS PA OTC<br />
ez-lets mis lancets OTC<br />
ez-lets 21g mis lancets OTC<br />
ez-lets 23g mis lancets OTC<br />
ez-lets 26g mis lancets OTC<br />
ez-lets 28g mis lancets OTC<br />
FASTTAKE KIT COMPACT PA OTC<br />
fc lancets mis colored OTC<br />
fc lancets mis thin OTC<br />
FIFTY50 GLUC KIT METR 2.0 PA OTC<br />
fifty50 safe mis lancets OTC<br />
fingerstix mis lancets OTC<br />
FLEXIFLO MIS 10FRENCH OTC NF<br />
FLEXIFLO MIS 8 FRENCH OTC NF<br />
FORA G20 KIT PA OTC<br />
FORA V10 MIS PA OTC<br />
FORA V12 MIS PA OTC<br />
FORA V20 MIS PA OTC<br />
FORA V22 KIT PA OTC<br />
fp lancets mis OTC<br />
fp lancets mis thin OTC<br />
FREESTYLE KIT FREEDOM PA OTC<br />
FREESTYLE KIT FREEDOM PA OTC<br />
FREESTYLE KIT SIDEKICK PA OTC<br />
FREESTYLE KIT SYSTEM PA OTC<br />
FREESTYLE KIT SYSTEM PA OTC<br />
freestyle mis lancets OTC<br />
freestyle mis lancets OTC<br />
FREESTYLE MIS LITE PA OTC<br />
freestyle mis unistick OTC<br />
gentle-let mis 26g OTC<br />
gentle-let mis 28g OTC<br />
gentle-let mis lancets OTC<br />
gentle-let mis lancets OTC<br />
GIANT EAGLE KIT VALU PK PA OTC<br />
GLUCOCARD KIT VITAL PA OTC<br />
GLUCOCARD KIT X-METER PA OTC<br />
GLUCOCARD 01 KIT MINI PA OTC<br />
GLUCOCARD 01 KIT SYSTEM PA OTC<br />
GLUCOCARD 01 MIS METER PA OTC<br />
GLUCOCOM KIT MONITOR PA OTC<br />
glucocom mis 28g OTC<br />
glucocom mis 30g OTC<br />
glucocom mis 33g OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 179
GLUCOCOM MIS MONITOR PA OTC<br />
GLUCOLAB KIT MONITOR PA OTC<br />
GLUCOMETER KIT CLASSIC PA OTC<br />
GLUCOMETER KIT ENCORE PA OTC<br />
glucosource mis lancets OTC<br />
gnp lancets mis OTC<br />
gnp lancets mis color OTC<br />
gnp lancets mis thin OTC<br />
gnp lancets mis thin OTC<br />
GNP TRUEREAD KIT PA OTC<br />
GNP TRUETRAC MIS SYSTEM PA OTC<br />
haemolance mis high flo OTC<br />
haemolance mis low flow OTC<br />
haemolance mis plus OTC<br />
haemolance mis plus low OTC<br />
haemolance mis plus max OTC<br />
haemolance mis plus ped OTC<br />
haemolance mis retract OTC<br />
hca lancets mis thin OTC<br />
IN CONTROL MIS 31GX6MM OTC QL<br />
IN CONTROL MIS 31GX8MM OTC QL<br />
INCONTROL MIS 29GX12MM OTC QL<br />
INFINITY KIT SYSTEM PA OTC<br />
INJECTION DEVICE 1 ML OTC<br />
INSPIREASE MIS BAGS QL<br />
INSPIREASE MIS DD SYST QL<br />
INSPIREASE MIS MOUTHPCE QL<br />
INSPIREASE MIS REP MOUT QL<br />
INSPIREASE MIS RES BAG QL<br />
INSULIN PEN MIS 29GX1/2" OTC QL<br />
INSULIN PEN MIS 31GX1/3" OTC QL<br />
INSULIN PEN NEEDLE 29 G X 12 MM (1/2") OTC QL<br />
INSULIN PEN NEEDLE 29 G X 12.7 MM OTC QL<br />
INSULIN PEN NEEDLE 29 G X 5 MM (3/16") OTC QL<br />
INSULIN PEN NEEDLE 29 G X 8 MM (5/16") OTC QL<br />
INSULIN PEN NEEDLE 30 G X 8 MM (1/3" OR 5/16") OTC QL<br />
INSULIN PEN NEEDLE 31 G X 5 MM (3/16") OTC QL<br />
INSULIN PEN NEEDLE 31 G X 6 MM (1/4") OTC QL<br />
INSULIN PEN NEEDLE 31 G X 8 MM (1/3" OR 5/16") OTC QL<br />
INSULIN PEN NEEDLE 32 G X 4 MM (5/32") OTC QL<br />
INSULIN PEN NEEDLE 32 G X 6 MM (1/4") OTC QL<br />
INSULIN PEN NEEDLE 32 G X 8 MM OTC QL<br />
insulin syrg mis 0.3/28g OTC<br />
insulin syrg mis 0.3/28g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 180
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/29g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 181
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/30g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
INSULIN SYRG MIS 0.3/31G OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.3/31g OTC<br />
insulin syrg mis 0.5/27g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
INSULIN SYRG MIS 0.5/28G OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 182
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/28g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 183
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/29g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
INSULIN SYRG MIS 0.5/30G OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/30g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 184
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
INSULIN SYRG MIS 0.5/31G OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
insulin syrg mis 0.5/31g OTC<br />
INSULIN SYRG MIS 1ML<br />
INSULIN SYRG MIS 1ML<br />
INSULIN SYRG MIS 1ML OTC<br />
INSULIN SYRG MIS 1ML OTC<br />
INSULIN SYRG MIS 1ML OTC<br />
INSULIN SYRG MIS 1ML/25G OTC<br />
insulin syrg mis 1ml/25g OTC<br />
insulin syrg mis 1ml/25g OTC<br />
insulin syrg mis 1ml/25g<br />
insulin syrg mis 1ml/25g OTC<br />
insulin syrg mis 1ml/26g OTC<br />
insulin syrg mis 1ml/27g OTC<br />
insulin syrg mis 1ml/27g OTC<br />
insulin syrg mis 1ml/27g OTC<br />
insulin syrg mis 1ml/27g<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g<br />
insulin syrg mis 1ml/28g OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 185
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/28g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
INSULIN SYRG MIS 1ML/29G OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
INSULIN SYRG MIS 1ML/29G OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 186
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/29g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g<br />
insulin syrg mis 1ml/30g<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
INSULIN SYRG MIS 1ML/30G OTC<br />
INSULIN SYRG MIS 1ML/30G OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/30g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 187
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
INSULIN SYRG MIS 1ML/31G OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 1ml/31g OTC<br />
insulin syrg mis 2/27.5g OTC<br />
insulin syrg mis 2ml/29g OTC<br />
insulin syringe (disp) u-100 0.3 ml OTC<br />
INSULIN SYRINGE (DISP) U-100 1 ML OTC<br />
INSULIN SYRINGE (DISP) U-100 1 ML<br />
insulin syringe (disp) u-100 1 ml OTC<br />
INSULIN SYRINGE (DISP) U-100 1/2 ML OTC<br />
insulin syringe (disp) u-100 1/2 ml OTC<br />
insulin syringe/needle u-100 0.3 ml 28 g x 1" OTC<br />
insulin syringe/needle u-100 0.3 ml 28 x 1/2" OTC<br />
insulin syringe/needle u-100 0.3 ml 29 g OTC<br />
insulin syringe/needle u-100 0.3 ml 29 x 1" OTC<br />
insulin syringe/needle u-100 0.3 ml 29 x 1/2" OTC<br />
insulin syringe/needle u-100 0.3 ml 29 x 1/2"<br />
insulin syringe/needle u-100 0.3 ml 29 x 5/16" OTC<br />
insulin syringe/needle u-100 0.3 ml 29 x 7/16" OTC<br />
insulin syringe/needle u-100 0.3 ml 30 g OTC<br />
insulin syringe/needle u-100 0.3 ml 30 x 1" OTC<br />
insulin syringe/needle u-100 0.3 ml 30 x 1/2" OTC<br />
insulin syringe/needle u-100 0.3 ml 30 x 3/8" OTC<br />
insulin syringe/needle u-100 0.3 ml 30 x 5/16" OTC<br />
insulin syringe/needle u-100 0.3 ml 30 x 5/16"<br />
insulin syringe/needle u-100 0.3 ml 30 x 7/16" OTC<br />
INSULIN SYRINGE/NEEDLE U-100 0.3 ML 31 X 3/8" OTC<br />
insulin syringe/needle u-100 0.3 ml 31 x 5/16" OTC<br />
insulin syringe/needle u-100 1 ml 25 x 1" OTC<br />
insulin syringe/needle u-100 1 ml 25 x 5/8" OTC<br />
insulin syringe/needle u-100 1 ml 25 x 5/8"<br />
insulin syringe/needle u-100 1 ml 26 x 1/2" OTC<br />
insulin syringe/needle u-100 1 ml 27 x 1/2" OTC<br />
insulin syringe/needle u-100 1 ml 27 x 1/2"<br />
insulin syringe/needle u-100 1 ml 27 x 5/8" OTC<br />
insulin syringe/needle u-100 1 ml 28 x 1/2" OTC<br />
insulin syringe/needle u-100 1 ml 28 x 1/2"<br />
insulin syringe/needle u-100 1 ml 28 x 5/16" OTC<br />
INSULIN SYRINGE/NEEDLE U-100 1 ML 29 G OTC<br />
insulin syringe/needle u-100 1 ml 29 x 1" OTC<br />
insulin syringe/needle u-100 1 ml 29 x 1/2" OTC<br />
insulin syringe/needle u-100 1 ml 29 x 1/2"<br />
insulin syringe/needle u-100 1 ml 29 x 5/16" OTC<br />
insulin syringe/needle u-100 1 ml 29 x 7/16" OTC<br />
insulin syringe/needle u-100 1 ml 30 g OTC<br />
insulin syringe/needle u-100 1 ml 30 g x 1" OTC<br />
insulin syringe/needle u-100 1 ml 30 x 1/2" OTC<br />
INSULIN SYRINGE/NEEDLE U-100 1 ML 30 X 3/8" OTC<br />
insulin syringe/needle u-100 1 ml 30 x 5/16"<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 188
insulin syringe/needle u-100 1 ml 30 x 5/16" OTC<br />
insulin syringe/needle u-100 1 ml 30 x 7/16" OTC<br />
INSULIN SYRINGE/NEEDLE U-100 1 ML 31 X 3/8" OTC<br />
insulin syringe/needle u-100 1 ml 31 x 5/16" OTC<br />
insulin syringe/needle u-100 1/2 ml 27 x 1/2" OTC<br />
insulin syringe/needle u-100 1/2 ml 28 x 1" OTC<br />
insulin syringe/needle u-100 1/2 ml 28 x 1/2" OTC<br />
insulin syringe/needle u-100 1/2 ml 28 x 1/2"<br />
INSULIN SYRINGE/NEEDLE U-100 1/2 ML 28 X 5/16" OTC<br />
insulin syringe/needle u-100 1/2 ml 29 g OTC<br />
insulin syringe/needle u-100 1/2 ml 29 x 1" OTC<br />
insulin syringe/needle u-100 1/2 ml 29 x 1/2" OTC<br />
insulin syringe/needle u-100 1/2 ml 29 x 1/2"<br />
insulin syringe/needle u-100 1/2 ml 29 x 5/16" OTC<br />
insulin syringe/needle u-100 1/2 ml 29 x 7/16" OTC<br />
insulin syringe/needle u-100 1/2 ml 30 g OTC<br />
insulin syringe/needle u-100 1/2 ml 30 g x 1" OTC<br />
insulin syringe/needle u-100 1/2 ml 30 x 1/2" OTC<br />
insulin syringe/needle u-100 1/2 ml 30 x 3/8" OTC<br />
insulin syringe/needle u-100 1/2 ml 30 x 5/16" OTC<br />
insulin syringe/needle u-100 1/2 ml 30 x 5/16"<br />
insulin syringe/needle u-100 1/2 ml 30 x 7/16" OTC<br />
INSULIN SYRINGE/NEEDLE U-100 1/2 ML 31 X 3/8" OTC<br />
insulin syringe/needle u-100 1/2 ml 31 x 5/16" OTC<br />
insulin syringe/needle u-100 2 ml 27.5 x 5/8" OTC<br />
insulin syringe/needle u-100 2 ml 29 x 1/2" OTC<br />
INSULIN SYRINGE/NEEDLE U-40 1 ML 25 X 5/8" OTC<br />
insulin syringe/needle u-40 1 ml 26 x 1/2" OTC<br />
INSUPEN SENS MIS 32GX6MM OTC QL<br />
INSUPEN SENS MIS 32GX8MM OTC QL<br />
INSUPEN ULTR MIS 29GX12MM OTC QL<br />
INSUPEN ULTR MIS 30GX8MM OTC QL<br />
INSUPEN ULTR MIS 31GX6MM OTC QL<br />
INSUPEN ULTR MIS 31GX8MM OTC QL<br />
INVERTA-PEG KIT 20FRENCH OTC NF<br />
KERR STARTER KIT PA OTC<br />
kinney mis lancets OTC<br />
kinney thin mis lancets OTC<br />
KINRAY KIT VALU PK PA OTC<br />
KROGER BGM KIT PA OTC<br />
kroger lance mis OTC<br />
kroger lance mis thin OTC<br />
kroger lance mis thin 30g OTC<br />
lady lite mis lancets OTC<br />
lancet mis 28g OTC<br />
lancet mis 2mm OTC<br />
lancet mis 30g OTC<br />
lancet alter mis site 26g OTC<br />
lancet micro mis thin 33g OTC<br />
lancet stand mis 21g OTC<br />
lancet super mis thin OTC<br />
lancet super mis thin 30g OTC<br />
lancet super mis thin 30g OTC<br />
lancet super mis thin 30g OTC<br />
lancet super mis thin 30g OTC<br />
lancet ultra mis 28g OTC<br />
lancet ultra mis thin 28g OTC<br />
lancet ultra mis thin 30g OTC<br />
lancets mis OTC<br />
lancets mis OTC<br />
lancets mis OTC<br />
lancets mis OTC<br />
lancets mis OTC<br />
lancets mis OTC<br />
lancets mis 21g OTC<br />
lancets mis 21g OTC<br />
lancets mis 21g OTC<br />
lancets mis 21g colr OTC<br />
lancets mis 23g OTC<br />
lancets mis 26g OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 189
lancets mis 26g OTC<br />
lancets mis 26g OTC<br />
lancets mis 28g OTC<br />
lancets mis 28g OTC<br />
lancets mis 28g OTC<br />
lancets mis 28g OTC<br />
lancets mis 28g OTC<br />
lancets mis 30g OTC<br />
lancets mis 30g OTC<br />
lancets mis 30g OTC<br />
lancets mis 30g OTC<br />
lancets mis 31g OTC<br />
lancets mis colored OTC<br />
lancets mis colored OTC<br />
lancets mis fine 28g OTC<br />
lancets mis funcolor OTC<br />
lancets mis orange OTC<br />
lancets mis original OTC<br />
lancets mis original OTC<br />
lancets mis thin OTC<br />
lancets mis thin OTC<br />
lancets mis thin OTC<br />
lancets mis thin 26g OTC<br />
lancets mis thin 30g OTC<br />
lancets mis thin 30g OTC<br />
lancets thin mis OTC<br />
lancets thin mis 26g OTC<br />
lancets thin mis 26g OTC<br />
lancets thin mis 26g OTC<br />
lancets thin mis 28g OTC<br />
lancets thin mis 30g OTC<br />
lancets ultr mis thin OTC<br />
lancets ultr mis thin OTC<br />
lancets ultr mis thin OTC<br />
lancets ultr mis thin 28g OTC<br />
lancets ultr mis thin 30g OTC<br />
lancets ultr mis thin 30g OTC<br />
lb lancet mis 28g OTC<br />
lifescan mis unistik2 OTC<br />
lite touch mis lancets OTC<br />
lite touch mis lancets OTC<br />
LONG STARTER KIT KIT PA OTC<br />
longs lancet mis adult OTC<br />
longs lancet mis standard OTC<br />
longs lancet mis thin OTC<br />
longs lancet mis ultra th OTC<br />
magellan ins mis 1ml/29g<br />
major comfor mis lancets OTC<br />
MAXIMA KIT SYSTEM PA OTC<br />
MAXIMA METER KIT PA OTC<br />
MAXIMA START KIT PA OTC<br />
medi-lance mis lancets OTC<br />
medichoice mis lancet OTC<br />
medichoice mis lancet OTC<br />
medlance mis extr 21g OTC<br />
medlance mis lite 25g OTC<br />
medlance mis plus OTC<br />
medlance mis unv 21g OTC<br />
MEIJER KIT STARTER PA OTC<br />
meijer mis lancets OTC<br />
meijer mis lancets OTC<br />
MICROCHAMBER MIS QL<br />
MICRODOT KIT SYSTEM PA OTC<br />
microlet mis lancets OTC<br />
microtainer mis lancet OTC<br />
monolet mis lancets OTC<br />
monolet neo mis lancets OTC<br />
monolet opd mis lancets OTC<br />
monolet thin mis lancets OTC<br />
monolettor mis lancets OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 190
navarro mis lancets OTC<br />
NEXGEN KIT METER PA OTC<br />
NOVA MAX KIT SYSTEM PA OTC<br />
NOVA MAX MIS SYSTEM PA OTC<br />
nova sure mis lancets OTC<br />
NOVOFINE MIS 30GX8MM OTC QL<br />
NOVOFINE MIS 32GX6MM OTC QL<br />
NOVOFINE 31 MIS DISPOS OTC QL<br />
NOVOFINE AUT MIS 30GX8MM OTC QL<br />
ONETOUCH KIT BASIC PA OTC<br />
ONETOUCH KIT PROFILE PA OTC<br />
ONETOUCH KIT ULT MINI PA OTC<br />
ONETOUCH KIT ULT SMRT PA OTC<br />
ONETOUCH KIT ULTRA PA OTC<br />
ONETOUCH KIT ULTRA 2 PA OTC<br />
ONETOUCH KIT ULTRALNK PA OTC<br />
onetouch mis combo OTC<br />
onetouch mis lancets OTC<br />
onetouch mis lancets OTC<br />
onetouch mis lancets OTC<br />
ONETOUCH MIS ULT SMRT PA OTC<br />
ONETOUCH MIS ULTRA PA OTC<br />
onetouch fp mis lancets OTC<br />
onetouch us mis lancets OTC<br />
OPTICHAMBER MIS ADV LRG QL<br />
OPTICHAMBER MIS ADV MED QL<br />
OPTICHAMBER MIS ADV SM QL<br />
OPTICHAMBER MIS ADVANTAG QL<br />
OPTICHAMBER MIS FACE MAS OTC QL<br />
OPTICHAMBER MIS FACE MAS OTC QL<br />
OPTICHAMBER MIS FACE MAS OTC QL<br />
OPTIUM KIT BL GLUC PA OTC<br />
OPTIUM MIS SYSTEM PA OTC<br />
PARADIGM KIT LINK PA<br />
PEAK FLOW METER W/INHALER ASSIST DEVICE KIT QL<br />
PEN NEEDLE MIS 29GX1/2" OTC QL<br />
PEN NEEDLE MIS 31GX5/16 OTC QL<br />
PEN NEEDLES MIS 29GX1/2" OTC QL<br />
PEN NEEDLES MIS 29GX12MM OTC QL<br />
PEN NEEDLES MIS 29GX12MM OTC QL<br />
PEN NEEDLES MIS 29GX12MM OTC QL<br />
PEN NEEDLES MIS 29GX12MM OTC QL<br />
PEN NEEDLES MIS 29GX12MM OTC QL<br />
PEN NEEDLES MIS 29GX12MM OTC QL<br />
PEN NEEDLES MIS 29GX12MM OTC QL<br />
PEN NEEDLES MIS 29GX12MM OTC QL<br />
PEN NEEDLES MIS 29GX12MM OTC QL<br />
PEN NEEDLES MIS 29GX12MM OTC QL<br />
PEN NEEDLES MIS 29GX12MM OTC QL<br />
PEN NEEDLES MIS 29GX12MM OTC QL<br />
PEN NEEDLES MIS 31GX1/4" OTC QL<br />
PEN NEEDLES MIS 31GX1/4" OTC QL<br />
PEN NEEDLES MIS 31GX3/16 OTC QL<br />
PEN NEEDLES MIS 31GX5/16 OTC QL<br />
PEN NEEDLES MIS 31GX6MM OTC QL<br />
PEN NEEDLES MIS 31GX6MM OTC QL<br />
PEN NEEDLES MIS 31GX6MM OTC QL<br />
PEN NEEDLES MIS 31GX6MM OTC QL<br />
PEN NEEDLES MIS 31GX6MM OTC QL<br />
PEN NEEDLES MIS 31GX6MM OTC QL<br />
PEN NEEDLES MIS 31GX6MM OTC QL<br />
PEN NEEDLES MIS 31GX6MM OTC QL<br />
PEN NEEDLES MIS 31GX6MM OTC QL<br />
PEN NEEDLES MIS 31GX6MM OTC QL<br />
PEN NEEDLES MIS 31GX6MM OTC QL<br />
PEN NEEDLES MIS 31GX6MM OTC QL<br />
PEN NEEDLES MIS 31GX6MM OTC QL<br />
PEN NEEDLES MIS 31GX6MM OTC QL<br />
PEN NEEDLES MIS 31GX8MM OTC QL<br />
PEN NEEDLES MIS 31GX8MM OTC QL<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 191
PEN NEEDLES MIS 31GX8MM OTC QL<br />
PEN NEEDLES MIS 31GX8MM OTC QL<br />
PEN NEEDLES MIS 31GX8MM OTC QL<br />
PEN NEEDLES MIS 31GX8MM OTC QL<br />
PEN NEEDLES MIS 31GX8MM OTC QL<br />
PEN NEEDLES MIS 31GX8MM OTC QL<br />
PEN NEEDLES MIS 31GX8MM OTC QL<br />
PEN NEEDLES MIS 31GX8MM OTC QL<br />
PEN NEEDLES MIS 31GX8MM OTC QL<br />
PEN NEEDLES MIS 31GX8MM OTC QL<br />
PEN NEEDLES MIS 31GX8MM OTC QL<br />
PEN NEEDLES MIS 31GX8MM OTC QL<br />
PEN NEEDLES MIS 31GX8MM OTC QL<br />
PEN NEEDLES MIS 31GX8MM OTC QL<br />
pharmacy cou mis lancets OTC<br />
PLAS ADAPT MIS 1ML OTC<br />
PLAS ADAPT MIS B-D PLAS OTC<br />
POCKETCHEM KIT EZ PA OTC<br />
PRECISION KIT LINK PA OTC<br />
PRECISION KIT XTRA PA OTC<br />
precision mis 28g OTC<br />
precision mis 28g(t) OTC<br />
PRECISION MIS QID PA OTC<br />
PRECISION MIS SOF-TACT PA OTC<br />
PRECISION MIS XTRA PA OTC<br />
PRECISION MIS XTRA PA OTC<br />
pres smart mis lancets OTC<br />
PRESTIG SMRT KIT VALU PK PA OTC<br />
PRESTIG SMRT MIS METER PA OTC<br />
PRESTIGE LX KIT STARTER PA OTC<br />
PRESTIGE LX KIT STARTER PA OTC<br />
PRESTIGE LX MIS METER PA OTC<br />
PRESTIGE SMT KIT SYS/METR PA OTC<br />
PRODIGY KIT PA OTC<br />
PRODIGY MIS PA OTC<br />
prodigy mis 21g OTC<br />
prodigy mis 26g OTC<br />
prodigy mis 26g OTC<br />
prodigy mis 28g OTC<br />
prodigy mis 28g OTC<br />
PRODIGY AUTO KIT METER PA OTC<br />
PRODIGY AUTO KIT MONITOR PA OTC<br />
PRODIGY AUTO MIS METER PA OTC<br />
PRODIGY EJCT MIS METER PA OTC<br />
PRODIGY PCKT KIT METER PA OTC<br />
PRODIGY PCKT MIS METER PA OTC<br />
PRODIGY PREF KIT METER PA OTC<br />
PRODIGY PREF MIS METER PA OTC<br />
PRODIGY VOIC KIT METER PA OTC<br />
PSS IQ METER MIS PA OTC<br />
PSS IQ START KIT KIT PA OTC<br />
pss safe lan mis OTC<br />
pss sel lanc mis OTC<br />
px lancets mis 28g OTC<br />
px lancets mis ult thin OTC<br />
qc lancets mis OTC<br />
qc lancets mis 28g OTC<br />
qc lancets mis 30g OTC<br />
qc lancets mis thin OTC<br />
QUICKTEK KIT PA OTC<br />
ra e-zject mis 28g OTC<br />
ra e-zject mis thin 26g OTC<br />
ra e-zject mis thin 28g OTC<br />
ra e-zject mis ult thin OTC<br />
RA GLUCOSE MIS MONITOR PA OTC<br />
ra lancets mis OTC<br />
ra lancets mis alternat OTC<br />
ra lancets mis colored OTC<br />
ra lancets mis thin OTC<br />
ra lancets mis thin OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 192
RA PEN NEEDL MIS 31GX5MM OTC QL<br />
reality mis lancets OTC<br />
reality trig mis lancets OTC<br />
REFUAH PLUS KIT SYSTEM PA OTC<br />
RELION KIT MONITOR PA OTC<br />
relion mis lancets OTC<br />
RELION MICRO KIT PA OTC<br />
relion stand mis lancets OTC<br />
relion thin mis lancets OTC<br />
relion ultra mis thin OTC<br />
relion ultra mis thin pls OTC<br />
renew adv mis refills OTC<br />
RIGHTEST SYS KIT GM100 PA OTC<br />
RIGHTEST SYS KIT GM300 PA OTC<br />
safe lancets mis 21g OTC<br />
safe lancets mis 26g OTC<br />
safe-t-lance mis 21g OTC<br />
safe-t-lance mis 25g OTC<br />
safe-t-lance mis hi flow OTC<br />
safe-t-lance mis low flow OTC<br />
safe-t-lance mis nor flow OTC<br />
safe-t-pro mis lancets OTC<br />
safe-t-pro mis plus OTC<br />
safety let mis lancets OTC<br />
sb lancets mis thin OTC<br />
sb lancets mis ultr thn OTC<br />
SENTRY KIT STARTER PA OTC<br />
SENTRY BLOOD MIS GLUC MET PA OTC<br />
SHOPRITE KIT VALU PK PA OTC<br />
single-let mis 23g OTC<br />
sm lancets mis OTC<br />
sm lancets mis 21g OTC<br />
sm lancets mis thin OTC<br />
sm lancets mis thin OTC<br />
sm lancets mis thin 26g OTC<br />
sm lancets mis thin 30g OTC<br />
SMARTEST KIT EJECT PA OTC<br />
SMARTEST KIT PROTEGE PA OTC<br />
SMARTEST MIS EJECT PA OTC<br />
smartest mis lancets OTC<br />
SMARTEST MIS PROTEGE PA OTC<br />
soba lancets mis colored OTC<br />
soba lancets mis thin OTC<br />
soft touch mis lancets OTC<br />
softclix mis lancets OTC<br />
SOLO V2 KIT SYSTEM PA OTC<br />
solo v2 twst mis lancets OTC<br />
super thin mis lancet OTC<br />
super thin mis lancets OTC<br />
super thin mis lancets OTC<br />
SURE COMFORT MIS 29GX1/2" OTC QL<br />
SURE COMFORT MIS 31GX3/16 OTC QL<br />
SURE COMFORT MIS 31GX5/16 OTC QL<br />
sure comfort mis lancets OTC<br />
sure comfort mis lancets OTC<br />
SURE EDGE MIS PA OTC<br />
SURE-FINE MIS 29GX1/2" OTC QL<br />
SURE-FINE MIS 31GX3/16 OTC QL<br />
SURE-FINE MIS 31GX5/16 OTC QL<br />
sure-lance mis 26g OTC<br />
sure-lance mis lancets OTC<br />
sure-lance mis lancets OTC<br />
sure-lance mis lancets OTC<br />
SURE-TEST MIS EASYPLUS PA OTC<br />
SURECHEK KIT PA OTC<br />
SURECHEK MIS PA OTC<br />
surelite mis lancets OTC<br />
SURESTEP KIT W/METER PA OTC<br />
techlite mis lancets OTC<br />
techlite ast mis lancets OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 193
tgt lancet mis 23g OTC<br />
tgt lancet mis 28g OTC<br />
tgt lancet mis 30g OTC<br />
tgt lancet mis alternat OTC<br />
thin lancets mis OTC<br />
thin lancets mis OTC<br />
thin lancets mis OTC<br />
thin lancets mis OTC<br />
thin lancets mis 26g OTC<br />
thin lancets mis 30g OTC<br />
thin lancets mis ultra OTC<br />
thinlets mis 28g(t) OTC<br />
thinlets gp mis 26g OTC<br />
TRUE CARE KIT STARTER PA OTC<br />
TRUE2GO KIT PA OTC<br />
TRUERESULT KIT OTC QL<br />
TRUERESULT KIT SYSTEM PA OTC<br />
TRUETEST LIQ LEVEL 1 PA OTC<br />
TRUETEST LIQ LEVEL 2 PA OTC<br />
TRUETEST LIQ LEVEL 3 PA OTC<br />
TRUETRACK KIT SYSTEM OTC QL<br />
TRUETRACK KIT SYSTEM OTC QL<br />
TRUETRACK MIS BLD GLC OTC QL<br />
TUBERCULIN/ALLERGY SYRINGE/NEEDLE (DISP) 1 ML 27 X 1/2" OTC<br />
TUBERCULIN/ALLERGY SYRINGE/NEEDLE (DISP) 1 ML 28 X 1/2" OTC<br />
ultilet mis 26g OTC<br />
ultilet mis 28g OTC<br />
ultilet mis 28g OTC<br />
ultilet mis 30g OTC<br />
ultilet mis lancets OTC<br />
ULTILET PEN MIS NEEDLE OTC QL<br />
ULTIMA KIT MONITOR PA OTC<br />
ultra thin mis 28g OTC<br />
ultra thin mis 30g OTC<br />
ultra thin mis lancets OTC<br />
ultra thin mis lancets OTC<br />
ultra thin mis lancets OTC<br />
ULTRATRAK MIS PRO PA OTC<br />
UNIFINE PNTP MIS 29GX1/2" OTC QL<br />
UNIFINE PNTP MIS 29GX12MM OTC QL<br />
UNIFINE PNTP MIS 29GX12MM OTC QL<br />
UNIFINE PNTP MIS 29GX12MM OTC QL<br />
UNIFINE PNTP MIS 29GX12MM OTC QL<br />
UNIFINE PNTP MIS 31GX6MM OTC QL<br />
UNIFINE PNTP MIS 31GX6MM OTC QL<br />
UNIFINE PNTP MIS 31GX6MM OTC QL<br />
UNIFINE PNTP MIS 31GX6MM OTC QL<br />
UNIFINE PNTP MIS 31GX6MM OTC QL<br />
UNIFINE PNTP MIS 31GX8MM OTC QL<br />
UNIFINE PNTP MIS 31GX8MM OTC QL<br />
UNIFINE PNTP MIS 31GX8MM OTC QL<br />
UNIFINE PNTP MIS 31GX8MM OTC QL<br />
UNIFINE PNTP MIS 31GX8MM OTC QL<br />
UNIFINE PNTP MIS 6MM OTC QL<br />
UNIFINE PNTP MIS 8MM OTC QL<br />
unilet mis 21g OTC<br />
unilet ex ii mis 28g OTC<br />
unilet excel mis 23g OTC<br />
unilet g.p mis supr 23g OTC<br />
unilet g.p. mis 21g OTC<br />
unilet gp 28 mis ult thin OTC<br />
unilet lance mis 21g OTC<br />
unilet super mis 23g OTC<br />
unilet super mis g.p. 23g OTC<br />
unistik 2 mis neonatal OTC<br />
unistik ii mis lancets OTC<br />
universal 1 mis lanc 26g OTC<br />
universal 1 mis lanc 30g OTC<br />
value health mis lancets OTC<br />
value plus mis lancets OTC<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 194
value plus mis lancets OTC<br />
VICTORY MIS SYSTEM PA OTC<br />
vitalet pro mis OTC<br />
vitalet pro mis plus OTC<br />
w&f lancets mis 21g OTC<br />
w&f lancets mis 26g OTC<br />
w&f lancets mis 26g OTC<br />
w&f lancets mis 30g OTC<br />
WAVESENSE KIT AMP PA OTC<br />
WAVESENSE KIT JAZZ PA OTC<br />
WAVESENSE KIT KEYNOTE PA OTC<br />
WAVESENSE KIT PRESTO PA OTC<br />
wavesense mis 33g OTC<br />
wd lancets mis OTC<br />
wd lancets mis thin OTC<br />
wd lancets mis thin OTC<br />
WIN DIX MEDI KIT VALU PK PA OTC<br />
Pharmaceutical Aids<br />
ACETYLCYST POW<br />
ACETYLCYST POW OTC<br />
ACETYLCYSTEINE POWDER OTC<br />
ACETYLCYSTEINE POWDER<br />
BACTER WATER INJ BENZ ALC PA<br />
BACTER WATER INJ PARABENS PA<br />
BENZOYL PER POW 70%<br />
BENZOYL PER POW HYDROUS OTC<br />
BENZOYL PER POW HYDROUS<br />
BENZOYL PEROXIDE POWDER<br />
BENZOYL PEROXIDE POWDER OTC<br />
BROMHEXINE POW HCL<br />
BROMHEXINE HCL POWDER<br />
CYCLOBENZAPR POW HCL<br />
CYCLOBENZAPRINE HCL POWDER<br />
DEXTROMETHOR CRY MONOHYDR OTC<br />
DEXTROMETHOR POW HBR<br />
DEXTROMETHOR POW HBR MONO<br />
DEXTROMETHORPHAN HBR CRYSTALS OTC<br />
DEXTROMETHORPHAN HBR POWDER<br />
glycine diluent for injection PA<br />
GRISEOFULVIN MICRONIZED (BULK) POWDER<br />
GRISEOFULVIN POW MICRONIZ<br />
GUAIFENESIN POW<br />
GUAIFENESIN POWDER<br />
HSA DILUENT SOL STERILE PA<br />
HYDROCODONE CRY BITARTRA<br />
HYDROCODONE POW BITARTRA<br />
HYDROCODONE BITARTRATE CRYSTALS<br />
HYDROCODONE BITARTRATE POWDER<br />
HYDROXYZINE POW HCL<br />
HYDROXYZINE HCL (BULK) POWDER<br />
IBUPROFEN POW<br />
IBUPROFEN POWDER<br />
INDOMETHACIN POW<br />
INDOMETHACIN POWDER<br />
ISONIAZID POW<br />
ISONIAZID POWDER<br />
KETOPROFEN POW<br />
KETOPROFEN POWDER<br />
METHOTREXATE POW<br />
METHOTREXATE POWDER<br />
N-ACETYL-L- POW CYSTEINE OTC<br />
NAPROXEN POW<br />
NAPROXEN POW SODIUM<br />
NAPROXEN POW USP<br />
NAPROXEN POWDER<br />
NAPROXEN SODIUM POWDER<br />
PHENOBARB POW<br />
PHENOBARB POW USP<br />
PHENOBARB POW USP NF<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 195
PHENOBARBITAL POWDER<br />
PIROXICAM POW<br />
PIROXICAM POWDER<br />
POT CHLORIDE CRY OTC<br />
POT CHLORIDE GRA OTC<br />
POT CHLORIDE GRA<br />
POT CHLORIDE POW<br />
POTASSIUM CHLORIDE CRYSTALS OTC<br />
POTASSIUM CHLORIDE GRANULES OTC<br />
POTASSIUM CHLORIDE GRANULES<br />
POTASSIUM CHLORIDE POWDER (FOR COMPOUNDING)<br />
PREDNISOLONE POW<br />
PREDNISOLONE POW ANHYDROU<br />
PREDNISOLONE POW HYDROUS<br />
PREDNISOLONE POW USP NF<br />
PREDNISOLONE POWDER<br />
PRIMAQUINE POW PHOSPHAT<br />
PRIMAQUINE PHOSPHATE POWDER<br />
PROMETHAZINE HCL POWDER<br />
PROMETHAZINE POW HCL<br />
STERIL WATER SOL<br />
SULINDAC POW<br />
SULINDAC POWDER<br />
TERPIN POW HYDRATE<br />
TERPIN HYD CRY<br />
TERPIN HYDR POW MONOHYDR<br />
TERPIN HYDRATE CRYSTALS<br />
TERPIN HYDRATE POWDER<br />
water for inject, bacteriostatic PA<br />
water for injection PA<br />
water for iv injection PA<br />
WATER, STERILE INHAL SOLN<br />
QL:Quantity Limitation PA:Prior Authorization Required ST:Step Therapy OTC:Over-the-Counter SP:Specialty Program<br />
Brand Name:UPPER CASE Generic Name:italic lower case NF:Approved: Non-Formulary<br />
created on 20100520 196
INDEX<br />
1<br />
1/2 ALLERGIST TRAY SYRING 176<br />
12 hour antihistamine/dec 4<br />
12 hour nasal decongestan 4<br />
1ML ALLERGIST SYRINGE DET 176<br />
1ML ALLERGIST TRAY REGULA 176<br />
1ML ALLERGIST TRAY SYRING 176<br />
1st choice lancets super 176<br />
1st choice lancets thin 176<br />
1st choice lancets ultra 176<br />
1ST CHOICE PEN NEEDLES 31 191<br />
1ST TIER UNIFINE PENTIPS 176<br />
4<br />
4-way fast acting 138<br />
4-way menthl 138<br />
4-way no drp 138<br />
6<br />
666 cold preparation 89<br />
666 cold 34<br />
666 cold 36<br />
8<br />
8 hour pain 58<br />
A<br />
a-cof dh 89<br />
a-tan 12x 125<br />
a.r.m. 4<br />
a/b otic 137<br />
A1C NOW SELFCHECK 176<br />
A1C NOW 176<br />
ABBOKINASE 41<br />
ABELCET 27<br />
aber-fed 125<br />
aber-tuss dr 89<br />
aber-tuss hc 89<br />
ABILIFY DISC 69<br />
ABILIFY 69<br />
ABRAXANE 29<br />
ACANYA 158<br />
acarbose 148<br />
ACCOLATE 125<br />
ACCU-CHEK ACTIVE CARE KIT 176<br />
ACCU-CHEK ACTIVE STRIPS 79<br />
ACCU-CHEK ACTIVE 176<br />
ACCU-CHEK ADVANTAGE DIABE 176<br />
ACCU-CHEK ADVANTAGE METER 176<br />
ACCU-CHEK ADVANTAGE TEST 79<br />
ACCU-CHEK AVIVA 176<br />
ACCU-CHEK AVIVA 79<br />
ACCU-CHEK COMFORT CURVE T 79<br />
ACCU-CHEK COMPACT CARE KI 176<br />
ACCU-CHEK COMPACT PLUS CA 176<br />
ACCU-CHEK COMPACT PLUS 176<br />
ACCU-CHEK COMPACT STRIPS 79<br />
ACCU-CHEK COMPACT TEST DR 79<br />
ACCU-CHEK INSTANT GLUCOSE 79<br />
ACCU-CHEK INSTANT PLUS 79<br />
accu-chek multiclix lance 176<br />
accu-chek safe-t-pro lanc 193<br />
accu-chek safe-t-pro plus 193<br />
accu-chek soft touch lanc 193<br />
accu-chek softclix lancet 193<br />
ACCU-CHEK TRANSFER PIPETT 176<br />
ACCU-CHEK VOICEMATE 176<br />
ACCUHIST PDX 89<br />
ACCUHIST 4<br />
accusure insulin syringe/ 183<br />
accusure insulin syringe/ 184<br />
accusure insulin syringe/ 186<br />
accusure insulin syringe/ 187<br />
accusure insulin syringe/ 188<br />
ACCUTREND GLUCOSE 79<br />
acephen 58<br />
acetamin 58<br />
acetaminophen childrens 58<br />
acetaminophen jr 58<br />
acetaminophen junior stre 58<br />
acetaminophen pm ex-str 75<br />
acetaminophen pm extra st 75<br />
acetaminophen pm 75<br />
ACETAMINOPHEN W/ CALCIUM<br />
CARBONATE 59<br />
acetaminophen w/ calcium carbonate<br />
59<br />
ACETAMINOPHEN W/ CODEINE 53<br />
acetaminophen w/ codeine 53<br />
ACETAMINOPHEN W/ DM 89<br />
acetaminophen w/ dm 89<br />
ACETAMINOPHEN W/ PAMABROM 59<br />
acetaminophen w/ pamabrom 59<br />
ACETAMINOPHEN-BROMELAINS 59<br />
acetaminophen-caff-dihydrocod 53<br />
acetaminophen-caffeine-pyrilamine 59<br />
acetaminophen-caffeine 59<br />
acetaminophen-codeine #4 53<br />
ACETAMINOPHEN-GUAIFENESIN 125<br />
acetaminophen-guaifenesin 125<br />
ACETAMINOPHEN-MAGNESIUM<br />
SALICYLATE-CAFFEINE 59<br />
acetaminophen-pamabrom-pyrilamine<br />
59<br />
ACETAMINOPHEN-<br />
PHENYLTOLOXAMINE-CAFFEINE 1<br />
ACETAMINOPHEN-SALICYL-CAFF 59<br />
ACETAMINOPHEN-SALICYLAMIDE-<br />
PHENYLTOLOXAMINE 59<br />
acetaminophen-salicylamidephenyltoloxamine<br />
59<br />
ACETAMINOPHEN-SALICYLAMIDE 59<br />
acetaminophen/caffeine/di 53<br />
acetaminophen/codeine #2 53<br />
acetaminophen/codeine #3 53<br />
acetaminophen/codeine #4 53<br />
acetaminophen/codeine pho 53<br />
acetaminophen/codeine 53<br />
acetaminophen/hydrocodone 53<br />
ACETAMINOPHEN 58<br />
acetaminophen 58<br />
ACETAMINOPHEN 59<br />
acetaminophen 59<br />
acetaminophn 59<br />
acetasol hc 136<br />
acetazolamid 139<br />
acetazolamide sodium 139<br />
acetazolamide 139<br />
ACETEST 83<br />
acetic acid (otic) 140<br />
acetic acid w/hc ear drop 136<br />
acetic acid/hydrocortison 136<br />
acetic acid 140<br />
ACETONE (URINE) TEST 83<br />
ACETYLCYSTEINE 195<br />
acid reducer 142<br />
acid relief 142<br />
acne medicat 159<br />
acne medication-5 159<br />
acne treat 159<br />
acne treatment vanishing 159<br />
acne-clear 159<br />
acne 159<br />
created on 20100520 197
ACRIVASTINE & PSEUDOEPHEDRINE<br />
16<br />
actanol 4<br />
ACTEMRA 173<br />
ACTHAR HP 150<br />
ACTHIB 156<br />
ACTHREL 82<br />
acticin 159<br />
actifed cold & allergy 4<br />
actifed cold/sinus 4<br />
ACTIFED PLUS 4<br />
ACTIMMUNE 172<br />
ACTIVASE 41<br />
active syrup 4<br />
ACTOS 150<br />
ACULAR PF 137<br />
ACULAR 137<br />
ACURA BLOOD GLUCOSE MONIT 176<br />
ACURA BLOOD GLUCOSE TEST 79<br />
ACUVAIL 137<br />
ACYCLOVIR NA 29<br />
acyclovir sodium 29<br />
acyclovir 28<br />
acyclovir 29<br />
ACZONE 158<br />
ADACEL 156<br />
ADAGEN 88<br />
ADENOSCAN 79<br />
adenosine 44<br />
ADRENACLICK 36<br />
ADRIAMYCIN 29<br />
ADULT MASK LARGE 176<br />
ADVAIR DISKUS 35<br />
ADVAIR HFA 35<br />
ADVANCE INTUITION BLOOD G 176<br />
ADVANCE INTUITION TEST ST 79<br />
ADVANCE MICRO-DRAW METER 176<br />
ADVANCE MICRO-DRAW TEST S 79<br />
ADVATE 42<br />
ADVIL ALLERGY SINUS 4<br />
ADVIL COLD & SINUS 36<br />
advil jr st 52<br />
ADVIL MULTI-SYMPTOM COLD 4<br />
ADVOCATE BLOOD GLUCOSE MO 176<br />
advocate lancets 176<br />
ADVOCATE REDI-CODE/TALKIN 176<br />
ADVOCATE REDI-CODE 176<br />
ADVOCATE REDI-CODE 79<br />
advocate safety lancets 176<br />
ADVOCATE TEST STRIPS 79<br />
AEROBID-M 144<br />
AEROBID 144<br />
AEROCHAMBER MV 177<br />
AEROCHAMBER PLUS/LARGE MA 176<br />
AEROCHAMBER PLUS/MASK 176<br />
AEROCHAMBER PLUS/SMALL MA 176<br />
AEROCHAMBER PLUS 177<br />
AEROCHAMBER Z-STAT PLUS/F 176<br />
AEROCHAMBER Z-STAT PLUS/L 176<br />
AEROCHAMBER Z-STAT PLUS/S 176<br />
AEROCHAMBER Z-STAT PLUS 176<br />
AEROCHAMBER/FLOWSIGNAL 176<br />
AEROGEAR ASTHMA ACTION 176<br />
aerohist plus 4<br />
AEROKID 4<br />
AEROTUSS 12 89<br />
af lancets super thin 177<br />
af-apap allergy sinus 5<br />
af-apap infa 59<br />
af-apap sinus 36<br />
af-aphedrid 5<br />
af-cough fm decong 89<br />
af-dibromm dm 89<br />
af-dibromm 5<br />
af-effer antacid pain 11<br />
af-effer cold 5<br />
af-flu cough/cold maximum 89<br />
af-ibup sinus 36<br />
af-nitetime cough 89<br />
af-nitetime 89<br />
af-pseudoephedrine sinus 126<br />
af-triacting nitetime 89<br />
af-triacting sore throat 89<br />
af-tussin cf 89<br />
af-tussin dm 89<br />
afedi 47<br />
AFLURIA 2007-2008 156<br />
AFLURIA 2008-2009 156<br />
AFLURIA 2009-2010 156<br />
AFLURIA PF 2007-2008 156<br />
AFLURIA PF 2008-2009 156<br />
AFLURIA PF 2009-2010 156<br />
afrin allerg 138<br />
afrin child 138<br />
AGENERASE 27<br />
AGGRASTAT 41<br />
AGRIFLU 2009/2010 156<br />
AH-CHEW II 5<br />
AH-CHEW ULTRA 5<br />
AH-CHEW 5<br />
ah-chew 5<br />
aimsco insulin syringe ma 183<br />
aimsco insulin syringe ma 185<br />
aimsco insulin syringe ul 180<br />
aimsco insulin syringe ul 182<br />
aimsco insulin syringe ul 183<br />
aimsco insulin syringe ul 184<br />
aimsco insulin syringe ul 185<br />
aimsco insulin syringe ul 186<br />
aimsco insulin syringe ul 187<br />
aimsco insulin syringe/0. 183<br />
aimsco insulin syringe/1m 186<br />
aimsco insulin syringe/ul 181<br />
AIRACOF 89<br />
ak-dilate 138<br />
ak-pentolate 137<br />
ak-tob 135<br />
ala cort 162<br />
ala-cort 162<br />
ALA-HIST D 5<br />
ALA-HIST PE 5<br />
ALACOL DM 89<br />
ALACOL 5<br />
ALAHIST AC 89<br />
ALAHIST DHC 89<br />
ALAHIST LQ 1<br />
alavert 16<br />
ALBAFORT S 170<br />
ALBAFORT 170<br />
ALBATUSSIN CF PEDIATRIC 126<br />
ALBATUSSIN CF PEDIATRIC 89<br />
ALBATUSSIN CF 126<br />
ALBATUSSIN DM PEDIATRIC 89<br />
ALBATUSSIN EX PEDIATRIC 126<br />
ALBATUSSIN NN 126<br />
ALBATUSSIN NN 89<br />
ALBATUSSIN PEDIATRIC DROP 89<br />
ALBATUSSIN PEDIATRIC NR 89<br />
ALBATUSSIN PEDIATRIC 89<br />
albatussin pediatric 89<br />
ALBATUSSIN SR F 126<br />
ALBATUSSIN SR 126<br />
ALBATUSSIN SR 89<br />
albatussin sr 89<br />
created on 20100520 198
albatussin-nn 89<br />
ALBATUSSIN 89<br />
albertsons childrens non- 12<br />
albertsons cold & allergy 9<br />
albertsons decongestant c 10<br />
albertsons extra strength 76<br />
albertsons flu and cold m 11<br />
albertsons flu/cold & cou 100<br />
albertsons flu/cough & co 100<br />
albertsons multi-symptom 63<br />
albertsons night time col 106<br />
albertsons sinus 37<br />
ALBERTSONS STARTER KIT 177<br />
albertsons suphedrine sin 37<br />
ALBERTSONS TEST STRIP 79<br />
albertsons tussin dm 123<br />
albertsons ultra thin lan 194<br />
albumin, human 39<br />
ALBUTEROL SULFATE 35<br />
albuterol sulfate 35<br />
albuterol 35<br />
ALCOHOL 10%/DEXTROSE 5% 86<br />
ALCOHOL 5%/DEXTROSE 5% 86<br />
ALCOHOL 86<br />
alcohol 86<br />
ALDEX-CT 1<br />
ALDURAZYME 88<br />
alenaze-d nr 5<br />
ALENAZE-D 5<br />
alfentanil 53<br />
ALFERON N 29<br />
ALIMTA 29<br />
ALINIA 29<br />
ALKA-SELTZER PLUS COLD & 89<br />
ALKA-SELTZER PLUS COLD 5<br />
alkabel-sr 33<br />
ALKERAN 29<br />
all day allg 16<br />
all-nite cold formula 89<br />
all-nite multi-symptom co 89<br />
all/sinus/head 1<br />
allanhist pdx 89<br />
allantan pediatric 5<br />
allanvan-dm 89<br />
allanvan-s 3<br />
ALLEGRA-D 16<br />
allepak 5<br />
aller-time 5<br />
allerclear 16<br />
allerfed 5<br />
allerfrim 5<br />
allergen 137<br />
ALLERGIST PACKAGE 177<br />
allergy & sinus intense 1<br />
allergy am/pm 5<br />
allergy decongestant 2<br />
allergy dn pe 5<br />
allergy dn 5<br />
allergy multi-symptom day 5<br />
allergy multi-symptom nig 1<br />
allergy multi-symptom 5<br />
allergy relf 16<br />
allergy relf 1<br />
allergy relief child 16<br />
allergy sinus headache re 1<br />
allergy sinus-d maximum s 5<br />
allergy/sinus headache 1<br />
allergy/sinus non-aspirin 5<br />
allergy/sinus pain reliev 5<br />
allergy 16<br />
allerhist-1 1<br />
ALLERSCRIPT 5<br />
ALLERTAN 5<br />
ALLERX DOSE PACK 5<br />
ALLERX PE 5<br />
ALLERX 5<br />
ALLFEN A 126<br />
ALLFEN C 89<br />
ALLFEN CD 89<br />
ALLFEN CDX 89<br />
ALLFEN CX 89<br />
ALLFEN DM 89<br />
allfen dm 89<br />
ALLFEN DMA 89<br />
ALLRES D 89<br />
ALLRES G 89<br />
ALLRES PD 89<br />
ALOXI 142<br />
ALPHAGAN P 138<br />
ALPHANATE/VON WILLEBRAND 42<br />
ALPHANATE 42<br />
ALPHANINE SD 42<br />
alphatrex 162<br />
alprazolam 74<br />
alprostadil 45<br />
altafed 5<br />
altafrin 138<br />
altarussin dm 89<br />
altarussin-pe 126<br />
altarussin 126<br />
altex-pse 126<br />
ALTRETAMINE 29<br />
ALUMINUM CHLORIDE 166<br />
aluminum chloride 166<br />
aluminum cl 166<br />
ALUPENT INH 35<br />
ALVESCO 144<br />
ambi 1000/55 89<br />
ambi 1000/5 89<br />
ambi 10peh/400gfn/20dm 89<br />
ambi 10peh/400gfn 126<br />
ambi 10peh/4cpm/20dm 89<br />
ambi 10peh/4cpm 5<br />
ambi 20dm/4cpm 89<br />
ambi 40/1000/60 90<br />
ambi 40/1000 126<br />
ambi 40pse/400gfn/20dm 89<br />
ambi 40pse/400gfn 126<br />
ambi 45/800/30 90<br />
ambi 45/800 126<br />
AMBI 5/15/100 90<br />
ambi 60/1000/30 90<br />
ambi 60/1000 126<br />
ambi 60/580/30 90<br />
ambi 60/580 126<br />
ambi 60pse/400gfn/20dm 89<br />
ambi 60pse/400gfn 126<br />
ambi 60pse/4cpm/20dm 89<br />
ambi 60pse/4cpm 5<br />
ambi 80/700/40 90<br />
ambi 80/700 126<br />
ambi 80/780/40 90<br />
ambi 80/780 126<br />
AMBIFED CD 90<br />
AMBIFED CDX 90<br />
AMBIFED DM 90<br />
AMBIFED-G CD 90<br />
AMBIFED-G CDX 90<br />
AMBIFED-G DM 90<br />
AMBIFED-G 126<br />
AMBIFED 126<br />
AMBISOME 27<br />
amdry-c 5<br />
amdry-d 36<br />
created on 20100520 199
AMERIFED DM 90<br />
AMERIFED 5<br />
AMERITUSS AD 90<br />
ames gluco system lancets 177<br />
AMEVIVE 166<br />
ami-tex la 126<br />
amibid dm 90<br />
amidal 126<br />
amidrine 77<br />
amigesic 51<br />
amikacin sulfate 17<br />
aminate fe-90 170<br />
AMINESS 86<br />
amino acid electrolyte infusion 86<br />
amino acid infusion 86<br />
aminocaproic acid 42<br />
aminofen 59<br />
AMINOHIPPURA 82<br />
aminophylline 167<br />
AMINOSYN 7%/ELECTROLYTES 86<br />
AMINOSYN II 3.5% 86<br />
AMINOSYN II 3.5 86<br />
AMINOSYN II 4.25 86<br />
AMINOSYN II 5/DEXTROSE 25 86<br />
AMINOSYN II M 3.5%/DEXTRO 86<br />
AMINOSYN II M 4.25/DEXTRO 86<br />
AMINOSYN II 86<br />
AMINOSYN M 86<br />
AMINOSYN-HBC 86<br />
AMINOSYN-PF 7% 86<br />
AMINOSYN-PF 86<br />
AMINOSYN-RF 86<br />
AMINOSYN 86<br />
amiodarone hcl 44<br />
amiodarone 44<br />
amitex pse 126<br />
amitriptylin 68<br />
amitriptyline hcl 68<br />
AMLODIPINE BESYLATE-BENAZEPRIL<br />
HCL 47<br />
amlodipine besylate-benazepril hcl 47<br />
amlodipine besylate/benaz 47<br />
AMMON MOLYBD 84<br />
AMMONIUM CHL 83<br />
ammonium molybdate 84<br />
AMMONUL 83<br />
amoclan 22<br />
amoxicillin & pot clavulanate 22<br />
AMOXICILLIN & POT CLAVULANATE<br />
23<br />
amoxicillin & pot clavulanate 23<br />
AMOXICILLIN-CLARITHROMYCIN W/<br />
LANSOPRAZOLE 143<br />
amoxicillin/clavulanate p 22<br />
amoxicillin/potassium cla 22<br />
AMOXICILLIN 22<br />
amoxicillin 22<br />
AMOXICILLIN 23<br />
amoxicillin 23<br />
AMOXIL 23<br />
amoxil 23<br />
AMPHADASE 88<br />
amphetamine-dextroamphetamine 72<br />
amphetamine/dextroampheta 72<br />
AMPHOTEC 27<br />
amphotericin b 27<br />
ampicillin & sulbactam sodium 23<br />
ampicillin sodium 23<br />
AMPICILLIN 23<br />
ampicillin 23<br />
AMRIX 38<br />
AMVISC PLUS 140<br />
AMVISC 140<br />
AMYLASE-LIPASE-PROTEASE 140<br />
amylase-lipase-protease 140<br />
AMYLASE-LIPASE-PROTEASE 141<br />
amylase-lipase-protease 141<br />
AMYTAL SOD 74<br />
ANABAR 59<br />
anacin af 59<br />
ANAPLEX DMX 90<br />
andehist dm nr 90<br />
andehist nr 1<br />
andehist nr 5<br />
anexsia 53<br />
anextuss 90<br />
ANGIOMAX 40<br />
ANTHRALIN 166<br />
anthralin 166<br />
ANTHRALIN 167<br />
anti-dandruf sha 159<br />
anti-itch maximum strengt 162<br />
anti-itch 162<br />
ANTI-PERSPIR 166<br />
anti-stick insulin syring 182<br />
anti-stick insulin syring 183<br />
anti-stick insulin syring 186<br />
antiben 137<br />
antibiotic ear 136<br />
antihistamine nasal decon 5<br />
antihistamine/decongestan 5<br />
ANTIHISTAMINE 5<br />
antipyrine/benzocaine 137<br />
antispasmodic 33<br />
ANTIVENIN CROTALIDAE POLY 155<br />
ANTIVENIN LATRODECTUS MAC 155<br />
ANTIVENIN MICRURUS FULVIU 155<br />
anucort-hc 162<br />
anumed-hc 162<br />
ANZEMET 142<br />
apap child 59<br />
apap drops 59<br />
apap ex str 59<br />
apap x-str sleep aid pm 75<br />
apap-isometheptene-dichloral 77<br />
apap-plus 59<br />
apap/diphenhydramine 75<br />
apap/oxycodone 53<br />
apap/oxycodone 57<br />
APAP 59<br />
apap 59<br />
apara 59<br />
apexicon 162<br />
aphedrid 5<br />
APIDRA SOLOSTAR 148<br />
APIDRA 148<br />
APLISOL 83<br />
apra 59<br />
apri 146<br />
aprodine 5<br />
aquabid-dm 90<br />
aquanil hc 162<br />
AQUASOL A PARENTERAL 168<br />
AQUATAB C 90<br />
AQUATAB D 126<br />
AQUATAB DM 90<br />
ARALAST NP 134<br />
ARALAST 134<br />
aranelle 146<br />
ARANESP ALBUMIN FREE SURE 41<br />
ARANESP ALBUMIN FREE SURE 42<br />
ARANESP ALBUMIN FREE 41<br />
ARANESP ALBUMIN FREE 42<br />
ARANESP 41<br />
created on 20100520 200
ARANESP 42<br />
ARCALYST 174<br />
ARGATROBAN 40<br />
ARGENTUM METALLICUM 8X 174<br />
ARGENTUM-D20 174<br />
ARGYLE LUMBAR PUNCTURE TR 154<br />
ARGYLE PARACENTESIS PROCE 155<br />
ARGYLE PNEUMOTHORAX PROCE 155<br />
ARIDEX PEDIATRIC 90<br />
ARIDEX-D PEDIATRIC 1<br />
aristocort a 162<br />
ARISTOSPAN 144<br />
ARIXTRA 41<br />
ARMOUR THYRO 151<br />
aromatic inhalants 173<br />
ARRANON 30<br />
ARTHROTEC 50 52<br />
ARTHROTEC 75 52<br />
arthrts pain 59<br />
ARZERRA 30<br />
ASACOL 144<br />
ASCENSIA BREEZE MONITOR 177<br />
ASCENSIA BRIO 177<br />
ASCENSIA ELITE TEST STRIP 79<br />
ASCENSIA ELITE XL DIABETE 177<br />
ascorbic acid 169<br />
asp 300/200/20 59<br />
ASPERGILLUS 79<br />
aspirin free 59<br />
ASPIRIN-ACETAMINOPHEN-CAFFEINE<br />
51<br />
aspirin-caffeine-butalbit 51<br />
ASSURE 3 METER 177<br />
ASSURE 3 TEST STRIPS 79<br />
ASSURE 4 BLOOD GLUCOSE ME 177<br />
ASSURE 4 TEST STRIPS 79<br />
ASSURE II CHECK STRIP 79<br />
ASSURE II TEST STRIPS 79<br />
ASSURE II 79<br />
assure lance lancets 177<br />
ASSURE PRO BLOOD GLUCOSE 177<br />
ASSURE PRO TEST STRIPS 79<br />
ASTELIN 134<br />
ASTEPRO 134<br />
AT LAST BLOOD GLUCOSE SYS 177<br />
at last lancets 177<br />
AT LAST TEST STRIPS 79<br />
atenolol 46<br />
ATGAM 173<br />
ATOMOXETINE HCL 77<br />
atracurium besylate 38<br />
atropin-care 137<br />
atropine sul 137<br />
atropine sulfate (ophthalmic) 137<br />
ATROPINE SULFATE 33<br />
atropine sulfate 33<br />
ATROVENT HFA 33<br />
ATRYN 41<br />
ATTENUVAX 156<br />
ATUSS HD 90<br />
ATUSS HS 90<br />
ATUSS HX 90<br />
aug betamet 162<br />
AUGMENTIN 23<br />
AUGMENTIN 24<br />
aurodex 137<br />
auroguard 137<br />
aurora healthcare lancets 177<br />
aurora lancet super thin 177<br />
aurora lancet thin 23g 177<br />
AURORA PEN NEEDLES 29GX12 191<br />
AURORA PEN NEEDLES 31G X 191<br />
auroto 137<br />
AUTOCODE GLUC TEST STRIPS 79<br />
AVANDAMET 150<br />
AVANDIA 150<br />
AVAPRO 50<br />
AVASTIN 30<br />
aveeno anti-itch maximum 162<br />
AVELOX 24<br />
avidoxy 25<br />
avita 166<br />
AVONEX 172<br />
ayr 174<br />
AZACTAM 20<br />
AZATHIOPRINE 173<br />
AZELASTINE HCL 134<br />
AZITHROMYCIN 21<br />
azithromycin 21<br />
AZMACORT 144<br />
azo dine 165<br />
azo tabs 165<br />
azo-dine 165<br />
azo-gesic 165<br />
azo-septic 165<br />
azo-standard 165<br />
azurette 146<br />
created on 20100520 201<br />
B<br />
b-6 168<br />
b-complex vitamins 168<br />
b-vex d 5<br />
b-vex pd 5<br />
BABEE COF 126<br />
bac/poly/neomy/hc 136<br />
bacitracin (ophthalmic) 135<br />
bacitracin-poly-neomycin-hc 136<br />
bacitracin/neomycin/polym 135<br />
bacitracin 135<br />
bacitracin 26<br />
BACK PAIN-OFF 60<br />
baclofen 38<br />
BACTERIOSTATIC WATER FOR 195<br />
BACTERIOSTATIC WATER PARA 195<br />
BACTOCILL 24<br />
BAL IN OIL 144<br />
balacall dm 90<br />
balacet 325 53<br />
balagan 137<br />
BALNEOL 162<br />
BANZEL 65<br />
baycadron 144<br />
BAYER BREEZE 2 BLOOD GLUC 177<br />
BAYER CONTOUR BLOOD GLUCO 177<br />
BAYER CONTOUR BLOOD GLUCO 79<br />
bayer microlet lancets 177<br />
bd lo-dose insulin syrin 182<br />
BD ALLERGIST TRAY SYRINGE 177<br />
BD AUTOSHIELD 29G X 1/2" 177<br />
BD AUTOSHIELD 29G X 3/16" 177<br />
BD AUTOSHIELD 29G X 5/16" 177<br />
bd genie lancets 177<br />
bd genie 177<br />
BD INSULIN SYRINGE LUER-L 185<br />
bd insulin syringe microf 180<br />
bd insulin syringe microf 182<br />
bd insulin syringe microf 185<br />
bd insulin syringe safety 182<br />
bd insulin syringe safety 183<br />
bd insulin syringe safety 186<br />
BD INSULIN SYRINGE SLIP T 185<br />
BD INSULIN SYRINGE U-40/1 185<br />
bd insulin syringe ultraf 180<br />
bd insulin syringe ultraf 181<br />
bd insulin syringe ultraf 182
d insulin syringe ultraf 183<br />
bd insulin syringe ultraf 184<br />
bd insulin syringe ultraf 186<br />
bd insulin syringe ultraf 187<br />
bd insulin syringe ultraf 188<br />
bd insulin syringe/detach 185<br />
bd insulin syringe/u-100/ 184<br />
bd insulin syringe/u-100/ 185<br />
bd insulin syringe/u-100/ 188<br />
bd integra insulin syring 186<br />
bd integra syringe/retrac 185<br />
bd lancet ultrafine 30g 177<br />
bd lancet ultrafine 33g 177<br />
BD LATITUDE DIABETES MANA 177<br />
BD LOGIC BLOOD GLUCOSE MO 177<br />
bd microtainer lancets 177<br />
BD PEN NEEDLE/MINI/ULTRAF 177<br />
BD PEN NEEDLE/NANO/ULTRA 177<br />
BD PEN NEEDLE/SHORT/ULTRA 177<br />
BD PEN NEEDLE/ULTRAFINE/2 177<br />
BD PEN NEEDLES SHORT/ULTR 177<br />
BD PLASTIPAK SYRINGES ALL 176<br />
BD PUDENDAL/LOCAL BLOCK 155<br />
bd safety-glide insulin s 183<br />
bd safety-lok insulin syr 186<br />
bd safetyglide insulin sy 184<br />
BD TEST STRIPS 79<br />
bd ultra fine lancets 177<br />
BD ULTRAFINE MINI PEN NEE 177<br />
be-flex plus 60<br />
BEBULIN VH 42<br />
BECLOMETHASONE DIPROP<br />
MONOHYD 136<br />
BECLOMETHASONE DIPROPIONATE<br />
144<br />
BECONASE AQ 136<br />
BEE VENOM 174<br />
belladonna alka/pb 33<br />
belladonna alkaloids-phenobarbital 33<br />
belladonna alkaloids/phen 33<br />
bellahist-d la 5<br />
BENADRYL ALLERGY & SINUS 1<br />
BENADRYL ALLERGY/COLD FAS 1<br />
BENADRYL ALLERGY/SINUS FA 1<br />
benadryl severe allergy & 1<br />
benadryl severe allergy/s 1<br />
BENADRYL-D ALLERGY & SINU 1<br />
BENAPHEN PLUS 1<br />
benazepril & hydrochlorothiazide 49<br />
benazepril hcl/hydrochlor 49<br />
benazepril hcl 49<br />
benazepril 49<br />
BENEFIX 42<br />
BENICAR HCT 50<br />
BENICAR 50<br />
benprox 159<br />
BENZAMYCINPAK 158<br />
BENZASHAVE 159<br />
benzashave 159<br />
BENZIQ 159<br />
BENZOCAINE & ANTIPYRINE 137<br />
benzocaine & antipyrine 137<br />
BENZONATATE 90<br />
benzonatate 90<br />
benzotic 137<br />
benzoyl per 159<br />
BENZOYL PER 160<br />
benzoyl per 160<br />
BENZOYL PER 195<br />
benzoyl pero 160<br />
benzoyl peroxide cleanser 159<br />
benzoyl peroxide creamy w 159<br />
benzoyl peroxide creamy w 160<br />
BENZOYL PEROXIDE HYDROUS 195<br />
benzoyl peroxide w/ cleanser 160<br />
BENZOYL PEROXIDE WASH 160<br />
benzoyl peroxide wash 160<br />
BENZOYL PEROXIDE-ERYTHROMYCIN<br />
158<br />
benzoyl peroxide-erythromycin 158<br />
BENZOYL PEROXIDE-SULFUR 167<br />
benzoyl peroxide-sulfur 167<br />
BENZOYL PEROXIDE-UREA 161<br />
benzoyl peroxide-urea 161<br />
benzoyl peroxide 159<br />
BENZOYL PEROXIDE 160<br />
benzoyl peroxide 160<br />
BENZOYL PEROXIDE 161<br />
benzoyl peroxide 161<br />
BENZOYL PEROXIDE 195<br />
beta diprop 162<br />
beta hc 162<br />
beta-val 162<br />
betameth dip 162<br />
betameth val 162<br />
betamethasone acetate & sod<br />
phosphate 144<br />
betamethasone dipropionate (topical)<br />
162<br />
betamethasone dipropionate<br />
augmented 162<br />
betamethasone valerate 162<br />
BETASERON 172<br />
BETATAN 90<br />
betavent 90<br />
BETAXOLOL HCL (OPHTH) 139<br />
BETAXOLOL 139<br />
bethanechol chloride 33<br />
bethanechol 33<br />
BETIMOL 139<br />
BETOPTIC-S 139<br />
BEXAROTENE (TOPICAL) 167<br />
BEXAROTENE 30<br />
BEXXAR 131 IODINE 30<br />
BEXXAR 30<br />
BICILLIN C-R 22<br />
BICILLIN L-A 22<br />
BICNU 30<br />
BIDEX-A 90<br />
bidex-dmi 90<br />
bidex 126<br />
bidhist-d 5<br />
BIMATOPROST 140<br />
BIO-TUSSI PEDIATRIC 90<br />
BIO-TUSSI 90<br />
BIOBRON SF 90<br />
biocotron 90<br />
biodec-dm 90<br />
BIODEC 1<br />
BIODESP DM 90<br />
biofed-pe 5<br />
biogil 90<br />
BIONEL PEDIATRIC 90<br />
BIONEL 90<br />
BIOSCANNER GLUCOSE TEST S 79<br />
BIOSPEC DMX 90<br />
biotuss dm 90<br />
biotuss pe 126<br />
biotuss pediatric 90<br />
biotuss 90<br />
biotussin ac 90<br />
biotussin dac 90<br />
bisoprol fum 46<br />
bisoprolol & hydrochlorothiazide 46<br />
created on 20100520 202
isoprolol fumarate/hydro 46<br />
bisoprolol fumarate 46<br />
bl acne 161<br />
bl color lancets 177<br />
bl flu/cold/cough 100<br />
BL HOT STEAM LIQUID 174<br />
bl ibu-profen cold & sinu 36<br />
bl infants pain reliever 90<br />
bl insulin syringe/0.3ml/ 181<br />
bl lancets super thin 177<br />
bl lancets thin 177<br />
bl lancets 177<br />
bl pain reli 60<br />
bl prenatal vitamins 170<br />
bl severe cold/flu maximu 90<br />
BL TEST STRIP 80<br />
BL TEST STRIPS 80<br />
bl triacting chest conges 126<br />
bl triacting cold/allergy 5<br />
bl tussin cf 90<br />
bl vit b-6 168<br />
bl womens menstrual relie 60<br />
blanex-a 5<br />
bleomycin sulfate 30<br />
BLEPHAMIDE LIQUIFILM 136<br />
BLEPHAMIDE S.O.P. 136<br />
BLEPHAMIDE 136<br />
BLOOD GLUCOSE METER 177<br />
BLOOD GLUCOSE MONITOR KIT 177<br />
BLOOD GLUCOSE MONITORING<br />
SUPPLIES 176<br />
BLOOD GLUCOSE MONITORING 177<br />
BLOOD GLUCOSE SYSTEM 177<br />
BLOOD GLUCOSE TEST STRIPS 80<br />
BONE MARROW ASPIRATION TR 154<br />
BONIVA 172<br />
BOOSTRIX 156<br />
BOTOX COSMET 174<br />
BOTOX 174<br />
bp 8 cough 90<br />
bp multinatal plus 170<br />
bp wash 161<br />
bpm mal/phenyleph hcl/dm 90<br />
bpm mal/pse hcl/dm hbr 90<br />
bpm pe dm 90<br />
bpm pe hc 90<br />
bpm pe 5<br />
bpm pseudo 5<br />
bpo 161<br />
bps 167<br />
BRANCHAMIN 4% 86<br />
BRAVELLE 147<br />
BREEZE 2 BLOOD GLUCOSE MO 177<br />
BREVIBLOC 46<br />
BREVITAL SOD 50<br />
BREVOXYL-4 CREAMY WASH 161<br />
BREVOXYL-8 CREAMY WASH 161<br />
BRIMONIDINE TARTRATE 139<br />
brimonidine tartrate 139<br />
brimonidine 138<br />
brimonidine 139<br />
BRITE LIFE BLOOD GLUCOSE 177<br />
BROFED 5<br />
brom mal/phenyl hcl/dex h 90<br />
brom tann/dm tann/pse tan 90<br />
brom/pseud/dm 90<br />
bromaline dm 91<br />
bromaline 5<br />
bromaphedrine d 5<br />
BROMATAN PLUS 91<br />
bromatan-dm 91<br />
bromatane dx 91<br />
bromax d 5<br />
bromaxefed dm rf 91<br />
bromaxefed rf 5<br />
bromcomp hc 91<br />
bromdec dm 91<br />
bromdec 1<br />
bromdec 5<br />
bromdex d 91<br />
brometane dx 91<br />
bromfed dm 91<br />
BROMFED 5<br />
bromfenex pd 6<br />
bromfenex pe pediatric 6<br />
bromfenex pe 6<br />
bromfenex 6<br />
BROMHEXINE HCL 195<br />
bromhist pdx 91<br />
bromhist pediatric 6<br />
bromhist-dm pediatric 91<br />
bromhist-dm 91<br />
bromhist-nr 6<br />
BROMHIST-PDX 91<br />
bromophed dx 91<br />
BROMPHEN-PSEUDOEPHED-<br />
CHLORPHEN-PHENYLEPH-<br />
METHSCOPOLAMINE 5<br />
bromphenex dm 91<br />
BROMPHENEX HD 91<br />
BROMPHENIRAMINE & PHENYLEPH 6<br />
brompheniramine & phenyleph 6<br />
BROMPHENIRAMINE & PSEUDOEPH 6<br />
brompheniramine & pseudoeph 6<br />
BROMPHENIRAMINE MALEATE-<br />
PHENYLEPHRINE HCL TANNATE 6<br />
brompheniramine maleate/p 6<br />
brompheniramine tann/phen 5<br />
BROMPHENIRAMINE TANNATE-<br />
PHENYLEPHRINE TANNATE 6<br />
brompheniramine tannatephenylephrine<br />
tannate 6<br />
BROMPHENIRAMINE TANNATE-<br />
PSEUDOEPHEDRINE TANNATE 6<br />
brompheniramine tannatepseudoephedrine<br />
tannate 6<br />
BROMPHENIRAMINE W/ DM-GG 126<br />
BROMPHENIRAMINE W/<br />
HYDROCODONE-GG 91<br />
BROMPHENIRAMINE-<br />
DIPHENHYDRAMINE-PHENYLEPHRINE<br />
6<br />
BROMPHENIRAMINE-PSE W/ APAP 6<br />
brompheniramine/dextromet 90<br />
brompheniramine/dextromet 91<br />
brompheniramine/hydrocodo 90<br />
brompheniramine/phenyleph 6<br />
brompheniramine/phenyleph 90<br />
brompheniramine/pse 6<br />
brompheniramine/pseudoeph 5<br />
brompheniramine/pseudoeph 6<br />
brompheniramine/pseudoeph 90<br />
bromplex dm 91<br />
bromplex hd 91<br />
bromtuss dm 91<br />
bronchial asthma relief 126<br />
broncho sal 134<br />
BRONCHOLATE 126<br />
BRONCOPECTOL 91<br />
BRONCOTRON-D 91<br />
broncotron 91<br />
BRONKAID 126<br />
BRONKIDS 91<br />
bronkids 91<br />
created on 20100520 203
BRONTEX 91<br />
brontuss la 91<br />
BRONTUSS SF 91<br />
brotapp dm 91<br />
brotapp 6<br />
BROVEX ADT 6<br />
BROVEX CB 91<br />
BROVEX CBX 91<br />
BROVEX PB C 91<br />
BROVEX PB CX 91<br />
BROVEX PB DM 91<br />
BROVEX PB 6<br />
BROVEX PD 6<br />
BROVEX PEB 6<br />
BROVEX PSB 7<br />
BROVEX PSE DM 91<br />
buckleys chest congestion 126<br />
BUCKLEYS COUGH 91<br />
budeprion 69<br />
BUDESONIDE (INHALATION) 144<br />
budesonide (inhalation) 144<br />
budesonide 144<br />
bullseye safety lancets 177<br />
bumetanide 87<br />
bupivacaine hcl 154<br />
bupivacaine in dextrose 154<br />
bupivacaine w/ epinephrine 154<br />
BUPIVACAINE/NS 154<br />
buprenorphine hcl 58<br />
bupropion hcl (smoking deterrent) 69<br />
bupropion hcl 69<br />
bupropion 69<br />
BUSPIRONE HCL 75<br />
buspirone hcl 75<br />
BUSPIRONE 75<br />
buspirone 75<br />
BUSULFAN 30<br />
BUSULFEX 30<br />
butal/asa/caff 51<br />
butalbital compound 51<br />
butalbital-acetaminophen-caffeine 60<br />
BUTALBITAL-ACETAMINOPHEN 60<br />
butalbital-aspirin-caffeine 51<br />
butalbital/apap/caffeine 60<br />
butalbital/asa/caffeine 51<br />
butalbital/aspirin/caffei 51<br />
butorphanol tartrate 58<br />
by-ache 60<br />
BYETTA 148<br />
C<br />
C-HIST SR 7<br />
c-phed dpd tannate 91<br />
c-phed tannate 7<br />
c-phen dm 91<br />
c-phen 7<br />
C-TAN D PLUS 7<br />
c-tan d 7<br />
c-tanna 12 91<br />
c-tanna 12d 91<br />
caffeine citrate 73<br />
CAFFEINE/SODIUM BENZOATE 73<br />
calc acetate 84<br />
CALCIPOTRIENE 167<br />
calcitonin (salmon) 150<br />
CALCITRIOL 169<br />
calcitriol 169<br />
CALCIUM ACETATE (PHOSPHATE<br />
BINDER) 84<br />
calcium acetate (phosphate binder) 84<br />
calcium chloride (dihydrate) 84<br />
CALCIUM DISO 144<br />
CALCIUM DISODIUM VERSENAT 144<br />
calcium gluconate 84<br />
caldecort 162<br />
CALDOLOR 52<br />
CALOMIST 168<br />
CALPHOSAN 84<br />
camila 146<br />
CAMPATH 30<br />
camphor (inhalant) 174<br />
CAMPHOR-EUCALYPTUS-MENTHOL-<br />
BENZOIN 173<br />
camphor-eucalyptus-mentholturpentine<br />
oil-white petrolatum 173<br />
CAMPHOR-EUCALYPTUS-MENTHOL<br />
173<br />
camphor-eucalyptus-menthol 173<br />
CAMPHOR-MENTHOL (INHALANT) 174<br />
CANCIDAS 27<br />
CANDIN 81<br />
canges-hc nr 91<br />
CANGES-HC 91<br />
canges-xp 91<br />
CAPASTAT SUL 27<br />
CAPITAL/CODEINE 53<br />
CAPMIST DM 91<br />
captopril & hydrochlorothiazide 49<br />
captopril/hydrochlorothia 49<br />
captopril 49<br />
car-b-pen ta/chlor-tan 91<br />
CARAC 167<br />
CARAFATE 143<br />
carb pse 12 dm 91<br />
carb pseudo-tan 91<br />
carb/phenyl-12 91<br />
carbachol (ophth) 139<br />
carbamazepin 65<br />
CARBAMAZEPINE 65<br />
carbamazepine 65<br />
CARBAPHEN 12 PED 91<br />
CARBAPHEN 12 91<br />
carbatab-12 91<br />
CARBATUSS-12 91<br />
CARBATUSS-CL 91<br />
carbaxefed dm rf 91<br />
carbaxefed rf 1<br />
CARBETAPENTANE CITRATE-<br />
CARBETAPENTANE TANNATE-PE HCL-<br />
PE TAN 91<br />
CARBETAPENTANE CITRATE-<br />
GUAIFENESIN TANNATE 91<br />
CARBETAPENTANE CITRATE-<br />
PSEUDOEPHEDRINE HCL TANNATE 91<br />
CARBETAPENTANE CITRATE-<br />
PSEUDOEPHEDRINE HCL TANNATE 92<br />
CARBETAPENTANE TANNATE-<br />
PYRILAMINE TANNATE 92<br />
carbetapentane tannate/ch 91<br />
CARBETAPENTANE TANNATE 92<br />
CARBETAPENTANE-GUAIFENESIN 92<br />
carbetapentane-guaifenesin 92<br />
CARBETAPENTANE-<br />
PSEUDOEPHEDRINE 92<br />
carbetapentane/phenylephr 91<br />
carbetaplex ts 92<br />
carbetaplex 92<br />
carbic ds 1<br />
CARBINOXAMINE & PHENYLEPHRINE<br />
1<br />
carbinoxamine & phenylephrine 1<br />
CARBINOXAMINE & PSEUDOEPH 1<br />
carbinoxamine & pseudoeph 1<br />
carbinoxamine compound 92<br />
carbinoxamine pse 1<br />
created on 20100520 204
CARBINOXAMINE TANNATE-<br />
PSEUDOEPHEDRINE TANNATE 1<br />
carbinoxamine tannatepseudoephedrine<br />
tannate 1<br />
carbinoxamine-pseudoephedrinemethscopolamine<br />
1<br />
carbinoxamine/pseudoephed 1<br />
carbodex dm 92<br />
carbofed dm 92<br />
carboplatin 30<br />
carboxine 12 d 1<br />
carboxine 12 dm 92<br />
carboxine dm 92<br />
carboxine-d 1<br />
CARBOXINE-PSE 1<br />
cardec dm 92<br />
cardec 7<br />
CARDENE IV 47<br />
CARDIZEM CD 48<br />
careone lancet thin 178<br />
careone lancet ultra thin 177<br />
careone lancet 177<br />
careone ultiguard insulin 180<br />
careone ultiguard insulin 181<br />
careone ultiguard insulin 183<br />
careone ultiguard insulin 184<br />
careone ultiguard insulin 186<br />
careone ultiguard insulin 187<br />
CARIMUNE NF 155<br />
carisoprodol w/ aspirin 38<br />
carisoprodol/aspirin 38<br />
CARISOPRODOL 38<br />
carisoprodol 38<br />
cartia xt 48<br />
CAT HAIR EXTRACT 174<br />
CATHFLO ACTIVASE 41<br />
cavan prenatal/ec calcium 170<br />
CAVERJECT 45<br />
CCP CAFFEINE FREE 126<br />
CECON 169<br />
CEENU 30<br />
CEFACLOR ER 18<br />
cefaclor er 18<br />
CEFACLOR MONOHYDRATE 18<br />
cefaclor monohydrate 18<br />
CEFACLOR 18<br />
cefaclor 18<br />
cefadroxil 18<br />
CEFAZOLIN SODIUM 18<br />
cefazolin sodium 18<br />
CEFAZOLIN 18<br />
cefdinir 19<br />
cefepime hcl 20<br />
CEFEPIME 20<br />
CEFIXIME 19<br />
CEFIZOX 19<br />
CEFOTAN-GALAXY 20<br />
cefotaxime sodium 19<br />
CEFOTAXIME 19<br />
CEFOTETAN 20<br />
CEFOXITIN SODIUM 20<br />
cefoxitin sodium 20<br />
CEFOXITIN 20<br />
cefpodo prox 19<br />
cefpodoxime proxetil 19<br />
cefpodoxime 19<br />
cefprozil 18<br />
CEFTAZIDIME 19<br />
ceftazidime 19<br />
ceftriaxone sodium in dextrose 19<br />
ceftriaxone sodium 19<br />
CEFTRIAXONE 19<br />
cefuroxime sodium 19<br />
CEFUROXIME 18<br />
CEFUROXIME 19<br />
CELEBREX 51<br />
CELLCEPT IV 173<br />
CENHIST 7<br />
centergy dm 92<br />
centergy 7<br />
centex-pse er 126<br />
cephalexin 18<br />
CEPROTIN 41<br />
CERECOMP 174<br />
CEREDASE 88<br />
CEREZYME 88<br />
CERNEVIT 170<br />
ceron-dm 92<br />
ceron 7<br />
CERTAIN DRI 166<br />
CERTUSS 92<br />
CERVARIX 156<br />
CERVICAL CAPS 78<br />
cetacort 162<br />
cetirizine hcl 16<br />
cetirizine 16<br />
cgh suppress 92<br />
CHANTIX 38<br />
CHANTIX 39<br />
chd pain rel 60<br />
CHEK-STIX COMBO PAK URINA 83<br />
CHEK-STIX CONTROL 83<br />
CHEMSTRIP-K 83<br />
cheratussin ac 92<br />
cheratussin dac 92<br />
chest conges 126<br />
chest congestion & pain r 126<br />
chest congestion and sinu 126<br />
chest congestion daytime 126<br />
chest congestion relief p 126<br />
chest congestion relief p 92<br />
chest congestion relief 126<br />
chest congestion/cough re 92<br />
chest congestion/pain & s 126<br />
chest/sinus congestion re 126<br />
chewable multivitamins/fl 171<br />
chewable multivite w/fl 171<br />
child apap 60<br />
child nite time 106<br />
child nonasa 60<br />
child pn rel 60<br />
child pn/fev 60<br />
childrens acetaminophen 60<br />
childrens advil cold 36<br />
childrens apap 60<br />
childrens aspirin free 60<br />
childrens cold & allergy 9<br />
childrens cold plus cough 92<br />
CHILDRENS COLD/PAIN 7<br />
childrens cough 92<br />
childrens ibuprofen cold 36<br />
childrens mapap rapid tab 60<br />
childrens medi-tabs 60<br />
childrens mucus relief co 105<br />
childrens nite time cold/ 92<br />
childrens non-aspirin col 107<br />
childrens non-aspirin pai 60<br />
childrens non-aspirin plu 106<br />
childrens non-aspirin plu 107<br />
childrens non-aspirin 60<br />
childrens pain relief col 7<br />
childrens pain relief 60<br />
childrens pain relief 62<br />
childrens pain reliever c 92<br />
created on 20100520 205
childrens pain reliever 60<br />
childrens pain/fever 60<br />
childrens plus cold & all 2<br />
childrens plus cough/runn 92<br />
childrens plus multi-symp 92<br />
childrens tactinal 64<br />
CHILDRENS TRIACTING COUGH 121<br />
childrens triacting cough 121<br />
childrens triacting night 121<br />
childrens tylenol plus co 92<br />
CHILDRENS TYLENOL SINUS 38<br />
childrens 60<br />
childs allergy cold/cough 92<br />
childs apap 60<br />
childs cold/allergy 9<br />
childs pain reliever with 60<br />
chld meditab 60<br />
chld non-asa 60<br />
chld pain rl 60<br />
chld pn rel 60<br />
chld silapap 60<br />
CHLO TUSS 92<br />
CHLOPHEDIANOL-PSEUDOEPHEDRINE<br />
92<br />
chlor-mes d 7<br />
chlor-mes jr 7<br />
chlor-mes 7<br />
chlor-tan a 12 7<br />
chlor-trimeton 7<br />
CHLORAL HYDR 75<br />
chloral hydr 75<br />
CHLORAL HYDRATE 75<br />
chloral hydrate 75<br />
CHLORAMBUCIL 30<br />
CHLORAMPHEN 20<br />
chloraseptic sore throat 60<br />
chlordex gp 92<br />
chlordiazep 74<br />
chlordiazepoxide hcl/clid 33<br />
chlordiazepoxide hcl 74<br />
chlordiazepoxide/clidiniu 33<br />
chlorex-a 12 7<br />
chlorex-a 7<br />
chloroprocaine hcl 154<br />
chlorothiazide sodium 88<br />
chlorphen hd 92<br />
chlorphen mal/dex hbr/pse 92<br />
chlorphen mal/pseudoeph h 9<br />
CHLORPHEN TAN & PSEUDOEPH TAN<br />
7<br />
chlorphen tan & pseudoeph tan 7<br />
chlorphen-pe-atropine-hyoscyaminescopolamine<br />
7<br />
CHLORPHEN-PHENYLEPH W/APAP 7<br />
chlorphen-phenyleph w/apap 7<br />
CHLORPHEN-PHENYLTOLOX-PE 8<br />
chlorphen-phenyltolox-pe 8<br />
chlorphen-pse-atropine-hyoscyaminescopolamine<br />
8<br />
CHLORPHEN-PSEUDOEPHED W/ APAP<br />
13<br />
CHLORPHEN-PSEUDOEPHED W/ APAP<br />
8<br />
chlorphen-pseudoephed w/ apap 8<br />
CHLORPHENIRAMINE &<br />
PHENYLEPHRINE 8<br />
chlorpheniramine & phenylephrine 8<br />
CHLORPHENIRAMINE & PSEUDOEPH 7<br />
CHLORPHENIRAMINE & PSEUDOEPH 8<br />
chlorpheniramine & pseudoeph 8<br />
CHLORPHENIRAMINE MAL-<br />
PHENYLEPHRINE HCL-METHSCOP NIT<br />
TANNATE 7<br />
CHLORPHENIRAMINE MALEATE-<br />
PSEUDOEPHEDRINE HCL TANNATE 8<br />
chlorpheniramine maleate/ 10<br />
CHLORPHENIRAMINE POLACRILEX-<br />
PSEUDOEPHEDRINE POLISTIREX 7<br />
CHLORPHENIRAMINE TAN-<br />
PYRILAMINE TAN-PHENYLEPHRINE<br />
TAN 7<br />
chlorpheniramine tan-pyrilamine tanphenylephrine<br />
tan 7<br />
CHLORPHENIRAMINE TANNATE-<br />
CARBETAPENTANE TANNATE 92<br />
chlorpheniramine tannatecarbetapentane<br />
tannate 92<br />
CHLORPHENIRAMINE TANNATE-<br />
HYDROCODONE TANNATE 92<br />
CHLORPHENIRAMINE TANNATE-<br />
PHENYLEPHRINE TAN-<br />
METHSCOPOLAMINE 7<br />
chlorpheniramine tannatephenylephrine<br />
tan-methscopolamine 7<br />
CHLORPHENIRAMINE TANNATE-<br />
PHENYLEPHRINE TAN-<br />
METHSCOPOLAMINE 9<br />
CHLORPHENIRAMINE TANNATE-<br />
PHENYLEPHRINE TANNATE 7<br />
chlorpheniramine tannatephenylephrine<br />
tannate 7<br />
CHLORPHENIRAMINE TANNATE-<br />
PHENYLEPHRINE TANNATE 8<br />
chlorpheniramine tannatephenylephrine<br />
tannate 8<br />
chlorpheniramine w/ apap 8<br />
CHLORPHENIRAMINE W/ CODEINE 92<br />
chlorpheniramine w/ codeine 92<br />
CHLORPHENIRAMINE W/ CODEINE 93<br />
CHLORPHENIRAMINE W/ DM-GG 93<br />
CHLORPHENIRAMINE<br />
W/HYDROCODONE 93<br />
chlorpheniramine-diphenhydraminephenylephrine-apap<br />
7<br />
CHLORPHENIRAMINE-DM 93<br />
chlorpheniramine-dm 93<br />
CHLORPHENIRAMINE-<br />
PHENYLEPHRINE-ASA 9<br />
CHLORPHENIRAMINE-<br />
PHENYLEPHRINE-<br />
METHSCOPOLAMINE &<br />
HOMEOPATHIC 4<br />
CHLORPHENIRAMINE-<br />
PHENYLEPHRINE-<br />
METHSCOPOLAMINE 12<br />
chlorpheniramine-phenylephrinemethscopolamine<br />
12<br />
CHLORPHENIRAMINE-<br />
PHENYLEPHRINE-<br />
METHSCOPOLAMINE 7<br />
chlorpheniramine-phenylephrinemethscopolamine<br />
7<br />
CHLORPHENIRAMINE-<br />
PHENYLEPHRINE-<br />
METHSCOPOLAMINE 8<br />
chlorpheniramine-phenylephrinemethscopolamine<br />
8<br />
CHLORPHENIRAMINE-<br />
PHENYLEPHRINE-<br />
METHSCOPOLAMINE 9<br />
chlorpheniramine-phenylephrinemethscopolamine<br />
9<br />
CHLORPHENIRAMINE-<br />
PHENYLTOLOXAMINE-<br />
created on 20100520 206
PHENYLEPHRINE-APAP 16<br />
chlorpheniramine-phenyltoloxaminephenylephrine-apap<br />
16<br />
CHLORPHENIRAMINE-<br />
PSEUDOEPHEDRINE & BELLADONNA<br />
ALKALOIDS 7<br />
CHLORPHENIRAMINE-<br />
PSEUDOEPHEDRINE & HOMEOPATHIC<br />
PRODUCT 4<br />
CHLORPHENIRAMINE-<br />
PSEUDOEPHEDRINE &<br />
METHSCOPOLAMINE 13<br />
chlorpheniramine-pseudoephedrine &<br />
methscopolamine 13<br />
CHLORPHENIRAMINE-<br />
PSEUDOEPHEDRINE &<br />
METHSCOPOLAMINE 7<br />
chlorpheniramine-pseudoephedrine &<br />
methscopolamine 7<br />
CHLORPHENIRAMINE-<br />
PSEUDOEPHEDRINE &<br />
METHSCOPOLAMINE 8<br />
chlorpheniramine-pseudoephedrine &<br />
methscopolamine 8<br />
CHLORPHENIRAMINE-<br />
PSEUDOEPHEDRINE-ASPIRIN 8<br />
CHLORPHENIRAMINE-<br />
PSEUDOEPHEDRINE-IBUPROFEN 9<br />
CHLORPHENIRAMINE-PYRILAMINE &<br />
PHENYLEPHRINE 8<br />
chlorpheniramine-pyrilamine &<br />
phenylephrine 8<br />
CHLORPHENIRAMINE-PYRILAMINE<br />
TAN-PHENYLEPH HCL-PHENYLEPH<br />
TAN 16<br />
chlorpheniramine/codeine 95<br />
chlorpheniramine/methscop 9<br />
chlorpheniramine/phenylep 10<br />
chlorpheniramine/phenylep 92<br />
chlorpheniramine/phenylep 95<br />
chlorpheniramine/phenylto 10<br />
chlorpheniramine/pseudo/d 92<br />
CHLORPHENIRAMINE/PSEUDOEP 10<br />
chlorpheniramine/pseudoep 10<br />
CHLORPROMAZ 71<br />
chlorpromaz 71<br />
chlorpromazine hcl 71<br />
CHLORPROMAZINE 71<br />
chlorpropam 149<br />
chlorpropamide 149<br />
chlortan d 9<br />
CHOICE DM DIABETES RISK I 178<br />
CHOLOGRAFIN 82<br />
chorionic gonadotropin 147<br />
chromium chloride 84<br />
ciclopirox olamine 158<br />
ciclopirox olamine 159<br />
ciclopirox 158<br />
ciclopirox 159<br />
CILOXAN 135<br />
CIMETIDINE HCL/NACL 142<br />
cimetidine hcl 142<br />
cimetidine 142<br />
CIMZIA 144<br />
CIPRODEX 136<br />
ciprofloxacin hcl (ophth) 135<br />
ciprofloxacin hcl 24<br />
ciprofloxacin in d5w 24<br />
ciprofloxacin 24<br />
ciprofloxacn 135<br />
ciprofloxacn 24<br />
cisplatin 30<br />
citalopram hydrobromide 66<br />
citalopram hydrobromide 67<br />
citalopram 66<br />
citalopram 67<br />
cladribine 30<br />
CLAFORAN/D5W 19<br />
CLAFORAN 19<br />
CLARINEX-D 16<br />
CLARINEX 16<br />
clarithromyc 20<br />
clarithromyc 21<br />
clarithromycin 20<br />
clarithromycin 21<br />
CLARITIN 16<br />
claritin 16<br />
clean & clear persa-gel e 162<br />
clean & clear persa-gel m 162<br />
clean&clear 161<br />
cleanlet lancets 28g 178<br />
clear cough dm 93<br />
clear-atadin 17<br />
clearplex x 161<br />
clearplex 161<br />
clearskin 161<br />
clemastine fumarate 1<br />
clemastine-1 1<br />
clemastine 1<br />
CLEOCIN 26<br />
CLEVER CHEK AUTO CODE VOI 178<br />
CLEVER CHEK AUTO-CODE BLO 178<br />
CLEVER CHEK AUTO-CODE TES 80<br />
CLEVER CHEK AUTO-CODE VOI 178<br />
CLEVER CHEK AUTO-CODE VOI 80<br />
CLEVER CHEK BLOOD GLUCOSE 178<br />
clever chek lancets ultra 178<br />
CLEVER CHEK TEST STRIPS 80<br />
CLEVER CHOICE AUTO-CODE P 178<br />
CLEVER CHOICE AUTO-CODE P 80<br />
CLEVER CHOICE MINI BLOOD 178<br />
CLEVIPREX 47<br />
CLICKFINE PEN NEEDLE UNIV 178<br />
CLICKFINE UNIVERSAL PEN N 178<br />
clidinium & chlordiazepoxide 33<br />
clidinium/chlordiazepoxid 33<br />
CLINAC BPO 161<br />
CLINDA 158<br />
clindamax 158<br />
clindamycin hcl 26<br />
CLINDAMYCIN PHOSPHATE (TOPICAL)<br />
158<br />
clindamycin phosphate (topical) 158<br />
clindamycin phosphate vaginal 158<br />
clindamycin phosphate-benzoyl<br />
peroxide 158<br />
clindamycin phosphate 158<br />
clindamycin phosphate 26<br />
clindamycin 158<br />
clindamycin 26<br />
CLINDAREACH 158<br />
CLINIMIX 2.75%/DEXTROSE 5 86<br />
CLINIMIX 4.25%/DEXTROSE 1 86<br />
CLINIMIX 4.25%/DEXTROSE 2 86<br />
CLINIMIX 4.25%/DEXTROSE 5 86<br />
CLINIMIX 5%/DEXTROSE 15% 86<br />
CLINIMIX 5%/DEXTROSE 20% 86<br />
CLINIMIX 5%/DEXTROSE 25% 86<br />
CLINIMIX E 2.75% 86<br />
CLINIMIX E 2.75% 87<br />
CLINIMIX E 4.25% 87<br />
CLINIMIX E 5%/DEXTROSE 15 87<br />
CLINIMIX E 5%/DEXTROSE 20 87<br />
CLINIMIX E 5%/DEXTROSE 25 87<br />
created on 20100520 207
CLINIMIX E 5%/DEXTROSE 35 87<br />
CLOFERA 93<br />
CLOLAR 30<br />
clomipramine hcl 68<br />
clomipramine 68<br />
clonazepam 64<br />
clonidine hcl (analgesia) 44<br />
clonidine hcl 44<br />
clonidine 44<br />
CLOPIDOGREL BISULFATE 41<br />
clopidogrel bisulfate 41<br />
clopidogrel 41<br />
clotrimazole tro 158<br />
CLOTRIMAZOLE VAGINAL 158<br />
clotrimazole w/ betamethasone 158<br />
clotrimazole/betamethason 158<br />
clotrimazole 158<br />
CLOZAPINE 69<br />
clozapine 69<br />
co-gesic 53<br />
co-natal fa 170<br />
coaguchek lancets 178<br />
COCET 54<br />
COCILLANA-TERPIN HYDRATE 126<br />
codafed expectorant 93<br />
codafed pediatric expecto 93<br />
codal-dh 93<br />
codal-dm 93<br />
CODEINE PHOS TAB SOL 54<br />
codeine phosphate/acetami 54<br />
codeine phosphate/apap 54<br />
codeine phosphate/guaifen 93<br />
CODEINE PHOSPHATE 54<br />
CODEINE-BROMPHENIRAMINE 93<br />
codeine-brompheniramine 93<br />
CODEINE-CHLORPHENIRAMINE-<br />
ACETAMINOPHEN 93<br />
CODEINE-PYRILAMINE 93<br />
codeine/acetaminophen 54<br />
codeine/guaifenesin 93<br />
codiclear dh 93<br />
CODIMAL DH 93<br />
CODIMAL PH 93<br />
codituss dh 93<br />
codituss dm 93<br />
COENZYME COMPOSITUM 174<br />
cofex-dm 93<br />
cold & allergy 9<br />
cold & cough dm 93<br />
cold & flu intense streng 2<br />
cold caplets 93<br />
cold control + 1<br />
cold control pe intense c 1<br />
cold head congestion day/ 93<br />
cold head congestion dayt 93<br />
cold head congestion nigh 93<br />
cold head congestion seve 93<br />
cold medicine plus 9<br />
cold multi-symptom day/ni 93<br />
cold multi-symptom daytim 93<br />
cold multi-symptom nightt 93<br />
cold multi-symptom severe 93<br />
cold multi-symptom 93<br />
cold multi-symptom 9<br />
cold relief effervescent 9<br />
cold relief plus 9<br />
cold symptoms relief maxi 93<br />
cold tablets 36<br />
cold/allergy childrens 9<br />
cold/allergy pe 9<br />
cold/allergy/sinus 9<br />
cold/allergy 9<br />
cold/cough childrens 94<br />
cold/cough dm childrens 94<br />
cold/cough multi-symptom 94<br />
cold/flu relief day/night 94<br />
cold/flu relief daytime m 94<br />
coldamine 9<br />
coldcough hc 94<br />
COLDCOUGH HCM 94<br />
coldcough pd 94<br />
coldcough 94<br />
coldec d 2<br />
coldec dm 94<br />
coldec-tr 2<br />
coldec 2<br />
coldex-a sr 9<br />
coldmist dm 94<br />
coldmist jr 126<br />
coldmist la 126<br />
coldtuss-dr 94<br />
colfed-a 9<br />
colidrops 33<br />
colistimethate sodium 26<br />
color lancets 178<br />
COLYTROL PEDIATRIC 33<br />
COMBIVIR 28<br />
comfort lancets 178<br />
COMHIST 9<br />
COMPACT TEST STRIPS 80<br />
complete sinus relief 14<br />
COMPLETE SINUS RELIEF 9<br />
complete 94<br />
compro 71<br />
COMTREX ACUTE HEAD COLD 9<br />
comtrex cold & cough 94<br />
comtrex cold/cough relief 94<br />
COMTREX DAY/NIGHT COLD & 94<br />
COMTREX DAY/NIGHT FLU THE 9<br />
comtrex deep chest cold m 126<br />
comtrex deep chest cold 94<br />
comtrex flu therapy maxim 9<br />
comtrex maximum-strength 94<br />
COMTREX NIGHTTIME ACUTE H 9<br />
COMTREX NIGHTTIME COLD & 94<br />
comtrex nighttime cold & 94<br />
COMTREX NIGHTTIME FLU THE 9<br />
comtrex severe cold & sin 9<br />
comtrex sinus & nasal dec 9<br />
comtrex sore throat 60<br />
COMTREX/DAY & NIGHT/COLD 94<br />
COMVAX 156<br />
conal 9<br />
CONCERTA 73<br />
condasin 94<br />
CONEX COLD/ALLERGY 9<br />
congesta dm 94<br />
congestant 9<br />
conison 39<br />
conpec la nr 126<br />
CONPEC 126<br />
CONRAY 400 82<br />
CONRAY 82<br />
constulose 83<br />
contac cold+flu maximum s 34<br />
CONTAC COLD/FLU DAY & NIG 9<br />
CONTAC COLD/FLU MAXIMUM S 9<br />
CONTAC DAY/NIGHT ALLERGY/ 2<br />
CONTAC DAY/NIGHT COLD/FLU 94<br />
contac severe cold/flu no 94<br />
CONTOUR BLOOD GLUCOSE MON 178<br />
CONTOUR USB BLOOD GLUCOSE 178<br />
CONTROL AST 80<br />
created on 20100520 208
CONTROL BLOOD GLUCOSE MON 178<br />
CONTROL TEST STRIPS 80<br />
COPAXONE 172<br />
COPHENE #2 9<br />
COPPER SULF 84<br />
CORDRON-12 D 2<br />
CORDRON-12 DM 94<br />
cordron-d nr 2<br />
CORDRON-D 2<br />
cordron-dm nr 94<br />
CORDRON-DM 94<br />
cordron-hc nr 94<br />
CORDRON-HC 94<br />
COREG CR 46<br />
corfen-dm 94<br />
coricidin d cold/flu/sinu 9<br />
coricidin d 9<br />
CORICIDIN HBP CHEST CONGE 94<br />
coricidin hbp nighttime m 94<br />
CORICIDIN NIGHTTIME COLD/ 2<br />
cortaid advanced 163<br />
cortaid maximum strength 162<br />
cortaid 162<br />
CORTIFOAM 163<br />
cortizone-10 external ana 163<br />
cortizone-10 intensive he 163<br />
cortizone-10 plus 163<br />
cortizone-10/aloe 163<br />
cortizone-10 163<br />
cortizone-5 163<br />
cortomycin 136<br />
coryza-d 9<br />
coryza-dm 94<br />
CORZALL PLUS 94<br />
CORZALL 94<br />
COSMEGEN 30<br />
cosyntropin 79<br />
COTAB A 94<br />
COTAB AX 94<br />
COTABFLU 94<br />
cotuss ex 94<br />
cotuss hd 94<br />
cotuss ms 94<br />
cotuss 94<br />
cough & cold 94<br />
cough & sore throat day t 94<br />
cough & sore throat day 94<br />
cough & sore throat night 94<br />
cough cold & flu relief m 94<br />
cough formula d 94<br />
COUGH FORMULA M 94<br />
cough relief 94<br />
cough reliever double str 92<br />
COUGH SYRUP D 94<br />
cough syrup m 94<br />
cough/cold medicine 9<br />
cough/cold/flu relief m 92<br />
cough/head congestion rel 94<br />
cough 126<br />
coughtuss 94<br />
COUMADIN 39<br />
COUMADIN 40<br />
COVERA-HS 48<br />
cp dec-dm 95<br />
cp dec 9<br />
cpm 8/pe 20/msc 1.25 9<br />
cpm 8/pse 90/msc 2.5 10<br />
cpm-pe-msc 9<br />
cpm/pse dm 95<br />
cpm/pse 10<br />
CRAMP TABS 60<br />
CRANTEX HC 95<br />
crantex la 126<br />
crantex 126<br />
CREO-TERPIN 95<br />
CREOMULSION 95<br />
CREON 10 141<br />
CREON 20 141<br />
CREON 5 141<br />
CRIXIVAN 27<br />
CROFAB 155<br />
cromolyn sod 125<br />
cromolyn sod 135<br />
cromolyn sodium (ophth) 135<br />
CROMOLYN SODIUM 125<br />
cromolyn sodium 125<br />
cryselle-28 146<br />
CUBICIN 26<br />
CUPRIC CHLOR 84<br />
cvs 8 hour 60<br />
cvs acne 161<br />
cvs allergy sinus headach 1<br />
cvs allergy 17<br />
cvs anti-itch maximum str 162<br />
CVS BLOOD GLUCOSE STRIPS 80<br />
CVS BLOOD GLUCOSE TEST 80<br />
CVS BLOOD GLUCOSE 178<br />
cvs chest congestion expe 126<br />
cvs chest congestion reli 92<br />
cvs chest rub medicated 174<br />
cvs childrens allergy rel 17<br />
cvs childrens cold plus c 95<br />
cvs childrens cold 10<br />
cvs childrens multi-sympt 105<br />
cvs childrens triacting c 95<br />
cvs childs 60<br />
cvs cold & allergy dm 93<br />
cvs cold & allergy relief 9<br />
cvs cold & cough 95<br />
cvs cold reliever 9<br />
cvs cold/allergy children 10<br />
cvs cold/allergy 9<br />
cvs cold/cough dm childre 95<br />
CVS COMPLETE MONITORING 178<br />
cvs congestion & pain nig 14<br />
cvs cortisone + maximum s 163<br />
cvs cortisone maximum str 163<br />
cvs dayhist 2<br />
cvs daytime cold/flu 95<br />
cvs daytime multi-symptom 95<br />
cvs daytime sinus relief 34<br />
cvs decongestant plus 10<br />
cvs flu & severe cold nig 2<br />
cvs flu/cold/cough medici 100<br />
cvs flu/cold/cough/maximu 100<br />
cvs head congestion cold 95<br />
cvs hot steam 174<br />
cvs hydrocortisone maximu 164<br />
cvs hydrocortisone plus m 164<br />
cvs ibu-profen cold & sin 36<br />
cvs ibuprofen cold childr 36<br />
cvs infants cold 95<br />
cvs infants decongestant 95<br />
cvs infants 60<br />
cvs insulin syringe/0.3ml 180<br />
cvs insulin syringe/0.3ml 181<br />
cvs insulin syringe/0.5ml 183<br />
cvs insulin syringe/0.5ml 184<br />
cvs insulin syringe/1ml/2 186<br />
cvs lancets 21g 178<br />
cvs lancets micro thin 33 178<br />
cvs lancets original 178<br />
cvs lancets thin 26g 178<br />
cvs lancets thin 178<br />
created on 20100520 209
cvs lancets ultra thin 30 178<br />
cvs nasal decongestant an 12<br />
cvs nasal decongestant 12<br />
cvs nasal 138<br />
cvs night time cold & flu 94<br />
cvs night time cold/flu r 106<br />
cvs night time cold/flu 106<br />
cvs night time cough 106<br />
cvs night time formula 106<br />
cvs night time formula 95<br />
cvs night time multi-symp 106<br />
cvs nighttime multi-sympt 106<br />
cvs non-asa 60<br />
cvs non-aspirin allergy 12<br />
cvs non-aspirin child 62<br />
cvs non-aspirin cold mult 107<br />
cvs non-aspirin cold 95<br />
cvs non-aspirin flu medic 107<br />
cvs non-aspirin jr 62<br />
cvs non-aspirin pm extra 76<br />
cvs non-aspirin pm 76<br />
cvs non-aspirin severe co 119<br />
cvs non-drying sinus 126<br />
cvs nose 138<br />
cvs pain relief extra str 60<br />
cvs pain relief pm extra 76<br />
cvs prenatal 170<br />
cvs saline spray 134<br />
cvs severe cold formula 119<br />
cvs sinus & allergy maxim 14<br />
cvs sinus headache decong 36<br />
cvs sinus maximum strengt 36<br />
cvs sinus pain & congesti 14<br />
cvs sinus pain & congesti 34<br />
cvs triacting cough & col 121<br />
cvs triacting cough & sor 121<br />
cvs triacting night time 121<br />
cvs tussin cf 95<br />
CVS TUSSIN CHILD COUGH/CO 123<br />
cvs tussin cold severe co 134<br />
cvs tussin cough/cold cf 95<br />
cvs tussin cough/cold max 95<br />
cvs tussin dm clear 123<br />
cvs tussin dm 123<br />
cvs tussin pe 126<br />
cvs tussin-dm 123<br />
cvs tussin 126<br />
cvs ultra thin lancets 194<br />
cvs vaporizing 175<br />
cvs vit b-6 168<br />
cyanocobalamin 168<br />
cyclobenzapr 38<br />
CYCLOBENZAPRINE HCL 195<br />
CYCLOBENZAPRINE HCL 38<br />
cyclobenzaprine hcl 38<br />
CYCLOGYL 137<br />
cyclopentol 137<br />
CYCLOPENTOLATE HCL 137<br />
cyclopentolate hcl 137<br />
CYCLOPHOSPH 30<br />
cyclophosph 30<br />
CYCLOPHOSPHAMIDE 30<br />
cyclophosphamide 30<br />
cyclosporine modified (for<br />
microemulsion) 173<br />
cyclosporine modified 173<br />
cyclosporine 173<br />
CYKLOKAPRON 42<br />
cylate 137<br />
CYMBALTA 66<br />
cyproheptad 16<br />
cyproheptadine hcl 16<br />
cysteine hcl 87<br />
CYSTO-CONRAY II 82<br />
CYSTOGRAFIN-DILUTE 82<br />
CYSTOGRAFIN 82<br />
CYTARABINE 30<br />
cytarabine 30<br />
CYTOGAM 155<br />
CYTOVENE 29<br />
cytuss hc 95<br />
cytuss-hc nr 95<br />
created on 20100520 210<br />
D<br />
d&k insulin syringe/u-100 180<br />
d&k insulin syringe/u-100 181<br />
d&k insulin syringe/u-100 183<br />
d&k insulin syringe/u-100 184<br />
d&k insulin syringe/u-100 186<br />
d&k insulin syringe/u-100 187<br />
d-amine-sr 10<br />
d-feda ii 126<br />
d-hist d 10<br />
d-methorphan hb/pe/cpm 98<br />
d-phen 1000 126<br />
d-tab 126<br />
D-TANN AT 95<br />
D-TANN CD 95<br />
d-tann ct 95<br />
d-tann dm 95<br />
d-tann hc 95<br />
d-tann 2<br />
DACARBAZINE 30<br />
dacarbazine 30<br />
dacex-a 95<br />
dacex-dm 95<br />
dacex-pe 95<br />
DACOGEN 30<br />
DAILY DIABETIC 178<br />
dailyhist-1 2<br />
DALLERGY PE 10<br />
DALLERGY PSE 10<br />
DALLERGY-JR 10<br />
DALLERGY 10<br />
danazol 146<br />
dandrex 161<br />
dandruff shampoo 161<br />
DANTRIUM IV 38<br />
dantrolene sodium 38<br />
DAPSONE (TOPICAL) 158<br />
DAPTACEL 156<br />
DARAPRIM 29<br />
daunorubicin hcl 30<br />
DAUNOXOME 30<br />
day time multi-symptom co 95<br />
day time 95<br />
day-time cold/flu relief 95<br />
day-time multi-symptom co 95<br />
day-time pe cold/flu reli 95<br />
day-time pe 95<br />
day-time sinus 34<br />
day-time 95<br />
dayhist allergy 12 hour r 2<br />
dayhist-1 2<br />
DAYTIME COLD MEDICINE 95<br />
daytime cold/flu relief 95<br />
daytime cold/flu 95<br />
daytime multi-symptom col 95<br />
daytime non-drowsy cold/f 95<br />
daytime pe multi-symptom 95<br />
daytime 95<br />
DAYTO ANASE 60<br />
DAYTRANA 73<br />
dd lancets 178<br />
dd thin lancets 178
de lancets 178<br />
de thin lancets 178<br />
de-chlor dm 95<br />
de-chlor dr 95<br />
de-chlor g 95<br />
de-chlor hc 95<br />
de-chlor hd 95<br />
de-chlor mr 95<br />
de-chlor nx 95<br />
dec-chlorphen dm 95<br />
dec-chlorphen 10<br />
DECAHIST-DM 95<br />
DECAVAC 156<br />
decon dm 95<br />
DECON-A 10<br />
DECON-G 126<br />
DECONEX DM 95<br />
DECONEX 127<br />
decongest ii 127<br />
decongestant + 10<br />
DECONGESTANT D COUGH 95<br />
decongestant d 96<br />
decongestant inh nasal 174<br />
decongestant inh 174<br />
decongestant plus 10<br />
decongestant rub 174<br />
decongestant vapor inhale 174<br />
decongestant/antihistamin 10<br />
decongestant 10<br />
decongestant 138<br />
decongestine tr 10<br />
DECONSAL CT 10<br />
DECONSAL DM 96<br />
deconsal ii 127<br />
decorel forte plus severe 96<br />
DECOREL FORTE 127<br />
deferoxamine mesylate 144<br />
dehistine 10<br />
DEKA PEDIATRIC 96<br />
DEKA 96<br />
del-aqua 161<br />
del-beta 163<br />
DELSYM 96<br />
DELTUSS DMX 96<br />
DEMADEX 87<br />
DEMEROL 54<br />
denaze 10<br />
DEPO-ESTRADI 147<br />
DEPO-MEDROL 144<br />
DEPO-PROVERA 151<br />
DEPO-SQ PROV 151<br />
DEPOCYT 30<br />
DERMTEX HC 163<br />
desipramine hcl 68<br />
desipramine 68<br />
DESLORATADINE-PSEUDOEPHEDRINE<br />
17<br />
desmopressin acetate refrigerated 150<br />
desmopressin acetate spray<br />
refrigerated 150<br />
desmopressin acetate spray 150<br />
desmopressin acetate 150<br />
desmopressin 150<br />
desogestrel & ethinyl estradiol 146<br />
desonide 163<br />
desoximetas 163<br />
desoximetasone 163<br />
DESPEC DM 96<br />
DESPEC DROPS 96<br />
DESPEC NR 96<br />
DESPEC SR 127<br />
DESPEC-DM 96<br />
DESPEC-EXP 96<br />
despec-pd 96<br />
despec-tab 127<br />
despec 127<br />
DESPEC 96<br />
desquam-e 161<br />
DESQUAM-X 161<br />
detuss 96<br />
dex pc 96<br />
dex-tuss dm 96<br />
dex-tuss 96<br />
dexa 136<br />
DEXALL 96<br />
DEXALONE 96<br />
dexameth pho 136<br />
dexamethason 144<br />
dexamethasone sodium phosphate<br />
(ophth) 136<br />
dexamethasone sodium phosphate 144<br />
dexamethasone 144<br />
DEXAMETHASONE 145<br />
dexamethasone 145<br />
dexaphen sa 10<br />
dexasporin 136<br />
dexatrex d nasal 96<br />
DEXBROMPHEN-PSEUDOEPHED<br />
W/APAP 10<br />
dexbromphen-pseudoephed w/apap 10<br />
DEXBROMPHENIRAMINE &<br />
PSEUDOEPHEDRINE 10<br />
dexbrompheniramine &<br />
pseudoephedrine 10<br />
DEXBROMPHENIRAMINE TAN-<br />
PYRILAMINE MAL-PHENYLEPHRINE<br />
TAN 10<br />
DEXBROMPHENIRAMINE-<br />
PHENYLEPHRINE-ACETAMINOPHEN 10<br />
DEXBROMPHENIRAMINE-<br />
PHENYLEPHRINE 10<br />
DEXCHLORPHENIRAMINE &<br />
PSEUDOEPHEDRINE 10<br />
DEXCHLORPHENIRAMINE TAN-<br />
PYRILAMINE TAN-PSEUDOEPHEDRINE<br />
TAN 10<br />
DEXCHLORPHENIRAMINE TANNATE &<br />
PSEUDOEPHEDRINE TANNATE 10<br />
DEXCHLORPHENIRAMINE-<br />
PHENYLEPHRINE-<br />
METHSCOPOLAMINE 10<br />
dexchlorpheniramine-phenylephrinemethscopolamine<br />
10<br />
DEXCHLORPHENIRAMINE-<br />
PHENYLEPHRINE 10<br />
DEXCHLORPHENIRAMINE-<br />
PSEUDOEPHEDRINE-ACETAMINOPHEN<br />
10<br />
dexchlorpheniraminepseudoephedrine-methscopolamine<br />
10<br />
dexcon-dm 96<br />
dexcon-pe 96<br />
DEXPAK 10 DAY 145<br />
DEXPAK 13 DAY 145<br />
DEXPANTHENOL 168<br />
dexpanthenol 168<br />
dexphen m 10<br />
dextran 40 in d5w 84<br />
dextran 40 in saline 84<br />
dextran 70 in saline 84<br />
DEXTRAN 70 84<br />
DEXTRAN HM 84<br />
dextroamphet 72<br />
created on 20100520 211
dextroamphetamine sulfate 72<br />
DEXTROMETHORPHAN HBR MONO 195<br />
DEXTROMETHORPHAN HBR-<br />
GUAIFENESIN TANNATE 96<br />
dextromethorphan hbr/chlo 98<br />
dextromethorphan hbr/phen 98<br />
dextromethorphan hbr/pseu 98<br />
DEXTROMETHORPHAN HBR 195<br />
DEXTROMETHORPHAN HBR 96<br />
dextromethorphan hbr 96<br />
DEXTROMETHORPHAN POLISTIREX 96<br />
dextromethorphan tan/phen 98<br />
DEXTROMETHORPHAN TANNATE 96<br />
DEXTROMETHORPHAN-<br />
ACETAMINOPHEN-<br />
CHLORPHENIRAMINE 96<br />
dextromethorphan-acetaminophenchlorpheniramine<br />
96<br />
DEXTROMETHORPHAN-<br />
CHLORPHENIRAMINE-<br />
METHSCOPOLAMINE 96<br />
DEXTROMETHORPHAN-<br />
DIPHENHYDRAMINE-<br />
ACETAMINOPHEN 96<br />
DEXTROMETHORPHAN-DOXYLAMINE<br />
-ACETAMINOPHEN 96<br />
dextromethorphan-doxylamineacetaminophen<br />
96<br />
DEXTROMETHORPHAN-DOXYLAMINE<br />
-ACETAMINOPHEN 98<br />
dextromethorphan-gg-pot citratecitric<br />
acid 98<br />
DEXTROMETHORPHAN-GG-<br />
POTASSIUM CITRATE 96<br />
DEXTROMETHORPHAN-GG-SODIUM<br />
CITRATE 98<br />
DEXTROMETHORPHAN-GUAIFENESIN<br />
96<br />
dextromethorphan-guaifenesin 96<br />
DEXTROMETHORPHAN-GUAIFENESIN<br />
97<br />
dextromethorphan-guaifenesin 97<br />
DEXTROMETHORPHAN-<br />
PHENYLEPHRINE-ACETAMINOPHEN 97<br />
dextromethorphan-phenylephrineacetaminophen<br />
97<br />
DEXTROMETHORPHAN-POTASSIUM<br />
GUAIACOLSULFONATE 97<br />
dextromethorphan-potassium<br />
guaiacolsulfonate 97<br />
DEXTROMETHORPHAN-POTASSIUM<br />
GUAIACOLSULFONATE 98<br />
DEXTROMETHORPHAN/CHLORPHE 105<br />
dextromethorphan/chlorphe 98<br />
dextromethorphan/guaifene 98<br />
dextromethorphan/phenylep 98<br />
DEXTROMETHORPHAN/PSEUDOEP 98<br />
dextromethorphan/pseudoep 98<br />
DEXTROSE 10%/NACL 0.45% 84<br />
DEXTROSE 5% 84<br />
DEXTROSE 10%/NACL 0.225% 84<br />
DEXTROSE 5%/NACL 0.225% 84<br />
DEXTROSE 5%/NACL 0.3% 84<br />
DEXTROSE 5%/POTASSIUM CHL 85<br />
dextrose in lactated ringers 84<br />
dextrose in ringers 84<br />
dextrose w/ sodium chloride 84<br />
DEXTROSE 87<br />
dextrose 87<br />
dextrostat 72<br />
di bromm cold/allergy 10<br />
DIABETA 149<br />
diabetic siltussin-dm max 119<br />
diabetic siltussin-dm 119<br />
diabetic sterile lancets 178<br />
DIABETIC TUS 127<br />
diabetic tus 127<br />
DIABETIC TUSSIN C 97<br />
DIABETIC TUSSIN COLD & FL 97<br />
DIABETIC TUSSIN COLD/FLU 97<br />
diabetic tussin dm 97<br />
diabetic tussin for child 97<br />
diabetic tussin maximum s 97<br />
diabetic tussin maximum 97<br />
DIABETIC TUSSIN NIGHT TIM 97<br />
DIABETIC.COM STARTER KIT 178<br />
DIABETIC.COM TEST STRIPS 80<br />
diabtc tussn 127<br />
diacetazone 77<br />
DIAGNOSTIC KIT 79<br />
DIAPHRAGM ARC-SPRING 78<br />
DIAPHRAGM COIL SPRING 78<br />
DIAPHRAGM FLAT SPRING 78<br />
DIAPHRAGMS 78<br />
diatrizoate meglumine & sodium 82<br />
DIAZEPAM 74<br />
diazepam 74<br />
DICEL DM 97<br />
DICEL 10<br />
diclofenac sodium (ophth) 137<br />
DICLOFENAC SODIUM 52<br />
diclofenac sodium 52<br />
diclofenac 137<br />
DICLOFENAC 52<br />
diclofenac 52<br />
dicloxacill 24<br />
dicloxacillin sodium 24<br />
dicyclomine hcl 33<br />
dicyclomine 33<br />
DIDGET 178<br />
diflorasone diacetate 163<br />
diflorasone 163<br />
DIGIBIND 155<br />
DIGIFAB 155<br />
DIGOXIN 44<br />
digoxin 44<br />
dihistine dh 97<br />
DIHYDRO-CP 97<br />
dihydro-gp 97<br />
dihydro-pe 98<br />
DIHYDROCODEINE-GUAIFENESIN 98<br />
dihydrocodeine/bpm/phenyl 98<br />
DILANTIN-125 64<br />
DILANTIN 64<br />
DILATRATE SR 45<br />
DILAUDID-HP 54<br />
dilotab 36<br />
dilt-cd 48<br />
dilt-xr 48<br />
diltiazem cd 48<br />
DILTIAZEM HCL COATED BEADS 48<br />
diltiazem hcl coated beads 48<br />
diltiazem hcl extended release beads<br />
48<br />
diltiazem hcl 48<br />
DILTIAZEM 48<br />
diltiazem 48<br />
diltzac 48<br />
dimaphen childrens 10<br />
dimaphen dm cold/cough ch 98<br />
dimaphen dm 98<br />
dimaphen 10<br />
DIMENHYDRIN 142<br />
DIMETAPP COLD & CONGESTI 98<br />
created on 20100520 212
DIMETAPP COLD & ALLERGY 10<br />
DIMETAPP COLD & FEVER 10<br />
dimetapp cold & fever 36<br />
DIMETAPP DECONGESTANT PLU 98<br />
DIMETAPP LONG ACTING COUG 98<br />
dimetapp nd 17<br />
dimetapp nighttime cold & 2<br />
dimetapp nighttime flu 98<br />
DIOVAN HCT 50<br />
DIOVAN 50<br />
DIPHEN TANN 25/PE TANN 10 98<br />
diphenatol 140<br />
diphenhydram 2<br />
DIPHENHYDRAMINE & PSEUDOEPHED<br />
2<br />
diphenhydramine & pseudoephed 2<br />
DIPHENHYDRAMINE CITRATE-<br />
PSEUDOEPHEDRINE 2<br />
DIPHENHYDRAMINE HCL-<br />
PHENYLEPHRINE HCL TANNATE 2<br />
diphenhydramine hcl 2<br />
DIPHENHYDRAMINE TANNATE-<br />
CARBETAPENTANE TANNATE 98<br />
DIPHENHYDRAMINE TANNATE-<br />
PHENYLEPHRINE TANNATE 2<br />
diphenhydramine tannatephenylephrine<br />
tannate 2<br />
diphenhydramine w/ apap (sleep) 75<br />
DIPHENHYDRAMINE W/ APAP 2<br />
diphenhydramine w/ apap 2<br />
diphenhydramine-phenylephrineacetaminophen<br />
2<br />
DIPHENHYDRAMINE-PHENYLEPHRINE<br />
2<br />
diphenhydramine-phenylephrine 2<br />
DIPHENHYDRAMINE-PSE W/ APAP 2<br />
diphenhydramine-pse w/ apap 2<br />
DIPHENHYDRAMINE-PSE W/ APAP 3<br />
DIPHENMAX D 2<br />
diphenoxylate w/ atropine 140<br />
diphenoxylate/atropine 140<br />
diphentann-d 2<br />
DIPHTHERIA/TETANUS TOXOID 156<br />
DIPIVEFRIN HCL 138<br />
dipivefrin hcl 138<br />
dipivefrin 138<br />
dipyridamole (diagnostic) 45<br />
DISCOUNT DRUG MART TEST S 80<br />
DISCOUNT DRUG MART VALUE 177<br />
DISCOVISC 140<br />
DISCUS COMPOSITUM 174<br />
disophrol 10<br />
ditussin hc 98<br />
divalproex sodium 65<br />
divalproex 65<br />
dixaphedrine 10<br />
DM TANN/PE TANN/BROM TANN 98<br />
dm-pe-chlor 98<br />
dm-pot guaiacolsulfonate 98<br />
dm/guai 98<br />
DMAX PEDIATRIC 98<br />
DMAX 98<br />
dobutamine hcl 35<br />
dobutamine in d5w 35<br />
dolacet 54<br />
dolagesic 54<br />
dolorex forte 54<br />
dolorex 60<br />
dolotic 137<br />
dometuss cough/cold 98<br />
dometuss dm 98<br />
DONATUSS DC 98<br />
DONATUSS XP 98<br />
donatussin dc 98<br />
DONATUSSIN DM 98<br />
DONATUSSIN MAX 98<br />
donatussin 127<br />
donnaphen 33<br />
dopamine hcl 35<br />
dopamine in d5w 35<br />
DOPAMINE 35<br />
DORIBAX 20<br />
DORYX 25<br />
dorzolamide hcl 139<br />
dorzolamide 139<br />
DOVONEX 167<br />
doxapram hcl 73<br />
doxazosin mesylate 45<br />
doxazosin mesylate 46<br />
doxazosin 45<br />
DOXEPIN HCL 68<br />
doxepin hcl 68<br />
DOXIL 30<br />
doxorubicin hcl 30<br />
doxy-caps 25<br />
doxycyc mono 25<br />
DOXYCYCL HYC CAP 25<br />
doxycycl hyc 25<br />
DOXYCYCLINE (MONOHYDRATE) 25<br />
doxycycline (monohydrate) 25<br />
DOXYCYCLINE CALCIUM 25<br />
DOXYCYCLINE HYCLATE 25<br />
doxycycline hyclate 25<br />
doxycycline 25<br />
doxylamine-dm 98<br />
doxylamine-phenylephrineacetaminophen<br />
2<br />
doxylamine-pseudoephedrine-apap 2<br />
DOXYLAMINE-PSEUDOEPHEDRINE-<br />
APAP 3<br />
dr lancets 178<br />
dr thin lancets 178<br />
drihist sr 10<br />
DRINEX 10<br />
drinex 10<br />
dristan cold non-drowsy 36<br />
dristan cold 10<br />
dristan sinus 36<br />
DRITHO-CREME HP 167<br />
DRITHO-SCALP 167<br />
drituss dm 98<br />
drituss hd 98<br />
drixomed 11<br />
DRIXORAL ALLERGY SINUS 11<br />
DRIXORAL COLD/FLU 11<br />
DRIXORAL COUGH & SORE THR 98<br />
DROCON-CS 98<br />
droperidol 75<br />
DROSPIRENONE-ETHINYL ESTRADIOL<br />
146<br />
drospirenone-ethinyl estradiol 146<br />
drotuss-cp 98<br />
drotuss 98<br />
DRUG EMP STARTER KIT 178<br />
DRUG EMPORIUM TEST STRIPS 80<br />
drug mart lancets thin 190<br />
drug mart lancets ultra t 190<br />
drug mart ultra comfort i 180<br />
drug mart ultra comfort i 181<br />
drug mart ultra comfort i 182<br />
drug mart ultra comfort i 184<br />
drug mart ultra comfort i 186<br />
drug mart ultra comfort i 187<br />
DRYMAX 11<br />
created on 20100520 213
dryphen 11<br />
drysec 11<br />
DTP ADSORBED 156<br />
duane reade lancet altern 189<br />
duane reade lancet super 189<br />
duane reade lancet ultra 189<br />
DUANE READE STARTER KIT 178<br />
DUANE READE TEST STRIPS 80<br />
DUANE READE UNIFINE PENTI 194<br />
DUO-CARE TEST STRIPS 80<br />
DUOCAINE 154<br />
DUOHIST DH 98<br />
duomax 127<br />
DUOTAN PD 11<br />
DUOVISC 140<br />
dur-tann dm 98<br />
dur-tann forte 98<br />
DURACLON 44<br />
DURADEX FORTE 98<br />
duradrin 77<br />
duradryl sr 11<br />
duradryl 11<br />
DURAMAX 98<br />
DURASAFE SPINAL/EPIDURAL 155<br />
duratan pe 11<br />
DURATUSS A 127<br />
DURATUSS AC 12 98<br />
DURATUSS CS 98<br />
duratuss da 11<br />
DURATUSS DM 12 98<br />
DURATUSS PE 127<br />
duravent-da 11<br />
duravent-dpb 98<br />
duravent 11<br />
DURAXIN 60<br />
duraxin 60<br />
DUREZOL 136<br />
DYGASE 141<br />
DYNACIRC CR 47<br />
DYNAHIST ER 11<br />
dynatuss ex 98<br />
dynatuss hc 98<br />
dynatuss 98<br />
DYNEX 12 98<br />
DYNEX VR 98<br />
DYNEX 127<br />
DYSPORT 174<br />
DYTAN-CS 98<br />
DYTAN-HC 98<br />
E<br />
e-z ject blood lancets 178<br />
e-z ject lancets color 178<br />
e-z ject lancets super th 178<br />
e-z ject lancets thin 178<br />
e-z ject lancets 178<br />
e-z ject thin 178<br />
e-z ject xl blood lancets 178<br />
E-Z SPACER MASK 178<br />
E-Z SPACER/MASK 178<br />
E-Z SPACER 178<br />
E.E.S. GRAN 20<br />
e.e.s. 20<br />
e.s.p. 20<br />
ear drops 137<br />
EASIVENT/MASK-LARGE 178<br />
EASIVENT/MASK-MEDIUM 178<br />
EASIVENT/MASK-SMALL 178<br />
EASIVENT 178<br />
EASY CHECK BLOOD GLUCOSE 178<br />
EASY CHECK GLUCOSE TEST S 80<br />
easy comfort insulin syri 181<br />
easy comfort insulin syri 184<br />
easy comfort insulin syri 187<br />
EASY STEP BLOOD GLUCOSE M 178<br />
EASY STEP TEST STRIPS 80<br />
easy touch insulin syring 181<br />
easy touch insulin syring 182<br />
easy touch insulin syring 183<br />
easy touch insulin syring 184<br />
easy touch insulin syring 185<br />
easy touch insulin syring 186<br />
easy touch insulin syring 187<br />
easy touch insulin syring 188<br />
easy touch lancets 178<br />
EASY TOUCH PEN NEEDLES 29 178<br />
EASY TOUCH PEN NEEDLES 31 179<br />
EASY TOUCH PEN NEEDLES/31 179<br />
easy twist & cap lancets 190<br />
EASYGLUCO VALUE PACK 179<br />
EASYGLUCO 179<br />
EASYGLUCO 80<br />
EASYMAX N BLOOD GLUCOSE S 179<br />
EASYMAX TEST STRIPS 80<br />
EASYMAX V BLOOD GLUCOSE S 179<br />
EASYPRO BLOOD GLUCOSE MON 179<br />
EASYPRO BLOOD GLUCOSE TES 80<br />
EASYPRO PLUS 179<br />
EASYPRO PLUS 80<br />
easytest ii lancets 179<br />
easytest lancets 179<br />
ECK A-PHEDRIN 4<br />
eck acetamin 60<br />
ECK BLOOD GLUCOSE MONITOR 177<br />
ECK BLOOD GLUCOSE TEST ST 80<br />
eck bromtapp cold/allergy 6<br />
eck bromtapp dm 98<br />
eck child cold 92<br />
eck child na flu 98<br />
eck childrens non-aspirin 60<br />
eck flu non-drowsy 100<br />
eck ibuprofe 52<br />
eck ibuprofen cold/sinus 36<br />
eck infant cold 36<br />
eck insulin syringe/0.3ml 181<br />
eck insulin syringe/0.5ml 183<br />
eck insulin syringe/0.5ml 184<br />
eck insulin syringe/1ml/2 186<br />
eck insulin syringe/1ml/3 187<br />
eck loratadine disintegra 17<br />
eck loratadine 17<br />
eck max n-d cold/flu 98<br />
eck night time 106<br />
eck nighttime cold & coug 106<br />
eck nighttime cold formul 106<br />
eck non-asa 60<br />
eck non-aspirin allergy s 11<br />
eck non-aspirin allergy s 5<br />
eck non-aspirin pain reli 76<br />
eck non-aspirin severe co 98<br />
eck non-aspirin sinus max 37<br />
eck non-aspirin sinus rel 37<br />
eck pediatric cough/cold 108<br />
eck pms pain relief multi 60<br />
eck prenatal 170<br />
eck severe cold 119<br />
eck sinus headache maximu 36<br />
eck sinus 11<br />
eck su-phedrin maximum st 37<br />
eck su-phedrin multi-symp 120<br />
eck suphedrine cold/aller 15<br />
eck supherine non-dry 133<br />
eck thin lancets 179<br />
eck tri acting chest cong 133<br />
eck tri acting cold & all 15<br />
created on 20100520 214
eck tri acting sore throa 121<br />
eck tussin cf 99<br />
eck tussin cold/cough 98<br />
eck tussin dm 123<br />
eck tussin pe 127<br />
eck tussin pediatric coug 123<br />
eck tussin severe congest 127<br />
ECLIPSE BLOOD GLUCOSE MON 179<br />
ECLIPSE TEST STRIPS 80<br />
ED A-HIST 11<br />
ed a-hist 11<br />
ED CHLORPED D 11<br />
ED DM 99<br />
ed k+ 84<br />
ed-a-hist dm 99<br />
ed-apap 60<br />
ed-flex 60<br />
ed-tlc 99<br />
ed-tuss hc 99<br />
edetate disodium 144<br />
EDEX 45<br />
edrophonium chloride 82<br />
effervescent plus cold 11<br />
effervescent pot chloride 85<br />
effervescent potassium/ch 85<br />
EFFEXOR XR 66<br />
ELAPRASE 88<br />
ELECTROLYTE-48 84<br />
electrolyte-75 in dextrose 84<br />
electrolyte-m in dextrose 84<br />
electrolyte-r in dextrose 84<br />
electrolyte-r 84<br />
ELEMENT AUTOCODE SYSTEM 179<br />
ELEMENT TEST STRIPS 80<br />
ELETRIPTAN HYDROBROMIDE 76<br />
ELETRIPTAN HYDROBROMIDE 77<br />
ELIDEL 167<br />
ELIGARD 30<br />
ELIPHOS 84<br />
ELITE-THIN INSULIN SYRING 182<br />
elite-thin insulin syring 182<br />
elite-thin insulin syring 183<br />
elite-thin insulin syring 184<br />
elite-thin insulin syring 185<br />
elite-thin insulin syring 186<br />
elite-thin insulin syring 187<br />
elite-thin insulin syring 188<br />
ELITEK 88<br />
ELIXOPHYLLIN 167<br />
ELIXSURE COUGH 99<br />
ELIXSURE FEVER/PAIN 60<br />
ELLIOTTS B 84<br />
ELOXATIN 30<br />
ELSPAR 30<br />
EMBRACE BLOOD GLUCOSE MON 179<br />
EMBRACE BLOOD GLUCOSE TES 80<br />
emcin clear 158<br />
EMEND 142<br />
enalapril maleate 49<br />
enalaprilat 49<br />
ENBREL SRCLK 173<br />
ENBREL 173<br />
endacof-ac 99<br />
endacof-c 99<br />
endacof-dc 99<br />
endacof-dh 99<br />
endacof-dm 99<br />
endacof-hc 99<br />
endacof-pd 99<br />
endacof-plus 99<br />
endacof-tab 99<br />
endacof-xp 99<br />
endacon-dm 99<br />
ENDACON 99<br />
ENDAL CD 99<br />
endocet 54<br />
endodan 54<br />
ENDRATE 144<br />
ENFALYTE 84<br />
ENGERIX-B 156<br />
ENGYSTOL 174<br />
ENLON-PLUS 33<br />
ENLON 82<br />
enpresse-28 146<br />
ENTEX ER 127<br />
ENTEX HC 99<br />
entex la 127<br />
entex pse 127<br />
entre-b 11<br />
entre-s 99<br />
enulose 83<br />
ENVISION AUTOCODE TEST ST 80<br />
ENVISION AUTOCODE 179<br />
ENZYCAP 141<br />
ENZYMAX 141<br />
ephedrine sulfate (pressors) 36<br />
EPHEDRINE W/ ASPIRIN-CAFFEINE-<br />
ACETANILID 36<br />
EPHEDRINE-GUAIFENESIN 127<br />
ephedrine-guaifenesin 127<br />
ephrine nose 138<br />
epidrin 77<br />
EPIFOAM 163<br />
epinephrine hcl 36<br />
EPINEPHRINE 36<br />
EPIPEN 2-PAK 36<br />
EPIPEN-JR 2-PAK 36<br />
EPIPEN-JR 36<br />
EPIPEN 36<br />
epirubicin hcl 31<br />
EPIRUBICIN 30<br />
epitol 65<br />
EPIVIR HBV 28<br />
EPIVIR 28<br />
EPOGEN 42<br />
epoprostenol sodium 45<br />
eq allergy sinus maximum 11<br />
eq allergy/sinus headache 1<br />
eq allergy/sinus 1<br />
eq antihistabs 5<br />
eq arthritis 60<br />
eq childrens cold 11<br />
EQ COLD PLUS COUGH CHILDR 99<br />
eq cold plus cough childr 99<br />
eq cold plus 11<br />
eq cold relief complete 93<br />
eq cold relief convenienc 99<br />
eq cold relief 99<br />
eq cold/allergy childrens 9<br />
eq cold/cough dm 94<br />
EQ COLD/COUGH PLUS 94<br />
eq dayhist 2<br />
eq daytime cold/flu relie 99<br />
eq effervescent cold plus 11<br />
eq flu relief 100<br />
eq flu/severe cold/conges 99<br />
eq heartburn relief 142<br />
eq ibuprofen cold childre 36<br />
eq ibuprofen cold/sinus 36<br />
eq infants cold plus coug 99<br />
eq medicated chest rub 174<br />
eq night time cough 106<br />
eq nite time cold/flu rel 99<br />
eq non-drying sinus 127<br />
created on 20100520 215
eq nose drops extra stren 138<br />
eq pain reliever junior 62<br />
eq pain reliever pm 76<br />
eq sinus maximum strength 37<br />
eq sinus relief maximum s 36<br />
eq triacting cold/allergy 11<br />
eq triacting cold/cough 99<br />
eq triacting cough/sore t 99<br />
eq triacting night time 99<br />
eq tussin cf 99<br />
eq tussin cold/congestion 99<br />
eq tussin dm 99<br />
eq tussin 127<br />
eql acetamin 60<br />
eql acetamin 61<br />
eql all day allergy 17<br />
eql allergy/sinus headach 1<br />
eql arthrits 61<br />
eql childrens pain relief 7<br />
eql cold & allergy 9<br />
eql cold & cough 99<br />
eql cold/allergy children 9<br />
eql color lancets 21g 179<br />
eql cough/cold/flu relief 92<br />
eql dayhist 2<br />
eql daytime cold/flu reli 99<br />
eql daytime multi-symptom 99<br />
eql effervescent plus col 11<br />
eql flu/cold/cough night 99<br />
EQL FLU/SEVERE COLD/CONGE 99<br />
eql flu/severe cold/conge 99<br />
eql headache pm 75<br />
eql ibuprofen cold childr 36<br />
eql ibuprofen cold/sinus 36<br />
eql infant 61<br />
EQL INFANTS DECONGESTANT/ 99<br />
eql infants pain relief p 99<br />
eql insulin syringe/0.3ml 181<br />
eql insulin syringe/0.3ml 182<br />
eql insulin syringe/0.5ml 183<br />
eql insulin syringe/0.5ml 184<br />
eql insulin syringe/0.5ml 185<br />
eql insulin syringe/1ml/2 186<br />
eql insulin syringe/1ml/3 187<br />
eql insulin syringe/1ml/3 188<br />
eql insulin syringe/u-100 181<br />
eql insulin syringe/u-100 183<br />
eql insulin syringe/u-100 184<br />
eql insulin syringe/u-100 186<br />
eql insulin syringe/u-100 187<br />
eql multi-symptom nightti 99<br />
eql night time cold/flu r 106<br />
eql night time cough 106<br />
eql nighttime cold/flu re 106<br />
eql non-drying sinus 127<br />
eql pain relief allergy m 11<br />
eql pain relief chest con 127<br />
eql pain relief plus cold 107<br />
eql pain relief plus flu 99<br />
eql pain relief pm 76<br />
eql pain relief/allergy s 12<br />
eql pain relief/cold 107<br />
eql pain relief/sinus 37<br />
eql prenatal formula 170<br />
eql severe cold/flu 99<br />
eql severe cold 119<br />
EQL SHORT PEN NEEDLES 31G 192<br />
eql sinus congestion & pa 34<br />
eql sinus headache maximu 36<br />
eql sinus/allergy 11<br />
eql super thin lancets 30 179<br />
eql thin lancets 26g 179<br />
eql triacting chest/nasal 126<br />
eql triacting cold/allerg 11<br />
eql triacting cold/cough/ 121<br />
eql triacting cold/cough 99<br />
eql triacting cold/night 121<br />
eql tussin cf cough/cold/ 99<br />
eql tussin cough/chest co 123<br />
eql tussin cough/cold max 99<br />
eql tussin dm cough/chest 99<br />
eql tussin ped cough/cold 99<br />
eql tussin 127<br />
eql tussin 99<br />
EQL ULTRA SHORT PEN NEEDL 191<br />
equate regular lancets 179<br />
equate thin lancets 179<br />
ERAXIS 27<br />
ERBITUX 31<br />
ergocalciferol 169<br />
ergotamine tartrate/caffe 77<br />
ERGOTAMINE W/ CAFFEINE 77<br />
ergotamine w/ caffeine 77<br />
ERGOTRATE 155<br />
errin 146<br />
ERY-TAB 20<br />
ery-tab 20<br />
ERY-TAB 21<br />
ery-tab 21<br />
ery 158<br />
eryderm 158<br />
ERYPED 21<br />
ERYTHROCIN 21<br />
erythrocin 21<br />
erythrom eth 21<br />
ERYTHROM ST 21<br />
erythrom st 21<br />
erythromycin (acne aid) 158<br />
erythromycin (ophth) 135<br />
ERYTHROMYCIN BASE 21<br />
erythromycin base 21<br />
ERYTHROMYCIN ETHYLSUCCINATE<br />
21<br />
erythromycin ethylsuccinate 21<br />
ERYTHROMYCIN STEARATE 21<br />
erythromycin stearate 21<br />
erythromycin-sulfisoxazole 21<br />
erythromycin/benzoyl pero 158<br />
erythromycin/sulfisoxazol 20<br />
erythromycin 135<br />
erythromycin 158<br />
ERYTHROMYCIN 21<br />
erythromycin 21<br />
ESCITALOPRAM OXALATE 67<br />
esmolol hcl 46<br />
estazolam 74<br />
estradiol valerate 147<br />
ESTRADIOL 147<br />
ethambutol hcl 27<br />
ethambutol 27<br />
ETHAMOLIN 45<br />
ethexderm bpw-10 161<br />
ethexderm bpw-5 161<br />
ETHIODOL 82<br />
ethosuximide 65<br />
etodolac er 52<br />
etodolac 51<br />
etodolac 52<br />
etomidate 51<br />
ETONOGESTREL-ETHINYL ESTRADIOL<br />
146<br />
ETOPOPHOS 31<br />
ETOPOSIDE 31<br />
etoposide 31<br />
created on 20100520 216
EUCALYPTOL 127<br />
EUFLEXXA 174<br />
EVENCARE + BLOOD GLUCOSE 80<br />
EVENCARE BLOOD GLUCOSE MO 179<br />
EVENCARE BLOOD GLUCOSE TE 80<br />
EVOLUTION AUTOCODE 179<br />
EVOLUTION AUTOCODE 80<br />
ex str apap 75<br />
ex-dec-tr 2<br />
EXACTECH R-S-G TEST STRIP 80<br />
EXACTECH TEST STRIPS 80<br />
EXALL-D 99<br />
EXALL 99<br />
EXCEDRIN MIGRAINE 51<br />
EXCEL G TEST STRIPS 80<br />
excof-sf 99<br />
excof 99<br />
execlear-c 99<br />
execlear-dm 99<br />
execlear 99<br />
execof-xp 99<br />
execof 99<br />
exefen dmx 99<br />
exefen-dm 99<br />
exefen-dmx 99<br />
exefen-ir 127<br />
exefen-pd 127<br />
exefen 127<br />
EXEL INSULIN PEN NEEDLES 180<br />
EXEL INSULIN PEN NEEDLES 191<br />
exel insulin syringe/0.3m 181<br />
exel insulin syringe/0.5m 182<br />
exel insulin syringe/0.5m 183<br />
exel insulin syringe/0.5m 184<br />
exel insulin syringe/1ml/ 186<br />
exel insulin syringe/1ml/ 187<br />
exetuss-dm 99<br />
exetuss-gp 127<br />
exetuss-hc 99<br />
exetuss 127<br />
exp cough ct 127<br />
EXPECTUSS 100<br />
EXPRESS MED STARTER KIT 179<br />
EXPRESS MED TEST STRIP PA 80<br />
exratuss 100<br />
EXTAVIA 172<br />
extendryl g 127<br />
extendryl gcp 100<br />
EXTENDRYL HC 100<br />
EXTENDRYL PEM 34<br />
extendryl pse 36<br />
EXTENDRYL SR 11<br />
extendryl sr 11<br />
EXTENDRYL 11<br />
extra strength pain relie 61<br />
extuss la 100<br />
extussive 100<br />
EXUBERA COMBINATION PACK 148<br />
EXUBERA KIT 148<br />
EXUBERA PATIENT PACK 148<br />
ez smart blood glucose la 179<br />
EZ SMART BLOOD GLUCOSE TE 80<br />
EZ SMART DIABETES MONITOR 179<br />
EZ SMART PLUS BLOOD GLUCO 80<br />
EZ SMART PLUS DIABETES MO 179<br />
ez-lets lancets 21g 179<br />
ez-lets lancets 23g 179<br />
ez-lets lancets 26g 179<br />
ez-lets lancets 28g 179<br />
ez-lets lancets 179<br />
F<br />
FABRAZYME 88<br />
FACTREL 82<br />
famotidine in nacl 142<br />
famotidine 142<br />
farbital 51<br />
FASLODEX 31<br />
FASTTAKE COMPACT MONITORI 179<br />
FASTTAKE TEST STRIPS 80<br />
fat emulsion 87<br />
FATHER JOHNS MEDICINE PLU 100<br />
father johns 100<br />
FAZACLO 69<br />
FAZACLO 70<br />
FEBROL 61<br />
FEEDING TUBES - SETS 176<br />
FEEDING TUBES - TUBING 176<br />
FEIBA NF 42<br />
FEIBA VH IMMUNO 42<br />
felodipine 47<br />
FEMCAP 78<br />
FENESIN DM IR 100<br />
fenesin ir 127<br />
fenesin pe ir 127<br />
fenoldopam mesylate 45<br />
FENTANYL CITRATE/ROPIVAC 54<br />
FENTANYL CITRATE/ROPIVACA 54<br />
fentanyl citrate 54<br />
FENTANYL/BUPIVACAINE/NS 54<br />
FENTANYL/NS 54<br />
feogen 39<br />
FERAHEME 39<br />
FERIDEX I.V. 82<br />
ferocon 39<br />
ferotrin 39<br />
ferotrinsic 39<br />
ferragen 39<br />
ferrex 150 forte 39<br />
FERRLECIT 39<br />
ferrous fumarate w/ b12-vit c-fa-ifc 39<br />
FETRIN 39<br />
FEVERALL INF 61<br />
FEVERALL SPRINKLE CAPS CH 61<br />
FEVERALL SPRINKLE CAPS JU 61<br />
feverall 61<br />
FEXMID 38<br />
fexofenadine hcl 17<br />
FEXOFENADINE-PSEUDOEPHEDRINE<br />
17<br />
fexofenadine-pseudoephedrine 17<br />
fexofenadine/pseudoephedr 17<br />
fexofenadine 17<br />
FIFTY50 GLUCOSE METER 2.0 179<br />
FIFTY50 GLUCOSE TEST STRI 80<br />
fifty50 safety seal lance 179<br />
fingerstix lancets 179<br />
FIRMAGON 31<br />
first choice ins syringe/ 182<br />
first choice insulin syri 180<br />
first choice insulin syri 183<br />
first choice insulin syri 184<br />
first choice insulin syri 186<br />
first choice insulin syri 187<br />
first choice lancets colo 179<br />
first choice lancets thin 179<br />
FLEBOGAMMA DIF 155<br />
FLEBOGAMMA 155<br />
FLECAINIDE ACETATE 44<br />
FLECAINIDE 44<br />
FLEXIFLO LAP J LAPAROSCOP 179<br />
FLEXIFLO OVER-THE-GUIDEWI 179<br />
FLEXTRA 2<br />
FLOVENT HFA 145<br />
floxuridine 31<br />
created on 20100520 217
flu bp maximum strength 100<br />
flu cold & cough medicine 100<br />
FLU FORMULA 100<br />
flu relief therapy daytim 100<br />
flu relief therapy nightt 2<br />
flu,cold & cough 100<br />
FLU/COLD MEDICINE 11<br />
flu/cold/cough medicine m 100<br />
flu/cold/cough medicine 100<br />
flu/cough/cold maximum st 100<br />
flu/cough/cold nite 100<br />
flu/severe cold daytime 34<br />
FLUARIX 2005-2006 156<br />
FLUARIX 2006-2007 156<br />
FLUARIX 2007-2008 156<br />
FLUARIX 2008-2009 156<br />
FLUARIX 2009-2010 156<br />
fluconazole in dextrose 26<br />
fluconazole in nacl 26<br />
FLUCONAZOLE IN NACL 27<br />
fluconazole 26<br />
fludarabine phosphate 31<br />
fludrocort 145<br />
fludrocortisone acetate 145<br />
FLULAVAL 2008-2009 157<br />
FLULAVAL 2009-2010 157<br />
FLULAVAL 157<br />
flumazenil 77<br />
FLUNISOLIDE (NASAL) 136<br />
flunisolide (nasal) 136<br />
FLUNISOLIDE 136<br />
flunisolide 136<br />
FLUNISOLIDE 145<br />
FLUOCIN ACET 163<br />
fluocin acet 163<br />
FLUOCINOLONE ACETONIDE 163<br />
fluocinolone acetonide 163<br />
FLUOCINONIDE 163<br />
fluocinonide 163<br />
fluor-op 136<br />
fluorescein sodium injection 82<br />
fluoromethol 136<br />
FLUOROMETHOLONE (OPHTH) 136<br />
fluorometholone (ophth) 136<br />
FLUOROPLEX 167<br />
FLUOROURACIL (TOPICAL) 167<br />
fluorouracil (topical) 167<br />
fluorouracil 167<br />
fluorouracil 31<br />
FLUOXETINE HCL (PMDD) 67<br />
fluoxetine hcl (pmdd) 67<br />
fluoxetine hcl 66<br />
FLUOXETINE HCL 67<br />
fluoxetine hcl 67<br />
fluoxetine 66<br />
fluoxetine 67<br />
fluphenazine decanoate 71<br />
FLUPHENAZINE HCL 71<br />
fluphenazine hcl 71<br />
FLUPHENAZINE 71<br />
fluphenazine 71<br />
flurazepam hcl 74<br />
flurazepam hcl 75<br />
flurazepam 74<br />
flurbiprofen sodium 137<br />
flurbiprofen 137<br />
flutabs 100<br />
FLUTICASONE PROPIONATE HFA 145<br />
fluticasone propionate (nasal) 136<br />
fluticasone propionate 136<br />
FLUTICASONE-SALMETEROL 35<br />
FLUVIRIN 2005-2006 157<br />
FLUVIRIN 2006-2007 157<br />
FLUVIRIN 2007-2008 157<br />
FLUVIRIN 2008-2009 157<br />
FLUVIRIN 2009-2010 157<br />
FLUZONE HIGH-DOSE PF 2009 157<br />
FLUZONE PEDIATRIC PF 2005 157<br />
FLUZONE PEDIATRIC PF 2006 157<br />
FLUZONE PEDIATRIC PF 2007 157<br />
FLUZONE PEDIATRIC PF 2008 157<br />
FLUZONE PEDIATRIC PF 2009 157<br />
FLUZONE PF 2005-2006 157<br />
FLUZONE PF 2006-2007 157<br />
FLUZONE PF 2007-2008 157<br />
FLUZONE PF 2008-2009 157<br />
FLUZONE PF 2009-2010 157<br />
FLUZONE SPLIT 2005-2006 157<br />
FLUZONE SPLIT 2006-2007 157<br />
FLUZONE SPLIT 2007-2008 157<br />
FLUZONE SPLIT 2008-2009 157<br />
FLUZONE SPLIT 2009-2010 157<br />
FML FORTE 136<br />
FML 136<br />
FOCALIN XR 73<br />
FOLIC ACID 168<br />
FOLLISTIM AQ 147<br />
FOLOTYN 31<br />
foltrin 39<br />
FORA D10 BLOOD GLUCOSE TE 80<br />
FORA D15C BLOOD GLUCOSE T 80<br />
FORA D15G BLOOD GLUCOSE T 80<br />
FORA D15Z BLOOD GLUCOSE T 80<br />
FORA G20 BLOOD GLUCOSE MO 179<br />
FORA G20 BLOOD GLUCOSE TE 80<br />
FORA V10 BLOOD GLUCOSE MO 179<br />
FORA V10 BLOOD GLUCOSE TE 80<br />
FORA V12 BLOOD GLUCOSE MO 179<br />
FORA V12 BLOOD GLUCOSE TE 80<br />
FORA V20 BLOOD GLUCOSE MO 179<br />
FORA V20 BLOOD GLUCOSE TE 80<br />
FORA V22 BLOOD GLUCOSE MO 179<br />
FORA V22 BLOOD GLUCOSE TE 80<br />
FORADIL AEROLIZER 35<br />
FORMOTEROL FUMARATE 35<br />
formula d 100<br />
fortabs 51<br />
FORTAZ 19<br />
FORTEO 150<br />
FOSCARNET 29<br />
fosinopril sodium 49<br />
fosphenytoin sodium 64<br />
fp insulin syringe/0.3ml/ 180<br />
fp insulin syringe/0.3ml/ 181<br />
fp insulin syringe/0.3ml/ 182<br />
fp insulin syringe/0.5ml/ 182<br />
fp insulin syringe/0.5ml/ 183<br />
fp insulin syringe/0.5ml/ 184<br />
fp insulin syringe/0.5ml/ 185<br />
fp insulin syringe/1ml/30 187<br />
fp insulin syringe/1ml/31 188<br />
fp insulin syringe/u-100/ 180<br />
fp insulin syringe/u-100/ 181<br />
fp insulin syringe/u-100/ 182<br />
fp insulin syringe/u-100/ 183<br />
fp insulin syringe/u-100/ 184<br />
fp insulin syringe/u-100/ 186<br />
fp insulin syringe/u-100/ 187<br />
fp lancets super thin 189<br />
fp lancets thin 179<br />
fp lancets 179<br />
fp multi-symptom pms 61<br />
FRAGMIN 40<br />
FREAMINE HBC 6.9% 87<br />
created on 20100520 218
FREAMINE III 3% 87<br />
FREAMINE III 8.5%/DEXTROS 87<br />
FREAMINE III 87<br />
FREESTYLE FLASH SYSTEM 179<br />
FREESTYLE FREEDOM LITE 179<br />
FREESTYLE FREEDOM 179<br />
freestyle lancets 179<br />
FREESTYLE LITE BLOOD GLUC 179<br />
FREESTYLE LITE TEST STRIP 80<br />
FREESTYLE SIDEKICK II VAL 179<br />
FREESTYLE SYSTEM KIT 179<br />
FREESTYLE TEST STRIPS 80<br />
freestyle unistick ii lan 179<br />
FRENADOL 61<br />
FURADANTIN 29<br />
furosemide 87<br />
FUZEON 27<br />
G<br />
g p tex 127<br />
g phen dm 100<br />
g-bid dm 100<br />
g-fen dm 100<br />
g-fen ex 127<br />
g-phed-pd 127<br />
g-phed 127<br />
g/p 1200/60 127<br />
G/P 127<br />
GALIUM-HEEL 174<br />
GAMASTAN S/D 155<br />
GAMMAGARD LIQUID 155<br />
GAMMAGARD S/D IGA LESS TH 155<br />
GAMMAGARD S/D 155<br />
GAMMAGARD 155<br />
GAMMAPLEX 155<br />
GAMUNEX 155<br />
GANCICLOVIR 29<br />
ganciclovir 29<br />
gani-tuss dm nr 100<br />
gani-tuss nr 100<br />
ganidin nr 127<br />
GANITE 172<br />
GARDASIL 157<br />
gauifenesin/pseudoephedri 101<br />
gdp-ex 100<br />
GEMZAR 31<br />
genac 11<br />
genacol maximum strength 100<br />
genantuss 100<br />
genantussidex 100<br />
genapap extra strength 61<br />
genapap sinus maximum str 36<br />
genapap 61<br />
genaphed plus 11<br />
GENARC 42<br />
genatuss dm 100<br />
gene-t-press 100<br />
genebrom dm 100<br />
GENEBRONCO-D 100<br />
genebs 61<br />
GENECOF-HC 100<br />
genecof-hc 100<br />
GENECOF-XP 100<br />
genecof-xp 100<br />
GENEDEL 100<br />
genedotuss-dm 100<br />
GENEPATUSS 100<br />
generic entex la 127<br />
generlac 83<br />
genetuss-2 100<br />
genetuss 100<br />
GENEXA LA 127<br />
GENEXPECT DM 100<br />
GENEXPECT-PE 100<br />
GENEXPECT-SF 100<br />
gengraf 173<br />
genoptic 135<br />
GENOTROPIN 151<br />
genta 135<br />
gentacidin 135<br />
gentak 135<br />
gentamicin in saline 17<br />
gentamicin sulfate (ophth) 135<br />
gentamicin sulfate (topical) 158<br />
GENTAMICIN SULFATE/0.9% S 17<br />
gentamicin sulfate 17<br />
GENTAMICIN-PREDNISOLONE<br />
ACETATE 136<br />
gentamicin 135<br />
gentamicin 158<br />
GENTEX HC 100<br />
GENTEX LA 127<br />
gentex-lq 100<br />
gentle touch insulin syri 182<br />
gentle touch insulin syri 183<br />
gentle touch insulin syri 186<br />
gentle-let gp lancets 179<br />
gentle-let lancets genera 179<br />
gentle-let lancets safety 179<br />
GEODON 70<br />
GEREF DIAG 82<br />
geri-tussin dm 100<br />
geri-tussin 127<br />
gestuss-hc 100<br />
GFN 1000/DM 50 100<br />
gfn 1000/dm 60 100<br />
gfn 1200/dm 20/pe 40 100<br />
gfn 1200/dm 60/pse 120 101<br />
gfn 1200/dm 60 100<br />
gfn 1200/phenylephrine 40 127<br />
gfn 1200/pse 50 127<br />
gfn 500/dm 30 101<br />
GFN 550/PSE 60/DM 30 101<br />
GFN 550/PSE 60 127<br />
gfn 595/pse 48/dm 32 101<br />
gfn 595/pse 48 127<br />
gfn 600/phenylephrine 20 127<br />
gfn 600/phenylephrine 40 127<br />
gfn 795/pse 85 127<br />
gfn 800/dm 30 101<br />
gfn 800/pe 25 127<br />
gfn 800/pse 60/dm 30 101<br />
GFN 800/PSE 60 127<br />
GFN/DM/PSE 100<br />
gfn/pse 127<br />
gfn600/pse60/dm30 sa 101<br />
gg 200 nr 127<br />
gg/pse/cod 101<br />
giant eagle lancets color 190<br />
giant eagle lancets 189<br />
GIANT EAGLE PHARMACY TEST 80<br />
GIANT EAGLE PHARMACY VALU 179<br />
GILPHEX TR 128<br />
GILTUSS HC 101<br />
GILTUSS PED-C 101<br />
GILTUSS PEDIATRIC 101<br />
GILTUSS TR 101<br />
GILTUSS 101<br />
glimepiride 149<br />
glipizide er 149<br />
glipizide er 150<br />
glipizide xl 150<br />
glipizide 149<br />
GLIPIZIDE 150<br />
glipizide 150<br />
created on 20100520 219
GLOFIL-125 82<br />
GLUCAGEN HYPOKIT 150<br />
GLUCAGEN 150<br />
GLUCAGON (RDNA) 150<br />
glucagon (rdna) 150<br />
GLUCAGON 150<br />
glucagon 150<br />
GLUCOCARD 01 BLOOD GLUCOS 179<br />
GLUCOCARD 01 SENSOR 80<br />
GLUCOCARD 01 TEST STRIPS 80<br />
GLUCOCARD 01-MINI BLOOD G 179<br />
GLUCOCARD VITAL BLOOD GLU 179<br />
GLUCOCARD VITAL TEST STRI 80<br />
GLUCOCARD X-METER 179<br />
GLUCOCARD X-SENSOR 80<br />
GLUCOCOM BLOOD GLUCOSE MO 179<br />
GLUCOCOM BLOOD GLUCOSE MO 180<br />
glucocom lancets 28g 179<br />
glucocom lancets 30g 179<br />
glucocom lancets 33g 179<br />
GLUCOCOM TEST STRIPS 80<br />
GLUCOFILM TEST STRIPS 80<br />
GLUCOLAB BLOOD GLUCOSE MO 180<br />
GLUCOLAB TEST STRIPS 80<br />
GLUCOMETER DEX TEST SENSO 80<br />
GLUCOMETER ELITE CLASSIC 180<br />
GLUCOMETER ELITE 80<br />
GLUCOMETER ENCORE QA+ SYS 180<br />
GLUCOMETER ENCORE TEST ST 80<br />
glucopro insulin syringe/ 181<br />
glucopro insulin syringe/ 182<br />
glucopro insulin syringe/ 184<br />
glucopro insulin syringe/ 185<br />
glucopro insulin syringe/ 187<br />
glucopro insulin syringe/ 188<br />
GLUCOSE BLOOD 80<br />
glucosource lancets 180<br />
GLUCOSTIX 80<br />
GLUCOTROL XL 150<br />
glyburid mcr 150<br />
glyburide micronized 150<br />
GLYBURIDE 150<br />
glycine diluent 195<br />
glycopyrrolate 33<br />
glycron 150<br />
GLYOXAL COMPOSITUM 174<br />
gnp acetamin 61<br />
gnp acne 161<br />
gnp all day allergy 17<br />
gnp allergy & sinus heada 1<br />
gnp allergy multi-symptom 11<br />
gnp allergy sinus pe day 11<br />
gnp cgh relf 101<br />
gnp childrens di bromm co 11<br />
gnp childrens di bromm dm 101<br />
gnp childrens ibuprofen c 36<br />
gnp childrens pain relief 107<br />
gnp childrens plus cough 101<br />
GNP CLICKFINE UNIVERSAL P 178<br />
gnp cold & allergy childr 11<br />
gnp cold & allergy pe 9<br />
gnp cold & cough children 101<br />
gnp cold head congestion 101<br />
gnp cold head congestion 93<br />
gnp cold multi-symptom da 93<br />
gnp cold multi-symptom ni 93<br />
gnp cold severe congestio 101<br />
gnp color lancets 180<br />
gnp complete cold & flu r 101<br />
gnp cough & sore throat d 101<br />
gnp cough & sore throat n 101<br />
gnp day time cold/flu rel 101<br />
gnp day time cold/flu 101<br />
gnp day time d cold/flu 95<br />
gnp day time liquid caps 101<br />
gnp day time sinus/multi- 34<br />
gnp dayhist 2<br />
GNP FLU & SEVERE COLD/NIG 11<br />
gnp flu cold & cough medi 100<br />
gnp flu/severe cold dayti 34<br />
gnp headache relief 61<br />
gnp histafed 11<br />
gnp hot steam 174<br />
gnp hydro-lotion 163<br />
gnp hydrocor 163<br />
gnp hydrocortisone plus 163<br />
gnp hydrocortisone/aloe 164<br />
gnp ibuprofen cold/sinus 36<br />
gnp infants pain relief 62<br />
gnp infants pain reliever 101<br />
gnp insulin syringe/0.3ml 180<br />
gnp insulin syringe/0.3ml 181<br />
gnp insulin syringe/0.3ml 182<br />
gnp insulin syringe/0.5ml 182<br />
gnp insulin syringe/0.5ml 183<br />
gnp insulin syringe/0.5ml 184<br />
gnp insulin syringe/0.5ml 185<br />
gnp insulin syringe/1ml/2 186<br />
gnp insulin syringe/1ml/3 187<br />
gnp insulin syringe/1ml/3 188<br />
gnp jr strength non-aspir 61<br />
gnp lancets super thin 180<br />
gnp lancets thin 180<br />
gnp lancets 180<br />
gnp mucus relief cough ch 105<br />
gnp mucus relief dm 105<br />
gnp mucus relief multi 129<br />
gnp mucus relief pe 129<br />
gnp night time cold/flu r 106<br />
gnp night time cough 106<br />
gnp night time d cold/flu 106<br />
gnp night time sinus/mult 3<br />
gnp nose drops extra stre 138<br />
gnp pain rel 61<br />
gnp pain relief plus coug 107<br />
gnp pain relief pm extra 76<br />
gnp pain relief sinus pe 34<br />
gnp pain reliever extra s 61<br />
gnp pain reliever junior 62<br />
gnp prenatal vitamins 170<br />
gnp severe cold/flu maxim 101<br />
gnp sinus & allergy pe 14<br />
gnp sinus congestion & pa 11<br />
gnp sinus congestion & pa 34<br />
gnp sinus congestion/pain 11<br />
gnp sinus congestion/pain 133<br />
gnp sinus maximum strengt 34<br />
gnp suphedrin cold/cough 120<br />
GNP TEST STRIPS 80<br />
gnp triacting chest conge 128<br />
gnp triacting cold/allerg 11<br />
gnp triacting cough & sor 121<br />
gnp triacting day time co 121<br />
gnp triacting night time 121<br />
gnp triacting night time 3<br />
gnp triacting nite time 101<br />
GNP TRUEREAD 180<br />
GNP TRUEREAD 80<br />
GNP TRUETRACK SMART SYSTE 180<br />
GNP TRUETRACK SMART SYSTE 80<br />
gnp tussin cf cough & col 101<br />
gnp tussin cf 101<br />
gnp tussin dm cough 101<br />
gnp tussin dm 101<br />
created on 20100520 220
gnp tussin 128<br />
gnp vit b-6 168<br />
gnp womens menstrual reli 61<br />
gold sodium thiomalate 144<br />
GOLYTELY 140<br />
GONAL-F RFF 147<br />
GONAL-F 147<br />
gp-1200 128<br />
gramicidin/neomycin/polym 135<br />
GRANI 142<br />
granisetron hcl 142<br />
GRIFULVIN 27<br />
gripex pe pediatric 128<br />
GRIPP-HEEL 174<br />
GRIS-PEG 27<br />
GRISEOFULVIN MICRONIZED 195<br />
GRISEOFULVIN MICROSIZE 27<br />
griseofulvin microsize 27<br />
GRISEOFULVIN ULTRAMICROSI 27<br />
GRISEOFULVIN ULTRAMICROSIZE 27<br />
GRISEOFULVIN 195<br />
griseofulvin 27<br />
GUACOL DM PEDIATRIC 101<br />
guai 800mg/dm 30mg 101<br />
guai 800mg/pse 60mg/dm30m 101<br />
guaiasorb dm 101<br />
guaiasorb 128<br />
guaiatussin ac 101<br />
guaiatussin dm 101<br />
guaicon dm 101<br />
guaicon dms 101<br />
guaidex-tr 101<br />
guaif/dm/pse 101<br />
GUAIFED 128<br />
guaifen dm 101<br />
guaifen pe 128<br />
guaifen pse 128<br />
guaifen-c 101<br />
guaifen/pse 128<br />
guaifenesin 600/pse 120 128<br />
guaifenesin ac expectoran 101<br />
guaifenesin ac 101<br />
guaifenesin ac 102<br />
guaifenesin dac 102<br />
guaifenesin dm nr 101<br />
guaifenesin dm 101<br />
guaifenesin dm 102<br />
guaifenesin nr 102<br />
guaifenesin nr 128<br />
guaifenesin pse 128<br />
GUAIFENESIN-CHLORPHENIRAMINE<br />
MALEATE 128<br />
guaifenesin-codeine 101<br />
GUAIFENESIN-CODEINE 102<br />
guaifenesin-codeine 102<br />
guaifenesin-dm nr 101<br />
guaifenesin-dm 102<br />
guaifenesin-pseudoephedri 127<br />
guaifenesin/carbetapentan 101<br />
guaifenesin/codeine phosp 101<br />
guaifenesin/codeine 101<br />
guaifenesin/codeine 102<br />
guaifenesin/dex 101<br />
guaifenesin/dextromethorp 101<br />
guaifenesin/dextromethorp 102<br />
guaifenesin/dm sr 102<br />
guaifenesin/phenylephrine 127<br />
guaifenesin/phenylephrine 128<br />
guaifenesin/pse sa 128<br />
guaifenesin/pse/dm 100<br />
guaifenesin/pseudoephedri 102<br />
guaifenesin/pseudoephedri 128<br />
GUAIFENESIN 128<br />
guaifenesin 128<br />
GUAIFENESIN 195<br />
guaifenex dm 102<br />
guaifenex gp 128<br />
guaifenex pse 120 128<br />
guaifenex pse 60 128<br />
guaifenex pse 80 128<br />
guaifenex pse 85 128<br />
GUAIMAX-D 128<br />
guaimist dm 102<br />
guaimist s 128<br />
guaiphen-d 1200 128<br />
guaiphen-d 128<br />
guaiphen-pd 128<br />
guaitussin ac 102<br />
guaitussin dac 102<br />
guapetex hc 102<br />
guapetex 128<br />
guaphen forte 102<br />
guaphen ii dm 102<br />
GUAPHENYL II 128<br />
guaphenyl la 128<br />
guia-d 102<br />
guiadex dm 102<br />
guiadex pd 128<br />
guiadrine dx 102<br />
guiafen ii dm 102<br />
GUIAPLEX HC 102<br />
guiatex pe 128<br />
guiatuss ac 102<br />
guiatuss clear dm 102<br />
guiatuss dac 102<br />
guiatuss dm 102<br />
guiatuss pe 128<br />
guiatuss 128<br />
created on 20100520 221<br />
H<br />
H 9600 SR 128<br />
h&h thinlet lancets 26g 190<br />
h&h thinlet super thin la 190<br />
H-E-B IN CONTROL PEN NEED 180<br />
H-E-B INCONTROL PEN NEEDL 180<br />
haemolance low flow lance 180<br />
haemolance plus high flow 180<br />
haemolance plus low flow 180<br />
haemolance plus max flow 180<br />
haemolance plus pediatric 180<br />
haemolance plus 180<br />
haemolance 180<br />
HALCINONIDE 163<br />
halobetasol propionate 163<br />
halobetasol 163<br />
HALOG 163<br />
haloperidol decanoate 70<br />
haloperidol lactate 70<br />
haloperidol 70<br />
haloperidol 71<br />
haponal 33<br />
HAVRIX 157<br />
hayfebrol 11<br />
HAYSMA 36<br />
hc tussive-d 102<br />
hc tussive-nr 102<br />
hc tussive 102<br />
hca azo 165<br />
hca childrens non-aspirin 61<br />
hca cold & allergy dm 93<br />
hca cold & cough formula 126<br />
hca cold caps 2<br />
hca cold/allergy 9<br />
hca cold/flu medicine 11<br />
hca complete sinus relief 11
hca cough formula 102<br />
hca cough-ex 102<br />
hca day-time 102<br />
hca expector 128<br />
hca heartburn relief 142<br />
hca hydrocor 163<br />
hca infants non-aspirin 61<br />
hca insulin syringe/u-100 180<br />
hca insulin syringe/u-100 181<br />
hca insulin syringe/u-100 184<br />
hca insulin syringe/u-100 187<br />
HCA INTENSE COUGH FORMULA 102<br />
hca lancets thin 180<br />
hca lancets ultra thin 190<br />
hca maximum strength hydr 163<br />
hca nite-time multi sympt 102<br />
hca nite-time 102<br />
hca non-asa 61<br />
hca non-asp pm extra stre 75<br />
hca non-aspirin pm 75<br />
hca non-drying sinus 129<br />
hca severe congestion/cou 133<br />
HCA SEVERE COUGH STOPPER 102<br />
hca sinus 11<br />
hca suphedrine plus 11<br />
HCA TEST STRIPS 80<br />
hca tri-afed 11<br />
hca triactin cold & aller 11<br />
hca triactin cold & cough 102<br />
hca tussin cf 102<br />
hca tussin cold/cough 102<br />
hca tussin dm clear 102<br />
hca tussin dm 102<br />
hca tussin expectorant 129<br />
hca tussin pe 129<br />
hca ultra comfort insulin 182<br />
hca ultra comfort insulin 185<br />
hca ultra comfort insulin 188<br />
hca vit b6 168<br />
hctz/triamterene 88<br />
hdc dm 102<br />
headache pm 75<br />
HEALON GV 140<br />
HEALON5 140<br />
HEALON 140<br />
HEALTH ALLIANCE STRIP 80<br />
HEALTHWISE MINI PEN NEEDL 191<br />
HEALTHWISE PEN NEEDLES 29 191<br />
HEALTHWISE SHORT PEN NEED 192<br />
healtussin dm 102<br />
heartburn relief 142<br />
heartburn 142<br />
HECTOROL 169<br />
HELIDAC 29<br />
HELIXATE FS 42<br />
HEMABATE 155<br />
hematogen 39<br />
HEMOFIL M 42<br />
hemorrhoidal-hc 163<br />
hemril-30 163<br />
HEPAGAM B 155<br />
HEPAR COMPOSITUM 174<br />
heparin (porcine) in sodium chloride<br />
40<br />
HEPARIN LOCK 40<br />
heparin sod (porcine) in d5w 40<br />
heparin sodium (porcine) 40<br />
heparin sodium (porcine) 41<br />
HEPARIN SODIUM DCU 40<br />
HEPARIN SODIUM/NACL 0.45% 40<br />
HEPARIN SODIUM 40<br />
HEPATASOL 87<br />
HEPSERA 29<br />
HERCEPTIN 31<br />
hetastarch in sodium chloride 84<br />
HEXABRIX 82<br />
HEXAFED 11<br />
HEXAFLU 11<br />
HEXALEN 31<br />
HEXTEND 84<br />
HIBERIX 157<br />
HIBTITER 157<br />
hist-pse 11<br />
hista-tabs 11<br />
hista-vent da 11<br />
hista-vent pse 11<br />
histacol bd 102<br />
histacol dm 102<br />
histacol la 11<br />
histade mx 11<br />
histade sr 11<br />
HISTADEC DM 102<br />
HISTADEC 11<br />
histafed 11<br />
HISTAMAX D 2<br />
histatab d 11<br />
histatab ph 12<br />
histatab 11<br />
HISTATROL 82<br />
HISTENOL-FORTE 102<br />
HISTEX SR 12<br />
histinex hc 103<br />
histinex pv 103<br />
histuss hc 103<br />
histussin d 103<br />
histussin hc 103<br />
HIVID 28<br />
HIZENTRA 155<br />
hm monoject insulin syrin 180<br />
hm monoject insulin syrin 182<br />
hm monoject insulin syrin 183<br />
hm monoject insulin syrin 186<br />
homatropaire 138<br />
HOMATROPINE HBR 138<br />
homatropine hbr 138<br />
homatropine 138<br />
HONEY BEE 174<br />
honey tussin 103<br />
HORNET VENOM 174<br />
hot steam medication 174<br />
hot steam 174<br />
hpb max 103<br />
hpr end 103<br />
HSA STERILE DILUENT 195<br />
ht-tuss dm 103<br />
HUMALOG KWIKPEN 148<br />
HUMALOG MIX 50/50 KWIKPEN 148<br />
HUMALOG MIX 50/50 PEN 148<br />
HUMALOG MIX 50/50 148<br />
HUMALOG MIX 75/25 KWIKPEN 148<br />
HUMALOG MIX 75/25 PEN 148<br />
HUMALOG MIX 75/25 148<br />
HUMALOG PEN 148<br />
HUMALOG 148<br />
HUMATE-P 43<br />
HUMATROPE 151<br />
HUMIBID 129<br />
humibid 129<br />
HUMIRA PEN-CROHNS DISEASE 173<br />
HUMIRA PEN-PSORIASIS STAR 173<br />
HUMIRA PEN 173<br />
HUMIRA 173<br />
HUMULIN 50/50 148<br />
HUMULIN 70/30 PEN 148<br />
created on 20100520 222
HUMULIN 70/30 148<br />
HUMULIN N U-100 PEN 148<br />
HUMULIN N 148<br />
HUMULIN R U-500 (CONCENTR 148<br />
HUMULIN R 148<br />
hy-kxp 103<br />
hy-vee insulin syringe/u- 180<br />
hy-vee insulin syringe/u- 181<br />
hy-vee insulin syringe/u- 183<br />
hy-vee insulin syringe/u- 184<br />
hy-vee insulin syringe/u- 186<br />
hy-vee insulin syringe/u- 187<br />
hy-vee lancets 190<br />
hy-vee thin lancets 190<br />
HYALGAN 174<br />
HYCAMTIN 31<br />
HYCET 54<br />
hycomal dh 103<br />
HYDASE 88<br />
hydex pd 103<br />
hydralazine hcl 45<br />
hydralazine 45<br />
hydro gp 103<br />
hydro-dp 103<br />
hydro-pc ii plus 103<br />
hydro-pc ii 103<br />
hydro-tussin cbx 2<br />
hydro-tussin dhc 103<br />
hydro-tussin dm 103<br />
hydro-tussin exp 103<br />
hydro-tussin hc 103<br />
HYDRO-TUSSIN HD 103<br />
hydro-tussin hg 103<br />
hydro-tussin xp 103<br />
hydro/pseudo/brom 103<br />
hydrocet 54<br />
hydrochloric acid 141<br />
hydrochlorot 88<br />
hydrochlorothiazide 88<br />
hydrocod/cp/pseud 103<br />
HYDROCODONE BITARTRATE<br />
(ANTITUSSIVE) 195<br />
hydrocodone bitartrate/ac 54<br />
hydrocodone bitartrate/ap 54<br />
hydrocodone bitartrate/gu 103<br />
hydrocodone bitartrate/ho 103<br />
HYDROCODONE BITARTRATE 195<br />
hydrocodone bitrate/pheny 103<br />
HYDROCODONE POLISTIREX-<br />
CHLORPHENIRAMINE POLISTIREX 103<br />
HYDROCODONE W/ HOMATROPINE<br />
103<br />
hydrocodone w/ homatropine 103<br />
HYDROCODONE-ACETAMINOPHEN 54<br />
hydrocodone-acetaminophen 54<br />
hydrocodone-acetaminophen 55<br />
HYDROCODONE-GUAIFENESIN 103<br />
hydrocodone-guaifenesin 103<br />
HYDROCODONE-IBUPROFEN 55<br />
hydrocodone-ibuprofen 55<br />
HYDROCODONE-POTASSIUM<br />
GUAIACOLSULFONATE 103<br />
hydrocodone-potassium<br />
guaiacolsulfonate 103<br />
hydrocodone/acetaminophen 54<br />
hydrocodone/acetaminophen 55<br />
hydrocodone/apap 54<br />
hydrocodone/guaifenesin e 103<br />
hydrocodone/guaifenesin 102<br />
hydrocodone/guaifenesin 103<br />
hydrocodone/homatropine 103<br />
hydrocodone/ibuprofen 54<br />
hydrocodone/phenylephrine 102<br />
hydrocodone/potassium gua 103<br />
hydrocof-hc 103<br />
hydrocort ac 164<br />
hydrocort/ab 164<br />
hydrocort 145<br />
hydrocort 163<br />
hydrocort 164<br />
hydrocortiso 164<br />
hydrocortisone (rectal) 164<br />
HYDROCORTISONE (TOPICAL) 164<br />
hydrocortisone (topical) 164<br />
HYDROCORTISONE ACETATE<br />
(INTRARECTAL) 164<br />
hydrocortisone acetate (rectal) 164<br />
HYDROCORTISONE ACETATE W/<br />
PRAMOXINE 165<br />
hydrocortisone acetate-aloe vera 164<br />
hydrocortisone acetate/al 163<br />
hydrocortisone acetate/al 164<br />
hydrocortisone maximum st 164<br />
hydrocortisone plus 12 164<br />
hydrocortisone plus 164<br />
hydrocortisone sod succinate 145<br />
hydrocortisone valerate 164<br />
hydrocortisone w/acetic acid 136<br />
HYDROCORTISONE-ALOE VERA 164<br />
hydrocortisone-aloe vera 164<br />
hydrocortisone/acetic aci 136<br />
HYDROCORTISONE/ALOE 163<br />
HYDROCORTISONE/ALOE 164<br />
hydrocortisone/aloe 164<br />
hydrocortisone 145<br />
hydrofed 103<br />
hydrogesic 55<br />
hydromet 103<br />
hydromorphone hcl 55<br />
HYDROMORPHONE/BUPIVACAINE 54<br />
HYDROMORPHONE/NS 55<br />
HYDROMORPHONE/SODIUM CHLO 55<br />
hydron cp 103<br />
hydron ex 104<br />
HYDRON KGS 104<br />
hydron psc 104<br />
HYDROXOCOBAL 168<br />
hydroxychlor 29<br />
hydroxychloroquine sulfate 29<br />
hydroxyurea 31<br />
hydroxyz hcl 75<br />
hydroxyz pam 75<br />
hydroxyz pam 76<br />
HYDROXYZINE HCL (BULK) 195<br />
HYDROXYZINE HCL 195<br />
hydroxyzine hcl 76<br />
HYDROXYZINE PAMOATE 76<br />
hydroxyzine pamoate 76<br />
HYLENEX 88<br />
hyomax-sl 33<br />
hyomax 33<br />
hyoscyamine sulfate 34<br />
hyoscyamine 33<br />
hyoscyamine 34<br />
hyosyne 34<br />
HYPAQUE MEGL 82<br />
HYPAQUE SOD 82<br />
HYPAQUE-76 82<br />
HYPAQUE-CYST 82<br />
HYPAQUE-CYSTO PEDIATRIC 82<br />
HYPER-SAL 134<br />
hypercare 166<br />
HYPERHEP B S/D 155<br />
HYPERRAB S/D 155<br />
created on 20100520 223
HYPERRHO S/D 155<br />
HYPERSTAT IV 45<br />
HYPERTET S/D 155<br />
hyphed 104<br />
hyphen-hd 104<br />
HYSTOLYN-CYL 82<br />
hytone 164<br />
I<br />
ibu-profen cold/sinus 36<br />
ibu 52<br />
ibudone 55<br />
ibuprofen cold & sinus 36<br />
ibuprofen cold/sinus 36<br />
ibuprofen jr 52<br />
ibuprofen/pseudoephedrine 36<br />
IBUPROFEN 195<br />
ibuprofen 51<br />
ibuprofen 52<br />
ibutilide fumarate 44<br />
ICAR PEDIATRIC 39<br />
ICAR PEDS 39<br />
idarubicin hcl 31<br />
iferex 150 forte 39<br />
IFEX 31<br />
ifosfamide & mesna 31<br />
IFOSFAMIDE/MESNA 31<br />
IFOSFAMIDE 31<br />
ifosfamide 31<br />
ILARIS 61<br />
imipram hcl 68<br />
imipram pam 68<br />
imipram pam 69<br />
imipramine hcl 69<br />
IMIPRAMINE PAMOATE 69<br />
imipramine pamoate 69<br />
IMITREX STATDOSE REFILL 77<br />
IMITREX STATDOSE SYSTEM 77<br />
IMITREX 77<br />
IMMUNE GLOBULIN 155<br />
IMOGAM RABIES-HT 155<br />
IMOVAX RABIES (H.D.C.V.) 157<br />
IMPLANON 146<br />
INAMRINONE 44<br />
INCRELEX 151<br />
indamix dm 104<br />
indigotindisulfonate sodium 82<br />
INDOCIN 51<br />
INDOCIN 52<br />
indocyanine green 79<br />
indomethacin sodium 52<br />
INDOMETHACIN 195<br />
INDOMETHACIN 51<br />
indomethacin 51<br />
INDOMETHACIN 52<br />
indomethacin 52<br />
industrial 138<br />
inf asa free 61<br />
inf mapap 61<br />
inf non-asa 61<br />
INFANRIX 156<br />
infant apap 61<br />
INFANT FOODS 86<br />
infantaire 61<br />
infants acetaminophen 61<br />
infants apap 61<br />
infants pain relief cold/ 104<br />
infants pain relief 62<br />
infants pain reliever col 104<br />
infants pain reliever col 36<br />
infants silapap 61<br />
INFERGEN 28<br />
INFINITY BLOOD GLUCOSE MO 180<br />
INFINITY BLOOD GLUCOSE TE 80<br />
INFLUENZA A (H1N1) MONOVA 157<br />
INFLUENZA A (H1N1) MONOVALENT<br />
VACCINE LIVE 157<br />
INFLUENZA A (H1N1) MONOVALENT<br />
VACCINE SPLIT 157<br />
INFLUENZA VIRUS VACCINE SPLIT<br />
PRESERVATIVE FREE 157<br />
INFLUENZA VIRUS VACCINE SPLIT 157<br />
INFLUENZA VIRUS VACCINE TYPES A<br />
& B SURFACE ANTIGEN 157<br />
INFUMORPH 55<br />
inhaler decongestant 174<br />
INJECTION DEVICE 176<br />
INJECTION DEVICE 180<br />
INNOHEP 41<br />
INNOPRAN XL 46<br />
INSPIREASE BAGS 180<br />
INSPIREASE DRUG DELIVERY 180<br />
INSPIREASE MOUTHPIECE 180<br />
INSPIREASE REPLACEMENT MO 180<br />
INSPIREASE RESERVOIR BAGS 180<br />
instacort 5 164<br />
INSULIN ASPART PROTAMINE &<br />
ASPART (HUMAN) 148<br />
INSULIN ASPART 148<br />
INSULIN DETEMIR 148<br />
INSULIN GLARGINE 148<br />
INSULIN GLULISINE 148<br />
INSULIN ISOPHANE & REG (HUMAN)<br />
148<br />
INSULIN ISOPHANE (HUMAN) 148<br />
INSULIN ISOPHANE (HUMAN) 149<br />
INSULIN LISPRO (HUMAN) 149<br />
INSULIN LISPRO PROTAMINE &<br />
LISPRO (HUMAN) 149<br />
INSULIN PEN NEEDLE 176<br />
INSULIN PEN NEEDLE 180<br />
INSULIN REGULAR (HUMAN) 149<br />
INSULIN SYRINGE LUER-LOK/ 185<br />
insulin syringe/0.3ml/28g 180<br />
insulin syringe/0.3ml/29g 180<br />
insulin syringe/0.3ml/30g 181<br />
insulin syringe/0.3ml/31g 182<br />
insulin syringe/0.5ml/27g 182<br />
insulin syringe/0.5ml/28g 182<br />
insulin syringe/0.5ml/29g 183<br />
insulin syringe/0.5ml/30g 184<br />
insulin syringe/0.5ml/31g 185<br />
insulin syringe/1ml/28g x 186<br />
insulin syringe/1ml/29g x 186<br />
insulin syringe/1ml/30g x 187<br />
insulin syringe/1ml/31g x 187<br />
INSULIN SYRINGE/NEEDLE U-100 188<br />
insulin syringe/needle u-100 188<br />
INSULIN SYRINGE/NEEDLE U-100 189<br />
insulin syringe/needle u-100 189<br />
INSULIN SYRINGE/NEEDLE U-40 189<br />
insulin syringe/needle u-40 189<br />
insulin syringe/u-100/0.3 180<br />
insulin syringe/u-100/0.3 182<br />
insulin syringe/u-100/0.5 182<br />
insulin syringe/u-100/0.5 183<br />
insulin syringe/u-100/0.5 185<br />
insulin syringe/u-100/1ml 186<br />
insulin syringe/u-100/1ml 187<br />
INSULIN SYRINGES (DISPOSABLE) 188<br />
insulin syringes (disposable) 188<br />
INSUPEN SENSITIVE 32GX6MM 189<br />
INSUPEN SENSITIVE 32GX8MM 189<br />
INSUPEN ULTRAFIN 29GX12MM 189<br />
INSUPEN ULTRAFIN 30GX8MM 189<br />
created on 20100520 224
INSUPEN ULTRAFIN 31GX6MM 189<br />
INSUPEN ULTRAFIN 31GX8MM 189<br />
INTAL 112 125<br />
INTAL 200 125<br />
INTAL INH 125<br />
INTEGRILIN 41<br />
INTELENCE 28<br />
intense cold medicine 2<br />
intense cold/flu medicine 2<br />
intense cough reliever do 104<br />
intense cough reliever ex 104<br />
intense cough reliever 104<br />
INTRON-A 31<br />
INULIN 82<br />
INVANZ 20<br />
INVEGA SUST 70<br />
INVEGA SUSTENNA 70<br />
INVERTA-PEG BASIC GAST KI 189<br />
INVIRASE 27<br />
invisible acne maximum st 161<br />
iobid dm 104<br />
IODOPEN 82<br />
IONOSOL-B/DEXTROSE 5% 84<br />
IONOSOL-MB/DEXTROSE 5% 84<br />
IONOSOL-T/DEXTROSE 5% 84<br />
iophen c-nr 104<br />
iophen dm-nr 104<br />
iophen dm 104<br />
iophen-nr 129<br />
iosal ii 129<br />
iotex pse 129<br />
IPLEX 151<br />
IPOL INACTIVATED IPV 157<br />
ipratropium bromide (nasal) 34<br />
IPRATROPIUM BROMIDE HFA 34<br />
ipratropium bromide 34<br />
ipratropium 34<br />
iprin cold/sinus 36<br />
IRESSA 31<br />
irinotecan hcl 31<br />
IROFOL 39<br />
IRON & FOLIC ACID 39<br />
IRON COMBINATIONS 39<br />
iron combinations 39<br />
iron dextran 39<br />
iron polysaccharide complex-vit b12folic<br />
acid 39<br />
IRON 39<br />
ISCAR MALI SERIES I 174<br />
ISCAR MALI SERIES II 174<br />
ISCAR MALI SERIES O 174<br />
ISCAR MALI SPECIAL 174<br />
ISCAR MALI 174<br />
ISCAR PINI SERIES I 174<br />
ISCAR PINI SERIES II 174<br />
ISCAR PINI SERIES O 174<br />
ISCAR PINI 174<br />
ISCAR QUERCU 174<br />
ISCAR QUERCUS SERIES I 174<br />
ISCAR QUERCUS SERIES II 174<br />
ISCAR QUERCUS SERIES O 174<br />
ISO CARBACHO 139<br />
ISO HOMATROP 138<br />
ISO HYOSCINE 138<br />
iso-chlor 12<br />
ISOCARBOXAZID 66<br />
ISOLYTE-H/DEXTROSE 5% 84<br />
ISOLYTE-P/DEXTROSE 5% 84<br />
ISOLYTE-S PH 7.4 84<br />
ISOLYTE-S/DEXTROSE 5% 84<br />
ISOLYTE-S 84<br />
isometheptene/apap/dichlo 77<br />
isometheptene/dichloralph 77<br />
ISONIAZID 195<br />
ISONIAZID 27<br />
isoniazid 27<br />
ISOSORBIDE DINITRATE 45<br />
ISOTONIC GENTAMICIN 17<br />
ISOVUE-200 82<br />
ISOVUE-250 MULTIPACK 82<br />
ISOVUE-250 82<br />
ISOVUE-300 MULTIPACK 82<br />
ISOVUE-300 82<br />
ISOVUE-370 MULTIPACK 82<br />
ISOVUE-370 82<br />
ISOVUE-M 200 82<br />
ISOVUE-M 300 82<br />
ISRADIPINE 47<br />
isradipine 47<br />
ISTALOL 139<br />
ISTODAX 31<br />
ISUPREL 35<br />
itch-x 164<br />
itraconazole 27<br />
IVEEGAM EN 155<br />
IXEMPRA KIT 31<br />
IXIARO 157<br />
created on 20100520 225<br />
J<br />
J-COF DHC 104<br />
J-MAX DHC 104<br />
J-MAX 129<br />
J-TAN D HC 104<br />
J-TAN D PD 12<br />
J-TAN D 12<br />
jantoven 40<br />
jaycof-hc 104<br />
jaycof-xp 104<br />
jaycof 104<br />
JE-VAX 157<br />
jolivette 146<br />
jr non-asa 61<br />
jr strength non-aspirin 61<br />
jr strength pain reliever 61<br />
jr. acetamin 61<br />
junior mapap rapid tabs 61<br />
K<br />
k-tan 4 4<br />
k-tan 3<br />
KADIAN 55<br />
KALBITOR 174<br />
KANAMYCIN 17<br />
kaon-cl-10 84<br />
kariva 146<br />
KCL 0.15%/D10W/NACL 0.2% 84<br />
KCL 0.15%/D5W/LR 85<br />
KCL 0.15%/D5W/NACL 0.225% 85<br />
KCL 0.3%/D5W/LR IV LAC RI 85<br />
KCL 0.3%/D5W/LR 85<br />
KCL 0.3%/D5W/NACL 0.9% 85<br />
KEFLEX 18<br />
ken-tuss sf 104<br />
KEPIVANCE 166<br />
KEPPRA 65<br />
kericort 10 164<br />
KERR DRUG STARTER KIT 189<br />
KERR DRUG TEST STRIP PACK 81<br />
KETALAR 51<br />
ketamine hcl 51<br />
KETOCARE 83<br />
KETOCONAZOLE & PYRITHIONE ZINC<br />
158<br />
KETOCONAZOLE (TOPICAL) 158<br />
ketoconazole (topical) 158<br />
KETOCONAZOLE (TOPICAL) 159
ketoconazole (topical) 159<br />
ketoconazole 158<br />
ketoconazole 159<br />
ketoconazole 27<br />
KETOPROFEN 195<br />
KETOPROFEN 52<br />
ketoprofen 52<br />
KETOROLAC TROMETHAMINE<br />
(OPHTH) 137<br />
ketorolac tromethamine (ophth) 137<br />
ketorolac tromethamine 52<br />
ketorolac tromethamine 53<br />
ketorolac 137<br />
ketorolac 52<br />
KETOSTIX 83<br />
ketotifen fumarate (ophth) 135<br />
kgs-hc 104<br />
KGS-PE 129<br />
kidkare cough/cold 104<br />
kin-ray insulin syringe/0 183<br />
KINERET 173<br />
KINEVAC 82<br />
KINLYTIC 41<br />
kinney lancets 189<br />
kinney thin lancets 189<br />
kinray insulin syringe pr 182<br />
kinray insulin syringe pr 185<br />
kinray insulin syringe pr 187<br />
KINRAY TEST STRIPS 81<br />
KINRAY VALUE PACK 189<br />
KINRIX 156<br />
klor-con m 85<br />
klor-con 85<br />
klotrix 85<br />
kmart valu plus insulin s 181<br />
kmart valu plus insulin s 183<br />
KMART VALU PLUS INSULIN S 184<br />
KMART VALU PLUS INSULIN S 186<br />
kmart valu plus insulin s 186<br />
KOATE-DVI 43<br />
KOGENATE FS BIO-SET 43<br />
KOGENATE FS 43<br />
KOLEPHRIN-GG/DM 104<br />
kolephrin/dm 104<br />
kolephrin 12<br />
KROGER BLOOD GLUCOSE MONI 189<br />
KROGER BLOOD GLUCOSE TEST 81<br />
kroger insulin syringe/0. 180<br />
kroger insulin syringe/0. 181<br />
kroger insulin syringe/0. 182<br />
kroger insulin syringe/0. 183<br />
kroger insulin syringe/0. 184<br />
kroger insulin syringe/0. 185<br />
kroger insulin syringe/1m 186<br />
kroger insulin syringe/1m 187<br />
kroger insulin syringe/u- 180<br />
kroger insulin syringe/u- 181<br />
kroger insulin syringe/u- 184<br />
kroger insulin syringe/u- 186<br />
kroger insulin syringe/u- 187<br />
kroger lancets 21g 189<br />
kroger lancets micro thin 189<br />
kroger lancets super thin 189<br />
kroger lancets thin 26g 190<br />
kroger lancets thin 189<br />
kroger lancets ultrathin 189<br />
kroger lancets 189<br />
KROGER PEN NEEDLES 29G X 191<br />
KROGER PEN NEEDLES 31G X 192<br />
KROGER PEN NEEDLES 31GX1/ 191<br />
KROGER TEST STRIPS 81<br />
kronofed-a-jr 12<br />
kronofed-a 12<br />
KU-ZYME HP 141<br />
KU-ZYME 141<br />
kuric 159<br />
KUTRASE 141<br />
kwelcof 104<br />
created on 20100520 226<br />
L<br />
l-all 12 nf 104<br />
l-all 12 104<br />
labetalol hcl 46<br />
labetalol 46<br />
lactated ringer's 85<br />
lactulose (encephalopathy) 83<br />
lactulose 83<br />
lady lite lancets 189<br />
lahey mixture #3 34<br />
LAMICTAL ODT 65<br />
LAMICTAL XR 65<br />
LAMICTAL 65<br />
lamotrigine 65<br />
lancets 26g twist top 189<br />
lancets 28g 190<br />
lancets 30g twist top 190<br />
lancets 30g 190<br />
lancets 31g twist top 190<br />
lancets fun color 190<br />
lancets safety seal 21g 189<br />
lancets safety seal 26g 190<br />
lancets safety seal 28g 190<br />
lancets safety seal 30g 190<br />
lancets super thin 190<br />
lancets thin 190<br />
lancets twist top 189<br />
lancets ultra thin 190<br />
lancets 176<br />
lancets 189<br />
lancets 190<br />
LANOXIN 44<br />
LANSOPRAZOLE 143<br />
lansoprazole 143<br />
LANTUS FOR OPTICLIK 149<br />
LANTUS SOLOSTAR 149<br />
LANTUS 149<br />
lanzatuss-n.f. 104<br />
LAPASE 141<br />
LARTUS 104<br />
LATANOPROST 140<br />
lavoclen-4 acne wash kit 161<br />
lavoclen-4 creamy wash 161<br />
lavoclen-8 acne wash kit 161<br />
lavoclen-8 creamy wash 161<br />
leader insulin syringe/0. 180<br />
leader insulin syringe/0. 181<br />
leader insulin syringe/0. 182<br />
leader insulin syringe/0. 183<br />
leader insulin syringe/0. 184<br />
leader insulin syringe/0. 185<br />
leader insulin syringe/1m 186<br />
leader insulin syringe/1m 187<br />
leader lancets colored 190<br />
leader super thin lancet 193<br />
leader thin lancets 194<br />
leena 146<br />
LEMOHIST PLUS 129<br />
LEUKERAN 31<br />
LEUKINE 42<br />
LEUPROLIDE ACETATE 31<br />
leuprolide acetate 31<br />
LEV/PSE/GG 129<br />
LEVALL 5.0 104<br />
LEVAQUIN 24<br />
LEVATOL 46
LEVEMIR FLEXPEN 149<br />
LEVEMIR 149<br />
levetiracetam 65<br />
LEVO DROMORA 55<br />
levobunolol hcl 139<br />
levobunolol 139<br />
levocarnitin 174<br />
levocarnitine (metabolic modifiers)<br />
174<br />
levocarnitine (metabolic modifiers)<br />
175<br />
LEVOFLOXACIN 24<br />
levonorgestrel & eth estradiol 146<br />
LEVONORGESTREL (EMERGENCY OC)<br />
146<br />
levonorgestrel (emergency oc) 146<br />
LEVONORGESTREL-ETH ESTRADIOL<br />
(TRIPHASIC) 146<br />
levonorgestrel-eth estradiol (triphasic)<br />
146<br />
levora 0.15/30-28 146<br />
levothroid 151<br />
levothroid 152<br />
levothyroxin 152<br />
LEVOTHYROXINE SODIUM 152<br />
levothyroxine sodium 152<br />
LEVOXYL 152<br />
levoxyl 152<br />
levoxyl 153<br />
LEVSIN 34<br />
LEXAPRO 67<br />
lexuss 210 104<br />
LIALDA 144<br />
LIBERTY BLOOD GLUCOSE MET 177<br />
LIBERTY BLOOD GLUCOSE MON 177<br />
LIBERTY TEST STRIPS 81<br />
LIBRIUM 75<br />
lidocaine hcl (cardiac) 44<br />
lidocaine hcl (local anesth.) 154<br />
lidocaine hcl (mouth-throat) 137<br />
lidocaine hcl 137<br />
LIDOCAINE HCL 154<br />
lidocaine in d5w 44<br />
lidocaine viscous 137<br />
lidocaine w/ epinephrine 154<br />
LIDOCAINE 44<br />
lidomar viscous 137<br />
LIFE MED BLOOD GLUCOSE MO 177<br />
LIFE MEDICAL TEST STRIPS 81<br />
lifescan unistik 2 deep p 190<br />
lifescan unistik ii lance 194<br />
lifescan unistik ii neona 194<br />
LINCOCIN 26<br />
LINDANE 159<br />
lindane 159<br />
LIORESAL INT INJ 38<br />
LIORESAL INTRATHECAL 38<br />
liothyronine sodium 153<br />
LIPRAM 4500 141<br />
LIPRAM-CR10 141<br />
LIPRAM-CR20 141<br />
lipram-pn10 141<br />
LIPRAM-PN16 141<br />
LIPRAM-PN20 141<br />
LIPRAM-UL12 141<br />
LIPRAM-UL18 141<br />
lipram-ul20 141<br />
LIQUADD 72<br />
liquibid d-r 129<br />
LIQUIBID-D 1200 129<br />
LIQUIBID-D 129<br />
LIQUIBID-PD 129<br />
liquibid 129<br />
LIQUICET 55<br />
liquicough dm 104<br />
liquicough hc 104<br />
lisinopril & hydrochlorothiazide 50<br />
lisinopril/hydrochlorothi 49<br />
lisinopril 49<br />
lisinopril 50<br />
lite touch insulin syring 180<br />
lite touch insulin syring 181<br />
lite touch insulin syring 182<br />
lite touch insulin syring 183<br />
lite touch insulin syring 184<br />
lite touch insulin syring 185<br />
lite touch insulin syring 186<br />
lite touch insulin syring 187<br />
lite touch lancets 190<br />
LITE TOUCH PEN NEEDLES/31 191<br />
lithium carb 76<br />
lithium carbonate 76<br />
LITTLE COLDS DECONGESTANT 104<br />
LITTLE COLDS DRO 104<br />
LITTLE COLDS MULTI-SYMPTO 104<br />
LITTLE FEVERS FEVER/PAIN 61<br />
LITTLE NOSES 138<br />
live better lancet super 189<br />
live better lancet ultra 190<br />
LIVE BETTER PEN NEEDLES 2 191<br />
LIVE BETTER PEN NEEDLES 3 191<br />
LIVE BETTER PEN NEEDLES 3 192<br />
livetan dm 104<br />
LODRANE 24D 12<br />
LODRANE D 12<br />
lodrane ld 12<br />
lofene 140<br />
lohist-12d 12<br />
lohist-d 12<br />
lohist-dm 104<br />
lohist-lq 12<br />
lohist-pd 12<br />
LOMUSTINE 31<br />
LONG STARTER KIT 190<br />
LONG TEST STRIP 81<br />
longs childrens cgh/cold 92<br />
longs childrens flu formu 100<br />
longs cold/cough dm 94<br />
longs insulin syringe/0.5 185<br />
longs insulin syringe/u-1 180<br />
longs insulin syringe/u-1 181<br />
longs insulin syringe/u-1 183<br />
longs insulin syringe/u-1 184<br />
longs insulin syringe/u-1 186<br />
longs insulin syringe/u-1 187<br />
longs lancets adult 190<br />
longs lancets standard 190<br />
longs lancets thin 190<br />
longs lancets ultra thin 190<br />
longs nasal decon/antihis 12<br />
longs nasal decongestant 12<br />
longs original lancets 190<br />
longs pedia relief cough 108<br />
longs pedia relief infant 108<br />
longs super tussin cf 123<br />
longs super tussin dm cle 120<br />
longs super tussin pedia 120<br />
longs ultra thin lancets 194<br />
lonox 140<br />
LORABID 20<br />
LORACARBEF 20<br />
loradamed 17<br />
loratadine & pseudoephedrine 17<br />
loratadine allergy relief 17<br />
created on 20100520 227
LORATADINE 17<br />
loratadine 17<br />
lorazepam 75<br />
LOROXIDE 161<br />
losartan potassium 50<br />
LOTREL 47<br />
LOVENOX 41<br />
low-ogestrel 146<br />
loxapine succinate 72<br />
loxapine 72<br />
LUMIGAN 140<br />
LUMINAL 74<br />
LUPR DEP-PED INJ 31<br />
LUPRON DEPOT INJ 31<br />
lusair 129<br />
LUSEDRA 51<br />
LUSONEX PLUS 129<br />
LUVERIS 147<br />
LYMPHAZURIN 79<br />
LYMPHOMYOSOT 175<br />
LYNOX 55<br />
LYRICA 65<br />
LYSODREN 31<br />
M<br />
m-clear jr 104<br />
m-clear wc 104<br />
m-clear 104<br />
m-end (reformulated) 104<br />
m-end dm 104<br />
m-end max 104<br />
M-END PE 104<br />
m-end wc 104<br />
M-M-R II W/DILUENT 1 DOSE 157<br />
M-M-R II W/DILUENT 10 DOS 157<br />
M-M-R II 157<br />
M-R-VAX II 157<br />
m-vit 170<br />
M.V.I. ADULT 170<br />
M.V.I. PEDIATRIC 170<br />
M.V.I.-12 WITHOUT VITAMIN 170<br />
MACRODANTIN 29<br />
magellan insulin safety s 190<br />
MAGNACET 55<br />
magnesium chloride 85<br />
MAGNESIUM SU 65<br />
magnesium sulfate 65<br />
MAGNESIUM SULFATE 85<br />
MAGNESIUM W/ POTASSIUM-<br />
PYRIDOXINE 168<br />
MAGNEVIST 79<br />
major comfort lancets 190<br />
MANGANESE CL 85<br />
MANGANESE SU 85<br />
mannitol 88<br />
mapap apap 61<br />
mapap arthri 61<br />
mapap child 61<br />
mapap childrens cough/sin 104<br />
mapap childrens 61<br />
mapap cold formula multi- 104<br />
mapap cold formula 104<br />
mapap cold 104<br />
MAPAP HEADACHE PLUS 61<br />
mapap jr str 61<br />
mapap pm 76<br />
mapap sinus maximum stren 34<br />
mapap sinus maximum stren 37<br />
mapap 61<br />
MAR-COF BP 104<br />
MAR-COF CG EXPECTORANT 104<br />
marcof expectorant 104<br />
MARDROPS-DX 104<br />
MARDROPS-EX 129<br />
margesic-h 55<br />
MARPLAN 66<br />
martinic 39<br />
masophen 61<br />
maternity-90 170<br />
maternity 170<br />
MATULANE 31<br />
max strength complete 94<br />
MAXAIR AUTOH AER 35<br />
MAXALT-MLT 77<br />
MAXALT 77<br />
maxapap ms 61<br />
maxapap rs 61<br />
maxi-comfort insulin syri 182<br />
maxi-comfort insulin syri 186<br />
MAXI-TUSS HCG 104<br />
maxichlor peh 12<br />
maxichlor pse 12<br />
MAXIFED CD 104<br />
MAXIFED CDX 104<br />
MAXIFED DM 104<br />
maxifed dmx 104<br />
MAXIFED-G CD 104<br />
MAXIFED-G CDX 104<br />
maxifed 129<br />
MAXIFLU CD 104<br />
MAXIFLU CDX 104<br />
MAXIFLU DM 105<br />
MAXIFLU-G 105<br />
MAXIMA BLOOD GLUCOSE MONI 190<br />
MAXIMA BLOOD GLUCOSE TEST 81<br />
MAXIMA METER KIT 190<br />
MAXIMA STARTER KIT 190<br />
MAXIPHEN ADT 105<br />
MAXIPHEN CD 105<br />
MAXIPHEN CDX 105<br />
MAXIPHEN-G DM 105<br />
MAXIPHEN-G 129<br />
maxiphen 129<br />
MAXIPIME 20<br />
mc jr cough 105<br />
MD-76 R 82<br />
MD-GASTROVIEW 82<br />
MEBENDAZOLE 17<br />
mebendazole 17<br />
med-derm hc 164<br />
med-fast monoject insulin 183<br />
med-fast monoject insulin 186<br />
medent-dmi 105<br />
medent-ldi 129<br />
MEDENT-PE 129<br />
medent-pei 129<br />
medi-brom cold allergy dm 105<br />
medi-brom 12<br />
MEDI-GRAINE 61<br />
medi-lance lancets 190<br />
medi-phedrine plus 12<br />
medi-phedrine severe cold 105<br />
medi-profen cold/sinus 37<br />
medi-synal 37<br />
medi-tabs allergy sinus m 12<br />
medi-tabs childrens 61<br />
medi-tabs cold 105<br />
medi-tabs extra strength 61<br />
medi-tabs flu 105<br />
medi-tabs jr 62<br />
medi-tabs pm extra streng 76<br />
medi-tabs sinus maximum s 37<br />
medi-tabs 61<br />
medi-tussin cough/cold 105<br />
medi-tussin dm diabetic 105<br />
created on 20100520 228
medi-tussin dm double str 105<br />
medi-tussin dm 105<br />
medi-tussin max strength 105<br />
medi-tussin pe 129<br />
medi-tussin severe conges 129<br />
medi-tussin 105<br />
medi-tussin 129<br />
medic insulin syringe/0.3 181<br />
medic insulin syringe/0.5 184<br />
MEDICATED CHEST RUB 175<br />
medicated chest rub 175<br />
medichoice pre-set safety 190<br />
medichoice safety lancet 190<br />
medicidin-d 12<br />
medicine shoppe lancets t 190<br />
medicine shoppe lancets 189<br />
MEDICINE SHOPPE PEN NEEDL 191<br />
MEDICINE SHOPPE PEN NEEDL 192<br />
MEDIFIRST COLD RELIEF 93<br />
medisense thin lancets 194<br />
medlance plus lancets 190<br />
medlance/extra 190<br />
medlance/lite 190<br />
medlance/universal 190<br />
MEDROL 145<br />
medroxypr ac 151<br />
medroxyprogesterone acetate<br />
(contraceptive) 151<br />
medroxyprogesterone acetate 151<br />
MEFOXIN 20<br />
megestrol ac 31<br />
megestrol acetate 31<br />
megestrol acetate 32<br />
meijer cough syrup dm 94<br />
meijer jr strength aspiri 59<br />
meijer lancets thin 190<br />
meijer lancets 190<br />
MEIJER PEN NEEDLES 29G X 191<br />
MEIJER PEN NEEDLES 31G X 191<br />
MEIJER PEN NEEDLES 31G X 192<br />
MEIJER STARTER KIT 190<br />
meijer super thin lancets 193<br />
MEIJER TEST STRIPS 81<br />
melphalan hcl 32<br />
MELPHALAN 32<br />
MENACTRA 157<br />
MENOMUNE-A/C/Y/W-135 157<br />
MENOPUR 147<br />
menstrual complete maximu 62<br />
menstrual pms 62<br />
menstrual relief maximum 62<br />
MENVEO 157<br />
meperi 55<br />
MEPERIDINE HCL-SODIUM CHLORIDE<br />
55<br />
MEPERIDINE HCL/NS 55<br />
MEPERIDINE HCL 55<br />
meperidine hcl 55<br />
MEPERIDINE W/ PROMETHAZINE 55<br />
meperidine w/ promethazine 55<br />
MEPERIDINE/NS 55<br />
meperidine/promethazine 55<br />
MEPERIDINE 55<br />
meperidine 55<br />
MEPHYTON 169<br />
mepivacaine hcl 154<br />
MEPIVACAINE 154<br />
MEPROZINE 55<br />
mercaptopur 32<br />
mercaptopurine 32<br />
MERREM 20<br />
MERUVAX II W/DILUENT 10 D 157<br />
MESALAMINE 144<br />
MESTINON TIMESPAN 33<br />
MESTINON 33<br />
METADATE CD 73<br />
metadate 73<br />
METAPROTEREN 35<br />
metaproteren 35<br />
METAPROTERENOL SULFATE 35<br />
metaproterenol sulfate 35<br />
METAPROTERENOL SULFATE 36<br />
metaproterenol sulfate 36<br />
METASTRON 175<br />
METFORMIN HCL 148<br />
metformin hcl 148<br />
METFORMIN 148<br />
methadex 136<br />
methadone hcl diskets 56<br />
methadone hcl 56<br />
METHADONE 55<br />
methadone 55<br />
methadone 56<br />
methadose 56<br />
methazolamid 139<br />
methazolamide 139<br />
METHIMAZOLE 154<br />
methimazole 154<br />
METHOTREXATE SODIUM<br />
(ANTIRHEUMATIC) 32<br />
methotrexate sodium (antirheumatic)<br />
32<br />
methotrexate sodium 32<br />
METHOTREXATE 195<br />
methotrexate 32<br />
methyldopa 44<br />
methyldopa 45<br />
METHYLDOPATE 45<br />
methylergonovine maleate 155<br />
methylin er 73<br />
METHYLIN 73<br />
methylin 73<br />
methylphenid 73<br />
METHYLPHENIDATE HCL 73<br />
methylphenidate hcl 73<br />
METHYLPHENIDATE HCL 74<br />
methylpred 145<br />
methylprednisolone acetate 145<br />
methylprednisolone sod succ 145<br />
METHYLPREDNISOLONE 145<br />
methylprednisolone 145<br />
metoclopram 143<br />
metoclopramide hcl 143<br />
metolazone 88<br />
metoprol tar 46<br />
metoprolol succinate 46<br />
metoprolol tartrate 46<br />
metoprolol 46<br />
METRO IV 29<br />
METROGEL-VAGINAL 158<br />
metronidazol 29<br />
metronidazole in nacl 29<br />
METRONIDAZOLE VAGINAL 158<br />
metronidazole vaginal 158<br />
METRONIDAZOLE-TETRACYCLINE W/<br />
BISMUTH SUBSALICYLATE 29<br />
metronidazole 29<br />
MIACALCIN 150<br />
MICRHOGAM PL 155<br />
MICROCHAMBER 190<br />
MICRODOT BLOOD GLUCOSE MO 190<br />
MICRODOT TEST STRIPS 81<br />
microlet lancets 190<br />
MICROLIPID 87<br />
created on 20100520 229
microtainer safety flow l 190<br />
MIDAZOLAM HCL/NACL 75<br />
midazolam hcl 75<br />
midol menstrual headache 62<br />
MIGERGOT 77<br />
migquin 77<br />
migratine 77<br />
migrazone 77<br />
migrin-a 77<br />
MILLIPRED 145<br />
milrinone in dextrose 44<br />
milrinone lactate 44<br />
miltuss 105<br />
minirin 150<br />
MINOCIN 25<br />
minocycline hcl 25<br />
mintex dm 105<br />
mintex hc 105<br />
mintex pse 3<br />
mintex 12<br />
mintuss dr 105<br />
mintuss g 105<br />
mintuss hc 105<br />
mintuss hd 105<br />
mintuss mr 105<br />
mintuss ms 105<br />
mintuss nx 105<br />
MIOSTAT 139<br />
miraphen pse 129<br />
mirtazapine 69<br />
misoprostol 143<br />
mission prenatal hp 170<br />
mission prenatal/folic ac 170<br />
MISSION PRENATAL 170<br />
mitomycin 32<br />
MITOTANE 32<br />
mitoxantrone hcl 32<br />
MIXED VESPID VENOM PROTEI 175<br />
MODAFINIL 74<br />
MOMETASONE FUROATE (NASAL) 136<br />
mometasone furoate 164<br />
mometasone 164<br />
MONARC-M 43<br />
monistat 164<br />
MONOCLATE-P 43<br />
MONOJECT BASIC BIOPSY TRA 154<br />
MONOJECT BONE MARROW ASPI 154<br />
MONOJECT BONE MARROW BIOP 154<br />
monoject insulin syringe/ 180<br />
monoject insulin syringe/ 181<br />
monoject insulin syringe/ 182<br />
monoject insulin syringe/ 183<br />
monoject insulin syringe/ 184<br />
MONOJECT INSULIN SYRINGE/ 185<br />
monoject insulin syringe/ 185<br />
monoject insulin syringe/ 186<br />
monoject insulin syringe/ 187<br />
MONOJECT INSULIN SYRINGE 185<br />
monoject ultra comfort in 180<br />
monoject ultra comfort in 181<br />
monoject ultra comfort in 182<br />
monoject ultra comfort in 183<br />
monoject ultra comfort in 184<br />
monoject ultra comfort in 185<br />
monoject ultra comfort in 186<br />
monoject ultra comfort in 187<br />
monolet lancets 190<br />
monolet neolet lancets 190<br />
monolet opd lancets 190<br />
monolet thin lancets 190<br />
monolettor safety lancets 190<br />
mononessa 146<br />
MONONINE 43<br />
MONTE-G HC 105<br />
MONTEFLU HC 105<br />
MONTELUKAST SODIUM 125<br />
montephen 129<br />
moore med monoject insuli 182<br />
moore med monoject insuli 183<br />
moore med monoject insuli 185<br />
moore med monoject insuli 186<br />
MORPHINE SUL TAB 56<br />
MORPHINE SUL 56<br />
morphine sul 56<br />
MORPHINE SULFATE IN DEXTR 56<br />
MORPHINE SULFATE/D5W 56<br />
MORPHINE SULFATE/NS 56<br />
MORPHINE SULFATE 56<br />
morphine sulfate 56<br />
MORPHINE/D5W 56<br />
morrhuate sodium 45<br />
motrin cold & sinus 37<br />
MOXATAG 24<br />
mp acetamin 62<br />
mp acetaminophen es 58<br />
mp acetaminophen pm 75<br />
mp azodine uranary 165<br />
mp cold-allergy dm relief 93<br />
mp cold/allergy relief 9<br />
mp heartburn 142<br />
mp hydrocort 164<br />
mp hydrocortisone maximum 164<br />
mp multi symptom cold 105<br />
mp nite time 106<br />
mp non aspirin 106<br />
mp non aspirin 37<br />
mp pain reliever pm 76<br />
mp tri-fed cold 15<br />
mp triactin chest congest 133<br />
mp triactin cold-allergy 15<br />
mp tussin cf 105<br />
mp tussin dm 105<br />
mp tussin pe 129<br />
ms insulin syringe/0.3ml/ 180<br />
ms insulin syringe/0.3ml/ 181<br />
ms insulin syringe/0.3ml/ 182<br />
ms insulin syringe/0.5ml/ 183<br />
ms insulin syringe/0.5ml/ 184<br />
ms insulin syringe/0.5ml/ 185<br />
ms insulin syringe/1ml/29 186<br />
ms insulin syringe/1ml/30 187<br />
ms insulin syringe/1ml/31 188<br />
ms.-aid 62<br />
MUCINEX CHLD GRA 129<br />
mucinex chld 129<br />
mucinex cough childrens 105<br />
MUCINEX COUGH FOR KIDS 105<br />
mucinex cough for kids 105<br />
MUCINEX COUGH/KIDS 105<br />
MUCINEX D 129<br />
mucinex dm maximum streng 105<br />
MUCINEX DM 105<br />
MUCINEX JUNIOR STRENGTH 129<br />
MUCINEX/KIDS GRA 129<br />
mucinex/kids 129<br />
MUCINEX 129<br />
MUCOSA COMPOSITUM 175<br />
mucosa dm 105<br />
mucosa 129<br />
mucus relief adult 129<br />
mucus relief chest conges 129<br />
mucus relief cough childr 105<br />
mucus relief d 129<br />
mucus relief dm cough 105<br />
created on 20100520 230
mucus relief dm 105<br />
mucus relief pe 129<br />
mucus relief 129<br />
mucusrelief dm 105<br />
mucusrelief sinus 129<br />
mult-vitamin/fluoride 170<br />
multi prenatal 170<br />
multi symptom cold severe 105<br />
multi vit/fl 170<br />
multi vita-bets/fluoride/ 170<br />
multi vita-bets/fluoride 170<br />
multi-symptom allergy rel 12<br />
multi-symptom cold & coug 105<br />
multi-symptom cold relief 105<br />
multi-symptom cold/cough 105<br />
multi-symptom pms menstru 62<br />
multi-vit/fluoride 1/2 st 170<br />
multi-vit/fluoride/iron 170<br />
multi-vit/fluoride 170<br />
multi-vit/iron/fluoride 170<br />
multi-vitamin drops 170<br />
multi-vitamin/fluoride 170<br />
multi-vits/fluoride 170<br />
MULTIDEXOL M 105<br />
multifol plus 170<br />
multiple symptom cold 105<br />
multiple vitamin 169<br />
multiple vitamins/fluorid 170<br />
MULTITRACE-4 NEONATAL 85<br />
MULTITRACE-4 PEDIATRIC 85<br />
MULTITRACE-4 85<br />
MULTITRACE-5 85<br />
multivitamin drops/fluori 171<br />
multivitamin/fluoride 171<br />
multivitamins/fluoride/ir 171<br />
multivitamins/fluoride 171<br />
MUMPSVAX W/DILUENT 10 DOS 157<br />
MUSTARGEN 32<br />
mvc-fluoride 171<br />
MYCAMINE 27<br />
MYCELEX-7 COMBO PACK 159<br />
myci-gc 105<br />
mydex 129<br />
mydocs 129<br />
mydral 138<br />
MYELO-KIT 82<br />
myferon 150 forte 39<br />
myhist-dm 105<br />
myhist-pd 12<br />
MYKIDZ IRON 10 39<br />
MYLERAN 32<br />
MYLOTARG 32<br />
mynatal plus 171<br />
mynatal-z 171<br />
mynate 90 plus 171<br />
MYOBLOC 175<br />
MYOZYME 88<br />
myphetane dx 105<br />
mytussin ac 105<br />
mytussin dac 105<br />
N<br />
N-ACETYL-L-CYSTEINE 195<br />
NABI-HB 155<br />
nabumetone 51<br />
nabumetone 53<br />
nacon 3<br />
NADOLOL 46<br />
nadolol 46<br />
nadolol 47<br />
NAFARELIN ACETATE 147<br />
nafcillin sodium 24<br />
NAFCILLIN 24<br />
NAGLAZYME 88<br />
nalbuphine hcl 58<br />
NALDECON SENIOR 129<br />
NALDEX 12<br />
NALEX DH 106<br />
nalex expectorant 106<br />
nalex-a 12 12<br />
NALFRX 12<br />
NALLPEN ISO-OSMOTIC IN DE 24<br />
NALLPEN 24<br />
naloxone hcl 64<br />
NANDROL DEC 146<br />
naproxen dr 53<br />
naproxen ec 53<br />
naproxen sod 53<br />
NAPROXEN SODIUM 195<br />
naproxen sodium 53<br />
NAPROXEN 195<br />
naproxen 51<br />
naproxen 53<br />
narcof 106<br />
NARDIL 66<br />
NARIZ-HC 106<br />
NAROPIN 154<br />
NAROPIN 155<br />
narvox 56<br />
NASACORT AQ 136<br />
nasal decongestant non-dr 129<br />
nasal decongestant sinus 37<br />
nasal four 138<br />
NASATAB LA 129<br />
NASCOBAL 168<br />
nasex-g 129<br />
nasex 129<br />
nasohist 12<br />
NASONEX 136<br />
NATACYN 135<br />
NATAFORT 171<br />
natalcare pic forte 171<br />
natalcare pic 171<br />
natalcare plus 171<br />
natalcare rx 171<br />
natalcare three 171<br />
natamar rx 171<br />
NATAMYCIN 135<br />
natatab fa 171<br />
NATRECOR 45<br />
NATURE-THROI 153<br />
NAVANE 71<br />
NAVARRO BLOOD GLUCOSE MET 177<br />
NAVARRO BLOOD GLUCOSE TES 81<br />
navarro lancets 191<br />
nazarin hc 106<br />
nazarin 129<br />
NEBUPENT 29<br />
necon 0.5/35-28 146<br />
necon 1/35-28 146<br />
necon 1/50-28 146<br />
NECON 10/11-28 146<br />
necon 7/7/7 146<br />
NEDOCROMIL SODIUM 125<br />
nefazodone hcl 67<br />
nefazodone hcl 68<br />
nefazodone 67<br />
NEMBUTAL 74<br />
NEO AC 106<br />
NEO DM 106<br />
NEO HC 106<br />
neo/poly/bac/hc 136<br />
neo/polymyxin/hc 5-10000- 136<br />
neocin-pg 135<br />
neocin 135<br />
created on 20100520 231
neofrin 138<br />
neomycin sulfate 18<br />
neomycin-bacitracin zn-polymyxin<br />
135<br />
neomycin-polymy-dexameth 136<br />
neomycin-polymy-gramicid 135<br />
neomycin-polymyxin-hc (ophth) 136<br />
neomycin-polymyxin-hc (otic) 136<br />
neomycin/bacitracin zn/po 135<br />
neomycin/bacitracin/polym 135<br />
neomycin/bacitracin/polym 136<br />
neomycin/polymyxin/bacitr 135<br />
neomycin/polymyxin/dexame 136<br />
neomycin/polymyxin/gramic 135<br />
neomycin/polymyxin/hc 136<br />
neomycin/polymyxin/hydroc 136<br />
neomycin 17<br />
NEOPROFEN 53<br />
neostigmine methylsulfate 33<br />
NEOTRON-S 39<br />
NEOTUSS PLUS 106<br />
NEOTUSS-D 106<br />
neotuss 106<br />
NEPHRAMINE 87<br />
NERVIDOX-6 NR 168<br />
NESACAINE 155<br />
nescon-pd 129<br />
nestrex 168<br />
netgroup lancets 189<br />
NEULASTA 42<br />
NEUMEGA 42<br />
NEUPOGEN 42<br />
NEURO-B12 FORTE NR 168<br />
NEURO-B12 FORTE 168<br />
neuro-k-250 vitamin b6 168<br />
neuro-k-500 168<br />
neuro-k-50 168<br />
NEURODEP 171<br />
NEUT 83<br />
neutrahist pdx 106<br />
neutrahist 12<br />
NEUTREXIN 29<br />
NEUTROGENA ACNE MASK 161<br />
neutrogena 161<br />
NEXAVIR 175<br />
NEXGEN METER KIT 191<br />
NEXGEN TEST STRIPS 81<br />
NEXIUM I.V. 143<br />
NEXIUM 143<br />
nexphen pd 129<br />
next choice 146<br />
nicardipine hcl 47<br />
nicotine polacrilex 39<br />
NICOTINE TRANSDERMAL SYST 39<br />
nicotine 39<br />
NICOTROL INHALER 39<br />
NICOTROL NS 39<br />
nifediac cc 47<br />
nifedical xl 47<br />
nifedipine 47<br />
niferex-pn forte 171<br />
night time cold medicine 106<br />
NIGHT TIME MULTI-SYMPTOM 106<br />
night time pain medicine 76<br />
night time 106<br />
night-time cold medicine 106<br />
night-time cold/flu relie 106<br />
night-time cough 106<br />
night-time multi-symptom 106<br />
night-time sinus 3<br />
nighttime cold & cough 106<br />
nighttime cold medicine 106<br />
nighttime cold/flu relief 106<br />
nighttime cold 106<br />
nighttime cough 106<br />
nighttime flu/cold/cough 106<br />
nighttime multi-symptom c 106<br />
nighttime sinus congestio 12<br />
NIMBEX 38<br />
nite time childrens cold 106<br />
nite time cold medicine 106<br />
NITE TIME LIQUID CAPS 106<br />
nite time multi-symptom c 106<br />
nite time 106<br />
NITE-TIME COLD/FLU RELIEF 106<br />
nite-time cold/flu relief 106<br />
nite-time cold/flu relief 3<br />
nite-time cough medicine 106<br />
nite-time liquid caps 106<br />
nite-time multi-symptom c 106<br />
nite-time multi-symptom 106<br />
nite-time 106<br />
nitetime multi-symptom co 106<br />
nitrofur mac 29<br />
nitrofurantn 29<br />
nitrofuranto 29<br />
NITROFURANTOIN MACROCRYSTAL<br />
29<br />
nitrofurantoin macrocrystal 29<br />
nitrofurantoin monohyd macro 29<br />
NITROFURANTOIN 29<br />
NITROGLYCER 45<br />
nitroglycerin in d5w 45<br />
NITROGLYCERIN 45<br />
NITROLINGUAL PUMPSPRAY DU 45<br />
NITROLINGUAL PUMPSPRAY 45<br />
NITROPRESS 45<br />
NITROSTAT 45<br />
NIZORAL A-D 159<br />
nohist dmx 106<br />
nohist-a 12<br />
nohist-pdx 106<br />
nohist-pe 12<br />
nohist-plus jr 12<br />
nohist-plus 12<br />
nohist 12<br />
nomuc-pe 129<br />
non aspirin 62<br />
non-asa chld 62<br />
non-asa infa 62<br />
non-asa jr 62<br />
non-asa pain 62<br />
non-asa severe allergy 3<br />
non-aspirin childrens 62<br />
non-aspirin cold 107<br />
NON-ASPIRIN EXTRA STRENGT 62<br />
non-aspirin extra strengt 62<br />
non-aspirin flu maximum s 107<br />
non-aspirin jr strength 62<br />
non-aspirin junior streng 61<br />
non-aspirin junior streng 62<br />
non-aspirin pain relief p 76<br />
non-aspirin pm extra stre 76<br />
NON-ASPIRIN REGULAR STREN 62<br />
non-aspirin severe conges 107<br />
non-aspirin sinus maximum 37<br />
non-aspirin sinus/allergy 12<br />
non-aspirin sinus 37<br />
non-aspirin 62<br />
non-drowsy sinus 37<br />
non-drying sinus 129<br />
non-pseudo cold relief 107<br />
non-pseudo sinus pain/pre 34<br />
NONOXYNOL-9 78<br />
created on 20100520 232
nora-be 147<br />
NORDITROPIN CARTRIDGE 151<br />
NORDITROPIN FLEXPRO 151<br />
NORDITROPIN NORDIFLEX PEN 151<br />
NOREL EX 129<br />
NOREL LA 3<br />
norel sd 12<br />
NOREL SR 16<br />
NORELGESTROMIN-ETHINYL<br />
ESTRADIOL 147<br />
norepinephrine bitartrate 37<br />
norethin ace 151<br />
norethindrone & eth estradiol 147<br />
norethindrone & mestranol 147<br />
norethindrone (contraceptive) 147<br />
norethindrone acetate 151<br />
NORETHINDRONE-ETH ESTRADIOL<br />
(BIPHASIC) 147<br />
norethindrone-eth estradiol (triphasic)<br />
147<br />
norgestimate-ethinyl estradiol 147<br />
norgestrel & ethinyl estradiol 147<br />
norgestrel/ethinyl estrad 147<br />
NORMOSOL-R 85<br />
nortemp 62<br />
NORTHYX 154<br />
northyx 154<br />
nortrel 0.5/35 (28) 147<br />
nortrel 1/35 (21) 147<br />
nortrel 1/35 (28) 147<br />
nortrel 7/7/7 147<br />
nortriptylin 66<br />
nortriptylin 69<br />
nortriptyline hcl 66<br />
nortriptyline hcl 69<br />
nortuss-de 107<br />
nortuss-ex 107<br />
NORVIR 27<br />
NORVIR 28<br />
nose 138<br />
NOTUSS-FORTE 107<br />
NOTUSS-PE 107<br />
NOVA MAX BLOOD GLUCOSE MO 191<br />
NOVA MAX GLUCOSE TEST STR 81<br />
nova sureflex lancets 191<br />
novadyne dh 107<br />
novadyne expectorant 107<br />
novagest expectorant/code 107<br />
NOVAHISTINE DH 107<br />
NOVAPLUS NABI-HB 155<br />
NOVASUS 107<br />
NOVOCAIN 155<br />
NOVOFINE 30GX8MM 191<br />
NOVOFINE 31 191<br />
NOVOFINE 32GX6MM 191<br />
NOVOFINE AUTOCOVER 30GX8M 191<br />
NOVOLIN 70/30 INNOLET 149<br />
NOVOLIN 70/30 PENFILL 149<br />
NOVOLIN 70/30 149<br />
NOVOLIN N INNOLET 149<br />
NOVOLIN N U-100 PENFILL 149<br />
NOVOLIN N U-100 149<br />
NOVOLIN N 149<br />
NOVOLIN R INNOLET 149<br />
NOVOLIN R U-100 PENFILL 149<br />
NOVOLIN R U-100 149<br />
NOVOLIN R 149<br />
NOVOLOG FLEXPEN 149<br />
NOVOLOG MIX 70/30 PENFILL 149<br />
NOVOLOG MIX 70/30 PREFILL 149<br />
NOVOLOG MIX 70/30 149<br />
NOVOLOG PENFILL 149<br />
NOVOLOG 149<br />
NOVOSEVEN RT 43<br />
NOVOSEVEN 43<br />
NPLATE 42<br />
nu-way 138<br />
NUCOFED 107<br />
nuhist pediatric 12<br />
NUMOBID DX 107<br />
NUMOBID 129<br />
NUMONYL DX PEDIATRIC 107<br />
NUMONYL DX 107<br />
numonyl pediatric 129<br />
numonyl sr 129<br />
numonyl 129<br />
NUMORPHAN 57<br />
nupercainal hc 164<br />
nupercainal 164<br />
NUTRITIONAL SUPPLEMENTS 86<br />
NUTROPIN AQ NUSPIN 5 151<br />
NUTROPIN AQ 151<br />
NUTROPIN 151<br />
NUVARING 147<br />
ny-tannic 12<br />
nycair 107<br />
nyquil d cold/flu 107<br />
nystatin (mouth-throat) 27<br />
nystatin (topical) 158<br />
nystatin (topical) 159<br />
NYSTATIN VAG 159<br />
NYSTATIN VAGINAL 159<br />
nystatin-triamcinolone 164<br />
nystatin-triamcinolone 165<br />
nystatin/triamcinolone 164<br />
nystatin 158<br />
NYSTATIN 159<br />
nystatin 159<br />
nystatin 27<br />
created on 20100520 233<br />
O<br />
OCELLA 147<br />
ocella 147<br />
OCTAGAM 156<br />
OCTREOSCAN 175<br />
octreotide acetate 175<br />
OCTRON 171<br />
ocusulf- 135<br />
ocutricin 135<br />
ofloxacin (ophth) 135<br />
ofloxacin (otic) 135<br />
ofloxacin 135<br />
ofloxacin 24<br />
ofloxacin 25<br />
ogestrel 147<br />
OLMESARTAN MEDOXOMIL-<br />
HYDROCHLOROTHIAZIDE 50<br />
OLMESARTAN MEDOXOMIL 50<br />
OLOPATADINE HCL 135<br />
omeprazole 143<br />
OMNIFLEX DIAPHRAGM 78<br />
OMNIHIST II LA 12<br />
omnihist l.a. 12<br />
OMNIPAQUE 82<br />
OMNIPAQUE 83<br />
OMNISCAN SAFEPAK 79<br />
OMNISCAN 79<br />
OMNITROPE 151<br />
ONCASPAR 32<br />
ondansetron hcl and dextrose 142<br />
ONDANSETRON HCL 142<br />
ondansetron hcl 142<br />
ondansetron 142<br />
ONETOUCH BASIC SYSTEM 191<br />
ONETOUCH BASIC/PROFILE TE 81
ONETOUCH BASIC/PROFILE/ON 81<br />
onetouch club lancets fin 191<br />
onetouch combo pack 191<br />
onetouch delica lancets 191<br />
onetouch finepoint lancet 191<br />
onetouch lancets 191<br />
ONETOUCH PROFILE SYSTEM 191<br />
ONETOUCH TEST STRIPS VIAL 81<br />
ONETOUCH TEST STRIPS 81<br />
ONETOUCH ULTRA 2 191<br />
ONETOUCH ULTRA MINI 191<br />
ONETOUCH ULTRA SYSTEM KIT 191<br />
ONETOUCH ULTRA TEST STRIP 81<br />
ONETOUCH ULTRA 191<br />
ONETOUCH ULTRALINK SYSTEM 191<br />
ONETOUCH ULTRASMART 191<br />
onetouch ultrasoft lancet 191<br />
ONSET FORTE 12<br />
ONTAK 32<br />
OPANA 57<br />
OPTICHAMBER ADVANTAGE/LAR 191<br />
OPTICHAMBER ADVANTAGE/MED 191<br />
OPTICHAMBER ADVANTAGE/SMA 191<br />
OPTICHAMBER ADVANTAGE 191<br />
OPTICHAMBER FACE MASK/LAR 191<br />
OPTICHAMBER FACE MASK/MED 191<br />
OPTICHAMBER FACE MASK/SMA 191<br />
OPTIRAY 160 83<br />
OPTIRAY 240 83<br />
OPTIRAY 300 83<br />
OPTIRAY 320 83<br />
OPTIRAY 350 83<br />
OPTIUM BLOOD GLUCOSE MONI 191<br />
OPTIUM TEST STRIPS 81<br />
ORAL ELECTROLYTES 84<br />
ORAMORPH SR 57<br />
ORAXYL 25<br />
ORENCIA 173<br />
organ-i nr 130<br />
organidin nr 130<br />
ornex maximum strength 37<br />
orphenadrine citrate 38<br />
ORPHENADRINE COMPOUND DS 51<br />
orphenadrine compound ds 51<br />
ORPHENADRINE W/ ASPIRIN & CAFF<br />
51<br />
orphenadrine w/ aspirin & caff 51<br />
ORPHENADRINE/ASA/CAFFEINE 51<br />
orphenadrine/asa/caffeine 51<br />
orphenadrine 38<br />
orsini insulin syringe/u- 183<br />
orsini insulin syringe/u- 184<br />
orsini insulin syringe/u- 187<br />
ORTHO DIAPHRAGM ALL-FLEX/ 79<br />
ORTHO DIAPHRAGM ALL-FLEX 79<br />
ORTHO DIAPHRAGM COIL SPRI 78<br />
ORTHO DIAPHRAGM FLAT SPRI 78<br />
ORTHO DIAPHRAGM FLAT SPRI 79<br />
ORTHO EVRA 147<br />
ORTHO TRI-CYCLEN LO 147<br />
ORTHO UNIVERSAL INTRODUCE 79<br />
ORTHOCLONE OKT3 173<br />
oscion clnsr 161<br />
oscion 161<br />
OSELTAMIVIR PHOSPHATE 28<br />
oticin hc 136<br />
OTILAM NR 137<br />
otogesic otic 137<br />
otogesic 137<br />
otra nr 137<br />
OVIDREL 147<br />
oxacillin sodium 24<br />
OXACILLIN 24<br />
oxaliplatin 32<br />
oxaprozin 53<br />
oxazepam 75<br />
oxcarbazepine 66<br />
oxy 10 balance emergency 161<br />
oxy 10 balance maximum me 161<br />
oxy balance 161<br />
oxybutynin chloride 167<br />
oxybutynin 167<br />
oxycodone hcl 57<br />
OXYCODONE W/ ACETAMINOPHEN 57<br />
oxycodone w/ acetaminophen 57<br />
oxycodone w/ aspirin 57<br />
oxycodone-apap 57<br />
oxycodone/acetaminophen 57<br />
oxycodone/apap 57<br />
oxycodone/aspirin 57<br />
oxycodone 57<br />
OXYCONTIN 57<br />
oxytocin 155<br />
created on 20100520 234<br />
P<br />
p chlor gg 130<br />
p d natal vitamins/folic 171<br />
p-d natal plus w/folic 171<br />
p-epd tan/chlor-tan 13<br />
p-hist dm 107<br />
p-hist 107<br />
p-tann d 12<br />
p-tuss dm 107<br />
P-V TUSSIN 107<br />
pacerone 44<br />
paclitaxel 32<br />
PACNEX MX 161<br />
pacnex wash 161<br />
pain ex str 62<br />
pain pm extra strength 76<br />
pain rel 8hr 62<br />
pain rel cld 62<br />
pain relief allergy sinus 12<br />
pain relief cold pe sever 107<br />
pain relief cold pe/day 107<br />
pain relief cold pe/night 107<br />
pain relief cold severe c 107<br />
pain relief cold-cough ch 107<br />
pain relief cold 107<br />
pain relief extra strengt 62<br />
PAIN RELIEF FLU 107<br />
pain relief junior streng 62<br />
pain relief plus cough 107<br />
pain relief pm extra stre 76<br />
pain relief pm 76<br />
pain relief severe allerg 3<br />
pain relief sinus maximum 37<br />
pain relief sinus pe dayt 34<br />
pain relief sinus 37<br />
pain relief 62<br />
pain relieve 62<br />
pain reliever & sleep aid 76<br />
pain reliever allergy sin 12<br />
pain reliever cold multi- 107<br />
pain reliever cold plus c 107<br />
pain reliever extra stren 63<br />
pain reliever flu childre 107<br />
pain reliever junior stre 62<br />
pain reliever junior 62<br />
pain reliever pm extra st 76<br />
pain reliever pm 76<br />
pain reliever sinus 37<br />
pain relievr 63<br />
painaid pmf 63<br />
PALCAPS 10 141
PALCAPS 20 141<br />
pamidronate disodium 172<br />
pamidronate disodium 173<br />
PAMIDRONATE 172<br />
pamprim multi-sympton max 63<br />
PANATUSS DXP PEDIATRIC 107<br />
PANATUSS DXP 107<br />
PANCREASE MT 10 141<br />
PANCREASE MT 16 141<br />
PANCREASE MT 20 141<br />
PANCREASE MT 4 141<br />
PANCRECARB MS-16 141<br />
PANCRECARB MS-4 141<br />
PANCRECARB MS-8 141<br />
PANCRELIPASE 10000 141<br />
PANCRELIPASE 16000 141<br />
PANCRELIPASE 20000 141<br />
PANCRELIPASE 4500 141<br />
PANCRELIPASE MST-16 141<br />
PANCRELIPASE 141<br />
PANCRON 10 141<br />
PANCRON 20 141<br />
pancuronium bromide 38<br />
PANGESTYME CN 10 141<br />
pangestyme cn 10 141<br />
pangestyme cn 20 141<br />
PANGESTYME EC 141<br />
pangestyme ec 141<br />
pangestyme mt 16 141<br />
pangestyme ul 12 141<br />
pangestyme ul 18 141<br />
pangestyme ul 20 141<br />
PANGLOBULIN 156<br />
PANHEMATIN 39<br />
PANOCAPS MT 16 141<br />
PANOCAPS MT 20 141<br />
PANOCAPS 141<br />
panokase-16 141<br />
PANOKASE 141<br />
panoxyl aqua 161<br />
panoxyl wash 161<br />
PANOXYL 161<br />
pantoprazole sodium 143<br />
papaverine hcl 45<br />
PARADIGM LINK BLOOD GLUCO 191<br />
parenteral electrolytes 84<br />
paroxetine hcl 66<br />
paroxetine hcl 67<br />
paroxetine 66<br />
paroxetine 67<br />
PATADAY 135<br />
PATANOL 135<br />
PAXIL CR 67<br />
pbm allergy 107<br />
PC UNIFINE PENTIPS 29G X 194<br />
PC UNIFINE PENTIPS 31G X 194<br />
pcm allergy 12<br />
pcm la 12<br />
pcm 12<br />
pd-cof 107<br />
pd-hist d 12<br />
pdm gg 107<br />
pe 15mg/guai 600mg/dm 30 107<br />
pe 30mg/guai 1200mg 130<br />
pe 30mg/guai 900mg 130<br />
pe tann/cp tann 12<br />
pe-guai 130<br />
pe-hist dm 107<br />
PE-PSE-CPM-PYRIL W/ HYDROCODONE<br />
107<br />
PEAK FLOW METER W/INHALER<br />
ASSIST DEVICE 191<br />
ped multivitamins w/fl & iron 169<br />
pedi-atric cough-cold 108<br />
pedi-atric nightrest 108<br />
pedia relief cough-cold 108<br />
pedia relief cough/cold 108<br />
pedia relief infant 108<br />
pedia relief infants 108<br />
PEDIACARE CHILDRENS ALLER 3<br />
pediacare childrens long- 108<br />
pediacare childrens multi 108<br />
PEDIACARE CHILDRENS NIGHT 3<br />
pediacare infant deconges 108<br />
PEDIACARE INFANT LONG-ACT 108<br />
PEDIACARE LONG ACTING COU 108<br />
pediacare long-acting cou 108<br />
PEDIACARE MULTI-SYMPTOM 108<br />
pediahist dm 108<br />
pediaphyl d 13<br />
PEDIARIX 157<br />
PEDIATANN-CT 3<br />
PEDIATEX-JR DM 108<br />
pediatric cough/cold 108<br />
pediatric decongestant/co 108<br />
pediatric formula cough a 108<br />
pediatric multivitamins w/fl 169<br />
pediatric super tussin co 108<br />
pediatric vitamins acd fluoride & iron<br />
169<br />
pediatric vitamins acd w/ fluoride 169<br />
PEDVAX HIB 157<br />
PEG 3350-KCL-SOD BICARB-SOD<br />
CHLORIDE-SOD SULFATE 140<br />
PEG-INTRON 28<br />
PEGASYS 28<br />
PEN G PROC 22<br />
PEN G SOD 22<br />
PEN NEEDLES 29G X 12MM 191<br />
PEN NEEDLES 29GX1/2" 191<br />
PEN NEEDLES 31G X 1/4" SH 191<br />
PEN NEEDLES 31G X 6MM 191<br />
PEN NEEDLES 31G X 8MM 192<br />
PEN NEEDLES 31GX5/16" 191<br />
PENBUTOLOL SULFATE 47<br />
pendex 130<br />
PENICILLIN G POTASSIUM IN 22<br />
penicillin g potassium 22<br />
penicillin v potassium 22<br />
penicilln vk 22<br />
PENTACEL 157<br />
PENTAM 29<br />
pentamidine isethionate 29<br />
PENTASA 144<br />
PENTASPAN 85<br />
pentostatin 32<br />
PENTOTHAL 50<br />
PENTOTHAL 51<br />
pentuss 108<br />
PEPCID 142<br />
percogesic extra strength 3<br />
PERLOXX 57<br />
permethrin 159<br />
peroderm cleanser 161<br />
peroderm cleanser 162<br />
peroderm 161<br />
perphenazine 71<br />
pertussin 8h 108<br />
pertussin 108<br />
PHANASIN 130<br />
phanasin 130<br />
phanatuss dm 108<br />
PHANATUSS HC 108<br />
pharbedryl 3<br />
created on 20100520 235
pharbetol 63<br />
pharm monoject insulin sy 183<br />
pharm monoject insulin sy 186<br />
PHARMACIST CHOICE AUTOCOD 177<br />
pharmacist choice ultra t 190<br />
pharmacist choice ultra t 194<br />
pharmacy counter lancets 192<br />
pharmasin 130<br />
pharmatuss dm 108<br />
phen/chlor hc 108<br />
PHENA-HC 108<br />
PHENA-PLUS 13<br />
PHENA-S 12 16<br />
phenabid 13<br />
phenadoz 4<br />
phenavent d 130<br />
phenavent la 130<br />
phenavent ped 130<br />
phenavent 130<br />
phenazo 166<br />
phenazopyrid 166<br />
phenazopyridine hcl 166<br />
phenazoyrid 166<br />
phencarb gg 108<br />
phenclor tannate pediatri 13<br />
phendacof hc 108<br />
PHENDACOF PLUS 108<br />
PHENELZINE SULFATE 66<br />
PHENFLU CD 108<br />
PHENFLU CDX 108<br />
PHENFLU DM 108<br />
PHENFLU G 108<br />
phenhist expectorant 108<br />
pheniramine-pe w/ sod salicylate &<br />
caffeine citrate 13<br />
PHENIRAMINE-PHENYLEPHRINE W/<br />
APAP 13<br />
PHENOBARB 74<br />
phenobarb 74<br />
phenobarbital sodium 74<br />
PHENOBARBITAL 195<br />
PHENOBARBITAL 196<br />
PHENOBARBITAL 74<br />
phenobarbital 74<br />
phenoptic 138<br />
phenydex pediatric 130<br />
PHENYDEX 108<br />
phenydryl 13<br />
phenyl chlor-tan 13<br />
PHENYLEPH HCL-DIPHENHYD HCL-<br />
DEXTROMETHORPHAN HBR TANNATE<br />
108<br />
PHENYLEPH HCL-PYRILAMINE MAL-<br />
DEXTROMETHORPHAN HBR TANNATE<br />
108<br />
PHENYLEPH TAN-DEXBROMPHEN TAN<br />
-PYRILAMINE MALEATE-DM TAN 107<br />
PHENYLEPH TANNATE-BROMPHEN<br />
TANNATE-CARBETAPENTANE<br />
TANNATE 108<br />
phenyleph tannate-bromphen tannatecarbetapentane<br />
tannate 108<br />
PHENYLEPH TANNATE-BROMPHEN<br />
TANNATE-DEXTROMETHORPHAN<br />
TANNATE 108<br />
phenyleph tannate-bromphen tannatedextromethorphan<br />
tannate 108<br />
PHENYLEPH TANNATE-CHLORPHEN<br />
TANNATE-CARBETAPENTANE<br />
TANNATE 108<br />
phenyleph tannate-chlorphen tannatecarbetapentane<br />
tannate 108<br />
PHENYLEPH TANNATE-CHLORPHEN<br />
TANNATE-DEXTROMETHORPHAN<br />
TANNATE 108<br />
PHENYLEPH TANNATE-DIPHENHYD<br />
TANNATE-CARBETAPENTANE<br />
TANNATE 108<br />
phenyleph tannate-diphenhyd tannatecarbetapentane<br />
tannate 108<br />
phenyleph tannate-diphenhyd tannatedextromethorphan<br />
tannate 108<br />
PHENYLEPH TANNATE-PYRILAMINE<br />
TANNATE-CARBETAPENTANE<br />
TANNATE 108<br />
phenyleph tannate-pyrilamine tannate<br />
-carbetapentane tannate 108<br />
PHENYLEPH TANNATE-PYRILAMINE<br />
TANNATE-DEXTROMETHORPHAN TAN<br />
109<br />
phenyleph tannate-pyrilamine tannate<br />
-dextromethorphan tan 109<br />
PHENYLEPH-CPM W/ HYDROCOD 109<br />
phenyleph-cpm w/ hydrocod 109<br />
PHENYLEPH-DM-PYRIL-POT GUAI-SOD<br />
CIT-CITRIC ACID 88<br />
phenyleph-dm-pyril-pot guai-sod citcitric<br />
acid 88<br />
phenyleph-dm-sod citrate-citric acid<br />
109<br />
PHENYLEPH-HYDROCODONE 109<br />
phenyleph-hydrocodone 109<br />
phenyleph-promethazine w/ cod 112<br />
PHENYLEPH-PYRIL W/ HYDROCOD 109<br />
phenyleph-pyril w/ hydrocod 109<br />
PHENYLEPH-PYRIL-DM W/APAP 109<br />
phenyleph/chlorphen/hydro 103<br />
phenylephrin 138<br />
phenylephrine cm 13<br />
phenylephrine complex 109<br />
phenylephrine hcl (ophth) 138<br />
phenylephrine hcl (pressors) 34<br />
PHENYLEPHRINE HCL-BROMPHEN<br />
MAL-HYDROCODONE BITART<br />
TANNATE 107<br />
PHENYLEPHRINE HCL-<br />
DEXTROMETHORPHAN HBR-<br />
GUAIFENESIN TANNATE 107<br />
phenylephrine hcl/guaifen 130<br />
PHENYLEPHRINE HCL 138<br />
phenylephrine hcl 138<br />
phenylephrine hd 109<br />
phenylephrine hydrochlori 12<br />
phenylephrine hydrochlori 130<br />
PHENYLEPHRINE TAN-<br />
CARBETAPENTANE TAN &<br />
HOMEOPATHIC PRODUCT 88<br />
PHENYLEPHRINE TAN-<br />
DEXCHLORPHENIR TAN-<br />
DEXTROMETHORPHAN TAN 107<br />
phenylephrine tan-dexchlorphenir tan<br />
-dextromethorphan tan 107<br />
PHENYLEPHRINE TAN-<br />
DEXCHLORPHENIRAMINE TAN-<br />
HYDROCODONE TAN 107<br />
PHENYLEPHRINE TAN-<br />
DIPHENHYDRAMINE TAN-<br />
HYDROCODONE TAN 107<br />
phenylephrine tan-diphenhydramine<br />
tan-hydrocodone tan 107<br />
PHENYLEPHRINE TANNATE-<br />
CARBETAPENTANE TANNATE 109<br />
created on 20100520 236
phenylephrine tannate-carbetapentane<br />
tannate 109<br />
PHENYLEPHRINE TANNATE-<br />
GUAIFENESIN 130<br />
PHENYLEPHRINE TANNATE-<br />
PYRILAMINE TANNATE-GUAIFENESIN<br />
130<br />
phenylephrine tannate-pyrilamine<br />
tannate-guaifenesin 130<br />
phenylephrine tannate/chl 13<br />
PHENYLEPHRINE W/<br />
ACETAMINOPHEN 34<br />
phenylephrine w/ acetaminophen 34<br />
PHENYLEPHRINE W/ CODEINE-GG 110<br />
PHENYLEPHRINE W/ CODEINE 110<br />
PHENYLEPHRINE W/ DM-GG 110<br />
phenylephrine w/ dm-gg 110<br />
PHENYLEPHRINE W/ DM-POTASSIUM<br />
GUAIACOLSULFONATE 130<br />
PHENYLEPHRINE W/HYDROCODONE-<br />
GG 110<br />
phenylephrine w/hydrocodone-gg 110<br />
PHENYLEPHRINE W/HYDROCODONE-<br />
GG 111<br />
phenylephrine w/hydrocodone-gg 111<br />
PHENYLEPHRINE-ACETAMINOPHEN-<br />
GUAIFENESIN-CAFFEINE 130<br />
PHENYLEPHRINE-ACETAMINOPHEN-<br />
GUAIFENESIN 130<br />
phenylephrine-acetaminophenguaifenesin<br />
130<br />
PHENYLEPHRINE-APAP-CAFFEINE 63<br />
PHENYLEPHRINE-BROMPHENIRAMINE<br />
W/ CODEINE 111<br />
phenylephrine-brompheniramine w/<br />
codeine 111<br />
phenylephrine-brompheniraminecarbetapentane<br />
111<br />
PHENYLEPHRINE-BROMPHENIRAMINE<br />
-DEXTROMETHORPHAN-GUAIFENESIN<br />
109<br />
phenylephrine-brompheniraminedextromethorphan-guaifenesin<br />
109<br />
phenylephrine-brompheniraminedihydrocodeine<br />
111<br />
PHENYLEPHRINE-BROMPHENIRAMINE<br />
-DM 111<br />
phenylephrine-brompheniramine-dm<br />
111<br />
PHENYLEPHRINE-BROMPHENIRAMINE<br />
-GUAIFENESIN 130<br />
PHENYLEPHRINE-BROMPHENIRAMINE<br />
-HYDROCODONE 109<br />
phenylephrine-brompheniraminehydrocodone<br />
109<br />
PHENYLEPHRINE-CARBETAPENTANE-<br />
GUAIFENESIN & HOMEOPATHIC PROD<br />
88<br />
PHENYLEPHRINE-CARBETAPENTANE-<br />
GUAIFENESIN 111<br />
phenylephrine-carbetapentaneguaifenesin<br />
111<br />
PHENYLEPHRINE-CARBETAPENTANE-<br />
POTASSIUM GUAIACOLSULFONATE<br />
109<br />
PHENYLEPHRINE-CARBINOXAMINE<br />
W/ HYDROCODONE 111<br />
phenylephrine-carbinoxamine w/<br />
hydrocodone 111<br />
PHENYLEPHRINE-CARBINOXAMINE-<br />
CARBETAPENTANE 111<br />
PHENYLEPHRINE-CARBINOXAMINE-<br />
DM 111<br />
phenylephrine-carbinoxamine-dm 111<br />
PHENYLEPHRINE-CHLORPHEN-DM 111<br />
phenylephrine-chlorphen-dm 111<br />
phenylephrine-chlorphen-gg 130<br />
PHENYLEPHRINE-<br />
CHLORPHENIRAMINE W/ DM-GG 109<br />
phenylephrine-chlorpheniramine w/<br />
dm-gg 109<br />
PHENYLEPHRINE-<br />
CHLORPHENIRAMINE-<br />
CARBETAPENTANE 109<br />
PHENYLEPHRINE-<br />
CHLORPHENIRAMINE-<br />
DIHYDROCODEINE 111<br />
phenylephrine-chlorpheniraminedihydrocodeine<br />
111<br />
phenylephrine-chlorpheniramine-dm<br />
w/ apap 107<br />
phenylephrine-chlorpheniramine-dm<br />
w/ apap 109<br />
PHENYLEPHRINE-<br />
CHLORPHENIRAMINE-DM-GG-<br />
METHSCOPOLAMINE 107<br />
PHENYLEPHRINE-<br />
CHLORPHENIRAMINE-PYRILAMINE-<br />
HYDROCODONE 109<br />
PHENYLEPHRINE-CODEINE-<br />
GUAIFENESIN-ACETAMINOPHEN 111<br />
PHENYLEPHRINE-<br />
DEXBROMPHENIRAMINE-<br />
CHLOPHEDIANOL 111<br />
PHENYLEPHRINE-<br />
DEXBROMPHENIRAMINE-<br />
DEXTROMETHORPHAN 111<br />
PHENYLEPHRINE-<br />
DEXBROMPHENIRAMINE-DM-<br />
GUAIFENESIN 111<br />
phenylephrine-dexbrompheniraminehydrocodone<br />
111<br />
PHENYLEPHRINE-<br />
DEXCHLORPHENIRAMINE-CODEINE<br />
112<br />
PHENYLEPHRINE-<br />
DEXCHLORPHENIRAMINE-<br />
HYDROCODONE 109<br />
phenylephrine-dexchlorpheniraminehydrocodone<br />
109<br />
phenylephrine-dexchlorpheniraminepyrilamine-dm<br />
109<br />
PHENYLEPHRINE-<br />
DEXTROMETHORPHAN-SODIUM<br />
CITRATE 112<br />
PHENYLEPHRINE-DIHYDROCODEINE-<br />
GUAIFENESIN 112<br />
PHENYLEPHRINE-DIHYDROCODEINE<br />
112<br />
PHENYLEPHRINE-DIPHENHYDRAMINE<br />
-CODEINE 109<br />
PHENYLEPHRINE-DIPHENHYDRAMINE<br />
-DM W/ APAP 109<br />
PHENYLEPHRINE-DIPHENHYDRAMINE<br />
-DM W/ APAP 112<br />
PHENYLEPHRINE-DIPHENHYDRAMINE<br />
-DM-GG 107<br />
PHENYLEPHRINE-DIPHENHYDRAMINE<br />
-DM-GUAIFENESIN-APAP 107<br />
phenylephrine-diphenhydramine-gg<br />
w/ apap 130<br />
phenylephrine-diphenhydraminehydrocodone<br />
109<br />
created on 20100520 237
PHENYLEPHRINE-DM-GG W/ APAP 112<br />
phenylephrine-dm-gg w/ apap 112<br />
PHENYLEPHRINE-DM 112<br />
phenylephrine-dm 112<br />
phenylephrine-doxylaminedextromethorphan-acetaminophen<br />
107<br />
PHENYLEPHRINE-DOXYLAMINE-<br />
DEXTROMETHORPHAN-<br />
ACETAMINOPHEN 112<br />
PHENYLEPHRINE-EPHEDRINE-<br />
CHLORPHENIRAMINE W/<br />
CARBETAPENTANE 109<br />
phenylephrine-ephedrinechlorpheniramine<br />
w/ carbetapentane<br />
109<br />
PHENYLEPHRINE-GUAIFENESIN &<br />
HOMEOPATHIC PRODUCT 125<br />
PHENYLEPHRINE-GUAIFENESIN-<br />
CHLORPHENIRAMINE-<br />
METHSCOPOLAMINE 12<br />
PHENYLEPHRINE-GUAIFENESIN-<br />
POTASSIUM CITRATE 130<br />
PHENYLEPHRINE-GUAIFENESIN 130<br />
phenylephrine-guaifenesin 130<br />
PHENYLEPHRINE-GUAIFENESIN 131<br />
phenylephrine-guaifenesin 131<br />
PHENYLEPHRINE-<br />
METHSCOPOLAMINE 34<br />
PHENYLEPHRINE-PHENIRAMINE-COD-<br />
SOD SALICYLATE-SOD CIT-CAFF 88<br />
PHENYLEPHRINE-PHENIRAMINE-DM<br />
112<br />
PHENYLEPHRINE-POTASSIUM<br />
GUAIACOLSULFONATE 131<br />
PHENYLEPHRINE-PYRILAMINE W/ DM-<br />
GG 112<br />
PHENYLEPHRINE-PYRILAMINE W/ DM-<br />
POT GUAIACOLSULFONATE 109<br />
PHENYLEPHRINE-PYRILAMINE W/COD<br />
112<br />
PHENYLEPHRINE-PYRILAMINE-DM 112<br />
phenylephrine-pyrilamine-dm 112<br />
phenylephrine/chlorphenir 13<br />
phenylephrine/cpmm/methsc 12<br />
phenylephrine/gg la 130<br />
phenylephrine/guaifenesin 130<br />
phenylephrine/hydrocodone 107<br />
phenylephrine/hydrocodone 108<br />
phenylephrine/phenyltolox 13<br />
phenylephrine/pyrilamine/ 108<br />
phenylhistine dh modified 112<br />
PHENYLHISTINE DH 112<br />
phenylhistine expectorant 112<br />
PHENYTEK 64<br />
phenytoin ex 64<br />
PHENYTOIN SODIUM EXTENDED 64<br />
phenytoin sodium extended 64<br />
phenytoin sodium 64<br />
PHENYTOIN 64<br />
phenytoin 64<br />
phlemex forte 112<br />
phlemex-pe 112<br />
phlemex 112<br />
PHOSLO 85<br />
PHOTOFRIN 32<br />
PHRENILIN FORTE 63<br />
PHYSOS SALIC 33<br />
physostigmine salicylate 33<br />
PHYTONADIONE 169<br />
phytonadione 169<br />
pilocar 139<br />
PILOCARPINE HCL 139<br />
pilocarpine hcl 139<br />
PILOCARPINE 139<br />
pilocarpine 139<br />
PILOPTIC-1/2 140<br />
piloptic- 139<br />
PILOPTIC- 140<br />
piloptic- 140<br />
piperacillin sodium-tazobactam<br />
sodium 24<br />
PIPERACILLIN 24<br />
PIRBUTEROL ACETATE 36<br />
PIROXICAM 196<br />
piroxicam 53<br />
PLAN B 147<br />
PLARETASE 8000 141<br />
plaretase 8000 141<br />
PLAS/SD GROUP B 39<br />
PLASBUMIN-20 39<br />
PLASMA-LYTE 56 85<br />
PLASMA-LYTE A 85<br />
PLASMA-LYTE-148/D5W 85<br />
PLASMA-LYTE-148 85<br />
PLASMA-LYTE-56/D5W 85<br />
PLASMANATE 39<br />
PLASTIC ADAPTER FOR BUSH 192<br />
PLAVIX 41<br />
pledgaclin 158<br />
PLENAXIS 32<br />
pluratuss 112<br />
pms formula 63<br />
PNEUMOVAX 23/1 DOSE 157<br />
PNEUMOVAX 23/5 DOSE 157<br />
POCKETCHEM EZ BLOOD GLUCO 192<br />
POCKETCHEM EZ BLOOD GLUCO 81<br />
POLY HIST HC 112<br />
poly iron pn forte 171<br />
poly iron pn 171<br />
POLY TAN D 13<br />
POLY TAN DM 112<br />
poly-dex 136<br />
poly-iron 150 forte 39<br />
POLY-TUSSIN HD 112<br />
POLY-TUSSIN XP 112<br />
POLY-TUSSIN 112<br />
POLY-VENT JR. 131<br />
POLY-VENT PLUS 131<br />
POLY-VENT 131<br />
poly-vit drops w/fluoride 171<br />
poly-vitamin/fluoride 171<br />
poly-vitamin/iron/fluorid 171<br />
POLYGAM S/D 156<br />
polygesic 57<br />
polymyxin b sulfate/trime 135<br />
polymyxin b sulfate 26<br />
polymyxin b-trimethoprim 135<br />
polysaccharide iron forte 39<br />
polyvitamin/fluoride 171<br />
polyvites/fluoride 171<br />
polyvits/fluoride/iron 171<br />
PONTOCAINE 155<br />
portia-28 147<br />
pot chloride 85<br />
pot cl micro 85<br />
potassium acetate 85<br />
potassium bicarb & chloride 85<br />
POTASSIUM CHLORIDE 0.224% 85<br />
potassium chloride in dextrose &<br />
sodium chloride 84<br />
potassium chloride in dextrose 85<br />
potassium chloride in nacl 84<br />
potassium chloride microencapsulated<br />
crystals cr 85<br />
created on 20100520 238
POTASSIUM CHLORIDE 196<br />
POTASSIUM CHLORIDE 85<br />
potassium chloride 85<br />
potassium guaiaco/hydroco 112<br />
POTASSIUM GUAIACOLSULFONATE<br />
131<br />
POTASSIUM IODIDE (EXPECTORANT)<br />
131<br />
potassium phosphate dibasic 85<br />
pr benzoyl peroxide wash 162<br />
PRAMOXINE-HC 165<br />
PRANDIN 149<br />
prazosin hcl 46<br />
pre-hist d 13<br />
pre-natal formula 171<br />
pre-natal 171<br />
PRE-PEN 81<br />
PRECARE PRENATAL 171<br />
PRECEDEX 76<br />
PRECISION LINK 192<br />
PRECISION PCX PLUS TEST S 81<br />
PRECISION PCX 81<br />
PRECISION POINT OF CARE T 81<br />
PRECISION QID MONITOR 192<br />
PRECISION QID TEST STRIPS 81<br />
PRECISION SOF-TACT MONITO 192<br />
PRECISION SOF-TACT TEST S 81<br />
precision sure-dose insul 181<br />
precision sure-dose insul 182<br />
precision sure-dose insul 183<br />
precision sure-dose insul 184<br />
precision sure-dose insul 185<br />
precision sure-dose plus 180<br />
precision sure-dose plus 186<br />
precision thin lancets 192<br />
precision thins gp lancet 190<br />
precision ultra lancet 192<br />
PRECISION XTRA BLOOD GLUC 81<br />
PRECISION XTRA MONITOR 192<br />
PRECISION XTRA 192<br />
pred sod pho 145<br />
PRED-G S.O.P. 136<br />
PRED-G 136<br />
prednicarbat 165<br />
prednicarbate 165<br />
prednisolone acetate (ophth) 137<br />
PREDNISOLONE ANHYDROUS 196<br />
PREDNISOLONE HYDROUS 196<br />
prednisolone sodium phosp 145<br />
PREDNISOLONE SODIUM PHOSPHATE<br />
145<br />
prednisolone sodium phosphate 145<br />
prednisolone sol 145<br />
prednisolone/sulfacetamid 136<br />
prednisolone/sulfacetamid 137<br />
prednisolone 137<br />
PREDNISOLONE 145<br />
prednisolone 145<br />
PREDNISOLONE 196<br />
PREDNISONE 145<br />
prednisone 145<br />
PREDNISONE 146<br />
prednisone 146<br />
preferred plus insulin sy 180<br />
preferred plus insulin sy 181<br />
preferred plus insulin sy 182<br />
preferred plus insulin sy 183<br />
preferred plus insulin sy 184<br />
preferred plus insulin sy 185<br />
preferred plus insulin sy 186<br />
preferred plus insulin sy 187<br />
preferred plus lancets co 189<br />
preferred plus lancets su 190<br />
preferred plus lancets th 190<br />
PREFERRED PLUS UNIFINE PE 194<br />
PREGABALIN 66<br />
PREMARIN 147<br />
PREMASOL 87<br />
premsyn pms maximum stren 63<br />
premsyn pms 63<br />
prenaplus 171<br />
prenatabs fa 171<br />
prenatal 1 plus 1 171<br />
prenatal and iron 172<br />
prenatal fa 171<br />
prenatal formula 3 171<br />
prenatal formula 171<br />
prenatal forte 171<br />
prenatal low iron 171<br />
prenatal mr 90 fe 171<br />
prenatal mtr/selenium 171<br />
prenatal multivit-min w/fe-fa 169<br />
prenatal multivitamin & 171<br />
prenatal plus nf 171<br />
prenatal plus/27mg iron 172<br />
prenatal plus/betacaroten 171<br />
prenatal plus/iron 171<br />
prenatal plus 171<br />
prenatal rx 1 172<br />
prenatal rx/beta-carotene 172<br />
prenatal rx 172<br />
prenatal s 172<br />
prenatal vit w/ docusate-fe fumaratefolic<br />
acid 169<br />
prenatal vit w/ ferrous fumarate-folic<br />
acid 169<br />
PRENATAL VIT W/ FERROUS<br />
FUMARATE-FOLIC ACID 170<br />
prenatal vit w/ ferrous fumarate-folic<br />
acid 170<br />
PRENATAL VIT W/ FERROUS<br />
GLUCONATE-FOLIC ACID 170<br />
prenatal vit w/ ferrous gluconate-folic<br />
acid 170<br />
PRENATAL VIT W/ IRON CARBONYL-<br />
FE SULFATE-FOLIC ACID 170<br />
prenatal vit w/ iron carbonyl-fe<br />
sulfate-folic acid 170<br />
prenatal vit w/ iron polysaccharide<br />
complex-folic acid 170<br />
PRENATAL VIT W/ SELENIUM-FE<br />
FUMARATE-FOLIC ACID 170<br />
prenatal vit w/ selenium-fe fumaratefolic<br />
acid 170<br />
prenatal vitamins 171<br />
prenatal vitamins 172<br />
PRENATAL WITHOUT A VIT W/ FE<br />
FUMARATE-FOLIC ACID 170<br />
prenatal without a vit w/ fe fumaratefolic<br />
acid 170<br />
prenatal z advanced formu 172<br />
prenatal z 172<br />
prenatal/folic acid 172<br />
prenatal 171<br />
prenavite multiple vitami 172<br />
prenavite protein coated 172<br />
PRENTIF CAVITY-RIM CERVIC 79<br />
PRENTIF FITTING SET 79<br />
prep h hc 165<br />
prestige lite touch lance 190<br />
PRESTIGE LX BLOOD GLUCOSE 192<br />
PRESTIGE LX STARTER KIT 192<br />
PRESTIGE SMART SYSTEM CO- 192<br />
PRESTIGE SMART SYSTEM CO- 81<br />
created on 20100520 239
PRESTIGE SMART SYSTEM IQ 192<br />
prestige smart system lan 192<br />
PRESTIGE SMART SYSTEM VAL 192<br />
PRESTIGE SMART SYSTEM/MET 192<br />
PRESTIGE TEST STRIPS 81<br />
PRESTIGE VALUE PACK 81<br />
PREVACID 24H 143<br />
PREVACID I.V 143<br />
PREVACID NAPRAPAC 53<br />
PREVACID SOLUTAB 143<br />
PREVACID 143<br />
previfem 147<br />
PREVNAR 13 157<br />
PREVNAR 157<br />
PREVPAC 143<br />
PRIALT 63<br />
PRIMALEV 57<br />
PRIMAQUINE PHOSPHATE 196<br />
PRIMAQUINE PHOSPHATE 29<br />
PRIMAQUINE 29<br />
PRIMAXIN I.M. 20<br />
PRIMAXIN IV 20<br />
primidone 64<br />
PRIMLEV 57<br />
PRISMASOL B22GK 2/0 85<br />
PRISMASOL BGK 0/2.5 85<br />
PRISMASOL BGK 2/0 85<br />
PRISMASOL BGK 2/3.5 85<br />
PRISMASOL BGK 4/0/1.2 85<br />
PRISMASOL BGK 4/2.5 85<br />
PRISMASOL BK 0/0/1.2 85<br />
PRIVIGEN 156<br />
PRO-CLEAR AC 112<br />
PRO-CLEAR 112<br />
pro-otic 137<br />
PRO-RED AC 112<br />
PRO-RED 112<br />
pro-tannate pediatric 13<br />
PROAIR HFA 35<br />
PROAIR HFA 36<br />
PROCAINAMIDE HCL 43<br />
procainamide hcl 43<br />
PROCAINAMIDE HCL 44<br />
procainamide 43<br />
PROCAINAMIDE 44<br />
PROCALAMINE 87<br />
PROCANBID 44<br />
PROCARBAZINE HCL 32<br />
PROCENTRA 72<br />
prochlorper 71<br />
prochlorperazine edisylate 71<br />
prochlorperazine maleate 71<br />
prochlorperazine 71<br />
PROCRIT 42<br />
procto-kit 165<br />
procto-pak 165<br />
proctocare-hc 165<br />
proctocream-hc 165<br />
PROCTOFOAM HC 166<br />
proctosert h 165<br />
proctosol hc 165<br />
proctozone-hc 165<br />
prodec-dm 112<br />
PRODIGY AUTOCODE BLOOD GL 192<br />
PRODIGY AUTOCODE BLOOD GL 81<br />
PRODIGY BLOOD GLUCOSE MON 192<br />
PRODIGY BLOOD GLUCOSE TES 81<br />
PRODIGY EJECT BLOOD GLUCO 192<br />
PRODIGY EJECT BLOOD GLUCO 81<br />
prodigy insulin syring/u- 182<br />
prodigy insulin syringe/1 185<br />
PRODIGY NO CODING BLOOD G 81<br />
PRODIGY POCKET BLOOD GLUC 192<br />
PRODIGY PREFERRED BLOOD G 192<br />
prodigy pressure activate 192<br />
prodigy safety lancets 192<br />
prodigy twist top lancets 192<br />
PRODIGY VOICE BLOOD GLUCO 192<br />
PRODIGY VOICE BLOOD GLUCO 81<br />
PROFASI HP 147<br />
PROFILNINE 43<br />
progesterone 151<br />
PROGRAF 173<br />
PROHANCE 79<br />
PROLASTIN-C 134<br />
PROLASTIN 134<br />
PROLEUKIN 32<br />
prolex dh expectorant 112<br />
PROLEX DMX 112<br />
promethazine & phenylephrine 4<br />
PROMETHAZINE HCL 196<br />
PROMETHAZINE HCL 4<br />
promethazine hcl 4<br />
promethazine vc plain 4<br />
promethazine vc/codeine 112<br />
promethazine vc 4<br />
promethazine w/codeine 112<br />
promethazine-dm 112<br />
promethazine/codeine 112<br />
promethazine/dextromethor 112<br />
promethazine/phenylephrin 4<br />
PROMETHAZINE 4<br />
promethazine 4<br />
promethegan 4<br />
PROMIT 86<br />
PROMOTE 87<br />
PRONESTYL 44<br />
PROPANTHELIN 34<br />
propanthelin 34<br />
PROPANTHELINE BROMIDE 34<br />
propantheline bromide 34<br />
PROPINE 138<br />
PROPLEX T FACTOR IX COMP 43<br />
propofol 51<br />
propoxacet-n 57<br />
propoxyphene napsylate/ac 57<br />
propoxyphene-n w/ apap 57<br />
propoxyphene-n w/ apap 58<br />
propoxyphene-n/acetaminop 57<br />
propranolol hcl 47<br />
PROPRANOLOL 47<br />
propranolol 47<br />
propylthiour 154<br />
propylthiouracil 154<br />
PROQUAD 157<br />
proset d 131<br />
PROSOL 87<br />
PROSTASCINT 175<br />
PROTAMINE SU 42<br />
protex d 112<br />
protex 112<br />
PROTID 13<br />
PROTONIX 143<br />
PROTOPIC 167<br />
PROVENGE 32<br />
PROVENTIL HFA 36<br />
PROVIGIL 74<br />
PROVISC 140<br />
PROZAC WEEKL 67<br />
pse 120/msc 2.5 37<br />
pse 15/cpm 2 13<br />
pse 90/cpm 8/msc 2.5 10<br />
pse allergy dm 112<br />
pse allergy 3<br />
created on 20100520 240
pse bpm hd 112<br />
pse bpm 13<br />
pse brom dm 113<br />
pse carb dm 113<br />
pse carbinoxamine dm 113<br />
pse cpm 13<br />
pse/cpm 13<br />
pseubrom-pd 13<br />
pseubrom 13<br />
PSEUDACARB 113<br />
pseudatex hc 113<br />
pseudo carb dm 113<br />
pseudo carb 3<br />
pseudo cm 13<br />
pseudo cough 113<br />
pseudo gg tr 131<br />
pseudo max dmx 113<br />
pseudo max 131<br />
pseudo-chlor/codeine 113<br />
pseudo-plus 13<br />
pseudo/bromphen maleate 13<br />
pseudo/guaifen/dex 113<br />
pseudo/trip 13<br />
PSEUDOEPH HCL-PYRILAMINE MAL-<br />
DEXTROMETHORPHAN HBR TANNATE<br />
113<br />
PSEUDOEPH W/HYDROCODONE-GG<br />
116<br />
pseudoeph w/hydrocodone-gg 116<br />
PSEUDOEPH-CHLORPHEN W/ COD 116<br />
pseudoeph-chlorphen w/ cod 116<br />
PSEUDOEPH-CPM-DM W/APAP 113<br />
pseudoeph-cpm-dm w/apap 113<br />
PSEUDOEPH-CPM-GG 131<br />
PSEUDOEPH-DIPHENHYD-DM W/APAP<br />
113<br />
pseudoeph/carbinox/dm 113<br />
pseudoeph/guaifenesin 131<br />
PSEUDOEPHED HCL-CARBINOX MAL-<br />
DM HBR TANNATE 113<br />
pseudoephed hcl-chlorphen mal-dm<br />
hbr tannate 113<br />
PSEUDOEPHED-BROMPHEN-DM 114<br />
pseudoephed-bromphen-dm 114<br />
PSEUDOEPHED-CARBINOX-DM 114<br />
pseudoephed-carbinox-dm 114<br />
PSEUDOEPHED-CPM W/ HYDROCOD<br />
113<br />
pseudoephed-cpm w/ hydrocod 113<br />
pseudoephed-doxyl-dm w/apap 113<br />
PSEUDOEPHED-METHSCOP &<br />
CHLORPHEN-PHENYLEPH-METHSCOP<br />
13<br />
pseudoephedrine cold/alle 13<br />
PSEUDOEPHEDRINE HCL-CHLORPHEN<br />
MAL-HYDROCODONE BITART<br />
TANNATE 113<br />
PSEUDOEPHEDRINE HCL-<br />
DEXTROMETHORPHAN HBR-<br />
GUAIFENESIN TANNATE 113<br />
pseudoephedrine hcl/chlor 13<br />
pseudoephedrine hcl/guaif 113<br />
PSEUDOEPHEDRINE HCL/GUAIF 131<br />
pseudoephedrine hcl/guaif 131<br />
pseudoephedrine hcl/tripr 13<br />
pseudoephedrine plus 13<br />
PSEUDOEPHEDRINE TAN-BROMPHEN<br />
TAN-DEXTROMETHORPHAN TAN 113<br />
pseudoephedrine tan-bromphen tandextromethorphan<br />
tan 113<br />
PSEUDOEPHEDRINE TAN-<br />
BROMPHENIRAMINE TAN-<br />
HYDROCODONE TAN 113<br />
PSEUDOEPHEDRINE TAN-<br />
CARBINOXAMINE TAN-<br />
DEXTROMETHORPHAN TAN 113<br />
pseudoephedrine tan-carbinoxamine<br />
tan-dextromethorphan tan 113<br />
PSEUDOEPHEDRINE TAN-CHLORPHEN<br />
TAN-DEXTROMETHORPHAN TAN 114<br />
pseudoephedrine tan-chlorphen tandextromethorphan<br />
tan 114<br />
PSEUDOEPHEDRINE TAN-<br />
DEXCHLORPHEN TAN-<br />
DEXTROMETHORPHAN TAN 114<br />
pseudoephedrine tan-dexchlorphen<br />
tan-dextromethorphan tan 114<br />
PSEUDOEPHEDRINE TANNATE-<br />
CARBETAPENTANE TANNATE 114<br />
pseudoephedrine tannatecarbetapentane<br />
tannate 114<br />
PSEUDOEPHEDRINE TANNATE-<br />
HYDROCODONE TANNATE 114<br />
PSEUDOEPHEDRINE W/ APAP-DM 114<br />
pseudoephedrine w/ apap-dm 114<br />
PSEUDOEPHEDRINE W/ APAP-DM 115<br />
pseudoephedrine w/ apap-dm 115<br />
PSEUDOEPHEDRINE W/ APAP 37<br />
pseudoephedrine w/ apap 37<br />
PSEUDOEPHEDRINE W/ CODEINE-GG<br />
115<br />
pseudoephedrine w/ codeine-gg 115<br />
PSEUDOEPHEDRINE W/ CODEINE 115<br />
pseudoephedrine w/ codeine 115<br />
PSEUDOEPHEDRINE W/ DM-GG 115<br />
pseudoephedrine w/ dm-gg 115<br />
PSEUDOEPHEDRINE W/ DM-GG 116<br />
pseudoephedrine w/ dm-gg 116<br />
pseudoephedrine w/ hydrocodonepotassium<br />
guaiacolsulfonate 113<br />
PSEUDOEPHEDRINE W/<br />
HYDROCODONE 116<br />
pseudoephedrine w/ hydrocodone 116<br />
PSEUDOEPHEDRINE-ACETAMINOPHEN<br />
-GUAIFENESIN 131<br />
PSEUDOEPHEDRINE-<br />
BROMPHENIRAMINE-CODEINE 116<br />
pseudoephedrine-brompheniraminecodeine<br />
116<br />
PSEUDOEPHEDRINE-<br />
BROMPHENIRAMINE-<br />
DIHYDROCODEINE 114<br />
pseudoephedrine-brompheniraminedm-gg<br />
114<br />
PSEUDOEPHEDRINE-<br />
BROMPHENIRAMINE-HYDROCODONE<br />
113<br />
pseudoephedrine-brompheniraminehydrocodone<br />
113<br />
PSEUDOEPHEDRINE-<br />
CARBETAPENTANE-GUAIFENESIN 114<br />
pseudoephedrine-carbinoxamine w/<br />
hydrocodone 113<br />
PSEUDOEPHEDRINE-CHLOPHEDIANOL<br />
-GUAIFENESIN 116<br />
PSEUDOEPHEDRINE-CHLORPHEN-DM<br />
114<br />
pseudoephedrine-chlorphen-dm 114<br />
PSEUDOEPHEDRINE-<br />
CHLORPHENIRAMINE W/ DM-GG 114<br />
PSEUDOEPHEDRINE-<br />
CHLORPHENIRAMINE W/<br />
HYDROCODONE-GG 116<br />
created on 20100520 241
pseudoephedrine-chlorpheniramine<br />
w/ hydrocodone-gg 116<br />
PSEUDOEPHEDRINE-<br />
CHLORPHENIRAMINE-<br />
DIHYDROCODEINE 114<br />
pseudoephedrine-chlorpheniraminedihydrocodeine<br />
114<br />
PSEUDOEPHEDRINE-CODEINE-<br />
GUAIFENESIN-ACETAMINOPHEN 114<br />
PSEUDOEPHEDRINE-<br />
DEXBROMPHENIRAMINE W/ DM-GG<br />
116<br />
PSEUDOEPHEDRINE-<br />
DEXCHLORPHENIRAMINE-<br />
CHLOPHEDIANOL 114<br />
PSEUDOEPHEDRINE-<br />
DIHYDROCODEINE-GUAIFENESIN 116<br />
pseudoephedrine-dihydrocodeineguaifenesin<br />
116<br />
PSEUDOEPHEDRINE-DM-GG W/ APAP<br />
116<br />
pseudoephedrine-dm-gg w/ apap 116<br />
PSEUDOEPHEDRINE-DM-GG W/ APAP<br />
117<br />
PSEUDOEPHEDRINE-DM-GG-SODIUM<br />
CITRATE 117<br />
PSEUDOEPHEDRINE-DM 116<br />
pseudoephedrine-dm 116<br />
PSEUDOEPHEDRINE-GUAIFENESIN 131<br />
pseudoephedrine-guaifenesin 131<br />
PSEUDOEPHEDRINE-GUAIFENESIN 132<br />
pseudoephedrine-guaifenesin 132<br />
PSEUDOEPHEDRINE-IBUPROFEN 37<br />
pseudoephedrine-ibuprofen 37<br />
pseudoephedrine-methscopolamine 37<br />
pseudoephedrine-naproxen sodium 53<br />
PSEUDOEPHEDRINE-PYRILAMINE-<br />
CARBETAPENTANE 114<br />
PSEUDOEPHEDRINE-PYRILAMINE-<br />
CODEINE 117<br />
PSEUDOEPHEDRINE-TRIPROLIDINE-<br />
HYDROCODONE 114<br />
pseudoephedrine/brompheni 13<br />
pseudoephedrine/chlorphen 13<br />
pseudoephedrine/codeine 113<br />
PSEUDOEPHEDRINE/DEXTROMET 113<br />
pseudoephedrine/dextromet 113<br />
pseudoephedrine/guaifenes 113<br />
pseudoephedrine/guaifenes 114<br />
PSEUDOEPHEDRINE/GUAIFENES 131<br />
pseudoephedrine/guaifenes 131<br />
pseudoephedrine/hydrocodo 113<br />
pseudopehedrine-dextromet 113<br />
PSEUDOVENT 400 132<br />
pseudovent 400 132<br />
pseudovent dm 117<br />
pseudovent ped 132<br />
pseudovent 132<br />
pseudox m 3<br />
psoriatec 167<br />
pss select gp lancets 192<br />
pss select safety lancets 192<br />
PTS PANELS GLUCOSE TEST 81<br />
pulexn dm 117<br />
pulmari-gp 117<br />
pulmari 117<br />
PULMICORT FLEXHALER 146<br />
PULMICORT TURBUHALER 146<br />
PULMICORT 146<br />
px allergy sinus pe 13<br />
px childrens pain relief 60<br />
px cold relief multi-symp 93<br />
px cold/flu relief day/ni 94<br />
px dayhist 3<br />
px daytime cold/flu relie 117<br />
px daytime cold 117<br />
px daytime multi-symptom 117<br />
px daytime pe 95<br />
px dibromm cold/allergy c 13<br />
px dibromm dm cold/cough 97<br />
PX EXTRA SHORT PEN NEEDLE 191<br />
px ibuprofen cold & sinus 37<br />
px insulin syringe/u-100/ 181<br />
px insulin syringe/u-100/ 182<br />
px insulin syringe/u-100/ 184<br />
px insulin syringe/u-100/ 185<br />
px insulin syringe/u-100/ 187<br />
px insulin syringe/u-100/ 188<br />
px lancets ultra thin 192<br />
px lancets 192<br />
PX MEDICATED CHESTRUB 175<br />
px nighttime cold 117<br />
px nitetime cold/flu reli 117<br />
px nitetime cough 117<br />
px nitetime multi-symptom 117<br />
px pain relief pm extra s 76<br />
PX PEN NEEDLE 29GX12MM 191<br />
PX PEN NEEDLE 31GX8MM 192<br />
px prenatal multivitamins 172<br />
px severe cold 117<br />
px sinus relief 34<br />
px tussin cf 117<br />
px tussin dm 117<br />
px tussin 132<br />
pyrazinamide 27<br />
pyri 168<br />
pyrichlor pe 13<br />
pyridostigm 33<br />
PYRIDOSTIGMINE BROMIDE 33<br />
pyridostigmine bromide 33<br />
pyridoxine hcl 169<br />
PYRIDOXINE/MINERALS 169<br />
pyridoxine 168<br />
pyridoxine 169<br />
pyril d 13<br />
pyril dm 117<br />
pyril mal/phenyleph hcl/d 117<br />
pyril mal/phenyleph hcl 13<br />
pyrilafen tannate-12 4<br />
PYRILAMINE MALEATE-<br />
PHENYLEPHRINE HCL TANNATE 13<br />
pyrilamine maleate-phenylephrine hcl<br />
tannate 13<br />
PYRILAMINE MALEATE-<br />
PSEUDOEPHEDRINE HCL TANNATE 4<br />
PYRILAMINE TANNATE-<br />
PHENYLEPHRINE TANNATE 4<br />
pyrilamine tannate-phenylephrine<br />
tannate 4<br />
PYRILAMINE-DM-GG-SODIUM<br />
CITRATE 117<br />
PYRILAMINE-PHENYLEPHRINE 4<br />
PYRIMETHAMINE 29<br />
PYRLEX CB 117<br />
PYRLEX PD 4<br />
pyrroxate 34<br />
created on 20100520 242<br />
Q<br />
q-pap child 63<br />
q-pap childrens 63<br />
q-pap ex st 63<br />
q-pap infant 63<br />
q-pap 63<br />
q-tapp dm 117<br />
q-tapp 13
q-tussin cf cough & cold 117<br />
q-tussin dm 117<br />
q-tussin pe -af 132<br />
q-tussin 132<br />
q-v tussin 117<br />
qc allergy relief multi-s 13<br />
qc allergy relief multi-s 3<br />
qc allergy/sinus headache 3<br />
qc allergy/sinus-d 3<br />
qc arthritis 63<br />
qc azo 166<br />
qc cgh relf 117<br />
qc childrens non-aspirin 60<br />
qc cold & allergy dm 93<br />
qc cold & allergy 9<br />
qc cold head congestion n 117<br />
qc cold head congestion s 117<br />
qc cold multi-symptom nig 105<br />
qc cold multi-symptom sev 105<br />
qc cold relief plus multi 117<br />
qc cold relief plus 9<br />
qc cold relief 3<br />
qc cold/allergy 9<br />
qc cough/cold 117<br />
qc cough/sore throat dayt 117<br />
qc cough/sore throat nigh 117<br />
qc daytime cold medicine 117<br />
qc daytime multi-symptom 117<br />
qc daytime sinus 34<br />
qc daytime sinus 37<br />
qc flu relief therapy sev 117<br />
qc flu relief therapy sev 3<br />
qc heartburn 142<br />
QC HOT STEAM 175<br />
qc hydrocort 165<br />
qc hydrocortisone maximum 165<br />
qc ibuprofen cold/sinus 37<br />
qc ibuprofen/pseudoephedr 36<br />
qc infants 63<br />
qc insulin syringe 0.5ml/ 183<br />
qc insulin syringe 0.5ml/ 184<br />
QC INSULIN SYRINGE 1ML/29 186<br />
qc insulin syringe/0.3ml/ 181<br />
qc insulin syringe/0.5ml/ 183<br />
qc insulin syringe/0.5ml/ 185<br />
qc insulin syringe/1ml/29 186<br />
qc insulin syringe/1ml/30 187<br />
qc insulin syringe/1ml/31 188<br />
qc intense cold medicine 3<br />
qc intense cough reliever 104<br />
qc lancets super thin 192<br />
qc lancets thin 192<br />
qc lancets ultra thin 192<br />
qc lancets 192<br />
qc medifin cp 132<br />
qc medifin dm 117<br />
qc medifin 132<br />
qc multi way 138<br />
qc nighttime cold/flu rel 117<br />
qc nighttime cough 117<br />
qc nighttime multi-sympto 117<br />
qc nighttime sinus 3<br />
qc non-aspirin childrens 63<br />
qc non-aspirin pm 76<br />
QC PEN NEEDLES 29G X 12MM 191<br />
QC PEN NEEDLES 31G X 6MM 191<br />
QC PEN NEEDLES 31G X 8MM 192<br />
qc pms multi-symptom 63<br />
qc prenatal 172<br />
qc severe allergy 3<br />
qc severe cold & cough da 117<br />
qc severe cold & cough ni 3<br />
qc severe cold congestion 119<br />
qc sinus congestion & pai 133<br />
qc sinus pain relief 34<br />
qc suphedrine cold/allerg 13<br />
qc suphedrine sinus night 13<br />
qc triactin chest congest 132<br />
qc triactin cold/allergy 15<br />
qc triactin cold/cough 121<br />
qc tussin cf 117<br />
qc tussin cf 123<br />
qc tussin cold/cough 123<br />
QDALL 13<br />
quad tann pediatric 117<br />
quad tann 117<br />
quad-tuss tannate pediatr 117<br />
QUADRAMET 155<br />
quadratuss pediatric 117<br />
quadratuss 117<br />
qual-tussin dc 117<br />
qual-tussin pediatric 132<br />
qual-tussin 117<br />
quala-hc 117<br />
quartuss dm 117<br />
quartuss 117<br />
QUELICIN 1000 38<br />
QUICKTEK TEST STRIPS 81<br />
QUICKTEK 192<br />
quinapril hcl 50<br />
quinapril 50<br />
quindal-hd 117<br />
QUINIDINE GL 44<br />
quinidine gl 44<br />
quinidine gluconate 44<br />
quinidine su 44<br />
quinidine sulfate 44<br />
quintex hc 117<br />
quintex 132<br />
qv-allergy 13<br />
QVAR 146<br />
created on 20100520 243<br />
R<br />
R-GENE 82<br />
r-tanna pediatric 13<br />
r-tanna 13<br />
r-tannamine pediatric 13<br />
ra acetamin 63<br />
ra acetaminophen extra st 63<br />
ra acetaminophen flu nigh 3<br />
ra acetaminophen flu seve 117<br />
ra acetaminophen plus ext 63<br />
ra acetaminophen pm extra 76<br />
ra acne 162<br />
ra acta-tabs pe 13<br />
ra acta-tabs 13<br />
ra allergy multi-symptom 13<br />
ra allergy multi-symptom 3<br />
ra athenol 63<br />
ra benzoyl 162<br />
RA BLOOD GLUCOSE MONITOR 192<br />
RA BLOOD GLUCOSE TEST STR 81<br />
ra cetirizin 17<br />
ra childrens flu formula 117<br />
ra childrens nite time 117<br />
ra childrens plus cough/r 117<br />
ra childrens plus multisy 117<br />
ra chld apap 63<br />
ra cold & allergy 13<br />
ra cold & cough dm 117<br />
ra cold & flu 13<br />
ra cold multi-symptom day 93<br />
ra cold multi-symptom nig 93<br />
ra cold multi-symptom sev 93<br />
ra cold relief maximum st 93
a cold/allergy dibromm 9<br />
ra complete symptomatic c 117<br />
ra cough/cold dm 117<br />
ra dandruff shampoo 162<br />
ra day time cold/flu form 117<br />
ra daytime cold/flu 117<br />
ra daytime multi-symptom 117<br />
ra decongestant inhaler 175<br />
ra decongestant pe cough 132<br />
ra e-zject lancets 28g 192<br />
ra e-zject lancets thin 2 192<br />
ra e-zject lancets ultra 192<br />
RA EFFERVESCENT PLUS COLD 11<br />
ra flu maximum strength 117<br />
ra flu/cold/cough medicin 100<br />
ra hydrocort 165<br />
ra hydrocortisone maximum 165<br />
ra hydrocortisone plus 12 165<br />
ra hydrocortisone plus 165<br />
ra ibu-profen cold/sinus 37<br />
ra ibuprofen cold childre 37<br />
ra infants cold/cough 117<br />
ra insulin syringe/0.5ml/ 183<br />
ra insulin syringe/1ml/29 186<br />
ra insulin syringe/u-100/ 184<br />
ra insulin syringe/u-100/ 187<br />
ra lancets alternate site 192<br />
ra lancets colored 192<br />
ra lancets thin 192<br />
ra lancets ultra thin 192<br />
ra lancets 192<br />
RA MEDICATED CHEST RUB 175<br />
ra menstrual relief 63<br />
ra nasal decongestant/ant 13<br />
ra nighttime flu/cold/cou 117<br />
ra nite time cold formula 117<br />
ra nite time cold/flu for 117<br />
ra nite time cold/flu for 118<br />
ra nite time cough 118<br />
ra nitetime cold/flu 118<br />
ra non-asa 63<br />
ra non-aspirin junior str 62<br />
ra nose drops extra stren 138<br />
ra pedia relief cough/col 108<br />
RA PEN NEEDLES 31G X 5MM 193<br />
RA PEN NEEDLES 31G X 8MM 192<br />
ra premenstrual symptom r 63<br />
ra prenatal/folic acid 172<br />
ra prenatal 172<br />
ra sinus congestion & pai 13<br />
ra sinus congestion & pai 34<br />
ra sinus formula daytime 34<br />
ra sinus formula 37<br />
ra sinus tablets extra st 13<br />
ra sinus 13<br />
ra suphedrine cold/allerg 13<br />
ra suphedrine non-drying 132<br />
ra suphedrine pe sinus he 35<br />
ra suphedrine pe 15<br />
ra suphedrine pe 34<br />
ra suphedrine 13<br />
ra triacting cold/cough n 118<br />
ra triacting sore throat 121<br />
RA TRUETEST STRIPS 81<br />
ra tussin cf 118<br />
ra tussin cough 123<br />
ra tussin dm 118<br />
ra tussin pe 132<br />
ra tussin 118<br />
ra tussin 132<br />
ra urinary 166<br />
ra vaporizing steam 175<br />
ra vit b-6 169<br />
RABAVERT 157<br />
ralix 13<br />
ramipril 50<br />
RANITIDINE HCL 143<br />
ranitidine hcl 143<br />
ranitidine 143<br />
RAPAMUNE 173<br />
RAPTIVA 167<br />
re all 12 118<br />
re chlordiazepoxide/clidi 33<br />
re dcp 118<br />
re multivit with fluoride 171<br />
re tann d 3<br />
re-azo 166<br />
re-drylex jr 14<br />
RE-DRYLEX 14<br />
re-pb hyos 34<br />
re2+30 14<br />
reality insulin syringe/u 182<br />
reality insulin syringe/u 183<br />
reality insulin syringe/u 185<br />
reality insulin syringe/u 186<br />
reality lancets 193<br />
reality trigger lancets 193<br />
REBIF TITRATION PACK 172<br />
REBIF 172<br />
RECLAST 173<br />
reclipsen 147<br />
recofen caps 118<br />
RECOMBINATE 43<br />
RECOMBIVA HB 157<br />
RECOMBIVA-HB 157<br />
RECOMBIVAX HB 157<br />
recort plus 165<br />
rectasol-hc 165<br />
rederm 165<br />
redur-pcm 14<br />
REFACTO 43<br />
refenesen chest congestio 132<br />
refenesen chest congestio 133<br />
refenesen dm 118<br />
refenesen pe 133<br />
refenesen plus 133<br />
refenesen 132<br />
REFISSA 166<br />
REFLUDAN 40<br />
REFUAH PLUS BLOOD GLUCOSE 193<br />
REFUAH PLUS BLOOD GLUCOSE 81<br />
REGONOL 33<br />
RELACON LAX 118<br />
relacon-dm nr 118<br />
RELACON-DM 118<br />
relacon-hc nr 118<br />
RELACON-HC 118<br />
relahist-dm 118<br />
relasin dm 118<br />
relasin-hc 118<br />
relasin-hcx 118<br />
relatuss hc 118<br />
relcof c 118<br />
RELCOF DN PE 14<br />
RELCOF DN PSE 14<br />
RELCOF PE 14<br />
relcof pse 14<br />
RELENZA DISKHALER 28<br />
relera 14<br />
RELION 70/30 INNOLET 149<br />
RELION 70/30 149<br />
RELION BLOOD GLUCOSE TEST 81<br />
RELION CONFIRM BLOOD GLUC 193<br />
relion insulin syringe/u- 181<br />
created on 20100520 244
elion insulin syringe/u- 182<br />
relion insulin syringe/u- 183<br />
relion insulin syringe/u- 184<br />
relion insulin syringe/u- 185<br />
relion insulin syringe/u- 187<br />
relion insulin syringe/u- 188<br />
relion insulin syringe/u 183<br />
RELION KETONE 83<br />
relion lancets 193<br />
RELION MICRO BLOOD GLUCOS 193<br />
RELION MICRO BLOOD GLUCOS 81<br />
RELION MINI PEN NEEDLES 3 191<br />
RELION N INNOLET 149<br />
RELION N 149<br />
RELION PEN NEEDLES 29GX12 191<br />
RELION PEN NEEDLES 31GX8M 192<br />
RELION R 149<br />
RELION SHORT PEN NEEDLES 192<br />
relion standard lancets 193<br />
relion thin lancets 193<br />
RELION ULTIMA BLOOD GLUCO 81<br />
relion ultra thin lancets 193<br />
relion ultra thin plus la 193<br />
RELISTOR 144<br />
RELPAX 77<br />
reluri 133<br />
reme hist dm 118<br />
reme tussin dm 118<br />
REMICADE 173<br />
REMODULIN 45<br />
RENAMIN 87<br />
renew advanced lancing ca 193<br />
RENO-30 83<br />
RENO-60 83<br />
RENO-CAL-76 83<br />
RENO-DIP 83<br />
RENOGRAFIN-60 83<br />
RENOVA PUMP 166<br />
RENOVA 166<br />
rentamine pediatric 118<br />
REOPRO 41<br />
repan 63<br />
REPREXAIN 58<br />
reprexain 58<br />
REPRONEX 147<br />
RESCON DM 118<br />
RESCON-JR 14<br />
RESCON-MX 14<br />
RESCON 14<br />
RESCRIPTOR 28<br />
RESPA C&C IR 118<br />
RESPA C&C 118<br />
RESPA DM 118<br />
RESPA SA 3<br />
RESPA-1ST 133<br />
RESPA-A.R. 14<br />
RESPA-PE 133<br />
respahist 14<br />
respaire-120 133<br />
RESPAIRE-30 133<br />
RESPERAL-DM 118<br />
resperal 118<br />
RESPI-TANN G 118<br />
RESPI-TANN PD 118<br />
RESPI-TANN 118<br />
RESPIGAM 156<br />
RESPIRATORY THERAPY SUPPLIES 176<br />
respivent-d 37<br />
rest easy nighttime cough 118<br />
RESTORIL 75<br />
RETAVASE HALF-KIT 41<br />
RETAVASE 41<br />
RETIN-A MICR 166<br />
RETIN-A MICRO PUMP 166<br />
RETROVIR 28<br />
REVATIO 45<br />
REVEX 64<br />
RHEUMATREX 32<br />
rhinabid pd 14<br />
rhinabid 14<br />
rhinaclear 14<br />
rhinacon a 14<br />
RHINAHIST 14<br />
rhinall 138<br />
RHINOCORT AQUA 137<br />
RHOGAM HUMAN 156<br />
RHOGAM PLUS 156<br />
RHOPHYLAC 156<br />
ri-tussin dm 118<br />
ri-tussin 133<br />
RIASTAP 43<br />
ribavirin (hepatitis c) 29<br />
RICOBID 14<br />
RICOTUSS 118<br />
ricotuss 118<br />
RID-A-PAIN COMPOUND 63<br />
rifampin 27<br />
RIGHTEST GM100 BLOOD GLUC 193<br />
RIGHTEST GM300 BLOOD GLUC 193<br />
RIGHTEST GS100 BLOOD GLUC 81<br />
RIGHTEST GS300 BLOOD GLUC 81<br />
rinate pediatric 14<br />
rindal hd plus 118<br />
rindal hd 118<br />
rindal hpd 118<br />
ringer's 86<br />
RISPERDAL 70<br />
RISPERIDONE ODT 70<br />
risperidone 69<br />
risperidone 70<br />
RITALIN LA 74<br />
ritifed 14<br />
RITUXAN 32<br />
RIZATRIPTAN BENZOATE 77<br />
robafen ac 118<br />
robafen cf cough & cold 118<br />
robafen cf 118<br />
robafen cgh 118<br />
robafen dm clear 118<br />
robafen dm 118<br />
robafen 133<br />
ROBAXIN 38<br />
robituss ped 118<br />
robitussin allergy/cough 118<br />
robitussin cf 118<br />
robitussin childrens coug 118<br />
robitussin cold/congestio 14<br />
robitussin cold/cough/flu 118<br />
ROBITUSSIN COUGH & ALLERG 118<br />
ROBITUSSIN COUGH & COLD D 118<br />
ROBITUSSIN COUGH & COLD D 119<br />
robitussin cough & cold l 118<br />
robitussin cough/cold cf 118<br />
robitussin flu 118<br />
robitussin head/chest con 133<br />
ROBITUSSIN NIGHT RELIEF 118<br />
robitussin night time cou 118<br />
robitussin night time cou 3<br />
ROBITUSSIN PEDIATRIC COUG 118<br />
ROBITUSSIN PEDIATRIC 118<br />
robitussin to go cough & 118<br />
robitussin 118<br />
ROCEPHIN 19<br />
rocuronium bromide 38<br />
created on 20100520 245
ROFERON-A 32<br />
romilar ac 119<br />
romycin 135<br />
RONDEC TR 3<br />
RONDEC-TR 3<br />
rondex -dm 119<br />
rondex-dm 119<br />
rondex 14<br />
ROXICET 58<br />
roxicet 58<br />
ru-hist forte 14<br />
RU-HIST-D 4<br />
RU-TUSS 800 DM 119<br />
RU-TUSS DM 119<br />
ru-tuss jr. 133<br />
ru-tuss 14<br />
ry-t-12 4<br />
ry-tann 14<br />
RYBIX ODT 58<br />
RYDEX 119<br />
RYMED 14<br />
RYNA-12 S 4<br />
RYNA-12X 133<br />
RYNATAN PEDIATRIC 14<br />
RYNATUSS 119<br />
rynesa 12s 4<br />
S<br />
S-T FORTE 2 119<br />
safe tussin 30 119<br />
safe-t-lance low flow 25g 193<br />
safe-t-lance normal flow 193<br />
safe-t-lance plus safety 193<br />
safesnap insulin syringe/ 181<br />
safesnap insulin syringe/ 183<br />
safesnap insulin syringe/ 184<br />
safesnap insulin syringe/ 185<br />
safesnap insulin syringe/ 187<br />
SAFETUSSIN CD 119<br />
safety lancet 2mm 189<br />
safety lancets 193<br />
safety let lancets 193<br />
safety-glide insulin syri 181<br />
salflex 51<br />
salflex 52<br />
saline, bacteriostatic 86<br />
SALINE/PHENOL 86<br />
SALMETEROL XINAFOATE 36<br />
salsalate 52<br />
SANDOSTATIN LAR DEPOT 175<br />
SAPHRIS 70<br />
SARAFEM 67<br />
SARAPIN 175<br />
sarnol-hc 165<br />
sb allergy & cold pe 3<br />
sb allergy multi-symptom 14<br />
sb allergy/sinus/headache 3<br />
sb antihistamine 14<br />
sb bronchial 133<br />
sb cgh contr 119<br />
sb cgh contr 133<br />
sb cgh relf 119<br />
sb childrens nite time 119<br />
sb childrens non-aspirin 60<br />
sb childrens plus cough/r 119<br />
sb childrens plus multisy 119<br />
sb cold & allergy childre 14<br />
sb cold & cough dm childr 119<br />
sb cold & cough hbp 119<br />
sb cold & flu hbp 14<br />
sb cold head congestion s 119<br />
sb cold med non drowsy 119<br />
sb cold medicine 119<br />
sb cold multi-symptom day 119<br />
sb cold multi-symptom sev 119<br />
sb cough control cf 119<br />
sb cough control pe 126<br />
sb cough 133<br />
sb day time cold/flu reli 119<br />
sb daytime sinus 34<br />
sb daytime 119<br />
sb flu maximum strength h 119<br />
sb flu relief therapy sev 119<br />
sb flu relief therapy sev 3<br />
sb flu/cold/cough 119<br />
sb hydrocort 165<br />
sb infants concentrated d 63<br />
sb insulin syringe/u-100/ 183<br />
sb insulin syringe/u-100/ 184<br />
sb insulin syringe/u-100/ 187<br />
sb insulin syringe/u-100/ 188<br />
sb lancets thin 193<br />
sb lancets ultra thin 193<br />
sb night time cold/flu re 106<br />
sb nightime 119<br />
sb nighttime cough 119<br />
sb nighttime sinus multi- 3<br />
sb non aspirin sinus 1<br />
SB NON ASPIRIN SINUS 37<br />
sb non-asa night time 76<br />
sb non-asa 63<br />
sb non-aspirin extra stre 63<br />
sb non-aspirin jr strengt 62<br />
sb non-aspirin nighttime 76<br />
sb non-aspirin 63<br />
sb pain reliever children 63<br />
sb pain reliever extra st 62<br />
sb pseudoephedrin sinus 37<br />
sb pseudoephedrine plus 14<br />
sb sev/congest 133<br />
sb severe cold congestion 119<br />
sb severe cold pe 3<br />
sb sinus & allergy maximu 14<br />
sb sinus congestion & pai 133<br />
sb sinus congestion & pai 14<br />
sb sinus congestion & pai 34<br />
sb sinus/allergy max stre 14<br />
scalacort 165<br />
schnucks insulin syringe 184<br />
scopohist-pe 14<br />
scopohist 14<br />
SCOPOLAMINE HBR (OPHTH) 138<br />
SCOPOLAMINE 34<br />
SCOT-TUSSIN DIABETES CF 119<br />
SCOT-TUSSIN DM COUGH CHAS 119<br />
scot-tussin dm 119<br />
scot-tussin expectorant 133<br />
SCOT-TUSSIN SENIOR 119<br />
se bpo wash 162<br />
se-care conceive 172<br />
se-natal 90 172<br />
se-natal one 172<br />
selegiline hcl 77<br />
selenium sul sha 162<br />
selenium sul 162<br />
selenium sulfide 162<br />
SELENIUM 86<br />
selfemra 67<br />
SEMPREX-D 17<br />
SENSORCAINE-MPF/EPINEPHRI 155<br />
SENTRY BLOOD GLUCOSE METE 193<br />
SENTRY STARTER KIT 193<br />
SENTRY TEST STRIPS 81<br />
seradex-la 14<br />
SEREVENT DISKUS 36<br />
created on 20100520 246
SEROQUEL XR 69<br />
SEROQUEL XR 70<br />
SEROQUEL 70<br />
sertraline hcl 67<br />
sertraline 67<br />
servira 34<br />
severe allergy 3<br />
severe cold & flu 119<br />
severe cold/flu maximum s 119<br />
severe cold 119<br />
severe congestion/cough a 133<br />
sg ex-prin child 63<br />
sg ex-prin for children c 119<br />
sg ex-prin infant 63<br />
sg ex-prin jr strength 63<br />
sg ex-prin multi-symptom 119<br />
sg ex-prin pm extra stren 76<br />
sg ex-prin 63<br />
sg flu/cold/cough medicin 119<br />
sg hydrocort 165<br />
sg hydrocortisone/aloe 165<br />
sg nasal decongestant/ant 14<br />
sg nighttime cold/flu 119<br />
sg nighttime flu/cold/cou 119<br />
sg nighttime for children 119<br />
sg pedia relief cough/col 119<br />
sg su-phedrin maximum str 37<br />
sg su-phedrin plus 14<br />
sg tussin dm clear cough 119<br />
sg tussin dm cough 119<br />
sg tussin 133<br />
SHELLGEL 140<br />
SHERI-B-12 169<br />
SHOPRITE TEST STRIPS 81<br />
SHOPRITE VALUE PACK 193<br />
SHOWER TABLETS 175<br />
sil-tex 133<br />
silafed 14<br />
sildec dm 119<br />
sildec pe-dm 119<br />
sildec-pe 14<br />
sildec 14<br />
sildec 3<br />
SILDENAFIL CITRATE 45<br />
silphen dm 119<br />
siltuss das 133<br />
siltussin dm das 119<br />
siltussin sa 133<br />
siltussin-dm 119<br />
silver sulfa 162<br />
silver sulfadiazine 162<br />
SIMILAC LOW-IRON 87<br />
SIMILAC/IRON 87<br />
simply cough 119<br />
simply saline baby 134<br />
SIMPONI 173<br />
simuc-dm 119<br />
simuc-gp 133<br />
simuc-hd 119<br />
simuc 133<br />
SIMULECT 173<br />
SINA-12X 133<br />
SINADRIN PE COMPLETE SINU 14<br />
sine-off night time formu 3<br />
sine-off 14<br />
single-let 193<br />
SINGULAIR 125<br />
SINOGRAFIN 83<br />
sinuhist 14<br />
sinus & allergy pe maximu 14<br />
sinus congestion & pain 34<br />
sinus congestion/pain day 14<br />
sinus congestion/pain day 34<br />
sinus congestion/pain nig 14<br />
sinus congestion/pain sev 133<br />
sinus extra strength 14<br />
sinus headache max streng 37<br />
sinus max 14<br />
sinus maximum relief 37<br />
sinus maximum strength 14<br />
sinus maximum strength 37<br />
sinus non-drowsiness 37<br />
sinus non-drowsy maximum 37<br />
sinus non-drowsy/maximum 37<br />
sinus pain & pressure 37<br />
sinus pain reliever maxim 37<br />
sinus relief 37<br />
sinus tablets 14<br />
sinus w/o drowsiness 37<br />
sinus/allergy maximum str 15<br />
sinus/allergy pe 15<br />
sinus 14<br />
sinus 37<br />
sinutab maximum strength 15<br />
sinutab non-drowsy maximu 37<br />
sinutab non-drying 133<br />
sinutab sinus maximum str 34<br />
sinutab sinus/no drowsine 37<br />
SINUTUSS DM 119<br />
SINUVENT PE 133<br />
SIROLIMUS 173<br />
SITREX PD 133<br />
SITREX 133<br />
sm acid redu 143<br />
sm allergy multi-symptom 15<br />
sm allergy/sinus headache 1<br />
sm arthritis 63<br />
sm chest congestion relie 126<br />
sm chest congestion relie 92<br />
sm childrens non-aspirin 63<br />
sm childrens pain relief 119<br />
sm cold & allergy childre 15<br />
sm cold & allergy childre 9<br />
sm cold & allergy pe 15<br />
sm cold & cough childrens 94<br />
sm cold & cough dm childr 120<br />
sm cold head congestion d 120<br />
sm cold head congestion n 93<br />
sm cold head congestion s 120<br />
sm cough & cold multi-sym 119<br />
sm cough & runny nose chi 120<br />
sm cough & sore throat da 120<br />
sm cough & sore throat ni 120<br />
sm day time cold & flu re 120<br />
sm day time pe cold & flu 120<br />
sm daytime cold & cough c 95<br />
sm decongestant cough for 96<br />
sm flu/cold/cough medicin 120<br />
SM GLUCOSE TEST STRIPS 81<br />
sm hydrocort 165<br />
sm hydrocortisone plus 165<br />
sm hydrocortisone/aloe ma 164<br />
sm ibuprofen cold & sinus 37<br />
sm ibuprofen cold childre 37<br />
sm ibuprofen jr 53<br />
sm infants pain reliever 104<br />
sm insulin syringe/0.3ml/ 182<br />
sm insulin syringe/0.5ml/ 185<br />
sm insulin syringe/1ml/31 188<br />
sm insulin syringe/u-100/ 181<br />
sm insulin syringe/u-100/ 182<br />
sm insulin syringe/u-100/ 184<br />
sm insulin syringe/u-100/ 185<br />
sm insulin syringe/u-100/ 187<br />
created on 20100520 247
sm lancets 21g 193<br />
sm lancets 193<br />
sm loratadin 17<br />
sm medicated chest rub 175<br />
sm mucus relief cough chi 105<br />
sm nasal decongestant/ant 12<br />
sm nasal 138<br />
sm nite time cold & flu r 120<br />
sm nite time cold/flu rel 120<br />
sm nite time cough 120<br />
sm non aspirin allergy si 15<br />
sm non aspirin cold 120<br />
sm non aspirin sinus 37<br />
sm non-asa 63<br />
sm non-aspirin flu 120<br />
sm nose drops nasal decon 138<br />
sm pain rel 63<br />
sm pain relief extra stre 63<br />
sm pain reliever 8 hour e 63<br />
sm pain reliever allergy 12<br />
sm pain reliever cold 107<br />
sm pain reliever extra st 62<br />
sm pain reliever junior s 62<br />
sm pain reliever pm extra 76<br />
sm pain reliever sinus ma 37<br />
sm pain reliever sinus pe 34<br />
sm pedia relief for child 108<br />
sm pedia relief infants 108<br />
sm pediatric 133<br />
sm prenatal vitamins 172<br />
sm severe cold 119<br />
sm sinus & allergy maximu 15<br />
sm sinus & allergy pe max 14<br />
sm sinus headache 37<br />
sm sinus maximum strength 37<br />
sm super thin lancets 30g 193<br />
sm super thin lancets 193<br />
sm tension headache 63<br />
sm thin lancets 26g 193<br />
sm thin lancets 193<br />
sm triacting citrus 133<br />
sm triacting cold & cough 121<br />
sm triacting orange 15<br />
sm tussin cf 120<br />
sm tussin cough & cold ma 120<br />
sm tussin cough & cold 120<br />
sm tussin dm clear 120<br />
sm tussin dm 120<br />
sm tussin 133<br />
sm ultra comfort insulin 181<br />
sm ultra comfort insulin 184<br />
sm ultra comfort insulin 187<br />
sm vit b-6 169<br />
SMARTEST BLOOD GLUCOSE TE 81<br />
SMARTEST EJECT BLOOD GLUC 193<br />
SMARTEST EJECT STARTER KI 193<br />
smartest lancets 28g 193<br />
SMARTEST PROTEGE BLOOD GL 193<br />
SMARTEST PROTEGE STARTER 193<br />
smz-tmp ds 25<br />
soba child pain reliever 63<br />
soba childrens pain relie 120<br />
soba childrn 63<br />
soba cold reliever 93<br />
soba cold/flu daytime 94<br />
soba dayhist 3<br />
soba infant pain reliever 36<br />
soba lancets colored 193<br />
soba night time cold/flu 120<br />
soba pain reliever allerg 12<br />
soba pain reliever cold 107<br />
soba pain reliever flu 107<br />
soba pain reliever junior 63<br />
soba pain reliever pm 76<br />
soba pain reliever/sinus 37<br />
soba pedia relief 120<br />
soba profen ib cold/sinus 37<br />
soba profen ib junior str 53<br />
soba sinus 15<br />
soba thin lancets 193<br />
soba tussin cough/cold 120<br />
soba tussin pe cough 134<br />
sod chloride 134<br />
SOD EDECRIN 87<br />
sod fluoride 172<br />
SOD NITRITE 144<br />
sod sulfacet 135<br />
SOD THIOSULF 144<br />
sodium acetate 83<br />
sodium ascorbate 169<br />
sodium bicarbonate 83<br />
SODIUM CHLOR 134<br />
sodium chlor 134<br />
SODIUM CHLORIDE (INHALANT) 134<br />
sodium chloride (inhalant) 134<br />
SODIUM CHLORIDE BACTERIOS 85<br />
sodium chloride 86<br />
sodium fluoride 172<br />
SODIUM LACTATE 83<br />
sodium lactate 83<br />
sodium phosphate 86<br />
sodium thiosalicylate 64<br />
sodium thiosulfate 144<br />
solia 147<br />
SOLO V2 BLOOD GLUCOSE MAN 193<br />
SOLO V2 TEST STRIP 81<br />
solo v2 twist lancets 193<br />
SOLOTUSS 120<br />
SOLU-CORTEF 146<br />
SOLU-MEDROL 146<br />
soluclenz rx 162<br />
SOMA 38<br />
SOMATULINE DEPOT 175<br />
SOMAVERT 151<br />
SOMNOTE 76<br />
sonahist dm 120<br />
sonahist 15<br />
SORBUTUSS NR 120<br />
SORBUTUSS 120<br />
sorbutuss 120<br />
SOTALOL HCL 47<br />
SOTRADECOL 45<br />
SPACER/AEROSOL-HOLDING<br />
CHAMBER SUPPLIES - BAGS 176<br />
SPACER/AEROSOL-HOLDING<br />
CHAMBER SUPPLIES - MOUTHPIECES<br />
176<br />
SPACER/AEROSOL-HOLDING<br />
CHAMBERS 176<br />
SPASCUPREEL 175<br />
spasdel 34<br />
SPHERULIN 82<br />
SPORANOX 27<br />
sprintec 28 147<br />
ssd af 162<br />
ssd 162<br />
st joseph co 120<br />
stagesic 58<br />
stamoist e 133<br />
STAPHAGE LYSATE I & III 175<br />
statuss dm 120<br />
STATUSS GREEN 120<br />
stavudine 28<br />
STELARA 173<br />
created on 20100520 248
STERILE WATER 196<br />
STIMATE 150<br />
STRATTERA 77<br />
STRATTERA 78<br />
STREPTOMYCIN 18<br />
su-tuss dm 120<br />
su-tuss hd 120<br />
SUBOXONE 58<br />
suclor 15<br />
SUCRALFATE 143<br />
sucralfate 143<br />
SUCRETS DM 120<br />
SUDACARE SHOWER SOOTHERS 175<br />
SUDAFED CHILDRENS COLD & 120<br />
sudafed pe cold & cough c 120<br />
SUDAFED PE COLD/COUGH MUL 120<br />
SUDAFED PE DAY & NIGHT CO 120<br />
SUDAFED PE DAY & NIGHT 3<br />
sudafed pe nighttime cold 3<br />
sudafed pe non-drying sin 133<br />
sudafed pe sinus headache 34<br />
sudafed pe sinus/allergy 15<br />
sudafed plus 15<br />
sudafed sinus & pain 12 h 53<br />
sudafed sinus extra stren 37<br />
sudafed sinus nighttime 15<br />
sudafed sinus 37<br />
SUDAFED TRIPLE ACTION 133<br />
SUDAHIST 15<br />
SUDAL 12 TANNATE 15<br />
SUDAL 12 15<br />
sudatex g 133<br />
sudatex-dm 120<br />
sudatex-g 133<br />
sudatex 133<br />
sudatrate 37<br />
sudatuss dm 120<br />
sudatuss-2 df 120<br />
sudatuss-2 120<br />
sudatuss-sf 120<br />
sudex 133<br />
sudogest cold & allergy 15<br />
sufentanil citrate 58<br />
sulf- 135<br />
sulfac 135<br />
SULFACET SOD 135<br />
sulfacet sod 135<br />
SULFACETAMIDE SOD-<br />
PREDNISOLONE 137<br />
sulfacetamide sod-prednisolone 137<br />
SULFACETAMIDE SODIUM (OPHTH)<br />
135<br />
sulfacetamide sodium (ophth) 135<br />
sulfacetamide sodium/pred 137<br />
sulfacetamide/prednisolon 137<br />
sulfamethoxazole-trimethoprim 25<br />
SULFAMETHOXAZOLE/TRIMETHO 25<br />
sulfamethoxazole/trimetho 25<br />
sulfasalazin 25<br />
sulfasalazine 25<br />
sulfatrim 25<br />
sulfazine ec 25<br />
sulfazine 25<br />
SULFISOXAZOLE 25<br />
SULFOXYL REGULAR 167<br />
SULFOXYL STRONG 167<br />
SULINDAC 196<br />
sulindac 53<br />
SUMATRIPTAN SUCCINATE REF 77<br />
SUMATRIPTAN SUCCINATE 77<br />
sumatriptan succinate 77<br />
SUMATRIPTAN 77<br />
sumatriptan 77<br />
SUMAVEL DOSEPRO 77<br />
SUMYCIN 26<br />
SUPARTZ 175<br />
super cold tabs 15<br />
super strength sinadrin 15<br />
super thin lancets 193<br />
super tussin pe 133<br />
supertussin dm 120<br />
supertussin 133<br />
suphedrin plus 15<br />
suphedrin severe cold 120<br />
suphedrin sinus/maximum s 37<br />
suphedrine cold/allergy 15<br />
suphedrine severe cold/fl 120<br />
suphedrine sinus 38<br />
SUPPRELIN LA 32<br />
SUPRAX 19<br />
SUPREME TEST STRIPS 81<br />
supress-dx pediatric 120<br />
SUPRESS-PE PEDIATRIC 133<br />
sure comfort insulin syri 181<br />
sure comfort insulin syri 182<br />
sure comfort insulin syri 183<br />
sure comfort insulin syri 184<br />
sure comfort insulin syri 185<br />
sure comfort insulin syri 187<br />
sure comfort insulin syri 188<br />
sure comfort lancets 28g 193<br />
sure comfort lancets 30g 193<br />
SURE COMFORT PEN NEEDLES 193<br />
SURE EDGE BLOOD GLUCOSE M 193<br />
SURE EDGE BLOOD GLUCOSE T 81<br />
sure one insulin syringe/ 182<br />
sure one insulin syringe/ 183<br />
sure one insulin syringe/ 184<br />
sure one insulin syringe/ 185<br />
sure one insulin syringe/ 187<br />
sure one insulin syringe/ 188<br />
SURE-FINE PEN NEEDLES 29G 193<br />
SURE-FINE PEN NEEDLES 31G 193<br />
sure-ject insulin syringe 181<br />
sure-ject insulin syringe 182<br />
sure-ject insulin syringe 183<br />
sure-ject insulin syringe 184<br />
sure-ject insulin syringe 185<br />
sure-ject insulin syringe 187<br />
sure-ject insulin syringe 188<br />
sure-lance flat lancets 193<br />
sure-lance lancets 26g 193<br />
sure-lance thin lancets 2 193<br />
sure-lance ultra thin lan 193<br />
SURE-TEST EASYPLUS MINI B 81<br />
SURE-TEST EASYPLUS MINI S 193<br />
SURECHEK BLOOD GLUCOSE MO 193<br />
SURECHEK BLOOD GLUCOSE TE 81<br />
surelite lancets 193<br />
SURESTEP COMPLETE BLOOD G 193<br />
SURESTEP PRO TEST STRIPS 81<br />
SURESTEP TEST STRIPS 81<br />
SUSTIVA 28<br />
sutan-dm 120<br />
SUTAN 15<br />
sw cold & sinus pain reli 38<br />
symax-sl 34<br />
SYMLIN 148<br />
SYMLINPEN 60 148<br />
SYMLNPEN 120 148<br />
SYMPAK DM 120<br />
SYMPAK II 15<br />
SYMPAK PDX 15<br />
SYMPAK 15<br />
created on 20100520 249
SYMTAN A 120<br />
SYMTAN 120<br />
SYNAGIS 28<br />
SYNAREL 147<br />
SYNERCID 26<br />
SYNTHROID 153<br />
SYNVISC ONE 175<br />
SYNVISC 175<br />
T<br />
T-TANNA DM 120<br />
TABLOID 32<br />
tacrolimus 173<br />
tactinal 64<br />
TALWIN 58<br />
TAMIFLU 28<br />
tana dm 120<br />
tana pse 15<br />
tana r-12 4<br />
tana t-12 120<br />
tanabid da 15<br />
tanabid sr 15<br />
tanabid 15<br />
tanacof-dm 120<br />
TANAFED DMX 120<br />
tanahist-d pediatric 15<br />
tanatan rf 15<br />
tanatuss pediatric 120<br />
tanavan 4<br />
tannate 12 s 120<br />
tannate dmp-dex 120<br />
tannate pd-dm 120<br />
tannate pediatric 15<br />
tannate-12 120<br />
tannate-12d s 120<br />
tannate-v-dm 120<br />
tannic-12 s 121<br />
tannic-12 121<br />
tannihist-12 d 121<br />
tannihist-12 rf 121<br />
TARGRETIN 167<br />
TARGRETIN 32<br />
taron-ec cal 172<br />
tavist nd 17<br />
tavist sinus non drowsy m 38<br />
TAXOTERE 32<br />
TAZAROTENE 167<br />
TAZICEF 19<br />
TAZORAC 167<br />
taztia xt 48<br />
TE ANATOXAL BERNA 156<br />
tebamide pediatric 142<br />
tebamide 142<br />
techlite ast lancets 193<br />
techlite lancets 193<br />
TEGRETOL XR 66<br />
TEGRETOL 66<br />
TEKRAL 3<br />
TEMAZEPAM 75<br />
temazepam 75<br />
TEMODAR 32<br />
tenar dm 121<br />
TENAR PSE 133<br />
TENORMIN 47<br />
TENSILON 82<br />
TEQUIN 25<br />
terazosin hcl 46<br />
terbinafine hcl 26<br />
terbinafine 26<br />
terbutaline sulfate 36<br />
terbutaline 36<br />
ternamar 172<br />
TERPIN HYDRATE MONOHYDRAT 196<br />
TERPIN HYDRATE 196<br />
terumo insulin syringe/0. 181<br />
terumo insulin syringe/0. 184<br />
TERUMO INSULIN SYRINGE/1M 187<br />
terumo insulin syringe/u- 181<br />
terumo surguard insulin s 181<br />
terumo surguard insulin s 182<br />
terumo surguard insulin s 183<br />
terumo surguard insulin s 185<br />
terumo surguard insulin s 187<br />
TESLASCAN 79<br />
TESTOPEL 146<br />
testosterone cypionate 146<br />
testosterone enanthate 146<br />
TETANUS TOXOID ADSORBED 156<br />
TETANUS TOXOID 156<br />
TETANUS/DIPHTHERIA TOXOID 156<br />
tetra tannate pediatric 121<br />
tetracaine hcl 155<br />
TETRACYCLINE HCL 26<br />
tetracycline hcl 26<br />
tetracycline 26<br />
TEV-TROPIN 151<br />
tg 10peh/380gfn/15dm 88<br />
tg 10peh/380gfn 125<br />
tg 40pse/4brm 4<br />
tg 45pse/400gfn/15dm 89<br />
tg 45pse/400gfn 125<br />
tgt acetamin 64<br />
tgt acetaminophen extra s 64<br />
tgt acetaminophen infants 64<br />
tgt anti-itch plus oatmea 162<br />
tgt anti-itch/aloe maximu 162<br />
tgt anti-itch/aloe/vitami 162<br />
tgt arthritis pain relief 59<br />
tgt childrens acetaminoph 64<br />
tgt cold head congestion 121<br />
tgt cold relief multi-sym 121<br />
tgt cold relief multi-sym 93<br />
tgt cold/flu relief day t 121<br />
tgt cold/flu relief day/n 94<br />
tgt cold/flu relief multi 121<br />
tgt cold/flu relief multi 94<br />
tgt cold/flu relief night 121<br />
tgt cough & cold 94<br />
tgt cough formula dm 121<br />
tgt lancet alternate site 194<br />
tgt lancet super thin 30g 194<br />
tgt lancet thin 23g 194<br />
tgt lancet ultra thin 28g 194<br />
tgt mucus relief cough ch 105<br />
tgt multi-symptom cold pl 121<br />
tgt pain reliever pm extr 3<br />
tgt pain reliever pm extr 76<br />
tgt sinus congestion/pain 14<br />
tgt sinus congestion/pain 34<br />
tgt tussin dm cough 123<br />
THAM 83<br />
THEO-24 167<br />
THEO 167<br />
theo 167<br />
theochron 167<br />
theophylline in dextrose 168<br />
theophylline sr 168<br />
THEOPHYLLINE 167<br />
theophylline 167<br />
THEOPHYLLINE 168<br />
theophylline 168<br />
theracaps cough & cold re 121<br />
THERACOF PLUS COUGH AND C 121<br />
theracort 165<br />
THERAFLU COLD & COUGH 121<br />
created on 20100520 250
THERAFLU COLD & SORE THRO 15<br />
theraflu cold & sore thro 15<br />
THERAFLU COLD/COUGH DAYTI 121<br />
THERAFLU COLD/COUGH NIGHT 3<br />
THERAFLU FLU & CHEST CONG 121<br />
THERAFLU FLU & CHEST CONG 133<br />
THERAFLU FLU & SORE THROA 15<br />
theraflu flu/cold/cough 121<br />
THERAFLU FLU/COLD/SORE TH 15<br />
theraflu flu/cold 15<br />
theraflu flu/congestion m 121<br />
THERAFLU LONG ACTING COUG 121<br />
theraflu nighttime maximu 121<br />
THERAFLU NIGHTTIME MEDICI 121<br />
theraflu non drowsy formu 121<br />
theraflu severe cold & co 121<br />
theraflu severe cold dayt 121<br />
theraflu severe cold nigh 121<br />
THERAFLU SEVERE COLD NIGH 15<br />
THERAFLU WARMING RELIEF C 133<br />
theraflu warming relief f 3<br />
theraflu warming relief s 121<br />
theraflu warming relief s 3<br />
thermazene 162<br />
thiamine hcl 169<br />
thin lancets 194<br />
thinlets gp lancets 194<br />
thinlets lancet 194<br />
thinpro insulin syringe/0 181<br />
THINPRO INSULIN SYRINGE/0 182<br />
thinpro insulin syringe/0 183<br />
thinpro insulin syringe/0 184<br />
THINPRO INSULIN SYRINGE/0 185<br />
thinpro insulin syringe/1 185<br />
THINPRO INSULIN SYRINGE/1 187<br />
thinpro insulin syringe/1 187<br />
THINPRO INSULIN SYRINGE/1 188<br />
THIOGUANINE 32<br />
thioridazine hcl 71<br />
thioridazine 71<br />
THIOTEPA 32<br />
thiotepa 32<br />
thiothixene 71<br />
THIOTHIXENE 72<br />
thiothixene 72<br />
thor cough & cold 121<br />
THORAZINE 71<br />
THROMBAT III 41<br />
THYMOGLOBULN 173<br />
THYREL TRH 79<br />
THYROGEN 82<br />
THYROID 153<br />
thyroid 153<br />
tibamine la 15<br />
tidafen dm 121<br />
tidafen la 133<br />
TIGER BALM EXTRA STRENGTH 175<br />
TIGER BALM REGULAR STRENG 175<br />
TIGER BALM ULTRA STRENGTH 175<br />
TILADE 125<br />
TIME-HIST QD 15<br />
TIMENTIN 24<br />
timolol gel 139<br />
timolol mal 139<br />
TIMOLOL MALEATE (OPHTH) 139<br />
timolol maleate (ophth) 139<br />
tizanidine hcl 38<br />
tizanidine 38<br />
tl icon 39<br />
tl-dex dm 121<br />
tl-hist cd 121<br />
tl-hist cm 121<br />
tl-hist dm 121<br />
TNKASE 41<br />
tobra 135<br />
TOBRADEX 137<br />
TOBRAMYCIN SULFATE (OPHTH) 135<br />
tobramycin sulfate (ophth) 135<br />
TOBRAMYCIN SULFATE/SODIUM 18<br />
tobramycin sulfate 18<br />
TOBRAMYCIN-DEXAMETHASONE 137<br />
tobramycin-dexamethasone 137<br />
tobramycin/dexamethasone 137<br />
tobramycin 135<br />
TOBRAMYCIN 18<br />
TOBREX 135<br />
TOFRANIL-PM 69<br />
TOLAZAMIDE 150<br />
tolazamide 150<br />
tolbutamide 150<br />
tolu-sed dm 121<br />
topcare ultra comfort ins 181<br />
topcare ultra comfort ins 182<br />
topcare ultra comfort ins 183<br />
topcare ultra comfort ins 184<br />
topcare ultra comfort ins 185<br />
topcare ultra comfort ins 186<br />
topcare ultra comfort ins 187<br />
topcare ultra comfort ins 188<br />
topco insulin syringe/u-1 181<br />
topco insulin syringe/u-1 183<br />
topco insulin syringe/u-1 185<br />
topco insulin syringe/u-1 186<br />
topiramate 66<br />
TORISEL 32<br />
TORSEMIDE 87<br />
TOURO ALLERGY 15<br />
touro allergy 15<br />
TOURO CC-LD 121<br />
TOURO CC 121<br />
TOURO DM 121<br />
TOURO HC 121<br />
TOURO LA 133<br />
TRACE ELEMENTS 4/PEDIATRI 86<br />
TRACE METALS ADDITIVE FTV 86<br />
trace minerals (cr-cu-mn-se-zn) 86<br />
trace minerals (cr-cu-mn-zn) 86<br />
TRAMADOL HCL 58<br />
tramadol hcl 58<br />
tranylcyprom 66<br />
tranylcypromine sulfate 66<br />
TRASYLOL 43<br />
TRAUMEEL 175<br />
TRAVASOL 2.75%/DEXTROSE 1 87<br />
TRAVASOL 2.75%/DEXTROSE 5 87<br />
TRAVASOL 3.5%/ELECTROLYTE 87<br />
TRAVASOL 4.25%/DEXTROSE 1 87<br />
TRAVASOL 4.25%/DEXTROSE 2 87<br />
TRAVASOL 5.5%/DEXTROSE 10 87<br />
TRAVASOL 5.5%/DEXTROSE 20 87<br />
TRAVASOL 5.5%/ELECTROLYTE 87<br />
TRAVASOL 8.5%/DEXTROSE 10 87<br />
TRAVASOL 8.5%/DEXTROSE 20 87<br />
TRAVASOL 8.5%/DEXTROSE 50 87<br />
TRAVASOL 87<br />
trazodone hcl 66<br />
trazodone hcl 68<br />
trazodone 66<br />
trazodone 68<br />
TREANDA 32<br />
TRELSTAR DEP 32<br />
TRELSTAR LA 32<br />
TRELSTAR MIX 32<br />
TRETIN-X 166<br />
created on 20100520 251
tretinoin (chemotherapy) 32<br />
TRETINOIN (FACIAL WRINKLES) 166<br />
TRETINOIN EM 166<br />
TRETINOIN MICROSPHERE 166<br />
TRETINOIN W/ CLEANSER &<br />
MOISTURIZER 166<br />
tretinoin 166<br />
tretinoin 32<br />
trexbrom 121<br />
trezix 58<br />
tri-a-vite w/fluoride 172<br />
tri-afed allergy/head col 15<br />
tri-fed x 121<br />
tri-gestan s 15<br />
tri-hist pediatric 15<br />
tri-pseudaphed 15<br />
tri-vent dm 121<br />
tri-vent dpc 121<br />
tri-vent hc 121<br />
tri-vit/fl chewable 172<br />
tri-vit/fluoride/iron 172<br />
tri-vit/fluoride 172<br />
tri-vita bets w/fluoride 172<br />
tri-vitamin/fluoride 172<br />
tri-vitamin/iron/fluoride 172<br />
TRIACTIN CHEST CONGESTION 133<br />
triactin chest congestion 133<br />
triacting chest congestio 133<br />
triacting cold & cough 121<br />
triacting cold/allergy 15<br />
triacting cold/cough 121<br />
triacting day time cold/c 121<br />
triacting expectorant 133<br />
triacting nighttime cold& 3<br />
triacting nite time 121<br />
triacting sore throat for 121<br />
triacting sore throat 121<br />
triacting 121<br />
triall 15<br />
TRIAMCINOLON 165<br />
triamcinolon 165<br />
TRIAMCINOLONE ACETONIDE<br />
(INHALANT) 146<br />
TRIAMCINOLONE ACETONIDE<br />
(NASAL) 137<br />
TRIAMCINOLONE ACETONIDE<br />
(TOPICAL) 165<br />
triamcinolone acetonide (topical) 165<br />
triamcinolone acetonide 146<br />
triamcinolone/nystatin 165<br />
triaminic am cough/decong 122<br />
TRIAMINIC CHEST & NASAL C 133<br />
TRIAMINIC CHEST/NASAL CON 133<br />
triaminic chest/nasal con 133<br />
TRIAMINIC COLD & ALLERGY 15<br />
TRIAMINIC COLD & COUGH DA 122<br />
triaminic cold & cough da 122<br />
TRIAMINIC COLD/ALLERGY 15<br />
TRIAMINIC COLD/COUGH DAYT 122<br />
TRIAMINIC COLD/COUGH NIGH 3<br />
triaminic cold/cough/feve 122<br />
triaminic cough & nasal c 122<br />
TRIAMINIC COUGH & RUNNY N 122<br />
TRIAMINIC COUGH & SORE TH 122<br />
triaminic cough & sore th 122<br />
TRIAMINIC COUGH 122<br />
TRIAMINIC DECONGESTANT PL 122<br />
TRIAMINIC FLU COUGH & FEV 121<br />
TRIAMINIC FLU/COUGH/FEVER 122<br />
triaminic flu/cough/fever 122<br />
TRIAMINIC LONG ACTING COU 122<br />
triaminic long acting cou 122<br />
TRIAMINIC MULTI-SYMPTOM F 122<br />
triaminic night time coug 122<br />
TRIAMINIC RUNNY NOSE & CO 15<br />
TRIAMINIC VAPOR PATCH 175<br />
TRIAMINIC-D 122<br />
triaminic 17<br />
triamterene & hydrochlorothiazide 88<br />
triamterene/hydrochloroth 88<br />
TRIAZ 162<br />
triazolam 75<br />
tricare 172<br />
TRICHOPHYTON 83<br />
TRICODENE SF 122<br />
tricof exp 122<br />
tricof pd 122<br />
tricof 122<br />
tricold pediatric 122<br />
tricon 39<br />
tridal hd plus 122<br />
tridal hd 122<br />
TRIDAL 122<br />
triderm 165<br />
trifed 15<br />
trifedrine 15<br />
trifluoperaz 71<br />
trifluoperazine hcl 71<br />
trifluridine 136<br />
TRIHIBIT 156<br />
TRIKOF-D 122<br />
trimethobenz 142<br />
trimethobenzamide hcl 142<br />
trimethobenzamide-benzocaine 142<br />
trimethoprim sulfate/poly 135<br />
trimethoprim/polymyxin b 135<br />
trimethoprim/sulfamethoxa 25<br />
trimethoprim 29<br />
trimox 24<br />
trinatal rx 1 172<br />
trionate nf 122<br />
trionate 122<br />
triotann pediatric 15<br />
triotann-s pediatric 15<br />
trip-pse 15<br />
TRIPEDIA 156<br />
TRIPHASIL 28 147<br />
triple antibiotic 135<br />
triple antibiotic 137<br />
triple tannate pediatric 15<br />
triplex ad 15<br />
triplex dm 122<br />
TRIPOHIST D 15<br />
TRIPROLIDINE & PSEUDOEPHEDRINE<br />
15<br />
TRIPROLIDINE & PSEUDOEPHEDRINE<br />
16<br />
triprolidine & pseudoephedrine 16<br />
TRIPROLIDINE TANNATE-<br />
PSEUDOEPHEDRINE TANNATE 16<br />
TRIPROLIDINE-PSEUDOEPH W/APAP 16<br />
triprolidine/pseudoephedr 15<br />
TRISENOX 32<br />
trisofed 16<br />
TRISPEC DEX 133<br />
TRISPEC DMX PEDIATRIC 122<br />
TRISPEC DMX 122<br />
TRISPEC PSE PEDIATRIC 122<br />
TRISPEC PSE 122<br />
TRISPEC SFX 133<br />
trital dm 122<br />
trital sr 16<br />
trivora-28 147<br />
TROCAL COUGH 122<br />
created on 20100520 252
TROPHAMINE 87<br />
tropicacyl 138<br />
tropicamide 138<br />
TRUE CARE STARTER KIT 194<br />
TRUE CARE TEST STRIP PACK 81<br />
TRUE2GO BLOOD GLUCOSE MON 194<br />
TRUERESULT BLOOD GLUCOSE 194<br />
TRUETEST GLUCOSE CONTROL 194<br />
TRUETEST STRIPS 81<br />
TRUETRACK BLOOD GLUCOSE M 194<br />
TRUETRACK SMART SYSTEM 194<br />
TRUETRACK TEST 81<br />
TUBERCULIN/ALLERGY SYRINGES 177<br />
TUBERCULIN/ALLERGY SYRINGES 194<br />
TUBERSOL 10 TEST 83<br />
TUBERSOL 50 TEST 83<br />
TUBERSOL 83<br />
TUR-BI-KAL 138<br />
tusana-d 122<br />
TUSDEC-DM 122<br />
TUSDEC-HC 122<br />
tusnel c 122<br />
tusnel diabetic 122<br />
TUSNEL PED-C 122<br />
TUSNEL PEDIATRIC 122<br />
tusnel-a 122<br />
TUSNEL-DM PEDIATRIC 122<br />
TUSNEL-HC 122<br />
tusnel-hc 122<br />
TUSNEL 122<br />
TUSNEL 133<br />
TUSS-DA NR 122<br />
tuss-pv 122<br />
tussadur-hd 122<br />
tussafed ex 122<br />
tussafed hc 122<br />
tussafed-la 122<br />
TUSSAFED 122<br />
tussafed 122<br />
tusscough dhc 122<br />
tusscough hc 122<br />
TUSSI PRES-B 122<br />
TUSSI PRES-B 133<br />
TUSSI-12 122<br />
TUSSI-12D S 122<br />
TUSSI-12D 122<br />
tussi-bid 122<br />
tussi-organidin nr dm 122<br />
tussi-pres pe pediatric 133<br />
TUSSI-PRES PEDIATRIC 122<br />
TUSSICAPS 122<br />
tussiclear dh 122<br />
tussiden c 123<br />
tussiden dm 123<br />
TUSSIGON 123<br />
tussin cf cough & cold 123<br />
tussin cf 123<br />
tussin chest 134<br />
tussin cold-cough 123<br />
tussin cold/congestion 123<br />
tussin cold/cough 123<br />
tussin cold/cough 94<br />
TUSSIN COUGH-COLD 123<br />
tussin cough/cold maximum 123<br />
tussin cough/cold 123<br />
tussin cough 123<br />
tussin cough 134<br />
tussin dm clear 123<br />
tussin dm max 123<br />
tussin dm 123<br />
tussin exp 134<br />
tussin max 123<br />
tussin pe 134<br />
tussin pediatric cough & 123<br />
tussin pediatric cough/co 123<br />
tussin severe congestion 134<br />
tussin severe 134<br />
tussin 123<br />
tussin 134<br />
TUSSINAL 12 123<br />
TUSSIONEX PENNKINETIC EXT 123<br />
TUSSIREX 123<br />
tussitab 123<br />
tussizone-12 rf 123<br />
TUSSO-DF 123<br />
TUSSO-DM 123<br />
TUSSO-DMR 123<br />
TUSSO-HC 123<br />
TUSSO-XR 123<br />
TUSSO-ZMR 123<br />
TUSSO-ZR 123<br />
tussplex dm 123<br />
tussplex 123<br />
tustan 12s 123<br />
TWINJECT 38<br />
TWINRIX 157<br />
tycolene 64<br />
TYGACIL 26<br />
tylenol allergy multi-sym 16<br />
TYLENOL CHEST CONGESTION 134<br />
TYLENOL CHILDRENS PLUS CO 16<br />
TYLENOL CHILDRENS PLUS CO 3<br />
tylenol chld 64<br />
TYLENOL COLD & FLU SEVERE 123<br />
tylenol cold head congest 123<br />
TYLENOL COLD MULTI-SYMPTO 123<br />
tylenol cold multi-sympto 123<br />
TYLENOL COLD RELIEF NIGHT 3<br />
TYLENOL COUGH & SORE THRO 123<br />
tylenol cough & sore thro 123<br />
TYLENOL FLU CONVENIENCE P 123<br />
tylenol flu no drowsiness 123<br />
TYLENOL GO TABS EXTRA STR 64<br />
TYLENOL INFANTS PLUS COLD 123<br />
tylenol infants plus cold 123<br />
TYLENOL INFANTS PLUS COLD 35<br />
tylenol infants plus cold 38<br />
tylenol maximum strength 124<br />
tylenol sinus congestion 16<br />
tylenol sinus congestion 35<br />
TYLENOL SINUS CONVENIENCE 3<br />
TYLENOL SINUS SEVERE CONG 134<br />
TYLENOL SORE THROAT NIGHT 3<br />
tylophen 64<br />
TYPHIM VI 157<br />
TYPHOID VI 157<br />
TYSABRI 172<br />
created on 20100520 253<br />
U<br />
UBICHINON COMPOSITUM 175<br />
ulticare insulin syringe/ 181<br />
ulticare insulin syringe/ 183<br />
ulticare insulin syringe/ 184<br />
ulticare insulin syringe/ 185<br />
ulticare insulin syringe/ 186<br />
ulticare insulin syringe/ 187<br />
ulticare insulin syringe 182<br />
ulticare insulin syringe 185<br />
ulticare insulin syringe 188<br />
ULTICARE MINI PEN NEEDLES 191<br />
ULTICARE ORIGINAL PEN NEE 191<br />
ULTICARE SHORT PEN NEEDLE 192<br />
ulticare thin lancets 30g 190<br />
ulticare thin lancets ult 190<br />
ultiguard insulin syringe 181
ultiguard insulin syringe 182<br />
ultiguard insulin syringe 183<br />
ultiguard insulin syringe 184<br />
ultiguard insulin syringe 185<br />
ultiguard insulin syringe 186<br />
ultiguard insulin syringe 187<br />
ultiguard insulin syringe 188<br />
ultilet classic lancets 194<br />
ultilet insulin syringe/0 181<br />
ultilet insulin syringe/0 183<br />
ultilet insulin syringe/0 184<br />
ultilet insulin syringe/1 186<br />
ultilet insulin syringe/1 187<br />
ultilet insulin syringe/s 182<br />
ultilet insulin syringe/s 184<br />
ultilet insulin syringe/s 187<br />
ultilet lancets 194<br />
ULTILET PEN NEEDLE 194<br />
ULTIMA TEST STRIPS 81<br />
ULTIMA 194<br />
ULTIVA 58<br />
ultra comfort insulin syr 181<br />
ultra comfort insulin syr 182<br />
ultra comfort insulin syr 183<br />
ultra comfort insulin syr 184<br />
ultra comfort insulin syr 185<br />
ultra comfort insulin syr 186<br />
ultra comfort insulin syr 187<br />
ultra comfort insulin syr 188<br />
ultra insulin syringe/u-1 183<br />
ultra thin lancets 28g 190<br />
ultra thin lancets 30g 190<br />
ultra-comfort insulin syr 181<br />
ultra-comfort insulin syr 182<br />
ultra-comfort insulin syr 183<br />
ultra-comfort insulin syr 184<br />
ultra-comfort insulin syr 185<br />
ultra-comfort insulin syr 186<br />
ultra-comfort insulin syr 187<br />
ultra-comfort insulin syr 188<br />
ultra-thin ii auto lancet 177<br />
ultra-thin ii insulin syr 181<br />
ultra-thin ii insulin syr 182<br />
ultra-thin ii insulin syr 183<br />
ultra-thin ii insulin syr 184<br />
ultra-thin ii insulin syr 186<br />
ultra-thin ii insulin syr 187<br />
ultra-thin ii lancet/28g 189<br />
ultra-thin ii lancet/30g 189<br />
ULTRA-THIN II PEN NEEDLE/ 191<br />
ultrabrom pd 16<br />
ultrabrom 16<br />
ULTRACAPS MT 20 141<br />
ULTRASE MT 12 141<br />
ULTRASE MT 18 141<br />
ULTRASE MT 20 141<br />
ULTRASE 141<br />
ULTRATRAK PRO TEST STRIPS 81<br />
ULTRATRAK PRO 194<br />
ultratuss 12 s 124<br />
ULTRAVIST 83<br />
un-aspirin 64<br />
uni all 12 124<br />
uni-cof exp 124<br />
uni-cof 124<br />
uni-hist pdx 124<br />
uni-hist 16<br />
uni-tann cs 124<br />
uni-tann d 3<br />
uni-tex 120/10 er 16<br />
UNIFINE PENTIPS 29G X 12M 194<br />
UNIFINE PENTIPS 29GX12MM 194<br />
UNIFINE PENTIPS 31G X 6MM 194<br />
UNIFINE PENTIPS 31G X 8MM 194<br />
UNIFINE PENTIPS 31GX6MM 194<br />
UNIFINE PENTIPS 31GX8MM 194<br />
UNIFINE PENTIPS 194<br />
unilet comfortouch lancet 178<br />
unilet excelite ii 194<br />
unilet excelite 194<br />
unilet g.p. lancet 194<br />
unilet g.p. superlite lan 194<br />
unilet gp 28 ultra thin 194<br />
unilet lancet 194<br />
unilet superlite lancet 194<br />
UNIPHYL 168<br />
unith direct 153<br />
unithroid 153<br />
unithroid 154<br />
universal 1 lancets thin 194<br />
universal 1 lancets ultra 194<br />
urinary anal 166<br />
urinary pain 166<br />
UVADEX 166<br />
created on 20100520 254<br />
V<br />
v-cof 124<br />
v-hist 16<br />
v-r heartburn relief 142<br />
v-r monoject insulin syri 181<br />
v-r monoject insulin syri 182<br />
v-r monoject insulin syri 183<br />
v-r monoject insulin syri 185<br />
v-r monoject insulin syri 186<br />
v-r non-asa 64<br />
v-r tussin 134<br />
v-r vit b-6 169<br />
v-r womens menstrual reli 64<br />
v-tann b.i.d 4<br />
V-TANN 4<br />
va-zone 77<br />
VALCYTE 29<br />
VALGANCICLOVIR HCL 29<br />
valproate sodium 66<br />
valproic acd 66<br />
valproic acid 66<br />
VALSARTAN-<br />
HYDROCHLOROTHIAZIDE 50<br />
VALSARTAN 50<br />
value health insulin syri 183<br />
value health insulin syri 186<br />
value health lancets 194<br />
value plus lancets standa 189<br />
value plus lancets super 189<br />
value plus lancets thin 2 190<br />
value plus lancets 194<br />
value plus thin lancets 195<br />
valumark lancet super thi 189<br />
valumark lancet ultra thi 189<br />
VALUMARK PEN NEEDLES 29GX 191<br />
VALUMARK PEN NEEDLES 31G 191<br />
VALUMARK PEN NEEDLES 31G 192<br />
vanacet 58<br />
VANACOF CD 124<br />
VANACOF DX 124<br />
VANACOF 124<br />
vanacon 124<br />
VANATAB DX 124<br />
VANCOMYCIN HCL ISO-OSMOTI 26<br />
vancomycin hcl 26<br />
VANCOMYCIN 26<br />
vandazole 158<br />
vanishpoint insulin syrin 184<br />
vanishpoint insulin syrin 186<br />
VANOS 165
VANTAS 32<br />
vapor inhaler 175<br />
VAPOR PATCH 175<br />
VAPORIZING CHEST RUB 175<br />
vaporizing steam 175<br />
VAPORX BALM 175<br />
VAPRISOL 88<br />
VAQTA 157<br />
VARICELLA-ZOSTER IMMUNE G 156<br />
VARIVAX 157<br />
vaso dose pack 10 16<br />
vaso dose pack 30 16<br />
vasopressin 150<br />
VAZOTAB 16<br />
VAZOTUSS HC 124<br />
VCF VAGINAL CONTRACEPTIVE 79<br />
VECTIBIX 32<br />
vecuronium bromide 38<br />
veetids 22<br />
VELCADE 32<br />
VENLAFAXINE HCL 67<br />
venlafaxine hcl 67<br />
venlafaxine 66<br />
venlafaxine 67<br />
VENOFER 39<br />
VENOGLOBUL-S 156<br />
VENOMIL HONEY BEE VENOM 175<br />
VENOMIL MIXED VESPID VENO 175<br />
VENOMIL WASP VENOM PROTEI 175<br />
VENOMIL WHITE FACED HORNE 175<br />
VENOMIL YELLOW HORNET VEN 175<br />
VENOMIL YELLOW JACKET VEN 175<br />
VENTOLIN HFA 36<br />
VERAPAMIL HCL 49<br />
verapamil hcl 49<br />
verapamil 49<br />
VERIPRED 146<br />
verotin-by 172<br />
verotin-gr 172<br />
VFEND IV 27<br />
VFEND 27<br />
vi-q-tuss 124<br />
VIADUR 32<br />
VIAGRA 45<br />
VIBATIV 26<br />
VIBRAMYCIN 26<br />
VICKS 44M PEDIATRIC COUGH 124<br />
VICKS CASERO 134<br />
VICKS CASERO 175<br />
VICKS DAYQUIL COUGH 124<br />
vicks dayquil multi-sympt 124<br />
VICKS FORMULA 44 COUGH RE 124<br />
VICKS FORMULA 44 CUSTOM C 100<br />
VICKS FORMULA 44D COUGH/N 124<br />
VICKS FORMULA 44E COUGH/C 124<br />
VICKS FORMULA 44E PEDIATR 124<br />
VICKS FORMULA 44M MULTI-S 124<br />
VICKS FORMULA 44M PEDIATR 124<br />
VICKS NYQUIL CHILDRENS CO 124<br />
vicks nyquil multi-sympto 124<br />
VICKS VAPORUB 175<br />
vicoclear 124<br />
vicodin hp 58<br />
VICTORY AGM-4000 TEST STR 81<br />
VICTORY BLOOD GLUCOSE MON 195<br />
VICTOZA 148<br />
VIDAZA 32<br />
VIDEX 28<br />
VIMPAT 66<br />
vinatal forte 172<br />
vinate c 172<br />
VINATE M 172<br />
vinate one 172<br />
VINBLASTINE 32<br />
vincristine sulfate 32<br />
vinorelbine tartrate 32<br />
VIOKASE 16 141<br />
VIOKASE 8 141<br />
VIOKASE 141<br />
VIRACEPT 28<br />
VIRAMUNE 28<br />
VIRATAN-DM 124<br />
viratan-dm 124<br />
VIRAVAN-P 4<br />
VIRAVAN-PDM 124<br />
VIRAVAN-T 4<br />
VISCOAT 140<br />
VISIPAQUE 83<br />
visonex 134<br />
visrx dose pack 16<br />
VISTARIL 76<br />
VISTIDE 29<br />
VISUDYNE 140<br />
visvex hc 124<br />
vita-numonyl ad 124<br />
VITA-NUMONYL DM 124<br />
vita-numonyl nr 124<br />
vita-numonyl pediatric 124<br />
VITA-NUMONYL 134<br />
VITA-NUMONYL 172<br />
vitafol-ob 172<br />
VITAFOL-PN 172<br />
VITAJECT 172<br />
vitalet pro lancets 195<br />
vitalet pro plus lancets 195<br />
vitamin b-6 169<br />
vitamin b1 & b12 169<br />
VITAMIN K1 169<br />
vitamins a/d/c/fluoride 170<br />
vitelle nestabs 172<br />
VITRASE 88<br />
VITRAX 140<br />
vitussin 124<br />
VIVAGLOBIN 156<br />
VIVELLE-DOT 147<br />
VIVITROL 64<br />
VOLUVEN 86<br />
VOPAC 58<br />
vp insulin syringe/u-100/ 181<br />
VPRIV 88<br />
VUMON 32<br />
vynatal fa 172<br />
VYVANSE 72<br />
VYVANSE 73<br />
created on 20100520 255<br />
W<br />
w&f color lancets 195<br />
w&f lancets 26g 195<br />
w&f lancets colored 21g 195<br />
w&f lancets ultra thin 195<br />
wal-act 16<br />
wal-dryl allergy/sinus he 3<br />
wal-dryl-d allergy/sinus 3<br />
wal-dryl-d 3<br />
wal-finate-d 16<br />
wal-flu severe cold dayti 35<br />
WAL-FLU SEVERE COLD NIGHT 16<br />
wal-flu warming comfort s 3<br />
wal-four 138<br />
wal-hist 3<br />
wal-itin aller-melts 17<br />
wal-itin 17<br />
wal-phed pe severe cold 3<br />
wal-phed pe sinus headach 35<br />
wal-phed pe sinus/allergy 16
wal-phed sinus/allergy 16<br />
wal-profen cold/sinus 38<br />
wal-tap childrens 16<br />
wal-tap cold & allergy 16<br />
wal-tap dm cold & cough 124<br />
wal-tap dm cold/cough 124<br />
wal-tussin cf 124<br />
wal-tussin cold 124<br />
wal-tussin cold 134<br />
wal-tussin cough & cold 124<br />
wal-tussin cough/cold cf 124<br />
wal-tussin cough 124<br />
wal-tussin dm clear 124<br />
wal-tussin dm 124<br />
wal-tussin pediatric coug 124<br />
wal-tussin 124<br />
wal-tussin 134<br />
wal-vert 17<br />
wal-zyr 17<br />
walgreens lancets 189<br />
walgreens thin lancets 194<br />
walgreens ultra thin lanc 194<br />
WARFARIN SODIUM 40<br />
warfarin sodium 40<br />
warfarin 40<br />
WASP VENOM 175<br />
water for inject, bacteriostatic 196<br />
water for injection, sterile 196<br />
WATER, STERILE 196<br />
WAVESENSE AMP TEST STRIPS 81<br />
WAVESENSE AMP 195<br />
WAVESENSE JAZZ TEST STRIP 81<br />
WAVESENSE JAZZ 195<br />
WAVESENSE KEYNOTE TEST ST 81<br />
WAVESENSE KEYNOTE 195<br />
WAVESENSE PRESTO TEST STR 81<br />
WAVESENSE PRESTO 195<br />
wavesense ultra-thin lanc 195<br />
wd lancets thin 195<br />
wd lancets 195<br />
wd medic insulin syringe/ 181<br />
wd medic insulin syringe/ 182<br />
wd medic insulin syringe/ 183<br />
wd medic insulin syringe/ 184<br />
wd medic insulin syringe/ 186<br />
wd medic insulin syringe/ 187<br />
wd thin lancets 195<br />
we allergy 16<br />
we mist ii la 134<br />
wellbid-d 1200 134<br />
wellbid-d 134<br />
welltuss exp 124<br />
welltuss hc 124<br />
west-decon m 16<br />
WESTHROID 154<br />
WHITE HORNET 175<br />
WILATE 43<br />
WINN DIXIE MEDIC TEST STR 81<br />
WINN DIXIE MEDIC VALUE 195<br />
WINRHO SDF 156<br />
womens menstrual relief 62<br />
womens tylenol 64<br />
X<br />
x-hist dm 124<br />
x-hist 3<br />
XALATAN 140<br />
xedec ii 134<br />
XEDEC 134<br />
XENICAL 144<br />
XIAFLEX 88<br />
XIGRIS 175<br />
XIGRIS 176<br />
xiral sr 16<br />
XIRATUSS 124<br />
xiratuss 124<br />
XODOL 58<br />
XOLAIR 134<br />
XOLE 159<br />
XOLEGEL DUO/HEAD & SHOULD 159<br />
XOLEGEL DUO/XOLEX 159<br />
XOLOX 58<br />
XPECT-AT 124<br />
XPECT-HC 124<br />
xpect-pe 134<br />
xpect 134<br />
XYNTHA 43<br />
created on 20100520 256<br />
Y<br />
Y-COF DM 124<br />
YAZ 147<br />
YELLOW HORN 176<br />
YELLOW HORNT 176<br />
YELLOW JACK 176<br />
YELLOW JACKT 176<br />
YF-VAX 157<br />
yl vit b-6 169<br />
YODEFAN-NF 134<br />
YODEFAN 134<br />
Z<br />
Z-COF 12DM 124<br />
Z-COF DMX 124<br />
z-dex 12d 124<br />
z-dex 124<br />
Z-TUSS 2 EXPECTORANT 124<br />
Z-TUSS AC 124<br />
z-tuss dm 124<br />
zaclir 162<br />
ZADITOR 135<br />
ZAFIRLUKAST 125<br />
zaleplon 76<br />
ZANAMIVIR 28<br />
ZANOSAR 33<br />
ZANTAC 143<br />
ZEEL 176<br />
ZEGERID OTC 143<br />
ZEGERID 143<br />
zema-pak 10 day 146<br />
zema-pak 13 day 146<br />
zema-pak 6 day 146<br />
ZEMAIRA 134<br />
ZEMPLAR 169<br />
ZENAPAX 173<br />
zerlor 58<br />
ZEVALIN IN-111 33<br />
ZEVALIN Y-90 33<br />
zhist expectorant 124<br />
ZIAGEN 28<br />
zidovudine 28<br />
ZINACEF 19<br />
ZINC SULFATE 86<br />
ZINC TRACE 86<br />
ZINX ALLERGY 16<br />
ZINX COLD 124<br />
ZINX CONGESTION 134<br />
ZINX COUGH 124<br />
ZINX KIDS SNEEZE 16<br />
ZITHRANOL-RR 167<br />
ZITHROMAX 21<br />
ZMAX PEDIATR 22<br />
ZMAX 22<br />
ZODERM 162<br />
ZODRYL AC 25 125<br />
ZODRYL AC 30 125<br />
ZODRYL AC 35 125
ZODRYL AC 40 125<br />
ZODRYL AC 50 125<br />
ZODRYL AC 60 125<br />
ZODRYL AC 80 125<br />
ZODRYL DAC 25 125<br />
ZODRYL DAC 30 125<br />
ZODRYL DAC 35 125<br />
ZODRYL DAC 40 125<br />
ZODRYL DAC 50 125<br />
ZODRYL DAC 60 125<br />
ZODRYL DAC 80 125<br />
ZODRYL DEC 25 125<br />
ZODRYL DEC 30 125<br />
ZODRYL DEC 35 125<br />
ZODRYL DEC 40 125<br />
ZODRYL DEC 50 125<br />
ZODRYL DEC 60 125<br />
ZODRYL DEC 80 125<br />
ZOLADEX 33<br />
ZOLMITRIPTAN 77<br />
zolpidem tartrate 76<br />
ZOMETA 173<br />
ZOMIG ZMT 77<br />
ZOMIG 77<br />
ZONATUSS 125<br />
ZOSTAVAX 157<br />
ZOSYN 24<br />
ZOTEX -GP 134<br />
ZOTEX GPX 134<br />
ZOTEX HC 125<br />
zotex-12 125<br />
zotex-12d 125<br />
ZOTEX-C 125<br />
ZOTEX-D 125<br />
ZOTEX-DM 125<br />
ZOTEX-DMX 125<br />
ZOTEX-EX 125<br />
ZOTEX-G 125<br />
ZOTEX-LA 125<br />
zotex-pe 16<br />
ZYDONE 58<br />
ZYMAR 135<br />
ZYMINE DXR 16<br />
ZYMINE HC 125<br />
ZYPREXA RELP 70<br />
ZYPREXA ZYDI 70<br />
ZYPREXA 70<br />
zyrphen-hc 125<br />
zyrphen 134<br />
ZYVOX 26<br />
created on 20100520 257